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Home My WebLink About02-13-09 5056041114 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~ l ~' 00 L1.-( ~ Po Bax 2eosol Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 008-18-5114 11242007 01181928 Decedent's Last Name Suffix Decedent's First Name MI GRAVES FREDERICK (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ANNA MAY GRAVES Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Qx 1. Original Return ~ 2. Supplemental Return Q 3. Remainder Return (date of death 0 4. Limited Estate 0 4a. Future Interest Compromise (date of pnorto 12-13-82) 0 5. Federal Estate Tax Return Required death after 12-12-82) 0 6. Decedent Died Testate (Attach Copy of Wilq 0 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 0 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 TO: Name Daytime Telephone Number ROBERT G. FREY 717-243-583 ~ ~:~ Firm Name (If Applicable) - ,:~ REGISTER OF WII1'~JSE ONLYf.Yy FREY & TILEY ;fin c~ First line of address ~' rn ""' .: =C Cr: ,,~ ,` 5 SOUTH HANOVER STREET ,'~ ~:~~ -c c Second line of address ',: ,, ~__ . ~_- ~ t` n C l~ City or Post Office State ZIP Code DATE FILED CARLISLE PA 17013 Correspondent's a-mail address: RFREY@FREYTILEY. COM 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 belie , 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 TORE OF PERSON RESPONSIBLE FOR FILING RETURN DATE G:. ~ ~~1 r ~ ~ t' C~ ADDRESS 1 PERSIMMON DRIVE, BOILING SPRINGS, PA 17007 SIGNA R F PREP,~RER 'fH RE SENTATIVE // DATE ADDRESS 5 SOUTH HANOVER STREET, C LISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY 1505604111.4 Side 1 15056041114 ,~„~, -A, ~~ -~ ~_.; _,, f ~ "-} _... ,'i7 __, , ~.5 __ r=te ~. <_1 -: i ti~ ~' J 15056042115 REV-1500 EX Decedent'sNanne: FREDERICK GRAVES RECAPITULATION 1. Real estate (Schedule A) ........................................... 1. NONE 2. Stocks and Bonds (Schedule B) ...................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages & Notes Receivable (Schedule D) .......................... . . 4. NONE 5. Cash, Bank Deposits i;< 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) OSeparate Billing Requested ........ 7 NONE 8. Total Gross Assets (total Lines 1-7) .................................. 8. 61388.00 2710.00 2088.00 66186.00 9. Funeral Expenses & Administrative Costs (Schedule H) .................... 9. 2 5 017.0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. NONE 11. Total Deductions (total Lines 9 & 10) ................................. 11. 2 5 O 17 . O 0 12. Net Value of Estate (Line 8 minus Line 11) ........................... .. 12. 4 116 9 . O 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... . 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) 14 4116 9 0 0 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.o 0 35585.00 19. 0.00 16. Amount of Line 14 taxable at linealrateX.o 45 5584.00 16. 251.00 17. Amount of Line 14 taxable at sibling rate X • 12 17. 0 O 0 18. Amount of Line 14 taxable . at collateral rate X , 15 18. 0.0 0 19. TAX DUE .......................................................19. 2 5 1. O O 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~ Side 2 15056042115 15056042115. REV-1500 EX Page 3 008-18-5114 Decedent's Complete Address: DECEDENTS NAME FREDERICK GRAVES STREET ADDRESS 1 PERSIMMON DRIVE CITY (OILING SPRINGS Tax Payments and Credits: 1. Tax Due (Page 2 Line 19} 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Flle Number 21-OS-0471 STATE ZIP PA 17007 (1) 251 00 Total Credits (A + B + C) (2) 0 00 Total Interest/Penalty (D + E) (3) 0 00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 0 00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 251 00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 251 00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: ~ a a. retain the use or income of the property transferred; .......... ... , . X 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. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving.spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger 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. zn REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA fNHERITANCE TAX RETURN ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER FREDERICK GRAVES 21-08-0471 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. Treasury Securities RI ) v I AL (Also enter on line 2 Recapitu (If more space fs needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 61,388 388 217 REV-1508 EX+(6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PEINNSYLVANIA INHERITANCE TAXF,ETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER FREDERICK GRAVES 21-08-0471 Include the proceeds of litigation and the date the proceeds were received by the estate. ~~~ ~"~,~ ~Na~~ ~~ ~~~~uC~, niseri aaoltlonal sneers or the same size) z~~ REV-1509 EX+(6-96) COMMONWEALTH OF PENNSYILVANIA INHERITANCE TAX RETUFIN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT 1 Persimmon Drive Boiling Springs, PA 17007 A. Anna May Graves B. Judith Hess C. J~INTLY.nWNFr] PRf)PPR1n/• ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING 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. -B F & M Bank Account 67885-11 6,266 33.33% 2,088 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2634 Girard Avenue West Lawn, PA 19609 TOTAL (Also enter on line 6 Recapitulation)I $ 2 088 (If more space is needed, Insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8 IN RES DENTEDECEDENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER FREDERICK GRAVES 21-08-0471 Debts of decedent must be re orted on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home 7 754 2. Post memorial service food 134 3. Flowers 260 B. ADMINISTRATIVE COSTS: 1. Personal F;epresentative's Commissions Name of Personal Representative(s) Anna Mav Graves street address 1 Persimmon Drive City Boiling Springs state PA zip 17007 Year(s) Commission Paid: 2008 3,000 2• Attorney Fees 3,000 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Anna Mav Graves street address 1 Persimmin Drive city Boiling Springs state PA zip 17007 Relationship of Claimant to Decedent Wife 3,500 4. Probate Fees 177 5. Accountant's Fees Included w/ atty fee 6. Tax Return Preparer's Fees included w/ arty fee 7. Final medical bill to Carlisle Regional Medical Center 138 e. Final medical bill to Church of God Home 6,769 9. Final medical bill to Continuing Care RX 285 TOTAL (Also enter on line 9, R (If more space is needed, insert additional sheets of the same size) 7 217 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FREDERICK GRAVES SCHEDULE) BENEFICIARIES NUMBER NAME ~4ND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Judith Hess 2. Linda Dyarman RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 21-08-0471 AMOUNT OR SHARE OF ESTATE daughter 1/4 less $15,000 daughter 1/4 less $15,000 -ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ON'REV 1500 COVER SHEET 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 I $ (If more space is needed, insert additional sheets of the same size) ~ TD 5177 (November 2005) Legacy Treasury Direct www.treasurydirect.g ov 1-800-722-2678 1-304-480-6464 (Outside the U.S.) FREDERICK ORISON GRAVES 1 PERSIMMON DRIVE BOILING SPRINGS PA 17007-9704 Mailing Number: 021006287 STATEMENT OF'AC~4UNT Page' 1 of 2 rout Sife ,_ TREASURY RETAIL SECURITIES SITE P.O. BOX 567 PITTSBURGH PA 15230-0567 PHONE: (800) 722-2678 ~ay;l'geL~ incormatton Payments made by direct deposit to: MEMBERS 1ST FED CR UNION Routing Number: 231382241 Name on Account: FREDERICK O. GRAVES CHECKING Account Number: Confidential w...,,.,.,~~ ACCOUNT HOLDINGS SECURITY SECURITY SU$ :4~C(~liN~' SCH~;D. <: ~IrSIP 1ZETIVV, Total Par Nn. Par amount ` T~sue Par~hase Yields Di_ec !~o. Term' 13escriptioa Date pricel$100 Rate Rate 4latu rity Date of par (~~} l"'a) 912828EZ9 O1 60,000 03/31/06 99.801852 4.73 4 5/8 NOTE T 08 03/31/08 60,000 TRA,NcA.C'i'ION HISTORY For 03/31/2006 to 09/14/2007 03/31/06 912828CD0 03/31/06 912828CD0 03/31/06 912828EZ9 1 1/2 NOTE M 06 1 1/2 NOTE M 06 4 5/8 NOTE T 08 Security Price: Interest Payment 450.00 Redemption Reinvestment Purchase 59,881.11 I~F,h. ~':,: PAY117Ei+IT Date T'vp c' Amount 09/30/07 Interest 1,387.50 -60,000 +60,000 IF YOU HAVE QUESTIONS CONCERNING THIS STATEMENT, PLEASE CONTACT YOUR TREASURY RETAIL SECURITIES SITE AND PROVIDE YOUR ACCOUNT NUMBER Kelley Blue Book -Private Party Pricing Report -Ford, Windstar -Official Kelley Blue Book Site Ke~~ey B~u~ Buo~C TtiE 7RU5Tlt) RESQURCE a..,. m. , .~:..,_ k~L.i~ 1998 Ford Windstar Minivan E' UE ~~O~i P~1VAT~ P~~R3Y YALI~E Condition IExce~~ent ~' Good (Selected) l=air Value $3,040 $2,710 $2,305 Average Consumer Rating (70 Reviews) Read Reviews r~-~~g~~.,~ ~. ~ 3.7 out of 5 Review This Vehicle Vehicle Highlights Mileage: 64,050 Engine: V6 3.0 Liter Transmission: Automatic Drivetrain: FWD Selected Equipment Standard 7 Passenger Power Windows Dual Front Air Bags Air Conditioning Power Door Locks ABS (4-Wheel) Power Steering ,4M/FM Stereo Blue Book Private Party Value Private Party Value is what a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold "As Is" and carries no warranty (oth~=_r than the continuing factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for insurance and vehicle donation purposes. Close Window 04/25/2008 05:17 PM http://www.kbb.com/KBB/UsedCars/PricingReport.aspx?Manufacturerld...ry=6520%7c24932%7c17013%7c0%7c0%7c&Condition=Good&Printable=true Page 1 of 2 _ ~ Send to Printer Y ' ,t -~---m- advertisement Kelley Blue Book -Private Party Pricing Report -Ford, Windstar -Official Kelley Blue Book Site Vehicle Condition R<~tings ~xcelien~ _._.. _; $3, ~3~~3 Looks new, is in excellent mechanical condition and needs no reconditioning. • Never had any paint or body work and is free of rust. • Clean title history and will pass a smog and safety inspection. Engine compartment is clean, with no fluid leaks and is free of any wear or visible defects. • Complete and verifiable service records. Less than 5% of all used vehicles fall into this category. '~ GOOd (Selected) i • Free of any major defects. Clean title history, the paints, body, and interior have only minor (if any) blemishes, and there are no major mechanical problems. Little or no crust on this vehicle. Tires match and have substantial tread wear left. • A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall into this category. Fair :'_:,~,~ $2,3D5 • Some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. • Clean title history, the paint, body and/or interior need work performed by a professional. Tires may need to be replaced. There may be some repairable rust damage. Poor ~~ ~:, N/A • Severe mechanical and/or cosmetic defects and is in poor running condition. May have problems that cannot be readily fixed such as a damaged frame or a nested-through body. Branded title (salvage, flood, etc.) or unsubstantiated mileage. Kelley Blue Book does not attempt to report a value on a "poor" vehicle because the value of these vehicles varies greatly. A vehicle in poor condition may require an independent appraisal to determine its value. * Pennsylvania 4/25/2008 04/25J2008 05:17 PM http://www.kbb.comJKBBJUsedCarsJPricingReport.aspx?Manufacturerld...ry=6520%7c24932%7c17013%7c0%7c0%7c&Condition=Good&Printable=true Page 2 of 2