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1'01 DAlIS 01 DIATH A"II 12131/91 CHICK HIRI
INHERITANCE TAX RETURN ~o'Y::~yU::~DIT IS CLAIMED [I
RESIDENT DECEDENT I ill. NUMBII . ..., .n_'
(TO BE FILED IN DUPLICATE 21-!l7-1I6!J7
WITH REGISTER OF WILLS) lCOUNTY CODE ....... . YEAR
-_.~---~_..- O! cfiii'rjEro~\P1ITfA.{)DREr-~-~-~-'--
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Frey Ilnd Tiley
TfLf.PHCjN~ NUMBER
2f, Orion Hood
Boll in~ Springs, P A 17007
("""'r Cumberland.. .,.... ....
I AM('Jlnll ItfCfly[D (5H IN5fRUCflON5j
I
II J
115
~..,B
Remaindur Relurn
(for doles 01 death prior to 12.13.82)
Federal Eslate To:(Reluro R(tquired
Tolal Number of Safe Deposit 8nll.es
__ 'il'l~
. 243-5838_
_.~--_.__.~._---_._~-_.._-
5 South Hanover Street
Carlisle, PA 17013
12. Net Value of Eslate (line 8 minus linell)
13, ctlorltable and Governmental BequeUS (5chedule J)
14. Net Value Subject to To... (line 12 minus Une 13)
15. Spousollransfers (for dote, 01 dflath after 6-30.94)
See In,tructlons far Applicable Percentage on Revene
Side. (Include value, from Schedule K or Schedule M.l
16. Amount of lh,e 14 taKable at 6% role
(Inclodo values from Schedole K or Schedule M.l
17. Amount of line 14 taxable at 15% rale
(Include value, from Schedule K or Schedule M,l
18, Principal lox due (Add tux Irom Unes 15, 16 and 17,)
19. Credits Spousal Poverly Credit Prior Paymenh
___.._____..._n. ...__ + --.---~--- +-
20, If line 19 is grealer than Une 18, enter the difference on line 20,Thls is the OVERPAYMENT.
11 O..:'I'ZI'lI.i1iITlJIl..J:.U.'....I...I.IIY.'II.I.~._I..lft":'nn..J:.IU_.1.J:0IIU"'Jllllai'
21, If Une 18 Is grealer than Line 19, eoter the difference on line 21. This b Ihe TAX DUE.
A. Enter the inleresl on the balance due on Line 21 A
B. Enter the tOlol 01 Line 21 and 21A on Line 21B, This is Ihe BALANCE DUE,
~a~~. Check Payable t~~_~Aell.t.r of ~1I1" Ale~~_._._. ___....____. ....__~_____
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1. R.ol Es'ol. (Sch.dule A)
2. Stock, and Bonds (Schedule 8)
3. Closely Held Stock/Parlnership Interest (Schedule C)
4. Mortgage, and Noles Receivable {Schedule 01
5, Cosh, Bonk Deposih & Miscellaneous Personal Properly
(Schedule E) .
6. Jointly Owned Property (Schedule Fl
7, Transfers (Sch.dul. 0) ISchedule l}
8. Total Gran Auets (10101 Lines 1.71
9, Funeral EKpenses, Administrative Cosh, Miscellaneous
hpenses (Schedule H)
10, Debll, Mortgage Liabilities, liens (Schedule I)
11. T otol Deductions Ilolal Lines 9 8. 10)
.(OMMONWEAllH Of PENN~VlVANI^
D[PAR1MENI OF REVENUE
DEPl 280601
HARRISBURG, PA 17128.0bOl
DECEOENT'St.l!~ME (lASf, fIRST, AND MIDDLE INl1l~q
EBY, ROY W.
I ';~A;~~c~:~:~~'''---T:~~:O;~~~~~;T;:::~''~~', 1924
__~_ "~""""~':'''''~o..:::''M' """;'~':~.':':" ,,,,;,.,'-_tc,^, "cu,'" N"M" ,
[j 1. Original Return f] 2. Supplemenlal Return
o 4. limited Eslate L 'j 40. Future Inleresl Compromise
liar oales of dealh after 12.12.82)
[] 6. Dscedenl Died Teslole [J 7. Decodent MainloinEld a li"inq Tru~1
(Alloch copy of Will) (Allach copy of Trust) .
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULO-iiEOiiicrEP TO;'~-'------'----'-"
NAME COMmIE MAILING ADDRESS
~
~
~
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,..
( 1 ) ,..__.__-'LJlJl'O&lL-"
( 2 ) _... .."..__________'_".~_'
1 J I - "..--.......-..-----..
( 4 ) ____.....__....,,_'__ .......-..-...
(5) ........_....,.....__ ..,..-"--
(6)_..._____,___
(7) ..____
19) __Jl. 081.....30___
(10)
(8)__.
8,000.00
!!..083,-~Q__
___.___.".~.~QL
(II)
(12)
(13)
(l4)
(83,.301."
(l5} .._._,_..___,__..__x,c~=
----_.__..~.~-.._._-_.._-_.
(l6} .
.._.___._...._____~~__)( .06 ;:;
_._...._---_....._-----~--,_._--
(l7)_......,_,__..,.._....__..__.x .15 =
----_._.~._~._---
(lB}
_._._..~_..-._--~-----_._-_...
Discounl
Inleresl
(19)
120)
_~_~.___~__...__~.__u__..._._.__
(21}
(2IA)
(218)
.._.__.~--~-~~--~.._~----_..
,. ~ BE SURE TO ANSWER ALL QUESTIONS ONREVi'm SiDEANDTO- RECHECK MA'iIl~.c---'---""
Under penahie~ pi perlury, I declar;tholl hovo exomined this ,elurn, including occompony'ing schedule~ and stotemanls, and t~ tho besl of my knowlodgo and beliftf,
ills trut'l, corree! and complele. I declare thaI all real e,Iole has been roparled 01 lrue morkol value. Declaration of preparer 01 her Ihan the personal representative i~
based on all information of which preparer has any knowledge.
~:~TU:.f_P Jlfif 1)~6NA-., .R,~_!5 ...P6N.-~lilffO"R Fllt~.c;RE',u"nN--".."'-.-~ODRf55."..."-'-------.... .--.-.------. ........-..---.------.-.--. _._______._.__._.___.___.___....___.....____._.._._u_._ DAT.t'---..-.-----...-. -. .----.-
,~ ..' u250rioIlHd'LI3()i1inltf>p.rings,PA 1700~ ..._. ,..No\', ,.. _,1997
SIGN lURE Of PRU'AREIl OHl II TH REPRE5[N1ATI"f ADDR('j5 OAlE
..j"lJT;:c.~ :4.~1'~ 5 S. Hanover St., Carlisle, PA 17013 u.......n Nov. ,1997
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C:OMMONWb\I.Ttl OF p[tmSYlVM.jIA
~ INHl'HI1ANCt !AX IlI1UHN
..u ) J-N
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
HOY W. EBY
FILE NUM8ER
21-97 -0697
Iltbl' of dacld,nl mutt b. r.ported on Schldul. I,
ITEM
NUMBER
A,
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Ewing Brothers Funoral Home, funeral services
Westmlnstel' Cemetery, grave opening
Funeral luncheon
Noss Flowers, funeral spray
5,555.00
735.00
160,00
.164.30
.8 ADMINISTRATIVE COSTS:
1, Personal Rep,esenIaWa', Commissions
Nama of Personal Rap,esenlative (,)
Social SeClJn~ Numbe~,) f EIN Number of Person.1 Repre,.nlatlv.!'1
Slreet Addres,
C~ Sial. Zip
Year(,) Commission Paid:
2, Attom.y Fee, 500.00
3, ' Family Exemption: (If decaden!', addr.ss Is nol the same a, <Jalman!", allach explanaUon)
Claimant
Street Address
CI~ Slale Zip
Relatlon,hip.f C~lmant 10 Decedenl _
4, Probal. Fee, 39.00
FlUng fee 10.00
5: Ac:counlan!', Fee.
6, Tax Return Prepare" Fee,
7, Register of WiUs, certified copies 50.00
8. Harrisburg State Hospital, balance due 870.00
TOTAL (Also enter on line 9, Recapltulallon) $
(If more space ia needed, Insert addillonal sheets of the same size)
8,083.30
r)/~;Y,f
IURIAU O~ INDIVIOUAl TAMIB
INHtiM.IAMCt 'AM PIVISIOM
PEI'I. ,.....
HAMtllltltU, fl. 1"'''''''"
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
c..-
NOTICE Of INHERITANCE TAM
ArrRAISE"ENT, AllOWANCE OR DISALLOWANCE
Of DEOUtTIONS AND ASSESS"ENT Of TAM
In.I~~' II ." 1"'''1 .
06-08-98
EBY
04-23-97
21 97-0697
CUMBERLAND
101
t---'A_r:~Uteci _~
MAKE CHECK PAYAILE AND REMIT PAYMENT TOI
REGISTER OF WILLS
CUMBERLAND CD COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIll LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~
R'Iv:Uiii-ix-AFpufilr:,'T"ilcificiuoP-YNHiiiii'ANCi-TA'irA'ppiiA'isiiiil'r;-Ai:.i"ciiiANCi-iiii--------------u-
DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ROY W FILE NO. 21 97-0697 ACN 101
FREY . THeY
S S HANOVERST
CARLISLe
DATE
ESTATE OF
DATE OF DIATH
FILE NUNlER
COUNTY
ACN
ROY
PA 17013
ESTATE OF EBY
DATE
06-08-98
TAM RETURN liAS' (X I ACCErTEO AS filED
RESERVATION CONCERNING FUTURE INTEREST - SiitREVERSE
APPRAISED VALUE OF RETURN lASED ONI ORIGINAL RETURN
I. R..I E.t.t. (Sohedul. AI
2. Stook. ..... Bond. (Sohedul. 81
5. Clo..ly Held Stook/r.rtner.hip Int.r..t tSoh.dul. CI
~. Nod_./Not.. RIIO.IYIlbI. (Sohedul. DI
S. C.oh/811nk Depodh/"l.o. r.r'OI\III rrop.rty (Soheclul. EI
6. Jointly OWned rroperty (Sohedul. FI
7. Tr....f.r. (Schedule 01
8. Tot.l A...t.
I CHANOED
NOTE; To inlure prop."
or.ell t to "our IICOOW'tt J
...,.,U the upp.r portion
of thll for. with your
tlX p.y..nt.
8.000.00
.00
.00
.00
.00
.00
.00
(8)
(11
121
(51
I~I
IS!
161
171
8,000.00
APPROVED DEDUCTIONS AND EXEMPTIONSI
9. Funeral Expen.../Ad., Co.tl/HiIO. EMpen... CSchedule H)
10. Dobt./Nort_ Lillbllltl../Li.n. (Sohedul. II
11. Tot.1 _tion.
12. Net V.l... of T.. Return
15. Cheritobl./Go..r...nt.1 ..que.t., Non-.l.ot.d 9115 Tru.t. (Soh.dul. JI
I~. Net V.l... of Eotot. Subj.ot to T..
191
1101
8,083.30
.00
1111
1121
11S)
11~1
R.OA~ :<0
83.30-
.00
83.30-
If .n a.......nt we. i..u.d pr.viou.ly, lin.. 14, 15 and/or 16, 17 end lS will
r.fl.ct figur., thet include the total of 6kb return. .s.....d to d.te.
ASSESSMENT OF TAXI
15. AlIOUrtt of line I~ .t Spou..1 r.t. liS I
16. AlIOUrtt of Line I~ t....I. .t Line.l/Cl... A r.t. 116J
17. Aoount of line I~ t....I. .t Coll.t.r.I/C1... B r.t. 1171
lB. rrinoip.1 r.. Due
TAX CREDITS I
rAVNENT
DATE
NOTE I
.00 X .00.
.00 M .06.
.00M.1S.T
I1BI
.00
.00
.00
.00
.+-
() (I')
\l)
(',I
lL:
RECEIPT
IlUItBER
," <{
-, rl.
DISCOUNT It I
INTEREST/PEN rAID (-I
AMOUNT PUP
~
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
.,'
~
~
I.,
(l ,_-,'
el r.1'1
roCI:
a:
. IF rAID AFTER DATE
fOR CALCULATION Df
.U
.:.:s=
';'5
OU
INDICATED, SEE REVERSE
ADDITIONAL INTEREST.
If TOTAL DUE IS LESS THAM .1, NO rAV"ENT IS REQUIRED.
If TOrAL DUE IS REfLECTED AS A "CREDIT" (CRI, VOU HAV 'E DUE
A REfUND. SEE REVERSE SIDE Of THIS fORN FOR INSTRUCTIONS.)
W
"'SERYATlONI E.t.t.. of dHtMMtnt. <<bing on or Mfor. bee...r 12, 1912 ,." If MY future lnt.r..t'n the ..tat. is tr.n.'trrld
in po.....lon or tnjOyeent to Cle.. . (ooll.t.r,ll beneficleri.. of thl decedent eft.r the .xplr.tlon of InV ..t.t. for
life or for year., the C~.lth herlbY IMpr...1v r...rv.. the rl1l1t tc IPprell. Ind ...... tr~.f.r Inharltence tIM.'
.t the l.wful Cia.. I (col1.t.rlll rate on ~Y .uch future Int.r..t.
PURl'OSE OF
NOTICE I To fulfill thl r.qulrawent. of S.otlon 2140 of thl Inheritanc. and E.t,te T'M Aot, Act 21 of 1995. (12 P.S.
Section 9140),
PAVMEtff, DIItllCh the top porUorl of thlt Notice ~ .ubIllt wJth your PIYlHH1t to thl R.,ht.r of Will. prlr-ted on the rev.r.. .Ide.
u"', check or ~y order plyllbl. tal REGIRTER OF MILLS, AGENT
REFUND (CAh A refund of IteM oredlt, which WII not reque.ted on thl TIM Rlturn, "Y be rMtUllted by oo.pletlrtt WI "Appllo.Uon
for Refund of Pennlylvenl. Inherltanc. end E.t.t. T'M~ (REY-1S1]). Application' .re .v.llllbl. at thl Offloe
ef thl RIII.t.r of Mill., WlY of thl 2] R.venue DI.trlct Offlc.., or by c.111ng thl splol.1 2~-hour
en...rlng ..rvlOl nuahlrl for for.. or~rlng, In Pann'Ylv""l. 1-100-S62~20S0, out. Ida Penn'V1VMII end
within locel,Hlrrl~r. .r.. (111) 187-8094, TDD' (717) 772-2252 (H..rlng IIp.lred only).
OIJECTJOM$I Any P.rty In Inter..t not ..thfled with the eppreh...nt, .110wanc. or dl..lhtttencl of dlducUon., or ..........t
of t.M (Including dl.eooot or 'inter..U .. thottn on thh Notlc. MI.t obJ.ct ..!thin .hcty (60) dan of reo.lpt of
thlt Motlc. bYI
--written prot..t to tilt PA Dlpart""t of R.venun, Board of App.ah, Dept. 281021, ."rrltbur., p" 17121-1021, GR
--election to hev, thft ..U.r deter.loed et MKtIt of the account of the par.onel repr..en'tltlvl, GR
--appaal to thl Orphan.' Court.
ADttIN
ISTAATJVE
CORRECTIONS I
fectual Irrcrt dbcovarad on thlt ........nt .hould be .ddr....d In wrltlna tOI PA baplrtMnt ef R.vanw,
aureau of Indlvldu81 '1M", ATTNI pc.t A.......nt R.vl.w unit, Dlpt. Z80601, Harrl.bUrg, PA 17128-0601
Phone (717) 187-6505. s.. P'" 5 of thl booklet ''In.tr1IOtlon. for Inherltanc. l.x R.turn for . R..ldant
Decedent.. (REY~1501) for IIn .MpllMtlon of _lnlttr.Uv.h cOI"ractllbl. errors.
DISCDlltlI
If toy t.M due 1. paid within thr.. (5) cal.ndar ~nthl .fter the deCedent', delth, a flv. p.roant (5X) dl.aount of
thl tax ptlld It IIUowad.
PENAL TVI
lhe 15X t.M ....ty non'.pertlclpetlon penal ty It cOIIPut.d on thl total of the tax and Int.ra.t ......~, and not
paid bafor. J~,y 11, 1996, the flr.t dlY eft.r the ~ of the tax .ana.ty period, 'his non-Plrttclp.tlon
PM1fllty 11 .pp..lllbl. In thl ... .anner and In the ttM .... Un par lod .IC YOU would 1lPP..l the teM end Inter..t
thet hII. been ......ad II lndlc.tad on thlt netic...
INTEREST'
Inter..t It ch8rged bIIlnning with flrat day of dellnquency, or nino (9) IIDnth. end one U) day frotl thll data of
death, to the date of ply..nt. taM" which beo.. dtllInquant blfor. JW1uary 1, 1982 bear lnt.r..t at thl rat. of
.Ik (6X) parcent ,.,' InnUIl o.lculat.d at . daUy rat. of .000I.~. All tlxlI which bIo... deUtlqU8nt on and .ft.r
January 1, 1981 will bllr Int.rll.t .t a r." which wIll vary frOl calendar y...r to 0.1~'1' yeer with th.t rat.
announced by thl PA Dapart.-nt of R.venue. ThI .,pl'cabll Int.r..t r.t.. fer 1'82 throuth 1991.rll
'!!!r Intere.t R.t. DIllY Int.r..t FlDtcr X!!r Int.r..t Rat. DailY Int.r..t flOtor
1962 2aX .0005lt6 1987 'X .000247
191] 16% .000458 1'68-1991 11:-: .00OSOI
,\984 llZ .000501 .992 9:-: .0002~7
1965 13% .000556 1993-199~ 7% .000192
"86 lOX ,OOO27lro 1995~199. 'X .000247
--Jnter..t I. oalculated .. follOW"
INTEREST F IALANCE OF TAX UNPAID X NUNIER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Hotlc. Is.ued Ift.r the tex baC~' dtlllnquent will rlfl.ct an Int.~..t calculation to liftean (15) day.
beyond the dIIta of thl .....lIIInt. If P'YHflt It ... aft.r the Int.r..t cDIlPut.tlon etat. .hown on the
Hotlcl, additional Int.rl~t .u.t be c.lculated.
STATUS RE!'.QJtT_\lJ:lQ_~R RUr.,E 6, l~
Name of Decedent I Ro.1. W, Eby
Date of Deathl AprIl23~~__
Will No. Admin. No. 21-97-0697
.---
Pursuant to Rule 6. 12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estatel
1, State whether administration of the estate is completel
Yes X No___,_
2. If the anflwer is No, state when the personal
representative reasonably believes that the administration will be
complete I _____________
3. If the answer to No.1 is Yes, state the followingl
a. Did the personal representative file a final
account with the Cou.rt? YeB___ No_~_,
b. The separate Orphans' Court No. (if any) for
the personal representative's account is:
c. Did the personal representative state an
account informally to the parties in interest? Yes-L_ No__
d. Copies of receipts, releases, joinders and
approvals of formal or informal accounts may be filed with the
Cerk of the Orphans' Court and may be attached to this report.
Date I March 21, 2000..'
f''('"/{"'UA - l.t. '-;" )).~
Signature f
.-
\C: .:(
-,(.L
_ Robert M. Frey
Name (Please type or print)
5 S. Hanover St., Carlisle, PA 17013
Address
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J 717) 243-5838
Te I, No.
l3
Capj3clty:
Personal Representative
(MAli I rmfl AM3)
X Counsel for personal
representative