HomeMy WebLinkAbout05-19-15 1505614134
EX(03-14)(FI)
REV-1508 OFFICIAL USE ONLY
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 3 1 6 2 0 1 5 1 0 2 4 1 9 3 ?
Decedent's Last Name Suffix Decedent's First Name MI
S H A M M 0 G E R A L D I N E A
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name Mi
THIS RETURN MUST BEFILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1.Original Return ❑ 2.Supplemental Return 3. Remainder Return(date of death
Prior to 12-13-82)
❑ 4.Agriculture Exemption ❑ 5. Future interest Compromise(date of ❑ 6, Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
❑ 7.Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 9.Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
❑ 10.Litigation Proceeds Received ❑ 11.Non-Probate Transferee Return 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13. Business Assets ❑ 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
J A C Q U E L I N E A K E L L Y ? 1 ? 5 4 1 5 5 5 0
First Line of Address
8 4 5 S I R T H 0 M A S C 0 U R T
Second Line of Address
S U I T E 1 2
City or Post Office State ZIP Code
H A R R I S B U R IS P A 1 ? 1 0 9
Correspondent's e-mail address: JACKI E0JAN BROWN LAW.COM
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REGISTER OF WILLS USE ONLY C)
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DATE FILED MMDDYYYY
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PLEASE USE ORIGINAL FORM ONLY
Side I
1111111 VIII VIII VIII illll VIII VIII VIII Illli VIII IIII IIII
1505614134 1505614134
1505614234
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: GERALDINE A - SHAMMO
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 and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 1 2 4 0 . 0 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 3 7 2 2 . 2 5
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 5 7 8 9 4 . 9 0
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 6 2 8 5 7 . 1 5
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 5 2 4 9 . 3 4
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 1 4 7 4 6 . 6 5
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 9 9 9 5 . 9 9
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 4 2 8 6 1 . 1 6
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. 4 2 8 6 1 . 1 6
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 _ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X.045 2 4 2 8 9 . 2 2 16. 1 0 9 3 . 0 1
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 1 8 5 7 1 . 9 4 18. 2 7 8 5 . 7 9
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 3 8 7 8 • 8 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑X
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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN TE
DA
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ADDRESS
10 SGRIGNOLI LANE, ENOLA PA 17025
SIG TUREOFPREVAREROTH N, ERSON RESPONSIBLE FOR FILING THE RETURN DATE w��
AqbRESS
5 S R THOMAS COURT, SUITE 12 HARRISBURG PA 17109
111111111111111 III1I 111111111111111 IN IN Side 2
L 1505614234 1505614234 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 0 0
DECEDENT'S NAME
GERALDINE A. SHAMMO
STREET ADDRESS -- - -. _. ------_-__--. .__. ___ _ ------ ------_—_- ---
100 MOUNT ALLEN DRIVE Y —
CITY - ---- — ---TSTATE ZIP--
MECHANICSBURG PA 117055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 3,878.80
2. Credits/Payments
A.Prior Payments _
B.Discount _ 193.9_4_
(See instructions.) Total Credits(A+B) (2) 193.94
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) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 3,684.86
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 ...................................................................... ❑ ❑X
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑X
c. retain a reversionary interest ..................................................................................................... ❑ ❑X
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? ....................................................................................... x❑ ❑
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ Q
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 decedents 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-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
GERALDINE A. SHAMMO 0 0
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. Erie Insurance; refund 632.00
2. 2013 income tax refund 588.00
3. 2014 income tax refund 20.00
TOTAL(Also enter on Line 5,Recapitulation) $ 1,240.00
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GERALDINE A. SHAMMO 0 0
If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. Susan A. Weary 10 Sgrignoli Lane sister-in-law
Enola, PA 17025
t3.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 2009 Santander checking account; Account#921778694 7,444.50 50. 3,722.25
TOTAL(Also enter on Line 6,Recapitulation) $ 3,722.25
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GERALDINE A. SHAMMO 0 0
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE, VALUE OF ASSET INTEREST (IFAPPUCABLEI VALUE
1. Santander savings account; Account#924027014 5,942.60 100.00 5,942.60
Made joint with sister-in-law, Susan A. Weary in Jan. of 2015
2. Santander money market account; Account#9991632476 27,663.08 100.00 27,663.08
Made joint with sister-in-law, Susan A. Weary in Feb. of 2015
3. Athene IRA/Annuity; Contract#00467043 24,289.22 100.00 24,289.22
Beneficiary is daughter, Cheryl A. Kimmel
TOTAL (Also enter on Line 7,Recapitulation) $ 57 894.90
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GERALDINE A. SHAMMO 0 0
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Sullivan Funeral Home 2,430.00
2. Larry Hale; minister 50.00
3. Enola American Legion; funeral luncheon 344.72
4. Pealers Flowers; flowers 143.05
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: Jan L. Brown &Associates 1,500.00
3, Family Exemption:(If decedent's address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4• Probate Fees:
5 Accountant Fees:
6. Tax Return Preparer Fees: Larry Shoop; 2014 income tax preparation 175.00
7. USPS; postage 9.80
8. Register of Wills; Inheritance tax return filing fee 15.00
9. Patriot News; obituary 581.77
TOTAL(Also enter on Line 9,Recapitulation) $ 5,249..34
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(12-12)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GERALDINE A. SHAMMO 0 0
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. Messiah Lifeways; outstanding bills 12,565.00
2. Capital Area Health Assoc.; outstanding bill 31.65
1 Hospice; outstanding bill 1,875.00
4. Jan L. Brown &Associates; outstanding bill 275.00
TOTAL(Also enter on Line 10,Recapitulation) $ 14,746.65
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GERALDINE A. SHAMMO 0 0
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec.9116(a)(12)]
1 Cheryl A. Kimmel Lineal 24,28912
107 Mill Street, Apt. 3G Sch G asset
Middletown, PA 17057
2. Susan A. Weary Collateral 18,571.94
10 Sgrignoli Lane Sch E, F and G assets
Enola, PA 17025
I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
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.
I
TOTAL OF PART 11-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.
ATTACHMENT TO REV-1500
ATTACHMENT
GERALDINE A.SHAMMO,DECEASED SOCIAL SECURITY NO.
No probate estate has been opened for Geraldine A. Shammo because she held no
probateable assets. Geraldine A. Shammo's banking funds with Santander(Schedule F and G
assets)were jointly held with her sister-in-law, Susan A. Weary. Upon Geraldine's death,
because no probate assets existed for payment of obligations, Susan assumed responsibility for
all expenses and debts (Schedules H & 1) and all Schedule H and Schedule I debts and expenses
have been paid by Susan from the Santander joint accounts. Therefore, all Schedule H and
Schedule I debts and expenses are being credited against Susan's jointly held property on
Schedule F and Schedule G. A copy of the check register is attached showing payment of all
debts and expenses.
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