HomeMy WebLinkAbout07-21-14 (2) REV 1500 EX(06-05) 15056051058 OFFICIAL USE ONLY
PA Department of Revenue -
Bureau of Individual Taxes County Code Year File Number
PC BOX 28✓ OI INHERITANCE TAX RETURN I�!
Harrisburg,PA17128..D1 RESIDENT DECEDENT G+
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
E 112/28/2004 ' 10311511909
Decedent's Last Nama Suffix Decedent's First Name MI
Weave(_ _` _ Edith. _
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name __— (((Su```ffix Spouse's First Name _ t MI
Spouse's Social Security Number
[ — THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
( i REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C'J 1.Original Return o1i 2.Supplemental Return C=:) 3. Remainder Return(date of death
prior to 12-13.82)
C=) 4.Limited Estate p 4a.Future Interest Compromise(date of (=D 5. Federal Estate Tax Return Required
death after 12-1282)
M 6.Decedent Died Testate C5 7.Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
C'r7 9.Litigation Proceeds Received C1 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 Sch.O)
CORRESPONDENT— THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
�Naamee — Daytime Telephone Number
,Ter{ ence J. Barra, Esq. (717) 852-702p,t
,Firm Name(If Applicable) 9
REGISTER S USE ONLY r:1
Benn Law Firm 1 CID-X,t ; C= _
First line of address n ha r" rn
103 E. Market Street
7 (=0 .t
Second line of address O
FPO O Box 5185
City or Post Office Y — s State ZIP Code DATE FILED W t
York I A 17405-5185
Correspondent's e-mail address: tbarna @bennlawfirm.com
Under penalties of per)ury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
It Is true,convert and complete.Declaration of preparer other than the personal representable Is based on all Information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ATE
gq C
ADDRESS
Doris Anne Young, Executrix, 9445 Carlisle Road, Dillsburg, PA 17019
BIGNATUR ER OTHER THAN REPRESENTATIVE DATE !
ADDRESS ` r .ill
Benn Law Firm, 103 East Market Street, P.O. Box 5185,York, PA 17405-5185 -
PLEASE USE ORIGINAL FORM ONLY
Side 1
C_ 15056051058 15056051058
_J 15056052059
REV-1500 EX
Decedent's Social Security Number
-�
Decedent's Name: Edith M Weaver
RECAPITULATION `---
1. Real estate(Schedule A). ..... .. . ...... .. .......... . ........ . . . .. .. . . 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&Notes Receivable(Schedule D). . . ......... ........ .. . . . . .. . 4. 0.00 I
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E) .. ..... . 5. 18,000.00
6. Jointly Owned Property y(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 1-7). . ........ . . ..... ........ ..... ... ... 8. I 18,000.00
9. Funeral Expenses&Administrative Costs(Schedule H)... . ........... ...... 9. i 7,505.00
10. Debts of Decedent,Mortgage Liabilities, &Liens(Schedule I). . ..... . ........ 10. 0.00
11. Total Deductions(total Lines 9&10)........... ... .. ............... .... 11. I 7,505.0
12. Net Value of Estate(Line 8 minus Line 11) ........................ ...... 12. V 10,495.00
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ---i
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. j 10,495.00
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.0_
5.
16. Amount of Line 14 taxable -._
at lineal rate X.0 45
10,495.001 16. 472.28
17. Amount of Line 14 taxable
at sibling rate X.12 ! 17. i
18. Amount of Line 14 taxable
at collateral rate X.15 18 !
