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NRIERITANCE TAX RETURN ~/ ~ C J ~ ~ ~G
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183-12-4026 02/10/2010 01/2411921
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TNI6 R~i1NIN MUTT EE FILED IN OUFLICATE 1NRN THE
REGISTER OF WILLS
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Name
Daryl Nate
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2324 Chestnut St.
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Camp Hill PA 17011
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810NATUNE OF OTTER 7fYW affNfATiVE DATE
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1505610105
REV-1800 EX
DsosdarM'e SoolY Sacudly NumbM
oeow«w. Henw: Elwood Nate 183-12-4026
ItIE CA/ffill.AT10N
1. ReM Eelw (~+.di~eA) ............................................. 1. 134,200.00
2. Blocks and Bads (t3disd~Ae 8) ....................................... 2. 0.00
3. CIaNy Held Corpora0on. PaAnnsMp ar 8Wa-P-opristoishlP (8cMdula C) ..... 3. 0.00
4. Malppee and', NoNs Raoalvabla (Schedule D) ........................... 4. 0.00
B. CaeA. 8ardc DapaNte and MNoepmeoue Personal PRAY (Stiiedule E)....... 8. 238,362.00
8. JokfBy Owned IPropeAy (Sduduie F) O 8aparaES BINNp Regiw6ed ....... 8. 0.00
7. IrM.r-Vlore 7Ya-M~s 6 AMeoeNarNOw Nan-Prol-als proper-y
(8disdule O) O Separate BWn9 ~4u~d........ 7. 0.00
8. TetN Oros Ayaats (total Una 1 through 7) ............................. 8. 872.562.00
9. Fune-N Ferree and AdminMbaWe Coats (sd+eduls H) ................... 9. 21.164.76
10. DatMS d DecadnM. UaDUNMa, snd Uarp (t3chsdule t) .............. 10. 3.631.71
11. Total Dedlrallorre (bW LYw 9 and 10) ................................. 11. 24,796.47
1z. Net Vihw dlrgle (Una a minus LNu 11) .............................. tz. 347,765.53
13. CharNabk and 4tovsnanenlN Baqusehlgec 9113 Tngte for wMdr
an eNolbn b tebc ha not bean made (Sdwdula J) ........................ 13. 0.00
14.
.~. Nat VMw tN~hNd to Tiic (LNu 1z mYuN I.Mis 13) ........................
~~_ 14. 347,765.53
7Alt CALCULATION • ~ NliifltlCT10N{ FOR APPLlCAlI,a RATEi
18. Amowd d lMN 14 tar<abN
at tlr spousal tlpc nle. or
Varrbrs under $ec. 9118
(ax1.~) x .o_ 1s.
18. Amount d Una t4 faxabk
atNnealraM X:og,t 347,765.53 te. 15,849.45
17. AmourN d Una 14 taxable
at eltwkp role X .12 7r.
18. Amaak d Urr 14 taxable
at collateral role X .18 18.
19. TAXtxle ......................................................... 19. 15,649.45
20. FILL MI TIIE OW1L IF YOU ARE gpllifTMq A IIptMO OF AN OVERMYMENT
sidtl 2
L 1505r.1D105
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Elwood A. Nate
STaffTAtxX<iE38
735 Bosley Avenue
GrY
Lemoyne
~A~Pa
17043
Tax Pa~Im~Ms and Ctrtadib:
f. lane Dw (Ppe 2, une 19)
2. GedblPayrnerka
A Prior Peynrerds 0.00
B• DNeouK 0.00
3. haereet
4. M Lire 2 k peeler tlren Line 1 + Line 3, enkr tlrs dNbiMioe. TM k er W9IMYMENi
ql b owl on IMaoe Z, lJee ~ k rogrrat a sherd.
S. B Line 1 + ~ 3 k peMer then LYn 2, enter the dlRasnoe. Thk k the TAX DUE
0.00
(5) 15,649.45
Make check payable to: REGISTER OF WILLS, AGENT.
~ .,
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLA~MIG AN'7C' IN THE APPROPRIATE BLOCKS
1. Did deoeded melee a irerrebr erxk Ye6 ~
a, rsldn the uM a btopne d Mre properly Yanewnea .......................................................................................... ^
b. ieabr the right b deeipneM who elere we the piopwly transferred a ae inconr :............................................ ^ x^
a ratan a rwMaianry MMerest or ......................................................................................................................... ^
d. nave the prarMee for lib d either peyrrrerNs, berrelNs a cars4 ...................................................................... ^
2. lr essay occrand afkr Dec.12,11181, did deoedeM tr.rreter properly wieri- arr ywr of death
wehout raaivNq adequuaM ooiridr.tfon4 .............................................................................................................. ^
3. Did deoederrt dwn an 1n Yrrst for a peye0larporr•dssMr UarYc sboorre a aeeuYy at Me a her dealh7 .............. ^
1. Did dsaederrt awn en krdividil,I ntlramerrt acaouA, snnuNy ar alMr nar•prabals WoP~Y. which
conbNrs a beiNAckry deeiparion4 ........................................._............................................................................. ^ 0
IF THE ANSMIER TO ANY OF ~ ASONE QUESTIONS M YES, YOU MIST COI~LETE tN,E 6 AND FS.E R AS PART OF T~ RETURII
(~I
Far data d death an a alMr July 1,1991, and bNae Jan. 1, 1985, the ml raM inpoeed an the net value d 6anakre b or br ttte ua d the aurvhdrlp epoua k
3 peroenl [l2 P.S. X118 (a) (1.1) (ilJ.
