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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Cudd Jane B.
DATE OF DEATH (MM-DD-Vear)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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OFFICiAl USE ONLY
FILE NUMBER
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SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD--Year)
207-03-7845
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
01/04/2001 04/01/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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[Xl 1. Original Return
o 4. Limited Estate
[jI 6, Deceq,ent Died Testate (Attachcopyof~lI)
V'o-r I'j(0I3/t"T6Uj
o 9. litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of dealh afler 12.12.82)
o 7. Decedent Maintained a Living Trust (Attach copyofTrust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
. 'MuST BE COMii!ttTED. ALL' ",
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under See, 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17, Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19, Tax Due
"'7"ONDENCE'~NFIDE~~INFO~T" ,0 ,~~""'O:
COMPLETE MAILING ADDRESS
3631 North Front Street
(1)
(2)
Harrisbur PA 17110
OFFICIAL USE ONLY I
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NAME
James D. Cam bell Jr. Es uire
FIRM NAME (If Applicable)
CALDWELL & KEARNS
TELEPHONE NUMBER
717 232-7661
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3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
(5)
200.00
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1.7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13, Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
93,795.68
L___J
(8)
93,995.68
615.00
383.24
(11)
(12)
(13)
998.24
92,997.44
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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(14)
92,997.44
X .0_(15)
92,997.44 X .04.5 (16)
X .12 (17)
X .15 (18)
(19)
4,184.88
4.184.88
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
;;-;; EIE':SIiIRE TO ANSWER ALL QI1IlSTlO~RSE sms~ECI:llili:KMAI:J.t.< "
Decedent's Complete Address:
STREET ADDRESS 770 Poplar Church Road
CITY I STATE I ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
4,184.88
209.24
Total Credits (A + B +C)
(2)
209.24
3. InteresVPenalty if applicable
D.lnterest
E Penalty
TotallnteresVPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 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)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
3,975.64
3,975.64
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; ...........................................,............................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ D IKI
c. retain a reversionary interest; or ................... .......................... . ............................... .................... D lKl
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [X]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?................... ................... ............. ........................................... 0 lKl
3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ................. D ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 lKl
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 penalties of perjury, I declare that I have examined this return, including accompanying scbedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preRarer other than the personal representative is all information of which pre parer has any knowledge.
SIGNATUR F PERSON RESPONSIBLE FOR FI G R RN DATE
3 :;./ 01
ADDRESS "
3<6'/0 )...~f~+ Dr,ve. H'~~"f"-~1 {If {III!
SIGNATURE OO:::EROTHEL~RE~TATlVE
ADDRESS 0_. '
3b'?l N FV.~t <;J.- l-("a'''~-1 (I't /1/10
DATE
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For dates of death on or after July 1, 1 994 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 t"msfers to ortor the use of the surviving spouse is 0% [72 PS. ~9116 (a) (1.1) (iill.
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are stHl 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 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)(1.211.
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneflcmies 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.
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COMMONWEALTH OF PENNSYLVANIA
\NHERI1 ANCE 1 AX RE1URN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
FILE NUMBER
Cllddv Jane B
Include the proceeds of litigation and the date the proceeds were received by the estate. AU property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
200.00
Personal effects, clothing
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
200.00
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Cuddv .Jane B
If an asset was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
FILE NUMBER
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. William C. Cuddy
3810 Sunset Drive
Harrisburg, PA 17111
Son
B Janice A. Hewitt
736 Bosler Avenue
Lemoyne, PA 17043
Daughter
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JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH OECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held realeslate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 6/14/88 Mellon Checking 252-112-4053 13,960.38 50. 6,980.19
2. A. 2/10/98 Mellon CD #00669238 71,051.54 50. 35,525.77
3. A. 2/25/98 Mellon CD #00678554 15,020.06 50. 7,510.03
4. B. 1/28/97 Mellon CD #00439405 67,511.41 50. 33,755.71
5. B. 3/20/98 Mellon CD #00695074 20,047.95 50. 10,023.98
TOTAL (Also enter on line 6, Recapitulation) $ 93 795.68
(If more space is needed, insert additional sheets of the same size)
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P.O. Box 7899
Philadelphia, PA 19101-7899
Mellon Bank
February 09,2001
Caldwell & Kerns
3631 North Front Street
Harrisburgh, PA 17110
Estate Of Jane B Cuddy
Date of Death: 01/04/200 I
SSN 207-03-7845
Dear Sir/Madam:
In accordance with your request, the attached information sheet has been provided in the
above decedents name as of his/her date of death.
For IL or LC accounts, contact our Loan Department at 1-800-537-5591. For all other inquiries,
please call (215) 553-1585.
~..
