HomeMy WebLinkAbout11-08-13 (2) REV-1500 EY t0e-11)(Fn 1505610140
OFFICIAL US_E ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO Box 280601 2 1 1 3 0 8 1 8
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death iMMDDYYYY Date of Birth MMDDYYYY
0 7 0 1 2 0 1 3 0 3 2 4 1 9 2 6
Decedent's Last Name Suffix Decedents First Name MI
H A R T E R E L I Z A B E T H F
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouses First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1.Original Return Q 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)
6.Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust 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 ® 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 tpgber
DAV '1 D W . REAGER 7 � b76' 983
Tt of s U qH
y r- rn rn
rn CO �0 t=
First Line of Address
2331 MARKET STREET <=>
Second Line of Address rV rte—
City or Post Office State ZIP Code DATE FILED }
CAMP HI L L PA 1 7 0 1
Correspondents e-mail address- DWREAGER@REAGERADLERPC.COM
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my kno Medge 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.
SIGNATURE OF ERSON RESP L FO ING RETURN DAT
// 2-1'Lb J
1
ADDRESS
10 VICKSBU G C09RT MECHANICSBURG PA 17050
SIGNATURE OF PR E AN REPR THE DA E 7
i
ADDRESS
2331 MARKET STREET CAMP HILL PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140
1505610240
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's-Name ELIZABETH F. HARTER.
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. 7 5 1 3 . 4 8
6. Jointly Owned Property(Schedule F) ❑ Separate-Billing Requested....... 6.
7..Inter Viv6s.tTtansfers:&-Miscellaneous Nor probate Property. .
{Schedule G) U Separate Billing Requested....... 7.
8:, -Total Gro§s Assets(total Lines 7) .....:....:................. 8. 7 5 1 3 4 8
9. Funeral Expenses and Administrative Costs(Schedule H) .................. 9. 1 3 7 2 1 . .3 1
16. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ............. 10. 2 3 7 9 . 0 6
11. Total.Deductions(total Lines 9 and 10) ........ ,,,,,,,,,,,,,,;,, 11. 1 6 1 0 0. 3 % '
12. Net Value of Estate(Line 4,rninustine 11) ..........: 12. - 8 5 8 81,9
13. Charitable and Governmental"bequests/Sec 9113'Trusts for which
an election jo tax'has not been made(Schedule J) ...................... 13. ,
14. Net Value:Subject,to Tax,(Line 12.minus Line 13) ... 14. - 8 5 $ 6�. •8 9
w TAX CALCULATION=-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14-:taxable
at the spousal tax,rate,or
transfers under Sec.9116
(a)(i2)xzo
0 . 0 0 15. 0'.. 0 0
16. Amount of line-114-taxable
at lineal rate X:0451 0.• 0 0 16. 0. 0 0
17. Amount-of.Line 14::taxable
of sibling rate x A 2 0 . 0 0 17. Q, Q Q
18: ,Amount of Line:14taxable
at collateral rate X.'i5 0 .. 0 0 18. Q :0 Q
19. TAX DUE .............. .................................. 19. 0... 0. 0.
20 FILL IN THE OVAL IF YOU.ARE'REQUESTiNG A'REFUND-'OF AN OVERPAYMENT ❑
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Side 2
1505610240 1505610240
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REV-i508 EX+(08-12)
pennsylvania SCHEDULE E
OEPAR'rMENTOF'REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ELIZABETH F. HARTER 29 13 0898
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. WELLS FARGO-CHECKING ACCOUNT 4,846.22
PO BOX 6995
PORTLAND, OR 97228-6995
2. VANITY FAIR PENSION 43.00
3. FIRST ENERGY PENSION 873.26
4. PERSONAL'PROPERTY 250.00
5. SOCIAL SECURITY 1,501.00
-- -
TOTAL.(Also enter on Line 5,Recapitulation) $
7,513.48
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10.09)
pennsylvania SCHEDULE H
DEPARTIVIENTOFREVF14UE FUNERAL EXPENSES AND
INHERITANCE
ESID RESIDENT EDEN TURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF _ -
FILE NUMBER
ELIZABETH F. HARTER 21 13 0818
Decedenfs debts must be reported on Schedule i.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
I.. BEAN FUNERAL HOME 9,585 42
2. ANTHONY'S TRATTORIA-FUNERAL LUNCH 1,250.26
3. ST. PAUL'S CHURCH- FEE FOR SERVICE 175.00
4. OFFICE MAX-FUNERAL DISPLAY MATERIALS 102.13
B. ADMINISTRATIVE COSTS:
1. Personal'Representative Cornrnissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Years)Commission Paid:
2. AffomeyFees: REAGER&ADLER, PC 2,500.00
3. fairy 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 108.50
5 Accountant Fees:
6. Tax Return PreparerFees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 13 721.31
II more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsyivania SCHEDULE
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ELIZABETH F. HARTER 21 13 0818
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. FINAL RENT-ESSEX HOUSE/HOLIDAY RETIREMENT CORP. 1,612.50
2. DISPOSAL FEE-1-800-GOT JUNK 384.00
3. FINAL PHONE BILL VERIZON 26.24
4. USPS-MAIL 1.00
5. AMEDISYS 30.00
6. VISA BILL-WELLS FARGO 250.32
7. MEDICAL BILL PENN STATE HERSHEY 75.00
TOTAL(Also enter on Line 10,Recapitulation) $ 2,379.06
If more space is needed,insert additional sheets of the same size.
REV-1513 EX*(01-10)
pennsyivania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ELIZABETH R HARTER 21 13 0818
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not LlstTmstee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).)
1. KEVIN M. HARTER Lineal
10 VICKSBURG COURT
MECHANICSBURG, PA 17050
2. RICHARD D. HARTER Lineal
146 BROWNBACKS CHURCH ROAD
SPRING CITY, PA 19475
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
11. 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 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.