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Home My WebLink About01-15-15 J `:pennsylvania 15 0 5 61410 5 oEPnrtrnEnroFaEVEnuE EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO Box 280601 INHERITANCE TAX RETURN i) ' (� �� Harrisburg, PA 17128-0601 RESIDENT DECEDENT /�1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 204-03-4156 08042010 10111919 DecedenYs Last Name Suffix DecedenYs First Name MI SIEG MARTHA L (If Appiicable)Enter Surviving Spouse's information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW p 1. Original Return � 2. Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) p 4.Agricuiture Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) p 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets � 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Ronald P Sieg, Executor (717) 564-1808 First Line of Address 3737 Sharon Street Second Line of Address City or Post Office State ZIP Code Harrisburg PA 17111 � �� r� c� CorrespondenYs emaii address: rpsieg@verizon.net � d � �� C"> C.7 —p `�' t;:+ � REGISTEf� M1L S-USE LY ,;-� �^+'i !� 4 ►� .. ,,_ :.,. c_,,i �„rt .;,a �a REGISTER OF WILLS USE ONLY ' � ,� f::? DATE FILED MMDDYYYY . • . • __�� ;ti —r� �� t�'� � '_'7 —,�a _,,.� C"� � �:m.. N {" �'1 ,.� � '"ti �-� G7 DATE�F'fLED STAMP F"'� PLEASE USE ORIGINAL FORM ONLY Side 1 � i iiiiii iiiii iiiii i�ii��iii iii�iiiii i��iiiii iiiii iiii ii�i J 56 41 1505614105 n ;' � 1505614205 REV-1500 EX(FI) DecedenYs Social Security Number Decedent's Name: 204-03-4156 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. Mort a es and Notes Receivable Schedule D 4. 21,189.24 9 9 ( ) .... ......... .... .. ........ 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). .... . . 5. 789.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. ..... 6. 7. Inter-�vos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... .. . 7. 8. Total Gross Assets total Lines 1 throu h 7 8. 21,978.24 ( 9 ).. ... .... .... .... . .... .. ... .. 9. Funeral Expenses and Administrative Costs(Schedule H)... ............ .. .. 9. 134.69 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)....... .. .... .. 10. 11. Total Deductions(total Lines 9 and 10). ... ...... .. .. ... .............. .. 11. 134.69 12. Net Value of Estate(Line 8 minus Line 11) ..... .. .. ...... . ........... ... 12. 21,843.55 13. Charitable and Governmentai 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 (a)(1.2)X.0_ 15. 16. Amount of Line 14 taxable at linea�rate x.0 45 21,843.55 �g. 982.96 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. 19. TAX DUE . ....... ....... .................... ... ....... ......... .. . 19. 982.96 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and beliet, it is true, correct and complete. Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE F R FILING RETURN DATE R.�.�z.� :�, � ��.,,.- � I �� I r�-' �- ADDRESS �� J �Q�t�� S�, �.� a� r � �_u�- a : P {� `� , �1 SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS � i iiiiii iiiii iiiii i��ii��i�i�i�i�i�iiiii iiiii iiii iiii Side 2 J 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME MARTHA L. SIEG STREETADDRESS CITY STATE ZIP Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 982.96 2. Credits/Payments A.Pnor Payments _ B.Discount (See instructions.) Total Credits(A+B) (2) 0.00 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) 982.96 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 properry 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 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 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 child 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a step-parent 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 decedenYs 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 decedenYs 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-1507 EX+ (04-13) � pennsylvania SCHEDULE D DEPARTMENT OF REVENUE MORTGAGES & NOTES INHERITANCE TAX REfURN RECEIVABLE RESIDEM DECEDENT ESTATE OF FILE NUMBER MARTHA L SIEG 2010-00836 All property jointiy owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH � Final re-payment of investment note(Account 3500893270)of Advanta Corp.after bankruprcy. I 21,189.24 Payment was received 12/13/14. I I I I I I ( ( I I I I I I I I TOTAL(Also enter on Line 4,Recapitulation) $ 21,189.24 (If more space is needed,insert additional sheets of the same size.) REV-15o8 EX+(08-12) � pennsylvania SCNEDt�LE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARTHA L SIEG 2010-00836 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. Refund of an old insurance policy from Prudential Insurance(Contract DIP350616)Received 1012812014. 789.00 We were not previously aware of this policy. TOTAL(Also enter on Line 5, Recapitulation) $ 789.00 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+ (08-13) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARTHA L SIEG 2010-00836 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: Z. Attorney Fees: 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: �• Executors direct out of pocket expenses for travel,postage,etc. 134.69 TOTAL(Also enter on Line 9, Recapitulation) $ 134.69 If more space is needed,use additional sheets of paper of the same size. n � � \ � �