HomeMy WebLinkAbout07-18-13 (4) J 15�56101�5
Rev-1�ooIX��_�,>���,
aFFiva.os�o�nr
PA Deparkmenk of Revenue PM^sYb�aMa �y� Ysu Fiie Nwnher
9ureauaFLadlWdualTaxes °""""°°°'"�"""`
ao Box z8o5oi INHERITANCE TAX RETElRM �' �� � �
HarrSSburg,PA 17�z8-oboi RESIDENT DECEDEMT
EN7ER 6ECEDEN7 MtFpRMA'fl6N BEIOW
Social Sacuriry Number Data ot Death MMDDYYYY Date of Birth MMCI�YYYY
... _.. . . _. ... , ._... ...... .. . .. .... ..
. . . .. . , ..._. ._... ..... ..
i I01/28/2013 06/02/1929
Decedent's laffi Name . ..... ... � '. . ..... .. Suiflx � DecedeM's First Name. .... � MI
,_... ._. ._ ._..._..._... ..____......_ ......�.._.__.._ . ....�,_.. _ ._...�.._,,,._�_,._� ._.,_.� _..__._ _. .
Harm Patncia G "
{!}Appliubis�EnterSurvtvinp�Spcuse's�informatlanBeiow __. . __. . .. ..,. . ._.. .: ,. .
Spouse s Last Name Suflix Spouse's First Nsme MI
..... ._._ . ._.. . .. . .... . .. .. . �,.. :
Spousa's Sceiat Sewrity Number .. .. ._ ..._�.. . .._.. . . ._.
—�- THIS RETURN MUST BE FILED IN DUPLICATE WRH THE
; ' REGISTER OF WlL�.S
w______ _ __�.._ �____.__ .
FILI IN APPROpRNTE OVALS BELOW
t� 1.pri9inai ReNm p 2.Supplemental Retum O 3. Remalnder ReWm t�ate of Deeth
Pr�ta 12-t3-82)
p 4.I.imited Estate p 4e.Future lnterest Compromise(date of p 5. Federul Estate Tax Retum Required
deatA aRer 12-12•82)
p 6.pecedeM Dietl Testste O 7.DeceAent MaintalneC a Living Trust � 8. Tatal Numbar of Safe Depasit Boxes
(Attach Copy of Will) (Attach Capy ot Trust.) '
O 9.I.itigetion Pror,eeds Received O 10.Spwasel Prnerty Credit(Date of DeaM O 11. Election to Tau uMer Sec.9173(A)
Between 1237-97 and 7-155) {Atterh 9rhedub O)
CORRESPPt�ENT- THIS BECTION M418T B6 COMPLETED.ALL CORRESPONbENCE AND CONflDENTUL T/J(INFOItlU1TI0N SNWLD 8E DIRECTEp T0:
Name �ytime 7etephana Number
.__. . __ . ....__.. . ....
. . __.. . _.... _.... . .� �..,_._.__.._..___.. ........_._..___. _... ._.,.
Mark T. Silliker, Esquire (717}F�7-1504 Vt „� �
_ _. _�._ , _ ____ _ .__ . _______ _ _._ _..�_.� w rn
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n oF m se w'�
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m � � '— ._, r�+
FitStlinet�Addres3 � � �'i � t � �7
__._._, . .._�...._._..�...._...._.._,____..._..... �_ __......... . ,.
_.._._... ... . .._. ,_ ._.,,
5822 Linglestown Road =� �': � � '
SecondLineofAddrese ....-. .__ .._.. ..... ..._ . . � c,� �, � '�� ...i
._... ..__.. . .._.. ....,__. . __ _ __. .. ... . : ;:� t'- � t._. - - ?'>
y :�t:! f._. �.._ ��tl .
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:�...�_ ._._,_...�_ .._.......__... ___,__..__....__,.�__.....��._ .._......� _.._.- *' 6A7EAiLG� C') 4
City or Post Otfice State ZIP Code
Harcisburg __ _ I PA 17112 . ... _ _'
CorrospanMrN's amNl addnss:
Ur�der Po��s otPwlwY.t datlare that!he�e b�umirrd mie retum,incWdU'i9 aca�nGartyln6 scheduiea eM staiemaMs.aM to the bwt of my knowbtlge aiM beibt.
R ia tlue,mnOCt antl oomplMe.DBdaralipn of preparar WMr ihen tlw pers�nal represenhWa ic dasa}pn atl Iniametbn of whkh preperer hea any knowletlqb.
