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HomeMy WebLinkAbout01-12-10 15056051058 REV- ~ ~ O O EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number INHERITANCE TAX RETURN PO BOX 28060, O `~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 172-36-0856 01/13/2009 ~, 1 .3 d (C~ 4~ I Decedents Last Name Suffix Deced nt's First Name MI Chilton III John F (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Chilton Brenda......... T Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ 3g~' ~~~' - ~oq~~ REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW !(: 1. Original Return ,..,. 2. Supplemental Return ,..,.,..., 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ':°~ 4a. Future Interest Compromise (date of f:; ~, 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate - 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. litigation Proceeds Received ~~`:;"~ 10. Spousal Poverty Credit (date of death ~.N;,.... 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number James D. Flower Jr. Esq (717) 243-6222 Firm Name (If Applicable) r.,,~y _ _..... _. REGISTER VY.~LLS USE _ '"a Saidis Flower & Lindsay -_~. _~ ~ ` ~ _~ First line of address i+, , -~-: ~--, ~ `~ ;~ ~ f . _ , .) 26 West High Street s _ , ~ .__. d ~... Second line of address '~. ~ {-~ ;-~ ~ .: c ,_, `: r _-; +~ ~ ~_.! City or Post Ofi'ice State ZIP Code _ ~,'~ LED ,_,•~ ~ w Carlisle PA 17013 _ © ~ Correspondent's a-mail address: JflOWerJr@Sfl-IaW.COm Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAjURE OF PER N RESPO SIBLE ILING TURN DATE ,_ ~.' . _ _ A S _ - --~~ -~ U_ Q-- _ 1432 Pine Island VW, Mt. Pleasant, SC 29464 GNATURE OF PREPARER OTHE THAN REP ENTATIVE DATE - - ---- ~~-~ AD E S -- ~.___ 2 West High Street, Carlisle, PA 17 PLEASE USE ORIGINAL FORM ONLY 1 505605 1 058 Side 1 15056051058 J 15056052059 REV-1500 EX Decedent's Social Security Number decedent's Name: John F Chilton ........ .... 172-36-0856 .........~ . ~ ....... ~ _~..., .................~,_~.~ .,..._.........H ........ ~ .......... ~...., ~_..........~........._....._.._.. H~,~.. _....~. RECAPITULATION .....H..,~.... .. ..,. , w, .....,.., M~.......~.....,....._ ..,..... ~ ..... ..... . ........... 1. Real estate (Schedule A) . ............................................ 1. 58,000.00 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 8 Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) _.:;:°'m Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Y;:M.~:.f Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 13 58,000.00 9. Funeral Expenses 8 Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. 11. Total Deductions (total Lines 9 & 10) .............................. 11 0.00 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 58,000.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........ .............. • • ....,... ~ ....................... H~ ,......,....., .. ,.~, .. ,.._ . ~.........,..~.......~..._.._... _....._.,.~ w _,.._ ~,..m, ................~.,......~ . 14. 58,000.00 , .,~._.M,... ~..~......~...._.._ ..... AX 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 0 58,000.00. 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 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. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 SCHEDULE A Real Estate Decedent's sole property in the Commonwealth of Pennsylvania, was cone-fifth interest in real estate at 175 Meeting House Road, Carlisle, Pennsylvania. Contract sales price was $290,000., as demonstrated by the attached settlement statement, and decedent's one-fifth interest in said property as of the date of his death was $58,000. r• ,i ~ a. i r rt Vr LVHN: U.S. DEPARTMENT OF HOUSING ~ URBAN DEVELOPMENT 1.QFHA 2.QFmi-.. , 3. QCONV. UNINS. 4. QVA 5. QCONV. INS. 6. FILE NUMBER: 7. LOAN NUMBER: SETTLEMENT STATEMENT 1 8. MORTGAGE INS CASE NUMBER: C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are,shown. Items marked "(POCJ" were paid outside the closing; They are shown here for informational pu-poses and are not included In the totals. 1.0 3/98 (13488.1 LAWS/13488.1 LAWS/51) D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER: Kenneth L. Laws and Ann Clark Chilton Froehlich Priscilla W. Laws Estate of John Fry Chilton,lll 10 Douglas Court James Anderson Chilton Carlisle, PA 17013 Robert Wilson Chilton, Jr. Mary Sanborn Chilton Foote G. PROPERTY LOCATION: 175 Meeting House Road Carlisle, PA 17013 H. SETTLEMENT AGENT: Martson Deardorff Williams Otto Gilroy & Faller I. SETTLEMENT DATE: D b Cumberland County, Pennsylvania PLACE OF SETTLEMENT 10 East High Street Carlisle, PA 17013 ecem er 11, 2009 J. SUMMARY OF BORROWER'S TRAN SACTION K SUMMARY OF SELLER'S TRANSACTIO N . 101. Contract Sales Price 290,000.00 401. Contract Sales Price 290 000 00 102. Personal Pro a 402. Personal Pro e , . 103. Settlement Char es to Borrower Line 1400 4,797.75 403. 104. 404. 105. 405. r 106. Count /Tw .Taxes 12/12/09 to 01/01/10 16.26 / r 406. Coun /Tw .Taxes 12/12/09 to 01/01/10 107. School Taxes 12/12/09 to 07/01/10 413.75 407. School Taxes 12/12/09 to 07/01/10 16.26 413 75 108. Assessments to 408. Assessments to . 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 295,227.76 420. GROSS AMOUNT DUE TO SELLER 290 430 01 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE rn SF~ ~ FR• , . 201. De osit or earnest move 1,000.00 202. Princi al Amount of New Loan s 203. Existin loans taken sub'ect to 204. 205. 206. 207. 208. 209. us men s or terns n a~ a er 210. Coun /Tw .Taxes to 211. School Taxes to 212. Assessments to 213. 214. 215. 216. 217. 218. 219. 220. TOTAL PAID BY/FOR BORROWER 1,000.00 501. Excess Deposit (See Instructions 502. Settlement Char es to Seller Line 1400 503. Existin loans taken sub'ect to 504. Payoff of first Mortgage 505. Pa off of second Mort a e 506. 507. De osit disb. as roceeds 508. 509. ustmen s or terns n a/ a er 510. Coun /Tw .Taxes to 511. School Taxes to 512. Assessments to 513. 514. 515. 516. 517. 518. 519. 520. TOTAL REDUCTION AMOUNT DUE SELLER 300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SI 301. Gross Amount Due From Borrower Line 120 295,227.76 601. Gross Amount Due To Seller Line 420 302. Less Amount Paid By/For Borrower (Line 220) ( 1,000.00) 602. Less Reductions Due Seller (Line 520) 303. CASH (X FROM) ( TO) BORROWER 294 227.76 603. CASH (X TO) ( FROM) SELLER 6,012.50 6,012.50 -- 290,430.01 6,012.50, 284,41 6 HUD-1 (3-86) RESPA, HB4305 2 I •= . ~ACKN~. ~VLEDGMENT OF RECEIPT OF ° 'TLEMENT STATEMENT Borrower: Kenneth L. Laws and Priscilla W. Laws Seller: Ann Clark Chilton Froehlich Estate of John Fry Chilton, II I James Anderson Chilton Robert Wilson Chilton, Jr. Mary Sanborn Chilton Foote Settlement Agent: Martson Deardorff Williams Otto Gilroy & Faller (717)243-3341 Place of Settlement: 10 East High Street Carlisle, PA 17013 Settlement Date: December 11, 2009 Property Location: 175 Meeting House Road Carlisle, PA 17013 Cumberland County, Pennsylvania I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. 1 further certify that I have received a copy of the HUD-1 Settlement Statement. Kenneth L. Laws ~~_ Priscilla W. Laws //~'LC~[i ~ C7~~ n Clark Chilton Froehlich -_y1 nda T. Chilton, Individually and ~cutrix of the Estate of John Fry hilton, III ~ Jim nderson Chilton ~-` ~```'^' ~/ Robert Wilson Chilton, Jr. ~ ~1 ry Sanborn Chilton Foote To the best of my knowledge, the HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds which were received and have been or will be disbursed the undersigned as part of the settlement of this transaction. --. ~• Martson Deardorff Willia Otto Gilroy & Faller Settlement Agent WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. HUD-1 (3-86) RESPA, H64305 2