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HomeMy WebLinkAbout01-21-10 15056051058 REV-1500 EX 06 05 ( - ) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN _----_ _ , _ _-- _ ~ _..__ ___ Harrisburg, PA 17128-OSOt RESIDENT DECEDENT 21 08 j 1168 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 022-24-8798 1 12 /23/08 7/5/32 Decedent's Last Name. _ Suffix Decedent's First Name MI __ _ - Gordon - - - __ _- _ l ~ __.~ l __, l Catherine H - (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ', _.._ . - -- _ ___ _ Spouse's Social Security Number _._- __ (____ -_-1 __ ___ _ _ ._ _ I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (~ 1. Original Retum C~ 2. Supplemental Retum C~ 3. Remainder Retum (date of death prior to 12-13-82) CJ 4. Limited Estate O 4a. Future Interest Compromise (date of C~ 5. Federal Estate Tax Return Required death after 12-12-82) O 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 O 10. Spousal Poverty Credit (date of death C~ 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 T0: Name Daytime Telephone Number Bradford Dorrance, Esquire j ~ (717) 255-814 _ Firm Name (If Applicable) ---------------__.__-- -----------.-, ,_ ___. _ _ _ ___ _ _ REGISTER OF WILLS USE ONLY ~ KEEFER WOOD ALLEN & RAHAL, LLP _ _--- _ ~ First line of address - C ~ o -, ; , r i _..._ __._...._.. _.... -... ..---1 . -210 Walnut Street ' ~' ~ ~? ~ ~ j`y J Second tine of address _ _ _. . - -. ~ m N r ~ ~ ____. __ _.._. ___ - - , ' 1 r ' i P.O. Box 11963 ~ ~c~C-~ ~ ; City or Post Office State ZIP Code ~„ D LE~a ------ - - _ - - _ _ H i -.. _ _ ----- ________„~ • - --i ~ ~ - _ _ _ ~ -- .: t-r-t ~ < ~ ~ ~ arr sburg __ _ . 17 1 08-19 i PA 63 ~ ~ ; ~ - . ._ . ___ ...-_._ Correspondent's a-mail address: 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 PERSON RESPONSIBLE FOR FILING RETURN DATE L nn M. Toland ~~ ~~.,-..,,.Z_ ~.-~ ~ _~v ADDRESS 1003 East Coover St., Mechanicsburg, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE Bradford Dorrance, Esquire v~•--L 1 ~"20 ~1 0 ADDRESS 210 Walnut St., P.O. Box 11963, Harrisburg, PA 17108-1963 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: Gordon, Catherine H. ' 022-24-8798 RECAPITULATION ~~ _ __ _ __ _ 1. Real estate (Schedule A) ............................................. 1. $61,133.38 ..................... 2. I _.._._____._.___-____.__. .__.~.._.____..__... 2. Stocks and Bonds (Schedule B) .................. ' $ 549.53 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. $ 3, 086.59 r._.._.___..._...____..___ 6. Jointly Owned Property (Schedule F) chi Separate Billing Requested ....... 6. ~' $ 5, 933.68 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~--~-----------____._. (Schedule G) G Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. i $70, 703.15 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9• ' $15 , 459 0~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. $28, 677.47 11. Total Deductions (total Lines 9 & 10) ................................... 11. ! $44, 136.65 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12 j $26, 566.50 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. ; $26, 566.50 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ____ 15. Amount of Line 14 taxable at the spousal tax rate, or trans ers un er Sec. 9116 , 16. Amount of Line 14 taxable ~ ~ '`~~~'-~"--'`"~"~`-""" at lineal rate x .0 45 $1,195.49 16. % $ 1,195.49 17. Amount of Line 14 taxable I ~_~~~~~«~ °---___~.'__.._ „._~.__._.._.._.____..._ at sibling rate X .12 ' : 17, j ~ .___._.._______._._.~____.._._.r_~___ 18. Amount of Line 14 taxable '~`""~_._.___.___ _ ,_..._....___..._______ at collateral rate X .15 ' 18. 19. TAX DUE ......................... ........................... .....19.,.,•$1,195.49 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: _.. _ FlleNumber_.._.___.,_______._ ~21 ~~08~; 1168 ~ DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Gordon, Catherine H. 022-24-8798 STREET ADDRESS 29 Southmont Drive CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 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. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. 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. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT ._... ,._>. r sir, ,,..~.. c~t~.~,~ .~ ~..a~~.. `MT;~,.'~ .. __.. ~..~r-3.:, k5 .~r;,. ,. 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 "intrust 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. ~7 Cl `~ a. '>~ ... .. .. ~ .. F . K'P ., .f: , rn. . 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)J. 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 (O) 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)j. 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-1502 EY,i-(11-OII) ~~~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Gordon, Catherine H. 21-08-1168 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 that 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, ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common, VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• 28 Southmont Drive $56,543.38 Enola, _-PA 170.2.5.......... (fee attached HUD-1 settlement statement) (net sale ~3roceeds) 2. Two Bur;;aal Plots at: $ 4,590.00 Forest Lawn Memorial Gardens 5755 Mallory Rd. College Park, GA 30349 TOTAL (Also enter on Line 1, Recapitulation.) I $ 61, 133.38 If more space is needed, insert additional sheets of the same size. _ __ __ _ _ _ _~ APR-01-2D09 WED 68:33 AM M1ST SE^'T1EMENT SERVICES FAX:717795517i P, 001 A. Settlement Statement U.S. Department of Housing OMB Approval No. zsoz-D26s and Urban Development (expires 7 i/3o/2008) e.. type of Loan _ 0. FiN NumD9G 7. loan Number: 6. Mortgage Ineuranrw Cau Number. 1. ^ FHA 2. ^ FmHA 3. ©Cpnv, Unins. 4. ~ VA 5. ~ Corn, Ina. ~ 0272746991 C. Noss: This form )a famished to give you s statement o} actual setdertwnt costs. Amounts patd to antl by the setdement agent are shown. Items marked '(p.o.c.)' were paid outside dosing; th aro shown hers for informational purposes and not Included in the totals. oO. Na~ns and Addraa or borrower. E. Nano and Addr4ss of Bader: F. Name and Address or LerdC AARON C. KELLEY LYNN M. TOLAND EXECUTRIX MEMBERS 1ST LAURA R. KELLEY OtRHE ESTATE OF CATMERWE M- GORDON FEDERAL CRFrD1T UNION 109 SUMMER LANE r 5000 LOUISE DRIVE ENOLA PA 17025 ~ENOIA _,-, , PA_ 17 MECHANICSBURG PA-..17035 , G. Pmpany l.egtbn: M, aeaNmant Apant MEMBERS 1ST SETTLEMIiiNT SERVICES, lLC TAX PARCELtf09.140ti35.159 _ 28 SOUTHMONT DRIVE PNOa d 8atuamarit I. Sotuement Oak; ENOIA pA yt0~ 6000 LOVISE DRIVE 3l31n009 MECHANICSBURG PA 17DSS DNburM7MPo Oak: tat alaox: 3r3tr~nna J. Summary ad Boerowet^s Tnnwdion K summary of 5s 100. Gross Amount 0u! From torrower 400. Dross Amon 101. Conbad tale price.., .... 141 000.00 401, Co~b'ad itNa,P 102 Poisons! Oroparty .. - 402 P4rsaal r 109. sedNmant d,aroa ro bonowar (f_na ta00), ._ 4068.10 409. toe. __ 404. toe. 4d3. Adjustments for items paitl seller in atltrin0! AEJusgrtents for items paid py sever In sdvanq .. ..._ 106. Cilrlrown taxes to _ 406. Ciy/town taxes m ' to7. CounNtaxes 3/31/2D09 12/31 .._ to 16.70 407. Coon Nxa 3/31!2009 a12/31l2009 -,,,_ ._, 316.70 _.._ . , toe. Aaaaartunb ro aoe. Afae4smatu a toe. SCHOOL 3131/2009 ro 6/30/2009 , „ 327.71 400. SCHOOL 3/31!2009 to 6!30/2009 _ ,- _ __ 327.77 tt0. b 117. ro 410.0 ro 411. ro 11 b , ... 41~ to 118, ..__ lt7 ~ 41 a, ... ._. t0 .... na. to i au. - _ a 115. ro 478. ro 120. Gross Amount Due From Borrower 145,713.51 d20_ Gross Amount Dw To Seller ~ 141,644.b1 2M. emru,rrls la.le wv or tw 9•rurr er Boe.w,r•. ruin 4.elrWlwwa In Awvvrw} du Tw S.II.r 201. Dapofittx•samatmatay 1,000.00 901. Ex9eaadepodl (esawbucsarro) 202 Pdnc at amount of new ban(s) _ 133,950.00 502. Settlement Cttar0o4 to seller Oine 1400) 6.843.35 2t%i. Exiadiolvinif)fakMfub'ettro .._....... _ 503. ExNUnpban(4)ro n tp 204. SW. Payoaof }Iret'rx7rQlana ban PHH MTG. 76 20S .......__ ~ 003. Pa er aaeane mortaaae loan .._.. . _ Z00. .. .. ...- _ _- 'JOa. ._. _. _.. __ 207. - . - --- 807. toe. _.__.. boa. 209, ._.._ .. _. 309. Adiuslmentttp iterrU unpaid by seller ..... _.._._ .. _ _ .... Ad)ustrnsnts for items unpaid try seller 210, npNn Nxq ro .__~___._ _... _ Std. Chy/tOwntax4a W 17, taxes ro 311. coo taxes m 212 AteoaanMfaf b 512. Atxnnlent9 W 273. to 618, to 214 p .... -_._ 614. to W 215. . --'-'_. _ _ _ . . ......----'- 515. 10 ro 210. 1 316. to ---..._.__. ._ ~?• ...... to St7. ro I 2t 3. k _ .. - _-_---- 616. 10 ~ -- i 279. to _.... . 619, to _ .. _ 710. Toni Pakt by/Fer borrower 134,850.00 520. Total Reduction Amount Dus Seller 85,101.03 F m/7 80 0. Cash At Settlement TolFrom Seller -°... _ apt. Gross Amount due frgn borrower, Qine 720) _ ,. , ._ ..._ _ . _ _ 145,713,b1 801, Gross amount due to seller (Wr!? aZpZ_ ~ 141.644.41 502. law ~moums veld tryflor borrower Pine 220).. ( 134,950_00 502 Lns aductbns In amt. due asnac (Brie 520) I ( 85.101.03 ) 303. Cash ®From ^ To Borrower 7 b03. Cash ®To ^ From Seller 56 543.38 Sepias b of the Ftea1 Estate Seiuement ProoeOUres Act (RESPA) requires Section 4(a) of RESPA rtwndates that HUD develop and presalbs this the following: • HUD moat dttvebp a Spedat Intametlon Booklet to help atsndsrd form to be used at the time of loan settlement t0 provide Toe persons bortowing money to finance the purchase of reskfentlsl nal estate diaGoauro o1 all charges imposed upon 076 borrower and seller. These are io better untlaratand The nswn and casts oT nal estate searemsnt services; Otird parry g16U0SUroe that are deslgnetl to provitle the borrower with • E9Ch lender must provide the booklet tb all applipnti from whom k perdnent infOm,atlOn during the semement process In order to be a Defter ncelves ar far whom it prepares a wAtten ipplipdon to pomOw money to chopper, ltnmp the purohase of res)denWl roal estate; • Lenders must prepare and The Public Reporting Burden for this collection of intornadon is eadmatetl distribute With the Booklet a Good Faith Estimate of the aearement costs to average one hour per response, including the dme for reviewing instruct that eta borrower is uk.y w Inver In connection with ate semement. Trtese tlona, searching exibbng tleta sourc6s, gathering and maintaining the data disclosures are mandatory, needed, end Compl6dng and rev)ewing the wlle~on of informat(on. This apsncy may not collect this inTormaBon, and you are not requ(rsd [o complete this form, unless It displays a wrr9mly valid OMB control number. The informa0on requested doss not Isnd Itself to COnAdentiality. Preview edftlons era otueolete Page 1 of Z 1d'm HUD-1 (3186) ref Mantlb00k 4305.2 APR-O1-2009 WED 08:33 AM MIST SETTLEMENT SERVICES FAX: 7177955171 P, 002 L. Settlement Cha ei 700. Teyl ?D4NroWrs Canmtssten Waea On OrIN S 141 000.00 '/.' 0.00 .. Psltl From P ld F ~_ Diviabn er t.emmtagan (lms 700) a rostnw: 9orrowafs a rom sa0ara 701. S 3450.00 to EXIT PLATINUM Funds At Funds At 702 S 3 475.00 to H~LP.USELL - --' " .,.....- ma"""t sanlenlant 703. COmrtlissi°n Paid an Sattkltwnt ._" 8 825 00 70x. FEE , . _.. .. ... 800. kama Payable In Contraction Wkh Lawn _. -- e0t. Loan orl nation Fee., 133,980,00 Ye 002 loan Discount 133 850.00 K ...- -~--~-° °-'- 903..4PPnhal Rea ro ~ ., .. I ..._. 90x, CnOi[ l4Pen ro aoa t.«,d.r~ InsWCdtm Iee _ - tl06. Mwsgege lMUranCe AttWicetbn Fee ro _._...... ..... i 807. AssumpdOn Rae - 806, APPLICATION FEE (5350.00 p,O;C.) MEMBERS 15T FCU ~ ~~ ~-~ 90p. UNDERWRITING FEE M MBERS 7ST FCU 160.00 ~ "~ eto. DOCUMENT PREP FEE _ ," MEMBERS 1ST FCU 295.00 _ _ 611. ._._ .. - -- .._ 812. _. ....-- __. _._. ...- 013. I 900. hams"Raquirod eY LNrder 70 Eta Paid In Atlyan0e F~muW last day In Dabs-IM pOt 9bt. Imenesetrem 3.+3112009 to 3131!2009 ®S 18.1391 rdav :. _.,. ~ _ _~-~ 18.14 fW2. Mere lnsyren4a. Vremllvh fpr tneNha ip .. ~ ~_. 803. HaZarQ Imuranec Pranium for _ . years t_o - . -- 1000. Raaetnrp Deoeahad Wkh Lander . .. ...-. toot. tl.zawlnwnna _.. 3 ._ montln®S 41.87 oar month . 1002 MonOaoeineuranoe ..- ttgnUrs®f oarmOmh -. .-. 1003. G ~'0P_oftYterzeS,_. ..._. mOnlhe®t wr moth -.... -- 1004. COUntvp~tRxes 2"_. rnentns®S 35.03 wr mttrtM ._ --- 1000. AnrrWlatawsmems __ matlhs4pf Itsr mOnN ... fobs. SCHOOL 10 momhs4pf 70834 pa rnontl+ 1007. FLOOD INS_._ mOMttcl@S _ .._ Per mond+ 1008. Aodlamtedemunsneaww.~~r ..' 1100. Title CMrwe trot, 8ettlernsrk ar elOSilrOfia _ .. --- to -"._ ~ ' 1102. AbtlnU 0r tltle search p ... .._ 1109. rltlaexaminaDon . . ..~ m ..- 1104. Title instairlCe binder ... to .. ...._- 1105. t0oaan.nt men - , ro SALZMAN HUGHES P C 1708. Naarvtaes .. ro ANNETTE C MYERS -~ ~ ~~ 7107. Ad°mey's flee 1e '-' Onduda, above Items ntanpeR; .. . 1108. Title Insraanee to MyRREI_(i, WALTERS. III ESQUIRE ,(Includes sDOVS items numDSfs: 1101-tt04,~~ PENN ATTORNEYS TITLE INSURANCE CO t tom' u"d"y C0'e''+eQ _ . S _ _. 133.930.00 endoroemenle 100 300 and f 1110. Ovmsrseoverapa _ .. S__ 141.000.00 1111 1112 1119. ~ ~--- 1200. Govemmeni Reeording and Tpne{ar Charm _-. ._ 50.00 20,00, 10.00 1207- RaoOrdmo tees: Dfxtl f ' 50.50 ~ Marloaw S ~ _ 78.30 ;RNeases f 127.00 lzba ctly/rdr.nytev/aymps; Osetl S 1 x10.00 ;Mtx~agc f _ _ 7203. Slate ®1d61emDe: Deed S 1.610 OQ : Mo!t919e f - ~ 1.410.00 ~ j. . 1204. .... • - .., 1.410.00 1 _ ..,_ ~ _ - 1300. Add"AiorW 8e8!lement Charges 7901. Survey _ tO •° .. _ ~ _ 1902. Past inaoaaion b " _.. ... - tf09. OVERNIGHT FEE FOR PAYOFF FED•EX tsoa, TAX CERT FEE _ ~ TO DEB67E LUPOLD .. ~ 8.00 1905. 378 CTYRWP TAXE$ DUE TO DEBBIE LyPOLD ~ 10,00 ~ ~ 1306, ~ _ . 