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HomeMy WebLinkAbout01-27-15 REV-1500 EX 10"011505610140 OFFICIAL USE ONLY Department of Revenue Bu CountyCode Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO Box 2806D1 Harrisburg,PA 17128-0601 RESIDENT DECEDENT 2 1 1 3 0 3 2 ? ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYM Date of Birth MMDDYYYY 1 2 2 6 2 0 1 3 1 0 1 0 1 9 3 3 Decedent's Last Name Suffix Decedent's First Name MI N 0 L L M A R Y 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 0 1.Original Return 0 2.Supplemental Return 3.Remainder Return(date of death prior to 12-13-82) 4.Limited Estate 4a.Future Interest Compromise(date of ❑ 5.Federal Estate Tax Return Required death after 12-12-82) © 6.Decedent Died Testate 7.Decedent Maintained a Living Trust _,. 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9.Litigation Proceeds Received 10.Spousal Poverty Credit(date of death n 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 Daytime Telephone Number DOUGLAS G MILLER 717n249 ' 3 � a G M C-> REGISIO 9F tNiLLS LIS ONL t 1 C) y First line of address j••- - r n —j I R W I N & M c K N I G H T P - C F ' '" -- , Second line of address N� -� :=, R� � . 'M 6 0 W E S T P 0 M F R E T S T R E E T ` r City or Post Office State ZIP Code DATE FILED C A R L I S L E P A 1 7 0 1 3 Correspondents e-mail address: Under penalties of perjury,I declare that I have e4amined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is t5A correct and complete.De tion f p rer other than the personal representative is based on all information of which preparer has any knowledge. T E OF P N RESP N BLE O ILIN RETUr Q TE AD ESS 2 VISTA CIRCLE LEMOYNE PA 17043 SIGNWf E Of,TYjAF P EPA O ER N REPRESENTATIVE DATE ADDR 60 WEST POMFRET STREET CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX Decedents Social Security Number Decedent's Name: M A R Y E• N 0 L L RECAPITULATION 1. Real Estate(Schedule A) ... ...... ....... . .. . . .. . . . .... ... . . ........ 1, 2 7 5 0 0 . 0 0 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) ❑ Separate Billing Requested 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . ... . 7. 8. Total Gross Assets(total Lines I through 7) .... .................. ... 8. 2 7 5 0 0 . 0 0 9. Funeral Expenses and Administrative Costs(Schedule H) ... . .... . . ... .. ... 9• 6 6 5 . 0 0 10, Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. .. . .. ... ... 10. 11. Total Deductions(total Lines 9 and 10) ..... .... ... ... ... . . ..... ... ... 11, 6 6 5. 0 0 12. Not Value of Estate(Line 8 minus Line 11) ......... ... .. .. . . . .. ...... . 12. 2 6 8 3 5 . 0 0 13. Charitable and Governmental BequeststSec 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. 2 6 8 3 5 . 0 0 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 _ 0 . 0 11 is. 0 . a 11 16, Amount of Line 14 taxable at lineal rate X-045 2 6 8 3 5 . 0 0 16. 1 2 0 7. 5 8 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 11 0 18. Amount of Line 14 taxable at collateral rate X.15 11 . 0 11 18. 11. G 11 19. TAX DUE ... .. .. ... .. . .. .. .. .. ..... ...... .... .... . .. ........ 19. 1 2 0 7 • 5 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 13 0327 DECEDENT'S NAME MARY E. NOLL STREET ADDRESS 100 CHESTER STREET CITY STATE 7JP CARLISLE PA 117013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,207.58 2. Credits/Payments A.Prior Payments B.Discount 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) 0.00 5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,207.58 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; ....................... .............................................. ❑ IZI b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ 0 c. retain a reversionary interest;or ............................................................................. .................. 