The URL can be used to link to this page

Home My WebLink About01-07-14 J REV-1500 Ex`°'-u)(R) 1505610105 enns lvania OFFICIAL USE ONLY PA Department of Revenue PF Y County Code Year File Number Bureau of Individual.Taxes INHERITANCE TAX RETURN PO BOX 280601 2 G Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW -- -- Date of Birth MMDDYYW Social Security Number — Date of Death MMDDYYYY L 09 125 Zpiz i ! o�/mB/O/!o _ I Decedent's Last Name Suffix Decedent's First Name - MI (If Applicable)Enter Surviving Spouse's Information Below `J Spouse's Last Name Suffix Spouse's First Name _ MI Spouse's Social Security Number r- —--: ---� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _J REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (� 1. Original Return C= 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) 4M 4. Limited Estate O 4a. Future Interest Compromise(date of C=) 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.) O 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 O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number oShe r-rq A. Ky_P'Fi- --! 7/7 ��9-75G10 __J1 REGISTER OF WILLS USE ONLY First Line of Address n - X7 rn 541 //are5 _-Drive CO C_ , � _ o Second Line of Address n Z rn ;:0 i Cni azrn v mr+r D0EFILED i0 y - City or Post Office State ZIP Code Carlisle_ !� ►70/5 0 //1r /� 11 Correspondent's e-mail address: 6o.kaPraPa-cmca5-t rat°L {r 'n 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 knowledge. SIGNAT OF PERSO ES SIB E OR FILING RETURN DATE ADDRESS l Gr � 1Y� YI15� 1 Dl� SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 -�UN CN\V4 J 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number I Decedent's Name: Ra4he iIQ NaY4,5oeK I RECAPITULATION 1. Real Estate(Schedule A). ........ .... . . .. ............ . . . . ............ 1. - 1 2. Stocks and Bonds(Schedule B) ........ ...... ......................... 2. -U - 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ..... 1 4. Mortgages and Notes Receivable(Schedule D) . .. . .. ........... . . . ... .... 4. - 0 - 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ..... . 5. L i 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . ... .. 6. f - 0 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property i (Schedule G) O Separate Billing Requested....... . 7. _ 0- 8. Total Gross Assets(total Lines 1 through 7)....... . .... .. ............... 6. j i 9. Funeral Expenses and Administrative Costs(Schedule H)....... . .. .. ....... 9. l 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). . . .. ... ........ 10. 11. Total Deductions(total Lines 9 and 10). . ... .. .................... . . . .. . 11. 4?JR,9d� 12. Net Value of Estate(Line 8 minus Line 11) ..... . ...... ........... . . .. ... 12.E ' 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . ............ ....... 13. 11� 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . .... ............ ... 14. - 0- j 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_ j 16. j IT Amount of Line 14 taxable j at sibling rate X.12 I 17.1 18. Amount of Line 14 taxable -j at collateral rate X.15 19. TAX DUE . . ... .............. .. .................. . . .. ... . . . ........ 19.1 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: DECEDENT'S NAME —At 4-heLla Narfsoek STREETADDRESS 512_VIlLn i- red- ;?Oad CGoId en I iJlrg Cer Tker� CRY STATE Zip u and 21502- Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (i) 2. Credits/Payments A.Prior Payments S.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 oval 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) 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.......................................................................................... ID b. retain the right to designate who shall use the property transferred or its income ............................................ 13 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?.............................................................................................................. ❑ 3. Did decedent own an'in cost for'or payable-upon-death bank account or security at his or her death?.............. ❑ 19 4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa beneficiary designation? ........................................................................................................................ ❑ IRJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 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)(11)(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 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-1512 EX+(12-12) pennsylvania SCHEDULE I ail DEPARTMENT OF REVENUE DEBTS.OF DECEDENT, mRERtTANce TAY RETum MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER - - - �u�l�eJl� l�arlsoeK Report debts incurred by the decedent prior to death that remained unpaid at the date of death,Including unrelmbursed medical expenses.' ITEM - VALUE AT DATE • NUMBER DESCRIPTION OF DEATH r! Ted �� !