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Home My WebLink About06-28-07 . . .-J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Hams~,PA17128~1 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death OFFICIAL USE ONLY ~~ty~ode Year 21 Or' File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 0475 Date of Birth MARY 05/14/2005 01/06/1920 Decedent's First Name (It Applicable) Enter Surviving Spouse's Intonnatlon Below Spouse's Last Name First Name ~p<>~~'~ Sol:il:il~~?~~ty~urn~er..... THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW c:::J 1. Original Retum c:::J 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required 2. Supplemental Retum <:a> 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 ...................................................m................................................. c:::J 4. Limited Estate c:::J c:::J 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes c:::J THOMAS E. FLOWER (717) 737-3405 g ................................................. i-R"EGISTER i~s USE ~ I . . ~c1 -0 --.. -- , (n:I:'-"- I :g}::;.~ N 1-' "0 ..c..:;, '::P CtJ ."'. (j) 7"- 'SOO C)O-n - ,- ~.) '35 .. ~ ~ DATE FILED Firm ",l:i.rntl!lf ,A.ppli?l:l~I~! .... . AlDIS, FLOWER & L1NDSA First line of address 2109 MARKET STREET - ~ - - .' c..n ZIP Code 17011 or Post Office Correspondent's a-mail address: tfIower@sfl-law.com AD S THOMAS E. FLOWER, EXECUTOR, 2109 MARKET STREET, CAMP HILL, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE 06/22/07 ADDRESS SAIDIS, FLOWER & LINDSAY, 2109 MARKET STREET, CAMP HILL, PA 17011 PLEASE USE ORIOINAL FORM ONLY Side 1 L 15056051058 .-J 15056051058 MI J MI ....,:J ,1"1'\ ...:Jr.. 0 ,I" .-) 1~?51 ~~cj f-~~l rTl -.:J-.iC C)Q -n::.g c-') rn \~-;.-~: ~;.~~ Sf . . --.J 15056052059 REV-1500 EX Decedent's Name: RECAPITULATION MARY J BYERS 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) c:> Separate Billing Requested . . . . . .. 6. 7. Inter-VIVos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:> 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. Decedent's Social Security Number i 177-16-1054 I 131,095.35 131,095.35 11. Total Deductions (total Lines 9 & 10). . . . . . . .. . . . .. . .. . . . . . . . . . . . . . . . . .. 11. 3,648.81 127,446.54 12. Net Value of Estate (Line 8 minus Line 11) . . . . . .. . . . . . . .. . . . . . . . .. . . . . . . 12. 13. Charitable and Governmental Bequests/Sec 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 45 127,446.54 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 127,446. 5,735.09 5,735.09 c:> 15056052059 ~ REV-l500 EX Page 3 Decedent's Complete Address: DECEDENrs NAME MARY J BYERS STREET ADDRESS 23 HENDEL LOOP DECEDENrs SOCIAL SECURITY NUMBER 177-16-1054 CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 5,735.09 Total Credits ( A + 8 + C ) (2) 3. InterestlPenalty 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) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (58) 5,735.09 557.87 6,292.96 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 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 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 [i] 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 exempt 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 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 ofthe 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. REV-1508 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDULI I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF MARY JO BYERS FILE NUMBER 21-05-0475 ITEM NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with right of survivorship must be disclosed on Schedule F. 1 DESCRIPTION Lutheran Social Ministries, Resident Refund, received upon resale of unit in CCRC TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 131,095.35 131,095.35 REV-1511 EX+ (12-99)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDULI H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF MARY JO BYERS FILE NUMBER 21-0~0475 Debtl of decedent mUlt be reported on Schedule L ITEM NUMBER A. FUNERAL EXPENSES: 1. DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Numbar(s)/EIN Number of Personal Representative(s) Street Address City Year(s) Commission Paid: 3. Family Exemption: (If decedent's address is not the same as daimant's, attach explanation) Claimant 2. Attorney Fees Street Address Relationship of Claimant to Decedent TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 4. Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. . . ' . . " REV-1513 EX+ (9-00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY JO BYERS NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS Ondude outright spousal distributions, and transfers under ..~c:. ~11~(1I)J1.2)1 1 NANCY A. HESS, 430 N. 67th St., Harrisburg, PA 17111 FILE NUMBER 21-0$0475 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not Lilt Trustee(s) OF ESTATE step-daughter ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-I500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- 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) ~ 00 U1 W W U1 CTI 0 U1 0 -..J Z < 0 C'i m z c :s:: lD m ;:0 0 Z CTI < ......... 0 0 C'i U1 m ......... 0 0 )> -l -..J m ::0 t:rJ Z (D H < t::l 0 C'i t:rJ m Z 0 I-j m en ::0 n ;:0 t:rJ =c "Ij -l ~ (5 z t::l ~ Gl ~ ;:0 W W 0 ~ ~ en en 0 0 )> \D \D :s:: U1 U1 0 C W W Z -l U1 U1 0 en 0 0 n 0 c 0 0 Z 0 0 -l ....' ~ ~ W W Z ~ ~ m 0 0 -l \D \D )> U1 U1 ~ C W W Z U1 U1 -l ~ >: ~~ O~ t;~ t:rJ~ ~~ t:rJ~ O~ ":tJC ~~ ><:~ C-4~ O~ tJjr;; ><: ~~ enS; t;.5 CTI 0 U1 0 -..J Z < 0 C'i m z c :s:: lD m ;:0 0 Z CTI < ......... 0 0 C'i U1 m ......... ~ 0 -..J m ::0 t:rJ en Z H < t::l 0 C'i t:rJ m Z 0 I-j m en ::0 n ;:0 t:rJ =c "Ij -l ~ (5 z t::l Gl ~ ;:0 W 0 ~ en en 0 )> \D :s:: U1 0 c w Z -l U1 0 en 0 n 0 c 0 z 0 -l ~ W Z ~ m 0 -l \D )> :s:: U1 0 C W Z U1 -l ~ ~ ~~ O~ t;~ t:rJ~ ~~ t:rJ~ O~ "IjC ~~ ><:~ C-4~ O~ tJjr;; ><: ~~ enSj t;.5 ~ 00 U1 W W U1 o CTI ......... ~ ~ ......... o -..J o CTI ......... ~ ~ ......... o -..J JOHN E. SUKE ROBERT C. SAlOIS JAMES D. FLOWER, JR CAROL J. UNDSA Y JOHN B. LAMPI MICHAEL L. SOLOMON GEORGE F. DOUGLAS, III DEAN E. REYNOSA THOMAS E. FLOWER MARYLOU MATAS SUZANNE C. HIXENBAUGH LAW OFFICES SAIDIS, FLOWER & LINDSAY A PROFESSIONAL CORPORATION 2109 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407 EMAIL: attomey@sfl-Iaw.com www.sfl-Iaw.com June 27, 2007 Cumberland County Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013-3387 Dear Ms. Strasbaugh: CARLISLE OFFICE: 26 WEST HIGH STREET CARLISLE, PA 17013 TELEPHONE: (717)243-6222 FACSIMILE: (717)243-6486 REPLY TO CAMP HILL g --"..0 ::- :P t"?,--oiO ---0 r- 7"-- m -'-" - ::0 ",-7 (f) 7"- :500 ,)01'1 be ::Et ~ r--) ~ ~ 2: :z: N co ~ Enclosed are two copies of the Supplemental Inheritance Tax Return for The Estate of Mary Byers, one for the Pennsylvania Department of Revenue and one for your office. Also included is a copy to be time-stamped and returned to me in the enclosed self-addressed stamped envelope. If you have any questions, please call. Sincerely, SAlOIS, FLOWER & LINDSAY Cil-ctl Thomas E. Flower JS Enclosures - - .. -.0 J:J fTl \-."11 (_J G)CJ --- :XJ ~~C) cnin ::a CJ C) -n .-n C'5 ;-n c.J1 - L.1~. e, if> uJ-J ~;~; u... ' 1 0',- a @~ ~~ C_' '-"...' L.J ct. c:::: \D o fit s: Q.. t--:cf a: = ~88 ~ : ~~~~ ~ ~ g a c...a " ""- ~,.,.~~ ..... ::( :IE en 5 o tii - LL - I ~ ~ ...l ...- ~~~I ~ g .cn- ~~ ...~ ~~ I, ~ i ~I 0 Q, - ~ NU ~ ~ f/) -I ~ fI) ~ 'Om &.. ;::, .sO fI).s::. ._ t:= js~r--. LL.UmCO ~~ 5-~ C:C:CI)M s;::'Q)"" u ,q" fI) 0 _;::,r--. -0-00"" c:c:.s::.<( mmt:=a.. 't:'t:;::' Q)Q)O ~ .o.ouJ!2 E E Q).~ ;::,;::,c:'t: uuo~ I I - . -