HomeMy WebLinkAbout08-23-06
REV .1500 EX" (6-00)
OFFICIAL USE ONLY
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 171211-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
05
COUNTY CODE YEAR
__0.._______.
SOCIAL SECURITY NUMBER
0003
NUMBER
-II)ECED~NT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
i Foor, Daniel T
>- '
~ I DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
~ 12/13/2004 04/29/1969
Cl
190-54-2727
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
l:8I 1. Original Return 0 2. Supplemental Return
o 4. Limited Estate 0 4a. Future Interest Compromise (date of death
after 12-12-82)
l:8I 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach
of Will) copy of Trust)
o 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 11.Election to tax under Sec. 9113(A) (Attach Sch 0)
, . 12-31-91 and 1-1-95)
. " F1i~::"~~:.....;Ot~Ofliiij,W~...ctAiii!laiiiii':"'::'~J~~,:,""'ilO>OiiPi~jjW
~ ~ rRM NA-ME (If applicable) . -I 5440 Jonestown Road
8 ~ I PO Box 6216
rELEPHONE NUMBER -~'I Harrisburg, P A 17112
, 717/541-1428
=-~Real Estate (Schedule A)
I 2. Stocks and Bonds (Schedule B)
I 3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
I 5
I
I 7.
I
110. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
112. Net Value of Estate (Line 8 minus Line 11)
i
113. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
~et Value Subject to Tax (Line 12 minus Line 13)
I SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
w
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wo..u
IOO
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o..m
0..
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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
........................................................................................................~::-.-:.:-...:.:;~:;--
(1)
204,908.00
OFFICIAL USE ONLY
(2)
Non~:
(3)
None
(4)
None
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Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
(5)
2,890.37
(6)
None
(7)
None
. .
............................................................................
(8)
207,798.37
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
7,549.75
(10)
163,265.50
(11)
170,81525
(12)
36,98312
(13)
(14)
36,983.12
x .no
(15)
z .045 (16)
0 16. Amount of Line 14 taxable at lineal rate x
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0.. 17. Amount of Line 14 taxable at sibling rate x :12 (17)
::E
0
u
>< 18. Amount of Line 14 taxable at collateral rate
<( 36,983.12 x :15 (18) 5,54747
>-
19. Tax Due (19) 5,54747
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
}*E:!"'~~~J9A@>W~~A@'*'g$t@N~ON~$Y~~~~II:)$AN[.)a$c;BJ#9~Mf\,l1-i.o:~
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
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Decedent's Complete Address:
STREET ADDRESS
10 North 21 st Street
I STATE P.A ---pp 17011
CITY
Ci'Jllp Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits (A + B " C)
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + 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.
(3)
(4)
(5)
(5A)
(5B)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
5,547.47
0.00
0.00
5,547.47
5,547.47
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
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?..................................................... ......................... .............................
Yes
o
D
D
D
D
D
D
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?..............................................................................
No
D
o
D
D
D
D
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 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
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. _
ADDRESS DATE
100 North 23rd Street
Camp Hill, PA 17011
ADDRESS
5440 Jonestown Road
PO Box 6216
Harrisburg, P A 17112
~
-i'~'
. 7 5 t!'.l.,
ATE
DATE
Fo ates 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. S9116 (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. S9116 (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. 39116 (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. 39116
1.2) [72 P.S. 39116 (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. 39116 (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.
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
\NHERITANCE TAX. RETURN
RESIDENT DECEDENT
ESTATE OF
Foor, Daniel T
I
I FILE NUMBER
21 - 05 - 0003
All real property owned solely or as a tenant in common must be reported at fCiir market value. Fair market value is defined as the price
at which property would be excnanged 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
I
DESCRIPTION
VALUE AT DATE
OF DEATH
56,088.00
Real estate at 1021 Green Street. Full property assessment is $98,400.00 x 1.14 = 112,176.00. Decedent
owned one-half interest in property.
2
Real estate at 10 & 12 North 21 st Street, Camp Hill, Pennsylvania assessed at $148,820
148,820.00
TOTAL (Also enter on Line 1, Recapitulation)
204,908.00
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
I
!
I
I
I
I
I FILE NUMBER
21 - 05 - 0003
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Foor, Daniel T
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 DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
--~---_.-
1 Household furniture and furnishings 600.00
2 2004 Snow Bear Trailer 500.00
3 1992 Mazda Protege 500.00
4 Construction & landscaping equipment (old) 200.00
5 Check from Pauline Wallin 225.00
6 Check from Monique Henry 220.00
7 Check from Lorraine Wachowski 25.00
8 Waypoint Bank checking account 620.37
TOTAL (Also enter on Line 5, Recapitulation) 2,890.37
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATlVE COSTS
L
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
21 - 05 - 0003
ESTATE OF
Foor, Daniel T
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Hetrick Funeral Home
3,207.62
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State
Zip
2.
Attorney's Fees
Nora F. Blair, Esquire
2,557.10
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
State
Zip
4.
Probate Fees
Cumberland County Register of Wills
Cumberland County Bar journal
Paxton Herald
75.00
3800
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Executor's expenses
35628
2
PPL
290.98
----~
Total of Continuation Schedule(s)
1,024.77
TOTAL (Also enter on line 9, Recapitulation)
7,549.75
Schedule H
Funeral Expenses &
Adninistrative Costs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
I FILE NUMBER
I 21 - 05 - 0003
I
ESTATE OF
Foor, 'Daniel T
3
Verizon
65.58
4
P A American water
59.19
5
Clean out property
900.00
Page 2 of Schedule H
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
I
I
l
i FILE NUMBER
I 21 - 05 - 0003
ESTATE OF .
Foor, Damel T
Include unreimbursed medical expenses.
ITEM
NUMBER
1 Waypoint bank line of credit
DESCRIPTION
2 Commerce Bank line of credit
3 Chase Bank
4 Citicorp Credit services 2005
5 Citicor credit services 7288
6 Penn Waste, Inc.
7 Boscov's
8 Chase credit card 3200
9 Home Depot credit card
10 Providian credit card
11 Verizon
12 PPL
13 UGI
14 P A American water
AMOUNT
TOTAL (Also enter on Line 10, Recapitulation)
400.72
150,000.00
915.68
3,082.37
1,83243
16148
67.98
543.57
1,60000
4,548.74
24.36
2344
29.92
3481
163,265.50
~~-1515 E){+ (9-00}
SCHEDULE J
BENEFICIARIES
I
I FILE NUMBER
21 - 05 - 0003
RELATIONSHIP TO I AMOUNT OR SHARE
DECEDENT OF ESTATE
Li~t Tru~t~e(~)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Foor, Daniel T
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I.
TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Peter Steinke
100 North 23rd Street
Camp Hill, PA 17011
Friend
All of estate
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS I\JOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART~::NTER TOTAL NON- T A><ABLE DISTRIBUTIONS ON LINE 13 OF REV-1500COVER SHEET
))I'o(,/'cln,
1 alllvo)' sorry 10 fa)' alT this 01/ )'Oll, '1(, [O/Ilpcflsatcfor tilc IiI/UiatltcJ task/!(c!;:(/ll/lIiJ lip Ill)'
(10;7 ilS d t my di'at Ii f am dl'danl/ff YOI/, cPeter S tcink,r of 100 :!\~ 2l,J ,')1 reet, Camp :)'{iI[, tlie jori:
III 111'111 01 ill/J c(c([ifOr ofarr my 'WorMly posseSSIOns, I/ot [0 C\lIlIdl' m)' prOperl} at 10,/12 '1\. :: /"
Slreet, (ol!ll' Hlrr .1swef/.' m)' fandscapln,q fiuslness, afilillugh casily dl,\6andi'Ji/I/i[jc)f;qottcn 060/11,
1.\ }(1I1rs 10 dOII'llii i1syou '(('Ish, crliis Is lIIos16' 6ccaLlsc 1 Lfu[lIo1 want m)' sU/CTdl' to ad~,'crse(y
IIi! (IF Ie (('It II you rfil/I/ncw {oMiBatiolls at 1021 Cj'rcclI St rcet IIi j [lun~\6/1I;<], :}\ e ltiier of III)' Jiil ri'l! I .I
,I/iO/l fJ 01/ /'111]'1 to interrupt tlie trall-fler of tile deed" to )'our name, liowcueI; pfease (ic aJuunf tfial Ill)'
6mllierlias a (i/I l!fwced'in him. 'Use tnis fctter to feBaffy satisfy my'wishes. 'Usc any mOlley 11/ Ill)'
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