HomeMy WebLinkAbout02-01-05
REV-1500 EX + (6-00)
'* COMMONWEALTH OF
, ' PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.n601
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DECEDENfS NAME (LAST. FIRST, AND MIDDLE INITIAl)
Bonnie M. Schell
DATE OF DEATH (MM-DD-Year)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
fiLE NUMBER
.D!. L -1l. L Q,Qfd.--'IL_
COUNTYCODf yEAR NUM6ER
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
407-22-6027
THIS RETURN MUST BE FILED IN DUPLICATE WITN TNE
REGISTER OF WILLS
11/09/2004 01/30/1924
(IF APPLICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[Xl 1. Original Return
o 4. LimKed Estate
o 6. Decedent Died Testate (AtlaCh copy of Will}
o 9. litigation Proceeds Received
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82l
o 7. Decedent Maintained a Living Trust (Attach cOpY ofTrusij
o 10. Spousal Poverty Credit (dateofcl6athbelween 12-31-91 and 1-1.95)
o 3. Remainder Return (daleofdeathpriorto12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A)_hSohO)
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, P~rtnershlp or Sole-Propnetorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal.Property (5)
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0 6. Jointly OWned Property (Sche<lule F) (6)
i= o Seperate Billing Requested
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:::) 7. Inter-Vivos Transfers & Miscellaneous Non'-Probate Property (7)
I- (Schedule G or L)
ii: 1-.,
"" 6. Total Gross Assets (total Lines 1-7)
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W 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
IX
10. Debls ot Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines g & 10)
12. Net Value of Estate (Line 8 minus Line 11)
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NAME
Marielle F. Hazen
FIRM NAME (If Appl;cable)
Law Office of Marie/le F. Hazen
TELEPHONE NUMBER
717 540-4332
COMPLETE MAILING ADDRESS
2000 Linglestown Road, Suite 303
Harrisbur
:-'j?A 17110
bFFieIil.L USE ON
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1,966.70 -'
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1 ,055.421
1 ,800.00 1___
(8)
4,822.12
706.00
32.50
(11)
(12)
(13)
738.50
4,083.62
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
4,083.62
14, Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (.)(1.2)
16. Amount of line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
0.00 X 0.00 (15) 0.00
4,083.62 X .045 (16) 183.76
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 183.76
20 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's omplete ress:
$TR:;;ET ADDRESS
940 Walnut Bottom Road
CITY I STATE I ZIP
Carlisle PA 17013
C Add
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
183.76
174.57
9.19
3. InteresWenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 +C)
(2)
183.76
T otallnteresUPenalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE, (58)
Make Check to: REGISTER OF AGENT
0.00
0.00
0.00
0.00
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; ........ ..................................................... 0 IKI
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IKI
c. retain a reversionary interest; or ....................... ...,............ ................................................ 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IKI
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?................... ............... .............. ............................................... IKI 0
3. Did decedent own an "in trustlor" or payable upon death bank account or security at his or her death? ................. 0 IKI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ................................................................ ................................... .. 0 IKI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penaties of perjury, I declare thai t have examined this return, includin~ 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 mformation of which preparer has any knowledge.
SIGNATURE OF PE ON RESPONSIBLE F FILING RETURN DATE
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ADDRESS
ADDRESS
PA 17061
DATE
J - .5 -0 S
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (ill.
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)].
The statute does not exemot 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 Juiy 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one 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% [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%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(I)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [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-1508 EX + (6-98)
*
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bonnie M Schell
FILE NUMBER
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
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,966.70
Manor Care Refund
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 966.70
REV-1509 EX + (6-98)
*
SCHEDULE F
JOINTLY -OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bonnie M Schell
FILE NUMBER
If an asset was made joint wtthin one year ofthe decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Evelyn Keefer
125 Klinger Road
Millersburg, PA 17061
daughter
B
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INS111U110N AND BANK ACCOUNT NUMBER OR SIMILAR DA1E OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 04/2001 Community Banks 1,074.67 50. 537.34
Checking No. 1481800306
2. B 04/2001 Community Banks 1,036.16 50. 518.08
Savings No. 1481800320
TOTAL (Also enter on line 6, Recapitulation) $ 1 055.42
(If more space is needed, insert a.dditional sheets of the same size)
REV.1510 EX + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bonnie M. Schell
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REY-1500 COYER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAt.lE OFTHE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPV OFTHE OEED FOR REAl ESTATE VALUE OF ASSET INTEREST \lFM'P\.lCABLE\ VALUE
1. Gift to Evelyn M. Keefer, Daughter 4,800.00 100. 3,000.00 1,800.00
$1,700.00 on 9/2004
TOTAL (Also enter on line 7 Recapitulation) $ 1 800.00
(If more space is needed, insert additional sheets of the same size)
REV.1511 EX+ (12-99)
.*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bonnie M Schell
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. James A. Reed Funeral Home 206.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s)JEIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Marielle F. Hazen 500.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 706.00
(If more space is needed, insert additional sheets 01 the same size)
REV-1512 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIOENT DECEDENT
ESTATE OF
Bonnie M Schell
FILE NUMBER
Include unreimbursed medical expenses.
VALUE AT DATE
OF DEATH
ITEM
NUMBER DESCRIPTION
1. Turtle Fir
Community Bank Check #1129 cleared after death
32.50
TOTAL (Also enter 011 line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
32.50
REV_1513EX>I.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
. iii !'lchell
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [InClude outright s~ousal distributions, and transfers under
500. 9116 (a) (1. II
1. Evelyn Keefer, Daughter Lineal
125 Klinger Road 100% Residue
Millersburg, PA 17061
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRiBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE
1_
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, insert additional sheets of the same size)
CUMBERLAND COUNTY REGISTER OF WILLS
INVENTORY
Estate of Bonnie M. Schell
, Deceased
No.
Date of Death 11/9/2004
Social Security No. 407226027
also known as
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the reat estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IfWe
verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Marielle F. Hazen
Evelyn Keefer
1.0. No.: 68003
Address: 2000 LinQlestown Road, Suite 303
HarrisburQ
Telephone: 717 540-4332
Dated
PA 17110
Description
Value
Manor Care Refund
1,966.70
Total
(Attach Additional Sheets if necessary)
1,966.70
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
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