HomeMy WebLinkAbout06-03-15 {�pe��sy��ania 1505614105
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REV-1500 OFFICIAL IISE ONLY
Bureau of Indivitlual Taxes CountyCoee Year .. . PileNumber
Po Box 28o6oi INHERITANCE TAX RETURN
Harrisburg PA 17128-0601 RESIDENT DECEDENT '.L-1 . �j � O 3 7� . �
ENTER DECEDENT INFORMATION BELOW
Social Security Number Da�e o!Oeath MMO�VYYV Oa[e of Birth MMD�YYYY
02172013 �� � 06022015
Decedenfs Lasl Name SuRz Decedenfs Flrst Name MI
SCHARF ..... . . ..... . . . JOHANNA ..... ..._ .. . . A �.
�ItApplicable)Enter Surviving Spouse's Infermation Below ��� �
Spouse's Last Name SURx Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS 9ELOW
� 1. Original Rewm O 2,Supplemental Retum O 3. Remaintler ReNm(tlate of tleath
pdor to 12-1&82)
p 4.AgricWture ExemO�ion(da�e of p 5.FUWre Interest Compmmise(date o( p 6. Fetleral Estate Tax ReNrn Requlred
tleaN on or aner]-L2012) aeath after 1242-82)
m ].Deceden��ietl Tes�ale O 8�Decedent Mainlained a Crving Trus� �4� A Tolal Number of Safe�eposi�Boxes
(Altacb copy of will.) (A�Uch wpy of ImsL)
p iQ Litigation Pmceeds Received O 11.NoroPmbate Transteree ReWrn O 12 Defertal/Election o/Spousal Trusts
(Schetlule F antl G Assels Only)
O 13.Business Assels O 14.Spouse is Sole Benefciary
(No hus�involvetl)
CORRESPONUENT- THIS SELTION MIIST BE COMPLETEO.ALL LORRESPONOENCE ANO GONFI�ENTIAL TA%INFORMATION SHOUL�BE�IRECTE�T0:
Name Day�ime Telephone Number
RICHARD M SCHLUDE EA � (570) 387-0548 � �,
..._ .._. _.. .... . �
First Line of Atltlress
326EFIFTHST ��� .
..... ___ _.:
semna Line orAaaress
. .... . . .__ ...... ,
PO BOX 374 �'��.
City or Post ORce � S�ate ZIP Cotle
.... ..... . �.� A
BLOOMSBURG .. . ���. PA '.. 17815 �' I' �� m
c J ' c'
. ..._ ._.. .......... = o c_ .:-; c�
,� _ �
CorrespontlenPs omail adtlress: '� - ` '��
�
REGISTEROFWI�LS�U�EOI � �
�
REGISTEROFWILLSUSEONLV � � " _'Ll ��� �;
.OAIE FILED MMDOYYYY� � � ' =i -
. ., .. . . ..i l : �)
CJ _ n
_ ,
....... �, o �' n
�
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLV
Side 1
L ����������������������������������������������������� ysos61v1os J
J 15056142�5
P/�F_ 2 / -/ 3- O 370
REV4500 EX(FI) DecedenCs Social Securiry Number
oe�aa�r:Name: JOHANNAASCHARF . �� � �
RECAPITULATION _. _ . . _._. . ._.
1. Real Estate(Schetlule A) . . .... .. 1. 0.00 �.
. . ... ... . ... ... . . ... . ... . ... . ...... .. ..... ..._.. ._....j
2 5[ocks and 8onas(Schetlule B) .. . 0.00 �''�.
.. ... . ... .. . .... . .. . .... ... . . . ...... 2.
.___._._... .__ .___'�.
3. Closety Heltl Corporelion,Partnership or Sole-Pmprie�o�ship(Schetlule C) ..... 3. 0.00
4. Mortgages antl Notes Receivable(Schetlule O) ... .... ... ....... . .. .... .. 4 �� � � �� �.��.
..... _._.. . . ..
