The URL can be used to link to this page

Home My WebLink About10-21-08-J REV-1500 15056041147 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 0 8 0 0191 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02142008 04031923 Decedent's Last Name Suffix Decedent's First Name MI GRIM JUNE 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 ~ qa. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (date of death after 12-12-82) 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 Cretlit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number JAMES M ROBINSON 7172459688 Firm Name (If Applicable) TURO LAW OFFICES First line of address 28 SOUTH PITT STREET Second line of address City or Post Office CARLISLE CA 94587 REGISTEF`t ~F WILLS U~F,'ONLY_ , _-; =-' ~ , - =i r.*~ -Ya ;~ _~_ DATE~ILED ... r.~ Correspondent'se-mail address: jrobinson@turolaw.com 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~~reparer other than the personal representative is based on all information of which preparer has any knowledge. ADDRESS 4533 Darcelle Drive, Union State ZIP Code PA 17013 Marlet E. Grim SIGNA RE OF PREPARER~OT'1E AN RESENTATIVE ATE ~- James M Robin /U t~ South Pitt Stlieet, Carlisle, PA 17013 Side 1 15056041147 15056041147 ~ .~ < t ADDITIONAL Personal Representatives Grim, June Marie SS# 193-18-7017 2/14/2008 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. 2 Signature Name es M. binson Address 28 South P t Street city, state, zip Carlisle PA 17013 Date 3 Signature Name Address City, State, Zip Date 4 Signature Name Address: City, State, Zip Date 5 Signature Name Address: City, State, Zip Date 6 Signature Name Address: City, State, Zip Date i t REV-1500 EX Decedent's Social Security Number oecedenYsName: GRIM JUNE MARIE 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 8 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) ...................................................................... . 8. 0 . 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ........................................ . 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. .. 10. 2 1 , 8 3 6 . 7 8 11. Total Deductions (total Lines 9 & 10) .................................................................... .. 11. 2 1 , 8 3 6 . 7 8 12• Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12. - 2 1 , 8 3 6 . 7 8 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. - 2 1 , 8 3 6 . 7 8 __ _ _ 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 .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 - 2 1, 8 3 6. 7 8 16. - 9 8 2 6 6 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due .................................................................................................................... . 19. - 9 8 2 6 6 15056042148 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15056042148 Side 2 1505042148 ti REV-1500 EX Page 3 File Number 21 - 08 - 00191 Decedent's Complete Address: UCI,000IV 1 J IVHMC Grim, June Marie STREET ADDRESS 1000 Claremont Drive cITY Carlisle - - STATE ZIP ~ 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 3. InteresUPenalty if applicable p. Interest E. Penalty Total Credits (A + B + C) Total InteresUPenalty (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) -982.66 (2) -49.13 (3) 0.00 (a) 933.53 (5) (5A) (5B) Q.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 :.................................................................................. ~ J Lx c. retain ahreversionary interest oo shall use the property transferred or its income :.......::..::::......::..:::::...... f __ ~X_ 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? ....................................................................................................................... I X - __ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ' Lx 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ~_ ~ ~x_~ 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. -49.13 SCHEDULEI DEBTS OF DECEDENQT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES O LIENS INHERRANCE TAX RETURN 'I 1 RESIDENT DECEDENT --.-. ___.. _.- -___- __ I~ __.- 'FILE NUMBER ESTATE OF Grim, June Marie 21 - 08 - 00191 Include unreimbursed medical expenses. _____ -_ -- -- ITEM NUMBER DESCRIPTION ____-- 1 Patient Accounts Billing Office -Acct. No. 10003233HAR TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 21, 836.78 21,836.78 Aug 20 08 03:11p p.2 I PATIENT ACCOUNTS BILLING OFFICE 1?515 Research $hd, Bldg 2, Suite 100, Austin, T]: 7k759 P.O. Box 203500 Austin, TX 7872x- X500 FOR INQUIRIES PLEASE CALL LOC.AI.: 5I2-719-7580 TOLL FREE: ]-300-880-2056 I ~~~ c-rr~ /-~c- ~- - August 16, 2003 June Grim 4533 Darcelle Dr Union City, CA 94587-4719 ACCOUNT. IDENTIFICATION Re: Triumph Healthcare Harrisburg Reference Number :17336018 - 353 Account Number : I0003?33HAR~ Patient Name :June Grim Date of Service : I1-30-07 Balance Due : $21,836.78 Responsible ParrST: June Grim This is our final attempt to reach an agreement for payment of the above referenced account. Any further may result in your account being placed with a collection agency. Please remit payment today in the accompanying