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Home My WebLink About01-04-06 (2) REV.l500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPl 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY INHERITANCE TAX RETURN RESIDENT DECEDENT DATE OF BIRTH (MM-DD-YEAR) 12/28/1915 I- Z W C w (,) w C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Grubb Ruth L. DATE OF DEATH (MM-DD-YEAR) 12/22/2004 FILE NUMBER 21 0008 - 05 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 172-.{)1 ~ ""5255 THIS RETURN MUST BE FILED IN DUPLICATE WITH n REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) NAME John A. Roe FIRM NAME (If Applicable) TELEPHONE NUMBER 717/671-9870 z o ~ -.oJ :;:) !::: Q. <( (,) W a::: 14. Net Value Subject to Tax (Line 12 minus Line 13) w .., :.:::!!;cn ull::':: wQ.u :1:00 ull:..J Q.1lI Q. < D 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach ccpy of Will) D 9. Litigation Proceeds Received ~ 2. Supplemental Return o 4a. Future Interest Compromise (dale of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach ccpy ofTrust) o 10. Spousal Poverty Credit (date of death between 12.31-91 and 1-1-95) D. 3. Remainder Return (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 Soh 0) z o ~ ~ :;:) Q. ::e o (,) g 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 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) COMPLETE MAILING ADDRESS 2520 Doehne Road Harrisburg, PA 17110 (1) (2) (3) (4) (5) OFFICIAL USE ONLY 11,692.28 (6) , 11 (7) ! ) (8) 11,692.28 (9) (10) 818.46 (11) 818.46 (12) 10,873.82 (13) (14) 10,873.82 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 10,873.82 x.O _ (15) x .042..... (16) 489.32 x .12 (17) x .15 (18) (19) 489.32 ~ Decedent's Complete Address: STREET ADDRESS CITY Carlisle 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 (1 ) 489.32 Total Credits (A + B + C ) (2) 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( 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) ZIP 17013 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 489.32 (5) (5A) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or ................................ .................................... ..... ....... .......................................... 0 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............... ... ................... .............. ........................................................... 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 No [3 [it Q Q [3 Ui [3 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 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 information of which preparer has any knowledge. PA 19081 ADDRESS DATE IXI.'OI. .I.. .....;11 n ... j, .I!'"" 11. .. ._ 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. 99116 (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. 99116 (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. S9116(a)(1.2)]. ~\))he 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. 99116(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-1503 EX + (1-97) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ruth L. Grubb FILE NUMBER 21-05-0008 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 1. 284 shs Verizon Communications @ 41.17 11,692.28 An additional 284 Book Shares (which resulted from a 2 for 1 stock split) were held by Verizon which we did not know about when we filed the original Inheritance Tax Return. TOTAL (Also enter on line 2, Recapitulation) $ 11,692.28 (If more space is needed, insert additional sheets of the same size) REV.1511EX. (1.97) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS II COMMONWEALTH OF PBlNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ruth L. Grubb FILE NUMBER 21-05-0008 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMIN!STRATIVE COSTS: 1. Personal Representative's Commissions 584.61 Name of Personal Representative (s) ~l1'7~nnp r.: l{pllpr Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2006 2. Attomey Fees 233.85 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. Proba1e Fees 5. Accountant's Fees , 6. Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 818.46 (If more space is needed, insert additional sheets of the same size) Historical Pricing Valuation Worksheet Edward Jones Account Number: 2:;77 '~()Bt:;40 J;L f;2!l- /01 date EdwardJones Date of death valuation Alternate valuation date QUANTITY SECURITY DESCRIPTION/CUSIP VALUE PER ITEM TOTAL VALUE , q (;5" 0.27 &3.88 J.8.l 3.7 t7'? BZ.. ;2 '5/j5 "7 8,/~ 7J.- &0&, 5( l~~ 374.:22 l6N YL 'See- ~MlAl\\leA-TI6N51 (. SEt 007,dD &).1. .~ f..~\ 1.6N Cawu.A.v.. rJ \ e s \Jl. .11 ;2..tJD W'fl> ,,^~~f: S MK 7 8&.a) -\-l e.. ",::::.a~lle l S t.t,e ptt pe l-/ sac....n ~)-l.s: . o.\- "J &.((2. 2:?) 'Lf" 25. ~2 aJ- SO'Yh e p611-'1' . ~ This information is approved for use with the public. Page 1 of 1 Revised: 19 Oct 2004