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Home My WebLink About08-01-06 -.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 21 06 0292 Date of Birth 175-26-0597 12/12/2005 05/01/1935 Decedent's Last Name Suffix Decedent's First Name KLEE DONALD (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name KLEE NATALIE Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate 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 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 8. Total Number of Safe Deposit Boxes THOMAS E. FLOWER (717) 737-3405 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY SAIDIS, FLOWER, LINDSAY First line of address Second line of address 2109 MARKET STREET ----, City or Post Office DATE FILED State liP Code CAMP HILL PA 17011 co Correspondent's e-mail address:tflower@sfI-law.com 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 informat h preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADD~t~~~~ CL 1'~------ J / Z-'1-/ 0 ~, NATALIE A. KLEE, 2110 PAGE ST., CAMP HILL, PA 17011 ~ _n ______. ______ 'fGNATUrR. ~ OF PREPARE~~AN. REPRESENT, ATIVE \. I- \./V^,-.../'-- MJ----------- -- _ .n_ ADDRi":SS SAIDIS, FLOWER & LINDSAY, 2109 MARKET STREET, CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY DATE Side 1 L 15056051058 -.J 15056051058 MI T MI A . ) ,J ---I 15056052059 REV-1500 EX Decedent's Name: DONALD T KLEE RECAPITULATION 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. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. g. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 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. 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 .OL 143,990.41 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE... . ._ ............................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 175-26-0597 Decedent's Social Security Number 43,602.82 100,387.59 143,990.41 143,990.41 0.00 15056052059 ---I REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME DONALD STREET ADDRESS 2110 PAGE STREET 21 06 0292 T KLEE DECEDENT'S SOCIAL SECURITY NUMBER 175-26-0597 CITY CAMP HILL STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty - n________ 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) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 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 [K] b. retain the right to designate who shall use the property transferred or its income; ............................................ D [K] c. retain a reversionary interest; or.......................................................................................................................... D [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... D [K] 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D [K] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D [K] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D [K] 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 P.S. S9116 (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. S9116 (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 P.S. s9116(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 P.S. S9116(1.2) [72 P.S. s9116(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. s9116(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-15G8 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DONALD T. KLEE FILE NUMBER 21-06-0292 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 DESCRIPTION MEMBERS 1st MONEY MANAGEMENT (SAVINGS) ACCOUNT #6031-05 PRINCIPAL BALANCE - $43,567.82, PLUS ACCRUED INTEREST - $26,00 VALUE AT DATE OF DEATH 43,602.82 TOTAL (Also enter on line 5, Recapitulation) $ 43,602.82 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DONALD T. KlEE FILE NUMBER 21-06-0292 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. NATALIE A. KlEE 2110 PAGE STREET CAMP Hill, PA 17011 SURVIVING SPOUSE B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE, VALUE OF ASSET 'NTEREST DECEDENT'S INTEREST 1. A. 10/16/62 MEMBERS 1ST SAVINGS ACCl. # 6031-00 15,271.19 50 7,635.58 2, A 02/01/01 MEMBERS 1ST SAVINGS ACCT. #6031-04 2,000.99 50 1,000.50 3. A 03/03/83 MEMBERS 1ST CHECKING ACCT. # 6031-11 3.503.02 50 1,751.51 4. A DWELLING HOUSE AND lOT, 2110 PAGE ST., CAMP Hill, PA 180,000.00 50 90,000.00 I TOTAL (Also enter on line 6, Recapitulation) $ 100,387.59 (If more space is needed, insert additional sheets of the same size) SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established LIFE SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established MONEY MANAGEMENT ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner tv 1st MEMBERS 1st FEDERAL CREDIT UNION 6031 -00 10/16/1962 $15,266.59 $4.60 $15,271.19 Natalie A. Klee 10/16/1962 6031 -04 02/01/2001 * $2,000.00 $.99 $2,000.99 Natalie A. Klee 02/01/2001 6031 -11 03/03/1983 $3,503.02 $.00 $3,503.02 Natalie A. Klee 03/03/1983 6031 -05 08/10/1990 $43,576.82 $26.00 $43,602.82 None * Account established by transfer of funds from 6031-00 Estate of: DONALD T. KLEE Date of Death: 12/12/2005 Social Security Number: 175-26-0597 1JM . B~RS 1'. T FED~R..~L CREDIT UNION .'''7:tck d /tl: enise A. Wolfe -j/ Insurance Services upervisor May 25, 2006 5000 Louise Drive . Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . www.members1st.org REV-1513 EX+ (9-00) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF DONALD T. KLEE FILE NUMBER 21-06-0292 RELATIONSHIP 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. NATALIE A. KlEE, 2110 PAGE STREET, CAMP Hill, PA 17011 SPOUSE 100 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- 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) DISCLAIMER I, PAMELA K. GRACEY, hereby disclaim any right, title and interest I may have, under the intestate laws, in the estate of my father, Donald T. Klee, deceased. Dated 1/ ~ vZ ~ PAMELA K. G 3950 BROO GE DR. MECHANICSBURG, P A DISCLAIMER I, PATRICE K. FERL, hereby disclaim any right, title and interest I may have, under the intestate laws, in the estate of my father, Donald T. Klee, deceased. Dated: 1/1/D(P Q~tf&kL PATRICE K. FE 24 STONE RUN DR. MECHANICSBURG, P A DISCLAIMER I, KATERI K. MARTIN, hereby disclaim any right, title and interest I may have, under the intestate laws, in the estate of my father, Donald T. Klee, deceased. Dated 11!~h TERI K. MAR TIN 3914 RIDGELAND BLVD. MECHANICSBURG, P A