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HomeMy WebLinkAbout07-16-08 (2)15056051047 ---~ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year Fil? Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~ ~ ~ ;~ PO BOX 280601 RESIDENT DECEDENT Harrisburg,. PA 17128-0801 ENTER DECEDENT INFORMATION BELODate of Death Date of Birth Social Security Number ~ ~ ~ Decedents First Name MI Suffix De/c]edent's Last Name /7 <~ G~ ~~ ~ L° ~ L° YJ (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name MI Spouse's Last Name Spouse's soy a~ security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL. IN APPROPRIATE OVALS BELOW O 3. Remainder Return (date of death ~ 1. Original Return O lemental Return 2. Supp prior to 12-13-82) ture Interest Compromise (date of O 5. Federal Estate Tax Return Required F 4 O p 4. Limited Estate u a. death after 12-12-82) Total Number of Safe Deposit Boxes 8 O . 7. Decedent Maintained a Living Trust Q 6. Decedent Died Testate (Attach Copy of Will) (Attach Copy of Trust) nder Sec. 9113(A) h O 11 Qi 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of deat ~ (Attach SchaO) between 12-31-91 and 1-1-95) E DIRECTED T0: ALL CORRESPONDENCE AND CONFIDENTIALDAX MPLETED H F CORRESPONDENT -THIS SECTION MUST BE CO . Numbe e Te ephone tim Name ~~ ~ ~~~ 1~~~ ~ J L(J ~- S Q ~ ~ Q ~ ~ ~ __ licable REGISTER OF LLS USE LY Firm Name (If App ) -~ ~ sue-- ~ r f'~ C a7 -v'"-- ~ t' - - «3~ ~ C`7 First line of address ~~--~~ ~ ~ ~~ ~~~ % ~ /, d ~ / ~Q-~~o ~C~~ 3 ;tit Second line of address ~ ~ •" ~_~` 3a ~ DATE FILED C7 State ZIP Code City or Post Office ,/ ~r ~ ~ J Q. ~~ f ~ ~ o2J C orrespondent's a mail address - ~~~+ ~=~:of Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements and to the best of my Kriowledg it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which prepay DATE any knowledge SIGNATURE PERSON RESP~IBLE~OR FILING RETURN ~/ EPA OTHER THAN REPRESENTATIVE ADDRESS - PLEASE USE ORIGINAL FORM ONLY 15056051047 Side 1 15056051047 -;~ -J 15056.052048 REV-1500 EX REiCAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. / `3 ~j ~ O • 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. ~ ~ ~ D 3 . 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ~~ f ~ 3 • 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ~ ~ ~'Z , 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. ~~ ~~ 9 • 13. Charitable and Governmental Bequests/Sec 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. 3~~~ ~ ,' TAJC 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_ 15. 16. Amount of Line 14 taxable • at lineal rate X .0 ~ ~ S ~'Q y . 16. / ~'' ~ ~. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 ±axable at collateral rate X .15 1g. 19. TAX DUE ....................................................... .. 19. ~ ~f 4 • 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p '^ \. \ REV-1500 EX Page 3 File Number Decedent's Complete Address: UtGtUtN I',S~N/AME: /' --- _. TREET ADDRESS / _ O'f_ _ _ _ _ _ _ _ - - CITY _ STATE ,--~ ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits(PaymE;nts A. Spousal Poverty Credit __ _ _ _ __ B. Prior Payments C. Discount - - __ ___ _ _ _ __ __ _ Total Credits (A + B + C } 3. Interest/Penalty if applicable D. Interest -- -_ __ E. Penalty (1) ~~'y~ (21 - u - Total InterestlPenafty (D + E } (3} , O - 4. If Line 2 is grE;ater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, line 20 to request a refund. (4} _ o _- 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~~~~ A. Enter the interest on the tax due. (5A) _ ~ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~~~~ 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 :.................................................................................... ...... ^ [~ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ ~' c. retain a reversionary interest; or .................................................................................................................... ...... ^ ~' d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ Q~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ [~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................................. ...... ^ (~ IF THE ANSVWER 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) percf:nt [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-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)j. 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-1502 EX~• (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER iB~~ ~~`~ ~ ~~ ~rrS 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. (If more space is needed, insert additional sheets of the same size) ~J NADAguides.com Vafue Report @utDl3 ,~.,.o (THIS IS NDT AN APPRAISAL FDRM) '~, Reference Nurrtber 158834 Office Location Costa Mesa ©ate 8/29/2008 Guide Edition May-Aug 2008 Year 'd n c rer T Ws g ion 151T9 ZIMMER UNKNOWN pA MA Floor Areas: Single-Wide Width x Leng~i Total Value Main Floor Area- 14 70 $6,81088 1. t3a~se Structure Value ~•s'la.~ 2. State Location Adjustment x ~ •~ 3. To1at Guide Soak Retail Value (in average condition) $6,847.10 4. Condition Adjustment Excellent ^ Good 0 Average ^ Fair ^ Poor D NIA D x 1.1396 5. Condition Ad}usied Value $7,850.22 ti Total Adjusted Value of Home ;7,860.22 7 Total Additional Features $3,G~J7.44 8 Iota! Adjusted (Ratai!} Yalue of home and Optional Equipment $11,547.66 Camplebed 8y: OnGne StmYrrary Comments: This ~s a base retail value (without irupection) Cased on information supplied t:y the customer. Copyright ® 2008 NAD.A. Appraisal Guides, Inc, Ali rights reserved. Pa e 1 of 3 q ____ Page 1 of 1 Sued From: "John Carroll" <Carrolt~fib-corp.corn> To: ~~woodtrib'(c~pa.neh Seim: Tuesday, May 27, 20Q8 5:49 PM Sub)ect: IMabite 1-lcme Value I wasn't ante to get an answer to my question regarding the source of pricing, a#ter than it came out of a mobile home guidebook. The "NAUA" valuation I was given for the 1979 Zimmer, 14X7U mobile home was $5811.OQ. Although we dp not make loans for homes 10 years or alder, we normally loan up to 85°fb of the NADA which in this case would have been $5,448.80. I ,just tries! to get the info from Highsptre Names, Inc (717) 944-7437. The recepttanist indicated that a caA back during the day would put you in touch with a person who h~ access to valuation gooks. I explained to the reoeptlonlst that the mobile was in an estate and that you were trying to sei a value for esbbe purposes. Good tuckt John Carron Private Hanker' 25ot) cammerae Drive i•tarrisburg, l~A 17110 Ph: (717) 54~ - 3366 FAX: {717) 441-3423 .. - .. . ~ .~ •~ ~ -- _~ ._..__ J_J t.. _.......... L... Ft.... ..-.ri.. i.. u~l.....n a 7~ ~r~l+•lrnrrnr'~ Tf REV-1508 EX t (t-97) SCHEDULE E COMPADNWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. IIVHRESIDENTDECEDENTRN 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 G ,5'SD G,Q.~ /i s/ ~,?,c r ~~e. h a.r~ i e S burg /-4 /70.~~ ~e:Covs~TS .° ~ti~Lk, Hy ~ ~~. ~~~o~ ~ ~3~. ~~~~ao ~y a t~ ~~~~/ f d'a ~- TOTAL (Also enter on line 5, Recapitulation) I $ ,,~~ ~~ r (If more space is needed, insert additional sheets of the same size) _ _ - - _ _ _ _ _ ~~,. - - - _ .mss ... _ _ _ _ - - .r` -..~ . f1~r,~ Jiyl~Vli - . - _ -_ •.39'3. ~ E'.: ...~J.s ~3 . -' ` u y :... .. :'.'::~:.~. .:..... .. .. .. L•V.:.~ ' .~ ~ r. ~a1i~~'0: :~. ,,. ~La.~~~..7~: :~ :. i n. r+.ii':: .:. L.w:iJ :'.ivt j 1Sie42i4410ti8T tliT MARKET AAifANTAC ~ DEC.29-MAR.2S,260f 1 OE 3 l ee a o61D9M MM !ir """"` lf~f FN M AIIAlM'S T. 10 56ftItal~fREI LN ENtiLA #'A ?7(i2~ ruYC qc!• .•ya•~.~•rw -!+!• .~a~rwr.~~ nr s•ww ;NTERE3T PAID YEAR TO DATE .42.'-2 37%! ~. Ef~INC S/ILANGE /O. t AJl0{711 a.ei A111ii1l/ F ~MYE~lEST,_f!~Sd . BAI~lICE . NT ACTYVITY tY~l9-DI'~EEGllRiDIC lAEAMCE e1-15-08#CtfSTONER NTTFRiRAMAt, v1`1e-OC~Ifift-ti4tai i'AYiiei~i D2-2l.1-9~INTERfST rAYM£NT NJGQ'Mipi ,till ~llia• i~I.tESiyAi 03- 26-iil~ Ci0SE0t1T i s__ f i13.73y.8S j 3•een.e0 ~ 15,i3q.8.5 1!'s . S! ~J'gRC AA i !3, .1S 13.39 ~ ~~~ 5,7K.54 ii.i~ i5,777,7t ~ 0.08 I :! te.00 .F(yN.q. nr *r!'N+.r+r •ifT~ M .n~M - !!A NO11. l1OESM'T 1T f£El GOOD TO lMVE A PLAM? f'LAilg3lwi +GUfr fU7~i~7E 61iR YOM£11JIES PRt~eii! [litr.Li:il[.1 ~$il11MI5 AM7 C11Oltt5. Ai TIMES, IT MAY SEEM A BTT OAiERMMELMZMC. MEAL, ClL1SE YDIlR LYE'S, TAKE A BREATH, AM3 COlIM7 TD TkRf.E. YOU'RE .Il1 T1iE t4!!