HomeMy WebLinkAbout09-09-05
REV-1500 EX of- (0 10)
'*
COMMONWEALTII OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
,
(y 'I~FFr~;;L USE ONLY
FILE NUMBER
2 1 -0 5 0 4 8 4
cOuNh'CoiiE -VEAR- - - NuMBER- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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Volland Roxanne
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
05/08/2005 OS/29/1955
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1 9 1 - 4 6 - 4 7 9 8
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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00 1. OJi.Jinal Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy 01 Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date 01 death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy 01 Trust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
D 3. Remainder Return (date 01 death prioflD 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
John M. Eakin Market Square Building
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
717 766-3172
Mechanicsburg, PA 17055
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnernhip or Sole-Proplietorship
(1)
(2)
(3)
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4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
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)
698.07
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6,804.86
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14. Net Value Subject to 'Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at UIe spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount 01 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
X _(15)
X _(16)
X .12 (17)
X .15 (18)
(19)
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(8)
7,502.93
6.670.50
1,949.31
(11)
(12)
(13)
8,619.81
-1,116.88
(14)
-1,116.88
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
I STREET AOORESS
CITY
I STATE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
I ZIP
Total Credits (A + 8 + C) (2)
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
(3)
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 (4)
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)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
5.
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
No
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; ........................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ........................................ D
c. retain a reversionary interest; or ...................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ............................................................. D
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? ....................................................................................................... D
D
D
D
D
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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.
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.
SIGN TU E OF PE S N RE NSI FOR FILING RETURN 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 spouse is 3%
[72 P.S. ~9116 (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. ~9116 (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 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. ~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. ~9116(1.2) [72 P.S. ~9116(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. ~9116(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.
R",-'"'' EX' "-.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Volland. Roxanne
FILE NUMBER
21
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
05
0484
DESCRIPTION
ITEM
NUMBER
1.
176.3229076 Shares Rite Aid @ 3.96
VALUE AT DATE
OF DEATH
698.07
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
698.07
~EV-1508 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Volland. Roxanne
FILE NUMBER
21 05
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.
0484
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
4,958.45
Rite Aid - Three pay checks
2.
Progressive Insurance, Auto Insurance Refund
42.98
3.
Rite Aid Employees Credit Union
622.40
4.
PNC Account - Checking 50-0201-9971
1,043.60
5.
PNC Account - Savings 50-0456-4402
40.00
6.
BookSpan - Refund
4.00
7.
PP&L - electric refund
17.74
8.
PP&L - electric refund
31.36
9.
Trustmark Insurance refund
44.33
TOTAL (Also enter on line 5, Recapitulation) $
(II more space is needed, insert additional sheets of the same size)
6 804.86
Total Banking StatCll11~nt
"NC Balik
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For tho "oriod 04/13/2005 to 05/11/2005
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ROXANNE VOLLAND
105 E ALLEN ST APT 306
MECIfANICSBURG PA 17055-3395
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Relationsllil) Overview
Bank DelJosit Accounts
Description
Rq~\II;lI Clwd:.il1g
S;lvil1g~
)'..tal Jkl'o.c;il."
Account Number
r,O-O';!fI1-'./!17I
r,o-o I:1li-I.102
orklJlaee ellseldng WOl'k Place Bonking
eglllar elleeldng Aeeollnt SIIIII...OI'Y
ccounlnull1ber: 50-0201-9971
alance Summary
Se<linnlnl]
bnl,mce
I!HiO
Deposit, and
other addition 5
1.727.:1!I
Checks and other
deductions
:l,7m.:w
Average monthly
balance
1.I!H.Oll
l"a!l~3ction SIUUnmrv
Chech pnlrll
wllhdrawals
Check Card ras
signed transactions
Chpdo: Card/Snnh;ard
pas PIN transactions
7
Tot", ATM
tr"ns"cllons
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PNC S"nk
ATM Ir"ns"cllons
Olher S"nk
ATM Irans"ctlons
17
12
elivity Detail
eposits and Other Additions
"Ie Amounl Description
1.1/ 1 J 30.02 \lil ell lkp"'il - 1';lY'"11 Rill' ,\id COli" 'I;!
'V l!i (j3!'dIO Reverse Cltel. k
ElIntiV!' ot-II-Wi
It" If,
!1.2!', R..v.., 'l' t :hnk
l~lI('(tiH' 01-1.1-0:,
1.1 '1:,
)1/2!1
1.1/27
1,:,00.00
1 !II. II.
ROI..I.:I
Deposil R..lcll'I1IT No. 021.:,:12!'.!I!1
Ikposil Rd..lllltT No. 0277:nliol.
l)ill'" Ikp",il - l':1noll Rife Aid CO'l"":1
eposits and Other Additions continued on next pag~
Ch"rges
and fees
t.i!1.!i0
II
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Primary account number: 50-0201-9971
Page 10f3
NUll1ber of enclosures: 0
tJ For 24-hour banking, customer service and
~ transaction or interest rate information,
'D' sign-on to Account Link <!\l by Web on
pncbank,colll or call 1-888-PNC-WORK
Para servicio en espatTol, 1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-WORK
(2!;1 Write to: Customer Service
PO Box 609
Pillsburgh PA 15230-9738
e Vi~i' "" I'll pnr.hl'll1k r:OIn
~
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TOO terminal: 1-800-531-1648
For h('~r ill~ imp:lirrrt (liell'." only
-
Deposil B"',,nce
Roxanne Volland
Please see the Activity Detail section for
additional information,
There were 9 Deposits and Other Additions
totaling $4.727.39.
FORM953R-0104
'3EV-1S11 fox + (12"99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Volland. Roxanne
FILE NUMBER
21
05
0484
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers Funeral Home, Inc. 3,605.00
2. Gingrich Memorials, marker 2,470.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
SlreetAddress
City State Zip
Year(s) Commission Paid:
2. Attomey Fees John M. Eakin 400.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
SlreetAddress
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Letters Testamentary 126.00
5. Accountanfs Fees
6. Tax Retum Preparer's Fees
7. Silver Spring Ambulance 49.50
8. PNC - Check charge 10.00
9. Filing Fee 10.00
TOTAL (Also enter on line 9, Recapitulation) $ 6 670.50
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Volland. Roxanne
FilE NUMBER
21
05
0484
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Pinnacle Health - medical
VALUE AT DATE
OF DEATH
27.70
2. PP&L - electric
3. MCI - telephone
4. WSO Imaging Center - medical
5. Nephrology Associates - medical
6. Conner Rich Associates - medical
7. Heritage Cardiologists - medical
8. J.C. Penny - Book account
9. Holy Spirit Hospital
10 Quest Diagnostics - medical
11 Verizon - telephone
117.93
55.13
68.64
25.00
42.40
73.60
162.68
781.00
3.00
592.23
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 949.31