HomeMy WebLinkAbout08-11-15 (2) � 1505614134
EX(03-14)(FI)
REV-1500 -- - -
Bureau of Individual Taxes County Code Year File Number
Po Box 2soso� INHERITANCE TAX RETURN
Harrisburg,PA 17128-0601 RESIDENT DECEDENT 2 1 1 5 0 1 1 7
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
5 2 0 1 1 4 2 0 1 5 0 2 0 1 1 9 2 8
• DecedenYs Last Name Suffix DecedenYs First Name MI
C R 0 L L J E A N M
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M�
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOIK ,
Q 1.Original Return � 2.Supplemental Return � 3.Remainder Return(date of death
Priorto 12-13-82)
� 4.Agriculture Exemption � 5. Future Interest Compromise(date of � 6.Federai Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
QX 7.Decedent Died Testate � 8.Decedent Maintained a Living Trust 1 9.Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of Uust)
� 10. Litigation Proceeds Received � 11.Non-Probate Transferee Return � 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13. Business Assets ❑ 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONOENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name ' Daytime Telephone Number
M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4 6 S 0
First Line of Address
W A L T E R S & G A L L 0 W A Y , P L L C
Second Line of Address
5 4 E • M A I N S T R E E T
City or Post O�ce State ZIP Code
M E C H A N I C S B U R G P A 1 7 0 5 5
.,,
CorrespondenYs e-mail address: ,c',..�. � �
n �' S'c1 C'>
REGISTER �yVV1�S USE O —
REGISTER OF WILLS USE ONLY � � � � r-� �..{�
DATE FILED MMDDYYYY er� }t,;, S"' �"' ',', t'3
;-71 1�'s
r_ : J.y C:�
.
.. : _,�
- _ "L] �i
� .,, _--
G�
. �,..-� q, rs1
DATE FILED STAMP N p
-i'1
—J
PLEASE USE ORIGINAL FORM ONLY
Side 1
I IIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII �
� 15�5614134 1505614134 � �
� 1505614234
REV-1500 EX(FI)
DecedenYs Social Security Number
�ecedenrs Narr�e: J E A N M • C R 0 L L
RECAPITULATION
t. Real Estate(Schedule A) ........... .. ..................... . ..... ... 1. 1 3 8 2 5 0 . 0 0
2. Stocks and Bonds(Schedule B) .................. . ..... .... ... ... .... 2. •
3. Closely Heid 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. 1 4 6 1 5 . 6 3
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . ... 6. •
7. Inter-Vivos Transfers 8�Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested ....... 7. S 6 �, 1 1 , 0 4
8. Total Gross Assets(total Lines 1 through 7) . . .......... ............... 8. 2 0 8 9 7 6 . 6 7
9. Funeral Expenses and Administrative Costs(Schedule H) .. . . .. .. . . . ....... 9- 3 2 3 6 1 . 7 9
10. Debts of Decedent, Mortgage liabilities,and Liens(Schedule I) ........... .. 10. 2 2 7 7 5 . 4 7
11. Total Deductions(total lines 9 and 10) . ... ........ . ... ...... .. . . .. ... 11. 5 5 1 3 7 . 2 6
12. Net Value of Estate(Line 8 minus Line 11) .. .......... . .. .. .. .... .. ... 12. 1 S 3 8 3 9 . 4 1
t 3. 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. 1 5 3 8 3 9 . 4 1
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-� - � . � � 15. ❑ . 0 ,Q
16. Amount of Line 14 taxable
at�inea�rate x.045 1 5 3 8 3 9 . 4 ], ��. 6 9 2 2 . 7 7
17. Amount of Line 14 taxable
at sibling rate X.12 � . � � 17. � . Q Q
18. Amount of Line 14 taxable
at collateral rate X.15 � . � � �g, ❑ . Q �
19. TAX DUE ..... .... . .............. .. . ........................... 19. 6 9 2 2 • 7 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Under penalties of perjury,I deGare I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the person responsible for filing the retum is based on all information of whiCh preparer has
any knowledge.
OF PERS ESPON E FOR FILING RETURN DATE
`4 ' �. � /
�r j 2c� �
AD ESS
LVIN C • CRO , . 1 0 BOYDTON PLANK RD DINWIDDIE VA 23841
SIGNATURE OF PREP OT R P SON RESPONSIBLE FOR FILING THE RETURN DATE i
g �' 'l�
ADDRESS
MURREL R • WAL ERS II , 54 E- MAIN ST MECHANICSBURG PA 17055 �
I I�IIII IIJ�I IIIII IIIII IIIII'III�II'll IIII)IIIII(III)I'll IIII Side 2
� 1505614234 1505614234 �
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
JEAN M.CROLL 21 15 0117
Decedent's Name Page 2 File Number
Correspondents
Name Daytime Telephone Number
K A R E N J . U N I T I S
First line of address
1 3 4 0 K U H N R O A D
Second line of address
City or Post Office State ZtP Code
B O1 L I NG S PR I NG S P A 1 7 0 0 7
CorrespondenYs e-mail address:murrgl(CC�Waltel'SqallOWaY.com
Under penalties of perjury,I declare that I have examined this re#um,induding accompanying schedules and statements,and to tl�e best of my knowledge and belief,
it�s true,corcect and complete.Dedaratlon of preparer other than the personal representative is based on all infortnation of which preparer has any knowledge.
SIGNATU OF PERSON ESPONSI FILING RETURN DATE
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 15 0117
DECEDENTS NAME
JEAN M. CROLL
STREETADDRESS
577 BRIGHTON PLACE
CITY STATE Z�p
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) _ 6,922.77
2. Credits/Payments
A.Prior Payments
B.Discount
(See instructions.) Total Credits(A+B) (2) 0.00
3. Interest
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. (3)
Fill in oval on Page 2,Line 20 to request a refund. (4) 0.00
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 6,922.77
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 ...................................................................... ❑ Q
b. retain the right to designate who shall use the property transferred or its income ............................... ❑ OX
c. retain a reversionary interest ..................................................................................................... ❑ 0
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ Q
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving a�+equate consideration? ..:......................................••••••••..............-••••................... ❑ Q
3. Did decedent own an"in t�ust for"or payable-upon-death bank account or security at his or her death? ......... ❑X ❑
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?.................................................................................................. 0 ❑
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 su►viving 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 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 decedent's Iineal 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 decedenYs 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-1502 EX+(12-12)
pennsylvania SCHEDULE A
OEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JEAN M. CROLL 21 15 0117
All real property owned solely or as a tenant in common must be reported at fair market value.Fair ma�ket 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,both having reasonable knowledge of the relevant facts.
Real property that is jointly-ovmed with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM I�clude a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1 577 BRIGHTON PLACE 138,250.00
MECHANICSBURG, PA 17055
GROSS SALE PRICE
TAX PARCEL#42-24-0791-164-U577
TOTAL(Also enter on Line 1,Recapitulation.) $ 138 250.00
t �^rr��.���.�..���-�.��
��9 I��II�II�,.� A• Settlement Statement (HUD-1) v
e"u oedfl�n
f. Type of Loan
,Q FHA 2,�RHS 3.�Conv.Unins. 6. File Number: 7, Loan Number; 8. Mortgage Insurance Case Number:
,Q VA 5.0 Conv.Ins. KELLENBERGEREVAIS 0010028637
�. Note: This lorm is lurnlshed fo gn.e you a statement of actual settlement oosfs. Amounfs pald to and by the settlement agent ere shown.
Ifems marked"(p.o.a)"were pald outside the Gosing;they are shawn here/or In/ormafional purposes and are not inGuded!n the fofals.
�. Name and Address of Borrower; E. Name and Address of Seller: F. Name andAddress of Lender:
=va J.Kellenberger Estate of Jean M.Croll Membere 1sf Federel CredN
19 S.Hfgh Street 577 Brighton Place Union
Nllierstown,PA 17062 Mechani�,burg,PA 17055 5000 Loulse Drive
Mechanlcsburg,PA 17055
3. Properry Loratlon: H. SettlementAgent; I. Settlement Date;
i77 Brighton Place Preferred Service Settlemenls,LLC
Nechanl�sburg,PA 17055 570 Carlisle Street August 7,2015
Hanover,PA 17331 Ph. (717)632-9343
Piace o(Settlement:
570 Carlisle Street
Hanover,PA 17331
l Summary of Borrowers transaction K. Summary of Sellers trensaction
00. GrossAmount Due ftom Borrower; 400. GrossAmount Due to Seller:
01. Contrad sales ric� 138,250.00 40t. Contrad sales rice 138 250.00
02, Personal ro ert 402. Personal ro e
03. Setflement Char es to Borrower Line 1400 5 194,46 403.
04. 404.
