HomeMy WebLinkAbout05-03-13 (2) � 1505610140
REV-1500 EX �°,_,°>
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO aOx zsoso� INHERITANCE TAX RETURN
Harrisburq PA 17128-0601 RESIDENT DECEDENT 2 1 1 3 0 0 5 8
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 2 1 1 2 0 1 2 1 0 2 8 1 9 2 8
Decedent's Last Name Suffix Decedent's First Name MI
S O U T N E R P A U L i N E B
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Su�x 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
Q 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)
QX 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 T0:
Name Daytime Telephone Number
C H A R L E S E P E T R I E 7 1 7 5 6 1 1 9 3 9
REGISTER OF WI�LS U$��LY �',
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First line of address ' '�� : ; } �,-�
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3 5 2 8 B R I S B A N S T R E E T r.�� -> i i '� I
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Second line of address :� �; :: �.� �;; '
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Cit or Post Office _ -:. �ATE F►�o :" �j
Y State ZIP Code — __ _._ :" rn
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S B U R G P A 1 7 1 1 1 ; �� �
CorrespondenYs e-mail address: PetrieLaw(c�,AOL.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,co nd complet ra n of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN U F PERS PO BLE F G RETUR DATE
ADDRESS
4105 N. GARLAND STREET ALEXANDRIA VA 22304
SIGNATUE�O REP Er T�TyFAN REPRESENTATIVE DATE
� `�i�
ADDRESS
3528 BRISBAN STREET HARRISBURG PA 17111
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 1505610140 � �
�
� 1505610240
REV-150a EX
DecedenYs Social Security Number
�ecedent's Name: PAULINE B. SOUTNER
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 Deposil:s and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 3 4 � 4 8 . 6 4
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. •
7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property
(Schedule G) � Separate Billing Requested . . . . . . . 7. .
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3 4 i' 4 8 . 6 4
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 6 3 0 8 . 2 7
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. 2 I 8 1 . 3 6
11. Totai Deductions(;total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 9 0 8 9 . 6 3
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 2 5 6 5 9 . 0 1
13. Charitabie and Governmentai 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. 2 5 6 5 9 . 0 1
TAX CALCULATION-5EE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 kaxable
at the spousal tax rate,or
transfers under Sec. 9116
(a)(1.2)X•�_ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at�ineal rate x .045 2 5 6 5 9 . 0 0 1 s. 1 11 5 4 . 6 6
17. Amount of Line 14 taxable
at sibling rate X.1z 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 1 g. 0 . 0 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 1 5 4 • 6 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 15�567,0240 150561024� J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 2� 13 0058
DECEDENT'S NAME
PAULINE B. SOUTNER
STREET ADDRESS
208 SENATE AVENUE
CITY --- --- STATE --- -- -' ZIP
CAMP HILL PA ' 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,154.66
2. CreditslPayments
A.Prior Payments
B.Discount
Total Credits(A+g) �2� 0.00
3. Interest
4, If Line 2 is greater than Line 1 +Line 3,enter the difference,This is the OVERPAYMENT. (3}
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} 1,154.66
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: ...................................................................... ❑ X❑
b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ �X
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? ....................................................................................... ❑ OX
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?.................................................................................................. ❑ 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 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 i:
3 percent[72 P.S.§9116(a)(1.1 j(i)J.
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 decedenYs 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 decedenYs siblings is 12 percent[72 P.S.§9116(a)(�&.3)].A sibling is defined, undei
Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1508 EX+(6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS� a MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PAULINE B. SOUTNER 21 13 0058
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointty•owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CHECKING ACCOUNTS AT M &T BANK 14,173.44
2. SALE OF FORD FOCUS 3,200.00
3. RETURN OF SECURITY DEPOSIT 212.00
4. ACCOUNTAT 17,163.20
TOTAL(Also enter on line 5,Recapitulation) $ 34 748.64
(If more space is needed,insert additional sheets of the same size)
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PAULINE B. SOUTNER 21 13 0058
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1. WIEDEMAN FUNERAL HOME 4,609.77
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) �NAIVED
Street Address
City State ZIP
Year(s)Commission Paid:
2, ,4ttomeyFees: CHARLES E. PETRIE 1,500.00
3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.)
ClaimaM
SVeet Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: 198.50
5 Accountant Fees:
6. Tax Retum Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 6 308.27
If more space is needed,use additional sheets of paper of the same size.
..
REV-1512 EX+(�2_OS)
pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES, & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PAULINE B. SOUTNER 21 13 0058
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. CUMBERLAND CROSSING 331.53
2. BOSCOVS 421.65
3. WEST SHORE EMS 173.10
4. SEARS 235.00
5. COMENITY-BLAIR 84.34
6. TE CONNECTIVITY 726.74
7. EAST PENNSBORO AMBULANCE SERVICE 809.00
TOTAL(Also enter on Line 10,Recapitulation) $ 2 7g1.36
If more space is needed,insert additional sheets of the same size,
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
PAULINE B. SOUTNER 21 13 0058
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 [Include outr'g ht spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. SUSAN B. GOODHART Lineal 8,553.01
4105 N. GARLAND STREET
ALEXANDRIA, VA 22304
2. JOHN P. SOUTNER, JR. Lineal 8,553.00
283 OLD STONEHOUSE RD S
MECHANICSBURG, PA 17055
3. STEVEN M. SOUTNER Lineal 8,553.00
960 22ND AVENUE N
NAPLES, FL 34103
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 DISTRIBU710NS 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. ' ' �