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Home My WebLink About01-05-06 (2) . >> REV-1500 EX + (8-00) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 I- Z W C W o W C DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) Smith Winifred E. DATE OF DEATH (MM-DD- Year) DATE OF BIRTH (MM-DD-Year) 09/13/2005 10/18/1925 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) w ~ :ll: ~(#) (,) Go !II: wo(,) %ar::g (,)tlll 0( 001. Original Return D 4. Limited Estate 00 6. Decedent Died Testate (AlIach copy ofWdI) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (daleofdealh aller 12-12-82) D 7. Decedent Maintained a Living Trust (Allach copy of Trust) D 10. Spousal Poverty Credit (daI8ofdeathbetween 12-31-91 and 1-1-95) IOu11 OFFICiAl USE ONLY FILE NUMBER 2 1 -0 5 0 8 3 2 ""'OOUN'TYCl5iiE' - - - - NuMaER- - SOCIAL SECURITY NliJMBER 2 1 7 - 0 - 3 2 0 5 THIS RETURN II BE FILED IN DUPLICATE WITH THE RE~ISTER OF WILLS SOCIAL SECURITY N MBER D 3. Remain~er Return (da\eofdealhpriorllJ 12-13-82) D 5. FederallEstate Tax Return Required _ 8. Total N~mber of Safe Deposit Boxes D 11. Electi n to tax under See. 9113(A) (A\Iaoh Sch 0) ~ z W Q Z o Go (#) W ar:: ar:: o (,) THIS SECTION MUST' BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION $" ULD BEDIRECTEDTO= NAME COMPLETE MAILING ADDRESS William S. Dick 13 West Main Street FIRM NAME (If Applicable) Dick Stein & Schemel LLP Suite 210 TELEPHONE NUMBER 717 762-1160 Wa nesboro (1) (2) (3) (4) (5) z o j:: :5 ~ l- ii: cC o W B: 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) D 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) 10. Debts of Decedent Mortgage Liabilities. & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (6) (7) (9) (10) ". 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPUCABLE RATES z o j:: cC I- ~ ID.. :& o o >< cC I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See. 9116 (a)(1.2) 0.00 X _ (15) 220,930.37 X .045 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) 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 20. 0 CHECK HERE ,F YOU ARE REQUESTiNG A REFUND OF AN OVERPA yr,lE W > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK M TH < < 61.066.36 114,256.841 58,000.00 (8) 11 ,930.32 462.51 (11) (12) (13) (14) ONLY I c.r; :? {---,~ ,'fr t\,) , ... I ,", ~..') f".,) 1'-'"" .... 233,323.20 12.392.83 220.930.37 220,930.37 . Decedent's Complete Address: STREETADDRESS Shippensburg Health Care 121 Walnut Bottom Road CITY I STATE I ZIP Shippensburg - PA 17257 - Tax Payments and Credjts: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 9.941.87 497 09 Total Credits (A + 8 + C) (2) 497.09 3. Interest/Penalty if applicable D.lnterest E. Penalty TotallnterestlPenalty ( 0 + E) (3) 4. If Une 2 is greaterthan Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Une 20 to request a refund (4) 5. If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 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 9,444.78 9.444.78 . PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE Ai'PROPRIA TE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ........................................................................... D IX! b. retain the right to designate who shall use the property transferred or its income; ........................................ D IX! 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?.... ...................................................... .................. .................. IX! D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. DlXl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which' contains a beneficiary design~tion? ..... ................. ..................................... .............. .............. ................ 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. Under penalties of perjury, I declare lhat I have examined lhis return, includinQ accompanying schedules and statemenls, and to lhe best of my knowledge and belief, it is true, correct and Declaration of preparer other lhll1lhe personal representallve is based on all Information of which preparer has any knowledge. SIGNATURE OF PE ON RESPONSIBLE FOR FI~NG RETURN jJ C l fl DATE ADDRESS \ 17268 DATE = 1.1/ / I Y' / 1'Jrt;" - ' , 17268 13 West Main Street, Suite 210 :< (p () P cpl tI VVavnesboro , - ;( t( () cL .l/J For dates of death on orafter July 1, 1994 and before January 1, 1995, tt,_ : 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 tht---= AI tJ.-tf? j) -\% [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and ~_ Ll-C~ 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 1w-:; 1;ral parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)1. /.'. ~ The tax rate imposed on the net value of transfers to or for the use of the dec. L _l16(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 dec __~ _'~ ~"IIU\;a]{T.3}J. A sibling is defined, under SectIon 9102, as an individual who has at least one parent in common with the decedent, whether -7 _.W~ VI dUUpnon. ADDRESS ( J REV-1503 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Smith Winifred E FILE NUMBER 21 05 All property jointly-owned with right ofsurvlvorship must be disclosed on Schedule F. 0832 ITEM NUMBER 1. DESCRIPTION Government Obligation Fund, Ephrata National Bank Account # 50-00-8012-00-2 VALUE AT DATE OF DEATH 58,726.36 2. 60 shs Honeywell International Inc. (HON) @ 39.00/sh 2,340.00 i , , , TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 61 066.36 - -- ---I I 1 REV-1508 EX + (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith Winifred E FILE NUMBER 21 05 I Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of sUlVivorship must be disclosed on Schedule F. 0832 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Proceeds of Erie Family Life Annuity 10,810.00 account #25N638, payable to decedent upon the death of her son, Thomas, who died July 1, 2005. 2. Treasury Bank Certificate of Deposit, Ephrata National Bank 100,012.60 Principal $100,000.00; interest accrued to dod $12.60 3. Ephrata National Bank 1.86 checking account # 84-347-4 4. Shippensburg, Health Care Center 3,420.00 refund of nursing care payment 5. Uncashed dividend check from Honeywell International, Inc. (HON) 12.38 TOTAL (Also enter on line 5, Recapitulation) $ 114256.84 If more s ace is needed, insert additional sheets of the same size p , REV-1510 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Smith Winifred E. FILE NUMBER 21 05 0832 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COV~R SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RElATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPYOFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABlE) VALUE 1. Gift to Joyce E. Wilhide on May 22, 2005 to prepay 25,000.00 100. 3,000.00 22,000.00 pecuniary bequest in Will 2. Gift to Judy A. Robison on May 22, 2005 to prepay 25,000.00 100. 3,000.00 22,000.00 pecuniary bequest in Will 3. Gift to Anjolee F. Smith on May 22,2005 to prepay 5,000.00 100. 3,000.00 2,000.00 pecuniary bequest in Will 4. Gift to Matthew T. Smith on May 22, 2005 to prepay 5,000.00 100. 3,000.00 2,000.00 pecuniary bequest in Will 5. Gift to Robin Kling on May 22, 2005 to prepay 5,000.00 100. 3,000.00 2,000.00 pecuniary bequest in Will 6. Gift to Paula Dowlin on May 22, 2005 to prepay 5,000.00 100. 3,000.00 2,000.00 pecuniary bequest in Will 7. Gift to Cheyenne Kling on May 22, 2005 to prepay 5,000.00 100. 3,000.00 2,000.00 pecuniary bequest in Will 8. Gift to Brooke Moats on May 22, 2005 to prepay 5,000.00 100. 3,000.00 2,000.00 pecuniary bequest in Will 9. Gift to Tyler Cooper on May 22, 2005 to prepay 5,000.00 100. 3,000.00 2,000.00 pecuniary bequest in Will TOTAL (Also enter on line 7 Recapitulation) (If more space is needed, insert additional sheets of the same size) 58000.00 REV-1511 EX + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ESTATE OF Smith Winifred E Debts of decedent must be reported on Schedule I. 21 05 0832 ITEM ! NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I 1. Grove - Bowersox Funeral Home, funeral services 6,030.44 ! B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees Dick, Stein & Schemel, LLP 5,300.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Glenda Farner Strasbaugh, Register of Wills 306.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. The Record Herald, advertise Personal Representatives' Notice 120.90 8. Cumberland Law Journal, advertise Personal Representatives' Notice 75.00 9. Dick, Stein & Schemel, LLP, reimburse for Federal Express 41.48 10. Glenda Farner Strasbaugh, Register of Wills, filing fee for ITRlINV 30.00 11. William Vandrew, Clerk of Courts, filing fee for Petition 26.50 TOTAL (Also enter on line 9, RecaPitulation~ $ 11 930.32 .. (If more space IS needed, Insert additional sheets of the same sIZe) REV-1512 EX + (6-98) . SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Smith Winifred E. FILE NUMBER 21 05 Include unreimbursed medical expenses. , 0832 ITEM NUMBER 1. 2. 3. 4. DESCRIPTION Cumberland Valley EMS, medical services , Diamond Pharmacy Services, prescription services Keystone Rural Health Center, medical services Sahara Internal Medicine Associates, medical services ! : TOTAL (Also enter on line 10, Recapilulaliory) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 160.43 302.44 21.00 23.45 507.32 . . REV-"" EX' '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES FILE NUMBER NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 63,117.73 AMOUNT OR SHARE OF ESTATE 1. Joyce E. Wilhide 39 Clover Court Eph rata , PA 17522 Judy A. Robison 7513 Toogoodoo Road Meggett, SC 29449 John A. Smith 12755 Pen Mar Road Waynesboro, PA 17268 Lynne M. Smith, FBD Matthew T. Smith 11892 Gehr Road Waynesboro, PA 17268 Lineal 31,558.87 Lineal 2. Lineal 63,117.73 3. Lineal 63,117.73 4. 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, N REV-1500 COVER SHEET ll. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 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) $