HomeMy WebLinkAbout06-02-11CHARLES E. SHIELDS, III
ATTORNEY-AT-LAW
6 CLOUSER ROAD
Corner of Trindle and Clouser Roads
MECHANICSBURG, PA 17055
GEORGE M. HOUCK
(1912-1991)
Ms. Wanda Zeigler
Register of Wills
Cumberland County Court House
1 Courthouse Squaze
Carlisle, PA 17013
Deaz Ms. Zeigler:
May 27, 2011
Re: Estate of Dorothy F. Black
No. 21.11.0283
TELEPHONE (717) 766-0209
FAX (717) 795-7473
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Please find enclosed herewith two (2) copies of the Inheritance Tax Return for the
Dorothy F. Black Estate as well as Check No. 6728 in the amount of $15.00 for the filing fee
due.
These Returns are being filed separately and independently of any later Returns to be
filed by the Executor via his probate. All receipts and the like regarding this particular Return
should be sent to me and not to the Executor. Anything filed by the Executor in connection with
the probate or related thereto should continue to go to him. My representation in this matter is
exclusive to Jeffrey Black and Laurie A. Black in their individual capacities and is not
involved with the probate portion of the estate administration. I have attached copies of this
letter to the Return itself for everyone's convenience.
Thank you for your kind attention to and help in this matter.
Very truly yours,
C'~~,
Chazles E. Shields, III
Attorney-At-Law
CES/mj j
Enclosure
cc: Jeffrey and Laurie A. Black
J 1505610101
REV-1500 ~` `°'-'°' ~
PA Department of Revenue pennsytvarda
oewxn,¢,n er ~EVwve
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box z8o6oi RESIDENT DECEDENT
Harrisburg. PA 37sz13-o6oi
ENTER DECEDENT INFORMATION BELOW
Social Security N~1u-~m-b~r ~T;;TT~11 Date of Death ~~-M~MDDYYYY
Decedent's Last Name Suffix
S L i} C
(H Applicable) Enter Surviving Spouse's Information Below
OFFICIAL USE ONLY
County Code Year File Number
Date of Birth MMDDYYYY
x ~ g i q~
Decedent's First Name MI
OSLO
Spouse's Last Name Suffix Spouse's First Name
~~ ® T„r„m
spouse's Social Secudty Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
1__L..L~L~~ REGISTER OF WILLS
MI
FILL IN APPROPRIATE OVALS BELOW
pplemental Retum~Addihbns/
S
u
~ 2
O 3. Remainder Retum (date of death
O 1. Original Retum }
~
.
SpnllA7/C fC)~/'A
`"''YV' prior to 12-13.82).
O 4. Limited Estate 4a. Future Interest Compromise (date of
O O 5. Federal Estate Tax Retum Required
death after 12-12-tit)
O 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 121-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DI~CTED TO: -~y
Name Daytime Tel~hone Number .,., ~t
First line of address
Second line of address
Z
v~T f.`~
~ ~ ~-r"c
n ~
ro
~
State ZIP Code ~~-~~~~-~DATE
c~ gr P C N A~ / C S .B u Q G / o S1ZL_l:~
Correspondent's e-mail address: C Q ~~ f Uu S ~
Under penalties of perjury, I declare that 1 have examined this return, it
it is true, correct and complete. Dedaretion of preparer other than the
sIGMATURE OF PERSON RfrSPONSIBLE FOR FILING RE_
I~L/p//~~C~ AM~
~~6, iiCOQ.el . i
Ca~Ca~t, ~e f
axompanying schedules and statements, and to the bast of my knowledge and belief,
al representative is based on all information of which preparer has any knowledge.
DATE c~7ZJ/'O
DATE b~ Z' // O
ADDRESS _Cy,~,Q[~cj E, ~/~.~ ~j
L 150.5610101
Side 1
15056101D1 ~'
REV 1500 EX
l~tent'sNarne: Dbko7NY F. /.3LifCe~
1. Real Estate (Schedule A) ........................................ ..... 1.
2. Stocks and Bonds (Schedule B) .................................. ..... 2.
3. Ck~sety 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. Jointly Owned Properly (Schedule F) O Separate Biting Requested .. ..... 6.
7. Inter-Vivos Transfers $ Miscellaneous Non-Probate Property
(Schedule G) p Separate Billing Requested... ..... 7.
8. Total Gross Assets (total Lines 1 through 7) ........................ ..... 8.
9. Funeral Expenses and Administrative Costs (Schedule H) .............. ..... 9.
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 Vsiue Sat>)ect 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 1g,
Decedents Social Security Number
19. TAX DUE .........................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A R6FtlND ~ AN OVERPAYMENT
1505610105
r~
Sfde 2
L, 1505610105 1505610105
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TA%ES
DEPT. 280801
HARRISBURG. PA 17128-0801
RECEIVED FROM:
BLACK. LAURIE A
6971 WERTZVILLE ROAD
ENOLA, PA 17025
•-•---•- told
REV-1182 EX111.981
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssN: 2oi-~s-as35
FILE NUMBER: 2111-0283
DECEDENT NAME: BLACK DOROTHY F
DATE OF PAYMENT: 05/25/2011
POSTMARK DATE: 05/25/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 02/26/2011
ACN
ASSESSMENT
CONTROL
NUMBER
N0. CD 014509
AMOUNT
101 ~ 513,859.55
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO ATTY
513,859.55
CHECK# 6722
INITIALS: WZ
sEAL RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
REV-1500 EX Page 3 File Number oZ~'"//-
Decedent's Complete Atltlress:
~CEDENTSNAME poRaTKy F. /,i[~CK
STREET ADDRESS 6 9 6 ~r (,rJEnTZ v!L L C /low
aTr ~-~-~OG!¢ sTATE P~ ~P ~ 70 ~~.
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits-Payments ~3, ~5 `/. ~S
A. Prior Payments t 7 2 `t. ~{S
B. Discount
3. Interest
4. Ii Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
FNI M oval on Page 2, Urra 20 to rsgrast a rattxld.
5. If Line 1 + Line 3 is greater than Lkle 2, enter fhe difierenoe. Thy is fhe TAX DUE.. (5)
Make check payable to: REGISTER OF WILLS, AGENT.
(4) -~~ a 9
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 irXwme : ............................................ ^
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, 19132, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. ^
3. Did decedent own an "in trust fort' or payable-upon-death bank acca~nt or security at his or her death? .............. ^
4. Did decedent own an individual refiremeni account, annuity or other non-probate property. which
caltains a beneficiary designation? ........................................................................................................................ ^
IF THE ANSYYER TO ANY OF THE ABOVE QUESTjONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN.
For dates of death on or after Jury 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)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 Doty berreflaary
For dates of death on or after July 1,2000:
The tax rate imposed on the net value of transfers from a dec~sed child 21 years of age or younger at death io or for the use of a nature parent, an
adoptive parent ~ a stepparent of the child is 0 percent (72 P.S. §9116(a)(1.2)].
The tax rate im sed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as rwthd in
72 P.S. §9116(1.2i•12 P.S. §9116(a)(1)j.
• The tax rate imposed on the net value of transfers ip or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)j. Asibling is defined, under
Sedan 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoptwrt.
(1) ly ssi, 9/
Total Credits (A + B) (2) ~~y -5~~- eo
(3)
D
. REV-is+o Ex «ryarl
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON•PROBATE PROPERTY
KttllUtNl Utl.tVtrvi
ESTATE OF FILE NUMBER
~oao,~y F, ,BC~¢CK ~~- /i-o~~3
This schedule must be completed and filed it the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THENAYEOFTHETWWSFEREE,THEIRREIATICN6MIPTODECEDENTPNOTHEDATEDFTRANSFER. DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
ATTACHACCPY OF SHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICA&E
JM ER
t• 'pecedent, on ~1. /3, 1995 Or~n'~ed ainr.~
Go n pelf ed re s i d en f; al r'e.l 2sta~ ~ o e a.#'e d at
(n96~ ~Jpr•~Zv;lle toad, E•no~a, Cwmlxr~a.vt/~
~'ou,nty, j~11r15y~Yd'nla ~Ter,~e areal illo. 38-/3_
o ~&~-D/~, ~%Irer Spy%~-y wp.J ~ her s°h
GMd c~auril~f~-'-%„-la.~, ~"eff--eY 4. /3/ac% and
/..Qu,riC ~. ~lucl(. ~y die firms
ricer.( off' ~onveyaHCe, dececleait Y~sev~/e°I
wr-ty /v-^selF u /rfc e.5~'af~ .
(SG>e C61py ~ y ~ P~ a'l~i c~)
l~ d• o• d• ~x -/a/ua~''cn ~uas c4/ck/aTa-'
QS ~/(ows:
99 ~
%ef~~ .32~f, aDD •pO ~,3 ~~~ QOO.av 1 DO/o --~D - 32~f, ZOD.eo
(Sce ~f % of Cic/n~cr/u~xc~ ~'ou~ T"~
,fs5c3s~cnf q~I`gcluq! Tiic Currf~f
/hrr/f.~/,'e r {r (~un~ ~r/~ Cau~y
~5 i o )
(Scg ~qr~o/4~a/So/~ o~ ~x C~~CU/aiSost
QJfx~c~)
TOTAL (Also enter on line 7, Recapitulation). I S 3 a ~ o70O. eo
(H more space is needed, insert additional sheets of the same
Tax Parcel No. 'J6' 13 - 09`1- Ol(o
Made the 131hday of '~e~.ucwy.... in the year one thousand nine hundred and
ninety-five (1995). 0
Between DOROTHY F. BLACK, an unremarried widow, of 6969
Wertzville Road, Enola, Cumberland County, Pennsylvania, Grantor,
and
JEFFREY L. BLACK and LAURIE A. BLACK, his wife, of 6971
Wertzville Road, Enola, Cumberland County, Pennsylvania, Grantees, as
octants by the entireties
WTTNESSETH, that in consideration of the sum of ONE ($1.00) DOLLAR in hand paid,
the receipt whereof is hereby acknowledged, the said Grantor does hereby grant and convey to the
said Grantees, their heirs and assigns:
ALL THAT CERTAIN property located at Silver Spring Township,
Cumberland County, Pennsylvania, more particularly bounded and described
as follows, to wit:
BEGINNING at an iron pin in the center of the stau highway leading from
Harrisburg to Sterret's Gap; thence along the center line of said stau highway
by lands now or formerly of Frank Colescott, North 86 degrees 30 minutes
East 300 feet to an Trott pin in the center of said stau highway; thence along
lands now or formerly of Ada C. Ewing et al, of which this tract was fotrrterly
a art, the following courses and distances: South 11 de s 36 minutes East
133 feet to a pin; South 38 degt+ees 51 minutes East 100.8 feet to an iron pin;
thence South 0 degrees 16 minuus West 65.6 feet to a pin; thence South 18
deArocs 15 minutes West 113.97 feet; thence South 6 degrees 10 minutes East
226.89 feet to a pin; ther-ce South 4 degrees 32 minutes West 80 feet; thence
South 37 degrees 29 minutes East 258.77 feet to a pin; thence South 4 degrees
40 minutes West 125.21 foet to a point at corner of lands now or formerly of
Christian Waggot~r-, thence along said lands now or forrrtcrly of Christian
Waggoner, North 83 degrees 48 minutes West 519.05 feet to a pin at corner of
lands of Francis E. Stoner and Carrie B. Stoner, thence along said lands of
Francis E. Stoner and Carrie B. Storter, Notch 0 degrees 07 minutes West 943
feet to an iron pin in the center of said highway, place of Beginning.
THE ABOVE DESCRIBED tract of land being improved with aone-story
frame dwelling and a frame bam. The above description is according to a
survey on the ground made by W. B. Whitlock, Reg. Eng. on December 6,
1955.
BEING the same property which G~rgia B. Hatch, formerly Georgia B.
Quackenbush and Carr Hatch, her husband, by deed dated June 22, 1962 and
Recorded in the Recorder of Deeds Office in Cumberland County in Deed Book
Q, Volume 20, Page 240 granted and conveyed unto I. Dale Black and Dorothy
F. Black, his wife. The said I. Dale Black has since departed this earthly life
whereupon full title by operation of law incident to tenancies by the entireties
vested in the said Dorothy F. Black, his widow.
THIS IS A TRANSACTION FROM MOTHER TO NATURAL SON AND
DAUGHTER-IN-LAW AND IS THEREFORE TAX EXEMPT.
GRANTOR HEREIN RESERVES TO HERSELF, FOR AND DURING HER
NATURAL LIFE, A LIFE ESTATE IN AND TO THE ENTIRE PREMISES.
:1~.~ ..- ~ ~•t
f,00r Y::i,r i)i.
AND the said Grantor will warrant generally the property hereby conveyed.
IN WITNESS WHEREOF, the said Grantor has hereunto set her hand and seal the day and
year first above written.
Signed, sealed and delivered
in the presence of:
~i~ii~ ~ „i~i~G4~ ~ C/6 ) .l n i ~ c%~ ,,~~ (SEAL)
~ /i~~y ROTHY F. A K, an unremartied wt~
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF CUMBERLAND
On this, the /3M day of , A.D. 1995, before me the
undersigned officer, personally appeared DOR Y F. BLACK, an unremarried widow, known
to me, (or satisfactorily proven) to be the person whose name is subscribed to the within
instrument, and acknowledged that she executed the same for the purposes therein contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
cn~ E ~ls ~~ -°' Notary Public
Na~vF'uWc
tM ao, isc0"ss
Aseodasu, a Nomries
CERTIFY that the precise residence of the Grantees is
6 ~/7/ Werhri%/e ~f?a! , s`si•'la, P~ /7mzS
Attorney for Grantees
~,~. T S.~
<•~+a of Pennsyhranie ~
:~ of Cumtrerland
adnd in the office for the recording of Deese
nd fo Berland County
Book Vot. =Page ~~
n .:«s my hand and eal of office
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eooii 118 P~cE 576
c:umpenana county Pennsylvania
TAX COLLECTOR COPY -RETURN 1MTH PAYMENT FOR PROPER CREDIT
BLACK, JEFFREY L 8 LAURIE A
6971 WERTZVILLE RD
ENOtA, PA 17025-1039
Payable To:
DEBRA BASEHORE WIEST
289 WOODS DRIVE
MECHANICSBURO, PA 17050-2835
Phone: (717) 697.1294
6969 WERTZVILLE ROAD
Aores 8.030 Deed: 00118-00676
LOT 1 PB 52 PG 119 '
Residential W/ Comm Funct
BIII No: 818
Bill pate: 311111
Corrtral No: 38001338
MAP N0: 38-13-0987-016
Accessed Value; Lend: 196,100 ImprovemeM:128,100 Total: 4,200 _
DbCauflt Faoe PeneMy
COUNT 1,90100 SQ04.30 5818.83 1878.20
COUNTY LI6 •14900 ~•~ ~•~ ~1'~
MUNIC. R/E •~ ~~~ ~•~ ~'~
TAX AMOUNT DUE
It DtU Of Payment Is On 5905.33
911111 thru 4130111 1!4].11
tV1/11 8tru 8190111 51,018.19
711111 or Lahr
Payable To: DEBRA PU8EHORE WIt38T Otlke Hours: MONDAY 9•i?: TUESDAY 9.11 AM Q91 No:
Blp Deb: 416
311/11
180 W0008 DRIVE
MECHANIC8BUR0, PA 17060.2638 ALSO 4R0 a 4f27,e-TPM
CALL FOR HOURS AFTER .TUNE ~ CoMro1 No:38001338
Pl,ons: (717) 897.1294 PHONE (117) e97-1294
MAP NO: sl.13~9lSt~1! Aseeased Value; Ltnd: •198,100 In,proramenN 128,100 Trial: 324,100
Oeec: 6B8D WERTZVILLE ROAD D~uM p~ pew
Agree 6.000 Deed: 0011800876
LOT 1 PB 61 PO 119 COUNTY RIE 1.90100 5804.30 1018.83 5878.29
ReeWraiN W! Comm Funot COUNTY UB ,14300 146.43 546.38 561.00
(~~~~~~~~ MUNIC. RIE .80450 5268.80 1280.82 5286.90
11.00 FEE FOR ADDITIONAL RECEIPTS TAX AMOUNT DUE 5l05.~3 t54s.51 St,019.i9
Tex payer: II Date Of Payment la On 311/11 thN 4130/1 t 611It t tlru 813W11 711 M t er Later
BLACK, JEFFREY L 8 LAURIE A
8871 WERTZVILLE RD
ENOLA, PA 17026.1039
-KEEP THIS
DEBRA BASEHORE WIEST
2L9 WOODS DRIVE
11ECHANICSBURG, PA 17050-2635
TE11P -RETURN SERVICE REQUESTED
FOR YOUR RECORD8
hrdl'i''~IIIIII,Llllllu,'~yldlnLW~h~i4rlllllhnr~ n„o.,rio7
s BLACK, JEFFREY L i LAURIE A
6971 YERTZVILLE RD
ENOLA, PA 17025-1039
I~~~~M~ balled old Wdl9~£ IIOd 'L '1~NP07
I b9Rl'oN
- __
.rIANGF or ~~cI~E_.ss ln:rorlr:~nllorv
CURRENT INFORMATION
MAP NO: 33.13-0987-016
BLACK, JEFFREY L & LAURIE A
6971 WERTZVILLE RD
ENOLA, PA 17025.1038
NEW INFORMATION
TAX INSTRUCTIONS -READ CAREFULLY
1. if serviced by a mortgage company, forward entire bill to company immediately.
2. If you require an official receipt; send your check, both wpm and aself-addressed, stamped envebpe.
3. If not paid by 1y1912Q11 this bill will be returned to Tax Claim Bureau for collection and tiling of a lien against your property.
4. Failure to receive a bill does not relieve you from liability for prompt payment.
6. No partial payments or postdated checks will be accepted and payment must be received or U.S. p~ marked by the due data.
Payable To: OE9RA ®AEEHORE WIEST
~ WOObB DRIVE
MECFNNIC8BUR0, PA 17060.2836
Phone; (Tt7)807.1291
MAP N0: 3t-1a~at7-0ti
Deco: 8060 NfERT2'VILLE ROAD
Aans a.a3o Deed: ooi is-oos~s
L0T1 PB6'tP0110
Reafdentlal WI Carom Funat
otrex Hotp'a: ~ ~ ~ 2~ 47~Y si t AM
CALL FOR HOURS AFTER JUNE 28
ounup nrn aa7.ta94
sla No: •,e
BiN Date: 3MM 1
Conh'et No:38001338
TeX Payer.
SLACK JEFFREY l b LAURIE A
ae71 WERTZVILLE RD
ENOLA, PA 17'0261030
l/l 'd 5981'~N
AseeeaadValw: Land: tO6,t00 br~provenlent:126,100 Tab1:324,200
Diaoount Fee PeniMy
couNrrR~E 1.00200 seat.3o ieie.e3 S67e.2o
COUNTY LIB .11300 116.13 116.38 161.00
MUNIC. R!E ~ .80160 1266.00 5280.82 ~.~
TAX AMOUNT DUE i000.~3 SO23.a1 i1,01a.1e
K Dat101 Pey~ Ie On 3M M t ttlru 4CdOM t 6MM i thru 6130M 1 7MM 1 a Lehr
felled ~Id Wdl9~E llOd '[ '1eW
REV-1511 EX+ (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDIlLE H
FUNERAL EXPENSES &
ADMINISTRATNE COSTS
ESTATE OF D 0~0 T/y y F
ITEM
IUMBER
A. FUNERAL EXPENSES:
1.
R. ~ ADMINISTRATIVE COSTS
BL/~-CK
Debts of decedent must be reported on Schedule L
FILE NUMBER 2l - ~/` O ~ y3
~, Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Com/lmission Paid: _ _- -
2. Attorney Fees Cti4r/ts E, c~1i6/ads !L. ~~c c?r/o/a'/~a6oN of {tac al~acl~ell,-
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant -
Street Address
City State Zip
Relationship of Claimant to Decedent -
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
~. ,~,'/„~' .1" heri farce T.yr 6~efurn fa ~i r~, o f /v,%/s
r8oy zs
f/S,a~
Zs
TOTAL (Also enter on line 9, Recapitulation) $ fjz
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF ~R~THy F ~~Ck
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1~ 5~~' bFTA~/GS SE'T FoeTy on/ SCH~Du~
%///s ~2ETTli~N /s F/L~ SGrP~~2A'TEL¢'' /f
~/l'DEpENDE.(lTly Fr2v~1 TiS~/P~i o~ rsr,
E kECC{ Td~S ~ /~~ CDdElZ L'O.Q,pES ~o~
FILE NUMBER
.7 /- //- Dz~3
4TIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not LlstTrustee(s) OF ESTATE
G.
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
[I NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $
(If more space is needed, insert additional sheets of the same size)
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Nom' IAI
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