The URL can be used to link to this page

Home My WebLink About10-21-14 (3) 1505610101 REV-1500 Ex(oi-io) 10 OFFICIAL USE ONLY PA Department of Revenue pennsytvania Bureau of Individual Taxes D"RTM`RrU` County Code Year File Number PO BOX 28o6o1 INHERITANCE TAX RETURN Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT 2 1 1 4 0 0 5 3 ENTER DECEDENT INFORMATION BELOW 0 1 0 9 2 0 1 4 1❑'1 12 14 1119 12 18 Decedent's Last Name Suffix Decedent's First Name MI 0 A 1 I I I I ® J e s s i e 1 1 1 1 1 1 G® (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI I I I I I I I I i I I I I I I ] ® ri I I I I I I I I I I 10 Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE I I I II] REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW i 1.Original Return O 2.Supplemental Return C 3. Remainder Return(date of death prior to 12-13-82) - O 4. Limited Estate O 4a. Future Interest Compromise(date of Q 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust): C 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 Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name i��- Daytime Telephone Number L D e L u c a E IS q I n1 17 j 21518 6 8 4n4, REGISTE WILLS US62LY rr, n First line of address 1111131 F r o n t S t r e e t I I I I r M is 7-0 r__3 , Second line of address ,fi C7 CD T7 P O o, x 5 3 8 P C= City or Post Office State . ZIP Code DAT FILED -- r B o i l i n g S p r i n g s P A 1 7 0 0 7 II Irl V Cn -� 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,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. S / PERSON RESPONSIBL FOR FILING ETURN DATE AD RE SIGNATU OF PREA ER OTHER A EPRES TATIV DATE r, AD SS s �v PLe#SE USE ORIGINAL FOiijlJ ONLY Side 1 1505610101 1505610101 V _ 150 5610105 .J REV-1500 EX RECAPITULATION 1. 'Real'Estate(Schedule A'). ..... .................................... .... 1. 00 00- DOL-6i D 0 0 2. Stocks and Bonds(Schedule'B) .... ....................... ..... ..... .. 2. 11O.M.13XII Oo -lolg 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0 0 4. Mortgages and Notes Receivable(Schedule D)............................ 4. 00F]F]ULM 0 0 0 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 224X, 7 C 51 0 0 5 110U- 6. Jointly Owned Property(Schedule F) (M Separate Billing Requested ....... 6. D111 U0 a 0 IVol 7. Inter-Vivos Transfers&Miscellaneous Non-Prdbate Property (Schedule G) C=D Separate Billing Requested........ 7. -f-IO LM,00 _L01,00 '8. Total Gross Assets(total Lines 1 through 7).............................. �8. 9. Funeral Expenses and Administrative Costs(Schedule H)................... - 3 0 4 1 2 4: L-Gk-i 10. Debts of Decedent,Mortgage Liabilities,andLiens(Schedule 10 ............... 10. 2 1 1 1 0 11. Total Deductions(total Lines 9 and 10)..... ............................ 11. 5 1 5 4. 12. Net Value of Estate(Line,8 minus Line 11) . ............ ................ .. 12. 1 5. 9 8 5 1 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)......................... 13. 90 , 0 14. Net Value Subject to Tax(Line 12 minus'Line 13) ................. ..... ... 14..0 U�J:2]3,1]5 ]9 81 -5 Di 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))(1.2)X.0-4-5 00Q0L-21R,,51L9J08 -L56 15. 9 7 1 3 16. Amount of Line 14 taxable at lineal rate X.0 0016. UJ 17. Amount of Line 14taxable • .at sibling rate X.12 17. 18. Amount ofLine 14 taxable at collateral rate X.15 01 18. 9 7 1 9 3 19. TAX DUE.... ........ .... ............................................ 19. 20. FILL 1N THE OVAL iIF YOU ARE REQUESTING AREFUND'OFAN OVERPAYMENT C=) Side 2 1505610105 151056110105 REV-1502 EX+ (01-10) -- Is pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jessie G. Carroll 21 -14-0053 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 of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 NONE —0- TOTAL(Also enter on Line 1, Recapitulation.) $ —0— If more space is needed, use additional sheets of paper of the same size. REV-1803 EX+(6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Jessie G. Carroll 21 -14-0053 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' NONE -0- TOTAL(Also enter on line 2, Recapitulation) $ —0— (If more space is needed,insert additional sheets of the same size) REV-1504 EX+(1-97) SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN RESIDENT DECEDENT SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Jessie G. Carroll 21 -14-0053 Schedule C-1 or C-2(including all supporting information)must be attached for each closely-held corporation/partnership interest of the decedent,other than a sole-proprietorship.See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. NONE -0- TOTAL(Also enter on line 3, Recapitulation) $ —0— (If more space is needed,insert additional sheets of the same size) REV-1,1ko7 EX+(1-97) b SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Jessie G. Carroll 21 -14-0053 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �. NONE —0- -0- TOTAL(Also enter on line 4, Recapitulation) $ (If more space is needed,insert additional sheets of the same size) REV-15o8 EX+(ii-io) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jessie G. Carroll 21 -14-0053 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 1 . Checking account at Members 1st Federal Credit Union $1 ,883. 