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Home My WebLink About12-23-13 � 15�5610�05 REV-15t?0 Ex�oz-��>�F�, .:.. OFFICIAL USE QNLY PR Department of Revenue pennsylvania Courty Code Year File Number „«x ��,.» Bureau oF Individuat Taxes NHERITANCE TAX RETURN Po BOX 28o6oi RESIDENT DECEDENT � �� I S Harrisburg PA t�t28 060� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMUUYYYY Date of Birth MMDDYYYY _ __ _ 182-22-5822 . ' 12/31/2012 I .01/28/1929 ', DecedenYs�ast Name Suffix DecedenYs First Name M� _ _ ___ _ ___ SHADLE ' ROMAINE M (If Applicabie)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix 5pouse'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 BE�OW � 1. Original Return O 2.Supplerriental Ret�m O 3. Remai�der Retum(Date of Death Priar to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Esiate Tax Retum Required death after 12-12-82) Q 6. Decedent Dieci Tesiate Q 7.Decedent Maintained a Living Trust ___._ 8. Totei Number of Safe Deposit Boxes (Attach Copy of Wiil) (Attach Copy of Trust.) C1 9. L.Jtigation Pror.eeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax�mder Sec:9113(A) Betwee�12-31-91 and t-1-95) {Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPIETED.ALL CORRESPONDENCE AND CONfIDENTIAL T/u(INFORMATION SHOULD BE DIRECTED T0: Name Daytime�ejephone NumbBr � �, :L� __ _ C� �:�..� r'� BEVERLY A BRITCHER "7 i�1 � �;y I— � 5 �� ; _ ......... ......... ._.._. ......... .. _...._f.7 �..�...... ....._f"''7 r-�:. ....__ --'.'- '�-"A' _ _ R�Gtst�x 6�wi�� se�Y'� �. , . r N _ + �,.f a,..r.p i � " � C..J ;,,,-, ,°,� f.;i First Line of Address _ � 'J" ��n '� _ _ _ __ _ _, 'T? -e,; - .� 1507 TERRACE AVE � '.' ` ; '' :'= --° , ,., _� a:7 Secand Line of Address ; —'— "-- �°� ' ,» , Q �rT C`� � �.._a "�l __ DATE FILED City or Post Office . . State ZIP Code . CARLISLE PA ' !17013 Correspondent's e-mail address: Unde�penafties of perjury,I dedare tha:I have examined this retum,mdudiny accompanying schedules and statements:and to the best of my knowledge and belief. it is':rue,correct and comp�ete.Dedaration of preparer other than the,personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P RSON RESPONSIBLE FOR FILING RETURN DATE � .v�,t.� � �. DDRESS SIGNATURE OF PREPARER OTNER THAN REPRESENTATIVE DATE (�,�{ N} 1.G�i� Z - J�3 -/ 3 AQDRESS "3 G S. /�Alvo✓rlt, s T- t'A h/'s�• ' ��6 /��3 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610105 1505610],05 � � 15�56102�5 REV-1500 FX(FI) DecedenYs Social Security Number _ __ _ _ _ __ __. __. �ecedenrs tiame: ROMAINE M SHADLE ! 182-22-5822 ' RECAPITULATION _ _ 1. Real Fstate(Schedule A). . ... . . . .. . . . .. . . ... . . . . .. . . .. . . .. .. .. . ... .. 1. _ _ 2.. Stacks and Bonds(Schedule B) . . . .. . .... . . ... . .. .. . . . .. . . . .. ... . . .. . . 2. , 3. Clasely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . .. 3. ' 4. Mortgages and Notes Receivable Schedule D 4 _. ' i >..... ... .. .. ... ..... .. .... . 5. Cash, Bank Deposits and Misceilaneous Personai Property(Schedule E).. .. . . . 5. 5,350.00 6. Jointiy Owned Property(Schedule F) O Separate Billing Requested ..... .. 6. .._. .. _. .. ....... . . .... _ . 7. Inter-Vivos Transfers&Misceilaneous Non-Probate Property , (Schedule G) O Separate Billing Requested... ..... 7. .. 8. Total Gross Assets total Lines 1 throu h 7 ....... ...... 8. ! 5,350.00 ' � g ). ..... ....... ... 9. Funeral Expenses and Administrative Costs(Schedule H).. .. ... ... .. ..... .. 9. 11,243.�� 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).. .... . ... . . ... 10. 11. Total Deductions(total Lines 9 and 10}....... .......... .............•. . 11. ' 11,243.00 12. Net Value of Estate(Line 8 minus Line 11) ...... .... .. ... ....... ... .. ... 12 . �.. .,. .... . .. . . 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made(Schedule J} ...... . ... .. .. ... ..... . . 13. I. 14. Net Value Subject to Tax(�ine 12 minus Line 13) . .. .. .... . . .. ..... .. .. . . 