HomeMy WebLinkAbout08-17-15 1505614134
EX(03.14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 �2 484--3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 7 0 5 2 0 1 2 0 6 1 4 1 9 2 5
Decedent's Last Name Suffix Decedent's First Name MI
D 0 N N E L L Y R 0 S A N N A V
(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 IN APPROPRIATE OVALS BELOW
D 1.Original Return ❑ 2.Supplemental Return ❑ 3.Remainder Return(date of death
Prior to 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 ❑ 8.Decedent Maintained a Living Trust 0 9.Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
❑ 10.Litigation Proceeds Received ❑ 11.Non-Probate Transferee Return 0 12.Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13.Business Assets ❑ 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
J A M E S H T U R N E R E S Q U I R E 7 1 7 2 3 2 4 5 5 1
First Line of Address
4 7 0 1 N 0 R T H F R O N T S T R E E T
Second Line of Address
City or Post Office State ZIP Code
H A R R I S B U R G P A 1 7 1 1 0
C=
Correspondent's e-mail address: jht ,turnerandoconnell.com c> m
REGISTE FWLLS USEMLY
rri
REGISTER OF WILLS USE ONLY Imo- 4--4
DATE FILED MMDDYYYY r"" a rrI -J CD
(r? C7 CD
C.' ►v n
DATE Fll Ep STAMP rte' M
w,
t Cp -71
PLEASE USE ORIGINAL FORM ONLY '
Side 1
1111111 VIII hill VIII VIII VIII VIII VIII VIII VIII IIII IIII
1505614134 1505614134
1505614234
REV-1500 EX(FI) Decedents Social Security Number
Decedent's Name: ROSANNA V . DONNELLY
RECAPITULATION
1. Real Estate(Schedule A) . ..... ... .. . ... . . ... .. ......... .. ... . . . . .. .
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. 3 0 0 0 . 0 0
6. Jointly Owned Property(Schedule F) F1 Separate Billing Requested ..... . . 6.
7. Inter-Vivos Transfers&Miscellaneous No Probate Property
(Schedule G) ri Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . .. . . . . .. .. .. .. .. . . 8. 3 0 0 0 0 0
9. Funeral Expenses and Administrative Costs(Schedule H) ... . . . . ... . . . ... . . 9. 1 7 5 0 . 0 0
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) ...... . .. . . . 10. 1 5 0 0 . 0 0
11. Total Deductions(total Lines 9 and 10) . . . . .. .. . .. . . .. . . . . . . . . . .. .. .. . 11. 3 2 5 0 . 0 0
12. Net Value of Estate(Line 8 minus Line 11) . . . . . .. ... .. .. .... . . .. . . . . . . 12. - 2 5 0 . 0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . . . .. .. .. .. . . ... . . . 13.
114. Net Value Subject to Tax(Line 12 minus Line 13) ..... .............. 14. - 2 5 0 0 0
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 . 11 0 15. 0 . a 0
16. Amount of Line 14 taxable
at lineal rate X.0- 0 . 0 0 16. 0 . G 0
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . a 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE ....... ... .. .. .. ... . . . .. . .. .. .. .... . .... .. . .. ... . . . . . . 19. 0 . 0 0
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT n
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.
SIGNATURE OF P§IRSON RESPONSIBLE FOR FILING RETURN DATE
'i L-7- /5-
AIDDRESS
299 W. Ridcre Road, Dillsburg, PA 17019
SIGZ!: �ON RESPONSIBLE FOR FILING THE RETURN DATE
ADDRE.BS-
4701 NORTH FRONT STREET HARRISBURG PA 17110
111111111111111111111111111111111111111 IN Side 2
L 1505614234 1505614234
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 0 0
DECEDENT'S NAME
ROSANNA V. DONNELLY
STREET ADDRESS
1100 GRANDON WAY ROOM 218
CITY STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
I. Tax Due(Page 2,Line 19) (1) 0.00
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions,) 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 the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
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 ................................................................. ❑ n
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ 0
c. retain a reversionary interest ..................................................................................................... ❑
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑
121
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ ❑X
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ MX
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-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
ROSANNA V. DONNELLY 0 0
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, checking account at Citizens Bank 1,000.00
2. checking account at PSECU 2,000.00
TOTAL(Also enter on Line 5,Recapitulation) $ 3,000.00
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROSANNA V. DONNELLY 0 0
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1 1,000.00
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: Turner and O'Connell 750.00
3. Family Exemption:(if decedents address is not the same as claimants,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.
TOTAL(Also enter on Line 9,Recapitulation) 1,750.00
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX-(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROSANNA V. DONNELLY 0 0
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. misc. medical bills 500.00
2. short term loan for assisted living 1,000.00
TOTAL(Also enter on Line 10,Recapitulation) $ 1,500.00
If more space is needed, insert additional sheets of the same size.
RE-V-f513EX+(01-10)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
ROSANNA V. DONNELLY 0 0
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).)
i. Patti Single Lineal 0.00
229 West Ridge Road
Dillsburg, PA 17019
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE,
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.
Turner and O'Connellst zP-F"W3SUP
Attorneys at law
4701 North Front Street RECORDED
Harrisburg,PA 17110 R E i✓ � OF
?015 7 pn
61 EX OURT
Register of Wills Office
Cumberland County Courthouse
Carlisle,PA 17013
171_ X33'92S9
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RECORDED OFFICE OF
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REGISTER OF WILES G1
9015 AUG 13 Pn 1 13 0 �, 1
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CUMRERLI
TURNER AND O'CONNELL
Attorneys at Law
4701 North Front Street
Harrisburg, PA 17110
Register of Wills Office
Cumberland County Courthouse
Carlisle,PA 17013