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Home My WebLink About01-25-07 ~, -.J 15056051047 REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes ii.; PO BOX 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 Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Last Name Suffix MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW .. 1. Original Return c:::> 2. Supplemental Return c:::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 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: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received ~ 8. Total Number of Safe Deposit Boxes 4. Limited Estate c:::> - c:::> A.J d kDW Ii 7 S"7,.3(" Firm Name Applicable) REGISTE~9F WILLS US~NLY (- _'" --J , - So.: <- :<~~~ .~-~.,." ?2>" u.} Pd )(C f' () PT b J:.# f') Ui First line of address Second line of address ::-~, -i:a City or Post Office State ZIP Code D1>.;"lE-~ILED U-'j C A 1'Y1-? He L-L- PA 17 C) / / Correspondent's e-mail address: U:54./7 _ d u i..b tJr c.>J.J ;1 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. ADDRESS ~ 1?34J W. Cz;>(vruP+ . I SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE G/lM jJ )!}/bl- fJA / 1'70) ? DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 -.J s r----~~ -I 15056052048 REV-1500 EX Decedent's Name: Decedent's Social Security Number I 7<-{ J-1 ?CLI 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) 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). . ...................... 8. 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). .... . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. 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 -3 Sf I... 9 ~ 15. 16. 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 . 17. . 18 19. TAX DUE . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 7 I. 16 c::> 15056052048 -I REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME ,JOA.N' 0, qu iN rJ STREET ADDRESS ZtYlu -SENATe Avl::':. APT I a..3 File Number CITY STATE ,;0 A CA .rrr;P 41 L<- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) Total Credits (A + 8 + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 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 I 7011 3/57/, ~ \> 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. (5) (5A) (58) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 3, .57 ( . 7}.o . I &/7 .3S7;2.~) 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;.......................................................................................... D b. retain the right to designate who shall use the property transferred or its income; ......................................... D c. retain a reversionary interest; or.......................................................................................................................... D d. receive the promise for life of either payments, benefits or care? ...................................................................... D 2. If death occurred after Dacember 12, 1982, did decedent transfer property within one year af death 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? ........................................................................................................................ D No ~ a kSl ! ~ 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. 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 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 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. --..~ . COMMONWeALTH OF PENNSYLVANIA INHERITANCe TAX RETURN RS NT ENT SCHEDULE B STOCKS & BONDS ESTATE OF ..::r DA N GJ, Qu...I!\.J I\J All property joinllyo(lWl1ed with right of sUNivoBhip must be disclosed on Schedule F. FILE NUMBER ITEM NUMBER 1. DESCRIPTlON VALUE AT DATE OF DEATH I aVo Sha ,e!; ~-v rdrl '7ixC<.c" G rp. (Cv X) \b6;; ,COo rf} u::Ia-4L/ FU" Is _ II ~ (ca./) H-r u h rrlca o'Y'\.e fl?,.s13Z (1#1-1:1:7)( ) 6)., Ct.~ - I. eJ~"J. '777 C)R()uJT! If FUND or: A/'o1e-,e((A XNC (Ac;TH><") S~~.s - ~plo. 4 -$' /,;) ,33 ~ 7{ " 13, 216L/, sy " TOTAL (Also enter on line 2. Recapitulation) $ RE'V.'5OIlEX.I"": .'. . '. ... COVMONWEAc TH OF PENNSYl '/ANIA iNhERITANCE TAX RETURN RES/DEW DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF 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. nEM NUMBER 1. DESCRIPTION (Jank. ~fX>.s rI..s TOTAL IAlso enter on line 5, Reca~ltulation) VALUE AT OA TE OF DEA TH 6: 119,5g i ~ t '" ~""".,.." .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT 0 DENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES: 1. .se...vlct"~, CI'e-rn",--f'<lVl J (r)~'l rr>~.."..:T '~.3. '7</ I, 7.;J- B ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name or Personal Representative (s) Social Secunty Number(s) I EIN Number 01 Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2, Attorney Fees 3. Family Exemption: (If decedenfs address Is not the same as claimanfs, aU8ch explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4 Probate Fees ...& 1T$.oO 5. Accountanfs Fees 6, Tax Retum Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ S Cj ~(p 19 d).... (If more space is needed, insert additional sheets of the same size) R!V.lIU EX + (..17) '* COMMONWIALTH or ,INNSYLVANIA INIlIAlTA"CI TAX lITIIR" RIIlDfNT DiaD IN! SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE 1. A. Taxabl. B.qu.sls: rY)AIV~ QU./I";N &:IN $SclJ. 00 C '-A.(~ 'O~OI'Z..)c....U - 'OcP w ;;:;'t(c~~r be . (A rnl' N' u..._ At .. 01M~DI.JAx,H~ -SSdclcJ.ocJ SU.SAN ~.e.()~0 - 8'34> cu. R..JKC.~cr.6r. ~ ~ tfk,.c.- ~fJ;A )yJ~C7~ 6Z' % 0/-') St- c.,C. .;.- n1,~A_:~'-<...../ (f'.( d ~ Be/I+- rn()IZ.~s. -- .a'l7 f, .s~4U.EJ-I!V.JNAQ' [)~~ ~O<A.JN~ p.", 6~ / (j arC;s A- r:k. .. rnc..t~_-J ?~,,~ ITEM NUMBER "- NAME AND ADDRESS OF BENEfiCIARY AMOUNT OR SHARE OF ESTATE B. Charitabl. arid Gov.rom.nlal Bequests: 1. .. -- TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also Inllr on lin. 13, Rlc:apilulalionl S (If more .pace I. n..d.d, In..r! additional .h..ts of sam. size I WILL OF JOAN G. QUINN I, Joan G. Quinn, Camp Hill, Cumberland County, Pennsylvania, declare this to be my last Will and hereby revoke all prior Wills and Codicils. 1. I direct that all my just debts, funeral expenses, gravemarker and administrative expenses shall be paid from my residuary estate as soon as practicable after my death. 2. I direct that all inheritance, estate, transfer, succession and death taxes of any kind whatsoever which may be payable by reason of my death shall be paid out of my residuary estate. 3. I direct that my entire estate be distributed as follows: A. I leave five hundred ($500.00) dollars to Mark Quinn. B. I leave five thousand ($5000.00) dollars to Claire Durborow. !c I leave the rest of the value of my stock portfolio to ~ be divided equally to Susan J. Durborow and Beth Morris. D. I leave my Heisey Glassware to Susan J. Durborow. E. I leave my household goods to Gerard Peters. F. I leave The Cat painting to Beth Morris. G. I leave my Ahab Hit painting to Susan J. Durborow. H. I leave my Red Bible to Susan J. Durborow. LAW OFFICES OF STEPHEN J. HOGG 19 S. HANOVER STREET SUITE 101 CARLISlE. PA 17013 I. I leave my Black Bible to Beth Morris. J. I leave my Angel sculpture to Susan J. Durborow. LAW OFFICES Of n"EPHEN}. HOGG 19 S. HANOVER STREET SUITE 101 CARLISLE. PA 17013 K. Should Mark Quinn, Claire Durborow or Beth Morris predecease me, their share shall go to Susan J. Durborow. Should Susan J. Durborow predecease me her share shall go to Claire Durborow. 4. I appoint Susan J. Durborowas Executrix of this my Will. Should Susan J. Durborow predecease me or cease to act in such capacity, I then appoint Beth Morris as my alternate. 5. The Executrix of this Will shall have the power to distribute my estate in kind or in cash, or partly in either. 6. I direct that no Executrix acting under this Will shall be required to enter bond in any jurisdiction. F I J have hereunto set my hand this fV day ,2003. )i;G. :t,,'in~~ ..:.. r ~ Q ~~ C ~' ~ ~ "" . ~ ~ ~ ~ .\"- ~ ~ " ~~ ~ ~ !o~~ ! j ~ 1 ~ "" - - N o o u l)'l ()'l I (F) N (t) It) .t- M .... o 1'- .... Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: DURBOROW SUSAN J 836 W FOXCROFT DRIVE CAMP HILL, PA 17011- Qty 1 Fee Description Additional Probate Fee Total $75.00 75.00 Total: $75.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. 1263 1/25/2007 lOAN G OUINN 21-05-761 CJ