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Home My WebLink About04-07-14 (2) J 15�56101�5 REV-1500 EX�oz_��,�F�, � PA Department of Revenue Pennsytvarria oFFICIAL uSE ONLY Bureau of Individuat Taxes ��'""�""'��`�"°` County Code Year File Number PO BOx z8o6oi INHERITANCE TAX RETURN Harrisburq,PA i'7128-o6oi RESIDENT DECEDENT �' I � �►�I� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 09/27/2013 10/25/1947 DecedenYs Last Name Suffix DecedenYs First Name MI SMITH BARBARA ,1 (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 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1.Original Return O 2.Supplemental Return p 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) (� 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust � 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Numbe� JAMES LEWIS PROCTOR, JR (717)55��-A�3 c � �' � _ m �'�'., REG1S�'F�F�JSYILLS�E O�� a�..._ � t".� � � :;y„ � ��''� � °�'� �� First Line of Address � � �`� �� g.C7 ` �°. �.�i C) JAMES PROCTOR LAW OFFICE,LLC '� � � 3 `�'� � Second Line of Address .� ,� ►—+ ""� n `47 ~ ~ t��-- rn 35 EAST HIGH STREET,SUITE 202 � ,� � 4 City or Post Office State ZIP Code DATE FI�"D � CARLISLE PA 17013 CorrespondenYs e-mai�address: LEGAl.@JAMESPROCTORLAW.COM Under penalties of pery'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. eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA7URE OF PE S N E PONSIBLE FOR FILING RETURN DATE I ' �if�� AD ESS 77 WEST PINE STREET, PALMYRA, PA 17078 IGNATURE OF PRE THER THA REPRESENTATIVE DAT� ....� ��1 � D RESS MES PROCTOR LAW OF LLC, 35 EAST HIGH STREET, SUITE 202, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610105 1505610105 � �� 1505610205 REV-1500 EX(FI) DecedenYs Social Security Number oecedent's Name: Ba�ba►'a J. Smith RECAPITULATION 1. Real Estate(Schedule A). . .. .. . .. .. .. .. .. . .. .. .. .. .. .. . .. .... .. .. . ... 1. 0.00 2. Stocks and Bonds(Schedule B) 2. 0.00 . ..... .. ...... . ..... .. .. .. .. .. .. .. .. . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. .. . 3. 0.00 4. Mortgages and Notes Receivable(Schedule D) .. .. .. .. .. .. . .. .. . ... .. .. . . 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). .. .. .. 5. 7,978.47 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. .. . .. 6. 0.00 7. inter-Vivos Transfers 8�Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. . .. ... 7. 0.00 8. Total Gross Assets(total Lines 1 through 7). .. .. .. .. . .. .. .. .. .. .. . .. .. .. 8. 7,978.47 9. Funeral Expenses and Administrative Costs(Schedule H). . . .. .. . .... .... ... 9. 2,881.92 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).. .... ..... .. . . 10. 2,764.88 11. Total Deductions(total Lines 9 and 10). ... .. ... . . . . . . . .. . . .. .. . .. .. . . . . 11. 5,646.80 12. Net Value of Estate(Line 8 minus Line 11) .. .. .. . . ... . . .. ..... ... .. .. . .. 12. 2,331.67 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . .. .. .. .. . . . .. .. .. .. .. .. 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) .. .. .. .. . .. .. .. ..... .. .. 14. 2,331.67 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_ 15. 16. Amount of Line 14 taxable at lineal rate X.0_ 16. 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable 2 331.fi7 349.75 at collateral rate X.15 � 18. 19. TAX DUE . .. .. .. .. .. . .. .. ....... . .. .. .. .. .. . ..... . .. .. ...... .. .. . . 19. 349.75 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 L 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Barbara J. Smith STREETADDRESS 16 South Enola Drive, Unit 202 CITY -- -- --- STATE --- ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 349.75 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 Total Credits(A+g) (2) 0.00 3. Interest (3) 0.00 4. if Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2,Line 20 to request a refund. (4) 5. If Line 1 +Line 3 is greater than Line 2,e�ter the difference.This is the TAX DUE. (5) 349.75 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.......................................................................................... ❑ � 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 containsa 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 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 suroiving spouse from tax,and the statutory requirements for disclosure of assets and filing a tax retum are s611 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 decedent's 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 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-i5o8 EX+(o8-i2) �� pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Barbara J. Smith 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 �. Checking account 1,060.33 2, Money market savings account 571.14 3, Automobile-2005 Hyundai Elantra 2,971.00 4, Refund of apartment security deposit from landlord 402.00 5, Rent rebate from Pennsylvania Department of Revenue 500.00 g, Auto insurance premium refund 71.75 7, Home insurance premium refund 14.25 g_ Prepaid funeral expenses,credits,and discounts 1,823.00 g. Household furnishings 200.00 10. Computer equipment 165.00 11. Refrigerator • 200.00 TOTAL(Also enter on Line 5, Recapitulation) $ 7,978•47 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 Barbara J. Smith Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: i' Cremation 1,695.00 2 Interment of cremated remains 400.00 3 Coroner cremation approval fee 30.00 4 Newspaper notice 156.42 s Death certificates 42.00 s �asoline 170.00 � Ivory plastic container 35.00 e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 0.00 Name(s)of Personal Representative(s) Dorene L. Koons Street Address 77 West Pine Street city Palmyra __ ___ _state PA ZIP 17078 Year(s)Commission Paid: N/A 2• Attorney Fees: 280.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) 0.00 Claimant Street Address___ City __ _State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 0.00 5. Accountant Fees: 0.00 6• Tax Return Preparer Fees: 0.00 �• Non-Probate(small estate)filing fees 73.50 TOTAL(Also enter on Line 9, Recapitulation) $ 2,88�•g2 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+ (12-12) �� pennsylvania SCHEDULE I DEPAHTMENTOFREVENUE DEBTS OF DECEDENT, INHERITANCE TAX REfURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Barbara J. Smith 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� Unreimbursed medical expenses-West Shore EMS-ALS 1,276.34 2. Ceil phone-Verizon Wireless 98.33 3. Credit card-Phillips&Cohen Associates,Ltd. 877.29 4. Credit card-AscensionPoint Recovery Services,LLC 128.48 5. Credit card-Capital One 384.44 TOTAL(Also enter on Line 10, Recapitulation) $ 2,764.88 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) �� pennsylvania SCHEDULE � DEPARTMENT OFREVENUE INHERITANCE TAX REfURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Barbara J. Smith 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[Include outright spousal distributions and transfers under Sec.9116(a)(1.2),] 1• Dorene L.Koons Cousin 50°/a 2. Harry W. Fetter Uncle 25% 3. Tina Fetter Aunt 25% 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.