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Home My WebLink About05-20-15 (2) � i pennsytvania 15 0 5 61410 5 � °�ra"'ME"T°`�vvx� EX(03-I4)(FI) REV�i SOO �FFICIAL USE ONLY Bureau of Individual Taxes Caunty Code Year � File Number PO BOX 28D601 INHERITANCE TAX RETURN n � Harrisburg, PA 17128-0601 RESIDENT DECEDENT `� � �.� � ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Bi�th MMDDYYYY 02232015 00001928 DecedenYs Last Name Suffix DecedenPs First Pdame MI Church William L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x Spouse's First IVame M� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1.Original Return p 2.Supplemental Retum p 3. Remainder Retum(date of death pnorto 12-13-82) p 4.Agricu�ture Exemption(date of p 5.Future Interest Compromise(date of p 6. Federat Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 7. Decedent 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 Retum C� 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 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 T0: Name Daytime Telephone Number Victoria C. Ceneviva (336)403-6969 First Line of Address 215 Nanzetta Way Second Line of Address City or Post Office State ZIP Code Lewisville NC 27023 Correspondent's email address: vICklCen@yBhOO.COm ___ REGISTER OF WILLS USE ONLY , ..� REGISTER OF WILLS USE ONLY `� � � �� . DATE FILED MMDDYYYY �= � rn O ..� �. C? _�°" �`„� ,�.� _ C'� -ti7 � �7 .. ,_,.� � rl„'7 �; . N �.,..1 ,.„., ; F—' . �:3 DATE FILED STIAMP : ,--� _ � ., 471 - y .� � . , `,� .....�. .. r .....� �� i �Y �...... �,� PLEASE USE ORIGINAL FORM ONLY � �� Side 1 W (�"�')(I"I'llll"�'I'III"II'I II'��'I"I II'I�"I'I III)I'� � � 1505614105 1505614105 �V" 1 II'.11....8161111. 1 . � 1505614205 REV-1500 EX(FI) DecedenYs Social Security Number DecedenYs Name: WIIIIaI'Tl L. CIIUfCII 171- i. Reai Estate�scneduiea�. ................... ............... ..... . .. .. �. 0.00 2. Stocks and Bonds(Schedule B) 2. 151,990.00 . . .............. ............... ....... . 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .... 3. 0.00 4. Mort a es and Notes Receivable Schedule D 4. 0.00 9 9 � ) .......................... . 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)... .... 5. 39,768.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers&Misceilaneous Non-Probate Property (Schedule G) O Separate Biliing Requested.... .... 7. 8. Totai Gross Assets total Lines 1 throu h 7 8. 191,758.00 � 9 )......................... .... 9. Funerai Expenses and Administrative Costs{Schedule H)............... .... 9. 12,455.00 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I). .............. 1Q. 0.00 11. Total Deductions(total Lines 9 and 10)................................. 11. 12,455.00 12. Net Value of Estate(Line 8 minus Line 11) .......... ............... . .... 12. 179,303.00 13. Charitable and Govemmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule Jj . .. ... ......... .... . .... 13. 14. Net Value Sub'ect to Tax Line 12 minus Line 13 ta. 179,303.00 1 � ) ...................... .. 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_ 15. 16. Amount of Line 14 ta�cable at lineal rate X.045 179,303.00 �6. 8,069.00 17. Amount of Line 14 taxable at sibling rate X.12 �� 18. Amount of Line 14 taxable at collateral rate X.15 18� 19. TAX DUE .. ...... ............ ..�-�-•--.. .. ....... ... ........ .. . ... 19. 8,�69.0� 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENl� O Under penatties of peryury,i declare I have examined this retum,inGuding accompanying schedules and statements,and to the best of my knowiedge and belief, it is hue,correct and compiete. Declaration of preparer other than the person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNATURE O�PERSON RESPONSIBLE FOR FILING RETURN DATE L�L- � �-\a ' 2 Q�1y �//4/�0�� ADDRESS � . z�6 ntc�, c a-�o 1 /x r9�r ,,�,:��i r✓l�.Loc�.L.o�✓� i�i/�f'�i�t, `�- SIGNATURE OF PREPARER OTHER THA PERSON RESPONSIBLE FOR FILING THE RETURN DATE �3/I Z ADDRESS i iiiiii iiiii iiiii i�i��ii��i�iii�i�i�iiiii iNii iiii iiii Side 2 � � y 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME William L. Church STREET ADDRESS 8 Pine Circle CITY STATE' - ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19} (1) 8,069.00 2. CreditslPayments A.Prior Payments B.Discount 403.00 (See instructions.) Total Credits(A+B) (2) 403.00 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) 7,666.00 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 .......................................................................................... ❑ � 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 fo�'or payable-upon-death bank account or security at his ar her death?.............. ❑ � 4. Did decedent own an individual retirement account,annuity or other non-probate property,which containsa 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(aj(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 suroiving 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 yaunger 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 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. r�v-isos oc+(oi-is) �pennsylvania SCNEpY1.E B °�'"�"�`r�� STOCKS & BONDS INHHiITANCE 7AX RE7URN RESIDQdT DECEDENT ESTATE OF FILE NUNBER W�liam L Church AII ProPe�jl��h owned wilh riyM of�rvivorship must be disdosed on Sd�edula F. � VALUE AT DATE NUMBER DESCRIFiION OF DEATH _. __ _ __._ __ ___._._ __. ---- _ __—_- �. y� ��s,s7s.00 -.:- . _ PN1C�ve�ments :. , 36,114A0 _ _ __ __ _ _ _ __ _ _ _ : _ _ . _ _ __ _--- _ __ __ _ _-- _ __ _ _ _ __. ._ _ ___ _._ ___ _ ,� � -- __ . _ _ __ __ -_ __ ____ ___ _ . _ ___ _ .__ _ . TOTAI.(Also enter on Line 2,Recapitulation) ; , 151,990_OQ If more space is needed,ins�t additionai sheets of tlte same size REV-1513 EX+(02-15) � pennsylvania SCHEDULE J DEPARTMENT OF REVENUE gENEFICIARIES INHERITANCE TAX RETllRN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: 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[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. Victoria C.Ceneviva,215 Nanzeita Way,Lewisville,NC 7023 Daughter 50% 2. Sheldon L.Church,12191 Flintlodc Lane,Fort Myers,FL 33912 Son 50°k ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REU-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: L 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. iai,i: .�inn i REV-15o8 IX+(o�i2) i pennsylvania �NEp11LE E � ��+� CASH, BANK DEPOSITS 8E MISC. i"'�""�T"X'�"'�" PERSONAL PROPERTY �sro�rr o�o�r ESTATE OF: . FILE NUMBER: William L.Church 2015-00430 Indude d�e proceeds of lidgation and tlie date tl�e proceeds were received by the esta0e. �P�h�It owned with right at swvivaship must 6e disdosed on Schedule F. 1TEM VALUE AT DATE NUMBER DES(RIFTiON OF DEATH � ACNB Acooun�s 24,392.00 Personal Property 500.00 Treasury N�es 14,876.00 � . TOTAL(Also enter on Line 5, Recapitulation) # 39,768.00 If more spaoe is needed,use additional sheets of paper of the same size. i IIII pllllll! I REV-1511 EX+ (OZ-15) � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND iNHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER William L. Church 2015-00430 Decedent's debts must be reported on Schedule I. ITEM —� NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Funeral Expenses 3,830.00 e. ADMINISTRATIVE COSTS; 1. Personal Representative Commissions Name(s)of Personal Representative(s) 5treet Address City State ZIP Year(s)Commission Paid: Z• Attorney Fees: 3• Family Exemption: (If decedenYs address is not the same as ciaimanYs,attach explanation.) Claimant Street Address GtY ___.... __ State ZiP Relationship of Ciaimant to Decedent _. __ _ _ 4• Probate Fees: 375.00 5• Accountant Fees: 6• Tax Return Preparer Fees: 7. 9. Administrative Expenses for Co-Executors Victoria Church Ceneviva and Sheldon Church Travel(three trips from Florida for Sheldon and three from North carolina for Victoria) 5,358.00 Meals when traveling on Probate Business 2,160.00 Postage/FedEx Fees 132.00 U Haul Rental for donation of personal effects 600.00 TOTAL(Afso enter an Line 9, Recapitulation) $ 12,455.00 If more space is needed,use additional sheets of paper of the same size.