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HomeMy WebLinkAbout04-01-13 REV-1500 EX(02-11) 116" 1505610143 OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 12 1071 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 168 24 4416 08 30 2012 04 07 1927 Decedent's Last Name Suffix Decedent's First Name MI TROUT JEAN G (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 (Date of Death Remainder Return 1. Original Return 2. Supplemental Return 3. Prior to 12-13-82) 4. Limited Estate 4a.Future Interest Compromise Federal Estate Tax Return Required EI (date of death after 12-12-82) 6. Decedent Died Testate nX 7. (D;cedent Maigained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) Attach Copy Trust) — 10.oggsanl P�jr ,%CreditjDate of Death 11.Election to tax under Sec.9113(A) 9. Litigation Proceeds Received F1 ee 1 1- 1 and -1-95) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JESSICA L FISHER 717 697 3223 REGMTER OF WILLZUSE-ANtg C_ C> First Line of Address rn =c c-> 555 GETTYSBURG PIKE := z> r- r t-- Second Line of Address --o —n n STE C100 C,> C� a kA:TE FILEA-, P M I City or Post Office state ZIP Code --4 MECHANICSBURG PA 17055 Correspondent's e-mail address: jessica@_keystoneelderlaw.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, SIGNATU OF PERSON RESPO ISLE FO ,LING RETU DATE George E.Trout ADDRESS 1910 Valley Road, Efters,PA 17319 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Jessica L.Fisher ADD SS 655 Gettysburg Pike,Mechanicsburg,PA Side I 1505610143 1595610143 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: Trout, Jean G. 168 24 4416 RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... I 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. 15 , 807 . 94 6. Jointly Owned Property(Schedule F) 1:1 Separate Billing Requested............ 6. 3, 191 . 49 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) [-] Separate Billing Requested............ 7. 46, 924 . 34 8. Total Gross Assets(total Lines 1 through 7).........................................._........... 8. 65, 923 . 77 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 16F358 . 51 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 1, 199 . 60 11. Total Deductions(total Lines 9 and 10)........................................... .................... 11. 17 , 558 . 11 12. Net Value of Estate(Line 8 minus Line 11)................................ .. ..................... 12. 48 , 365 . 66 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. 48 , 365 . 66 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 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 48 ,365 . 66 16. 2F176. 45 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................ .........I.................................... 19. 2 , 176 . 45 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 21-12-1071 Decedent's Complete Address: DECEDENT'S NAME Trout,Jean G. STREETADDRESS 824 Lisburn Road CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 2,176.45 2. Credits/Payments A. Prior Payments 2,933.84 B. Discount 108.82 Total Credits(A +B) (2) 3,042.66 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 866.21 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) Make Check Payable to: REGISTER OF WILLS, AGENT a -,A rfi: wLL. mg— an a 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;............................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ ❑ d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving 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 containsa 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[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 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)]. 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+(11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE p�+ p p INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Trout,Jean G. 21-12-1071 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 NUMBER DESCRIPTION OF DEATH 1 Integrity Checking Account 15,807.94 TOTAL(Also enter on Line 5, Recapitulation) 15,807.94 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Trout,Jean G. 21-12-1071 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Gec3vop. 'E. Tco\lt \q\o \ 0.\\Q Roca Sof B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NUMBEER OR IIMILARrIDENTIFY IDENTIFYING INSTITUTION ER ATTACH DEED FOR DATE OF DEATH DECD$ DECED DECEDENT'S INTEREST VALUE OF NUMBER TENANT JOINT VALUE OF ASSE INTEREST JOINTLY-HELD REAL ESTATE. Credit Union 6,382.97 50.000% 3,191.49 TOTAL(Also enter on Line 6, Recapitulation) 3,191.49 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10) Rev-1510 EX+(0"9) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Trout,Jean G. 21-12-1071 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH k OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER SATTACIiTA COPRELATIONSHIP OF E DEED FOR REAL ESTATDE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Gift to George E.Trout,Trustee of Jean G.Trout 55,924.34 9,000.00 46,924.34 Irrevocable Trust dated 6/27/2012-three beneficiaries TOTAL(Also enter on Line 7, Recapitulation) 46,924.34 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Trout,Jean G. 21-12-1071 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 12,154.01 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid 2. Attornev's Fees Keystone Elder Law P.C. 4,055.00 3. Family Exemption: (if decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationshio of Claimant to Decedent 4. Probate Fees 149.50 See continuation schedule(s)attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs TOTAL(Also enter on line 9, Recapitulation) 16,358.51 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF F21-12-1071 NUMBER Trout,Jean G. ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hotel Room for Paul and Lindsay For Funeral-Paid for by George Trout reimbursed with 298.59 check#501 2 Parthemore Funeral Home&Cremation Services-Paid for by George Trout reimbursed from 11.855.42 Estate H-A 12,154.01 Probate Fees 3 Register of Wills,Cumberland County -Paid for by George Trout, Reimbursed check#505 119.50 4 Register of Wills: Inheritance Tax Return Filing Fee 15.00 5 Register of Wills: Inventory Filing Fee 15.00 H-B4 149.50 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-08) SCHEDULE pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Trout,Jean G. 21-12-1071 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I Hospice-Paid by George Trout,reimbursed check#501 740.00 2 Per Capita Tax-paid by George Trout and reimbursed from Estate 10.00 3 Spartan Pharmacy-Paid for by George Trout reimbursed by check#501 35.17 4 Spirit Physicians Services 102.00 5 The Woods-Paid for by George Trout, reimbursed by check#501 192.83 6 West Shore EMS TOTAL(Also enter on Line 10, Recapitulation) 1,199.60 1,199.60 (If more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1513 EX+(0140) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE �+ /�p INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Trout,Jean G. 21-12-1071 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT (Words) ($$$) Q2 Not List Trusteets)I TAXABLE DISTRIBUTIONS [include outright spousal • distributions,and transfers under Sec.9116(a)(1.2)] 1 Lindsay Klein Granddaughter 16,121.89 8542 West Holbrook Court Boise,ID 83704 2 Holly Trout Granddaughter 16,121.89 8715 First Avenue Apt 507D Silver Spring,MD 20910 3 Kelly Trout Granddaughter 16,121.89 7057 Carroll Avenue,Apt.8 Takoma Park,MD 20912 Total 48,365.67 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: IL A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1508 Schedule J(Rev.01-10)