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1505610140 6
REV-1500 EX 101-111lFI)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601 2 1 1 2 0 9 4 4
_ Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 8 2 2 2 0 1 2 0 6 2 8 1 9 2 0
Decedent's Last Name Suffix Decedent's First Name MI
H E R R O N G R A C E V
(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
0 1.Original Return 2.Supplemental Return 3.Remainder Return(Date of Death
Prior to 12-13-82)
M 4.Limited Estate 4a.Future interest Compromise(date of 5.Federal Estate Tax Return Required
death after 12-12-82)
QX 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
9.Litigation Proceeds Received 0 10.Spousal Poverty Credit(Date of Death 11.Election to Tax under Sec.9113(A)
Between 1231.91 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
M U R R E L W A L T E R S , I I I E S Q 7 6 9 77' 4,'T16 M5 0
REGIStEFZ-QF WILLS U5.-I N,JJ
J
r :z CA)
Crl r
First Line of Address �'- r✓a "''' 'r
5 4 E M A I N S T R E E T
Second Line of Address =u s r— rrT
„77 —! r—
City or Post Office State ZIP Code L__ _DATE FILED 'T )t
M E C H A N I C S B U R G P A 1 7 0 5 5
Correspondent's e-mail address: 111urrel(o7WaltersgallowaV.COn1
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 ova,correct and complete.Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
51 URE OF PERSON RESP N ISLE FOR FILING RETURN DATE
c) 3
ADDRESS
BARBAR EA ER 240 WOODS DRIVE MECHANICSBURG PA 17050
SIGNATURE' E O ER THAN REPRESENTATIVE DATE
ADDRESS
MURREL WA TERS III ESQ 54 E MAIN ST MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
J 1505610240
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: GRACE V . HERRON
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . .. . .. . .. .. . .. . . . . . . . . . . . .. . .. . . . . . . 1. 1 6 6 4 1 1 , 6 3
2. Stocks and Bonds(Schedule B) . . . . . . .. . . . . . . . . . . . . . .. . .. . .. . .. . . .. . . 2. 1 5 5 0 7 5 , 5 1
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. 5 6 3 6 9 S . 6 3
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . .. . 6.
7. Inter-Vivos Transfers&Miscellaneous N n-Probate Property
(Schedule G) Separate Billing Requested . . . . . . . 7. 2 9 6 6 2 9 , 6 6
8. Total Gross Assets(total Lines 1 through 7) .. . . . . .. . . . . . . . . . . . . . . . . . . . 8. 1 1 8 1 8 1 2 , 4 3
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . .. . . . . . . 9. 9 6 4 5 5 . 9 7
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) .. . .. . . . . . .. . 10. 5 8 4 2 . 1 2
11. Total Deductions(total Lines 9 and 10) .. . .. . .. . .. . . . . .. . . .. . .. . . . . . . . 11. 1 0 2 2 9 8 . 0 9
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . .. . . . . . . . . . 12. 1 0 7 9 5 1 4 . 3 4
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. 1 0 7 9 5 1 4 . 3 4
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 _ 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate x.045 1 0 6 6 9 6 2 . 9 3 16. 4 8 0 1 3 . 3 3
17. Amount of Line 14 taxable
at sibling rate x.12 0 . 0 0 1-7. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate x.15 1 2 5 5 1 . 4 1 18. 1 8 8 2 . 7 1
19. TAX DUE . . . . .. . . . . . . .. . . . . . . . . .. . . . . . . . . .. . .. . . . . . . . . .. . .. . . .. 19. 4 9 8 9 6 . 0 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240 J
REV-1500 EX(Fl) Page 3 File Number
Decedent's Complete Address: 21 12 0944
DECEDENTS NAME
GRACE V. HERRON
STREET ADDRESS
610 GRANTHAM ROAD
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
I. Tax Due(Page 2,Line 19) (1) 49.896.04
2. Credits/Payments
A.Prior Payments 45.000.00
B.Discount 2,250.00
3. Interest Total Credits(A+B) (2) 47.250.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. (3)
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2.646.04
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 ............................... ❑ Q
c. retain a reversionary interest ..................................................................................................... ❑ I]
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ ❑X
3. Did decedent own an'in trust for'or payable-upon-death bank account or security at his or her death? ......... ❑X ❑
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
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 V2 P.S.§9116(a)(1)I.
• 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-1502 EX+(12-12)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GRACE V. HERRON 21 12 0944
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant fads.
Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1. 610 GRANTHAM ROAD 166,411.68
MECHANICSBURG, PA 17055
GROSS SALE PRICE
TOTAL(Also enter on Line 1,Recapitulation.) $ 166 411.63
0 more space is needed,use additional sheets of paper of the same size.
REV-1503 EX+(8-12)
pennsylvania SCHEDULE B
DEPARTMENT STOCKS & BONDS
INHERI fANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GRACE V. HERRON 21 12 0944
All propertyjointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MORGAN STANLEY 10,316.31
MUNICIPAL BOND FUND
2. U.S. SAVINGS BONDS 144,759.20
71 BONDS
REDEMPTION VALUE
I
TOTAL(Also enter on Line 2,Recapitulation) $ 155 075.51
If more space is needed,insert additional sheets of the same size
REV-1508 EX.(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
GRACE V. HERRON 21 12 0944
Include the proceeds of litigation and the date the proceeds were received by the estate.
All propertyjointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
1. PNC BANK 129,029.52
CHECKING
2. PNC BANK 25,038.19
MONEY MARKET
3. PNC BANK 288,168.08
INVESTMENT ACCOUNT
4. COMCAST 25.07
REFUND
5. MORGAN STANLEY 101,134.34
INVESTMENT ACCOUNT
6. NATIONWIDE INSURANCE 639.00
AUTO INSURANCE REFUND-$447.00
HOUSE INSURANCE REFUND-$192.00
7. MYERS-BUHRIG FUNERAL HOME&CREMATORY 2,970.00
REFUND
8. DODGE CARAVAN 2009 11,240.00
BLUE BOOK V ALUE
9. AFLAC 2,605.00
MEDICAL CARE-$1,705.00 &HOSPICE-$900
10. CHASE VISA 8.03
REFUND
11. HAAR'S AUCTION 337.40
HOUSEHOLD ITEMS
12. INCOME TAX REFUND 2,501.00
2012 FEDERAL
TOTAL(Also enter on Line 5,Recapitulation) $ 563 695.63
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GRACEV. HERRON 21 12 0944
This schedule must be completed and fled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF"KICABLE) VALUE
1. PNC INVESTMENTS 119,970.43 100.00 119,970.43
TRANSAMERICA
P.O.D. TO MICHAEL, STEVEN &TIMOTHY HERRON
2. PNC INVESTMENTS 62,707.72 100.00 62,707.72
NEW YORK LIFE
P.O.D.TO MICHAEL, STEVEN &TIMOTHY HERRON
3. PNC INVESTMENTS 12,551.41 100.00 12,551.41
ALLSTATE ANNUITY
P.O.D. TO BARBARA A. SHEAFFER
4. MORGAN STANLEY 59,400.10 100.00 59,400.10
MET LIFE ANNUITY
P.O.D.TO MICHAEL, STEVEN &TIMOTHY HERRON
5. MORGAN STANLEY 42,000.00 100.00 42,000.00
TRANSAMERICA ANNUITY
P.O.D. TO MICHAEL, STEVEN &TIMOTHY HERRON
TOTAL Also enter on Line 7,Recapitulation) $ 296 629.66
If more space is needed,use additional sheets of paper of the same size.
REV-1514 EX-(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GRACE V. HERRON 21 12 0944
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS-BUHRIG FUNERAL HOME&CREMATORY, MECHANICSBURG, PA 13,015.00
S. ADMINISTRATIVE COSTS:
t Personal Representative Commissions:
Name(s)of Personal Representative(s) BARBARA A. SHEAFFER 30,800.00
Sheet Address 240 WOODS DRIVE
City MECHANICSBURG State PA ZIP 17050
Years)Commission Paid: 2013
2, Attorney Fees: MURREL R.WALTERS, III 30,800.00
3. Family Exemption:(if decedents address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City state ZIP
Relationship of Claimant to Decedent
4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 797.50
5 Accountant Fees: JAMES HOLLAND, CPA 225.00
B. Tax Return Preparer Fees: JAMES HOLLAND,CPA 985.00
7, S.W. BARRETT REAL ESTATE&APPRAISAL SERVICES 375.00
8. REAL ESTATE SALE -SETTLEMENT CHARGES 19,458.47
TOTAL(Also enter on Line 9,Recapitulation) $ 98 455.97
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX-(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GRACE V. HERRON 21 12 0944
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
I. RICHARD WAGNER 450.00
LAWN MOWING
2. VERIZON 170
TELEPHONE
3. HOSPICE 3,700.00
RESIDENTIAL CARE
4. UNITED WATER 91.71
WATER
5. WEST SHORE EMS 209.29
AMBULANCE
6. CHASE FREEDOM 338.15
CREDIT CARD
7. PPL 509.27
ELECTRIC
8. DILLSBURG SEPTIC 221.00
REPAIR
9 PA DEPARTMENT OF REVENUE 319.00
2012 TAXES
TOTAL(Also enter on Line 10,Recapitulation) $ 5,842.12
If more space is needed,insert additional sheets of the same size.
REV-0543 EX.Nr-tioi
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GRACE V. HERRON 21 12 0944
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (Include ou ''ghtspousal distributions and transfers under
Sec.91 16(a)(1.2).]
1. MICHAEL O. HERRON Lineal
14 SURREY LANE
MECHANICSBURG, PA 17050
2. STEVEN P. HERRON Lineal
9240 MATTHEW DRIVE
MANASSAS PARK,VA 20111
3. TIMOTHY D. HERRON Lineal
SLODGEROAD
MECHANICSBURG, PA 17055
4. BARBARA A. SHEAFFER Collateral 12,551.41
240 WOODS DRIVE
MECHANICSBURG, PA 17050
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
7.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed,use additional sheets of paper of the same size.