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HomeMy WebLinkAbout05-04-15 (2) _ � • pennsytvania 15 0 5 6 7,410 5 oevnar„im*ar��=venue EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO sOx 28o6oi INHERITANCE TAX RETURN �� /��-; � ��' Harrisburg, PA 17128-0601 RESIDENT DECEDENT ��,i;�� ' ( ��J � E ��y �s ENTER DECEDENT INFORMATION BELOW Sociai Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _ _ _ _ __. _ . ' 02062015 ' 11181948 Decedent's Last Name Suffix Decedent's First Name MI SCHORR ' DONNA (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 p 2. Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) p 4.Agriculture 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) p 7. Decede�t Died Testate p 8. Decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) p 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets � 14. 5pouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIOENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number __ _ _ _ . _ _ _ _ _ ':JODI RINEER (717) 571-2583 First Line of Address _ _ _ 32 CHERISH DR _ __ _. � � Second �ine of Address � � � M _ ._ ._ rn c-� � ca '� �? c� � � � ; City or Post Office State ZIP Code ��,� � C� � � � _ _ '� s � CAMP HILL _ __ ; � PA � °17011 _��.�.._x.r. �..�����, � �� __ __ � _� __.� _ :a .__ _ — ,, .� _E o Yry Correspondent's email address: - \ ` "� � � � � C� REGISTER OF.7WILLS U�E-�ONLI,.— . Q REGISTER OF WILLS USE ONLY �� ��,�. ��{ � � r�� 1'lllkTE Flk.�C3141�(�AD#�YYYY „ DATE FILED STAMP PLEASE USE ORIGINAL FORM ON�Y Side 1 � i iiiiii iiiii iiiii iiiii iiii�iiiii iiiii i�ii iiiii iiiii iiii iiii � 150 6141 5 1505614105 � �� ��a,��„,_,,��������� � __. .. _ J 15056142�5 REV-1500 EX(FI) DecedenYs Social Security Number �ecedent's Name: DONNA SCHORR I RECAPITULATION __. _ _. 1. Real Estate(Schedule A). .. . .. . .. .. . .. . . . .. ... .. . .. ... ... ... . ... .. . . . 1. 139,900.00 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. I 45,688.9� 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. .. . . 6. ' �_. ___� _�._ ..� �_. __.. �. m 7. Inter-Vivos Transfers&Miscelianeous Non-Probate Property ' (Schedule G) O Separate Biliing Requested...... . . 7. I 8. Total Gross Assets(total Lines 1 through 7). . . ... ... .. . .. . .. .. .. ... .. . . . 8. ' 185,588.90 ! 9. Funeral Expenses and Administrative Costs{Schedule H).. . .. . .. ... .. . ... .. 9. '' 7,624.15 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).. .. . .. .. .. .. . . 10. ' 1,930.62 11. Total Deductions(totai Lines 9 and 10). . .. . .. ... ... .. . . . .. ... .. . .. ... . . 11. ', 9,554.97 12. Net Value of Estate(Line 8 minus Line 11) .. . .. . .. .. . ... . ... ... .. . .. .. . . 12. ', 176,033.93 13. Charitabie and Governmental Bequests/Sec.9113 Trusts for which ----� �°---- - -•-•-._ .___ . __. an election to tax has not been made(Schedule J) .. . . .. ... . . .. . .. ... .. .. . 13. ' 14. Net Value Sub'ect to Tax Line 12 minus Line 13 14. ''� 176,033.93 ', 1 t ) .. ... ... ... . ... ..... .. . . 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_ i ( 15. �. _ .�__„__�.. �...._. �,_,rv.� �__,,,,� __..... __. � �__._.__,... .�..w � .�___ .__. W. ..._... 16. Amount of Line 14 taxable at lineal rate x.0 45 176,033 93 i 16. 7,921.53 ' : _....._ ._.... ._._, __. .�_. .� _ ._... _........ .. . .. ..__.. ..._ . 17. Amount of Line 14 taxable at sibling rate X.12 t ��� '� w,..,.. w_ . ��... _.�m _ ..._.._....� �,.....� ._� ._. ..,.�� ��_ ��_..� � 18. Amount of�ine 14 taxable at coilateral rate X.15 i ; 18. ; __ _ � _. .....___. _, _.. ..� . ..��_.. _ . _ 19. TAX DUE . . .. .. .. . .. .. . .. .. . . . .. . .. . .. .. . .. . . .. . . .. . .. . .. ... .. . . . . 