HomeMy WebLinkAbout03-07-13
---I REV-1500 Ex(01-10) 1505610143
OFFICIAL USE
PA Department of Revenue ONLY
pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO 60x.280601 INHERITANCE TAX RETURN 21 13 0 0 0 5 2
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
161 34 2292 06 08 2012 07 09 1943
Decedent's Last Name Suffix Decedent's First Name MI
ANDERSON RICHARD F
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
ANDERSON CAROLE A
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return (date of death
prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest compromise ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
g Decedent Died Testate Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
® (Attach Copy of Will) ❑ (Attach Copy of Trust)
❑ 9. Litigation Proceeds Received ❑ 1 p. Spousal Poverty Credit (date of death ❑ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JAMES M ROBINSON 717 245 9688
C7 REGISTEkbF WI~bSJSE ONLY
C= M
X M M
First line of address co C)
129 SOUTH PITT STREET r r-
~ rf-I r°r I ;7X rn Second line of address
CD
DATE FII=
City or Post Office State ZIP Code r,_ t1
CARLISLE PA 17013 1-" Cn C.'>
Correspondent's e-mail address: jrobinson@turolaw.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.
SIG TURE OF PERS N R7ZL,2. OR FILING RETURN DATE
cdd4 41, Carole A. Anderson - 0/
ADDRESS
8 E. First Street, Boiling Springs, PA 17007
SIGNA URE OF PREPA R O.TH HAN RESENTATIVE D TE
t James M Robinson I
AD R SS
1 South Pitt itreet, Carlisle, PA 17013
Side 1
1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: ANDERSON, RICHARD F 161 34 2292
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 & Notes Receivable (Schedule D) 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. 5,338.11
6. Jointly Owned Property (Schedule F) ❑ Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested 7. 52,957. 92
8. Total Gross Assets (total Lines 1-7) 8. 58,296.03
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 17,729.51
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) 10. 2,511.77
11. Total Deductions (total Lines 9 & 10) 11. 2 0 , 2 4 1 .28
12. Net Value of Estate (Line 8 minus Line 11) 12. 3 8 , 0 5 4 .75
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. 38,054.75
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X.00 34,430.75 15. 0.00
16. Amount of Line 14 taxable
at lineal rate X .045 2,289.00 16. 103.01
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate x .15 1,335.00 18. 200.25
19. Tax Due 19. 3 0 3. 2 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 - 13 - 00052
Decedent's Complete Address:
DECEDENT'S A
Anderson, Richard F
STREET ADDRESS
8 East First Street
CITY STATE ZIP
Boiling Springs PA 17007
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1) 303.26
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits (A + B) (2) 0.00
3. Interest (3) 0.00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5) 303.26
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; I_J ]x]
b. retain the right to designate who shall use the property transferred or its income; ❑ [x]
c. retain a reversionary interest; or U U
d. receive the promise for life of either payments, benefits or care? 11 [x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ❑
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? xJ
IF THE ANSWER TO 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 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 re5n 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)1. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, wfiether y blood or adoption.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Anderson, Richard F 21 - 13 - 00052
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 Metro Bank Savings Acct. No. 06271222567 714.11
2 2000 Chevy S-10 Truck - valued at sale price 1,000.00
3 Ruger Blackhawk Revolver with Holster- 357, Serial 122986 425.00
As valued by Farwell's Gun Shop, Newville, PA
4 Thompson Center Muzzle Loader, 50 cal. with Case - Serial 17035 424.00
As valued by Farwell's Gun Shop, Newville, PA
5 Ruger Mini 14, 223 Cal. with Scope, Sling/Case - Serial 18740555 755.00
As valued by Farwell's Gun Shop, Newville, PA
6 Remington 870 Express 126A with Scopi and Case - Serial Under Mt. 570.00
As valued by Farwell's Gun Shop, Newville, PA
7 Remington 760 with Scope and Case - Serial 529401 540.00
As valued by Farwell's Gun Shop, Newville, PA
8 Rllchnoll 9 Cinnlo Rinnridnrc nn RAotni nnnllnt rFnvA7VrnvAn)i Tilfoll Trinnri 150.00
9 Simmons 2 Single Binoculars on Metal Mount, Model 1208 (25x50) 60.00
10 Ruger 204 Cal. Single-Shot - Serial not available, valued at sale price 700.00
