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HomeMy WebLinkAbout04-27-11 1505610140 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY - Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number Po Box 2sosol .~ 1 1 0 0 3 6 3 ` Harrisburg, PA 17128-0601 RESIDENT DECEDENT ' ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth h~MDDYYYY 2 7 1 5 0 9 4 1 8 0 2 1 3 2 0 1 0 0 5 2 1 1 9 5 0 Decedent's Last Name Suffix Decedent's First Name MI LONG DAVI D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI PHI LLI PS- LON G BARB ARA R Spouse's Social Security Number 1 O O 3 8 3 8 ® 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ^X 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) ^X 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 1'AX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number MARK A MATEYA ESQUI RE 7'17 241 6500 First line of address 5 5 W CHURCH A V E N U E Second line of address City or Post Office CARL I S L E State PA ZIP Code L 1 7 0 1 3 ~- ~-~ ~ : REGISTER ~ VY~{ LS USE ITNLY .~ ,, y ..~ " n ~~ m ~ G ~ ~~ - _.~' -..,7 ~~> . =C7 Z,, . . DATE FILED f~,.: ~._ ,..~._ . ~ ~ Correspondent's a-mail address: MAM@MATEYALAW.COM ~'7 ~`~`i ~~ _~ `~ ?i _. „_J ,~; -? 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 C~PERSON RESPONS~LE ~ILING RETURN _ A DATE LL .gyn. f' >_ ADDRESS' ~' ~" - ~ (/" ' '' 205 WEST GREEN STREET SHIREMANSTOWN PA 17011 SIGNA URE P PA E ER THAN REPRESENTATIVE ~~ I~, ~~E u ADDRESS 55 W CHURCH AV UE CARLISLE PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX C)ecedent's Social Security Number Decedent's Name: DAVID LONG 2 7 1 5 0 9 4 1 8 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. 6 1 9 1 3 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 1 1 7 9 1 7. 2 2 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ....... 7. 3 1 2 1 1 4. 0 3 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 4 3 6 2 2 2 . 5 9 9. Funeral Expenses and Administrative Costs (Schedule H) ........... ....... 9. 2 1 5 1 1 6 1 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ...... ....... 10. 7 1 7 8 9 • 7 7 11. Total Deductions (total Lines 9 and 10) ........................ ....... 11. 9 3 3 0 1 3 8 12. Net Value of Estate (Line 8 minus Line 11) ..................... ....... 12. 3 4 2 9 2 1 2 1 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. 3 4 2 9 2 1 2 1 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 3 4 2 9 2 1 2 1 15. O. 0 0 16. Amount of Line 14 taxable at lineal rate x .0 0. 0 0 1 g. 0. 0 0 17. Amount of Line 14 taxable 0 0 0 0 0 0 . at sibling rate X .12 17. . 18. Amount of Line 14 taxable 0 0 ll t t l 1 t X 0 0 0 0 a co a era ra e . 5 18. . 19. TAX DUE ............................................... ....... 19. 0 • 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610240 1.505610240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 0363 DECEDENT'S NAME DAVID LONG STREET ADDRESS 205 WEST GREEN STREET CITY SHIREMANSTOWN STATE PA ZIP 17011 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. Total Credits (A ~~ B) (2) (3) (4) (5) 0.00 0.00 0.00 0.00 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 : .................................................................. .... ^ X^ b. retain the right to designate who shall use the property transferred or its income; ........................... .... ^ Q c. retain a reversionary interest; or ............................................................................................ .... ^ ^X 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? ................................................................................... .... ^ 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, 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 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)]. 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. • • C~OG°'~ LAST WILL AND TESTAMENT OF DAVID W. LONG I, DAVID W. LONG, of the Borough of Shiremanstown, Cumberland County, Pennsylvania, being of sound mind, memory, and understanding, make, publish, and declare this to be my Last Will, and hereby revoke all wills and codicils previously made by me. ITEM I. I direct my Executor hereinafter named to pay all of my legal debts and funeral expenses, including the cost of my gravemarker, and administration expenses of my estate, as soon as practicable after my death. ITEM II. I give and bequeath all my automobiles, jewelry, wearing apparel, books, pictures, household furniture and furnishings, and all other articles of h~~usehold and personal use, together with any insurance existing thereon, to my wife, BARBARA R. PHILLIPS LONG, if she survives me; but if she predeceases me, then to my children, ALISON CATHERINE LONG and OWEN DAVID LONG, to be divided among them as they shall see fit, but if said children fail to agree upon such division within a period of two (2) months after my death, then the items to which there has been no agreement shall be sold and the proceeds therefrom shall be added to, become a part of, and administered with my residuary estate as hereinafterset forth. ITEM III. The rest, residue and remainder of my property and estate of every kind and nature, and wheresoever situate, including all lapsed legacies ar~d bequests, and including any property over which I may have a power of appointment at the time of my death, I give, devise, bequeath as follows: Document #: 1667/ 7.1 • • A. If my wife, BARBARA R. PHILLIPS LONG, survives me, to her absolutely and forever. B. If my wife, BARBARA R. PHILLIPS LONG, predeceases me, one- half (1/2) thereof to my daughter, ALISON CATHERINE LONG, or if she is not then living, to her issue per stirpes; and the remaining one-half (1/2) thereof to my son, OWEN DAVID LONG, or if he is not then living, to his issue per stirpes. In the event that a child of mine shall predecease me without issue I~im or her surviving, his or her share shall be distributed to my other surviving children, or if one of them is not then living, to his or her issue per stirpes. ITEM IV. All estate, inheritance, legacy, succession, or transfer taxes, including any interest and penalties thereon, imposed by any domestic or foreign law with respect to all property taxable under such laws by reason of my death, whether or not such property passes under this Will, by operation of law, by contract, or otherwise, shall be Maid without any right of reimbursement from any recipient of any such property, without any right of apportionment, and without postponement. ITEM V. Should any person entitled to a share of my estate be a minor at the time of distribution to him or her, and should the value of such property be more than the amount which may be paid or delivered to him or her or in his or her behalf witr~out the appointment of a guardian or other fiduciary or the delivery of security, such share shall be paid and distributed to my Trustee hereinafter named to be held IN TRUST and managed, invested, and reinvested, together with the accumulation of income thereon, if any, and the Trustee shall use and apply from time to time such portion of the income and principal thereof as it deems necessary or desirable for the minor's reasonable maintenance, support, and complete education, including - 2 - • • preparatory, college, post-graduate, or professional training, or to make such payment for such purposes to the guardian or person with whom such minor resides or' directly to or for the benefit of the minor without further responsibility to such minor or any person taking care of such minor, and when such minor attains the age of eighteen (18) years, any principal or income not so paid or applied shall be distributed to such minor, or if he or she dies prior thereto, to his or her personal representative. ITEM VI. I nominate and appoint my daughter, ALISON CATHERINE LONG, as guardian of the person of my son, OWEN D. LONG. ITEM VII. In addition to the powers granted by law, my personal representative shall have the following powers: A. To sell at public or private sale, to exchange, to lease, to pledge, to mortgage, to transfer, or convert or otherwise dispose of, or- grant options with respect to any and all property, real or personal, at the time forming a part of my probate or trust estate, in such manner, at such time or times, for such purposes, for such price or prices, and upon such terms, credits, and conditions as shall be deemed advisable or necessary under the circumstances. B. To compromise any claim or controversy. C. To invest in all forms of property without being limited to legal investment. ITEM VIII. I nominate and appoint my wife, BARBARA R. I°HILLIPS LONG, or if she predeceases me, fails to qualify, or ceases to act, I nominate and appoint my daughter, ALISON CATHERINE LONG, as the sole Executrix of this my Last Will, to serve without bond for the faithful performance of duties in any jurisdiction, and I nominate and appoint my daughter, - 3 - • • ALISON CATHERINE LONG, as the sole Trustee of any trusts created by this my Last Will. IN WITNESS WHEREOF, I have hereunto set my hand this ~~2 day of March , 2000. David W. Long The preceding instrument, consisting of this and three (3) other typewritten pages, was on the date thereof signed, published, and declared by DAVID W. LONG, the Testator named therein, as and for his Last Will, in the presence of us, who, at his request, in his presence, and in the presence of each other, have subscribed our names as witnesses hereto. Wi es: ~. .~ Nam / i~ Name 32 ~~ ~~ ~,~ s~ ~ ~ `2G~ Address Address - 4 - • • Commonwealth of Pennsylvania County of Dauphin ss I, the Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my free and voluntary act for the purposes therein expressed. David W. Long SWORN to or affirmed to and acknowledged before me by the above named Testator this ~J=day of March, 2000. Notary Public My Commission Expires: NOTARIAL SEAL CAROL A. LYTER, NOTARY PUBLIC (SEAL) Harrisburg, Dauphin County My Commission Expires Dec. 28, 2000 Commonwealth of Pennsylvania ss County of Dauphin We, the undersigned witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses and that to the best of our knowledge the Testator was at the time eighteen (18) or more years ~of age, of sound mind and under no constraint or undue influence. SWORN or affirmed to and acknowledged before me by the ak-ove named witnesses this ~,~day of March, 2000. ~~ Notary Public My Commission Expires: (SEAL) NorARiA~ sE~ CAROL A. LYTER, NOTARY P(~gUC Harrisbur& Dauphin County My Commies Expires Dec. 28, 20Q0 REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID LONG 21 10 0363 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PSECU (PENNSYLVANIA STATE EMPLOYEES CREDIT UNION) 616.45 SAVINGS ACCOUNT ACCOUNT NO. ~JCXX;XX4659 (S1) 2. PSECU 5,115.43 CHECKING ACCOUNT (S4) ACCOUNT NO. X~UUCX4659 3. U.S. TREASURY 459.46 DIRECT LOAN REFUND TOTAL (Also enter on line 5, Recapitulation) I $ 6 191.34 (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 SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF: FILE NUMBER: DAVID LONG 2'1 10 0363 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) ADDRESS RELATIONSHIP TO DECEDENT A. BARBARA PHILLIPS LONG e. c JOINTLY-OWNED PROPERTY: 205 W GREEN STREET SHIREMANSTOWN, PA 17011 SPOUSE ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 8/98 REAL ESTATE LOCATED AT 205 W. GREEN ST 222,616.80 50. 111,308.40 SHIREMANSTOWN, PA 17011 ASSESSED VALUE 2. A BNY MELLON SHAREHOLDER SERVICES 206.86 50. 103.43 DIV REINVESTMENT & STK PURCH PLAN CUSI P: 001-314-29101110 3. A 8/98 SOVEREIGN BANK 2,060.59 50. 1,030.30 INTEREST CHECKING ACCOUNT ACCOUNT NO. XXX;XXX2674 4. A 1/06 SOVEREIGN BANK 355.18 50. 177.59 SAVINGS ACCOUNT ACCOUNT NO. XXXX;XX1029 5. A 1997 CHEVROLET LUMINA AUTOMOBILE 2,605.00 50. 1,302.50 KELLY BLUE BOOK VALUE -SEE ATTACHED 6. A 2004 CHEVROLET IMPALA AUTOMOBILE 7,990.00 50. 3,995.00 KELLY BLUE BOOK VALUE -SEE ATTACHED TOTAL (Also enter on Line 6, I~ecapitulation) I S 117,917.22 If more space is needed, use additional sheets of paper of the same size. 2004 Chevrolet Impala -Suggested Retail Value -Kelley Blue Bl~ok Page 1 of 2 ~i~ ~~ , . 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Power Door Locks AM/FM Stereo To View List, Click ', Power Steering Dual Air Bags V•1e111/ AnOtt>er Vehicle Select Year... '? ~a~ "~ h!cwei.. _ Blue Book Suggested Retail Value Kelley Blue Book Suggested Retail Value is representative of dealers' asking ': prices for a used car, and the starting point For negotiation between a consumer and a dealer. This Suggested Retail Value assumes thak the vehicle has been fully reconditioned and has a clean title history, but has not advertisement http://v~~ww.kbb.com/used-cars/chevrolet/lamina/ 1997/retail-value/pricing-r... 4/ 19/2011 REV-1510 EX+ (OS-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID LONG 21 10 0363 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 NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET '% OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. T. ROWE PRICE 401(K) 120,202.62 100.00 120,202.62 RETIREMENT PLAN THROUGH RITE AID CORP BARBARA PHILLIPS LONG BENEFICIARY 2. FENIMORE ASSET MANAGEMENT 153,393.77 100.00 153,393.77 CHARLES SCHWAB IRA ACCOUNT NO. 3. FAM FUNDS 38, 517.64 100.00 38, 517.64 US BANK C/F IRA ACCOUNT NO. 36381-00 TOTAL (Also enter on Line 7, Recapitulation) ~ $ 312,114.03 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 ESTATE OF FILE NUMBER navln I nNr 21 10 0363 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1, PARTHEMORE FUNERAL HOME 5,676.71 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP _ Year(s) Commission Paid: 2, AttomeyFees: MATEYA LAW FIRM 3, Family Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address 4 5. 6. 7. 8. 9. City State ZIP _ Relationship of Claimant to Decedent Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS Accountant Fees: Tax Retum Preparer Fees: CUMBERLAND LAW JOURNAL -LEGAL ADVERTISEMENT THE SENTINEL -LEGAL ADVERTISMENT CUMBERLAND COUNTY REGISTER OF WILLS -FILING FEE FOR INH. TAX 585.50 75.00 219.40 30.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 6,586.61 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER DAVID LONG 21 10 0363 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PSECU 2,946.06 VISA LOAN (L9) ACCOUNT NO. XX)CXXX4659 JOINT WITH SPOUSE ($5,892.12) 2. PNC MORTGAGE 41,471.92 LOAN ACCOUNT NO. ~;XXX;XX7122 HELD JOINTLY WITH SPOUSE ($82,943.84) 3. CHASE BANK USA, N.A. 12,170.85 CREDIT CARD ACCOUNT ACCOUNT NO. 5787 4. CARDIOVASCULAR SURGICAL INST. 202.73 MEDICAL SERVICES ACCOUNT NO. 56260-1-1 5. PSECU 26.39 VISA LOAN MEMBER NO. 8899XXXX)CX 6. PINNACLE HEALTH MED SVCS 249.17 MEDICAL SERVICES ACCOUNT NO. 180178 7. SOVEREIGN BANK 20.00 ACCOUNT INFORMATION FEE 8. CAPITAL AREA SURGICAL ASSOCIATION 176.80 MEDICAL SERVICES ACCOUNT NO. LONDA001 9. HEMATOLOGY & ONCOLOGY CONSULTANTS OF PA 192.02 MEDICAL SERVICES ACCOUNT NO. 3445 10. PINNACLE HEALTH HOSPITALS 1,410.39 MEDICAL SERVICES ACCOUNT NO. 100214737 11. PINNACLE HEALTH EMERGENCY 27.35 MEDICAL SERVICE ACCOUNT NO PHE 271509418 12. RIVERSIDE ANESTHESIA 120.90 MEDICAL SERVICES ACCOUNT NO. 36785325 13. ASSOCIATES IN KEDNEY DISEASE 288.00 MEDICAL SERVICES ACCOUNT NO. 14445767 14. PATHOLOGY ASSOCIATES OF CENTRAL PA 32.60 MEDICAL SERVICES ACCOUNT NO. 100214737 15. QUANTUM IMAGING AND THERAPEUTIC ASSOCIATES 50.04 MEDICAL SERVICES ACCOUNT NO. 244379 TOTAL (Also enter on LinE:10, Recapitulation) I S 71.789.77 If more space is needed, insert additional sheets of the same size. v ~ Continuation of REV-1500 Inheritance Tax Return Resident Decedent DAVID LONG 21 10 0363 Decedent's Name Page 1 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. DISCOVER 2,791.95 CREDIT CARD ACCOUNT ACCOUNT NO. 1555 17. N.A. THE HOME DEPOT CREDIT CARD ACCOUNT ACCOUNT NO. 8095 9,612.60 SUBTOTAL SCHEDULE I 12,404.55 GRAND TOTAL SCHEDULE I $ 71,789.77 REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: DAVID LONG 21 10 0363 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 transfers under Sec. 9116 (a) (1.2).] 1. BARBARA PHILLIPS LONG Spousal 352,548.71 205 WEST GREE STREET SHIREMANSTOWN, PA 17011 I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF RE:V-1500 COVER SHEET, AS APPROPRIATE. Ij, 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 LINE 13 OF REV-1500 C(JVER SHEET. I $ If more space is needed, use additional sheets of paper of the same size. 2004 Chevrolet Impala -Suggested Retail Value -Kelley Blue Book Page 1 of 2 ~~~~~~~ ~~ SEARCH THE SEED •B~11ECE ,. Home New Cars Certified Pre-Owned Used Cars Research Reviews & News Dealers 8c Inventory Used Cars For Sale Loans & Insurance Used Car Values ( Search Used Car Classifieds ~ Certified Pre-Awned ( Compare Vehicles ~ Perfect Car Finder ~ Most Researched Vehicles ~ CARFAX Vehicle History Welcome Back ~ Sign In ~ Create Account ~ My KBB ZIP Code: 17013 Recently Viewed You Might Also Like Free Dealer Price Quote Your E$timat+ed Score is: c~ y~- h~rvs a mortgi~g~7 ~~ drr~tln~gwsni acoounis pcyw7 Home > Used Cars > ~QQq > Chevrolet > Im°aia > Sedan 4D 2004 Chevrolet Impala Sedan 4D Trade-In Value Private Party Value Suggested Retail ~~ _ ~__. 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