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Home My WebLink About09-24-07 .....J 15056051058 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 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year ~I 0& File Number 05 189-09-0347 Date of Birth 11/29/2006 05/13/1920 Decedent's Last Name Spahr Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Pauline A Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS c::. 1. Original Return ta) 2. Supplemental Retum c:::) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required i..:':::J 4..Limited Estate c:::::> 4a. Future Interest Compromise (date of death after 12-12-82) c:::) 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 c::) 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes R. Scott Cramer Firm Name (If Applicable) (717) 834-5700 P.O. Box 159 - ..r-,<). REGISTER OF ~s USE ONLyg i c:=; 0 -..J : _:..:->.. hrJ (j''); .; =TJ '-'-1 ; '-,e") -0' . .'~~~~ ~ ' First line of address Second line of address ZIP Code .8~T~ ""D -,..... , r) City or Post Office Duncannon State .J.J DATE~EcJ _.._,..^,-"-.:....-.-_.....~ 1"3 .. ' I, r PA 17020 ."', en Correspondent's e-mail address: Under penalties of perjury, I declare that f have examined this retum, Including accompanying schedules and statements, and to the best of my knowledge and belief, Itls 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 PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS DATE ADDRESS r -~ 1-07 L 15056051058 Side 1 15056051058 --' l-~L --.J 15056052059 REV-1500 EX RECAPITULATION '~-~""""""----"'''-'--''''''''''--'-<" Decedent's Name: Pauline A Spahr Decedent's Social Security Number ''''''-'~''''''_e,.,._~." .........__,..q .>- ...'".~", '-';~""'^'~"'-'-"-"""" .,"..... 189-09-0347 ""~"..._"...;......,_..,,_.. ~"..M"_~ 1. Real estate (Schedule A). ............................................ 1. 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. 4,218.11 6. Jointly Owned Property (Schedule F) ;,~::) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C::) Separate Billing Requested.. . . . . .. 7. ." c' '. ."... "--'C~_'____~_'''r'' '_'4~'~"'~~ '" _.""..... .~,_,~_..__ 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 4,218.11 300.00 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. 300.00 12. Net Value of Estate (Line 8 minus Line 11) . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 3,918.11 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. -'-.-----~.-._-_._..---~-"-...~-.-..-..--.-...-.,.---,,-...,,....-.........-........-.."..M....... __....._.,,_.._...._"-...................__ _.._ 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . .. . . . . . . . . . . . 14. 3,918.11 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 45 176.31 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 15. 176.31 16. 17. 18. 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .................. . . . . 19. 176.31 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (~::-~ L 15056052059 Side 2 15056052059 --.J REV-1500 EX Page 3 Decedent's Complete Address: filll Number '" DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Pauline A Spahr 189-09-0347 STREET ADDRESS 22 Tory Circle CITY I STATE I ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 176.31 3. InteresllPenalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C ) (2) TotallnteresllPenalty ( 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. A. Enter the interest on the tax due. (5) (SA) (58) 176.31 8. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT 176.31 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 [iJ b. retain the righlto designate who shall use the property transferred or its income;............