TOTAL (Also enter on Line 5, Recapitulation) 5,338.11
COMMONWEALTH OF PENNSYLVANIA SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Anderson, Richard F FILE NUMBER
21 - 13 - 00052
This schedule must be completed and filed if the answer to any of questions 7 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF EXCLUSION
NUMBER Include the name of the transferee, their relationship to decedent VALUE OF ASSET '1 DECD'S TAXABLE VALUE
and the date of transfer. Attach a copy of the deed for real estate. INTEREST OF APPLICABLE)
1 ! Fidelity Investments - Advance 401(k) Savings Plan 52,957.92 ! 100% 0.00 52,957.92
SM 40472
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TOTAL (Also enter on line 7, Recapitulation) 52,957.92
SCHEDULE H
FUEL EXPENSES &
'~~/~/~►/CO~~~+
COMMONWEALTH OF PENNSYLVANIA /~~~~IM & I f 1Y G J
INHERITANCE TAX RETURN AC
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Anderson, Richard F 21 - 13 - 00052
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
_ E -
A. 1 Myers Buhrig Funeral Home & Crematory 11,092.00
2 Rolling Green Cemetery Co. 1,940.00
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3 VFW Post 8851 - Costs of post-funeral reception 248.23
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B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Turo Robinson Attorneys at Law 500.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Carole A. Anderson 3,500.00
Street Address 8 E. First Street
city Boiling Springs State PA Zip 17007
Relationship of Claimant to Decedent Surviving Spouse
4. Probate Fees Register of Wills 163.50
Cumberland Law Journal 75.00
The Sentinel 210.78
5. Accountant's Fees
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6. Tax Return Preparer's Fees
7. Other Administrative Costs
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TOTAL (Also enter on line 9, Recapitulation) 17,729.51
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES, & LIENS
INHERITANCE TAX RETURN ,
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Anderson, Richard F 21 - 13 - 00052
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION AMOUNT
NUMBER
1 Carlisle Regional Medical Center 1,176.72
2 Holy Spirit Hospital 40.76
3 Pinnacle Health Hospitals 290.84
4 Yellow Breeches Family Practice 319.66
5 Central Medical Equipment Co. 22.26
6 Pinnaclehealth Cardiovascular Inst., Inc. 34.91
7 Cumberland Goodwill Fire Rescue EMS 83.68
8 Camp Hill Emergency Physicians 10.15
9 Carlisle HMA Physician Management 82.62
10 Hershey Kidney Specialists, Inc. 51.15
11 Walnut Bottom Radiology LLC 25.35
12 Carlisle Medical Pathology, PC 180.97
13 Urology of Central PA 39.50
14 Three Springs Family Practice 42.80
15 Carlisle Digestive Disease 94.03
16 Blue Mountain Anesthesia Assoc. 16.37
TOTAL (Also enter on Line 10, Recapitulation) 2,511.77
REV-1513 EX+ (11-08) SCHEDULE) I
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Anderson, Richard F
21 - 13 - 00052
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words)
RECEIVING PROPERTY Do Not List Trustee(s)
ITAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Carole A. Anderson Spouse Residuary
8 E. First Street
Boiling Springs, PA 17007
2 Alice L. Anderson Daughter Specific Devise 2,290.00
1901 Clayton Avenue
Harrisburg, PA 17109
3 Sonny J. Goodyear Daughter Specific Devise 0.00
3111 Dickinson Avenue
Camp Hill, PA 17011
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Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
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B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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TOTAL OF PART 11 - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET j 0.00
REV-1513 EX+ (8-00)
SCHEDULEJ
COMMONWEALTH SYLVANIA BENEFICIARIES continued
INHERITANCE TAX TAX RETURN
RESIDENT DECEDENT
ESTATE OF Anderson, Richard F FILE NUMBER
21 - 13 - 00052
RELATIONSHIP
NUMBER NAME AND ADDRESS OF PERSON(S) TO SHARE OF ESTATE AMOUNT OF ESTATE RECEIVING PROPERTY DECEDENT (Words)
Do Not List Trustees)
TAXABLE DISTRIBUTIONS
distributions, and transfers
under Sec. 9116 (a) (1.2)]
4 Amy L. Zilka Daughter I Specific Devise i 0.00
13 Glendale Drive
Mechanicsburg, PA 17055
5 Danny Gould Friend Specific Devise 60.00
14 Springers Lane
New Cumberland, PA 17070
6 Brian Gould Friend Specific Devise 150.00
1 522 N. Second Street
Steelton, PA 17113
7 Mark E. Biggs Step Son-in-law I Specific Devise 1 425.00
12 E. Keller Street
Mechanicsburg, PA 17055
8 Greg Giles Friend Specific Devise 700.00
P.O. Box 251
Boiling Springs, PA 17007
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Page 2 of Schedule J