HomeMy WebLinkAbout08-20-13 J ysos61o14n
REY-7,-7V� �ctaz-��tt�g
OFFIGIAL USE ONLY
PA Department of Revenue �{���y Year F�Num6er
eureau ot Indivldua�Ta�s INHERITANCE TAX RETURN
PO BOX 280601 2 1 1 3 0 3 3 5
tiaarrl�sCum PR tnze-oso� RESlDENT DECEQENT
ENTER DECEpENT INFORMATION BELOW
Social Secw�ty Number Date of Qeath MMDDVriY Qate of Birth MMD6vWv
0 3 0 2 2 0 1 3 D 9 1 D 1 9 2 0
DecedenPs Last Name Sutflx DeCedenPs First Name MI
B 0 0 Z E L L E N H
(if Appileabie)Errter Surviving Spouse's information Below
Spouse's last Name Suffix Spouse's First Name M7
Spouse's Social Security Number
THtS RENRN MUST BE Fi�ED!N D1,7PLICATE WIT}I THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVpLS BEIOW
� �.Urigina!Retum Q 2.S�api�nentai fieturn � 3.Remair�Retum(Date of Death
Pnor to 12-13-82)
� 4.Limited Estate � 4a.Fuhne interast Compromi�e{date of [] 5.Federai Eslate Tax Retum Raquired
death after 12-12-82)
� 6.Deceden!Died Testate � 7.Decedent Mainiair�ad a living Tnist � 8,Tatai Rlumber of Safe Oeposit Boxes
(Attach Copy oi Will) (Attach Copy of Trust.)
� S.litiga8on Prfloseds Recelve0 � 1D.Spousal Povatry Credit{Date of f}eatt� � 11.Eiection to Taxt�der Sec.9113(A)
Between 12-31•91 and 1-1-95) ,y�Attach Sche¢a�V O) �
C6ftRESPONDENT-THIS SEGTIQN t�tST 8E COt�LETED.ALl C�tE$PONDENCE AUD CONFKiENTUL T F6$tMATt6N S�Qt1LD�[A,RECTEp T0:
Name DaytiRla F�ephone I�nber,;� ;,�
' M U R R E L W A L T E R S , I I I E S Q 7 � z � 9� 4 r k�r 5 �
GI6TlTt OF IN�I,�La u,��Y
� C�e � ....�i
C7 ' ,
p C �, ".: c7
First Line af Adtlress . � p �,� � .
5 4 E . M A T k S T R E E T A � u' 4
Second Line of Address
City or Post Qifice State ZiP Code DA'fe FILEn ��
fl E t H A N I C S B U R G P A 1 7 � 5 5
corcesPona.orsamaiieddreas: murrelaweltersqallowav�com
Undar per�attles of perjury,i deciaro tliat i have examinetl this retum,inciWing accampanylnp scheEUies arM sisterrrcnts,and ro the best of my krw�NOAge antl bellef,
it is trug,wrcect arM compleb.DaWaratipn of preparer other than the perspnal representative is based on all IMortnatlon pf whlch prepercr has any krwwladge.
