HomeMy WebLinkAbout02-0805
*' I REV.1500 oz,l':'O;;r: &05
COMMONWfAJ.THOfPENNSn.VAMA I INHERITANCE TAX RETURN F'LENUMBER
__ ;c;7J~?r~~!:=1 _L_ RE~D_~~T ~~C!:~_~_~!___~._l.___wuN~}co_~_ _ ~~;~_
I-DECEDENTS NAME- (LA.ST:-FIRS-T. A-NO MIDDlE INITIAl'---- r---SOClAl SECURITY NUMBER
I THOMPSON, Mary lane 162-36-8242
~DOA3TE/'OOF80/EA2 OTHO(2MM-OD-YEARf --~- -TDAO-2lE/OOF8B/'R1 T9H-1CM4MOOD-YEARl ----~ - -~msRETiJRN MUST BE FILED IN DUPLICATE-WITH THE
I I 0 REGISTER OF WILLS ____.
(IF APPLICABLE) SUm/WING SPouSE'S Nil:ME ( LAST, FIRST AND MIOOlE INITIAL) -- ------- ---- - SOCIAL SECURITY NUMBER
THOMPSON, David!.
-----1181 1 OriginalRetum 0 2. SupplementalRetum --rr"3. RemainderRetum(daleotdealhpriQ,-io12~13_82j--
X ~ !'! I. 0 4. Limited Estate 0 4a. Future lnle(est Compromse. {date (If death after 0 5. Federal Estate Tax Return Required
.., LZ;..... 12.12-82)
5 ~ ~ I ~ 6. Decedent Died Testate (Attach copy 181 7. Decedent Maintained a Living Trust (Allacl1 0 8. Total Number of Safe Deposit Boxes
ll.. m, ofWtu) copyofTrusl)
!t ! 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (dale ot death between
12-31-91 n 1-1-95
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NU~_ER
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2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole--Proprletorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(ScheduCe E)
6. Jointly Owned Property (ScheduCe F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(ScheduCe 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)
rAME
,;,~ f
will
~ 0 : IRM NAME (If appliar.ble)
u~_ tELEP:ONENuM-BER-- m_-=.-= =-- =-=__--=1__
mu m__-r l-:-;eaIE;ta;(Schedu~ A) (1)
12. Net Value of Estate (Line 8 minus Line 11)
11. Election to lax under Sec. 9113(A) (Allach 5ch 0)
COMPLETE MAILING ADDRESS
None
OFFICiAL USE ONLY
(2) None
----.~~-
(3) None
--.---
(4) None
(5) None
(6) None
(7) 655,756.46
(8)
655,756.46
(9)
(10)
(11)
(12)
655,756.46
655,756.46
0.00
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)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Une 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
~
~
=>
~
~
u
~
~
x .00
(15)
x .045
(16)
! 16. Amount of Line 14 taxable at lineal rate
I 17. Amount of Line 14 taxable at sibling rate
I
I 18. Amount of Line 14 taxable at collateral rate
119. Tax Due
120. 0
~a~~al'Il!\\I1\Il.4';\\li!itE
x .12
(17)
x .15
(18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(19)
Copyright 2000 form software only The Lackner Group, me.
Form REV.1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
640 Mooreland Avenue
f---- ---
CITY
ISTATE;A- -lZiP-I;~-
Carlisle
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Tolal Credits (A + 8 + C)
(2) 0.00
3. Interest/Penalty if applicable
D. Interest
E. Penally
Tolai InteresUPenally (0 + E)
4. If Line 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund
5. If Line 1 + Line 3 is greater than line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the tolal of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4) __<._.___
0.00
(5)
(5A)
(58)
0.00
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:
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; or........................................................................... .................
d. receive the promise for life of either payments, benefits or care?.............................................................
2. If death occurred after December 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?... ................................. ...........,..... .......,..., ........ .............. ................... ..,........
Yes No
~ ~
o 0
o ~
o ~
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 penalties of perjury, I deClare thall have exarnned this retvm. including aCCOl'J1l8'1}'ing schedules and statements, and 10 the besl of my knowledge. and De<<ef, i\ is lrue. correct
and complete. Declaration of
preparerolherthanl~personalrepre$enlaliv~_isbasedon.a!linf~tiooofwhichpreparerhasany~~ge. .._____ ___ ___ ..__ __ . _ __._
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS - -" -DATE - -
D.1)T~~~ps.n ~ \;:/ _ ~~IIj~~p'l'"i%\3enue r/'-I/OL
~OF~R~N~ORilto~t:I~N - ADDRESS ------- -- --- DATE
REROT~~N~ ..:...
ADORESS--
'--O,(TE---
10 East High Street
Carlisle, PA 17013
qAJo2-
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. 99116 (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. s.9116 (a) (1.1) Oi)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements fordisdosure
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 af 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. 99116 (a) (1.2)J.
The tax rate imposed on the net value of transfers to Of far the use of the decedenfs tineal benefidaries is 4.5%. except as noted in 72 P.S. 99116
1.2) [72 P.S. 99116 (a)(l)].
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 Sectlon 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
.
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-..--.---
I SCHEDULE G
1 MI~~:;~~~~~;;;~;~~~~~_________
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
THOMPSON, Mary Jane
I FILE NUMBER
I 21-02-
,
'._~'---._.'--_._-.-..-..._._-
ESTATE OF
This schedule must be com leted and filed Ifthe answer to an of uestions 1 throu h 4 on a e 2 is s.
-ITEM -I' DESCRIPTION OF PROPERTY DATE OF DEAT~ % OF I. -- .
. '"d"d.the",~offh'''''"'''''''.th''''"",""'t"ptod''od''''a''''thedateof_'',,,. VA UE ASSET DE.CD'S EXCLUSION I TAXABLE VALUE
NUMBER Atta,ha_offh.d"""fo<..alostat.. L OF INTEREST (tFAPPLlCABLE)
- --1--1 Trust under Agreement dated February 20,2002'(.';-- --'655.'756.46 -1'00% -----r -- 655,756.46
attached statement of trust assets) i I
I !
I I I
_.------.L..____ _ _ L..__ _J _
TOTAL (Also enter on line 7, Recapitulation)
J
655,756.46
ESTATE OF THOMPSON, MARY JANE FILE NO. 21-02-
ATTACHMENT TO SCHEDULE "G"
Date of Death Value
Fidelitv Account No. X40-102873:
Shares Companv Unit Price Value
860.000 Bell South Corp. $38.7950 $ 33,363.70
1500.000 Constellation Energy Group $30.8500 $ 46,275.00
2115.000 PPL Corp. $35.4200 $ 74,913.30
Accrued Dividend, PPL $ 761.40
1304.000 Potomac Electric Power Co. $22.8400 $ 29,783.36
1056.000 SBC Communications $38.6100 $ 40,772.16
8019.681 Fidelity Puritan Fund $17.9900 $ 144,274.06
Accrued Dividend, Fidelity Puritan Fund $ 962.36
2414.192 T. Rowe Price Tax-Free HighYield Fund $11.4200 $ 27,570.07
4082.260 Vanguard Wellington Fund $28.1600 $ 114,956.44
4203.934 Vanguard PA Long-Term Tax-Exempt Fund $11.2400 $ 47,252.22
1775.210 Fidelity Muni Money Market Fund $1.0000 $ 1,775.21
Vanguard Account No. 9908000789:
6963.140 Vanguard Intermediate-Term Tax-Exempt Fund $13.37 $ 93,097.18
TOTAL ASSETS: $ 655,756.46
F: \F1LES\OA T AFlLB\EST A TES\93202~SCHEDULE.G
REV.1513 EX+ (9-001
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PE.NNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
I
I 21 -02-
-- --~~ \ -----~- - -~- r-RElAnONSHIPTO--I-- -~-
_ ~UMBER I _ _ _ _~~~AND ADDRESS OF PERSON(S) RECEIVING PROPER~_~ _ 00 ~;f.;.~;,~.l:.w ~~~l~1~t~~ _
I. i TAXABLE DISTRIBUTIONS (include outright spousal distributions) I
1 I
I \ I
! I
ESTATE OF
II.
THOMPSON, Mary Jane
I I I
I I I
I I
I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet I
I I
I NON-TAXABLE DISTRIBUTIONS: I
IA. SPOUSAL DISTRiBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT I
I BEiNG MADE I
I David I. Thompson, Trustee, Residuary and Disclaimer Trust under Revocable Trust Agreement I
I dated February 20, 2002
I
i
I
I
I
I
I
I
I
I
IB' CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
I
I
I
I
I
I
\
\
I
I
655,756.46
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
655,756.46
F:\FILESIDA T AFILEIEST ATES\93202-disclaimer.l
INRE: ESTATEOF
1,00
~
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
MARY JANE THOMPSON, DECEASED,
REVOCABLE TRUST AGREEMENT
ORPHANS' COURT DNISION
ESTATE NO. 21-02- ~O~
DISCLAIMER AND RENUNCIATION
I, David I. Thompson, hereby exercise the rights granted to me in Chapter 62 ofthe Probate,
Estates and Fiduciaries Code (the "PEF Code"), and I hereby irrevocably and unqualifiedly disclaim
and renounce any interest to which I may be entitled under Article N(B) of the Revocable Trust
Agreement of Mary Jane Thompson, dated February 20,2002, and under applicable law, including
but not limited to the following assets:
Fidelity Account No. X40-102873:
Shares Company
860.000 Bell South Corp.
1500.000 Constellation Energy Group
Unit Price
$38.7950
$30.8500
$35.4200
2115.000 PPL Corp.
Accrued Dividend, PPL
1304.000 Potomac Electric Power Co.
1056.000 SBC Communications
$22.8400
$38.6100
$17.9900
8019.681 Fidelity Puritan Fund
Accrued Dividend, Fidelity Puritan Fund
2414.192 T. Rowe Price Tax-Free HighYield Fund
4082.260 Vanguard Wellington Fund
4203.934 Vanguard PA Long-Term Tax-Exempt Fund
$11.4200
$28.1600
$11.2400
1775.210 Fidelity Muni Money Market Fund $1.0000
Vanguard Account No. 9908000789:
6963.140 Vanguard Intermediate-Term Tax-Exempt Fund $13.37
TOTAL ASSETS:
-1-
Date of Death Value
Value
$ 33,363.70
$ 46,275.00
$ 74,913.30
$ 761.40
$ 29,783.36
$ 40,772.16
$ 144,274.06
$ 962.36
$ 27,570.07
$ 114,956.44
$ 47,252.22
$ 1,775.21
i 93.097.18
$ 655,756.46
I hereby irrevocably and unqualifiedly disclaim any interest in and renounce the power to
request the Trustee to pay to me annually, including the year 2002, such sum from the principal of
the Residuary and Disclaimer Trust not exceeding the greater of Five Thousand Dollars ($5,000.00)
or five percent (5%) of the then aggregate value of the principal of this Trust, which power was given
to me as set forth in Article V (B) ofthe referenced Revocable Trust Agreement. I further certify that
I have not heretofore exercised such power or accepted any such payment or application of principal
from the Trustee since the inception of said Trust.
Notwithstanding this Disclaimer, I hereby accept any interest to which I may be entitled
under the Residuary and Disclaimer Trust as set forth in Article YeA) ofthe referenced Revocable
Trust Agreement.
IN WITNESS WHEREOF, intending to be legally bound hereby and intending that this
Disclaimer and Renunciation shall be filed of record in the Office ofthe Clerk ofthe Orphans' Court
Division of the Court of Common Pleas of Cumberland County, Pennsylvania, and a copy thereof
delivered to David I. Thompson, Trustee, as provided in Section 6204 of the PEF Code, I have
hereunto set my hand and seal, this ~ day of September, 2002.
~. Th:~psoi-/ ~
COMMONWEALTH OF PENNSYLVANIA )
: SS.
COUNTY OF CUMBERLAND )
On this, the t{JI,,- day of September, 2002, before me, a notary public, personally
appeared David I Thompson, known to me to be the person whose name is subscribed to the within
instrument, and acknowledged that he executed the same for the purposes therein contained.
~,y~j;x'2r
Public
NOTARIAL SEAL
CORRlNE L. MYERS. ~1AIIic
Carlisle Boro. Cumbert Commission Ex ires Ma 27, 2
-2-
/7- c?b- /0
\,
..,.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1547 EX AFP 101-021
JOHN B FOWLER
MARTSON ETAL
10 E HIGH ST
CARLISLE
'().:~
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
, '~:,t;bUNTY
ACN
10-22-2002
THOMPSON
03-08-2002
21 02-0805
CUMBERLAND
101
MARY
J
Allount Rellitted
PA 1701i':[.
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=is4-j-EX-AFP-foY=02Y-NOYicE--OF-YNHEiiiTiNCi-Yix-A-PPRAisEifENT~--AL1-owiNci-oR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF THOMPSON MARY J FILE NO. 21 02-0805 ACN 101 DATE 10-22-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
.00
.00
.00
.00
655.756.46
(8)
NOTE: To insure proper
credit to your account.
subllit the upper portion
of this forll with your
tax paYllent.
655.756.46
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11 . Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
.00
.00
(11)
(12)
(13)
(14)
00
655.756.46
655.756.46
.00
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Allount of Line 14 at Spousal rate (lS)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
NOTE:
.00 X
.00 X
.00 X
.00 X
00 =
045 =
12 =
15 =
(19)=
.00
.00
.00
.00
.00
TAX CREDITS:
. "' .._n' ..---., (+J AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR). YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)