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Home My WebLink About07-14-06 (2) REV-1500 EX (6-00j COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 .... Z W o W U W o w I- ~::!;en UO::~ wc..u :roo uO::...J c..OJ c.. 0<{ INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) J.I Tl 6' ~.;~<J T'J.I'IJE DATE OF DEATH (MM-DD-YEAR) / ~~1~0 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) \ZJ1. Original Return D 4. Limited Estate jR] 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of deafh after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit {dafe ofdeafh between 12-31-91 and 1-1-951 FILE NUMBER kL -12 ~ COUNTY CODE YEAR 6' / J, t2- _ fuMBE:r- TELEPHONE NUMBER '/ 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) ~~clll 1/ 0 go 13, "Pi; SOCIAL SECURITY NUMBER ~~ - ~<f? -J ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) I- Z w Cl Z o c.. en UJ 0:: 0:: o U THiS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INF()RMATIONSHOULD,BEDIRECTED TO: NAME COMPLETE MAILING ADDRESS ,-J / / '7-0 '7 ;J ~;A/;'</ 61Y1,vT I~ ~d C/t!??;?;f I fJ// / 7 c:~ it- - /g''!-15 / /10/91'0 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) (6) _ (7) z o ~ ..J :;:) .... 0.. <t u w ~ 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (9) (10) /7--; (d;;o I ' ~-=> OJ (8) ').-1::: C; 3 J--. 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ .... :;:) 0.. :!: o U >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0_ (15) x .0 tf{ (16) x .12 (17) x .15 (18) (19) (11) (12) (13) /P,000 /_7- 7 f 1--:7 z.-- 16. Amount of Line 14 taxable at lineal rate 'J.- t- 3/ 'Z--~ 2.- (14) ~ z.-.3" "2---~ Z--- 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSVVERALLQUESTIONS ON REVERSE SIDE AND RECHECK MATH ..:: <: /O.dJ/? . . / ?11 f)#-1 Decedent's Complete Address: STREET ADDRESS CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) /!/i'~1 9/ cPCJC> ,/11 Total Credits ( A + B + C ) (2) ___ 0;) 'i.1 f 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 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. B. Enter the total of Line S + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 2 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred;......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; .......................................... 0 c. retain a reversionary interest; or.......................................................................................................................... 0 d. receive the promise for life of either payments, benefits or care? ................................................................... 0 If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............ 0 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .. ............................. ................ ................................................... No [Z! lZJ [ZJ ~ 3 4 ~ ..1ZJ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perJury. I declare thai 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 pre parer other than the personal representative is based on all information of which preparer has any knowledge. AI3DRESS A I ^ 3/7 3t1~ 5"r,.IIb) ;-t/SA) (~~/fL'!f~~/\ ~J! ,/~/b 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 3% [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 0% [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 0% [72 P.S. ~9116(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 4.5%, except as noted in 72 PS. 99116(1.2) [72 PS. 99116(a)(1 )J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [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. REV-1S03 Ex" SCHEDULE B STOCKS & BONDS :OMMON\I\!EALTH 01' PE~n~SYLVNM INHERITANCE TAX RETURN RESIDE~IT DEC~9.E.i111_=~ ESTATE OF c.:5~XjtlEk!j)/:--- ;J .K.(.J rZ. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM l' NUMBER DESCRIPTION ti. ,<;;. ):;;'/ - ~K1t~:$" /7' .~/ - '-'{~~-.---D"~j;i/-q--q '/16/39'1I?f ~'" V/7--7-(",3:3~? .- .6 00 IIOeo /' ~! CJOO Ii (JOO !J; 000 /1-( '/-:2 q<;~'- I / "," Cr~ .=;./ :"'l>-.:~f JL I 11/-;. -z, t~ ~ 3 r;: /-' IlM~:-;:://~~-15.r-- ;(\15'- 6f?~tQf/;i;e:;)-::;t! II I .4./'" /, 01/0 1/ ..1; .-;:; /l/c.-/\'C' I; -~b~f. ~~;r3-o-co?- 3, .h-J~I!A;;; ~J /--; t/ 14/~- /"1 33 '7 -.31",,'-,tf'.7 ?? ~ 5-/9 ;,~ [', - ? "'}o'.. .. ..-1 ..... Ii ,/~".:;":~ t ,,/'i~/-~' //1- L ~ C-i\ . /,l/1/ ..~~-,;,_., < ~,"'.I'v.().~ ""_" p?'?' $' ~/I,A ,c=:-S" ,....,.... <{! ~ 7/ FILE NUMBER z-/ - 06 - c::P/ /;;7 Ilf n-'\nr"n C"........r-o ic- noorlorl ineort -::lrlrlitif"\n-::ll chQQtc nf th.:;:l ~:::lm&:l C;;:17P\ TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE OF DEATH / ~ .;,.,(- ..f~"'" '-. ~1/c;l / (1, Z-~.;C) 1-7 ()/tl-:- ,I I $ ///:/7') !' /" :..:-.-, // /" v/ REV-1508 EX + (1-97; SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF /,5Er/7J!t/ lic" /1-J...iJ ,Ti. FILE NUMBER 2-/- tPt;- 0//0 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. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH \. t j/,/t/ C h/f/vi!; /' tZ. :..::': 7.:C, <,>'( '"'- - /f/c~ \ ~/~(/03G;J!/'h~' . ~.A\I ;A(,;. .dr' , " It ' // ---, ',' A' ",-, ..:j t;. >< - ,if" :--- . (.:.'" '. /' 7-:2- f'1 ;:. ,> '161 /~ /'71/ ~Ic"': ~- ....._ ,_ )\ -):7" '---,/'~/-' Lt '/:--1"/ c::;.";""'" ......- /T'-' ,..' -- - ./ " ,../." -2 I)A ' '/ ," -L-.-"//c;, A'-c:' ;>;;,t r ;'/,X I/'tyf:,f"}, ;f;.c-S/6/',;~ "" J i /"27 A' .~ /f KL? V~1:' /./;;:..',?<-{ -5- / TOTAL (Also enter on line 5, Recapitulation) $ h'~ 07"'/ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. za0601 HARRISBURG, PA ll1Z8-060l INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0110 ACN 06118854 DATE 04-24-2006 II:V-1545 EX AFP (19-00l ** JEAN K HENRY 1207 PENN GRANT RD LANCASTER PA 17602 TYPE OF ACCOUNT EST. OF GERTRUDE A KUTZ 0 SAVINGS S. S. NO. 186-28-3476 [X] CHECKING DATE OF DEATH 01-25-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORMS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 PNC BANK has pr-ovided the Depar-tment with the infor-mation listed below which has been used in calculating the potential tax due. Their- records indicate that at the death of the above decedent, you wer-e a joint owner-/beneficiary of this account. If you feel this information is incorr-ect, please obtain written cor-rection from the financial institution, attach a COpy to this farm and retur-n it to the above address. This account is taxable in accor-dance with the Inheritance Tax Laws of the Commonwealth _oj'_~I'~ennsylvania. auestions~._.a3Lbe_anSMer:ed_by_calling (7~21. 787-8321. COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5140036358 Date 01-25-2006 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 29.866.72 100.00 29,,866.'72 .15 4.480.01 TAXPAYER RESPONSE To insure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register- of Wills. Hake check payable to: "Register of Wills, Agent". x NOTE: If tax payments er-e Bade 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 became delinquent nine (9) months after the date of death. Tax PART [!] [CHECK ] ONE BLOCK ONLY A. 0 The above inforAlation lInd tllx due is corr-ect. 1. You may choose to r-emit payment to the Register of Wills with two copies of this notice to obtain a discount Or avoid interest, or you IliJY check box "An and return this notice to the Register- of ;6 lIills and an official assessment will be issued by the PA DepartAlent of Revenue. B. The above asset has been Dr will be r-epor-ted and tax paid with the Pennsylvania Inheritance Tax r-eturn to be filed by the decedent's repr-esentative. C: 0 The above inforll8tion is incorrect and/or- debts and deductions were paid by you. You must co~lete PART ~ and/or PART ~ below. PART [!I DATE PAID DEBTS AND DEDUCTIONS CLAIMED If you indicate a different tax rate" please state your relationship to decedent: PART [!J TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINrr:--lF.iite-':s-ta6llSl1iiCl~--I- 2. Account Balance 2 3. Percent Taxable 3 X 4. AIKKBlt Subject to Tax .. S. Debts and Deductions S 6. A.ount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PAYEE DESCRIPTION AMOUNT PAID I TOTAL (Enter on Line 5 of Tax Computation) I $ Under penalties of perjury, I declare that the facts I have reported above are true, correct and co.plete to the best of my knowledge and belief. HOME ( ) COHHO~WEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE NO. 21 06-0110 ACN 06118853 DATE 04-24-2006 REV-154S EX IFP lD9-BD> JEAN K HENRY 1207 PENN GRANT RD LANCASTER PA 17602 TYPE OF ACCOUNT EST. OF GERTRUDE A KUTZ [X] SAVINGS S.S. NO. 186-28-3476 0 CHECKING DATE OF DEATH 01-25-2006 0 TRUST COUNTY CUMBERLAND 0 CERTIF. REMIT PAYMENT AND FORtIS TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PNC 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 lIIay be answered bYucalling (717) 787-11327~Mc____ ____u___u____ ______u_ uCOMPLETEuPA~T 1 BELOW. . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5080532287 Date 01-25-2006 Established Account Balance Percent Taxable Amount Subject to Tax Rate Potential Tax Due x 14,174.09 100.00 14,174.1:19 .15 2,126.11 TAXPAYER RESPONSE To insure proper credit to your account, two (l) copies of this notice DUst 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 ill A. 0 The above inforlllation 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 IIaY check box "A" and return this notice to the Register of ~ Wills end an official assesSllent will be issued by the PA Deparblent of Revenue. B. The above asset has been or will be reported and tax paid with the PllfWIsylvania Inheritance Tax return ~o be filed by the deCllden~'S rep~esentative_ C. c=J The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ~ and/or PART ~ below. [CHECK ] ONE BLOCK ONLY If you indicate a different tax ratel please state your relationship to decedent: PART @] TAX RETURN - COMPUTATION OF TAX ON ~OINT/TRUST ACCOUNTS LINE--1:.-o.t.--Establisfl..d - 1 . 2. Account Balance 2 3. Percent Taxable 3 X i'i. Amount Subject to Tax If 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax Rate 7 X 8. Tax Due 8 PART @] DATE PAID PAYEE DESCRIPTION AMOUNT PAID I $ I TOTAL (Enter on Line 5 of Tax Computation) Under penalties of perjury, I declare that the facts I have reported above are true, correct and compl~e to the best of, lilY knowledge and belief. HOME' ( ., REV.l509 EX . 11.97) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERIT ANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~":;x)/7fh'h~,' /I. J:'-t,/ n. FILE NUMBER 2-/-tJb -0//0 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. B. c. JOINTLY -OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %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 DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1//10:: d /1~/1 /?:7d ~/f t. ?r?cc:ll T i?//?\.._/" 313r.>-2J ,SO /; r:; 150 ;1/C~(/b/1r:Z"5- ( teJ I f-/, ~)bA/ -I/?h/f/!h ?,/t//:7- ) "---_._.-.._-"..-.-~_."- TOTAL (Also enter on line 6, Recapitulation) $ /;{,'f?O (If more space is needed, insert additional sheets of the same size) REV-1510 Ex + (1~9T1 SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 6"4\;/R// ljr-- A /(,tJ r-z- . FILE NUMBER 7-/-(;(:;;- - ()//Ci This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION TAXABLE VALUE IF APPLICABLE i""- ;viI /00 ",-7,;-' 'J..ij / /1. (.r. ('Y, ~/.,(~7? 0030-0-"7'-?7 -...-:;1/,/., ./1 7' ~"::>~ f (;;t(.l,.... 2. -(JO! ,/ "'"i--J ,.~~~ '/\//c TOTAL (Also enter on line 7, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) r7' .:' "7.1 / I /.",lJ ,.....-,r/ REV-15'1 EX+ (12-99) . 9;\~;~ ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS / c /c- :J--- ESTATE OF 6c7?7lctlhA-~ A. ~i T:z- FILE NUMBER ;?/-{)G -C)//o ITEM NUMBER A Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAL EXPENSES: Mrt';';; /1 /-(c:'/~' hA'~':;('It t. \-, . f.u:V. b t.J R (5/1!. L - S..:: 'r,,? ~ t1 H',<;,://r-t/T// :;;:>ft/Ac;;:/; - ~P'#C~P-CN 6:1/ A/ ~;( Ie:: 4-- #~/o/C?/'/I/7~ - $-/fc./ _C;7i'A//;,-~0::;:;/\~/1V-/ii/6' B ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(sL 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 Add ress City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees - '.' _ ~ )A_.I""""";! '/..;l.,y'); /::!"'r.. nil "ric, ' - 1'.,. . ,."v. ''''1'' IF"~' -. ,., p.;rv I i , . ..:,.-.. ~"~ 5 Accountant's Fees - ,J..;::- ,," ,....,..'1'\. \- ""'.. "C,' ~ \ 6 Tax Return Preparer's Fees - ,~;;::c1c'~~'I'/. (.. /5':1;1 'I:,~." : 0~ ?-o;,::<;:, ,... I' " -- ,.' 42 /: -1- J /,~t./1f5,<I/Jf/)( - C:W7C~)I.c:;/1::Jd",(~"::?~' /,&j4;;;:'JZ1.s771(;i:'::~; '/J?A~' ~:;;t:;::;:/f{~ :/1/1I~~//<'2://4 Id'47t+1\ ;4#:7' r~I;7;(/'-1/h;;.;'/. ' #P-"';SS/,4L. -~//\;.> /rI')'lJc~'1,t(p,' ( 1/'1'0#1:'4) / /' _, _ ,I' I '. ~., l.. . ,." rt~"jft~';r~'r J' /VC1A,) /; 1/;'5i;;;',,"7 I./;j I Oll/ ~:c/<~ifr l'- f{/lir /fA' ~ r J:;;/~--;kS7"/J,4ll 7, s, Cj. AMOUNT /Z2- /Cf? /?;! ~% ':J.. 7'5"' 7-/ r- 7-~ t319 //0 ;z.~;~/ ~ /tltj 1/ 1,1 ~\~ TOTAL (Also enter on line 9, Recapitulation) $ /1; .1-//0 (If more space is needed, insert additional sheets of the same size) // ...,.....,.. dd/:'~' ,-'" /....c7/'1/./__ [b'-7t::'_2-aC~__ c--.... ./ -- / /u"' "'t Uv ~ff~:d"l~ /7 _ ." /,; ,/.:,' A _______~~.v--N~4.c?~ .-.. p:?;ff;~:"'&r: J5~',T;~,A);:: LtJ:#7Z- _______~___tJi6.-~//CZ -- -- -- ------ - ~- b-c~c;<( fJ-hd/'/ L--=~ ~=\bi~lffC!' i ..L\~' I' -.-.-------.--.-- I -/d,f},q,rj) -' ",'?,,41-/e"'~/ TA-x A~r7'VA';</!i" (LlS; fib L_____.__._.___ ...... , "'..-;--~~/:z.-tl' ;--..-- /'~ -~~;iZ.-i c:;~-k JJ___-~ "..J.~. .....-.-- ___ ---;. _ / I !.,f::72 -"r..! . ~.L.N...L~,. n;::-7-.~')AL/ <:'-1;. -h J-- ___L ~ --~~.~ --- u .... __~_~ _ -::=::~..- ~,*' / -" / . ~ + y~.- --;110'- I .' I · . iF 1;t-?C&..'4'N7A-/'I..i,T..-rC~0~.;-:" /b,;;;k"ir " I I ./" ~ rS" N/: / ; / .c'~::'/IJ~_'r~6L;' -l-t! ..]/; ($ " - ----L__ 1 ! I / i ! 4['-- ~/~.~- -, T:J!fx / / At hY/'L/ A/ fr7?/P i ' I "TAx k=L' '/')4</ <:_ '0''-7 / k"/4 /1') ).-- I: f ,.' 1 \ ' f _\' ' , , ,if7r6/ /(Jr z. ~ ! j : i 1 : . i ' ! " I , I ' 1 ! I : -".........-fl "~,/II_SC~~ JO;~ES G7503 CoiumnWrite i + J ,I I~-t- .. j t -=r= -- I~-=! ! I , I - -------+--~ f--_. j -.-.+-t ---1--- ~ i I 'r-~ . \!---,,--, jl----~--i- It=-~H1.-.-l I \--.-~ - - " I " ----i--\ ---,_..*--- 11---!--1\-- 'iI' 11- -- n._I._1 . 11---\ -+-- IRf lL.._ · ..JL ----r -=- _-LA /0' y~ "L r- +- i '-1 l I I , _ _._.nj I -4. ,c;:." -' ~O. po ., ",-- ...~._~- ---~-,3t?' , 1__- , Z. 'LrJ j/~;Ji, . . /7..,,1_1.';,' ! ,-. . , 21 . i ._._---,_.,-~-_.._--_.~---'.'_"- Tli~~E~~~ l~- ; . , +---- --- -r 22 . .:::.~) --;---- 21 25 26 - ..-- .-- --.--- .. .- ... .._- .-.. m - '- . ... .....- .._-- I ; , , i , . . : : , f -~~~-_.~._-- -.--...- ..-- .,," --', .---...---j. '-"'---" 1\ . _1 ----[- 1------ . ..f\: ! I ,1 ....._.______.. .._, __. _____.jl... __ _. _, ...' . il -----1 I -- 1 . I I . __I ! i II .----,-r--+ _'. m' '_.. ..\___\ \ - - i-- ;-'T-11 . t -- .--.- --;'-'-+-i I 11 Jj REV.1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 7;? FILE NUMBER ;?-/--c'. - ?J//O RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 ~,e--/fN AN4E7/,;;?- /O/h. ,I(~;V!<Y /~1/~;VNGI<?/f;1IT/!.d M/fl ,:;::../1$' ~')(', t A bfhJ -p/ ,..j 0 /0 /-, j\) Ie: It /1/2 b 42:"";I::i-rJ7Z.. 3 -;,0 t fA) (/0]) A \~.c,-' B ;j R 7.~/'~ (// i.-t.'c~ ;t1 b So;'! 3o~h ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET " 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 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) STONE, SAJER & STEWART Attorneys at Law 414 Bridge Street New Cumberland, Pa. 17070 LAST WILL AND TESTAMENT OF GERTRUDE ANNE KUTZ I, GERTRUDE ANNE KUTZ, of the Borough of New Cumberland, County of Cumberland, and Commonwealth of Pennsylvania, declare this to be my last will and revoke any will previously made by me. ITEM I: I devise and bequeath all of my estate of every nature and wherever situate in equal shares to such of my children, JEAN ANNETTE KUTZ HENRY, of Lancaster, Pennsylvania, and RICHARD LEE KUTZ of Burtonsville, Maryland, as survive me by thirty days. ITEM II: Should my daughter, JEAN ANNETTE KUTZ HENRY or my son, RICHARD LEE KUTZ, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the share of such child to his or her issue, per stirpes, living on the thirty-first day following my death; and should any either my daughter, JEAN ANNETTE KUTZ HENRY or my son RICHARD LEE KUTZ, leave no such issue living on the thirty-first day following my death, I devise and bequeath the share of such child to my other child or his or her issue per stirpes, living on the thirty-first day following my death. ITEM III: I appoint my executors or their successors guardian of any property which passes either under this will or otherwise to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion to distribute a share where possible to the minor or to another for the minor's benefit. Such guar- dian shall have the power to use principal as well as income from time to time Page 1 of 4 pages f' " STONE, SAJER 8: STEWART Attorneys at Law 414 Bridge Street New Cumberland, Pa. 17070 < " for the minor's support and education (including college education, both gra- duate and undergraduate) without regard to his or her parent's ability to pro- vide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. ITEM VI: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. ITEM V: I appoint my children, JEAN ANNETTE KUTZ HENRY and RICHARD LEE KUTZ, co-executors of this my last will. ITEM VI: I direct that my executors or guardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ANNE KUTZ, Testatrix, have hereunto IN WITNESS WHEREOF, I, GERTRUDE j~ set my hand and seal this ..!.:L.- day of 711 .:(."!:r C7 , 1985. Y'" I - GiR~~~~~ ~v"" ~-:1r SEAL) ( \~,.- ../ Page 2 of 4 pages STONE, SAJER 8: STEWART Attorneys at Law 414 Bridge Street New Cumberland, Pa. 17070 SIGNED, SEALED, PUBLISHED and DECLARED by GERTRUDE ANNE KUTZ, the Testatrix above named, as and for her Last Will and Testament, and in the pre- sence of us, who at her request, in her presence and in the presence of each 1j 1\ other, have subscribed our names as witnesses. ii !I~ ~ Il.L6Qu . Ii Witn~"" . !I /)~ b II /, ( II w~~ ~. .... A'~ , ~ ii " iI " II , !I COMMONWEALTH OF PENNSYLVANIA: II : SS: d COUNTY OF CUMBERLAND 11 ~Q\~~~J 1 (1 ss v 7 i1..~~~~ ~~, Address - Ii iI !, ti Ii attached or foregoing instrument, having been duly qualified according to law 11 1i 11 i! do hereby acknowledge that I signed and executed this instrument as my last ;\ I' d will; that I signed it willingly and that I signed it as my free and voluntary ;! !! I, GERTRUDE ANNE KUTZ, the Testatrix whose name is signed to the act for the purposes therein contained. L: i! !! H il ,', " .. .... · I k' ~ //fk,~ (~/~~ ~ GERTRUDE ANNE KUTZ (',J Sworn to or affirmed to and acknowledged before me by GERTRUDE ANNE KUTZ, the Testatrix, this I~ z:A., day of ~~ ' 1985. G ..:..~zL t:~ WA'~~1. Notary Public r~TH ANN HECKMAN, Notary Pub! New Cumberland, Cumberland Cr My Commission Expires Feb. 8, 1 )i' Page 3 of 4 pages STONE, SAJER & STEWART Attorneys at Law 414 Bridge Street New Cumberland, Pa. 17070 COMMONWEALTH OF PENNSYLVANIA :88: COUNTY OF CUMBERLAND we~{j~ and r;~()r() ~.S~r,l;~_ the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, depose and say that we were present and saw Testatrix sign and execute the instrument as her last will; that Testatrix signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; that to the best of our knowledge, the Testatrix was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. Q~~ ~ ~\rj1 k (-~~ Sworn to or affirmed to and acknowledged before me by e/lA/2(1S Ai S7.../j&E~_ and ~V/A /-/ this ~~day of _y~~, 1985. ,- , ~ / G7 A/(::: witnesses, -.-' _ z,~ ~,"''- ~h~!L. Notary Public .'~Tl-l jl,NN HECKMAN, Notary Public !'Jew Curnoerl.Jnd, Cumberland Co., 0" My Commjssion Expires Feb, 8, 19[),; Page 4 of 4 pages