Loading...
HomeMy WebLinkAbout10-21-14 (2) 1505611101 REV-1500 EX(02-11) enns lvania Bu OFFICIAL USE ONLY Department Revenue p Y . File mbeer Bureau of Individual.Taxes P,�,M`Mro.aEENUE Coun Code Year PO BOX 28o6o1 INHERITANCE TAX RETURN Harrisburg,PA 1'7128-0601 RESIDENT DECEDENT I `� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY / / / 29Zo / 3 / 0 / 5l / 9' Z.3 Decedent's Last Name Suffix Decedent's First Name MI E-VAAID V / C / ALoAi e- (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 Q 2.Supplemental Return Q 3. Remainder Return(Date of Death Prior to 12-13-82) Q 4. Limited Estate Q 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 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 TO: Name Daytime Telephone Numbe o Vic/ R11 R 7 i �J f!. tJ/`T l �. 7 % 7 �9 7 5 REGISrMRS SLS b",ONIy) -- frt tTi First Line of Address 0'.) I--� ! r� r, PA 77o N " " ' -� Second Line of Address i W r=- rn City or Post Office State ZIP Code DATE FILED /yCdlSAN e5 OUR4S; Correspondent's e-mail address: 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,correc nd com fete.Declaration of rsparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATU F P N ON ��FILING RETURN DATE © —17`/ ADDRES _ SIGNA URE OF PREPARER OTHERTH�PRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505611101 1505611101 1505611201 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate(Schedule A). . .... . ..... ... .. . .... . ..... . ... .. ... .. ... .. . 1. S'� QQ • 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. 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. 9. Funeral Expenses and Administrative Costs(Schedule H). .... .. ... .. ... .. . . 9. 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1).. . .... . .. ... .. 10. 3 Q �7. 11. Total Deductions(total Lines 9 and 10). . .... . ... .. . . .. ... ... .. ..... ... . 11. 0 12. Net Value of Estate(Line 8 minus Line 11) .. . . .. . .. ... ... .. . .. . .. .. . .. .. 12. 7 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. ! f ? 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 (� at lineal rate X.01� 3 D. 16. 17. Amount of Line 14 taxable at sibling rate X.12 17. • 18. Amount of Line 14 taxable at collateral rate X.15 18. L • 19. TAX DUE . . . . . .. ... . ... .. ..... . ... . . . .. .. . ... . . . ... .. . .. . . .... . . .. 19. 1� �• r' 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505611201 1505611201 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME STREETADDRESS �E l zip 5 5 Tax Payments and Credits: _ 1. Tax Due(Page 2,Line 19) (1) 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 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) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 3 0 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?.............. ❑ []r 4. Did decedent own an individual retirement account,annuity or other non-probate property,which --,/ contains a beneficiary designation? ........................................................................................................................ ❑ L� 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 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 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. 4 REV-1502 EX+ (01-10) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy o the deed showing decedent's interest if owned as tenant in common, VALUE'AT DATE NUMBER OF DEATH DESCRIPTION TOTAL(Also enteron Line 1, Recapitulation.) $ If more space is needed,use additional sheets of paper of the same size. i AIM£"'g Q OMB Approval No.2502-0265 A. Settlement Statement (HUD-1) P Ndae OEJ9t'� B. Type of Loan 1.©FMA 2.Q RHS 3.❑Conv.Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4.Q UA 5.❑Conv.Ins. 25317 2898179 442:4009190-703 C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked"(p.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals. D. Name and Address of Borrower: E. Name and Address of Seller: F. Name and Address of Lender: B.Yvonne Waugaman Estate ofAlona C.Evanovich, Allegheny Mortgage Corp. 2716 Lafayette Street aka Alona Evanovich,Deceased Oak Park Mail,2001 Lincoln Way McKeesport,PA 17055 c/o Martin A.Dumic,Son White Oak,PA 15131 9 Patton Road,Mechanicsburg,PA 17055 G. Property Location: H. Settlement Agent: I. Settlement Date: 2716 Lafayette Street Security Settlement Services,Inc McKeesport,PA 15132 150 Robbins Station Road September 11,2014 Allegheny County,Pennsylvania North Huntingdon,PA 15642 Ph. (724)864-9191 Place of Settlement: Howard Hanna Wilson Baum 314 Long Run Road, McKeesport,PA 15132 J. Summary of Borrower's transaction K. Summary of Seiler's transaction 100. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller: 101. Contract sales price 40 500.00 401. Contract sales price 40 500.00 102 Personal property 402. Personal property 103. Settlement Charges to Borrower Line 1400 5,972.70 403. 104. 404. 105, 405. Adjustments for items paid by Seller in advance Adjustments for items paid by Seiler in advance 106. City Taxes 09/11/14 to 01/01/15 106.43 406. City Taxes 09/11/14 to 01/01/15 106.43 107. County Taxes 09/11/14 to 01/01/15 37.34 407. County Taxes 09/11/14 to 01/01/15 37.34 108. School Taxes 09/11/14 to 07/01/15 412.50 408. School Taxes 09/11/14 to 07/01115 412.50 109. September Rent 09/01/14 to 09/12/14 137.50 409. September Rent 09/01/14 to 09/12/14 137.50 110. 410. 411. 112. 412. 120. Gross Amount Due from Borrower 47,166.47 420. Gross Amount Due to Seller 41,193.77 200. Amounts Paid by or in Behalf of Borrower 500. Reductions in Amount Due Seller: 201, Deposit or earnest money 11000.00 501. Excess deposit see instructions 202. Principal amount of new loans 39,765.00 502. Settlement charges to Seller Line 1400 10,178.65 203. Existing loans taken subject to 503. Existing loans taken subject to 204. Total Collected U Front 375.00 504. Payoff First Mortgage to PNC/#301005734631514 13,143.25 205. 505. Payoff Second Mortgage 206. 506. Dep.retained $1,000.00 1,000. 0 207. 507. 208, Rent Credit 3,375.00 508. Rent Credit 3,375.00 209. Seller Assist 2,430.00 509. SetlerAssist 2,430,00 Adjustments for items unpaid by Seller Adjustments for items unpaid by Seller 210. City Taxes to 510. Ci Taxes to 211. County Taxes to 511. CountyTaxes to 212. School Taxes to 512. School Taxes to 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518, 219. 519. 220. Total Paid by/for Borrower 1 46,945.00 520. Total Reduction Amount Due Seller 30,126.90 300. Cash at Settlement from/to Borrower 600. Cash at settlement to/from Seller 301. Gross amount due from Borrower line 120 47 166.47 601. Gross amount due to Seller line 420 41,193.77 302. Less amount paid by/for Borrower line 220 ( 46,945.00) 602. Less reductions due Seller line 520 ( 30,126.90 303. Cash E From 1:1 To Borrower 221.47 603. Cash M To From Seller 11,066.87 'Paid outside of closing by borrower(B),seller(S),lender(L),or third-party(T) By signing page 2 of this statement the signatories acknowledge recelotora completed copy of page 1 of this two page statement. Substitute Form 1099.5: SELLER'S TAX to SOLICITATION:THE INFORMATION IN BLOCKS E,G,H,IAND ON LINES 401,406,407 and 408 IS IMPORTANTTAX INFORMATION AND IS BEING FURNISHED TO THE INTERNAL REVENUE SERVICE,IF YOU ARE REQUIRED TO FILEA RETURN,A NEGLIGENCE PENALTY OR OTHER SANCTION MAYBE IMPOSED ON YOU IF THIS ITEM IS REQUIRED TO BE REPORTED AND THE IRS DETERMINES THAT IT HAS NOT BEEN REPORTED,YOU ARE REQUIRED BY LAN TO PROVIDE THE SETTLEMENTAGENT WITH YOUR CORRECT TAXPAYER IDENTIFICATION NUMBER.IF YOU OO NOT PROVIDETHE SETTLEMENT AGENT WITH YOUR CORRECT TAXPAYER IDENTIFICATION NUMBER,YOU MAYBE SUBJECT TO CML OR CRIMINAL PENALTIES IMPOSED BYLAW. For sales or exchanges of certain real estate,the person responsible for closing areal estate transaction must report the real estate proceeds to the Internal Revenue Service and must furnish this statement to you.To determine if you have to report the sale or exchange of your main home on your tux return,seethe 2014 Schedule D(Form 1040)Instructions.0the real estate was not your main home,report the transaction on Form 4797,Sales of Business Property,Form 6252,installment Sale Income,and/or Schedule O(Form 1040),Capital Gains and Losses.You mayhave to recapture(payback)all or part of a Federal mortgage subsidy if all the following apply.a)You received a loan provided from the proceeds of a qualified mortgage bond or you received a morgage credit cerlificate;b)Your original mortgage loan was provided after 1990.and:c)You sold or disposed of your home at again during the first 9 years after you received the Federal mortgage subsidy,This will increase your tax.See Form 8828,Recaptura of Federal Mortgage Subsidy,and Pub.523,Selling You Home. H you have already paid the real estate tax for the period that includes the sale date,subtract the amounts on Lines 406,407 8408 from the amount already paid to determine your deductible real estate tax. But if you have already deducted the real estate tax in a prior year,generally report this amount as income on tne'Oiher income'line of Form 1040.For more Information,see Pub.523. For Paperwork Reduction Act Notice,see the 2014 Instructions for Forms 1099,1098,5498.and W-G2. 3 Department of the Treasury.internal Revenue Service UN)RPjaBNAi.T1Z$OF PERJURY,I CERTIFY THAT THE NUMBER SHOWN BELOW ON THIS STATEMENT IS MY CORRECT TAXPAYER IDENTIFICATION NUMBER. ettlentent Charges Total Real Estate Broker Fees $4,000.00 Paid From Paid From Division of commission(line 700)as follows: Borrowers Sellers 701 S 2000, 0 to Howard Hanna-Wilson Baum Funds at Funds at 702. 2,000. 0 to Howard Hanna-Wilson Baum Settlement Settlement 703.Commission paid at settlement 3,000.00 704. Deposit Refd By SellinQ Agent to Howard Hanna-Wilson Baum $1000.00 POC 705. Broker's Fee 225.001 225.00 706. Home Warranty to HSA 435.00 800.Items Payable in Connection with Loan 801.Our origination charge $ 750.00 from GFE#1 802.Your credit or charge(points)for the specific Interest rate chosen $ (from GFE#2 803.Your ad'usted origination charges from GFE#A 750.00 804.Appraisal fee to McCarthyAppraisal s from GFE#3 350.00 805.Credit Report to Credit Plus from GFE#3 77.00 806.Tax service to from GFE#3 807.Flood certification to CoreLo is Flood Services,LLC from GFE#3 16.00 808, from GFE#3 809, from GFE#3 810. from GFE#3 811, (from GFE#3) 900.Items Required by Lender to Be Paid in Advance 901.Daily interest charges from 09/11/14 to 10/01/14 20 $4.360000/da from GFE#10 87.20 902.Mortgage insurance premium for months to HUD from GFE#3 683.94 903.Homeowner's insurance for 1.0 years to Erie Insurance from GFE#11 #Q57-5502114 540.00 904. from GFE#11 905. from GFE#11 1000.Reserves Deposited with Lender 1001.Initial deposit for your escrow account (from GFE#9) 380.58 1002.Homeowner's insurance 3.000 months @ $ 45.00 per month $ 135.00 1003.Mortgage insurance months 43.97 per month 1004.Property taxes $ City Taxes months er month County Taxes monthsper month School Taxes monthsper month 1005. 1006. City Taxes 9.000 months @ $ 28.90 per month $ 260.10 1007. CountyTaxes 9.000 months @ $ 10.14 per month $ 91.26 1008. School Taxes 4.000 months $ 42.82 per month $ 171.28 1009. Aggregate Adjustment $ -277.06 1100.Title Charges 1101. Title services and lender's title insurance from GFE#4 1,305.00 1102. Settlement or closing fee to Security Settlement Services Inc 150.00 1103. Owner's title Insurance to Chicago Title Insurance Company from GFE#5 6.50 1104. Lender's title insurance to Chicago Title Insurance Company 715.00 100.300.&900 1105. Lender's title Policy limit 39 765.00 SALE RATE 1106. Owner's title policy limit $ 40,500.00 SALE RATE 1107. Agents portion of the total title insurance premium to Security Settlement Services Inc 627.70 1108. Underwriter's portion of the total title insurance premium to Chicago Title Insurance Company $ 93.80 1109. Deed Prep Fee to Security Settlement Services,Inc $ 200.00 1110. Notary Fees and Postage to Security Settlement Services,Inc $ 24.80 1111. Lien Letter Fees to Security Settlement Services CostAct. $ 200.00 1112. UPS Fee for Payoff to Security Settlement Services,Inc $ 15.50 1113. Inheritance Tax Escrow to Security Settlement Services,Trustee $ 3,037.50 1114. Reimb Occupancy Permit Fee to Howard Hanna Wilson Baum $ 55.00 1200.Government Recording and Transfer Charges 1201.Government recording charges to Department of Real Estate from GFE#7 486.00 1202.Deed 162.00 Mortgage 162.00 Releases Other 1203.Transfer taxes to Recorder's Office from GFE#8 607.50 1204.City/County City/Countytax/stamps 810.00 405.00 1205.State tax/stamps $ 405.00 $ 202.50 1206. Assignment Recording Fee $ 162.00 $ 162.00 In Line 1201 1207. Estate Exemplification to Department of Court Records 55.00 1300.Additional Settlement Charges 1301.Required services that you can shop for from GFE#6 1302. Pest inspection to Hall's 60.00 P.O.C.$60.00 B' 1303. $ 1304. $ 1305. See addit'I disb.exhibit to $ 457.98 2,173.35 1400.Total Settlement Charges(enter on lines 103,Section J and 502,Section K) 1 5.972.701 10,178.65 'Paid outside of closing by b wer(B),seller(S),lender(L),or third-party(T) The undersigned her ackno ledge recelp of a completed copy of this statement 8 any attachments referred to herein Borrow / r %� I t� Seller Estate ofAlona C.Evanov)ch,aka Alona Evanovich, B.Yv fine Waugaman Deceased � L C.Marty B . In A7SdrnTc,Administrator TO THE BEST OF MY KNOWLEDGE,THE HUD-1 SETTLEMENT STATEMENT WHICH 1 HAVE PREPARED ISATRUEAND ACCURATE ACCOUNT OF THE FUNDS WHICH WERE RECEIVED AND HAVE BEEN OR WILL BE DISBURSED BY THE NDERSIGNE T OF THE SETTLEMENT OF THIS TRANSACTION. ` Security S e ent Services,Inc,Settlement Agent REV-1508 EX+(11-io) � pennsydvania p u SCHEDULE E I&' DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: 0 ,4 a—"1q1oDVl4 -1 FILE NUMBER: 'v Include the proceeds off litigation and the date Fthe 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 TOTAL(Also enter on Line 5, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size.