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04-11-12
Pa. O.C. Rule 6.12l/STATUS REPORT REGISTER OF WILLS OF '~~~ `''''~~~~h,k~.~.-~~-=L~ COUNTY, PENNSYLVANIA :, .~ Name of Decedent: ''^ ' G~ --~ %~-~-s-~--G', `„ ~^- ~. Date of Death: 3/i~/wia l ,. File Number:_. ~~c. %~~ ~" -- ~' Sri ~ Pursuant to Pa. O.C. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete :.................... ~I'es ^ No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is YES, state the following: /~ a. Did the personal representative file a final account with the Court? ....... Yes ^ No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account ~_ informally to the parties in interest? ............................... ^ Yes ^ No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Dnte / t ~ 7 ._' ~ ~~ ~ '! r; ,1 ems, l.' lti~.. f ~` t ~ r ~'Z' ~vv'~L~ ~.. Z-', ~/i`j~o ~ ` Stgnnture Af Person Filing this Form ~!~- Capacity: ~rsonal Representative ^ Counsel , ' _..... . `~-~% '-' Ly _ ~ t--; Nnme afPer~n Fi l m this Form - C ~-7 ~ ~-- f ': ~ ~`-~ Rf' ~' ~ ' ~,~ ~ ~ - t , -- ~ C~~ ~ _ j. ~- `~ L.:' Addres ' ~f ~ ~~ r f]_ .~ G ', U Telephone Form RW-/0 rev. /0.!3.06 ~~ ;i ~.~; ~. ~'~~"1~. _ ~-11.;7_. ~~ r .~_1.. •.. _. i (~ ..~~_. .. ' ~'.1_...!J i_ ~. °~i? ~c ~? i 1 t ~F I~~ 27 In Re: Estate of RUSH JOSEPH F II CLERK., nr ,~, ORPH~'J`~ ~~~~>,)RT ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2010-00325 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: MCDONOUGH-WITTE MARGARET Counsel for Personal Representative: Date of Decedent's Death: 3/11/2010 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given that you have ten (10) days to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will request that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 4/2/2012 Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File ~ ~,[ ~~ ~~,, ~~s - ~~ / ~ `~ ,~- ~~- ~~ ~ G NOTICE OF INHERITANCE TAX BUREAU OF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE INHERITANCE TAx DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX PO BOX 28060] HARRISBURG PA 17128-060] MARGARET MCDONOUGHWITTE PO BOX 22 3283 DURHAM RD MECHANICSVILLE PA 18934 Pennsylvania ~~ `~r~~ DEPARTMENT OF REVENUE ~: REV-1547 EX AFP (12-10) DATE 07-12-2011 ESTATE OF RUSH JOSEPH F DATE OF DEATH 03-11-2010 FILE NUMBER 21 10-0325 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 09-10-2011 (See reverse side under Objections ) Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ---- ---) RETAIN LOWER PORTION FOR YOUR RECORDS -------------------- -------------- ~ REV-15 --------- 47 EX AFP C12-10) NOTICE OF INHERITANCE TAX -------------- APPRAISEMENT, ALLOWANCE _ OR - DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF: RUSH JOSEPH FFILE N0.:21 10-0325 ACN: 101 DATE: 07-12-2011 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 00 2. Stocks and Bonds (Schedule B) C2) . ,p0 NOTE: To ensure proper credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) 00 of this form with your 5. . Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6,711.85 tax payment. 6. Jointly Dwned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 8. Total Assets (B) __ 6 , 711.85 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (y)_ 9,988.9 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions C11) 9,988.92 12• Net Value of Tax Return (12) 3,277.07- 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00 14. Net Value of Estate Subject to Tax (14) 3,277.07- NOTE: If an assessment was issued previously, lines I4, 15 and/or 16 17 18 and 19 il reflect figures that include the total of ALL , , returns assessed to date w l ASSESSMENT OF TAX: . 15. Amount of Line 14 at Spousal rate (15) .00 X 0 0 - 00 lo. Amount o` Linz 14 taxable at Lir.~al/Class A rate (15) 00 x 045 = . 17 A . .00 . mount of Line 14 at Sibling rate (17) n 0 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due TAX CREDITS (19)= .00 : PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX PAYMENT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE ,pp * IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. J 1505610101 REV-1500 ex t°'-'°) PA Department of Revenue Pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes PO BOX z8o6ot °"""'"`"~°`"`"`""` Coun Code Year INHERITANCE TAX RETURN N Fiie Number Harrisburg, PA 1'7iz8-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYW ~°~3 3Q 9~'~~ v ii ~~o~ d o~~~"/q 3q Decedent's Last Name C (f J Suffix Decedent's First Name MI J,p 5E ~~ (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 ® 2. Supplemental Return '~ 3. Remainder Return (date of death ~ 4. Limited Estate ® prior to 12-13-82) 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ® (Attach Copy of Will) 7. Decedent Maintained a Livin Trust g 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) ® 9. Litigation Proceeds Received ® 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec 9113(A) b . etween 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name f~ A ~ 6 ~- ~2 ~ ,t~ G ~ Daytime Telephone Number o ~ rJ ' ~ -- - ~ ` " , . ,~-tr.% r ? U ? ~ ° T ~ ~ ! c~ ~ ~' :~ ~ ~S t?EGISTER OF +AJILLS USA OP~iLY First line of address (~v IJ u~ ~~ Second line of address 3~5~ ~~~~~~~ K~ City or Post Office f'~i ~ C° tt ~i /,.,~ / e s U / ' ~ L ~ State ZIP Code t~ J~ / ~ ~ O.ATE FILED 3 `~ Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statementV~ s, and to the bes~ l~-tot my knowledge and belief, it is true6correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG~A~TURE OF PERSON RESPON IBLE FOR ILING RETURN , ~~ '~""" ~ - """-a-~^ '~ ~~ DA ~~, ~. - i I /~' a --- z..-,-.s~-. ~~ /.,:/~. _ . _,.._ -,_T-_.r.~. SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~ _..-..-__._.w.~r.. l` DATE T _..- ADDRESS ~-°,. _-. ._,.... _r .--f-_ r..__ ...=.~G__.. PLEASE USE ORIGINAL FORM ONLY _ . Side 1 1505610101 1505610101 J 1505610105 REV-1500 EX '~` (' Decedent's Social Security Number Decedent's Name: / l~ J C ~~ ~. ~ (~ry~ / ~ ~ '~, ~ ../ !~ ~ RECAPITULATION t 1 . Real Estate (Schedule A) ...................... .................... ... 1. ~' ' p; U 2 . Stocks and Bonds (Schedule B) ......... ...... . 2. _ ;. d 0 ,' 3. Closely Held Corporation Partnershi or Sole P i , p - ropr etorship (Schedule C) .. ... 3. ;, Q, 4. Mortgages and Notes Receivable (Schedule D} .... 4 .................... ... . , ~~! 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5 ~ ~ :. ~ . ~ ~ l 6. Jointly Owned Property (Schedule F) ®Separate Billing Requested .. 6 e' - --' 7. .. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ... . ~- ~>: (Schedule G) ®Separate Billing Requested..... ... 7. ~ Gw, 8. Total Gross Assets (total Lines 1 throw h 7 % --~ ~ ` ~ ~ v 9. Funeral Ex enses and Administrative Costs (S~hedule H) p ................ .. 9. .l~ ` C/ "" ~ ~ ~! ~/' Z 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 , ~ ............ .. . ~ , ~ . 11. Total Deductions (total Lines 9 and 10) ............................... .. 11. Q ,... ~l ~~ ~ G Z, ( 7 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 '' ..:. .. . ~ U 14. Net Value Subject to Tax (Line 12 minus Line 13) 14 .-~____. ___.___~_._- ____~. r G C, ~ TAX CALCULATION -SEE INSTRUCTION S FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, cr transfers under Sec. 9116 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 . 18. 19. TAX DUE ........................................................ . 19. .__.~-_ -_ -.` ._~--- ~. _ ; :: ~ ~Cj', 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 15056101,05 ._ REV-1500 EX Pepe 3 Decedent's Complete Address: STREET ADDRESS aTY Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments __ B. Discount 3. Interest oa 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 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (4) it ~,~- J-- -- (5) b(i _ 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: 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 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. - ... _r :,~ ~ :... ,. 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(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 deceden~s siblings is 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual ~,vho has at least one parent in common with the decedent, whether by blood or adoption. ,~~ ~t ~o ~v /7d~ ~ - ss~a_/ File Number STATE n~ (1) ZIP /70 55-5~`-~.~ ., o-o Total Credits (A + B) (2) a ~ REV-1502,EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT tJlAlt OF FILE NUMBER r~~r~~ ~r ~••~~~~ ~~~r~y ~~ es a cenan- 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 prOperlV WItICh IS IOIrItIV-OW11Pd with rinhf nr m~.vh~n~el.in .....~~ ti., a~...,~,..._~ __ ~_~_~__._ ~~~ civic apaca is neeueo, msen aoamonal sneers of the same size) REV-1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS tS IATE OF FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM _ NUMBER DESCRIPTION VALUE AT DATE OF DEATH ,~©~~ _ TOTAL (Also enter on line 2 Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV-1504 EX+ (1-97) SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN RESIDENT DECEDENT SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporationlpartnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER DESCRIPTION VALUE AT DATE OF DEATH ~o ~~ TOTAL (Also enter on line 3, Recapitulation) I $ (If more space is needed, Insert additional sheets of the same size) REV-1505 EX+ (6-98) SCHEDULE C-1 COMMONWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATE INHERITANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT 4. wiN~~ yr 1. Name of Corporation Address City 2. Federal Employer I.D. Number 3. Type of Business FILE NUMBER '`~ State on Incorporation Date of Incorporation State Zip Code Total Number of Shareholders Business Reporting Year ProducUService STOCK TYPE VotinglNon-Voting TOTAL NUMBER OF SHARES OUTSTANDING PAR VALUE NUMBER OF SHARES OWNED BY THE DECEDENT VALUE 4F THE DECEDENT'S STOCK Common _ Preferred $ Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? ................................. ^ Yes ^ No It yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ................................... ^ Yes ^ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date _ Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? ..................................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? .................... ^ Yes ^ No It yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. (If more space is needed, insert additional sheets of the same size) REV-1506' EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C-Z PARTNERSHIP INFORMATION REPORT ESTATE OF FILE NUMBER 1. Name of Partnership _ Date Business Commenced Address Business Reporting Year _ City State Zip Code _ 2. Federal Employer I.D. Nurn~ f 3. Type of Busine~s~ ProducUService 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. PARTNER NAME- PERCENT OF INCOME PERCENT OF OWNERSHIP BALANCE OF CAPITAL ACCOUNT A. B. - C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................. ^ Yes ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent self or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No It yes, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedent's death? ...... ^ Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? ....................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedent's death? ................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .................................... ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • ~- ~ ~ ~ A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addresses and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. REV-1507 EX+ (t-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE D MORTGAGES 8 NOTES RECEIVABLE FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. C/ ~~ VALUE AT DATE OF DEATH TOTAL (Also enter on line 4, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) R,EV~ 1508 EX . IY97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, 8t MISC. PERSONAL PROPERTY FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned wkh the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ~t1 E./~l~'~f~'~/~.f `.~,~~~~ ~v fill ~ ~~ ~~f ~/~~ ~~o~ ~~ ~'~S ~C~U ®` UCH Ej) EjC/! GJ ~ -~ ~-~~2~ ~ ~-~ ~ f TOTAL (Also enter on line 5, Recapitulation) ~ $ ~' ~(~' ~~ (Ii more space is needed, insert additional sheets of the same size) JOSEPH F RUSH Balances Account # 1661224946 Beginning$alance $5 613.39 Current Balance $6 408 85 Deposds/Credits + $2,311.62 Average Daily Balance ~~ 5R7 qa Interest 16' Paid'this Period * $ 0:05 Annual Percentage Yield. Famed 0:01°1° Earned this Period $ 0.05 Paid Last Year $0.50 Paid Year-To-Date $ 0.13 'The interest earned and the interest paid may differ depending on when interest is credited to your account. Service Fees -Itemized Date # Transactions Fee Total 'MONTHLY MAINTENANCE FEE __ 03!18110 1 '' 10.00 _ i$1000 , DIRECT DEPOSIT DISCOUNT 03/18/10 1 -10.00 - $10.00 Total 50.00 Checks Posted Check # Date Paid Amount Reference _1065 03/08 __ _ $660.00 990263695 995004' 02/19 $52 00 634863970 4 Check(s) Posted = $888.86 An asterisk ("j indicates a skip in sequential check numbers. Account Activity Date Description Check # Date Paid Amount Reference 995009'` Q3/17 _ _ $124.86 995478560 995011' 03/18 $52 00 634540240 An (E) indicates check was converted to an elecironic item. Additions Subtractions Balance 02-19 Beginning Balance $5,613.39 02-19 CHEEK 995004 $52.00_. $5,561:39. 02-19 CHK CARD PUR 339637 KARNSQUA KARNSQUALIT $31.88 $5,529.51 MECHANICSBURGPA 02-22 CHK CARL? PUR 321653 DELLSALE DELLSALES&S $113.40 $5,416.11 866-393-9460.TX 02-22 PUR W/CSH BK310713 WEISMARK 5140SIMPSON ~ $75.38 $5,340.73 MECHANICSBUR PA 02-23 CON1M OF PA UCD UCBENEFITS FEB-10 $50:00 $5,390:73`: 320525 02-23 CHK CARD PUR 064192 MECHANICS MECHANICSB ~ J $29.25 J $5,361.48 MECHANICSBURGPA 02-24 US TREASURY 303 SOC SEC 022410: ~ $1,557:00 ' $6,918:48': A SSA POS PURCHASE 703745 18.05 $6 900 43 MECHANICSBUR PA 02-24 CHK CARD PUR 0561.15 CLASSICD GLASStCDRYC $11:07 $6 889:36, MECHANICSBURGPA' , 02-25 PUR W/ CSH BK069283 KARNSOUA 4870CARLISL $67.22 76,822.14 MECHANICSBUR PA 03-01 EDS RETIREMENT P PN PMTS/CC MAR 10 $52.57 $6;874.1 F64098MJG/10060 03-01 PUR W/ CSH BK401170 WEISMARK 5140SIMPSON $76.11 $6,798.60 MECHANICSBUR PA 03-01 CHK CARD PUR 705102 lNFOFREE 1NFOFREECRE $24.95 $6,773.65 INFOFCR.COM CA =~c ~overei~n ~ Santander Account Activity (Cont. for Acct# 1661224946) Date Description Additions Subtractions Balance 03-02 UNITED WATER ONLINE PMT 100302 $14.28 $6 759.37 CKF419732955POS , 03-03 COMM OF PA UCD UCBENEFITS MAR-10 $602.00 $7,36.1.37: .866194 03-03 PUR W/ CSH BK746162 WEISMARK 5140SIMPSON $64 89 8 MECHANICSBUR PA . $7,296.4 03-05 GHK CARD PUR 341363 INFOFREE INFOFREECRE $14.95 $7;281:53 INFOFCR.COM CA 03-08 CHECK 1065 $660.00 $6,621.53 03-09 COMM OF PA UCD UCBENEFITS MAR-10 $50.00 ' $6,671;53 866194 03-15 CHK CARD PUR 464454 EQUIFAXC EQUIFAXCONS $12.95 $6,658.58 866-640-2273 GA 03-16 CHK CARD PUR 152881 THESENTI THESENTINEL $12.92' $6,645:66 717-2432611 PA 03-17 CHECK 995009 $124.86 $6,520.801 03-18 UGI UTILITIES ONLINE PMT 100318 $60.00 $6,460.80 CKF419732955POS 03-18 CHECK 995011 $52.00 $6,408.80 03-18 INTEREST'CREDIT ` $0.05 - $6,408:85 03-18 Ending Balanr•.e _ _ . _ _ IN CASE OF ERRORS OR QUESTIONS ABOUT YOUR ELECTRONIC TRANSFERS CALL YOUR CUSTOMER SERVICE CENTER AT THE NUMBER SHOWN ON THE TOP OF YOUR STATEMENT OR WRITE TO THE BANK FOR DEBIT CARD ISSUES: Soverci~,n Bank Attn: Debit Card Services MAI MB 301-06 P.O. BOX 841003 Boston, MA 02284-1003 FOR ALL OTI IER ISSUES: Sovereign Bank Attn: Client Kelations 10-42 I -C R I P.O. BOX 12646 READING. PA 1 96 1 2-2646 Please contact us if you think your statement or receipt is wrong or if you need additional information about a transfer on the statement or receipt. We must hear from you no later than 60 days aRer we sent you the FIRST statement nn which the error appeared. • 'Dell us your name and account number. • Describe the error or the transfer that you are unsure about and explain as clearly as you can wiry • "fell us the dollar amount of the suspected error. you believe there is an error or why you need further information. If you tell us orally, we may require you to send your complaint or question in writing within 10 business days. We will promptly investigate the matter and call or write to you with an answer within 10 business days (10 calendar days in Massachusetts). If we need more time, we may take up to 45 days to investigate your complaint or question. If we do, we will credit your account within This ]Q-day period for the amount ~rou think is in error, so you wdl have the use of the money during the time tt takes us to complete our investigation. I1 we ask you to pui your complaint or question m writing and we do not receive it within 10 business days, we may choose not to credit your account. For errors involvingg new accounts, point of sale purchases or foreign transactions, we may take up to 90 days to investigate your complaint or question. For new accounts we may take up to 20 business days to credit your account for the amount you think is in error. We will tell you the results of our investigation within 3 business days after completing our investigation. If we decide there was no error, we will send you a written esplanation.JYou may ask for copies of tre docwnents we used in our im~estigauon. Important information about your Sovereign Debit Card The nehvorks through which some of your Sovereign Debit Card purchases are processed have begun allowing merchants to process ))'our purchases without either a signature or a PIN. Ifyou are not required to enter your PIN when you make a purchase. your purchase may be processed eitlier through the Visa network or through the STAR or NYCE networks. If)~our purchase is processed through S'fAR or NYCE, dil7erent terms apply and you will not be eligible for the rights and protections available through Visa. Please see your Personal Deposit Account Agreement for more information. r page 3 of 4 166/12=I9~J6 REV.,SOS ex • I, sr) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 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. ~l? A~~ ------a B. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach deed for jointly-held real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. , f s /~ !V ~ r TOTAL (Also enter on line 6, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) REV.157° E% • 11.97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 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 is yes. 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 IF APPLICABLE Na~V~ ~~______-. ___---.~ TOTAL (Also enter on line 7 Recapitulation) I $ (If more space Is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: _ 1. A,tp/~~LLO /~/~ls'Q~L ~/py1~ ~/t/ '~. d ~O~ G-~Tr~ s~i~2~/~ C7er~di ET~~ <l B. t ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip 2. Attorney Fees 3- Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 5. 6. 7. Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees AMOUNT 7~.~s~~~ ~U~s~~ 100 So TOTAL (Also enter on line 9 Recapitulation) I $ ~ ~~,~, ~~.. (If more space is needed, insert additional sheets of the same size) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Zip r FuneraC Home Inc. Mrs. Marjorie Joseph 220 Lewis Circle Easton, PA 18045 JOHN A. MORELLO F.D., SUPVR. 3720 NICHOLAS ST. EASTON, PA 18045-5 ] 16 TEL.:610-253-4941 FAX: 610-253-8010 wwW.MORELLOFUNERALHOME.COM April 12, 2010 The Funeral Service for Joseph F. Rush, II We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. PROFESSIONAL SERVICES Services of Funeral Director and Staff Embalming $ 1,595.00 Dressing, Cosmetology, Personal Grooming $ 7 ] 5.00 OTHER STAFF AND RELATED FACILITIES $ 235.00 Services & Facilities for Viewing Services & Facilities for Funeral Ceremony $ 262.00 Services & Equipment for Graveside Service $ 720.00 'TRANSPORTATION $ Inc. Transfer of Decedent to Funeral Home Hearse $ 315.00 Flower Car $ 310.00 Lead Car /Clergy Car $ 1 l 5.00 $ Inc. MERCHANDISE Saturn Blue, 20ga Steel Concrete Grave Liner $ 1,495.00 Register Book $ 985.00 Prayer Cards $ 40.00 Temporary Gravemarker $ 60.00 Interior Cross $ 40.00 CASH ADVANCES $ 20.00 Out-of--town Transportation -Harrisburg $ Clergy /Mass Offering 393.00 Certified Copies of the Death Certificate $ 150.00 Newspaper Notices -Harrisburg Paper $ 48.00 $ 156.00 Joseph F. Rush, II Page 1 TOTAL CHARGES Payments April 12, 2010 April 12, 2010 BALANCE DUE: ~ 7,654.00 $ 7,654.00 $ 0.00 The statement is net and payable in full on or beforeApril 10, 2010 The unpaid balance over 30 days is subjected to a 1.25% service charge per month (15.00% per annum). Payment - CK#101 $ 4,950.00 Payment - CK# l 026 $ 2,704.00 Joseph F. Rush, II Page 2 OCT-07-10 02:08PM FROM-Keystone Nazareth Bank 8 Trust O ~- o ~ o ti b o o Cs ~ ~ .-. ~ ~, w r W 0~ r ~ .a ru r •~ E~ U~ O ~` IC ~~ ~~ +610-B11-0892 T-617 P. 006/006 F-714 ov - r ~ m°O~ a ~ O i~ m ~ ~ ~~1~ 7~ g 0 ~ ~ ~ ~1' ~ ~ {~ u t D rn -\ a~~ 01 ~ ~ O r ~ ~ ~ ~ ~ $ ID ~ ~~~ ~~ a'; 0 w- "- ---- - ~ -~ - ' --- -- -- OCT-07-2010 13:44 +610 671 0892 97% P.OO6 < < /~. E.>.'~ r ~„ ~ _ _ _ •~ ~ '' ~'f. ~-- ~.w ..--. _ \\\ / n ~. ~ ~ ~~ c- J vim-, ~--~-.~. L _~ '._ _.~'~- ~ S , t. , w E `~ F~ ~.. -6 -~ .~ . ,< i v '` v~ - , 000041742 Funera] Casket Spray ~~ " ` - Occasion: Sympathy, $150.00 $0.00 $9.00 $159.00 $159.00 Rush -Inv. 14225 `: ;.: ~~ r ~ ~/ r _- ~ 0000017801 ~ . - - .. ; - $159.00 $0.00 $0.00 $0.00 - - - $0.00 $159.00 page 1 of 1 Sales On All Plants Are Final. Sr.['ATEMENT -Please Check Invoice Numbers To Avoid Duplicate Payments. Thank You. RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sgware Carlisle, PA 17613 Receipt Date: 3/29/2010 Receipt Time: 14:56:01 Receipt No.: 1060538 RUSH JOSEPH F II Estate File No.: 2010- 00325 Paid By Remarks: JAMES WITTE WZ ------------------------ Receipt Distrib ution ----- -------- ------- ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 45.00 CUMBERLAND COUNTY GENERAL FUN WILL SHORT CERTIFICATE 15.00 12.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN JCS FEE AUTOMATION FEE 23.50 5.00 -- BUREAU OF RECEIPTS CUMBERLAND COUNTY & CNTR GENERAL M.D FUN Check# 2950 -------------- 100.50 Total Received......... 100.50 REV-1512 EXt (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI~IEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death inrl~irlinn ~~~.o~mti~~.~e .. .......:....~ ,..,______ t~~ nwie space is neeoeo, msett additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES to rAt t ur FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE 1 TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. ~~~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. ~o~t/c: ______ B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. ~d~~ 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) REV-1514 EX+ (t2-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN heck Box 4 on REV-1500 Cover SheE FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ Will ^ Intervivos Deed of Trust ^ Other NAME(S) OF LIFE TENANT(S) DATE OF BIRTH • NEAREST AGE AT DATE OF DEATH TERM OF YEARS LIFE ESTATE IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ~ ^ Life or ^ Term of Years / ` ^ Lite or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ..........................................$ 2. Actuarial factor per appropriate table .............................. . .................. Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 3. Value of fife estate (Line 1 multiplied by Line 2) ......................................$ NAME(S) OF LIFE ANNURANT(S) DATE OF BIRTH NEAREST AGE AT DATE OF DEATH TERM.OF YEARS ANNUITY IS PAYABLE ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ............................................$ 2. Check appropriate block below and enter corresponding (number) ........ . ................. Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^ Semi-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 ............................... . 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (see instructions) ................................................. . 7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 ..........................$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ ~ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) REV-1644 EX . (3-04) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT I. ESTATE OF INHERITANCE TAX SCHEDULE L REMAINDER PREPAYMENT OR INVASION OF TRUST PRINCIPAL FILE NUMBER I~aa~ rvaine) (First Name) (Middle Initial) i nis scneclule is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust orincioal_ II. rctmAnvutR PREPAYMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Schedule L-1 1. Real Estate .............................. .$ 2. Stocks and Bonds ......................... .$ 3. Closely Held Stock/Partnership .............. .$ 4. Mortgages and Notes ...................... .$ 5. Cash/Misc. Personal Property ............... .$ ~ .' 6. Total from Schedule L-1 ..................... ............. ~ $ D. Credits: Complete Schedule L-2 ~ 1. Unpaid Liabilities .......................... .% .$ ~ 2. Unpaid Bequests .......................... .$ 3. Value of Unincludable Assets ................ .$ 4. Total from Schedule L-2 .......... ......... .................................$ E. Total Value of trust assets (Line - minus Line D-4) ............. . ...................$ F. Remainder factor (see T e I or Table II in Instruction Booklet) ~ ........................ . G. Taxable Remainder value (Line E x Line F) ........ .................................$ (Also enter on Line 7, Recapitulation) i'` /~ III.( INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) or Annuitant(s) C. Corpus consumed ............................................................$ D. Remainder factor (see Table I or Table II in Instruction Booklet) ........................ . E. Taxable value of corpus consumed (Line C x Line D) .................................$ (Also enter on Line 7, Recapitulation) Date of Birth Age on date Term of years income corpus or annuity is payable consumed oRV~.1te5 E%+ I7-851 INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- FILE NUMBER 1. Estate of (Last Nome) (First Name) 11. Item No. (Middle Initial) Description Value A. Real Estate (please describe) Total value of real estate (include on Section II, line C-1 on Schedule B. Stocks and Bonds (please list) i ~~ r Total value of stocks and bonds 5 (include on Section II, line C-2 on Schedule L) C. Closely Held Stock/Partnership.,(attach Schedule C-1 and/ar C-2) (please list) Total value of Closely Held/Partnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgog~s'and Notes (please list) Total value of Mortgages and Notes S (include on Section II, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property t (include on Section II, line C-5 on Schedule L) III• TOTAL (Also enter on Section II, Line C-6 on Schedule L) (If more space is needed, attach additional 8'/z x 1 1 sheets.) REV-1646 EX+ (3-84) INHERITANCE TAX SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FILE NUMBER i. Estate of (lost Nome) (First Name) ll. liem No. Description A. Unpaid Liabilities Claimed against Originol Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities $ (include on Section ll, Line D-1 on Schedule'L)' B. Unpaid Bequests payable from assets reported on Schedul€~L-1 (please list) ~: 1 ;' Total unpaid bequests S (include on Section II, Line D-2 on Schedule L) C. Value assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that ore not included for tax purposes or that do not form a part the trust. / Computation as follows: Total unincludoble assets S (include on Section II, Line D-3 on Schedule L) III• TOTAL (Also enter on Section II, Line D-4 on Schedule L) S (If more space is needed, attach additional 8Yz x 11 sheets.) (Middle Initiol) Amount REV-1647 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1500 Cover Sheet FILE NUMBER This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ WIII ^ Trrict rl nrhe. I. Beneficiaries - NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. ~~ ~._.--~-°- - II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exe erne a right of withdrawal within 9 months of the decedent's death check the appropriate block and attach f m , a copy o the dod ent in which the surviving spouse exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: ~ - ~~ / :, ~ ) i ~ N. Summary of Compromise Offer: - 1. Amount of Future Interest .........................................................