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Home My WebLink About05-24-14 1505610105 REV-1500 EX(02 1)(FoV1 OFFICIAL USE ONLY PA Department of Revenue peennsytva�nia Bureau of Individual Taxes County Code Year File Number PO BOX 28o6o1 INHERITANCE TAX RETURN 2ni.3� Harrisburg PA 17128-0601 RESIDENT DECEDENT 2� , ! 053 , ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMODYYYY Date of Birth MMDDYYYY 4L/27/2' _012 08/03/1934 Y^! Decedent's Last Name_ Suffix Decedent's First Name MI Klinger Anzonetta 1j:1 (if Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix_ Spouse's First Name MI Klinger__.__ - Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW OLD 1.Original Return C) 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) C=> 4.Limited Estate C=) 4a.Future Interest Compromise(date of C') 5. Federal Estate.Tax Return Required death after 12.12.82) O 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.) C) 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death p 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: Daytime Telephone Number !Daniel E Klinger _ _V 7177618 REGINFILEDC� ? s t First Line of Address n 22 Cedar Cliff Dri ve rT Second Line of Address E Lr~City or Post Office State ZI Code iCamP _. !17011 Correspondent's e-mail address: n s m m Under penalties of perjury,t declare that i he"examined this return,including accompanying schedules and statements,and to th sW my know a an AP it is true,cortect and complete.Declaration of preparer other than the personal representative is based on all information of whi 1 p:r,4s anQRilowle 56 SIG NAT OF P SON RESPOt7SiBLE FOR Fit.ING RETURN D^077E r-O � ryi m ADDRESS E"a cD 3 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE p GATE TV r rn C ra ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 t W� f , _J 1505610205 REV-1500 EX(Fl) Decedent's Name Decedent's Social Security Number : - , RECAPITULATION 1. Real Estate(Schedule A). ... ......................................... 1, - 2. Stocks and Bonds(Schedule B) .................... .................. 2, 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3, 1 4. Mortgages and Notes Receivable(Schedule D)......... ................ 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5, 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ......, 6, 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 40,000.00 (Schedule G) O Separate Billing Requested........ 7, S. Total Gross Assets(total Lines i through 7 -- - ---. 9. Funeral Expenses and Administrative Costs(Schedule H)...... 9. ' 4,870.06 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10, -__--^--1 11. Total Deductions(total Lines 9 and 10)................................. 11. 12. Net Value of Estate(Line 8 minus Line 11 4,870.06 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 35,129.94 an election to tax has not been made(Schedule J) ..... 13 14. Net Value Subject to Tax(Line 12 minus Line 13) .......I................ 14, TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 3$,129.94 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 - - - - (a)(1.2)X.O O - -35,129.94 - 16. Amount of Line 14 taxable 15' 0.00 at lineal rate X.0_ ---7 17. Amount of Line 14 taxable 16. at sibling rate X.12 ` 18. Amount of Line 14 taxable -_ 17. at collateral rate X.15 '- 19. TAX DUE ........................ ... _.. ......................... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O L Side 2 1505610205 1505610205 REV-1506 EX(Fl) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME P liter -- __ _ STREETADDRESS 4621 S-CleandewnihLe- CITY STATE ZIP( amp Hill Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 2. CreditsfPayments A.Prior Payments B.Discount Total Credits(A+B) (2) _ 1 Interest (3) n 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) n 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) n 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........................................._............................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ N c. retain a reversionary interest ..........................................................................................._................................. ❑ 0 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?..................................................._........................................................ ❑ 1 Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?............. ❑ N 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 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 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)j. • The tax rate imposed on the net value of transfers to or for the use of the decedents 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)j.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-iSo4 EX+(oJ-Bo) �. pennsytvania SCHEDULE F ry DEPARTMENT TAX REVENUE RET URN JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Anzonetta J Klinger If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVMNG JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH DIM 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)DINTLY HELD REAL ESTATE VALUE OF ASSET INTEREST DECEOEmS INTEREST I. A. 01W/67 4621 S C)earview Drive,Camp Hill PA 17011 60,000.00 50 40,000.00 TOTAL(Also enter on Line 6,Recapitulation) $ 40,000.00 If more space is needed,use additional sheets of paper of the same size. . . . . . . . - ¥ . . k 0 \ \ \ _ ƒ / /