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Home My WebLink About09-23-09w J REV-1500 EX (OB-05) PA Depatlmenl of Revenue Bureau of Individual Taxes PO Box 280501 Harrisburg, PA 17128.0801 15056041169 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN ~~~~jj Q RESIDENT DECEDENT ~.~' V'f DO ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 201-07-4664 080120 09 07071919 Decedent's Last Name Suffix Decedent's First Name MI MACFARLAN AGNES R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffx Spouse's First Name . MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE BOXES BELOW ® 1. Original Re[urn ~ 2. Supplemental Return ~ 3. Remaintler Return (date of death prior to 12.13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Fetlerel Estate Tax Return Requimd tleath alter 12-12-52) ^X e. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 0 5. Total Number of Sefe DeposN Boxes (Attach Copy of wllq (Attach Copy of Trust) 9. Litigation Proceetls Received ~ 10. Spousal Poverty Credit (date of tleath ~ 11. Election to tax under Sec. 8113(A) between 12-31-91 and 1-1.95) (Attach Sch. O) CORRESPONDENT -THIS SECTH)N MUST BE COMPLETED. All CORRESPONDENCEAND CONFIDENTIAL TAX INFORMATION SXOULD BE DIRECTED T0: Name Daytime Telephone Number JEAN M GRIFFITH rv C ~ .~ Firm Name (If Applicable) -r ~ c~D ~:~ ~>e: ' -~, -- First line of address 428 MEADOW DRIVE Second line of address City Or Post Office CAMP HILL S U r- NLY .-!.. o~ - :a7 ~ :I r_ 7 c j ~ r7 _ T ~' P i `Ti - . ~ _ -o --+ -- i -~ n N ~- r v StatO ZIP Code ~ DATE FILED PA 17011 Correspontlent's a-mail address: Under penalties of perjury, I declare that I have examinetl this return, including accompanying schedules and statements, and to the beat of my knowledge and belief it iq,kua,~corcect and complete. Declare~n of greparer other than the personal reprasentaUve is based on all information of which preparer hae any knowledge. S NATO OF PERSON,F~SPON$ ~OR FI ING R TURN pgyP I ~ O ^ 4 EADOW DRIVE ,C ILL PA 17011 %~/D 176 CUMBERLAND PKY MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041169 15056041169 J ~/ ~~ 15056042160 REV-1500 EX Decedent's Social Security Number Decedent's Name: AGNES R MACFARLAN 2 01- 0 7- 4 6 6 4 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. Mortgages & Notes Receivable (Schedule D) ............................. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... .. , . 5. 1 , 2 7 5 . 0 0 8. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ... .... 6. 19 , 4 3 7 . 7 0 7. Inter-Vvos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ... .... 7. 8. Tofal Gross Assab (total Lines 1 - 7) ............................... .... B. 2 0 , 712.7 0 9. Funeral Expanses & Administrative Costs (Schedule H) ................. .... 9. 1 , 8 9 6 . 3 7 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ............ ... 10. 11. Total Deduetlons (total Lines 9 & 10) ............................... ... 11. 1 , 8 9 6 . 3 7 12. Net Value of Eafate (Line 8 minus Line 11) ........................... ... 12. 18 , 816.3 3 13. Charitable and Governmental BequeatslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 14. Net Value SubJeet to Tax (Line 12 minus Line 13) ...................... .. 14. 18 , 816.3 3 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~ 18 , 816.33 16. 846.73 17. Amount of Line 14 taxable at sibling rata x .12 17. 18. Amount of Line 14 taxable at collateral rate x .15 18, 19. TAX DUE ........................................................ 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 846.73 Side 2 L 15056042160 15056042160 J REV-1500 EX Pape 3 Decedent's Complete Address: Flle Number DECEDENT'S NAME A nes R MacFarlan STREETADDRESS 208 Senate Ave A t 103 CITY Camp Hill STATE PA ZIP 17011-2352 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 42.34 Total Credits (A + B + C) 3. InterestlPenalty 0 appliceble D. Interest E. Penalty Total InteresUPenaOy (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill In box on Page 2, Llne 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 + SA. This is the BALANCE DUE. (1) 846.73 (2) 42.34 (3) 0 . 0 0 (4) (5) 8 04.3 9 (5A) (5B) 8 0 4. 3 9 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 transferted : ........................................ .. ^ 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, benefts or care? .............................. .. ^ x^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ......................... ........................ .. 3. Did decedent awn an "in trust tor' or payable upon death bank account or security at his or her death? ... .. ^ 4. Did decedent own an Individual Retirement Acceunt,annuity, orother 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 p2 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 fling a tax return are still applicable even if the surviving spouse is the only benefciary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers horn 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 def ned, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1505 EX+ (5-88) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER s R MacFarlan )amore space is nee0e0, insert atltlilional shaeb ofthe same sae) REV-1509 EX« (8-BB) SCHEDULEF COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Agnes R MacFarlan If an easel waa made Joint within one year of the tlecedent'e date of death, It must be reported on Schedule G SURVIVINGJOINT TENANT(S)NAME I ADDRESS RELATIONSHIPTO DECEDENT A. Jean M Griffith 8. C. 428 Meadow Drive Camp Hill PA 17011 JOINTLYAWNED PROPERTY: REM NUMBER UTTER FOR XNM TENANT DALE MADE JDINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCW.INSTTNTION ANO BANK ACCWNi NUMBER ORSNIIAR IOENnFYING NUMBER ATTACH DEED FOR JOINTLY~HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECO'3 INTEREST DATE OF DEATH VALUE OF DECEDENT'S NTEREST t• A. M&T Bank CD #31003918449157 5,005.14 50.0 2,502.57 2 A M&T Bank CD #31003918449165 5,005.14 50.0 2,502.57 3 A M&T Bank CD #31003918449173 5,013.58 50.0 2,506.79 4 A M&T Bank CD #31003918449181 5,013.58 50.0 2,506.79 5 A M&T Bank CD #31003918449199 5,013.58 50.0 2,506.79 6 A M&T Bank CD #31003918449206 5,016.95 50.0 2,508.48 7 A M&T Bank CD #31003918449214 5,016.95 50.0 2,508.48 8 A M&T Bank Checking #9844887522 3,790.45 50.0 1,895.23 TOTAL (Also enter on line 6, Recepdulation) I S 19 , 4 3 7 . 7 0 (If more space is needed, inaen addhional sheep of the same size) REV-1511 EXi (10-d8) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCETAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Agnes R MacFarlan Debb of decedent mwt be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Hetrick Cremation Services of Central PA 1,721.37 B. 1. ADMINISTRATIVE COSTS: Personal RepresenWtNe's Commissions Name of Personal Representative(s) Street Address Ciry Year(s) Commission Paid: Slate ZIP 2. Adorney Fees 3. Famiry Exemptbn: (Ifdecedent's address is not the same as claimant's, aMach explanation) Claimant 4. 5. 8. 7. Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees Accountant's Faes Taz Return Preparer's Fees 175.00 TOTAL (Also enter on line 9, Recapitulatlan) 5 1, 8 9 6 . 3 7 (If more space is needed, insen additional sheets of the same size) REN1513 EX+ (11-08) ~ Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES 0.ESIDENT DECEDENT ESTATE OF Agnes R MacFarlan FILE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not Llat Truatee(a) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).) 1. Jean M Griffith Daughter 100$ 428 Meadow Drive Camp Hill PA 17011 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NONTAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARRABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART A -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV•1500 COVER SHEET. ; Ir more space is needetl, insert additional sheets of the same size, ~5 LAST WILL AND TESTAMEN'P OF I~ Agnes R, MacFarlan , a resident of the STATE OF _Pennsylvanla COUNTY OF Dannh;n being of sound mind and memory, dQ hereby declare that this is my will. My Social Security number is: 201-D7- K6 . FIRST: I revoke all previously made. SECOND: Ii~ive, dev husband illiam T. THIRD: In the event survive me by sixty (60) My daughter, (Mrs.) Jean former wills and codicils that I have ise, and bequeath all of my estate to my MacFarlan that my husband shall predecease or fail to days, I give all my estate to: M. Griffith in equal shares, or should any of them predecease me, to their issue per stirpes. FOURTH: I direct all my just debts and funeral expenses be paid as soon as possible after my death. FIFTH: I name my husband William T. MacFarlan to be personal representative (Executor) of this will. If he shall predecease me or decline, or for any reason fail to qualify or cease to act as personal representative, I name 7Aan ~~ ~ as personal representative, without bond, instead}th SIXTH: I hereby empower my Executor to sell property, real or personal, for cash or on time, without an order of Court, at such time and upon such terms and conditions as shall seem best. (a) 3.J_T. Er.tarpziswa ~ /f / I ~ li.t/~S / `. /t'l,~e ~21,,J „' the testator, sign my nAme to this w~13, consisting of ~^ pages, this a.~ day of p-/_ ,~e~:, 19 97. Being duly sworn, I declare to the undersigned authority that I sign this document as my last will, that I sign it willingly, and that I execute it as my free and voluntary act for the purposes therein expressed. I declare that I am of the age and majority or otherwise legally empowered to .make a will, and under no constraint or undue influence. (Signed) We, the witnesses, sign our name to this document, and we declare under D~nalty of perjury, that the foregoing is true and correct, this ,~~7 day of ]YICw~,,L,- , 19 ~ . residing at: 38b3 1 f x~, r, ~br.,,~ ~~ XY>7.y i.v, ~ 17/U~ ~ ~ Ce ~ - residing at: a t.~/ ' ~ /7/~ ~ ~~-- // residing at: _p,3 ~+i~.~~ ~~i,,>` .y~U ~~S} * FOR NOTARY PUBLIC THE STATE OF ~ ~~ ~~'/`~ _ _ , COUNTY OF Subscribed, swo rn to and acknowledged be fore me by and, and witnesses, personally known to me (or proved to me on the basis of satisfactory evidence to be the persons), this day of _ _ 1g , Official Capacity of Officer NDTARIALSEAL WALTER L. WINCH, Notary Publlc SusquehannaTwp., Dauphin County My Commission Expires Juty 5.1997 '"RiW~ (o) a_J.T. ant~rDZi~~s m~ ¢ d ~ - "N M~ N Jam' M OOJ~ •Z N p.rrr-iON~ ~~o ¢¢I~N= ~o •2 0 N = W¢ ~ ¢ N U ~~ M ~~ o r `~3 \ \ 1 ~'f