HomeMy WebLinkAbout02-09-06
REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BLANCHE R. FOX
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER C <'2/ '\
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COUNTYk YEAR NUMBER
SOCIAL SECURITY NUMBER
2 06- 3 6 - 9 4 5 1
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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11/18/2005 08/04/1905
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
00 1. Original Return
o 4. Limited Estate
00 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 death after 12-12-62)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrusQ
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date 01 death prior to 12-13-62)
o 5. Federal Estate Tax Return Required
Q.. 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
CHARLES E. PETRIE 3528 BRISBAN STREET
FIRM NAME (If Applicable)
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TELEPHONE NUMBER
717 561-1939
HARRISBURG PA 17111
OFFICIAL USE ONLY
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(1)
(2)
(3)
(4)
(5)
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)
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)
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)
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83,604.28 '
(6)
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(7)
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(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19. Tax Due
X _(15)
71,654.83 X .045 (16)
X .12 (17)
X .15 (18)
(19)
(8)
83,604.28
7,028.14
4,921.31
(11)
(12)
(13)
11,949.45
71,654.83
16. Amount of Line 14 taxable at lineal rate
(14)
71 ,654.83
17. Amount of Line 14 taxable at sibling rate
3,224.47
3,224.47
18. Amount of Line 14 taxable at collateral rate
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
>>BESURE TO ANSwER ALL QUESTIONS ON REVERSE SlOE ANO RECHECK MATH < <
Decedent's Complete Address:
STREET ADDRESS
1000 WESLEY DRIVE
CITY 1 STATE I ZIP
LOWER ALLEN TOWNSHIP PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
3,224.47
161.22
Total Credits (A + 8 + C)
(2)
161.22
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)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
3,063.25
3,063.25
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 IKI
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IKI
c. retain a reversionary interest; or ...................................................................................................... 0 IKI
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IKI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.. .... ............... ........................... ............... .... ........................... 0 IKI
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 IKI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .. ............. ................... ................................................ ................. .... 0 IKI
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 pe~ury, 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
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ADDRESS
ADDRESS
DATE
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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. 99116(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. 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-1508 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
BLANCHE R. FOX
FILE NUMBER
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
CERTIFICATE OF DEPOSIT WITH INVEST FINANCIAL
VALUE AT DATE
OF DEATH
53,748.71
2.
M & T BANK ACCOUNTS
29,855.57
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
83 604.28
REV-1511 EX + (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BLANCHE R. FOX
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. GINGRICH MEMORIALS 1,380.00
2. LUNCHEON AFTER FUNERAL 238.14
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) CAROLE WEAVER 2,500.00
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 4619 SURREY ROAD
City HARRISBURG State P A Zip 17109
Yea<<s) Commission Paid: 2006
2. Attomey Fees CHARLES E. PETRIE 2,500.00
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 260.00
5. Accountants Fees
6. Tax Return Preparer's Fees 150.00
7.
TOTAL (Also enter on line 9, Recapitulation) $ 7028.14
(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
BLANCHE R. FOX
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. BONNIE MILLER - TAXES
VALUE AT DATE
OF DEATH
11.00
2. BETHANY VILLAGE
4,484.25
3. ALERT PHARMACY
315.46
4. PA STATE INCOME TAX
70.00
5. ZIMMERMANS
40.60
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4921.31
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
BLANCHE R. FOX
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
1. SEAN E. SHOVER GRANDSON 9,798.79
322 SUNSET TRAIL
MICHIGAN SHORES, IN 46360
2. LAURIE R. SCHMIDT GRANDDAUGHTER 9,798.79
502 OAK STREET
VALPARAISO, IN 46383
3. LEATH A. BARNETT GRANDDAUGHTER 9,798.79
210 FELTON STREET
MICHIGAN CITY, IN 46360
4. THOMAS W. SHOVER GRANDSON 9,798.79
1204 W. WAVELAND #3
CHICAGO, IL 60613
5. HAROLD K. WEAVER GRANDSON 9,798.79
215 E. HIGH STREET
HUMMELSTOWN, PA 17036
6. ROCHELLE E. BENDER GRANDDAUGHTER 9,798.79
623 CHESTNUT HILL ROAD
YORK, PA 17402
7. KYLE R. WEAVER GRANDSON 9,798.79
940 PLEASANT GROVE ROAD
YORK HAVEN, PA 17370
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)
REGISTER OF WILLS
CUMBERLAND COUNTY, PENNSYLVANIA
INVENTORY
Estate of BLANCHE R. FOX
No. 2005
01030
also known as
, Deceased
Date of Death 11/18/2005
Social Security No. 206369451
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We
verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney: CHARLES E. PETRIE
1.0. No.: 29029
Address: 3528 BRISBAN STREET
HARRISBURG, PA 17111
Telephone: (717) 561-1939
Personal Representative:
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CAROLE E. WEAVER
Dated 01/02/2006
Description
CERTIFICATE OF DEPOSIT WITH INVEST FINANCIAL
Value
53,748.71
M & T BANK ACCOUNTS
29,855.57
(Attach Additional Sheets if necessary)
Total
83,604.28
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
STATUS REPORT UNDER RULE 6.12
Name of Decedent: BLANCHE R. FOX
Date of Death: 11/18/2005
at,o 5-ro~
Admin. No.
Will No.
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate:
1 . State whether administration of the estate IS complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3 . If the answer to No. 1 is Yes, state the following:
a.
account with the Court?
Did the personal representative file a final
Yes No X
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c . Did the personal representative state an
account informally to the parties in interest? Yes X No
d . Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans' Court and may be attached to this report.
Date: 2/1/2006
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Signature
CHARLES E. PETRIE
Name (Please type or print)
3528 BRISBAN STREET
HARRISBURG. PA 17111
Address
((71) 7)561-19
Tel. No .
Capacity :
Personal Representative
X
Counsel for personal
representative
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.2B0601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WEA VER CAROLE E
4619 SURREY ROAD
HARRISBURG, PA 17109
_____n_ fold
ESTATE INFORMATION: SSN: 206-36-9451
FILE NUMBER: 2105-1030
DECEDENT NAME: FOX BLANCHE R
DATE OF PAYMENT: 02/09/2006
POSTMARK DATE: 02/09/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 11/18/2005
NO. CD 006312
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,063.25
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TOTAL AMOUNT PAID:
REMARKS: C E WEAVER
CHECK# 7297
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
$3,063.25
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS