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HomeMy WebLinkAbout08-29-06 (2) REV-1500E ;\6--0(;) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 ~L 0291 ___ YEAR NUMBER COUNlY CODE I- Z W Cl w U w Cl DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Bousum Catharine DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 3/14/2006 1/24/1924 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) E SOCIAL SECURITY NUMBER 191-18-3920 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER Litigation Proceeds Received D 2. Supplemental Retum D 3. Remainder Retum (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 D 10. Spousal Poverty Credit (d'" of de,'h b,'we" 12-31-91 ,"d 1-1-95) D 11. Election to tax under Sec. 9113(A) (All"h Soh 0) W I- ~:::sU) uO::~ Wtl.U rOO uO::...J tl.lXl tl. <l: 001 04 006 D9 Limited Estate Orig inal Return 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 f- Z w o z o n. U) w a:: a:: o (J Richard C. Snelbaker FIRM NAME (If Applicable) Snelbaker & Brenneman, P.C. TELEPHONE NUMBER 44 West Main Street Mechanicsburg, PA 17055 717-697-8528 1. Reallostate (Schedule A) (1) 0.00 OFFICIAL USE mIL Y > 2. Stocks and Bonds (Schedule B) (2) 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0.00 4. Mort!)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 CJ Separate Billing Requested l- e:( Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) .-1 7. ::::> (Schedule G or L) !:: 0.. 8. Total Gross Assets (total Lines 1-7) e:( U W 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 0:: 10. Debts of Decedent, Mortgage liabilities, & Liens (Schedule I) (10) 11. Totell Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 0.00 4,384.17 0.00 47,425.52 (8) 2,105.33 0.00 51,809.69 13. Charitable and Governmental Bequests/See 9113 Trusts for which an eiection to tax has not been made (Schedule J) (13) 2,105.33 49,704.36 0.00 (11) (12) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0.00 Z rate, or transfers under Sec. 9116 (a)(1.2) 0 i= 16. Amount of Line 14 taxable at lineal rate 49,704.36 <l: I- :::J 0.00 tl. 17. AmDunt of Line 14 taxable at sibling rate :2: 0 0.00 U 18. Amount of Line 14 taxable at collateral rate >< <l: Tax Due I- 19. 20 ~O (14) 49,704.36 x .0 ~(15) x .0 ~(16) x .12 (17) x .15 (18) (19) 0.00 2,236.70 0.00 0.00 2,236.70 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 3W4645 1.000 Decedent's Complete Address: STREET ADDREOSS Manorcare Nursinq Home, 940 Walnut Bo_tt.om Road Cumberland County CITY I STA1E I ZIP Carlisle PA ~ 7013- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 2,236.70 0.00 0.00 0.00 3. Interest/Penalty if applicable o Interest E. Penalty Total Credits (A + B + C) (2) 0.00 0.00 0.00 TotallnterestJPenalty (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) 2,236.70 A. Enter the interest on the tax due. (SA) 0.00 8. Enter the total of Line 5 + SA This is the BALANCE DUE. (58) Make Check to: REGISTER OF 2,236.70 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] 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, Yes No D D D D ~ 05t ~ ug ~ [}g C~i(HCIc Marie E. Bousum-Forbes, Co-Executor DATE <--- 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 spoese is 3% [72 PS 89916 (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 tre use of the surviving spouse is 0% [72 ps. 89116 (a) (1 1) (ii)] The statute dJ8S not exempt a transfer to a surviving spouse from tax, and the statutory requirements for d:sciosure of asse~s and filing a tax return are stil: applicab!e even if :he surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: The tax rate l'Tlposed 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 PS, S 9116(a)(12)J, The tax rate imposad on the net value of transfers to or for the use of the decedent's lineal benefic:aries is 4,5%, 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 12% (72 P.S. 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. 3 W4 646 '; DOC REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYL VANIA INHERIT ANCE TAX RETURN l'l.ESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Catharine E. Bousum FILE NUMBER 21 06 0291 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 Conooonwealth of Pennsylvania rent rebate 424.00 2 Hi9hmark Blue RX refund on prescription insurance program 94.92 3 Hiqhmark Medigap Insurance Program re:Eund unused premium on health in::;urance 351.25 4 PNC Bank Interest accrued to 3/14/2006 ch2cking account # 50-7007-7102 3,439_60 0_40 5 U.S. Treasury refund on 2005 personal income tax returns 74.00 3W46AD 1.000 TOTAL (Also enter on line 5, Recapitulation) $ (If more space IS needed, insert additional sheets of the same size) 4,384.17 REV-151O EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CatharinE3 E. Bousum SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 060291 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. DESCRIPTlON OF PROPER1Y ITEM I~LDE TI-E NAME OF T\-E TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER HE DATE OF TRA!\SFER_ ATTACH A COPV OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF AFPLlCABLEl VALUE 1. PNC Bank, N.A. 47,425.52 100.0000 0.00 47,425.52 IRA account #65001005888 TOT AL (Also enter on line 7, Recapitulation) $ 47 425.52 (II more space is needed, insert additional sheets 01 the same size) 3W46AF 1.000 REV~1511 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Ca tharine, E. Bousum FILE NUMBER 21 06 0291 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Gingrich Memorials inscription on marker 125.00 'Total from continuation schedules 987.60 B. 1. ADMINISTRATIVE 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 lip 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 lip Relationship of Claimant to Decedent 4. Probate Fees 76.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Cumberland Law Journal Advertising Executors Notice 75.00 Total from continuation schedules 841.73 3W46AG 1.000 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ 2,105.33 191-18-3920 Estate of; Catharine E. Bousum Item No. 2 3 Schedule H Part 1 (Page 2) Description Amount Myers Funeral Horne, Inc. funeral services 487.60 Trind1e Spring Lutheran Church funeral luncheon 500.00 Total (Carry forward to main schedule) 987.60 Estate of: Catharine E. Bousum 191-18-3920 Schedule H Part 7 (Page 2) 2 H&R Block preparation of Individual Income Tax Returns for year 2005 171 . 00 3 Patriot News advertising Executors notice 155.73 4 Register of Wills filing fee for Inheritance Tax Return 15.00 5 Reserve for filing fees, accounting fees, and other miscellaneous costs associated with the administration of the Decedent's estate 500.00 Total (Carry forward to main schedule) 841.73 REV-1513 l:X+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Catharine E. Bousum NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Richard M. Bousum 894 Flagler Drive Gaithersburg, MD 20878 1 50% of Residue: 24,852.18 2 ]~rie E. Bousum-Forbes '740 Allen Road Carlisle, PA 17013 50% of Residue: 24,852.18 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER 21 06 0291 AMOUNT OR SHARE OF ESTATE Son Daughter 24,852.18 24,852.18 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET ~ NON-TAXABLE DISTRIBUTIONS: I A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 3W46AI 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 1 "i"~ -:\ '\1 \\) \~ "'t I I \ \ MARTSON AND SNELOAKER II I LAW OFFICES LAST WILL AND TESTAMENT I, CATHARINE E. BOUSUM, of the Borough of Mechanicsburg, County of Cumberland and State of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last 'viii and Testamen-t, hereby revoking and making void all former wills and codicils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executor or Executrix, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I \ II give, devise and bequeath unto my husband, CHARLES M. BOUSUM, JR., absolutely and in fee simple. If, however, my husband, ClffiRLES M. BOUSUM, JR., does not survive me, then, and in that event, I give devise and bequeath my entire said Estate unto my children, RICHARD M. BOUSUM and MARIE E. BOUSUM, in equal shares. THIRD. I nominate, constitute and appoint my husband, CHARLES M. BOUSUM, JR., to be the Executor of this, my Last Will and Testament, and if for any reason he shall fail to qualify as such Executor, or cease so to serve, then I nominate, constitute and appoint my children, RICHARD M. BOUSUM and ~ARIE E. BOUSUM, or the survivor thereof to serve in his place, each to serve without bond. IN WITNESS WHEREOF, I, CATHARINE E. BOUSUM, have hereunto LAW OFFICES MARTSON AND SNELBAKER II I I I II II ,I II set my hand and seal to this, my Last and Will and Testament which consists of two (2) typewritten pages to each of which I have affixed my siganture -this (", 'HI day of ;///anc.L A. D. , One Thousand Nine Hundred Seventy-three (1973). ~ 'rfl - (. ~a.ru~ (?:: ~ (8 EAL) The preceding instrwnent, consisting of this and one (1) other typewritten page, each identified by the signature of the Testator, Was on the date thereof signed, sealed, published and declared by CATHARINE E. BOUSUM, the Testatrix therein named, as and 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 subscribed our names_~ hereto. . ( ~J tIf_ ~U;~~ w1 n(~J /'