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fOR OATIS Of DlATH Anu 12/31191 CHlCK HUl
If A SPOUSAL
POVl.~!! CUDIT IS _CLAIMlD J.l
flU NUMBlR
~{
COUNTY CODE ,.
~~
COMMONWEAltH Of PENNSYlVANIA
DlPARIMfNIOf REV[NUE
OfP' 1S0bOl
HARRISIIURG, PA 171280601
I INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
'_ WITH REGISTER OF WILLS)
515
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R[V.UOO (ll:. 11 QA)
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O(C(OWI'~ NAM( (lA!lT, fIR!!1, AND M1UDllINIII"lJ
DE:rn!H, 1:.5 rH~ II:
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,. "'''C'''', """'''0 "0'''' ...., '"'' '''' ...,. ','" "~"". ]")"A~'~U"IY '~"M'"
~ 1. Original Return !] 2. Supplemental Return
o 4. limited eslole [] 40. Future Inleun' Compromise
(lor dale' of death after' 2.12.82)
06. Decedent Died Tellale rJ 7. Decedenl Maintained a living Trusl
(Alloth copy of Willi (Alloch copy 0' T,u'l)
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TOI
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CHlUlUS E; :5H/B05 7lI
TELEPHONE NUM!U
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1. Real Eslote (Schedule A)
2. Stoc~s and Bonds lSchedule 81
3. Closely Held Stoc~/Porlnership Inlerest ISchedule C)
... Mortgages and Noles Receivable (Schedule 01
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule EI
6. Jointly Owned Property ISchedule FI
7. TrDn.fe" (Schedule GI (Schedule LI
8. Total Gross Assets ltotallines 1.7)
9. Funeral Expenses, Adminislrative Costs, Miscellaneous
Ellpenles ISchedule H)
Debts, Mortgage liobililies, lienl (Schedule II
Tolal Deduclions ltolallines 9 & IO)
Iqqlo
YEAR
OIClOltll..(OI.lJ'tlll .OOlU"
AS& ~7~I'Je-c RP.
MECHIMIICSl3W'i'v (/I1~,v1lU>E' Twf?)
CO"", Cum e~~.!:>_.____________
:t~U"~I(I~'D ,I" ''',,""'''0'''1
I] 3.
fJ 5.
Remainder Relurn
/for date I of dealh prior to 12.13.82)
Foderal estale Tall Return Required
10.
11.
12,
13,
%
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..
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Net Value of Ellote (line B minus line 11)
Charilable and Governmental 8eque'" (Schedule J)
1.4. Net Value Subject to Tax (line 12 minus line 13)
15. Spoulol Tronlfen (for dale I of deolh after 6.30.94)
See Inltrudio", 'or Applicable Percentage an Reverse
Side. llnclude voluel from Schedule K or Schedule M,I
16. Amounl of line 14 laxoble at 6% rate
(Include values from Schedule K or Schedule M,)
17. Amounl of line 14 taxoble 01 15% role
llnclude value I from Schedule K or Schedule M,I
18. PrincipaltaA due (Add lax 'rom linel IS, 16 and 17.1
19. Credits Spoulal Poverty Credit Prior Payments
_~C? + ...._J?_ _.._ _. +
_8. Tolal Number 0' Safe Depolit 80xel
COM"! I[ M.ltlt~G ADORU!.
;l. W. I'l1AI^3 ~-r:
1)1 ECI-/Il-^3 I cs'B u.rec.-, PA 17oS~
11 ) _.__ __.___.9 __ _ __. .
(21 _____Cl______'__.___
131 ________0.__._.__
141 _____.Cl._____
(51 ,___.__E~_
(6)________Cl______
17) _~1,...f"() ~/.y.:::.. N6T..E
19) ____ ,'it>.' _"!:__
(101 ___&!_._______
(B)
o
"/0 -
111) _~__-I-, .
(12) ___. 0
(13) _,_ _.,__. 0
(141 0
(151 J1P_~ dJJ..G"'-'..=>fFIf$ut., (;) =
f1't:.n5!ir f1<r ..",'tI-,,,r.I:
(161 (;), ________ . ,06 =
o
~
(171
o
o
. ,15 =
(181
tJ
Discount
o
Inleresl
o
(191
1201
o
o
20.
II line 19 ilgTealer than line 18, enler the difference on line 20.
aD
Th;,;. ,he OVERPAYMENT.
21.
Chock hero If you 0'0 requesllng a r.fund of your,overpayment.
If line 18 il greoler than line 19, enler Ihe difference on line 21. Thil ilthe TAX DUE.
A. Enler Ihe inlerell on Ihe balance due on line 21 A.
8. Enler the tolo1 of line 21 and 21A on line 218. Thil illhfO BALANCE DUE.
Mak. Check Payable to: Reglst.r of Willi, A~.nl
121)
121A)
12181
tJ
i/
0.
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH -<-<
Under penolhes 01 perjury, I declare thai I have ellomlnod thiS rtllurn, Including occompanYlng uhedules and I!olemenh, and 10 the besl of my ~nowlf'dge and belief,
it iI true, correct and comple!e I declare thai 011 teal fulole hOI been reported 01 true mO'~PI ...alue DecleJlollon of prepoter O,hfH Ihan !he pOllanal rep'ell~nloll""f1 II
baled on 01 informOhonfiich preparet hOI ony L.nowlodge
"GO '" "~r'P "'iI\l~G:'U";;---.-'''''''''- ~5'il';!Jill iRd . OAI! - -
- 'Y~__ , MeeJ,...f1;;:C..r,\: rA 1105S' 7-1'-f(,
UIt[O" fJ'.'[1l01HI"/~~&!~p~.ll"l A{11;~'~" d.. w. met."" ~f. D""I
. _ ._.f'. s#'ud~ mec.ha.ll',c-sb,,'U, PA 110 ~S" '1-J'1-%
..
Act #48 of 1994 provides for the reduction of the tax rates Imposed on the net value of transfers to or for
the use of the spouse. The rates 01 prescribed by the statute will be:
. 3% (.03) will be applicable for estates of decedents dying on or alter 7/1/94 and before 1/1/96
. 2% (.02) will be applicable for estates of decedents dying an or alter 1/1/96 and before 1/1/97
. 1% (.01) will be applicable for estates of decedents dying an or alter 111/97 and before 1/1/98
. Spousal transfers occurring an or alter 1/1/98 will be exempt from Inheritance tax.
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK (V') IN THE APPROPRIATE BLOCKS.
.YES J'!.o_
1. Did decedent make a transfer and:
x
a. retain the use ar incame of the property transferred, ......,....'..............'...........,................
b, retain the right to designate who shall use the property transferred or its income, ..,............
'I-
c, retain a reversionary interest; or ......................,.....................,......................................
d, receive the promise for life of either payments, benefits or careV..................................,....
x
2. If death occurred on or before December 12, 1982, did decedent within two years preceding
death transfer property without receiving adequate cansiderationV If death accurred alter
December 12, 1982, did decedent transfer property within one year of death without receiving
adequate consideratianV,..,..,......,..,..",....".....",."..",.,...", ........", ....... .....,..."..,......'....""
'f.
1<.
x
3, Did decedent awn an 'in trust for' bank account at his or her death?.....................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESr
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
.,vl~lll.t ('U!
ESTATE OF
ITEM
NUMBER
.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
COMMQNW(ALHt Of p(tm~Y1VAWA
INIl(RlfAN(( 1A_ !i{luIlN
R(!I10(NIO(((OWI
_'. __ ~Ieale _Print ,or, Ty".
fFiIE NUMBER
u_____.__ _ ____.. _ ,__,L.___ ______ _._~_____
.E.51"fI e(
Dc/TCfl
v.
DESCRIPTION
AMOUNT
1.
A. Funeral Expen....
8, Admlnlltrative COlli:
2.
3,
4.
C.
1.
2,
3.
4.
5,
6.
7,
8.
1.
Personal Representative Commissions
Social Securily Number of Personal Represenlotive:
Year Commissions paid _.
NONE
Allorney Fees (!1It912t.€S E. ~HIIfLPS;ur (ulldehrrn.ncd ",f
{..'/'-"'i)
Family Exemplion
Claimanl -.-Mtf Relationship _.
Address of Claimanl at decedent's dealh
Slreel Address ___nO
AJ/.4
Cily ________.
Slate
Zip Code
Pro bale Fees
Mllcellaneous Expens..:
Jt
/0."0
PILING.
/Nl(tfl2/1/1-Nc.&
7Jf)r t2E'utell/
TOTAL (Also enler on line 9. Recapitulation)
(If mar. space il needed, Insert additionallh,," of lame sl...)
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COlolMOUWEALTH OF PENNSYlVANIA. DEPAnrlolun OF tlEALTII. VITAL RECORDS
CERTIFICATE OF DEATH
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lIershey !-led.
lIershey. Pa,
Clr,
17033
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BUREAU OF INDIVIDUAL TAXES
lNIIERIU,"'C[ tall DIVISION
DEPT. :B06D1
UARAISBURC. Pi 1I11B.0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INIlERITANCE TAX
APPRAISEMENT. ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
CHARLES E SHIELDS III
? W MAIN ST
MECHANICSBURG PA 11055
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
to-28-96
DE ITCH
05-19-96
21 96-0515
CUMBERLAND
101
Allount ReitH ted
l/
-
V
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE. PA 11013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ifili:i5'4TEiC "j:p-ifi:;:96Y-NDYicE--OF-YNHEiiiTANCE-YAx-A'piiiiA'isEHENr;-"LL'owAiicE-oliu---------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF DEITCH ESTHER V FILE NO. 21 96-0515 ACN 101 DATE to-28-96
TAX RETURN WAS' I ) ACCEPTED AS FILED I X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R.d E.toto ISch.dul. A) 11)
2. Stocks and Bonds (Schedule 0) (2)
3. Closely Held Stack/Partn.rship Interest (Schedule CI (3)
4. Hortgag.s/Hat.. Receivable (Schedul. 0) (4)
S. Cash/Bank D.pasits/Hisc. Personal Property (Sch.du1e E) (5)
fl. Jointly Owned Proper-ty (Schedule F) (6)
7. Transfer. (Schedule G) (7)
8. Total Assets
If an assessment was issued previously, lines 14, 15 and/or 1&, 17 and 18 will
reflect figures that include the total of ~ returns assessed to date.
ASSESSMENT OF TAX:
IS, Anount of line 14 at Spousel rat. (15)
16, Anount of line 14 ta~abl. .t lin.al/Clall A rate (16)
17, Anount of line 14 t.~.bla at Collat.ral/Clals Brat. (17)
18. Principal Tax Due
TAX CREDITS:
PAYMENT
DATE
,00
,00
,00
,00
,00
,00
12,222,33
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.ral E~p.nla./Adn. Costs/Hisc. E~penl.s ISchedu1a H) (9)
10. D.bts/Hortgage liabilities/lians ISchadula II (10)
11. Total D.ductions
12. H.t V.lu. of Tax Return
13. Charitable/Gov.rn..antal a.que.ts ISchadula JI
14. H.t Value of Est.t. Subject to Tax
10.00
,00
Ill)
(12)
113)
114)
NOTE:
12.212.33 X .00:
.00 X .06:
,00 X .15:
118)
RECEIPT
HUMBER
DISCOUNT (.)
INTEREST (-)
AMOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
,.,.lh' tll" ",.,.,
ESTIlER
HOTE: To inlur. proper
cr.dit to your account,
lub..it tha uppar portion
of this forn with your
t.x pay.,en\'
(8)
12.222,33
,00
,00
,00
,00
,00
.00
,00
,00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR). YOU MAV BE DUE
A REFUND, SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS,)
In nn
12.212,33
,00
12.212,33
.', ... '-.
,IIVJ.,0111'''1
.
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEAlTH Of PENNSYlVANIA
DEPARTMENT Of REVENUE
BUREAU OF INDIVIDUAL TAXn
DEPT. 2B0601
HARRISBURG, PA 1712B.0601
DECEDENI'S NAME
filE NUMBER
t:SlheT l1elld,
2196-0sn
ACN
101
SCHEDULE
ITEM
NO.
EXPLANA liON OF CHANGES
Thl' trnnsft'r Is It'pnr'.,hl., on ~ch..dlJl.. G "",, t,ll,,'d ,,' zero p"rcenl.
Chnr ]"6 ~!r Il'.hr
TAX EXAMINER, ___ ___ .
PAGE