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Home My WebLink About08-24-07 (2) --.J 15056041125 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN 2 1 0 7 RESIDENT DECEDENT File Number o 1 8 5 Date of Birth 09007 034 3 o 2 122 0 0 7 04011916 Decedent's last Name Suffix Decedent's First Name MI G RAY L ILL I A N (If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW D 1. Original Return D 4. Limited Estate D D 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death D 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 [ZJ D D o 8. Total Number of Safe Deposit Boxes 2. Supplemental Return o D 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required W ILL L I A M A ADD A M S E S Q 717 243 763 8 Firm Name (If Applicable) I REGISTeR OF WilLS O_~- ONLY I - -',__,J . ~. .. ! First line of address 4 3 W SOU T H S T Second line of address City or Post Office State ZIP Code ~~: f'0 DATE FILED" CAR LIS L E P A 17013 N Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF RSO RESPO BLE FOR FILING RETURN DATE 8/9/2007 '",- South St. , SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE Carlisle PA 17013 DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 ---1 --1 15056042126 REV-1500 EX Decedent's Name: Li 11 ian Gray RECAPITULA TION 1. Real estate (Schedule A) 2. Stocks and Bonds (Schedule B) 2. 3 Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. 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 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested. 7. 8. Total Gross Assets (total Lines 1-7) Decedent's Social Security Number 090070343 1. 4. 5. 2613398 8. 2613398 9. 9. Funeral Expenses & Administrative Costs (Schedule H) 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) . . . . . . . . . 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . 12. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . 14. 2613398 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.O _ 16. Amount of Line 14 taxable at lineal rate X .O~ 15. 2 6 1 3 3 9 8 16. 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 17. 18 19. Tax Due " . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 2613398 1 1 7 6 o 3 1 1 7 6 o 3 o 15056042126 .....J REV-1.500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Li Ilian Gray STREET ADDRESS 1 3 Strawberry Dr. File Number 0185 CITY Carlisle STATE PA ZIP , 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,176.03 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( 0 + 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) 1,176.03 A. Enter the interest on the tax due. 1,176 03 Make Check Payable to: REGISTER OF WILL~ 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; .................................. ...... ...... ........................ D D b. retain the right to designate who shall use the property transferred or its income; ............................... D D c. retain a reversionary interest; or ................................................................................................ D D d. receive the promise for life of either payments, benefits or care? ....... ........................................... .... D D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... D D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... D D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. D D 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 PS. S9116 (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. S9116 (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. s9116(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 PS S9116(1.2) [72 P.S. s9116(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. s9116(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 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Lillian Gray FILE NUMBER 0185 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Members 1 st, Checking, Account 51977, dod balance VALUE AT DATE OF DEATH 4,36909 2 Members 1 st, Savings, Account 51977,dod balance 10,223.05 3 Members 1 st, Money Management Account 51977,dod balance 11,541.84 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 26,133.98 REGULAR SAVINGS ACCOUNT: Account Number/ Suffix Ddte Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner CHECKING ACCOUNT: Account Number/ Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner INVESTMENT SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Estate of: LILLIAN E. GRAY Date of Death: February 12, 2007 Social Security Number: 090-07-0343 50UO Louise Drive . P. 0. 130x 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 . w\vw.members1st.org tv l~t MEMBERS 1st FEDERAL CREDIT UNION 51977 -00 08/10/1976 $10,219.98 $3.07 $10,223.05 None 51977-11 01/05/1982 $4,369.09 $.36 $4,369.45 None 51977-05 10/01/1985 $11,541.84 $6.89 $11,548.73 None ~"\\MBERS 1ST FEDERAL CREDIT UNION l)J~ ~ 'LQ,t~ Danielle A. Kline Insurance Services Specialist August 16,2007