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Home My WebLink About06-23-05 11["\/ 1 ',()(1 r x (6-00) 1 '. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ z w o w t> w o uJ I- " ~ lfJ ~ a:~ () a. () uJ 00 :c a:..J () a. CD a. <( DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) Bonsall, Carole DATE OF DEATH (MM-DO-Year) DATE OF BIRTH (MM-DD-Year) OFFICIAL USE ONL y FILE NUMBER 2 - 0 5 o 3 7 0 03/05/2005 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) [R] 1. Original Return D 4. Limited Estate lliJ 6. Decedent Died Testate (Artach copy of Will) D 9. Litigation Proceeds Received D 2 Supplemental Return D 4a Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ""'COuNTY"'CODE -vEA~ - - NuMBER-- SOCIAL SECURITY NUMBER 5 0 7 - 2 8 - 6 7 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death prior to 12.13-82) D 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under See 9113(A) (Mach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCEANDCONFIDENTIALTAXINFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS John D. Gri sb , Es 101 S. Market Street FIRM NAME (If Appllc;;hle) z o ~ <C ..J => t: a.. <C t> w a: z o ~ <C ~ => a.. :E o t> X <C ~ ;r I- Z uJ o z o a. lfJ uJ a: a: o () TELEPHONE NUMBER 717-796-6537 Mechanicsbur 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5 Cash, Bank DepOSits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested (5) (6) 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (Schedule G or L) (7) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (9) (10) 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 SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X _(15) X _(16) X .12 (17) X .15 (18) 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 PA 17055 OFFICIAL USE ONLY r ., \,D -+'..} 1'-. . ~ C.' (8) 20,696,08 5,268.00 15,949.42 (11) (12) (13) 21,217.42 -521.34 (14) -521.34 (19) 20. 0 Decedent's'Com lete Address: · 01 REL 1 ADDRESS B' h PI 524 n ton ace CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C Discount Total Credits (A + B + C) (2) 3 Interest/Penalty if applicable D Interest E Penalty TotallnterestiPenalty ( 0 + 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) B. 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 Old decedent make a transfer and Yes No a retain the use or income of the property transferred; ................... ........................................................ 0 ~ b retain the right to designate who shall use the property transferred or its income; ........................................ 0 ~J c, retain a reversionary interest; or ...................................................................................................... 0 [J d, receive the promise for life of either payments, benefits or care? ............................................................. 0 EJ 2, :i~~:~~ r~~~~:;~: :::~~;:e:~::d:~~t~:~~.'. ~i.~. ~.e~~~~.nt .tra~s~~~ ~:~~~~~.~:t.~:~. ~~.~ .~.~~.r. ~~ .~~~.t.~...................... 0 Q'/ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 IT 4 ~~~t~~~:~e~~:;i:i:~yl::~~~;li;~tir~~~nt. ~~~~u.~t,. .~n.n~i.t~,. .~:.~.t~~.r. .~~.~~~~~~~.t~ .~~~~.~~~. ~.~i.~~........................ 0 Gi 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 periury, 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 preparer other than the personal representative is based on all information of which pre parer has any knowledge. SIGNATUOF PERSON RESP.ONSIBLE FOR FILING RETURN DATE -0(0,-05 PA 17055 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 PS S9116 (a) (1.1) (i)], For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or Ie The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements fc 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 YOI or a stepparent of the child is 0% [72 PS. s9116(a)(1 ,2)], The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 Individual who has at least one parent in common with the decedent, whether by blood or adoption. (\ ~Pj) PS, 99116 (a) (1,1) (ii)], are still applicable even if .. )arent, an adoptive parent, 3.~\~ 1,2) [72 P,S. 99116(a)(1 )]. Ider Section 9102, as an I;f '1'1\-97'1 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY t COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bonsall Carole FILE NUMBER 21 05 0370 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Members First FCU Checking Acct. #170935 2,504.55 Mechanicsburg, PA 17055 2. Members First FCU Savings Acct. #170935 14,066.53 Mechanicsburg, PA 17055 3. 1995 Toyota Camry 2,325.00 4. Miscellaneous furniture 1,800.00 Personal items TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 20,696.08 '~. ...,,~ COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMiNISTRATIVE COSTS ESTATE OF FILE NUMBER Bonsall Carole 21 05 0370 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES 1 Malpezzi Funeral Home 4,253.00 B ADMINISTRA TIVE COSTS 1 Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2 Attorney Fees John D. Grigsby, Esq. 750.00 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 115.00 5 Accountant's Fees 6 Tax Return Preparer's Fees 7. The Patriot News 75.00 8. Cumberland County Legal Journal 75.00 TOTAL (Also enter on line 9, Recapitulation) $ 5,268.00 (If more space IS needed, insert additional sheets of the same size) '~- ,w""'~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bonsall. Carole Include unreimbursed medical expenses. ITEM NUMBER SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER 21 05 0370 DESCRIPTION Choice Nursing, Inc. (Unreimburseable) 3514 Trindle Rd., 2nd Floor Camp Hill, PA 17011 Members 1 st Visa #4287590002709356 (Unreimburseable) 2. 3. Homeland Nursing 1901 N. Fifth Street Harrisburg, PA 17102 Stoken Opthalmology 338 Alexander Spring Rd. Carlisle, PA 17013 4. (Unreimburseable) (Unreimburseable) AMOUNT 5,243.52 6,448.31 4,190.09 67.50 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 15,949.42 ."c~"d';, '"_ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FilE NUMBER ~ " ( :rlrnlA ?1 ni:i 0370 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)] 1 Greg Weeks Son 1/6 2511 Woodfield Loop SE Olymbia, WA 98501 2. Douglas Weeks Son 1/6 1475 S. State College #224 Aneheim, CA 92806 3. Kenneth Weeks Son 1/6 PO Box 6877 Phoenix, AZ 85005 4. Randall Weeks Son 1/6 2207 Nut Tree Loop SE Loympia, WA 98501 5. Susan Myers Daughter 1/6 160 Cedar Hill Dr. Dover, PA 17315 6. William Weeks Son 1/6 525 East Alder Brea, CA 92621 ENTER DOLLAR AMOUNTS FOR DISTRIBUTiONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-T AXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 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)