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HomeMy WebLinkAbout07-17-08a Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~,,, County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN a Harrisburg, PA 17128-0601 RESIDENT DECEDENT ' ~~: , ~ ~ ~ t ~ ENTER DECEDENT INFORMATION BELOW Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Narne MI FILL IN APPROPRIATE OVALS BELOW .iri 1. Original Return O 4. Limited Estate ® 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received REGISTER OF IMILLS O 2. Supplemental Return O 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) O 3. Remainder Return (date of death prior to 12-13-82) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TpJ(INFORMATION SHOULD BE DIRECTED TO: Name ,~~ 11 nn Dsiytime Telephone NuQmber q - Firm NamA (If Applicable) REGISTE~ ' WILLS U ONLY; ,' , _` s r- - i Fir t line of address - fit; `~ s Secon line of address ~ t~ _-- _. ~ ~ ~';~ - ' ' y ---- . , City or Post Office State ZIP Code I DATE FILED Correspondent's a-mail address O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) 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, ct and complete. Declaration of preparer other tha the personal representative is based on all information of which preparer has any knowledge. SIG OF PERSON RESPON,~SIB)LE FO G R N DAT _ /~/ % ADDRE ~~ ~ ~~,.~ ~ ~ / ~,v') SIGNA URE OF PREPARER OTHER THA REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 15056051047 Side 1 15056051047 15056052048 REV-1500 EX RECAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. ---`--r--''' 2. Stocks and Bonds (Schedule B) .................................... ... 2 ~- 3. Closely Held Corporation, Partnership or Scle-Proprie±orship (Schedule C) .. ... 3. - 4. Mortgages & Notes Receivable (Schedule D) ...................... ... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. ~i ~ ~,~~ . ~ l 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 U~ ~ ~ ~~ . 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ~~ ~ J . ~ 3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ~ ~ . 11. Total Deductions (total Lines 9 & 10) ............................... ... 11. ~ ~ ~ .3 3 12. Net Value of Estate (Line 8 minus Line 11) ... 12. J ~ _ 13. Charitable and Governmental BequestslSec 9113 Trusts for which t an election to tax has not been made (Schedule J) ..................... ... 13. , f 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 1S. Amount of Line 14 taxa at lineal rate X .0 ~(; ~, (} ~ .S V~ 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 • ~• 15. 17. 18. / ~/ l 19. TAX DUE ......................................................... 19. ~'(.~° ` •v` 20. FILL fN THE OVAL tF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 15056052048 O REV-1500 EX Page 3 File Number (~ ~ ~ ! ~~ J~ ~~ Decedent's Complete Address: DECEDENT'S NAME STREET ADDRESS ~ ~~ ~ ~ ~ ~~ J ~ ~~' ~~~ S ~- CITY ~ STATE ~~ ZIP ~ ~ L~ j Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount Total Credits j A + S + C.) (2) 3. InterestlPenalty if applicable D. Interest E. Penalty Total InterestlPena{ty (D + E: } (3) 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. (4) 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. ;~~7.s~~ (5A} B. Enter the total of Line 5 +',iA. This is the BALANCE DUE. (56) '7 1 -~ -ate. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN ThiE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes NQ 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? ................................................................ ...... ^ ~d 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death avithout receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........ ...... ^ ®. 4. Did decetlenl own an Individual Retirement Account, annuity, or other non-probate property which 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 tn~nsfers 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 [7'2 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-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE 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 rea:~onable 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-1511 EX+ (10-06) s' ~,. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ - ~r~ rL~ 1 \ F~ C~ ©~R' Q o `r l r~ ~ F~ `_V\ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ./' ~ ~ U~ (~. ~ ~ e.,~-., ~ ~ I L. t ~./ j S-r~-~ ~,~ ~, ~~ s ~ rte, t 7 ~ ~~ ~~ ~. B. ADMINISTRATIVE COSTS: ~ ~ ~. S . (~ 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2 3 4. 5. 6. ~. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Zip ~, 1 ~.kk~ TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7a , s c~ ~ !. ~ (~ 5 ~ 3.33 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~LE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF ~ ^ n °~ , ~ FILE~UMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, inclucling unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) .~ REV-1513 EX+ (9-00) , SCHEDULE J COMMONWEALTH OF PENNSYLVANfA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMO NT OR SHARE OF ESTATE I 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~ f l J C ' ~~ ~' ~~ ~ r~ t. i ~J ~ ~`(~ ~ c.,N ~~ Q~ ~, ~---~ , ~ ~' ~, ~.a-- d ~~ f~'~~ `~ ~~~~ 1 ~ ,~. o-r W ~~ C~ r>/L ~ 1 .~.. Q-.~,,s'J ~~.- C~ 2-1- t ~ I I ~' ~ S (lam ( L ~ .k. -~r ENT-R DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON 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, 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS s~ TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET f ~ (If more space is needed, insert additional sheets of the same size) ,/ f REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE Oi= GRANT OF LETTERS No . 2008- 00462 PA No . 21- 08- 0462 Estate Of : RAE E CARLIN /First, Middle, Last/ Late Of : CARLISLE BOROUGh' CUMBERLAND COUAITY Deceased Social Security No WHEREAS, on the 24th day of April 2008 an instrument dated July 21st 1996 was admitted to probate as the last will of •~ RAE E CARLIN /First, Middle, Last/ l.a to of CARL/SLE BOROUGH. CUMBERLAND County, who died on the 17th day of April 2008 and, ~~ WHEREAS, a true copy of the will as probated i:~ annexed hereto. ~... THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and ~"' for CUMBERLAND County, in the Commonwealth of Penn~~ylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: EUGENIA P L ESKIE who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according t:o law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HDUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 24th day of April 2008. ~ a ~~ r - ~ ~: '~i ~' ~ Deputy * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ~. t I, RAE E. CARLIN, being of sound mind, residing in Tfew Gein3~antown, _ - -.n ~ Perry County, Pennsylvania, do hereby make, publish and declare ~hi~s a~.~:~nd - -~ i~~> for my Last Will and Testament: -_~_~ --a _.., . c= - _ ~-,: FIRST: I authorize and direct that all my just debts and.'.€ii'•neral'•J expenses be paid out of my estate. ~ SECOND: I give, demise and bequeath all my estate, real and personal, wherever situate, to my children: Eugenia P. Leskie, Patrick J. Carlin, Michael J. Carlin, Rae Maria Zerby, Timothy Carlin, Terence Carlin, Eileen C. Smith and Rita C. Rohm, in equal shares. In the eve..,. ~ •• e; m;y c?:il:.ren s`::csl-' predecease mom, then his i; or her share shall be given to my remaining children. THIRD: I direct that all Inheritance taxes shall lie paid from my estate. FOURTH: I hereby nominate, constitute and appoint ray daughter, EUGENIA P. LESKIE, to be the Executrix of my Estate without the necessity of filing any Bond. In the event my daughter cannot act as Executrix, I nominate my son, PATRICK J. CARLIN, to be substitute Executor of my estate without the ra_cessii:y cf fi.ling any Bond. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~ ~ day of ate''"''' A.D. 1996. Signed, Sealed, Published and Declared by Rae E. Carlin, the / ~ ~C ~~~K_(SEAL) above named Testator, as and for ~/~~ _~ r her Last Will and Testament in the Rae E. Carlin presence of us, who in her presence, all being present at the same time, have hereunto subscribed our names as witnesses. ~j~~ Vii. ?'l-C,k=:-~ ~~ ~/~~'1..-,9,.~y.t~+~,L~'" -( SEAL) ~ , ~~' ~ ~ ; ~ ~;~ ~.--_ (SEAL) r 7 ~- ,L. `~,~ L Add/,/ress fl~t-L:~~ a (/ L ~ & r {~ Address i 1 ,,____. .__..__. COMMOI<f1iV~ OF PENNSYLVANIA ) COUNTY OF ~ ~ )SS. On this, the ~- / day of ~~~ , A.D. 19 PGa .before me, the undersigned officer, personally°appearctd /~,n z_ ,~ C,n ~.. ~ . ~: ~ - known to me (or satisfactorily proven) to be the person whose name is (are) subscribed to the within instrument, and ~:.cknaw•ledged that Jhe executed the same for the pur uses therein contained. ~n ~iMeg~ ~iyerrof, I hereunto set my hand and official seal. Notary Public My Canmission F,:cpires: i ~'.ait~~!("J~~fS ~tK'f9tjr P7s~l~?d~u:~„ ~~P~a~u~~ Z..~f.^::J!='!' t~T49T:r"~f ~r~t'. ~k..l~.'~r.'.Y~i~~i{~ ~~,re~~!''~31 ~. ~~~11 t ry~yp 4~:'t, {O.. IC'Y_~A ill~.Y~~ ~Qi '~~,5•Yf'~ I COMMONWEAL OF PENNSYLVANIA )SS COUNTY OF ~.x--~ ) ' On this, the .J- ( day of =,s.~ ~ A.D. 19 ~(~ beforc me,/~ , the undersigned officer, personally ppear~ ~i,,~,>y .~~ b ~+ ~. ,~~~~•~ ~. ~'~~ j 0 ~ !`_ known to me (or satisfactorily proven) to be the person whose name - is (are) subscribed to the within instrumeat, and acknowledged chat .S'he executed the same for the purposes therein contained. ._:: ':~»l.~tdd ~t,•*rof. _r hereunto set my hand and official seal. ~j Notary Public My Com;~ission Expires: I '~~2FF€`~`.-1~ 4~IY~;7 ~.131~0~~1` ~ Ilc~~ G~ ~ t N".'~ I~U"!nr(U I~ t; . '`.~~J~'~,'r~;i;VV SSA" F'~: iQik-+it'.~::~~%',~:}U'h: y I COMMONVVEAL'T#~ OF)?,ENNSYLVANIA ASS. COUNTY OF ~Ly-~'~ On this, the - `-~ ~ day of .~-~~~~ , A.D ~~~, before f e, the undersigned officer, personally PP~ed e ..+,~,,~ ~ ~ ~ I /,~ ~' ~' ~`-~' ~. known to me (or satisfactorily proven) to be the person whose name ~ ~ is (aze) subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. 3~n ~ihtegg ~fjereef, I hereunto set my hand and official seal. ~ n _ ~j LL Notazy Public My Commission Expires: ~H~ i~~Ei ~tra~n iCJE f~3Czt~,~.~ ~tgr l.lp'~~r ti7~~r 7"~r~(,a„ ~r~~rx q?Ra,y r o $ ~' ~ v ~, m ? ~ 3qi r O V: ~ m m m ro 2 ~ m a Eft ~ ~ ~ ~ ~ ` w F. D. CF A. Q1 GRIF CUENT ~ c . T '31' E.FLJNEWAI.hIOMrc n ,n m D 9 n~ w m C1~ W I ~ I ! ~ m m n m o 3 c°s~ p~ ~`,~° ©~ ~ u m I V I~ ~ p O i . + r ~c~77 S~~"~~.~m~C2. 17~`~ ~"~A ~ ~ 5. _ `" - G 'T1 T s ~. 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C- ~ ?I i ~o~~ m ~a ,,~ c iy 'Ci m vy y ....,y .,0 p'~L ~~ of ~. m ~ -, m ~ ~ I o i m m ~ ~ o c K m ~ i5~ m Q ~• ~ m ~pp to Q ~ '. N N N O p"°~'M p N ~, K G ~ a• s ~~ p W N a . ' v ~'n~ , ~ ~~ ~ R~~ ~1'•' ~ (7 , yy q' ~ m N . m a 3 E{ Y t, t~~l 5 4~ ~ c6c?? y E ~ t; ~ l ~'n i'T vr~~~~ ~ to - ~ ~ ~ ~ ~ ~ II '~ ~ ~ f~ ~. ~ ~~~ 1` ,1~ r 7~ i O ~ ~ ~~~ ~ `f11 t ~ ~ ., I ~; I ~~, ~ I I I ~. ~~~ ~~~ i ^~ r ~Mw ~ k. I~~~ INSCRIPTION 0 RDER FORM ~--^ RICE MEMOF~IAL WORKS a division of No. 13- ingr ie MEMORIALS Since 1921 R.D. 2, Box GA-9, West Main Street (3/4 mile west of the square), New Bloomfield, PA 17068 (717) 582-2512 • Fax (717) 582-3404 • www.gingric)F~memorials.com CEMETERY NAME OF DECEASED _ LETTERING REG~UIRED: LOCATION FAMILY NAME MEMORIAL IND. NAMES ON MEMORIAL _ TYPE OF MONUMENT °°- COLOR OF GRANITE LOCATION: DRAW A PRECISE MAP OF LOCATION OF MEf4d4RIAL ON CEMETERY (Use back of work order if necessary) ~~.U BILL TO: '~-- DATE OF ORDER _ - .. ORDERED BY PHONE # ( ) _ - UPON EXAMINING THE ABOVE INSCRIPTIONS, I/WE THE U NDERSIGNED, FIND THE SPELLING AND DATES TO BE CORRECT. THE WORK WILL BE COMPLETED AS IT IS ACCUMULATED. NO SPECIFIC COMPLETION DATE IS GUARANTEED. SIGNED SIGNED PRICE $ DEPOSIT $ BALANCE DUE $ WHITE-Office YELLOW-Production PINK-Customer GOLDENROD-Branch RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA EARNER STRASBAUGH Receipt Date: 4/24/2008 Cumberland County - Register Of Wills Receipt Time: 12:31:19 One Courthouse Square Receipt No.: 1052445 Carlisle, PA 17613 CARLIN RAE E Estate File No.: 2008-00462 Paid By Remarks: CJ ------------------------ Receipt Distribution ------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 30.00 CUMBERLADID COUNTY GENERAL FUN WILL 15.00 CUMBERLArfD COUNTY GENERAL FUN SHORT CERTIFICATE 12.00 CUMBERLAI~fD COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF' RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 - CUMBERLAI~fD COUNTY GENERAL FUN ---- Cash ---------- - $72.00 Total Received......... $72.00 C k1 5 ~ ~~ ~~ ~~~ ~ ~u Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Statement Date: 05/14/2008 Rae Zerby 5095 Fowler Hollow Rd Blain, PA 17006 D~~e Date: 05/25/2008 R arlir Account Nr: 101546 1 Date Description Days Rate Charq_es Payments Balance Quant BALANCE FORWARD 04/14/08 PAYMENT 04/16/08 Cable Television 1,269.03 1.00 17.00 17.00 1,269.03 1,269.03 17.0 0" ~~, ~~ ~ ~el'~ i NOTE: ***** PAYMENT IS DUE UPON RECEIPT ***** BUT NO LATER THAN THE 25TH OF THE MONTH ***** Please remit the LAST AMOUNT printed on your statement. Include the ACCT# from the statement on the MEMO LINE of your check. Payments after 05/09/08 do not reflect on statement. NOTE: ** LATE PAYMENTS ARE SUBJECT TO A 1.250 LATE CHA~ZGE PER MONTH ** A $10.00 FEE WILL BE CHARGED for RETURNED CHECKS ** N Q 7r A ti 4 7 ~ j~ ~~ 1 ~" \~ ~`h` \ ~ '~ ~'' ~ C`. u ~ ~~ ~ti ~~ <:. C ``1 ,,, C~ ~~ ~~ ~~ ''~..~ ...~,~, .~ 1~ ~? t•1 `~ c `~ Y ~ c4 Q O V ~ "~ ~ ~ ~ r~ c V 4 1~l-1 ~ d d ~ ~ ~ ~'~~ ~ -a '9 41 ~ 113 i3- C ~J ~ ~ o ~o ~ © ~s ~~ z vow ~ ~, ~ ° ~NZ 4 ~ ~~ ~~ o~ %~ ~ a' ~~