HomeMy WebLinkAbout09-05-06
--I
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
Fie Number
d. I (-,
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Date of Birth
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Suffix
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Decedent's Last Name
Decedent's First Name
MI
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/1-1 r;:- L I" A
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(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
Ml
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
- Original Return <::) 2, Supplemental Return <::) 3, Remainder Return I date of death
prior to 12-13-82)
<::) 4, limited Estate <::) 4a, Future Interest Compromise (date of <::) 5 Federal Estate Tax Return ReqUired
death after 12-12-82)
- 6, Decedent Died Testate <::) 7, Decedent Maintained a living Trust S, Total Number of Sate Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
<::) 9, litigation Proceeds Received C=> 10, Spousal Poverty Credit (date of death <::) 11 Election to tax under Sec, 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 l\lumber
lif
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v'A-LLl'Y
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REGIST6.~~~S U~NLY
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Firm Name (If Applicable)
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HFt3EfLZ'C
First line of address
Second line of address
City or Post Office
State
ZIP Code
DATE FILED
MAL j.C"AX.
fA
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Correspondent's e-mail address:
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SIG~jATURE OF PREPARER OTHER THAN REPRESE~JTATIVE
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DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041046
15056041046
-1
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15056042047
REV-1500 EX
Decedent's Social Security Number
Decedents I~ame
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RECAPITULATION
Real estate (Schedule A)
1.
.
2 Stocks and Bonds (Schedule B)
2.
,-.
3 Closely Held Corporation Partnership or SOle-Proprietorship (Schedule C)
3
. \... ......
4 Mortgages & Notes Receivable (Schedule D)
4
. l
,
'-
5
Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E)
5
,
;
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6 Jointly Owned Property (Schedule F) C=> Separate Billing Requested
7 .nter-Vlvos Transfers & Miscellaneous Non-Probate Property
SchedJle G) C=> Separate Billing Requested.
6.
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7.
.
8 Total Gross Assets (total Lines 1-7).
8.
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; /7
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9 ;:Cunera' Expenses & Administrative Costs (Schedule H)
9
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1 O. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I)
10.
. ( C
11 Total Deductions (total Lines 9 & 10).
11.
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12 Net Value of Estate (Line 8 minus Line 11)
13 Charitable and Governmental Bequests/Sec 9113 Trusts for which
an ele':t1on to tax has not been made (Schedule J)
12.
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:2
. _/
13
· C C
14 Net Value Subject to Tax (Line 12 minus Line; 13)
14.
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TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15 Amour,t of Line 14 taxable
at the spousal tax rate or
trar,sfers under Sec 9116
la)(12)XO_
.
15
.
16 "-mou'lt of Line 14 taxable
at Ilnedl rate XO~'
'7 ,Amount of line 14 taxdole
at slbl,ng rate X 12
18 Amour1t of line 14 taxable
at collateral rate X 1 S
-..oF /l. 'I'" 7
16.
:' '7 . ", 'i
.
17.
18.
.
19 TAX DUE
19,
. ./ ~..
. -
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Side 2
L
15056042047
15056042047
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REV-15CC EX Page 3
File Number
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Decedent's Complete Address:
DECEDENTS NMv1::c
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STREET ADDRES~
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STATE
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CITY
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Tax Payments and Credits:
1 Tax Due (page 2 Line 19)
2. Credits/Payments
A. Spousal P'Jverty Credit
B. Prior Payments
C Discount
(1)
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Total Credits ( A + B + C )
(2)
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3 Imerest/Penalty If applicable
D Interest
E Penalty
Total Interest/Penalty ( D + E )
4 If line 2 IS greater tran line 1 + Line 3 enter the difference This IS the OVERPAYMENT,
Fill in oval on Page 2, Line 20 to request a refund,
(3)
14)
5 If line 1 T L,ne 3 IS ~reater than Line 2 enter the difference, Tlis is the TAX DUE.
- -------------~> ~,~---~~-
A Enter the nterest on the tax due
(5A)
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B. Enter the :otal of Une 5 + 5A This IS the BALANCE DUE.
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACiNG AN "X" IN THE APPROPRIATE BLOCKS
Di; deceoent make a transfer and
a retain the use or income of the property transferred
e, retain the rigr,t tc deSignate who shall USE the property transferred or ItS income
r retain a reversloncFY interest or. ...
~ receive the prOlTlSe for life of either payments, benefits or caret
L if :leath occurred after December 12, 1982. clid deceder,t transfer property Within one year of death
w,'hout receiving adequate consideration? .,.
3 DJ decedent own an "in trust for" or payablE upon death bank account or security at r,is or her death?
4 D:j decedent own an indiVidual Retirement .i,ccoun\. annuity or other non-probate property which
cOltalnS a beneficiary deSignation? .
{es
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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 decth on or after July 1. 1994 and before January 1. 1995. the tax rate Imposed on the net value of transfers tOJr for the Lse of tre
IS three (3) percent [72 PS ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate mposed on the net value of transfers to or for the use of the surviVing spouse IS zero (0) percent
[72 PS ~9116 : a) (1.1) (II)]. The statute does not exempt a t'ansfer 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 'Jr for the use of a natural parent. an
adoptive parent or a stepparent of the child is zero (0) percent [72 P,S. S9116(a)(1.2)].
The tax rate imJosed on the net value of transfers to or for jhe use of the decedent's lineal beneficiaries IS four and one-flalf (4.5) percent except as noted in
72 PS S9116(12) [72 PS S9116(a)(1)]
The tax rate imposed on the net value of transfers to or for the Jse of the decedent's siblings IS twelve (12) percent [72 PS S9116(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.
spouse
REV-1508 fX.. (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIJl
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
1/ ," i' ..7/ ___
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FILE NUMBER
,~/-{( - ( 73)
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
1.
DESCRIPTION
( r:... 11 <.' {II} C .f~;- II/u ~J_S/A, G: /J/I//) 1.....'[ lido (- [tf.,. rEA?. (ItSif /-(;11,,-
VALUE AT DATE
OF DEATH
1I/3(:J./Y
TOTAL (AI" eetm '" 11",5 R"'pltcl''',") ~
(If more space is needed, insert additional sheets of the same size)
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REI1:)09 EX + (1-97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERiTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
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L,
FILE NUMBER
,,:2/ (t: -[ ?31
If an asset 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
RELATiONSHIP TC DECEJENT
A I~ /1 (' /1 .~ i) '1
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8.
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JOINTLY-OWNED PROPERTY
A .?/tS/%
DES':RIPTION OF PROPERTY
Include name of financial institution and bank account number or similar Identifying number. Attach
deed for Jointly,held real estate.
(' fill f"/,L'(, Il 0.: T ((~ /17I.:/l1f: {ls I :I"!I/{./, :J(3
j::-/l 7l:'k'ES ( ij (;eL'tdij 7(. /)t}1t t,;",JOiTII
%OF DATE OF DEATH
DATE OF DEATH DECD'S VALUE (C
VALUE OF ASSE] iNTEREST DECEDENTS INTERE 8T
5~;). '1.5 ')t itA ;J-;/ _11
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ITEM
NUMBER
LETTER DATE
FOF JOiN r MADE
TE~",NT JOINT
.,
t1
''l/rrlth )thltC(~ fJ('(; Ie. 1~1tll1/i(i:':.' ~r,.ll J{;(J(.3
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TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
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Send Inquires to:
5000 Louise Drive
PO Box 40
Mechanlcsburg, PA 17055
www.memberw1slorg
Main Switchboard: (717) 697-1161 or (800) 283-2328
EZ Call: (717) 697-4372 or (800) 283-4372
TOO: (717) 697-5312 or (800) 283-2328 ex\. 5312
TeleBranch: (717) 795-6049 or (800) 237-7288
Statement of Accounts
Jun 25, 2006 thru Jul 24, 2006
Account Number:
MEMBERS 1st
fEDERAL CREDIT UNION
Account Balances at a
Checking:
Savings:
Certificates:
Loans:
Money Management:
THELMA L HEBERLlG
1000 CLAREMONT ROAD, ROOM 420-1
CARLISLE PA 17013
160203
Glance:
367.25
2,646.73
0.00
0.00
0.00
Page: 1 of 2
Please read the enclosed insert regarding changes to your electronic services
P-W..tAat will hu-e#feGt QQAugust 7, 2006. .
CHECKING ACCOUNTS
11 - CHECKING
Date_
Jun 25
Transaction Description
Balance Forward
Joint Owner: BARBARA HEBERLlG
Check 001584 Tracer 0628013113
Check 001585 Tracer 0710012925
Check 001586 Tracer 0712016643
Check 001587 Tracer 0717001535
Ending Balance
---.Ac1ciitions
Subtractions
Jun 28
Jul10
Jul 12
Jul17
Jul24
96.93-....-
25 . 50- .....
100.00- ,/
SO. 00-/
CHECK SUMMARY
Check #
001584
001585
Amount Date
96. 93 Jun 28
25.50 Jul10
4 Checks Cleared for 272. 43
__~he~k _#
001586
001587
. __Amoum___
100.00
50.00
Balance
639.68
542.75 )(
517.25
417 . 25
367.25
367 . 25
_J)~L
Jul 12
Jul 17
SAVINGS ACCOUNTS
00 - REGULAR SAVINGS
Date Transaction Description
Jun 25 Balance Forward
Joint Owner: BARBARA HEBERlIG
Jun 30 Deposit Dividend 1 . 000%
Annual Percentage Yield Earned 1. 000% from 0610112006 through 06/30/2006
Jul24 Ending Balance
Additions Subtractions
2.17
Balance
2,644. 56
2,646. 73
2,646.73
YTD SUMMARIES
TOTAL DIVIDENDS PAID
00 REGULAR SAVINGS
11 CHECKING
13.88
0.58
- - - Continued on following page - . .
REV-1511 EX+ (12-99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Ilr/? t- f1L ~-
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iHE L. 4Ut
L
FILE NUMBER
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Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A FUNERAL EXPENSES:
l/r:, Ie e c S i:t~J./ 0 L/,-'/I L- /Il,} ,1../- S C: \i
C'/-IC(((( KLIt~IJ/-1/l -5 EI2v/(t: 111u-'i.IC
fA I'i.. 17[iJ /JJ{Ti-I c ~I J r- f.t... i, J! E'( - [LI/lt",1 SLf.!It;[ [
/:(1 It' l::;:/lL ,) / (; -rr/ n e - S e:;2 V'le t:
/)l~i?L EI!\ f'::f..-l tl' E-/! S
DESCRIPTION
AMOUNT
1/
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iji7 :;
B ADMINISTRATIVE COSTS:
Persona, Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
~::r:-~:~-~ission P=-----~~----------~- State - Zip ---I
I
I
2 Attorney Fees
3. Family Exemption (If decedent's address is nct the same as claimant's, attach explanation)
Claimant
Street Address
City _____~____~__
State __ Zip
Relationship of Claimant to Decedent
(1(,(0
4.
Probate Fees
5_ Accountant's Fees
6. Tax Return Preparer's Fees
) " ,; L" -7 HIIJ'G,',., J {' J /I_J.<- ( 'l (
1,,1/(S l.. '- _~nlt_~7 I.?l:r',':'l ,.,';,:>/:,':"
IEL [' rlle,i, c e /h l S Cf /L.C Tl(' (:'-.s
\':l/IL r J':/,L Ai. /SIL L
Dr} ;:'3.--1-21 /-tG3 t~ k!. eIe!:.: . ^?EllJJb t./ (St.- ;::t'c 7:(>1(:1<;
_l ;:://A I'. t'.1( I!t;JIE/ (t /li! /( kF', ,/-/J){ IIU]C,,,,'S,
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7.
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TOTAL (Also enter on line 9, Recapitulation) $
/J, ,..-.1
. /'-f '74-
(If more space is needed, insert additional sheets of the same size)