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Home My WebLink About04-27-15 (2) 1505610143 REV-1500 EX(01-10) io OFFICIAL USE ONLY PA Department of Revenue pennsylvania County code Year File Number Bureau of Individual Taxes AEPAFUNFW OF REVENUE PO BOx.280601 INHERITANCE TAX RETURN 2 1 15 0 0 0 5 3 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 12 27 2014 03 13 1966 i Decedent's Last Name Suffix Decedent's First Name MI 1 GOOLD STEVEN C (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI GOULD KIMBERLY J Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ❑ 2. Supplemental Return I3 3.Remainder Return(date of death prior to 12-13.82) 4. Limited Estate ❑ 4a,Future Interest Compromise ❑ 5. Federal Estate Tax Return Required (date of death after 12-12-02) 138, Decedent Died restate [37. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of W0i) (Attach Copy of Trust) ❑ 9. Litigation Proceeds Received ❑ 10.Spousal Po Credit(date of death ❑ 11.Election to tax under Sec.9113(A) between 1231 l and 1-1 95) (Attach SCh.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number SAMUEL L ANDES , 717 761 5,.3,61 REG I OF WILtX)USE 9Ng rT1 C**) First line of address r (V r rt r._ M —3 525 NORTH 12TH STREET Second line of address 3 DATE FILE r— City or Post Office State ZIP Code --.] LEMOYNE PA 17043 Correspondent's e-mail address: Sam uelAndes168@gmail.com Under penalties of perjury,I declare that 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 personal representative is based on all Information of which preparer has any knowledge. SIGNATU)IE OF PERSO SPONSIBLE FOR FILING RETURN DATE Kimberly J. Gould AD ESS ' 2130 Canterbury Drive, WChaollburg, PA 17055 SIGN RE F PRE ROTH REP ES A IVE DATE Samuel L Andes 13 nRf / A ESS 525 North 12th Street, Lemoyne, PA 17043 Side 1 1505610143 1505610143 J r .. 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: G O U L D, STEVEN C 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&Notes Receivable(Schedule D).......................................................... 4. 5• Cash,Bank Deposits&Miscellaneous Personal Property 36 , 934 . 70 p p rty(Schedule E)................ 5. 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 1-7)....................................................................... 8. 36 , 934 . 70 9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 13 , 540 . 58 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1)................................ 10. 2 , 966 . 36 11. Total Deductions(total Lines 9&10)...................................................................... 11. 16 , 506 . 94 12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 20 ,427 . 76 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. 20 , 427 . 76 TAX COMPUTATION-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 10 , 213 . 88 15• 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 10 , 213 . 88 16• 459 . 62 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..................................................................................................................... 19. 459 . 62 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21 - 15 - 00053 Decedent's Complete Address: DECEDENT'S NAME Gould, Steven C STREET ADDRESS 2130 Canterbury Drive CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 459.62 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 0.00 3. Interest (3) 0.00 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) 459.62 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 propeity transferred;.................................................................................. ❑ ®' b. retain the right to designate who shall use the property transferred or its income;.................................... ❑ y" c. retain a reversionary interest;or.................................................................................................................. ❑ L✓J d. receive the promise for life of either payments,benefits or care?.............................................................. F] 2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without ❑ / receivingadequate 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 lcontains 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)(1)]. 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 stepparent 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 1.2)[72 P.S.§9116(a)(1)l. •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 bloo�or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX A%RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Gould, Steven C 21 - 15-00053 Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 8 Final pay from Commonwealth of Pennsylvania, including accrued and unpaid sick and 36,534.70 vacation pay 9 Miscellaneous items of personal clothing and personal effects 400.00 TOTAL(Also enter on Line 5,Recapitulation) 36,934.70 SCHEDULE H FUNERAL EXPENSES& COMMONWEALTH OF PENNSYLVANIA �A �w INHERITANCE TAX RETURN AD INE I f WB&(QOM RESIDENT DECEDENT o,w,,v-�,.-`COM vv ESTATE OF Gould, Steven C FILE NUMBER21 - 15-00053 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Malpezzi Funeral Home(funeral bill) 8,391.40 2 Country&Town Baptist Church (post-funeral reception) 225.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Years)Commission paid 2. Attorneys Fees Samuel L.Andes 1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Kimberly J. Gould 3,500.00 Street Address 2130 Canterbury Drive city Mechanicsburg State PA Zip 17055 Relationship of Claimant to Decedent Wife 4. Probate Fees Register of Wills 190.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 8 Cumberland Law Journal(advertising) 75.00 TOTAL(Also enter on line 9, Recapitulation) 13,540.58 C Schedule H COMMONWEALTH OF PENNSYLVANIA Full NW EMmses& INHERITANCE TAX RETURN A&T Cosft(or*nwd RESIDENT DECEDENT ESTATE OF Gould, Steven C FILE NUMBER 121 - 15-00053 9 The Sentinel(advertising) 158.68 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gould, Steven C FILE NUMBER21 - 15-00053 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 8 Holy Spirit Hospital(emergency room fee) 50.00 9 Chase credit card 2,916.36 TOTAL(Also enter on Line 10, Recapitulation) 2,966.36 REV-16'1,3 EX+(11-08) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Gould, Steven C FILE NUMBER 21 - 15-00053 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not Ust Trustee(s) I� TAXABLE DISTRIBUTIONS jinGude outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Preston Gould Son 16.67% 706 Henry Street Mechanicsburg, PA 17055 2 Madison Gould Daughter 16.67% 706 Henry Street Mechanicsburg, PA 17055 3 Kennedy Gould Daughter 16.66% 2130 Canterbury Drive Mechanicsburg, PA 17055 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1511P EX+(9-00), vow SCHEDULE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF Gould, Steven C FILE NUMBER 21 - 15-00053 RELATIONSHIP TO SHARE OF�ESTATE AMOUNT OF ESTATE RELATIONSHIP t�� NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY 00 Not List Trust*s) TAXABLE DISTRIBUTIONS Include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 4 Kimberly J. Gould Wife 50% 2130 Canterbury Drive Mechanicsburg, PA 17055 Page 2 of Schedule J