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Home My WebLink About10-06-06 REV-1500 EX (&000) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ... z w c w (.) w c DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Clifford Ma DATE OF DEATH (MM-Do..YEAR) DATE OF BIRTH (MM-Do..YEAR) 9/8/2005 7/14/1914 (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) B W I- ~Sn CO!:: ~ a..u :J:~ (J a..~ a.. <<( D 1. Original Retum D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received [X] 2. Supplemental Ratum D 3. Remainder Ratum (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Return Required D 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (dlte ofduth botwlln 12-31-81 and 1-1-85) D 11. Election to tax under Sec. 9113(A)(AttachSchO) ~ Z W C Z o Q. II) ~ a: o u COMPLE1E MAILING ADDRESS 44 West Main Street ON Slidb]LO$E OtRI3CTSD 1'-0: .~tiit$'$..iitiiQNMQii.il.ii"i~~iEim.,.~~. NAME Richard C. Snelbaker FIRM NAME (If Applicable) Snelbaker & Brenneman, P.C. TELEPHONE NUMBER 717-697-8528 OFFCIAL USE ONLY FILE NUMBER ~L COUNTY CODE -9L 0827 ___ ~ NUMBER SOCIAL SECURITY NUMBER 167-14-7308 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER Mechanicsburg, PA 17055 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Per1nership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (SchedUle D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) z o i= :3 ;:) ... n: <C (.) W IX: 6. J~ 01M"led Property (Schedule F) LJ Separate Billing Requested 7. Inter-Vivos Transfers & MiscaJlaneous Non-Probate Property (7) (Schedule G or L) (6) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedenl, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequesls/See 9113 Trusts for v.hich an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax z rate, or transfers under Sec. 9116 (a)(1.2) o i= <<( 16. Amount of Line 14 taxable allineal rate I- ;:) ~ 17. Amount of Line 14 taxable at sibling rate o (J 18. Amount of Line 14 taxable at collateral rate >< ~ 19. Tax Due 20. D x.o L (15) x.o 45 (16) x .12 (17) x.15 (18) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT OFFCIAL USE ONLY C"") '-c; 0 C . :':.J .,j C) r-' :T1 -~"., 0.00 - - (-~; ,:--:' -~1"1 ) :c.iJ --l (8) 0.00 0.00 (11 ) (12) (13) (14) (19) > > BE StJR:E to ANSW~ALLq!J,~~T~~N$ONAeveJt$!:SlfjE AND RJ:CHECKM~lH' << 3W46451.0oo ~ => c;;;;;> ~ C> C-) -1 I at :::0 ~, ,rn h" (-) ,,;i~ ~.:- i eg 1-") rn :"7 C"") ~-ji _ -n <:=5 .' fTl ,~-, ~1 --"~'-..... ::: --- +'" 11,150.74 0.00 11,150.74 0.00 11,150.74 0.00 501.78 0.00 0.00 501.78 · Oecedenfs Complete Address: STREET ADDRESS 2100 Bent Creek Blvd Silver S irn CITY Mechanicsbur , Cumberland STAlE PA ZIP 17050- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 501.78 0.00 0.00 0.00 Total Credits (A + 8 + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty (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) 501.78 A. Enter the interest on the tax due. (5A) 0.00 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Pa able to: REGISTER OFWI.LS, AGENT (58) 501. 78 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes D D D D 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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [Ja 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 lIlXXlIllpanying schedules and statements. and to the best of my knowledge and belief, K is true, oorrect and oomplete. Declaration of preparer other than the personal represenlatMl is based on all information of which preparer has any knowledge. ~ OF PERSON ~~IBLE FOR FILING RE1URN . ~?,/~ /~ 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 No ~ ~ ~ [j []I [}g DAlE 10/5/2006 106 Skyline Drive, Mechanicllburq, PA 17050 DAlE 10/5/2006 Richard C. Snelbaker, Esquire 44 West. Main St.r_t., Mechanicllburq, PA 17055 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. ~ 9916 (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 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. ~ 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiartes is 4.5%, except as noted in 72 P.S. ~ 9116(1.2) [72 P.S. ~ 9116(a)(1 )1. The tax rate imposed on the net value of trensfers to or for the use of the dececlenfs 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 dececlent, whether by blood or adoption. 3W4646 1.000 RI!V-1503 EX +'(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESloe.Ir DECEDENT ESTATE OF SCHEDULE 8 STOCKS & BONDS FILE NUMBER Marv B. Clifford 21 05 0827 All property Jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NlNBER DESCRIPTION 1. Agere Sys tems, Inc. 10.30 shares of stock valued at $10.26 per share VALUE AT DATE OF DEATH 105.68 2 Comcast Corporation 331 shares of Class A common stock valued at $30.46 per share 10,082.26 3 NCR Corp 29 shares of stock valued at $33.20 per share 962.80 3W46961.000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 11,150.74 REV-1'S13 EX. (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Marv B. Clifford FILE NUMBER 21 05 0827 NUMBER I 1 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] William H. Clifford, III 1544 Giddings Avenue, SE Grand Rapids, MI 49507 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE 25% of Residue: 2,787.68 Son 2,787.68 2 Linda Mary Fortini 106 Skyline Drive Mechanicsburg, PA 17050 25% of Residue: 2,787.68 Daughter 2,787.68 3 Victoria Regena Hara 2385 Black River Falls Drive Henderson, NV 89044-1005 25% of Residue: 2,787.68 Daughter 2,787.68 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18. AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISlRlBUTlONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 3W46A11.000 (If more space IS needed. Insert additional sheets of the same sIZe) ... .. . Estate of: Mary B. Clifford Item No. Description 4 Terry Odhner 14079 North 34th Place Phoenix, AZ 85032 25% of Residue: 2,787.68 167-14-7308 Schedule J Part 1 (Page 2) Relation Amount Daughter 2,787.68