SI O�AERSON RE 318LE F FU. RE=URN OA7E � /
I
Ti r Chase Drive, Mechancisburg, PA 17050 �+M r%'/c
Ti1RE OF PRE • OA
s:/r.l��' 7 �' / ?
ADORESS
j'y� ,z �; �s /.c-rc.�.. . �.t . �jc. r.. � s,. , �. , � iiz
K E US!6R7GINAL FORM N�r
Side 1
� 15056101C]5 150561U1�5 J
��J
�A
J Lsos6loens
ftEV-t54JQ EX{FI)
DecedenPs Spcial Security Number
. _.____ __.. .__. .
o,o,aa,rs rram,: Patricia G. Harm
RECAPITULATION
t. Rest Estate(SCheduie A). .............. ... .. . .. . .. ........ .. . ........ 1. i .
2. Stocks and Bonds{Schedule 9) ....................................... 2. y �
3. Cipseiy Heid Carppra60n,PertneBM1ip tK SOIe-RoprietMShiP(Sch9duie C) ..... 3. ' .
4. Mod9ages end Notes ftacgivable{Schedule D)........................... 4. j .
��_.._... ._.,,_._..._..,.._....__. . .._._.._....._.._... ,_.
6. Cash.Benk Oaposita and Miscelianeous Parsonai Property(Schedu�e E)....... 5. ; 5,509.43 -
6. Jdntly Qwned Property{Schedule F) O Separate 8i81ng Requesled ......, 6. i �
7. Inter-Vivos Transfers&Miacellaneous Non-Probete Property '---Y����-�-.-----___w . ._._....__._... ._...._ .._::
(Scheduie G} O Separate BitYng Requested..... 7. �
4,_......�..._._._�......_- .__..r....... _..,..__.....T....
B. 7olsl Gross AssNS(Wfai Lines t through 7)............................. 8. i 6,609.A3 �'
9. Furterat Eupenses and Administrative Costs{Scheduie H). ......... . ........ 9. '; 1,423.50 i
i-...__.._ _ �_ _._ . . , __ '
10. Debts of Decedent,Mortgage Lla6iliGes and Liens{Schedule 11............... t0. '. 879.28 �-.
z...__.____._......�..__w_ __ .w_..�..._ .. ._... �.._... ..,
11. Totai Deductions{totel Li�s 9 and tOj........ . ....... . ......... . ...... it. �: Z��2.76 i
�.,._,......__.-„-°___ .� , __..._ .. .--........__..._.
12. Net Value of Estate(Line 8 minus Line 77)......................_...... 12. i 3 2�6.67 ��
13. Gharitable and Govemmental Bequests/Sec 8113 TrusLS for which ""- ".�"�"°�"`."`..""'�"'�`"""`.�"`
an elecBon to tex has not been made(Schedufe d} ..... . ...... .. ... .. 13. G 500.00 '
m._.._._._......_..�.,.._..� _,,.._ ._..-.._.__._, .,
14. N�t Value Subj�et to T�{lNe 12 minus Line 13) . ......... .. ......... t4. i. 2�706.87 �
TAIS CALCULATION-SEE INSTRUCTIQN3 FOR APPUCABLE RATES �
15. Artaunt of Line 14 taxable
at the spousai tax rete,or
transtersunderSec.8N6 •_..___,... . .�..._,...._. ,,..__,...._. _. _. , ._.,..__ _ ..__....__.. _._.. .. .
(ax12)X.0_, � 75. �'`. .
16. Amount of Line 1A ta�cable �.__..._..... .. . .. .... _ ._ .__..._. .�. ...,; ......._..._.r.__..�...._....... .... ..._,.w._.__,
at iineai rate X.0 4� 2 706.67 i �6. �,�..�..� 121.80 '�..
'IT. Amowit of Line 19 tazaWe �.-.."�.__ ....._..__,-_.. _�__,_.._ . �� ��._... _._ _._.n..._. . ._ ..�
a�sibling rata X.12 � 17.i .
�--...._....,. _. _._..___ ..._.....w.___ ..__..; ,..._...__.,_ . ..,_,..._ ._......_.._.._._ .. .__....__..:
1&. Amnunt af Llne 94 tgxable , .
at caiiaterat rate X.15 �� 18. ;
.._..._ , .. .. .,.__ . . .._ .. .. .. W.._,..... ..........-a.._..._ ... .,_....,._. . ..._._.._.__,......._ .
