HomeMy WebLinkAbout05-19-15 J 1505611101
REV-1500 �"°"" �
enns lvania orricin�useorv�r
PADepartmen[ofRevenue P„ Y GountyCotle Yeer FleNomber
BureauotlntlividuaiTaxes �INHERITANCETAXRETURN /9
PO BOX�8o6m // I I 3 V �O9
Harr�sburqPAa�aze-o6oi RESIDEN7DECEDENT L
ENTER DECEOENT INFORMATION BELOW
Sociel Secu�ity Number Dala of pea�h MMD�WYV Dale of Birth MM�DYVVY
Suf(iz �ecetlenfs Flrst Neme MI
F� obi tpi LL �. mRs, To�NN �i.
(If Applicable)Enter Survivin9 Spouse's Informalion Below
Spouse s Last Name SuHlx Spouse's Flrst Name MI
Spouse s Social Secvrity Number
THIS RETURN MUST 8E FILE�IN DUPLICATE WITH THE
REGISTER OF WILLS
FlLl IN APPROPRIATE OVALS BELOW
O 1. Odginal ReW m � 2 Supplemen�al Re�um O 3_ Remaintler ReNm(Date of�ea1M1
Prior to 1213-82)
p 4. Limited Es�a�e O 4a. PUNre In:aras�Compmm�sa(de�e of O i Fetleral Es�a�e Tax ReWrn Hequlre0
tl08iM1 Af[B!12-12-B2)
O 6. Decatlenl Dled Testele O ]. Dawtlent Main�ained e Liv�ng Tms� 8. Totel Number ol3efe�eposi�9oxes
(Alt2ch Gopy of Wil1J (AVacM1 Copy oi TmsL)
O N_Litiga�lon Pmceeds Received O 10. Spousal Poverty Cretli�(�a�e of�eath O it Elec�lon Yo Tax under Sec 9113(A)
8atween 12-31-91 antl t-1-95) (AVach SCM1edule OJ
CORRESPONOENT- iH15 SECTION MUST BE COMPLETE�.AlL CORRESPONOENCE ANO CONFIOENiIAL TAX MFORMATION SHW LO BE OIRELTEO T0:
Name Daytime Telephone Number
� Rv ic�. A. I'� obi �'H i LLE Cxec. 71 '7 �7! 3 � i ��
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REGIS , �WI�LSlL9BONIY-
C�
F� � 1
First Line of Address . � �� �
8a � tNd� D2iv �. � ; � :;
Second Line of Atltlress � >
� of 3a «� ,_ �,
I �., �� ,
cryorvos�orr�e s�a�e zivcoae L— __on.c-_aeu_m_ . . �
m � � hAN � � sb �Ry PA ► '7050
CorrespondenPs e-mail atltlress: �// /
Ontler penellies of per�ury.l tledare Net I�ave eseminN tM1is reWm InGutl�ng aanmpanying scM1edules antl stetemenLs.entl ro IM1e bast of my knowletlge antl Oelia�.
Il ls�me.wrract antl complete.Dedara�lon of preparer o��er iM1en IM1e personel representalYe Is based on all mforme�ion olwM1ic�preperer M1es eny hnowledge.
51�' RE OF PERS �, I SPQD�31BLi0�����i �E/�-/ �n
/'� � S
ADDRE55 � � • �'7
Sa L1NC1R D21V£ LD`f3a�rnECI1HNl <S_ b�i T� � 7�J��
SIGNATIIREOFPREPAREROTHERTHANREPRES NIATNE DATE
ADDRE55
PLEASE USE ORIGINAL FORM ONLV �
$ide 1
L Lsos6111o1 Lsos6111o1 J�
t 1505611201
J
REV-1500 EX
Decedenfs Social Security Number
oa�eda�,s�amarnas, ToqN,v f� l�abif�ti'L L� ►
RECAPITULATION
1. RealEs[a[e(Schedule A). . . . . . . . . . . . . .. . . . . . . . . .. . .. . . . . .. . .. . . . . . .. . 1. .
2 Stocks and Bonds(Schedule B) . .. . .. . . .. . .. . .. . .. . . . . . . . .. . . . . . . . . .. . 2. .
7. Closeiy Held Corporetioq Parinersnlp orSole-Propnerorship(Schetlule C) . . . .. 3. .
4. Mortgages and Noles Receivable(Schetlule D). . . . . . . . . .. . . . . .. . .. . .. . .. . 4. •
5. Cash.Bank�eposits antl Miscellaneous Personal Property(Schetlule E). . . . . .. 5. .
fi. Join�ly Ownetl Pmperty(Schetlule F) O Separa�e Billing Requested . . .. . .. 6. .
]. Inter-Vivos Transfere 8 Miscellaneous Non-Probale Property
(Schedule G) O Separe�e Billing Requested.. . .. . .. ]. .
8. Total GmssAssets(roial Lines 1 �brougM1]). . . . . . . . .. . .. . . . . .. . . . . . . . . . . 8. ,
9. Poneral Expenses and Atlminisha�ive Costs(Schetlule H). . . . . . . . . . . . . . . . . . 9. ,
10. Debls ot Oewdenl, Mohgage Liabili�ies antl Liens(Schedule I). . . . .. . .. . . . . .. 10. 7 3 �'f'D•� q
11. Total OeJuc[ions(�o�al Llnes 9 antl 10). . .. . . .. . . . . .. . .. . . . . . . . . . . . . . . . . 11. /,3 �D.7 9
12. Ne[Value of Es[ale(Line B minus Line 11) . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . 12. 7/3 �"t'�•� 9
13. -Charilable and Governmental Bequests/Sec 9113 Tmsts for which
an election to lax has not been made(SCM1edule J) . . . .. . . . . . .. . . . . .. . . . . .. 13. � .
14. Ne[Value Subject[o Tax(Gne 12 minus Line 13) .. . .. . . .. . .. . .. . .. . . . . .. 14. ���T 0 .� 9
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amoun�of Line 14 taxable
at Ihe spousal�x ra�e, o
�ransfers untler Sec. 9116
(a7(12)x .0_ . �a .
,e_ a�����eai°a�e,�X ,o�e�e �, 34- D. 79 � ,� 3 �0• 3y-
1]. Amount of Line 14 taxable
atsiblingra�e X .12 . 1]. .
�8. Amountot Line 14tardble
at collale2l 2te x_15 • 18- •
19. TA%DUE . . . .... . . .. . . . . . .. . . . . .. . . . . . . . . . . . .. . 19. .
20. FILL IN THE OVAL IF YOU ARE RE�UESTING A REFUND OFAN OVERPAVMENT �
Side 2
L 1505611201 1505611201 J
aev isoo ex aaqe s Fne rvumeer
DecedenPs Complete Address �
oECEOENrs Nnn+E
mRs . �o� NN K. I�Ubi AILL �
SrREErAooREss17'1 �rvvR Ct�R � 1—� � ctLtl� 5�4�vices —�� RC; sL�
9 '-1-0 t,�/� LN�t J3o ftom l�o c�c� � ��crn a o �I
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�"" C R r� L i s L � STArE �� Z�P 1 '7 0/5
Tax Payments and Credits:
1. Tax�ue(Page 2, Line 19) (1)
2. Credi�siPaymenis
A.Prior Paymen�s
B. Dismunt
TotelCredits�A+B) (2)
3. Inlerest
(3)
4. If Line 2 is greater Ihan�ine i +Line 3,enler the difierence. This is the OVERPAYMENT.
Fill in oval on Page 2,Line YO lo request a refuntl. (4)
5. It Gne 1 �Cine 31s greater�hen Line 2 enlerthe diHe2nce.Thls Is Ihe TAX DUE. (5)
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. �id decadenl maka a Vansfar an0: Yes ���Nofff
a. relain the use or inwme of Ihe propetly Iransierred .._._ ........ ...... .._. ❑ �
b. relain the righl to designate who shall use ihe property transferted or rts income ...... _._ ❑
c. retainareversionaryinteresl .......... __.._. __ ..... ..._ ❑ �n�t
tl. receive Ihe promise for hfe of eM1her payments,benefts or care� _._ ..... _.... ❑ I�l
2. If dealh acarretl after Oec.12 1982,did decetlent Vansfer propetly within one year oi death �,/
withoutreceivingatlequatewnsideration7. ........_ ..._._ ._._._ ._. ❑ ICF
3. �Id decedenl own an"in imsl for"or payeble-upon�ealh bank accowt or searily at his or her tleaih� __. ❑ �
4_ �id decedenl own an lndrvidual reVremen�accoun� annuiry or olher non pmbata property whmh }�
con�ainsabeneficiarydesgnation� ........... ._._. _.._._ ....... ......... ❑ y�
IF THE ANSWER TO ANY OF THE ABOVE�UESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Pordates of death on or after July 1, 1994,antl before Jan. L. 1995,ihe tax rete Imposed on the net value of iransfers to or for ihe use of ihe surviving spouse
is 3 percent�72 P.S. §9116(a)(1.1);i)].
Por dates of death on or after Jan. 1, 1995. the tex rate Imposed on ihe net value of Iransfers �o or for Ihe use of ihe surviving spouse is 0 percen�
�72 H5.§9116(aJ(1.1)(I�].The stamte tloes not exempt a Irensier to a sarvrving spouse from lax,and the statWory requirements(or tlisclosure ot assets and
flling a tax reNm are sbll appllcable even If�he surviving spouse is the only beneficiary.
For dates o(death on or after July L.2000:
. The tax rete imposed on the ne�value oi Vansfers from a deceasetl chlltl 21 years of aga or younger at death to or for the use o(a naWral parent. an
adoplive perent or a stepparen�of�he chlld Is 0 pement[72 P.S.§911fi(a)(12)].
. ThetaxrateSmposedon�henelvalueoftransfersloorfortheuseofihedecedenPsllnealbeneficiariesis4.5percent,exceptasnotedin[72PS.§9116�a)(i)�.
. The tax rete imposed on�he ne�value of Vansfers to or for Ihe use of ihe decedenfs siblings is 12 percent[72 PS. §9116(a)�1.3�J.A si�ling is defned.
under Section 91�2, as an individual who has at least one parent in common with ihe decedent.whe�her by blootl or adoption.
0.EV-'512 E%r (12-OB)
�� pennsylvania SCHEDULE I
oE�^a�^E���FAF�F^��F DEBTS OF DECEDENT,
�""E""""�E'^"°E�V'" MORTGAGE LIABILITIES & lIENS
aEs�oErvr oECEOEn.
ESTATE OF 1 FILE NUMBER
mas, JopNN K. Rob� 1-p � L��.
Report tlebts incurred by the deadent prior to death that remaineE unpaiE a[the Eate o(Eeath,incluEing unreimburseE metlical expenses.
ITEM VAWE AT�ATE
NpMBER DESCRIPTION OF DEATH
� Che�K # a5`f dat�d y-/ � µ � ao�� C�+A�,vd� � -7 3`�-U, � 9 —
�Jent }0 t 1 h� DP�R2�-vn4N f OF f ubli� Ulel�tRz ��
=C' I`�Jf� �
I� i=i'�R d��edent 's �s+pt� i,✓ascomPie{ely
Seti-led., W4 R�c�ivec� a le }-FeR Frzon'i
The c�e�Wre�'r^ cn-�- o � �uyU� � c iNelFw/tf /+sKi�
+hA� �e 2e+�an � 7, 3'l-0. 79 ba �K -)-o
�-�'l2wt FofL NURs� rg ffdme �cx (�enSeS. Uk ARc�
A-SK��y th�V�t yvu �leu� �Ze,FuveP �v�
IfYh-C2if2hcQ -r"RX rllo✓��� hc( t�C f-o U5.
ar � you. Fart -F�iis 2ke7.�s-e5t, unc�
yav2 H551�5+-�+��e � � thi5 M��ER�
�9�u��/� f�
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TOTAL(Also enter on Llne 10, Recapi[ulatlon) $ � 3�-1-D, 7 9 -
[f more space is needetl,insert aAaitional sheets of ttle same size.
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PH.717-713-3165 2ig�i3xxy
215 MEALS DR '' //
CAIiLISLE,PA 17015 /��
DATE
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