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Home My WebLink About09-27-13 � � 150561C1143 REV-1500 �'°,��' ��' dFFICIAt USE ONtV PA Department of ftevenue pennsylvania counry Coae vee� File Number Bureau of Individual Taxes 0e'"TM�"�"�"� PO BC7X280601 INHERITANCE TAX RETURN 2�, 1g Q743 Harrisburg,PA 17128-0607 RESIDENT DBGEDEFIT ENTER DECEDENT INFORMATldN BELOW Social Secudty Number Date of Death Date of Birth Name Suffix DecedenPs First Name MI HARLIN ,7R. J�'u" D (If AppFicabley Enter Surviving Spquae's infartnation Below Spouse's Lsst Name Suffx Spouse's First Name MI HARL2N JEAN V Spouse's Sociai Senurity Number THIS RETURN MUST BE FILED IN pUPLICA7E WITH THE REGISTER OF WILLS FILL IN A?PROPRIATE dYALS BELOW � 1. Onpinal RMUm � 2. Supplemental Retum � 3. Remaintler Retum(date W death pnorto 12-13-62) L� 4- timited Estate �� 4a,Fwxe mterest Corrg�ra+eae j� 5. Federai Estate Taz Retum R uired ttl�eU�e>hafter12A2�82) �'W g pecetlaM Dietl Tes�ete � pp�g e t Mei ined a Living Truet 0 �� U+nach copyofwin) ❑ � (nnac��opy o�n,aq -..._ 8. Total Numder of Safe Deppsit Boxes � a i�ao�P�eea�r�ea (� 2 �a ��,i�',3"�- ��£�s�r°�' ❑ ��.E��or,�mxu��s� e»�a} �ana�,s�n.o} CORRESPONDENT�THIS SECTION MUST BE CdMPLETED.pLL CORREBPpNDENCE AND CONFIDENTIAL TAX INPORMATION SHOULD BE DIREC7ED TO: Name Daytime Teiepho�N�ber BRADI�EY L GRIFFIE 717 �?43 SS51 c reE6rszES`tsF wnu:susE bw[,�,' rn __� � , .a �': r Firs�line af aadress r-- �`-+ =" �..ti :.. -,.t . . 240 NORTH HANOVER STREE _� , : , � Second line of address ��'� ��- . .-:�:? � �� _. : ��:! �_._.. � Ctty a�Post tlffice Sffite ZIP Code �� DATE FIItfrD +:� ", �i+=�� PA 17013 Correspontlent's e-mall eddr9ss: �9r��G9ri��IBW.COIT Underc penalties o/peryury,I deGare that I have exeminetl this retum,iocludin0 accompanying schetlules antl atafeme�ts,anC to t�e beot of my knowiedge and beliaC, li is trwe,corzed�+tl compkRe.�eGaratlon of preparer Wher ttfan the personai nspresemative is 6asetl m ali ir�tammation ot which preparer nas any knaMetlge. SIG RE OF PERSQN RE&P NStBLE FOR FIIING RETURN 6ATE V .�...r� Jean V. Harlin 6 �� no s , 10 8 Centerviile Road Newvilie PA 17241 SION UR OF ESENTATIVE DAT Bradiey L GriHie `� �b � aoo 200' h Hanover Street Carlisle PA Side 1 � 150561�143 1S[]5610143 � /� 1' J 1505610243 REV-1500 EX RECAPITULATION - 1. Real Estate(Schedule A)....................................................................................... t. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5� Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 2 , 008 . �0 6. Jointly Owned Property(Schedule F) ,� Separete Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Nnq Probate Property (Schedule G) !I Separate Billing Requested............ 7, 8. Tofal Gross Assets (total Lines 1-7)..................................................................... 8. 2 , 008 . 00 9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 5 , 616 . 48 10. Debts of Decedent,Mortgage Liabilities,6 Liens(Schedule I).............................. 10. 60 , 938 . 07 1 i. Total Deductions(total Lines 9&10)................................................................... 11. 66, 554 . 55 72. Net Va�ue of Eswte(Line a minus Line 1 t).................................. -64 �54 6 . 55 ........................ i 2. 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 Tau(Line 12 minus Line 13)............................................... �4. -64 ,546. 55 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(12)X .00 0 . 00 15. 0 . 00 t6. Amount of Line 14 taxable at lineal rete X .oa5 0 . 00 16. 0 . 00 17. Amount of Line 14 taxable at sibling rate X.12 � . �� 17. Q . Q Q 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. Q . Q Q 19. Tax Due.................................................................................................................. 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REpUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 1505610243 150561U243 J REV-t500 EX Page 3 File Number 21-13-8743 DecedenYs Complete Address: DECEDENT'S NAME Harlin,James D.Jr. STREETADDRESS �� '�� 9008 Cerrt�rville Rqad CITY --.—..��.-----------------�------STATE ZIP i-- Newville I PA I �7241 Tax Payments and Credits: i. TaY Due(Page 2,kine 19) {1} 0.60 2. Gredits/Payments A. i�rior Payments B. Discount 4.06 � � Tptal Credits{A +g} {2} 0.00 3. InteresY (3j q, If line 2 is greater#han Line 1 +Line 3,enter the dii'ference. This is the OVERPAYMENL �q) Check boz on Paga 2 Lirre 20 M request a refuntl 5. If Line 1 +Line 3 is greater than line 2,enter the diffarence. This is the TAX DUE. {5} O,�(} Make Check Pa able to: REGISTER OF WILLS AGENT. E Pi�EASE ANSWER THE POLLOWlNG GtUESTiONS BY PLACING AN"X"!N THE APPROPRIATE BLOCKS t. Did decede�rt make a transfer arttl: Yes No a. retain the use or income of the property tranaferred......................_......._...._....._.................................. ❑ b, retain tfie right to tlesignate who shali use the property tr8nsfertetl or its inwme:.................................. � c. retain a reversianary interest:or.....__.._._._..........................................._......._......_..._._._._...---.....__ Lx d. receive the promise for iife W either payments,benefits or care7............................................................ � 2. If tleath accurred aRer December 12, t982,did decedent tran8far property within one ysar pf death mrithaut r� receiving adeQUaie consideration?.................................................................................................................... ❑ ux 3. Ditl decedeoS own an"in trust for" or payabie uAQn death bank account ar sewrity at his or her deffih?....... � � 4. Ditl decedent own an Individual ftetirement Account,annuity,or other non-probate praperty which .� � cantains a beneficiary designation?.............................._...._...................._..... ' .._...................................._......_ � x iF THE ANSWER TO ANY OF THE A86VE 4UES710NS IS YES,VOU MUST COMPLE7E SCHEDULE G AND FILE IT AS PAR7 OF THE RETURN. For dates tif deakh on or after Juty 1, 1994 and before Jan. t, t 995,the tax rate imposed on the neS value of transfers to or for the use of the surviving � spouse is 3 percent(72 P.S.§9115(a)(i J7(i)]. For dates of death on or after January t, 7995,the tax rate imposed on ihe net value of transfers to or for the use of the surviving spouse is 0 perc:enf [72 P.S.§9176(a)(1.1)(ii)j. 7he statute dces not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and'-filing a tax retum are sHll applicable even if the surviving spouse is the oMy beneficiary. For dates af death on ar after July 1,2000: . The tau rate imposed fln the net vatue of transfers from a deceased chiid 21 years of ege or younger at tleath to or for tM1e use of a naturai parent,a� adoptive parent, or a stepparent of the child is 0 percent[72 P.S. §9716(a)(1.2)]. . The t�rate impased on tMe net vaiue of tra�sfers to or for the use of the decetleM's iineai beneficiaries is 4.5 percent,except as naied in 72 P.S.�9116 1.2)[72 P.S.§9116(a)(1)1. . The taac rate imposad on the net vaiue of transfers to ar tflr tF�e use of the decedeM's sibiings is 12 percent[72 P.S.§9116(a)(1.3)j. A sibling ie defined under Section 9102,es an individual who has at least one parent in common with the decedent,whether by blood or adpption. rtar-t5aa EX+S5.9g} SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMqNWeaLTNOFCENrvsvLVANin INHERRANCETAXRE(URF RESIpENiDEGEDEM ESTATE OF FILE NUMBER Harlin,James D.Jr. 27-13-4743 Inclutle the procaetls M litigefion entl the tlate tM proceetla ware receivetl by ihe estate All prop�rty}aintlycwnstl wiTh the rigM of aurvNnnhip must ba Eiecio�aC ott vcMduie F. ITEM VALUE AT DATE NUMBER DESCf21PTI0N OF C}EA7H 1 1898 Chevrolet Tahae- 2,QOS.QO (See adacHed Kelley BI�e Bopk vaiuej TOTAL{Also eMer an Line 5, RecapitulaGort) 2,80$.00 {tt mwe sp<�oe is�eetletl.aGdi6onat papes of Ne same s"va} Copyright(c)2002 form sottware only The Laakner C,roup, Ina Fortn PA�1500 Schedule E(Rev.6-98) i �-it5t�+t,�} SCHEDULE H CQMMO F� �AN,A FUNERAL EXPENSES & �"`�o�� ADMINlSTRATIVE COSTS ESTATE OF �t�E NUMBER Harlin, James p.Jr. 21-13-0743 Debts of decedent must be reported on 9chedule I. «� pESCRIPTION AMOUNT q, FUNERAL EXPENSES: See cantinuatian schedule(s)attached 3,873.18 B. ADMINtSTRATIVE COSTS: t. Perso�al Representative's Commissians Name of Personal Representative(s) Streek Address Ciry State Zio Year(st Commission Aaid ^ z. aaornev�s Fees Griffie 8�Associates, P.G. 1,500.� 3. Family Exemption: Qf tlecedenPs address is nat the same as daimanYs,attaqh euplanation) Ciaimant Street Address City Skate Zin Reia#ionshio of Ciaimant to Decedent 4. Probate Fees 5. Accoun#anfsFees 6. Tax Return PrepareYs Fees 7. CYtherAdministrativeCosks 243.30 See eantinuatian sehedule{s)attached TpTAL tAfsa errter on line 9,Recapituiation) 5,616.48 CopyriAht(C)20tl9 form software onty The LaCkner Group, Inc Fortn PA-1500 Sahedule H{Rev_10-06) i SCHEDULE H FUP1ERAl. EXPENSES AIYD ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Harlln,James D. Jr. 27-13-0743 ITEM NtlMBER DESCRIPTt6N AMOUNT Funeral Exoenses 9 Haffman-Roth Funera!t+ome 3,873.78 y^A 3,8T3.78 dther Administrative Gosts 2 Cumt�erkand Law Jouma!{Advertising} 7r�0� 3 The Sentinel(Advertfeing) 168.30 H-B7 243.30 Copyright(c)2002 form sbflware only The Lackner Group,Inc. Form Pp•1500 Schetlule H(Rev.6-98) rse��s�s ex+�ia-0e� SCHEDULE 1 DEBTS OF DEGEDENT, MORTGAGE LIABILITIES, & LIENS COMMqN W FALTH OF PENNSYLVRNIA INMERITGNCE TA%RETIIHN RES�CERT pEC@pEM ESTATE OF FILE NUMBER Harlin,James D.Jr. 21-13-0743 Report tlebM Ineumtl by Ma tlseadent pHOr to tleatM Ihet nmainW unpeitl et the deta af tlsath,inclutlinp unraimdunetl matlical azpanees. IFEM VAIUE AT QA7E NUPABER DE3CRIPTi4N OF DEATH 7 Chambersburg Hospital 4,393.01 2 Summit Physician Services 3$5.78 3 Apria Healthcare 405.06 4 American Honda Finance Corp. 2,709.35 5 CaNisie Reglona!A�Medica!Cent+er 9$,313.87 6 MBNA America, N.A. 2,45U.79 7 Summit Aneathesioiogy 136.SU 8 Chambersburg Imaging Assoaiates 114.24 9 Health Network Laboratories 15.79 14 Spring 12aad Family Practice 232.81 11 American Express Centurion Bank 2,973.65 12 Capitat One Bank 22.889.00 13 Chase Health Advance 4.908.44 TOTAL{Aiso enter on Line 10,Reca�pltutation} 60,93$.O7 {lf more Space is neetletl,atltlitionai peges of the Same size) Copyright(c)2p09 form soflware only 7he Lackner Group, Ina Form PA•1500 Schedule I(Rev. 12-08) i REV-0b13 EX+�71-08) SCHEDUI.E J coM��o��vnNia gENEFiC1AR{E5 ESTATE OF FILE NUMBER Hariin,James D.Jr. 21-13-0743 RELATIONSHIP TO NAME AND ADDRESS OF SHARE OF ESTATE AMOUN7 OF ESTA7E NUMBER pERSON(S)RECEIVING PROPEftTY DECEDENT (yVOrtls) ($$$) � TAXAB�E DISTRIBUTi6NS [i�ciude outright spausai distrlbutions,and transfers under Sec.9718 a 1.2 7 Jean V.Marlin Wife Qne hundred t608 Centervilie Raad peroent of net Newville,PA 17241 distrlbutable estate TO#81 Enter dollar amounts for distributions shown above on lines 15 thro h 18 on Rev 150Q cover sheet as a ro riate. NON-TAXRB�E diSTRlBEl7IOMS: ii• A.SPOUSAI DISTRIBUTIONS UNpER SEC71pN 9113 FOR WHIGH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GflVERNMENTRL DlSTRIBUT14PtS 707At 6F PART tF-ENTER TOTAL NON-TAYJtBLE DISTRIBUTIONS ON UNE 73 OF REV-15pp COVER SHE Copyright(c)2009 form software only The Lackner Group, Inc Fortn PA•1 S00 Schedule J(Rev. 11-08) _ _ . Kelley Blue Book Page 1 of 2 � Kettey Btue Book r�T��s�a�� ____ r � ,�,; ," � ' FfllDsr "fl�,qps' ', '.. aavertlxmmt ._.. __ ��. wM aas? Used 1998 Chevrolet Tahoe Pricing Report , E��,r,;., . . .._._ �, Style:scwc unnN 40 ��... Mileage:is0000 � F ��. f�:x. ,. '�� E� ''�.. Private Party Value � I Excellent...�.��— . .��.' $2,833 i ' � ; Very Good . ��.�'.. ' S2,633 � Gooa . ..... �',.,., ' S2,508 ,. �'�.. Fair . ,��.'�.. $2,008 ' Vehicle Highlights � MPG:City 12/Hwy 15 Max Seating:6 '��.. � Doors:4 Engine:V8,5J Liter '�.. Drivetrain:4W D Transmission:Automatic ' EPA Class:Sport Utiliry Vehicles Botly Sryle:Sport Utility '�.. Country of Origin:United States Country of Assembly:United States � , Your Configured Options Our pre'selected oPtlortS,basetl on tYViml e9uiPmen[for MI5 or. ..��'' �� !Optims Mat you atlded whik confguring this mr. : http://www.kbb.com/chevroledtahoe/1998-chevrolet-tahoe/sport-utility-4d/?vehicleid=632... 8/29/2013 _ . _ Kelley Blue Book Page 2 of 2 Engine Braking and Troction Safety and Security Op is95-2ot3 V8,SJ L'Rer ABS(4-Wheel) Dual Air Bags ewe emk co. Transmission Comfort and Convenience Carqo and 7owinp � mi nynrs reve� � Automatic Air Condi[ioning Roof Rack ��. Drivetrain Power Windows . Wheels and 7ircs � 4WD Power poar Locks Alloy Wheels '��. Accessory Packages Cruise Conhol '�.. LS Steering , Power Steering � �. . Tilt Wheel . EMeriainment and InstrumeMation '�. AM/FM Stereo . '�, Cassette '�. rtl]Ol3 Nelley Blue Book Cc„Inc A/I tlgM161c'erveLL B/23/3013-B/29/3013 EtllNOn/or Ponnsylvanla I]101.T�e spe[lOC In/ormetlon ieqWma to OeMmine[M1e value b�Nrs per4wlar rehi[k w su00fletl bV Me person qmerehng MB rtport.VeM1icle velwHOns are oqmons anE may vary fivm veMOe ro veMCle.Acfual value[bns wpl vary base0 u0on maikel mnpltlons,SpttlBUf/ons, �� veM1itle mnplHO�or ofher parFalar[Ircumslentts pertlnen[(o t/ns Oarticular vehick or Me transac[bn or Me{v�ties ro[he hansacflon.Tbls re0ort is mtenJM br[be inElNOVaI use olfhe OMan �� pmeratln9 tMS rcpart onlY an0 sMII no[M ml4 0�bansmttRO N anotberparty KelleY&ue Book assumes no rcspansdlllry k�errors or omisslons.(v.13p63) http://www.kbb.com/chevroleUtahoe/1998-chevrolet-tahoe/sport-utility-4d/?vehicleid=632... 8/29/2013