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Home My WebLink About03-24-06 (4) ~ , ---I 15056041046 REV-1500 EX (05-04) PA Department of Revenue Bureau of Individual Taxes Dept 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year ~I () ~ File Number 0.... :;. ;;-9 Date of Birth 2./ fo.Eo 9rtj.3 o 2./ ~ '2-00 f.o 03/ / 9/ 9 Decedent's Last Name Suffix Decedent's First Name MI S p.U If LI NG- RLRV NO ~e 5 (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return c:::::> 2. Supplemental Return c:::::> 4. Limited Estate c:::::> 4a. Future Interest Compromise (date of death after 12-12-82) c:::::> 6. Decedent Died Testate c:::::> 7. Decedent Maintained a Living Trust (Attach Copy. of Will) (Attach Copy of Trust) c:::::> 9. Litigation Proceeds Received c:::::> 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) c:::::> 3. Remainder Return (date of death prior to 12-13-82) c:::::> 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes c:::::> 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime TelephoneNumber L,':;,;,;', 5 H- I If L,E t Firm Name (If Applicable) 11./ LL 1/7 7 9~ 0 ~~.( C1:.' REGISTER OF WILLS USE ONI:.'y First line of address 9 .f V 1/ .S./J.. / 05 ..of? I VE r .--~ Second line of address ,.....1 ,.) 't City or Post Office State ZIP Code DATE FILED CI}.I? L / SLE fJA- / ?tJ / :3 Correspondent's e-mail address: 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. SIGNATURE RSON RESPONSIB.L~ FOR ILlNG RETURN . ~. ttJ~ . ADDRESS 95 V ,'//6~ \.7),.,'t/~ (O,../,'S!(. IlA /7d/.:] SIGrr\'"URE OF PREPARER O~ T~A~ ~:P~ESENTATIVE I ~ l..Q.~ .AtY-ff :E/~ ADDRESS ~O() E. ~~) afr. CtUJ/.!!;/~ ~I) PLEASE USE ORIGINAL FORM ONLY DATE e5'- ':<~-old-e~ /'70/3 Side 1 L 15056041046 15056041046 ....J .-J 15056042047 REV-1500 EX Decedent's Name: Decedent's Social Security Number RECAPITULATION 1. Real estate (Schedule A). . . . . . . . .. 1 . 2. Stocks and Bonds (Schedule B) . . . . . . . . . . ........... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . ..................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) C::) Separate Billing Requested 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C::) Separate Billing Requested. . . . 7. .......... 8. 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) . . . 12. 9. 10. 11. . 13. 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amou nt of Line 14 taxable at lineal rate XO if 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042047 15. 16. 17. 18. 19. C::) 15056042047 ~ REY-1500 Ex~page 3 Decedent's Complete Address: DECEDENT'S NAME ~J..E()/'IoRE s. STREET MD,RESS '15" l//r~/~/D--5 ell-I? l./ .:5 ~ E File Number S'Pvfl~,Ala- ~IIE CITY /l"q- STATE i /70/3 ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payment;; A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) glJ , 0 0 /,SD Total Credits (A + B + C ) (2) JI/..:ro 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. Fill in oval on Page 2, 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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) A. Enter the interest on the tax due. ~9,~O 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 No a. retain the use or income of the property transferred;................................................... .......................... D ~ b. retain the right to designate who shall use the property transferred or its income; ........................................ D [rJ c. retain a reversionary interest; or......................................................................................................................... D ~ d. receive the promise for life of either payments, benefits or care? .................................................................... D [XJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D I&T IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [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 zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemDt 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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [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. 217' REV-15G8 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF ELEONORE SPURLING 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 DESCRIPTION 1 MEMBERS FIRST BANK ACCOUNT 2 1992 HONDA ACCORD 3 CLOTHING AND PERSONAL ITEMS VALUE AT DATE OF DEATH 9,004 2,000 500 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 11,504 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: HOFFMAN AND ROTH FUNERAL HOME 5,012 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 Year(s) Commission Paid: State Zip 2. 3. Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant SHIRLEY HILL Street Address 95 VASILlOS DRIVE City CARLISLE State PA Zip 17013 Relationship of Claimant to Decedent DAUGHTER 3,500 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 50 7. COURT COSTS 88 l TOTAL (Also enter on line 9. Recaoitulation $ (If more space is needed, insert additional sheets of the same size) 8650 R5V-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. VISA 2,185 2. BLAIR 10 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. Insert additional sheets of the same size) 2,195