The URL can be used to link to this page

Home My WebLink About04-17-06 REV - 1500 EX + (6..00) *' REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT,280601 HARRISBURG. PA 17128-0601 21 05 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 01120 NUMBER "" z UJ o UJ U UJ o ! DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) i CLOSS, ALICE G i DATE OF DEATH (MM-DD-YEAR) 12/23/2005 142-24-8708 DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 06/15/1931 REGISTER OF WILLS SOCIAL SECURITY NUMBER UJ "" ~:$Ul Ul>:~ UJo..U J:OO 1>:-" iICABlE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL) ~ 1. Original Return 0 2. Supplemental Return I 0 4. Limited Estate 0 4a. Future Interest Compromise (date of death after I 12-12-82) ~ 6 Decedent Died Testate (Attach copy 0 7 Decedent Maintained a Living Trust (Attach o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required o 8. Total Number of Safe Deposit Boxes Uo..lIl of Will) copy of Trust) ~ 0.. < 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 12-31-91 and 1-1-95) ~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ----- tAME COMPLETE MAILING ADDRESS ."" UlZ Daniel K. Deardorff UJUJ IRM NAME (If applicable) 1>:0 10 East High Street I>:z Martson DeardorffWilliarns & Otto 00 Uo.. Carlisle, P A 17013 ElEPHONE NUMBER 717/243-3341 -- ....... ----., 1. Real Estate (Schedule A) (1 ) None I 2. Stocks and Bonds (Schedule B) (2) None I 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None I 4. Mortgages & Notes Receivable (Schedule D) (4) None ! I ! 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 3,370.48 I (Schedule E) I 6. Jointly Owned Property (Schedule F) (6) None z o Separate Billing Requested I 0 i 5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None .- --~.- I " (Schedule G or L) "" 0:: 8. Total Gross Assets (total Lines 1-7) (8) 3,370.48 < U UJ 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 12,719.52 I>: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 35,993.26 11. Total Deductions (total Lines 9 & 10) (11 ) 48,712.78 12. Net Value of Estate (Line 8 minus Line 11) (12) insolvent 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) chedule J made (S 14. Net Value Subject to Tax (Line 12 minus Line 13) z o >= < "" " 0.. ::E o U ~ "" (14) x .00 (15) --------- x .045 (16) x .12 (17) x .15 (18) (19) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 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 19. Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) ~..J ~,,~:r" J\.~/ " / Decedent's Complete Address: STREET ADDRESS 145 Imperial Court CITY I STATE PA I ZIP 17013 Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) 3. Interest/Penalty if applicable D. Interest E. Penalty 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 greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (1 ) (2) 0.00 (3) 0.00 (4) (5) 0.00 (5A) (5B) 0.00 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 ~ :: ~::::~ ~;e~;~;i:on:~:~~;:s~~~. .~.~~~~. ~~~.~~~. :'~.~.~.~.~:. .t~~.~~.~~~~~~. ~~ .i.t.~. ~~~~~~~:::::::::::::::::::::::::::::::::::: ~ ~ d. receive the promise for life of either payments, benefits or care?.............................................................. 0 ~ 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 ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. pre parer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR F. G RETURN ADDRESS Patrick E. Closs _:::vy',/"'/ 7/ C--z...... 1550 Waggoners Gap Road Carlisle, PA 17013 ADDRESS ADDRESS DATE J.) Ii 'il:; DATE I lATE / /)//-'-1/ (C 10 East High Street Carlisle, PA 17013 " ..... ....'i~;j.i'ij;~~~~_W~___~~l~~J.~&..}f.~~,~~[t,;..t~>.~.$;' jf.<. ' 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 3% [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 0% [72 P.S. ~9116 (a) (1.1) (ii)]. 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 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 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. ~9116 (a) (1 )]. The tax rate imposed on the net value of transfers 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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CLOSS, ALICE G I FILE NUMBER 21 - 05 - 01120 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 Citizens Bank, checking #6100728714 DESCRIPTION VALUE AT DATE OF DEATH 706.56 2 Citizens Bank, savings #6245539515 997.92 3 Household goods, appraised value 1,666.00 TOTAL (Also enter on Line 5, Recapitulation) 3,370.48 *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CLOSS, ALICE G I FILE NUMBER 21 - 05 - 01120 Debts of decedent must be reported on Schedule I. ITEM I NUMBER DESCRIPTION A. i FUNERAL EXPENSES: 1 Hoffman-Roth Funeral Home AMOUNT 7,334.70 2 Carlisle Memorial Service Inc. 1,278.40 3 Cumberland Valley Memorial Gardens, cemetery lot 2,495.00 4 Bon Ton, burial clothing 59.49 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions B. Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Martson Deardorff W illiarns & Otto (estimated) 1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. Probate Fees Register of Wills of Cumberland County 58.