Far deka d dedh on or alterJ~r 1, 1995, mle fart rate MnPoad an the net value d Uanakra b a (a the we d the autvhlrp apoua k 0 percent
(12 P.S. $9118 (a) (1.1) (in)• The a4t~bule dos not exempt a tranekr b a airvivkp epoua tram lax, and the afahAOry nquirorrrerrle for dkdoelxe d webs and
ANnp a tax room ero qlN appicablel awn K tM eurvivhg apoua k the ony UerleSCiary.
For delea d death on a alter Juy ~,2000:
• The kx rate Inpaed on the sat value d hanks tram a deceeeed diNd 2t yearo d ape a younger at dalh b a for the ua d a rrehaal parent, an
adaptive parent a a slepparoMi d the diNd k 0 percent (72 P.S. ~118(aN1.2)).
• The talc role ' an the net value d tranekra b a to the ua d the deoederrCa AriaM berrelciarka k 4.5 percent, eucapl ae scaled k
72 P.S. §9118(1P.S. §91t8(ax1n.
• The fax yak NnPaad on the nst value d trankn b ar for Mre ua d the deoedenl'a k 12 percent (72 P.S. ~118(ax1.3p. A aibWrp k deMred, under
Seclbn 9102, a an bdbiduel rrlro flea at leaf one psrerN in common rsltli 9le deoederN~ by blood or edopdon.
(1) 15,649.45
TdN t.ndee (A + 8) (2) 0.00
(3)
REV-i50Z EX+ (11-08)
{ pennsylwaMa SCHEDULE A
DFMRTNlNr OP RlVENUE REAL ESTATE
INNERITANCF TA7C RETURN
REBDIENT DECEDEtrT
~TAn ~ FILE NUMBER
Elwood A Nate 2010-00166
Ali rMl oropsrty owned solsh or a! ! tsnsM In common molt bs nPortsd st 41r market vslw. Fair market value Is defined as the prke at whkh property
would be exchanged belweeh a willing buyer and a willing sdkr, neither being compelled to buy or sell, both having reasalable knowledge of the relevant fads,
keel propsrq that h Jolotlr-owned wkh Mght of wrWvordNy must be dNdond on scheduN F.
Attach a wpy of the settkmeM sheet If the property has been sold.
ITEM Indude a copy of the deed showing decedent's Interest If owned as tenant In common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. Two Stary Detached House wilh garage on .11 saes at 735 Beeler Avenue Lemoyne,PA 17043 134,200.00
TOTAL (Also enter on Une 1, Recapitulation.) I # 134,200.00
IF more space Is needed, Insert addRlonal sheets of the same size.
REV-1608 EX+ (8.88)
s~N~ouu ^
COMMONWEALTN of v~NNSvwnNw CASH. BANK DEPOSITS, 8t MISC.
INNERRANCETAXIRETURN ~~~
RESIpENT DECffffDDEN7
ESTATE OF
FILE NUMBER
Elwood A Naoe 2010-00166
IncNrde Ore proceeds of iitige0on mid the dare db proceeds mere received t7' die estate.
~t P-OPmtY letath~0wted aA~ t10ht of wrvlwnhb moat hs dleclmed on l3Meeule F_
to more space ~a neeaea, ecsett aaaaoael sheets of de amne size)
REV-1511 EX+ (10-09)
P~~YLvaMa SCHEDULE H
°a°""*"a"*°'"nreMUE FUNERAL EXPENSES AND
'""s"'T""~T"""~T'"'" ADMINISTRATIVE COSTS
RESIDENT DECFDEMr
ESTATE OF FILE NUNlER
~lweo~ ~. i/AGE ,24/0 - OD ld, 6
Decsdent'e debt moat be sported on Scheduls L
ITEM
NUMBER DESCRIPTION
AMOUNT
A. FUNERAL EXPENSES:
1' Musselman Funeral Home 6,913.44
Rolling Green', Intemnent 1,34500
Bricker House 262.50
Food and Flowers after interrmeM 1,234.77
Estate Notice 6n Patriot News 75 ~
Minister Brad Moore 50.00
B. ADMINISTRATIVE COSTS:
1. Personal Reprelxmtatlve Commissions: 0 ~
Name(s) of Personal Representatlve(s) Daryl L. NeCe
street adddress 2324 Chestnut Street
Cgy CNmp Hill Sta<e Pa ZIP 17011
Year(s) Commissron Paid:
Z• Attorney Foes: 0.00
9. Family Exemption: (lf decedent's address Is not the same as dalmant'a alted~ 0•~
explanatlon.)
Claimant
Street Address
~Y _ State
Relation9hlp of paimant to DeadeM
4.
5.
6.
7.
Probate Fees:
Accountant Fee6:
Tax Return Preparer Fees:
Real Estate Tax
Utility Bills
Home Repaint and Maintenance
Estate Auction with refuse
Travelers Home CMrtier Insurance
Z1P
443.50
1,399.81
1,634.65
4,133.56
3,242.05
430.00
TOTAL (Also enter on Une 9, Recapitulation) ¢ 21,164.76
If more space is needed, use additlonal sheets of paper of the same size.
REV-1512 EX+ (12.08)
scH~~u~E z
~~~,
A1116lifANCE TA%~REfININ MORTOAAE LIAdILITt~ ~- LIEN
Elwood A. Place 2010-00166
n ngra ipRE is f1600lO~ IIIRII ~RlOlli !11lKi p~ Q~ ~~ ~.