HomeMy WebLinkAbout08-12-14 (2) J 1505610140
REV-1500 EX (02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 1 3 1 3 1 6
Harrisbur , PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY D2te Of Birth MMDDYYYY
1 1 1 5 2 0 1 3 1 1 0 3 1 9 5 5
Decedent's Last Name Suffix DecedenYs First Name MI
KAUFFMAN RANDY R
(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
Prior to 12-13-82)
� 4. Limited Estate � 4a. Future Interest Compromise(date of � 5. Federai Estate Tax Return Required
death after 12-12-82)
� 6. Decedent Died Testate � 7. 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 af Death � 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 CORRESPUNDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
DAVI D R . GAL LOWAY , ESC,2 71 7 697 4650
REGISTER OF WILLS USE ONLY
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� '� �
First Line of Address �'� y. r"i;�^
��, � �+_ , ,'
5 4 E . MAI N STREET '-'"'�'� � f � �
a��-- ; E :
�L_.. .__ �� r..l d....
Second Line of Address � N - � t �
Cj�--�, `• -; '._:
n�; � , ,".: � ',i
State ZIP Code QRA_TE FIIED ."-_ `=j
City or Post Office = � — �,:: rY"�
MEC HA NI CS BU RG PA 1 7 5 0 5 5 � � ``'Q
CorrespondenYs e-mail address: daVld waltG't'SgallOway.COill _
Under 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 complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON ESP N IBL OR ILING ETURN DATE
,� w ,��c P c : —« -�y
ADDRESS
MICHAEL S KAUFFMAN 14 CHARING CROSS MECHANICSBURG PA 17050
SIGNATU OF PREPA HE THAN REPRESENTATIVE D E
/
ADDRESS
DAVID R. GALLO AY, ESQ 54 E. MAIN ST MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 1505610140 � �
J 15�5610240
REV-1500 EX(FI)
DecedenYs Social Security Number
oecedenrsrvame: RANDY R • KAUFFMAN
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 1. 7 5 0 0 0 , 0 0
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. 5 3 � 7 4 . � 1
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. •
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . . . . 7. � . 0 �
8. Totai Gross Assets(total Lines 1 through 7) . . . . . . . ... . . .. . . . . . . . . . . . . . 8. 1 2 8 0 7 4 . � 1
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9• 1 9 6 2 4 . � 8
10. Debts of Decedent,Mort a e Liabilities,and Liens Schedule I 10. 1 3 6 4 3 . 4 9
9 9 � ) . . . . . . . . . . . . .
��. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3 3 2 6 7 . 5 7
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . �2• 9 4 8 0 6 . 4 4
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) . . . . . . . . . . . . . . . . . . . . . . 14. 9 4 8 0 6 . 4 4
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 _ � . � O 15. O . 0 �
16. Amount of Line 14 taxable
at�inea�rate X.045 9 4 8 0 6 . 4 4 �6. 4 2 6 6 . 2 9
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 • � 0 18. � • � 0
19. TAX DUE . . . . . . . . . . . . . . .. . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 4 2 6 6 • 2 9
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
� 1505610240 1505610240 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Compiete Address: 2� 13 1316
DECEDENT'S NAME
RANDY R. KAUFFMAN
STREET ADDRESS
331 FIFTH STREET
CITY STATE ZIP
NEW CUMBERLAND PA 17070
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4,266.29
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 0.00
3. Interest
(3)
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) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 4,266.29
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 ...................................................................... ❑ 0
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑
X
c. retain a reversionary interest ..........................................�......................................................... ❑ ❑X
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? ....................................................................................... ❑ �
3. Ditl decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ 0
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.
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
is 3 percent[72 P.S.§9116(a)(1.1)(i)].
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 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 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 p2 P.s.§st�s(a��t)�.
� 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.
