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HomeMy WebLinkAbout09-15-14 j 1505610140 REV-1500 EX (02-11)(A) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 260601 2 1 1 3 1 3 2 0 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 1 3 0 2 0 1 3 0 5 1 1 1 9 2 9 Decedent's Last Name Suffix Decedent's First Name MI M C C L I N T 0 C K D A L E J (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI M C C L I N T 0 C K M A R I L Y N A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 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.Federal Estate Tax Return Required death after 12-12-82) ❑X 6.Decedent Died Testate C3 7.Decedent Maintained a Living Trust S.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) 9.Litigation Proceeds Received C] 10.Spousal Poverty Credit(Date of Death 0 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 CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4 6 5 0 REGISTER OF WILLS USAF ONLY a r7 I( First Line of Address � 5 4 E M A I N S T R E E T + Second Line of Address rte- n Cn � in c U Cv c n ^rl City or Post Office State ZIP Code r-oAT,E FILED M E C H A N I C S B U R G P A 1 7 0 5 5 Cn r m Correspondent's e-mail address: nTut're((a'SWalteYSpaIIOWBV.com 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.Deciaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON F FILING RETURN DATE_ ADDRESS MARILYN A, MCCLI NT CK, 618 APPLE DR MECHANICSBURG PA 17055 SIGNATUR n=THAN REPRESENTATIVE DATE ,{ ADDRE MURREL R WALTERS II, 54 E . MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side i 1505610140 1505610140 ...1 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedents Name: DALE J . MCCLINTOCK RECAPITULATION 1. Real Estate(Schedule A) . .. . . . .. . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . 2. Stocks and Bonds(Schedule B) . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .. . . . 2. 1 2 3 9 5 8 , 1 5 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 1 7 8 . 0 3 6. Jointly Owned Property(Schedule F) El Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property Q • Q Q (Schedule G) E] Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) 8. 1 7 7 1 3 6 . 1 8 9. Funeral Expenses and Administrative Costs(Schedule H) . . . , . 9. 1' 9 9 3 9 . 0 4 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . .. . . . . .. . . . 10. 4 4 3 . 9 L. 11. Total Deductions(total Lines 9 and 10) . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 0 3 8 3 . 0 Q 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 1 5 6 7 S 3 . 1 8 an election to tax has not been made(Schedule J) . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . 14. 1 S 6 7 5 3 . 1 8 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 _ 5 2 2 5 1 . 0 6 15. 16. Amount of Line 14 taxable 0 . Q 0 at lineal rate X.045 1 0 4 5 0 2 . 1 2 18 17. Amount of Line 14 taxable 4 7 0 2 • 6 Q at sibling rate X.12 0 . 0 0 17 18. Amount of Line 14 taxable 0 • 0 0 at collateral rate X.15 0 . 0 0 18 Q . Q Q 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . 19. 4 7 0 2 . 6 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 1505610240 1505610240 REV-1500 EX(Fi) Page 3 File Number Decedent's Complete Address: 21 13 1320 DECEDENT'S NAME DALE J. MCCLINTOCK STREET ADDRESS - 618 APPLE DRIVE —_� — --- `----- `---- --- CITY —�__�------ —� STATE 27P ---� - MECHANICSBURG 1 PA---- 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 4,702.60 2. Credits/Payments A.Prior Payments 5,100.00 S.Discount 267.83 Total Credits(A+8) (2) _ 5,367.83 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) 665.23 5, If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 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 ...................................................................... ❑ nX b. retain the right to designate who shall use the property transferred or its income ............................... ❑ 0 c. retain a reversionary interest ..................................................................................................... El d. receive the promise for life of either payments,benefits or care? ..................................................