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Home My WebLink About10-10-08 15056051047 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN `~ RESIDENT DECEDENT ~~'~ ~ ~ CI ! ~ ~~~_~-~ ~ REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Decedent's Last Name Suffix ,~E)Z~ i ~ (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Date of Birth ~f / ~ L --, DecedeaCs First Name MI Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW S 1. Original Return O 2. Supplemental Return O 4. Limited Estate O 4a. Future Interest Compromise (date of death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received 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 O '11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TA)I: INFORMATION SHOULD BE DIRECTED TO: Name Da~~time Telephone Number Y Firm Name (If Applicable) First line of address ~~ ~ _~ p~ ~~ ~ r ~ >~~~ Second line of address Cit or Post Office State ZIP Code Correspondent's a-mail address: "~lA'1 >~ fr h //~% ~ ~? ~~ ~y :~ a ~ ' ~ C ~ "`~ 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. SIGNATUR~OF F~RSON f~SPOI~t3BLj~ FOR FILING RETURN„ DATE ADDRESS ~ _~'+ ~` /~. ~ ~~ ,~z fir.-~->, ~,,,,,v yt~z:~.~ ,~ ~ ~~ ~'~~~'~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY 15056051047 Side 1 15056051047 J~ J 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real estate (Schedule A) ............................................ . 1. fJ C3 . V ~ 2. Stocks and Bonds (Schedule B) ...................................... . 2. ~ v. ~i ~? 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. U L~ •t-~ ~-~ 4 T B ~ • ~ ~ ~~ 4. Mortgages & Notes Receivable (Schedule D) ............................ . . ~/ . h d l E l P rt S 5 1 d 5. ) ....... u e rope y ( c e Cash, Bank Deposits 8~ Miscellaneous Persona . . 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 ~j' J ~ O l 8. Total Gross Assets (total Lines 1-7) ................................... . . 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. ~ ~ ~ • 1 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 _ 15. 16. Amount of Line 14 table at lineal rate X .O~i ~. ~; Z, 16. ~• r'l, 1v 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. (y 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 15056052048 15056052048 5 ~RE~-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME STREET ADDRESS CITY // - - ~ STATE ! ZIP - -- - Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments _ C. Discount (1) ~.~iL ----- ---"--- Total Credits (A + B + C) {2) 3. InterestlPenalty if applicable D. Interest _ _ E. Penalty --_- -- Total InterestlPenalty (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. (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) ~, g ~. 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 :.................................................................................... ...... ^ ~" b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ ~' c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits or care? ................................................................ ...... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................ ...... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her deaih? ........ ...... ^ 4. Did decedent 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 (~ 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 ~~t 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)j. 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 (1 Z) 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. RN4508 IX ~ (1-97) - COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE: NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be discbsed on Schedule F. VALUE AT DATE ITEM OF DEATH NUMBER DESCRIPTION ~ . - 1~f~~ ~- t~ v.~..~% ,tit +-`T ~ L(, . ~ v L ~i~ Y~ C~~./Z TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) M&T Bank ACCOUNT. NO. ACCOUNT-TYPE 2670043203 CLASSIC CHECKING -__._ ~-_. 51ATEMEIVT PERIOD _ ~~ PAGE OCT.04-NOV.02,2007 1 OF 3 00 0 04344M NM I17 11107 MILDRED P MERRIS 1875 HOLLY PIKE CARLISLE PA 17013-9118 •I~~+nll\IT OIIYVA~V SPRING GARDEN BEGINNING:. ,BALANCE = DEPOSITS & OTHER AOOITIONS ... ... .. . .... _. - CHECKS PAID .. . OTHER: _ SUBTRACTIONS CURRENT INTEREST PD ENDING -' BALANCE NO. AMOUNT N0. AMOUNT N0. AMOUNT 947.60 0 0.00 8 811.00 2 '.x.90 0.00 126.70 •i+r~n~~uT Af`TTVTTV POSTING DATE. -. _. _.. _ _ : _, '' TRANSACTION DESCRIPTION _ - - - - DEPQSITS;INTEREST. & OTHER ADOITiONS : CHECKS & OTHER ? SUBTRACTIONS _ : AAILY BALANCE 10-04-07 BEGINNING BALANCE ~~ h~ ~ 5947.60 10-04-07 ~ CHECK NUMBER 4609~itiD~ 14.00 10-04-07 AD6D 8008607182 679168347 ~ 4.95 10-04-07 CHECK NUMBER 4613 4.30 924.35 10-09-07 CHECK NUMBER 4611 300.00 624.35 10-10-07 CHECK NUMBER 4612 122.00 10-10-07 CHECK NUMBER 4615 110.70 391.65 10-11-07 CHECK NUMBER 4616 200.00 191.65 10-15-07 CHECK NUMBER 4610 ! 10.00 181.65 10-17-07 ._. ._ _ CHECK NUMBER 4617' 50_ 00 - - 131.65 11-'0 -07 -,-_,_ MUTUA AHA INS. PREM. _ ---- - __ _ ~ ... 4.95' 126.70 NDING BALANCE __ ._ _ _ _ ___ - - ~ _,__ 5126.70 , ~ ~~~ _ _. CHECKS !PAID SUMMARY 4609 10-04-0 ~ ,/4610 10-15-07 10.00 ,14611 10-09-07 300.00 4612 10-10-07 122.00 6613 10-04-07 4.30 4615* 10-10-07 110.70 4616 10-11-07 200.00 ~i617 10-17-07 50.00 '~~ 9 " i, ~~ ,~ ~ooen ~sro7~ Commerce CBank o~saozirnru+oooo7szo MILDRED P MERRIS 1875 HOLLY PIKE CARLISLE PA 17015 Commerce BanklHarrisburg N.A. P.O BOX 4999 Harrisburg, Pennsylvania 17111-0999 1-888-937-0004 We're here 7 days a week, 24 hours a day at 1-888-937-0004. 50 PLIJS CHECKING 0537611956 Statement Balance as of 09113/07 ~ ~ i 4 ~ '' Plus , 1' flep~sits and Other Credits $0.01 Less D d Other Debits $0.00 Statement Balance as f 10/'15/07 $71.42 Transactions By Date Date Description Debit Credit Balance 101'15107 INTEREST PAYMENT 50.0'1 S71.42 Interest Summary Cycle Page 1 of 1