HomeMy WebLinkAbout05-05-15 e_1
Qpennsyfvania 1505614105
omnnTn OFFnEvwue EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN aI I t
Harrisburg, PA 17128-0601 RESIDENT DECEDENT lD
4
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
71 04192014 11151917
Decedent's Last Name Suffix Decedent's First Name _ MI
Shaffer [Sophie 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
C=) 1.Original Return c@D 2.Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
C=D 4.Agriculture Exemption(date of C=:) 5. Future Interest Compromise(date of O 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
C=D 7.Decedent Died Testate O 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
C=3 10.Litigation Proceeds Received O 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets C=D 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
Mary L Mills (717) 938-1344
First Line of Address
481 Old Stage Road
Second Line of Address
City or Post Office State ZIP Code
Lewisberry PA 17339 Ca r�,l
� rn
O G7
Correspondent's email address: ` ' . .
REGISTER.O FWILLS��SE ONEY
��-
REGISTER OF WILLS USE ONLY
DATE FILED MMDDYYYY T1
Ga
Ltil � -rl
0
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
ii4iitIIiiiii 15 0 5 61410 5
bb LL LI J
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: SOPHIE L. SHAFFER (Supplemental Return)
RECAPITULATION
_ ---
1. Real Estate(Schedule A). ............................................ 1. 1
2. Stocks and Bonds(Schedule B) ....................................... 2.
i
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3.
j -
4. Mortgages and Notes Receivable(Schedule D) ........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 987.69
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. ! 987.69
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 1,902.00
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 11,178.29 i
11. Total Deductions total Lines 9 and 10 ................ ................. 11. I 13,080.29 f
12. Net Value of Estate(Line 8 minus Line 11) ............... ............... 12. ^ T -12,092.60 '
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. E� -12,092.60
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 F_
(a)(1.2)X.0_ 15. 1
16. Amount of Line 14 taxable
at lineal rate X.0 45 -12,092.60 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.
19. TAX DUE ........ -544.17 E
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 knowledge.
SIGNU OF PERSON RE PO SIBLE FOR FILING RETURN DATE
D <3o ars/s
ADDRESS
� encu
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
ADDRESS
Side 2 J
4 1505614205
REV-1500,EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENTS NAME
SOPHIE L. SHAFFER(Supplemental Return)
STREETADDRESS
CITY STATE ZIP
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) -544.17
2. Credits/Payments
A.Prior Payments 5,003.19
B.Discount
(See instructions.) Total Credits(A+B) (2) 5,003.19
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) 544.17
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.
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,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?.............. ❑ ❑
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+(o8-]2)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
SOPHIE L. SHAFFER (Supplemental Return) 2120140683
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.
3 Refunds deposited into the Estate Checking Account:
Pro-rated Hampden Twp.School Tax 599.73
Pro-rated 1 St Q Sewer Refund 133.96
Pro-rated Vacant House Insurance Refund 254.00
TOTAL(Also enter on Line 5, Recapitulation) $ 987.69
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(02-15)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SOPHIE L. SHAFFER (Supplemental Return) 2120140683
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Cost of Interement: Tri-County Memorial Gardens-04-06-2015 1,902.00
$ 457.00 Vault&Installation Charge
$1,445.00 Interment Fee
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:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 1,902.00
If more space is needed,use additional sheets of paper of the same size.
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ESTATE OF SOPHIE L SHAFFER 1007
MARY L MILLS,EXEC
481 OLD STAGE RD.
LEWISBERRY,PA 17339 DAA 491$1-1
PAY TOTHE7--. $
0
RDERIF &Arj;Ve�
9 .,DOLLARS ED
MM&TBank
mmo
403L3029551: 98 G 3 7800 9 5112-foo,
REV-1512 EX+(02-15)
17pennsytvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SOPHIE L. SHAFFER(Supplemental Return) 2120140683
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
3 Additional pro-rated Utility Bills 192.40
$ 90.65 PP&L
$ 76.07 UGI
$ 25.68 Am.Water
1st Quarter Sewer Bill 160.75
7 Pro-rated County Tax 15.19
10 Settlement Costs for Sale of House 10,780.00
$ 8,820.00 Agent Commissions
$ 350.00 Broker Fee
$ 15.00 Title Service
$ 1,470.00 Deed
$ 125.00 Deed Prep
11 Cost of Checks for Estate Checking Account 29.95
TOTAL(Also enter on Line 10, Recapitulation) $ 11,178.29
If more space is needed,insert additional sheets of the same size.
� = A. Settlement Statement (1-HUD-1)
lSCri li pati':=�'' .
B. Type of Loan
1_❑FHA 2.Q RHS 3.R Conv.Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number:
4.Q VA 5.Q Conv.Ins. 14-222 104305277
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
ftems marked(p.o.c.)"were paid outside the dosing,they are shown here for informational purposes and are not included in the totals
D- nta,,,o ^a E. Name and Address of Seller: F. Name and Address of Lender:
Estate of Sophie L.Shaffer Primary Residential Mortgage,
6007 Robert Drive Inc.
Mechanicsburg,PA17050 1480 No.2200 West
Salt Lake City,UT 84116
H. Settlement Agent: I. Settlement Date:
Midstate Abstract Company
2331 Market Street January 16,2015
Camp Hill,PA 17011 Ph. (717)763-1383
Place of Settlement:
2331 Market Street
Camp Hill,PA 17011
K. Summary of Seller's transaction
400. GrossAmount Due to Seller.
401. Contract sales price 147,000.00
402. Personal property
403.
404.
405.
