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Home My WebLink About01-17-06 (2) REV-1500 EX. (6-00) .. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ z w c w (.) w c W I- ~ :$Ul ulIi:~ w&U J: lli:g Ull.lll ll. c( z o i= c:( ...J ~ ~ 0:: c:( (.) w 0:: z o i= ~ ~ 0. :E o (.) ~ ~ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SHEAFFER MARY DATE OF DEATH (MM-DD-Year) E. DATE OF BIRTH (MM-DD-Year) OFFICIAL USE ONLY FILE NUMBER 2-.!.- -.J!.... .L ~ SL ~ ~ S COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 210-26-7534 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (dateoldeathpnorto 12-13-82) D 5. Federal Estate Tax Return Required !.. 8, Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A)(Attach Sch 0) NAME MURREL R. WALTERS III FIRM NAME (II Applicable) A 17055 OFF\'9;I~L USE ONL.Y; ( '.. .......-1 123.16 33,505.88 1;LJ 10/04/2005 03/07/1916 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) 00 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy 01 Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date 01 death after 12-12-82) D 7, Decedent Maintained a Living Trust (Attach copy ofTrust) D 10, Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95) (8) 33,629.04 I- Z W C Z o ll. Ul W iii: iii: o U 5,280.38 157.50 (11) (12) (13) 5,437.88 28,191.16 TELEPHONE NUMBER 717.697-4650 MECHANICSBURG (14) 28,191.16 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole.Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (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) 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 Governmental 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 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under See, 9116 (a)(1.2) X _(15) 28,191.16 X .045 (16) X .12 (17) X .15 (18) (19) 1,268.60 1,268.60 pt 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 IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 3405 BEDFORD DRIVE CITY CAMP HILL STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,268.60 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + 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) 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due, (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check to: REGISTER OF WILLS, AGENT 0.00 1,268.60 1,268.60 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 DATE / -/ G:. - ::<.,66 <;::.. ~~\ PA 17011 DAYE ;: 11ft (;> ". I I U'IU1'.lRnUIH,t-i-i ~ ~~~t\\~\:) For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate [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 vall The statute does not exempt a transfer to a surviving spouse from tax, and the stal 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-c ath 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, Jers to or for the use of the surviving spouse is 3% the surviving spouse is 0% [72 P.S. ~9116 (a) (1.1) (ii)]. of assets and filing a tax return are still applicable even if REV-150B EX + (6-9B) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHEAFFER FILE NUMBER MARY 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 VALUE AT DATE OF DEATH 123.16 BLUE CROSS/BLUE SHIELD REFUND TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 123.16 REV-1509 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHEAFFER MARY E. If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. MARIE E. SHEAFFER B c JOINTL Y.OWNED PROPERTY: SCHEDULE F JOINTLY-OWNED PROPERTY ADDRESS 3405 BEDFORD DRIVE CAMP HILL, PA 17011 FILE NUMBER RELATIONSHIP TO DECEDENT DAUGHTER 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. 4/16/01 PNC BANK 25,670.80 50. 12,835.40 CHECKING ACCOUNT 2. A. 5/25/01 PNC BANK 3,835.37 50. 1,917.69 CERTIFICATE OF DEPOSIT 3. A. 5/25/01 PNC BANK 37,505.58 50. 18,752.79 ANNUITY TOTAL (Also enter on line 6, Recapitulation) $ 33,505.88 (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 SHEAFFER MARY E. Debts of decedent must be reported on Schedule I. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. NEILL FUNERAL HOME 4,396.00 2. KARNS MARKET. FUNERAL MEAL. FOOD 95.00 3. FUNERAL MEAL. BRICKER HOUSE. RENTAL FOR MEAL 289.38 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) MARIE E. SHEAFFER RENOUNCED Social Security Numbe~s)/EIN Number of Personal Representative(s) Street Address City State Zip Yea~s) Commission Paid: 2. Attorney Fees MURREL R. WALTERS III, ESQUIRE 450.00 3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS, CUMBERLAND COUNTY 50.00 5. Accountanfs Fees 6. Tax Return Prepare(s Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 5,280.38 (If more space is needed, insert additional sheets of the same size) REV-1~12 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHEAFFER MARY SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS E. Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. CAPITAL CARE. PERSONAL CARE FILE NUMBER TOTAL (Also enter on line 10. Recapitulation) $ (If more space is needed. insert additional sheets of the same size) VALUE AT DATE OF DEATH 157.50 157.50 ~'''~".(* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES ~HEAFFER MARY E. NUMBER 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. MARIE E. SHEAFFER 3405 BEDFORD DRIVE CAMP HILL, PA 17011 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) DAUGHTER AMOUNT OR SHARE OF ESTATE 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 $ (If more space is needed, insert additional sheets of the same size)