HomeMy WebLinkAbout02-16-06
REV.1500 EX + (6.00)
'*
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)
CHARETTE
DATE OF DEATH (MM-DD-Year)
JOSEPH A.
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER
~1Ytr--~A;'- -1.. JL ~Rl-
SOCIAL SECURITY NUMBER
o 1 8 - 0 1 - 5 852
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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04/03/2005 10/05/1916
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale of death after 12-12-82)
D 7. Decedent Maintained a Living T rust (Attach copy olTrust)
D 10. Spousal Poverty Credit (dale of dealh between 12-31-91 and 1-1-95)
D 3. Remainder Return (date 01 death prior to 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)
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THIS\SEC110N\.fytUSTSeCOMPI..ETEO.ALLCORRESPONDENceANO..CONFIDENTIAI.. TAX INFORMATION. SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
DOUGLAS G. MILLER ESQUIRE 60 WEST POMFRET STREET
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353 CARLISLE PA 17013
OFFICIAL USE ONLY
(1)
(2)
(3)
(4)
(5) 15,946.22
(6) 1 ,114.56
(7)
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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) (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/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
0.00 X _(15) 0.00
0.00 X _(16) 0.00
0.00 X .12 (17) 0.00
11 ,953.17 X .15 (18) 1 ,792.98
(19) 1 ,792.98
(8)
17,060.78
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)(I.2)
~---, .
3,417.93
1,689.68
(11)
(12)
(13)
5,107.61
11,953.17
16. Amount of Line 14 taxable at lineal rate
(14)
11 ,953.17
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
19. Tax Due
Decedents omple e ress:
STREET ADDRESS 208 SENATE AVENUE
CITY I STATE I ZIP
CAMP HILL PA 17011
I C I t Add
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 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)
5. 11 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 AGENT
1,792.98
0.00
0.00
1,792.98
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
. .' t 0
c. retain a reversionary Interes ; or ......................................................................................................
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
1,792.98
No
IX]
IX]
IX]
IX]
IX]
IX]
IX]
Under penalties of perjury, I declare that I have examined this return, includinQ 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 pre parer has any knowledge.
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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. ~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)].
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. ~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-15G8 EX + (6-98)
.
O::>MMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
CHARETTE
FILE NUMBER
JOSEPH A. 19 05
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.
1043
ITEM
NUMBER
1.
DESCRIPTION
Citizens Bank - Savings #6140181461
VALUE AT DATE
OF DEATH
1,757.62
2.
Citizens Bank - Time Deposit #6140844673
4,013.71
3.
Citizens Bank - Time Deposit #6140849748
3,499.43
4.
Citizens Bank - Time Deposit #62400995326
2,137.00
5.
Citizens Bank - Time Deposit #6244728136
2,033.86
6.
Citizens Bank - Time Deposit #6244731862
2,504.60
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
15.946.22
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
CHARETTE
FILE NUMBER
JOSEPH
A.
19
05
1043
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. Emma B. Henry
317 Messiah Circle
Camp Hill, PA 17011
Friend
B
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JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF OA TE 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 JOINTL V-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 4/17/90 Citizens Bank - Time Deposit #6140896428 2,229.11 50. 1,114.56
TOTAL (Also enter on line 6, Recapitulation) $ 1 114.56
(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
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
CHARETTE
FILE NUMBER
JOSEPH
A.
19
05
1043
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Frank S. Miller/David T. Sekely, Funeral Services, Inc. 1 ,499. 16
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. Attomey Fees Irwin & McKnight 1,200.00
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. Probate Fees Register of Wills 94.00
5. Accountant's Fees
6. Tax Return Preparer's Fees Patricia A. Rosendale, CPA 350.00
7. Register of Wills, Filing Fee for Petition 30.00
8. Register of Wills, Filing Fee for Inheritance Tax 30.00
9. Notary Fees 10.00
10. Cumberland Law Journal 75.00
11. The Sentinel 129.77
TOTAL (Also enter on line 9, Recapitulation) $ 3.417.93
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (6-98)
'.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
CHARETTE
FILE NUMBER
JOSEPH
A.
19
05
1043
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1,
AT&T Consumer Lease Services
70.65
2. Associated Cardiologists, Medical
3. Conner Rich Associates, Medical
4. Holy Spirit Hospital, Medical
5. Moffitt Heart and Vascular, Medical
6. OSL DBA ORTH Institute of PA, Medical
7. Quantum Imaging & Therapeutic, Medical
8. Physicians of Rehab, Medical
9. West Shore Anesthesia, Medical
10. EKG Associates, Medical
5.31
15.79
1,003.80
162.78
283.89
19.31
105.49
20.89
1.77
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1 689.68
,,,,,,,,,. ".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
r.HARETTF
JOSEPH
A.
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
Emma B. Henry
317 Messiah Circle
Mechanicsburg, PA 17055
FILE NUMBER
19 O~
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Collateral
104::1
AMOUNT OR SHARE
OF ESTATE
11,953.17
Remainder
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)
-Baal (j{Jr~ ahut C%JtiMnent
OF
JOS12I'!-1 A. CHAld-TIT
I, .lOSEI'll A. CIIARETTE of208 Senate Avenue, Ci,mp Hill, Commonwealth of
Pennsylv~lIlia, hereby declare the following to be my Last Will and Testament, hereby revoking all
\Vills and Codicils heretofore made by Ilk
FI RST: I direct that all my just debts, expenses 1)1' any last illness and flineral expenses
including any gravemarLer, shall be paid from my estate as soon as practicable after my decease as
a part ufthe administration (Ifmy estate
SIi:COND: I hereby contirm the instructions which [ have given to my Executrix, El\HvIA
HENR Y, that my body be cremated.
'nIIlU); 1 hereby bequeath my elltire estate, reaL per~;onal, or mixed wherever situated,
of which I may die seized or possessed. to EMtvIA IIENR \ n~Lwl.tl .m, Pennsylvania" per
stirpes
FOURTH: I hereby nominate and appoint Ervli\f i\ H FNR Y of Elizabethtown,
Pel1l1sykania, as ExecutrIx, of this my Last Will and Testamelll [ c1irect that my Executrix shall
not be required to give bond for the !ilithfltl perf~1rmance "C her duties in ilny jurisdiction
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IN WITNESS \VIJEREOF, I haw hereunto sd IIIV lHtI1d and seal on this instrument
only.,lhis
day ot
199-1 Thi,; Document, in its entirety, consists of
Three Pclges, this being Page Two
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JOSEPII 1\. CHARETTI
SIGNED, SEALED, PUBUSHED ANI) DECL\ltEO by the above named Testator,
JOSEPH A. CII:\I(ETTE, as his Last \Vill and Testamelll. in Ihe presence of us, who, at his
request in his presence and in the presence of each othu, h,we hereunto subscribed our names as
witnesst..'s.
of I\lechi!llicsburg, Pennsylvania
or Mechanicsburg, Pennsylvania
ACI{NOWLEDGMENT ANI) AFFIlH VIT
CC)rvIMON\VEALTH Of PENNSYLVANIA
COUt'JTV OF CUMBEHLAND
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WF, JOSEPH A. ('IIARETTE 1 L\RR Y G. nM~7J IOFF, and ROBERT K.
BANZHOfF, the Testator and the \Vitnesses, respectivd\' II hose names are signed to the
fOlegoin~; instrurnem, heing first duly SWOII1, do herehy (\,ceLtlt to the undersigned authority that
therestator signed and executed the instnlll1ent as his I il'.l \\'ill and thm he signed willingly, and
tint he e\eclIted it a~; his th'e and volunlarv dCt ll)r the PUlj)(I'ie therein expressed, and that each of
the witnesses, in the presence and hearin;1, of the Testator, sl!ilkd the Will as witness and that to
tht' besl of his knOlvledge, tlw Tt;;tator was at the time, ot Sl lllIld mind and under no constraint or
undue influence
~_.J>_:;)'1~/-.L, ~_,: (:~:i'<o'~ '. .:-7;"/
JOSEPH A. Cll,\IZFI fE, Testator
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WITN[:SS
Subscrihed, sworn to and ad~nO\\ledged bef.:lfe me hI' JOSEPll A CHARETTE, the
TestMoL. :lnd subscribed Clnd swom bef(He me by HARRY C HANZHOFF and ROllERT K,
BANZHOf.F, witnesses, thi';
(by of
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NOTAR YPlWLI('
.~ CITIZENS BANK
Account Number 6140181461
Account Title JOSEPH A CHARETTE
Date Opened 9/4/79
Account Type Savings
Principal Balance as ofDOD $1757.58
Interest from Last Postin,gto DOD $ .04
Account Balance as of DOD $1757.62
YTD Interest to DOD $ .55
.~ CITIZENS BANK
Account Number 6140844673
Account Title JOSEPH A CHARETTE
Date Opened 11/5/01
Account Type Time Deposits
Principal Balance as of DOD -- '- $4000.00
Interest from Last Posting to DOD $13.71
Account Balance as of DOD $4013.71
YTD Interest to DOD $41.08
.~ CITIZENS BANK
Account Number 6140849748
Account Title JOSEPH A CHARETTE
Date Opened 10/20/01
Account Type Time Deposits
Principal Balance as of DOD $3498.00
Interest from Last Posting to DOD $1.43
Account Balance as ofDOD $3499.43
YTD Interest to DOD $8.63
.~ CITIZENS BANK
Account Number 6240995326
Account Title JOSEPH A CHARETTE
Date Opened 1/6/03
Account Type Time Deposits
Principal Balance as of DOD $2131.99
Interest from Last Posting to DOD $5.01
Account Balance as ofDOD $2137.00
YTD Interest to DOD $15.48
.~ CITIZENS BANK
Account Number 6244728136
Account Title JOSEPH A CHARETTE
Date Opened 10/7/04
Account Type Time Deposits
Principal Balance as of DOD $2030.26
Interest from Last Posting to DOD $3.60
Account Balance as of DOD $2033.86
YTD Interest to DOD $11.12
.:: CITIZENS BANK
Account Number 6244731862
Account Title JOSEPH A CHARETTE
Date Opened 5/14/04
Account Type Time Deposits
Principal Balance as of DOD $2500.00
Interest from Last Posting to DOD $4.60
Account Balance as of DOD $2504.60
YTD Interest to DOD $19.73
.~ CITIZENS BANK
Account Number 6140896428
Account Title JOSEPH A CHARETTE or EMMA HE~'RY
Date Opened 4/1 7/90
Account Type Time Deposits
Principal Balance as ofDOD $2200.00
_.
Interest from Last Posting to DOD $29.11
Account Balance as of DOD $2229.11
YTD Interest to DOD $ .00
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