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Home My WebLink About05-01-121505610140 REV-1500 ~` "°'-'°' PA of Ravem» ~~ UeE 011LY Bureau d IrMivMwl Taxes INHERITANCE TAX RETURN Count' ~' r~ FN NumUer PO ~x 280801 2 1 1 0 1 0 7 9 Hartisbum. PA 1712aoeol RESIDENT DECEDENT ENTER DECEDENT INFORMATWN BELOYy sodal seamty Numbsr Date a Desk, waDDVrrr Dete m Bkth rMloovrrY DeoadaM'a Last Nine Su8& Decedent's Fib Name MI F A L L E R U R S U L A E (If ApPkuble) Eater Survivlnp 8pouee's IMormaUon BNow Spouse's Last Noma SuIB:c Spouse's First Name MI Spouse's Sochi Seeurky Number THIS RETURN MUST BE FlLED IN DUPLICATE WITH THE REGISTER OF WILLS FlLL IN APPROPRIATE OVALS BELOW ^ t. Original Relum ® 2. Supplemental Retum ^ 3. Remainder Retum (dale of loth prbr to 12.1382) ^ 4. Lbnked Estate ^ 4a. Future htsmt Compremhe (dsh of ^ S. Pedant Estate Tax Retum Requhed ^ 6 Decedent Died Testate ^ death alhr 12-12.82) 7 D d t M h M . . eca en a t ned a LNkp Tnut 8. Total Number a Safe Deposit Bo:ros (Attach Copy of WW (ABach Copy of Trust) ^ 9. Utipatbn Proceeds Rscehred ^ 10. Spausd Poverty Credk (date d death ^ 11. Ehdion to tax under Sec. 9113(A) taNrexr 12~1~91 and 1-1~ (Attach Sah. O) COIartEBPONDENT - THM SECTION MUST BE COMPLETED.ALL CORR~ON~NCE AND COOIFIDENf1AL TAX BffOR11ATIDN SFIOULD BE D9tECTEO T0: Name Daythna Tohphone Number G E O R G E B F A L L E R J R 7 1 7 2 4 3 3 3 4 1 Firt Ibre of address N A R T S O N L A W O F F I C E S SecorM kne of address b 0 E H I G H S T R E E T CNy or Post OMbs C A R L I S L E ComspontlenYs eanall address: Stets 21P Code RE018TER~ tAltll.S U8E ~.Y ev ~ n 3C .~ ~~n ~ ~ _ -,Zn m 1 ~v~~ -'~ :'> O ~ ?" J~ -> W _yFILED _~ P A 1 7 0 1 3 etaeernsrae, and a aro Iwa 6donnatlon daRtlch plepen Z L b5056bOb40 EA8E U8E ORIGINAL FORM ONLY Side 1 1505610140 J 7 .L '_~=. _~.i m J 1505610240 REV-1500 EX Decedent's Social Security Number Decedent'sNama: URSULA E. FALLER RECAPITULATION 1. Real Estate (Schedule A) ........................................... 1. 2 1 7 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) ................................... ... 2. 3. Closely 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. 4 9 8 4 7 , 4 1 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Np~ Probate Property (Schedule G) u Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 2 6 6 8 4 7 • 4 1 9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. 5 6 Q 1 7 . 1 4 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10. 11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 5 6 Q 1 7 . 1 4 12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 2 1 0 8 3 0 . 2 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................... .. 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) .................... .. 14. 2 1 Q 8 3 0 . 2 7 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 _ D. Q O 15. 0. Q O 16. Amount of Line 14 taxable at lineal rate X .045 2 1 0 8 3 0. 2 7 1s. 9 4 8 7. 3 6 17. Amount of Line 14 taxable at sibling rate X .12 Q. Q Q 17. Q• Q Q 18. Amount of Line 14 taxable at collateral rate X .15 Q. Q Q 1 g, Q, Q Q 19. TAX DUE ...................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 9 4 8 7. 