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Home My WebLink About08-11-09,~,, 15056051058 REV 1500 Ex cGS.oS, Bureau nt YiNNduld T ~L 118E ONLY Po Sox ze9em INHERITANCE TAX RETURN ~r case rBar F+e NuMa ~ ntaa oriot RESIDENT DECEDENT ~ ~ U ~ '~ 9 ENTER DECEDENT NgFORMATNNI EEL.OW 07/12/2008 11/02/1931 Deceded's Last Name Sldtic FiStlef ,$ FNSt ~~ MI (`.8111elllle 1R APpNgble) Error Sugv;lp 80aue's IMomsetlon Below 6 Spouse's Lest Name SrAPoc Spouse's Frst Kane MI Spouse's Social SearNy Number tlas r+En1R11 itwsT rrE fxED w twtlLlcATE rtntH rills FlLL IN REGISTER OF WILLS APPROPIBATE ovALs Elo ~~ ,. t>rl~,e Reaan w :. =, 2 gr4Plenrxaal RNUm '::::::~ 4. LhnNed Estate : ~:] Ia. Future (~ d ;::-"~ 8. Daoedent Died Tesyle (Atydr Copy d WIU) dyer aRw -1212-82 __ Maarmlrred a LMrp 7Mt `.-' T' -'-~ 9. Litlpatbn Proceeds ReceNed (At ) C~ 10. Spousal Powsty CredN (day d death between 12-91-91 and 1-1-95) CORRESPONDENT - TM18 SECTION BBST BE COIIPLEIED ALL Name ~'N:E AND I:ONFI Thomas P. Andrews Firm Nana (NAppiicable) e First line d address 33 West Simpson Street Second line d address Oily or Poet Olfice Mechanicsburg Correspondenra eyiyil address: _ Il^aer PerWtlea d per)ury, I daGene Bwt I taws FOR 33 West Simpson Street; Mech SIGNgTURE OF PREPARER OTNER TW W syy PA c=, a. Remeb~aar Ramn (secs d o~m plat b 12-13-82) L='~ 5. Faderel Ecyy Taz Retun Requhetl 8. TaIY Nundyr d gate Deposit Bmres '~-~ 11. Ebctlon b tax ands gec. 9113(A) (AltaM Sch. O) nAL TAx INFONNATp118N0OLD BE DNIECTED T DaylMy Telephone Number (717)691-8576 REGISTER OF wILLB USE ONLY C7 ° C~ ~..i~ C ~T_~ G7 I ;r~rT Ur `:.:~'C7 ~-~ 't7 X70=7 3 nP code ~ ~ ED Lv --+ 17055-6323 a w rn one PA 17055323 DATE PLEASE U3! Ofi1WNAL F01G1 ONLY L._ 15056051058 Side 1 15056051058 ~ .~: I ~,iJ _ '- <. ,._,$ `c ~ -ri _ -~~ r. ~. -~ :;, V~j _J 15056052059 REV-1500 EX . Catherine Decedem's SoGal Security Number ~,M g ~. B Fisher ..____ -___ - - .___.. - --_ RECAPITULATION _.. 1. Real eabb (Schedule A) .............. ........................... .... 1. 0.00 2. Stotlcs and Beads (Sdredub B) ............ - ... ....................... .... 2. 0.00 3. CkxxNy Held Corporatlm, PaNxirMip or S°b-ProPrbprsaldP (Sdredub C) 3 . .... . 0.00 4. Mgtgages 8 Nobs Receivabb (ScfredrAe O) ....... .................. .... 4. 0.00 5. Cash. Bank Deposits & Miacelbneoug Personal Property (Sdbdub E) 5 ..... ... . 8,213.82 6. Jointly Awned Property (Shcedub F) O Separate Bifxg Repreaped .... 7. Inter-Vivrvos Transfers 8 Mbosllenaou$ ryon-probab p ... 8. 0.00 ~~ (Schedule G) c:~ $epareta BNlrg RMrx»ted..... . 7 .. . 0.00 8. Total Gross Aasps (tMal Linea 1-7).. .. .. . __ ..... .... __ _... -_ -. _. ... e. _... _-... 8.213.82 9. Funeral Expenses 8 Admbisha0ve Caaffi (SChedrb H) _ ..... "" "" 9' 2,100.81 10. Debts of Decedent Mortgage LiatrHabs, 8 Liens (Sc9ledub 1) ............. ... 10. 8,488.79 t1. total Daduotlpu (trial Lines 9 $ 10) ......... ........................ .. 11. 10,589.60 12. Net Value off Eahb (Etna 8 mhos Line 11) ......... 13. Charibbb end Govemmen~ ................... BequeatalSec 9113 TrtrsLS Hot wfrich .. 12' -2,100.81 an ebcpbn to tax hai not been made (Stlredub J) ... ................... .. 13. 0.00 14. Nat Value Sugaet to Tax (Lxre 12 mirxrs Lyre 13) . . _ .... ..... __ _ _. 7AX COMPUTATION .SEE INSTRUCTIpNg FAR AP PLICABI,E RATES -.. _ .. 1a. -... _ 0.00 . __ -_-. _... - _. 15. Amoum of Line l4 taxable at the spousal fax rate, or transfers under Sec. 9116 (ax1.2) X .0_ 0.00 15 16. Amount of Line 14 bzable . 0.00 at lirxtal rate X .0_ 0 ~ ' 17. Amount d Line 14 taxable 16. 0.00 at siblkrg rate X .12 0 00 . 18. Amount of Line 14 bxable 17. 0.00 at colbtergl rape X .15 0.00 16. 0.00 19. TAX DUE .............. .......................................... . 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REg1E$T1NG A REFUND OF AN OVERPAYMENT L. 15056052059 Side 2 15056052059 REV•1500 EX Page 3 Decederrt's Complete Address; DECEDENT'S NAME Catherine B Fisher sTREETADDRESS -- 33 West Simpson Street Tax Paymetrsts and Credits: 1. Tax Dtre (Page 2 Line 19) 2. CredilwPaymenfs 9 ~ Creddit 0.00 0 00 C. Discount . 0.00 3. InterestlPenalty N applicable D. Imerest 0.00 E. Penalty File Nranper PA (1) Total Credits(A+g+C) (2) 4. N Lme 2 ie grayer than Line 1 + Line 3, err6ar the d8ference. Thin is the OVERPAYMENT, I~ (D + E) (3) FlN In oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Lina 3 is grater tlren Line 2, enter tlta direrer~ce Ths is the TAX DUE (4) (5) A Err the interest on the tax due. B. Enter the Oo1al of Line 5 + gA, Thy ~ the BALANCE DUE (~) (SB) Make Check Payable )b: REGISTER OF WILLS, AGENT ~` ~ ~.a;,, . ~r..x,>,~, .erxu .a~~.w..... 17055-6323 o.oo 0.00 0.00 0.00 0.00 0.00 0.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN eX" IN THE AP 1. Did decedent make a trarlsfar and: PROPR IATE BLOCKS a. reform the use a kgarle of the P10P~Y Yes No ' ........................................ b. retain the ' b nqd daignala who shall use Nta property transferred a iq ~ ............................................. c. retain a ~ ........................................ reversarrary inkrask a .................. ... .... ^ .................................................................................................... d. receive the pnxrlise for life of eNhar PeYn~, berre6ls a carer ................... 2 N d N ....... .... ^ . raa r acaxred agar Decertrbar 12.1982. did deosderd ........................................ trarmfer Property wimkl arts year of daa, wiMgd receivktg adegaale oorrsiderationT . .... ..................... . payable upon datlr baNc accoud a ........................................ 3. Did decedent own an Srr trum for" ar ..................................... daMT ........... 4• Did decedent own a IMividuel Retirement Aaourd i ... ... ^ , annu ty, a oMar non•probale property ~ contains a beneficiary designeBonT .............. .......................................................... ABOVE QUESTIONS IF THE ANSMIER TO ANY OF THE ` k IS YE3, YOU MUST COMPLETE SCHEDULE G AND FlLE R AS PART OF THE RETURN. Fa dates of drxsth on a after Juy 1,1984 and before January 1, 1995, Nte tax rate im ' ~ is three (3) percent (72 P.S. §9118 (a) (1.1) ()]• PDSed on the net value of transfers b or fa the use of Ste surviving spouse Fa dates of death on a after January 1, 1995, the tax rate i [/2 P.S. 9116 a 1.1 ii .The stahlte mposed on the net value of transfers b a fa the use of the survivkrg appose is zero (0) percent § () ( ) ()1 does not exempt a transfer to a surviving spouse from tax, and the filing a tax return are still appficaWe even M the surviving spouse is the only beneficiary $~~Y requirements fa discbsure of assets and Far dates d death on a afar Juy 1, 2000: The fax rate imposed on the net value of transfers from a deceased child hvonlybne years ~ age or younger at death to a fa the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [/2 P.S. §9116(a)(1.2)]. The tax rata imposed an file net value of transfers b a fa the ua of the dec~edeM's linrasl brmrdkdariee ie tour and one-half (4.5) percent, except ore noted in 72 P.S. §9116(1.2) [/2 P.S. §9116(a)(1)]. The fax rate imposed on tfre rret value of transfers to or fa the use of the decedent's siblings is tweke (12) peroard [/2 P.S. §9116(a)(1.3)]. Asiding isdefined, under Section 9102, as an individual who has at least one parent in common witlt the decedent, wftether by Wood a adoption. REki50e EJ(+(gge) colYaroNwEwur of t=ErxasvtvAtwn INHERTfAN(~ TA% RETURN RESIDENT DECEDENT Catherine B. Fisher SCNEp11LE E CASH,p~BQ~4N~IC~DEPpOpSRS~, & AMSC. rG'°~' "~. rwv~"O~I M lea wa wiu~ noM a u~ ~ nroceeae were recavetl nr me ea~aa. rvlvorldp mire w dACloeed on xirduk F. 1 Cantlerce Bank 9 aoceuld 2 Sale of aufarl1ob17e 3 Saleof9aragedooropener 4 Sale of clothes masher trod cbtlres dryer TO7AL (Also erttx an Gne 5. Recepihlleaon) _ QI more apace is needed. insert taldi6plel sheer of the same size) FILE AT 1,113.82 7,000.00 25.00 75.00 8,213.82 REK7511 FJC+(12-99) COAMaONWFALTN of PEwasvLVnNw IIVNERRANCE iAX RETURN RESIDENT DECEDENT scNSnu~ M FUNER/LL EXPENSES dr ADMINISTRATIVE COSTS Catherine B. Fisher Dehls of dleatlsK Illllll a raPerbd On Slhldllb L A FUNERAL EXPENSES: .sca.nr~Ma t' HoMitlger Funeral Hlxne and Clernabry, Inc; 501 N. Batr;more Are; Nbud Ndly , PA 17(165 B• ADMNiISTRATIVE COSTS: t' pBBp1y 'a Conenbsism Name d Pdamel ~Pleaenbtse(a) $0pv ~~T Nlartel(a-~EtN Hurter d Peleorul ~Dresellbtre(a) SleetAtlAess CM' Sbb 1'emisl Commbsbn Pain: 2. AIEOniey Fees 3• Famty Exemptlon: (N dsoedenrs atldgsa b not tie same ae dernril'a, Mbrli axpbnetlon) ('lernam sleet Adbess CM Sbla Reblmsh9 d Cbrlleit b neceeem <• Probeb Fees 5. Aocoutam's Fees 8. Tax Relan Pleperer's Fees ~. 2,022.81 0.00 0.00 0.00 Zro TOTAL (Abo eli~r on Nne 9 RecaplpYalln) I = Qf more apace b needed, inaen additiwrel aheeb d ttq same size) 78.00 0.00 0.00 2,100.81 REV-1512 E%+ (12-Oe) Pennsylvania DEPARTMENT OF NEVENUE INNE3UTAN(E TAl( RE71NtN Nesmarr oEaDerr SCHEDULE I DEBTS OF DECEDENT, MORT611GE LUIBILITIES ~ LIENS ~~wlc Vf atherine B. Fisher Report detib hrarrnd M We decedent prior to Metlr tRN ronreYrae ITEM ~---_ NUMBER ,_ DESCRa'I70N 1' Cumberland VaYey Medal Savicea 2 Calisle Regiafal Medical Center 3 Mas1aW Aesociatss, Doctors ORice < Shipperbburg EMS, Ambulance Service 5 Belvedere Medical ration 6 Cottages of Sfdpperlebure, Atft Rental 5 Arrow, Debt CoNectigf Agency e DCM Services, Debt Collection Agerfcy 7 Bads of America, Credit Card 8 Capitol One, Credt Card 9 Comrast, lltitity BII 10 PPL, lJtikly Bi0 11 Penelec, Lltitily Bdl 12 AT&7 WNaleae, UUlily gtil FILE NUM6ER urgeW at tM dete of deetlr, IndWNrp uMalwbweed rnadkal elraelree. VALUE AT DATE OF DEATH 1,070.00 119.11 72.00 884.00 65.00 545.00 537.82 543.98 3,829.19 64.68 362.88 82.91 119.50 192.94 TOTAL (Ako enter on Lice 10, Reapitulation) ; 8,488.79 If more spare Is needed, Insert addlNOnal sheers of the same size. IISA fIRST 455- ~~ 1 1 ~~ ~ ~ . fl ~ ~ .. N 3 w 0 ~ ~ o s+ o ., cc ~ ., ~ ~ ~ a ~ L ~ rl V L V rn N m b r 3 ~~a 4 C fN O ~ 6 rtn U_ F y C R ,: 3 ~ ~M~