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Home My WebLink About12-06-06 (2) w ~ ll::::$1I) oa::ll:: w~o :z:a::9 Oll.lll ll. c( REV-1500 EX + (~OO) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 21 -0 5 028 3 '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-{)601 "'COuNTY'CoiiE -YEA~ - - NUMBER- - SOCIAL SECURITY NUMBER 278-16-3609 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Retum (date of death prior to 12-13-82) D 5. Federal Estate Tax Retum Required !... 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) z o i= 01( ..J ;:) l- n: 01( u W D:: z o i= ~ ;:) D.. :E o u ~ I- I- Z W C W o W C DECEDENfS NAME (LAST, FIRST, AND MIDDLE INITIAL) WHITEHEAD ROBERT DATE OF DEATH (MM-DD-Year) A. DATE OF BIRTH (MM-DD-Year) 03/19/2005 02121/1921 (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) ~ 1. Original Retum D 4. Limited Estate ~ 6. DecedentDied Testate (AttachcopyofWiH) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 4a. Future Interest Compromise (date of death afler 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy oITrus!) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ~ z W Q Z o ll. II) W a:: a:: o o NAME MURREL R. WALTERS III FIRM NAME (If Applicable) COMPLETE MAILING ADDRESS 54 EAST MAIN STREET TELEPHONE NUMBER 717-697-4650 MECHANICSBURG 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 Govemmental 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 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X _(15) 638,512.03 X .045 (16) X .12 (17) X .15 (18) (19) 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 0.00 -) (-; C) ":' (~) -1", ),-= 658,849.04 - ~ :s! :%> :x CO W N 1,318.25 (8) 660,167.29 5,334.00 16,321.26 (11) (12) (13) 21,655.26 638,512.03 (14) 638,512.03 28,523.04 28,523.04 Decedent's Complete Address: STREET ADDRESS 1514 BRANDT AVENUE CITY I STATE I ZIP NEW CUMBERLAND PA 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1 ) 28,523.04 25.600.00 1.280.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 26,880.00 Total Interest/Penalty ( 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. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 1,643.04 1,643.04 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 IRl b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 IRl c. retain a reversionary interest; or ...................................................................................................... 0 IRl d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IRl 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............. ..... ................... ....... .............. .......... ...... ..... ...... ........ 0 IRl 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 IRl 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... 0 IRl IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ADDRESS MUR EL R. WALTERS III 54 EAST 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 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 beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(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. REV-1508 ~ + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF WHITEHEAD ROBERT FilE NUMBER A. 21 05 Include 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. 0283 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 576,385.40 THE PENNSYLVANIA TRUST CO. INVESTMENT ACCOUNT 2. REALMARK PROPERTY INVESTORS REAL ESTATE TRUST 20 SHARES @ 155.00 PENN INSURANCE AND ANNUITY COMPANY 3,100.00 3. 42,257.09 4. DREYFUS FOUNDERS FUND 24,939.40 5. "ANUS 7,026.77 6. ERIE AUTO INSURANCE REFUND 338.00 7. VERIZON REFUND 2.38 8. 1998 CHRYSLER SALE OF CAR 4,800.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 658,849.04 REV-1509 E!< + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF WHITEHEAD FILE NUMBER ROBERT A. 21 05 0283 If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. BARBARA E. WHITEHEAD 1514 BRANDT AVENUE NEW CUMBERLAND, PA 17070 DAUGHTER B c JOINTL Y.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 DECEDENfSINTEREST 1. A. 12/14/01 FULTON BANK 1,004.99 50. 502.50 SAVINGS ACCOUNT 2. A. 9/15/98 FULTON BANK 1,612.76 50. 806.38 CHECKING ACCOUNT 3. A. 11/01/96 PSECU 6.17 50. 3.09 REGULAR SHARES 4. A. 11/01/96 PSECU 12.55 50. 6.28 CHECKING TOTAL (Also enter on line 6, Recapitulation) $ 1,318.25 (If more space is needed, insert additional sheets of the same size) REV-1511 ~ + (12-99) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF WHITEHEAD FILE NUMBER ROBERT A. 21 05 0283 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. AUER MEMORIAL HOME AND CREMATION SERVICES, INC. 212.00 2. FUNERAL MEAL 992.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) BARBARA E. WHITEHEAD. RENOUNCED Social Security Number(s)/EIN Number of Personal Representative(s} Street Address 1541 BRANDT AVENUE City NEW CUMBERLAND State PA Zip 17070 Year(s) Commission Paid: 2. Attomey Fees MURREL R. WALTERS III 3,750.00 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 380.00 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 5,334.00 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (6-98) . SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WHITEHEAD FILE NUMBER ROBERT A. 21 05 0283 Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. STONE, LaFAVER & SHEKLETSKI LEGAL SERVICES 1,125.00 2. STONE, LaFAVER & SHEKLETSKI ADVERTISING 113.61 3. QUANTUM IMAGING MEDICAL 75.99 4. PATRIOT NEWS NEWSPAPER 1.80 5. KUNKEL SURGICAL GROUP MEDICAL 19.19 6. VERIZON TELEPHONE 30.51 7. WEST SHORE EMS MEDICAL TRANSPORT 1,068.01 8. HOLY SPIRIT HOSPITAL MEDICAL 937.00 9. NUEROLOGICAL SURGERY MEDICAL 14.03 10. TIMOTHY A. CLARK, M.D. MEDICAL 264.57 11. METRO MEDICAL SERVICE MEDICAL 85.00 12. INTERNIST OF CENTRAL PA MEDICAL 49.37 13. VETERANS AFFAIRS 154.00 14. HOSPITAL TELEPHONE TELCOM SERVo 4.00 15. PINNACLE HEALTH EMERGENCY MEDICAL 78.39 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 16,321.26 Continuation of REV-1500 Inheritance Tax Return Resident Decedent WHITEHEAD ROBERT A. Decedent's Name Page 1 21 05 0283 File Number Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. VOGT & BRUZGA 1,060.00 TAX RETURN PREPARATION - 2004 INCOME TAXES 17. CARDIOLOGY DIAGNOSIS ASSOC. 3.54 MEDICAL 18. KANTOR & THATCH, PC 69.20 19. AMERICAN HOME PATIENT 44.66 MEDICAL 20. NEUROLOGY CENTER 65.23 MEDICAL 21. NEW CUMBERLAND AMBULANCE 113.28 MEDICAL TRANSPORT 22. VISITING ANGELS 352.12 23. EAST PENNSBORO AMBULANCE 77.50 MEDICAL TRANSPORT 24. JACKSON GASTROENTEROLOGY 107.36 MEDICAL 25. CARDIOLOGY DIAGNOSIS ASSOC. 3.54 MEDICAL 26. RICHARD PLACEY, ESQ. 1,452.00 LEGAL 27. DEPT. OF TREASURY - INTERNAL REVENUE SERVICE 8,845.00 TAXES 28. JACKSON GASTROENTEROLOGY 107.36 MEDICAL SUBTOTAL SCHEDULE I 12,300.79 GRAND TOTAL SCHEDULE I $ 16,321.26 '~-"""..{- COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WHITEHEAD NUMBER 1. 1. 2. 3. 4. 5. 6. 7. SCHEDULE J BENEFICIARIES ROBERT A. FILE NUMBER 21 05 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 0283 AMOUNT OR SHARE OF ESTATE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DiSTRIBUTiONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ROBERT WHITEHEAD, JR. 2924 BROOKWOOD STREET HARRISBURG, PA 17111 JASON R. WHITEHEAD 4008 GOLFVIEW DRIVE MECHANICSBURG, PA 17055 JAMES G. WHITEHEAD 2404 E. 73RD AVENUE MERRILLVILLE, IN 46410 NATHAN J. GELFANT 10 BELLA ROAD LUMBERTON, NJ HANNAH R. GELFANT 10 BELLA ROAD LUMBERTON, NJ MATTHEW R. MAHONEY 129 HEATHWOOD DRIVE ROYAL PALM BEACH, FL 33411 RYAN MAHONEY 1514 BRANDT AVENUE NEW CUMBERLAND, PA 17070 SON 10,000.00 GRANDSON 10,000.00 GRANDSON 10,000.00 GRANDSON 8.25% OF RESIDUE . GRANDDAUGHTER 8.259/0 OF RESIDUE GRANDSON 8.25% OF RESIDUE GRANDSON 8.25%. OF RESIDUE 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. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - 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) Continuation of REV-1500 Inheritance Tax Return Resident Decedent WHITEHEAD ROBERT A. Decedent's Name Page 2 21 05 0283 File Number Schedule J - Beneficiaries - 1 RELATIONSHIP TO DECEDENT AMOUNT OR S'HARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. PATRICE A. GELFANT DAUGHTER 22.33% OF RESIDUE 10 BELLA ROAD LUMBERTON,N.J 9. BARBARA E. WHITEHEAD DAUGHTER 44.67% OF RESIDUE 1514 BRANDT AVENUE NEW CUMBERLAND, PA 17070