HomeMy WebLinkAbout09-11-15 � LsoseLOLo1
REV-1500 `"`°''°' �`
OFFlCIAL USE ONLY
PqDepaRmen[ofRevenue Pennrylvania Coun�yGotle Year FileNumber
Bureau of[nEiviaualla�es ������� INHERITANCE TAX RETURN
POBO%ieo6oa RESIDENTOECEDENT �� IS ^���I�
H b PA ] 8 6
ENTER DELEDENT INFORMATION BELOW A1MO�VYVY
Social Security Numbet Oate of Oea1h MMDDYVYY Dale o�Birth
04/29/2015 12/24/1928
Decetlenfs LastName
� SURx DecetlenCs First Name MI
SWARTZ JEAN . H
Qf Applicable)Enter Surviving Spouse's Information Balow Sufiix Spouse s Flrs�Name MI
Spouse's Lasl Name �
Spouse's sotlai Securiry Number THIS RETURN MUST BE FILEO IN�UPLICATE WITH THE
REGISTER OF WILLS
FILL IN FPPROPftIATE OVALS BELOW 3. eamainder Rewm(date of deatn
p L O�iginal ReWrn m 2.Supplemenlal ReNrn � prior�0 1243-82)
p 4 Limitetl Estate O 4a. FUWre Interest Compmmise(Ea�e of O 5. Federal Es�ate Tax ReWm ReQuired
tlee1M1 efter4-12A2)
� � (q�teoM1 Cop�Y ot lMl)� � � (A���C py of ims�a Llving Trust 0 8. Tolel Numbar ol Safe DeposiY Boxas
O 4 Llli9alion Pmceetls Receive0 O 10. b�een�231-9��E 1a1195) deat� O t1. �A�ta h Sc�aO�oder Sec.91191A)
GOflRESPON�ENT- TNIS SECTION M WT BE COMPLELEO.PLL LORRESPONDENCE PN�LONROfNPAL T�Dayfine Te ephon�e NumpIR�EQE�T0:
Name
KAYE H WISHARD (717)766-2075
REGISTEHOFWILLSUSEOl�Lsi �
n cn ' Rl
� �• ��n n
� � J) z� �
1" ] �
Flrst Ilne af address . — � .�
�
821PAMELA'SLANE . . " �� "'
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Semntl line oi atlaress � .
�� - -
OATEFILE� �
S�ate ZIPCode �+ � ��
City or Pos1 Offce N '"- m
MECHANICSBURG PA 17oW � � �,� o
S -n
Correspondenfs e-mail adtlress:
nisweew�nec�nartwmoieie�o�ierz����aor�am�neam�srewm,mcmam
g amom0eny�ng scM1eEules an0 sialamen�s,anU to Ne ces�ol my knowietlga antl bel'�el,
preparer o0er Ihan lM1e personal re0resenbGve Is DaseE on all In(ormatlon of wM1lch prepa�DATEany knowletlge.
S GNAT�IRE OF PERSON RESPON51 LErFOR FlLING RETURN O j
0.-� -�/� �I
NDDRSNI Y(,VI� � ��� � � �A I lO� ATE
SIGNPTURE OF PREPHRER OTHER THAN REPRESENThTNE
H��ftE55
PLEASE IISE ORIGINAL FORM ONLY
Side 1
L 1505610101 1505610Y01 �
�
J1505610105
REV-0500 E% DeceOenls Social Securily Number
oececem's Hame�.
RECAPITULATION
1. RealEslatefSchedule A). ........ ........ ......... ... ............ . ... t . ..
2. StocksandBonEs(Scbetlule9) . .... � ��� �������� ��--"""" ' �' ���
3. Closely Heltl Coryoxlion,Partnership or Sole-Pmprietorship(Sc�edule G) ..... 3. . . . .
4. Mortgages and Notes Receivable(Schetlule D).......... ............ ..... 4. . . _. .. . .. .
7,312.36
5. Cash,Bank Deposits and Mlscellaneous PersonalProverty(Schedule E).. .... . 5. . .
6. Jointly Ownetl Properly(Schetlule F) O Separale Billing Requested ...... . 6. ..
1. In�e�-Vlvos Transfers 8 Miscellaneous Non-Probafe Property
(Schetlule G) O Separate Bllling Requested_ ...... L . .
.. .. e. 7,372.36
8. TOWI Gmss Asuts(lotal Lines 1 ihmugn])... .... .... ... ... . .. . .
y 303.50
9. Funeal Expenses antl AdminisVative Gosts(Schetlule H)............. .
ip 7,008.86
10. Debts of oecetlenl.Motlgage Liabilities,antl Liens(Schetlule I).... ........ .. .
_ �i. 7,372.36
it. Total Uetluclions(tolal Lines 9 and 10).... ... .... ... ... . ... _ , .
12. 0.00
12 Net Value of Estale(Line 0 minus Line 11).... ... ..................... .
13. Charila�le antl Govemmental Bequestsl5ec 9113 Tmsls for wM1ich 3
an ele<tion to lax�as nol been made(Schetlule J) .. ... ............ ..... . ..
. ..... .. 14. 0.00
i4. Net Value Subject to Tax(Cine 12 minus Line 13) ........ ..� -��
TAX CPLCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amounl of Line 14laxable
atihe svousallaxrate,or .. - � �
transfers untler Sec.9116 15
(a)(�21 X.o— ... . .. . .
t6. AmounlofLine 141axable �fi
atlinealrate %o_ . ... � -� �� - � �
iZ Amounl of Line 141axable ��
at siblin9 rate X.12 . . � � - � � - -
18. Amoun�ofLinel4�axable �� 18
at mllateal rale X.15
19. TAX OIIE . ....... .. .. .... ..... .......... ... 1& . . ..
20. FILL IN THE OVAL IF VOU ARE REOUESTING A REFUNO OF AN OVERPAYMENT �
$I(�B 2
L 1505610105 150561�1�5 J
Flle Numba�
REV45W EX Pa9e 3
DecedenYs Complete Address:
OECE�ENT'S NAME
JEAN H SWARTZ . _ ——. __. ____ . . _ .—.. __ .. . ...
STREETA�ORE55 �� �� �� �� �
210 BIG SPRING ROAD __ _.. __._— .--�--- —� --
—.—.. ._— . I . __. .___.
.—_. --.— ___ . _ .�-STATE ZIP
— �- —� . 17241
�c�NENNILLE � PA
Tax Payments and Credits ��� 0.00
7. Tax Due(Page 2,Line 19)
2. CredilslPaymenLs 99876
A.PnorPaymenls . - ——
B.�iscoum . ... --- -- ---. Total Credits(A*8 I (2) 998.76
3. Interesl (3)
4. If Line 2 is grealer Ihan Line 1+Line 3,enler the diHerence. IDis is 0e OVERPAYMENT. 4 ygg�g
Fill in oval on Page 1,Line 2010 requesl a refund.
5. II Llne 1 t line 31s gree�er tM1Bn Line 2,enter�he GHarence.This Is�he TAX DUE. (5)
Make check payable to: REGISTER OF WILLS,AGENT
� PLEASE ANSWER THE FOLLOWING QUESTIONS 8Y PLACING AN "X" IN THE APPROPRIATE BLOCKS
ves No
1. �iddecetlentmakeaVansterand: � �
._... ...........
X
a. retain Ihe use or inwme of Ihe DropeM�rans ert ......._ �
_ ._... ❑ o
�. reteln the right to designala who shall use IDa proparty transferreG or its incomat.. ❑ �
_..... ...._.... .
K
c. retain a reversionary imerest or ......... ��-�����,� � �
d. receivefiepromisebrlleofeitherpayments,Gene�tsorcare� ���-��
_....,. ...... x
2. If dea�h aarteG after�ec.72,1982,tlid Eecedent Iransfer propeny wil�in one year of tleath ❑ ❑
_.... .. .......
x
withoutreceivingatlequateconsideralion?.... -.������- �— "' O
3. OiG decetlen�own an'in W s�for'br payable-upon-death bank account or security at his or her death4.,. ........ ❑
4. Ditl decedent own an in0ividual retirement acwunt,annuity or other non-pmbate properry,which ❑ ❑
mntainsabeneficiarydesqretion? .......... ��������� ---- ""
._......_.. K
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 aeath on or after July 1, 1994,and before Jan, 1,1995,�he tax rate imposed on the net value of iransfers to or for the use of the survivin9 spouse is
3 percem�72 PS.§91161a)�1,1)�i)�.
For dates of tleath on or atler Jan. 1, 1995, the tax rate imposed on the ne� value of transfers to or for ihe use of the surviving spouu is 0 percent
[/2 PS. §9116(a) (1.1)(�)6 The s�atute tloes not exempt a iransfer to a survrving spouse imm tex, and Ne staNtory requiremenls for Olsclosure of assets and
fJing a tax reWrn are still applicable even if fhe surviving spouse is ihe only 6eneficiary.
Por dates of death on or afler July 1,2000�,
. The tax rate imposed on the net value of Vansfers hom a deceased child 21 years of age or younger at dea�h to or for Ue use of a naNral parent, an
adoplive parent or a s�epparent of the chlltl Is 0 percent[I2 P.S.§9116(e�(12)�.
. The tax rate imposed on Ne net value of transfers lo or for the use of ihe deceOenCs lineal benefciaries is 4.5 percenl, except as noted in
�zPs §sns��.s���zcs §snsla)(i)I� g
� Sectlon 9102,a�ao nd vldua�l who has at lea�sl one parenl m commorn w ih ihe decede bl'whethw�by blood or ad pfion��8(a)(1.3)].A sIDling is defined,under
0.EV-1511 E%ro(12-02)
� pennsylvania
SCHEDULEI
L�� oEvar+rne�u*oFxEVErvvE DEBTS OF DECEDENT�
�rv��ai.nxcemx aer�an MORTGAGE LIABILITIES& LIENS
aEsiocxr oeceoervr
FILE NUMBER
ESTATE OF 2015-00608
JEAN SWARTZ P mcWEin unrelmburseE mediolezpenses,
rtepert debts incurreE bY�he Eeceden[priar[o Eea[M1 Ma[remaineC un aid a[lhe date ot deafh,� 9 VFLUE At�ATE
REM pE5CRi4Ti0N OF OEATH
NUMBER
7,008.86
�� MEDICAIDCLAIMCIS#560370962
TOTPL(Alsa enter on Line 10,RecapiNla[ion) ;
7,008.66
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