HomeMy WebLinkAbout04-13-06 (3)
REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYL VANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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08/09/2005 09/16/1923
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Jum er Lester
DATE OF DEATH (MM-DD-Year)
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DATE OF BIRTH (MM-DD-Year)
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[g] 1. Original Retum
o 4. Limited Estate
o 6. Decedent Died Testate (AltachcoPyofWill)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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NAME
H. Anthon Adams
FIRM NAME (If Applicable)
~IIIIIIIIIIDI
OFFICIAL USE ONLY
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FILE NUMBER
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COUNTvCODE ---vEAA- - - NUM'BER--
soaALSECU~TYNUMBER
1 83- 1 6 - 6 506
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (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 Sch 0)
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COMPLETE MAILING ADDRESS
49 W. Orange Street
TELEPHONE NUMBER
717 -532-3270
Suite 3
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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) (6)
o Separate Billing Requested
(1)
(2)
(3)
(4)
(5)
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(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/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(8)
(11) =
(12)
(13)
(14)
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a}(1.2)
0.00 X _ (15)
23,968.44 X .045 (16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
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OFFICIAL USE ONLY
PA 17257
38,105.45
L__ _________
14,137.01
38,105.45
14,137.01
23,968.44
23,968.44
0.00
1,078.58
0.00
0.00
1,078.58
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Decedent's Complete Address:
STREET ADDRESS
7 S. Hollar Dr., S.M.E.
CITY 1 STATE I ZIP
Shippensburg PA 17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
1,078.58
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits ( A + B + C)
(2)
0.00
Tota/lnterest/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 to: REGISTER OF WILLS, AGENT
0.00
0.00
1,078.58
1,078.58
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 [KJ
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................. 0 [KJ
3. Did decedent own an Rin trust forR or payable upon death bank account or security at his or her death? ................. 0 [KJ
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
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.
Sl A URE OF PERSON RESPONSIBLE FO FILING RETURN OAT
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For dates of death on or after Ju/y 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use 0
(72 P.S. ~9116 (a) (1.1) (i)J.
For dates of death on or after January 1, 1 995, 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) (iill
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 retum 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 val ue 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)( 1ll
The tax rate imposed on the net value oftransfers 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.
~EV-1508 ~X + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jum er Lester E.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. U.S. Savings Bonds 1,766.80
2. Refund on AAA membership 35.83
3. Allianz (payment on annuity) 327.28
4. ERIE Insurance (final insurance payment) 79.00
5. Charles Schwab #4870-9768 10,922.59
6. Refund for Sprint 13.48
7. Refund for Adams Electric 27.03
8. Patriot Federal Credit Union 13,930.50
Account #0001476860
9. Refund on Property Insurance 129.00
10. Final Balance for Patriot 10.61
11. 19~BUiCk ~.~ ~.i\)~. 8,600.00
NADA Book
12. Allianz Annuity Contract (Policy Number 711604) 2,263.33
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.
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
38.105.45
REV-1511 EX + (12-99)
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Jumper
Lester
E.
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsonage -Bricker Funeral Home 6,043.40
2. Thomas Jumper (Funeral Reception) 399.80
3. Lester Jumper (Parklawn Cemetary-fees and grave opening) 995.00
4. Lester Jumper (Parklawn Cemetary plot purchase) 2,673.57
5. Vivtorian Corner (flowers for funeral service) 45.53
B. ADMINISTRA TIVE 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. Attorney Fees H. Anthony Adams 900.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 104.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Sprint (final utility) 131.81
8. Adams Electric Co-op (final utility) 445.91
9. Tuscarora Burial Association 400.00
10. Shippensburg Mobile estate 1,238.36
11. Barry Negley (taxes on real estate) 18.98
12. Lester Jumper (repair on Car for sale) 417.73
13. Comcast (utility) 25.92
14. Everett Cash Mutual (Insurance) 157.00
15. Tim Martin (Mantain Est. property) 100.00
16. Todd Martin (maintain Est. Property) 40.00
TOTAL (Also enter on line 9, Recapitulation) $ 14,137.01
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV-l513ElI.+(*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
J
SCHEDULE J
BENEFICIARIES
FILE NUMBER
umoer Lester E.
RELA TIONSHIP 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. Lester E. Jumper Lineal
5049 Orrstown Road 25%
Orrstown, PA 17244
2. Thomas E. Jumper Lineal
8496 Newburg Road 25%
Newburg, PA 17240
3. Norma J. Jumper Lineal
2167 Lindsay Lot Road 25%
Shippensburg, PA 17257
4. Pauline R. Martin Lineal
238 McCulloch Road 25%)
Shippensburg, PA 17257
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)