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Home My WebLink About08-12-13 (2) � 1505610143 REV-1500 Ex`�.,,,�, OFFICIAL USE ONLY PA DepaRment of Revenue pennsyfvania couniy coae ves� Flle Numpe� Bureau of Individual Taxes ^o+a^��^�^M� ao aox2eoso� INHERITANCE TAIC RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT °� i � I O�gD ENTER DECEDENT INFORMATION BELOW Social Securily Number Dale of Dealh Date of Birth 08 06 2011 05 12 1927 Decedenfs Last Name Su�x DecedenYs Firsl Name MI Txoru� �xx, x (IfApplieable)Enter Surviving Spouse's Information 8elow 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 {NiL�S FILL IN APPROPRIATE OVALS BELOW � 1. Original Relum � 2. Supplemental Retum ❑ 3' prior t n12 13-82) (Date of Dealh � 4. Llmftetl Esfate � qe.Fvtura IMeraffi Comwomise � 5. Federal Estate Tax Retum Requi2d (Eate af tleaU eRar 12-1482) � 8, DeceEenl DioO Tes�ele � � UeceEeqi MeIMBirred�LMrp Trust __ 8. TOf31 NURIbEf O(S21B DE S�l BoXE9 (Atleth Copy W Will) (AneM�opy o(Tnmt P° � 9. Litigatlon Proceeds Receivetl � 10.ysg°�'��P��a�� 71.Election to tax untler Sec.9713(A) (Attac�Schedule O) CORRESPONDENT•7HIS SEC710N MUST BE COMPLE7ED.ALL CORRESPONDENCE AND CONFIDEN7IAL TAX INFORMA710N SHOULO BE DIRECTED 70: Name Oaytime Telephone Number htP,RR A MATEYA 717 241 6500 REGISTER OF WILLS USE ONLY � � m First Line of Atldress c � � � c> 55 W CHURCH AVENUE i � � �� m = c� -a m Second Line of Atldress ^� 7x � �"'� ' � �— Z fi i (v p O ZNT- d � Ci or Post Office � C'? UATE F 6J ED '� -�rt h SGte ZIPCOde C� v '„ ; � CARL=SLE PA ° � c� r— m ' = � i— o "o c�� u' -*� � {J Correspondenfs e-mau adaress: mam@mateyalaw.com UnEer penalties ofpe�ury,I CeUare lhat 1�ave examineE Uis retum,InUudinB accompanyi,ng schcWUles an0 atetements,and to the best of my Nnowledge anE belie�, ft�s We,corted anA complete.Decla2tion of preparer other than Ue personal represenlallve is base0 on ell lnfartnadon ot whicli preparer has any knov+letlge. SIGNATURE F PERSON RESPONSIBLE F/O�R FILING RETUftN DATE � 1 L., �_� KarlCThoma � A��,,,i �ac3 AO R S$ 1130 Shan on Lane Cartisle PA 17013 SIGNANRE OF PR PAR R O ER THAN REPRESENTATNE pp}� �.��1/��.�t�p Mark A. Mateya $ - 8- f 3 aooaess l� U 55 W, Church Avenue, Carlisle, PA Side 1 � 1505610143 1505610143 J _ _ � 15�561�243 REV-1500 EX . RECAPITULATION 1. Real Estate(Schedule Al....................................................................................... 1. 2. Stocks and Bonds(Schedule 8)............................................................................. 2. 3,7 31 _ 62 3. Closely Held Corporation,Partnership or Soie-Proprietorship(Schedule C)...,..... 3. 4. MoRgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers$Miscellaneous f�oq-Probate Property (Schedule G) U Separete Billing Requested............ 7. 8. ToWI Gross Assets(total Lines 1 through 7).......:................................................ 8. 3�'J31 . $2 9. Funeral Expenses and Administrative Costs(Schedule H)............................._.._. 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines 9 and 10)......................._.............._..._.................. 1�. 12. Net value of Estate(Line 8 minus Line t t).......................................................... t2. 3 , 731 . 82 �3. Charita6leandGovemmentalBequests/Sec9113Tmstsforwhich an election to tax has not been made(Schedule J)............................................... 73. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... 14. $� 73�. _ 82 TpX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES �5. Amouat of Line 14 taxable at the spousal tax rale,or transfers under Sec.9116 (a)(12)X.00 15. 0 . DO �6. Amountof Line 14 taxable 3 � 731 . 82 16. 167 . 93 at lineal rate X A45 17. Amountof Li�e 14 taxable at sibling rate X.12 � . �� 17. � . �� 18. Amount of Line 14 tazable at collateral rate X.15 � . �� 18. O . OO �s. raxoue................................................................................................................ �s. 167 . 93 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OYERPAYMENT. � Side 2 L 1505610243 1505610243 � REV-1500 EX Page 3 File Number DecedenYs Complete Address: DECE�ENT'S NAME Thoma, Karl H STREETADDRESS 1130 Sha�non Lane CITY STATE ZIP Cariisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (7) 167.93 2. Credits/Payments . A. Prior Payments 0.00 B. Discount 0.00 Total Credits(A +g) (2) 0.00 3. lnterest - �3� q_ If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to requ�st a refund 5. If Line 1 +Line 3 is greater than Line 2,enter the diHerence. This is the TAX DUE. (5) �s'],93 Make Check Payable to: REGISTER OF WILLS AGENT. � � � .�� T __ , � ..� PLEASE ANSWER THE FOLLOWING QUESTIONS BY PIACING AN "X" IN THE APPROPRIATE BLOCKS 1. �id decade�t make a transfer and: Yes No a. retain the use or incame of the property trans5erred:............................................................................... � b. retain the right to designate who shall use the propeRy transferred or its income:.................................. � ��011 c. retzin a reversicna:J in:e.reaY,et................._............................................................................................ L�' d. receive fhe promise for life of either payments,benefits or care?............................................................ � 2. If death occurred after Dec. 12, 1982, did deceden[ transier property within one year of death without receivingadequate Consideration?.................................................................................................................... ❑ 0 3. Did tlecedent own an"in trust fo�' or payable upon death bank account or security at his or her death?....... ❑ Qx 4. Did decedent own an individual retirement account,annudy,or other non•probate property which ❑ ❑ � contains a beneficiary designation?.........................................................................................._..............._..... z IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF SHE RETURN. ' �� . ��s:. ,. , ..z ., .�� . ,.,: �. . . _ W . - -., . � .�. . �. �... . .x . . ... .. .�q..� ,.,.�. �. ;. �� :.., _� . ::a For dates of death on or after Jury'I,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.§91'16(a)(1.�)(i)). � For dates of death on or after January 7, 1995,the tax rate imposed on the net value of trensfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9�'16(a)(1.5)(ii)j. 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 benefciary. For dates of death on or aker July 1,2000: • The tax rate imposed on the net value of transfers trom 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 decedenPs lineal beneficiaries is 4.5 percent,except as noted in [72 P.S.§9116(a)(1)1. . . The tax rate imposed on the net value of tra�sfers to or for the use of the decedenPs siblings is 12 percent[72 P.S.§9116(a)(�.3)]. A sibling is defined under Section 9102,as an undividual who has at least one parent in common with the decedent,whether by blood or adoption. Rav-15U3 EXi(6A8) SCHEDULE B STOCKS & BONDS COMMONWFALTHOF PENNSttVANIA INHERITANGETA%RETURN RESIOENTOECEOENT ESTATE OF FILE NUMBER Thoma, Karl H All properryjoinllyownetl With right of aurvivwship�wst be Eiaclosetl on Schetlule F. ITEM CUSIP VALUEATDATE NUMBER NUMBER DESCRIPTION UNiT VALUE OF DEATH 1 17 shares of Huntington Ingalls Industries-1 T Shares of 30.51 518.67 Common Stock-Account No. C000022U451 2 93 shares of MetLife Stocks-93 Shares of Common Stock- 34.55 3,213.15 AccountNo. C0054327722 TOTAL(Also enter on Line 2, Recapitulation) 3,731.82 pf more space is�uetled,atlditional pages of the 5ame size) � Copynght(c)2002 form software only The Lackner Group,Ina Form PA-1500 Schedule B(Rev.&-98) ,