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HomeMy WebLinkAbout03-17-15 (5) 1505611101 REV-1500 Ext°z-1'' Iff OFFICIAL USE ONLY I PA Department of Revenue Pennsylvania Bureau of Individual Taxes OERIREHEN,OFRENENOE County Code Year File Number PO BOX 2g8o6o1 INHERITANCE TAX RETURN rr� ( rffl ;--�� Harrisburg,PA 1'7128-0601 RESIDENT DECEDENT d� l�)U�� LZ�J0❑ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _ jl' ,d,D6—, j Decedent's Last Name Suffix Decedent's First Name MI �!I C�CiLJDI� 0UD iRL�':c.o-11q [17K (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ILJLJI- _0 Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE C - J�JI�L�� REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1.Original Return O 2. Supplemental Return Q 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a.Future Interest Compromise(date of O 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 • ____ —_.- � � Ql.- • -�j, `--`1l f-� IK , WY .. . a, f , • Aj . , , IIJ; �1J REGISTER OF WILLS USE ONLY \ .v First Line of Address n m _ CrTi 7.3 LZ -10 Second Line of Address-0-0-000 0 0 LE DDOUILTIL City or Post Office _ State ZIP Code _DATE FIL - �C �aliM�'��t �l �'t�Ct�'��CUOI�L�00 IPJJ� �� I�� U�' Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined t i 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. SIGNATU E F RSON PONSIBLE FOR FI NG RETURN DA7E VZ/ ADDRE S /� Ee n f b Il SIGNATURE OF PREPARER OTHER THAN R P SENTA IVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505611101 1505611101 1505611201 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 and Notes Receivable(Schedule D) . ... .. .. .. .... .... ... . ..... 4. • 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E)... . .. . 5. 5 .all 1 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. 8. Total Gross Assets(total Lines 1 through 7). . . ... . . .. . . ..... .. .. .. .. .... . 8. �U l Q .p2, cl 9. Funeral Expenses and Administrative Costs(Schedule H).. ... . . .. . ... . ..... 9. I s 1 0 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)... .. .. .. . ..... 10. 1 . 11. Total Deductions(total Lines 9 and 10). .. .... ... . . .. ...... .... ... . ... .. 11. l 12. Net Value of Estate(Line 8 minus Line 11) ... . .... . .. . ..... .. .. .. .. .. .. . 12. 39 9 . t� 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. �, 8 q • I 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 A at lineal rate X.0_1� 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. r 19. TAX DUE .. . .. .. .. . . .. . .. . . ... .. .. .. . . .. .. . . . . .. .. .. .. .. . . .... .... 19. aY 8 g J t 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505611201 1505611201 REV-1508 EX+(ii-io) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSIT'S & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: h anl/) S OnclCde the proc ds 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 om .4(a--o Qo TOTAL(Also enter on Line 5, Recapitulation) $ �S/b If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H ' DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE FILE NUMBER Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) e Street Address Q City (�1 t State ![ ZIP 7 f v 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: 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) 9 ~pennsylvania SCHEDULE I { DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE FFILE NUMBER c,�z1 �aS�)a S — l-75 Report debts incurred by the decededt rior to death that remained unpaid at the date of death,including unreimbursed medical expenses, ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• Curn�,���.n�( ��„ss;nys �vr.�}�� �or�e t � � CQ ��� TOTAL(Also enter on Line 10, Recapitulation) $ j i .o 0.00 If more space is needed,insert additional sheets of the same size. JOIRSDEPARTMENT OF THE TREASURY INTERNAL REVENUE SERVICE CINCINNATI OH 45999-0023 Date of this notice: 03-10-2015 Employer Identification Number: 47-6864800 Form: SS-4 Number of this notice: CP 575 B RICHARD REDDEN HASTINGS ESTATE KELLY PENNYPACKER ADM 1712 KENT RD For assistance you may call us at: CAMP HILL, PA 17011 1-800-829-4933 IF YOU WRITE, ATTACH THE STUB AT THE END OF THIS NOTICE. WE ASSIGNED YOU AN EMPLOYER IDENTIFICATION NUMBER Thank you for applying for an Employer Identification Number (EIN) . We assigned you EIN 47-6864800. This EIN will identify your estate or trust. If you are not the applicant, please contact the individual who is handling the estate or trust for you. Please keep this notice in your permanent records. When filing tax documents, payments, and related correspondence, it is very important that you use your EIN and complete name and address exactly as shown above. Any variation may cause a delay in processing, result in incorrect information in your account, or even cause you to be assigned more than one EIN. If the information is not correct as shown above, please make the correction using the attached tear off stub and return it to us. Based on the information received from you or your representative, you must file the following form(s) by the date(s) shown. Form 1041 04/15/2016 If you have questions about the form(s) or the due date(s) shown, you can call us at the phone number or write to us at the address shown at the top of this notice. If you need help in determining your annual accounting period (tax year) , see Publication 538, Accounting Periods and Methods. We assigned you a tax classification based on information obtained from you or your representative. It is not a legal determination of your tax classification, and is not binding on the IRS. If you want a legal determination of your tax classification, you may request a private letter ruling from the IRS under the guidelines in Revenue Procedure 2004-1, 2004-1 I.R.B. I (or superseding Revenue Procedure for the year at issue) . Note: Certain tax classification elections can be requested by filing Form 8832, Entity Classification Election. See Form 8832 and its instructions for additional information. To obtain tax forms and publications, including those referenced in this notice, visit our Web site at www.irs.gov. If you do not have access to the Internet, call 1-800-829-3676 (TTY/TDD 1-800-829-4059) or visit your local IRS office. REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDEN ME STREET ADD E S CITY STATE ZIP L 176 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) JUU 79 , s1 2. Credits/Payments A.Prior Payments B.Discount , p 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) - 3 S-, S3 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.......................................................................................... ❑ M 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?.............................................................................................................. ❑ 9 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? ........................................................................................................................ ❑ 54 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 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[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.