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Home My WebLink About99-0060 ~ " ~ 15056051047 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 Date of Birth ~~ Suffix Decedent's First Name 0:0 OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT File Number Decedent's Last Name MI m (If Applicable) Enter Surviving Spouse's information Below Spouse's Last Name Suffix OJ] Spouse's First Name MI D THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER 'OF WillS FILL IN APPROPRIATE OVALS BELOW _ 1. Origin~1 Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate TaxRetum Required ~ 4: Limited E;tate ~ - ~ 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 B~ DIRECTED TO: Name , Daytime Telephone Nurnber 6. Decedent Died Testate' (Attach Copy of Will) 9. Litigation Proce,eds Received .~ 8. Total Number of Safe Deposit Boxes ~ Correspondent's e-mail address: Under pe,'alties of perjury, I declare that I have examined this retum. including accompanying schedules and statements, and to the best of my knowledge and 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. SIGNATURE OF ~o-:o~nN RESPONSIBLE FOR FILING RETURN DATE ADDRESS .,., ., SIGNATURE 0 DATE 1.).-/1-0 J ADDRESS 3tt7 ll-r-h's'~ ~ /70/3 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ---I , ~ ... ' .. ,2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . , . . . :...:-.,~,~ ~ '.-. ~ ";"-'_" "'1;'" .. .~::-:- -::.:.-: ;;.::...tt-"',-r-'<:' ;::",r.:i"rJL;;~ . . 4. M.ortgages & NotEls Receivable'(~chE1duleoo)~: ::......................... " "-..' ",,' ,;-: ~ :' ' 5. Cash, Bank Deposits & Miscellan~ou~ Personal Property (Schedule E) . .-. . . . . . ... . ",-'..,': ., 6, Jointly OW~b'd'P~6g~r!'X(~~~~~01~Vr~E::rs~ph(a.t~iI3;lIi.n~'R~~Ge~ier.. . . .. ." l' ~ ~-- '. ;,...], _'I- or .1- _ .J. _' ..J ",,' ,A"-' "",' '_' ~ 7. Inter-Vivos Transfers & 'Miscellaneous Non~Pr'obate . Property (Schedule G) c::::) Separate Billing Requested.. . . . . . . ,-.t.:;.:.,: '"" "'_-. (' ~_ <-. ., 'r_ :.'\::::.z1'~"~,,,,;;;:'~ r. "..--..... ..... ~".::: .t, 8. "TotlllGrbs~'~sse!s(total ~ines 1:i(:..............;. .-::........ :.....:.' -' _:"'_i, ;-:-";"_:~"'_!,-~ _. ':~"'::-_'_~_~, <",:~:,..,~,::~,:;::.'-.~, _',::;.. 9. . Funerai Expenses & Admln'istrative'Costs (Schediihi H). . .' ,.; . .: : ,': :.'.:';'~. :. . .. ,- '. ", '":'" ..\: ~ ~ ." ..-.~; '.. ~ "'; <~ ~:','.,;--',;~:T.__~' J'" - ::-Y~~ff,:.~id1.~',;i;;,i~:;~'b::",,_::-:;,~'}"~:~'-=.;:~h~7.:,'in...,,:... ~. 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I)~ .. , ..::;-: :.. >.. . .10. ~'~.!L.::) '..;.~: :-:; ';i-,'._~;'~""'bi3. 3-t '..=::,'_~ - :,,;.~-:i$.:2'i;~'!~J::.(< I~.>. -: ,- . . or. , 11. Total Deductions (total Lines 9&'10), .......~ .;;,.::, .','~;; .~'. ::" ;,..:;,; ..;,.... 11. ;,. :-;:.~c'r"-,' "c":;:':"~":;:":.I'::/;;~~.;~';;f~~~~ia.{~"~1';'::':~'. ",.,,:~.;";; .1.';~:'3-'~~;:" :6 "12:' Net'val~e'orE~tate)(L:i~"8 mi;Js-jJned11)~: ~ :~Y'::' ::'. ~~'~:'.':~:',..': ::,~"': ~,: .~ 12.' .' ,'. _, ',- '. A.:'.) ;;:i:::..i;,-.;..~<;c:.\lt~~~,~,tl.~.t.h"~9:"';:~:"T~-f;'-:' '::><":_'~':'>. ~._,,':,',_' ,_., .~_,.'''' ~'.;'~ . ;, 1~.. Charita~'e~n9 ~o~e~ry;eii~~I~~q~estslS~ 9113Tnists for which .. \"~a!" electiol'ltotax h(l~~o~ be;e~~a,d,e(ScheduleJ).. ,.. " . .. . .. . ,.l. .. ;, .,.,_",.,,: ~ . ~:i-':' ,.- '" ." ". ..... ; ~:, _", _:~ : ,.'. . :.. '~,":' ..;.:,~.:'. ;;,_": ~ _..:..._._.......".......... :.~~.t<': ..,'Co.' ".:\ ",c".,'. . . 14~:NetValue Subjectto.Tax (Line.12 minus Line 13);,.:..,...,.,. .......... .14. ,: ~'. '.-.....__, ~,... "- ; .~..." ;'.-,.~i.:.. ~ .'\("'_'..,........"'.. ,::'.,.-_ ,.,...~., ......' -:. ''';'''!;,.;:".,._:..J';_. 'l1,"Y ,c;,...,'r.{;. J', ,,::.- " .. '-:, , ... ....~', '. <.:--" "._ :.':. ,,_' TAX COMPUTATION ~. SEE INSTRUCTIONS FOR APPLICABLE RATES. " -, --,...... . -- '......;.. . '. 15. Amount ofLin~,14 taxable .". . at the spousal taxnite;or>>' transfers urider Sec. 9116 ~,'~;( (a)(1.2)X .0_' 16. Amount of Line 14 taxable at lineal rate X .O..c.,...- . 17. Amount of LilJe 14 taxable at~ibling rate, X .12 . . 18. Amount dUne 14 taxable at collateral rate X .15 19. TAX DUE.. . . ':':::":::~.~;.~:,.~:<.:,:~:.-;,,;;,::;,~:'..:..:.,::,: . . . . . . . . . . .. . . . , . . . . 19. ..: . .;~;.":'-'.-"':;,'!~'"":~;':::;--:i'~} <:;.Jb/~~.-:-J.' j:.\.' '-'. ';': - :~. :~> . ~~\:-;t~~,;? ", :~i }:~::Z~:.::::~::::' ,'.l'~';;~~ ~J:.:.:~~t~ ~. ','" - 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 2. 3. 4.' 5. 6. 7. , ., " 8. 9. .1 . ~ ~ ,. ~ : ~ .. REV-1500 EX Page 3 File Number '?A. ~, t?1- OObO eu..w.