HomeMy WebLinkAbout05-05-06
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1Ea:ff>41169
REV-1500 EX (06-05)
PADepartmenl of Revenue
Bureau of Individual Taxes
PO Box 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
2- 05
File Number
03lcl
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
196.22.1510
04142005
01231929
Decedent's Last Name Suffix
Decedent's First Name
GARCY
JOHN
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
GARCY
GERALDINE
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
~ 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
i 10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
8. Total Number of Safe Deposit Boxes
6. Decedent Died Testate
(Allach Copy of Will)
9. Litigation Proceeds Received
CORRESPONDENT - lHlS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
,.....~
;.--)
FRANK H KELLY, EA
717.774.7,~6
,:-)
REGISTER OF WILLS USE O~v.
. ')
Firm Name (If Applicable)
KELLY FINANCIAL SERVICES INC
01
First line of address
400 BRIDGE STREET SUITE #4
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I;
Second line of address
---.j
City or Post Office
State
ZIP Code
DATE FILED
NEW CUMBERLAND
PA
17070
Correspondent's e-mail address:FRANKKELLY@KELLYTA~.COM
Under penalties of perjury, 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 Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
PONSIBLE Ii FILING RETURN Q./p AT~
UtlCA6tJ It... &Jt Og
DATE
ADORES
PLEASE USE ORIGINAL FORM ONLY
Side 1
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1~1100
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15CHD42100
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: JOHN J GARey
RECAPITULATION
196.22.1510
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . .
11.
0.00
0.00
0.00
0.00
8,972.00
0.00
0.00
8,972.00
5,187.00
0.00
5,187.00
3,785.00
0.00
3,785.00
1. Real estate (Schedule A) . . . . . . .
.. 1.
2. Stocks and Bonds (Schedule B) . . .
.. 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 Properly (Schedule E) ........ 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested ." .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested. . . .. 7.
8. Total Gross Assets (total Lines 1 - 7) . . . . . . 8.
9. Funeral Expenses & Administrative Costs (Schedule H) . . .
... 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . .
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) .
12.
13.
14. Net Value Subject to Tax (Line 12 minus Line 13) .
14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 4,285
(a)(1.2) I I .045 15. 192.83
16. Amount of Line 14 taxable
at lineal rate [I .0 16. 0.00
17. Amount of Line 14 taxable
at sibling rate IJ .12 17. 0.00
18. Amount of Line 14 taxable
at collateral rate I I .15 18. 0.00
19. TAX DUE ................... . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 192.83
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Side 2
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15CHD42100
15CHD42100
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REV-1500 EX Page 3
Decedent's Complete Address:
File Number 2 0 0 5 . 0 0 3 6 7
DECEDENTS NAME
JOHN J. GARCY
STREETADDRESS
601 ALISON AVE
CITY I STATE 1ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
192.83
250.00
Total Credits (A B C) (2)
250.00
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
4.
Total Interest/Penalty (D
If Line 2 is greater than Line 1" Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box on Page 2, Line 20 to request a refund.
E)
(3)
(4)
(5)
(5A)
(5B)
0.00
57.17
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
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Yes No
24
21
21
rA
;1
21
X
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. ~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 zero (0) percent
[72 P.S. S9116(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 zero (0) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [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.
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REV-1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchange between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1. NONE
DESCRIPTION
VALUEAT DATE
OF DEATH
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
NONE
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets afthe same size)
0.00
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
REV-1504 EX+ (6-98)
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
Schedule C-1 or C-2 (induding all supporting information) must be attached for each dosely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitledfor sole-proprietorships.
ITEM
NUMBER
1. NONE
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1505 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
JOHN J. GARey
1. Name of Corporation NON E
Address
FILE NUMBER
2005.00367
State of Incorporation
Date of Incorporation
City
2. Federal Employer 1.0. Number
3. Type of Business
State
Zip Code
Total Number of Shareholders
Business Reporting Year
Product/Service
4.
STOCK TYPE TOTAL NUMBER OF PAR VALUE NUMBER OF SHARES VALUE OF THE
Voting/Non-Voting SHARES OUTSTANDING OWNED BY THE DECEDENT DECEDENTS STOCK
Common $ 0.00
Preferred $ 0.00
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? . . . . . .
