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REV-1500 Ex (os-o5> INFORMANT REPORT
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN ('ounty Code Year File Number
PO BOX 280601 / /~(~ ~ j
Hanisburg, PA 17128-0801 RESIDENT DECEDENT ~~ZI C~ D C~~P SG'
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 9 7 1 0 1 3 8 2 0 9 2 5 2 0 0 7 0 7 1 0 .L 9 1 7
Decedent's Last Name Suffix Decedent's First Name MI
B I S H O P FAY A
(If Applicable) Enter Surviving Spouse's Informatlon Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
0 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Retum Required
death after 12-12-82)
6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL. TAX INFORMATION SHOULD BE DIRECTED T0:
Name Claytime Telephone Number
J A N E M A L E X A N D E R, E S Q 7 1 7 4 3 2 4 5 1 4
Firm Name (If Applicable)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF 1NILLS
First line of address
1 4 8 S B A L T I M O R E S T R E E T
Second line of address
City or Post Office
D I L L S B U R G
State
P A
ZIP Code
REGISTER OF NfILLS USE ONLY
rte.?
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:_'• G ;
- C~
ATE FILES,.,
Correspondent's e-mail address:
Under penalties of perjury, I declare that I have examined this return, inducting accompanying schedules and statements, and in the best of my knowledge and belief,
it is true, coned and complete. Declaration of pnparer other than the personal representative Is based on aB information of which preparer has any knowledge.
SIGNATURE OF PERSON RE~SRONS~LF~ F~R FLL(p~ RETURN ~ DATE
630,Range End Road Dillsbura ,/ PA 17019
SIG URE OF PREPARE OT ER E ENTATNE ~ i~.e~i DATE
~~ ~ >
AD S
S. Balti ore Street Dillsbura PA 17019
PLEASE USE ORIGINAL FORM ONLY
Side 1
15U56(141125
15056041125
J~
15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: F'AY A. BISHOP 1 9 7 1 0 1 3 8 2
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) ...... . 5.
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ...... . 6. 2 0 1 8 • 8 7
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ...... . 7.
8. Total Gross Assets (total Lines 1-7)
--• .......................
. 8. 2 0 1 8• 8 7
9. Funeral Expenses 8 Administrative Costs (Schedule H) ............... . 9. 1 1 3 0 • 2 7
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ........... . 10.
11. Total Deductions (total Lines 9 ~ 10) .......................... . 11. 1 1 3 0 , 2 7
12. Net Value of Estate (Line 8 minus Line 11) ........................ . 12. 8 8 8 • 6 0
13. Charitable and Governmental BequestslSec 9113 Trusts for which
an election to tax has not been made (Schedule J) ................. . 13•
8 8 8 6 0
14. .................
Net Value Subject to Tax (Line 12 minus Line 13) .14. •
TAX COMPUTATION - 5EE 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 _ 0 0 0 15.
16. Amount of Line 14 taxable
0
0
0
at lineal rate X -0 16
17. Amount of line 14 taxable 8 8 8 6 0
at sibling rate X .12 17.
18. Amount of Line 14 taxable
0
0
0
at collateral rate X .15 18
19. Tax Due ................. ...................... .. ..... ..19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Side 2
15056042126
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0. 0 0
1 0 6. 6 3
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1 0 6. 6 3
15056042126 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
Q 0
DECEDENTS NAME
FAY A. BISHOP
_
STREET ADDRESS
Sarah A. Todd Memorial Home
1000 West South Street
CITY STATE ZIP
Carlisle PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
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 Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(1) $106.63
Total Credits (A + B + C) (2) $0.00
Total InteresUPenalty (D + E) (3) $0,00
(4) $0.00
(5) $106.63
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) $106.63
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 : ...................................................................... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^
c. retain a reversionary interest; or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^
2, ff death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ^ ^X
3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ X^
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 (i 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 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-0ne 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-1509 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF 1=1LE NUMBER
FAY A. BISHOP 0 0
SCHEDULE F
JOINTLY-OWNED PROPERTY
ff an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G.
630 Range End Road
Dillsburg, PA 17019
RELATIONSHIP TO DECEDENT
ADDRESS
SURVIVING JOINT TENANT(S) NAME
A. Isabel P. Albert
B
C
JOINTLY-OWNED PROPERTY:
Sister
ITEM
NUMBER LETTER
FOR JDINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FlNANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VF~LUE OF ASSET % of
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1. A. PNC Bank, N.A. -checking account no. 5140466948 $1,296.53 50. $648.27
2. A PNC Bank, N.A. -certificate of deposit no. 31900289187 $1,370.60 50. $685.30
3. A PNC Bank, N.A. -certificate of deposit no. 31700288035 $1,370.60 50. $685.30
TOTAL (Also enter on line 6, Recapitulation) I S 2,018.87
(If more space is needed, insert addfional sheets of fhe same size)
REV-1511 EX + (12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES Sr
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FAY A. BISHOP 0 0
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
t. Cocklin Funeral Home $365.27
2. James Spencer, Pastor $100.00
3. Dillsburg Brethren in Christ Church -funeral lunch, organist $300.00
B. ADMINISTRATIVE COSTS:
~, Personal Representative's Commissions
Name of Personal Representative (s) None chimed
Social Security Number(suEIN Number of Personal Representative(s)
Street Address
City State Zip _
Year(s) Commission Paid:
2. Attorney Fees Jane M. Alexander, Esquire $350.00
3, Family Exemption: (If decedents address is not the same as daimanYs, attach explanation)
Claimant None claimed
Street Address
City State Zip _
Relationship of Claimant to Decedent
4• Probate Fees
5 Accountants Fees
6. Tax Return Preparer's Fees
7. Register of Wills -filing Inheritance Tax Return (Informant's Report) $15.00
TOTAL (Also enter on line 9, Recapitulation) I $
1,130.27
(If more space is needed, insert additional sheets of the same size)
Cocklin Funeral Home ,Inc.
30 N. Chestnut Street
Dillsburg, PA 17019
(717)432-5312
October 22, 2007
Mrs. Sharon A. Hess
53 Golf Course Rd.
Dillsburg, PA 17019
The Funeral Service for Mrs. Fay A. Bishop
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, AUTOMO"FIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
Funeral Service Charge -Total Professional Activities . $3495.00
FUNERAL HOME SERVICE CHARGES - - $3495.00
SELECTED MERCHANDISE:
Alex. $1695.00
Graveliner . $700.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED $5890.00
Cash Advances
Flowers. $2 ] 5.18
Certified Copies of the Death Certificates. $60.00
Clergy Honorarium - (James Spurrier), $75.00
Music Honorarium-(Susan Hatch) . $50.00
Cutting Date on Stone $150.00
Cemetery Opening & Closing $750.00
Cemetery Equiptment, $140.00
Obituaries -Harrisburg $153.19
-Carlisle $81.90
TOTAL CASH ADVANCES AND SPECIAL CHARGES • $1675.27
Total
Total Cost . $7565.27
SUB-TOTAL $7565.27
INl'f1AL PAYMENT' / ll1S000NT! CREDITS 7200.00
TOTAL AMOUNT DUE $365.27
t}~ ,~. .
Mrs. Fay A. Bishop
Page 1
REV-1513 EX + (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I°ILE NUMBER
FAY A. BISH OP 0 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 [ndude outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)1
1. Isabel P. Alberl Sibling
630 Range End Road 100°~ residue
Dillsburg, PA 17019
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS .APPROPRIATE, O N 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. None
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. None
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ;
(If mon; space is needed, insert additional sheets of the same size'I
REV-1513 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FAY A. BISHOP
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS (ndude outright spousal distritwtions, and transfers under
Sec. 9116 (a) (1.2)]
1. Isabel P. Albert
630 Range End Road
Dillsburg, PA 17019
RELATIONSHIP TO DECEDENT
Do Not List lfrustee(s)
Sibling
AMOUNT OR SH
OF ESTATE
100% residue
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 TAXIS NOT BEING MADE
1. None
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. None
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I =
(If more space is needed, insert additional sheets of the same size)