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Home My WebLink About03-21-11 (3). ~ ', J 1505610140 REV-1500 EX (°'_'°' PA Department of Revenue ~ ~~ ~ OFFICIAL USE ONLY_ Bureau of Individual Taxes INHERITAN County Code Year File Number Po Box 2sosol CE TAX RETURN Harrisbur PA 17128-0601 RESIDENT DECEDENT ~ ~~ ~,`' ~ 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 9 7 4 0 7 4 6 3 0 9 2 4 2 0 0 9 0 3 0 4 1 9 5 1 Decedent's Last Name Suffix Decedent's First Name MI Gar n e r Rob e r t F (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 a 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ^ 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 T0: Name Daytime Telephone Nlumber Jason E Gar ner 717 776 4600 First line of address 9 8 D o u b l i n Second line of address City or Post Office N e w v i I l e Correspondent's a-mail address: Gap R o a d State PA ZIP Code ~~ REGISTER OF VIIILL&~ISE ONLY--- ;~ ._ > _. ,~ . DATE 1=ICED 1 7 2 4 1 Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNET E OF P~ RESPONSIBLE FOR FILING RETURN ~' `,~.,, D~4TE A ESS -3 ~ 98 Doublin Ga Road Newville PA 17241 SIGNATURE OF ~REPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 :1~`7 - ~ _ _; 5 ,~ ;, ~. ~~ 1505610240 REV-1500 EX Decedent's Social Security Number Decedents Name: Robert F. Garner 1 9 7 4 0 7 4 6 3 RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. • 2. Stocks and Bonds (Schedule B) ...................................... 2. • 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) .......................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 1 3 0 9 6. 3 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous N~Probate Property (Schedule G) S eparate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 1 3 0 9 6 , 3 3 9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9. 4 4 1 7. 2 1 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 3 ~ 5 6 . 6 2 11. Total Deductions (total Lines 9 and 10) ............................... 11. $ 1 7 3 . $ 3 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 4 9 2 2 . 5 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. 4 9 2 2 . 5 0 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 .0 0 . 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 4 9 2 2. 5 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 19. TAX DUE ...................... ......................... ..... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1505610240 0. 0 0 2 2 1.5 1 0. 0 0 0. 0 0 2 2 1.5 1 J REV-1500 EX Page 3 Dec'edent's Complete Address: DECEDENTS NAME Robert F. Garner STREET ADDRESS CITY Tax Payments and Credits: ~~ Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 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 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. File Number 00 STATE (1) Total Credits (A + B) (2) (3) (4) (5) ZIP 221.51 0.00 0.00 221.51 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; ............................... ^ Q c. retain a reversionary interest; or ................ .. ................................................. d. receive the promise for life of either payments, benefits or care? ....................................................... ^ ^ ^ X 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? ......... ^ X^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? .................................................................................................. ~ I-I 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse i. 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)J. 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 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)j. • 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 [72 P.S. §9116(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 adoption. REV-1502 EX+ (01-10) ~, pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE `~" ~' ` ter' FILE NUMBER: Robert F. Garner 0 0 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 willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on Line 1, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + {6-98) .. SCHED IJLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT is i A i t ur FILE NUMBER Robert F. Garner 0 0 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1504 EX + (6;98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDlJLE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP wir~~~vr FILE NUMBER Robert F. Garner 0 0 Schedule C-1 or C-2 (including all supporting information) must be attached for each closelyfield corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 3, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) REV.'t,505 EX + (5-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHED~/LE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT ESTATE OF FILE NUMBER Robert F. Garner 0 0 1. Name of Corporation Address City 2. Federal Employer I.D. Number 3. Type of Business State State of Incorporation Date of Incorporation Zip Code Total Number of Shareholders Business Reporting Year Product/Service 4• TYPE TOTAL NUMBER OF NUMBER OF SHARES STOCK Votin /Non-Voti SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT Common __ $ Preferred S Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? ....................................... ^ Yes ^ No If yes, Position Annual Salary $ Time Devoted to BusinE~ss 6. Was the Corporation indebted to the decedent? ....................................... ^ Yes ^ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ............... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ VALUE OF THE DECEDENTS STOCK Owner of the policy 8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ............ ^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ........................ . ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. ~ ~ ~ 11. Was the corporation dissolved or liquidated after the decedent's death? ....................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ...................... ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 precedincl years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies, D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) REV-1506 EX + (g-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER Robert F. Garner 0 0 1. Name of Partnership Address 2. 3. 4. 5. Date Business Commenced Business Reporting Year _ City State _ Zip Code Federal Employer I.D. Number Type of Business Product/Service Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ PARTNER NAME PERCENT PERCENT BALANCE OF OF INCOME OF OWNERSHIP CAPITAL ACCOUNT A. B. C. D. 6. Value of the decedent's interest $ 7 8 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death?........ ^ Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? .................................. ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................. ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? ............................... ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? ................. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. Was the Partnership indebted to the decedent? ................................ ^ Yes ^ No If yes, provide amount of indebtedness $ Was there life insurance payable to the partnership upon the death of the decedent? ........ ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy REV-1507 EX + (6;98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF FILE NUMBER Robert F. Garner 0 0 _ All property jointty-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. VALUE AT DATE OF DEATH TOTAL (Also enter on line 4, Recapitulation) a (If more space is needed, insert additional sheets of the same size) REV-1508 EX + !6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. I" R SIDENT DECEDENT " PERSONAL PROPERTY ESTATE OF FILE NUMBER Robert F. Garner 0 0 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. Payment for State leave and accrued benefits 12,500.72 Refund from Tanner Oil I 595.61 TOTAL (Also enter on line 5, Recapitulation) 19- 13, 096.33 (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHED IDLE F JOINTLY-OWNED PROPERTY `~' "' ` ter' FILE NUMBER: Robert F. Garner 0 0 If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) A. B C. JOINTLY-OWNED PROPERTY: LETTER DATE ITEM FOR JOINT MADE NUMBER TENANT JOINT 1. A. DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET RELATIONSHIP TO DECEDENT OF DATE OF DEATH DE:CEDENT'S VALUE OF INTEREST DECEDENT'S INTEREST TOTAL (Also enter on Line 6, Recapitulation) I $ If more space ~s needed, use addfional sheets of paper of the same size. REV-1510 EX+ (0~-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert F. Garner 0 0 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY - INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S E:XCI.USION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (11= APFiICABLE) VALUE 1. TOTAL (Also enter on Line 7, Recapitulation) ~ ~ If more space Is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS to i A i t ur FILE NUMBER Robert F. Garner 0 0 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hollinger Funeral Home & Crematory, Inc. 2,920.16 Advertising-Cumberland Law Journal 75.00 Advertising-The Evening Sentinel 225.05 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State _ ZIP Year(s) Commission Paid: 2. Attomeyl=ees: Karl E. Rominger, Esquire 1,000.00 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State ,__ ZIP Relationship of Claimant to Decedent 4. 5. 6. 7. Probate Fees: Cumberland County Register of Wills Accountant Fees: Tax Retum Preparer Fees: 197.00 TOTAL (Also enter on Line 9, Recapitulation) I ~ 4,417.21 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (q 2-08) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert F. Garner 0 0 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimburseci medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Tanner Oil 404.39 Merrick Bank-Account#41206130689008026 I 1,765.99 DCM Services-Reference # 5761936 I 1,481.42 Waste Managment ~ 104.82 TOTAL (Also enter on Line 10, Recapitulation) I $ _ 3, 756.62 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-1 Q) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert F. Garner 0 0 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfe-s under Sec. 9116 (a) (1.2).] 1. Jason E. Garner Lineal 50.00 98 Doublin Gap Road Newville, PA Nancy Porter Lineal 50.00 133 Lincoln Street Steelton, PA I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SPIFFY, AS APPROPRIATE II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I ;6 If more space is needed, use additional sheets of paper of the same size. REV-1514 EX+ (4-09) ' pennsylvania DEPARTMENT OF REVENUE Bureau of Individual Taxes PO Box 280601 Harrisburg PA 17128-0601 SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (CHECK BOX 4 ON REV-1500 COVER SHEET) ESTATE OF FILE NUMBER Robert F. Garner 0 0 This schedule should be used for all single-life, joint or successive life estate and term-certain calculations. For dates of dE~ath prior to 5-1-89, actuarial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to~ 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Othler NAME OF LIFE TENANT DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE ^ Life or ^Term of Years ^ Life or ^Term of Years ^ Life or ^Term of Years ^ Life or []Term of Years ^ Life or ^Term of Years 1. Value of fund from which life estate is payable , , , , , , , , , , , ,, , ,, , ,, , ,,,,, $ 2. Actuarial factor per appropriate table . . . . . . . . . . ........ . .. . . . Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) . . . . . . . .. . . .... . .. . ... $ NAME OF LIFE ANNUITANT DATE OF BIRTH • NEAREST AGE AT DATE OF DEATN TERM OF YEARS ANNUITY IS PAYABLE ^ Life or ^Term of Years ^ Life or [] Term of Years ^ Life or [] Term of Years ^ Life or ^Term of Years 1. Value of fund from which annuity is payable . . . . . . . . ..... . ....... . S 2. Check appropriate block below and enter corresponding number . . . . ........ . .... . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ...................................................... S 4. Aggregate annual payment, Line 2 multiplied by Line 3 , , , , , , , , , , , ,, , ,, ,,,, , 5. Annuity Factor (see instructions) Interest table rate - ^ 3.5% ^ 6% ^ 10% ^ Variable Rate _% 6. Adjustment Factor (See instructions) , , , , , , , , , , , , , , ,,,, , 7. Value of annuity - If using 3.5%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ...........................a If using variable rate and period payout is at beginning of period, calculation is (Line4xLine5xLine6)+Line3 .................................................$ NOTE: The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax return. The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of'the return. If more space is needed, use additional sheets of the same size. REV-1644 EX+ {01-10) pennsylvania INHERITANCE TAX DEPARTMENT OF REVENUE SCHEDULE L INHERITANCE TAX RETURN REMAINDER PREPAYMENT RESIDENT DECEDENT OR INVASION OF TRUST CORPUS I. ESTATE OF FILE NUMBER Garner, Robert F. ___ o, ~ This schedule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust corpus (principal). II. REMAINDER PREPAYMENT: A. Election to Prepay Filed with the Register of Wills on _ (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Terrn of Years Income or Annuitant(s) of Election or Annuity is Payable C. Assets: Complete Schedule L-1 1. Real Estate . , a ........................... $ 2. Stocks and Bonds ......................... $ 3. Closely Held Stock/Partnership ............... $ 4. Mortgages and Notes ....................... $ 5. Cash/Misc. Personal Property ................ $ 6. Total from Schedule L-1 .................................................... $ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities .......................... $ 2. Unpaid Bequests .......................... $ 3. Value of Non Includable Assets ............... $ 4. Total from Schedule L-2 .................................................... $ E. Total Value of Trust Assets (Line C-6 minus Line D-4) ............................... $ F. Remainder Factor ........................................................... ---- --- G. Taxable Remainder Value (Multiply Line E by Line F) .............................. $ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of Corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income or Annuitant(s) Corpus or Annuity is Payable Consumed C. Corpus Consumed ...........................................................$ D. Remainder Factor ........................................................... -- E~ Taxable Value of Cor us Consumed Multi I Line C b Line D (Also enter on Line 7, Recapitulation) --- -- REV-1645,EX+ (~ 1-09) ' ' ~ INHERITANCE TAX pennsylvania SCHEDULE L-1 DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- I. ESTATE OF FILE NUMBER Garner, Robert F. 0 0 II. ITEM NO. DESCRIPTION VALUE A. Real Estate (Please describe.) Total Value of Real Estate (Include on Section II, Line C-1 on Schedule L. B. Stocks and Bonds (Please list.) Total Value of Stocks and Bonds $ (Include on Section II, Line C-2 on Schedule L.) C. Closely Held Stock/Partnership -Please list. (Attach Schedule C-1 and/or C-2.) Total Value of Closely Held/Partnership $ (Include on Section II, Line C-3 on Schedule L.) D. Mortgages and Notes (Please list.) Total Value of Mortgages and Notes $ (Include on Section II, Line C-4 on Schedule L.) E. Cash and Miscellaneous Personal Property (Please list.) Total Value of Cash/Miscellaneous Personal Property $ Include on Section II Line C-5 on Schedule L. III. TOTAL (Also enter on Section II, Line C-6 on Schedule L.) $ If more space is needed, attach additional sheets of paper of the same size. REV-164fj EX+ (11-09) pennsylvania INHERITANCE TAX DEPARTMENT OF REVENUE SCHEDULE L-2 INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -CREDITS- I. ESTATE OF FILE NUMBER Garner, Robert F. 0 0 II. ITEM NO. DESCRIPTION AMOUNT A. Unpaid Liabilities Claimed against Original Estate and Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Liabilities $ (include on Section It, Line D-1 on Schedule L) B. Unpaid Bequests Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Bequests ~ (include on Section II, Line D-2 on Schedule L) C. Value of Assets Reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are Not Included for Tax Purposes or that Do Not Form a Part of the Trust. Calculation as follows: Total Non Includable Assets $ (include on Section II, Line D-3 on Schedule L) TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ If more space is needed, attach additional sheets of paper of the same size. REV-1647 EX-~ (02-10) pennsytvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on REV-1500) ESTATE OF Robert F. Garner FILE NUMBER 0 0 This schedule is appropriate only for estates of decedents who died after Dec. 