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Home My WebLink About01-21-14 1505611101 i REV-1500 EX(02-11) ----'`"� OFFICIAL USE ONLY PA Department of Revenue pennsylvania Bureau of Individual Taxes County Code Year File Number PO BOX 28o6o1 INHERITANCE TAX RETURN I /1 7 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY y7 D cedent's Last Name. Suffix Decedent's First Name MI (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 1.Original Return C=) 2.Supplemental Return C=) 3. Remainder Return(Date of Death Prior to 12-13-82) C ) 4. Limited Estate C=:) 4a. Future Interest Compromise(date of . C=) 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit(Date of Death O 11. Election to Tax under Sec.9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Nu'�§er ;M �KaA/S RBI ROF WILLS USE-CIN +O D r— M-' IT, � r- = rr a) First Line of Address 7C _,0 - c� �a �� o �� o � M Second Line of Address ry t- O City or Post Office State ZIP Code DATE FILED " �5114 Z14 P14 7 owl-.S Correspondent's e-mail address: 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 true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG RE OF PERSON RESPO SIBLE WK FILING RETURN D� AMAESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505611101 1505611101 J 15056112011 i r'•r f f �. -::REV-15 "_"' tl. 15 00 EX Decedent's Social Security Number Decedent's Name: . RECAPITULATION 1. Real Estate(Schedule A). ...... . .... . . ... . . ... . .......... ... . ... . .. . .. 2. Stocks and Bonds(Schedule B) ................... .... ........ ... . .... 2.� 31 Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. i 4. Mortgages and Notes Receivable(Schedule D)......... .... .:......... .. 4. • , -0 r� e.. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. a E./ G �C/� -- 6. Jointly Owned Property(Schedule F) C )Separate Billing Requested ..... .. 6. • 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C) Separate Billing Requested........ 7. 8. Total Gross Assets(total Lines 1 through 7)....................... ...... 8. 9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. Y �, 4 j ' •, ;L�' 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............:.. 10. � 7 . tl� �q 11. Total Deductions(total Lines 9 and 10)............................ .... 11. k 12.- Net Value of Estate(Line 8 minus Line 11).............................. 12. ?00 13.. Charitable and Govern mental Bequests/Sec 9113 Trusts for which f/�r/"�- an election to tax has not been made(Schedule J) V}V '14. Net Value Subject to Taxr(Line 12 minus Line 13) ........................ 14. TAX CALCULATION:SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or - transfers under Sec.9116 16. Amount of Line 14 taxable ^^^ - ""y-y"'^--r^• ,y-�! "- at lineal rate X.0- �1-1� 16. �u� r 17. Amount of Line 14 taxable - at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X,15 - 18. - 'i r• 19. TAX DUE........................................._...........4.. 19. .. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT , C=) r Side 2 1505611201 1505611201 J REV 508 ER+(11-10) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: U✓1 S Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL(Also enter on Line 5, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. .ti 1•. VV f. +4 M r-4 J �, pia •i � 1 — �S� ill Y, O • � V � rl Z3' 1 �S•'9 c , • •'N� r f --j'a t t.On 1 WcCoo•w it . 1. RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ. Receipt Date : 1/22/2014 Cumberland County - Register Of Wills Receipt Time : 08 : 42 :43 One Courthouse Square Receipt No . : 1076780 Carlisle, PA 17613 LYONS GEORGE R Estate File No. : 2013-01297 Paid By Remarks : ESTHER LYONS DB1 ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 1117 $15 . 00 Total Received. . . . . . . . . $15 . 00 �Q N V CJ� - Oc f p i w tf N --� M (� r- 1-3 cn ' Li W Nm j r � .� N `c•)� �r T� �O m LO Cl o U)cD w IQL