HomeMy WebLinkAbout07-30-13 '-J �sos61o�n1 �. .
REV-1500 °`�°'-'°> �' .
� PA Department of Revenue Pennrylvania �FFICIAL USE ONLY
Bureau of IndivSdual Taxes '"�'�°"�0ri"`�` Counry Code Year file Number
PO BOX2806o1 INHERITANCE TAX RETURN
Harrisburq,PA 1�u8-o60i RESIDENT DECEDENT ,�I � —I 9 I
ENTER DECEDENT INFORMATION BELOW „ � � - � . �, .
062. � ol. � ( o X ,a
Deceden!'s Last Name Suffix Decedent's First Name MI
0. _ k � �' eJe e �'
(If Applieable) Enter Surviving Spouse's Informatlon Below
Spouse's Last Name Suffix Spouse's First Name MI
� ❑
, Spouse's Socia�Securiry Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGIS7ER OF WILLS
FILL IN APPROPRIATE OVALS BELOW • � �- � �
p 1.Original Retum p 2.Supplemental Retum q 3. Remainder Retum(date of death
� priorto 12-13-82)
p 4.Limited Estate p 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Retum Required
death after 12-12-82) .
O 6.Decetlent Died Testate O 7. Decedenl Mainlained a Living Trust d 8. Total Number ot Safe Deposit Boxes
(Attach Copy of Will) (Ariach Copy of Trust) �
O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of tleath q it. Election to tax under Sec.9N3(A)
between 1231-91 and i-1-95) (Anach Sch.O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETEO.ALL CORRESPONOENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
�o h L 1Z� � �T- e i� a��n� C' - l �z 8� � Z 6
�� REGISTER Q�ILL$Yl ONLY
• ^ m �
;n c c.; o
FiBt line of address y n • Cn �
�. ✓ r W m m
� 3 �� �o ,C e y � �,�� D � � � � ��
Second line of addreu � • � o 0
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= C� p 'R �t .
:'> 4 -r� � � "n
� L' r--• = C'�
�� hT FILED m
City or Post Office State ZIP Code
�� �h � , � b � � � � i � c�:s- _ � � �, o
- Correspondent's e•mail address:
Untler penalties of perJury,I deUare�hat I have examined this relum,Induding accompanying schetlules end statemenis,and to the best of my knowletlge an0 belief,
it is We,cortecl antl campl .DeG tion of arer olher Ihan the personal representative Is Oased on all info�mation of whlU preparer hes any knaMed9e.
SIGNATURE OF SO RESP NSIBL FILING RETURN 7�7 ''//3
ADDRESS �r � D�
. 7/v l.�/�A�/ rJ ��r �'l�c�drivi�S�iuc�� //�7 ' ��L�o 7�2���
SIGNATURE OF PREPAR OTHER THAN REPRESENTATIVE DA7E
ADDRESS •
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 15a5610101 1505610101 J
�
� 1505610105 :
REV-1500 EX '
DecedenPs Social Secunry Number
Decedem's Neme: �� /�J�l/� / • �/C!°I P/l�(�j�. �� �`��/�
RECAPITULA710N
1. Real Estate(Schetlule A). .... ...... ........ ....... .... .... ... ........ t. •
• 2. Stocks and Bonds(Schedule B) . ........ .............. ........ .... ... . 2. I ` ` •� .
� -
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. ��-����•^
4. Mortgages and Notes Receivable(Schedule D).................. ........ . 4. ����`��'��•
5. Cash. Bank Deposits and Miscellaneous Personal Property(SChedule E). ...... 5. _��� � �•j
6. Jointy Owned Property(Schedule F) p Separate Billing Requested ... .... 6. ` �R��.��•� -
7. Intervvos Transfers&Miscellaneous Non-Probate Property - -� � - - -
(SchcWule G) O Separate Billing ftequested.... .... 7. ��.�
8. Total Gross Assets(total Lines 1 through 7). ........ ....... ........ ..... 8. � �.�
. - ' ...-_ ' _-�. -
� 9. Funeral Expenses and Administrative Costs(Schedule H).. .... .... ....... .. 9. � .