Adjustments for items paid by Seller in advance
406. Ci !Town Taxes to
407. County Taxes - to
408. School Taxes 01/16/15 to 07/01/15 599.73
409. 1st Qtr.Sewer 01/16/15 to 04/01/15 133.96
410.
411.
412.
420. Gross Amount Due to Seller 147,733.69
500. Reductions in Amount Due Seller:
501. Excess deposit see instructions
502. Settlement charges to Seller Line 1400 14,940.75
y 503. E)astin loans taken subject to
504. Payoff First Mortgage
505. Payoff Second Mortgage
506-
507. (Deposit disb.asproceeds)
508.
509.
Adjustments for items unpaid by Seller
510. Ci /Town Taxes to
511. County Taxes 01/01/15 to 01/16/15 15.19
512. School Taxes to
513.
514.
515.
516.
517.
518.
519.
520. Total Reduction Amount Due Seller 14,955.94_
600. Cash at settlement tolfrom Seller
601. Gross amount due to Seller line 420 147,733.69
602. Less reductions due Seller(line 520) ( 14,955.94,
603. Cash ❑X To EY
From Seller 132,777.75
nt&any attachments referred to herein
Seller Estate of Sophie L.Shaffer /,
U Settlement Char es
T00.Tutal Real Estate Broker Fees $8,820.00 Paid From Paid From
Division of commission(line 700)as follows• Borrower's Sellers
701 0 Banker Residential Brokerage Funds at Funds at
702. 4,410.00 to RE/MAX REALTY ASSOCIATES Settlement Settlement
703.Commission paid at settlement 8.820.00
704. Broker Fee to Coldwell Banker Residential Brokerage 350.00
705. Broker Fee to RE&W Really Associates,Ina 295,00-t-
800.Items Pa able in Connection with Loan
801.Our origination charge $ 995.00 from GFE#1
802.Your creel or charge(points)for the specific interest rate chosen $ (from GFE#2) -
803.Your ad'u ed origination charges from GFE#A 995.00
804.Appraisal fee to NVS from GFE#3 425.00 '
805.Credit Re ort to from GFE#3
806.Tax service to from GFE#3
807.Flood certification to from GFE#3
808. from GFE#3 _
009. from GFE#3
810. from GFE#3
811. (from GFE#3)
000.Items Re uired by Lender to Be Paid in Advance
901.Daily interest charges from 01/16/15 to 02/01/15 16 $9.395830/da from GFE#10 150.33
902.Mortgage insurance premium for months to from GFE#3 _
903.Homeowners insurance for 1.0 years to State Farm Insurance from GFE#11 717.00
04. from GFE#11
905. (from GFE#11)
1000.Reserves Deposited with Lender
1001.Initial deposit for your escrow account (from GFE#9) 864.01 !"
1002. Homeo ner's insurance 2.000 months @ $ 59.75 per month $ 119.50
1003. Mortgage insurance monthsper month
tel.
1004. Property taxes $ 1,085.92 ¢ '
Countv Taxes 11.000 months 30.19 per month
School Taxes 7.000 months 107.69 per month '-
1005.
1006. months Q $ per month $
1007. months @ $ per month $
1008. $
1009. Aggregate Escrow Adjustment $ -341.41
1100.Title Charges
1101. Title services and lender's title insurance from GFE#4 1,296.10 15.00
1102. Settlement or dosing fee
1103. Owner's title insurance to First American Title Insurance Company from GFE#5 367.40
1104.lender's title insurance to First American Title Insurance Company 1,081.10
1105. Lender's title policylimit $ 82 000.00 y
1106. Owner's title policy limit $ 147,000.00
1107. A ent's portion of the total title insurance premium to Midstate Abstract Company 1,298.68 - -
1108. Underwriter's portion of the total title insurance premium to First American Title Insurance Company $ 149.82
1109. $
1110. $
1111. $
1112. $
1113. $
1200.Government Recording and Transfer Charges
1201.Government recording charges to Recorder of Deeds Office from GFE#7 180.00
1202.Deed $ 79.00 Mort-gage 101.00 Releases Other
1203.Transfer taxes to Recorder of Deeds Office from GFE#8 1,470.00
1204.Citv/County tax/stamps Deed 1,470.00 Mortgage - - 4
1205.State tax/stamps Deed $ 1,470.00 Mortgage $ 1,470.00
'1206.
1207.
1300.Additional Settlement Charges
1301.Required services that you can shop for from GFE#6
1302. $
1303. Deed Prep. to Guardian Transfer $ 125.00
1304. 1 st Qtr.f3ewer to Hampden Township Authority $ 160.75
1305. Escrow Pending final inheritance tax return to Midstate Abstract Escrow Account $ 4,000.00
1400.Total S ttlement Charges(enter on lines 103,Section J and 502,Section K) 6,759.84 14,940"75
'Paid outside of dosing by borrarer(B),seller(S),iender(L),or twd-party(T) �r /
By sigrArg page 1 of this statement.the signatories acknowledge receipt of a completed copy of page 2&3 of Ws Uree page statement.
i L
REV-1513 EX+ (02-15)
, I pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
SOPHIE L. SHAFFER (Supplemental Return) 2120140683
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).]
I. Mary L Mills Child 1/3 Share
481 Old Stage Road $31,543.44
Lewisberry,PA 17339
2 Jacqueline L.Jumper Child 1/3 Share
1641 Main Street, Lisburn $31,543.44
Mechanicsburg,PA 17055
3 Warren D.Shaffer Child 1/3 Share
199 Blue Mountain Drive $31,543.44
Lewistown,PA 17044
*Share dollar amount based on assumption of a$544.17 Refund
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:
1.
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.