19. T/UC DUE .. _._... ....... ............ 13.i 1$'1.8Q s.
20. FtLt IN"fHE OVAL IF YOU ARE REGUE3TING A REFUND OF AN OVERPAYMENT O
side z
� 15056102�5 yso�6loeas J
REV-1560 EX(FI) Pega 3 Flk NumMr
Decedent's Camplete Address:
aECeoENrs ronn�
Patricia�. Harm
57REETADpRESS �
20 North 12th Street,Ap2. 123
Gn" STA7E ZiP
�-�nov�� PA �7oaa
Tax PaymerMts and Credi#s:
i. Tax Due(Page 2.tine 19} (1} 121.80
2. Credits+Payments
A Friw Payrtrents
&Discpunt
TotalCred�r.v(A+B} {2}
3. Interest
(3}
4. If Une 2 is grea4er then Line 1+Line 3,enter tl�e difierence. This is the OVERpAYMENT.
Ffll in oval an Pape 2,Lirw YO W roqueet a retund. (4}
5. If 1.ine f+Cine 3 is greaterlfttxn li�e 2,enter ihe difierence.Thie is tlre TA7t 6UE. (5j 121.80
Make check payable to: REGISTER OF WIl.LS,AGENT.
FIEASE ANSWER TNE FOLLOWING QUESTIONS BY PLACING AN "X"iN 7HE APPROPRIATE BLOCKS
1. Did decedeot make a transTer and: Yes No
a. retam tha use ur income of the property transferced.......................................................................................... ❑ �
b. ref2�f ihe right�designate who shaN use the property trznsferred or ifs income ............................................ ❑ �
e. reta&t a reversionary interest......................_.......,....._....................................................................................... ❑ �
d. receive U�e promise tor I�e of eitlrer payments,6enefiLa w care?...................................................................... ❑ �
2. If death occurted after Dec 12,t992,did decedent trartster property wiN�one ysar W death
wilhout receNing adequate consideratbn?.............................................................................._........_........_......_.. ❑ �
3. Did AecedeM own an'in Wst for"or payable�pon�death bank account or sacurity et his or her deaN?.............. ❑ �
4. Did decadeM own an ind'nidua�retlrement accaunt,ennuiry a other non-probate propeAy,which
cordsins a benaficiary designaiion? ........................................................................................................................ ❑ �
!F THE ANS44ER TO ANY OF THE ABQYE QUESTI�VS 15 YES,YOU MUST C4kiPLETE SCMEdULE G AND FtLE i�AS PART OF THf RETf1RN.
For dates of death on or after July 1,1994,and betare.1an.1,1995,the taz rate imposed nn the net value of transfers to a for the use of tne serrviving spouse
is 3 percent[72 P.S.§9716(a)(1.1)(i)j.
For dates of deaM an or after Jan. 1, 1995, the ta�� rate imposed on Uie net value of transter� ta or for the use of tt� surviviru� spouse is 0 percent
[/2 P.S.§917$(a)(1.1}(ii)j.The siaiute does not exempt a transier to a surviving apouae hnm tax,and the staluWry aeyuirements for disclusure of assets a�
t�ing a tax reWm are stiM applicsWe even if the surviving spouse is the on�y beneficiary.
For dates of death on or atter Juiy 1,2000;
• The ta�c raie imposed on fhe net velua of transfers from a deceased child 21 years of aga or younger at death to a for the use of a natural parent,arz
adoptive par�t ot a stepparant of Me chikf is 0 par�r�t(72 P.S.§91t6(a)jt.2}j.
• The t�rate imposed on the net vaiue of trar�sfers to a fior ihe use of the decgdenPs iineal benefidarias is 4.5 percent,excepl as noted in[72 P.S.§9116(a�{1)].
• The ta�c ra#e imposed on ihe net vaiue of transfers to pr for the use of the decedenPs sibiings is 12 percent(72 P,S.§9116(a�{t.3)].A sibling is defined,
under Sectbn 9102,as an irxNviduai who has at Iesst one pareM in common with Ure decede�rt,whether by Woad or adoptlan.
REV-i5a8IX+(pg-u}
�i pennsylvania ��N�dvl� �
�,�� dEPA{TfMENTOFHEVENUE CpSH, BANK DEPOSITS &MISC.
`""e�"m"ceT""R�r"R" pERSONAL PROPERTY
0.ESIOENT pEfEDEtrt
ESTATE OF: FILE NUMBER:
Patricia G. Harm 2013-0016d
Uxiude the proceeds ef Ikigation amt Me date the proceeds were recetved kry Me eState.
All Proper2y�ofntly owned wltl�Hqh!ot aurvironMp mw!be disdoaad on Schaduk R.
