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Home My WebLink About08-15-14 (2) J 1505610105 REV-1500 EX(rU) ' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 2Eo6o1 INHERITANCE TAX RETURN Harrisburg,PA 171.2E-o6o1 RESIDENT DECEDENT j ENTER DECEDENT INFORMATION BELOW Decedent's Last Name Suffix Decedent's First Name MI . _—.------.._._... _ --- Mahone — Dorothy IN Applicable)Enter Surviving Spouse's Information Selm Spouse's Last Name Suffix Spouse's First Name MI Spouses Social Security Number ' -- —' --- --- � THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1.Original Realm OND 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 S. Federal Estate Tax Realm Required death after 12-12-82) O R.Decedent Died Testate O 7.Decedent Maintained a living Trust ,-,T 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) I O 9.Litigation Proceeds Received p 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sea 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 Katherine L. McDonald Esq ( (717)975-9446 REGISTER OF WILLS USE ONt,Y First Line of Address i- ,` Dethiefs-Pykosh Law Grp — �51 E: tcu–' .� ' to Second line of Address - 2132 Market St p r!:, City or Post Office State ZIP Code DAT l Camp Hilt PA_.1 [17011 `f1 Correspondent's email address:kmedonald @dplglaw.Com Under penalties of perjury,i dedere that I have examined this return,Including accornpanping schedules and statements,and to the best of my towwtedge and beget, ft is true,correct and cornpiste. ration of preparerotlrer than the personal retxeserrtativa is lased at'aR iMOrmatiwt of which prepet hes arty knowtedg8, SIG URE F p ON FOR FILING RETUR - pgTE ADD ESS 673 Moores Rd,Lewisberry,PA 17339 SIG PA E TH RE E E TAT DATE ADDRESS 2132 Market St,Camp Hill, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 9 1505610105 1505610105 1 VV � , REV-1 son Ex(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Dorothy Q. Mahone STREETADDRESS 5225 Wilson Lane CITY STATE ZiP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 45.80 2. Credits/Payments A.Prior Payments B.DiscouM 3. Interest Total Credits(A+8} (2) 0,00 4. If Line 2 is greater than Line t+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) 46.80 Make check payable to: REGISTER OF WILLS,AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent rake a transfer and: Yes No a. retain the use or income of the property transferred..........—............................................................................ ❑ 0 b. retain the right to designate who shall use the property transferred or its Income ............................--............ [❑ 0 c. retain a reversionary interest........................................................................._.........................---................... ❑ 0 d. receive the promise for fife 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?...............................—............................................................................ ❑ ■ 1 Did decedent own an In trust for:or payable+rponAea4r bank account or security at his or herdeath?............ .. ❑ 4. Did decedent own an ind'mdual 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 6 AND FILE IT AS PART OF THE RETURN.on For 3 percent death P.S §9116(a)my 1 {ig4,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse 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)).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'd 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 f 72 P.S.§9116(a)(1.2)]. • The tax rate Imposed on the net value of transfers to or for grouse of the decedertfs Lineal beneficiaries is4.5 percem,except as noted in[72 RS,§9t16ja)(i}j, • The tax rate imposed on the net value of transfers to or for the use of the deoedenfs 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. i J 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Dacedenrs dame: Dorothy Q. Mahone 406-22-5293T - RECAPITULATION t. 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 and Notes Receivable(Schedule D)........................... 4, 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 1,017.86 -- 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .,..... 6. 7. Inter-Vvos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... 8: Total Gross Assets(total Lines 1 through 7)............................. 8. 1,017.66 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 11. Total Deductions(total Lines 9 and 10)................................. 11. 0,00 12. Net Value of Estate(Line 8 minus Line 11).............................. 12. 1,017.86 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ......................_ 13. 14. Not Value Subject to Tax(Line 12 minus Line 13) ........................ 14.i� 1,017,86 TAX CALCULATION-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- 15.i 16. Amount of Line 14 taxable at lineal rate X A 45 1,017.66 16. 45.80 j 17. Amount of Line 14 taxable at sihling rate X.12 17 18. Amount of Line 14 taxable at collateral rate X.15 �.� _ 18.( 7 19. TAX DUE......................................................... 19. 45.80 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 '„� 1505610205 1505610205 REV-%SoB EX+(o8-tx) [ js pennsytvania SCHEDULE E �y DennnnMMTOFREVENUE CASH, BANK DEPOSITS&MISC. INHERITANCE TM RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Dorothy O. Mahone 2113-1057 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. nfm VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1.' 'Acacia Life Insurance Policy No.4010523676 TA Proceeds,Check No.40285642 dated 6f23t14 ; 1,011.86 „r f i�. TOTAL(Also enter on Line S,Recapitulation) $ L _1,017.86 _—. If more space is needed,use additionat sheets of paper of the same size.