HomeMy WebLinkAbout07-31-15 (2) pennWvanfa 1505614105
EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year T— File Number
PO BOX 280601 INHERITANCE TAX RETURN aI� �
--
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 1 �� F_� -70
ENTER DECEDENT INFORMATION BELOW
Social Secudty_N_umber Date of Death MMY Date DDYYYof Birth MMDDYYYY
-- -� I 06012015 -. Q�--�` W q ra
Decedent's Last Name _ _ _ _ Suffix Deced nt's Fi Name_ _ _ MI
North Harold
(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 INAPPROPRIATE OVALS BELOW
CgD 1.Original Return p 2.Supplemental Retum p 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of O 5. Future Interest Compromise(date of p 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
ID 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust _ 0 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
O 10.Litigation Proceeds Received CM 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13,Business Assets C=:) 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
�. !
�Cynthia Roche (908)507-5311
._______._...�...._
First Line of Address _
102 D St
Second Line of Address
City or Post Office _ State ZIP Code
Es
Seaside Park � i NJ 08752
Correspondent's email address: susan81953@aol.com
REGISTER OF WILLS USE ONLY
REGISTER OF WILLS USE ONLY
j DATE FILED MMDDYYYY CJ11 �J
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PLEASE USE ORIGINAL FORM ONLY
Side 1 CO
1111111 IIIII IIIII
1 i11�11111 IIIII IIIII IIIII IIIII IIIII IIII IIII
05614105 1505614105 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
Harold L. North
STREETADDRESS
Cumberland Crossing
1 Longsdorf Way
CITY STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 13,549.31
2. Credits/Payments
A.Prior Payments
B.Discount 677.47
(See instructions.) Total Credits(A+B) (2) 677.47
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) 12,871.84
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.......................................................:.................................. ❑
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 fife 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?............................................................................................................... 0 ❑
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ 0
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
containsa beneficiary designation? ........................................................................................................................ ❑
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 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 orfor 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.
1505614.205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name:
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. 194,826.17 a
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... ... 6. 48,746.25
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
y
(Schedule G) Separate Billing Reqnested.... .... 7. 6R3_,-2.9T5.06
^-` I
8. Total Gross Assets(total Lines 1 through 7.).. .... .. .. .... .... ..... .... .. . 8. 1 306,867.48 ¢�
9. Funeral Expenses and Administrative Costs(Schedule H).. .... ... . .... .... . 9. f 4,600.78 6
( )
1,171.001
10. Debts of Decedent,Mortgage Liabilities and Liens Schedule I .. .... .... .... . 10.
11. Total Deductions(total Lines 9 and 10).. ........ .... .... . ....... .... ... 11. 5,771.78
12. Net Value of Estate(Line 8 minus Line 11) .. . .... ........ .... ......... .. 12. 301,095.70
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. 301,095.70
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.045 301,095.70 i 16, 13,5499.31
17. Amount of Line 14 taxable I d
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
�- -- - -�--�-
19. TAX DUE .... .... .... ... . .... .... . ... ... .... . ... .... .i.. .... .. .. .. 19. 1 13,549.31
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Under penalties of perjury,1 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 knowled
SIGN/ OF PERSO ESPON E FOR FILIN RETURN DAT
S NATURE OF PREPAR OOTHER THAN PERSON R PO 1 OR E RETURN D;`)
AT O t
ADDRESS Llool1
102 D St Seaside Park, NJ 08752
Side 2
150561420 1505614205
PFV-1508 EX-t-(02-15)
0 pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Harold L. North 21-15-0701
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Susquehanna Bank Money Market Lititz PA acct#107611 132,577.79
2 Morgan Stanley Money Market 419 Village DR Carlisle PA acct#410-893754 28,810.38
3 refunds/rebates 33,438.00
TOTAL(Also enter on Line 5, Recapitulation) $ 194,826.17
If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+ (02-15)
A pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE 30INTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Harold L. North 21-15-0701
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.Kathleen E. Ruegg 57 Longs Gap Rd Daughter
Carlisle,PA 17013
B.Cynthia S Roche 102 D St Daughter
Seaside Park,NJ 08752
Victoria N. Holbrook 7100 Fox Meadow Dr Dau1.ghter
Hummelstown, PA 17036
JOINTLY 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 DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 11/23/11 Checking Account Susquehanna Bank Acct#15835230 47,492.49 50 23,746.24
2. A 12/12/11 Savings Note Susquehanna Conference United Methodist Church 2-52127 9,666.67 50 4,833.34
3.. C 12/12/11 Savings Note Susquehanna Conference United Methodist Church 2-52128 9,666.67 50 4,833.34:
4. B 12/12111 Savings Note Susquehanna Conference United Methodist Church 2-52129 9,666.66 50 4,833.33
5.` A 12/12/11 Savings Note Susquehanna Conference United Methodist Church 2-52340 7,000.00 50 3,500.00
6. C 12112/11 Savings Note Susquehanna Conference United Methodist Church 2-51055 7,000.00 50 3,500.00
7. B 12/12/11 Savings Note Susquehanna Conference United Methodist Church 2-52281. : 7,000.00: 50; 3,500.00-
TOTAL(Also enter on Line 6, Recapitulation) $ 48,746.25.
If more space is needed,use additional sheets of paper of the same size.
pennsylvania SCHEDULE G
co DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Harold L. North 21-15-0701
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
ItJC;UDE THE NAME 0=THE TRANSFEREE,THEIR RELAT 10'VSH[P"0 DECEDENT A16
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. IRA Morgan Stanley
62,795.06 100 62,795.06
Gift to Aaron Holbrook 10/2014
2. 100.00 100 3,000.00 0.00
Gift to Adrienne Ruegg 8/2014
3.. 100.00 100 3,000.00 0.00
Gifts to Allison Ruegg 6/2014,8/2014
4.` 450.00 100 3,000.00 0.00
Gift to Amelia Lamonde 10/2014
5. 100.00 : 100 3,000.00 0.00
Gift to Sloan Lamonde 10/2014
6. 100.00 100. 3,000.00 0.00
Gifts to Beth Ruegg 6/2014, 1/2015
7. 940.00 100 3,000.00 0.00
Gift to Caitlin Ruegg 8/2014
8. 100.00 100 3,000.00 0.00'
Gift to Cecily Bricker 712014
9. 100.00 100- 3,000.00 : 0.00
Gift to Meredith Bricker 3/2015
10. 100.00 100 3,000.00 0.00
Gifts to Tim Roche 8/2014, 12/2014
11. 250.00' 100: 3,000.00 : 0.00
Gifts to Victoria Holbrook 6/2014,3/2015
12. 1,040.00 100 3,000.00 0.00.
Gifts to Cindy Roche 6/2014,8/2014
13. 600.00 100 3,000.00 0.00
Gift of Painting to Cindy Roche 4/2015
14 3,500.00- 100 3,000.00 500.00
TOTAL(Also enter on Line 7, Recapitulation) $ 63,295.06
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(02-15)
0 pennsylvania . SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Harold L. North 21-15-0701
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Carlisle United Methodist Church Custodian 75.00
2. Carlisle United Methodist Church Organist 175.00
3. Carlisle United Methodist Church Pastor,Assistent Pastor,Reception Room&Refreshments 71100
4. Grave Preparation Fee
50.00,
5. Obituaries
1,682.15:.
6: Perpetual Care Fund 150.00
7. :Tombstone Engraving
125.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4, Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. Register the Will,Death Certificates,Short Certificate, Photo Copies 587.00
8. Death Notices 456.48
9. Traveling expense for executrixes,2 roundtrips from Seaside Park NJ and from Hummelstown PA 587.15
TOTAL(Also enter on Line 9, Recapitulation} $` 4,600.78`
If more space is needed,use additional sheets of paper of the same size.
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Harold L. North 21-15-0701
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. Pharmacutical Bills 249.00
2. Bill from Assisted Living Residence 837.00.
3. Bill from Dr Geiswhite 50.00
4., Bill from Radiologist 25.00
5. Dr Kaufman 10.00
TOTAL (Also enter on Line 10, Recapitulation) $ 1,171.00
If more space is needed,insert additional sheets of the same size.
ai.., X,
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Harold L. North 21-15-0701
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 outright spousal distributions and transfers under
Sec,9116(a)(1.2).)
1. Victoria Holbrook 7100 Fox Meadow Lane Hummelstown PA Daughter 96031.90
2. Kathleen Ruegg 57 Longs Gap Rd Carlisle PA Daughter 96031.90
3. Cynthia Roche 102 D St Seaside Park,NJ Daughter 96031.90
4. Timothy Roche 944 42nd St Oakland CA Grandson 1000.00
5. Amelia Lamonde 44 Rupell Rd Hampton NJ Granddaughter 1000.00
6. Jesse Ruegg 78 Linda Ave Oakland CA Grandson 1000.00
7. Adrienne Ruegg Ting Chou Rd Taipei Taiwan Granddaughter 1000.00
8. Allison McCoy 261 S West St Carlisle, PA Granddaughter 1000.00
9.; Caitlin Ruegg 57 Longs Gap Rd Carlisle PA Granddaughter 1000.00
continued on additional form
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.
REV-1513 EX+(0-2-15)
pennsylvania SCHEDULE J
p DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Harold L. North 21-15-0701
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 outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
I. Meredith Bricker 3 Heather Dr Wilton,NY Granddaughter 1000.00
2. Aaron Holbrook 7100 Fox Meadow DR Hummelstown, PA Grandson 1000.00`
I Leah Holbrook 7100 Fox Meadow Dr Hummelstown, PA Granddaughter 1000.00:
4.: Sloan Lamonde 44 Rupell Rd Hampton, NJ :Great Grandson 1000.00
5. Kellan Lamonde 44 Rupell Rd Hampton NJ `Great Grandson 1000.00.
6. Joel Bricker 3 Heather Dr Wilton, NY Great Grandson 1000.00
7.: Cecily Bricker 3 Heather Dr Wilton,NY Great Granddaughter 1000.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II— ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.