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Home My WebLink About02-21-08 (2) ...J 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 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number Date of Birth Decedent's Last Name Suffix Decedent's First Name MI (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 Return c::::::> 2. Supplemental Return c::::::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required - c::::::> 4a. Future Interest Compromise (date 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 Deposit Boxes c::::::> 4. Limited Estate c::::::> c:::. 111 +CI0 OZ~ Firm Name (If Applicable) REGIST,ER OF WILLS uSE ONLY First line of address IOt!J Ci (1 .U u K. 0 It.D Second line of address City or Post Office I~i\ m-P 1+ \ L, l State ZIP Code DAtE FILED .::- 'PiA \1- 0 \ \ Correspondent's e-mail address: 1\ 0 (' fY\ C. m \J 1\ c:\, e. \ @ ~O 1\\ c a s.-t, n cL Under penalties of perjury, I declare that I have examined this return, including accompanyin9 schedules and statements, and 10 the best of my knowledge and belief, it is Iru~...~recl and complete. Dec ration of pre arer other than the personal representative is based on all information of which preparer has any kn wledge. SI I\DDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051047 15056051047 ~ ---I 15056052048 REV-1500 EX Decedent's Name: RECAPITULATION 1. Real estate (Schedule A). 2 Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . 2. 3 Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. 4. Mortgages & Notes Receivable (Schedule 0) . . . . " .........." 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . 5. 6. Jointly Owned Property (Schedule F) c:::> Separate Billing Requested . . . . 6. ;'. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::> Separate Billing Requested. . . 7. g. Total Gross Assets (total Lines 1-7). . . . . . 9. Funeral Expenses & Administrative Costs (Schedule H). 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . " . 10. 11. Total Deductions (total Lines 9 & 10).. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(12) X .0_ . 16. ~~i~~~\~~t;in~ ~~ble ~.... ~.. 03.:34 17. Amount of Line 14 taxable at sibling rate X. 12 18. Amount of Line 14 taxable at collateral rate X. 15 · 19. TAX DUE " . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT o o () A-- ~-k~~~ cfd -:t 8 'IS 15056052048 Side 2 Decedent's Social Security Number J-o I 0 l 4 ~ ~:A 1. t 8. 9. . 11. 15. 16. ~:<:6 3 17. 18. ~:<6{) '3 '3.:~' c::> 15056052048 ~ REV-1500 EX p,lge 3 File Number Decedent's Complete Address: DECroNZ~:~~\O-(\ \~ 1 be S;:Sel STREET ADDRESS r \ D u:3l0ooc.\ Laue. r;L I - O't -o-:}'L5 CITY(, \ .~ _ \. LdV~ \':::. C STATE 1J J~ ZIP l '1- (: \ . Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousall:loverty Credit B. Prior Payments C. Discount (1) %.:j.\(~03~ / Total Credits ( A + B + C ) (2) 3. InterestJPenalty if applicable D. Interest E. Penalty TotallnterestJPenalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in avalon Page 2, Line 20 to request a refund. (3) (4) 5. 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 + 5A. This is the BALANCE DUE. (5) (5A) (5B) A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;....................................................................................... 0 III b. retain the right to designate who shall use the property transferred or its income; .................................. 0 ~ c. retain a reversionary interest; or........................................................................... ................................. 0 ~ d. receive the promise for life of either payments, benefits or care? ................................................................. 0 g 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................ ..................................................... 0 III 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 III 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. 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. S9116 (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. S9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax 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 zero (0) percent [72 P.S. s9116(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. S9116(1.2) [72 PS s9116(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. s9116(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. - . Pi=IRf< PLACE PROPERT I ES LLC . FA>< ~JO. : 71 ( 258 4574 Oct. 30 2007 10:38Af'1 P2 - SI::TTl,fMENT STATEr"lCNT Sr.i1ers: Estate of Norman Besser Lee W. Ruzilow & Vir9inia F.. Buzilow Job ~ 07-18 Buyers: $~LlER5 r~ANSACTlQN SAI.E PRICE : LESS Commisio(l: LESS Payoff: LESS Other: 07-08 School Tax LESS Other:. LESS Other: PLUS Proration of Lot Rent: PLUS ProrCltion of Taxes: PLUS Other: DUE TO )(~RXlOOt& .July 12, 2007 DATe List it 11360 $ 14,OOO.cJO 2,500.00 ., BJ.12 " o 221.~,L ~3.79 9l t- ) 2,583.12 315.05 (.; ) $ 11,731.93 ..~._..~,~~*_~.~.......,,~_~:~.,_~.,.,.~, or' ,~....~...... '.r.~t................~~~..........,.~.~.'t..~.......,. BUl'ERS TRANSACTION SALE PR.ICE Title Fees: ,._.___ In:.urilJl(.~ Closing Fee<;: Proration of Lot Ren~: Proralion of Taxes: 354t:9yS School BO.39 CounLy Other ~2'~~, Home Shield Other Other Other Other ." _...." SU6TOTAL Less Denosit Received: I.ESS Amount Financed: TOTAL CREDITS DUE~fRm~ BUYERS $,~.4 , 000.00 Vear" 22 _ ~,O p.0.c. 125.00 221.26 1n~ 13.40 93.79 375.00 r6 o o o $ "14(~3?55 500.00 ~ 500.00 $ 14,337,.;;5.. ....~.~'~~.~~I..._~...~...>>......~..y~'r~.~~~~~....."..".~~~~~~~~.........~.~.........~..~tt.~~............. DJS6.U~MENTS Proceeds to Estate of Norman A. Resser Commission to Park Place properties, LLC COl1Tl:iS5ion to Exit Realty Group Closing Fee to E-.d t Real ty Group Warranty Fee to American IIane Shield 07/08 School Tax to Penny Davis Tille Fee to ~1n Dot t?~1o, '{Jdtm~a ~"" >L''--, A)_l. ' I Z'i.0 Lgj.ljl:~_ :?eer- --~--._-,."----'--' .-........ 11,731.93 2,080.00 420.00 125.00 375.00 83.12 22.50 cLJ,J, Z ..4~-:, " B.rfa: ~'= C'." , "'''-: " . .0;; f '~' .<<')'<.L~_"':.. .__'." : F'APK PLACE PROPEPT I ES LLC ~. 3321144 f A. . ;;;11." ,~"..l, ..I FA>~ ~JO. : 717 258 4574 Or: t. 30 ;2007 ::.0: 39Pr1 P3 "" mtE.NUMBER (AS 8HOWN ON ~D Tm..El 35261710001 BE IlEHIC\..E IDeNTII'ICXT1ON NUMBeR '89512 B. I E NonMn 1\. (Deceased) J c. LAST NAME lOll F\)LL BUSINESS NAMEI Buzilow 'I CO-PUHO-tASER ~ Buzilow !~ mEn 1- 'D~ Lane .e CITY S1l\TE Carlisle PA [). lAST NAME lOA FUtJ.. BUSINESS NAME) CO-PURCHASEA Besser ~u..ER FIRST NAME M1001..E INITIAL Lee W. Virginia E. ZIP ceDE 17015 FlEFEOl 10 ';OLJ~TV COOEE USl1NCI QN """"flSC SlOE OF PlNl\ COpy a. Linn Fee F~TNAME MIODLE INITI"L DATE ACQUII~EO/ PURC! lASED 4.~14IrefiOl1'1f Pm<:e~~ing Fee ~ 1...1 I i ~ ~ENllIll'IWllml)e' ;~~\1~~": 5. 0upl/ca18 fl&{I. File No. of C.,d. GOUNTY CODe STREET " ZIP CODE STATE REFEA 'to (>>JNTV COOEe lISTING nN FlEvEFl~~ :>i1Jl.. <'>>f'lI'fl(OOpy . Trcn910r fM CITY E. MAKE OF IJIOHIClE Replacement F(lD VEHiCLE 10ENTIFlCATION NUMBER "_Ir~,n:=a Fw . II MOOEL YEAR CONDITION o GOOD o FAIR DpOOA F. o TRANSFER OF PAEVlOUSLY ISSUED i>L"TE o TRANSFER & RENEWAL OF PLATE o TA,ANSFER & REP\..ACEMENT OF PLATE o TRANSFER OF PLATE & REPl/.cEMENT OF e;nCv.ER \~';t.~~o-;O'D\L REASON FOR F1Ef'LAGtMtNT WcU'>'r 0 OEF.v.;l:~ D~~~1f.~':SE~te~~'ir. l)/<lCk I~ CMC~<1d ~ .- VIN ~GINAl. PlATE ./ CIIed<. Or"! o PlATE TO BE IS-CJU(:I) 8'1' BUREAU (PROOF OF IN- SUI'\ANCE MUST BE AT- TN.."HeO.1 E;><<;HANGE /'UITI: TO BE ISSUED 8'1' BUREAU TEMPORARY PL.&TE lSSiJEO BV FUll AGENT TOTAl. PAID (Add 1 Inru 8) '~l ;1 SIGN i1fRE 14,000 .00 . ~ . . 0 . 0 . 22 .50 ~ " . . 9. 0 0 . " ~ 10. 22 .50 . . S<ll\Cl an.. Cl'oQck '" n,ja. Amount . 22 . 50 o ,TOLLN nELATION~~1" TO ,APPLICANT REO RfG. (lROS!; 'NT INCLUD1N!) LOM REO REG. GROSS COMS- WT (IF APPUCABLE) ~OUC'l' CFFECTI\ii: u,.r~ !>OI.ICY ~~PIRATION DAre I CER'MI''I' THAT ON MOfolTli.~ _ DAY _ '(!;A,R "'. _....__ ISSUING ~GENT (PRINT 'JAMEI I HAIlE CHECKEO TO OETEPMlNE THAT THE VEHICLE IS INSURED AND ISSUED TEMPORAJ'l'I' REGISTRATiON TO THE Di30Vf APPLICANT IN COMPLIANCE WITH AU. APPUCABl..E PACV1$IONS OF TH. VEHIC:LE COOE I$SUlNG IIGENT SIGNATURE TE:I..EPHONE NO. <\NO OEI'AATMENT REC.\JI..&TIQNS. ( i l,wE TIFY THAT I/WE HAVE illAMINEO AND SIGNED THIS FORM AnEA 1T'3 COMPLETION AND THAT THE INFORMATION GIVEN ~'i TRUE AND CORRECT If m EXEM,."Qt4 1.'1 CLAl"'iO. THE PURCHASER FUffrHEFl CERTIFIES THAT !-iE/SHE IS AUTHORIZED 1t) CLAIM "HIS .XEMPTION. I/INE ACKNOWLEOCE THAT (/WE Wo.Y waf MV IUU'" ()lo'~ AM.,Jr. i>RIVlL.EGE(SI OR VEHICL.E lolEGlSTRAOON(S) !'OR FAlLURE TO MAINTAIN ~1W.N(.IM RFSP()N:';lRI!.IT'I ON THE CURRENTI.Y REGISTERED vEHICLE FOR TI-t~ PGRIOO OF REOIST\U.TION. I/INE ACI<NOWl.EOGE THAT I'WE /.MY FIE !';lJaIECT TO ^ FlfJE fJOT EXCEEDIIJl.1 i5!),)] ANIl IMI'I<I$ONMENT OF NOT MORE TH/l.~J T y "R:~ FOF< AN" FALSE S1l\TEMENT Tl'W 1/v.,;: i'MKE ON TH!!> FOI'!M. $ III' .nf ~~ ~~ or Au......riuxl SiOl'r9( l~iT {..1 r;;v~. ..... ~~~. ~'! ~'C?'Purena~T~I~ Al.l!I'Ml Sig"';;-'- ISSUING /\Of NT INFOR- MAnoN G. AGEfI.NO I TI'I~PIIONC NUMGeR I vI<.(U TELEPHONE IJUM6Efl Slon8lu1~ of Silll~r 2ND ASSfaN~ '-4ENT ~lgrlll1Ufe l)f t..o-P'JIoMs",iT;lIe 0( ......1I.""'f:(J So;,ner sili~;i:.-;e ~f Co-SOIJOI H. ~ ~~I NOTE: If 8 co-purchaser other than your spous.e is listed and you want the title to be listed as "Joint Tenants Wilt! Rigtll of Survivorship. (On death of one owner, II1IfI goes [0 surviving owner.) CHECK HERE O. Otherwise, the title will be issued as "Tenants In Common. (On ,lealn of one owner, interest of deceased Qwnar g06S 10 his/her heirs or estate). NOTE. IF THE IrEHlCI..E IS TO BE USEO AS A OAllY RENTAl OR LEASEO IIEHlelE. CHECK THIS eLOCK 0 IF BLOCK IS CHECKED. COlAPlETE AND ATIACH FORM MII.IL. MESSENGER NUMBER: REV-1502 EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EST~T~ OF , 1\)Or\Y16n A. MesSC'-r 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. FILE NUMBER d\ - C -1- --0,::2 \ 3 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH t lY-ooo.oC I 'V3\\ec (I Y'6 3) TOTAL (Also enter on line 1, Recapitulation) $ I ~I [)OO,OD (If more space IS needed, Insert addlllonal sheets of the same size) REV.1508 EX + (1.97) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~ .DeS5er COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESI NT DECEDENT ESTATE OF 'U I or \$\(if\ FILE NUMBER c:J1- 0 -:; - C'c21X' 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. \qq'b t\,ev ,0 \~t C-h~ck, )\~ aCC* S c \J ~ f\.~ S- (~CC---\- DESCRIPTION <<\~\\b u (k€.\\~ ~\v~ bOO~ \1\'\\ \5ch\ \( (pq l--1 ~3 rn~' bel \\ lis GOY d.. ooC\ ""3c,o d-\ V ,0, ~ 'i-- ':::\ ~i- \j0~\o I{U~ \4d-Lto-Ol-lo'l-- (s-kkm~rli- aJkcWj J), ..3 VALUE AT DATE OF DEATH $IC\O.oo r!.. (j \ Y ~04 ..J-\ ) . LfY q 1 ~. d ~ ) TOTAL (Also enter on line 5, Recapitulation) $ l!! 0, 1-10[1. ~ \ (If more space is needed, insert additional sheets of the same size) m M&I'Bank STATEMENT PERIOD PAGE FEB.10-HAR.09,2007 2 OF 2 NORMAN A BESSER ANNA MAE BESSER EN~OY PEACE OF HIND WITH H&T OVERDRAFT PROTECTION. HIT OVERDRAFT PROTECTION IS A LINE OF CREDIT OR A SAVINGS LINK, FROM WHICH FUNDS ARE AUTOMATICALLY TRANSFERRED TO YOUR CHECKING ACCOUNT TO COVER ANY CHECKS OR WITHDRAWALS THAT HAY OCCUR WHEN FUNDS ARE NOT AVAILABLE. TO LEARN MORE, CALL 1-800-724-3222. ACCOUNT. I NORHAN A BESSER TITLE .. ANNA MAE BESSER M&T PERSONAL SAVINGS ACCOUNT NIt). 15004200939021 NORTH HIDDLETON ACCOUNT SUMMARY BEGINNING DEPOSUS. . & WITHDRAWALS & OTHER CURRENT ENDING BALANCE OTHER.ADDITtOHs SU8tRACTIONS . .. INTEREST. PAID BALANCE NO. I AMOUNT NO. I AHOUNT 44,~'67 .52 01 0.00 11 44,975.22 7.70 0.00 POSTING DATE ACTIVITY DEPO$:tTS.JXNTEREST W/DRAWALS & OTHER &()THERADD:tTIONS SUBTRACTIONS DAIL Y BALANCE 02-10-07 BEGINNING BALANCE 03-07-07 INTEREST PAYHENT 03-07-07 Cl.OSEOUT $44,967.52 7.70 44,975.22 0.00 ENDING BALANCE $0.00 ANNUAL PERCENTAGE YIELD EARNED = 0.25 % ** END OF STATEMENT ** LOOSA (1/03) rD ST ATEMENTPERIOD PAGE FEB.10-MAR.09,2007 1 OF 2 00 3 043351'1 1'1 021 723 NORMAN A BESSER ANNA MAE BESSER 1D DOGWOOD LN CARLISLE PA 17013-7842 SELE CTEDiACCOUN T . SUMMARY ACCOUNT TYPE ACCOUNT NUMBER INTEREST EARNED YEAR-TO-DATE MATURITY DATE ENDING BALANCE CLASSIC CHECKING M&T PERSONAL SAVINGS 000000000647853 015004200939021 0.00 27.10 4.59 0.00 TOTAL DEPOSITS 4.59 CLASSIC CHECKING NORMAN A BESSER ANNA MAE BESSER ACCOUNT NO. 647853 NORTH MIDDLETON 13,316.09 DEPosXTS.& OTHER. ADD 1T IONS NO. AMOUNT 2 2,017.50 CHECKS PAID AMOUNT 15,329.00 ENDING BALANCE 4.59 I. POSTING I DATE ACTIVITY DEPO$ITS,INTEREsT & OTHER ADDITIONS CHECKS ~.OTf!ER SUBtRACTIONS DAILY BALANCE 02-10-07 BE,GINNING BALANCE 02-21-07 CHECK NUMBER 2892 02-26-07 CHECK NUMBER 2904 02-28-07 PA. TREASURY DEPT ANNUITANT 03-02-07 US TREASURY 303 SOC SEC 03-08-07 CHECK NUMBER 0055 378.00 351. 00 $13,316.09 12,938.09 12,587.09 13,701.59 14,604.59 4.59 1,114.50 903.00 14,600.00 ENDING BALANCE $4.59 C.ll~CKS<PA:rD .SUI'IMARY 55 113-08-07 14,600.00 2892* 02-21-07 378.00 2904lt 02-26-07 351. 00 La08A (1/03) Se e \E'N'e-{' S. e.... REV-1511 EX+ (12-99) . ~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTAT5, OF -1L) () \- 0, CV\ FILE NUMBER A. nESS'e/{ c9-1 - Gl- - o~;+ \ _(~ , Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION FUNERAL EXPENSES: n\~ <2-\--:; tG IJ~('-6- \ t\.oOIc:. i 1\\c~S' ) PA (E.llle.Cc..\ e'f-Vt'\\s,('S) .:), ~~ \C. \\\OU Il"h\ n) \\\cS'4~~. .0R (t-Ulle,-a.\ \€--\.--edH\\E'Id-S) 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 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 Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees LJS;T (he~-\-11'\.Gi t)t~Q\ \,e r- (,u;-\~ \ sold') U ':--"I:.. (I'. (\) I . ,_J ~)(. ,1.H' n aLe af\ d a, (' CC n d ~ ,- i G )\ \ ^-J) '1" Y L Ce\ecA,-,c -\b k, Ie... U{\t; \ Sol d) 10. ~D"f\~ W\""Df UJ,es't-(mo~~~~ '~&1- len+) t,\ ':el~f\b-\ \yews: f~e-r (es~ (\ctlce~ I;}... I ~v\~\)cr\oRO LO-uJ ,~OL) \"cJ e!:. -k~ YK~ 7. o 1.. o~ -\c- C~ TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) AMOUNT ~~ 3~O. 00 /- c:f- Il-l q ~ 41~, 3'6 ') (..-J '6 " ,?,- ,_:J ' I U c: \qq,5~" ) ~84-/oc ) IOC/-+j '''1_ ,j, ~, T':::),CLJ REV-1S11 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 'd-, COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER _ ) c9- \ - O-=t -0 J-l 5 , ESTAT~ OF nJ Cr-fy\o(\ A ' hcSSc(- Debts of decedent must be reported on Schedule I. ITEM NUMBEFt A. FUNERAL EXPENSES: DESCRIPTION B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 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 Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7 CJa:\-~ O(\W\ d ~ 11\0-\-V ~\ 'f;te- ~(\~. (({or\\~ClA-,\ef~) t\J \\\ ~ C' ,- \ ~\1. d CG V Il\-q ~E:1' <;kr 0'\- lD ( l \s . ' ',_ --tLe~'-;;/<;\'\C,* cer-'\~~,/ ('€..r\O/\C\' <Ltt iCW\ S ') I ~ lUC-\tG~,\ S pC::' cK (e..\-e\l(\l/~ O-V 't1QJ le v- \ . l(O, lO\\,Ud,\JE\\ ()C\.-\ (S\\OL0 \1::rV\ov' '-'-\ 6-"\- ---\--~Q'i \el- ) 1-, (~\+ ~~\ Vd{-\..L\)\a.ce..?ro eriies \ SS~ 01\ ~ler ~'d.k: \3, 1+ TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT 3C,.+ :) l \ \.00 -~o ,0 0 30,00 ~~oc.O() $ 0:..ci\~\\\)(J 1\n-~ \)(6 REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EST~~ OF ----1UCN$\Q{\ f\, --c:z FILE NU.MBER ,J LJC$$c'::( ,;U -C;'1 - C.;,l\ ~5 Debts of decedent must be reported on Schedule I. ITEM NUMBEH A. FUNERAL EXPENSES: 1. DESCRIPTION B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State _ Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, allach explanation) Claimant Street Address City State _ Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees [9:: I I Ci . ('"'}o, ,?I, ,J.d, kelYlpe" ~-\v dlLC ~"1 e.. (G \!~ \ "S;V[CClc:e-) S~I\ \~ Syr', \~S \(S$\\N~S:~C CQ~-), r~ leu ~\ ~+G d(\~ \" res (0.\' ~y)n\ e.nt-\ ~~d \J 01\ ceO t\v\:o v~~~ -\-\V1- s) . , C-\ou$ e ~\o~l ~a('~ ctnd \\\JcKS C ~ {'E__) AMOUNT 1'3 ,:j ,(~ 0 IC~j-=r~ <4-f5. c~ .~ ir~;J,q:A i-to, +i;l (If more space IS needed, Insert additional sheets of the same sIze) TOTAL (Also enter on line 9, Recapitulation) $ I J I .~ ~ q .30 REV-1512 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTI}{E\OF (\ FILE NUMBER -1LJOr-Mo(\ t-\-. beSSer ~\-01--0J-\(:) Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. d" '3 DESCRIPTION 1)\" . ~('al\do(\ I \k\~\ao~ J PA- {1\0 -\-VI +- \-\t:-~-+ ~d VaSCu \ O-C C-U1'o'Ioer\o.'\d \I a.-\\~ &hOO\ -k~ VALUE AT DATE OF DEATH ~~,OO -~q ,00 ~3,1~ ITEM NUMBER 1. TOTAL (Also enter on line 10, Recapitulation) $ d- \ L\ L \~ (If more space is needed, insert additional sheets of the same size) REV-151:3 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTAJ,E <?F I \.J 0 f'rY\ oJ\. ~~ be s.s;:er NUMBEH I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under U. L Se~.,9116 (a) ,1.2)] .' 'I. (JCrOdrG.. Shadocn 1 Z4 l~ Le ~ So f'e LDo r\ 2j OIe$tl it L I I ~J... -J e{:\.~Lj ~es~e\'1 ( -=t-\t-~ a.f'\ Vab\o KOad Bc\\eJ:~o S~~ (\c\ S c.J\- qdC;e+ J ~J ) ~). ':r~ \ \ S "^' '-\~ ,.;tl-~OT~\c3 ~()e "1or-k PI~ l~qO'\-) ) ~'. I'D 0 ,f\i\ d- \\\ u nc-.h::-\ ' 10i-6 eOu~,\ C:..\ub lioaol C:..O--mf H II ()frt \ '1-0 I ( FILE NUMBER J (..)..I - o':t - O;)..\~ RELATIONSHIP TO DECEDENT Do Not List Trustee(s) VdDe{ ~~r b. ~c~0 <_J Son '0 a~5~- Lxi-~s Vrk. r AMOUNT OR SHARE OF ESTATE Y\ C! ~ ~-::J- --) I (j 'I J lSj Cy ~J (0 d- 5 '0 d~ Lib 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 ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) - "- "- - - - - - - 0- "- - 0- - "- - - 0- - - - "- - "- 0- --- --- ~-- .-- --- --- .-- !!!!~~ .-- .-- --- --- ~====== :J: rn n .,., :c c: f"I' :D :DOl Z (/) :x ---0. o-o-..Jn:D C(!)OV1l-l""O Z.U1crlOa -; .U1C (/) C) :c -I c::n C") I)