HomeMy WebLinkAbout05-29-15 pennrylvania 1505614105
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REV-1500 °FF"'"`°sE°"`"
BureauoflndlvidualTaxes CountyCotle Year .. FileNumber
Po eox zaoaoi INHERITANCE TAX RETURN �- -
n � b g PA vizx-oem RESIDENT DECEDENT �� �I I� .. C.�25.�
ENTER�ECEDENT INFORMATION BELOW
Soclal Secudty Numbe� Date ot DeatM1 MM�Oriri �a�e of BiMh MMD�YYVY
02272015 .. 06241929 _ .....
Decedenfs Las[Name � Suffix Decedenfs First Name MI
�Sanford . . . . . ' � Donnell R ,
Q(Applicable)En[er5urviving5pouse'slnformationBelow ��� �
Spouse's Lasl Name SuRx. Spouse's Firsl Name .. . . MI
�� � THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WIILS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original ReWm O �� Supplemental Retum O 3. Remainder ReNm(da[e o(death
pnor W 12-13-ffi)
p 4. AgdoNNre Exemp�wn(da�e of 0 S Po[ure Inleres�Compromire(tla�e of � fi Federal Es�ate iax ReWm Requiretl
death on or efler]4-2012J tlearo aflar 1&12-82)
p 1. �ecedent Dierl Testate O 8� Decedent Malntainetl a Living Tmst 9. Total Numbet of Safe Deposit Boxes
(Attachmpyofwili) (AttachcoVYoftrust)
p 10. Litigation Pmceeds Receivetl O 11. Non-Pmbale Transferee ReWm O 12. DefenaVEleclion of Spousal Tmsls
(Schetlule F and G Assets Only)
O 13. Buslnoss Asse�s O 14.Sppure Is Sole Benefidary
(nb wst Involvetl)
WRRESPONDEM- THIS SECTION MOST BE COMPLETE�.FLL CORRESPoNOENCE AN�CONfIOENTIAL TAC MFORMATION SHOUL�BE DIRECTED T0:
Name Daytime Telephone Number _
_
'�Herschel Lock, Esq. .. . . . .p17)238-6667
First Line of Atltlress � __.
'3107 North Front SL _ _. . . . . ... . . '
Semntl Line ofAtltlress
CityorPoslORice ��� ���� 5[ate ZIPCode
Narrisburq . ... .. . PA �:17110 ..._...
Gerrespontlenps email atltlress: __. .__ _-_
REGIStEROFWILL505EONLY �,
REGISiEROFWtISl15EONlY '�
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J 1505614205
REV-i5W EX(R) Dece�enfs Social Securiry Number
oeceae,�rs N�m� �182-22-6552
RECAPITIILATION . . . .... .. . . .. .
1. Real Es�ate(Schedule A). . . . .. . . . . . . . .. . .. . .. . . . . ... . . . . . . . . . ... . . . .. 1. �
......_ __. ._. ._...
2. S�ocks and Bonds�Schetlule B) . . .. . .. .. . ... .. . .. . ... . .. . . . . . . ... ..... 2. 0
3. Closely Heltl Coryoralion, Petlnership or Sole-Pmprie�orehip(Schetlule C) . ..-- 3_ . 0
4. Mortgages and No�es Receivable(Schedule D) .. . .. . .. . . . . . . . ... . .. 4 �
5. Cash.Bank Depwi�s and Miscellaneous Personal Propetly(Schedule E).. ..... 5. ' 134179
__._ ...._ .. . . .._.._.
6- JOlntly Owned Propehy(Schetlule F) O Separate Blling Requestad . . .-- 6 �Q��_QQ
1. Inter-Viws Transiers 8 Miscellaneous Non-Probale Propetly � � � ���� �
(Schetlule G) O Separe�e Billing Reques[etl_ . ... . . Z �. p.
8. To�al GrossAssets(to[al Lines 1 ihrough 1). ... ...... . ... . .... .... ... . . . 8. 22 �2��y
9. Funeral Expenses antl AtlminisVative Costs(Schedule H). .. .. . .. . . ... . .. 9. 10 31.0.34
10. Debts of Decedenl.Mortgage Liabilifies antl liens(Schedule I)..... ... . ... . .. 10. $7$7.94
11. Total Detluctions(rolal Lines 9 and 10). .. . . ... .... .. . .. . ... . ... 11. 14,068.28
12 Net Value of Estate(Line 6 minus Line 11) . . .. . . .. . . ... . .. . . . 12 $y055,57
13. Charilable antl Govemmental Bequestsl5ec. 9113 Tmsls for which '� � � �� ��� �
an election�o�ax has not been made(Schedule J) . ... .. . . . . . .. ... ... . .. . . 13. '�. ��
14. Net Value Subject lo Tax(Line 12 minus Cme 13) .... .. . . .. . ... . .. 14 �. 8,055.51 '.
TA%CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
16. Amount of Llne 14 laxabla
a�the spousal lax 2te,or .__. _ . . _
Iransfersuntler5ec.9116 ��� �
(a)(121X.0- . 15.�. .
. _ ._. ..._ ._._. ..__.__ "_.___. ..__..�.
16. Amount ol Line 14[axable �
atiinealrate XAq� 8i055.51 i6 36249
__. .___ __- .____. ... ___ .
1]. Amaunto(Lineib;axable �
atsiblingrate % .12 »� '
.... .. ._.._ ..."__ ._ ..__..._ ._.._..__
18. Amount o(Llne 16 taxable �.
at collateral rate X.15 � ��, �8- �'
is. itacoue _ _ _ _.. . . . ... ... ... . ._ _... ._ ia� 362.49
2�. FILL IN THE OVHI IF YOU ARE REOUESTING A REFUNO OF AN OVERPAYMENT O
Untler penalties of per�ury. I aeclare 1 lieve examineA�his raWm.IncluEing acwmpanyin9 sch¢dules antl statemen6,aM to Na Oesl of my ImwA Nge eno Oelief.
it is We.mrtect aM mmploto. OeGara�ion of preparer oYmr�M1an ihe person responsible!or(li�g Me reW m is bascd on all inlormauon ol wM1ICM1 preparer M1as
any knowledge.
SIGNATU F PER50 R O I LE FOR FlLING RETURN ATE
�
A°°RE�59o1 Imer Dr Norrisbur� PA i� ii2
SIGNAiURE PREP E TH `T�NPERSONRESPONSIBLEF FlLINGTHERETURN �)F�.q�S
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nooREss j1�7 ��Uk� �.26'r./f ,�� 2R���d� � N �:���
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Decedent's Complete Address:
DECEDENT 5 MA�dE
Donnell R. Sanford Sr. . . � �� �
STREEiADDR[SS
4905 E Trindle Rd.,Apt 7031 . .
CITY � $TAT[ ZIP
Tax Payments and Credits:
t. Tax Oue(Page 2,One 79) ���_ �62,49
2. CfQdI�SIPdYmEn�S
A.PriorPaymen�s . . 344.37
e.�iscowt .._1g,�p
__ —
(See iretmc�lons-J � Tolal Credlts(A�B) �2) . zF� ao
3. Inlerest
13)
4. If Line 2 is greater than Line t +Lie�e 3,enter the diHerence. This is�he OVEkPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. 14) , .. . .Q
5. If Gne i*Line 3Is greater than Line 2,enter Ihe dtflerence-Thls is Ihe TAX DUE (5)_ _, n
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did deceden�make a t2nster aritl: Ves No
a. relain the ure or income of the propeT�transferred _...... _..._._ _....._ _.._.. J �
b. relainlherghltodesignatewhoshalluselhepmpeTytrareferredorifsincome ._.___._...._..........._.._._. [, �
c. relain a reversionary mteres� _.__ ____. _.. _.._ . r J �
I.
d. recelvethepmmiseforhFeofeitherpayments benefi�sorcare� .— — -� �
2. If death ocarretl aBer Dec. 12, 1982,did dea:den�iransfer propertyµithin one year o(tleath
wilhoulreceivinaadequalemnsiCeration? .___..... .._...... ............... __._ L �
3. Diddecetlenlownan"inVus�fol'orpayable-upon�tleathbankacmunlorseariryathisorhertleath?__.___ ❑ �
4. Did decedenl ovm an indivitlual retiremen�account annuiryorother non-probate proDerty,which
containsabene(ciarydesi9naUon? ...__ .__.._ ...__. ._._.... .._.._ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHE�ULE G AND FILE IT AS PART OF THE RETURN.
---"`�-�',x� � -�� � '.- s,�;.-.�.. ,, .:� , �., • .: . ._-�.' . . , � ,.,, ;� .. , ..._ . .
Por dales of dea�h on or atter July 1,1994,and before Jan.i, 1995,the tax rate imposed on the ne�value of Vansfers io or�or the use ot the survivin9 spouse
�s a perce��pz Ps.gsns�a)(i.i) 0)1.
For dates of death on or aker Jan. i, 1995, the lax rate imposed on Ihe ne� value of transfers to or for the use of the surviving spouse is 0 perwn�
�72 P.S.§9116(a)(1.1)(i)J.The stalute dces not exempt a iransfer to a surviving spouse 6om tax,and�he siatutory requiremenis for dlsclowre of assels and
fiing a tax reNm are siill applicable even if ihe surviving spouse is ihe only beneficiary
For dates of death on or afler July i,2000:
. The�ax rate imposed on ihe net value of Iransfers�rom a dewased chiid 21 years of age or younger at death to or for the use of a naNral parent,an
adoptive parent or a step-parent of the child is 0 percent[72 PS.§9116(a�(12)].
. The tax rate imposed on ihe ne�value of Vansfers�o or for ihe use of ine decedenPs lineal be�fdanes is 4.5 percent,except as noted in[72 PS.§9116(a)(1)].
• The�ax rdte imposetl on the net value of t2ns[ers�o or for ihe use of Me decedenfs sibliogs Is 12 percent�72 PS. §911fi(a)�1 3)]-Asibling Is tlefinetl.
under Section 9W2,as an individual who has a�leas�one paren�in common with me decedent,whether by blood or adopiion.
HEKga6 Ex.(o8-rz) I '
� pennsytvania ' SCHEDULE E
L�� oeaaarnervrorAevenue CASH� BANK DEPOSITS & MISC.
��,��,.a�.a�a,a�k«�aN PERSONAL PROPERTY
�:sioErv,ne�EOErv.
ESTATE OF: FILE NUMBER:
DONNFI I R SANFORD _ _._ .. 27.-1fl-�751
IncWde Me pmceeds of G6gafion and H�e date thz p�aceeds wele received by the es[ate.
All property jointly owned witM1 righ[of survivorehip must be discloseA on ScheGule F
RE�q � -� VNWEATDATE
NUM3ER DESCRIPTION OF DEATH
1. 2014 Federal Income Tax refuntl 1151.00
2. Metro Bank-checkina acct.no. xxx3554 19079
TOTAL(Also enter on Line 5, Rewpitulation) ; 1341]9
If more space is neeaed, use adtli[ional shee[s of paper oF[he same size.
zFo-�soarx+�oz-ie� I I
'� pennsylvania SCNEDULE F
L�� oecnnrneNroFnevervue JOINTLY-OWNED PROPERTY
irvnea�.rNtie,u vri oNrv
RFSIDHliDECHi3JT �
ESfATE OF: FILE NUMBER:
nnn�uF a nvcnan . 91-15-0253
If an asset became jaintly ownetl within one year of the tlecedenPs date of death, it mvst be reporteE on Schedule G.
Sl1RVNINGIO[MTENANT(5) NAME(5) A��RE55 REUTIONSHIPTO�ECEDENT
q,Cheryl L. Goss 5901 Palmer Dc, Harrisburg, PA�7112 daughter
B.
C.
JOINTLY OWNED PROPERTY:
�eii[k oaiE DESCRIVIIONOFPaOPEaTV �� %oF onhoFOEAn
REM FOR]OINI MppE INQOOENAMEOFFlNANCIAINSIINiIONFNpOM'kTCY.J01Y(NUMBE0.0RSIMLLAR OAiECFDEAIH DECEOENTS VRWEOF
NOMBE0. iE1JPNi JOINT IpENTMIJGNOM8E0.AIIPCNOFFOfOR1�INRYHEIJREAlF5W1£ VPWEOFASSH IMERE57 �EC�ENPSINfrAESi
1. Q.
prior�o2014642sharesoNerizonsiock-4itlhighL49.66/low$49A5-average$49.35 31,68270 50% 15,84135
2 A. prior�o2014 1575haresofFron�ierCommunicationstcek-
dodhiph58.O511ow$794-average87.99 123046 50% 6t523
3 A_ orior�o 2014 Metm Bank accl.no.x�3571 4998.60 50% 2499.30
4. A. prior to 2014 MeVo Bank accl.no.a552 365224 50% 1826.12
I
I
TOTAL(Also enter on Line 6, Rerapitulation) ¢ 20,782.00
if more space is neetletl, vu atldi[ional sheeLs of pa0er of the same size.
�v-is�.� Fy..n�.�s '
� pennsylvania SCHEDULE H
oEvaa�ncuroFnEVEr�uF FUNERAL EXPENSES AND
1N°E'�,""�T"""�T�"" pDMINISTRATIVE COSTS
RFSIIJENT DECEUfN!
ESTATE OF FILE NUMBER
nnNuc� LR_SANFnanCR _ ,. ��-�S_n�s'2
UecedenPs Eeb[s must be reporteE on Schedule 1.
ITEM
NUMBER �ESCRIPTION AMOVNT
A. FUNERALEXPENSES:
t.