{FORT ~OltE. LF7'S TALK A!lOLiT r1xH1 CMALLEMOES Af~lfi COAiS TpDAV. COMTRCT AN MiT EilANGit RtPRESENTATIYE SQ ME GAM BESIlt THE CANYERSA7IOM OR TO LEARN MORE VISIT NMM.MTd.COM/COMfO!'f2OME. i Welwme to M&T Online Banking Page 1 of 2 Accounts Transfers Bill Pay Customer Service ' ~ .... - : > , - - ., - :. - - > STATEMENT VIEW Statement View ~~~ _~ Related Links: .:..;..:,._.:-.~:.: = ,, . . ...--- ~ :....: ~ . .. .....-,r.-- -.... { ........._..: -.:. ...,, . Account Relationshi kg 8800 ' . _.~' -- , .- . '- ~~a~ ;.s-:.:: ... .. . ,. [; ". '._, :.. is-: :'..`:: :r Statement Date April 03, 2008 ,• - _ . 7a view a statement, select an account n a Statement Date ftom the drapdawns below. SUSAN E WEARY j` f1~,[' .s' ~-Q 1O SGRIGNOLI LN ~ ~ =~*tt ~~`~~ Et~taLA PA 17025 't~,z. 'zC ~~~ix 3 ~'x~.. INTEREST EARNED FOR STATEMENT PERIOD 0.23 INTEREST PAID YEAR TO DATE b.67 ACCOUNT SUMMARY BEI"sINNING BALANCE ~~~ A OTHER ADDRiONS GHECKS PAIq OTHER SUBTRACTIONS CURRENT INTEREST PD ENOINO BALANCE NO. AMOUNT NO. AMOUNT NO. AMOUNT 1,609.8 3 4,793.27 6 677.14 1 14.60 0.2 x,711.6 ACCOUNT ACTIVITY po.ST1NG. DATIE TRANSACTIQMI.I~SC~pTION DEPOSITS, NVTERE;3;~ ~.QI~R,AQOITIONS GHECKS & OTHE$ ~.URT~GTK)NS DAILY BALANCE Og~..(38 BEGINNING BAE.ANCE $1,609.89 03-04.08 CHECK NUMBER 59-71 $1,600.18 03..06..(}8 DEPOSIT ~ $1,869.00 $3,459.18 03-07..08 US TREASURY 312 CIVIL SERV $2,591.$9 ~1~t~ ~r 03-07•-08 UNITED OF OMAHA INS PREM $14.60 ~ ~~/ $6 036.'1 03-13-08 CHECK NUMBER ~ $40.50 $5,995.67 03-19~-08 DEPOSIT ~' $342.68 $6,338.35 03-20-08 CHECK NUMBER : - ~' $147. $6,191.29 03-28-08 CHECK NUMBER`.=. S736A0 $6,0'55.29 Oq,_01.Og CHECK NUMBER $16.17 $6.039.12 0403.0$ INTEREST PAYMENT $0.24 b4-03-08 CHECK NUMBER : $327.70 $5,711-66 ENDINd BALANCE ~.7i~•~ C4IECKS PAID SUMMARY CHECN~ NO. PATE AMOUNT CHECK NO. DATE AMOUNT CHECK NO. DATE AMOUNT ... 03-04-08 04-01-08 9.71 18.17 .. 03-13-08 .. 03-28-~ 4D.50 136.00 03-20-08 04-03-08 147,06 32T.7D ANNUAL PERCENTAGE YIELD EARNED = b.04 9S kftnn•1Jnnlinvhnnkina manrlth~nlc r.emir.~cstnmPrarrvir~lrne~.zasrin~t/fits~temetstView~.a~t~x ~/~Q/~Qa~ <<:- MiQc1' Unline Banking ~~~ fi t: 4csrurris Transfe~fi 6i!! Psy .. - ...;s~; ;' ~:.±l::anR~ ~ c.~~. fC>a,.;:rt ~.~~?VI•': = ~ STATEMENT VIEIrV Statement View Relateef Links: ;7~f)trlTtE:'?t'.:C~~'ti ~`~:.:r'Si ~ i?l,^IEt_ r3.~!LS ~T.i;~1~c37r~C_r:~,F_rKs ~'~!2'4Y_r-_p~fCQ_~r~t~^CK Page. ot~ 2 `'ustamer S+_~rvice To view ~I statement, select an account and then a Statement Date from the dropdowns !}stow. ACCOUrrt Re#etionSfiiA Ckg 88Qt) ~' . Ptl ~t o: ~:ave voi~r s=~t~.;ItP:I's _........_............_......:...~...._..:....., A. P,rl+sssaae irz3m tF-Fe I~resicterit of Iv'I&T Sank Statement Date Marrh D3. 2008 ~ ~ ,.. ,-~.--. ,., ..>.....-..., r.......:_.,., ,~....,. ~_._. ~~......:_.,.~ r....._...~.. HELEN AA ADAMS 10 ~G~:ISniu~.i L`~ ENOLA PA 17025 INTEREST PAID YEAR T(7 DATE 0.43 ACCOUNT SUMAAARY ~~.aiNNlNfi JENOSi1S & CHECKS PAlD ' _____ BAIriINCF Ol'HER ADDF710N5 GTFiER CURRENT ENDING 52187RAC710tYS 111tTEREST PD BALANCE ~~ Np. AMOUNT NO. AMOUNT Np_ AMOUNT 4, 850. 1 200 Oa 3 _ ~ 3, 40 r 59 2 32.60 0.08 1;609.8 ACCOUNT ACTlViTY f"-~gT;~'~ .. DATE TkANSAGTIi1N t-ES~.RIPTIGIV l~EPOSlTS,ltdTER£ST, ~,.4T}IER pDC1iI~lONS CHEGKS 4.nT!~~4? siila~ia~Tiolvs D~tlLY BALANCE 02-02-()8 BEGINNING BALANCE S'4.850.0(3 E 02-06-{18 ~ CHECK NUM6ER r+3.: ~ $3,251 00{ S'1,599.OOI 02-f17-f1R IJNITEQ bF bMAHA INS PRFM t1d RQ R1 _+5gd 4n, 02-91-()8 ~ CHECKNUMBERG:=:~. ~ ~ $'f42.59~ 51,441.811 n2.hl.rtig rNFr,-tNtIMBErCf,i, c~~ran c1.a~Ta~ 1 02-26-(x8 ~ UNITl:p bF OMAHA INS PREM ~ 1 518.OD~ 51,409.81 rte n~ no nr~ci~' !~?nn On 03_03.{ ~ ii INTEREST PAYMENT $0.08 1 ~ y1,609.89 L ENDING BALANCE #1,609.881 C€iECKS PAID SUMMARY cr •~~cic luo. uAtiE ArsouNT cts~elc rso. ;~Az~ ~o~+to:ic~z encelc ~c. • t~~,~ ~rriounl r 02-06-0$ 3,251.00 h~4?* q2-11-08 142.58 t>5a;= Q2-21-08 94.00 ANNUAL PERCENTAGE YEELD EARNED = 0.04 °k W'OW. DUESN'T IT FEEL LOUD TU RAVE A PLAN? ~I Aw~aW ~. ` y.~~ ~~ ~Ir~! its c- '-nn~ nrs r-rrRSrn fi r~_~,rr nir-rrn~ ~, T i ~rr+T~r.wrn n~~n r~ pry nrr~ nT J^d Yl ~., _ _ _ \ `h 1:. ~~1 :.. J~i. ,:Y:L~ ft~ J.. -'~.i ut~-L.. 1~~:\x:71':. .~ ~.~'. t'~~IL: L~:. :'1~ TIMES, IT MAY SEEM A BIT OVERWHELMING. WirLL,~ CLOSE YOUR EYES, TAifE A BF2EAT1-i, AND COUNT TJ THREE. YOU`RE IN THE COMFORT ZONE. LET'S TALK ABOUT YOUR CIiALLENtUtS ANU (UAi-$ 1 UL3AY . cfV N l AG E AN Mlii t t3KANCH Ftl=PI^2E$tN I A i 1VE SU WE t:AN 6EGIN THE CONVERSATION OR TO LEARN MORE VISIT WWW.MT$.GOMlCOMPORTLONE. attps:~'lonliinebanlsing.mandtbank.comicustomerservice;messaging,~StatementView.aspx 5/3012t~8 ~~ i~ C~~~`(1''~°' P 115 , O 7 5 , 77 9 ~. 03 D3 08 31 PHILADELPHIA, PA '"''`'"~~ 2053 88742b25 280453CID S1 2 Pay to ~ur~~~ur~~~wru~r~r~e~ur~r~~rjnu~~t~r~ne+e~~ljnun~~~ ~- the order of SUSAN WEARY FOR F{EI.EN ZS MQASGRIGNOLI LN X ENOLA PA 17D2S-2939 ., . t;t-eck No. 2053 88742b25 P SOC 5EC FOR INS S****738*00 o~NrrsaMea~ YOlD ARER ONE YEAB n^ 20 5 3 7n' #:O000DD 5 LBO: 8$ ? 4 2 6 ~ 5 4n^ p 20 308 ._.~ ~~~" ~ ' 15~-sv P 152,$79,3bb ',"•"'-r /~ "' .; Clticck iti1o. '" ~'r!. 02 D1 08 82 PHILADELPHIA, PA 2049 88b75D64 ,, , ._~ 2049 886750b4 28D45300 S2 2 P Pay to ',,;, the ceder oc SUSAN WEARY FOR 64 SOC SEC HELEN M ADAMS X FOR INS 10 SGRIGNOLI LN S****255*OD :.. ENOLA PA 17D25 ~~~ vata A~reR one reap t i98' 1 ~' 2D4q 3n' ~:OD0000 5 i8~: 886? 5064 5~" D9Q 208 ~~~ I~~~ 15 5i P '! S 2 , 871 , 29 2 ~.• ~ ~. aoo ch~k refl. ~ 02 D'[ 08 58 PHILADELPHIA, PA 2049 88b74990 ~.... _.~ 2049 88b74990 28D45300 S2 2 P P~qr to cheorderaf SUSAN WEARY FOR HELEN 90 SOC SEC ,~*** * 1~DASGRIGNOLI LN X FOR INS S 8b6 00 ENOLA PA 17fl25 •~.~•~• voia AFt'ER aae YEAR 'f w 204~i3r ~:fl00D005 ~rB~: 886749gC18n" 090 20B I~~~ ~~ -; p ~ - l3~ ~ ~ `~,. y ` ~ ~ ;~~ L 4` ~ ~ _ ~ ~` s ~ ll _) ~ J ~ _ I ~ ~~ fT: y~ Lff V <~ ~~ ~.. v- iJ E> vi\ ~ ~~ ... :L.}s :~ ~.~ wi~i .. ~yy _ ~. t ~~ 1 ~~ J `~ ~: ~ ~~ y~ ~\ E~~:> ~~~~e ~3~~ - ~~~~gest~~ Rtai Pric~n ~~~a~ti;-t _ Tr,~~nt~; ~° rvtE dkt'!~{fEi KE}d3tt2CE f+~etccns~ hack ,~ ' fcxfe :'7C?2S __ ~~ ~ ;J. . s ~~~ c`~y~~. ~.'~Ygr~eir~ i;`~~ .,~""~e .., ~''', Vs#ae Ac3iameffi ~ S n 'amt d i.. ~.~tF/lk i-4~~ r ,. ,...._ ..urs~ ,~ .. _..... _. v...:Y «:. Zti~13 ~a ~aslrs y~ ?296! ~rsaaa y i+° ia.e ~. = ~ ~ . r. i.n. A { ~~ed. . I ~~ .! r f ~ fi . } ... a ~~ ~~ ~ ~ ,, p^a yy ...t: ._. Ar.:. Jjf t . ... .., ,. .. _, 1. 1 `,~:, ~Li ~~ n~ri~~yt l~'ai\~~~~eir ikill.l14"~~~.~7 ,4.~.V.~~)~2~.23L I~~T..i1~~i,rL~t.~.ci.l~~.`~~Ir:A:I~~-t~~£tFVft.j~~~i ).~~_.'',~. t~t~. l~C~~t A1-i ~.1 -~... 41~t~1~: ~:.. Y n,~t~A~.)~,. 4,_.,l r.. ~..,~~ ~ .~~E ~. EV-1511 E.X+ (12-99) ~~~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE CIF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBEFI DESCRIPTION AMOUNT A. FUNERAL EXPENSES: / ~~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) LL ~ ~, Social Security Number(s)/EIN Number of Personal Representatives / - ~ ~ ~fG70.. / Street Address ~O S~-/-C°iy`!l~'~~ L~~~~ City ~Gi o ~ct State ~ Zip j7c'1e?S~ / Year(s) Commission Paid: ~Od ~S/_.,ZUL~9 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 ~~ v~ ~ ~~S- j~~ - ~/ t . ' 5. , Accountant s Fees 6. Tax Return Preparer's Fees ~~-~he~ ~ ~ ~,~ ~re~/'w~~os~ o ~' !'~CuP_rI /~O- 7. TOTAL (Also enter on line 9, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE f)F ,(~ / FILE NUMBER 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 or the same size) REV-1513 EX+ (9-00} SCMEDItILE ~ COMIMONWEALTH OF PENNSYLVANIA BENE~ICtAR1ES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF F4LE NUMBER _~~ .~ /tel. .s RELATIONSHIP TO DECEDENT AMOUNT OR SNARE NUMBER NAME AND ADDRESS OF PERSONS} RECEIVING PROPERTY Do Noi List Trusiee(s} OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions,. and transfers under Sec. 9116 {a) (1.2)} ~,(~, /C" i mac: fi ae.,e a~ !7"ctc2.tr~ S ,~ f ..~ ~ 1~'~'G~' ~~~-' ~,3 ~vo2S,~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGii 18, AS APPROPRIATE. ON REV-7500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MRDE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS t. 1fOTAL QF PART tI - ENTi=R Tt~TAL N()N-TAXASUE DIS~RISI~fTlri?NS CAN SINE 13 OF REV-i~Qtj C(}VER SHEET I ~