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Home My WebLink About10-17-07 (3) --.J 15056051047 REV.1500 EX (06-05) PA Departmenl of Revenue . Bureau of Individual Taxes PO BOX 280601 ~... Harrisburg, PA 1712B-()6()1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year RIe Number ~\ b ~ b1 '1 L Date of Birth 0711f 7'1/ 07~~ 2-007 Decedent's Last Name Suffix 10 J31,!.:zo Decedent's First Name MI Pt<o ~,fNr ~IfK/Z'- TDH Nt (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 Retum c:=> 2. Supplemental Retum c:=> c:=> 4. limited Estate c:=> 3. Remainder Retum (date of death prior to 12-13-82) 5. Federal Estate Tax Retum Required c:=> c:=> 4a. Future Interest Compromise (dale of death after 12-12-82) c:=> 7. Decedent Maintained a living Trust (Attach Copy of Trust) c:=> 10. Spousal Poverty Credit (date of death c:=> 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 Deposil Boxes c:=> PON~C.I? t. f' ~ c:> tv /9 /f" T 71 T l~g saPO Firm Name (If Applicable) REGISTER OF WILLS USE ONLY City or Post Office State ZIP Code DATE FILED i I I i . ., I I i i I I I ~ First line of address /685 t2EVS/<E P/<'/v€ Second line of address ~$CtV,plU/ CS~tJ~~ Correspondent's e-mail address: /:)0/\/ ~ J? /If I 7 (J S-o L(./Fr:/'1F~#I'~. {!'''M --I . .'.j - - Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my know1 nd 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. ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 --.J \ % 'QI17Z 'plel 'AJO^I'6u,,!IM I030.01d uosdWIS ..J 1S0SbOS2048 REV-1500 EX Decedenfs Name: C'H "~l Tt? P ~ ~t' ~ ""'h, RECAPmJLATION 1. Real es1ate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation. Partnership or SoIe-Proprietorip (Schedule C) .. . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & MlsceIIaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) <::) Separate BlRing Requested . . . . . .. 6. 7. Inter-VIvos Transfers & Miscellaneous Non-Probate Property (Schedule G) <::) Separate BitIng Requested. . . . . . .. 7. 8. Total Gross Anets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent. Mortgage UabIIIIies. & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total DecIuc:tIons (total Lines 9 & 10).. .. .. .. . .. . .. .. . .. . .. . .. . .. .. .. .. . 11. 12. Net Value of Estate (Line 8 minus Line 11) .. . .. . .. . .. .. .. .. .. . .. . . .. .. . . 12. 13. Charitable and GovemmentaI BequestsISec 9113 Trusts for which an election to tax has not been made (Schedule J) .. .. .. . .. .. . . .. . . .. .. . .. 13. 14. Net Value SUbject to Tax (Line 12 minus Una 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of Una 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (aX1.2) X .0_ 16. Amount of Line 14E at IlneaI rate X.O 17. Amount of Line 14 at sibIlng rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 . 15. 3 <j'.1 ~tf8. 06> 16. . 17. . 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1S0SbOS2048 Decedent's Social Security Number 61/ 1~7''I7 . 37,J,77.8lf . . 3Z 005.8'1 . . /f f I 'B / ..78 I *3 ,s,. 7.s- 134'-17 IBd~.$.7~ 313 c:i 4-9 .0" . 393 '4~.tf)6 . /1 7 /./f. l(p . . J7111'.//P <::) 1S0SbOS2048 ..J "m +.7 'aAnAA '.(RICllnn" 'BunUM ID~DUlLI u......e File Number CITY PI/ECto/'/!;AJ/C5 ST~/f ZIP I ? t:J St::> Tax Payments and Credits: t Tax Due (Page 2 Line 19) 2. CreditsIPaymenl A. Spousal Poverty Credit B. Prior payments C. Discount (1) /~ '7/#., /~ p~2. ~O Total Credits ( A + B + C ) (2) ?3z.. 30 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestJPena/ty ( 0 + E ) (3) 4. If Une 2 is greater than Line 1 + Une 3, enter the dlfference. This is the OVERPAYMENT. fill In oval on Page 2, Une 20 to request a refund. (4) 5. If Line 1 + Line 3 is gl98fsr than Line 2, enter the dlfference. This is the TAX DUE. A. Enter the interest on the tax due. /~/ 7B/. B(p B. Enter the lotaI of Line 5 + SA. This is the BALANCE DUE. (5) (SA) (58) 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 transfeJTed; .......................................................................................... 0 ~ b. retain the r1lht to designate who shaH use the property transferred or its income; ............................................ 0 iii c. retain a reversionary interest; 01'.......................................................................................................................... 0 ~ d. receive the promise for life of either payments, benefits 01' care? ...................................................................... 0 LA 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 3. =~:n ~::::";bj;.;;;;.;;.b;;~~.~~~;.~~.~.h~.;;;;.;;?:::::::::::::: B ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probale property which contains a beneficiary designation? ........................................................................................................................ J8l 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. 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. ~116 (a) (1.1) (0]. 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 exenp a transfer to a surviving spouse from tax, and the statutory requirernenls for disclosure of assels 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 chUd 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 decedenfs 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 bJood or adoption. .01 j,7 '3^OAA 'A3lQ 100~ 'BUllUIIIO:J01D.1.1 UosdWllI REV-1503 EX+ (6-98. COMMONWEAl1M OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHIDUU . STOCKS & BONDS FILE NUMBER ESTATE OF a#J'*?~LfZJAl m ;:?~CP/9P-r An property joInt1y-ownecl with right of IUrVIvorIhlp IllUIt be dllcloHd on Schedule F. ITEM NUMBER 1. DESCRIPllON VALUE AT DATE OF DEA1M 5t!3tE /9TTAcHEb TOTAL (Also enter on line 2, Recapftulalion) $ (" more space is needed, insert additional 8heets of the same size) Schedule B Charlton M Prowant Security Symbol # Shares Bid Ask NAV Value Total Baker Hughes BHI 540 $80.74 $82.49 $81.62 $44,072.10 Boeing BA 16 $98.00 $98.47 $98.24 $1,571.76 CitigrouD Inc C 200 $48.45 $48.60 $48.53 $9,705.00 DNP Select Income Fund DNP 505 $10.13 $10.90 $10.52 $5,310.08 Intermac Inc IN 200 $22.00 $30.00 $26.00 $5,200.00 Mirant Com MIR 2 $37.70 $37.81 $37.76 $75.51 Mirant Com MIR WSA 6 $19.00 $114.00 Public Service Entemrise GrouD PEG 100 $86.74 $88.56 $87.65 $8,765.00 Rockwell Automation ROK 200 $69.07 $70.89 $69.98 $13,996.00 Rockwell Collins COL 200 $67.14 $68.96 $68.05 $13,610.00 Southern Company SO 200 $36.05 $36.75 $36.40 $7,280.00 TXU Coro TXU 400 $65.54 $67.26 $66.40 $26,560.00 Mutual Funds At Ameritrade Dodae & Cox Balanced Fund DODBX 356.267 $87.84 $87.84 $31,294.49 Gabelli Asset Fund GABAX 389.16 $51.93 $51.93 $20,209.08 Vanauard Fixed Income VFIIX 1246.532 $10.05 $10.05 $12,527.65 Vanauard Fixed Income VFSTX 4324.299 $10.55 $10.55 $45,621.35 Vanauard Fixed Income VSGBX 1166.468 $10.29 $10.29 $12,002.96 Vanauard Index Fund VTSMX 2112.218 $35.55 $35.55 $75,089.35 Mutual Funds At Vanauard VanQuard Short Term COrD VFSTX 540.993 $10.54 $10.54 $5,702.07 VanQuard Total Stock Market Index VTSMX 402.329 $35.55 $35.55 $14,302.80 VanQuard Small-Cap Growth Index VISGX 800.319 $20.08 $20.08 $16,070.41 Merril Lynch Preferred Plus TR SRS PIS 300 $24.73 $7,417.50 MorQan Stanley CP TR III MWR 140 $22.72 $3,180.80 Total $379,677.89 Schedule B Charlton M Prowant Securitv Svmbol # Shares Bid Ask NAV Value Total Baker Hughes BHI 540 $80.74 $82.49 $81.62 $44,072.10 BoeinQ BA 16 $98.00 $98.47 $98.24 $1,571.76 Citigroup Inc C 200 $48.45 $48.60 $48.53 $9,705.00 DNP Select Income Fund DNP 505 $10.13 $10.90 $10.52 $5,310.08 Intermec Inc IN 200 $22.00 $30.00 $26.00 $5,200.00 Mirant Corp MIR 2 $37.70 $37.81 $37.76 $75.51 Mirant Corp MIR WSA 6 $19.00 $114.00 Public Service Entererise Group PEG 100 $86.74 $88.56 $87.65 $8,765.00 Rockwell Automation ROK 200 $69.07 $70.89 $69.98 $13,996.00 Rockwell Collins COL 200 $67.14 $68.96 $68.05 $13,610.00 Southern ComDanv SO 200 $36.05 $36.75 $36.40 $7,280.00 TXU Core TXU 400 $65.54 $67.26 $66.40 $26,560.00 Mutual Funds At Ameritrade Dodge & Cox Balanced Fund DODBX 356.267 $87.84 $87.84 $31,294.49 Gabelli Asset Fund GABAX 389.16 $51.93 $51.93 $20,209.08 Vanguard Fixed Income VFIIX 1246.532 $10.05 $10.05 $12,527.65 Vanauard Fixed Income VFSTX 4324.299 $10.55 $10.55 $45,621.35 Vanguard Fixed Income VSGBX 1166.468 $10.29 $10.29 $12,002.96 Vanauard Index Fund VTSMX 2112.218 $35.55 $35.55 $75,089.35 Mutual Funds At Vanguard Vanauard Short Term Coro VFSTX 540.993 $10.54 $10.54 $5,702.07 VanQuard Total Stock Market Index VTSMX 402.329 $35.55 $35.55 $14,302.80 Vanauard Small-Cap Growth Index VISGX 800.319 $20.08 $20.08 $16,070.41 Merril Lvnch Preferred Plus TR SRS PIS 300 $24.73 $7,417.50 Moraan Stan lev CP TR III MWR 140 $22.72 $3,180.80 Total $379,677.89 _B.~ '* C<MIClHWEAl. TH Of f'E/>MSYlVAMA INHEMAHCE TAX RETURN ESTATE OF d#;9.1Z{ ~1fJ SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ,.;/J? r:'/f'!:d~,A'iIV 'T FIlE NUMBER Indude lfle ~ d IllgabIlfIlIlhlI dale.. ~ WIlItl8QlMld by lhlI8IlIIII. AI pI'lIpIIty ~ .. lie tight of IlIfYIllionIdp IIIUIt III dlIc:IoIId on Scllldull F. ITEM VAlUE AT DATE NUMBER DESCRIPTION OF DEATH 1. /JA?F!2ITtel9oF ~A.lEY n:lI9RKE, ?~3t:1#t:JlI Scrt.3Z ;2. lHe~iUu... ~ YAFCH ~'IOFY ,p?/,?;e.cF, ~ 5~t/ctz€,/~;I() /J/PA-I/C ~D ../tPlA./r ~a-k'Eres/y/r? /~r::fJe, ~f ""2- 83+tt ()z- '-I /)~/)ve- y,&IU 3~, O(!) 5' 5~v~.FI(:A..J ~/9,<)K I"Z". ~S- TOTAL (AIsoenlerm Hne5, Recapitulation) $ 3 Z, ,003. V9 (If more space is needed, insert additional sheefs d lhe same size) RE\l.15lO ex + (1.f7J . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COWONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF FU NUMBER lllls sc:htduIe must be lXlIY1!lIl*Id and lIled If 1he I/llIWIl'to ." of questions 1 through" on the I8V8II8 side of tile REV.1500 COVER SHEET Is yes. DESCRIPTION OF PROPERTY %OF ITEM INClUDETIIE_OFTIE-. TIBIIlB.'_TODEC8lEllF_TIE QfoTt(lf_ DATE OF DEATH DECO'S EXCLUSION TAXABlE VAlUE NIIURI=R ATTACH A COI'f OF TIE IJEB) FOR -. mAT1!i. V. INTEREST 1. A esr REL)c5'~/I(. S" tf L /It!~ #~r <:>?~~o,," /(;, /~ ~~GI 0 lit 11 ,Aeer o9~4011999 2, 2..2~. 9) 0 I tt I? /lee r- 0'7 (, 40/ Z 1:)00 2; 2.t:> 9.. <1~ 0 TOTAL (Also enteron line 7, Recapitulation) $ t:J (If more space IS needed, Insert addtIonal sheets rllhe same size) REV-1511 EX+ (1()-()6)* COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT IeH.DULI H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DebIa of decedent must be reported on Schedule L DESCRIPTION AMOUNT ITEM NUMBER A. FUNERAL EXPENSES: at. () r~ w# Ft..