HomeMy WebLinkAbout07-01-15 (2) 1505611101
REV-1500 EX tot-11, '
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania
DEPAHTI-OP-ENUE County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN :U�l
PO BOX 2g8o6o1 � � I I1 , ( Ill I
Harrisburg,PA 1'7128-o6o1 RESIDENT DECEDENT (SIJ
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
Decedent's Last Name Suffix Decedent's First Name MI
�JI�JC U " ��� M_J C CJJJ�JJ ®R
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name _ Suffix Spouse's First Name MI
Un� ,J J_� ���� I�,'= 1Ji�U] Ff
I U� JDDiJJi�J1JQJCJ �1
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
JLJ REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C=) 1.Original Return 4W 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise(date of Q 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMAPON SHOULD Bg�tECT�TIP
Name _ _ _ Daytime elephone NuncGer r*I
f;�Ioj�
Rgi—s-rER OF.WIL{.S1USE OJJLA'j
O
First Line of Address _ _ �'O O
CD
CD
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Second Line of Address
r-
LJOL
City or Post Office _ State ZIP Code DATE FILED
Z�J L�'s �G�! '�JJJCIOi� REZ` Fo —'� 8 ��J � ��JU.JJ,�J�JJ�J
Correspondent's e-mail address: UA1,nn , 'C l7 P-2
Under penalties of perjury,I declare that 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 personal representative is based on all information of which preparer has any knowledge.
SIGNA E OF 20!MBLE R FILING RETURN DATE
SIGNATURE OF PR AR OTHM THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505611101 1505611101 J
1505611201
REV-1500 EX
Decedent's Social
Social Security Number
Decedent's Name:
RECAPITULATION
1. Real Estate(Schedule A). ... ... . .... ... .. ..:.. ... . . .... . . .... ... .. ... 1. 0 ? �
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. •
6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . .. ... 6. •
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. .. .... 7.
8. Total Gross Assets(total Lines 1 through 7).. .. . .. ... ... .. . .. .. .. .. ... .. 8. . .
9. Funeral Expenses and Administrative Costs(Schedule H)..... ... . . .. .. ..... 9.
10. Debts of Decedent, Mortgage Liabilities and Liens{Schedule 1). ... . . .. .. ..... 10.
11. Total Deductions(total Lines 9 and 10).. . .... . .. .. . .... . .. . . ... .. ... .. . 11. Q
12. Net Value of Estate(Line 8 minus Line 11) .. .. ... .. . ..... .. . . ... . . ..... . 12. 7 p l
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . .. ... . . ..... .... . ... .. . 13. !-p
14. Net Value Subject to Tax(Line 12 minus Line 13) .. . .. . .. ... .. . . .. . .. . . . . 14. 2 (7
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 taxable
at lineal rate X.0- 1, 16.
17. Amount of Line 14 taxable
at sibling rate X.12 17. •
18. Amount of Line 14 taxable
at collateral rate X.15 18. 1 •
19. TAX DUE .. .. . . .. . .. .. .. .. .. .. . .. .. . .... . .. . . . .. .. . .. . . . . . ... . .. .. . 19. I
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
J
Side 2
1505611201 1505611201 J
1. ✓V FHA 2.[]RHS 3. []Conv.Unins. 6.File Number. 7.Loan Number. 8.Mortgage Insurance Case Number:
4. ❑VA 5.❑Conv.Ins. KWC68987 3804036851 446-2520988-703
C.Note: This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.Items marked'(p.o.c.)'were paid outside the closing;they are
shown here for informational purposes and are not included in the totals.
D.Name&Address of Borrower. E.Name&Address of Seiler: F.Name&Address of Lender.
JOHN A RICORDS JOHN R HOLDER,JR.,EXECUTOR FOR THE ESTATE OF HOME POINT FINANCIAL CORPORATION
7806 BRIDLE LANE JOHN R.HOLDER 9 ENTIN ROAD,SUITE 200
HARRISBURG,PA 17112 4186 NANTUCKET DRIVE PARSIPPANY,NJ 07054
MECHANICSBURG,PA 17050
I
G.Property Location: H.Settlement Agent PINNACLE LAND TRANSFER,LLC 1.Setuemeni Date I Disbursement Date
4186 NANTUCKET DRIVE 4242 CARLISLE PIKE,SUITE 151-B, 6/26/2015 ! 6/26/2015
MECHANICSBURG,PA 17050 (CUMBERLAND) CAMP HILL,PA 17011 (717)920-3331
(10-16-1058-115,HAMPDEN TOWNSHIP) Place Of Settlement: 4242 CARLISLE PIKE,SUITE 151-B,
CAMP HILL,PA 17011 (717)920-3331
i
IJ.Summary of Borrower's
100.Gross Amount Due From Borrower 400.Gross Amount Due To Seller
101.Contract sales price $194,000.00 401.Contract sales price $194,000.00
102,Personal Property 402.Personal Property
103.Settlement Charges to Borrower line 1400 $12,437.03 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Ad ustments for items paid by seller in advance
106.Sewer/Trash 6/26/2015 to 6/30/2015 @$160.75/Quarter . $7.05 406;Sewer/Trash 6/26/2015 to 6/30/2015 0,$160.75/Quarter $7.05
107.County taxes 6/26/2015 to 12/31/2015 @$460.22/Year. $237.04 407.County taxes 6/26/2015 to 12/31/2015 @$460.22/Year $237.04
108.School Tax 6/26/2015 to 6/30/2015 $17.43 408.School Tax 6126/2015 to 6/30/2015 $17.43
109.HOA Quarterly Dues 6/26/2015 to 6/30/2015 @ $9.64 409.HOA Quarter) Dues 6/26/2015 to 6/30/2015 $9.64
110. 410.
411.
112. _ 412.
120.Gross Amount Due From Borrower $206,708.19 420.Gross Amount Due To Seller $194,271.16
200.Amounts Paid By Or In Behalf Of Borrower 500.Reductions In Amount Due To Seller
201.Deposit or Earnest Money $3,000,00 501.Excess deposit see instructions
202.Principal amount of new loan $190,486.00 502.Settlement Charges to Seller line 1400 $13,990.00
203.Existing loan taken subject to 503.Existing loan taken subject to
204. 504.Pa off of first mortgage loan
205. 505.Payoff of second mortgage loan,
206.Seller Assist $3,000.00 506.See Addendum 506 $3,000.00
207. 507.Disbursed as proceeds $3,000.00
208. 508.
209. 509.
Adjustments for items unpaid by seller Adjustments tor items un ald by seller
210.CI /town taxes 510.Ci /town taxes
211.County taxes 511.County taxes
212.Assessments 512.Assessments
213. 513.
214 514
215. 515.
'216. 516.
217. 517. <
218.. 518.
219. 519,
220.Total Paid By/For Borrower $196,486A0 520.Total Reduction Amount Due Seller.. $16,990.00
300:Cash At Settlement FromfTo Borrower 600.Cash•At SettlementTo/From Seller
301;Gross Amount Due From Borrower fline 120 $206,708.19 601.Gross Amount Due To Seller line 420- $194,271.16
302.Less Amounts Paid B 1For Borrower(line 220) $196,486.00 602.Less.Deduction in Amt:Due To Seller line 520 $16,990.00
303.Cash ❑✓From ❑To Borrower $10,222.19 603.Cash ✓❑To E]From Seller $177,281,16
REV-1502 EX+ (01-10)
pennsytvania SCHEDULE A.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
'7-'qY/J R, PDZ'0E�'k, S�. 21 /y /Ra 7
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM VALUE AT DATE
NUMBER Include a copy of the deed showing decedent's interest if owned as tenant in common, OF DEATH
DESCRIPTION
1.
RC-5 IAWCC /-/)N NAMTCPCkFT Of
IToSa TAx AtIPEH+�y PROD
�,zooER7"y SOLD ?6 JWV6 aolS J �? 8l
piFF�R�i�eE — YXhNe-E 7-AX awE,d A7 X81.
TOTAL(Also enter on Line 1, Recapitulation.) $ 7,a 8
If more space is needed,use additional sheets of paper of the same size.
REV-1500 EX Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
.T011W P, 140 i,P
STREETADDRESS
�i18�6 NANTctcX�r ��'•
CITY STATE ZIP
I1I6'eI /CS
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) �l a
2. Credits/Payments
A.Prior Payments ��D
8.Discount
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.
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 ..................................................................................I....... ❑ 9
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 for"or payable-upon-death bank account or security at his or her death?.............. ❑ IR
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation? ........................................................................................................................ ❑ 2
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(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 stepparent 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.