HomeMy WebLinkAbout07-18-13 , � Lsos61o1os
REV-1500IX(m-ia)(Fl)�
OFFICIAL USE ONLV
PA Department of Revenue VM�Y��e^�a Coun Code Year Fle Number
w.u.�d,�n.0
eureauofIndiWduat7axes �NHERITANCE TAX RETURN � "
PO BOX z8o6o1 / �
Harrisbum,PA 191z8-O6o1 REStDENT DECEDENT �I ��I� ' � ���C7LJ . i
ENTER DECEDENT INFORMATION BELOW
Social Sacudty Number Date of Death MMDDYYYY Date of Birth MMDDVYYV
. ... .. . _... .. ... _ _._.__ .
01/28/2013 06/02/1929
DecedenPs Last Name � Sufix ��DecedenPs First Name ��� MI
..____. ._ __.. .._.,.
. _.,.__._. . ._._ .___.. ..._
..._.�___..._..._._ ..._...
Harm Patricia -.--_ ,G
pf Appliuble)Enter Surviving Spouse's�lnformallon Balow ... .. . . .... . .. . ... ..... .... ... ... . :
Spouse's Last Name ........ ... Su1fiz Spouse's First Name MI
SPQuse's Social Sewrfty Number . ._.. . . ... .. _ ' ���. .... . .__ _...._ _.... ...
" THIS RETURN MUST BE FILED IN DUPLICATE WfTH THE
____ __ REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original ReWm O 2.Supplementel Retum O 3. Remainder Return(Date of Death
Priorta 12-13-82)
p 4. Limited Estate O 4a.Future Interest Compromise(dare af O 5. Federel Estate Tax Retum Required
death after 12-12-82)
O 6.Deceden[Died Testate O 7.Decedent MaiMained a Living Trust _ 8. Totel Number of Sefe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. LiHgatbn Proceeds Received O 70.Spousal Prnerry Credit(Date ot Death O 11. Election to T�under Sec.9113(A)
Belween 12-31-91 and 7-1-95) (Attach Schedule O)
CORRESGONDENT- iH18 SECTpN MU3T BE COMPLETED.ALL CORRESPONDENCE AND CONFlDENTWL TAX INFORMAiION SNW LD BE dRECTED T0:
Name. .. . .. .. ._.... _..._ ._. _ ._ .. . __... Daytime Telephone Number
. ,_,.._.._._..._...._., .. .___.__. . ..._..
Mark T. Silliker, Esquire �(717)C�1-1500 -: �
__ _ -- --_.__ ,_ .— :'
— < — -�---___"_ s.n �?__.
R ZYI!pF YV�� L8E `F-�
��' - LFY '.O
m � C: � _e C7
FirstLineofAddress � r" rri-, F�J r`� i�'�
_,......_ _._ .__.._._ .... ..._._..__.__. .... . .__.____ � c0 ;;�, t,�7
5922 Linglestown Road � °'- � c� :>
�
__.... ' ° �'' <`• � -' --i
SecondLineofAddress ..... . . . . ...... ...... �, �, .�� . - .
._. .___ _... .. ...__.. .__. ...._ ,;., c� ' �._. :: r:�
. . �:o t.__ - t�i
_ _
_.... . _ ._.._.._�. __.._...__. t; �,.1 C�
� ��� �-� DATEFILE6
Cky or Post Otfice ..... Stete ZIP Code '_ `.
Harrisburg PA 17112
ComspondaM's e-mall addnss:
Untler panaltlas ot perjury,I dedere that I hew ezeminad thN Mum,inGudhq acoornpenying echedulee arM atatemenb,end b the besl 01 my knowletlge anC helief,
k Is true,cotrec[aM oDmplete.Declarelion d prepaier other then the penonal repreaenfaWe Is besed on all Inbrmetbn of whk�O��rer hae any knoxiedge.
SI OF PERSON RE SIBLE F FILI RE'�'URN pq7f
� �
AD S
Ti r Chase Drive, Mechancisburg, PA 17050 �r r I/�
S TURE OP PREPARE RE q
_ ri���'��(� � DA� , /
ADDRESS
5911 �; ,y /��,,,, ,. �,l . �, ��. � �l,. , i°. � � //L
' PL EE US6 OR161NAL FORM NLY
Side 1
� 15056101U5 1505610105 �
\`i 1�✓
\D'
_
� 1505610205
REV-1500 EX(FI)
Decadent's Sociat Security Number
o�aeora Na�: Patricia G. Harm ;
RECAPRULATION
,.. ..._. .._._ ...... .._.
1. Real Estate(Schedule A). .... ........ ........ .. . ......... . ....... . . . . 1. � ...�.
2. Stocks and Bonds(Schedule B) .... ........ . . . .... .. . . ....... . . ....... 2. � .
�-�. _...._....___...__.___.....
3. Gosely Held Corporation,Partnership a Sole-Propdetorship(Schedule C) ..... 3. i !
4. Mortgages and Notes Receivable(Schedule D).. . . .. . .. . ....... ....... . .. 4. i
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). ...... 5. ' S,509.43 i
_.. m .
6. Jointly Owned Property(Schedule F) O Separete Billing Requested ... . . . . 8. �' �'
_._..._ ___._... . _._. __ __._..
7. Inter-Vivos Trensfers 8 Miscellaneous Non-Probate Property ��� .
(Schedule G) O Separete Billing Requested... ... .. Z '�
� _.,�._.__ _.......___._.....m...._.._�
8. Tohl Groas AsNts(total Lines 1 through 7). .. .. . . . .......... ... ........ 8. i 5,509.43 :
I
9. Funeral Expenses and Administretive Cos4s(Schedule H)..... . ....... . ..... 9. ' 1,42$.50
. ..,. ___...._.....__.._.._.,
10. DebS of Decedent,Mortgage Liabilities and Liens(Schedule I)..... . ....... .. 10. i 879.26 ;
. . ..,w..___ ...__. ..__. .
1t Total Deduetlons(total Lines 9 and 10)... . ..... .. . ............ ..... . .. . 11. � $�$�Z.76 ���.
....-m..�,_______..__._. ..__._____..___._._.
12. Net Valus of Eshb(Line B minus line ii) .... ...... .. ... ....... . . ...... 12. !� 3,206.67 '.
13. Charifable and Govemmenfal BequestslSec 9113 TrusGS tor which "�"'�"""'�"° '"�'�`"""""° ��"i
an etection to tax has not been made(Schedule J) .. ... .......... ...... . .. 13. I 500.00 '
.� ...._....
14. Net Vslua Sub)eet!o Tax(Line 12 minus Line 73) ....... . .......... ...... 14. �I Y��.$� '
TAX CALCULATION-SEE INSTRUCTION$FOR APPLICABLB RATES
15. Amount of line 14 taxable
at the spousal tax rete,or
VansfersunderSec.9116 �� ".___--_----_ .,..,__._. . .__ .. _...
. ...._._ _._.__.. ..____
(a)�12)X.0_ i . 15. �� ��
16. AmountoiLinel4texeble -.--.--.-_ .....__. _._,...,.. _� .._.._._...............w_ . .. .._--._ ...-.---
at lineal rate X.0 4�` 2,706.67 �6. ; 121.80 !
17. Amount of line 14 faxable � .� ..�.�--�---...........� � ...... .. `" !
at sibling rete X.12 � � �7. ;
..........__._ .___.._._- --�..,..._.._ ..__� �._...___..__ ...._._..._.. __.__... __
18. Amount of Line 14 taxable ' , ,
at collaterel rate X.15 �'�� �g, �.. �
,...�._._-.._...,�.�.�..._.,,-......_..�.,......m.: .,.......
19. TAX DUE ... .. ........ . ....... ........ ... .. .. . .......... .. . .... ... 19. � �Z�.� i
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
$ide 2
L 1505610205 1505610205 �
REV-7500 EX(FI) Page 3 File Numb9r
DecedenYs Complete Address:
DECEDENTS NAME
Patricia G. Harm
STREETADDRESS
20 North 12th Street,Apt. 123
CIN STATE ZIP
Lemoyne PA 17043
Tax Payments and Credits:
t. Tax Due(Page 2,Line 79) (�) 12� gp
2. CreditslPayments
A.Prior Payments
B.Discount
Total CrediS(A+B) (2)
3. Interest
4. If Line 2 is greater than Line 1 +Line 3,enter ihe dilference. This is ihe OVERPAYMENL (3)
Fill In oval on Pape 2,Lina 20 to request a rePond. (q)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 121.80
Make check payable to: REGISTER OF WILLS,AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedem make a trans�er and: Yes No
a. retain the use or income of the property transferted.......................................................................................... ❑ �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. refain a revarsbnary interest .............................................................................................................................. ❑ �
d. receive the promise for life of eiNer payments,benefifs or care?...................................................................... ❑ �
2. If death occurted after Dec.12,1982,did decedent transfer propeAy within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an'in trust fof'or payable-upondeaM bank account or securily at his or her deaM?.............. ❑ �
4. Did decedeM axn an individual retirement account,annuity w other non�probate property,which
containsa beneficiary designatbn? ........................................................................................................................ ❑ �
If THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU NUST 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,fhe tax rate imposed on the net value of Vansfers to or for the use of Me 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 iransfers to a fa the use of ihe survivirg spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)].The statute dces not exempt a transfer to a surviving spouse from tax,and the stalutory requirements for disclosure of assets and
filing a tax retum are still applicaMe even'rfthe surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
. The tax rete imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or fw the use of a naturel parent, an
adoptive parent or a stepparent of fhe chiW is 0 percent(72 P.S.§9116(a)(12)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenPs lineal beneficiaries is 4.5 percent,except as rated in(J2 P.S.§9116(a)(1)).
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,
under Secfion 9102,as an individual who has at least one parent in common with the decedent,whether by blood a adoptlon.
REV-i5�8IX+(o8-u)
• �pennsylvania SCN�pULE E
DEPARTMENTOFREVENUE C�H� BANK DEPOSITS & MISC.
INHERfTANCETA%RENRN PERSONAL PROPERTY
RESIDENT DECEOENT
ESTATE OF: PILE NUMBER:
Patricia G. Harm 2013-00160
Include the proceeds of Iitlgation and the date the proceeds were received by the esUte.
All property joiMly owned wkh right of survivorship mus[be dbclosed on Schedula F.
�M VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Suequehanna Bank checking account#5400631009 4,425.43
p. Refund from Manor Care 584.00
3. Miscellaneous personal property 500.00
TO7AL(Also enter on Line 5, Recapitulation) ; 5,509.43
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
. �pennsylvania SCHEDULE H
UEPRFTMENTOFqEVENUE FUNERAL EXPENSES AND
]NHERITFNCETA%REN0.N ADMINISTRATIVE COSTS
RESIOENT DECEDENT
ESTATE OF FILE NUMBER
Patricia G. Harm 2013-00160
Uecedant's dabb must be rcporhd on Schedula I.
ITEM
NUMBER DESCRIVRON AMOUNT
n. FUNERAL EXPENSES:
1' Funerel meal 378.00
2. Memorial service supplies 132.00
3. Royersflowers 35.00
a. Pastor's fee 100.00
s. OrganisPs fee 100.00
s. Funeral Labor 75.00
e. ADMINISTRAAVE COSTS:
1. Personal RepresenWtive Commissions:
Name(s)of Personal Representative(s)
Street Address
Ciry State_ZIP
Year(s)Commission Paid:
Z• Attomey Fees:
450.00
3. Family Exemption:(If decedent's address is not the same as daimant's,attach explanation.)
Claimant
Street Address
City State 2IP
Relationship ofClaimant to Decedent
4• Probate Fees: 148.50
5. Acauntant Fees:
6. Taz Retum Preparer Fees:
� EsNate checking acoount fee 5.00
TOTAL(Also enter on Line 9, Recapitulatlon) ; 1,423.50
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+ (12-12)
� �pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCE TPl(REfURN MORTGAGE LIABILITIES & LIENS
NESIDENT OECEDENT
ESTATE OF FILE NUMBER
Patricia G. Harm 2013-00160
Report debts ineurred by the dacadent prlor M darifi that romainad unpald at the date of daalh,Including unrofmbuned medlaal expansea.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Comcasl 43.52
2. ConsumerCellular 96.48
3. Capital Blue Cross 153.80
4. Manor Care 120.00
5. Pinnicle Health Emeigenq 33.38
6. West Shore EMS 81.16
7. Heartland Pharmacy 145.45
e. Or.Darryl Guislwite 181.92
9. ConsumerCetlular 23.55
TOTAL(Also enter on Line 10, Recapitulation) # 8�9•Z6
If more space is needed,insert additional shee[s of the same size.
REV-1513 EX+(01-30)
• �pennsytvania SCHEDULE �
INHERITANCETr1X REN0.N BENEFICIARIES
0.ESI�EM OECEDENT
ESTATE OF: FILE NUMBER:
Patricia G. Harm 2013-00160
RELAT[ONSHIP TO DECEDENT AMOUNT OK SHARE
NUMBER NAME AND ADDRE55 OF PERSON(S)RECEIVING PROPERTY Do Not Lirt TruttN(t) OF ESTATE
I 7A)(ABLE DISTR[BUT[ONS[Include outright spousal dlsMbutions and transfers under
Sec.9116(a)(11).]
1• Stad Bias, 136 Grimm Lane,Middletown,PA 17057 Granddaughter 25%
2. Keni L.Atticks, 1801 North Second Street,Hartisburg,PA 17101 Grenddaughter 25%
3. Jacqueline L.Smith, 1506 Timber Chase Drive,Mechanicsburg PA 17050 Daughter 50°h
EN7ER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18 OF REV•1500 LOVER SHEEf,AS APPROPRIATE.
« NONdAXABIE DISTRIBUf10N5 - �
A. SPOUSAL DISTRIBUT10N5 UNDER SECf10N 9113 FOR WHICH AN ELECfION TO TAX IS NOT TAKEN:
1.
B. CHARRABLE AND GOVEkNMENTAL DISTRIBUTIONS:
I.
St.Michaei's Lutheran Church,Hartisburg,PA 500.00
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SMEEL � 500.00
If more space is needed,use additional sheets of paper of the same size. �
. __. ... . . ._ ... .