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HomeMy WebLinkAbout09-12-13 i 1505610105 REV-1500 Ex(02-11)(FI> PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN i - I - /�- Harrfsburg PA17128-o6o1 RESIDENT DECEDENT ,�� ENTER DECEDENT INFORMATION BELOW 07/30/2012 !05/19/1926 I Decedent's Last Name Suffix Decedent's First Name MI _. Mercer j Constance W ; If Applicable)Enter Surviving Souse's Information Belo ( pP ) 9 p w Spouse's Last Name Suffix Spouse's First Name Ml i i I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _ . _ I REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW QD 1.Original Return CD 2.Supplemental Return CD 3, Remainder Return(Date of Death Pr±or to 12-13-82) CD 4.Limited Estate CJ 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate CD 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) ,(Attach Copy of Trust.) C} 9.Litigation Proceeds Received ( D 10.Spousal Poverty Credit(Date of Death CD 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 TAR INFORMATION SHOULD BE DIRECTED TO: Name - Daytime Telephone Number _ Barbara White 91 99 5 -7426 , n n I­REG0 TER OF WILLS USE'ONLY First Line of Address )o- 40 1412 Nottingham DR `: 0 3 r 1 I c ' r.1 Second Line of Address r:1 CD I y GLD City or Post Office State ZIP Code DATE FILED ---- Chapel l°1111 NC 127817 Correspondent's e-mail address:.barbarawhitemd@yahoo.com 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 true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN E OF PP SON RESPONSIBLE FOR FILING RETURN DATE ADDR SIGNATURE OF PREPARER OTHER AN REPRESENTATIVE PATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) RECAPITULATION 1. Real Estate(Schedule A). ........... ... . 0.00 2. Stocks and Bonds(Schedule B) ...... .. .... ... ... .. ... ... ............. 2. lr 65,717.60 3. Closely Held Corporation, Partnership or Sole-Pro rietorshi Schedule C . ... 0.00 4. Mortgages and Notes Receivable(Schedule D)...... .. .P.......... .. . ... 3 4.1 0.00 5. Cash, Hank Deposits and Miscellaneous Personal Property(Schedule E).. . .... 222,717.20 6. Jointly Owned Property(Schedule F) r_-� Separate Billing Requested ... ... 6. w 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property`Schedule G OSeparate Billing Requested... . .... 7. V� 122,669.73 8. Total Gross Assets(total Lines 1 through 7)...... ... ..... ...... . ..... .. . 8. �- 411,104.53 9. Funeral Expenses and Administrative Costs(Schedule H).. ... ..... . ........ 9. 1I 11,451.08 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). ...... ... ..... 10. ! 20,460.80 -- 31,911.88 1 11. Total Deductions total Lines 9 and 10 ... ....... .. ... ... .. ... ....... .. . 12. Net Value of Estate(Line 8 minus Line 11) ... ... ... . I 379,192.65 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13. - an election to tax has not been made Schedule J ................ . 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) .. . .. ...... ............. 14. 1 379,192.65 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_ _ 16. Amount of Line 14 taxable -at lineal rate X.0 45 17,063.67 g 17,063.67 17. Amount of Line 14 taxable _.--_.-- at sibling rate X.12 17. 18. Amount of Line 14 taxable -'--_J ------ at collateral rate X.15 18 19. TAX DUE .. .. . .... . ...... ...... .. . . ........ ... . .. ... .... ..... . .... 19. 17,063.17 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 1505610205 REV-1500 EX(FS) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Constance W. Mercer' STREETADDRESS cto Barbara White 412 Nottingham DR ^ CITY STATE �uu ZIP Chapel Hill NC 27517 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 17,063.17 2. CreditslPayments A.Prior Payments S.Discount Total Credits(A+B) (2) 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. 5. If line t +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 17,063.17 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 ............................................ ❑ E c. retain a reversionary interest..................................................................._.................................._................... ❑ N d, receive the promise for life of either payments,benefits or care?...................................................................... ❑ 2 If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 3. Did decedent own an'in trust for"or payable-upon-death bank account or security 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 THE ANSWER TO AHY OF THE ABOVE QUESTIONS IS YES,YOU MUST COl PLETE 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 3 percent[72 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)(11)(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)1. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 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 Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1503IX+(8-12) pennsylvania SCHEDULE B T DEPARIMENTOFREVENUE INNERRANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Constance W Mercer All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION _ OF DEATH 1. Vanguard Growth Index Fund 24,260.00 2 DWS Investments 41,457.60 1 TOTAL(Also enter on Line 2, Recapitulation) $ 65,717.60 If more space is needed,insert additional sheets of the same size REV-1508 EX+(o8-iz) _ IVpennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Constance W. Mercer Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule R ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. HAPO Savings 10.29 2 HAPO 48 Month Certificate of Deposit 32,687.60 3 Mars Bank Savings 1000396577 5,332.19 4 Mars Bank Checking 1000251331 23,220.00 5 Mars Bank Certificate of Deposit 1000283994 83,889.20 6 Mars Bank Certificate of Deposit 1000348361 10,873.82 7 Mars Bank Certificate of Deposit 1000370933 43,179.30 8 Mars Bank Certificate of Deposit 1000456305 22,703.80 9 PSERs death benefit 137.00 10 Reimbursement from Vincentian regency for unused days 576.00 11 Reimbursement from Metropolitan Life for overpayment 108.00, TOTAL(Also enter on Line 5, Recapitulation) $ 222,71720 If more space is needed, use additional sheets of paper of the same size. G REV-1510 EX+ (08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE RETURN RESIDENT TDECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Constance W/Mercer FILE NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER INCLUDE THE NAME OFTHE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Fidelity and Guaranty Life Insurance(annuity) 58,455.52 100 58,455.52 2 New York Life Insurance and Annuity Corp(annuity) 64,214.21 100 64,214.21 TOTAL(Also enter on Line 7, Recapitulation) $ 122,669.73 If more space is needed,use additional sheets of paper of the same size. r REV-1511-Ex+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENT`E DECEDENT RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE Of Constance W. Mercer FILE NUMBER Decedent's debts must be reported on Schedule I. ITEM. NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES:1. Weischedel Florists 85.60 Fred Donatelli Cemetary Memorialsm cehck 377 4,475.00 Hampton Presbyterian Church,check 381 800'00 Herbert R.King Jr.Funeral Home,check 380 2,503.60 Hopewell Hebron Grave and Custer's grave preparation,checks 378 and 379 7_65.00 Barbara White-Meal expenses for funeral preparation 30.88 Clndy Tomazich-reimbursemnt forgrave digging 300.00 B. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State—zip Year(s)Commission Paid: Z. Attorney Fees: 2,500.00 3• Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) t Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. I� TOTAL(Also enter on Line 9, Recapitulation) $ 11,451.08 If more space is needed, use additional sheets of paper of the same size. REV-1512 Ex+(12-12) pennsytvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT' ESTATE OF FILE NUMBER Constance W. Mercer Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM i VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1- Payments for nursing home care 6,218.00 2 Payments for long term health care insurance and Medicare insurance 777.40 3 Taxes and tax preparation 319.00 4 Payments for personal expenses 13,061.40 5 Dental Expenses 85.00 6 7 8 9 10 t TOTAL(Also enter on Line 10, Recapitulation) $ 20,460.80 If more space is needed,insert additional sheets of the same size. --------- REV-1513 EX+(01-10) in pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: Constance W. Mercer FILE NUMBER: NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE ( ) Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] I Wayne White,822 Carquinez Way,Martinez,CA 94553 Child 20% 2 Barbara White,412 Nottingham DR.Chapel Hill,NC 27517 Child 20% 3 Martha Hunkele,2912 Cavey Crest Circle,Allison Park,PA 15101 Child 20% 4 Cynthia Tomazich,2547 Red Oak CT,Allison Park,PA 15101 Child 20% 4 Wallace White,5018 Hardt RD,Gibsonia,PA 15044 Child 20% i t 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: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: e TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $ 0 If mare space is needed,use additional Sheets of paper of the same size.