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Home My WebLink About12-9-11 (2)J 1505610105 REV-1500IX(a2-xx)(Fp OFFICU\L USE ONLY PA Department of Revenue pertrxsylvania County Code Year Fle Number Bureau of Individual Taxes ~~~aF..~~E Po Box z8o6oi INHERITANCE TAX RETURN Harrfsburq PA iTiz8-o6oi RESIDENT DECEDENT _ _ ZI ~ I O~ ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death lAMDDYYYY Date of Birth MMDOYYYY 195-16-3316 06/0512011 09/07/1921 Decedent's Last Name URICH Suffix Decedent's First Name LENORE MI K (tf Applesable) Enter Surviving Spouse's Intormatlon Below Spouse's last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS ~~~ INUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OPALS BELOW O 1, Original Retum O 2. Supplemental Retum O 3. Remainder Retum (Date nt Death. Prbr to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromtse (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) Old 8. Decedent Died Testate O 7. Decedent Malntak-ed a Living Trust 0 8. Total Number of Safe Depostt Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Lttigatbn Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Electlon to Tax under Sec. 9113(A) BeMreen 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFtDENT1AL TAX INFORMATION SHOULD BE OtRECT'ED Tn: Name Daytime Telephone Number RONALD B ZEiGLER (717j 319-60A5 First Line of Address 506 N SECOND STREET Second Una of Address City Or Post Office WORMLEYSBURG State ZIP Code PA 17043 REGISTER OF WILLS USE ONLY C-~ e::a ~~ ~ c-~ .~ ~ ~ ~ 1 ~~,' }}~~ jj ~ ' ~D OA -~ ..,,1 `.+.9 -"~,'~ a <'-: r's;t-, ( i~j t «~ r" ~.~ T_~~ lr] .r.,r Correspondent's e-ma6 address: Under penalties of perjury,) declare that I have examined this return, including atxxxnpanying schedules and statements, and to tltta best of my knowledge and belief. K is true, coned and ~mpleta. Declaration of preparer other than the personal representative is based on all infortnaUon of which preparrar has any knowledge. SIGNATURE OF PERSQN Itc.SPONSIBLE F~2 FILING URN D^TE ~ _ _ OF NREPARE OTHER THAN REPRESENTATIVE ~" ~ DATE ... ~ ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J J 1505610205 REV-1500 EX (FI) Decedents Social Security Number Decedents Nama LENORE K URICH 195-16-3318 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0•~ 4. 9 9 ( ) ........................... Mort a es and Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)... , ... 5. 6,904.41 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6. 30,000.00 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property 0 ~ (Schedule G) O Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 36,904.41 9. Funeral Expenses and Administrative Gusts (Schedule H) ................... 9. 354.16 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) ............... 10. 1,754.75 11. Total Deductions (total Lines 9 and 10) ................................. 11. 2,106.91 12. Net Value of Estate (Line 8 minus tine 11) .............................. 12. 34,795.50 13. Charitable and Governmental BequestslSec 9113 Trusts for which 0 ~ an election to tax has not been made (schedule J) ........................ 13. • 14. Net Yalue Subject to Taz (Line 12 minus Line 13) ........................ 14. 3'4.7~5•~ TAX CALCULATION -SEE INSTRUCTION8 FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Lirre 14 taxable at lineal rete x .0 45 34,795.50 1ti. 1 ~~•~ 17. Amount of Line 14 taxable at sibling rate X .12 17. 18, Amount of Line 14 taxable at collateral rate X .15 18. i9 1,563.80 19. TAX DUE ......................................................... . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT r~ Side 2 L 1505610205 1505610205 REV-1502 EX+ (11-O13) Pennsylvania SCHEDULE A DEFMRTMENT OF REVENUE INFIERIfANCE Tax RETURN REAL ESTATE RESIDENT DECEDENT ESTA1~ OF FILE NUMBER LENORE K URICH 21-11-0762 Afl real property owned sokiy or as a tenam in common must be reported at fair market value. Fair market value is defined as the price at which property If more space is needed, inert additional sheets of the same size. ~-i5o3 ~+ (7-il) Pennsylvania DEPARTMENT OE REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT scNEOU~ s STOCKS & BONDS ESTATE OF FILE NUMBER LENORE K URICH 21-11-0762 All properly jointly owned witlr right of survivorship must be disclosed on Sdreduk F. If more space is needed, insert