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Home My WebLink About06-30-06 t REV-'j;:'lO EX + (6-00) '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 -05 070 1 COuNTYCOOE ---VEAP:-- - - NuMBER- - DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURIT'Y NUMBER I- Z W C W U w C KENNEDY SHIRLEY DATE OF DEATH (MM-DD-Year) L. DATE OF BIRTH (MM-DD-Year) 1 7 1 - 2 8 - 3 3 2 1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 06/14/2005 12/04/1920 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY N~~ 1-- 6'~;)/ w ..... ll:~en ua::ll: w l5u :I:a::g u c..m c.. <I: [X] 1. Original Retum o 4. Limited Estate [X] 6. Decedent Died Testate (Attach copy of Willi o 9. Litigation Proceeds Received o 2. Supplemental Retum o 4a. Future Interest Compromise (date of death after 12-12-82) o 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) o 3. Remainder Retum (date of death prior to 12-13-82) o 5. Federal Estate Tax Retum Required ~ 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) NAME COMPLETE MAILING ADDRESS MURREL R. WALTERS III, ESQUIRE FIRM NAME (If Applicable) ..... z w c z o c.. en w a:: a:: o u 54 EAST MAIN STREET TELEPHONE NUMBER 717-697-4650 MECHANICSBURG PA 17055 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) o 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) z o i= < ..J =>> l- ii: < u w I:t: OFFICIAL USE ONLY r....."o_' -) J ---,,, C) (8) 804.00 32,447.87 (11) (12) (13) 33,251.87 -33,251.87 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) -33,251.87 z o i= < l- =>> D.. :!: o U ~ I- 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) (18) (19) X .15 ~v. ' '1 , '\ \ ';:,;\:?""-' CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT . .';_:,,:<,:,:...~ '> > . BE $UREl'O ANSWER:ALL;QU,EStlONSQRSEVI$R$E SfDE'AHD'R~HECK'MA"" ,J<< ~ ..':; 20. D ;~:;\~ Decedent's Complete A dress: STREET ADDRESS 113 EAST MAPLEWOOD AVENUE CITY I STATE I ZIP MECHANICSBURG PA 17055 d Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) TotallnterestlPenalty ( 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 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 [&J b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [&J c. retain a reversionary interest; or ...................................................................................................... 0 [&J d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [&J 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. 0 [&J 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 [&J 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 [&J 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 infomnation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE L . ADDRESS DIANE K. DEGUMBA 119 RIVER ROAD, E. BRUNSWICK NJ ~ 1.0 r-f 0 c.. 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) (ill. 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 exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a lax return are still applicable even if the surviving spouse is the only beneficiary. For dales 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. ~9116(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. RW-1511 EX+(12-99) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF KENNEDY FILE NUMBER SHIRLEY L. 21 05 0701 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. AUER MEMORIAL HOME & CREMATION SERVICES - PREPAID B. ADMINISTRA TIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) .JOHN E. KENNEDY, .JR. - RENOUNCED Social Security Numbe~s)/EIN Number of Personal Representative(s) 168366548 Street Address BOX 62 City TROXELVILLE State PA Zip 17882 Year(s) Commission Paid: 2. Attomey Fees MURREL R. WALTERS III 750.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees REGISTER OF WILLS. CUMBERLAND COUNTY 54.00 5. Accountanfs Fees 6. Tax Retum Prepare~s Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 804.00 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent KENNEDY Decedent's Name SHIRLEY L. Page 1 21 05 0701 File Number Schedule H - Funeral Expenses & Administrative Costs - 81 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative's Commissions 2. Name of Personal Representative (s) DIANE K. DeGUMBA - RENOUNCED Social Security Number(s)/EIN Number of Personal Representative(s) 197407374 Street Address 119 RIVER ROAD City EAST BRUNSWICK State NJ Zip 08816 Yea~s) Commission Paid: SUBTOTAL SCHEDULE H.B1 REV-1512 EX + (6-98) .. SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KENNEDY FILE NUMBER SHIRLEY L. 21 05 0701 Include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH PINNACLE HEALTH HOSPITALS 5,487.93 2. PINNACLE HEALTH EMERG 40.41 3. DR. JOHN I. GILSON DENTAL 303.00 4. PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE MEDICAL ASSISTANCE 26,616.53 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 32,447.87 "v~"n":I* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF KENNEDY SCHEDULE J BENEFICIARIES L. SHIRLEY NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS ~nclude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] .JOHN E. KENNEDY, .JR. BOX 62 TROXELVILLE, PA 17882 DIANE K. DeGUMBA 110 ROVER ROAD EAST BRUNSWICK, N.J 08816 1. 2. FILE NUMBER 21 05 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SON DAUGHTER 0701 AMOUNT OR SHARE OF ESTATE 50% 50% 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)