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Home My WebLink About07-16-08 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 7 0 0 6 91 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204038171 07112007 0122].918 Decedent's Last Name Suffix Decedents First Name MI LEBO MELVA M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credd (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 70: Name Daytime Telephone Number JAMES M ROBINSON 7172459688 F' N If A I' bl Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^ 1. Original Retum ® 2. Supplemental Return ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ® g Decedent Died Testate ^ 7 Decedent Maintained a Living Trust 0 8. Total Number of Safe De osit Boxes (Attach Copy of VJili) (Attach Copy of Trust) p irm ame ~ pp ica e) TURO LAW OFFICES First line of address 28 SOUTH PITT STREET Second line of address City or Post Office CARLISLE State ZIP Code PA 17013 REGISTE~F WILLS U~ONLY I ~= Q ~6 - `~ n -= ~ ~, _a- _ _~ U,~~ _ - r~C~ "7 c-.' -'1 ~7 -n - ~ -, ,fir _ ~~ ' DAT>~ILED tV ,w ' O~ Correspondent's a-mail address: j r o b i n s o n@ t u r o l a w. c o m 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. South Pitt Street, Carlisle, PA 17013 L.~, 15056041147 Side 1 15056041147 ____~ 17 Hilltop Lane, Newville, PA 17241 SIG TURE OF PREP R ROT R T REPRESENTATIVE ATE y~ _J~'~----~ James M Robinson "l ~d L ~1~~ 15056042148 REV-1500 EX Decedent's Social Security Number oeceaenc's Name: L E B O, M E L V A M 2 0 4 0 3 8171 _-__ 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. - 4 3 0 . 8 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............ . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............ . ~~. 8. Total Gross Assets (tota{ Lines 1-7) ...................................................................... . 8. - 4 3 0 . 8 0 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ........................................ . 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............................... . 10. 6 , 5 1 1 . 5 0 11. Total Deductions (total Lines 9 & 10) .................................................................... .. 11. 6 , 5 1 1 . 5 0 12. Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12. - 6 , 9 4 2 . 3 0 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. - 6 , 9 4 2 . 3 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate x .15 - 6 , 9 4 2 . 3 0 18. -1 , 0 41.3 5 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. -1,041.35 Side 2 I,~, 15056042148 15056042148 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 07 - 00691 Lebo, Melva M ----- STREET ADDRESS __ _ -. __ -. - ___ _ _ - _- - __ _-_- ~ 740 North College Street CITY ,STATE ;ZIP Carlisle I PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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. (1) -1,041.35 (2) 23,508.92 (3> _ ___ 0.00 (a) 24,550.27 - (5) (5A) (56> 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :.................................................................................. ! ~ ~,_x b. retain the right to designate who shall use the property transferred or its income :........................... ~ ~ ~ x ~, c. retain a reversionary interest; or .................................................................................................................. ~~ ~X d. receive the promise for life of either payments, benefits or care? .............................................................. IL ~ ~i~x '' 2. If 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 "in trust for" or payable upon death bank account or security at his or her death?......... j ] fix] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ~ I ~ z 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 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)]. 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. 23,508.92 ~ SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT _ -.. __ -_._ _ __r _- _ _. -. ____. _ _ - _ z_- -_~.:-. -. TFILE NUMBER ESTATE OF Lebo, Melva M i~ 21 - 07 - 00691 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 OF NUMBER DESCRIPTION DEATH 1 Refund to U.S. Treasury Series E - U.S. Savings Bond C75 460 590 E, reported lost and paid -430.80 out in the 1980's TOTAL (Also enter on Line 5, Recapitulation) -430.80 SCFEDUI.E H FIJPERAL EXrENSES & ~I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TFU( RETURN ~, e~~e~ RESIDENT DECEDENT rv~-a _v . , r~ ESTATE OF Lebo, Melva M FILE NUMBER ~ 21 - 07 - 00691 Debts of decedent must be reported on Schedule {. ITEM _ __ _ _ _ ~ __- -_-. NUMBER FUNERAL EXPENSES: DESCRIPTION ~ AMOUNT A. 1 2 3 B. ADMINISTRATIVE COSTS: L Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address _ ~i City State Zip Relationship of Claimant to Decedent 4. Probate Fees i 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 TOTAL (Also enter on line 9, Recapitulation) 0.00 SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA ~ LIABILITIES ~ LIENS INHERITANCE TAX RETURN f RESIDENT DECEDENT FILE NUMBER ESTATE OF Lebo, Melva M 21 - 07 - 00691 Include unreimbursed medical expenses. __--- ITEM NUMBER DESCRIPTION 1 Closing Costs from sale of 740 N. College St., Carlisle, PA TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 6,511.50 6,511.50 ' ~'~~ DEPARTMENT OF THE TREASURY (~ ~ _~ BUREAU OF THE PUBLIC DEBT `~, ,r,.._.~ PARKERSBURG, WV 26106-2188 vi~ Phone (304) 480-6592 FAX (304} 480-79G4 Refer to: 01019126050 LUTHER H LEBO (PA} INVIIIIII~IINIIgIIIIIIIIIIIIIIINIIIIIIINNIIIIIN BARRY J SHUGHART ," 17 HILLTOP LANE - NEWVILLE PA 17241 ,, Dear Mr. Shughart: April 15, 2008 I'm writing about a United States Savings Bond paid to you as legal representative of the estate of Melva Lebo. I've enclosed a photograph of the bond. Our records indicate that a claim was filed reporting the loss of the bond and a Treasury Check was issued. Undoubtedly, you were not aware of the previous claim when you redeemed the original bond. When the substitute bond was issued; the original bond became the property of the United States Government. When you received payment, the estate of Melva Lebo received funds to which it was not entitled. As a result, the Department of the Treasury must be reimbursed in the amount of $430.80. Please send us a check or money order drawn payable to the Bureau of the Public Debt, Attention: Accounts Receivable Group, with the enclosed copy of this letter. The Debt Collection Act of 1982, the Debt Collection Improvement Act of 1996, and the Federal Claims Collection Standards for Administrative Collection of Claims (31 CFR parts 900 through 904) require agencies of the United States Government to assess interest, administrative costs, and penalties on debts. Agencies are also required to provide debtors a notice of the assessment of late charges. In accordance with these requirements, the following notification is provided. To avoid the assessment of late charges, this account must be paid within 30 days of the date of this letter. If the account is not paid, interest will be assessed at the Current Value of Funds Rate determined by Financial Management Services. Administrative costs for processing and handling your debt will also be charged. If your account remains unpaid for 121 days from the date of this letter, penalties will be assessed at the annual rate of 6 percent, accruing from the 31St day after the date of this letter. Our legal counsel has advised me to call to your attention Section 3713 of Title 31, United States Code, concerning the priority of claims of the United States and the personal responsibility of the legal representative of the estate. This section reads as follows: " § 3713. Priority of Government Claims (a) (1) A claim of the United States Government shall be paid first when-- For information about Treasury Retail Securities, go to: www. t re a s u ry d i re ct. g o v 2 (A) a person indebted to the Government is insolvent and-- (i) the debtor without enough property to pay all debts makes a voluntary assignment of property; (ii) property of the debtor, if absent, is attached; or (iii) an act of bankruptcy is committed; or (B) the estate of a deceased debtor, in the custody of the executor administrator, is not enough to pay all debts of the debtor. (2) This subsection does not apply to a case under title 11. (b) A representative of a person or an estate (except a trustee acting under title 11) paying any part of a debt of the person or estate before paying a claim of the Government is liable to the extent of the payment for unpaid claims of the Government." If you have any questions, please call a Collection Representative on (304) 480-6592. 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'aa:o I t7k^SEt-5SJ'S~N71F'Lt£A. ~! dy3' 111U,[]lT_`t;FF ~ •'1 eV I; _ liii~7 r r~ ~ xbi c L~`ItClY41TI£ ~R ~ IIl751§ If;~ CR L~~AYCa~ ~~ td t e~ IEG ^.~ T i~ l^ ila,,r. !~f 9 9(Yf~?2 tP 'w SF^ tt tY 1dE ~.:tn I f Y Tr !~ E YYn S I[4A?`-~ Yxa :,LS1~- FE HE fFGU to ~ gqjw3nt ~+diF~i~~ i ~~ ya~r ~€~~~ ( SR~k4u,nu3r s ..y,__ ., ?tYU . r z ._- r a : ~~ao rL.,~s .. _--.--... ~ ._CUf i<~ u, re~riy(iLtt~ ti,t~s rl '~~'~ ;" -: isgr~i~,. ~ 4 4 H~N tINE CX~ c bF ~ -. h ~F~~ -LiN 4 S ~ YI. f Tit-~T4.. µ '., ~'~..,- _,_,.~_,,,~,.~-.~: ~a~ ~?I JrE~lEH Ix~ ~4 rc2[LY33r0f`StiE ;~N LC} ~w u.;~ ~w nscqu~tF F'3~fn B r KCr~ z,:~r~riy n,H,nu.~ tir_..fZ ~ ~,A7 u.~,t u+~riY~. -~.. pt~+`A'!' - n .. ~. » q ~ _ T L_. _ ~ -1 - .Y ~ ~ ~#X ':,~/ F ,.~ ,,~ ~ .:t 1 ..'_y) f~ ~su. ` i4 'ri:.~a - S E. ' - ~ i i-~ 1~1 1-IUD - 1 UNIFORM SETTLEMENT STATEMENT OMB Approval No 2502-OZ65 A. U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT B. TYPE OF LOAN 1. FHA 2.FmHA 6. File Number: 7 Loan Number: 66002088 2008-09 12908009/8153025 3. X Conv. Unins. 4. VA 5. Conv. his. 8. Mortgage hisurance Case Number C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c )" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. NOTE: TiN =Taxpayer's ]dentification Number D. NAME AND ADDRESS OF BORROWER: Amanda L. Shughart 29 S. High St., .Apt. 2 Newville, PA 17241 E. NAME, ADDRESS AND TIN OF SELLER: Barry L. Shughart, Executor of the Estate of Melva M Lebo 17 Hilltop Lane Newville, PA 17241 F. NAME AND ADDRESS OF LENDER. Philadelphia Fin. Mortgage Div. of Leesport Bank 355 North 21st Street Camp Hill, PA 17011 G. PROPERTY LOCATION: 790 North College Street Carlisle, PA 17013 H. SETTLEMENT AGENT NAME, ADDRESS AND TIN TURO LAW OFFICES 25-1616709 28 South Pitt Street„ Carlisle, PA 17013 06-19-1643-321 PLACE OF SETTLEMENT 28 South Pitt Street Carlisle, PA 17013 I SETTLEMENT DATE 02/01/2008 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION ~ 100. GROSS AMOLINT DCIE 1~ROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract sales price 117 , 0 0 0 . 0 0 401. Contract sales price 1 17 , 0 0 0 . 0 0 102. Perso~ial property 402. Personal property 103. Settlement charges to borrower (Line 1400) 6 , 13 0.16 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance Adjustments fbr items paid by seller in advance 106. City/town taxes 406. City/town taxes 107. County taxes 407. County taxes 108. Assessments 408. Assessments 109. 409. 110. 410. III. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 123, 130.16 420. GROSS AMOUIJT DUE TO SELLER 117, 000.00 200. AMOLINTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: ~n i i~en~cit nr earnest tnonev 501. Excess deposit ~„ ~n L. SETTLEMENT CHARGES 700. TOTAL SALES/BROKER'S COMMISSION based on price $ 117 , 000.00 @ PAID FROM PAID FROM Division of Commission (line 700) as follows: BORROWER'S SELLER'S 701. ~ FUNDS AT FUNDS AT 702, $ SETTLEMENT SETTLEMENT 703. Commission paid at Settlement 704 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801. Loan Origination Fee $ 802. Loan Discount $ 803. Appraisal Fee to S W Earrett Real Estate 350.00 804. Credit report co Eeluifax Mortgage Solutions 12.03 805. Lender's Inspection Fee 806. Flood Certification to First American Flood 16.00 507. 808. 809. 810. 811. slz S13 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 9UI Intereslfrom 02/19/2008-02/29/2008 @ $19.082 per day 209.90 902. Mottgage insurance Premit.im for ~ ~(QA~ TO HUO 1, 715.51 903. Hazard insurance Premium for 1 year (s) to Armed Forces Insurance 378.00 904. ' 90~. 1000. RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance 4 month (s) @ $31.50 er month :L26. 00 1002. Mortgage insurance ~ (Y~pn~h(3~ ~ ~(l. VS Pei .1n o~'t'N 1003. City Property Taxes 1004. County Property Taxes 14 month(s) @ $41.38 per month 579.32 1005. Annual assessments 1006 School Taxes 9 month(s) @ $104.87 per month 943.83 1007. 1008. Aggregate Accounting Adjustment - 6 O 5.18 1100. TITLE CHARGES 1101. Settlement or closing fee to 1102. Abstract or title search to'I'ri-COUnty Abstract Service POC _ 1103. Title Examination to 1104. Title insurance binder to I10~, Document preparation to Turo Law Offices (Deed) 100.00 1106. Notary fees to 1107. Attorney's Fees to COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF= TAX PO BOX 280601 HARRISBURG PA 17128-0601 REV-1547 EX AFP C06-O5) DATE 07-07-2008 ESTATE OF LEBO MELVA M DATE OF DEATH OT-11-2007 FILE NUMBER 21 07-0691 COUNTY CUMBERLAND JAMES M ROBINSON ACN 101 TURD LAW OFCS APPEAL DATE: 09-05-2008 28 S P ITT ST (See reverse side under Objections) CARLISLE PA 17013 Amount Remitted X3,5 zj MAKE CHECK PAYABLE AND REMIT PAYM REGISTER OF WILLS ~`~ CUMBERLAND CO COURT HOUSE '7~ISI~~' CARLISLE, PA 17013 CUT ALONG THIS LIME -~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ______________ ----------------------------------------------------------------------------- REV-1547 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LEBO MELVA M FILE N0. 21 07-0691 ACN 101 DATE 07-07-2008 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 117,000.00 NOTE: To insure proper C2) ,0 0 credit to your account, 2. Stocks and Bonds (Schedule B) submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) C3) _ .0 0 of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .0 0 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 5 7,98 6.9 3 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .0 0 (B) 174,986.93 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 13,589.09 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) CLO) 4,761.90 11. Total Deductions (11) 18.;50.99. 156,635.94 12. Net Value of Tax Return C12) .00 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedu le J) (13) 156, 635.94 14. Net Value of Estate Sub]ect to Tax (14) NOTE: If an assessment was issued previously. lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 00 .00 15. Amount of Line 14 at Spousal rate C15) • X = 16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045 = . 00 17. Amount of Line 14 at Sibling rate (17) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) 156,635.94 X 15 23,495.39 c19)= 23,495.39 19. Principal Tax D ue .nr PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 04-14-2008 CD009545 .00 23,495.39 BALANCE OF UNPAID INTEREST/PENALTY AS OF ~ IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 04-15-2008 TOTAL TAX CREDIT 23,495.39 BALANCE OF TAX DUE .00 INTEREST' AND PEN. 13.53 TOTAL DUE 13.53 ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 80X.280601 2 1 0 7 0 0 6 91 Harrisburg, PA 17128-0601 RESI®ENT ®ECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204038171 07112007 01221918 Decedents Last Name Suffix Decedent's First Name MI LEBO MELVA M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise ^ (date of death after 12-12-82) ^ 5. Federal Estate Tax Return Required ^ g Decedent Died Testate ^ ~ Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 1 p. 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 TO: Name Daytime Telephone Number JAMES M ROBINSON 717245688 Firm Name (If Applicable) TURD LAW OFFICES First line of address 28 SOUTH PITT STREET Second line of address City or Post Office CARLISLE State ZIP Code PA 17013 Correspondent's a-mail address: ~ x' O b i ri s O ri@ t 11 r' o l a W. C o m t~ ~ -` ) _ REGISTER,O~ I~Ik6S USF~NLY ;- _ ~ - _ _~-. - -- O .~' DATE FILED C..17 ."~ °r; - -; Under penalties of per}ury, t 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. SIGNATURE OF PERS RESPON IBLE OR FILING RETURN DATE ~~~ Barry L. Shughart ~ ~ 14~ y~'' ADDRESS 17 Hilltop Lane, Newville, PA 17241 SIGN TURE OF PREPARER OT~~ THP;J+I~EPRESENTATIVE DATE '1._-,,ter-~;>=~' ~~;-i//--,~t,~,~.,v James M Robinson , ~ ~ t -~ ~ ~,~w South Pitt (Street, Carlisle, PA 17013 Side 1 15056041147 15056441147 REV-1500 EX 15056042148 Decedent's Name: L E B Q, M E L V A M 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. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... g- Decedent's Social Security Number 204038171 117,000.00 57,986.93 174,986.93 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/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. 13,589.09 4,761.90 18,350.99 156,635.94 156,635.94 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 15. 16 Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18 Amount of Line 14 taxable at collateral rate X .15 1 5 6, 6 3 5. 9 4 18. 19. Tax Due ....................._................................................._..................... ~ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 23,495.39 23,495.39 Side 2 15056042148 15056042148 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 07 - 00691 DECEDENT'S NAME Lebo, Melva M STREET ADDRESS 740 North College Street CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 23,495.39 Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable p. Interest E. Penalty Total InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box 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. (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 to: REGISTER OF WILLS, AGENT 0.00 0.00 23,495.39 23,495.39 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 :.................................._ ~ x c. retain a reversionary interest; or .............._..._.............. ........................................................._..............._ ~~ d. receive the promise for life of either payments, benefits or care?......._ ...................................._............._ ~ j x', 2. If 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 "in trust 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? ....................................._........_..._.............._ _ ~ _ x L~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 1S YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART O F THE RETURN. Fordates 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)]. Fordates 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. Fordates 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)J. The tax rate imposed on I:he net value of transfers to or for the use of the decedents siblings is twelve (12} percent [72 P.S. §9116 (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. COMMONWEALTH OF PENNSYLVANIA INHERfTANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE FILE NUMBER ESTATE OF Lebo, Melva M 21 - 07 - 00691 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 wilting 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. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 740 North College Street, Carlisle, PA 17013 117,000.00 TOTAL (Also enter on Line 7, Recapitulation) 117,000.00 SCHEDULE E ~ GASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lebo, Melva M FILE NUMBER 21 - 07 - 00691 Include the proceeds of litigation and the date the proceeds were received by the estate. Alf property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Citizens Sank Checking Account 610073-550-8 14.458.13 2 ~ Citizens Bank Certificate of Deposit 6246-663651 ~ 17.449.84 3 I Citizens Bank Certificate of Deposit 6247-706044 ~ 10,648.16 4 I Citizens Bank Certificate of Deposit 6140-874998 ~ 15,000.00 5 Series E - U.S. Savings Bond C75 460 590E 430.80 TOTAL (Also enter on Line 5, Recapitulation) 57,986.93 ~ SCFiEDyIJLE H p COMMONWEALTH OF PENNSYLVANW ~~~~~~^~~~ -" INHERITANCE TAX RETURN A MAI\NC~TOAT7~ /L (~~1C+7't+ RESIDENT DECEDENT MLAY~,~~Ih7 ~ fV'U ~YG VW ~ ~7 ESTATE OF Lebo, Mefva M Debts of decedent must be reported on Schedule I. ITEM -- NUMBER (FUNERAL EXPENSES: DESCRIPTION A. 1 ', Hoffman-Roth Funeral Home & Crematory Services 2 Cumberland Valley Memorial Gardens 3 ; St. Matthews United Church of Christ -Post Funeral Reception ~I B. ~ ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / ElN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Turo Law Offices 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant I Street Address City State Zip Relationship of Claimant to Decedent a. ~ Probate Fees Register of Wills Cumberland Law Journal The Sentinel -Legal 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 7,989.75 1,210.00 300.00 3,499.74 348.00 75.00 166.60 TOTAL (Also enter on line 9, Recapitulation) 13,589.09 FILE NUMBER 21 - 07 - 00691 AMOUNT SCHEDULEI DEBTS OF DECEDENQT, MORTGAGE i COMMONWEALTH OF PENNSYLVANIA LIABILITIES, (X LIENS INHERfTANCE TAX RETURN RESIDENT DECEDENT '. _ I FILE NUMBER ESTATE OF Lebo, Melva M 21 - 07 - 00691 Include unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Miscellaneous Supplies Needed to Clean and Repair Home 24.70 2 Betra In-Home Care 352.00 3 Embarq -Telephone Service 99.99 4 PPL Electric Utilities 815.58 5 Boro of Carlisle -Water & Sewer service 137.82 6 Penns Wood Physical Therapy 57-92 7 Carlisle Area Schoo! District -School Taxes 1,258.39 8 Richard Farber -Lawn Care and Sidewalks 300.00 9 Waste Management - Dumpster 404.00 10 Expenses to Sell House 1,311.50 - - -- TOTAL (Also enter on Line 10, Recapitulation) 4,761.90