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Home My WebLink About01-14-09FAMILY SETTLEMENT AND FINAL RELEASE ESTATE OF MELVA M. LEBO ~ "~ ~~ ; _~ 1-~ KNOW ALL MEN BY THESE PRESENTS, that Melva M. Lebo, ~(e of-`the Borough of Carlisle, Cumberland County, Pennsylvania, deceased, died t~st~~e on July;:- -;; a~ 11, 2007, having first made her Last Will and Testament, which was dufy=~xecut~ti on; :_ -z :- _ December 12, 2000 and probated in the Office of the Register of Wills~of Cumberland ~ -_ C;"! ` ~ County, on July 20, 2007 as No. 2007-00691. WHEREAS, the said Melva M. Lebo, by the aforesaid Last Will and Testament, named Barry L. Shughart as Executor of said Last Will and Testament; WHEREAS, Letters Testamentary on the Estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to the said Executor, hereinafter called personal representative; WHEREAS, the personal representative has gathered the assets of the Estate of the said decedent and the assets consist of personal and real property with the total value of $174,556.13 as set forth in Exhibit "A", which is a copy of the Pennsylvania Inheritance Tax Return filed and approved by said personal representative, and which is attached hereto and made a part hereof, and marked Exhibit "A"; WHEREAS, the debts and deductions, including the payment of inheritance tax in the said Estate, which have now been paid, leave a balance for distribution of $127,239.60, also as set forth in the statement of said personal representative, which is attached hereto and marked Exhibit "B"; WHEREAS, the balance for distribution as shown in the said statement marked Exhibit "B" has been reduced to cash and has been distributed as herein indicated in accordance with the terms of the Last Will and Testament of the said Decedent; NOW, THEREFORE, the undersigned, being all of the heirs under the Last Will and Testament of the said decedent, and being those persons entitled to inherit under said Last Will and Testament, do hereby each of us acknowledge that we have this day had and received from the aforesaid personal representative, in full satisfaction and payment of all sums of money, legacies, bequests, and devises as are given, devised and bequeathed to each of us respectively by the said Last Will and Testament, the amounts due us under said Last Will and Testament, which amounts we have received this day or prior to this day; and, each of us do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution, we each agree that no account is necessary and we do hereby agree that we do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphan's Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania. THEREFORE, we and each of us, do hereby remise, release, quitclaim and forever discharge the said personal representative, Barry L. Shughart, his heirs, executors, administrators and assigned, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the Estate of the said decedent, and each of us do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, we and each of us do hereby covenant and agree with each other and the aforesaid personal representative, that we will contribute pro-rata our share of the Estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said Estate or the aforesaid personal representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. IN WITNESS WHEREOF, we have hereunto set our hands and seals the day and year noted below. ,~ ~ l /~ ~~~ D to Witness Barry t,: Shughart D~te~ Witness v Rebecca Koch ~~ 1 ~ ,;' )f//^^ {, _ ~•~ Vim, ~ ~~~~~ fs Date . Witnes Betz" aster ;~ ~ ~ f'`. Date `~ c~ D to _~ ~ Gc Da i ~ Y-' Date r < ~~ '(~; Date -- ~ '°~ _ ~, -t~. Date Da#e ~- Date /~ ~ d Date f _ ! '" 'f Date Date ~.., { ,.... ~ ,. ~~~ __ ~, Witness' ~----- Witne ~' Witne s Witnesfi Witness Witness ~~ Witness r / ~ _ ,~ ~~_.. *J Bart Shughart ~~~~ ~~ J n Watkins ~~ ~ ,:L F ~ ,~- Cindy itrich r r p 3 "^ ..., L , ~._. ... Lee Moss a ) s1 John Moss ,. _ . . ~..~__ i l~orraine Flynn „ Freda Wentz Albert Lebo ~~~~°u ~~ Theresa Lucas ,~ Witness ~~ 5~- Witne s ~' ~ tt.. ~ ~~~ lf~~ ,, y2. Gary E ders Anne Baker COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX INHERITANCE TAX DIVISION PO BOX 280601 RECORD ADJUSTMENT HARRISBURG PA 17128-0601 REV-1593 EX AFP C03-05) DATE 12-01-2008 ESTATE OF LEBO MELVA M DATE OF DEATH 07-11-2007 FILE NUMBER 21 07-0691 COUNTY CUMBERLAND JAMES M ROBINSON ACN 101 TURD LAW OFCS Amount Remitted 28 S PITT ST CARLISLE PA 17013 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE -) RETAIN LOWER PORTION FOR YOUR RECORDS E-- REV-1593 EX AFP C03-05) ** YNHERITANCE TAX RECORD ADJUSTMENT *~ ESTATE OF LEBO MELVA M FILE N0. 21 07-0691 ACN 101 DATE 12-01-2008 ADJUSTMENT BASED oN: ADMINISTRATIVE CORRECTION VALUE OF ESTATE: 1. Real Estate (Schedule A) (1) 117,000.00 2. Stocks and Bonds (Schedule B) C2) .00 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 4. Mortgages/Notes Receivable (Schedule D) C4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) C5) 57,5 56.1 3 6. Jointly Dwned Property (Schedule F) C6) .0 0 7. Transfers (Schedule G) C7) .00 8. Total Assets cs) 174,556.13 DEDUCT IONS AND EXEMPTIONS: 9. Funeral Expenses/Administrative Costs/ Miscellaneous Expenses (Schedule N) (9) 13,589.09 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11,273.40 11. Total Deductions C11) 24,862.49 12. Net Value of Tax Return 112) 149; 693.64 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (S chedule J) C13) .0 0 14. Net Value of Estate Subject to Tax C14) 149,693.64 TAX: 15. Amount of Line 14 at Spousal rate (15) . 00 X 00 = . 00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 045= . 00 17. Amount of Line 14 at Sibling rate C17) . 00 X 12 = . 00 18. Amount of Line 14 taxable at Collateral/Class B rate C18) 149,693.64X 15 = 22,454.05 19. Principal Tax Due C19) 22,454.04 TAV (`D (TIT TC. DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID 04-14-2008 CD009545 12.93- 23,495.39 07-15-2008 CDO1D016 .00 13.53 11-20-2008 REFUND .DO 1,041.95- TOTAL TAX CREDIT 22,454.04 EXHIBIT BALANCE OF TAX DUE .00 ~~ ~~~ INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER DATE INDICATED, SEE RE~ , LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTERES REFLECTED AS A °iCREDIT^ (CR), YD'J MAY Bc DUE A REFUND. SEL REVEPcc ST_DE OF TF{TS FORM FOR INSTRUCTIONS.) `~~._ '' iNHER1TANCE TAX ~, ~ EXPLANATlQN ~~E ~~~.~~ i~rrr o~ E~~ ~ ~~~ ~~_ OF CHANGES BUI FAU OF INDIVIf)il4i C J=~ ~, ~ ~ - _ _° ,~ -- -- _ ~ ~r)~ h1T C; , _ - _ --- - _ __ Melva C_ebc~ ~ i _I ~~~ ~r ~~~~~~~ Z 107-0(;g l - - - - -- ~F~~i~-~,iFO t3~; nrei - - _ _ Department of Revenue/ Emerson Luciano 101 ---- T E M - ------ --- - SCI-IEDULE Np EXPLANATION OF CHANGES Adjustment has been made removing duplicated deductions F'.~~u 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 80X.280601 Harrisburg, PA 17128-0601 R1=SIDENT DECEDENT 2 1 0 7 O O b y 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204038171 07112007 01221918 Decedents Last Name J!~TTlX Decedent's First !lame jyjli LEBO MELVA M (if Applicable) Enter Surviving Spouse's Information Belovv Spouse's Last Name Suffix Spouse's First Name M1 Spouse's Social Security Number THIS P.ETURN MUST BE FILED IN DUPLICATE `JVITH THE REGfSTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ t. Original Return ~ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) (~ 4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required (dale of death after 12-12-82) g Decedent Died Testate ^ 7 Decedent Maintained a Living Trusi ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Wifp (Attach Copy of Trust) 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 T0: Name Daytime Telephone Number JAMES M ROBINSON 7172459688 Firm Name (It Applicable) TURO LAW OFFICES First line of address 28 SOUTH PITT STREET Second line of address City ar Post Office CARLISLE Slate ZiP Code PA 17013 Correspondent's a-mail address: j r o b i n s O ri@ t u r o 13 W C O m REGISTER OF WILLS U~ONLY c`~ ~-=~ c.- n ~Y -- s~; it ;7 h~.- ,, _r, ~-~ ;~~~; - -r, `` , , "~: _ DA1'~~ILED rv 4'V rn 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. SIG~TURE OF PE N RESPON BL FOR FILING RETURN DATE ~._,~,,,.~, •~ ~~•~--~ -- Bar-y L. Shughart !'~ .; t_~l ;'~' j- ADDRESS 17 Hilltop Lane, Newville, PA 17241 SIGH TURF OF PREP RER OThI~R TgtAN REPRESENTATIVE LATE ,~ ~~~ ~~ ~-~ ~ James MRobinson -7. ~ t r~~~'~ AD RESS ~ '.~8 South Pint Street, Carlisle, PA 17013 i~ _ Sicle 1 1505604114 15055041 ~ 4~' _v___ 15056042148 REV-1500 EX Decedents Social Security Number Decedents Name. L E B O, IVI E L V /Q M 2 0 4 0 3 81 ~] 1 RECAPITULATION 1. Real Estate (Schedule A)......._.._ ............._......._...........-........_.........._.._....... _ . 1. 2. Stocks and Bonds (Schedule B) ............................._..........._.__..._..........._._..._. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)........ . 3. 4. Mortgages & Notes Receivable (Schedule D) ................._............_....._........__.. . 4. 5 Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... . 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............ . 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested... _...._. . 7. 8. Total Goss Assets (total Lines i-7)__.....__ .........................................._.........._. . 8. 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 Vatue 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 Vatue Subject to Tax (Line 12 minus Line 13) ................_..........._........_....... . 14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 15. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17, Amoun4 of Line i4 taxable at sibling rate X .12 17. 18 Amount of Line 14 taxable at collateral rate X .15 ~ n_ ; ~1 18. 19 Tax Due.._..._.. ...__._... _...._..._ ..............__.__..._ ......._....__.........._.. _..... ..... 19. 20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. -430.80 =43C.o0 6,511.50 6,511.50 -6,942.30 -6,942.30 -1,041.35 -1,041.35 8ic~e 2 15056042°~4~8 1505604214 __ REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 07 - 00691 Lebo, Melva M IADDRESS 740 North College Street CITY --- ------- -- -.-_----- Carfisle I STATE ~ ZIP PA I 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable p, Interest E. Penalty Total InteresUPenalty (D + E) Tota{ Credits {A + 8 + C) 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check bax on Page 2 Line 2u t:o 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. Make Check Payable to: 14EGISTER JF Vt//BLS, AGENT (1) -1,041.35 (2) 23,508.92 (3) 0.00 (a) 24,550.27 (5) (5A) (5B) 0 . ~ ~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No r ~ I- a. retain the use or income of the property transferred :............._......................_._....._........._.....__...._..... _l , xJ b. retain the right to designate who shall use the property transferred or its income; _.._....... L ~ 'i x -. c. retain a reversionary interest; or ......... ............ ..._.. .....-- ..__.. _.._ x'~ d. receive the promise for life of either payments, benefits or care?_........._._..._....._.. .. ...._._............ ,I x' 2. if death occurred after December 12, 1982, did decedent transfer property within one year of death without - _.. x ' receiving adequate consideration?.. _..... .. .._ ............. _ ...._. _.. .. '' 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death?..... _.. ', _~ ~ x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?............_....._ ...............__....._._..__ ......_......_ .. _ . _.... _ _.._.... !, _~ I x ~, 1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent j72 P.S. §9116 (a) (1 1) (ii)J. 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 sti11 applicable even if the surviving spouse is the only beneficiary. For dates of death on or after Juiy 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)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 12) [72 P.S. §9116 (a} (1)]. The tax rate unposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P_S §9116 (a) (1.3)]- A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 23,508.92 SCHEDULE E 'i CASH, BANK DEPOSITS, & MISC. COM NHERITANCE TAX RE7URNANIA ~ PERSONAL PROPERTY RESIDENT DECEDENT I I -_-_- ~FILE NUMBER ESTATE OF Lebo, M21va M 121 - 07 - 00691 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of ,u^:i+.~orsh~p must he uisclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER ~ DEATH 1 Refiund to U.S. Treasury Series E - U.S. Savings Bond C75 460 590 E, reported lost and paid -430.80 out in the 1980's __ ___ -_ __- TOTAL (Also enter on Line 5, Recapitulation) -430.80 SCHEDULE H FUNERAL EXPENSES & COMMONWEALTH OP PENNSYLVANIA '~ INHERITANCE TAX RETURN ~'N~CT •~T 1 V C ~VJ~ RESIDENT DECEDENT _-.__._ __.-..--.-__-_--..---.____--._-_L-_~-_.-.--.-_ _-._--,.---__---___-.. ESTATE OF Lebo, Melva M Debts of decedent must be reported on Schedule 1. ----ITEM _ _ - - -- ----------__ ~-- ------- NUMBER ,FUNERAL EXPENSES: DESCRIPTION e_ 1 i 2'~ 3 B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions i Social Security Number(s) (EIN Number of Personal Representative{s?: FiL€ NUir7o~rt - 21 - 07 - 00691 AMOUNT Street Address i City State Zip i Year(s) Commission paid 2. ', Attorney's Fees 3. Family Exemption: Qf decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7, Other Administrative Costs 1 TOTAL (Also enter on line 9, Recapitulation) 0.00 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI ~ DEBTS OF DECEDENT, MORTGAGE II LIABILITIES, & LIENS ~ FILE NUMBER 21 - 07 - 00691 ESTATE OF Lebo, Melva M Include unreimb~arsed medical expenses. --- ---- ITEM DESCRIPTION NUMBER 1 Closing Costs from sale of 740 N. College St., Carlisle, PA AMOUNT -. ___ 6.511.50 __ __ ___ __ _ - _ - TOTAL (Also enter on Line 10, Recapitulation) 6,511.50 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT DF REVENUE NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE DR DISALLOWANCE INHERITANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 280601 HARRISBDRG PA 11128-9601 REV-1547 EX AFP (06-05) DATE 07-07-2008 ESTATE OF LEBO MELVA M DATE OF DEATH 07-11-20D7 FILE NUMBER 21 07-0691 COUNTY CUMBERLAND JAMES M ROBINSON ACN 101 7UR0 LAW OFCS APPEAL DATE: 09-05-2008 (See reverse side under Objections) 28 S P ITT ST CARLISLE PA 17013 Amount Remitted~~ MAKE CHECK PAYABLE AND REMIT PAYMENT 70: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE --) RETAIN LOWER PORTION FOR YOUR RECORDS (-- REV-1547 EX AFP C03-05) IVOTICE OF IN HERITANCE TAX APPRAISEMENT, ALLOWANCE OR D:[SALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF LEBO MELVA M FILE N0. 21 07-0691 ACN 101 DATE 07-07-2008 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 117,000.00 NOTE: To insure proper 2. Stacks and Bonds (Schedule B) (Z) ,00 credit to your account, 00 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) (3) of this Corm with your 4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) CS) 5 7,98 6.93 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 174 , 986.93 (g) 8. Total Assets _ APPROVED DEDUCTIONS AND EXEMPTIONS: 13,589.09 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. DebtslMortgage Liabilities/Liens (Schedule I) (10) 4,7 61.90 11. Total Deductions (11) _ ]-8 •350.99 156,635.44 12. Net Value of Tax Return C12) _ .00 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) C13) _ 156,635.94 14. Net Value of Estate Subject to Tax (14) _ NOTE: If an assessment was issued previously, l ines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 00 00 . 00 15. Amount of line 14 at Spousal rate (15) = X 16. Amount of Line 14 taxable at Lineal/Class A rate (16) . 00 X 045 = .00 17. Amount of Line 14 at Sibling rate C17) 00 X 12 = .DO 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 156 , 635.94 X 15 = 23, 495.39 19. Principal Tax Due (19)= 23,495.39 f AX l;Ktlll 1 J PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 04-14-2008 CD009545 .DD 23,495.39 BALANCE OF UNPAID INTEREST/PENALTY AS OF 04-15-2008 TOTAL TAX CREDIT 23,495.39 BALANCE DF TAX DUE .00 INTEREST AND PEN. 13.53 TOTAL DUE 13.53 IF PAID AFTER DATE INDICATEIJ, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMEPJT IS REQUIRED. FDR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY RE DUE A REFUND. SEE REVERSE SIOE OF IH15 FURr1 FuR 1NJ`TRUCI"IONS-% ~1 1~n~~na~747 RG~~ 1 ~~J® EX (06-05) OFFICIAL USE ONLY' PA Department of Revenue County Code near File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 ~zESIUtN 1 UECtL~tN I 2 1 v 7 ~ O ~i ~ i ENTER DECEDENT fNFORMATION BELOW Social Security Number Date of Death Date of Birth 204038171 07112007 0122191.8 Decedent's Last Name Suffix Decedent's First Name MI LEBO MELVA M (If Applicable) Enter Surviving Spouse's information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF 11VILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-32) ~ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate lax P.eturn Required (date of death after 12-12-82) g Decedent Died Testate ^ 7 Decedent Maintained a Living Trust v 8. Tota4 Number of Safe Deposit Boxes ^ (httach Copy of Wll) ~ (Attach Copy of Trust) 9. Liti ation Proceeds Received 1 p Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(Al ^ g ^ between t23I-et and ~-t-g5> (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAMES M ROBINSON 717245,3,688 ~_=~ ~-;~ - Firm Name (If Applicable) TURD LAW Ok'FICES First line of address 28 SOUTH PITT" STREET Second line of address City ar Post Office CARLISLE Scats ZIP Gade PA 17013 Correspondent's e-mail address: j r Ob 1 ri S o n@ t u r O l a W C Om _ ~~ ._., REGISTER OF l,li!IIc~S US~'C~NLY -..~- _I Y -, ~- -`-' _Y -, -, .. - C+ .~ DATE f=1LED 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. SIGNATURE OF PER.S RESPON 18LE OR F1UNG RETURN DATE ~. e. ~ ~.~,~~ Barry L. Shughart >~ ~ 14~ ~~~~~ ADDRESS 17 Hilltop Lane, Newville, PA 17241 SIGN/\TURF_ OF PREPARER OTH~f$ THA1J-12EPRESEN7ATIVE GATE ? ! f ~ ~``..~.~..-:.-i ,~~,~ ~t ~ ,,.,~ ,.e-..., _- --- James M Robinson ;.j ~ I , ~ ,(~. ?.DDR;ESS ~S SOUth Pitt street, Carlisle, PA 17013 Side 1 15U560~114~ 1505604~11A11' .~.~`._._~. 1~n56Qa?1aR REV-1500 EX Decedent's Social Security Number ceceaent's Name. L E Et O, M E L V A M 2 0 4 0 3 8 1 7 1 RECAPITULATION --- _-- - - - -_ - - - 1 Real Estate (Schedule A)..._._.._._._.._._.._......_.........._._ .................__....-...-...._ 1. 1].7 , 000.00 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. ~~ 7 , 9 8 6 9 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested._._...... 6. ?. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. g. Total Gross Assets (total Lines 1-7) ................_..............._.........................__._.-.. 8. ~ 7 a, 9 8 6 9 3 --- _ 9. _ --- Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. ~ 3 , 5 8 9 . 0 9 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule 1)..........._..........._..... . 10. 4 , 7 6 1 9 0 11 Total Deductions (total Lines 9 & 10)......._............_.........._............_.._........_.... _ . 11. ~ 8 , 3 5 0 9 9 12 Net Value of Estate (Line 8 minus Line 11)._..._......_ ................................._........ . 12 G- ~~ ~ 4 13, Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ............................................... 13. 14. Net Value Sub}ect to Tax (Line 12 minus Line 13)......_..........._..-.._....._ ............. . 14. 1 5 6 , 6 3 5 g 4 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15 Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 15. 16 Amount of Line 14 taxable at lineal rate X -045 16. 17 Amount of Line 14 taxable at sibling rate X -12 17. 18 Amount of Line 14 taxable at collateral rate X .15 X 5 6, 6 3 5 9 4 1 a. ? 3 4 9 5 3 9 19 Tax Due...-.._........- ., . _.. 19. :~ 3 4 9 5 . 3 9 20 FILL IN THE OVAL IF YOU ARE RECIUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 a •~, 15C1560~~'~ ~ ~~ 5p5Q0A~~1 ~k8 .... _.,_ REV-1500 EX Page 3 File Number 2'{ - 07 - 00699 Decedent's Complete Address: Lebo, Melva M TP.EET ADDRESS 740 North Caliege Street CITY Carlisle STATE ,ZIP PA ~ 97013 Tax Payments and Credits: 1 Tax Due (Page 1 Line 19) 2. ; redifs(Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. interesUPenalty if applicable D. interest E. Penalty Total InteresUPenalty (D + E) Total Credits (A + B + C) 4 1f Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check bax on Pans 2 Lane 20 is reaues*. 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. g. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) 23,495.39 (2) 0.00 (3) 0.00 (4) - (5) 23,495.39 (5A) (5B) X3,495.39 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" {N THE APPROPRIATE BLOCKS Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;........._......-_ .............._....._.... __.._. _...__..._..._.._ ~ ~ j xj b. retain the right to designate who shall use the property transferred or its income;.......... _... j __~ z' c. retain a reversionary interest; or.......... ._.._....._ ......... ........_..._........... _........ _... ~ i ~ x I d. receive the promise for life of either payments, benefits or care?......_ _......_. _......__...._ ._ __. . __. j x ~. If death occurred after December 12, 1982, did decedent transfer property within one year of death without __ receiving adequate consideration? ..... ..................._.. .......... _.... ....._... ....._......_.. __.._ _ ; x_! _.. - -_ 3 Did decedent own an ' 4n trust for" or payable upon death bank account or security at his or her death`'. j_ ' ; x !, 4 Did decedent own an Individual Retirement Account, annuity, or other non-probate property which _ contains a beneficiary designation?._._............_........... I I x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCFIEDULE 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) (r)]. 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 daes 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. ~911G 1.2) [72 P.S- §9116 (a) (1)]_ The tax rate +mposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent ~%2 P.S. §9116 (a) (1 .3)]_ H sibling is defined under Section 9102. as an individual vdho has at least one parent in common with the decedent, whether by Mood cr adoption SCnEv`t~LE A CJMMON WEAN„OF PENNSYLVANIH I REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT _ _._._ _ ESTATE OF Lebo, Melva M ~ LB l~lt)MBER ---- -- - -- ----- i 21 - 07 00691 All real property owned sole)y or as a tenant in common must be reported at fair market Nalue. 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 n;hich is jointly-ovrned ..ith right of su, ~ivorship must be disclosed or schedule F. ITEM NUMBER DESCRIPTION 1 740 North College Street, Carlisle, PA 17013 TOTAL (Also enter on Line 1, Recapitulation) VALUE AT DATE OF DEATH 117, 000.00 117,000.00 ~ ~ SC~-IEDU~ I-I '' ~~ ~ ; FUNERAL EXPENSES & - ----- - COMMON WEALTH OF PENNSYIVANVA NH ITANC- TAX RETURN- --- - ADMINISTRATIVE COSTS RESIDENT DECEDENT i _ __ ESTATE OB Lebo, PJlelva M - --- I FILE NUIUI~ER ---- --- ----- -- - -- --- - --- ------- I 21 - 07 - 00691 -- - -- - Debts of decedent must be reported on Schedule 1. __ -- ------ ITEM ~. _------- -_ -__ ------ - NUMBER FUNERAL EXPENSES: DESCRIPTION ' AMOUNT - _ - ----- A. 1 Hoffman-Roth Funeral Home & Cremato ;~ Ser`rices 7,ggg 75 2 'Cumberland Valley Memorial Gardens 1,210.00 3 I St. Matthews United Church of Christ -Post Funeral Reception 300.00 I B. ~I ADMINISTRATIVE COSTS: 1. Persona! Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2 Attorney's Fees Turo Law Offices Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills Cumberland Law Journal The Sentinel -Legal 5 Accountant's Fees 6 Tax: Return Preparer's Fees 7 Other Administrative Costs 3,499.74 348.00 75.00 166.60 TOTAL (Also enter on line 9, Recapitulation) 33,589.09 EXHIBIT "B" GROSS ESTATE NET OF TAX $ 152,102.09 LIABILITIES A. Hoffman-Roth Funeral Home $ 7,989.75 B. Cumberland Valley Memorial Gardens 1,210.00 C. St. Matthews United Church of Christ 300.00 D. Turo Law Offices 3,499.74 E. Register of Wills 348.00 F. Cumberland Law Journal 75.00 G. The Sentinel -Legal 166.60 H. Betra In-Home Care 352.00 I. Embarq 99.99 J. PPL Electric Utilities 815.58 K. Borough of Carlisle -Water/Sewer Service 137.82 L. Penns Wood Physical Therapy 57.92 M. Carlisle Area School District -School Taxes 1,258.39 N. Richard Farber -Lawn Care/Sidewalks 300.00 O. Waste Management 404.00 P. Misc. Supplies to Clean & Repair House 24.70 Q. Expenses to Seil House 1,311.50 R. Closing Costs at Settlement for House 6,511.50 TOTAL LIABILITIES $ 24,862.49 AMOUNT REMAINING TO BE DISTRIBUTED $ 127,239.60 DISTRIBUTIONS: Barry L. Shughart $ 17,550.90 Rebecca Koch 2,550.90 Betzi Carter 2,550.90 Bart Shughart 2,550.90 John Watkins 10,203.60 Cindy Deitrich 10,203.60 Lee Moss 10,203.60 John Moss 10,203.60 Lorraine Flynn 10,203.60 Freda Wentz 10,203.60 Albert Lebo 10,203.60 Theresa Lucas 10,203.60 Gary Enders 10,203.60 Anne Baker 10,203.60 TOTAL DISTRIBUTIONS $ 127,239.60