HomeMy WebLinkAbout10-17-05 (2)
REV-150~~X (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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FILE NUMBER
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COUNTY CODE YEAR
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NUMBER
SOCIAL SECURITY NUMBER
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THIS RETURN MUST BE FILED IN DIiJPLlCATE WITH THE
REGISTER OF ILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date ofd~ath prior to 12-13-82)
o 5. Federal Estate Tax Return IReqUired
_ 8. Total Number of Safe Dep~sit Boxes
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o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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TMiS8eC'tIONMUsl,*. COM~ALL".NE~Cl5i'
NAME
COMPLETE MAILING ADDRESS
FIRM NAME Ilf Applicable)
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(8) 3,"~ go /:1. 3 0
(11)$ 7 870. c2.~
(12'::rj 9'f.~. (h3'
(13) -oj
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(14) ;L
19. Tax Du-e
x .15 (18) I
(19l1 J ~...)7. -3 f
~ 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Willi
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (cate of deafh alter 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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1. Real Estate (Schedule A)
2. Stocks and ~s (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
(1) - C)
(2) ':, 0, 1.:2..2.. 4~
(3) -- 0
(4) - C)
(5(J ~:1) '1 'J - fA! tfj g
(6) ~ ~) 9 / ~.. 90
4. Mortgages & Notes Receivable (Schedule D)
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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)
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(9) 1) I3L70.. .,j. 7
(10) 0
(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/Sec 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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
x.O _ (15)
16. Amount of Line 14 taxable at lineal rate
x.O _ (16)
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
18. Amount of Line 14 taxable at collateral rate
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.
Decedent's Complete Address:
STREET ADDRESS
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
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(1)1 1/ ;L.j-7.3 9
Total Credits (A + B + C )
(2)
Ii (p:/.." f 1
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) If ) / '1'1 ' s ~
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A. Enter the interest on the tax due. (5A) 0
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~/ J q'f. ..j' ~
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Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes N
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
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 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 complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
DATE
/0
ADDRESS
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. 99116 (a) (1.1) (i)l.
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 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.
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REV-1503 Ex + (1-97\
ESTATE OF
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SCHEDULE B
STOCKS & BONDS
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I~ (2,/ f"' II VV I '-~ e. r
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
I
I VALUE AT DATE
. OF DEATH
DESCRIPTION
-10-=-6- e~~ 0~
# 10.1 000
(/ )
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0-: tP sr:/~
~e qo -00
rpd. lbf) u1)
p.....p t:> .30.00
-.J- ~ \1\ cS\
TOTAL (Also enter on line 2, Recapitulation) $ / () /~. .If ~
(If more space is needed, insert additional sheets of the same size)
REV-,5Oll EX + ('-97) ,
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
H e..[ e..n
.
IYf . WI. ""le..r
DESCRIPTION
~a.3h
c"he..~j~1 Y\j A C.COUh t
~ o..Vln~.s AG(.our\.t
t. D. (Leo Ie elt S~hcd.u..' e.. E)
Men e. Y IV( ar k,.,f A t
...... c..c.. C l{ Yl
Pre - pa', d {-un e..ra I
lOrrs.toWI1]jQnk.. 'Burlltl Fl.l<ld)
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
V~LUE AT DATE
OF DEATH
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S.~if9. 07
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s; ,qto. K ()
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$~ 77t,.9B
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
j-{ e./ ~n
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule Go
SURVIVING JOINT TENANT(S) NAME
A.
H. Lo U."-5 eKC0e.nbe..r y
B.
c.
JOINTLY-OWNED PROPERTY:
SCHEDULE F
JOINTLY-OWNED PROPERTY
IVI. W I ~ <se.. r
ADDRESS
~s 37 'R-eX bu ry
8 h 0, P re...n s bLlr'j )
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FILE NUMBER
RELATIONSHIP TO DECEDENT
Rd.
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17 J...S 7
'D b. tlj hr e..f
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
~ I 11
1. A. ~ - y...'} l o r r.stow n 'Ba n k. S;l~ 8D So "/01 c1,) 1/:2 . 9 0
C.,D. I
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TOTAL (Also enter on line 6, Recapitulation) $ Cl.t) q I ~. iO
(If more space is needed, insert additional sheets of the same size)
REV-1511 t;;X+ (12-99) -
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
H e.. ( t 1'\
1\1.
