The URL can be used to link to this page

Home My WebLink About11-09-05 REV-1500 EX. (6-00) .. I- Z W C W () W C COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Sollenber er Mabel DATE OF DEATH (MM-DD-Year) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER ~\-~S ~.~~~ COuNrvCOiiE -VEAR- - - Nu'MiiER- SOCIAL SECURITY NUMBER K 1 99- 3 4 - 8 9 8 6 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS DATE OF BIRTH (MM-DD-Year) 07/21/2005 05/16/1911 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) W l- ll:: :$ (/) ull::ll:: w~u :I:ll::g U ll.lD ll. <( [2S] 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received SOCIAL SECURITY NUMBER D 2. Supplemental Return D 4a. Future Interest Compromise (dale 01 death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy olTrust) D 10. Spousal Poverty Credit (dale 01 death between 12-31-91 and 1-1-95) D 3. Remainder Return (date 01 death prior to 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 COMPl.ETEO. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS H. Anthon Adams 49 W. Orange Street FIRM NAME (If Applicable) I- Z W o z o ll. (/) W ll:: ll:: o U z o ~ <C ...J ::::l !::: D.. <C () w ~ z o ~ I- ::::l D.. :E o () ~ I- TELEPHONE NUMBER 717-532-3270 Suite 3 Shi PA 17257 OFFICIAL USE ONLY (1) (2) (3) (4) (5) 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) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6, Jointly Owned Property (Schedule F) (6) D Separate Billing Requested '_,_,"1 , , ,.a 7,345.26 '~"rJ 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 Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 2,199.19 r',,) c> c..T"I (8) 9,544.45 10,356.78 (11) (12) (13) 10,356.78 -812.33 14. Net Value Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 0.00 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 0.00 X _(15) 0.00 0.00 X _(16) 0.00 0.00 X .12 (17) 0.00 0.00 X ,15 (18) 0.00 (19) 0.00 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .Decedent's Complete Address: STREET ADDRESS 17223 Cumberland Hi hwa CITY Newburg STATE PA ZIP 17240 ~ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 0.00 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. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 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 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ D 00 c. retain a reversionary interest; or ...................................................................................................... D 00 d. receive the promise for life of either payments, benefits or care? ............................................................. D 00 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?....... ...... ...................... ......................................... .................. D 00 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... D 00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. \}J For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net va ue 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 PS. ~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. REV-150ft EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Sollenberger FILE NUMBER Mabel K 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. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 7,345.26 Van Camp Account C/O Orrstown Bank TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7,345.26 REV-150!! EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Sollenberger Mabel K If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Eleanor Kelso B c JOINTL V-OWNED PROPERTY: SCHEDULE F JOINTLY-OWNED PROPERTY ADDRESS 17223 Cumberland Highway Newburg, PA 17240 FILE NUMBER RELATIONSHIP TO DECEDENT daughter 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 DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1999 Orrstown Bank 683.72 50. 341 .86 Checking Account #103000673 2. A. 1999 Orrstown Bank 3,714.65 50. 1,857.33 Savings Account #163210175 TOTAL (Also enter on line 6, Recapitulation) $ 2,199.19 (If more space is needed. insert additional sheets of the same size) RfiV-151' EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Sollenberger FILE NUMBER Mabel K Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Fogelsanger - Bricker 6,577.00 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 Zip Year(s) Commission Paid: 2. Attomey Fees 150.00 3. Family Exemption: (If decedent's address is not the same as claimanfs, attach explanation) 3,500.00 Claimant Eleanor Kelso Street Address 17223 Cumberland Highway City Newburg State P A Zip 17240 Relationship of Claimant to Decedent daughter 4. Probate Fees 15.00 5. Accountant's Fees 6. Tax Return Prepare~s Fees 7. Newburg-Hopewell Ambulance Service 50.00 8. West Shore EMS 60.78 9. Chambersburg Hospital 4.00 TOTAL (Also enter on line 9, Recapitulation) $ 10,356.78 (If more space is needed, insert additional sheets of the same size) REV-1.513'EX + (g-~~ .' ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER Sollenberner Mabel K NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE 1. Eleanor Kelso 17223 Cumberland Highway Newburg, PA 17240 Lineal 100% 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 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)