HomeMy WebLinkAbout08-01-06
REV- 1500 EX + (6-00)
'*
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 6 0 4 1 5
""COuNT'icoDE ---YEA~ - - N'UMiiER- -
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I-
Z
W
C
W
()
W
C
Martin Evel n R.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
SOCIAL SECURITY NUMBER
205-16-5768
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
W
I-
::.::~(J)
() 0::::.::
w ~()
J: 0::3
() [L CD
[L
<
03/03/2006 01/15/1924
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[J 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
[J 11. Election to taX under Sec. 9113(A) (Attach Sch 0)
Martin Sr. Ra mond B.
[R] 1. Original Retum
o 4. Limited Estate
[R] 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
D 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy olTrust)
D 10. Spousal Poverty Credit (date ofdealh between 12-31-91 and 1-1-95)
THIS SECTION MUST BE COMPLETED. AL[CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
R. Mark Thomas Es uire
FIRM NAME (If Applicable)
I-
Z
W
o
z
o
[L
(J)
W
0::
0::
o
Ll
TELEPHONE NUMBER
717-796-2100
Mechanicsbur
PA 17055
OFFICIAL USE ()NL Y .
z
o
i=
<t
...J
~
t:
a..
<t
()
w
a::
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)
40,321.19
107,273.74
100.00 X _(15) 000
0.00 X _(16) 0.00
0.00 X .12 (17) 000
0.00 X .15 (18) 0.00
(19) 0.00
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subjectto Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
o
I-
<t
I-
~
a..
:!
o
()
><
<t
I-
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
101 South Market Street
16. Amount of Line 14 taxable at lineal rate
C) 147,594.93
(8)
533.00
(11)
(12)
(13)
(14)
533 00
147,061.93
147,061.93
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
> >BE SURE JOANSWERAL.L QUESTIONS ON REVERSE SIDEAND RECHECK MATH < <
19. Tax Due
Decedent's Complete Address:
STREET ADDRESS 1500 Main street
CITY
Mechanicsburg
I STATEp1\
I ZIP 1 7 0 5 5
Tax Payments and Credits:
1. T ax Due (Page 1 Line 19)
2 Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
0.00
(1)
0.00
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
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. (5A)
B. Enter the total of line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
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 Q9
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 []
c. retain a reversionary interest; or ...................................................................................................... 0 []
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 og
2 If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. 0 []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................ 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.
Mechanicsburg, PA 17055
101 South Market Street, Mechanicsburg, PA 17055
DATE
:t~/~h
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 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.
REV-15GB EX + (6-9B)
*'
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Martin. Evelyn R.
FILE NUMBER
21 06
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 Schedulle F.
0415
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
29,114.27
PNC Bank, Mechanicsburg, PA 17055
ertificate of Deposit, Account No. 31300283545
2.
PNC Bank, Mechanicsburg, PA 17055
hecking Account No. 5004877478
11,206.92
TOTAL (Also enter on line !5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
40321.19
REV-1509 EX + (6-98)
'*'
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Martin Evelvn R.
FILE NUMBER
21 06
0415
If an asset was made joint within one year of the decedent's date of death, it must be reported I~n Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
~ELATIONSHIP TO DECEDENT
A. Raymond B. Martin, Sr.
1500 Main Street
Mechanicsburg, PA 17055
Spouse
B
C
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE 010 DEATH DE CD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. v.,. 10/27/05 PNC Bank, Mechanicsburg, PA 17055 12,710.48 50. 6,355.24
Checking Account No. 5004866322
2. V\. Marital Residence 201,837.00 50. 100,918.50
1500 Main Street
Mechanicsburg, PA 17055
(The date of death value was determined by multiplying the
assessed value of $177,050.00 by the Cumberland County Common
Level Ratio Factor of 1.14)
TOTAL (Also enter on line 6, Recapitulation) $ 107273.74
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Martin Evelyn R.
FILE NUMBER
21
06
0415
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1. (Prepaid)
B, ADMINISTRA TIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Raymond S, Martin, Jr. 0,00
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2, Attorney Fees R. Mark Thomas, Esquire 250.00
3, Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4, Probate Fees Probate Fees: $268.00 Inh. Tax Return Filing Fee: $15.00 283.00
5, Accountant's Fees
6, Tax Return Preparers Fees
7.
TOTAL (Also enter on line g, Recapitulation) $ 533.00
(If more space is needed, insert additional sheets of the same size)
'''''''''''''-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Martin Evplvn R. 21 06 0415
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List TrUlitee{s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Raymond B. Martin, Sr. Spousal 100.00
1500 Main Street
Mechanicsburg, PA 17055
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 BEI~IG 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)
.. " '
LAST WILL AND TESTAMENT OF EVELYN R. MARTIN
I, EVELYN R. MARTIN, of Lower Allen Township, Cumberland County, Pennsylvania,
being of sound and disposing mL'ld, memory and understanding, do make, publish and declare this
my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at
any time heretofore made.
1.
I direct the payment of all my just debts and funeral expenses as soon after my decease as
the same can conveniently be done.
2.
All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and
wheresoever situate, I give, devise and bequeath to my beloved husband, Raymond B. Martin, to
his own use and benefit absolutely.
3.
In the event my said husband should predecease me or die at about the same time I do, such
as in an accident or disaster common to both of us, I hereby direct all the rest, residue and
remainder of my Estate to be divided and distributed as follows: In equal shares, per stirpes,
among my three children, to wit: Raymond B. Martin, Jr., Lois Boeckel, and Richard L. Martin.
4.
I nominate, constitute and appoint my husband, Raymond B. Martin, to be the Executor of
this my Last Will and Testament. In the event that he should predecease me or for any reason be
unwilling or unable to act as such Executor, I nominate, constitute and appoint my son, Raymond
B. Martin, Jr., to be Executor in his place and stead. As second alternate, I appoint my daughter,
Lois Boeckel and as third alternate, I appoint my son, Richard L. Martin. I further direct that they
shall not be required to fIle bond or other security in the Office of the Register of Wills for the
purpose of administering my Estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this /7'14 day of
~ . A.D. 1997. .
'~MA1TIN CM~ (SEAL)
Signed, sealed, published and declared by the above-named EVELYN R. MARTIN as and
for her Last Will and Testament, in the presence of us, who at her request and in her presence, and
in the presence of each other, have hereunto subscribed our names as wi~esses.
~E~~-zD.
0J,J~ m. 9~