~II!!I.s:r S c.J.5~O e H ~NICI/1 et:. ~d - FC/N'€ leNt. (:""7:I't=-'?~N~ c';.It2lsr,H'# ~/Ftr c'lVv....e"e"H FJ*~rN~~t:J/t'F r&-i~E,~,,,~ ,,</.,r/./sP /i1lf~I'2I'C,.-,l1f) LF FrC~v 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) ____nn Street Address City Year(s) Commission Paid: State _Zip __"0 2. Attorney Fees 3. Family Exemption: (If dec;edent's address is noIlhe same as claimant's, attach explanation) Claimant SIteeI Address City Relationship of Claimant to Decedent Stale _Zip _un 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. rl9n?/L.Y ~K EJ?1;t?T/c~ /~?t,o /42?- ~O I /9~~o ~3~7: 7~ /~.D() 3 S-OO, C>C> I TOTAL (Also enter on tine 9. Recapitulation) $ /..3; ~6. 7S- (If more space is needed. insert additional sheets of \he same size) REV-1512 EX+ (12.03) .- COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESl)ENT DECEDENT SCHIDUU I DEBTS OF DECEDENT, MORJGAGE UABlunES, & UENS ESTATE OF ~ FILE NUMBER C'1I1'912t.."(l:)/V dl '/'eaw/?A/T F7",.;J:;&" /4F 2 Report c1tbts Incurred by lhe cItcedent prior to cItath which I'HlIInId unpeld .. of the dIte of c1tetfl, inclucllng unl'limbul'Md medical expenses, VALUE AT DATE OF DEATH ITEM NUMBER 1. ~ ,5". DESCRIPTION 3 ,P'.II J)~~r aT" 6r/EA.Jl/C. ~ /~C;?;"IC ) ?';?x.. ;::'/?/O oP/I!)//t) 7 (J# P~rY IJr ~V€,lUue, 2a!)~ /pc:.t:JHIE r"'~ . ;7HI'D ?/z.el()7 fJ/P /)ef"?r ()r 4(/~IIUV€, ~"7 //t.JCop,E r.l?K, ~/t!) 9/1/t:} 7 ~54,e;p z.~. /~ 3S4.00 /3t!:J;J,. DO 7/. 84 I~ 5"~ . " 0 } Z , (!)t::J .cl'l-_ 00 / ~ . 00 ~ t::J~ II t'VQ//5~I!'~f) tAJv,vr/ 1fE~/:'i'e'#~ t?FUI,'CC.s;. ~3T-oo ~ tJS rt<~N5 v,er/ ~t. //f.ICo~?IE Tff,X . 1'/110 9/llc7 ,1";# k . us r~z/95V~~ ;!OCt;. /~c~/F (/191() 1~/8107 () 5 r~E",sot<{, Z<,o7 //tIt::tP??E r~x. ~/9I't) 9/1/07 c,. 1 fl;A./p/lCl.c t-I~;t?~ rr...f - f?;.Ir:?~2. 5:e."e,t/t'ce fll1l~ 9/1 Ie'" g> ;4ot?l77tJA.lI;)~ I/z;97f~ e~K:-'Tll:-/[-/7' T~c 5 7 '. SHOJe.:r ez~rIFIC/9n5: /0 ,ut'Jr#~r SE1f'V/C~ TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed. insert additional sheels of the same size) REV-1512EX+ (12.(J3) *' SCHEDULI I COM!OMEALTH OF PENNSYlVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE UABIU11ES, & UENS RESIDENT DECEDENT ESTATE OF JA? #.&"~ ~.I ~ A ,_ L? FILE NUMBER ~1'/p;1/c-~ro,v,,. / /tV~'7I~1 r'/1't::€ 2 Dr 2 Report cIIbtIlnc:ulTlcl by the dec:edInt prior to cINth which remained unpaid.. of the date of cINth, Inc:IucIlng unrelmbul'Md medical npIllHI. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH j2 ~ / M t; /t'/~ h"" ~F /?/tt'/(? /;'f1 L S 5~.s; Ot::> TOTAL (Also enter on IN 10, Recapitulation) $ 9.3 4', '11 (If 1110I8 space is needed, insert additional sheets of the same size) REV-1S13 EX+ (9-00* COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT HHIDUU J BENEFICIARIES ESTATE OF FILE NUllBER RELATIONSHIP TO DECEDENT NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LIIt'1hllell(I) I TAXABlE DISTRIBUTIONS (lncIude 0WIghl epouIlII cIIIlributionI. and transfers lIlder Sec. 9116 (a) (1.2)) AMOUNT OR SHARE OF ESTATE 1. ()();V ;4-t... ~ '- Pie I) tV /9 A/'7'" :SO^-J / ttJO %, ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON UNES 15 THROUGH 18. AS APPROPRIATE, ON REV-1500 COVER SHEET n NON- TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABlE AND GOVERNMENTAl DISTRIBUTIONS 1. TOTAL OF MRT n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV.1500 COVER SHEET $ (II more space is needed, insert additional sheets of the same size) ~\~