HomeMy WebLinkAbout03-09-15 (2) 1505610105
REV-1500 EX(m-ii)(H)
PA Department of Revenue pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes °"""T"` OF" E"°` County Code Year File Number
PO BOX2806o1 INHERITANCE TAX RETURNKJ
Harrisburg,PA i 128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
[03/20/2014 12/01/1956
Decedent's Last Name Suffix Decedent's First Name MI
SmithL�ale -^�
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First NameMI
I.... _
—.____--___. I E
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C@D 1.Original Return C=D 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4.Limited Estate C=D 4a. Future Interest Compromise(date of C=D 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 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 TO:
Name Daytime Telephone Number
Mar Silliker, Esquire 1(717)671-1500
REGISTER OF WILLS USE ONLY
\7
Cri ^7
First Line of Address -,- cD
73
Second Line of Address r; c1)
City or Post Office State ZIP Code DATE NLED3
Harrisburg I PA 117112
-J -TI
Correspondent's e-mail address:
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 goepArer has any knowledge.
SIG TUBE OF R NR SPONSIBLE FOR F G RETUjI DATE
AD R
6033 Wertzville Rd. Enola PA 76 Beard Rd. Mechanicsburg PA 4009 S.E. 43rd Circle, Ocala FL
SIGNATURE OF PREPARER O AN N IVE / DATE
ADDRESS
5922 Linglestown Road, Harrisburg, PA 17112
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 j
ob
1505610205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: Dale E. Smith, Sr.
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1. 323,037.00
2. Stocks and Bonds(Schedule B) ....................................... 2. 3,884.46
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. 25,054.70
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7. 469,138.28
8. Total Gross Assets(total Lines 1 through 7)............................. 8. 821,114.44
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 17,304.14
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 5,386.52
11. Total Deductions(total Lines 9 and 10)................................. 11. 22,690.66
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. 798,423.78
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. 798,423.78,
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- 15.
16. Amount of Line 14 taxable
at lineal rate x.045 798,423.78 16. 35,929.07
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. 35,929.07
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
L 1505610205 1505610205
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Dale E. Smith, Sr.
STREET ADDRESS
6200 Wertzville Road
CITY STATE ZIP
Enola PA 17025
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 35,929.07
2. Credits/Payments
A.Prior Payments 35,916.06
B.Discount
Total Credits(A+B) (2)
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)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 13.01
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.......................................................................................... ❑
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑
c. retain a reversionary interest.............................................................................................................................. ❑ 0
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ 0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ N
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 0
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 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(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[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)
Iffpennsylvania SCHEDULE A
DEPARTMENT OF REVENUE REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Dale E. Smith, Sr. 2114-0549
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 fads.
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. 6200 Wertzville Road,Enola,Cumberland County,Pennsylvania 17025 193,347.00
2 6033 Wertzville Road,Enola,Cumberland County,Pennsylvania 17025 129,690.00
i
� c
TOTAL(Also enter on Line 1, Recapitulation.) $1 323,037.00
If more space is needed,use additional sheets of paper of the same size.
REV-1503 EX+(8-12)
pennsylvania SCHEDULE B
�-� DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT .
ESTATE OF FILE NUMBER
Dale E. Smith, Sr. 2114-0549
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Manulife Financial stock
3,884.46
• • - IIDIIIIillllll9
TOTAL(Also enter on Line 2, Recapitulation) $ 3,884.46
If more space is needed, insert,additional sheets of the same size
REV-15o8 EX+(o8-i2)
r pennsyivania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS &MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Dale E.Smith, Sr. 2114-0549
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Tools and equipment 1,500 00,
2 Miscellaneous personal property 500.W1
3. 1990 Ford van 1,OOp p0
4. .Credit from Verizon 23.30,'
5 Manulife Financial Corporation dividend payment 40.75;
6. Metro Bank checking account number 0537223463 1 6,632 89}'
7. John Hancock Life Insurance policy(inherited) 5,309.2&',
8 Manulife Financial Corporation dividend payment 48 4gq
y
t
TOTAL(Also enter on Line 5, Recapitulation) $ 25,054.70,
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INMERITANCETAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dale E. Smith, Sr. 2114-0549
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.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECO S EXCLUSION TAXABLE
DlCLUDE TtIE NAME OF THE TR+U15ffRff,THEIR REUTtOHSNIP TD DECEDENT AM
NUMBER rHE DATE OF TrbWSFER.ATTACH A COPY of 7K DEED FOR RE&EsrATE. VALUE OF ASSET INTEREST IF Appucam VALUE
I. Morgan Stanley Traditional Inherited IRA
469,138.28; 100 469,136.28..
s`
i
E
It
TOTAL(Also enter on Line 7, Recapitulation) $ 469,138.28 .
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
Dale E. Smith, Sr. 2114-0549
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Richardson Funeral Home 8,158.79
F' Funeral meal 493.59;,
Gingrich Memorials1,494 00,1
f �
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: f ^^
Name(s)of Personal Representative(s)
Street Address
City State .ZIP
Year(s)Commission Paid:
4,500.00 1
2. Attorney Fees: l;
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: 493.50
5. Accountant Fees: T 180.001
6. Tax Return Preparer Fees:
7• Hampden township(sewer and trash) [=-- -3111 0.1
Allstate Insurance(vehicle insurance) � _ 184.96;:.
0 Commonwealth of Pennsylvania(van registration) 81.00
F10. Hampden Township(sewer and trash for 6033 Wertzville Road) 155.05;j',
Hampden Township(sewer and trash for 6200 Wertzville Road) 155.05 J
12. Allstate Insurance(homeowners insurance for 6200 Wertzville Road) 331.55;
TOTAL(Also enter on Line 9, Recapitulation) $ 17,304:14{
If more space is needed,use additional sheets of paper of the same size.
SCHEDULE H
Continued
Estate of Dale E. Smith,Sr. File No.2114-0549
13. Allstate Insurance(vehicle insurance) $68.65
TOTAL $179304.14
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
IWERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Dale E. Smith, Sr. 2114-0549
Report debts Incurred by the decedent prior to death that remained unpaid at the date of death,inducting unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
i. Cumberland County real estate tax for 6033 Wertzville Road,Enola,PA 326.72
2. Cumberland County real estate tax for 6200 Wertzville Road,Enola,PA 487.08 .
3. Hampden Township per capita tax 10.00 ..
4. F.M.Oppel fuel oil 801.90
5. PPL 197.31
6. Hampden Township(sewer and trash) 341.12
7. Verizon 91.54
8. Cumberland County real estate tax for 6200 Wertzville Road,Enola,PA 1,848.65
9. Cumberland County real estate tax for 6033 Wertzville Road,Enola,PA 1,282.20
4
TOTAL(Also enter on Line 10, Recapitulation) $ 5,386.52
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10) ;
& pennsyLvania SCHEDULE J
DEPARTMENT OF REVENUE ,BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Dale E. Smith, Sr. 2114-0549
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).]
1. Kristy A.Chubb,6033 Wertuille Road, Enola,PA 17025 Daughter
F�2 Dale E.Smith,Jr.,6033 Wertuille Road, Enola,PA 17025 Son -_ 50%
❑
F-1 I
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:
F1 I
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
F1 I
-- _
F-1 I
I
TOTAL OF PART II- 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.