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Home My WebLink About01-26-15 J 1505611180 REV-1500 EX(02-11)(FI) pennsylvania OFFICIAL USE ONLY PA Department of Revenue DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individuai Taxes INHERITANCE TAX RETURN / PO BOX 280601 '^� � Harrisburq,PA 17128-0601 RESIDENT DECEDENT L � /� � ENTER DECEDENT INFORMATION BELOW .-- Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ], 09272011 07061935 DecedenYs Last Name Suffix DecedenYs First Name MI DYARMAN ESTHER ARLENE (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 BOXES BELOW 0 1.Original Return � 2.Supplemental Return Q 3.Remainder Return(Date of Death Prior to 12-13-82) Q 4.Limited Estate Q 4a.Future Interest Compromise(date of Q 5.Federal Estate Tax Return Required death after 12-12-82) � 6.Decedent Died Testate Q 7.Decedent Maintained a Living Trust � 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Q 9.Litigation Proceeds Received Q 10.Spousal Poverty Credit(Date of Death Q 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 T0: Name Daytime Telephone Number ROBERT G . FREY 7172435838 REGISTER OF WILLS USE ONLY.,,� C'� c�a --�� "�' � m First Line of Address cz3 � C.. � C7 !-r� � � _`�,,`-�_, �? p 5 S . HANOVER � - n� `'.; ;' j..�.. Second Line of Address F ' ' �j t rr� _ _. _, . . . , ,_:� �_ --y.� , ,;� _ P .,1 DATE FI fD'� "=3 '_' City or Post Office State ZIP Code _ f.._, -• 4� _; C� f'` R7 CARLISLE PA 17013 y �--... '�� N G� C� �7 CorrespondenYs e-mail address: R F R E Y a�F R E Y T I L E Y . C 0 M 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 ail information of which preparer has any knowledqe NATURE OF PERSO SPONSI OR FILING TURN / DATE �.1.� ° /� o�- �.. RES 199 HORS SHOE ROAD CARLISLE PA 17013 SIG A RE OF EPA OTHE HAN ESENTATIVE / �?D E� � ' ADDRESS 5 SOUTH HANOVER STREET LISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 � 15D5611180 1505611180 J ��'`� � 1505611280 REV-1500 EX(FI) DecedenYs Social Security Number �ecedenrsName: ESTHER ARLENE DYARMAN RECAPITULATION 1. Real Estate(Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. N 0 N E 2. stocks and Bonds(scneaule B>. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. N 0 N E 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C). . . 3. N 0 N E 4. Mortgages and Notes Receivable(Schedule D). . . . . . . . . . . . . . . . . . . . . . . . 4. N 0 N E 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . 5. N O N E 6. Jointly Owned Property(Schedule F) OSeparate Billing Requested. . . . . . . 6. N 0 N E 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) �Separate Billing Requested. . . . . . . 7. 3 0 5 9 . �� 8. Total Gross Assets(total Lines 1 throuqh 7). . . . . . . . . . . . . . . . . . . . . . . . . . 8. 3 O$9 . 0� 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . 9. 50� . 00 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). . . . . . . . . . . . 10. N O N E 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 5 0 0 . 0 0 12. Net Value of Estate(Line 8 minus Line 11). . . . . . . . . . . . . . . . . . . . . . .. . . . 12. 2 S S 9 . �0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J). . . . . . . . . . . . . . . . . . . . . . 13. 0. �0 14. Net Value Subject to Tax(Line 12 minus Line 13). . . . . . . . . . . . . . . . . . . . . .14. 2 5 5`I. �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 O 15. O . 0� 16.Amount of Line 14 taxable at�inea�rate x.0 4 5 2 5 5 9 . 0 0 �s. 115 . 16 17.Amount of Line 14 taxable at sibling rate X . 12 17. ❑. 0� 18.Amount of Line 14 taxable at collateral rate X . 15 18. 0 . �� 19.TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . 19. 1,1 5 . 1 6 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 1505611280 1505611280 � REV-1500 EX(FI) Page 3 File Number 171-28-2998 Decedent's Complete Address: 21-11-1094 DECEDENT'S NAME ESTHER ARLENE DYARMAN STREET ADDRESS 171 LIMEKILN ROAD CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 115.16 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 box 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) 115.16 Make check payable to: REGISTER OF WILLS, AGENT � < �_�� .�:�: � �, �. :; �� , < .. � ,. , ,>�;.;� e�. �''�� . .�� `.�.� `~$� � ,�'` � � . : .. . . . a. . _.,.... 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. �y<. „. .. _ ' � �� .. . �;��.::� . ,sm..��,a3�<�`�:��'�1`" �`� � � 'i�'�xa. . �ur�� a`{�£.�`z� a;,. .,.,�. >''..c� :'�`�`�� k ... .. ... . . ',� ��'..-.�,�<..,.T,. 5 : �' 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 sunriving 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)J. • 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-1510EX+(OS-09) SCHEDULE G pennsylvania lNTER-VIVOS TRANSFERS & DEPARTMENT OF REVENUE INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER EstherArlene Dyarman 21-11-1094 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IIFAPPLICABIE) VALUE 1. IRA with Bankers Liffe 3,059 100.00% 0 3,059 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL Also enter on Line 7 Reca itulation $ 3 059 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND RESIDENTDEC ENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Esther Arlene Dvarman 21-11-1094 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: 2. Attorney Fees: 500 3. Famiiy Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Retationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Aiso enter on Line 9, Recapitulation) $ 500 If more space is needed, use additional sheets of paper of the same size. REV-1513 EX+(Ot-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Esther Arlene D arman 21-11-1094 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] � Tara Palm 504 North Hanover Street, Carlisle, PA 17013 granddaughter 1/2 of IRA 2 Seth Dyarman grandson 1/2 of IRA ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ O.00 If more space is needed,use additional sheets of paper of the same size. BANI�RS LIFE AND CASUAi,TY COMPANY `�,'� CLAIMS ADMII�]ISTRATIVE 4FFICB P.O.Box 1937 � � Carmel,IN 46082-1937 (800)621-3724 I3ovember 28, 2Q11 = Tara Palm 5�4 N Har�over ST Carlisle, PA 3.7013 In�ured: E Arlene Dyarman Contract Number: 7833452 Dear Tara L'alm: We again wish to extend our deepest sympathy to you and your family for your recent loss. Your claim on the above mentioned contract has been approved and processed. The benefits have been calculated as follows: Aeath Benefit $3,059.30 Your Share $1 ,529.65 Taxable Amount $1 ,529.65 Federal Tax Withholding $ 152.97 Final Benefit Amount $1 ,375.68 A £orm 1099R will be mailed at the end af this tax year for the taxable amount. 8LC2P6 We reaiize that the period following such a loss is a difficult time for individuals and families and we are committed to providing you with the best possible service. i £ you have any questions regarding your claim, please contact our office at the number above. Sincere�y Annuity Claims Department BLC0311 KB2 For local service, contact; Branch Sales Office 1051 1215 MANOR DR STE 300 M�CHANICSBJRG, PA 17055 Phone: (717} 791-2100 Agent: NONE