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Home My WebLink About04-04-13 (3) A 1505610105 REV-1500 EX(02-11)(FI) OFFICIAL USE ONLY PA Department of Revenue pennsytvania County Code Year File Number PO BOX 28o6ol INHERITANCE TAX RETURN Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT 6A16 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MIVIDDYYYY 03 1?/ .17ellz /R J/ 14102-1 Decedent's Last Name Suffix Decedent's First Name MI *Ta Y lo j- 0///L, L (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 1.Original Return C=:) 2.Supplemental Return C=) 3. Remainder Retum(Date of Death Prior to 12-13-82) C=) 4.Limited Estate C=:) 4a. Future Interest Compromise(date of C=) 5. Federal Estate Tax Return Required death after 12-12-82) C=) 6.Decedent Died Testate C=:) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) C=) 9.Litigation Proceeds Received C=D 10,Spousal Poverty Credit(Date of Death CZD 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Robe-rZ D IaYlOr J C-)r REGQEQF WILLS Z*ONVO M k 7w> First Line of Address Second Line of Addres:Y Z3 -V W Cf) City or Post Office State ZIP Code lrK ro )2,011 DATE FIL Correspondent's e-mail address: 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- Pf OF FRSON BLE FOR FILING RETURN DATE ADDRnS 3222 #Ouse pr IfVt SIGNATURE OF PREPAFttR OTHER THAN REPRESENTA E UAl ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 t 1505610105 1505610105 1505610205 REV-1500 EX(FI) ^/ l Decedent's Social Security Number Decedent's Name elx e /Q.U�d / 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. 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. 'g2 ,7 j 9. Funeral Expenses and Administrative Costs(Schedule H).. . . . . . . . . . . . . . . . . 9. 5�2. mac? 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1). . . . . . . . . . . . . . 10. _ 11. Total Deductions(total Lines 9 and 10). .. . . . . . . . . . .. . . . . . . . . . . . . A 12, Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . 12. b 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . . . . . . . .. . . . . . . . . . . . . . . . 11 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. 4 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES of 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 J ` �� y(�4 �, 16. 47 le 99 Iq 17. Amount of Line 14 taxable J� at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 G r� 19. TAX DUE . . . . . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . .. . . . . . . 19. 161 9/. Gw / 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX(R) Page 3 File Number �16 9 Decedent's Complete Address: DECEDENT'S NAME I-nll, e —4 _...___I ---- --- -,-- --,- -I - - . -- STREETADDRESS STAT E ZIP 7D Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1 Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 3. Interest 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 decadent make a transfer and: Yes No a. retain the use or income of the property transferred........ .......---.........- ❑ 2 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)(11)(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 F2 PS. §9116(a)(1.3)].A sibling is defined, e pa under Section 9102,as an individual who has at least on rent in common with the decedent,whether by blood or adoption. REV-1508 EX+(08-12) i= pennsylvania SCHEDULE E DEPAaTMENTOEaEVErvuE CASH, BANK DEPOSITS & MISC. tNE{ERIrnNCE rax REruR PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: �� FILE NUMBER: Y &�� rltrri c�P USN �l �CCt>i�/`fi�� 1U// 7`--Include the proceeds of litigation and the date the proceeds were received by the estate. Alf property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM _ _ NUMBER DESCRIPTION VALUE AT DATE -- —_ OF DEATH i.3 7 9-7 i i i I i i i I I TOTAL(Also enter on Line 5, Recapitulation) $ �.33 13 If more space is needed,use additional sheets of paper of the same size. , 902 r ' REV-1511 EX+(I,,'-Oq) Pennsylvania SCHEDULE H DEPARTMENT or REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF / ,J©��° •S �a y�oY .��.��(arrJccyF�USr /r � FILE NUMBER 1 , / /' - 6 y Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1. Flat 1pe zz� Fi�nFrc,.l >4� %�saa C'e�ne G '70, �o B. ADMINISTRATIVE COSTS: I 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: Z. Attorney Fees: 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: TOTAL(Also enter on Line 9, Recapitulation) $ y �� CO If more space is needed,use additional sheets of paper of the same size. 8 Market Plaza Way•Mechanicsburg, PA 17055 dal p ezzi Phone: 697-4696 FUNERAL HOME Michael J.Malpezzi, Owner Jeremy J. Shartzer, Funeral Director STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Kyle C.Knipe,Funeral Director Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain the reason in writing below. If you selected a funeral that may require embalming,such as a funeral viewing, you may have to a for embalming. ing you did not approve if you selected arrangements such as direct cremation or immediate burial.If we charged for embalming,we will explain why below. pay b You do not have to pay for embalm- For the Service of to: Charge Date of Death Name Address Ciry State A. CHARGE FOR SERVICES SELECTED; I. PROFESSIONAL SERVICES Other clothing Services of Funeral Director/Staff . . . . . . $ Cremation urn . . . Embalming .. . . . . . . $ (Description) Other preparation of body -- OTHF,R $ . . .. . . . . . . . SUB-TOTAL OF PROFESSIONAL SERVICES.. . . . . . .Ai $ TOTAL MERCHANDISE SELECTED . . . . . . . . . .. . . .. . .B $ 2. FACILITIES AND SERVICES C. SPECIAL CHARGES: Use of facilities and services for Forwarding of remains to viewing(Visitation/Wake) Use of facilities and services (Funeral Home}for funeral ceremony . . Receiving of remains from Use of facilities and services for $ Memorial Service . . . . . . .. (Funeral Home) $ Immediate Burial . . . Use of equipment and services $ for graveside service . . . . . . . Direct Cremation . . . g Other use of facilities SUB-TOTAL,OF SPECIAL CHARGES D.CASH ADVANCED SUB-TOTAL OF FACILMES/E UIp Q MENT . . .. Opening Grave . . . .. . ... . . . .. . . . . . . .A2 $ Cemetery Equipment . . . . . . . . . . . . . . $_--- 3. AUTOMOTIVE EQUIPMENT Lot and Deed $ Vehicle to transfer remains to Funeral Home 5 — Newspaper Notices-Local . . . . S _ Local Newspaper Notices-0 ut-of-to .. . . . . . wn . . . . . $ _ Hearse(Casket Coach) Telephone&Telegrams $ . . . . . . . . . . . . Local --- . . . . . . . . . . . . . Airfare . . . . . . . . . . . . . . . . . . . . . . . . $_ $ Clergy/Mass Offering b Limousine -- . . . . . . . . . . . . . . _ Local . . . . . . . . . . . . . . . . . . . . . . . . . $ Pallbearers . . . . . . S _ Family car Certified Copies of the Death $ Local. . . . . . . . .. . . . . . . . . . . . . . . . 5 Certificate . .. . . .. . . . . ... .. Flower car or floral disposition Police Escort . . . . .. . . . . . Local . . . . .. . . . . . . . . . . . . . . . . . . . 5 Flowers . . . . . . . . . . . . . . . . . . . . . . . $ — Lead car/clergy car Vault Service Charge .. . . . . .. . . . . . . $ Local ---- Car for pallbearers $ — $--- Local S — Out of town transportation . . . . . . . . . . --—`-- $--- $ $ SUB-TOTAL OF AUTOMOTIVE EQUIPMENT$ $--- SLBTOTAL OF ADVANCES . . . . . . . . . . . . . . .A3 $ D $ TOTAL OF PROFESSIONAL SERVICES, charge you for our services in obtaining: FACILITIES AND AUTOMOTIVE (specift cash advances that are marked-up) EQUIPMENT A $ B. CHARGE FOR MERCHANDISE SELECTED: SUMMARY OF CHARGES Casket.. . . . . . . . . . . . . . . $ A. Professional Services,Facilities and (Description) Equipment,and Automotive Equipment . . . . ... . . . .. . . . . . . . . . $ Other Receptacle . . . . . . . .. . . . . . . . $ B. Merchandise . . . . . . . .. . . . . . . . . . . . $ — (Description) C. Special Charges . . . .. . . . . . . . . . . $ - Outer burial container $ D.Cash Advances . . . . . . . ... . . . . .. . . $(Description) TOTAL OF ALL SECTIONS . .. . . . PAID AT TIME OF OR PRIOR TO . . . . . . .. . . . $ Acknowledgement cards . . . . . . S ANGEMFNT$ .. ... . . . .. . . . . BA . $ LANCE DUE .. . .. . . . . . Contract File Folder Name/Number CEMETERY INTERMENT RIGHTS,MERCHANDISE,AND SERVICES PURCHASE/SECURITY AGREEMENT THIS AGREEMENT PROVIDES FOR PERPETUAL/ENDOWMENT CARE. The undersigned,referred to as'Purchaser,hereby agrees to purchase the Interment Rights,Merchandise and Services described herein,subject to acceptance and approval of the above named cemetery,hereafter referred to as'Seller'. Purchaser:Last Name: First: j 'I I I I I I I I Middle: Telephone: SSW DOB: Email: Address: City: L_jj I j l State: Zip: Co-Purchaser:Last Name: First: Middle: Telephone: -----7- SSN:_ DOB: Email: Address: 1-1-1—1-i lily: I I I I I I ! L I I I I I State: L—L j Zip: Deceased:Last Name: First:s,t: Middle! DOB: t DOD: Burial Date: Veteran: Description of Interment Rights to be used: Memorialization Rights: Issue Certificate of Interment Rights to: Address: City: State: Zip: INTERMENT MERCHANDISE&SERVICES • Interment Rights Urn (Includes Perpetual/Endowment Care of$ Supplier • Interment and Recording Fees Type/Color • Outer Burial Container Design/Size Supplier Admin/Processing Fee Model/Design Other Material/Color • Other • Outer Burial Container installation Other MEMORIALIZATION Other • Memorial Other Supplier Other Type/Color TOTALS, ALLOWANCES&TAXES DesigniSize • Interment Rights --....... .......... ....... ......... • Memorial Base Reason Supplier • Merchandise/Service....................................... Type/Color Reason Design/Size Apply to • Memorial Perpetual/Endowment Care • Merchandise/Service.... .............................. • Memorial Installation Fee Reason • Memorial Inspection Fee Apply to • Naineplate/Scroll Sub Total • Lettering Total Taxable • Flower Vase Sales Tax(it applicable)...,.............................................. Supplier TOTAL CASH PRICE Type/Color Less: Down Payment Design/Size Other. • Vase Base Total Down Payment Size/Material Unpaid Balance of Total Cash Price S Notes&Payment Terms(where applicable): TERMS The Total Cash Price is due and payable as of the date of this Agreement. A delinquency charge of------percent will be assessed monthly on any balance not paid within 30 days of the date of this Agreement. If less than full payment is received, Seller shall deduct the accrued delinquency charge from the amount received and credit the remainder of the r)avment to the I finnniri Rilanop UPDEGRAFF & RUHL CERTIFIED PUBLIC ACCOUNTANTS 4330 CARLISLE PIKE CAMP HILL, PA 17011 (717) 763-8038 EIN: 25-1869799 Mr. & Mrs. Robert D. Taylor, Jr. (Confidential) INVOICE: 4541 3828 Carriage House Drive Camp Hill , PA 17011 :3 rq '27 3 STATEMENT AS OF MARCH 8, 2013 For the year ending December 31, 2012: Preparation of Federal , State and Local Income Tax Returns for 2012 Robert D. & Brenda K. Taylor Kristy L. Taylor $ 200.00 011ie L. Taylor 200.00 60.00 Total Amount Due PLEASE RETURN THE COPY OF THIS INVOICE WITH YOUR PAYMENT.