Loading...
HomeMy WebLinkAbout10-12-10- - -- _ _ _ i --T-i- 1505610140 REV-1500 ~` ~°'-'°' PA Department of Revenue OFFICIAL U8P~ OILY Bureau of Individual Taxes County Code Year ' File Number Po Box 26oso1 INHERITANCE TAX RETURN 2 1 1 0 0 0 0 0 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 1 2 1 9 2 0 0 9 1 1 0 9 1 9 4 8 Decedent's Last Name Suffix Decedent's First Name MI K I M B L E J R THOMAS R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffur Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ^X 1. Original Retum 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received MI THIS RETURN MUST BE FILED IN DUPLICATE'VIIITH THE REGISTER OF WELLS 2. Supplemental Retum 4a. Future Interest Compromise (date of death aRer 12-12-82) 7. Decedent Maintained a Living Trust _ (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Retum (date of death prior td 12x1 ti-82) 5. Federail E$talte Tax Retum Required 8. Total Numbr}r of Safe Deposit Boxes 11. Election CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INF01 Name Daytime Te MARK A M A T E Y A 7 1 7 Ax0' nder Sec. 9113(A) ~ SHOULD BE DIRECTED T0: )Number' X41 X500 ~~, -~ REGI8 ~ WILLS U~ONLYF-~-i , - " C'1 G:; ~ ~ ~ 1 ~ First line of address ~ ~ N !~; 5 5 W CHURCH AVENUE x ~© ` = _ r Second line of address ~ ~ ; ~'= ' ~ = ~~ T'i ~'- ~~ '--I v o - •~ ~ __ gA7E FILED ~ ~ City or Post Office State ZIP Code CARL I SL E PA 1 70 1 3 Correspondent's email address: MAMCa4MATEYALAW.COM --r-- Under penalfks of perjury, I dedare that I have examined this ratan, inducting accompanying acliedubs and statements, and to of my knowbdge and belief, R is true, oorect and complete. Dedaratron of preperer other than the personal r ased on all information of which', pre~efer has any knotivledge. SIGNA R~ OF PERSON RE$PpNSIBLE FO~~ING RETURN ' DATE ~ ~„ I ADDRESS 264 WHITME ROADi SHIPPENSBURG SPA 17257 SIGNATU OFppREPARE R THAN REPRESENTATNE DATE 55 W. CHURCH AVENUE 1505610140 CARLISLE PLEASE USE ORIGINAL FORM ONLY Side 1 1505610],'40 17013 Y' 1505610240 REV-1500 EX DeoedenYs Sodial Security Number oeo~aenrsName: THOMAS R. KIMBLE, JR RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 2. Stocks and Bonds (Schedule B) ............................... .... ... 2. 3. Closet' Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) ................... .... ... 4. 7' 6 0 4 6 9 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... ... 5. • 6. Jointly Owned Property (Sdiedule F) ^ Separate Billing Requested .... ... 6. ~ 7 8 O 0. 5 5 7. Inter Yrvos Traraafers B~~AAisc~eileneous N Probate Property ~ (Schedule G) Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1 through 7) .................... .... ... 8. 1 Q 5' 4 O 5. 2 4 9. Funeral Expenses and Administrative Costs (Schedule H) ........... .... 9. ... 7' 2 4 1 5 2 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... .... ... 10. ~ ~ 7 s 8 • 5 4 11. Total Deductions (total Lines 9 and 10) ........................ .... ... 11. 1 Q 3 0 1 0. O 6 12. Net Value of Estate (Line 8 minus Line 11) ..................... .... ... 12. ~ 3 9 5 . 1 8 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. ~' 3 9 5 . 1 8 TAX CALCULATION -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.o _ 0. 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate x .oa5 2 3 9 5. 1 8 16. 1 0 7. 7 8 17. Amount of Line 14 taxable 0 0 0 17 0 0 0 . at sibling rate X .12 . . 18. Amount of Line 14 taxable 0 0 ll l 0 0 0 0 atera rate X .15 at co 18. . 19. TAX DUE ............................................... .... ...19. 1 0 7. 7 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 15056102410 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 00009 DECEDENT'S NAME THOMAS R. KIMBLE JR STREET ADDRESS 1671 TRINDLE ROAD cITY CARLISLE STATE PA zIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPaymerits A. Prior Payments 1, 600.00 B. Discount 5.39 3. Interest 4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the lrIERPAYMENT. Fill in oval on Psige 2, Una 2tl to requests refund. 5. ff Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 107.78 Total Credits (A + B) (2) 1,605.39 (3) i (4) ~ 1,497:61 (5) ' 0.00 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRmF~RIATE BLOCKS 1. Did decedent make a transfer and: y'e~ No a. retain the use or income of the property transfemed : ...................................................................... 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 oax~rred after December 12,1982, did decadent transfer property within one year of death without receiving adequate consideration? ............. ^ .......................................................................... X 3. Did decedent own an "in trust for• or payable-upon~eath bank account or security at his or her death? ......... ^X 4. Did decedent own an individual retirement account, annuity or other non-probate property, which rr---'11 caitains a benefiaary designation? .................................................................................................. i~.l IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A~S 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'fdr 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 reduir~~ients for disdosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefiaary. 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 th~ 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 benefiaaries is 4.5 peroenp:, e~Ccept 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. §~11 ~(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 adoptimn. ', REV-1508 EX + (8-98) scw~ou~~ ~ CASH, BANK DEPOSITS, ~ MISC. COMMONWEALTH OF PENNSYLVANIA INHERITANCE 7Ax RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBE THOMAS R KIMBLE JR 21 10 OpOm9 Include the proceeds of litigation and the date the proceeds wee received by tfle estate. AN properly joinNy.owned with right of survNorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. MUTUAL OF OMAHA INSURANCE COMPANY 146.08 CHECK NUMBER 0012110103 2. METLIFE AUTO 8 HOME 281.88 PAYROLL EARNED FROM 12/1109 - 12/15/09 CHECK NO. 001682542 3. METLIFE AUTO ~ HOME 1,241.94 PAYROLL EARNED FROM 12/16!09 - 12!31!09 CHECK NO. 0016982869 4. MET LIFE AUTO 8~ HOME 1,340.90 EXPENSE REIMBURSEMENT CHECK NO. 000230199 5. MET LIFE AUTO & HOME 129.25 EXPENSE REIMBURSEMENT CHECK NO. 000230100 6. AETNA LIFE INSURANCE CO 1,298.65 REIMBURSE FOR GOODWILL FIRE & RESCUE AMBULANCE SERVICE 7. BMW AUTOMOBILE 1994 540i SERIES 2,350.00 KELLEY BLUE BOOK VALUE TRADE IN VALUE -GOOD CONDITION -SEE ATTACHED 8. METLIFE BANK, N.A. 815.99 CHECKING ACCOUNT ACCOUNT NO. XXXXXX7127 TOTAL (Also enter on line 5, Recapitulation) I ; 7.604.69 (H more space is needed, insert additional sheets of the same sire) 1994 BMW 5 Series -Trade In Value, blue book value -Kelley Blue Book Page 1 of 3 SEARCH ~~~ ~ 1HE ~fO1llCle '~~°~ • Home New Care Certified Pre-Owned Used Cars Research Reviews i News Dealers i Inventory Can: For gale Loans i Insurance Used Car Values ~ Search Used Cars for Sale ~ Certified Pre-0wned ~ Compare Vehkies { Perfect Car Finder ~ Most Researched Vehkks ~ CARFAx Vehicle History Welcome Sack {Sign In (Create Account ~ My KBB ZIP Code: 17013 LatAst Car News ZisID4 > ~$AIg > aSOdd01 > 1~ > S.~Ca1 > 1`134 > B4ei Sedan 4D 1994 BMW 5 Series 5401 Sedan 4D Trade-In Value PrNate Party Value Suggested Retail Value CPO Value Photo Gallery Cars For Sale .Bait Compare Vehices Blue Book Review Consumer Ratings Find Your Next Car Specifications ~~IISED~ On Mue Book GassMedsTM BMW S Series _ . 75 Mlles Near ZIP.17013 To View Ads, Clldt tlwl shoppirty rods Free CARFAX Record Check ~ Auto Loan from 3.85% APR Compare Insurance Rates i with Progressive Payrrbnt Glculator I Find a Dealer iiit~'1!E f1E,Ytf UR Compare used vs. New i Under 35,000 ~ i Both New and I/sed ~ ! Sedan To Vtaw Ust, dick t1EN 11NOiMEt YENIU.E j Shed Year... ~a!ect Ma4~.. j Or Search by Category Or Change Z[P Code BLUE IQIN(a'TRADE-IM VALUE 'n`"a"irY More Photos Condition .wwrsr~r Value Excellent ;2,700 Good ;2,350 F2tir ;1,775 H EXT STE Pa Price New Cars Local Listings: search BMW S 5ertes ~Rj Search CertMed Pre-Owned BMW 5 Series { ~ Search all Grs For Sale near 17013 I L._...._...--- _..-...._..._....- .......- -- -.... _....._...__......._._._..--- ~ Averapa Consumer Rating (141 Raviavw) Read Reviews I ~* 4.7 out of 5 R~iew tMs Vehicle i_..__..~._ ..~.._.._...._._..-.._____------------__._-_._.-.~.__....~. Similar New Vehicles 2011 BMW S Series 2011 Inflnltl M _- I Phot05 ^ Photes P!lr104 P.tltl04 More Rpults Cheek Out Our 10 MostrResearched Sedans 2011 Toyota Camry 2010 Honda Accord 201Y Nyundal Sonata 2010 Honda Civic ~} Save Vehicle Prirpt iiili'Email (~9901R1MMC.~~~tiJ ® Finenu i Irrouranp Get a New Gr Loan from 3.65% APR Gat aPre-Owned Loan from 4.24% APR Get Your Gedit Score Now Get a Free Insurance Quote - advertisement --- http://www.kbb.com/kbb/LTsedCars/PricingReport/1994 BMW 5%20Serie... 6/17/2010 REV-1509 F,(+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT S6HE©ULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NU R: THOMAS R. KIMBLE JR 21 10 a00p9 if an asset was made joi~ly owned within one year of the decedanYs date of death, it must be refwrte~i oa Schedule G. SURVMNG JOINT TENANT(S) NAME(S) A. REBECCA ADDRESS 1671 TRiNDLE ROAD CARLISLE, PA 17013 TO DECEDENT FRIEND 13. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTIC~1 OF PRDPERTY INCLUDE NAME OF FINANgAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTiFY1NG NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF bECEDENTS INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. 12/05 REAL ESTATE LOCATED AT 1671 TRINDLE ROAD 174,636.b0 50. 87,318.00 CARLISLE, PA 17103 FAIR MARKET VALUE (SEE ATTACHED DEED) 2. A. 6/04 METRO BANK 18,833.1 50. 9,416.56 CHECKING ACCOUNT ACCOUNT NO. XXX)CX6506 3. A 3/08 METRO BANK 2,131.7 ''~ 50. 1,065.99 CHECKING ACCOUNT ACCOUNT NO. XXXXX8040 TOTAL (Also enter on Line 6, Recapitulation) I i 97, 800.55 If more space is needed, use additional sheets of paper of the same size. ~~ 'y~ ~,~ ~~.t3~ e, F:\Uw FoldalFi~m Duu~Btnta~3802-Ideedw~pd Prepared By: Sean M. Shultz, Esquire KNIGHT & ASSOCIATES, P.C. 11 Roadway Drive, Suite B Carlisle, Pennsylvania 17013 RCpr~:7 °. ZlEGLEfi ~E~UiuER OF'J~E~~' Ci'ItiF3E~LAIdD CO~aT'"-`'.' ZOOS Jl1N 22 P(~ 2 15 Parcel No.: .~ ~ -~~ - a $'~ S - v ~ () ~~ ~ THIS DEED Made theday of June, in the year #wo thousand five (2005) BETWEEN CARL E. KOSER, of Cumberland County, Pennsylvania, DORI$ J. WAGNER, of Cumberland County, and ROBERT L. KOSER, of Cum~berli<nd County, Pennsylvania, Co-Executors under the Last Will and Testament of MARY K. KOSER, late ofMiddlesex Township, Cumberland County, Pennsy~valnia, hereinafter referred to as: Grantors, AND THOMAS R. KIMBLE, JR, single man, and REBECCA A. BAGCM'T, single woman, of 115 South Filbert Street, Mechanicsburg, Cumberland Countty, Pennsylvania, hereinafter referred to as: as ~ Dint tenants with the right ' o$ survivorship Grantees, WHEREAS, the said MARY K. KOSER died testate on February 25, 2005', and'~her Last Will and Testament was duly probated in the Office of the Register of Wills of Cumt~er~aind County at Estate No. 21-05-0030?; and WI~REAS, CARL E. KOSER, DORIS J. WAGNER and ROBERT ~,. ISCOSER were granted Letters Testamentary by the Register of Wills of Cumberland County on ~6,pifill, 2005; and NOW THEREFORE, That CARL E. KOSER, DORIS J. WAGNER ~d ~tOBERT L. KOSER, Co-Executors as aforesaid, for and in consideration of the sum of N~'HUNDRED SIXTY-SEVEN THOUSAND AND NO/100 ($~~;A~~~~~y ~~la, the receipt whereof is hereby acknowledged, the said Grantors do h d c o e skid Grantees, as joint tenants with the right of survivorship, their heirs and assigns: ALL that certain tract of land situate in the Village of Hickorytown, Midc~le~ex Township, County of Cumberland and State of Pennsylvania, bounded and described Iby its various courses and distances, to wit: eoo~ 269 Pac'~2499 01/06/2010 9:55:11 AM CUMBERLAND COUNTY Inst.# 200'522131 -Page 1 of 4 BEGINNING at a post, corner of lands of the Hickorytown M. E. Church aid hands, formerly of J. S. Ginter, now of Jacob Spidle, on the North side of the Trindle Springs Road; thence along said Road, North 74 degrees 30 minutes West, a distance 175 feet'to a stake; thence along lands, formerly of J. S. Ginter, now of Jacob Spidlc, North 13 degrees 30~minutes East, a distance of 548.5 feet to a stake on line of land, formerly of William Sny~,dct, ~aow of Elmer Weaver; thence by lands, foanerly of William Snyder, now of Elmer ~Nda~ver, South 71 degrees 15 minutes East, a distance of 220.6 feet to a post; thence aXong lands of the Hickorytown M.E. Church, South 19 degrees West, a distance of 533.8 Ifcttt to a post, the place of BEGINNING. CONTAINING 2.45 acres, more or less. BEING the same premises which Paul Edward Koser, a!k/a Paul E. Koser, by and thmugh his attorney-in-fact, Mary K. Koser, and Mary Kathryn Koser, hu'~b~nld and wife, by their Deed dated March 4, 2003 and recorded on March 7, 201,03; in the Office ofthe Recorder of Deeds of Cumberland County in Deed Book 25b,'iPa~ge 123, granted and conveyed unto Mary K. Koser, married woman, Grantor herein: AND the said Grantors, Co-Executors as aforesaid, hereby covenant and agree that they will warrant specially the property hereby conveyed. IN VV:[TNESS WHEREOF, the said Grantors have hereunto set their harldsland seals, the day and yeaz first written above. SIGNED, SEALED AND DELNERED IN THE PRESENCE OF ESTATE OF MARY K. KOSER ~~ ~- /C a-~~,w (SEAL) Carl E. Koser, Co-Executor O (SEAL) Doris J. Wa , Co-E for :+~~'` -,Z' ~''~~-~ -, (SEAL,) Robert L. Koser, Co-Executor ~oo~ 26~ ~ac~2500 01/06/2010 9:55:11 AM CUMBERLAND COUNTY Inst.# 200522131 -Page 2 of 4 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND On this, the ~ day of June, 2005, before me, the undersigned officer, personally appeared Carl E. Koser and Doris J. Wagner, Co-Executors of the Estate of Mary K. Koset, l~nown to me or satisfactorily pmven to be the persons whose names are subscribed to the within i>tistrument, and acknowledged that they executed the within instrument for the purpose therein contained. _ IN WITNESS WHEREOF, I have hereunto set my hand and official seal.. R;>~~ see Dory t~. ho•,~sel, Public Saulh Middleton ~ w+a., Cumberlarsd Coi:: ~!y My Corrrn~sicx~ F~cpires .cam 2n, 200u i f ~~'l. .- _ - _ -_ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS ., M} 1~~~r ,~ .: ~` ~o ~ .,, ;,;-~ ~.. ... ~~., ;,•~ . ' .- ,._ ;, On this, the ~~~ day of June, 2005, before me, the undersigned off cer, personally appeared Robert L. Koser, Co-Executor of the Estate of Mary K. Koser, known to me or sati~farrtorily proven to be the person whose name is subscribed to the within instrument, and ackngwleclged that he executed the within instrument for the purpose therein contained. ~: ~; `~.r;~ ,k ITT IJVITNESS WHEREOF, I have hereunto set my hand and official seal. ;r; ~ ;: %~ I _~~ Ski- kY~ ~~ (SEAL ~,;r~F ~ . COMMO EALTH OF PENNSYL A IA ~ ` `'~: ~ ` ~ ', ,~` Jetni<ef Qtoss, Ndety S~-dDtic Ny Canrrreelon E>a~se sapt.ll, 2 CERTIFICATE OF ~'~""'"'' AssoclaUOn of otailes I hereby certify that the precise residence and complete post office address of the within Grantees is 1-k-5 -S l~~t T~rdt~. 12a. Date: ~ o~ 1 ~ 519. ( p ~ ~ ? c~ ,~ Attorney for Grantees 01!0612010 9:55:11 AM CUMBERLAND COUNTY 2619! ~~^~25~1 Inst.# 200522131 -Page 3 of 4 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND . RECORDED on this day of A. D. 2405, in the Recorder's IOEIi~ce of the said County in Deed Book ,Page Given under my hand and the seal of the said office, the date above writtien. Recorder C«et~erland Cbu-r~y Recof-der of Deeds IbStrun~ent Filin4 Re~eiFtH 554093 InStr~ 2005~4~2131 6/~2/~445 i4:2k:86 fte~arks: tf~.~TATE ABSTRACT CD K~~lBLE SEftRIB 2.44 DEED 11.50 DEED - i4RIt .54 DEED - RTT TAfiE 1b50.04 COMBERLAtN LEY X5.44 ~IDDlESEX TIIF Dv5.44 DEED - A/H ' 11.54 I.C.S. / A..3, 10.00 C4 I~fPR4~k T I Ft~D 2.00 REC. 1?4PRWi I'I;~D 3.00 Checks 1187. ~8~.i3.54 CheckA ? 51~6.~tl.40 CheckA 733 1825.44 Total Recei~ied~....., t3a3i8.50 eoo~ 2691 PAC~2502 01/06!2010 9:55:11 AM CUMBERLAND COUNTY Inst.