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HomeMy WebLinkAbout03-06-131505610143 REV-1500 Ex `02_"' OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Code Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 Harrisburg, PA 17128-0601 RESIDENT DECEDENT Y~r File Number ~" ~ Z 1Q ENTER DECEDENT INFORMATION BELOW Decedent's Last Name GORMAN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name GORMAN Spouse's Social Security Number Date of Birth 03 08 1935 Suffix Decedent's First Name MI THOMAS P Suffix Spouse's First Name MI BARBARA S THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return 4. Limited Estate ~ 4a. Future Interest Compromise (riata of rlaath aftar 1 ~_17_A~1 g Decedent Died Testate ~j 7• AttacheCo a~of T usd a Living Trust (Attach Copy of Will) Py ) (~ 9. Litigation Proceeds Received ~ 1 p• Spousal Povertyy Credit (Datef Death between 12-31 ~J1 and 1-1-95 3. Remainder Return (Date of Death Prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number LINDA J OLSEN ESQ 717L„~540 4~2 First Line of Address 2000 LINGLESTOWN ROAD S Second Line of Address SUITE 202 City or Post Office HARRISBURG State ZIP Code PA 17110 Correspondent's a-mail address: lolsen@hazenelderlaw.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 is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. ATURE OF PERSON RE NSIBLE FOR FILING RETURN TE ~~ RC~..-~ Barbara S. Gorman - " ~ f ADDRESS 108 Monarch Lane Mechanicsbur PA 17050 SIGNAT RE REPARER 0 ER TH N REPRESENTATIVE DATE Linda J. Olsen, Esq. Esq. h/ /,~ 2000 Linglestown'Rd. ,Harrisburg, PA 17110 Side 1 1505610143 1505610143 . -~ REE3'i6R OF WINS U O'14~.Y ~ C'~ ~,- ~.... ~ M... G- ~ ~ ~~~ ~~ ~ ~ ~~ © ~ O ~ ~ ~ ~j ,,,~, ..., f f F.._. r" ~"1 " ~. DAT LEDt `V "'Irk J REV-1500 EX Decedents Name: Gorman, Thomas P. Decedent's Social Security Number RECAPITULATION 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................. 2. 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C)......... 3. 4. Mortgages 8~ Notes Receivable (Schedule D) ........................................................ 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ............... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Inn; Probate Property (Schedule G) ^ Separate Billing Requested............ 7. 8. Total Gross Assets (total Lines 1 through 7) ........................................................ 8. 777,406.21 777,406.21 9. Funeral uses and Administrative Costs Schedule H Expe ( ) .................................... 9. 1 , 972.80 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............................ 10. 5 , 0 3 0.16 11. Total Deductions (total Lines 9 and 10) ................................................................ 11, 7 , 0 0 2 . 9 6 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 7 7 0 , 4 0 3.2 5 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. 7 7 0 , 4 0 3 . 2 5 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 7 7 0 4 0 3.2 5 15. (a)(1.2) X .00 ~ 16. Amount of Line 14 taxable 0 0 0 16. at lineal rate X .045 . 17. Amount of Line 14 taxable 0 0 0 17 at sibling rate X .12 . . 18. Amount of Line 14 taxable 0 0 0 18 at collateral rate X .15 . . 19. TAX DUE ................................................................................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 1505610243 0.00 0.00 0.00 0.00 0.00 J Rev-1510 EX+ (08-08) SCHEDULE G pennsylvania INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF (FILE NUMBER Gorman, Thomas P. 21-12 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY TINFiE ATE OAF TROAFNSFERSATTACN ACOPY OFTTHE DEED FOOR RFE.ADLEESTATDE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Fidelity Investments Acct #219-243752 -Beneficiary is 49,602.38 49,602.38 Decedent's spouse, Barbara Gorman 2 Fidelity Investments -Acct #x47-104450 -Beneficiary 77.909.49 77,909.49 is Decedent's spouse, Barbara Gorman 3 TD Ameritrade -Valley Forge Asset Mgmt Corp -Acct. 622,289.00 622,289.00 #901-955085 -Decedent's spouse is the beneficiary. 4 USAA Certificate of deposit Acct ending 7859 - POD 27,605.34 27,605.34 to Decedent's spouse, Barbara Gorman TOTAL (Also enter on Line 7. Recapitulation) 777,406.21 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 08-09) REV-1511 EX+ (10-09) SCHEDULE H Pennsylvania DEPARTMENT OF REVENUE FUNERAL EXPENSES AND RESIDENTDECEDENTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Gorman, Thomas P. 21-12 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached 1,305.80 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zia Year(s) Commission Paid 2. Attomev's Fees Hazen Elder Law 652.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zia Retationshio of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 1,972.80 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Gorman, Thomas P. 21-12 ITEM NUMBER DESCRIPTION AMOUNT Funeral Exaensg~ 1 Malpezzi Funeral Home 854.67 2 Panera Bread -funeral luncheon 317.94 3 Wegmans Grocery -funeral luncheon 133.19 H-A 1,305.80 ether Administrative Costs 4 Register of Wills, Agent -filing fee for PIT return 15.00 H-B7 15.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Gorman, Thomas P. 21-12 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Brockie Pharmatech -medical 151.36 2 Harrisburg Pharmacy -medical 3 Hospice of Central PA -medical 4 ~ Kantor and Tkatch Assoc., P.C. 28.96 4,810.00 39.84 TOTAL (Also enter on Line 10, Recapitulation) I 5,030.16 (If more space is needed, additional pages of the same size) Copyright (c) 2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Gorman, Thomas P. 21-12 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not L's tee I TAXABLE DISTRIBUTIONS [include outright spousal • distributions, and transfers under Sec. 9116 a 1.2 1 Barbara S. Gorman Spouse 100% of the 108 Monarch Lane Residue Mechanicsburg, PA 17050 Tota Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 150 0 cover sheet, as a r o riate. NON-TAXABLE DISTRIBUTIONS: - - - - - --- - - - II. 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 SHEET Copyright (c) 2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 01-10) ntw.otu tcny (yiu/ LOCAL REGISTRAR'S CERTIFICATION OF DEATH WARNING: It :is Illegal to duplicate this copy by' photostat or photograph. Fee for this certificate, $6.00 P 18861941 Certification Number 8 This is to certify that the information here given ~ correctly copied from an anginal Certificate of Deat duly filed with me' as Local .Registrar. The ongin~ certificate will be forwarded to the State Vita 'I Records Office for permanent filing. f ~1'f~~~ Local Registrar Date Issued CAMMONWEALTH Oi PENNMVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH _.. _.... /Prmtin narleM L DaadenPs lace) Name (wst, Mldek, last, SufRx) 2. Sex 3. Soda1 SecvrRY Number ~ .. Dote d oeaeh lMo/Day/Yr) lsvee Moj Zl~ianas P. Gorman Male 054-28-0997 November 13, 2012 Sa. Ap-Wt Ekthday lYrsj Sb. tinder 1 Yar se. under i 6. oaa d wrth (Mo/Day/Yearj (Spell Montb) 7a. Birth plae a {tlty and State er Foni3n Camtry- 77 Month Days Hours Minutes ~ a ~ 935 n ~ L ~~^'^~ Netd Yark , `. ?b`blrtAM>~.lcoimtY) New York Ba: R .. ~ ~ a Foreign Country) t)b. Residence (Street and Number - IrVArde Apt Na.j !k t Uve In» Townahip7 -. Peru~sylvani8 108 MOILa1~I ~[~E', jflYesdetedent lived iri Silver Sp~~g tw~p:, l~Resldeack (Cgimty( C.~YCIbP..r.121T1d Be. Residence (Lp Code) ©No,:decedent Ryedwithln Nmhs 01 tity/tioro. 9. Ever M US Armcd Forces? 10. Marital Sbtw at Time d Death ~ Msrrkd 11: Spouses Uf wNe, gh%e name prbr b first manlege) Yes ^NO ^lNikrrown ^ONOrad ^Never Married ^UMtnown Bgr}~'g $. junk 12. Fathers Name (Fleet, MWdle, last. Suflk) . 13. Mothers Name Prior to First aaarrbge (FNet, MdrM, last) 4lianas P. Gol:man Esther A. Quinn 14a. Informant's Name lib. Relatlorohip b Decedent 11c. IIIfMInaIN's Malprig Address Street and Nunber, Cky, State. 2Ip Code) g . Barbara S. Gorman 108 t!7orlarch..Iaane . ,Mechani PA 17050 e~Ir-Deael+DccwndNFaNospltit ..t,("InpacieM......~...~....._~ !•MMathOcarrMSoi~ewhe'ieONxt7lunatlnsplul.:.• _~~HosDioefsciRly...~..~~..ll~cedint'iHOme.. I 's .~ E ~ Room/OutplNent Dead on AMval Nufsl!i1 No!nellor~f-farm Cage FaMItV ~r 1~HY) ~~ . • 1 _ : F Named net auaibman;p~ street and nmrber; SSC tkyor Town.~Ssab, ahd ~: .. 15d. Coixid d oeath ~aral~in f:~nxton:> Slane Residence Haxri PA `17110 Da ita. MetIiOA d ....: Burial - Crenatlon Stib. Date d~01>pasitbn 1&: tKece d (Name df ~oeinetery, vemaeory, ar other place) ~ ^ Removal from Sbb Q Donatlan Gate of Heaven (7anet '17 2tt12 > z + aner(splahi , : . e ~ ... ~ igd. Loatbn d Olspoklon laly a ToleT;;;tate; snd 21pF .. .. 17a. - .. . ~ or Pelson let d IMennent 1 .:1kYASeiiwnb'N... - . Mechanicsburg, PA 17055. ~~ : F)-138630 6 17c N and Coerlpkte Address d Furwlll F~eIIRy I Ma~pezzi Funeral Hone 8 Market laze Wa `' Mechani , PA 17055'' 18.OeeedehCs Eduatlon - lack th! boa that best dasalbes the 19. DaadeM d Hispank OrgM -beck the 10.Oacaderlt's Raa • CTIerA ONE OR MORE raw b kdkab what ~ highest depee or ktvd d schod comPktfed at tM fleece d daeth box Uat bat describes wttatlrn the dtcedern tM decedent aruidared hknseM or hersaN b be. ^ BM Breda ar less b SIwM~. Check the'No' WMb Q Korean ^ No diploma, 9th -12th grade box M decedaM k not Siwin~• ^ llbde or Afrlan Artierkan ^ Yketnanlese ^ ~ « iced gadran or CsED completed ®No, not spardsMOSpank/Utka ^ Amxkan Indan or Atoka Natlve ^ odor Allan ^ Some ageq aadk, but no dagra ^ Yes, Mexkan, Makin Amerian, Chkano ^ Asian Indian ^ NatM Maaalhn ^ AssocYb desree Ns. A0. AS) ^ Yes. Puerto wan ^ Cldnese ^ Guamanpn ar Oamerro ^ eaclalors degree 1lg. BA. AB, BSI ^ Yes, Cuban Q FINpMO ^ Samoan Maths degree (eg. MA, MS, MErig, MEd, fASYY, MBA) ^ Yes, oUler S,~tlno ^ Japanese ^ Other Patlflc Islander ^ Doaonb 1e.4 PhD. Edo) or Profenloral dagne (SPedM ^ Other (SPaaNI ! MD ODS DVM UD m 2L OtoedeM's Skyk Race Self-Ded{natbn -Lack ONLY ONE to kdkate whit the decadent arviderad hknself ar herseK to be. 22s. Decedent's )Mal Ooarpatlon - Mdiate type d work Whhe ^ Japanese ^ Samoan done duriry mat d wakNg Nfe. DO NOT USE RETBUiO. ^ Blark ce Afrksn Amerkan ^ Korean ^ Other Padgc Hander Oolanel ^ Amarkan Inaan ar Alaka NatM ^ vkebrrase ^ Don't Know/Not wit ^ AHan kdlan ^ t>1Mr Asian Rehued 22b. Klyd d Mamas/IMustry ^ Cldrla! ^ Native Haw.Nan ~ «her (SpacNyj v. s . Army . ^ ^ titamanlan or damorro . .. !E OORePlETEO 7A!-~ ii PEIISON tIIN10 NIONOtJNCES OR 23a. notd Dead ij. - - 2 ,.'; ~ Persoit~PTgnounelag- . QnM when appga .. 23a iii 23d. Dave Blgrad (NW /Yr) z4. Tkne d Death ~ ~~ ~~.: 10:27. S. Was:k~fe~ExamMeF:erCOfonerCoiitxtadl ^ Ya No >CAUSE OF tiEJ3?H ~pproxlmacaz 26. Part L Eller the I--0Neasa, injurks. or oompliatlons-•tlat dlntNy tweed the lath. DO NOT enter terminal eveMS such a ardlac artesT i Mterval: raspkatay arrest, or veMrktrhr flbrMladon wltlaut sh owhK the etiology. DO NOT ABBREIMTE . Eller only one pux on a Bite. Add additlenal Nnes K neasury ~ Onset to Deatfi ( ^ IMMEDIATE UUSE ---'-' a. ~ (1 C) ) ~~~ ~. Ct:J. r~ lrt~ C '„ ~,F'`~ ~~ e (Flea) dlsesse or andlebn Due to for as a wnaapanee ot1: . e w m d th! ~ r su rie ea ~. f ~ i t, d'n t? b. ~ -~~SMuenUaiNNstoprdRl4tu;. ~ ~ Durto(or.ast ~ aa1: - :H.arM;~learN!IB tgtta.caasa i IlebdoniNN:a..Enbithe e. I ENIQEILLYMGUtiJSE. ~ Dueb~lorasa,COroeauenuofl: idseara~.orlnjury.thx +, ~ ~~ krwatad~tM evenb rewrltky d. : in deatlr) LAST. ..... ~ Oue b (a as a cansegratra dl: :. ~. . ~:, ... . ._ _ 28. -art K. Ella other but rqt rasuhky k1 the.urdvlyky cause ghan M Part I 37. WOS M autOpry! 7 : 'Yee: so ; 28:w.rcavroannrwklgs:avawbka to gtiiepMO(the auw ofdeath7 Ya -~ .. ~ : iJio 29. N Female: ~ wxlrn ^ Not re ~ w 30. Did Tobacco llse ContrWrrte b Daathi Y 31. My~ar d Death f dal ^ NonYelee v g O Y ^ Pregnant at tkne d loth a ^ ^ ^ No ~Ihd<rw rr C ^ Aaident ^ NrdMg hwa+tiptlon ^ Nat pregnant, but pregnant wRhin 42 nays er deKt ~ ^ wwa. ^.lardd rot be debrrnkad ^ Not prynrrp latrt pregnant 43 aays b 1 yes. tarore dealt 3L Data d m(ury INkslo.v/rd lswK Q Unknown N pregnant wMdn the past year 33. Time d Mtiw 34. Phce d hsjury (eb home: mnsbuctlon sRe; farm: sdrool) 35. )cation d Injury (Street and Number, ay, State. 2tP Code) 36. MrJury at Work 37.8 Transporhtlon IrI(wy, Spatlfy: 38. t>estrlbe Npw Injury tXarrad: ^ Ya ^ Orlvar/Operater ^ Pedestrian . ^ No ^ Paaerrger ^. Other lSpeciry) 39a. CertiRer (Check only one): m'firWllrig physWan • 7o Ule bat d my kravrkdge, dnth b tM ousels) and marawr stated ^ Prarlolakkig 6 6xtMying physMan - To the deatli oopHbd at tM time, date, and plea, snd dw to the cawels) and meraar stated e we(s) and mantar stated d st fhe tkne, date, Md Plan. and due b t h e ^ Medical Examk+ar/Coronar • On the or Mwatlgatlon, M , loth CCU rre o ^ { ~ ' r ' ~ A SlpiaWye of:oertlRer: ..: ,~TltJe d certlft4r:. r 1 ~ ~-! ..~ .-:.. Ucenaa Number.) ^"~ Z.ds"1 K Z-- 39b Nsme, Addrea and 21p Cade d tenon ComPkW+g Cawed . Ilbm 2ty k:'7 U 4 . 39c. Wte Sipad ( /Yr) ' G.U\ R ra tie ~ 0 ~ l ~i: ~-r :S~f ~ ~'-+v~ 'tl. t l ~ H 2bt 1..,. 40. Raghtrars ddtlel ~ 4L 4L Ragbtrar Dab .. 43. AmerlMranb ..... wsPmRwn Permit No. 0819451 H106.143 REV 07/2011 w vi civuv --1tA.it1111{,ai' 1 1~.LVti<)' 111 Y t/J6111V11W - - -, ~ ~;: ~E'~:'. i... f ---_ _.. _. _ .._.1 saw, i ._.~J Quotes Customer Service Accetrnts & Trdc Mews $ lr.;iahts Rr_se: tch Gu;cia.:;r:e P., Ratireme~t A.teourtts P Tradr. Portfolio Total: $124,419.55" Summary Portfolio Positions Portfolio Research analysisNe-v Statemer:ts Aot:OUSttg IhlDIV10tJAL - In Select Action + 574.404.; _ - r t 45i'~ e8 ants Subtotal S74,404.78 TRA~tT10NAL tR Select Action + 8ro 43752 546.788.88 eterred Annui Select Action ~ 53,226.09 e en'e 3E4014Q ~~ 550,014.77 POR?FOLIO TOTA!_ 5124.418.55 Name accounts and customize display • Brokerage accounts reported as oi: 06/1112012. 11:05am (detadsl . Annully contract values reported on an individual basis. Cttck an the individual contract for detaUs (detaiisl. vuoiv3 are deiayetl at feast i6 malutes for securities. Now you can customize Your' account information by naming and hkNng specific acooants. Select Name accourtt$ and r::e*-r-,: a;c-,'r.,•toraddfiana!in!orr~atia^. Fidelity t3tokerage Servtoas LLC. Member NYSE. StPC and/or Fideity Insurance Agency. Ina, distribute faced and variable insurance ptodutts issued by Fidelity lnvestmenis Lice Insurance Company. Empire FidaBty Investments Li[e Insurance Comnanv. Ftev~ YcAc. t'JY, and cartain'hud early tn~rranco comns,H-,ies. vAtich a: a not 2H'dizte~! ;;~iih Fidetiiv investments. Ths CorlfrBGt's iatancrai tiuarrutiebs are surely tint rdaponarUlhly vi lflr; rSauriry +nsuraitce corii}iany. ertrlcerage servrces .'fie Wovicied by Fidelty Brokerage Services LLC. 900 Salem Sheet. Smithfield, RI 02917. Custody and other services ergv6deF hr luatic+nat Finanr.:al Services L;_v. nth art Fi:;Hitt lr.;restmen;s comAartfes and memb,*rs StPG. NYSE. ~,l~r'~/elit~ hops://olt~.fidelity.com/~ftgw/~/afsurnmary/defaultFage r arc i vt i Oper. an Account Log Our !~ ve~t~~ent Prodcrcts Monday, June 11.2012 N~o-p... u..~.:N^~~. e... Service Messages (Vte~v Existinc~j llfarkQ! Undata WtA f2,511.51 - - 42.69 0.3496 tJASpAQ 2,846.48 - - 11.94 0.429b SAP 500 1,321.31 -x.35 - 0.3396 A4arket Nevrs Vlratch List Hs of 6/1 1 12 01 2. i 1:OSAM ET Retirement t?istributian Center VFew. trade and manage dsEritwliorts from your rotir+ernertt end int~tted retirement accounts. o Go to Retirement Distribution ^~: ,: . ~ i998 -2012 FMR LLC. 1~lI riChts reRerved 6/11/2012 Haz~v Fr..n~ L.aw Estate Planning • Elder Law • Special Needs Planning 2000 Linglestown Road Suite 202 Harrisburg, PA 17110 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013-3387 March 5, 2013 Re: Estate of Thomas P. Gorman Social Security No.: 054 28 0997 Date of Death: 11/13/2012 Inheritance Tax Return To: The Register of Wills: ~.: (7177 540-4332 Fax: (717) 540-4313 www.HazenElderLaw.com ~ ;.ti ~ ~m ~~ ~ ~?~ ~ ~ ~ ~~ ~ ~ ~-~ ~ ' c'' cry ;, - ma ~ c~ ~-~, rya ~' Enclosed for filing please find the original and one copy of the above-referenced Inheritance Tax Return, along with a copy of the first page of the Inheritance Tax Return. Please date stamp the first page of the return and return it to my office in the enclosed self-addressed envelope. Also enclosed is a check for the filing fee in the amount of $15.00. If you have any questions or require any additional information, please do not hesitate to contact me. Sincerely, ~,~~D~~ Corinne Eggers Woodhouse Paralegal Enclosures cc: Barbara Gorman w , tj ,- ~ „ ~~~ ~ W ~ C~ ?~,~Ca Q, Q- f' 7 ~'~' ,~ C'1~ o N ~~ ~ ~~i 1~i~ N ~ rx. ~ li1 '~ ~ -' ~5~311Nn Ca ~ r 4. 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