HomeMy WebLinkAbout05-02-14 REV-1500 EX (02-11)(FI) 1505610140
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 0 6 5 0
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 6 0 2 2 0 1 3 0 3 1 4 1 9 1 9
Decedent's Last Name Suffix Decedent's First Name MI
D E A N G L A D Y S P
(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 2.Supplemental Return 3.Remainder Return(Date of Death
Prior to 12-13-82)
4.Limited Estate 4a.Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
RX 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 10.Spousal Poverty Credit(Date of Death ❑ 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 Number
M U R R E L W A L T E R S , I I I E S Q 7 1 7c., 6 9 724 �L_5a0 j
Ri WILL E ONL�Y O !
nT O C C Ln t
n,1 m t
First Line of Address )>
W A L T E R S & G A L L O W A Y P L L C �
o �-, � rI "T1
<a
Second Line of Address
5 4 E M A I N S T R E E T o -�+DATE FIL CO r o
City or Post Office State ZIP Code
D N
M E C H A N I C S 8 U R G P A 1 7 0 5 5
Correspondent's e-mail address: murrel(lIwaltersCiallowaV corm
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.
SIl"ATURE OF PERSON RESYRONSIBLE FOR FILING RETURN DATE og wt r�i x1'.%N e a/rJ
ADDRESS d
ANDREA L . SINGISER, 217 W . KELLER ST MECHANICSBURG PA 17055
SIGNATURE OF.P EP E 7 ER T N REPRESENTATIVE DATE
ADDRESS
MURREL L I, 54 E . MAIN ST MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610140 1505610140 J
O�
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GLADYS P. DEAN 21 13 0650
Decedent's Name Page 3 File Number
Correspondents
Name Daytime Telephone Number
M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4 6 5 0
First line of address
W A L T E R S & G A L L O W A Y
Second line of address
5 4 E M A I N S T R E E T
City or Post Office State ZIP Code
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:murrel(Wwaltersgalloway.com
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,coned and complete.Declaration preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIG 7 UR OF PERS N E P F R FILING RETURN DATE
AbRiRESS
NO MA G • WHITE, 601 S . FREDERICK ST MECHANICSBURG A 17055
J 1505610240
REV-1500 EX(FI) Decedent's Social Security Number
Decedent'sName: GLADYS P . DEAN
RECAPITULATION
1. Real Estate(Schedule A) .. . .. . ... . .. .. . .. . . . . . .. . .. . .. . . . . . . .. . .. . 1- 1 4 2 6 6 1 , 8 7
2. Stocks and Bonds(Schedule B) . . .. . .. . .. . .. . .. . .. . . .. . .. . .. . .. . .. . . . 2.
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. 8 2 9 2 4 , 6 8
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . .. . .. 6.
7. Inter-Vivos Transfers&Miscellaneous No -Probate Property 4 5 4 2 3 , 3 4
(Schedule G) Separate Billing Requested .. .. . .. 7.
8. Total Gross Assets(total Lines 1 through 7) . . .. . .. . .. . .. . .. . . . . .. . .. . . 8. 2 7 1 0 0 9 , 8 9
9. Funeral Expenses and Administrative Costs(Schedule H) 9. 3 3 8 6 2 . 0 1
. . . .. . .. . .. . .. . .. .
10. Debts of Decedent,Mortgage Liabilities,and Liens Schedule I 10. 1 6 6 0 8 . 3 8
11. Total Deductions(total Lines 9 and 10) . . .. . .. . .. . .. . .. . . .. . .. . .. .. . .. 11. 5 0 4 7 0 . 3 9
12. Net Value of Estate(Line 8 minus Line 11) .. . .. . .. . . . . . .. . .. . .. . .. . . . . 12. 2 2 0 5 3 9 . 5 0
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. 2 2 0 5 3 9 . 5 0
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 2 2 0 5 3 9 . 5 0 16. 9 9 2 4 . 2 8
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE . . .. . . . . . . . . .. . . . . . .. . . . . . .. . .. . .. . . .. . .. . .. . .. . . . . . . . 19. 9 9 2 4 . 2 8
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Side 2
1505610240 1505610240 J
REV-1 500 EX(FD Page File Number
Decedent's Complete Address: 21 13 0650
DECEDENTS NAME
GLADYS P. DEAN
STREET ADDRESS
826 CHARLES AVENUE
CITY STATE ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 9.924.28
2. Credits/Payments
A.Prior Payments 10.000.00
B.Discount 500.00
3. Interest Total Credits(A+B) (2) 10,500.00
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) 575.72
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00
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 ...................................................................... IR
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ ❑
c. retain a reversionary interest ..................................................................................................... ❑
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?.................................................................................................. ❑X ❑
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)(1)].
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[72 P.S.§9116(a)(1)).
• The lax 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
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GLADYS P. DEAN 21 13 0650
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 facts.
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. 826 CHARLES AVENUE 142,661.87
MECHANICSBURG,PA 17055
GROSS SALE PRICE INCLUDING PRORATIONS
TOTAL(Also enter on Line 1,Recapitulation.) $ 142 661.87
If more space is needed,use additional sheets of paper of the same size.
OMB Approval No.2502-0265
A. Settlement Statement (HUD-1)
B.Type of Loan
6.File Number: 77.Loan Number. 8.Mortgage Insurance Case Number:
1.�% FHA 2. RHS 3.❑ Canv.Unins.4.[ VA 5.[] Conv.Ins. 1482088 82088 443-2032555-703
C.Note:This form is furnished to give you a statement of actual settlement costs.Amounts paid to and by the settlement agent are shown.Items marked
"(p.o.c.)"were paid outside the closing;they are shown here for informational purposes and are not included in the totals.
D.Name 8 Address of Borrower: E.Name 8 Address of Seller: F.Name 8 Address of Lender;
CARLOS A. REYES-BENITEZ SUSQUEHANNA BANK
JENICA GRINDBERG ESTATE OF GLADYS P. DEAN
908 W.TRINDLE ROAD 601 S. FREDERICK STREET 3501 CONCORD ROAD
MECHANICSBURG PA 17055 MECHANICSBURG PA 17055 YORK PA 17402
G.Property Location: H.Settlement Agent: I.Settlement Date:
MURREL R.WALTERS,111 717-697-4650
TAX#22-24-0783-134 54 E.MAIN STREET 312712014
MECHANICSBURG PA 17055
Place of Settlement:
826 CHARLES AVENUE 54 E. MAIN STREET 3/27/2014
MECHANICSBURG PA 17055 IMECHANICSBURG PA 17055
100.Gross Amount Due from Borrower 400.Gross Amount Due to Seller
101.Contract sales price 142 000.00 401.Contract sales price 142 000.00
102.Personal property 402.Personal property
103.Settlement charges to borrower(line 1400) 8,713.04 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller In advance
106.City/town taxes to 406.Cityhown taxes to
107.County taxes 312r12014 to12r31/2014 334.04 407.County taxes 3/27/2014 1o1213112014 334.04
108.Assessments to 408.Assessments to
109.School Tax 3127/2014 [06130/2014 317.39 409. School Tax 3/2'/2014 [0613012014 317.39
110.Sewer 3/2T/2014 t031m12014 10.44 410. Sewer 3/27/2014 t03/31/2014 10.44
111. to 411. to
112. 412.
120.Gross Amount Due from Borrower 151 374.91 420.Gross Amount Due to Seller 142 661.87
200.Amounts Paid by or in Behalf of Borrower 500.Reductions In Amount Due to Seller
201.Deposit or earnest money 1,500.00 501.Excess deposit(see instructions)
202.Principal amount of new loan(s) 139 428.00 502.Settlement charges to seller(line 1400) 10 415.00
203.Existing loan(s)taken subject to 503.Existing loan(s)taken subject to
204. 504.Payoff of first mortgage loan
205. 505.Payoff of second mortgage loan
206. 506. 2014 County/Townshi Taxes 437.01
207.Seller Assist 6 976.88 507. Buyer Assist 6,976.88
208. 508. Mid Penn Home Inspections 485.00
209. 509.
Adjustments for Items unpaid by seller Adjustments for items unpaid by seller
210.Cityftown taxes to 510.Cityho m taxes to
211.County taxes to 511.County taxes to
212.Assessments to 512.Assessments to
213. to 513. to
214. to 514. to
215. to 515. to
216. 516.
217. 517.
218. 518.
219, 519.
220.Total Paid by/for Borrower 147,904.88 520.Total Reduction Amount Due Seller 18,313.89
no.Gash at Sleent from/to Borrower 600.Cash at Settlement tolfrom Seller
301.Gross amouettm
nt due from borrower(line 120) 151 374.91 601.Gross amount due to seller(line 420) 142 661.87
302.Less amounts paid by/for borrower(line 220) ( 147 904.88) 602.Less retluc[ions in amount due seller(line 520) ( 18 313.89)
303.Cash R From E]To Borrower 347n nq 603.Cash a To From Seller 124 347,98
The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting,reviewing,and
reporting the data.This agency may not collect this information,and you are not required to complete this form,unless it displays a
currently valid OMB control number.No confidentiality is assured;this disclosure is mandatory.This is designed to provide the parties to
a RESPA covered transaction with Information during the settlement process.
Previous editions are obsolete Page 1 of 3 - HUD-1
L.Settlement Charges
700.Total Real Estate Broker Fees Paid From Paid From
Division of commission(line 700)as follows: Borrower s Seller's
lot.$ 4,020.00 to Help-U-Sell Detwiler Realty Funds at Funds at
Settlement
702.$ 4,955.00 t RE/MAX 1st Advantage Inc $etnement
703 Commission paid at settlement 1__8,975.00,
704. _. . ...... . �_.
800.Items Payable in Connection with Loan
801.Our origination charge ([net Origin Pts.2457%2r$342.58) $ 1,237.58 (from GFE#1)
802.Your credit or charge(points)for the specific interest rate chosen$ (from GFE#2)
803.Your adjusted origination charges (from GFE A) ___1 237.581
804.Appraisal fee to Lenders Allies (from GFE 43) _ _ 375.001
805.Credit report to Corelog is Credco _ (from GFE#3) _ 28.001
806.Tax service to _ (from GFE#3)
807.Flood certification to CorelogiC Flood Services (from GFE#3) 12.501_ _
808. Appraisal Management Compaq Fee to ALS,Inc. 85.001
809. Property Re-Inspection Fee to Appraiser _ _ 125.00___
8016 Commitment Fee $895.00
900.Items Required by Lender to Be Paid in Advance X Exclude last day in bales-line 901
901.Daily interest charges from 3/27/2014 to4 11/2014 @$ 15.7600/day (from GFE#10) _ 78.801____
902.Mortgage insurance premium for months to FHA Mort Ins Dept of Housing&Urban Qev (from GFE#3) _,398.03
903.Homeowners insurance for 1 years to State Farm Insurance Companies (from GFE#11) 507.00
904
___ ----.._-
1000.Reserves Depositetl with Lender
1001,Initial deposit for your escrow account (from GFE
1002.Homeowner's insurance 3 months @$ 42.25 per month $ 126.75
1003.Mortgage insurance 0 months @$ 152.95 per month $ 0.00
1004.Property taxes 2 months @$ 36.41 per month $ 72_82 _
1005.School Propel Tax 10 months @$ 101._62 per month $ 1,016.20
1006.a. months @$ per month $ 0.00
1007.Aggregate Adjustment - _ _ -$ -356.89
1100.Title Charges I
1101.Title services and lenders title insurance (from GFE#4) _ 12.37.00 _
1102.Settlement or closing fee $ ___ _ __ _
_1103.Owners title insurance (from GFE#5) _ _ 23.00 _
1104.Lenders title insurance PA End. 100,300&900 $ 325.00
1105.Lender's title policy limit$ 139,428.)0 Ohio Bar Title Insurance Company ___
1106.Owners title policy limit$ 142 000.00 Ohio Bar Title Insurance Comp any
1107.Agent's portion of the total title insurance premium $
1108.Underwriter's portion of the total title Insurance premium _ $ ___348.00
1109. Closing Protection Letter $75.00
1110. Notary Fee $20.00 10_00.
1111, Federal Express Mortgage Package $18.00
_1112 AttornByyy�ortion of the total title insurance premium $799.00
1200.Government Recording and Transfer Charges
1201.Government recording charges (from GFE#]) 146.50i
1202.Deed$ 67.50 Mortgage$ 79.00 Releases $
1203 Transfer lazes (from GFE#S) 1,420.0_0__ _1,420.00.
1204 City/County tax/slamps Deed$ Mortgage $
1205.State tax/stamps Deed$ Mort_gaga $
1206.
1300.Additional Settlement Charges
1301 Required services that you ban shop for (from GFE#6) � _ _� __ _
1302. Tax Certification-Mary Murray $ 10.00 10.00;
1303. Chimney Sweep stems $ 180.75 1 F
1304.
. 1305.
1400.Total Settlement Charges enterim lines 103,Section J and 502,Section K) 8,713.041 10,415.00
CERTIFICATION
I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief,it is a true and accurate statement of all receipts and
disbursements made on my account or by me in this transaction I further certify that I have received a copy of the HUD-1 Settlement Statement.
Borrower. �S �� ) ? ' __ Date 3/2712014_ Seu C ii:! 4 <�' Date:3/2712014
CARLOS A. REYES BENITEZ ANDREA L SI NGI S ER .EXEC.
/ t
Borrower . �(-�G�vo-� _�_rvya.l(_Date.3/27/2014_ Seller {�- 11( `-�P t_�J'� _ 1).t.:3127/2014
1FNICA GRINDBERG t j NORMA G.lilts , EXEC.
To the best of my knowledge the HUD-1 Settlement Statement which I have prepared is a true and accurale/aLC,oun�o(tpe unps which were received
and have been or will be disbursed by the undersigned as part of the settlement of this transaction. // i
Settlement
Date: _ Agent: _ /✓ _ _ Date:3/27/2014
MURREL R.WALTERS,III
WARNING:It is a crime to knowingly make false statements to the United Slates on this or any other similar form.Penalties upon conviction can include a fine
and imprisonment.For details see:Title 18 U.S.code Section 1001 and Section 1010.
2 of 3 HUD-1
Previous editions are obsolete Page
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:
GLADYS P. DEAN 21 13 0650
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. EDWARD JONES 65,355.77
ANNUITY
2. PNC BANK 10,822.12
CHECKING
3. CASH 949.26
4. PA DEPARTMENT OF REVENUE 500.00
REFUND
5. WEED MAN PENNMAR, LLC 245.52
REFUND
6. UNITED AMERICAN INSURANCE COMPANY 801.84
REFUND
7. BRICKER'S AUCTION 2,339.50
HOUSE CONTENTS- NET SALE PRICE
8. QUANTUM IMAGING 4.09
REFUND
9. AFFINION 176.68
INSURANCE REFUND
10. UNITED STATES TREASURY 1,650.90
RETIREMENT
11. ERIE INSURANCE 79.00
HOMEOWNERS REFUND
TOTAL(Also enter on Line 5,Recapitulation) $ 82 924.68
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
GLADYS P. DEAN 21 13 0650
This schedule must be completed and filed 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 % DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (FAPPUC*TF7 VALUE
1. LINCOLN FINANCIAL-ANNUITY 45,423.34100.00 45,423.34
50%- NORMA G.WHITE- DAUGHTER
50%-ANDREA L. SINGISER- DAUGHTER
TOTAL (Also enter on Line 7,Recapitulation) $ 45 423.34
If more space is needed,use additional sheets of paperof the same size.
REV-1511 1(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESIDENT DE ED RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GLADYS P. DEAN 21 13 0650
Decedents debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MALPEZZI FUNERAL HOME, MECHANICSBURG, PA 5,633.97
2. GINGRICH MEMORIALS-HEADSTONE 1,165.00
3. MECHANICSBURG PRESBYTERIAN WOMEN - FUNERAL MEAL 100.00
4. GARDEN BOUTIQUE-FLOWERS 132.50
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
1. Name(s)of Personal Representative(s) ANDREA L. SINGISER
Street Address 217W. KELLER STREET
City MECHANICSBURG State PA ZIP 17055
Year(a)Commission Paid: (RENOUNCED)
2. AttomeyFees: MURREL R.WALTERS, III 7,800.00
3, Family Exemption:(if decedents address is not the same as claimants,attach explanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4, Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 398.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
T PNC-ESTATE CHECKS 18.15
8. BRETT LECHTHALER-REAL ESTATE APPRAISAL 300.00
9. REDUCTIONS IN AMOUNT DUE TO SELLER FROM SALE OF 18,313.89
821 CHARLES AVENUE, MECHANICSBURG, PA
TOTAL(Also enter on Line 9,Recapitulation) $ 33 862.01
If more space is needed,use additional sheets of paper of the same size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GLADYS P. DEAN 21 13 0650
Decedent's Name Page 1 File Number
Schedule H - Funeral Expenses &Administrative Costs - 131
ITEM
NUMBER DESCRIPTION
AMOUNT
B. ADMINISTRATIVE COSTS:
Personal Representative Commissions:
2. Name(s)of Personal Representative(s) NORMAG. WHITE
Street Address 601 S. FREDERICK STREET
City MECHANICSBURG state PA ZIP 17055
Year(s)Commission Paid: (RENOUNCED)
SUBTOTAL SCHEDULE 1-1-131
REV-1512 EX-(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
MHERRANCE TAX RETURN MORTGAGE LIABILITIES&LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GLADYS P. DEAN 21 13 0650
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
1. MONROE TOWNSHIP 964.00
SEWER
2. QUANTUM IMAGING 4.09
MEDICAL
3. HOME HELPER SERVICES 659.32
LAWN CARE
4. WEST SHORE EMS 232.50
AMBULANCE
5. PINNACLE HEALTH HOSPITALS 13.67
MEDICAL
6. CLAREMONT NURSING HOME 580.00
RESIDENTIAL CARE
7. VERIZON 51.83
TELEPHONE
B. MET-ED 1,751.40
ELECTRIC
9. UNITED AMERICAN 218.00
INSURANCE
10. MARY A. MURRAY 1,219.44
201312014 CUMBERLAND VALLEY SCHOOL TAXES
11. AD &D 4.95
ACCIDENTAL DEATH INSURANCE
12. UNITED WATER 211.66
WATER
13. ALERT PHARMACY 66.66
MEDICAL
14. BRYAN MITCHELL 520.00
LAWN MOWING
i5. BANKS PEST CONTROL 78.50
TREATMENT
TOTAL(Also enter on Line 10,Recapitulation) $ 16 608.38
If more space is needed,insert additional sheets of the some size.
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GLADYS P. DEAN 21 13 0650
Decedent's Name Page 2 File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, &Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. RANNY L. SINGISER 533.41
HOUSE REPAIR- PAINT $44.14
REPLACEMENT WINDOW-$489.27
17. MITS-MYER ELECTRICAL CONTRACTOR 1,200.00
REPLACE ELECTRICAL PANEL
18. FIVE STAR CONTRACTING LLC 7,300.00
ROOF FOR RESIDENCE&REPAIR BATHROOM SHOWER
19. BASS AIR QUALITY SYSTEMS 775.00
RADON MITIGATION
20. ACCIDENTAL DEATH & DISMEMBERMENT 4.95
INSURANCE
21. UNITED AMERICAN INSURANCE COMPANY 218.00
INSURANCE
SUBTOTAL SCHEDULE 10,031.36
GRAND TOTAL SCHEDULE $ 16,608.38
REV-1513 EX-(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GLADYS P. DEAN 21 13 0650
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS UndWe outright spousal distributions and transfers under
Sec.9116(a)(1.2).)
1. ANDREA L. SINGISER Lineal
217 W. KELLER STREET
MECHANICSBURG, PA 17055
2. NORMA G. WHITE Lineal
601 S. FREDERICK STREET
MECHANICSBURG, PA 17055
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1$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:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1,
TOTAL OF PART U-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
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