3 6 Side 2 L 1505610240 1505610240 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 10 1079 DECEDENTS NAME URSULA E. FALLER STREET ADDRESS 380 WILSON STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: t. Tax Due (Page 2, Line 19) (1) 9,487.36 2. Credits/Payments A. Prior Payments 9,500.00 B. Discount 394.73 Total Credits (A + B) (2) 9,894.73 3. Interest (3) 174.26 4. If Line 2 is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT. F(II in oval on Page 2, Llne 20 to request a refund. (4) 5. I(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 YIWNII~bIWNI11M11tltluHNlitlltlll@W WM1•YIMIIL,WIXNIWIIWMIxx„p,xw,ue,u,xxe,wunuuwn,wunxuwm.rvu,unnnn.uxnxnunw.muw.mn..~.~.~.~n..~ ........................~..~.............................................-......-.. 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 properly 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, benefts or caret ................................................. ...... ^ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration7 ................................................................................. ...... ^ 3. Did decedent own an "in trust for" orpayable-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. lll9 ll I~Vllp B 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 benefciary. 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) p2 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 URSULA E. FALLER 21 10 1079 All real property owned solety 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 behveen a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real orooerly that is IolntN•owned with rlaht of survivorehio must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION :nce located at 380 Wilson Street, Carlisle Borough, PA, known as Tax Pazcel No. •0322-287 being described in Deed dated 12/27/04 and recorded in Cumb. Co., Deed "B", Vo1.52, Page 1031 and being conveyed to George B. Faller and Ursual E.. Faller, his George B. Faller died 10/13/20021eaving title solely vested in Ursual E. Faller. is actual sale value. See attached Settlement Statement TOTAL (Also enter on Line'I, 217,000.00 If more space is needed, use additional sheets of paper of the same size. REV-1508 EX+ (11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: URSULA E. FALLER 21 10 1079 InGude the proceeds of litigation and the date the proceeds were received by the estate. All properly bintb owned whh rlpM of survNorahip must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OP DEATH 1. Rowe's Auction, sale of personal property 46,530.38 2. PA Department of Revenue, refund 932.50 3. County real estate tax proration 852.57 4. School tax proration 622.83 5. HB McClure, refund of budget plan payments 909.13 TOTAL (Also enter on Line 5, Recapilwlation) ~ $ more space is needed, Insert additional sheets of paper of the same s¢e 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 URSULA E. FALLER 21 10 1079 Decedents debts must be repoAed on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. B. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address city Year(s) Commission Paid: State ZIP 2. Attorney Fees: Mattson Law Offices 3. Famiy Exemption: (If decedents address is not the same as claimants, attach explanation.) Claimant Street Address City State Relationship of Claimant to Decedent 4. ~ Probate Fees: 5. I Acxpuntant Fees: 6. I Tax Relum Preparer Fees: 11,600.00 7. Hooke Hooke & Eckman/Wolfe & Company real estate commission 10,850.00 8. 