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Home My WebLink About02-09-11 (2)J 1505607121 REVS-1500 EX (06.05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Indvidual Taxes Coumy Code Year File Number PDBOx2eosol INHERITANCE TAX RETURN 2 1 1 0 0 1 3 7 Harrisbum, PA 1~t2s-OSOt RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 5 8 4 8 1 1 4 8 0 1 1 4 2 0 1 0 0 2 0 6 1 9 1 1 Decedent's Last Name Suffix Decedent's First Name MI G R A Y L O U I S E A (N Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI N / A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of prior to 12-13-82) ~ 5. Federal Estate Tax Retum Required 8. Decedent Died Testate (Attach Copy of Will) ~ death after 12-12-82) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 1231-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONRDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number D A V I D R G E T Z E S Q U I R E 7 1 7 2 3 4 4 1 8 2 Finn Name (If Applicable) n ~ s' W I X W E N G E R & W E I D N E R REGISTER ~ LS USE Y ~ ~ - First line of address , r~~ CC r- ~ ,f < <~ r ' ~' 5 0 8 N O R T H S E C O N D S T R E E T r~i 7 ~ ~ ~° Second line of address ~~ ~ ~ ~~ - P O B O X 8 4 5 A"t ~~ City Or Post Office State ZIP Code DATE FILED ~ H A R R I S B U R G P A 1 7 1 0 8 0 8 4 5 Correspondent's a-mail address: DGETZ~ W1 Under penakies of perjury, I declare that I have examined this d is true, coned and tmmplete. Declaration of preparer other 1 SIGNATURE OF PERSON RESPONSIBLE FOR FILING DATE ADDRESS SEE ATTACHED SIGNATt1RFOF PRERARER.OTHER~+IAN REPRESENTATIVE DATE I 508 NORTH SECOND ST/PO BOX 845 HARRISBURG PA 17108 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505607121 romny ran the schedules and statements, and to the best of my knowledge and is based on all iMormation of which preparer has any knowledge. 1505607121 J Estate of Louise A. Gray SSN 158-48-1148 Estate No. 21-t0-0137 Date of Death: January 14, 2010 Under penalties of perjury, we declare that we have examined this return, including accompanying schedules and statements, and to the best of our knowledge and belief, it is true, correct, and complete. SEE ATTACHED N. Comely Gray, Co-Executor 147 IVlanthorne Road, Unit #2 West Roxbury, MA 02132 ~~~ David A. Gray, Co-Exec r 43 Summer Drive Dillsburg, PA 17019 Dated: JGi , 2011 Estate of Louise A. Gray SSN 158-48-1148 Estate No. 21-10-0137 Date of Death: January 14, 2010 Under penalties of perjury, we declare that we have examined this return, including accompanying schedules and statements, and to the best of our knowledge and belief, it is true, correct, and complete. N. Comel Gray, Co- ecut 147 Manthorne Road, t # West Roxbury, MA 02132 SEE ATTACHED David A. Gray, Co-Executor 43 Summer Drive Dillsburg, PA 17019 Dated: r~6 t , Zo 1 ~ , 2011 J 1505607221 REV-1500 EX Decedent's Social Security Number Decedent's Name: L O U I S E A. GRAY 1 5 8 4 8 1 1 4 8 RECAPITULATION 1. Real estate (Schedule A) ...................................... .. 1. 0 . 0 0 2. Stocks and Bonds (Schedule B) ................................ .. 2. 1 2 8 3 6 . 7 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0 . 0 0 4. Mortgages & Notes Receivable (Schedule D) ...................... .. 4. 0 . 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... .. 5. 0 . 0 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Ngp~ probate Property (Schedule G) a Separate Billing Requested ..... .. 7. • 8. Total Gross Assets (total Lines 1-7) ...... . .. . . .. . . . . . ... . . ... . g. 1 2 8 3 6 . 7 0 9. Funeral Expenses & Administrative Costs (Schedule H) . . . ..... . . . . . . . . 9. 4 1 5 , 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ........... . 10. 0 . 0 0 11. Total Deductions (total Lines 8 & 10) .......................... . 11. 4 1 5. 0 0 12. Net Value of Estate (Line 8 minus Line 11) ........................ . 12. 1 2 4 2 1. 7 0 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. 1 2 4 2 1, 7 0 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 .o _ 0. 0 0 15. 0. D O 16. Amount of Line 14 taxable at lineal rate x .oas 1 2 4 2 1. 7 0 is. 5 5 B. 9 8 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate x ., 5 0. o o , 8. o. o o 19. Tax Due ................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Sid® 2 L 1505607221 1505607221 5 5 8. 9 8 REV-1500 EX Page 3 D'ecedent's Complete Address: File Number 21 10 0137 DECEDENTS NAME LOUISE A. GRAY STREET ADDRESS 735 OAK OVAL CITY MECHAIVICSBURG STATE ZIP PA 17055 Tax Payments and Credits: t Tax Due (Page 2 Line 19) 2. CredltsrPaymerns A. Spousal Poverty Credit _ B. Prior Payments _ C. Discourn (1) 558.98 Total Credits (A + B + C) (2) 0.00 3. InteresUPenatty'rfappIicable D. Irnerest E. Penalty otal InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference This is the OVERPAYMENT 0.00 . . Fill in oval on Page 2, Lino 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 558.98 A. Enter the interest on the tax due . (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE . (56) 558.98 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING GIUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedern 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 fls income : ............................... ^ c. retain a reversionary irnerest; or ............................................................................................... ^ 0 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? .......... ................................................. .................. my 3. Did decedent own an 'intrust for' or payable upon death bank account or secu ' 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. . >r+t; 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 io or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requiremerns for disclosure of assets and filing a tax return are still applicable even H 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 or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparern of the child is zero (0) percent p2 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedern's lineal beneficiades 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 tweMe (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. REV-1503 EX + (8-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT LOUISE A. GRAY 21 10 0137 All property jointly-owned with right of survivorship mast be disclosed on Sdieduk F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 340 SHARES METLIFE INC. COMMON STOCK ®$37.755/SHARE 12,836.70 TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert addtional sheets of the same size) REV-1511 EX+(10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN A. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 1 Debts of decedent must be reported on Schedub I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1. B• ADMINISTRATIVE COSTS: t • Personal Representative's Commissions Name of Personal Representative (s) Street Address City State ~p Year(s) Commission Paid: 2. AttomeyFees WIX, WENGER 8 WEIDNER 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanafion) Claimant Street Address City State Zp Relationship of Claimant to Decedent 4• Probate Fees 5• I AccountanCs Fees s• ~ Tax Retum Preparer's Fees 7• I CUMBERLAND COUNTY REGISTER OF WILLS -FILING FEE TOTAL (Also erlter on line 9, ReCapRulation) I $ (If more space is needed, insert additional sheets of the same size) AMOUNT 400.00 15.00 REV-1513 EX r (9.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDUL~J BENEFICIARIES FILE NUMBER LOUISE A. GRAY 21 10 0137 NUMBER I. 1. 2. 3. 4. 5. 6. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [inGude outd t spousal distributions, and transfers under Sec. 9116 (a~(1.2)] MARILYN LOUISE GRAY 8936 BEVERLYWOOD STREET LOS ANGELES, CA 90034-2418 JANICE MARGARET GRAY 220 MILLBURN AVE. MILLBURN, NJ 07041 JONATHAN DAVID GRAY 30 EMMA LANE GORHAM, ME 04038 DAVID A. GRAY 43 SUMMER DRIVE DILLSBURG, PA 17019 N. CORNELL GRAY 147 MANTHORNE ROAD, UNIT #2 WEST ROXBURY, MA 02132 TODD M. GRAY 612 NW 70TH ST SEATTLE, WA 98117 Do NOt List Lineal Lineal Lineal Lineal Lineal ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES 15 THROUGH 18, AS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) OF ESTATE 372.65 372.65 372.65 5,465.55 5,465.55 372.65 ON REV-1500 COVER S .-1 m I I 1 U ~ ¢i I a gg I S~ I lei I I Aol to l0 0 I h I h h 1 1 ~1 1 10 . 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