HomeMy WebLinkAbout01-08-101505607120
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue county code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO 60X.280601 21 0 8 10 5 6
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
10 03 2008 10 O1 1935
Decedent's Last Name Sufhx Decedent's First Name MI
KELLEY LOIS A
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
X^ 1. Original Retum ~ 2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
X g Decedent Died Testate ~. Decedent Maintained a Living Trust 1, 8. Total Number of Safe Deposit Boxes
(Attach Copy of III) - (Attach Copy of Trust)
9. Litigation Proceeds Received ~ 1 p, Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
TRACEY B . GRINESTAFF (717) 62 6 Oo2,91
Firm Name (If Applicable)
GIBBEL KRAYBILL & HESS LLP
First line of address
P.O. BOX 16
Second line of address
City or Post Office
LITITZ
Correspondent's a-mail address:
State ZIP Code
PA 17543
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REGISTEI~`WILLS l~ ONI~ `-
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DATE FILED '~
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.
SIGNATURE OF PE N RE PONSIBLE FOR FILING RETURN DATE
. ~, G a ~ i s ~ ~! , Debra A. Field 12 ~ ~ 4. /]G
ESS
~4~0~9 Lakeview Drive, Lititz, PA 17543
ATURE OF PREPARER OTHER THAN REPRESEN TIVE DATE
1C'l t (1. 1~. 61 ~ e<<~/ Tracey B. Grinestaff ~~ ~Q ~~
P.O. Box 16, Lititz, PA 17543
Side 1
1505607320 1505607120 J
J
REV-1500 EX
Decedent's Name: L O I S A. K e l l e y
Decedent's Social Security Number
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 8~ Notes Receivable (Schedule D) .......................................................... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5.
6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested ............. 7..
8. ( ) .......................................................................
Total Gross Assets total Lines 1-7 8.
192,950.00
23,042.91
77,207.42
2,337.50
295,537.83
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 5 2 x 2 7 1. 7 5
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 1 1 , 2 6 7 0 4
11. Total Deductions (total Lines 9 8 10) ...................................................................... 11. 6 3, 5 3 8. 7 9
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 2 3 1 , 9 9 9 . 0 4
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. 2 3 1 , 9 9 9 . 0 4
TAX COMPk1TATION -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 .00 0 0 0 15.
16. Amount of Line 14 taxable
045
0 4
9 9 9
2 3 1
16.
at lineal rate X . .
,
17. Amount of Line 14 taxable
0
0 0
17.
at sibling rate X .12 .
18. Amount of Line 14 taxable
18
at collateral rate X .15 0 . 0 0 .
19. Tax Due .................................................................. .................................................. . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
1505607220
0.00
10,439.96
0.00
0.00
10,439.96
Side 2
L 150560722 1505607220
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-08-1056
DECEDENT'S NAME
Lois A. Kelley
STREET ADDRESS
9 Kitszell Drive
CITY
Carlisle STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
p, Interest
E. Penalty
10,260.00
522.00
Total Credits (A + B + C)
(1) 10,439.96
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box 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.
(2) 10,782.00
(3)
(4) 342.04
(5)
(5A)
(5B)
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 :............................:..................................................... x
b. retain the right to designate who shall use the property transferred or its income :.................................... x
c. retain a reversionary interest; or .................................................................................................................. x
d. receive the promise for life of either payments, benefits 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 own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ 0
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)]. 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 EX+ (11-08)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which 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 relevant facts.
Real property which is Jointly-owned with right of survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Tract of land with dwelling thereon erected at 56 Partridge Circle, South Middleton 68,950.00
Township, Carlisle - as more fully described in Deed recorded in the Office of the
Recorder of Deeds in and for Cumberland County, Book 162, page 123. Value per
sale price. One-half value reported in spouse's estate.
2 Tract of land with dwelling thereon erected at 9 Kitszell Drive, South Middleton
Township, Carlisle - as more fully described in Deed recorded in the Office of the
Recorder of Deeds in and for Cumberland County, Book K-36, page 679. Value per
sale price. One-half value reported in spouse's estate.
124,000.00
TOTAL (Also enter on Line 1, Recapitulation) I 192,950.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08)
Rev-1503 EX+ (6-98)
SCHEDULE B
,.
STOCKS & BONDS .
CONMAONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 188 shares of Banco Santander, S.A. -one-half value 15.65 2,942.20
reported in spouse's estate
FIDELITY BROKERAGE ACCOUNT #614-456926
2 773.01 shares of Loomis Sayles Bond Instl -one-half 11.58 8,951.46
value reported in spouse's estate
3 370.852 shares of Pimco Total Return Fund -one-half 10.36 3,842.03
value reported in spouse's estate
4 22.183 shares of Dodge & Cox Stock Fund -one-half 91.95 2,039.73
value reported in spouse's estate
5 Fidelity Municipal Money Market -one-half value 5,267.49
reported in spouse's estate
TOTAL (Also enter on Line 2, Recapitulation) 23,042.91
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (8-98)
,~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
InGude 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
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 American Express -unused travelers checks 500.00
2 Genworth Financial -premium refund 456.76
3 Hoffman-Roth Funeral Home -refund 100.00
4 Members 1st Federal Credit Union CD Account #246784-46 -one-half value reported 5,615.70
in spouse's estate
Accrued interest on Item 4 through date of death 1.58
5 Members 1st Federal Credit Union Savings Account #246784-00 25.00
6 Orrstown Bank CD Account #4000026106 6,655.11
Accrued interest on Item 6 through date of death 7.65
7 Orrstown Bank Checking Account #402362 -one-half value reported in spouse's 2,191.07
estate
8 Orrstown Bank Christmas Club Account #450295 -one-half value reported in 480.00
spouse's estate .
Accrued interest on Item 8 through date of death 2.38
9 Sovereign Bank CD Account #1675206807 -one-half value reported in spouse's 5.033.64
estate
Accrued interest on Item 9 through date of death 2.69
Total of Continuation Schedules See attached
pa es
TOTAL (Also enter on Line 5, Recapitulation) 77.207.42
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev1508 EX+ (8-98)
SCHEDULE E
- ~ CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
CONMAON WEALTH OF PENNSYLVANIA continue d
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
10 Sovereign Bank Checking Account #0351059067 -one-half value reported in 106.39
spouse's estate
Accrued interest on Item 10 through date of death 0.04
11 Sovereign Bank Money Market Account #1674062206 -one-half value reported in 1,791.64
spouse's estate
Accrued interest on Item 11 through date of death 0.30
12 United States Treasury -Social Security payments for September (one-half value 399.00
reported in spouse's estate)
13 2000 Ford Mustang -value per sale price 3,500.00
14 Sovereign Bank IRA Account #1678179860 -beneficiary: estate 18,024.90
Accrued income on Item 14 through date of death 7.56
15 Sovereign Bank IRA Account #1678180355 -beneficiary: estate 10,559.31
Accrued income on Item 15 through date of death 7.24
16 Capital One Auto Finance Account #9117206 -refund 4.22
17 Department of Veterans Affairs - copay refund 12.53
18 Erie Insurance -personal injury claim (survival action) 20,000.00
19 Highmark Blue Shield -premium refund 98.98
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1508 EX+ (8-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMON WEALTH OF PENNSYLVANIA continue d
INHERITANCETAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
ITEM
NUMBER DESCRIPTION VAOF DEADHTE
20 Humana -premium refund 50.40
21 Sale of real estate -prorated reimbursement of taxes (Kitszell Drive) (one-half value 704.46
reported in spouse's estate)
22 Sale of real estate -prorated reimbursement of taxes (Partridge Circle) (one-half 416.37
value reported in spouse's estate)
23 Personal property -value per appraisal (one-half value reported in spouse's estate) 452.50
TOTAL (Also enter on Line 5, Recapitulation) ~ 77,207.42
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+ (6-98)
,.
COMMONWEALTH OF PENNSYLVANIA
INHERrfANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
If an asset waa made Joint within one year of the decedents date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Morgan Garrett c/o 409 Lake View Drive Grandchild
Lititz, PA 17543
B.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER
LETTER
FOR JOINT
TENANT
DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1 A before 2006 Chevy Cobalt 4,675.00 50.000% 2,337.50
2008
TOTAL (Also enter on Line 6, Recapitulation) I 2,337.50
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98)
REV-1151 EX+ (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A, FUNERAL EXPENSES:
See continuation schedule(s) attached ~ 6,493.44
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name(s) of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Gibbet Kraybill & Hess LLP 10,295.00
3, 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
4. Probate Fees 365.00
5. Accountant's Fees 348.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs 34,770.31
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 52,271.75
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Expenses
1 Debra A. Field -reimburse for funeral expenses 2,060.00
2 Hoffman-Roth Funeral Home -funeral services 3,930.00
3 Hoffman-Roth Funeral Home -air transport 503.44
H-A Subtotal 6,493.44
Other Administrative Costs
4 Bev Kelchner -resale certificate for Kitszell Drive 40.00
5 Carl Cecil -house repairs (Kitszell Drive & Partridge Circle) 326.23
6 Carl Cecil -house repairs (Kitszell Drive) 60.00
7 Cumberland Law Review -estate notice 75.00
8 Debra A. Field -reimburse for trash removal fee (175.00), carpet shampoo (106.00), 752.83
insurance deductible (60.00), long distance calls (52.00), car ad (31.00) and
gas/travel (328.83)
9 Erie Insurance -homeowner policy 386.00
10 Erie Insurance -homeowner policy 90.00
11 Erie Insurance -homeowner policy 251.00
12 Erie Insurance -homeowner policy 256.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
ITEM
NUMBER
DESCRIPTION
AMOUNT
13 Fidelity Investments -advisor fee; one-half value reported in spouse's estate 256.85
14 Gibbel Kraybill & Hess LLP -reimburse for expenses paid for personal injury 189.98
settlement
15 Gibbel Kraybill & Hess LLP -fees related to settlement of personal injury claim 4,500.00
16 Herman Plumbing -winterize Kitszell Drive 75.00
17 Herman Plumbing - dewinterize and repair master toilet at Kitszell Drive 74.60
18 Holechek Funeral Home -additional death certificates 55.00
19 John M. Hess Auction Service -appraisal fee 45.00
20 Lebo's Plumbing 8~ Heating -replace water heater (Partridge Circle) 1,117.00
21 Mayapple Village Homeowners Association - 2009 dues for Patrdge Drive 95.00
22 Met-Ed -electric service during estate administration 30.37
23 Met-Ed -electric service during estate administration 30.48
24 Met-Ed -electric service during estate administration 22.78
25 Met-Ed -electric service during estate administration 21.67
26 Met-Ed -electric service during estate administration. 20.24
27 Met-Ed -electric service during estate administration 17.64
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF ~ FILE NUMBER
Kelley, Lois A. 21-08-1056
ITEM
NUMBER
DESCRIPTION
AMOUNT
28 Met-Ed -electric service during estate administration 22.04
29 Met-Ed -electric service during estate administration 20.16
30 Met-Ed -electric service during estate administration 55.98
31 Met-Ed -electric service during estate administration 21.81
32 Met-Ed -electric service during estate administration (final) 26.13
33 North Middleton Township -water/sewer for Partridge Drive 82.30
34 North Middleton Township -water/sewer for Partridge Drive 93.49
35 North Middleton Township -water/sewer for Partridge Drive 82.30
36 North Middleton Township -water/sewer for Partridge Drive 82.30
37 North Middleton Township -water/sewer for Partridge Drive 82.30
38 North Middleton Township -water/sewer for Partridge Drive 104.68
39 Ocean Pines Ownership Association -timeshare annual fee 445.00
40 Ocean Pines Ownership Association -remaining fee 11.51
41 Register of Wills -additional short certificates 40.00
42 Register of Wills -exemplification of record 40.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
ITEM
NUMBER
DESCRIPTION
AMOUNT
43 Register of Wills -exemplification of record 40.00
44 Reserve for closing costs 900.00
45 Rick's Towing -removal of vehicle 200.00
46 Sale of real estate -settlement charges (Kitszell Drive) (one-half value reported in 9,069.20
spouse's estate)
47 Sale of real estate -settlement charges and seller assist (Partridge Circle) (one-half 6,437.38
value reported in spouse's estate)
48 Seawatch Island Club -timeshare annual fee 637.00
49 South Middleton Township Municipal Authority -water/sewer for Kitszell Drive 101.00
50 South Middleton Township Municipal Authority -water/sewer for Kitszell Drive 101.00
51 South Middleton Township Municipal Authority -water/sewer for Kitszell Drive 101.00
52 South Middleton Township Municipal Authority - waterlsewer for Kitszell Drive 101.00
53 The Sentinel -estate notice 150.64
54 Thomas H. Orlousky -painting at Partridge Circle 2,662.80
55 Thomas H. Orlousky -painting at Partridge Circle 230.00
56 Thomas H. Orlousky -painting at Kitszell Drive 2,118.50
57 UGI -household fuel during estate administration 202.61
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
ITEM
NUMBER
DESCRIPTION
AMOUNT
58 UGI -household fuel during estate administration 223.08
59 UGI -household fuel during estate administration 202.75
60 UGI -household fuel during estate administration 50.89
61 UGI -household fuel during estate administration 20.37
62 UGI -household fuel during estate administration 37.39
63 UGI -household fuel during estate administration 23.21
64 UGI -household fuel during estate administration 23.21
65 UGI -household fuel during estate administration 23.21
66 UGI -household fuel during estate administration 38.79
67 Woody's Lawn Care -yard care 239.45
68 Woody's Lawn Care -yard care 107.00
69 Woody's Lawn Care -yard care 140.00
70 Woody's Lawn Care -yard care 137.44
71 Woody's Lawn Care -yard care 111.72
72 Woody's Lawn Care -yard care 140.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
ITEM
NUMBER DESCRIPTION AMOUNT
73 Woody's Lawn Care -yard care 112.00
74 Woody's Lawn Care -yard care 89.00
H-67 Subtotal 34,770.31
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev1512 EX+ (12-08)
SCHEDULE 1
. DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
~.tucomA.lrc re V DCT ID~I
ESTATE OF FILE NUMBER
Kelley, Lois A. 21-08-1056
Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, Including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Capital One Auto Finance Account #9117206 9,412.43
2 Capital One MasterCard Account #5291-4920-8273-2138 687.57
3 Capital One MasterCard Account #5291-4920-8273-2138 -finance charge 2.51
4 Checks clearing personal account after death -one-half value reported in spouse's 235.21
estate
5 UGI -household fuel; one-half value reported in spouse's estate 17.18
6 Washington Mutual Credit Card Account #4185-6407-8932-5083 912.14
TOTAL (Also enter on Line 10, Recapitulation) I 11,267.04
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-1513 EX+ (11-08)
OMMONWEALTH OF PENNSYLVANIA
C INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Lois A.
Kelley,
NAME RED E V NG PROPERTY
NUMBER PERSON(S)
TAXp,BLE DISTRIBUTIONS [include outright spransfers
distrib Sec. 911 (a)(1.2)]
j, under
Debra A. Field
409 Lakeview Drive
Lititz, PA 17543
Pamela S• a Circje
56 Partridg
Carlisle, PA 17013
FILE NUMBER
21-08-1056
RELATIONSHIP TO SHARE OF ESTATE AMOUN ($$$)ESTATE
DECEDENT (Words)
Do Not List Trustee(s)
Daughter 50% ~f residue
Daughter 150% of residue
I I Total
h 18 on Rev 1500 cover sheet, as appropriate,
Enter dollar amounts for distributions shown above on lines 15 throug ~ IS NOT TAKEN
NON-TAXABLE DISTRIBUTIONS.
TRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO
II A. SPOUSAL DIS
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
.......
_TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVm PA-1500 Schedule J (Rev. 11-08
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BENEFICIARIES