--
10. Debts of Oecedent, Mortgage Liabilities,and Liens(Schedule I). ............. 10. .
- - �- -_ �
11. Total Deductions(total Lines 9 and 10).. ... ..... .... ........ ... .... .... 11. �
12. Net Value of Estate(Line 8 minus Line 11) ....... ... .... .... .... ... ..... 12. _� 1._��i m.
J
13. Charitable antl Govemmental Bequests/Sec 9113 Trusts for which -��+ ��-7 � �- -
an election to tax has not been made(Schedule J) ..... ...... . ............ 13. 4 . 7 .{
- - - - `f !
14. Net Value SubJect to Tax(Line 12 minus Line 13) .... .... .... ............ 14. .��
TAX CAI.CULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount ot Line 14 laxable
at the spousal tax rete,or �
iransters under Sec.9716
(a)(1.2)X.0_ � 15.
16. Amount ot Line 14 Wzahle I
at lineal 2te X A_ ��.�� 16. �a� � --r�� � 1�•1
--'-'�I-�-�
17. Amouni ot line M14 faxable -
at sibling rate X.12 ` � 17. �•�
58. AmouM of Line 14 taxabte - - I" - �
at wllateral rate X.15 •1 18.
19. TAX DUE ..... .... .......... .... .. .... ........ ............... ..... 19. •
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
� 1505610105 1505610105 J
/
�• 3�
�.EX Pe9e 3 Flle Numbor
ecedent's Complete Address:
DECEDENPSNAME
�/e�en��e 1 1�e���e��e/L
STREETADDRE�� � � ����"n��
i�
CIN ST Zll�Q3�O
yvl �e �/',g�i� uLG 'r¢-- .
Tax Payments and Credits:
t. Tax Due(Page 2,Line 19) (�)
2. CredilslPaymenls
A.Prior Paymenls
B.Discount
Total Credits(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line t �Line 3,enter the difference. This is lhe OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a retund. (4)
5. If Line 1 +Line 3 is greater fhan Line 2,enter the diBerence.This is the TAl(DUE. (5)
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedeni make a fransfer and: Yes No
a. retain the use or inoome of the property transfened:.......................................................................................... ❑ �
b. retain the right to designate who shall use the properry hansferted or its income:............................................ ❑ �
c. retain a reversionary inferest:or......................................................................................................................... ❑
d. receive the promise for life of either paymenls,benefils or care?...................................................................... �
2. If dealh oceurted after Dec.12,1982,did decedent transfer property wilhin one year of deaih �
without receiving adequate consideration7.............................................................................................................. ❑
3. Did decedent own an"in trusl foI'or payable-upontlealh bank accounf or security at his or her dealh?.............. ❑
4. Did decedent own an individual relirement account,annuiry or other non•pmbate properry,which �
contains a beneficiary designaGon? ........................................................................................................................ ❑
IF 7HE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PAR7 OF 7HE RETURN.
For dates of death on or after July t, 1994,and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of ihe surviving spouse is
3 percent[72 P.S.§9116(a)(1.1)(i)1•
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 dces not exempt a transfer to a surviving spouse ftom tax, and the statutory requirements for disclosure of assets and
filing a tax retum are still applicable even if the surviving spouse is the onty 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)(12)].
• The tax rate imposed on the net value of transfers to or for the use oi the decedent's lineal beneficiaries is 4.5 percent, except as noted in
72 P.S.§9116(12)[72 P.S.§9116(a)(1)1.
• The tax rate imposed on lhe net value of transfers to or for the use of the decedents siblings is 12 percent[72 R.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.
