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Home My WebLink About08-13-10 (3)1505610148 1500 EX (°'-'°' REV - OFFICIAL USE ONLY PA Department of Revenue County Code Year Flle Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX-RETURN 21 09 1072 Harrisburg, PA 17126-06°1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date Of Birth MMDDYYYY 174-05-0502 11132009 12201918 Decedent's Lasl Name Suffix Decedent's First Name M I GRIBBLE MARIE E (If Applicable) Enter Surviving Spous e's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES 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 RICHARD C• SNELBAKER 717-697-8528 First line of address 44 WEST MAIN STREET Second line of address City or Post Office MECHANICSBURG Correspondent's e-mail address: State ZIP Code PA 17055 REGISTER OF WILLS U5ErQMLY n C ~(~ C _ ~ - ~ a r i1 ~ ~~' ~ ~.~: fil ~ C~ ~ ~ - -'m~ 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 infonnaaon of wh~h preparer has eny knowledge. S RE OF ERSO ES IB FOR FILING RETURN ~^ DATE !J ~il ~/O DRESS ' DAVID GRIBBLE, EXECUTOR 641 WHISKEY SPRINGS ROAD, BOILING SPRINGS SIG O 'i ~~ EPRESENTATIVE ~//~~~ RICHARD C• SNELBAKER 44 WEST MAIN STREET, MECHANICSBURG PLEASE USE ORIGINAL FORM ONLY PA 17055 Side 1 1505610148 9M46474.000 1505610148 REV-1500 EX Decedent's Social Security Number 174-05-0502 oecedenPS Name: G R I B B L E MARIE E RECAPITULATION 1. Real Estate (Schedule A) 1 17 Q, 0 0 0• 0 Q 2. Stocks and Bonds (Schedule B) . 2. Q • Q Q 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , g. 0 • 0 0 4. Mortgages and Notes Receivable (Schedule D) 4, Q • Q Q 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 3 , 8 5 0 .0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 5 , 19 4 • 8 Q 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (Schedule G) ~ Separate Billing Requested 7. Q . Q Q B. Total Gross Assets (total Lines 1 through 7) 8 ], 7 9 , 0 4 4 •8 0 9. Funeral Expenses and Administrative Costs (Schedule H), , 9. 7 , 516.3 5 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) . 10. 7 7 7 • 4 2 11. Total Deductions (total lines 9 and 10), 11. 8 , 293 • 77 12. Net Value of Estate (Line 8 minus Line 11) 12. 17 Q , 7 51 • Q 3 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) , , 1 g. Q • 0 Q 14. Net Value SubJect to Tax (Line 12 minus Line 13) , 14, 17Q , 751.03 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unfter Sec. 9116 U (a)(1.2) X .0 - 0. 0 0 15. Q• Q Q 16. Amount of Line 14 t xable t li l t x o4~ a nea ra e . 170,751.03 1s. 7,683.80 17. Amount of Line 14 taxable at sibling rate X .12 Q• Q Q 1 ~ Q• Q Q 18. Amount of Line 14 taxable at collateral rate X .15 Q. Q Q 18. 0• O Q 19. TAX DUE 19. 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 1505610248 1505610248 9M4848 4.000 7,683.80 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 1072 DECEDENTS NAME R B E MARIE E STREET ADDRESS MONROE TOWNSHIP T CITY STATE ZIP M CHANICSBURG PA 17 55- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments _ B. Discount 3. Interest (,) 7,683.80 Total Credits (A + B) (2) 4. If Line 2 is greater than Llne 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. ~• (3) ~ • ~ 0 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 7 , 6 8 3 • 8 ~ 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 Na a. retain the use or income of the property Vansferred; ^ 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 Dec. 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 a security al his or her death? ^ 4. Did decedent own an indivldual 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 disGosure 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 21 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 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 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 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. BM4871 2.000 REV-1502 EX ~ (01-10) pennsylvania DEPMTh1ENr OF REVENUE IM~ERITANCE TAX RETURN ESTATE OF: SCHEDULE A REAL ESTATE FILE NUMBER: rie E. Gribble __. _ _ 21 091072 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 prtee at which property would be exchanged between a willing buyer and a willing seller, neither befog compelled to buy or sell, both having reasonable knavtedge of the relevant fads. Real property that Is Joirrdyowned with rlgM 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 DESCRIPTION OF DEATH 1. Property known and numbered as 805 Fairfield Street, Monroe Township, Cumberland County, Mechanicsburg, PA 17055, appraised value (see attached appraisal) 2 Property (Lot) located on Fairfield Street, Monroe Township, Cumberland County, Mechanicsburg, PA 17055, appraised value (see appraisal) 115,000.00 55,000.00 TOTAL (Also enter on Line 1, Recapitulation.) I S 170, 000.00 9W4895 2.000 If more space is needed, use additional sheets of paper of the same size.