Mellon Bank, N.A
Deposit Support Services 199-5355
Page 1 of 2
@ Mellon Bank Friday, February 09,2001
Account
Number Account Title
252-112-4053 Jane B Cuddy Date Opened: 06/14/1988 Account Type: 00
William C Cuddy Principal Bal Int from Last Account Bal YTD Intto
as of DOD Posting to DOD as of DOD DOD
$13,956.14 $4.24 $13,960.38 $0.00
00439405 Jane B Cuddy Or Date Opened: 01/28/1997 Account Type: TO
Janice A Hewitt Principal Bal Int from Last Account Bal YTD Int to
as of DOD Posting to DOD as of DOD DOD
$65,286.33 $2,225.09 $67,511.42 $35.72
00695074 Jane B Cuddy Or Date Opened: 03/20/1998 Account Type: TO
Janice A Hewitt Principal Bal Int from Last Account Bal YTD Int to
as of DOD Posting to DOD as of DOD DOD
$20,000.00 $47.95 $20,047.95 $0.00
00669238 Jane B Cuddy Or Date Opened: 02/10/1998 Account Type: TO
William C Cuddy Principal Bal Int from Last Account Bal YTD Int to
as of DOD Posting to DOD as of DOD DOD
$60,000.00 11,051.54 $71,051.54 $34.02
00678554 Jane B Cuddy Or Date Opened: 02/25/1998 Account Type: TO
William C Cuddy Principal Ba/- Int from Last Account Bal YTD Int to
as of DOD Posting to DOD as of DOD DOD
$15,000.00 $20.06 $15,020.06 $0.00
Page 2 of 2
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Cuddv .Jane B
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A FUNERAL EXPENSES:
1. Prepaid
2. Funeral luncheon 300.00
S. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Numbe~s) f EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s} Commission Paid:
2. Attorney Fees Caldwell & Kearns 300.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7. Filing fee, inheritance tax return 15.00
TOTAL (Also enter on line 9, Recapitulation) $ 615.00
(If more space 15 needed, Insert additional sheets of the same size)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF
Cuddv Jane B.
Include unrelmbursed medical expenses.
ITEM
NUMBER
FILE NUMBER
DESCRIPTION
AMOUNT
269.00
1
PA Department of Revenue - State Income tax
2.
East Ambulance Service Association
60.26
3.
Foot Care Center
7.24
4.
Dr. Rich
9.04
5.
Pinnacle Health
37.70
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
383.24
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
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RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. William C. Cuddy Son 50%
3810 Sunset Drive
Harrisburg, PA 17111
2. Janice A. Hewitt Daughter 50%
736 Bosler Avenue
Lemoyne, PA 17043 (By mutual agreement)
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space IS needed, Insert additional sheets of the same size)
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LAST WILL AND TESTAMENT
OF
JANE B. CunDY
I, JANE B. CUDDY, presently of Camp Hill, Cumberland
County, pennsylvania, being of sound mind, memory and
understanding, do make, publish and declare the following to be
my Last Will and Testament, hereby revoking and making void all
former wills by me at any time heretofore made.
ITEM I.
I direct that all my just debts and
funeral expenses be paid as soon after my death as may be
practical.
ITEM II.
All the rest, residue and remainder
of my property and estate, both real and personal, of whatsoever
il
II kind and wheresoever situated, which I may own at the time of'my
death, I give, devise and bequeath unto my children, william C.
Cuddy, of Harrisburg, Dauphin County, Pennsylvania, and Janice A.
Hewitt of Lemoyne, Cumberland County, Pennsylvania, in equal
portions, share and share alike, per stirpes.
In the event that
either of my said children shall not survive me, his or her share
shall pass to his or her children, in equal portions, share and
share alike. The children of my son, William C. Cuddy, are Brian
D. Cuddy of Edgewood, Maryland, and Michael A. Cuddy, of
Pittsburgh, Pennsylvania. The children of my daughter, Janice A.
Hewitt, are David Hewitt of Harrisburg, Pennsylvania, and Daniel
Hewitt of Lemoyne, Pennsylvania.
ITEM III.
I hereby nominate, constitute and
appoint my son, William C. Cuddy, to be the Executor of my estate
with the power to sell all real and personal property at private
or public sale.
In the event my said son shall not survive me,
or shall otherwise fail to qualify as my Executor, I then
nominate, constitute and appoint my daughter, Janice A. Hewitt,
to service in his place and stead.
"
IN WITNESS WHEREOF, I, Jane B. Cuddy, the Testratix herein,
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have hereunto set my hand and seal this
day of
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Jane B. Cuddy
The preceding instrument, consisting of this and two (2) other
typewritten pages, was on the date thereof signed, published and
declared by JANE B. CUDDY, the Testatrix therein named, as and
for her Last Will, in the presence of us, who at her request in
her presence and in the presence of each other, have subscribed
our names as witnesses hereto.
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
~~L*
(; ~EV-1547 EX AFP n2-DDl
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
DATE OF DEATH 01-04-2001
FILE NUMBER 21 01-0308
1 : COUNTY CUMBERLAND
JAMES D CAMPBELL JR ESQ ACN 101
CALDWELL & KEARNS I Amount Remitted I
3631 N FRONT ST I
HBG PA 1711Q
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 .....
REY=iS'4-j-EX-AFP-n'2=OOY-NO'TicE--OF-YtiHERiTANCE-TAj(A-PPRAisEiiiNT~--Ai:LOWANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CUDDY JANE B FILE NO. 21 01-0308 ACN 101 DATE 05-07-2001
TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this forn with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 200.00 tax payment.
6. Jointly Owned Property (Schedule F) (6) 93,795.68
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 93,995.68
APPROVED DEDUCTIONS AND EXEMPTIONS: 615.00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 383.24
11. Total Deductions (11) QQ8 24
12. Net Value of Tax Return (12) 92,997.44
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 92,997.44
NOTE: If an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (5) .00 X 00 = .00
16. Anount of Line 14 taxable at Lineal/Class A rate (6) 92,997.44 X 045 = 4,184.88
17. Amount of Line 14 at Sibling rate (7) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (8) .00 X 15 = .00
19. Principal Tax Due (19)= 4,184.88
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-21-2001 AA478185 209.24 3,975.64
TOTAL TAX CREDIT 4,184.88
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
II IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
DATE
ESTATE OF
05-07-2001
CUDDY
JANE
B