HomeMy WebLinkAbout07-16-13 � �so56zo1�a
�EV-�sao EX �o,.,e,
PA DBpartment of Revenue OFFICIAL USE ONLV
6uroau of Individual Taxes INHERITANCE TAX RETURN �nry code Year Fi�e N�nter
Po eox 2aosoi 2 1 1 3 � 5 2 7
Harr�aaurfl.Pn 17tza060t RESIDENT DECEDENT
ENTER DECEDENT INFORMATIQN BELOW
Social Security tJUm6er Qate of Ckeath PM.iDDYYYY date of BiRh MR.iD6YVYY
D 4 2 9 2 0 1 3 0 S 1 5 1 9 4 2
DecetlenYs Last Name SuHlx DecedenPS First Name MI
N I C H 0 L S S H I R L E Y A
(It Appiicablei Enter Sarviving Spousa'a iniortnartlon Below
5pousa's Last Name Su�x Spouse's First Name MI .
N 0 N E
5pouae's Social Secwity Number �
THIS RETURN MUST 8E Fl�Ed IN 6UPLIGATE WITH THE
REGISTER QF WILLS
Flll IM APPROPt2IA7'E OVALS BELQW
� 1.Original Return � 2.Supplemental RaWrn � 3.Remainder Return{dete of death
pnorto 12-13-8�
� 4.Limited Estate � 4a.Futuee Intorest Canpromias{date of � 5.Fadersi Eatete Tax Retum Required
deafh aftor 12-12-82)
� 6.Decedent Died Testete � 7.Dscedent Meintained a Living 7rust � 8.Tota4 Number of$ate Daposit Baaces
(Attech Capy oi Will} (Atlach Copy of Trust) �
� 9.Litigation Proceeds Raceived � 10.Spousal Poverty Credft(date of death � t t.Election to tax under Sec.9113{R) -
betwean 12-31-91 and t•1-95} tAttach Seh,O) �.
CQRRESPONDENT-THlS SECTI4N MU$T BE COMPLETED.Ai.l CORRESPONDEMCE AND COXPIDENTIAL TA7C INFORMATpN SNOUCD BE DIRECTED T4:
� Nama �aytime Telephona Nwpber :
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E L I Z A 8 E T H H . F E A T H E R 7 �76 2 3� � �6 1
C'�TF�OF WIlt9 U9RrOp �
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r a m o-� � -�
First lina of addre9s � cn � � �
C A L D W E L L & K E A R N 3 I � o ° � .r �
3econd line of addresa `•� C �'—' "'"" n �
. � N r- m
3 6 3 1 N F R b N T S T y,.�°, � cn � �
City ar Post Qffice State ZIP Cpde �_.�._ bAT�fI�.ED
H A R R I 3 B U R 6 P A 1 ? b 1 [l
correspo�aenrs e-maii aaa.ess: efeather�d2ckieaai.net
Untler penaitieG of p9fjury,!QBGare that 1 havs exartfirred Gue reWm.inGUdi�ecGOmperrying eChedt�aMf 8stemants.a�W the best of my knowiedge 8tM beiiaf, -
it is true,corract entl compiete.Declere6on of preparor other than t1�M perwnal repreeentative Is ba9ed on all Intormation af vfikh preparOr has any kno�NNedge.
SIGNAT RE 4F PERSQN RESPDNS161.E FOR FftING RETURN DA E
!Y`�a+.a C ►'1�-� �.�cE � i a/�.3,
�RESS
1218 �EORGIA AVENUE ROANOKE RAPIDS NC 2787�
SIf3NATtlRE_ Op P$EP�£R O�HER THAN REPRESENTATNE ��1��1� '..
11� �d se�.,
AD4R S
3631 N FRONT ST HARRISBURG PA 17110
PLEASE US£ORIGINAL FORM ONIY -.
Side 1
� 150561014� 150561014U �
__
� 1505610240
REV-1500 EX
DecedenYS Soclal Security Number
oecauenesName: $HIRLEY A • NICHOL$
RECAPITULATION
1. Real Estate(Schedula A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 1 3 0 3 0 � , 0 0
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. •
3. Closely Held Corporetion,Partnerahip or Sole•Proprietorship(Sahadule C) . . . . . 3. .
4. Mortgages and Notes Recaivable(Sehedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . �
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 1 5 9 � 3 8 . 9 6
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requastad . . . . . . . 6. . .
7. Inter-Vivos Transfers 8 Miscellaneous N -Probate Property
(Schedule G) � Separete Billing Requested . . . . . . . 7. � , 0 �
8. Total Gross Asaeb(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 2 8 9 3 3 8 . 9 6 ��
9. Funeral Expensea and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 2 3 9 7 5 . 0 2
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) . . . . . . . . . . . . . 10. $ � � . 1 9 �'
11. Total Deductions(total lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 4 5 4 5 . 2 1 �
12. Net Value oi Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 2 6 4 7 9 3 . 7 5 '�
13. Charitable and Governmental Bequests/Sec 9113 Trusts tor which
an election to tax has not baen made(SChedule J) . . . . . . . . . . . . . . . . . . . . . . 13. , ��
14. Net Valus 3ubJsct to Tax(Line 12 minus Line 73) . . . . . . . . . . . . . . . . . . . . . . 14. 2 6 4 7 9 3 . 7 $ �
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount ot Line 14 taxabla
at the spousal tax reta,or
trensfers undar Sec.9116
(a)(1.2)X.0 _ � . � � 15. � . � �
16. Amount of Line 14 taxable
at�inea�rate x .oas 2 6 4 7 9 3 . 7 5 �s. 1 1 9 1 5 . 7 2
17. Amount oi Line 14 taxable �
at sibling rate X.12 � . 0 0 17. Q . 0 0 ��
18. Amount of Lina 14 taxable
accona�ereireca x.�e 0 . 0 0 �8. 0 . 0 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1 1 9 1 5 . 7 2 ....�..
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � ��
Side 2
� 1505610240 1505610240 J
REV-1560 EX Page 3 flN Number
Decedent's Camplete Address: 2� 13 052�
DECEDENT'S NAME
SHIR�EY A. NICNdIS __ _
STREETqDDRESS
A23 HILLSIDE ROAD _
CITY ��.'.i-- - ' � � STATE � �� ZIP
NEW GUMBERLAN� PA 17474
Tax Payments and Credits:
�. Tax Due(Page 2,Line 19) (1) 11,9t8i.72
2. CreditstPaymenis
A.Prior Payments
B.Discount 59579
To�al Credits(A+g) {21 595179
3. interest
�3� '
4. If Line 2 is greater ihan Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. �—
FIII in ova!on Page 2,Une 20 ro requeat s retund, (4} p�Qp
5. !f Line t�Line 31s greater than line 2,enterihe diBerence.This is the TAX DUE. (5) 11,319�93
Make check payable to: REGISTER OF WILLS, AGENT
j
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS '
i. Did decedent make a transfer and: Yes No
a. retain the use or income of the propedy fransfened� ......................................................................
b, retain the nght to designate who shall use the propedy transferred or its income; .......................
o. retain a reversionary interest;or ............................................................................................__ ..
d. recaive the promise for 1(fe of either payments,treneftts or care?
....................................................
2, If deaih occurred afier December 12,iS92,did decedent transfer propeAy wiihin one year of death
without receiving adequate consideradon? ....................................................................................... ❑ � '
3. Did decedent awn an'in trust fflr'or payzbie-upbn-death bank acmunt a seourity at his or her death? .._..... ❑
4. Did decedent own an individuai retiremeni accouni,annoity or other non•probate property,which
contains a beneficiary designation?.................................................................................................. ❑ �
IF THE ANSWER TO ANY 4F THE ABOVE QUESTIONS IS YES,YOU MUST GOMPLETE SCHEOtl�E{3 AND FIIE I7 AS PART OF T}IE RETURH.i
'f
For dates of death on or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of hansfers ta or for the use af the surviving sp�use is
s percent(72 P.s.§s11s{a}(1.1){I}�.
For dates of death on or after Jan. 1, 1995,the tax rate imposed qn the net value of transfers to or for the use of khe surviving spouse is Q percent '
' [72 P.S.§9116(a)(1.1)(ii)J.The statute does not exempt a transfer to a surviviog spouse from tax,and the statutory requireme�ts for disdosure of assetsj and
filing a tar return are stiii applicaMe even if the survi»ng spatse is the oniy bene6asry.
For dates af death on or aRer July 1, 2000,
• The tax rate impased on the net value of Vansfers from a deceasad child 21 years of age or younger at death to or for the use of a natural parent,an '
adopNve paren;or a steppatent of the child is 4 percent[72 P.S.§9116{a}{12}j.
. The tax rate imposed on the net value of transters to or for the use of the decedenFS Iineai beneficiaries is d,5 percent,except as nqted in
72 P.S.§9116(1.2)(72 P.S. §9116(a)(1)j.
• The tax rate imposed an the net value of transfers to or for fhe use of#he decedenYS sibiings is 12 percent[72 P.S.§9118{a}{t.3}�.A si6ling is deflned,�tnder
Section 9102,as an individuai who has at ieast one parent in cammon with khe decedent,whether by biood or adoptlon,
REV-7542 EX+tt&t2}
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCETAXRE7URN REAL ESTATE
RESIDENT pECEDENT
ESTATE OF: FlLE NUF�ER:
SHIRLEY A. NICNOLS 21 13 0527
All�eal property owned solely ar as a tenent in common must be reported al hir markat velue.Fair market value is defined as the pnce at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled io buy or sell,6oth having reasonable knrnvledge ot the relevant facfs.
Nea!property tleat h joi�Fy�ovmad wfth rlgM at survhraship must�dhclosed an Schiduie P.
Attach a copy oi the settlement sheet If the propedy has been sold.
ITEM Include a copy of the deed showing decedenPs interest if ownad as tenant in common. VALUE A?OATE
NUMBER 4F DEATH
DESCRIPTIQN
1. Real Estate known as 423 Hillside Road, New Cumberland, Cumberland County, 130,300j.Op
Pennsylvania, with tax parcei number na. 25-25-0008-015
The value was determined using the tax assessed value of�134,300 x the common Ievel
ratio factor of 1.00= $130,300.
i
TOTAL(Also enter on une 1,Recapitulation.) S 13q 300.p0
If mae spece is rreedad.use edditianal aheeb of psper of t#re sama s¢e.
REV-�soa Ex+tos-�z]
pennsylvania SCNEDULE E
�EPARTMENTOFREVENtJE �ASH, BANK DEPt}SITS 8�MISC.
RESIDENTbECE ENTTURN pERSONAL PROPER'i'Y
ESTATE OF: FIIE NUMBER:
SHIRLEY A. NiCN0�3 21 13 052?
include the proceeds of litigation snd the date the proceeds were rcCeived by the eatate.
All propsrty jolntly pwnsd wlth right oi survivorohip must be dlaclosed on$chsdule F.
ITEM VAIUE AT 6ATE
NUMBER OESCRIPTION OF DEATH
1, Sovereign Bank cheoking account#0771102224 100100
2. Savereign 8ank savings account#2334020951 177',.00
3. Savereign Bank certificate of deposit account#0775149057 10,196',79
4. Sovereign Bank ceRiflcate of depasit accoun##4775280811 10,fi78i66
5. Sovereign Bank certifica#e af deposit accaunt#0775331785 10,679i2fi
fi. Soverefgn Bank certificate af deposit account#07755t5562 10,004iO4
7. Sovereign Bank certiflcate of depoist account#p775543457 10,335152
8. 5overeign Bank certificate of deposit ancount# 0775545734 1p,171 i80
9. Savereign Bank certificate of deposit accqunt# p775545742 10,012.188
10. Sovereign Sank certificate of deposit account#7672288583 1 p,276!,18
11. Savereign Bank cert�cate of depoist account# 1055540536 10,OOd.�00
12. PNC checking account#51A0220112 2,51g.�ig
13. PNG savings account#5401116163 62,222.E17
14. 1999 Oldsmobile motor vehiole in fair conditian-spld ta third party 1,004.b0
15. Hausehold goods and furnishings 25p.pD
16. Capital BlueCross reimbursement 169.�0
TO7AL(Also enter on Line 5,Recapitulatbn) S 159 038. 6
I#mora space is needed,use sdditWnat sheets ot paper of the same size.
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_ .
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SHIRLEY A. NICHOLS 21 13 0527
DecadenP�dabh mu�t be repoAed on Sehedule[.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNER4LEXPENSES:
1. Musselman Funeral Home 8,40�,.00
2. musician at funeral SO100
B. ADMINISTR4TIVE COSTS:
1. Personal Representative Commissions �
Name(s)otPeraonalRepmsentative(s) MafkNICh015 3,OOOI.00
screeinddress 1218 Geors7ia Avenue
c�y Roanoke Rapids s�ace NC ZiP 27870
veaqs)Commissbn Paid: 2013
2, anomey Fees: Caldwell & Keams 2,5001,00
3. Family Ezemption:pf decedenYs addrese is not the same as daknanCs,attach ezplanatbn.) .
Claiment
Street Addmss
City 5tate ZIP
Relationship of Clalmant to Decedent
4 aronace Fees Cumberland County Register of Wills 38a.00
5 Accountant Fees �
6. Tex ReNm Preparer Fees: �
z New Cumberland Borough-sewer and trash until house sold 15Ti.04
8. utilities for house 88 .58
9. Nationwide-homeowners and auto insurace 25�.52
10. real estate taxes 1,121'I.20
11. Executor's costs-stamps, fax service 2q'.00
12. Executor's hotel expenses 30a.00
13. U-Haul rental to remove items from house 19�.42
14. repairs to house for sale 6,38 .48
15. legal advertising-Cumberland Law Journal and Sentinei 28 .78
16. SovereignlSantander fee for date of death balances 2d.00
TOTAL(Also enter on Une 9,Recapitulation) S 23 97a�.02
If more space is needed,use eddidonal sheeta of paper of Me same size.
__
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
�EPARTMENTOFREVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES� LIENS
RESIDENT DECEDEN7
ESTATE OF FILE NUMBER
SHIRLEY A. NICHOLS 21 13 0527
Report debb incurred by the decedent prlorto death thet remalned unpald at the date of death,ineluding unrolmbuned medleal expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. QVC 296.60
2. Kohls 2��.59
TOTAL(Also enter on line 10,Recapitulation) 5 570.19
If more apace is needed,inseA addkional sheets of the same size.
. . . . ...._. ..__
REV-1513 EX�(01-10)
pennsyivania SCHEDULE J
OEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TA%RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
SHIRLEY A. NICHOLS 21 13 0527
RELATIONSHIP TO DECEDENT AMOUNT OR SHAR
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not llst 7ruatee(e) OF ESTATE
� TAXABLE DISTRIBUTIONS (Include outr'g ht spousal distributians and ironstera under
Sec.9116(a)(11).�
1. Mark Nichols Lineal 31 f real esFa}c ard
1218 Georgia Avenue S o�f resi due..
Roanoke Rapids, NC 27870 J{ r�� Qt,�.k a,,,d
2. Stephen Nichols Lineal i �f �S;d�.e
322 Braddock Drive 5
Etters, PA 17319
3. NicoleLathrop Lineal 3of Yta�es��-ahd
236 Green Lane Drive 5 0� resiAue
Camp Hill, PA 17011
4. Michele Jumper Lineal S o� res�ua
121 E. Water Street
Middletown, PA 17057 1 af res�due
5. Kathy Worthing Lineal S
17 Kramm Avenue
Hahndorf, SA 5245, Australia
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV•1500 COVER SHEET,AS APPROPRIATE. '
II. NON-TAXABLE DISTRIBUTIONS
A.SPOUSAI DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAI DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 Of REV-1500 COVER SHEET, S
If more space is needed,use additional sheets oi paper of the same size.