03 2. Savings account at Members 1st Federal Credit Union 4, 884. 36 3. Promissory Note, #1003656, at Heritage Investment 5, 574. 35 Services Fund. 4. Promissory Note, #1005622, at Heritage Investment 4, 455. 30 Services Fund. 5. Promissory Note, #1006326, at Heritage Investment 4, 120. 62 Services Fund. 6. Promissory Note, #1007200, at Heritage Investment 3, 421 .91 Services Fund. 7. Promissory Note, #1008955, at Heritage Investment 2,410. 48 Services Fund. TOTAL(Also enter on Line 5, Recapitulation) $ 26, 750 .05 If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+(o1-1o) pennsylvania , SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jessie G. Carroll 21 -14-0053 If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH. DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. NONE TOTAL(Also enter on Line 6, Recapitulation) $ —0— If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-06) ` SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jessie G. Carroll 21 -14-0053 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Parthemore Funeral Home — Funeral $1 , 051 . 24 Gingrich Memorials - Gravestone 175. 00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid: 2. Attorney Fees Anthony L. DeLuca, Esquire 1 , 000. 00 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 90. 00 5. Accountant's Fees 400.00 6. Tax Return Preparer's Fees 7. Legal Advertising - Cumberland Law Journal 75. 00 8. Legal ADvertising - The Sentinel 250.00 TOTAL(Also enter on line 9, Recapitulation) $. 3, 0 41 .2 4 (If more space is needed,insert additional sheets of the same size) REV-15-12 EX+ (12-08) i pennsytvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jessie G. Carroll 21 -14-0053 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. Church of God Home - Kursing Home $1 ,870.25 2. Carlisle Regional Medical Center - Medical 50. 05 3. Klingler and Associates - Taxes 190. 00 l4. TOTAL(Also enter on Line 10, Recapitulation) $ 2, 110. 30 If more space is needed,insert additional sheets of the same size. LAST WILL AND TESTAMENT OF :JESSIE G. CARReLL - n m c> �- Cv M -" c5 v, o x r r m I, JESSIE G. CARROLL, of the Township o.'--ai-,tvij C) <� _ County of York and State of Pennsylvania, being of<�amnd and rn disposing mind, memory and understanding, do make, ;Publishrz'�ne .ten declare this my Last Will and Testament, hereby revoking and making void all former Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon as conveniently may be after my decease. 2. All the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my husband, JOSEPH CARROLL, absolutely and in fee simple. 3. In the. event my husband should predecease me or die within thirty (30) days of my death, then I give, devise and bequeath my entire estate, in- equal shares, to my children. 4. LASTLY., I nominate, constitute and appoint my husband, JOSEPH CARROLL, to be the Executor of this, my Last Will and Testament, and in the event he should predecease me or for any other.reason be unwilling or unable to act as such Executor, I nominate, constitute and appoint my daughter, JOAN E. WONDERS, to be the Executrix in his place. and stead; and if she should also predecease me or for any other .reason is unable or unwilling to .serve as such, I nominate, constitute and ap- point my son, STEPHEN J. CARROLL, to be the Executor in her place and stead. IN WITNESS WHEREOF, I have .hereunto set my hand and seal this ! day of August, A. D. 1985. (SEAL) ,'Jess.ie uCarrol Signed, sealed, publi.she.d and .declared by the ablve-named JESSI.E G. CARROLL, as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence, and in the presence of each other, have hereunto subscribed our names as witnesses, r % i -2- REV-1500 EX Wage 3 File Number 21 -14-0053 Decedent's Complete Address: DECEDENT'S NAME Jessie G. Carroll STREETADDRESS 801 North Hanover Street CITY STATE 21P Carlisle PA 170133 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1). $971 .9F� 3 2. Credits/Payments A.Prior Payments —0— B. 0— B.Discount —0— Total 0— Total Credits(A+B) (2) —0- 3. 0- 3. Interest F 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) $971 . 93 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;.... ................................................................................. ❑ EN b. retain the right to designate who shall use the property transferred or its income;............................................ ❑ c. retain a reversionary interest;or.......................................................................................................................... 1-1d. 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?.............................................................................................................. ❑ Ex 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. 4. Did decedent own an individual retirement account,annuity or other non,probate property,which containsa 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 benefisiary., 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(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 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. 3 i « i Y, 1 ri V