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HomeMy WebLinkAbout08-04-09p ~ REV-1500 EX (06.05) PA Department of Revenue Bureau of Individual Taxes PO Box 280601 Harrisburg, PA 17128-0601 15056041169 OFFICIAL USE 01 County Code Year INHERITANCE TAX RETURN h I RESIDENT DECEDENTRESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 12082008 Decedent's Last Name Suffix WEAVER (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffuc Spouse's Social Security Number Date of Birth 02041927 Decedent's First Name EDITH Spouse's First Name THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE BOXES BELOW © 1. Original Return ~ 2. Supplemental Return ~ 3. Remaintler Return (date of de prior to 12-13-82) 4. Limitetl Estate ~ 4a. Future Interest Compromise (date of ~ 5. Fetlerel Estate Tax Return Re death after 12-12-e2) 6. Decedent Dietl Testate ~ 7. Decedent Maintained a Living Trust e. Total Number of Safe Deposit (Attach Copy of W Ip (Attach Copy of Trust) 9. litigation Proceeds Received ~ 1 D. Spousal Poverty Credit (date of tleath ~ 11. Election to tax under Sec. 911 between 12-31-91 antl 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCEAND CONFIDENTIAL TAX INFORMATION SNOULD BE DIRECTED T0: Name Daytime Telephone Number FRANK H KELLY, EA 717-774-7536 Firm Name (If Applicable) REGISTER OF WILLS U KELLY FINANCIAL SERVICES INC First line of address ~.p 400 BRIDGE STREET SUITE 4 ~S~ r- ~ rr Second line of address a-G, ~ C7r~ City or Post OiFce NEW CUMBERLAND Correspondent'se-maileddress: FRANKKELLY@KELL~ Under penalties of perjury, I tledare that I have examinetl this return, in it is Uue, correct antl complete. Dedaretion of praparer other than the HOGESTOWN ROAD MECHANICSBURG PA 1 schetlules and statements, antl to the best of my knowle re Is basetl on all informeaon of which praparer hea any MI H MI I 'T7 ~ 4_~ ern J C:7 C? ~ n -n _'`> r r'1 ,:_ belief, ADDR SS 400 BRIDGE STREET SUITE 9 NEW CUMBERLAND PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041169 15056041169 State ZIP Code I ' •~' File Numt ~a J J REV-1500 EX 15056042160 II it it Decetlent's Social Security Number RECAPITULATION 1. Real estate (Schedule A) .......................................... ... 1. ~~I 2. Stocks and Bonds (Schedule B) ..................................... ... 2. I 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. ~~'i 4. Mortgages & Notes Receivable (Schedule D) .......................... ... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... ... 5. 3 , 21 '~.. 0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested .... ... 6. 7. Inter-Vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1 - 7) ................................ ... 8. 3 , 21 '~.. 0 0 9. Funeral Expenses &Administrative Costs (Schedule H) .................. ... 9. 8 , 637 . 00 10. Debts of Decetlent, Mortgage Liabilities, 6 Liens (Schedule I) ............. .. 10. 11. Total Deductions (total Lines 9 & 10) ................................ .. 11. 8 , 6 3 7 '. 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. (5 , 4 2 2 1.0 0 ) 13. Charitable 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. (5 , 9 22 ',. 0 0 ) TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .09 5 15. i6. Amount of Line 14 taxable at lineal rate x .0_ 1g. 17. Amount of Line 14 taxable at sibling rate x .12 17. 18. Amount of Line 14 taxable at collateral rate x .15 1g, 19. TAX DUE .................................................... .... 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056042160 15056042160 00 00 REV-1500 EX Page 3 rlwewdwnt's Cnmelete Address: Flle NumDar DECEDENT'S NAME Edith H Weaver I STREETADDRESS 327 Hod estown Road l CITY Mechanicsburg STATE PA ZIP i 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Cred'A 8. Prior Payments C. Discount (1) Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty fi appliceble D. Interest E. Penalty Total Interest/Penalty (D + E) (S) 0 . 0 0 4. 1f Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box an Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the diBerence. This is the TAX DUE. (5) A. Enter the interest on the tax due. (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 BLO KS 1. Did decedent make a lrensier and: Yes No a. retain the use or income of the property trensferted : .......................................... ^ x^ b. retain the right to designate who shall use the property transferred ar its income : .................... ^ x^ c. retain a reversionary interest; ar ......................................................... ^ ~ d. receive the promise for life of either payments, benefits or care? ................................ ^ Q 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 "in Wst for or payable upon death bank account or security at his or her death? ..... ^ 4. Did decedent awn 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 1~HE 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 the surviving spouse is three (3) peroent [72 P.S. §9116(a)(1.1 J(i)]. For dates of death on or after January 1,1995, the fax rate imposed on the net value of transfers to or for the use of the surviving spouse Is z ro (0) percent [72 P.S. §9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosur of assets and 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 a deceased child twenty-one years of age or younger at death to or for the use of a tural parent, an adaptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(12)]. 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, a cept as noted in 72 P.S. §9116(12) [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 twelve (12) percent [72 P.S. §9116(a)(1. )]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1502 E%+ (11-OS) I' z ~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE ~. INHERRANCE TAX RETURN GI1 G I1 G '. RESIDENT DECEDENT ESTATE OF FILE NUMBER c,a; ~~, ~ wo ~.ro.- 2008.01279 All real property owned solely or as a tenant in common must be reported at talr market value. Fair market value is defned as the price at h ich property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the rel v ant facts. Real property that Is jointlyowned with rlgfit of survivorship must be dlscbsed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's Interest if owned as tenant in common. VALUE T DATE NUMBER OFD ATH DESCRIPTION 1, None TOTAL (Also enter on Line 1, Recapitulation.) ; u mare space ~s neeaeD, mserc auwuunm anew m um amnc mcc. REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF r.ul ~ti n weaver All properly jointtyavmed with rlpht of survivorship moat he disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE OFD TDATE ATH t None TOTAL (Also enter on line 2, Recapitulation) S (If more space is needed, insert adddianal sheets of the same size) NhV-i W4 EX+(6-98) SCHEDULE C !, CLOSELY-HELD CORPORATION, ~! COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN RESIDENT DECE SOLE-PROPRIETORSHIP R R R DENT ESTATE OF FILE NUMBER Edith H Weaver Schedule C-l or C-2(including ell supporting information)must be attachedforeach Gosety-held corporetioNpartnership interest of the decedent othertha a sole-proprietorship. See instructions forthe supporting information to be submiaed forsale-proprtelorshipa. ITEM NUMBER DESCRIPTION VALUE OFD TDATE ATH t. None TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) REV-1505 EX+ (a-se) SCHEDULE C-1 CLOSELY-HELD CORPORATE COM NHERW TA CE AX RETURNANIA STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Edith H Weaver Name of Coporetion NOne State of Incorporation 1 . Address Date of Incorporation Zip Code Total Number of Shareholders City State _ Number Business Reporting Year D Federal Employer I 2 . . . Type of Business ProducUService 3 . 4. Common S Preferred $ Provide all rights and restrictions pertaining to each class of stock. 6. Was the decedent employed by the Corporation? ........................................ []Yes ~No Position Annual Salary $ Time Devoted to Business If es y , 6. Was the Corporation indebted to the decedent? .........................................QYes ~No If yes, provide amount of indebtedness $ 7. Was there 1'rfe insurance payable to the corporation upon the death of the decedent? ............QYes ^ No Cash Surrender Value $ Net proceeds payable $ If yes , Owner of the policy 8. Did the decedent sell or transfer any stock in this company wthin one year prior to death or within two years if the date of death was prior to 12-31-82? Yes ~NO ttyes, ~Transter Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separete sheet for additional transfers and/or sales. 9. Was there a wr'dten shareholder's agreement in effect at the time of the decedent's death? ....... Yes ~ No ~~, If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ...................................................... QYes ~No ~' If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? ................... ..QYes ~No Ii yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ....................QYes ~ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • •• • e A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding y .ors. C. d the corporation owned real estate, submit a list showing the complete addresses and estimated fair market value/s. If real estate ap reisals have been secured, attach copies. D. List of principal stockholders at the dale of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the wrporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insect additional sheets of the same sae) REV-1508 EX+ (9-00) SCHEDULE C-2 PARTNERSHIP COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Edith H Weaver Name of Partnership None Date Business Commenced 1 . Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number Type of Business Product/Service 3 . Decedent was a ^General ^Limited partner. If decedent was a limded partner, provide initial investment $ 4 . 5. ~ A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent7 ......................................... ^Yes ^No ~' If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ............ ^ Ves ^ No I Cash Surrender Value $ Net proceeds payable $ If yes , Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership wthin one year prior to death or within lwo years if the date of death w prior to 12-31-82? ^Yes ^No It yes, ^Transfer ^Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ......... ^Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? .......................................... ^Yes ^No If yes, provide a wpy of the agreement of sale, etc. I 12. Was the partnership dissolved or liquidated after the decedent's death? ...................... ^Yes ^ No tt yes, provide a breakdown of distributions received by the estate, including dates and amounts received. I 13. Was the decedent related to any of the partners? ........................................ ^Yes ^ No If yes, explain 14. Did the partnership have an interest in other coryorations or partnerships? .................... ^Yes ^No II If yes, report the necessary information on a separate sheet, inGutling a Schedule G-1 or C-2 for each Interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market value/s. It real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX4 (6-98) SCHEDULE D MORTGAGES 8t NOTES COM NHER ANCE~AX RETURNANIA RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Edith H Weaver All properly Jalntlyowned with Nght of survivorohlp moat be disclosed on Schedule F. BEM VALUE TDATE NUMBER DESCRIPTION OFD ATR 1. None TOTAL(Alsoenteronline4,Recapitulagon) 5 (If mom space is needed, insen additional sheets of the same size) REV-158 EX* (6-98) SCHEDULE E p ~+/~ CASH, BANK DEPOSITS, $t M~$C. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Edith H Weaver Include the proceeds of litigation and the date the proceeds were received by the estate. All properly )olndy-owned with rightof aurvlvorshlp mustbe disclosed on Schedule F. ITEM VALUE TDATE NUMBER DESCRIPTION OF ATN 1. Citizens Bank Acct#610070.228.6 3,040 2. Clothing - Watch etc 175 TOTAL (Also enter on line 5, Recapitulation) $ 3 ~ 215.0 0 (If mare space is needed, insert add'Aional sheets of the same size) REV-1509 EX+ (6-88) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Edith H Weaver If an assetwas made Jolnt within one year of the decedent's date of death, it must be reported on Schedule G SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIPT DECEDENT A. None B. C. JOINTLYAWNED PROPERTY: ITEM lET1ER FOR JOINT DATE MADE DESCPoPnON OF PROPERTY INCLUDE NAME OF FINANC41LwSTITITTIONPND BPNKACCOUM NLMBER OR SMIIAR DATE OF DEATH %OF DELD'S TE OF DEATH VALUE OF ' NUMBER TENAM JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOIMLYk1ELD REPL ESTATE. VALUE OF ASSET INTEREST DEC S INTEREST OENT i. A. TOTAL (Also enter on line 6, Recapitulation) S (If more space is needed, insen addAional sheets of the same sae) REV-151d EX+ (8-9e) SCHEDULE G INTER-VIVOS TRANSFERS & COM NHERWI ANCEOTAX RETURNANIA MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Edith H Weaver ~ ~, This schedub must be compbled and filed if the answer to any ofquestionslthrough4on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM NCLUDE THE NAME OFIFIE TRANSFEREE, THER REIATIONSHIPi00ECEDENTAND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACMA COPV OF THE 0EEt1FIXt REAL ESTATE. VALUE OF ASSET INTEREST Is APPLICABLE) VALUE 1. None TOTAL (Also enter on line 7, Recapitulation) ; (If more space is needed, insed addhional sheets of the same size) REV-1511 EXr (10.!)6) SCHEDULE H FUNERAL EXPENSES & COM NHERWTANCETAXRETURNAN~ ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Edith H Weaver Debts of decedent moat be reported on Schedule 1. ITEM NUMBER DESCRIPTION AM NT p. FUNERALEXPENSES~. f Myers Funeral Home Inc, Mechanicsburg, PA 6,501 2. Cumberland Valley Memorial Gardens, Carlisle, PA ~, 1,335 B. ADMINISTRATIVE COSTS: 1. Personal RepresantatWe's Commissions Name of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees 3. Fatuity Exemption: (Ifdecedent's address is not the sameas claimant's, attach explanation) Caimant Street Address City Stale ZIP Relationship of Claimant to Decedent 4. Probate Fees 6 6 5. Accountant's Fees 4 7 5 6. Tax Return Preparer's Fees 2 6 0 7. TOTAL (Also enter on line 9, Recapitulation) $ 8 6 3 7 . 0 0 (If more space is needed, insert add'Aional sheets of the same size) REV-1512 EX+ (12-08) ~ pennsylvania DEPARTMENT pF REVENUE SCHEDULE I DEBTS OF DECEDENT, INHERRANCE TAX RETURN MORTGAGE LIABILITIES & LIENS 0.ESIDENT ~ECEDEDIT ESTATE OF FILE NUMBER Edith H Weaver Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical a penses. ITEM NUMBER DESCRIPTION VALUE OF T DATE ATH i. None TOTAL (Also enter on Line 10, Recapitulation) ; If more space is needed, insert additional sheets of the same size, REV-1513 EX+ (11-OB) ~ ~pennsylvania SCHEDULE ' DEPARTMENt DF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Edith H Weaver RELATIONSHIP TO DECEDENT AMOUNT R SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF E TATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under I Sec. 9116 (a) (1.2).] 1. James Weaver Son 1/3 327 Hogestown Road Mechanicsburg PA 17055 2. Barry E Weaver Son 1/3 Newville, PA 3. Ricky L Weaver Son 1/3 Mechanicsburg, PA ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECRON TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. E OF R -1500 COVER SHEET. TA OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LIN 13 EV TO L 3 If more space is needed, insert additional sheets of the same size. REV-1514 EX+(12-03) SCHEDULE K LIFE ESTATE, ANNUITY COMMONWEALTH OF PENNSYLVANIA & TERM CERTAIN INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4 do REV-1500 Cover Sheet) ESTATE OF FILE NUMBER Edith H Weaver This schedule is to be used for all single life, joint or successive life estete and term certain calculations. For dates of death prior t 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specia8y Tax UnN. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5.1-89 to 4-30 9, and in Aleph Volume for dates of death from 5.1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. Will ^ Intervlvos Deed of Trust ^ Other Life or Q Term of ears Life or ~ Term of ears Life or ~ Term of ears Life or ~ Term of ears Life or ~ Term of ears Value of fund from which life estate is payable .............................................. $ 1 . Actuarial factor per aPProPriate table ..................................................... . 2 . Interest table rate-31/2% [I6% ~10% Variable Rate 3. Value of life estate (Line 7 multiplied by Line 2) ........................................... $ Life or ~ Term of ars LHe or ~ Term of ars Life or ~ Term of ars Life or ~ Term of ars 1. Value of fund from which annuity is payable ................................................ $ 2. Check appropriate block below and enter corresponding (number) ............................. . Frequency of payout- Weekly (52) ~Bi-weekly (26) ~MOnthy (12) Quarterly (4) Semi-annually (2) Annually (1) Other ( ) 3. Amount at paYOUt Per pedod ............................................................ $ 4. Aggregate annual payment, Lina 2 multiplied by Line 3 ...................................... . 5. Annuity Factor (see instructions) Interest table rate-31/2% ~6°h ~10°!° ~Veriable Rate °/° 6. Adjustment Factor (see instrudions) ..................................................... . 