StGNA PONS�IE FOF2 FILiNG R6TURN DATE
!4 � �j
A SS
ROBERT H- OOZ, b TA LA E DURHAM T 06422
S�GNATUR O O? THAN F2EPRESENTATNE DA7 �
f
ADDRE
11URR L WA TERS IIZ Q 54 E. t1AIM ST MEtNANIC BURG PA 17055
PLEASE USE ORIOINAL FORM ONLY
Side t
� 1505610140 1505610Z4� � {�
/
J 1505610240
REV-1500 EX(FI) DecedenPS Social Security Number
oecedenrsNama: ELLEN H . BOOZ
RECAPITULATION
1. Real Eslate(Schedule A) .. . . . . .. . .. . .. . . . .. . . . . . . . . . .. . .. . . . . . . . . . . 1. •
2. Stocks and Bonds(Schedule B) . . .. . . . .. .. .. . . . . . . . .. . . . . .. . .. .. . . . . . 2. 1 2 6 2 2 . 4 0
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. 5 6 3 9 5 . 5 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. . .. .. 6. 2 4 3 6 2 8 , U 7
7. Inter-Vivos Transfers 8 Miscellaneous Probate Property
(Schedule G) Separale BIIIing Requested . . .. . .. 7. L 8 7 8 9 � , 7 6
8. Total Gross bsab(total Lines 7 ihrough 7) ... ... . . ... ... . .. . .. ...... . 8. 5 O 0 5 3 6 , 7 3
9. Funeral Expenses and Administrative Costs(Schedule H) .. .. . . .. . .. .. . .. . . 9. 1 0 2 2 5 . 4 7
10. Debts of Decedent,Mortgage liabilities,and Liens(Schedule I) . .. . . . . . . . . .. 10. � 4 9 � 6 . 9 2
�7, Total Deductions(total Lines 9 and 10) ... . . .. . .. . . ... . .. . .. . . . . . .. . . . 11. L 5 1 3 2 . 3 9
12. Net Value of Estate(Line 8 minus Line 11) . .. . ..... . .. ... . .. . .. .. . .. . . 72. 4 8 5 4 0 4 . 3 4
13. Charltable and Govemmental Bequests/Sec 9113 Trusts for wfiich
an electlon to tax has rwt been made(Schedule J) ... .. . .. .. . . . .. .. . .. . . 13. .
14. Net Value Subjaet to Tau(Line 12 minus Line 13) .. . .... . . . ... . .. . .. . .. 14. 4 8 5 4 0 4 . 3 4
TAX CALCULATION•SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the Spousal tax rate,or
transfers under Sec.9116
(a)(12)X • 0 0 . � � 75. - � . p 0
18. Amaunt of Line 14 faxable
atlinea�rete x •045 4 8 5 4 0 4 . 3 4 is. 2 1 8 4 3 . 2 0
17. Amount of Line 14 taxable �
atsibling rate X.12 � . � � 17. � . � 0
18. Amount of Line 14 taxable
at collaterel rate x.is 0 . 0 D �e. 0 . 0 0
19. TAX DUE . . .. . . . .. .. . ... . . . . . . . ... .. .. . .. . .. .. . .. . . . . . . . . . . . . . . 19. 2 1 8 4 3 . 2 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 1505610240 1505610240 �
R£V-15U�EX{Ft) Page 3 Flie Numbar
DecedenYs Compiete Address: 21 Z3 Q335
DECEDENT'S NAME
ELIEN H� BOOZ
STREE7ADDRESS �� i�
325 WESTLEY DRTVE, APT � #311i,
CITY 'J i STA7E -i.i�--- ZIP
MEtHANICSBURG PA 17055
Tax Payments and Credits:
i TaxDue{Page2,Linei9) (1) 21,843�20
2. CreditsiPayments
A.Priw Paymenta 2�,5 Q��C]�
e.Discount 1,�N 5•0 0
ToialCredits(A+g� �p� �Z,945�00
3. Inieresf
(3)
4. If Line 2 is greate�th�Line 7*Lir�3,�ter the difference.This is the pVERPAYMEMT.
fill In oval on Paga 2,Llne 24 to requsst a refu�d. (4) y Q y,g p
5. H Line 1+(.ine 3 is greater than Line 2,enter the ditference.This is ihe TAX pUE. (5) Q.p Q
Make check payabie to: REGISTER OF WiLLS, AGENT
PLEASE ANSWER THE FQLLQWING QUESTIONS BY PLAGING AN "X" IN THE APPR4PRlATE BIOCKS
t. Did decedeot make a transter az�d: Yas No
a. retain it�e use a incane�the pmperty transferred ...................................................................... ❑
b, reta+n khe right to designate artw sh�l use ihe propwty transfened�its income ............................... ❑
a retain a reversionary intsresk ..................................................................................................... ❑
d. receive the promise for life of either paymenGa.benefits a care7 ....................................................... ❑
2. If death occurted afler December 12,1982,did decedent Uansfer property within one year o(death
without receiving adequate consideratian? ....................................................................................... ❑ �
3, Qid decedeni own an'in Uvsf for or payabie-upondeath bank account or security at his or her death7 ....,.... 0
A. Did decedent own an individuai refiremant account,annuiry or other non-probate{xoperty,which
containsabeneficiarydesignation?.................................................................................................. � ❑
IF THE ANSWER Tp ANY Of THE ABOYE QUESTEONS!S YES,YOU MUS7 COMPLE7E SGNEDUIE G ANd FILE I7 AS PART OF THE RETURN.
�or dates of death on ar after July 1,1994,and before Jan. t, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
is s Peroenc�r2 Ps,gs��s(a)(�.t)f?]
F�dates of death on a after Jan.1,1995,the tax rate impased an khe net vaiue of Vansfers ta or for the use of ihe surviving sppuse is 0 percent
(72 P.S.§9f 18(a)tt.i)(u)].The stat�te does not exempt a tr�sfer ta a surviving spouse ftan tax,and the statutory requirements for disciosure of assets and
tiling a tax retum aze sUll applicabla even if 4he surviviny spouse is the only beneficiary.
fa dates of�aUr on or after July 1,200Q:
• The taa�rate imposed on the net value of Vansfers from a decaased chi�21 years of�e or}roungsr at deaih to or for the use af a naWra!parc�+t,a�
adopNve parent or a stepparenk of the child is 0 percent[72 P.S.§9116{a){L2)].
• The tax rate imposed on tha net value of transfers to or for the use of the dacedenYs lineal beneflciaries is 4.5 percent,except as nated in(�z a.s.gs�te(sKiy).
+ The taas rale imposed on the net value of transfers to a for the uss of Ure de�enR's si6lings is 12 percent[72 P.S.§91 i8(a}(1.3}�.A siMing is defined,
under Section 9102,as an individual who has at least one parent i�comrrwn with the decedent,wheShar by bbod or ackption.
REV-1503 EX+(8-12)
pennsylvania SCHEDULE B
OF.PARTi�NT#REVENUE
INHERITANCETAXftETURN STOCKS & BONDS
RESi�NT�CEDENT
ESTATE QP F�.E MUMBER
ELLEN H • BOOZ 21 13 C1335
All propaRyjointly owned with right of aurvivorshlp must be disclosed on Schedule F.
ITEM VAIUE AT DATE
NUM6ER DESCRIP71flN OF DEATH
1 • AXA 2,�10•72
118 SHARES
2. ST. PAULS TRAVELERS 8,069 •DO
1Da SHARES
3. PIETROP4lITAN 2,542.68
?2 SHARES
TOTAL(Also enter on Une 2,Recapitulaiion) S y 2,6 2 2 . 4�
if mare sP�a is naeded,irwsert addiNanal stfeeis of ttre same sFCe
REV-1508 EXt(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS 8� MISC.
INHERITANCE TAX RETURN
RESIDENTOECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ELLEN H . 800Z 21 13 0335
Include the proceeds of Iitlgatlon and the date the proceeds were received by the estate.
All property jointly owned with right of survivonhip must be disolosed on Schodule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T BANK 851. 10
SAVING3
2 . AXA 39,115. 37
SINGLE PREMIUM ANNUITY
3 . FORD 640.71
STOCK DIVIDEND
4 • BETHANY VILLAGE 14,421. 46
ENTRANCE FEE REFUND
5 • BETHANY VILLAGE 154 . 86
PERTONAL CARE ACCOUNT REFUND
6 • PENNSYLVANIA DEPARTMENT OF REVENUE 4�0 • 00
2012 INCOME TAX REFUND
7. INTERNAL REVENUE SERVICE 812 • 00
2013 INCOME TAX REFUND
TOTAL(Also enter on Line 5,Recaptulation) ; 5 6,3 9 5• 5 0
If more space is needed,use add�tional sheets of paper of the same size.
_ _.. . _. _ _ __. _ .. _ .. _ .
_ _
REV-t5Q9 EX+{61-ip)
pennsylvania SCHEDULE F
OEPAtiTMENTOFREYENUE ,JOINTLY-OWMEDPROPER'fY
iNHERITpNCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FlLE NUMBER:
E��EN H- BOOZ 21 13 �335
If an aseet xras made Jointty ovmed within one year of fhe decadenPa date of doath,R muat ba reported on Schedule 0.
