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HomeMy WebLinkAbout10-16-08/~C 15056051058 REV- ^ 5OO 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 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 0428 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 200-34-9292 .01/18/2008 ' 10/23/1944 Decedent's Last Name Suffix Decedent's First Name MI THOMAS GEORGE B (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THOMAS 'LINDA M Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 174-3s-2596 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~ 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 ~ 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) t_"~.~ 9. Litigation Proceeds Received 10. Spousal Poverty Credit (date of death ~~,` 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number David Englehart (717) 761-4646 Firm Name (If Applicable) - r.' _. _, _ _ _ REGISTER SF%WILLS USE ONt:Y Professional Tax Adviso - `-? r- ., First line of address -- '"~ ~--t 704 Lisburn Road Ste 102 ~ ,i;, Second line of address _ _ \ , , _ - -r~ ._~ City or Post Office ~~ DATE~FTL~D State ZIP Code - - ' '~ i-:' ,~ ~-., Camp Hill ' PA 17011 + '~ Correspondent's a-mail address: denglehart@profinadvinc.com Under penalties erjury, 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, cor ct d complete. Declaration f preparer other than the personal representative is based on all information of which preparer has any knowledge. SI NA~~ E$ O FF~O~R FILING RETURN.. ~p-~DATE~''^ /~ AD R SS 8 Bourbon Red Dr Mechanicsburg PA 17050 SIGN TURE OF P A R O ER AN REPRESENTATIVE DATE rp - la'~O ADDR SS 704 Lisburn Rd to 102 Camp Hill PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 t REV-1500 EX Decedent's Name: GEORGE RECAPITULATION _______.~._ 15056052059 B THOMAS Decedent's Social Security Number 200-34-9292 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. ', 154,156.00 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ' 154,156.00 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. ', 7,485.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 13,587.00 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ', 21,072.00 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ' 133,084.00 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. ' 133,084.00 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 0 129,257.42 ', 15. ' 0.00 16. Amount of Line 14 taxable __ __ ' ___ at lineal rate x .0 45 3,826.58 '' 16. 172.20 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. 172.20 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 ";~, 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: GEORGE B STREET ADDRESS 8 Bourbon Red Drive THOMAS clrY Mechanicsburg _21.. 08 ,.0428 DECEDENT'S SOCIAL SECURITY NUMBER 200-34-9292 __ _ _ _ STATE _ ZIP pA 17050 Tax Payments and Credits: (1) 172.20 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit ___ _ __ _ - 163.58 B. Prior Payments -- -- -- C. Discount 8.62 - Total Credits (A + B + C) (2) 172.20 3. InterestlPenalty if applicable D. Interest _ _ _ _ __ _ _ _ _ E. Penalty Total Interest/Penalty (D + E } (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 4 . Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Llne 1 + Line 3 Is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56} 0.00 Make Check Payable to: REGISTER OF W1LLS, 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 ................................................................................................................... benefits or care? ............................................................... ments a life of either i f h ....... ....... ^ , p y or se e prom d. receive t If death occurred after December 12, 1982, did decedent transfer property within one year of death 2 . without receiving adequate consideration? ....................................................................................................... ....... ^ ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ....... ....... Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 4 . 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 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 lax 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)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY George B Thomas 21 08 0428 If an asset waa made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• Linda M Thomas B' Andrew L Thomas C. JOINTLY-0WNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~' A' 01108/00 American Funds Account #64606445 14,964.00 50 7,482.00 2 A 02101/80 PSECU Account #200349292 35,543.00 50 17,772.00 3 A 02/01/80 Members First CU Account #128977 12,582.00 50 6,791.00 4 A 08114/97 Personal Residence 210,000.00 50 105,000.00 5 B 04/18/83 PSECU Account #0188627586 34,221.00 50 17,111.00 8 Bourbon Red Road Spouse Mechanicsburg PA 17050 905 Greenbriar Drive Son Mechanicsburg PA 17050 TOTAL (Also enter on line 6, Recapitulation) S 154,156.00 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER George B Thomas 21 08 0428 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER. ATTACHACOPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE t~ Lincoln Benefit Life IRA #LBLA122830 133,800.00 100 133,800.00 0.00 TOTAL (Also enter on line 7 Recapitulation) $ I 0.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER George B Thomas 21 08 0428 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Hollinger Funeral Home 6,040.00 Gate of Heaven Cemetary 1,245.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Paid: 2. Attorney Fees 3. 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 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Zip Zip TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 200.00 7,485.00 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER george B Thomas 21 08 0428 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 of the same size) t REV-1513 EX+ (g-00) ~ SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER George B Thomas 21 08 0428 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Linda M Thomas 8 Bourbon Red Dr Mechanicsburg PA 17050 Spouse 129,257.42 2 Andrew L Thomas 905 Greenbriar Dr Mechanicsburg PA 17050 Son 3826.58 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO 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 $ (If more space is needed, insert additional sheets of the same size) i C;~perations f~artfOtira - F - _ Ope_ratio_ns > Shareh_older Name Sear_ch_ > S_earch_Res_ults > Account Details Account Va I ue by Date Account #: 64606445 r~s _y~y~;~,..~~,. i., I°~~~~~~,,~ Tax ID/SSN: 200-34-9292 (~ Registration: GEORGE B THOMAS & LINDA M THOMAS JT WROS 8 BOURBON RED DR Statements MECHANICSBURG PA 17050-7902 Statements Details Acct Overview Acct Value by Date Transaction History Maintenance Histot^ Cost Basis 2007 Tax Summary 2008 Tax Su_mma.....ry Breakpoint Center: -Rights of Accumulation Phone #: Not On File Mgmt Co: AMERICAN FUNDS Fund Name: FUNDAMENTAL INVESTORS - A View Fund Details Fund Code: 10 Ticker: ANCFX Tota15 CUSIP: 360802102 Accour Account Type: 03 -JOINT TENANTS Enter a price date to retrieve an account value from a previous day. Price Date: 01 /18/2008 '~ search Current Price Date: Current Net Asset Value Current Total Shares: Current Value: Top_of._pa_ge 09/29/2008 Price Date: $31.6300 Net Asset Value .0000 Total Shares: $0.00 Value: Conta..ctU....s.. ~ Dis..c...laimer 01 /18/2008 $38.5100 388.5690 $14,963.79 Copyright ©2008 DST Systems, Inc. All Rights Reserved. Covered by US Patent No. 7,275,046 ti Account Balances Account Statement is available. Shares REGULAR S_N_ARES_(S_01_) VACATION SHARE _~S02) CHRISTMAS SHARES_(_S03) CHECKING (S04j _- __- MONEY MARKET_(S.07) Loans PSL _L_OAN (L01_) Details VISA LOAN (L09) Details Total Balance Details $4,089.89 Details $4,132.53 Details $571.08 Details $3,758.20 Details $22,991.66 Current Balance Pay! $0.00 PaX! $0.00 .'"1 ~, 1 ' ~-- ~j~///feF ~\ \~ / 1 !i https://homebank.psecu.comBalancesBalances.aspx rag Available Balanc $4 $4 $3 - $22 Payment Due D+ $0.00 $0.00 02/. 1 /31 /2008 ritrwutlL ~LUninary rage t of j +o~.~~ aeouT us cc~arACr us ~~1E§~r a E~~Eni ~ s ousL,c.:,-ionu aESOJRCEn Account Summery Transfers eStatements Bill Payer Services vsa Loan Appllcatlons My Profile Messages Welcome to Members 1st Online -Linda Thomas f You last successfully logged in 01/30/2008 11:57AM. Your last unsuccessful login was 11/28/2007 08:03AM Announcements 'Subject Date ' Welcome_back_to the EASIEST way to do your taxes with TurbpTax~ and Members 1st. 12/14/2007 ' Accounts Open an Account _ Account iDescription ~ Available) Balaneei YTD Dividend _ Prior Year _ Dividends i ' 128977-500 i ~~,tZLAR SAV3N~,5 i $179.37 ! $184.37 I. $0.00' $16.50 ' 128977-505 i MONEY MANAGEMENT I' $12,398.00 ' $12,398.00 !, $0.00 $204.32 ',' Total! $12,577.37',., $12,582.37,_ _ $0.00', _____ $220.82 Loans Apply for a Loan __ __- Account iDescriptionl Open Date j AvailAvail a Balance Payment) Due Rate 128977-LOl ', M2BTGAGE I'~ 12/3/1997 ~ $0.00' $15,174.05 I $658.50 i 09/01/2009 6.63% ' Total! $0.00'', $15,174.05 $658.50 __ ~~_____ Credit Cards Amy for a Visa Credit Card Visa EZCard Info __ ___ J200i i>>1 E.V,BE?S 15T FEDE?AL CPEDiT U~IO~J b/iEOHAPIIC58UP, G, PENNSILVANIA IIJTERFIE7 TEr~, dAS ~F USAGE I PRIVAC'/sTATEMENi ~ r.°.AUu&SEG'-IRI'~~~.E;JTER f}pen a certificate and eam a rate I w barus tleCaerSe Of ~ your Piatinum ': z membership' ~- } p Lenr+rr doxE i ~r~ o~ ~` ..; ~ _._~~a https;//mlonline.memberslst.org nlineBanking/AccountSummary/AccountSummary.px 1/31/2008 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE BUREAU Of INDIVIDUAL TAXES A N D DEPT: 280601 TAXPAYER RESPONSE HARRISBURG, PA 17128-0601 eEV-1543 IX AFP (09-00] FILE N0. 21 ACN 08114332 DATE 04-09-2008 ~L ~ ANDREW L THOMAS 905 GREENBRIAR DR MECHANICSBURG PA 17050-1915 TYPE OF ACCOUNT EST. OF GEORGE B THOMAS ^ savlNGs S.S. N0. 