HomeMy WebLinkAbout07-18-05
REV.IOOOEX{6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONLY
FILE NUMBER
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COUNTY CODE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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SOCIAL SECURITY NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DON~\O\I€R LOWS1=- E.
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-jl;AR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Suppl~mental Return
D 4a. Future Interest Compromise (cate of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Mach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 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
o 11. Election to tax under Sec. 9113(A) (Atlach Sch 0)
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JHISSECTIOIlMUST BE'C,OMPLETEO:'ALL CORRESPONOENCE'ANO'CONFIOENTIAL'\)TMINFORMATlONfSHOULO a, IREcrEol'to:'~
NAME"l\ b""" 1\ U C'lo.'\\1'\ COMPLETE MAILlNGADDRES.S I I T\
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FIRM NAME III App""b"l Carlis1€:') 'PA 1l0/3
TELEPHONE NUMBER 1 n-lQO - dd-~ q
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1. Real Estate {Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Joinlly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
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)
(1) NONF
(2) u, ;;).llOS. :17
(3)_NOI\\.f
(4) NONE-
(5) II. \ d3. J?fj ,3 'f
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(6) AiO fJ C
(7) ~JO r-J-E
IOFFICIAL USE ONLY
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12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
(11)
(12)
(13)
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14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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 rale
19. Tax Due
1f, j4ip/151,35 x.O_ (15) t/; 05QO,.3/
x .0'1-5 (16)
x .12 (17)
x .15 (18) {l (p 5QO _3/
(19)
20,0
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>"BEiSURE;TO'ANSWER'A~~QUESTIQN$I.ONRE.Vr;!RSI<^.SIQ
Decedent's Complete Address:
STREET ADDRESS . Oll- . Q n ('(6le ('
CITY
fA
STATE
Tax Payments and Credits:
1. Tax Due (Page 1 Une 1 g)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C Discount ~ 3;:{ q , 5/
(1)
055
t CO S10, 3 !
Total Credits (A + B + C )
(2)
S 3Jq " 51
(3) 0
(4) J, ro :2?l) I 'to
(5)
(5A) !I; 0:J!o() , 2-0
(5B)
3. InteresUPenally if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 0 + E )
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Une 1 + Une 3 is greater than Une 2. enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Yes
o
........0
..............0
.........0
1. Did decedent make a transfer and:
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; or ................................................................. .....................
d. receive the promise for life of either payments, benefits or care? ...................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ......................... ......................................................... D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. ........... D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................... ......................... ..................................
No
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to [he best of my knowledge and beliel, it is true. correct and complete.
Declaration of preparer other than the personal representative is based on al I information of which preparer has any knowledge
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ADDRESS
DATE
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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. 39116 (a) (1.1) (ill.
For dates of death on or after January 1. 1995. the tax rale imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 39116 (a) (1.1) (ii)].
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. 39116(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%. except as noted in 72 P.S. 39116(1.2) [72 P.S. 39116(a)(111.
The tax rate imposed on the net value of transfers to or for Ihe use of the decedent's siblings is 12% [72 P.S. 39116(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.t503 E)(+ (J.971
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF \ ^' - n
LUll'- S to E- von moy €I<'"
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
!q 302,10 V
~30G, 03
3,
S~Y:LQS 5 BDYJd s
1Y co stock"
Tyco \Y1trV\ctiton~ (
T~ CD 3tock__ at ~ VI c(QYld 5
,
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3ooskqve~ -j-,00JI)Lj 100
~ Tv -CDVY\i\'Y'\1)V\ ~LOcJ<...
J,
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TOTAL (Also enteron line 2, Recapitulation) $;)1 70S, ;)7
(If mnrp c:n::lrp is npPrll"(j, insert ;::Irlrlitinn;,! c:hf>pts of the S::lmf> si7e)
REV-l508EX + (1.97!
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
VOy)nlOL(6'<
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF L I c::::
OU I S (, L-
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. fC\Lttb ins. fe.-fixnd d..5c" ~o
:L So V erE? \ 3 VI C b d '=sOdO, b G
~VRb-eYS 1st CD IS I 8-0 991/ /0
3, d- SQ:J IJ Iflq S
A r!;oYlQ ( p rCJ p~ r1l( ij{Jo-
1 s~ 7g-
L rYkm ~ ICS Isf i;~~f dd.; oC;
J,
~, Sauere-'ijV) )'n(Qresr 1057/, II
PNe, CJn~J QQcf
1,
TOTAL (Also enter on line 5, Recapitulation) $ I.J. 3 ,} frO, 3 cj
(If more space is needed, insert additional sheets of the same size)
REV-15~1 EX+ (12-99) _
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF L-OW'S e E. "DC) n rnO y e~VZ
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: Ho Yl1L ftd.OifY, -
1. '1(\\1 (',1'S- ~arne.r FC.(neXCL!
1Z0 \\in6 G-V€QX\ Co rN-tClJrLj 5'Q 5, ---
LI:;). <f0
rlo L\fi.rS
100, --
PQstoY"
ISO.~
rood
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(sl
Street Address
City State _Zip
Year(s) Commission Paid:
2. 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
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ :2 0; 35, 'f!}
(If more space is needed, insert additional sheets of the same size)
REV-15i2EX'P-9T)
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SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INH~~~~~~iZ:c"E~~~~RN MORTGAGE LIABILITIES, & LIENS
ESTATE OF Lo > "
U\Se. E - VOn mOVff:
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
1.
~rd'l
fJ-T d- T
Vtr1LOYj
s'QCtrS
To.f- Es1.
AMOUNT
-;-3" '-II
15. 5S
I~.qd..
1(;, qr
/500. -
TOTAL (Also enter on line 10, Recapitulation) $
(If more space IS needed, insert additional sheets of the same size)
J 57g, &-b
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
MCCLAIN DEBRA DONMOYER
2 WHEA TFIELD DRIVE
CARLISLE, PA 17013
"_nnn fold
ESTATE INFORMATION: SSN: 177 -24-6341
FILE NUMBER: 2105-0400
DECEDENT NAME: DONMOYER LOUISE E
DATE OF PAYMENT: 07/15/2005
POSTMARK DATE: 07/15/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 04/22/2005
NO. CD 005578
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $6,260.80
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 1001
SEAL
INITIALS: MW
RECEIVED BY:
REGISTER OF WILLS
$6,260.80
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS