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Home My WebLink About12-29-14 1505610105 REV-1500 EX(02-11)(FI) � OFFICIAL USE ONLY PA Department of Revenue pennsylvama oerurtnemm a�nmie County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN — ' 1. i PO BOX rg,PA 1 1 i I (_"] i Harrisburg,PA 1128-o6oi RESIDENT DECEDENT 7 I 3 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Decedent's Last Name _ _ Suffix Decedent's First Name MI (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 p 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.Limited Estate O 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust _ - B. 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 Number P/7` 9/7. 3 '74 0 1 REGISTER OF WILLS USE ONLY ras C13 -3 First Line of Address Second Line of Address City or Post Office State ZIP Code DAT 149-7 Correspondent's e-mail address: ,s 4/• LIS II')e55 49 c moi/ 'Li[ ' C_ttyn.�'' CZ) Under penalties of pedury,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. SIGNATURE OF PERSON RESPE FOR FI G ETU DATE ADDRESSZ5_0,0 0D LJ" 77W -17 2— l" F4Y�4 A /2/2-Y _ 7/,/,0-/ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: 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. I 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. i 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. 11. Total Deductions(total Lines 9 and 10)........... I 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 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. TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 I -- __ . _1 _ .-_• - -�_--- (a)(1.2)X.0_ i 16. Amount of Line 14 taxable at lineal rate X.0 i 16. 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable - ---_ at collateral rate X.15 I 18. 19. TAX DUE......................................................... 19.L _... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME a1v P. STREET ADDRESS �— CITYSTATE ZIP/70/ �eL/sem- / d/3 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) 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?.............. ❑ 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 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. BUREAaU OF INDIVIDUAL TAXESPenns Ivania Inheritance Tax pennsylvania PO BOX 280601 Y HARRISBURG PA 17128-0601 Information NoticeDEPARTMENT OF REVENUE ' REV-1543 EX DocEXEL(06.12) And Taxpayer Response FILE NO ACN 13164883 DATE 11-28-2013 Type of Account Estate of WARREN P WHITE Savings SSN Checking Date of Death 10-25-2013 Trust JONATHAN S WHITE County CUMBERLAND Certificate 210 TAUNTON DR CARLISLE PA 17013-4702 n M M.c) 3r , _ 6'> a M -p C —1 —� s 73a p. r ry rr► rM quo 3 ry r rn r-- -v cn un c> ORRSTOWN BANK provided the department with the information below indicating Mat at the loath of th-Z above-named decedent you were a joint owner or beneficiary of the account identified. Account No.706002419 Remit Payment and Forms to: Date Established 06-18-2007 REGISTER OF WILLS Account Balance $5,031.10 1 COURTHOUSE SQUARE Percent Taxable X 50 CARLISLE PA 17013 Amount Subject to Tax $2,515.55 Tax Rate X 0.150 Potential Tax Due $ 0.150 NOTE*: If tax payments are made within three months of the decedent's date of death,deduct a 5 percent discount on the tax With 5%Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months after the date of death. PART Step 1 : Please check the appropriate boxes below. 1 A F-1 No tax is due. I am the spouse of the deceased or l am the parent of a decedent who was 21 years old or younger at date of death. Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount shown above as PntAntial Tax Due. em r�r anon is ea ove in ormisa ion correct,no deductions are being taken,and payment will be sent correct. with my response. Proceed to Step 2 on reverse. Do not check any other boxes. CThe tax rate is incorrect. 4.5% 1 am a lineal beneficiary(parent,child,grandchild, etc.)of the deceased. (Select correct tax rate at right,and complete Part F—] 12% 1 am a sibling of the deceased. 3 on reverse.) 15% All other relationships(including none). D F,—]Changes or deductions The information above is incorrect and/or debts and deductions were paid. listed. Complete Part 2 and part 3 as appropriate on the back of this form. E F�Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax inheritance tax form Return filed by the estate representative. REV-1500. Proceed to Step 2 on reverse. Do not check any other boxes. Please sign and date the back of the form when finished. A 1 PART 2 Debts and Deductions Allowable debts and deductions must meet both of the following criteria: A. The decedent was legally responsible for payment,and the estate is insufficient to pay the deductible items. B. You paid the debts after the death of the decedent and can furnish proof of payment if requested by the department. (If additional space is required,you may attach 81/2"x 11"sheets of paper.) Date Paid Payee Description Amount Paid Total Enter on Line 5 of Tax Calculation $ PART Tax Calculation s 3 if you are making a correction to the establishment date(Line 1)account balance(Line 2),or percent taxable(Line 3), please obtain a written correction from the financial institution and attach it to this form. 1. Enter the date the account was established or titled as it existed at the date of death. 2. Enter the total balance of the account including any interest accrued at the date of death. 3. Enter the percentage of the account that is taxable to you. a. First,determine the percentage owned by the decedent. i. Accounts that are held"intrust for'another or others were 100%owned by the decedent. ii. For joint accounts established more than one year prior to the date of death,the percentage taxable is 100%divided by the total number of owners including the decedent. (For example:2 owners=50%,3 owners=33.33%,4 owners =25%,etc.) b. Next,divide the decedent's percentage owned by the number of surviving owners or beneficiaries. 4. The amount subject to tax is determined by multiplying the account balance by the percent taxable. 5. Enter the total of any debts and deductions claimed from Part 2. 6. The amount taxable is determined by subtracting the debts and deductions from the amount subject4o tax. 7. Enter the appropriate tax rate from Step 1 based on your relationship to the decedent. If indicating a different tax rate,please state your relationship to the decedent: -San / 1. Date Established 1 07 2. Account Balance 2 $ X03/•/ 3. Percent Taxable 3 X 3J- 3J ��' 4. Amount Subject to Tax 4 $ /6 76,-oP7 5. Debts and Deductions 5 f�1 6. Amount Taxable 6 $ 1676-e7 7. Tax Rate 7 X J plc 8. Tax Due 8 $ /S-- 9. 9. With 5%Discount(Tax x.95) 9 X 74 k Step 2: Sign and date below. Return TWO completed and signed copies to the Register of Wills listed on the front of this form, along with a check for any payment you are making. Checks must be made payable to"Register of Wills,Agent:' Do not send payment directly to the Department of Revenue. Under penalty of perjury, I declare that the facts I have reported above are true,correct and complete to the best of my knowledge and belief. Work Home /7-g/7_37 (,d Ta ayer Signature Telephone Number Date IF YOU NEED FURTHER ASSISTANCE, CONTACT PENNSYLVANIA DEPARTMENT OF REVENUE DISTRICT OFFICE, OR THE INHERITANCE TAX DIVISION AT 717-787-8327. SERVICES FOR TAXPAYERS WITH SPECIAL HEARING AND/OR SPEAKING NEEDS ONLY: 1-800-447-3020 RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ. Receipt Date : 12/29/2014 Cumberland County - Register Of Wills Receipt Time : 12 : 37 : 59 One Courthouse Square Receipt No. : 1080014 Carlisle, PA 17013 WHITE WARREN P Estate File No. : 2014-00067 Paid By Remarks : JONATHON S WHITE DB1 ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 187 $15 . 00 Total Received. . . . . . . . . $15 . 00 ' o � Q ki ru— a �. p r*: w , i •^yY sasses goo 1n�nowiV V1 IN 330 4$b9� YI'HlVOGlV ,1� 30 VISOd*s,n A