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Home My WebLink About02-0272COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 000969 ROOT JUDY 96 ASHFORD DRIVE ENOLA, PA 17025 ESTATE INFORMATION: SSN: 526-54-8800 FILE NUMBER: 21 02-0272 DECEDENT NAME: HOPPER POLLY DATE OF PAYMENT: 03/18/2002 POSTMARK DATE: 03/1 4/2002 COUNTY: CUMBERLAND DATE OF DEATH: 01/24/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $75.85 REMARKS: JUDY B ROOT TOTAL AMOUNT PAID' $75.85 SEAL CHECK# 105 INITIALS: AC RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS REV-1500 EX (6~00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I OFFICIAL USE ONLY REV-1 500 INHERITANCE TAX RETURN / R E S I D E N T D E C E D E N T DECED~J~T'S N/~IE,(LAST, FIRST, A~D MIDDLE INITIAL) DATE OF DEATH (MI~-~D-YEAR) ~ DATE OF BIRTH (MM-DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) j~l. Original Return ~---~ 4. Limited Estate [~]6. Decedent Died Testate (Attach copy or Will) ---]9. Litigation Proceeds Received [--~ 2. Supplemental Return [~4a. Future Interest Compromise (date of death after 12-12-82) [~7. Decedent Maintained a Living Trust (Attach copy of Trust) ---]10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~-~oo, fl. NAME ~-'-~,~ ~.) ~/ FIRM NAME (If Applicable) TELEPHONE NUMBER Real Estate (Schedule A) Stocks and Bonds (Schedule B) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIALSECURITYNUMBER 2. 3. 4. 5. (1) (2) Closely Held Corporation, Partnership or Sole-Proprietorship ] 3. Remainder Return (date of death prior to 12-13-82) [~5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [~] 11. Election to tax under Sec. 9113(A)(Attach Sch O) (3) (4) (5) (6) Mortgages & Notes Receivable (Schedule D) Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) Jointly Owned Property (Schedule F) ---]Separate Billing Requested COMPLETE MAILING ADDRESS 0 (8) ~OFFI~iA~ USE ONLY 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. 11. 12. 13. 14. 18. 19. 20. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 6 minus Line 11) Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) Net Value Subject to Tax (Line 12 minus Line 13) (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 __ (15) Amount of Line14 taxable at lineal rate /[/'~2 ,/?~', F/ x.0 I,~E~' (16) Amount of Line 14 taxable at sibling rate x .12 (17) Amount of Line 14 taxable at collateral rate x .15 (18) Tax Due (19) Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) 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. retain a reversionary interest; or .......................................................................................................................... [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] 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? .............. [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] ,~ TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. IF THE ANSWER Under penalties of perjury, I declare that [ 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. SIGNATURE OF I~RE'~ARI~I~' O~--IER THAN R. EPRF_L~'ENTATIVE ' ' ' DATI~ ~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [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% [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 twenty-one 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% [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%, 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% [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 + (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF po 1 ) ,,-, Debts of d~ent must be repo~ on Schedule I. ITEM NUMBER 5. 