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HomeMy WebLinkAbout01-0006 REV-1500 Ef i~-IIO) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 / C;:,' - /9 <P'- II REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FI~ NUMBER ~.i-C>~ OO'OOG. COUNTY CODE YEAR NUMBER w .... ::.:::$tf.l Oil"" W"O ",00 00:"" ..lD .. " OFFICIAL USE ONLY I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) IlVlC/t;,. lZj....SIE '/c. DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) (}t-2-/-~0<90 d~-.J-S-/7'// (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER 5'03 - /0 3tf30 ~1,OriginaIReturn o 4. Limited Estate 06. Decedent Died Testate (Allach oopy of Will) o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a, Future Interest Compromise (dale of death after 12-12-82) 07. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit(d.ateol..w.a\hbe~ \1-31-91 arnl1-1-95) o 3. Remainder Return (date of death \ll"io[ to 12-1~a2) o 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11, Election to tax under Sec. 9113(A) (Altacl1 Sell 0) .... z w o z o .. .. W 0: 0: o <.> NA~ t:5fl;<J.3~ FIRM NAME (If Applicable) I. Bte/42:) L - COMPLETE MAILING ADDRESS "5/0 ~ cr #66, /J4 /71'// TELEPHONE NUMBER 717- 6-/S"- 2. 1;,- 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) OFFICIAL SI:' ONLY (') () o 6 ..34.,4:3 7. ~3 z o ~ ;:) I- 0: <C u w 0:: 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 7. Inler-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule GorL) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) /, 9~;t,(J7 5~ 6-0 S:. 3 fo (6) ('- ) (7) o 3G;, ~37. ~~ (9) (10) (8) / / 95. () 0 -73-1. 0,/ (11) (12) (13) 12. Net Value of Estate (line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) .:'5 '/. .<,-05"",3.6 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o !;i I-' ;:) ll.. ::E o u ~ 15, Amount of Line 14 taxable althe spousal tax rate, or transfers under Sec. 9116 (a)(1.2) i) ,.0_ (15) 3 <-/, S-oS: X ,0 ~(16) o ,.12 (17) Cl , .15 (18) /;-'Jo",z.7</ 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 141axable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due (19) /6-5.;(.7</ 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS P-"J S )I /I/J i) J ~ oS T .4 2- /1 CITY CA USee: Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + 8 + C) (2) 3. InteresUPenally if applicable D. Interest E. Penalty TotallnteresUPenally ( 0 + E ) (3) 4. ~Une 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) .' ZIP / 7()/..:3 /Q"S'';;; ,771' 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. IS5';? . 7';/' A. Enter the Interest on the tax dUe. (5) (SA) 8. Enter the total of Une 5 + SA. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT /oS';?,7<< PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS No ~ IX! IRI I2SJ IRI lEI Ves o o ..0 .......0 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;................... ...m.............., ........................................... b. retain the right to designate who shall use the property transferred or its income; ................." c. retain a reversionary interest; or....................................... .......................... .............................. d. receive the promise for life of either payments, benefits or care? ............. ................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........... .................... ............. .............................. 