05. 405.
d ustments for items ald b Seller in advance Ad ustments for items aid b Seller In advance
06. C' /iown Taxes OB/OB/15 to 01/01/16 132.88 406. C' /Town Taxes OB/OB/15 to 01/Ot/16 132.88
07. Coun Texes OB/OB/15 to 01/01/16 141.22 407.Count Taxes OB/OBI15 l0 01/01/16 141.22
O8. SchoolTaxes 08/OBf15 to 07l01l16 1,555.05 408. SchoolTaxes 08/OB/15 to 07/01/16 1555.05
09. 3rd Qtr Sewer Proratlon 08/08/15 to 10/01H5 65,74 409, 3rd Qlr Sewer Proratlon 08/OB/15 to 10/01/15 65.74
10. HOA Dues OBIOBH 5 to 09/01/15 127.74 410. HOA Dues OB/08/15 to 09101/15 127.74
11. 411.
12. 412.
20. Gross Amount Due from Bonower 145,467.09 420.Gross Amount Due to Seller 140,272.63
00. Amounts Paid b or In Behalf of Bonower 500. Reductlons In Amount Due Seller.
01. De osk or earnest mone 1 000.00 501. Excess de osil see Instrudions
02. Princi al amount of new loan s 124 425,00 502. Settlemenl char es to Seller Line 1400 14,339.02
03. Existin loan s taken sub ect to 503. Existin loen s taken sub act to
04. 504. Payoff Flrst Mortgage to Members tst Federal Credl 5,432.02
05. 505. Pa oN Second Mort a e
06. 506.
07• 507, De osit disb,as roceeds
08, 508.
09. SellerAssist 6,650.00 509, SellerAssist 6,650.00
d ustments for Items un aid b Seller Ad ustments for Items un aid b Seller
10. C' lTown Taxes to 510.C ITown Taxes to
11. Coun Taxes to 511. Counl Taxes to
12, School Taxes to • 512.School Taxes to
13. 513.
14• 514.
15. 515.
16. 516.
17. 517. Sewer Bill-1/1-9I30115 to U erAllen Townshl 347.82
18. 518. Refuse Bill to Re ublic Services 15.15
19. 519.
20. Total Paid b Ifor Bortower 132,075.00 5Z0. Total Reduction Amount Due Seller 26,784.01
00. Cash at Settlement from/to Borrower 600. Cash at settlement tolfrom Selier
01. Gross amount due from Borrower line 120 145 467.09 601. Gross amount due to Seller Iine 420 140 272.63
02. Less amount afd b/for Borrower fine 220) ( 132,075.001 602. Less redudions due Seller Ilne 520 � 26,784.01
03. Cash �From � To Bortower 13,392.09 603. Cash X�To � From Sellar 113,488.62
•PyAoulelde U�ociry bi borrwslB),stlls(S),lerKler(ll.a w�dpatylT)
The undersigned hereby a�Jcnowledge receipt af a compieted oopy o(fhls statement 8 any attachments referred to herein
Borrower � ���r� Seller ��G-.�✓I�.l*�g �'��w..���(-Cy-v
�E G�
Eva J.Kellenber e Estate o(Je M.Croli /
Tln P�E�Ie Repatlrq Bvden for W�W IecUm d IriarmeUm I�mVmeled et SS mlMm per respon+e tar edlecUrg,rMeMnp,aM�eparUrp Ihe tlela TNe agar¢y mry not edleel Wi Infamellar�adya rs nol reqJred lo eompMe
W a fam,W eas II aaprye e evreMly velltl OMB cmVd nmber,No wfidentlelly i s asaved IH�ds�ave la menCalay.TMa la En+lgred lo provitle Un per8m lo e RESR4eovered VernxUmulth IAvm aUm Wliqlhe�eNen enl
pae�s.
PaQe 1 0(3 HUD-1
(KELLENBERGER EVAIS.PFDlKELLENBERGEREVA15124)
..�e�uCiiiCn<<.nar es
00.Total Real Estate Broker Fees $8,295.00
Division o(oommission(line 700)as/olbws: Pald From Paid Frum
eo�ers se�iers
01.$4,147,50 to Coldwell Banker Residential Real Estate Funds at Funds at
02.$ 4,147,50 to ERA Preferred Properties Real Estate,Inc. Settlement Settlement
03.Commission afd at settlement
04. Broker Fee 8,295.00
to Coldwell Banker Residential Real Estate 300.00
05. Broker Fee to ERA Preferred Properties,Inc. 195,00
00.Items Payabie In Conneetion with Loan
01.Our ori ination char e $ 645.00 from GFE#1
02.Your credR or char e olnts for the s eGfic interest rate chosen from GFE#2
03.Your ad usted ori Ination char es from GFE#A 645.00
04,A raisal fee to Members 1st Federal Credit Union from GFE#3 P.O.C. 425.00 B'
O5.Credft Re ort to from GFE#3
06.Tax servioe to from GFE#3
07,Flood cert�cation to Members 1st Federal CredN Union from GFE#3 12 50
08. from GFE#3
09� from GFE#3
��' from GFE#3
��' (from GFE i!3)
00.Items Requlred by Lender to Be Pald In Advance
01,Dai Inferest char es from 08/07115 to 09/01/15 25 $14.061700/da from GFE#10 351.54
02,Morigage insurance premium for months to (from GFE#3)
03.Homeowner's Insurance for 1.0 years to Mutual Benefd (from GFE#11) P.O.C.$334.00(B)•
D4.
�5 (from GFE#11)
((rom GFE#11)
000,Reserves Deposfted with Lender
J01.InNial deposil for your escrow account (from GFE#9) 778.42
J02.Homeawner's Insurance 3.000 months @ $ 27.83 per month S 83.49
J03.Mort a e insuranco 0.00 months $ 40.44 er month g
J04.Property taxes $
)05.
J06• months @ $ per month $
J07, County/Twp Taxes 7.000 months @ $ 57.10 per month $ 399.70
)08, SchoolTaxes 3.000 months Q $ 147.55 per month $ 442,65
J09.Aggregate EscrowAdjustment $ -147.42
100.Tltle Charges
101. Title services and lender's tRle insurance (from GFE#4) 1,563.50
102. Seltlement or closin fee g
103. Owner's tille insurance to Stewart Tdle Guaranty Co. (from GFE#5) 70.00
104. Lender's tNle Insurance to Stewart Tdle Gua ranty Co. $ 1,334.300/300/900/AR9/810
105. Lender's titie polfcy Iimft $ 124,425.00
106. Owner's titie policy Ilmit $ 138,250.00
107. Agenfs portion of the total tille Insurance premium to Preferred Service Settlements,LLC $ 1,240.25
108. UnderwrNer's portion of the lotal tille insurance premium to Stewarl TRIe Guaranty Company S 164.25
109. Overnight Mail Fee to Preferred Servlce Settlements,LLC $ 30.00
110. g
N1. Closing Protedion Lelter to Stewart TRte Guaranty Company $ 125.00
112, g
113. Pre arat(on o(Deed g
114. Nota Fee to Caroi M.Arentz $ 15.00
116. Au usl HOA Fee to BrI hton Place Condominium Assoc. $ 165.00
H7. Resale Cert Fee to Bri hton Place CondominiumAssoc. $ 75.00
118. Iniliatlon Fee to Bri hton Place CondominiumAssoc. $ 495.00
200.GovemmentRecordin andTransferCharges
?01.Government recardfn char es to Count Recorder of Deeds from GFE#7 196.00
�02.Deed $ 79.00 Mort a e $ 117.00 Releases $ Olher $
203.Transfer taces to County Recorder of Deeds (from GFE#8) 1,382.50
?04.C' /Coun tax/stam s $ 1,382.50 $
?05.State tax/stam s $ $ 1,382.50 1,382.50
?06.
�07.
300.Additlo�al Settlement Charges
301.Requ(red servlces Ihat you can shop for (from GFE tl6)
302. Pestlnspedlon to S.A.F.E.Homelnspedlons 50.00 P.O.C,$50.00(B)•
303, Home/Radon Inspedlons to S.A,F.E.Home Inspedlons $ P.O,C.$400.00(B)'
304. Home Warranty lo Amerkan Home Shield $ 423.54
305.Tax Cert�ration Fee lo Dennis Zerbe $ 15.00
306. 2015 Countylfwp Taxes to Dennis Zerbe,Tax Colledor $ 753.77
307. 2015-16 Schaol Taxes to Dennls Zerbe,Tax Colledor $ 1,735.21
908. EleGrical Repalrs to Bob Beaver $ 65.00
309.Garage Door Opener to Baker poor Co. $ 413.00
310. Plumbing Repairs to Eyler Mechanipl $ 176.00
100.Total Settlement Charges(enter on Iines 103,Section J and 502,Section K) 5,194.48 14,339.02
•Pald aulslda d Gasirp by borrwer(B),�dlar(5),lerder(L),v Wrdpery(T)
ey sipHnp pape 1 orwe elelemst,u+e c�g�ala�c ecMno.deege recelp d a comdelad capy a pege z a a tl we urm peQe e�elem /�
��i�.��.� �ti"1 /i��V���-h.
