HomeMy WebLinkAbout01-04-07
REV-l500 EX (6-00)
OFFICIAL USE ONLY
COMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
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COUNTY CODE
-.!!L 05~___
YEAR NUMBER
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DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
BARNES ZEYNEP
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
3/18/2006 12/28/1980
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
S
SOCIAL SECURITY NUMBER
203-66-0866
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
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[X] 1.
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o 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82)
o 4a. Future Interest Compromise (date of death after 12-12-82) 0 5. Federal Estate Tax Return Required
o 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes
o 10. Spousal Poverty Credit (da'e of death between 12-31-91 and 1-1-95) 0 11. EJection to tax under Sec. 9113(A) (Attach Sch 0)
Original Return
Lim ited Estate
Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
THIS SECTION MUST BE COMPLETED. ALL CORRESPONQENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
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David W. Barnes
FIRM NAME (If Applicable)
145 South 32nd Street
Camp Hill, PA 17011
TELEPHONE NUMBER
717-772-5160
1. Real Estate (Schedule A)
0.00
C) c:,~
::~'(51AL USE ON~'l-'
(1)
2. Stocks and Bonds (Schedule B)
0.00
0.00
F"..c'
(2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
0.00
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(4)
(5)
2,999.28
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6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
0.00
0'\
0.00
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
(8)
3,375.91
4,652.43
2,999.28
8. Total Gross Assets (total Lines 1-7)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
8,028.34
(5,029.06)
0.00
(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)
(5,029.06)
(14)
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)
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~ 16. Amount of Line 14 taxable at lineal rate
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~ 17. Amou nt of Line 14 taxable at sibling rate
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u 18. Amount of Line 14 taxable at collateral rate
X
~ 19. Tax Due
20.0
0.00
0.00
x.O ~(15)
x .0 ~(16)
x .12 (17)
x .15 (18)
(19)
0.00
0.00
0.00
0.00
0.00
0.00
0.00
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
3W4645 1.000
Decedent's Complete Address:
SlREET ADDRESS
2116 Cedar Run Drive, Apt. 308
Cumberland
CI1Y I STATE I ZIP
Camp Hill PA 17011-
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? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 5LJ D
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
0.00
0.00
Total Credits (A + 8 + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
0.00
Total Interest/Penalty (0 + 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. (SA)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
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:
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
0.00
0.00
0.00
0.00
0.00
0.00
0.00
No
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Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSO~nNS~BLE F
ADDRESS
145 South 32nd Street
SIGNATURE OF PREPARER OlHER"THAN REPRESENTATIVE
Camp Hill, PA 17011
DATE
,2 Cr~ 7
ADDRESS
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value oftransters to or for the use of the surviving spouse is 3%
[72 P.S. 99916 (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. 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 0% [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 4.5%, except as noted in 72 P.S. 9 9116(1.2) [72 P.S. 99116(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. 9 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.
3W4646 1.000
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
ZEYNEP S. BARNES
FILE NUMBER
2~ 06 0505
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 DESCRIPTION
VALUE AT DATE
OF DEATH
~ ~995 Oldsmobile Ciera automobile, stolen 2 weeks' before
decedent's death, recovered by family after death, was
vandalized by thieves - No value because of its poor
condition unless funds are put into it to restore it to
fair condition
0.00
2 Insurance check for damage to decedent's auto
1.33.00
3 Final paychecks from Carlisle Syntec and partial return
of apartment deposit
2,683.1.4
4 West Shore Tax Bureau, refund
1.83.1.4
3W46AD 1.000
TOTAL (Also enter on line 5 Recaoitulation) $
(If more space is needed, insert additional sheets ofthe same size)
2,999.28
REV-1511 EX+ (12-99)
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
ZEYNEP S. BARNES
FILE NUMBER
21 06 0505
Debts of decedent must be reported on Schedule J.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Musselman Funeral Home, cremation costs
1,481. 71
A.
2
Costs for postage, cards and related expenses
338.00
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
B.
Name of Personal Representative(s)
Social Security Number(s) I 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
60.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Death certificates
36.00
2
Law Journal and newspaper advertising costs
145.00
Total from continuation schedules .
1,315.20
3W46AG 1.000
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
3,375.91
Estate of: ZEYNEP S. BARNES
203-66-0866
Schedule H Part 7 (Page 2)
3
Costs to retrieve decedent's stolen auto from
Philadelphia: Tolls, $18; Gas, $110; Miscellaaneous,
$145.98
273.98
4
Costs of closing out decedent's apartment:
and disposal of furniture, $423; gas bill,
electric bill $96.42
Moving
$100;
619.42
5
Telephone bills, some due at decedent's death, some
related to estate administration
391.80
6
Filing fees, Inheritance Tax return and Inventory
30.00
Total (Carry forward to main schedule)
1,315.20
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ZEYNEP S. BARNES
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
21 06 0505
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Pinnacle Health Hospitals, EMT on-site charges
155.87
2
Citibank Credit Card Acct. #5424181020061847
Balance due at death
4,399.14
3
Student loan, forgiven at decedent's death
1. 00
4
Electric bill
96.42
3W46AH 2.000
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,652.43
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ZEYNEP S. BARNES
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)]
David and Vahide Barnes
145 South 32nd Street
Camp Hill, PA 17011
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
2106 0505
AMOUNT OR SHARE
OF ESTATE
Parents
0.00
Insolvent Estate
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
3W46A11.000
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)
$
0.00