HomeMy WebLinkAbout02-01-05
REV-1500EJt+(6-00)
. '* COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-1)601
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Martin Mar'orie
DATE OF DEATH (MM-DD- Year)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DATE OF BIRTH (MM.DD-Year)
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OFFICIAl USE ONLY
FILE NUMBER ~
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COUNTYCOOE YEAR NUMBER
SOCIAL SECURITY NUMBER
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WillS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of death priorto 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AIlachSch0)
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17,048.58 X ~(15) 0.00
0.00 X _(16) 0.00
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 0.00
Martin Maurice
M1. Original Retum
o 4. Limited Estate
o 6. Decedent Died Testate (AtlachcopyoIWiII)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and1-1-95}
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COMPLETE MAILING ADDRESS
49 West Orange Street
Suite 3
TELEPHONE NUMBER
717-532-3270
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortga9es & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JoinUy Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total DeducUons (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. NelValue Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Une 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. AmountofUne 14 taxable at lineal rate
17. Amount of Une 14 taxable at sibling rate
18. Amount of Une 14 taxable at collateral rate
19. Tax Due
20 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
17,420.00 ~..
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PA 17257
OFFICIAL USE ONLY
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17,048.58
(11)
(12)
(13)
17,048.58
(14)
17,048.58
Decedent's omplete ress:
STREET ADDRESS
16541 Westland Drive
CITY I STATE I ZIP
Gaithersburg MD 20877
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)
0.00
Total Credits (A +8 +C)
(2)
0.00
3. InteresUPenalty ~ applicable
D. Interest
E. Penaity
TotallnteresUPenalty (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 ofthe property transferred; ........................................................................... D IKI
b. retain the right to designate who shall use the property transferred or ifs income; ........................................ D IKI
c. retain a reversionary interest; or ...................................................................................................... D IKI
d. receive the promise for life of either payments, benefits or care? ............................................................. D IKI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?................................................ .............................................. D IKI
3. Did decedent own an "in trustfo~ or payable upon death bank account or security at his or her death? ................. D IKI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... D 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 penalties of pe~ury, 1 declare thai I have examined this return, including a:companying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of prepcrer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE 0" PERSON RESPONSIBLE F FILING R , DATE . .
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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 use of the surviving spouse IS 3%
[72 P.S. ~9116 (a) (1.1) (i)].
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 July 1, 2000:
The tax rate imposed on the net vaiue of transfers from a deceased child twentY-<lne 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)(1)].
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 ieast one parent in common with the decedent, whether by blood or adoption.
REV.150~ EX + (6.98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Martin Mariorie
All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real DroperIY which is iointly-owned with right of sUNivorshiD must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
1/7 interest in land located in Hopewell Township, Cumberland County being
61.539 acres more or less. HUD sheet attached
VALUE AT DATE
OF DEATH
17,048.58
TOTAL (Also enteron line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
17048.58
REV_1513~~'(.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Martin M'rinrie
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 [mcIude out~ht spousal d~tnbulions, and transfe1S under
Sec. 9116 (a (1.2))
1. Maurice Martin Spousal
16541 Westland Drive 100%
Gaithersburg, MD 20877
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 EUECTION 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)
U.S. O""A~TMENT OF HOUSING AND URBAN DEVELOPMENT (OMB' 2502-0265)
A. HUD-1 UNIFORM SETTLEMENT STATEMENT
B. Ty _e of Loan
, 1fJ FHA 2.[ J FmHA 3.[] Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4.[ ] VA 5.[] Conv. Ins.
C. NOTE: This form furnishes a statement of settlement costs. Amounts paid to and by the settlement agent are shown. Items marked
"(p.o.c.)" were paid outside the closing; they are shown for informational purposes and are not included in the totals
D. Name & Address of Borrower: E. Name, Address & TIN of Seller: F. Name & Address of Lender:
Ammon H. Weaver Means Family
Edna Z. Weaver
G. Property Location: TIN of Seller: I H. Settlement Agent:
Old Sawmill Road Place of Settlement H. Anthony Adams
Newburg, PA 17240 49 W. Orange Street, Suite 3
Hopewell Township, Cumberland County Shippensburg, PA 17257 I. Settlement Date: INovember 19, 2004
J. Summary of Borrower's TransactIon
100. Gross Amount Due from Borrower:
K. Summary of Seller's Transaction
400. Gross Amount Due to Seller:
101. Contract sales price 130,000.00 401. Contract sales price 130,000.00
102. Personal Property 402. Personal Property
103. Borrowe(s settlement charges (line 1400) $1,738.50 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
106. City/town taxes to 1.23 406. City/town taxes to 1.23
107. County taxes to 407. County taxes to
108. Assessments to 408. Assessments to
109. School taxes to 42.82 409. School taxes to 42.82
110. 410.
111. 411.
112. 412.
113. 413.
120. Gross Amount Due from Borrower $131,782.55 420. Gross Amount Due to Seller $130,044.05
200. Amounts Paid by or in Behalf of Borrower: 500. Reductions in Amount Due to Seller:
201. Deposits or earnest money 1,000.00 501. Excess deposit (see instructions)
202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) $9,404.00
203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to
204. 504. Payoff of first mortgage
205. 505. Payoff of second mortgage
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments for items unpaid by seller
210. City/town taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. to 513. to
214. 514.
115. 515.
116. 516.
117. 517.
118. 518.
'19. 519.
120. Total Paid By/for Borrower $1.000.00 520. Total Reduction Amount Due Seller $9,404.00
100. Cash at Settlement From/to Borrower 600. Cash at Settlement To/from Seller
',01. Gross amount due from borrower (line 120) $131,782_55 601. Gross amount due to seller (line 420) $130.044.05
-02. Less amounts paid by/for borrower (line 220) $1,000.00 602. Less reductions in amount due seller (line 520) $9,404.00
03. Cash W xl! from If 11 to Borrower $130,782.55 603. Cash IlXlI to W 1 from Seller $120,640.05
Substitute Form 1099 Seller Statement
he information in Blocks E, G. H. I & line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being
Irnished to the Internal Revenue Service. If you are required to file a return, a sanction will be imposed on you if this item is required to be
,ported and the IRS determines that it has not been reported. If this real estate is your principal residence, file Form 2119, Sale or
xchange of Principal Residence, for any gain, with your income tax return; for other transactions, complete the applicable parts of Form
797, Form 6252 and/or Schedule D (Form 1040). You are required to provide the Settlement Agent (named above) with your correct
xpayer identification number. If you do not provide the Settlement Agent with your taxpayer identification number, you may be subject to
vii or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct
xpayer identification number.
(Seller)
(Seller)
/lent Charoes
,tal Sales/Broker's Commission: (based on crice) $130,000.00 llil 6 % Paid from Paid from
Division of Commission (line 700) as follows: Borrowe~s Selle~s
J2. Funds at Funds at
Selllement Selllement
'03. Commission-naid at Settlement to ReMax Jeff Shatzer $7,800.00
'04.
100. Items Pavable in Connection with loan
101. Loan Orioination Fee
l02. Loan Discount
103. Aooraisaf Fee
104. Credit ReDort
305. Lende~s fnsoection Fee
306. Mortnaae Insurance ADDlication Fee
B07.
B08.
B09.
810.
811.
812.
813.
814.
900. Items Reouired bv lender to Be Paid in Advance
901. Interest from I I to I @$ I Inerdav
902. MortDaDe Insurance Premium for
903. Hazard Insurance Premium lor
904.
905.
1000. Reserves DeDosited with lender iij)
1001. Hazard insurance months Der month
1002. MortaaDe insurance months !ll$ Der month
1003. City DroDertv taxes months !ll$ Der month
1004.CountvDrooertVtaxes months !ll$ per month
1005. Annual assessments months !ll$ Der month
1006. months !ll$ per month
1007.
1008.
1009. ADDreDate Accountina Adiustment
1100. Title Charaes
1101. SelllemenUclosino lee
1102. AbstracUtitle search
1103. Title examination to H. Anthonv Adams 400.00
1104. Title insurance binder
1105. Document preDaration
1106. Notarv lees
1107. Allornev's lees to H. Anthonv Adams COeed Prep-& Review) 275.00
(includes above item numbers
1108. Title insurance
(includes above item numbers
1109. Lende~s coveraae
1110. Owner's coveraoe
1111.
1112.
1113.
1200. Government Recording and Transfer Charg<>s
1201. Recordino lees: Deed 38.50 MortnaDe Release 38.50
1202. City/county tax/stamos: Deed 1,300.00 Mortoaae $1,300.00
1203. State tax/stamns: Deed 1,300.00 Mortoaoe 1,300.00
1204. Recorder 01 Deeds (surcharoe on oaoes and names) 29.00
1205.
1206.
1300. Additional Settlement CharDes
1301. Survev
1302. Pesllnspeclion
1303.
1304.
1305.
1306.
1307.
1308.
1400. Total Setllement CharDes (This Number Translers to lines 103 & 502 Above) $1 738.50 $9,404.00
CERTIFICATION
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction. I further certify tha aye received a cOPY. of the HUD-1 Settlement Statement.
Seller U.1~.,!'~ Borrower
arPl L ~~.b'e-;?<1~ ,,:It Seller ~ Borrower
WARNING: 1\ is a aime 10 knowingly make false stataments to the Unit
Code Section 1001 and Section 1010
les on this or any other similar form. Penalties upon conviction can
which were received and
To the best my knowledge the HUD-1 Settlement Statement which I have prepared is true
have been or . . as part of the settlement of this transaction.
. Settlement Agent
Date