HomeMy WebLinkAbout12-05-06
.*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
I-
Z
W
C
W
o
w
C
HOSTETTER RENA
DATE OF DEATH (MM-DD-Year)
M.
DATE OF BIRTH (MM-DD-Year)
01/18/2005 10/07/1933
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
w
....
~~m
(.JO::~
wO-(.J
:%;00
(.Jlf~
0-
oc(
[Xl 1. Original Return
D 4. Limited Estate
[Xl 6. Decedent Died Testate (AlIach copy of WlI)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (AlIach copy ofTrust)
D 10. Spousal Poverty Credit (dalllofdealh between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 6 0 4 2 7
""CoUN'rY"'Co5E -~ - - 'NuMaER- -
SOCIAL SECURITY NUMBER
205-26-4225
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (daleofdealhpliorto 12-13-82)
D 5. Federal Estate Tax Return Required
.!!.. 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under See. 9113(A) (Atlach Sch 0)
....
z
w
c
z
o
0-
m
w
0::
0::
o
(.J
NAME
MURREL R. WALTERS III, ESQUIRE
FIRM NAME (If Applicable)
COMPLETE MAILING ADDRESS
TELEPHONE NUMBER
717-697~50
54 EAST MAIN STREET
MECHANICSBURG
z
o
~
<C
..J
=>>
....
ii:
<C
o
w
~
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation. Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent 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 Bequests/See 9113 Trusts for which 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
z
o
~
<C
....
~
Q.
:E
o
o
~
15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under See. 9116 (a)(1.2)
16. Amount of Line 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
(8)
(11)
(12)
(13)
(14)
PA 17055
OFFICIAL USE ONLY
).>
1,574.00
,...."
c::::::I
<=>
0"\
o
f'T1
('"")
I
(J1
:XJ
rTl
(J
o
::u
CJ
r-n
C1
C:-JO
-"'"1 .
. -"Tl
;:.;~
r-~ rn
121,285.68 X ~ (15)
X _ (16)
X .12 (17)
X .15 (18)
(19)
J>
:x:
a>
c...>
\~/) ~.~~
122,859.68
1,574.00
121,285.68
121,285.68
0.00
0.00
o
d t' C
I t Add
ece en s ampl e e ress:
STREET ADDRESS
16 S. 24TH STREET
CITY I STATE I ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
Total Credits (A + 8 + C) (2)
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
4.
T otallnterestlPenalty ( D + E )
If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
If Une 1 + Une 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Une 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
(3)
5.
0.00
0.00
0.00
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ................. ............................. .......... ................... 0 I&J
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 I&J
c. retain a reversionary interest; or ........................................................................ .............................. 0 I&J
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 I&J
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?............. ................................................................................. 0 00
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? ................................................................................................ ....... 00 0
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 peljury, I declare that J have examined this return, includi~ ~ying schedules and statements, and to the best of rny knowledge and belief, it is true, correct and complete.
DecIa'ation of preparer other than the personal representative is based on a11lnformalion of Which prepa-er has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR F ING RETURN DATE
ADDRESS
~
PA
ADDRESS
Sill
MAIN STREET, MECHANICSBURG
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. ~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 exemot 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. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use ofthe decedent's lineal beneficiaries 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 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.
REV-'"!'" EX + (.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOSTETTER
RENA
FILE NUMBER
M. 21 06
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0427
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
122,859.68
AMERICAN FUNDS - IRA
BENEFICIARY - HUSBAND - H. CLAIR HOSTETTER
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
122,859.68
REV-1511 EX+(12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HOSTETTER
RENA
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
M.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21
0427
06
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. NEILL FUNERAL HOME (MOSTLY PREPAID) 653.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) H. CLAIR HOSTETTER - RENOUNCED
Social Security Number(s)/EIN Number of Personal Representative(s)
StreetAddress 16 S. 24TH STREET
City CAMP HILL State PA Zip 17011
Year(s) Commission Paid:
2. Attomey Fees MURREL R. WALTERS III 600.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS - CUMBERLAND COUNTY 321.00
5. Accountanfs Fees
6. Tax Retum Prepare(s Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 1.574.00
(If more space is needed, insert additional sheets of the same size)
. RB'-:51~EX'(*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Hu~ I I:: I I::K
RENA
M.
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnclude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
H. CLAIR HOSTETTER
16 S. 24TH STREET
CAMP HILL, PA 17011
FILE NUMBER
21 06
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
HUSBAND
0427
AMOUNT OR SHARE
OF ESTATE
1 00%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
IT. 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 n - 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)