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Home My WebLink About09-04-15 J pennsytvania 1505614105 DEPART ENT OF REVENUE 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 MMDDYYYY Date of Birth MMDDYYYY , 02062015 10221928 Decedent's Last Name Suffix Decedent's First Name MI Christmas Angeline T (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 CM 1. Original Return O 2.Supplemental Return O 3. Remainder Return(date of death prior to 12-13-82) O 4.Agriculture Exemption(date of C=:) 5. Future Interest Compromise(date of O 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) O 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) O 10. Litigation Proceeds Received O 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets 0 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 David J. Christmas (310)600-7561 First Line of Address PO Box 1612 Second Line of Address City or Post Office State ZIP Code Manhanttan Beach CA 90267 Correspondent's email address: startree2@gmail.com REGISTER OF WILLS USE ONLY REGISTER OF WILLS USE ONLY ry DATE FILED MMDDYYYY o Q i r1 .CD i DATE�Fil_6STAMP C� Q y 7 PLEASE USE ORIGINAL FORM ONLY { N rte- Side 1crr 4 n "' Q `T7 11111111111111 IN 1505614105 1505614105 1505614205 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate(Schedule A). ... . . . . . .. .. .. .. .. .. . .. .. . . .. . . . . . .. . ... .. . . 1. 154,000.00 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. 29,484.65 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . .. . .. . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... .. . . . 7. 612,208.85 8. Total Gross Assets(total Lines 1 through 7). . .. .. .. . . .. . .... . . .. . . ... .. . 8. 795,693.50 9. Funeral Expenses and Administrative Costs(Schedule H).. .. .. . .. . . . . .. . .. . 9. 24,226.38 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). . . .. . .. . .. . .. . 10. 3,392.02 ( ). . . .. .. .. .. .. ... . .. . . ... .. . .. . . . . 27,618.40 11. Total Deductions total Lines 9 and 10 11. 12. Net Value of Estate(Line 8 minus Line 11) .. . . . . . .. . . .. . . . . .. .. . .. . . . .. . 12. 768,075.10 13. Charitable 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. 768,075.10 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. 0.00 16. Amount of Line 14 taxable at lineal rate X.0 45 16. 768,075.10 17. Amount of Line 14 taxable at sibling rate X.12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X.15 18, 0.00 19. TAX DUE .. .. . . . . . .. .. . . .. . .. . . . . .. . . .. . . . .. .. . . . . .. . .. .. . .. .. .. .. 19. 34,563.38 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT < ) Under penalties of perjury,I declare I have examined this return,including c mpanyin schedul �Leents,and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the p o resp si f s based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADD ESS l[� � C SIGNATURE bF PfkEPAREFrOtHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE ADDRESS 11111111111111 Jill Side 2 1505614205 1505614205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Angeline T. Christmas STREETADDRESS 9 Citadel Drive CITY STATE 717011 Camp Hill PA Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 34,563.38 2. Credits/Payments A.Prior Payments 35,775.00 B.Discount 1,728.17 (See instructions.) Total Credits(A+B) (2) 37,503.17 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) 2,939.79 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 .............................................................................................................................. ❑ E d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ N 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. E ❑ 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 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-1313 EX(7-14) APPLICATION FOR Pennsylvania REFUND OF official Use only � DEPARTMENT OF REVENUE PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES INHERITANCE/ESTATE PO BOX 280601 TAX HARRISBURG, PA 17128-0601 See Instructions on Reverse TO: PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 FROM: Official Representative Decedent Information Name David J Christmas Name of Decedent Angeline T. Christmas Address PO Box 1612 File Number 21-15-0211 Date of Death 02/06/2015 Manhattan Beach, CA 90267 Social Security Number Phone Number (310)600-7561 Email Address startree2@gmail.com The undersigned requests a refund in the amount of $ 2,939.79 for the above-referenced decedent's estate. REFUND REQUESTED ON: Original or Supplemental ❑Joint/Trust Assets Remainder Return Estate Tax Probate Return EXPLANATION OF OVERPAYMENT Overpaid by$2,939.79.after accounting for all deductions and 5%discount. ignature Date Please allow six to eight weeks for the processing of your refund request. INSTRUCTIONS This application must be signed by the party who paid the tax or that party's assignee; the executor or administrator of the estate; or the attorney for the estate. No other signature is acceptable. This application must be filed with the PA Department of Revenue within three years after payment or final determination of the tax, whichever is later. See Section 2181 (d) of the 1995 Inheritance and Estate Tax Act for statutory alternatives. If the issue(s) involved in this refund application is/are similar to the issue(s) in any litigation pending before a court of law, file your refund request after final disposition of such pending litigation. This application cannot be used as a substitute for an appeal from an allegedly erroneous appraisement, the disallowance of deductions or an incorrect assessment of tax. See Section 2186 of the 1995 Inheritance and Estate Tax Act for correct procedure with respect to such appeals. If all or part of the refund amount requested within this application is claimed to be as the result of an issue not previously raised, and where the statutory appeal provisions of Section 2186 of the Inheritance and Estate Tax Act have expired, a petition for refund may be filed with the Board of Appeals providing all taxes assessed are paid in full. Such requests should be filed with the Board of Appeals, PO BOX 281021, Harrisburg, PA 17128-1021. The petition form is available at www.boa rdofappeaIs.state.pa.us. REV-1502 EX+(02-15) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Angeline T. Christmas 21-15-0211 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1' 9 Citadel Drive,Residence 154,000.00 TOTAL(Also enter on Line 1, Recapitulation.) $ 154,000.00 If more space is needed,use additional sheets of paper of the same size. A. Settlement Statement(HUD4) C648ApprovdNa.25D!P= 1.OF11A 2.OPM &MCM.UNnaa 1p11°"°0 . 15151 4.13YA &OConn.M& w 3oa a slaianau ao ad salYanM ara 'prey+ra�l�aArNMtAsdowlb;llnYsnssesmrMvrsDsr4dWnubnrtpspasssaidsnnol6ispodsdbOsblda Q.tiamaiAddnaaot8arrowar ENamaiAddnasot4M0ar: F.N@=&Addraaottaadw. Cha11A WKn EpabdAnBd'aaChbbaa ttlISC6mam1,i4A. r06Ya8erPlaad,YMd�a,PA1T,183 9C+bddQlra,CanplgPAt101t QaaC4mauPlraiPmrldmoiRAtO2603 PropeRlrt,,oeetliMt FL 8afsl�+entAberd: 844tlt7a�06ti5t2015 aCbaddOft 1dAdnadga8dlud6an1a kr. obbWasmodoMMONIAM5 Camp tt16.PA 17011 577511WMOft&ft V%k%dwAC*B,PA Tt0ra0 I.owsrA4atloMMhpt Ta0phanwK 11141ita165 Face 111451 x158 Ma�ioury Sbdrdab�wiPA1tOB0 ft&dMO tbat Mam by AAt Aomord0asbaia 441L OaraAamimS bba@rr S4L kmd 106 Saelaaent tobawawar(bm 5,81x.30 408. Is. 404. t0i bu adaba4wmea 6artbaaa b 01 C nbua b 40a am to W powOIYISt2016bt216tt2d16 481 Oar. Coaarlaoa 06ti5"IDU t11M 45171 SdmdTaa O6N112015bO1t30r $ 15206 405 8"Taa 51005R1Q 5 i82A8 10n 8aaar441waa OSHSt20#6bO8R10p014 M 408: UWARaba OStIdr AIDOsfi1r I 08;16 ttn 40. 111. 411. 1 41 124 OmsAmwatQabaaBanowar I%=" at GFMM A*Dwbbdar Bail-, 200abhid wbttlM Clo"norar RdosOaasb► to bm4a 111111"W -1111M IM PgrtcipatsawonaaWR 150OOOAD IOL &OWAd P - loodbrpd1a140a) 11,466A0 b M " 20t 504. FWdAMMMICalobw X& 506. Pgdda dmafge IM 20n 50L W. lar. 206 108. 206. 408. aamaan a5ar tarbhast a8ar b110as b b 211. boons b 511. Ca ftw b 211 5dwTow b 512. &"Tom to 217. 517 2N. 514 215. 515. to 515. 211. 61L 214 615. 219. 5/t 224 TddPddbvftrBommw VOW 62L Taisl,bdwdwAuwMDts8odtar 1rr46SAQ tan CuhdSdMamtb mbboffw&w O00. Cuhdldb dbbom$d* 301. 0oowMvAdwtanbw wcerpinol2D) 1 SM, aomadduaba0ar(W42a) 7 3OZ taa+aa r9 ps22) 81.00000 801 aaamdduaaNer(ba620} 1 AMM 3111. 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See attached addendum for additional information rd are ammul MUD CERTIFICATION OF BUYER AND SELLER 1 have cars"reviewed Me NMI SaM OMWO SIQIWMM and to aro bed of my 10WAsdge and WW.it Is a tons and 8=010111 etahment of d aid dbbm11aneMa made an my oeewnd or by me In this tronsoMm l Nrlher coNy OW I have ace!wed a copy of tM NMI Sefllanmd StetanaM ESTATE OF AN �lRI Tae HUD-1 SetBe11b1d StWanronl whIM l have prepared Is a true and accurate aowunt o10da transaction,I have caused orwill cause the funds to be disbursed 6K acw lon=e wall this statemorit. SETTLEMENT AGE! DATE WARNIHM R IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR FORM PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT.FOR DETAILS SEE TITLE 1S:U.S.CODE SECTION 1001 AND SECTION 1010. See attached addendum for additional Information Previous editions are obsolete age 4—at 4 MUD-1 NEW tleae IfemodSeterFUNOW ChW A.MWfn Eotete of Anne CWMMn 16164 Plow W IVIN116d621 an Ndw This page le fumIshad to We you an itemization of the amounts shown an Peal From Paid From Linea 1101,1108 and 1104 of the Settlement Statement(HUD-1).Thle page 8ofrowefs se"Be'e axis path Ih-formation showt a n the Settlement d of the settlement statement. )appfl@c Sememwit Setllemunds at Funds�t 1100 lmegar�a "'�6�i0 h ua 1101 1161.Ifft toesWIN deftit5lsbnar M 1 .� s.tiftbree S 1500 k ST40MCW Fee 50011 C 210 i Q WMAN 4SOD 110E SeIDanada 0w ! 1100.OraehQlsOxumrae f 5260 39A UK LeadsfY6UYmaene 1117.60 5 low e.End=wa d00 Gtft Wad<d 60AD 0 IRAMOM am sm e.Endoneiaent50 50AD a sentoetme< 1250D out 1100.11 1106.1eid1A011s etodl ri06.Owah00s YmH I=#WftWftcfftWftftW"own i USA 1108.tpxTmptfeh d0letlmOlhbisaanoe 31301 ate!1107+11 � 1509. 111& 1111. 1112 Toed ftQa1roMn1sft 1m rtes chum b!b Lee I. 1101.ibleGMIMINWIN feWakwaame $ L VftInFeeb IdAftftpSdWmdSwd=Lit so 1600 b.6ne11Doe Feebtst SetllanedSWAMbn 5&00 50.00 G b Id 8Nftmld c p IF,s ba: Sao SAO IL Nd"Felb"Muffin 4W 4500 1101. LertdehltaletolstAdvardwS SWAMDM 1082.50 1 5 W-90 1J37.50 REV-1508 EX+ (02-1.5) TVpennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Angeline T. Christmas 21-15-0211 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 PNC Checking Account 29,484.65 TOTAL (Also enter on Line 5, Recapitulation) $ 29,484.65 If more space is needed, use additional sheets of paper of the same size. REV4510 EX+ (02-15) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Angeline T. Christmas 21-15-0211 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEMDESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND NUMBER THE DATE OF TRANSFER. ATTACHACOPY OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1• SPS Account-David Christmas,Son,4/6/2015 191,630.80 100 191,630.80 2 SPS Account-Daniel Christmas,Son,4/6/2015 191,630.80 100 191,630.80 3 SPS Account-Diane Christmas,Daughter,4/6/2015 191,630.80 100 191,630.80 4 PNC IRA-David Christmas,Son,3/11/2015 2,662.81 100 2,662.81 5 PNC IRA-Daniel Christmas,Son,3/11/2015 2,584.49 100 2,584.49 6 PNC IRA-Diane Christmas,Daughter, 3/11/2015 2,584.49 100 2,584.49 7 Riversource Annuity,David Christmas,Son,3/13/2015 9,828.22 100 9,828.22 8 Riversource Annuity,Daniel Christmas,Son,3/13/2015 9,828.22 100 9,828.22 9 Riversource Annuity,Diane Christmas, Daughter,3/13/2015 9,828,22 100 9,828.22 TOTAL(Also enter on Line 7, Recapitulation) $ 612,208.85 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(02-15) M pennsytvania SCHEDULE CCH DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Angeline T. Christmas 21-15-0211 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Parthemore Funeral Home 660.01 2 Gate of Heaven Memorial 1,105.00 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: 975.00 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: 685.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 985.00 7. Financial Advisor Fees 1,000.00 8 Settlement Costs, 9 Citadel Drive(see attached settlement sheet) 17,465.00 9 Property Maintenence,9 Citadel Drive 1,350.87 TOTAL(Also enter on Line 9, Recapitulation) $ 24,226.38 If more space is needed, use additional sheets of paper of the same size. REV-1'512 EX+(02-15) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Angeline T. Christmas 21-15-2011 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. State Farm Credit Card 2,559.39 2 2014 Federal,State&Local Taxes 832.63 TOTAL(Also enter on Line 10, Recapitulation) $ 3,392.02 If more space is needed,insert additional sheets of the same size. REV-?513 EX+(02-15) pennsylvania SCHEDULE 1' DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Angeline T. Christmas 21-15-0211 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] I. Sheena Polito,Wormleysburg PA Granddaughter $5,000 2 Christopher Polito,Camp Hill PA Grandson $5,000 3 Molly Shenk,Lewisberry PA Granddaughter $5,000 4 Owen Shenk,Lewisberry PA Grandson $5,000 5 David Christmas, Manhattan Beach CA Son $5,000 & 1/3 6 Daniel Christmas,Camp Hill PA Son 1/3 7 Diane Shenk,Lewisberry PA Daughter 1/3 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: TOTAL OF PART II — 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.