SURVMNCa JQiNT TENANT(S}NAME(S? ADDRESS RELATIONSHIP TO OECEDENT
n. ROBERT H . BOOZ S6 BANTA LANE SON
DURNAf1, CT �6422
a.
c.
JOINTI.Y�OWNED PROPERTY:
%� DATE�oFnTH
ITEM FORJOINi MADE INCtUDENAME#FINANpALi�N MIO�tiR 08�ANKEACCOUNTNUMBERORSIMRAR DATEOFDEATH DECEpENTy VALUEOF
NUMBER TENANT JOINT IDENTIKYINGNUMBER, ATfACHDfEDFORJ0INTLY�HELDREAl6STATE. VALUEOFASSET� INTEREST DECEpENT'SINTEREST
1• A. 612�12 GITIZENS BANK 7,233.15 100. 7,233•15
{IRtLE 60�D CNE{KIN6
2- A bieula CITIZENS BANK 2$,968�87 1�t?� 28,96�.8?
PER�ORIIANCE M4N€Y MARKET
3- A 612�12 PNC BANK - 4,293.6D 10C1� 4,293.6�
INTEREST CFlEtKZNG
4 . A �,iaolz PNC BANK � 203,132. 45 1C10. 203,132 �45
PREMIUM M4NEY MARKET
i4TAl(Aiso enier af l�ie$,Rerapit��} S 2 4 3.62�.�? �
it mae xpace is needed,use additlonai sheeb of paper of tlie same ska �.
REV-1510 EX+{08�08}
pennsylvania SCHEDULE G
OEPARTAffM OF REYENUE (NTER�VIVOS TRANSFERS AND
ua�ewvuaceuocReruaN MISC, NON-PROBATE PROPERTY
RESIDENT DECEOENT
ESTATE OF FllE NUMBER
EE�EN H- BtiOZ 21 13 �335
ihis schedule must be completed and filed B the answer lo any of questione 1 through 4 on page three of Me REV�150�is yes.
DESGRIPTIININ��PROPERTY
�T�� �NCli1DEiHENM1E0FiHEilIMlSFENEETHEIRPEUIH)NSMPTOOECEDENfANp DATEOFdEATH %OFOECp'S EXClUSION 7AXABLE
NUMBER THEWiEpFTp�MSFEq.A7fACHACOPYpF}�{EDEfDFORREAlESiAIE. VALUEOFA$SET INTEREST i�v�ic,�i VALUE
1. INVESCO INVESTMENT SERVICES 5�,253.66 10�.Q[! 5Q,253.6b
ANMUZTY
ROBERT H• 804Z, 30N, TOD
2 . JOHN MANCOCK 32,OS3.88 10�.�U 32,�53.88
MUTUAL FUND
R08ERT H. BOOZ, TdN, TOD
3 . M8T BANK 18,644 • 33 1C10 .00 18,644 . 33
IftA
RflBERT N� BBflZ, SON, T{YD
4 . VISTEON 291 • 50 100 • 00 291. 50
5 3HARE3
ROBERT N. B44Z, S4N, TOD
5• F4RD i10TOR COMPANY 80,794 .10 100 •00 8d,794 .1�
6407 •135 SHARES
R4$ERT H• 944Z, S4N, TOD
6. tITIGROUP 5,853�29 100.0� 5,853•29
139 SHARES
ROBERT H. BOOZ, SON, TOD
ioTA� Al��rtaroni��7, ' �an # 187,$9d•76
If moip spaca is needad,use additkmal sheeb M psper ol Me same size.
REV-�s7��+{ta-os}
pennsylvania SCHEDULE H
OEPAF?TMENT OF REVENUE p�J���L EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS �
RESIDENT DECEDENT
ESTATE OF PILE NUMBER
ELLEN H• BOOZ 21 L3 0335
DecadanMs debb must be rapaHed on Schedule I.
ITEM
NUMBER DESCRIPTIpN AMOUNT
A. FUNERALEXPENSES:
1• tREMATIQN — AUER FUNERAI NOME, HARRISBURG 2,439.5?
2• HEADSTONE — GINGRICH MEMORIALS 1,320 .00
3. CEMETARY — GHESTNUT HII.L 500 .p0
4 • MINISTER — MYR7'LE McCAI.I 150•D�
5� 4RGANIST 5�.00
6 � FAMILY MEAL 972.40
? � FLOWERS 220.0�
8. A6MINISTR4TNE G4ST5:
1. PersonalRepresentativeCommissions:
Name(s)of Persanal Repreaentative(s� R 0 8 E R T H• 8 0 0 Z
sae�Ada�ess bb BANTA �ANE
c�ry DURHAM S�i� CT Z�P 06422
resr{s}ca�,w,sianaa�: tRENOUNCE4)
2 , nttomeyPees: MURREL R • WALTERS� TII 4�0�0•00
3. Fam�y Ezempti�n:(Iraacedenrs address is�t a,e sarne as�imanrs.atta�e�iatron.j
Claimant
SUeet Address
C�'! S�a� Z1P
Rela6onship of Claimant ro pecedent
4 . Pm�ep�s: {Ut18EftLAND tOUNTY REGZSTER 6F WI��S 493.50
5, AccountantFees: '
6• �azttemmPrevarerFees; LZNDA 3TMONT, CPA — TAX PREPARATION 80 •00
7 .
TOTAL(Also enter an Line 9,RecapitulaUan} 5 y p,2 2 5.4? I
It mae Msece is neaded.use additWtiai sheeb Ot paper af the aeme size. ��'�
REV•1512 EX+(t2-12)
pennsylvania SCHEDULE I
DEPARTldENT OF'REVENUE pEBTS OF DECEDEMT�
�NH��nrnNCeTnxRETUaN MORTGAGE LiABIL1TIES&LIENS
RESIpENT DECEDENT
ESfATE OF FIIE MUh�ER
ELLEN H � BOOZ 21 13 0335
Raport debta incuned by tba decedent prlor to death that remained unpaid at the dete ot death,induding unreimbuned medkai�penees.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OFf7EATH
b. t�EST SHORE EMS 338.?8
AMBULANLE
2• ANDREWS � PATEL, MD 10��0
t7EDItAI
3• JAMES NORTON, DPM 10.00
MEDSCAI
4 • HOLY SPIRIT HOSPITAL 25.p0
(�EDItAI
5• OMNICARE OF KING OF PRUSSIA 25� 14
PREStRIPTION
6 BETHANY VII.LAGE 4,498 � 00
RESIDENTIAL CARE
TdTAL(Also snfer on line 10,Recapilulatlon) S 4,9�6• 9 2
If mae space ts needed.ir�sert addlBaral sheets af tl�tie same size.
Rer�isia�c.to�-�a>
pennsylvania SCHEDULE J
DEPARThffNT Of REVENUE g�NEFICIARIES
INHEPoTANCETAXRETURN
RESIDENTDECEOENT
ESTATE Of: FIIE NUMBfR;
fL.IEN N • B40Z 21 Z3 0335
RELATIONSHIP TO DECEDENT AMOUNT pR SHARE
NUM@ER NAME ANQADDRESS oF PERSON(S)RECEIVING PROpERTY Dc Nct LiatTrustea�aJ QF ESTATE
I. TAXAB�E 01StRlBUTIONS Qnclude�M�dis4�utions aroi Uansfers ur�der
Sec.9f 6(a (1.2).]
1. R08ERT H . BOOZ Lineal 100.00
56 BANTA LANE
DURHAM , CT 06422
ENTER DOLLAR AMOUNTS FOR DiSTRIBU7{ONS SHOWN A60VE ON UNES 15 FHROUGH 18 OF REV-15W COVER SHEET,AS APPRtSpRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DIS7RI6UT14NS UNQER SECTION 9tt3 FOR WHIGH AN ELECTION TO TAX IS N07 TAKEN:
1�
6.CHARlTABCE AND GOVERN6AENTAl.DISTRIBUTIQNS:
1 .
TQTAL OF PAR7 Q-ENTER TOTAL NON-TAXABLE DISTRI6UTIONS ON LINE 13 OF REV-1500 COVER SHEE7. S
I#more space is needed,use additi«i�sheets�pa{�er af the s�size.