HomeMy WebLinkAbout08-17-05
REV-15Oll EX ('"00) REV-1 500 OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA INHERITANCE TAX RETURN
DEPARTMENT OF REVENUE FILE NUMBER
DEPT. 280601 RESIDENT DECEDENT ~ - -'2-S -1l J2L~3
HARRISBURG, PA 17128-0601 eoLNT'( COOE YEAR MMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURrTY NUMBER
I-
Z SHEIBLEY , FRANCIS J 168 - 70 - 12 97
W DATE OF DEATH (MM-DD- YEAR) DATE OF BIRTH (MM-DD- YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
C
W 12 17 2 004 03 05 1984 REGISTER OF WILLS
0 - - - -
W (IF APPLICABLE) SURVMNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
C
W [ZJ 1, Original Return 0 2. Supplemental Return 0 3. Remainder Return (dale of deatl1 prior to 12-13-82)
~ <J) 0 4. Limited Estate 0 4a. Future Interest Compromise (date 01 death after 12-12-82) 0 5_ Federal Estate Tax Return Required
"'(I: '"
00- 0
Wo 0 0 6. Decedent Died Testate (Attach copy of WI) 0 7. Decedent Maintained a Living Trust (Attach "py 01 Tru;I) 8. Total Number of Safe Depos~ Boxes
:I: a: -' -
00- ell
0- 0 9. L~igation Proceeds Received 0 10. Spousal Poverty Credit (dale 01 deatl1 between 12-31-91 and 1-1-95) 0 11, Election to tax under See. 9113(A) (Attach Sell 0)
<{
>- ml$i~~'l"IR':"~$J'!:i~j_~Il!'1'Il!P'.lI.J.!Li:Q~gQ_e'~pl!!jl:Ij~..~i.t.i.~_$~iE!e1~~_i.jll!jjn::
z NAME COMPLETE MAILING ADDRESS
W
0 KENNETH H SHEIBLEY 1 12 ROUND RIDGE ROAD
z
0 FIRM NAME (If Applicab,,)
0- MECHANICSBURG, PA 17055
<J)
W
(I:
(I: TELEPHONE NUMBER
0
0 717 - 2 4 1 - 1242
1, Real Estate (Schedule A) (1) 0 pFFICIAL DSE ONLY
:.::-:) TI':J
1 7 883 c~,., I , ;,
2. Stocks and Bonds (Schedule B) (2) , "> in--)
-- en>
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0 , , c. ) 0
- :7
, _.~.- "
Mortgages & Notes Receivable (Schedule D) (4) 0 - C.F) :__::J
4. ,
,
-, , C)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 1 6 905 - 1"1 ..n
, -n
Z (Schedule E) c ,:"5
- ) ;--r1
0 6. Jointly O,vned Property (Schedule F) (6) 3 , 442 C)
~ 0 -- ,
Separate Billing Requested c..n
~ 7 Inter-\'\vos Transfers & Miscellaneous Non-Probate Property (7) 0
I- (Schedule G or L)
c:: 8. Total Gross Assets (total Lines 1 - 7) (8) 3 8 23 0
<( ,
0 9. Funeral Expenses & Adminislrative Costs (Schedule H) (9) 23 76 1
W ,
0::: 10. Debts of Decedent, Mortgage Uabilrties, & Liens (Schedule I) (10) 43 5
11, Total Deductions (total Lines 9 & 10) (11) 24 , 196
12. Net Value of Estate (Line 8 minus Line 11) (12) 14 , 034
13- Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been (13) 0
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 14 , 034
SEE INSTRUCTIONS FOR APPLICABLE RATES
Z Amount of Line
0 15. 14 taxable at the spousal tax 034
~ rate, or transfers under See. 9116 (a)(12) 14 , x .0 00 (15) 0
~ 16 Amount of Line 14 taxable at lineal rate Decedent under 2 1 x .0_ (16) 0
~
a. 17. Amount of Line 14 taxable at sibling rate Exempt x .12 (17) 0
::E
0 18. Amount of Line 14 taxable at collateral rate X .15 (18) 0
0
~ 19. Tax Due (19) 0
20 [ZJ 11;i;~_I$IF'i"~(_..F$$rt.~;~~ljlp;.!.iMM~'i"M~1
.<<, , :: ......~..~... ::.cc;;;i!.:j;j;j;j; .,;:<j;..
Decedent's Complete Address:
STREET ADDRESS 112 ROUND RIDGE ROAD
CITY MECHANICSBURG
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE PA
ZIP
17055
(1)
o
450
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
450
TotallnteresVPenalty (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)
o
450
o
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
o
PLEASE ANSWER THE FOLLOVVlNG QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Yes
..0
o
o
o
o
o
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 [XJ
IF THE ANSWER TO AtN OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declae that I have examined this return, including accompanying schedules and statements, and to the best of my kn<1Nledge and belief, it is true, correct and complete.
Decaration of preparer other than the personal representative is based on all inf . which preparer has any knowl ge.
SIGN TUR PER 0 OR FILING RETU
No
~
~
~
~
~
[Xl
ADDRESS
112 ROUND RIDG
SIGNATURE OF PREPARER OT
PA 17055
DATE
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. 99116 (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 for the use of the surviving spouse is 0% [72 P.S. 99116 (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 retum 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. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(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.
STF PA42021F.2
RE\I-1503 EX + (1-97) (I)
COMMO~LTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
SHEIBLEY, FRANCIS J
FILE NUMBER
21-05-00023
All property jointlY-<lWl1ed with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1.
2 .
600 Shares Disney Co
209.985 Shr Merrill Lynch Global Tech Fund CL B
VALUE AT DATE
OF DEATH
16,422
1,461
SlFPA42021F.4
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, Insert additional sheets of the same size)
17,883
REV-1508 EX + (1-97) (I)
CO'-'MONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
SHEIBLEY, FRANCIS J
FILE NUMBER
21-05-00023
Include the proceeds of Irtigalion and the dale 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.
2.
3 .
4 .
5.
6.
7.
Merrill Lynch Bank Deposit Program (mma)
M&T Bank - checking account
Penn State University - Tuition refund
Penn State University - Deposit refund
US Treasury - Federal income tax refund
Personal property
Allstate - Auto Insurance death benefit
339
630
5,335
100
501
7,500
2,500
STFPA42021F.9
TOTAL (Also enter on line 5, Recapitulation) $
(If more space IS needed, insert additional sheets of the same size)
16,905
REV-15Q9 EX + (1-97) (1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY -OWNED PROPERTY
ESTATE OF
SHEIBLEY, FRANCIS J
FILE NUMBER
21-05-00023
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVMNG JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Kenneth H. Sheibley
112 Round Ridge Road
Mechanicsburg, PA 17055
Father
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Irdude name of finarcial institliion am bark aa::Ol.nt runber or similar identifying rn.mber. DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT Attach deed for joint~-he~ real eslate. VALUE OF ASSET INTEREST DECEDENTS INTEREST
1. A. 2002 97 Ford Explorer 6,884 50 3,442
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
TOTAL (Also enter on line 6, Recapituiation) $ 3,442
.,
(If more space IS needed, Insert additional sheets of the same size)
SlFPA42021F.10
RE'..1511 EX + (1.97)(1)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
SHEIBLEY, FRANCIS J
FILE NUMBER
21-05-00023
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
2 .
3 .
4.
5.
B.
1.
2.
3
4.
5.
6.
7.
8.
9.
STFPA42021F.12
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Malpezzi Funeral Home
Natures Harmony - Flowers
Rolling Green Cemetery - Plot and burial
St. Elizabeth Ann Seton Church - Funeral luncheon
Rolling Green Cemetery - Marker
10,897
200
1,295
700
5,328
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
Attorney Fees
Family Exemption: (~decedent's address is not the same as claimanfs, altacl1 explanation)
Claimant Kenneth H. Sheibley
Street Address 112 Round Ridge Road
Crty Mechanicsburg State PA
Relationship of Claimant to Decedent Fat he r
State
Zip
1,000
Zip 17055
3,500
Probate Fees
61
Accountant's Fees
Tax Retum Preparer's Fees
Unreimbursed towing, storage and shipping charges
Additional probate fees
Filing fee
705
60
15
TOTAL (Also enter on line 9, Recapitulation) $
23,761
(If more space IS needed, Insert additional sheets of the same size)
REV-1512 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
SHEIBLEY, FRANCIS J
FILE NUMBER
21-05-00023
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
2 .
Commonwealth of Pennsylvania - Income taxes
Capital One Bank - Credit card balance
4
431
STFPA42021F.13
TOTAL (Also enter on line 10. Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
435
RE>J-1513 EX + (9-QO)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
SHEIBLEY, FRANCIS J
FILE NUMBER
21-05-00023
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s)
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Kenneth H. Sheibley
1. 112 Round Ridge Road
Mechanicsburg, PA 17055 Father
2. Patricia K. Sheibley
418 Candlewyck Road
Camp Hill, PA 17011 Mother
AMOUNT OR SHARE
OF ESTATE
50%
50%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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.
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)
o
STF PA42021 F.14