HomeMy WebLinkAbout04-08-05
IEV.15DO EX (6.001
REV-1500
.~ COMMONWEALTH OF
. PENNSYLVANIA
.'iilaL DEPARTMENT OF REVENUE
, DEPT. 280601
HARRISBURG, PA 17128-0601
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OFFiCIAL USE ONLY
INHERITANCE TAX RETURN FILE NUMBER
c2 L -0 S
RESIDENT DECEDENT COUNTY CODE YEA'
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NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SCHmll\l1< EJ..rnf(Z fIJ
DATE OF DEATH (MM.DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
() -II - 'JOt! oS-/5-19/9
IIF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
- 10;2
[Xl 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate IAttach oopy of W~I)
o 9. Litigation Proceeds Received
o 2, Supplemental Return
o 4a. Future Interest Compromise (dateo/death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death betwee~ 12-31-91 and 1-1-95)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
03. Remainder Return (dateofde~thpnort012-13-B2)
o 5. Federal Estate Tax Return Required
~ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
COMPLETE MAiliNG ADDRESS
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NAME J) f
FIRM NAME (If Applicable)
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(8)
!J~ D/Lf.7'I
(11)
(12)
(13)
7) 3'2,t; ~5<'
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
(1)
(2)
(3)
(4)
(5)
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(14)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6, Jointly Owned Property (Schedule F)
o Separate Billing Requested
7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(9)
(10)
(0) CJoo. 94-
13 5_ 7f
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(6)
61 7P7. J.Jf
10 't c,~ 7. 5"0
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(7)
12, Net Value of Estate (line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax 0
rate, or transfers under Sec. 9116 (a)(1.2) x.O_ (15)
16. Amount of Line 14 taxable at lineal rate //3) !ol$'. {)/" x .0 'F5- (16)
17. Amount of Line 14 taxable at sibling rate 0 x .12 (17)
18. Amount of line 14 taxable at collateral rate () x .15 (18)
19. Tax Due (19)
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
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RCAn
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[ STATE
PA
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Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
5 1I.lJ. ~I
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Total Credits (A + B + C ) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
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TotallnteresUPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
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5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
(5A)
5") 1/'5 ">'/
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8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
SJ/IL;,s;
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
ie NO
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FilE IT AS PART OF THE RETURN.
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; .............................................................................
b. retain the right to designate who shall use the property transferred or ils income; ..
c. retain a reversionary interest; or...
d. receive the promise for life of either payments, benefits or care? ..
2. )f death occurred after December 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? .
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Urrder penalties of perjury, 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, correct
and complele
Deciarationofpreparerotherlhanlhe persorral representative is based on all information of which preparer has any knowledge
DATE
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DATE
ADDRESS
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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 3%
[72 PS 39116 (a) (1.1) (il].
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% [72 P.S. 99116 (al (1.1) (Ii)
The statute does not exemDt 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
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 paren
or a stepparent of the child is 0% [72 P.S. 39116(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 4.5%, except as noted in 72 P.S. 39116(1.2) [72 P.S. 39116(')(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 39116(a)(1.3)]. A sibling is defined, under Section 9102, as a
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REv-1508 EX+ (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EJ...mEA-.. (V, 5dffiltVk
FILE NUMBER
Inetude the proceeds of litigation and the date the proceeds were received by the estate. All property jQintly~wned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
P~'t -PA'-D (urJER.Ak ACC-oLl(\.l1
I' :5 ~8'(J .6P
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TOTAL (AlSO enter on line 5, Recapitulation) $ 5. tP 80 . ()O
(If more space Is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
E L/'()ff-. N
:;-'c fI tnl jlJ 1<
FILE NUMBER
If an asset was made joint within one year ofthe decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
Pll'ltv(llf ~'D'>N{lJELI...
/007 ..)WA{l.:rt\mo(l...f. R.o(lp
/Vf.w O)M\',<t:.Rl..AiV~1 p^ I707J?-n3o
P If UGH IEf(.
B.
c.
JOINTLY.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account nl.lmber or similar identifying number. AttcK;h DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate, VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. f/;~ft/ fSEcu /leer; 'It-'U;'()() if'J9'f'ft /3) 4-/'-1. 'f7 5tJ/o &) 1tJ 7. ;.
