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Home My WebLink About01-0475 REV-1S00EX+{6.QO) j(" " /\ ~""' -';-:-1"'..".:) ij REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT w >- :J::~(I) u"'''' w~(,) :I:o::g Uo..<ll 0.. < DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL) I- Z W C W CJ w c Lauver Marlin H. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM.DD-Year) 19 10/10/2000 08/12/:!Q17 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) OFFICIAL USE ONLY FILE NUMBER ~TYk-~EAR' 1R7l~ SOCIAL SECURITY NUMBER 207-07-5316 THIS RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3. Remainder Return (date of death prior to 12.1J-82) o 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL tAX INFORMATION SHOUl.D BE DIReCTED TO: NAME COMPLETE MAILING ADDRESS H. Anthon Adams Es uire 128 E. King Street FIRM NAME (II Applicable) z o i= ct: ...J ::J l- ii: ct: CJ w 0:: z o i= ct: I- ::J ll. :i! o CJ ~ I- Lauver Glad s M. 00 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attacl1 copy of Will) o 9. LiUgation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12.12.82) o 7. Decedent Maintained a living Trust (Attacl1 copy oITrust) o 10. Spousal Poverty Credit (date 01 death between 12-31.91 and 1.1-95) >- Z w C Z o 0.. V) W '" '" C U Suite A TELEPHONE NUMBER 717 -532-3270 Shi ensbur 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts 01 Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE StOE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a}{1.2) X _(15) -2,714.28 X .045 (16) X .12 (17) X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SORE TO At./SWER ALL QUESTIONS 011I REVEl'tSE SIDE AND RECH CK MATH < < PA 17257 OFFICIAL USE ONLY 3,83804 i l____ (8) 3,838.04 6,552.32 (11) (12) (13) 6,55232 -2,714.28 (14) -2,71428 -12214 -122.14 D d - , C Add ece ents omplete ress: SrRE::ET ADDRESS 17809 Cumberland Hiahwav CITY, I STATE I ZIP Newburg PA 17240 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C Discount (1) -12214 3. InteresUPenalty if applicable D.lnterest E. Penalty Total Credits (A + 8 + C) (2) TotallnteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 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) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 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 a/the property transferred; .. ..... .................. ................................... ..... 0 IKJ b. retain the right to designate who shalt use the property transferred or its income; ... 0 IKJ c. retain a reversionary interest; or .......... ......................... ............................. D [Z] d. receive the promise for life of either payments, benefits or care? ...... ............................ ......................... 0 IKJ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................ ........................... ......................... ...... 0 [K} 3. Did decedent own an "in trust fo~ or payable upon death bank account or security at his or her death? ................. 0 IKJ 4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............ .................... ................. ............................ ................ 0 [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. Under penalties of perjury, I declare that 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 pre parer other than the personal representative is based on all information of which preparer has any knowledge SIG ATURE OF fE,R~ON RESPONSIBLE FOR FILING ~TURN DATE ~.)-~-:- ~. 1'?~'1l' >.-,,~a.,--G{r'{.~,.'t/ ./z,(. " 1- " "'6 iJ / A DRESS SIGNATURE OF. \ ADDRESS For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. !/9116 (a) (1.1) (i)l. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. !/9116 (a) (1.1) (ii)l. The statute does not exemot 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. !/9116(a)(I.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%, except as noted in 72 P.S. !/9116(1.2) [72 P.S. !/9116(a)(I)]. The tax rate imposed on the net vaiue of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(I.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 > !1.97r SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 'I" ~'.-"""'iii'~. . li ~" ~ t~ '~.~' ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lauver Marlin H. Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 3,83804 Checking Account Acct#: TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3838.04 REV-,51'EX+(1-9;" SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lauver Marlin H. FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) 1,500.00 Social Security Numbe<<s) } E1N Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2001 2 Attorney Fees H. Anthony Adams, Esquire 450.00 3. Fami~ Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) 3,500.00 Claimant Gladys Lauver Street Address 17809 Cumberland HiQhway City NewburQ State PA Zip 17240 Relationship of Claimant to Decedent Wife 4. Probate Fees Register of Wills 69.00 5 Accountant's Fees 6. Tax Retum Preparer's Fees 7. David A. Zickafoose 124.11 8. White Rose Ambulance 100.84 9. Minnick's Pharmacy, Inc. 23.94 10. Hanover Cardiology Associates 87.88 11. Lois P Gable (Funeral) 696.55 TOTAL (Also enler on line 9, Recapitulation) $ 6552.32 (If more space Is needed, insert additionai sheets of the same size) REV.1513E:<..n ~7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER L""v"r M"rlin H RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE J. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. Gladys Lauver Wife 100% 17809 Cumberland Highway Newburg, PA 17240 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. I TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)