HomeMy WebLinkAbout94-01094
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CERTIFICATE OF DEATH
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
'OR DATlS 0' DIATH A"IR 12/31/91 CHICK HIRI
I' A SPOUSAL
POVIATY CRlDIT 15 CLAIMID 0
'Ill NUMBIR
will not probated
COUNTY CODE YEAR
Qlrmf << ADO.ln
REY.!JOO [lC+ IM'1
t3,/-1'1-/tJ9'/ l/
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COMMONW[AUH 0' PENNSYlVANIA
DlI'A.lMrNt Of R[YfNur
om. 210601
HAIIlRISlUIlO, P'" 11 21-0601
o IOtN" NAM II" . fll . At40 MIOOII INIlIAII
Matthews Helen C.
SOC'AlIlCUllltY NUMIU
180-09-2958
OIClO N '
[" UtllCAl1l1 'UI'I'I'I'lt.O IPOVUI NA'" '1"". II." .'10 III'Dlllllfj,II"11
N/A
210 Big Sprin::J Hand
Newville, PA 17241
c.,", Cumberland
AMOUNt II(IIVED IUllNsnUCIIONSI
NUM8ER
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DAIf 01 DIAtH
7/16/94
DAII 0' 811m
7/14/1902
+ +
20. If lIn. 1911 gr.al., than lIn. 18, .nl., Ih. din.r.nc. on lIn. 20. Thl. II Ih. OVERPAYMENT.
aD
21. If lIn. 18 It gr,ol., than Line 19, ent.r the din.,.nc. on lIn, 21. Thl, I, ,h, TAX DUE.
A. Ent.r ,h.lnl.,..t on ,h. balanu due on line 21A.
B. Enle, the 10101 of line 21 and 21A on line 218. Thl. It Ihe BALANCE DUE.
Male. Check Pavable tal Reg,.te, of WIII" Agent
': .1 SURI TO ANSWIR ALL QUlmONS ON RIVIRSI SIDI AND TO RICHICK MATH: :,\f:,;:",.,,",,",\,. ,I
Under penallle. of perlury, I d.c1are Ihall have uomlned lhl. relurn, Including accompanying tchedule. and .talemenh, and 10 Ihe bllt of my knowledge and belief,
III. true, correct and complele. I declare Ihol all real I.tole ho. blln reporled ollruI market value. Declarallan of preparer olher than the personal reprel.nlallvl II
baled on alllroformallon of which pre arer hal an knowl.d ..
!IGN U 0' '('''ON IIU'ONSlIL!'O fI~INO UlUlIN ADOUU DAIl I
4720 W:xxl1and Ave., Drexel Hill, PA 19026 12j2..~/9'1
A.."" O"~~/~~/l'1
lRJ I. Original Rllurn
o 2. Supplemenlal Relurn
o 3. Remalnde, Relurn
(10' dol.. 01 d.olh p,'o, 10 12.13,82)
o 5. Federal Ellall Tax Relurn Required
o A. limited Ellate 0 Aa, Fulu,e Inlerllt Campramlll
(10' do'.. 01 d.o,h a".' 12,12,821
o 6. Decedent Died Tlllale wLl 1 . not 0 7. Dlcedent Malnlalnld a living TrUll
(Atto,h 'oPY a' WillI prOMteO (Atto,h 'opy 01 T,u.'1
'A....,CO..UPONDINCI'AND CONPIDINTlAL TAXINPORMATlON SHOULD....DIR.CTlD,TO"..;'; '~,.Lj,t:f,i;(iI! 'i>'/\!~1i.i\ o;.(';';r,,\>1"
'-"I! MAIl! A
_ 8. Tolal Number of Safe Oepolll 80xII
Joel R. Zu11in er
IUfPHON! HUMIU
717 264-6029
Suite 310 Chnmbcrsburg Trust Co. Bldg.
Chnmbc ur~, PA17201
;/...
1. R.ol Eslol. IS,h.dul. AI II )
2, Slo'~. and 80nd'IS,h.dul. B) 12 )
3. C1o..ly H.ld Slo,~/Po'ln."hlp In'....tIS,h.dul. C) (3 I
A. Mortgagel and Naill Receivable (Schedule 0) ( .. I
5. Calh, 8ank aepolill & Mbcellaneou. Personal Properly ( 5 J
IS,h.dul. E)
6, Joln"y Own.d P,op'''y IS,h.dul. F) 16 )
7, T,onal... IS,h.dul. 0) IS,h.dul. LJ 171
8. T 0101 Grall Alleh (Iolalllnll 1.7)
9. Funeral Expenl", Admlnlllrallve COlli, Mllcelloneou. 19 )
bpen". (Schedule HI
10, D.b", MO'lgog. lIobllitl.., lI.n. IS,h.dul. I) (101
11. T 0101 D.ductlon. ('olollln.. 9 & 10)
12. Net Value of Eltale (line 8 minus line 11)
13. Charitable and Governmental Bequelh (Schedule J)
IA. Nel Value Sub eel to Tax (line 12 mlnul line 13)
15. Spoulal Trande,. (for datil of deolh aft., 6.30.9AI
5.. In.lructlons for Ar,pllcable p.,cenloge on Rev.,,, (151
Side. (Include volulI rom Schedule K or Schedule M.)
16. Amount of line IA laxoble 01 6% role 116)
(Include valulI from Schedull K or Schedule M.)
17. Amounl of lIn_ IA laxable at 15% rale (17)
(Include volulI from Schedule K or Schedule M.I
18. Principal lox due (Add tax from lIn" 15, 16 and 17.)
19. Credill Spoulol Povlrty Credit P,ior Poymenll
1.919.45
g~ :0
3 ";," ~ :tIm
c;-.o;' mo
H; . t::J 'Jd'a,
i:. n ,'\1111
.;.1 I ~, 0..
c..'. W I
('"J.," <::> :j~O
u .....31
~~) ~,91~
-
4, 238.50
4,238.50
o
III)
(12)
1131
(141
- 0 -
M.__
)( .06.
M .1.5 .
(181
- 0 -
Ollcount
Inl.rlll
Clll..'(~ helL' ,I VOU (lIe' wqul'\ling n wfund of YOUI OVl:'lpovmcnl. .
1191
(20)
o
(21)
121A)
12181
- U
Act .41 .f 1994 provide. for Ihe reduction of the lax role. Impo.ed on the nel value of Iran"er. to or for
Ihe u.e .f Ihe .pou.e. The role. a. pre.crlbed by Ihe .Ialule will be,
e 3"- (.031 will be applicable for e.tale. of decedenl. dying on or after 7/1194 and before 1/1/96
e 2"- (.021 will lie applicable for e.lale. of decedenl. dying on or after 1/1/96 and before 1/1197
e 1"- (.011 will lie applicable for e.lale. of decedenll dying on or after 1/1197 and before 1/1198
e 5..."..1 Ir.n"er. occurring on or after 1 /1 /98 will be exempl from Inherllance lax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
IY PLACING A CHECK MARK k) IN THE APPROPRIATE BLOCKS.
1. Old decedenl make a Iransler and:
a. retain the use or Income of the property transferred, .......................................................
b. retain the right 10 dellgnate who shall u.e the property tranalerred or Its Income, ...............
c. retain a reversionary interest; or ...................................................................................
d. receIve Ihe promise for life of either payments, benellts or care' .......................................
2. If deoth occurred on or before D.c.mb.r 12, 1982, did d.ced.nt within two yeon pr.c.dlng
death tranal.r prop.rty without r.c.lvlng adequate consideration' II death occurred alter
Dec.mber 12, 1982, did d.c.dent tranal.r prop.rty within one year of death without receiving
adequate consideration' .. ........... ..........................., .t....... t............ ........... .0_..... ....... to ........
3. Old decedent own an 'In trust for' bank account at his or h.r d.ath9.-..........................,.........
YES 0
_._~.t.
X
X
X
x
Nt
x
x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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COMMONWfAlIH 0' ~fNNIYIV'NIA
INHIIITANCI 'A IITOlN
..IIDIH' ole DI""
E~TATE OF
Helen C. Matthews
"~UOl." fU7J
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SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
IAII p,.,.rty lelntl.,.ewMd with the light of Survivorship mu" b. IIII,cloMIII on Schedule P)
ITEM
NUMBER
1.
2.
DESCRIPTION
Refund, SWaim Health Center
Refund, Blue crosS/Blue Shield
TOTAL Allo onlor on IIno 5; Roca
(A"ach addlllonal IYI" x 11" sh..ts If ma,.. space Is noeded.1
Ploalo Print or l' 0
FILE NUMBER
will not probated
VALUE AT
DATE OF DEATH
1,826.25
93.20
S 1,919.45
~1ii4r-dt~lll.;Mi'.t\'~:I?,~-,'''e;(~,\~)'r>~~y"-q''~''4~",,,~..q!;'5.<!~;1-"-,,,_"_,,~ci.'.
~-';,2:,;.:y:~;_t:~--2:.~ ;_~~~"-~'~:-$~-x""~'j(.t;~V
.
\1I...UIIU.11.111
.'
ITEM
NUMBER
A.
B.
~:'~.~
-.Vi>.!
COMMONW'AltH O' PfNNSYLYAHIA
IHHI.nANCI TAl InUIN
IIIIOINT OlceOINT
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
PI.a.. Print or T .
Helen C. Matthews
will not probated
DESCRIPTION
AMOUNT
1.
Fun.ral Exp.n....
Fogelsanger-Bricker Funeral Hare
SpriD] Hill CeIretery, grave opening
Gravemarker
3,322.50
325.00
341.00
2.
3.
1.
Admlnl.tratlv. Ca.t..
P.rlanal Rep...,enlall.e Camml..lan. none
Social Securlly Number 01 Perianal Reprelenlatl.e,
Year Comml..lon. paid
2.
Attorney Fe.. Joel R. Zullinger
250.00
3.
family Exemption
Claimant
Add..... al Claimant at decedenl/. dealh
St...et Add.....
Relatlon.hlp
City
4. Probate Feel
C. MI.e.llan.ou. Exp.n....
1.
2.
3.
4,
5.
6,
7.
8.
Slale Zip Code
TOTAL (AlIa enter an line 9, Recapitulation)
(If more .pac. I. n..d.d, In..r! additional .h..t. 01 .am. 11'..1
s
4,238.50
-,-"
~ /5'7-~)-
R!V-1547 EX AFP 112-94*
<_AlIll OF PENHSYlY'NI' ACN 101
O[.'O'NENT OF OEVI',,"E HOTlCE OF IHHERlTANCE TAX
....uu OF INDIYIDUAl lAM.. APPRAISENENT. ALLOWANCE OR DISALLOWANCE
::~i.~~~:'.. 1712...... OF DEDUCTIONS AND ASSESSNENT OF TAX DATE 03-06-95
FILE NO.
DATE OF DEATH 07-16-94 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBNIT TNE UPPER PORTION OF THIS FORN WITH YOUR TAX
PAVNENT TO THE REOISTER OF WILLS. NAXE CHECX PAVABLE TO "REOISTER OF WILLS, AOENT"
REMIT PAYMENT TOI
JOEL R ZULLINGER
CHAMBERS BURG TR CO 310
CHAMBERS BURG PA 17201
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 17013
AMount Re.ltted
CUT ALONO THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS """ill
iiiY-:iii47-iif-AFj:i-nz:94Y-iliffici--cij1-i-riHEiiifAiici-YAx-'Appii'AisEHiilr-,--,U.i.."ciwANci-iili-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
!STATE OF MATTHEWS HELEN C FILE NO. 21 94-1094 ACN 101 DATE 03-06-95
TAX RETURN WAS. I X I ACCEPTED AS FILED
RESERVATION CONCERNINO FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL
1. Reel E.t.te (Schedul. A)
2. stock. and Bond. (Schedule B)
5. Clo.ely Held Stock/Pertn.r.hlp Intere.t (Sch.dul. C)
4. Hortgaae./Note. Recelvabl. (Schadul. D)
S. Ca.h/Bank Dapollt./HI.o. Parlonal Property (Schedule E)
6. Jointly Owned Property (Schedul. F)
7. Tran.far. (Schadule G)
a. Totll A..at.
I CHANOED
III
121
CSI
141
CSI
iiI
171
ntJjlO
~ iiilIO tJ1
t...: 00
'... .00 ~~
1.9'19.45 ;0
.00 d,
,DO
.;..) (a) "V
l)
:u.:: ..
4.23il~0 A
:oi?i'
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ro ~.~
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral Expan.a./Ad.. Co.t./Hi.c. Expan.e. (Schadul. H) (9)
10. Dabt./Hortalaa Llabllltle./Llan. (Schadule I) (10) .00
11. Total Deduotlon. (11)
12. Nat V.lue of Tax R.turn (12)
15. Charltabla/Govarn.ental aaqualt. (Sch.dule J) (15)
14. Hat Value of E.tat. Subjact to Tax (14)
NOTEI If an aooBoomBnt was 100UBd prBv1DuoIY, I1nBo 14, 15 and~ar 16, 17 and 18
rBflBct f1gurBo that 1ncludB thB tDtal of abh rB~urno aooesoad to date.
ASSESSMENT OF TAXI
IS. A.ount of Lln. 14 .t Spau.al r.t. CUi) .00 )( .03.
16. A.ount of Llna 14 taxabla .t LlnaaI/Cla.. A rata (16) .00 )( .06.
17. AMount of Llna 14 taxabl. at CoU.t.ral/Cla.. Brat. (17) .00 X .15.
1a. Prlnolpal Tax Dua (la)
"
,'1,919.45
VlO
-"
4,'38 ~n
2.319.05-
.00
2,319,05-
will
.00
,00
.00
.00
TAX CREDITS I
PAVNENT
DATE
RECEIPT
NUNBER
DISCOUNT C+I
INTEREST I-I
ANOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED. SEE REVERSE
FOR CALCULATION OF ADDITIDNAL INTEREST,
IF TOTAL DUE IS LESS THAN .1. NO PAVNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCRI, YOU NAV BE DUE
A REFUND, SEE REVERSE SIDE DF THIS FORN FOR IHSTRUCTIONS.I
A!IERVATJDH, E.t.t.. of dec~~t. d~lng on o~ b.fo~. DIe'~'~ 11, 1.., .. If an~ futu~. Int.~e.t In the ..t.t. I. tr~.f'rred
In po.....lon or .nJopent to CI... . (coUetulU beneflobrl.. of thl decedent .U.r the 'lIplraUon of en~ ..tat. fa,.
lIf. or for v..r., the C...on....Uh her.b~ .JIlpr...b r...rv.. tM right to appr.I.. ~ ...... tr.,,".,. Inherltanc. Tell"
., the lawful CI... . (colll'.r.l) ret. on an~ tucn future Int.re.t.
PUllPOU OF
NOTICEI To fulflU the r,qulr..."t. of S.etlon 2140 of the IntI.rHane. end E,t.t. taw Act, Act 2Z of 1991. 7Z P...
IHUon 1140.
Detach the top portion of thh MoUe. and lubelt ..Hh your p'~'ent to the Reght.,. of WUh p~lnt.d on the rev.r.. lid..
.""ek. check or aoney order p.yabl. to. REGISTER OF MILLS, AGENT
AU P'YHnt. nc.lvad Ih.U first b. appllad to any Int.r..t which ..y H due ..lth any r...lndar appll.d to U. ....
REfUND (eR). A r.fLWMt of . tt. credit, which .... not requutact on tt. Tell R.turn, "V be requeltad by co...I.Uno an "Appllc.Uon
'or R.,und 0' PMnsvlv."l. Inh.rItMe' and E.t.t. Tn" (REV-ISU). AppllcIUon. ara avaU..la .t the Office
D' the R.gl.t.r D' Willi, anv 0' the 25 A.venue Dlltrlot D"lc.., or bV c.lllng the .p.ol.1 24-hour
.".w.rlng urvlea nuab.n ,far far.. Drd.rlngl In pann'ylvenla l-aDD"562.2050, outtld. Pann.vlv."lt end
..Ithln local H.rrl.burg .r.a (717) 187..094, TOOt (117) 772.2252 (H..rlng 1....lr.d Only).
PAMNT I
alJECTlDHSI Any plrt~ In Int.r.st not ..thfJld wHh tM appnh..lnt, allDWlnc. or dluUOlItnCa a' d.ducUon" or ........",
of tIll (Inoludlng dl.oount or Int.r..t) .. shown on thl. Hotlc. .u.t obJeot wtthln .lllty (60) day' a' r.c.lpt 0'
thh HoUc. bYI
..wrlUan prDtl.t to the PA a.plrt...,t 0' AIVWIUe, loard 0' App..l., Dapt. 211021, Hlrrhburg, PA 17111.1021, OR
....I.cUon to hive the a.tt.r dltaraln.d It Mldlt D' the ICCOunt 0' the p.rsonal rep,....nt.Uv., OR
.-app.Il to thl Orphan.' Court.
AD'UN
IITRATlVE
CORRECTIONS,
IHTEREST I
'.otual .rror. dl.covlrad on thl. ......eent .hould b. tddr....d In ..rltlng tOI PA D.part.ent of R'venue,
Bur.au 0' IndlvldUll TIX", ATTHI Po.t A......ant Ravlaw Unit, Dlpt. 210601, H.rrl.burg, PA 11121.0601
Phon. (717) 717-6505. S.. pag. 50' the boo....t ''In.trUCItlon. for InharUMce Till A.turn for. R..'d.nt
a.c.dlnt" CREV-1501) 'or en .xplan.tlon 0' Idtlnl.tr.tlv.l~ corrlOtlbl. .rror..
If an~ till due It p.ld within three (3) c.l.nd.~ tonth. .U.,. the d.c.d.ntl. d..th, . 11\11 parcent CS:O dltcount of
the tIll paid I. allDM.d.
Int.r..t I, charg.d beginning with 'Ir.t dl~ of d.llnquanc~, or nln. (,) lonth. and ana (1) dlY frOt thl dlt. 0'
d'lth, to the data 0' p.y..nt. TaxI' which ~ dallnquent b,'ot. January I, 19.Z ba.,. Int.r..t .t thl r.ta 0'
tlx (6:0 parcent p.r annua calculat.d .t a dllb nt. a' .000164. All t.x.. which b.c... dallnqu."t on and .U.,.
Janu.rv 1, 19aZ will b..,. Int.r..t .t . rltl which will vlry fro. clllnd.r y..r to cII.ndar y..r with thlt r.t.
announc.d by thl PA Depa,.t.."t of A.vanu., The IPplIclbl. Intlr..t rat.. for 1911 through 1995 ""
DlICOUHT I .
~ Intar..t A.t. Dally Int.ra.t Fletor !!!! Intar..t R.t. Dally Int.,.a.t Factor
19az 20X .000548 1917 9X .000147
1915 16X .0004S1 19...1991 IlX .010501
1914 IlX .000501 1"2 OX .000247
1985 U. .000556 1995-1994 1X .000192
19.6 lOX .000274 1995 OX .000241
....Intlr..t It cl1culttad .. follow'l
INTEREST . BALANCE OF TAX UNPAID X HUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Motlet I..uad IUar the tIll bac.... d.lInqu."t will "fI.et an Inta~..t calculation to fifteen (15) dlya
b.yond the dati 0' the ......eent. If p'Ylent 11 .td. Iftll" thl Inta,...t cOllpUtaUon dlt. lhown on thl
Notice, add I tlonll Int.,.... ...t b. ..Iculltad.