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Home My WebLink About07-27-15 (2) � �i Pennsylvania 15 0 5 61410 5 DEPPPTMEMaFpEVENUE EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 C INHERITANCE TAX RETURN ,,, � � Harrisburg, PA 17128-0601 RESIDENT DECEDENT "�� ' ��D�� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _ _ _ _ _ 11162014 12011918 _ _ _ _ . _ _ _ ___ _ _ . . _ _ _ Decedent's Last Name Suffix DecedenYs First Name MI __ _ _ _ _ _ _ _ _ _ Houser Mildred E _. _ . (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x Spouse's First NaiYie MI _ _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW (rj 1.Original Return p 2.Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) p 4.Agriculture Exemption(date of p 5.Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 7. Decedent Died Testate p 8.Decedent Maintained a Living Trust _. 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) p 10.Litigation Proceeds Received p 11.Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13.Business Assets O 14.Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number _ __ _ _ _ __ _ James M. Bach, Esquire (717)737-2033 First�ine of Address 352 S. Sporting Hill Rd _ _ Second Line of Address __ _ _ _ _ . . . City or Post Office State ZIP Code . _ _- _ _ _ _ __ . __ _ .__ Mechanicsburg PA 17050 __ _ _ __ - __ _ ___ _ --. _ __ _ __ _ _ ;„ CorrespondenYs emaii aadress: staff@jamesmbach.com � � � rn 0 REGISTER @fj S USE ��7 ��1 -�- C'� r` cn REGISTER OF WILLS USE ONIY ;:':7 t�y �-- N .-_{ DATE FN.ED MMDAYYYY :�� ;; ["'1 .,,J �� ' _. , ._ , � t �. . . t.:� {-� ') C:.> -=� -�l "� �a � � � DATE FILE�STAMP • f'— ----- .,.., �. N � Q W -T7 PLEASE USE ORIGINAL FORM ONLY Side 1 � i iiiiii iiiii iiiii i�i�iiii�iii�iiiii i�i�iiiii iiiii iiii iiii J 0 6 41 1505614105 �T' ,� �. J 1505614205 REV-1500 EX(FI) DecedenYs Social Security Number ___.__ __ Decedent's Name: HOUS@t', Mildred E. RECAPITULATION ___ __ _ __ 1. Real Estate(Schedule A). ..... . ... ... . . ... ... .... . ....... ........... . 1. 125,000.00 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. 645.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . ... ... 6. __ __ _____. _..__--. 7. Inter-Vivos Transfers 8�Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. ...... 7. 8. Total Gross Assets total Lines 1 throu h 7 8. �28,645.00 � 9 ).. . . ..... . . ... ... . . ... . .... .. 9. Funeral Expenses and Administrative Costs(Schedule H). .... . ... . . ... .... . 9. 24,896.79 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).. . .... ..... ... 10. 11. Total Deductions(total Lines 9 and 10)... . . ... .... . ... ... . ......... ... . 11. 24,896.79 12. Net Value of Estate(Line 8 minus Line 11) ....... ... .... . ... ..... ..... .. 12. 1�3,748.21 _ __-----.--._._--__---..._ .----.._--____,____.__.__. 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, ��3,748.21 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 taxable . _ _ _ _.. _____._.__ __ ._ at�inea�rate x.0 6 103,748.21 �g. 6,224.89 __ . _ . _.. _._ ___._ _ ____ _ _________._.------______._. 17. Amount of Line 14 taxable at sibling rate X.12 �7 ___. _ _.. _- - ________ ___. ._._ _ _._.___ .�..._._ _ _____....___--.__. 18. Amount of Line 14 taxable at collateral rate X.15 �$. 19. TAX DUE ...... . ... ... . .... .... .. . .... . ...... . ... . ... .. ... .... . ... 19. 6,224.89 __ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perjury,I declare I have examined this return,including accompanying schedules and st:�ternents,and to the best of my knowiedge and belief, it is true,correct and complete. Declaration of preparer other than the person responsible for filing the rE:turn is t��ased on all information of which preparer has any knowledge. S NATU OF PERSON RESPO IBLE FOR F�ETURN DATE � /� � DRESS 221 Wood Street, Camp Hill, PA 17011 � SI A RE OF PREPAR OTHER THA RSON RESPO SIBLE FOR FILING THE RETURN DATE ,_ .- AD RE S 52 outh Sporting Hill Road, Mechanicsburg, PA 17050 � �I��I��III��I��II��II�)��II�I��I��I�I�I I�� Side 2 � 1505614205 1505614205 REV-1500 EX (FI) Page 3` File Number Decedent's Complete Address: DECEDENT'S NAME Mildred E. Houser __ _._ - -- __ ----_ —_ ____ _ STREET ADDRESS 2920 Harvard Avenue CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 6,224.89 2. CreditslPayments A.Prior Payments B.Discount (See instructions.) Total Credits{F�+B) (2) 0.00 3. Interest (3) 0.00 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) 6,224.89 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,whlch 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 s�atutory 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 step-parent 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 i5 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 decetlent's siblings is 12 percent[72 P.S. §9116(a)(1.3)].A sibling is definetl, under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(12-12) � pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Houser, Mildred E. All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,hoth having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedute F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1• 2920 Harvard Avenue,Camp Hill PA 17011 128,000.00 Value set by Real Estate Agreement of Sale.See Exhibit"A" TOTAL(Also enter on Line 1, Recapitulation,) $ 128,000.00 If more space is needed,use additional sheets of paper of the same s�ze. STAPriDARD AGREEMENT FQR THE SA�,E t7F R.�;AL ESTATE A5� This fonn►awmmcnded nnd approved for,6ut not reatricled tn ux by,ttre mwnbers of the pennsylvania Association of Realtors�(PAf�. . r._ PAI�TIES . Btr�xcs�: --�-�s s�.z.,�R�s�: .��,....��, • �- _ CLn�al h�, r,�r� ,c' �.�.,., _ BUYER'S MAILiNG ADD�SS: SELY,ER'S MAILINtG AD�RE�SS: � PRQPERTY ADDRE5S(including postal ciry)� p��e� �lt,r'Vd.�',�,r ��,,,, �' ��QI/ in tt�e municipality of ,Caunry of��ri,.�RK�, ` � in the School District of ,in the Commonweatth of pr,nn8yivania. Ta�c ID#(s): --- Identification(e.g.,Parce]#;Lot,Block;Deed Book,Page,Recortling Date); a 3�p �O1 BUYER'S RELATIC3NSHII"WITH PA LICENSEri SRUKER ❑No Business�eJationship(Buyer is not represented by a brol�er) Broker(Company} Howard Hanna Rea1 Es�a.�e Licensce(s)(Name)�4.�.'.�g�i� � 8erviae� � Company Address Direct Plione(s) Com an Phone ,. �phone(s) `�j/-�-;,$/, ']_ P Y �at9fl Fax Corn.pany Fax � Bmail _ Bro er is(check only one}; Li nsee(s)is(check on]y ane); �'�Bayer Agent(Broker repzesents Buyer only) �uyer Agent ❑Dnal Agcnt(5ee Dnal and/or Desigreated Agent box below) ❑Bayer Agent with Designated Agency ❑DuaI Agent(5ee Dual and/or Deaignated Agent box below} � ❑TransBetion Licensee(Bmker and I.icensee(s)provide real estate services bat do nat represent Bpye,r) SELLER'S RELATIONSHTC"'V(�IT�I PA LICENSED BROKER ❑No Business Relationship(Seller is not represented by a broker) Broker(ComP�Y) �sC l : d�.J�,�' _____ Licensee(s)(Narne)��L- /11�/ha� f-l�21�.L`t3�Q.-._��Ca�_ _,pc.��YC..,.�_ ' �—. � Company Address Direct Phone(s) `-`-� Cell Phone(s) Company Phone p� Company Fax - " ' F.�mail��G� /�f'YI G► Ls.yy.� Br er is(aheck only one); Li e�)�s f ci�Ck anty one}: Seller Agent(Hroker represents 5eIler only} SelIer Agent ❑Dual Agent(5ee Duai andlor I7esignsted Agent bax below) ❑Seller Agent with Designaced Agency ❑Dual Agent(5ee Duai and/ar S�esignated A,�ent boz below) ' ❑Transaction Licensee(Broker and I.icensee(s)provide res]estate semces but do not represent Sellor) DUAL ANDIOTt AESIGNATED AGENCY � A Broker is a Dual Agent when a Brokes zepresonts both Bnyer and Seller im the same transactiun. A Licensee is a Dual Agent when a Licensee represents Buyer and 5e11er in the same txansaction. All of B�oker's licensees are atr�o Dual Agents UNL,ESS th�re are �epazate Designated Agents for Bnyer and Seller.Tf Che same Licensee is designated far Buyer and Sellar,the Licensee is a Dual Agent B� signipg this .Agreement, Buyer and Seller each acknowledge havfng b�en previously informed of, apd consented ta, dual aget�cy, if applicable Iieeyer Initis � / ASR Page 1 of 13 Beller Tnitials: C"• •/ '• I Pennsylvania Associat�on of Rea(tors COPYCtYGt1TYLNNSYLVAN7AAS,90GATYONOFR$ALTp125�ZD14 4114 Howard Humr-Cen4rl pA,37t 0 Ma�lcd Skoot Csmp T�iij,pA 170I I Phone:717-920-9500 Fu: �oroan Wilwn P�otkiced with zlpFOm'�by zlpLnqlX 18070 F(teen Mlls Road,Fraser,A4i0hlgan 4f102G xnnv.z mi �+ �u � �. By this Agreement, a�� .�► -- Z Seller hereby agrees to sell and cat►vey to$uyer,who agrees fo pwrchase,the identiPied�"roperty. ' 3 2• PURCHASE PRICE AND DEPOSTTS(4-14) � (A)Purchaeo Pri $ L�n � � w. 7 1. Initial Deposit,within days of B�cecution Date,if not ineludec! �.5.DO��),to be paid by Buycr ay follows: 8 with fhis Agreement; ��l�r� d,.�, 9 2. A,dditional Deposit within days of the Bxecution Date: � � io 3, � 11 Remaining balance wilr be paid at settlemank 22 ($)All�unds paid by Bnyer, including dePosftsr wliC be patd by check, casbder's ch�k o�wired Iunds. Ait t�nds paid by Buyer 13 within 30 days oi sett[emea►t, imclucling funds pa#d at settlement, will be by cashier's che�g or w3red �wnds, but nat by per. I4 ��g, �5 (C)Deposits,regardless of t6e form of payment,will be paid in U.S.Dotlars to Bmker for Seller(�inIess otherwise stated here: i6 i7 who will retain deposits in an escrow account in confomuity �yitt► all applicable laws a��d reguIations until cansummatian or ter� 18 mination of this Agreement. Only real estate hrokers are reqnired to hold deposits in accardanco with the rules and rogulationa of r9 the Stat�s Real Estate Comiziission, ChecYs kendered as deposit monies may be held uncashed pending the ra�ecution of t6.is � Agreemeut. 21 3. SELLER ASSIST(Yf Applicalrle)(1-10) 22 Soller will pay$_ A.� or 0.Q 00 96 af Purchase PrFce(0 if not e 23 Buyer's costs, as permitted hy the mo gage lender, if any.Seller is only obligated ta pay up to q�e amount or ��)�W� 24 appmved bY mortgage londer. Pe,rc�ntago which is 25 4. SET�NT AND PO5SESSIUN 14) � n,� �� 26 (A)Settlernent Date is y�.�G} p� � ,or before if Hnysr and Selter agrea. 27 (B)Settlement will occur in the ooun w the Pro �'"� agre h' perty is ]ocated or in an aci.jacent c.�anty. dnring narmal bnsiness hours, nuiless 2$ Buyer and Sellar agre�otl�erwise, Z� (C�At time of settlernent, the fotlow�ir�g will be prarateci on a daYly basis between Buyer and Seller, xeimbursing whera upplicable: 3o currenE t�es; rents; interast on mortgage assumpaans; condomininm fees and hometiwner assadation feos; yv$ter and/or sewer a1 fees, together with any other lienable municipa� sarvice fees. ATl charges will be prorated for Ehe p�riiod(s) c�v�. 5��, �Pay 32 up to and inclading the date of setdement and Buyer will pa�for all days following setttement,unleys otheruvise st.�ted hese; 33 3¢ (D)For pniposes of praratin$real estate taxes,die"periods covered"are as follows: 35 1. Municipal tax bills for atl counties and manicipalities in Pennaylvania am for the period From 7anaary 1 to Dacem��31. 36 2. Schaol tax bills for the Philadelphia, pittsbnrgh aud Scrankon School Districts are for the period from Januaiy 1 to December 31. 37 SchooI tax bills for all other schoaI districts are for tha period froui Juty 1 to June 3U. Jg (E)Conveyance from Seller will be by fee simple deed of special wanranty unless otherwise statefl hra-e: 39 - d� (F)Paymeui of trauisfar t�xes will ba divided equally hetween Buyer and Seller untess otherwise stated here; 4I 42 (G}Possesaion is to be de3iwered by deed, existing keys and physical possession to a vacant Property ;Free ap deb�� structures 43 broom-cIean, at day and time of settlement, unless Seller, befoze signing this Agreement, i�as idantified in vvriting tbat the Property Q4 is su6ject to a lease. 45 (F�Tf 5eller has identified in wniting that t6e Property is subject to a lease, possession is to be deliveird by deed, existing kcys and �' assignment of ezisting leases for khe Property,together with security deposits and interest,if�ny,at day and time of settlemant, Se11er 47 t+viIl not enter into any new leases, nor ex#end existing leasea, for the Property without the wnitten conser►t of Buyer. Buyer wi11 4g acknowledge e�cist3ng Iease(s) by initiaLing the leese(s) at ttte execution of this Agreement, unless otherwise stated in this Agreement 4g ❑Tenant-Occupied Properly Addendam(PAR Form TOP)is attached rwd made part of this Agreemen� 50 5. DATES/TIM�L9 OF T'HE ESSENCE(1-ZO) i / / 5� (A)Written acceptance of all partie.s will be on or before: (Y� � ( �� 52 (g}The Settiernent Date and all other dates and times idenh�ied or Ehe performance of any obligationa of th�s Agneement are of the 53 essence and are binding. 54 (G�Tbe Execution Dace of tFiis Agreemenk is the date when B�tyer and Sellar have indicated fuil dcceptance of this Agreement by sign- 55 ing and/or initialing it. For parposes of tftis Agreemcnt, tbe nt�mber of days will be cnunked from tha $aecuflan Date� excluding 5s the day tltis Agreoxaent was executed and including the last day of tl�e�nme period. A!1 c]zanges to tftis Agreement should be ini- 57 tialec�and dated. S$ (D)The SetElement Date is not extended by auy other provision of this Ageement and ma�only be extended by mutual written agree- 59 ment of die parties. 60 (E)Certain terms and time periode are pre-printed in this Agreement es a canvenience to the liuyer and Se11er, ,q,� p�,p�t� ��s 61 and time peniods are negotiable arid may be changed by striking aut the pre-printed text and inserting different terms acceptable 62 to all part�ies,except where reslricted by law. , 63 Bnyer Initials:�/ � ASIx Page 2 of 13 Selter Inttlals: C� �•/ Prafuced witlt zipFomW(D 6y zlpLoglX 18070 Flttean M31e Roed,Frassr,MiclAgen 4802B www.zlo Mix com 981e5 REPL'Y TU INSPECTIUNS/REPORTS � ADDF.NT)UM TO AGREEMENT OF SALE This form recomw�cnded end approvad for,but aat rosaicted to use by,the mcmbrxs af tha Pennsylvania Assoaiation of RealWrs�(PAR). 1 PROPE1tTY .�L C.� �'`� 17L�1I 2 SELX�R � 3 BUYER 4 DATE OF A RE� �. �� $ In reply to the following inspections/reparts only: 6 � Homell'roperby Inspectione and F�uviron- Wood�nteBEatlon ❑Property Baundaries 7 tnenta!Hazards(mold,etc.): ��don ❑Deeds,�Strictlana and Zon�ng 8 ❑Water 5ervice ❑Lesd-Based Pa4tt Hascatds 9 �On-Lot Sewage []Manidps�t Requirr�nents 10 ❑ APPraisal/Mort�age Le�nder Inspection ❑I'roperty sn�Flood Insarance ❑Qt6er: 11 1. C] Accept: Buyer accepts the Property in the condition rgfle�ted'vn the above Re}�ort(s)lResnits. 12 2�, Writte�u Carreckive Paroposal:�n rasponse ta the attachedReport(s),Buyar acce�ts�ie Property and Seller agrees to satisfy the 13 te f tha following Writken Coxrecti�ve Praposal(s): 14 (A) � Correcl3ons/Repa[rs and/or credits: Seller, at Seller's expense, vvill zraake the following coirectionslrepairs to the 15 Property in a workmanlike nnanner, with permits if required, or provide the following credits prior to settlement: 16 17 J� � �►,! 18 e 19 � aa ai zz 23 ----� 24 2S 26 � 27 28 29 3Q 31 ❑See attached Proposal(s) r 32 (B) 5e11er Assdst:Seller Assist is changed ta$ U� �,ar 'fo of the Purchase Price,znaximvm, 33 �toward Buycr's costs as permitEed by the mortgage lender(s),if any.Seller is or�y oblig�ated to pay up to the amount 34 or percentage which is approved by mortgage lender. 35 (C} C] Purehase Price.Purchace price is changed fmm$ to$ 36 (D) D Clther: 37 38 39 3, ❑ Change of Time Period(s)'The Contingency Periods stated in the Agreement af Sale are ehanged.as follows: 40 ��g�cy period for ,elected in the Agreement of Sale is changed to 41 The contingency pariod for ,elected in the Agreernent of Sale is changed ta 42 A�l other tenns an co ditians of the Agr�ra t of Sale rexnain unchanged and in full�orce anc�effect. 43 BUYER ..f` DATE 44 BUYER DATE 45 �iJYEIt DATE t�� / ' f� B r.S� 4b SL�T.�R X� -�`c.tT''� � .�f.��'4-' nATE 47 SELT�R DATE 48 SELLER DATE �� I Pennsylvania Association of Realtors� ��'r'�'�TMNSYr.var�u�ssacaaTTaNOFa�aroxsm�oia 04/14 Flowud Hanna-Cenvd PA,33101dvicat Streat Cemp HUi,PA 17011 Phooe:717A2U-9600 Puc: ri�mn Wil.on P�'oduced with zipFom�by zlpLopix 18070 fllteen Mtle Roed.Freser,Mlchigon 48026 Yiiww.zbLaalx.com REV-i5o8 EX+(o8-i2) � pennsytvania SCNEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Houser, Mildred E. 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 an Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M&T Bank Checking Account 645.00 TOTAL(Also enter on Line 5, Recapitulation) $ 645.00 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(08-13) j i�' pennsylvania SCHEDULE H `,y DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERiTANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Houser, Mildred E. DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1' Musselman Funeral Home Inc. 8,500.00 B. ADMINISTRATIVE COSTS: l. Personal Representative Commissions: 6,400.00 Name(s)of Personal Representative(s) Cal'012 J. La171aSOn Street Address 221 Wood Street City Camp Hill State PA ZIp 17011 Year(s)Commission Paid: 2016 3,500.00 2. Attorney Fees: 3. Family Exemption: (If decedenYs address is not the same as claimanYs,attach explanation.) Claimant Street Address City State ZI? Relationship of Claimant to Decedent _ . 4. Probate Fees: 355.50 5. Accountant Fees: �.�0 6. Tax Return Preparer Fees: 0.00 �• Cumberland Law Journal(Legal Advertising) 75.00 s. The Guide(Legal Advertising) 65.00 s. Register of Wilis(Cost to file Inheritance Tax) 15.00 �o. Realty Transfer Tax 1,280.00 ��. Cumberland County Real Estate Taxes 2,400.00 �2. Payment for Utilities and other home care 2,306.29 TOTAL(Also enter on Line 9, Recapitulation) $ 24,896.79 If more space is needed,use additional sheets of paper of the same s�ze. REV-1513 EX+(01-10) �� pennsylvania SCHEDULE � DEPARTMENT OFREVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Houser, Mildred E. 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 and transfers under Sec.9116(a)(1,2).] 1• Carole J.Lamason Daughter 100°/a 221 Wood Street,Camp Hill,PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN; 1. n/a B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. nla TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 If more space is needed,use additional sheets of paper of the same size.