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HomeMy WebLinkAbout02-17-11~ REV-1500 PA Department of Revenu Bureau of Individual Taxe PO BOX 28o6oi Harrisburg. PA 17128-060 1505610101 oc (oi-io) 1.f7 e Pennsylvania s oEO.w,ME~.oF INHERITANCE TAX RETURN i RESIDENT DECEDENT OFFICIAL USE ONLY Code Year File Number Date of Birth MMDDYYYY iJ ~,/ ~ ~~ rm Decedent's First Nccame MI G ~~~ Spouse's First Name MI ~TTTT i"'lIT1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust Q 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 REGISTE ~ ILLS USEC~NLY r ~ Q First line of address r- ~ ~ ....1 _ ~ '~ Second line of address ~ ~ _ ~"'~ ~~ . ~_~a,a .. may,- ,: - = ~ ";: ~~ Y = ~ ,_.__ 'TCl ' ..~ City Or POSt Office ~ ~~ State ZIP Code DATE FILED ftia 5 •~ IY/~~~ Ile AI- Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including 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. SIGNATURE OF ERSON RESPONS LE FOR FILING RETURN DATE ADDRE _ / ~.fZ~~ 1~I s ~~c/ ~ ~ ~. f 71J/S SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505610101 1505610101 . ~~/"" J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: ,~ / ~ ~~' '.~s f r,~ ~Y RECAPITULATION 1. Real Estate (Schedule A) ......................... ................. 1. a. .../ ~ ..*,,..,~ ~ w ., ,. -r~.~~.~ ~x - ~~ 2. Stocks and Bonds (Schedule B) ....................................... 2. ' '. ~ ' '~ ~, t E k~. ,~<,~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. x, s: -~ r ~.~ _ i,,,~'~d s ~ 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. r ~ i ,yf,~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ~ i ~ ~~ Kf~~~, ns ~..' . 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. y ~ 2 `~ 7. Inter-~vos Transfers & Miscellaneous Non-Probate Property qA~ (Schedule G) p Separate Billing Requested........ 7. ) ~ ~_ i ~` i ~` ~ ~ 8. Total Gross Assets total Lines 1 throu h 7 8. 9. Funeral Expenses and Administrative Costs (Schedule H) .......... ......... 9. ~ ~ "s ~.~,: 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ..... ......... 10. ^ 11. Total Deductions (total Lines 9 and 10) ........................ ......... 11. 12. Net Value of Estate (Line 8 minus Line 11) ..................... ......... 12. 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. 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_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT t~ Side 2 1505610105 1505610105 J REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENTS NAME STREET ADDRESS ~oX ~ CITY STA ZIP Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) ~ 2. Credits/Payments ~~ y A. Prior Payments B. Discount ~~ , s~ 3. Interest 4. If tine 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FiH in oval on Page 2, LJne 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) '~ ~ .390, ifs Total Credits (A + B) (2) ~ ~ ~~..7 ~ / (3) (~ (4) ~~ .s~ (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 :.......................................................................................... ^ 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 Dec. 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~leath 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 Jan. 1,1995, the tax rate imposed on the net value of transfers to or for the use 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 surviving 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 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)]. • 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)]. 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-1502 EX+ (6-98} SCHED~iLE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ck~' - L~ 1~'t~C~ l~'f ~ ~o/a- o//D~ All real property owned solery or ~ 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 Lary or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of gurvhrorship must be disclosed on Schedule F• VALUE AT DATE ITEM ncenolnrlnll OF DEATH 1 !I?ob.l~ ¢~om~ ~/adc~l~ ~l~ on ~ ~. a~a-q~ n 'y ~ Q e~ES /° cxc.