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HomeMy WebLinkAbout95-021521-q5 ~c~21~ N,OS.t~a Rev. 2/87 TTPE~vnwT w PERMANENT ~~ ~~ ~~I i D u ~~ This is to certify that the certificate hereunto attached is a tine and accurate copy of the original death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L. 304. Date AUG 16 200 ? ~_ Fran eropoli, ' ect Division of Vital Records P.O. Box 1528 New Castle, PA 16103 COMMONWEALTH OF PENNSYLWINIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH G26122 J ~ srRERla /AU1ee1 NAME OF OECEDENfIF•aL Miea•, L•b 8E% SOCIAL SECURITY WUMEER DRE OFOERH WaM.O•k'AUrI ,. Carolyn Sue Weaver a. Female , 278 _ 34 _ 7958 ~ ~.,~~ a ~99s ADE (I•r EirnbN 1wDER1YEM UNOl111DN oREOP.RT11 8wI1~l~ApCy~~ICCpWap,q~ P1AUDr DFRNICD•d~mlMan_,••+MrucwrranaMr aoy Mar1• I Dey Nan I MY•r• IMaMD.O•T.'hrl ggpp ~ngI161Q ~~ 55 YR Apr 21, 1939 TOh~O ~4rre1 ER101R1••a• ^ DuA ^ ,~ ^ n..~s.,w ^ Is ~» ^ eole+rroPDERII rnr.Eaa.TwoaPDERN rwlEa•a.."e.a.. w•raw.wa.ro.l MA9 oPNlslwrc oRNRrrr RACE-AerloAwr.aNdL wNr..1c Dauphin Harrisburg p f(~ -r "°~""~""'''0"'''"i°"'' RISBuLU. ~SOI / y4L Mrrm..~.R•Rka•..I~ 'l An ite DECEDEr1rs oocuRalDN ,01aOf 81161NESR18R71/BTRY wN1DECmort EVE11w OECEOEIrt's EDUG810N MR881l STRUB-Mrr4• (Ow~MnOdrpY brr m••I U.R APM~RORtEBt SINNNNO SiO11SE de1M8Mq be•I U1• LrJZ Rw~NrrY4 WMn•4 ~ Registered Nurse 71 Nursing u. "^ N•^ ~°'~' „i•vs.l Divoice~'$°~R ~~~~~ M•uNSADDRESSp..acMra.•~.srra"coea s ' ,~ ennsy van a ~ ,h^ ~~~~ 213 West Coover St. ,>a ~r er•wr ,~ Mechanicsburg, PA 17055 d ~" ~~ Cumberland Ma,:wr ~~~ ~ Mechanicsburg "°"°s'i~"lry"y'~C.euy ~°`"~as~ie~Las~ '~ ~ w vavw~n 'wes`~~oo~ve~r`~~`."'a~ei~h`a~icsburg, PA 17055 °F asDMPOSITN>.1 P7A1xDPaaPDSn1DN-Nr•.acarn"a•a•dn acaaN-w/!.w nrc.a. ~ D""r'°'^ Rin1oY10O18Y1^ 1~1~}I 4 1995 D,,,e".,^ D,,,,, h ~ , icsburg Cemetery Mechanicsburg, PA 17055 ~ aIR ~ OR PERBOM SI1Ci1 0162 L ~3'~°~ °R~` °l - . a n t. , Mechanicsburg, PA 17055 Ger r1r1•dbrnr ~ aaA•nar ur, Pwraw•. ^ LICENSE NUMBEA DATE SIGNED rrerr•..dar. El LrL l~ D•Yt T•nl ~/ ~ ~ -• CJOlv`? ~o / - G iua rt~l Z , 199'S Pr••n.+w Pi~ar~w•1.6~•M DP OERN~S aa+D.Dw~. M.n p vwecASE RES¢mEDro NEacu ExANINERIOpRDNER, at, ~ ~ RoU 'v/ ~"'/ / /~ aE w ~ ».1.1Rf r. EaWn•rrw•.Muwaa•,rrrbe••NCDab•OEI.Oa•"1. De rA"•aw Yr eod•d W a•,ara~r••e •AaI M. "/6i8. aealraMrar •n•L •D•ckaDwlMia•. ~AOO~P•Ia PART! Ollr MprkMaa~r•a~aw•M•Ygpb•n, 01e YAIWID•Ie•r I ea aall-wI•wu••aypbw8lvlen PRRT I. RrmmrecAUSetF r ,ar.aee..n OlR W 10RASA Cp6E0UENCE Dfy. "•Mt~W biln•are D i vt~Eel•r 11111110 DUE TOpR ASA CONSEQUENCE DfT I CAIMEEAr•ra •iav i •1r nRa11e •~r OUE W pR AS ACONSEOUENCE OF): nNAYq inb•1"lABi MREANAUlOPBY YVElf AUTOPSY HHDIN(iS MANNER OF DF PN DRE OF wN/RY TIME OF WNIRY wJlN1YRNORK9 DEBCIYEE IIDW W"RIYOCpIgRED. PERFQRMEp7 A1RSA8LE /111011 W Main. 0•K Her) CS•iLET10//OFCAUSE ,y OE/SM Nr••1 L7 ^ AcaAN• ^ P•ndnB M•aagrpn ^ YM ^ N• ^ Yr ® Ne ^ YN ^ Ne +~ Saae• ^ Ca•enar bDwaYwO ^ M• PLACE Of wANiY • N Dar Mn rM qaa%dW LOCRION , , . (S-rt Ci,a6w.. Sery L•. 79. esq. Me (SV•dYl CwY1WM(Clr! a~' aW 781. 'CSR1IPYw0-N YSICIANIP7'Yaic~na•1M1+5c•urdo.ln vl.nanahr 7DYnClm llr vawunc.a ban a,a TITLE OP , COeclel.a lre27) 1b1M D•rd• rD •e••M1 • ry M. • sear.r awaw.c.,.•IN adarw.rrr.aa ................ ..................... ^ a~GGk![ (/C•c~¢L1 ~J ~- •PI10MOtRICM0AN0 C9RIP1M0 PNY81ClAN pmarCinq O•anaMearDippbvuf•a ban) LICENSE NUMEER tD rrDrd,.rw.sel••w.e.a",axwn•ruw!••,br,a.aPl.w.andawml.ee,rMgwnr.wrwe .......................... ~ a, G 5 -~~o Jr Gt( -L aDRE gDREDM,~,a+DL r4 r1$~ NAMEAND RNSIES9 a PERSDN V/IIOCOMPLETED CAl19EOP0ERN I8em 271 T,q•a P~W~-~ c On uI•s•w~a •airMlri {~- y L ~ ~ M, LLi uc l/~^i I.L S o xlwrk•1ro~1. D1 rr •P+n+a,. aeaM oeeurrw w a. mn.. ar•. ane PNC.. ena eu. ro 1D. eau•Np ana ~i c. G elrln•r ••su11w ........ ..................................................................... ................. ^ C(n.rrcy(~iu::~ i~c~sP1f4 atL REG ISTR ' ' # ` AR S SIDNRIIRE AND NUMBER ' 4C- 1 Yl5 ~Ct+ ~ ~ ~ ~ ~ ~ ~ ~ ~~ DRE F11ED Main. DM. 1ar1 ~fl~ `~?'~~~ t7 REV-t~yO,EX+(t1-9t) FOR DATES OF DEATHAtTER1213il91CNECn . o.'c . ' `~ ~` INHERITANCE TA7~ RETURN 'IPOVEnr~c ~n IS CLAIMED ^ ' ~~ .K : RESIDENT DECEDENT FuE NUMBER . COMMONWEALTH OF PENNSYlYAN1A (TO BE FILED IN DUPLICATE DEPARTMENT OFREYENVE DEPT. 280601 WITH REGISTER OF WILLS] 021'5 Y O HARRISBURG, PA 17128-0601 DE YEAR COUNT C NUMI DECEDEN 'S NAME (LAST, FIRST, AND MIDOL INITIAL) DECEDENT'S OMPLETE ADORE55 t- Z W W n Sue 213 W. Coover Street SOCIAL SECURITY NUMBER DATE OF DEATH DATE OF BIRTH Mechanicsburg PA 17055 0 278-34-7958 3/2/95 4/21/39 co~n,r Cumberland W -- ® 1. Original Return ^ 2. Supplemental Return 3. Remainder Return a vs (for dates of death prior to 12-13-, W a V ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax V~O (for dates of death aher 12-12-82) Return Required J d0° ®b. Decedent Died Testate ^ 7. Decedent Maintained o Living Trust _ 8. Total Number of Safe Deposit Bo: a (Attach copy of Will) (Attach copy of Trust) <ALi.~CORRESPONDEh[GE ~LND;~CONFIOENTIAL':TAXINF.QRMAT [ONSHOULD~BE.;,DIRECTEDTp: , -: :' ,. „~; , , ;;.. ...~ I NAME COMPLETE MAILING ADDRESS ~ n Lawr nce J. Near Es uire Connelly, Reid & Spade O Z TELEPH NE NUMBER P. O i $OX 9 6 3 ~ ~ 717 238-4776 Harrisburg• PA 17108 1. Real Estate (Schedule A) (1) 111, 0 3 8 . 9 0 C7 C7 ~~, ~ ~ . 2. Stocks and Bonds (Schedule B) (2) 0.00 `-' 3. Closely Held Stock/Portnership Interest (Schedule C) (3) 0 ' 0 0 ~^ -- 4. Mortgages and Notes Receivable (Schedule D) (4) 0 . 0 0 t 5. Cash, Bank Deposits & Miscellaneous Personal Property( 5) 24 , 017 ' S6 i~~.l Z O (Schedule E) ~~ Q b. Jointly Owned Property (Schedule F) (b) 0 . 0 0 ,._, ic:? 4 _ ~ 7. Transfers (Schedule G) (Schedule L} (7) 0 . 0 0 s_. r - ` a't d 8. Total Gross Assets (total lines 1.7) (8) 135 056.46 r W 9. Funeral Expenses, Administrative Costs, Miscellaneous (9J 15 , 8 74.6 9 ~ Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 2 $ , 3 77.2 9 11. Total Deductions (total lines 9 & 10) (11) 44, 251.98 12. Net Value of Estate (line 8 minus line 11) (12) 0.00 13. Charitable and Governmental Bequests (Schedule J) (13} 0.00 14. Net Value Subject to Tax (line 12 minus line 13) (14) 9 0 , 8 04.5 8 Z O a o. O v )C 4 4 t3 . N/A (17) 0.00 (18) 0.00 (lq) 0.00 (Z0) 5, 4 4 8 .2 7 (2oA) 0 . 0 0 (2oB) 5, 448 .27 Under penalties of perjury, 1 decare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and 6eli it is true, correct and complete. I declare that all real estate has been reported at true market value. Declaration of preparer other than the personal repressniativc bused on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE Lawrence J.,Fd~ary, P. 0. Box 963 Harrisburg PA 17108 ~ i 95 SIGMA U ~,{r rKCrnKC~vinflc inns REP~tESENTATIVE ADDRESS DATE 15. Amount of line 14 taxable at 6% rote (15) 9 0 , 8 0 4 . 5 8 x .Ob = _ (Include values from Schedule K or Schedule M.) N/A 16. Amount of line 14 taxable at 15°/6 rate (16) x .15 = (Include values from Schedule K or Schedule M.) 17. Principal tax due (Add tax from line 15 and from line 1 b.) 18. Credits Spousal Poverty Credit Prior Payments Discount Interest 0.00 + 0.00 + 0.00 - 0.00 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. ~^ Z0. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. A. Enter the interest on the balance due on line 20A. B. Enter the total of line 20 and 20A on line 208. This is the BALANCE DUE. Make Cheek Payable to: Register of Wills, Agent L PLEASE ANSW tR THE FOLLOWING QUcSTIONS BY PLACING A CHECK MARK (,~ j 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, yid 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 ANSVI/ER TO ANY OF THE ABOVE Q°UE~S-T10NS IS YES, YOU Nti3ST CO~~LETE S.CI'iEt?ULE G Ai~i© FILE iT' AS P'A.RT O~F~ THE. RETURN. REV•1502 E:C+ 112.851 '~~ ` SCHEDULE A COMMONWEALTH Of.PENNSylVAr11A REAL ESTATE OF FILE NUMBER Carolyn Sue Weaver 21-95-0215 (Property jointly-owned w:;n Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled (!f more space is needed, insert addifiona! sheets of same size.) ~ 'ItEK 1508 EX+ 12.87) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RES10EiVi DECEOEIVT Carolyn Sue Weaver Please Print or Type FILE NUMBER 21-95-0215 (All property - - - ----_ jointly-owned with the Right of Survivorship must b• disclosed on Schedule F) ITEM DESCRIPTION VALUE AT NUMBER DATE OF DEATH 1. Share savings account with Members 1st F.C.U., Account no. 146987-00 $101.23 2. Checking account with PNC Bank, Account No. 5070033556 $1,128.51 3. Checking account with PNC Bank, Account No. 5070045389 $5,987.58 4. Savings account with PNC Bank, Account No. 5030057983 $7,091.49 5. 1994 Tax Refund from West Shore Tax Bureau $1.60 6. 1990 Pontiac Grand Prix $6,150.00 7. Redemption of Mutual Funds with Prudential Mutual Fund Services $1,252.26 8. 1994 Income Tax Refund $2,295.00 9. ~ PNC - Mortgage Escrow Refund $g,gg S~~E~D1~E~ E CASH, BANK DEPOSITS AND MISCELLANEOUS PERSONAL PROPERTY TOTAL (Also enter on line 5, Recapitulation) ~ $ 24 , 017 56 (Attach additional 8%:" x 11" sheets if more spoce is needed.) ,HEYaS1~ EXt (R88) ~• SCttED~~E ~i ~p,~r~y `~ FUNERAL EXPENSES, COMMONWEAUH OF VENNSYIVANIA ADMINISTRATIVE COSTS AND INHERITANCE TAX RETURN 11RIISCELLANEOtJS EXPENSES RESID"cNT DECEDENT PI:~ firiat or 7Ype ESTATE OF FILE NUMBER Carolyn Sue Weaver 21-95-0215 1TEM NUMBER DESCRff'TION AMOUNT A. Funeral Expenses: ~• Mechanicsburg Cemetery $985.00 2. Myers Funeral Home $5,596.50 3. Gingrich Memorials $1,455.00 B. C. 2. 3. 4. 1. 2. 3. 4. 5. 6. 7. 8. (If more space is Headed, insert additional sheets of same size.) Administrative Costs: Personal Representative Commissions _ Social Security Number of Personal Representative: Year Commissions poid Attorney Fees Lawrence J. Neary, Esquire Family Exemption Claimant Robert & Kimberly Weave~elationship Children Address of Claimant at decedent's death Srreet Address _ 213 W . Coover Street Ciry Mechanicsburg grate PA Z;p Code 17055 Probate Fees Register of Wills of Cumberland County Miscellaneous Expenses: Patriot News Company Cumberland County Law Journal $0.00 $4,000.00 $3,500.00 $250.00 $48.19 $40.00 °` ~'' ~'~ TOTAL (Also enter on line 9, Recapitulation) ~ $ 15,874.69 RE`/•1512 EX+ (1.OJJ ~ ~ ' , , SCH(ED.ULE t( COAMAONWEAUN Of -fNNSnVANIA DEBTS OF DECEDEPiT IN , HERITANCE TA7f RETURN MORTGAGE i.iABiLITiES AND LIENS RESIDFNT DECEDENT ESTATE OF Please Prin! or Type FILE NUMBER ~ 21-95-0215 ITEM NUMBER DESCRIPTION AMOUNT 1. Blair $2.90 2. Sammons Cummunications $67.46 3. General Waterworks $162.54 4. Bell Atlantic $63.16 5. PP&L $167.82 6. Keystone Oil $372.00 7. Orthopedic Institute of PA $10.00 8. Barry L. Heckard, Tax Collector (1995 Real Estate Taxes) $322.46 9. Barry L. Heckard, Tax Collector (1995 Personal Taxes) $g,80 10. Prudential $246.00 ... 11 . i~10'ttgage Payoff ~~ $24, 908.80 12. Auto Loan Payoff $1,635.63 /~' 13. Capital Health System $26.32 14. Borough of Mechanicsburg $196.40 15. West Shore Advanced Life Support $50.00 16. CoreSource - Final Health Insurance Premium $7.63 17. United Water - PA $128.37 ~• TOTAL (Also enter on line 10, Recapitulation) $ 2 8 3 7 7 2 9 (If more space. is needed, insert additional sheets of same size.) . . REV.1f 17 EX+ (2.87( A~ COMMONWEAUH Gf PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BEPIEFIC1ARiE5 FILE NUMBER - ITEM NUMBER --- NAME AND ADDRESS OF BENEFICIARY Ll-y5-UL15 RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: I. Robert W. Weaver ~ Son 500 of 213 W. Coover Street Residue Mechanicsburg PA 17055 2• Kimberly K. .Weaver Daughter 500 of 213 W. Coover Street Residue Mechanicsburg PA 17055 ITEM NUMEtER NAME AND ADDRESS OF BENEFICIARY B. Charitable and Governmental Bequests: None AMOUNT OR SHARE OF ESTATE TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I $ (If more space Is needed, insert additional sheets of same size) 1500 EX+ ('/•94) z W a W 0 FOR DATES OF DEATH AFTER 12131191 