HomeMy WebLinkAbout05-22-06
REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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Morrison Mildred E.
DATE OF DEATH (MM-DD-Year)
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21 -0 6 02 0 8
COuN'rv"CciliE -YEAR- - - NUMaER--
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
1 60- 1 6 - 9 782
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
02/24/2006 03/11/1913
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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00 1, Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
SOCIAL SECURITY NUMBER
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 of Trust)
o 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)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A} [AttachSch 0)
TH'S...SEC1'10N..Ml.i$"l'...Be.e~MeEleD~..~iillt.eQRResi~NDENee..AND:IINFileN'FIAi.1liiB...'Ie.oSMIIIIN.S.Ffoii.1loiBE.i.biReeIEDFrI:
NAME COMPLETE MAILING ADDRESS
Ste hen J. Ho Es uire 19 S. Hanover Street, Ste. 101
FIRM NAME (If Applicable)
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 Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
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TELEPHONE NUMBER
7172452698
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Carlisle
PA 17013
OFFICIAL USE ONLY
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8,403.25
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(8)
8,403.25
2,455.03
178.54
(11)
(12)
(13)
2,633.57
5,769.68
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
5,769.68
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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
X _(15)
X _ (16)
X .12 (17)
4,173.02 X .15 (18) 625.95
(19) 625.95
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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ece ents om pi ete Address:
STREET ADDRESS
1000 Claremont Road
CITY I STATE I ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
625.95
Total Credits (A + B + C) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total I nteresUPen alty ( 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. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
625.95
625.95
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?.......... .... ........................ ........ ................ ................................. 0 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
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 pe~ury, I declare that I have examined this retum. 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.
SIGNATURE OF PERSON RESP NSIBLE FOR FlING RETURN DATE
ADDRESS
PA
ADDRESS
For dates of death on or after July 1, 1994 and before January 1, 1995, tt
[72 P.S. ~9116 (a) (1.1) (i)]. ,
For dates of death on or after January 1, 1995, the tax rate imposed on th )j c:.... j}; M' A
The statute does not exemDt a transfer to a surviving spouse from tax, an_~~---'-'
the surviving spouse is the only beneficiary. '5 () ~_.___._
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child t ~
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)].
The tax rate imposed on the nei value of transfers to or for the use of the d Iff. P ?
The tax rate imposed on the net value of transfers to or for the use of the d f\J I
individual who has at least one parent in common with the decedent, whett '
,
: the surviving spouse is 3%
)% [72 P.S. ~9116 (a) (1.1) (ii)].
[ return are still applicable even if
~tural parent, an adoptive parent,
~9116(1.2) [72 P.S. 99116(a)(1)].
ed, under Section 9102, as an
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REV-1508 EX + (6-98)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Morrison Mildred E
FILE NUMBER
21 06
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.
0208
ITEM
NUMBER
1.
DESCRIPTION
America Financial Life & Annuity Ins. Co. funeral payment
VALUE AT DATE
OF DEATH
1,549.81
2.
Claremont Nursing & Rehabiliation Center Refund
6,853.44
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8 403.25
REV-1511 EX + (12-99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Morrison Mildred E.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
06
0208
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Barbara Wiser 1,000.00
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 1104 Pine Road
City Carlisle State P A Zip 17013
Year(s) Commission Paid:
2. Attorney Fees Stephen J. Hogg, Esquire 1,000.00
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 83.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Advertising
The Sentinel 137.03
Cumberland Law Journal 75.00
8. Inheritance Tax Return Filing Fee 30.00
9. Filing Accounting (Est.) 130.00
TOTAL (Also enter on line 9. Recapitulation) $ 2.455.03
(If more space is needed. insert additional sheets of the same size)
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REV-1512 EX + (6-98)
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SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Morrison. Mildred E.
FILE NUMBER
21 06
0208
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Department of Public Welfare Medical Assistance Claim (amount actually paid out of total
debt of $55,144.43
VALUE AT DATE
OF DEATH
0.00
2. Irwin & McKnight Law Office
175.00
3. Associated Cardiologists
3.54
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
178.54
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REV.'513""'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FilE NUMBER
NUMBER
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not list Trustee(s) OF ESTATE
1.
Barbara Wiser
1104 Pine Road
Carlisle, PA 17013
Priscilla Alspaugh
74 Regency South Trailer Park
Carlisle, PA 17013
Neice 75%
2.
Neice 25%
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)
INVENTORY
';
Estate of Mildred E. Morrison
No.21
06
0208
, Deceased
Date of Death 2/24/2006
Social Security No. 160-16-9782
also known as
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We
verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Personal Representative:
Name of
Attorney: Stephen J. Ho~~, Esquire
Barbara Wiser
I.D. No.: 36812
Address: 19 S. Hanover Street, Ste. 101
Carlisle
Dated 05/02/06
PA 17013
Telephone: 7172452698
Description
Americo Financial Life & Annuity Co.
Value
1,549.81
Claremont Nursing & Rehabilitation Center Refund
6,853.44
C,,)
Total
8,403.25
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-961
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WISER BARBARA
1104 PINE RD
CARLISLE, PA 17013
____un fold
ESTATE INFORMATION: SSN: 160-16-9782
FILE NUMBER: 2106-0208
DECEDENT NAME: MORRISON MILDRED E
DATE OF PAYMENT: OS/22/2006
POSTMARK DATE: OS/22/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 02/24/2006
NO. CD 006723
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $625.95
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TOTAL AMOUNT PAID:
$625.95
REMARKS: WISER BARBARA J
CHECK#102
SEAL
INITIALS: CM
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS