HomeMy WebLinkAbout10-17-13 _-T �_ �� . __
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REV-1500°"°�">`�'�
PA Department of Revenue P���Ma O .CuLL U8E ONIv
Bureau of Individuat Taxes """��"'�`"'�` C.� nry CoEe Yeaz . Fda Number
PO BOX zeo6o1 INHERITANCE TAX RETURN ' �� 5�
HaM pq 1 1 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW �;
Soclal SecurHy Number Date of Death MMDDYYYY Data of Birlh - MMDDYYVY
........ ....... .. .. . ..._ _._ _._ ._... .i. _.. _....
04/05/2012 : 11/27/1907
DecedenPs Lest Name � � � ��. Suffix �� DecedenYs First 1� me � �� MI
Anthony , Evelyn ', ,
(NAppllqbls)Enter Surv{ving Spouae'a Informadon Balow .. . . . . . . . . . .
Spouse's Last Name Suffix Spouse's First Na MI
.. . . .... . ... . . . . ... ... .... . .. .. . . . .. .. ... . .. ....
Spouse's Sodal Securlty Number. _. .. ._ ... ... ...
THIS RETURN MUST BE FILED IN LICATE YYITH THE
REGISTER OF ILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Retum O 2.Supplemental Return O I 3. Remainder Retum(Date of Death
PriorW 12-13-82)
O 4.Limited Estate O 4a.Future IMerest Compromise(date of O 5. Fetleral Estate Tax Retum Required
deaM afier 12-12-82)
O 6.Decetlent Died Teafete O 7.Decedent MeiMalnetl a Living Tiust 0 6. Total Number of Safe Deposit Boxes
(Altech Copy of Will) (Attech Copy of Trust.)
O 9.Lidgation Proceeds Recaived O 70.Spousel Poverly Credit(Date ot Death O 7. Election to T�undx Sec.9113(A)
Between 1231-91 aM 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS 9EC710N MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENiIAI TAX IN ��RMATION SHOULD BE OBtEyTEO T0:
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Name . . .... . .... .... .. . ... . ... .... ... .. . ..... D ime l�phone Numbei� � �
John C Ouustowicz ( 17)2�-f�, 37 y � � o ,
. ... . ..... ._.. .. ..... ... . ..._ .... .. . ...... t,7 ,.r_. _{. ... — �, ,..
REqE QF�M11Lt$.,{(SE O�'m �
f—.,. n� � � b
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First Line of Address i ;'- ��' -'< O o
..... . .... . . . . _. . .. .._. .. . . ... . . . . ... .. . _. .. . , ..: c.� _n �t -�y.
104 S Hanover St. —'� -'" �
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�SecondLineofAddress . . .. . ... . .. . . .. . .. .. . . . . . . . =� �_.. � n7
. ._ . . .. . .. . .. .. _... . _._. . .. .. . . . .. . .. .�,. i _L V' �
C7J
Cityw�PostOffice ... . . .. ... .. . .. . . . . .. .... ..State 21PCode DATEFILED
..__ .__ _._. ___ __... .._. .._. .i..... ..... ,
i Carlisle PA 17013 '
Carerpondsnrs smail addm.:
u�a.r�anww orpe�wy,i aame nrei i�rw axamw�ea wa rewm,u�audMe��e ea�eawes ena �c,arw w me cesi a�n w�wn.dBe ana ceaet
N b We,oonec!rq ampeb.Deduatlon d prepver oMx thn Me po�eonel�epreeentetive is beaeA on ell i qon ol aAdCh prepver Ibe airy knowleOpe.
SIGW�NREOF RES FOR N DATE
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ADDRESS
19 Spring Dr., Downingtown, PA 19335
31GNATURE OF O ESEMATIVE D TE
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ADDRESS
104 S Hano t., Cadisle, PA 17013
PLEASB USE ORIGINAL FORM ONLY (
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Side 1
L 150561�105 � 15056101�5 �
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J Lsos6lozos !
REV-7500 EX(FI) �
Decedenfa Sociel Securlly Number
oaoaaeiw•�Mrne: . .'... .. . ......... . �'�..,
RECAPRLLATION
_,. . . ..... ..... ...._..._.
1. Reel Eetate(Schedule A). . ......................... .................. t. �� '�.
. + ._. ._�.._... ........__ ........
2. Stocks aiW Bonda(Schedule B) ....................................... 2. '., ',� ''�..
. __.�...,,. .._..__,,,_,.. .....____ _._.....,.�
3. Cbaely Held Corporatla�.Partnaship a Sole-Proprietoiahip(Schedule C) ..... 3. ���.�'. ,,�..�
...wi....� ............ .............. . . ._. �-..
4. Mortgeges and Notes Receivable(Schedule D)........................... 4. �...
5. Cash,Bank Deposits end Miscelleneous Personal Properry(Schedule E).... ... 5. ' 19,758.38 '���..
..... ._.. _..._. ........_......--
8. Jdntly Owned Property(Schedule F) O Seperate BIIIing Requasted ....... 6. I ���.���'��..
7. I�x-VNos Tranafero 6 Mlacelleneous NOn-PrObete Property . .. ..... .. . . .. ... . '��..
(Schedule G) O Seperate Billing Requested........ Z '��. '��..
. .,,,, . . . ,.__..... ...._._ .. ._�._-,.
s. roa�aros.Asa.b(roca luiea 1 mrougn 7)............................. b. ' 18�768.38 '
9. Funeral Expenaes end Administretive Costa(Schedule H)................... 9. �� 6,787.31 '�,.
10. Debts of DecedeM,Mortgage Llebiltties and liens(Schedule I)........... .... 10. �. 453.81 �'�,
...__ .._. _._. . ._
1t Total Dsducetons(wtal unes 9 and�o)................................. 7t '��, 7,241.12 �'��'�.,
.............. . . ..... , ......._,. .._.. �_
12. N�t lhlw of Esqb(Line 8 minus Line 11).............................. 12. �.. 12 517.26 '�.
13. Charilebb and Govemmentel BequestalSec 9713 Trusls for which �,`---. ......... -.__�.---- -..........w.. ._ -
an electlon to faz hea rat been made(Schedule J) ........................ 13. �
. .....� .. ......�..
74. N�t Wlus Subj�et to Tax(LJne 12 minus Lirre 13) ........................ 14. '�. 12,517.26 �'��..
TAX CALCUTAiION•SEE INSTRUCTIONS FOR APPLICABLE RATES
15. AmouM of Liiw 141ezable
at the spousal tez rete,w
tranafersunderSec.9176 ._..... _._ ...._ _._ _.._. .._. .
(ax12)X.0- ,',�, 15.,�'�., '�,.
....__."_-- --'---'_-______ _. ..__ . ._......... ............ . ....��_...
16. AmouM W Line 14 taxeble '���
at lineal rate x.0 4�` 12,517.26 I is. '' 583.28 '
17. Amount of Line 14 taxable _..,,.,..�m, �...�.� ._... _, . .,,,., _.: . . .... __ ..,. .. �...
at siblinp rete X.12 �.. 17, I
, _........... ..�_.., .. ......_._.. ; . � . .._w
1 B. Amount of Line 14 tazable .._ ........__ ......... . . . ....
at collaleral rate X.15 ... .. ... _... ...... . .... 18. � ,._ .... _.
_...
19. TAX DUE.............. ......... ......... ......... ......... 19. 563.28 '.
20. Flll IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Slde 2
L 1505610205 50561D205 J
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REV•1500 FJ((FI) Pape 3 Flb NunYl�ar
Decedent's Complete Address:
Everlyn Anthony �
STREETADDRESS —
442 Walnut Bottom Road
— -- - — ---- —+ _— ---
cm STA — LP
Carlisle PA 17013
Tax Paymenta and Credits: �
i. Tax Due(Page 2,Line 19) (1) 563.28
2. Credite�Payments i
A Prior Paym�ts �
B.Disoount
Total Crediis(P) B) (2)
3. Interest j
(3)
4. If Line 2 ie gr�er tl�Line 1+une 3,enbr y�e diRerence. This is Ne OVERPAYIAENT.
Ffll In oval on Pays 2,Line 20 to roqusat a rofund. (4)
5. H Line 1+Line 3 is greater than Liire 2,enter the dilference.This fs the TAX DUE. (5) 56328
Make check payable to: REGISTER OF WILLS, GENT.
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN HE APPROPRIATE BLOCKS
1. Dk decedenl make a transfer and: Yes No
a. Main the use a hwrome of tlie propeAy tranaterted............................................................ .......................... ❑ �
b. �eta�the rigM to deai�ate wlw shafl uae Ihe ProPeAy transferted or its income.............. .......................... ❑ �
c. retain a rerasionery iMereat................................................................................................ .......................... ❑ �
a. receFre nre pomiae ror uie w eitl�er parmeMS,beneflts o�care�......................................... .......................... ❑ ■
2. If deatl�oxurted afler Dec.12,1982,did decedent Vansfer property within one year of death
without recerving adequate consideration9............................................................................................................ ❑ �
3. Did decedent own en 5n 6usl for a payable-upon-0eath bank aaount or security at his a death7.............. ❑ �
4. DIO deoedent own an Individual retlrement accouM,annuily a other nor�probate p�opeAy,w '
cor�s e benefidery designatbn7 ...................................................................................................................... ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUEST10N5 IS YES,YOU MUST COMPLETE SCHEDU G AND FILE IT AS PART Of THE RETURN.
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Far dates of death on a afler July 1,1894,and before Jan.1,1995,the tax rate imposed on the net value o nsfers to or for the use of the surviving spouse
is s percent(7z P.s.§s�1s(a)(�.1)(i)].
For dates ot dealh on a after Jan. t, 1995, !he fax rate imposed on ihe net value of Vansfers to or f tlie use of the surviving spouse is 0 percent
(72 P.S.§9116(a)(1.1)(e)].The stadRe does not exempt a transfer to a surviving spouse from tax,and the s ry requirements for disdosure of assets and
f�ing a te�c redim are stip�pik�ade even ff the surWving spouse is the only benefldary.
For de�s of death on a a1Ber July 1,2000:
• The tax rate imposed on itre net value of VansTers from a deceased child 21 years af age or younger death to or for the use of a naWrol parent, an
adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(aH1.2)].
• The tax rate imposed on the net value of 7ansfers ta or fa the use of ihe decedenfs lineal benef�daries is 4. percent,except as noted in[72 P.S.§9116(a)(1)].
• The tax rate imposed an the iret value of transfers to or fa ll�e use of the decedents siblings is 12 pe ent[72 P.S. §9116(a)(1.3�].A sibling is defined,
under Secdon 9102,as an individual who has at least ane parent in comman with the decedent,whethe y blood or adapGan.
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REV-f5o8IX+(o8-u)
�pennsylvania SCNEp11LE E
UEPARTMEF�TOFREVENUE CASH, BANK DEPOSITS & MISC.
INH6UTAN�TA%RENRN PERSONAL PROPERTY
RESIDENT pECEDEM
ESTATE OF: ��ry��R;
Evelyn Anthony 21-13-0508
[nclude the proceeds of Iltlgatlon and the date the proceeds were receNed y the aWte.
All ProPeKY 7d�Y ownad wkh rlpM of wrvNonhlp muat be disd �� Schaduk F.
� VALUE AT DATE
NUMBER DESCRIFfION ' OF DEATH
L F'ust Niagara Checking Acct ending in 6791 ! 7,690.90
2' First Niagara Certificate of Deposit ; 12,067.48
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TOTAL(Alw enter on Line 5, pitulation) ; 19,758.38 '
If more space is needed,use addiNonal sheets of paper of the sam ize.
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REV-1511 EJt+(pfl-Y3} �
SCHEDULE H
�pennsylvania i
�PU+TM�M��+� FUNERAL EXPEMSES AND �
iru+c�nn�rucaeruurtn ADMINISTRATIVE COSTS
RESIDEM DC{E�ENT
ESTATE Of FItE NUMBER
Evelyt�Rrr#hany 21-13-U5d8
Deced�t's dabb must 6e reported on Schedule I� i
ITEM
NUMBER OESCRI7TtON AMOUNT
a. FUNERA4�JtP�NSES; i
i. HoHman Roth Funeral Home,Cariisle,PA 4,528.52 '
2 RiNa's�staurant-foodfarmemoriai _ . , 560.09'
3 Honaariums tq pastor&orgariist ; 150.00 :
a Westr�anster Cemetary-headstone engraving 210.44
B. ADMINISTRATIVE COSTS: __ _
i. Personal RepraentaHve Cammisao�: I
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Name(s)of Personal Representative(s) � � � �� � � � �
Streek Address
City State� SP_,,,.,
Ywr(s)Commission Paid:
2• Attomey Feas: .
1,000.00
3. Family Fxamptfon: (If decedmt"s addre�s is nM ttre snme as daimaM's,aHach�pia�ation.} ( . , .
Claimant
� Street Address
Ciry Stah�,_ IP
' Reiatianship nf Gaiment ta Decedent
4. Probate kes: i 148.50
f :
5. Acc�rdm�kes: i
8. 7az Retum Weparer Fees: �
--� -.>_ , .� .. , ,
7. The Ssntinei-Iega1 advertising 115.20
a, CumbeAand County Law Joumal-lagal advefiaing 75.00
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TOTAL(IUso enter on Li 9, Racapitulation) � 6,787.31 `
If�re space is needed,use addki�al sheets flf paPer 4#the same � . . .,.:. .
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REV-1512 EX+(]2•II) �
�pennsytvania SCHEDULE I I
DEPANfMENTOFREVENUE DEBTS OP DECEDENT, �
'""E"'T""�T""^E"'"" MORTGAGE LIABILITIES 8c LIENS
RESIOFlf�OEGEDEM
ESTATE OF FIl.E NUMlER
Evel n Mthon 21-13-0508
Raport da�s InamA by Ma daadaM pNOr to daathlha!rcmalned unpNd at ths ds�of dath,I �udinp unrNmbuned�dlal axpan�n.
�M VALUE AT DA7E
NUNBER DESCRIPfION OF DEATH
1 Centurylink phone bil 7,g7
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2 ThomwaW Nursing Home-final bill 445.94
TOTAL(Also enter on Line 10, ecapituladon) ; 453.81
If mwe space Is needed,InsM addiUonai sheets of the same size
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REWi513 E%+(O1-10) .
�pennsylvania SCHEDULE �
DEFANTMENT Oi NEVENUE BENEFICIARIES
IMIBUfRNCE TAX RENRN
RESmB/f O[CEOEM
ES�ATE OF: FILE NUMBER:
Evelyn AMhony 21-13-0508
RElAT10N5N �.TODECEDENf AMWMOHSHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEMNG PROPER7Y Do NM LI ��Tru�taa(s) Of ESTATE
I TA%ABLE DISTRIBUTi0N5[Indude oWight spouul dlsbibutions and transfers under
. . .... . . Sec.9116(a)(1.2),I . . . ... . .... . . . . . i . . . . . .. .
1• Joseph E Mthony,Jr.,19 Spring Meadow Dr.,Downingtown,PA 19335 'Son 100°�
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ENTER DOLUR AMWNTS FOR DISTRIBUTIONS SHOWN A80VE ON LINES 151HRWGH 18 OF REVd COVER SHEEf,AS APPROPRIATE.
�I PIWI TANABLE DISIRf&RIONS
0. SPOUSAL DISTRIBUTIONS UNDER SECf10N 9113 WR WHICH AN ELECRON TO TAI(IS NOT TAK :
1. _..... . _ ._. .__.. ..... ...... . . .. ... . ... . . ._. . . . . ..
.. .. . 8. CHARRABLE AND GOVERNMENTAL DISTRIBUIIONS...... _. .. _ .... . .. . . . . . . .... .........
1. � . . . .. . . ....
TOTAL OF PART II—ENTER?OTAL NON-TAXABLE DISTRIBUf[ONS ON LINE 13 OF REV-15 �ICOVER SHEET. ; ��.
If more space Is needed,use addidonal sheets of paper of the same te.