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ReI- 1500 EX (8-001
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REV-1500
'* COMMONWEALTH OF
- PENNSYLVANIA
, DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0001
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COlIlTY COIlE YEAR
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NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INmAL)
Bonnie S. Shepler
DATE OF DEATH (MM-DD-YEAR)
12/1912004
SOCIAL SECURITY NUMBER
176-34-9059
DATE OF BIRTH (MM-OD- YEAR)
09/16/1943
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPUCABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (AlIadl ~ of WiI)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dati> ofdea1h after 12-12-82)
o 7. Decedent Maintained a Living Trust (AlIadl ~ of Trust)
o 10. Spousal Poverty Credit (dati> ofdealh between 12-31-91 and 1-1~)
03. Remainder Return (dati> ofdea1h prior 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) (AlIadlSchO)
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NAME
Lori C. Duarte
FIRM NAME (If Appil3*)
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COMPLETE MAILING ADDRESS
3614 Montour Street
Harrisburg, PA 17111
TELEPHONE NUMBER
(717) 564-7724
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
160,000.00
1,660.00
0.00
0.00
279,213.00
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly 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)
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)
167,652.00
273,221.00
0.00
(6)
0.00
C)
(7)
0.00
440,873.00
(9)
(10)
(8)
4,202.00
163,450.00
(11)
(12)
(13)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
273,221.00
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.O_ (15)
273.221.00 x.O~ (16)
x .12 (17)
x .15 (18)
(19)
12,294.95
16. Amount of Line 14 taxable at lineal rate
12,294.95
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at coUeteral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Decedent's Complete Address:
STREET ADDRESS
900 Brentwater Road
CITY Camp Hill I STATEpA TZ'P
17101
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. CreditsJPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
12,294.95
Total Credits ( A + 8 + C ) (2)
614.75
3. InterestlPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( D + 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)
0.00
8. Enter the total of Line 5 + SA. This is the BALANCE DUE,
(SA)
(58)
0.00
12,294.95
0.00
12,294.95
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.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; .....................................,.................................................... D
b. retain the right to designate who shall use the property transferred or its income; ........,................................... D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
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
DATE
ADDRESS
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
For dates of death on or after July 1, 1994 and belOre 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 retum 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 paren~ an adoptive paren~
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 decedenrs 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 decedenfs 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 deceden~ whether by blood or adoption.
REV-1510 EX+ (6-98.
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
Bonnie S. Shepler
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side oflhe REV-1500 COVER SHEET is yes.
FILE NUMBER
DESCRIPTION OF PROPERTY
ITEM INClUllE TIE NAIIE OF TIE 11WI5FEREE. THEIR RElJIfION5HP TO DECEIlENT AND DATE OF DEATH ex. OF DECD'S EXCLUSION TAXABLE
NUMBER TIE DATE OF 11lANSfER. ATTACH A copy OF TIE DEED fOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPUCAIllE) VALUE
1. 401K Account to Lori C. Duarte, daughter on Dec. 20, 2004 12,000.00 100 12,000.00
2 Teamsters 776 Pension Account to Lori C. Duarte, daughter on Jan. 28, 2005 202,000.00 100 202,000.00
3 Teamsters 53 Pension Account to Lori C. Duarte, daughter. Not yet received. 53,000.00 100 53,000.00
100
100
100
TOTAL (Also enter on line 7 Recapitulation) $ 267,000.00
(If more space is needed. insert additional sheets of the same size)
REV-1502 EX+ (6-98.
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
Bonnie S. Shepler
AI ...1 property ClIWI1Id saIeIy or as . ..... in common nud be report8d It lIir IIIIrtcet Vllue. Fair market value is defined as the price at which property would be
exchanged between a wiDing buyer and a willing seHer. neither being compelled to buy or sell, both having reasonable knowledge d the relevant fads.
RIll property whiolt is jointly.-ned with right of lIIIrVivorship must be discIoIed on Schedull F.
FILE NUMBER
ITEM
NUMBER
1.
DESCRIPTION
House and properly located at 900 Brentwater Road, Camp Hill, PA 17101.
VALUE AT DATE
OF DEATH
160,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more spa<:e is needed, insert additional sheets d the same size)
160,000.00
REV-1503 EX+ (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Bonnie S. Shepler
FILE NUMBER
AU property joInlly-owned with right of survivorship must be dlsc:losed on Schedull F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Metropolitan Life Common Stock Shares
1,660.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
1,660.00
REV-1508 EX+ (6-98) '*
COMMONIfv'EALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Bonnie S. Shepler
FILE NUMBER
Include the proceeds r:J litigation and the date the proceeds were received by the estate.
All property jointty.owned with..vht of survivorship must be disalosecl on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Citizens Bank Checking Account 1,685.00
2 Citizens Bank Savings Account 421.00
3 PA Central Federal Credit Union Savings Account 1182903-013 1,802.00
4 PA State Employees Credit Union Savings Account #176-34-9059 305.00
5 Personal property 2,500.00
6 Auto 1999 Toyota Cam!)' 5,500.00
7 Mass Mutual 401 K Savings Account 12,000.00
8 Teamsters 776 Pension Account 202,000.00
9 Teamsters 53 Pension Account 53,000.00
TOTAL (Also enter on line 5, Recapitulation> $
(If more space is needed. insert additional sheets r:J the same size)
279,213.00
REV-1511 EX+ (12-99).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAl EXPENSES &
ADMlNISTRAllVE COSTS
ESTATE Of
Bonnie S. Shepler
FILE NUMBER
Debts of decedent must be reported on Schedule L
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
,.
FUNERAl EXPENSES:
Funeral seMces and cremation as conducted Fackler Weideman Funeral Horne on Dec. 21, 2004.
4,202.00
B. ADMINISTRATIVE COSTS:
,. Personal Representative's Commissions
Name of Personal Representatlve(s)
Social Security Number(s)/EIN Number of Personal Representatlve(s)
Street Address
City
. State
Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
.Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
lUTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,202.00
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE UABlunES, & UENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bonnie S. Shepler
Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
FILE NUMBER
1.
Wells Fargo 30 Year Home Mortgage Loan 110030135016
Wells Fargo 30 Year Home Equity Loan 1A550 291 3356 1998
125,500.00
37,950.00
2.
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
163,450.00
REV-1513 EX+ (9-00) *
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(SI RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec. 9116 (al (1.2))
Lori C. Duarte, 3614 Montour Street, Harrisburg, PA 17111 Daughter 100.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n NON- TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER lUTAl NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If mOrt space is needed, insert additional sheets of the same size)