171 FX1 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑ IZI 2. If death occurred after December 12,1982,did decedent transfer property within one year of death X1 without receiving adequate consideration? ....................................................................................... ❑ F 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... 171 EK 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?............. .................................................................................... 0 191 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)(11.11)(1)], 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 decedents 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 decedents 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-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARY E. NOLL 21 13 0327 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. LOT#73, ESTHER DRIVE, CARLISLE, PENNSYLVANIA 27,500.00 TOTAL(Also enter on Line 1,Recapitulation.) $ 27,500.00 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY E. NOLL 21 13 0327 Decedent's debts must be reported on Schedule Y. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, B. ADMINISTRATIVE COSTS: 1. Persona(Representative Commissions: Name(s)of Personal Representatives) Street Address City State ZIP Years)Commission Paid: 2. Attorney Fees. IRWIN&McKNIGHT, P.C. 400.00 3, Family Exemption:(If decedents address is not the same as claimants,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. REGISTER OF WILLS-FILING FEE 15.00 8. REGISTER OF WILLS-ADDITIONAL PROBATE FEE 250.00 TOTAL(Also enter on Line 9,Recapitulation) $ 665.00 If more space is needed,use additional sheets of paper of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MARY E. NOLL 21 13 0327 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec.9116(a)(1.2)J 1 TRICIA FRAMPTON Lineal 467 CROSSROADS SCHOOL ROAD CARLISLE, PA 2. NICHOLAS GILBERT Lineal 202 STEELSTOWN ROAD NEWVILLE, PA 17241 3. SUSAN J. SHERMAN Lineal 18,784.50 2 VISTA CIRCLE 70% REMAINDER LEMOYNE, PA 17043 4. JODY L. GILBERT Lineal 8,050.50 26 CHESTNUT STREET 30% REMAINDER NEWVILLE, PA 17241 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART I[[-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. toms Nuo-1(3/86)ret Handbook 0305.2 A. Settlement Statement U.S.Department of Housing and Urban Development "'Ing of Loan OMB Approval No.25w-w s 1. ❑FHA 2. ❑FmHA 3. ❑Conv.Unins. 6.File Number 7.Loan Number 8.Mortgage insurance Case Number 04 This form Is fumished to give you a statemam of actual settlement Costs.Amounts paid to and by the statementasariere shown. C.Note: Items marked•(pa.e.)•vAre pall outside the tlosingg;they are shown here for Information purposes and are not included In the totals. 11 C. Settlement System WARNING:h Is a pine to knowingly make false statanenls to the United Shales do this wan omersim0erform.Permutes upon 1112 D.NAME OF BORROWER James R Wilson and Yanna M.Wilson E.NAME OF SELLER The Estate of Mary E.Noll ADDRESS- F.NAME OF LENDER: N/A ADDRESS- G.PROPERTY ADDREss: Lot#73 Esther Drive,Carlisle,PA 17013 North iddleton lowvwft H.sErmEMENT AGENT: PA Real Estate Settlement Services,LLC,Telephone:717-249-6333 Fax:717-249-7334 54 AlexanderCarlisle. 17015 1.SETTLEMENT DATE- 09/16/2014 J SUMMARY OF BORROWERS TRANSACTION: SUMMARY OF SELLER'S TRANSACTION: 100- GROSS AMOUNT DUE FROM BORROWER 400, GROSS OUNT DUE TO SELLER Jai- Contract eaten prfe- 27 500.00 27 500.00 103 Settlement chamas to bummer(firm 140111 1,149.00 ind 404 ins, 405- Adjustments for items paid by seller n advance Adjustments for items Bald tLy seller n advance 107- County taxes 09 16 14 12 31 14 48.93 09 16 14 12 31 14 48.93 ID& School taxes 09 16 14 06 30 15 330.02 09 16 lA 06 30 15 330.02 Ing 409- 110, 41n- 111- 411, 112 412- 29 027.95 420, GROSS AMOUNT DUE To SELLER 27 878.95 200, AMOUNTS PAID 13Y OR ON BEHALF OF BORROWER S IN AMOUNT DUE TO RFLLFR 201rJougulit or earnest mona)e 2,000.00 