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Home My WebLink About05-01-15 (2) , J � pennsytvania 15 0 5 61410 5 orvnHrnrHrovuevr��rvue EX(03-14�(FI) REV��OO OFFICIA�USE ONLY Bureau of Individual Taxes County Cotle Year File Number Po Box 2806oi INHERITANCE TAX RETURN ,��j � j) �/ (j, Harrisburg, PA 1712$-0601 RESIDENT DECEDENT `s�. T «' �'1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW 178-54-1297 02212014 03081958 DecedenYs Last Name Suffix DecedenYs First Name M� ' LEHMAN _ , KATHLEEN C (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`NITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) p 4.Agriculture Exemption(date of p 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes (Attach copy of wiii.) (Attach copy of trust.) � 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 O 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 LESLIE M. FIELDS (717) 761-2121 ' _ _ __ First Line of Address _ 831 MARKET STREET Second Line of Address City or Post Office State ZIP Code LEMOYNE _ PA !17043 Correspondent's emaii address: LFIELDS@COSTOPOULOS.COM REGISTER OF WILLSVSE ONLY G� �.�Ji REGISTER OF WIL�S USE ONLY C � � �� DATE FILED MMDDWYY � � '� � �7 .:..� '�? c� r`i ��,-, c`� —c :',� ;.z� ;,., ,,. r... ...{ r,-7 � �-,. �: �'r� �-, � , . ", , . .::? ,�:,3 . .., D,ATE'FILED MP ' , �.,.� ' - ,... � � + -, '-; _.ry "T'� : � �:. �.j __�� N ' ' f+1 , r`" PLEASE USE ORIGINAL FORM ONLY � N � � Side 1 i iiiiii iiiii iiiii iii�iiiii�iii iiiii i�ii iiiii iiiii iiii iiii J � 1 05 141 5 150567,4105 � � ��,��:,��,��„ �,��R�� . � 15056142�5 REV-1500 EX(FI) DecedenYs Social Security Number �ecedenrs Name: KATHLEEN C. LEHMAN 178-54-1297 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. 101,463.47 ' 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. . . . .. 6. ' 4,125.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Biliing Requested.. . .. .. . 7. 8. Total Gross Assets total Lines 1 throu h 7 . . .. .. .. .. .. . 8. ' 105,588.47 ' � 9 ). . .. .. ... ... .. .. 9. Funeral Expenses and Administrative Costs(Schedule H). .. . . . .. .. ... . . . ... 9. 8,494.30 , 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I).... .. ... . . . . . . 10. 11. Total Deductions(total Lines 9 and 10) 11. 8,494.30 12. Net Value of Estate(Line 8 minus Line 11) 97 094.17 ', . .. .. .. .. . ... .. . ... .. .. .. .. .. . 12. � 13. Charitable and Govemmental 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. ' 97,094.17 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 4,369.24 at lineal rate X.0 45 16. , _ 17. Amount of Line 14 taxable ' at sibling rate X.12 �� 18. Amount of Line 14 taxabie at coliateral rate X.15 _ �8' _ . 4,369.24 19. TAX DUE . .. .. .. . . . .. . . . . . .. .. .. . . . .. . . .... .... .. .. . .. .. .. . ... . . . . 19. ' _ . 20. FILI.IN THE OVAI 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 knowledge. SIGNATURE OF RS ESP LE FO G RETURN ��ATj �� 7' ADDRESS O � �flit�tJi! l�U' /'/'�k�l��Ie. / � I�d� 7 � �• SIGNATUR�F PREPARER OTH�R THA PERSON.RESPONSIBLE FOR FILING THE RETURN DATE �� ADDR� � / /'l..�/il�� E'rI'�0��^C' //-T � / U 7 � I��I��I"��I�I��'�II��'��'�'��I�'�'��I��(�'� Side 2 � � 150567,4205 1505614205 .�.ii,ii�,ii,�,r_rimiii � REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME KATHLEEN C. LEHMAN ________ STREET ADDRESS 7 Mountainview Terrace _..__ _ _ _ ___.___ - .__ _--__ _......___--- _ ___ __ __...__. — STATE ZI __.._ CNewville PA � 17241 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 4,369.24 2. Credits/Payments A. Prior Payments __.. __._ ___. B.Discount 0.00 (See instructions.) Total Credits(A+B) (2) 3. Interest �g� 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �4� 0.00 Fill in oval 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) 4,369.24 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 .......................................................................................... � � 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,bene6ts 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 decetlent own an"in trust for"or payable-upon-death bank account or security ai 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 io 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,antl 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 deceasetl child 21 years of age or younger at tleath 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 imposetl 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)]. • 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 indivitlual who has at least one parent in common with the tlecedent,whether by blood or adoption. �e.�i uirm i�i r ��m��7ii� � REV-15o8 EX+(o8-iz) � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS &MISC. �� INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT FILE NUMBER: ESTATE OF: Kathleen C. Lehman 2014-00469 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 disclased on Schedule F. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER �. Proceeds of litigation received on April 20,2015. Total settlement of$312,500 which the Department has 101,463.47 approved as 50%taxable minus 33113%counsel fees on the taxable amount($52,083.34) and 50%of the costs ($2,703.20)attributable to the taxable amount. TOTAL(Also enter on Line 5, Recapitulation) $ 101,463.47 If more space is needed,use additional sheets of paper of the same size. ��'""YIIII'llllfll "fllf�lll" ` REV-1509 EX+ (02-15) , pennsylvania SCHEDULE F . ... :� DEPARTMENTOFREVENUE ,70INTLY-OWNED PROPERTY INNERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER: ESTATE OF: 2014-00469 KATHLEEN C. LEHMAN If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A•Betty J. Lehman 84 Mohawk Road, Newville, PA 1724 Mother B. C. JOINTLY OWNED PROPERTY: _ LETTER DATE DESCRIPTION OF PROPERTY /o oF DArE OF oEArH ITEM FOR JO[NT MADE WCLUDE NAME OF FlNANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR yA UE OF AS ET DWT RESTS DECEDENT'S INTEREST NUMBER TENANT ]OINT [DENTIFYING NUMBER.ATiACH DEED FORJO[NTLV HELD REAL ESTATE. 1. a• 09126198 ritz craft mobile home 8,250.00 50% 4,125.00 TOTAL(Also enter on Line 6, Recapitulation) $ 4,125.00 If more space is needed,use additional sheets of paper of the same size. �`",.11lll�lll�lfl'I T'I�In�" ` . � �Ev-�sli ex+ (o�-r3) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FIIE NUMBER Kathleen C. Lehman 2014-00469 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; i' Egger Funeral Home, Inc. 4,702.00 Eby Granite Works 1,718.80 Cumberland Valley Memorial Gardens 1,795.00 e. 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 decedenYs address is not the same as claimant's,attach explanation.) Claimant ----------- Street Address ------- City State_______ZiP Relationship of Claimant to Decedent —_—.__ 4. Probate Fees: 278.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 8,494.30 If more space is needed, use additional sheets of paper of the same size. -�'+TM^II 11Pllf 11'll 1'llflll' 3