HomeMy WebLinkAbout07-14-14 1505610105
REV-1500 EXtoz-"1'FI'Iff
PA Department of Revenue p�mrytvarda OFFICIAL USE ONLY
Bureau of Individual Taxes """" County Code Year File Number
PO BOX28o6oi INHERITANCE TAX RETURN rr � ``
Harrisburg,PA 171284601 RESIDENT DECEDENT �� `-Y �11'-TS
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Dale of Birth MMDDYYYY
--7 04/30/2014 08/10/1919
Decedent's Last Name Suffix Decedent's First Name MI
Namey Jean
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's last Name Suffer Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE VVRFI THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
QD 1.Original Return O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return Required
death after 12-12.82)
O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 B. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of TmsL)
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 TO:
Name - Daytime Telephone Number
Jody A Atty (717)737-7733
:•3
REGISTER O (LB USE ONLY' —�J
c a
First Line of Address r
1619 Walnut St C/5 r l
_l V1 ZD
Second Line of Address
M
m ~ �nrn
Or Post Office DAT�'E FILED -
CIIY State ZIP Code � -
Camp Hill PA 17011
r
Correspondents e-mail address: �j a—f 7
Under penalties of perjury.I declam that I have examined this retum,including accornpanying schedules and statements,and to the best of my knowledge end belie.
It Is true•correct and mmploto.Declaration of prepare,other than the personal representative Is based on all Infomgtion or which pmparer has any knowledge.
SIGN: F P . ON R PO�S BLE FO G RETURN DATE
�T/i 07101/2014
ADDRESS
1619 WYnUt St,C mp Hill, Pa 1701
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
A-0
1505610205
1 REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name:
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1. 1
2, Stocks and Bonds(Schedule 8) ....................................... 2. j Z
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3.
4. Mortgages and Notes Receivable(Schedule D)........................... 4..___� 4
S. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5,
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 1
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested......... 7. ,{
8. Total Gross Assets(total tines 1 through 7)............................. 8. • Zjg �7(l 'z���__�;
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. ; J
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 3Z!
11. Total Deductions(total Lines 9 and 10)................................. 11. �� ��
�--- --
12. Net Value of Estate(Line 8 minus Line 11).............................. 12.
13. Charitable and Governmental BequestrdSec 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) ........................ 14.
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate.or
transfers under Sec.9116 i - ---
(a)(1.2)X.0- 15.;
16. Amount of Line 141 bie �,/
at lineal rate X.0C a 16.: q Z,3g
17. Amount of Line 14 taxable
at sibling rate X.12 -...._. .__. _ 17. _._._,-
18. Amount of Line 14 taxable
at wllateral rate X.15 _ 18.'
19. TAX DUE......................................................... 19..
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205
REV•1600 EX(FI) Page 3 File Number
Decedenllfs Complete Address:
DECEDENT'S NAME .
STREETADDRESS
�6/ 9 f/4(/ur fST;
VI
crry STATE
Tax Payments and Credits: Q
1. Tax Due(Page 2,Una 19) 0)
2 CreditslPayments
A.Prior Payments
B.Discount ��� — -
Total Credits(A r 8) (2)
3. Interest
(3)
4. If Line 2 Is greater than Una 1+Una 3,enter the di6erenca. This is the OVERPAYMENT.
FIJI in oval an Page$Una 20 to request a refund. (4) n 0174
5. If Line 1 r Line 3 is greater than Una 2,enter the difference.This is the TAX DUE. (sl Q/
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 shag use the property transferred or Its income............................................ ❑ 9
c. retain a reversionary interest.............................................................................................................................. ❑
d. receive the premise for fife of either payments,benefits or care?...................................................................... ❑ l�
2. If death occurred after Der:12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ 0
3. Did decedent own an 9n trust for'or payableupo"eath bank account or security at his or her death?.............. ❑ 9)
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a benefidary designation? ........................................................................................................................ ❑ I
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)(1)).
For dales 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
F2 P.S.§9116(a)(1.1) (6)].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 vaue 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)(12)).
• 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 i72 P.S.§9116(a)(1)j.
• 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.
RM sm EX+(8-u)
IPDPsOFREVB a SCHEDULE B
oEVaRmwroFaEVenrE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENr OECEDOU
1
ESTATE O.F �s�p� FILE NUMBER
All properly jointly owned with right of survivarship must be disdosed on Sdmdule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
I. ZPZ ZIZ- dle e 0Qsh C ce I /3f/• 0 3
9. 7J-/-68'2 S,4%
0024, 6 TON (/�iUC6/t�pPG?ZlUivc �7��/ •6/
F
3 ri />r�NKL/�T-�tlCOr9E l_G SS� 3 '66
�C?tAP_TGaarurN CL % gy3S�•77
17� lA7/GiT/�f �Gfh� A /0 y9), y�
�. g03'169 PMcd /�'F,9L If6-1mPA/ Cz 4 7P1/P.06
c&- rl-va .TnAu c4or/ASU9 LL ll y�6 •/9
�z51 .fdfr /�MeA� l'1 9/ov 3c
..{/y4
/9iY4Z/CIW /YU7/IAe- eL A S/332,/V
Y ,a6sa �iY6Pr�?,t/ TAx FEiy,�r �,vo o s'
/Z 5/0 v 978 �9PiTA� Gl/oeL,> ,�o vo C/i A �� y •2 7
-77
o i
TOTAL(Also enter on Line 2,Recapitulation) 1$ Z/ 170
REV-1511 Etc(48-13)
-I= pennsytvania SCHEDULE H
DEPARTMENT OFREVENUE FUNERAL EXPENSES AND
RESIDENT`E DECEDENT RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
i N r
i Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
2 (/'r. Pldlrp d/�T/-ldbdk OAI/F�f! 15 ro
/Z
LCJ7 uN£/
/0,77 , Cf/
fTc�,u d/?rrtac�x C�rrrr t, f>z� G,z�ru r /J6 fl�
B. ADMINISTRATIVE COSTS:
1. final Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
Z, Attorney Fees:
31 Family Exemption:(I€decedent's address is not the same as daimant's,attach explanation.)
Claimant
Street Address
City _State ZIP
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
T.
Cp
TOTAL(Also enter on Line 9, Recapitulation)JO Id 2-5--Z
PEV-1512 EX+(12.12)
� 7pennsylvania SCHEDULE I
OEPARTMENTOFREVENUE DEBTS OF DECEDENT,
EMI)ENT OEC XREiURN MORTGAGE LIABILITIES & LIENS
�bESiDENi DECEDENT
ESTATE OF `7—eA'V/ _/"1.16 FILE NUMBER
i
Report debts Incurred by the decedent prior to death that rematned unpaid at the date of death,Including unrelmbumed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 060vrR% q,��42 !97-1 i'l rCL 2�,
Z EkPcNfES- 3Z 'p0
TOTAL(Also enter on Line 10,Recapltulatian) $ 0.00
If more space Is needed,Insert additional sheets of the same size.
RECEIPT FOR PAYMENT
LISA M. GRAYSON, ESQ. Receipt Date : 7/14/2014
Cumberland County - Register Of Wills Receipt Time : 08 :28 : 09
One Courthouse Sguare Receipt No. : 1078532
Carlisle, PA 17613
NAMEY JEAN
Estate File No. : 2014-00648
Paid By Remarks : JODY A ATTY
DB1
------------------------ Receipt Distribution ---------- --------------
Fee/Tax Description Payment Amount Payee Name
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 1008 $15 . 00
Total Received. . . . . . . . . $15 . 00
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