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HomeMy WebLinkAbout05-14-15 J 1 . pennsytvania 1505614105 DEPA MEM ofFWVENUE EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number �p .................. ...I............. __._..( ._. INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2� �S j c ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY � o Decedent's Last Name Suffix Decedent's First Name MI I i �€ - t G [.ER i ; .To YcF (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N.., ... .. .................................. .. .._.................._......................... _............_....... __ ................... ._ ............................... _ i..........................................-............_.._......................................_.......................... .__ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE . REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Oji 1.Original Return p 2.Supplemental Return p 3. Remainder Return (date of death prior to 12-13-82) O 4.Agriculture Exemption(date of p 5.Future Interest Compromise(date of p 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) O 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.) C=D 10. Litigation Proceeds Received O 11.Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets O 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 FoN� .T. C ft-nl�Ds _ .-7 Y- q First Line of Address Second Line of Address I 1...................._._._....-.........................._._..............-......................................._...........__........................................................_.................................._.........__........._....._.........._.............. .............._...._ City or Post OfficeState ZIP Code �_— .............__........_._._...................._............................__.............................._.......--; r J �19Pc�ah,esd�, Pro j C= o r i t->......__. Correspondent's email address: = �^ - Q-1) �- E ISTER;CIF MnLLS USE ONLY r r tREGIS7TE �F WILLS USE ONLY �' j} ? 71 ::3- r1 N In t U) G>, OJ DATE FILED STAMP J 1505614205 REV-1500 EX(FI) Decedent's Social Security Number I Decedent's Name: SO y CLQ E. F I L L FR i / s RECAPITULATION 1. Real Estate(Schedule A). .. .... ... ..... ... ................... ........ 1. • DO 2. Stocks and Bonds(Schedule B) ................... ............ ..... ... 2. 'r 1967 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. .. . 3. •OD 4. Mortgages and Notes Receivable(Schedule D)..... ... ............... .... 4. 119,9 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ... ... 5. ADD 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. .... 6. �� E 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property r o (Schedule G) O Separate Billing Requested..... ... 7. �✓ �p, OZ 8. Total Gross Assets(total Lines 1 through 7).............. ......... ..... . 8. OZ 9. Funeral Expenses and Administrative Costs(Schedule H). . ............. .. . . 9. 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1).............. . 10. �Q 11. Total Deductions(total Lines 9 and 10).......... ... ........ ....... .... . 11, r�S 00 12. Net Value of Estate(Line 8 minus Line 11) ... .. ......... .. ...... ... .. ... 12. 13. Charitable and Governmental Bequests/Sec.9113 Trusts for which an election to tax has not been made(Schedule J) .......... ...... ... ..... 13. P�d 14. Net Value Subject to Tax(Line 12 minus Line 13) S 383, TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 t_-_-_-- (a)(1.2)X.00- i Q 15. • pC, 16. Amount of Line 14axable at lineal rate X.0 38, 672 16. 17. Amount of Line 14 taxable at sibling rate X.12 I e, p D 17. i dd 18. Amount of Line 14 taxable w at collateral rate X.15 a BO 18. ..,_. u 4 19. TAX DUE . ....... ... ..... .................. ................ ....... 19. Q 7 •�. Z� 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O 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 knowled e. SIGNAT E F PERSON R SPONSIBLE FOR FILING ,RETURN DATE ADD E pVN.+ /f /COs leov A A*146e.•t J9• , meehonjes6 a l, M /?OSS SIGMT E OF PREP6RER TR,J N PERSON RESPONSIBLE FOR FILING THE RETURN DATE f ADDRESS ► ,, � F-• SH/e2,0J 1�l, (� C'/o usu^ A20/, /Yed6&w;erA* f, P* 17,&S-S" Side 2 - u11Iti�iiii�i�i�iiiii J 4 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME STREET ADDRESS o y A/. .`11_4672 r J7- CITY TCITY �ZLE(�Y/A�i?/lCS�GI/L�G STATE nA ZIP/7os.S� Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 2. Credits/Payments o� 13 A.Prior Payments B.Discount (See instructions.) Total Credits(A+B) (2) 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) Make check payable to: REGISTER OF WILLS, AGENT. MM 77 MMS �h,H .. _.�,....—. .. `'` ............,u.�.....,,......��._ .u =� w.,. .;€� �.u.,.,,..�>.; �,.,,a , "111", 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 .............................................................................................................................. ❑ W1 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 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 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. � - .,._x ,._ .;. .. 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 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 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-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 IVUMBER�/-��,,,,� 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. ITEMDESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND NUMBER ))THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE 1. /VQ,/Jonel y;fe Z7.suranct_ W1;na1T 67/6 Th;s ifr, wks pn�a�d/e in kve Ks-�e��4/ ,hares �v : /Rope J: Jvbas 61"2, d't afA&r 7cna T. 61't.wpos, W'ia9h&r rs fi%/er, s/c/v-soa �/Z/,'s'W F'll r, cskp—s o n j'a/hes fi.'//er, S*J104 fi(W 4/X/ a/•a.W Valke of fI-��s aanu.'f was ,FuoA rertCeider/ 2,q. 230.x/ ),li C/i �. Na�enaL L��e .Insurance �'ony /�nnaifi �oaG/ Mg. 69 8'7o 2 X U h2sti R T. .Tohn son, ola.�G>,ilzr -Pena J7. Ca"y"s, d� A_0, va Gue ©f 7%;s annai t Guar A L16/ 3 3S:kZ FQGh rGCiQDeri rec.t;✓a a,-31147, 11 23, 167,91 /ooyfl -p 3r /6 9/ TOTAL(Also enter on Line 7, Recapitulation) $ off, 3 98 0 2. If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERALEXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER F11-LER.; JOYCE A: /s -- Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 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: !e 6e 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant } l b'cahlG Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5.— Accountant Fees: 6. Tax Return Preparer Fees: 7. r//'n� dee 1vister of Gvi`/s TOTAL(Also enter on Line 9, Recapitulation)is If more space is needed,use additional sheets of paper of the same size. Dona J. Campos 404 North Filbert Street .o Mechanicsburg,PA 17055 ;n' May 8, 2015 4., . .;7. �..f-r7 Ms. Wanda Zeigler crap`. Office of the Register of Wills Cumberland County Court House I Courthouse Square Carlisle, PA 17013 Re: Estate of Joyce E.Filler,deceased Late of 404 North Filbert Street Mechanicsburg,PA 17055 Docket No.21-15- Dear Ms. Zeigler: As per your recent conversation with Charles E. Shields III, Esq., please find enclosed the following items: 1. Two copies of the Inheritance Tax Return for my share of an annuity held by my late mother. 2. Check in the amount of$15.00 for the filing fee made payable to "Register of Wills." 3. Check in the amount of$1,940.13 for estimated Inheritance Tax also made payable to "Register of Wills." This check represents a five (5%) discount from the face amount due. Thank you for your kind help in this matter. Very truly yours, l�.fYlio--: Dona J. os Enclosures 1 - d �o O