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Home My WebLink About04-08-13 (2) J REV-1500 EX(01.10) 1505610143 PA Department of Revenue OFFICIAL USE ONLY p Pennsylvania County Cade Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 80x.280601 INHERITANCE TAX RETURN 21 12 01271 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 191 40 8113 05 17 2012 12 12 1949 Decedent's Last Name Suffix Decedent's First Name MI MARCY KEVIN J (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI MARCY DANA M 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 ❑ 7. 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 ❑ 10.beiween12-371 sir Credit(date f death ❑ 11.Election to tax under Sec.9113(A) 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 9¢x$8 REGeMOF WILLiRISE�IL Cr First line of address x" M �t f" v rr3 pp �° r-*.) 129 SOUTH PITT STREET Cf-' a -rt � C-) Second line of address � T1 n CD i iTI City or Post Office State ZIP Code D/TE FILES Gh CARLISLE PA 17013 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. SIGNAT7 OF PERSON RESPONSIBLE FOR FI G RETURN DATE 22 Zj DANA M. MARCY ADDRESS 205 PENNSYLVANIA AVENUE,CAMP HILL, PA 17011 SIG NAT RE OF PREPARER OTHE T ESENTATIVE DA E James M Robinson c S zDR S South Pi Street, Carlisle, PA 17013 Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: MARCY, KEVIN JAMES 191 40 8113 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. 24 , 807 . 41 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7. 157 , 000 . 00 8. Total Gross Assets(total Lines 1-7)........................................................................ 8. 181 , 807 . 41 9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 9 , 454 . 17 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1)................................ 10. 18 , 943 . 69 11. Total Deductions(total Lines 9&10)...................................................................... 11. 28 , 397 . 86 12. Not Value of Estate(Line 8 minus Line 11)............................................................. 12. 153 , 409 . 55 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. 153 , 409 . 55 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.00 141 , 005 . 84 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 12 , 403 . 71 16. 558 . 17 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. 558 . 17 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. F-1 Side 2 1506610243 1505610243 J REV-1500 EX Page 3 File Number 21 - 12 - 01271 Decedent's Complete Address: DECEDE NAME MARCY, KEVIN JAMES STREET ADDRESS 205 PENNSYLVANIA AVENUE CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 558.17 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 0.00 3. Interest (3) 2.28 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) 560.45 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.................................................................................................................. ❑ ❑x 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. 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 172 P.S.§9196(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 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)l. •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,w9ether y blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMOMEALTHOFPENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF MARCY, KEVIN JAMES 21 - 12 -01271 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 DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 BELCO FEDERAL CREDIT UNION-ACCT. NO. 0000753230 1,616.50 2 JANNEY MONTGOMERY SCOTT, LLC 3,209.91 ACCT. NO. 1241-7699 3 2005 NISSAN FRONTIER TRUCK 10,131.00 4 2008 HARLEY DAVIDSON FLHT ELECTRA GLIDE MOTORCYCLE 9,850.00 TOTAL(Also enter on Line 5,Recapitulation) 24,807.41 COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN �A INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF MARCY, KEVIN JAMES FILE NUMBER 21 - 12-01271 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION TAXABLE VALUE NUMBER Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECD'S (IF APPLICABLE) and the date of transfer. Attach a copy of the deed for real estate. INTEREST 1 205 PENNSYLVANIA AVENUE, CAMP HILL, PA 160,000.00 100% 3,000.00 157,000.00 VALUED AT ASSESSED VALUE X COMMON LEVEL RATIO ($160,000.00 X 1.0) TOTAL(Also enter on line 7,Recapitulation) 157,000.00 SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL INHERITANCE TAX RETURN RESIDENT DECEDENT a MNISMI E ESTATE OF MARCY, KEVIN JAMES FILE NUMBER 21 - 12-01271 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 PARTHEMORE FUNERAL HOME&CREMATION SERVICES, INC. 3,409.00 2 PEALER'S FLOWER SHOP-FLOWERS AT MEMORIAL SERVICE 105.89 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 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant DANA M. MARCY 3,500.00 Street Address 205 PENNSYLVANIA AVENUE City CAMP HILL State PA Zip 17011 Relationship of Claimant to Decedent SURVIVING SPOUSE 4. Probate Fees REGISTER OF WILLS 153.50 CUMBERLAND LAW JOURNAL 75.00 THE SENTINEL 210.78 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 TOTAL(Also enter on line 9, Recapitulation) 9,454.17 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT BER ESTATE OF MARCY, KEVIN JAMES 21 -FILE NUM- BER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 BANK OF AMERICA-ACCT. 4313-0709-9817-9359 13,206.96 2 U.S. BANK-ACCT. 4006-1385-6632-9532 5,196.85 3 HOLY SPIRIT HOSPITAL-ACCT. 41278706 323.04 4 PEERLESS CREDIT SERVICES INC., ON BEHALF OF A. BAILEY WOOD, D.D.S. 216.84 TOTAL(Also enter on Line 10, Recapitulation) 18,943.69 REV-1513 EX+(11A8) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARCY, KEVIN JAMES FILE NUMBER 21 - 12-01271 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 DANA M. MARCY SPOUSE 205 PENNSYLVANIA AVENUE CAMP HILL, PA 17011 2 RYAN MARCY SON 24 OAK DRIVE MOUNTAINTOP, PA 18707 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. III NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00