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Home My WebLink About05-28-10J 1505607121 PR EV-150 0 EX (06-05) OFFI epariment of Revenue CIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box 2sosol INHERITANCE TAX RETURN Harrisburg, PA 1712s-0601 RESIDENT DECEDENT 2 1 1 0 0 2? 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 6 6 4 6 4 2 9 4 0 3 0 4 2 0 1 0 0 9 0 4 1 9 5 1 Decedent's Last Name Suffix Decedent's First Name MI P R O V O S T S H I R L E Y L (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 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 ^ 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 ^ 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 R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3 Firm Name (If Applicable) I R W I N & First line of address 6 0 W E S T Second line of address City or Post Office C A R L I S L E Correspondent's a-mail address: OAD Under penalties of perjury, I declare that f 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. SIGNATUJ+2E~F PERSOy.R€SP~ IBj.E TURN D TE X a~~ '/ ADDRESS ~ ~7 ~~ ~ 58 LEBO SIGNATURE;01 State ZIP Code P A REGISTER OF WILLS USE ONLY ~~ ~ ~7 - ' ~. _,,... ,,~ . ~~:: .. w . C7 ~ . ~ ~ r ~~ ~ .:~ r...~ TE FILED-`~" ~ -? _ F 1 7 0 1 3 CARLISLE ,~ : •. ~~~ PA 1,701, S ETHER THAN R RESENTATIVE ~7 //v 60 WEST POD ET STREET CARLISLE PA 1,7013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 M c K N I G H T P C. 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(~ 6 aui~ snuiw g aui~) a;e;s3 ~o an1eA ~aN 'Z6 Q 2 +~ E 0 2 E . ~ ~ ........................... (06'8 6 saui~ ~elo3) suol;onpap le;ol ' ~ 6 I Q 'h 5 6 E 9 '06 • • • • • • • • • • • • (~ a~npayoS) suai~'8 `sai;i~igei~ a6e6;aoW `;uapaoaa ~o s;qaa '06 E fi 'S h 9 Q~ 6 • • • • • • • • • • • • • • • • (H a~npayoS) s;sod ani;e~;siuiwpy ~ sasuadx3 ~e~aun~ •g Q E '6 O E 5 2 .8 ........................... (L_ 6 saui~ ~e~o~) s;asst' sso~O le~ol '8 6 6 'S 5 6 5 6 ' •L • • • • • • • pa;sanba~ 6wpi8 a;e~edaS ~1 (O a~npayoS) sonin-~a;u~ •L sue~ ~a ~ •~ '- l ~ g s N snoaue~~aosiw u ~(}.~adad a;egad- g • • • • • • • pa;sanba~ 6ui~~i8 a}e~edaS ~ (~ a~npayoS) ~adoad paunnp ~~}uio£ •g •g • • • • • • • (3 a~npayoS) ~adoad ~euos~ad snoauepaosiW '8 s;isodaa ~ue8 `yse~ 'S 6 6 '~ Q 6 E .~ ........................ (d alnPayoS) aigeniaoa~ sa;oN'8 sa6e6}~oW •~ .£ ..... (O a~npayoS) diys~o;aiadad-a~oS ~o diys~au~ed `uoi;e~od~o~ PIaH ~~aso~~ '£ •Z .................................. (9 a~nPayoS) sPuoB Pue shoo;S •Z 6 ........................................ (d a~nPayoS) a;e;sa ~eaa • 6 0 0'0 0 0 2 6 NOllt/'1f111dV~32! .L S 0 I10 2! d • 1 Jl 31 ZI I H S :awaN s,;uapaoaa h 6 2 h 9 h 9 9 2 ~agwnN ~(;unoaS ~eiooS s,;uapaoaa X3 0056-n32i '[22L09505'C REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0275 DECEDENT'S NAME SHIRLEY L. PROVOST STREET ADDRESS 22 LEBO ROAD CITY STATE ZIP CARLISLE PA 17015 Tax Payments and Credits: ~ • Tax Due (Page 2 Line 19) (1) 1 441 54 2. Credits/Payments , . A. Spousal Poverty Credit B. Prior Payments C. Discount 72 08 Total Credits (A + B + C) (2) 72 08 3. Interest/Penalty if applicable . D. Interest E. Penalty 4. Total Interest/Penalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 0.00 Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1, 369.46 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (5B) 1,369.46 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; ............................... ^ Q c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for fife of either payments, benefits or care? ....................................................... ^ 0 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ Q 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 exemot 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-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SHIRLEY L. PROVOST 21 10 0275 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 roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, 58 LEBO ROAD, CARLISLE, PENNSYLVANIA 92,000.00 TOTAL (Also enter on line 1, Recapitulation) ~ $ 92 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. IN RESIDENT DECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER SHIRLEY L. PROVOST 21 10 0275 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T BANK -CHECKING ACCOUNT #778362 466.49 2. PERSONAL PROPERTY -SETTLEMENT STATEMENT ATTACHED (ESTATE PROCEEDS ARE $3,522.50) 3,522.50 TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) ' SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & IN RESIIDENT DECEDENT N ADMINISTRATIVE COSTS t~ i A i t ur FILE NUMBER SHIRLEY L. PROVOST 21 10 0275 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 5,791.60 2. THE SENTINEL -OBITUARY 143.64 3. NEWS CHRONICAL -OBITUARY 60.00 B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City Year(s) Commission Paid: State Zip 2. Attorney Fees IRWIN & McKNIGHT, P.C. 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant 5,800.00 Street Address City State Zip 4 Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS 5. I Acx;ountanYs Fees 6. ~ Tax Return Preparer's Fees 163.50 7. REGISTER OF WILLS -FILING FEE 30.00 8. NOTARY FEES 25.00 9. CUMBERLAND LAW JOURNAL -ESTATE NOTICE 75.00 10. THE SENTINEL -ESTATE NOTICE 187.54 11. CLOSING COSTS ON SALE OF REAL ESTATE 945.00 12. KEVIN M. WICKARD -AUCTIONEER COMMISSION ON REAL ESTATE 985.00 13. KEVIN M. WICKARD -AUCTIONEER COMMISSION ON PERSONAL PROPERTY 352.25 14. KEVIN M. WICKARD -ADVERTISING -PUBLIC SALE 750.85 TOTAL (Also enter on line 9, Recapitulation) $ 15.309.38 (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 SHIRLEY L. PROVOST 21 10 0275 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH See Attachment Page(s) TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) • Continuation of REV-1500 Inheritance Tax Return Resident Decedent ~HIRLEY L. PROVOST ~ 21 10 0275 Decedent's Name Page 1 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION 1. MABLE G. STITT, TAX COLLECTOR -TAXES 2. CHASE -MORTGAGE PAYMENTS (2) 3. CHASE -MORTGAGE PAYOFF -SEE SETTLEMENT SHEET 4. ALLSTATE INSURANCE COMPANY -INSURANCE 5. CAPITAL TAX COLLECTION BUREAU -TAXES 6. WEST SHORE EMS -AMBULANCE 7. PP&L -ELECTRIC 8. CENTURYLINK -TELEPHONE 9. GRAHAM MEDICAL CLINIC -MEDICAL 10. CARLISLE MEDICAL PATHOLOGY -MEDICAL 11. KINETIC IMAGING -MEDICAL 12. ALLIED INTERSTATE, INC. -OUTSTANDING EXPENSE 13. CARLISLE REGIONAL MEDICAL CENTER -MEDICAL 14. KUHN COMMUNICATIONS -CABLE 15. HEALTH NETWORK LAB -MEDICAL AMOUNT 183.19 974.59 45,528.47 158.86 192.59 137.99 391.13 124.89 12.95 9.70 31.80 198.67 30.09 74.44 32.42 SUBTOTAL SCHEDULE I ~ 48,081.78 Continuation of REV-1500 Inheritance Tax Return Resident Decedent 5HIRLEY L. PROVOST Decedent's Name Page 2 21 10 0275 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. AERO ENERGY -FUEL 30.25 17. CARLISLE HMA PHYSICIAN MGMT -MEDICAL 264.00 18. PENN CREDIT CORPORATION -OUTSTANDING EXPENSE 36.00 17. BLUE MOUNTAIN ANESTHESIA ASSOC. -MEDICAL 233.40 SUBTOTAL SCHEDULE I 563.65 GRAND TOTAL SCHEDULE I $ 48,645.43 REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER SHIRLEY L. PROVOST ~~ ~n n~~~ L. ~ 1 V VG/ J 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)) 1. PAUL R. WHISTLER Lineal 32,034.18 58 LEBO ROAD REMAINDER CARLISLE, PA 17015 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (Ir more space Is needed, Insert additional sheets of the same size) HUD -1 UNIFORM SETTLEMENT STATEMENT OMB Approval No. 2502-0265 ~ ~ ~. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT . S. TYPE OF LOAN 6. File Number: 7. Loan Number: 1. FHA 2. FmHA 2 010 -16 3. Conv. Unins. 4. VA 5. Conv. Ins. 8. Mortgage Insurance 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 aze shown. Items marked "(p.o.c.)" were paid outside the closing; they aze shown here for informational purposes and are not included in the totals. NOTE: TIN = Tax a er's Identification Number D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER: Scott Hench Estate of Shirley L. Provost None Paul R. Whistler, Executor 251 Sheaffer Road 22 Lebo Road Carlisle, Pa 17013 Carlisle „ Pa 17013 G. PROPERTY LOCATION: H. SETTLEMENT AGENT NAME, ADDRESS AND TIN 22 Lebo Road Jacqueline M. Verney, Esquire Carlisle, PA 17013 44 South Hanover Street Carlisle PA 17013 PLACE OF SETTLEMENT I. SETTLEMENT DATE 31-11-0296-053 44 South Hanover Street 05/18/2010 Carlisle, Pa. 17013 AT 7 - .,.,.,. ~,~„~~ iv o~e,i,.Lr.rc _ I 44, 753. 9~ SELLER'S STATEMENT The information contained in Blocks E, G, H, and I and on line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax information and is being furnished to the Internal Revenue Service (see Seller Certification). If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines that it has not been reported. You are required to provide the Settlement Agent with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement is my correct taxpayer identification number. (Seller's Signature) Estate of Shirley L. Provost (Seller's Signature) Paul R. Whistler, Executor m EASY SOFT, Inc. 2001 Previous editions are obsolete Page 1 form HUD-1 (3/86) ref Handbook 4305.2 L. SETTLEMENT CHARGES PAID FROM PAID FROM BORROWER'S SELLER'S FUNDS AT FUNDS AT Y. 1000. RESFRVF.C DF.PC1CiTF11 wiTU r r~mcn 1001. Hazard insurance 1002. Mort a insurance 1003. Ci Pro Taxes 1004. Coun Pro Taxes 1005. Annual assessments 1006. 1007. 1008. A to Accountin Ad'ustment »nn_ ~rrrr.i,` rusncse 103. I1 .0 CERTIFICATION: I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and bel' i a true and accurate s U ment of all re eipts0and disbursements made on m--y~~''a__ccount or by me in this transaction. I further certify that I received a copy of the HUD- a ment Statement. . ~ 1,,, eller Estate of Shirley L. Provost Bo Scott ench y/U,,,,,.~ v~, Seller Paul R. Whistler Borrower The HUD-1 Settlement Statement which I have prepared is a true and accurate account of the funds disbursed or to be disbursed by the undersigned as part of the settlement of this saction. 1 "~~` 05/18/2010 Se ent nt Jacqueline M. Verney, Es Date WARNIN . It is a crime to knowingly make false statements to th nited States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. ® EASY SOFT, Inc. 2001 Previous editions are obsolete Page 2 fonm HUD-1 (3/86) ref Handbook 4305.2 `' t SELLER NAME (~ I Y _ \ (. ~ , ~e i~~ ~' ~l 1 '~ ~ ~ ~'' r- r ineL SETTLEMENT ,s _ ,-DATE OF .SALE :'~ f ~ ~. ~=~ ~ ~~~ ~' t U. / i ~ ~~ r~l ADDRESS !'~ i ;PHONE ~~~ ~~' ~.l`.~ ~~ ~ ~ ! ~=' _ ZIP _. LOCATION OF SALE -:~% ~ i - ~ ~ t`=' (~ (`1 -r }!`~ :; ~- ~• ~ s AUCTIONEER ~` ~ P r! , ,'~, ~~/ ~j~ I E^ ~.~ (1 ~ tL. PHONE SEI~:EI't`.S=~7fPENS~s°~ ~RECE#PTS PROFESSIONAL FEES r ~ ~ ~. ; , /AUCTIONEER $ ~ ~ ~ CASH $ ~~:• ;;' ~~ ~ f ;~;' ~) 1 J,~ ~..` CLERK s `~fi/~, $ CHECKS $ ~ _L> ~~~ j 6 ~"' f l~ I' CASHIER $ OTHER RECEIPTS ~.,...r OTHER EXPENSES _ $ ~~~~~ $ _ _ $ , ~ ~; -- --~ { ~ ens ~c ~ , `~ I - $ ~_ $ ' $ a ~ ('~ ~f ~ ~ ~ I ~ ~ ~ ~~~ 1 - ` ! 1 ~ 1l'~ $ _f y _ : ~ ~ . ' -; $ - ~~ ~ $ - ~ _ $ c~ c.~~ ~ .~ C, ~ J $ i ~ _ $ ~~~-- $ ~. ,~ ~. ~ v ih~ RECEIPTS $ ~` (~= ~ / -~ ~ T $ ,~ ~ LESS TOTAL EXPENSES $ ~, ~''} ~ln ;;~ TOTAL EXPENSES $ ~ `~ NET PROCEEDS PAYABLE TO SELLER $ ~ `~~ .~ ~~ _ ~~, I (or we), the seller, accept this settlement and acknowledge receipt of the above specified net proceeds from the auction of my goods and property sold on the above date. I accept all responsibility merchantable title to all goods, and property sold, and for delivery of title to the purchaser. For providing ~, ~.~ ~-+~~r'". `~.~E l ,"'~~~ ~~ I ~~~~~,~ i,~~ ~• ~~.:~~ 1.-t~i ~ Date ~_~~,~ ~C--~° Auctioneer or Cashier's Signature _; (Seller s Signature) ';~ - ,~' ` - .~ ~ i ~ Date {~ Date ,, r_. ~ ~ ,~ r 4:~ ~-. (Seller's Signature) • °°~ SELLER 'S COPY ~~ ~iQ ato~c~ Ctn. i 3s- ,cn~ (app --1s ~cz~ ~ ~~~ o~