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Home My WebLink About01-24-13 1505610105 REV-1500 ..X (o2-u) (FI) ~) ~2 PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX 28o6oi °""pT"`"'°`"`"`""` County Code Year File Number INHERITANCE TAX RETURN - Harrisburg, PA 1']128-0601 I RESIDENT DECEDENT C~` ` I (J~'~~~ ENTER DECEDENT INFORMATION BELOW - Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYWY 02/17/2011 12/01/1941 Decedent's Last Name Suffix Decedent's First Name MI Welch James __ C (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 INAPPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (Date of Death O 4. Limited Estate O Prior to 12-13-82) 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O (Attach Copy of Will) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) PONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRE~D TO: «7 N ame ~ Daytime Tele~one Number ~~' L?T ~1 J. Chad Moore, Esquire ~ z__ ti`s 717 6 ( ) 92~~ ~ ~ ~~ ,; First Line of Address 270 Market Street Second Line of Address City or Post Office State ZIP Code Millersburg PA 17061 Correspondent's a-mail address: jcmesgUlre(a~aol.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATt~RE OF PERSON ESPON BLE OR FILING RETURN DAT AD ESS l ~/~~I !~~ I-OTHER THAN ~`- ~~. ~.' A~! t 70; z USE ORIGINAL FORM ONLY 1505610105 Side 1 150561D105 ~~~ J ],505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate (Schedule A) .......................... 1 ............... .... . 0.00 2. Stocks and Bonds (Schedule B) .................................... ... 2. _ .. 0.00 _ . _ _ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 0.00'..- 4. Mortgages and Notes Receivable {Schedule D) ........................ ... 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 1,441.73 _. _ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. _. 0 00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . (Schedule G) O Separate Billing Requested..... ... 7. ', 0.00 8. Total Gross Assets (total Lines 1 through 7) _.. _ _ .......................... ... 8. 1,441.73 9. Funeral Expenses and Administrative Costs (Schedule H) .. 9 .... ......... ... . 2,025.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ ... 10. ___ . _ _ _ 0.00 11. Total Deductions (total Lines 9 and 10) .. ............................ ... 11. 0.00 12. Net Value of Estate (Line 8 minus Line 11) ................ 12 3 13. ........... Charitable and Governmental Bequests/Sec 9113 Trusts for which ... . -58 .27 - - - - -' an election to tax has not been made (Schedule J) ......... 13 '' ............ ... . 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. 0.00 TAX CALCULATION -SEE INSTR UCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spous<31 tax rate, or transfers under Sec. 9116 (a)(1.2) X .0__ 16. Amount of Line 14 taxable "~ °~ - 15. 0.00 at lineal rate X .0 _ 16. 0 00 ~ 17. Amount of Line 14 taxable _ . at sibling rate X .12 17, ' 0 00 18. Amount of Line 14 taxable - _ _ _ _ . - at collateral rate X .15 1 g. 0.00 19. TAX DUE .. 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 O REV-1500 EX (FI) Page 3 Decedent's Complete Address: James C. Welch STREET ADDRESS Golden Living Center 770 Poplar Church Road clTV Camp Hill Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) Z. Credits/Payments A. Prior Payments _ B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval 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. File Number STATE ZIP PA 17011 (1) ~ Total Credits (A + B) (2) (3) (4) (5) Make check payable to: REGISTER OF WILLS, AGENT. 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 .......................................................................................... ^ ^ b. retain the right to designate who shall use the property transferred or its income ............................................ ^ c. retair a reversionary interest .............................................................................................................................. ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............. . 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ^ ^ HE ANSWER T . _ .. , ,., 0 ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN 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)]. For dates of death on or after Jan. 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(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)]. Asibling 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-1511 EX+ (10-09) r ~.., ;~ ~~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS FILE NUMBER Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1' Auer Cremation Services of Pennsylvania B, 1 2. 3. 4. 5. 6. 7, ADMINISTRATIVE COSTS; Personal Representative Commissions: Name(s) of Personal Representative(s) Michael J. WeICh Street Address 227A Pleasant View Road City Halifax State PA ziP 17032 Year(s) Commission Paid: Attorney 1=ees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Strf~et Address City _ State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees Tax Returr. Preparer Fees: TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. AMOUNT 1,650.00 0.00 250.00 125.00 2,025.00 REV-i5o8 EX+ (u-io) ~ ~ Pennsylvania ~'~ ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: James C. Welch SCHEDULE E CASH, BANK DEPOSITS & MISC. 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