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Home My WebLink About00-0040 COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE BUREAU OF INOIVIDUAL TAXES DEPT, 2B0601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT WEST JOHN S 3832 PAMA Y DRIVE MECHANICSBURG, PA 17050 __u____ fold ESTATE INFORMATION: SSN: 000-00-0000 FILE NUMBER: 2100-0040 DECEDENT NAME: V ANTINE EMMA DATE OF PAYMENT: 09/13/2007 POSTMARK DATE: 09/12/2007 COUNTY: CUMBERLAND DATE OF DEATH: 09/29/1999 NO. CD 008671 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $93.15 I I I I I I I I TOTAL AMOUNT PAID: $93.15 , REMARKS: CHECK# 1075 SEAL INITIALS: AJW RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS uSA FlRST_C.Lfl..S5 fORt'JiR If! '-.' .';" '\ ~'...~ ~.' ~ V'J ;:J - ! .v .' ~, < ~. \ it.. ^ a-'~) .~ LJ....Jj' *' Vi Lt' 1""\ ~ (: ~ V,-' / , ! "",','" // t., ) ;:::: ----- <0 ,..... 6 en o ,..... ,. ------ ~ ~ ~ ~ ~rr. ~ ~~ \~ ~::); ~~ , ~,~ ~d~~ 'iii < '" "- ~ ~ . ---la:? = ~E :g ~ .SJ ~~~ ~ C') <J :2 co '" M:2 f%g/ 02 Yc? - "":l; j ......., ..i ~ f:"~ ,,~ "; ~ !: ..~ -- :l! ;~ ...... !~ .. ,. " ~= - J ..... .-J 15056051047 REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 ....... ~ RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Cf OFFICIAL USE ONLY County Code Year File Number ;R~ bu l:J ~ i 0 Date of Birth z, 0 0 0 7 6 6 0-6 Decedent's Last Name 01Zfl??? V,4!JTINE M~5 O~ l 3 I r I L/ Decedent's First Name E /l1 ."" A MI Suffix (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 _ 1. Original Return <=:) 2. Supplemental Return <=:) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required <=:) 4. Limited Estate <=:) <=:) <=:) 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 <=:) 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 8. Total Number of Safe Deposit Boxes <=:) T u P (Tf( V Firm Name (If Applicable) We5T REGISTER OF WILLS USE ONLY "1 First line of address 38 32- f AIf1 If Y Pi. ( VE Second line of address City or Post Office State ZIP Code DATE FILED 'I M E C i-( A fJ ( C. S B () /( G- fit 7 cSO Correspondent's e-mail address: .r I W~ 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 aM 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 knowls!ige. , 70 SO ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --.J , -1 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: ~0007"COb RECAPITULATION 1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. ( b I .5.6 0 O. D. o · D. t> . D. I b I 3.c 0 5" 'I 7.0 0 '0 · > I( 7.0 0 I (){:6:.0D o. ( OCt;.DD 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. 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.o~6o 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 G 3. cr ~ 15. (;3 9',6 ~.fg . 16. . 17. . 18. . 19. TAX DUE. . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. ~.~ 63,'16 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c:::> Side 2 L 15056052048 15056052048 --.J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME CITY r;- It( !f1A- '7J ;t)T(VE Foi<,€ ;; L . nfJRK. 7 {/ 0 tt'l1?-I/t!r- i!zt:5 .7Lt2 ~ .. >LF STREET ADDRESS H~fL -e/f .. .1<,l)1fP TSTAT'}'> Cr=--I/~R Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3. Total Credits ( A + B + C ) (2) -0 (3) (4) (5) (SA) (58) ~f Xt:- ? 3. I S- InterestlPenalty if applicable D. Interest E. Penalty ~{'nFlr 2(1. /{ 0__ 4. TotallnteresUPenalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in avalon Page 2, Line 20 to request a refund. I ZIP 170(3) ~/,. P 7- 6 3, ?'-t 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. 8. Enter the total of Line 5 + SA. This is the BALANCE 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 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 d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 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 No ~ W [JJ/ m- ~ u:v-- ~ 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 PS. ~9116(1.2) [72 PS. ~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 PS. ~9116(a)(1.3)]. AsibJing 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+ (6-9* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF ~/!!/l111 MVTIA/E All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing sener. neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. FILE NUMBER ITEM NUMBER 1. DESCRIPTION (ft -II{ ~~ ~@_ 670 L~ 11-~/ ;V~ ~/ fA ;->06l? VALUE AT DATE OF DEATH (I h I 3 .- / ~ TOTAL (Also enter on line 1, Recapitulation) $ 16' ('$ ~ (If more space is needed. insert additional sheets of the same size) . . REV-1511 EX+ (10-06) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF t:"1I1/fJ11- , V/f/J TI IVr: Debts of dececlent must be reported on Schedule L FILE NUMBER ITEM NUMBER A. DESCRIPTION AMOUNT f S" i(7 FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1 . Personal Representative's Commissions Name of Personal Representalive(s) o Street Address City State _Zip Year(s) Commission Paid: 2. Attorney Fees o 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant o Street Address City State _Zip __. Relationship of Claimant to Decedent 4. Probate Fees (/ 5. Accountant's Fees 6. Tax Return Preparer's Fees (;) o 7. TOTAL (Also enter on line 9, Recapitulation) $ .>C( 7 ~ (If more space is needed, insert additional sheets of the same size) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280&01 HARRISBURG PA 17128-0&01 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE [\U\ n~T#~E~i)F INHERITANCE TAX r:n:CD~~j!J~Af\SlM-iNl, ~-'Ai.LOWANCE OR DISALLOWANCE . 'c:;-::.-HF;:,DED1JQr.tPHs AND ASSESSMENT OF TAX ! 'j_,.\..)I,-,! _I :'.,) ;, I...' '* REV-1547 EX AFP (0&-05) DATE 11-26-2007 ESTATE OF VANTINE EMMA DATE OF DEATH 09-29-1999 FILE NUMBER 21 00-0040 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 01-25-2008 ( See reverse side under Objections) Amount Remittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF VANTINE EMMA FILE NO. 21 00-0040 ACN 101 DATE 11-26-2007 Z001 DEe -5 PM 12: 33 JUDITH V WEST 3832 PAMAY DR MECHANICSBURG (d i:Q, -K nF- VLL.1 -i~ ;:",...., , nRr' I'. '. 1" " j!\JT , 1\-'.-1,1""\\' ,....... \ - . ~ )t~\ I V ,. ' ' . '".~ .,. ',' eu' ' ~A PA 17050 TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) s. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) S. Total Assets (1) (2) (3) (4) (s) (6) (7) 1,613.00 .00 .00 .00 .00 .00 .00 (S) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 1,613.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. 11. 12. 13. 14. Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return (9) (10) 547.00 .00 Cl1) Cl2} Cl3} Cl4} 1147.00 1,066.00 .00 1,066.00 Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Net Value of Estate Subject to Tax NOTE: If an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of Ahl returns assessed to date. ASSESSMENT OF TAX: IS. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate IS. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TA C DITS: PAY ENT DATE 09-12-2007 11-19-2007 Cls} Cl6} Cl7} ClS} .00 X 00 1,066.00 X 06 .00 X 00 .00 X 15 Cl9}= .00 63.96 .00 .00 63.96 RECEIPT NUMBER CD008671 SBADJUST DISCOUNT (+) INTEREST/PEN PAID (-) 29.19- .00 AMOUNT PAID 93.15 .02 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 63.96 .00 .00 .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. 'i IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DU A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)