HomeMy WebLinkAbout05-06-05
REV.1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
II j0, VI)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Thorn son Frank W.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER. i I ) 3
2.. L-O 5 - '1 (
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COUNTY CODE YEAR NUI.IBER
SOCIAL SECURITY NUMBER
196-05-9170
THiS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WillS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of dealh prior to 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total NumberofSafe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (AtlachSch0)
02/14/2005 04/03/1915
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[X] 1. Original Return
D 4. limited Estate
D 6. Decedent Died Testate jAttach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-821
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (date ofdeath between 12.31.91 and 1-1-95)
(8)
(11)
(12)
(13)
(14)
PA 17109
OFFICIAL~USE ONLY
464.61
1,061.87
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COMPLETE MAILING ADDRESS
845 Sir Thomas Court
NAME
Jac ueline A. Kell
FIRM NAME (If Applicable)
Jan L. Brown & Associates
TELEPHONE NUMBER
717-541-5550
Suite 12
Harrisbur
31 ,664.00
33,190.48
1,750.00
1,750.00
31,440.48
31 ,440.48
1,414.82
1 ,414.82
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly owned Property (Schedule F)
D Seperate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts ot Deoedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines g & 10)
12. Net Value of Estate (line 8 minus Une 11)
13. Charitable and GovemmentalBequestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(g)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x _(15)
31 ,440.48 X .045 (16)
X .12 (17)
X .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
20. 0
CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT
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ece en s omole e ress:
STREET ADDRESS
1000 Claremont Road
CITY I STATE I ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
1,414.82
7074
Total Credits ( A + 8 + C)
(2)
70.74
3. InteresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty (0 + E) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. It Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
8. Enter the total of Une 5 + 5A. This Is the BALANCE DUE. (58)
Make Check to: REGISTER OF AGENT
0.00
1,344.08
1,344.08
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 IRI
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IRI
c. retain a reversionary interest; or ...................................................................................................... 0 IRI
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IRI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?..... ................................... ...................................................... IRI 0
3. Did decedent own an "in trust fo~ or payable upon death bank account or security at his or her death? ................. 0 IRI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 IRI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of peljury, I declare that I have examined this return, includinQ 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 a1lmformation of which preparer has any knowledge.
SIGNA;U5E OF PERSON, RESPONSIBLE FOR FILING RETURN . gATE
Irk>> (( ~-U~.nJ- if - 27- ~5
ADDRESS 127 Tory Circle
Enola
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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A SS 845 Sir Thomas Court, Ite 12
Harrisburg
PA 17025
DATE
"I. 21-/J5
PA 17109
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For dates of death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)l.
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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% [72 P.S. ~9116 (al (1.1) (iill.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requiremenls for disclosure of assets and filing a tax retum 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 twenty-one 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% [72 P.S. ~9116(a)(1.211.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(111.
The tax rate imposed on the net value oltransfers to orforthe use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)1. 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 + (6.-98)
Ow
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Thomoson Frank W
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right 01 survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Refund from Claremont Nursing Home
VALUE AT DATE
OF DEATH
464.61
TOTAL (Also enteron line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
464.61
REV-1509 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
ThomDson. Frank W
FILE NUMBER
If an asset WlS made joint within one year of the decedent's date of death, It must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Phyllis A. Levengood
127 Tory Circle
Enola, PA 17025
daughter
B
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JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 2003 Wachovia Bank N.S. 2,123.73 50. 1,061.87
Checking Account #1000840373035
TOTAL (Also enter on line 6, Recapitulation) $ 1,061.87
(If more space is needed, insert additional sheets of the same size)
REV.151Q EX + (6-98)
*'
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC, NON. PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ThomDson Frank W
FILE NUMBER
This schedule must be completed and flIed if the answer to any of questions 1 through 4 on the reverse side of the REY.1500 COYER SHEET is yes,
DESCRIPTION OF PROPERTY
ITEM INCLUOETHENAMEOFTHETRANSFEREE,THEIARB.ATIONSHIPTODECEDENTANO DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFeR. ATTACHACOPVOFTHE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST VALUE
(lFAPPLtCABLE)
1. Gift to daughter, Phyllis A. Levengood, April 2004 6,071.23 100. 3,000.00 3,071.23
2. Gift to daughter, Phyllis A. Levengood, May 2004 22,371.77 100. 22,371.77
3. Gift to daughter, Phyllis A. Levengood, July 2004 6,221.00 100. 6,221.00
TOTAL (Also enter on line 7 Recapitulation) $ 31 664.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+{12~99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ThomDson Frank W
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Opening of grave 550.00
2. Memorial Service lunch 65.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s)JEIN Number of PelSonal Reprasenlative(s)
Street Addrass
City Slate Zip
Yea~s) Commission Paid:
2. Attomey Fees Jan L. Brown & Associates 1,000.00
3. Family Exemption: (If decedents address is not the same as claimants. attach explanation)
Claimant
Street Address
City Slate Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountanfs Fees
6. Tax Return Preparer's Fees Kelli Eckert 7500
7. Filing of Inheritance Tax Return--Cumberland County 15.00
8. Flowers for Beverly and Jerry Bradigan. who catered the memorial service 45.00
TOTAL (Also enter on line 9, Recapitulation) $ 1 750.00
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheem of the same size)
REV_15';EX'I.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Frank W
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include ou~t spousal distributions, and transfers under
Sec. 9116(a (1.2)]
1. Phyllis A. Levengood daughter joint property
127 Tory Circle
Enola, PA 17025
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)