1 % Realty Transfer Tax 2,170.00 9. Borough of Carlisle, final sewer/water bill 74.52 10. 2012 County real estate taxes 1,155.72 11. 20t 1 County real estate taxes 2,650.65 12. Pennington Home Improvents, house repairs pending sale of real estate 13,600.00 13. Chubb Insurance, personal property insurance pending auction sale 860.94 14. Start to Finish Lawn Caze, maintainence pending sale of real estate 2,040.00 15. PPL, electic service pending sale of real estate 1,873.84 16. Century Link, phone service pending sale of real estate 1,791.14 17. HB McClure, heating oil and furnace repair pending sale or real estate 5,875.91 18. Ohio Casualty, homeowners insurance endin sale of real estate 639.46 TOTAL (Also enter on Line 9, Recapitulation) S 56.017.14 ZIP If more space to needed, use addidonal sheets of paper of the same size Continuation of REV-1500 Inheritance Tax Return Resident Decedent URSULA E. FALLER 21 10 1079 Decedent's Name Schedule H -Funeral Expenses & Administrative Costs - B7. File Number ITEM NUMBER DESCRIPTION AMOUNT 19. I Borough of Carlisle, sewer/water pending sale of real estate I 384.93 20. Louie McCartney, house cleaning pending sale of real estate 450.00 SUBTOTAL SCHEDULE H-87 I 834.93 REV-1513 E%+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TA%RETURN RESIDENT DECEDENT URSULA E. FALLER 21 10 1079 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Indude oufn' ht sppusal dis6ibutions and Uansfers under Sec. 91 f6 (a) (1.2).] 1. David J. Faller Lineal 26,353.78 260 S. West St. Carlisle, PA 17013 2. Michael J. Faller Lineal 26,353.78 1125 S. Spring Gazden St. Carlisle, PA 17013 3. Constantine P. Faller Lineal 26,353.78 P.O. Box 237 Amesville, OH75711 4. Nancy A. Faller Lineal 26,353.78 93 K St. Turner Falls, MA 01376 5. Therese F. Faller Lineal 26,353.78 6014 Nassau Dr. Springfield, VA 22152 6. Mary E. Duxburg Lineal 26,353.78 148 N. Hanover Sheet Carlisle, PA 17013 7. George B. Faller, Jr. Lineal 26,353.78 1115 Fleetwood Dr. Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE. 1I. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. E If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent URSULA E. FALLER 21 10 1079 Decedent's Name Page 2 File Number Schedule J -Beneficiaries -1 NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustees) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Indude outr' ht spousal distributions and t2nsfers under Sec. 91 i6 (a) (1.2).] 8. Helen F. Hayssen Lineal 26,353.78 4135 Bayside Rd. Maple Plain, MN 55356 P,evroos aubons mq oeedeln A. Settlement Statement R Tvno of 1 ron m,m nuo-1 Iareel rel nn~moox aaos.z W.S. Department at Hausirg ann Urban f)evabgnent i. ~PAA 2. ~PmFtA 1, OCanv. Unirb. b. Pile Number ]-Loav Number B. Mortgage Insurance Case Number 0 V 4 amh 'eEnwOharou ei4lnmemMam w4mnl eae4. Am0unlY ryle to antl by wnu nl pemue elarn. C. Nela: Nmman,yM1ab'Ipac)'xmre poM OUblepay cbbp;p~'wtlvn lyre lw lnbmbmn pupwMwre rval4cYwMbVy Ia1W. TitbEspreu sanlemen1 sy618m WAFNINO: Y 4 e vNy w MnMHply irellelNx Ygwmenb b NO Unllp SYW M VYem myoNOr Wnly (crln. perelM ulOn gNyw,o„ N„n„n boo ¢jY'iI~llYlylppllaplyfgwpW.F-LdIW.