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HomeMy WebLinkAbout04-29-11 (3)J 1505610105 REV-1500 EX (02-1 1) (FI) PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes "~"""°`""`"°` County Code Year File Number INHERITANCE TAX RETURN Po Box zso6ot ' ` Harrisburg, PA 17128-o6ot ~ ~ ' ~ ~ / / RESIDENT DECEDENT (~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Binh MMDDYYYY 192-14-6003 02/06/2111 02/28!1925 Decedent's Last Name Suffix Decedent's First Name MI File Martha ' J (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 ~ 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 Retum Required death after 12.12-82) OD 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 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 Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Robert C. May, Esq (717) 612-0102 First Line of Address 4330 Carlisle Pike Second Line of Address City or Post Office Camp Hill State ZIP Code L PA 17043 REGISTER OF Vf1LLS USE ONLY :~... r;-. ~. ~~m ~ ~~x ~ ~~~ ~ w Tr i~""1, ''rl C r, ~ '~ tit ',r,.~ ~, ? !-~ _i:~ r- r-F~ c~ correspondent's e-mail address: bob(~mayandmay.ctim Under penalties of perjury, I deGare Mat I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is We, correct and complete. OeGarelion of preparer other than the personal represenladve is based on all informallon of which preparer has any knowledge. SIC~PyTjURE OFAERSCfI RFsSPONSIBLE FOR FILING RETURN DATE Jr,~G~ ak~~ G~ -v~-r3t~~a~ _ ~- 17~~ .~ y- 2 7 - / / SIGNATURE OF EPARER OTHER THAN REP ESENTATIVE ' DATE ADDRESS "/J~ ~~ n~ r~~'L~ ~~/A_ ~! t)ri~ 1' l• PLEAKS,E USE ORIOINr/ApL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: .192-14-6003 RECAPITULATION 1. Real Estate (Schedule A) ........................................... .. 1. 117,200.00 ', 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 667.80 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. __ 0.00 _ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. ', 10,384.49 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. ' 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 0.00 8. Total Grose Assets (total Lines 1 through 7) ........................... .. 8. 128,252.29 9. Funeral Expenses and Administrative Costs (Schedule H) ................. .. 9. 10,411.61 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............. .. 10. 1,936.95 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. 12,348.56 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 115,903.73 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. 115,903.73 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 l4 taxable - _ at lineal rate X .0 45 115,903.73 16. 5,215.67 17. Amount of Line 14 taxable _ _ ._ at sibling rate X .12 17. 18. Amount of Line l4 taxable " "' - at wllateral rate X .15 ig, 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 REV•1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Martha J. File STREET ADDRESS 53 Ashford Drive CITY Enola STATE PA ZIP 17043 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPaymenis A. Prior Payments __ B. Discount 3. Interest 0.00 260.78 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 2l1 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (~) 5,215.67 Total Credits (A + B) (2) 260.78 (3) 0.00 (4) 0.00 (5) 4,954.89 Make check payable to: REGISTER OF WILLS, AGENT. ~ ~~.1s„~!$i~~'~~ P}~JI~:~!~"~~ ~~ ri(~~~~~i~°~',Y"4~f]'w~,~r~"ii~'r~ ~r~~9~1~~61'~9~4~Ylii ~ ~r j~~}iA~~i~~'1 °lE'{,sPkii~, r~lilq~~b. ;~r,`i6'~di2~~y..ni ~i I,I~F~G~ yob ~„~~.~i~~OYi ~~~~i~lA~7~F ~' ~~r~i i' t~ ~~ "'Y d ~Flx ,nom 1~. r Y ~ i dh s i~ 4 u i w ~ r. ~, M III P 9 4 ~1 u 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 inwme of the property transferred ...................................................................................... .... ^ b. retain the right to designate who shall use the property transferred or its income ........................................ .... ^ c. retain a reversionary interest .......................................................................................................................... .... ^ 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-upontleath 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 THEYy~ AN5WElR TO ANY OyF~ THE ABOVE QU~~ESTIONSI~IySy YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS ^PIARTd OF T4~HE RETURN, w n.5y~~. M~~i)^~7~MN~--~.~t, ~~~y~iyjWll~~i'. ~,r~ oi,Lw, ~d}Hll~pw(`1W.f•~lt iiV~~~¢~v+TA~ti'~`i ~e°y ^i!Ni~~i aS~l(pp Yet II~~~ry PcB~x ~~ p~Ii Ipry~Y.~ ~~idra. ~,+ .~M ~r~"flT'. ~yy '~'Z~i "N'k ~i9~ i~r (~L l~ill~~.~¶'~yry~'~I ~~ G~I N ~"..wn°~Cr~l~~i9i"ul~ilX ~ ~k ~~Hl M 4. Yb ~i'1'I I Itf~Mtl~' 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, 2D00: 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 D percent [72 P.S. §9116(a)(1.2)]. • The taz 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(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 comrrron with the decedent, whether by blood or adoption. REV-1502 Ex+ (11.08) pennsylvania SCHEDULE A INHERITANCE TA% RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Martha J. File 21-11-0211 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 mmpelted to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survlvorshlp 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 OF DEATH DESCRIPTION 53 Ashford Drive, Enola, PA 17025 (assessed value x common level ratio) ~ 117,200.00 TOTAL (Also enter on Line 1, Recapitulation.) ~; 117,200.00 If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (a-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER MARTHA J. FILE 21-11-2017 All property jointlyowned with right of survivorship must be disebsed on Schedule F. (If more space is needed, insert addigonal sheets of the same size) REV-1508 EX+ (11-1DI Pennsylvania / SCNEpIJLE E DEPARTMENT OF REVENUE y/~$1~7r BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Martha J. File 21-11-0211 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned wkh right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE 1. M&T SECURITIES, INC., BROKERAGE ACCOUNT N0. AZD-053585 -MONEY MARKET FUND 7,141.68 285 DELAWARE AVE, STE 2000, BUFFALO, NY 14202-1885 2 M&T BANK, CHECKING ACCOUNT N0.9845199836; ENOLA PA BRANCH 3,119.29 3 REFUNDS RECEIVED AFTER DEATH 123.52 4 1996 FORD CONTOUR(POOR CONDITION) COST TO REPAIR EXCEEDED VALUE (SEE ATTACHED) 0.00 5 wearing apparel, household goods & furnishings, books, and other miscellaneous tangible personalty 0.00 TOTAL (Also enter on Line 5, Recapitulation) $ I 10,384.49 If more space is needed, use additional sheets of paper of the same size. 1996 Ford Contour -Private Party Pricing Report -Kelley Blue Book t ~ SEARCH Page 1 of 2 Home Haw cars cartlrlaa pre-0wned Used Can Reaasrch Reviews & News Dealers & Inventory Used Can For Sale Ware A Imuranee Used Car Values I Search Used Car Classifieds I Catffied Pre-Oyrnad I Compare Vatddes I PeAect Car Finder I Moo Resmret,ed Vahides I CARFAX Vehicle History Wekema Nark I Sign In I Create Acwunt I MY KBB 2IP Coda: 17025 Recently Viewetl Vou Might Also Like Free Dealw Price Quote iib ENS*Y fal~li . ,;. Ad(. '. ~soE Sts~s [araswaatnat4Nl PWaren/aselisYr~4 t~ > iksdSa6 > 1444 > Eeld > > oL Eason aO 1996 Ford Contour GL Sedan 4D Trade-In Value _.... _ _. Priv~ta party {/aloe BLUE BOOKS PRIVATE PARTY VALUE '."„ Suggasted Retail Value __ --~_,.__ - _ cpovalu~ Condition.~~w.,< ~<; Value Photo canary Excellent ;1,695 Cars For Sale a.,ul Compare vehicles Good ;1,545 Blue Book Review Filr X1,070 Consumer Ratings ' More Photos Find Your Next Car Spec~ficatiuna sF~tRCH t.OCAI. usTRlos ~ NEXT STEP: ...: aJYAUNEDCNt -011 NkM Naak aaaaNleee° ,..2 v , ... ..nxo m .. .,z .. e H v<. as .e . ,.ppa Ahrv v SFr a+,reu ford - ~ GRFA% Reeord Check Powered ~, Comnur ~ VIN: 75 Milos e:.:~ rvo VIN7 No Problem! Nmr 2IP 17025 News Reviews !k Top iM ro vkaa Aea, aldt , ,~ 9wppkp Teals 30 coolest Cars Urtder S38,o00 1 o New Names for 2011 Flyirp Car For Sale: Buy CMtty Chitty Berg Bang. No Kidding! - AOL Autos 2011 Best Redesigned Vehicle Best April Deals - AOL Autos Read More ,. ~ _. o .. ., e -._ ., ..,r-~ w-... . .. ,_. Average COnNUmar RatMg (34N RevMws) Read Reviews NHLVOMI dR ~~ ~ ~ ~$>~~`-' 3.9 out of N Review the 1996 Ford Contour For one low price ri ~q JVL~ You can reach . u .x, e,.. , ~_v., <~. , ,>. ~. ... ._., ,,. milllorts W used car Vatlricle NighNghb shoppers Mllayae 92,000 learn Moro nor EnNlla: 4{YI, 2.0 Liter TrN1a111Wipw: Automatic Odratrain: FWD • Print Fa SaN Sqn ~~ '. , • Sfnre wah Fr1etN , " _ .a.:, ev., . + ._„ ... .. , - . „u .. c s. rn n~.. ' T ~ uo-to-dae LM Selected Equipment Change Equipment - valuae" NtaMeN Gat Your Too1Mt ar Conditlanhtg AM/FM Staao Sorel WhaMs . ~ ' "`~. A nO~ ~a Power SWnnq Cassatb rile wlwl DuH Air Gage G Haw under ss,ooo ~ , z .~. .,~,,,_,~~ ~ ~,., m. Blue Hook Private Party Value 'Both Naw arid Usatl ' Kelley Blue Beak Private Party Value Is tM amount a twyar mn aspect to Sedan ~~ PeY what buylrg a used car from a pnvaG party. The Pdvata Party Vaiue aeamtes Vre vehtcq is sdd'As tc' and larties ro waramy (otter than arty To l/favr lit skit remairertg factory warrar2y). The Oral sale price may vary dapettdirtg on the ' , vehicle s actud mndMat and local market coMlbortc. This value rtray also ba aced to derive Fair Market Vslue for Irrsurartp and vahide donatlon Purposes. CARFAK Record Check Auto Loan from 3.499'e APR Get Your Credit Score Now Compare insurance RMes ' with Progressive Paymem Calculator C-c[ended Warranty Quote (~ http://www.kbb.com/used-cars/ford/contour/1996/private-.party-value/pricing-report?condi... 4/25/2011 News More Car News 10 Coldest Cars Under 818,000 '. 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NUEV~# .w °`"~. ` CRUZE M A N tt)A C0 X Y0 G D ~¢9 > lh9tl.Sea > 14Pi > Emy > SrB,t~[ > cL••e.n •s 1996 Ford Contour GL Sedan 4D ~.w ... , ~~,,... . ~., ,, a,,,,....n , , ,.,: ,~ .,b~.~,.mx, .max SELECT THE VEHICLE CONOiTION Not wre7 Take the CondFtbn quiz l~+Eirullept LX7©©Q • Loolm new, u in ezmllant mechanical mndalm and needs rq remndmonifq. • Never had any paint or fxrdy work and is free of ruu. • Clean the history and will paK a smog and asfaty inepedian. • EEn~p~n~e~mm~pder~tr~narynt~isycslara~di,~wirtah~nro~fl~uid leeks and is free of any wear or vlaide ddacts. l.ms thbn 5% of elf ufiC vTidaa 7aR into tMS cahpary. • Free of any major dadecta. • Clean title history, the pelota, body, and interior haw only mlrlw (if any) blemicfgs, and there are rKr major mechanical problems. • Little or rw rust on this vehicle. • ATplneaa~sy,mvclIa~ch and My~~~~~wn~seau•dbdefamialrotcnxmdd~tiwoeraar left. ~1act~rLnpan~ lodiverwdlwhfdesa Irdo this mb~ryrx fad x retail. ~, Far [7CfL7....:.:.. • Sane mechaniml or marrlxlt defects ant rleedf fervlanfl but is still in raawru6le running corMition. • Clean tlde Matory, the paint, body and/or Interior rived work pertonned try a pnofafsional. • Tirac may need to ix replaced. • There may be some reWirede rust damage. Voor L} • Severe madmraml and/or cosmetic defects and is in pow running <onditlon. • May haw problems that mono[ 6e rmdly fiord sudr as a damaged frame or a rented-through ~ Ggod~Yda~ tits ~~y eft') ~myapad o~~~aaoa KallareY 9IW 96olCfTJeaa~k Op[ ro a vNUa Dtf !'poor- Jahicle 6amus• tM value of these vehicles vadec grmtlY. A vehicle in poor mndtion nuY require an independent apprelml to dxennina tts value. On 1®a.com Home New Cars CeNOed Pre-gvned Used Cars Resee2h Reviews a Nevrs [>e01ers Used Grs Fw Sale Loans a insurance KOBa Green KOOSn Mobile Motortydes News More Car Naves 10 Coaest Cars Under f 19,000 Best April Deals - AOL Autos ~~ Email QB70I.19Afa: ~ .-'- B' ......q av.a wumr nvw anew sv. • aesc nesae value gwema to camry Gera Under f30K 10 Cool Cps Under f 1aK This Wee1c's 5 Greet Cer Deals Afinet 10B Abwk Us Confect Us Greens FAQ Media Advemsing Unnng PrWecy Site Map CoIMi9ht a Tradenpks Tenns of Service O 1995-2011 Krl•y Bel• Book G., inc. Business Irquines http://www.kbb.com/used-cars/ford/contour/1996/private-party-value/~ndition7id=8923&... 4/25/2011 "'/ YF 1996 Ford Contour -Private Party Pricing Report -Kelley Blue Book Page 2 of 2 Visa hrollrstlalide Vahida COttditlon Ratirt9s Select Veer... _;] Check Vehkk: Ttth History Soled Make... - F_ltceilent r:::a~ 51.695 Select model... Lnolg new, is in excelhrd mechanical condition and neetlc rq : remndltloning. • Never had am/ peim or body woAc and is free of rust. Or Search b Cate o • Chen title history and will pa% a smog end safety Inspecoon. y g ry 6rgirro canpartmam is clam, with rq flub hales and is free d am Or Charge ZIP Coda wear or vidde ddeds. • Complete aM venflabh sarNCe records. less than 5% of all used vehices fall into this rafapory. Si,s4s • Free N any major dafaNs. • Clean title history, the peiras, body, and Interior have only minor (If anY) hlemishrg, and tMse are rw major machanrml pmhlans. • Little or no rust on this vahide. • Tiros match and haw substantial treed wwr left. • A "good' vehide will need sane necondltlonirg to be veld et retail. Most cansurner owrwd vehicles fall into this retepary. Fair QiL7 51,070 • Soma medreniral or msmetlc defects and needs servlNrg but K atilt in raesonebh mm~inq condlton. • Chan tide hlatory, the paint, body and/or interior need work prrdarmed by a prafesaiorxl. • Tiraa may neetl to be replaced. • There may be some repafraNe net damage. Poor • Severe mrrdlanital arM/or camatlc dafacK and is in poor running condition. • May hew problems that carmot bo rrsadlly fixed such as e damaged frame or a Rlstad-thralgh body. • Breaded tlda (salvage, flood, etc.) or unwbstarltiatatl mileage. Kelley Biw Book does rat attempt [o report a velth on a "pool' veMde bereave the value of these vahidaa vanes grenny. A vatrlde in poor condmon may reQlllre an Independent appreisal to determine its value. * Penncylvanie 04/25/1031 Accurate Condition Appniwl Charge Condttbn Acarataly appraidrp the caditlon d a vWVde is an important arlpect in determining Its Blue Back value. TeWng our 16 Qumtlon mnditlon Wu will ensure you know the rorrect conddon redrg. NEXT STEP: $~Aa~M~~A~~~s 01011 Keaey ewe Brok CP., Lac. AN llyhtz neaeMd. ylyaoll-y1$/3ou Ed,tlon. T!e apeeMC brforrrradon,aquUd m determinethe value for aMS pslthr9x veMC/e was appal by the penmrr generdag tNa report. 19wc1e vpuad9re arc rplererq errd may wry fmm veMtk fa vehkY. Achtal vewatloro veal very bead upon nrdkat roMtbm spedacariwq vrrwW condlUar orader partltWsr drcunaWnor pargnelt lD thb pomade' vdlkte or the transcdon o! the pa/tles LD the treraactloll 7hk RpoK k NeerdeN b the brdAdnYlleeW Ne petam Iprwetbq fhb lapprt sal' ens shoe net be sold wberwrYMed m erctler perry. Kdby dote 9etlr ealalrea no aespalmMlay for armrs a om.Mions (v.110a3) On KB&cwn None New Cers Cortlfkd Pre-0wned Used Cars Research Reviews 8 News Dmkas Uses Cars For Sale I.aazfs a tnsuerce KeBa Greco KBB°"' Mobile Motorcycles MetarlM 2011 Debolt Auta Stgw 2011 Belt Resale Value Awema 10 rAmfy Cen lxrdc f30K 10 Cad Cars Under i leK Tha Waefs 5 Great CN Deals asaB IW About lie C9MacC Us Carvers FAQ Media AdvreUSlrg linking PnvacY Sae MaP CopYri9ht i Tredanarks Terms of Servi¢ O 1995-2031 Ke1hy BNre Book DO., IK. eralrr>S Iipulrla http://www.kbb.com/use~carslford/contour/1996/private-patty-value/pricing-report?condi... 4/25/2011 p < ~ O O ~ ~ ~ ~ m -y k ~ U ^ ^ ^ ^ '.,. ~ ~ O D O Z ~ m < m ~ 1D i ~ ~ ~ ~ W ~ ~ O r O ~ y ~ S ~ ~ ~ Z m ~ nl ~ ~ 4 v 0 ~, A ~ ~ ~ ~ ~ ~ ~ 1 ~ --~ . ~ t p ~ ., ~ a ~ ~ ~ r~ ~ ~ ~ ~ ~ ~ ~ ` ~l ( ' ' ~ ~ ~ ~ ~ ~ b ~ o m P ~ ` A t\ r C l v c ~~ n ~ ~ m °~ ~ ~, !}- z o~ m ~ `- vJ 1i+ ~ ~ mm m m V G m v i O Z ~ ~ U ~1 ~ °~ Q ~ ~~ ' ~ y mN m ~ a z m ~ ~ `~ ~ °°~o ~~ m niD~G ~ .~+ w Q w ~y~ 3~ m~07Dm ~ d ~ y s N 8 m a n ~~•Y ~ m ~ ~ v N 00 r C ~ ~ m ~ C ~~ 9 3~ O Z~ c '" " m m r vZi p m ~ O O m ~ O O r m C 9 m Z ~ ~ m O ~ D ~ ; Z ~ ; w~ O D ~O 8°.~'g O 9 m m ~ 6 a 2 N = m ~ m ~ W 171 ~ ~ I^ ~ N m [3fl mm p s ~ m a ,2 o d .n ~ m m ~ m N N Q ~ (!i 71 m~~ u m m~~~m n O ~ Z ~ Z O ~ N ~ N N r T ~ ~ ^~ , ~ x m .~ ~~~ ~~ 4 m ~e' 3 ~ ~ m~$ m~ ~ m u ~R x ~ ~ ~ ~ ~ b O 31 fn fTl ~ m = ~ ~ ~r r C m mpn 9 m o ~ ~ ~ ° Q ~ b r m ~ O "' S ~ ~~~o 0 4 ~ Z A ( ~~` ~ m D~ ~ ~ ~ ~ y ~, ry = V 1A\ ~ ~ _ B.g-- _o '.~1`~ ~~3jF ~ ~ 'v nv ` h w p~ 1~ ~ + y m $ ~ ~~~~ N \ b ~ ^' ~ ~ _ m ~ ~ m w ~ ~ ~ ~ ~ b ° ~ ~ ~.og~~ R Z '~~ ~ ~ , ~ ~ ~ _ m~m~s ~ W ~ ~ ~ c N 9 , w ~$_~ J~oa- ~ ~ a 9 ,~1 " N r ~~o~ ~ ~ ~ N ~ o0 Om ~ O m;_ ~ L>O ern a3yvyR~ pWo N y m ~ ~ ~ ~ ~ y 9 BO ' O~ Ddb D~ my O m ~ m N m y X ~ ~~ IpTI~ y T N~ NSk ~ ~ JJ N Z ~~:, ~ O n O ~ O W 3 ~ m ~ ~ W m ~ i m ~ ~ ~m ~ ~ ~ o Z O Z m ~ ~ 1 ~ D O a ~ 2 ~ ~ D ~ G 2 p p ~ ~ D a o ~ W ~ V ; ; m m m O D _ A \ ~ N ~ ~ w TMR Rw nnlM .n~I R wnn1A . ~.......~..., e ........... . .. .. .. . .. ~ ,., ~.: „ y ... .. ;/~ ~A , n -' .~ Y1 ' ' ~ ` ,,. ~, f, ;M/ ~. .,.E r' ~ ' i~'i REV-1511 EX+ (10-09) Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Martha J. File 21-11-0211 Decedent's debts must be reported on Schedule I. REM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' Sullivan Funeral Home 5,135.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: 900.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500.00 Claimant Elizabeth F. May Street Address 53 Ashford Drive City Enola State PA zIP 17025 Relationship of Claimant to Decedent Daughter 4. Probate Fees: 353.50 5. Acwuntant Fees: 0.00 6. Tax Return Preparer Fees: 187.00 ~• Newspaper Publication Costs (county barjoumal and local newspaper) 177.58 a Commission on Sale of 212 Shares of Allied Irish Banks 38.53 s Cost to Transfer Home to Elizabeth F. May (Tftle Search, Deed & Filing Fee) 120.00 TOTAL (Also enter on Line 9, Recapitulation) ; 10,411.61 If more space is needed, use additional sheets of paper of the same size REV-1512 EX+ (12-08) Pennsylvania SCHEDULE I DEPARTMENT DF REVENUE DEBTS OF DECEDENT, INHERRANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Martha J. File 21-11-0211 Report debts incurred by the decadent prior to death that remained unpaid at tha date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size.