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HomeMy WebLinkAbout04-29-13 J 1505610140 REV-1C/'�0 EX (01-10) X tijjr/jj OFFICIAi.USE ONLY PA Department of Revenue County Code Year Fits Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 2 1 1 2 1 1 2 8 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 0 8 1 5 2 0 1 2 0 1 0 2 1 9 8 0 Decedent's Last Name Suffix Decedent's First Name MI N o r r i s M i c h a e I C IN Applicable)Enter Surviving SprwWs information Below Spouse's Last Name Suffix Spouse's First Name Ml 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(date of 5.Federal Estate Tax Return Required death after 12-12-82) f 6.Decedent Died Testate 7.Decedent Maintained a Living Trust � 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9.Litigation Proceeds Received 10.Spousal Poverty Credit(date of death F1 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 TelephonpINurnber J o h n W , F r e y 701 7 5 7 moim 0` 0 G © 0 ty ISTF-R O LLSi—&06VNLY Prt s7 --4 C-7 rn First line of address =cD x> 1 1 9 E B a I t i m D r e S t r e e t c, r Second line of address ry r'rt r w City or Post Office State ZIP Code DATIALED G r e e n c a s t l e P A 1 7 2 2 5 Corresponclenrs*-mail address: iohndsslaw0pamet 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, lt is true,correct and complete.Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNATUJtE OF ERSON RESP ISLE FOR FILING RETURN DA ADDREP 310010erpod Court Chambersburg PA 17201 SIGNAI,r P OTHERTHA EPRSENTATE DATE ADDRE 119 Y. Baltimore t Greencastle PA 17268 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 Jti J 1505610240 REV-1500 EX 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 and Notes Receivable(Schedule D) .. . . .... . . .... .... .... . ... 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .. .. 5. 3 5 8 9 . 4 3 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers&Miscellaneous Ng�Probate Property (Schedule G) u Separate Billing Requested .. .... . 7. 0 . 0 0 8. Total Gross Assets(total Lines 1 through 7) . . . ... . . .... ..... .... . ... . . 8. 3 5 8 9 . 4 3 9. Funeral Expenses and Administrative Costs(Schedule H) . .... .... . . ... . ... 9. 8 3 3 3 . 4 9 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ... . .... . ... . 10. 6 7 2 2 . 0 5 11. Total Deductions(total Lines 9 and 10) .. . . .... . . .... . . ... .... .... . . .. 11. 1 5 0 5 5 . 5 4 12. Not Value of Estate(Line 8 minus Line 11) .. .. . .. .. . ...... ... .. .. . . . .. 12. - 1 1 4 6 6 . 1 1 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. - 1 1 4 6 6 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_ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate x.045 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X.12 0 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 0 0 18, 0 . 0 0 19. TAX DUE .. . . ... . . . . . .. . . . ...... . .... . . . ...... ... . . .. . . . ... .... 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 REV-1500 EX Page 3 21 Number 1128 Dacedent s Complete Address: DECEDENTS NAME Michael C. Norris STREET ADDRESS 83 E. Main Street Apt. 1 CITY STATE ZIP Newville PA 117241 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in oval on Page 2,Line 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) 0.00 Make check payable to: REGISTER OF WILLS, AGENT ... � rvyl�tiINfN � tre� 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...... ❑❑ O 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? ....................................................... ❑ IZI 2. If death occurred after December 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? ......... ❑ ❑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. ,.,Mil 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 3 percent p2 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)(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)]. • 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,unde 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) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, 8 MISC. INHERITANCE TAX PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Michael C. Norris 21 12 1128 Include the proceeds of IitigaWn and the date the proceeds were received by the estate. All property Johtly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1991 Honda CRX, at sales price 300.00 2. 1996 Toyota Camry, at sales price 1,900.00 3. Engagement ring, at anticipated net sales price 100.00 3. 