19. TAX DUE ........:....... . . .......... ....... ..... .. . .............. 19. 472.28)
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056052059 Side 2
l_ 15056052059
REV-1500 EX Page 3 File Numhar
Decedent's Complete Address:
DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER
Edith M Weaver 205-30-5880
STREETADDRESS i i�-
Messiah Village, 100 Mt.Allen Drive
CITY STATE u P
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2 Line 19) (1} 472.28
2. Credits/Payments
A.Spousal Poverty Credit
B.Prior Payments
C.Discount
Total Credits(A+B+C} (2) 0.00
3. InteresttPerelty if applicable
D.Interest
E.Penalty
Total Interest/Penalty(D+E) (3) 0.00
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)
5. If line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 472.28
A.Enter the interest on the tax due. (5A) 0.00
S.Enter the total of Line 5+5A.This is the BALANCE DUE. (5B) 472.28
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:.......................................__............................................... ❑ Q
b. retain the right to designate who shall use the property transferred or its income:............................................ ❑
c, retain a reversionary interest;or_...................____...............................................-......__........____....__ El
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?.................__......................................................................................... ❑
1 Did decedent own an"in trust for°or payable upon death bank account or security at his or her death?.............. ❑ R
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 January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three(3)percent 172 P.S.§9116(a)(1.1)(1)].
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 zero(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 twenty-one 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 zero(0)percent 172 P.S.§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 four and one-half(4.5)percent, except as noted in
72 P.S.§9116(1.2)[72 P.S.§9116(x)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve(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.
REV-1508 EX+(6x98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, Br MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Edith M.Weaver 21-05-0028
Include the proceeds of litigation and the dale the proceeds were received by the estate.
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1. On or about June 27,2014 the Estate received litigation proceeds from integrity Insurance Company in 18,000.00
Liquidation in Connection with York County State Court litigation initiated prior to the decedent's death,
Weaver v.Donald K.English,et at.,No.87-SU-03093-01,said proceeds in the amount of$18,000.00
TOTAL(Also enter on line 5,Recapitulation) $ 18,000.00
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REV1511 EX+(12-ee)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES $
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Edith M.Weaver 21-05-0028
Debts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t �
B, ADMINISTRATIVE COSTS:
5. Personal Representative's Commissions
Name of personal Representative(s) _ _ _ ,_ ""' �""""'�"•"""°"S
Social Security NumbegsyEIN Number of personal Represemative(s)
Street Address;
City....._._... ._. .« _ .Statej�- ...
Year(s)Commission Paid_
2. Attorney Fees ._...._.. 7��yy
raaw.weCw?O'Y
w�mFrJa,e�e,+mw.,+.ua�.
3. Family Exemption:pf decedent's address is not the same as dalmant's,attach explanation)
Claimant r
StreetAddress •.- .....f._•.__.... ,-._._....�.......__ .___... .. _-.�..-_._ .- .. '____
City;_..____.. estate+ !Zip t
Relationship of Claimant to Decedent i
4. Probate Fees ' r
5. Accountant's Fees ,{t
ARtIF�1S¢SV"Me%d�11Y%�4Ytw.g
6. Tax Return Preparer's Fees
T. Senn Law Firm--contingency fee paid on litigation proceeds # 7,200.00
B.', Cumberland County Register of Wills filing fees - - - ^•~ _. . •� _ ! 30.0
.. IF..Ni 3[Y\'�M1'Y-YH'.YIf Ai YNW
_ ..•.r.._.« .,.__.v...... «.__.,._..,___.._ F .. _ . .w •. ,"CIII..,'Tllllw'YIMw.
._...�.. ....._......«...... nn. ....._«...._, ..r. ... .__con , ._r__., �,
j .�f JO:J'm'MI.I.F^.Y.•L''YA'!tFiliR-f
. - +. F6"xwOVS:ta'-'�e�rawra�'DS
Hs,.v?pw,NaZ A
TOTAL(Also enter on line 8,Recapitulation) $1 _ 7,505,000
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+ REV�1513 EX+(11-08)
pennsytvania SCHEDULE J
DEPARTMENT OF REVENUE
—— INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Edith M. Weaver 21-05-0028
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. Doris Anne Young,9445 Cadisle Road,Dillshurg,PA 17019 daughter 50%residue
2. Donald E.Weaver,4307 Lemonwood Circle,Bradenton,FL 34208 son 50% residue
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV•1SOO COVER SHEET,AS APPROPRIATE,
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
1.
t
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,Insert additional sheets of the same size.