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1505610243
REV-1500 EX
Decedent's Social Security Number
Decedents Name: L Y T L E, T A M I N. 2 0 0 5 0 5 0 2 4
RECAPITULATION
1. Real Estate (Schedule A) .......................................................................................... 1.
2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3 2 5. 6 1
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3.
4. Mortgages 8 Notes Receivable (Schedule D) .......................................................... 4.
5~ Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 1 , 3 5 4 . 3 8
6. Jointly Owned Property (Schedule F} ®Separate Billing Requested ............. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
0 0 0
(Schedule G) ^Separate Billing Requested ............. 7.
g. Total Gross Assets (total Lines 1-7} ....................................................................... 8. 1 , 6 7 9 . 9 9
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 3 , 0 0 0 0 0
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 2 6 , 0 7 6 5 6
11. Total Deductions (total Lines 9 & 10) ...................................................................... 11 • 2 9 , 0 7 6 5 6
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. - 2 7 , 3 9 6 . 5 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 7 , 3 9 6 . 5 7
TAX COMPUTATION -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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 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. 0 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 - 1 1 - 00919
Decedent's Complete Address:
DE EDENT'S NAME
Lytle, Tami N.
STREET ADDRESS
3122 Yale Avenue
CITY
Camp Hill STATE
PA ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box 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.
(1) 0.00
Total Credits (A + B) (2) 0.00
(3) 0.00
(4)
(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: Yes No
a. retain the use or income of the property transferred :.................................................................................. ~ ^x
b. retain the right to designate who shall use the property transferred or its income :.................................... ^ ^x
c. retain a reversionary interest; or .................................................................................................................. ^
d. receive the promise for life of either payments, benefits or care? .............................................................. ~ ~x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ....................................................................................................................... ^ ^x
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? ...................................................................................................................... ^ ^x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
.._. w
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 January 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 decedent's siblings is 12 percent [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, w ether by bloo or adoption.
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Lytle, Tami N. 21 - 11 - 00919
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF
DEATH
1 Orrstown Financial Services, Inc. (ORFF) 25.94 325.61
12.5526 shares
TOTAL (Also enter on line 2, Recapitulation) 325.61
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Lytle, Tami N. 21 - 11 - 00919
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 PSECU -Individual Account -Reference No. 2461538281347
(S1) Savings ($98.86; $0.16 accrued interest) $99.02;
(S4) Money Handler ($593.11; $0.07 accrued interest) $593.13;
(S7) Money Market ($602.43; $1.42 accrued interest) $603.85
2 I Members 1st Savings Account No 305369-00
($58.37; $0.01 accrued interest) $58.38
1,296.00
58.38
~ TOTAL (Also enter on Line 5, Recapitulation) ~ 1,354.38
SEPARATE BILLING REQUESTED
' ~ SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Lytle, Tami N. 21 - 11 - 00919
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
Elisa S. Cohen 3122 Yale Avenue Partner
A Camp Hill, PA 17011
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number
similar identifying number. Attach deed for jointly-held real estat
DATE OF DEATH
~/ALUE OF ASSET o,(~ OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
1 A 06/05/2003 Real Estate: ss,os2.so 50% 32,526.30
3122 Yale Avenue
Borough of Camp Hill
(Conveyed to Elisa S. Cohen and decedent as
joint tenants with the right of survivorship by
deed dated June 5, 2003, recorded June 17,
2003, in Cumberland County Deed Book 257,
Page 3034).
Assessed Value: $153,500 (based on
Cumberland County Assessment Value and
Common Level Ratio Factor of 1.00);
Mortgage balance owed as of date of death
$88,447.40
Date of Death Value: $65,052.60 ($153,500 -
$88,447.40).
TOTAL (Also enter on line 6, Recapitulation) I 32,526.30
SCHEDULE H
' FUI~RAL E)CCPENSES &
COMMONWEALTH OF PENNSYLVANIA 'c ~/~ n /~
INHERITANCE TAX RETURN ~NIJTI~IT1 V G ~1~~
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Lytle, Tami N. 21 - 11 - 00919
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A.
B. ADMINISTRATIVE COSTS:
~ . Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Ball, Murren & Connell (Estimated Costs/Fees) 3,000.00
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
5. I Accountant's Fees
6. ~ Tax Return Preparer's Fees
7. Other Administrative Costs
1
TOTAL (Also enter on line 9, Recapitulation) 3,000.00
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS
INHERITANCE TAX RETURN ~
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Lytle, Tami N. 21 - 11 - 00919
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 PSECU- Vehicle Loan (L12) 9,753.87
(Reference No. 2461538281347)
2 Members 1st -VISA Loan 8,322.92
(Account No. 4672 XXXX XXXX XXXX)
3 PSECU -VISA Loan (L9) 5,107.85
(Reference No. 2461538281347)
4 Best Buy - HSBC (Phillips & Cohen Assoc., Ltd.) 1,090.67
(Reference No. 18105368)
5 Abington Neurological Assoc., Ltd. (NCO Financial Systems, Inc.) 793.81
(Reference No. 58328087)
6 Pinnacle Health (Carolann Newkam account) 503.72
(Reference No. 200505024)
7 Pinnacle Health Hospital (Accounts Recovery Bureau, Inc.) 378.72
(Reference No. 112490289)
8 Pinnacle Health Hospital (Computer Credit, Inc.) 125.00
(Account No. 110315780)
TOTAL (Also enter on Line 10, Recapitulation) ~ 26,076.56
REV-1513 EX+(11-08}
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Lytle, Tami N.
21 - 11 - 00919
NUMBER
NAME AND ADDRESS OF PERSON(S)
RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT
Do Not List Trustees} SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
I
' TAXABLE DISTRIBUTIONS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
1 Shirley Mogerman Mother 0.0{
1606 Orrstown Road
Shippensburg, PA 17257
2 Samuel Mogerman Brother 0.0{
1606 Orrstown Road
Shippensburg, PA 17257
3 Thomas Lytle Brother 0.0{
15 Scott Drive
Shippensburg, PA 17257
Enter dollar amounts for distributions shown above on lines 15 t hrough 18 on Rev 1500 cover sh eet, as appropriate.
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 0.00
REV-1513 EX+ {9-0O}
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES continued
ESTATE OF FILE NUMBER
Lytle, Tami N. 21 - 11 - 00919
NUMBER
NAME AND ADDRESS OF PERSON(S)
RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s) SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
I
' TAXABLE DISTRIBUTIONS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)]
4 Harold E. Lytle, Jr. Father 0.01
723 Pointer Road
Forest City, NC 28043
Page 2 of Schedule J
LAW OFFICES
BALL, MURREN & CONNELL
2303 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011
(717) 232-8731
PHILIP J. MURREN FACSIMILE (717) 232-2142 WILLIAM BENTLEY BALL
RICHARD E. CONNELL (1916-1999)
TERESA R. McCORMACK
THOMAS A. CAPPER MAILING ADDRESS:
P.O. BOX 1108
HARRISBURG, PENNSYLVANIA 17108-1108
Glenda Farner Strasbaugll
Register of Wills _ Cumber. [and Coulity c~
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RE: Estate of Ta1ni N. Lytle (decezseu) .
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Date of Death.: ~-3 1. -2011 °v
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PA No. 2111-091 Q ~ ~''
Our File No. 2979
Dear Ms. Farrier Strasbaugh:
Enclosed please find; in duplicate, the Inheritance :~~~..~ I~etz~ill for the Estate of Tami N.
Lytle.
Also enclosed are the Esiate Ins-er,.tory anal a check: in tl~~' am~~11l11t c?f X30 for the filing of
the Inheritance Tax 1Zeturn and t.hL Iris%e1~t~r3~,
Kindly date-stamp the additiola_al ;op~es of the 1111~ea ita~~~~e -r a~. I e~urll and Inventory and.
return them to me in the self-address:~~, :~tal2~ped en~%elope prov~~~ecz.
~~er~~,. tr~;ly vc~urs,
T1larnas A. {~anl~~er
Enclosures
cc: Elisa S. Cohen, Administraor
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LAW OFFICES
BALL, MURREN & CONNELL
2303 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011
(717) 232-8731
PHILIP J. MURREN FACSIMILE (71 7) 232-2142 WILLIAM BENTLEY BALL
RICHARD E. CONNELL
(1916-1999)
TERESA R. MCCORMACK
THOMAS A. CAPPER MAILII~[G ADDRESS:
P.O. BOX 1108
HARRISBURG, PENNSYLVANIA 17108-11OH
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CJlenda r alner Sirasbaugh
Register of VVill.s - Cun~beri.a;nt~ C'~:~~sn~.ti;
Ciil~nberland Cc)ur~ty {'~~~~rthciuse
One Courthouse ~rluare, R c~ol~t 1 v7 ~ ;"
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Carlisle..PA 17{.11.3 ~? "T {
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REa Estate of i ami ~(. I~yrle {;dec,~:~secl) :~ _
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Date of Death. ~-.3 ] -?~`~ l I ,
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I~eal.° ~~Is. ~a;Ti~:I' `~tra:~lsaugh:
Fer the instructions from ~~o~ir offizr~, I/nc4osed rlc,atie Iind the fi=st piage oi`the Inheritance
F'ax Return and tl~e I~xve~Iitc~ry «~iti~ t~il*° o~°igi.~ai si~;i3att.~res of I~;lisa. ~. Cohen, administrator of the
above referenced estate. I'revio~~slyw 1"i}T ietrer d~:ed ~~ug~~sk iC, ~{~1~2, «~e sent to you, in
duplicate, the Inheritance fax IZ_etul~r~, she II~v~;ntcs~y, the ~lirzg fee of ~3t? and apostage-prepaid
envelope.
Kir_~dly send us the data-starr~ped ropier of thc~ I~~~~.erta~ice i ax Return and Inventory in the
postage-prepaid. envelope.
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Enclosures
cc, Elisa ~. Cohen, ~Adrr,inistratc~~°
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