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HomeMy WebLinkAbout11-04-09J 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year Bureau of Individual Taxes ~ INHERITANCE TAX RETURN PO BOX 280601 ~ ~ 0 Harrisburg. PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death ~ ~~ ~ 0o5zoo~, Decedent's Last Name Suffix C C~O~~ MRS (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return File Number Date of Birth a3 i 4t ~ ~ Decedent's First Name MI ~~~A '~ Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return 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 Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) Litigation Proceeds Received O 9 (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death O under Sec. 9113(A) a 11 • . between 12-31-91 and 1-1-95) O Attach Sch ( ) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number Name c C R ~g ~ c~ ~ ~ N. ~ Y ? t '? ~ ~ '? ~ ~ ~ Firm Name (If Applicable) REGISTERe„O~F WILLS USF~QjpILY c~-s ~' ':'t'~ . .~ F' , i ;- ~~ d <""" ~ ~.~ .' First line of address ~C ~ _~~ ~ ~ p ~ L T 0 ~ __~ Second line of address {.°{;~ -~ ~ ~~,t ;~. FILED ;;' r:.... r`'+~ City or Post Office State ZIP Code .... :..? ~~ c,~m~ ~ ~ ~ ~ ~~0~ ~ '~~z3 Correspondent's a-mail address: ~ Under penalties of perjury, I declare that I havof ee areeo her thaun the persogal rep esentati a is based on alit nfo mation oawhich p epa er,has any knowledge lief, it is true, correct and complete. Declaration p p DATE SIGALBTU,RE OF PERSON~E~SPOQdST~LE FOR FILING RETURN ; ~ ~ r1 3 _ ~~ ADDRESS l ` ~ t C ` ~ DATE PREPARER OTHER THAN REPRESENTATIVE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 15056051047 Side 1 1505605104? J ~P J 15056052048 REV-1500 EX Decedent's Social Security Number ' s Name: Decedent RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. • 2. Stocks and Bonds (Schedule B) ....................................... 2. ---_ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. 9 9 ( ) ............................. Mort a es 8~ Notes Receivable Schedule D 4• l E d 5 ~ l ~ ~ " 5. ) ........ u e h Bank De osits & Miscellaneous Personal Property (Sche Cas p . 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. -_~... ~ 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. ~ 8 ~ ` -l ~• J 8. Total Gross Assets (total Lines 1-7) .................................... . 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. ~ !''~ ~ ~ ~ * ~ I 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. ~ ~ g• 11. Total Deductions (total Lines 9 & 10) ................................... 11. ~ ~ l ~9 • v 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. l ~ ~ ~• 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. • 14 L ~ ~ ~• 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ . ,~~ ~, 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 .0_ 15. 16. Amount of Line 14 taxable // at lineal rate X .0 ~ (D ~ • 2 d 16. ~ 8 17. Amount of Line 14 taxable at sibling rate X .12 ` 17. 18. Amount of Line 14 taxable at collateral rate X .15 ~ 18. 19. TAX DUE ......................................................... 19. e 8.2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O _~ ~ ~~ ~~ t__._~ ~- ~`~ ` _- .~ 15056052048 Side 2 15056052048 J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME STREETADDRESS Q _ ~.r ~~~-_ __~_-~ cee`~_ ., ~.~_Q c-_ C ol`~-Q _ _._ ______ __ _ __ CITY ~'` T STATE ~ ~ ;ZIP ~~ l ~ h/1 ~ ~ ~ ~ ~ ~~ Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit ___ B. Prior Payments C. Discount 3. InterestlPenalty if applicable D. Interest E. Penalty ~+~ ~ ~ . ~ U Total Credits (A + B + C) (2) ~ Total Interest/Penalty (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, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) t (4) (5A) (5B) Co 8.2 O 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 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 care? ...................................................................... ^ 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 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 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 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. §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)]. 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 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 natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. 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)]. 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)(1.3)]. Asibling 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•1508 EX + (1.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETl1RN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER ~ll~, ~. ~~Qw~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH B '~, ~~~•3'? TOTAL (Also enter on line 5, Recapitulation) $ ~ ~ ~ ~ 3 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) SCFIEDVLE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ~ ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. /^1 ~ ~ a~`Q- ~ 1 ~~ l.~ ~ ~~ T ~ ~ ~ ~YIR.~.Q P ~ ~ ~~3"2O 1 t`~'V'~ , ~ O `~ ~~. ~~ ~ W ~ cs~ ~~-t~ - PR ~ D .~ B. 1 2 3 4 5 6 7 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach~explanation) Claimant Street Address City State Zip _ ____ _ Relationship of Claimant to Decedent Probate Fees ~~~~t ~ ~~1l,.QQ,~~ ~~ Accountant's Fees Tax Return Preparer's Fees '"l "1 ~ C~ TOTAL (Also enter on line 9, Recapitulation) I $ ~ O 3 8 , (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size} ,,....a..,.~ N N m n m ro ~+ M O n ti tD M H m d n ~ n tD d rt~ ~ ~ ~ ~ 'd ~ ~K ~ ~~ ~~ ~ ~- ~,~ NN ?OM H n ~ n- x .~ x r L~3 ~ r ~ ~ ~ d~ r ~o a "~ H ~~ ~ ~~ ~ ~r ~ z~ ~o ~ m~ ~~ o ~ ~ ~ .. ~ ~ r ~ ow ~ ~.. ao ~ N W N ~p OD O F~ t!t .~ *p ~P ~' ~ aG ~ :* N 'b ~ W ~j O `J ~'1 N `` . ~i1 `O O ~ ~ M , .. O H ~+ Q N W 10 Send Ingwres to' S~ 5000 Louise Drive PO Box 40 Mechanicsburg, PA 17055 www.memberstst.org 1-Asin Switchboard: (800) 283-2328 EZ Csll: (717) 697-4372 or (800) 283-4372 TDD: (717) 697-5312 or (800) 283-2328 ext. 5312 ® TileBrench: (800) 237-7288 MEMBERS 1st FEDERALCREDIT UNION 4288 1 AV 0.324 8575-428£3 •~ I~~~III~~~lll~~~~~rll~r~ll lrr~l~l~lr~~l~l~rll~ll~~rr~i~l~~~lll ~! ELLA B CROWE ~ 1502 LETCHWORT N H ROAD ~ CAMP HILL PA 170 11 ~, ~ ~~ o~ .~ Statement of Accounts Aug 25, 2008 thru Sep 24, 2008 Account Number : 269102 Account Balances at a Glance Checking : 1,360.74 -- Savings : 1,893.62 Certificates : 0.00 ---- Loans: 0.00 Money Management : 239.13 Page : 1 of 2 Your current Member Loyalty Rewards level is Silver. Your aggregate balance as of September 1st is 53,559.91. An aggregate balance of 615,000 and having 3 products will move you to the Gold level. Access over 25,000 surcharge-free ATMs in the United States. See the enclosed insert for more details. 0 5 ~~~ CHECKING ACCOUNTS 11 - CHECKfNG Dote Tnut~saction Descrbtion Additlons Subtracilons 8alanoe At~g 25 Fotnv~evtd 489 , 96 Sep 03 Deposit Transfer From Share 00 1,004.00 1, 473.96 Sep 09 Withdrawal ACH BANKERS FIDELITY 396.00- 1, 077.96 TYPE: BANKDRAFTS ID: 4580658,963 CO: BANKERS FIDELITY Sep 17 Deposit Members 1st Online Transfer From Share 00 1.500.00 2,577.96 Sep 19 Check 000182 Tracer 0001061374 18.56- 2,569.41 Sep 19 Check 000181 Tracer 0001276238 1,198.87- 1,360.74 Sep 24 Erndirx~ 1,380.74 CHECK SUMMARY 000181 1,198.67 Sep 19 000182 18.56 Sep 19 2 Ch~er.~ !a(eMVed fix f,21T.22 SAVINGS ACCOUNTS ;= 00 -REGULAR 3AVING3 >r Date Trarlsactbn Deer~iDi~n__ _~ A~dditlons Subtractlona Q Aug 25 Fot+ward ~: ~ - Aug 25 Deposit ACH tNG USA AN ULTX.~. TYPE : GALSG ID: 'f~ AMITY Aug 31 Deposit Dividend 1.00096 -~ ~ - ~ - ~ -~ n ~4~nuav Perlc~elnllitgle YAelid E~Imdtd t. AOIOX l ~~11~111d' 1~8~311,~I61B Sep 03 Deposit ACH SOC SEC ID: 30310380©0 CO: SOC SEC Sep 03 Withdrawal Transfer To Share 11 Sep 17 Withdrawal Members 1st Online Transfer To Share 11 Sep 19 Deposit ACH ING FIN SER 406 TYPE: GALSG ID: 1410991508 CO: ING FIN SER 408 Sep 24 Endbwg- Be/erxaa 2,75A.88 88.87 2,848.73 2.OA 2,860.82 1,004.00 3,864.82 1,004.00- 2,860.82 1,500.00- 1,350.82 542.80 1,893.82 1,893.62 - - - Continued on fo{lowing page - - - ~ Send Inquues to: Main Switchboard: (800) 283.2328 5000 Louise Drive ~ Call: (717) 697-4372 or (800) 283-4372 PO Box 40 TOO: (717) 697-5312 or (800) 283-2328 ext. 5312 ,,,,-•,.• AUg 25 , 2008 thru Sep 24 , 200$ . Mechanicsburg, PA 17055 Account Number : 269102 •1r1EMBERS>r www.membenlst.org TMeeranch: (800) 237.7288 Pa(~p 2 of 2 Mq~Y.I/M Vfl. y~ 05 -MONEY MANAGEMENT _ Date Transaction Description Additions Subtractions Balance _~ Aug Z5 Balance Forward 239.08 Aug 31 Deposit Dividend Tiered Rate 0.05 239.13 Annul Percentage Y,~td Eamed 0. Z'r.~16 hrorn AB/01/ZgQB thrlvugih U8/31/ZrAAB - +~ Sep ?4 Enda~g ~Aence 239.13 aaa„~ ~_ N ~~ N~ Y'TD SUMMARIES V TOTAL DIVIDENDS PAID ~~ 00 REGULAR SAVINGS 14.17 + as ~ 05 MONEY MANAGEMENT 0.40 11 CHECKING 0.00 Total Year To Date Dividends Paid 14.57 NOTE : Total includes closed shares Don't forget about our new Member Loyalty Rewards Program. The mode products you have with us, the more benefits you'I[ receive. Ask an associate for details or visit our website at www.membsrslst.or9 for details. ~2~ .~ ~ ~~c t I ~ ~ . ' _`' ~; ~ /, .~ ~ ~- CASKET DIVISION YORK "~~d CASKET .................................................................................................................................................... FOR THE LOCATION NEAREST YOU, CALL 800.223.4964 m.~-Q.9~.~.~~. a01~(o~.e I titr~~~art Ilar~l~. I'h.l~. `i~i~~r r~~i--r. I--lu~ I ( lir~-i k. RI 11i~. t ~~~~~ ~ n ____.__ O __-- . _ ____ __._-- l:Villlge(iC~il l.Uthefllll Church ~~~i~i ~~i i~~~i~•r l ~u~ .ti. I ~Itiii~t--n. Ir.. 11.l ~. ~o -a1-o$ ~y70B ~7~c~3~.o October 16, 2008 Mrs. Becky Enney 1502 Letchworth Rd. Camp Hill, PA 17011 INVOICE Charges for the Ella Crowe funeral meal: Total cost of meal Total amount due Q~~-L1 ''-!~ $Z63.Z0 If you have any questions about this invoice, please feel free to call me at the church. T ank you, ~ ~ Paul Hensel Financial Administrator 2000 Cheslnu~ ~lrect, Camp Hill, f cnnsyl~-aria 1701 i~ii~~tii: 717.737.t~fi35 • r.~~ 717.730.y2~)7 • ~:-~~.~~~ trinluthC?trinity~am~hilL~~r~; • ~~~~;~~~~ www.~rinityc~u111~hill.~~r~; r~ RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 10/17 2008 Cumberland County - Register Of Wills Receipt Time: 09: 2:04 One Courthouse Sqquare Receipt No.: 1054386 Carlisle, PA 17Q13 CROWE ELLA B Estate File No.: 2008-01038 Paid By Remarks: CJBECCA ENNEY ------------------------ Receipt Distrib ution --------------------- --- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 20.00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 5.00 CUMBERLAND COUNTY GENERAL FUN JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN Check# 4705 $ 40.00 Total Received......... $ 40.00 ~~ .% /' RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sgqware Carlisle, PA 17Q13 CROWE ELLA B Receipt Date: 10/20/2008 Receipt Time: 14:42:58 Receipt No.: 1054426 Estate File No.: 2008-01038 Paid By Remarks: ~BECCA ENNEY ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 4.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 4707 $4.00 Total Received......... $4.00 .,, ~• y c `. ~' REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS ADMINISTRATION No . 2008- 01038 PA No . 21- 08- 1038 Estate Of : ELLA B CROWS (first, Middb, Lestl Late Of : CAMP HILL BOROUGH CUMBERLAND COUNTY Deceased Social Security No: 194-36-4573 WHEREAS, ELLA B CROWS /First, Middle, Lull late of CAMP HILL BOROUGH CUMBERLAND COUNTY died on the 5th day of October 2008 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 1I s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, have this day granted Letters of Administration to: REBECCA C ENNEY who has duly qualified as ADMINISTRATOR (RIX) of the estate of the above named decedent and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 17th day of October 2008. i egtster o I uty * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) i ~£ HCR ManorCare MANORCARE HEALTH SERVICES -CAMP HILL 1700 MARKET STREET CAMP HILL, PA 17011 (717) 737-8551 Rebecca Enney 1502 Letchworth Rd. Camp Hill, PA 17011 Ella Crowe ,, ~ . r: 10/01 /08 Private Portion 10/1-10/5/2008 08/28/08 Beauty and Barber 08/28/08 Beauty and Barber Credit ~_ ~~- .~z~~ # 2221 $624.08 $26.00 PAYMENT DUE UPON RECEIPT $ 12.00 o`~ ,.~' .o $650.08 $ 12.00 AMOUNT DUE $638.08