HomeMy WebLinkAbout95-00570
'R!~.. 1500 EX . (7-14)
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS COUNTYCOOE
DECEDENT"S NAME (LAST. FIRST, AND MIDDLE INITIAL) DECEDENT'! COMPLETE ADDRESS
Bovon Roo T. 430 Brookviow Court
SOClALSECURITYIlU"BER OATEO'OEATH DATE 0' BIRTH Mochonicsburg, PA 17055
140.20.8661 01/28/1995 01/03/1926
C.,..,
Of APPLICABLE) SURVIVlNQ SPOUSE'S NAME(LAST,FIRST AND MIDDLE INlflAL)
CO"~F/!l1.H.M\1'l1'.P~~ANIA
HAARISR6~~.9.m\i'-"0601
~
C
~
,
f X 1.
D ~ 4.
C Co
K ~ ~ e.
2. Suppl.mental R.lurn
4a. Future Interest Compromse
(far d.,.. 01 dllth Ih.. 12-12.82)
D.c.d.nl DI.d T.IlII. 0 7. D.c.d'nl Mllntaln.d I Living Trusl
(AIlach ca of Will) (Altach I ca 01 Trust)
C p ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
o 0 NAlAE CO"PLETE "AILING ADDRESS
I! g Robocca R. Hu hos IR\lIN, McKNIGIIT & IIUGHES
~ fi TELEPHONE NU"BER 60 \lost Pomfrot Stroot
T 717.249.2353 Car1io1o PA 17013
1. Rill Estall (Sch.dul. A) 1 Nono
2. Slocks Ind Bonds (Sch.dul. B) (2) Nono
3. Clos.1y Hlld SlackIPlrtn.l1hlp Inl....1 (Sch.dul. C) (3) Nono
4. MaMgIgI..nd Nol.. R.c.lvlbl. (Sch.dul. D) (4) Nono
e. Clsh, Blnk D.pasits & Mlscllllneaus Pel10nal P,op.rty (Sch. E) (e) 1,555.43
e. Jolnlly Own.d Prop.rty (Schedull F) (e) Nono
7. T,"nst"" (Schldul. G) (Sch.dull L) (7) Nono
e. Total Gross Asse.. (total Lines 1-7)
9. Funeral Expenses. Administrative COSIS, MlsceUaneaus
Exp.ns.s (Schedul. H)
10. Debls, MoMgagl Llabllltl.., Liens (Sthedule I)
11. Total Dlductlons (tolal L1n.. 9 & 10)
12. N.l Valu. 01 Estat. (Lln. 8 minus Line 11)
13. Cherltable and Gov..nmental B.quests (Schedul. J)
14. Nel Valu. Sub .cllo Tax CLlnl 12 minus Line 13)
Ie. Spousal Transf... (for dll.. of delth oher 6-30-94)
See Instructions far Applicable Percentage an page 2.
(lncludl vllu.s from Schedule K 0' Sthodul. M.)
11. Amount of LIne 14 talCabl. at 6.1. rat.
(lnclud. vllu.. I,om Schedule K or Sthodulo M.)
17. Amounl 01 Line 14laxablo al15% ralo
(Include vllues from Schedulo K 0' Schedulo M.)
Ie. P,lnclplltax due (Add tax from Line 15, 16 and 17.)
19.Credits/Sp Poverty Prior Payments Discount Intor..l
0.00+ 0.00 + 0.00 0.00
20. II L1nl 191s greate' lhan L1no 18, enlor tho dllference on Llno 20. This Is Iho OVERPAYMENT.
(E] D ICheck here If you are requIIUng I refund of your overpaymlnt.1
21. If Llnl lB '" greater lhan Line 19, enle, lho dillerenco on Line 21. This Is Ihe TAX DUE.
A. Enter the Interes' an thl balance due on line 21A.
B. Enler thelolal 01 Line 21 end 21A on Line 21B. This Is tho BALANCE DUE.
Mako Chock Po oblolo: Ro 1.1e, 01 Will.. A anI
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH .. ..
elp.natno pefuty. Klr.. I ......uml I Ir.lwn. ncUdng.ccomp'nyngac U'I. It.l.menl." lot. .10 my now g. . .Ialn_,
conlCt and compl.I.. dlClIr'lh.lall ,..1..1.1. h.. ba.n "port.d.1 Itu. mark'l v.lu.. DlClltlllon 01 pr'p',.r oth.r thin Ih. personal r.p,.ItnIlU....I. buad on .lIlnfcnmatlon 0'
whIch Pf'P".' hu Ilrf knowlac:lg..
Original R.lurn
Limited ESlale
D
C
~
T
U
!
N
~
C
o
M
C
t
o
N
SIQNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
/5 ~LII~ i
(v.._
FOR DATES OF DEATH AFTER 12/:1"" CHECK HEnE
IF A SPOUSAL
FILE NUMBER
21.95.5'70
'tEAR
NU..-BEA
Cumbor1and
SOCIAL SECURITY NUMBER
AMOUNT RECEIVED (SEE INSTRUCTIONS)
R.malnder R.tum
lIor dalll 01 death prior 1012-13-82)
Fed.ral Estate TalC R.turn R.qulr.d
Total Numba, 01 Safe Depos~ BoxlI
De.
.JLe.
(e)
1,555.43
(9)
5,605.89
(10)
Nono
(11)
(12)
(13)
(14)
5,605.89
(4,050.46)
Nono
(4 050.46)
(15)
0.00 x
:
0.00
(Ie)
(4,050.46)< .06:
0.00
(17)
0.00 X .15:
0.00
(IB)
0.00
(19)
(20)
0.00
0.00
(21)
(21A)
(21B)
0.00
0.00
0.00
....................-......-....-.-.........-.-.----.
DATE
IR\lIN, McKNIGHT & HUGHES
60 \lost Pomfrot Stroot
cori"i';ie- "Pi..- - -i7iiij' -- - -.- - - -. - - - - -.. -- -. - -- -. ...---
Cf-1-9S-
Fo,m 1500 (R..... 7.14)
'REV .1'" EX. 12,17)
CO"~_M'1l'ANIA
ESTATI Of
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
PII..1 Prlnl 0'
FILE NUMBER
21.95.
Rae T. Boven SSe 140.20-8661
01/28/1995
(All ro a
ITEM
NUMBER
1
01 ownod wllh RI hi 01 Survlvorahl mual'" dl.cloood on Schodull F)
DESCRIPTION
CoroStatos Bonk, N.A.,
balance in account #59000845
VALUE AT DATE
OF DEATH
900.34
2
Bovor1y Entorprisos
Ponnsylvania, Inc., pationt
trust fund ba1anco
260.60
3
Camp HilI Caro Contor,
refund on account #90922
394.49
TOTAL (Also anlor on IIna 5. Reel hulallon)
(AllIch addlt1onalO 112" x II" sheels ~ mora spiel Is Mlded.)
CopyrlQhl (t) 1... lann "'!War. only CPSyoI...., I....
S 1 555.43
Fann 1800 Schodulo E (Ro..z.I7)
COl.t.nm~~,WbYAHIA
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
FI..I. Print 0. .
FILE NUMBER
21-95-
REV - 1111 EX . (7...)
Rae T.
ITlM
NUMBER
A.
Bovan
SS 140-20-8661
01 28 1995
DESCRIFTION
AMOUNT
1
Fun.ral Exp.nulI
Neill Funoral Homo
5,095.89
B. Admlnl.lra1Iv. Co.la.
1. P.raonal R.p,...nIaUv, Commissions 0.00
Social S.cu,ity Numb.. 01 P."onal RepresentaUvI:
V.., Commissions paid NONE
2. AIlomay F.le Irwin, McKnight & Hughos 500.00
3. Family Ex.""tIon 0.00
Claimant NONE Relationship
Addre.. of Clalman1 al dlcedent'. deoth
SIr..t Add,...
