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Home My WebLink About04-15-09REV-1500 EX(D6-D5) Lsos6o411s8 PA Depertrnenl of Revenue OFFICULL USE ONLY Bureau of IntlMtluel Taxes County Cotle Yeer Fila Number Poaoxzaoeol INHERITANCE TAX RETURN 21 08 0890 Hem:berg, PA tTtza-0sot RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Secudry Number Dete of Death Date of Berth ~ O ~^ - V 192-34-6549 08272U08 01211903 Decedent's Last Name FRY Suffbc Decedents First Name CHLOE (If Applicable) Enter Surviving Spouse's Irrformation Below Spouse's Last Name Suffur Spouse's First Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WfTH THE - - REGISTER OF WILLS 717-233-1000 FILL IN APPROPRWTE BOXES BELOW ^ 1. Original Retum ^ 2. Supplemental Return ^ 3. Remaintler Retum (date of tleath ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. pr(or to 12-13-82) Federal Estate Tax Return Required ^X 6. Decedent Died Testate (Attach Copy of Will) ^ 7. death after 12-12-82) Decedent Maintained a Uving Trust (Attach Copy or Trust) ~ 8. Total Number of Sefe Deposit Bows ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credd (date of death ^ 11. Election to tax untler Sec. 9113(A) between 12-31-91 and 1-1-96) (Atladt Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAx INFORMATION SHOULD ~ DIRECTED TO: Name Daytime Telephone Number BRIDGET M• WHITLEY Firm Name (If Applicable) SKARLATOS & ZONARICH, LLP first line of address 17 S 2ND ST Second line of address 6TH FLOOR City or Post Office Slate ZIP Code HARRISBURG PA 17101 REGISTER OF WILLS USE ONLY N n °e ~ " . ~ o G7 ~ ~ L C,J'i J r~ C/), =7nr~ ._ C.', `~~ = i-~` i-n' N MI 0 MI Correspondents e-mail address: BMWaSKARLATOSZONARICH•COM Untler penalties of perjury, 1 deWro that I hew examined this rotum, including eooompanying schetlulee entl statements, end to the best or my knowletlga entl Dalid, it Is tme, correct aM complete, Declaration of proparor other than the penumal roprosentatiw k basetl on all information of which preparor has any knowledge. SIGNATUg~ OF PERSON RESPIXJSIBLE FOR FWNG RETURN _.- __17 S• 2ND ST•, 6TH F OOR HARRISBURG PA 17101 PLEASE USE ORIGINAL FORM ONLY L 15056041158 Side 1 eM4667 3.000 18086041188 o~ ~~ o~ ~°~ ~ ~~~ ~, 1 15056042159 REV-1500 FCC Decedent's Social Security Number 192-34-6549 DecedenYS Named R Y f U I h C .. RECAPITULATION 1. Real estate (Schedule A) ..... ................... 1. o•oo z. stocks andBonds(saa:duk:B) ..........................2. 1475789.00 3. Closely Heid Corporation, Partnership or Sole~Proprletorship (Schedule C) ...... 3. U , Q Q 4. Mortgages & Noles Receivable (Schedule: D) .................... 4. Q . 0 Q 5. Cash, Bank Deposits & Miscellaneous Personal Properly (Schedule ~ ........ 5. 6 7 5 6 5 • Q Q 6. Jointly Owned Properly (Schedule ~ ~ Separate Billing Requested ..... 6. Q • Q Q 7. Inter-Vivos Transfers & Mlaceilaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ..... 7. Q•QQ 8. Total Gras Assets (total Uses 1-7) .................... 8 l S U a S y Q Q s. Funeral ExpensesBAdministrative Cods (Schedule H) ............... 9. 50370.00 10. Debts of Decedent, Mortgage Uabilities, & Liens (Schedule I)........... 10. 111 D 2 • Q Q 11. rots) Deductbna (total Lines 9 & 10) ...................... 11. 61472 • QQ 12. Net value of Estate (Line 8 minus Une 11) ................... 12. 1481882 • Q Q 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................ 13. 1 Q Q Q Q • Q Q 14. Net Value SubJeet to Tax (Line 12 minus Line 13) ................ 14. 7 4 71 8 8 0 ^ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unn~~rr Sec. 9116 (a)(1.2)X.OLL Q,QQ 75. Q•QQ 16. Amount of Llne 14 tarmbie at lineal mteX.045 0.00 16. Q • UQ 17. Amounl of Line 14 taxable al sibling rate X .12 0 • 0 0 17~ (] , Q Q 18. Amount of Line 14 taxable at collateral rate x .15 14 718 8 2. 0 0 1 B• 2 2 0 7 8 2. 0 0 1e. raxDUE ................................... 19. 220782.00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042159 eN4easz.aoo 15056042159 J REV-1500 EX Page 3 FlN Number Decedent'sCom IeteAddress: 21 08 0890 DECEDENT'S NAME SfREETADORESS Ctl'1' STATE ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal PoverlyGedit O • OO e. Prior Payments 212 0 0 0.0 0 D. Diecmmt 10600.00 3. InleresVPenalty ii applicable D. Interest ^ . Q 0 E. Penalty 0.00 (1> 220782.00 raraedk.(A+B+q (z) _ 222600.00 Total Inlerea9Penaxy (D+E) (3) 0 • OQ 4. If Line 2 is greeter than Line i + Line 3, enter the difference. This is the OVERPAYMENT. Fill In box do Page 2, Line 20 to request a refund. (4) 8 T 8 • Q Q 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 • 0 0 A. Enter the interest on the tan due. (5A) 0 • 00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) _ 0 • 00 Make Check Payable to: IZEgSTEROFWIL.LS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a trensfer antl: Yes N a. retain the use or income of the property transferred; ^ X b. retain the right to designate who shall use the propeAy transferred or its Income; .......... ^ x c. retain a reverelonary interest; or ............................... X d. receive the promise for IHe of either payments, llertents or care? .................. X 2. If death ocwrred after December 12, 1982, did decedent transfer properly within one year of death without receiving adequate considera8on? .............................. ^ 3. Did decedent own an "in trust for" or payable upon tleath bank account or secunty et his w her tleath? . ^ x^ 4. Dtd decetlent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneflclary designation? ............................. ^ ^ X IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE O AND FILE R 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. §9118 (a) (1.1) (i)]. Far dates of death on or offer Jamuary 1, 1995, the tax rate imposed on the net value of transfere to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9118 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving Spouse from tax, antl the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only bene0dary. For dates of tleath on or after July 1, 2000: The tax rate imposed on the nef value of transfers from a deceased chiltl twenty-one years of ape or younger at death to or for use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~116(a)(1.2)]. The tax rate Imposed on the net value of transfers to or far the use of the decedent's lineal bene0dades is four and one-half (4.5) percent except as noted In 72 P.S. §9116(1.2) [72 P.S. §9118(a)(1)). The tax rate imposed on the net value of transfers to a for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. A sibling is defined, untler Section 9102, as an indivdual who has at least one parent in common with the decedent, whether by blood or adoption. 6M4ar1 1.000 REV-1503 EX «(&9a) SCHEDULE B COMMONWEALTH OF PENNSriVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE Frv. Chloe O. 21 OB 0800 All properly Jdntly-owned with dght d aurvWonhip must be disclosed on.3ehedule F. ITEM VAUE AT DAlE NUMBER OESCPoPIION „","~„ V y Exxon MObil Corp ql gqg , 2 9 Shares Fairpoint Communications, Inc 77 3 1,279.588 Shares FPL Group, Inc. 77,562 4 174 Shares Northrop Grumman Corp. 11,941 5 652 Shares PACTIV Corp. 16,779 6 558.39 Shares PPL Corporation 2q gqg , 7 765.694 Shares Public Service Enterprise Group, Inc. 31,344 8 497.399 Shares Verizon Communications 17,143 9 30 Shares Consolidated Edison PFD $5 2~g74 10 2,714.801 Shares American Century Equity Income 6 Growth Fund 66,847 11 667.292 Shares Dodqe S Cox Stock Fund 77 080 ' 12 8,060.64 Shares John Hancock G1oba1 3harholder Fund 72,304 13 674.69 Shares Janus Investment Funds Mid Cap Value Fund 1q~gg2 14 6,964.245 Shares Julius Baer Total Return Bund Fund 91,913 Total from continuation schedules 926,335 TOTAL (Also enter on Tina 2, Recapflulatlon) E 1 , 475.789 3w4ase i.ooo (It more space is needed, Insert additional sheets dthe same size) Estate of: Fry, Chloe O. 21 OB 0890 Schedule B (Page 2) Item Value at Date No. Description of Death 15 472.376 Shares Lazard Fundy Emerging Markets Portfolio 9,674 16 7,014.525 Sharea Mainstay High Yield Corporate Bond Fund 80,474 17 2,949.055 3hasea Managers Fundy Hond Fund 70,963 18 538.098 Sharea Munder Midcap Core Growth Fund 14,082 19 1,037.325 Shares Oppenheim Main Str Small Cap Fund 20,072 20 11,620.011 Shares Pimco Funds PAC INVT MGMT 3ER TOTAL RETURN FUND 123,986 21 3,895.464 Shares Pimco Fundy Emerging Markets Bond Fund 40,123 22 5,168.555 Sharea Prinicpal Investment Fundy High Yield Fund II CL A 39,746 23 11,047.574 Shares T Rowe Price Short Term Bond Fund 52,145 24 1,379.407 Shares T Rowe Price Blue Chip Growth Fund 49,217 25 2,174.845 Shares TIAA-GAFF International Equity Fund 21,640 26 5,219.026 Shares Wells Fargo Funds Short Duration Government Sond Fund 52,347 27 12,775.392 Shares Western Asset Core Plus Sond Fund 121,111 28 5,013 Sharea First Trust Dividend S Income Select C/E Port. Ser 7 32,843 29 14,673 Shares First Trust Strategic Income Adv Select C/E Ser 8 116,924 30 8,716 Shares Claymore Securities Closed-End Equity 6 Income Ser 13 69,366 Total (Carry forward to main schedule) 874,713 Estate of: Fry, Chloe O. 21 OB 0890 Schedule H (Page 3) Item Value at Date No. Description of Death 31 3,938 Shares First Trust Target 50/50 3rd qtr 08 39,577 32 100 Shares Pennsylvania Insured Municipals Income Trust 104 12,045 Total (Carry forward to main schedule) 51,622 REV-1509 EXa(9-ee) SCHEDULE E (AfrA:ON~YVEALTH OF PE~NNSVI.VANIA CASH, BANK DEPOSITS, & MISC. InUOtle me proceeds d IiOpetiDn antl the tlele the procmtla wa,e recdved by the estate. Aq tavperty 1ddlyowMd wNh fM rhht dsurvlvonhlD must W dhcbsatl Dn Sclwdule F. ~M VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Diamond and amethyst bracelet 2 Amethyst and diamond pendant 3 Wachovia 3ecuritiea Cash accounts 4 Goldman Socha Money Market Fund 5 Tangible personal property Valued at net proceeds received on sale by Rowe's Auction Service 6 Refund of Investment Consulting fee 7 Sovran Self-Storage Refund 5,050 3,762 37,756 20,185 152 205 455 TOTAL (Also enter on Tine 5 Recaodulalbnl S I 67 565 9waEAO t.op9 (If moro space ie needed, insen eddidatal sheds d the same siu) REV-1511 EX+(1606) SCHEDULE H FUNERAL EXPENSES 8 ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Frv. Chloe O. 'I OS OBo Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPftON AMOUNT A. FUNERAL EXPENSES: ~, Myers Haraer Funeral Home 2,884 2 Rolling Gsean Cemetery 895 B. 1. ADMINISTRATNE COSTS: Personal Represenlathe's Commissions Name of Personal Represenmthe(s) Street Address City Year(s) Commission Paid: State Zip 2. 3. Attorney Fees Family F~mption: (if decedent's address is not the same as daimaM's, attach explanahon) Claimant 44,000 Street Address City State Zip Relationship of Claimant to Decedent a. Probate Fees 960 5. Accountant's Fees 6. Tax Retum PrepareYS Foes 900 7. 1 State Employees Retirement System 57 2 The Sentinel 175 3 Cumberland Law Journal 75 Total from continuation schedules 424 TtlTAI /Also nnfn.M Onuo oe...,.a~. a..a~. . __ ___ ~waaAG 1.000 to more space is neeaec, insert adWaonal sheets of the same size) Estate of: Fry, Chloe O. Schedule H Part 7 (Page 2) 4 5 6 7 8 9 10 Americhoice FCU LISPS Morrow Jewelry Expedited Delivery Fee Goldman Sacha Redemption fee Register o£ Willa Skarlatoa S Zonarich, LLP 21 08 0890 47 185 105 8 8 55 16 Total (Carry forward to main schedule) 424 REV-1513 EX ~ (12-0~ Pennsylvania SCHEDULE I OEPPRIE¢Nr OF REVENUE DEBTS OF DECEDENT, rJERRANCE TAX RETURN RESOENf MORTGAGE LIABILITIES & LIENS OECEDENr ESTATE OF FILE NUMBER Fry, Chloe O. 21 OB 0890 Report debts Incurred by the decedent prior to death that remained unpaW at the data of death, inclutling unretmbureed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION _ OF DEATH t~ Mobile X-ray 2 Messiah Village 3 ~Linka2Care 4 Alert Pharmacy Services, Inc. 5 (Paul D. Dalbey, DPM 38 7,662 3,221 123 38 aW08AH 1.000 It more space is needed, insert edditicnal sheets of the same size. REV-1513 EX+(11-09) pennsy~vania SCHEDULE J OEPARIEEMOF REVENUE BENEFICIARIES INfRRANCE TAX RETURN RESIOEM DECEDENT F}v. ChT ne n FILE NUMBER --- -'- 21 0 8 0890 NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUf101JS pntlude ouuipM apouad tlieMbuliOna, end tranalme under Sec. 2116 (a) (1.2).) 1. Geraldine F. Howard 101 Millfording Rd Mechanicsburg, PA 17055 Two Thirds of Residue: 945,380 Niece 945,380 2 Leeta Fickea 511 Center Road Newville, PA 17241 General Bequests: 5,000 None 5,000 3 Jane Brown 8 Frances Drive Harrisburg, PA 17109 General 8equeata: 2,500 None 2,500 EN1ER DOLLAR AMOt1M5 FOR gSIRIeUTIINJS SHDWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APPR OPRIATE. II NOPLTAXABLE DISTRIBUTIONS: A SPOUSAL DISTPoBURONS UrDER SEC710N 2119 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B CHARrFABLE AND GOVERNMEMAL DISTRIBUTIONS 1~ 3ee Attached TOTAL OF PART II - ENTER TOTAL NON-TN(ABLE DISTRIBUf10NS ON LINE 13 OF REV-1500 COVER SHEET. If more I E 10 , 000 B W46AI 2.000 space s needed, Insert adddlonal sheets of the same size. Estate of: Fry, Chloe O. Schedule J Part 1 (Page 2) Item No. Description 4 Clair Lewis 416 Herryhill Road Harrisburg, PA 17109 General Bequests: 2,500 5 Gordon Fry 227 N. 19th St. Camp Hill, PA 17011 General Bequests: 5,000 6 Doris Domask 4327 Greenwich Circle Sacramento, CA 95823 General Bequests: 15,000 7 Robert Wachtman 8110 Chambers Hill Road Harrisburg, PA 17111 General Bequests: 5,000 8 Cindy Orris 225 N. 19th Street Camp Hill, PA 17011 General Bequests: 5,000 9 Jennifer Hensley 216 Windy Hills Drive Wilmington, NC 28409 General Sequeata: 5,000 10 Nancy Wagner 3568 W. Mango Circle Tucson, AZ Amethyst and diamond pendant Inventory Value: 3,762 None None None None None None None Relation 21 OS 0890 Amount 2,500 5,000 15,000 5,000 5,000 5,000 3,762 Estate of: Fry, Chloe O. Schedule J Part 1 (Page 3) Item No. Description 11 Valerie Peres P.O. Box 773690 Steamboat Springs, CO 80477 Diamond and amethyst bracelet Inventory Values: 5,050 Relation 21 OB 0890 Amount One Third of Residue: 472,690 None 477,740 Estate of: Fry, Chloe O. Schedule J Part 2S (Page 1) Itam No. Description 1 Unity Church 927 Wertzville Road Enola, PA 17025 Cash 10,000 21 08 0890 Amount 10,000 oszsooosssasz2 ~ ~Y• OI W N ~~y~~ NO~~~ ~aN~a ?LLLLQ j '!. y~, S J~ a _ ~ ~ ~ _ O - to ~ _ 7 _ ~U _ ~ = O w M 6 N ~ ~ ~ ~ O N 'O ~ C 7 ~ O Q O N 'C N O'y ~~ Uc`o <,. Skarlatos~~-~~:~ar~ ~.~-~ LLn Sound Advice. Smarter Decisions. 17 South Second Street, 6'" Floor Harrisburg, PA 17101-2039 717.233.1000 Voice 717.233.6740 Fax www.ska rlatoszon a rich.com Sharon K. Shaffer, Estate Administator s ha ron @s ka rlatoszo na rich.com April 14, 2009 Office of Register of Wills Cumberland County Court House One Courthouse Squaze Carlisle, PA 17013 RE: Estate of Chloe O. Fry To Whom It May Concern: ~ 0 O aqe ~ :~ ~ „ c a ~~d ~v5~ ul ~ ? ~~' oc z r7 Enclosed for filing is an original and one copy of the Pennsylvania Inheritance Tax Return and Cumberland County Inventory. Please time-stamp the extra copies and return to me in the envelope provided. Also enclosed is a check in the amount of $30.00 representing the filing fees. If you have any questions or concerns, please contact me. Sincer~e~ly~, ,,,y /C,Gr//v'C./ Shazon K. Shaffer Estate Administrator Enclosures A Member of LawPactTM - An International Association of Independent Law Firms