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REV-1500 Ex (02.11) (FT) 1505610105
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes ;c- ` County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN 2 i o S $
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
189-18-6851 09/28/2011 10/18/1922
Decedent's Last Name Suffix Decedent's First Name MI
STONE MABEL M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1. Original Return CID 2. Supplemental Return C=) 1 Remainder Return (Date of Death
Prior to 12-13-82)
C=) 4. Limited Estate p 4a. Future Interest Compromise (date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
CID 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O_)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMWN SHOULD BE5$ECTE~O~
Name DaytimeQelQt0one Number r i n
THOMAS E. FLOWER 9 c-i r,
(717) 943513
M = r> c a C'1
RISERIt1rF WIl LOUSE t3 Ll
First Line of Address c ) L 1
FLOWER LAW, LLC r= r y ALL" a
rv ; trt
Second Line of Address
t~
10 W. HIGH ST.
City or Post Office State ZIP Code DATE FILED
CARLISLE PA 17013
Correspondent's e-mail address: Tom@Flower-Law.Com
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief,
it' true, correct and complete. Decla ion of preparer other than the personal representative is based on all information of which preparer has any knowledge.
IG ATUR60F P RS ESPO LE FOR FILIN RETURN D E
SS
J SSICA B. SHAWVER, 10 SHOVER DR., CARLISLE, PA 17013
S OF PR R ER THAN REPRESENTATIVE D TE
ADDR
THOMAS E. FLOWER; FLOWER LAW, LLC; 10 W. HIGH ST.; CARLISLE, PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
J 1505610205
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: MABEL M. STONE 189-18-6851
RECAPITULATION
1. Real Estate (Schedule A) 1.
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. 14,503.50
6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1 through 7) 8. 14,503.50
9. Funeral Expenses and Administrative Costs (Schedule H) 9. 15,286.75
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) 10.
11. Total Deductions (total Lines 9 and 10) 11. 15,286.75
12. Net Value of Estate (Line 8 minus Line 11) 12. -783.25
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) 13. -250.64
14. Net Value Subject to Tax (Line 12 minus Line 13) 14. -536.21
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_ 15.
16. Amount of Line 14 taxable
at lineal rate X .0 _ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 -536.21 18 -79.89
19. TAX DUE 19. 0.00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT CIO
Side 2
L 1505610205 1505610205 J
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21- 11 - t o S$
DECEDENT'S NAME
MABEL M. STONE
STREETADDRESS
7798 WERTZVILLE ROAD
MIDDLESEX TOWNSHIP
CITY STATE ZIP
CARLISLE PA 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1)
2. Credits/Payments
A. Prior Payments
B. Discount
Total Credits ( A + B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
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 ❑
b. retain the right to designate who shall use the property transferred or its income ❑
c. retain a reversionary interest ❑
d. receive the promise for life of either payments, benefits or care? ❑
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ❑
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? ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 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(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, whether by blood or adoption.
REV-15o8 EX+ (11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
MABEL M. STONE 21-11-1058
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SERIES HH US SAVINGS BONDS 2,500.00
2. SERIES E US SAVINGS BONDS 9,040.53
3. 1794 PENNY IN SAFE DEPOSIT BOX 210.00
4. MISC. SILVER COINS IN SAFE DEPOSIT BOX 105.00
5. NET AUCTION PROCEEDS, SALE OF HOUSEHOLD GOODS 1,912.30
6. PROCEEDS, SMALL DESK AND SHELVES SOLD PRIOR TO AUCTION 225.00
7. FEDERAL AND PA 2011 PERSONAL INCOME TAX REFUNDS 510.67
TOTAL (Also enter on Line 5, Recapitulation) $ 14,503.50
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
" II pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
MABEL M. STONE 21-11-0158
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
i.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 3,607.19
Name(s) of Personal Representative(s) JESSICA B. SHAVWER
Street Address 10 SHOVER DR
City CARLISLE State PA zip 17013
Year(s) Commission Paid: 2012
2. Attorney Fees: 104.56
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. Accountant Fees:
6• Tax Return Preparer Fees:
7. REALTY TRANSFER TAX 1,500.00
8. HOOKE, HOOKE & ECKMAN, REAL ESTATE AGENCY COMMISSION ON SALE 9,000.00
9. REGISTER OF WILLS, FINAL ACCOUNT FILING FEE 330.00
10. TRASH REMOVAL AND CLEANING 745.00
TOTAL (Also enter on Line 9, Recapitulation) $ 15,286.75
If more space is needed, use additional sheets of paper of the same size.
OMB NO. 2502-0265 Wr
A B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1.❑FHA 2.E]FmHA 3. ❑CONV. UNINS. 4. []VA 5. E]CONV. INS.
6. FILE NUMBER: 7. LOAN NUMBER:
14872.1 RAMP
SETTLEMENT STATEMENT 8. M
ORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
Items marked (POC]" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
1.0 3/98 (14872.1 RAMP/14872.1 RAMP/37)
D. NAME AND ADDRESS OF BORROWER: E. NAME AND ADDRESS OF SELLER: F. NAME AND ADDRESS OF LENDER:
Robert E. Diehl Estate of Mabel M. Stone
500 Redco Drive
Enola, PA 17025
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE:
7798 Wertzville Road Martson Deardorff Williams Otto Gilroy & Faller
Carlisle, PA 17013 September 13, 2012
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
10 East High Street
Carlisle, PA 17013
J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION
100, GROSS AMOUNT DUE FROM BORROWER: 400- GROSS AMOUNT DUE TO SELLERe
101. Contract Sales Price 150,000.00 401. Contract Sales Price 150,000.00
102. Personal Property 402. Personal Property
103. Settlement Charges to Borrower Line 1400 2,539.50 403.
104. 404.
105. 405.
. A&s1m9nts F76F Items Pat~d Bv Seller in advance A01 stments For Items P50-8-y Seller in advance
106. Count /Tw . Taxes 09/14/12 to 01101/13 161.05 406. Coun /Tw . Taxes 09/14/12 to 01/01/13 161.05
107. School Taxes- 09/14/12 to 07/01/13 1,146.80 407. School Taxes 09/14/12 to 07/01/13 1,146.80
108. Assessments to 408. Assessments to
109. 409.
110. 410.
111. 411.
112. 412.
120. GROSS AMOUNT DUE FROM BORROWER 153,847.35 420. GROSS AMOUNT DUE TO SELLER 151,307.85
200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER:
201. Deposit or earnest money 5,000.00 501. Excess Deposit See Instructions
202. Principal Amount of New Loans 502. Settlement Charges to Seller Line 1400 10,520.00
203. Existing loan(s) taken subject to 503. Existing loans taken subject to
204. 504. Payoff of first Mortgage
205. 505. Payoff of second Mortgage
206. 506.
207. 507. (Deposit disb. as proceeds)
208. 508.
209. 509.
Adjustments or ems Unpaid Seller Adiustments or ems n a- a er
210. Count /Tw . Taxes to 510. Count /Tw p. Taxes to
211. School Taxes to 511. School Taxes to
212. Assessments to 512. Assessments to
213. 513.
214. 514.
215. 515.
216. 516.
217. 517. Escrow for clean-up to Martson Law Offices 5,000.00
218. 518.
219. 519.
220. TOTAL PAID BY/FOR BORROWER 5,000.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 15,520.00
300. CASH AT SETTLEMENT FROMITO BORROWER: 600. CASH AT SETTLEMENT TO/FROM SELLER:
301. Gross Amount Due From Borrower Line 120 153,847,35 601. Gross Amount Due To Seller Line 420 151,307.85
302. Less Amount Paid By/For Borrower (Line 220) ( 5,000.00) 602. Less Reductions Due Seller (Line 520) ( 15,520.00
303. CASH ( X FROM) ( TO) BORROWER 148 847.35 603. CASH( X TO) ( FROM) SELLER 135,787.85
The undersigned hereby acknowled ages 1&2 of this statement & an achments referred to herein.
Borrower _ Seller E tate o M I M. Stone
By.
s Ica B. hawv , xe tnx
HUD-1 (3-86) RESPA, HB4305.2
rage <
L. SETTLEMENT CHARGES
700. TOTAL COMMISSION Based on Price ° 9. 00.00 PAID FROM PAID FROM $ 150,000.00 (cD 6,0000 Division of Commission line 700 as Follows: BORROWER'S SELLER'S
701. $ 4,500.00 to Hooke, Hooke & Eckman Realtors LLC FUNDS AT FUNDS AT
702. $ 4,500.00 to REDCO Associates Realty SETTLEMENT SETTLEMENT
703. Commission Paid at Settlement 9,000.00
704, to
800, IITEMS PAYABLE IN CONNECTlgkN WITH LOAN
801. Loan Origination Fee to
802. Loan Discount % to
803. Appraisal Fee to
804. Credit Report to
805. Lender's Inspection Fee to
806. Mortgage Ins. App. Fee to
807. Assumption Fee to
808.
809.
810.
811.
900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interest From to @ $ /day ( days
902. Mortgage Insurance Premiumfor months to
903. Hazard Insurance Premium for 1.0 ears to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER
1001. Hazard Insurance $ per
1002. Mortgage Insurance $ - per
1003. Coun /Tw . Taxes $ per
1004. School Taxes per
1005. Assessments @ $ per
1006. $ per
1007. @ $ per
1008. CCD- $ per
1100. T1TLE'CHAR E
1101. Settlement or Closing Fee to
1102. Abstract or Title Search to
1103. Title Examination to
1104. Title Insurance Binder to
1105. Document Preparation to
1106. Notary Fees to
1107. Attorney Certificate of Title to Martson Deardorff Williams Otto Gilroy & Faller 977.50
includes above item numbers:
1108. Title Insurance to
includes above item numbers:
1109. Lender's Coverage $
1110. Owner's Coverage $
1111.
1112.
1113.
1200, GOVERNMENT RECORDING D TRANSFER CHAR GES
1201. Recording Fees: Deed $ 62.00; Mortgage $ Releases $ 62.00
1202. City/County Tax/Stamps: Deed 1,500.00; Morta e 1,500.00
1203. State Tax/Stamps: Deed 1,500.00; Mortgage 1,500.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Survey to
1302. Pest Inspection to
1303. Tax Certification Fee to Frank Roberto 20.00
1304.
1305.
1400. TOTAL SETTLEMENT CHARGES Enter on Lines 103, Section J and 502, Section K 2,539.50 10,520.00
By signing page 1 of this statement, the signatories acknowledge receipt of a complet cop of page 2 of this two page statement.
Certified to be a true copy. MartsonVe-a-rd*Fff Williams Otto Gilroy & Faller
Settlement Agent
( 14872.1 RAMP / 14872.1 RAMP 137)