HomeMy WebLinkAbout07-08-15 ,
� 1505610140
REV-1500 EX (oti-�o)
OFFICIAL USE ONLY
PA Departrnent of Revenue County Code Year Flle Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po sox 2aasoT � y y 4 0 4 b 8
Harrisbu PA.17128-0601 RESiDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Socia�Secur(ty Number Qate of Dead� MMDDYYYY Date of Birth MMDDWYY
0 2 2 5 2 0 1 4 1 1 1 0 b 9 2 6
DecedenYs Last Wame Suffix DecedenYs First Name M�
W A R D D 0 R 0 T W Y J
(If Applicablo)Enter Survlving Spouse's Information Below
Spouse's Last Name 5u�x Spouse's First Name MI
Spouse's Soael Security tJumber
THIS RETURN MUST BE FILED IN DUPLfCATE W#TH THE
' REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
Q 1.Original Return � 2.Supplemental Return � 3.liemsinder Retum(date of death
priorto 12-13-82)
� 4.Limited Estate � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Retum Required
death aRer 12-12-82)
� 6.Decedent Died Testate ❑ 7.Decedent Maintained a Living Trust _ 8.Total Number of Safe Deposit Boxes
(Rttach Copy of Wilq (Attach Copy of Trust)
� 9.Litigation Proc�eds Received � 10.Spousal Poverty Credit(date of death � 11.EleCtion to tax under Sec.9113(A}
between 12-31-91 and 1-1-95) (Athach Sch.O}
CORRESPONDENT-THIS SEC7tON MUST BE CONPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORIYIIATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
M A T T H E W A . M c K N I G H T 7 1 7 2 4 9 2 3 5 3
REqSTER OF WILLS USE ONLY rv
o _s
n �,�j-� .�7 �i
G � � ;'�1 c
First line of address � � � �-'
c`r
I R W I N � M c K N I G H T , P • C • �' � �' r �`� �
a7 ,;;,. r— �,-i �r
Secand pne of address ;� �� � � =� �
�=�7
6 0 W E S T P 0 M F R E T S T R E E T �"" ` '`� `� �
�.a c, c� "v -n
City or Post Office State ZIP Code DATE flLED _ ,`� �, � � c
c-'> L—
C A R L I S !. E P A 1 7 0 1 3 - 3 w N �
u� _
.y� �
CorrespondenYs e-mall address:
Under Ities of perjury,I detiare that 1 have examined this reNm,including accompanying schedules and statements,and lo lhe lxsl of my knowledge and beliet;
it ts tru ct and plete.De preparcr other than the personal representative is based on all information of which preparer has arry knowle8ge.
StG RE OF R N RES FO ILING RETURN � �
/
DRESS
909 VAftD WESTFIELD NJ 07090
SIGNATURE OF PREPARER OTHER THAN REPRESENTATfVE DATE
ADDRESS
6� WEST POM�RET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORfiA QNLY
Slde 1
� 1505610140 1505610140 �
-,
�
�
�
r
� 15a561�240
REV-1500 EX Decedent's Social Securiiy Number
DecedenCs Name: D 0 R 0 T H Y J • W A R D 1 9 5 2 0 0 7 1 6
RECAPITULATION
1. Real Estate(Schedule A) ........................................... ti• �
2. Stocks anci Bonds(Schedule B) ...................................... 2• �
3. Closely Held Corporation,Partne�ship or Sole-Proprietorship(Schedule C} ..... 3. '
4. Mortgages and i3otes Receivable(Schedule D) .......................... 4. '
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E�....... 5.
1 6 9 9 9 . 7 0
6. JoinUy Owned Properiy(Schedule F7 ❑ Separate BiNing Requested ...... , 6. '
7. Inter-V4vos Ttansfers&Miscellaneous N Probate Property
(ScheduEe G) � Separate Billing Requested ....... 7. •
8. Total Gross Assets{total Lines 1 through 7) ............... 1 6 9 9 9 . 7 0
............ 8.
9. Funeral Expenses and Administrative Costs(Schedule H) .................. 9• � 3 0 1 . 7 �
10. Debts of Decedent,Mo�igage Liabilifies,and Liens(Schedule i) . 10. � � 4 6 7 . 2 �
11. Tota1 Qaduttions(total Lines 9 and 10) .................. .... 11. � 0 � 6 8. 9 0
12. Net Value of Estate(Line 8 minus Line 11} .......-....••••••••••••••�• t2• - 3 7 6 9. 2 0
13. Charitabie and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made(Schedule J} ..................... . '3• '
14. Net Vatue Subject to Tax(Llne 12 minua Line 13) ...................... 14. - 3 7 6 9. 2 0
TAX CALCULATE0IV-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Ltne 14 taxable
at the spousal tax rale,or
transfers under Sec.9116
(a)(1.2)X.0 _ 0 . 0 0 15. a • � �
1fi. Amount of Line 14 taxable � � Q Q 16. 0• 0 0
at lineal rate X.045
17. Amount of Line 14 taxable Q � � 0 �� � � � �
at sibling rate X.92
18. Amount of Line 14 taxabfe 0 � Q 0 i 8 O . � �
at collateral rate X.15
19. TAX DUE ..,. .. 19. O• O O
................................................
20. FlLL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
L Z50561024Q 15�5610240 J
REV-1500 EX Page 3 File NumBer
Decedent's Complete Address: 2� 14 oass
DECEDENT'S NAME
DOROTHY J.WARD
STREET ADDRESS
1 LONGSDORF WAY --
CITY STATE ZkP
CARLISLE PA 17013
Tax Payments and Credits: ��� o.00
1. Tax Due(Page 2,Line 19)
2. CreditslPayments
A.Prior Payments
B,Discount 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 ihe OVERPAYMENT.
Fill In oval oa Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1+Line 3 Es greater than Line 2,enter the difference.Thfs is the 7AX DUE. (5} O.OQ
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 transfe�and; Yes No
a. reiain the use or income of the property transferred: ...................................................................... ❑ �
b. retain the right to designate who shall use the p�operty transferred or its income: ............................... ❑ �
c. retain a reve�sionary interest;or ................................................................................................ ❑ �
d. receive the promise for life of eithec payments,beneflts or care? ....................................................... � �
Z. If death occurred aftet Decemher 12,1982,did decadent transfer property within one year of death
wifhaut receiuing adequate consideration? ....................................................................................... ❑ �
3. Did decedent own an"in trust for"or payahle-upon-death bank�count or security at his or he�death? ......... ❑ 0
4. Oid decedent own an individual retirement account,annuify w other non-probate property,which
contains a beneficiary designadon7.................................................................................................. ❑ �
IF THE ANSWER TO ANY OF tHE ABOVE QUESTIONS IS YES,YOU MU3T COMPI.ETE 3CHEDULE G AND FILE IT AS PART OF THE RETURN.
�or dates of death on or after July 1,t994,and be#ore Jan. 1,1995,the tax rate imposed on the net value of transfers to or for the use of ihe surviving spouse is
3 percent[72 P.S.§9116(a}(1.1)(i�].
For dates of death on or after Jan, 1,1895,ihe tax rate imposed on the net value of transfers to or for the use o#the surviving spouse is 0 percent
[72 P.S.§9116{a)(1.1)(fi)j.The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and
flling a tax return are still applicable even if the sunriving spouse is the only benefiaary.
For dates of dea4h on or aRer July 1,2000:
• The tax rate imposed on the net value af t�ansfers from a deoeased 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 an 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(1.2)[72 P,S,�9116(a}(1}].
• The tax rate imposed on the net vaEue 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 deflned,under
Section 9102,as an individual who has at least one parent in cammon with the decedent,whefher by bload or adoption.
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
OEPARTMENTOFREVEMUE CASH, BANK DEPOSITS 8�MISC.
INHERITANCETAXRETURN pERSONAL PROPERTY
RESIDEPfT DECEDENT
ESTATE OF: FILE NUMBER:
DOROTHY J.WARD 21 14 0468
Inciude the proceeds of litigation and fhe date the proceeds were received by the estate,
AIV property jointly owned with right of survivorahip must be disciosed on Schedule F.
VALUE AT DATE
ITEM OF DEATH
NUMBER DESCRIPTION
1, METRO BANK-CHECKING ACCOUNT#2840249953 7,914.16
2, WELLS FARGO-1RREVOCABLE BURIAL RESERVE ACCOUNT#1010120'l30195 8,666.37
3. HiGHMARK-REFUND 203.63
4. BLUE CROSS-REFl1ND 37'$0
5. THE SENTINEL-REFUND 56.74
6. OMNICARE-REFUND 12'��
7. ALEC H.JARET, DMD-REFUND 109.00
TOTAL(Also enter on Line 5,Recapilulation) S 16 998.70
1f more space is needed,use add'+tional sheets of paper of the same size.
,m.,���„ �. ��.•, �
, REV-1511 EX+(10-08)
� pennsylvania SCHEDULE H
DEPARTMENT OF REVENltB FUNERAL EXPENSES AND
INHERITAkCETAXRETURN ADMINISTRATIVE COSTS
RE6IDENT OECEDENT
ESTATE OF FILE NUMBER
DOROTHY J.WARD 21 14 0�468
DecedeM's debts mast be reportad on Schedule I.
ITEM
NUMBER OESCRIP710N AMOUNT
A. FUNERAL EXPENSES:
t. HAROID SNOWDON HOME FC)R FUNERALS, INC. 5,492.00
B. ADMINISTRATlVE COSTS:
1. Personai Representative Commissions;
Name�s)of Personal Represeniative(s)
Street Address
City State ZIP
Yea�s}Cnmmission Paid:
z, AttomeyFees: IRWIN&McKNIGHT, P.C. 1,200.00
3, Family Exemptlon:(I(dec�denCs address ls not the same as clalmanYs,attach explanation.)
(�aimant
Sheet Address
�, State �P
Relationship oE Claimant to Decedent
4. Probate Fees:
5 Accountani Fees:
6. Tax Retum Preparer Fees:
7, S.JEAN WARD-TRAVEL EXPENSES 546.20
8. REGISTER OF W1LLS-FILING FEES 58,50
9. REGISTER OF W1LLS-CERTIFICATION OF COEJRT ORDER �•�
TOTAL(Also enter on Line 9,Recapitulation) $ 7 301.70
If mo�e space is needed,use ad6tional sheefs of paper o(tl�e same size.
REV-45i2 EX+(12-12)
pennsylvania SCHEDULE I
DEPAR7MENT OF REVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABIUTIES 8�LIENS
RESI�ENfDECEDENT
ESTATE OF FILE N!l�IBER
DOROTHY J.WARD 21 14 0468
Report debts fncurred by the decedent prlor to death that remained unpatd at ihe date of death,including unreimburoad medical expenses.
VALUE AT DATE
NUM ER DESCRiPTiON OF DEATH
1. DEPARTMENT��PUBL{C WELFARE CLAIM '13,413.20
CIS#720347798
2. DIAKON LUTHERAN SOCIAL MINISTRIES-NURSING 54.00
TOTAL tAlso enter on Line 10,Recapitulation) $ �3 467.20
If more space is needed,insert additional sheets of the same size.
. REV-ib13 EXt(01-10)
pennsylvania SCHEDULE J
OEPARTMENT OF REVENUE BENEF'ICtARiES
INHERI7ANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DOROTHY J.WARD 21 94 0468
RELATIONSHIP TO aECEpENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS pnclude ouMght s usal distdbutb�and transiers under
Sec.9116{a�(12).]
1. SHERRY JEAN WARD Lineal
909 BOULEVARD
WESTFIELD, NJ 07090
2. JAMIE WARD LIEBERMAN Lineal
310 W. 1 ZOTH#80
NEW YORK, NY 10027
3. MALLORY ANN WARD L.ineal
60 NOYES AVENUE
SWOYERSVILLE,PA 18704
4. GRETCHEN�WARD CARVELLA Lineal
113 WOODLAND DRIVE
MECHANICSBiJRG, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LlNES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
�, NON-TAXABLE DISTRIBUTIONS;
A.SPOUSAL DISTRIBUTIONS UNflER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN;
1.
B.CHARITABLE AND GOVERNMENTAL DISTR18UTlONS;
1.
TOTAL OF PART I[-ENTER TOTAL NON-TAXABIE DISTRIBUTIONS ON LINE 13 OF REU-1500 COVER SHEET, 3
If more space is needed,use addiiional sheets of paper of the same size.