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Home My WebLink About95-0159~ODUlU2~ REV-1500 EX+ 1 7-9~4) ~, FOR DATES OF DEATH AFTER 12131191 CHECK HERE r ` INHERITANCE TAX RETURN ^ P OVERTY CREDIT IS CLAIMED RESIDENT DECEDENT FILE NUMBER COMMONWEALTH OF PENNSYLVANIA (TO BE FILED IN DUPLICATE ` J G'/L/ ~ DEPARTMENT OF REVENUE DEPT. 280601 WITH REGISTER OF WILLS) ~ ~S Y AR HARP.lSBURG, PA 17128-0601 COUNTY CODE E NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) DECEDENT'S COMPLETE ADDRESS ~ ~ A• 2116 Cedar Run Dr., Apt. 203 W SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH Camp HL11, PA 17011 201-42-9153 11/29/94 7/21/08 c oin p (IF APiLICABLE( SURVIVING SPOUSE'S NAME (IAST, FIRST AND MIDDLE INITIAII SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) ~++ ®1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return Yarn (for dates of death prior to 12-13-82) W o°C.o ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required ~ ~ ~ (for dates of death after 12-12-82) a m ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) . ~ _.. _:. ~s-: ...: W W NAME JeL.ry R. Dllffie, a~. COMPLETE MAI IN ADDRESS 301 Market St., P. O. Box 109 ~ ~ TELEPHONE NUMBER I,enlaylle, PA 1704~~09 ~ ~ 717 761-4540 , ~ =~ _ ~ ti~ Z 0 s a W z 0 a r d 0 x 1. Real Estate (Schedule A) (1) • - ~~~ '~?, r --t 4-: 2. Stocks and Bonds (Schedule B) (2) _ ~"'~ - - 3. Closely Held StocklPartnership Interest (Schedule C) (3) _ ~~ 4. Mortgages and Notes Receivable (Schedule D) (4) °"" C7' 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) ~-x651.76 ~ rT == `~ ~ ~ (Schedule E) t_:'~. -'~ I .J --" b. Jointly Owned Property (Schedule F) (b) , 30.391.40 . ~~ 7. Transfers (Schedule G) (Schedule L) (7 ) 8. Total Gross Assets (total Lines 1-7) (g) _ 32,043.16 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 5, 509.00 Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 1,808.33 11. Total Deductions (total lines 9 8 10) (11) _ 7,317.33 12. Net Value of Estate (line 8 minus Line 11) (t2) _ 24,725.83 13. Charitable and Governmental Bequests (schedule J) (13) _ -0- 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) _ 24,725.83 15. Spousal Transfers (for dates of death aher b-30-94) -0- See Instructions for Applicable Percentage on Reverse Side (Include val e f h l S d K S h d l M (15) x. __ . u s rom c e u e or c e u e .) 16. Amount of Line 14 taxable at b% rate (16) 24,725.83 x .ob = _ 1,483.55 (Include values from Schedule K or Schedule M.) 17. Amount of Line 14 taxable at 15% rate (17) x .15 = _ -0- (Include values from Schedule K or Schedule M.) 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) _ 1,483.55 19. Credits Spousal Poverty Credit Prior Payments Discount Interest + + 74.18 _ (19) _ 74.18 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. (20) ~^ 21. If Line 18 is greater than Line 19, enter the difference on Line 21. This is the TAX DUE. (21) _ 1,409.37 A. Enter the interest on the balance due on Line 21 A. (21A) _ -0- B. Enter the total of Line 21 and 21 A on Line 21 B. This is the BALANCE DUE. (21 B) _ 1.409.37 Maks Check Payabls to: Regi:ter of Wills, Agent Under penalties of perjury, I deck it is true, correct and complete. I i based on all information of which R . L7(uu~e , Esq . return, including accompanying I been reported at true market >i c:ornelJ_ llrive Camp Hill, PA 17011 3-61 Mare t. P. T~enloyne, PA 17b43-0109 nd statements, and to the best of my knowledge and belief, ration of preparer other than the personal representative is w /_.~ / ~. DATE DATE ~~'~3~~_ Act #48 of 1994 provides for the reduction of the tax rates imposed on the net value of transfers to or for the use of the spouse. The rates as prescribed by the statute will be: • 3% (.03) will be applicable for estates of decedents dying on or after 7/1/94 and before 1/1/96 • 2% (.02) will be applicable for estates of decedents dying on or after 1/1/96 and before 1/1/97 • 1 % (.O1) will be applicable for estates of decedents dying on or after 1 /1 /97 and before 1 /1 /98 • Spousal transfers occurring on or after 1/1/98 will be exempt from inheritance tax. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (,~) IN THE APPROPRIATE BLOCKS. YES NO 1. Did decedent make a transfer and: 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 X ................................................................................... d. receive the promise for life of either payments, benefits or care$ X ....................................... 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration$ 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'. bank account at his or her death$ ...................................... 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. REV-1508 EXy+ (2-87) SC H E D U L E E CASH, BANK DEPOSITS AND COMMONWEALTH OF PENNSYLVANIA MISCELLANEOUS INFIERITANCE TAX RETURN PERSONAL PROPERTY Please Print or RESIDENT DECEDENT THOMAS, DOROTHY A. (Attach additional 8Yx" x 11" sheets if more space is needed.) SCHEDULE F COMMONWEALTH OF ~ENNSYL~ANlA ,JOINTLY-AWNED PROPERTY INHEiII*.4hECE ?A.X RET! tRN itES!dENT d'cCEdENT ESTATE OF FILE NUMBER 'PHQsfl:~S, D(7ROtTfiY A. Joint tenopt(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A• Judith T. Imler 8 Cornell Drive Camp Hill, PA 17011 Daughter B• Beverly T. DelGrosso 2222 Bull Frog Road Fairfield, PA 17320 Daughter- C. ITEM NUMBE LETTER FOR JOINT TENANT DATE JOpINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DECD'S % INT. DOLLAR VALUE OF DECEDENT'S INTEREST ~• A 1/1/74 PNC Bank, N.A. -checking account No. 51-4010-5261 10,427.45 50$ 5,213.73 2. A 9/2/93 PNC Bank, N.A. Certificate No. 11-43120169192 10,071.15 50~ 5,035.58 3. A 9/2/93 PNC Bank, N.A. Certificate No. 11-43120169191 10,071.04 50$ 5,035.52 4. B 9/2/93 PNC Bank, N.A. -Certificate No. 11-43120169187 10,071.06 50~ 5,035.53 5. B 9/2/93 PNC Bank, N. A. -Certificate No. 11-43120169188 10,071.04 50$ 5,035.52 6. B 9/2/93 PNC Bank, N.A. -Certificate No. 11-43120169189 10,071.04 50$ 5,035.52 Jointly-owned property: TOTAL (Also enter on line 6, Recapitulation) I $ 30, 391.40 (If more space is needed insert additional sheets of same size) REV-151 E%~ x.98, SCHEDULE H ,~ , ~~ FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN MISCELLANEOUS EXPENSES Please Print or Type RESIDENT DECEDENT FILE NUMBER ESTATE OF THQ~S, DOROiISY A ITEM DESCRIPTION AMOUNT NUMBER A. Funeral Expenses: 1 Musselman Funeral Home -funeral expenses 4,670.00 . 2. Rolling Green Cemetery - 34.00 B. Administrative Costs: 1. Personal Representative Commissions _ Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees -Johnson, Duffie, Stewart & Weidner 750.00 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code 4. Probate Fees C. Miscellaneous Expenses: 1. Chuck E. Bricker, Auctioneer -household goods appraisal 40.00 2• Register of Wills -file Inheritance Tax Return 15.00 3. 4. 5. 6. 7. 8. TOTAL (Also enter on line 9, Recapitulation) $ 5, 509.00 (If more apace is needed, insert additional sheets of same size.) REV-1512 EX+ (~ 93) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OP DECEDENT, MORTGAGE LIABILITIES AND LIENS THQ~IAS, D()Ft02'HY A. Please Print or ITEM DESCRIPTION AMOUNT NUMBER 1• Holy Spirit Hospital -decedent's account balance not covered by insurance (Private room adjustment and Blood) 674.00 2. Health Force -Home nursing care provided. 1,056.00 3. Bell Atlantic -decedent's account -final charges 60.17 4. Pennsylvania Power & Light -decedent's account -final charges 16.38 5. Sammons Communications -decedent's account -final charges 1.78 TOTAL (Also enter on line 10, Recapitulation) ($ 1,808.33 (If more space is needed, insert additional sheets of same size.) REV-1113 EX+ $2-87) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT __ ESTATE OF 7.~iQ~S . DORO~PHY A. FILE NUMBER ITEM NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: t. Judith T. Imler Daughter One-half 8 Cornell Drive Camp Hill, PA 17011 2. Beverly T. DelGrosso Daughter One-half 2222 Bull Frog Road Fairfield, PA 17320 ITEM NAME AND ADDRESS OF BENEFICIARY NUMBER B. Charitable and Governmental Bequests: 1. AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) ~$ (If more space is needed, insert additional sheets of same size) L