$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ......$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ^ 6%, ^ 3%, ^ 0% ......................$ (also include as part of total shown on Line 15 of Cover Sheet) - 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% ...........................$ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$ (If more space is needed, insert additional sheets of the same size) REV-1649 EX (11-99) SCHEDULE N :~~ SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH 01!01/92 TO 12/31/94 INHERITANCE TAX DIVISION ) ESTATE OF FILE NUMBER This schedule must be completed and tiled if you checked the spousal poverty credit box on the cover sheet. • • ~~ 1 Taxable Assets total from line 8 (cover sheet) ..... .................................... .. 1 . 2. Insurance Proceeds on Lite of Decedent .............. .. , 2 3. Retirement Benefits .... ........................................................... . 3. 4. Joint Assets with Spouse .. ......... ................................ . ........ . 4. 5. PA Lottery Winnings ....... - ................................................ . 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6b. 6c. 6d. . r-_ 6. SUBTOTAL Lines 6a, b, c, d / ( ) ............ - - -- ----- ---- pa~°"`~ .......................... .......... 6. 7. Total Gross Assets (Add lines 1 thru 6) .......... l/ ................ I 8. Total Actual Liabilities ........ - ~ ...... ........................... ... ........ .... 9. Net Value of Estate (Subtract line 8 from line 7) ...... = ~ 8 - .......... !f line 9 is greater than $200,000 -STOP. The estate is not eligible to c!a the credit. If not, on'tinue to Part Il . 9 • • • • • Income: 1. TAX YEAR: 19 2. _ 'TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse ........... 1 a. '- 2a. ~ - 3a. ~ b. Decedent .......... 1 b. ~' 2b. - 3b. - c. Joint ............. 1c. 2c. 3c. d. Tax Exempt Income .. 1d. ~ 2d . e Other Income not ~~ 3d. listed above ........ 1e. 2e. 3e ~ t. Total ........... if. 2f . - . 4. Average Joint Exemptio~ry' come Calculation 3i. - 4a. Add Joint Exemption rTcome from above: (1 i) + (2f) + (3f) _ (- 3) 4b. Av age Joint Exemption Income ....................... . _ f line 4 b is reater than $40 000 -STOP. The estate is not eli ible to claim the credit. if not continue to Part 111. ~ ~ ~ • ~ 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less . ... . ................ 1. 2. Multiply by credit percentage (see instructions) ............. . ...... ....................... 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure 2. in the calculation of total credits on line 18 of the cover sheet . .............. . ................ 3. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate .................... . .................................... 4. .... 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Povertv Credit .Include this iiaure in the calculation of total crarJit li S nn no 1R of iha rnvar ~haat 5. REV~+6a9 EX ~ (1~9i) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF FILE NUMBER Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance ~ Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital residual A B By pass Unified Credit etc ) If a trust or slmllar arrangement meets the requirements of Section 9113(A), and. a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in fhe election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arran ement included as a taxable asset on Schedule 0. The denominator is e ual to the total value of the trust or similar arran ement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's survivin souse under a Section 9113 A trust or similar arran ement. DESCRIPTION vai UE Y i'~ N PART B: Enter the desc / Part A Total ~ y and value of all interests in~Itl~ed in Part A for which the Section 9113 SCHEDULE 0 ELECTION UNDER SEC. 9113(A) SPOUSAL DISTRIBUTIONS) Part B Total ~ (If more space is needed, insert additional sheets of the same size) election to tax is being made.