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Home My WebLink About03-31-05 NA~!) REY.1500 EX. (8-00) . OFFICiAL USE ONLY *' COMMONWEALTH OF REV-1500 PENNSYLVANIA INHERITANCE TAX RETURN FILE NUMBER DEPARTMENT OF REVENUE II 05 ~O DEPT. 280601 RESIDENT DECEDENT HARRISBURG, PA 17128.{)601 COUNTY CODE YEAR NUMBER DECEDENrS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ... Smith, Robert J. 127-16-5701 z DATE OF DEATH (MM-DD-YEARJ OAII: uF BIRIH \MM.uu.Yt:AK) W THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C W 10-11-2004 09-29-1925 REGISTER OF WILLS u w (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( lAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C Smith, Esther M. D 3. Remainder Return (date of death prior to 12.13.82) D ~ 1. Original Return D 2. Supplemental Return o 4. Limited Estate D ~ 6. Decedent Died Testate (Attach ~ copy of Wi!I) D 9. Litigation Proceeds Received D 10. Spousal Poverty Credit (date of death between D 11.Electlon to tax under Sec. 9113{A) (Altach 5ch 0) 12-31-91 and 1-1-95) THISSEC11ON'MUS1"BE CllMPI.ETED.AU,;CORRESPONDENCE AND CONl'!l?l'llJIAL TAX JNF()RMAT1QII8HQULD IlEtllRECTEDTp: NAME COMPLETE MAILING ADDRESS Gary L. James, Esq. I!! ~~!2 ""\1 ~o~ ufm ~ 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ~ z W Q !i .. '" w ili o " FIRM NAME (If applicable) James, Smith, Dietterick & Connelly, LLP 134 Sipe Avenue Hummelstown, PA 17036 TELEPHONE NUMBER 717/533-3280 OFFICIALJJSE ONLY 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnen;hip or Sole-Proprieton;hip (1) (2) (3) (4) (5) (6) (7) None None None None None None 227,513.80 (8) 1,015.00 r"," 4, Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointiy Owned Properly (Schedule F) D Separate Billing Requested 7 .lnter~Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) D Separate Billing Requested 8. Total Gross Assets (total Lines 1.7) 9. Funeral Expenses & Administrative Costs (Schedule H) C~; z o i= S :;) ... ii: < u w 0:: C,il I'.~ 227,513.80 (9) 10. Debts 01 Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) (12) (13) (14) 1,015.00 226,498.80 0.00 226,498.80 12. Net Value 01 Estate (Line 8 minus Line 11) 13. Charitable and Governmental BequestslSec 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount 01 Line 14laxable at the spousal tax rate. 226,498.80 x .00 (15) or transfers under Sec. 9116(.)(1.2) z 0 0.00 .045 (16) ~ 16.AmountolLine 14 taxable at lineal rate x :;) ... 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :IE c u 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) S 19. Tax Due (19) 0.00 0.00 0.00 0.00 0.00 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT >>'BE'SlJllE'TOrANSWERAELiQUE$:t1QNS ottftEVERSE:SIDE'.lfD RECHSCK'MA TH<< Copyright 2002 form software only The Lackner Group, Inc. Form REV-1S00 EX (Rev, 6-00: v-- Decedent's Complete Address: STREET ADDRESS 119 Hickory town Road CITY Carlisle jSTATE PA IZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty jf applicable D. Interest E. Penalty TotallnterestlPenalty (D + E) 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 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 total of line 5 + SA. This is the BALANCE DUE. (3) (4) (5) 0.00 (SA) (5B) 0.00 Make Check Payable 10: REGISTER OF WILLS, AGENT 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? ...................................................................................................................... ~ 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 penalties 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. Declaration of preparer other than the personal representative is based on all Information of whIch preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS ES$h,er M. Smith ~ Yos No ~ D ~ B ~ D D D ~ ~ DATE 119 Hickorytown Road Carlisle, PA 17013 ") Z"r 7 -' /~ ADDR A E A R S "3-2..'( 2",v~- A 134 Sipe Avenue Hummelstown, PA 17036 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 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 sUlViving spouse is 0% [72 P.S. ~9116 (a) (1.1) (Ii)]. The statute does not exemot a transfer to a sUlViving 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 nabJral parent, an adoptive parent, or a stepparent of the child is 0% [72 P.8. ~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 ,So ~9116 1.2)[72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to orfor the use ofthe decedent's siblings is 12% [72 P .S. 99116 (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.1510 EX+ (6-981 *' SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COUMON'NEAl..1H Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Smith, Robert J. IFILE NUMBER 21- ESTATE OF This schedule must be completed and filed If the answer to any of questions 1 through 4 on the reverse sIde of the REV.1500 COVER SHEET Is yes. ITEM "u"Ut-1 " DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, niEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE niE DATE OF TRANSFER. ATTACH A COPY OF niE DEED FOR REAL. ESTATE. 1 Midland National Annuity Polley No. 8500115002 123,962.18 100.000 0.00 123,982.18 - beneficiary Is spouse - valued per memo 2 Midland National Annuity Policy No. 8500127843 103,551.82 100.000 0.00 103,551.82 - beneficiary Is spouse. valued per memo TOTAL (Also enter on Line 7, Recapltuletlon) 227,513.80 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV.1151 EX+ (12.99) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Smith, Robert J. I FILE NUMBER 21- ESTATE OF Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Pel1lOnal Represenlative(s): Street Address City Slate Zip - Year(s) Commission paid 2. AttorneYs Fees James, Smith, Dletterick & Connelly, LLP 1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Slate Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL (Also snter on line 9, Recspltulatlon) 1,015.00 Copyright (c) 2002 fonn software only The Lackner Group, Inc. Fonn PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-88) . SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Smith, Robert J. IFILE NUMBER 21- ESTATE OF ITEM NUMBER 1 DESCRIPTION Register of Wills, Cumberland County - filing fee for PA Inheritance Tax Return AMOUNT 15.00 Subtotal 15.00 Copyright (c) 2002 fonn software only The Lackner Group, Inc. Fonn PA-1500 Schedule H-a7 (Rev. 6-96) REV 1513 EX+ (9.QO) *' SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Smith, Robert J. 21- NAME AND ADDRESS OF 'TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not Wst Trustee(s) L ,'u"'" ~nCl~oe oUUlgm spousal distributions, and transfers undor Soc, 9116(0)(1.2)] Esther M. Smith Spouse Annuities 226,498.80 119 Hlckorytown Road Carlisle, PA 17013 Total 226,498.80 Enter dollar amounts for distributions shown above on lines 5 through 18. as appropnate, on Rev 1500 cover sheet II. 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 II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET U.UU Copynght (c) 2002 Ionn softwore only The Lacknor Group, Inc. Fonn PA-1500 Schedule J (Rev. 6.98)