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HomeMy WebLinkAbout05-13-14 1 15�561a140 �1 REV-1 511�{8 EX (02-11)IFI) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 1 4 0 2 9 5 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMOOYYYY Date of Birth MMODYYYY 0 3 1 5 2 0 1 4 0 9 2 0 1 9 2 5 Decedent's Last Name Suffix Decedent's First Name MI L a u g h In a n B e t t i e J (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 Q 1, Original Return ❑ 2.Supplemental Return E] 3.Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate 4a.Future interest Compromise(date of 5.Federal Estate Tax Return Required death after 12.12-82) F� 6.Decedent Died Testate E] 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) ❑ 9. Litigation Proceeds Received E] 10.Spousal Poverty Credit(Date of Death 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 TO: Name Daytime Telephone Number S t e p h e n i H o g g E s q 7 1 7 2 4 5 2 6 9 8 REGISTER OF WILLS USE ONLY r.t First Line of Address - :'� Xt 'i'D • 1 9 S H a n o v e r S t r e e t m =in j Second Line of Address i�7 S t e • 1 0 1 0 City or Post Office State ZIP Coda -- t-aan4 , aED {r. C a r l i s l e P A 1 7 0 1 3 ' ' f—}M Correspondent's a-mall address: Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SICrNA�T�Of;PEgSON RE$QONSIBL•�R FILING RETURN � DATE y u .��(117711 r`Y7- i-'/.!F•N(_YU✓rnM.G 1 ) 7 ADORES 25 Beidler a Shippensburg PA 17257 SIGNATURE OF PR T ESENTATIVE DATE ADDRESS 19 S. Hanover St Ate. 101 Carlisle PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: Bettie J . Laughman RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . .. . . . . . . . . . . . 1. 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . .. 2. 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. 1 4 6 0 2 . 9 2 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 0 • 0 0 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) 8. 1 4 6 0 2 . 9 2 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 5 9 4 1 . 6 3 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 1 3 6 2 . 3 4 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 7 3 0 3 . 9 7 12. Net Value of Estate(Line 8 minus Line 11) . . . .. . . . . . . . . . . . . . . . .. . . . . . . 12. 7 2 9 8 . 9 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . .. . .. . . . . . . . . . . 11 14, Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . .. . . . . . . . . . . . 14. 7 2 9 8 . 9 5 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 _ 0 . 0 0 15, 0 . 0 0 16. Amount of Line 14 taxable at lineal rate x.045 7 2 9 8 . 9 5 16. 3 2 8 . 4 5 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . ... . . . 3 2 8 . 4 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 14 0295 DECEDENT'S NAME Bettie J. Lau hman STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: 1 Tax Due(Page 2,Line 19) (1) 328.45 2. Credits/Payments A.Prior Payments B.Discount 17.29 3. Interest Total Credits(A+B) (2) 17.29 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. A 311.16 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 ...I........................... ❑ ❑ c. retain a reversionary interest ..................................................................................................... ❑ ❑ 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? ...................................... El F­1 ................................................. 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?.................................................................................................. ❑ ❑ 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)(1)]. 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 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 F2 P.S.§9116(a)(i)I. • 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. 4 � REV-1508 EX-(08-12) pennsylvania SCHEDULE E DEPARTMENT AX RETURN &REVENUE INHE RITANCE TAX CASH, BANK DEPOSITS MISC. INHERITANCE RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Bettie J._Laughman 21 14 0295 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. ACNB Bank Acct#189154 Checking Account$38,570.02 1/3 value of jointly owned 12,856.67 account 2. Retirement Fund - Knouse Foods 1,746.25 TOTAL(Also enter on Line 5,Recapitulation) $ 14 602.92 If more space is needed, use additional sheets of paper of the same size. REV-1509 EX-(01-10) pennsylvanla SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Bettie J. Laughman 21 14 0295 If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANTS)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Joseph E. Laughman 1146 Newville Road son Carlisle, PA 17013 B.Charles R. Laughman 967 Big Spring Road son Shippensburg, PA 17257 C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTEREST 1. A. ACNB Bank Acct#189154 Checking Account 38,570.02 0.00 I 2. B. ACNB Bank Acct#189154 Checking Account 38,570.02 0.00 TOTAL(Also enter on Line 6,Recapitulation) $ 0.00 If more space is needed,use additional sheets of paper of the same sire. REV-1511 EX+(0843) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Bettie J. Laughman 21 14 0295 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home, Inc. 3,757.44 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representatives) Cary Laughman 730.15 Street Address 25 Beidler Drive city Shippensburg state PA ZIP 17257 Year(s)Commission Paid: 2. AttomeyFees: Stephen J. Hogg, Esquire 1,000.00 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: 148.50 5 Accountant Fees: 8, Tax Return Preparer Fees: 25.00 I Cumberland County Bar Association Referral Fee I 7. Advertising: Law Journal 75.00 The Sentinel 190.54 8. Petition 15.00 TOTAL(Also enter on Line 9,Recapitulation) $ 5,941.63 If more space is needed,use additional sheets of paper of the same size. s REV-1512 EX-(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Bettie J. Laughman 21 14 0295 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. Carlisle Regional Medical Center 1,216.00 2. Carlisle Physician Services 146.34 TOTAL(Also enter on Line 10,Recapitulation) $ 1,362.34 If more space is needed,insert additional sheets of the same size. A 1 5 REV-1513 EX.(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Bettie J. Lau hman 21 14 0295 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE J TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(12).] 1. Joseph Laughman Lineal 1,500.00 2. Harry Laughman I ineal 1,500.00 I 3. Charles Laughman Lineal 1,500.00 4. Larry Laughman Lineal 1,500.00 5. Gary Laughman Lineal 1,500.00 6. Marlin Laughman Lineal 1,500.00 7. Carl Laughman Lineal 1,500.00 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. i B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. 701'AL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed,use additional sheets of paper of the same size.