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15056051047
REV -1500
EX (06-05)
INHERITANCE TAX RETURN
. RESIDENT DECEDENT
PA Department of Revenue
Bureau of Individual Taxes
PO Box 280601
Hanisburg, PA 17128-0801
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Oeath Date of Birth
~~
Sutlix Decedent's First Name
[ill
Sutlix
[ill
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
~ . 1. Original Retum
c::::> 4. Limited Estate
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2. Supplemental Retum
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8. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
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. Correspondent's e-mail address:
MI
B
MI
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3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Retum Required
8. Total Number of SOB's
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4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach a Copy of Trust)
10. Spousal Poverty Credit (date of death c::::> 11. Election to lax 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 SHALL BE DIRECTED TO:
Name Da 'me Telephone Number
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unaer penaRles 01 perJury, I allClare tnat I nave examlnea tnlS return, InCluolng accompenytng scneaUles ana statemerns, ana to toe DeS! 01 my kIlowteage ana Dellll!, R IS true, correct
and complete. Declaration of preparer other than the personal representative is based on all the Information of which the preparer has any knowledge.
OF ~ON?SPO~.~-RETURN DATE
ADD
013
. AN REPRESENTATIVE
Side 1
L
15056051047
DATE
15056D51D47
-.J
~
:LSDSbDS2Dlfl!l
REV-1500 EX
Decedenfs Name:
RECAPITULATION
1. Real estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (tota.1 Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J)
14. Net Value Sub to Tax Line 12 minus Line 13
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 .045 $45 752.70
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
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L
Side 2
J.SDSbDS2Dlfl!l
1.
$0.00
2.
$48,624.62
3.
4.
$0.00
5.
$0.00
6.
$6,318.08
7.1
8.1
9.1
10.1
11.1
12.1
13./ .
$0.00
$54,942.70
$9,190.00
$0.00
$9,190.00
$45,752.70
$0.00
14.
$45,752.70
15. $0.00
16. $2,058.87
17. $0.00
18. $0.00
191 $2,058.871
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. J.SDSbDS2Dlfl!l J
REV-1500 EX Page 3
File Number
Decedent's Com Jete Address:
Decedent's Name
Olive M. Martin
STREET ADDRESS
1 Longsdorf Way
CITY
STATE
Carlisle
Tax Payments and Credits:
1. Tax Due
2. CreditslPayments
A. Spousal Poverty Credit
8. Prior Payments
C. Discounts
PA
(1)
Total Credits (A+B+C)
(2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
TotallnterestlPentalty (D+E) (3)
4. If Une 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Fill In oval on Page 2, line 20 to request a refund
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. (SA)
8. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
ZIP
17013
$2,058.87
please calculate
--- __...,__r~
PLEASE ANSWER THE FOllOWING QUESnONSBY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Old decedent make a transfer and: yes no
a. retain the use or income of the property trensferred:
b. retain the right to designate who shall use the property transerred or its income:
c. retain a reversionary interest: or
d. retain the promise for life of either payments or cere?
2. If death oc:c:urred after December 12, 1982, did decedent trensfer property within one year of death
without receiving adequate consideration?
3. Old decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary disignation?
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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For dates of death on or efter July 1,1994 end before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72P.S. Sec. 9116(a)(1.1)(I)].
For dates of death on or efter January 1,1995, the tex rate imposed on the net value of transfers to or for the use of the surviving spousels 0% [72 P.S. Sec. 9116(a)(1.1)(ii)).
The ll8Iute 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 dllles of death on or efter July 1, 2000:
The tax rete Imposed on the net value of lr8nafer8 from a deseased child _nty-one yeers of age or younger at death to or for the use of a natural parent~ an edoptive parent,
or a stepparent of the child is 0% [72 P.S. Sec. 9116(a)(1.2)].
The tax rate imposed on the net vslue of transfers to or for the use of the decedenfs Iinesl benefICiaries is 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) [72 P.S. Sec.9116(a)(1).
The tax rate imposed on the net value of transfers to or for the use of the decedent's Siblings is 12% [72 P.S. Sec.9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who hes 81 least one parent in common with the decedent, whather by blood or adoption.
SCHEDULE B
STOCKS AND BONDS
ESTATE OF
FILE NUMBER
Olive M. Martin
All prooerty Joiotlv-owned with Ri2ht of Survivorship must be disclosed 00 Schedule F
DESCRIPTION VALUE AT DATE
OF DEATH
ITEM
NUMBER
Charles Schwab Securities account no: 4030855 (see attached)
$48,624.62
TOTAL (also on line 2, Recapitulation)
$48,624.62
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SCHEDULEF
JOINTLY-OWNED PROPERTY
ESTATE OF
FILE NUMBER
Olive M. Martin
if an asset was made joint within one year of the decedent's death, it must be reported on Schedule G
Survivin Joint Tenant (s):
NAME
ADDRESS
RELATIONSHIP TO
DECEDENT
A
Carol E. Clark
31 East Gate Drive, Camp Hill, P A 17011
daughter
Jointly-owned property:
ITEM NUMBER LETTER FOR DATE MADE JOINT DESCRIPTION OF PROPERTY INCWDE NAME OF TOTAL VALUE OF DECD'S % INT. DOLLAR VALUE OF DECEDENT'S
JOINT TENANT INSTlTIJTJON AND BANK ACCOUNT NUMBER OR ASSET INTEREST
SIMILAR IDENTIFYING NUMBER ATTACH DEED
FOR JOINTLY-HELD REAL ESTATE
1 A 7/2/01 Acct no: 6100662217 -
Citizens Bank (see attached) $12,636.16 50% $6,318.08
TOTAL (also on line 6, Recapitulation)
$6,318.08
a Citizens Bank-
525 William Penn Place
Suite 153-2618
Pittsburgh, PA 15219
June 5, 2007
RONALD E. JOHNSON
ANDREWS & JOHNON
78WESTPONWRETSTREET
CARISLE P A 17013
Estate of OLIVE MARTIN
Date of Death: May 29, 2006
SSN: 173-44-9107
Dear Sir/Madam:
In accordance with your request, the attached information sheet has been provided in the above decedent's
name as of his/her date of death.
For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please
call 1-888-999-6884
Sincerely,
~~
Robert Roos
Operations Services
a Citizens Bank"
Account Number 6100662217
Account Title OLIVE MARTIN OR CAROL CLARK
Date Ooened 7/2/2001
Account Type Checking
Princio&B&mce~ofDOD $12636.16
Interest from Last Posting to DDD $.00
Account B&ance ~ of DDD $12636.16
YTD Interest to DDD $.00
. SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
ESTATE OF
FILE NUMBER
Olive M. Martin
A.
e ts 0 eee ent must reporte on e e u e .
ITEM DESCRIPTION AMOUNT
NUMBER
Funeral Expenses:
1 Smith Funeral Home $8,590.00
2 Harrisville Memorial - Headstone expense $85.00
Administrative Costs:
I Personal Representive Commissions
Name of Personal Representative(s)
Social Security Number of Personal Representative:
Street Address:
City: State: Zip:
Year(s) commissions paid:
2 Attorney fees to Andrews & Johnson $500.00
3 Family Exemption
Claimant
Street:
City: State & Zip
Relationship of Claimant to Decedent:
4 Probate Fees to Register of Wills
5 Accountant Fees to Patricia Rosendale, CPA
6 Tax Return Preparer's Fees
7 Register of Wills - Inheritance Tax Return filing fee $15.00
8
9
10
11
12
13
14
15
16
17
18
19
TOTAL (also on line 9, Recapitulation) $9; 190.00
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B.
SCHEDULE J
BENEFICIARIES
ESTATE OF
Olive M. Martin
FILE NUMBER
ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE
NUMBER Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include ouIriJht lpCllISoJ diIlributi_ one! _fin ... Sec. 9116(1)(1.2)]
I Carol E. Clark daughter 50%
31 East Gate Drive, Camp Hill, P A 170 II
2 Thomas C. Martin son 50%
4291 Bethel Road, New Wilmington, PA 16142
II NON-TAXABLE DISTRIBlmONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. Charitlble and Govemmentel Bequesu:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation)
$0