HomeMy WebLinkAbout11-07-06 (2)
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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
File Number
~,\ 0(0,
Dq~1
Date of Birth
j
oqliD;}oo(o
Ido
Iq/4
Decedent's Last Name
Suffix
Decedent's First Name
MI
ELY
/VI
(If Applicable) Enter Surviving Spouse's Information Below
Last Name Suffix
Spouse's First Name
MI
Social
Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Return
4. Limited Estate
c:::>
3 Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:>
2. Supplemental Return
c:>
c:>
c:> 4a. Future Interest Compromise (date of
death after 12-12-82)
c:> 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
c:> 10. Spousal Poverty Credit (date of death c:> 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:
i_'
Name Daytime Tel~one Nurnbelt-) .
1 \ '..-'~71F3, )f"f -, ci~~QJ
,,_, " , .' '. ,J
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
c:>
c:>
e... A ...~...o "L
A
A~A
Firm Name (If Applicable)
REGISTER OF ~ILLS Uf)E ONLY
. -.J
First line of address
i5
s-rotJf'S~~;tJc,
LANE
~-,~
)
Second line of address
( '1
o
City or Post Office
~r+tI\ p ~ \
State ZIP Code
DATE FILED
{?A- 0
Correspondent's e-ma;1 address:
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.
CA~ HtU-
SENTATIVE
~A-
\
i(ell
ADDRESS
I q AN'\r-\e~
CAfY\P Hi LL- G>Pr 170t \
PLEASE USE ORIGINAL;"ORM ONLY
Side 1
L
15056041046
15056041046
---I
-~
---I
15056042047
REV-1500 EX
Decedent's Name:
RECAPITULATION
1. Real estate (Schedule A).
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5.
6. Jointly Owned Property (Schedule F) c:=) Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:=) Separate Billing Requested. . 7.
8. Total Gross Assets (total Lines 1-7). .
9. Funeral Expenses & Administrative Costs (Schedule H). . . . .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .
. . . . . . 10.
11. Total Deductions (total Lines 9 & 10)...
. . .. 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . .
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)
. . . . 12.
13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
...14.
~3 '-\ q ., . d<3
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O '15
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
(005
\
16
17.
18.
19. TAX DUE.
. . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056042047
Decedent's Social Security Number
11 d 0 { d' 5;J-
1.
2.
4.
8.
&4 (04 5.~ 0
I \ 'l q ~.$~
9.
q ~.S'6
.
(00
(005.. \
c:::>
15056042047
....J
REV-1500 EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME
ELVA- mMy. iiJA0~G~
STREET ADDRESS
CLM...J2f{\.Q~\" ~oj2..S.i~ +
/000 C~L~ff\Cf::>\ ~
CITY
eRE l-I f\ B (LIT Ii Tf Clt~
STATE
rPl+
C;A~LI SJ..~
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payment?
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3.
InteresUPenalty if applicable
D. Interest
E. Penalty
c O.s;)-(P3 "{p )
(2)
3\.~
Total Credits ( A + B + C )
Total InteresUPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
ZIP
/70(3
(r;J:>5, Id-
3 \ ,'3.,"",
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
513, ;;t3
A. Enter the interest on the tax due.
(5)
(5A)
(5B)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
~ST~, a'8
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
a. retain the use or income of the property transferred; ........................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ..................................... 0
. c. retain a reversionary interest; or............................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ............................................................ 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............ ................................................................................................. 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .......................................................................,................................ 0
No
~
~
~
~
18l
~
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 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 three (3) percent [72 PS. 99116 (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 zero (0) percent
[72 P.S. 99116 (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 zero (0) percent [72 P.S. 99116(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 four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 PS. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(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.
REV-15GB EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
EL'v'A /Vl. VlJAcaJt:R.
FILE NUMBER
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
VALUE AT DATE
OF DEATH
So\J2RE I CoN <3A.0+<\
c.. tJ-Gc..;< \ tJ CO
SAUI/JlOS
c..c~. ..1= 'S::x2(?c;SIT
3~,", ,~d-
qLt<.o,O~
.sOO'd- i (.,
TOTAL (Also enter on line 5, Recapitulation) $ (P 333 . 01
(If more space is needed, insert additional sheets of the same size)
REV.I509 EX + (1.97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
{;LOPt m. (,I..JAMER-
FILE NUMBER
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 TO DECEDENT
A, ELr2A~H M. ~LlHtJ
\C{ '1M.~'ST ~.
Q.I\ tv\.P Hi L L \? R
I
noil
"bAu,G,HTE R...
B,
c,
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '!oOF DATE OF DEATH
ITEM FOR JOIN r MADE Include name of financial institution and bank account number or similar identifying number, Attach DATE OF DEATH DE CD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1, A, 11)}OI tl~ELrT'f I tJ V ES-r IY\ {; tJ" rs 3(oCodS . '-II SO~ l~3Id.l~
TOTAL (Also enter on line 6, Recapitulation) $ 11s31d ,'13
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
_9J. ..:.\.1 :.~ .'~..
~~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
t?LUA IY), /i.J,!\'Ne~
FILE NUMBER
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
1.
(?AICTHGfYlor.$ FUiJEICAL HomE
G?Ol.Li#J6 (O~Grv Q.EmGTE~"i
Fu~.?RAL ~cpR-c:smEN.rs - L.. i KO~"f\ \hl-L-A
oTHcf'~ Ft..c,\...l€ R.S - <?c::r-lt..€~ '.5 F(..lA.uG~S
1S j '3-1 , dO
d3 '70 .00
3;}~,3~
S3.00
1.
ADMINISTRATIVE COSTS: ESTATE" Nci'(~tE S - C?{-\T~lo'-i ^,EuU<<";)
'?,
Personal Representative's Commissions -,; -
j 'd ' 00
~L4.~f3
B.
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2.
Attorney Fees
~ L,0f'C\, N\ILLc:~ LE"rnOYt..i~ ,9$+
i "'
1#J1-r,A-L- Q:D tJS"...\J..L I A T ION
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
dOO ,Ob
3.
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ \ I \ '1<6 . =5'6
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
€.Li,'A f\'\. WA~IUEtc..
FILE NUMBER
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
AMOUNT OR SHARE
OF ESTATE
1.
I. ~Au..~tt T,:(L
II j y ,J. 50
f
~L A, f(\(\~A~A ,
IS S"Tbt..jE"S'J~I~G:; LN
~1\t'f'P {{iLL, (~..".. ",0 \l
"
:;). E LI2 A BErH ((\, +(u..t-\ l--J
I Ct A (V\ t\E- t?zr ~,
LA('(\.() f.:H LL. \ 9A- (Ie II
;). ~~COttTER-
I I I C( d . 50
I
3. ~\Cl4AR.\) L. \}.i,r.HcI-JG~
qoi N, F~0T sr,
H'OCo, ~A- 1"110:+
,
~,
Sc~
(0.000.00
/'
. <:::" '\
L1, ....)b \.J
; 01000.00
Li S<c6:;;':'C:.T S. \jJ AQ; ~ e~
qol N. r~;:;T ST.
t-(.OGJ , C? P, / -, , 0.::,)..
,
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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)
INHERITANCE TAX JOINT BANK ACCOUNT COUNTYFILENUMBER
ADVANCE PAYMENT WORKSHEET INHERITANCE TAX RECEIPT NUMBER
DECEDENT
INFORMATION
FINANCIAL
INSTITUTION
INFORMATION
ACCOUNT
INFORMATION
DECEDENT'S NAME (LAST)
\J-JAGl\\GR.
(FIRST)
ELVA
(MIDDLE INITIAL)
/Ill,
DECEDENT'S SOCIAL SECURITY NUMBER
lid -01 -2>ISa-
ADDRESS OF DECEDENT
&.A~G"MCr..:.-r ~~itJ~ ~i?
DATE OF DEATH
q -I (" -Olo
9A
CITY
STATE
ZIP
~ISLE
17
NAME OF FINANCIAL INSTITUTION
FIDELITY ll'J:JE.&TME~Jrs
ADDRESS
<?o. COc'~ ,1000 i
CITY
c.l1JC!I1J,v~Ti
STATE
ZIP
OM
L#5d1'J
TELEPHONE NUMBER
(~. )
TYPE OF ACCOUNT
~{ (r1(jJe V
\sa OTHER Mi\RKCT
o SAVINGS
o CHECKING
o TRUST
o CERTIFICATE OF DEPOSIT
ACCOUNT BALANCE (INCLUDE INTEREST TO DATE OF DEATH)
'?:J..D (p d S-: <<-l,
ACCOUNT NUMBER
Z '-I~-ld<g3Y'
ACCOUNT TITLE AS APPEARS ON SIGNATURE CARD OR CD
ELl/~ /VI vJ~;';€R... G'LI~,q&'IH ~,1<uH~-\NR05
ORIGINAL DATE ESTABLISHED
01 ~ O~ - OJ
SURVIVING
JOINT OWNER
INFORMATION
NAME (Last)
-KUt-\W
ADDRESS
fCi AMt-\e~T
CITY
~AMP HILL
RELATIONSHIP TO DECEDENT
"MU6>HTE~
Department of Revenue
Use Only
(First)
ELf2.AGETH
~\"'f"'
(Middle Initial)
fV\
PERCENT TAXABLE
STATE
CPA
ZIP CODE
110(1
TELEPHONE NUMBER
( 1 t 1 ) -,(O~.~( St.J
TAX RATE
SURVIVING
JOINT OWNER
INFORMATION
NAME (Last)
(First) (Middle Initial)
PERCENT TAXABLE
STATE ZIP CODE
/
TEj.EPHONE NUMBER TAX RATE
/(/
(Middle Initial)
PERCENT TAXABLE
STATE ZIP CODE
TELEPHONE NUMBER TAX RATE
ADDRESS
"-.
..............
SURVIVING
JOINT OWNER
INFORMATION
NAME (Last)
//
ADDRESS
,,/
/
CITY
RELATIONSHIP TO DECEDENT
Date Paid
LIST DEBTS & DEDUCTIONS BELOW
Amount Paid
Payee
Description
Note: Please attach to receipt
Total $
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~t Sovereign Bank'"
STATEMENT OF ACCOUNTS
1-877-S0V-BANK (1-877-768-22651 www.sovereignbank.com
Statement Period 09/15/06 TO 10/15/06
FREE INTEREST CHECKING
Financial Summary statement period 09/15/06 - 10/15/06
ELVA M WAGNER
c/o BETSY KUHN
Deposit Accounts
Account Number
Average Daily Balance
Current Balance
STATEMENT SAVINGS ACCOUNT
Total Deposit
1054020092
$3,420.75
Time Deposit Accounts
Account Number
Maturity Date
Interest Rate
Current Balance
FREE INTEREST CHECKING statement Period 09/15/06 - 10/15/06
ELVA M WAGNER
c/o BETSY KUHN
Account # 1051073251
Balances
Deposits/Credits
+ $100.19
Average Daily Balance
$2,287.93
Interest
Earned this Period
$ 0.19
Paid Last Year
$0.90
*The interest earned and the interest paid may differ depending on when interest is credited to your account.
page 3 of6
1051073251
1-877-S0V-BANK (1-877-768-2265) www.sovereignbank.com
Statement period 09/15/06 TO 10/15/06
FREE INTEREST CHECKINC
Checks Posted
Check # Date Paid
Amount Reference #
Check # Date Paid
540
09/25
Amount Reference #
$326.38 642899830
2 Check(s) Posted = $8,463.58
An asterisk (*) indicates a skip in sequential check numbers which may be caused by one of the following:
. A check not yet received
· A check that was converted to an electronic transaction, which will be listed in the "Electronic Checks Posted"
section below. If no checks were electronically converted, this section will not appear.
Account Activity
Date Description Additions Subtractions Balance
09-15 Beginning Balance $8,863.81
ROS
09-22
09-25
10-03
STATEMENT SAVINGS ACCOUNT Statement Period 09/15/06 - 10/15/06
ELVA M WAGNER
c/o BETSY KUHN
Account # 1054020092
Balances
Beginning
Deposits/Credits
awals/Debits ..
* This balance was calculated for the period beginning on 09/01/06 and ending on 09/30/06
+ $27.00
Average Daily Balance
$3,420.75 *
Interest
Paid this Period *'
Earned this Period
*The interest earned and the interest paid may differ depending on when interest is credited to your account.
page 4 of6
105/07325/