HomeMy WebLinkAbout01-0061
REV-150oEX(6-00)
.
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
~
Z
W
o
W
()
W
o
w
'"'
::.::500
u"''''
w"u
",00
U"'-'
..Ill
..
"
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF DEATH (MM-DD-YEAR)
;1,; __ ;)D02 - lc
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
&2.1--0l..
___JlL
NUMBER
COUNTY CODE
YEAR
SOCIAL SECURITY NUMBER
7
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-YEAR)
8 24 68
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[X] 1, Original Return
o 4. limited Estate
o 6. Decedent Died Testate (Attach copy 01 Will)
o 9. litigation Proceeds Received
o 2. Supplemental Return
D 4a. Future Interest Compromise (dale 01 death after 12-12.82)
o 7. Decedent Maintained a Living Trust (Attach copy 01 Trusl)
o 10. Spousal Poverty Credit ldalll 0\ death OON4W\ 12-:,1..g, and 1-1-S5)
o 3. Remainder Return (date 01 dealh priOf 10 12.13.821
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election \0 tax under Sec. 9113(A) (Attach ScI1 0)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F)
5 o Separate Billing Requested
::l 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
~ (Schedule G or L)
a:
.:( 8. Total Gross Assets (total Lines 1-7)
0 Funeral Expenses & Administrative Costs (Schedule H)
W 9.
0:: Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
10.
11. Total Deductions (total Lines 9 & 1Q)
12. Net Value of Estate (Line 8 minus Line 11)
'"'
"
w
o
"
o
..
ID
~
NAME
FIRM NAME (II Applicable)
TELEPHONE NUMBER
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to lax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
COMPLETE MAILING ADDRESS
246 Oak Crave Court
Mechanicsburg, PA 17055
(1)
(2)
(3)
(4)
(5) 'inn nn
(6) 900 gg
(7)
(8)
(9) 1 n 1 h 1 n4
(10) h , nnl nh
OFFICIAL USE ONLY
/-" ..
1,400.66
ill)
(12)
(13)
1h 1h.? 1n
(H,76L~~)
(14)
(14 71;1 LlLl)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
x.O_ (15)
x.O_ (16)
x .12 (17)
x .15 (18)
(19)
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
z
o
<
I-'
::l
f1.
:E
o
()
~
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
20.0
Decedent's Complete Address:
I=m~~
CITY :::R::: 0::::: Court
.
I STATE
PA
I ZIP
170~~
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + B + C) (2)
3. InleresVPenaUy if applicable
D. Interest
E. PenaUy
TotallnteresVPenalty ( D + E ) (3)
4. If Line 21s greater than line 1 + line 3, enler the difference. This is Ihe OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If line 1 + line 3 is greater than Line 2, enler the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax dUe.
(SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
Yes
...u.'Uu".. . 0
......0
............0
u'u 0
...........0
o
...g 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,
1. Did decedent make a transfer and:
a. retain the use or income of the property Iransferred;u
b. retain the right to designate who shaH 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? . ................... m................
3. Did decedent own an "in trust fo( 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? .m .................. ....................."
No
IKJ
IXI
IKI
IKJ
IX]
IX]
Under penalties of perjury, I declare thai I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tnre, correct
and complete.
Declaration of preparer other than the personal represenlalive is based on all inlorrnation of which preparerhas any knowledge.
E OF PERSON RESP NSIBlE FOR FILING RETURN
yn~
DATE
o
ADORES
246 Oa~ Grove Court Mechanicsburq PA
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
17055
DATE
ADDRESS
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 sUNiving spouse is 3%
[72 P.S. $9116Ia) (1.1) (i)J.
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% [72 P.S. $9118 la) (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 retum 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent offhe child Is 0% [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%, except as noted in 72 P.S. $9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of Ihe 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.
III
REV.'''''''.''.7'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
R [DENT ECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Michael S. Mason
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointfy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
500.00
1982 Datsun 280Z
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
500.00
REV.1513EX+11-97)
COMMONWEALTH OF PENNSYLVANIA
INHE.RITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
M;rh",,' " M"Qnn
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS (include outright spousal distnbutions)
1. Roderick F. Mason Father 50%
2 . Wanda L. Mason Mother 50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11. 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)
'EV.''''''''.''''.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
FILE NUMBER
Mirnr:lpl ~ Mrlc::::nn
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
Roderick F. Mason
246 Oak Grove Court
Mechanicsburg, FA 17055
Father
B.
c
JOINTLY -OWNED PROPERTY:
LEITER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. Members 1st Federal Credit Union 1,634.42 50% 817.21
Acct #172359
2 A Members 1st Federal Credit Union 166.90 50% 83.45
Acct #134045
TOTAL (Also enter on line 6, Recapitulation) $ 900.66
(If more space is needed, insert additional sheets of the same size)
"".,,""'.,..".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Michael S. Mason
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
ThiS schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTOOECEDENTANOTHE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATTACH A COPYOFTHE OEEO FOR REAl ESTATE. VALUE OF ASSET INTEREST IFlIPPllCABLE\
NUMBER
1. Roth IRA Janus Fund 820.23 100% 820.2~ 0
2 Excel Logistics Retirement/Savings 11,366.85 1(1)0% 1,366.85 0
Both accounts were subject to 10%
penalty if accessed prior to 59~.
TOTAl (Also enter on line 7, Recapitulation) $ 0
(~more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
~'-,'...,D
~ " ).')\
....,.,;.'..~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Mir'hrl~l ~ M;::lc::nn
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezzi Funeral
Home Funeral Service 5,025.00
Mechanicsburg, PA
2 Thomas Weber Paster, Mchbg PA 50.00
3 Brown Funeral Home Funeral ServIce 3,287.51
Martinsburg, WV
4 Martinsburg Granite Co Monument 1,638.34
Martinsburg, WV
5. Ste~hensons's Florist Casket Spray 110.19
6 DanIel Montague Pastor, Mtsbg WV 50.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Repr€s€ntatilJe(s)
Social Security Number(s)/EIN Number 01 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 01 Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6, Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 10,161.04
Debts of decedent must be reported on Schedule 1.
(/f more space is needed, insert additional sheets of the same size)
REV.1512 EX + 11-9?)
ESTATE OF
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
Michael S. Mason
Include unreimbursed medical expenses.
ITEM
NUMBER
4
6
7
8
DESCRIPTION
AMOUNT
1,500.00
1.
MEMBERS !ST Federal Credit Union
Loan Payable Acct #172359
2
Loan Payable - Roderick F. Mason
1,500.00
3
Erie Insurance Group Auto Policy #Q083006169H
6.00
Holy Spirit Hospital
1,523.50
5
West Shore Emergency Medical Services
591.06
Silver Springs Ambulance
380.00
Mary Murray, Tax Collector
2000/2001 CV School District
489.50
Mary Murray, Tax Collector
2000 Monroe Township Tax
11.00
TOTAL (Also enter on line 10, Recapitulation) $ 6, 001 . 06
(If more space is needed, insert additional sheets of the same size)
\,/~ -0202-- ~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
51
~
U
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
t..J.
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
02-27-2001
MASON
09-02-2000
21 01-0061
CUMBERLAND
101
RODERICK F MASON
246 OAK GROVE CT
MECHANICSBURG
*
REV-1S41 EX AFP <12-00>
MICHAEL
S
Allount Rellitted
PA ~1~055
, .,1,
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:is4j-Ex-iFP-(i2:oo1--NOTicE--oF-I-NHEifiTANci-'~"-Ai-A-PPRAiSEMENY-,--iii-oWANCi-oi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MASON MICHAEL S FILE NO. 21 01-0061 ACN 101 DATE 02-27-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RES~RVATION 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. Hortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
.00
.00
500.00
900.66
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
10,161.04
6.001.06
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this forll with your
tax payment.
1,400.66
16.162 10
14,761.44-
.00
14,761.44-
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
IS. Allount of Line 14 at Spousal rate (IS)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
.00 X 00 =
.00 X 045 =
.00 X 12 =
.00 X 15 =
(19)=
.00
.00
.00
.00
.00
PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
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 PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT-- (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)