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J 15056041147
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes coumv cme rear File Number
PO BDx.28osot INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 D 8 0 0 8 3 1
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
08 05 2008 O1 19 1922
Decedent's Last Name Suffix Decedent's First Name
MI
CRAWFORD MARY C
(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 WILLS
FILL IN APPROPRIATE OVALS BELOW
~X.I 1. Original Retum I ~ 2. Supplemental Return ' 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate i qa Fotura Interest Compromise
ieate or seam arter 12-12-e2) 5. Federal Estate Tax Return Required
~- a Decedent Dletl Testate
' (mtacn copy or wuq ' ~ OeceGent Maintained a Living Tmst
~' (quacn copy or imsp
8. Total Number of Safe Deposit Boxes
~'. 9. Litigation Proceeds Received ''~. 1p spousal Poverty cretin (date or beam
' 'between 12-31-91 antl 1-1-85) 11. Election l0 tax under SZC. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD eE DIRECTED 70:
Name
JAN M WILEY Daytime Telephone NumbeN
717 9~2 966 r
Firm Name (If Applicable) C `° -..~ ~ ' ' '
.~D r:;
THE WILEY GROUP , PC REGISTErpro 1Cpsu'-%
First line of address an
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130 W, CHURCH STREET ~
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Second line of address ~
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CJS
City or Post Office State ZIP Code DATE FILED
DILLSBURG PA 17019
Correspondent's a-mail address:
Under penalties of perju eclare hat I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
i[ is true, correct an te. D r 'on of preparer other than the personal representative is based on all information of which
51 F ESPO FO FILING RETURN preparer has any knowledge.
ADDRESS
Wallace B. Crawford Jr. onrE
a a-
~
84 Nance Road, Stanfield, NC 28163
SI NATURE OF PREPARER OTHER THAN REPRESENTATIVE
Jan M Wiley DATE
.~ 7 ~
j, I
130 W. Church Street, Dillsburg, PA 17019
L Side 1
15056041147
15056041147
J ~~
J 15056042148
REV-1500 EX
Decedent's Social Security Number
oaceae^r: Nama Mary C. Crawford 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. 1 7 1 6 0 0 3 z
6. Jointly Owned Property (Schedule F) ' '~ Separate Billing Requested .......... ... 6.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) Se crate Billin Re nested....
P 9 q ...... 7.
...
8. Total Gross Assets (total Lines 1-7) ....... .......... _.... ......_..... ... 6. 1 7 1 6 0 0 3 2
9. Funeral Expenses 8 Administrative Costs (Schedule H) ...................................... ... 9. 1 0 8 2 1 9 5
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............................. ... 10. 5 0 1 2 0
11. Total Deductions (total Lines 9& 10) ................................................................... ...
11. 1 1 3 2 2 6 5
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... ... 12. 1 6 0 2 7 7 6 7
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 6 0 2 7 7 6 7
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 .00 0 D 0 15.
0.
00
16. Amount of Line 14 taxable
at lineal rate X .045 1 6 0, 2 7 7 6 7 16. 7, 2 1 2 5 0
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 77~ 0 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18. 0 0 0
19. Tax Due ......................._................................................................_................_........ 19. 7. 2 1 2. 5 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
L Side 2
15056042148
15056042148 J
REV-1500 EX Page3 File Number 21-08-00831
Decedent's Complete Address:
DECEDENT'S NAME
Mary C. Crawford
STREET ADDRESS - - -- - -
825 N. Hanover St.
CITY _.
t:arllSle ,STATE I~ZIP
PA 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments (1) 7,212.50
A. Spousal Poverty Credit
B. Prior Payments 5,985.00
C. Discount 315.00
3. InteresUPenalt rfa licable Total Credits (A+B+C)
Y PP (2) 8,300.00
D. Interest
E. Penalty
Total InteresVPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT
.
Check box 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) 912.50
A. Enter the interest on the tax due. -
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE
. (5B) 9 ~ 2.5
j~3t~''Make Check Payable to: REGISTER OF W/LLS, AGENT
, I I i~ ". , i;t°~i4'~sitl-'.{~ t f I i
a I .,.4~)i , .,iF,~ 46f., ,~t ,:a s.,. ,. "- t ~ ... 'mitt ~ o'~./i f >i„E~-a`i~'~a~i!!~'~_~~4,~~~ii?4~~~!'
U
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 properly transferred;......... _ x
b. retain the right to designate who shall use the property transferred or its income;..... ~ z I.
c. retain a reversionary interest; or ................................................... ~~ ~~ '
......_ ........ x
d. receive the promise for life of either payments, benefits or cares .........
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
IF THE ANSWER TO ANY OF THEIABOVE QUtESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
,.. ~] o,.Na4s s, .::..a 3,-!. n 4>li f.H:v"s:k .., i{, y,~1 tt,t x dam;,; ,!, ~~~;~"'. i
. ~ , n .fie`' ~ r ; ., ) i+rp n~: =..i ti it P r?lo4r,.tat,i a~.,.
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 oftransfers to or for the use of the surviving spouse is zero
(0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does nol 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)]. 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.
Rev~1808 EX* (898)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSTLVgNIA
INHERITANCE Tq%gETURN
RESIDENT pECEpENT
ESTATE OF
_ Crawford, Mary C. FILE NUMBER
21 08 00831
Inclutle tha proceeds of litigation antl tha data the proceetls were receivetl by tha estate.
All property IolMly.owneE with [he dgh[ of survlvorehip must be tlieclosetl on schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 Church of God Home (refund deposit):
27,200.00
2 Citizens Bank Account Number 6100742008:
24,500.88
3 Citizens Bank Account Number 6204678152:
118.653.86
4 Genworth Long Term Care refund:
214.97
5 Hartford Healthcare payment:
6.62
6 IRS Stimulus check:
600.00
7 Marsh premium refund:
283.20
8 Patriot News refund:
90.75
9 Tricare Healthcare payment:
50.04
TOTAL (Also enter on Line 5 Recapitulation) I 171 600 32
(If mo a space s needed, addRwnal pages of the same srze)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 schetlule E (Rev. 6-98)
~~ Citizens Sink
Account Number
Account Tale
Date Opened
Account 7 ype
Pnnc~pal Balance as of DOD
Interest from Last Posting to DOD
Account Balance as of DOD
YTD Interest to DOD
6204678152
MARY C CRA Wf'ORD
3/11/2003
Checking
$118,653.86
$ .00
$] 18,653.86
~~ ~~izens Ban~C
Account Number
Account Title
Date Opened
Account Type
Pnnc~pal Balance as of DOD
Interest from Last Posting to DOD
Account Balance as of DOD
YTD Interest to DOD
6100742008
MARY C CRAWFORD
2/7/] 972
Checking
$24,500.88 _
$ .00
$24,500.88
$72.26
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` REV-1161 EXi (1399(
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Crawford, Mary C.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
Cocklin Funeral Home:
FILE NUMBER
21-08-00831
AMOUNT
820.87
B• ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Wallace B. Crawford Jr.
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address 4484 Nance Road
city Stanfield State NC Zip 28163
Year(s) Commission paid 2009
2. I Attorney's Fees The Wiley Group, PC
3. 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
5. ~ Accountant's Fees
Register of Wills:
6. I Tax Return Preparer's Fees
7~ Other Administrative Costs
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation)
8,500.00
311.00
1,389.58
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
• Rev-160] EXt I6-96)
COXfitINWEgLTH OF PENNSYLVPNIA
INHERITANCE TN{ RETURN
RESIDENT DECEDENT
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
ESTATE OF
Crawford, Mary C.
LE NUMBER
21-08-00831
ITEM
NUMBER DESCRIPTION
AMOUNT
1 Cumberland Law Journal (adv
rti
e
se estate):
75.00
2 Gunn Mowery Insurance (bond):
1,110.00
3 Register of Wills (filing fee):
30.00
4 The Sentinel (advertise estate):
174.58
Subtotal I 1 389 58
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-7500 Schedule H-87 (Rev. 6-98)
..
Rev-1613 EXr (899)
COM1M'JNWEALiH OF PENNSYLVANIH
INHERITNNCE TN%ftETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8E LIENS
ESTATE OF FILE NUMBER
Crawford, Mary C. 21-08-00831
Inclutle unrelmbursetl metlical expenses.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
1 Church of God Home:
407.12
2 Hartzel Eye Assoc.:
75.00
3 Walnut Bottom Radiology:
19.08
TOTAL (Also enter on Line 10, Recapitulation) I 501 20
(If more space Is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
... .
REV~1510 EXt (900)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Crawford, Mary C. ~~_nu_nrlcaa
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
Do Not Llat Trustee s (Words) ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
1 Mary Crawford Daughter one-half of 80
138.84
114 Southworth Drive residual estate ,
Ashford, CT 06278
2 Wallace B. Crawford Jr. Son one-half of 80
138
84
4484 Nance Road residual estate ,
.
Stanfield, NC 28163
Enter dollar amounts (or distributions shown above on lines 1
5 through 18, as appropri Total
ate, on Rev 1500 cover
sheet 180,277.88
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 Q QQ
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98)