HomeMy WebLinkAbout03-22-05
REV.15<JO EX 1....1
REV-1500
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
F~E NUMBER 0 0 0 'I
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COUNTY tooE YEAR NUMBER
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NAME
Rodney Harris
FIRM NAME (W Applicable)
COMPLETE MAILING ADDRESS
Rodney Harris
22 Stiles Dr.
Marysville, PA 17053
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Harris Doris I
SOCIAL SECURITY NUMBER
196-14-3653
DATE OF DEATH (MM-DD-YEAR)
01/13/2005
DATE OF BIRTH (MM-DD.YEAR)
02/12/1925
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
TELEPHONE NUMBER
(717) 957-4568
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy otTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death pnor to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Soh 0)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
17,796.50
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17,796.50
3,339.07
14,457.43
14,457.43
650.58
650.58
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & 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)
(7)
(6)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (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)
(9)
(10)
(8)
3,339.07
(11)
(12)
(13)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x .0_ (15)
14,457.43 x.O ~ (16)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
x .15 (18)
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
(19)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS
335 Weslev Drive
Act. 306
CITY M h . b I STATEpA I ZIP 17055
ee ames urg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
650.58
32.53
Total Credits (A + B + C ) (2)
32.53
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( 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)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
0.00
0.00
618.05
0.00
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.
618.05
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;.......................................................................................... D Ii]
b. retain the right to designate who shall use the property transferred or its income; ............................................ D Ii]
c. retain a reversionary interest; or.......................................................................................................................... D [i]
d. receive the promise for life of either payments, benefits or care? ...................................................................... D [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D [i]
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? .............. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D ~
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 penatties of pe~ury. I declare that I have examined this retum. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
DATE
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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DATE
ADDRESS
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) (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 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)(1 )J.
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) '*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Doris I Harris
FILE NUMBER
ITEM
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.
M&T Bank
5219 Simpson Ferry Rd
Mechanicburg, PA 17055
2 M&T Bank
Same as above
3 M&T Bank
Same as above
DESCRIPTION
Checking Acct # 1289284
CD Acct # 31003910354809
Interest Due on CD Acct # 31003910354809
4 Auer Memorial Home and Cremation Services Inc.
Prepaid Funeral Acct # 21927
4100 Jonestown Rd.
Harrisburg, PA 17109
5 Susquehanna Trust and Investment Co.
329 Pine St.
Williamsport, PA 17701
6 Patriot News
PO Box 2265
Harrisburg, PA 17105
7 Bethany Towers
335 Wesley Drive
Mechanicsburg, PA 17055
8 TV Guide
Payment due thru date of death Acct # 43-S153-01-5
Payment due thru date of death Acct # 43-S149-01-3
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Subscription Refund
Rent refund
Security Deposit Refund & Interest
Subscription refund
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
6,019.68
10,062.60
8.55
900.00
52.62
493.00
97.90
30.00
53.31
78.84
17,796.50
REV-1511 EX+ (12-99.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Doris I Harris
FILE NUMBER
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule L
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Auer Memorial Home and Cremation Services Inc.
Prepaid Funeral Expense
County Coroner Fee, Death Certificates (Reimbursed from estate to Rodney Harris, Adm.)
Newspaper Obituary
Paxtang Cemetary Open/Close Grave Site (Reimbursed from estate to Rodney Harris,
W. Orville Kimmel Funeral Home Graveside Services and Clergy
Romberger Memorials Gravestone
1,230.00
2
900.00
35.00
72.00
525.00
3
4
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State~Zip
2. Allorney Fees
Year(s) Commission Paid:
3. Family Exemption: (If decedent's address is not the same as claimant's, allach explanation)
Claimant
Street Address
City
State ~Zip
4. Probate Fees
Relationship of Claimant to Decedent
5. Accountant's Fees
7.
6. Tax Return Preparer's Fees
Cumberland County Resister of Wills (Reimbursed from estate to Rodney Harris, Adm.)
A TM Charge acquired due to County needing cash or check. Check not available
88.00
2.00
7.39
29.68
8
Verizon
Final Telephone bill
9
Health South Regional Specialty Hospital
Television Usage
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
3,339.07
Rodney R Harris
22 Stiles Dr.
Marysville, P A 17053
Dear Sir or Madam:
I wanted to offer some explanation about the Susquehanna Trust and
Investment Co. accounts in hopes of answering your questions in advance. These
accounts were trust funds setup by my mothers' mother and her stepfather to offer
my mother financial assistance during her life. These accounts were not transferable
beyond my mother. Both accounts were written with the beneficiaries being
Albright Church in Sunbury, PA and the Masonic Home. Hopefully this clarifies
why I have not listed them on any other schedule.
Sincerely,
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