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Home My WebLink About04-28-15 J �' pennsyivania 15056184U3 DEPARTMENTOFREVEN�X(03-14) REV-1500 OFFICIAL USE ONLY County Code Year Fiie Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 21 14 0 7 7 7 Harrisbur PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMD�YYYY 196 07 23 2�14 03 31 1939 DecedenYs Last Name Suffix Decedent's First Name M� SULLIVAN ERIC D (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 � 1. Original Return � 2. Supplemental Return � 3. Remainder Return(date of death prior to 12-13-82) � q, Agricultural Exemption(date of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) � 7. Decedent Died Testate � 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 � 11. Non-Probate Transferee Return � 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) � 13. Business Assets � 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number EDMUND G MYERS ( 717 ) 761 4540 First Line of Address 301 MARKET STREET Second Line of Address PO BOX 1❑9 City or Post Office State ZIP Code LEMOYNE PA 17043 0 ;,� c ``'�' rn rn CorrespondenYs email address: egm(a�jdsw com � � =� � � tZ7 REGIST�O£V��S USE ONLY—I � - � �1 'v'�p t�"1 C7 REGISTER OF WILLS USE ONLY " " � DATE FILED MMDDYYYY � rJ+ Y �' r� 7 ;J � � ^�rt _`,� —r� - � °':;:a CX'J �""' M :::�:� �"" � ., � � DAT�E FILED STAN� Side 1 � I(�'I�I II��I�III��I�I�II��II�I II��I I�III�I�II��I��II I ��I ��J 1505618403 1505618403 � _ � 1505618411 REV-1500 EX DecedenYs Social Security Number DecedenYsName: SUIIIVa11, Eric Douglas _____ 196 30 5631 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 ,9 3 0 • 0 0 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 5 ,9 3 0 • 0 0 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 15 • 0 0 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 15 • ❑0 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 5 ,915 - 0 0 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. 5 ,915 • 0 0 TAX CA�CULATION-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.00 15. 0 • D 0 16. Amount of Line 14 taxable at lineal rate X .045 0 • �0 16. 0 • 0❑ 17. Amount of Line 14 taxable at sibling rate X.12 0 • 0 0 �7• 0 - D 0 18. Amount of Line 14 taxable at co��atera�rate X .15 5 ,915 - 0 0 �$. 8 8 7 • 2 5 19. TAX DUE................................................................................................................ 19. 8 8 7 • 2 5 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 complete.Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any nowledge. S 0 PERSO RES IBLE FOR FILING RETURN Kathleen Sullivan /� TE �f' DRESS 100 M' itown Road, Camp Hill, PA 17011 GNAT F PREP R ER THAN REPRESENTATIVE Edmund G. Myers D T i ,� ADDRESS 301 MARKET STREET, Lemoyne, PA I IIII�I IIIII�IIII��I�I�III��II�I II�II I�III II��I II��I II�I I�� Side 2 � 1505618411 1505618411 � ...�,«n n:u.r.i..��v..irn..m..�.. a REV-1500 EX Page 3 File Number 21-14-0777 Decedent's Complete Address: DECEDENT'S NAME Sullivan, Eric Douglas _—__ STREET ADDRESS 325 Wesley Drive Apt. 3131 - STATE ZIP CITY PA 17055 Mechanicsburg Tax Payments and Credits: �� 887.25 1. Tax Due(Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) (3) 3. Interest 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5, If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) $$7.25 Make Check Payable to REGISTER OF WILLS, AGENT �. � ��_,. _ .�. . � , , .> t _.,,. _ _.. . , ,....... . ° x ;,+ ...._�:...:.._.._ . .. ,__.. ........... . ... PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: 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:.................................. ❑ 0 c. retain a reversionary interest;or............................................................................................................... x 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?.................... . . . ... .................................................................................... . . . . . 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?..................... • •�••••� �••�••• •�••••�•• ••�� """" ...................................... . IF THE ANSWER TO ANY OF THE ABOVE(IUESTIONS 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)j. For dates of death on or after January 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)]. � undeaSect o 9102aas etn nd vtidual whothas at least onerpa ent n ommon w h the delcedent 1whether by blood o§adoption�1.3)]. A sibfing is defined, Rev1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE pERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sullivan, Eric Douglas 21-14-0777 Include the proceeds of litigation and the date the proceeds were received by tha estate. All propeRy jointly-ownedwith the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Bethany Villiage-Refund on Account 2,400.00 2 U.S.Treasury-Refund of 2014 Federal Income Tax Return 3,530.00 TOTAL(Also enter on Line 5, Recapitulation) 5,930.00 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.08-12) REV-1511 EX+(08-13) SCHEDULE H pennsylvania DEPARTMENTOFREVENUE FUNERAL EXPENSES AND R SEDENTDEC D NTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Sullivan, Eric Douglas 21-14-0777 DecedenYs debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER q, FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission Paid 2, Attorney's Fees 3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationshi�of Claimant to Decedent 4. Probate Fees 5. AccountanYs Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 15.00 Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Sullivan, Eric Douglas 21-14-0777 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Cumberland County Register of Wilis-Filing Fees for Supplemental Return 15.00 H-B7 15.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) :�m,iir�i ..rn•yR�. � REV-1513 EX+(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BEN EFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Sullivan, Eric Douglas 21-14-0777 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee s I� TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 1 Scott Conboy Nephew 1l9th of Residue 136 Barrintgon Drive Oakdale, PA 15071 2 Suzanne Sullivan Grossman Niece 1/9th of Residue 14516 Cuba Road Cockeysville,MD 21030 3 Carol Ann (Sullivan) McKissick Niece 119th of Residue 8 Dishley Drive Mechanicsburg, PA 17055 4 John Patrick Sullivan Nephew 1/9th of Residue 183 South Spring Mill Road Villanova, PA 19085 5 Kathleen Sullivan Niece 1/9th of Residue 2100 Milltown Road Camp Hill, PA 17011 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) :,:w�nvnr,.�r.�.n.,�..... P SCHEDULE J BENEFICIARIES (Part I,Taxable Distributions) ESTATE OF: Eric Douglas Sullivan 07/2312014 196-30-5631 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) l$�$) 6 Mark Alan Sullivan Nephew 1/9th of Residue 3308 Prairie Vista Court Richfield,OH 44286 7 Terence S Suilivan Nephew 1/9th of Residue 57 Sunny Side Avenue Carnegie, PA 15106 8 Virginia Lynn(Sullivan)VanBlaricom Niece 1/9th of Residue 5323 Sand Lilly Drive Naperville,IL 60564 9 Jennifer Ann(Sullivan)Wright Niece 1/9th of Residue 10471 Montecito Drive Lone Tree, CO 81024 1 ......�..a mrri,,.e.i .,t.�..m.,,,. s ��Hizl�ft,D�,2�r�ii; L A t�� a F� � t c c s t3.ati�;[E:B. (�f�;r�i�i.F;i�� «�,��,��„ �1�,�-��1� ��NSON �, �>>,,,,�:� ��,��,,. r;�7��:��»� til��;s � ��,�r,��5 � �.�,c�1��, DAt IU��". T�1.L�c�l C',16u1 t� E3 11c�CI,nIN <<�,,. a s�,��fh UFFIE �t��, a t��, �� (i [i�,i:� � (,r�rrc ,i.�rrin 1ti Ril�i.i�� 1I:1i;1i C. 1)UFPtL l�li;f:� L.�'(,1SCIU JOH1 K.i�il�t)tit�} I�Rlhti�1' C,11i1'F!i i�11C1IAF,1.�.('1SSID1� . � NIF.L(SSA P.G[tli.l:Vl' OF COUNSE[. �l'�ll��.D. Al�vt.i;�� 1914-2014 I1�>l;�c 1:A. �otiss�>�� C. I�uy'�t"r:ii�>,ti�c�;.�t�. € ., �. _ ; ;� April 22, 2015 Register of Wills Office (Heidi) Cumberland County Courthouse One Courthouse Square Larlisie Fi-+ �i 7u�fi3 RE: Estate of Eric Douglas Sullivan Date of Death: July 23, 2014 Your File No. 21-14-0777 Our File No. 16254-1 Dear Register: Enclosed please find the our check in the amount of $15.00 representing the filing fee for the Supplemental Inheritance Tax Return. Thank you for your assistance in this matter. Should you have any questions, or require any additional information, please feel free to contact us. Very truly yours, OHNSON, DUFFIE, STEWART &WEIDNER . �i� I1 ��,.��JM'{`ti� Dana Wie eman Estate Administration Parale�al Enc. :695837 C� �c.� � �.�..� G O � c"� p' � � � ,LLi � i'1 y c? N a.� (1� "';:S �;,� C_�, ,,,,� �1 C=:3 ~ '.a � c,� .y-� ".��?� � '^�, � : � �� 1'�'1 ::, (".�' Q :_.{ � 4t� —� , � 301 ti1ARKE� STREET P0.B0� 109 LEJ�lOYtiC,PG�;:�'� :`� �`,:If� i i0�43-OIOy .� l�'�1'Zt'.Jl)S1t'�O�I i 11.7Eil.�i`i-�0 F:1�: i 1%76l.3(il� � 'Ik,C ;1)S�1'.Ct)\l JOHNSON, DUFFIE, STEWART & WE�{1�NE'R, P.C. .. . . .. . ., .. . . . ... ,: .,..., �.. �� ii iiu.., r � _.id� az� ��„,+ �•' ix: ,c3 .._ �;�"" �' ('��i �..., t�� '� �-, .. �..„�� (1 '.,� p�'�� ,��..{ ..., .6u7#�,. 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