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Home My WebLink About07-11-13 _ -- -_ �A� _ � � 150561�143 REV-1500 �`�02-1' ''�3' OFFICIAL USE ONLY PA Department of Revenue pennsylvania co�r,ry code rear File Number Bureau of Individual Taxes °��TM�*�� ' Po sox.2soso� INHERITANCE TAX RETURN 21 12 01104 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 26 2012 02 12 1954 ; DecedenYs Last Name Su�x Decedent's First Name M�;� �T� WALTER JI i (If Applicable)Enter Surviving Spouse's Infortnation Below , i Spouse's Last Name Suffix Spouse's First Name IV�� ' ; �; Spouse's Social Security Number 'i THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTEF'c OF 'J�iiiLLS FILL IN APPROPRIATE OVALS BELOW � � 1. Original Retum � 2. Supplemental Retum � 3. Remainder Retum(Date of Death i Priorto 12-13-82) ! � 4. Limited Estate � 4a. Future interest Compromise 5. Federel Estate Tax Retum R uired 'i (date of death efter 12-12-82) ❑ � ' I � g Decedent Died Testate � pecede0t Maint med a Living Trust B. Total Number of Safe De OSit BOX@S � (Attach Copy of Will) ❑ (Attech Gopy of'efrust) O P � 9. Litigation Proceeds Received � 10.b��lwe n12 31�J1 ^8 d't�(Da�s�f osath � ��.Election to tau under Sec.9113(A) 'I (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTE Tb: Name Daytime Telephone_Number MARK A MATE YA 7�' 2 41 �0 Q_� ;�;� w c.� +;� �--, '�, �_ � �.� _,., :- .; 17E�1&-`tE�(bOF 1fYILlS 133,�?C1�VLY I a7 >�. r �..� - ' " C'-° `;,.,. �� .�1 �;p First Line of Address > �r �.. • � - .. :;., .C� �� 55 W CHURCH AVENUE �-° �-: :-- '� � _ �3 �� Second Line of Address -� ," .. � C.:_J ' �-��^� - ....: y.� � , ._;� C.'-� :�� City or Post Office � DATE-�fLED State ZIP Code CARLISLE PA 17013 ; Correspondent's e-mail address: mam�mat@YalaW.com � Under penalties of peryury,I declare that I have examined this retum,including acCOmpanying schedules and statements,and to the best of my knowledge and belief it is true,correet and complete.Deciaration oF preparer other than the personal representative is based on all infortnation of which preparer has any knowledge. SIGNATURF„QF,PERSON RESPONSIBLE FOR FI NG RETURN DATE P'C �� Delbert Smith 7— ��O/?j ADDRESS i { 2544 Kin ston Drive Florence SC 29505 SIGNATURE O PREPA R THE THAN REPRESENTATIVE DATE � _ Mark A. Mateya ADDRESS 55 W.Church Avenue,Carlisle, PA � Side 1 ' i L„� 15D561D143 1505610143 J � ^� � _�.i_ _ __ _ _ _ _ . _ _ _ __ _ _- *�� 15�5610243 REV-1500 EX DecedenYs Social Security Number Dacedent�SNemB: Srfllth,WalterJ RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. i ��i 2. Stocks and Bonds(Schedule B)............................................................................. 2. ; � 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. ; 4. Mortgages 8�Notes Receivable(Schedule D)........................................................ 4. ; 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 13,83� . 02 � � 6. Jointly Owned Property(Schedule F) ❑ Separate Biiling Requested............ 6. � 7. Inter-Vivos Transfers&Miscellaneous I�q Probate Property ; (Schedule G) �J Separate Billing Requested............ 7. ' 8. Total Gross Assets(total Lines 1 through 7)........................................................ g. 13,83� . 02 ' � 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. i 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. ' i 11. Total Deductions(total Lines 9 and 10)................................................................ 11. i 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 13� 830 . 02 ' ' 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ! an election to tax has not been made(Schedule J)............................................... 13. ' j ' i 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... �q. 13 ,830. �2 � ' � TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES ' 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 j (a)(1.2)X.00 15. 0 . 0� ' � 16. Amount of Line 14 taxable ' i at lineal rate X .045 0 . 0 0 16. 0 . 0 Q i 17. Amount of Line 14 taxable I at sibling rafe X �2 13�830 . 02 �7. 1� 659. 60 18. Amount of Line 14 taxable at collateral rate X 15 0 . �0 18. 0 . 0� ' 19. TAXDUE.............. ................................................................................................. 19. 1� 659. 60 � i I 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � I � � �� I i j I Side 2 � � J i 150561D243 15D5610243 ; _ __ _ - � , . _ _ _ _ _ �p� REV-1500 EX Page 3 File Number 21-12-01104 Decedent's Complete Address: DECEDENT'S NAME Smith,Walter J STREET ADDRESS 422 Walnut Street �i CITY STATE ZIP Boiling Springs PA 17007 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,659.�p i-- 2. Credits/Payments � A. Prior Payments B. Discount Total Credits(A +B) (2) 3. Interest �3� 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4j ; Check box on Page 2,Line 20 to request a refund --r;— 5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) ��659.s ' � Make Check Pa able 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:............................................................................... � � b. retain the right to designate who shall use the property transferred or its income:.................................. � a ! c. retain a reversionary interest;or...... ........................................................................................................ x d. receive the promise for life of either payments,benefits or care?........................................................... � � 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑ ❑ receiving adequate consideration?.................................................................................................................... x 3. Did decedent own an"in trust fo�' or payable upon death bank account or security at his or her death?....... ❑ ❑x ' i 4. Did decedent own an individual retirement account,annuiry,or other non-probate property which r� �: contains a beneficiary designation?.................................................................................................................. u � ' IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETU 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 survivin I spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. , � For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percentl [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,�}� 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(a)(1)l• . 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 individual who has at least one parent in common with the decedent,whether by blood or adoption. - - - �i .� �� _ _ � Rev-7508EX+(ti�-�D) . SCHEDULE E pennsylvania CASH, BANK DEPOSITS, � MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESI�ENT DECE�ENT ESTATE OF FILE NUMBER Smith,Walter J 21-12-01104 , InGude the proceeds of litipation and the date the praceeds were received by the estete. I All property jointlyownad with the Aght of survivorahip must be disclosed on achedule F. �i i ITEM VALUE AT DA NUMBER DESCRIPTION OF DEATH'', 1 M&T Bank-CD#31003911177383 13,83�U2 i i � i i i i i f , i i i i �� i � TOTAL(Also enter on Line 5, Recapitulation) 13,830.0� (If more space is needed,additional pages of the same size) Copyright(c)2010 form software onfy The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-1�� ' �i i-