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Home My WebLink About06-04-09J 15056051047 rr... REV-1500 EX ((Hi-OS) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280501 ~ ~ 09 ~a 9g Hardsburg, PA 171280601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW -.....-..____._..____. Social Security Number Date of Death Da te of Bi rth / ~~ n 4 + Decedent's Last Name Sutfix Decedent's First Name MI +<~(~ ilk tf 7 ~ "` r )) jj (H Applicable) Enter Surviving Spouse's Informatton Below Spouse's Last Name Suffix Spouse's Social Secudry Number FILL IN APPROPRWTE OVALS BELOW ~ 1. Original Retum O Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Rehm Required death after 12-12-32) O d. Decetlen[ Otetl Tes[ate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposrl Boxes (Attach Copy of Will) (Attach Copy of Tmst) L~ 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) behxeen 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST 8E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Dayfime Telephone Number Finn Name (If A licable) pp REGISTER OF WILLS USE ONL`f-~ First line pof address fi ,, f_- Second Tine of address Ciry or Post Office ~ ~ 0 Er,z4 Correspondent's a-mail address: fate ZIP Code I-- I `7 ~a ~- Under penaltles of perjury, I Declare that I have examined this return, inclutling accompanying schedules and statements, antl to the Vest of my knowledge and belief, it is W e, correct and complete. Declaration of preparer oUer than the personal representative is basetl on all Info_mretion of whk:h ~__ _ preparer has any_knowledge. S`~NATUFjS~G PE ON RE~fON~$J~L,~OR R,INGN~hN' /~ DATES /r /mot LY ~P OF PREPARER OTHER THAN REPRESENTATIVE ADDRESS PLEASE YSE ORIGINAL FORM ONLY Side 1 15056051047 DATE FILED 15056051047 J J 15056052048 REV-1500 EX D~e(cedent's SoG)al Secudty Number Decedent's Name: / ~ ~l ~ / ~ ~ 1~0 _-. ~~ ~..,.._...._.~._~....,-_. .~...___._.,--_.........W..___._.._~..__.._ RECAPITULATION 1. Real estate (Schedule A) ........... ............................... ... 7. _'.--'`~.- 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) ..... ... 6. ~ /( ~ ( ; , ~ 6. Jointly Owned Property (Schedule F) Ca Separate Billing Requested .... ... 6. --- 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested..... ... 7. _ _ _~ _ , 8. Total Gross Aasets (total Lines 1-7)......... . ,.' ,C .. '' 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 3 .5 .j ,~ ~~--' 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. -~"'~-- 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. .~1 ~~ „} ,; ~ 12. Net Value of Estate (Line 8 minus Line 11) ........................... 12. ... ~' 3 3 ~ :~ ~ '`a ,. ~' 13. Charttable 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. ~ ~ ~ ~ ,(_._ (` TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ~~~.a 4_._.~ .....,...,_.....n_"~-~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ . 15. 16. Amount of Line 14 taxable at lineal rate X .0_ . 1fi 17. Amount of Line 14 taxable at sibling rate X .12 1 ~ 16. Amount of Line 14 taxable at collateral rate X .15 18 . 19. TAX DUE ....................................................... .. 19. ~^_. .~. f 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ,_v Side 2 15056052048 15056052048 J REV-1500 EX-~ Page 3 Flle Number ueceaenT~s complete Adtlress: STREET ADDRESS - __ __--- ---- --.___ --... - _- _. ~L L ~ w~' l ~~ ... X~ i clTV _ _ ___ --- -- ~ ~ , ~„ l STATE ZIP ~ - _-~- -- , < /t )ca 111 " t ~i'~'tf ,'~"~ / ~~/~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount - - 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) Total InteresUPenalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill In oval on Page 2, Llne 20 to request a refund. 5. If L'me 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) (4) (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 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 Nansfened :.................................. b. retain the dght to designate who shall use the Property transferred or its income : ..................................... ....... ^ t.. c. retain a reversionary interest; or ................................................................................................................... ....... ^ Q d. receive the promise for life of either payments, benefits or pre? ................................................................ ...... ^ ~' 2. If death attuned 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?....._. ...... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or oihernon-probate property which contains a beneficiary designafion? .................................................................................................................. ...... ^ ~/' 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 j72 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)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 still applicable even if the surviving spouse is the only beneficiary. ' For dates pf death on or after July 1, 2000: The tax rake imposed on the net value of transfers from a deceased child twentyone years of age or younger at dea0t 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 ra~ 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)j. The tax rat$$ imposed on the net value of transfers to or for the use of the decedents siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 91b2, as an individual who has at least one parent in crommon with the decedent, whether by Mood or adoption. RSV-7591 EX+(10-OB) scNeou~E x COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8r INHERRANCE TAX RETURN ADMINISTRATIVE COSTS RE3IDENT DECEDENT ESTATE OF n yl/ ~,/ ~- _ FILE NUMBER ° ~ ~ ~- l ~/ _~-! ("fl /' ~ ~ ~ ;cam ~< :;- , Debts of decedent moat be rooorled on Schedule i. ITEM UMBER DESCRIPTION AMOUNT I~ A. t FUNERAL EXPENSES: ~/~,y ~(,~r~ ~ YI"/r /~~ ~El~/ B. ADMINISTRATIVE COSTS: ~Ci'~_ ~` ~ %"C"'f~~J`+ ~f ~'ft ' 1. Personal Represente8ve's Commissans ~ ~~.J? ~ ..~ -. ~~~ = ~ f ., ,/J 7 Name of Personal Representadve(s) ______ ----- _-__ _ Street Address ~~~~'"`- ---------j----- ------ - Ciry State Zip --.____- Year(s) Commission Paid: 2. Attorney Fees /!/- 9. Family Exemption: (If decedent's address is not the same as claimant's, attach ezptanatbn) Claimant ----- Street Address city State Zip ------_ Relationship of Claimant to Decedent 4. Prebete Fees --~- 5. Accountant's Fees -""`- S. Tax Return Preparer's Fees ~---- 7. TOTAL (Also enter on line 9, Recapitulation) E " ~~ ~~ RECEIPT FOR PAYMENT GLENDA FARMER STRASBAUGH Receipt Date: 3/30/2009 Cumberland County - Register Of Wills Receipt Time: 13:20:42 One Courthouse ScTUare Receipt No.: 1056275 Carlisle, PA 17013 WEAVER RUSSELL K ate File No.: 2009-00298 d By Remarks: JUDY K NEUMAYER CJ Receipt Distribution ee/Tax Description Payment Amount Payee Name ILLTION LTRS TEST 20.00 CUMBERLAND COUNTY GENERAL FUN 30RT CERTIFICATE 15.00 8.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN P FEE 7TOMATION FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN zeck# 145 $58 00 ~tal Received......... S . 58.00 a=v.~so6a.l+on COANIONYYEALTN OF PElmsvtvANIA INHEPoTANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. r f. ~' ~"` / h0.E NUMBER ~C~'`1' , . ' !" the pmoeeds of Mgedon end the de0e the praoeeds wem received hY dle eNale. All PrePMY 1~Y~'+ned wNh 1M rlpM of turvNorsUlp must M dbebsad on tiCAedele F. I EM NU BER VALUE AT DATE DESCRIPTION OF DEATH I ~`° ~` , ,f , ~` _ ~~~„~ _. ~ . ,//v =_~ . ~ , , ~,~~ ~ ~~~l !, `>• ` TOTAL !Also enter on line 5. Recaoilelaatieon) ~ S -*d ..'~r }` ~ ` ~~~ ~~ i ~, acre Stare Farm Muluai Auromobib Insurance Cowry One Stare Farm Q ConmWAre PA 19939 MAR 1 RE: Pc The ff you 2623 5 56S OF WEAVER, RUSSELL 5T OWN PA 17011-6515 3. 2009 - _ -- -- hcy Number: 688 6045-618-381 Fund Amount: """73.33 refund is a result oT the termination of your policy. any questions, please contact your State Farm agent. Service 1 Rev. 07-01-2002 (o1bOrOib) ooua AGENT ROCKY RADABAUGH 1223 BRIDGE STREET NEW CUMBERLAND, PA 17070-1670 (717)774-2517 39477-5-S w ° o ~~- ui ain•°r r?`w °°¢o N~ ~yo ¢~roo ~o •ao- z c N w ~¢ ~ 7 M ~~ o n ~~ ~_ m M 1 M J r ~ ~ v '~ `~ •~ S b 1 s d ~ -~ 4) v ~ ~ ~ _~ ~ v m, n~W o Ir ~~ ~s