•••.nm la,~ , D. NgME OP BORROWER: A. Slerr Wlllflen E. NAMfi OF SELLER: Tne 8618te of Ursula Elaine Falle! F.NAME OF LENDER: N/A c. PROPERTY ADDRE55: 380 W ikon SUeet, Carlisle, PA 17013 x. sETfLEMBNT AGENT: PA Real Bs[ate Settlement Services, LLC, Telephone: 717-249-6333 Fax: 717-249-7334 cLMMARY OF RE R'c TRAhSACT10N~ 217 000.00 217 000.00 3 820.13 04 06 12 12 31 12 852.47 04 06 12 12 31 12 852,57 OI 06 32 06 30 12 622.83 04 06 12 O6 30 12 622,83 222 295.53 218 d75.I0 5 000.00 l4 2so.z4 of Clwr Mnn nm L~ - -leemntl mnnnaa loan Mb~.imenlc tnr ilwm~yTnd'~~ S 000.00 14 250.24 222 295.53 218 474.40 000.00 24 250.24 237 295,53 204 225.16 SUreBp8YTpIp~ ~~ aod~umECm hjyaMENT: ]M IMpmBlbn Xm~yNeC Iw~Nnb m~genl W InlpmMbn uM 4 bi~lp IuMMmm wa MMnY nwanua Sarvks. X yw w reyl~H m yib a,61wn. IFe 001 gmvacuulWbs NUmu RveeN of y~iy yana~ayypt~ ~ 4 requkeOm f» IaIwIME ygyy In8 blunbn NM i Ilu nd Eon rpmtl Tla ConYep 601u Prta Envbm Pn TIN: ~,~. ~_-LJ..,!_[/~-~_~ SELI£P(5)NEW MPIIINe p0UflE6S: SELLEP(6) PHQNE NUMBEgS: ~~~..~~ HUp CEflOF1OATION W eUVEfl AND SPLLEfl I Mw mreNllyravYweE tlq HU0.l SUtlOmsnl Slelemml pY b Me Eesid my'uwxYUNSxY MX01, N U a Vw qM n¢ureu B41N11fi111 d YI ~ppIMB uq OF Wxmend mWe m my e¢wm w 0y me In WO m,IluilM1p//eNty NYaCCq/d Me HU61 &BdNrenI SUlMlenl. n_ l ~ ilA r m Ttie EYBU OI UnWe EIWq Felb /~f~/~L,~~IJI ~~ eY. nnrNe HY1C> ABM, Ea'W ~ 1 ~'-tL~.i WpflNNJp:1TISA(:NAIIE TUI(NUWWWYMAHE FALSE BTATFMENT6 Tp THE TM NU0.ISBOIangn164ixnnlwMCNIOM pepsWlOe CUe vq accur0u xmunl of Nie hOnaxlM. UNIIEpSTATEB CN TN180fl N1Y 81MUXPONM PfNALT1E8 UPON CONVICTION Ilw0 wu~0rwd puY ~u~ NOB Elyyns]I~ eme yM N40le(emeM. CAN INLLUOEA FINE AND IM%IISONMENT FOq pETpIL68EE T11LE 1B: // U.6. CODE 6EOTION 1 Wt AND 6ECTIDN tOt O. 61- P~eWOw e]umoa4 d~001¢u bum HU0~113R61 rel Ha~bOOOe <905.] U.S.DEPARTMEN'f OF HOUSING AND UREAN DEVELOPMENT File Number: 2012-Otl4 PAGE2 COMMONWEALTH OF PENNSYLVANIA TePARTMENT OP REVENUE BUREAU OF INDIVIOVAL TAXES DEPT. 280601 HARR159URG, PA 1 J 128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1 162 EXI i 196) NO. CD 014737 FALLER GEORGE BRYON JR i0 E HIGH STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: ssN: i9a-12-ii55 FILE NUMBER: 2110-1079 DECEDENT NAME: FALLER URSULA ELAINE DATE OF PAYMENT: 07/20/2011 POSTMARK DATE: 07/20/2011 COUNTY: CUMBERLAND DATE OF DEATH: 10/21/2010 REMARKS: SEAL CHECK#14409 101 ~ 52,000.00 TOTAL AMOUNT PAID: INITIALS: DB RECEIVED BY: 52,000.00 GLENDA EARNER STRASBAUGH REGISTER OF WILLS TAXPAYER COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 T 280601 RECEIVED FROM: FALLER GEORGE BRYON JR 10 E HIGH STREET CARLISLE, PA 17013 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ACN ASSESSMENT' CONTROL NUMBER ESTATE INFORMATION: ssN: tsa-t2-it55 FILE NUMBER: 2110-1079 DECEDENT NAME: FALLER URSULA ELAINE DATE OF PAYMENT: 01/20/2011 POSTMARK DATE: O1 /20/201 1 COUNTY: CUMBERLAND DATE OF DEATH: 10/21 /2010 AMOUNT 101 ~ 57,500.00 TOTAL AMOUNT PAID: REMARKS: CHECK#14142 SEAL 57,500.00 INITIALS: CJ RECEIVED BY: GLENDA EARNER STRASBAUGH REGISTER OF WILLS REV-7 162 EX ~ ] 7 -96) N0. CD 013922 TAXPAYER