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Home My WebLink About09-14-07 ..J 15056051047 REV.1500 EX (()6.{)5) PA Deparlmenl ~ Revenue '* Bureau ~ Individual Taxes PO BOX 280601 Harrislltl'g, PA 17128-0601 · ~ J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year d-.\ \)\ Ale NlII1ber \)~~l\ Date of Birth ~l) q ~ 0 9 0 ~ cr Decedent's Last Name Suffix o(pOLf''1.3~ Decedent's First Name MI Gf\I\OJ (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix AT A H l( 5 A 1 ~ Spouse's First Name MI Ef\1(\tJt Spouse's Social Security Number A5MA THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ALL IN APPROPRIATE OVALS BELOW .. 1. OrIginal Retum c:::> 2. Supplemental Retum c:::> 3. Remainder Retum (data of death prior to 12-13-82) 5. Federal Ealate Tax Return Required c:::> 4. Limited Estate c:::> 48. Future Interest Compromise (date of c:::> death after 12-12-82) c:::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c:::> 10. Spousal Poverty CredIt (data of death c:::> 11. EIecIlon to tax under See. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECnON MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENnAL TAX INFORMAOON SHOULD BE DIRECTED TO: Name Daytime Telephone Number 8. Total Number of Safe Deposit Boxes c:::> 6. Decedent Died Testate (Attach Copy of Will) c:::> 9. Litigation Proceeds Received 1\ tJ /!; e )'{,- 'C, Firm Name (If Applicable) 11) ~TfS -, I J l "7 Lf 3 1 6.:3 First line of address ~1i~of1!f) 1 D f(~ f(b fi D REGISTER OF W1LLS USE ONLb -...J C') ;-, ',,', -u -- j ! City or Post Office AI E- W tu. M ~ e R.. )... "It N () State ZIP Code _ J DAT~(Eb r,) c.) P/i / 7 ~1 0 Correspondent's e-mail address: DATE Side 1 L 15056051047 15056051047 --.J <J ...J 15056052048 REV-15Q0 EX Decedenfs Name: Decedent's Social Security Number ~09 s-o 1 oJ....~ RECAPITULATION 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . .. . . . . . . . . . . . . . .. .. . . . . . . .. . . . . .. .. 2. 3. Closely Held CorporatIon, Par1nersh1p or SoIe-ProprietorIp (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & MlsceIfaneous PersoneI property (Schedule E) . . . . . . .. 5. 6. Jointly Owned property (Schedule F) ~ Separate SiIHng Requested . . . . . .. 6. 7. Inter-VIVos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. _ I> 0 -010 -a <<) - 00 -6 &1 -" e - 0 () -00 - 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Ueblllties, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Unes 9 & 10).. .. . . . .. . . . . . .. . . . . .. . . . . . .. .. . . . . 11. 12. Net Value of Estate (Une 8 minus Une 11) . .. . . .. . .. . .. .. .. . . .. . . .. . . . . . 12. 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) .. . .. . .. .. . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Une 12 minus Une 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 Une 14 taxable at lineal rate X.O_ 17. Amount of Une 14 taxable at s/bHng rate X .12 18. Amount of Une 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 Side 2 L 15056052048 - - - - - - - - - 6- c) D ~ 15056052048 --I REV.1500 EX Page 3 Decedent's Complete Address: OECEOENrS NAME File Number STREET CITY ZIP fl.DS"b Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) () 1. tJD Total Credits ( A + B + C ) (2) .r (JrC-O 3. InterestJPenalty if applicable D. Interest E.Penalty TotaIlnterestlPenalty ( 0 + E ) 4. If Une 2 is greater than Line 1 + Line 3, enter the difl'erence. This is the OVERPAYMENT. Allin oval on Page 2, Une 20 to request a refund. (3) (4) (5) (5/4.) (58) ~ ...'bO 5. If Line 1 + Line 3 is greater than Line 2, enter the difl'erence. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5/4.. This is the BALANCE DUE. 0,00 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 Iil b. retain the right to designate who shaH use the property transferred or its income; ............................................ 0 id c. retain a reversionary interest; or.......................................................................................................................... 0 Ila d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 I!j 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 1M 3. Did decedent own an oin trust for" or payable upon death bank account or security at his or her death? .............. 0 [i;J 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 I!t IF THE ANSWER TO ANY OF THE ABOVE QUEmONS IS YES. YOU MUST COMPLETE SCHEDULE G AND RLE 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. 19116 (a) (1.1) (OJ. 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. 19116 (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 retum are stllI 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. 19116(a)(1.2)]. The tax rate Imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 19116(1.2) [72 P.S. 59116(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. 19116(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. -~.~~. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN NONRESIDENT DECEDENT ESTATE OF ~-'( I\\-\\AS ~ I tV f f\ Q..O , When flat tate method is elected. list the beneficiaries of the Penns Ivania SCHEDULE J BENEFICIARIES FILE NUMBER f l 'onate method is elected, list all beneficiaries. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not UstTrustee(s) OF ESTATE NUMBER 1. NAME AND ADDRESS OF PERSON{S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1\ S M, t--. \: f'1v ,,=-0 , __ 115" ill ~\\\ to ~ I) p_ M G C r\ flttJ l C 51 ~u.J<b. 1 f\. \.ll\f~ 1. . ALL JOINT' PFpf,,~\\j ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON REV 1737 COVER SHEET OR THE PROPORTIONATE METHOD WORKSHEET ON THE REVERSE SIDE OF REV-1737 COVER SHEET. AS APPROPRIATE. . NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 911; FOR WH.!f~ f-N ELECTION TP TAX IS NOT BEING MADE 1. M+, f>ArJK ~33~qrtbO c:: ~l"!^"b ~ . p. ...1 (\b"-q'6?-"ll.f3'i~- '3:> ~DUe--ree(b N BA.~ .. N tv 5~. Hf}-CL.t;AIlJ ~CS~J(,,~ , 10,-"S e"; J-O'T 't '" W ~~T 0 ~l · . - H n0~ r3l>bk:::. , 'l5 p~" e- tqs' ~S(riCSSl5t) ~L.L...€' J T r7 IZo->Tw e-ffl1J f\) t= c tf 0 C:-tU\ AND f\Ll-O l N '0 &.0 , 5u.ALHU jT1J0 oJ lFtf' J A shA. EMI\ (0 , II. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. I, (~.?4 ~)~ F)~S7 ~ Vr;: :2.,~l)..r J d. b. D'Ch on _1_...... !___..... _..a....~..:_....,.1 II!!>h.ao.ta nf th.:. C:llmA size) TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV 1737 COVER SHEET $':b BMarl\ ACCOUNT.JtO . 33398860 "&T CLASSIC CHECKING W/INTEREST DEC.20-JAN.19,2007 1 OF 1 00 0 06117H NH 017 52464 ATAHUSAIN E EMADI OR ASMA EMADI 115 W MAIN S1 MECHANICSBURG PA 17055-6228 INTEREST PAID YEAR TO DATE 0.10 HECHANICSBURG CURRENlENDING INTERESTPD BALANCE 0.10 1,183.79 ACTIVITV DEPOSITS:'INlERESl ..CHECKS&OTHER DAILY &OTHERADtU:fl:ONS SIJ8TRACTIONS BALANCE 12-20-06 BEGINNING BALANCE 01-02-07 PURCHASE ON 12131 GIANT FOOD STO 01-02-07 POS ATH FEE 01-05-07 PURCHASE ON OlIOS GIANT FOOD STO 01-05-07 POS ATH FEE 01-19-07 INTEREST PAYHENT $1,232.14 31.60 HECHANICSBURGPA 0.50 15.85 1,200.04 HECHANICSBURGPA 0.50 1,183.69 1,183.79 0.10 ENDING BALANCE t......