~e('I~A.. 00. ,qq 'l- OOO"c> Decedent's Complete Address: DECEDENT'S NAME STREETADDRESS~ \ 937 (l~ll~{e A. Ge.or j e.. (V\ Af k t.0 00 0\ Ave. CITY I STATE I j ?-A : ZIP I 11b1-3 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount -0- 3. Interest/Penalty if applicable D./nterest E. Penalty Total Credits ( A + B + C ) (2) - t;}) - Total Interest/Penalty ( D + E ) l 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. A. Enter the interest on the tax due. (3) -0- (4) .---~ - (5) --~- .. ., (SA) -- ~-- (5B) - 0- l. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLSi,AGENJ .. ~~ wit P - ~1il~1!II, I... 1I"~.I.t.l~_ 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 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [g c. retain a reversionary interest; or.......................................................................................................................... 0 IS? d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [X 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?,.. n I)g 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 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. or 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 ; three (3) percent [72 P.S. ~9116 (a) (1.1) (i)]. :or 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 '.2 P.S. ~9116 (a) (1.1~ (ii)]. ~he statute ?oes not :~empt a tra~sfer to a survivin~ spouse from tax, and the statutory requirements for disclosure of assets and ling a tax return are stili applicable even If the surviVing spouse IS the only benefiCiary. =or dates of death on or after July 1, 2000: he 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 doptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(a)(1.2)]. - he 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 2 P.S. ~9116(1.2) [72 P.S. 99116(a)(1)]. 1e tax rate imposed on the net value of transfers to or for the useef the decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)]. A sibling is defined, under 3ction 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. - . . . REV-150~H+(6-98. COMMONWEALTH OF PENNSY-LVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER ~ ~. ~~-oo f.;,() 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 seller, 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. f'J\~ A, ~t"je. ~ {"L> ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH No" e. TOTAL (Also enler on line 1, Recapitulation) $ {If more space is needed, insert additional sheets of the same size) -0- ..... , ' -,~".,'~, '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF MAR-tf A. G eD('je. FILE NUMBER ?~ .:2./Qer-oo'='6 ~kl4M.A.a Jq~-o60'O All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. None.. TOTAL(Also.enteron line 2, Recapitulation) . $ (If more space is needed, insert additional ~heets of the same size) -0- I' -,~.."." .. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSEL Y.HELD CORPORATION, PARTNERSHIP or SOLE.PROPRIETORSHIP ESTATE OF MA~ A.G~e FILE NUMBER ~ ~ ,</'1. Db Go ~bu-lLM Q,. I qtftj,-CO/)h 6 Schedule C-' or C-2 (Including all supporting information) must be attached for each dosely-held corporation/partnership interest of the decedent other than a sole-proprietorship. See instnJclions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH tvOr'\e... =rOTAL~Alsoenteron tine 3, Recapitulation) $ ~If more space is needed, insert additional sheets()Une~amesize) - 0- , . REV-1505EX. (1-97) . SCHEDULE Cmi CLOSEt YcHELD CORPORATE STOCK INFORMA TIONREPORT A, ~r'rj~ FILE NUMBER ~...:J I q~ -00 c;" 0 ~OV'/~ DD lq~- 000"0 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF M A~ 1. Name of Corporation Address City 2. Federal Employer 1.0. Number 3. Type of Business State Zip Code State of Incorporation Date of Incorporation Total Number of Shareholders Business Reporting Year Product/Service STOCK TYPE Voting / Non-Voting TOTAL NUMBER OF SHARES OUTSTANDING PAR VALUE NUMBER OF SHARES OWNED BY THE DECEDENT VALUE OF THE DECEDENT'S STOCK 4. Common $ $ Preferred Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? 0 Yes DNa If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? 0 Yes DNa If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock of this company within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes 0 No If yes. 0 Transfer 0 Sale Number of Shares Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. g. Was there a written shareholder's agreement in effect at the time of the decedent's death? If yes, provide a copy of the agreement. Consideration $ Date o Yes 0 No tv/A 10. Was the decedent's stock sold? 0 Yes 0 No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? 