200-34-9292 ~ CHECKING DATE OF DEATH 01-18-2008 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this farm and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. puestions may be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0188627586 Account Balance Percent Taxable Amount Subject to Tax Tax Rate Potential Tax Due PART a~ CHECK C ONE BLOCK ONLY A. ^ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your relationship to decedent: TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS LINE 1. Date Established I 2. Account Balance 2 3. Percent Taxable 3 X 4. Amount Subject to Tax 4 5. Debts and Deductions 5 6. Amount Taxable 6 7. Tax-Rata 7 X 8. Tax-Duo 8 PwRr ffi ~` ~ ` ~~x ~; 'DEBTS -:AND DEDUCTIONS - ~ - :;~ ~- ~ i~c...m~ Date 04-OS-1983 Established 2,278.50 x 50.000 1,139.25 x .045 ~ 51.27 .~ To insure proper credit to your account, two C2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". NOTE: If tax payments are made within three (3) months of the decedent's date of death, you may deduct a 5% discount of the tax due. Any inheritance tax due will become delinquent nine C9) months after the date of death. GLAil1fD - TON ~- AMOUNT; PAID _ ~.,-; ~k•9h''s'S~ sere: = ~ k .. _. ~.. , : , ~ a-'1~°~f r COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 r,aK i a~ REV-L543 IX AFP C09-09) Lam- ANDREW L THOMAS 905 GREENBRIAR DR MECHANICSBURG PA 17050-1916 INFORMATION NOTICE FILE N0. 21 AND ACN 08114331 TAXPAYER RESPONSE DATE 04-09-2008 TYPE OF ACCOUNT EST. OF GEORGE B THOMAS ®SAVINGS S.S. N0. 200-34-9292 ^ CHECKING DATE OF DEATH 01-18-2008 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PSECU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of this account. If vau feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pennsylvania. Questions may be answered by calling C717) 7A7-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0188627586 Account Balance Percent Taxable Amount Subject to Tax Tax Rate ~/ Potential Tax Due ~, Date 04-08-1983 Established 490.21 x 50.000 245.11 x .045 To ihsure proper credit to your account, two (2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". NOTE: If tax payments are made within three C3) months of the decedent's date of death, you may deduct a 5Y, discount of the tax due. Any inheritance tax due will become delinquent nine C9) months after the date of death. A. The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. ONE BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N L Y to be filed by the decedent's representative. C. ^ The above information is incorrect and/or debts and deductions were paid by you. You must complete PART ^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your -_ __ -- .-',~_~'~_ ........ ........ relationshl to decedent: ~~•••• -•~•~~ ~~ `~••' ` `~~~~~-~ P - - ~t:s~:~;s~te:=__~~i;i;;;isdi~;_''s€issi:'si'-'~=€~_.`-.€=_€~~~i.:~1'.`_::< € :.....:.:...:.._...... ~~,::T _:::~ :._~ ......................_.SEeai~i:i:^nird~~C--: _ TT4'~.:r_'-':5 c F _•:~•^ei ~ze:_'~^iESi'_ "v`=' la'`2 ~c R S T ACC 0 U N T S ~~€~~i[sG€~::J~?:?~:' ~r;;,;:;:;~:~:r:€'°i;:==~ €; ~~ _. ~ _:~:,.-::.,.:.,::-:. f,~u~ G ~; TAX RETURN - COMPUTATION OF TAX ON JOINT/T U ~~~~~~~~ ~•~ ~~• •~•••~ ......r•az:. s^•"aid3e:!3'rE°i : ?'rdid~...;;:~ ra..,..:......i':;'.~x :c:e: ~::::•~.ii::::::r.-Pc::d "F:. dti d: ........ TM::. ~ 1 ~ 4 C .. ~ ti .a a 1 - ea,}_:i'v'.i~~!_iaii_ ''^ ii~r~ ?.~~d:~ eL,,:,m -. • ..•.....•_.-•. :~..e_:: 4.Fi', iiuiai2e :F?ii. 7A'Y.:d i:' _INE _. D__e ~_-3..lish~_ _ ..,. __.. ~'='s':i::......... -- ;:; 2. Account Balance 2 ::..., ~ ,:=''•~i,,;,~::::.