Loading...
HomeMy WebLinkAbout08-11-15 J 15D5614134 EX{03-14)(FI) REV-1500 OFFICIAL USE ON�Y Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1, 5 0 2 2 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDWYY Date of Birth MMDDYYYY Suffix DecedenYs First Name MI W e i g a n d J e a n � (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW o 1.Original Return � 2.Suppiemental Return � 3. Remainder Return(date of death Priorto 12-13-82) � 4.Agriculture Exemption � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required (date of death on or after 7-1-2012) death after 12-12-82) � 7. Decedent Died Testate � S. Decedent Maintained a Living Trust 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 invoived) CORRESPONDENT•THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number S t e p h e n J • H o g g , E s q • 7 1 7 2 4 5 2 6 9 8 First Line of Address 1, 9 S • H a n o v e r S t r e e t Second Line ofAddress S t e • 1 0 1 City or Post Office State ZIP Code C a r 1 i s 1 e p q 1 7 p 1 � � .� � � rn CorrespondenYs e-mail address: C Q �� `� � � �_ ..._ ��--�-------�---�f� �7 - .._ _---- 7 c:�- REG13TLRIIF�LLS�JS€ONCY ,-.� _--- ------ . � �,. �:"'� REGISTER OF WILLS USE ONLY ' � " � � f'"'� DATE FILED MMDDYYYY � ' `� '�� ---- —_— ---- _..._ � r� y ...il : , � � --r� -- ----- � . �'� ��, � . �,v 1._,__ {..�.� . f__' _ .. r N C�7 � D1�1'fE FILED STAIIQp PLEASE USE ORIGINAL FORM ONLY Side 1 I IIIIII Ilill IIIII IIIII Illlf IIIII Ilill IIIII IIIII IIIII IIII IIII � 150567,4134 15056141,34 J I ' .J 1505614234 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Jean L . Weigand 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. 1 6 3 . 1 6 6. Jointly Owned Property(Schedule F) n Separate Billing Requested . . . .. . 6. 2 1 5 4 3 . 7 1 7. Inter-Vivos Transfers&Miscellaneous Non-probate Property (Schedule G) n Separate Billing Requested . . . . .. . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . .. . . . .. .. . . .. . . 8. 2 1 7 0 6 . 8 7 9. Funeral Expenses and Administrative Costs(Schedule H) . .. . . . . . . . . . . . . . . . 9. 7 5 6 4 . 0 5 10, Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. . . ... ,. ...: 10. 6 2 . 2 7 11. Total Deductions(total Lines 9 and 10) . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . 11. 7 6 2 6 . 3 2 12. Net Value of Estate(Line 8 minus Line 11) 1 4 0 8 0 . 5 5 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. 1 4 0 8 0 • 5 5 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 _ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.045 1 4 0 8 0 . 5 5 16. 6 3 3 . 6 2 17. Amount of Line 14 taxable at sibling rate*X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 • 0 0 18. 0 . 0 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . 19. 6 3 3 - 6 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT nX 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. Slikt�TU E OFZSUNESPONSIB OR FILING RETURN & AT /I ACUESS V 39421 BI-061pfidqe Drive Mechanicsburg PA 17050 SIGNATURE O R A AN PERSON RESPONSIBLE FOR FILING THE RETURN ZTE ADDRES6 19 S . Hanove//S/reet, Ste . 1,01, Carlisle PA 17013 111111111111Illi(VIII VIII VIII Ilio hill 11111VIII Illi ilii Side 2 1505614234 1505614234 Id 1 REV-1500 EX (F!) Page 3 File Number Decedent's Complete Address: 21 15 0224 DECEDENT'S NAME Jean L. Weigand STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 633.62 2. Credits/Payments A.Prior Payments 739.54 B.Discount 31.68 (See instructions.) Total Credits(A+B) (2) 771.22 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) 137.60 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 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 ..................................................................................................... 171 ❑ 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? ....................................................................................... Q ❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... C] ❑ 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a 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 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-'ISOS EX+(08-12) pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Jean L. Weigand 21 15 0224 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. Blue Cross Refund 163.16 TOTAL(Also enter on Line 5,Recapitulation) $ 163.16 If more space is needed, use additional sheets of paper of the same size. REV-�509 EX+(01-10) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jean L. Weigand 21 15 0224 If an asset was made jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT a. John L. Weigand 3942 Brookridge Drive son Mechanicsburg, PA 17050 B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERIY %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 REA�ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTERES? 1. A. 01/1987 AmeriChoice Savings Acct#312940001 40.10 50. 20.05 2. A. 10/1999 AmeriChoice Checking Acct#312940013 8,448.57 50. 4,224.29 3. A. 10/1999 AmeriChoice Money Market Acct#312940018 34,59&.74 50. 17,299.37 TOTAL(Also enter on Line 6,Recapitulation) $ 21,543.71 If more space is needed,use additional sheets of paper of the same size. REV-15 At EX+(08-13) pennsyivania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jean L. Weiqand 21 15 0224 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Funeral Home 3,155.00 2. Brooklyn Heights Cemetery 670.60 B. ADMINISTR,4TIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) �ohn L. Weiqand 1,302.41 StreetAddress 3942 Brookridqe Drive C;ty Mechanicsburq State Pa ziP 17050 Year(s)Commission Paid: 2, attorneyFees: Stephen J. Hogg, Esquire 2,000.00 3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address ���Y State ZIP Relationship of Claimant to Decedent 4 ProbateFees: Inheritance Tax Return and Inventory 155.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. Advertising: The Sentinel 190.54 Cumberland Law Journal 75.00 8. Petition 15.00 TOTAL(Also enter on Line 9,Recapitulation) � 7,564.05 If more space is needed,use additional sheets of paper of the same size. RE:/-15�2 EX.+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT� INHERITANCETAXRETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jean L. Weigand 21 15 0224 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. Pinnaclehealth Cardiovascular Institute 62 2� TOTAL(Also enter on Line 10,Recapitulation) $ 62 2� If more space is needed, insert additional sheets of the same size. REV-�513 EX+(01-10) 1 pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERiTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jean L. Wei and 21 15 0224 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee{s) OF ESTATE J TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under 5ec.9116(a)(1.2).] �. John L. Weigand Lineal 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: 1. TOTAL OF PART 11 -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.