HomeMy WebLinkAbout09-20-13 (2) REV-1500 EX (n2-11)(R) 1505610140
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 9 2 8
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 5 0 7 2 0 1 3 1 0 0 9 1 9 2 1
Decedent's Last Name Suffix Decedent's First Name MI
E D M I S T 0 N C 0 R B I N A
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
N 1 A
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1.Original Return ❑ 2.Supplemental Return 3.Remainder Return(Date of Death
Prior to 12-13-82)
n 4.Limited Estate ❑ 4a.Future Interest Compromise(date of 5.Federal Estate Tax Return Required
death after 12-12-82)
Q 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
9.Litigation Proceeds Received 10.Spousal Poverty Credit(Date of Death 0 11.Election to Tax under Sec.9113(A)
Between 12-31.91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
J E D W A R D B E C K J R 7 1 7 2 6 4 1 1 1 0
REGISTER OF WILLS USE ONLY
First Line of Address h
c- n
C>
Second Line of Address :
L.
=L..
1 0 3 5 W A Y N E A V E N U E " ro
City or Post Office State ZIP Code HATE FILED '
D
C H A M B E R S B U R G P A 1 7 2 0 1
Correspondent's e-mail address: EBECKPa7KKFB.COM ry
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is hue,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
GNA URE�OF PERS)'/j Nvj2E 6NS16_ LE FOR F iy!NG RETURN / 2 1
vADDRESS COA//4/fGL//ll(/�r/lr//.•Y�rrvrsl_NY r_�/� W
117 FEATHERDALE CIRCLE FAYETTEVILLE PA 17222
SIGNAN„BEyF P PA R THEF;.TH N R RESENTAT�IA}7,j;- Q J/ TE}/-
ADDRELSS
1035 WAYNE AVENUE CHAMBERSBURG PA 17201
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
1505610240
REV-1500 EX(Fl) Decedent's Social Security Number
13ecedervrstfame: CORBIN A. EDMISTON
RECAPITULATION
1. Real Estate(Schedule A) ...... .......... 1
2. Stocks and Bonds(Schedule B) . .. . . ... .. .. .... . .. ...... .. ... .. .. .. . . 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0 . a G
4. Mortgages and Notes Receivable(Schedule D) , .. ... .. .. ..... . 4,
5- Gash,Bank Deposits and Miscellaneous Personal Property(Schedule E). 5. 1 5 2 3 0 . 3 8
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested 6. 9 7 8 • 5 6
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) [:] Separate Billing Requested ....... T
8. Total Gross Assets(total Lines 1 through 7) . .. .. . .... ....... ... ..... .. 8. 1 6 2 0 8 • 9 4
9. Funeral Expenses and Administrative Costs(Schedule H) .........__ 9. 1 1 1 5 . 0 0
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . .. .. . .. ..... 10. 3 1 5 1 . 2 5
11, Total Deductions(total Lines 9 and 10) ............... ................ 11, 4 2 6 6 . 2 5
12. Not Value of Estate(Line 8 minus Line 11) . .. .. . .... . . . ..... . . .. .. .... 12. 1 1 9 4 2 . 6 9
13. Charitable and Governmental BequestsiSec 9113 Trusts for which
an election to tax has not been made(Schedule J) ... .... ... ...... 11
14. Net Value Subject to Tax(Line 12 minus Line 13) ..... .... ...... .. ..... 14. 1 1 9 4 2 6 9
TAX CALCULATION•SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(aXI.2)X.0 - 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.045 1 1 9 4 2 . 6 9 16. 5 3 7 . 4 2
17. Amount of Line 14 taxable
at sibling rate X.12 11 . ❑ 0 17. 0 . 0
18. Amount of Line 14 taxable
at collateral rate X.1 5 0 . 0 0 18. 0 • 0 0
19. TAX DUE ........ ...__.. ... .. .............. ....... 19. 5 3 7 - 4 2
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240
'REV-150A'EX(FI) Page 3 File Number
Decedent's Complete Address: 21 13 0928
DECEDENT'S NAME
CORBIN A. EDMISTON
STREET ADDRESS
101 NORTH PRINCE STREET
APARTMENT 213
CITY STATE ZIP
SHIPPENSBURG PA 17257
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 537.42
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 537.42
Make check payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred ...................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ Q
c. retain a reversionary interest ..................................................................................................... ❑
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ ❑X
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ ❑x
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designator?.................................................................................................. ❑ n
IF THE 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 is
is 3 percent 172 P.S.§9116(a)(1.1)(i)].
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 does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing 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 transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent,except as noted in V2 P.S.§9116(a)(1)).
• The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent[72 P.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.
i
REV-1509*EXt(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
CORBIN A. EDMISTON 21 13 0928
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properly jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CHECKING ACCOUNT#488631 AT MEMBERS 1ST FEDERAL CREDIT UNION 5,056.61
2. SAVINGS ACCOUNT#488631 AT MEMBERS 1ST FEDERAL CREDIT UNION 8,924.84
1 COMCAST- REFUND 79.86
4. VISA-REFUND 1118
5. EPISCOPAL SQUARE-REFUND 581.00
6. NET PROCEEDS FROM SALE OF PERSONAL PROPERTY AT KENNY'S AUCTION 470.92
7, NATIONWIDE,INSURANCE- RENTER'S INSURANCE REFUND 77.00
8, WEST PENN POWER, REFUND ON UTILITY BILL 28.97
TOTAL(Also enter on Line 5,Recapitulation) $ 15,230.38
If more space is needed,use additional sheets of paper of the same size.
REV-1505 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CORBIN A. EDMISTON 21 13 0928
If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule O.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. DONALD EUGENE EDMISTON 117 FEATHERDALE CIRCLE SON
FAYETTEVILLE, PA 17222
I 8.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER, ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTEREST
1. A. 12/1999 CHECKING ACCOUNT WITH MIFFLIN COUNTY 1,957.11 50. 978.56
SAVINGS BANK
TOTAL(Also enter on Line 6,Recapitulation) $ 978.56
If more space is needed,Use additlonal sheets of paper of the same size.
REV-1649 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CORBIN A. EDMISTON 21 13 0928
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. DONATION TO TRINITY LUTHERAN CHURCH, MCCLURE, PA FOR LUNCHEON 100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
StreetAddress
City State ZIP
Year(s)Commission Paid:
2, Attorney Fees: KELLER, KELLER&BECK 1,000.00
3. Family Exemption:(If decedents address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 15.00
5 Accountant fees:
8. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 1,115.00
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX-(12-12)
pennsylvania SCHEDULE 1
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CORBIN A. EDMISTON 21 13 0928
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
I. SHIPPENSBURG EMS-AMBULANCE BILL 100.00
2. WEST SHORE EMS-AMBUALNCE BILL 983.70
3. PENELEC- ELECTRIC BILL 51.51
4. CHAMBERSBURG HOSPITAL-OUTSTANDING HOSPITAL BILLS 1,139.44
5. COMFORT KEEPERS-IN HOME CARE 45.00
6. SUMMIT PHYSICIANS SERVICES, BILLS, DEMATOLOGY 831.60
TOTAL(Also enter on Line 10,Recapitulation) $ 3,151.25
If more space is needed,insert additional sheets of the same size.
REV4513."cXt{et-16}
pennsyivania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
CORBIN A. EDMISTON 21 13 0928
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
i TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under
See.9116(a)(1.2).j
1. DONALD EUGENE EDMISTON Lineal
117FEATHERDALE CIRCLE
FAYETTEVILLE, PA 17222
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-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
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