~ ~ ~ ~y fox ,lv. Ne~vr1 /~ , >°~ ~?- ~v~-f,o7j ~~~ ~,a°i1 sG ~~ ~p~ ~ //S, DOaI. 00 ~ee-s I SE~1 ~ men- f ~ -~ //~~ (cG 3, ~ ~ TOTAL (Also enter on line 1, Recapitulation)' S 1/~ (N more space is needed, insert additional sheets of the same size) Cumberland County Board of Assessment Appeals Old Courthouse, First Floor One Courthouse Square Carlisle, PA 17013 43000323-U-19781 Iru111~uh~1~I~h~h~~IIlnhIn~IJnInI~I~~hIJnIIuIJ MACICEY, THOMAS R SR & GRACE M VOLD 24 FOR LANE- NEWVILLE, PA 17241-8742 13049 T39 Pl THIS IS NOT A TAX BILL Deadline for Scheduling, an Informal Review Appointment: April 12, 2010 The Cumberland County Board. of Assessment Appeals is providing you with notice of the value on this property, determined as a result of the Cumberland County countywide reassessment completed this year. The countywide reassessment values each property at current Fair Market Value, as of January 1, 2010, equalizing and establishing a uniform tax base so that properties of like characteristics and the same actual Fair Market Value will be taxed the same. ~ VALUE NOTIFICATION _ MAILZMO DATE: March 1. 2010 Muaic.: 43 - IIPPER gRAlIICFORD TYrP School: 1 - BIO SPRIG SD Locatioa: as FoX L11NS L71tiD APPROX 4 ACRES Taxable Property Land Size: 4.37 acres property Type: RT Mobile Home - vrith Land Hpsestead nppraved ESTIMATED TAX IMPACT FORMAL APPEAL DEADLINE: April 12, 2010 The ESTIMATED impact statement printed below is our best estimate of change, based on 2010 COUNTY tax figures. THiS ESTIMATE DOES NOT INCLUDE ANY BOROUGH, TOWNSHIP, OR SCHOOL DISTRICT IMPACT. Current 2010 County mills 2.465 Adjusted 2010 County mills = 1.982 $ 264 2010 COUNTY Tax HEFORB Reassessn~nt . $ 237 2010 COUNTY Tax AFTER Reassessment. (see. reverse side) Parcel Identifier. 43-04-0389-029. Prarlaa adWona an obaolaM ,s ~`.' +~ term HUD-1 (31N) jai Handbook X506.2 FaNao adltlpn an a4aalala U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT sErn.~~ srar~~rr ~ Huet h-stj Iw Miaalbeok asta File Number: LEHMANK2.11 PAGE 2 Ti1I@E%pr888 $etdelrlArlt Svstem PrirNali mHN9n1 ~ ~ ~a•no u.o ~. ~c i l ~CMtn I ct1AKGr:S PAID FROAA . _ - 700. TOTAL SALESBROKER'S COMMISSION based on rice 6115000.00 = BORROWER'S PAID FROM ' ~ ~~ 700 ~ FUNDS AT SELLER S 701. t0 8~ FUNDS AT 702. ~ 3ETTLEIIAENT 703. Carlmis~on ~ 800. REMS PAYABLE IN CONNECTION WRH LOAN 801. Loan Fee % 802. Loan Discount 96 803. A 'sai Fee 804. Crectlt 805. Lender's In Foe 806. Mort Fee 807. Assum ' n Fee 808. 809. 810. 811. 900. REM3 REQUIRED BY LENDER TO BE PAID IN ADVANCE 901. Interest From to Ida 902. M Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905. 1000. RESERVES DEPOSRED WITH LENDER FOR 1001. Hazard Insurance mo. Imo 1002. Insurance mo. !mo 1003. C Tax nlo. /~ 1004. Coon Tax mo. 21.53 Imo 1005. Sdrod Talc mo. 129.88 Imo. 1 0.00 0.00 1100. TITLE CHARGE8 1101. t or fee to IRWIN B MCKNIGHT P.C. 200 1102. a title search 1103. Title examination 1104. Title insurance birxier 1105. Document atlas 1106. Not Fees to CASH 1107. A s fees to NtWiN B MCKNIGHT P.C. indudes above items No. 1105 1107 5.00 . 750.00 1108. Title Insurance ' indudes above hems No: 1109. Lenders NONE 1110. Owner's 115000.00 - 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 120E Fees Deed 8200 • Release 82.00 1202. tax/stam Deed 150.00 1150.00 1203. Staff T Deed 1150.00 1204. AUCTION FEES to JONES & MARTIN AUCTIONS P.O.C. 3 219 Seller 1150.00 1205. 1300. ADDRIONAL SETTLEMENT CHARGES 1301. Su 1302. Pest lns .. 1303. 1304. 1305. 1306. 1307. 1308. 1400. TOTAL SETTLEMENT CHARGES enter on lines 103 Section J and 502 Sed9on 1412.00 1905.00 HUD CERi1FICATION OF BUYER AND SELLER ~h ~ canh/ly ~Ntlu MUD-1~sMW~ tneNvid to ~ cam! U~s HUED-1 tkNH~M S~Yten~ienbMiN, k is a hw uW aeeunKe statement of dl roaiFls and ~ mntb on my aaooun! or by n t 4 f BRACE MACKEY VOLD YIIARINN3: n' 13 A CRMIE TO KNOYYNiOLY ~ FALSE 8TATEIIENTS 7+0 THE TM MUD•1 sattlanwM Sq>rmant whlah I hawp~p~ k alroa and aoovaM aaaount M MMa ha~etlaa. UNITED STATES ON TIMS OR ANY SNI~AIt 1°ORII. FE.NAI.TIEB UFON CONVICTION I haw pusad a will eaua tln twnd..o W da(awsW M aaegdr~¢a wph S~ ~p~, CAN NrCLUDE A F~ AND SENT. FOR DETAILS SEE TITLE 18: u.a c:ooE sEC'nWJ pow AND SECTION ~o+o. '"'A LI w ~ _.,,. i / ey: REf-150~IX • (187 - SCHEDULE E ror~toNwF.~TrtoFPE,~rtsnvNrna, CASH, BANK DEPOSITS, ~ MISC. n~tEwrnrtcE rnx RETUUr:rrt PERSONAL PROPERTY ~ ~~~ ESTATE OF FILE NUMBER /1~~}C~~'~ --1~4/D C'/C~AC~ /E'J, ~D/D - O // U o~ Include the proceeds of litigation and the dad the proceeds were received by the . Aq property jo~dy-owned witlt the right of survivorship must be discbsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ~~ ~q~ ~ Qc~ou-n f a-t Sa'v~'Q~ i~~ ~~~ ~ ~ 3t3, 954. ~ 7' ~) /°F~s'ona..1 ~~eopE~ ~ y : , ~ .E /a~,sE ~Co ~d -~x /y '7a0 ~ ~ ca ~ ~- n~~s~ - TOTAL (Also enter on line 5, Recapitulation) I S 7 ~~ (~ (~, / j (If more space is needed, insert additional sheets of the sarr-e size) ~:. GRACE M MACKEY-VOLD Account # 3381139819 Your account is currently at a zero balance. If your account remains at a zero balance for two entire statement periods with no activity, your account may be closed. Please deposit funds into this account quickly to prevent it from closing. If this account is not meeting your needs, it would be our pleasure to discuss other options with. you. Balances t~grtrtittc~ E~attce 547,544,70 Current Balance ~:~ .~p.00 Deposits/Credits + $0.00 Average Daily Balance 517,539.54 Wit~ttira~ILlelS~s - 517,541;70 Interest .. . Paid-hies r~erio¢'-.. S d.DO Annual Wrttt~ge Yield ~ai'ned :~ 0:00% Eamed this Period ; 0.00 Paid Last Year ;105.10 Pait}'Ye~r-Tii~ESate ~ 2:58: 'The interest earned and ttte interest paid may differ depending on when interest is credited to your account. Account Activity Date Description Additions Subtractions Balance 10-27 Beginning Balance $17,541.70 44-05."CLbS11JC-TR1it~fSAC1liJN a17,544~70 - SO.00~: 14-28 Ending Balance $0.00 IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS CALL YOUR CUSTOMER SERVICE CENTER AT THE NUMBER SHOWN ON THE TOP OF YOUR STATEMENT OR WRITE TO THE BANK FOR DEBIT CARD ISSUES: Sovereign Bank Attn: Card De ales Team MAI MB3 02 OS P.O. Box 831002 Boston MA 02283-1002 FOR ALL OTHER ISSUES: Sovereign Bank Attn: Client Relations 10-421-CRl P.O. BOX 12646 READING, PA 19612-2646 Please contact us if you think your statement or receipt is wrong or if you need additeonal information about a transfer on the statement or receipt. We must hear from you no later than 60 days after we sent you the FIRST statement on which the emx appeared. • Tell us your name and acxAUnt number. • Describe the error or the transfer that you are unsure about and explain as clearly as you can why • Tell us the dollar amount of the suspected error. you believe there is an error or why you need further information. If you tell us orally, we may require you to send your complaint or question in writing within 10 business days. We will promptly investigate the matter and salt or write to you with an answer within 10 business days (10 calendar dayyss m Massachusetts). if we need more time, we may take up to 45 days to investigate your complaint or question. if we do, we will credit your account within this 10-day period for the amount you think es in error, so ou will have the use of the money during the time rt takes us to complete our investigation. tf we ask you to put your complaint a questia~ m writing and we do not receive it within 10 business days, we may choose not to credit your mount. For errors involving new accounts, point of sale purchases or foreign transactions, we may take up to 90 days to investigate your complaint or question. For new accounts, we may take up to 20 business days to credit your acxount for the amount you think is in error. , We will tell you the results of our investigation within 3 business days after comph;ting our investigation. if we decide there was no ertor, we will send you a written explsnatia~. You may ask for copies of the documertts we used in our mvestigatn~n. Irnportarat iriformatt•ra aboat yoar Soverctg® Ikbit Card The networks through which Borne of your Sovereign Debit Card purchases are processed have begun alk-wing rnerct~ants to process yarc purchases without either a signature a a PIN. tf you are not regmred to enter your PIN when ~rou make a purchase, your purcvase may be processed either ttuough die Visa network or through the STAR or NYCE networks. If your purchase is processed through STAR or NYCE, differerrt temps apply snd you wilt not be eligible for the rights andprotections available through Visa. Please see your Personal Deposit Account Agreement for more informatia-. page 2 of 2 3381139819 ,~ ~„~, f` GRACE M MACKEY-VOL:D Balances Account # 3381139797 ... ;,a~ _., ;.~ ~~ ~;.~, ~ xr;: g1fi,4i813 - .,~~ i~ Currerti Balance r r~.. S7:OEiF1:^^" itslCredits + $0.04 Avera e Daily Balance 55,93225 Interest F'~iilfthks~ejiod ~`,~ ~ .'`" " ~,, : b U:04 ` Anr}ua~' F'ercttag~ Yield Formed ; O.bO°~' Famed this Period $ 0.00 Paid Last Year 5102.98 Pa-Tor- "~ - ~.. _ b 3.~i' : ,~°` ~- ~, 'The interest earned and the interest paid may d'rffer depending on when interest is credited to your account. Account Activity - Date Description Additions Subtractions Balance 10-27 Beginning Balance 616,418.13 114. II~~ Ct71T - ~~ '~ _ ~ ' r SO-b4 ._ _ Y ' _ , ~ ~~~7`~' 11-05 WTHDRWL $14,418.13 b2,000.04 11-28 Ending Balance 62,000.04 IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS CALL YOUR CUSTOMER SERVICE CENTER AT THE NUMBER SHOWN ON THE TOP OF YOUR STATEMENT OR WRITE TO THE BANK FOR DEBIT CARD ISSUES: Sovereign Bank Attn: Card Disputes Team MAl MB3 02 OS P.O. Box 831002 Boston MA 02283-1002 FOR ALL OTHER ISSUES: Sovereiggnn Bank Attn: Cfrer-t Relations 10-421-CRI P.O. BOX 12646 READING, PA 19612-2646 -try . . Please contact us if you think your statement or receipt ~s wrong or if you need additional information about a transfer on the statement or receipt. We must hear from you no later. than 60 days aRer we sent you the FIRST statement on which the error appeared. • Tell us your name and account number. • Describe the error or the transfer that you are unsure about and explain as clearly as you can why • Tell us the dollar amount of the suspected error. you believe there is an error or why you need further informaton. if you tell us orally, we may require you to send your complaint or question in writing within 10 business days. We wiB promptly investigate the matter and call or write to you with an answer within 10 business days (10 calendar dayys in Massachusetts). if we need more time, we may take up to 45 days to investigate your complaint or question. if we do, we wt71 credit your account within this l0-day period for the amount you think is in error, so ou wrll havt the use of the money during the time rt takes us to complete our investigation. If eve ask you to put your complaint a queston m writing and we do not receive it within 10. business days, we may choose not to credit your account. For errors involvingg new acxounts, point of sale purchases a foreign transactions, we may take up to 90 days to investigate your complaint or question. For new accounts, we may take up to 20 business days to credit your account for the amount you think is in erns. We wifl tell you fhe results of our investi~ttat within 3 business days after completing our investigation. if we decide there was. no error, we will send you a written explanatron. You may ask for copies of the documents we used in our inveshgatron. Important iatoreiataa about your Sovereign lkbit Card The networks through which sane of your Sovereign Debit Card purchases are processed have begun allowing merchants to process your purchases without either a signature or a PIN. if you are not regmred to eater your PIN when you make a your ppuurrcchale may be processed either through the Visa network or throepphh the STAR or NYCE networks. 1f purchase is sed throe STAR or NYCE, different terms apply and you will not be eligble for the rights andpro~tions available through Visa. Please see your Per onal Deposit Account Agreement for more information. page 2 of 2 338/ /39797 REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYf_VANIA INHERITANCE TAX RETURN FUNERAL EXPENSES & ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER /~1~~~ ~_ I/rJi~ C~~~ /~?: ado - dr/oa. Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~~ F,~~~ ~~~ 8 5~ ~ ~~- , y , ` ,,7~©0 ~ oC3 Gft ~R Gh -~ 1,v fti'l~ _.~ ~ .,~ ~O ~ r 4C3 .S'i ~tJ6~i-Z - ~ ~'R t/i C E-5 ----, ~` SO, a0 ~~srav~ ~iU ~,~v ~ ~ ~ •~ a3~opo~y(.3~ ~ X70 ~ OQ 0 ,0 -~' a3o /~/~S .~N~~"~ ~[i C7C~ f /~ y 7 .~ SG7i / O p~-~~o~ -. ~~~. °~o .,~ ~~5, 00 --~'_ 9,'7-~a, ~,~ 9, 7-Y~, ~ ~v g. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name 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 daimant's, attach explanation) Claimant Street Address Ciiy State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. AcxrourtlanYs Fees 6. ~ Tax Return Preparers Fees ~. misc. F~pi:,,s~_ s ~ . s~~0 3, .fib "~` ~d3, yG~ ,q~ ,,-S -~ //'7, sa ~ eo ~~~,oo cc~s~s ~ ~ f}~c-~-'on `~ -~/fig/. ~- ,~(~ 135" L'~~li l ~l halls •~` ~(,~9, 3~' ~. `50~p0 ~'h c:~7 C E~ Ti F c Et~~ _ ~ f-ccipi t~s ~' ~• ~ .~ / 5 % ~s C!i ec/1s --~ / s, yS' TOTAL (Also enter on line 9, Recapitulation) S /oZ~v v4, 7t~ (If more space is needed, insert additional sheets of the same size) SG~G~ ._ ,,:$S, ~ 0 i,~, f3 ..514 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDI~LE 1 DEBTS `Of DECEDENT, MORTGAGE L{ABILRIES, & LIENS ESTATE OF FILE NUMBER /J~~C~~y- Uri/c/ ~'~~cE /yl. ~oio - oi~o a Renort debts incurced by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed. insert adolaonal sneers or me same s¢e~ ,< _ _ - c'- ~ :. r i ~ ~~~ _~yow oa ~ °`~~ ~.,,~, ;, ~ M F ~. . f / =~ 3 ~ O.. i i Mks i ~~p $ ~ Ei .' i ~ ~ / ~ ~ y ~ ~ , ~ ~ti~ ~ ~ Cam. C . W ~ A~ yT. WW P a C ~ ~ °' s '~ /~ Vm ® L(~ O~ O ca iD nna °~ A i u~ ~~ ~ +i y m0. ,o~ m ~ ~ ~ ¢ ~ ~ i ~ ' `< ° w¢ ¢~ ~ i c « V W ~ 00 w~ VN • ~ a y ri a 0 r O _y :.I ~ ~ O= ~~ ~= >T jam;.: r x N S t1J Q' ia. O.C. Rute 6.12 ST_~TUS REPORT REGISTER OF WILLS OF ~ ~~-N~-~~~~~ C0~' iY, PEN`NSI'LVA~TI_A------- ---- Name of Date of Death: /~ ~~ '~~ ~~ file Number: ~ /~ _ ~/~ Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration. of the above-captioned estate: - ~ ~ .......... ~ Yes ~ No 1. State whether administration of the estate is complete: _ ........ . 2. If the answer'is Nd, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: a.. Did the personal representative file a fnal account with the Court? ....... Yes ONo b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account Yes ~No ....... informally to the parties in interest? ......................... . d. Copies of receipts, releases, joinders and approvals of fot-mal or informal accounts maybe filed with the Clerk of the Orphans' Court and maybe attached to this report. Date ~ - ~ ~ _ ~'~/ Signature of Person Filing ~s C3p3CltY: ~PCTSOII3IIZC~resentatlVC ~COW1SCl Nmnc of Person Filing dais Form Address Tztephone RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of-Wills One Courthouse Square Carlisle, PA 17613 MACKEY-VOLD GRACE M Estate File No.: 2010-01102 Paid By Remarks: DJANA F ZEIGLER ------------------------ ~~~,~ Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCS FEE AUTOMATION FEE RENUNCIATION Cash Total Received......... Receipt Date: 11/04/2010 Receipt Time: 14:34:15 Receipt No.: 1063211 Receipt Distribution ----- -------- -------- --- Payment ~ mount Payee Name 00 135 CUMBERLAND COUNTY GENERAL FUN . 00 15 CUMBERLAND COUNTY GENERAL FUN . 00 8 CUMBERLAND COUNTY GENERAL FUN . 50 23 BUREAU OF RECEIPTS & CNTR M.D . 00 5 CUMBERLAND COUNTY GENERAL FUN . 5.00 - CUMBERLAND COUNTY GENERAL FUN --------------- $191.50 $191.50 ,~ ~t~ /o ~ S~ C~ r s 7~ Es~~- _ ,.