additional sheets of the same size ~~~ REV-,~ EX+ cs-sa> f1-CNEp1~I.E C CLOSELY HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR IN RESTDENTEDECEDENTRN SC1LE-PROPRIETORSHIP E8TATE OF FEE tAt1~BER LENORE K URICH 21-11-0762 Schedub Gf or C~ (including aq supportlng irrr(ormetion) m>st be atEedred for each cbsely-tNlld t~orporaiiodpertnership interest of the decedent: aihsr than a sole-proprietorship. See insiruciiorrs for the supporling infomretion ib be submr7ted for sok-ploprisEorsh~s. (If mae speoe is needed, insert add~lortat sheets of itre same size) REV-1507 EX+ (6-98j scNEOU~ o COMMONWEALTH OF PENNSYLVANIA MORTGAGES 8c NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT E8TATE QF ---------- - FILE NUMBER LENORE K URICH 21-11-0762 /lM properly joMtlyo~nud wHh right of survivorship must be dh~oloaed on Eohsdule F. (y more spans is needed Insert adddiaced sheets d dte same a¢e) REV-1508 EX+ (li-io) pennsylvania SC~IEa1~iLE E DEPARTMENT Of REVENUE CASH, BANK DEPOSITS 8e MISC. Il~NiERrrANCE TAX RETURN PERSONAL PROPERTY RESiDEHT DECEDENT ---- - - ESTATE OF: FILE NUMBER: LENORE K URICH 21-11-0762 lndude the proceeds of litigation and the date the proceeds were received try the estate. AI! property jointly owned with right of swvivo~ship must 6e disclomed on Schedule F. !f mac space is needed, use additional sheets of paper of the same size. REV-rig EXt (oi-iol pennsytvania bEPARTMENT OF REVENUE IIMERAANCE TAX RETURN RES[DEIR DECPDENT SCN~di1LE F 70INTLY-0WNED PROPERTY ESTATE OF: FILE 1~lMBER: LENORE K URICH 21-11-0762 If an cant became jobNllt owned v~hin one year oi: the daoedenYs dabs of deatll, R moat be r~eporbed on Shcedule ci. SURYMNG 3DINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A• RONALD B ZEIGLER 506 N SECOND STREET,IMORMLEYSBURG, PA SON 17043 8. C. ]diNTLY OWNS PROPERTY: m>M NUFD6l tETiBe IOR p-RE WIDE ]QNT DESCRIPTION Of PROPERTY DICLIDE NAIE of FDIIINQAL DlSiIIUitDN AID aUpc ALCDIR(f NUNBBt oR SIIBtAR IDBITIFYING NIMBBt. A7TAQ1 DEID FOR 70U1n.Y HB.D REAL 6TATE DATE OF o6lTH VALUE aF ASSET 'x DF Dg,'®PiTS Hf1[REST DATE ~ DF~RH W1t11E DF I. A, d4ro9/93 508 N 8ECOND STREET. WORMLEYSBURG, PA 17043 60,000.00 50 ......30,000.00 TOTAL (Also enter on line b, Recapitulation) ~ ~ ~~~~~ if more space is needed, use additional sheets of paper of the same sine. REV-1510 EX+ {08-09) pennsytvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INI1ERiTANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER LENORE K URICH 21-11-0762 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 IHCUIDE THE NAME OF THE TRAlSFEREE, THEIR REUUIDNSHIP TO DECEDEHt AND THE DATE OF TRArLSFER. ATTACH A LDPY OF THE DEED FOR REAL ESTATE DATE OF DEATk VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICiBL TAXABLE VALUE 1. NA 0.00 0 0.00 0.00 TOTAL (Also enter on Une 7, Recapitulation) ~ 0.00 If more space is needed, use additional sheets of paper of tiTe same size. REV-1511 EX+ (10-09) ~`~'i pennsytvania DEPARTMENT OF REVENUE IrMfERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPEN5E5 AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMQUNT A. FUNERAL EXPENSES: I' MAJORITY OF FUNERAL EXPENSES WERE PREPAID - REtuIAtNING EXPENSES 115.00 B. 1 2. 3. a. 5. 6. ~. ADMINISTRATNE COSTS: Personal Representative Commissions: Name{s} of Personal Representative(s) Street Address City State ZIP Year{s) Commission Paid: Attorney Fees: Family Exemption: {if decedent's address is not the same as daimant`s, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: LEGAL. ADVERTISEtii~NT 143.50 95.66 TOTAL (Also enter on Line 9, Recapitulation) ~ 352.18 if more space is needed, use additional sheets of paper of the same size. REV-1512 EXt (12-08} Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES $~ LIENS RESIDENT DECEDENT ESTATE OF FIlE NUMBER LENORE K URICH 21-11-0762 Report debts incurred by the decedent prior to death that remained unpaid at the daft of death, indudiny unreimbursed medical expenses. 1 • SOVEREIGN BANK CHECKS WRITTEN BEFORE DEATH AND CLEARING AFTERWARD 822.50 2 `PSECU VISA CREDIT CARD -CHARGES MADE BETWEEN 051'02111 AND O6J01/11 637.56 3 PSECU VISA CREDIT CARD -CHARGES MADE BETWEEN 06102/11 AND 06103N 1 206.69 4 AZIZKHAN INTERNAL MEDICINE ASSOCIATES 88.00 TOTAL (Also enter on Line 10, Recapitulation) $ 1,754.75 lF more space is needed, insert additional sheets of the same size.