_KS��er�l��/!��COn✓eLSC1 7,?3-3000 __j J �; I I 4; _ �t _ � J I 1 i I I TOTAL(Also enter on Line 10, Recapitulation) S�I 3 y50_pd I - If more space is needed,insert additional sheets of the same size. REV-iSog EX+(0842) pennsytvania SCHEdULE E DEPARTMENT OFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: �uflteila NArFsack Indude 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 Sa�ian�7�3�s3lLb r f�/i� fJcc£ 6A A4q Al @6" c?a _- cfainf Accoun �074iD. z t I 1 . TOTAL(Also enter on Line 5, Recapitulation) If more space is needed,use additional sheets of paper of the same size. INHERITANCE TAX JOINTLY HELD DJ TRUST ASSETS �j !j7 Pennsylvania BUREAU OF INDIVIDUAL TAXES '� DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION REV-1604 EX AFP C12-131 PO BOX 280601 HARRISBURG PA 17128-0601 DATE 12-17-2013 ESTATE OF HARTSOCK RUTHELLA DATE OF DEATH 09-25-2012 FILE NUMBER 21 13-0984 ' COUNTY CUMBERLAND SHERRY A KUFFA SSN/DC 166-32-1959 ACN 12156274 547 HILLCREST DR Amount Ramittad CARLISLE PA 17015-4333 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE --I, RETAIN LOWER PORTION FOR YOUR RECORDS !-- REV-1604 EX AFP (12-133 ■■ INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS 11■ DATE- 12-17-2013 ESTATE OF: HARTSOCK RUTHELLA DATE OF DEATH: 09-25-2012 COUNTY: CUMBERLAND FILE NO. : 21 13-0984 S.S/D.C. NO. : 166-32-1959 ACN: 12156274 ADJUSTMENT BASED ON: ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: SUSQUEHANNA BANK ACCOUNT NO. : 16032985D1 TYPE OF ACCOUNT: C ) SAVINGS C X) CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 10-29-1982 Account Balance 4,021 .64 NOTE: TO ENSURE PROPER CREDIT TO YOUR Percent Taxable X 01500 ACCOUNT, SUBMIT THE UPPER PORTION Amount Subject to Tax 2,010.82 OF THIS NOTICE WITH YOUR TAX Debts and Deductions 31950.00 PAYMENT TO THE REGISTER OF WILLS Taxable Amount .Q0 AT THE ADDRESS SHOWN ABOVE. Tax Rate X •045 MAKE CHECK OR MONEY ORDER PAYABLE Tax Due .00 TO: "REGISTER OF WILLS, AGENT." TAX CREDITS: PAYMENT RECEIPT DISCOUNT Ca) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID C-) TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE 0 INTEREST AND PEN. TOTAL DUE I no IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. P BOARD O Box 208102 PEALS pennsylvania HARRISBURG, PA 17128-1021 DEPARTMENT OF REVENUE BOARD OF APPEALS SHERRY A KUFFA IN RE ESTATE OF: 547 HILLCREST DR CARLISLE, PA 17015-4333 HARTSOCK RUTHELLA DOCKET NO. : 1318423 TAX TYPE: Inheritance APPEAL TYPE Protest FILE NUMBER: 2113-0984 ACN: 12156274 APPRAISEMENT: 9/10/2013 PETITION FILED: 9/13/2013 EXAMINER: HOLLY MOORE Direct Dial: (717) 783-7905 Fax: (717) 787-7270 Email:holmoore @pa.gov MAILING DATE: December 16, 2013 DECISION AND ORDER On September 13, 2013, the Department issued a notice of appraisement and assessment for ACN 12156274, which taxed 50% of Susquehanna Bank account number 1603298501. Petitioner has now provided documentation for deductions against the account in the amount of $3,950.00. Petitioner has also indicated that her relationship to the decedent is a daughter. Section 2126 of the Inheritance and Estate Tax Act of 1991, 72 P.S. § 9126, states that deductions shall be allowed to a survivor of a jointly owned account only to the extent that the survivor has actually paid the deductible items and either the survivor was legally obligated to pay the deductible items or the estate subject to administration by a personal representative is insufficient to pay. The Petitioner has provided documentation for a check written prior to the decedent's death in the amount of $3,950.00. Petitioner HARTSOCK RUTHELLA Page 2 of 2 BOARD DOCKET NO. 1318423 also indicates the decedent was her mother; therefore the tax rate of 4.5% would be applicable. Accordingly, it is hereby ordered that the protest is sustained. The Department is directed to apply deductions in the amount of $3,950.00 to ACN 12156274. Additionally, the Department is directed to adjust the tax rate to 4.5%. FOR THE BOARD OF APPEALS LAUREN A. ZACCARELLI, CHAIR ANY APPEAL FROM THIS DECISION MUST BE FILED WITH THE ORPHANS' COURT WITHIN SIXTY (60) DAYS OF RECEIPT OF THIS DECISION. A COPY OF THE APPEAL SHOULD BE SERVED ON THE DEPARTMENT OF REVENUE, OFFICE OF CHIEF COUNSEL, P.O. BOX 281061, HARRISBURG, PA 17128-1061. ANY APPLICABLE NOTICE REFLECTING ANY CHANGES TO THE ACCOUNT PURSUANT TO THE BOARD'S DECISION AND ORDER MAY BE MAILED TO YOU BY THE APPROPRIATE BUREAU. IF YOU REQUIRE THIS INFORMATION IN AN ALTERNATE FORMAT UNDER THE PROVISIONS OF AMERICANS WITH DISABILITIES ACT OF 1990, PLEASE CALL (717) 783-3664, OR FOR SERVICES FOR TAXPAYERS WITH SPECIAL,HEARING._ AND SPEAKING NEEDS: 1-800-447-3020 (TT ONLY). Board of Appeals PO Box 281021 I Harrisburg, PA 17128 1 717.783.3664 ( www.revenue.state.pa.us