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Home My WebLink About05-16-14 � 1505610105 REV-1500 EX(o�-ii)(FI)�� PA Department of Revenue pennsytvania OFFICIAL USE ONLY °°°'^'„°••°'a°°E�°F Coun Code Year File Number Bureau of Individual Taxes �' PO BOX 280601 INHERITANCE TAX RETURN �l� ,/� � Harrisburq,PA i�i28-o6oi RESIDENT DECEDENT o� � �f ENTER DECEDENT INFORMAT�ON BELOW Social 5ecurity Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Suffix DecedenYs First Name M� N e�-� _ 1'�'1 t r � a rrt s _ _ (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 Retum O 2.Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4.l.imited Estate p 4a.Future interest Compromise(date of O 5. Federai 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 INFORMATI01�[,$FIOULD BE DIR�ED TQ�7 � Name Daytime Tel�h�Number� Y'�"i � _[��tT y _ �, S kc,t'to 717- �� -� � _ g....,, " ,....p ._.� c� REQ��'fF�OE'=VUILLS�E 0141;� ? ;"�`; -' r,::� c� , �'� t� � ..,i .T'1 First Line of Address � � -:7 � -� _ ti;� C'� -°" a R��S� � v� :.� � � � � Second Line of Address �'4''-' -L Cn O C!'� 'tI City or Post Office State ZIP Code DATE FILED C�rli"S�G' �x} ! 7013 Correspondent's e-mail address: Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true,conect and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowiedge. � SIG�jI^TURE OF PERSON RESPON�ylBI„E FOf2 FILING RETURN DATE %�_.C/�i`T"� lJ' ..a'%li/1%�'O �- i�, l�( DRESS � /�it�9� I�vC �.Gr I�'s �e -1Q1� 1 �D1.3 SI TUR OF PREPARE OTHER THAN REPRESENTATIVE DATE 1 `� ,rr,�� A to z 7-ux sc-rv1��c' I•u. 5-1�l-1 y ADDRESS t553 1�ridqC 5�" NG-w Lur�,bc-rt�N� !°l�} 1 ?0�0 ` PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505610105 1505610105 J � t � � 15�561�205 REV-1500 EX(FI) Decedent's Sociai Security Number DecedenYs Name: N C�� ►�1 �Y��L'i f'�'1 5, �� RECAPITULATION 1. Real Estate(Schedule A). .. . .. .... . ..... ...... .. .. ..... ........ ...... 1. 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. 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ... ... . 6. 5 S a 9• 7. inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested... ..... 7. 8. Totai Gross Assets(total Lines 1 through 7)........... .... .............. 8. 5�� + y 9. Funeral Expenses and Administrative Costs(Schedule H)..... . .... ........ . 9. � �O �� I 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I)... .. . .. ... .... 10. 11. Totai Deductions(total Lines 9 and 10). .......... ... .. ... ........ ..... . 11. 3 �� 12. Net Value of Estate(Line 8 minus Line 11) .. .......... .. ... ...... .... ... 12. ' �3 $� 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an electio�to tax has not been made(Schedule J) ... ...... . ..... .. ... .... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13) .. . ....... ..... . ........ 14. ( �3$+ 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-�- 15. _ _ _. .. . _ __ _ ' 16. Amount of Line 14 taxable atlinealrate X.O� �q3g, �6. g`7� 17. Amount of Line 14 taxabie at sibling rate X.12 �7. 18. Amount of Line 14 taxable at collateral rate X.15 �g. 19. TAX DUE ... ........... .. .......... ..... . .. .......... ... .......... 19. $ �e 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 � 1505610205 15056b0205 J REV-1500 EX(FI) Page 3 File Number DecedenYs Complete Address: DECEDENT'S NAME '�w1 S , N- '� STREET ADDRESS i C PI e CITY STATE �� Z�P17 013 CG r i��s 1� Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (�� g'�� 2. Credits/Payments A.Prior Payments B.Discount Totai Credits(A+B) (2) 3. Interest (3) 4. if Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. , 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) g 7. 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.......................................................................................... ❑ � 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 surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)J. 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 retum 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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)J. • 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 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-15o9 EX+(oi-io) � pennsylvania SCHEDULE F DEPARTMENTOFREVENUE �OINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: N�� " j1�f�C�Y►'1 S a� '�-- '� 3— If an asset became jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(5)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. B. C. )OINTLY OWNED PROPERTY: tEITER DATE DESCRIPTION OF PROPERIY a/OF DATE OP DEA1ti IfEM FOR]OIMT MADE INCLUDE NAME OF FINANCL4L INSfI1l1TI0N AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER iENANT 70INT IDENTIFYING NUMBER.ATTACH DEED FOR lOINTLY HELD REALES�ATE. VALUE OF ASSET INTEREST DECFDENT'SINTEREST 1. A, -I S-O N Ck�CJ�Iti� A Gc�otit' �- #�10 0�3 3 y�t o C..�ttz�u.s �3a�k — �°0 80,� 7oao ll �v5�'d. 50�0 5$�9. ��7' Pr�iJe►�cc• R.� oz94a VD�WI DVM(?r �4�'�'("tr 6�t�ry P, si,�tto �—. TOTAL(Also enter on Line 6, Recapitulation) $ ,>�29.00 If more space is needed,use additional sheets of paper of the same size. � REV-1�511 EX+ (08-13) � pennsylvania . SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND [NHERITANCE TAX REfURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER �� , ��'1jr�c��+ S, a1- 13 - Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1 FUNERAL EXPENSES: _ �V�.�.�„�pn - �v�'� FunG-vo� Nor+G GM� cr��4r�•y zn� �� 1�„ Nvfic;3 1tit oQ�rr ty �wcs Prv�eJ d b c-�vrc- �D w1'c- o� i0C'�t'�+ � �rr��e M�rk1�� - Cu�bwfa»d Vatl�y M��►oriwl G-QrGJGws a�3�► �9z1 R�t'�Y �lryt,W�y �wcri�. P�9 ,7oa3 B. ADMINISTRATIVE COSTS, 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: Z. Attorney Fees: 3, Family Exemption; (If decedent's address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Return Preparer Fees: A fi� Z Tw� $C►'v�LG Z''��-� p,f� {707 U —1�. �ssa �.�dy� sr N�w c�..,la�G,� '. 5 3 9 , RG 1 �51 ou� ScN�cc-�r,e►,o�i�I - ISfi u�ittz! G1�wr�� n� C�►'i.f7- 3� N, �s�"r sr- cvr��J l� �� 7v t3 TOTAL (Also enter on Line 9, Recapitulation) � 3�9 �• If more space is needed,use additional sheets of paper of the same size. y� C i t i ze n s Ba n k Checking Account , '�� 1-888-910-4100 Statement PO BOX 7000 � Call CiHzens PhoneBank anytime far ROP� account information,cunent rates and ProvldenCe RI 02940 answers to your questions. O OF 5 Beginning November 26, 2013 through December 23, 2013 AT 01 009512 53598B 32 B"3DGT ,i��linl�illlllr��"�lill��l�il�llilllilrl��i�ii�,l��"III�� MIRIAM 5 NEFF 2 RIDGE AVE CARLISLE PA 17013-8764 Checking us2s9 23 1 ' N S U M M A R Y MIRIAM S NEFF o 0 Balance Calculation Balance BET��FJ1N SHATTO Personal Checking with Interest Previous Balance 11,828.25 Ave(age Daily Balance 11,193.37 XXXXXXX344-0 Checks 4,823.37 - Int�erest Withdrawals .00 - Deposits &Additions 1,096.00 + CurrentlnterestRate .019'a Interest Paid pg + Annua(Percentage Yie(d Eamed .01% _ Current Batance 8,1OQ.97 = Number of Days Intemst Eamed 28 - Inteiest famed .09 = Interest Paid this Year 1.02 You can waive the monthly maintenance fee of$11.99 by maintaining an average daily balance in = your account of 52,500 or making 5 qualifying transactions. = Your average daity balance* used to qualify this statement period is: $11,192 — Your number of qualifying transactions this statement period is: 23 *The Average Daily Balance used to calculate interest on your account may differ from the average daity - balance used to determine if your monthLy maintenance fee is waived due to minor�ifferences in how we — calculate these amounts. —° Previous Balance TRANSACTION DETAILS 11,828.25 ChCCkS'There is a break in check sequence Check# Amount Date Chedc# Amouqt DaLe 0 25.00 12/06 3307* 25.00 12/03� 3291* 100.00 11/26'�^ 3309* 11.00 12/05 � - 3292 200.00 12/021/ 3310 5.00 12/04�/' 3293 200.00 12/02�/' 3311 50.00 12/10� 3294 200_00 12/02 ✓ 3312 55.00 12/10 V 3295 125.00 12J09� 3313 100.00 12/12✓ 3297* 100.00 il/29 � 3314 100.00 12/17►/ 3298 100.00 12/02 3315 2,538.00 12/23 ✓ 3300* 100.00 12/02 L- 3316 100.00 12/16 ✓/ 3301 150_00 12/04 Y 3317 150.00 12/17 V 3304* 75.00 12/03 ✓ 3318 289.37 12/17 c/ 3305 25.00 12/09 ✓ n TotalChecks , 4,823.37 �Aamber FOIC � Equal Ha�sing LerWx • �� Citizens Bank Checking Account , i-888-910-4100 Statement Catl Citizens PhoneBank anytime for accountinformafian,wnent rates and answers to your questions. Q DF 5 Beginning November 26, 2013 through December 23, 2013 Checking mntinaed from previous page Deposits&Additions MIRIAM S NEFF wte Amount Description BETTYJFANSHATTO 12/03 1,096.00 SSA Treas 310 X�csoc Sec 120313 Personal Checking with Interest XXXXXXX344-0 n Total Deposits&Additions 1,096.00 Interest Date Amount Desaiption 12/23 .09 Interest /;1 Totat Interest Paid �t1 .� � Current Balance Daily Batance , —�-- 8,100.97 Date Balance Date Balance Date Balance 11/26 11,728.25 12 05 11,658.25 12/12 11,27$.25 11/29 11,628.25 1 , . 12/16 11,178.25 12/02 10,828.25 12/09 •11,483.25 12/17 10,638.88 12/03 11,824.25 12/10 11,378.25 12/23 8,140.97 12/04 11,669.25 MEMd --Effective January 12, 2014,the ability to waive the �11.99 monthly maintenance fee by having five qualifying payment transactions post to your account is being discontinued. However,you may stilt waive the monthly maintenance fee by maintaining an average daily batance of 52,500 in your account By changing your account to Green Checking before January 12, 2014,you can still avoid monthly fees by having five qualifying payment transactions post and clear to your accounL If yoa wish to change your account, simply catl us at the number listed on your statement or stop by your Local branch to discuss this and other options. --If you have paid Overdraft or Insufficient Availabte Funds Fees,your account statement includes a table that shows Totat Overdraft Fees and Total Returned Item Fees, less any rebates, you paid for the statement period and for the calendar year to date. Transaction descriptions for fees paid in Totat Overdraft Fees inctude "Overdraft Fee" and "Sustained Overdraft Fee". Transactions labeted "Insufficient Available Funds Fee" are inctuded in Totat Returned Item Fees. NEWS FROM CITIZENS --Enjoy a great introductory APR on purchases and balance transfers this holiday shopping season with a NEW Citizens Bank Credit Card! Visit citizensbank.com/creditcard to apply for a NEW credit card today. --We all have savings goals. Whether i�s a new home, a child's education, retirement or being prepared for unexpected expenses, Citizens Bank makes it easy and rewarding for you to start saving. Creating an emergency savings account can prepare you for�nexpected events and help you reach your savings goals. No matter what you're saving for,we have a great savings solution_ Ask your banker about what savings accounts and programs are right for you.We also offer money market accounts and CDs with the peace of mind of FDIC insurance. For more information or to open a new account, visit your locat branch today or call 1-888-821-3900. Member FDIC. See a banker for FDIC coverage amounts and transaction timitations. . �.Fo�� Q' Equal Fbusinp Lender _ ;�-- 2a9 Nart►Harover Slreefi Cari�fe,Pansylvarro 77D13 717243.d519 io�ir+ee 1.8b6.453_451] .,., fax7l 724�3.37�3 � FiJNERt�I_ HOME +� �REIUiATCaRY', INC. �� t�risbg�SHH�u—Oa�aecP�i�eat VblllamEHa�an-'�JiaeAesid�t RabestA.F�7bam1Q—Snpenvar 15�amG.3�er—FmealDirecbor I�vid EFerz1�—F�l I�eebr December 24, 2013 Betty Jean Shatto 2 Ridge Avenue Carlisle, PA 17013 Statement of Funeral Expenses for: Miriam S. Neff Date of Death: December 5, 2013 Account Id: 17051-285 PACKAGE: Traditional Funeral Service TRADITIONAL FUNERAL SERVICE PACKAGE $ 5,050.00 Sub Total: � 5,050.00 MERCHANDISE: Casket: Sanctuary(praying Hands) $ 4,195.00 Outer Container: Monticello $ 1,820.00 Sub Total: � 6,015.00 TOTAL FUNERAL HOME CHARGES: $ 11,065.00 CASH ADVANCES: Cumberland Valley Memonal Gardens $ 1,906.00 3 Certified Death Certificates at$6.00 each $ 18.00 Newspaper Notice-Sentinel ' $ 406.74 Clergy $ 100.00 Flowers $ 159.00 Hairdresser $ 40.00 Credit For Grave Opening $ -1,206.00 Sub Total: S 1,423.74 PreNeed Disc PreN/Cont Dec 20, 2013 3,051.00 Sagicor Check 119668 Dec 20, 2013 8,714.00 Total Funeral Expense: 512,488.74 Total Payments Made: � 11,765.00 , Balance: � 723.74 ��`,,uC� 33 a-� �'"b �a.a�-�3 �° �� e�tn�ir��t�r �Cen�eterp 1921 RITNER HIGHWAY CARLISLE, PA 17013 PHO►vE 717.243.3541 F,vc 717.243.4495 Summary of expenses for the burial of Miriam S. Neff � Nameplate Bronze Scroll $499 • Granite Base for Memorial $683 • Reinstallatiori of Granite Base and Memorial $150 • Bronze Refinish(Normally$505) $0 • Interment Service and Recording $1681 � Permanent Records and Processing $225 Total $3238 Minus Funds trom runerai Home ��?001 Total Balance ' $2538 �"Q,�' f.le'� 33 i�� Sincerely, G��'�'�. �;y., / g2...� I,3 Lyn C. Gregg Family Service Counselor . Osiris Holding of Pennsylvania-Broker _ _ /�� a �j` �... ��.��-��.�,�.- ��;�c�,— �-°� °��" v - L�� .rx�-� e i�.�,�'�a:.�.�- �� ..�....� . �� c� ` �� - �yY G� � ��.,�.�� ___-.—�---��— � s ��-� / C��►r'�h �-��11 �c-z `�.;'� fl , �� 3 1 r 3`7 �.��_...m. � - � �� u�.r�. _ �-�`.�,� r `� � �� '�LQ�V � �" �� 33 ��' ��i la--�3 -i3 . . � � 'P'i.:s.,..r1..�..��".+�i...,>=v.:e'. , ,.-{�i. .r t�.,.��r4�:�:i., .,�,v —:�a:9i;"' ,.'t.'..'�.r—„ •,�"i�..�&,��N„!ukp.ty _ . .� . , . . , . . . ;� � � . ' �. � � '.i A To Z Tax Service Inc. I '� 1553 Bridge Street �� = � New Cumberiand, PA 17070 � �� (717) 774-4068 ! �49-$i66 ;�°, ,�� `� �Jame 1- � Y'��f . r��- _1�1c �:" � �, .: c��,.�� Phflne � ,., _ _ Pickup Pate , �.;i , dfc �� ED �'f f/S?,. COC +CiJ T°tal =:� Copy �< i �,y;l ;�,,,' L� +. .:-r�'` � .� �,"�- :� �#'t��+' �'r` � _ ... ., . . . -rv, _ . � : . . � � a _ �:� _ _ .. . . . , , ;�� : ; - � , a : _: 1 . � ; . : � : _ , ,, : ,.; , , '� � , _� �;; _ , _ - ,.y _ , < :a _ ` , .. � �PECIAL�NSTRIlCfiIONS: � .� �� _ � PREPARED BY: ,, . COST i� 'fax Consultant . � ;i � � �� ;;� � •y ...� F� , ,a , � ` _ , �