REV-1502 EX+(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RANDY R. KAUFFMAN 21 13 1316
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonabie knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE
NUMBER OFDEATH
DESCRIPTION
1 RESIDENCE SITUATED AT 331 FIFTH STREET, NEW CUMBERLAND, PA 17070 75,000.00
ACTUAL SALE PRICE
TOTAL(Also enter on Line 1,Recapitulation.) $ 75 000.00
If more space is needed,use additional sheets of paper of the same size.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
RANDY R. KAUFFMAN 21 13 1316
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PRUDENTIAL 15,934.14
MUTUAL FUND-Account Ending XXXXXX4426
2. PNC BANK 2,803.40
CHECKING ACCOUNT XXXXXX9075
3. PNC BANK 19,584.14
SAVINGS ACCOUNT XXXXXX5195
4. ERIE INSURANCE 341.50
REFUND-HOMEOWNERS INSURANCE
5. ROWE'S AUCTION-NET PROCEEDS 2,201.10
HOUSEHOLD GOODS, GRAND AM &CONVERSION VAN
6. COMCAST 81.00
REFUND CABLE& INTERNET
8. PROGRESSIVE INSURANCE 204.52
REFUND-CARINSURANCE
9. PPL 3.43
REFUND- ELECTRIC SERVICE
10. ADJUSTMENTS-SALE OF PRIMARY RESIDENCE(HUD-1) 764.71
PRO-RATED TAXES&REFUSE
11. PRUDENTIAL 11,156.07
VARIABLE ANNUITY-Account Ending XXXX8269
TOTAL(Also enter on Line 5,Recapitulation) $ 53 074.01
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENTOF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RANDY R. KAUFFMAN 21 13 1316
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTAND DATEOFDEATH %OFDECD�S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICABLE) VALUE
1. SOVEREIGN BANK 1,380.94 100.00 1,380.94 0.00
IRA CD
UNDER 59112 YEARS OF AGE
2. JOHN HANCOCK 15,956.67 100.00 15,956.67 0.00
IRA
UNDER 59112 YEARS OF AGE
TOTAL (Aiso enter on Line 7,Recapitulation) $ 0.00
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RANDY R. KAUFFMAN 21 13 1316
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS BUHRIG-FUNERAL HOME&CREMATORY 6,342.00
2. MYERS BUHRIG-FUNERAL HONE&CREMATORY-GRAVE MARKER 1,100.00
FUNERAL LUNCHEON 78.63
B, ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s) MICHAEL S. KAUFFMAN 5,675.00
StreetAddress 6214 CHARING CROSS
�iry MECHANICSBURG State PA► zIP 17050
Year(s)Commission Paid: 2014
2. AttorneyFees: DAVID R. GALLOWAY 5,675.00
3, Family Exemption:(If decedenYs address is not the same as claimanPs,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 358.50
5 Accountant Fees:
6. Tax Return Preparer Fees: A to Z TAX SERVICE- PREPARATION OF 2013 TAXES 138.00
7. PATRIOT NEWS-PUBLICATION 120.45
8. CUMBERLAND LAW JOURNAL-PUBLICATION 75.00
9. ROBIN GASPERETTI,TAX COLLECTOR 10.00
10. PROTHONOTARY, CERTIFIED COPY OF DIVORCE DECREE 16.50
11. SANTANDER BANK, DATE OF DEATH BALANCE 20.00
12. REGISTER OF WILLS- PETITION FOR GUARDIANSHIP-FILING FEE 15.00
TOTAL(Also enter on Line 9,Recapitulation) $ 19 624.08
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RANDY R. KAUFFMAN 21 13 1316
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. NEW CUMBERLAND BOROUGH 236.24
SEWERITRASH
2. PPL 232.68
ELECTRIC SERVICE
3. PA AMERICAN WATER 96.45
WATER SERVICE
4. MICHAEL S. KAUFFMAN 156.95
REIMBURSEMENT-FURNACE REPAIR ADVANCED BY EXECUTOR
5. VERIZON 20.50
PHONE SERVICE
6. COMCAST 144.77
CABLE& INTERNET
7. UGI 597.85
GAS SERIVCE
8. PROGRESSIVE INSURANCE 110.52
CARINSURANCE
9. ERIE INSURANCE 488.50
HOMEOWNERS INSURANCE
10. LORI BUSER 400.00
CLEANING SERVICE
11. MIKE NORRIS 125.00
APPRAISAL FEE
12. MATTHEW HOUSEKNECHT 100.00
SNOW REMOVAL
13. CONSTRUXX, INC. 974.22
PLUMBING REPAIRS
14. IRS 653.00
2013 FEDERAL INCOME TAX
15. HEATHER'S PEST CONTROL 842.70
TERMITE TREATMENT
TOTAL(Also enter on Line 10,Recapitulation) $ 13 643.49
If more space is needed,insert additional sheets of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
RANDY R. KAUFFMAN 21 13 1316
Decedent's Name Page 1 File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, �Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. SHANE BOULDER 500.00
TRASH REMOVAL& HAULING
17. MIGUEL CORREA, PAINTER 1,000.00
PAINTING- PRIMARY RESIDENCE
18. REDUCTIONS-SALE OF PRIMARY RESIDENCE(HUD-1) 6,964.11
COMMISSIONS, REALTY TRANSFER TAX&OTHER LIENABLE ITEMS
SUBTOTAL SCHEDULE I 8,464.11
GRAND TOTAL SCHEDULE I $ 13,643.49
REV-1513 EX+(Ot-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
RANDY R. KAUFFMAN 21 13 1316
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 [Inciude outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. DAVID ALAN LAUFFER, minor child Lineal 0.50
107 SUSAN DRIVE,APT 5
EBENSBURG, PA 15931
2. ALLI LOUISE LAUFFER, minor child Lineal 0.50
107 SUSAN DRIVE,APT 5
EBENSBURG, PA 15931
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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:
1.
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,use additional sheets of paper of the same size.