HomeMy WebLinkAbout06-27-06
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15056041046
REV-1500 EX (05-04)
PA Department of Revenue
Bureau of Individual Taxes
Dept. 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
2 )
v - I
File Number
'-
(j;
I' ,
-<...1
y
Date of Birth
~( J.. 5'1 1S'} C
Cd--.. I '1 J-..6 ( fi
C j C 1 /1 I ,~
Decedent's Last Name Suffix
Decedent's First Name
MI
..1cIJ.Sbf\ MR~
~~KY
f2,
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
-...
.J.)e. t, t>J1 ~ e cl
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1, Original Return
c:>
2, Supplemental Return
c:>
3, Remainder Return (date of death
prior to 12-13-82)
5, Federal Estate Tax Return Required
c:>
4, Limited Estate
C=>
-
c:> 4a, Future Interest Compromise (date of
death after 12-12-82)
c:> 7, Decedent Maintained a Living Trust
(Attach Copy of Trust)
c:> 10, Spousal Poverty Credit (date of death c:> 11. Election to tax under See, 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch, 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name), Daytime Telephone Number
~ A- R A- ~ (J C K N/i--N1 (e~ i2C:r tf-,-,Q. j X 7 I I 7 " I l?i3 7
Firm Name (If Applicable)
REGISTEROF WILLS USE ONLY
6, Decedent Died Testate
(Attach Copy of Will)
9, Litigation Proceeds Received
8, Total Number of Safe Deposit Boxes
c:>
First line of address , I
6"?-~ ..sr R ( N(~.J rt-:o LI~~ ~() A-)
Second line of address
Under penalties of perjury, 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, D claration of preparer other than the personal representative is based on all Information of which preparer has any knowledge,
State
I4-ILL "PA
~~I SJj.. Ci~ ~/, L~
ZIP Code
DATE FILED
City or Post Office
~A-JtP
'1101
Correspondent's e-mail address:
., t10lf
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041046
15056041046
....J
~
15056042047
REV-1500 EX
Decedent's Name:
RECAPITULATION
1. Real estate (Schedule A).
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)
4. Mortgages & Notes Receivable (Schedule D) .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)
6 Jointly Owned Property (Schedule F) c:::> Separate Billing Requested . .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested.
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). . .
1 L 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 (ScheCule J)
14 Net Value Subject to Tax (Line 12 minus Line 13)
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15 Amount of Line 14 taxable
at the spousal tax rate. or
transfers under Sec. 9116
(a)( 12) XO __ .
16 Amount of Line 14 tqX~
at lineal rate X.O ~'J .
17 Amount of Line 14 taxable
at sibling rate X .12 .
18 Amount of Line 14 taxable
at co!lateral rate X .15 .
19 TAX DUE.
. . 10.
11.
. 12.
13.
. . 14.
15.
16.
17.
18.
19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L_
15056042047
Decedent's Social Security Number
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15056042047
-...J
REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'l fjf.M.E .\ ' ;-7 'Ii
fYt1 f~m f-a'r-' I
STREET ADDRE~3~"1.( ('. ,.). C I,) . .
~~2 d- ~_j twLfc-c ~j
i &'1 \.Ii1;}~" .
JcLt'";)t (""
CITY
~:r~~
"
ZIP
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Tax Paymlents and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
i . :/~C(c , C~
~~c:;. 3c~.
Total Credits (A + B + C ) (2)
11. ./1 3
WW(J..~)C
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestiPenalty ( D + E ) (3)
4. If Line 2 is [Jreater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT.
Fill in avalon Page 2, Line 20 to request a refund. (4)
B. Enter the total of Line 5 + 5A. ThiS is the BALANCE DUE.
(5)
(5A)
(5B)
LfJ Sil1
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
i':)'~J (,. 7 j
Make Check Payable to: REGI.STER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and: Yes No
a. retain the use or income of the property tr2nsferred: .............. ................ ......... ....... [J ~
:. ~:::Ii~ :h~e~;~~I~~:r:sii~t:~:est~:~ .shall.~~~.t~~.~ropertytransferr~d.or.lt~.inc.ome. ............ '.. ...:.:. .:.'. ..... :... .:.:... B ~
d. receive the promise for life of either payments, benefits or care? ........................... ... ............. .......... 0 Gi1
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 Jpon death bank account or security at his or her death? . ........ [J [SJ
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,
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 three (3) percent [72 P.S. 89116 (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 zero (0) percent
[72 P.S. 89116 ,: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 zero (0) percent [72 P.S. 89116(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 four and one-half (4.5) percent, except as noted in
72 P.S. 89116(1.2) [72 P.S. 89116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 89116(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 A
REAL ESTATE
ESTATE OF~, . ~_ (1 ,', /
L\f\ ~l I ~o.(-~="
All real proper own d 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.
FILE NUMBER
ITEM
NUMBE:R
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
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TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
""~V-"'.13~,\+ iT.,;""
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
ITEM
NUMBER
1,
DESCRIPTION
VALUE AT DATE
OF DEATH
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J!; ~. ~ I SCHEDULE F
CCMMCM;;:\'LTH, CFPE~NS<"L\jANIA ~OINTL Y-OWNED PROPERTY
INHEf~ITNJCE "AX RETURN
-----~~~.Q!I----
ESTATEOF. b' .~~'
__<__~ ( ' 1-~lr ,-'k<~r---
If an asset was i ade joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
SUR'iIW'IG j()!hI f:::~MH(S) NAME
ADDRESS
RELAT!Oi\!SHil:J C(.:CECL:~',I;
11
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A.
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8.
c.
JOINTLY-OWNED PROPERTY
N
1 LETTER ! DATE DESCRIPTION OF PROPERTY '10 OF '0' _'C
ITEM FOR JOIN r MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE (;
UMBER TENANT I JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S I~,;
1 T A I) _ , -_..._.'---.~"
N~'-- ,~~ ,'j. .' r, ~l1il .., A " -C--~._=~ '-.~ <., 01 ~~ ~ 4
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TOTAL (Also enter on line 6, Recapitulation) $
. --.---,.-..--
TEf-!2-.., I
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R""!-1511 EX+ (12-99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF , " _
1\\ ' '~ ._
1.. 1 \-1." j.~,- '. ,,'IIf. i
r I' \ t {' I \ ...... .... - I
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
1.
r' -,,'''.'' -, I
't1 '." ,C \
}v
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I " .' , _' I
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,,-tl 1 ~ 'I
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r~;# '" I L.'rk,'" (1..11 ~ let)
/}
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B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN 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 ('I . ' rl" '.:'
.-W\\~~',.:'l: kl
Accountant's Fees
II .' (';j , ,1
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5.
6,
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Tax Return Preparer's Fees ~ ,~r;. ,:,) -tl.; \7'/)('('-
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)+ ~ '[)
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TOTAL (Also enter on line 9, Recapitulation) $,~) L,) L; {i!",
(If more space is needed, insert additional sheets of the same size)
REV<512 EX-- :12-03)
*
I SCHEDULE I
: DEBTS OF DECEDENT,
I MORTGAGE LIABILITIES I & LIENS I
CCMMCNlNE;lUH OF PE"I~jS'lL'iANtA
INHERI~MjCE TAX RETURN
RESIDENT DECEDENT
ESTATE OlF rvL. '7 C:{. FILE NUMBER
~iU ii~\r ~~(
Heport debts \ncurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Ii.
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TOTAL (Also enter on line 10. Recapitulation) $
/')- ~1 r:
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(If more space is needed. insert additional sheets of the same size)
REV-1513 EX+ (9-00) ,
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTAT\O.F
I i\1 <'
NUMBER
I
FILE NUMBER
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec, 9116 (a) (1,2)J
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHO\VJ ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
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1.
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
1.
AMOUNT OR SHARE
OF ESTATE
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13
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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 TEST Al\iIENT
OF
MARY FAIR SOUSER
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I, Mary Fair Souser, being of sound and disposing mind, memory and understanding, do
hereby make, publish and declare this instrument as and for my Last Will and Testament,
hereby revoking all other Wills and Codicils by me at any time heretofore made.
ITEM ONE: I direct that all my just debts and funeral expenses be paid as soon after my
decease as may be practicable.
ITEM TWO: All the rest, residue, and remainder of my property and estate, both real and
personal, of whatsoever kind and wheresoever situated, which I own at the time of my
death, I give, devise and bequeath unto the following:
A I give, devise and bequeath unto my daughter, SARA L WORMAN, a sum of
money equal to my share of the fair market value of the home in which I live at
the time of my death, together with any or all of the furniture and furnishings
of that home, my car(s), and my time share at the Green Springs Plantation
Resort, Club Sunterra. All the rest, residue and remainder of my property and
estate, in such event, both real and personal, of whatsoever kind and
wheresoever situated, which I may own at the time of my death, I direct to be
divided into three equal shares, and I give, devise, and bequeath said property
and estate as follows:
B. I give, devise and bequeath one of said shares unto my daughter, SARA
LOUISE WORMAN, absolutely.
C. I give, devise and bequeath one of said shares unto my daughter, JOAl'l
KENDR..L\ SPIRE, absolutely.
D. I give, devise and bequeath one of said shares unto my son, JOHN
FREDERICK ROSS SaUSER, absolutely.
ITEM THREE: I hereby nominate, constitute and appoint my daughter, SARA LOUISE
WORMAN, Executrix ofthis, my Last Will and Testament. In the event that my said
daughter, SARA LOUISE WORMAN, should predecease me, or should otherwise fail or
refuse for any reason to qualify as executor, I then nominate, constitute and appoint my
other daughter, JOAN KENDRA SPIRE, and my son, JOHN FREDERICK ROSS
SOUSER as Co- Executers of this, my Last Will and Testament.
ITEM FOUR: My personal representatives shall have the following powers in addition
to those vested in them by law, exercisable without court approval, and effective until
actual distribution of all property hereunder.
A. To sell, lease, pledge, mortgage, transfer, exchange, convert or otherwise
dispose of, or grant options with respect to, any and all property at any
time forming a part of my estate, in such manner, at such time or times, for
such purposes, for such prices and upon such terms, credits and conditions
as they may deem advisable. Any lease made by the Executrix may extend
beyond the period fixed by statute for leases made by fiduciaries.
B. To make distribution of my estate and to cause any share to be composed
of cash, property or undivided fractional shares in property different in
kind from any other share.
C. To execute and deliver any and all instruments in writing which they may
deem advisable to carry out any of the foregoing powers. No party to
any such instrument in writing signed by the Executrix shall be obliged to
inquire into its validity, or be bound to see to the application by the
Executrix of any money or other property paid or delivered to her
pursuant to the terms of any such instrument.
IN WITNESS WHEREOF, I, MARY FAIR SOUSER, the Testatrix, have to this,
my Last Will and Testament, written one side only of two (2) sheets of paper, set my
hand and seal this day of ,. 2002.
MARY FAIR SaUSER
Signed, sealed, published and declared by the above-named Testatrix, MARY FAIR
SaUSER, as for her Last Will and Testament, in the presence of us, who at her request,
in her presence and in the presence of each other, have hereunto subscribed our names as
witnesses.
Name:
Address:
Name:
Address: