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Home My WebLink About06-08-06 (2) -.J 15056051058 REV-1500 EX (0&-05) PA DepaI1rnent of ReYenue *' Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 3/Z.' I Z 66'" I Suffix OFFICIAL USE ONLY CoIIlIy Code Year fie Nlmber b~ Od."1 \ <~\ 3g'--C>3-D7~1 Decedent's Last Name /J/lLL- (If Applicable) Enter Surviving Spouse'. Infonnatlon Below Spouse's last Name Date of Birth D!1;si (a9l3 CWe U~ Suffix Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Retum 2. Supplemental Retum c:~) 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required c:::) c=) 48. Future Interest Comprpmise (date of C=) death after 12-12-82) r'-, 7. Decedent Maintained a Living Trust (Attach Copy of Trust) CJ 10. SpowIeI poverty Credit (date of death C.::.:' 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE.C8IIPLETED. ALL CORRHPONDENCE AND CONFlOENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number (117) 13~,35~ _._._ C;:3 REGISTER ()~wl!?,s USE o~ =-~..'n ~~ 4. Limited Estate c::::) 6. Decedent DIed Testate (Attach Copy of Will) 9. litigation Proceeds Received 8. Total Number of Safe Deposit Boxes "lO.!JelZ D. Firm Name (If Applicable) /fALL- Fii;;of7:rsr- ~LR.A2.v,e ~ be- Second line of address ,........, ~.~J I co . J C) State ZIP Code DATE FILED N (J,4"';, """"/II L L Correspondent's e-mail address: f cI fI 0'+ 'Z- tf) ~ /) Nt cAsJ": Ai e-;- Under penalties of pe!jury, I declare that I have examined this return, including lICCOmpanying schedules and statements, and to the best of my knoWledge and belief, it is true. COfT8ct and complete. Declaretlon of preparer other than the ~ representative is based on all information of which preparer 11M any knowtedga. ~~FORAUNGRrnJ'" ' E ~ 57 e e~.bfL- (} SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ?A /7011-- J./.{)Z3 ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 -.J MI !J MI ::0 ?~FS c-;-j 0 '~,; el " in :. _I C:J ) C~ ; i -r.1 -", ., "~O ,_ -- i'n (/) t~ -11 @ REV.1500 EX Page 3 Decedent's Complete Address: DE NAMEC './ STREET ADDRESS //3 File ",qm""" ,..~l.. CITY J.t l L. STATE "7J?- . ()z:s Tax Payments and Credits: 1. Tax Due (Page 2 line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 5 .5. 'I S- 3. InterestJPenalty if applicable D. Interest E. Penalty (1) I / J ~. fig I Total Credits ( A + B + C ) (2) s5.9~ 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, Une 20 to request a refund. (4) 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. ~D ~3, /)3 B. Enter the total of line 5 + SA. This is the BALANCE DUE. (5) (SA) (58) A. Enter the interest on the tax due. ~o t.3.D3 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 r&. :: ::~ :~:=~w:;.~~~.:.~.~~~.~~.~.:.~.~:::.:::::::::::::::::::::::::::::::::::::::::::: B ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 % 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 exemDt 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 beneficiary. 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 parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is four and one-half (4.5) percen~ 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 decedenfs 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. --.J 15056052059 REV-1500 EX Decedenfs SocieI Security Number ___~r~~: {'/J)/Zl-t. 5____12_':-_jjALk--..__._._._.._~.____.__.__._._..~.1.?:._=....~~.~...~ 7 J 'i.... RECAPITULATION 1. Real estate (Schedule A). .............. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 31 5 g 1 . 2.1D J 3. Closely Held Corporation, Partnership or ~ (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank DeposIts & Mlscelleneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c.:.:; Separate Billing Requested .. . . . .. 6. 7. Inter-VIVOS Transfers & Miscellaneous Non-Probete Property (Schedule G) c=:> Separate BIlling Requested.. . . . . .. 7. 8. Total Gross Assets (total Unes 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. "'_~"'_<";"""'''"~'_''''''.'''""'''''_ ~,,,_.._.__~.,_~,,~_._~,"~__.~_.___.__~'.~__,_.~.....~_'~'_,'~"e_^_'~~~~""'_'~'_~"'_.'_.'_'~~'W___"~'" 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage UablIities, & liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Unes 9 & 10).. .. ..... .. ........... ............. 11. 12. Net Velue of Estate (Une 8 minus line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and GovemmentaI BequestslSec 9113 Trusts for which an election to tax has not been made {Schedule J) . . . . . . . . . . . . .. . . . . . . . . . . 13. 14. NetVelueSubJecttoTax (line 12 mlnusUne 13) ........................14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Une 14~' at lineal rate X .O~ zt/; 3111ft,. Z3 17. Amount of Une 14 taxable at siblng rate X .12 18. Amount of line 14 taxable at collateral rate X .15 q3 if. ZO 39, S' z~. 'fit, Jz.. '-fOb. lD4 , J 259 51 I 13 t, taD. 23 I zl/ ~(pk.l3 ; 24 1oft>,1.3 15. 16. ( J J~. 9 g ; 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. J J' g. CJ S ) 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 15056052059 -1- REV-1,503 EX+ (6-98. COMMONWEALTH OF PENNSYlVANIA INI-ERITANCE TAX RETURN RESIDENT DECEDENT SCHIDUU . STOCKS & BONDS ESTATE OF 0;.))12- Lt S D. PILL- All property joInt1y-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER ZJ-{J~-/)l11 ITEM NUMBER 1. DESCRIPTION /IU~t.~ .51AAi Le Y (,d CCt:ft 4- 1005'43'-17- /) 10'1 VALUE AT DAlE OFDEAnt 315'37, zf> TOTAL (Also enter on line 2, Recapitulation) $ 31 Sg 1. U (If more space is needed, insert additional sheels of the same size) REV-1,508 EX+ (6-98) .- COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDUU I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF {] IJAflLt. 5 b. JlIJ L L Include the proceeds of ltigation and the date the proceeds were received by the estate. All property Jolntly-ownld with right of survivorship must be dlsclond on Schedule F. FILE NUMBER Z/-olo-ol1/ ITEM NUMBER DESCRIPTION / WAC l-Jo.J " A (Ace[ f1.- loa d fp 1/ !Z 3 ffli J1) -A ccr. -::Jb1;"l.y /) wJ( b LJt-nl SD~ LI<bj4 h~ /-/;/LL) z.. f;.A>p.J~lli.f~ I. ?tJ.J,-jU<~ "" CL()f1{,~f en~J 3 /982 CJ.1tJ'1 )y1),lj~1.l VALUE AT DATE OF DEATH t.f 39. Z () Z Of). ()/) 30~. OIJ l' TOTAL (Also enter on line 5, Recapitulation) $ 7' 3 'I. 20 (If more space is needed, insert additional sheets of the same size) REV-~511 EX+ (12-e9l* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDUU H FUNERAL EXPENSES & ADMINISlIA1IVE COSTS ESTATE OF /111A L /Zit S D~ /.JAiL- DebtI of dec:edenI must be reported on Sc:heduIe L FILE NUMBER 1/- g(P- Oz.1/ 1. DESCRIPTION FUNERAL EXPENS~S: 11 Mi~,l..S ~wJl,IJ{ H~W(l. ~c.. G /)6/) 5}l1f1W~ ePlI~ lP - /I k ~ ~L JUJ.... luJ0J8N1) AMOUNT ITEM NUMBER A. '" 95/). /)() .5'OO,{){) z. B. 1. ADMINISTRATIVE COSTS: Person8I RepnJsentaIiv8's Commissions Name of Person8I Repl8senfative(s) 5CJ.li. bf,lU- A f-IA c/J4J Social Sea.ui\y NlJ'Nler(s)/EIN Number af Personal RepreserllalMl(s) SlIeel AddnIss 3 g s 1. ~4 J Cily Year(s) Conmission Paid: Slate Zip 2. Altomey Fees 3. Family Exemption: (If decedent's address is noIlhe same as claimanl's. attach explanation) Claimant Street AddnIss Cily ReIaIionship of CIainant to Decedent State . Zip 4. Probate Fees Cf~.I)O 5. Accountant's Fees 6. Tax RelIIm PnIpar8I"'s Fees 7. TOTAL (Also enter on line 9, RecapiluIation) $ /2, Ii ()(J . ",pi (If more space is needed, insert additional sheets of the same size) Attachment to Schedule H - Personal Representative's information 1. Roger D. Hall, Social Security Number 161-34-0951, 113 W. Clearview Dr., Camp Hill, Pa 17011 111'12. /Q.3 Z- / 2. Carolyn A. NetT, Social Security Number 186-34-1389, '+229 Nantucket Drive, Mechanicsburg, P A 17055 /II 9 z.. h.3;J. .I REV-1512 EX+ (12.03) . . SCHIDULI I DEBTS OF DECEDENT, MORTGAGE UABllnIES, & UENS COMMONWEAlTH OF ~YLVANIA IttfERITANCE TAX RETIJRN RESl)ENT DECBlENT ESTATE OF/) I J b II FILE NUMBER LtJA/ZU> _H)LL- '1,1- b ~ - /)Z" Report debts Incurred by the decedent prior to deatIl which remained unpaid u of the date of death, Including unrelmbursed medical expenMS. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 3 '-f :Y b 1. Pf-fL ~ Yf1J ;J"~'(d Ail/LillA ( b).s D.Ot '-- ) 1?,'HJA.b DAs.seL l ~A5f./ j/Aut~"!J) Ie Iii /J,J C,If/tIfJ P.LL -rLJzA to. LMJflJJ'J~rll;~j C IJ JIt e~sr :S'~.-'Z- J I ~. It Z Z5, ()/J 11. .51- iOS. /)l> z-/. /1 z.. TOTAL (Also enter on nile 10, Recapitulation) $ I, ,};;59. 5'1 (If more space is needed. insert additional sheels of the same size) REV-1513 EX+ (9-00) \ . SCHEDUU , BENEFICIARIES . . COMMONWEALTH OF PEtf'olSYLVANIA NlERfTANCE TAX RETURN RESIDENT DECEDENT ESTATEOF (J b FILE NUMBER :tl4llle > ' J./JLL- 2/-010 - 07-1/ RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERlY Do Not lilt TIUllM(I) OF ESTATE I TAXABlE DISTRIBUTIONS [1IlCIude ouIrighI spousal disIrIlutions, 1DI tnmsrers IIIder 14. r9~ 1?~tfZA 1:> Ii~ tt;),i j} (l:Je.5'1 C Le..A /lilt '- ~ j) P- So) / Z IlL ~ /70'/ ~ ta-)jIL. I t.f. Zfj 1ft CAR~ ,d #tt!r -/172 'J,.}-riJf- ~I ~t1/Ja/l-UJC- 2- MeQ 7"JA P'm' /1tJ55 3 ~J>.~#.P fl. 'i-'-fA~PJ/ 1lIZ1A,J "R-P 5IJ;.! I if. Z'I ~ h1-e-(J1I4Jit;J~"1l ~ I ~5D z :1J/ 13LP<I>!~ 112 lC"bL~,ttJ.n-=- 13,4 ~~v-rl1Z-r IL/-, 29 r; if 'ff!!#; VIU" I>> ~ jtHiPMpdluJa: j),4ltJ J./uL- I If. z,f, .5 ~ l1b,m t.. $J, ~, ~ r I /11 T~A ',4 Z 3 z..:1V I tf. zJI ~ ~ ~PA (!,4i3/l., V:;~bSJl~ 7?/J, ('1I,~ItJIIY ))/JUj JJU IZ- lJ/Jifl1bV$L- J.It~z ItJ :) I Lf, z.q1/D 1 ..4% :t:.J.3e,i. -SbL'- 'o/fll alik i<D (z Z5 ))Attg JI-1d/Z- 5). ~A"',J.us 1>IJL~, 7J /7/J 9 b ENTER DOllAR AMOUNTS FOR DISTRIBtJT10NS SHOWN ABOVE ON UNES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n NON- TAXABlE DISTRIBUTIONS: A. SPOUSAL DlSTRIBtJT10NS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed. insert additional sheets of the same size)