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Home My WebLink About10-24-13 (2) � 150S61p140 REV-15�8 �` {°�_„'{F� PA Depertment ot Revenue OFFICIAI.USE 4NLV Bureau of Indi�riduai Taxes GamH� Year F�e Nurt�bgr ao eox zaosoi INHERITANCE TAX RETURN �� 1 .� ,g�� ttarcisbura PA i7728-�01 RESIDfNT DEGEQfNT � Q ENTER pECE6ENT INFORMATION BELOW Socia!Security NumV7er � 6a{$qt Death A+hADOYYYY DatB flt 8lrth A�D6YYYY � 2 � 8 2 � 1 3 � 5 � 3 1 9 5 $ ' DecadenPs Last Name ' Suffix � DecedeoYs First Name ' MI M i z e 1 1 C 1 i n t o n E (it Appiicabie)Enter Surviving$pouse'a information Beiow Spouse's Last Nartre 5uffix Spouss's FSrat Name MI Spouse's Social Secutity Number THfS REFURN MUST BE FIIED!N OUPI.FCATE WITH TNE REGISTER OF WILLS FILL iN APPROPRIATE OVALS BELOW Q t.Original Returr� � 2.SupplemanW!Retum � 3_1?emainder Retum{Date ai Death Prkrr to 12-13-82) � 4. Limited Estate � 4a.Puture IMerest Compromise(data of Q 5.Fedarsl Estate Tax ftetum Required � death aRer12-72•82) ❑ 8.Decedent Died Testate � 7.DeCadBnt Maintained a�ivi�g Trust _ 8.Totai NumEet ot Safe Oeposft Bo�s (Attach Copy of W itq (Attach Copy of Trust.) � 9_LitigaNOn Proceads Receivad � 10.Spousal Peverty Credit{Date of Death � 19,Etection to Taz nnder SeC.9133{A} Between 12•31-91 and i-1-85) (Attach Schedub O) G4R#tESP4NDEN7-TH15 SEGTION IASIST 8E GOMPtETEO.Alt C6RRESPQNOEtiCE AND CONFI6ENTUl TAX�1fORMATION SN4UL0�6IttECtEO T0: Name . Daytime Telephone Number fi T t e p h e n J . H o g g , E s q . 7s.,1 ? 2 :4. 5 �,�6 9 8 c `�' m n REBISTERQF��.. LY c�'' __� r„� � tTt -... C-. _,� t7 �"�,•� :: ' r fV :�'7 ��T� First line oP Address �"� � � ��"� �_ ;�� z'� ,..... -.,., � c_:s 1 9 S . H e n o v e r T t r e e t _n -�� 'n Second Line of Address � `��; �t � �_., �= c-x r_. ° - ' $ t e • 1 0 1 � „ :�., s _ ;, . rrt �... 6 c�v w aost otrce state ziP code ��eo' �— t e r i i s i e P A 1 7 � 1 3 CorreapondenCa rmail addrosa: UnCer penatties of perjury,i Cadare that i�ave examGretl this retutn,indt+ding eccampany�nq schedutes entl statqmanU,anC to the beet of mY knavieEg9 s�W beiief, it is true,wrced e,M wmplele.CSeGaradon of preparer olher than the pereonal represenWtive is based on all informatlon of whkh preperer has any knowUEpe. SIGNATURE 6f PE#2SQN SPON BlE FpR FIIING RETURN pATE i �n�� A6QRE S ' 1 Wes P reet, A t. 511 Carlisle PA 17�13 �. SiGNATUR£ P RESENTATIVE � 0 0A� RDDR SS PLEASE USE ORIGINAL FORM ONLY Side 1 � 15[1561�14� 150561[1140 � �� J 150561�240 REV-1500 EX(FI) DecedenYs Social Security Number o�aMrgNeme: Clinton E. Mizell RECAPITULATION 1. Real Estate(Schedule A) . .. . . .. . . . . . .. . .. . . . . . .. . . . . . . . . . . . . . . . . . . . 1. . 2. Stocks and Bonds(Schedule B) .. .�. . . . .. ... . . . .. . .. . . . .. . � , . . . .. . . . : . . . . .... 2. . 3. Closely Held Corporetion, Partnership or Sole-Proprietorship(SChadule C) . . . , , 3, , 4. Mortgages and Notes Receivable(Schedule D) . . .. . .. . . . .. . . .. . . . . ... . . . 4. . 5. Cash, Bank Deposits and Miscailaneous Personal Properry(Schedule E). . ... . . 5. 7 4 7 9 , 7 6 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . .. . . 6. . 7. Inter•Vivos Tronsfers 8 Miscellaneaus N -Probata Property (Schedula G) � Separete Billing Requested . . . . . . . 7. � 8. Tofal Gross AssaM(total Lines 1 through 7) . .. . .. . . . .. . . . . . .. .. . . . . . . . 8. 7 4 7 9 . 7 6 9. Funeral Expenses a�d Administrative Costs(Schedule H) . . .. . . . . . . . . . . . . . . 9. 4 2 1 1 . 5 8 10. Debts of Decedent,Mortgage Liabildies,and Liens(Schedule I) . . . . . . . . . . . . . 10. 2 3 9 . 4 9 11. Tofal Deductions(total Lines 9 and 10) . . . . .. . . . . . . . . . . . . . . . . . . . . . .. . . 11. 4 4 5 1 . 0 7 12. Net Value of EsGte(Line 8 minus Line 71) . .. . . .. . . .. . . . .. . . . .. . . . . . . . 12. 3 0 2 8 . 6 9 13. Charitable and Governmental BequestdSec 97 73 Trusts for which an election to tax has not bean made(SChedule J) . .. . .. . . . .. . . . . . . . . . . . 73. , 14. Nst Value SubJeet to Tax(Line 12 minus Line 13) . .. . . . .. . . . . . . . . . . . . . . 14. 3 0 2 8 . 6 9 . TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 75. Amount at Line 14 taxable atthe spousaltax 2ta,or transfers under Sec.9116 (a)(1.2)X A _ 0 . 0 0 15. 0 . � 0 i6. Amount of Line 14 taxabla � at lineal rate X.0_ 0 . 0 0 �g, � . � 0 77. Amount of Line 14 taxable at sibling rete X.72 � . � � 17. � . � � � 18. Amowt of Line 14 taxable atwllateralrete x.�s 3 0 2 8 . 6 9 i8. 4 5 4 . 3 0 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . . . . . . . . . . . . . . . . . . . . 19. 4 5 4 . 3 0 20. FILL IN THE OVAL IP YOU ARE REQUESTtNG A REPUND OF AN OVERPAYMENT � Side 2 � 1505610240 1505610240 J REV•t¢00�((Flj Page 3 File Numbtrr Decedent's Camplete Address: � � DECEDENT'S NAME Clinton E. Mizell --- — - ------. .-----r.�.—__ _�------- __--------------- ---------- STREETA6DRESS _—.---------_--.'.'---___ —._ —_.------.—._______ . .. . . - -- CITY STATE ZIP _ �___. . __ .— ____._ _._ ___ _—_.—�—..�...^__ Tax Payments and Credifs: f. Tax Due{page 2,Line]9} (t} q5q.3� 2. Cre�tslPayments A,Pria Payr�rents B.Discount T��Gredits(A+g} {2j 0.00 3. Interest �s} 4. If Lina 2 is greater than Line 1 +Line 3,enter the ditference.7his is the OVERPAYMENT. F�i in ovaf on Page 2,U�24 fo roqueet a ro#und. (d} p.pp 5. {f Une 3+�jne 3 is�eater th�t�ne 2,ent�the ckfference.This is the 7AX DU£, f 5} 454.30 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOtLOWING QUEST{ONS BY PLACING AN"X"IN 7HE APPROPRiATE BLOCKS i. Did decedent make a tr�tsfer�d: Yes No a. ratain the use or income of the propaRy Uansferred ...................................................................... � ❑ b, reiain the tight io designate who shaii use the property transfarred or its income ............................... ❑ ❑ c. retain a reversionazy infer�t ..................................................................................................... ❑ ❑ d. ieceive the pramise for I'rfe of either payments,ben�ts or care7 ....................................................... ❑ ❑ 2. If de�h oaxrrred after December 12,T982,did decedent hansfer properfy within are year of death without receiving adequate cunsideration? .............................................._............._..............._....... ❑ 3. pid decedent own an'in trusi fa"a pzyaWe-upon�deafh bank account w security at his or her deaih9 ......... ❑ 4. Did decedent own an individu�retirem�t acawM,a�nulty a other non-prab�e�ope�tY,which cc�ntains a beneficiary designation7.................................................................................................. ❑ ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST CpMPLETE SCHEDULE G AND fILE IT AS PART pF THE RETURN. Fot dates of death on�after July i, 19g4,and bet�e Jan.1,1995,the tax rate imposed on the net v�ue of Uansfers ta ar for the use ot the surviving spause is is 3 percent p2 P.S.§9116(a)(1,1)(i)]. For dates of death on or after Jan. S, 1995,ihe ta�c rate imposed on the net vatue of trensiers to or for the use ot Ihe surviving spouse is 0 percent {72 P.S.§9716{a}(7.1)(ii}].The statute does rrot exempt a Vansfer ta a s�rviv�ng spouse from tax,�td ths statutory requirerr�nts for discbsare af asse#s arut fiVing a tax return are sGll appiicabie even if the surviving spouse is the oniy beneficiary. For dates af dea#h on or after Jnty i,2009: I � The tax rate imposed on the ne!value of transfers from a deceased child 21 years of age or younger at dea�to a�for Yhe use of a natural parent,an adoptive parent or a stepparent of the chiid is 0 percent(72 P.S. §9716(a)(1.2}j. • The taz rate impased on the net value af transfers to or far the nse of the decedent's Iineai beneficiaries is 4.5 percent,except as noted in p2 v.s.§sits(a}tti). • The tax rate impesed on the net value of transfers to or for the use of the decedenPs siblings is f 2 percent[72 R.S.§9?t${a)(1.3}�.A sibNng is defined, under Section 9142,as an individua�who has at feast one parent in common with the decedent,whether by blood or adopkion. � �� REV-1508£X�(U8-12) pennsylvania SCHEDULE E °E�'u�T',�"7°�RE"E""� CASH, BANK DEPOSITS 8 MISC. RESi�rii oE�oewr uRN PERSONAL PRCYPERTY ESTATE Of: FttE NUMBER: Clinton E. Mizeil 0 0 Inciude the prflceerls of titigation and the data the proceeds were received by the estate. All properCy jointly owned with right of survivor9hip must be diaclosed on Sehetlule f. (TEFA VALUE AT DATE NUMBER DESCRIPTIqN pF DEATN t. . PNC Checking Account 33J5 2. Esta#e ot Bruca Mizeii, deceased PNG Accaunt#5044439925 ciosed 9127Jt3 7,448.d1 I TOTAL(Also enler on Line 5,RecapiWlation) E 7 479.76 If more space is needed,use additional sheets of paper of the same size. �._....�_� � REV�151}EJ6.YY0-09) � pennsyivania SCHEDULE H DERAftTkffNiOFREVENUE FUNERAL EXPENSES AND iNHewTArrceTnx�TUaH ADMINISTRATIVE GQSTS RESIDENi DECEOEN7 ES7ATE 0� FICE NUMBER Clinton E. Mizeil 6 0 DecedenYs debts must be repoAed an Schedule!. ITEM NtJMBER DESCRIPT(ON AMOUNT A. . FUNERALEXPENSES: 1. Hoffman-Roth Funerai Home&Cremetory, Ina 2,209.55 & ADM#NlSTRATIVE CdSTS: t. Person�RepresentaGve Ganmissions: Name(s�oFPersonalRepresentadve(s) MarvSchlusser 373.99 soee�aadress 1 West Penn Street, Apt. 511 �;ry Cariisie stste �A ztP 17a13 Year{s)Commissbn Paid: z, ananerFees: Stephen J. Hogg, Esqurre 1,200.00 3. Famdy Exemptbn:�f ee�denes address�irot the ss�ss dairt�anPs.atbd+exptanation.} Claimant SVee�Address Gty Slate ZIP R�gpr�ahip of G�imant b Oecedent � 4. �a��ees: 9$.50 5 AaountantFees: 6. Tax Retum Preparer Fees: 7. PetitionlCitation 35.00 8. Advertising: Law Journal 75.00 The Sen6nei 189.Sd 9. Tax Return and Inventory filing Fee 30.Q0 � TOTAL(Also enteron Line 9,Recapitulatian) 5 4 2�1 5$ It mae space is needed,use addiUOnal shee�af paperof the same size. , a�v-+s�z at.t�za2} ' pennsylvania SCHEDULE I OEPARTA�NT Of REVENUE DEBTS OF.DECEDENTr �Nr+ewrnNCernxeEruRN MORTGAGE LIA8ILITIES&LIENS RESIDENT DECEDENT ESTATE OF Fl�E NUt�fR Ciinton E. Mizeii d 0 Report debts incurced by the desedent prior to death that remained unpaid at ffie date of deatb,insluding unreimbursed medicat expenses. ITEM VAIUE AT DATE NUMBER_ DESCRIPTIpN OF DEATH 1. Centurylink 187.93 2. CBCS{Creditorfor PPL Eiec#ric Utilities) 51.56 TOTAi.(Aiso eMer on tine 10,Recapitufation) S z39.49 If more space is needed,insert additional sheeta of the same size. - !�� REV�15�3 Elf+(pi"10) � � pennsyivania SCHEDULE J oEanrzTrnenr of R�NUE BENEFICIARIES INHEWFANCE TRX RETURN RESIDENT 6EGEDEN7 ESTATE OF: FIE.E NUb18ER: Clinton E. Mizell 4 Q RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON{$)RECEIVWG PROPER7Y Do N�Liet Trushe(s} OF ESTATE � TAXABLE DIS7RIBUTIONS pndude ou�r�'qht spousal tlistnbudons and irensters under Sec.9f f6(a�{12).J . 1. , Mary SChlusser Collaterai 1 West Penn Street, Apt. 511 Carlisle, PA 17013 ENTER DOLLAR AMpUNTS FOR DISTRIBUTION5 SHOWN A80VE ON LINES 15 THROU�H 18 OF REV-1500 COVER SHEET,A5 APPROPRIATE. II. NON-TAXABIE DiSTR18UT1�iS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARI7A8lE AND G�VERNM6NTAL DISTW9U710N5: i. TOTAC qF PART I I-ENTER TOTAI NON-TAXA9LE DISTRIBUTIONS ON LINE 13 OF REV-i506 COVER SHEET. E It more space is needed,use addiCCnai sheets of papar of the sarr�e sae. COMMONWEAITN OF FENNSY�VANIA REV-11$2 EX(11-98} DEPARTMENT Of REVENUE BURfAU OF INDIVIOUALTAXES OEPT.280601 HAPAISBURG,VA i]i28-p801 PERINSYEVANIA RECEIVED FRbM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 018303 SCH�USSER MARY E 1 WEST PENN 5T APT 51 1 CARLIS�E, PA 17413 ACN ASSfSSMENT AMOUNT CONTRO� NUMBER ------- �ob ------...� 101 � $454.30 ESTATE tNFflRMATlON: SSN: tso-ae-ss2� � FILE NUMBER; 2113-0803 � dECEDENT NAME: MIZE�L GLINTON E � DATEOFPAYMENT: 10/�4/2013 I POSTMARK DATE: 10/24/2013 � CouNTY: CUMBERLAND ( DATE QF DEATH: 02/O$/201� � E TOTAL AMQUNT PAIQ: $454.34 REMARKS: RCPT 70 A7TY CHECK# 104 INITIALS: DBi sea� RECEIVED BY: GLENDA FARNER STRASBAUGH REGIS7ER OF WILLS REGISTER OF WILLS