The URL can be used to link to this page

Home My WebLink About07-14-0915056051058 --J REV 1500 EX (06-05) OFFICIAL USE ONLY County Code Year File ~mb~~~ ~~ PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN Po Box zaosol RESIDENT DECEDENT Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Date of Birth Date of Death Social Security Number Og~2711 g24 08/1912008 MI 579-20-4490 Suffix Decedent's First Name Decedent's Last Name Francis X Mayhew MI (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name Spouse's Last Name Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS PROPRIATE OVALS BELOW 3. Remainder Return (date of death 2 FILL IN AP 2 Supplemental Return ) prior to 12-13-6 ~ 1. Original Return Federal Estate Tax Return Require 5 4a. Future Interest Compromise (date of . 4. Limited Estate death after 12-12-82) Total Number of Safe Deposit Boxes 8 7. Decedent Maintained a Living Trust . 6. Decedent Died Testate (Attach Copy of Trust) Election to tax under Sec. 9113(A 11 (Attach Copy of Will) 10. Spousal Poverty Credit (date of death . (Attach Sch. O) 9. Litigation Proceeds Received between 12-31-91 and 1-1-95) ORMATION SHOULD BE DIRECTED T THIS SECTION MUST BE CO MPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INF Daytime Telephone Number RRESPONDENT - CO Name (717) 243-7437 John C. Oszustowicz REGISTER OF WILLS USE ONLY Firm Name (If Applicable) C~ r.a Law Office of John C. O szustowicz .,-C7 _ , ~ ,-.c~ First line of address ~ ~ te" f_ `"'_ `` J 104 S. Hanover Street r -- ('rl ---tT ~ ' -- '-r i .J ~ ~:\ Second line of address '---` ~J C~ _ State ZIP Code - tJ --i CJ ~ ~~ I . 3-r-t City or Post Office PA 17013 ~ ` '`' Carlisle -.i Correspondent's a-mail address: in schedules and statements, and to the best of my knowledge and belief, n y g pa om tative is based on all information of which prepare t I have examined this return, including acc h ~ any w ge a rsonal represen Under penalties of perjury, I declare t t and complete. Declaration of preparer other than the pe f ~ ~ DATE O J ? J , i'%r~"""°"- ~ ~ it is true, corcec SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETUR /~~ ~ S l ADD ~r/ e ~y r/~ ~ DATE ?~ ~ W 7 O SIGNAT E OF PARE OTHER THAN REPRESENTATIVE ` ~~ ~~~t3 ~D K S ~~ 5,1--. ~~~, ~~>~, ADDRESS ~ ;~ Y „ .~ o~ FoSE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 Decedent's Social Security Number REV-1500 EX 579-20-4490 X Mayhew Francis Decedent's Name: RECAPITULATION 1. ..................... 1. Real estate (Schedule A). ....... . 2. 2. Stocks and Bonds (Schedule B) .. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . 3. 3. 4. 4. Mortgages & Notes Receivable (Schedule D) .. 1 589 80 Bank Deposits 8 Miscellaneous Personal Property (Schedule E) . Cash 5. , 5. d Property (Schedule F) Separate Billing Requested ...... . 6. 6. Jointly Owne 7. Inter-Vivos Transfers & Miscellaneous Non-Pgeparater 8ieng Requested....... . 7. (Schedule G) 1,589.80 8. g. Total Gross Assets (total Lines 1-7)...... 2,076.75 g. Funeral Expenses 8 Administrative Costs (Schedule H) .............. 9. 67,18 10. Debts of Decedent, Mortgage Liabilities, i~ Liens (Schedule I) .............. .. 10. 2,143.93 . .. 11. 11. Total Deductions (total Lines 9 & 10) ......................... 0.00 12. . 12. Net Value of Estate (Line 8 minus Line 11) .. . ts/Sec 9113 Trusts for which 13. Charitable and Governmental Beques t been made (Schedule J) 13. an election to tax has no 0.00 Net Value Subject to Tax (Line 12 minus Line 13) . 14 14. . TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. (a)(1.2) X .o_ 0.00 Amount of Line 14 taxable 0.00 1g 16. . at lineal rate X .0 45 17. Amount of Line 14 taxable 17. at sibling rate X .12 18. Amount of Line 14 taxable 18. 00 0 at collateral rate X .15 . ..... 19. ............. 19. TAX DUE ........................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 File Number REV-1500 EX Page 3 Decedent's COmp~ete AddreSS: DECEDENT'S SOCIAL SECURITY NUMBER 579-20-4490 DECEDENT'S NAME Francis X Mayhew STREET ADDRESS Claremont Nursing & Rehabilitation Center 1000 Claremont Rd. sTATE zIP PA 17013 CITY Carlisle Tax Payments and Credits: (1) o.oo 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3, InterestlPenalty if applicable 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. (4) Fill in oval on Page 2, Line 20 to request a refund. 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) (5A) A. Enter the interest on the tax due. (5B) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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. 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 carep • " • within one ear of death 2. If death occurred after December 12, 1982, did decedent transfer roperty Y ^ without receiving adequate consideration? ...... ^ ^x 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 ^ x contains a beneficiary designation? ........................ ........................................................... . NY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. IF THE ANSWER TO 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 imposedo a survitvin v spousetfrom tax t and the tstatutory requi eme1ntsgfo Pd sclosure of a0ssets and [72 P.S. §9116 (a) (1.1} (ii)]. The statute does no_ t=xemot a transfe 9 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 acent 72 P.S §91 6(a)(1 2)] years of age or younger at death to or for the use of a natural paren , an adoptive parent, or a stepparent of the child is zero (0) pe [ 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)]. 1 3 Asiblin Is defined, under 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)(. )]~ 9 Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) COM INO ERITANC OAX RETURNANIA .,~o~r~cnir nFrFf1FNT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Francis X. Mayhew ~__~...,., ~~,e „~~~pa~~ of litioation and the date the proceeds were received by tce~es~aiP. F REV-1511 EX+ (12-99) COM ND ER TANCEOTAX RETURNANIA ^FCinFNT DECEDENT ESTATE OF Francis X. Mayhew ITEM NUMBER A, FUNERAL EXPENSES: t ~ Little Flower Catholic Church 2. LynnCooks -caterer s. The Washington Post- obituary B. 1 2. 3. 4. 5. 6. 7. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. DESCRIPTION FILE NUMBER AMOUNT 450.00 1,010.00 316.75 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address State City Year(s) Commission Paid: Attorney Fees Family Exemption' (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State City Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Zip 300.00 Zip 2,076.75 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) R'c'•J-1512 EX+ X12-~6) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN oFanPNT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER ESTATE OF _ _ ., ~e,,.,ho,., .. . ,__.~ :_~~,,,,~~„ ~~n.pimbursed medical expenses. R=V-1513 Fk* (1'..081 pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Francis X. Mayhew SCHEDULE ~ BENEFICIARIES NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY NUMBER I TAXABLE DISTRIBUTIONS [Inclu$e o 91g6t(e) (15z) jistributions and transfers un er ~ . Marian Mauldin 206 Wedgewood Lake, Lake Jackson, TX 77566 2. Walter C, Mayhew -address unknown RELATION H PIS TO DECEDENT Do Not List Trustee(s) daughter son OLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV•1500 COVER SHEET, AS APPROPRIATE. ENTER D II NON-TAXABLE DISTRIBUTIONS'. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAK 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 FILE NUMBER AMOUNT OR SHARE OF ESTATE 0.00 0.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONsheets of oe same1si00 COVER SHEET. $ If more space Is needed, insert additions LAST WILL AND TESTAMENT I Francis Xavier Mayhew, of Cumberland County, Pennsylvania, being of sound ' do make, Publish and declare this as and for my last mind, memory and understanding, void all former wills by me at any time will and testament, hereby revoking and making heretofore made. FIRST. I direct all my just debts and funeral exp r ~~ d aslsoon asaconve elntdly out of my estate by my personal representative heremafte may be after my decease. ive, devise and bequeath all of my estate, real and personal, equally SECOND. I g to my children Marian Mauldin and Walter e'to his 1 wing children perystirpeseri predeceases me then I leave that child s shat oint Donald Mayhew, Executor, of this THIRD. I nominate, constitute and app m last will and testament. If he is unable or unwilling to serve, I nominate John C. Y Oszustowicz, Esq. as alternate Executor. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ',!~`~ - 2004. day of Francis Xavier yhew Signed, sealed, published, acknowledged and declared by the above- named Testator, Francis Xavier Mayhew, as and for hiss the W es n e of each other,thave presence of us, who, at lus request, in his presence and P hereunto subscribed our names as witnesses thereto. 'I i" l~ ~. ~_ 1 v Of ~ ~ ti ~~ ~--~- l~ ~ ~~-~ 1 ~ s~ ~ ~~ f ~~~ 1 3 COMMONWEALTH OF PENNSYLVANIA ~ SS: COUNTY OF CUMBERLAND ' a hew, Testator, who signed the foregoing instrument, having I, Francis Xavier M Y to law, acknowledge that I signed and executed the been duly qualified according act for the purposes therein contained. ~ instrument as my free and voluntary rancis Xa ier Mayhew Sworn to or affirmed and Acknowledged before me by Francis Xavier Mayhew the Testator, this 1l ~' day of ~ ~~ ~ , 2004. Notary Public Y R LE Amy COMMONWEALTH OF PENNSYLVANIA ~ SS: COUNTY OF CUMBERLAND ~ being duly We, the undersigned witnesses who signed the foregoing instrument, din to law, depose and say that we were pre~~~ hed gn a and executed it qualified accor g and execute the instrument asri s La t on thepm'po herein expressed; that each of us in willingly as his free and volu ary si ned the Will as witnesses; that Testator is known to each o us; his sight and hearing g to the best of our ~owledge and observation ehe Testator was at the time o and that ri,ie mfluenc sound mind and under no constraint or un Sworn to or affirmed and subscribed to before me by~ -~n~~~a p~ ~~ ~r ~,~,z itnesses, and ;~~~ ~~ ~ ~ , 2004. *'~` day of ~' this ~_ '~ ~ .~~ Notary Public YN- ~l1a~ P~ pd. ~0, 20ci5