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Home My WebLink About02-05-14 (2) � 15a56�o1�0 � REV��5�� Ex �oa-�1)tFq OFFlCIAL SE ONLY PA Uepa�tment of Revenue � -. Bureau of Indtvidua�Taxes �NHERtTANCE TAX RETURN �OtntyCode Yeer FN�eNumber Po Box 2soso� 2 7, Z 3 1 0 3 1 Har�isburg, PA 17'128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORAAATION BELOW � Social Security Number pate of Death MMOOYYYY Date of 8irth AAA+iDDYYYY 0 9 1 9 2 0 1 3 1 1 0 8 b 9 2 4 DecedenYs Last IVame Sufflx Decedenfs First Name ►y� S I M S D A V Z D � (If Applicable)Hnter Survivl�g Spouse's Information Below Spouse's Last Name Sufflx Spouse's First IVame M� S I M S L 0 I S M Spouse's Social Security Number THIS RETURN MUST BE FILED IM DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1.Or(ginal Return � 2,Supplemental Return � 3.Remainder Return(Oate of Death Prior to 12-13-82) � 4.Limited Estate [� 4a.Future t�terest Compromise(date of [] 5.Federal Estate Tax Return Required death after 12-12-82) ❑X 6.Decedent Died Testate � 7.Decedent Maintained a Living Truat _ 8.Total Number of Safe Deposit Boxes (Attach Copy M Wiln (Attach Copy of Trust.) � 9.Litigation Proceeds Received � 10.Spousal Poverty Credit(Date of Death Q 11.Election to Tax under Sec.9113(A) BeMreen 12-31-91 and 1-1-95) (Attach Schedule O) CpRRESPONDENT-THlS SECTION MUST BE COIYi�IETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAK INFORblATiON SHOULD BE DIRECTED T0: Name Daytime Telephone Number M U R R E L W A L T E R S , I I I E S Q 7 �.,7 6 9 ;-�' 4 6� 0 C --- ,� r�i � �rt oF w�s us� �, �� r-., ._ rn ._ c, c� rn =.� � � � Flrst Line o#Address � �` �� r� I'> �� v `� _,�, Ci 7 �'J 5 4 E • M A I N S T R E E T --. . �� c� K-> Second Line of Address �� c'> '^ -r7 -,� c,`� _.__ �;"7 [ J �.� �3 ";i 1v5 C. = C"? � ;�7 C.J t'— i�"1 City or Post Office State ZIP Code '� _� DA D � c.'� � M E f H A N I C S BU R G P A 1 ? Q 5 5 CorrespondenYa e-mail address: murrel(c�waltersgallowav.com Under penalNea of pe�ury,I declare that 1 have examined this return,induding accomparryinp schedules a�d statemeMs,and to lhe�st of my knowledge and belief, it is true,correct and complete.Dedaratbn of preparer other than the pereonal represerrtathre is based on afl Inforrnafion ot whfch preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE M- , "" f 4 l. ADDRESS CAROL A• SIMS, 1387,6 S SS LANE TRUCKEE CA 96161 SIGNATURE OAP P R 0 ER R E5ENTATNE , /DA�v _/� ADDRESS ; MURREL A ER , I , E• MAIN ST MECHANICSBURG PA 17D55 � PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610140 150561D140 J � 1505610240 REV-1500 EX(FI) DecedenYs Social Security Number �ecedent's Name: D A V I D C • S I M S 1 9 0 1 4 1 7 2 4 RECAPITULATION 1. Real Estate(Schedule A) ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. • 2. Stocks and Bonds(Schedule B) 2. 1 0 6 1 4 . � � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. • 4. Mortgages and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . .. . . . . . . . . 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. $ 4 6 6 � . 0 � 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. • 7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property (Schedule G) � Separate Billing Requested . .. . . . . 7. . 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . .. . . . . . 8. 6 5 2 8 1 . � � 9. Funeral Expenses and Administrative Costs(Schedule H) . .. . . .... . . . . . . . . . 9• 7 8 5 2 . 4 3 10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule I 10. 1 3 2 5 . 2 8 9 9 ( ) . . . . . . . . . . . . . 11. Total Deductions(total Lines 9 and 10) . . . . ... . . . . . . . . . . . . . . . . . . .. . . . . 11. 9 1 � � . � 1 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . .. . .... . . . . . . . . 12. 5 6 1 0 3 . 2 9 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . .... . . . . . . . . . . . . . . . . 13. . 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . .. . 14. 5 6 1 � 3 . 2 9 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(�.2)x.o _ 5 6 1 0 3 . 2 9 15. O . 0 0 16. Amount of Line 14 taxable at lineal rate X.0_ � • 0 � 16. � . � 0 17. Amount of Line 14 taxable at sibling rate x.�2 0 . 0 0 ��. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 � . 0 � �g. � . � Q 19. TAX DUE . . . . ....... . .. . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .. . . . . . 19. � • � 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 L 1505610240 1505610240 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 2� 13 1031 DECEDENT'S NAME DAVID C. SIMS STREET ADDRESS 5225 WILSON LANE,APT. 3135 CITY STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: �• Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0.00 3. Interest 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. (3) Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00 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 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 ...................................................................... ❑ ❑X b. retain the right to designate who shall use the property transferred or its income ............................... ❑ �X c. retain a reversionary interest ..................................................................................................... ❑ 0 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ ❑X 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X 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. 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 is 3 percent[72 P.S.§9116(a)(1.1)(i)j. 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 atloptive 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 p2 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-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENTOFREVENUE STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID C. SIMS 21 13 1031 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PRINCIPAL STOCK 4,300.00 100 SHARES 2. PRUDENTIAL STOCK 6,314.00 82 SHARES X$77 TOTAL(Also enter on Line 2,Recapitulation) $ 10 614.00 If more space is needed,insert additional sheets of the same size REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: DAVID C. SIMS 21 13 1031 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PRINCIPAL 15,053.00 IRA-ANNUITY 2. PRINCIPAL 8,500.00 IRA-ANNUITY 3. PRINCIPAL 31,114.00 ANNUITY TOTAL(Also enter on Line 5,Recapitulation) $ 54 667.00 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID C. SIMS 21 13 1031 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. PARTHEMORE FUNERAL HOME 5,396.00 2. BLOOMS-FLOWERS 482.25 3. BETHANY-CATERING 475.68 4. COLUMBARIUM ETCHING 160.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) CAROL A. SIMS StreetAddress 13876 SWISS LANE City TRUCKEE State CA Z�p 96161 Year(s)Commission Paid: (RENOUNCED) 2, AttorneyFees: MURREL R.WALTERS, III 1,100.00 3, Family Exemption:(If decedenYs address is not the same as claimanYs,attach expianation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 238.50 5 Accountant Fees: 6. Tax Retum Preparer Fees: 7. TOTAL(Also enter on Line 9,Recapitulation) $ 7 $52.43 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID C. SIMS 21 13 1031 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. COMMONWEALTH OF PENNSYLVANIA 1,325.28 REPAYMENT- PENSION TOTAL(Also enter on Line 10,Recapitulation) $ 1 325.28 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: DAVID C. SIMS 21 13 1031 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(sj OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. LOIS M. SIMS Spousal 5225 WILSON LANE,APT. 3135 MECHANICSBURG, PA 17055 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: 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,use additional sheets of paper of the same size.