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HomeMy WebLinkAbout09-22-14 (2) � 1505610105 REV-1500 Ex�°Z_",`F`, � OFFICIAL USE ONLY PA Department of Revenue pennsylvania oEa.w.�E�.oFwE�Ex�E County Code Year File Number Bureau of Individuat Taxes INHERITANCE TAX RETURN � �� / /„� PO BOX 28o6oi / �� Harrisburg PA 1'71z8-o6o1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 01/27/2013 04/13/1927 DecedenYs Last Name Suffix DecedenYs First Name MI GONTER JOHN 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 O 2. Supplemental Return Q 3. Remainder Return(Date of Death Prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise(date of Q 5. Federal Estate Tax Return Required death after 12-12-82) m 6. Decedent Died Testate O 7. Decedent Maintained a�iving Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Wiil) (Attach Copy of Trust.) p 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 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 T0: Name Oaytime Telephone Number DAVID ENGLEHART (717) 761-4646 � REG�EROOF WILL� E ON�LY� E�7 � Jj i`s7 rTi � � � � O First Line of Address � � � � t,r> �j 704 LISBURN RD STE 102 '; �;; �T' c�,n �''� ."��i : � ;, � Second Line of Address l , , --tj .% � � _'� � , "Tl :IJ City or Post Office State ZIP Code ��i OATE I�1t�ED � � CAMP HILL PA 17011 C.'�J �' � Correspondent's e-mail address:dengl2h81't profinadvinc.com Under penalties of perjury,I declare that I have examined this return,induding accompanying schedules and statements,and to the best of my knowledge and belief, it is true,correct and complete.Dedaration of preparer other than the personal representative is based on ail information of which preparer has any knowledge. SIG RE OF PERS RESP SIBI,E R FILING RET�JRN . DATE . � R_��_� A D S 323 W MEADOW DR CHANICSBURG PA 17055 SIGN RE�OF P RER THER/THAN REPRESENTATIVE DATEG _ � � %' 1�_ --(0 � ADDRESS 704 LISBURN D STE 102 CAMP HILL PA 17011 PLEASE USE ORIGINAL FORM ONI.Y Side 1 � 1505610],OS 150561,0],05 J � � 15056b0205 REV-1500 EX(FI) DecedenYs Social Security Number �ecedent's Name: JOHN R GONTER 209-20-6495 RECAPITULATION 1. Real Estate(Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 455,512.58 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. 15,098.55 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 117,849.41 (Schedule G) O Separate Billing Requested.. . . . . . . 7. 8. Total Gross Assets totai Lines 1 throu h 7 . . . . . . . . . . . . 8. 588,460.54 � 9 ). . . . . . . . . . . . . . . . 9. Funeral Ex enses and Administrative Costs Schedule H 9. 7,377.53 P ( ). . . . . . . . . . . . . . . . . . . 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). . . . . . . . . . . . . . . 10. 579•22 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 7,956.75 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 58�,503.79 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. 580,503.79 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. 16. Amount of Line 14 taxable 26,122.67 at linea� rate x.0 45 580,503.79 16. 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. 26,122.67 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610205 150561,02�5 � __ _ _ _ REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT`S NAME JOHN R GONTER STREET ADDRESS 323 W MEADOW DR CITY STATE Z�P MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 26,122.67 2. CreditslPayments A.Prior Payments B. Discount � Total Credits(A+g) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +�ine 3,enter the difference. This is the OVERPAYMENT. 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) 26,122.67 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 transferretl 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 decetlent 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 tleath 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 decedent's 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 decetlent'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-i5o3 EX+(8-1z) '" � pennsylvania SCHEDIJLE B DEPARTMENT OF NEVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN R GONTER 2113-0165 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1� Charles Schwab Acct#1140-0171 430,669.03 2 Wells REIT II Acct#01004023515 24,843.55 TOTAL (Also enter on Line 2, Recapitulation) $ 455,512.58 If more space is needed, insert additional sheets of the same size REV-i5o8 EX+(o8-iz) ` � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSIT5 & MISC. �NHER�TANCE TAX RET�R" PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JOHN R GONTER 2113-0165 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 �. M&T BANK Checking Acct#254854 15,098.55 TOTAL (Also enter on Line 5, Recapitulation) $ 15,098.55 If more space is needed, use additional sheets of paper of the same size. �CV�151;1 Ek+ ,('� ��c), �� pennsylvania SCHEDULE G DEPARTMENT OF HEVENUE INTER-VIVOS TRANSFERS AND �NHERITAN�E TAX RET�RN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN R GONTER 2113-0165 Thls 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 ;�;cw�E Tr+E NaMe oF rHE ranNSFEREE,rHEiR aEwnoNSr+�P ro oECeoENr nrvo DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST QF APPLICABLE) VALUE 1. Jackson National Non Qualified Annuity#1006250714 73,650.82 73,650.82 2 American Funds IRAAcct#74568460 44,198.59 44,198.59 TOTAL (Also enter on Line 7, Recapitulation) $ 117,849.41 If more space is needed, use addltional sheets of paper of the same slze. ;?r••:��i5(1 �e.F ;��',k.t3-.. � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND iNHERiTANCE TAX RET�RN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN R GONTER 2113-0165 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 The Stevens Mortuary 1421 Eighth Ave Altoona PA 16602 5,143.90 2 Calvary Cemetary 2417 Pleasant Valley Boulevard,Altoona, PA 16602 240.00 3 Allegro Restaurant 3926 Broad Ave,Altoona, PA 16601 545.27 a Ramada Inn 1 Sheraton Dr Altoona PA 16601 603.08 s T J Rockwells 896 W Grantham Rd, Mechanicsburg,PA 17055 156.78 s Lena's Cafe 2000 8th Ave,Altoona, PA 16602 101.94 � Zach's 5828 6th Ave,Altoona,PA 16602 78.06 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commisslon Pald: 2. Attorney Fees: 3. Famlly Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City _ State ZIP Relationshlp of Clalmantto Decedent 4, Probate Fees: 508.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation} $ 7,377.53 If more space is needed, use addltlonal sheets of paper of the same size. �r� '.�'� r'�:+ ;�� � pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INHERITANCE TAX RET�RN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JOHN R GONTER 2113-0165 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� Gorsuch Plumbing 494.22 2 Harrisburg Foot and Ankle 85.00 TOTAL (Also enter on Line 10, Recapitulation) $ 5�9.22 If more space is needed, msert additlonal sheets of the same size. REV 1513 EX+ ;O1 ?0; � pennsylvania SCHEDULE � DEPARTMENT OFHEVENUE INHERITANCE TAX REfURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JOHN R GONTER 2113-0165 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 [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. LYNNE M NICKUM 323 W MEADOW DR MECHANICSBURG PA 17055 DAUGHTER 50 2 SCOT A GONTER 2136 ENGLEWOOD CT ENOLA PA 17025 SON 50 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.