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COMMONWEALTH OF PENNSYLVANIA I INHERITANCE TAX RETURN RLENUMBER
DEPAR:~T2:S~~ENUE i RESIDENT DECEDENT i 21 07 01083
HARRISBURG, PA 17128-0601 ~ J______ __~_ m____~_m___~___ ~_~___'. ~~~______J~~.oUNTY COQL_'l"!;~Fl___ _f'l\.JMBER___
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE iNiTiAL) ----- - ~------ - U~_~_ .-~ - T - SOCIALSECURlTYNUMBER------ ----
Garrett, Janet L . 171-28-5342
.
REV-1500
OFFICIAL USE ONLY
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DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
11/14/2007 02/02/1935
(IF APPUCABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
1. Original Return
4. Limited Estate
rr~2.'-&JPPleir;ental Return-----u- _u__ ------rr 3. Remainder Return (date of death prior to 12-13-82)
6. Decedent Died Testate (Attach copy
of Will)
9. Litigation Proceeds Received
4a. Future Interest Compromise (date of death alter
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10. Spousal Poverty Credit (date of death between
12- 1- 1
o 5. Federal Estate Tax Return Required
1 8. Total Number of Safe Deposit Boxes
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IRM NAME (If applicable)
Ahrens Law Firm, P.C.
------~ ------1
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52 Gettysburg Pike
Mechanicsburg, PA 17055
(1)
(2)
(3)
(4)
...ofFICIAL USE ONtb
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ELEPHONE NUMBER
717/697-1800
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
154,330.00
19,242.84
None
--.,
p,
CD
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
None
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(5) 1 2 1 ,71 4. 53
(6) None
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(7) None
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(8) 295,287.37
(9) 23,202.76
-------~
(10) 9,860.12
(11 )
33,062.88
262,224.49
(12)
I 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13)
I made (Schedule J)
_ I 14. Net Value Subject to Tax (Line 12 minus Line 13) _ .___________~4~_u___~~_3. 24.4 9 ~
----r SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2) _._-.---_._-_..._-~_._. ----
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
~ .----..---....--.- --- .-.--. .__._-~-_._--~---
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A- 17. Amount of Line 14 taxable at sibling rate x .12 (17)
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0 _____.__._._ __ ._._n
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~ 18. Amount of Line 14 taxable at collateral rate 262,224.49 x .15 (18) 39,333.67
19. Tax Due (19) 39,333.67
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
2914 Harvard Avenue
CITY
. .U_ ._H 1-----.-..- .--....--.-------.--
STATE PA IZIP17011
Camp Hill
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
6. Prior Payments
C. Discount
(1 )
39,333.67
1,966.68
3. InteresVPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 6 + C)
(2) 1,966.68
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
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.
6. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(3)
(4)
(5)
(SA)
(56)
0.00
37,366.99
37,366.99
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;.................................................................................. ~ e
~: ~:::~ :h;e~:i~~~~s:~~e~~s~~~. .~~.~~~.~~~.~~~. :.~~:..~:.t.~~~~~~~~~~. ~.~.i~.~.~~~~~~~::::::::::::::::::::::::::::::: :::::
d. receive the promise for life of either payments, benefits or care?..............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ................ ...... ............. ................ .......... ............................. ..................... ... ..... D 181
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... D 181
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?...................................................................................................................... D 181
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
~~- ~.._ ____ __._____u_____ .._ __ _ _________ .____.__ __..________ __ _
Under penalties of pe~ury. I declare that I have examined this return. induding accompanying schedules end statements, and to the best of my knowledge and belief, it is true, corred and completa. Dedaratlon Of
preparer other than the peI8Ofl8I representative Is based on all infannation of which preparer has ant'<n~edge"n _
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADORESS
Dorothy C. Waggoner ,
DATE
2914 Harvard Avenue -, 7 ' 1>
Camp Hill, ~~ 17011___ _____ L - - CJ 0
-----..~._--.----..-DATE- .-.--. .-
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
Th.m..~ /f ____
ADDRESS
DATE
52 Gettysburg Pike
Mechanicsburg, PA 17055
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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 3% [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 0%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [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 4.5%, 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 12% [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.
. .
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SCHEDULE A
REAL ESTATE
-------- ----------- -----_____1___
----------- -- ------------- rFILE NUMBER
___________ _____ ____ __________1?~~~7-_~_~~3_ __________ ________
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Garrett, Janet L
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.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
.~-~--
154,330.00
2914 Harvard Avenue, Camp Hill, PA 17011
-~_._- --_._--_...-._-.._-------_.__.~-._-"-~---------_._--------- ---.--
TOTAL (Also enter on Line 1, Recapitulation)
154,330.00
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
..~....
SCHEDULE B
STOCKS & BONDS
ESTATE OF Garrett, Janet L
---'-~-----"---" -----..---------..----- -------.~____ _ _ L_______...._____________ ______ __.__...._.__,_..__.__~~
-.----.-----.----.,~~-,-------,---- -- - - fFILE-NUMBER ----------~--
.____E_~~_01~_83 _
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
4
---..-----.----. ..----.-----.---- .--------------- -.------..----- .---
DESCRIPTION
2
i 348 Shares of General Motors Stock
I
i 30 Shares of Raytheon Stock
3
I U.S. EE Savings Bonds - see attached listing
I
64 Shares of EDS Stock
~' UNIT VALUE j" VALUE AT DATE 0 F
DEATH
. -,. ______n______._.____.
31.47 10,951.56
62.66 1,879.80
5,117.08
20.225
1,294.40
TOTAL (Also enter on line 2, Recapitulation)
19,242.84
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEAl.1H OF PENNSYLVANIA _I
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-_.__._~-.._._~----~---~-~---------
FILE NUMBER
21-07-01083
ESTATE OF Garrett, Janet L
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
DESCRIPTION
VALUE AT DATE OF
DEATH
- ~-------I-----~--~
71.00
1
-------~--------------~-------~-- - -~---- ---------
Coins & paper bills in safe deposit box
2
2004 Chevrolet Trailblazer
12,980.00
3
Household contents
5.000.00
4
PNC checking account # 51-4002-2669
25,681.38
5
PNC Money Market Account # 51-3006-4232
54,164.76
6
PNC CD # 31300265807
23,817.39
-~..._~_._------.,._----------------~.._..._---_._._---'-
TOTAL (Also enter on Line 5, Recapitulation)
121,714.53
.
SCI-EDU...E H
FlN:RAL EXPENSES &
ADNINSTRATIVE COS1S
COMMONWEAl. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
n -. -r FILEfNlfMBER~ n _~~_n_~__
.-_..~.__._J.~___~J-=-Q?_-.Q1083 ____~__._
ESTATE OF Garrett, Janet L
Debts of decedent must be reported on Schedule I.
~.ITEM .T-------~---~.
I
NUMBER I FUNERAL EXPENSES:
A. 1 Funeral bill
i
----_._-_._-_..~._._-------~-~~._-------.----------_.._----
DESCRIPTION
AMOUNT
I
--+--
i
9,000.00
2
Grave marker
2,090.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City
State
Zip
2.
Year(s) Commission paid
Attorney's Fees Ahrens Law Firm, P.C.
11,300.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills
364.00
5. Accountant's Fees
6.
Tax Return Preparer's Fees
Estimated 2007 Income Tax
175.00
7. Other Administrative Costs
1
Estate notices
217.66
Total of Continuation Schedule(s)
56.10
23,202.76
TOTAL (Also enter on line 9, Recapitulation)
'OM~~~ I_~ ~~~~.~ ~~lLENUMBER---U---
ESTATE OF Garrett, Janet L 121 _ 07 _ 01083
----------- --- --------- ----- --------- --------------,---- --------------- 15.00----
2
PA Inheritance tax filing fee
3
Postage
12.00
4
Mileage
29.10
Page 2 of Schedule H
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~ILE NUMBER
,21 - 07 - 01083
-_.._-~- -- -- -......-----.....--.-
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Garrett, Janet L
- ---_._.__._---~--_.~~~---------.------
Include unreimbursed medical expenses.
ITEM
NUMBER
14
15
DESCRIPTION
AMOUNT
--'---'--~----- --_.._---'--.-._-----.. ...-.---..,-----,....------ --..----.---------------.-------.---..-----. ----------.--,.------
1
Dental bill
32.00
2
Quantum Imaging Assoc
36.00
3
Boscov's credit card
25.00
4
GM Extended Family Card
164.40
5
Discover credit card
38.25
6
Discover credit card
25.03
7
Final gas bill
31.08
8
Final Electric bill
35.78
9
Final water bill
47.90
10
Final telephone bill
48.03
11
Final trash bill
44.62
12
Final oil bill
219.00
13
Final cable bill
53.03
Check # 9515,9516 and 9518 uncleared
9,040.00
PNC Bank charge for insufficient balance service fee
20.00
~.~-~._._-"--~-------_._----,._-_._..._---------,.~----_..~-_._-------,._-_._--.._.-
--- .~--_.__.- -----._- ----- -.-----.--.--
TOTAL (Also enter on Line 10, Recapitulation)
9,860.12
REV-1513 EX+ (9-00)
.
SCHEDULE J
BENEFICIARIES
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--- ---- ________L___ ___~______~__________
-- - ------- --TFILiNU-MBER--------~--~-
i 21-07-01083
RELATIONSHIP TO --1 AMOUNT OR SHARE
DECEDENT ' OF ESTATE
Do Not Usl Trualee(a)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-----~-----_.._--------
-~---._--.._---_._------_..~_._~~.._----
ESTATE OF
Garrett, Janet L
1
-------------------r-
NAME AND ADDRESS OF PERSON(S) RECEIVING P~
TAXABLE DISTRIBUTIONS (include outright spousal distributions) I
Dorothy C. Waggoner IFriend
2914 Harvard Avenue, Camp Hill, PA 17011 I
NUMBER
I.
Entire remainder
after expenses
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria e, on Rev 1500 cover sheet,
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
-,._._-_.,-_.._------~._----_._~.~._.__._------_._----.-----------.-.--...----...------
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