HomeMy WebLinkAbout11-08-13 (2) REV-1500 EX(m-11)(FI)is 1505610105
OFFICIAL USE ONLY
PA Department of Revenue pennsytvania
Bureau of Individual Taxes `` County Code Year File Number
INHERITANCE TAX RETURN q
PO BOX 28o6o1l.
Harrisburg PA 17128-0601 RESIDENT DECEDENT 1 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMODYYYY
12/22/2012 08/02/1944
Decedent's Last Name Suffix Decedents First Name MI
....... _.,
KOUGH JULIE A
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
t?................ _....... ............. .. . ...... .. ...... ... ..... ....... .. ._.... _ _..
KOUGH JR ROBERT W
............ ..................... _ .. ...:.. .....
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
197-40-5272 REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
CND 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6.Decedent Died Testate O 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 O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule t5}:, -�7 fi
n.
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMIMN SHOULD BE.............................. i�CTE 1:p
Name .. ...... .. .. ............ .... Daytimeleone Num ... _ ......�. .....
. ...I......
LISA M. GRAYSON (717) V547
.. ........ ,-..................... , ..
RE STE_kO� YILLS USE ON .
C7 C7 c>
FirstLine of Address ..........................................._....................._.........................._......................._........................................................................_............................., G -Y t �� t
11 SHERATON DR
N us
Second Line of Address
........................................._._....................,............................._...............................................,..........................................................................................,............................................ DATE FILED
City or Post Office State ZIP Code
.„ . ....... ..,, .._...
CARLISLE PA :17013
Correspondent's e-mail address:LMGJAG GMAIL.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.DeclAratiq of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG T E F E S S 51 FOR FILING RETURN D TE
1I g t 3
ADD ESS
34 PEACH ORCH D DR, NEWVILLE, PA 17241
SIGNATURE OF PRE A OTHER THAN REPRES THE ATE
ADDRE4S
11 SFTERATON DR,CARLISLE 013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
lJ'�
J 1505610205
REV-1500 EX(FI) Decedent's Social Security Number
............__...............................
...................................._...,........_._....,
:
Decedent's Name:
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.
4. Mortgages and Notes Receivable(Schedule D)........................... 4.
........................_...........,.....,.....................................,.............................................
.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 3,300.00
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property i
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7)............................. 8. 3,300.00
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 18,704.05
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 30,680.78
11. Total Deductions(total Lines 9 and 10)................................. 11. 49,384.83
_.._............._............................................_...._........,...................
..._..,............;
12. Net Value of Estate(Line 8 minus Line 11).............................. 12. 1 -46,084.83
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........................ 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) ..........I............. 14. 0.00
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_ 15.
_..__,..._.,..._. .._._._._.........,... _._.,.......__....._..__...._...............
...._.__.................................
16. Amount of Line 14 taxable
at lineal rate X.0_ 16•
_.__._...._.__._.._..._...,..._..........__..__..........
.............. .__- .....__................... ......._.........,
17. Amount of Line 14 taxable
at sibling rate X.12 17•
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
JULIE A. KOUGH
STREETADDRESS
34 PEACH ORCHARD ROAD
CITY STATE ZIP
NEVWILLE PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credfts/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3) 0.00
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) 0.00
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.......................................................................................... ❑ E
b. retain the right to designate who shall use the property transferred or its income............................................ L1 N
..
c. retain a reversionary interest............................................................................................ ................................ ❑ 0
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 ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
-�.r . ,* ��"�.. `���-•°� ,,,. � .,. >:�%� ,..fit':�.'���,,, �Ta.�,r`:-s'
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)(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 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 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-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JULIE A. KOUGH 2012-00219
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 F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 2004 DODGE INTREPID,VIN: 2B3HD46R44H620938 KELLY BLUE BOOK DOD VALUE 3,000.00
2. 1997 DODGE INTREPID,VIN 2B3HD46FXH737513 KELLY BLUE BOOK DOD VALUE 300.00
TOTAL(Also enter on Line 5,Recapitulation) $ 3,300.00
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (08-13)
pennsylvania SCHEDULE H
o H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JULIE A. KOUGH 2012-00219
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' EWING BROTHERS FUNERAL HOME 8,604.12
2. WESTMINSTER CEMETARY,PLOT AND HEADSTONE 9,059.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
500.00
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address —
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 238.50
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. THE SEINTINEL-ADVERTISING 227.43
8. CUMBERLAND LAW JOURNAL-ADVERTISING 75.00
TOTAL(Also enter on Line 9, Recapitulation) $ 18,704.05
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+ 12-12)
Is- pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JULIE A. KOUGH 2012-00219
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
1. ORRSTOWN BANK HOME EQUITY LOAN#160037832 3,781.04
2. M&T CREDIT SERVICES,LLC LOAN#97702980001 26,899.74
TOTAL(Also enter on Line 10, Recapitulation) $ 30,680.78
If more space is needed,insert additional sheets of the same size.