The URL can be used to link to this page

Home My WebLink About05-02-06 REV .1500 EX + 16~0) . REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONL.V I COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 FIL.,E NUMBER 21 200S" 0321 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) WINFREY, DANA M. 175-64-6877 l- Z u.l C u.l C) W C DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 08/31/2004 08/10/1973 REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) 4. Limited Estate o 2. Supplemental Return o o D 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95 o 3. Remainder Return (date of death prior to 12-13-82) o 5. Federal Estate Tax Return Required 8, Total Number of Safe Deposit Boxes .0 11.Ele'ction to tax under Sec. 9113(A) (Attach Sch 0) W l- ::.:::~(I) UO::~ wo..u ;:I: 00 uO::..J o..[l:) 0.. oCt ~ 1. Original Return o o D 6, Decedent Died Testate (Attach copy of Will) 9. Litigation Proceeds Received COMPLETE MAILING ADDRESS 3901 Market Street Camp Hill, P A 17011-4227 (1 ) None (2) None (3) None (4) None (5) 1,557.04 (6) None (7) None OFFICIAL USE ONLY AME en ~ Lisa Marie Coyne ~ ~ IRM NAME (If applicable) O::z 8 ~ Coyne & Coyne, P.C. ELEPHONE NUMBER 717/737-0464 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (J i"'--.> C::3 c ) C'" 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o 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) -','~1'.lIi I , I C~) " '''), , ; \ C!.} I '-, _~) I :~i,1 (-~ 3. Closely Held .Corporation.. Partnership or Sole-Proprietorship --~.. - ( )".:.',," --< 4. Mortgages & Notes Receivable (Schedule D) t rv . 1 w (8) r~'" o 1,557.04 (9) (10) 11,038.95 4,291.49 11. Total Oeductions (total Lines 9 & 10) (11 ) 15,330.44 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) made (Schedule J) 14. Net Value Subject to Tax (Line 12.minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SlOE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z .045 (16) 0 16. Amount of Line 14 taxable at lineal rate x i= oCt l- ;:) 0.. 17. Amount of Line 14 taxable at sibling rate x .12 (17) :E 0 C) ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) l- 19. Tax Due (19) 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ~opyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) ,{J Decedent's Complete Address: STREET ADDRESS 41 Oak Avenue CITY Camp Hill I STATE PA jZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) Total Credits (A + B + C) (2) 0.00 3. Interest'Penalty if applicable D. Interest E. Penalty 4. Total Interest/Penalty (0 + E) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPA YMENT. Check box on Page 1 Line 20 to request a refund If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 +5A. This is t~eBALANCE DUE. (3) (4) 0.00 5. (5) (SA) (58) 0.00 0.00 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 ~ b. retain the right to designate who shall use the property transferred or its income;................................ D ~ c. retain a reversionary interest; or............................. .__:........................... _................. .............................. D ~ d. receive the promise for life of either payments, benefits or care?.......................................................... D [81 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?............................ ................................ n..................... ...... ........................ D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........ D [81 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?........................... ..---........... ................ _...... ....................... n.................... D r&1 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 return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration preparer other than the personal representative is based on all information of which preparer has .any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS D N WILLEY , R FILING RETURN 41 Oak Avenue Camp Hill, PA 17011-4238 ;z g 10ft; / DATE I ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Lisa Marie Coyne ADDRESS DATE 3901 Market Street Camp Hill, PA 17011-4227 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)]. 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. 99116 (a) (1.1) (ii)J. The statutedoes 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. 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. S9116 1.2) (72 P.S. 99116 (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)]. 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 WINFREY, DANA M. I FILE NUMBER 21 - 2004 - 0321 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 PSECU Savings Acct. DESCRIPTION VALUE AT DATE OF DEATH 9.01 2 PSECU Checking Acct. 1,048.03 3 Misc. Household Furnishings 500.00 TOTAL (Also enter on Line 5, Recapitulation) 1,557.04 *' SCHEDULE H FUNERAL EXPENSES & ADMINIS1RATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WINFREY, DANA M. I FILE NUMBER 21 - 2004 - 0321 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: Dean Wetzler Funeral Home, Milesburg, P A 16853 5,645.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions DIANN WILLEY Social Security Number(s) / EIN Number of P~rsonal Representative(s): 500.00 Street Address 41 Oak Avenue City Camp Hill Year(s) Commission paid Attorney's Fees Coyne & Coyne, P. C. State ~ Zip 17011-4238 2. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Taime Willey Street Address 41 Oak Avenue City Camp Hill 1,000.00 3,500.00 Relationship of Claimant to Decedent State P A Daughter Zip 17011 4. Probate Fees Cumberland County Register of Wills 69.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Postage 39.00 2 Inheritance Tax Filing Fee 10.00 Total of Continuation Schedule(s) 275.95 TOTAL Also enter on line 9 Recapitulation 11,038.95 ~ ~ Schedule H Funeral Expenses & Adninislratiw Costs cootinued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WINFREY, DANA M. I FILE NUMBER 21 - 2004 - 0321 3 Cumberland Law Journal 75.00 4 Patriot News 100.95 5 H&R Bleok --Tax Preparation 100.00 Page 2 of Schedule H .~ ~ SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WINFREY, DANA M. I FILE NUMBER 21 - 2004 - 0321 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 MCI Worldcom, Inc. 133.52 2 Holy Spirit Hospital 25.50 3 UGI 100.10 4 PP&L 1,071.36 5 Quantum Imaging 154.00 6 Craig E. Rahar, DMD 214.01 7 Applied Credit Card (Cross Country Bank) 1,337.99 8 Fashion Bug 723.76 9 Quest Diagnostic 531.25 TOTAL (Also enter on Line 10, Recapitulation) 4,291.49 REY-1313 EX+ (9-00) .... .~ ~ SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WINFREY, DANA M. I FILE NUMBER 21 - 2004 - 0321 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE 00 Not .",t 'n''''t....'..1 I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Taime A. Willey Daughter 1/3 of Residual 2 Kylie Winfrey Daughter 1/3 of Residual 3 Damon Winfrey Son 1/3 of Residual ! Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover shee t 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 SHEE)r COYNE & COYNE ( A PROFESSIONAL CORPORATION ATTORNEYS AT LAW / Henry F. Coyne Lisa Marie Coyne 3901 Market Street Camp Hill, Pennsylvania 17011-4227 717-737-0464 Fax: 717-737-5161 April 28, 2006 Office Of the Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Estate of Dana M. Winfrey, Deceased No. 21-05-0321 Dear Sir or Madam: Enclosed please find an original and two copies of the Inheritance Tax Return for the above- referenced insolvent Estate. Kindly docket the original and return to this office one "clocked-in" copy with the enclosed stamped envelope. Also enclosed is check no. 241 in the amount of $10.00 which represents the filing fee for this insolvent estate. Kindly issue a receipt for payment of this filing fee. If you have any questions, please advise. Very truly yours, a;~~. LMC/amd Enclosure Cc: Mrs. Diann Willey