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Home My WebLink About05-15-14 �. �...' 1505610105 � REV-1500EX(oz-ii)(FI) � PA Department of Revenue pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes °`"°'"`"°`°`"`"°' PO BOX z8o6oi v INHERITANCE TAX RETURN County Code Year File Number Harrisbur ,PA 1�128-o6oi RESIDENT DECEDENT 21 ENTER DECEDENT INFORMATION BELOW 05 �827 Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 167-14-7308 09/08/2005 _ - - _ 07/14/1914 Su�x DecedenYs First Name Clifford Mi Mary B (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 F�LED IN DUPLICATE WITH THE FILL IN APPROPRIATE OVALS BELOW REGISTER OF WILLS O 1.Original Return � 2.Supplemental Return O 3. Remainder Return(Date of Death O 4. Limited Estate O 4a. Future Interest Compromise(date of Prior to 12-13_g2) death after 12-12-g2) O 5. Federal Estate Tax Return Required O 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust (Attach Copy of Will) 8. Total Number of Safe Deposit Boxes O 9. Litigation Proceeds Received (Attach Copy of Trust.) - 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) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE D RECTED T0: Name Richard C. Sneibaker, Es - - �ayt�me reiepnone rvumber _ _ q., _ _ _ _ _ _ _ i(717) 697-8528 REGISTER OF WILLS USE ONLY First Line of Address ("� '-.,� 44 West Main Street �a� �-„�-�- � � Second Line of Address -�-��''� �-�'�-�. �, f�� f' "'^C 7 , �.0 t._; /-.�.. + �' .... �G�.-;_ .� `✓i :�•�i 1 i City or Post Office C-,ti'._ __� State ZIP Code �&ILED �• `�� P"._� Mechanicsburg _ . ..._ ... r; _ PA 17055 , � r, , � __ _ _ __ � `� cb ,-��1 ......... .___.......... . •, f `-� � Correspondent's e-mail address: G1 �� C� 'Tt Under penalties of pery'ury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief, SIG�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. RE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS � DAT �` Linda B. Fortini, Executrix, 106 Skyline Drive, Mechanicsburg, PA 17050 SIGN RE Oj-P{; ER OTHER THAN REPRESENTATIVE ADDRESS � / DA E Richard C. Snelbaker, Esquire, 44 West Main Street, Mechanicsburg, PA 17055 I PLEASE USE ORIGINAL FORM ONLY L Side 1 1505610105 1505610105 J � 1505610205 REV-1500 EX(FI) DecedenYs Social Security Number DecedenYs Name: RecaPiru�arioN 1. Real Estate(Schedule A). . .. . .. . . _ .. .. . .. .. .. .. . ....... .. .. .. .. . ... . . . 1. 2. Stocks and Bonds(Schedule B) - _ 0.00 ' . .. . . .. . .. .. .. .. .. . . .. .. ... . .. . . .. . .... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ..,. , 3 4. Mortgages and Notes Receivable(Schedule D) . .. ..... .. �.00 .. .. .. .. .. ... . . .. 4. 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. . . . ., 5. - 0.00 6. Jointly Owned Property(Schedule F g q 72�•61 7. Inter-Vivos Transfers&Miscellaneous NoOn-p obate Pr p'lelrtY Re uested .. .. . .. g, (Schedule G) 0.00 O Separate Billing Requested.. .. .. . . 7, 8. Total Gross Assets(total Lines 1 through 7). 0.00 ' . . . .. .. .. .. ..... . .. . . .. ..... 8. ' 9. Funeral Expenses and Administrative Costs(Schedule H). . .. , , 727•61 . .. .. .. . .. ... 9. 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I). .... .. .. .. .... - - 15.00 10. 0.00 11. Total Deductions(total Lines 9 and 10). .. . .... .. ... .. . .. .. .. .. .... .. . .. ��, 12. Net Value of Estate(Line 8 minus Line 11) 15.00 : 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which . .. .. ... . . ... ... . 12. an election to tax has not been made(Schedule J) .. ... .. . - ��2•61 . .. . .. .. .... .. .. 13. 14. Net Value Subject to Tax(Line 12 minus Line 13 - 0.00 ) ... .. .. .. .. ... ... . .. .. .. 14. ' TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES ��2•61 15. Amount of Line 14 taxable at the spousal tax rate,or ' transfers under Sec. 9116 (a)(1.2)X A._ , _ 16. Amount of Line 14 taxable 15. ' at lineal rate X.0 45 - 17. Amount of Line 14 taxable ��2.61 ' �6 at sibling rate X.12 _ ; _ 32.07 , 18. Amount of Line 14 taxable ��• ' at collateral rate X.15 18. 19. TAX DUE . .. .. .. .. .. ... . .. .. .. .. .. ... .. .. .. . . .. .. ... .. . . .. .... 19. 32.07 ; 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � L Side 2 1505610205 1505610205 J REV-1500 EX(FI) Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME Clifford, Mary B. STREETADDRESS 2100 Bent Creek Blvd. Silver Spring Township, Cumberland cin Mechanicsburg � STATE Z�P PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 2. Credits/Payments �� 32.07 A.Prior Payments B.Discount 3. Interest Total Credits(A+g) �2� 0.00 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) 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. �5� 32.07 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APP 1. Did decedent make a transter and: ROPRIATE BLOCKS a. retain the use or income of the property transferred........................................... Ya No 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 Dec. 12, 1982,did decedent transfer property within one year of death • ... ............ .. ................................... ❑ without receiving adequate consideration?.............................................................................................................. ❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. � ■ 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 survivin s ou is 3 percent[72 P.S.§9116(a)(1.1)(i)]. g p se 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 erce [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 asset filing a tax return are stiil applicable even if the surviving spouse is the only beneficiary. P nt s and 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 arent adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)j, p , an • 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 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 siblin§is defin( )) under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. 9 ed, REV-iso8 EX+(08-12) � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: Clifford, Mary g, FILE NUMBER: Include the proceeds of litigation and the date the proceeds were received by the estate. 21-05-0827 All property juintly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. Unclaimed property held with the Pennsylvania Treasury(uncashed dividends from AT&T, It1C.) OF DEATH Monies received May 6, 2014 (see attached co �27.61 py'of check) TOTAL(Also enter on Line 5, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 72�•61 ��v-rs�r Ex+ tos-zs; � pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERA� EXPENSES AND ESEDENTNDECE ENTrURN ADMINISTRATIVE COSTS ESTATE OF Clifford, Mary B. FILE NUMBER ITEM Decedent's debts must be reported on Schedule I. 2�-05-0827 NUMBER A� FUNERAL EXPENSES: DESCRIPTION 1. AMOUNT B• ADMINISTRATIVE COSTS: 1• Personal Representative Commissions: Name(s)of Personal Representative(s) ------ — --------------- Street Address ------------- City State ZIp Year(s)Commission Paid: ---- 2• Attorney Fees. 3• Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State Zip Relationship of Claimant to Decedent ------------- 4� Probate Fees: 5� Accountant Feer. 6• Tax Return Preparer Fees �• Cumberland County Register of Wills,filing fee for Supplemental Inheritance Tax Ret 8, um 15.00 TOTAL (Also enter on Line 9, Recapitulation) $ If more space is needed,use additional sheets of paper of the same size. 15.00 REV-1513 EX+ (01-10) � ��' pennsylvania SCHEDUL 7 �� DEPARTMENT OF REVENUE E .�/ INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: Ciifford, Mary B. FILE NUMBER: NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT 21-05-0827 I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under po Not List Trustee(s) AMOUNT OR SHARE OF ESTATE Sec. 9116(a)(1,2),] 1• Terry Odhner Daugher 14079 North 34th Place, Phoenix AZ 85032 25% 2. Victoria Regena Hara - Daughter 2385 Black River Falls Drive, Henderson, Nevada 89052 25% 3� William H. Clifford, III Son 1544 Giddings Avenue, SE.,Grand Rapids,Michigan 49507 25% 4. Linda B. Fortini Daughter 25% 106 Skyline Drive, Mechanicsburg, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET AS II NON-TAXABLE DISTRIBUTIONS APPROPRIATE. , A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: L B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: L 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. # �ommonwealth �f Pennsy°Ivania Remittance Ac�vice 1 °f 1 000025 36 00624771 Pennsylvania Treasury - Bureau of Unclaisued Pro ert Pa P Y yment CLAIM # 77884078 �.� ------------------------ ----------------- ---------------------- �—' Property ID Holder Name ------"-- Deseription Amount 12839947 AT&T INC DIVIDENDS 727_61 Total: 727.61 __ __.__-__._�:�� _._.__,_�.__----------___..__ .__, �� v��' .� :,a�— �..'�:� , �� o� V� N�� V� �� ' �.� PAYEE INFORMATION: NOTB: Direct payment inquiries to: FORTINI LINDA B PA Unclaimed Property 1.800.222.2046 __..______ _ 106 SKYLINE DR – _____.__--- P.O. Box 18 3 7 _---- -- MECHANICSBURG _--._-- __ PA 17050-1752 --- ---- Harrisburg, pA 17105-1837 �--' FOLD ON PERFORATION,THEN DETqCH CAREFULLY '� • • .• . •.. .-.::: _ -• � • _ .. ' ', �.�.>:: f.. �-..`>: ..�..� . . . � . .t. � :M :'. � ...��. .:�:. .. . � � . ' ."^. � � � �� ... _ . .. ��....e:::. ..:�. .:.,.... � � 00000 003 042914 02657639 411838 l 000025 � �; <' , � COC fUND DEPT PREP DATE VOUCHER WARRANT ip ' � �ij { � i , ,. ' , � ` i�WIG��/-` � .� :>Fir,st Nationai�ank , .. ,: w� ,:: : CH��1C��.. � �f�IF��AT{ON AVAILAl3LE ^pOgITNE pl��t' pF2dT€CtED� � � o� - O� �� °��r.4�.,.�.�e,w„�� a 05f02�2014. �i o�PAY crscrs : eare o�—�•TO THE ORDER OF voio aFTeR ,so �nv o� v� FORTINI LINDA B ��Ar�k#�#####**�27.61 N� 106 SKYLINE DR . _,.- '` � MECHANICSBURG PA 17050-1752 ,�, �� O�� .:N. � � . . �� _ . p�I�t�Ilti��Iti�ul,�E�r�u��E��i��I�tII��y�III��I�t��Il�rr1 ' =Robert ilit Mc�'�td -• TRER$URER:�F P£ALNSY.LVAN:I.A ��'006 2477 ii�' �:04 i 20 25 L i�: 950 i998 2n'