0 3. Did decedent own an "in trust fa!' or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or otner non-probate property which contains a beneficiary deSignation? .... .................... .. ................... ...................0 1:0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN, SIGNATURE Under penalties of perjury, I declare tI1atl have examined this return, incruding accompanying schedules and statements, and to the best of my knowJecJge and beljef, it is true, correct and complete. Declaration of preparer other than tI1e personal representative is based on all information of which pre parer has any knowledge. DATE /2 -00 ADORE S 4-S-/0 ~Ce.. ~ ///-5'tY-, A SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE /? // I ADDRESS DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. ~9116 (a> (1.1) (i)). For dates of death on or affer January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from lax, 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 dales of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a sfepparent of the child Is 0% [72 P.S. 99116(a)(1.2)]. The lax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries IS 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on Ihe net value of transfers to or for the use of the decedent's siblings is 12% [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.''''''''''.9n. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R SlDENl DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF rJU~/r., iZt...Sl€.. IC, FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of sUlVivol'Ship must be disclosed on Schedule F. ITEM NUMBER 1. I-IAI<.iVS PD. Bo K VALUE AT DATE DESCRIPTION OF DEATH sA II 11U<i.-:S oA/.l/(; Gi/e-eJ(/NG.- 1/6tlr.i: /~ ~o:531&':2- /0,337.413 17//, NEGr,;C:A /71-5- 1711 2, fe-Rb6/JA L C J. () 7;/1 N G-/ ,j €Z<.JeL-ICy zs-o.oo 3. C LlI!./J I ru,<€- 4.sD . IJ 0 4. . ReruR. AJ l! t:= pe;OoSIT F i<.C/H (! If c/l!.cH .:1-..- 6-0 D ,fo; AI /I /fIJ!J i/&/Z 57> CA,et-/5LI?, A /70/3 Ifc,fiY€ J ZS, t.,/(UI.iJO TOTAL (Also enter on line 5, Recapitulation) $ 3':;', "f!:J 7. -'/3 (If more space is needed, insert additional sheets of the same size) R~S Leaving Our Mark. Harris Savings Bank PO Box 1711 Harrishurg, PA l71lY>.171l MembtlrfDlC ElSIE K INRIG 825 N HANOVER ST # 211 CARLISLE PA 17013.1539 STATEMENT DATE 8/18/00 1127 iAGE 1 ACCOUNT NUMBER TYPE OF ACCOUNT: 2100033162 FIFTY PLUS FREE INTEREST PAlO YEAR 10 DATE 13.56 ANNUAL PERCENTAGE YIELD EARNED (APYEl 1.10 J DAYS IN CYCLE i VERAGE BALANCE 31 9,IB3.79 ---------------------------------~----------------------------------------------------------------------------------------- PREVIOUS BALANCE DEPOSITS WITHDRAWALS CHARGES lNlEREST ENDING BALANCE B07,5B 10.699.00 U77 .63 .00 8.48 10,337.43 DATE ACTIVITY DESCRIPTION DEPOSITS WITHDRAWAL S aALANCE 7/24/00 MONEY ACCESS SER/OOA 1R6046 60 .00 141.58 921 CAVALRY RD CARLISLE. ?A 7/24/00 CHECK #1108 86.69 660.19 7/25/00 MONEY ACCESS SERIDDA TR3269 9.825,00 10.485.89 6075 ALLENTOwN BLV HARRISBURG. PA IlmOD CHECK *1:09 121.00 ID.364.89 7131/00 CHECK 11110 74.18 10,290,11 8/02/00 US TREASURY 303/S0C SEC 874.00 11.164.11 8/02100 CHECK 11112 13,30 11.150,81 8/03/00 CHECK 111ll 500.00 10,650,81 8/04/00 CHECK 1l1l3 40.73 10.610.08 8/07/00 AAR? HEALTH CARE/?REMIUM 127,0~ 10,483,08 8/07100 CHECK #1115 85. )) 10,397,31 8/11/00 CHECK tlll6 5o.GO 10.341.31 8/16/00 CHECK 11117 18.36 10.328,95 8/18/00 INTEREST EARNEG 8.48 10.331.43 CHECK SUMMARY , indicates skip in check numbers AMOCNT DATE CHECK NO. AMOUNT OATE CHECK NO, AMOUNf DATE CHECK NO. 7(24/00 1108 86,69 SlD3iOO 1111 5,0,Oj 8/07/00 ll15' 85. )) 7/17/00 1lO9 111.00 8/02/CJ 111" 13.30 8/ll/00 ll16 50.00 ....l 7/3l100 IlIO 74.78 8104/00 l' ~ ~ JU3 8/16/CO 1"" 18,36 .,. I" -------------------------1i'ed-'asiinippTy-foi'-' .Rarrls-loeii-Hoiid'y-tiii'oilgh7i'tilay-before------------------- . ------------- 2:00 p,m. and we guarantee you a creoit answer that sam. d,y or we'll p'y you 1100.00 tn cash! Apply tOday' Customer .ltknri..-e 1.80Q..232-6995 . HarnsAccess JjIW ("'17) 731-IB5 Of TOI.L ~'REE 1-800~2"".7991 . w\\v.'_l1arrissavin: ....bank,com POO.S02 (7/99! AEV;1511 EX+ (12-99) _ . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF flJ /ZIG FILE NUMBER ,tZ"L5/€ K. ) - Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. f'A eX? €1?1AT/'(),u \5Oc/ETY if? /Iy,?- p-o B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s} Social Security Number(s)/EIN Number 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's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enler on line 9, Recapitulation) $ //pgc;o (If more space is needed, insert additional sheets of the same size) ~ REV.1$12 EX' P-9?) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETUR~J RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS EST ATE OF I/l/R./"=, eL.-$/,E /C ' FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION W8/J)f /fote'O<:!14 (C.K:e-1Nr C,",,{'.llJ BR-Oe..J(/€ jJ/I,qRmAT€Z?~ AMOUNT "/D,~ 0 2, .3. c~u I2..C/-I tT/- G 02:> ,H'oi/?€ ..3"/. 73 is -I. .:5 '/ TOTAL (Also enter on line 10, Recapitulation) $ 7 if> t.I- ~ 7 (If more space is needed, insert additional sheets of the same size) RE"~1513 EX+ (9-00) '. '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF rA/R/C;, ELs/e ..K FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONIS) RECEIVING PROPERTY Do Not List Trustee{s} OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 la) 11.2)J 1 t: //f-/Py L. 73E?/t.J/?7AI?I A:_s 612.A/Jj;,bI\U611'7l':7f. 00.% /? o. ,<SO)<. 2-SSC 0/L<.ES - 'BAI2-"'€, /'.11 / <f;74..3 2. ?J4RB-41f!JI :T. ,B,<2fiPt!-c=y 'DAV6-/fn=:-re:. ~ (;SIO T~CE CT rll'Il2i?./S'bUl2fd, ft /7,01 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV.1500 COVER SHEET II NON.TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 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, insert additional sheets of the same size) \;/6-/9J7-// COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE c/- 7) C/ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX BARBARA L BRADLEY 6510 TERRACE CT HBG , , t...I1 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 02-27-2001 INRIG 08-21-2000 21 01-0006 CUMBERLAND 101 , II '* REV-15~7 EX lFP 112-10) ELSIE K PA ,Ull1 Allount Rellitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=is4'-Ex--AFP--f12=OOY-NoYicE--oF-YNHEifiTAifcE-YAx-jrpPRjrisEifENT~-ALrOWANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF INRIG ELSIE K FILE NO. 21 01-0006 ACN 101 DATE 02-27-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) S. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets U) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 36,437.43 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) UO) 1,198.00 734.07 Ul) (2) (3) (4) NOTE: To insure proper credit to your account, subllit the upper portion of this form with your tax paYllent. 36,437.43 1.932 07 34,505.36 .00 34,505.36 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: IS. Allount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: US) .00 X 00 = .00 (6) 34,505.36 X 045 = 1,552.74 un .00 X 12 = .00 (8) .00 X 15 = .00 (9)= 1,552.74 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 01-02-2001 AA477837 .00 1,552.74 TOTAL TAX CREDIT 1, 552 . 74 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) tfi ij1 )> s::: . 0 U' ti1 c Cr: c' z .,,'. -l ru iU l1 L. ,,-~.1 'J ~ :- + .." ~ <::> I m ~ JJ m s::: )> tfJ JJ m ^ )> tfJ r r-J in n T '# ,- i'J ~.-,i JJ m o m <: )) .'i:m IT"' i> 0 G'; :r:,~ :"-' -l.'J "'-, ,J,.' ,~ .r:.~ 1-' r~'. 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