Loading...
HomeMy WebLinkAbout06-29-15 +" pennsylvania 1505618403 DEPARTMENT OF REVEN =X(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT 21 14 00953 ENTER DECEDENT INFORMATION BELOW 09 27 2014 06 05 1925 Decedent's Last Name Suffix Decedent's First Name MI WOODS JACK L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1- Original Return 1:12. Supplemental Return 1:13. Remainder Return(date of death prior to 12-13-82) 4. Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) ❑X 7. Decedent Died Testate 8. Decedent Maintained a Living Trust 0 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 SHAWN M STOTTLEMYER 717 632 4656 First Line of Address 2 SOUTH HANOVER STREET Second Line of Address City or Post Office State ZIP Code CARLISLE PA 17013 SSS U �{ Correspondent's email address: Aoa> G t,,> 4-am 4=3 -,-I rp - REGISTER OF VVILLS USE 9-Y u REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY rn co ;;} C.> l r'"a CD -77 -- C7 c:*.- J t DATE F..ILED'S'TAMP —n N Side 1 Illill III�IIIII�II�III�IIIVIIIIIiIIIIIIIIIIII �IIII 1505618403 1505618403 ' 1505618411 REV-1500 EX 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. 15,125 - 92 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 15 ,125 - 92 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 12 -,348 - 65 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 1 ,296 • 20 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 131644 • 85 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 1,481 • 07 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. 11481 - 07 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.00 15. 0 • 0 0 16. Amount of Line 14 taxable at lineal rate X .045 11481 - 07 16. 66 - 65 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 66 - 65 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ 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 RETUF� Ginger L o ter DATE J oi .e�i.. to t5 ADDRESS 336 Fairview Street, Carlisle, PA 17015 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Shaw M. Stottlem r DATE ADDRESS isle, PA 17013 5� �/arr�vr 111111111111111111111111111111 111111111 Side 2 1505618411 1505618411 REV-1500 EX Page 3 File Number 21-14-00953 Decedent's Complete Address: DECEDENT'S NAME ,v Woods,Jack L STREET ADDRESS 336 Fairview Street CITY STATE ZIP Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 66.65 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.'This is the TAX DUE. (5) 66.65 Make Check Payable to REGISTER OF WILLS AGENT r.. `'��'��'-,'�i� '�.r "�'�'� � i:v.r': ''�"9�`,�...tS ..n.,�,"� a�.,,,�"4 „��ci� ..r....Yu .. ,....,�?.`�,'..` ,;; ..�, .....,.�.. ice„ ,�✓', ,, v,r ..e. rv, ti.... .. .,�..�, 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;............................................................:.................. ❑ 0 b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... El lxl 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?....... ❑ ❑x 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ ❑ contains a beneficiary designation?.................................................................................................................. x 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 January 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-1508 EX+(08-12) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE p INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Woods,Jack L 21-14-00953 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Ewing Brothers Funeral Home, Inc.-credit for price increase waived per Steve Ewing at 2,227.97 Ewing Brothers Funeral Home, Inc. 2 Members 1st Federal Credit Union Checking-Acct. No.: 14646-11 6,519.14 Accrued interest on Item 2 through date of death 0.36 3 Members 1st Federal Credit Union Savings-Acct. No.: 14646-00 5,030.81 Accrued interest on Item 3 through date of death 0.64 4 Eagles Club-funeral benefit 500.00 5 IRS-refund 547.00 6 Veterans Administration-funeral benefit 100.00 7 White Circle Club-funeral benefit 200.00 TOTAL(Also enter on Line 5, Recapitulation) 15,125.92 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.08-12) REV-1511 EX+(08-13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DE EDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Woods,Jack L 21-14-00953 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 10,062.15 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid 2. Attorney's Fees Shawn M. Stottlemyer 2,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 150.50 See continuation schedule(s)attached 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 136.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 12,348.65 Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.08-13) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Woods,Jack L 21-14-00953 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Ewing Brothers Funeral Home, Inc.-funeral bill 10.062.15 H-A 10,062.15 Probate Fees 2 Cumberland County Register of Wills-inital Probate fees: Letters Testamentary$45.00;filing 150.50 Will $15.00;Short Certificates$20.00;JCS&Auto fee$40.50;filing Inventory$15.00;filing Inheritance Tax Return$15.00(Note:pd. in cash by Ginger) H-B4 150.50 Other Administrative Costs 3 H&R Block-tax preparation fee 136.00 H-87 136.00 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev.6-98) Rev-1512 EX+(12-12) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Woods,Jack L 21-14-00953 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 Claremont Nursing&Rehab Center-nursing home bill 1,100.00 2 Community Lifeteam EMS-medical bill 116.20 3 Cumberland Goodwill Fire Rescue-medical bill 80.00 TOTAL(Also enter on Line 10, Recapitulation) 1,296.20 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12) REV-1513 EX+(01.10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Woods,Jack L 21-14-00953 NUMBER NAME AND ADDRESS OF DECEDENT RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE PERSONS)RECEIVING PROPERTY (Words) ($$$) Do Not List Trustee s ITAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Ginger L Hollister Daughter 100%residue 336 Fairview Street Carlisle, PA 17015 Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appiopriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)