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument that created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other III. I. I Beneficiaries I NAME OF BENEFICIARY I RELATIONSHIP I DATE OF BIRTH I NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents who died on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of ~IVithdrawal Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amount of future interest .................................................. $_ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (Also include as part of total shown on Line 13 of REV-1500.) ...... $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check one. ^ 6%, ^ 3%, ^ 0% ................ $ (Also include as part of total shown on Line 15 of REV-1500.) 4. Value of Line 1 taxable at lineal rate Check one. ^ 6%, ^ 4.5% ...................... $ (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate (12%) (Also include as part of total shown on Line 17 of REV-1500.) ...... $ 6. Value of Line 1 taxable at collateral rate (15%) (Also include as part of total shown on Line 18 of REV-1500.) ...... $ 7. Total value of future interest (sum of Lines 2 thru 6 must equal Line 1) ..................... $ If more space is needed, use additional sheets of paper of the same size. REV-1648 EX (p2-09) . pennsylvania DEPARTMENT OF REVENUE Bureau of Individual Taxes PO Box 280601 Harrisburg PA 17128-0601 ESTATE OF Robert F. Garner FILE NUMBER 0 0 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. ... ~ ~ .~ 1. Taxable assets total from Line 8 cover sheet ......... 1 • 11,213.08 2. Insurance proceeds on life of decedent ................................................................................................ 2. 3. Retirement benefits ............................................................................................................................... 3. 4. Joint assets with spouse ....................................................................................................................... 4. 5. PA Lottery winnings .............................................................................................................................. 5. 6a. Other nontaxable assets: List and attach schedule if necessary .. 6 a. 6 d. 6. SUBTOTAL (Lines 6a, b, c, d) .............................................................................................................. 6. 7. Total ross assets Add Lines 1 thru 6 9 ( ) .................................................. .. ~. 11,213.08 . ........................................... 8. Total actual liabilities ..................................................................................... . 8. 9. . ..................................... Net value of estate (Subtract Line 8 from Line 7) ....................... .. .. ....................................................... 9. 11,213.08 If Line 9 is greater than $200,000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part II. Income: 1 • TAX YEAR: 19 2. TAX YEAR: 19 3. TAX YEAA;: 19 a. Spouse ............................. 1 a. 2a. 3a. b. Decedent ......................... 1 b. 2b. 3b. c. Joint ................................. 1 c. 2c. 3c. d. Tax-exempt Income ......... 1d. 2d• 3d. e. Other income not listed above ..................... 1 e. 2e. 3e. f. Total ................................. 1 f. 2f. 3f. 4. Average joint exemption income calculation 4a. Add joint exemption income from above: (1fl + (2fl + (3fl (''3) 4b. Average joint exemption income ............................................................................................................... If line 4(b) is greater then $40, 000 -STOP. The estate is not eligible to claim the credit. If not, continue to Part III. 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less .......................................... 1 2. Multiply by credit percentage (see instructions) ....................................................................................... 2. 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet ................................................................ 3• 4. For nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate .......................................................................................................................... 4. 5. Multiply Line 3 by Line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit. Include this figure in the calculation of total credits on Line 18 of the cover sheet .......... 5• SCHEDULE N SPOUSAL POVERTY CREDIT FOR DATES OF DEATH 01/01/92 TO 12/31/94 REV-1649 EX +~(6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) ESTATE OF FILE NUMBER Robert F. Garner 0 0 Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. _ This election applies to the Trust (marital residual A B, By pass, Unified Credit, etc.). If a trust or slmllar arrangement meets the requirements of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or sim- ilarproperty treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator is equal to the total value of the trust or similar arrangement. Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's survivin souse under a Section 9113 A trust or similar arran ement. Description \/alue Part A Total ~ $ B: Enter the descri tion and value of all interests included in Part A for which the Section 9113 A election to tax; i bs ei Description Value Part B Total (If more space is needed, insert additional sheets of the same size) • '~ REV-1500 Discount, Interest and Penalty Worksheet Discount Calculation Total Amount Paid within three calendar months of the decedent's date of death: Discount: 0.0 Interest Table Year Days Delinquent Balance Due Interest this time period this year this period Before 1981 -- 1982 _ - 1983 -- 1984 - 1985 - 1986 - 1987 1988 through 1991 - Total Balance Due on January 17, 1996: Penalty Penalty Calculation If the decedent's date of death was on or before March 31, 1993, insert the applicable amount: