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Home My WebLink About12-06-06 --1 15056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT ~ \ ole ltlC1 Date of Birth 172-01-5092 10/19/2006 01/03/1909 Decedent's Last Name Suffix Decedent's First Name MI Eckerd Nora S (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Return 2 Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9 Litigation Proceeds Received 10. Spousal Poverty Credit (date of death 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: Name Daytime Telephone Number Ronald C. Eckerd (717) 766-2069 ~ = = REGISTER oa\J-l)S USE o~ . ~.1 CJ . . 1""'1 ';J 0 C-) c;; C;:, I L: ':=1:' A' . (J) :;~~ Firm Name (If Applicable) First line of address 312 Monroe St. ~ ~ {~~-.. ....-~(.\ - Ii --~ ;~~ Second line of address City or Post Office State ZIP Code ::':.; -. 1'1 DATE ~D \.0 W N Mechanicsburg PA 17055 Correspondent's e-mail address:rceckerd@verizon.net JTE . /;2. ~ /.2-S0 {.> 17055 DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ~ ~ .-.J 15056052059 REV-1500 EX Decedent's Name: Nora S Eckerd RECAPITULATION 1. Real estate (Schedule A). 1. 2. Stocks and Bonds (Schedule B) . 2. 3 Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. 4. Mortgages & Notes Receivable (Schedule D) . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested.. 8. Total Gross Assets (total 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 tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 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) XO_ 16. Amount of Line 14 taxable at lineal rate X.O 45 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 8,747.49 19. TAX DUE. ..10. 11. 12. . 13. . . 14. 15. 16. 17. 18. ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 L 172-01-5092 Decedent's Social Security Number 6. 7. 8. 9. 215,807.43 215,807.43 9,352.20 12,066.65 21,418.85 194,388.58 194,388.58 8,747.49 15056052059 ~ REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Nora S Eckerd 172-01-5092 STREET ADDRESS 312 Monroe St. CITY I STATE i ZIP Mechanicsburg PA I 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 8,74749 460.38 Total Credits ( A + B + C ) (2) 460.38 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + 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) B Enter the total of line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) 8,287.11 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. 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 No 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 [iJ d. receive the promise for life of either payments, benefits or care? .......................................................... ........... 0 [iJ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ......................... .......................................... ...... 0 [iJ 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 ~ 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 P.S. S9116 (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. S9116 (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 PS. s9116(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, S9116(1.2) [72 PS. s9116(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. s9116(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-1512 EX+ (12-03) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Nora S. Eckerd FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Alert Pharmacy Services, Inc., 219 N. Baltimore Ave., Mt. Holly Springs, PA VALUE AT DATE OF DEATH 45256 2. Alert Pharmacy Services, Inc., 219 N. Baltimore Ave., Mt. Hall y Springs, PA 60.27 3. Messiah Village, Mt. Allen Drive, Mechanicsburg, PA 7,254.92 4. Messiah Village, Mt. Allen Drive, Mechanicsburg, PA 4,26390 5. Paul D. Dalbey, DPM, 5 Kacey Court, Suite 202, Mechanicsburg, PA 3500 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 12,066_65 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTlY-OWNED PROPERTY ESTATE OF Nora S. Eckerd 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. Ronald C. Eckerd 312 Monroe St., Mechanicsburg, PA 17055 Son B C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY.HELD REAL ESTATE VALUE OF ASSET INTEREST DECEDENTS INTEREST 1. A. 01/01/98 Checking Account PNC Bank Accl. #5070078527 13,37501 50% 6,68750 2 A 07/01/93 TAP Account Brethren in Christ Foundation Accl. #2973 55,305.89 50% 27,65295 3 A 07/09/02 CD Bank of America #68100405516729 20,00000 50% 10,000.00 4 A 01/24/05 CD Bank of America #68100408442691 20,00347 50% 10,00174 5 A 09/07/04 CD Bank of America #68100404347092 20,00464 50% 10,00232 6 A 07/21/03 Janney Montgomery Scott Account #2978-2530 266,33418 50% 133,167 09 7 A 02/25/99 PNC Investments Accl. #32156847 27,801.65 50% 13,900.83 8 A 11/22/93 Limited Partnership PLM Equipment Growth VII Investor #156494 8,790.00 50% 4,39500 TOTAL (Also enter on line 6, Recapitulation) $ 215,807.43 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Nora S. Eckerd FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 3 FUNERAL EXPENSES: Myers Funeral Home Giant Food (Funeral Refreshments) Rothermel's Florist, Inc. Gingrich Memorials 8,979.00 89.20 159.00 12500 1. 2 4 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions 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 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9,35220