HomeMy WebLinkAbout12-30-05
.~
\V REV-1500 EX + (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I-
Z
W
C
W
()
W
C
w
!C(
~-tIl
U II::~
W D-U
xOO
U II::...J
D-lD
D-
oc(
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Frick Donald
DATE OF DEATH (MM-DD-Year)
E.
OFFICIAL USE ONLY
,~
FILE NUMBER 1 C
C~NTYC~DE - 0 YEAR5 - ~ lR- -
SOCIAL SECURITY NUMBER
2 1 8 - 2 4 - 9 8 9 8
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Retum (date of death prior to 12-13-82)
D 5. Federal Estate Tax Retum Required
Q... 8. Total Number of Safe Deposit Boxes
D 11, Election to tax under Sec. 9113(A) (Attach Sch 0)
DATE OF BIRTH (MM-DD-Year)
08/16/2005 08/19/1929
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[Xl 1. Original Retum
D 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrusl)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
PA 17257
OFFICIAL USE ONLY
216,445.96
72 ,481.49
351 ,210.83
j~ "'il
....
z
w
c
z
o
D-
tIl
W
II::
II::
o
U
COMPLETE MAILING ADDRESS
49 W. Orange Street
u
I
,_,___J
NAME
H. Anthon Adams
FIRM NAME (If Applicable)
Suite 3
(8)
640,138.28
TELEPHONE NUMBER
717-532-3270
Shi
12,757.32
(11)
(12)
(13)
12,757.32
627,380.96
(1)
(2)
(3)
(4)
(5)
z
o
!;i
~
:J
l-
ii:
<(
()
w
a:::
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
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
(14)
627,380.96
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
!;i
I-
:J
a.
:iE
o
()
~
I-
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
X _(15)
627,380.96 X .045 (16)
X .12 (17)
X .15 (18)
(19)
28,232.14
28,232.14
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
Decedent's Complete Address:
STREET ADDRESS
510 Ridqe Road
CITY I STATE I ZIP
Shippensburg, PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
28,232.14
26.500.00
1.325.00
Total Credits (A + B + C)
(2)
27,825.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
4.
Total Interest/Penalty ( D + E)
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
If Line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE.
(3)
A. Enter the interest on the tax due.
(4)
(5)
(5A)
B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
407.14
5.
407.14
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.
ADDRESS'
sf-
/;)5 "/
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value
[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)l.
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 retum 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 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 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-1507 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
Frick
FilE NUMBER
Donald
E.
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Mortgage Note from C&D Properties, LLC
dated November 16,2001
VALUE AT DATE
OF DEATH
119,446.69
2.
Mortgage Note from C&D Properties, LLC
dated December 12, 1996
96,999.27
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
216,445.96
REV-1508 EX + (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Frick Dona~
FILE NUMBER
E.
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
Citizens Bank checking account #060-000-0000-6203665731
VALUE AT DATE
OF DEATH
6,875.87
2.
2004 Toyota Corolla
12,250.00
3.
Security Benefit Annuity #7053003696
53,355.62
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
72,481.49
REV-1509 EX + (6-96)
'*
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Frick
FILE NUMBER
Donald
E.
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. Bruce I. Frick
510 Ridge Road
Shippensburg, PA 17257
son
B
c
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 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. 2002 T. Rowe Price Account #30A584116 33,392.87 50. 16,696.44
2. A. 1 0/04 T. Rowe Price Growth Fund Account #670705479-3 5,166.03 50. 2,583.02
3. A. 1 0/03 Citizens Bank Money Market Account #060-000-0000-620 418,976.57 50. 209,488.29
4. A. 3/12/03 Citizens Bank Certificate of Deposit 101,135.48 50. 50,567.74
#00006241049661
5. A. 3/12/03 Citizens Bank Certificate of Deposit 101,173.83 50. 50,586.92
#00006241049890
6. A. 12/02 Fidelity Service Bond Fund #12288688 42,576.84 50. 21,288.42
TOTAL (Also enter on line 6, Recapitulation) $ 351,210.83
..
(If more space is needed, Insert additional sheets of the same size)
REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Frick
Donald
E.
FILE NUMBER
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker Funeral Home 7,646.00
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. Attorney Fees H. Anthony Adams 1,200.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) 3,500.00
Claimant Bruce I. Frick
Street Address 510 Ridge Road
City Shippensburg State PA Zip 17257
Relationship of Claimant to Decedent son
4. Probate Fees 321.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. VA (last illness) 36.00
8. VA (last illness) 54.32
TOTAL (Also enter on line 9, Recapitulation) $ 12,757.32
(If more space is needed, insert addiltonal sheets of the same size)
'~~M~'"''
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Frick Donald
SCHEDULE J
BENEFICIARIES
FILE NUMBER
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Bruce I. Frick lineal 100%
510 Ridge 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 II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
..
E
(If more space is needed, insert additional sheets of the same size)
1- ·
. COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FRICK BRUCE I
510 RIDGE ROAD
SHIPPENSBURG, PA 17257
u_nn_ fold
ESTATE INFORMATION: SSN: 218-24-9898
FILE NUMBER: 2105-0779
DECEDENT NAME: FRICK DONALD E
DATE OF PAYMENT: 12/30/2005
POSTMARK DATE: 1 2/30/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 08/16/2005
REMARKS: B I FRICK
CHECK# 1242
SEAL
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 006164
AMOUNT
$407.14
$407.14
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS