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HomeMy WebLinkAbout04-11-13 ( �•�1 REV-1500 EX `01-10) 1505610140 OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number 0 7 0 7 2 0 1 2 0 2 2 7 1 9 2 8 Decedent's Last Name Suffix Decedent's First Name MI S H I E L D S A N N E B (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 © 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) © 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 ❑ 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 Telephone Number M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4 6 5 0 Ij SGISTER OF WILLS USE ONLY c.. O w rn First line of address m 4'> O 5 4 E A S T M A I N S T R E E T I-- i+ r- 7> Z n^l Second Tine of address 6 { 'YT 17 1 City or Post Office State ZIP Code Q c s iDATE3FILED M E C H A N I C S B U R G P A 1 7 0 5 5Jc� cn vii o 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. SIGNAT R PERSO RES SI E OR FILING RETURN DATE ADDRESS WILLIAM L. BRUB KE ; 85 W CARDINAL AVE WHEELING WV 26003 SIGNATURE F RE R OT R THAN REPRESENTATIVE 41 7 y T , ADDRES MUR L R WALTERSn III, 54 E- MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side i 1505610140 1505610140 i t \�� Continuation of REV-1500 Inheritance Tax Return Resident Decedent ANNE B. SHIELDS 21 12 0762 Decedent's Name Page 2 File Number Correspondents Name Daytime Telephone Number First line of address Second line of address City or Post Office State ZIP Code Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this return,including=,anying schedules and statements,and to the best of my knowledge and belief, it is true,coos plete.Declaration of preparer other than the perso I representative is based on all information of which preparer has any knowledge. SIGNATUR OF PE ON RESPON I L FO ILING t2T N DATE ADDRESS JOANN • SCHELL, 2227 ASPEN DRIVE MECHANICSBURG PA 17055 1505610240 REV-1500 EX RECAPITULATION I. Real Estate(Schedule A) ........... ...................... .......... 1. 1 0 1 0 0 0 . 0 0 2. Stooks and Bonds(Schedule B) .. . ... . . . .. . . . . . . . .... . .. . . .. . .. . . . . . 2. 4 7 6 2 6 . 9 1 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 1 4. Mortgages and Notes Receivable(Schedule 0) . . .. . . . . . .. . .. . . . . . . . . . . . . 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).... ... 5. 9 9 8 3 0 S. 4 4 6. Jointly Owned Property(Schedule F) ❑ separate Billing Requested . . . . . .. 6. 0 . 0 0 7. Inter-Vivos Transfers&Miscellaneous N,QL-Probate Property (Schedule G) u Separate Billing Requested .... ... 7. 4 3 2 8 0 . 3 2 8. Total Gross Assets(total Lines 1 through 7) . .. . . .. . .. . . . . . . . . . . .. .. . .. 8. 1 1 9 0 2 1 2 . 6 7 9. Funeral Expenses and Administrative Costs(Schedule H) _................ 9. 2 1 9 6 9 . 4 2 10. Debts of Decedent,Mortgage Liabilities,and Liens Schedule I 10. 8 5 4 . 5 0 11, Total Deductions(total Lines 9 and 10) ..................... ... ....... 11. 2 2 8 2 3 . 9 2 12. Net Value of Estate(Line 8 minus Line 11) .. . . . . . . .. . . . .. . .. . . . . . . . .. . 12. 1 1 6 7 3 8 8 . 7 5 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 6 7 3 8 8 . 7 5 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (ax1.2)X.0_ 0 . 0 0 15, 0 . 0 0 16. Amount of Line 14 taxable at lineal rate x.045 1 1 6 7 3 8 8 . 7 5 16. 5 2 5 3 2 . 4 9 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 fig. TAX DUE ............. .................... .................. ... 19. 5 2 5 3 2 . 4 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 L 1505610240 1505610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 12 0762 DECEDENT'S NAME ANNE B.SHIELDS STREETADDRESS 2113 FOXFI RE DRIVE ——------—-----——---- —----- CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: 1 Tax Due(Page 2,Line 19) 52,632.49 2. Credits/Payments A.Prior Payments 49,000,00 B.Discount 2,450.00 Total Credits(A+9) (2) 51,450.00 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 Une 2,enter the difference.This is the TAX DUE. (5) 1,082.49 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; ....... .........----........ .......... 171 MX b. retain the fight to designate who shall use the property transferred or its income; —1...........I.............. 171 MX c, retain a reversionary interest;or .................................... ...................... ............................. 171 0 d. receive the promise for life of either payments,benefits or care? ...--.......................................... 171 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?.................................................................... ............ ................ 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)(1)]. 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 172 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 berieficiaries is 4,5 percent,except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)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.§91116(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-1502 EX,(01-10) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ANNE B. SHIELDS 21 12 0762 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is Jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 2113 FOXFIRE DRIVE 101,000.00 MECHANICSBURG, PA 17055 ONE-HALF COUNTY ASSESSED VALUE BASED UPON TENANCY IN COMMON AS SET FORTH IN DEED TOTAL(Also enter on Line 1,Recapitulation.) E 101 000.00 If more space is needed,use additional sheets of paper of the same size. REV-1503 EX�(e-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ANNE B. SHIELDS 21 12 0762 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. SERIES EE SAVINGS BONDS 27,580.00 18 @$1,000.00 REDEMPTION VALUE 2. SERIES E SAVING BOND 46.91 1 @$10.00 REDEMPTION VALUE 3. TREASURY NOTE 5,000.00 4. TREASURY NOTE 15,000.00 TOTAL(Also enter on line 2,Recapitulation) $ 47 626.91 (If more space is needed,insert additional sheets of the same size) REV-1508 EX+ pennsytvania SCHEDULE E DEPARTMENT OF REVENUE INHERITANCE TAR RETURN CASH, BANK DEPOSITS, & MISC. RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: ANNE B.SHIELDS 21 12 0762 Include the proceeds of ktgation and the date the proceeds were received by the estate. All property joinfl owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MERRILL LYNCH 775,307.55 INVESTMENT ACCOUNT 2. MORGAN STANLEY 156,428.69 MUTUALFUND 31 VANGUARD 43,850.69 MONEY MARKET 4. PNC 20,718.51 CHECKING TOTAL(Also enter on Line 5,Recapitulation) E 998 305.44 If more space is needed,insert additional sheets of paper of the same size REV-1510 EX-(08-08) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER ANNE B,SHIELDS 21 12 0762 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. DESCRIPTION OF PROPERTY ITEM INCLUDETtE N"OF THETRANSFEREE,THEIR RELATVMP TO DECEDENTAND DATE OF DEATH % DECDS EXCLUSION TAXABLE NUMBER 11HE DATE OF TRANSFER,ATTACH ACOFYOFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST tIFAWUCAfl VALUE 1. PNC 43,280.32100.00 43,280.32 IRA WILLIAM L.BRUBAKER-SON-50% 285 W.CARDINAL AVE,WHEELING,WV 26003 JOANNE M,SCHELL,DAUGHTER-50% 2227 ASPEN DRIVE,MECHANICSBURG, PA 17055 TOTAL Also enter on Line 7,Recapitulation $ 43 280.32 If more space is needed,use additional sheets of paperof the same sae. REV-'51' EX+(,10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ANNE B. SHIELDS 21 12 0762 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. MALPEZZI FUNERAL HOME,MECHANICSBURG,PA 13,143.94 2. GINGRICH MEMORIALS-INSCRIPTION ON TOMBSTONE 165.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) WILLIAM L. BRUBAKER Street Address 285 W.CARDINAL AVENUE City WHEELING State WV ZIP 26003 Year(s)Commission Paid: (RENOUNCED) 2, Attorney Fees: MURREL R.WALTERS, III, ESQUIRE 6,800.00 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: CUMBERLAND COUNTY REGISTER OF WILLS 958.50 6 Accountantfees: MARK L.WETZEL,CPA-TAX PREPARATION 650.00 6. Tax Return Preparer Fees: 7. CUMBERLAND COUNTY LAW JOURNAL-PUBLICATION 75.00 8. PATRIOT NEWS-PUBLICATION 158.03 9. EXPRESS MAIL 18.95 TOTAL(Also enter on Line 9,Recapitulation) E 21 969.42 If more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent ANNE B. SHIELDS 21 12 0762 Decedent's Name Page t File Number Schedule H-Funeral Expenses &Administrative Costs- B1 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative Commissions: 2. Name(s)of Personal Representative(s) JOANNEE.SCHELL Street Address 2227 ASPEN DRIVE City MECHANICSBURG State PA ZIP 17055 Yeaqs)Commission Paid: (RENOUNCED) SUBTOTAL SCHEDULE H-131 REV-1512 EX+(12-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER ANNE B. SHIELDS 21 12 0762 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 1. STORAGE DEPOT SOUTH INC. 854.50 RENT TOTAL(Also enter on Line 10,Recapitulation) $ 854.50 If more space is needed,insert additional sheets of the same size. REV-1518 EX.(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ANNE B. SHIELDS 21 12 0762 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 [includeoutri ht spousal distributions and transfers under Sec.9116(a)(1.2).] 1. WILLIAM L. BRUBAKER Lineal 285 W. CARDINAL AVENUE WHEELING,WV 26003 2. JOANNE M.SCHELL Lineal 2227 ASPEN DRIVE MECHANICSBURG,PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. u, 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.