CHECK HERE IF A SPOUSAL POVERTY CREDIT IS CLAIMED ^ FILE NUMBER 21 95 0215 COUNTY CODE vFea .,,...,.... __ yn ue ~ ~` ~`' ~ ~ '-l~fi,~RITANCE TAX RETURN • .. ~ ;.RESIDENT DECEDENT WEALTH OF PENN:iY'LVANIA (TO' BE FILED IN DUPLICATE 4RTMENT OF REVEiVLIE DEPT. zeoaol WITH REGISTER OF WILLS) ISBURG, PA 17126.0:101 ENT'S NAME (LAST, FIRST, ANO MIDDLE INITIAL) DECEDE Weaver Carol S -"^"""'^"' ""^'OCR DATE OF DEA1 278-34-79`;8 3/2/ APPIICABIFI SU0.VIVING SPOUSE'S NAME (LAST, f10.ST AND MIDDLE INITIAL( 213 W. Coover Street F eIRTH Mechanicsburg, PA 17055 1/39 cow°~„ a,,,.t,o,.i ,._~ IN f- "' ^ 1. Original Return ® 2. Supplemental Return d y C- 'u_ a ~ ^ 4. Limited Estate 00 ^ 4a. Future Interest Com romisa m (for dates of death after 12-12-82) d ^ b. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust (Attach copy of Will) (Attach copy of Trust) ALL CORRESP fn ~ W 2 ~ W ~° oz U d z 0 J a 4 W m 0 1= a p U x ONDENCE AND CONFIDENTIAL TAX NAME Lawrence J. Neary LD.BE.DIRECTED.TO: . ~~'~._ p.: F; m' ^ 3. Remainder Return (for dates of death prior to 12-13-82J ^ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes Connelly, Reid & Spade 717 238-4776 P•0• Box 963 1. Real Estate (Schedule A) (1' ) 2'. Stocks and Bonds (Schedule B) (2 ) 3. Closely Held Stock/Partnership Interest (Schedule C) (3 ) 4. Mortgages and Notes Receivable (Schedule D) (4 ) 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Sch d l E (5) _ 450 00 e u e ) b. Jointly Owned Property (Schedule F) (b ) 7. Transfers (Schedule G) (Schedule L) (7 ) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses, Administrative Costs, Miscellaneous Ex ense (S h d l H (9) 60.00 p s c e u e ) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) _ 1, 399.60 11. Total Deductions (total Lines 9 ~ 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 15. Spousal Transfers (for dates of death aher b-30 94 - ) Se I t f e ns ructions or Applicable Percentage on Reverse (15] Side. (Include values from Schedule K or Schedule M.) x'-- 16. Amount of Line 14 taxable at b% rate (16) " ~ ~~ ---~ /~/;~~ (Include values from Schedule K or Schedule M.) x .Ob . ~A 6 17. Amount of Line 14 taxable at 15°k rote (17) (Include values from Schedule K or Schedule M.) x .15 _ 8. Principal tax due (Add tax from Lines 15, 16 and 17.) (18) ``'C:.i ~ ~j~,~ 9. Credits Spousal Poverty Credit Prior Payments Discount Interest + + _ 20. If Line 19 is greater than Line 18, enter the difference on Line 20. This is the OVERPAYMENT. 21. If Line 18 is greater than Line 19, enter the difference on•Line 21. This is the TAX DUE. A. Enter the interest on the balance due on Line 21A. B. Enter the total of Line 21 and 21A on Line 218. This is the BALANCE DUE. Make Cheek Payable to: Register of Wills, Agent (19) (20) (21) (21 A) (21 B) ~ ~ ~:; BE SURE TO ANSWER ALC"CiUEST10NS ON REVERSE SIDE ANI ~r penalties of perjury, I declare that I have examined this return, including accompanying schedules an. sue, correct and complete. I declare that all real estate has been reported at true market value. Declare j on all information of which preparer has any knowledge. QURE PFPSnE.I °°e°nue.e.~ .,._ _....._ ___ TO RECHECK MATH " ;: ~-. ~~t~" statements, and to the best of my knowledge and belief, Ion of preparer other than the personal representative is P.O. Box 963, Harrisbur DATE 7108 i a ~ DATE (8) t,~ ~ (~,, d~ (12) "- (13) p. T ., .~. ~ . 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, ....................................................... b. retain the right to designate who shall use the property transferred or its income . ............... v c. retain a reversionary interest; or ................................................................................... d. receive the promise for life of either payments, benefits or care? ....................................... 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? ................................................................................................... ~, V 3. Did decedent own an in trust for .bank account at his or her death? ...................................... 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-1308 EX• (Z.g7) ~...~ SCHEDULE E I ~`:L~.~- CASH, BANK ,DEPOSITS AND I COMMONWEALTH Of PENNSYLVANIA MISCELLANEOUS 'N RESIDENTEDECEDENTRN PERSONAL PROPERTY ESTATE OF Please Print or Type FILE NUMBER Carolyn Sua-: Weaver (All ro ert y 9 P 21-95-0215 P P Y lointl -owned with the Ri ht of Survivorshi must be disclosed on Schedule F) ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATFI Additional proceeds from sale of 1990 Pontiac Grand Prix (previously valued at $6,150.00 on original return) 350.00 I i i TOTAL (Also enter on line 5 (Attoch additional 8'iS" x 11" sheets if more space is needed.) S r • REV.1511 EX• (7.88) i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Carolyn Sue-: Weaver ITEM NUMBER A• Funeral Expenses: 1. B. 2 3 4. C. 1. 2. 3. 4. 5. 6. 7. 8. SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ! Please Print or T FILE NUMBER j 21-95-0215 DESCRIPTION Administrative Costs: Personal Representative Commissions Social Security Number of Personal Representative: Year Commissions paid Attorney Fees Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address City State Zip Code Probate Fees Cumberland County -Additional Probate Fees Miscellaneous Expenses: Filing Fee - Inheritance Tax Return AMOUNT 35.00 25.00 TOTAL (Also enter on line 9, Recapitulation) $ 60 00 llf more soave is nwR(~wfi. Ifllwr•r nrlrii4innnl CIfwP+c n•F cnmw ei~w.l REV-1512 EX+ (L9JJ - SCHEDULE coMn+oNwEAVHOfrENNSnvANiA DEBTS OF DECEDENT INHERITANCE TAX RETURN RE510ENTDECEDENT ,. MORTGAGE LIABILITIES AND LIENS ESTATE OF Please Prirtt or Type FILE NUMBER Carolyn Sue Weaver 21-95-0215 ITEM NUMBER DESCRIPTION AMOUNT ~• Bell Atlantic 2• Sammons 13.51 3• Keystone 22.93 4• P. P.&L. 116.62 5• Phtocopies 51.79. 6. Real Estate Taxes 13.00 7• Capital Health Systems 1,036.75. $• Prudential Auto Insurance 6.00 139.00 TOTAL (Also enter on line 10, Recapitulation) $ 1 ,399.6 (If more space is needed, insert addifional sheets of same size.) ~• REV-1547 EX AFP (12-95) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX ACN 101 BUREAU OF INDIVIDUAL rAxES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DEPT. 280601 HARRISBURG, PA 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 03-25-96 ""'"" "' FILE NO . 21 9 - 0 DATE OF DEATH 03-02-95 COUNTY CUMBERLAND NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT" REMIT PAYMENT T0: LAWRENCE J NEARY CONNELLY ETAL PO BOX 963 HBG PA 17108 REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 Amount Remitted CUT ALONG THIS LINE - RETAIN LOWER POR TION FOR YOUR RECORDS ~ ------------------------------------------ _ _ ---- -------------------- REV-1547 EX AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF WEAVER CAROLYN S FILE N0. 21 95-0215 ACN 101 DATE 03-25-96 TAX RETURN WAS: ( l ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTERE ST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0 O1 1. Real Estat• (Schedule A) (1) . .00 2. Stocks and Bonds (Schedule B) (2l .00 3. Closely Hald Stock/Partnership Interest (Schedule C) (3) .00 4. Mortgages/Notes Receivable (Schedule D) (4) .00 5. Cash/Bank Deposits/Misc. Personal Property (Schedule El (5) 350.00 6. Jointly Owned Property (Schedule F) ((,) .00 7. Transfers (Schedule G) (7) .00 B. Total Assts (81 350.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (q) 60.00 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 1,399 60 11. Total Deductions 12. Nat Value of Tax Return (11) ) .459 60 13. Charitable/Governmental Bequests (Schedule J) (121 1,1 09.60- 00 14. Nst Value of Estate Subject to Tax (131 . (141 89,694.98 NOTE: if an assessment was issued previously, lines 14, reflect figures that incl d 15 andior 16, 17 and 18 will u e the total of ALL returns assessed to ASSESSMENT OF TAX: date. 15. Amount of Line 14 at Spousal rata (15) • 00 X . 00- . 00 16. Amount of Lins 14 taxable at Lineal/Class A rats (16) 89,694.98 X . 06. 5 381 69 ' 17. Amount of Line 14 taxable at Collateral/Class 8 rat' (17) .0 0 X .15. . 00 18. Principal Tax Due . TAX CREDITS: (181 5,381.69 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST (-) AMOUNT PAID 06-02-95 AA047832 257.89 4,900.00 INTEREST IS CHARGED FROM 12-03-95 TO 04-02-96 TOTAL TAX CREDIT AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 5,157.89 223.80 REVERSE SIDE OF THIS FORM INTEREST 6.74 TOTAL DUE 230.54 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LES$ THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAV BE DUE «L-1470 .% ~6~RA) COMMONWEALTI- Of PENNSYLVANIA DEPARTMENT O REVENUE BUREAU OF INDIV'DUAL TAXES DEPT. 28(601 HARRISBUF:G, PA 17128-0601 DECEDENT'S NAME SCHEDULE INHERITANCE TAX EXPLANATION OF CHANGES R i..~-- ! . .,". ,:~, _ EXPLANATION OF CHANGES __ t.,_..,r~., TAX EXA~NINER: + ~ ~"'`~^ :,~ ~1 ~.. PAGE