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COMMONWEALTH OF
PENNSYLVANIA
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DEPARTMENT OF REVENUE
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DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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5. federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Elaction to tax undW Sec. 9113(A)
(Attach~O)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule 0) (4)
5. Cash, Bank Deposits & Misc. Personal Property (Schedule E) (5)
1,799.59
6,443.50
$0.00
(8)
4,190.42
$0.00
(11)
(12)
(13)
(14)
(15)
(16)
(17)
$0.00
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6. Jointly Owned Property (Schedule F)
(6)
. Separate Billing Requested
7. Inter-Vivos Transfers & Misc. Non-Probate Property
(7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
8,243.09
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(10)
10. Debts of Decedent, Mortgage Liabilities & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
4,190.42
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
4,052.67
$0.00
4,052.67
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$0.00
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$0.00
182.38
17. Amount of line 14 taxable at sibling rate
18. Amount of line 14 taxable at collateral rate
x -::;s-- (18)
19. Tax Due
(19)
182.38
20..
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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TotallnteresUPenalty (0 + E) (3)
If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
If line 1 + line 3 is greater than line 2. enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN X IN THE APPROPRIATE BLOCKS
lete Address:
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
182.38
Total Credits (A + B + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
",-, ---~- - ~- --'""'-- - ~ ,~~
(2)
9.12
4.
5.
1.
Did decedent make a transfer and:
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 revisionary interest; or
d. receive the promise for life of either payments, benefits or care?
If death occurred on or before December 12,1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? If death occurred
after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
Did decedent own an individual retirement account, annuity, or other non-probate property?
$0.00
$0.00
173.26
173.26
Yes
No
2.
3.
4.
.
.
.
.
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penallies of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, Ills true, correct,
and complete.
Declaration of preparer other than the personal representative is based on all the information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
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ADDRESS 5 /
DATE
-----
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving
spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% f72 P.S. ~9116
(a) (1.1) (ii)). The statute does no 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 jf 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 twenty-one 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% [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%, except as noted in 72 P .S. ~9116(1.2) [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% [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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF Mildred M. Gardner
Include the proceeds of litigation and the date the proceeds were received by the estate.
be disclosed on Schedule F.
ITEM DESCRIPTION
NUMBER
FILE NUMBER
All property jolntly..owned with the right of survivorship must
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Mildred M. Gardner
FILE NUMBER
Debts of decedent must be re orted on Schedule I.
ITEM
NUMBER
DESCRIPTION
AMOUNT
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
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BUREAU OF I~IVIDUAL TAXES
IHHERJ~4~CE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
03-26-2001
GARDNER
11-17-2000
21 01-0152
CUMBERLAND
101
FRANCES H DEL DUCA
10 W HIGH ST
CARLISLE PA 17013-0029
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REV-1S47 EX AFP 02-DD)
MILDRED
M
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WIllS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iff,,=is4j-e:x--jFP-[i"2-:oo1--NoTICE--OF-'rNHEififANci-TAX-XPPRA"iSEMEN;::--jLI"OWANCi-OR----------- - - - - --
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GARDNER MILDRED M FILE NO. 21 01-0152 ACN 101 DATE 03-26-2001
TAX RETURN WAS: ( ) ACCEPTED AS FILED
( X) CHANGED
SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
1,799.59
6,443.50
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
NOTE: I~ an assessment was issued previously, lines
re~lect ~igures that include the total o~ ALL
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15)
16. Amount of Line 14 taxable at Lineal/Class A rate (16)
17. Amount of Line 14 at Sibling rate (17)
18. Amount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
(9)
(10)
2,490.01
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
8,243.09
2.490 01
5,753.08
.00
5,753.08
14, 15 and/or 16, 17, 18 and 19 will
returns assessed to date.
.00
258.88
.00
.00
258.88
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-07-2001 AA477982 9.12 173.26
PAYMENT MUST BE MADE BY 08-17-2001*. TOTAL TAX CREDIT 182.38
BALANCE OF TAX DUE 76.50
INTEREST AND PEN. .00
TOTAL DUE 76.50
.00
(11)
(12)
(13)
(14)
.00 X 00 =
5,753.08 X 045=
.00 X 12 =
.00 x 15 =
(19)=
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS lESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REflECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
~~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENT'S NAME
REV-1470 EX (6-88)
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REVIEWED BY
SCHEDULE
ITEM
NO.
H
83
INHERITANCE TAX
EXPLANA TION
OF CHANGES
Mildred M. Gardner
FILE NUMBER
Angelique Foica
ACN
2101-0152
101
EXPLANATION OF CHANGES
Reduced to $1,799.59. Family exemption can only be claimed against assets subject to
will or intestacy.
ROW
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'/i.; '*
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-I'D? EX AFP <12-00)
FRANCES H DEL DUCA
10 W HIGH ST
CARLISLE PA 17013
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
04-23-2001
GARDNER
11-17-2000
21 01-0152
CUMBERLAND
101
MILDRED
M
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
ifEv: i6"ifj-E:X-AFP--(i2-:0(ff------...--iNifERi~.._ANCE--TA3f-STA-fEMENT-OF-AC-Couiif--.-..--------------- - - - - --
ESTATE OF GARDNER
MILDRED
M FILE NO.21 01-0152
ACN 101
DATE 04-23-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 03-19-2001
P R I NC I PAL TAX DUE: ..................................................................................................................................................................
258.88
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
02-07-2001 AA477982 9.12 173.26
03-26-2001 AA478205 .00 76.50
TOTAL TAX CREDIT 258.88
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )