HomeMy WebLinkAbout01-21-14 � penns��vania 15 0 5 613110
OEPARTMEN OF REVENUE EX(06-13)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po sox 2eosoi INHERITANCE TAX RETURN �j I � ��I�
Harcisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
04152012
DecedenYs Last Name Suffix DecedenYs First Name MI
SHERIFF KEVIN �
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH
THE
FILL IN APPROPRIATE BOXES BELOW REGISTER OF WILLS
Q 1. Original Return Q 2. Supplemental Return Q 3. Remainder Return(date of death
Priorto 12-13-82)
Q 4. Agriculture Exemption Q 5. Future Interest Compromise(date of Q 6. Federal Estate Tax Return Required
date of death on or after 7-1-2012) death after 12-12-82)
XQ 7. Decedent Died Tesfate Q 8. Decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
Q 10. Litigation Proceeds Received Q 11. No Taxable Asset Retum Q 12. Election to Tax under Sec.9113(A)
(Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALl CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
ROBERT G. FREY 7172435838
First Line ofAddress
5 SOUTH HANOVER STREET
Second Line ofAddress
City or Post Office State ZIP Code �
� —_' � f z1
CARLISLE PA 17013 � � �� �, �
REC�T� O�-jMLLS�t�SE ON�4_P �
REGISTER F WILLS USE ONLY ''� '"^' r N ►}'°� f'�'t
DATE FILED �`� G> r^�+ ~ � �^�
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CorrespondenYs email address: R F R E Y a�F R E Y T I L E Y .C 0 M ^�DATE FILED P �' °
Under penalties of perjury,I declare I have examined this return,inGuding accompanying schedules and statements,and to the best of my knowledge and belief,it
is true correct and com I .Declaration of re arer ot r t an the onal re resentative is based on all information of which re arer has an knowled e.
SIGNATURE OF PERS fV-RESPONSI OR FILW ETU �AT l 7 j
1��_ ��
ADDRESS � � � , � ,D� ���
3`� � C� a ss �. �� �.� c-rr- � s �e
SIGNATURE OF E RER O ER ENTA DATE
.- / ! � `�
ADDRESS
5 SOUTH HANOVER STREET CARL E PA 17013
PLEASE SE ORIGINAL FORM ONLY
Side 1
L 1505613110 1505613110 �
J 1505613210
REV-1500 EX DecedenYs Social Security Number
DecedenYS Name: K E V I N L S H E R I F F
RECAPITULATION
1. Real Estate(Schedule A) �• ��
. . .. . .. .. . .. .. ... . . .. . . . .. ... . . . .. .. . . . . . . . 1.
2. Stocks and Bonds(Schedule B) 2• �� ��
.. . . .. . . . . . . . . . .. .. .. . .. .. . . .. .. .. . ..
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).. . 3. � •��
4. Mortgages and Notes Receivable(Schedule D).. .. .. . . . . . . .. .. . . . . . .. . . 4. 0 •��
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). .. . . 5. 6 2 4 .��
6. Jointly Owned Property(Schedule F) �Separate Billing Requested.. .. .. . 6. 38329. 5�
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) �Separate Billing Requested. . .. .. . 7. �•��
8 Total Gross Assets(tota��ines 1 throuqh 7) .. .. . . . 8. 3 8 9 5 3. 5 0
9. Funeral Ex enses and Administrative Costs(Schedule H) s. 1623. ��
p .. .. . . . . .. . . .. .. .
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I). . . .. . .. .. .. .10. � •��
11. Total Deductions(total Lines 9 and 10). . . . . .. . . . . . . . .. .. .. .. . . . . . .. . 11. 1623. 0�
12. Net Value of Estate(Line 8 minus Line 11). .. .. .. . . . . . .. . .. .. . . .. .. . . . 12. 37330. 50
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which O �Q o
an election to tax has not been made(Schedule J). . .. .. . . . . . . . .. .. .. .. . 13.
14 Net Value Subject to Tax(Line 12 minus Line 13) .. . . . 14. 37330. $�
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 O 15. O•��
16. Amount of Line 14 taxable
at�inea�rate x.0 45 37330. 50 �s. 1679 . 87
17. Amount of Line 14 �. ��
taxable at sibling rate X • 12 ��•
18. Amount of Line 14 taxable
at collateral rate X • �+5 18. �•��
19. TAX DUE. . . . . .. . . . . . . . .. . .. . . . . .. . . . .. . . . . .. . . . . . .. . .. .. .. .. . . .. 19. LIa7°I.87
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0
Side 2
L 1505613210 1505613210 �
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21-12-0517
DECEDENT'S NAME
KEVIN L SHERIFF
STREETADDRESS
200 Valle Road
CITY STATE ZIP
SUMMERDALE PA 17093
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1679.87
2. Credits/Payments
A.Prior Payments 1740.70
B.Discount
Total Credits(A+B) (2) 1740.70
3. Interest
(3) 15.29
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fili in box on Page 2,Line 20 to request a refund. (4) 45.54
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.
. . . .. .
F :�.. .
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......................................................................................... ❑ ❑
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?............................................................................................................. ❑ ❑
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 individual retirement account,annuity 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.
.. P . . . ... �. �`�,.n..: �' rr: `��'���`�'�,�3."3�i:... 3.� � ., .:
.. . <. .. . ... . ... , :.
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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)].
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 decedenPs 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 decedenYs 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-1508EX+(08-12) SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENTOFREVENUE PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Kevin L Sheriff 21-12-0517
Include the proceeds of litigation and the date the proceeds were received by the estate.
Ail property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Real Estate pro-rations from HUD-1 settlement statement 624.00
TOTAL(Also enter on line 5, Recapitulation) $ 624.00
If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Kevin L Sheriff 21-12-0517
If an asset became jointiy owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. John H. Sheriff,Jr. and Doris F. Sheriff 395 Opossum Lake Road Parents
Carlisle, PA 17015
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY °k OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
200 Valley Street, Summerdale, PA 115,000.00 33.33% 38,329.50
1. A. 3/18/92
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL(Also enter on Line 6, Recapitulation) $ 38,329.50
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(OS-13)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
RESIDENTDEC DENTURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Kevin L Sheriff 21-12-0517
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees:
3. Family Exemption:(If decedenfs address is not the same as claimanYs,attach explanation.)
Claimant
Street Address
��ty State ZIP
Relationship of Ciaimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return PreparerFees:
7. Costs of sale of Real Estate, HUD-1 Settlement statement attached 1,623.00
TOTAL(Also enter on Line 9, Recapitulation) $ 1,623.00
If more space is needed,use additional sheets of paper of the same size.
Personal Income Tax e-Services Center 1/15/14,9:55 AM
Penalty and Interest Calculations
CALCULATION DATES-
1/15/13 TO 5/6/2013
TAX DEFICIENCY $ 1,679.87
CALCULATED INTEREST $ 15.29
BALANCE AS OF 5/6/2013 $ 1,695.16
( Start Over �
https:J/www.doreservices.state.pa.us/pitservices/Default.aspx Page 1 of 2
Previa�o editions are ob::alefe
c� (orm HUO-1(31Bfi)ref Hantlbook 6305.2
A. �"Gttle�lent Statement U.S.DepaRment of Housing and Urban Development
B.Type of Loan OMB A roval�NO.2502-0265
� ?. ❑FHA 2. ❑FmHA 3. OConv.Unins. � 6.Fife Number 8.Mortgage Insurance Case Number
7.Loan Number
� d. OVA 5. ❑Conv.lns. 13•02
is orm rs umis o grve yau a a emen a emen c oun s pa� y e sa emen agen a
C.NOfO: Items markatl"(p.o.c.�"we Pa�a�,�,�a�v,a ao,;,,9;cnaY a,�sn�n�,�rw�„ro�euo„P�,�os�,a„d„a„a,,,�i„aad�,,;�°a io�,s. TitleExpress Settlement System
WARMING.It is a ai e ta knowingly make false statements ta the Unitetl Stales on tnis or any Nher similar fortn.Penaltiea upon
mnvi<lion wn inclutle a fne and imonsanment For tle�ails sce:Ttle 18 U.S.Cotla Sadion 1001 antl Settion 1010.
D.NAME OF BoF:ROWER: Mark L.Myers and Jill L.Myers
ADDRESS: P.0.Box 249 Summerdale PA 17093
E.NAME OF SELLER: John H.Sheriff,Jr,and Doris F.Sheriff
ADDRESS: 395 0 ossum Lake Road Carlisie PA 17015
F.NAME OF L'cNDER:
ADDRESS:
G.PROPERTY ADDRESS: 200 Vailey Road,Summerdale,PA 17093
East Pennsboro Townshi
H.SETTLEMENT AGENT: A One Sett�ement Services,Telephone:717-249-0020 Pax:717•249•0026
PLACE OF SETTLEMENT: 19 South Hanover Street Suite 105 Carlisle PA 17013
I.SETTLEMENT DATE: 01N112013
J.SUMMARY OF BORROWER'S TRANSACTION: K.SUMMARY OF SELLER'S TRANSACTION:
100.GROSS AMOUNT DUE FROM BORROWER 400.GROSS AMOUNT DUE TO SELLER
101. Contract sales nce 115 00�.00 401. Contract sales nce 115 000.00
102. Personal ro ert 402. Personai ro ert
103. Settlement r.har es to bortower Iine 1400 2 680.67 403.
104. 404.
105. 405.
Ad�ustments for items aid b seller in adva�ce Ad'ustments for items aid b seller in advance
108, School Taxes 01111/13 to06/30113 544.00 408. Schooi Taxes 01/11113 to 06(30H 3 544.00
109. SewerProration 1/11-3/31/13 80.32 409. SewerProration 1/11-3131/13 80.32
110. 410.
111. 411.
��2' 412.
120.GROSS AMOUNT DUE FROM BORROWER 118 304.99 420.GROSS AMOUNT DUE TO SELLER 115 624.32
200.AMOUNTS PAID BY OR ON BEHALF OF BORRO ER 500.REDUCTIONS IN AMOUNT DUE TO SELLER
201. De osit or eamest mone 11 500.00 501. Excess De osit see instructions
202. Pnnc al amount of new loans 502. Settiement char es to seller line 1400 4199.00
� 203. Existin loan s taken sub ect to I 503. Existin loan s taken sub'ect to
204. 504. Pa off of First Mort a e Loan
205. 505. Pa off of second mort a e loan
206. 11 da s Count/Tw rora(ion 11.08 506. 11 da s Coun /iw roration 11.08
20�' 507. Water Pnvate-PA Amencan
208, 508.
209. 509.
Ad'ustments for items un aid b seller Ad'ustments for items un aid b seller
213. 513.
214 514.
215. 515.
216. 516.
21� 517.
218. 518.
219. 519.
220.TOTAL PAID BY/FOR BORROWER 11 511.08 520.TOTAL REDUCTION AMOUNT DUE SELLER 4 210.08
300.CASH AT SETTLEMENT FROM OR TO BORROWER 600.CASH AT SETTLEMENT TO OR FROM SELLER .
301. Gross amount due from borrower line 120 178 304.99 601. Gross amount due to seller line 420 115 624.32
302. Less amowts aid b/for borrower Iine 220 11 511.08 602. Less reduc;ion amount due seller line 520 4 210.08
303.CASH FROM BORROWER 106 793.91 603.CASH TO SELLER 111 414.24
SUBSTITUTE FORM/099 SELLER STATEMENT:The infortnation containeE herain is important taz irrtorma�ion end is being furnis�etl b tha Inlemel Revenue Service.If you are required to Flle a refum,
i�neeao9 ae e con'stitulea tn�G�osa P�I�ep da m�n stltrens�a�ionhis item Is required to be repartetl ano Na IRS tlelermines fhat if has not been reportetl.The Conirad Salas Pnce tlescnDetl on
SELLER INSTRUCTIONS'If Uiis real estate wac yaur pnndpal resitlente,fle Fartn 2119,Sale or Exchange of Pnndpat Residenca,Por any gain,wiN your Income fez retum;fw o�her Irensactions,
Complete tlte ao0lifab�e parts of Form 4797,Fonn 6252 andlor Schetlule D(FOrtn 1040).
num are requiretl hy law to proviEe the setllement agent�FeE.Tae i0 No: with your correct tazpayer itlen�itrcetion numbar.It do no�
Cer.you may ba s�bject to uvil w aiminal penalties imposeC by law.Untler penallias perjury,I certify that tha number Shown on Ni5 statam muis m P��iCe your correcf�axpeyer Itlen[if W�ion
y mnact;aupayer idazrtificanon number.
TIN: _/ .SELLER(S)SIGNATURE(S): �
SELLER�S)NEW MAILINGA�DRE55:
_ __
;e��e�� � form HUD-1(3lB6)ref Mantlbook 43052
;•OE°ARTMENT OF HOUSING AN�URBAN DEVELOPMENT File Number.13-02 PAGE 2
,ETTLEMENT STATEMENT TitleEr ress setuement s stem
SETTLEMENT CHARGES PAID FROM PAID FROM
�, A. TOTAL SALES/BROKER'S COMMISSION based on nce 5115 000.00= BORROWER'S SELLER'S
Division of commission line 700 as follows: FUNDS AT FUNDS AT
701, $ t0 SETTLEMENT SETTLEMENT
702. $ to
703. Commission aid at Settlement
600.ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan On ination Fee %
802. Loan Discount %
803. A raisal Fee
804. Credit Re art
605.
806.
807.
808.
80�
810.
811.
900.ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. interest Frcm to $ /da
902. Mort a e Insurance Premium for to
903. Hazard Insurance Premium for to
904.
905.
1000.RESERVES DEPOSiTED WITH LENDER FOR
1001.Hazard Insurance mo. $ /mo
1CO2.Mort a e Insurance mo. /mo
1003.Ci Pro ert Tau mo. /mo
1004.Count Pro ert Tax mo. $ /mo
1C05.School Taxes mo. $ 97.33/mo
1009.A reoate Anai sis Ad'ustment 0.00 0.00
1100.TITLE CHARGES
1101.Settlement or Closin Fee
1102.Abstract or Tiile Search
1103.TiUe Examination
1104.Title Insurance Binder
1105.Document Preoaration to A One Settlements 100.00
1106.Nota Feea to An ela F.Un er 20.00
1107.Attome's rees to Byron Walker 386.25
indudes above items No:
1108.Title insurance to First American TitlelA One Settlement Serv 393.75
includes above items No:
1109.Lenders Policv NONE
1?10.Owner's Polic 115 000.00 -393.75
' 1111.Wire Transfer Fee to A One Settlementsl0rrstown Bank 12.00
1112.Title Search to Patrica Black Abstractin 95.00
1113.Deed Pre Fee ro Fre 8 Tile 350.00
1200.GOVERNMENT RECORDING AND TRANSFER CHARGES
1201.Recordin Fees Deed$62.00 Mort a e$ Release 62.00
1202.CitvlCount taxlstam s Deed 1 150.00 Mort a e$ ?150.00,
1203.State Taxlstam s Deed$1 150.00 Mort a e$ 1 150.00
1204, Deed 3 Mort a e�
1205.
1300.ADDITIOMAL SETTLEMENT CHARGES
1301.2012 Counhr/Tw .taues to Debbie Lu old Taz Collector P.O.C. 375.26 Seiler
1302.20t2-13 Schcol taxes to Deb6ie Lu old Tax Collector P.O.C. 1 168A3 Seller
1303.Tae Cert Reimbursement to A One Settlements 10.00
13�4.2013 Count/Tw .tax escrow to A One Settlements 422.92
1305.First Qtr Sewer to East Pennsboro Townshi 91.50
1306.Trash from�It 1-3131 to East Pennsboro Townshi 38.75
1307.Inheritance Tax Escrow to A One Settlement Services 2 587.50
1308.SewerlTrasti CeKifcation to East Pennsbora Townshi 10.00
1400.TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Section K ^ 2 680.67 4199.00
I have carefully reviewc-0 the HU�-1$ettlemerrt StetBmeM end to Iha best af my knowietlge and belief,It is a tn�e antl accura slet4 tament Pf al'�reCeiptS a4f isbu/sement5 matle on my account or hy me
in this transacnon.1(unM1er certiry Nat I have�eceivaC a A py of the HUD-1$ettlamen�S�a�ement. j
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�-�ye�z � .anr�i �
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„p n eri, c �-- ons ..,
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WARNING'IT IS A CRIME TO KNOWINGIY MAKE FALSE STATEMENTS TO THE The H11�-1�8€€€ffftlemanl Statem.ant wnich I M1ave preparatl Is a We and accurate account of this hansaction.
UNI7E0 STA7E5 ON l"HIS OR ANV SIMIUIR FORM PENALTIES UPON CONVICTION I have �d�Or �ill rau e ttte funtls to be 4isburseC In acCOrtlance with this statemenl.
CAN INCLUDE A FINE AN�IMP0.150NMENT.FOR�ETAILS SEE TITLE 1B'.
U.S.CODE SECTION I001 ANO SECTION?010. / /J �/�/�� � /� ,,
BY.- C�� � OAfic� .