HomeMy WebLinkAbout06-20-14 � REV-1500 E"�0z-„> 1505610143
,
PA De artment of Revenue .� OFFICIAL USE ONLY
P pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENTOFREVENUE
Po sox.2soso� INHERITANCE TAX RETURN 2 1 0 9 10 4 1
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death Date of Birth
10 30 2009 O1 21 1920
DecedenYs Last Name Suffix DecedenYs First Name MI
ELRICK $MMA G
(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
❑ 1. Original Return � 2. Supplemental Return � 3,Remainder Return(Date of Death
Priorto 12-13-82)
� 4. Limited Estate � 4a.Future interest Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� g Decedent Died Testate � � Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
� 9. Litigation Proceeds Received � 10.Spousal Poverty Credit(Date of Death � �1,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
DAVID C MILLER JR 717 9� 9 980;3�L' �
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REGISTLR(��WILLS l�OML,Y �"
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First Line of Address _, p
�, . , C:
1100 SPRING GARDEN DR ; �7 ,_,.; ' ' ' `~~�
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Second Line of Address c� < ' ,`, ��
S U I T E A :'� �--�t W i— rn
Ci4 or Post Ofifice �"�.DATE FILED� � �
Y State ZIP Code
MIDDLETOWN PA 17057
Correspondent's e-mail address: d a V I d C Ifl i I I@ 1'j 1'Ue V e�I Z O Il.n e t
Under penalties of perjury,1 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FIL�NG RETURN ' DATE
�Z_�—����, ReeDean (Q J � '��
ADDRESS
1009 Wooded Pond Drive, Harrisburg, PA 17111
SIGNAT F R OTH AN REP ESENTATIVE DATE
DAVID C MILLER JR � �g l
ADDRESS
LAW OFFICE OF DAVID C. M LLER,JR.
1100 SPRING GARDEN DR., MIDDLETOWN, PA 17057
Side 1
� 1505610143 1505610143 J
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
o�eeorsNaroe: ELRICK� EMMA GENE
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.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5• Cash,Bank De osits&Miscellaneous Personal Pro e 3 , 0 0 8 . 7 6
p p rty(Schedule E)................ 5.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested............. 7.
g. Total Gross Assets(total Lines 1 through 7).......................................................... g. 3 , 0 0 8 . 7 6
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9. 5 2 1 . 0 0
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10.
11. Total Deductions(total Lines 9 and 10).................................................................. ��. 5 2 1 . 0 0
12• Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 2 , 4 8 7 . 7 6
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)................................................. 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. �4. 2 , 4 8 7 . 7 6
TAX COMPUTATION-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.00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 16•
17. Amount of Line 14 taxable
at sibling rate X .�2 17.
18. Amount of Line 14 taxable
at collateral rate X .15 2 , 4 8 7 . 7 6 �$� 3 7 3 . 16
19. TAX DUE................................................................................................................... 19. 3 7 3 . 1 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
� 1505610243 1505610243 J
_ ,,. _ �. .._ _
REV-1500 EX Page 3 File Number 21 - 09 - 1041
Decedent's Complete Address:
Elrick, Emma Gene
STREET ADDRESS
5225 Wilson Lane
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 373.1 6
2. CreditslPayments
A. Prior Payments
B. Discount
Total Credits(A +g) (2) 0.00
3. interest (3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,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. (5) 3 7 3.�6
Make Check Payable to: REGISTER OF WILLS, AGENT.
,-.�: t ..�`....�� . . . ,.�� , .. �c,�'�.��;��s b�3�.' y� , s��Y�?,'a� �:`a .,.., .... �r��8�x_. ,fi�4''A . �� . ., . ���a^,Fi' ... . ,€�+���.. .''1�A`s°t�;; e..
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:.................................................................................. ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income:.................................... ❑ ❑x
c. retain a reversionary interest;or.................................................................................................................. ❑ ❑X
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?....................................................................................................................... ❑ ❑x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... � ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?...................................................................................................................... ❑ ❑X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
� ��, � . . �.,x � � �° s�
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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.§9196(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 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 refurn are still applicable even if the suroiving 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)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether by blood or adoption.
� . �._ _ .. :�, w .
� pennsylvania SCHEDULE E
� DEPARTMENTOFREVENUE CASH BANK DEPOSITS AND MISC.
INHERITANCE TAX RETURN �
RESIDENT DECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Elrick, Emma Gene 21 -09- 1041
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Pennsylvania Treasury-Unclaimed Property-MetLife Dividends and Dividend Reinvestment 3,008.76
TOTAL(Also enter on Line 5, Recapitulation) 3,008.76
REV-1611 EX+(10-09)
�, pennsylvania ���H
� DEPARTMENT OF REVENUE ������
� INHERITANCE TAX RETURN w��,�.pw��
RESIDENT DECEDENT /'11.ArwIM�71 IVY
ESTATE OF Elrick, Emma Gene FILE NUMBER
21 -09- 1041
DecedenYs debts must be reported on Schedule i.
ITEM DESCRIPTION AMOUNT
NUMBER FUNERAL EXPENSES:
A.
B. ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Name of Personal Representative(s)
Ree Dean 200.00
Street Address 1009 Wooded Pond Drive
city Harrisburg state PA zip 17111
Year(s)Commission Paid
2. Attorney's Fees Law Office of David C. Miller, Jr. 300.00
3, Family Exemption: (If decedent's address is not the same as claimanYs,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. AccountanYs Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
� Register of Wills, Filing Fee, Supplemental Pa. Inheritance Tax Return 15.00
See attached 6.00
TOTAL(Also enter on line 9, Recapitulation) 521.00
SdiedWe H
COMMONWEALTH OF PENNSYLVANIA ��w " «
INHERITANCE TAX RETURN �'��C�j('�
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Elrick, Emma Gene 21 -09- 1041
2 Register of Wills-Short Certificate 6.00
Page 2 of Schedule H
REV-7513 EX+(01-10)
�; pennsylvania SCHEDULE J
' DEPARTMENT OF REVENUE
INHERITANCETAXRETURN - BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Elrick, Emma Gene 21 -09- 1041
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Truatee�s)
I� TAXABLE DISTRIBUTIONS[include outright spousai
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Ree Dean Friend One-Third (1/3) of
1009 Wooded Pond Drive Rest, Residue and
Harrisburg, PA 17111 Remainder
2 Grace Ann Gornik Friend One-Third (1/3) of
2090 Sunset Drive Rest, Residue and
Camp Hill, PA 17011 Remainder
3 James L. Snyder Friend One-Half(1/2) of
637 Glenbrook Drive One-Third (1/3) of
Harrisburg, PA 17111 Rest, Residue and
Remainder
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
REV-1513 EX+(01-10�
,,;� pennsyivania SCHEDULE J
� DEPARTMENT OF REVENUE
INHERITANCETAXRETURN BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF Elrick, Emma Gene FILE NUMBER
21 -09- 1041
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY DoNotLiatTruatee(s)
I� TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
4 Thelma Snyder Friend One-Half(1/2) of
9 Andrew Court One-Third (1/3) of
Hanover, PA 17331 Rest, Residue and
Remainder
Page 2 of Schedule J