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FOR OATIS OF DIATH AnlR 12/31/91 CHICK HIRI
IF A SPOUSAL
POVIRTY CRIDIT IS CLAIMID 0
'I-i. NUM'I.---~~----_._--- -------.-.--..
INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
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COMMONWfAllH Of PfU"~n'o,NIA
O(PA"IM(N' Of II(VfNU(
O(Pf "0601
HAIIII$lUIfG, 'A 1117',0601
Dl((OlNI.~ NAMf IlA~I. flUl, AND MIOOtl INIIIAll
Gardner Thomas H.
~OCIA\ ~I'UI.IT NUMUI 01011 01 OlAIH
165-18-4542 7/2/96
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1. Real Eslale (Schedule A)
2, Stock. ond Bond. (Sch,d,', B)
3. Closely H.ld SIocUPar1n.rship Inlerllt (Schedule C)
A. Mor1gages and NOI" Receiyobl. (Schedul. D)
5. Ca,h, Bank Depalits & Milcellaneoul Penonel Property
ISched,le E)
6. Jointly Owned Proper1y (Schedule FI
7, T,ons/". (Sch,d,I, GIISch,d,', l)
8. Total Gran Auell (totollin.. 1.7)
9. Fun.ral Expenses, Administrative Costs, Miscellaneous
Expens.. (Schedule HI
10. Oebu, MOr1goge liobililies, liens ISchedule I)
11. Tolal Oeductionl (Iotallin.. 9 & 101
12. Nel Value of Ellolelline 8 minus Line 111
13. Charitable and Governmenlal Bequesls ISchedule JI
14. Ne' Value Subject to Tall lline 12 minus line 13)
15. Spousal Tranlfe,. (for dalll of death after 6.30.941
See Inslructions for Ar,plicoble Percenloge on Reve,.e (15)
Side. (Include values rom Schedule K or Schedule M.)
16. Amount of line 14 ta..oble at 6% role (16)
(Include values from Schedule K or Schedule M.I
17. Amount of line 14 'allobl, a' 15% role (17)
(Include valulI from Schedule K or Schedule M.J
18. Principal'olt due (Add 'ax from lin.. 15, 16 and 17.1
19. Credill Spaulol Pover1y Credit Prior Poymenh
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COUNlY CODE
__" ___u
I C/C/1tJ "'53
YEAR .. , .. NUMBER
CAl( O. IIITH
tll(lOI"I-~(OMmll AOOIUS
11/18/23
238A North Second Street
Wormleysburg, PA
Co_" Cumberland
AMOUN' 1I(I.'t'1O I~U .N!lIIUCllON~1
2706.81
03,
05,
Remainder Relurn
Ifor dot.. of death prior to 12.13.821
Federal EIIOI. Tall Return Required
Gardner, Nancy C. 172-24-8096
[2g 1. Original Relurn 0 2. Supplemental Relurn
o A. limited Eslale 0 40. Future Interllt Compromill
(for dol.. of d,o,h oft" 12.12.82)
~ 6. Decedent Died Tlllote - Not 0 7. D.cedent Maintained 0 living Trult
(Attoch copy of Willi Prcba ted (Attoch copy of Truttl
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO.
NAM( COM'lfl( MAilING ACOtlU
James D. Campbell J~,Esquire 3631 North Front Street
""'HOH'NUMII' Harrisburg, PA 17110
III 0
(21 0
(31 0
(4) 0
(5) 500.00
16 ) 0
17 ) 0
19 ) 8,297.80
(101 1,744.93
2.706.81
Discount Inlerell
+
_ 8. Total Number of Sale Depolit Bo....
181
500.00
(II)
(121
(131
IUI
:' "'r !' 1.>
Insolvent
o
)(.~=
o
x ,06::
)( .15 =
(18)
(191
1201
~
...
20. If line 19 is greoler than lint 18, enler th, difference on line 20. Thil iSlhe OVERPAYMENT.
aD
o
Check hero if you are requesling a refund of your overpayment.
1211
(21AI
(21BI
o
21. If line 18 is glloler than line 19, enler the difference on line 21. This ilthe TAX DUE.
A. Enter Ihe interllt on ,he balance due on line 21 A.
B. Enter 'he 'alai of line 21 and 21 A on line 21 B. This il the BALANCE DUE.
Mah Check Payable 10: R,gltter of Willi, Agent
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH 00( 00(
~~der penalties of perjury, I declare that I hove uamined Ihis rei urn, including accompanying Ichedules and slalemenh, and to the bes' of my kno.....ledg. and beliel,
".1 true, correct and complele. I declare that all IIaleslale hal been reportea 01 true morhl value. Declorolion of preparer olh.r than the pellonol repreltnlolive il
baled on 011 informal ion 01 which prepar.r has any ~nawledge.
!I1(iNA'Ulf or 'lRWN IU'ON!!lllf fO' 'ILlNG InUIN ADDIUS OI,l(
, l\.~" U (',. I ''11'('1/ 238A N. 2nd st. l'iormlcysburq, Pt\ 17043
SIGNA Ult.O' nlrA I OIMU J N 'fPIUlNlAl.'t'1 ADDIU!!
Oil , I I' , 3631 N.
! I
1'1'
0.111(
,
, I,'
('i "
Front St., lIarrisbur:.9J
P^ 17110
11\!-lill"_I'.'"
ESTATE OF
JJ~:~l\
-~Iu.-
COMMONW(AUH 0' P(NN$Y1VANIA
INH(lIfANC( lAll. R( 'UIN
RnlD(N'D(C(D(NI
1 SCHEDULE H
FUNERAL EXPENSES,
ADMINIS,TRATIVE COSTS AND
MISCELLANEOUS EXPENSES
___ ___. _ _____ u
PI.as. P,lnt or Type
JFILE,NUMBER ---- "n_"
AMOUNT
Gardner, Thomas II.
ITEM
NUMBER
A. Fun.ral Expens.s:
1.
B,
1.
2,
3.
4.
C,
1.
2.
3.
4,
5.
6.
7.
8.
DESCRIPTION
Musselman Funeral Home
4,797.60
Administrative CoslI:
Personal Representative Commissions
Social Security Number of Personal Represenlalive:
Year Cammissions paid
Allarney Fees
Family Exemption
Claimant Nancy C. Gardner Relationship
Address of Claimant at decedent's dealh
Spouse
3,500.00
Slreet Address
236A North Second Street
Cily
Wormleysburq
Stote P A Zip Code
17043
Probate Fees
Mlscellan.ous Expens..:
TOTAL (Also enler on line 9, Recapitulation)
(If mo,e space Is ne.ded, Ins.rt additional sheell of same sl...)
58,297.80
.~ . ....
"''''''''1'''1 '*'
COMMONWI.UH Of "Ntl'l\~.NI"
INHllll...U,,,.IUU'"
IUIOINIOICtOltit
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
PI"a," Print ar Typl
______~__,_J~~LE NUMBER "
ESTATE OF
Gardner, Thomas II.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
Harrisburg Belco Federal Credit Union
Loan
614.16
2.
II
II
II
II
II
- VISA
1,130.75
TOTAL (Also enter on line 10, Recapitulation)
(II more space is needed. insert addirional sheels 0' some size.)
S 1,744.93
MEV.IM? \,X'IK"'1
'*
scm:nuu: 0
TnANSFEUS TO SU\tVIVING SI'OUSE
n-...1toIWf.N nlofn')*4",Ir.uo\A
..u.n"""".....rn.H
.....en(ll'l1n)ol1
..U,Numbtr
UTATY. Of
Gardner, Thomas II.
PART A: F.nIer \hi dcs<.T1l"ion and ..Iue of.1I inlrrnU,l>oIh "..bl. and lIOO,tmbl., "Iardl... oflo<."'" (net of deducti...)
....hi~h rasa to lht d<<edm", .uM\"ln~ IJ'I'.lUK hy ""III. inttstlC)', allOl1 of law, or olhnwiw.
Oeseri lion of items i\mOUnl
I
2,706.81
Harrisburg Belco Federal credit Union
Acct H 162190
Par1 A Total: Entttthe amount sho\\n on the rtC"ritubtion Wet in the l><<tdrnl InfonnlUon Stctlon.
Election To Subject Propert)' To Tal Under See lion 21IJ(A) As ^ Talable Transfer By This DecedenL
1f a UUSt or similar arnngcmmt mecU \he "'1uircmmts orSn1ion 211 )It\). and:
L lbc trust or similar amngnntnl is Ii~td on SchNule O. and
b. The ,,'.Iue orthc \rUst Of similar amngc:mml is mtCTed in "hole or in pm as an uset on Schedule 0,
then \hi """fer"', pmonal 1'1"....."lh'. nul' .pecifically identify"" tJUJI (.11 or . f"ction.1 porIion or pcr''"''&') to be included in "" c1",ion to ...,'.
ouch tJUJI 01 .imilar property .uted" .1",.b1. .....rcr in this ""Ie, If I...lhan "" ,"tire ..Iu. of "" \nIst 01 .imilar property is included".
....bl. uwrcr on Schedul. 0, "" pmonal r'1"....."li'~ WlI be coNidcred to ...,'. nude "" .I"'ion 0011' ,,10' fraction of "" tJUJI 01 .imilar unnlcm<nt.
The numcntOlofthi. frulion is equ.llo "" amour< of"" tJUJI 01 .imilar unn&cm<nl included'" "",bl. W<I on 5<hcdul. 0, The cImomio>tOl is equ.1
to the total nlue ohhc \lUst or similar amngc:mml
ELECTION: Do '0. aim undtr SKtlon 2113(,\)10 ,.... u. "..bl, 'raNr..1n thb ..".. all 0" porllon ora lnul 0' .1m11a, .rranlamant
(rUiN ror tht IOI~ IIH ofthls drud,nll, IUl"'h-lnllPOUJf durinl tht lun'hlnC1pouw" rnUn UrrUmr'!
YES D NO 0 Sip_tUft Oalf
No": Ifth. almloo .ppll...o mo..'h.n on. lnul o..lmll.. ..ranl.m.n~ 'h.o' ..p.rata fonn mwl be .I&o.d .nd Nod.
Part B: EntC"t the description and valur or.ll interestS. both tnable and non-uublc, rrgudlCSS oflocation. (nc1 of dtduclions)
\lohkh pUS to \he decedent', lu,,-j\"ing If'OUs.c for "hi,h I St\.1ion 2113 (A) election i. b.:ing nude.
Oeseri lion of ilems Amount
I
ParlOT",,1
Decedent Estale Information Form
1. Name(s) In lllhlch the ac~ount,l lias held: IJ~1 W:'l.
~'l q ~ \ {\ (,1)1(1.') (')(t ((~ nFf
2, Account Number: ~) 0
3. Balance as of date of death: 11 :1) Clio
c (
, "
:)(1 ((,JW,\ )
\.1 ():\'\ \'
Regular Savings: $
Christmas Savings: $
Honey Hanagement Savings: $
Checking Savings: $
I Accrued
B~lan~c I Dividends
')10 ,(1 ) $ - 0 -
~'\"",lr 'CI$ - 0 '
$ -
,^;j,\~,')'" 1$ I.l!c.
I Accrued I Certificate
I Dividends I Number
1$
1$ I
1$ I
GIJ~I 8l'
w/A
r ,
/VIA
,
Balance
Certificates: $
$
$
4. Date the account lias initiated:
5. Name(s) in IIhich Safe Deposit Box lias held:
6. Date the box lias initially rented:
7. Branch address at IIhich the box is located: }II f1
8. Loan Information
a. Unsecured loans: L (g
VI s,o..
Accrued
Interest
~
Per Diem
Interest
,lq
,30
$ ~ 14, \ &
$ II >'O,1S
$
b. Secured Consumer loans: $
$
$
c. Hor tgage loans: $
$
$
9. Hiscellaneous:
ATG - 176 REV 11/92 PAGE 2
IJ~/.J.1-3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
"
'--
1*
BUREAU OF INDIVIDUAL TAXES
IHtt[AIUHC[ lAlC DIVISIOH
DlPf. 180601
ItARR1SIUNC. PA III:lI-ObOI
NOTICE Of INIIERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
."-1'" II." III....
T1lOMAS
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiEV:i54"i"EiC"AFP-fliF96T"Nii'ficE"-oF-YN"HEiiiiAifcE-Ylix-"A-piiR"A-isEifENT-,--AiTciwAN-cnifi-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESi"ATE OF GARDNER THOMAS FILE NO. 21 96-0653 ACN 101 DATE 11-19-96
TAX CREDITS:
PAYHENT
DATE
.00 X ,00=
,00 X .06=
.00 X ,15=
llBI
JAMES D CAMPBELL
3631 N FRONT ST
HBG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
11-19-96
GARDNER
07-02-96
21 96-0653
CUMBERLAND
101
NOTE: To insure proper
credit to your account,
sub.it the upper portion
of this forn with your
t.x pay...nt.
500,00
TD.04;> n
9,542.73-
.00
9,542.73-
If an assessment was issued previously, lines 14, 15 and/or 16, 17 and 18 will
reflect figures that include the total of abh returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 .t Spousal rat. lIS)
16. Allount of line 14 taxable .t lin.al/Cla.s A rat. (16)
17. Allount of Lin. 14 taxable at Collateral/CI... Brat. (17)
18. Principal Tax Du.
JR ESQ
PA 17110
Anount Renltt.d
TAX RETURN WAS: I X) ACCEPTED AS FILED
) CNANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Roo! E.toto ISchodulo Al III
2. Stocks and Bonds (Schedule 8) (2)
3. Closely Held Stock/P.rtnership Inter.st (Schedul. C) (3)
4. Hortg.g../Hot.. R.c.ivable (Schadul. D) (4)
5. Cash/Bank D.po.it./Hisc. P.rsonal Property ISchedule E) IS)
6. .Jointly Dwnod Prop.rty ISchodulo Fl 161
7. Tran.f.r. ISch.dul. G) (7)
8. Tot.l As.ets
,00
.00
.00
.00
500.00
.00
,00
IBl
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.ral Expensa./Ad.. Costs/Hlsc. Expens.. (Schedule H) (9)
10. Dobt./Hortgogo Llobl11tlo./Llon. (Schodul. II 1101
il. Tot.l Daductions
12. Net Value of rax Return
13. Charitable/Govern..ntal Bequa.t. ISchedul. ~)
14. Hat Valu. of Eat.te Subject to rax
8,297.80
1,744.93
111l
(12)
1131
1141
NOTE:
RECEIPT
NUHBER
DISCOUNT (+ I
INTEREST 1-)
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
· IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.00
.00
.00
.00
,00
.00
.00
.00
I IF TOTAL DUE IS LESS THAN '1. NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE DF THIS FORH FOR INSTRUCTIONS.)
'.1\'
RESERYATIONI E.tat.. of d.c.d.nt. dying on or b.for. O.c..b.r 12, 191Z -- If any future Int.r..t In the ..tal. I. Iran.f.rr.d
In Po.....lon or .njoy..nl to Cia.. I (coll.t.rall b.n.flclarl.. of Ih. d.c.d.nt aft.r the ..plratlon of any ..t.t. for
llf. or for y..r., the Co..anwlalth h.r.by Ixpr...ly r...rv.. the right to .ppral.. and ...... tran.f.r Inh.rltanc. rax..
.t thl lawful Cl... B (collat.ral) r.ta on any .uch future Int.r..t.
PURPOSE OF
NOTICE r
To fulfill the r.qulr...nt. of S.ctlon 21~D of the Inherltanc. and E.tate rax Act, Act 2Z of 1991. 12 P.S.
S.cUon 2140.
PAVtcENTI
D.tach the top portion of thl. Hotlc. and .ub.lt with your pay..nt to the Regl.t.r of will. prlnt.d on the r.v.r.. .Id..
--Hak. chIck or .on.y order p.yabl. tal REGISTER OF MILLS, AGENT
All p,y'lnt. r.c.lv.d .h.lI flr.t b. appll.d to any Int.r..t which .ay be due with any re..ind.r appll.d to the taM.
REF1JHD C CA ) r
A r.fund 0' a t.x credit, which wa. not r.qua.t.d on the T.x R.turn, .ay b. r.qul.t.d by coapletlng an -Application
'or Rlfund 0' Penn.ylvanla Inh.rltance and E.t.t. Tax- (REY-ISIS). Application. .r. av.llabl. .t the Offlc.
0' the Rlgl.t.r 0' will., any of the Z1 AevlnUa Ol.trlct Of'lc.., or by c.lllng the .p.claI 24-hour
an.werlng I.rvlca nu.bar. 'or for.. ordlrlngr In P.nn,ylvanla 1-100-36Z-205D, outlld. Pennlylvanl. end
..lthln local Harrisburg ar.. C1ln 111-8094, TOOl (1171 71Z-2252 fIle.rlng lapalr.d Onlyl.
OBJECTIONSr Any party In Int.r..t not ..tl,'led ..Ith the .ppr.l.e..nt, .Ilo..anc. or dl.allowanc. 0' d.ductlon., or .......ant
of taM (InclUding dl.count or Int.r..t) .. ~wn on this Hotlc. .u.t obJlct ..I thin slMty (601 d.y. of r.calpt of
this HoUc. by,
AOKIN
ISTRATIVE
CORRECTIONS'
--wrltt.n prot..t to the PA O.p.rt.ant 0' R.v.nu., Board 0' App.al., Dapt. 211021, Harrl.burg, PA
-..lactlon to have thl ..tt.r det.r.lned at audit 0' the .ccount of tha p.r.onel r.pr...nt.tlv.,
--app.al to the Orphanl' Court.
11121-1021,
OR
OR
Factual error. dlscover.d on thl. ........nt .hould b. .ddr....d In ..rltlng tal PA Dapart-.nt 0' R.v.nue,
Bur.au of Individual T...., ATTN, Po.t A.......nt R.vl... unit, D.pt. 210601, Harrl.burg, PA 11121-0601
Phone (111) 111-6505. 5.. pag. S of the bookl.t -In.tructlon. for Inh.rltanc. Tax A.turn for a R..ldant
Decadent- (REV-IS0I' for an .xplanatlon 0' ad.lnlstratlv.ly corr.ctabl. .rror..
DISCQUHTI
I' any taM due I. paid ..Ithln thr.. fSI cal.ndar ~nth. a't.r thl d.c.dant'. d.ath, . flv. p.rcant 15~) discount of
the tax paid I. allowed.
PENAL TY I
ThI 15% t.x sanl.ty non-p.rtlclpltlon penalty I. coaputed on the total of the tax and Intlr..t a......d, and not
paid b.for. January 11, 1996, the flr.t day aftlr the .nd of the ta. a~..ty p'rlod. Thl. non-participation
pen.lty I. app..labl. In the .... .ennar and In the the .... tl.. p.rlod .. you "ould app..1 the taM and Int.r..t
th.t h.. b..n a.....ad .s Indlc.t'd on thl. notlc..
INTEREST I
Int.re.t I. ch.rged b.glnnlng ..Ith flr.t day of delinquency, or nln. (9) .onth. end on. 11) day fro. the data of
d..th, to the data 0' payeent. T.... which b.c... d.llnquent b.for. Janu.ry 1. 1912 b.ar Int.r..t .t the rat. of
.Ix (6XI p.rc.nt par annul calculatad at a dally r.t. of .000164. All ta... which blea.. d.llnquent on and aft'r
January 1, 19'2 will b..r Int.r..t .t . rat. which will vary fro. cal.ndar v.ar to c.landar y..r with that rat.
announcad by the PA D.part..nt of R.vlnu.. Th. apPllcabl. Inter..t rat.. for 191Z through 1996 ar.1
'!!!! Jntar..t Rat. Dally Intar..t Factor :!!!! Jntar.st Rat. Dally Inhr." Factor
1982 20X .OD05~8 1911 .~ .000Z41
1983 16X .OOO"'SI 19'1-1991 IlX .00OSOI
1984 lIX .00OSDl 1992 .~ .oaoZ~l
1915 In .000356 1993-199ft ,~ .000192
1916 lOX .000214 1995-1996 .~ .OOOZ"'7
.-Intar..t I. calcul.t.d a. followlI
INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Hotlc. I"u.d .ft.r the t.. b.eo.e. delinquent ..III r.flact an Int.r..t c.lculatlon to flft.an (151 day.
beyond Ih. data of Ihe ........nt. If paY'.nt I. ..d. .fl.r the Int.r..t co.putatlon data .hown on the
Hottc., additional Inter..t ...,.t be calcul.t.d.