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Home My WebLink About10-21-11J 1505610145 REV-1500 ~``°'-'°' PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes DEPARTMENT OF REVENUE County Code Year File Number Po sox z8osol INHERITANCE TAX RETURN .~ Harrisbur , PA 17128-0601 RESIDENT DECEDENT ^~ I (J~ +/~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 199-38-6424 10172009 02071957 Decedent's Last Name Suffix Decedent's First Name MI Warrick Carl (If Applicable) Enter Surviving Spouse's Information Below L' Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE FILL IN APPROPRIATE BOXES BELOW REGISTER OF WILLS Q 1. Onginal Retum Q 2. Supplemental Retum 3. Remainder Retum (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of d prior to 12-13-82) Q 5. Federal Estate Tax Return Required eath after 12-12-82) 0 6. Decedent Died Testate (Attach Copy of Will) Q 7. Decedent Maintained a Livin Trust 9 0 8. Total Number of Safe Deposit Box 0 9. Litigation Proceeds Received Q (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death es Q 11 El ti between 12-31-91 and 1-1-95) . ec on to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRE Name CTED TO: Daytime Telephone Number Robert G. Frey 7172435838 REGISTER _ MILLS USE QNLY First line of address '_, ' , I_ ~ . ~ ~ , ' , `~ , ~-~, 5 South Hanover Street - Second line of address - ,1 City or Post Office State ZIP Code ,.,.J :_ "SATE FILED ' r 1 Carlisle PA 17013 ' <.'; T, Correspondent's a-mail address: r f rey@ f reyt i 1 ey . com 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 corn lete. Declaration of re arer other than the ersonal re resentative is based on all information of which re arer has an knowled e. SIGNATURE OF PERSON RESPONSIB FOR FILING RETURN ,r~ . ,, ~ ATE r ADDRESS ~ ~ ~ ` SIGNATURE OF Pg ER HAr~REfsR~ ITATI~v E ADDRESS ' 5 South Hanover Street, Ca sle, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 L. 1505610145 `~ 1505610145 /l '1 ,` J 1505611280 REV-1500 EX (FI) Decedent's -vame: CARL L W A R R I C K RECAPITULATION Decedent's Social Security Number 199-38-6424 1. Real Estate (Schedule A) ....................................... .. 1. 0.00 2. Stocks and Bonds (Schedule B) .................................. . . 2. 5660.30 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .. 3. NON E 4. Mortgages and Notes Receivable (Schedule D) ...................... . . 4. NONE 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .. .. 5. 7411.00 6. 7. Jointly Owned Property (Schedule F) OSeparate Billing Requested ..... Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested ..... .. 6. N 0 N E . . 7. NONE 8. Total Gross Assets total Lines 1 throw h 7 ............. . ~~~~~~~~~~ ~~ 8. 13071.30 9. Funeral Expenses and Administrative Costs (Schedule H) .... . .......... . 9. 1278.00 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ........... . 10. 61486.00 11. Total Deductions (total Lines 9 and 10) ..... . ...................... . 11. 62764.00 12. 13. Net Value of Estate (Line 8 minus Line 11) ............ . ............. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ..................... . 12. . 13. -49692.70 0. D0 14. Net Value Sub'ect to Tax Line 12 minus Line 13 .......... . TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 14 - 4 9 6 9 2. 7 0 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 D 16. Amount of Line 14 taxable 15. D . D D at lineal rate X .0 4 5 17. Amount of Line 14 1s. D . 00 taxable at sibling rate X . 12 18. Amount of Line 14 taxable 17' D , D D at collateral rate X . 15 18. 0.00 19. TAX DUE ....................................................... 19. 0.00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611280 1505611280 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number 199-38-6424 STREET ADDRESS CITY Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest STATE Total Credits (A + B ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. ZIP 17013 (1) 00 (2) 0.00 (3) (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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: a. retain the use or income of the property transferred ................................. Yes No 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-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 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(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+ (01-10) Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT w~.~~~..vr. FILE NUMBER: Carl L Warrick II 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 compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM Attach a copy of the settlement sheet if the property has been sold. NUMBER Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE DESCRIPTION OF DEATH 1. House and Lot of ground, 1391 Waggoners Gap Road, Carlisle, suspended pending sale of real estate TOTAL If more space is needed, use additional sheets of paper of the same size. enter on Line 1, Recapitulation.) ~ $ REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Carl L Warrick II All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM JMBER DESCRIPTION 1. 92 shares of PPG, 61.525 average of Friday and Monday prices TOT line 2 VALUE AT DATE OF DEATH 5,660 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (11-10) SCHEDULE E Pennsylvania CASH BANK DEPOSITS f~ ~A //.~ DEPARTMENT OF REVENUE ~ f `~'~ M IS\+• INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: Carl L Warrick II FILE NUMBER: 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 wt3tt~ DESCRIPTION VALUE AT DATE OF DEATH 1 1992 Dodge Dakota, appraisal attached 2 Satum 200 3 Trailer 500 4 Exterior wood stove 100 5 Americhoice Federal Credit Union 5,000 6 Personal property. Auction Statement attached 270 1,341 TOTAL (Also enter on line 5, Recapitulation) $ I 7 411 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 Carl L Warrick II Decedent's debts must be reported on Schedule I. ITEM DUMBER A. FUNERAL EXPENSES: 1. B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zlp 2. Attorney Fees: 750 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: 244 5• Accountant Fees: 6. Tax Return Preparer Fees: 7. Advertising in the Sentinel and Cumberland Law Journal 284 TOTAL (Also enter on Line 9 Recapitulation) I $ 1 278 If more space Is needed, use addltlonal 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 Carl L Warrick II Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Financial Recoveries, collection agency for Bryn Mawr Rehab Hospital 54,650 2. Physicians of Rehab 132 3. Hershey Medical Center 936 4. West Shore EMS 1,422 5. Carlisle Regional Medical Center 100 6. Transcare Ambulance Corp 1,945 7. Cumberland Goodwill 1,354 8. Alexander Springs Emergency Physicians 408 9. Special Events Medical Services 113 9. Radiology of Main Line 426 TOTAL (Also enter on Line 10, Recapitulation) I $ 61 486 If more space is needed, insert additional sheets of the same size. DAN HERSHEY Aiic~rrnrr C~n~rr~~ t t ~ SELLERS NAME ~~. ~, .-;. ... f: ~ ,, , ,,. .. _ DATE ADDRESS ~,~~ ~ ~ .~ ~.... .. _. ' PHONE OTHER ~ r ~e. « ~;~" ~,- AUCTIONEER % AUCTION DATE/LOCATION ~.~' ~`~ ~-~ `' CLERK DESCRIPTION OF MERCHANDISE ~. ,, . ,: ,R ~., ' :d' ~ ~ .~.,~ . ~~ ;.~i .. ~ .., °~ ~ _ LI ~ ~, - ~, d { ;,, ,:~ t ~, r. .. ... . v -. t . ~ ~ 1a ~ .. ~ ~ . ~ f f` ~ ~ ~~ , S r ~~ ~,~~',, yr . I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized representa- tive of the merchandise, goods and/or property and have good title and the right to sell and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to hold harmless the Auctioneers against any claims of the nature referred to in this agreement. Trash fee applied if applicable. _~.. rs ... .. ~ f° f . ,. .. AUCTION SIGNATURE SELLERS SIGNATURE Total Sales (Clerking Tickets Attached) $ ~ f~ • ~ j~s . `, Less Sale Expense: ,,. S {„~ rt"rti, / ~ C E $ ' ~' % Commission Auctioneer ~ _ Commission Clerks $ OTHER: TOTAL SALE EXPENSE DEDUCTED $ 790 West High Street Carlisle, PA 17013 (717) 532-4647 Steve Ege 717-385-5438 Cell Chris Bream 717-226-1920 Cell SELLERS NET $ AUCTION SIGNATURE Elickman's Auto Ser~Tice f417 Ti-indle Rd Car-lis1e, Pa 1701; "Ju st B zing It" Z'trebsite: w~;w,ra.hic~-mansaut~a.com General Repairs Pa State Inspection Fa Emission Testing Emission Repairs Electrical &['Vizang 1992 Dodge Dakota. Description Pa State Inspection & Emission Test VEHICLE WAS ASSESED VALUE IS ABOUT $200.00 NEEDS FOR inspection FRONT AND REAR BRAKES FRONT BRAKE ROTORS BOTH REAR TIRES BRAKE LINE HOSES IN FRONT & POSSIBLE CALIPER EGR TUBE TO MANIFOLD EXHAUST LEAK AT HEADER BODY CANCER UNDER LEFT SIDE REAR Repair Invoice Date Invoice # To: 7/23/2010 4228 'e Warrick 1447 Goodyear Rd. Gardners, Pa 17324 Amount Total $o.oo