HomeMy WebLinkAbout04-14-08 (2)
--I
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
OFFICIAL USE ONLY
County Code Year
1-.\ D~
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
o ."<1' '..1, 7...-
Date of Birth
/ r 23 2if 5 25-
012.. 9 I 9 2.5'
0'1 2.00 8
Suffix
Decedent's First Name
bEOI<.6E:
Decedent's Last Name
.5 O.vDEl<:S
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FII_L IN APPROPRIATE OVALS BELOW
.. 1. Original Return
2. Supplemental Return
c::::>
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c::::>
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 S~~LD BE DIRECTF.e,TO:
Name Daytime Telephone;Nflmber ;?
7 I ? 7 ~~~Lf I f9 I
~------ --.- ~ ~---.:::;g -
REGISTER Of' YV)li~~~SE or-a.x. 1
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L__.___l:lI\!..~~I~E::[)__ _______ ._...J
C:)
4. Limited Estate
c::::>
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6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
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8. Total Number of Safe Deposit Boxes
C:J
PRO'ZboWSK I
.l)UA . .N,.C
Firm Name (If Applicable)
First line of address
70
f<!.ID6
ORiVe
Second line of address
City or Post Office
State
ZIP Code
C A.fZL I ..s L.
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,
.'Y\ \. C C) VII)
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, 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.
E FOR FILING RETURN
ADDRESS /J . J 0 - /' IJ, /J ~
. i? 0 /-<, (/ ~ r I ve.1 L-~ I /f
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
/70/S-
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056051047
15056051047
MI
M
MI
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15056052048
REV-1500 EX
Decedent's Name:
Decedent's Social Security Number
'lr z ~ 2' 'Is 2S
RECAPITULATION
1. Real estate (Schedule A). ...... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . .
6. Jointly Owned Property (Schedule F) c:::> Separate Billing Requested . . 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . ., 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10.
11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
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)(1.2) X .0_
16. Amount of Line 14 taxable
at lineal rate X.O_
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE. . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056052048
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5.
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15.
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16.
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17.
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18.
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3,'90. ~ 7'(1f),SCOW~
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15056052048
-...J
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME S
<S:e f ('ilL () U ers
STREET ADDR.ESS _~ v -1-- r:e 01"'\ A Sf-, -j- S) 3
......__.._.........__....______.........!-_........LiJ~:::~:::::1__...._........._.....__.___..___-j.........._.......1:?__.__..........._......____
File Number
CITY
C,{.r ) I ~ I~
STATE P A
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
390~67
Total Credits ( A + B + C )
(2)
o
3.
Interest/Penalty if applicable
D. interest
E. Penalty
4.
-..----.---------~----->----------_._-- Total Interest/Penalty ( D + E )
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.
(3)
(4)
(5)
(5A)
(5B)
ZIP /7013
l)
5.
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
390 I (,7
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
39'0, ro 7
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
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
c. retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
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? .............. 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................... ........ ..................... ....................... ..................... .... 0
No
~
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'&
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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. S91116 (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 rale 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 PS. 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.
SAFE DEPOSIT BOX INVENTORY Page
INSTRUCTIONS
of
The Department is authorized under federal taw, 42 U.S.C. ~ 405(c), to use the decedent's Social Security number in
administering this state tax law. The Department uses Social Security numbers to establish a decedent's identity and
ensure proper credit for tax payments.
(1) Cash: Report total only.
(2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be
designated by name of company, Certificate number, date of certificate, name in which stock is registered, and
number of shares and class of stock.
(3) Obligations of U.S. Government: Number of items, date of issue, face value, names in which registered and
type of ownership, Le., jointly held, payable on death, etc.
(4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds)
(5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book,
name of bank and branch, and balance.
(6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible.
(7) Deeds, Mortgages, ~urrent Insurance Policies or other evidences of indebtedness: List and describe as fully
as possible.
(8) All other contents.
ITEM
NO.
ITEM DESCRIPTION
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I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF
CORRECT AND COMPLETE TO THE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY:
SIGNATURE SIGNATURE
CA.A.. c..l-
~ 17 I'-- \--t r.-4-y 'tr
t'i'J.-j ($I'lv~r-
}-ct ~
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PRINT NAME AND CHECK APPROPRIATE BOX BELOW; (\
U v",rJt 'CUo V\,JJ'k",
CHEC~PROPRIATE BOX;
0'Executor(trix) 0 Administrator(lrix)
o Estate Representative iii Joint owner of safe deposit box
PRINT NAME (),
9 U~N... D('\JZ-dJO wJ,K/
PRINT TITLE
NOTE: Attach additional 8'//' x 11" sheet(s) if ece sary or use duplicates of this page of form.
HOllrs ofOperat;OIl
Monday, Tuesday, Wednesday 11:00 a.m.-5:00 p.m.
Thursday, Friday 11:00 a.m.-6:00 p.m.
Saturday, Sunday Closed
A & C Coin and Card Sholl
RlIvin!! Coins. Gold, Silver and Paper Money
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::::IVED FROM 0 . ;^~ lN~o13Z"D. f~; No. 23~1;6 \) I
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C"e - If S J fi" I r A. . /7 tiff
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FOR RENT C
FOR
;.~ {:
ACCOUNT
PAYMENT
BAL, DUE
@CASH
~CHECK
O MONEY ~ BY
ORDER iI
I n
'1/ FROM L/,'t't'lt ~ TO
C:/f~
DOLLARS
1182
~ M&TBanl<
ACCOUNT.NO.
ACCOUNT TYPE
STATEMENT PERIOD
PAGE
3740103217
CLASSIC CHECKING
FEB.26-MAR.25,2008
1 OF 2
00
o 04319M NM 117
4493
GEORGE SOUDERS
442 WALNUT BOTTOM RD RM A-a
CARLISLE PA 17013
HIGH STREET-CARLISLE
BEGINNING DEPOSITS & OTHER CURRENT ENDING
BALANCE OTHER ADDITIONS CHECKS PAID SUBTRACTIONS INTERESTPD BALANCE
NO. I AMOUNT NO.1 AMOUNT NO. I AMOUNT
932.63 41 746.82 11 475.50 o I 0.00 0.00 1,203.95
ACCOUNT SUMMARY
ACTIVITY
DEPOSITSJINTEREST
& OTItERADDITIONS
CHECKS &.OTHER
SUBTRACUONS
02-26-08 BEGINNING BALANCE
02-29-08 US TREASURY 310 SUPP SEC
02-29-08 COMM OF PA SSP SSPBENEFIT
03-03-08 DEPOSIT
03-06-08 DEPOSIT
03-10-08 CHECK NUMBER 0143
$932.63
276.00
27.40
62.42
381.00
475.50
1,236.03
1,298.45
1,679.45
1,203.95
ENDING BALANCE
$1,203.95
I
CHECKS. PAID. SUMMARY
143 03-10-08
475.50
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PLANNING YOUR FUTURE CAN SOMETIMES PRESENT DIFFICULT QUESTIONS AND CHOICES. AT
TIMES, IT MAY SEEM A BIT OVERWHELMING. WELL, CLOSE YOUR EYES, TAKE A BREATH,
AND COUNT TO THREE. YOU'RE IN THE COMFORT ZONE. LET'S TALK ABOUT YOUR
CHALLENGES AND GOALS TODAY. CONTACT AN M&T BRANCH REPRESENTATIVE SO WE CAN
BEGIN THE CONVERSATION OR TO LEARN MORE VISIT WWW.MTB.COM/COMFORTZONE.
LOOBA (6/07)
Ewing Brothers Funeral Home, Inc.
630 South Hanover Street
Carlisle, P A 17013-
(717)243-2421
March 12, 2008
Duane W. Drozdowski
170 Ridge Drive
Carlisle, P A 17015
The Funeral Service for George M. Souders
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. PROFESSIONAL SERVICES
Services of Funeral Director/Staff .
C. SPECIAL CHARGES
Direct Cremation. . . . . .
FUNERAL HOME SERVICE CHARGES
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THATYOUHAVESELECTED . . . . . . . . . . . . .
$895.00
$295.00
$1190.00
$1190.00
Cash Advances
Certified Copies ofthe Death Certificate .
Obituary with photo Sentinel . .
Cumbo County Crem. Authorization
Cremation Pouch. . . . . .
Green Cultured Marble Urn. . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES .
$12.00
$99.92
$25.00
$35.00
$225.00
$396.92
Total
Total Cost .
$1586.92
SUB-TOTAL
INITIAL PAYMENT / DISCOUNT / CREDITS
TOTAL AMOUNT DUE
$1586.92
0.00
$1586.92
The unpaid balance over 30 days is subjected to a 1.50 % service charge per month - 18.0000 % per annum.
!~/7j 02a79
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Carlisle Memorial Service, Inc.
DESIGNERS AND BUILDERS OF
e8llle~ M~
41 South Bedford Street
Carlisle, PA 17013
01 l
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Price Lj '"/...5~ c-<'
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Total Price !1. .7.' ;;;:', ,':;;.::Z-; . . .
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Carlisle Memorial Service, Inc.
Carlisle, PA.
Telephone 243-5480
Please design and build the following memorial
; /
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DATE .....,.-r.t:.A.
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For ...,. .", . . 'r-'~AL; . . .'\ . . . . . . (...(. . . . . . .. . 0/.-:'. . . . .. . . . .\ . . . . . . . . . . . . . . . " ................
, '1" it::1C A?.:1' ), ( 4. (ti A~~ L",> '-? (\ i
Ad~ress .... i . .~.. l . .. ,. . '-'.{ ;'"~ . . '.--;~"". :-: . . . . ~~: . . . .'. ~: . . . . .'. . .. .; .". . . . . _ . . . . . . . . . . . . .
DeSign No........... .... G. .'
M ' . I I-<a..n.-rcA.- /!:L~f/ (a.e!..-i. ,,:,, <::', l-e c;y
atena ................. 11"
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Die ., .,
Base .,~~. . . . . . . . . .
,- I ..1" l~ () - / 0 l 0 ,.. y
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Posts
Price
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Deposit .
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Balance Due
Family Name
Inscription .
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Style of Letters .."\....... I
Foundation to be furnished by ..
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Mawrial to be best selected monumental grade and to be free from imperfections and first class in every way, Work to be finistJed in a workmanlike
manner. /';, _. L..J .LI!.-k i~/ z::~-O ,,(..4'-1
." /,L-'li-,~/&W4-~,/ /~. II l
This memorial to be erected 10 . . . . . . . . , . " ~'......,.............". /~,1.-<"...?:<..,..1-,G.{/.. \< " : . . .. , Cemetery
in or near . . . , . . . . . . . , . . . . . . . . . . . . . . . , . , . . ., during the month of . . . . . , . . . , . . : . .0. . . W--1,,)<'~L.:r:~. . . . _ . . .
unless unavoidably delayed by labor troubles and other contingencies beyond our control and then as soon as possible. Additional letM'ring and other
work on this memorial in the future is not included in the Contract Price.
Title and right of possession and removal of said stone, monument or appurtenances shall remain for all purposes in Carlisle Memorial Service
until work and materials ordered are fully paid by purchaser or purchasers. In consideration of the acceptance by Qarlisle Memorial Service of this
order, the undersigned (hereinafter known as the purchaser) agrees to pay Carlisle Memorial Service. . . . . :/:..i' ..--:":. . . . . . . . . . , . . . . . . . . . . . . . . ,
. , . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . , . . . . .. . . . . . . . . ..< . . . , . . . . . . . . . . . . . . . . . . Dollars on or
before the 15th day following the billing of the work or job upon completion thereof by Carlisle Memorial Service said billing to be notice of completion
thereof, this order shall become a contract between the purchaser and Carlisle Memorial Service upon acceptance thereof in the space below by a
duly authorized representative of said Carlisle Memorial Service; it being understood that this instrument upon such acceptance covers all of the
agreement between the purchaser and Carlisle Memorial Service and that no agent or representative of Carlisle Memorial Service has made any
statements or agreements, verbal or written, modified or adding to the terms and conditions herein set forth.
It is further understood that upon the acceptance of this order the contract so made cannot be cancelled, altered, or modified by the purchaser
or by any agent of Carlisle Memorial Service or in any manner except by agreement in writing between the purchaser and Carlisle Memorial Service,
and it is hereby understood and agreed by all parties involved that in case of default by purchaser or purchasers, twenty.five per cent of the total
original cost of the work or work and materials ordered, as the case may be, shall be specified correct sum as liquidated damages which purchaser
shall owe Carlisle Memorial Service. less any payment on account made prior to such default, this specification of damages to be due. regardless of
removal and taking possession of stone, monument or materials from purchaser or purchasers by Carlisle Memorial Service upon following such
default. ." ----....
y~-::?.-6 ' .;----'
......,................,..........,'......"..........,.........,..........,...........,...,........(SEAL)
.................,...............3.../..K.......,....................j~::.....~.;..... 2.0..41.% '/: .,vl.:.~.......>.;.~~~...~..~.:~::..................................."..............(SEAl)
C "sl' Memor'al Serv',ce Approval By . ;:_.J .~"'l.,...(,J' i ',/ J ) t.-''- V"'" ...........L-. ... ~ (SEAL)
ar, .. I . /',.-< . . . . . ..' . . . . ,:.-r-' . . . , . . . . . . . . . . . . . . . , . . . . . . , . . . . . . . . . . . . . .
White: Offfce Copy, Canary: CustoOl~r Copy; Pink: Salesman Copy; Gold: Office Copy
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