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Home My WebLink About04-25-05 Lt\ ~ 1: , 10 '0 () ''J " 'en ~.,.-~i i l , , ~, \ !l~~ ] "'~ ~~ ~~ \\r] , "",;.. 0- ! \ \ , \ \ \ \ ' \ \ \ I ~ ~ , ! ! :C,' , , i" r,l,!, r' e, iC '~ ~ .;:----.\.i~ ~, -1 ~ ~ ~ :~ ~~ r~ '\ ",r~T \, 1~ l'~ ~ ~ .~ \~ ~ '''-W ~ .~ ,\~ ~.~ ~. ~\ ~~ ~J ~~ .~ 'J ~~, \ ',- , .,~ ......J '~ ,~ \~~ . ; -\ REV-l500 EX (6-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL LISE ONLY '* COMMONWEALTH OF PENNSYLVANIA . DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 FILE NUMBER L L -D-~ COUNTY CODE YEAR Q3-I..tLi-_ NUMBER I- Z W C W o W C DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Ketner, Bright W DATE OF DEATH (MM.DD-YEAR) 1 DATE DFBIRTHIMM-DO:YEAR) D1I22/2005 03/13/1926 ____ __L_ (IF APPLICABLE) SURVIVING SPOIlSES NAME (LAST, FIRST, AND MIDDLE INITIAL) Ketner, Irene E I' SOCIAL SECURITY NUMBER 191-14-8760 I TH~ RE1UR:~~;;;~~E~~ :~~~EWITH THE --- ---- SOCIAL SECURITY NUMBER w ,.., :.::':!tn u"'''' w"" ",00 ,,"'''' ..., .. '" ~ 1. Original Return o 4. Limited Estate E!6. Dec.edenl. Died Testate (Anach copy otWIll) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of cleath after 12-12-82) 07. Decedenl Maintained a Uving Trust (A~achoopyofTl\Jst) o 10. Spousal Poverty Credit (da\eofdaathbelW68n 12.31-91 WId 1-1-95) o 3. Remainder Return (date of dealtI pior to 12-13-82) D 5. Federal Estate Tax Return Required 8, Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9~13(A}\AIl.ath$ctJO) ,.., z w NAME !i! Sheila I Small ~ -FIRMNAME(ll~\ .. w '" ~ TELEPHONE NUMBER " (717) 737-6508 COMPLETE MAILING ADDRESS 837 Mandy Lane Camp Hill, PA 17011 (I) (2) (a) (4) (5) 0.00 88,020.00 0.00 0.00 304,874.00 r---tjFFlCIACUSE ONLY-"! I ' ' " z o 5 :::I !:: a.. < o W 0:: 1. Real Estate (Sdledule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held COl'llOration, Partnership or Sole-Propf1etQrStlip 4. Mortgages & Notes Receivable (Schedule DJ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate BlUing Requested 7. InterNlVos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8, Total Grass Assets (lotal Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage LiabHilies, & Uens (Schedule I) 11. Total Deductions (total Unes 9 & 10) 12. Net Value of Estate (Une 8 minus Une 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which arr e\ectiorr to tax has not been made (Schedule J) 7,353,00 660,813.00 D.OD 275,272.00 -_J (6) (7) 0.00 668,166.00 (9) (8) 7,255.00 98.00 (11) (12) (13) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 660,813,00 SEE INSTRUCTIONS ON REVERSE SlDE FOR APPLICABLE RATES z o !ci: I- :::I a.. :::E o o g 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 17. Amount of Line 14 taxable at sibling rate 35,508.00 x .0 00 (15) 625,305.00 x.045 (16) x .12 (17) x .15 (18) (19) 28,139.00 0.00 28,139.00 16. Amount of Une 14 taxable at lineal rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF yOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ::r- -1 Decedent's Complete Address: STREEf ADDRESS .. 837ManclyLane CITY c;mPHlIi Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Pnor Payments C. Discount STATEpA liP 17011 (1) 28,139.00 1,4(!7.00 Total Credits ( A + B + C ) (2) 1,407.00 3. InteresllPenal\y if applicable D. Interest E. Penally TotallnteresUPenal\y ( 0 + E ) (3) 4. If Line 2 is greater Il\an Line 1 + Line 3, enlerthe difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 26,732.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 26,732.00 A. Enter the interest on the tax due. (5A) B. Enter fhe total of Line 5 + 5A. This is fhe BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 26,732.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN .X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. refain the use or income of the property transferred;....... ........................................ ............ 0 [iJ b. retain the nght to designate who shall use the property transferred or its income; .................. 0 [iJ c. retain a reversionary interest; or ........................ .................... ................. ............................ 0 [il d. receive the promise tor life of either payments, benefits or care? ............... .................... .......... 0 [iJ 2. "death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........... ......................................,............................................ 0 IiI 3. Did decedent own an 'in trust fo~ or payabkl upon death bank accounf or secun\y at his or her death?.............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, Of other non-probate property which. contains a benefICiary designation? ...................... ................... ................................................. 0 [iJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of peljuFY, I declare that I have e)(amined this return, including accompanying schedules and statements, and 10 the best of my knowledge and belief, ltis true, o::orrectand oomple\e. Declaralion of preparer other lhan lhe personal representative is based on all information of which prepaffirhas any knowledge . SIG:u:D~~N~RETURN ADDRESS '8'~7 ~~'.. cf~L~.~ SIGNATURE OF PREPARER OTHEl THAN REPRESENTA11VE DATE /.f 11R')O~ 1M T P I'L 1]01' DATE ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sUrliv\ng spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the lax rate impose<l on the net value of transfers 10 or for the use of the surviving spouse is 0% [72 P.S. ~9t16 (a) (1.1) (ii)]. The staMe does not exemot a transfer to a sUlviving spouse from tax, and the staMory requirements for disclosure of assets and filing a tax retum 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 thM twenty-one 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% [72 PS. ~9116(a)(1.2)]. The tax rate impose<l on the net vaiue of transfers to or for the use of the deceden!'s lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [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% [72 P.S. s9116(a}{1.3}}. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the deceden~ whether by blood or adoption. REV-15Q3 EX+ (6-9B} . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Bright W. Ketner FILE NUMBER All property Jolntly-owned wtth rlghto! survlvol'lhlp must be _ on Sl:he<luIe F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1000 shares Riteaid 3,740.00 2. 790 sh Cohen & Steers REIT and Util income fund . . . 3. 9425.954 sh FrankUn income fund 23,094.00 44,912.00 4. 4273.222 sh Franklin PA tax free fund TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) I';,! .' 88,020.00 REV-150B EX' (6-9B) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Bright W. Ketner FILE NUMBER ITEM NUMBER Indude the proceeds of litigation and the date the proceeds were received by the estate. All property loinUy-owned with right of $urvlvol'$hlp must be dl&closed on Schedule F. 1. UBS Paine Webber Cash Account 2. Conseoo annuity 3. ING annuity ,Household and furnishings Wearing apparel DESCRIPTION TOTAL (Also enter on line 5, Recapitulation) $ (tf more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 783.00 77,350.00 225,991.00 500.00 250.00 304,874.00 REV-1509 EX' (6-98. COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-DWNED PROPERTY ESTATE OF Bright W. Ketner FILE NUMBER If an ...et WlI made Joint within on. year of the decedents date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME I\. Sheila I Small ADDRESS RELATIONSHIP TO DECEDENT :837 Mandy Lane, Camp Hill, PA 17011 , Daughter B. 'Irene E Ketner 837 Mandy Lane, Camp Hill, PA 17011 Spouse C. JOINTLV-ClWNED PROPERTY: LEmR CIA'" DESCRIPTION OF PROPERTY 'OF DATE OF DEATH ITEM FOR JOINT MADE INCWOE NAME OF FINANCIAl INSTITUTION AND BANK ACCOl..IHT NUMBER OR SIMIlAR DATE Of DEATH DECD'S VAlUE OF ....... "'NNfT JOINT 1000000000G NUMBER ATTACH DEED FOR JOtNTlY-HELD RfAl ESTATE. VALUE OF ASSET INTEREST OfCEDENrS IN'fEREST ,. I\. 10/31103 : Commerce 8ank Checking Account 455,064.00 50 227,532.00 A 10131103 , M&T Bank ChecI<ing Account 50 12,232.00 B ,01101/75 American Express Note - acct 1133 2844 7 001 50 15,352.00 B '01101/75 ,American Express Annuity- acct 1133 2844 7 001 50 20,156.00 TOTAL (Also enter on line 6, Recapitulation) $ (if more space is needed, insert additional sheets of the same size) 275,272.00 REV-1511 EX+ (12-99) *' COMMONWEALTH OF PENNSYLVANIA lNHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Bright W. Ketner FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAl. EXPENSEs: Schuyikm Memorial Park - professional services Schuylkill Memorial Pari( - facilities Schuylkill Memorial Pari( - auto services Schuylkill Memorial Pari( - newspaper and clergy 2. 3. 4. Moyers - Flowers 6. Red lion - Luncheon 7. State of PA - Death Certificates B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of _ Represeotalive(s) StleetAddress Cityi Year(s) Commission Paid; (Stale 'Zip 2. Attorney Fees 3. FamUy Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant Irene E Ketner S_Address '837 Mandy Lane City Camp Hill State PA,Zip 17011 3,500,00 Relationship of Claimant 10 Decedent spouse 4. Probate Fees 5. Acoountant's Fees 6. Tax Return Preparer's Fees 7, TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 7,255,00 " REV.1512 EX... (12-03) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABIlITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA N-lERITANCE TAX RETURN RESIDENTDECCDENT ESTATE OF FILE NUMBER Bright W. Ketner Report debts Incurred by the decedent prlor to death which remained unpaid II of the date of death,lncludlng unrelmburstd medical expertMl. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Nepl1rology Associates 98,00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 98.00