HomeMy WebLinkAbout09-04-14 � 1505610105
REV-isoo°���-u>«�
P�►Deaarhnent of Revenue �Avan�. �7cw.us�oN�v
Bur�u of Indivlduat Taxes °"""°`«•"""` Co�rdy Code Ye�r Fie rMirnber
POSOXzBosoi INHERITANCE TAX RETURN ; _ � � __. .
_. .
HaRISbuR_* PA i��8-o6oi RESIDENT DECEDENT � ����
lNTER DECEDENT WFORMA710N BELOW
Sode�Seadity Number Oate of Deafh MMDOYYYY Date of Buth MMDOYYYY
620-18-6745 10/04/2013 12/14/1984
__ _ . ___. __ ___
__ _ __ _.
DecedenPs Last Neme _ ___ __
S� DeCedent's First Name MI
Smith _ _ _ : ,Jr. Tere�ce _ _ . ___
:G :
(MAPP�ic�Ws)Enter Surv7ving 8ppuso's Informatlon Below _ _ _ _ _ �
Spouse's last Name
SuAGc 3pouae's F'ust Nart�e MI
Spaise's Social 3ecurity Number
THIS RETURN MUST BE FILED IN DUPLICATE MfITH TNE
- REGiSTER OF WILLS
FILL IN APPROPRIATE OVAI$BEl,pyy
C� 1.Original Retum O 2.S�plernental ReWm
O 3.R�nainder Retum(Date pf peatl�
PAOr to 12-13-82)
O 4.Limi�ed Estate O 4a.Fulure Interest Coir�promise(daEa of O 5.Fedsral Estate Ta�c Retum Required
death aRer 12-12$2)
O 6.Deoedent Died 7estate O 7.Deoedern Meinfained a LMing Trust a 8,Toiel Numb�ef Safe DeposN Boxes
�A��oPY��) (/41taCFt Copy of Trust.)
O 9.Lidgation Prooeeds Received O 10.Spousal Poveity Credit(pate c(peeth O 11. Election to Tax under Sec.8113(A)
Between 72-31-91 and 1-1-95) (Atlach We O) rv
COR�ONDENT—THS SECTpN YU8T BE COMPLETEO.ALL CORRESPONDENCE AND l�1DENTUIL TAX NFORMATION 8 � �7
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Law Office of John C OszU 5{'OW I G2 ; (717)243-�3? c� '�'v f;, �
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Fkst line ofAddress ,.� c.�'_�. � � .� -y
104 S Hanover S"t. • �-� � "'�
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Seoond une of Address }-' � �
[ _ _. _ . .. ___ _ _ DATE FII.ED
Cily or Post Olfioe 31ate Z1P Code
�Carlisle ' PA '17013
; ___ .__ .._ _ __ . . _..... __... _ _.
Comspondent's etnail address:
Under Paial�a of P�f�I dedme lhat I ha�e exsmfned this ro4ur4�dudin9�Y�9 echadules and sts6eme�ts�end b fhe best ct my knowledps and baUef.
k fs true,correct end mnplete.Dedaration of preparet dhar U�►1he Pe�sor�ai ropre�tive la beeed an e6 irdommdon af rrhkh preparar hes arcy knowlsdp�.
���it/PE l I ' S IBLE�€ F�EfURN� '�A �7E / T
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ADDRE3S
3922 Emil Ridge Dr.,Mechanicsburg,PA 17050
SI(iNATURE OF REPRESENTA'11VE DA�E
�T
aooRess
104 S Han er St.,Carlisle,PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 15�561�105 15056b01D5 J
J 1505610205
REV-1500 EX(FI)
DecedenYs Social Security Number
Decedenes Na,,,e: Terence G Smith, Jr
RECAPITULATION
_ _ _
1. Reai Estate(Schedule A). ............................................ L
___ __ �-._. ___
_. . . .._.. ..
2. Stocks and Bonds(Scheduie 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. 8,212.28
_ ___ �
_. ... _., ���
6. JoinUy Owned Property(Schedule F) O Separate Billing Requested ....... 6. 285.14 ;
7. IMer-Vivos Transfers 8 Miscellaneous Non-Probate Property '
(Schedule G) q Separate Billing Requested........ 7. !
8. Total Gross Assets(totai Lines 1 through 7)............................. 8. . 8,497.42 '
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 7,846.68 I
10. Debts of Decedent,Mortgage Liabilities and Liens(Scheduie I)............... 10. 3,378.75
_. .. _ __ . ...._._._
�.._�.... .
11. Total Deductions(totai Lines 9 and 10)................................. 11. 11,225.43
12. Net Value of Estate(Line 8 minus Line 11)........ ...................... 12. .. 0.00
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which � ����-� ��� �-� �
_T. _�_
� ...
an election to tax has not been made(Schedule J) ........................ 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) ........................ 14. , 0.00
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 A_ ',
16. Amount of Line 14 taxable � ���� � " -��"� ��°`� �
_ . 15.
__ �_ __..._
_ __ _. _. .._.._ ._
_._. .
at lineal rate X.0 45 0.00 �g, 0.00
17. Amount of Line 14 taxable .' . . -
_
at sibling rate X.12 ��
18. Amount of Line 14 taxable _ _ _ _ _ __ .
at collateral rate X.15 ! �8
19. TAX DUE......................................................... 19. _ _ 0.00
_ __ __ i
__ _.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
L 15056102�5 15�5610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
Terence G. Smith,Jr
STREETADDRESS --
509 Louisa Lane
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments _ 12.19
B.Discount _ 0.64
3. Interest
Total Credits(A+g) (2) 12.83
4. If Line 2 is greater than Line 1+Line 3,enter the difference. This is the OVERPAYMENT. �3�
Fill in oval on Page Z,Line 20 to request a refund. (4) 12.83
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. �5�
� _, , _
Make check payable to: REGISTER OF WILLS, AGENT.
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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 shall use the property Vansferred or its income............................................ � �
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. receive the promise for life 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?.............................................................................................................. ❑ �
3. Did decedent own an"in trust fo�'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
oontains 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.
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For dates of death on or after Juiy 1,1994,and before Jan.1,1995,the tax rate imposed on the net value of transfers to or for the use of the suroiving spouse
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 retum 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)j.
• 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[72 P.S.§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)j.A sibling is defined,
under Secqon 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-i5o8 EX+(o8-sz)
� pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH� BANK DEPOSITS & MISC.
INHERITANCE TAX RE7URN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Terence G Smith, Jr 21-13-1246
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
NUMBER VALUE AT DATE
_ DESCRIPTION OF DEATH
1. 2003 Saab
1,500.00
2 :Final paycheck from Capitai Blue Cross 1,355.59
3 Bonus paycheck from Capital Blue Cross 3,127.56
q, 2013 Federal tax refund
2,179.13
5 Progressive car insurance refund
50.00
TOTAL(Also enter on Line 5, Recapitutation) ¢ 8,2�2•28
If more space is needed,use additional sheets of paper of the same size.
REV-isog EX+(oi-1o)
�pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN �OINTLY-OWNED PROPERTY
RESIDEFfr DECEDENT
ESTATE OF:
FILE NUMBER:
Terence G Smith,Jr 21-13-1246
If an asset became jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVING]OINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A•Terence G.Smith,Sr 3922 Emil Ridge Dr., Mechanicsburg, PA 17050 Father
B'Patricia A Smith 3922 Emil Ridge Dr., Mechanicsburg, PA 17050 Mother
C.
)OINTLY OWNED PROPERTY:
LEITER DA7E DESCRIPTION OF PROPERN
ITEM FOR)OINT MADE %OF DATE OF DEATH
INCLUDE NAME OF PINANCIAL lNSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE Of
NUMBER iENM(r JpINT IDENT[FYING NUMBER.ATTACH DEED FORJOINTLY HELD REALESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTEREST
1' A' 02/06/09 Members 1st Checking Account 197952
1,710.80 .16 285.14
TOTAL(Also enter on Line 6, Recapitulation) $ 285.14
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
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Terence G Smith, Jr 21-13-1246
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A• FUNERAL EXPENSES: AMOUNT
1' Neiil Funerai Home-Harrisburg,PA
5,275.67
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
��ty— State ZIP
Year(s)Commission Paid:
Z� Attomey fees:
3• Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City_ State ZIP
Relationship of Claimant to Decedent
4• Probate Feer.
158.50
5� Accountant Peer
6• Tax Return Preparer Fees
�• The Senfinel-legal advertising
116.20
8 Cumberland County Law Journal-legal advertising
75.00
9 qftermath Biohazard Management
: 2,081.31
�o .Suretybond
. 140.00
TOTAL(Also enter on Line 9, Recapitulation) $ 7,846.68
If more space is needed,use additional sheets of paper of the same size.
REV-IS]2 EX+(]2-12)
,�i 'pennsylvania SCHEDULE I
� DEPARTMENTOFREVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Terence G Smith, Jr 21-13-1246
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical ezpenses.
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1• Debit card purchase at Giant foods
68.84
2 Debit card purchase at Arby's 6.96
3 Debit card purchase at Kam's Food 5.29
4 October rent 800.00
5 :Check#1135-unknown purchase cleared checking account on10/7 38.00
6 ';Discover Credit Card balance due 2,459.66
TOTAL(Also enter on Line 10,Recapitulation) � 3,378.75 `
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
� pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX REfURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Terence G. Smith, Jr. 21-13-1246
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRE55 OF PERSON(5)RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE
I TAXABLE D[STRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1• Patricia A Smith 3922 EmilRidge Dr.,Mechanicsburg,PA 17050 Parent ��2
2 Terence G Smith,Sr.3922 EmilRidge Dr.,Mechanicsburg,PA 17050 Parent ��2
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:
L
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
L , _
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.