14. ' 0.00 ' TAX CA�GULATION-SEE INSTRUCTIONS FOR APPI.ICABLE RATES 15. Amount of Li�e 14 taxable at the spousal tax rate,or __ __ _ transfers under Sec.9116 , (a}(1.2)X .0_ , 15. , . . ., .... � 16. Amaunt of Line 14 taxable at lineal rate X.0___ 16. . _... , 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. _ 20. FILL IN THE OVAL IF YpU ARE REQUESTING A REFUNO OF AN OVERPAYMENT 0 $IC�@ 2 � 150561�205 15056b0205 � REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME ROMAINE M SHADLE STREET ADDRESS 1000 WEST SOUTH STREET CITY STATE ! Z�P CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,line 19) (1) 0.00 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. Fill in ovai on Page 2,Line 20 to request a refund. �4) _.__—_— --- 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 `�c 4� ` �� ,a �� mz°?� ��y��'�� '�....,,.��ea�� ..:�� ,,.��:��»��. ...'a� ��, ,.a.::;:'�.`,�",'%��...'.��.��..�. \ 'Z;_ '�� ' ` �� .� ,�.. ,.. „ � � .._,,, PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did tlecedent 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 transferretl 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 decetlent 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 indivitlual reiirement account,annuily 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\ . �` � � ��` � . ;:..A� '' .. .w�'--'+�" � �" r'�,,'r'" � r�e �'� ..��'. ,.��,�.:,� ,', xr�.�{�. ��`:.:�om .t- ..,��.�. ..,��.°z.,,+��.��':��^�s,�:� .... F.� ..y , i.�`*s l. ._,r,.us,kz^ ,� .. , _s4-_> '�a� . 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)J. For tlates of death on or after Jan. 1, 1995, the tax rate imposetl on the net value of transfers to or for ihe 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 ta 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 tlecedenYs lineal beneficiaries is 4.5 percent,except as notetl in[72 P.S.§9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3iJ.A sibling is defined, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by biood or adoption. R[V-15o8 EX+(o8-1z) � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. ir�HeRtr,arvice rax aeTUarv PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: ROMAINE M SHADLE Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointiy owned with right of survivorship must be disciosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �, MT BANK CHECKING ACCOUNT 5,350.00 TQTAL(Also enter on Line 5, Recapitulation) $ 5,350.00 If more space is needed,use additional sheets of paper of the same size. REV-l.5il EX+ (G8-7.3j � pennsylvania SCHEDULE H DEPARTMENTOFiiEVENUE FUNERAL EXPENSES AND INHERI7ANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ROMAINE M SHADLE DecedenYs debts must be reported on Schedule I. ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: i. 11,243.00 HOFFMAN ROTH FUNERAL HOME g, ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative;s)_ _ ---_____ .—_------._.__ _......_-_--.-- 5treet Adtlress __..... _ __...... _- ...__.. __._._ City ___...State _ ..._.___..ZIP_____ _ .._ ...___ __.. _......__ _ .._...._ _..._-- __ __....._ _.._ Year(s)Commission Paid: __. ____.. ___..._ ____.__ __ ...._.____..__.... ____...__. ....__.. _ _. _ _... _.. . 2. Attnrney Fees 3. Famiiy Exemption: (If decedent's address is not the same as claimanYs,attach explanation.) Ciaimant Street Address _ - - _... ..___..... __. _ ..__.... . --....._ _...._._ _....__ __. _.._ ... City __..State _._._.ZIP___.. _ __...---....._._ __.... _ _____ __ _ ....._.. ___ _....._. Relationship of Claimant to Decedent _...___ ---- ---- __ _..._..__ _ _.. __ ..__..... _ _ _ 4. Probate Fees. 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. _ TOTAL(Also enter on Line 9, Recapitulation) $ 11,243.00 ' If more space is needed,use additional sheets of paper of the same size. REV-1513 EX+ (01-10) �� pennsylvania SCHEDULE � - D[PARTMENT OPf2EVENUG INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPER7Y Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1,2).] 1. 'BEVERLY A BRITCHER DAUGHTER � ' 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: L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II—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.