HomeMy WebLinkAbout06-03-0815056051047
REV-1500 EX (06-05)
~,, ~ PA Department of Revenue
Bureau of Individual Taxes " ~- INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 P RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year File Number
~~ ~ ~,~ ~ ~ v~ ~ J
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
~~_o ~ ~ 3q ~v o3 ~3 ~oo~ ~~t~~ 96~
Decedent's Last Name Suffix Decedent's First N~3me MI
AEcc.. TR. ~ ~R r,r s D
(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 DUIPLICATE WITH THE
REGISTER OF V111LLS
FILL IN APPROPRIATE OVALS BELOW
O 1. Original Return 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Firm Name (If Applicable) RE OF wIL SE OWk~f c;` ,
~~KFS ~ A~ ~s5 do t ~T~s ~~~ ~ ~-~t_~
First line of address
~~~ w ~~_
Second line of address ~~ = _,!--
City or Post Office
~ARR1s,~uRG
~ --+ .. ~
A ~ z.~
Cif
State ZIP Code DATE FILED
Correspondent's a-mail address: /11~`~a S e C1Q CDMGAST'. /UCl
Under penalties of perjury, I declare that 1 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.
SIGNATURE OF PERSON,RESPr~NSIBLFy FOI~FILING RETURN DATE
Ado 8~ ~,,,,~, v S~"f. ~ ~ N~~ ~ l~A / Boa s
S N TURE OF PREPARER HER THAN REPRESENTATIVE DATE
_ _ j~~ - ~ s~ a9/ a f
AD RESS ,/
f~~,y. ~79~ /v"/~~/PiS,QUr2G ~A /7//i
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051047 15056051047 J
J
],5056052048
REV-1500 EX
Decedent's Social Security N
umber
/~,1
Decedent's Name: C ((2 )~( ,~ v ~~e~, ~~, ~ ~ U ~ o
~ ~ `
RECAPITULATION
1. Real estate (Schedule A) . .......................................... .. 1. ~• r7 (~
2. Stocks and Bonds (Schedule B) ..................................... .. 2. O • a ~
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. Q • Q Q
4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. ~ •
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... . .. 5. ~ ~~ ~j • ~ B
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ~ • Q Q
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested......
.. 7
~ ~
~ ~~ ~ • d
8. Total Gross Assets (total Lines 1-7) .................. ............... .. 8. ~ Q S ~ ~. ~~'
9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ~ '? ~ ~ . Q d
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/Sec 9113 Trusts for which
~~ ~~•4D
14. an election to tax has not been made (Schedule J) .
Net Value Subject to Tax (Line 12 minus Line 13) . .....................
..................... .. 13.
.. 14.
,~ ~ ~ ~ ~
tP 9
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
16. Amount of Line 14 taxable
at lineal rate X .0 ~`~ ~~'
~ ~ ~ • ~ ~
16.
l ~ Q . G
~ 7
17. Amount of Line 14 taxable
17
at sibling rate X .12 . . •
18. Amount of Line 14 taxable
at collateral rate X .15 • 18.
19.
TAX DUE ..................................
.....................
.. 19. p
~ p ~ •
'Z ~ ;
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
15056052048 15056052048 J
REV-1500 EX Page 3 File Number Qv - d G ^~(~
Ilor_prlpnfi'c C~mnlete Address:
DECEDENT'S NAME
~~'uR r i s l~. !fie e ,[, ~jz
STREET ADDRESS
.3 ~ ~ O~ /r/O /~
CITY STATE ~~~ ZIP! 7~ ~~
~NU~ f~
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits~Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount ~/.~pU
3. InterestlPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C) (2) ~/~ lPU
Totai Interest,'Penalty (D + E_ )
4. 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.
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) >~
(4)
(5) / 02 ~ t~ ~/
(5A}
(56) 9 a Fr ~ 5
Make Check Payable fo: 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 :....................................................................................
i
i ......
^
ncome : ......................................
ts
b. retain the right to designate who shall use the property transferred or ......
c. retain a reversionary interest; or .................................................................................................................... ...... ^
^
d. receive the promise for life of either payments, benefits or care? ................................................................ ......
If death occurred after December 12, 1982, did decedent transfer property within one year of death
2
.
without receiving adequate consideration? .......................................................................................................
" ....... ^
^
or payable upon death bank account or security at his or her death? .......
3. Dld decedent own an "in trust for .......
Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
4
.
contains a beneficiary designation? ................................................................................................................. ....... ® ^
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. §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 zero (0) percent
[72 P.S. §9116 (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 stiff 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. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1b02 EX+ (6-98)
.~ ~ , SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
, RESIDENT DECEDENT
ESTATE OF FILE NUMBER
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.
(If more space is needed, insert additional sheets of the same size)
REV-503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
' RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
CURTIS /~. ~~eL ~R. p,~- ooa~o
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
(If more space is needed, insert additional sheets of the same size)
RED(-1504 EX+ (1-97)
~i t
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF FILE NUMBER
~uRf~S ,~. ,l~e~L ~ 2 0~- oa~~-a
Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporationipartnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting information to be submitted for >ole-proprietorships.
(Il more space is needed, insert additional sheets of the same size)
REV-1505 EX+ (6-98)
' ,~ ~~ SCHEDULE C-1
COMMONWEALTH OF PENNSYLVANIA ~~~~~~~~~~~~ ~~~~~~~~
INHERITANCE TAX RETURN STOCK INFORIYWTION REPORT
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CDuR~IS ,1~. ~~eL, ~2 X98 - pC~ ado
1. Name of Corporation
Product/Service
Address ]l/ ~ ~ ~ Date of Incorporation
City
2. Federal Employer I.D. Number
3. Type of Business
4.
State on Irn~orporation
Business Reporting Year
TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE
STOCK Voting/Non-Voting SHARES OUTSTANDING pAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK
Common ~0/l~ ~ $ Q
Preferred D ~'~ ~ $ d
Provide all rights and restrictions pretaining to each class of stock.
5. Was the decedent employed by the Corporation? ................................. ^ ti'es ^ No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? ................................... ^ ti'es ^ No
If yes, provide amount of indebtedness $
7
Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ 1~'es
If yes, Cash Surrender Value $ Net proceeds payable $__
Owner of the policy
8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....^ Yes ^ No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? ..................................................... ^ 1''es ^ No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? .................... ^ Y'es ^ 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? ............. ^ Y'es ^ No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
• ~ •- • ~ ~
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation 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 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 received 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 decedent's stock.
State Zip Code Total Number of Shareholders
^ No
(If more space is needed, insert additional sheets of the same size)
REV-t`_;06 EX7 (9-00)
SCHEDULE C-Z
PARTNERSHIP
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN ' INFORMATION REPORT
RESIDENT DECEDENT
ESTATE OF
_ ~ C.~/i~ ~T ~. S _
1. Name of Partnership
Address
City
FILE NUMBER
U~ ~`lJC>~ ~a
Date Business Commenced
Business Reporting Year
State __ Zip Code
2. Federal Employer I.D. Number
3. Type of Business ProducUService
4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $
5 PERCENT PERCENT BALANCE OF
PARTNER NAME OF INCOME OF OWNERSHIP _ CAPITAL ACCOUNT
A• i
B.
_ - - ---- ~. i -
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ................................. ^ Yes ^ No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes ^ No
If yes. Cash Surrender Value $ Net proceeds payable $
-- -
Owner of the policy _
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or w thin two years if the date of death was
prior to 12-31-82?
^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/scld
Transferee or Purchaser _ Consideration $____ ___ Date
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? ... ... ^ Yes ^ No
If yes, provide a copy of the agreement.
11 Was the decedent's partnership interest sold? .................................... ... ^ Yes ^ 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 ^ No
If yes, provide a breakdown of distributions received by the estate, including dates and amou nts received:
13. Was the decedent related to any of the partners? ................................. ... ^ Yes ^ No
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
• • •~ • ~ ~
A. Detailed calculations used in the valuation of the decedent's partnership 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 copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
e~L J
REV-1507 EX+ (1-97)
~~ SCNED~ILE D
COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ca u~ t ~s ~ . 1~ e eL ~2 08 - oDa ~~
All property jointly-owned with right of survivorship must be disclosed on Schedule F
i~~ nwre space is neeaea, insett aaaitional sheets of the same size)
REV-1508IX ~ (19~ -
~' ~ - SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHRESIDENTDE EDENT~ PERSONAL PROPERTY
ESTATE OF FILE NUMBER
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~~ CLo?K~n/G .~(od•od
C~sil` D N i{~Nfl ~' a a
NK /~'~ duNT ~o~~ t°~Pce ~j,~~vK ~C.tiecKi~ -
$A~ ~a qo,~ ~o~f, as
ply Ghee /YJ~~ONaLVS ~lo~T-fib
. D s~ /~IeL.So N I Q~TiP~ a ~r/ ~'
~Nd~ o ~~ / ~o~.r
TOTAL (Also enter on line 5, Recapitulation) I S ~S3~e~ L ~
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX . J,1-97)
SCHEDULEF
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
' itJHERITANCE TAX RETURN
ESTATE OF FILE NUMBER
C URTI S ,~ . ~ ~ ~~ ~/2 08'-0 o a. ~~
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
ADDRESS
SURVIVING JOINT TENANT(S) NAME
A.
/~Di/2
C.
JOINTLY-OWNED PROPERTY:
RELATIONSHIP TO DECEDENT
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number or similar identifying number. Attach
deed for jointly-held real estate.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1. A.
Q~~d
~~ ~~.
TOTAL (Also enter on line 6, Recapitulation) ~ b (~ ~ C7(J
(If more space is needed, insert additional sheets of the same-size)
REV-151° EX. (t-9i)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON•PROBATE PROPERTY
ESTATE~f FILE NUMBER
C aR?/S ~. T~e~L SR o8 -oo a ~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-1500 (OVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIPTO DECEDENT AND THE DATE OF TRANSFER.
ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST
EXCLUSION
IFAPRUCnaLE
TAXABLE VALUE
1 /~~I /r o u~ ~. ~eTiRe,~leNr f7cc r C ~Ra
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,
n/~ a rn ~ ,~ee~.
7'RANsFcR ~~a s~ o~
TOTAL (Also enter on line 7, Recapitulation) I $ pZ ~f q 7 ~ ~ Q ~j
(If more space is needed, insert additional sheets of the same size)
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REV-1511 EX+ (12-99) • ~
r
SCHEDULE N
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
L'uR r~s ~. /~e~~ ~Q a~- aoa ~o
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
/S~~chaROSo~ FuN~A~ /-~o~Q
~DDo2 •oa
~Lowef25 ~a7•ao
~UNG~I GoN ~loX ~~
7aG'~~
/11i,~/i s? eQ s eK v i c e ~t t ?'6.00
e. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Rep sentative(s)
Street Address
City State 7_ip
Year(s) Commission Paid:
2. Attorney Fees I d
3. Family Exemption:,,(If decedent's address is not the same as claimant's, attach explanation)
Claimant ///{y~/!1l ~tCL
Street Address .30~ pZ/VD 5{'
city EN v L ~ _ State ~ zip ~~'IOR ~' 3 ,S"d O
Relationship of Claimant to Decedent ~p9'/~fGrP
7 r•ao
4. Probate Fees ~q, d 0
D
5. Accountant's Fees Q
/~O.00
6. Tax Return Preparer's Fees ~ oZ,O. OD
7
TOTAL (Also enter on line 9, Recapitulation) $ ~ ~~ /{
(If more space is needed, insert additional sheets of the same size)
l~+ J/~~/1 1t 29 SOUTH ENOLA DRIVE
~J ~/~~I Y~Y<.4t7~Yb ~unerdl ~~/ V ~~e~ ~C• ENOLA, PA 17025
(7171 732.0587
MICHAEL G. MURRAY
STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED SUPERVISOR
Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will
explaintn writing below.
If you selected a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalring. You do not have to pay for embalming
you did not approve if you selected arrangements such u a direct cremation or immefiiate burial. If we charged for embalming, we will explain why below.
For the Service of ~ [~ ~ 7~ • ~s ,~ - ~~ `= ~ ' .r/~' _ _ Date of Death -~r~ ~ ~ c'
~---
Charge to: ~v, ~ cr .'71 • ~~ 47~ ~ / o tt ~ 1 ~, ~ ~ ~ ir. i Fps ~ ~`''~ .`i ~~rC'' ~,'' '`i _ ./7 c'.~ ~
Name Address Ctty State
A. CHARGE FOR SERVICES SELECTED:
1. •PROFESSIONAL SERVICES
Services of Funeral DirectorlStaff .... i ~~y'~'
Embalming ...................... f"'~ ~-'"
Other preparation of body
Other clothing
f
f
Cremation urn ...... / ....... f-~~~-k--'
(Description) Ci~il_a.l~~= 4 ~r 3 K y
OTHER f
..............................~~1~ Ci f
SUB-TOTAL OP PROFESSIONAL SERVICES......... Alf ``f~ ' '~ ` "`s~ f ~-
TOTAL MER HANDISE SELECTED ........ . ......... B f
FACILITIES AND SERVICES
Use of facilities and services for
viewing (Visitation/Wake} ... ~ ... .. f ~'
Use of facilities and services
for funeral ceremony .......... . , t
Use of facilities and services for
Memorial Service ............. .. f
Use of equipment and services
for graveside service ........... .. i
Other use of facilities
C. SPECIAL CHARGES:
Forwarding bf remains to
f
(Funeral Home)
Receiving of remains from
(Funeral Home)
Immediate Burial ................. S
Dfi ect Cremation ............ f 2 E
!"air` sr.:~, ~ • ~'.~,.-,.1r':~ f,.L.~.~j•- vc'
SUB-TOTAL OF SPECIAL CHARGES ................ C f
......................... f
SUB-TOTAL OF FACILITIES/EQUIPMENT ........... A2 f
3• AUTOMOTIVE EQUIPMENT
Vehicle to transfer remains to Funera] Home.
Local............; ........... v;
.... f. .Y
Hearse (Casket Coach)
~ Local ....................... .... f
Limousine .
Local ....................... .... f
Family car
~ Local ........................ ... S
Flower car or floral disposition
Local ........................ ... f
Lead car/clergy car
Local ........................ ... f
Car for pallbearers
Local ........................ ... f
Out of town transportation ...... ... f
D. CASH ADVANCED
Opening Grave ................ .. f
Cemetery Equipment ........... .. f
Lot and Deed .................. .. f
Newspaper Notices-Local ....... .. i ~ S~ . ~.- ~
Newspaper Notices-Out-of-town .. .. f
Telephone & Telegrams ......... . , f
Airfare ....................... .. f
Clergy/Mass Offering ............ .. f oe - v ~
Pallbearers .................... .. f
Certified copies of the Death
Certificate ....... /` ~ `~
i~,,~ ` u \ _ ~' '
Police Escort .................. .. f
Flowers ...................... .. f _~T_.
Vault Service Chargr ........... . . .. f
f
f
f
f
S
S
- --
SUB-TOTAL OF ADVANCES ....................... D f ~, -~. ~ " `
i
SUBTOTAL OF AUTOMOTIVE EQUIPMENT........ A3 f We charge you for our services in obtaining:
TOTAL OF PROFESSIONAL SERVICES, (specify cash advances tbat are marked-up)
FACILITIES AND AUTOMOTIVE
EQUIPMENT ................................... A i-3 S~"5 , d
CHARGE FOR MERCHANDISE SELECTED:
Casket .......................... S
(Description)
Other Receptacle ................. f
(Description)
SUMMARY OF CHARGES
A . Professional Services, Facilities and
Equipment, and ~wiomotive
Equipment ...................... f
B. Merchandise ..................... f
C . Special Charges .................. ~3 C ~ ~5 _ v <.
D. Cash Advances ................... f~j,__
TOTAL OF ALL SECTIONS .............. f
] G, 1
~ Outer burial container ............. PAID AT TIME OF OR PR R TO. ~q `;,,~~
{Description) ARRANGEMENTS ....... ~, r C,/` , , , , , ,^ ..a . , , f
BALANCE DUE ........ ... /D. ~, ~..... -. ~-, -
L~~'Sr~ ~ .~ f • , ~ c
RFxSON FOR EMB,IILMING ---~ ~~ tC
~ ~6/~Y Pas?na2i 009 - cuio~
_.- ~ ~maD~14 wwnj MOl'13A iou3i~Q ~uaUn~ 311HM ~ uo~lLpoTSy vo1»>IQ ~sa0un3 qucn~dsuuad ~
_-- ~o»aliQ ~taaun3 pasua~~~) (Jasey~md}
- ~%!ry/ - ~~~ (ftaS?
(alcQ) -~' (Jasey~md)
•~uawaatas ~o ~~~q ~tmd aye uo pa~aa~aJ aq itim ;oa~ayt ~soa at{~ put luaiuaaJBe stya ;o »ed pa~apisuoa aq
ib ~uawaar8t siya;o aup ay> >a~;t pa~sanba~ so paJapio asiputy~~aw 1o saainaas ~euop~ppe ,(uy •s~soa ~ay~o put s~soa i~noa 'saa; ,s,(awont apnpui ,(tw s~so~ asoy,~
uawaaJBt s(y> >apun abo ~ s~unowe »apoa o> >oiaa~ia ~t~aun3 ay1.(q p[td s~soa a~ euosea~ pt ~o~aanQ ~raaund aye o~ ~(ed osjt pb I wawaaJBe siyi;o ahp aye wog;
yep 8uiuur8aq aave~tq predun aye o~ papddt aq lllm eta,( lad i~"`- ol8ununowt y~uow gad --^~r-;o a8ny~ a~t~ y mo~aq su8rs
ym as~a auo,(ut ynb a~gei~ ,(pe~anas put ,(polo( aq o~ aaJBt ~ s,(ep ~ u~y~rb'~~s;o ~uaw~{ed aKew o~ aa~8t os~e - ~pa»a~as sa~cn~as put
>008 ayi io; aaud yse~ aye;o roaw,~td to; a~gt~itne spun; ~uapi;;ns aney ~ ~ey~ luasaida~ t •pa~aa~as saain~as put spoo0 ~t~aund;o luawalels sry~;o ~(doa e;o ~dia~a~
3pa~,nou~{ae ~ •pa~sanbal aney i stuawa8uran aye o~ 8uipaoa~e put »ai~o~ aq of ways puno; put anoge pa»a~as saar,+~as put spoo8;o swan aye pauiwtxa aney ~ ~ty~ aaJBe ~
s ................... Sucy~op itu~g
_ ~~ 7 ~, ~'_ .. aa~itw antJB ,(Jt~odwaZ
~o~aq pauit~dxa s~ ~uawaJmba~ io roes aye anoge paasi~ swan aya ;a ~(ut ;o ~ f ' " " ' ' ' ' ' ' ' " ' ' " " " " " " ' " spJt~ ia,~e~d
zya~nd aye pa~mba~ anty sluawannba~ ,(~ ewaia so ` ia~awaa 'nits ~(ut;I _ ' ' ' ' ' ' ' ' ' ' ' ' ' saap~o; ~(iowayy
~~ .................. (s)~ooq ~a~sc8ag
e • • • ~ • ~ • " song mawa9narmou~w
REV-ti512 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
CuRTrs 11. Diet- -J',2 08 - ooa~ro
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
.~• ec~. ~ G~fS-OOaZB'0
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER 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
Sec. 9116 (a) (1.2)J
ee~- /Ylo7,~f~R ~a/~Sf•Gg
/1/~oTi~f eR f~A'oi'rl r ~
3 0 ~ ~tiA fit'
~N oc ~ ~~
~ soaks'
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS: D
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1530 COVER SHEET $ a j~ 88,G r1
(It more space is needed, insert additional sheets of the same size)
REV-1b14 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDIJLE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
heck Box 4 on REV-1500 Cover SheE
ESTATE OF FILE NUMBER
~u~er~s ~ . D eel.. ~~. X18'-0o e~~ro
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of 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 <~ copy to the tax return.
^ Will ^ Intervivos Deed of Trust ^ Other
NAME(S) OF LIFE TENANT(S)
DATE OF BIRTH •
NEAREST AGE AT
DATE OF DEATIi
TERM OF YEARS
LIFE ESTATE IS PAYABLE
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
1. Value of fund from which life estate is payable ..........................................$
2. Actuarial factor per appropriate table ................................ .
Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2) ......................................$
NAME(S) OF LIFE ANNUITANT(S)
DATE OF BIRTH •
NEAREST AGE AST
DATE OF DEATH
TERM OF YEARS
ANNUITY 15 PAYABLE
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
^ Life or ^ Term of Years
1. Value of fund from which annuity is payable ............................................$
2. Check appropriate block below and enter corresponding (number) ......................... .
Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12)
^ Quarterly (4) ^ Semi-annually (2) ^ Annually (1) ^ 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 - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate
6. Adjustment Factor (see instructions) ................................................. .
7. Value of annuity - If using 3 1/2%, 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 future interests must be reported as part of tfie 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 18.
(If more space is needed, insert additional sheets of the same size)
REV-1644 EX ~ is-oal INHERITANCE TAX
. SCHEDULE L
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT
IN RESIDENTEDECEDE TRN OR INVASION OF TRUST PRINCIPAL FILE NUMBER 08 'QO o~ FlU
I. ESTATE OF
Cunt,
(Last Name)
e eL J~~
(First Name)
(Middle Initial)
This schedule is appropriate only for estates of decedents dying on or before December 12, 1~
------~-
This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of
Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal.
II.
REMAINDER PREPAYMENT:
A. Election to prepay filed with the Register of Wills on
B. Name(s) of Life Tenant(s)
or Annuitant(s)
C. Assets: Complete Schedule L-1 ~'
1. Real Estate ...............................$
2. Stocks and Bonds ..........................$
3. Closely Held Stock/Partnership ...............$
4. Mortgages and Notes .......................$
5. Cash/Misc. Personal Property ................$
6. Total from Schedule L-1 ......................................................$
D. Credits: Complete Schedule L-2
1. Unpaid Liabilities ...........................$
2. Unpaid Bequests ...........................$
3. Value of Unincludable Assets .................$
4. Total from Schedule L-2 ......................................................$
III.
E. Total Value of trust assets (Line C-6 minus Line D-4) .................................$
F. Remainder factor (see Table 1 or Table II in Instruction Booklet) ........................ .
G. Taxable Remainder value (Line E x Line F) .........................................$
(Also enter on Line 7, Recapitulation)
INVASION OF CORPUS:
A. Invasion of corpus
(Month, Day, Year)
B. Name(s) of Life Tenant(s) Date of Birth Age on date
or Annuitant(s) corpus
consume+d
Term of years income
or annuity is payable
C. Corpus consumed ............................................................$
D. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ .
E. Taxable value of corpus consumed (Line C x Line D) .................................$
(Also enter on Line 7, Recapitulation)
(Date)
Date of Birth Age on date Term of years income
of election or annuity is payable
PTV-16d5 EX+ 1.851 INHERITANCE TAX
SCHEDULE L-1
COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTIONI _ p~
INHERITANC7= TAX RETURN FILE NUMBER ~(~ Oa ~ oa
RESIDENT DECEDENT -ASSETS-
I. Estate of 7' ~ . ~ e ~
(Last Name) (First Nartie) (Middle Initial)
II. Item No. Description Volue
A. Real Estate (please describe)
Total value of real estate
(include on Section 11, Line C-1 on Schedule L) $
B. Stocks and Bonds (please list}
Total value of stocks and bonds
(include on Section II, Line C-2 on Schedule L) $
C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-:?)
(please list)
Total value of Closely Held/Partnership
(include on Section ll, Line C-3 on Schedule L} $
D. Mortgages and Notes (please list)
Total value of Mortgages and Notes
(include on Section II, Line C-4 on Schedule L) $
E. Cash and Miscellaneous Personal Property (please list)
Total valve of Cash/Misc. Pers. Property
(include on Section II, Line C-5 on Schedule L) $
III. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $
(If more space is needed, attach additional 8'/s x 1 1 sheets.)
REV-1646 EX+ (3-84i
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
INHERITANCE TAX
SCHEDULE L-2
REMAINDER PREPAYMENT ELECTION
-CREDITS- FILE NUMBER ~a add oZCYd
I. j Estate of l~ uR 7 ~5 /~ . /~ e c~-.
i (Last Name) ~ (First Name) (Middle Initial)
II. Item No. Description Amount
A. Unpaid Liabilities Claimed against Original Estate, and payable from assets
reported on Schedule L-1 (please list)
Total unpaid liabilities $
(include on Section II, Line D-1 on Schedule L)
i
i B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list)
Total unpaid bequests $
(include on Section II, Line D-2 on Schedule L)
C. Value of assets reported on Schedule L-1 (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.
I Computation as follows:
Total unincludable assets $
(include on Section II, Line D-3 on Schedule L)
III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $
(If more space is needed, attach additional 8%i x 11 shetets.)
• REV,-1647 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDIJLE M
FUTURE INTEREST COMPROMISE
Check Box 4a on Rev-1500 Cover Sheet
ESTATE OF FILE (NUMBER
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
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.
^ Will ^ Trust ^ Other
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.
^ Unlimited right of withdrawal ^ Limited right a~f 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 ^ 6%, ^ 3%, ^ 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 ^ 6%, ^ 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 collateral rate (15%)
(also include as part of total shown on Line 18 of Cover Sheet) ......$
7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$
(If more space is needed, insert additional sheets of the same size)
RE`d-1648 EX j11.99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX DIVISION
SCHEDULE N
SPOUSAL POVERTY CRED{T
(AVAILABLE FOR DATES OF DEATH 01/01/92 TO 12131194)
ESTATE OF FILE NUMBER
This schedule must be completed and filed if you checked the spousal poverty credil box on the cover sheet.
1 Taxable Assets total from line 8 (cover sheet) ............................................ 1 .
2. Insurance Proceeds on Life of Decedent ..........................lV. . ~ ........... , .. 2
3. Retirement Benefits ........................................../.. ../..'............... 3.
4 Joint Assets with Spouse ............................................ ............... 4.
5. PA Lottery Winnings ................................................... 5.
6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. ~~
6b.
6c. ~,
--~
6d.
6. SUBTOTAL (Lines 6a, b, c, d) .......................................................
7. Total Gross Assets (Add lines 1 thru 6) ................................................ 7.
8. Total Actual Liabilities .............................................................. a.
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 Pa~711.
Income:
a. Spouse ........... 1.
ia. TAX YEAR: 19
b. Decedent .......... ib.
c. Joint ic.
d. Tax Exempt Income .. id.
e Other Income not
listed above ........
1 e.
f. Total ...... 1f.
4. Average Joint Exemption Income Calculation
4a. Add Joint Exemption Income from above:
(1 f) + (2f) _
+ (3f)
4b. Average Joint Exemption Income ................................................... _
If line 4tb) is oreater than $40.000 -STOP. The estate is not elioible to claim the credit. If not, continue' to Part
1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ..................... 1
2. Multiply by credit percentage (see instructions) ........................................... 2
3. This is the amount of the Resident Spousal Poverty Credit. Include this figure
in the calculation of total credits on line 18 of the cover sheet . .............................. 3.
4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the
decedent's gross estate ............................................................. 4.
5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal
Poverty Credit .Include this figure in the calculation of total credits on line 18 of the cover sheet. ...... 5
2c.
2f.
T
3a.
3b.
3c.
3d.
3e.
3f.
RE'~'5ac flx •'."-971
SCHEDULE 0
c~MMONwr~~T" or PENNSY~~ANiA ELECTION UNDER SEC. 9113(A)
N"ERA-"NCE Tnx RETURN SPOUSAL DISTRIBUTIONS
RESIDENT DECEDENT
EST TE Of FILE NUMBER
~uR ~'~ 5 ~. ,,~ e e~ o ~-oDa~v
Do not complete this schedule unless the estate is making the 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 applies to the Trust (marital, residual A, B, By-pass Unified Cred!t, etc.
I` 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 transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have suc'n trust or
s~miiar 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
pe~sonai 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 ar~•ount of the trust or similar arrangement included as a taxable asset on Schedule 0 The denominator is equal to he total value of the trust or similar arrangement.
PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's
surviving spouse under a Section 9113 (A) trust or similar arrangement.
(If more space is needed, insert additional sheets of the same size)
STATE OF PENNSYLVANIA
COUNTY OF CUMBERLAND
estate of CURTIS D DEEL JR
(First, Middle, Lastl
in said county, deceased,
SHORT CERTIFICATE
I, GLENDA EARNER STRASB.4UGH
Register for the Probate of Wills and Granting
Letters of Administration in and for
CUMBERLAND County, do hereby certify that on
the 13th day of March, Two Thousand and Eight,
Letters of ADMINISTRATION
in common form were granted by the Register of
said County, on the
late of EAST .PENNSBORO TOWNSH/P
to NAOMI l DEEL
(First, Middle, Lastl
and that same has not since been revoked.
F
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the
seal of said office at CARLISLE, PENNSYLVANIA, this ~:3th day of March
Two Thousand and Eight.
File No. 2008-00280
PA Fi 1 e No . 21- 08- 0280
Date of Death 3/03/2008
S . S . # 220-64-3960
NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL
REGISTER OF WILLS
CUMBERLAND COUNTY
`~ PENNSYLVANIA
No . 20D8- 00280
Estate Of : CURTIS D DEEL JR
CERTIFICATE OF
GRANT OF LETTERS
ADMINISTRATION'
PA No . 21- 08- 0280
IFiist, Middle, Lastl
Late Of : EAST PENNSBORO TOWNSH/P ~.
CUMBERLAND COUNTY
Deceased
Social Security No: 220-64-3960
WHEREAS, CURTIS D DEEL JR
(frtst, Middle, Lastl
' ~~.
late of EAST PENNSBORO TOWNSHIP CUMBERLAND~COUNTY
died on the 3rd day of March 2008 and, .
WHEREAS, the grant of Letters of Administratiorl
is required for the administration of the estate.. E,
THEREFORE, I, GLENDA EARNER STRASBAUGH RE~gi s ter of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, have
this day granted Letters of Administration to:
NAOMI l DEEL
who has dulk qualified as ADMINISTRATOR (RIX) of the estate
of the above named decedent and has agreed to administer the estate
according to law, all of which fully appears of record in my office at
CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 13th day of Marcft 2008.
..
~, ~~ ~ _
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~4eg!'ste~ o !
~~ , ~ ~ ~. ,
epuiy
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
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