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Home My WebLink About05-30-13 _ _— — - .,,T„ . � 1505610140 REV-1500 EX �°,_,°> PA Department of Revenue OFFICIAL USE ONLY Bureau of fndividual Taxes County Code Year Fi1e Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 2 5 8 Harrisbur9, PA 17128-0601 RESIDENT DECEDENT ENTER QECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 0 1 2 7 2 0 1 3 0 5 2 9 1 9 1 7 Decedent's Last Name Su�x Decedent's First Name MI F U R R Y L E O N A E (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Mf Spouse's Social Security Number THIS RETURN MUST SE 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 T0: Name Daytime Telephone Number R OB I N H OL MA N L OY 7 1 7 5 $ 2 2 �4: 1 0 _c —.____ �.�; _� i i � REGISTERt+I�I�l'L,1 LS USE 01�4,.Y ��i i.-;y r.yy ,�� _ �'�y ;:'y -;� �_ 4'.�r _' �� =:_ ''.�ta First line of address ' c_,.; � 1 6 E MA I N S T � ` N, � � . .. ° • C„� ,�7 Second line of address � l PO BOX 97 i.� � if ;: , ° r � City or Post Office State ZIP Code �I DATE kILED �,,I � ,��., -r� N E W B L O O M F I E L D P A 1 7 0 6 8 Correspondent's e-mail address: Under penalties of perjury,I declare that{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 ot which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RET RN DATE ,�°o-�va-�,,,�.C�' �.�e�.�- �— G �____s�,, 5/29/2013 ADDRESS PO BO 65 GRANTHAM PA 17027 SIG O P RER OT REPRESENTATIVE DATE 5/29/2013 A DRESS PO BOX 97 NEW BLOOMFIELD PA 17068 PLEASE USE ORIGINA�FORM ONLY Side 1 � 1505610140 1505610140 � J 1505610240 REV-1500 EX DecedenYs Social Security Number oecede�esName: LEONA E. FURRY 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 Misceltaneous Personal Property(Schedule E). . . . . . . 5. � � 8 1 9 . 7 � 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . .. 6. • 7. Inter-Vivos Transfers&Miscellaneous N�-Probate Property (Schedule G) � Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. � � $ 1 9 � 7 � 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 3 � 0 . � 0 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. • 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3 � � . � � 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. � 1 5 0 9 . 7 � 13. Charitable and Governmental BequestslSec 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 5 0 g . 7 � TAX CALCULATION-SEE{NSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.0 _ � . � � 15. � . 0 � 16. Amount of Line 14 taxable at�inea�rate X.045 1 1 5 0 9 . 7 0 16. 5 1 7 . 9 4 17. Amount of Line 14 taxable at sibling rate X.12 � . � � 17. � . � Q 18. Amount of Line 14 taxable at collateral rate X.15 � • � 0 18. 0 . � � 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. �J � 7 . 9 4 20. FILI.IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 L 1505610240 1505610240 J —. . . _ _ -. _ _ ._ ._ . - - -- �-- -. .. _ .. . . .�,w*+. . REV-1500 EX Pafle 3 File Number Decedent's Comptete Address: 2� �3 0258 DECEDENTS NAME LEONA E._FURRY__ _ __ _ _ __ ___ _ _. ._ __ STREET ADDRESS _ _ _ _ _ _ _ _ _ _ _ _ ---- -- — _ __ — - - _ __ . _ — - --— ----—._ —- CITY STATE I ZIP Tax Payments and Credits: �� Tax Due(Page 2,Line 19) (1) 517.94 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. Fiil 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) ��7,g4 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY RLACING 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: ...................................................................... ❑ XQ b. retain the right to designate who shal{use the property transferred or its income; ............................... ❑ OX c. retain a reversionary interest;or ................................................................................................ ❑ 0 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ OX 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ XQ 3. Did decedent own an"in trust for"or payable-upon�ieath 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?.................................................................................................. ❑ 0 IF THE ANSWER TO ANY OF THE ABQVE 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 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 fo�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 decedenPs 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)(1.3)].A sibling is defined,under Section 9102,as an individuai who has at least one parent in common with the decedent,whether by blood or adoption. _ . _ ._. .. _ . _ - - - _ _ _ _. _ _ - - -� - - Rw*+. ... REV-1508 EX+(ti1_}p) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & M1SC. INHERITANCE TAX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: LEONA E. FURRY 21 13 0258 Indude ihe proceeds of litiga6on and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATM 1. Members 1 st Federal Credit Union -Checking Account-Typographical error- incorrectly -100.00 stated (original return -$2,913.07; correct amount$2,8313.07) Statement attached 2. Genworth Life Annuity Co. - Refund of inedical insurance premium 2,119.70 3. Williamsburg Community Burial Fund - Refund 800.00 4. Invesco- Distribution sent on 1/26/13 and not received by Members 1st until after the 9,000.00 date of death TOTAL(Also enter on Line 5,Recapitulation) $ 11 819.70 If more space is needed,insert additional sheets of paper of the same size . _ REV-1511 EX+(t0-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER LEONA E. FURRY 21 13 0258 DecedenYs debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. attomey Fees: Holman & Holman 310.00 3. Famity Exemption:(If decedenYs address is not the same as claimanYs,attach explana6on.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4� ProbateFees: 5 Acxountant Fees: 6. Tax Retum Preparer Fees: 7. TOTAL(Also enter on Line 9,Recapitulation) $ 310.00 If more space is needed,use additionai sheeGs of paper 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: LEONA E. FURRY 21 13 0258 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 (InGude outright spousal distnbutions and transfers under Sec.9116(a)(12).] 1. Romayne E. Reeser Lineal PO Box 65 20% Grantham, PA 17055 2. Mary Jane Holman Lineai 1508 South Market Street 200�0 Mechanicsburg, PA 17055 3. Martha Jean Sproat Lineal 905 Derbyshire Avenue 200�0 Mechanicsburg, PA 17055 4. Sharon W. White Lineal 8000 West Crestline Avenue, Apt#1138 200�0 Littleton, CO 80123 5. Lewis C. Furry, Jr. Lineal 110 Watson Lane 20°!0 New Bloomfield, PA 17068 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. _ _ _ _ - ..,,,�. � �� MEMBERS 15t FEDERALCREDIT i3NION REGULAR SAVWGS ACCOUNT: Account Number/Suffix 250943-00 D-ate Account Established 09/13/2004 Principai Balance at Date of Death $309.68 Accrued lnterest to Date of Death $0.04 Total Priricipal and Accrued Interest $309.72 Name of Joint Owner None CHECKING ACCOIfNT: Account Number/Suffix 250943-11 , D-ate Account Established 09/13/2004 � Principal Balance at Date of D�ath $2,812.97 P.�cr;aed lnterest to Date cf Death $0.10 Total Principal and Accrued Interest $2,813.07 Name of Joint Owner None INVESTMENT SAVWGS ACCOUNT: Account Number/Suffix 250943-05 D-ate Account Established 01/20/2006 Principal Balance at Date of Death $8,270.25 Accrued Interest to Date of Death $1.18 Total Principal and Accrued Interest $8,271.43 Name of Joint Owner None MEMBERS 1ST FEDERAL CREDIT UNION � �� Tessa L Klugh Lending insurance Support Specialist March 15, 2013 Estate of: LEONA E FURRY Date of Death: 01/27/2013 Social Security Number; 5000 Louise Drive • P.O. I3ox 40 * Mechanicsburg,Pennsylvarua 17055 • (800) 283-2328 • w�nvmemberslstorg __