HomeMy WebLinkAbout04-16-15 pennsytvania 1505614105
OEi'.1N1HEN7OF HkVbWE Ex(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number ^—,
PO BOX 280601 INHERITANCE TAX RETURN Z
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
110312014 01271926
Decedent's Last Name Suffix Decedent's First Name MI
MOYER ANN I FI
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
j I I i
i——- ---- - -- — - - -- ' - - --- - - _. --J
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C=:) 1.Original Return O1D 2. Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of 0 5. Future Interest Compromise(date of C=:) 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 1 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
O 10. Litigation Proceeds Received O 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13.Business Assets C=:) 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
THOMAS E. FLOWER (717) 243-5513
First Line of Address
FLOWER LAW, LLC
Second Line of Address
_10 W.
HIGH ST
City or Post Office — State ZIP Code
'CARLISLE I PA 17013
Correspondent's email address: TOm@Flower-IaW.COm C �, ``-' m cm's
` G. b
REGIST-ER 017 VelN LS L%WONLYP �;O
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I 4 REGISTER OF WILLS USE ONLY r— m rT1
DATE FILED MMDDYYYY
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OA,E FILED STAMPS G!) O
PLEASE USE ORIGINAL FORM ONLY -
Side 1
111111 IIIII IIIII IIIII IIIII IIIII IIIII IIII IIIII IIIII IIII IIII
150561410 1505614105
.J 1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: ANN F. MOYER
I
RECAPITULATION
1, Real Estate(Schedule A). . . .. . . ... ... ... . .. .. . . .. .. . .. ... .. . . . .. . . . . . 1.
2. Stocks and Bonds(Schedule B) .. . . ... . . .... . .. .. . . .. .. . .. .. . .. . . .. .. . 2. i
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . .. 3. ' I
is_,..._...,,....._......W...,......�...._.�.___.�_.�,_.,...,..__._..._.,�....__..,
4. Mortgages and Notes Receivable Schedule D
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). .. .. .. 5. 129.00
i
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. 129.00
9. Funeral Expenses and Administrative Costs(Schedule H)... .. ... .. .. . .. .. . . 9. 8,150.42
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). .. . .. . . . . . .. . . 10. ' 33,630.95
11. Total Deductions(total Lines 9 and 10)... .. .. ... . ... .. . . .. .... . .. .. .. . . 11. 41,781.37
12. Net Value of Estate(Line 8 minus Line 11) ... . . .. . . .. ... . . . .. . .. . . .. .. .. 12. -41,652.37
_,._, .... .. _...........................
. ,....w,. .-..._.....,,_.v....>.._
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. -41,652.37
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 i .... .......
(a)(1.2)X.0_ I 15. `
16. Amount of Line 14 taxable
at lineal rate X.0_ 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.
m
19. TAX DUE ........ .... . .. . .. . .. . . . . .. .. .. .. .. . .. . . . . .. . .. .. . .. . . .. . 19. '
................ ....................._....
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Under penalties of perjury,I declare I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true, correct and corn I t . Declar tion of preparer other than the person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNATURE rR ESP FOR FILING DATE
ADDRESS
ALEXANDER P. SPRARIIPE, EXECUTOR; 1590 BOILING SPRINGS ROAD, BOILING SPRINGS, PA 17007
SI�OF HER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
04/13/2015
ADDRESS
FLOWER LAW, LLC; 10 W. HIGH ST., CARLISLE, PA 17013
1111111111111111111111111111111111111111111 Side 2
1505614205 1505614205
'f
REV-1500 EX (FI) Page 3 File Number 121—
— J f — 106
6 (D 0/
Decedent's Complete Address: f ` �"
DECEDENT'S NAME
ANN F. MOYER
STREETADDRESS
1590 BOILING SPRINGS ROAD
CITY STATE ZIP
BOILING SPRINGS PA 17007
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1)
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions.) 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) 1,874.36
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5)
Make check payable to: REGISTER OF WILLS, AGENT.
I -
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.......................................................................................... ❑ 0
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?...................................................................... ❑ N
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ■ ❑
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? .................................................................................................. ❑
......................
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 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.
REV-15o8 EX+(ii-io)
I pennsylvania SCHEDULE E
'1(DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ANN F. MOYER 21-14-1062
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. REFUND OF CREDIT CARD BILL OVERPAYMENT 129.00
TOTAL(Also enter on Line 5, Recapitulation) $ 129.00
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-09)
Vj
j pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANN F. MOYER 21-14-1062
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
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:
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: US TRUST,for preparation of amended 2012 income tax returns 1,500.00
7. Stark&Stark,RC-attorney fees 4,549.76
8. F&M Trust Co.-wire transfer fees(3 @$15) 45.00
9. Charles Schwab-wire transfer fees(3 @$25) 75.00
10- Jamison,Eaton&Wood, Inc.-financial advisor's account management fee 1,880.66
11. Charles Schwab-prime broker fee to redeem T-Bills(4 @$25) 100.00
TOTAL(Also enter on Line 9, Recapitulation) $ 8,150.42
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-08)
-j-A-L-pennsytvania SCHEDULE
Z1 DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES &LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANN F. MOYER 21-14-1062
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
1• US TREASURY,TAX DUE WITH AMENDED 2012 INCOME TAX RETURN 29,931.00
2. PA DEPT.OF REVENUE,TAX DUE WITH AMENDED 2012 INCOME TAX RETURN 3,686.00
3. CARLISLE MEDICAL GROUP,LLC 13.95
TOTAL(Also enter on Line 10, Recapitulation) $ 33,630.95
If more space is needed,insert additional sheets of the same size. -
REV-1513 EX+(01-10)
7pennsylvania SCHEDULE ]
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ANN F. MOYER 21-14-1062
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• Patricia Sprague,207 Vance Ct Henderson,NV 89074 DAUGHTER 1/9
2. Daniel Sprague,112 Junction Rd,Hampton,NJ 08827 GRANDSON 1/9
3. Jacqueline Sprague,112 Junction Rd,Hampton,NJ 08827 GRANDDAUGHTER 1/9
4. Christa Sprague 21800 Townctr.Plza,Ste 266a,Box 220,Sterling,VA GRANDDAUGHTER 1/9
5. David Sprague,3909 Meridian Ave N,Tulalip,WA 98271 GRANDSON 1/9
6. Brenna Sprague,1590 Boiling Springs Rd,Boiling Springs,PA 17007 GRANDDAUGHTER 1/9
7 Peter Sprague, 1590 Boiling Springs Rd,Boiling Springs,PA 17007 GRANDSON 1/9
8 Anna Claire Sprague,1590 Boiling Springs Rd, Boiling Springs,PA 17007 GRANDDAUGHTER 1/9
9 Gretchen Sprague,1590 Boiling Springs Rd,Boiling Springs,PA 17007 GRANDDAUGHTER 1/9
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:
i.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
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.