If yes, Position
Annual Salary $
I Yes No
Time Devoted to Business
6. Was the Corporation indebted to the decedent? . . . .
If yes, provide amount of indebtedness $
I Yes
No
7. Was there life insurance payable to the corporation upon the death of the decedent? . . . . . . . . . . . . I i Yes i No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer any stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
Yes ! No If yes, I Transfer i Sale Number of Shares
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers andlor sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? . . . . . . .
If yes, provide a copy of the agreement.
Yes
No
10. Was the decedent's stock sold? . . . . . . . . .
If yes, provide a copy of the agreement of sale, etc.
.......... i Yes
I No
11. Was the corporation dissolved or liquidated after the decedent's death? . . . . . . . . . . . . .. I Yes No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . .. .......... Yes i No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete addressles and estimated fair market valuels. If real estate appraisals have
been secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
Go Any other information relating to the valuation of the decedent's stock.
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
1. Name of Partnership NONE
Date Business Commenced
Address
Business Reporting Year
City
State
Zip Code
2. Federal Employer I.D. Number
3. Type of Business ProducUService
4. Decedent was a I General I j Limited partner. If decedent was a limited partner, provide initial investment $
5.
PARTNER NAME PERCENT PERCENT BALANCE OF
OF INCOME OF OWNERSHIP CAPITAL ACCOUNT
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent?
If yes, provide amount of indebtedness $
I Yes
! No
8. Was there life insurance payable to the partnership upon the death of the decedent? . . . Yes No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to
12-31-82?
:] Yes I I No
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
If yes,
Transfer
[- Sale
Percentage transferred/sold
Consideration $
Date
10. Was there a written partnership agreement in effect at the time of the decedent's death? . . . . . . . . . [ . Yes ! No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold?
If yes, provide a copy of the agreement of sale, etc.
i Yes
No
12. Was the partnership dissolved or liquidated after the decedent's death? . . . . . . . . . . . . . . . . . . . . .. j ] Yes [No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? . . . . . .
If yes, explain
j Yes
No
14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . . . .. [Yes I No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
REV-1507 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUEATDATE
OF DEATH
NONE
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
JOHN J. GARCY
FILE NUMBER
2005.00367
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.
ITEM
NUMBER
1.
2.
3.
DESCRIPTION
VAlUEAT DATE
OF DEATH
7,094
1,290
588
COIN COLLECTION
ASSORTMENT OF GUNS
ASSORTMENT OF RIFLES
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8,972.00
REV-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
lfan asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINTTENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY "kOF DATE OF DEATH
ITEM FOR JOINT MAIlE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAl ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL (Also enter on line 6, Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
This schedule must be completed and filed ilthe answer to any 01 questions 1 through 4 on the reverse side olthe REV-1500 COVER SHEETis yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RElATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. 0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
TOTAL (Also enter on line 7, Recapitulation) $ 0.00
(II more space is needed, insert additional sheets 01 the same size)
REV-1511 EX+ (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
JOHN J. GARCY
FILE NUMBER
2005.00367
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1
DESCRIPTION
AMOUNT
FUNDERAL EXPENSES:
MYERS FUNERAL HOME
MECHANICSUBRG PA 17055
4,687
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Numberof Personal Representative(s)
Street Address
City
State ZIP
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is notthe same as claimant's, attach explanation)
Claimant Geraldine M Garey
Street Address 6 0 1 AL i son A v e
City Meehaniesurg
State P A ZIP 1 7 0 5 5
Relationship of Claimant to Decedent S pO use
4. Probate Fees
5.
Accountant's Fees
500.00
6. Tax Retum Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
5,187.00
REV-1512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
Report debts incurred by the decedent prior to death which remained unpaid as ofthe date of death, including un reimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. None
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
JOHN J. GARey
NUMBER
I
1.
2 .
3.
4.
5.
6.
