HomeMy WebLinkAbout08-21-14 (2) 1505610140
REV-1500 EX (02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 5 3 8
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 5 2 4 2 0 1 4 1 1 0 4 1 9 8 8
Decedent's Last Name Suffix Decedent's First Name MI
L NGO MATTHEW D
(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
❑X 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)
6.Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
9.Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death [:] 11.Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
S U S A N H C O N F A I R 7 1 7 7 6 3 1 3 8 3
REGISTER OF WILLS USEONLY
H
C i
ri
First Line of Address `ci c =i
=r G-3 .T z7
2 3 3 1 MARKET ST R E E T
=1
Second Line of Address
City or Post Office State ZIP Code DANE FILED
C A M P H I L L P A 1 7 0 1 1
CorrespondenCs e-mail address: SCONFAIR -REAGERADLERPC.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.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN E OF PER N ESPONSIBLE FOR FILING RETURN D TE
.tea Cx�cr, C(z
ADDRESS
3508 DELWOOD DRIVE MECHANICSBURG PA 17050
SIGNATURE PR"E,R OTHER THAN REPRESENTATIVE �yJ DATE
ADDRESS
2331 MARKET STREET CAMP HILL PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
J 1505610240
REV-1500 EX(FI) Decedent's Social Security Number
DecedenrsName: MATTHEW D. LINGO
RECAPITULATION
1. 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. 5 9 6 0 9 , 3 2
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property
(Schedule G) 5 Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . .. . . . . . . . . . . 8. 5 9 6 0 9 , 3 2
9. Funeral Expenses and Administrative Costs Schedule H 9. 2 1 1 1 6 . 5 7
10. Debts of Decedent,Mortgage Liabilities,and Liens Schedule I 10. 1 4 1 4 . 4 0
11, Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 2 2 5 3 0 . 9 7
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . .. . . . . . . .. . . 12. 3 7 0 7 8 . 3 5
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. 3 7 0 7 8 . 3 5
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 _ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable 1 6 6 8 . 5 3
at lineal rate X.045 3 7 0 7 8 . 3 5 16.
17. Amount of Line 14 taxable 0 0 0 17 0 • 0 0
at sibling rate X.12
18. Amount of Line 14 taxable 0 0 0
at collateral rate X.15 0 . 0 0 18.
19. TAX DUE 1 6 6 8 . 5 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑X
Side 2
1505610240 1505610240
REV-1560 EX(F6 Page 3 File Number
Decedent's Complete Address: 21 14 0538
DECEDENTS NAME
MATTHEW D. LINGO
STREET ADDRESS
103 MAY DRIVE APT. 4
CITY STATE ZIP
CAMP HILL I PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,668,53
2. CreddslPayments
A.Prior Payments 1,585.11
B.Discount 83.42
Total Credits{A+8) (2) 1,668.53
3. Interest
(3)
4. If Une 2 is greater than Line 1+Une 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 Une 1+Une 3 is greater than Une 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 ...................................................................... ❑
b. retain the right to designate who shall use the property transferred or its income .............I................. ❑
c. retain a reversionary interest ..................................................................................................... ❑ IR
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑
2. If death occurred after December 112,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑
3. Did decedent own an*m trust for'or payable-upon-death bank account or security at his or her death? ......... ❑ rXi
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 spous
is 3 percent(72 P.S.§9116(a)(1 A)(i)).
For dates of death on or after Jan. t, 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 ar
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(x)(1.2)).
• 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[72 P.S.§4116(aX,
• 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 dented,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1508 EX+(08.12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
TAX
RESIDENT INHERITANCE DENTiuRN PERSONAL. PROPERTY
ESTATE 4F: FILE NUBS EW.
MATTHEW D. LINGO 21 14 0538
Include the proceeds of litigation and the date the proceeds were received by the estata.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. WELLS FARGO-CHECKING ENDING IN 0149 9,812.32
MAC P6102-03A, PO BOX 6995
PORTLAND, OR 97228-6995
2. WELLS FARGO- SAVINGS ENDING IN 4651 14,022.66
MAC P6102-03A, PO BOX 6995
PORTLAND, OR 97228-6995
3. OPPENHEIMER FUNDS- MUTUAL FUNDS INVESTMENT ACCOUNT 35,081.77
PO BOX 5270
DENVER, CO 80217-5270
4. PERSONAL PROPERTY 250.00
5, COMCAST REFUND 17.07
6, UPS VACATION PAY 39832
7. RENTER'S INSURANCE REFUND 1.24
8, SECURITY DEPOSIT REFUND 25.54
TOTAL(Also enter on Line 5,Recapitulation) $ 59,609.
If more space is needed,use additional sheets of paper of the same size.
RE S11"+(08-13)
pennsylvania SCHEDULE H
DEPARTAAENT Of REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MATTHEW D. LINGO 21 14 0538
Peeodent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t. NEILL FUNERAL HOME, INC. -FUNERAL 11,088.07
2. ROMBERGER MEMORIALS-GRAVE MARKER 5,345.00
3. ST. JOHN'S CEMETERY- BURUAL PREP. 860.00
4. ST. JOHN'S CEMETERY- PLOT PLUS OPENING 1,400.00
B. ADMINISTRATIVE COSTS:
t. Personal Representative Commissions:
Namels)of Personal Representatives)
Stmt Address
City State ZIP
Year(s)Commission Paid:
2, Attorney Fees: REALER&ADLER, PC 2,200.00
3, Family Exemption:(If dewdenfs address is not the same as claimants,attach explanation.)
Claimant
Sheet Address
City Staff ZIP
Relationship of Claimant to Decedent
4. Probate Fees: REGISTER OF WILLS,AGENT 223.5C
6 Accountant Fees:
6. Talc Return Preparer Fees:
7,
TOTAL(Also enter on Line 9,Recapitulation) $ 21 116.5
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX-(12.12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MATTHEW D. LINGO 21 14 0538
Report debts Incurred by the decadent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. CAMP HILL APARTMENTS-JUNE RENT 999.81
2. PPL-ELECTRIC FOR MAY/JUNE 8635
3. CAMP HILL APARTMENTS -MAY/JUNE WATER AND GAS 164.64
4, RIVERSIDE ANESTHESIA-MEDICAL 56.60
5. CUMBERLAND COUNTY TAX BUREAU-2013 LOCAL TAXES 10700
TOTAL(Also enter on Line 10,Recapitulation) $ 1,414.4
If more space is needed,insert additional sheets of the some size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MATTHEW D. LINGO 21 14 0538
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Tntstoe(c) OF ESTATE
I TAXABLE DISTRIBUTIONS (Incw deou ' htspousaldi5sibsiionsandtransferstmder
Ssc.9116(a)(1.2).)
1. SUSAN B. LINGO Lineal 18,53917
3508 DELWOOD DRIVE
MECHANICSBURG, PA 17050
2. ROBERT S. LINGO Lineal 18,53918
3508 DELWOOD DRIVE
MECHANICSBURG, PA 17050
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE I6TRI UTIONS:
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 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
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