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Home My WebLink About08-19-15 � 150561D1�1 REV-1500 Ex`°'1°; � OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes ` County Code Year File Number Poeoxz8o6o1 � INHERITANCE TAX RETURN 2� 14 0741 Harrisburg PA i'7iz8-o6oi RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Sociai Security Number Date of Death MMDDYYYY Date of Birth ti9MDDYYYY 07/27/2014 07/19/1929 DecedenYs Last Name Suffix DecedenYs First Name M� WALKER ANN N (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix 5pouse's First Name �`/�� Spouse's Social Security Number THIS RETURN MUST BE FILED iN DUPLICATE WITH THE REGISTEFt OF WlLLS FILL IN APPROPRIATE OVALS BELOW p t.Original Return �1 2. Supplemental Return O 3. Remeinder Return(date of death prior to 12-13-82) p 4.Limited Estate O 4a. Future interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82} � 6. Decedent Died Testate � 7. Decedent Maintained a Living Trust ____ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will} (Attach Copy of Trust) O 9.Litigation Praceeds Received O 10. Spousal Poverty Credit(date of death O 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) {Attach Sch.O) CORRESPONDENT- TNIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number THOMAS E. FLOWER (717) 243-5513 � c� � � � ................_..._.._.....�...................__..__..__......._....__....._...._..---- ' REGI�EI�F WILLS�ON� i �� –� — ("-� .�,_ !� G� {i7 - __.� C .7 ..�,. ,�_. First line of address - -;� � , � r FLOWER LAW, LLC , : —� —;� ; Second line of address � � , : 10 W. HIGH STREET L c_.� 1=: City or Post Office State ZIP COd2 DATE FILED ZT� � . � CARLISLE PA 17013 CorrespondenYs e-mail address: TOM a�FLOWER-LAW.COM _ Under penalties of perjury,I deciare that I have examined ihis return,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,cor ect and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT F PE S RESP SBLE FOR FILING RETURN � E/ r �f AD ESS M TRUST CO., 20 S. AIN STREET; CHAMBERSBURG, PA 17201 SI F PREP THAN REPRESENT/�TIVE p E (� / �✓ ADDRE FLOWER LAW, LLC; 10 W. HIGH STREET; CARLISLE, PA 17013 PLEASE USE ORIGlNAI FORM ONLY Side 1 � 150561,�1�1 1,5�567,01�7, � � � 1505610105 REV-1500 EX Decedent's Social Security Number �ecedent's Name: ANN N. WALKER 040-28-7951 RECAPITULATION 1. Real Estate(Schedule A). . . .. . . . .. . .. . . . . . . . .. . . . . . . .. . . . . ... . . . . .. . . i 0.00 2. Stocks and Bonds(Schedule B) .. . . .. . .. . . . .. .. . . . . . . . . .. .. . .. . . . . . . . . 2. 0.00 3. Ciosely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3. 0.�0 4. Mortgages and Notes Receivable(5chedule D) 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E) . . . . . . 5. 3,811.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . . . . 6 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 0.00 (Schedule G) O Separate Billing Requested.. . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7).. . . . . .. . . . ... .. . . . .. .. .. . . . . 8. 8,811.00 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . . . 9. 415.00 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . .. . . . . . . . .. . 10. 11. Total Deductions(total Lines 9 and 10). .. . . . . . . . . . . . . . . . .. . . . . . . . . . .. . . 11. 415.00 12. Net Value of Estate(Line$minus Line 11) . . . . .. .. . .. .. . . . . . .. . . . . . . .. . . 12. 3,396.00 13. Charitabie and Governmental Bequests(Sec 9113 Trusts for which an election to tax has not been made(Schedule J) .. . . . .... .. .. . . . . .. . . . . . 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . .. . . . .. . . . . . . . . . . . . 14. 3,396.00 TAX CALCULATION-SEE INSTRUCTIONS FQR 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.0_ 16. 17. Amount of Line 14 taxable at sibling rate X.12 �� 18. Amount of Line 14 taxabie 3,396.00 509.40 at collateral rate X.15 �8 19. TAX DUE . . . . . . .. . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 509.40 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Side 2 � 15�5610105 15056101,05 � REV-1500 EX Page 3 File Number 21-14-0741 Decedent's Complete Address: DECEDENT'S NAME ANN N. WALKER STREETADDRESS 2100 BENT CREEK BOULEVARD STATE ZIP C�MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 509.40 2. CreditslPayments A.Pnor Payments B.Discount 0.00 Total Credits{A+B) (2) 3. Interest 4.67 (3) _ 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. 0.00 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 QUE. (5) 514.07 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 properly transferred:.......................................................................................... � � b. retain the right to designate who shall use the property transferretl or its income:............................................ ❑ � c. retain a reversionary interest;or......................................................................................................................... ❑ X❑ d. receive the promise for life of either payments,benefits or care?...................................................................... X 2. if death occurred after Dec.12,1982,did decedent transfer property within one year of death n without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decetlent own an"in trust for"or payable-upon-death bank account or security at his or her death7.............. � � 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 imposetl 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 imposetl on the nei value of transfers to or for the use of the surviving spouse is 0 percent (72 P.S. §9116 (a) (1.1) (ii)j. 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 tlates of death on or after July 1,2000: . The tax rate imposetl on the net value of transfers from a tleceased child 21 years of age or younger at death to or for the use of a naturai parent, an adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(aj(1.2)]. . The tax rate imposed on the net value of transfers to or for the use of the tlecedent's lineal beneficiaries is 4.5 percent, except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. . The tax rate imposetl on the net value of transfers to or for the use of the decetlent's siblings is 12 percent[72 P.S. §9116(a)(1.3)�.A sibling is definetl, under Section 9102,as an individual who has at least one parent in comman with the decedent,whether by blood or adoption. REV-iSo8 EX+(1i-io) � pennsylvania SCNEDULE E � 6EPARTMENT OF R[V[NUE CASH, BANK DEPOSITS & MISC. WHERITANCE TAX RET"URtJ PERSONAL PROPERTY� RESIDENT DECEDENT PILE NUMBER: ESTATE OF: 21-14-0741 ANN N. WALKER Include the proceeds of iitigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER �— �, Federal income tax refund 2,709.00 2. Pennsylvania income tax refund 567.00 3. Country Meadows,refund of waiting list deposit 535.00 TOTAL (Also enter on Line 5, Recapitulation) $ 3,$11.00 If more space is needed, use additional sheets of paper of the same size. (Y'r.:V-I.`i3.1.EXa ;�.0-09j �� ' pennsylvania SCHEDULE H ` o�PAaTMeNTofRev�N�e FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER ANN N. WALKER 21-14-0741 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: � 1. B, ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commissior Paid: 2. Attorney Fees: 3. Family Exemption: (If decedenYs address is not the same as ciaimant'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: �� Smith,Elliot&Kearns&Co.,preparation of 2014 personal income tax returns 415.00 TOTAI(Also enter on Line 9, Recapitulation) $ 415.00 If more space is needed,use additiorai sheets o�paper of the same size.