HomeMy WebLinkAbout96-00212
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J5-QO-3
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
o 4a, Futuro Inlorost Co~romlso
(lor dalos 01 doalh aner 12-12-82)
o 8, Docodont Dlod Tostale 0 7, Decodenl Malnlalnod a Uvlng Trusl
(Attach copy of Will) (Anach copy of Trusl)
AUiiCClRFll!8PClNDENCaAND CONFlDElITlALTAlC INFORMAlIDH8HOLUl BE DIRI!CI'ED,TO:11'I""+'"", ':""": "~I,,:
NAME COMPLETE MAIUNG ADDRESS
FOREST N MYERS 10000 MJLLY PlrolER HIGlWAY
TELEPHONE NUMBER SHIPPENSBURG, PA 17257
717 532-9046
1, Roal Eatato (Schodulo A)
2. Slocka and Bonds (Schedule B)
3, Clollllly Hold Slock/Partnershlp Inlorost (Sch, C)
4, MOl1gag.. and Nol.. RocoIvablo (Schedule D)
5, Cash, Bank Deposl1s & Mlscollenoous Personal
Proporl'f (Schodule E)
8. Jointly OWned proporl'f (Schedule F)
7. Transfers (Schedulo G) (Schedule L)
8, Total Gro.. Asso19 (total Unosl-7)
9. Funeral Expen..., Admlnls1rallve Costs,
Miscellaneous Expenses (Schodule H)
10, Dab19, Mol1goge Uebllltlos, lions (Schedule I)
11, Total Doductlons (Iolal Un.. 9 & 10)
12, Net Value 01 Eslale (Uno 8 minus Unel1)
13. Charttablo end Govornmental Bequests (Schodule J)
20, II Une 19 Is greater Ihan Unel8. enter Ihe dittorence on Uno 20, This Is tho OVERPAYMENT,
~lthiiiilllilNlIYOU'''~n9.'''''''dOfYo'''' ......1)laYIllMlt;'"' , .." " '1,,,,
21, II Uno 181s greater lhan Unel9, enler tho ditterenco on Une 21. This Is the TAX DUE.
A. Enter thelntorost on the balance due on Uno 21A,
B, Enter tho tOlal of Uno 21 end 21A on Une 21B, This Is tho BALANCE DUE.
Make Check P I. to: R star 01 WIlla, A nl
iiHililil1i iliiliUiliiiii!liI:iIHliHi!I!!il!iilliiI\l1l!IiiiM1iiil:..ilSE'SURE!TQ'iANSWER'AI.L!alESTIOHSON PAGE:tAfGTQ'AECHECKMA"nt::.j!:ii:'-,ii!ll!!Wiiliii!i1ii:I!lhIWHilIWIl iW H! IIi il i'll
n iK' PGn 0 per ury, are al ave ox ne t s return. U Ing accompa ng 8C e U 89 an statements. an to tea r:nv no
and boUoI, h Is truo, corruct and co~lote. I declare that all real ..Iale has bOOn repol1ed at true mllket value, Declaretlon 01 preparor olhor than tho personal
rosontallvels basod on alllntormatlon 01 which r aror has a knowlod 0,
Sla OF PERSON SIBLE FOR FILING RETURN ADDRESS DATE
-< See Schedule attached -S-'-~
hIY"'IOO IXt ('al"l
COMMONWEALTH OF PENNSYLVANIA
DIPARTMWT OF REVENUE
DEPT. 210.01
HARAUIDURQ. PA 17"'-0101
DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
IA'I'SBI\Ini IIDlEL M
SOCIAL SECURIlY NUMBER
175-40-1403
(I I
FIRST AND MID LE INITIAlI
u
1, Original Return
CHECK
APPRO-
PRIATl!
BLOCKS
lR 4, Umllod Eslale
. ,
CORRES-
PONDENT
,
RECAPIT -
ULATlON
l
14, Nel Value Sub
15. Spou.aITran.f.r'lfor dal.. 01 death aU.r 1-30-0"). S..
In.Wetlon. lor Appllcabl. P.rctntlg. on P.O' 2.(lnclud.
vatu.. from Schldull Kor 5eh.dull M.)
18, Amounlof Uno 141axeblo et 8% ralo
(Include vaJuostrom Schedule K or Schedule M.)
17, Amount 01 Une14 taxable ot 15% rele
(Include values from Schedule K or Schedule M,)
TAX Ill, Princlpal tax due (Add tax from Un.. 15, 18 and 17,)
COMPlITA- 19. Crodits Spousal pov.rty Cr.dlt Prior Payments
1I0N .
FOR DATU OF DeA~'FTI!R 12131111
CHECK HE I! IP A 8 8AL
POVI!RTY ~REDIT 18 LAIMI!D
FIll! NUMBI!R
Oll
COUNTY CODE YEAR
DECEDENT'S COMPLETE ADDRESS
201 FAST BURD srnEI?l'
1996
-2.J:L
NUMBER
DATE OF BIRTH
AMOUNT RECEIVED (SEE INSTRUCTIONS)
3, RomaIndor Roturn
(for d.t.. of d"th prior to 12-13-12)
o 5. Federal Eslalo Tax Return Required
..Q.. Il. Total Number 01 Salo Deposit Box..
iiiii;!i!i:::lii'Ii::;~ii i<ii!':HIi:iiiii!h:l!iijl
- ,
,
(1)
(2)
(3)
(4)
(5)
None
None
None
None
None
(8)
(7)
11,037.75
None
(8)
11,037.75
(9)
250.00
(10)
205.02
(11)
(12)
(13)
455.02
10,582.73
None
14
10,582.73
(15)
x.
.
(16)
10,582.72 x .08 .
634.96
(17)
O.OOx ,15 .
0.00
(18)
634.96
Discount
I nlorost
.
(19)
(20)
0.00
(21)
(21A)
(21 B)
634.96
0.00
634.96
AOIJRESS
10000 MJLLY PI'IOlER HIGlWAY
SHIPPENSBURG, PA 17257
DATE
'3-j- 9E:.
AN REPRESENTATIVE
Copynght Form. Bottwart On,y, 1"14 N.lco,lnc. ND..PAOOI
, "'#:.-' _ ;~./i:~/;:;;~iti'5:i..:t~<" ~._,o
.. -..."...-~ - -.-.' .-
PA REV-1eoCl EX (7-04) PllQ8 2
Act 1148 01 111M provide. lor Ihe reduction 01 the \IX rile. Impo.ed on Ihe nel velue 01 Ir.n,'er. 10 or lor Ihe u.e 01
the Ipou.e. The rlln e. preecrlbed by Ihe .lIIule will be:
. 3% (.03) will be .ppllcable lor e.llle. 01 deced.nl. dying on or eller 7/1/94 .nd belore 1/1/ll8
. 2% (.02) will be .ppllcable lor e.lllo. 01 deced.nt. dying on or allar 1/1/ll8 and belore 1/1/97
. 1% (.01) will be applicable lor elllle. 01 decedent. dying on or 811ar 1/1/97 8nd balore 1/1198
. Spouul trenelere occurring on or 811er 1/1198 will be exempt from Inherll8nce \8ll.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (oJ) IN THE APPROPRIATE BLOCKS.
YES NO
1. DId decedent make a transfer and:
L I8lIIn Ihe use or Income 01 \he property transferred.. ............................................................... x
b. I8lIInlherlghltodealgnatewhoehallUS8lheproper1ytransf8ITedorl1slncome"......................................... x
c. I8lIIn e revenlonary Interesl; or.............. ... .,. ... .., ........ .... ............ ...... ..................... .,. X
d. I'lIC8IV8lheprorriselorUfeol either peymentll, benelltllorc&re?...................................................... X
2. If death occurred on or before December 12, 1982. did decedent within two years preceding death transfer property without receMng
adeqUate consldera1lon?1f death occurred after December 12. 1982. did decOdent transfer property within one year 01 death without
receiving adeqUaI8conslderatlon?............................................................................... X
3. Old decedent own an 'In!rUat lo( bank BCCOuntal his or her death?. ... ... ............. ... ., ........ ..... ... .......... .. X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
PA1e002 NTF ,",.
Copyright Form' Sotlwu. Only, ,.1& N.lco,lnc. NI.PAOOZ
REV-11lOD EX. (12-88)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
EnlEL M I.ATSBAIJ3H
i FILE NUMBER
-1996-
JoInt tenanl(I):
RELATIONSHIP TO DECEDENT
IJAI.G{ffiR
NAME
A pm:;y A MYERS
ADDRESS
1939 ():)ldsmith Road
SHIFPENSBURG, FA 17257
LEnER DATE DOl.LAII VALUE OF
ITEM FOR MADE DESCRIPTION OF PROPERlY TOTAL VALUE DECO'S DECEDENT'S
NO. JOINT OF ASSET % INT.
TENANT JOINT INTEREST
1 A 03/21/78 730.15 50 365.07
CHECKING ACCOUNT #0097356069,
DNJPHIN DEl'WIT BANK
ACCRUED INIERFSl' 0.79
2 12/08/94 CElUIFlCA'lE OF DEroSIT 10,610.05 50.00 10,610.05
#8100468974, DNJPHIN DEroSIT
BANK
A ACCRUED INIERFSl' 61.84
TOTAL (Also enter on line 6, ReCaDhulatlonl $ 11.037.75
Jolntly-owned properlY:
(II more space Is needed, Insert additional shoetll 01 same slze.)
PA15Ot1 NTF 12I1A
CoPyrl1l1l1 Forml Sottwar.Only, 11114 NIlco,lnc. NII4PAQII1
.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISmATlVE COSTS AND
MISCELLANEOUS EXPENSES
Pl.... PrInt or Typo
FlU! NUMI!II
-1996-
"lV-nUll' ('-II,
COMMONWIALTH 0' PINNSYLVANIA
lNHIRITANCI TAl( RUUAN
"IBIOINT OICIDIN'
mATI! 01'
EnlEL M IAn;BAI.GI
ITI!M
NO.
A. FUTIInlI!lqlenHl:
DeSCllIPTlON
AMOUNT
Na1e
B. Admlnlatra1lv. Coa":
0.00
1,
Personal Repmentltlve Cormissfons
SocIal Securlty Number of P8I1lOnal RepresentstIve:
Ye17 CormUslons paid
250.00
2. AItomey Foes
0.00
3, FerriIy exemption
ClsJmant
Relationship
Add7eoa 01 Claimant et decOdenrs death
SIr88IAdd7eoa
CIty
Stste
ZIp Code
0.00
4, Proba18 Foes
c. ,......_ EJponoea:
Nooe
TOTAL Also enter on line 9, Rec
(II more opoce II neocIod. In..rt .ddltlonal ah_ of oem. "",,)
$
250.00
PA16111 NTF 1211
CoPyrlllht Form. Softwar. Ontv, 1'" Nllco,I"C. N14PA1 1 1
D
Dauphin Deposit Bank
and Trust Company
MAIN OFFICE: 213 MARKET STREET, HARRlSOURG, PENNSYLVANIA \1\0\
717 2SS.212'
Decedent Confirmation
Name:
Ethel M. Lotsbaugh
Social Security No.: 175-40-1403
Date of Death (000): 11/21/95
Account No.
8100468974
0097356069
------------------------ ------------------------ ------------------------
Type
Date Opened
or Issued
Certificate of Deposit
Checking
------------------------ ------------------------ ------------------------
------------------------ ------------------------ ------------------------
12/08/94
03/21/78
Date Closed
or Matured
03/08/96 (Maturity)
------------------------ ------------------------ ------------------------
Date of Death
Balance $10.610.05
$730.15
. .:....:~:_l\fr~r}
________~_:J.___
------------------------
------------------------
PlUS
DEO 111995
Date of Death
Accrued Int. $123.69
$.79
,. ....~":
i ,...
:1' : . ,'::.j": ..~
------------------------ ------------------------ ------------------------
Joint owners
(if any) Peggy A. Myers
------------------------ ------------------------ ------------~-----------
PeHgy A. Myers
Date of Joint
ownershi p 12/08/94
03/21/78
------------------------ ------------------------ ------------------------
------------- ------------------------ ------------------------ ------------------------
Special comments: N/A
Additional information available at $20.00 per hour. On. hour .inimum.
Date Prepared: December 8, 1995 Prepared by: Carolyn A. 8erkebile
CUstomer Management Information Dept. (eMI)
Telephone No. (717) 255-2054
Page 1 of 1
Fono 00-020-218 (REV 7/93)
/
I'" j'.' '"
/..) .. '. (. "")
REV-1547 EX AFP 112-95*
COHHOfMALlH or PfMdYLVAHII
D(PARTM(HT Dr' R(ynu:
IURfAU Of INDIVIDUAL I"M[I
DEPf.IID1Dl
HARRISIURQ, PI 1'.,1-0601
ACN 101
NOTICE OF INNE~ITANCE TAX
APP~AISENENT, ALLOWANCE O~ DISALLOWANCE
OF DEDUCTIONS AHO ASSESSNENT OF TAX
DATI 06-05-96
FILE NO.
DATE OF DEATH 11-21-95 COUNTY CUMBERLAND
HOTE. TO IHSU~E P~OPE~ C~EDIT TO YOU~ ACCOUNT. SUBNIT TNE UPPE~ PO~TION OF THIS FO~N WI TN YOU~ TAX
PAYNENT TO THE ~EGISTE~ OF WILLS, NAKE CNECK PAYABLE TO "~EGISTE~ OF WILLS, AGENT"
REMIT PAYMENT TO:
FOREST N MYERS
10DOO MDLLY PITCHER HWY
SHIPPENSBURG PA 17257
REGISTER DF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17DI3
~ A.ount ~o.lttod
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEV:isf,j-EX"AFp."iiz:9SrNiificE."ciF""fNHEiiifANCE"TAiC-ApjiiiA"isEHENT";",U.i."ciiiANCnrFimmo.mm_..
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF LATSBAUGH ETHEL M FILE NO. 21 96-0212 ACN ID1 DATE 06-05-96
If an assassmant was issuad praviously, linas 14, IS and/or 16, 17 and 18 will
reflact.figuras that includa tha total of ALL raturns assassad to data.
ASSESSMENT OF TAX:
IS. Aoount of Linn 14 ot Spoulol roto 1151
16. Aoount of Linn 14 to.oblo ot Linool/Clol1 A roto 1161
17. Aoaunt of Lino 14 to.oblo ot Collotorol/Clol1 B roto 1171
la. Principol To. Duo
TAX CREDITS:
PAYNENT
DATE
03-D8"96
TAX RETURN WAS. 1 X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Rool Eltoto ISchodulo Al III
2. Stockl and BondI ISchodulo al 121
S. Clololy Hold stock/Portnnrlhip Intorolt ISchodulo CI ISI
4. Kortgag../Not.. Receivable (Schedul. D) (4)
5. Cash/Bank Dapoltt.'Hllc, Parlon.l Property (Schedule EJ IS)
6. Jointly Owned Proporty ISchodulo FI 161
7. Tronlforl ISchodulo CI 17J
a. Total AI.at.
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. funeral Expen.../A~. Coatl/Hi.c. Expan... (Schadule HJ (9)
Ie. Oobtl/Hortoogo Liobilitiol/Lionl ISchodulo II Ilel
11. Totol DoducUonl
12. Hat Value of Tax R.turn
13. Charitable/Covern..ntal a.qUa.t. ISchadul. J)
14. Not Voluo of Eltoto Subjoct to To.
NOTE:
RECEIPT
HUHBER
AA112594
DISCOUNT l+ I
INTEREST (-)
.00
I CHANGED
.00
,00
,00
.00
.00
11,037,75
,00
(al
11.037.75
250.00
205,02
(Ill
1121
I1S1
1141
4~~ n?
10.582.73
.OD
10.582.73
.00
10,582,72
.00
X ,00.
X,06.
X .15.
116J
.OD
634.96
.DO
634.96
ANOUNT PAID
634,96
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
634.96
.00
.DO
.OD
I
I
I
I -
IF TOTAL DUE IS LESS THAN .1. NO PAYNENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF TN IS FORM FOR INSTRUCTIONS. I
ex) t'o:(
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a: a: ~8
Il!IPVATIlIM'
E.I.I.' of ...odonl. awl.. on .. ..f..' Doc..... IZ. I"Z .- If on. fulu" Inl....t In thO ..1.1. I. I.on.f...od
In .......Ion .. onl.,...1 10 CI." S 1.011.1...11 ....fl.t..I.. .f lho ...odont .fl.. thO ..pt..llon of on. ..1.1. for
11f. .. for ...n. thO .-.Ith ho.... .""n..l' ........ lho .1""1 10 _..10. and ...... I.on"" 1_.11-' 1....
.t the l~ful el." . (cOllet,r'l) r.t. on ~y .uch future In\.r..t.
pURI'OSt t1f
MOTtal
To fulfIll thO ...,1._1. of sootlon ZloO .f thO 1_.llone. and E.I.I. 1.. ADI. ADI ZZ of 1"1. 7Z P.S,
Seotlon 21"0.
PAYMEMT .
eol... thO ... ...llon of thh Motlco and .-It .Ith .ou. p.,...1 to lho AOII.I" of will. prlnlod on thO ....... .1110.
__.... cheCk or .,.v arcMf pIy.,11 tOI REGISTER OF MILLS, AGEHT
All p.,...I. .00.1... ....11 flnl .. _lIod 10 on. tnl....1 ...Ich ... .. dua .lln on. ._Indo' _lIod to thO 10>l.
A ..fund of . to>l ..odlt. ...Ich ... nol ..-.Iod on lho TO>l A.turn. ... .. ..-.Iod b. ._Iotl.. on ....II..tlon
f.. A.fund of pann..lvonl. 1_.llone. and E.I.I. 1... 1~-lstSI. ...It..llon. ... ...11..1. .t thO Offl..
of tho AOII.I.. of Will.. ... of tho ZS A.vonuo 01.1.1.1 Off I..', .. b. ..111.. tho ....1.1 ZO-hoU.
on....I.. ....100 ....... for fo." .....1... In pann..lvonl. l_aOO-56Z'ZO.D, oul.ldo ......Iuonl. and
.tthln 1...1 Nt..lobu" .... 17171 7a7-ao", 100' 17171 77Z-ZZ5Z lHo..I.. 1...I.od onl.l.
REfUNOICRlI
OlJ[cTIONS'
any p.." In Inl....1 nol ..tI.flod .tth tho _..I._I. .1I"one. .. .1..11""" of do_tlon.. o. ......-t
of 10>l line Iud I.. .1.....,1 o. Inl....tI .. ...... on Inl. Motl.. ~.I oblool .Ithln ...IV UOl .... of ncolpl of
this MoUe. byl
__..Itlon p.ol..t 10 lho PA .........t .f A.vonuo. 100'. of .....1.. ...1. Zal0Zl. Nt..lobu", PA 17Iza-IOZ1. OR
__.Iootlon I. _. thO ..tt.. dol...I.... .1 ....It of tho oe....,1 of lho .......1 ....._t.tI... OR
__.....1 to tM or"""" court.
AllIIN
ISTAAl1l1E
CORRECTIONS'
'oe...1 ...on .I......od on thl. ......-1 .....1. .. odd....od In .rltln. I.. PA .....1_1 of A.......
Bur'" of Individual T..... ATTN. p..1 A.....-I A.vl.. Unit. ...1. Z.OIDl. H...lobu", PA 171Za-01Dl
..... 17171 7S7-I.D.. ... POlO S .f lho ....I.t .In.truellon. f.. 1_.llone. 1.' A.lu.n for . A..ldonl
DtC~\. (REV-ISOI) for 8n ..pl.n8tlon of ~lnl.tr.tlv.1Y corr~t.bl. .rrora.
DISCOUNT'
If ... ... duo I. p.l. .llhln th... UI cot"''' _th. .ft.. tho ...odont', doOth. . flv' ..reonl 1511 .I.....,t of
the tax paid 1_ allowed.
PEKALTYI
Tho 1.% ... ....... __p..tlelP.tlon ....1.. 10 ._Iod on tho lolal .f tho 10>l ... Inl....t ......od. and not
..Id ..fo.' J...... IS. 1"'. tho flnt ... .ft.. tho ... of tho t.. ....... p.rI", 11l1. __p..tI.lp.tlon
....1.. 10 _1...1. tn tho _ ...... and In tho tho ._ tI.. ..rl.. .. .ou _t. .....1 lho I.' ... tnl....t
that has bHn ......ed II lncUclted on thlt noUc..
INfER[STI
Inl....t I. cno.... boIl...l.. .Ith flnl do. of doll"'-" .. nino 191 _th. ... ana III do. f." thO dol. of
do.th. to thO do" of p.,...I. T.... ...Ich ..._ doll_t ..fo" J...... 1. Inz -. Inl....t .1 lho nl. of
... IIlI ....ont ... ...... coleulotod .1 . d.lI. ..I. .f .000160. All to>l" ...Ich ...- doll_Ion and .ft..
JonuO.. 1, l,aZ .111 .... Inl....t .t . ..1. ...I.n .111 v." f... ..1..... y... 10 ..1..... y... .Ith thOt ..t.
.......od by tho PA .........t .f A.vonuo. Tho ...11....1. Inl....t ..1.' f.. 1"Z th..... I'" ....
y... Intenat Rate Dallv tnt.rest Factor !!!! tnt.r.st Ret. Dal1v tnter.st Factor
-
.,az ZO% .OOD541 19.7 ,.. .GOOZ'"
.,OS III .DOOOI 19.1-1991 11% .0aUGl
.,.. 11% . OQUal I"Z n .aoOZ"7
Ins IS% .0ODSS6 1,,'-1'" 7Z .000192
.,.. 10% .00OZl" 1,,'-1'" n .0002"7
..-tnterest 1. calculeted e. foU....t
1
!
"
IICTEREIIT . ..LAlCeE OF TAX UIlPAID X IMBER OF DAYS DELIHQUEIIT X DAILY IICTEREIIT FACTOR
--AnY Mott.. t..... .fl.. lno I.. ....... doll.....t .111 ..floel on Inl....t ..Ieul.tlon 10 flfloon 11.' ....
"yond tho dol. .f tho ....._1. 11 p.,...1 10 _ .ftor tho Inl....1 ._I.tlon dol. ...... on thO
Hotlce, additional lnt.r.at .uat be c.lculeted.
.'_~--'_"""'>',----....--'"'_-.--r .-,.,~ "