Hoover Funeral Home and Cremalory 762778
B. ADMINISTRATIVE CO5T5:
a. Personal Represeatative Commssions:
Name(s)olPersonal aevresentztive(s) _
Shre[Adaress
Ciry State ZIP I
Year(s)Commission PaiO:
I
2. Atrorney Fees'. 2260.00
3. Family&emption_(If aecedenPs aECress Is mt the same as claimanPs,attaCi explanation.)
Claiman[
SIIPPIA44�P55
�ty ..._ . $f2C2 Z�F �
Relationshio of Oaiman[[o Deretlent
4. vmbate Fees: 13550
5. Acmwtantfees:
6- Tax Re:uro Prepa�erfees�.
�' TheSenfinel-estateadvertising 148.06
s. , CumbetlandLawJoumal-estateadvedising 75.00
s. 2014 PA Inwme Tax due 44.00
TOTAL(Also enter on Line 9, Recapitulation) ; 10 310.34
If more spare is needed, use atl�itionalsheets ofpaper ofthe same size.
SPI-1S_2=y-�nz�n ' i
� pennsylvania SCHEDULE I ;
.y, evAarwFNrareev�rvae DE6TS Of DECEDENT, I
i�neairaHc�raxecrukr� MORTGAGE LIABILITIES & LIENS''�
aesrcervr o=�oer+r �
ESTATE OF � FILE NUHBER �
DONNELL-R—SAP7FORD_.--__— ^, •5-0253___._ ___..______
Report Debts incuneE by the dettCent prior[o Aearo tM1at remained unpald at the Jate of death,induding unreimburseE mediol expenses. _
� ITEM �� .� . . ��—�-- F�-- —... "— VAWEAT�ATE
NUMeEIt DSCRIPTION OF DE1iH
1.
Azizkhan Inlemal Medieine Assoc-medcal bill-check foe payment cleared MeUo Bank aec�.no. 10.0�
x�3571 afterdod
2. Azizkhan In�emal Medicine Assac.-inedical bill 20.00
3. IDiamond Pharmacy-dmg bill-check cleared Melro Bank acc�.no.ncx3571 akerdod 274.W
a. DiamondPharmacy-dmgbill 11444
5. Rosa's Team-nursing care blll-check cleared Metro Bank aat.no.xxx3571 after dod 1374.00
6. Rosa'sTeam-additional6illfornursinqrare 25200
7. Pinnade Health-medical bill 45.00
e. Re(und due Veterans'AdminisVation for monthly paymen�deposited in Metm Bank acct.no. 1,788,00
xxx3571 for deposit made Feb.27,2015
1
TOTGL(Also enter on tine 30, Recapitulationj $ 3757.94
If more zpace is neeGed, insert aGGitional shee[s of Me same size.
2rJ-1513 EV t tp�.�]'. i
� pennsylvania SCHEDULE J
L�� otaaarnervrovnevervue BENEFICIARIES
iw�evrtance rax aeruxrv
n�s�r�rn oe�rorrv'r
ESTATE OF: FILE NUMBER:
6fJN .SAN�,��SR. —.—. ___ ..._____.-
RannorvsH�vrdocceoemr no- - sHnat
rvuneEz NnwE ano nooaEss oF aeason(s� aecE�vm�aaovtan Oo No[Lis[Trustee(s) oF esrnrE
_. _ ._ _ _ __ - ---- .._._..
I iA%0.8LE DISiRIBUTI0N5[Intlude oucnght spousal d5ttibuCions an0 Uanslers un�er
Sec Stl6;a)(1 2).]
1.
Cheryl L Goss, 5901 Palmer Or.,Hamsburg, PA 17112 tlaugh�er 50% residuary es[ate
I
2 Donnell R.Sanford Jr., 14051mperial Rd., Coloratlo Springs,C080918 son 50% residuary estate
i III
ENTER�Ol1AR AMOVNTS FOR DISTRIBlfi70N5 SHOWN ABOVE ON lINES 15 THROU6H 18 Of REV-I500 COVER SHEET,AS APPROPRfATE.
t� NON TA%ABLE DISiAI3UTI0N5
A. SPOUSA��ISTRIBUTIOfi511NDER SECilON 9tt3 i0R 1NHICH AN ELECitON i0 TA%IS NOi TAKEN�. i
1. �
I
I
e. CNARITABLEANDGOVERNMENTALDISTRI90TION5�. '
1.
TOTAL OP PART II - EN7FR TOTAL NON-TA%ABLE DISrRIBUT]ONS ON I1NE 13 OF REVd500 COVER SHEEC $
If mare space is neeAW,use ad�ibonal shee6 of paper of Me szme size-