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Home My WebLink About04-27-12 REV-1500 EX(01-10) 1505610145 OFFICIAL USE ONLY PA Department of Revenue Pennsylvania DEPAaTMENTOCountyCode Year File Number IBureau of Individual Taxes NHERITANCE TAX RETURN PO BOX 280601 Harrisburg,PA 17128-0601 RESIDENT DECEDENT 6 0 ENTER DECEDENT INFORMATION BELOW 08022007 10061937 Decedent's Last Name Suffix Decedent's First Name MI Jones Kay A (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 Q 2.Supplemental Return Q 3.Remainder Return(date of death prior to 12-13-82) 0 4.Limited Estate 4a.Future Interest Compromise(date of 0 5.Federal Estate Tax Return Required death after 12-12-82) 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 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 Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Robert G. Frey 7172435838 REGISTER OFW LLLLS USE ONCY- n -XI First line of address Z_r:.rte- = 5 South Hanover Street i`f's Second line of address C--7-7 C-D Da- FILEDr-� City or Post Office State ZIP Code z Carlisle PA 17013 Correspondent's e-mail address: rfrey@freytiley.com Under Renalties 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,r46Vrect and complete.Declaration of preparer other an the personal representative is based on all information of which preparer has any knowledge. V�AJURE OFPE ON RESPON LE FOR F ING RETURN T AD RESS 555 Mount Road Road, Newville, PA 17241 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE 03/30/11 ADDRESS 5 South Hanover Street, Carlisle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610145 1505610145 U_/ ' �`: .. C Y-L.�� .. �� w . ? .' r^�� J 1505610245 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A).. .. . . . . .. . . . . . . .. . . ... . . .... .. . . .. .. .. .. .. 1. NONE 2. Stocks and Bonds(Schedule B). . . . . . . . . . ... . . . . . . . . . . . . .. . . . . . . . . . . . 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C). . . . . 3. NONE 4. Mortgages and Notes Receivable Schedule D 4. NONE 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . 5. NONE 6. Jointly Owned Property(Schedule F) Separate Billing Requested. . . . . . .. 6. 111560 . 00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) =Separate Billing Requested. . . . . . . . 7 9754 . 00 8. Total Gross Assets(total Lines 1 through 7). . . . . . . . . . . .. . .. . . . . . . .. . . . 8. 121314 . 00 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . . . 9. NONE 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1). . . . . . . . . . . . . 10. NONE 11. Total Deductions(total Lines 9 and 10). . . . .. . . ... . . . . . . . . . . .. . . .. . .. . 11. 0 . 00 12. Net Value of Estate(Line 8 minus Line 11). .. . . . . . . . .. . . . . . . . .. .. . . . . . . 12. 121314 . 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. 121314 . 00 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 0 121314 . 00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X.0 4 5 16. 0 . 00 17. Amount of Line 14 taxable at sibling rate X.• 12 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X . 15 18. 0 . 00 19. TAX DUE. . . . . . . .. . . . . . . . . . . . . . . . . . . . ... . . . . . . .. . . . . . . .. . . . . . . . . 19. 0 . 00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610245 1505610245 J REV-1500 EX Page 3 File Number 161-34-4450 Decedent's Complete Address: 21-08-0488 DECEDENT'S NAME Kay A Jones STREET ADDRESS 555 Mount Rock Road CITY STATE ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 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) 0.00 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; ............................................................................. ❑ ❑X b. retain the right to designate who shall use the property transferred or its income; ................................ ❑ El c. retain a reversionary interest;or............................................................................................................ ❑ 0 d. receive the promise for life of either payments, benefits or care?.......................................................... ❑ a 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?................................................................................................. ❑ M 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?..........................................................................................:................. ❑ 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 (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(1.2)[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. ti { ry 217 REV-1509 EX+(6-98) SCHEDU 0 LE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Kav A Jones 21-08-00488 If an asset was made joint within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Donald G.Jones 555 Mount Rock Road, Newville, PA 17241 Spouse B. C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER,ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUEOFASSET INTEREST DECEDENTS INTEREST 1. A. 7/14/98 555 Mount Rock Road, Newville,PA 17241 223,121 50.00% 111,560 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 6, Recapitulation)i $ 111,560 (If more space is needed,insert additional sheets of the same size) ti 217 PEV-1510 Ex+(6-98) SCHEDULE G INTER-VIVOS TRANSFERS & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX PETUPN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Kay A Jones 21-08-00488 This schedule must be completed and filed If the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE I Annuity through Pension Board of United Church of Christ 9,754 100.00% 0 9,754 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 Recapitulation) $1 9,754 (If more space is needed,insert additional sheets of the same size) f REV-1513 EX+(I 1-08) pennsylvania SCHEDULE DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT, ESTATE OF FILE NUMBER Kay A Janes 21-08-00488 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 3. TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.2116(a)(1.2).] 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 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. Donald G.Jones,surviving spouse,555 Mount Rock Road, Newville, PA 17241 100% B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,insert additional sheets of the same size.