HomeMy WebLinkAbout04-21-06
REV-1500 EX + (6-00)
.
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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OFFICIAL USE ONLY
FILE NUMBER
2 1 - 0 5
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
'"'CO'UNTYCOOE ---YEAr- - - 'NUM'B'ER- -
o 7 0 5
SOCIAL SECURITY NUMBER
ROBERTS MARY
DATE OF DEATH (MM-DD-Year)
ELLEN
DATE OF BIRTH (MM-DD-Year)
1 95- 3 2 - 4 9 8 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
07/22/2005 04/10/1942
(IF APPLICABLE) SURVIVING SPOUSE'S NAME {LAST, FIRST, AND MIDDLE INITIAL}
[Xl 1. Original Return
D 4. Limited Estate
00 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 ofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
SOCIAL SECURITY NUMBER
D 3. Remainder Return (date of 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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COMPLETE MAILING ADDRESS
54 EAST MAIN STREET
........'1 11111I~i""
NAME
MURREL R. WALTERS III, ESQUIRE
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717-697-4650
MECHANICSBURG
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
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)
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)
x _ (15)
79,462.28 X .045 (16)
X .12 (17)
X .15 (18)
(19)
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. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(8)
(11 )
(12)
(13)
(14)
85,350.00
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24,894.36 ,~J CJ 0
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19,028.00
11 ,754.08
PA 17055
OFFI<fLS- USE ONLY
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110,244.36
30,782.08
79,462.28
79,462.28
3,575.80
3,575.80
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Dece ents ampl e e ress:
STREET ADDRESS
6402 SALEM PARK CIRCLE
CITY I STATE I ZIP
MECHANICSBURG PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
3,575.80
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
T otallnterest/Penalty ( D + 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. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check to: REGISTER OF WILLS, AGENT
0.00
3,575.80
3,575.80
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 [&]
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [&]
c. retain a reversionary interest; or ............................................................ .......................................... 0 [&]
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? ................. 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 ~
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 perjury, I declare that I have examined this returnj'including accompanying 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 rspresentative i based on all inform . n of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR 'INRETU
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. DATE
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ADDRESS
PA 17055
DATE
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ADDRESS
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. 99116 (a) (1.1) (i)J.
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 exemot 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. 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 4.5%, except as noted in 72 P.S. 99116(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. 99116(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.
REV-1502 EX + (6-98)
-*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ROBERTS MARY ELLEN 21 05 0705
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
exchanged 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 iointly-owned with right of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
85,350.00
6402 SALEM PARK CIRCLE
SILVER SPRING TOWNSHIP, CUMBERLAND COUNTY
MECHANICSBURG, PA 17050 - ASSESSED VALUE
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
85,350.00
REV-1508 EX + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROBERTS MARY
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
ELLEN 21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of sUNivorship must be disclosed on Schedule F.
0705
ITEM
NUMBER
1.
SOVEREIGN BANK
CHECKING ACCOUNT
2.
SOVEREIGN BANK
SAVINGS ACCOUNT
3.
1998 HONDA ACCORD
DESCRIPTION
VALUE AT DATE
OF DEATH
19,866.34
4,028.02
1 ,000.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
24,894.36
REV-1511 EX + (12-99)
.*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROBERTS
MARY
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
ELLEN
21
05
0705
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS-HARNER FUNERAL HOME, INC. 7,347.00
2. GRAVE OPENING 995.00
3. FUNERAL LUNCHEON 295.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) D. .lAMES LINCOLN 5,370.00
Social Security Numbe~s)/EIN Number of Personal Representative(s) 168-48-4276
Street Address 105 CAMBRDIGE DRIVE
City MECHANICSBURG State PA Zip 17055
Year(s) Commission Paid:
2. Attorney Fees MURREL R. WAL TERS III, ESQUIRE 4,650.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS - CUMBERLAND COUNTY 371.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 19,028.00
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV-15~2 EX + (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ROBERTS
FILE NUMBER
MARY
ELLEN
21
05
0705
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
Include unreimbursed medical expenses.
DESCRIPTION
PP&L
ELECTRIC
APRIA HEAL THCARE, INC.
HEALTHCARE-OXYGEN
PA AMERICAN WATER CO.
WATER
VERIZON
PHONE
COMCAST
CABLE
CINGULAR WIRELESS
CELL PHONE
AT&T
PHONE
HAMPDEN TOWNSHIP
SEWERlTRASH
M&Z CARPET
CARPETITILE
SALEM PARK
HOMEOWNERS ASSN DUES
TRINSIC
PHONE
MARK LINCOLN
HOME REPAIRS
BBT MORTGAGE
HOUSE MORTGAGE
APRIA HEAL THCARE
OXYGEN
VALUE AT DATE
OF DEATH
716.60
476.59
267.73
121.30
31.29
24.51
23.42
363.00
2,775.87
127.00
62.37
3,200.00
3,511.45
52.95
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
11,754.08
REV.15.'3.EX+<W
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
J-i lHt-J-iTS
SCHEDULE J
BENEFICIARIES
FI LEN
MARY
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
D. JAMES LINCOLN
205 CAMBRDIGE DRIVE
MECHANICSBURG, PA 17055
MARK D. LINCOLN
125 FROST ROAD
GARDNERS, PA 17324
STEVEN A. LINCOLN
3084 E. HARRISBURG PIKE
MIDDLETOWN, PA 17057
2.
3.
FILE NUMBER
21 05
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
SON
SON
SON
0705
AMOUNT OR SHARE
OF ESTATE
1/3
1/3
1/3
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 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)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WALTERS MURREL Rill
54 E MAIN STREET
MECHANICSBURG, PA 17055
-------- fold
EST A TE INFORMATION: SSN: 195-32-4985
FILE NUMBER: 2105-0705
DECEDENT NAME: ROBERTS MARY ELLEN
DATE OF PAYMENT: 04/21/2006
POSTMARK DATE: 04/21/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 07/22/2005
NO. CD 006583
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $3,000.00
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TOTAL AMOUNT PAID:
$3,000.00
REMARKS:
MURREL WALTERS, III ESQ
CHECK# 546
SEAL
INITIALS: RSK
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS