HomeMy WebLinkAbout09-19-05
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REV.1500 EX (~OO)
OFFICIAL USE ONLY
COMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COUNTY CODE
....Q~ 00793~ _ _
YEAR NUMIJER
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DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL)
Johnson III Albert
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
2/28/2005 8/6/1938
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
Ma Louise Johnson
[X] 1. Original Retum
D 4. Limited Estate
[X] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
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SOCIAL SECURITY NUMBER
189-30-3840
THIS RETURN MUST BE FILED IN DUPLICATE WI H THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
!'-It) _10_ 4~1.3
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D 2. Supplemental Retum D 3. Remainder Retum (date of death prior 012.13-82)
D 4a. Future Interest Compromise (date of death after 12.12.82) D 5. Federal Estate Tax Return Required
D 7. Decedent Maintained a Living Trust (Attach copy oITrust) _ 8. Total Number of Safe Deposit Boxes
D 10. Spousal Poverty Credit (date ot death between 12.31-91 aod 1-1-95) 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
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Vick Ann Trimmer
FIRM NAME (If Applicable)
Mette, Evans & Woodside
TELEPHONE NUMBER
3401 N Front Street
Box 5950
717-232-5000
Harrisburg, PA 17110-0950
2. Stocks and Bonds (Schedule B)
(2)
42,740
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QFl'1c1AL USE ONLY
1. Real Estate (Schedule A)
(1)
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6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
(6)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
(4)
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(5)
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740
8. Total Gross Assets (total Lines 1-7)
(8)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Sdhedule I) (10)
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9. Funeral Expenses & Administrative Costs (Schedule H) (9)
(13)
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740
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11. Total Deductions (total Lines 9 & 10)
(11)
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)
(12)
14. Net Value Subjectto Tax (Line 12 minus Line 13)
(14)
740
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
Z rate, or transfers under Sec. 9116 (a)(1.2)
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~ 16. Amount of Line 14 taxable at lineal rate
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~ 17. Amount of Line 14 taxable at sibling rate
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() 18. Amount of Line 14 taxable at collateral rate
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~ 19. Tax Due
42,740
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X.O ~(16)
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x .12 (17)
(19)
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x .15 (18)
20.
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W46451.000
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Decedent's Com Jete Address:
S1RE6T ADDRESS
155 N 25th Street
Cumberland
CI1Y
Cam Hill
STATE
PA
ZIP
17011....
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
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Total Credits (A + B + C) (2)
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3. Interest/Penalty if applicable
D. Interest
E. Penalty
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Total Interest/Penalty (0 + E) (3)
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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)
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5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
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A. Enter the interest on the tax due. (5A)
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B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check to: REGISTER OF
(5B)
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AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;. . . . . . . . . . . . . . . D []I
b. retain the right to designate who shall use the property transferred or its income; . D []I
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . D [1a
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . D [1a
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 [Jg
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RE URN.
Under penalties of perjury, 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 com lete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR F: IN
Mary Louise Johnson
ADDRESS
155 N 25th Street
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Vick Ann Trimmer
ADDRESS
DATE
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Hill, PA 17011
Harrisburg, PA 17110-0950
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 300
[72 P,S'13 9916 (a) (1.1) (i)]. :
For dates of death on or after January 1, 1995, the tax rate imposed on the net VAil,.. nft'M-'---" - ving spouse is 0% [72 P.S. 99116 (a) (1.:1) (ii)]
The statute does not exempt a transfer to a surviving spouse from tax, an. :s and filing a tax return are still applicable tven if
the surviving spouse is the only beneficiary. I
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The tax rate imposed on the net value of transfers to or for the use of the de
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lr the use of a natural parent, an adoptive parent,
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ed in 72 P,S'139116(1.2) [72 P.S. 1391116(a)(1)].
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A sibling is defined, under Section 9102.1 as an
For dates of death on or after July 1,2000:
The tax rate imposed on the net value of transfers from a deceased child t
or a stepparent of the child is 0% [72 P.S. 139116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the dec
individual who has at least one parent in common with the decedent. wheth,
3W4646 1.000
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Ri"V-1502 EJt. (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Albert W Johnson
21 05 00793
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at lMlich property woul~ be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F
ITEM DESCRIPTION
NUMBER
1. Parcel No.
42+,386.0-01580.00-000+
Undivided 1/2 tenant in common
interest in real property
locatd in Nippenose Twp,
Lycoming County, PA
VALUE AT DAl E
OF DEATH
~2,740
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3W4695 1.000
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
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142,740
REV-15131;X+ (9-00)
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SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Albert W Johnson
NUMBER
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NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
Mary Loiuse Johnson
122 N 25th Street
Camp Hill, PA 17011
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100% Residue: 42,740
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RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21 05 00793
AMOUNT OR SHARE
OF ESTA-nE
Surviving Spouse
~2,740
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVE R SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
3W46AI 1.000
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)
$
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