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Home My WebLink About07-07-06 REV. 1'.,00 EX +16-00) w .... ~S'" Ua:~ w"-u :>:00 Ua:...I "-,,, "- <{ . ..... i .. I' I ~- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG. PA 17128.0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~ 2. Supplemental Retum D 4a. Future Inlerest Compromise (dale of death after 12.12.82) D 7. Decedent Maintained a Living Trust(Attach copy of Trust) D 10. Spousal Poverty Credit (date 01 death between 12,31'91ilnd.1-l'~5) . .' . ........ .......... ...... ".i . THIS SECTION MUST BEC().P.4PLE:TED, A,l.L <::()R_R~~p;()~P'I;!I!<::gA\.~P'.<::()N.FI1?!=I!!!~l..;[~.!!I!.F()~M~T!.()B.~l:IQIJ!'l:>E!E;;P'!~~g1];1?T(): NAME COMPLETE MAILING ADDRESS Dale F Shughart, Jr. Esquire .... z w o w U w o DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) Fuller, TelTY E. DATE OF DEATH (MM-DD.YEAR) DATE OF BIRTH (MM.DD-YEAR) 11/[4/2005 02/04/[955 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST AND MIDDLE INITIAL) D D D D 1. Original Return 4 Limited Estate 6. Decedent Died Testate (Attach copy o/Will) 9. Litigation Proceeds Received .... z w o z o "- FIRM NAME (If applicable) TELEPHONE NUMBER 717/241-4311 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) z o ;:: :3 :::> .... a: <{ U w a: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) FILE NUMBER 0<.- 21 ~ COUNTY CODE YEAR SOCIAL SECURITY NUMBER 00023 NUMBER 168-48-2967 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D D 3. Remainder Return (date 01 death prior to 12- 13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D ". Election to tax under Sec. 9113(A) (Attach Sch 0) IO West High Street Carlisle, P A 17013 (1) None , (2) None c~ (3) , ... None (4) None -..... (5) 2,325.00 _Oil ) (6) None (7) None (8) 2,325.00 (9) 265.00 (10) 54.00 (11 ) 319.00 (12) 2,006.00 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) 2,006.00 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 240.72 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 240.72 >> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate x .045 (16) 17. Amount of Line 14 taxable at sibling rate 2,006.00 x .12 (17) (j x 18. Amount of Line 14 taxable at collateral rate <{ x .15 (18) .... 19. Tax Due (19) Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS ManorCare Nursing Home 940 Walnut Bottom Road CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 240.72 Total Credits (A + 8 + C) (2) 0.00 3. InteresVPenalty if applicable D. Interest E. Penalty A. Enter the interest on the tax due. (3) 0.00 (4) (5) 240.72 (5A) (58) 240.72 TotallnteresVPenalty (D + E) 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 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check 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: a. retain the use or income of the property transferred;.............................................................m................ 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?............................................ ............. ..... ........................................................ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..................................................................................................................... Yes No ~ I o 181 o 181 181 0 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 Ihatl have examined this relurn. including accompanying schedules and stalements. and 10 the besl of my knowledge and belief, il is true. correCI and complete. Oeclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Ted Fuller DATE SIZ/E~;ES~RETURN SIGNATURE OF PREPARER O~ THA P N TIVE ;@h~ For dates of death on or after ,94 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)]. 430 Fairground Avenue Carlisle, l' A 17013 ADDRESS 77> /Db ADDRESS DATE 10 West High Street Carlisle, P A 17013 7 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 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. 99116 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. '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Fuller, Terry E. FILE NUMBER 21 - 05 - 00023 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 I DESCRIPTION VALUE AT DATE OF DEATH 2,325.00 ManorCare, additional nursing home bill refund. TOTAL (Also enter on Line 5, Recapitulation) 2,325.00 ;*, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H RJNERAL EXPENSES & ADMIr-.JSTRA11VE COSTS ESTATE OF Fuller, Ten)' E. FILE NUMBER 2] - 05 - 00023 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Dale F. Shughart, Jr., Esquire 250.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills, filing Supplemental Inheritance Tax Return State Zip 4. 15.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs I TOTAL (Also enter on line 9, Recapitulation) 265.00 ;.~ , . I . . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNS YL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Fuller, Terry E. FILE NUMBER 21 - 05 - 00023 Include unreimbursed medical expenses. ITEM NUMBER I DESCRIPTION AMOUNT Recorder of Deeds, additional mortgage satisfaction on 430 Fairground Avenue, Carlisle, P A 17013 property. 54.00 TOTAL (Also enter on Line 10, Recapitulation) 54.00 DU e q 0 . UD ::s 'Pel ~D .00 NAPD