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HomeMy WebLinkAbout03-13-07 --.J 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue '* County Code Year Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisbu ,PA 171~1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~~ File Number Decedent's Last Name Suffix Decedent's First Name [[[] MI ~ (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix [[[] MI o THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return c::J 2. Supplemental Return c::J 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required c::J c::J 4a. Future Interest Compromise (date of death after 12-12-82) c::J 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::J 10. Spousal Poverty Credit (date of death c::J 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent DIed Testate (Attach Copy of Will) 9. Litigation Proceeds Received L 8. Total Number of Safe Deposit Boxes 4. Limited Estate c::J - c::J o e-t t" SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --.J~ . --..- . ...J 15056052048 REV-1500 EX Decedent's Name: GIZA C E RECAPITULATION ~- SWAN Decedent's Social Security Number ~ 1. Real estate (Schedule A). ........ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. ~ I 3. B q 7 q ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. . - 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 5. ~ 7 3 / ~ , Jointly Owned Property (SChedlJle F) C separate Billing Requested. . . . . . . '2 .~ ~ Sf 6. 6. '-1 i"! 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C Separate Billing Requested. . . . . . . . 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. ~ ;< 3 3 ~ g- Co 19 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . . . 9. ~ I 0 7 5" / ~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . .. . . . . 10. ~ to ~t;,~ (eJ 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. 3 ~ 7 tol f{ I 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. ~ ~. p ~ 7 ~ .t 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. .I ~ ~ /~ I';; 7 ~! TAX COMPti,rATION . SEE INSTRUCTIONS. FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X.O ifS- 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 '18. 19. TAX DUE...... .. ......... ............. ... .. .... .............. .... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c:::::> Side 2 L 15056052048 15056052048 ...J . REV-1500 EX Page 3 Decedent's Complete Address: DECEDEN~ NAME 0::JRA C ~ C. S lJJ oN STREET ADDRESS 3~~ RiVe ~ File Number d I CJ ro 0 S- 0 S- CITY NIC.5~uRG Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) ~ 3 OJ 8-'. ;{3 l/eJOO,OO ;2/0.5d-. Total Credits (A + 8 + C ) (2) ,/:; Ie;. 5";l 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 6. (J [) ~.DO '//>?7.7/ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) tf/87.7/ Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did deaPdent make a transfer and: . Yes No a. retain the use or income of the property transferred;.......................................................................................... D IZI b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or............................:................:............................................................................ D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. D ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D cg 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D I2{l IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [72 P.S. ~9116 (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 zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot 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 beryeficiary. 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 p.arent, or a stepparent of the child is zero (0) percen\ [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 four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(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. . ;.... r. ". ~ ~ ~ ~ 'h ~ ~ ~ \ ". ALLEN E. HENCH ATTORNEY AT LAW 2M MMKET ST. NEWPdRT. PA 17074 TEL (717) 1187-31311 ~AX (717) 587-3130 I.OVSVLLE OFFICE: WEST MAIN ST. (RT. 274) I.OVSVILLE. PA 17047 Tel. 1717) 78t-3S47 ~I, . ,. ',- ~':\~.' 'fi .fl. .~: JLD~ W3fIJL MlD ~<fs;~~;fIl<fJlt!C I, GRACE C. SWAN, of Bethany Court, 325 wesley Drive, Mechanicsburg, Pennsylvania, being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills by me heretofore made. FIRST: I direct payment of the expenses of my last illness, funeral and burial costs from my. residuary Estate, as an expense of my Estate, as soon after my death as conveniently may be done. All Federal, State and other death taxes payable because of my death, with respect to the property forming my gross Estate for tax purposes, whether or not passing under this Will, including any interest or penalty imposed in connection with such tax, shall be considered a part of the administration of my Estate and shall be paid from my residuary Estate without apportionment or right to reimbursement. SECOND: I give and bequeath my :automobiles and tangible personal property, such as furniture, household goods, and personal effects, if any, and other tangible personalty of like nature, not including cash or securities, together with any existing insurance thereon to my children, RALPH EDWARD SWAN and DARLIS JEAN SWAN, in equal shares, share and share alike. THIRD: All the rest, residue and remainder of my estate, whether real, personal or mixed, of which I shall die seized and possessed, and to which I may be entitled at the time of my decease, and wheresoever the same may be situate, I give, devise and bequeath unto my children, RALPH EDWARD SWAN and DARLIS JEAN SWAN, in equal shares, share and share alike. FOURTH: In addition to all powers granted by law, I give my Executor, hereunder, the following powers, which may be exercised without leave of court: to retain and to invest in all forms of real and personal property; to compromise claims and to abandon any property which is of little or no value, if deemed appropriate to my Executor; to sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property, or interest therein, and to give option for sales or leases, and to give a good deed of conveyance or REV-1503 EX + (6-98) * SCHEDULE. STOCKS & BONDS COMMONWEAlTH OF PeNNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEpENT ESTATE OF GRACE C. SWAN ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. FILE NUMBER 21 06 0565 All property joInIIvoOWllld with right of survivorship must be dllc:loMd on Schtclule F. DESCRIPTION 105 Shares of A l& T stock with date of death value of 26.29 per share. See attached Historical Price sheet and August 1 Dividend confirmation sheet. Also see copy of 1099 dated October 1 (!) attached 117 Shares of Bellsouth Corporation with date of death value of 44.59 per share. See attached copy of chart and valuations, copy of 1099 showing 117 shares, and Statement from Mellon Investor Services. U.S. Treasury HH bond Serial # M7639795HH issued July 1996. See copy of Bonds attached. VALUE AT DATE OF DEATH 2,760.4E 5,217.0~ 1,OOO.OC U.S. Treasury HH bond Serial # M7639796HH issued July 1996. See copy of Bonds attached. 1,OOO.OC U.S. Treasury HH bond Serial # X1046239HH issued July 1996. See copy of Bonds attached. 10,OOO.OC U.S. Treasury Ht't bond Serial # X1 046238HH issued July 1996. See copy of Bonds attached. 10,OOO.OC I U.S. Treasury HH bond Serial # *1046237HH issued July 1996. See copy of Bonds attached. 10,OOO.OC U.S. Treasury HH bond Serial # X1046236HH issued July 1996. See copy of Bonds attached. 10,OOO.OC U.S. Treasury HH bond Serial # X1046235HH issued July 1996. See copy of Bonds attached. 10,OOO.OC U.S. Treasury HH bond Serial # X1046234HH issued July 1996. See copy of Bonds attached. . 10,OOO.OC U.S. Treasury HH bond Serial # X1046233HH issued July 1996. See copy of Bonds attached. 10,OOO.OC U.S. Treasury HH bond Serial # X1046232HH issued July 1996. See copy of Bonds attached. 10,OOO.OC U.S. Treasury HH bond Serial #X1046231HH issued July 1996. See copy of Bonds attached. 10,OOO.OC U.S. Treasury HH bond Serial # X1046230HH issued July 1996. See copy of Bonds attached. 10,OOO.OC 1180 Shares Wyeth Stock with date of death value of 43.56 per share. See attached Historical price sheet and Statement from Smith Barney. 51,400.5C 900 Shares Exxon Mobil Corporation Stock with date of death value of 57.80 per share. See attached Historical price sheet and Statement from Smith Barney. 52,020.0C TOTAL (Also enter on line 2. Recapitulation) $ (If more space is needed. Insert additional sheets of the same size) 213397.9€ eat~ (pmputershare + - - - - - - - - - - - . Computershare Shareholder Services Inc P.O. Box 43078 Providence RI 02940-3078 I J., I Within the US, Canada & Puerto Rico 800 351 7221 IMPORTANT TAX RE, j"RN DOCUMENT ENCLo.SED . . Outside the US, Canada & Puerto Rico 781 575 4729 ~ '." .... c:" U .... ) i~ "([' ", Vi '~ij'..:.... WWN.computershare.corrVatt H L..:::.::J ~~' L!::J G \~.i t:-S I GRACE C SWAN 1 , AnN RAlPH F SWAN~ .;'\ !~ . ForachangeofaddnlSlpleesecall1e8bcMt 165 DOWlIN FORGE 0 number or visit us at www.computershare.mmlatt OOWNINGTOWN PA 9335 BY' . ~--~---------______~ Holder Account Number '11I11I.111111111I1111,1.111I.11.'11'11,.1.1111I1111I1.'111.1.1 C 0013961581 INO nlnl6111111111 Record Dale Check Number SsNmN CerIIIed 10 0cI2006 0002531391 Y.. ent /2008 TIX Form1018wD1V ' Dividend Conflnnatlon Payment Date I CIaIt ~ptIon I partie::: I DIvidend I Gross I Deduction ., Rate DIvidend ($) Amount ($) Deduction I Type Net Dividend ($) 01 Nov 2006 COMMON Ytar.To-Oate PaId 105 $0.3325 34.91 139.84 0.00 0.00 N/A 34.91 138.84 . ~6UTX ATT + 002CS70003 OOMOMA(1 ) Page I of3 Yahoo! ! My Yahoo! i Mail I More WelcorrM......lIIf.. !h~~~lp Dow ... 0.68% Nasdaq'" 0.78% Thursday, March 8, 2007, 2:19PM ET. U.S. Mark_ cIo..ln 1 houl I Enter ~y~~ol.(~) . t J ...._..~. , ..'T'.'....~'i.""''',....: Symbol Lookup Finance Search Wyeth (WYE) f"-l ."" :1 FIdelity At 1:59PM ET: 49.69 ... NO maintenance t..$ m __TMDI Historical Prices Get Historical Prices for: I .'. SET DATE RANGE Start Date: I.Ju,~lIl14 ..1 l?oQ~.. . .: ~go~an 1, End Date: l~un.114' I?Q9~ (i: Daily o Weekly l Monthly l' Dividends Only First I Prev I Next I Last PRICES Date Open High Low Close Volume Adj Close* 14-Jun-Q6 43.40 43.96 43.13 43.56 4,949,200 42.89 * Close price adjusted for dividends and splits. First I Prev I Next I Last ~ Download To Spreadsheet ADVERTISEMENT http://finance.vahoo.comlalht>?s=WYE&a=05&b= 14&c=2006&d=05&e=14&f=2006&e=d ?,fR107 -; -; ^ XOM: Historical Prices for EXXON MOBIL CP - Yahoo! Finance Page 1 of3 Yahoo! i My Yahoo! I Mail I More Welcontl....I.,... ~~Ip Dow 't 0.69% Nasdaq 't 0.80% Thursday, March 8, 2007, 2:20PM ET - U.S. Markets elo..ln 1 hour IErlter~Yr11~o.l(~). . i .,J!!t,!Mt.L\" Symbol Lookup Finance Search o ~ FIdelity At 2:00PM ET: 71.86 't liD .....,... $9,,99 TRADD NO 8URPRI8U Historical Prices Get Historical Prices for: 1 III SET DATE RANGE Start Date: IJun .114 End Date: IJun. 11114 Eg. Jan 1, 2003 <i. Daily r Weekly r Monthly C Dividends Only 12oQ6 12006 First I Prev I Next I Last PRICES Date Open High Low Close Volume Adj Close. 14-Jun-06 56.65 57.99 56.64 57.80 24,867,900 57.04 · Close price adjusted for dividends and splits. First I Prev I Next I Last ~ Download To Spreadsheet ADVERTISEMENT http://finance.yahoo.comlq/hp?s= XOM&a=OS&b=14&c=2006&d=05&e=14&f=2006&g=d 3/8/07 REV-1508 EX + (6-98) . SCHE'DULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRACE C. SWAN FILE NUMBER 21 06 0565 Include the proceeds of IlIigation and the date the proceeds were received by the estate. All propelty Iolntly-owned wIIIi'rtg'ht of lUfVlyonhlp IIIUIt be dllcloHd on Schedule F. ITEM NUMBER 1. DESCRIPTION 3 Antique coins with appraised value of 249.00. See attached appraisal from R. F. Hess dated December 11, 2006 VALUE AT DATE OF DEATH 249.0C 2. 2005 Income tax refund 1,166.0C 3. Refund from Boyer Funeral Home 306.0C 4. Travellers Checks 280.0C 5. New York Life Insurance benefit 1160.94 Non Taxable O.OC 6. Miscellaneous furniture and personal effects 3,500.0C 7. SB Money Funds in Smith Barney Account # 724-07625-13 205. See attached Statement from Citigroup Smith Barney dated May 31, 2006 1,230.7i TOTAL (Also enter on line 5, Recapitulation) $ (If more space Is needed, Insert additional sheets of the same size) 6731.7i R. F. Hess Appraisals: SpeciaIzJng in antique tools & coins 185 Idle Road Marysville, PA 17053 Ph 717-957-4079 Dee 11, 2006 RE: Coin Appraisal for Grace C. Swan Estate; DOD 6/1412006 Quantity Description 1 1 1 1901-8 Gold Half Eagle 1921-5 Morgan Silver Dollar 1893 Columbian Exposition Half Dollar Appraised Value $ 225.00 $ 14.00 $ 10.OQ Total Appraised Value $ 249.0Q Appraiser: ~.. R.(J ~ "'-., Ronald F. Hess Auctioneer.:+-4"~. Dave Magee, PA Lie AU-3753 L - !!!II!!!!!!!! - !!IlIl!!!l!l! ====== . - 55!iii!5!! IIii .. IIii ~ IiiI - !EI!i i!iii!l!ii!!i ==== ~ iiiiiiIiiii "11- i :;o~~ Om :1 I: (I) "5t ~ -t _ I: 0 m ,. ~~ -t% 00 ~~ ~~ 8(1) m ~ o m (I) ~! .... ~ ~ l<< g . 3. i ~ :1 "5t o ,. c CD ~ o tit ;:;: tit ~ .. i c 3. IJ fII ;, & i o ~ ;, It :;- Q. 0'0 3 III III ~ ~,... ;, B lit fir ~ 0 ~ ;, ==~ & ~ ~n ~ ~ ~ ! !! ;, ~ III It ~ ;, !: ~ ~ 0 Q. ::t ~~ ~ i n i 0' II fir fir III ii ~ 0' ~ ~I!li !!jga :::E:%"5t I: g- o !;!:! r- 8 :;0 "V ~1 1:( ~"i' S tli 0) i M ~ If .. %loaC 9. 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'<CD WQ. ~ ~UJ 1\).... om 0.... mCD 3 CD a ~ n n o 5 .... ::II ~ Il:I" ell ... ~ o ~ ~ .... C4 ~ CII 'a "I...... i w 2- 01 REV-1509 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEbuLE F JOINTLY-OWNED PROPERTY ESTATE OF GRACE C. SWAN FILE NUMBER 21 06 0565 If an allet was made joint within one year of the decedent. date of death,lt must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Ralph E. Swan 165 Dowlin Forge Road Son Downingtown, PA 19335 B c JOINTL Y-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 DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTL Y.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENrS INTERES 1. A. 1/18/02 Checking Account #8606283283 at PNC Bank with date 6,517.87 50. 3,258.9.0:1 of death value of 6516.55 plus accrued interest of 1.32. See attached letter from PNC Bank dated 10/25/06 TOTAL (Also enter on line 6, Recapitulation) $ 3 258.9.0:1 (If more space Is needed, insert additional sheets of the same size) ~ ll::j; ca::l PNCBR'lK 412 768 3458 P.02 0PNCBAN< October 25. 2006 Allen E Hench Attorney at Law 220 Market St. Newport, PA 17074 RE: Estate of Grace C Swan (Deceased) SSN: 188-32-4561 roD: 06-14-2006 phVal Dear Mr. Hench: In response to your request for Date of Death balanClCs for the CWltomer noted above, oW' records show the following: CIleeldlll Accoa_ Account #8606283283 Established 01.18.2002 GRACE C SWAN RALPH E SWAN ~ DOD ba1mc.e; $6,516.55 + $1.32 accrued intaest Interest paid OI-Ol.Q6 thru 06-14-2006 $12.14 YTD The decedent did not maintain any loans with PNe Bank. Safe deposit box Tho deoeOent maintained safe deposit box #5b. It was in two names. RALPH C SWAN GRACE C SWAN It is located at: Bethany VilJaae Bnnch 325 Wesley Dr. Mecbani"bufa. P A 17055 717-691-4087 Our office does not close accounts. Please contact the branch listed before of iMtructiona on how to close the aceount. LIONVILLE and OENUARDIS 260 BaaIe View Blvd. Exton, PA 19341 484-875vI8SO Page 1 of2 REV-1511 EX + (12-99) . sCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRACE C. SWAN FILE NUMBER 21 06 0565 ITEM NUMBER A. 1. 2. B. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. Debts of decedent mUlt be reported on Schedule.. DESCRIPTION FUNERAL EXPENSES: Boyer Funeral Home Additional Funeral Expenses (Minister, etc.) ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Allen E. Hench Social Security Number(s)/EIN Number of Personal Represenlative(s) Street Address 220 Market Street City NewPort Slate PA Zip 17074 Year(s) Commission Paid: 2007 Attorney Fees Allen E. Hench Esquire Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip Probate Fees Accountants Fees Tax Retum Preparel's Fees Estate Notice and proof of publication in Cumberland Law Joumal Estate Notice and proof of publication in The Sentinel Six Death Certificates Certified Mailing Register of Wills 6 Short Certificates 12.00 + 12.00 R. F. Hess Coin appraisal Death Certificate for Ralph C. Swan Miscellaneous AMOUNT 7,306.0C 300.0C 11,165.0C 11,165.0C 306.0C 75.0C 122.51 61.0C 4.&1 24.0C 30.0C 16.0C 500.0C TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 31.075.1 E REV-1512 EX + (12'()3) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRACE C. SWAN FILE NUMBER 21 06 0565 Report debts Incurred by the decedent prior to death which remllned unpaid I' of the date of death, Including unrelmbursed medlcll expenses. ITEM NUMBER DESCRIPTION 1. Bonnie K. Miller tax collector VALUE AT DATE OF DEATH 11.0C 2. Bethany Village Skilled nursing 4,001 .2E 3. Public School Employees Retirement. Repay overpayment. 489.45 + 684.56 1,174.01 4. Miscellaneous 500.0C TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5686.2€ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Ust Trustee(l) OF ESTATE I. TAXABLE DISTRIBUTIONS [mclude ~ht rl dlstrlbutlons, and transfers under Sec. 9116 (a (1. )) 1. Darlis J. Swan Lineal 4307 Wimbledon Drive 50% Harrisburg, PA 17112 2. Ralph E. Swan Lineal 165 Dowlin Forge Road 50% Downingtown, PA 19335 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ ""'-""".'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRACE C. SWAN ~ ---~~ . SCHEDULE J BENEFICIARIES FILE NUMBER 21 06 0565 (If more space is needed, insert additional sheets of the same size)