HomeMy WebLinkAbout75-0355-, . __
~ ~ , -~ `~ ~ ' ,~ 5 '~
.,
®PNCA~v~soRs
June 21, 2002
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013-3387
RE: ESTATE OF LEONORE S. MAHAFFIE
Date of Death.: 06-02-19?5
File #21-75-355R
Dear Sir or Madam:
Enclosed herewith is a check in the amount of $10, filing fee for a PA Inheritance Tax
Return Resident Decedent on behalf of the above referenced estate.
Please acknowledge receipt of this letter by signing the enclosed copy and returning it to
us for our files.
Very truly yours,
~, ,
~~ .
Michael A. Maloney
Assistant Vice President _j
Enclosures
A member of The PNC Financial Services Group
T~~~o P'vC plaza 620 Liberty Avcrue Nitt,i~urq{~ P~. ~~ti~~vania 1222
s*a+s*~YrFiPsi«
` f ~~o
~ '
M o
~i ° a
eta
~~~ ~~~ S M
~ ~' Cp
W _
' ~ • ~~
~* w . _.
O cy
~ o
N
~ N
~ ` ' ~ _r
~ r L
L
!~ ~ aSYk! 1Sl~ U ~ M
1 ~ T~~.IYOS~EM ~' ~
` ,r' C~~
~ _y ~ ~ O
~ ~U C~
~~ C ~=a
~ L ~ ~ a
~,; Gs O Cs
~~ to .Q U to
T .~ ~ C •L
~C)OU
~~
O t
~ C7 ~
y ~
7J -fl
v
1 i d
v
N v
ca ~
c
'u ~
~ .._ ~
c
LL i
U ~
~ z
N a o
~. /'~ GJ N
O .C ~
^ F
O ~
V I ~ ~
1 ~ y ~
~ U
z N
GJ n-
E o N
Q h- ~
~z
0
~~
~~
N
LL
'_
.~,
r
:.~
.w`
;.Y
:-'c
i
r"'
r L~~ r ~ COMMONWEALTH OF PENNSYLVANIA
BUREAU OF INDIVIDUAL raxes DEPARTMENT OF REVENUE
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 171za-o6o1 NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 E% RFP (D1-027
DATE 09-30-2002
ESTATE OF MAHAFFIE LEONORE S
DATE OF DEATH 06-02-1975
FILE NUMBER 21 75-0355
COUNTY CUMBERLAND
BRUCE W HAUBRICK ACN 102
620 LIBERTY AVE
Anount Remitted
P2-PTPP-10-3
PITTSBURGH PA 15222-2705
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t
----------------------------------------------------------------------------------------------------------------
REV-1547 EX AFP (01-02] NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF MAHAFFIE LEONORE S FILE N0. 21 75-0355 ACN 102 DATE 09-30-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: REMAINDER RETURN
1. Real Estate (Schedule A) (1) .0 0 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fora with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00 tax payment.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) 132,646.79
8. Total Assets (8) 132, 646.79
APPROVED DEDUCTIONS AND EXEMPTIONS: .00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions (11) .00
12. Net Value of Tax Return (12) 132,646.79
13. Charitable/Governmental Bequests; Nonelected 9113 Trusts (Schedule J) (13) 132,6 46.79
14 Net Value of Estate Subject to Tax (14) .00
.
NOTE: if an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Anount of Line 14 at Spousal rate (15) • 00 X 00 = . 00
16. Anount of Line 14 taxable at Lineal/Class A rate (16l .00 X 06 = .00
17. Amount of Line 14 at Sibling rate (17) • 00 X 00 . 00
18. Anount of Line 14 taxable at Collateral/Class B rate (18) •00 X 15 .00
19. Principal Tax Due (19)= .00
rwrnen i Rc~.cir ( Y~J6VV~. ~ AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
O RFFI1Nn_ SFF REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
Rev-15eaex,rroot
COMMONWEALTH OF
a 5 O O ~ OFFICIAL USE ONLY ,~`"
~~
-~
PENNSYLVANIA !,, ~~ _ ~~~ ~ :
-
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER
DEPT. 280601
"
RESIDENT DECEDENT
5 R
g
-
S 3
"
HARRISBURG, PA 17128-0601 -
ER
COUNTY CODE
YEAR
NUI
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
W LEONORE S. MAHAFFIE 178-16-5072
~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
V 06-02-75 REGISTER OF WILLS
W (IF APPLICABLE) SURVNING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
D
RALPH MAHAFFIE 204-03-6373
w ~ 1. Original Return ~ 2. Supplemental Return XQ 3. Remainder Return (date or death prior to 12-13-s2)
~ ~ Y ~ 4. Limited Estate ~ 4a. Future Interest Compromise (dace of deatn after 12-12-e2) ~ 5. Federal Estate Tax Return Required
w4.U
_ ~ ~
V
Q 6. Decedent Died Testate (Attach copy of Will)
~ 7. Decedent Maintained a Living Trust (Attach wpy of rest)
8. Total Number of Safe Deposit Boxes
am
9. Litigation Proceeds Received
~ 10. Spousal Poverty Credit (date of death between 12-31-st and 1-1-ss)
~ 11. Election to tax under Sec. 9113(A) (Attach sch o)
~ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
w NAME COMPLETE MAILING ADDRESS
z° BRUCE W. HAUBRICK 620 LIBERTY AVENUE
FIRM NAME (If Applicable)
PNC BANK P 2- P T P P -10 - 3
w
o
TELEPHONE NUMBER PITTSBURGH PA 15222-2705
~ 412-762-9347
1. Real Estate (Schedule A) (1) -- OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Properly (5)
Z (Schedule E)
~ 6. Jointly Owned Property (Schedule F) (6)
Q ~ Separate Billing Requested
J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) 13 2 , 6 4 6. 7 9
lSnc~rlulo (; nr I 1
r
a
Q
V
W
8. Total Gross Assets (total Lines 1- 7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 810)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(11) 0. 0 0
(1z) 132, 646.79
(13) 132, 646.79
(14)
0.00
SEE INSTRUCTIONS FOR APPLICABLE RATES
0 15. Amount of Line 14 taxable at the spousal tax
~
a rate, or transfers under Sec. 9116 (a)(1.2) X .0 _ (15)
-
i 16. Amount of Line 14 taxable at lineal rate X .0 _ (16)
f1 17. Amount of Line 14 taxable at sibling rate X .12 (17)
U 18. Amount of Line 14 taxable at collateral rate X .15 (18)
19. Tax Due (19)
~ 20. ~ CHEGK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> >'BE SURE TO ANSWER ALL QUESTIONS ON RE1/ERSE'SIDE AND RECHECK- MATH
(8)
132,646.79
STFPh42021F.1 - ~ __-~
Decedent's Complete Address:
STREET ADDRESS 206 W. MAIN STREET
CITY S H I REMAN S T OWN STATE PA ZIP 17 011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2)
3. Interest/Penalty ifapplicable
D. Interest
E. Penalty
Total Interest/Penalty (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 1 Line 20 to request a refund (4)
5. if Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
(1)
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56)
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: Yes No
a. retain the use or income of the property transferred : ........................................ ^ ^
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 "intrust 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.
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.
RETURN
ESPONSIBLE FOR FILIN
G
R
SIGNATURE OF PERSON DATE
I
~
^
~
pn1c. ~o.-k-• "',v HIV\,lt.~fvAA ~ Ir~ r/Vta,~r•~-~ 6 ~b~~ 2
ADDRESS ~
6 20 L b~,~ ,,,~ ~ PA ! 5 2 Z-2 - 2?v Y
SIGNATURE OF PREPARER OTHER THAN REPRESENTATI E DATE
ADDRESS
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 3%
(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 0% [72 P.S. §9116 (a} (1.1) (ii)].
The statute does not exem t 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 t e 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 0% [72 P.S. §911ti(aX1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, 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 12% [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.
STF PA42021 F.2
REV-1510 EX + (1-97) (I)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
LEONORE S. MAHAFFIE 21-75-355R
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF TFE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE
OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET °!° OF
DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE VALUE
~. PNC ADVISORS, TRUSTEE U/W OF 132,646.79 32,646.79
LEONORE S. MAHAFFIE DTD 01108/74
VALUED AS OF RALPH MAHAFFIE DATE
OF DEATH OF 03/07/2002
(SEE ATTACHED VALUATION)
TOTAL (Also enter on line 7, Recapitulation) ~ $ 13 2 , 6 4 6. 7 9
more space is needed, insert additional sheets of the same size)
STF PA42021 F.11
a
.~
c
~
a ~ .n ~ w
a 0 0
N c ~
~ ~' c
M ._.tt1.. j M
C
au
r
H
W auy~
a pY
°' , a
H '~
Y
W
~ O
u
~ H
W
N
r
n
~
~ ~ N
~
H
~
N ~ .
-~
N 1
S a
0 N
~ ~ ~ ~
~
`s ~ M
M
a, r
m 'n
o N
.D ~
0`
S
M
°o
H
o °'
s `j!
~ ~
H ~
M
N
o °° o
rA m o o~
o o
o ~ s c ° ~
Vr M S ~,j M
s"~ ~ J .dip ~ H ~
~a
~~
u
Z ~
W O ~
~ '~ ~
r
N
W o
7 y~,t
2 \ W ~
o~c J
H Mo tHi. ~~
W
6
u. o a
a a ~
Y ~
d' 2
4 W
~ J
L
7
M
0
c0 a0 a °
rt1
o
~ N
~
• o
1 ~ M r~
r+
0
.c N m
r ~
p ~
N
' 3 ~ ~
c 1 ' N
M ~
H
N
m ~
to o:
o Q'
~ ~
a., r
,t
0
O
a
O
o'~ ~
~ r
a `O
~ S
0` ~
N
rM+
T N
r v
a
~
X "'
E
O W
U1 on
W
N
{
W
~
W
H ~
O
N
M
t11 Z z
W H Z
W
N
Y° N Z
Z w ~
"' G
~ U NW
7N 1~/1
~
7N G J ~J 4 H H Ham' H
u~
4rj V ~ U~
d H
J
a N
~ H d
4 WH
U J
~
O
.
H W O r
H 1
u Y
z O
~"
H N H W o
7 Y ,
.,
~ u w
O.
0
V
~ ^ N
y N O
0 111
yr
H
~ J p D ri tO 10 N
C
O Ii M r
i
H H X I ~ l
M d 6
o O ~,,
N
W
U'
¢ r c0 W H o~ 0 0 0
~, a C o o ~o o~ .e o 0
r U .7 ~t 1 0~ .t o o ,.
~t S N O~ N O o
M M 111 O~ t11 0 0
V S N ~ M M
M
O
Z OO 1p lit 0~ S O o
H W O O 0~ O~ O~ O o
d> M M S O~ J o 0
U
S S O~ 1ll I11 M M
M N ~O
rr
d W
Y ~O ~0 l~ ~ ~O
I
a a .-i .a 1n In ~
J S
r
~ c o 0 0
. G ~ I ~ N ~
y W W M
r ~
EO N '-1 M
(
.i
= H Z
r H
W W
~
r
r p~ N N M H I u1 ~1 N
y \ ~ (
M M ( N N
W ~ N .i I S
O O
O S M n 111 h
H o X~ ~7 S M o M ~D T
\ W C J ~! S '~ 10 ~7 t0 h
M M ¢¢ M M ~O N O~ M 10
o LL E> S S M N
LL li ¢ M N ~
O O Q
y E
¢
r y
z W
~
W
W 2 r
r
L o 0 0. O o
W Y o- o S O •i tll
W J C o M N 0~ ~t
r r
S ,.~ o~ o .o N
Z e-1 ri H
¢ ~
r
y
O
H
J
O
li r
C N O N
N N N
J¢ ¢ OQ O.¢
OJ OJ D_J J
E LL.U HU U YU
E
C J O J r J H J
CV1 O.Z h-Z W ~Z aZ
~1n O CO X a0 WO
~y y¢ OH OH H WH H
111 ¢J y Zr o_r u. r xr
N W U r O 7 ~ W 7 r~
C Z (nCOr yWr I yOr y3r
,.~ rJ W A H C]EM GJH OOH
N Z ¢ J ZWr ZOF- y Z¢r ZKr
M F-O 1AZ d ~r1n ~UVf O »1n ~C9y
I Z y{ ~ O > li ¢ Z Li Z Z Z lL 2 4, Z
I~ WF-' H H HH HH ~ T 1H D-H
N Ed Yr ~ A YO Y W r Y¢ Ys[
F-o F-H U~ a W UWO UGM H UU~O UUM
Z I yC OrN W X O SO~ O WH J ~ O ~7 O Q~
7f~ WU C'MO H COS C1.9 a a CJ CJ
ON >V7 y Yr3R = LL YW[] Y¢C ~ W YJG YJO
U I ZW r Uy v1 UrZ UZZ 1- U¢Z U6Z
U~D H O Z ¢ Z G d I a Z O 6¢> > I ¢ S O ¢ S O
d 'i W J H 1L U J H LL, J Z L~ E J y 1i J y li
J L] O y KI i0 y CO St0
> H o 4 Z O ~O 6 Z h M
W H LL 00 r O 111 I~ F- O ~O O
~ y ~ H O O ti tll r-1 O LL. N M
r r
W
>d ¢ J d M 1l1 6 O M
S 2 J M 7 •-1 ~7' 7 N N
y S S N
a. U O L S
t~
V
t~
l
Q
~ `~ N N
N
~
s aD
o o
~ ~ N ~ H V
~ t
tl
~ N
~ to N
~ ~
tMts~ t0 N ~ N L
1
°u ~ ~
.7
s15 Q 4
~ r
O
M
~ o o ~
0 0 0 0
0 0 0 0 0
0 0
0
'
O
O O O O C O
O ~ ,
C.
r u O O O
O O
~
Q• ~
O ~ ~
~ ~
`r O
O O O
p
0 0
O O 0
O O
O
O O O O
O O O O
G O O
O
~W ~
7 O O O
N H
o O p ° ^ O r1
°D
y
0
as a °o 0 0 .,
o tin ,n s
u a
'~
~
M ` M
6Y ~ ' hH-
'O
N
O"t
J Z N ' N N
h H
Y
H
W W
S
to
r ~ U
NH N
N l N
s
Z ~ N .n ~ I `o °.
W
Z ~
O~ ~ o ~
~ M
M r~
M
S N
N
Y '`' a M N N ~
S
, aD N ,N.~
W ~ ~ p
~ ~ H ~ ~ N N N rNi
N r s o o
O co H
Z o W ~~ ~ o M ~ ~
fi H
H M W Z9 ~
o ~
a
0 o a
tH
L O
o
Q N1 N Q.
r
Z W W
ao H
r O O
o o ~ ~
a ~ tt? r1
~ H
W y ,
,,, a
W ~L 0. .
~ ~`; o N H
W Z
r ~
4
r
~
H G a
Z u
N
u. ~ J
pU1 sLL..N yOp yyt
C3 4 HZ
U w
A ~ ~
a~ av
~
•
a a
W
W - i
u
j u.
W J
dr W= N j QZ O ~d q
H per[" ~ H
~p - ~~„{ Z
NW7 pYr =V KV N r
H
~
~-
N H
W
H 4 ~ H 6.
ti •..
D
; Z ~ s
C
" Z ~ y u.. ~
F tti Y W it G ors
N Z
~
~H
W
Y
1 '"
`t H J1W2 s4
H
~` y
-
r ~G
I
.~~-
Y=
,tea. uo-'r' Oar' 7r ~a
M p
~ '`r> >
Z p
7 O
''~a
" V
Z
c aVA S~ pO
r~ OE
p
O
~ ; S ~HW A
' G
O
H H
W
O N
U 1 .. Z A N
7 W v µ~ a
u
Zu. ~Z H
z
A J P H r
4 Z M O r
~. ~
t
H r
a °+ J
r
.1
°°
~ "° ° " m r Q ~ ~
o
~?
M N M r ~
4 o
U
H
O
N J
~ H
Z
6a M ~ ~ ~ L
~ ~ M
aN
Q
tL
r
N N N
~
Z u N
~
4
a
,., c~ r
M a
0
a, ~ ~
~ ~
G F ~ ~ ~ ~ ~
~ .t M
M rt
r~
t9 O~ C ~ ~
a?
Z w ~?
~ c ~ m
~' ~ f `
4 ~
4 7 ~ M
M
U e
•+
,.~
4 ~
~O ~ N
~~'~
6
AS
Y ra
,n{r
~
~
~ ~ ~
~ ~y M
/~ "= U
p. H H
r
z ~
w
w r
L w
LLoa r
r ~~
N
W ~
~ o
Z o y' J T
H M H 47
o u. ~
a
c o a
~ x
a ~
F^' w w
2
w O w W o
~ J 4 H ~
w ~Z
r ~
a
r
N
~r ~~
0
4
~", ~
d,, T N
~~ r ~
o ~ ~
.D
~' N
M eM^~
H
U
~~ r Q
4
N
.O
~ Q U ~' ~
W I.. ~ N
4
r r 4 yi Z °~
M cn~ y H
rH ~H ~ A x
N
I
N Wr ~r w w ~
Z
p w~ °~~~y ~
H
6
pµ
Z uxi
~ '= 04.
a
~
V~ ,
.
w
µ p ~ y.~ tt. J
N V
V Z
6µ 6 j
Z J a
o.
w ago O ~"{ N
J
~ a o,
x r
° ~
a ~"
aN
a
o-
W
rl
N
0
r
Z
W
Z
W
6
z
4
E
f-
z
w
Z
3
0
A
z
W
r
Z
W
S
W
r
a
r
N
r
Z
0
u
cs
v
z
a
W
J
0]
Q
r
H
K
a
x
u
N
0
0
N
M
}
Q
s
x
0
C
F
N
d
0
N
0
a
a ~
0
M
LL1 A
M ~
~ O
Z
Q
~ ~
a o'
W W
K ~
2 Z
O
6
a
r
Z
H
a
6
Z
7
a
U
u
a
W
z
O
H
J
O
LL
a
O
o.
0
M
N
O
O X
O W
O A
~.{ Z
p H
O C
~ LL
o G
f ~
~ O
~ O
F"' t11
~ 0.
O ue
u
Q N
X
W
U H
W 6.
H R
0
0
4 W ~
a a
W ~
Z
U' H
of
H
I
N
0
y
z
0
H
F-
U
a
y
Z
Q
d'
F
LL
O
a
£
£
y
N
0
H
M
0
S
U'
7
O
C
S
H
N
0
H
0
0
H
W
CD
6
a
X
W
q
Z
H
Q
ti
q
a
oD
y
M
N
0
0
H
0
Zo
~ rl
U ~
Q e-1
N O o 0
W O O O O
6 rl O O O
q\
F O
Q
W ~O
Y T
N
N
r~i
N o 0 0
0 0 0 0
ra c 0 0
J M
Q \
H ~
O o
F
I
N
0
H
0
0
e 0 0
~ 0 0
J 0 0 0
a
a.
H
U
Z
H
6i
a
~ 0 0
c 0 0
W 0 0 0
£
O
U
Z
H
J
Q
a
H
H
Z
w
H
Q-' W
d F..
Q
Z N
Q
F
~ Z Z U Z J
q ~
~ £ H M
£ QF
- F
y W y U \
o {- a y y Z I- y H Z u1
C
W W F> > O W H ~ W y
> > y Z Z U W W pq £ W
J Z W H H U 3 U y y W W ~
Q H C QHW 1- y yH y U' J
> w£ £ wz a H qZq ~ z a
Z HO O Oa0 H Z WO ~ Q >
f- O ZC C' H 2 W W U' HS CO S
W y HtL ti yy U £ CF-y y U H
Y q qF- yK6 W W Q~Q H W
C W ZygW W FWU d' y SOU q W Y
Q Z WWW£ £ HY.. C' UH 7 C
£ a' OCOO O yyR 2 O CC = J Q
Q H W C' U U O Z W y pA y H W y Q £
y w >F-uz z aax a y Wyx a >
7 HZUH M Wd'F U H WHH U (-
~ ~ qHQ qH0 q wq0
~ J J J W W
~ Z F O O Q p Q p
a H o t- -- U ~ £ U
V e
,o
V I
X
0
0
n
0
~O
N
t`
r•1
N
M
n
N
O
N
~O
N
~]'
n
lL \
O CO
3 .\i
~ C
F-
W C
W
H W W
N M M
~ LL W
~ W W
r==
~QQ
Z £ £
Vi S
OQO O C
Z
U O O
ZWG~
d J W
0
w
>
W '• W \
NN OCO
J a' \
WO Sri
W N ~ \
H W 7 C
N>O F-
Q ~ W C
U
K H W W
OZOO ~4. LL.
N
£ O F Q Q
ONJ
~QQ
6 Z £ £
LL >
Z Y {n =
~
W
£ 2 W J
MCI- CiO d'
a~a z
CiUF ZWLO
02 CJIi
H N
2 W
O Y U
M Q M
!-£>
a z
£ (n W
C'WN~
O U O
LLCl~Y
Z ~ Z
N O H O
N U F
N N
Z W C Z
H N a O
Q W N
I-2CF
ZI-ZQ
O Q U'
U M
•NJ
FW£Oq
Z J ~ O
WODH
£QLL.J
W H 6
F-JW~
awt~l-
Fa'QU
N ~ 6
wwz
NOOYF
M O Z
2 O C O
F-HmU
REV-1513 EX + (g-00)
SCHEDULE J
COM NOHERITANCEOTAX RETURNANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
LJ±,VLVVLCJJ J. L1L-~tLHr r lr., ~1- I `J-355 R
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
1.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIA TE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDERSECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
2
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1• HOLY SPIRIT HOSPITAL ATTN: KARL WALTMAN
503 NORTH 21ST STREET CAMP HILL PA 17011
33,161.70
2 SEIDLE MEMORIAL HOSPITAL C/0 PINNACLE HEALTH
PAUL BROWN VP GIFTS & ENDOWM.
P.O. BOX 8700 HARRISBURG PA 17105 33,161.70
3 VILLA TERESA NURSING HOME DIANE M MACK ADMIN.
1051 AVLLA ROAD
HARRISBURG PA 17109 33,161.70
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(SEE ATTACHED) )
(It more space Is needed, insert additional sheets of the same size)
STF PA42021 F.14
REV-1513 EX + (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LEONORE S. MAHAFFIE 21-75-3558
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers
under Sec. 9116 (a) (1.2)]
1.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIA TE, 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
4 THE COLLEGE OF NEW ROCHELLE MEIGHAN CORBETT
DIRECTOR OF PLANNED GIFTS
29 CASTLE PLACE NEW ROCHELLE NY 10805 33,161.69
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 13 2 64 6 . 7 9
(If more space is needed, insert additional sheets of the same size)
STF PA42021 F.14