The URL can be used to link to this page

Home My WebLink About04-13-06 z o j:: :5 ::l .... ii: < u W 0::: ) REV. 1500 e4 ;..00) . \<\)~ COMMONWEAL TH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0801 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I Copyright 2000 form software only The Lackner Group,lnc. .... z w o w u w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Diven, Anita L. DATE OF DEATH (MM-DD-YEAR) DA TE OF BIRTH (MM-DD-YEAR) OFFlCIA1. USE ONLY J FILE NUMBER 21 05 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 01033 NUMBER 02/05/2005 (IF APPLICABLE) SURVIVING SPOUSE'S ""ME ( LAST. ARST AND MIDDLE INITIAL) w .... :.::Scn uO::::':: wCLU 2:00 UO:::-J CLIXl CL < 1. Original Return 206-32-1942 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 3. Remainder Return (date of death prior to 12-13-82) 6. Decedent Died Testate (Attach COpy OlW;II) 9. Litigation Proceeds Received 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. SPousal Poverty Credit (date of death between 5 o 5. Federal Estate Tax Return Required 8. Total Number of Sate Deposit Boxes o 11.Election to tax under Sec. 9113(A) (Au""h Sch 01 COMPLETE MA/UNG ADDRESS 4 James Circle Shippensburg, P A 17257-2165 (1 ) None (2) None (3) None (4) None (5) 2,253.96 (6) None (7) None (8) (9) 2,321.25 (10) 2,379.13 OFTIGIAL l)::if:: ONLY :::. I ~.i 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) o 4. limited Estate o o 2. Supplemental Return r.,.) 2,253.96 ..... cnz Ww 0:::0 O:::z 00 UCL (11 ) 4,700.38 lRM NAME (If applicable) Perkins Law Office ELEPHONE NUMBER 7] 7/658-6531 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) o 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) to. Debts of Deeedent. Mortgage Liabilities. & Liens (Schedule I) 11. Total Deductions (total lines 9 & 10) 12. Net Value of Estate (line 8 minus line 11) (12) insolvent SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) - z .045 (16) 0 16. Amount of line 14 taxable at lineal rate x j:: - ~ ::l (17) CL 17.Amount of line 14 taxable at sibling rate x .12 :e 0 U )( 18. Amount of line 14 taxable at Collateral rate ~ x .15 (18) (19) Form REV-1500 EX (Rev. 6-00) pt. Decedent's Complete Address: STREET ADDRESS 27 South Earl Street Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount Shippensburg I STATE PA I ZIP 17257 CITY (1 ) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 0.00 Total Interest/Penalty (0 + E) 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 5. If Line 1 + Line 3 is grealer than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax dUe. 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. Unde, penellies of pe,u>y. I _e", thai I ha,e exemined this "'tum. Induding accompenYlng schedule. end statements. end to the bes' of my knOWledge and belief. It Is true. correct and comple', Deela'allon 0' poepa"" o'he, 'hen 'h' ""onal "''''esentelive is be.ed on attlntonnaHon ot Which p", a'e, has eny knowledge. SIGNA TURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Tonia L. Fasnacht ~ \ 3. Did decedent Own an "in trust for" Or payable upon death bank aCCOunt or security at his or her death?......... 4. Did decedent Own an Individual Retirement ACCOunt, annuity, or other non-probate property Which contains a beneficiary designation?....... ........ ........................................................................... ........................... 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;.... ................ ............... ............. ...... ............ ................ ~ j b. retain the right to designate who shall use the property transferred or its income;.................................... c. retain a reversionary interest; or.... ................ .......... .............. ......... ......................................... ..... ............... d. receive the promise for life of either payments, benefits or care? ...... ..................... .......... ....... ......... ......... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate conSideration?......................................................... .............................................................. 0 o o Make Check Payable to: REGISTER OF WILLS, AGENT (3) 0.00 (4) (5) 0.00 (5A) (58) 0.00 SIGNA TURE OF PREPARER OTHER THAN REPRESENTATIVE David Patrick Perkins ADDRESS \J G' IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 'S YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~ ~ L8l S/ ~G~~ ADDRESS 105 Hollar A venue Shippensburg, P A 17257 DATE F or dales of death on or after July 1, 1994 a nd before Janua ry 1, 1995, the tax rate imposed on the net va lue of transfers to or forthe use of the surviving spouse is 3% [72 P.S. 99116 (a) (1.1) (i)}. For da les of death on or after Ja n ua ry 1, 1995, the tax rate imposed on the net va lue 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 exem.l1! a transfer to a surviving sPOUse from tax, a nd the statutory requirements for disclosure of assets and filing a tax relurn 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 lwenty-one years of age or younger at death to or for the use of a natural pa rent, an adoptive parent, or a slepparent 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. 99116 (a) (1)J. The lax rate imposed on the net Va lue of transfers to or for the use of the decedent's siblings is 12 % [72 P. S. ~9116 (a) (1.3)J. 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. 4 James Circle Shippensburg, P A 17257-2165 * SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT _ -e~TATe OF _~ Diven, Anita L. I FILE NUMBER 21 - 05 - 01033 InClude the proceeds of litigation and the date the prOCeeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 M&T Bank - checking account No. 97209392 28 Walnut Bottom Road Shippensburg, PA 17257 DESCRIPTION VALUE AT DATE OF DEATH 175.89 2 Nationwide Insurance-tenant's insurance refund 3 Mutual of Omaha-refund 4 43.00 Capital Blue Cross- medical insurance 6.50 5 Capital Blue Cross-medical insurance 519.63 6 Social Security 395.94 1 , 113.00 TOTAL (Also enter on Line 5, Recapitulation) 2,253.96 *' SCHeouLEH FlJNERAL. EXPENses & AOIVIINISTRA TlVE COSTS COMMONWEAl TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Diven, Anita L. Debts of decedent mUst be reported on SChedule I. I FILE NUMBER 21 - OS - 01033 ITEM NUMBER A. DESCRIPTION FUNERAL EXPENSES: Auer Memorial Home & Cremation Services, Inc. reimbursement to Michele R. Fritz for funeral expense AMOUNT B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Tonia L. Fasnacht Street Address 105 Hollar A venue City Shippensbuig State Year(s) Commission paid 2006 Attorney's Fees David P. Perkins, Esquire PA Zip 17257 -- 2. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 1,750.00 Street Address 4. City =- Relationship of Claimant to Decedent Zip State Probate Fees Register of Wills 5. Accountant's Fees 89.00 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland Law Journal-advertising letters 2 The NewS-Chronic1e-advertising letters 75.00 92.75 Total of Continuation SChedUfe(s) TOTAL (Also enter on line 9, Recapitulation) 19.50 2,321.25 45.00 250.00 . I Schedule H FlI1eIaJ ~& AOninistrative CosIs CCIltinued I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ES~ATE OF ~ Diven, Anita L. 3 I Postage - David P. Perkins I FILE NUMBER 21 - 05 - 01033 19.50 Page 2 of Schedule H *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEAl TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Diven, Anita L. Include unreimbursed medical expenses. FILE NUMBER 21 - 05 - 01033 =---- ITEM NUMBER 1 Credit Management Company-colJection agent for Chambersburg Hospital 2121 Noblestown Road Pittsburgh, P A 15205 DESCRIPTION AMOUNT 2,379.13 TOTAL (Also enter on Line 10, Recapitulation) 2,379.13