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Home My WebLink About08-25-15 � � pennsylvania 15 0 5 61410 5 °��M°�OF�"`� EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po BOx 2so6o1 INHERITANCE TAX RETURN `��7 Harrisburg, PA 17128-0601 RESIDENT DECEDENT � �y (/ !� � ENTER DECEDENT INFORMATION BELOW Social Secunty Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 07302014 09261965 DecedenYs Last Name Suffix DecedenYs First Name MI Kean Jason A (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 Retum p 2. Supplemental Return p 3. Remainder Retum(date of death priorto 12-13-82) p 4.Agriculture Exemption(date of � 5. Future Interest Compromise(date of 0 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 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.) p 10. Litigation Proceeds Received p 11.Non-Probate Transferee Retum p 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 T0: Name Daytime Telephone Number Earl H. Kean (912) 399-3760 First Line of Address 231 Dogwood Dr Second Line of Address City or Post Office State ZIP Code Elizabethtown PA 17022 �-� Correspondent's email address: p �:; � c �-r' =� rn REGIST6�O WILLS US�X�NL C27 -.� C'- =- n G� ;,,> :-J REGISTER OF WILLS USE ONLY '`� T C`? { �� DATE FILED MMDDYYYY : '^ � , N ,7� . _ .. cn , , . , �.� �-> � � - i � _ -�r ' __.: <_> DATE FILED STA�1P'' t �� t`ri Cl1 G� � 'J T� PLEASE USE ORIGINAL FORM ONLY Side 1 � i iiiiii iiiii iiiii i��i�i�i��u�ii inn iiii iiii 15 0 5 61410 5 � � 1505614205 REV-1500 EX(FI) DecedenYs Social Security Number oecedenrs Name: Jason A. Kean 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. 18,046.25 6. Jointly Owned Property(Schedule F) O Separate Biiling Requested ....... 6. 7. Inter-�vos Transfers 8�Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets(totai Lines 1 through 7)............................. 8. 18,046.25 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. 1,525.84 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. 17,780.31 11. Total Deductions(total Lines 9 and 10)................................. 11. 19,306.15 12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. -1,259.90 13. Charitable and Govemmental 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. 0.00 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.0_ 16. 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. 19. TAX DUE ....---•............................................. .... 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Under penalties of pery'ury,I deGare I have examined this retum,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 retum is based on all infortnation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETUR DATE 04/22/2015 ADDRESS 231 Dogwood Dr Elizabethtown, PA 17022 SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS � i iiiiii iiiii iiiii i�i��ii��i�iiii�i�i�Niii iaii iiii iiii S,de 2 4 1505614205 J REV-1500 EX (FI) Page 3 File Number �)��'�,�-7 /� ✓ ,�!�/ l G/ jlGf' �/�Cn / Decedent's Complete Address: i DECEDENTS NAME �a��d � � � STREETADDRESS ��/ � �/v CITY /`� � STATE ZIP G��, L Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 2. Credits/Payments A.Prior Payments B.Discount (See instructions.) Total Credits(A+B) (2) 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) 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 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?.............................................................................................................. ❑ � 3. Did decedent own an"in trust fo�'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 retum 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 benefidaries 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+ (02-15) ' i ` pennsylvania SCNEDt�LE E � DEPARTMENTOFREVENUE CASH, BANK DEPOSITS &MISC. INHERITANCE TAX RENRN pERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Jason A. Kean 21-2014-07�,/ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointiy owned with right of survivorship must be disdos�l on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �� Federal Personal Income Tax Refund SSN 211-60-9359 rec'd by estate 06/06/2015 1,616.00 2. Bank Deposit,Acct.