19., 7,921.53 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 fiiing the return is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBIE FOR FILING THE RETURN DATE ADDRESS � i iiiiii iiiii iiiii iiiii iiii�iiiii iiii�iiiii iiiii iiiii iiii iiii Side 2 � 150 614 05 7,50561,4205 ..._ . . .. REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME DONNA SCHORR _ STREETADDRESS 103 HAMPDEN AVE CITY_ _. STATE ZIP __ CAMP HILL ' PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 7,921.53 2. Cretlits/Payments A.Prior Payments B.Discount 396.08 (See instructions.) Total Credits(A+B) (2} 396.08 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) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 7,525.45 Make check payable to: REGISTER OF WILLS, AGENT. � � ,� ��k -_ � � � � �� ,� � ,. •; : ,. '�, ���, P a� � ��. , r�� .. a�r., „° , PLEASE ANSWER THE FOL�OWING 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 accou�t,annuity or other non-probate property,wl�ich contains a beneficiary designation? ........................................................................................................................ ❑ � IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPI.ETE 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 tlates 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 chiid 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 chiltl 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 decedenYs 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 decetlent,whether by blood or adoption. ��v-is�z�x+{az-is) . pennsylvania SCHEDULE A DEPARTMENT OFREVENUE WHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both haviny reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disciosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedenYs interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' HOUSE -103 HAMPDEN AVE. CAMP HILL PA 17011 139,900.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 139,900.00 If more space is needed,use additional sheets of paper of the same size. ... . . .. REV-i$o8 EX+(o8-iz) � pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. �NHeR�Taruce Tnx a�uaN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: 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 �, Metro Bank Checking Acct.#513147835 3,854.30 2. Metro Bank Money Mkt Acct#537561995 12,773.79 3. Metro Bank CD #30119 1,605.02 4. IRA Acct Metro Bank 12,841.53 5, IRA Acct M&T Bank 35-004201788790 antl 35-004201830153 6,873.36 g. 2003 Toyota Rav4 6,315.00 7. Householtl Belongings-Hardees Auction 1,425.90 TOTAL(Also enter on Line 5, Recapitulation} $ 45,688.90 If more space is needed,use additional sheets of paper of the same size. Rev-.Ls:t�. Ex+ toz-�s� � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTIOfV AMOUNT A. FUNERAL EXPENSES: 1' Sullivan Funeral Home 4,030.00 2. Center Street Grill Funeral 1,213.65 B, ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State . _ ZIP_ ___ Year(s)Commission Paid: _. _ ___ 2,000.00 2. Attorney Fees 3. Family Exemption; (If decedenYs address is not the same as claimant's,attach explanation.) Ciaimant __ Street Address __ _ City _ State _ _ ZIP_. _ Relationship of Claimant to Decedent _ . 4, Probate Fees; 370.50 5. Accountant Fees: 6. Tax Return Preparer Fees: �• Notary Fees 10.00 TOTAL(Also enter on �ine 9, Recapitulation) $ 7,624.15 If more space is needed,use additional sheets of paper of the same size. _____ REv-isia Ex+�oa-ls� � pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT, INFiERITANCE TAX RETURN MORTGAGE LIABIIITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Donna Schorr 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� Home Owners Insurance(Penn National Ins) 318.00 2 Utilities UGI 70.00 PP&L 47.52 Verizon 10.53 Water 19.51 SewerlTrash 160.75 308.31 3 VitaLife Nursing Home 912.00 4 Kohis Credit Card Balance 392.31 TOTAL(Also enter on Line 10, Recapitulation) $ 1,930.62 If more space is needed,insert atlditional sheets of the same size. REV-'1513 EX+ (02-15) � pennsylvania SCHEDULE ] DEPARTMENT OF REVENUE gEN EFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Donna Schorr 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[Inclutle outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1• Jodi L Rineer 32 Cherish Dr.Camp Hill,Pa 17011 daughter 33.34 2 Keith Waggoner 235 Castle Rea Rd. Avondale,Pa 19311 son 33.33 3 Jennifer L.Thomas 1 Westminister Building Hershey,PA 17033 daughter 33.33 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 EI.ECTION TO TAX IS NOT TAKEN: l. 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.