32"flat screen tv, at sales price 100.00 4. Matrix Absence Management, Inc., uncashed disability check(07/30/12-08/06/12) 293.77 5. F&M Trust, checking account#0003655393 0.46 Principal$0.46; accrued interest$0.00 6. M&T Bank, checking account#950973130 0.00 Principal$-192.76; accrued interest$0.00 Account was overdrawn at date of death, see Schedule I. 7. Manitowoc Company, Inc.,final wages 895.20 TOTAL(Also enter on Line 5,Recapitulation) $ 3,589.43 If more space is needed,insert additional sheets of paper of the same size REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Michael C. Norris 21 12 1128 This schedule must be completed and filed If the answer to any of questons 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECUS EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATrACHA COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST UFAftCA&Q VALUE 1. BMO Retirement Services 500M 0.00 0.00 Decedent held a 401 k naming his fiance, Sarah Spahr, and their daughter, Olivia Norris as equal beneficiaries. Decedent was under the age of 59112 at the time of his death,therefore this asset is not taxable. TOTAL(Also enter on Line 7,Recapitulation) $ 0.00 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Michael C. Norris 21 12 1128 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REVA 500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OFDECUS EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER,ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPUCAKE) VALUE 1. SMO Retirement Services 582.25 0.00 0.00 Decedent held a 401 k naming his fiance, Sarah Spahr, and their daughter, Olivia Norris as equal beneficiaries. Decedent was under the age of 591/2 at the time of his death, therefore this asset is not taxable. l TOTAL Also enter on Line 7,Recapitulation) $ 0.00 If more space Is needed,use additional sheets of paper of the same size. REV-1511 Fa(+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Michael C. Norris 21 12 1128 Decedents debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Thomas L. Geisel Funeral Home, Inc., funeral services 5,999.40 2. Plasterer's Florist, funeral floral arrangements 78.39 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Yeaqs)Commission Paid: 2. Attorney Fees: Dick, Stein, Schemel,Wine&Frey, LLP 1,800.00 3, Family Exemption:(If decedents address is not the same as claimants,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. Glenda Farner Strasbaugh, Cumberland Cty Reg of Wills, Petition filing fee 58.50 8. Glenda Farner Strasbaugh, Cumberland Cty Reg of Wills, short certificates 20.00 9. Glenda Farner Strasbaugh, Cumberland Cty Reg of Wills, Inher Tax Return filing fee 15.00 10. AAA, transfer fee for Honda CRX 22.00 11. Classified advertisement to sell Toyota Camry 10.00 12. John Norris, reimburse for fuel to sell Toyotal Camry 15.01 13. The Sentinel, estate advertisement 240.19 14. Cumberland Law Journal, estate advertisement 75.00 TOTAL(Also enter on Line 9,Recapitulation) S 8,333.49 If more space is needed,use additional sheets of paper of the same size. REV-1512 Ex+(12-08) pennsylvania SCHEDULE 1 DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES,&DENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Michael C. Norris 21 12 1128 Report debts incurred by the decedent prior to death that remained unpaid at the data of death,including unrelmbunred medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. checksldebits writtenlmade prior to death;cleared after death 132.19 Giant Food Stores, check written for groceries$82.19+ return check fee$50.00 2. Giant Food Stores, check written for groceries$80.85+return check fee$50.00 130.85 3. Nationwide Insurance, preauthorized withdrawal for auto insurance premium 75.20 4. 192.76 M&T Bank overdrawn checks, try to find info on it Checks written after death 5. First Premier Bank, credit account#....1717, credit card balance 429.82 6. Department of the Treasury, Internal Revenue Service, 2009 individual income tax due 177.15 7. Department of the Treasury, Internal Revenue Service,2010 individual income tax due 1,607.00 8. Department of the Treasury, Internal Revenue Service,2011 individual income tax due 3,589.17 9. Bill Me Later,a PayPal Service,account#5049 9060 2717 3814, balance due 309.93 10. Verizon Wireless, cellular telephone services 77.98 TOTAL(Also enter on Line 10,Recapitulation) $ 6,722.05 If more space is needed,insert additional sheets of the same size. REV-1513 EX w(01-10) pennsylvania ECHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Michael C. Norris 21 12 1128 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS lincde outricht spousal d' and transfers under Sec.91 f6(a)(1.2).] 1. Levi Matthew Smith (minor)c/o Olivia Smith Lineal 1000 Walden Creek Trace 382H 50% Spring Hill, TN 37174 2. Riley Marie Norris(minor)c/o Sarah Spahr Lineal 52 Mountain View Terrace 50% Newville, PA 17241 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: 1. TOTAL OF PART II-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. Jo :t/►om� '' i r� /0��SC � 1-nv W. F --- ATTORNEY AT 1.fi s OJ a a ° DICK,STEIN,SCMMEL,WINE& FREY,LLP 60 n r-� 119 E.Baltimore Street 13 W. Main Street f� Greencastle,PA !7225 a Suite 210 n (717)597-0200 Waynesboro,PA 17268 (717)597-2542 Fax (717)762-1160 Johndsslaw@pa.oet "«a (717)762-6040 Fax i 1 . i qk, ,3 a , 1 1� j d tV 3 *0 0 n Y C y p rn W t ad N O ti rn 17000 1 O 1 i _ k 1 JJJyS)S)S) �.I f r tl 1 i �t