6. 7. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS DESCRIPTION FUNERAL EXPENSES: ~ ¥-x bo,_) )~ Pe~nalRepr~n~ve's Comm~ns Name of Pe~onal Rep~en~ve (s) S~al Secu~ Numa,s) / EIN Numar of Pe~onal Rep~n~Uve(s) S~t Addre~ C~ S~te Zip Yea~s) Commi~ion Paid: A~omey Fe~ Family Exemp~on: (If de~denfs addm~ ~ not ~e ~me as claimants, a~ch explana~on) Claimant Street Address C~y State Zip Relationship of Claimant to Decedent Pmbata Fees Accountant's Fees AMOUNT 3~,00 Tax Retum Prepamr's Fees h~ ~' c el/c~ nec) u ~' FILE NUMBER TOTAL (Also enter on line 9, Recapitulation) 7 (:::~, '~L~ (If more space is needed, insert additional sheets of the same size) ' 'REV-15f3 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I 1. II 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) BUREAU OF TND/VTDUAL TAXES TNHERTTANCE TAX DZVTSTOH DEPT. Z80601 HARR*rSBURO, PA 171Z8-060]. JUDY ROOT 96 ASHFORD DR ENOLA COHHONWEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOT/CE OF ZNHER/TANCE TAX APPRAZSEMENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCT/ONS AND ASSESSMENT OF TAX REV-IS~i7 El( AFP (01-o2) 17025 DATE ESTATE OF DATE OF DEATH FZLE NUHBER COUNTY ACN 05-06-ZOO/ HOPPER 01-04-2002 21 02-0Z72 CUHBERLAND 101 Amount Ram1 t'l:ed POLLY HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGZSTER OF WILLS CUHBERLAND CO COURT HOUSE CARLZSLE, PA 17015 CUT ALONG THZS L/NE ~ RETAZN LOWER PORTZON FOR YOUR RECORDS ~ REV-1547 EX AFP (01-OP) NOT/CE OF ZNHERZTANCE TAX APPRA]:SEHENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSMENT OF TAX ESTATE OF HOPPER POLLY FZLE NO. 21 02-0272 ACN 101 DATE 05-06-2002 TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: 1. Real Estate (Schedule A) 2. :5. 6. 7. 8. 0RZGZNAL RETURN (1) Stocks end Bonds (Schedule B) (2) Closely Held Stock/Partnership Zntarast (Schedule C) (:5) Mortgages/Notes Rece/vable (Schedule D) (~) Cash/Bank Dapos/ts/N/sc. Personal Property (Schedule E) (5) Jo/ntly Owned Property (Schedule F) (6) Transfers (Schedule G) (7) Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9. Funeral Expanses/Adm. Costs/N/sc. Expenses (Schedule H) 10. Debts/Mortgage L/ab/1/t/as/L/ans (Schedule Z) 11. Total Deduct/ons 12. Net Va/ua of Tax Return 1:5. 1~+. (9) (10) Char/table/Governmental Bequests; Non-a/acted 911:5 Trusts (Schedule J) Nat Value of Estate Subject to Tax 2~821.9~, .00 NOTE: To /nsure proper .00 credit to your account, . O0 subm/t the upper port/on .00 of this form with your tax payment. .oo .o0 (8) 1,156.45 .00 NOTE: 2,821 (11) 1.131 .i;~ (12) 1,685.51 (1:5) . O0 (lI) 1,685.51 Zf an assessnent was issued previous/y, lines 14, 15 and/or 16, 17, reflect figures that lnclude the total of ALL returns assessed to date. 18 and 19 will 75.85 IF PAZD AFTER DATE /NDZCATED, SEE REVERSE FOR CALCULAT/ON OF ADD/T/ONAL /NTEREST. TOTAL TAX CREDZT BALANCE OF TAX DUEJ ZNTEREST AND PEN. TOTAL DUE 79.6~ $. 79CR .00 5.79CR ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYMENT ZS REI~UZRED. ZF TOTAL DUE ZS REFLECTED AS A 'CREDZT" {CR), YOU NAY BE DUE A REFUND. SEE REVERSE S/DE OF TH/S FORN FOR ZNSTRUCT/ONS. ) ASSESSHENT OF TAX: 15. Amount of L/ne lq at Spousal rata 16. Amount of L/nm lfi taxable a~ L~neal/Class A rate 17. Amount of Line 1~ mt S/bling rate 18. Amount of L/nm 1~ taxable at Collateral/Class B rata 19. Pr/nc/~al Tax Due TAX CREDZTS: PAYMENT RECEZPT DZSCOUNT (+) DATE NUMBER /NTEREST/PEN PAZD (-) 05-1~-2002 CD000969 ~.79 AMOUNT PAZD (1.6) .00 X O0 = .00 (16) 1,685.51 X 045= 75.85 (17) . O0 X 12 = . O0 (18) .00 x 15 = .00 (19)= 75.85