=<~=9i`i i;~~i;c _~N?:t3'i!r's? ..... ;:;::::::~ ..:... :5..::a: ...._.raa:.....v,,._,,, r ......v _,: m - :'.'''..''2i::. e5ix._.`ii:::r :r r~i_:r,. x .sie':2`',~-_ d ~~~''~'au ai:a.. 3. Percent Taxable 3 X `"""`_"""i' ~''-'~'=~ `" "~iidi - _ _ • ..a. .. .....ic ... ::r_s ._.._.....,. ....._ ..... ~.:...:._..... :....._..__._....... _.._.._ s~r.~._..;;::ai~ 4. Amount Subject to Tax 4 ~~~~`~~~~•"~ `•~•'~ '•~•'•~"''~i iW~ri€€iBt='sis::1's€€~ii.W ='.'.€st' .....~-s: ~~: ~~.~ 5. Debts and Deductions 5 - `°°_-~':,°:~~:"w'=`"""==i:i°i - ... ==r~" ~' ......._..,.....:~ 4 ..::::::..... 6. Amount Taxable - - xe;> 6 :N~ :i;=;;'~iaP:':~Msi;'€~:'•_'~€i0€ik`•0€0`=sI'~ Rig 7 . Tax Rate 7 X ~i=;ira;:::.:: 4;si::aE=.a's:aa E~i!:~~_.-:~.~,_~~~=:-`_i=~OH~,~,~~' a `~;''. ': i=~:~s~is~€i~a+wayR:w~Mityf:ii+~:wili::r;~~ x~.~',_"~,,':,F_,'. ...._ .........:..::.::...,.:.... .zr _ 8. Tax Due ......:::.:-::a :~~.r.:::G::::=~:. .,:..~:~:~... ~:~a .:_ s2:"va=s,;.z ?cr.:4iic:nicc. ..............aig :mss _... .. ... ::::-::::::v.::::::x::-::::~::::~:::_:-::::::::,::x::::::::~::::<:y:r.:~a-:::o :c:-:c:ir..:::vy:=.,a~:c:a.:a.:.rr.. PART DEBTS AND DEDUCTIONS CLAIMED 0 DATE PAID PAYEE DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) S Under penalties of perjury, I declare that the facts comp to to th~1best of knowledge and belief. I have reported HOME C~~ / WORK C'7~7 above are true, ) I ) 0~1~{ `l~.CC~ ~or~reGc<t and ~7 ('•Jv ~J !~r_ Y~'' ~~. TAXPAYER SIGNATURE TELEPHONE NUMBER "DATE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INFORMATION NOTICE FILE No. 21 BUREAU OF INDIVIDUAL TAXES DEPT. 280601 TAXPAYER RESPONSE ACN 08114333. HARRISBURG, PA 17128-0601 DATE 04-09-2008 RE9-1543 E% AFP (09-QO) --' TYPE OF ACCOUNT EST. OF GEORGE B THOMAS ®SAVINGS S.S. N0. 200-34-9292 ^ CHECKING DATE OF DEATH 01-18-2008 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: ANDREW L THOMAS REGISTER OF WILLS 905 GREENBRIAR DR CUMBERLAND CO COURT HOUSE MECHANICSBURG PA 17050-1916 ~~ CARLISLE, PA 17013 PSECU has provided the Department with the information listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a point owner/beneficiary of this account. If you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth of Pe-nsllv~ris. Guastions may b. ansGSred by ._lling 0717) 787-?327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 0188627586 Account Balance Percent Taxable ONE BLOCK ONLY B. ^ The to above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return be filed by the decedent's representative. C. The You above information is incorrect and/or debts and deductions were paid by you. must complete PART O and/or PART 3^ below. Date 04-08-1983 Established 31,455.44 x 50.000 To insure proper credit to your account, two C2) copies of this notice must accompany your payment to the Register of Wills. Make check payable to: "Register of Wills, Agent". Amount Subject t0 Tax 15,727.72 NOTE: If tax payments are made within three C3) months of the decedent's date of death, Tax Rate x .045 You may deduct a 5% discount of the tax due. Potential TaX Due 707.75 Any inheritance tax due will become delinquent nine C9) months after the date of death. PART TAXPAYER RESPONSE .._..... _..._ ....._._..__......_ ..__-._ ..............:~~1~ =.~~~.~.:::~ ~.'.:~~l.E,:~:.;,.I~1..:.:Af~,1.,. _O.E.E.~.~#E,~:::fi/.::::~~~:E~~~l:E~1:~::::BAS:EI~:::::~~~aT:N:~S:-:#1 t11"~~E::::::: A. ^ The above information and tax due is correct. 