�;� ^L9MM(MrlEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENIIE INFORMATION NOTICE
BIIREAU OF INUIVIDUAL TA)(ES FILE N0. 21
PO BOX 2806�1 AND
NARRISBURG PA inzs-obot TAXPAYER RESPONSE ACN 12503384
xcv.�san�srn-�u DATE OS-02'2012
TYPE OF ACCOUNT
EST; OF HELENE T RIETHEIMER � SECURITV
S.S. N0. � Se[ nCCi
DATE OF DEAT}i 06-28-2012 � srocK
COUNTY CUMBERLAND � HONDS
REMIT PAYMENT AND FORMS T0:
JOHN L RIETHEIMERIII REGISTER OF WILLS
� 3710 LEYLAND DR 1 COURTHOUSE SQUARE
• MECHANICSBURG PA 17050-9165 CARLISLE PA 17013
PRUDENTIAL FINANCIAL has orovided the Daoartment v5th khe informetion 15sfetl balow w�ith hes ba¢n �sotl Sn
ealeuleting tha oof¢ntial taz Eu¢. Thair r¢tords lntlitate that at Yhe Eoeth of t�e ebove Eetedenk, you were a beneficiary of t�5s esset.
It you feel this inforneYlon Ss incorract, olease obtain �ritten correction from t�e Yrenifer a9ent, atta<h e copy to t�is fore enE
raturn St to tha a�ov¢ aAEress. This account fs tezabla fn aecordence w5th the Inheritanco Taz LaVS of Yhe Commomealth of Pennsrlvania.
Ouest3ons mey Ee ansVeretl Ey ce111ne ��17) 787-8321.
COMPLE7E PAR7 1 BELOW x a ■ SEE REVERSE SIDE FOR FILIN6 AND PAYMENT INSTRUCTIONS
Aetount No. 167166258 To inzure orooer eredit to vour eccount. Mo .
(2) eooias of this notiea oust aceonoeny your
DOD Valuetion 6�382. 00 oeroant to the Reelster of Wills. Meke eheck
oaveble to: •'Raplstcr of Wflls. Ag¢n[••.
Parceni Taxable X 100. 00
NDTE: If tax oaYments are oatle �ithin t�ree
Amount Subjeet to Tax 6.382.00 cs) months of the eecoaont•s dete of Eaetn,
Tax Rete X .045 vou may Eetluct e 5X Eistounf of the tax Eue.
Arry inheritance tax Euo will becooa A¢linquent
POLCntSal Td% DUe 287• 19 nine (9) qonths after the tlat¢ of tleaf�.
PAHT TAXPAYER RESPONSE
�
FAILURE TO RESPOND WILL RESUL7 IN AN OFFICIAL TAX ASSESSXENT BASED ON THIS NOTICE
A. T�¢ eGOVe lnformation anE tax tl�e is correcf.
1. You mav choose to rcoit oavnant fo the Rceisfar of Nills wfth two coDias of t�is notica to obtein
CH ECK e discount or avoitl Sntarest� or yau may eheck box '•q•' enE refurn this notita to the Register of
ONE W�lls ontl an off7tial assasznont will ba SssueO Ov the PA Oeoertoenk of Ravenua.
BL OC K B. �T�e abova assot has been or �ill bo reoortad anE faz Deid wSth the Pennsvlven5e InherStance Tax return
ONL Y to be filatl bY the Eocedent's r¢orasentative.
C. �The eEOre Snfomaflon is incarrect enE/or E¢bts a�a aea�«so�: �ara Da1E Ey you.
You nust comolete PART � anE/or PART � balov.
ppR7 If you indi<ato a Eifforent taz rate, ploasa state your OFFICIAL USE ONLY �AAFI
� relatlons�ip fo EecetlenY: +
PA DEPAR7MENT OF REVENUE J
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSET(S) , PAD
LINE 1. DOD Valuatlon 1 1 , �
2. Perc¢nY Taxable 2 X 2 �
3. Amount Subjaek to Tax 3 3 ' 'f
4. Debts and DeEU<tions 4 - i 4 �
5. Amount Tazabla 5 � 5 �
6. Taz Rate 6 X 6 ]
7. Taz Uue 7 ] ]
8 �
PART DEB7S AND DEDUCTIONS CLAIMED
�
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Linc 5 of Tax Lomputatfon) b
Untler penalfies of o ury Eo<lare t�at the fa<ts I havo roporteC abov¢ are true, correct anE
complete co cn nesc - a belief. HOME c7/7 ) 7.2g''y926 7��j3
WORK < > r� i
TAXPAYER SI N TURE� TELEPHONE NUMBER DATE
.. � �i.
GENERAL INFORMATIDN
r... �A
1 . FAILl1RE TO RESPOND WILL RESl1LT IN AN OFFICIAL TAX ASSESSMENT with applicable
Snkerest based on informatian submittetl by the transfer agent.
2. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. Assets held by a tlecedent "in trust for" another ar others are taxa6le fully.
REPORTING INSTRUCTIONS - PART 1 - TAXPAYER RESPONSE
1. BLOCK A - It khe information and com0utation in the notice are correct antl tletluctions are not being claimetl, olace an "X"
in block "A" of Part 1 of the "Tazpayer Resoonse" section. Si9� iro co0ies antl suEmit them with your check For the amouni of
tax to the Register of Wills of the counYV indicatetl. The PA Deoartment of Revenue will issue an official assessmenk
(Form REV-1548 IX) uoon receiDt of khe return from khe RegisTer of Wills. Do noY use the envelo0e orovidetl.
2. BLOCK B - If Yhe asset specifietl on Yh3s notice has been or will be reportetl antl tax paid vith the Pennsvlvania lnh¢�itance
Tax Rekurn filetl bv the decetlenY's reoresentative, olace an "X" in block "B" of Part 1 of the "Taxpaver Nesoonse" section. Sign one
copy antl return to the PA OeoarYment of Revenue, Bureau of Individual Tazes, Deot 260601, Harrisburg, PA 17120-0601 in the
envelooe orovitletl.
3. BLOCK C - If khe nokice inPormakion is incorrect and/or deductions are be3n9 claimed, check block "C" and complete Parts 2 antl 3
acca�ding ko Yhe 3nstruction5 below. Sign two cooies and submit khem w3th vour check for k�e amount of tu oavable to the Register
of Wills of the countv indicatetl. The PA Deoartment of Revenue will 3ssue an official assessmenk (Form REV4548 IX) uDOn receiot
of khe return from the Register of W311s. Do nok use Yhe envelope orovided.
TAX RETURN - PART 2 - TAX COMPl1TATI0N
LINE
1. Enter the total balance of khe account including interest accrued to the tlate of death.
2. The percent taxable assets ownetl by the decetlent but heltl in krust for or payable
to another indSVSdual(s) Cbenefieiaries):
1 DIVIDED BV TOTAL NUMBE2 OF BENEFICIARIES X 100 = PERCENT TAXABLE
Example: Assets registered in the name oF the decedent in trust for two other persons.. .
1 DIVIDED BY 2 BENEFICIARIESJ = .50 X 100 = 50% RAXABLE FOR EACH BENEFILIARV)
3. The amount subject to tax (line 4) Ss determined by multiplying the account balance
(line 2) by t�e percent taxable (line 3).
4. Enter the total oF khe debks and detlu<tions listetl in Part 3.
5. The amount taxable Qine 6) is dekermined by subtracting the debts and deductions
Qine 5) trom the amount subje<t to tax (line 4).
6. Enter the aporopriate tax rate (line �) as determined below.
A. For tlates of tleath occurrin9 after 6/30/94, the kax raTes for transters to spouses are as follows:
1. Dates of death on or after 7/1/94 and before 1/1/95 the rat¢ is 3%.
2. Dakes of death on or after 1/1/95 kransfers ko spous¢s will be taxed at 0% tax rate.
Note: For dates of death pr3or to 7/1/94 transfers Ya spouses are taxable at 6%.
B. Transfers to lineal d¢sc¢ndants inclutling tather, mother, son, dau9hter. erandchildren, san-Sn-law,
tlaughter-in-law, st¢pc�iltl antl their issue are taxable at six percent (6%7. A date of 7/1/2000 and after
are taxable at four antl a half percent C4.5%) .
� C. Transfers ta siblings will be taxed at twelve percenk (12%7 for dates of death on or after
�iiizoao .
D. Transfers to all others including Uncle, aunt, nephew. and nie<e are taxable at fifieen percent (15%).
E. Far tlates oF death on or after 7/O1/2000, transfers from a child (age 21 or untler) to a
natural pa�ent, adopied Pa�ent o� steP-parent a�e taxable at 0%.
F. If you chanee the Yax rate, pin.ase speeify your relationship to the tlecedenY in the area provSdetl.
7. The amount of tax due Cline 8) is tleterminetl by multiplving th¢ amount taxable (line 6)
hy the tax rate Qine 7).
CLAIMED DEDUCTIONS - PART 3 -- DEBTS AND DEDUCTIONS CLAIMEU
Allowable tlebts antl detluctions are tletermined as follows:
A. Vou legally are responsible for paymenk, or the estate sub�ect to administratian by a personal
representative is insufticient to pay the tletluctible items.
B. Vou ackually paid the tlebts after tleath of t�e decetlent antl can furnish proof of payment.
C. DebtS being tlalmed mu5t be itemiZed fully in Part 3.
If aAditional space is n¢etletl, use plain paper 8 1/2" x 11". Proof of
payment may be requested by the PA Department oF Revenue.
� k �i". "� '�' �'�a�,° .3e *�` ` � +'�. �" e5 � � be �k n4v ,�y S rt &t > a $
-ay�. � IP �Y011 MEED�FllRTHER IfFFDRMATI0IJ OR_ ASSiSTANCf, ,CONTAL?� ANY, "�
� �� .BEGISTf$z�DP,�WiLLSri'�PA'�DEPA?tTMEN7�DF_. REVENUE�D3S7RICT�OFFIG6 � � .,� � '�t,
� ,����aOR'�CALL�"�7H� $UREAtl;OF�YNDI#�iDUAL�TAXES;,�TAXPAYERa3N4t1SRY�UNiT` IN°� � � �
'NARRI5BUR6 �A'f' f717D'sa787=8327: a7DD#�1�.$D0=447=3fl2U.;"CSERYSCE� PDR•:TAXPAYERS '
_:m�.x �. .��.a��.4�, `�•.k.��n�WI�TH SPECIAI:'�HEARIN6o°AND_SPEAK3N6 NfEDS)':,.�� � �- � � � -
COMMO•f�WEALTH OF PENNSVLVANIA REV-1162 EX(11-96�
r�D@PARTMENT OF REVENUE
BUREAU OF IN�IVIDUAI TA%ES
DEPT.280601
HARRISBURG,PA 1J128-O601 .
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 017373
RIETHEIMER JOHN L III
3710 LEYLAND DRIVE
MECHANICSBURG, PA 17050
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
'__"_' <aa _'_"_'_ '__"'_
12503384 � 5287.19
ESTATE INFORMATION: sSrv: �
FILE NUMBER: 2127-0091 �
DECEOENT NaME: RIETHEIMER HELENE T �
DATE OFPAYMENT: 03/28/2013 I
POSTMARK DATE: 03/27(2013 I
COUNTY: CUMBERLAND � - - �
DATE OF DEATH: 06/28/201 2 I
�
TOTAL AMOUNT PAID: 5287.19
REMARKS:
CHECK# 3390
INITIALS: HMW
SEAL , � '� � , � RECEIVED BY: GLENDA FARNER STRASBAUGH
. � REGISTER OF WILLS
TAXPAYER
� 1