envelope. To pay by credit card you may complete the detachable coupon or contact a representative at one of the telephone numbers listed above. If you have already made payment arrangements and/or paid your account in full, please disregard this Thank you. Personal checks that you send us for payment maybe processed electronically. This means that checks clear faster, banks no longer return checks and bank statements are valid proof of payment. -------------------------------------------------------------Detach an~i Return------------------------ Reference Number :17336018-353 P.O. Box 203600 - ~ ~\T;~ 5~ Account Number : 10003233Id.AR Austin, TX 78720 3600 ~„ V ~ Balance Due : $21,836.78 (p Amount Enclosed: $ Return Service Requested g\ ~ ~ 1J~' ^ Visa ^ M; C \ , Credit Card #: _?~i ~ Exp. Date: ! i ~ Cardholder: ~ 3 or 4 digit security code: ~ Signature:- ~ PERSONAL & CONFIDENTIAL June Grim 4533 Darcelle Dr (Union Ciry, CA 94587-4719 117117)11111111[111111111111111111/111111111111111111111111111 353 Patient Accounts Billing Office P.O. Sox 203500 Austin, TX 78720-3500 111.11111111711111171II1711111{1111111117111111111111111111111 C20 000455P 1 9A3 000'1D1 228 067200 Z-CRE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES AppRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAX DIVISION DF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 HARRISBURG PA 17128-0601 REV-1547 EX AFP (06-05) DATE 07-28-2008 ESTATE OF GRIM JUNE M DATE OF DEATH 02-14-2008 FILE NUMBER 21 08-0191 COUNTY CUMBERLAND JAMES M ROBINSON ACN 101 TURD LAW OFCS APPEAL DATE: 09-26-2008 28 S P ITT ST (See reverse side under Objections) CARLISLE PA 17013 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ---- ~ --RETAIN LOWER PORTION FOR YOUR RECORDS E- -------------------- ------------------------------------------------------------ REV-1547 EX AFP C03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF GRIM JUNE M FILE N0. 21 08-0191 ACN 101 DATE 07-28-2008 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) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets cl) .00 ~2) .00 c3) .00 c4) .00 cs) 509.002.14 c6) .00 cn .00 C8) NOTE: To insure proper credit to your account, submit the upper portior of this form with your tax payment. 509,002.14 APPROVED DEDUCTIONS AND EXEMPTIONS: 27,995.53 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 2.178.68 11. Total Deductions (11) ;0.174.21 12. Net Value of Tax Return (12) 478,827.93 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax C14) 478,827.93 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: 15. Amount of Line 14 at Spousal rate (15) • 00 X DO _ . 00 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 478,827.93 X 045 _ 21,547.26 17. Amount of Line 14 at Sibling rate (17) •00 X 12 _ .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 _ .00 19. Principal Tax Due C19)= 21,547.26 TAY rRFT1TTC. PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID 05-09-2008 CD009690 1,077.36 20,469.90 TOTAL TAX CREDIT 21,547.26 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 ~ IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATIDN OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR TNSTRUCTTONS.) 15056041147 ~~ Y ~~ J~~ 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 2 1 0 8 O O i 91 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02142008 04031923 Decedent's Last Name Suffix Decedent's First Name MI GRIM JUNE M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Mf Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ® 1. Original Return ^ 2. Supplemental Return ~ 3. Remainder Return (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) B Decedent Died Testate ~ ~ 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 1 9 ~ 11. Election to tax under Sec. 9113(A) - between 12-31-91 and 1- 5) (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 7172459688 Firm Name (If Applrcable) TURO LAW OFFICES First line of address 28 SOUTH PITT STREET Second line of address City or Post Office State ZIP Code CARLISLE PA 17013 Correspondent's a-mail address: j r O b i I1 S O A@ t u r o l a W. C O m REGISTER OF WILLS USE ONLY ~-.~ .~ ,:--~ - ;~ -i., --- - '-. - I _ t~ _ - -: _~ -., r -; ,~_~ -_ ~ s _ -Tl - 1 -i t; ~ ~ . _. r l ~- ~a _ ~ -. , 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. Declar ion of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SIGNATUR OF PERSO RE NSI OR FILING RETURN DATE Marlet E. Grim ~1 ~Q zd(J ADDR SS 4533 Darcelle Drive, Union City, CA 94587 SIGNA RE OF PREPARER OTHE~ HAN ~ KESENTATIVE DA E ~ ~~,,~~,~,,~ ~ ~~ James M Robinson h~ e~ ~ `J:, AD R SS South Pitt treet, Carlisle, PA 17013 Side 1 15056041147 15056041147 ADDITIONAL Personal Representatives yrirr>!, rune l~larie aS# 19~-i8-i0'i7 2/14/2008 Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. ~l 2 Signature !---~~,~~-_~ ~ -ca -- ~ ~ :~fe ts.~t~, t~-a ~-c `~ , Name Ja~ines M. Rq'binson Address 28 South Pitt' Street city, State, zip Carlisle PA 17013 Date ~ ~ ~ ' ~~ Signature Name Address City, State, Zip Date 4 Signature Name Address: City, State, Zip Date 5 Signature Name Address: City, State, Zip Date 6 Signature Name Address: City, State, Zip Date 15056042148 REV-1500 EX Decedent's Social Security Number oeoeaenr5 name: GRIM , JUNE MARIE 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. 5 0 9 , 0 0 2 1 4 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) ....................................................................... 8. -- 5 0 9, 0 0 2 1 4 - --- 9. - - Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 2 7, 9 9 5 5 3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................... . 10. 2 , 1 7 8 6 8 11. Total Deductions (total Lines 9& 10) ..................................................................... . 11. 3 0, 1 7 4 2 1 12. Net Value of Estate (Line 8 minus Line 11) ............................................................ . 12. 4 7 8 , 8 2 7 9 3 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. 4 7 8 , 8 2 7 9 3 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 -ineal rate x .045 4 7 8, 8 2 7. 9 3 16. 21 , 5 4 7. 2 6 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ........ ............................................... ..................................................... . 19. 2 1, 5 4 7. 2 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 15056042148 15056042148 REV-1500 EX Page 3 File Number 21 - 08 - 00191 Decedent's Com[olete Address: DECEDENT'S NAME Grim, June Marie ____ __ _ _ _ STREET ADDRESS 1000 Claremont Drive 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 3. Interest/Penalty if applicable p. Interest E. Penalty 1,077.36 Total Credits (A + B + C) (1) 21,547.26 Total InterestlPenalty (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. q_ Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. ,Make Check Payable to: REGISTER OF WILLS, AGEMT (2) 1,077.36 (3) 0.00 (4) (5) 20,469.90 (5A) (56) 20,469.90 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? .............................................................. ~ ~z 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................... .........-................................................. ^ ~J 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 ~~~~11 contains a beneficiary designation? .... ................................................................................................................ u 0 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)J. 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. ', SCHEDULE E '. CASH, aAM1iK DEPOSITS, & illiiSC. CDMMONWEA~TFi OE FENNSY~VANIA PERSONAL PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT it -- --- - _ - - - _-- FILE NUMBER ESTATE OF Grim, June Marie ~ ~21 - 08 - 00191 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 DESCRIPTION I VALUE AT DATE OF NUMBER DEATH 1 Smith Barney Acct. No. 504-44261 ~ 507,025.64 2 ~ Charles Schwab Acct. No. 1383-9007 ~ 2.39 3 F & M Trust Irrevocable Burial Fund #02-11483 1,974.11 TOTAL (Also enter on Line 5, Recapitulation) 509,002.14 ~ SCHEDULE H ~UIdEP.AL EXPEtVVSES & COMMONWEALTH OF PENNSYLVANIA I /~ry~~ 'c o/~~7-' ^('~~+~+ INHERITANCE TAX RETURN I /~y''Nh7TRF11 lYE l~Va7' 1 J RESIDENT DECEDENT I ESTATE OF Grim, June Marie Debts of decedent must be reported on Schedule I. ITEM _ - NUMBER FUNERAL EXPENSES: DESCRIPTION A. 1 ~ Austin H. Eberly Funeral Home, Inc B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address li 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) I Claimant Street Address City State Zip I 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 ~ Family Travel Expenses to Funeral -Airfare, Lodging, Rental Car FILE NUMBER 21-08-00191 AMOUNT 9,021.70 15,270.07 511.00 75.00 166.60 2.951.16 TOTAL (Also enter on line 9, Recapitulation) 27,995.53 'i SCHEDULEI '~ DEBTS GF DECEDENT, i~Q~i~TGAGE COMMONWEALTH OF PENNSYLVANIA ; LIABILITIES, & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Grim, June Marie FILE NUMBER 21 -08-00191 Include unreimbursed medical expenses. ITEM DESCRIPTION I AMOUNT NUMBER 1 Philip D. Carey, MD 27.02 2 Carlisle HMA Physician Management 12.37 3 Cummings Associates, P.C. 135.00 4 Carlisle Ear Nose & Throat Associates 90.21 5 Blue Mountain Anesthesia Associates 16.60 6 Harrisburg Gastroenterology, Ltd. 10.51 7 West Shore EMS -Carlisle 84.68 8 Special Event Emergency Medical Services, Inc. 768.55 9 Special Event EMS (Dillsburg) 490.34 10 Nephrology Associates of Central PA 297.86 11 Joseph P. Cardinale, D.O. 245.54 TOTAL (Also enter on Line 10, Recapitulation) ~ 2,17$.6$ REV-7513 EX+ (9-001 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EBTATE ~F _ -- Grim, June Marie SCHECt~LE J BENEFICIARIES NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trusteels) FILE NUMBER 21 -08-00191 SHARE OF ESTATE AMOUNT OF ESTATE (Words) j ($$$) - - i I. jTAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers ~I under Sec. 9116 (a) (1.2)] I ', 1 I Marlet E. Grim Son 'Entire Estate 478,827.93 4533 Darcelle Drive ~ 'j Union City, CA 94587 I ~i I i ~ ~I ~ ~ ~', I '. I i i i I i, ~ I'~ ~ '~ i I 'I ., ', !Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet ~, II. INON-TAXABLE DISTRIBUTIONS: jA. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS ~ NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00