�M � VALUf A7 DATE
NUMBER 6ESCRIFRON OF DEATH
1. Susqueharma Bank chedcing accoun##5400631009 4,425.43
2, Refund from Manor Care Sgq pp
3. Misceiianeaus personai property 54Q.b0
TOTAL(Aiso enter on Line 5,Recapitulation) ; 5,509.43
If more spxce Is needed, use additional sheets of paper nf the same size.
REV-1511 E%+ (30-09)
�pennsytvania SCHEDULE H
DEPRqTMFNTOFqEVENUE FUNERAL EXPENSES AND
7NHERITANCETA%RENRN ADMINISTRATIVE COSTS
RESI�ENT DECEDENT
ESTATE OF
Patricia G. Harm FILE NUMBER
2013-00160
DetadenP�dabb must be rcportad on Schadule I.
ITEM
NUMBER DESCRIP'fION
A• FUNERAL EXPENSES: nn0UN7
1' Funeral meal
378.00
Z Memorial service supplies 132.00
3. Royer's flowers
35.00
4. Pastorsfee
100.00
s. OrganisPs fee
100.00
s. Funeral Labor
75.00
e. ADMINISTRATIVE COSTS:
1. Personal RepresenWtive Commissions:
Name(s)of Personal RepresenWtive(s)
Street Address
City State_ZIP
Year(s)Commission Paid:
Z� Attomey Fees: 450.00
3• Famlly Exemption:(If decedent's address is not the same as daimant's,attach explanation.)
Claimant
Street Address
Ciry State_ZIP
Relationship of Claimant to Decedent
<• Probate Fees:
148.50
5• Accountant Fees:
6� Tax Retum Preparer Fees:
�• Estate checking account fee
5.00
TOTAL(Also enter on Line 9, Recapitulation) # 1,423.50
If more space is needed,use additional sheets of paper of the same size.
0.EV-1512 EX+(12-12)
�pennsylvania SCHEDULE I
DEPApTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCETA%REfURN MORTGAGE LIABILITIES & LIENS
RESIDEM DECEDENT
ESTATE OF
Patricia G. Harm FILE NUMBER
2013-00160
Raport dabL incurrcd by the decedent prlor to daath that romainad unpald at Me date of death,including unrcimburaad meAical axpeneas.
1TEM
NUMBER DESCRIPTION VALUE AT DATE
1' COIIIC2Sf OF DEATH
43.52
2. Cansumer Cellufar
96.48
3. Capital Blue Cross
153.80
4. Manor Care
120.00
5. Pinnicle Health Emergency
33.38
6. West Shore EMS
81.16
7. Heartland Phartnacy
145.45
8. Dc Darryl Guistwite
181.92
9. Consumer Cellular
23.55
TOTAL(Also enter on Line 10, RecapiNlatlon) ; 879.26
If more space is needed,insert addit(onal sheets of the same size.
aev-isi3 ex+toi-io7
�pennsyivan�a SCHEDULE 7
pEPARTMENT QF PEVENUE
mHearrAnce Taz aeruRn BENEFICIARIES
0.ESIDBM DECEDENL
ESTATE OF: FILE NUMBER:
Aatricia G. Narm 2013-p0160
REtATlpNSHIP TO AECEDENT AMOUNT 4R SHARE
NUMBER NAME AND aD[iRE55 OF PERSON(Sj RKEMNG PAOPERiY DO Not Lift T��Btaa(S) Of ESTATE
i SA7(ABLE DISTItlBUTIONS[lndude outriglrt spousal distributfens and transfers under
Sec.91t6(a}(1.27•1
i. Stxi 8ias, 13&fiirimm�m�e,M��ta+n,PA 17457 Granddaughter 25°fo
2. Keni L.Atticks, i801 Norfh Second Street,Harrisburg,PA 17101 Granddaughter 25%
3. Jacqueline L Smikh, 1506 Timber Chase Drive,Mechanicsburg PA 17050 Daughter 5q%
ENTER pOLLAR AMOUNTS FOR DlSTRIBUTIONS$HOWN ABOVE ON LlNES f5 7HROUGH 19 OF AEV-ISOCt tAYER SNEET,AS APFROPRIA?E.
II NON-TAXABLE DISTRIBUTIONS � � �
A. SPQUSAL DISTRiBUTIONS URDER SECitON 9113 FOR WHICH AN EtECT[ON TO TAX PS NOT TAKEN:
1.
I
8, CHARSTABi.E AND GWEANMENTAL DISTRiBUTTONS:
S.
St.Michaei's Lutheran Church,Martisburg,PA 500.00
TQTAL OF PART II- ENTER TOTAL NONdNNBLE�ISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SNEET. ; 5�Q.Q(?
If mqre space is needed,use addiUonal sheets of paDer of the same size. �