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HomeMy WebLinkAbout07-12-13 J 1505610140 � REV-1500 EX �°,.,°, PA Department of ReVe�Ue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Numbe� Po sox 2aoso� INHERITANCE TAX RE7URN . 2 1 1 2 � 0 0 8 8 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Secwity Number Date of Death MMDDYY`n Date of Birth MMODVVVY 0 1 1 7 2 0 1 2 0 9 1 3 1 9 2 2 Decedent's Last Name Suffix DecedenPs First Name MI B L A K E E R N E S T H (If Applicable)Enter Surviving Spouse's lnformation Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUS7 BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1.Original Retum Q 2.Supplemental Return � 3. Remainder Retum(date of death priorto 12-�3-82) � � 4. Limited Estate � 4a. Future Interest Compromise(date of � 5. Federal Estate Tax Return Required death atler�2-12-82) � 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust � 8.Total Number of Saie Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) � 9. Litigation Proceeds Received � 10.Spousal Poverty Credit(date ot death � N. Election to tax under Sec.9113(A) between 1231-91 and 1-1-95} (Atlach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.AlL CORRESPONDENCE AND CONFIDENTIAL TAX I�{,FORMATION Sp.CiIILD 6F�1[tE�TED T0: Name Daytirr�Te�ephone Nhmber rn rn S E T H T • f1 0 S E B E Y 7 1s�7r; 2 4 � �,3� 1 m -�.,-�-.c�—� _� v ��tEGIS.;ER!'pF W�jS U-- S�c�-�Nk_�` :L �`� i� O' G '�'I First line of address � � C' n � � � "� r,� � -�t -- M A R T S 0 N L A W 0 F F I C E S ° � �� � �� I Second line of address � � T�J N � I %�" O 1 � E H I G H S T R E E T City or Post Offce Stete ZIP Code DA7E FILED ` J C A R L I S L E P A 1 7 0 1 3 CorrespondenYs a-mail adAress: SMOSEBEY(c�,MARTSONLAW.COM Under penalties of perjury,I dec�are tM1at I ha�e examinetl this reWm,including accompanying schetlules and statements,an0 to ihe best of my knowle0ge and belie[ il is true,correct a�d complete.Deciaration of preparer other than the personal represenWGve is baseC on all�mPormation of which preparer has any knowletlge. 81G URE OF R PONSIBLE FOR FILING RETURN DATE ADDRESS ' 522 WESTOVER ROA COLUMBIA SC 29210 SIG U E OF�AR/Eg� THER M REPRESENTATIVE �' ' �iT�� /� ADDRESS 10 E HIGH STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610140 15�5610140 J � .1 J 1505610240 � � � REV-1500 EX , Decedent's Social Security Number oecedenrsName: ERNEST H . BLAKE � � RECAPITULATION . 1. Real Estate(SChedule A) . . . .. . . . . . . .. . .. . .. . .. .. .. .. ... .. .. ... .. . .. 1. 1 2 4 0 0 0 , 0 OI 2. Stocks and Bonds(Schedule B) . .. . . .. . . .. . .. ... .. .. . .. .. .. .. .. . .. ... 2. � . 0 0� Y 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) .. . . . 3. . \ 4. Mortgages and Notes Receivable(Schedule D) .. .. . .. .. .. .. .. . .. .. ... .. . 4. , 1� 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . .. .. . 5. . 2 2 $ 2 . 0 1 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . .. 6. - � . � � 7. Inter-Vivos Transfers&Miscellaneous N -Probate Property (Schedule G) � Separate Billing Requested .. . .. . . 7. 0 . 0 U B. Total Gross Assets(total Lines 1 through 7) . .. . .. .. . .. .. .. . .. .. .. . .. . . 8. L �2 6 2 5 2 , 0 1 9. Funerel Expenses and Administrative Costs(Schedule H) .. . .. .. .. .. . .. . .. . 9. 3 1 2 0 0 . 0 6 10. Debts of Decedent,Mortgage Liabllities,and Liens(Schedule I) ... .. ... .. . . . 10. � . � 0 11, Total Deductions(total Lines 9 and 10) . . .. . .. .. . .. .. ... .. .. . .. .. .. . .. 11. 3 1 2 � 0 . 0 6 72. Net Value af estate(Line e minus Line t1) . . ... .. . .. .. .. .. . .. .. .. ... . . �2. 9 5 0 5 1 . 9 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an eledion to tax has not been made(Schetlule J) .. .. . .. .. .. . . . .. .. . .. . 13. , 14. Net'Value SubJect to Tac(Line 12 minus Line 13) . . . .. .. . .. .. .. . .. .. . .. 74. 9 5 0 5 1 . 9 5 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 _ 0 . 0 0 �5. p . 0 0 16. Amount of Line 14 taxable at linea�rate x .oa5 9 5 0 5 1 . 9 5 �5. 4 2 7 7 . 3 4 17. Amount of Line 14 taxable at sibling rete X.12 0 . 0 0 17. Q . � 0 18. Amount of Line 14 taxable at collateral rare X.75 0 . 0 0 �e. 0 . 0 0 19. TAX DUE . ... . .. . .. . . ... . . . .. . . .. . . .. . .. ... .. . .. .. .. .. . .. .. . .. . 19. 4 2 7 7 . 3 4 20. FILL IN THE OVAL IF YOU ARE REqUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505610240 1505610240 J REV-1500 EX Page 3 File Number DecedenYs Complete Address: 2� �2 000as DECEDENT'S NAME ERNEST H. BLAKE STREET ADDRESS 314 MANCHESTER ROAD cirv srare zia CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 4,277.34 2. Credits/Payments 4,622.59 A.Prior Payments B.Discount Total Credits(A+B) (z) 4,622.59 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is ihe OVERPAYMENT. Fill in nval on Page 2,Lioe 20 to request a refund. (4) 345.25 5. If Line 1+Line 3 is greater than Line 2,enler the difference.This is the TAX 6UE. (5) 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUE3TIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a Irans(er and: Yes No a. retain the use or income of the property transferred: ...................................................................... ❑ � b. retain ihe right to designate who shall use the property transferred or its income: ............................... ❑ Q c. retain a reversionary interest;or ............................................................ ❑ Q d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ � 2. If death occurred after December 12,1982,did decedenl transfer propedy within one year oi dealh without receiving adequate consideration? ....................................................................................... ❑ Q 3. Did decedent own an"in tmst for"or payable-upon-death bank account or sewrity at his or her death? ......... ❑ � 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ❑ � IF TNE 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 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 7995,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 fling 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,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 Vansfers 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)1. • The tax rate imposed on the net value of Uansfers to or for the use of the decedenfs siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is defined, unde Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-7502 EX+(01-10) pennsylvania SCHEDULE A �EPARTMENT OF REVENUE INHERITANCETAXRETURN REAL ESTATE RESIDENT�ECEDENT ESTATE OF: FILE NUMBER: ERNES'd'H. BLAKE 21 1� 00088 All real property ovmed solely or as a tenaM in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant(acts. Real properly that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheel if the propedy has been sold. ITEM Include a copy of ihe deed showing decedenPs interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Real property located at 314 Manchester Road,Camp Hill,Lower Allen Township, 124,000.00 Cumberland County,PA 1701 l; Tax Parcel No. 13-23-0545-283,being described in Deed dated October 1, 1971, and recorded in Cumberland County,PA,Deed book H24, Page 886,and being conveyed to Ernest H.Blake and Josephine M.Blake,his wife. Josephine M.Blake died on October ]3, 1994,leaving title solely vested in Emest H.Blake. See attached Settlement Statement(H�ad-1). TOTAL(Also enler on Line 1,Recapitulation.) $ 124 000.00 If more space is needed,use addi6onal sheets of paperof Ihe same size. REV-1508 EX+(�740) pennsylvania SCNEDULE E OEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. INHERITANCE 7AX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: ERNEST H. BLAKE 21 12 00088 Include the proceeds oi litigatlon and the date the proceeds were received by the estate. AI�propertyjointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Foremost Insurance Company-refund from homeowner's insurance 639.00 3. Household furnishings and personal property 500.00 4. U.S. Deparhnent of Treasury-refund 400.00 5. Tax proration($459.76+$]g 1.27) 641.03 6. Sewer and water-refund 73.98 TOTAL(Also enter on Line 5,Recapitulation) $ 2,252.01 IF more space is needed,insert additional sheeGS ot paDer of Ne same size REV-0517 EX+(10-09) � pennsylvania SCHEDULE H DEPARTMENTOPREVENUE FUNERAL EXPENSES AND mHewTaucernxReTURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF � FILE NUMBER ERNEST H. BLAKE 21 12 00088 DecedenCs debts must be repoAed on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. B. ADMINISTRATIVE