__ ❑ Q 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................... ... ❑ Q 3. Did decedent own an`in trust for or payable-upon-death bank account or security at his or her death? ......... ❑ 1 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.........__.................................................................................... ❑ nX 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 an 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 s6il 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 172 P.S.§9116(a)(1.2)1. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in V2 P.S.§9116(a)(1)I. • 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-1503 EX+(8-12) pennsylvania DEPARTMENT OF REVENUE SCHEDULE B INHERITANCE TAX URN STOCKS & BONDS RESIDENT DECEDENT EDENT ESTATE OF DALE J. MCCLINTOCK FILE NUMBER All propertyjointly owned with right of survivorshi 21 13 1320 ITEM p must be disclosed on Schedule F. NUMBER j, ATT DESCRIPTION VALUE AT DATE 1104 SHARES @$35.21 OF DEATH 2• VERI2ON 38,871.84 140 SHARES @$49.62 3• PPL 6,946.80 800 SHARES @$30.42 24,336.00 4. VODAFONE 262 SHARES @$67.99 17,813.38 5. UGI 600 SHARES @$40.26 24,156.00 6. FULTON FINANCIAL 275 SHARES @$13.07 7• COMCAST 3,594.25 100 SHARES @$49.12 8• ALCATEL 4,912.00 24 SHARES @ $4.31 9• FRONTIER 103.44 33 SHARES @$4.68 10. CENTURY LINK 154.44 100 SHARES @$30.70 3,070.00 TOTAL(Also enter more space is needed,insert additional sheetsof thesame Recapitulation) $ size 123 958.15 REV-1508 EX+(08-12) Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: DALE J. MCCLINTOCK 21 13 1320 Include the proceeds of Litigation and the date the proceeds were received by the estate. All propertyjointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2000 TOYOTA 8,390.00 TACOMATRUCK KELLEY BLUE BOOK VALUE 2. 2003 PONTIAC 8,935.00 GRAND AM KELLEY BLUE BOOK VALUE 3. 2012 HONDA 18,429.00 ACCORD KELLEY BLUE BOOK VALUE 4. SANTANDER 10,15150 INVESTMENT ACCOUNT 5. PNC BANK 9,270.53 SAVINGS TOTAL(Also enter on Line 5,Recapitulation) $ 53 178.03 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FUNERAL EXPENSES AND RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF DALE J. MCCLINTOCK FILE NUMBER 21 13 1320 ITEM Decedent's debts must be reported on Schedule I. NUMBER A. FUNERALEXPENSES: DESCRIPTION ) MALPEZZI FUNERAL HOME, MECHANICSBURG AMOUNT 2• OLIVE GARDEN- FUNERAL LUNCHEON 3. ROLLING GREEN CEMETERY-GRAVE OPENING 9962.23 358.31 1,495.00 B. ADMINISTRATIVE COSTS: Personal Representative Commissions: 1. Name(s)of Personal Representatives) MARILYNA. MCCLINTOCK Street Address 618 APPLE DRIVE City MECHANICSBURG Year(s)Commission Paid: (RENOUNCED) State PA ZIP 1705=� 2 Attorney Fees: MURREL R. WALTERS, III 3' Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.) Claimant MARILYN A. MCCLINTOCK 4,200.00 3,500.00 Street Address 618 APPLE DRIVE City MECHANICSBURG Relationship of Claimantto Decedent WIFE State PA ZIP 1705_= 4' Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 5. Accountant Fees: 423.50 S' Tax Return Preparer Fees: 7. TOTAL me 9,Recapitulation) $ If more space is needed,use additional sheets of paper of he same size 19 939.04 REV-1512 EX-(12-12) pennsylvania SCHEDULE ! DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER DALE J. MCCLINTOCK 21 13 1320 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 L CAMP HILL EMERGENCY PHYSICIANS 62.75 MEDICAL 2. QUANTUM IMAGING 6.01 MEDICAL 3. HOLY SPIRIT HOSPITAL 212.50 MEDICAL 4. HOLY SPIRIT PHYSICIANS 29.14 MEDICAL 5. ANDREWS &PATEL ASSOCIATION 18.75 MEDICAL 6. PINNACLE HEALTH 14.81 MEDICAL 7. WEST SHORE EMS 100.00 MEDICAL TOTAL(Also enter on Line 10,Recapitulation) $ 443.96 If more space is needed,insert additional sheets of the same size. REV-1513 EX-(01-1D) Pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: DALE J. MCCLINTOCK FILE NUMBER: 21 13 1320 NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT OR SHARE TAXABLE DISTRIBUTIONS [Include outri ht spousal distributions and transfers under Do Not List irustee(s) OF ESTATE I. g Sec.9116(a)(1.2).j 1. MARILYN A. MCCLINTOCK 618 APPLE DRIVE Spousal MECHANICSBURG, PA 17055 2. LAURA L. SLAYDEN 10145 WALHALLA PLATEAU COURT Lineal LAS VEGAS, NV 89148 3. MARCIA A. MCCLINTOCK 4025 CONCORD STREET Lineal HARRISBURG, PA 17109 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 I1-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.