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Home My WebLink About01-12-09 (2)'-', REV-1500 EX (D5-D4, PA Department of Revenue Bureau of Individual Taxes Dept 260601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Securl~ty Number Date of Death ~a , r ~ ~xaPv x Decedents Last Name Suffix ~~~]]~''.`~{{,w,..F w~ ~, ,~ rrz,eaGp,/ i u z # t _ ~, Bey.:.," (If Applicable) Enter Survivin Spouse's Information Below Spouse's Last Na Date of Blrth f '{'}~~K ry. x f .. .. Decedents First Name I MI aq me Suffix Spouse s First Name MI 5 y y k q q ry~ry q ,^, t 3 6i k,i~s 3=Atrx.miwx~v.sm%¢i ~v ..5»s kn a~saa „sx.. '~ .,a ..a .t ~ ~., s ~ t Spouse's Social Secunty Number ~ ~ '• -" ""' ""' ' ' - ~ • • • ~ _ _ ~>.M';,~ ' ,~T~~~ ~ ~ ' "§' ~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE °•a~m°'~°~I.~.~~Ax~,~~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Retum (date of death O 4. Limited Estate O prior to 12-13-82) 4a. Future Interest Com romise date of p ( O 5 F d . e eral Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8 (Attach Copy of Will) . 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 El . ection to [ax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED ALL CORRESP Name . ONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: .{"°'~a` °• ~"=«t°'~ n 3 w~:a= n £ u, n,,g. Daytime Telephone Number ~; t ~ f ~~ , ~ ~ ~~,~.,, rr~ _ ~ ((JJ , 5 :~ i ~~ ~ '~ " §~ * F~rm Name (If Applicable) ..,~q. ~ €, x ,W +.:C~ , . ~., f, { ~~rag~c.- : / x~xza~x ~.x~~x~s~x~.o-aae "~xtix~rn~ .aq,,,ssaf ~ xa~aea " ~ ~ ~ S it i f _.a = K .. •-s=~ ~ • y ., ~•• ° First line of address ~ . ~ • Second line of address y` ` ' "' •" °' r xrz„w g3' ~ y '*wpam-n. ~y@~* "a { ~ r $ a9Laa Za 4be0 LwA~ia 3 ~ .^3 i t City or Post Office d 1s= vrr~, t '~ ~ ~ t °"' i _>~.+_,,~,~.,,,~.ap~,:., ~ ,~1.<r , r y.45. S State k >~ I ZIP Code REGISTEI~Of WILLS USE~ILY O .A ;~i r aa. i i. ~7 r^ IV r f 1 - ~~ ~ l TE FILED ~ol,~~rn~~~~vf Iri.~.~ ~# •,..x, .a :, m x,. ,r .~~11;:7t~ y' ~, ~ ?'~,Y `r' i" Correspondent's a-mail address: aiiC> `, (rJ ~ y/ ~ n ry Fd- n -`-y F / U der penalties of pegury, I declare that I have examined this return, in uding accompanying schedules and statements, antl to the best of my knowledge and it is true, correct and complete. Declaration of preparer other than the py onal representative is based on all information of which preparer has any knowle0i SIGN/AiUR~ OF,;?~RSON RESPflNSyB'L~E FOR FILING~ETURN '' ~~// ' Ln / /l DATE SIGNATURE OF PREPARER OTHER THAN PLEASE USE ORIGINAL FORM ONLY Side 1 L, 15056041046 15056041046 OFFICIAL USE ONLY INHERITANCE TAX RETURN Cougn'tyCode vear File Number RESIDENT DECEDENT `n[sI ~! ~~ f/~,(~ ~ i 15056041046 J '-j t , .7 i~ 'I /mil 15056042047 REV-1500 EX Decedent's Social Security Number • ' j Decedent's Name: 1 ~(`s~ ~ '~ " Q ~~ % 1 7( x / I i RECAPITULATION G 1 . Real estate (Schedule A) .. .......... ................... ...... 1 e +, ..,>. _-~_„-- ~~ .. .. '.t }'1. ~ x rta1.• "r •' +~ ~ • ~ ~~ 2 . Stocks and Bonds (Schedule B) ....... ......... .................. .. 2 } ~ f ' ~ y i r } 3 $ 14§tt„sax #QY S:R~gVR Ab b''#%k`. t °vt„'° 3 . Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. .. 3. • ^-~-~- ms-" "% e ~sal%~3k#} t^ „}'i'.~ ~ 1k4~&xi~"k "akgx° 4. Mortgages & Notes Receivable (Schedule D).. ( ' ~ 5 --4 ..... ..... .... ....... .. 4 =• + p j 4tY tt#}~A}yTRP$$h}~'.Z k $k e+drkM1t~ v*~ 5. Cash, Bank Deposits & Miscellaneous Personal Pro ert Schedule E . E a & ' * ,t$6e#~ sre1.3=xr2xaeR 3r t ~^rf4=rx~~~, x ;:_. 6. Jointly Owned Propeily (Schedule F) O Separate Billing Requested .. .. 6 ; , , ~ + - , 7. Inter-Vivos Transfers&Miscellaneous Non-ProbateProperty ~'1 `ir"'~ °~s` +"w# ~ -x1k~ ~~ 1=`it (Schedule G) O Separate Billing Requested..... .. 7 s j .--: g 9t#i#E+?EhE *k5 ~r>.4:'"{ 4# (6M1 U'°G#4 6 t`yai l 8. Total Gross Assets (total Lines 1-7).... ~ $ ° i' i ++ J ~ ~• a ~. `" 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..... f 3 q g > i ]((j~~}} ~/J~ $J~~~q' ~JJ~ ' 1 } ~ ~ ~ { yt Sy i2~io$ f i44r^p++"+~7 $~ T n k 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .... . .. 10 '. + ---~--L-------++,-- 11. Total Deductions (total Lines 9 & 10) <; ~ • ' ... _. .... ... ~ ~ ~ ~ 11 t4 L~ y •~ 12. 13 Net Value of.Estate (Line 8 minus Line 11) .. , Charitable a d G Y ~~'i Y .~ Y S ir4Ja ~ d{ k 12 k R ' f / ty ~;~~ ~ ` _ } x~+~ '~" f ( , ~' / . n overnmental Bequests/Sec 9113 Trusts for which ` r' • °{ -Y~ `_~ '~` an election to tax has not been made (Schedule J) i a x m ... .................. .. 13 ke j:"2ttit } ~ y}; k x• :.=# as 14. Net Value Subject to Tax (Line 12 minus Line 13) .............. 14 " +' • ~+ ~ `~ ~'~~ rf 1 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES # 4~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 - ~` r. _ (a)(1.2) X .0_ ~ 16. Amount of Line 14 taxable ` e ' x z > „ ^. • ~ 15 ) ~ at lineal rate X.0_ i ~ ~/ ~7 ~~Jf (/ / * ki * 1 / ~P 76 {~1 ~- j, ~ ~" 17. t Y «,, . ..+ < . I Amount of Line 14 taxable x , ~ , , • 18. at sibling rate X .12 ' } ', Amount of Line 14 taxable ~ - ~ >•r+ e`r+ ~r • • , + # . dr r~, ~1 at collateral rate X .16 ~ 18 ? " 19. TAX DUE. ""..,.., ........................ .... ....... ,~ ~}~y~im ~~~ 19 ` r ........... . .: .,.. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L, 15056042047 15056042047 O Y REV-1500 EX Page 3 Decedent's Complete Address: File Number STREET ADDRESS 00 CITY ---~~ _ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount ~ __-- - - -- - - - p !~ ~ -. Total Credits (A+ g + C ) 3. Interest/Penalty if applicable D. Interest enalty- Total InterestlPenalty (D + E ) 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. 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. ~ ZIP _ t 2D/~5 (11 1,f~~~U (2) _ 9 ~, (8) --- (4) (s) ~ r34~ (SA) ~__ (5B) ~. / ~j arN Make Check Payable to REGISTER OF WILLS, AGENT =*r¢e°s~;~"~ ~ `+ :'rt4~~#~~kt~,st~~t~ t@~~~~'t~~~t`st~t~~~t~~t~~t~x«*~t~~~.~~ts46t'~~~tY#~~~~~~ rx~et~~;~~~"=.s~~~'~x~..~;, PLEASE ANS'JVER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BL~I^.tcc 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 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 death? ........ ...... ^ 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 G AND FILE IT AS PART OF THE RETURN. ~T~'t€tr*a.z~tt~~st~'t~i~~tn s~t~a~~tt~'*~~ ~'sG~'~~x...?. 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 i, 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 antl filing a tax return are still applicable even it 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-7502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ur SCHEDULE A REAL ESTATE FILE owned solely or as a tenant in common must be reporte at fair market ~ai~~> ^~~, m~.~e~ ,,..~..,. :..._.:__~ __ .~ _ _____~ ,,,,,,,,, ,,,,,,,,~„„a, ,,,ecw vi nro same size( REV-1503 EX+ (6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE T All property )olntly-owned with right of survi~rship must be disclosed on Schedule F. AT TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1504 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT TE OF - SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached far ach closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER VALUE AT DATE IFSCGIOTIlInI TOTAL (Also enter on line 3, Recapitulation) (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (7 -97) SCHEDULE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT FILE NUMBER yr All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DP OF DEATH TOTAL (Also enter on line 4, Recapitulation) (If more space is needed, insert additional sheets of the same size) ~RE0.iW8 E%• n-911 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE 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. ~/~C° ~a~,~ las" ,h/~,~1~ l31 ~~. ~~vls~r ~~ ~~a~,~ ~ ~ /V~ ~ a~ ~ lUS" /Ua~l~ ~)v ~. C'a~/~isl~ p%1`7~3 /~cc~.~ ,~1d bo~~4~aSS C. p 1,~, k~l- y3 ~~, ~ (U~ 13a,nk ~OJr ~o~~~ ,~lvdj ~~V/~s/e~~l7~w~ ~• dr~s~~ /,~a..~k Y~'7 I/rllag~ l~r~~d~~s/e p~/~ais C~# ~{pvaoa~o,~® ~~ ~t~f.3' TOTAL (Also enter on line 5 Recapitulation) I $ S~ ~ ~ 7 ~ C (I(more space Is needed, insert addlhonal sheets of the same srze) ~ .°~ ;f ,- ~,v~- REV~15p9 EX r I13]) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE SCHEDULE F JOINTLY•OWNED PROPERTY If an asset was made joint within one year of the decedent's date SURVIVING JOINT TENANT(S) NAME A. C. JOINTLY-OWNED PROPERTY: It must be reported on Schedule G. ADDRESS RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Inclutle name orfinancial insfiNtlon and bank account number or similar itlentitying 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 1. A. TOTAL (Also enter on line 6, Recapitulation) I S more space Is needed, Insert additional sheets of the same size) FEV9510 EX. p91) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER•VIVOS TRANSFERS & MISC. NON•PROBATE PROPERTY This schedule must be completed and fled if the answer to any ofquestions t Mrough 4 on the reverse side of fhe REV-1500 COVER SHEET is yes. ITEM utJUKIP I IUN OF PROPERTY wauoE rnE rwds or rnE rwwsEEaEC, rnea nrianoHSwa ro oECeoErrraHO rnE OnrE OE rwwsrER oA OF NUMBER . Arrncn a coEV aF rnE oEEO roa rrEU Esrnre. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE 1, VALUE OF ASSET INTEREST irnvEUCneiE TOTAL (Also enter on line 7 Recapitulation) 15 more space is needed, insert additional sheets of the same size) HEV-1517 EX+(10.08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCFIEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS orHi c ~r FILE NUMBER /f r i~/'Tdi1.7 /'~ ~1~~ JIh'~~rx / Debts of decedent must be reported o~chedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT t. f," Gc) +! N ~ /J rtJ' 7 ~I CWs" ~U 1/I ~ !/d ~ ,HEM r 1 YI C: (/3/lrs lE~ ~~ /7~/3 (ser a ~ (rC~~v9~ s ~`o wC'rs (.~a-/~-she ~>~ /Zvi3 ~~U', y~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip _ _ Year(s) Commission Paid: 2~ Attorney Fees ~ ~, G 3~ Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ~ 5 Claimant Street Address City State Zip ___ _ __ Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees '"7-/"~7 (~~ 6. Tax Return Preparer's Fees ,T O X 7. TOTAL (Also enter on line 9, Recapitulation) $ ~ ~. (If more space is needed, Insert additional sheets of the same size) ~-~ fr ~;, _ ,: ' December 27, 2008 William L. Drawbaugh 13) Brick Church Rd. Newville, PA 17241 Ewing Brothers Funeral Home, Inc. 630 South Hanover Street Carlisle, PA 17013- (777)243-2421 The Funeral Service for Martha E. Drawbaugh 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, A UTOMOTIVE EQUIPMENT AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRA , NGEMENTS. 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff , ~ ~ ~ ~ ~ $1495.00 Embalming, $695.00 Dressing, Casketing, Cosmo. etc $265.00 2. FACILITIES AND SERVICES Viewing (Visita[ion/Wake), $475.00 Funeral Ceremony, $475.00 3. AUTOMOTIVE EQUIPMENT Vehicle [o transfer remains to Funeral Home, $265.00 Hearse (Casket Coach) _ ~ ~ $295.00 ~ Lead car/Clergy _ $145.00 Service Car DeathCert./Filing/Retrieval $145.00 FUNERAL HOME SERVICE CHARGES $4255.00 SELECTED MERCHANDISE: Lila 20g pink ng casket _. $980.00 American OBC#5 Vault. $1325.00 Acknowledgement cards, $10.00 Register Book(s) . $25.00 Memorial folders $60.00 THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED $6fi55.00 Cash Advances Opening Grave, _ , Clergy/Mass Offering Certified Copies of the Death Certificate , The Sentinel Obit with Photo Valley Times/Shippensburg News . Hairdresser ~ ~ ~ ~ ~ ' TOTAL CASH ADVANCES AND SPECIAL CHARGES Total Total Cost $600.00 $100.00 $36.00 $131.00 $35.00 $40.00 $942.00 . . . . . . . . . . . . . . $7597.00 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF RepoA SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS incurred by the decedent prior to death which remained FILE NUMBER as of the date of death, including unreimbursed medical expenses. VALUE -~ l~ TOTAL (Also enter on line 10, Recapitulation) (If more space is needetl, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ / FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON S REC RELATIONSHIP TO DECEDENT AMOUNT OR SHARE 1 ( ) EIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Do Not List Trustee(s) OF ESTATE Sec. 9116 (a) (1.2)j 1. ._- ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET It 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 TOTAL OFPART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (It more space is needed, insert additional sheets of the same size) REV-1514 EX+ (72-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN heck Box 4 on REV-1500 Cover Shee FILE This schedule is to be used for all single life, joint or successive life es to and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ~ Wilt ^ Intervivos Deed of Trust ^ Other tk~~ § F SAT k I ~itk }Y „iks dAY]I~D`~Lip,~Y~NAN#f ~ • ~y x DA7'~ CIF}BIR71t , ~ ~~ DATA Gfl!~ rL YgA~" ^ Life or ^ Term of Years - ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ..........................................$ 2. Actuarial factor per appropriate table ................................................ . Interest table rate - ^ 3 1/2 % ^ 6 % ^ 10 % ^ Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) ......................................$ ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ............................................$ 2. Check appropriate block below and enter corresponding (number) ......................... . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^ Semi-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .......... . ........................ 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1/2 % ^ 6 % ^ 10 % ^ Variable Rate 6. Adjustment Factor (see instructions) ............................ . ..................... 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Llne 6 ..........................$ If using variable rate and period payout is at beginning of period, calculation is' (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE' The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 E%. (3-04) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I. ~ ESTATE INHERITANCE TAX SCFIEDULE L REMAINDER PREPAYMENT OR INVASION OF TRUST PRIN( II. FILE NUMBER ~' """'"""~ (Middle Ini This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of tn,~l ~~Ir„-L,~i nunnuwGR rRCYHT MCIV I: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate ...............................$ 2. Stocks and Bonds ........................ ..$ 3. Closely Held StocWPartnership ............. ..$ 4. Mortgages and Notes ...................... .$ _ 5. Cash/Misc. Personal Property ............... .$ 6. Total from Schedule L-1 ........ ............ ..................................$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities .......................... .$ 2. Unpaid Bequests .......................... .$ 3. Value of Unincludable Assets ................ .$ 4. Total from Schedule L-2 ........ ............ ..................................$ E. Total Value of trust assets (Line C-6 minus Line D-4) .................................$ F. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ . G. Taxable Remainder value (Line E x Line F) .... .... (Also enter on Line 7, Recapitulation) .................................$ III. "'-- Gy in vhawn ~r GUKPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) or Annuitant(s) C. Corpus consumed ............................................................$ __ D. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ . E. Taxable value of corpus consumed (Line C x Line D) .................................$ °~" (Also enter on Line 7, Recapitulation) - Date of Birth Age on date Term of years income corpus or annuity is payable consumed ?EV-16d5 EXi 17-851 INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- FILE NUMBER I. Estate of ~ (Last Noma) (First' ame) (Middle In II. Item No. Description Value A. Real Estate (please describe) ~. Total value of real estate (include on Section II Line C-1 on Schedule L) B. Stocks and Bonds (please list) L~ ,___ Total value of stocks and bonds (include on Section II, Line C-2 on Schedule C. Closely Held Stock/Partnership (attach Schedule C-1 and/or C-2) (please list) Q -,-. Total value of Closely Held/Partnership $ (include on Section II Line C 3 on Schedule L) D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ (include on Setlion II Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) ~- Total value of CashlMisc. Pers. Property $ (include on Section II, Line C-5 on Schedule L) III. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $- P~ (If more space is needed, attach additional 8Y, x I1 sheets.) REV-1646 E%+ {3-84) ~~~~~~6A-~~~ etr~.s~ S~P~E~~Df"~ L-~ COMMONWEALTH OF PENNSYLVANIA RE~A~~~~~ ~~~~A.~~~~~ ~N.~~T~~N INHERITANCE TAX RETURN RESIDENT DECEDENT .~("~~~~"~'~,:, FILE NUMBER I. Esfafe of ~~/ ~J/- a~~S~~_4-j~-~ ~- "" -_ ~. (L~ Nome) / ~ __-_ - __ .. __~LL9'lc -----.-. ___ (F~rst Nama) (Middle Init II. ITem No. _ _-- L9es rrp ucvvn -.--- --I---- ___ AmounT A. Unpaid .liabilities Claimer against iJrrraneal estate and payable from assets reported on Schedule L i (please. ~isfl f a, u~sa, ad l.us (i~ac~u r n `~:r a ,n II p,n LA-'E on Schedule L) _ -- 6. Unpaid Bequest; p I;~„}~~ r ,, ~:, u ~ Schedule L-1 (please list) _._ Tu~al in}xucr' I gi,.;ts _ 'ina.l,d< un S~ ~o li lint L~-',? on Schedule L) C. Value of assets rep<nrl a o , `xhE {~~ ~ I hE - them unpaid bequests listed under B" above) 7h:,. t <• X14 n ., r~ £.,, ~,:~,; a or that do not form a port of the trust. Computation as folloWS; ._-. Iota! u Ir Lc~~l ! ~ is --- I (inc!udc „ ~ °~ec: i! !,ine ~ 3 on Schedule LI ~" III. ~ TOTAL (Also enter an Secfioc~ I> ...;2 ~. -- -- ~Q ~~r,W, ~J --LS (If mare spat is ncerl <- , .+cr .y~+1~, ~ i ,:!< x I 1 sheets.) REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT OF SCHEDULE M FUTURE INTEREST COMPROMISE on RUM9ER This Schedule is appropriate only for estates of decedents dy g after December 72, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block d an attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: - IY Summary of Compromise Offer: 1. Amount of Future Interest .......... ...............................................$ _ 2. Value of Line 1 exempt from tax as amount passing to charities etc , . (also include as part of total shown on Line 13 of Cover Sheet) ......$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6%, ^ 3%, ^ 0% ......................$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% .......................... $ . (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must a ual Line 1 $ ,-- ~ --'°~~ 9 ) ...................... (If more space is needed, insen additional sheets of the same size) ~Ey-,~48 Ex r„-99, SCHEDULE N SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA (gyAILABLE FOR DATES OF DEATH 01/01/92 TO 17131/94) INHERITANCE TAX DIVISION ESTATE OF „ ,, ~-v ~n a /~ /rar_r.~ h a This schedule must be completed and filed if you checketl the poverty credit box on the cover sheet. 7 . Taxable Assets total from line 8 (cover sheet) .................................... . 1 2. Insurance Proceetls on Life of Decedent ................................................ _ 2. 3. Retirement Benefits ................................................................ 3. 4. Joint Assets with Spouse ..................... . ...................................... 4. 5. PA Lottery Winnings ..... -. ......................................................... 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. .... ~. 6d, ~ ~~~ 6. SUBTOTAL (Lines 6a, b, c, d) ....... ........ .. .......... 6 ......... ...... 7. Total Gross Assets (Add lines 1 thru 6) ................................................ . 8. Total Actual Liabilities ................ . .............................. 9. Net Value of Estate (Subtract line 8 from line 7 Il line 9 is greater than $200,000 -STOP. The estate is not eligible to claim the credit I/not, continue to Part II. ^ r~-assrru u r Income: f a. Spouse .......... . 1a b. Decedent ......... . 1b c. Joint ............ . 1c. tl. Tax Exempt Income . . 1d. e Other Income not listed above ....... . 1e. FILE NUMBER 7. 8. 9. ~. ,. wpm. ........ .. 71. I 2f. 4. Average Joint Exemption Income Calculation 3f. 4a. Add Joint Exemption Income from above: (~ f) + (7f) + (3f) _ (= 3) 4b. Average Joint Exemption Income ........................... . I/line 4 6 is neater than 40,000 -STOP. The estate is not eli ib/e tc claim the credit. I/not continue to Part I(]. • ~ •~ •• ~ • to ~ • ~ 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less 1. 2. Multiply by credit percentage (see instructions) .......................................... . 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure 7 in the calculation of total credits on line 18 of the cover sheet . .............................. . 3. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedents gross estate ............................................................. 4. 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit .Include this figure in the calculation of total credits on hne 18 Pf the coyer ghget....... `~ 5. ..-._.-_. _ c~ ~-.:. kEV yeas sx.Itsq SCHEDULE 0 coMruoNwEA~rHOFRENNSVtvANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN ._ _ _ .. _ _ _ NUMBER Do not complete this schedule unless the estate is making the election to asse under Section 9113(A) of the Inheritance 8 Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate orm must be f led for each trust. This election applies to the Trust (marital residual A B By pass Unified Credit etc ) If a trust or similar arrangement meets the regmrements of Section 9113(A), and. a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar anon emenl included as a taxable asset on Schedule 0. The denominator is a ual to the total value of the trust or similar arran emenL PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrannamant `--- ~~1- _._ PART B: Enter the description and value of all interests Included In Part A for which the Section 9113 (A) election to tax is being made. ~> .~'--- (If more space is needed, insert additional sheets of the same size) --- _ _ --- REGISTER OF WILLS CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA No . 2009- 00004 PA No . 21- 09- 0004 Estate Of: MARTHAEDRAWBAUGH (first, Middle, lash Late Of: PENN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 182-22-9826 WHEREAS, on the 5th day of January 2009 an instrument dated August 15th 1989 was admitted to probate as the last will of MARTHA E DRAWBAUGH lFirsC Middle, Gasp late of PENN TOWNSH/P, CUMBERLAND County, who died on the 21st day of November 2008 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: ROBERT E DRAWBAUGH and WILLIAM L ORAWBAUGH who have duly qualified as EXECUTOR(R/X) and have agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 5th day of January 2009. **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) ;,.:~, ~: -:.,a LAST WILL AND TESTAMENT OF f J~)~ ~}'t3 u ~ ~ 12° ~ 7 MARTHA E, DRAWBAUGH (` ~ , 11 ua U~irru ,~~i~r~,- I, Martha E. Drawbaugh, of Upper Frankford Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke all Wills and Codicils previously made by me. ITEM I: I direct that all my legally enforceable debts and funeral expenses, including all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. ITEM II: I direct that any automobiles or motor vehicles I may own at my death, my personal effects, household goods and other tangible personal property of like nature (not including cash or securities) shall be sold at public or private sale by my personal representative(s), and I further direct that the net proceeds thereof shall be administered and distributed as a part of the residue of my estate. ITEM III: I devise and bequeath the residue of my estate of every nature and wherever situate in equal shares to my seven (7) children, provided that the share of any child who predeceases me or dies on or before the thirtieth day following my death shall be distributed to his or her issue, per stirpes, living on the thirty-first day following my death, and in default of any such then living issue, such share shall be added to the share or shares for my other children. ITEM IV: I appoint CCNB Bank, N.A., of Newville, Pennsylvania, guardian of any property which passes, either under this Will or otherwise, to a minor and with respect to which I am authorized to appoint a guardian and have not otherwise specifically done so, provided that this appointment of a guardian shall not supersede the right of any fiduciary in its discretion <,_ _~ .- to distribute a share where possible to the minor or to another for the minor's benefit. Such guardian shall have the power to use principal, as well as income, from time to time for the minor's support, health and medical care, and education (including college education), or to make payment for these purposes, without further obligation or responsibility to see to the proper expenditure thereof, directly to the minor or to the minor's parent or to any person taking care of the minor. ITEM V: All Federal, State and other death taxes payable because of my death, with respect to the property forming my gross estate for tax purposes, whether passing under this Will or otherwise, including any interest or penalty imposed in connection with such taxes, shall be considered a part of the expense of the administration of my estate and shall be paid out of the principal of my residuary estate without apportionment or right of reimbursement. ITEM VI: I appoint my sons, Robert E. Drawbaugh and William L. Drawbaugh, or the survivor, Executors of this my last Will. Should both of my said sons fail to qualify or cease to act as Executors, I appoint my son, John P. Drawbaugh, Jr., Executor of this my last Will. Should my said son fail to qualify or cease to act as Executor, I appoint my daughter, Esther F. Mooney, Executrix of this my last Will. Should my said daughter fail to qualify or cease to act as Executrix, I appoint CCNB Bank, N.A., of Newville, Pennsylvania, Executor of this my last Will. ITEM VII: I direct that all fiduciaries acting under this Will, whether or not named herein, shall not be required to. give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal, ~, this;'z,;,a~ •'•'~ day of August, 1989. v `~ ., _ ~ , ~ .FF/';[ SEAL ] ~, The preceding instrument, consisting of two typewritten pages, each identified by the signature of the Testatrix, was on the date thereof, signed, published and declared by Martha E. Drawbaugh, the Testatrix therein named, as and for her last Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. _-~. ., x, ~ ,n' ' p r~ ~, ... ' _ . a t ~ s ~;~., ,.J~ ti,, . COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND ~ III, and Mary M• We, Martha E. Drawbaugh, John B. Fowler, whose names the Testatrix and the witnesses, respectively, do Price, being first duly sworn, are signed to the foregoing instrument, hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Wllhernareeaandhe had signed willingly, and that she executed it as and that each of voluntary act for the purposes therein expressed, the witnesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the bh~eenfyearshof age or knowledge the Testatrix was at that time eig older, of sound mind and under no constraint or undue influence. ~,, ~_. ,.a,;N;.. ;, ,•~ ~ ~ . Testa~,rix ~~ I i-i ,, i'~J ~/ -- I ) Witness `!~ ~' ~-=--W~ n e s s i_ Subscribed, sworn to and acknowledged before me by Martha E. Testatrix, and subscribed and sworn to before me day Drawbaugh, the witnesses, this John B. Fowler, III, and Mary M. Price, 1989. of August, ~' ~ ~ ~ n • :. 1 _ .~~ ~-LL/ ~ `- \ _~-~ Notary Public NO7AAIAL SERI tiiICNAEI R RUNOLE, NOTARY PUBLIC CARLISLE BUBO, CUMRERIAND COUNTY MY COMMISSION E%PIRES DECEMBER 20. 1990