202- PrIndRaI amount of new loami 502 Settlement chalges to-thir(firm 1400) 3,580.00 203- Existing loan(a)taken sublact to Son Exi,tin,foam(n)taken subject to 201 Anr 207- 507- Inheritance Tax Eecnaw, 4,125.00 209, 1 Adjustments for Items unpaid by sell rr Adjustments for items u paid by sell 211- CountIf taxem 511 Count(taxes 212, School taxes 512- School taxes 21d Sid 219 216- S16- 217 517- 219, 410 220, TOTAL PAID BWFOR 13ORROWER 2,000.00 520, TOTAL REDUCTION AMOUNT DUF SFLLFR 7,705.00 300, CASH AT SETTLEMENT FROM OR TO BORR IWER 600- CASH AT SETTLEMENT TO OR FROM SELLEI —= Gross amount dtm flown harro"r flin,12111 29 027.95 Sol. nines amcmt duo to seller flirm 42m 27 878.95 2,000.00 7,705.00 303, CASH FROM BORROWER 27 027.95 603, CASH TO SELLER 20 173.95 SUBSTITUTE FORM 1099 SELLER STATEMENT:The Information contained herein t9 Important tan Information and is being furnished to the Internal Remus SeMee.if you arerequbed to file a ratum, a neg0 enee penalty or other sanction will be imposed on you if this item is required to be reported and Ore IRS determines that It has not been reported.The Contract Sales Price described on line Ogi above cansfiNtes the Gross Proceeds of ft transaction. numbare r required by low to protide the settlement spent Ted.Tax ID No: wIN yow Correct taxpayer Identification number.If you do not provide your correct taxpayer Identification you may be subject to dull or criminal pens ties mposed by taw. n er pane es perjury,l pertify Nel the number shown on this statement Is my correct taxpayer Identification number. TIN: / SELLER(S)SIGNATURE(S): ) SELLER(S)NEW MAILING ADDRESS: SELLER(S)PHONE NUMBERS: (H) (W) PromouS adtbans are obsolete - reds-,tae.)...... 0e wua.e U.S.DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number.2014191 PAGE 2 OTTLEMENT STATEMENT I!. SETTLEMENT CHARGES PAID FROM PAID FROM 700,TOTAL SALES/13ROKERS COMMISSION based on arlee,$27,500.00 co 3,295.00 BORROWER'S SELLER'S Division of commission fling 700)as follows- FUNDS AT FUNDS AT SETTLEMENT SETTLEMENT 3,295.00 to Berkshire Hathaway BomeServices 703, Commission cald at Settlement 3.295.00 704- Rrokar Fee to Berkshire Hathaway BomeServices 295.00 800,IJEMS PAYABLE IN EC 901 Loan Orfnination Fee 809 Mortgage Application Fen 908 AID- all 900. ITEMS REQUIRED BY LENDER TO BE PAID IN AD-VANCE gnlInterest From Id,y 9Q2- Modgage Insurance Premium for t. --WHamrd Inturanca Premium for in 905, 1000.RESERVES DEPOSITED WITH LENDER FOR 1002 Morboaag Insurance mo-as /me 1005-School taxes me.03 1009Aggregate AnaWls Adlustrmant 0.00 0.00 1100.TITLE CHARGES 1101 Settlement or rinnlnn fee 1102 Abstract or fille,Aparch 1103 TiffeexamInatinn 11(16- Nota[y Feet 1107-Attgme)e,fees 1109 Title Insu-n— to Stewart Title Guaranty/PA RE SS 500.00 (Includes above Iterng No: 1109,Landges Policy 1110Owner's Policy 27 500.00 — 500.00 1113 1200.GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. RecordIna Fees need Z 79.00 79.00 275.00 M.dg.op S 275.00 1203State Taxistarnns need 275.00 marbutaft S 275.00 1204, 1300,ADDITIONAL SETTLEMENT CHARGES 1301-Tax Certification Raimb- to Salzmann Hughes, P.C. 10.00 CHARGES (enter on lines I OR Section J and S02-Section K) 1,149.001 3,580.00 HUD CERTIFICATION OF BUYER AND SELLER I carefully taut the HUD-14t. andtoNe bastofmyl mowtedge end belief.It Is a true and accurate statement ofall receipts end disbursements made on my account or by me ILstransadlon.Ioartllyth copy of the HUD-1 SetllemeM Statement. mes R.Wilson 7"', Wllson The teatA...4 C.• WARNING:R IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE The 0.1 Seto nlamen rh I have prepared Is a We and accurate account of this transection. UNITED STATES ON THIS OR ANY SIMILAR FORM.PENALTIES UPON CONVICTION 1 ve caused w1II use the s to be disbursed in accordance with this statement CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE IS: U.S.CODE SECTION 1001 AND SECTION 1010.