TOTAL (Also enter on line 6, Recapitulation) $ ~ liP 7. ;;J./-
If
(If more space is neeced, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
E:I-IYJ [f{ IJ S-c 11m / fi} f.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
,
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FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE i'lAME OF THE TRANBFEREE,lHEIR RELATIONSHIP TO DECEDENT A NDlHE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATTACH A COP'i OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE'
NUMBER
1 Y fl (U.((I)l: IIJJ( €flJfi-'( :::r>I'IUC.HT1"1t 6-17-0'!- 33; q 7s. 78 IM% ';3; IX'" 3'3, Q75. 7'6
7in "r 1\ ceO.,>(oI1
~, YII1 .,;,,/( D ',poMJEJ.L Y I/IJ<>HrER- ~-17 -(J'f- 10,077. "3/ /I?D % '3~ 37077,:31
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1" '" oJr ","C.C()v,oJr
3, E/-;IoN Ib/My'S :;::p"uG/(TE~ 1,-17-0,!- 3~ 57'1 iff jP"V % "3 m; 35 57"/ '/1
) . , ,
TufIVr f'Cl.()UlV\
TOTAL (Also enter on line 7, Recapitulation) $ / tl '6, rP :7-7. 50
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+(12-99)~~,
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ELmER..
FilE NUMBER
/IJ
Sdlm/;U~
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 H ooV€/l.. 'r fC",;u Et2i9L f/pmE rDJ 0 5'f-. 1fT)
~. mON UMfNI ::v....rl<o irvSC/l,rrIOcV g5, OJ)
3. PI\T\\.\oT-r0Ek!5 (OBlroIlIlY) I I I. "It-
4. HONoA G"ARJ> -porJfI 110 III fOil. fh 11../ rflll.j /'IOJVol(f' FvrJf!</ll SlRlil CE S- O. OD
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number{s)/EIN Number of Personal Representative(s) - " -
Street Address
City_. State ___ Zip
Year(s) Commission Paid:
2. Attorney Fees - 0 -
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address - 0 -
City__ State __ Zip
Relationship of Claimant to Decedent
4. Probate Fees - 0 .-
5. Accountant's Fees - '" .-
6. Tax Return Preparer's Fees - 0 -
7.
TOTAL (Also enter on line 9, Recapitulation) $ '')'100,~'f-
Debts of decedent must be reported on Schedule I.
(If more space IS needed, insert additional sheets of the same size)
REV_1S12EXO(1_91i,._,_
11~_~ _ _
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
,
FILE NUMBER
ESTATE OF
E/....fVllf.P- IV
'S" c H f'r1 II\) K
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
35.(J"f)
j.
3.
4-,
5.
S V S"quf. NAflJflJlI TowflJSI1/(' E-MS J:rvc.
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ifl..I\I\lSl'''R.'t'~l'I,JU I'" uJH flJ..c.HAIII.. 7l> HlR..SIH:V rHh""~~ cOm;"-
PR."" ~/>."." CVL...n /of/a./",! I
l-lOsHEj ~(vlc.f\l. C~NTffl-
C:o- r~t fo'" ,U..VlcH If/:;' -1P?f
, DD. "TO
moB/J..E X-p.,('IY lOmAGI/vGj ~",c.,
IfjIJ..yP'f
",i.S'il
W EST' SHORt E Il1S - :Bi...S
-s-r(l.fn:Nf/l.. TR,(jNSPPfl..TAlfHN f/l.ofl" 1'i"V Sl'/AIT }/iJ~I"TA/.... (i:>
fhAIJPiI- ('Ml HUqH SteVjcES IflJ {)1I1.J..lf'J..f 1".6;.0'1
N flGJ.lI3oRG.R.f. f~A,q,rMcl
'87.J.o
11\1. bt:.
TOTAL (Also enler on line 10, Recapitulation) $ If 3 5. 7 If-
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIOUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX('1-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
O'DONNELL DIANNE E
1007 SWARTHMORE RD
NEW CUMBERLAND, PA 17070-1730
____~u_ fold
ESTATE INFORMATION: SSN: 177-16-1027
FILE NUMBER: 2105-0330
DECEDENT NAME: SCHMINK ELMER N
DATE OF PAYMENT: 04/08/2005
POSTMARK DATE: 04/08/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 07/11/2004
NO. CD 005175
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $5,115.51
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TOTAL AMOUNT PAID:
$5,115.51
REMARKS:
CHECK# 3991
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS