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Home My WebLink About04-03-07 1___ ..J 15056051047 REV-1500 EX (06-05) PA Department of Revenue *' Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisbur . PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW . Social Security Number Date of Death ~ Suffix Date of Birth ~ Decedent's First Name MI o (If Applicable) Enter Surviving Spouse's Infonnation Below Spouse's Last Name Suffix MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW _ 1. Original Return C) 4. Limited Estate C) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required C) 2. Supplemental Return C) C) C) 4a. Future Interest Compromise (date of death after 12-12-82) C) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) C) 10. Spousal 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 COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Da 'me Tele hone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received ::8:- 8. Total Number of Safe Deposit Boxes - REGISTER OF WILLS USE ONLY (") ~ c- <=:) .-::: 0 --.t '1;:g ,):?", "i I (J l:J i J --r.7> j"'."- ::.0 ...~~~~ ~ (') . '. ('~'.i :t:>> ......T'.. N CO Correspondent's e-mail address: Under penalties of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. ration of parer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P ON R R FILING RETURN DATE , ~-2. (;) JJv- ADDRESS I y 'Q..ydS bu.r' SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ..J~ -I REV-1500 EX Decedent's Name: RECAPITULATION 15056052048 1. Real estate (Schedule A). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 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. 6. Jointly Owned Property (Schedule F) <::::)Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) <::::) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . .. . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . ... .... .......... .. ... ... ...... .. 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 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. TAX COMPUTATION - 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_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X. 12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. Decedent's Social Security Number 15. 16. 17. 18. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMeNT L 15056052048 Side 2 <::::) 15056052048 -I ,-- REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME ill o...rl cJ(\ A~.:5 k", YYl ~ j )') I I d a.rvn L..a. Vl ~ STREET ADDRESS CITY STATE P Ii-- a..ff\Sb~r- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B.PriorPayments C. Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty ZIP 1711?- 1009 I] Total Interest/Penalty ( 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. 1009 I}, (5) (5A) (5B) A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. / () OC; I ~ Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did ~nt make a transfer and: Yes a. retain the use or income of the property transferred;.......................................................................................... D 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, 1'982, 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 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..................................:..................................................................................... D No ~ ~ ~ ~ ~ ~ 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. 99116 (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. 99116 (a) (1.1) (ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only be~eficiary. 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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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. REV-1502 EX+ (6-98) . , *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF AA IrlJf IttlM. All real property owned solely or as a tenant in common must be rep, ed at fair market value. Fair market value is delined as the price at which property would be exchanged between a willing buyer and a willing seller, neither ing compelled to buy or sell, both having reasonable knowledge 01 the relevant facts. Real property which Is jointly-owned with right of survivorship must be disclosed on Schedule F. M4C ~~, v~ll'l1N FILE NUMBER --- 0 G -(j~,()~ ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH AJ(j~ TOTAL (Also enter on line 1, Recapitulation) $ 0 (II more space is needed, insert additional sheets 01 the same size) -~..~ . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF fYI IAA cL. jJ ILl (f'r1 IV ( iO <- :J{( 0"'1 1M , N All property jointJy-owned with right of survivorship must be disclosed ITEM NUMBER 1. No~ SCHEDULE B STOCKS & BONDS FILE NUMBER -0 -O~b~ Schedule F. DESCRIPTION TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH ~EV-1504 ~X+ (1-97* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP I'VlIQ ( ~~ ( /I11l u FILE ~MBCr~ 6 ESTATE OF JlA '''fl4A..l~ Schedule C-1 or C-2 (including all supporting information) must be attache r each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supp ing information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH /J(j~ TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) G REV-1507 EX+ (1-97) " . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE f:: / vY1 (.N\ HJ All property jointly-owned with righ survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. fJo~ TOTAL (Also enter on line 4, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) ~-.~"'" . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF H1 nV1 1'IIJ/(fUJl r"~(, Include the proceeds of litigation and the date the proceeds were receiv ITEM NUMBER 1. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~( ~t1t1 FILE NUMBER , '1..,(- O~ -O~ y the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. VALUE AT DATE OF DEATH DESCRIPTION fPfeM ~ /S Po to~ 40 fle ~""I' 0 WtJ 1 ( C U C4ecK.t1 ,4c,(,0 UV ffl. l10S(' TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) (;7Z1 ~ ~'!'"'"" . '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY ^^,AILI~ iVll4 <- S<: I vt\ tt,{ , If an asset was made joint within one year of the decedenfs date 0 SURVIVING JOINT TENANT(S) NAME RELATIONSHIP TO DECEDENT ADDRESS A. NGAL- B. c. JOINTLY-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 identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for joinUy-held real estate. VAlUE OF ASSET INTEREST DECEDENT'S INTEREST 1, A. TOTAL,(Also enteron line 6, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) -,~..,"" . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF IAA nA (' L VV{, i....1{fr\ VVI~<" ~~I It<AM II\) SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY FILE NUM',ER --/", l, - U~~V This schedule must be completed and filed if the answer to any of question rough 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE, VALUE OF ASSET INTEREST IIF APPliCABlE \ NUMBER 1. TOTAL (Also enter on line 7, Recapitulation) $ ()' (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) _ " '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF M rIAl( /(fl1 SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 1A-O fbb ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) ~EV-1512 EX+ (12-03) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Jt1r1/t I ()A. i'fJ1,- ~ k, ~IAA.. ( F':: NUMB~9 r{b' Report debts incurred by the decedent prior to death which re ained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 10, Recapitulation) $ 0 (If more space is needed, insert additional sheets of the same size) ~EV-1513 ~X+ (9-00. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF - ~g~E; f11 A C. ~ (, ~ ,1111 NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under M~I((( t11t1s~c'S~a~2~/A( "36 r.t 0 I cf) J:""~~ t.A~ 0 Nh5 /l~ 1711 L-- N e. €f) nA_ d f111O~ ~ k, .A-( lI1A I AJ( 309 ]Ilq Sr/; 0 SJ~IMlJ/La. f4 170Q3 1. FILE NUMBER 1U~-(J4eUJ NleClC AMOUNT OR SHARE OF ESTATE s-o% (0% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS 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 $ (If more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) '* ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on REV-1500 Cover Sheet COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Flll~B~~ .-0 ~ This schedule is to be used for all single life, joint or successive Iif estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be 0 ained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. o Will 0 Intervivos Deed of Trust 0 Other o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Actuarial factor per appropriate table ................................................. Interest table rate - 031/2% 06% 010% 0 Variable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ o o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Check appropriate block below and enter corresponding (number) .................. . . . . . . . . Frequency of payout - 0 Weekly (52) 0 Bi-weekly (26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) 0 Annually (1) 0 Other ( ) 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................................... 5. Annuity Factor (see instructions) Interest table rate - 031/2% 06% 010% 0 Variable Rate % 6. Adjustment Factor (see instructions) ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ 6 NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 EX+ (3-84) INHERITANCE TAX *' SCHEDULE "L" COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT OR INVASION INHERITANCE TAX RETURN RESIDENT DECEDENT OF TRUST PRINCIPAL FILE NUMBER I. Estate of (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Ad of 1961 or to report the invasion of trust principal. II. Remainder Prepayment: A. Election to prepay filed with the Register of Wills on (Date) (attach copy of election) B. Name(s) of life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule l- 1 1. Real Estate S 2. Stocks and Bonds S 3. Closely Held Stock/Partnership S 4. Mortgages and Notes S 5. Cash/Misc. Personal Property S 6. Total from Schedule l- 1 S D. Credits: Complete Schedule l-2 1. Unpaid liabilities S 2. Unpaid Bequests S 3. Value of Unindudable Assets S 4. Total from Schedule l-2 S E. Total value of trust assets (line C-6 minus line 0-4) S ,<- F. Remainder factor (see Table I or Table II in Instruction Booklet) G. Taxable Remainder value (line E x line F) S (Also enter on line 7, Recapitulation) III. Invasion of Corpus: A. Invasion of corpus (Month, Day, Year) B. Name(s) of life T enant(s) Date of Bi rth Age on date Term of years income or Annuitant!s) corpus consumed or annuity is payable C. Corpus consumed S D. Remainder factor (see Table I or Table II in Instruction Booklet) S E. Taxable value of corpus consumed (line C x line D) S (Also enter on line 7, Recapitulation) REV-1645,EX+ (7,. INHERITANCE TAX SCHEDULE L-l COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -ASSETS- FILE NUMBER I. Estate of (Last Name) (First Name) (Middle Initial) II. Item No. Description Value A. Real Estate (please describe) Total value of real estate $ (include on Section II, Line C-1 on Schedule L) B. Stocks and Bonds (please list) Total value of stocks and bonds $ (include on Section II, Line C-2 on Schedule L) C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Total value of Closely Held/Partnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ (include on Section II, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property $ (include on Section II, Line C.5 on Schedule L) III. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $ (If more space is needed, attach additional 8% x 11 sheets.) REV.1646 'Ex + (3.84) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE L-2 REMAINDER PREPAYMENT ELECTION -CREDITS- FilE NUMBER I. Estate of (Last Name) (First Name) II. Item No. Description A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule l- 1 (please list) Total unpaid liabilities $ (include on Section II, Line 0-1 on Schedule l) B. Unpaid Bequests payable from assets reported on Schedule l-l (please list) Total unpaid bequests $ (include on Section II, Line 0-2 on Schedule l) C. Value of assets reported on Schedule l-l (other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets $ (include on Section II, Line 0-3 on Schedule l) III. TOTAL (Also enter on Section II, Line 0-4 on Schedule l) (If more space is needed, attach additional 8Y2 x 11 sheets.) (Middle Initial) Amount $ REV-1647 EX+ (9-00) '. . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet ESTATE OF FILE NUMBER This Schedule Is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. o Will 0 Trust 0 Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. 0 Unlimited right of withdrawal 0 Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ..... .$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One o 6%, o 3%, o 00/0 . . . . . . . . . . . . . . . . . . . . . .$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One o 6%, o 4.5% .......................... .$ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ..... .$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ..... .$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ..................... .$ (If more space is needed, insert additional sheets of the same size) REV-1648 EX (11-99) SCHEDULE N SPOUSAL POVERTY CREDIT (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION ESTATE OF I ALE NUMBER This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. PART I - CALCULATION OF GROSS ESTATE 1. Taxable Assets total from line 8 (cover sheet) ............................................ 1. 2. Insurance Proceeds on Life of Decedent ................................................ 2. 3. Retirement Benefits ................................................................ 3. 4. Joint Assets with Spouse ............................................................ 4. 5. PA Lottery Winnings ............................................................... 5. 6b. 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) 6. 7. Total Gross Assets (Add lines 1 thru 6) ................................................. 7. 8. Total Actual Liabilities .............................................................. 8. 9. Net Value of Estate (Subtract line 8 from line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 9. If line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part II. PART II CALCULATION OF JOINT EXEMPTION INCOME (Attach copies of Federal Individual Income Tax Return for decedent and spouse.) Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse .......... . 1a. 2a. 3a. b. Decedent ......... . 1b. 2b. 3b. c. Joint ............ . 1c. 2c. 3c. d. Tax Exempt Income . . 1d. 2d. 3d. e Other Income not listed above ....... . 1e. 2e. 3e. f. Total ............ . 1f. 2f. 3f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1 f) + (2f) + (3f) (+ 3) 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ..................... 1. 2. 3. Multiply by credit percentage (see instructions) ........................................... 2. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. ............................... 3. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ............................................................. 4. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet. . . . . .. 5. 4. 5. r- ""'.,....,,~ . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 0 ELECTION UNDER SEC. 9113(A) SPOUSAL DISTRIBUTIONS ESTATE OF FILE NUMBER Do not complete this schedule unless the estate Is mlklng the election to tax ISSets under SectIon 9113(A) of the Inheritance & Estate Tu Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's survivin souse under a Section 9113 A trust or similar arran ement. DESCRIPTION VALUE Part A Total $ PART B: Enter the descri tion and value of all interests included in Part A for which the Section 9113 A election to tax is bein made. DESCRIPTION VALUE Part B Total (If more space is needed, insert additional sheets of the same size) tv l~fJm~~~!= P.O. Box 40 Mechanicsburg, Pennsylvania 17055 Check Purpose SHARE WITHDRAWAL Check# 224953 $6,727.53 Acct XXXXXXX025 MACSKIMMING,MARI Effect: 10/04/06 Post: 10/04/06 T1r: 0552 ID DUE DATE PRINCIPAL INTEREST FEES NEW BALANCE TRAN AMOUNT SEQ (See receipt for reference) #501962 I RECEIVED BY tv l~fJm~~~!= P.O. Box 40 Mechanicsburg, Pennsylvania 17055 ,. Check Purpose SHARE WITHDRAWAL Check# 224953 $6,727.53 Acct XXXXXXX025 MACSKIMMING,MARI Effect: 10/04/06 Post: 10/04/06 Tlr: 0552 ID DUE DATE PRINCIPAL INTEREST FEES NEW BALANCE TRAN AMOUNT SEQ (See receipt for reference) #501962 TO THE ORDER OF ~ i :; to- i ~(Q)[?)W REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS No. 2006-00866 PA No. 21-06-0866 Estate Of: MARION L MACSKIMMING (First, Middle, Lastl Late Of: MIDDLESEX TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 158-09-7838 WHEREAS, on the 2nd day of October 2006 an instrument dated November 29th 2005 was admitted to probate as the last will of MARION L MACSKIMMING (First. Middle. Last) la te of MIDDLESEX TOWNSHIP, CUMBERLAND County, who died on the 5th day of August 2006 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: MARK MACSKIMMING who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 2nd day of October 2006. il1p41o&..Regfi:tlJJt &h..u~ / Mi14? f!Jy-/Vl-' e u y . **NOTE** ALL NAMES ABOVE APPEAR (FIRST. MIDDLE.LART) o ~~~w ~o :3~ :;;::: 0 ~:.:.3 :~~ e ~.:i ~;~ ~ ~_.~) 8 ~ ~-:? Part 1. Personal Information :~)~:;s ::u-J I, MARION LYON MAC SKIMMING, a resident of the State ofPennsylvaiira, Will of MARION LYON MAC SKIMMING - .. 1"'-.' ..:;:- CUMBERLAND, declare that this is my will. My Social Security number is 158-09- 7838. Part 2. Revocation of Previous Wills I revoke all wills and codicils that I have previously made. Part 3. Disposition of Property All beneficiaries must survive me for 45 days to receive property under this will. As used , in this will, the phrase "survive me" means to be alive or in existence as an organization on the 45th day after my death. All personal and real property that I leave in this will shall pass subject to any encumbrances or liens placed on the property as security for the repayment of a loan or debt. If I leave property to be shared by two or more beneficiaries, it shall be shared equally by them unless this will provides otherwise. If I leave property to be shared by two or more beneficiaries, and any of them does not survive me, I leave his or her share to the others equally unless this will provides otherwise for that share. "Specific bequest" refers to a gift of specifically identified property that I leave in this will. "Residuary estate" means all property I own at my death that is subject to this will that does not pass under a specific bequest, including all failed or lapsed bequests. Pqelln--~~1ft-Jl:lli{ ...: ;"'-:4) '--C'1 11 -. (-) : rl Will of MARION LYON MAC SKIMMING ~(Q)~W I leave my residuary estate to NEEDRA ANN MAC SKIMMING and MARK MACSKIMMING in equal shares. Part 4. Executor I name MARK MAC SKIMMING to serve as my executor. If MARK MAC SKIMMING is unwilling or unable to serve as executor, I name NEEDRA ANN MAC SKIMMING to serve instead. No executor shall be required to post bond. Part 5. Executor's Powen I direct my executor to take all actions legally permissible to have the probate of my will done as simply and as free of court supervision as possible under the laws of the state having jurisdiction over this will, including filing a petition in the appropriate court for the independent administration of my estate. I grant to my executor the following powers, to be exercised as he or she deems to be in the best interests of my estate: 1) To retain property without liability for loss or depreciation. 2) To dispose of property by public or private sale, or exchange, or otherwise, and receive and administer the proceeds as a part of my estate. 3) To vote stock, to exercise any option or privilege to convert bonds, notes, stocks or other securities belonging to my estate into other bonds, notes, stocks or other securities, and to exercise all other rights and privileges of a person owning similar property . 4) To lease any real property in my estate. 5) To abandon, adjust, arbitrate, compromise, sue on or defend and otherwise deal Page 2 Initials: 4--1fJJ1 Date: f I-~ '1--05' Will of MARION LYON MAC SKIMMING ~(Q)~W with and settle claims in favor of or against my estate. 6) To continue or participate in any business which is a part of my estate, and to incorporate, dissolve or otherwise change the form of organization of the business. The powers, authority and discretion I grant to my executor are intended to be in addition to the powers, authority and discretion vested in him or her by operation of law by virtue of his or her office, and may be exercised as often as is deemed necessary or advisable, without application to or approval by any court. Part 6. Payment of Debts Except for liens and encumbrances placed on property as security for the repayment of a loan or debt, I want all debts and expenses owed by my estate to be paid in the manner provided for by the laws of Pennsylvania. Part 7. Payment of Taxes I want all estate and inheritance taxes assessed against property in my estate or against my beneficiaries to be paid in the manner provided for by the laws of Pennsylvania. Part 8. No Contest Provision If any beneficiary under this will contests this will or any of its provisions, any share or interest in my estate given to the contesting beneficiary under this will is revoked and shall be disposed of as if that contesting beneficiary had not survived me. Part 9. Severability If any provision of this will is held invalid, that shall not affect other provisions that can be given effect without the invalid provision. Signature I, MARION LYON MACSKIMMING, the testator, sign my name to this instrument, this ; q~ day of 0 ve.ritJoLr, a O() S- at Pa 3 IDitiall:~~Date: //-Zfj-as- Will of MARION LYON MAC SKIMMING (1y~~uJa..rJ. COU~~. I declare that I sign and execute this instrument as my last will, that I sign it willingly, and that I execute it as my free and ~(Q)[P>W voluntary act. I declare that I am of the age of majority or otherwise legally empowered to make a will, and under no constraint or undue influence. Signature: '\/\^ ' ~ i\^A ~ /'1 "". '", Y' '1 ~ ..! . ~ , Y\..tt-C--~ <f,-.('1 .... / - Witnesses We, the witnesses, sign our names to this instrument, and declare that the testator willingly signed and executed this instrument as the testator's last will. In the presence of the testator, and in the presence of each other, we sign this will as witnesses to the testator's signing. To the best of our knowledge, the testator is of the age of majority or otherwise legally empowered to make a will, is mentally competent and under no constraint or undue influence. We declare under penalty of perjury that the foregoing is true and correct, this J 9~ day of Ij~~ j()d5. at CuvJtr/4/td (1u(/,~ 1i4 Witness # 1: BId h-fM La~e #o-ff"sbc.f1 Ptt . ~ Residing at: Witness #2: Residing at: I 30Q ~fe.e. f 6u.II\I\.Me,rdtvle pfi- Sworn and Subscribed Before Me ~aDay of ^n tJW><.-20 4. ~ 'Y\.~ (G(Q)~W INSTRUCTIONS: Letter to Executor The following document outlines the tasks your executor will be asked to handle, either directly or through an attorney or an accountant. You may use this document in a couple of ways. You may show it to your proposed choice for executor so that he or she will have a good idea of what is involved. Also, you may attach it to your will, to be read by your executor when it comes time to deal with your estate. Please understand that use of this document is strictly voluntary and in no way will affect the validity of your will or what you hope to accomplish with it. Instructions: Letter to Executor - Page 1 (G(Q)[0W The Executor's Role You have been nominated to serve as executor for MARION LYON MAC SKIMMING, to be in charge of carrying out the plan as expressed in her will after her death. To perfonn this role well, you do not need special financial or legal knowledge. Common sense, conscientiousness and honesty are the main requirements. Should you need help, you will be able to hire lawyers, accountants or other experts and pay them from the deceased person's assets. So as you learn what an executor (called a "personal representative" in some states) is responsible for, keep in mind that you can always hire professional help. Must You Serve? Being named executor does not obligate you to serve. When it comes time, you can choose whether to accept this responsibility. Further, even if you do agree to serve as executor, you can resigri at any time. If you decide not to serve, or if you resign, an alternate named in the will should take over. Ifno alternate is available, the probate court will appoint someone else to step in. An Executor's Duties As executor, your duties are likely to include: · Deciding whether or not probate court proceedings are needed. · Deciding whether at least some assets can be transferred immediately, without fonnal probate, to the people who inherit them. · If probate is required, filing the will in the local probate court, asking the court to appoint you as executor and then shepherding the estate through probate. Letter to the Executor - Page 1 ~(Q)~W . Sending notice of the probate proceeding to the beneficiaries named in the will and if necessary, to certain close relatives--in most cases, a surviving spouse and children-who would have been entitled to property had there been no valid will. · Locating and securing the deceased person's assets and then sensibly managing them during the probate process, which commonly takes about six months to a year, depending on where you live. During this time you may need to manage the deceased person's investments, pay bills and sell items of estate property. · Handling day-to-day details, such as terminating leases and other outstanding contracts, and notifying banks and government agencies--such as the Social Security Administration, the post office, Medicare and the Department of Veterans Affairs-of the death and the fact that you are winding up the person's affairs. · Setting up an estate bank. account and transferring the deceased person's money to it. · Paying continuing expenses that are necessary to keep estate property secure-for example, mortgage payments, utility bills and homeowner's insurance premiums. · Paying any debts that the estate is legally required to pay. As part of this process, you must also notify creditors of the probate proceeding; the required method of notice will be set out by state law. They then have a certain amount of time- usually about four to six months--to file a claim for payment of any bills or other obligations you haven't voluntarily paid. As executor, you decide whether or not a claim is valid. · Paying income taxes. Income tax returns must be filed for the year in which the person died. If the estate receives enough income, you'll also have to file an income tax return for it. · Paying state and federal estate taxes. Most estates don't owe these taxes. It depends Letter to the Exeeutor - Page 2 ~(Q)~W on how much property the deceased person owned at death and to whom the property was left. Someone who dies in 2005 can leave up to $1.5 million worth of property without owing federal estate tax. The exemption amount will rise to $3.5 million by 2009, and the estate tax is scheduled to be repealed in 2010. (If Congress does not extend the repeal, however, the estate tax will reappear in 2011.) In addition, any amount of property left to a surviving spouse who is a U.S. citizen is estate tax free. . Supervising the distribution of property, such as cash, personal belongings and real estate, to the people or organizations named in the will. . When debts and taxes have been paid and all the property distributed to the beneficiaries, requesting the probate court to formally close the estate. Obviously, the main reason for acting as executor is to honor the deceased person's request. But you will also be entitled to payment The exact amount is regulated by state law and will be affected by factors such as the value of the property left by the deceased person and what the probate court decides is reasonable under the circumstances. Commonly, close relatives-especially those who will inherit a substantial amount under the will-and close friends opt not to charge the estate for their services, but the choice will be up to you. Working With a Lawyer Many people think that probate requires hiring a lawyer. Although this can often be a sensible choice, especially for estates with lots of different types of property, significant tax liabilities, or the potential for disputes among inheritors, it is not always necessary. If you have access to good self-help materials, you may decide to handle the paperwork yourself. This makes good sense especially if you are a main beneficiary, and the deceased person's property ownership situation and distribution plan are relatively straightforward. Letter to the Executor - Page 3 ~(Q)~W Essentially, handling a probate court proceeding requires shuflling a lot of papers through the court clerk's office; in the vast majority of cases, there are no disputes that require a decision by a judge. You may even be able to do everything by mail. Doing a good job requires persistence and attention to tedious detail-not necessarily a law degree. Here are two different ways to work with a lawyer: · Hire a lawyer to act as a "coach." You can do much of the work yourself, but consult the lawyer when legal questions come up. For example, you might want the lawyer to do some research for you or look over documents before you file them. And it is a good idea to work with a CPA rather than try to handle very technical documents such as estate tax returns all on your own. · Turn the process of probating the estate over to the lawyer. Y ou'll still be responsible for making decisions, but the lawyer will handle all of the paperwork and deal with the probate court. The lawyer will be paid out of the estate. In most states, lawyers either charge a lump sum or charge by the hour-about $150 to $200 is common-but be sure you negotiate this in advance. In a few states, however, a fee is authorized by state law. For example, in California and a few other states, the law authorizes the lawyer to take a certain percentage of the gross value of the deceased person's estate unless you make a written agreement specifying something different. You should be able to fmd a competent lawyer who will agree to a lower fee. Other Sources of Help Probate court clerks often answer basic questions about court procedure, but they staunchly avoid saying anything that could possibly be construed as giving legal advice. Some courts, however, have lawyers on staff who look over probate documents; they may point out errors in your papers and tell you how to fix them. In many law offices, lawyers delegate all the probate paperwork to paralegals. In some Letter to the Executor - Page 4 . ~(Q)~W areas of the country, experienced paralegals have set up shop to directly help people deal with probate paperwork. These paralegals do not offer legal advice; they just prepare documents using the information you give them. They can also file papers with the court for you. To find a probate paralegal, look in the yellow pages under Typing Services, Legal Document Preparers or Attorney Services. Make sure that the person you hire has lots of experience in this field and gives you references to check out. A couple of books written for non-lawyers may also be useful: The Executor's Guide: Settling a Loved One's Estate or Trust, by Mary Randolph (Nolo). This book is a thorough guide to an executor's duties. It explains how to wrap up someone's affairs with a minimum of heartache and hassle, from finding and protecting assets to transferring property to beneficiaries with or without formal probate. How to Probate an Estate in California, by Julia Nissley (Nolo). This book leads you step by step through the California probate process. It contains tear-out copies of all necessary court forms and instructions for filling them out. Names Mentioned in Will Here are the names of the people and organizations mentioned in the will of MARION LYON MAC SKIMMING, which may be useful to you as you go about the job of administering the estate. If the will-maker entered address and phone information, it appears after the name. MARK MAC SKIMMING OLD FARM LANE ~SB~G,PennsylvaniaI7112 DAUPHIN Day phone: 717-545-1000 Eve phone: 717-691-8007 Letter to the Executor - Page S . ~(Q)~W E-mail: EAGLEA7@AOL.COM Beneficiary, Executor NEEDRA ANN MACSKlMMING 309 THIRD STREET SUMMERDALE, Pennsylvania 17093 CUMBERLAND Beneficiary, Alternate Executor Letter to the Executor - Page 6 . Affidavit (G(Q)~W ACKNOWLEDGMENT Commonwealth of Pennsylvania County of: ClJ.-\M bu\ a. V\ J I, ~ B"J'M l. rfre$k.....;1 the testator whose name is sigoed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Testator: 'M ~ ;e. hi ~_'A..::......~ a ' , tr Offirer: ~ ~ ~' Notarial Seal Cathy M. Sheriff, Notary Public Silver Spring Twp., Cumberland County My Commission Exoires Oct. 21, 2006 i\.l~;.:t:2'i. Penn::::ylv~n:a Assc-;:i3tion Of I'lotClriss AFFIDAVIT Commonwealth of Pennsylvania County of: (}u.~kulo..W\.J We, .," -- " and 1eeJ~.. ~A~5klm""n, ,the witnesses whose names are signed to the attached or foregoing instrument, having been duly qualified according to law, do depose and say that we were present and saw the Affidavit - Page 1 . Affidavit (G(Q)(P)W testator sign and execute the instrument as his/her Last Will; that the testator signed willingly and executed it as his/her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or ai}irmed and. subscribed to hefure me by -4 1Pf1.t'5t:Y~Land ~e~~~ . witne~, this ~ day of -'JOVe-ViA , , 00.5 . Witness: Witness: Officer: . Notana! Seal "I Cathy M. Sheriff, Notary Public J Silver Spring Twp., Cumberland County _~~~Commission EXDi~es Oct.:..~:~006 )\:::.-,:-:-L ;.'Y, ::"el!i',<r~'jv3!1;:7J :'::,5;~,c~i:;::j:)n elf i'~o~~ri:;:s Affidavit - Page 2 /";(! '" ,,_:,:,; . "'-, -''''"-S' "'", ''"' ." ~-1 ! lT{ J !I ) I oS ..~ 0311bJ3S3bJ SlHf>lbJ 11'11 Sdsn 900~ iJenuer dt? 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