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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL
Guinivan, Harold Edwin
- REV-15OO
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year)
02/21/2002 I 12/17/1911
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
21-0: qb,5
~OU'~T¢ CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
2 0 4-0 3-6 5 1 6
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
[~31, Original Return
-'] 4. Limited Estate
'-']6. Decedent Died Testate (Attach copyofWill)
r'-] 9. Litigation Proceeds Received
r-12. Supplemental Return
r'-~ 4a. Future Interest Compromise (date ofde~ after 12-12-82)
~--"1 7. Decedent Maintained a Living Trust (Attach copy of Trust)
~--"~ 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
~'-] 3. Remainder Retum (date of death prior to 12-13-82)
[~5. Federal Estate Tax Return Required
__ 8. Total Number of Safe Deposit Boxes
["--~ 11. Election to tax under Sec. 9113(A) (Attach Sch O)
NAME
R. Mark Thomas, Esq.
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717-796-2100
COMPLETE MAILING ADDRESS
101 S. Market Street
Mechanicsburg
(1)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
r'~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. TOtal Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
17,047.9O
62,446.49
(8)
10,861.77
493.26
(11)
(12)
(13)
(14)
. ~ 17055
.... :~ ~ --__
'"'" O FFI(~A,I'."'~ S E ONLY
217,077.56
11,355.03
205,722.53
205,722.53
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20.
X (15)
205,722.53 X .045 (16)
X .12 (17)
X .15 (18)
(19)
9,257.51
9,257.51
Decedent's Complete Address:
STREET ADDRESS
1508 Elbridge Road
CITY
Harrisburg
Tax Payments and Credits:
1. Tax Due(Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
ISTATE PA
JZIP 17112
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest ¢,~.~ ':~',/~'
E. Penalty
9,257.51
Total Interest/Penalty ( D + E )
4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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.
A. Enter the interest on the tax due.
(3)
(4)
(5)
(5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
9,257.51
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 December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ............................................................................................... [] []
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] []
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.
Under penalties of perjury I dec are that have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. and complele.
Declarat on of preparer other than the personal representative is based on all information of which preparer has any knOWledge, correct
..G RETURN
ADDRESS 22_~ Ree~
DATE ,
Cam_E Hill
SIGNATURE OF P~~,~~ SENTATIVE
ADDRESS 101 S. Market Street
Mechanicsburg
PA 17011
DATE
PA 17055
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempj 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 twenty-one 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% [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%, 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% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1502EX + {~-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE A
REAL ESTATE
FILE NUMBER
Guinivan. Harold Edwin
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 pdce at which prope~ would be exchanged
between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of
survivorshi ~ must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
1508 Elbridge Road, Harrisburg, PA
Property was sold on 4/17/03. A copy of the settlement sheet showing net proceeds
available to the heirs is attached hereto.
TOTAL (Also enter on line 1, Recapitulatior
VALUE AT DATE
OF DEATH
$ 104,971.67
104,971.62
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE E
CASH, BANK DEPOSITS,& MISC.
PERSONAL PROPERTY
Guinivan, Harold Edwin
FILE NUMBER
Include the
ITEM
NUMBER
~roceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorshi
1994 Honda Del Sol
DESCRIPTION
Household furnishings
allfirst Bank
25 S. Charles St., Baltimore, MD 21201-3330
Checking Acct. #0039100057
Waypoint Bank
PO Box 1711, Harrisburg, PA 17105
Checking Acct. #2103020308
Waypoint Bank
Checking Acct. #200037339
TOTAL (Also enter on line 5, Recapitulation) $
must be disclosed on Schedule F.
VALUE AT DATE
OF DEATH
4,685.00
400.00
2,535.16
24,590.50
400.89
32,611.55
(If more space is needed, insert additional sheets of the same size)
REV. 1509 EX * (1-97} ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
Guinivan. Harold Edwirl
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Cheryl L. Kline 220 Reeser Road Daughter
Camp Hill, PA 17011
C
JOINTLY-OWNED PROPERTY:
LETTEF DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Altach DATE OF DEATH DECD'S
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF
VALUE OF ASSET INTEREST DECEDENT'S INTERE$
1. A. 8/5/96 allfirst Bank 20,043.97 50. 10,021.9~c
,Certificate of Deposit
Acct. #87008100943346
2. A 11/1979 Postmark Credit Union 4,014.11 50. 2,007.06
2630 Linglestown Rd.,Harrisburg, PA 17110
Acct. #1206 (Savings and Investment Savings)
3. A 3/3/00 Waypoint Bank
Certificate #2100012624 10,037.70 50. 5,018.85
TOTAL (Aisc enter on line 6, Recapitulation) $
(If mom ~n~¢, i~ n~4,~,~ ;r,~,~,~ ~,~,~*;~,~ ........... 17,047.90
~nal sheets of the same size)
REV-1510 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Guinivan. Harold Edwin
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET ~s ~es.
DESCRIPTION OF PROPERTY % OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE
VALUE OF ASSET INTEREST (IFAPPLICABLE}
1. Waypoint 25,070.27 100. 25,070.2;
Certificate #7000006493
2. MidPenn Bank 10,001.43 100. 10,001.4,'.
Certificate of Deposit #306071316
3. Postmark Credit Union 30,374.79 100. 3,000.00 27,374.7,c
Certificate Acct. #1206
TOTAL (Also enter on line 7, Recapitulation) $ 62,446.49
(If more space ~s needed, insert additional sheets of the same size)
REV-1511EX + (1.97} ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Guinivan. Harold Edwin
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
DESCRIPTION
FUNERAL EXPENSES:
Cremation Society
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s) / EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
AttomeyFees R. Mark Thomas, Esq.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
C~ty
Relationship of Claimant to Decedent
Probate Fees
Accountant's Fees
Tax Retum Preparer's Fees
Verizon
Lower Paxton Township
Merry Maids
Montour
Property clean-up
Allstate
Real estate taxes
Post Office
PPL Utilities
Smoke Alarm
Kohl Brothers Pumping Service
State Zip
TOTAL (Also enter on line 9, Recapitulation)
AMOUNT
45.00
5,000.00
327.00
300.00
125.80
238.80
137.80
683.82
175.00
510.43
1,165.30
34.0O
56.82
235.00
1,827.00
$
10,861.77
(if more space is needed, insed additional sheets of the same size)
REV-1512 EX + (1-97) ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES~_& LIENS
Guinivan. Harold Edwin
FILE NUMBER
Includ
ITEM
NUMBER
unreimbursed medical expenses.
DESCRIPTION
Postmark Credit Union
Central Medical Equipment
West Shore Hearing Center
IRS
TamDot Medical Equipment
TOTAL (Also enter on line 10, Recapitulation)
AMOUNT
3.27
71.55
156.00
212.44
50.00
$
493.2(;
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVAN A f
INHERITANCE TAX RETURN /
~ .~ESIDENT DECEDENT
SCHEDULE
BENEFICIARIES
FILE NUMBER
NUMBER
4o
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a)(1.2)]
Meredith Glazier
1508 Elbrdge Road
Harrisburg, PA 17112
David Glazier
220 Reeser Road
Camp Hill, PA 17011
Melissa Glazier
220 Reeser Road
Camp Hill, PA 17011
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Granddaughter
Grandson
Granddaughter
1/3
1/3
1/3
AMOUNT OR SHARE
OF ESTATE
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART I! - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
RPR ].'7 2003 10:25
^. Serderaent Statement
WARNIN(
D. NAME OF BORROWER:
E. NAM8 OF SELLEr:
F. NAME OF LENDJ~R:
G. PROPERTY ADDR.~S,5:
SETTLEMENT AOE/~T:
100.
Coldwell
:OWER
HP LRSERJET 3200
6. File Numbe~
03-i70
U.S. Department of Housing
% Loan Number
17042-3226
Governor Road, Hershey, PA 17033
1~4.
t05.
112.
o4/17
2,316.
500.48
403.
404.
405.
410.
411.
04/17 500
266.
213.
214.
215.
216.
217.
218.
219.
302. Le~ emou~ icl b borro~
3~33, CASH F~OM BORROWER
.~ FORM long ~iiE~ ~TAT~d E
5LL~R(S] N~W M.~,a. ING ACDREsS: ~
Flat. xpress Se~emcr. t 5y~tcm Prkll~
seller
1,500,0
571.34
2,071.
2,071
513.
514.
515.
$1E.
517.
518.
519.
ELL I"R
Loan
seller
14,22
57:/.3,
104,~71.$2
~/17;2003 at 10~]?
REV.
RPR 1'7 2003 10:25 HP LRSERJET :3200
u.5. DEPARTMENT ~ ~ HOU~iNo ANI) UI~BAN DEVi~LOpMi]NT
~ CB
%
%
Fil-.. Number: 03-170
BORROWER'S
FUNDS AT
SETTLEMENT
p.3
SELLER's
FUND8 AT
SETTLEMENT
810.
$
107.~3
1111.
1112.
to CP$S
to Cash
4.00
953 .!
1203
1204.
1205.
1303. Final ,Sewer
1304
1306.
:~tax
1307.
130~.
'400.
Fhl~Express Se~tJement System P.'~nted
$1,
43 .S0
Paxton Author/
of
10.00
125. O0
HUD CERTiFJ~ATJON OF ~JYER AND SI:L LER 2,3 3. 6 · ! 4,2 2 3 · & 4
APR 17 2003 10:25 HP LASERJET 3200
U.S. D~A]~T~, : ~IOl~lNO AND ~AN D~VELOP~T
File Number: 03-170
PAGE3
1503.
1504.
If~05.
500.
1507
150~.
1510.
1511.
1~14.
15'75.
'~51e.
1517
to CB ]'Ico. eeale Be]:'vLcel Gl~oup' Znc..
BUyer
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD 002562
THOMAS R MARK ESQUIRE
101 S MARKET STREET
MECHANICSBURG, PA 17055
........ fold
ESTATE INFORMATION: SSN: 204-03-6516
FILE NUMBER: 2103-0405
DECEDENT NAME: GUINIVAN HAROLD EDWIN
DATE OF PAYMENT: 05/1 3/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 02/21/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $9,485.65
REMARKS:
TOTAL AMOUNT PAID:
R MARK THOMAS ESQUIRE
$9,485.65
SEAL
CHECK//' 1945
INITIALS: JA'
RECEIVED BY.'
DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
MAY 23, 2003
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
D E FIA,~Tb1ENT 280604
HARRISB~; PA t7128L0601
'03 JUN -2 /~11:17
Telephone
717 787-3930
Dear Register of Wills:
Re:
Estate of HAROLD E. GUINIVAN
File Number: 2203-0049
County: DAUPHIN
Date of Death:02/21/02
The subject decedent legally resided in DAUPHIN County as of the date of death.
Accordingly, you are authorized to cancel file number 2103-0405. All matters concerning this
estate should be maintained under DAUPHIN County File Number 2203-0049.
All original Inheritance Tax documents for the subject decedent should be forwarded to
the DAUPHIN County Register of Wills; however, you may wish to retain a copy, including
photocopies of all receipts for the collection of Inheritance Taxes in the subject estate which
have been issued by your office.
Please contact me at the telephone number above if you have any questions.
Sincerely, ../ .,
................ 5;'
. -:
":';,~. ,:...' ..'"'" ''~ .... ' ..,.'//'~.. __
Claudia Maffei, 8uperVi~ ....
Document Processing Unit
Inheritance Tax Division