HomeMy WebLinkAbout09-06-06 (2)
-1
150560510117
Ph. Deoa:1menl Of Revenue
Bureau o!lndivldua! Taxes
PO BOX 280601
Harrisburg PF1712B.OS01
ENTER DECEDENT INFORMATION BELOW
Number Date of Death
REV-1500 EX (06-05)
~
OFFICIAL USE ONLY
County Code Year
Clip Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
i 21 !
,
o ;6
o 04 3
Date of Birth
Decedent's Las! Name
Suffix
Decedent's First Name
f\11
(If Applicable) Enter Surviving Spouse's Information Below
~ast Name Suffix
f'fir
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
c::J 1 Or:g'n81 Return .. 2. Euppiemental Return
c::J ~. Remainder Rf,turn (cate of deatl-
prior to 12- -: 3-82)
~ 5. Feijeial Estat~; Tax Retufl Kequired
c::J ..; Lrmreec! Estate C> 42. Future Interest Compromise (date 0;
ceath after 12-12-82)
c::J 6 Deceoent Died Testate C) 7. Decedent Maintained a Living Trust
(Attacn COPY of Will) (A.ttach Copy ofTrust)
c::J 9. litigation Proceeds Received c::J 10. Spousal Poverty Credle (date Of deat'l
between 12-31-91 anc 1-1-95)
8. Total Numbei of Sars DSDosit Boxes
c::l 11. Ele::::tion to tal: under See 9~ 13([\ 1
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLEED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIReCTED TO:
Name Telephone Number
:E3.r. Clg.l ey L
;:irm Name (If Applicable)
G r
f fie
~.35.:)51
200
Nor t h
H a n 0 v e r
S t r e.e t
REGISTER 0'" WILLS USE tl~y
o g
~o Q:'"
"'):n (,')
_. -0 (') rrJ
.'1i... -0
'"7 rn I
.".. (.';5 ~ 0"\
:'(JO
L='52'-:n
D45~LED
);.,..
I
I
G r iff i e &
Ass 0 c i Cl t e s
First line of address
Second line 0; address
.J
-0
::E
-', ()
City o~ Post Office
.c-
State ZIP Code
Car 1 i s 1 e
P
1 7
1
3
o
o
{~ . ~"
Correspondents e-maii address:
Under oenaltles of peflury, I declare tnat i have examined this return, Including accomoanyrng schedules and statements. anc to tne be.3t of my knOWledge and belief
II IS true, correel and complete DeClaration of oreoarer other tnan the personal representative is based on all informatron of which preoarec nas ail\' knowledoe
SIGNATUR::: Or- PERSON RESPONSIBLE FOR FILING RETURN
Linda Fisher
A:JDR::SS
DATE
'7/rJ(o
< .......... /
Hanover street,-~arlisle, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15 0 5 6 0 :; J, C1 4 7
--.J
---'
REV-150D EX
Decedentc I~ame
15056052048
207
Decedents Sociai3ecurily Number
o 5 7 5:
2 2
RECAPITULATION
1. Reai estate (Schedule A) 1.
2 StocKS and bondS (Schedule B) 2
3 Close!\' Held Corporatior, Dartnership or Sole-Proprietorship (Schedule C) . 3.
4 rciDrtgages &. I~otes Receivable (Schedule 0) . .
5. Cash, Bani: Deposits &. Miscellaneous Personal Property (Schedule E)
6 JOintly Owned Property (Schedule F) c:::> Se::Jarate Billing Requested. . 6.
7 l'lter-Vlvos Transfers &. Miscellaneous Non-Probate Property
IScnec:ule G; c:::> SeDarate Billing Requested.. . 7.
8. Totai Gross Assets !total lines 1-7).
4.
5.
8.
G. :=unera Expenses & Administrative Costs (Schedule H). .
~ ,
1 C ::leol3 of :::Jecedent, Mortgage Liabifities. &. Liens (Schedule I) .
Total Deductions (tota Unes 9 & 10). .
12 Ne: Value of Estate (Une 8 minus Line 11) . .
13. Ci1arltable and Governmental Bequests/See 9'13 Trusts for which
Wi eie~tion 18 tax has no', beer, mad8 (Schedu e J)
1L Net Value Subject to lax (Line 12 minus linE 13)
9.
. 10.
11.
12.
~?
I~.
14.
0'
0'
.... c;.-. ^..',,-;~J',,_;<,
-0
2~ 1
_ 0
1432-15.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at tne spousal lax fate or
transfers under Se~. 9116
laI11.2) X .0_
16. Amount of Line 14 taxabie
at lineal fate X .0 AS
17. Amount of :"'ine 14 taxable
a, s;bling rate X .12
12. Amount of Line 14 laxable
at coliateral rate X .15
19 TAX DUE.
15.
16.
/7
18.
. 19.
2C FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
15056052048
Side 2
6 4-
C:)
1S0560.s2048
-'
R'C\'.:50(j 'C); Page::
File Number 21 - 0 6 - 0043
Decedent's Complete Address:
DtCEDdf;-'S I~Atv1E
__~~abelle M._Hoc_k~pbe:r:::r::y
STREeT ADDRESS
80 Stone Church Road
Carlisle
STATE
PA
Zip
17013
CiTY
Tax Payments and Credits:
1. Tax Due (Page :2 Line 19)
, Credits/Payments
P.. Spousal Poverty CreeW
B. Pnor Payments
C Discount
(1
64.45
__~__~~_~___J)9_
.00
-----.~-~-. DO.
Total Credits (A + B + C ) i2i
.00
3 InterestPenalty if apoil:aoie
D. interest
E. Penalty
.00
-- ---~--"- --~--~-
.00
-----------~--~--------------~..- Tot21 interest/Penalty ( D + E )
4. Jf Uns 2 IS greaie~ rna~! Line 1 -; Line 3. enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
(3')
.00
1.1\
\"-t)
.00
64.45
.00
If line, -c line 3 IS greater than Line 2. enter the difference. This IS the TAX DUE.
~. ::nter tne Interest or tne tax due.
B. ::nte' the total of Line 5 + 5A. This is the BALANCE DUE.
(55)
.00
Make Check Payable to: REGISTER OF WILLSl AGENT
PLEASE ANSWER THE FOLLOW!NG QUEST!ONS BY PLACING .AN "X" !N THE APPROPRIATE BLOC~~S
~. Did aecedent make a transfer and: Yoc
5. retam the use or income of the proDerty transferred:......................................................................................... C
t.. retain the righ~ to designate who shall use th:; property transferred 01 its income; ....H...................................... I
C. retain a reversionary interest: or..... ....... ......... .... ......... ..... .... .................. ..... ..... .............................. .......... ...........
d receive the promise for life of eitner paymen's, benefits or care? ..................................................................... ~
2. Ii death occurred aher December 12, 1982, did decedent transfer proDerty within one year of death
r-
withou' receiVing adequate consideration? .............................................................................................................. L
J Did aecedenr own an "1Jl trust fOi" or payabie upon death bank account or security at his or her death? .......,.....
,; Old ,jecedent own an Individual Retirement Account. annuity. 01. otller non-probate property whicn
contains a beneficiary designation? '"'''''''''''''' ..................................................................................................... n
t~o
!xi
lxJ
:xl
~1
[;>L
xJ
KJ
KJ
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLEiE SCH~DULE 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 tne surviVing spaus2
is three (3) percent [72 P.S. S9116 (a) (1.1) (i)J.
For dates of death on or after January 1, 1995, the tax rate im:Josed on the net value of transfers to or for the use of the surviving spouse is zero (01 percent
[72 P.S. S9116 (ai (11) lii)J. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for discbsure 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. ~9116(a)(1.2)J.
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-haif (4.5) per:ent, except as i''Jtedn
72 PS. 39116(1.2) [72 PS. ~9116(a)(1 )}.
"I >e tax rate imposed on the net value of translers to or for the use of the decedent's siblin8s is twelve (12) percent [72 P.S. 39116(3)(1 1. /\ sibling is defined. ulrJ?r
Section 1:J102, as an individual who has at least one parent in cc mmon with the decedent, whc;ther by blood or adoption.
~'DM" .
CCMMONWEAlTH OF ?ENNSYLVANIA
INHERIT ANCC TAX RETURN
RESIDENT DEC~DENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Leabelle M. Hockenberry
FILE NUMBER
21-06-0043
lndude the proceeds of litigation and the aate the proceeds were received by the estate. All property jointly-<lwned with the right of sUl'livorship must be disdosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Supplemental Health Insurance Premium Refund
dated June 29, 2006
1,432.15
I
I
I
TOTAL (Also enter on line 5, Recapitulation) I s
1,432.15