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Home My WebLink About12-10-13 (2) w . • � �. . � . . - 1505610105 � � EX(o2-ii)(FI) I IAL USE ONLY REV 1 soo .FF C PA Department of Revenue pennsylvania Coun Code Year ` Flle Number � DE��TMENT��NHERITANCE TAX RETURN ; � Bureau of Individual Taxes � � � /�� PO BOX 280601 ' ' : Harrisbu PA� 128-0601 RESIDENT DECEDENT ; � ? F �� , 7 ENTER DECEDENT 1NFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth M y.v, MMDDYYYY f_,�...__.__._._..___._ __..____.__._..._. _v._..__ _,, �_..�.�_�__�_�_�� ,__�...--. .�.M._�_ ,_..,._._w_�._._ = ` 11/19/2012 ' � 1�.` � �-�� ._ . ... ; � _ _ _ _ ---- --.._ ...-- --__..... _ __ , ,... _ ___ __._. Decedent's Last Name Suffix DecedenYs First Name _ _ �__ _ .___ _........... .... _, . _ .. __... __.. .... _. ....___ . _. __ ..... ._... ...... __ _ . _... , __.._.. . ; _.. � `Greey ' 3 Florence�_._.._��_.�__._�._._.. .� ._ _' �� -�...�___.___.�.___�__� . .�.�..�.�... ._�..._._.�._..__ (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M� .. ...... _-- ____. j�, --_. __�____..... , ._ _ _ _ : _ � ._..�.__..�_�.�____.._m___�.._.._._.�..�.___�._..._.�_.�. { , � f : i ; , , ; , , ; ; , , . _... _ _ ..... __� t. ,..__._��_._r_._.__. _.. .��.._._.._r __�.�._. ____.__..�_.__�._ __._.._ �___. jSpouse's Social Secunty Number _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ' REGISTER QF WtLLS � FILL IN APPROPRIATE OVALS BELOW (,� 1.Originai Return O 2.Supplemental Return O 3. Remainder Retum(Date of Death Prior to 12-13-82) p 4.Limited Estate O 4a.Future tnterest 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 Tn.�st � 8. Total Number of Saf�posit Box� � (Attach Copy of Will) (Attach Copy of Trust.) C"� c"� � � O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Elec�en tpTax under,�.91�A� Between 12-31-91 and 1-1-95) (Atta�rSr.'kledule 0)� --- CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMA'�0�3H�QE DIRECTED T� � : Name Daytime Te�phC��+qmbe�._.. ...�. a _____ __ _.. _..__.. ._..__ _._.__... __ _._.. __, # _.__ ._ ...._. __..... . .__._... _. __ � 717 53 :�'��'."1� ca c� ;Elmer Greey �.�.._�; t� � ",� "'"! -� �__�_�__.___...._.�.. __..�,__�___�__...�.__ ._.__.__�____ --�n. REGI�,T�„��F VI�LS USE ONC� �„ � �,� � y " ....� Q � � First Line of Address ��` . .�......._._.___.._ �.__,_ _.._. _._ . ...__. _. _..,.._., .__.____. _.._ _..�.. ... ..._. . --J �8690 Rice Road _..__ _ _ __. . _ ___. Second Line of Address _.. _.__. _ __..._ .... . ___........_ _.......__ _ _._.__ _. _......_ , �_._._....�..__w..._�.._.... __ ______.. - ------ DATE FILED City or Post Office State ZIP Code __..._�.�..�. _�...__Mw.__._w..�,._�__�._._._____w_. Shippensburg ' P� 1725' � Correspondent's e-mail address: Under penafties of perjury,I declare that l have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. S GNATURE OF P RSON RESPONSIBLE FOR FILING RETURN DATE , N • 1�t �1 ADDRESS � �� ' SIGNATU P RE /� �TE l ADD �S 49 West Orange Sfreet Shippensburg, PA 17257 PLEASE USE ORIGINAL FORM ONLY � � Side 1 � 15056101 05 ],505610105 � . --� . 1505610205 � REV 1500 EX tFl) Decedent's Social Security Number �..�_.....__.,.._..__�_��,._....�.,...__.._.�._.._�_.._�___....__._._._..�.__.._._...___; # }261-50-7836 ; DecedenYs Name: RECAPITULATION ._..,_._.._...._. _.....�..�........�........._.___._ _ .. j f 1. Real Estate(Schedule A). ........................... ... ........... 1.# 5 € f � , � € � 2. Stocks and Bonds(Schedule�B)�....�...........................�........ � �a.�.� � _ � ��,.��..�. � � � � ; 3. Closely Held Corporation,Pa�tnership or Sole-Proprietorship(Schedule C) ..... 3 } f �._...�,,..�„�.,_.m...��.....�_�..�..v..�........y.,�,��,.,.�„�.�.�,.,,,.�.a,.�,� 4 ; 4. Mortgages and Notes Receivable(Schedule D)....... ' .................... �„w..�_: �.� \ 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. � 4,999.93 � {.�_�..�am.wMk_.�.�..,...�...w.��.,w..�.�,..�,.�,:..�...�.,..��.w,,.. ; 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6 ; g99•� �, _.�„�,�.�,.�� .� �,... 7. Inter-vvos Transfers 8 Miscellaneous Non-Probate Property . < (Schedule G) O Separate Billing Requested........ 7 ; E �� ; � � � ' � � 5,999.27 � � � �8. Total Gross Assets(totai Lines 1 through 7)............................. 8. � i ' 1,565.47 ; 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9 } , . ��,:�� 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule i)............... 10. � � _.�,.�......,,.�...,.�.r�,A..�.,�..�,.,.� 11. Total Deductions(total Lines 9 and 10)................................. 11 : �� 1,565.47 � �,,�,�.�...�� 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12.` � 4,433.8� � 13. Charitable and Governmental Bequests/Sec 9113 Tn.ists for which �m� ��€ an election to tax has not been made(Schedule J) ........................ 13. ; � ` �..�� ..�.._ _.��,.�..i � 14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14 4,433.80 ' TAX CALCULATION-SEE 1NSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or __._....._ _. _.__ _._._.._ _... ___ _.. ..._...... _ ._.... _.. . E...._.. __... : hansfers under Sec.9116 �a)�1.2)X.0_ �..,_.�.�.,...,�.�,�..�...�.�.,.�..v,.�....w..,�.��_,��,�. ...��.�� 15. ��,�,.,.�....�,. ..��.�...,� �- 16, Amount of Line 14 taxable � �� 16 '` � � � at lineal rate X.0_ � �� ,� ,.� k . �. ,y.r,.w�.�.��_�� .u,.u�.,. ,,..��.w.,x.._�.:�_�.._�.,�..�.�,.�..�.�,..w m... �,.�..�.�,u.�.».,,.�,�,.,�,,,�. _, 17. Amount of Line 14 taxable at sibling rate X.12 17. � a�....�..�,M.,.h,.:�,p�.»�,�,��v.��,..�..�,.�.,..�,..��....,�.�.....,�.:,._,�.� �.�.,, �,...�,�,.M...�,...,,�,.,��.��_.�,�m�,�....�..�.�..v...,�..�w�,.�..�,..�..r.��n.,. . 18. Amount of Line'!4 taxzh!e 4,�33.$G ' ' 665.C� at collateral rate X.15 ; ' �8• `� ' . _...... _ __ _ ._.._ . _ W._._... ..__�._... �_.. .�..n .. ". .. �} ' f 19. TAX DUE......................................................... 9 _. _.._ . ......._ .. .._.__... _.... _.. 1 20. FILL IN THE OVALIF YOU ARE REQU�STING A REFUND OF AN OVERPAYMENT 0 Slde 2 � 1505610205 1505610205 J _ � _w _ _ _ __ _ __ - - — ��a. : _. —_.-— _—. . :`L� �V..Rca , .._ . r , . � . . . ' ` . . . � . � .. REV-1500 EX(FI) Page 3 File Number Decedent's Compiete Address: DECEDENT3 NAME Florence Greey _ STREET ADDRESS 8690 Rice Road CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 665.07 2. Credits/Payments A.Prior Payments B.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. t4) Fill in oval on Page 2,Line 20 to request a refund. 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. t5) 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 ro ert transferred ••••••••••••••••••••••••••••••••••••••••••••••••••••••••�••••• � � P p Y .......................... : 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 occurred after Dec.12,1982,did decedent transfer property within one year of death � without receiving adequate consideration? •••�••�•�••�•••�•••••••••••••••�•••�•�°�°�""""" � Q ..................................... 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ Q 4. Did decedent own an individual retirement account,annuity or other non-probate property,which ❑ contains a beneficiary designation? ........................................................................................................................ � iF`�HE,��i'4'�1�0�T}�E A�E�flltt�3�1��'��,Y��UST�4M'�l.ETE S�#�EDULE G A�t�FlLE CT AS PART QF THE RETURN. t _��., _._ ��., �. x . For dates of'death an or after July 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of Vansfers to or forthe 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 sunriving 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 chiid is 0 percent[72 P.S.§9116(a)(1.2)]. . The tax rate impos e d an#he ne t va lue o f trans f e r s t o o r f o r t h e u s e o f th e d e c e d e n Y s l i n e a l b e n e fi c i a r i e s i s 4.5 p e r c e n t,exce pt as noted in[72 P.S.§9116(a)(1)J. . The tax rate imposed on the net value af transfiers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A si b ling is de f rne d, under Section 9102,as an individual who has at leas t one paren t in comm o n w i t h t h e d e c e d e n t,w h e t h e r b y blood or ado ption. � REV-i5o8 EX+{o8-i2�j . SCMEDULE E � pennsylvan�a . DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. iNHeRrrn►�cE Twc Reruwu PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Florence Greey 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. � VALUE AT DATE TTEM OF DEATH NUMBER DESCRIPTION _ ° , _., _. . X. .. ...�.� :. _, , .. _ . _ .. , �,,, :Fogelsanger Bricker Funeral Refund of burial account 4,999.93� � � .�:. ...�.. . ,.., __��. � �� ...�: , - :... ��_. , - . �, �. _ � � � � ,. y:� � ,E: s ,s� . _,�..,. _ . ,� : �. .: . � ,:�.. ... : v�.. . ,_ .< �. �' � . . . ..., ..x . +, _ . .., . ._ .... .,, _ . .. . _ �. ..,,�.., _.....M.,�. >,.. . . . . ,. .,_, y . .�,. ,. .�. L_. -' � ., a:F�:": . ��.- .,c .. ' � ..� 7 ::: '•`. '�� . 4;999.93 TOTAL{Also enter on Line 5, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size. . J REV-15o9 a+(o�-to) � pennsylvania SCNEDULE F DEPARTMENT OF REVENUE ,OINTLY�OWNED PROPER� INHERTfANCE TAX RETURN RES'IDEI�Df(�DEIYT ESTATE OF: FILE NUMBER: If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING 70INT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT _ .. ... � _ _ . . _ A•:Elmer Greey Jr 8690 Rice Road �Nephew Shippensburg,PA. 17257 : , ... , , . . ._ B.Charlotte G. Christy 8690 Rice Road Niece °Shippensburg, PA. 17257 C. � . � _ _.._ , __ . _ �OINTLY OWNED PROPERTY: � DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR lOINT MADE IN(IUDE NAME OF FINANQAL INSTITUTiON AND BAWK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDHrT'S VAWE OF NUMBER 'TENANT lOINT IDEMIFYING NI�IBER.ATTACH DE�FOR]OINTLY HELD REAL fSTATE. VALUE OF ASSET , INTEREST DECEDENTS IPREREST * , _. _._ _ __ i. A• :p7J13102 F&M Account 3415708'same as 6 ' 2,983.03.; 33 =u 993•� . . . �- �,...__. . ._ _. � � 2 B � 02113102 'F&M Aa;ount 3415708 same as A � 2,983 03 ; 33 , ;: . . . , .. __ _ . _ . H , .. .,.. : � _ _. r..ti. .. n,� . : n � � r � ..� .. _ , �.t.==., , ; __ .. _ .:-.,�. , � , T � . � _ __ _ _ _., ,t....; _ . _, . 993.34 TOTAL(Also enter on Une 6,Recapitulation) � ,. x ,� „ a , If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(14-�} � � PennsYlvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHE�rr�n►c�T�x�uRN ADMINISTRATIVE COSTS RESIDENf DECEDENT ESTATE DF FILE NUMBER Decedent's debts must be reported an Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: _ _ _ _ _ _ ._ _ _ . w.. _ _ _ 1. � � � ..... ,.,... _.., u., ... �w_... � ...,._�.. � ��.�.__�....�... �,_ r��.,.k ..�.. �� ,.� ., �_.. _. _. __v e �,. _ �_� �.._, __ ._ .. _. . .: . : . , ,. �, g. ADMINISTRATIVE COSTS: , , , L Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 250.00, 2. Attorney Fees: _. ,. 3. ��Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) , . Gaimant Street Address �ity State ZIP Relationship of Gaimant to Decedent 15.00 4. Probate Fees: 5. Accountant Fees: 6. Tax Retum Preparer Fees: _ _ _ _ _ _ , .1,300.47 �• Shippensburg Heaithcare Center TOTAt(Also enter on Line 9,Recapitulation) $ 1,565.47 If more space is needed,use additional sheets of paper of the same size. ; � � ...�_, s � ; . �;� .; � ,., , i . � .,, �� '� � ` COMMONWEALTH OF PENNS�'L VAIVIA ,:� :� �nn� tvar�i� . ::: , � � DEPARTII�ENT OF REY�IVUE DEP�tRT�IENT OF RE1fENUE , , ; . .._. ...._. INSERITANCE TA�DIYISION DAT�: November 25,2013. . SUBJECT: Filing duplicate retiuns and payment ; . f . TO: Elmer Gree ` ( � _ Y .�;� � , � � ; . FROM: Inheritance Tax Division , You must file in�duplica�e REV-1SOOiretums with°payment to the Register of Wills in which the decedent resided at time of�death. . �. . ,, . Please ca11(717) 787-8327 or(717) 787-6505 with questions. ��..,, � � � � � �.,� . : � � � � � � � m = c� � U' ,,�� ..� � r,, � � � �:� � � � � ` _ z � . �_ c► ca � � � � -�n -�'t , � e, ,,,�.� -� „'��: � : � � � � � � � � _ �► � � � � c.