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Home My WebLink About12-30-05 REV .1m ex... ~6-00\ .. OFFICIAL USE ONLY '* COMMONWEAlTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 __ _ ____.HABf.lJSBURG.I'A.17.J2&OllOL.___ DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Bowers, ZelIa K. -OATEOFDEATH (MM-"DD-VEAFi)----- i DATE OF BIRTH (MM-OD-YEAR) ! 11/14/1920 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT i FILE NUMBER 21 05 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 00607 NUMBER 06/23/2005 188-12-3339 --r- THIS RETURN MUST BE FlUED IN DUPUCATE Wrrl1 THE REGISTER OF WILLS sOciAL SECURITY NUMBeR ffi Q W o W Q o 3. Remainder Retum (date rI death prior to 12-18-82) -D- .-----------..------ ~ 1. Original Retum IQI 2. Supplementa' Return w lll: i ~ 0 4. Umited Estate 0 4a. Future Interest Compromise (date of death aller o A. 0 12-12-82) ~ ~ 9 . 0 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust(Attach o t III 01 WIll) copy rI Trust) < 0 9. UtlgationProceedsReceived 0 10. Spousal Poverty Credit (date oIdaalh betWeen 0 11.8ectlontotaxunderSec.9113(A)(AllachSchO) --- Dale F Shughart, Jr. Esquire ;~t~":'~~( .1~ ._':-~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( lAST, FIRST AND MIDDLE INITIAL) o 5. Federal Estate Tax Return Required 8. Total Number of Safe 'Deposit Boxes .... I~ lrz 8f FIRM NAME (If applicable) 35 E. High Street, Suite 203 Carlisle, P A 17013 (1) None (2) 2,722.44 (3) None (4) None (5) None (6) None (7) None TELEPHONE NUMBER 717/241-4311 z 5 ::l t: A. ~ W lr 1. Real Es1ate (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) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 274.00 (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 Govemmen1a1 BequestslSec 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) OFFICIAL ~ ONt y c.i1 I~ ~1 (J~ <:::) ~ =1: 6 . . -, ,----) -= --~ - C) (-~l (Jl o (8) 2,722.44 (11 ) (12) (13) 274.00 2,448.44 (14) 2,448.44 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES 15. Amount of Line 141axable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) x .00 ~ ~ ... ::l II. :IE 8 S (15) 16. Amount of Line 14 taxable at lineal rate 2,448.44 x .045 (16) 17. Amount of Line 14 taxable at sibling rate 110.18 x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) (19) 110.18 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Form REV-1500 EX (Rev. 6-00) Copyright 2000 form software only The Lackner Group. Inc. o s- PI,Ot (pD.oo pa.Jd 3 Q d.AY ~ - - 3 C5Je (iliff) t? e~ Decedent's Complete Address: STREET ADDRESS Chapel Pointe of Carlisle 770 South Hanover Street f------ CITY Carlisle i STATE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty (0 + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS. AGENT -,---------~- ----- I ZIP 17013 (1 ) 110.18 (2) 0.00 (3) 0.00 (4) (5) 110.18 (SA) (58) 110.18 PLEASE ANSWER THE FOLLOWING QUESllONS BY PLACING AN "X" IN THE APPROPRIATE BLOCl<S 1. Did decedent make a transfer and: Yes No 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 reversionary interest; or..............................................................-................................................ d. receive the promise for life of either payments, benefits or care? ............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..... ....... ..... .................. ..................... ...... ............ .............. ............... ...... .......... 0 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..................................................................................................................... 0 0 IF THE ANSWER TO ANY OF THE ABOVE QUESllONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART'OF THE RETURN. under penalties ol peljury, I declare thatl have examined this retum, Including accompanying schedules and statements, and to the beSt ol my knowledge and belief, h is true, corrett and complete. Declaration ol Jl'lI~ other than the personal representative is besed on all intonnatlon ol which preperer has any knOwledge. _ __ SIGNATURE OF PERSON RESPONSIBLE FOR RUNG RETURN ADDRESS DATE ~J. B. Ammerman 408 Burspers Road ~~SPONSIBLEFOFlRUNG'~ETURN ADDRESS Carlisle, A 17013 DATE ADDRESS 35 E. High Street, Suite 203 Carlisle, PA 17013 DATE /lf~d'IJ5 For dates of death on or after Ju . 4 and before January 1, 1995, the tax rate Imposed on the net value of transfers to or for the u$e of the surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% (72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% (72 P .S. ~9116 (a) (1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries ;s 4.5%, except as noted in 72 P .S. ~9116 1.2) (72 P.S. ~9116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. ~9116 (a) (1.3)]. A sibling i$ defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. *' SCHEDULE B STOCKS & BONDS COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETIJRN RESIDENT DECEDENT ESTATE OF Bowers, Zella K. FILE NUMBER 21 - 05 - 00607 All property jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER I UNIT VALUE 64.82 DESCRIPTION 42 shares, common stock, Prudential Financial @ 64.82 per share TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE OF DEATH 2,722.44 2,722.44 '. SCHEDUlEH fUERAL EXPENSES & ADl\.WSmAllVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCe TAX RETURN RESIDENT DeCEDENT ESTATE OF Bowers, ZelIa K. FILE NUMBER 21-05-00607 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Karen J. B. Ammerman Social Security Number(s) / EIN Number of Personal Aepresentative(s): 206-36-2453 Street Address 408 Burgners Road City Carlisle Year(s) Commission paid 2006 125.00 State P A Zip 17013 2. Attorney's Fees Dale F. Shughart, Jr., Esquire 125.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs I Register of Wills, one Short Certificate 4.00 2 Postmaster, certified mail 5.00 Total of Continuation Schedule(s) 15.00 274.00 TOTAL (Also enter on line 9, Recapitulation) .. .* Schec:Ue H F\.I1eI3 Expens es & Adl i isbaiveCosls COI"IIi'ud COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bowers, Zella K. 3 Register of Wills, filing Supplemental Retum FILE NUMBER 21 - 05 - 00607 15.00 Page 2 of Schedule H