0 Yes 0 No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. Detailed calculations used in the valuation of the decedent's stock. Complete copies of financial statements or Federal Corporate Income Tax retums (Form 1120) for the year of death and 4 preceding years. C, if the corporotion owned reolestote, submit 0 list showing the complete addrBss/es and estimated fair market value/s. If real ~stale appraisals have been secured, attach copies. . D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits r~ived from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the <lecedent's stock. , . . REV-150Ei EX+ (9-00) '" W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE (..2 PARTNERSHIP INFORMATION REPORT ESTATE OF Mttrj A . G eol'de. flLENUMBER p~ .:lllfe'f-Oo"o ~er/~ Oc,. jlq9-ooo~ Date Business Commenced 1. Name of Partnership Address Business Reporting Year City State Zip Code 2. Federal Employer 1.0. Number 3. Type of Business ProductlService 4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $ 5. PARTNER NAME PERCENT OF INCOME PERCENT OF OWNERSHIP BALANCE OF CAPITAL ACCOUNT A. B. C. D. 7. Was the Partnership indebted to the decedent? ................................. 0 Yes 0 No If yes, provide amount of indebtedness $ 6. Was there life insurance payable to the partnership upon the death of the decedent? ..... 0 Yes 0 No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy NA 6. Value of the decedent's interest $ 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? DYes 0 No If yes, 0 Transfer 0 Sale Percentage transferred/sold Consideration $ Date Transferee or Purchaser Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? .... .. 0 Yes 0 No If yes, provide a copy of the agreement. 11. Was the decedenfs partnership interest sold? ....................................... 0 Yes 0 No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................... .[] Yes 0 No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .................................... 0 Yes .[] No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . .. 0 Yes 0 No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE 1FOLLOW,JNG INFOR1\7IATJON MUST BE SUBTIlimrEo WJIH TfllS SCHEDULE A. DetaileG calculations useG in the valuation of the decedent's partneiShip interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and-estimated fair market value/s. If real estate appraisals have been secured. attach {:opies. D. Any other information relating to the valuation of the (jecedent's partnership interest. . . . REV-150? EX+ (1-97) SCHEDULE D MORTGAGES & NOTES RECEIVABLE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MA~ A. GeJ)"je FILE NUMBER (y~arf~~ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH None.. 1. TOTAL {Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) - 0-- . . RfV-l50B EX. (1-97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF fV\ A~ A. ~~ e. FILE NUMBER (>~ - 0\ , qCj -0 0 ~ D ~bq-/~ 0-0. ,~q-ooo" 0 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1- .;l. ~. 4. DESCRIPTION f;tla~t\f{l Trtt:>-t) ^~I, :>JI. ~ l/..$S~ Oj~ ~~ ~"ttr (5ee &-fuc.h@d , is,) '1fJf'''''. ~ ~Itb~j A~. <?!J~ar 03 D'I ;)16 A~ardl-~ tJ! ~\')Sflf*",~) '~ A ~ .~jf i~ \t) M .bic1l~~(y1~ ~jsbj~~ 1(111 p~ . VALUE AT DATE OF DEATH ~~tM, CO ~'i ~~ ~'I.ga l'l'l. 00 5. 1 t)o. ()O TOTAL {Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) b-'.3a.83 ''0 . .~ Mark K. Keller R.D. 1, Box 64 Landisburg, Pa. 17040 Phone 789-3616 AUCTIONEER * REAL ESTATE CONSULTANT Appraisal On January 9, 1999, I , Mark K. Keller, appraised the following items for the estate of Mary A. George, 1937 Maple Wood Avenue, Carlisle, PA Oak side board with mirror ----------------------------------------------------------------$225.00 Round oak pedestal table -------------------------------------------------------------------.125.00 Four vinyl covered chairs @ 5.00 -----------------------------------------------------------20.00 Hotpoint refrigerator (19.7 cu ft )------------------------------------------------------------7 5.00 G~ electric stove------------------------------------------------------------------------------25.~ Metal cabinet -----------------------------------------------------------------------------------.5.00 Pots, pans, & miscellaneous kitchenware---------------------------------------------------15.00 Small oak roll-top desk ---------------------------------------------------------------------.145.00 Plank bottom chair ----------------------------------------------------------------------------20.00 "inyl recliner------------------------------------------------------------------------------------.5.00 Drum table with drawer ----------------------------------------------------------------------4 5.00 Miscellaneous stands--------------------------------------------------------------------------30.00 Wooden rocker ----------------------------------------------------------.-----------------------5.00 Plank bottom rocker --------------------------------------------------------------------------35.00 Zenith portable color remote T" ------------------------------------------------------------25.00 Hallway mirror with hangers -----------------------------------------------------------------7 5.00 Pictures and frames ---------------------------------------------------------------------------15.00 Round beveled edge mirror ------------------------------------------------------------------10.00 Maple bedroom suit (double bed, dresser with mirror, chest ofdrawers)---------------85.00 Miscellaneous chairs --------------------------------------------------------------------------20.00 Single bed--------------------------------------------------------------------------------------10.00 Singer sewing maclrUle in cabinet------------------------------------------------------------25.(H) "eneered chest of drawers -------------------------------------------------------------------15.00 13lanket chest---------------------------------------------------------------------------------.100.00 Dry sink --------------------------------------------------------------------------------------.12:5 .00 Whirlpoo I washer------------------------------------------------------------------------------60. DO Wooden cupboard -----------------------------------------------------------------------------4 5.00 Small drawer stand ----------------------------------------------------------------------------35.00 Double door metal cabinet -------------------------------------------------------------------1 :5.00 Total A ppraisal-------------------------------------------------------------------------.$1435.00 ~. Mark K. Keller Au-1994-L Rtv-1509EX' (1.9'7) SCHEDULE F JOINTLY-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF fY1 r\ ~ A. ~~~ FILE NUMBER A. 01'~" -co f.., 0 ~{~{k 1t:t~'1- "Cb(..O If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S} NAME ADDRESS RELATIONSHIP TO DECEDENT A. t00 r\e.. B. c. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. ~ oY\e.. '. r. ~.r TOTAL (Also enter 00 line U, Recapitulation) $ (If more space is needed, insert additional sheets<lf the same size) REV;1510 EX+ 11-971, . SCHEDULE G INTER.VIVOS TRANSFERS & MISC. NON.PROBA TE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF M~I<-( A. ~('1 e.. FILE NUMBER ~ ~bu-/~ ~ ~J o!f4J ~OO~D Iqe:;1 ~000 {,o This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-l500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF 1TEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE ATTACH A COPY OF THE DEED FOR REAL ESTATE. NUMBER VALUE OF ASSET INTEREST IFAPPLICABLEI 1. NoY'J ~ TOTAL (Atso.enter on line 7, Recapitulation) $ -0- (If ~ ~ace is needed, insert additional 'Sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTAT€ OF FILE NUMBER Debts of decedent must be reported on Schedule J. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: . t-.h e. k k F' f-V"1U"a.t r\o M € 4: "- (u.M.pt,:uj '54.3,~ 3) 11731..80 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 5'k,\l tt.. '~r t1 5 2. Social Security Number(s)/EIN Number of Personal Representative(s) Street Address I '""h-1 iA..S Q."tA-r r City R.\~ 'v>o'('o State~ZiP \8Cf:S-~ Year(s) Commission Paid: uJa:lile~ Attorney FeeS~\ ~" W{'E'-kS, G-S.1 u..i f'e Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant _Or- ~~;o. CO 3. Street Address City State _ Zip Relationship of Claimant to Decedent Probate Fees (!o.,w..~IMulCc. F}~\~Q(' ,,~ w.lls ~77.0D;'~ ~""'A~~~ ~~~ Co. lJ.i4.'.:rour~ 4>lPD . ' ~o<O.o\S 4. 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL {Also enter on line 9, Recapitulation) $ 511 f.3. oS' (If more space IS needed, insert additional sheets of the same size) . REV-1512 !,X+ (12'{)3) . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INI-IERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. ~. 3. ~. · .s~ DESCRIPTION VALUE AT DATE OF DEATH '~.Ib Bt.oq ,~.OO .5S tf I. <fJ-- \ 00.0 0 .'il. Sf. .s(,. qq ~/)O I at,DO )5.73 lSbO,&3 ....1, .77 If.o~ (" 7, g. ? Ie II. \~ I~. \(E!-"'l"Il:th R :Gu cst ..u.~ II'! D ~'\'t;oie. PAte.-O\Ojl A 5$0(, 1)1\"'1 ~ ~.\A..7 .l.EL ML:> ?~ ~~, b s;. ~~/I'c LuJRn.f'e. . . m ~V1 ~.~tJ\e.r)ACl ~t.o-"'eer: J.\p~s.d; fir~\ Prop42ry ~.IW\+ t~T S~ bar) dul-r;c. c\1.!>co~~tiO'f\ tj r-e.w.oJed tJ ~ tt.f/>h~ ~l'r C6n~J J ft'~ ,-e..w.o lIA{) ~~:J~ Tt-U'5T) ;-,.v..:!>T ;HA!.cWt\~0 -t>C2.t.5 Gr-ej4>r~ ~e...W'15; MD ~€.C~~ t,.Ut1e.t /l4b J 1 i . .~ ) . 7/.3',S'/ TOTAL (Also enter on line 1{), Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ ~9-OO. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Mf\~ A. be-CfJe. FILE NUMBER A .;ll ~ - 00 ~ 0 (1.u....~u ll"\d a. ,qqtj -0004<>0 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMB1:R 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 cl1 ~lc:. o..u1o~lle 'Do "1 ~~~t., S~~9116 (a) (1.2)] P4. (\ -k.~ e 'Ii ~ ~ e.:=.tA'fe 1. k OL\ oSU. lie.. I .. ~~~;'}o~ etulto.. .::r^&>bs(!p ""B~" If:JB~ bore> P". 5\~ ~. , rrtlA '!:> c.u-, J ~ ~]oTA1a.. Iotll. \ \ ~ 3A(!llbO (de.~~II..St'.t) >> t'~if '1/3 bd. ~~ esi-A~e. 5. WI9Dl'l . ~ T hi'., ~Q.\r~.a~vJ I\SOIl :SA.~ ; ('. o .,~ i\,ll 51. u.pl~t fA ,lfo15 (!) fY\().J'~ AM k I ~t\er .3 tol, II C:t. jA..p'~ J p~ i~O'S" ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN EL-ECTION TO TAX IS NOT BEING MADE 1. Non~ B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 11- ENTER TOTAL NON-TAXABlE DISTRIBUTIONS ON LINE 13 0F REV-1500 COVER SHEET $ ~. tx.O: (If more space is needed, insert additional'sheets of \he same size) REV-1514 EX.. (12-{)* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN Check Box 4 on REV-1500 Cover Sheet ESTATE OF fV\ " ~ A, GeDrj'e. FILE NUMBER 0.. 011 etq-ooloo CL.rJl~c:twl a I'tj~" ()ODf.,O This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates ot death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. ~ Indicate the type of instrument which created the future interest below and attach a copy to the tax return. N o Will 0 Intervivos Deed of Trust D~Other - . LIFE ESTATE INTEREST CALCULATION NAME(S) OF LIFE TENANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LlfEfS'TATE.lS PAYABLE o Life or 0 Term of Years o Life or .0 Term of Years o Life or .0 Term of Years o life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Actuarial factor per appropriate table ................................................. Interest table rate - 031/2% 06% 0 10% 0 Variable Rate % 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ ANNUITY INTEREST CALCULATION NAME(S) OF LIFE ANNUITANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS ANNlIITY IS PAYABLE o life or 0 Term of Years o life or 0 Term of Years o Life or 0 Term of Years o Life or 0 Term of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Check appropriate block below and enter corresponding (number) .......................... Frequency of payout - 0 Weekly (52) 0 Bi-weekly {26) 0 Monthly (12) o Quarterly (4) 0 Semi-annually (2) .0 Annually (1) 0 Other ( ) 3. Amount of payout per period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ................................... 5. Annuity Factor (see instructions) Interest table rate - 031/2% 06% 0 10% 0 Variable Rate % 6. Adjustment Factor (see instructions) .................................................. 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period,'Calculation is: Line 4 x Line 5 x Line 6 . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4'x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which -create the above futur.e interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should .be reported at the appropriate tax rate on Lines 13 and 15 through Hl. {If more 'Space is needed, insert additional sheets of the same size) REV.1644 EX. (3-B4) INHERITANCE TAX ,. : .~ SCHEDULE ilL" COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT OR INVASION INHERITANCE TAX RETURN .:l1~-oO (pO RESIDENT DECEDENT OF TRUST PRINCIPAL fILE NUMB"ER Georcce.. f\I1 A^ - A. I. Estate of " ...., (Las! Name) . . (Firs! Name) (Middle Ini!ial) This schedule is appropriate only for estates of decedents dying on or before December 12. 1982. This schedule is to be used for 011 remainder returns when on election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Ad of 1961 or to repornhe inva!ion of trust principal. . II. Remainder Prepayment: tJA A. Election to prepay filed with the Register of Wills on (Dote) (attach copy of election) B. Name(s) of Life T enant(s) Date of Birth Age on dote Term of years im:ome or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule l- 1 1. Real Estate S 2. Stocks and Bonds $ 3. Closely Held Stock/Partnership S 4. Mortgages and Notes S 5. Cash/Misc. Personal Property S 6. Total from Schedule l-l $ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities $ 2. Unpaid Bequests $ 3. Value of Unincludable Assets S . 4. Total from Schedule l-2 $ E. T otar value of trust assets (Line C-6 minus Line 0-4) $ ,.". F. Remainder factor (see Table I or Table II in Instruction Booklet) G. Taxable Remainder value (Line E x Line F) $ (Also enter on Line 7, Recapitulation) III. Invasion of Corpus: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life T enant(s) Dote of Birth Age on dote Term of years income or Annuitant(s) corpus consumed or annuity is payable C. Corpus consumed S D. Remainder factor {see Table I or Tobie II in Instruction Booklet) S E. Taxobie v-otue of corpus consumed {line C x Line D) S {Also enter on Line 7, Recapitulation) \ /l.EV.J6.45 EX+ ~7-85) INHERITANCE TAX '* SCHEDULE L-l COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION cQ,q~-oo 60 INHERITANCE TAX RETURN RESIDENT DECEDENT -ASSETS- FlU NUMBtR I. Estate of GeOr6\'e. JVtA~ A (Last Name) ,j (Fir~ Name) (Middle Initial) II. Item No. Description Value A. Real Estate (please describe) iN~ Total value of real estate S (include on Section II, Line C-1 on Schedule L) B. Stocks and Bonds (please list) Total value of stocks and bonds S (include on Section II, line C-2 on Schedule Ll C. Closely Held Stock/Partnership (attach Schedule C.1 and/or C-2) (please list) Total value of Closely Held/Partnership S (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ (include on Section II, Line C-A on Schedule l) E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property S (include on Section II, Line C-5 on S'Chedule L) III. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $ (If more space is needed, attach additional 8% x 11 sheets.) " REV. 1-646 EX +(3.84) . COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITANCE TAX SCHEDULE L-2 REMAINDER PREPAYMENT ELECTION -CREDITS- FILE NUMBER .~ I ~q -<:do Ai I. Estate af ~qe (Last Name)\J MA~ (First Nalne) (Middle Initial) Amount II. Item No. Description A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L- 1 (please list) filA Total unpaid liabilities $ (include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests S (include on Section II, Line -0-2 on S{;hedule L) C. Value of assets reported on Schedule L-l {other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total uniocludabl.e assets S (include on Section II, Line 0-3 on Schedule L) III. TOTAL 1A~50 enter on Section II, tine D-4 on Schedule L) (If more space is needed, atta<:h additional 8% x 11 sheets.) $ , REV-1647 E)(+ (9-00. COMMONWEALTHDF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet ESTATE OF fV\A~ A. &Df~e.. FILE NUMBER P"A. ~,41t}. CD h O~bf.V'la.Nt 00. 1'141- ooobD This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in A possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^) o Will 0 Trust 0 Other f V I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. 0 Unlimited right of withdrawal 0 Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ..... .$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One 06%, o 3%, o 0%......................$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One 06%, o 4.5% .......................... .$ {also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ..... .$ 6. Value of Line 1 taxable at oollateral rate (15%) (also include as part of total shown on line 18 of Cover Sheet) ..... .$ 7. lotal value of Future Interest {sum of Lines 2 thru ~ must equal Line 1) ..................... .$ (If more space is needed, insert add~ional sheets of the same size) REV-16~ EX (11-99) . '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX DIVISION SCHEDULE N SPOUSAL POVERTY CREDIT (AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94) ESTATE OF fV)~~ A, e.. FILE NUMBER a.. 02.1 q'J -ooft D (ku.,..btr-lilMA ~ ti'jq~/)A:l6tJ This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. PART I - CALCULATION OF GROSS ESTATE 1. Taxable Assets total from line 8 (cover sheet) ..................................... 'f\.' ..... 1. : :::::~::::O"~'Of~oed'"t.............................. .NA. : 4. Joint Assets with Spouse ............................................................ 4. 5. PA Lottery Winnings ............................................................... 5. 6b. 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 6. 7. Total Gross Assets (Add lines 1 thru 6) ................................................. 7. 8. Total Actual Liabilities .............................................................. 8. 9. Net Value of Estate (Subtract line 8 from line 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 9. If line 9 is greater than $200,000 - STOP. The estate is not eligible to claim the credit. If not, continue to Part II. PART II - CALCULATION OF JOINT EXEMPTION INCOME - (Attach copies of Federal Indiv:dual Income Tax Return for decedent and spouse.) Income: 1. TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse .......... . 1a. 2a. 38. b. Decedent ......... . 1b. 2b. 3b. c. Joint ............ . 1c. 2c. 3c. d. Tax Exempt Income . . 1d. 2d. 3d e Other Income not listed above ....... . 1e. 2e. 3e. f. Total ............ . 11. 21. 3f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1 f) + (2f) + (3f) (+ 3) 1. Insert amount of taxable transfers to spouse or $100,000. whichever is less ..................... 1. 4. Multiply by credit percentage ~see instructions) ........................................... 2. This is the amount of the Resident Spousal Poverty Credit. InckJde this figure in the calculation of total credits on line 18 of the cover sheet. ............................... 3. For Nonresidents, enter the ratio of the decedent'-s gross estate in PA to the value of the decedent's gross estate ............................................................. 4. Multiply line 3 by line 4 and enter the k>tal here. This is the amount of the Nonresident Spousal ~_.._~. "OM"" '""',,"~ 'hi" fin".., in th., r.",Ir.III::ltion of total credits on line 18 of the cover sheet. . . . . .. 5. 2. 3. 5. . . . REV.16<9 EX. (1.97) ESTATE OF SCHEDULE 0 ELECTION UNDER SEC. 9113(A) SPOUSAL OlsTRtauTtONS FILE NUMBER ~ I ~#i e.. Do Jf~ ~ '" f) 00 not complete this sc dule unless the estate is making t e election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election a lies to the Trust(marital, residual A, 8, 8 ass, Unified Credit, etc. . If a trust or similar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transieror's personal representative may specifICally identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arran ement included as a taxable asset on Schedule O. The denominator is ualto the total value of the trust or similar arran ment. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, whlch pass to the decedent's survivi ouse under a Section 9113 A trust or similar arra ment. DESCRIPTION VALUE N~ Part A Total . $ PART B: Enter the descri tion and value of all interests included in Part A for which the Section 9113 A election to tax is bein made. DESCRIPTION VAlUE I Part B Total I (If more space is needed, insert aQciitional sheets of the same size) $ MARY ANN GEORGE I, MARY ANN GEORGE (nee JACOBS), of 1937 Maplewood Drive, North Middleton Township, Cumberland COllnty, Pennsylvania, do hereby m;ike this my Last will and Testament, hereby revoking any and all previous wills and Codicils ma~e by me. I was married to ORAH K. GEORGE. My husband died November 27, 1963, and I am presently a widow. FIRST I direct that all my just debts; expenses of my illness and funeral expenses, be paid as soon as may be convenient after my death. SECOND I aut~orize my personal represen~ative to purchase a grave marker, or to provide for the repose of my remains according to her best judgment. I authorize my personal representative to cause title to or ownership of my cemetery lot in my family plot at Elliotsburg, Perry County, Pennsylvania, to be vested in such person as my personal representative shall designate. THIRD A. I give, devise, and bequeath to my niece, DOLLYMAY L. SMITH, of Loysville, Pennsylvania, my aut~mobile and my drysink. B. I give, devise, and bequeath all of my personal property; including household furnishings, bank accounts, and all such property except my real estate and items bequeathed in Paragraph 3A above, to my sister, STELLA JACOBS BURNS, of Richboro, Pennsylvania. C. I give, devise, aM bequeath all the balance of my Estate of whatsoever nature and whe~esoever situate, to which I may be legally or Page I of 4 " '\ ii, , ,.' j .f,l . ,< !~ J I. _, .i..' "'J w~..,~....~, "..........".. .... ...n..."LI...., UL .....llll...lIl!;LUII, u~J.aware, ano my n1.ece, UlJLLYMAY L. SMITH, of Loysville, Pennsylvania. FOURTH I hereby nominate, constitute, and appoint my niece, DOLLYMAY L. SMITH, of Loysville, Pennsylvania, as Executrix of this my Last will end Testament. In the event she is unable to serve for any reason whatsoever, I hereby nominate, constitute and appoint my sister, SrELLA J. BURNS, of Richboro, Pennsylvania, as Executrix. I hereby relieve my Executrix from the necessity of posting security in connection with such duties in any jurisdiction in which she may be called upon to act insofar as I am able by law to do so. Fl FTH I authorize my Ex~cutrix to sell, with or without notice, at either public or private sale, and to lease any. property belonging to my Estate, subject only to suc~conf~rmation of Court as may be required by law, and to compromise claims. SIXTH I authorize and empower my Executrix to sell, convey, pledge or mortgage by proper instrument therefore, for such prices and on such terms nd conditions as said Executrix may deem best, any and all real and personal property which I may leave, without any judicial decree or other enabling authori ty. SEVENTH Anyone not named in this Will has been intentionally omitted. Page 2 of 4 .j : ! 7 , \/ / I /i' I.L i , . '...- ---/' " context so indicates. , ,,~ I subscribe my name to this wi 11 this ;) ,)' day I)f June, 1988, at Carlisle, County of Cumberland, State of pennsylvania. )1 .r- ;' ! ;' .,' \ I I " ,/ . '- .,~ . ..( t..,... '- I Mary Ann George Testatrix ,;. --- ~~~Cc' \ J-~(SEAL) (/ COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND We, MARY ANN GEORGE; RUBY D. WEEKS, DIANE L. MASENHEIMER, and SHIRLEY P. CLEVENGER, Testatrix and the witnesses, 'respectively, whose names are signed to the attached or foregoing instrument, being first dul1 sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last will and she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the will as witness and that to the best of their knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind, and under no constraint or undue influence. ) ! I / 1 ;'.1 / 1".1 \ t..l L.t_, Mary Ann G~orge Testatrix J1" ........r',(' - ,,'-- [ ."../--'.' I.... (SEA L) Page 3 of 4 , ' } , /.../ / I ,r I. ' , J_ I - .... . . !' -r V'li 1 1 . d . I'" \, '. '. \ \ \ I \ ('~L.a...-\'\...Q.... eX. \ rl{u:.'.J~"\"li,,~..-nu', ren log at _~__~'::'__~~'J Witness ' . .U n n I). , .1 t! ,) -" / . ,..: !! . I f./ /1_. ;1 /) ~/.I.lif/4 t--: ~1,~~M_- resiuing;~ _IV.j.L{ItL_~Ii.':.L.:;~4"=~~/ /7 W1.tnessO' U (/ ~~ ___ residing At -1-Qu~~~<:-:~i_t~:::~~_~~l:..~~{t R. Subscribed, sworn to and acknowledged before me by MARY A. GEORGE, the " Te.statrix', an~ subsdribed and sworn to before me by RUBY D. WEEKS, DIANE L.' MASENHEIMER~ arid SHIRLEy P. CLEVENGER, wi.tnesses, thi.<; ";-/cl~~ day of June, 1988 ~ . \jjr~. . ,../ // (t' ). J il __ .:;;-:~ --1l~-;::. ~-:.jL \-_ .__~_'_~:=--:' =--::::_!J'.-J....'.:.L__ __..__ ___ Notary Pub) ic . SHAP,ON ^. ('lUll. tllJ!.:I'Y Put111t C~riit.l"'. p'''. r. \:1!1t)nl !:lP{\ t,(\,Jnly My Commls5iol1 tx+li1t;S Jan. 16. 1989 Page 4 of 4 I: I: lI. I! COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEME~T. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 03-24-2008 ESTATE OF GEORGE MARY A DATE OF DEATH 01-03-1999 FILE NUMBER 21 99-0060 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 05-23-2008 ( See reverse side under Objections) Am 0 u n t Rem i t t e d I l 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 GEORGE MARY A FILE NO. 21 99-0060 ACN 101 DATE 03-24-2008 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISIDN PD BOX 280601 HARRISBURG PA 17128-0601 .'j I RUBY D WEEKS PO BOX 397 CARLISLE PA 17013 TAX RETURN WAS: (X) ACCEPTED AS FILED 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) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: REV-lS'.7 EX AFP (06-05) ) CHANGED (1) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 6,532.83 .00 .00 NOTE: To insure proper credit to your account. submit the upper portion of this form with your tax payment. (8) 6,532.83 (9) ClD) 5,183.05 9. 10. 11. 12. 13. 14. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) Debts/Mortgage Liabilities/Liens (Schedule I) Total Deductions Net Value of Tax Return Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Cl1) Cl2) Cl3) Cl4) 13.019.64 6,486.81- .00 6,486.81- If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. 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 (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) Net Value of Estate Subject to Tax NOTE: 19. Principal Tax Due TAX CREDITS: PAYMENT DATE DISCOUNT (+) INTEREST/PEN PAID (-) RECEIPT NUMBER 7,836.59 Cl5) .00 X .00 X .00 X .00 X .00 .00 .00 .00 .00 00 06 00 15 Cl6) Cl9)= AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 to * IF PAID AFTER DATE INDICATED. SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS REQUIRED. l . IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) I YOU MAY BE DUE '0 A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)