HomeMy WebLinkAbout09-06-05
REV.l500 EX (6.00)
. .
'* COMMONWEALTH OF
PENNSYLVANIA
, DEPARTMENT OF REVENUE
, DEPT. 280601
HARRISBURG, PA 17128-0601
w
'"'
lo:::$C/l
uCl:lo::
wll-U
:1:00
uCI:..J
lI-lIl
ll-
e{
REV-1500
OFHCiAL USE
FILE NUMBER
21 05
INHERITANCE TAX RETURN
RESIDENT DECEDENT
N MBER
NAME
SCOTT A. BANKERT
FIRM NAME (It Applicable)
TELEPHONE NUMBER
(717) 303-0103
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)
z
o
5
:J
l-
ii:
<(
t)
w
0::
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JoinUy Owned Properly (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
I-
Z
W
C
W
t)
W
C
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BANKERT, FAYE A.
0031
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
186-26-8393
DATE OF DEATH (MM-DD-YEAR)
09/08/2004
DATE OF BIRTH (MM-DD-YEAR)
04/19/1934
I THIS RETURN MUST BE FILED IN D PLICATE WITH THE
REGISTER OF ILLS
SOCIAL SECURITY NUMBER
176-26-0666
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BANKERT, EARL H.
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach oopy otWII)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Allach oopy oITrust)
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (dale of de~ prior 10 12-13-82)
o 5. Federal Estate Tax Return ~equired
8. Total Number of Safe Deporit Boxes
o 11. Election to tax under Sec. ~113(A) (Allach Sch 0)
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)
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)
COMPLETE MAILING ADDRESS
5 WEST GREEN STREET
APTC.
SHIREMANSTOWN, PA 17011
(1)
(2)
(3)
(4)
(5) 8,421.12
(6)
(7)
_~OFFiCIAL ET ONLY ~g I
() i C)
. ) ',) (i~
,-'j
:---I:J
",
-'~:1
, --:'1
- i'l
(- -.....
l:Orl
. ':-)
. :1
P...)
(Jl
N
---'
(9)
(10)
(8)
2,566.00
27,369.57
(11)
(12)
(13)
8,421.12
29,935.57
-21,514.45
(14)
-21,514.45
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
x .0_ (15)
z
o
~
~
:J
a..
:!:
o
t)
~
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 rate
19. Tax Due
20.0
x .0 (16)
x .12 (17)
x .15 (18)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(19)
. .
Decedent's Complete Address:
STREET ADDRESS
752 STATE STREET
CITY LEMOYNE
STATE
PA
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
Total Interest/Penalty ( 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)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
ZIP
1704
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BlO KS
1. Did decedent make a transfer and: Yes
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
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....... ..................................................... ....... ............... ...... ................................ 0
No
[KJ
[KJ
[i]
[iI
[i]
[KJ
[KJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF ~HE RETURN.
AD RESS
5 EST GREEN STREET, APT C. SHIREMANSTOWN, PA 17011
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
DATE
08/301 5
DATE
-
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 spou is 3%
[72 P.S. 99116 (a) (1.1) (i)l.
L~v-e. 1-\ 5 G0
I:c\ dO. <:.)'0
~Pb do 5 (ft
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
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of as
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 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 nc
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)('
individual who has at least one parent in common with the decedent, whether by blood or adoption.
~r ~J...0T
1) (Ii)].
lYen if
larent,
as an
REV-150B EX+ (6-9B) .
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FAYE A. BANKERT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ITEM
NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
PROCEEDS FROM ESTATE OF TROY E. BANKERT (50%)
2. CASH
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
FILE NUMaER
21-05-0031
REV-1511 EX+ (12-99>.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FAYE A. BANKERT
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
STONE AND MURRAY FUNERAL HOME
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative( s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State
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
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
FILE NUMBER
21-05-0031
Zip
,Zip
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size>
2,566.00
REV-1512 EX+ (12-03)
'*
112.12
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
FAYE A. BANKERT
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expens s.
ITEM VALUE T DATE
NUMBER DESCRIPTION OF D ATH
1.
ALLIED INTERSTATE
2.
CAPITAL ONE
975.99
3.
CCS FINANCIAL SYSTEMS
50.65
4.
CONSOLIDATED COLLECTION
150.00
5.
CREDIT PLUS COLLECTION
38.00
6. FIRST CHOICE REHAB
7. HARRISBURG FOOT AND ANKLE
8. LAWRENCE G. COX, D.O.
9. LIBERTY MEDICAL SUPPLY
10. NATIONAL RECOVERY AGENCY (VARIOUS ACCOUNTS)
11. ORTHOPEDIC SURGEONS
12. PEERLESS CREDIT (VARIOUS ACCOUNTS)
13. PENN CREDIT CORPORATION
15.
14. PINNACLE HEALTH (VARIOUS ACCOUNTS)
186.55
16.
17.
18.
20.
21.
22.
POWELL, ROGERS AND SPEAKS
QUANTUM IMAGING
8.65
QUEST DIAGNOSTICS
186.63
254.75
RIVERSIDE ANESTESIA
26.67
19.
SPIRIT PHYSICIAN SERVICES
15.10
TAMDOT HOMECARE
48.00
WE IS PHARMACY
36.30
YOUNG'S MEDICAL EQUIPMENT
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
7,369.57