7. Value of annuity - If using 3 1/2%, 6%, 10%, or'rf variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 8 ............................. $ If using variable rate and period payout is at beginning of period, calculation is: ~ (Line 4 x Line 5 x Line 8) + Line 3 ..................................................... $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A thro gh G of this tax return. The resuking life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If mare space is needed, insert additional sheets of the same size) REV-1844 EX+ c~~4i INHERITANCE TAX SCHEDULE L COMMONWEALTH CF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT REMAINDER PREPAYMENT OR INVASION OF TRUST PRINCIPAL FILE NUMBER I. ESTATE OF WEAVER EDITH H (Last Name) (First Name) (Middle Initial) This schedule is appropriate only for estates of decedents dying on or before December 12, 198 . This schedule is to be used for all remainder returns when an election to prepay has been filed under the provi ions of Section 714 of the Inheritance and Estate Tax Act of 1981 or to report the invasion of trust principal. II. REMAINDER PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years i come orAnnuitant(s) of election or annuity is Pa able C. Assets: Complete Schedule L-1 1. Real Estate .............................. $ 2. Stocks and Bonds ........................ $ 3. Closely Held Stock/Partnership .............. $ 4. Mortgages and Notes ..................... . $ 5. CashlMisc. Personal Property ............... $ 6. Total from Schedule L-1 .................................................... $ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities ......................... $ 2. Unpaid Bequests ......................... $ 3. Value ofUninGudableAssets ................ $ 4. Total from Schedule L-2 .................................................... $ E. Total Value of trust assets (Line C-6 minus Line D-4) ............................... $ F. Remainder factor (see Table I or Table II in Instruction Booklet) ....................... . G. Taxable Remainder value (Line E x Line F) ...................................... $ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years in me or Annuitant(s) corpus or annuity is pay ble consumed C. Corpus consumed .......................................................... $ D. Remainder factor (see Table I or Table II in Instruction Booklet) ....................... . E. Taxable value of corpus consumed (Line C x Line D) .......................... . ... $ (Also enter on Line 7, Recapitulation) REV-1847 EX+ (9-08) SCHEDULE M FUTURE INTEREST COMPROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Check Box 4a on Rev-1500 Cover Sheet) ESTATE OF FILE NUMBER Edith H Weaver This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future inter t vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEARE GE TO T BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withd awal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the sul iving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of Future Interest ...................................................... $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) .. $ 3. Value of Line 1 passing to s ouse at appropriate tax rate Check One ^ 6%, ~ 3%, ^ 0% .................. $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% $ (also include as part of total shown on Line 16 of Cover Sheet) I I 5. Value of Line 1 taxable at sibling rate (12°fo) (also include as part of total shown on Line 17 of Cover Sheet) .. $ 8. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) .. $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) .................. $ (If more apace is needed, insert addtlional sheets of the same size) REV-1648 Ex (11-99)({) SCHEDULE N SPOUSAL POVERTY CREDIT COMMONVJEAL7H OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH 0 7 /01192 70 12131194) INHERITANCE 7AX DIVISION ESTATE OF FILE NUMBER Edith H Weaver This schedule must be completed and filed it you checked the spousal poverty credit box on the cover sheet. 1. Taxable Assets total from line 8 (cover sheet) ........................ ....................... 1. 2. Insurance Proceeds on L'rfe of Decedent ............................ ....................... 2. 3. Retirement eenefta ............................................ ....................... 3. 4. Joint Assets with Spouse ........................................ ....................... 4. 5. PA Lottery Winnings ............................................ ....................... 5. 6a. Other Nontaxable Assets: List (Attach schedule 'rf necessary)... L 6. SUBTOTAL (Lines 6a, b, c, d) ..... . 7. Total Gross Assets (Add lines 1 thru 6) 8. Total Actual Liabilities ................................................................. . 9. Net Value of Estate (Subtract line 8 from line 7) ............................................ . if line 8 is greater than S20o,o00 -STOP. The estere As not eligible to claim the credtt. /f not, continue M Pertlf. Income: 1. TAX YEAR:? a. Spouse ............ 1a. b. Decedent .......... tb. c. Joint .............. 1c. d. Tax Exempt Income .. 1d. e. Other Income not listed above ........ 1e. f. Total .............. 1f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Inwme from above: (1f) + (2f) TAX YEAR: 19 + (3f) 3c. 3f. 4b. Average Joint Exemption lncome ........................................................... _ _ If line 4(b) is greater than $4Q,000 -STOP. The estate is not eligible to claim the credit. if not continue to Part I!!. 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ....................... 2. Multiply by credit percentage (see instructions) .............................................. 2. 3. This is the amount of the Resident Spousal Poverty Credit. Incude this figure in the calculation of total credits on line 18 of the cover sheet ................................... 3. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ................................................................ 4. 5. Multiply line 3 by line 4 antl enter the total here. This is the amount of the Nonresident Spousal Poverty Creda. Include this figure in the ce)culation of total credits on line 18 of the cover sheet........ 5 REV-1649 EX+ (6-98) SCHEDULE O ELECTION UNDER SEC. 9113(A) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN (SPOUSAL DISTRIBUTIONS) RESIDENT DECEDENT ESTATE OF FILE NUMBER Edith H Weaver Do not complete this schedule unless the estate la making the election to fez asset under Section 9773(A) of the Inheritance 8 Estate Taz Act. If the election appliesto more than onetnrat or similar arrangement, a separate Form must be filed for each tmst. This election applies to the Trust (marital, residual A, B, By-pass, Una Cred'd, etc.). If a trust or similar arrangement meats the requirements of Section 9113(A), and. a. The trust or similararcangement is listed on Schedule 0,and b. The value of the Irust or similar arrangement is entered in whole or in pad as an asset on Schedule 0, Then the transferor's personal representative may specifically identify the Wst (a9 ar a fractional porliat or percentage) to be inchnfed in the election to have such (rust or sim er property treated asatazabla transferin this estate. If less than the entire value of the trust orsimilarproperty is included asalaxabb trensferon Schedule O,the personal represenfativeshall be onsideredto have made the election ony as loafraction of the trust orsimilar amangement. The numerator of lhisfredion is equal tothe amount of the trust orsimilar enangement includeda atazable asset on Schedule 0. Tha denominator is equal to 9ie total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedents s rviving spouse under a Section 9113(A) trust or similar arran ement. Description Value PartATotal $ Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A) election to tax is being made. Description Value Part B Topl $ (Ifmore space is needed, insert add'Abnal sheets ofthe same s¢e) Citizens Bank 1-888-910-4100 [all cidnni PhawBankanydme foncpunt Inrermadan, N/pn[ ppy and in5M r3 [0 )OYr QYasd0114. U5259 8R 292 1 1 EDI TM H WEAYER 327 HOOESTOWN RD MECHANI CSBUfl6 PA 17050-3127 Checkin Account Statem t 0 a 1 Beginning ecember O4, 2006 through Ja uary O6, 2009 g Checking SD NNA0.Y Balms Calculation Previous Balasrce 3,060.36 Checks .00 - Withdrawafs 6,101.19 - Depositr 8 Addidons 1,060.83 + tumor Balance .00 TaAN3At TION D[MIlS WiMdnwala Dtilar Withdrawals Nb aneunt paMPtkn 01/05 4,101.19 Oebit Memo _ Deposits B Additions Dab Mount lNxpienon 12(22 515.00 Deposit 01(02 485.83 U5 Treasury 312 null Serv 010209 F 1584968 W Csf EDTTH H Basi<Cf Iovbw aNNw. 3,040.36 Topl WHhdpraU 4,101.19 Mpflp a Aaesep.a [uMRaNNM .00 Gaily Balann wn edNN. Gab sapns. ats e,u,Na 12/22 3,615.38 O1f02 6,101.19 01/05 .00 NEWS FROM CITIZENS -we're here for all your bortawing needs. Mortgages and home equity lines of credit or loans for debt consolidation, education, and life eventr. We Can help you manage your money as you star[ the New Year with a BT banowing checkup. See a Canker today to dsscua our convenien4 hassle free, eary borrowing prceess. Citizens Bank is a lender you ran oust. Visit your branch, calf 1-800-340-LOAN or www.Citizensbank.com. --Looking for high yields and easy access to your cash savings? Look no further! Citl7ens Bank offers savings and money market accounts with great rates and the peace of mind of FDIC insurance. Whether you are just starting out ar looking to preserve your liquid rash deposits, we have an account to suit your needs. For more informat(on, to open an account, or add to your existing balance, visit your local branch today or call 1-688-821-3900. Member PoI[, See a banker or FDIC coverage amounts and transaction limitations. m,md~, ro¢ v rw„v,,,~•„g ;~ ne, RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One courthouse Square Carlisle, PA 17013 WEAVER EDITH H Estate File No.: 2008-01279 Paid Hy Remarks: ~ ES WEAVER ----------------- Fee/Tax Description PETITION LTRS TEST WILL AUTOMATION FEE SHORT CERTIFICATE SCP FEE Cash Total Received......... Receipt Date: Receipt Time: Receipt No.: 12/29/2008 10:39:02 1055189 Receipt Distribution ------ ------- - Payment Amount Payee Name 20. 00 CUMBERLAND COUNTY E: 15. 00 CUMBERLAND COUNTY E! 5. 00 CUMBERLAND COUNTY Ei 16. 00 CUMBERLAND COUNTY E: 10. 00 BUREAU OF RECEIPTS & $66. 00 366. 00 FUN FUN FUN FUN M.D i ". Cumberland Valley Memorial Gardens 1921 Ritaer Highway Carlisle, PA 17013 717-243-3541 ~ Isl'ERMENT/ENTOMBMENT AUTHORIZATION AND INDEMNIFICATION -DATA ON DECEASED- 1 v. NE 1' D.G.R. DD.D. ~ITM N• 24/ 2 1z 08 N >DI)0.ESS: C ~~~ QRe~-n11~1A~>.IIAI.~ C~~ '~_ ' - '. /Me IJ rupaess: z ~__ 32 ~i ~', 9 N~ V'aJI I~ W Burial No. CON RACT NO. y2~f5 z%'- 30379 Properly Dttd No. Toile ' ~ s D k: ZJ8 ~' y, ~tSG, a TIME OF DEATH SEK AGE MARITAL STATUS DATA ON NEXT OF KIN OR REPRESENTATIVE - RELATIONSHIP:n J -DATA ON PROPERTY OWNER - / nDORE55'. -INTERMENT/ENTOMHMENTIINURNMENT DATA - aV. ~CEIVED DATE: TIME: RY: pfJpq I z 4 2'~ xINEx OME ADDRESR: S - 1 s PIIONE: FUNERAL HO ECOMALT: FUNERAL DIRECT 2 q mtr' DATfi OP pU U. F@35RAL ~_FllNERAI, OME _CfIURCH -CEMETERY. ERT. AR IVAL AT CEMETERY __ -.1 A 12 2 sekvtcgAT: nmE: 3O 30 r a -MAUSOLEUM- r l'IIMP: I'IIRM: _ MAUSOLEUM NAME: SECTION NO LEVEL NO. CRYPTMICNE NO. LETTE G'.CRYPT PLATE YES/NO INi ISING/SCROLLDEATfI DATENEEDEO: VESINO RELIGIOUSA IN/OTHER: N ~ 1 x Z RF:rveeD conrRACr: OPENING/CLOSING T V41lLT/VADLT INETALL. C \SKET -CURRENT CHARGES AND PREPAID INFORMATION - OATE NUMBER SELLING PRICE AMOUN DUE _I) _,R A-: _iu~a Tyr 0 00 s PROPERTY ~ r~.. OfIIER ~.. .„ .@ q AMOUNT DUE TD BE RLCEIVEO FROM: FAMILY -FUNERAL DIRRCTOR TOTAL DUl: ~7 5 !/(3 The undenigned heeby cenifin they have the full legal authariy to direct the Intermem, Enmmbtnent, or Inummenl of the krmina of the decent ,and hereby autlbr~ ize IhC cemetery to nuke dupoaWan o[Uk remains of the deceued sa indiakd. The undenigrRd Rertby further certify and represem that they a owner(q or aulhory izeJ repmsenletivels) of the owner(s) of the above described Inkrment RighD arld hereby authorize uR of said Inkmment Righk of the Ink nL Entombment, a Inumment of the rcmaim of tM1e herein named daeawd. The umekry is hereby directed m supmiae insDllMipn or insDll any eukr burial c Diner, to the exknl required by law, purchased m camuetbn with this IMermem and she Interment Righk described herein. The undersigned hereby agree m indemmify and hold hermlen the cemekry, its agents end emplRytta from any and MI LIABILITY, including easonable attomeyt lets, and against any IoD it ar they may avaktn in cnnncetion wish the lntemmenL Entombment, or lnummem authorized hereunder. The tamer ukn grcM cue ro evoiA e,rorc, ben in the event en irudvenent stmt does occur, the umckry rhall have the right to coned any error in the Intemmenr, P bmbme ar InummenL n iu own expense, withow my liability for each senor. Noyes FI•wen will be removed) drys fror :..cL~~i~.-P.of ~~G^ j Signature of Family Service Counselor Si/efWrc of Wt Owner/Authorized Rel OFFICE USE ONLY SPACE VERIFICATION -AUDIT AND RECORD' lnkmrent / /,/ 1 Onltbl soar ueh tleP b Check Famlly VerlDatl: /" w' MTEPMENT ORDfiR CHECKED __~~ INTERMENT CARD COMPLETED ANO F. I]-151 Surveyetl By: MASTER CARD UPDATED JJ 1I VV ~f PLAT gCf1K AND LOT MAPS UPDATED ~~1 /~ Checked Ry: r gURtAL PERMIT RP.CEIYEO AND FILED i~ 1 3 OTHER C D `NND-A:Knlnlnredon • prury Atlminletralbn • %nk-MalnDnana - BURIAL - G,~RDEN NAME/ SE"r N NO. LOT NO. 131 GMVE(S) ~ ~ SINGLFJREO DID TRIPLE fVPE OF OUTER BURIAL CONTAINER: '~ OUTER BU LCONTAINER CO.'. _Cf1APEL SERVICE _G VESIDE OTHER OTH EC L INSTRUCTIONS/SPECIAL EQUIPMENT: PN MEMORIAL INSTALLED O n 1 ECROLL UP.ATH DATE/ENGRAVINO NEEPE YERI O ffl!T 1a']~~''i g~~ r/r'~~n i-f. ST\~P° c ` cY-~`` four Gnvnninnr. CdoM1rmirq~ l iG llnnern!z n'oAiti,en MYERS NOYD ~. M111iC'HAM1ICS uneral ~Eame, c~7nc STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for chose items chat you elected or that are required. If wr are required by law or by a cemmeq or emmaux( explain in writing below. I[ youulecaed a funeral that may cequir<embalming, bueh ass funeral wish viewing, you may have m pay fa[ embalming. Yau do nos you did no[ approve if voJ' ~"leered~.a/uangemeuUtS,sec as a tees cremayun or immediate burial. If we charged for embalming, n For the Service of C"(/S'r~/~F //_~/C Date o'f D/cash [huge to: ~A.tt e $ ,tQ, ~i/.f'A/.>r~C 3 L 7 /may ~l a~ ~..~/ ~Cr/. A. CHARGE FOR SERVICES SELECTED: 1. PROPESSIONAL SERVICES Services of Funeral Dicecsor(SUR Embalming .............. 6~trLL Other preparation of body 3_ SUB-TOTAL OF PROFESSIONAL SERVICES........, Ai ~pf~ 2. EACILI'f1ES AND Sk'.RVIC.ES L'~se of facilities and services (or viewing (VleitationlWake)... _ f ~L Cse of facilities and services r ~ fur funeral ceremony .......... -n!' .. { Uu of fadlitics and services (m t '~" Memorial Service ........... isi .. f Ilce of eyuipmens and servitts .~ / °v for graveside service ........... .. 1 µ Other use of facilities SUBTOTAL OP FACILITIES/EQUIPMfiNT i. AUTOMOTIVE EQUIPMENT \'ehide to transfer remains to Funeral Hom< L Local ................... .... _ f vL Hearse (Casket Couh) Local.... ... { Limousine T Local ....... { C- Famdy car Local ... ..... _ S_ Flower car or Ooni disposition Local..... _ >~ Lead car/Elergy car_ tl l Local. L; ~A~r7IC/ r ,~ W,l Cu fa pallbearers Local. .... f Out of vlwv ¢ansportatian ....... f __ ___ 1 _ SUB-TOTAL OF AUTOMOTIYP. EQUIPMENT....... TOTAL OF PROFESSIONAL SERVICES, PACILITIES AND AUTOMOTIVE EQUIPMENT ... Ocher dushlnf Cremation urn..... tDesaipsionl OTHER IYERS, JRn.Supervisor F. >1 qIN STREET JBG-PENNSYLVANIA I4U55 Jlal9fi6$_I n use any hems, we will lave to pay fur embalming will explain why below. i~ -~-~~3 r ~u t_D TOTAL MERCHANDISE SELECTED.... j_ ..... B S""' (J '? C. SPECIAL CHARGES: Fsravrding of remains w Ifunaal Hnme) Receiving u[ remains from f fFUneral Home) Immediue Burial .. { Direct Cremation., f C f SUR-TOTAL OF SPECIAL CHARGES D. CASH ADVANCED Opening Grave - Al 7 x`a'~' femnery F.yuipmem f_ f _ Lo[and Deed.. 7_ Newspaper Notices-Local 83,: Newspaper Notices-Ouoof-town... . 71 Telephone & Telcµrams 3~ Airfare s Clergy/Slus Offering .. . f~ _ Pallbearers f_ Certified (opts of the Dea~ ~~ ~ Cersifiate ~ a~. ... e f _ Police Esmn 7_. Flowers .sty Vault Sernee Charµe f _ sAl u~ __ . _ ~/ SUBTOTAL OF ADVANCES .............. D ~ (90 A3 3~r W< rhuge yav fa[ nut xervlces in obtaining: (sperijy crib adrnnres ibOr ure marked-up/ SUMMARY OE CHARGES B. CHARGE FOR MERCRANDt$E SELECTED: ey, A. Professional Srrvi<es, Facililirs and Casks ... 1~ ~ Equipment and Awomauve ~AAawbY /r ~C (Descri tion ~ OQ p ) Fquipmem _. 3 e / 4_ A ST~iL B. Men'handnr 1 B- other Recrpude .. f ~ C. Special (huge f IDesccipsion) D. Cash Ads arises f L~ ` 0p Tr TOTAL OF AI L SECTIONS ~ f(r : Outer burial amuiner 1 PAID AT TIME OE OR PRLOR 70 IDra'riptionl ARRANC.EMENiS. S BALANCE DIIE. 1 A'k >wlvilgemrm cards ~ Nj ON FOR EMBA NG ~ R givmr hookp7 . ... _~. Q __ V ! f n ~ F Mrmc ry folders If any taw, wm eery, or vrmmom rcyuiremenrs hav e eyuired the purchasr Pnyrr curds f ~ o[ any vl' the items lixred above the law or requirem e t is esplaineU below. 'temporary govt marker {~ _ ~~y_/~ Ilurial duthinµ 3~ __ (agree thatlhave rxamineJ the items ofgmsds mdservittsselecred shove andfovnd Themmhe avreu and acnxdinµ nitheamngenseneslhase m crested lacknowledge rcaipr rata copy of this Statemem of Funeral Goods a SaNfTS S~ICCted. I represen I have +ufl utm hinds :rvuiluhlr far pavmem of the ' ' O c sh prin fnr the goods and ten ues selected. I also ogre b»mkr/naymem 6(T with dos, I apme m he Jointly ants severvlh Iuh e of 7 ll~~ signs below A late char th i l uithy}Umr else who ~ . g per mon amount ng ro per vrar will be appGcd m the unpaid balam~e Mgi ~ n log S_(_ days from the date of rhla agreemem. 1 will also pray to the Funeral Dimnor all reasunahle costs paid hv the Funeral Dirraor m collect amoums 1 o w under Chu agreement. Those met may indudr vsorn<ys' tees, court costs and other rose, .{ray additional servims or mrrchandisr ordered car reyuen ahrr the da m of this agreement will bt mmidered pan of this agreement and the cast thereof will be reFlevud nn the final hill or xarement . J f5ea71 _ s A ~ ~~1.-<!V wnlTe :..,~.: o,s,~ vr.:.u:w <.,~..,~~.