HomeMy WebLinkAbout02-18-15 (2) J REV-1500 EX c0z-„> , 1505610143
1� OFFICIAL USE ONLY
PA Department of Revenue pennsylvania councy code Year File Number
Bureau of Individual Taxes DEPARTMENTOFREVENUE
Po soxzsoso� INHERITANCE TAX RETURN 2 1 14 0 9 2 8
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
09 06 2014 04 22 1926
DecedenYs Last Name Suffix DecedenYs First Name MI
MCCOMBS BEATRICE H
(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
� 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)
g Decedent Died Testate � Decedent Mainlained a Living Trust 8. Total Number of Safe Deposit Boxes
� (Attach Copy of Wilp � (Attach Copy of Trust)
� 9. Litigation Proceeds Received � 10.Spousal PoveRy Credit(Date of Death � 11.Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Schedule 0)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
TERRENCE J KERWIN 717 362 3215
REGISTER OF WILLS USE ONLY
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First Line of Address =r� � �;-I rn
4245 STATE ROUTE 209 f' �7 `'�"� `=� �
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Second Line of Address • - OJ ' ' ��
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DATE-FIL i '',�
City or Post Office State ZIP Code - � -- _,_
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ELIZABETHVILLE PA 17023 : �.,� .' ��.�
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CorrespondenYse-mai�address: tjk@kerwinlawfirm.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.
S NA URE OF PERSON RESPO L��OR FILING RETURN DATE
`i ,, we � l Pe99Y A. Quick � /�
ADDRESS
1820 Brax�dt Avenue, New Cumberland, PA 17070
SIGNATURE OF PREPAR THER THAN REPRESENTATIVE DATE
/
�1..�ti., Terrence J Kerwin ,;2. ,,,z �
ADDRESS
Kerwin Kerwin, �LP
4245 State Route 209, Elizabethville, PA 17023
Side 1
� 1505610143 1505610143 J
\
J 1505610243
REV-1500 EX
DecedenYs Social Security Number
Decadent's Name�. M C C O M B S, B E A T R I C E H.
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.
22 , 870 . 12
5 Cash,Bank Deposits&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.
g. Total Gross Assets(total Lines 1 through 7).......................................................... g, 2 2 , 8 7 0 . 1 2
- --- -- 4 , 7 2 8 . 3 7
9. Funeral Expenses and Administrative Costs(Schedule H)..................................... 9.
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................. 10.
11. Total Deductions(total Lines 9 and 10).................................................................. 4 , 7 2 8 . 3 7
11.
18 , 141 . 75
�Z• Net Value of Estate(Line 8 minus Line 11)............................................................. 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 1 6 , 6 9 8 . 2 5
an election to tax has not been made(Schedule J)................................................. 13.
1 , 443 . 50
14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14.
TAX COMPUTATION-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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X 045 16.
17. Amount of Line 14 taxable
at sibling rate X 12
17.
18. Amount of Line 14 taxable 2 1 f) . 5 3
at collateral rate X .15 1 , 4 4 3 . 5 0 18.
19. TAX DUE................................................................................................................... 19. 2 1 6 . 5 3
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 1505610243 1505610243 �
REV-1500 EX Page 3 File Number 21 - 14 - 0928
Decedent's Complete Address:
DECED NT' NAME
McCombs, Beatrice H. _
STREET ADDRESS
Long Meadows Apartments __
9B Richland Lane
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 216.53_
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits(A +B) (2) 0.00
3. Interest (3) 0.0 0
q. 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) Z�s.5 3
Make Check Payable to: REGISTER OF WILLS, AGENT.
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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:.................................................................................. [� Ox
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?.............................................................. ❑ �
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receivingadequate consideration?....................................................................................................................... � �
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?......... � Ox
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.
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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 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,wfiether 6y bloo�or adoption.
��- pennsylvania SCHEDULE E
�� DEPARTMENTOFREVENUE CASH, BANK DEPOSITS AND MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
— FILE NUMBER
ESTATE OF McCombs, Beatrice H. 21 - 14 -0928
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.
lTEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Fulton Bank Checking Account#221838144 22,235.91
2 Members 1 st Checking Account#2185299506 � 353.00
3 Furniture 200.00
4 Refund - Security Deposit 81.21
_- —_ — —
TOTAL(Also enter on Line 5, Recapitulation) 22,870.12
REV-1511 EX+(�0-09)
pennsylvania SCHEDULE H
�� FUNERAL�CCPENSES AND
DEPARTMENT OFREVENUE
INHERITANCETAXRETURN /�ry�mwl�L+'Tp/�TT/Cl+AG C
RESIDENT DECEDENT /'1LlItN1�Ih7 1 fY'\I IYG t►W 1�7
- FILE NUMBER
ESTATE OF Mc�ombs, Beatrice H. 21 - 14 -0928
_- -- --- - - - - -
Decedent's debts must be reported on Schedule I.
ITEM AMOUNT
NUMBER FUNERAL EXPENSES: DESCRIPTION — _
A. 1 Funeral Expenses 1,703.00
I
;
B. I ADMINISTRATIVE COSTS:
�. Personal Representative's Commissions
, Name of Personal Representative(s)
Peggy A. Quick 1,143.50
Street Address 1820 Brandt Avenue �
City New Cumberland State PA ziP 17070
Year(s)Commission Paid 2015
z. ' Attorney's Fees Kerwin & Kerwin, LLP --Terrence J. Kerwin 1,200.00
3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation)
i
Claimant
Street Address
' City State Zip
i
Relationship of Claimant to Decedent
4. Probate Fees 170.50
5. I AccountanYs Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
� Verizon 37.35
' See attached 474.02
----�. -
— - --
TOTAL(Also enter on line 9, Recapitulation) I 4,728.37
Schedule H
Funeral F�cperises&
COMMONWEALTH OF PENNSYLVANIA �in����nued
INHERITANCE TAX RETURN
RESIDENT DECEDENT
- FILE NUMBER
ESTATE OF McCombs, Beatrice H. 21 - 14 -0928
Z PPL Electric I 273.68
3 East Pennsboro Township-taxes 11.00
I 75.00
4 Cumberland Law Journal - Estate Notice
5 � The Sentinel - Estate Notice
� 84.34
i
6 Notary Fee 5.00
�
� Register of Wills- Releases 15.00
$ � Closing costs, e.g. postage, copies � 10.00
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Page�2 of Schedule H
REV-1513 EX+(01-70)
� pennsylvania SCHEDULE J
' DEPARTMENT OFREVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
McCombs, Beatrice H.
21 - 14 -0928
, RELATIONSHIP TO ; SHARE OF ESTATE 'AMOUNT OF ESTATE
NUMBER � NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
I RECEIVING PROPERTY oo Not ust Trustee(s� _ __
T
I. ITAXABLE DISTRIBUTIONS[include outright spousal ,
distributions,and transfers j ;
i under Sec.9116(a)(1.2)] ' I ;
1 � Peggy A. Quick i 750.00
1820 Brandt Avenue
New Cumberland, PA 17070
I �
�
2 , Kathleen E. Snell ' ! 750.00
; 313 Seventh Street I
New Cumberland, PA 17070 , � I
, I
,
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� I I
I I
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. i 'I I
I Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. I,
II. �NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN E�ECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 Make-A-Wish Foundation 5,566.08
Susquehanna Valley Office, 1054 New Holland Avenue, Lancaster, PA 17601
2 PAWS 5,566.08
P.O. Box 855, Camp Hill, PA 17001
3 Humane Society of Harrisburg Area* 5,566.09
7790 Grayson Road, Harrisburg, PA 17111
4 *V'Jest Shore Humane Society no long in existance.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 16,698.25