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Home My WebLink About95-0290 <EV-t500 Ex. (7~9e1 ~ ~ FOR DATES OF DEATH AFTER 12131 J91 CHECK HERE ~,~ INHERITANCE TAX RETURN OUCAI p ~ OVER - RESIDENT DECEDENT FILE NUMB COMMONWEALTH Of PENNSYLVANIA DEPARTMENT OF REVENUE (TO BE FILED IN DUPLICATE •~' ~~~ DEPT. 280601 WITH REGISTER OF WILLS ~ ('C HARRISBURG, PA 17128.0601 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INIiIAII . DECEDENT'S COMPLETE ADDRESS Blue Ridge Raven. West ~ GROGNET Y~ W SOCIAL SECURITY NUMBER DATE Of DEATH DATE OF BIRTH 770 PClplar ChurC.h ROad 063-03-2864 1/24/95 12/15/01 ~ Hill PA 17011 ca~ p Ilf APPIiCAlIE) SURViv~NG SPOUSE'S NAME (lw$T, FIRST AND MtODIE tNiTiwL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED (SEE INSTRUCTIONS) r++ j~] 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return Yaws (for dotes of death prior to 12-13.62) WacY.i ^ 4. Limited Estate ^ 40. Future Interest Compromise ^ 5. Federal Estate Tax Return Required ~ °~ ° (for dotes of death after 12-12-82) a m ^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach copy of Trust) ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: - y' z NAME Jerry R. Dllffie, ESC;. COMPLETE MAILING ADDRESS Z Johnson, DLiffie, Stewart & Weidner V ~ TELEPHONE NUMBER 3O1 Market St. r ~~• BOX lO9 1~C 1. 717 761-4540 ~ 1. Real Estate {Schedule A) (1) - E:.. 2. Stocks and Bonds (Schedule B) (2) ~ - `a z, 3. Closely Held StocklPartnership Interest (Schedule C) (3) ~- 4. Mortgages and Notes Receivable (Schedule D) (4) ~ --' 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 721 - 50 t-- _ => -- - (Schedule E) b. Jointly Owned Property (Schedule F) (b) 2 0 0 41.8 2 ~ `'-~ • ~• ,:.{. ~~ `"" ~? `~~ ~ -'"' a ~ 7. Transfers (Schedule G) (Schedule L) (7 ) a 8. Total Gross Assets (total Lines 1-7) (g J 2 0, 7 6 3. 3 2 9. Funeral Expenses, Administrative Costs, Miscellaneous (9) 515.00 Expenses (Schedule H) 10. Debts, Mortgage Liabilities, Liens (Schedule I) (10) 1 .118 • 89 1 1. Total Deductions (total lines 9 8. 10) (1 1) 1 , 6 3 3.8 9 12. Net Value of Estate (line 8 minus Line 11) (12) 19 , 129.43 13. Charitable and Governmental Bequests (Schedule J) (13) -0- 14. Net Value Subject to Tax (Line 12 minus Line 13) (14] 19.129.43 15. Spousal Transfers {for dates of death after 6-30.94) See Instructions for Applicable Psresntage on Reverse (15J x._= -0- Side. (Include values from Schedule K or Schedule M ) . 16. Amount of Line 14 taxable at b°k rate (16) x .Ob = -0- (Include valves from Schedule K or Schedule M.) 17. Amount of line 14 taxoble at 15% rate (17) 19,129.43 x .ts = 2.869.41 z (Include values from Schedule K or Schedule M.) o a 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (1 g) 2 , 86 9.41 a 19. Credits Spousal Poverty Credit Prior Payments Discount Interest o + + 143.47 _ (19) 143.47 a 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 thou Line 19, enter the difference on Line 21. This is the TAX DUE. (21) 2 . 7 2 5 • 9 4 A. Enter the interest on the balance due on Line 21A. (21A) -0- B. Enter the total of Line 21 and 21A on line 218. This is the BALANCE DUE. (21B) 2.725 - 94 Make Check Payable to: Register of Wills, Agent ' = ' ~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH I t Jnder penalties of perjury, I declare that I have examined this return, including occompanying schedules and statements, and to the best of my knowledge and belief, t is true, correct and complete. I declore shot all real estate has been reported at true market value. Declaration of preparer other than the personal representative is eased on all information of which preparer has any knowledge. >IGNATUR F PERSON RESP NSIBIE FOR fIIING RET RN ADDRESS 3018 Harvard Avenue DATE C Hill , PA 17011 y / J y~s' HER T N REPRESENTATI ADDRESS 301 Market St . r P. O. BOX 109 DA E L,emovne. PA 17043-0109 ~~/7~J~S .7~a~rv R . ]~T£f ie , Esq . 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 offer 7/1/94 and before 1/1/96 • 2% (.02) will be applicable for estotes of decedents dying on or after 1/1/96 and before 1/1/97 • 1% (.O1j will be applicable for estates of decedents dying on or offer 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. 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, ............... 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 considerations: If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration$ ................................................................................................... 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 !T AS PART OF THE RETURN. "~'Sa Ex. n..~, S C H E D U L E. E ~.. ~~ CASH, BANK DEPOSITS AND COMMONWEAITN OF PENNSYLVANIA MISCELLANEOUS I""rtEEiIiDEMDKEDEHTR" PERSONAL PROPERTY Please Print or Type ESTATE OF FILE NUMBER GROGNET, YVONNE (All property jointly-owned whh the Ripht of Survivorship must be disclesad en Schedule FJ (Attoch odditionol BK" x 11" :heats if more spoce is needed.) ~ k ~ REK1509 EX+ 112.881 t ~, ,V COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER GROGNET, YVONNE Joint tenant(s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. Jane B. Cuddy 3018 Harvard Avenue Camp Hill, PA 17011 Friend B. C. Jointly-owned property: ITEM NUMBE LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY TOTAL VALUE OF ASSET DECD'S °k INT. DOLLAR VALUE OF DECEDENT'S INTEREST ~' A /19/85 Mellon Bank - Checking Account No. 252-111-3551 S ~ y~Z ~Sr Date of death balance, plus accrued interest. 4,241.69 50~ 2,120.85 2. A 8/26/85 Mellon Bank - Money Market Account No . ~ ,~ ~ Z ~ ?- 'j ~~ 250-070-7282 - Date of death balance, plus accrued interest. 35,841.94 50$ 17,920.97 i TOTAL (Also enter on line 6 Recapitulation) I$ 2 0, Q Q 1 $ 2 (If more space is needed insert additional sheets of same size) vE~-~'S11 :%. p~691 ~. COMMONWEAITM OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GROGNET, YVONNE SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES Please Print or Type FILE NUMBER ITEM DESCRIPTION NUMBER AMOUNT A. Funeral Expenses: 1. B. Administrative Costs: 1. Personal Representative Commissions _ Social Security Number of Personal Representative: Year Commissions paid 2. Attorney Fees -Johnson, Duffie, Stewart & Weidner 3. Family Exemption Claimant Relationship Address of Claimant at decedent's death Street Address 500.00 City State Zip Code 4. Probate Fees C. Miscellaneous Expenses: 1. Register of Wills -File Inheritance Tax Return 15.00 2. 3. 4. 5. 6. 7. 8. ;` TOTAL (Also enter on line 9, Recapitulation) $ 515.00 (If more spoce is needed, insert additional sheets of same size.) .. ~ ~, kE V•151i EE. ji~4il ~`x~j 7j COMMONN'EALTn OF PFNNSYIVANiA INHERITANCE TAX RETURN RESIDE N? DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS Plscse Print or Type ESTATE OF FILE NUMBER GROGNET, YVONNE ITEM DESCRIPTION NUMBER AMOUNT i~ ( Holy Spirit Hospital -decedent's account balance not covered by insurance - (Medicare Deductible not satisfied) 743.91 2. Internists of Central PA -decedent's account balance not covered by insurance. 137.45 3. West Shore Pharmacy -decedent's account balance 211.83 4. west Shore Advanced Life Support Services, Inc. -balance not covered by insurance 25.70 TOTAL (Also enter on line 10 Recapitulation) I $ 1 118 89 i (If more space is needed, insert odditiona! sheets of some size.) REV.151] E%• f~~b7) 1' r 1 .~~ COMMONwEAETM OE PENNSYLVANIA INHERITANCE TAX RETURN - RESIDEM DECEDENT ESTATE OF GROGNET, YVONNE SCHEDULE J BENEFICIARIES FILE NUMBER ITEM NUMBER NAME AND ADDRESS OF EENEFICIARY RELATIONSHIP AMOUNT OR SHARE OF ESTATE A. Taxable Bequests: t. Jane B. Cuddy Friend Residue as 3018 Harvard Avenue surviving joint Camp Hill, PA 17011 owner. ITEM NAME AND ADDRESS OF BENEFICIARY AMOUNT OR NUMBER SHARE OF ESTATE B. Charitable and Governmental Bequests: 1. TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recopitulation) I S (IF more space is needed, insert additional sheets of some size) t~ c~ ~'~ c~.s c~ r-,_ ~-_ ~. ~~