HomeMy WebLinkAbout05-20-13 � 1505610143
REV-1500 Ex`°2.,,,
OFFICIAL USE ONLY
PA Department of Revenue pennsylvanla co�,ry coes vaa� File Number
Bureau of Individual Taxes 0°""*"a"d1Q1°"'E
Po eox.2eoso� INHERITANCE TAX RETURN 21 12 1162
Hartisburg,PA 1712&0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
10 12 2012 OS 02 1926
DecedenYs Last Name Suffix Decedent's First Name MI
GRAY CLIFFORD E
(If Appliwble)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 Retum � 2. Supplemental ReNm � 3. P�e,o el�ntl2;�2'(Date of Death
� 4. Limited Estate � qg Fulure Interest Canpromiaa � 5. Fetle21 Estate Taz Return Required
(aeta o(aeeth eflx 12-12-82)
� g Decedmt DieE Testete � ], DeceEeM Mai�jnetl e Lhirq Trunt _ 8. Totel Number of Safe Deposit BOxes
(AttachCopyolWill) . (AHachCOPY �+st)
� 9. LitigationProceedsReceived � 10.��P9�'���a�a��o.�e��woeam � ��,EIeGtlOntO�exunderSeG9113(A)
(AHach Schetlule O)
CORRESPONDENT-THIS SECTION MUSi BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAXMFORMATION 8�UL6�BE�2ECTED T0:
Name Dayt�e Olephone.Ny�mb��'.�' ��
, r,_s
JOFiN A RVLE 61� =d8� �OOv? �-'
� c.
� : r.., - �:;�
RE 4GIaS�R 8F WII�LS US�OMLY �
c_' !"'' ��;
First Line of Address r: :.��' =��.�: _-' "`I. -..�
' '� ` � s ;�,.-�
3770 RIDGE PIKE STE 2 � -
'Y� ' c.a �7 r,i
Second Line of Address — c;a �"
DATE FILED
City or Post O�ce Sfate ZIP Code
COLLEGEVILLE PA 19426
correapondenYse-mauaddress: Jrule�millerturetsky.com
Under penaltks of pequry,I tleGare tMt I�eve examined this retum,inGuding aaomparryi,np schedules and statemenn,antl to the best of my knowledge and Eeliet,
It ia true,cortect anE complete.DeGantlon of preparer ofher Nan Me personal representa4ve is based on all informatlon of which preperer has any knowletlge.
SI TURE OF PERSO SP LE FOR FILING RETURN�/� DATE
,VyvY� ���,,��i_,p,�'`! Lynn G. Patterson 7�/S�/3
woones �
3 Circle Dr., Ea�lleville, PA 19403
S161mRURE OF PftEP O�' R THAN REPRESENTATIVE pq7E
�,�=;'`=� '.G�L. John A. Rule �//6 �/.�
noo
3770 Ridge Pike Ste 2,Collegeville, PA
Side 1
L 1505610143 1505610143 � `�
J 1505610243
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&Notes Receivable(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 37 , 7 B 6. 00
6. Joinlly Owned Property(Schedule F) ❑ Separate Billing ReQUested............ 6. 2 � 833 . 82
7. Inter-Vivos Transiers&Miscellaneous�{aq Probate Property �
(Schedule G) U Separate Billing Requested............ 7,
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 40� 619. 82
9. Funeral Expenses and Administrative Costs(SChedule H).................................... 9. 9� 028 .50
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. � 3 � 058 . O9
11. Total Deduetlons(total Lines 9 and 10)................................................................ 1 t. 12, 08 6. 5 9
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 28�533 .23
13. Cbaritable and Governmental Bequests/Sec 9113 Trusts for which �
an eledion to tax has not been made(Schedule J)............................................... 13.
• 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. 2 8 ,533 . 23
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 . 0�0
16. AmountofLinelataxab�e 2$�533 .23 16. 1�284 . 00
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount oi Line 14 tauable
at collateral rate X.t 5 0 . 0 0 18. 0 . 0 0
19. TAXDUE................................................................................................................ 19. 1�ZH4 . 00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21-12-1162
Decedent's Complete Address:
DECEDENT'S NAME
Gray, Clifford E.
STREETADDRESS
210 Big Spring Rd
CITY STATE ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 1,284.00
2. Credits/Payments
A. PriorPayments 1,250.00
B. Discount 64.20
Total Credits(A +gj (2) 1,314.20
3. Interest (3)
q. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 30.20
Cheek box on Page 2,Line 20 to request a refund
g. 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.
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 transferted:............................................................................... � �
b. retain the right to designate who shall usa the property transferred or its income:.................................. x
c. retain a revereionary interesk or............................................................................................................... :
d. receive the promise for life of ekher payments,benefits or care7............................................................
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ �
3. Did decedent own an'in trust foP or payable upon death bank account or security at his or her death7....... ❑ ❑x
4. Did decedent own an individual retirement awount,annuity,or other non-probate propeRy which
contains a beneficiary designation?.................................................................................................................. ❑ ❑X
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 aRer July 1,1994 and before Jan. 1, 1995,the tax rate imposed on the net value of trensfers to or for the use of the suniving
spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)].
For dates of death on or aRer 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)j. The statute does not exempt a trensfer to a surviving spouse from tax,and the statutory requirements for disclosure of
assets and filing a tax retum ara still applicable even ff 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 naturel 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
�n P.s.§s��s(a)(�)]. .
. 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.§91�6(a)(1.3)]. A
sibling is deflned under Sedion 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-7508 EX«(77.�p)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERRANCETA%RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OP FILE NUMBER
Gray, Clifford E. 21-12-1162
InduM ths proceetla of litipetian enE the Eeta IM procaatls xrers rewivetl by Cre esbte.
All propsrtyfolMlY�etl wiN ths right of�uMvorohip must M tlhclo�stl on scMEUls F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 PNCIRAAcct#75600028311 25,894.00
2 Prudential IRA#000555955 11,892.00
TOTAL(Also enter on Line 5, Recapitulation) 37,786.00
(If more space is needed,additional pages of the same size)
Copyright(c)2010 fortn software only The Lackner Group,inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-7509 EX+�O1-10)
pennsylvania SCHEDULE F
DEPAR7MENTOFREVENUE JOINTLY-OWNED PROPERTY
INHERRANCE TAX RE7URN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gray, Clifford E. 21-12-1162
M an wN wu m�Ee jolnt wiqin o�ro yser of M�tl�e�daM'a dab of Aeath,k muat Ee npoMd on�eA�dW�O.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Lynn Patterson 3 Circle Dr Daughter
Norristown, PA 19403
g. Catherine Gray 133 W Locust St Apt 115 Daughter
Mechanicsburg, PA 17055
C.
JOINTLY OWNED PROPERTY:
� DESCRIPTION OF PROPERTY °�OF oa�oF oea�rr
ITEM LETTER DATE INCLUDENAMEOFFINANCW.INSTITUTIONlWDB/WKACCOUNT DATEOFDEATH ��1LUEOF
NUMBER FOR JOIN� MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATfACH DEED FOR ALUE OF ASSE DECD'S DECEDEM'S INTEREST
TENANT JOINT JOINTLV-HEIDREALESTA7E. INTEREST
1 A,B 05/15/2006 PNC ckg account#5003979827 8,308.61 33:333°k 2,769.54
2 A OS/75/2006 PNC savings account#5004001257 128.56 50.000% 64.28
TOTAL(Also enter on Line 6, Recapitulation) 2,833.82
(If more space is needed,addkional pages o/the same size)
Copyright(c)2010 form soflware only The Lackner Group,Inc. Fortn PA-1500 Schedule F(Rev.01-10)
REV-0SH EX��10-09) -
pennsylvania SCHEDULE H
DEPAF2TMENT OF REVENUE FUNERAL EXPENSES AND
RESIDENTDEC ENT RN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Gray, Clifford E. 21-72-1162
DecedenYs debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
p, FUNERAL EXPENSES:
See continuatfon schedule(s)attached 5,979.00
B. ADMINISTRATIVE COSTS:
1. Personai Representative's Commissions
Name of Personal Representative(s)
Street Address �
City State Zio
Year(s)Commission Paid
2. nttornev�s Fees Miller,Turetsky, Rule& McLennan 2,685.00
3. Family Exemption: (If decedenYs address is not the same as claimanPs,attach explanation)
Claimant
Street Address
City State Zio
Relationshio of Claimant to Decedent
4. Probate Fees 164.50
5. AccountanYs Fees
6. Tax Return Preparers Fees
7. Other Administrative Costs
TOTAL(Also enter on line 9, Recapitulation) 9,028.50
Copyright(c)2009 form soflware only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
,
Rev�1512 E%�(12-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
UEPARTMENTOFREVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT�ECEDENT
ESTATE OF FILE NUMBER
Grey, Clifford E. 21-12-1762
Raport dabla luurtsa by ths tlwsEant prlor b tl�sth thet rn�ulneE unp�itl et tM Eab of MaM,Inclutlinp unroimburosd matlical expamaa.
ITEM VALUE AT DATE
NUMBER DESCRIPTION ap pEqTM
1 Green Ridge�Ilage Assisted Living 2,753.00
2 Green Ridge�Ilage Asslsted Living 145.04
3 Highmark 200.05
4 NewvilleAmbulance 280.00
5 NewvilleCommunityAmbulance 280.00
TOTAL(Also enter on Line 70, Recapitulation) 3,058.09
(If more space is neeCed,addRional pages of the same s¢e)
Copyright(c)2008 form software only 7he Lackner Group, Inc. Fortn PA-1500 Schedule I(Rev. 12-08)
. . . .
REV-7517 EX+�01-10)
pennsylvania SCHEDULE J
OEPARTMENT OF REVENUE
INHERITANCE TAX RETURN B EN EFICIARI ES
RESI�ENT DECEDENT
ESTATE OF FILE NUMBER
Gra , Clifford E. 21-12-1162
RELATIONSHIP TO
NAME AND ADDRESS OF SHARE OP ESTATE MOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (yyords) ($$$)
I TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 12
Catherine Gray Daughter Twenty flve 7,133.31
733 W Locust St Apt 175 percent residual
Mechanicsburg, PA 77055 beneficiary
Alan Gray Son Twenty five 7,133.31
1441 N.Trooper Rd percent residual
Trooper, PA 19403 beneficiary
Sandra Lu� Daughter Twenty five 7,133.31
7720 Lincoln Way East percentresidual
Fayetteville, PA 17222 beneficiary
Lynn G. Patterson Daughter Twenty flve 7,133.31
3 Circle Dr. percent residual
Eagleville, PA 19403 beneficiary
Total 28,533.24
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro riate.
NON•TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
8.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•1500 Schedule J(Rev.01-10)
M���1'u�rs�Rv� 1�cr�x�v
�����
MARK I},TtIRETSKY ATTQRNEYS AT LAW JAMES H.FREEMAN
JOHNA.RtILE 3770 RXDGE PIKE,SL7ITE 2 �f�ouasel
KESTH B.McLf•NNAN" COLLEGEYILLE,PENNSXZVANIA 19426 MITCHELL W.MILLER
ADAMH.TANKER {61Q)489-3300 Office ReNred
FARZEEN F.SIDHVA {610)489-1157 Facsimile jlLl K�ltVDERSON,J.D.
�trso hfe��c ffr�ew�a$pYann www.mxlieHuretsk�com
May 16,2013
Register of Wiils
Cumberland County Courthouse
dne Courthause Square Baom 142
Cazlisle, PA 17413
Estate of: Clifford E. Gray
Dateafdeath: idii2112
File No: 21-12-1162
Deaz Madarn;
Enclosed please find twa copies of the PA Inheritance taY retums and an extra first page.
Also enclosed aze two copies and e�ra page of the Inventory far the above estate. I am enclosing a check in
the amount of$I S for the filing fee. There is no inheritance taac due.
Kindly time starnp the extra first pages of the Pa return and the inventory and return them to me in the
enclosed envelope along with the receipts.
Thank you very much.
Very truly yaurs, ^
l.._�,�.f °`�• �:.,�GG.� _ .•C.�
!
G
Jill K. Anderson
Pazalegal
JKA:jka
BUSINESS•C42t5TAtK7tON�FAh�.Y+CNStJRANCE COYERAGE�LITSGATION•NON-PROFITS•PERSONAL M1URY�REAL ESiA'CE
TAX•TRALEMARKS,CC7PYRIGHTS Bc 7RADE SECRETS•WR.LS,IRUST$$ESTATES•WORKER'S COMPENSATION•ZONtNCi �
J_`_._ __
__.--------_
�,
, tp
N
a'. .7 Q
u :T
� 1; o .0
O
O
�. '� <l
;� 1
�,X Pi
4 t, U
� �
_- �Ct
_ tC
, ti.
q, n1� •�
�.iy.
1 , a��
4!'
_ �n: �'.. t�u-
�f , i
;���Y. t M
'�t�� 5
V N p
6r
e�^
� � N �
�
1:.. (�r') 0�.. � '"f v't � �, o
�n �, � �1,
Li.1 �3 C�! � ,�* �',trxn ,y N
•-�i � yc�
�y �. O C.� q ���" . "'' � U
� �.y
w. !1- �, 3+ �-+ '�`� � t''Y'^� c! ��„
� � O � tA .Q
�'..� C? �. uJ�'2 -� ��-� W a" ^ 0 �O
�'u- yu" �`� � x u� � R ^' � 'd ° '�
� tn � 0. � c� '� "' w c,
� � os � � �
w � � ¢ i �� "�' w �, s� C� �'
� ti � .�.a 'on a C �
� � � � � �
�
� G .
r