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Home My WebLink About03-16-15 (2) Pennsylvania 1505618627 3M464716,000 DEPARMENTOF REVENUE EX(03-14)(TP) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN — 7128-0601 RESIDENT DECEDENT L '5 Gq -75 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 06172014 12191921 Decedent's Last Name Suffix Decedent's First Name MI CUPP ALLEN L (if Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Fv 2. Supplemental Return 3.1. Original Return Remainder Return(date of death I F prior to 12-13-82) El 4.Agriculture Exemption(date of El 5. Future Interest Compromise(date of El 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) 7. Decedent Died Testate El 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) 10.Litigation Proceeds Received El 11. Non-Probate Transferee Return El 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) El 13.Business Assets F-1 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number BRIDGET M . WHITLEYi ESQ 717-233-1000 First Line of Address SKARLATOSZONARICH LLC Second Line of Address 17 S 2ND ST FL 6 City or Post Office State ZIP Code HARRISBURG PA 17101 73 Correspondent's email address: BMW@SKARLATOSZONARICH-COM _10 REGISTER OF WiLL5-USE-ONL*-' REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY rn DATE FILED STAMP PLEASE USE ORIGINAL FORM ONLY Side I 1111111 VIII 11!11 VIII 11111 11!11!III!lull 111111!1!111!!1111 1505618627 1505618627 1505618635 REV-1500 EX(TP) Decedent's Social Security Number Decedent's Name:CUPP ALLEN L RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0.00 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . 2, 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3, 11-00 4. Mortgages and Notes Receivable(Schedule D), , , , , , , , , , , , , , , , , , 4, 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E), , , , , , 5. 9,939-00 6. Jointly Owned Property(Schedule F) F-1 Separate Billing Requested. . . . . 6. 142-00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) FI Separate Billing Requested. . . . . 7. 0.00 8. Total Gross Assets(total Lines 1 through 7) , . . . . 8, 101081-00 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . 9. 3,14 2•0 0 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). , , . . , , , , . 10, 58,889-00 11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. 62,031-00 12, Net Value of Estate(Line 8 minus Line 11) , , , , , , , , . : . . . . . . 12. (51,950•00) 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule J). . . . . . . . . . . . . . . . 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13). . . . . . . . . . . . . . . . 14. (51,950-00) TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers ufWer Sec.9116 (a)(1.2)X. 0 .00 15. 0 .00 16. Amount of Line 1.exable at lineal rate X. 142-00 16. 6.00 17. Amount of Line 14 taxable at sibling rate X.12 0.00 17. 0-0 U 18. Amount of Line 14 taxable at collateral rate X.15 0.00 18. 0.00 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 6-011 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ 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 person responsible for filling the return is based on all information of which preparer has any know e. SIGNP OF PERSON RESPO IBLE F LI ETU.N DAT u� p 1 22- 0/-1 DRESS 490 BRENTWATER ROAD CAMP HILL, PA 1.7011 SIGNATUg OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS 17 S 2ND ST FL 6 HARRISBURG PA 17101 Side 2 1505618635 J 3M464810.000 REV-1500 EX(TP) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME CUPP ALLEN L STREET ADDRESS 490 BRENTWATER ROAD CUMBERLAND CITY STATE ZIP CAMP HILL PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 6 . 00 2. Credits/Payments A. Prior Payments 0 .00 R Discount 0 .00 (See instructions.) Total Credits(A+B (2) 0.00 3. Interest (3) 0 .00 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) 0 .00 5. If Line 1 + Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 6. 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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . D FRI b. retain the right to designate who shall use the property transferred or its income . . . . . . . . . D FX c. retain a reversionary interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments,benefits or care? . . . . . . . . . . . . . . . . . . . . . . El Ek] 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . El Fx� 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . El EK 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)(1)]. 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 172 P.S.§91 16(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 step-parent 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, 3M4671 4,000 REV-1508 EX-(08-12) pennsylvania SCHEDULE DEPARTMENT OF REVENUE CASH, BANK DEPOSITS&MISC. IWERITANCE TAX RE RESIDENT DECEDENTTURN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Allen L. Cupp Include the proceeds of litigation and the date the proceeds were received by the estate. All propeg jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Federal income tax refund for 2012 3,535 2 Federal income tax refund for 2013 3,496 3 Federal income tax refund for 2014 1,968 4 Refund of patient personal funds account at nursing home 940 TOTAL(Also enter on line 5,Recapitulation) $ 9,939 2W46AD 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Allen L. Cupp If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G SURV NING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A Wood, Bonnie L 490 Brentwater Road, Camp Hill, PA 17011 Daughter JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER ORSIMLAR DATE OF DEATH DECEDENTS VALUEOF NUMBER TENANT JOINT IDENTIFYINGNUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE, VALUE OF ASSET INTEREST DECED94T'S INTEREST 1 A 7/15/2011 PNC Bank Account 284 50.0000 142 The date of death value of $3,586 was adjusted to reflect a reduction for a check which was outstanding on date of death and cleared on 7/9/14 ($3,302) . TOTAL (Also enter on Line 6, Recapitulation) $ 142 9w46AE 2.000 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(0&13) SCHEDULE H pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Allen L. Cupp Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Auer Cremation Services Balance due after applying prepaid funeral credit and life insurance 292 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: 21000 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: 600 7. 1 Skarlatos & Zonarich, LLP Disbursements for filing fees, copies, postage, etc. 250 TOTAL(Also enter on Line 9,Recapitulation) $ 3,142 3w46AG 2.000 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX-(12-12) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, WHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Allen L. Cupp Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Department of Public Welfare Medical Assistance Estate Recovery claim 58,889 TOTAL(Also enter on Line 10,Recapitulation) $ 58,889 2W46AH 2.000 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: Allen L. CuiDiD RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] Bonnie L. Wood 490 Brentwater Road Camp Hill, PA 17011 PNC Bank Account Inventory Value: 142 Daughter 142 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. 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 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0 9W46AI 2,000 If more space is needed,use additional sheets of paper of the same size,