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Home My WebLink About06-20-06 (2) REV-1500 EX (6-00) OFFICl'\L USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~L COUNlY CODE -9L 0049 ___ YEAR NUMBER t- Z W o w o w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) EYSTER RUTH DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 12/29/2005 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) H SOCIAL SECURITY NUMBER 162-22-9840 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER w .... ~~cn ua:~ wl1.U :I:~ U I1.ID 11. c( [X] 1. Original Retum D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of \Mil) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required D 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes D 1D. Spousal Poverty Credit Idate of death between 12-31-91 and 1-'-95) D 11. Election to tax under See. 9113(A)(AllaChSchOl THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z W o z o D- In W It: It: o U JO ANN KEAGLE FIRM NAME (If Applicable) 113 STRAYER DRIVE CARLISLE, PA 17013 TELEPHONE NUMBER 717-258-6830 1. Real Estate (Schedule A) (1) OFFKfAL USE ON~"i~ 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Reeeivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) Z 6. Jointly O\M1ed Property (Schedule F) (6) 0 D Separate Billing Requested i= ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) :) (Schedule G or L) t- o: 8. Total Gross Assets (total Lines 1-7) c( 0 W 9. Funeral Expenses & Administrative Costs (Schedule H) (9) D:: 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) c. 8,249 13. Charitable and Governmental Bequests/See 9113 Trusts for lMlich an election to tax has not been made (Schedule J) 1,656 6,593 o 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0 Z rate, or transfers under Sec. 9116 (a)(1.2) 0 i= 16. Amount of Line 14 taxable at lineal rate 6,593 <( .... ::J 0 D- 17. Amount of Line 14 taxable at sibling rate ::E 0 0 U 18. Amount of Line 14 taxable at collateral rate )( c( Tax Due .... 19. 6,593 x .0 ~(15) x.o 45 (16) x .12 (17) x .15 (18) (19) o 297 o o 297 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 g c> CY <i,.. 90'o~ --z, '. .9 Decedent's Complete Address: STREET ADDRESS 113 STRAYER DRIVE CUMBERLAND CITY CARLISLE Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount STAlE PA ZIP 17013- (1) 297 o o o Total Credits (A + 8 + C) (2) o 3. Interest/Penalty if applicable D. Interest E. Penalty o o TotallnteresUPenalty (0 + E) (3) o 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) o 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 297 A. Enter the interest on the tax due. (SA) o 8. Enter the total of Line 5 + SA. This is the BALANCE Make Check (58) 297 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; . c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . 2. If death occurred after December 12. 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " D []a 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 ha"" """mined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tNe, correcl and complete. Declaration of preparer other than the personal representati"" is based on all information of which preparer has any knowledge S FILING RETURN Yes No D D D D [JQ [JQ [JQ [JQ [Jg []I r 3 STRAYER DRIVE SIGNA)t!RE OF PREPARER OlHER lHAN REPRESENTATIVE \..)u~ A (L.J~ ADDRESS CARLISLE, PA 17013 DATE 6/,(]Ok. POBOX 668 CARLISLE, PA 17013 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.9 9916 (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 statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the su rviving 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. 9 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. 9 9116(a)(1. 3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common ...;th the decedent, whether by blood or adoption. 3W4646 1000 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF RUTH H. EYSTER FILE NUMBER 21 060049 Include the proceeds of litigation and the date the proceeds were receilled by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER a:SCRIPTlON VALUE AT DATE OF DEATH 1 Capital Blue Cross refund 136 2 Citizens Bank checking acct. # 6100849074 8,113 3W46AD 1.000 TOTAL (Also enter on line 5. Recaoitulation) $ (If more space is needed, insert additional sheets cI the same size) 8,249 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INI-eRITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RUTH H. EYSTER SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 06 0049 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. None B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal RepresentatiYe(s) Social Security Number(s) I ErN Number of Personal Representative(s) - - Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 91 5. Accountant's Fees 500 6. Tax Return Preparer's Fees 7. 1 Register of wills - Filing fee 15 TOTAL (Also enter on line 9. Recapitulation) $ 606 3W46AG 1.000 (If more space IS needed, Insert additional sheets of the same size) REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RElliRN RESIDENT DECEDENT ESTATE OF RUTH H. EYSTER SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 06 0049 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUVlBER 1. lESCRIPTION VALUE AT DATE OF DEATH Forest Park Nursing Home 900 2 Xmas checks to family members clearing after death 150 3W46AH 2 000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 1.050 REV-1513 EX+ (S-DD) SCHEDULE J BENEFICIARIES COMMONVIIEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RUTH H EYSTER NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] KRISTAN C. APPLEFORD 4002 E TANGLEWOOD DRIVE PHOENIX, AZ 85044 RELATIONSHIP TO DECEDENT Do Not list Trustee(s) FILE NUMBER 21 060049 AMOUNT OR SHARE OF ESTATE 1 14.285714% Residue: 942 Granddaughter 2 KAREN J. EYSTER 1833 W PHILADELPHIA STREET YORK, PA 17404 14.285714% Residue: 942 Granddaughter 3 ROBERT A. EYSTER 667 GREENBRIAR ROAD YORK, PA 17404 14.285714% Residue: 942 Grandson 942 942 942 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 3W46AI 1.000 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) $ o Estate of: RUTH H. EYSTER Item No. Description 4 ALLAN E. KEAGLE 12221 W BELL ROAD, # 229 SURPRISE, AZ 85374-9696 14.285714% Residue: 942 5 DANIEL B. KEAGLE 6524 10TH STREET ALEXANDRIA, VA 22307 14.285714% Residue: 942 6 GEORGE P. KEAGLE 9409 BETHANY PLACE MONTGOMERY VILLAGE GAITHERSBURG, MD 20879 14.285714% Residue: 942 7 LAURA L. NAZMACK 355 BUTTER ROAD YORK, PA 17315 14.285714% Residue: 942 162-22-9840 Schedule J Part 1 (Page 2) Relation Amount Grandson 942 Grandson 942 Grandson 942 Granddaughter 942 ~~ (i izen Bank Account Number Account Title Date 0 ened Account T e Princi al Balance as of DOD Interest from Last Postin to DOD -----_. Account Balance as of DOD YTD Interest to DOD 6100849074 RUTH H EYSTER 1/1/1970 Checkin $8113.28 $ .00 $8113.28 $26.96