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Home My WebLink About06-27-13 r , 1505610105 REV-1500°"03-")(Fr) PA Department of Revenue Pennsylvania e OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number _ PO BOX 28o6o1 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06/07/2012 01/0611945 Decedent's Last Name Suffix Decedent's First Name MI Shirk Cheryl J (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Shirk Dennis L Spouse's Social Security Number I A THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C/-U& 311'1501 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Cli 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a,Future Interest Compromise(date of O S. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death (=D 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Jennifer C Shirk (717)395-0694 _ C�l x w m R SRER OF WILLS USE 6WO: First Line of Address y r— rV M rr1 905 Old SilverSpring Rd n CD 6 • T Second Line of Address C r C7 - � w r 1.1 City or Post Once _ _ State 21P Code DATE FILED r q Mechanicsburg PA 17055 Correspondent's e-mail address:jenshirk@aol.COm Under penalties of perjury,1 dedare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is We,conect and complete.Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNATURE OF PE ESPONS LE FOR I ETURN DAT�O ADDRESS K// I I 17oS� SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE f PATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 t , 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: Cheryl J Shirk _ RECAPITULATION 1. Real Estate(Schedule A). .. ....... ................... ................ 1. 0.00 2. Stocks and Bonds(Schedule B) ................... ........ ........... . 2. 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00 4. Mortgages and Notes Receivable(Schedule D)............ ............... 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 0.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . ...... 6. 0.00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property - -� (Schedule G) O Separate Billing Requested........ 7. t 12,246.77 8. Total Gross Assets(total Lines 1 through 7).......... . ............... ... 8. 12,246.77 9. Funeral Expenses and Administrative Costs Schedule H P ( )................ ... 9. 1,929.27 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 0.00 11. Total Deductions(total Lines 9 and 10)........................... ...... 11. 1,929.27 12. Net Value of Estate(Line 8 minus Line 11) .............. ................ 12. 10,317.50 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to lax has not been made(Schedule J) .. ...................... 13. L 0.00 i 14. Net Value Subject to Tax(Line 12 minus Line 13) .................... .... 14. t 10,317.50 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_ 15. 16. Amount of Line 14 taxable at lineal rate X.0 45 16. 464.29 i 17. Amount of Line 14 taxable r at sibling rate X.12 17. 18. Amount of Line 14 taxable r at collateral rate X.15 I 18.1 19. TAX DUE .............. .......... ....................... .......... 19. 464.29 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV-1500 EX(Fl) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Cheryl J Shirk STREETADDRESS 110 Woodland Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (i} 464.29 1 Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 3, Interest (3) 151-00 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) 5. If Line 14 Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. 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,..—...................-............................................................— ❑ 0 It. retain the right to designate who shall use the property transferred or its income......._................................... ❑ 0 c. retain a reversionary interest..........--........................---..............,..................---......---........................... ❑ 0 d. receive the promise for life of either payments,benefits or care?................................................--.................. ❑ N 2. If death attuned after Dec. 12, 1902,did decedent transfer property within one year of death without receiving adequate consideration?........................--.................._..........................—.......---........__...... ❑ 0 3. Did decedent am an'in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ E 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ............................................................................--.........--.......,, N ❑ ................ 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)(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 9 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(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 BS.§9116(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. L V X+ (08-09) pennsylvania SCHEDULE G DEPARTM ENT OFREVENUE INTER-VIVOS TRANSFERS AND RESIDENT MISC. NON-PROBATE PROPERTY RE910ENr D CEDEM ESTATE OF Cheryl J Shirk FILE NUMBER p 2112- (778 This schedule must be completed and riled if the answer to any of questions 1 through 4 on page three of the REV-IS00 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER mDLDE TXE i"NE OFT1E TRw'�•TAR p TJDTanp To DED a,•r,wo DATE OF DEATH % DECD'S EXCLUSION TAXABLE 11E 1%OF TUUMR-ATTACH A Oa OF OM)FOR R,,6rAM VALUE OF ASSET INTEREST ❑ARU VALUE 1• Sun Life Financial Straight annuity bequeathed to Cheryl J Shirk's daughter, tp 246 77 U -' Jennifer C.Shirk. 0.00 12 P4B 77J1 1 i I i i ) TOTAL(Also enter on Line 7, Recapitulation) $ 12,246.77 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+ (10.09) 7pennsylvania SCHEDULE H INHERITANCE TA REVENUE FUNERAL EXPENSES AND iESIDEN DE DECEDENT ADMINISTRATIVE ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER REM Decedent's debts must be reported on Schedule 1, NUMBER A. FUNERAL EXPENSES: DESCRIPTION 1. AMOUNT Flowers;Royers/Stephensons Clothing;Wart 360.39 Flowers;Ashcomb 105.92 Headstone Touchstone Memorials Mifflinburg PA 85.96 1,377.00 0.00 0.00 B• ADMINISTRATIVE COSTS: 0.00 1• Personal Representative Commissions: Name(s)of Personal Representatives) 0.00 Street Address City State_ZIP Year(s)Commission Paid: Z• Attorney Fees: - 0.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant 0.00 Street Address City State_ZIP Relationship of Claimant to Decedent 4. Probate Fees: S. Accountant Fees: 0.00 6. 0.00 Taz Return Preparer Fees: 7. 0.00 TOTAL(Also enter on Line 9, Recapitulation) g 1,929.27 If more space is needed,use additional sheets of paper of the same size. -