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Home My WebLink About06-08-15 (2) 1505611101 J REV-1500 EX(02-11) enns lvania OFFICIAL USE ONLY PA Department of Revenue p Y OERRRTMENT OF-ENU[ County Code Year File Number Bureau of Individual Taxes PO BOX 280601 INHERITANCE TAX RETURN Harrisburg,PA 17128-0601 RESIDENT DECEDENT I 5 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 9 g z Decedent's Last Name Suffix Decedent's First Name MI M Q () Tuc V ft K) 1 E-A. (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 i� 1. Original Return O 2. Supplemental Return O 3. Remainder Return(Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise(date of O 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 Number M � oR � 2 � ? 107 `917 (� 6 REGISTE WILLS Ltn ONLY rn Rt � O c_ C> First Line of Address ;J II ib 0 CL !-Le 61- R60 ' -- -I CX3 c� Second Line of Address City or Post Office State ZIP Code DAT&FILEt3 � � criS Correspondent's e-mail address: I jj/,' Lj( p, N1a 0 YC4 Ln, 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 at c p ete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE flE O S ONSIBLE FOR FIL G RETURN ATE AZI EL�o� ADDRESS G�S SIGNATURE OF PREPARER OTHER THAN REPRESENTATIV DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505611101 1505611101 J \ 1505611201 REV-1500 EX Decedent's Social Security Number Decedent's Name: 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. X17 1C1 • 5� 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .... .. . 6. • 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. ... .. . 7. 8. Total Gross Assets(total Lines 1 through 7). .. .. .. .. .. .... .. . . ... .. . . ... 8. T) . 9. Funeral Expenses and Administrative Costs(Schedule H). ... . .... .. . .. . . .. . 9. ' q 1� 4 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). .. . . .. . .. . . .. . 10. 11. Total Deductions(total Lines 9 and 10).. . . .. . . ... .. . . .. .. .. . .. .. .. . ... . 11. (� 12. Net Value of Estate(Line 8 minus Line 11) . ... . .. . .. . . .. .. .. . .. . . .. . . .. . 12. Z'$ 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. 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_ 15. 16. Amount of Line 14 tax le at lineal rate X .OW3 Z. 6 S 16. 17. Amount of Line 14 taxable at sibling rate X.12 17. 18. Amount of Line 14 taxable at collateral rate X.15 18. ` ... ... . . . . .. 19. , . l Z • 19. TAX DUE . . .. .. .... ... .. . . .. .. . . .. . .. . . .. .,:.:..,.. ... ., 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505611201 1505611201 REV-1500 E)< Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME STREET ADDRESS CITY ZIP�� Tax Payments and Credits: ' 1. Tax Due(Page 2,Line 19) 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 3. Interest i (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) T Make check payable to: REGISTER OF WILLS, AGENT. ss. :.'': 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 .......................................................................................... ❑ ,/ i 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)]. 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 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-1508 EX+(11-io) Qpennsytvania SCHEDULE E i DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: 'DaAA NLM (Lie- 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 II WSt-. &-"1'.ks LP -0/Q 2,.-0 ��S W4-vo T\) l 5-0 , 0 G) C(A-!S�' �""�p,�C65il � V f (mac 7 TOTAL(Also enter on Line 5, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND . INHERITANCE TAX RETURN ADMINISTRATIVE COSTS S RESIDENT DECEDENT ESTATE OF FILE NUMBER Day�tA K�- Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: .� C&' B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representatives) Street Address , e City State ZIP ( �L Year(s)Commission Paid: k I 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: P ,ire, l o0� 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $ 0 If more space is needed,use additional sheets of paper of the same size. z r A Family radi o I � AR HEM R.E Funeral Home & Cremation Services, Inc. Mrs.Susan M Orris 1/12/2015 315 11th Street New Cumberland,PA 17070 1303 Bridge Street For The Services of Daniel B.Moore P.O.Box 431 New Cumberland,PA 17070 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. The following PN:(717)774-7721 is an itemized statement of the services,facilities,automotive equipment and merchandise that you selected FX:(717)774-5546 when making the funeral arrangements. www.partheinore.com Terms Due Date Account# Net 30 2/11/2015 7031.1 �- � Description Amount 0.00 Direct Cremation 2,795.00 Gilbert W.Parthemore VisitationNiewing 470.00 Founder Memorial Service 630.00 Reflections Stationery Set 135.00 Gilbert J.Parthemore Total Services and Merchandise 4,030.00 Supervisor 0.00 Stephen K.Parthemore Death Notice,Harrisburg Patriot 362.04 President,CFSP 9 Certified Copies of Death Certificate 54.00 Clergy Honorarium 200.00 Bruce R.Parthemore organist Honorarium 125.00 Pre-Need Coordinator,CPC Cumberland County Coroner Fee,Cremation Authorization 30.00 Total Cash Advances 771.04 -� ---w— Less Consideration for Loss of a Child -403.00 Professional Memberships: d . � ' s.=a a.a^ :4' A Pennsylvania Funeral Directors Association Ordergfrhe y Golden Rule Tota) $4 3 Payments/Credits -$2,620.00 Balance Due $1,778.04 RECEIPT FOR PAYMENT ------------------- ------------------- LISA M. GRAYSON, ESQ. Receipt Date : 2/02/2015 Cumberland County - Register Of Wills Receipt Time : 12 : 22 : 21 One Courthouse Square Receipt No. : 1080357 Carlisle, PA 17613 MOORE DANIEL B Estate File No. : 2015-00125 Paid By Remarks : MICHAEL & CATHY MOORE DB1 ------------------------ Receipt Distribution ------------ ----------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 20 . 00 CUMBERLAND COUNTY GENERAL FUN RENUNCIATION 5 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 35 . 50 BUREAU OF RECEIPTS & CNTR M.D SHORT CERTIFICATE 5 . 00 CUMBERLAND COUNTY GENERAL FUN AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 3680 $100 . 50 Total Received. . . . . . . . . $100 . 50 i RO Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 937-0004 BANK myme robank.c mymetrobank.com t >19903 5154646 001 092140 ESTATE OF DANIEL B MOORE MICHAEL A MOORE EXECUTOR 165 OAKLEA RD HARRISBURG PA 17110 We're here to assist you 7 days a week,365 days a year! Call us Monday-Friday:6AM-Midnight,Saturday:8AM-8PM,Sunday:10AM-8PM at 1-888-937-0004. ESTATE CHECKING 2844286548 Statement Balance as of 03110/15 $0.00 Plus 3 Deposits and Other Credits $1,864.68 Less 2 Checks and Other Debits $175.50 Statement Balance•as of 03/31/15 51;689.1.8 Transactions By Date Date Description Debit Credit Balance 03/11/15 WEB TFR TO 000538222308 MOORE $100.50 $517.40 TFR 03112M 5 WEB TFIR TO 000538222308 MOORE $79.60 $442.40 tFR 03/13/15 WEB TFR FR 000538222308 MOORE $75.00 $517.40 TFR 32 p/ H5 CUSTOMER DEPOSIT j _ $1,171.78 $1,688.18 0 0 0 0 0 0 0 0 0 0 o 0 0 c 0 m m o 10 c 0 M 0 rn rn 31 Cycle Page 1 of 2 92140 ROLL 07/11 I NOTE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION Member FDIC i E Metro Bank 3801 Paxton Street MHarrisburg PA 17111-1418 BANK myme robankQ4 mymetrobank.com >06147 5250006 001 092140 ESTATE OF DANIEL B MOORE MICHAEL A MOORE EXECUTOR 165 OAKLEA RD HARRISBURG PA 17110 We're here to assist you 7 days a week,365 days a yearl Call us Monday-Friday.6AM-Midnight,Saturday.8AM-8PM,Sunday.10AM-8PM at 1-888-937-0004. ESTATE CHECKING 2844286548 . ta#eme�t Ba ante as o 1 1 .�S ,889. Plus 2 Deposits and Other Credits 11,241.l; Less 2 Mecics and Other Debits- 1044"01-05, Transactions By Date Date Description Debit Credit Balance q7_ - 1, 2ti;fl3. 04101/15 CHECK#316 $1,000.00 $826.83 04128/15 CUSTOMER DEPOSIT $1,104.00 $1,152.79 Check Transactions Number Date Amount Number Date Amount Number Date Amount 317 04/10 $778.04 Items denoted with an"E"are electronic entries and will not have a check image. Items denoted with an"'"indicate processed checks out of sequence. g g ` o is 8 r 31 Cycle Page 1 of 2 92140 ROLL 07/11 NOTE:SEE REVERSE SIDE FOR IMPORTANT INFORMATION Member FDIC b INVENTORY REGISTER OF WILLS OF COUNTY, PENNSYLVANIA COMMONWEALTH OF PENNSYLVANIA COUNTY OF SS File Number 6 C)12 Personal Representative(s)of the Estate of D(kV,)--eA 9z, 1 v "Eg—le r deceased,depose(s)and say(s)that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent,that the valuation placed opposite each item of said inventory represents its fair value as of the date of the decedent's death, and that Decedent owned no real estate outside of the. Commonwealth of Pennsylvania except that which appears in a memorandu n at the end of this inventory. I verify that the statements made in this Inven- tory are true and correct. I understand that false state- ments herein are made subject to the penalties of 18 Pa.C.S. § 4904 relating to unsworn falsification to authorities. Attorney-- (Name) (Supreme Court I.D. No.) (Address) (Telephone) p DATE OF EATH � LAST RESIDENCEG*hA6 ^ I�a DECEDENT'S SOC.SEC.NO. FIGURES MUST BE TOTALED (Attach additional sheets as needed) TOTAL: ZJ 2 Dt 33*w NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative include the value of each item,but such figures should not be extended into the total of the Inventory. (See 20 Pa.C.S.§3301(b)) Form RW-09 rev.10.13.06