HomeMy WebLinkAbout11-26-13 J 15os61a1o5
REV-1500 EX`°z_1',�FI, �
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN .r� 2 �j (�
PO BOX 28o6oi RESIDENT DECEDENT �^� � J �/`��
Harrisbur ,PA i�lz8-o6oi
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY
161-58-7847 02262013 07201970
DecedenYs Last Name Suffix DecedenYs First Name MI
Chase Kenneth W
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's 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. Originai Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
p 4.Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
� 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.)
O 9. Litigation Proceeds Received O 10.Spousai Poverty Credit(Date of Death O 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 T0:
Name Daytime Telephone Number
Nancy Stalker 717�5-1489 �;�; � �
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� ER OF NAELS�L.
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(�-- _..;. t-a'7 G.�i r�,)
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First Line of Address �M,� E,? � G ,
16 Warwick Circle `=' ��� � -'' «'' �
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,.`� ''�„_."r - ..,..... .
Second Line of Address '• ` ` '
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'_�. �,1�, C.i
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r DATE I ED "�'i
City or Post Office State ZIP Code
Mechanicsburg Pa 17050
Correspondent's e-mail address: I1StaIke�07 verizon.net _
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 knowiedge.
SIL��Y%�-OF PERSON R SPOI�IB�E FOR FI�ING RETURN DATE
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ADDRESS � �,�j
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
� ],505610105 1505610105 �
1
J 1505610205
REV-1500 EX(FI) Decedent's Social Security Number
oe�ede�c�s Name: Kenneth Wayne Chase 161-58-7847
RECAPITU�ATION
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(Scheduie D) . . .. . . . .. . . . .. . . . .. . . . ..... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . . . . 5. 18679.14
6. Jointly Owned Property(Schedule F) O Separate Biliing Requested . . . . .. . 6.
7. inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G} O Separate Billing Requested... .. . .. 7.
8. Total Gross Assets total Lines 1 throu h 7 .. . . . s. 18679.14
� 9 }... .. . . . .. . . . ...
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . .. . . . . .. . . . 9. $$49•9�
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). . . . . . . . . . . . . .. 10. 6932.65
11. Total Deductions total Lines 9 and 10 11. 15782.62
( ). .. . . . . . . . . . .. . . . .. . . . . . . . . . . . . . .
12. Net Value of Estate(Line 8 minus Line 11) . . .. . . . .. . . . .. . . . . .. . . . .. . . . .. 12. 2896.52
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) . .... . . . .. . . . .. . . ... . . . . 14. 2896.52
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 130.34
at lineal rate X.0 45 2896.52 �6.
17. Amount of Line 14 taxable
at sibling rate X.12 ��
18. Amount of Line 14 taxable
at collateral rate X.15 18 '
19. TAX DUE . . . ... .. . .. . . . .. . . . .. .. . . .. .. . . . .. . .. .. . .. . . . . . .. . .... . . . 19.
130.34
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0
Side 2
� 1505610205 15056102�5 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Kenneth Wayne Chase
STREET ADDRESS
438 Water Street
_..... _ --
_..__—-- —
_ _. ___ __—._...
_..--- r --_ _ —
CITY STATE i Z�P
New Cumberland Pa 17070
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 130.34
2. CreditslPayments
A.Prior Payments _
B.Discount
Total Credits(A+B) (2) 0
3. Interest
(3} 0
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fiii in oval on Page 2,Line 20 to request a refund. (4) 0
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 130.34
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 .......................................................................................... � �
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ �
c. retain a reversionary interest .............................................................................................................................. ❑ �
d. receive the promise for life of either payments,benefits or care?...................................................................... � �
2. If death occurretl after Dec.12, 1982,did decedent transfer propeRy 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
containsa beneficiary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUE5TIONS 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 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)(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 tlecedent'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-iso8 EX+(o8-i2)
� pennsylvania SCNEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN pERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Kenneth Wayne Chase 2013-00342
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 VAIUE AT DATE
NUMBER DESCRIPTION OF DEATH
�, Members 1st Credit Union, POBOX 40, Mechanicsburg Pa 17055
130860 Savings 731.17
130860 Checking 8•9$
130860 Money Management 15438.99
2. Dirt Bike 600.00
3. 1998 Dodge Dakota 1200.00
4. 1988 Honda Motorcycle 700.00
TOTAL(Also enter on Line 5, Recapitulation) $ 18679.14
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RE'u-ISiI EX+ (Ofi-�3)
� pennsylvania SCHEDULE H
DEPARTMENTOFREYENUE FUNERAL EXPENSES AND
INHERITANCE TAX REFURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kenneth Wayne Chase 2013-00342
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAI EXPENSES:
1' Malpeui Funeral Home 6879.97
Queen of Heaven Cemetary 1970.00
B. ADMINISTRATNE COSTS:
1. Personal Representative Commissions: NA
Name(s)of Personal Representative(s)
Street Address _
City State ZIP
Year(s)Commission Paid:
2. attorney Fees: NA
3. Family Exemption: (If decedent's address is not the same as ciaimanYs,attach explanation.)
Cfaimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees: NA
5. Aaountant Fees: NA
6. Tax Return Preparer Fees: NA
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 8849.97
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EXt (12-12;
� pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kenneth Wayne Chase 2013-00342
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 Jeffrey Sutton FEBIMAR rent 1438.00
2. Upfront expenses(cleaning out rental house,picking up vehicles etc) 1800.00
3. Pennsylvania Water 65.48
4. Pennsylvania Power Light 81.02
5. UGI Gas 120.88
6. Cycle Tech(outstanding repair bill) 455.68
7. Members 1st Visa 2196.68
8. Care of deceased pet's veticremation bill 775.00
TOTAL(Also enter on line 10, Recapitulation) $ 6932.65
If more space is needed,insert additional sheets of the same size,