HomeMy WebLinkAbout04-06-06
REV-1500 EX +,fIl-OOl
.~- COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
Bruno Adeline Q.
DATE OF DEATH (MM-DD-Year)
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REV-1500
INHERITANCE TAX RETURN
R SIDENT DECEDENT
FILE NUMBER
2 1 -0 6 0 0 0 64
'"'Ci5iiNTYcooe -YEAR- - - "NuiiiiER--
SOCIAL SECURITY NUMBER
DATE 0 BIRTH (MM-DD-Year)
2 00- 2 2 - 6 828
THIS RETlJRN IlUST BE FLED IN DUPLICATE WITH THE
REGISTER OF WILLS
01/06/2006 12/22 1904
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, RRST. AND MI LE INITIAL)
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00 1. Original Retum
D 4. limited Estate
00 6. Decedent Died Testate (AlIa:bcopyofWIII)
D 9. litigation Proceeds Received
NAME
Charles F. Sullivan CPA CFP
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717737-3339
15. Amount of line 14 taxable at the spousal tax
rate, or transfers under See. 9116 (a)(1.2)
16. Amount of Line 14 taxable at fineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
19. Tax Due
SOCIAL SECURITY NUMBER
I
D 2'1 Splemental Retum
D 4a. F ture Interest Compromise (dale of deaIIl after 12-12-82)
o 7. ent Maintained a living Trust (AlIachcopy ofTrustj
I
D 10. S usal Poverty Credit (daleofdea1h be!wIlen 12-31-91 and 1-1-95)
D 3. Remainder Retum (daleofdealllpriormI2-1~2)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under See. 9113(A) (AlIach Sch 0)
COMPLETE MAILING ADDRESS
352 Blacksmith Rd.
Camp Hill PA 17011
(1)
(2) 21.500.00 !
(3) c,"''\
:7"~"t)
(4)
(5) 500.00 ~- ."j
co
(6) 16,116.27
(7)
(8)
38.116.27
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 Deposils & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Bilfing 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 Morlgage Liabilities. & Liens (Schedule I) (10)
11. Total Deductions (tofallines 9 & 10)
12. Net Value of Estate (Line 8 minus line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for~hich an election to tax has not been
made (Schedule J) i
14. Net Value Subject to Tax (line 12 minus line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPl ABLE RATES
13,411.02
1,419.00
(11)
(12)
(13)
14.830.02
23.286.25
(14)
23.286.25
0.00 X _(15) 0.00
23.286.25 X ~(16) 1.047.88
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 1.047.88
20. 0
CHECK HERE IF YOU ARE REQUESTING I'.>.. REFUND OF AN OVERPAYf\1ENT
Decedent's Complete ress:
STREET ADDRESS .
352 Blacksmith Road
CITY '1 I STATE I ZIP 17011
Camp HII PA
Add
Tax Payments and Credits:
1. Tax Due (Page 1 line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
1.047.88
Total Credits (A + B + C)
(2)
52.39
3. Interest/Penalty if applicable
D. Interest
E. Penalty
to: REGISTER OF
(4)
(5)
(5A)
(58)
AGENT
0.00
0.00
995.49
4. If Une 2 is greater than line 1 + Une 3. enter the difference.
Check box on Page 1 Une 20 to request a
5. If Line 1 + Une 3 is greater than Une 2. enter the difference.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
Make Check
Total Interest/Penalty (D + E) (3)
the OVERPAYMENT.
PLEASE ANSWER THE FOLLOWING BY PLACING AN ..X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income ofthe property tran rred; ........................................................................... 0 00
b. retain the right to designate who shall use th property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ................ ..................................................................................... 0 I:&J
d. receive the promise for life of either payment. benefits or care? ............................................................. 0 I:&J
2. If death occurred after December 12. 1982. did dent transfer property within one year of death
3. =: ~n":".~:::;~4-i,;;;;k~~;;:~~~~;;:;;;;:;;;;:::::::::::::: B
4. :~t~=::;~:~I~:~~::i;~i:~~~.t.~~r~'.~~.~~i.t:.,..~~.~~~~:~~~.t~.~~.~~i.~~....................... 0
995.49
00
00
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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.
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717 737-3339
For dates of death on or after July 1, 1994 and before January 1, 19 5, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72P.S.~9116(a)(1.1)(i)). .
For dates of death on or after January 1, 1995, the tax rate imposed ion 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 exemot 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 phild 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)1.
The tax rate imposed on the net value of transfers to or for the use ~the decedent's lineal beneficiaries is 4.5%. except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
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~EV-1503 6X.. (6-98)
.
COtJNONWEAl TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Bruno. Adeline 0,
FILE NUMBER
06
00064
+ 21
All property jointly with right of survivorship must be disclosed on Schedule F.
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~SCRIPTION
U. S. Treasury I-Bond #X0021159rl
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U. S. Treasury I-Bond #)(0021159'51
U. S. Treasury I-Bond #M0065151~91
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U. S. Treasury I-Bond #000397311
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ITEM
NUMBER
1.
VALUE AT DATE
OF DEATH
10,000.00
2
10,000.00
3
1,000.00
4
500.00
1___
----t- .
TOTAL (Also enter on line 2. Recapitulation) $
?1 ~nn nn
,REV-1508EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bruno. Adeline 0,
ITEM
NUMBER
1.
Personal Property
SCHEDULE E
C. ;AS~rANK DEPOSITS, & MISC.
P RSONALPROPERTY
----- - .+-"~--'--'--
FILE NUMBER
___n~_ . 21 06
Include the proceeds 0 litigation and the date the proceeds were received by the eslate.
All property jolntly..~ right of survivorship must be disclosed on Schedule F.
00064
DESCRIPTION
- --1
.
TOTAL (Also enter on line 5, Recapitulation) I $
!i00 00
VALUE AT DATE
OF DEATH
500.00
,REV-1509.EX + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT ~..
SCHEDULE F
JqlNTL V-OWNED PROPERTY
ESTATE OF
Brurl0. Adeline O.
FILE NUMBER
~ 21 06
If an asset was made joint within ne year of the decedenfs date of death, It must be reported on Schedule G.
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00064
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Rose A. Sullivan
Daughter
352 Slac ksmith Road
Camp Hill Pa 17011
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JOINTLY-OWNED PROPERTY:
LEITER DATE
ITEM FOR JOINT MADE INCLUDE NAME
NUMBER TENANT JOINT IDENTIFY
~
1. A. 1/5/00 Commerce
2 A 8/28/84 M & T Ban
nL_.
DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
OESCR! TION OF PROPERTY
OF FINANCIAL INSTIT ION AND BANK ACCOUNT NUMBER OR SIMILAR
ING NUMBER A TT AC DEED FOR JOfNTL V-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
%OF
DECO'S
INTEREST
Bank Cheeki g Acet. #0536294903
k Chjecking lunt #90080165
25,920.06
50.
12,960.03
6,312.49
50.
3,156.24
TOTAl. (Also ""'" online 6,RoolpiluI_l 1-;--
1R 11R 77
.REV-1511.EX"" (12-99)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bruno. Adeline O.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
1
FILE NUMBER
21
06
00064
Debts of 4edent must be reported on Schedule I.
AMOUNT
10,172.60
100.00
100.00
400.00
ervice 200.00
213.03
-~
-
--
-
140.00
Return 1,500.00
Fiduciary 300.00
85.39
200.00
Recapitulation) $ 13,411.02
ITEM
NUMBER
A.
1.
2
3
4
5
6
B.
1.
2.
3.
4.
5.
6.
7.
8
I DESCRIPTION
FUNERAL EXPENSES: I
Wiedeman Funeral Home I
Fr. Thomas Haney - Concelebran of funeral service
Fr. Michael McFadden - Concele rant of funeral service
Five Choir Members - Soloists an Cantors for funeral service
St. Theresa Church Mercy Servic - Servers for luncheon following funeral s
Various food and supplies for lun heon following funeral service
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ADMINI8TRA TIVE COSTS: i
Personal Representative's Commissions' \
Name of Personal Representative (s)
Social Security Number(s}/EIN NUmbet of Personal Represenlative(s)
Street Address -- _ I
City ~._ I _ _ State __ Zip
i
Year(s) Commission Paid: I
Attomey Fees
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Family Exemption: (If decedenfs address is not tile same as c1aimanfs, attach explanation)
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Claimant
Street Address
City_ State __ Zip _
Relationship of Claimant to Decedent f-------
Probate Fees Register of Wills - Cu+berland County
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Accountanfs Fees Charles F. Sullivan! CPA - Preparation of Pa Inheritance Tax
r".__F... Charles F. ~Ullivan CPA - Preparation of Individual &
Income Tax Returns i
Rose A. Sullivan, Personal Repr,sentative - Thank-You Cards & Postage
Rose A. Sullivan, Personal Repr+sentative - Various Expenses
TOTAL (Also enter on line 9,
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'REV-1512 'EX + (6-98)
*
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SCHEDULE I ~...
iDEBTS OF DECEDENT,
MOR GAGE LIABILITIES, & LIENS _
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Bruno. Adeline O.
+----.
DESCRIPTION
21
06
00064
ITEM
NUMBER
1.
VALUE AT DATE
OF DEATH
1,000.00
Hospice of Central PA
2
2005 Federal Income Tax
419.00
TOTAL (Also enter on line 10, Recapitulation) $
1,419.00
(If more soace is needed. insert additional sheets of the same size)
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!'€""''''''w SCHEDULE J 11
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~~~~.---===--~-=-"'=:----====---=---=-~jLE NUMBER--=-~-===----=-
Bruno Adeline 0._ \ 21 06 . 00064___
\ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) R CEIVING PROPERTY Do Not List Trustee(s) _~ ESTATE _
I TAXABLE DISTRIBUTIONS [lIlCIude outright spousal distributions. and transfers under
. Sec. 9116 (a) (1.2)]
1
1. Rose A. Sullivan ; Lineal 23,286.25
352 Blacksmith Road \
Camp Hill PA 17011 I
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1.
ENTER DOllAR AMOUNTS FOR D1STRIBIJTIONS tow. N ABOVE ON LINES 15 THROUGH 18, AS APP~PRIATE, ON REV-1500 COVER SH~_
~.~-~.~~,._~.~~-~. ~~--~--~
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
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B. CHARITABLE AND GOVERNMENTAL DISTRlBIJTI~NS
II.
1.
. , -- J___ ---' ---- --- '-- ------r- --- --- ,,-- --- ----" --- ---
__ TOTAL OF PART n - ENTER TOTAL NON-TA~~TRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(1&__..._ ___-._:,.. _~_.J._.J :__......1. _""...1:...:___1_....__..._ _&......._ ____ _:_....\