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15QS630101 1s05L1~30~1 l
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J 1505610105
REV-1500 EX
Decedent's Social Security Number
_ .
Decedent's Name: Marie A. Clifford 030-03-5954
RECAPITULATION
1. Real Estate (Schedule A) ........................................... .. 1.
2. Stocks and Bonds (schedule B) ..................................... .. 2. ', 1,049,943.59
__
3.
Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ...
.. 3. i
4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4.
',
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 1,218,752.88
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
t
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Bill
R
7 ',
' 7
000
00
......
ing
eques
e
{Schedule G) O Separate .
.. ,
.
8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. ~~ 2,275,696.47
9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. I' 71,226.20
_ __.,_
10. Debts of Decedent, Mortgage Liabilities, and Liens {Schedule I) ............ .. 10. ~ 17,669.56
_
11. Total Deductions (total Lines 9 and 10) ............................... .. 11. L
, 88,895.76
12. Net Value of Estate (line 8 minus Line 11) ............................ .. 12. 12,186,800.71
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. ~ 2,186,800.71
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or .
transfers under Sec. 9116
,
is. a lineal rate X o 45 bie _ - _ 2,186,800.71 1,_...98,406.03
1s. _.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable .
at collateral rate X .15 18.
19. TAX DUE ....................................................... ..19. ~ 98,406.03
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT !, O
Side 2
1505610105 1505610105
REV-1500 EX Page 3
Decedent's Comfalete Address:
Flle Number
DECEDENTS NAME
Marie A. Clifford
^-~ _~-! - _-~'_-
STREETADDRESS
1001 Hillside Drive
CITY
Carlisle STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments _
B. Discount 4,920.30
3. Interest
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.
5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE.
(1) I, 98,406.03
Total Credits (A+ g) (2) 112,920.30
~--
(3)
~~ 1 4.27
(4) 4,51
~--
(5)
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 :.......................................................................................... ~ ~I
b. retain the right to designate who shall use the properly transferred or its income : :.:....:...:................................ ^
c. retain a reversionary interest; or ................................................................................................................ II
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? ........................................................... Ii
3. Did decedent own an "intrust for" orpayable-upon•death bank account or security at his or her death? .............. ^ ~',
4. Did decedent own an individual retirement account, annu'Ity or other non-probate property, which
contains a beneficiary designation? ........................................................................................................................ ^ ',
IF THE ANSVYER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS ART 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 u$e 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 sur~ving 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 or 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 21 years of age or younger at death to or for the arse 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 p2 P.S. §9116(a)(1.3)j. 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.
108,000.00
REy-1502 EX+,(11-08)
4: ..
a" `E'1 pennsytvania SCHEDULE A
~ DEPARTMENT OFREVENUE
INHERITANCE TAx RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF ftLE NUMBER
Marie A. Clifford 21-09-0900!
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 wilting buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that hz iolMiy-owned with rlyht of survivorship mutt be dlsciosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Intlude a copy of the deed showing decedent's interest if owned as tenant in common. ii VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1• Residential real estate known as 1001 Hillside Drive, Carlisle, PA 17013. The Estate is hereby
requesting ttte vaNle of this item be suspended from the appraisement of this return until the
~,
final value can be determined. A Supplemental Return will be filed after the real estate is sold
and wifl include the value of the real property and expenses of the sale. The Personal
Representative is hoping to have the property solo with in the next few months. ',
TOTAL (Also enter on Une 1, Recapitulation.) # 0.00
If more space is needed, insert additional sheets of the same size.
R6V-1503 EXir(6-98)
scN~ou~E s
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF F11E ,UMBER
Marie A. Clifford 21-0$-0800
Ail property joiridy~o~med wkh right or survivorship must be dleaiosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~• United States Series EE Savings Bonds (See attached Continuation Schedule) !, 93,186.00
~i
2. United States Series HH Savings Bonds (See attat~ted Continuation Schedule) ', 23,000.00
3. M&T Securities, Inc. Account (See attached Continuation Schedule) 215,056.92
~~
4. Stitel N'ICOlaus Account (See attadted Continuation Schedule) 717, 879.92
~~
5. 35 units of Pennsylvania Insured Muni Inc Tr Ser 2 Certificate No. 2004103 ! 820.75
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TOTAL (Also enter ap line 2, Recapitulation) S 1,049,943.59
(H more space fs needed, ir~seit eddiUonal sheets of the same size)
REV'~508 EX+(~-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDI/LE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF ILE NUMBER
Marie A. Clifford i21-09-0900
Indude the proceeds of litigation and the date the proceeds were received by the estate.
All property Jointlyowned with Nght of survivorship nwst be dbclosed on Schedule F. ~~
ITEM I VALUE AT DATE
NUMBER DESCRIPTION I OF DEATH
1. Replacement check from Avaya proceeds
2. Defense Finance -retirement benefits
3. Diakon Luthem Ministries - refund of nursing home care
4. Repayment of princpal from Jane Clifford loan
5. Interest on Item 4
6. Members 1st Savings Akxount#52829-00
7. Members 1st Money Market Aooount #52829-05
8. Members 1st Certificate of Deposit #52829-05
9. Members 1st Savings Account #170078-00
10. Members 1st Money Market Account #170078-05
11. Members 1st Certificate of Deposit #170078-40
12. Members 1st Certificate of Deposit #1700785
13. Miscellaneous Personal Property
14. Mirant Corporation proceeds check
15. MTB Money Market #AZD-498228
16. Stifel Nicolaus Ensured Bank Program #0306 8525-4106
17. M&T Bank Checking Akxount #2675049932
18. M&T Bank Market Advantage Axount #15004213033331
2,513.87
17.42
4,028.17
390,000.00
2,437.00
36.25
384.96
134,268.39
30.59
444.32
203,699.73
315,065.94
2,820.00
30.00
71,694.08
1,926.87
9,509.41
79,845.88
I
TOTAL (Nso enter on line 5, Recapitulation) i '~ 1,218,752.88
(If more space is needed, Insert additional sheets of the same size)
REd-1510 EX~r'(OS-09)
`~'pennsylvania
~~ SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBE
Marie A. Clifford 21-0~, -0900
This schedule must be completed and filed if the answer to any of questions 1 through A on page three of the REV-15001$ yes.
ITEM DESCRIPTION OF PROPERTY
mauoE T!E NNAE of THE 7RAtaFERff, nma RElA71oN5HIP m oECmErrc AHD DATE OF DEATH 96 OF DECD'S E% USION TAXABLE
NUMBER THE D,nE of TMRSFiit. ATfAQI A Copt of THE oEED FDR REAL ESTATE. VALUE OF ASSET INTEREST GBLE) VALUE
1 • Gift on 1I8I09 to granddagh~r, Kathryn Asad,106 Ampad Ct., Cary, NC 10,0.00 100 x,000.00 7,000.00
27513
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TOTAL (Also enter on Line 7, Recapitulation) $' 7,000.00
If more space is needed, use add'dional sheets of paper of the same size.
REV-1511 EX+"(10-09)
~` ~ pennsytvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUINBER
Marie A. Clifford 21-09-0900'.
Decedent's debts must be sported on Schadufe I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Carlisle Lebrt View Community Center -memorial service ! 1,440.00
2. Bishop Roque I 500.00
3. Stretch Funeral Services, Inc. 7,639.00
B. ADMINISTRATNE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City State ZIP
Year(s) Commission Paid:
2. Attorney Fees:
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:
5. Accountant Fees:
6. Tax Return Preparer fees:
~• Legal Advertising - Cumb~iand Law Journal
e. Legal Advertising -The Sentinel
60,000.00
1,459.00
75.00
113.20
TOTAL (A1so enter on Line 9, Recapitulation) ' $ ! 71,226.20
If more space is needed, use add'Afonat sheets of paper of the same size.
I,
REV-1512 EX+ (12-08)
~ ~:~~ Pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAx RETURN MORTGAGE LIABILITIES ~ LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBE
Marie A. Clifford 21-09-0900'
ITEM
NUMBER
DESCRIPTION ---- -- ---- .._.__...~ _...-....- ...-,.- ........ ..r~..~~.,.
VALUE AT DATE
OF DEATH
1 ~ Quadrangle -nursing home care ', 256.00
2. Twinning Village -nursing home ~', 10,509.00
I
3. Credit Manager -medical bill I 66.00
4. Omni Care -medication ~', 402.34
5. Continuing Care RX -medication ~II 1,276.89
6. PA Department of Revenue - 2008 personal income tax I 1,140.00
7. PA Department of Revenue - 2008 income tax penalty 76.33
S. U.S. Treasury - 2009 personal income tax ~ 2,069.00
9. PA Department of Revenue - 2009 personal income tax I' 1,874.00
TOTAL (Also enter on une 10, Recapitulation) ~ 17,669.56
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (O1-10)
~~ ~ Pennsylvania SCHEDULE ~
DEPARTMENT OF REVENUE * ES
INHERITANCE TAX RETURN BENE~IC ARI
RESIDENT DECEDENT
ESTATE OF: FI,.E NUMBER:
Marie A. Clifford 2r1-09-0900
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not L1st Trustee(s) I OF ESTATE
I TAXABLE DISTRIBUTIONS [Include ouMght spousal dlstrihuttons and transfers under
Sec. 9116 (a) (1.2).]
1. Kathryn Asad,106 Ampad Ct., Cary, NC 27513 granddaughter 7000.00
2. Jane E. Clifford, 206 Log Pond Lane, Newtown, PA 18940 daughter 1,089,900.36
3. Paul H. Clifford, 3355 Rocking Horse Lane, Encinitas, CA 92024 son 1,089,900.35
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS
II NON TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 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 L[NE 13 OF REV-1500 COVER SHEET. I ~
If more space Is needed, use additional sheets of paper of the same size.
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SERIES HH BONDS CONTINUATION SCHEDULE B PAGE 1 of 2
Estate of File Number
Merle A. Clifford 21-09-0900
T of Sevin s Bond ISSUE DATE IDENTIFYING NUMBER Value at Date of Death
Series HH 10/96 M6034502HH $ 1,000
Series HH 10/96 M6034501HH $ 1,000
Series HH 8/97 M6399500HH $ 1,000
Series HH 8/97 M6399499HH $ 1,000
Series HH 10/97 M6463493HH $ 1,000
Series HH 10/97 M6463492HH $ 1,000
Series HH 11/97 M6504652HH $ 1,000
Series HH 06/98 M6743885HH $ 1,000
Series HH 08/98 M6823292HH $ 1,000
Series HH 10/98 M6865938HH $ 1,000
Series HH 02/99 M6985565HH $ 1,000
Series HH 05/99 M7095241HH $ 1,000
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SERIES HH BONDS CONTINUATION SCHEDULE B PAGE 2 of 2
T of Sevin s Bond ISSUE DATE IDENTIFYING NUMBER Value at Date of Death
Series HH 07/99 M7173476HH $ 1,000
Series HH 10/99 M7268020HH $ 1,000
Series HH 11/99 M7311197HH $ 1,000
Series HH 01!00 M7385380HH $ 1,000
Series HH 05/00 M7495244HH $ 1,000
Series HH 07/00 M7585869HH $ 1,000
Series HH 12/00 M7727614HH $ 1,000
Series HH 03/01 M7852122HH $ 1,000
Series HH 07/01 M8055506HH $ 1,000
Series HH 01/98 D4598450HH $ 500
Series HH 02198 D4637138HH $ 500
Series HH 03/98 D4659771 HH $ 500
Series HH 04198 D4695757HH $ 500
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