#211-60-9359 PSECU PO Box 67013 Hbg,PA 17106 rec'd by estate 06/19/2015 1,478.47 3. Final Payroll,Comm of PA,Bureau of Payroll Ops PO Box 8006 Hbg,PA 17105 rec'd by estate 07/24/2015 6,831.78 4. 2005 Harley Davidson MC VIN 1HD1FCW175Y607542,fitle#61437404702KE rec'd by estate 06/19/2015 8,120.00 TOTAL(Also enter on Line 5, Recapitulation) $ 18,046.25 If more space is needed,use additlonai sheets of paper of the same size. 2005 Harley-Davidson FLHTCUI Electra Glide iJltra Classic Motorcycle... http://www.kbb.com/motorcycles/harley-davidson/flhtcui-electra-glide-ul... � ,.5,- U� � � � ,_ Home , Car Values Cars for Sale I Car Reviews Awards&Top lOs Research Tools Poputar at KBB.com � ��e � adeatseme�,E - ..., . , �c.fe. ,.�}�v� , xi u G}�E a,tl�� r -i3ie r � ., > . _ i r,. , .-�a�y'�Motorcycle Deka�S Your Motorcycle Value . 2005 Hartey-Davidson FLHTCUI Electra Glide Ultra Classic Trade-In Vatue Sugg�sted R�t�it Vat�te GoociCaxlition + , ?�°� 4 �atr ,: e��t � whmtradin9fnatadealeahip !�'�3 .�� .;'-:�';•�r Setl your Know your FICO Scare .�t:2rtrrn�n[ List it now! 'r+-s ,,. Shapping Tools , , _ ��.��, � �=t,,�t., - Shop for Your See a•ahat consumers and KBB ex rts sa lus et Get started P� Y,p 9 _,. ,�. �. i r+ , <h• free attess to KBB.com's Fair Purchase Price. . >�r,. 1-t _��f a:,<f ;;-.s Or Browse By Category - +��-_ � � ,.-�„,, � ��.:-- -��:�, �,,�, ,_ ,_::,ry� - ar� f,<„� G;� .i� T _ �:,, � . rty��,��,�. , . �,.� a� . ,_�:�.t,�� .. VIfI: Enr�r LTN ioptlonal�. Next Steps To Buying Smart ;_��-��_� _. Get Low, Established Pricing '8iry Like a Nro"on your nex.t ncw•a nx�torcycle, .� � ATV sid�bY-side,PVVC or s�ioc,�mobile. ""` '�o �o«. *-y Need a Motorcyde Part? Shop tlie biyyest selection of nwtorcycle parts, 9ear aixl acceswries on the web. c _., 1 Of 2 g�22�2�i s 11:22 AM REV-1511 EX+ (02-15) ��' i :y' pennsylvania SCHEDULE H � � DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCETAXRETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jason A. Kean 21-2014-07�/ Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; 1' Auer Cremation Services of PA, Inc.4100 Jonestown Rd. Hbg,PA 17109;removal of remains,direct 1,255.00 cremation and disposal of cremains B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: Z• 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: 150.50 5. Accountant Fees: 6. Tax Return Preparer Fees: �• Court Reporter for ROW hearing-09/02/2014 105.00 s. Witness Fee-PA State Police 09/02/2014 9.34 s. Dauphin Co. ROW short cefificate 6.00 TOTAL(Also enter on Line 9. Recauitulationl S 1,525.84 REv-t512 Ex+ ro2-ls) i � pennsylvania SCHEDULE I � DEPAATMENT OF REVENUE DEBTS OF DECEDENT� INHERITANCE TAX RETURN MORTGAGE LIABILITIES 8� LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jason A. Kean 21-2014-07�� 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• VISA Loan,Acct.#211-60-9359 PSECU PO Box 67013 Hbg,PA 17106 17,067.86 2. Motorcycle Repairs,High Strength V-Twin 201 S Cameron St Hbg,PA 17103 712.45 TOTAL(Also enter on Line 10,Recapitulation) $ 17,780.31 If more space is needed,insert additional sheets of the same size. � t ��v �y � � ..,., � IlFvUt� n��'nr a� � ._ �;,C n -(`�'^ - ";'_!_s � '�l5 �� 25 P�'1 1 5� � � . - � oRr"r,,.'; ' CUM�F�; , . . _ �� ,� _- � `� � ��` � (\� � �� x �� c � � �� . ��, � � � _ � � — , ` .; � � �` �� o � � � � w �� \\� S � J �, � �l � D \ N C m C �, g{�g�;,�� ` � �p oNN�� ,. C N1 w VVi V/ ~� 1 -� J D , � ;Q� � m N � Z � D ...-- � t�" %i � ' 'o � p � � , �,s�� '1 r,�:;,:;fh 'b :;:� tr, �..� C � ,. � tn �