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Home My WebLink About05-11-06 --.J 150~60411~~ REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes.. . INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number 2 1 0 6 o 182 Date of Birth 18438 2 1 9 5 08202 005 062 9 1 9 4 6 Decedent's Last Name Suffix Decedent's First Name MI FULTZ LARRY E (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI F U L T Z FLORENCE E Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW [2g 1. Original Return o 4. Limited Estate o o 2. Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 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 0 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number --:~ 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o o 8. Total Number of Safe Deposit Boxes S TAN LEY LAS K 0 W SKI E S Q 232 - 7 6 6 i Firm Name (If Applicable) ----.- - ~ REGISTER OF WILLS USEQNL Y C A L D W ELL K EAR N S P C First line of address 363 1 NOR T H FRO N T S T R E E T Second line of address l.".) City or Post Office State ZIP Code DATE FILED H A R R I S BUR G P A 17110 Correspondent's e-mail address: 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 of preparer other than the personal representative is based on all information of which preparer has any knowledge SIGNAT OF PERS R 0 I RUUR~N / TE , ~ / -1_17(.;, ENOLA PA 17025 "'pATE :J --fy - r/ ~ H FRONT STREET HARRISBURG PLEASE USE ORIGINAL FORM ONLY PA 17110 Side 1 L 15056041125 15056041125 --.J ( / ---I 1'::JO'::J604LIL6 REV-1500 EX Decedent's Social Security Number Decedent's Name LARR Y E. FUL T Z RECAPITULATION 184382195 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 Property (Schedule E) 5. 6 6 8 8 5 3 7 6. Jointly Owned Property (Schedule F) D Separate Billing Requested. . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested. . . . . . 7. 8. Total Gross Assets (total Lines 1-7) 8. 6 6 8 8 5 3 7 ....... . 9. Funeral Expenses & Administrative Costs (Schedule H) 9. 1 2 2 1 3 0 0 ....... . 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) .....11. 1 2 2 1 3 0 0 12. Net Value of Estate (Line 8 minus Line 11) . . 12. 5 4 6 7 2 3 7 . . . . . . . . 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . 14. 5 4 6 7 2 3 7 TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O _ 2 7 3 3 6 1 8 15. 0 0 0 16. Amount of Line 14 taxable 3 6 at lineal rate X .O~ 2 7 3 1 9 16. 1 2 3 0 1 3 17. Amount of Line 14 taxable 0 0 0 at sibling rate X .12 17. 0 0 0 18. Amount of Line 14 taxable 0 0 0 at collateral rate X .15 18. 0 0 0 19. Tax Due . . . . . 19. 1 2 3 0 1 3 ............................... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT D Side 2 L 15056042126 15056042126 ---I ~EV-1500 t:X Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME LARRY E. FULTZ --- -.---- I STREET ADDRESS 502 MAGARO ROAD 21 060182 CITY ENOLA STATE PA ZIP 17025 Tax Payments and Credits: 1 T ax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,230.13 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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) 0.00 0.00 1,230.13 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) A. Enter the interest on the tax due. 1,230.13 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; ...................................................................... 0 [Xl b. retain the right to designate who shall use the property transferred or its income; ............................... 0 [Xl c. retain a reversionary interest; or ................................................................................................ 0 [Xl d. receive the promise for life of either payments, benefits or care? ....................................................... 0 [Xl 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 [Xl 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... 0 [Xl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 [Xl 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 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 zero (0) percent [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 zero (0) percent [72 PS ~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 PS ~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 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. REV-1505 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF LARRY E. FULTZ FILE NUMBER 21 06 0182 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. DESCRIPTION VALUE AT DATE OF DEATH Firearms: a. Winchester Model 70220 rifle 425.00 b. Winchester Model 70264 rifle 400.00 c. Savage Model 99 300 rifle 350.00 d. 45 Caliber automatic pistol 125.00 e. Smith & Wesson K-22 pistol 150.00 f. Winchester 12-gauge shotgun 250.00 g. L.C. Smith 12-gauge shotgun 325.00 2. Fultz Family Coat of Arms; History of Fultz Family 0.00 3. Walnut rocking chair 50.00 4. 1989 Bayliner 19' - INB 7,165.00 5. 1989 Escort Trailer - VIN #40S119BA9KC00071 0 250.00 6. Distribution - Cash - from George M. Fultz Estate (File No. 21-05-00775) 56,514.57 7. Norfolk Southern Corporation Account No. 147787, Common stock, 24 shares @ $36.70/share 880.80 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 66,885.37 Rb/-1:,n I::X + (1:0'-88) '* SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF LARRY E. FULTZ FILE NUMBER 21 06 0182 Debts of decedent must be reported on Schedule I. ITEM NUMBER A DESCRIPTION AMOUNT 1. 2. 3. 4. FUNERAL EXPENSES Sullivan Funeral Home Flowers Luncheon United Methodist Church - West Fairview 6,414.00 212.00 140.00 75.00 1. ADMINISTRATIVE COSTS Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address B. City State Zip Year(s) Commission Paid: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Florence E. Fultz Street Address 502 Magaro Road 1,750.00 3,500.00 2. 3. AttorneyFees Caldwell & Kearns, P.C. City Enola Relationship of Claimant to Decedent Wife State PA Zip 17025 4. Probate Fees Cumberland County 117.00 5. Accountant's Fees 6. T ax Return Preparers Fees 7. Photocopy - Register of Wills 5.00 TOTAL (Also enter on line 9, Recapitulation) $ 12,213.00 (If more space is needed, insert additional sheets of the same size) "'''''''' '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF LARRY E. FULTZ FILE NUMBER 21 06 0182 RELA TIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] 1. Florence E. Fultz Spousal 502 Magaro Road 50% Enola, PA 17025 2. Aaron Fultz Lineal 160 Tyler Street 50% Grantville, PA 17028 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)