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Home My WebLink About09-08-05 KEH5()()Exifi.oe, REV-1500 '* COMMONWEALTH OF . PENNSYLVANIA . DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~L-j)5 COUNTY CODE YEAR 2_ 7 12 NUMBER I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) McConnell, John W. SOCIAL SECURITY NUMBER 714-18-1830 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ll:::$U1 (.)rtll:: w~g :E:rt...l (.)D.lD ~ DATE OF DEATH (MM-DD-YEAR) 02/07/2005 DATE OF BIRTH (MM-DD-YEAR) 12/27/1922 o 3. Remainder Return Idate of death prior to 12-13-821 o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Soh 0) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) [!] 1. Original Return o 4. limited Estate o 6. Decedent Died Testate (AUach copy of Willi o 9. Litigation Proceeds Received o 2. Supplemental Return o 4a. Future Interest Compromise Idate of death afier 12-12-82) o 7. Decedent Maintained a Living Trust (Attach oopy ofTruat) o 10. Spousal Poverty Credit Idata of death belWaerl 12.31.91 and 1.1.95) t- Z w Q Z ~ Ii! rt o (.) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Shaun E. O'Toole, Esquire 2813 North Second Street FIRM NAME (lfAppllcablet Harrisburg, PA 17110 TELEPHONE NUMBER (717) 213-6653 z o 3 :J I- 0: oCt o W 0:: 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, Jointly 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) 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) r-.'> C7"--:} (1) (2) (3) (4) (5) n 1 c.rt U1 , C'-I --':"J -:1 '.J (6) 563.10 (7) w (8) 563.10 (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) 5,967.27 (11) (12) (13) 5,967.27 -5.404.17 0.00 (14) -5,404.17 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ :J a.. :IE o o g 15. Amount of Line 14 taxabla at the spousal tax rate, or transfers under Sec. 9116 (a)(l2) x .0 16. Amount of Line 14 taxable at lineal rate x .0 __ 17. Amount of Line 14 taxable at sibling rate x .12 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < (15) (16) (17) (18) (19) 0.00 Decedent's Complete Address: STREET ADDRESS 40'5 I-r"", i ~~. CITY \IJ e ~ /:; ~#-. it' ,Ii ~ , STATE FA Tax Payments and Credits: 1, Tax Due (Page 1 Line 19) 2, Credits/Payments A, Spousal Poverty Credit S, Prior Payments C, Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D, Interest E, Penalty 4. Total Interest/Penalty ( D + E ) 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 (3) (4) (5) (5A) (5B) 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the totai of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT ZIP , '7025' 0.00 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS No ~ ~ [i] ~ 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 ~ (i] ~ 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 pe~ury, 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 preparer has any knowledge. ~E~~:ErP~r~B~F~.ILI~~R~TU~N_. ADDRESS ~ ~~.IJ\J._I2Ell.lphJn S!'"~~~._~()IEJ....!:e.rl.l1syII,'Cll1iEJ_2?Q~~ SIGNAT F PREPA~ER OJlil~AN REPRESENTATIVE '"'t'. W' ,/r.rt.fL, DATE ._9'~_.DS RESS 281~_~Qrth.Secol1~'-~tr49_e!..J-iCl~~_bu~g.J'el'l..n~~I.vcmiCl.1. 71J 0__ DATE 0"11" 1. 10 ";) 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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stili 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)(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. REV-1509 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF McConnell, John W. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER SURVIVING JOINT TENANT(S) NAME If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. RELATIONSHIP TO DECEDENT A. Brenda Hess B. C. JOINTLY.OWNED PROPERTY: ADDRESS 244 W. Dauphin Street Enola, Pennsylvania 17025 Daughter LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1'\"10 M&T Bank. checking account #58692356 1,126.20 563.10 1/2 TOTAL (Also enter on line 6, Recapitulation) $ 563.10 (If more space is needed, insert additional sheets of the same size) ~ REV-1737-? EX + (9-00) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS Use Schedule I. Part 2. ONLY for proportionate method of tax computation. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF FILE NUMBER McConnell, John W. Part 1 must include mortgage liabilities, liens and taxes against the Pennsylvania realty that were due and owing as of the date of decedent's death. Complete Part 2 ONLY when the proportionate method of tax computation is elected. PART 1 - OBLIGATIONS AGAINST PENNSYLVANIA REALTY ITEM NUMBER 1. DESCRIPTION AMOUNT PART 2 - ALL OTHER DEBTS OF THE DECEDENT TOTAL PART I 0.00 ITEM NUMBER DESCRIPTION AMOUNT 1. MidPenn Urology Inc. . medical expense 650.00 2. Stonebridge Health & Rehab Center - medical expense 3,634.50 3. West Shore EMS - Perry County. ambulance charge 522.54 4. Perry Physicians - medical expense 34.03 5. Quantum Imaging & Therapeutic 1,126.20 TOTAL PART 2 5,967.27 5,967.27 TOTAL (Also enter on line 10. Recapitulation) (If more space is needed. insert additional sheets of the same size)