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1505607121 ~ \/
REV-1500 EX (06-05) t
PA Department of Revenue O~FICIAL USE ONLY '
Bureau of Individual Taxes County Code Year File Number
Poaox2aosof INHERITANCE TAX RETURN
Harrisbu PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 1 0 2 7
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 4 0 3 0 0 5 1 1 0 1 6 2 0 0 9 0 3 3 0 1 9 1 7
Decedent's Last Name Suffix Decedent's First Name
F R I C K MI
G L A E R
(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
4. Limited Estate prior to 12-13-82)
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
S E T H T M O S E B E Y 7 1 7 2 4 3 3 3 4 1
Firm Name (If Applicable)
M A R T S O
N
L A W O F F I C r.
REGIS~2 OF WILLS l~ ONLY '_-1
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First line of address ,
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1 0 E A S T H I G H S T R E E T ~--~~'~ ~
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Second line of address ' ~' v` ~ %~ --
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City or Post Office State ZIP Code .~4T~ FILED ~ ~~ "~ C?
tr
C A R L I S L E P A 1 7 0 1 3 '"
correspondent's a-mail address: S M O S E B E Y a M A R T S O N L A W• C O M
Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct d complete aration of preps r other than the rsonal representative is based on all information of which preparer has any knowledge.
U P E FILING I~¢U N
~ DATE
DRESS ~~ - ~- ~~
2030 RITNER HIGHWAY CARLISLE PA 17015
SIG URE F PRE~RER THER ATl REPRESENTATIVE
J . d/ DATE
ADD S /C> ~/ - ~L~
EAST HIGH STR
CARLISL
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505607121
PA 17013
15056071,21 J
REV-1500 EX
1505607221
Decedent's Social Security Number
decedent's Name: G L A E R• F R I C K 2 0 4 0 3 0 0 5 1
RECAPITULATION
1. Real estate (Schedule A) , , , , , , , , , , , , ,, 1
2. Stocks and Bonds (Schedule B) .................................. 2. 1 1 8 1 . 5 1
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & 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. 1 1 ,
9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9.
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10.
11. Total Deductions (total Lines 9 & 10) ........................... 11.
12. Net Value of Estate(Line8minusLinell)
,,,,,,,,,,,,,,,
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12
an election to tax has not been made (Schedule J) , , , , , , , , , ,, , , , , , 13.
14. Net Value Subject to Tax (Line 12 minus Line 13)
........... ....... 14.
TAX COMPUTATION -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.0 _ D D D 15.
16. Amount of Line 14 taxable
at lineal rate X .045 1 0 8 1. 5 1
17. Amount of Line 14 taxable 1s.
at sibling rate X .12 D 0 0 17
18. Amount of Line 14 taxable
at collateral rate X .15 0 ~ D D 18
19. Tax Due ................................................ 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505607221
8 1. 5 1
1 0 0, 0 0
1 0 0. 0 0
1 0 8 1. 5 1
1 0 8 1. 5 1
0. D 0
4 8. 6 7
0. 0 0
0. 0 0
4 8. 6 7
1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
Nd ~.fF
File Number
21 09 1027
GLAE R. FRICK
STREETADDRESS
2320 RITNER HIGHWAY
CITY _ _
CARLISLE
Tax Payments and Credits:
~ Tax Due (Page 2 Line 19)
Z. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty if applicable
D, Interest
E. Penalty
STATE _ ZIP
PA 17015
Total Credits (A + B + C )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference, This is the OVERPAYMENT.T otal Interest/Penalty (D + E)
Fill In oval 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.
(1)
48.67
(2) 0.00
(3) 0.00
(4) 0.00
(5) 48.67
(5A) 0.40
(58) 49.07
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;
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 "in trust 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
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 (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 oryounger of 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) j. 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.
F2EV-1503 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GLAE R. FRICK
SCHEDULE B
STOCKS 8 BONDS
FILE NUMBER
21 09 1027
All prope-iy joinNy-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION
1. 23 shares, Prudential Financial, Inc. CUSIP 744320102
See attached
VALUE AT DATE
OF DEATH
1,181.51
TOTAL (Also enter on line 2, Recapitulation) I $ 1 18 l > 1
(If more space is needed, insert additional sheets of the same size)
r2EV-1511 EX + (10-08)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES 8
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
GLAE R. FRICK 21 09 1027
Debts of decedent must be reported on Schedule L
1 TEM
NUMBER DESCRIPTION
A• FUNERAL EXPENSES:
1.
B• ADMINISTRATIVE COSTS:
1 • Personal Representafive's Commissions
Name of Personal Representative (s)
StreetAddress
Cdy State Zip
Year(s) Commission Paid:
2, Attorney Fees MARTSON LAW OFFICES (estimated)
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Gaimant
Street Address
Cdy State Zip
Relationship of Gaimant to Decedent
4. ~ Probate Fees
5. ~ Accountant's Fees
6. I Tax Retum Preparer's Fees
7
AMOUNT
100.00
TOTAL (Also enter on line 9, Recapitulation) I $
100 00
(If more space is needed, insert addrt~onal sheets of the same size)
REV-1513 EX + ~g_00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
GLAE R. FRICK
21 09 1027
RELATIONSHIP TO DECEDENT
NUMBER NAME AND ADDRESS OF PERSON S RECEIVING PROPERTY
(~ AMOUNT OR SHARE
Do Not List Trustee(s)
I TAXABLE DISTRIBUTIONS (inGude outright spousal distributions
and tr
f
d OF ESTATE
,
ans
ers un
er
Sec. 9116 (a) (1.2)/
1. Cledith M. Frick Lineal
2320 Ritner Highway 3 60.5C
Carlisle, PA 17015
2. Paul W. Frick Lineal
21 Royal Drive 360.50
Carlisle, PA 17015
3. Phyllis E. Noggle Lineal
205 Redington Ave. 360.51
Troy, PA 16947
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18
AS APPROPRIAT
,
E, ON RE V-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space )s needed, insert additional sheets of the same size)
Estate Valuation
Cate of Death: 10/16/2009
Valuation Date:
10/16/2009 Est ate of: Glae R. Frick °;_a~e
Processing Date: 09/29/2010 Report Type: Date of Gea=~_
Number of Secur~t~es: _
File IG: '_C35Cy1.'r:c::
Shares Security
or Par
Description
High/Ask Low/Bid Mean and/or
Adjustments Div and In*_
Accrual Securi~,
'I
1
s a
ue
li 23 PRUDENTIAL FINL INC (744320102; PRU)
COM
NYSE
10/16/2009 52.06000 50.68000 H/L
51.370000 _ -ln-,•~l
Total Value:
Total Accrual: i
~---~--
Total: $1,181.51 SC.CO
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questi~r.s,
please contact EVP Systems at (818? 313-6300. (Revision 6.4.1)