HomeMy WebLinkAbout09-21-06
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, REV.I500 EX (8001
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
OFFICIAL USE ONLY
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
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FILE NUMBER
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COUNTY CODE YEAR
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
SOCIAL SECURITY NUMBER
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~ Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (Attach copyofW~I)
o 9, Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy 01 Trust)
o 10. Spousal Poverty Credit (date of death belween 12-31-91 and 1-1-95)
D 3. Remainder Retum (dale 01 death prior to 12-13-82)
o 5_ Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to lax under Sec. 9113(A) (Attach Sch 0)
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FIRM NAME (II Applicable)
COMPLETE MAILING ADDRESS
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TELEPHONE NUMBER
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.OFFicIAL USE ONty
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (tolal 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)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to lax has not been
made (Schedule J)
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14. Net Value Subject to Tax (line 12 minus Line 13)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
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x .O~ (16) A. 2.q ~ ~~A F'F.
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x .15 (18)
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16. Amount of Une 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Decedent's Complete Address:
STREET ADDRESS
CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
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Total Credits ( A + B + C ) (2)
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E ) (3)
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)
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.
(5)
(5A)
(58)
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8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes ~
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c. retain a reversionary interest; or..........................................................................................,............................... D ~ ~
d. receive the promise for life of either payments, benefits or care? ...................................................................... D I..M""
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
3. ~:~h~~~:~:;::~~:~~:~:~:ra~:~;~i~.~;~.d~~~~.b~~k.~~~~t..~.;.~~~~~.~~.~;~.~~.~~~.d~~~~;:::::::::::::: B ~
4. ~~t:~n~:e:::i:~ I~:~~:n~:o~~ti~~:~~~.~~~~.~.~'..~~~~i.~:.~~..~.t.~.~~.~~~~~~~~~~~.:.~~~.~..~~~~~...................... 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.
SIGNATURE OF PERSON RESPONSIBLE ~FIUNG . TURN it
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ADDRESS
DATE
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SIGNATURE OF PREPARER OTHER THAN RnSENTATIVE ~
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ADDRESS
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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 3%
(72 P.S. ~9116 (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. ~9116 (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 retum 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. ~9116(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. 99116(1.2) (72 P.S. 99116(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. ~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.
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.. REV-15ll8Ell,"{l-97)
'*
SCHEDULE E
CASH; BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
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TOTAL (Also enter on line 5, Recapitulation) $ \ ?l J ')..A. '\ . '2."3
(If more space Is needed, insert additional sheets of the same size)
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REV-1511 EX+ (12-99) .
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A. FUNERAL EXPENSES:
1.
DESCRIPTION
AMOUNT
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
~~~1::.
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
Slate _ Zip
Year(s) Commission Paid:
2. Attorney Fees ~b\.:>e
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 ~ B . 00
5. Accountant's Fees ~\..:)S;
6. Tax Return Preparer's Fees ~b~-g
7.
G,~ SS,OD
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TOTAL (Also enter on line 9. Recapitulation) $
(If more space Is needed, insert additional sheets of the same size)
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JUN. 22-JUL.21,2006
1 OF 1
..
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33932867 RELATIONSHIP CHECkING WITH INTEREST
00 0 06123H Ntt 017
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D EDGAR FOX
C/O JOAN l FOllETT
306 15TH ST
NEW CUMBERLAND PA 17070
62270
INTEREST PAID YEAR TO DATE
8.12
WEST SHORE PLAZA
15,147.05
ACCOUNT SUMMARY
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AItDUNT NO. AItDUNT
0.00 0 0.00
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:.m!i1iE$T::PO ':::,:':::,:jlUNtE::::
1.29 16,214.34
06-22-06 BEGI...ING BALANcE
07-05-06 DEPOSIT
07-21-06 INTEREST PAYMENT
tl5,147.05
16,213.05
16,214.34
ENDING BALANCE
tl6,214.34
ANNUAL PERCENTAGE YIELD EARNED =
0.09 Yo
WHAT DO YOU WANT TO DO THIS SUHHER VACATION? ENJOy FAMILY BARBECUES WITH A
NEW WEBER (R) GAS GRILL? PLANT THE PERFECT GARDEN WITH A fl00 GIFT CARD FROH
THE HottE DEPOT (R)? GET IN SifAPE LISTl:NING TO YOUR fAVORiTE TUMES OH YOUR NEW
APPLE IPOU UU HAHo? IMPROVE YOUR GAME NITH SOHE NEW TITlE 1ST PRO VI (R) GOLF
BALLS? YOU CAN DO IT ALL! RENARD VOURSELF! FOR INFOIHATlON OR TO APPLV FOR
VOUR HIT VISA(R) CREDIT CARD WITH WORLD POINTS (R) REWARDS TODAV, STOP BV ANV
MIT BRANcH, CALL THE TELEPHONE BANKING CENTER AT 1-800-724-3222, OR VISIT US AT
NWw.HANDTBANK.CONIPERSDNAL/LOANS/VISA.CFH.
LOO8A (1103)
~:M8trBallk.;~
........ ACCOUHl. . Hij,
33932867 RELATIONSHIP CHECKING WITH INTEREST
HAY.20-JUN.21,2006
1 OF 1
00
o 06123M NH 017
19027
D EDGAR FOX
C/O JOAN L FOLLETT
306 15TH ST
NEW CUMBERLAND PA 17070
INTEREST PAID YEAR TO DATE
6.83
WEST SHORE PLAZA
. . . . .
... .'OUNtE..
ACCOUNT SUMMARY
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NO. AHOUNT
o 0.00 1.34 15,147.05
13,508.57
05-20-06 BEGINNING BALANCE
05-25-06 DEPOSIT
06-21-06 INTEREST PAYHENT
.13,508.57
15,145.71
15,147.05
ENDING BALANCE
$15,147.05
ANNUAL PERCENTAGE YIELD EARNED =
0.09 7.
A t1,OOO FOR YOUR THOUGHTS?
CONDUcT A TRANSACTION AT YOUR lOCAL BRANCH BETWEEN JtlrtE 13 AND JULY 21, 2006 TO
RECEIVE AN INVITATION TO PARTICIPATE IN OUR CUSToMER SERVICE SATISFACTION
SURVEY. COMPLETE THE SURVEY FOR A CHANCE TO WIN A GRAND PRIZE OF U,OOO OR ONE
OF FIVE t100 PRIZES!
lOO8A (1103)
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Commonwealth of Pennsylvania
Remittance Advice
Acct. Purchase Order Invoice Invoice
Control Number Number Date Number
WE ARE PRESENTING THIS CHECK FOR YOUR UNCLAIMED PROPERTY, CLAIM #99613022
o 0 05/08/2006 99613022
000271 57 12941985
Payment
\ Amount
$1,637.14
IF YOU HAVE ANy QUESTIONS CONCERNING THIS PAYMENT CAll 1-800-222-2046
Total Payment Amount - $1,637.14
DETACH CHECK AT PERFORA -nON
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Check No.
06 30 06 1 AUSTIN, TexAs
2307 62517046 20092800 130 OFOX
111.111.1.111. ,11.. III'. 111.,11.,1 "1..11,1,1111 I i..II.",11 i I
JOAN L FoLLETT
306 15T11 ST
NEW CUMBERLNb ~A 17070-1311
2307 62517046
PHILA TAX h~FUNb
12/05
46
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j~ HMlnISaUnG, PA 17111
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DEPOSIT TICI<ET
60-83/0313
~891
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2001 Market Street, Harrisburg, PA 17103
(717) 238.2502
(;;:OR GeR. /110" \) , Supervisor
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FUNERAL HOME, INC.
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Telephone (717) 238-2502
HARRISBURG. PENNSYLVANIA 17103 Parking Facilities
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