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Home My WebLink About01-19-07 ..-J 15056051047 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 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 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 c::::> 2. Supplemental Return c::::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required _ 4. Limited Estate c::::> 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) c::::> o 8. Total Number of Safe Deposit Boxes c::::> 6. Decedent Died Testate c::::> (Attach Copy of Will) c::::> 9. Litigation Proceeds Received c::::> c::::> 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Da ime Number REGISTER OF WILLS USE ONLY First line of address C) l"--.J r-.'J (~ --' Second line of address ,-, ~;~'T'l , .. --. i ~:-~ .......- c.._ {, - State ZIP Code c.) ; J o CO Correspondent's e-mail address: PA )10,5 ADDRESS R M'~ CLiI ocK-, larll s/e SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ---1 --.-J 15056052048 REV-1500 EX Decedent's Name: ,Jql\et P \/a (\ SC-'-Io~ , 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::J Separate Billing Requested . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c::J 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 _ · 17. Amount of Line 14 taxable at sibling rate X .12 · 18. Amount of Line 14 taxable at collateral rate X .15 · 19. TAX DUE. . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 Decedent's Social Security Number .~ D 9 t d(? 01 .~ 15. . 16. 17. . 18. 0. .\) c::J 15056052048 -...J REV-1500 EX t'age 3 Decedent's Complete Address: DECEDENT'S NAME 'I ~nQ\Jl t t. File Number STREET ADDRESS ;t,Q1_ p, f .v 1/ 41'\_ .._ ':::2_t~p Lu_ \1:> ~v- cL ~.-t A t ___~n H?> / J- CITY STATE P /- Zlj 1 dS-- / Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) o -..,. . '.~ .-- Total Credits ( A + B + C ) (2) - () - 3. Interest/Penally if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) -C. 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 G2l b. retain the right to designate who shall use the property transferred or its income; ........................................... 0 [3' c. retain a reversionary interest; or................................................................ ......................................................... 0 W d. receive the promise for life of either payments, benefits or care? .................................................................... 0 [J 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [~l 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 GJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which O ,--vI contains a beneficiary designation? ....................................................................................................................... L!:1 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 PS. 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 PS. 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. R::I 1~~:9 EX + (1.97) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNS) c VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~Ut\\ ~'() e_ If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. JQ(\-et f. FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDEm A.~ \ \J\ G. \\ ,j ~)\\CV qq/ ,Mt Rcxk Rdl Carlislel PA /7015 'bQ.i-'Jh-ter B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. B~~o CAet'/<'Nj .4~C()U.tl-t -1F)0 SOu ;J.-}tJ 7 ~ 10''(;0.6 -7 ,5Z) ~-Y-O, or ur(SfoLw'l e;>c;l'IK d.- A- 7 fro I C-it~-I<,/~ .4ccoc,,rl =# 13 ~<';5 I If 1S-l IJ- Q) )3-7,8' Ac6l\LS Cc'-'-Irb-t ,Q1oj\tll ~RJ(~ 1\ k TOTAL (Also enter on line 6, Recapitulation) $ 711 ' 90 ~ (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 Ja n-€ t- p \Jan 5Gyc)~ Debts of decedent must be reported on Schedule I. FILE NUMBER ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. FO jf(Sc.\.s~r- Bit J<tr (;)(7st-Jl'\(/'\ \' 5 1--(( Um('I~{'-j F-<t.\_erOL i ~O!l,e- Ihsoc .. /1 /S~ g b II ~ 1 r (}G (~. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ ?:iJ~ J \~ It (If more space is needed, insert additional sheets of the same size) RF.V-1513 EX+ (9-00. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF '... \ (] n e--t p \l a V\. S <!.;'1 v FILE NUMBER c.--.- NUMBER I RELATIONSHIP TO DECEDENT NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] _\ " I \ n h' k OQ...Lc?t A..:~ ,r \J \. v ; Q ~'- <.j. '-a> ' i'c u AMOUNT OR SHARE OF ESTATE 1. Jo \ ..'ct. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 *C," INFORMATION NOTICE . F';"', t' -". ,...AND .TAXPAYER. RESPONSE FILE ACN DATE NO. 21 01 G\)I' 06156616 11-15-2006 REY-1545 EX AFP CD9-UDl P~sf~QfF JANET P VANSCYOC S.S. NO. 209-12-9012 C:nATE OF DEATH 10-03-2006 F~CWNTY CUMBERLAND TYPE OF ACCOUNT o SAVINGS IX] CHECKING o TRUST o CERTIF. ":1'1] I"" I q Ll.:u .)ti!~ w VIVIAN J COHICK 991 MT ROCK RD CARLISLE PA 17015 REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ORRSTOWN BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may bR answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 103002107 Date 08-24-2000 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 1,080.07 50.000 540.04 .15 81. 01 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent.s date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] [CHECK ] ONE BLOCK ONLY A. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. ~IThe above asset has been or will be reported and tax paid with the PennsYlvania Inheritance Tax return ~to be filed by the decedent.s representative. C. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. TAX ON JOINT/TRUST ACCOUNTS PART [!] TAX RETURN - COMPUTATION If you indicate a different tax rate, please state your relationship to decedent: LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 x x PART ~ DATE PAID DEBTS AND DEDUCTIONS CLAIMED PAYEE DESCRIPTION AMOUNT PAID TOTAL (Enter on Line 5 of Tax Computation) I $ facts I have reported above are true, correct HOME (1/1),1 (.,. ..- 3 I &---1 WORK ( '1 1"1 )"11 ~ r 3 '-fO TELEPHONE NUMBER and 1-1<[ AJ7 DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 INFORMATION NOTICE -,n_ . AND TAXPAYER RESPONSE FILE NO. 21 c) -, 00, t ACN 06161743 DATE 12-15-2006 PH 3= rEST. OF JANET P VANSCYOC S.S. NO. 209-12-9012 DATE OF DEATH 10-03-2006 COUNTY CUMBERLAND TYPE OF ACCOUNT D SAVINGS [Xl CHECKING D TRUST D CERTIF. ?~;17 '! '" f 9 ,..L;U J!1;V VIVIAN J COHICK 991 MT ROCK RD CARLISLE PA 17015 REMIT PAYMENT AND FORMS TO: REGISTER OF WIllS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ADAMS COUNTY NATIONAL BANK has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth nf Pennsylvania. Questions may be answered by calling (717) 787-8327. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 132551 Date 07-08-2001 Established Account Balance Percent Taxable Anount Subject to Tax Rate Potential Tax Due x 475.72 50.000 237.86 .15 35.68 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable .to: "Register of Wills, Agent". x NOTE: If tax payments are made within three (3) months of the decedent.s date of death, you may deduct a 57. discount of the tax due. Any inheritance tax due will become delinquent nine (9) months after the date of death. Tax PART [!] A. [ CHECK ] ONE BLOCK B. ONLY c. [] The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ~The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ~to be filed by the decedent.s representative. [] The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. PART [!] DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate, please state your relationship to decedent: PART [!l TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Anount Subject to Tax 5. Debts and Deductions 6. Anount Taxable 7. Tax Rate 8. Tax Due OF 1 2 3 4 5 6 7 8 x TAX ON JOINT/TRUST ACCOUNTS x PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Conputation) I declare that the facts I belief. I $ and HOME WORK t-:1E' 'ill