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Michael D. Cease, appraisal of personal property 125.00 2 Certified mail, Department of Public Welfare, estate recovery inquiry 4.64 Total of Continuation Schedule(s) 364.29 TOTAL (Also enter on line 9, Recapitulation) 12,719.52 *' Schedule H Funeral Expenses & Pdninistratiw Cos1s continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CLOSS, ALICE G I FILE NUMBER I 21-05-01120 3 Cumberland Law Journal, advertising Letters Testamentary 75.00 4 The Sentinel, advertising Letters Testamentary 144.29 5 Register of Wills, filing fee, inheritance tax return 15.00 6 Register of Wills, filing fee, Account 130.00 Page 2 of Schedule H *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CLOSS, ALICE G i FILE NUMBER I 21-05-01120 Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 DESCRIPTION AMOUNT Citizens Bank, checking, outstanding check on date of death 74.11 Internal Revenue Service, account payable, taxes 14,594.13 Capital Tax Collection Bureau, account payable, personal taxes 2,133.22 Penn Credit Corporation, account payable, per capita taxes 57.00 Commonwealth Financial Systems, Inc., judgment entered to No. 05-6332 Civil, in Court of Common Pleas of Cumberland County 8,117.50 TRIAD vantage Credit Services, collection for USAA Federal Savings Bank #5458830022031880 2,816.11 Academy Collection Service, collection for Target Visa #7352373388471994 2,090.19 Paragon Way, Inc. collection for Monogram Credit Card #CG8890907135313 1,946.36 Plaza Associates, collection for Citibank Shell Credit Card #514643782 1,116.53 Northland Group, collection for Capital One #5291151771435219 972.29 Alliance One, collection for Capital One #5291071503300848 816.98 First National Bank of Marin, Visa #4447960112689102 257.50 CollectCorp Corporation, collection for American Express Acct #373076291821006 72.48 Credit Collection Services, collection for Liberty Mutual 48.20 PPL, account payable, electric service 435.44 Sprint, account payable, telephone service 255.91 Comcast, account payable, cable service 95.59 Cumberland County Office of Aging, account payable, personal care 46.08 Andorra Radiology Assoc. P.c., account payable, medical service 47.64 TOTAL (Also enter on Line 10, Recapitulation) 35,993.26 REV.1513 EX+ (9-00) .* SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I FILE NUMBER 21-05-01120 RELATIONSHIP TO I AMOUNT OR SHARE DECEDENT OF ESTATE ESTATE OF CLOSS, ALICE G I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) None due to insolvency 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 1'" /1;:;' ;.:.) '.,l 'J: "'" ;; N,( E-!: ~) ~ . --'<!; .;1 ~ " - -... R;: ,,< -; ') Account Number 6245539515 Account Title ALICE G CLOSS Date Opened 12/14/2004 Account Type Savings Principal Balance as of DaD $997.92 -- Interest from Last Posting to DOD $ .00 Account Balance as of DaD $997.92 YTD Interest to DOD $1.15 ~~ (.t.. -- -,8- <'-' ,-" - I I ze n s _ a fl ~< Account Number 6100728714 Account Title ALICE G CLOSS Date Opened 2/28/1978 Account Type Checking Principal Balance as of DOD $706.56 Interest from Last Posting to DaD $ .00 Account Balance as of DOD $706.56 YTD Interest to DOD $ .00 :5L./l F I~}J~S - ) I 0- z.. F \FILESDATAFILE\Esme Pl3nning\IIIOS-1 w111.2004 LAST WILL AND TEST AMENT I, ALICE G. CLOSS, of Carlisle Borough, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all former Wills or Codicils made by me. 1. I direct that all my legally enforceable debts, funeral expenses. testamentary expenses and all death taxes (whether such taxes may be payable by my estate or by any recipient of any property) shall be paid from my residuary estate as soon as practicable after my decease and as part of the administration of my estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax so paid, even though on proceeds of insurance or other property not passing under this Will. 2. I give, devise and bequeath all of my estate, both real and personal property, unto my children, JAMES CLOSS, THOMAS CLOSS, TYLER CLOSS, PATRICK CLOSS and LESLIE A. BLESSING, provided that the share of any child who predeceases me shall be distributed to his or her issue, per stirpes, and in default of any such then-living issue, such share shall be distributed to my surviving children. 4. I nominate, constitute and appoint my son, PATRICK E. CLOSS, as Executor of my estate. In the event he is unwilling or unable to so act, then I appoint my daughter, LESLIE A. BLESSING, to act in such capacity. 5. I direct that my Executor shall not be required to file a bond to secure the faithful performance of his duties in any jurisdiction. 6. I authorize and empower my Executor, in his sole and absolute discretion, to purchase or otherwise acquire and retain any investments of which I die seized or any real or personal property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant options in A6- (2 [Initials] Page 1 of 3 Pages