HomeMy WebLinkAbout12-01-05
REV-1500 EX (6-00) Rev-1500 OFFICIAL USE ONLY
FILE THIS RETURN WITH:
COMMONWEALTH OF . ..................... ... ...............
'* FILE NUMBER
PENNSYLVANIA INHERITANCE TAX RETURN
DEPARTMENT OF REVENUE 21 05 0431
-
DEPT. 280601 RESIDENT DECEDENT COUNTY CODE YEAR NUMBER
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
I- GRAHAM, Mary S. 181-32-4013
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W DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
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W March 8, 2005 February 25, 1909 REGISTER OF WILLS
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W
C (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
N/A
w X 1. Original Return 2. Supplemental Return []~. Remainder Return ,,,,,,..'deolhpn""";>""'"
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:.::~1Il 4. Limited Estate 4a. Future Interest Comprise (dale of dealh after 12-12-82) 5. Federal Estate Tax Return Required
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rO-, X 6. Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a Living Trust (Attach a copy of TNSI) 8. Total Number of Safe Deposit Boxes
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n. >-- --- 10 Spousal Poverty Credit (dale of dealh between 12-31-91 and 1-1-95) D 11, Election to tax under Sec. 9113(A)
<( 9. Litigation Proceeds Received
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I- THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTIiP TO:
z COMPLETE MAILING ADDRESS
w NAME
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z William E. Miller, Jr., Esquire 1822 Market Street
0 FIRM NAME (If Applicable) Camp Hill, PA 17011
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w Miller & Associates, PC
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II:: TELEPHONE NUMBER
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U 7171737-9210 , ~
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1. Real Estate (Schedule A) (1) $0.00 OFFICIA\tJJSE ONLY")
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2. Stocks and Bonds (Schedule B) (2) $10,365.73 , ~:~
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3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) $0.00 ~ '. J
4. Mortgages & Notes Receivable (Schedule D) $0.00 :-q;-~ ; ..
(4) I " -,-.
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Z 5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5) $144,012.49 -- i T1
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I- 6. Jointly Owned Property (Schedule F) (6) $0.00 (...J
<X: D Separate Billing Requested
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I- 7. Inter-Vivos Transfers & Misc. Non-Probate Property (7) $0.00
....... - - - - - -..................... ~. -. -........-
a.. (Schedule G or L)
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U 8. Total Gross Assets (total Lines 1-7) (8) $154,378.22
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a::: 9. Funeral Expenses & Administrative Costs (Schedule H) (9) $22,773.96
10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (10) $0.00
11. Total Deductions (total Lines 9 & 10) (11) $77 773 96
12. Net Value of Estate (Line 8 minus Line 11) (12) $131,604.26
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) $000
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $131,604.26
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
W 15. Amount of line 14 taxable at the spousal tax
O::z rate, or transfers under Sec. 9116 (a)(1.2) x (15) $0.00
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:J:_ 16. Amount of line 14 taxable at lineal rate $131,604.26 4.5% (16) $5,9t2.19
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W:J 17. Amount of line 14 taxable at sibling rate x .12 (17) $0.00
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:J:O 18. Amount of line 14 taxable at collateral rate x .15 (18) $000
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<eX 19. Tax Due
~~ (19) $5,922.19
<e 20.D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS 222 Messiah Circle
CITY I STATE IZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
$5,922.19
Total Credits (A + B + C) (2)
$000
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4.
Total Interest/Penalty (D + E) (3)
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)
$0.00
5.
$5,922.19
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(5A)
(5B)
A. Enter the interest on the tax due.
$5,922.19
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS
1.
Did decedent make a transfer and:
a. retain the use or income of the property transferred;
b. retain the right to designate who shall use the property transferred or its income;
c. retain a revisionary interest; or
d. receive the promise for life of either payments, benefits or care?
If death occurred after December 12, 1982, did decedent transfer property within on year of death
without receiving adequate consideration?
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?
Yes
No
2.
~
B
;
EB
3.
4.
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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.
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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 the information of which pre parer has any knowledge.
DATE
'}( ? '1 lVov' 1.00 -
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ADDRESS
318 VIA CHICA COURT, SOLONA BEACH, CA 92075
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
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ADDRESS
MILLER & ASSOCIATES, PC, 1822 MARK
DATE
3 0 r00 v<UY\ ~ d-ooS'"
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. !l9~J6
(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. !l9116 (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 survlv,ing
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. !l9116(a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use ofthe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. !l9116(1.2) [72 P.S. !l9116(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. !l9116(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-1503EX + (6-98)
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Mary S. Graham
FILE NUMBER
21-05-0431
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
$10,355.57
$10.16
GNMA Fund Inv - Account No. 09889271158
Accrued Dividends
TOTAL (Also enter on line 2, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$10,365.73
REV.1508 EX + (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary S. Graham
FILE NUMBER
21-05-0431
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.
DESCRIPTION
PNC Bank Checking Account No. 5140024218
Accrued Interest
VALUE AT DATE
OF DEATH
$33,479.55
$0.92
2.
PNC Bank Savings Account No. 5130104804
$2.68
3.
PNC Bank Certificate of Deposit Account No. 31800170504
Accured Interest
$110,496.81
$32.53
TOTAL (Also enter on line 5, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$144,012.49
REV-1511 EX + (12-99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Mary S. Graham
FILE NUMBER
21-05-0431
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Myers-Harner Funeral Home, Inc. $8,860.00
B. ADMINISTRA TIVE 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. Attorney Fees $3,750.00
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. Messiah Village - Invoice received after death of decedent for nursing home care $7,381.86
8. James O. Bower Insurance, Inc. - Fiduciary Bond for out-of-state executor $950.00
9. Probate Fees to Cumberland County Register of Wills $325.00
10. Death Certificates $25.00
11. Newspaper notices $172.10
12. Estate administration expenses - photocopies, filing fees, etc. $35.00
13. Reimburse travel and administrative expenses to Executor $1,275.00
TOTAL (Also enter on line 9, Recapitulation) $22,773.96
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9-00))
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SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Mary S. Graham
FILE NUMBER
21-05-0431
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. Henry A Graham, Jr. Son 100%
318 Via Chica Court
Solana Beach, CA 92075
;
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 TAXIS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
,
TOTAL OF PART II. ENTER TOTAL NON.TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $0.00
(If more space is needed, insert additional sheets of the same size)
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