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REV - t600EX H7.141
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS
FOR OAfES OF OEATH AFTER 121J1111 CHECI\ tURE
IF A SPOUSAL
C
FILE NUMBER
.
21-95
qlo,
CO"~F~.l'/M.'l:\O' P,fM'ilb~AN'A
HARRlSH6ftt ,~~~t~~.06O I
YEAR
NUMnEH
COUNlTCOOE
o
E
C
E
D
E
~
DECEDENT'S NAUE {LAST. fiRST. AND MIDDI.[ INITIAL}
Thomos Anno
oeCEDENT'S COVPlETE ADDRESS
1069 A11onda1e Road, Apt. E
Mechanlcsburg, PA 11055
L.
SOCIAL SECURITY NUMOER
113-22.0010
DATE OF OE...Tlt
08/11/1995
OA'EOF BIRTH
01,/12/1901
County Cumbor.land
(IF APPLICABLE) SURVIVING SPOUSE'S NAME tLASf.FIRST AND MIDDLE INITIAL) SOCIAL SECURITY HUMBER
AMOUNT RECEIVED(SEE INSTRUCflONSI
0.00
Remaindet Return
(for datu 01 death prior to 12-13-82)
Federal Estale Tal Return Rltquired
Total Number of Sale Deposit Bolts
CAB
H P l
E P 0
C R C
K 0 K
P S
2. Supplemenlal nelurn
4a. Future Int.r8sl Compromiso
Hor dates of dealh aft.r 12.12.821
[!] 6. D.ced.nt Died hstale D 7. Dec.d.nt Maintained a Living Trust
(Anach cop of Will) (Anach a co of Trust)
ALL CORRESPONDENCE ANO CONFIDENTIAL TAX INFORMATION SHOULD BE OIRECTEO TO:
X 1. Original Return
4. Limit.d Estale
05.
o B.
C P
o 0 ,jAUE
R N
R 0 Robocca R. Hu hes
E E
5 N fELEPHONE NUMBER
T 111-249-2353
1, Real EstalelSchedule AI 1
2. S'ocks and Bonds (Schedule B) (2)
3. Closely Held SlocklPanne..hip In'erest (Schedule C) (3)
4. Mongag.. and Notes Receivable (Schadule 0) (4)
5. Cash, Bank OeposilS & Miscellaneous Pe..onal Property (Sch. E) (5)
6. Jolnlly Owned Property (Schedule F) (6)
7. Transfe.. (Schedule G) (Schedule L) (7)
8. Total Gross Ass.ts (total Lines 1.7)
9. Funeral EJlp.nses, Administrati\le Costs, Misc.llaneous
Expenses (Schedule H)
10. Debts, Mongag. Liabilities. liens (Schedule U
11. Total Deductions ('o'al line. 9 & 10)
12. Nel Value of Estate (Line B minus Line 11)
13. Charitable and GO\lernmental Bequests (Schedule J)
14. Nal Valu. Sub eel 10 Tax (Lln. 12 minus Lln. 13)
15, Spousal Translers (lor da,.s 01 d.ath aher 6.30-94)
See InS!luctions 'or Applicablo Percentago on plgtt 2,
(Include values horn Schedule K or Schedule Mo)
16. Amount of Llno 1414xable aI61/. ralo
(Include values horn Schedule K or Schedule M.)
17. Amount 01 Line 14 taxable at 151/1 ralo
(Include values from Schedule K or Schodule M.)
lB. Prlru:ipal tax due (Add lax from Lln. IS, 15 and 17,)
19.CredltsJSp Poverty Prior Paymenls Discount Inlorosl
0.00 + 0.00 + 0.00 0.00
20. If Line 1915 greater than Un. 1B. onlor tho dllf.ronco on Uno 20. This is the OVERPAYMENT.
[!J 0 'Check here If you Ir. ,equlltlng I ,.fund of your overpayment.1
21. II Llno 18 Is groater than Line 19, onlor tho dllferonce on Line 21. This Is the TAX DUE.
A. Enler thelnleresl on tho balance duo on Line 21A.
B. Enler Ihelolal 01 Line 21 and 21A on Lin. 21B, This is Ih. BALANCE DUE.
Make Check P. able 10: R. Iller 01 Wille, A enl
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON PAGE 2 AND TO RECHECK MATH ~ ~
Under penllUe. 01 ptlllury, I oecl".th.11 h..... e.lmIllCK! Ihlllelwn.lnclucUog ."ompolnylng KheOules.oo 1IIIe~ntl..nd tQ It.. bell 01 my .nowleage.nd bell.f,U I11Iue.
cOIIKI.nd complete. I ded.,. Ihll.III..1 .sl.te hll been l.po'l~ .IIIUClIfWII..t v.lue. Oecl".Uon of p'.p.,.r olh.,lh.n Ihe pellOt\IIl repl..ent'lIvell bned on .lIlnlol""lIon of
Whl'h plePl'" h"'ftJ knowl.dge.
SIONATUREOF PERSON RESPONSIBLE FOR FILUIG REtURN Botty S. Hoffman DATE
I.' " ~P.~~. ^A!~!l_~~~!lu~~!l.c!l_ ~.P.'= ~ uQ.. n...............
Mechanlcsburll, PA 11055
S'GNATUREO' PREPARER OTHER THAN REPRESENTATIVE IRWIN, McKN1GHT 0. HUGHES CATE
,/7 L(J .-'] 0/ '11 60 Wost Pomfrot Streot
, , ,-. .ill', Cari"lrii~".i>A"'i7ijij.--"..'.""""''''.''''.''''''
R
E
C
A
P
I
T
U
l
A
T
o
N
COMPLETE M.AJLlNQ ADDRESS
IRWIN, McKNIGHT 0. HUGHES
60 West Pomfret Street
Cer11slo PA 17013
None
Nono
None
None
1,148.01
Nono
None
(B)
1,11,8.01
(9)
2,105.00
(10)
3,057.93
5,162.93
(3 ,41/,.92)
Nono
(3/.11..92)
(11)
(12)
(13)
(14)
(15)
0.00 X
:
0.00
(16)
( 3 ,414 . 92)< ,06 :
0.00
~
(17)
0.00 X ,15:
0.00
C
o
M
C
I
T
I
o
N
(IB)
0.00
(19)
(20)
0.00
0.00
(21)
(21A)
(21B)
0.00
0.00
0.00
CoPy1lllh.tt) g4 fo,mlollw"eonty CI)SYlllllml, Inc.
Form 1500 (Rey. 1-g4)
co"rN\lt11lm{\~NlhY'N'A
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Ple.ne Print Of T .
FILE NUMBER
21.95
REV. tioe EX. (2.171
Anna L. Thomas
55(1 173.22-0010
08/11/1995
(All '0 0
ITEM
NUMBER
1
olnll -ownod with RI hi 01 Su,vlvollhl mUll bo dllclolld on Schodulo F)
OESCRIPTlON
VALUE AT OATE
OF OEA TH
152.00
Msadowood, apartment
security deposit refund
2
PNC Benk, N,A" checking
account 05070058251
(confirmation attached)
1,005,56
3
PNC Bank, N,A" savings
account 05030071048
(confirmation attached)
186.47
4
Capital Health System,
5eid1e Memorie1 Hospital
prepaid refund
403.98
TOTAL (Also Inlor on line 5, Rica ilulalion)
(Aneth addilionalB 112' x 1 I' shoots it mare space is needed,)
Copyright (c) 1994 form soflw". on'1 CPSYllems.lnc.
$ 1 748.01
Fo,m 1500 Schedule E (R.v. 2-171
CO"~Nmllm~g~1hYAN1A
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Pi.... P,lnl or T .
FILE NUM8ER
21-95
REV-1611EX t(7.'.)
Anna L. Thomas
ITEM
NUMBER
SSj 113-22.0010
08 11 1995
OESCRIPTlON
AMOUNT
1
Funeral EI,.n"'1
Cremation Society of
Pennsylvania
800,00
A.
2
Paxtsng Cemetery Assoc.
inurnment & footstone
795.00
8. Admlnl.lrallva Ca.hll
1. Penonal Representative Corrvnisslons 0.00
Social Slcurhy Number 01 Porsonal Rlpresentative:
Vlar Canvrisslons paid waived
2. Attorney FilS 500.00
3. Family Exemption 0.00
Clalmanl none R.lallanshlp
Address of Claimant at decldent's death
Str.., AddrlSs
Chy Stal' Zip CadI
4. Probat_ F... 0.00
C. MI.callanlau. Expan",'
1 Register of Wills, filing 10.00
fea
TOTAL IAI.a .nllr an linl 9, RICO IlulaUanl
(If more 'plce I. n..dedllnll" addltlonal,h"'1 of .Im. 1111.)
copy'lihllcl'H4 'olm .ollwlf. onty CPS~.I.m., Inc:.
S 2 105.00
FOfm 1500 Scht'dul. H (R..... '-aa)
REV.. \5UEX'" (Z-a7)
CO"'lI.\lWllm4\,g,NbYANIA
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-95
Anna L. Thomas
ITEM
NUMBER
SSI, 173 -22 -0010
08 11 1995
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
NAME ANO AOORESS OF BENEFICIARY
1
A. Takable aequests:
Alfred K. Thomas III
217 Spring Lsne
Eno1a, PA 17025
son
ITEM
NUMeER
NAME AND AOORESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
e, Charltablo and Govornmental eoquosts.
"
TOTAL CHARITABLE AND GOVERNMENTAL BEOUESTS (AI,o onter on llno 13, Roca hulatlon)
(If more spacD Is needed, Insen additional sheelS of same size.)
Copyright (cI1994 'orm IIOflwlI. only CPS)'lleml, Inc.
s
0.00
Form 1500 Schedul. J (A.y, 2.17)
100X
'j'out.Rlhent i" h10 ploco and at,ood.
IN Wl'rN":lfl Wlmlll~Oli'. 1 hevo herouut,o out, my heud UIlII ooul
thio .30 IJ. dny of "7n,tJ ' 19711.
/?'
I (0., r-f. '
Anna. "
'~/,} ~'.J
/" -:J1\.lh-"..II1l~AL)
'1'I1O"OU
Sigllod. uoeled, Jlubliohod alld doclared by tho ebove nllmed
Anllo I.. Thomoo, os olld for hor I,oot Will Ilnd Tostoment" ,in I,ho
prcuonne or '113 who hovo auhucrihau our nlllllon hllt'uto nn wi tn011900 I
lit I,llll roquont 01' auld t,oot/ll;l'ix, 111 hot' pl'OOOUoo /l11l1 111 I;ho
p1'oool)oo of unoh ot..hnr'.
-0
~......, -
(tl 'u
-?-
," I'NC U'm~t N.I\'
'I~I~ (~ull\II' l'il.I'
C~""I' lUll. 1'.\ 17/111
September 15, 1995
PNC lBAN IK.
To Whom It May Concern:
As per your request for information on accounts the referenced decedent
held with us, the information follows on the attached sheet(s).
If I can be of any further assistance, please feel free to contact me
at (717) 730-2321.
~il1cerely.
c2c efL yti._II.Ct'fJ
Edith Tand 1
Miscellaneous Services Supervisor
Bank Operations
ET/mky .'
. '
DECEDENT NAME:
DATE OF DEATH:
SOCIAL SECURITY NO.:
ANNA L THU~IAS
/IUGUST II. IY95
IZ3-i'~-1l1l11l
TYPE OF ACCOUNT:
ACCOUNT NUMBER:
NAME(S) ON ACCOUNT:
DOli
5U7uU5!l~51
ANNA L THUM/\S
DATE OPENED:
DATE OF DEATH BALANCE:
ACCRUED INTEREST:
INTEREST PAID YEAR TO DATE:
OTHER INFORMATION:
U4-U5-BI:I
$l,UU5,56
TYPE OF ACCOUNT:
ACCOUNT NUMBER:
NAME(S) ON ACCOUNT:
~V(;
5U3UU7 lU411
ANNA L THuMAS
DATE OPENED:
DATE OF DEATH BALANCE:
ACCRUED INTEREST:
INTEREST PAID YEAR TO DATE:
OTHER INFORMATION:
u~-23-!l!l
$lllb.ll:1
SU.2Y
$l~. 71
TYPE OF ACCOUNT:
ACCOUNT NUMBER:
NAME(S) ON ACCOUNT:
DATE OPENED:
DATE OF DEATH BALANCE:
ACCRUED INTEREST:
INTEREST PAID YEAR TO DATE:
OTHER INFORMATION:
STOCK INFORMATION CAN BE OBTAINED FORM CHEMICAL BANK
AT 1-800-982-7652
REV-lS41 EX AFP (12-95*
CO"HONWUllll or P(HNSYl YANIA
DfPARtMENT Of REVEHU{
BUREAU OF INDIYIDUAl 1.W[S
DEPT. Z80601
IIARAts.URa, PA 111I1"D601
ACN 101
NOTICE OF INHERITANCE TAX
APPRAISEHEHT. ALLOWANCE OR OISALLOWANCE
OF OEOUCTIONS ANa ASSESSHENT OF TAX
DATE 03-25-96
T OF FILE NO. - 919
OF DEATH OB-II-95 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT. SUBHIT TIlE UPPER PORTION OF THIS FORH WITH YOUR TAX
PAVHENT TO THE REGISTER OF WILLS. HAKE CHICK PAYABLE TO "REGISTER OF WILLS. AGENT"
REMIT PAYMENT TO:
REBECCA R HUGHES
IRWIN ETAL
60 W POMFRET ST
CARLISLE PA 11013
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 11013
AMount Ra..l Uad
CUT ALONG THIS LINE ~ RETAIN LOWER PDRTION FOR YOUR RECORDS .....
REV:is47-E'if-AFP-mr:9ijj-iiiiYicE--OF--iNHEh-ii'ANCE-YA"in-ppiiiiisEj.jiiir-'--ALi.-OWANC"E"'iili-mm_-_mm-
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF THOMAS ANNA L FILE NO. 21 95-0919 ACN 101 DATE 03-25-96
TAX RETURN WAS I I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Eat.t. (Schedule AJ IlJ
2. Stock. and Bond. (Schedul. 8) (2)
3. Clo..1~ Hald stock/Partner.hip Int.ra.t (Schedule C) (3)
4. "ortgags./Not.. Rac.ivabl. (Schedul. OJ 14'
5. Caah/Bank Deposita/Hllc. Parlonal Prop.rt~ (Schedule E) IS)
6. Jointly Owned Property (Schedule f) (6)
7. Transfa,.. eSchedul. OJ (7)
a. Total Au.h
. CNANGED
,00
,00
.00
.00
1.148,01
,00
.00
181
1,148.01
APPROVED DEDUCTIONS AND EXEMPTIONS:
t 2,105.00
9. Funa,.al Expan.../Ad.. Co. '/Hl.c. Expan... (Sch.dul. HI 191
10. Dabta/Hortgaga llabUltJ../LJanl (Schedule Xl (10) 3.057.93
11. Tatel Deduction. Ill)
12. Het V.lue of Tax Return U21
IS. Charitable/Govern..nt.l aeqUe.t. CSchedul. JI (13)
14. H.t Value of e.t.t. Subject to Tax (4)
NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
IS. A.ount of Lina 14 .t Spou.al
16. Aeount of Lina 14 t.xable at
17. Altount of Lina 14 t.xable .t
18. Princlpel TeM Du.
~ . H' q3
3.414.92-
,00
3,414.92-
will
rat.
Lin.aI/CI... A rat.
CollataraI/Cla.. 8 rat.
.00
.00
.00
X .00.
X .06.
X .15.
1181
.00
.00
.00
.00
1151
1161
(17)
TAX CREDITS:
PAVHENT
DATE
RECEIPT
WUHBER
OISCOUNT It)
INTEREST I-I
AHOUNT PAIO
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTER EST
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER OATE INDICATEO, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL OUE IS LESS THAN Ii, NO PAVHEHT IS REQUIRED.
IF TOTAL OUE IS REFLECTED AS A "CREOIT" ICR). YOU HAV BE OUE
A REFUNO. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.'
RES[RVAllOHI Eltlt.. of die"''' dying an or bttfar. DUIMlar 12, i.12 -- if III'lY futut. Int.n.t In th. .,t.t. It tr.."f.tt.d
In polI.ulan or ."jOy.."t to CI... . (coll.t.t.U bln.flclar I.. of the d.cadent aft.r thl ..plr.tlan of any ..tat. far
Ilf. or far y..t', thl Ca..unwI.lth hltlby '.Ptl.,ly tl'lr~.. (hi right to .ppr.I.. and ...... trlll'l.f.r Inh.tltanc. T....
.t thl l~ful ell.. I Ccoil.t.r.l) r.t. an any .uch futur. Int.r..t.
PURPOSE Of
NOTICE I To fulfill the tlqulr..-nt. of Slctlan ZiU of thl InhlrltBnCl and Eltltl TalC Act, Act n of 199" 12 P.S.
SHUon Zl~D.
PAYHENTI Dltach the top portion of thl. NatlCI and .ubalt with your pay'ant to th. Algl.tar of will. prlntad an tha t.y.r.. .Ida.
uN..... dtack or IIOMY atd.r p.yabl, tal REOISTER OF MILLS, AGENT
All p.~t. r.c.l~ad ah.11 flr.t b, applied to any Intarl.t which ..y ba du. with any r...lnd.r .ppllld to thl talC.
REFUND ceA)1 A r.fund of . t.lC credit, which WI' not t.qu..t.d an th. TllC A.tutn, .IY b. t.qu.,t.d by ca~l.tlng an "APpllc.tlon
far R.fund af P,"".yl~lII'll. Inh.rltBnCa and E.tata f.." (REV-1515). Appllcltlon. .ta IYlllabl. at th.offlca
of the Regl.t.t af Will', any af thl ~1 R.Y.nu. DI.trlct OffiCI', or by cllllng the .p.clll Z~-hour
an._tlng ..t~lca nuab.r. for far.. ord.rlnll In PIM.ylv.,11 I.UD-J6Z-l0SD, out.ldl Pann'YI~anla and
within local Hur hburg at.. l11n lU-n.,., TOO' 11In 71l-ZZS~ Clint Ing Iapaltld OnlYl.
olJECTIOMSI Any party In Intar..t not ..tl.fl.d with th. .ppr.I....nt, .Ilowanca or dl..llowanc. of d.ductlon., or .......ant
of t.. I InclUding dl.count at Int.r..t) .. .hown on thl. Notlc. MU.t abJ.ct within .I_ty (60) d.y. of t,cllpt of
thlt Nollca bYI
uwrltt.n ptot..t to th. PA D.path.nt of A.v.nu., Baard of Appnl., D.pt. llIDll, Il.rrllbutlh PA 17ll1-IDlI, OR
--allctlan 10 h.v. Ih. ..It.r dlt.t.ln.d .1 ~~dll af thl accounl of thl p.r.onal r.pt...nt.tlv., OR
-.8PP..a to Ih. Orphan.' Court.
AD"IN
ISfRAfIVE
CoRRECTlONSt
Factu.1 arror. dl.cov.rad on thl, .......ant .hould b. addr....d In wrltlno tOt PI. D.p.rt..nt of R.venu.,
BurelllJ of IndivIdual f...., .nHI Po.t A......ant R.vlew Unit, O.pt. ZlD601, Ilarrhbura, PA HUI-D'OI
Phon. (717) "'-6SD5_ s.. P.II 1 of the booklat "In.tructlon. for Inh.rltanc. t'M R.tutn for a H..ldant
O'Cldent" (REV-1SDI) far an a.planatlon of adalnl.tratlvalY cortect.bl. .rror..
DISeoUHTI
If any la. aua I. p.ld within thr.. ()) cal.ndar .onth. aft.r the d.c.dlnt'. d.ath, a flva p.rcent eS~1 dl.count of
thl ta. p.ld I. .llow.d.
IHTERESTI
Inl.te.t I. ch.tg.d blalnnlna with flr.t day of d.llnqulncy, or nln. (9) .onth. and on. ell day froa thl d.t. of
dl.th, to thl d.t. of p.y.ent. T.... which bec... d.llnqu.nt b.for. Janu.ry 1, 1982 b..r Int.r..t at Iha t.t. of
.Ix e6~) p.rcent p.r annul calculltld .t . d.lly r.t. of .ODDI'~. All t.... which b.c... dlatnquant on and .ftlr
January I, 1'.2 will b..r lntar..t at . r.t. ~hlch will ~.ry froa c.l.ndar y..r to c.l.ndar y..r with that rat.
announced by the PA Oapett.ent of A.v.nue. 'hi appllcabll Int.r..t rat.. far I'll through 19'6 .ra.
'!!!! Interllt Ratl DillY fntarut factoI' ~ Intatllt Aat. Oallv Int.,...t f.ctor
i.ll lOX .000541 1911 .X ,DDDZU
19U lOX .DQQ~ll 1981-1991 II~ ,DDD101
I9I~ II< ,000101 19" OX .DDDiI''''
1,.5 In .000156 1"1-1'99-. IX .DDOI9t
1916 lOX . DOOll,. I"!i-"" OX .00020\1
-.Intanst II calculat'd .. fallow.t
INTEREST' BALANCE OF TAX UNPAID X NunBER or OAYS DELINQUENT X OAILY INTEREST rACTOR
.-Any Hotlcl I..u.d a't.r the taM b.co... d.llnquent will r.fl_ct an Inl.r..t c.lculatlon 10 flftlln CIS) day.
b.yond the dal. of the ........nt. If p.y..nt I. ..dl aftar In. Int.r"I co.putatlon dal. .hown on the
Hotlc., additional Int.r..t ",.t b. c.lculat.d.