420.35 tSp7 ~ .. .. ~ _. -- 1506. - ... _ __ I ha rArdUly rcyiawetl the HU0.1 Setrlettrertt 34tarlent antl ro th0 best ai "cn r Irrt,~ l lvn -- my krrptMadOa antl t»IiN, tl i tnw end aeaweh f ant reosipts end tliabursamems an atzount W Dy ms In Ur transaeWn. I NNW eMtlly that l Mve ramHed • Dopy p/ tFre MU0.7 Ss Statbneg5~ . Lnwa M. TOLAND EXECUTRIX AA N .KELLEY ~ Oartowar ~ getter _ OFTHE ESTATE F TH N . G N - gorrOwer ro aw bast d m URA R 1tELl.E ebDYra6'tl ~ ~ a5 a1M ~ Sfifiment WFtiell l tyva PrePend k • fNe end eCCYrata ae°oum e} ale f e raeaiva0 and nave Dann a vAll tllertteM M this Vaniad'IOn. MEMBERS 1$T ENT SERVICES, LLC SatdementApaM C 3l - Dafi WARNING: It K a aims t0 knowingly make fi W atttamMti t0 tM Unihtl Stets nn tnia Or any o0yr timpar term, panNEas u i Fer details a: T 18 .g n Pon t:Onvittlon ran kKk+oe a sne and Prlvlous editlons dro ob9oletC POye 2 of 2 ffxm I4UD-1 (3188) ref Handbook x305.2 REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gordon, Catherine H. 21-08=1168 All property jolntlyowned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Gordon, Catherine H. 21-08-1168 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER Gordon, Catherine H. 21-08-1168 If an asset was made Joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Lynn M. Toland 1003 East Coover St. Daughter Mechanicsburg, PA 17055 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 DECEDENTS INTEREST ~. A. Susquehanna Bank $10,6T8:69 507 50% (Checking Account ~~4600414709) 2. A. Susquehanna Bank $ 1,248. b6 50% 50% (CD ~~4600414730) TOTAL (Also enter on line 6, Recapitulation) I S 5, 933.68 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Gordon, Catherine H. 21-08-1168 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t• Malpezzi Funeral Home $8;418.36 2. Funeral Luncheon $ 483.23 (reimbursed to Lynn Tolaand) B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) ' Lynn M. To land $2, 000.00 Social Security Number(s)/EIN Number of Personal Representative(s) 511-66-7940 Street Address 1003 East Coover St. Ciry Mechanicsburg state pA zip 17055 Year(s) Commission Paid: 2. AttomeyFees KEEFER WOOD ALLEN & RAHAL, LLP $3,500.00 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 $ 2D7.00 Two Additional Short Certificates (12/19/08) $ 12.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Real Estate Appraisal (Patrick A. McCarthy) $ 300.00 8. Mileage and Lting-Distance Telephone Charges; Stock Search $ 29.54 (Keefer Wood Allen & Rahal, LLP) 9. Legal Advertising $ 249.58 10. House Cleaning Supplies $ 259.37 TOTAL (Also enter on line 9, Recapitulation) $ 15, 459.08 (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 Gordon, Catherine H. 21-08-1168 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) REV-1513 EX+ (g-p0) CHEDULE S J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Gordon, Catherine H. 21-08-1168 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Lynn M. Toland Daughter 1/3 1003 East Coover St. Mechanicsburg, PA 17055 Barbara E. Zimmerman Daughter 1/3 230 Ridgeview Road Marysville, PA 17053 Lorraine H. Wallace Daughter 1/3 1b36 Sugar Maple Lane Conyers, GA 30064 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON RE V-1500 COVER SHEET tI NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I ~ (If more space is needed, insert additional sheets of the same size)