HomeMy WebLinkAbout08-17-06
REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 9 7 5
COuNTYCOOE ---YEA~ - - NuMBER- -
DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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Baker Charles W.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
12/06/1997 07/16/1931
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Baker Sandra E.
1 86- 2 4 - 9 356
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1 6 1 - 3 4 - 1 343
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[Xl 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copy 01 Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date 01 death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date 01 death between 12.31.91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12.13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATIONSHOULD.BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
Hubert X. Gilro Es uire 4 N. Hanover Street
FIRM NAME (If Applicable)
Brou'os & Gilro P.C. Carlisle, PA 17013
TELEPHONE NUMBER
717 -243-457 4
20,000.00
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IX:
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 Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
r'.)
20,000.00
(8)
1,200.00
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19. Tax Due
18,800.00 X 2-- (15)
X _(16)
X .12 (17)
X .15 (18)
(19)
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
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(11)
(12)
(13)
1,200.00
18,800.00
(14)
18,800.00
0.00
0.00
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
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ece en s omple e ress: .
STREET ADDRESS
1144 Doublina Gap Road
CITY I STATE I ZIP
Newville PA 17241
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2)
Total Interest/Penalty ( 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. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?........ ......... .................................. .... ...... ............ ..................... 0 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
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 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 information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
--P/v-7u:1'.0f...... g g e.-l<:j~A..
~ J '" 25/ S;iner RO~ .,
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SIGNATURE OF PR R
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ADDRESS
REPRESENTATIVE
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. ~9116 (a) (1.1) (il].
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 SPoNs from ta,x, and the, stat~ory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary. \\ I~~ ~ 11 CJ-t 1':/
For dates of death on or after July 1, 2000: \\ '-b \ ~0 L...-
The tax rate imposed on the net value of transfers from a decease c i1d 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. ~9116(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.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE",IDENT DlO"EDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Baker Charles W. 21 05 0975
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of
survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Real estate located at 1144 Doubling Gap Road, Newville, PA 1724
(copy of HUD-1 Settlement Sheet showing sale of property is attached hereto as
verification of value)
VALUE AT DATE
OF DEATH
20,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
20000.00
R~-1t)11EX+(1-97';
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Baker Charles W.
FILE NUMBER
21
05
0975
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees Broujos & Gilroy, P.C. 1,200.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountanfs Fees
6. Tax Retum Prepare~s Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 1 200.00
(If more space is needed, insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
R:::Jkp.r Ch:::Jrlp.!,: W. 21 n~ nc17 5
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)
1. Sandra E. Baker Wife 100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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)
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OMS NO. 25n2-0265 .,-,.
A. ' B. TYPE OF lOAN:
U.~. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.DFHA 2.DFmHA 3. DCONv. UNINS. 4.DVA 5.DcONV.INS.
6. ~~;~1~~~1BER: \7. lOAN NUMBER:
. SETTLEMENT STATEMENT
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked "[POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (BURKHOLDER, LUTHER.PFD/P.143810/40)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SEllER: F. NAME AND ADDRESS OF lENDER:
luther L. Burkholder Estate of Charles W. Baker,
198 Briner Road Sandra Baker, Estate Executrix
Elliottsburg, PA 17024 257 Briner Road
Elliottsburg, PA 17024
G. PROPERTY lOCATION: H. SETTLEMENT AGENT: 23-2267691 I. SETTLEMENT DATE:
1144 Doubling Gap Road Broujos and Gilroy, P.C.
Newville, PA 17241 April 26, 2006
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
4 North Hanover Street
Carlisle, PA 17013
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SEllER'S TRANSACTION
Inn "\1 4nn
101. Contract Sales Price 20,000.00 401. Contract Sales Price 20,000.00
102. Personal Proper1v 402. Personal Proper1v
103. Settlement Charaes to Borrower (line 1400) 338.50 403.
104. 404.
105. 405.
. , Bv Seller in
106. CitvlTown Taxes to 406. CitYlTown Taxes to
107. Countv Taxes 04/27/06 to 01/01/07 71.21 407. Countv Taxes 04/27/06 to 01/01/07 71.21
108. School 04/27/06 to 07/01/06 96.78 408. School 04/27/06 to 07/01/06 96.78
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 20,506.49 420. GROSS AMOUNT DUE TO SELLER 20,167.99
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 10,000.00 501. Excess Deposit (See Instructions)
202. Principal Amount of New loan(s) 502. Settlement Charaes to Seller (Line 1400) 309.39
203. Existina loan(s) taken subject to 503. Existina loan(s) taken subiect to
204. 504. Payoff of first Mortgage
205. 505. Payoff of second MortQaQe
206. 506. Deposit retained by seller 10,000.00
207. 507.
208. 508.
209. 509.
-Adlustments'Por Items nDaid Bv Seller Arl;ustments For Items Unpaid By Seller
210. CitvlTown Taxes to 510. CitvlTown Taxes to
211. Countv Taxes to 511. Countv Taxes to
212. School to 512. School to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 10,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 10,309.39
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TOIFROM SELLER:
301. Gross Amount Due From Borrower (Line 120) 20,506.49 601. Gross Amount Due To Seller (Line 420) 20,167.99
302. less Amount Paid By/For Borrower (line 220) ( 10,000.00) 602. less Reductions Due Seller (Line 520) ( 10,309.39
303. CASH ( X FROM) ( TO) BORROWER 10506.49 603. CASH ( X TO) ( FROM) SELLER 9,858.60
The undersigned hereby ac~ ceipt of a completed copy of pages 1 &2 of this statement & any attachments referred to herein.
Borrower Seller Estate of Charles W. Baker,
Luther L. Burkholder sanjLak:: j:e Execut~
~
BY: o..u- ... C--
Mr.
HUD.1 (3-66) RESPA. HB4305.2
Paoe 2
L. SETTLEMENT CHARGES -
700. TOTAL COMMISSION Based on Price 9; fa) n nnnn Ofn PAID FROM PAID FROM .
Division of Commission (line 700) as Follows: BORROWER'S SELLER'S
701.$ to FUNDS AT FUNOS AT
702.$ to SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement
704. to
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan OriQination Fee 1 .0000 % to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. MortQaae Ins. App. Fee to
807. Assumption Fee to
808.
809.
810.
811.
gOO. ITEMS REOUIRED BY I ENDER TO R~ PAin IN AnVANC~
901. Interest From to @ $ /day ( days %)
902. MIP Totlns. for LifeOfLoan for months to
903. Hazard Insurance Premium for 1.0 years to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance months $ oer month
1002. Mortgage Insurance months $ per month
1003. CitvlTown Taxes months $ oer month
1004. County Taxes months $ per month
1005. School months @ $ per month
1006. months @ $ oer month
1007. months @ $ per month
1008. months @ $ oer month
1100. TITLE CHARGES
1101. Settlement or ClosinQ Fee to
1102. Abstract or Title Search to
1103. Title Examination to Brouios and Gilrov, P.C. 100.00
1104. Title Insurance Binder to
1105. Document Preparation to
1106. Notary Fees to Brouios and Gilrov, P.C. 5.00
1107. Attorney's Fees to
(includes above item numbers: )
1108. Title Insurance to
(includes above item numbers: )
1109. Lender's Coverage $
1110. Owner's Coverage $ 20,000.00
1111.
1112.
1113.
1200 GOVERNMENT RECORDINr. AND TRANSFI=R CHARGFS
1201. Recording Fees: Deed $ 38.50; Mortgage $ Releases $ 38.50
1202. City/County Tax/Stamps: Deed . MortQaQe 200.00
1203. State Tax/Stamps: Revenue Stamps ; Mortaaae 200.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Insoection to
1303. 2006 County, Local Taxes to Shelbv Winters Tax Collector 104.39
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES (Enter on Lines 103, Section J and 502, Section K) 338.50 309.39
By signing page 1 of this statement, the signatories acknowledge receipt of a completed copy of pag
Certified to be a true copy.
cfge statement.
(P-143810 (P-143810 f 40)