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Home My WebLink About04-17-06 (3) -' 15056041125 REV-1500 EX (06-05) PA Department of Revenue * ~~~~:~~=ualTaxes INHERITANCE TAX RETURN Hanishu ,PA 1712~601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 5 File Number 034 4 184265479 Date of Birth 032 420 0 5 091 6 1 9 3 5 Decedent's Last Name FRY' Suffix Decedent's First Name (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix S H I R LEY Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW o 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach Copy of Will) o 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS [gJ 2. Supplemental Retum 0 3. Remainder Retum (date of death prior to 12-13-82) o 4a. Future Interest Compromise (date of 0 5. Federal Estate Tax Retum Required death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach Copy of Trust) o 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime T eJephone Number 8. Total Number of Safe Deposit Boxes J A C QUE L I N E A K ELL YES Q Firm Name (If APPlicable) 71754 1 555 0 J A N L B ROW N ASS 0 C I ATE S I REGISTE~,dF WillS USE~i.. Y i :::::::::8 C;)'". I First line of address 845 SIR THO MAS C 0 U R T Second line of address .....,....,~ SUI T E 1 2 City or Post Office r::'~5 L__~__DATE FllE~_ -~(.l]_ U) H A R R I S BUR G State ZIP Code P A 1 7 1 0 9 Correspondent's e-mail address:JACKIEJLBVERIZON.NET CARLISLE PA 17013 SUITE 12 HARRISBURG PLEASE USE ORIGINAL FORM ONLY PA 17109 L. Side 1 15056041125 15056041125 --1 MI. A MI --' 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: SHIRLEY A. FRY RECAP'TULA T'ON 184265479 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 2 6 1 7 3 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. Jointiy Owned Property (Schedule F) 0 Separate Billing Requested . . . . . .. 6. 7. Inter-Yivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate BIlling Requested. . . . . .. 7. 8. Tota' Gross Assets (total lines 1-7) ........................... 8. 2 6 1 7 3 2 3 0 0 0 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) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3 0 0 0 2 5 8 7 3 2 12. Net Value of Estate (line 8 minus line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has nol been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (line 12 minus line 13) . . . . . . . . . . . . . . . . . . 14. 2 5 8 7 3 2 TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of line 14 taxable at the Spousal tax rate, or transfers under Sec. 9116 0 0 0 0 0 0 (a)(1.2) X.O _ 15. 16. Amount of line 14 taxable 2 5 8 7 3 2 1 1 6 4 3 at lineal rate X .012- 16. 17. Amount of line 14 taxable 0 0 0 0 0 0 at sibling rate X. 12 17. 18. Amount of line 14 taxable 0 0 0 0 0 0 at collateral rate X. 15 18. . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " . . .. . . . 19. 1 1 6 4 3 19. Tax Due 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o < ~~)~~ ~.~.\?~. X\<. ""\ \'\ L Ide 2 1505604212 15056042126 ....J R~V-1500 EX Page 3 Decede'nt's Complete Address: DECEDENT'S NAME SHIRLEY A. FRY STREETADDRESS ~.. -----~. 1 SHERWOOD DRIVE -------------------..------ File Number 0344 CITY MECHANICSBURG ~._~._~----- .--- ---- I STATE , ZIP I PA 117055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 116.43 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C ) (2) 0.00 T otallnterest/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) A. Enter the interest on the tax due. 0.00 0.00 116.43 Make Check Payable to: REGISTER OF WILLS, AGENT (SA) (58) 116.43 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. 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 00 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 consideratiOll? .................. ....... ..... .................................... ..................... 0 00 3. Did decedent own an 'in trustfor' or payable upon death bank account or security at his or her death? ......... 0 00 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. 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. 99116 (a) (1.1) (i)J. For dates of death on or after January 1, 1995, the tax rate impoSed OIl the net value of transfers to or for the use of the surviving spouse is zero (0) percenl [72 P. S. 99116 (a) (1.1) (ii) J. The statute does not exem~t 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. 99116(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. 99116(1.2) [72 P.S. 99116(a)(1)J. 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. 99116( a)(1. 3)). A sibiing is defined, under Seclion 9102, as an individuai who has at ieast one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) . - COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~STATE OF SHIRLEY A. FRY SCHEDULE B STOCKS & BONDS L FILE NUMBER 0344 ITEM NUMBER 1. All JIl'Operly jointty-ownOd with right of survivorship must be disclosed on Schedule F. Metlife stock 68 shares of common stock @ $38.49 see attached valuation DESCRIPTION VALUE AT DATE OF DEATH 2,617.32 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2 617.32 REV-1511 EX + (12-99) . * COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SHIRLEY A. FRY SCHEDULE H FUNERAL EXPENSES & ADMINISTRA TIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 0344 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 8. ADMINISTRA TlVE 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 3. Family Exemption: (If decedents address Is not the same as claimanfs, a!tach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. Register of Wills--SuPPlementallnheritance Tax Return filing fee 15.00 8. Register of Wills-Supplemental Inventory filing fee 15.00 TOTAL (Also enter on line 9, Recapitulation) $ 30.00 (If more space is needed, insert additional sheets of the same size) RELA TlONSH/P TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pndude outright spousal distributions, and transfelS under Sec. 9116 (a) (1.2)] 1. Judy A. Fry Lineal 517.46 190 Birch Lane Carlisle, P A 17013 2. Lori A. Trace Lineal 517.46 20 W. Simpson Street Mechanicsburg, PA 17055 3. Christopher R. Trace, c/o Judy A. Fry, Trustee Lineal 258.74 20 W. Simpson Street Mechanicsburg, PA 17055 4. Matthew E. Trace, c/o Judy A. Fry, Trustee Lineal 258.73 20 W. Simpson Street Mechanicsburg, PA 17055 5. Larry W. Biller Lineal 517.46 6317 Forrest Drive Mechanicsburg, PA 17050 6. Regina B. Biller Lineal 258.73 441 Mumper Lane Dillsburg, PA 17019 7. Lindsay M. Biller Lineal 258.74 6317 Forrest Drive Mechanicsburg, PA 17050 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ R.EV_'513EX:(*, COMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~HIRLEY A. FRY SCHEDULE J BENEFICIARIES I FILE NUMBER 0344 (If more space is needed, insert additional sheets of the same size) - ATTACHMENT TO REV-1500 ESTATE OF Fry, Shirley A. FILE NUMBER 21 05 0344 A Supplemental Inheritance Tax Return is being filed in order to report the discovery of an additional estate asset. The additional asset was discovered after the filing of the initial Inheritance Tax Return, which was filed on September 26,2005 and accepted on January 6, 2006. Additional estate expenses are also being reported on Schedule H as these expenses are filing fees incurred from the discovery of the additional estate asset. 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