# 200522131 -Page 4 of 4 REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHEPoTANCE TAX RETURN RESII~NT DE(~DENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF F{LE NUtIABgR THOMAS R. KIMBLE, JR 21 10 0009 Decedent's debts must bs roported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. EWING BROTHERS FUNERAL HOME 3,636.62 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) _ ~_ - StreetAddress City State ZIP Year(s) Commission Paid: 2. Attorney Fees: MATEYA LAW FIRM 3,000.00 3, Family Fxemptan: (B decedents address 'rs not the same as dainrants, attach explanation.) Claimant Street Address City State ZIP Relationship of Clamant tD Decedent 4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 2$0.50 5 Aooountant Fees: 6. Tax Return Preparer Fees: 7. CUMBERLAND LAW JOURNAL -LEGAL ADVERTISEMENT 75.00 8. THE SENTINEL -LEGAL ADVERTISEMENT 219.40 9. CUMBERLAND COUNTY REGISTER OF WILLS -FILING FEE 30.00 TOTAL (Also enter on Line 9, Recapitulation) I S z 7d1 ~~ If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-0e) pennsylvania DEP1IRTMENT OF REVENUE INHERITANCE TAX RETl1RN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE 1JF FILE NUMBER THOMAS R. KIMBLE JR 21 10 Op009 Report debts incurred by the del:adeM prior to death that remained unpakl at the data of death, including unroirhbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CARLISLE REGIONAL MEDICAL CENTER 50.00 MEDICAL SERVICES ACCOUNT NO. 9453100 2. CUMBERLAND GOODWILL FIRE & RESCUE 1,815.29 AMBULANCE SERVICE ACCOUNT NO. 14747 3. CAPITAL ONE 1,627.12 CREDIT CARD ACCOUNT NO. XXXX-XX)CX-~CXX-6820 ESTATE INFORMATION SERVICES COLLECTION NO. 2616288 4. CENTURY LINK 94.60 TELEPHONE SERVICE ACCOUNT NO. 717-249-9090-609 5. CENTER CITY DENTAL CARE 52.00 MEDICAL SERVICES 6. CHASE CREDIT CARD SERVICES 13,056.99 CREDIT CARD ACCOUNT NO. X)OCX-X~CX-XXXX-1411 7. SUNOCO MASTERCARD 282.36 CREDIT CARD ACCOUNT NO. XXXX-XXXX-XXXX-0790 8. DCM SERVICES ON BEHALF OF AT8~T UNNERSAL 514.10 MASTERCARD CREDIT CARD ACCOUNT NO. 3154 9. DCM SERVICES ON BEHALF OF THE HOME DEPOT 571.45 CREDIT CARD ACCOUNT NO. 6499 10. CiTIMORTGAGE 62,023.94 HOME MORTGAGE ON REAL ESTATE ACCCT. 2002804217 FIRST MORTGAGE $124,047.87 (DECEDENT WAS JO{NT DEBTOR) 11. CITIMORTGAGE 15,680.69 HOME MORTGAGE ON REAL ESTAE ACCOUNT 0401425571 SECOND MORTGAGE $31,361.38 (DECEDENT WAS JOINT DEBTOR) TOTAL (Also enter on Line 10, Rec~itulption) S ec sae ~~ If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMS~R:' runun~ o rrueQr c ro 21 10 U~109 RELATIONSHIP TO DECED Nt AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustse(a) OF ESTATE I TAXABLE DISTRIBUTIONS [Indt~e out' M usal distribufiorrs and transfers under Sec. 91 t6 (a~(1.2).] 1. STACEY A. K]MBLE Lineal 798.40 264 WHITMER ROAD SHIPPENSBURG, PA 17257 2. THOMAS R. KIMBLE, III Lineal 798.39 35 S. 39TH STREET CAMP HILL, PA 17011 3. BONNIE KIMBLE GORDON Lineal 798.39 35 S. 39TH STREET CAMP H{LL PA 17011 4. REBECCA BAGOT Collateral 0.00 1671 TRINDLE ROAD CARLISLE, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 C VER S HEET, AS APPROPRIATE. II, NON-tAXABLE DiS1RiBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 5113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL Of PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEi~, S If more space is needed, use additional sheets of paper of the carne size. __ _ _ L