HomeMy WebLinkAbout11-28-05
REV-1500 EX. (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICiAl USE ONLY
FILE NUMBER
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COUNTY CODE YEAR NUMBER
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DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
ROSENBERRY, VIOLET A
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 75- 0 3 - 2 0 2 6
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
08/19/2005 06/12/1916
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
[Xl 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
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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
SOCIAL SECURITY NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (AttachcopyofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Retum (date of death prior to 12-13-82)
o 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)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Jered L. Hock Es uire 3211 North Front Street
FIRM NAME (If Applicable)
Metz er Wickersham Knauss & Erb, P.C. PO Box 5300
TELEPHONE NUMBER
717 238-8187 Harrisbur PA 17110-0300
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
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 Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
OFF~I~l USE ONLY
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48,551.33
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(8)
48,551.33
9,245.21
4,931.35
(11)
(12)
(13)
14,176.56
34,374.77
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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(14)
34,374.77
0.00 X _(15) 0.00
34,374.77 X .045 (16) 1 ,546.86
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 1 ,546.86
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SlOE AND RECHECK MATH < <:
Decedent's Complete Address:
STREET ADDRESS 6535 Roxburv Road
CITY I STATE I ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. T ax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
1,546.86
1.469.52
77.34
Total Credits (A + 8 + C)
(2)
1,546.86
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)
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
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; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 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.
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3211 North Front Street, PO Box 5300
Harrisburg
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PA 17110-0300
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. 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. ~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-1509 EX + (6-98)
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SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROSENBERRY. VIOLET A
FILE NUMBER
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
ADDRESS
RELATIONSHIP TO DECEDENT
A. H. Louise Rosenberry
6537 Roxbury Road
Shippensburg, PA 17257
(widow of son of decedent)
Daughter-in-law
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JOINTL Y.OWNED PROPERTY:
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 DE CD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HElD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 102599 Orrstown Bank, Checking Account #109000789 95,678.19 50. 47,839.10
Accrued Interest $11.79
2. A 11 0499 Orrstown Bank, Savings Account #36530 1,424.46 50. 712.23
Accrued Interest $0.68
NOTE: There were no probate assets. Decedent lived
among relatives who cared for her and had no furniture
or cash on hand.
TOTAL (Also enter on line 6, Recapitulation) $ 48.551.33
(If more space is needed, insert additional sheets of the same size)
REV-'," EX>".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ROSENBERRY. VIOLET A
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
H. Louise Rosenberry - reimbursement for funeral luncheon
250.00
2.
Eby Granite Works - head stone
6,753.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
B.
City
State
Zip
Year(s) Commission Paid:
2.
3.
AllomeyFees Metzger, Wickersham, Knauss & Erb, P.C.
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
(estimated)
2,000.00
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
5.
Accountant's Fees
6.
TaxRetumPreparer'sFees Metzger, Wickersham, Knauss & Erb, P.C.
(estimated)
165.00
7.
Metzger Wickersham - reimbursement for postage and photocopy
2.21
8.
Reserve for closing
50.00
9.
Metzger Wickersham - reserve for reimbursement of photocopy, postage, fax, etc.
25.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
9245.21
'REV-15"12 EX + (6-98)
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SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROSENBERRY. VIOLET A
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Barbara Wiser, Tax Collector - deb of decedent
VALUE AT DATE
OF DEATH
14.62
2. Rickey and Doreen Rosenberry - care of decedent while decedent was ill and unable to
care of herself and needed intense care
550.00
3. Bryan Rosenberry - care of decedent while decedent was ill and unable to care for herself
and needed intense care
3,000.00
4. Pleasant Hall Fire Company - ambulance debt of decedent
974.00
5. West Shore ALS - debt of decedent
181.60
6. Chambers burg Hospital - debt of decedent
143.19
7. Imaging Association - debt of decedent
8.63
8. American Home Patient - debt of decedent
28.09
9. Chambersburg Cardiology - debt of decedent
1.77
10. Chambersburg Imaging - debt of decedent
1.84
11 . Pulmonary Association - debt of decedent
27.61
TOTAL (Also enteron line 10, Recapitulation) $
(II more space is needed, insert additional sheets of the same size)
4931.35
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FilE NUMBER
ROSENE: ERRY VIOLET A
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
1. H. Louise Rosenberry (widow of son of decedent) Lineal 34,374.77
6537 Roxbury Road; Shippensburg, PA 17257
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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