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 fK] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 fK] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.............. 0 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [iJ 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 stalule 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 jf 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 P.S. ~9116(1.2) [72 P.S. ~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, SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY ESTATE OF Pauline A. Spahr FILE NUMBER: 2006-01105 (All propertv iointlv-owned with Right of Survivorship must be disclosed on Schedule F.) ITEM NUMBER DESCRlPTION VALUE AT DATE OF DEATH 1. Met-Life P.O. Box 4410 South Hackensack, NJ 07606 Distribution of Met-Life Account # 124923136001 $ 4,218.11 TOTAL (Also enter on line 5.capitulation) $ 4, 218 . 11 (lfmore space is needed. insert additional sheers of same size.) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Pauline A. Spahr FILE NUMBER 2006-01105 Debts of decedent must be reported on Schedule I ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Funeral Home B. ADMINISTRATIVE COSTS: I. Personal Representative's Commission _ Name of Personal Representative (s) Social Security Number(s) tEIN Number of Personal Representative(s) Street Address: City State Zip 2. ATTORNEY FEES _ R. Scott Cramer Law Office $ 300.00 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 FEE - TOTAL (Also enter on line 9. RecaDltulation) $ 300.00 SCHEDULE J BENEFICIARIES ESTATE OF Pauline A. Spahr FILE NUMBER: 2006-01105 ITEM NUMBER OF ESTATE NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT SHARE A. Taxable Requests: 1. Scott M. Spahr 417 Upper Bailey Rd Newport, PA 17074 Grandson one-third 2. Todd E. Spahr 511 Brenneman Dr. Lewisberry, PA 17339 Grandson one-third 3. Stacey M. Spahr 352 N. 25th Street Camp Hill, PA 17011 Granddaughter one-third ITEM AMOUNT OR NUMBER OF ESTATE NAME AND ADDRESS OF BENEFICIARY SHARE B. Charitable and Governmental Bequests: NONE CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $ (If more space is needed, insert additional sheets of same Size) ^ IMPORTANT TAX RETURN DOCUMENT ATTACHED ^ --------------------------------------------------------------------------------------------------------------------------------------- METlIFE, INC. 0712012007 INVESTOR 10 ACCOUNT KEY CHECK NUMBER 124923136001 SPAHR--PAULAOFoo 419413 SHARES SOLD PRICE PER SHARE ($) 67.0000 62.9568000 CLOSING TRUST INTEREST BALANCE Please Note: Your Sale Proceeds Check is Attached OMB NO. 1545-0715 BROKER'S Name, Address, ZIP Code, 2007 Proceeds From Broker and Barter Exchange Transactions Federal Identification Number and Form 1099-8 Instructions for Recipient Telephone Number: Brokers and barter exchanges must report proceeds from transactions to Substitute COPY B FOR RECIPIENT you and to the Internal Revenue Service. This form is used to report Mellon Investor Services -'MPORTANT TAX INFORMATlOW** these proceeds. 480 Washington Blvd. This is important tax information and is being Jersey City, NJ 07310 furnished to the Internal Revenue Service. If 1 a. Date of Sale lb. CUSIP Number you are required to file a return, a negligence 07120/2007 59156R10 22-3367522 penalty or other sanction may be imposed on 2. Slocks, Bonds, etc. 4. FEDERAL INCOME TAX WITHHELD Telephone: 1-800-649-3593 you if this income is taxable and the IRS determines that it has not been reported. $4,218.11 $0.00 TO WHOM PAID REPORTED 0 Gross Proceeds TO IRS 0 Gross Proceeds less commission and options premiums - JACK l SPAHR JR EX UW PAULINE A 7. Description SPAHR METLIFE, INC. 34 PARK DR . . r Recipienfs Identification Number ~.~~ DlllSBURG PA 17019-1300 Investor 10 124923136001 I 416558552 Box 1a. - Shows the trade date of the transaction. For aggregate reporting, no entry will be present. Box 1b. - For broker transactions, may show the CUSIP (Committee on Uniform Security Identification Procedures) number of the item reported. Box 2. - Shows the proceeds from transactions involving stocks, bonds, other debt obligations, commodities, or forvvard contracts. losses on forward contracts are shown in p:lrenthese:;. This box does not include proceeds from regulated futures contracts. Report this amount on Schedule 0 (Form 1040), Capital Gains and losses. Box 4. - Shows backup withholding. Generally, a payer must backup withhold at a 28% rate if you did not furnish your taxpayer identification number to the payer. See Form W-9, Request for Taxpayer Identification Number and Certification, for information on backup withholding. Include this amount on your Income tax return as tax withheld. Box 7. - Shows a brief description of the item or service for which the proceeds or bartering income is being reported. For regulated futures contracts and fOI\'V3rd contracts, "RFC" or other appropriate description may be shown. For inquiries about your account, contact Mellon Investor Services, MetLife's Transfer Agent: Telephone: 1-800-649-3593 U.S. Mail: E-Mail: met/ife@melloninvestor.com MetLife Internet: www.melloninvestor.com/isd c/O Mellon Investor Services PO Box 4447 South Hackensack, NJ 07606-2047 YOUR ACCOUNT HAS BEEN CLOSED. THE ATTACHED CHECK REPRESENTS THE FULL VALUE OF YOUR ACCOUNT. /I CUSIP 001 928 59156R10 OPENING TRUST INTEREST BALANCE 67.0000 TAX WITHHELD NET PROCEEDS $0.00 $4,218.11 00.0000 . - - - co N M o 8 ,... N M o o - MetLife- PLEASE DETACH BELOW CHECK NUMBER: 419413 .:1.1J=-.':I....'II.f.1..1,.1':Ii,..,d.1...~.MI.~aU.f='!lili.U.]:1..:I:i;ii~lil.;I.i*1kW;~.iii.il.I~;i...;I~i..il;.:..;;.r~.;I.iil;.(.i.;;,i..~i~;I~(.i:i;-:i;I.;..~;i."ir.:J~~...:iii.i.;j;::i~ - - - - 60-160 433 CHECK DATE 07/25/2007 CHECK NUMBER 419413 P.O. BOX 4410 SOUTH HACKENSACK, NJ 07606-2010 PAYABLE AT MELLON BANK N.A. PITTSBURGH, PA. INU,S. DOlLARS . . 1001.32701 MBO.360 ""AUTO T50 614717019-1300 341 DOMOOOOO101 Imlll,"l11nl,..III.I.. ...llnll.U... II", ..11..1..1...111 PAY TO THE ORDER OF: JACK L SPAHR JR EX UW PAULINE A SPAHR 34'PARK DR DIlLSlURG PA 11019~1300 I PAV***************$4,218.11I ~~ { AUTHORIZED SIGNATURE 11'00 I. ~ Ill. ~ :III' 1:0 I. :1:10 U;O ~I: o ~ ~"IO ~O :III' f;l \". o N o " 0::: ~ <( LLl -- :E~~~ 04: -l In :::i 0::: .... 0 >- <( a. Ul U >- ,Z t-Ul:n~ t-Zt-o.. o n:: ~ . () 0 a: Z .... 0( 0 Ul .... :l1 Z <( ui z 0::: Ul ~ Z :l Cl "- ~. ',I V I .....J \.0 N rJ .. ...1 ~ -' ~ 0- ) ...:r U N /.) a.. ~) w u V) :c ,..... <= = C"'-.,/ -? (l) (/) ::::l C'") o 't""" € R ::JQ)..- o L.. o ~.~ ~O'ro >:: en .. r- CI; > p::, Z ., !!1 g ~ ~ d~;: ~ 0 g E 25 ;'-c; '>- -g -e d:: -' 0 ro ::) U l-.C C ai ~~O(/) .~ l= Q) .;: g'3c:ro 0::000 .1 ,1ft' ..... : , !'"';$ ~ ;.." - '! I ..w; - ~ .. ~ ~ 'I l'k ~ ~ .' '~:' II ~~ Ii {$ (1j ;"., (i', r::. 'M , It' R. SCOTT CRAMER ATTORNEY AT LAW 5 S. MARKET ST., P.O. BOX 159 DUNCANNON, PENNSYLVANIA 17020 (717) 834-5700 FAX NO. (717) 834-9012 September 21, 2007 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, Pennsylvania 17013 RE: Estate of Pauline A. Spahr Dear Sir/Madam: Please find enclosed herewith an original and one (1) copy of a Supplemental Pennsylvania Inheritance Tax Return for the above-referenced estate. Also enclosed is a check in the amount of $176.31 which represents the tax owing and a check in the amount of $15.00 for the filing fee. Should you have any questions regarding same, please do not hesitate to contact my office. lj?J;lJ- R. Scott Cramer o ~o 0",,:0 ':~ucJ :~~ ~ ([) ~'-< -',' 2~~~ ~~ ~J (,__._ -' ::D --1 Enclosures . r---:) C::::") C:;::::) ----> (/) fTl --0 N .r:- I.J ~.: '">i' N 0"\