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Home My WebLink About09-12-07 .-J 15056041114 REV -1500 EX (06-05) OFFICIAL USE ONLY County Code Year File Number 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 INHERITANCE TAX RETURN RESIDENT DECEDENT ~\ b\ D \'-tl Date of Birth 172-30-1624 Decedent's Last Name 02112007 07101938 Suffix Decedent's First Name MI KAHLEY (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix DANIEL EJ 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 lJD 1. Original Retum 4. Limited Estate CJ CJ CJ CJ 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 between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes 2. Supplemental Retum CJ CJ o 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required CJ D CJ 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received D 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ROBERT G. FREY Firm Name (If Applicable) 717-243-5838 REGISTER OF WILLS USE ONLY FREY & TILEY First line of address \'-' (=t 5 SOUTH HANOVER STREET Second line of address o .:::0 -j ~".g = -.J U'> Pl -u )?: N ZIP Code , -)Cj DA~{LiJ:!D ~:D --1 -0 City or Post Office State .....b-. r:? CARLISLE PA 17013 :- U) SIGNATURE RFREY@FREYTILEY.COM ADDRESS fC{G "L ADDRESS 5 SOUTH HANOVER STREET, CARLIS PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041114 15056041114 .-J ---1 15056042115 REV-1500 EX Decedent's Name: DANIEL EJ KAHLEY RECAPITULATION Decedent's Social Security Number 172-30-1624 8. Total Gross Assets (total Lines 1-7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. NONE 2. NONE 3. NONE 4. NONE 5. 6. NONE 7. NONE 8. 9. 21634.00 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) DSeparate Billing Requested. . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) DSeparate Billing Requested. . . . . . . . 21634.00 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . . . . . . 7295.64 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 41111.00 48406.64 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. -26772.64 14. Net Value Subjectto 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.O ~ 16. Amount of Line 14 taxable at lineal rate X .0 ~ 17. Amount of Line 14 taxable at sibling rate X . 12 18. Amount of Line 14 taxable at collateral rate X . 15 0.00 -26772.64 15. 0.00 18. 0.00 0.00 0.00 16. 17. 19. TAX DUE.. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . .. . ...... . . . . . . .. . . . . . . . 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o Side 2 L 15056042115 15056042115 ---1 REV-1500 EX Page 3 172-30-1624 Decedent's Complete Address: File Number 21-07-0147 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER DANIEL EJ KAHLEY 172-30-1624 STREET ADDRESS 7073 CARLISLE PIKE LOT 78 . CITY II STATE I ZIP ':::ARLlSLE PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 0.00 Total Credits ( A + B + C ) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 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. (5) A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes 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 o o o o 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 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. c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . . No o o D D o o 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 .5. ~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 .5. ~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 .5. ~9116(1.2) [72 P .5. ~9116(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. ~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. 217 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DEceDENT ESTATE OF DANIEL EJ KAHLEY SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-07-0147 Include the proceeds of litigation and the date the proceeds were received by the estate. All Drooertv iointlv-owned with riaht of survivorshiD must be disclosed on Schedule F. ITEM NUMBER 1 2 3 4 5 6 7 DESCRIPTION VALUE AT DATE OF DEATH 4,000 1,658 5,894 63 172 1,085 8,762 Mobile Home, actual sales price M&T Checking account 2000 Ford Mustang, Balance owed on Loan Verizon and Allstate Refunds Suburban Propane Refund Pa. State Employment Retirement System benefit payable 2003 Dodge Neon, Balance owed on Loan TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 21,634 217 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF DANIEL EJ KAHLEY FILE NUMBER 21-07-0147 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Cumberland Valley Memorial Gardens 611 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Daniel E. Kahley Social Security Number(s) I EIN Number of Personal Representative(s) Street Address 727 Wood brook Lane City Plymouth Meeting State P A Zip 19462 Year(s) Commission Paid: 2007 2,000 2. Attorney Fees 2,000 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 235 5. Accountant's Fees included in atty. fees 6. Tax Retum Preparer's Fees included in atty. fees 7. Insurance on mobile home sold 183 8. Lot rent on mobile home sold 1,036 9. Final medical bills 246 10. Estate advertising 205 11. Taxes on mobile home sold 7 12. Administrator's mileage 773 TOTAL (Also enter on line 9 Recaoitulation) $ 7.296 Debts of decedent must be reported on Schedule I. (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R I T T ESTATE OF DANIEL EJ KAHLEY SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-07-0147 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank, loan on Ford Mustang 5,894 2. Wells Fargo, loan on Dodge Neon 8,762 3. GE Money Bank/Walmart 1,306 4. Fingerhut Direct Recovery 159 5. FIA Card Services 1,995 6. FIA Card Services 1,653 7. FIA Card Services 2,254 8. HSBC Card Services 4,510 9. Citibank (South Dakota), NA, Sears Roebuck 1,370 10. The Danbury Mint 43 11. Littleton Coin Co. 34 12. Publishers Clearing House 33 13. HSBC Bank, Nevada, N.A. 2,596 14. GE Money Line of Credit 10,502 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 41,111 217 REV-1513 EX... (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER DANIEL EJ KAHLEY 21-07-0147 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Daniel E. Kahley Son 33% 2 Laurie B. Kahley Daughter 33% 3 Clara Ann Kahley Daughter 33% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 e, AS APPROPRIATE, ON REV-1500 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 1$ (If more space is needed, insert additional sheets of the same size)