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Home My WebLink About01-23-15 (2) r t 1505610143 REV-1500 Ex(02-11) '*+y+f 1'�t , OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOx.280601 INHERITANCE TAX RETURN 21 15 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 12 11 2014 11 23 1928 Decedent's Last Name Suffix Decedent's First Name MI WEST ZELLARS C (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 X❑ 1. Original Return ❑ 2. Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a.Future Interest Compromise ❑ 5. Federal Estate Tax Return Required (date of death after 12-12-82) X❑ 8 Decedent Died Testate ❑ 7• DecedentMaintained a Living Trust 8. Total Number of Safe De osit Boxes (Attach Copy of Will) Copy of Trust) p 9. Litigation Proceeds Received 10. Spousal PovertyV Credit Date of Death ❑ 11.Election to tax under Sec.9113(A) ❑ between 12-31. 1 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 EDWARD P SEEBER 717 533 3280 �v -P• GIST Q5E ONLY H v 46. C-- rr?, =3 _ First Line of Address f7 r..n SUITE C400 -„ = rpt W r Second Line of Address -71 555 GETTYSBURG PIKE - ) - 6-"TE FIL City or Post Office State ZIP Code MECHANICSBURG PA 17055 Correspondent's e-mail address: epspjsdc.com 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. SIGNATURE FERSO ESPONSI L OR FILING RETURN / DATE Todd West ADDRESS J 1207 H' h HOROW, Mechanicsburg, PA 17050 SIGNATU OF PREPA ER THER THAN REPRESENTATIVE DATE_ Edward P Seeber i j ti ADDR Suite C-400, 555 Gettysburg Pike, Mechanicsburg, PA 17055 Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX 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&Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 24 . 75 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 27 , 162 . 38 7. Inter-Vivos Transfers&Miscellaneous N Probate Property (Schedule G) �J Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8, 27 , 187 . 13 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 13 , 351 . 45 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11, Total Deductions(total Lines 9 and 10)................................................................ 11. 13 ,351 . 45 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 13 , 835 . 68 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. 13 , 835 . 68 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 0 . 00 (a)(1.2)X.00 15. 16. Amount of Line 14 taxable 13 , 835 . 68 16. 622 . 61 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 0 0. 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 0 0 19. TAX DUE................................................................................................................ 19. 622 . 61 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21-15 Decedent's Complete Address: DECEDENT'S NAME West,Zellars C. STREET ADDRESS 824 Lisburn Road, Apt. 227 CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 622.61 2. Credits/Payments A. Prior Payments 591.48 B. Discount 31.13 Total Credits(A +B) (2) 622.61 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 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;............................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ ❑x d. receive the promise for life of either payments,benefits or care?............................................................ ❑ 51 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ 0 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x 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 January 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 172 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. R.-1 508 EX-(11-t0) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER West,Zellars C. 21-15 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Miscellaneous refund 24.75 TOTAL(Also enter on Line 5, Recapitulation) 24.75 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER West,Zellars C. 21-15 If an asset was made joint within one year of the decedent's date of death,it must be reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Todd West 1207 High Hollow Son Mechanicsburg, PA 17050 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY %OF DATE OF DEATH VALUE OF ITEM FORTJOINT MADE ER DATE (NUMBER OR SIMILARNCLUDE NAME OF NDENTIFY NG ANCIAL INUMIBERON AATTACHR ND BANK FOR ACCOUNTDATE OF DEATH DECD'S DECEDENTS INTEREST NUMBERTENANT JOINT JOINTLY-HELD REAL ESTATE. VALUE OF ASSE INTEREST 1 A 02/14/2008 Citizens Bank Checking Account No.*8007- 54,324.75 50.000% 27,162.38 valued per statement ending 12/12/14 TOTAL(Also enter on Line 6, Recapitulation) 27,162.38 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev.01-10) REV-1511Ex.(10-09) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DEC ENTTURN ADMINISTRATIVE COSTS ESTATE OF F21 E NUMBER West,Zellars C. -15 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 12,336.45 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s)Commission Paid 2. Attorney's Fees JSDC Law Offices 1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State ZiD Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s)attached TOTAL(Also enter on line 9, Recapitulation) 13,351.45 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER West,Zellars C. 21-15 ITEM NUMBER DESCRIPTION AMOUNT Funeral Exnenses 1 Costco-casket 2,503.00 2 Kepple-Graff Funeral Home-funeral services 7,392.25 3 McColly Monuments-grave monument 2,441.20 H-A 12,336.45 Other Administrative Costs 4 Register of Wills,Cumberland County-filing fee for Return 15.00 H-B7 15.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) e REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER West,Zellars C. 21-15 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S)RECEIVING PROPERTY a DoECEDList EN e s (Words) ($$$) I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Todd West Son Joint account 13,835.68 1207 High Hollow Mechanicsburg, PA 17050 Total 13,835.68 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)