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Home My WebLink About08-09-06 ,. REV. 1500 EX + (6-DD) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DEPT. 280601 HARRISBURG. PA 17128-0601 NUMBER 21 06 00109 NUMBER .____.___.._. ___ ___.. COLJNTY CODE__ YiOLR.. ------ --"--..--- --------..----- SOCIAL SECURITY NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Merideth, Robert William 299-64-8275 ... z W c W U W C '~DATE OFBIRfH(MM.DD-::YEAR) i 11.~/2~?Q05_ ___m__ m_ _ ~5 !23~5 8___ I (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) Merideth, Katherine Jean ~.. 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Future Interest Compromise (date of death after 12.12-82) Decedent Maintained a Living Trust (Attach copy of Trust) , REGISTER OF WILLS --I-S6C;~ ;~C5U~I~; ~~~ER--------- -O'~ Remainder Return (date -Of deathprJ"orta-12-=-13-82)- --- o 5. Federal Estate Tax Return Required --- ---- DATE OF DEATH (MM.DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W ... ",~lI> uQ:'" wll.U ,,00 uQ:-' Il.lD Il. <I: 8. Total Number of Safe Deposit Boxes '... lI>z Ww Q:c Q:z 00 Ull. 111 Roadway Drive, Suite B - Carlisle, P A 17015 1. Real Estate (Schedule A) (1 ) None 2, Stocks and Bonds (Schedule B) (2) None 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 10,000.00 (Schedule E) ---_.-----._--- 6. Jointly Owned Property (Schedule F) (6) 76,695.55 z o Separate Billing Requested ---..'---- .---_.- --- 0 ;:: 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None :) :;) (Schedule G or L) ... 0:: 8, Total Gross Assets (total Lines 1-7) (8) <I: u W 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 15,796,81 Q: ------. ._----- ---- ----.----..- 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 75,541.51 11, Total Deductions (total Lines 9 & 10) (11 ) 12, Net Value of Estate (Line 8 minus Line 11) (12) : -) CF,) I..D 86,695.55 91,338.32 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 SIDE 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: ... :;) (17) Il. 17,Amount of Line 14 taxable at sibling rate x .12 :IE 0 - ----- ---------.. --- u ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) >- ---- .-_..------ 19. Tax Due (19) ----,---- --------.._---- i 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group. Inc. Form REV-1500 EX (Rev. 6-00) ,AIC- , Decedent's Complete Address: STREET ADDRESS 339 Whitmer Road : STATE ! PA I ZIP 17257 CITY Shippensburg 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. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. 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. (3) (4) 0.00 B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5) (5A) (5B) 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;............................................................................. 0 C8] ~: ~::::~ ~h~e~;~~i~~~~s:~~;~es~~~. .~~~~I. .~.~.~. ~.~~. :.~~:.~.~~..t.~~.~.~.f.~~.~~.~. .~.~ .i.t~. i.~.~.~.~~~..............................~~::::::::::: ..:..... B ~ d. receive the promise for life of either payments, benefits or care?........................................................... 0 C8] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?..... .................... .............. .................... ... .............. ....... .............................. 0 C8] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 C8] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?............................................................................................................... 0 C8] 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. Dec:aration areparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Katherine Jean Merideth DATE 339 Whitmer Road Shippensburg, P A 17257 c;j """ J D~ DATE ADDRESS 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)]. The statutedoes not exemDta 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. ~9116 1.2) [72 P.S. ~9116 (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. ~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. . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Merideth, Robert William 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 DESCRIPTION VALUE AT DATE OF DEATH ---".--".--- --- 10,000.00 2000 Ford Mustang TOTAL (Also enter on line 5, Recapitulation) 10,000.00 SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Merideth, Robert William FILE NUMBER 21 - 06 - 00109 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 Katherine Jean Merideth 339 Whitmer Road Shippensburg, P A 17257 Wife JOINTLY OWNED PROPERTY: ---- .~.. --- I-------~ DESCRIPTION OF PROPERTY-~-~----- r--:----- ITEM F~~TJgl~TI ~~b~ IlnCIUd~ n~me <?f ~nancial institution and bank .a~count numberl DATE OF DEATH . D~c?tS I DA0~~~ED~~TH NUMBER TE:NT 112;~~:96 :-::~':::~~Z:t::~:'9 ~-;~~:::~m'~h'''-''~fALUEI::,::::~~ER;;~DECEDENT~~::::~ Southampton Township, Shippensburg, PAl I I 2 A 03/31/2000 Orrstown Bank Checking Account No. 103001743 670.29j 50% 335.15 3 A 10/16/2000 Orrstown Bank Savings Account No. 703002141 993.791 50% 496.90 I 50%1 4 A 4/5/06 12005 Federal Income Tax Return Refund 4,247.001 2,123.50 I 4 )'lLP 1 1995 GMC Van i 50%1 5 A I 1,500.00 750.00 L 1__- __ I 76,695.55 TOTAL (Also enter on line 6, Recapitulation) . SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT _l~_ ESTATE OF 'd h R b W'll' Men et, 0 ert 1 lam FILE NUMBER 21 - 06 - 00109 Debts of decedent must be reported on Schedule I. ITEM NUMBER .----- .------.-------------- ._-.~-~._~_._._._-_.._._._-- A. FUNERAL EXPENSES: I Funeral Expenses I I Memorial - Headstone r --- DESCRIPTION AMOUNT 2 B. I ADMINISTRATIVE COSTS: I, Personal Representative's Commissions 1, Social Security Number(s) I EIN Number of Personal Representative(s): 2. Street Address City Year(s) Commission paid Attorney's Fees to Knight & Associates, P.C. State Zip 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 4. City Relationship of Claimant to Decedent Probate Fees to Register of Wills State Zip 5. Accountant's Fees 6, Tax Return Preparer's Fees 7. 1 Other Administrative Costs The Sentinel - advertise letters 2 Cumberland Law Journal - advertise letters TOTAL (Also enter on line 9, Recapitulation) 10,595.00 4,300.00 550.00 118.00 158.81 75.00 15,796.81 ESTATE OF . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Merideth, Robert William Include unreimbursed medical expenses. ITEM NUMBER 1 2 3 DESCRIPTION Mortgage to First State Bank with a balance of $139,420.03 FILE NUMBER 21 - 06 - 00109 Loan to Orrstown Bank held jointly with wife, Katherine 1. Merideth with a balance of $8,652.98 Medical Expenses TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 69,710.02 4,326.49 1,505.00 75,541.51 REV-1513 EX+ (9.00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT -- TFILENU-MBE-R- -- ! 21 - 06 - 00109 ESTATE OF Merideth, Robert William NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY UT RELATIONSHIP TO DECEDENT __ DlLNoUlsUrustee(s)__ I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) ] Katherine Jean Merideth 1339 Whitmer Road Shippensburg, PA 17257 wife I I I AMOUNT OR SHARE OF ESTATE ---1---- ---- ------- - -- I 100% estate I I I I Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover she~t II. iNON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT I BEING MADE i I Is. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET