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Home My WebLink About09-05-14 (2) M _ �. � 1505610105 RE V�i 5 0 o EX(oz-ii){FI)��!�� •i� OFFICIAL USE ONLY PA Department of Revenue pennsylvania OFI��THFXT Oi�lVFMUF Coun ureau of Individuat Taxes ty Code Year File Number INHERITANCE TAX RETURN � j� PO BOX z8o6oi __ .... __.. � ; �� Harrisburg,PA i 128-o6oi RESIDENT DECEDENT ' ? LJ� . ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY , , . �180-01- � 08/17/2006 �04/08/1919 ' DecedenYs Last Name Suffix � DecedenYs First Name __... ..... . .... . _ .. ._........ .... _. Burrell , _._.. ...._... _._ ...._.. .__.. _.... _ R ` ; � Carl _ _ ......._ _ _ _...... � ; .. .... :_....._ ; _ ...... _._....._ __..._ .. .: Applicable)Enter Surviving Spouse's Informatfon Below Spouse's Last Name Su�x Spouse's First Name :.. .. ; . , _..._... ...__. . _._ . .... � _ _ ........ . _ _ ._. ....... . : _ . _. Spouse�Gociai Security�I,�mber ` ' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE __ __.._ . _ _ ..__ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1.Original Return C/� 2.Suppiemeniai Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4,Limited Estate p 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) O 6.Decedent Died Testate O 7. Decedent Malntained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9.Litigatlon Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Electibn to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) rv CORRESPONDENT- THIS SECTION MUST BE COMPLETED ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION ' ULD BE DIRE T0:� Name Da time Tele . _. _ _.y...__ i�rt�`lumber Jj � c'� ._. _ _..... _ _;_.O John F Lyons, Esquire (717) 238�7� c� � r�� ' . _ _ __. __.. .__ __._ _ _.. __.� . r- ..... ... _. .ri _....._.. C7 . ._..._._.._ _..._..... _... .._..... _.. ft'i REGIST�R�W1tiS U NLYr� � „�:' .. -.•:; � C:� •^�::a r.-' +:::� � �Y� First Line of Address ,� L-� ,_,� � .,,.. . ....._ _....... .. .. .._... . ..._... .._.._.._. .. . ...........__.. . .a� ___. 112 Walnut Street � `"� �- � I� � r� _. _ _... � __� r _ ___ . _... econd Line of Address � C1� ° _ ....... _ GJ _ _. ; _.. _ _ _........... .... ......_. . Citv or Post Office State ZIP Code DATE FILED .. ..... _ _. -- _ __.... , _ . , Harrisburg s PA ! 17101 _....................._ ........_ ........_............ .........................__� .._......._: __ CorrespondenYs e-mail address: Under penaltles of perJury,I declare that I have examined this return,Including accompanying schedules and statements,and to the best of my knowledge end beliei, it Is true,correct and complete.Deciaration of pr arer other lhan the personal representative Is based on all Information of which preparer has any knowledge. SIGNATURE OF PER N RESPONSIBL O FILING RETUR D E . �j � � c7�8�� ADDR 47 Da u Road, 7 g SIGN F P RE HER HAN IVE TE ADDRESS ,�O � 112 Wal ut Street, Harris rg, P 101 � — PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610105 1505610105 J `` J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number oe�ede�rs Name: Carl R. Burrell ' ' RECAPITULATION 1. Real Estate(Schedule A). . ... ... ...... ................ ............... 1. 2. Stocksand 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. ' 62,086.97 ' 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . ... . ,. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.... .... 7. ' 8. Total Gross Assets(total Lines 1 through 7)..... ............ ... ... ... ... 8. 62,086.97 9. Funeral Expenses and Administrative Costs(Schedule H)... .......... ... ... 9. ', 18,480.00 ' 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).. ... ... ... ... . 10. ' 11. Total Deductions(total Lines 9 and 10).. ... ... ... ... ....... .. ......... . 1L 18,480.00 12. Net Value of Estate(Line 8 minus Line 11) ..... .... .................. ... 12. 43,606.97 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which - - an election to tax has not been made(Schedule J) ........................ 13. 19,347.32 14. Net Value Subject to Tax(Line 12 minus Line 13) .. .......... ..... .... ... 14. 24,259.65 ! 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.0 45 24,259.65 ' �g. ! 1,091.68 ' 17. Amount of Line 14 taxable at sibling rate X.12 ' , �� : 18. Amount of Line 14 taxable at collateral rate X.15 , ' �$ , , 19. TAX DUE .............. .......... ... ............ ... ....... ... ... .. 19. ' __ 1,091.68 i 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 L, 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Carl R. Burrell STREET ADDRESS --—— —.. _---------- _----- . 4905 East Trindle Road --- - ----- CITY - - -- — ----- . .----- .__—._ - ---- STATE - —. .--- ._ Mechanicsburg i Pa ZIP 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) �� 2. Credits/Payments A.Prior Payments B.Discount 3. Interest Total Credits(A+B) (2) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �3� 349.71 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) 1,441.39 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.......................................................................................... � � b. retain the right to designate who shall use the property transferred 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 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? ........................................................................................................................ � ❑ 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 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 decedenPs 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 Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. R"eV-1510 EX+ (08-09} � pennsylvania SCHEDULE G DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF Carl R. Burrell FILE NUMBER 21-07-0271 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. ITEM DESCRIPTION OF PROPERTY NUMBER 1NCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE THE DATE OF TRANSFER. ATfACH A COPV OF iHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICABLE) VALUE 1• Franklin Templeton IRA Acct#102-2843101944 No beneficiary designation-paid to Estate on or about May 3,2013 62,086.97 100 62,086.97 Valuation letter to be provided under separate cover TOTAL(Also enter on Line 7, Recapitulation) $ 62,086.97 If more space is needed,use additional sheets of paper of the same size. _.., � �.� .�.:� �,ms.. �, REV-1511 EX+ (08-13) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Carl R. Burrell FILE NUMBER 21-07-0271 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES; AMOUNT L B. ADMINISTRATIVE COSTS: 1, Personal Representative Commissions Name(s)of Personal Representative(s) Street Address City State ZIp Year(s)Commission Paid: z• Attorney Fees: 4,895.00 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 Fees: 150.00 5� Accountant Fees 350.00 6• Tax Return Preparer Fees: 350.00 �• 2013 Income Tax 12,735.00 $. Supplemental Return-fee 15.00 9� Supplemnentallnventory 15.00 TOTAL (Also enter on Line 9, Recapitulation) $ 18,480.00 If more space is needed,use additional sheets of paper of the same size, W.. �. � � .�=�tr.� . ,-_ REV-1513 EX+(01-10) � � ;�'' pennsylvania SCHEDULE ,7 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Cari R. Burrell 21-07-0271 NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RE oTN tSL st T ust e(s)NT AMOOF ES ATE ARE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).J 1• Benjamin C.Burrell Estate Son $4,912.32 c/o Shaun E.0'Toole,Esquire,220 Pine St.,Harrisburg,PA 17101 50%ofnet Distribution pursuant to agreement reached between heirs which will be forwarded under separate cover. 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 Memorial Evangelicial Lutheran Church 50% c/o James Turner,Esquire,4701 North Front St.,Harrisburg,PA 17101 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.