HomeMy WebLinkAbout03-20-06
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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DECEDENrs NAME (LAST. FIRST, AND MIDDLE INITIAL)
1 _
OFFICiAL USE ONLY
FILE NUMBER
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COUNTY CODE YEAR
2- 0 :2-2-3
NUMBER
DATE OF DEATH (MM-DD- EAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
gl. Original Return
o 4. Umited Estate
~ Decedent Died Testate (Allach copy of WIll)
o 9. Litigation Proceeds Received
D 2. Supplemental Return
o 4a. Future Interest Compromise (date of dealh after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of TrusQ
D 10. Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95)
SOCIAL SECURIiY NUMBER
/9~-./~ - ~1CJS _
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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
o 11. Election to tax under Sec. 9113(A) (Attach ScI'I 0)
COMPLETE MAILING ADDRESS
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(1)
(2)
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(4)
(5)
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. - ~Iqsely H~ld ,Corporati~n, "P~rtn~!R ()rSole-Proprietorship
~. Mortgag~s & Notes Receiva~le (Sched~le 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 Properly
(Schedule G or L)
8. Total Gross Assets (total Unes 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I)
11. Total Deductions (total Unes 9 & 10)
12. Net Value of Estate (Une 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
OFFICIAL USE ONLY
(11)
(12)
(13)
_ d. d...t 7. 0 ()
(6)
(7)
(9)
(10)
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(14)
c2. b ~S-.50
14. Net Value Subject to Tax (Une 12 minus line 13)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)( 1.2)
(19)
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_______________.________________________________________ x .0 ________ (15)
16. Amount of Line 14 taxable at lineal rate
x .0 ______ (16)
x .12 (17)
___:__C__:"m_____.._________c___.,,________n_____'~_ -- X .15 _ _ __ (18)
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
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R~-1508 EX+ (6-98) '*
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ft}1JR.f/ ,-in Sf/WJi(E",-
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
/
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6
1
DESCRIPTION
e II-ECi( I /V~ ffCCOl-l Il/T-.p 1/k..13 Iff/lK - /kerll&- /jtJ3?- 53i.J9
CA-I-ECK - CkC6E OF PeJ?Son/1/L ~-BETHIJ/IJ?I V/LL,tJ(;G
C J+EC..K - pR..~IJ7IUm REFllfJI/J- tl-1~#l7JJM.K DCI BS
FunJERIi-L!kUST /fr;RE€/lJE1l7/ -5e:;l/IeCf/oICE
FILE NUMBER
VALUE AT DATE
OF DEATH
1;1. ?tJ, 11
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3 ~t I b /
~03.s: ad
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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'Regular Checking Account Statement
PNC Bank
For tl18 period 05/06/2005 to 06/06/2005
v
MARY JO SAWYER
C/O JOANN D ROCKEY
1170 CENTRE ST
BELLEFONTE PA 16823-2527
~ PNCBAN<
Primary account number: 51-4038-5347
Page 1 of 1
N umber of enclosures: 0
C For 24-hour banking, customer service and
~. transaction or interest rate information,
V sign-on to Account Link@ by Web on
pncbank.com or call1-888-PNC-BANK
Para servicio en espatlol, 1-866-HOLA-PNC
Moving? Please contact us at 1-888-PNC-BANK
~ Write to: Customer Service
PO Box 609
Pittsburgh PA 15230-9738
.9 Visit us at pncbank.com
~
~
TOD terminal: '1-800-531-1648
For hearing impaired clients only
Regular Checking Account Summary
Account number: 51-4038-5347
Mary Jo Sawyer
Balance Summary
Beginning
balance
1,270.79
Deposits and
other additions
.00
Checks and other
deductions
Ending
balance
1,270.79
.00
Average monthly
balance
1,270.79
Charges
and fees
.00
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FORM953R-0104
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5' PAY
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TO
THE
ORDER
OF
WESLEY AFFILIATED SERVICES, INC.
o BfTHANY VILLAGE RESIDENT FUNDS
~ PNCBAN<
04-90
4830
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60-1213/313 In
4112 I"
PNC Bank, N.A.
Central PA
040
DATE
8/15/2005
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One thousand two hundred and sixy dollars and 10/100 -------- DOLLARS $1 1,260.10
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The Estate of Mary J. Sawyer
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50? 0 . 0 ~ j ? ? II.'
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-- ------------_._---_--..._~.- --------.~---~---------..._----~-
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<+-II GHMJ\RKe
..C1TJZENSBANK 0022424
Direct Pay Western Region
Premium Refund
DATE
107/05/20051
*THREE HUNDRED FORTY-SIX AND 61/100 DOLLARS*
AMOUNT
I 346.61
PAY
TO THE
ORDER OF
THE ESTATE OF MARY J SAWYER
%325 WESLEY DR #318
MECHANICSBURG PA 17055
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II. 0 0 2 2 l. 2 l.u. I: 0 :l b 0 ? b . 5 0 I: b 2 0 5 l. 5 2 5 8 . II.
REV-1511EX + (1-97)
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF J '
---'!111--1t'i 0 SitU) Ve~
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
DESCRIPTION
FUNERAL EXPENSES: II
F It~;< Lt;R- - WeJ j) e-mA-'/ Fit IJIEJe/9L lITe mE
AMOUNT
~/ '1S;/Jd
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s) I EIN Number of Personal Representative(s)
Street Address
B.
City
State
Zip
2.
3.
Yea~s) Commission Paid:
Attorney Fees
Family Exemption: (If decedenfs address is not the same as c1aimanfs. attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
/~;L: 00
5.
Accountanfs Fees
6.
Tax Retum Prepare~s Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $~.;:< /; 7 ocJ
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
tnflR. V ,Jo .g1tWl(eR.
FILE NUMBER
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS pndude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
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3 -3 ~ I1J I LLET 1/1;116
IJI7T5Bt(I(C~ PI} J5~at
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
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I/Jt:'PHEuI
AMOUNT OR SHARE
OF ESTATE
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
n NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed. insert additional shee.ts of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ROCKEY JOANN 0
11 70 CENTRE ST
BELLEFONTE, PA 16823
_nn_n fold
ESTATE INFORMATION: SSN: 1 94-14-4905
FILE NUMBER: 2106-0233
DECEDENT NAME: SAWYER MARY JO
DATE OF PAYMENT: 03/20/2006
POSTMARK DATE: 03/16/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 06/21/2005
NO. CD 006450
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $396.83
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TOTAL AMOUNT PAID:
$396.83
REMARKS:
CHECK# 4058
SEAL
INITIALS: MG
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
S~~5
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)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallhterestlPenalty ( 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)
l?SS-
3q(" $13
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
oc39t,,~
A. Enter the interest on the tax due.
(5)
(SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER.OF WILLS, AGENT
-39~,8' 3
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
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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.
SIGNATU F PERSON RESPONSIB FOR Fill ETURN
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ADD ~ S" V ;:;.4 / b'Ra3
SIGNA~tl ~ PREPAR~''"TH~PRgN''i p h7/t/lE;
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. ~9116 (a) (1.1) (Q].
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 decedenrs 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 decedenfs 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.
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