HomeMy WebLinkAbout03-04-13 (2) J 1505610105
RED/-1500 Ex t°'-"'IFI'
PA Department of Revenue pennsytvarda OFFICIAL USE ONLY
^*�^ ^^•^^^ County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280 A 1 J h Q�'f
Harrisburg,PA 17328-06oi RESIDENT DECEDENT J L O
ENTER DECEDENT INFORMATION BELOW
Social
08/05/2012 05103/1952
Decedent's Last Name Suffix Decedent's First Name MI
VERNER GREGORY q
(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
O 1.Original Return CID 2.Supplemental Return p 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate p 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (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)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
:MARY A. ETTER DISSINGER (717)957-30A
m
REGISTE^ F-ULLS USE-ULY n
rnrn
x n
First Line of Address D 2 r'rI r, M
400 SOUTH STATE ROAD Z
Second Line of Address h O - -n
O cz
N C>
-I rrf
City or Post Office State ZIP Code 13ATE FILED p
p -n
MARYSVILLE PA 17053
Correspondent's e-mail address:
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.
SI TURE OF PERS PONSI LE OR FI 1 G ETURN
ADQ,fESS I 11
f �y,
SIG TU OF PREP ER THER THAN REPRESEN TIVE DATE
ADDRESS
400 SOUTH STATE ROAD, MARY ILLE, PA 17053
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105 J
� r
J 1505610205
REV-1500 EX(FI)
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. 59,909.11
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. 59,909.11
9. Funeral Expenses and Administrative Costs(Schedule H)......... .......... 9. 3,295.46
10. Debts of Decadent,Mortgage Liabilities and Liens(Schedule 1)....... ........ 10. 0.00
11. Total Deductions(total Lines 9 and 10)...... ........................... 11. 3,295.46
12. Net Value of Estate(Line 8 minus Line 11)........................ ...... 12. 56,613.65
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
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. 56,613.65
TAX CALCULATION-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.0_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0 45 56,613.65 16. 2,547.61
�.__..__. �..._ �__..
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE .......... ............................................... 19.'' 2,647.61
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
1505610205 1505610205 J
REV-1500 EX(Fi) Page 3 Fife Number
Decedent's Complete Address:
DECEDENT'S NAME
GREGORY A.VERNER
STREET ADDRESS
39 COLLEGE HILL ROAD
CITY — STATE
ENOLA PA 17025
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 2,547,61
2. Credits/Payments
A.Prior Payments _____. 0.00
B.Discount 0.00
Total Credits(A+B} (2) 0.00
3. Interest
(3) 0.00
4. If line 2 is greater than Lane 1+Ling 3,enter the difference. This is the OVERPAYMENT.
Fill In oval on Page 2,Une 20 to request a refund, (4) 0.00
5. if Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,547.61
Make check payable to: REGISTER OF WILLS,AGENT.
Via_, 9 g .,.
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.............................................................................................................................. ❑ ■
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ N
2. If death occurred after Dec.12,1902,did decedent transfer property within one year of death
without riving adequate consideration?.............................................................................................................. ❑ 0
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? ........................................................................................................................ ❑ I♦
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
NA
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)(ff)].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(x)(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+(08-12)
Pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS&MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF; FILE NUMBER:
GREGORY A.VERNER 21-12-0879
include the proceeds of litigation and the date the proceeds were received by the estate.
All property joifffly owned with right of survivorship roust be disclosed an Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Salary,Leave Payouts,Paid by employer after date of death(Copy of worksheet attached) 59,909.11
TOTAL(Also enter on Line 5,Recapitulation) $ 59,909.11
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-49)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GREGORY A.VERNER 21-12-0879
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City _ State----_-._ZIP
Year(s)Commission Paid:_
2. AttomeyFees: Dissinger & Dissit2ger
2,995.46
3, Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City ____---State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
S. Accountant Fees:
& Tax Return Preparer Fees: 300.00
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 3,295.46
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(01-10)
Iff pennsylvania SCHEDULE
DE--.ENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER;
GREGORY A. VERNER 21-12-0879
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trixtee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).)
I. Jennica Marie Heally Hocidey-111 East Columbia Avenue Stepchild 59,909.11
Enola,PA 17025
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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:
1,
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART A- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
BUREAU OF COMMONWEALTH PAYROLL OPERATIONS
DECEASED PAYMENT WORKSHEET
Date Submitted: 10/10/2012
Employee Name: Gregory A.Verner
Personnel Number. 00050817
TIN Number. 46-6194801
Payee Name: Estate of Gregory A.Verner
Payee Address:26 N.32nd Street Camp Hill,PA 17011
Taxable Non Taxable
PPE I Hours I Gross I Totals PPE I Hours Gross Totals
Salary 7/27/2012 75.00 $2,781.40 $0.00
Salary 8/10/2012 37.50 $1,390.50 $0.00
$0.00 $0.00
$0.00 $0,00
$0.00 $0.00
$0.00 $0.00
$0.00 $0.00
Total Salary Due $4,171.50 $0.00
Annual 429.24 $15,916.22 $0.00
Personal 7.50 $278.10 $0.00
Sick 1,170.00 $43,383.60 $0.00
Holiday $0.00 $0.00
comp $0.00 $0.00
$0,00 $0.00
Total Leave Payouts $59,577.92 $0.00
Conversion Pay $0.00 $0.00
Salary/Overtime $0.00 $0.00
Pre Tax Medical $68.54 $0.00
Other $0.00 $0.00
Total Gross Overpayments $68:54 $0.00
Salary Overpayment-Net $0.00 $0.00
Medical Hospital Percentage $0.00 $0.00
Social Security/Medicare $3,597.96 $0.00
Union Dues $0.00 $0.00
Retirement $173.81 $0.00
Total Deductions Owed $3,771.77 $0.00
Total Due BeneftlarylEstate $591909,11 $0.00
Total Deductions Owed $3,771.77
Total Ad/ustmeni Amount $3,771.77
7- $63,680.88 0.00
Rovi"d 823!07