1. You may choose to remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or avoid interest, or you may check box "A" and return this notice to the Register of Wills and an official assessment will be issued by the PA Department of Revenue. PART If you indicate a different tax l t rate, please state your __._... ...... : _: ~.5;:........r~ ::::_ :;~ ::;; ~:r ,: , - _ _ _ -- _._.. _ _._.. _: _._.. ~ i'~ ~ ' 2 re a ionship to decedent: -::~__:: .,..:~~.::~~_::-• ,~;~;.._4N,~, _ ,,, ~ ~ - ' ~ • ~s TAX RE TURN - COMPUTATION 0 F TAX ON JOINT/TRUST ACCOUNTS .. . ~:: ~~:5::~ ?~'~~' ~;€_;~ ~ •.;_.~ .:__•._~=~€~~~ €~=~~~==: ~•~;~ :€~~ x; =L€~€;L4 '~`~`' ' ••• - :::-m::. 2. Account Balance 2~ ,i .. ............._......c:.r.:.•:::::::c.s..,~~:z'sa...~'!'._::c:..s:s:n::.•af~:'~:cie:''':~^u ~a~,'4_~.a!';:~Tiszj_~: ........._s........ r._....__......... .. ~•~ :=::•~•~•'~•~• ....-~ - - -'~~ ..........~ -.. .::a . ercent Taxable X _ d.~© ........._..._-;c,'.F55S:::::xs:s::, i r a~:. v~ -?'I;ii'c;::o~ __ _ _ ri5i-aa5:_,F,:is:3?:5~1=ei3~?i~iF::"':=ei ;-ei~:i ..._ .............. v c - ..... -`-""""' :s:r~ . 4 . Amount S b J e c t t o Tax 4 _ ....._._.. ......_ ...... x,55 ...._._. ... .,a.: . ~ ::apc:~ ;::::_. :z:: •:--._...:_:.,.:.:::~_:- ~•-_..,•::5:: ~; =`~ • - - - -- '" . ~:. ..: ~..: ....._._.__... ........-...r.:::: .-- ,,,... s:.er-5:i-c:.:dir.e: scc" 15,5'FF^:::,;r _aa t: .........: s-:~ ::.-::.::::;::-... :::::~se5:;-::~t 5 . Debts and D ~ : ....._,::x:::any;::i5;5:::a:::;:z:c;e"."~5~ji ;E;ii='°s; :=F::,:,, _~..._..=5::'::~j .^R ._......._..,r:.r 'v_-.5..v ' .... -;;airi - - :::€ ~ - '~:~.r ' ~_. ; ~.~;... _ - ..........t::::::- ,~::.... ... 6. Amount Taxable 6 a ~~., ~ ..... r...-.::^s ~~ ~ `'~ - - '~4, _ ,a,~5e 7. T ax Ra to ......T........ .........._......_..,,.:~,::. ._._... s ;$t;;_ ............ .:,. _-.,::.,: ):s::::::_;__.::, sue:, €~ =:~ - - = .5i ~:~=F - =Es ~i 8. Tax Due ~• ~ - - ........~v:.~:::: ... : _-o:::::::::en:,:: •::: rr:::~~ c .,:-,mir cri55:a ' ;5'e ; ._ ..::::::::.::::.::_.:::.....:.: ~. i; ..:5.:. ::::....a :..:::..... :.......................................~..._.................................. PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID cif a o~ ~ ~ fi ~ y o0 ~ ao o$ oft ~ L, r ~x 6 c~ s~) ~ r v I V I NL Tenzer on Lane 5 or i ax computation) S ~~ a ~ .5 -.7 U Under penalties of perjury, I declare that the facts I have reported above are true, correct and comp t°A to he best of my knowle a and belief. , ) 7`~S"~7?~ HOME C if ~1 WORK C?( ) c~I',l'OSuq / O XPAYER SIGNATURE TELEPHONE NUMBER AT ,. ` PSEC~ ANDREW L THOMAS GEORGE THOMAS DR MECHANICSBURG PA 17050-1916 _ _ __ MEMBER NUMBER ~I STATEMENT GATE 0188XXXXXX ', 01/31/08 P0. Box 67013 (717) 234-8484 (Harrisburg) Harrisburg, PA 1 71 06-701 3 (800) 237.7328 (Nationwide) website - http://www.psecU.com 3 JOINT OWNER Number Amount Number Amount Number Amount Number Amount 000796 115.16 010908* 246.00 012611* 725.00 I 000797 127.36 012104* 381.35 122611* 1100.00 * Asterisk next to number indicates skip in number sequence Post Eff Description Amount Balance O1/O1 ID 07 MONEY MARKET Beginning Balance 19402.85 -01/05 Payment: via Home Banking Transfer From Share O1 12000.00 31402.85 ~ S ' hI C DIVIDEND RATE CHANGED FROM 3.93 TO 3.49 29 S ~l .S iE^ , 14 I T~ 31501 01./31 Payment: Dividend 3.490 98. . Annual Percentage Yield Earned 3.950 from 01/01/08 through 01/31/08 01/31 Ending Balance 31501.14 ', " *** ANNUAL PERCENTAGE RATE 6.490 *** Periodic Ra te (Daily) 0.54083 Post Desc ion Principal FIN CHG Fees Balance 01/04 I 51 REAL ESTATE EQUITY LOAN Beginnin Balance 0 01/04 ccoun us ment: I 12000.00 0.00 12000.00 01/04 Payments Transfer From Share O1 0.00 59.74 12000.00 01/29 Payments via Home Banking Transfer From Share 04 375.00- 0.00 11625.00 01/31 Ending Balance 11625.00 A Payment of 234.74 is due on 03/01/08 _ J ~~ Hollinger Funeral Home 8~ Crematory, Inc. Eric L. HoIlinaer, Supervisor January 24, 2008 Linda Thorrras 8 Bourbon Red Drive Mechanicsburg, PA 17050 The Funeral Service for George B. Thomas: We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Professional Service Cremation Package F -Cremation with memorial service $3495.00 Merchandise Rosemont Cherry Casket 935.00 Tree Urn -slate 395.00 15 Bookmarks @ $3.00 each 45.00 ATTHE TIME FUNERALARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advances tewspaper Notice -Sentinel Newspaper Notice -Patriot Newspaper Notice -Oil City Derrick Certified Copies of Death Certificate (10 @ $6) Cumber{and County Coroners Authorization Flowers -Family Spray - Rev. Richard P. Waldron Current Balance: -"~ - _- r ~._ - $185.00 ___._..--- -...--- _ 338.00 105.00 60.00 25.00 132.50 325.00 +~, ,,'~1. `~=~ ~ .r;v ~ "j kZv r ~~ ~;~~ 6040.50 ~~~} ~~ V :AE7ENllE • MOllNTHOLLY SPRINGS. PENNSYLVANIA 17065 • ;717) 486-3433 • FAX (717) 486-3215- _ www.hollin~erfuneralhome.com - - ~' - - ~ _ _ -- - ._ -; 1 __ ~_;,s ~-~~•e -x ~~~P 150 ~~~~~~r~~, p '_~~_~~~ ~~^^ yY; ;~~+ S 1 ~;r~ ~ L V nSj' G /aft .-~/ ~3Sn?~f%n ~ y ~r~~~ I~-'f ~~9~ ~t'~~b:7i'l ~i~ ~J ~~~~ i~J'."~+.~ 6.. x.19.. ~..' ~S+i. r /J% ._5~- ~... /.~.- u.f v:~v ~,~i ~.3.r L.~ ~,V ~.r ~` 1Vi'+.'~~L ~~~ a3 r~i~~av§v i. d9 a°~~9 ~Y.~ Gds. a~iB~`Qiab ~y"~e ~~5~~alo~~~ ;e~,'.~JoE7 xY ~'~.31~ ~dv~. .v it a .v v r /_ Y 4.7 w ." Y/Fi~ ~ L / ~~e~~ ~ .~~~~aa ~~~~~ ~~~ ~~9~~~~~~ ~~~~~~ ~~~~~ ~a~o ~~~ ~$/ Lincoln Benefit Life Company P.O. Box 94212 Palatine, IL 60094-4212 Telephone: (877) 499-6418 Facsimile: (866) 635-4523 LINCOLN BENEFIT LIFE AN ALLSTATE CQNI PAN Y March 14, 2008 Linda M. Thomas 8 Bourbon Red Drive Mechanicsburg, PA 17055 Re: George B. Thomas Contract No: LBLA122830 Dear Mrs. Thomas: We have been requested to complete IRS Form 712 with regard to the above referenced contract. The purpose of Form 712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain date (usually the owner's date of death or date of transfer of the contract). This contract is an annuity contract, which is not reportable on IRS Form 712. The following information is provided for estate purposes only as of the date specified: Date of Death: January 18, 2008 Annuity Value* as of Date of Death: $ 133,800.01 Cost Basis: $ 0.00 Annuity Value* as of March 14, 2008: $ 133,681.76 Named Beneficiary: Linda M. Thomas *The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender Charges. If you have any questions, please contact me at 1-877-499-6418 Ext. 86223. Sincerely, ~~/ Jonathan Tong Sr. Claim Examiner o"'"'.s.~-- ..~ ~~~ ., in' ±'! M M W ¢ N 1 Q rl o ~m _ N vN~ ' OOC...1P ~ ~ t"~o i 6CD^~' j.~}p a'-' ~ r+ tf~ V O ~ 2 S M J W,`! O O ~' ~ O WIC Z j J .w. ' l~ }-~ .. ~ i.L _ C ... . _. ;~~,... ~ _, _ ,t, _ - ,- ' ~-' ~~ 0 0 f 4 r-~ ~~ ~. 7Y N O ~^ r~ J v, O ~ ,_JOQ -~t~~ • O ~ or _~~J N ~ J ~~~ =W~ U ~! U