City Stale Zip Code
4. Probale Fee. 0.00
C. MI...llaneoua Exp.na.a.
1 Rogistor of Wills, fiUng 10.00
foo
TOTAL (Also 101.. on 11n. 9, RICa iIulatlon)
(If mo.. aplca la n.eded, Inurt addlUonaJ .hula of aim. alz..)
Ccpyrlghl (c) 104 form aattw.,. onl)' CPSytlteml,lnc.
$ 5 605.89
'onn 1500schadula H(R..... 7.81)
M/o1f__.......-.._~-..--~.>"...
. REV -1513 EX . (l.17)
COlA.Iim41b~,WhYANIA
SCHEDULE J
BENEFICIARIES
-
ESTATE OF
FILE NUMBER
21-95-
Roo T. Bovan
ITEM
NUMBER
140.20-8661
01 28 1995
SS
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
1
A. Taxable B.qU.sls:
Milton B. Hagan
3844 SE Fairway East
Stuart, FL 34997
brothor
100X
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Cherllable .nd Govemmenlal Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEOUESTS (Also enle, on Une 13. Rec. Ilulollonl
(II mora splc.1s needed, Insert .ddhlonal sh..1s of same slzl.)
eopyrlght(c) 1"4 fotm sollwar. only CPSysttml.lnc.
s
0.00
'arm 1500 Sthod.... J (Rev. Z.I7)
BEVERLY CALIFORNIA CORPORATION
511 ROGERS AVE., SUITE 40A
FORT SMITH, AR. 73919.8300
TELEPHONE (501) 484.8399
"P. NORGAN DelAWARE
WilMINGTON. DE 19801
61.23
JT1
9626213
VOID AFTER gO DAYS
PAY
"---
THREE HUNDRED NINETY FOUR AND 49/100 DOLLARS
TO
THE
ORDER
OF
IRWIN MCKNIGHT & HUGHES
60 WEST POMFREY STREET
CARLISLE FA
17013
1I11'l1; 21; 2l ~II' 1:0 ~ lloO 2 ~81:
::J~-:;k::-~-:'!;~:-. ~~'.r...: ~\:~: ~~-: ::\~~~,,,:, .~\:';: \: ::~: ~1~
''''\.''1'.''\-''';.''''1''.' .).....\... ....,.. '. .r. .~.. .:' . .'".
c,,;~..~.:.~~" :~..:~..;.~...::~- -{';:;~~.~~;.?;-: ',':.::i':Y:~: ::\~::
.y......,...!':.\... .,.~.,...... .,..\....:....
.. .'.-::::.;.:~.=.\o:..: . ,";;':-:.i.~ .... '\:::":;:;,;-;,:':<;,:.r.
'.,\"l.."'\"r' ~ .....,..~...,.\_
t;;:" !-, :"'.'~~'~~:\=';''''''' .l' ~.~.;~.-. .:~'...~~~'.~:-:,:~';o~~~i";" ~..;:
:-..,..).:.. ;"';.' ....'\:.1..;... :..':. .\....'l...\~ ,',:..',::, .,'.
2 ~O 0 ~ 1;0 I; Ii' ",; ....-.,...) ~.'..,,....... .1". ."........,.....
01-000-
H
DEVERLY ENTERPRISES
09626213
. -~ .1 '~rnCE AMOUNT' " ~
394.49
'I.. t,'OSCOUNT t '. ~ET AllOUHT " ,'::A,
.00
394.49
TOTALS
394.49
.00
394 .49
IEOP.20 (REV. 3/941 _ _ _
s~...-
._~ -.;.
~.;.
BEVERLY ENTERPRISES PENNSYLVANIA, INC.
CAMP HILL CARE CENTER #3959
PATIENT TRUST FUND
~6 ERFORO ROAD
CAMP HilL. PA 17011
2449
PAY ~ __
. TO THE I ~
'~ ORDER 0' 2C1L1 J~
! "'!:un I" "'."//1 ~ -1e.nrrnrl
PNClffiANlK
PNC Bank. N.A.
n Soulhcenlul PA 040
FOR K14 f. lSEv A N
lI.oo2....CjIl. 1:0 ~ l ~ ~ 2? ~81:
/ (5/
r.r 60-"'3109
"1~ 313
19_ ..--..
",._.,-'\. .
, \
I $\:..:J I (), 5..- J ·
DOLLARS
s.;)~
l1tl'vJ~
5~"020~;;':;" ~.?~
""
.t
, .
,-
-..,
13,EVI:I<'LV (::AI.lFUI~NIA CORPORATION
, 5111 nOGEHS ^VE" SUITE 40^
FI)I1T Sf,1ITH, ^Il i.:!tII\HI301)
TI::L,"PIIOrJL: (5UI) -10-\.11300
J I' ~h)lH\"" lll't <'\WA"\!
....1 '.111 II' i '~j 1'1 1'_11'111
II:'-;"l
-:in".
9712893:
VOID ,AFTER GO ,OAYE
" I' I
1f1f1f1f1f1f1l1l150.0
;1;,Ii
HUNDRED FIFTY ANO 08/100 DOLLARS
,'-'
lu
TH~
ORlJUH
or
. ;
II'''I? ~ 28"1 :III'
1:0:1 ~ ~OO 2 :181:
2:10 0"1
I
':.
DONNA FLYNN
516 POINTFIELD DR.
MILLERSVILLE MD
21108
01-000-
$$
BEVERLY ENTERPRISES
09712893
,.\ ~,~ INVOIC~ N~..,Il~IlT.:'..I,
i'ir:'''liIN~ IC':'M ~lil'~,".~..,
150.08
: ~ t:'fol~eovNT
.00
NET AMOUtn
150.08
TOT A L S
150.08
.00
150.08
"
, .
, .
,
'.
. ',. -"
'.
," .-...,.....---..
;5-1'1- 'i
u
REV-1547 EX AFP (12"94*
COtItDHWUL TH rw POtNSYLVAHrA
DOIARTMOfT OF AEYDU:
Il.RUU Of INDIVIDUAL TUEI
DlPT. nUll
HARAIIIUAG, PA 17111-0601
NOTICE GF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
GF DEDUCTIDHS AND ASSESSltENT OF TAX
ACN 101
DAT! 11"06-95
FILE NO.
DATE OF DIATH 01"28"95 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, suaHIT THE UPPER PORTION 0' THIS FORN WITH YOUR TAX
PAYHENT TO THE REOISTER OF WILLS. KAXE CHECK PAYABLE TO "REOISTER GF WILLS, AOENT"
REMIT PAYMENT TO:
REBECCA R HUGHES
IRWIN ETAL
60 W POMFRET ST
CARLISLE PA 17013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
Aoount R..1U..!
CUT ALONG THIS LINE ~ RETAIN LOWER PORnON FOR YOUR RECORDS ....
iiilj:ii;47"EX"AFP""nZ:94"i"iliificE""OF"i"NHEiiii'ANCi"YAX"A'PiiiiA'isEifiiir-,--AL'i."oiiANCi"il"Ii---"""""-----""""
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTAT! OF BEVAN RAE T FILE NO. 21 95-0570 ACN 101 DATE 11"06-95
TAX RETURN WAS. I X I ACCEPTED AS 'ILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l E.t.t. lSch.dul. AI III
2. stock. ond Bond. ISchedul. BI 121
S. Clo..l~ Hold Stock/P.rtnorahlp Int.r..t lSch.dul. CI 151
4. Horto..../Hot.. R..,dvobl. ISchedul. 01 141
5. c.ah/Bank DepoIUslHlao. P....son.l Property (Schedul. E) (5)
6. .Jolnt1~ Own..! Proptlrt~ ISchedul. FI 161
7. Tranafara (Schedule OJ (7)
8. Tat.l A...t.
I CIlAHClEO
.00
.00
.00
.00
1.555.43
.00
.00
IBI
1,555.43
APPROVED DEDUCTIONS AND EXEMPTIONS:
t 5,605.89
9. Funeral ExPen.../Ad.. COI a'"lle. Expen... (Schedule HJ (,)
10. Dobt./ltortoooo Llobll1tl../Llon. ISchodul. II 11.1 .00
11. Totol Doduatlon. 1111
12. Hot Voluo of Tax R.turn 1121
15. Ch.rltabl./aov.~t.l Bequa.t. (Schedule J) (15)
14. Hot Voluo of Eotot. _J..,t to Tax 1141
NOTE: I~ an aBBessmBnt was iSSUBd previouslY, lines 14, 15 and/or 16, 17 and 18
reflect ~igures that include the total at Ahh returns BsseBBBd to date.
ASSESSMENT OF TAXI
15. Aoount of Llno 14 ot Spou..l rot. 1151
1'. Aaount of Line 14 taxable .t Lin..l/CI... A rat. (16)
17. A~t of Line 14 taxable at Collateral/CI... 8 rat. (17)
18. Pr1nc1p.l Tax Due
~.~n~ R'I
4,050.46-
.00
4,050.46-
will
.00 X .00.
.00 x.06.
.00 X .15..
I1BI
.00
.00
.00
.00
TAX CREDITS I
PAYHENT
DATE
RECEIPT
HUHBER
OISCIlUIlT 1+1
INTEREST I-I
AItllUIlT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
.00
.00
.00
.00
. IF PAID A'TER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN fl, NO PAYHENT IS REQUIRED.
I' TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE 0' THIS FORN FOR INSTRUCTIONS. I
r-.
>i '.-"
;..> ,.
,
0,
I
,~
1:-:1
\'J HI
ii ~~: !J\ .jI ...]
00
AUOVAnClh Elt't.. of decedents Ib!'" on or Mfon ~r 12, "IZ woe Sf MY future Int.ntt In the ..tet. h '"",'.rred
In po.....lon or enJo~t to el... . (coll,tar..) ~flol'rl.. of the decedent I,t., the IXPlr.tlon of ~ ..tate 'or
11'. or for Y""" ~ C~.lth herlby IMPr..,., ,...rv.. the right to "'1'.1.. Ind ...... tr~"'r Inherlt~ T....
at th. l-.ful Cl... . (colltt.,..) r.t. on en, .uch future In'.r..t.
PIJRPOSE Of'
HOTlCE. To fulfill the ....,1'....,.. of Section 1140 of thI Inhel'lt~ MIl E.t,t, Tmc Act, Act IZ of 1"1. 11 P,I.
s.ctlon 2140.
PAvtCNTl Otbch the tap portlon 0' thh NoUe. Met IIUbIIIt with vour PIYNnt to the R..lttl.. 0' NUh prInted on the 1"'1'"'' ,.de.
......... check or 110M' 01'.1' p..l. tal REOIlTER OF MILLS, AGENT
All p.runts received _11 111'" be epplled to MY Int.r..t which MY be w. with .,,)' r-.lndel' ...11_ to the tut.
RUUND eeAh A r.'Wld of . t.. OI'8dlt, lilhlch .... not r....ttlMl on the Tax Altum, -.y 1M r.....tlld b1t COIIPltUng ." ooAppUuUon
'01' Refund of Penn.,lvanS. Inherltenca ~ E.t.t. T..~ (REV.ISIS). Applle.tlon. .ra avallebl. .t the Off Ie.
of the A..lltar of Will., '"w 0' the 2S A.venue Dlltrlot D'fle.., or by c.lllng the ~l.l 24.hour
.......rlng "rvl~ nuEerl for 'or.. orderlngl In Pwwl'W1V8rll. 1.100.162"2050, outllde Penn.wlv."l. WId
within 10C81 Herrbbura .r.. (117) 117.aOM, TDD' (717) n2.2ZS2 (....rlng J..lred On1y).
OLIE:CTJDNSI Any PIIrb In Int.....t not ..U.fJed with tM ......I......t, .UDWnC8 or dl..Uow.nc:. of cMduoUanl, or ........"t
0' tu (Including dlHClU'lt or Int.r.,t) .. IhcM1 on thb Not1~ .,.t obJlCt within .I.ty UOI dey_ of rK.lpt 0'
thl. f40tlc. bYI
....rltt.... prot..t to the PA Dlperteent 0' A.v..., ao.rd of AwNlI, Dept. Zlun, Harrisburg, PA 17121.1011, OR
....IHtlon to haft the ..thr det....lnect .t IiUdlt of the KCfhl'lt 0' the perlonlll rspr..."htlv., OR
..."..1 to the Drphan., Court.
~
AOft!"
IITRATlYE
COARECTlDHSI Flotu.l .rrars dllcovsred on thll ...........t Ihould be Mldr..... In wrltlna tal PA Dep.rt..,t of A.venue,
lur..u of Individual T...., ATTNI Po.t A.....eent Alvl.. unit, Dept. 210601, 'tarrlabUrg, PA 11128.0601
Phone (711) 787.6505. S.. p... S of the bookl.t -In.tructlon. 'or InhlrltlnC' Tax A.turn 'Dr I A..ldent
o.cedent~ (REY"1501) 'or... .Mplenetlon 0' Id.lnl.trltlv.lw corrlCtlbla Irror..
If MY tu due I. p.ld within thr.. U) cII""'r eonth. .ft.r the dKldwlt., dHth, . flvI p.rcent (5X) dhcCU1t of
the tax plld b IUowed.
,
,
DIICOlIfT I
1H1'tR(ITI
Intsrllt I. chIrged betl,.,lng ..Ith flnt dew of deUnquency, or nine (9) eonth. WId one (ll dey frOll the ct.t. of
dMth, to the date of P'YMnt. TlMII which bKIM deUl1qUMt before J..,.rw 1, I9IZ bllr Intsrllt It thl uti 0'
.he (6%) percent per """'- e.lcul.tld .t . ct.lh rltl 0' ,000164. All t.... which bee... dellnquent on Wld ,'tlr
JInuIry I, 1982 .,111 be.r Int.r..t .t . r.t. which .,111 v.ry 'ro. cIlendar y..r to c.lender y..r with that r.t.
announced bW the PA Pep.rt..,t 0' Alvenue. The ...IIClbI. Int.r..t r.t.. 'or 191Z through 1995 .ral
!!!! Inter.1l A... D.lly Internt hetor
!!!r
Intlr..t Rlt,
Dally Int.r..t Factor
191Z
1913
1'"
1915
I'"
"'Inter..t
20X .000548
161 ,000458
llX .OUSOI
ISX .000S56
lOX .00021"
I. c'lcul.ted .. 'ol1owlI
19.7
1911"1991
.99.
1995.1994
199.
,.
IlX
..
n
..
.oa02n
.oaun
.oa0241
.000192
.0002U
INTEIIElIT . BALAlfCE OF TAX UNPAID X /lVIlBER OF DAYB OELINQIIEIfT X OAILY INTEREST FACTOR
..Any Hot lei I..ued I'tl~ ~ tlM becOll. dellnquent .,111 r.,lsct ~ lnt.r..t c.lculltlon to 'I,t.-n (15) day.
beyond the det. 0' ~ ........,t. If p,y""t I. ... .fter the Int.rnt CDllpUt,UDf1 dIIt. shown on thl
MoUe., Iddltlonel Intlrllt ...,.t be cllcul.ted.
~..