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Home My WebLink About01-14-13 (2)1505610143 REV-1500 ~ (a1 10) ~ OFFICIAL USE ONLY PA Department of Revenue Pennsylvania county code veer File Number Bureau of Individual Taxes °EPARTM1CNTOF1E1°"'~ PO 60X.280601 INHERITANCE TAX RETURN 21 12 0545 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 04 29 2012 07 30 1956 Decedent's Last Name Suffix Decedent's First Name MI SLOTHOWER MARK L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum ~ 2. Supplemental Retum 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-122) g Decedent Died Testate (Attach Copy of Will) ~ ~• D ~~ r~t Ma o~tained a Living Trust lA oPy 7 ) 9. Litigation Proceeds Received ~ C ~tv 1 10. b~ en 12 31 91 ~at (datgeSM death 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Nut~iber :~3 DAVID J LENOX 717 ~ ~ 9 6 f6'6 r ~ First line of address 3 N BALTIMORE STREET Second Ilne of address City or Post Office DILLSBURG Correspondent's a-mail address: State ZIP Code PA 17019 _~~ REGI i~D ~ ILL J SE ~:~ ~ ~ e r _ - t . ' i ~ _...3 C"~ - ~ r-~- _~ . -.., Ra ~ -rt ;:~ f`J DATE FILED Under penalties of pery'ury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true,,,oorrect and complete. Decl~retion of pre~gr other than the personal representative is based on all information of which preparer has any knowledge. Marcella G. 15D5610143 1505610143 ~:~:/ 3 Baltimore Street, Dillsburg, PA Side 1 1505610243 REV-1500 EX Decedent's Social Security Number o~de~rsName: Slothower, Mark L. RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................................................ 4. 5• Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ............... 5. 19 , 580.97 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous -Probate Property arate Billin Re uested Se 7 9 2 0 6 98 ............ g q p (Schedule G) . . r 8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 28 , 787.95 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 15 , 360.90 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 4 , 449.05 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 19 , 8 0 9.95 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 8 , 97 8 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... 14. 8 , 97 8 . 0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15 0.00 (a)(1.2) X .00 . 16. Amount of Line 14 taxable $ 97 8 , 0 0 16. 4 0 4.01 ~ at lineal rate X .045 17. Amount of Line 14 taxable 0 0 0 17 0. 0 0 . at sibling rate X .12 . 18. Amount of Line 14 taxable 0 0 0 18 0. 0 0 . at collateral rate X .15 . 19. Tax Due .................................................................................................................. 19. 4 0 4.01 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505610243 1505610243 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-12-0545 DECEDENT'S NAME Slothower, Mark L. STREET ADDRESS 113 Sable Drive CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 404.01 Total Credits (A + B) (2) 0.00 (3) (4) (5) 404.01 Make Check Pa able to: REGISTER OF WILLS, AGENT. s ~~. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income :.................................. ^ ^x c. retain a reversionary interest; or .............................................................................................................. d. receive the promise for life of either payments, benefits or care? ............................................................ x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................................................... ^ ^x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ~ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. .. :ten ',r; . Tom"`"` For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)J. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)). . The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 {a) (1)]. . The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent (72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Rev-1508 EX+ (8-90) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSriVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Slothower, Mark L. 21-12-0545 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntlyowned with tha right of survivorship must be disclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-7570 EX+ (6-9ti) scHe~u~E ~ INTER-VIVOS TRANSFERS ~ MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER Slothower, Mark L. 21-12-0545 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATENOF TROANSFERSATTACIi ACOPY OF THE DEIED FOOREREAL EST TE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Civil Service Retirement Survivors Benefit 9,206.98 9,206.98 TOTAL (Also enter on Line 7, Recapitulation) I 9,206.98 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) ' REV-1151 Ex+ 110-06) COMNI(~~DECE~RN ANIA SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Slothower, Mark L. 21-12-0545 Debts of decedent must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT A, FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 8,690.82 Street Address City State Zip Year(sl Commission paid 2. Attorney's Fees The Wiley Group, P.C. 1,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Dorothy Slothower Street Address 113 Sable Drive City Carlisle State PA Zip 17013 Relationship of Claimant to Decedent Mother 4. Probate Fees 138.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 500.00 7. Other Administrative Costs 1,031.58 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 15,360.80 Copyright (c) 2009 form software only The Lackner Group, Inc. Forrn PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Slothower, Mark L. 21-12-0545 ITEM NUMBER DESCRIPTION AMOUNT 1 Funeral Exuenses Decedents burial garments 263.73 2 Ewing Brothers Funeral Home, Carlisle, PA 8,230.21 3 Funeral reception 71.88 4 Minister Honorarium, Rev. Tim Wheeler 125.00 H-A 8,690.82 5 Other Administrative Costs 21st Century Jeep Insurance 224.05 6 Bank Fee 21.75 7 Legal Advertising, Cumberland Law Journal 210.78 8 Legal Advertising, The Sentinel 75.00 9 Repair Expense on Jeep 500.00 H-B7 1,031.58 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 FJ(+ (12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Slothower, Mark L. 21-12-0545 Report debts incurred by ~e decedent prior to death that remained unpaid at the date of death, including unrelmbursed medical expenses. (If more space is needed, additlonal pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-OS) SCHEDULE J coM~~~~4rk ,~~~,,,s,R~VANIA BENEFICIARIES ESTATE OF Slothower, Mark L. FILE NUMBER NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Clark L. Slothower Father 1/2 of estate 113 Sable Drive Carlisle, PA 17013 2 Dorothy M. Slothower Mother 1/2 of estate 113 Sable Drive Carlisle, PA 17013 Total Enter dollar amounts for distributions shown above on lines 1 5 throu h 18 on Rev 150 0 cover sheet as a r o riate. II NON-TAXABLE DISTRIBUTIONS: . A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTA L OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-7500 Schedule J (Rev. 11-08) rev ~ ~ ~j ~ y`Z Z ~I .~ ~7 . (~ ~r