HomeMy WebLinkAbout08-22-06
REV-1500 EX (6-00)
OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYL VANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
06
0059
-----
COUNTY CODE
YEAR
NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Shindle Allen
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
11/14/2005 1/11/1984
(IF APPLlCP,BLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
J
SOCIAL SECURITY NUMBER
176-68-8105
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
Litigation Proceeds Received
o 2. Suppiemental Return 0 3 Remainder Return (date of death prior to 12-13-82)
o 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required
o 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes
o 10. Spousal Poverty Credit (dal, of d"th b,lw", 12-31-91 oed 1-1-95) 0 11 Election to tax under Sec. 9113(A) (Attoch Soh 0)
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09.
Limited Estate
Original Retum
Decedent Died Testate (Attach copy of Will)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
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Richard C. Sne1baker
FIRM NAME (If Applicable)
Sne1baker & Brenneman, P.C.
TELEPH01\E NUMBER
44 West Main Street
Mechanicsburg, PA 17055
717-697-8528
1 Real Estate (Schedule A)
(1)
0.00
0.00
OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B)
(2)
3. Closeiy Held Corporation, Partnership or Sole-Proprietorship (3)
0.00
4 Mortg ages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E) (5)
Z 6. Jointly Owned Property (Schedule F) (6)
0 o Separate Billing Requested
I-
<t Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
..J 7.
:::::l (Schedule G or L)
l-
e: 8. Total Gross Assets (total Lines 1-7)
<t
()
UJ 9. Funeral Expenses & Administrative Costs (Schedule H) (9)
0:::
0.00
8,600.00
1,450.00
i I
0.00
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
(8)
8,562.50
217.55
10,050.00
(13)
8,780.05
1,269.95
0.00
11 Total Deductions (total Lines 9 & 10)
(11)
12 Net Value of Estate (Line 8 minus Line 11)
13 Charitable and Governmental Bequests/Sec 9113 Trusts for yJ,ich an election to tax has not been
made (Schedule J)
(12)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
1,269.95
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amollnt of Line 14 taxable at the spousal tax 1,269.95 L(15)
z rate, or transfers under Sec. 9116 (a)(1.2) x .0
0
~ 16 Amount of Line 14 taxable at lineal rate 0.00 x .0 45 (16)
<l:
I-
::l 0.00
c.. 17. Amount of Line 14 taxable at sibling rate x12 (17)
::!;
0 0.00
c..> 18 Amount of Line 14 taxable at collateral rate x .15 (18)
><
<l: Tax Due (19)
I- 19.
20. []
0.00
0.00
0.00
0.00
0.00
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
Decedent's Complete Address:
SffiEET ADDRESS
Fairmont Apartments, 1107 Yverdon Drive
Cumberland County
CITY
Camp Hill
I STATE
PA
I ZIP
i 1.7011-
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
0.00
0.00
0.00
Total Credits (A + B + C) (2)
0.00
3 Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
Total Interest/Penalty (0 + E) (3)
0.00
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)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
A Enter the interest on the tax due. (SA)
0.00
B. Enter the total of Line 5 + 5A This is the BALANCE DUE. (58)
Make Check to: REGISTER OF
0.00
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. iXJ D
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 penaltiesJ~ perjury, I dec:are that: have examined this retum, Including ac:al1panying schedules and statements, ar.d to the best of my knov/edge a71d belief, it is :rue, correct and comp':ete.
Deciaration of preparer other thar. the pe~sona! representative is based 0"' ail information of which creparer has any knowledge.
SiGNATU~ OF PERS~N/.RES!PON~18LE F/~r RE/j
t-PVl.--' L j, , / ) 11.---.-'1"" ,A'-L Ii d/Jl '~1ISh:(,iot<'-
ADORES,! :o'
Ja Shindle, Administrator
SIGNAT' ER TrlAN REPRESENTATIVE
Yes
No
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DATE
8/ J'S /0 ~
34 George C~rclel Mechanicsburg,
PA 17055
DATE
811s-lub
For da;es of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the ne; value of transfers to or for the use of the surviving spouse is 3%
[72 PS8 991Ei (a) (1.1) (i)].
For dates of d"ath on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surv"ing spouse is 0% [72 P.S. 89116 (a) (1.1) (ii)]
The statute does nDt exempt a transfer to a surviving spouse from tax, and the statutory requirements for disciosure of assets and filing a tax return are still applicable even if
the surviving SpOL.iSe is the only bene~ciary
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 8 9116(a)( 1 .2)J.
The tax rate imposed on the net value of transfers to or fort he use of the decedent's lineal beneficiaries is4.5%, except as noted In 72 P.S S 9116(1.2) [72 P.S. 89116(a)(1)].
The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 PS. 8 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual whc has at least one parent in common with the decedent, whether by biood or adoption.
3W46461,000
REV-150S EX + (6-9S:
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
I~ESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Allen J. Shindle
FILE NUMBER
21 06 0059
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 DESCRIPTION
VALUE AT DATE
OF DEATH
1 2001 Honda
Kelly blue book value
8,600.00
TOTAL (Also enter on line 5, Recapitulation) $
8,600.00
3W46AD 1.000
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Allen J. Shindle
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21 06 0059
If an assE1t 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
RELA 1l0NSH I P TO DECEDENT
A.
Shindle, James W
34 George Circle, Mechanicsburg,
PA 17055
Father
B.
c.
JOINTLY-OWNED PROPERTY:
lETTER DATE DESCRIPTION OF PROPERTY 'loaF DA llE OF DEATH
ITEM FOR JOI:-.JT MADE INCLUDE NAME OF FINA~CI.A.L INSTITUT,~ON AND BANK ACCCUfT DAllE OF DEATH DECO'S VALUE OF
J\I..Jv1BER OR SIMILAR IDENTIFYING NUMBER ATTACH DEED FOR
NUMBER 'ENP.NT JOINT JOIr-JTlY-r-ELD REAL ESTATE. VALUE OF ASSET INllEREST DECEDENTS IN'TEREST
1. A.
1 !A Inception Member's First Federal
Credit Union 2,900.00 50.0000 1,450.00
checking account
i
I
3W46AE 1.000
I
TOT AL (Also enter on line 6, Recapitulation) '$
(If more space is needed, insert additional sheets of the same size)
1,450.00
REV-151O EX + (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWE!\L TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Allen J. Shindle
FILE NUMBER
21 060059
ITEM IN:::U.DETI-ENtlMEOF Tf-ETRPNSFEREE. THEIR RELATIONSHiP TO DECEDENT AND
NUMBER rot O,c,TEOFTRMBFER ATTACH A COPY OF THE DEED FOR REAL ESTATE
1. SYSCO SIP
401K retirement plan valued at
$517.03 and was administered by
Fidelity, account #93808. The
decedent was not of age to
withdraw from this plan without
a penalty. This account is
lis bed for informational
purposes only.
DATE OF DEATH
VALUE OF ASSET
% OF DECO'S
INTEREST
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
TAXABLE
VALUE
0.00 100.0000
TOT AL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3W46AF 1.000
EXCLUSION
(IF AFPLlCABLEl
0.00
0.00
0.00
REV-1511 EV,+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWE!\LTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Allen J. Shindle
FILE NUMBER
21 06 0059
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
A.
FUNERAL EXPENSES
1.
Halpezzi Funeral Home
funeral services
6,378.50
Total from continuation schedules
1,500.00
B.
1.
.l\DMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
State
Zip
Year(s) Commission Paid:
2.
Attorney Fees
Snelbaker & Brenneman, P.C.
500.00
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
69.00
5. Accountant's Fees
6, Tax Return Pre parer's Fees
7,
1
Register of Wills
filing fee for Inheritance Tax
Return
15.00
Total from continuation schedules
100.00
3W46AG 1000
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
8,562.50
Estate of: Allen J. Shindle
176-68-8105
Schedule H Part 1 (Page 2)
Item
No.
Description
Amount
2
Hechanicsburg Cemetery
burial plot and grave opening
1,500.00
Total (Carry forward to main schedule)
1,500.00
Estate 0:[: Allen J. Shindle
176-68-8105
Schedule H Part 7 (Page 2)
2
Reserve
:for filing fees and other
miscellaneous costs associated
~d th the administration of
Decedent's estate
100.00
Total (Carry forward to main schedule)
100.00
REV-1512 EX+ (12-1J3)
COMMONWEALTH OF PENNSYLVANIA
INHEFtlTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Allen J. Shindle
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 06 0059
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
Comcast
cable TV service
85.00
2 PPL Electric
electric service
132. 55
3W46AH 2.IJIJO
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
217.55
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERIT"NCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Allen J Shindle
FILE NUMBER
21 06 0059
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
James W. Shindle
34 George Circle
Hechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
NUMBER
I
50% of Residue: 634.98
Father
634.98
2 Janet A. Shindle
34 George Circle
Hechanicsburg, PA 17055
50% of Residue: 634.98
Mother
634.98
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
3W46Al 1 000
TOTAL OF PART 11- 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)
$
0.00
i ll"i.S05 REV J /05
This is to certify that the information here given is conectly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent' filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $6.00
p
12085084
No.
'f!
-j1t!?d~'1-(~~-I:.. /~ ,;(00 "/-
Date
1'"1105144 Aev 1191
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF liEALTH . VITAL RECORDS
CERTIFICATE OF DEATH
(Coroner)
TYPE/PRINT
IN
PERMANENT
BLACK INK
SEX
2. male
FLACE OF DEATH (Check only DrIB _n S~ inJ,ilu(':lluns on Olher sicle)
HOSPITAL
Inpalianl 0
g~ii~'!~
BIATHPLACE (City and
Slale()1 FoteigllCoufllfy)
Harrisburg,PA
Sf"TE FILE NUMI1EA
SOCIAL SECURITY NUMBER
3.176-68-8105i
/<-I ,;1 00
RACE. Amerlcan Indian, Blacl<., Wh<ltl, ole
(Speedy)
'whi te
'0.
MARITAL SlAT US. Married
Navar Married, Widowed.
Divorced (Spoci!y)
never married
14. 15.
17c~ Yos, decedanl li"ed in Upper Allen
SURVIVING SPOUSE
(II wile, 9've malden n..mll)
17b. CO~.HIly CWnber land
Did
dac:eclenl
jjveil'\8
lowl'\ship? l1d.D ~~i'~~~I~~~:I~I~~ 01
MOTHER'S NAME (First. Mldclie. M.,ioen SUl(\amel
,.Janet A. Jacob
clfylboro
'wp
[J
2005
UCE:NSE NUMBER
011667 L
2lCMechanicsburg Cemetery
NAME AND ADDRESS OF FACiLITY
"J'lalpezzi Funeral HOne
LICENSE NUMBER
Mechanicsburg, PA 17055
DATE SIGNED
(Munl)), Day, YlOal)
22b.
To Ihe btls: oj my knowledge, death OCCurred al lhtl lime, dale and place slillOd
(SllInalure und Tille) .
.~I)II r:ell~ {::Sl /JLJLL---GJi?I'(~~)
DUE (OR AS A C NSEOU[NC[ OF):
bJJlJJi:..-~_~( I" K 1!0.~r/)c luT
DUE TO (OR lIS A CONS[QUENC[ OF)
c:,~___~_
DUE TO (UR AS A CON!.:iEQU[NCE OF):
d
WERE: AUTOPSY FINDINGS
AVAILABLE PA:QH TO
COMPLETION OF CAUSE
OF DE.ATH7
MANNER OF DEATH
DATE OF INJURY
(Monlt). Day Year}
17055
23b. 23c.
WAS CASE REFERRED TO MEDICAL EXAM\NERiCORQNER?
YBS ca--- No 0
26.
I Approximate
: inlerv<l\ belween
!OnSeISr1ddeatll
PART II: Olher sig~i1icant conditions conltlDullng to oaath hut
nOl resulllng In 11le underlYing caws.tl QIVarllrl PART I
/}CeJ:Pc,:[
Yes 0
Accident
Psndinglrwtl5ligation
o f\X.()::mlx-~ 1'-1
o 308. ~ CC)).~
[.] PLACE OF INJURY. Al home. hHm. stille!, factory. oNice
~~~inQ, ale ($pccilY) " ~
o
g-----
o
Naturol
Hom,cide
No 0
Cu~,ld IlOt bo determined
SUICide
2.
21.. 211b.
CERTIF!E.R (CllOCk unly ona)
'CEPTIF'i!NG PHYSICIAN (Plly,;'C;I",I, t.;l;:I\lfyiIIY i,;,HIS€ ur (JuJIII whwl ullotlwr plly~,i~ii;l1\ 110.:; j)IWIOUfl(.;<!U ot:all1 ;lilt! COf)'lJ1e1tJd hIm' 23)
To thebe,1 of my knowledyCl, death occurred due to the CUII68(1I) and manner as ataled. .
'PRONOUNCING AND CERTIFYING PHYSJCIAN (f'lly$lClilfl b,)ltl pronoullcilllJ rJoalh llnd cellil'"iIlD to caus.l f.J1 rJ€;3lh)
To the bell 01 my knowt&dg8, dealh occurred &Ilhe lime, dlle, and place, and due to the cau'll(s) snd manner BIi Ilated..
"MEDICAL EXAMINER/CORONER
On lhe bel-Ia 01 examlna~lon lIIodfor ImltlllllgalJun, In my opinion, dealll O"::ClIrff!{j at the lime, date, ilnd plilce, and due 10 the cllu6e(s) and
manner as elsted.. . . . . .
31&.
R~~S S~GN4fURE AN~ NUM~~~ _
33. ".y,..-.(L/\...(.2 ~_R,^
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