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HomeMy WebLinkAbout06-11-14 J 1505610105 REV-1500EX�°�_��,�F', �� PA Department of Revenue pennsylvania OFFICIAL USE ONLY oE AA,„��.�f w��E��� Count Bureau of Individual Taxes ` �Code Year File Number Po Box zsosoi INHERITANCE TAX RETURN / / � �� Harrisbur ,PA 1�128-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 162-26-5606 '' ' 12/27/2012 ' 05/01/1934 Name Suffix DecedenYs First Name M� Cover . ' Rachel _ V (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 C� t.Original Return O 2.Supplemental Return p 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate p 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 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 Number Thomas P.Gleason Esquire (717) 532-3270 _ � -�^'-, REGISTEI{�FNSClLLS USE~Y '" � .-Y'3 .?7 L � �` �"7 , iD � " � ..�: r7 � �� � First Line of Address _,7 �,� ..: :. ��_. f,... t...� 49 West Orange Street = ��7 �,,, ,-;� ;: r�. � _. . . , c-� Second Line of Address � `_ • � � � � t7 Suite 3 _ .`�� � '7 � _._..' �� City or Post Office State ZIP Code ` ��FILED � +"` � Shippensburg PA 17257 � t-�.._,-+ t" -.°r,r Correspondent's e-maii address:t0111gIe8SOf1 tOfil leasonlaw.com Under penalties of perjury,I declare that 1 have examined this retum,including accom anying 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 r re� ntative is based on formation of w ich preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 05/09/2014 109 Spring House Road, Shippensburg, PA 17257 S GN T E OF PR��R OT�AN REPRESENTATIVE DATE � �DI�i�2., �/f�Z-�! � ADDRESS �°l � C�r��.c�� S�- F P 1-� ��Z S � (����c PLEASE SE ORIGINAL F RM ONLY Side 1 � 1505610105 1505610105 � � J 1505610205 REV-1500 EX(FI) DecedenYs Social Security Number Decedenrs rvame: Rachel V. Cover ' ' 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. ' 23,368.99 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . ..... 6. 0.00 ' 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. ... .. . 7. ' 0.00 ' 8. Total Gross Assets(total Lines 1 through 7)......... .............. . ..... 8. 23,368.99 9. Funeral Expenses and Administrative Costs(Schedule H)..... ........ ... ... 9. , 3,843.50 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).... .. ......... 10. ' 148,643.46 ' 11. Total Deductions(total Lines 9 and 10)... ... ........ ......... . ..... .... 11. 152,486.96 ' 12. Net Value of Estate(Line 8 minus Line 11) .................... ..... ..... 12. -129,117.97 ' 13. Charitable and Governmental 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. 0.00 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(iz)X.0_ ' 0.00 15. ' 0.00 ' 16. Amount of Line 14 taxable at lineal rate X.0_ 0.00 , �g, ' 0.00 ' 17. Amount of Line 14 taxable -- at sibling rate X.12 0.00 �7, ' 0.00 18. Amount of Line 14 taxable at collateral rate X.15 ' 0.00 �$ ' 0.00 19. TAX DUE .......... ... . .. . ............. ... ... .. .. .. ... ........ .... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Rachel V. Cover ---- --- —.__ _ __.._ ---__ ___ __ STREETADDRESS -- . -__ _ __ _ __ _ Shippensburg Health Care Center __.. _ __. _ _ _ _ 121 Walnut Bottom Road — -- -- _--._-- ---— CITY STATE --- , ZIP Shippensburg , PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments _____ 0.00 ------ —_--. B.Discount 0.00 3. Interest Total Credits(A+B) {2) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �3� 0.00 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. (5) 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: Yes No a. retain the use or income of the property transferred.......................................................................................... � � b. retain the right to designate who shail 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 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)j.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 decedenYs 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 decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)J.A sibling is defined, untler Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-15o8 EX+(o8-1z) � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN pERSONAL PROPERTY RESIDEM DECEDENT ESTATE OF: FILE NUMBER: Rachel V. Cover 21-13-0715 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. M&T Bank Checking Account No.97176362 9,657.48 2, Prudential Alliance Account No.4351003274600 13,711.51 s TOTAL(Also enter on Line 5, Recapitulation) $ 23,368.99 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(08-13) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Rachel V. Cover 21-13-0715 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: i. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 1,200.00 Name(s)oP Personal Representative(s) Diane K. Souder& Victoria R. Hippensteel street address_109 Sprinq House Road __ 123 Central Wav city Shippensburg State PA ZIP 17257 Year(s)Commission Paid: 2013 Z• Attorney Fees: 2,500.00 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; 128.50 5� Accountant Fees; 6• Tax Return Preparer Fees; �• Additional Probate Fee 15.00 TOTAL(Also enter on Line 9, Recapitulation) $ 3,843.50 If more space is needed,use additional sheets of paper of the same size, (tFV 1512 EX+ ;'��-12] �'� � pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT E57ATE OF FILE NUMBER Rachel V. Cover 21-13-0715 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1� Department of Public Welfare claim CIS#440196273 148,643.46 TOTAL(Also enter on Line 10, Recapitulation) $ 148,643.46 If more space is needed, insert additional sheets of the same size. REV-1513 EY+ (01-10) ��j3I � s pennsylvania SCHEDULE � '��� DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Rachel V. Cover 21-13-0715 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• Diane K.Souder Lineal-Daughter 1/3 2. Victoria R.Hippensteel Lineal-Daughter 1/3 '' 3. Harold L.Cover,Jr. Lineal-Son 1/3 ' 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: L _ 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.