WI."') e...r
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FOje..lsQY\je..r -'1>r;c..keX' Funeral
5'~arf?) Allie Etu..~~rfIe..n+
FUNERAL EXPENSES: Tc
Funcral Home
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c:. as k c t
'R. u..c. r 'r a e., I c.-
w~ r;Y"\j P. ppare.1 .
Men~ rn C;lt Enjravlnj
C ~ l:!..il \ ".'\ (1. ro. v e...
N e\i\l S ra~(.r' . . .
~t~gy"" or3'tr\ I ~r Nonora.rl urn
c...~f; .f. ,e.J.. ~p' e.5
F I (!)w'e.r.s
ADMINISTRATIVE COSTS:
1.
B.
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
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 _ Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
FC(jd
o ;se...ounf- en .s erVL ceS
Jlcme. :rn
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A OUNT
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~) ~o. c 0
I 8,SC . (1'0
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,,; 100 ,0 0
~o.5-. 0 0
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:$0 0 . 0 c
)e 0 , .;; ~
't~(j .4"
: <tJo,co
( rd." lJ
'# '
. ;tUG 00
# T.
. 7) q 15. o:Lo
1 (pi. qs
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
I'lEV-1513 ~X+ (9-00)
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SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
W, ~e.c'I' WI'5 <:.r
1 0 ~- I\.ex bu.r-y Rs:J I) S hi ~p<:tl5h llrq 1>A
17e2S7 J}
Th e..odore.. S. W;sc-r
Jfc ~ 7 R...ox bu ry Rd.) Sh '~~Ol.sbLL'j ,VA Il:J.S7
o an ~ ce. IV{. 'ba e..r
I c1..? J.h, J...J.l 'jQ n Rd,) L.t r~ ~ n ~p A I 7.13 ~
~. LC>lU.s~ 'it~.se.1l b~ry
~S 37 1(0)(' hury Rd. )5hl ppe.n,sbl1rj;l'A 17.
iJ ~jf
FILE NUMBER
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
SOY!
Son
'Dau3 ht e-r
7 'DQUjhter
AMOUNT OR SHARE
OF ESTATE
o2.Sr r~
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;2.510
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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 11- 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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WILL OF HELEN M. WISER
KNOVl ALL MEN BY THESE PRESENrS That It Helen Ma. Wiser of Star Rout~ #3,
Shippensburg, Pennsylvania, being of sound mind, memory and understand~ng.
do make, publish and declare this as my last will and testament, hereby
revoking and making null and void any and all wills and testaments or .
writings in the nature thereof by me a~ any time heretofore made.
First. I direct that all my- just debts and funeral expenses be fa4ly paid
and satisfied as soon as conveniently..may__be after my decea se.
Second. All the rest, residue and remainder of my estate, real anq
personal, I give, devise and bequeath to my four children, namely: Cecil
W. Wiser, Theodore S. Wiser, Janice M. Baer and Louise H. Rosenberry, '
equally share and share alike.
Third. I nominate. constitute and appoint my two daught_~rs, Janic~ M.
Baer and Louise H. Rosenberry, execut.;ricies of this my last will and testament,
and direct that they shall not be required to file bond for the perfoz1nance of
their duties as such; and they shall have full1':'power and authority to ~ell and
convert into cash any or all of any real estate or personal property b~ing a
part of my estate at either public or private sale, and to ma~~, exec~e and
deliver to the purchaser or purchasers of any real estate being a part of my
estate good, lawful and sufficient deed or deeds therefore, the same ~s I
could do if living.
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IN WITNESS WHEREOF, I have hereunto set my hand and seal, this -;:4.tJ . (l'ay
of July, 1967.
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(SEAL)
Signed, sealed, published and declared by the testatrix above n~ed as
and for her last will and testament in our presence, who in her preserce, at
h~r request, and in the presence of each other, have h~reunto subscriped our
names as attesting witnesses. ,
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COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) ,.
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005900
BAER JANICE M
12926 LURGAN ROAD
LURGAN, PA 17232
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---------- --------
101 I $1,194i52
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ESTATE INFORMATION: SSN: 194-28-9070 I
FILE NUMBER: 2105-0724 I
DECEDENT NAME: WISER HELEN M I
DATE OF PAYMENT: 10/17/2005 I
POSTMARK DATE: 10/12/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 08/03/2005 I
,
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TOTAL AMOUNT PAID: $1,194;52
REMARKS:
-
CHECK#1598
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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