HomeMy WebLinkAbout04-19-05
~EV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVI ING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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FILE NUMBER
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COUNTY CODE YEAR
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NUMBER
[XJ 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
D 9. litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a living Trust (Attach copy 01 Trust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
SOCIAL SECURITY NUMBER
S- '2- " - 2-0
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THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date 01 death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME
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FIRM NAME (II Applicable)
COMPLETE MAILING ADDRESS
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TELEPHONE NUMBER
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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)
(1 )
(2)
(3)
(4)
(5)
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(8)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D 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)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus line 11)
(9)
(10)
\D
(11 )
(12)
(13)
'11 sr1.1/S"
(6)
(7)
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
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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(14)
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16. Amount of Line 14 taxable at lineal rate
x .0 _ (16)
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(19)
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17. Amount of Line 14 taxable at sibling rate
x .12 (17)
x .15 (18)
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
Decedent's Complete Address:
STREET ADDRESS
~ l. L .sOOitf f"I2oV"T ~Tftf(r
CITY
WO~"'l\"'.s Bulte.
I STATE f14-
I ZIP , '7 0 I{ \
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
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Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(5B)
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Make Check Payable to: REGISTER OF WILLS, AGENT
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 r:;;;r
b. retain the right to designate who shall use the property transferred or its income .................... ...... ...... D lZ
c retain a reversionary interest; or..................................... ........ ..... ...... ........... D ~
d receive the promise for life of either payments, benefits or care? ....................... D L""'1
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ..... ............ ................ ...... D c;..r-
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 L6
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 perJuy I declare tha' I have examined thiS return. including accompanpng 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.
SIGNATURE OF PER~ON f}~SpON~JBLE fOR FI~ING RETURN / DATE
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SIGNATURE OF R EP ER THER THA REPRES ~NTATIVE
ADDRESS
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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 PS ~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
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 paren
or a stepparent of the child is 0% [72 PS. ~9116(a)(1.2)].
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T~'\tl~ 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 PS. ~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. s9116(a)(U)J. A sibling is defined, under Section 9102. as a
ndividual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-l508 EX + (1-97)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
(p,.s~A- C. St""p.sOA)
FilE NUMBER
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.
DESCRIPTION
VALUE AT DATE
OF DEATH
M ~'\ BA-WK - CWi-illl"''' 1rlt ()UN't AJo. 71 t S- J J'S""r-
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TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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R~V-1513 E~+ (9-oo*,
COMtVlONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER
I
FILE NUMBER
L 1>, ..s$A- (.. 51 IK P SD1J
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
1.
Sin p~,,~ St,
i
H".sISItP(.)
AMOUNT OR SHARE
OF ESTATE
'DO %
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
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s ) "t. ~b \J"t" If F 20 11\'" S. T fl f \ 1""
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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)
71776370:24
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ClAsstc CHECKING
DEC.17-JAH.18~2006
1 OF 1
ao 0 06123"~" II?
MRS EDISSA M SIMPSON
322 S FRONT S1
WORMLEVSBURG PA 17043-1340
1'.108
WEST SHORr PLAZA
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ND. AttDUNT
7,559.4!J 0 0.00
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ACCOUNT
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12-17-D~ BEGINNING BALANcE
12-22.D5 CLOSEOUT
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eNDING BALANe~
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DO VOUR TAXES WITH TURBOTA)URJ ONLINElSHl t BROUGHT TO YOU By HIT' IT.5 EASY,
THERE Is NO SOfTWARE TO DDWNLOAD OR IttSTALl. FILE VOUR RETuRN ELECTRONICALl v TO
gET YOUR REFUND fASTER. THE EASYSTEPlR) INT.EftVIEW ASKS SIMPLE QUESTIONS AND
PLACES YOUR ANSWERS INTO IRS APPROVED FORHS. THERE IS NO RISK - TRY IT BEFORE
YOU PAY! gET sTARTED Af WW.tlAt.oT8AN1( .CO"/TURBOTA)(!
TURBOTAX AND EASVSTEP ARE REGISTERED TRADE"AR~S AND TURBOTAX ~LINE IS A SERVICE
"ARK OF INTUIT INC.
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LAST WILL AND TESTAMENT
OF
EDISSA C. SIMPSON
I,
EDISSA C.
SIMPSON, of Wormleysburg,
County of
Cumberland, Corrunonwealth of Pennsylvania, being of sound mind,
memory and understanding, do make, publish and declare this to be
my Last Will and Testament, hereby revoking and declaring null and
void any and all wills and codicils at any time heretofore made by
me.
FIRST:
I direct my Executor, hereinafter named,
to pay my just debts, expenses of my last illness and my funeral
expenses as soon as convenient after my death.
SECOND: I declare that I am presently married to
CHARLES L. SIMPSON, SR., and any and all references in this will to
the term "my husband" refers to my beloved husband, CHARLES L.
SIMPSON, SR.
THIRD:
I give, devise and bequeath my entile
estate either, real, personal and mixed of whatever nat'Jye and
wheresoever situate, which I may own or have the right to dispose
of at the time of my death, to my husband, CHARLES L. SIMPSON, SR. I
to have and to hold the same for his own use absolutely and
forever.
FOURTH: In the event that my husband should
1
predecease me or fail to survive me by sixty (60) days, I direct
that my estate be liquidated and distributed in equal shares to my
children, namely my daughter, SANDRA M. LINDUSKA, of Chesterfield,
Virginia, my daughter, PAMELA J. SIMPSON, of Wormleysburg,
pennsyl vania, my son, CHARLES L. SIMPSON, JR, of Wormleysburg,
Pennsylvania, and my son, RUSSELL W. SIMPSON, of San Ramon,
California. In the event that anyone of my above named
beneficiaries shall predecease me or fail to survive me for a
period of sixty (60) days, the share that otherwise would pass to
that predeceased heir shall instead pass, per stirpes to the
deceased beneficiaries issue.
FIFTH: I appoint my husband, CHARLES L. SIMPSON, SR as
the Executor of this will. No bond or other securi ty shall be
required of any Executor appointed in this will.
SIXTH: In addition to all the powers conferred by
law upon my Executor and not in limi ta tion thereof, I hereby
authorize my Executor to sell any bonds, stocks or other personal
property and any and all real estate which I may own at the time of
my death, without the order of authority of any Court being
required, at public or private sale, upon such terms as may in the
discretion of my Executor seems to be in the best interest of my
estate. In pursuance of his power, my Executor shall execute and
deliver all documents of conveyance, including deeds or bills of
sale or any other instruments which may effectively transfer title.
2
I further authorize my Executor to settle and compromise any and
all claims in connection with the administration of my estate
herein and to do any and all things in his sound discretion, which
shall be conducive to the best interest of my estate.
It is my
desire that these powers be given to any successor to my named
Executor.
It shall not be necessary for any purchaser to see the
application of any purchase money, nor shall any person or
corporation inquire as to the propriety of any such sale or
assignment.
SEVENTH:
All pronouns referring to an executor
and the term "executor" shall be construed to mean any person
acting as my executor and the gender shall be construed as either
masculine, feminine or neuter.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
a t Cumberland County , Pennsylvania this I ()
da y 0 f ~~~ :..." '11(. ,
2005.
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Edissa C. Simpson
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The foregoing instrument was signed, sealed, published and
declared by the above named Testatrix, Edissa C. Simpson, as and
for her Last Will and Testament, in the presence of us, who at her
request, in her presence and in the presence of each other, have
hereunto subscribed our names as witnesses.
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
58:
COUNTY OF CUMBERLAND
I, Edissa C. Simpson, Testatrix, whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Will; that I signed it willingly; and
that I signed it as my free and voluntary act for the purposes
therein expressed.
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Edissa C. Simpson /
SWORN or affirmed to and acknowledged before me by Edissa
c.
Simpson,
the
Testatrix,
this
. \ .
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day
of
!.'<'\(t< '.:. \'," \";~' < ,:'
, 2005.
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NotarJy Public
NOTARIAl SEAL
TRACY K KATSHIR. ~_~ ~ okl1_ . .
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My Corimssial Expires Feb. ~ ~
5
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF CUMBERLAND
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the
wi tnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw the Testator sign and execute the
instrument as her Last Will, that she signed willingly and that she
executed it as her free and voluntary act for the purpose therein
expressed; that each of us in the hearing and sight of the Testator
signed the Will as witnesses and that to the best of our knowledge,
the Testator was at that time eighteen (18) or more years of age,
of sound m~~~nd under no con:traint or Indue
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SWORN or affirmed to and subscribed to before me by
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, and f :1,,- i:". Ii V itr'H"; ...t..
witnesses, this
~ day of N:.0:..y-,~(/L,
, 2005.
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