-$1,183.79 ANNUAL PERCENTAGE YIELD EARNED = 0.09 % A $1,000 FOR YOUR THOUGHTS? VISIT AN H&T BANK BRANCH BETWEEN JANUARY 16 AND FEBRUARY 16 TO RECEIVE AN INVITATION TO PARTICIPATE IN OUR CUSTOMER SERVICE SATISFACTION SURVEY. COMPLETE THE SURVEY FOR A CHANCE TO WIN A GRAND PRIZE OF $1,000. NO PURCHASE OR TRANSACTION NECESSARY. FOR COMPLETE SWEEPSTAKES RULES VISIT: WWW.HANDTBANKSURVEY.COM. .. .StAtEJolOO'PERIOD... . 98294385 "&T PRE"IUM INTEREST DEC.27-JAN.26,2007 1 OF 1 00 o 06117" NH 017 52474 ATAHUSAIN E EMADI OR ASMA EMADI 115 W MAIN 51 MECHANIC5BURG PA 17055-6228 INTEREST PAID YEAR TO DATE 0.48 "ECHANICSBURG ACCOUNT SUMMARY . .c<OlHERCURREN1>:1 : >ENDING su&TRAtttONS> ::: <INTERESTPDI.. :.8ALANtE NO I AMOUNT o I 0 00 o 48 5,657 98 5,657 50 ... .Ol':E~PO:DWfTfOtil~/ :: :.:.:.: :CHECKSPAtD. NO I AMOUNT NO I AMOUNT o I 0 00 0 I 0 00 8EGIMHIHG<< :::: : bALANCE :::: ACCOUNT ACTIVITY ...... ..:':...:<OEPOSITS:.tINTEREST <CHECRs: . <OtHER < .. :::: .TRANSAC'tIONDESCRII"T:ION<::::':... . i>otHElt>AnDltlONS :: . .stiBtRActlOHS:.. 12-27-06 BEGIMHING BALANCE 01-26-07 INTEREST PAY"ENT 0.48 $5,657.50 5,657.98 ENDING BALANCE $5,657.98 ANNUAL PERCENTAGE YIELD EARNED = 0.09 % A $1,000 FOR YOUR THOUGHTS? VISIT AN "&T BANK BRANCH BETWEEN JANUARY 16 AND FEBRUARY 16 TO RECEIVE AN INVITATION TO PARTICIPATE IN OUR CUSTOMER SERVICE SATISFACTION SURVEY. COMPLETE THE SURVEY FOR A CHANCE TO WIN A GRAND PRIZE OF $1,000. NO PURCHASE OR TRANSACTION NECESSARY. FOR COMPLETE SWEEPSTAKES RULES VISIT: WWW.HANDTBANKSURVEY.COM. Free 'Business Checking PNCBa~ o PNCBANK ASMA A EMADI D/B/A ASMA GIFTS ENTERPRISES 115 W MAIN ST MECHANICSBURG PA 17055-6228 Primary account number: 50-0391-4417 Page 1 of 3 Number of enclosures: 0 1! For 24-hour banking sign on to e PNC Bank Online Banking on pnc.com FREE Online Bill Pay For the period 12/30/2006 to 01/31/2007 For customer service call1-877-BUS-BNKG between the hours of 6 AM and Midnight ET. Para servicio en espafiol, 1-877-BUS-BNKG Moving? Please contact your local branch. t8l Write to: Customer Service PO Box 609 Pittsburgh, PA 15230-9738 Q Visit us at pnc.com/mybusiness/ Ia TDD terminal: 1-800-531-1648 ~ For hearing impaired clients only Free Business Checking Summary Account number: 50-0391-4417 Asma A ElIladi D/B/ A Asma Gifts Enterpdses Balance Summary Beginning balance Deposits and other additions Checks and other ded llctions Ending balance 1,793.50 2,197.68 2,946.91 1,044.27 Average ledger balance Average collected balance Deposits and Other Additions Description Deposits ACH Additions Total Daily Balance 1,450.03 1,446.40 Checks and Other Deductions 8 Amount Description Items Amount 2,114.10 Checks 14 2,159.70 L/8~~.58 ACH Deductions 4 787.21 2,197.68 Total 18 2,946.91 Date Ledger balance / Date Ledger balance 01/10 1,105.91 01/29 1,263.52 01./-12- 1,115.45 0l/30 1,103.08 (01/17 1,078.5Q.' 01/31 1,044.27 01/23 1,556.61 0l/25 1,738.69 Items 5 3 Date 12/30 01/02 01/03 01/04 01/09 Ledger balance 1,793.50 2,141.28 1,984.90 1,806.78 1,571.78 Activity Detail Deposits and Other Additions Deposits Date posted 01/02 01/10 01/23 . }'mount V273.74 V~82.25 ,)558.11 Transaction description Deposit Deposit Deposit Reference number 027835871 027889861 026595337 Deposits continued on next page FORM953R-1005