5. Wsh, Bank Deposi�s and Miscellaneous Personal Propetly(Schedule E).... ... 5. 5,302.54
_....____....... __.. . . . . ... . .
6. Jointly Owned Propetly(Schetlule F) O Separate 8111ing Requested ... .... 6. 2,323.44
1. Inter-Vivos Transiers 8 Miscellaneous Noo-Probate Pmperty ���� �� �
(Schetlule G) O Separa�e Billing Reques�etl.... .... Z . 0.00 �
._.__ .. _ ... _... ..
8. Tofal Gross Pssets(total Lines 1 ihrough])... ... . ... .... ... . .. . .... .. . . 8. 7,625.58 �.
9. Funeral Expenses antl Atlminishalive Cosls(Schetlule Hj.... ... . .. .... . .. . . 9. 5,146.4�
. ......... . .._.. .._..
10. �ebls o!Oecetlenl, MoNgage Liabilities and Liens(Schetlule I).. . ... ....... . 10 5,724.52 .
ii. Total Detluctions(total Lines 9 antl 101.. ... ... . ... .... ... . ... ...... . .. 11 .....�. .... . . 70.870.52 '.
__.__... ...._ ._._;
12. Nel Value of Estate(Line 8 minus Line 11) .. ... ... . ....... . ... ... .. . ... . 12 '�, 3.244.94
.. ..""'"___ "...... ........
13. Charitable and Govemmemal BequeslslSec.9113 Tmsls tor which '�.
an election[o tax has not been matle(Schedule J) .. . ... ... . ... ... . ... . .. . 13. �'��i �.�0
.__._ ._.. ... .._.
14. Net Value Subject to Tax(Line 12 minus Line 13) .. .... ... . ... ... .... .. . 14 . 0.00
TA%CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 74 taxable
at the spousal tax rete,or _______.
�ransfersunder5ec.9116 ��� � ������ � � ���� . ��� �
(e)(12)X .0_ 15.
i6. AmounlofLinel4taxable ����� ���� � �� �
atlinealrate X.045 0.00 �6. 0.00
_.._ _._._.. .__. ___. "'"_ ..._ . . ...._...
1]. Amount of Line 14 taxable '�..
at sibling rete % .12 »- �'
18. Amount of Line 14 taxable ...... .........�. ......�.. ....... ......�..
atcollate�al rete X.15 �8�
. . . .. _ . _. __.
..... ..... ..... ...... .
19. TA%DUE . 0.00 .,...
... ... . .. .. . .. .... ... ...... ... .... .... . ... ... ... . .. . .... 19.
20. FILL IN THE OVAL IF YOU ARE RE�UESTING A REFUND OF AN OVERPAVMENT �
Untler penahles of perjury, I tleclare I M1ave examinetl iM1is reW rn,including acmmpanying scM1eJules an0 s�alementa,and�o�M1e best of my knowledge an0 Uellei.
it Is�me, corrM antl complete. �eclara�ion ol preparer o��er�M1an Ne person responsi�le ior filing I�e reWrn Is Lased on all Inlormation o�w�lrli preparer M1as
any knowletlge.
SIGNAT LF ERSOf RE 516L FOR FlLING RETURN �ATE
��Z-��
AD�RE55
604 MALLARD RD, CAMP HILL, PA 1 701 1-1 21 9
SISjOlB.Tl1RE F P GA(�R O�ER 7f1{yJ P IR/5� ON RESP�BLE FOR FlLING THE RETURN �NTE
'K //"' ./r" i' �� 05/30/2015
a
ADDRE55
326 E FIFTH ST, PO BOX 374, BLOOMSBURG. PA 17815-0374
L iiiiiiiiiniiiiiu�i��ii��i�i�i�i�i�iiiiiiiiiiiiiiiiii Side2
1505614205 J
HEV�1500 EX (FI) Page 3 File Numbe� 'z l - � 3 _ Q p�p
J
Decedent's Complete Address:
oeeeoENrs Nnrne
JOHANNA A SCHARF
sraEETnooRess� - �
604 MALLARD RD
__ ._ __- ._______. . .._. __._
cirv I srnTe -� nv
CAMP HILL PA 17011
Tax Payments and Credits:
�. rax oue(aeqe z,�me is� (i� o.00
2. Credits/Payments
A.Prior Paymenis _ 104.54
B.Oiscounl �� ���� 0.00
(See insimdions.) � Total Credils(A+6) (2) 104.54
3. In�eres�
[3) 0.00
4. If Llne 21s greater than Llne 1 +Cine 3,enler the dlffarence. Thls Is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 104.54
5. If Line 1 �Line 3 is grea�er ihan Line 2,en�er�he DiHerence.This is the TA7(DUE. (5) 0.00
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedenl maze a Uansfer and: Yes No
a. re�ain the use or income of ihe propetly�2nsierred ............_........_......................................_.......................... ❑ �
b. re�ain the right to designate who shall use Ihe pmDeM�ransferred o�its income .........._._....._...................... ❑ �
c. re�ain a reversionary inlerest.........................._._.._..........................._...._......................_...._.......................... ❑ �
d. receive Ihe pmmise for lite of ei�her payments,benef�s or care?............_........................................................ ❑ �
2. If death occurred afler Dec.12, 1982,did decedent trznsfer property within one year of dealh
withoutreceivin9ade9uatecansideration?......_..............................................._..............................._..._.._........... ❑ �
3. Diddecetlentownan"inWstfor'brpayable-upon-0eath6ankaccountorsecuritya�hisorher0ealh?._._._._.. ❑ �
4. Did decedent own an individual retirement account annuity or other non-pmbate pmperry,which
contains a beneficiary designa�ion? .._._._.. . . ..._........._ ....... ......._.. . ._ , .........._. . ............ ❑ �
IF THE ANSWER TO ANY OF THE A80VE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE ITAS PART OF THE RETURN.
For dafes of death on or after July 1, 1994,and before Jan. 1,1995,�he tax mte imposed on the net value of transfers�o or for the use of Ihe surviving spouse
is 3 percent�72 P.S.§9116(a)(1.1)(i)].
For dates of tleath on or after Jan. 1, 1995, the tax rate imposetl on ihe net value of iransfers to or for the use of the survivinq spouse is 0 percent
[72 P.S.§9116(a)(t.i)(li)].The statute does not exempl a transferto a survrving spouse from lax,and the staWtory requiremen�s for disclosure of asaets and
fling a�ax reWm are still applicable even if ihe surviving spouse is�he only benefciary.
For tlates of dealh on or after July 1,2000:
• The tax ra�e imposed on ihe net value of iransfers from a deceased child 21 years of age or younger at deaU to or for Ihe use of a naWral parent, an
adoptive parent or a step-parent of the child is 0 percent[72 P.S.§9116(a)(1211�
• The tax rate imposed on the net value of Iransfers to or for�he use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in(72 P.S.§9116(a�(1��.
• The tex rate Imposed on�he net value of transfers�o or for the use of fhe decedenfs sihlings ia 12 parceM[72 P.S.§9116(a)(1.3)].A sibling is defned,
under Section 9102,as an intlivitlual who has at least one parent in common wiU�ihe decedent,whether by blood or adoption.
REV-SOS E%- (02-b)
� pennsylvania SCFIEDULE E
�y,� oeana*nervTOFaever�ue CASH� BANK DEPOSITS & MISC.
�^'�Ea�T^^'cET^"'+ET"'+" PERSONALPROPERTY
aesmervr oeceoerv r
ESTATE OF: FILE NUMBER:
JOHANNA A SCHARF 21-13-0370
Include the pmceeds of litigation and the date the proceeds were received by the es[ate.
All O�opertyjointly owned with right o!survivorship must be Eisclosed on Schedule F.
ITEM VALUE AT DATE
IVUMBER DESCRIPTION OF DEATH
� �IAMOND SOLITAIRE 14KT TWO-TONE GOLD RING PER APPR4ISAL 1,600.00
Z CLOTHING 200.00
g SMITH&WESSON38SPL SER#30K7892 SOLD4-15-2013 350.00
q 2003TOVOTAECHO VIN#JTDAT123530275389 SOLD547-2013 3,000.00
5 STATE FARM AUTO WSURANCE REFUND ACCT 1134579513 152.54
TOTAL(Also enter on Line 5, Recapitulation) $ 5,302.54
If more space is needed,use aA�i[ional sheeb of paper of[he same size,
RW-1509 E%n (02-15)
� pennsylvania SCFIEDULE F
es� oevnarner�roraevervue ]OINTLV-OWNED PROPERTY
1VHFUiANCE TF%RETORN
RESIDfNT OECE�tNi
ESTATE OF: FIIE NUMBER:
JOHANNA A SCHARF 21-13-0370
If an asset became jointly owneE within one year o(the decedenYs date of Aeath,it must be reporteA on Schedule G.
SUftVNING]OIM TENANT(5)NAME(5) AD�RESS RELATIONSHIP TO DECEDENT
q.LIND A BOYD 604 MALLARD RD DAUGHTER
CAMP HILL, PA 1 7 01 1-121 9
8.
C.
]OINTLY OWNED PROPERTY:
�tilEa oar[ DESCRIPTIONOFPROPERIY %,or onhoFOEnirv
RFM F00.]OMT NP�f IIKLUDENAMEOFFINANCIALINSTRVi�ONAN�BANKFCCOUMNUM9EROP9MIUR OAiE0F0EAlM DECE�EM'S WWfOF
HOMBE0. iENAM. ]OINi I�EMIfYINGNVMBE0..AIIPCH0EE0FOR10IMLVNEL'JPFP:ESfATE VAWFOFASSEf IMFFfSf DECEOENi'$MiE0.E5T
1' A' 07123/09 METROBANKACCTM833053648 7,1d0.90 50% 520A5
2 A 07123/09 METROBANKACCTk833053655 3,505.17 50°h 1,75259
TOTAL(Also enter on Line 6, RecapiWlation) ; z�2�3'�4
If more space is needed,use additional sheets of paper of[he same size.
REV-]5l1 tX- (0245
� pennsylvania SCHEDULE H
+ .. oevnn.menroFnevervue FUNERAL EXPENSES AND
���E�A�=ET�aETua^' ADMINISTRATIVE COSTS
aes�oExr oeceoervr
ESTATE OF FILE NUMBER
JOHANNA A SCHARF 21-13-0370
DecedenPs Eebts must 6e reported on Sahedule I.
ITEM
NUNBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1� GORDON C EMERICK FUNERAL HOME CLIFTON PARK, NY 858.31
B. ADh11NISTRATIVE COSTS:
L Penonal Representative Commissions'.
Name(sJ ofPersonalRepresen[aflve(s) _ _ ___
Street Address
CItY___.__. ._ ... .__- ____.State ZIP . . .._._._.
Year(s)Commission Paid . _ . ..._ _.
L Attomey Fees.
3. Famiry Exemption', (If OeceOenPs address is no[the same as tlaimanPs,a[[ach explanation,) 3,500.00
Claimant LINDAABOYD
SheetAdGress 604 MALLARD RD �
City CAMP HILL . State PE+ ZIP 17011
Relationshlp af[laimant to Decedent DAUGHTER _
4. Pmbate Fees: 193.50
5. AcrountancFees� 500.00
6. Ttx ReNrn Grepare�Fees:
1� 2003 TOYOTA ECHO INSPECTION,SALES PRICE ESTIMATE&NOTARY FEE ON SALE 94.19
TOTAL(Also enter on Line 9, Recapitulation) ¢ 5,146.00
If more space is neetleQ use addi[ional sheets af paper of[he same size.
aEv-isiz ex+ (ox-is)
� pennsylvania SCHEDULE I
ry� oevnarmen.oraevervue DEBTS OF DECEDENT�
�:�xea�raxcernxaEruan MORTGAGE LIABILITIES & LIENS
aes�oerv*oecEOE�vr
ESTATE OF FILE NUMBER
JOHANNA A SCHARF 27-13-0370
ReOort Eebts incurred by the EereEen[prior to Eeath that remaineE unpaid at the date of Eeath,incluEing unreimburted me0ical ezpenses.
IIEM VAW E AT OATE
NpMeER DESCRIPTION OF DEATH
1� PENNSYLVANIAGASTROENTEROLGYCONSULTANTS 3327
2 QUANTUM IMAGING AND THERAPEUTIC ASSOCIATES 4271
3 ANDREWS AND PATEL ASSOCIATES PC 19.81
4 CAMP HILL EMERGENCY PHYSICIANS 42.91
5 SPIRITPHYSICIANSERVICES 191.17
6 METROBANKVISA ACCTR4040781001900934 889.73
7 HOLY SPIRIT HOSPITAL VIA COMPUTER CREDIT INC ACCT#44529667 A 1,184.00
e SPIRT PHYSICIAN SERVICES ACCT#87595 26.46
9 VISIONS FEDERAL CREDIT UNION via ASWAD&INGRAHAM,ATTORNEYS AT LAW 770.96
10 LEASE PAYMENT SHARE-LANDLORDS ARE RICHARD L&JUANITA B R4UDABAUGH
LEASE TERM OCT 1,2012 THROUGH SEPT 3Q 2013 AT$721 PER MONTH. ONE-HALF SHARE
IS$360.50 PER MONTH FOR 7 MONTHS. (MAR 2013 THROUGH SEPT 2013) 2,523.50
TOTAL(Also enter on Line 10, Recapi[ulation) S 5,724.52
If more space is needed,insert aEGitional sheets of the same sixe.
REVa 513 E%- ;W 45;
� pennsylvania SCHEDULE ]
��' oEcaarnErvlaFaEVErvuE gENEFICIARIES
�rvxeartnrvce rnx aEroan
aEsioErvr oeceoervr
ESTATE OF: FILE NUMBER:
JOHANNA A SCHARF 21-13-0370
RElAT10N5HIP TO DECEDENT AMOl1NT OR SHARE
NUM6ER NAME AND ADDRE55 OF PERSOIJ(5) RECEIVING PROPERTY Do No[List Tmstee(s) OF ESIATE
I TA%ABLE�ISTRIBUTIONS [Nclude outrightspousaltllshlbubons and[mns(ers un0er
Sec 9116(a) (12).]
�. LINDAABOYD DAUGHTER 50°/
604 MALLARD RD,CAMP HILL,PA 17011-1219
2 FREDERICK N SCHARF SON 50%
604 MALLAR�Rq CAMP HILL,PA 17011-1219
EMER�OLLAR AMOUNTS FOR DISTRIBUTIDNS SHOWN ABOVE ON LINES IS THROUGH 18 OF REVd500 COVER SHEET,AS AGPROG0.IATE.
�� NON-TA%ABLE DISTRBUTIONS
A. SPOUSAL�ISTRBUiI0N5 UN�ER SECTION 9113 FOR WHICH AN ELEQION TO TAX IS NOT TAKEN'.
1.
B. CHA0.1'ABLEAND GOVERNMENTALDISTRIBUTIONS:
l.
TOTAL OF PART lI- ENTER TOTAL NONdAkABLE DISTRIBUTIONS ON LME 13 OF REV4500 COVER SHEET. {
If more s0ace is neeEetl,use ad�i[ional shee6 of paper of the same size.
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