FILE NUMBER
2005.00367
NAMEANDADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116(a)(1.2)]
Geraldine Garey
Meehaniesburg PA
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNTORSHARE
OF ESTATE
Spouse
Valerie Garey
Bowie MD
Daughter
Kenneth J Garey
Puwallup WA
Son
Daniel J Keane
Bowie MD
Grandson
Mildred Kulehoek
Uniontown PA
Sister
Alexander A Goldbeck
Bowie MD
Granddaughter
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 WHICHAN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAl DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
0.00
(If more space is needed, insert additional sheets of the same size)
REV-1514 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
(Check Box 4 on REV.1500 Cover Sheet)
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89,
actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
'j Will [ Intervivos Deed of Trust i Other
I UFE ESTATE INTEREST CALCULATION I
NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH LIFE ESTATE IS PAYABLE
NONE Life or Term of Years
Life or [ , Term of Years
I Life or I I Term of Years
Life or I Term of Years
Life or i Term of Years
1. Value of fund from which life estate is payable ...................,.......................... $
2. Actuarial factor per appropriate table. . . . . .
Interest table rate - I. 3 1/2% L; 6%
0.000000
10% U Variable Rate
%
3. Value of life estate (Line 1 multiplied by Line 2) . . . . . . . . . . . . . . .
............... $
0.00
I ANNUITY INTEREST CALCULATION I
NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT TERM OF YEARS
DATE OF DEATH ANNUITY IS PAYABLE
Life or I Term of Years
I Life or Term of Years
Life or I Term of Years
Life or Term of Years
1. Value of fund from which annuity is payable ................................................ $
2. Check appropriate block below and enter corresponding (number) ....... . . . . . . . .
Frequency of payout - I] Weekly (52) [Hi Bi-weekly (26) ,I Monthly (12)
i Quarterly (4) ,I Semi-annually (2) l! Annually (1) Other ( )
3. Amount of payout per period ..... . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
4. Aggregate annual payment, Line 2 multiplied by Line 3 ............
5. Annuity Factor (see instructions)
Interest table rate - [i 3 1/2% C.I 6%
o
$
0.00
10%
Variable Rate
%
0.000000
6. Adjustment Factor (see instructions) . . . . . . . . . . . . .
7. Value of annuity -If using 3 1/2%, 6%, 10%, or if variable rate and period
payout is at end of period, calculation is: Line 4 LJ Line 5 I I Line 6 . . . . . . . . . . . .
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 LI Line 5 [I Line 6) Line 3 . . . , . . . . . . . . . . . . . . . . . . . . . . , . . . . . . .
$
.. $
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of
this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18.
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
INHERITANCE TAX
SCHEDULE L
REMAINDER PREPAYMENT
OR INVASION OF TRUST PRINCIPAL FILE NUMBER 2005. 00367
REV-1644 EX+ (3-04)
I. ESTATE OF
GARey JOHN J
(Last Name) (First Name) (Middle Initial)
This schedule is appropriate only for estates of decedents dying on or before December 12,1982.
This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of
Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal.
II. REMAINDER PREPAYMENT:
A. Election to prepay filed with the Register of Wills on
B. Name(s) of Life Tenant(s)
or Annuitant(s)
(Date)
Date of Birth
Age on date
of election
Term of years income
or annuity is payable
C. Assets: Complete Schedule L-1
1. Real Estate. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. $
2. Stocks and Bonds ........................ $
3. Closely Held Stock/Partnership . . . . . . . . . . . . .. $
4. Mortgages and Notes. . . . . . . . . . . . . . . . . . . . .. $
5. Cash/Misc. Personal Property. . . . . . . . . . . . . .. $
6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
0.00
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . . .. $
2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . . .. $
3. Value of Un includable Assets . . . . . . . . . . . . . . .. $
4. Total from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
E. Total Value of trust assets (Line C-6 minus Line D-4) ............................... $
F. Remainder factor (see Table I or Table II in Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . .
G. Taxable Remainder value (Line E LJ Line F) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $
(Also enter on Line 7, Recapitulation)
0.00
0.00
0.00
III. INVASION OF CORPUS:
A. Invasion of corpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s)
or Annuitant(s)
Date of Birth
Age on date
corpus
consumed
Term of years income
or annuity is payable
C. Corpus consumed .......................................................... $
D. Remainder factor (see Table I or Table /I in Instruction Booklet) . . . . . . . . . . . . . . . . . . . . . . . .
E. Taxable value of corpus consumed (Line C i Line D) .............................. $
(Also enter on Line 7, Recapitulation)
0.00
REV-l64? EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST COMPROMISE
(Check Box 4a on Rev-1500 Cover Sheet)
ESTATE OF FILE NUMBER
JOHN J. GARey 2005.00367
This Schedule is appropriate only for estates of decedents dying after December 12,1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
Will I I Trust ] Other
I. Beneficiaries
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
1.
2.
3.
4.
5.
II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within
9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving
spouse exercises such withdrawal right.
Ii Unlimited right of withdrawal I Limited right of withdrawal
III. Explanation of Compromise Offer:
IV. Summary of Compromise Offer:
1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .... . $
2. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) . . $
3. Value of Line 1 passing to spouse at appropriate tax rate
Check One ~J 6%, i 3%, r: 0% .................. $
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One I _~ 6%, 4.5% ....................... . $
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) . . $
6. Value of Line 1 taxable at collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) . . $
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . $ 0.00
(If more space is needed, insert additional sheets of the same size)
1
'J
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX DIVISION
ESTATE OF
JOHN J. GARey
SCHEDULE N
SPOUSAL POVERTY CREDIT
(AVAILABLE FOR DAlES OF DEATH 01101192 TO 12131/94)
REV-1648 EX (11-99)(1)
FILE NUMBER
2005.00367
I PART I - CALCULATION OF GROSS ESTATE I
1. Taxable Assets total from line 8 (cover sheet) .......... . .................... . ... . . . ...... . . . 1.
2. Insurance Proceeds on Life of Decedent. . . . . . . . . . . . .. . . . . . , . . . . . . . . . . . . . , . .... . .' . ...... . 2.
3. Retirement Benefits .....,........... . .......... . .................. . .. . .. . ........ . 3.
4. Joint Assets with Spouse ............. . ........ . ....... . . . . . . . . . . . . . .... . ............ . 4.
5. PA Lottery Winnings . . . . . . . . . . . . ........ . ..... . ." . . . . . . . . . . .. . .. . .... . ... . 5.
6a. Other Nontaxable Assets: List (Attach schedule if necessary) . . . 6a.
6b.
6c.
6d.
6. SUBTOTAL (Lines 6a, b, c, d) ...... . ... , ......... . .............. . ..' . ., . . . . . . ........ . 6. 0.00
7. Total Gross Assets (Add lines 1 thru 6) ..' . ........ . . . . . . . . . . . . . . . . ..... . .' . ..... . ....... . 7. 0.00
8. Total Actual Liabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........ . ..... . ........ . 8.
9. Net Value of Estate (Subtract line 8 from line 7) ...........,................. . . . . . . . . . . . . . . . 9.
If line 9 is greater than $200,000 - STOP, The estate is not eligible to claim the credit. If not, continue to Part fI. 0.00
I PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Individual Income Tax I
Return for decedent and spouse.)
Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19
a. Spouse .........., . 1a. 2a. 3a.
b. Decedent ......... . 1b. 2b. 3b.
c. Joint . . . . . . . . . . . . . . 1c. 2c. 3c.
d. Tax Exempt Income . . 1d. 2d. 3d.
e. Other Income not
listed above ... . ... . 1e. 2e. 3e.
f. Total ....... . .' . .' . 1f. 0.00 2f. 0.00 3f. 0.00
This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(1 f)
o . 0 - (3f)
0.0 II
0.00
o . 0 - (2f)
(113)
4b. Average Joint Exemption Income. . . . . . .' . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. ................ I I
If line 4(b) is greater than $40,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part 1JI
0.00
I PART III - CALCULATION OF SPOUSAL POVERTY CREDIT FOR RESIDENT AND NONRESIDENT ESTATES I
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less. . . .... . .......... . .. . 1.
2. Multiply by credit percentage (see instructions) . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . ...... . ..... . .. . 2.
3. This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 18 of the cover sheet. . . . . . . . . . . . . . . . . . . . ..... . ... . ... . 3. 0.00
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate . . . . . . . . . . . . . . ................................. . ........... , ... . 4.
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal
Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. . . . . .. . 5. 0.00
.\ .
..
REV-1649 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 0
ELECTION UNDER SEC. 9113(A)
(SPOUSAL DISTRIBUTIONS)
ESTATE OF
JOHN J. GARey
FILE NUMBER
2005.00367
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) ofthe Inheritance & Estate Tax Act
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
if a trust or similar arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated
as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have
made the election oniy as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on
Schedule O. The denominator is equal to the total value of the trust or similar arrangement.
Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse
under a Section 9113(A) trust or similar arrangement.
Description
Value
Part A Total $
Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A) election to tax is being made.
Description Value
0.00
Part B Total $
0.00
(If more space is needed, insert additional sheets of the same size)
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