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Home My WebLink About01-27-15 (4) pennsytvama 1505614105 �f°` EX(03-14)(FI) REV-1500 500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO Box 280601 INHERITANCE TAX RETURN [St n( U Harrisburg, PA 17128-0601 RESIDENT DECEDENT �� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY [04162008 01301922 Decedent's Last Name Suffix Decedent's First Name Ml WILSON MRS KEMA ❑ (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI WILSON MR RICHARD Y� ❑F THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C=:) 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) C=:) 4.Agriculture Exemption(date of p 5.Future Interest Compromise(date of O 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) QD 7.Decedent Died Testate Q 8.Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) O 10. Litigation Proceeds Received O 11.Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets O 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DONALD L. SUTHERLEN J 1(717)766-3585 First Line of Address 1409 FROST RD. Second Line of Address 1 City or Post Office State ZIP Code MECHANICSBURG PA 17055 Correspondent's email address: SUtherleft@msn.com REGISTER OF tNILLS USE ONLY REGISTER OF WILLS USE ONLY j"I DATE FILED MMDDYYYY 1711 LJ_jIi- C d IIAT"LE©STA t�3 -, r-- f-1 C:) -71 PLEASE USE ORIGINAL FORM ONLY Side 1 w rn L 4 1505614105 J �U-1 1505614205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: LEMA WILSON RECAPITULATION 1. Real Estate(Schedule A). ............................................ 1. 2. Stocks and Bonds(Schedule B) ....................................... 2. 3. Closely Held Corporation,Partnership or Sole4%prietorship(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) Ob Separate Billing Requested ....... 6. 23,750.00 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. 23,750.00 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9.1 12,957.69 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 11. Total Deductions(total Lines 9 and 10)................................. 11. 12,957.69 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 10,792.31 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. 10,792.31 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 10,792.31 (a)(1.2)X.0_ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X.0- 16. 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. 0.00 20. 'FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perl'ury,I declare 1 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 person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNATUW OF PERSON RESPOOI�ISIBLE FQR FIL1 G/ETUR DATE c 01/22/2015 ADDRESS SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILIN E RETURN DATE 01/22/2015 ADDRESS Side 2 J 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME LEMA WILSON STREETADDRESS 1409 FROST RD. CITY STATE 717055 MECHANICSBURG PA Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A,Prior Payments 0.00 B.Discount 0.00 (See instructions.) Total Credits(A+B) (2) 0.00 3. Interest (3) 0.00 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) 0.00 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 .......................................................................................... ❑ N b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ E 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? ........................................................................................................................ ❑ 0 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 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 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 decedenfs 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-i$og EX+(oi-io) pennsylvania SCHEDULE F DEPARTMENT RTMFOFRETURN JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: LEMA WILSON 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•RICHARD F.WILSON 1409 FROST RD. MECHANICSBURG,PA 17055 SPOUSE B. C. JOINTLY OWNED PROPERTY: LEITER 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 DECEDENTS INTEREST 1. A. 12101107 Americhoioe FCU Acoount No.41999 47,500.00 50 23,750.00 TOTAL(Also enter on Line 6, Recapitulation) $ 23,750.00 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT'DECEDENT ESTATE OF FILE NUMBER Lema Wilson Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Chandler-Hays Funeral Home 11,857.69 Eitels Flowers 475.00 Holiday Express(out of state lodging) 625.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 2. Attorney Fees: 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: S. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 12,957.69 If more space is needed,use additional sheets of paper of the same size. �v Glv(r `r-v - 5445. FUNERALPURCHASECONTRACT dt f eS 7, (STATEMENT OFFUNERAL GOODS AND SERVICES SELECTED) r (Charges are only for those Items that you selected or that are required.If we are required by law CHANDLER-HAYS FUNERAL HOME or by a cemetery or crematory to use any Items, we will explain the reasons in writing below.) 4 N.Percy Julian Drive No. A OUR SERVICE: GREENCASTLE,IN.46135 2 ( ) Phone(765)655-2356 Date r•:-2,L} o BASIC SERVICES OF FUNERAL DIRECTOR&STAFF ..... $ V d a EMBALMING....................................... $ Full name of deceased e,.l lit 1A,(/,iV1+` Age Z4 — o z w N you selected a funeral that may require embalming, (Please PRINT Name) d w z such as a funeral with viewing,you may have to pay for (. * p arranging services. LL:0 embalming.You do not have to pay for embalming you did Date of Death Al-1G-Glj Deceased is of arson arran in not approve If you selected arrangements such as a direct (Give( )Forward a a cremation or Immediate burial.N we charged for embalm- (B) CASH ADVANCE ITEMS Total(A)Forward $ �f Z C�•,�L' z u O Ing,we will explain why below. O a a We charge you for our services in obtaining: Q � REASON FOR EMBALMING: $ 3-1 '- 0 o Sales Tax ...................................... OTHER PREPARATION OFTHEBODY .................. $ 4-1 Cemetery Charges ..40.'426>........................ $ 'yAo".0 USE OF FACILITIES,STAFF&EQUIPMENT: \ Vault Delivery ....................................... $ 24460 Funeral Ceremony(Conducted at Funeral Home) ..........)$ Clergy Honorarium ................................... $ 4.••N Visitation/Viewing(conducted at Funeral Home)........... $ Organist Honorarium.................................. $ FA Irl Memorial Service(Conducted at Funeral Home) ............ $ Certified Copies of Death...fele.12).1................... $ 72.00 ......... $ $ Jow f7 Hairdresser/Barber.................................. $ .5.¢60 USE USE OF STAFF AND EQUIPMENT: Flowers&Tax....................................... $ Funeral Ceremony(Conducted at another facility) .......... $ e fl"-frrL 0b,'4 ....... $ Sr0.00 Visitation/Viewing (Conducted at another facility) ......... $ /p]A��ul J E•t ....... $ 'G• Memorial Service( Conducted at another facility)........... $ ,Af�$ go Q ....... $ Graveside Service ...... ........ ................. $ x" ....... $ ......... $ Total(B) $ L1t ar!,Q$-LLL'-, L'-, $ (C) OTHERITEMS: Total(A)&(B) C'iL nit Vrr�� LiiYY'eN�^ $ TRANSFER OF REMAINS TO FUNERAL HOME............ $ ( Miles Transported) Total(C) $ $ AUTOMOTIVE EQUIPMENT: Total(A)(B)&(C) Casket Coach(Hearse) .. ......................... $ r Family Car............. ......................... $ LESS: Preneed Adjustment/Allowance❑INS❑TR $( ) Utility Vehicle .......... ......................... $ Payment/Date( ) $( ) ......... $ Other(Specify) $( ) CASKET .=i Nr: 4,4Urte/ P}i�ti'1 ......... BALANCE$ LEGAL,CEMETERY, CREMATORY OR,�.OTHER REQUIREMENTS COMPELLING THE PURCHASE OF ANY ITEMS LISTEDABOVE: felon 7944 XJ 4� t,rte•'` O4>ra:�f ea-4N,^�E 1e - OUTER BURIAL CONTAINER(As Selected) $ I '17t�ti= The undersigned purchaser(s)hereby aftesfto the following:(1)1/We did( /,-1 did not( )authorize embalming of the i• UC(t r c z "r,.k! above named deceased.(2)I/We were shown a Casket Price List and an Outer Burial Container Price List before the showing of caskets and outer burial containers.(3)I/We were giventoffered for retention a General Price List upon the beginning of MISCELLANEOUS MERCHANDISE: a discussion of funeral arrangements and/or selection of services and merchandise. Acknowledgment Cards ........................... $ TERMS:This is a CASH TRANSACTION,due in full y ;,t)-nom and,in all events,becomes - PAST DUE AND DELINQUENT upon expiration of due date. A charge of 1-1/2% per month - 18% per year for Visitors Register................................. $ $ <�� +(.' UNANTICIPATED LATE PAYMENT will be charged effective S 23 .Purchaser(s) Memorial Package $ /1 .LSD agrees to pay reasonable attorney's fees,court costs and other costs of collection if incurred in the collection of this debt. I,or we,having read the above,accept and approve same,and jointly and severally promise to make full payment therefor. ......... $ Receipt of a copy of this contract is acknowledged. MR. ......... $ MRSA?.; Receptacle(other than casket) $ MIS lzw'f Signature of Purchaser(s) StreelAddress Wearing Apparel $ $ S.S.No. City State Zip Code FORWARDING OF REMAINS TO ANOTHER FUNERAL HOME................... $ Signature of Purchaser(s) StreetAddress CityandState Zip Code CRMN RECEIVING OF REMAINS FROM ANOTHER FUNERAL HOME................... $ E] DIRECT CREMATION(As Selected $ Signature of a andf furnish SlreetAddress Cityand State ZipCode We agree to render the service and furnish the IMMEDIATE BURIAL(As Selected) ....................................... $ merchandise indicated above. t E Total(A) $ i' �`) Chandler-Hays Funeral Home By -.