COSTS: i. Personal Representative Commissions. Name(s)of Personal Represenlative(s) Pamela Vazquez 3,832.00 Streetnddress 522 Westover Road City Columbia g��e SC Z�p 29210 Year(s)Commission Paid: 2013 Z, nriomey Fees: Martson Law Offices 6,800.00 3, Famiry Exemptio¢pS decedeM's atldress is not the same as claimanPs,attach explanaflon.) Claimant StreetAddress City State ZIP Relatlonship oi Claimant to Decedent 4. Probate Fees: 5 AccountantFees: 6. Tax ReWm Preparer Fees: 7. Register of Wills,additional short certificates ]0.00 8. Postage 22.50 9. Pennsylvania American Water,water service pending disposition of property 302.76 ]0. UGI,gas and heating service pending disposition of properiy 368.64 11. Lower Allen Township, sewer/trash service pending disposition of properiy 489.]4 12. PPL,elechic service pending disposi[ion of property 786.82 13. Wilson Hardscape Works, landscaping pending disposition of property 1,61620 14. B.T.B�enneman Electric,electrical work pending disposiYion of properry 205.00 I5. Double T Sealcoa[ing,pressure washing siding pending disposition of proper[y 350.00 16. Clean Break,house clea�ing pending disposition of property 250.00 17. Home repairs pending disposition of property 1,448.93 18. Dumpster service pending disposition of property 1,510.00 TOTAL(Also enter on Line 9,Recapitulation) $ 31,200.06 li more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent ERNEST H. BLAKE 21 12 00088 DecedenYs Name Page t File Number Schedule H - Funeral Expenses &Administrative Costs -67. ITEM NUMBER DESCRIPTION AMOUNT 19. I Paint and A-I Painting,paint house pending disposition of property 2,475.00 20. Foremost Insurance Company,homeowner's insurance pending dispositionof property 1,581.00 21. Deed preparation 75.00 22. Real estate commission 6,560.00 23. Realty transfer tax 1%,sale of proper[y ],240.00 24. Bonnie K.Miller,real estate taxes ��� �� 25. Duplicate ta�bill 1.00 26. Register of Wills,Additional Probate 50.00 27. Register of Wills, filing fee for Supplemental Inheritance Tax Retum 15.00 28. Reserve for miscellaneous filing fees and expenses 500.00 SUBTOTAL SCHEDULE H-B7 ]3,208.07 REV-1513 E%+(Ot-00) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESiDENi DECEDENT ESTATE OF: FILE NUMBER: ERNEST H.BLAKE 21 12 00088 RELATIONSHIPTODECEDENT AMOUNTORSHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s� OF ESTATE � TAXABLEDISTRIBUTIONS pncludeouMghtspousaldistnbutionsandtransiersunder , Sec.9116(a)(12�.7 1. Pamela B. Vazquez Lineal 10,56133 522 Westover Road ll9 of residue Columbia, SC 29210 2. Michael Bowser Lineal 10,56133 408 Temple Drive l!9 of residue Sanford,FL 32771 3. Stephen Bowser Lineal 70,56133 618 Hope Street 1/9 of residue Pittsburgh,PA 15220 4. Katherine Vazquez Lineal 10,56133 522 Westover Road ]/9 of residue Columbia,SC 29210 5. Grayson Vazquez Lineal ]0,56133 522 Westover Road U9 of residue Co]umbia, SC 29210 6. Morgan Bowser Lineal 10,561.33 408 Temple Drive l/9 of residue Sanford,FL 32771 7. Alexis Bowser Lineal 10,56133 408 Temple Drive I/9 of residue Sanford,FL 32771 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-TAXABIE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent ERNEST H. BLAKE 21 12 p6Q$g DecedenYS Name Page 2 File Number Schedule J -Beneficlaries -1 RELATIONSHIP TO�ECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRE55 OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outnght spousal disMbu6ons and transfers under Sec.9116(a)(12).] 8. Crystal Bowser Lineal 10,56132 618 Hope Street ]/9 ofresidue Pittsburgh,PA 15220 9. SabrinaBowser Linea] ]0,561.32 618 Hope Street 1/9 of residue Pittsburgh,PA 15220 a'P�Mf NI�FHO OMB Approvel No.2503-0265 YO+ II{III�1*�£ A. Settlement Statement (HUD-1) �D� L I QB�N o�yEiO� Pe9c 10!] 8.Type o/Loan 1.❑FH� 2❑NMS l. X❑CPnv.UnI�K. b.Flle NumEGr: L tnan Humpe.: 8.Mortgeqe MwmMC CASe NumEer. a.❑ve i❑COnv.im. �olIU099�{8 1M99x3 .NOTF: TM1h Iqm if Nm14itE ro qNe you e{Uhmmt af ec[Ual�ettlem�nl cofh.Amoun6 pnq[o erM Ey[Irc settkmen[eqmt O�e�Mra. I!<ms meheC'(D.o.c.)'wert pab oYtske Me clWlip;tMy eR afown lierp fq informetbmlO�TO�enG erc mt IrchpeE In We toteb. D.M�m��nE�0Cro00f BOf�OMlf e.mma.na�ea.es�orsena s.n.me.�a�ae.m m�.�ae. 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