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Home My WebLink About10-31-08~, .:~ • •. J REV- _ 1500 EX (06 05) PA Department of Revenue Bureau of Individual Taxes - ~,, PO BOX 280601 __ __ Harrisburg, PA 17128-0601 15056051047 INHERITANCE TAX RETURN RESIDENT DECE~FNr • ~ ~.~. ~c~,cucrv i mtURMATION BELOW Social Security Number Date of Death ~~5 18 ~~~ ~ t~~~:~Zc~v 7 Decedent's Last Name Suffix L: (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number OFFICIAL USE ONLY County(Code /Year Fil~ejNum)k~er Date of Birth Decedent,'/s First Name M~I} Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death O 4. Limited Estate prior to 12-13-82) O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Livin Trust (Attach Copy of Will) 9 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 91'13(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 ~ ~ 5 ~ + € ~ ~ rC C~ ~ H '7 i °'T ~~ C ~, ~ ,3" '~ T Firm Name (If Applicable) First line of address `~ Second line of address City or Post Office State ZIP Code L l° R ~ °7 G ~ S REGISTER OF WILLS USE ONLY t.) -- _ ~J ° -"i ~ 7_:~ C'7 _._ -- _ °- - < ~ _ _. = C...) _- ='~ATE FILED.^ ~----~ -a-, =-+ ?> C~3 l.:.J Correspondent's a-mail address: 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 of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN T E OF PERSON RESPONSIBLE FOG RETURN ~~ 7c.~„ - DA E ADDRESS 1~~~,,L ~':~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 DATE 15056051047 J,,„ ~ ~~' `~ J REV-1500 EX 15056052048 Decedent's Name: RECAPITULATION 1. , 1. Real estate (Schedule A) . ........................................... . 2 2. Stocks and Bonds (Schedule B) ....................................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. 4. Mortgages & Notes Receivable (Schedule D) ............................ . 5. 5. Cash. Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . Schedule F O Separate Billing Requested ....... 6. 6. Jointly Owned Property ( ) 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. s. a T.,rai Gross Assets (total Lines 1-7) .................................. . Decedent's Social Security Number i G~>~.pG lu~~' a . ~ ~.~~ ~ ~,~cs~ 9. `r' ~ Q ~ ~•G~ 9. Funeral Expenses & Administrative Costs (Schedule H) .................... . 10. (~ ~ d • C~ ~i 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... . ~ ~ ;~ ~ .D0 11. Total Deductions (total Lines 9 & 10) ................................... 11. 3 ~- 7 ~ . a o ...............12. 12. Net Value of Estate (Line 8 minus Line 11) ........... . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 1J • an election to tax has not been made (Schedule J) ....... 14. ~ ~ 1 ~ .G~ (1, ............. 14. Net Value Subject to Tax (Line 12 minus Line 13) .......... . TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. (a)(1.2) X .0 - -7 16. Amount of Line 14 taxable .3 , 7 a • ~ Q 16. ~ ~ ` at lineal rate X .0 __ ~` 17. Amount of Line 14 taxable 17 • at sibling rate X .12 18. Amount of Line 14 taxable ~ 18 • at collateral rate X .15 ! ',f 7 . o U 19. TAX DUE ......................................................... 19. O 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .~ ~ ~ .~' ~ . ~ ~ ~ ~~~ ,~ ~ ~~ _~ Side 2 15056052048 L 15056052048 ___ .~ REV-1500 EX Page 3 ~ ~ y ~ Y _~ ~/ File Number /v'~ t/J! ~' Decedent's Complete Address: DECEDENT' NAME STREETADDRESS a :3 ~ ~ et c h L.r~-~~ CITY p ~~~/~11,5~~ STATE ~~- ZIP~~~I~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) ~ , /,~ ~~7 ~ 2. CreditslPayments _ ~ f A. Spousal Poverty Credit ~ B. Prior Payments ~ l , ~~ C. Discount 3. Interest/Penalty if applicable Total Credits (A + B + C) (2) ~7 I • Q ~ D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal InterestlPenalty (D + E) (3) 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. (5) ~~~ A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE . (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APP ROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the property transferred :........................................................................................ Yes .. ^ No 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 fife 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 death? ............ .. ^ [~ 4. Ditl 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 G AND FILE IT AS PART OF THE RETURN For dates of death on or after Jufy 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.5. §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-1502 Ex+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT CJrAIt ~r FILE NUMBER ~~~~ ~, Jn~u~ ~~~~-c~~~z All real rraperty awned 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 reasonable knowledge of the relevant facts. Real property which is jointly-owned with rinhr ~f ~~~.~~~„r~ti~~ ..,~~~« tie a,~.,~,...,.a __ ~_~_~..~_ ~~~ ~~~~~~ ~,.u..~ ~~ nccucu, ~~~~c~~ auumonai sneers or me same size) cX * (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~, SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY /~ ~ ~ ~~~ Q 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 disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE _ OF DEATH 1. J v ~ a~~~-~~ ~~~cA C/~tC,Ci~ ~ccau~~ ~ TOTAL (Also enter on line 5 Recapitulation) I $ (If more space Is needed, Insert addltlonal sheets of the same size) ~~~a. ~ w. 1511 EX+ (10-06) r' . ~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE N FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ~~>~~ur~ ~~, ;~o ~~ ;~ 1 ~ 7-. ~ q/~. Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City - Year(s) Commission Paid State 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 7. Zip Zip TOTAL (Also enter on line 9 Recapitulation) I $ o2C~CJ~. (;Q (Ii more space is needed, insert additional sheets of the same size) REV~1512 E + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIJLE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF n ~~-rn~~ o ~' FILE NUMBER l ~ a r~~G ~. IC 7 ~ C~ q/.~ Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (It more space is needed, insert additional sheets of the same size) RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 YOUNG RAYMOND P Receipt Date: 10/09/2007 Receipt Time: 15:31:45 Receipt No.: 1()50156 Estate File No.: 2007-00912 _ Paid By Remarks: LESLIE KOCH - - JA Receipt Distribution Fee Tax Description Payment Amount Payee Name ---- ---- PETITION LTRS TEST RENUNCIATION 30.00 CUMBERLAND COUNTY GENERAL FUN WILL AUTOMATION FEE 5.00 15.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN SHORT CERTIFICATE JCP FEE 5.00 16.00 CUMBERLAND CUMBERLAND COUNTY GENERAL FUN 10.00 --------- COUNTY BUREAU OF RECEIPTS GENERAL & CNTR FUN M D Cas ------- . 'T'otal Received......... 81.00 81.00