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Home My WebLink About08-25-15 M7 pennsytvania 1505614105 OEvgnTMEM I. 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 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY -- 1 06042015 12311928 —� Decedent's Last Name Suffix Decedent's First Name MI M [Clancy [Katherine i (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 1.Original Return O 2.Supplemental Return O 3. Remainder Return(date of death prior to 12-13-82) C=:) 4.Agriculture Exemption(date of p 5. Future Interest Compromise(date of C=:) 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) C=:) 7. Decedent Died Testate p 8.Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) C=:) 10.Litigation Proceeds Received OD 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets O 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 _ Susan E. Breen 1(717)766-8187 First Line of Address 10� 7 Glendale Drive Second Line of Address i City or Post Office State ZIP Code Mechanicsburg PA 17050 _ 7:1 Correspondent's email address: REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY DATE FILED MMDDYYYY. v - �_ C cn MrT1 Q C") DATE FILEID 8 4 N rrn ~;3 c rt -r, V c"'7 ? ^1 - z ?7 PLEASE USE ORIGINAL FORM ONLY Side 1i N r M N C GO 14 1505614105. J 1505614205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: Clancy, Katherine M. RECAPITULATION 1. Real Estate(Schedule A). ........................................... 1.{ 0.00 2. Stocks and Bonds(Schedule B) ................................. ...... 2. 0.00 ! 3. Closely Held Corporation,Partnership or Sale-Proprietorship(Schedule C) ..... 3. ( 0.00 4. Mortgages and Notes Receivable(Schedule D)........................... 4. i 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. t 0.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. 1 47,389.0 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. ! 0.00 iI8. Total Gross Assets(total Lines 1 through 7).. ....... ........ ............ 8. 1 47,389.04 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. ' 12,118.141 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 0.04 11. Total Deductions(total Lines 9 and 10)................................. 11. �- 12,118.141 12. Net Value of Estate(Line 8 minus Line 11) ............... . .............. 12. 1 35,270.90 13. Charitable and Governmental Bequests/See.9113 Trusts for which an election to tax has not been made(Schedule J) ........................ 13. 1 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) ... ..................... 14. 1 35,270.90 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_ ( 0.00 15.1 0.00 16. Amount of Line 14 taxable at Lineal rate X.0 45 # 35,270.90i 16.1 1,587.19 17. Amount of Line 14 taxable l 0.00 at sibling rate X.12 0.00 17. i !!! 18. Amount of Line 14 taxable at collateral rate X.15 0.00 18.1 0.00 19. TAX DUE .............. 19. 1,587.19 ! ... ............... .................. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O 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. SIG Q,TURE OFPERSON ONSIBLE FOR FILING RETURN DATE t�D� ADDRESS Susan E. Breen, 107 Glendale Drive, Mechanicsburg PA 17050 SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS � � ��i�i Side 2 1 56 4 D � 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Katherine M. Clancy STREETADDRESS 813 Topper Street CITY STATE ZIP York PA 17406 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,587.19 2. Credits/Payments A.Prior Payments 1,503.66 B.Discount 83.53 (See instructions.) Total Credits(A+B) (2) 1,587.19 3. Interest (3) 0.00 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 .......................................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ E c. retain a reversionary interest .............................................................................................................................. ❑ N d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ E 2. If death occurred after Dec.12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 3. Did decedent own an"in trust for'or payable-upon-death bank account or security at his or her death?.............. ❑ 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-1509 EX+(02-15) � pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Clancy, Katherine M. 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.Susan E. Breen 107 Glendale Drive, Mechanicsburg PA 17050 Daughter B. C. 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 DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 03/12/93 The York Water Company,Symbol YORW,4,345.625 shares common stock,$21.81/share 94,778.08 50 47,389.04 TOTAL(Also enter on Line 6, Recapitulation) $ 47,389.04 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(02-15) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Clancy, Katherine M. Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Heffner Funeral Chapel&Crematory,Inc. 11,794.89 2. Funeral luncheon 148.52 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: S. Accountant Fees: 6. Tax Return Preparer Fees: 175.00 7. TOTAL(Also enter on Line 9, Recapitulation) $ 12,118.41 If more space is needed,use additional sheets of paper of the same size.