Preferred Service Settlemenls,LLC,SeGlem ntAgent
Cerl�ed to be a true copy.
Page 2 of 3 HUD•t
(KELLENBERGEREVAIS.PFD/KELLEN BERGEREVA15/24)
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
JEAN M. CROLL 21 15 0117
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
1. MEMBERS 1 ST FEDERAL CREDIT UNION 10,025.64
CD
2. MEMBERS 1ST FEDERAL CREDIT UNION 332.65
SAVINGS
3. MEMBERS 1 ST FEDERAL CREDIT UNION 50.88
SUPPLEMENTAL SAVINGS
4. MEMBERS 1ST FEDERAL CREDIT UNION 1,143.43
CHECKING
5. ASSOCIATED BANK N.A. 2,Jpg.g2
CHECKING
6. GREAT LAKES CREDIT UNION 5.00
SAVINGS
7. THRIVENT 150.21
REFUND- PREMIUM
8. INTERNAL REVENUE SERVICE 25.00
20141NCOME TAX REFUND
9. PENNSYLVANIA DEPARTMENT OF REVENUE 174.00
2014 INCOME TAX REFUND
TOTAL(Also enter on Line 5,Recapitulation) $ 14 615.63
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JEAN M. CROLL 21 15 0117
This schedule must be completed and filed if the answer to any of quesGons 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF iHE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH °/a OF DECD�S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSfER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLEI VALUE
1. THRIVENT 13,028.22100.00 13,028.22
ANNUITY
P.O.D.TO SON, MELVIN C. CROLL 1/3
P.O.D. TO DAUGHTER, KAREN J. UNITIS 1/3
P.O.D. TO GRANDSON, ERIC C. GARCIA 1/3
2. THRIVENT 40,445.51 100.00 40,445.51
SETTLEMENT OPTION
P.O.D. TO SON, MELVIN C. CROLL 1/3
P.O.D. TO DAUGHTER, KAREN J. UNITIS 1/3
P.O.D. TO GRANDSON, �RIC C. GARCIA 1/3
3. THRIVENT 2,637.31 100.00 2,637.31
SETTLEMENT OPTION
P.O.D. TO SON, MELVIN C. CROLI 1/3
P.O.D. TO DAUGHTER, KAREN J. UNITIS 1/3
P.O.D. TO GRANDSON, ERIC C. GARCIA 113
TOTAL (Also enter on Line 7,Recapitulation) $ 56 111.04
REV-1511 EX+(OS-13)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JEAN M. CROLL 21 15 0117
DecedenPs debts must be reported on Schedule(.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. PARTHEMORE FUNERAL HOME&CREMATION SVC, INC., NEW CUMBERLANO 5,249.75
2. GAROEN BOUQUET-FLOWERS 162.18
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
2• Name(s)of Personal Representative(s) MELVIN C. CROLL
SVeetAddress 14108 BOY�TON PLANK ROAD
�ity DINWIDDIE State VA Z�p 23841
Year(s)Commission Paid: (RENOUNCED)
2. AttomeyFees: MURREL R.WALTERS, III 7,100.00
3. Family Exemption:(If decedenYs address is not the same as claimanPs,attach explanation.)
Claimant
Street Address
City State ZIP
Rela6onship of Claimant to Decedent
4. ProbateFees: CUMBERLAND COUNTY REGISTER OF WILLS 360.50
5 Accountant Fees:
6. Tax Remm PreparerFees: 2014 PERSONAL INCOME TAXES- H&R BLOCK 160.00
7. ADJUSTMENT TO SALE OF 577 BRIGHTON PLACE INCLUDING 19,329.36
PRORATIONS LESS: SETTLEMENT CHARGES, FINAL SEWER
AND REFUSE
TOTAL(Also enter on Line 9,Recapitulation) $ 32 361.79
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Continuation of REV-1500 Inheritance Tax Return Resident Decedent
JEAN M. CROLL 21 15 0117
DecedenYs Name Page 1 File Number
Schedule H - Funeral Expenses 8�Administrative Costs - B1
ITEM
NUMBER DESCRIPTION AMOUNT
B. ADMINISTRATIVE COSTS:
Personal Representative Commissions:
2• Name(s)ofPersonalRepresentative(s) KAREN J. UNITIS
StreetAddress 1340 KUHN ROAD
City BOILING SPRINGS State PA 2�p 17007
Year(s)Commission Paid: (RENOUNCED)
SUBTOTAL SCHEDULE H-61
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENTOFREVENUE DEBTS OF DECEDENT�
INHERITANCETAXRETURN MORTGAGE LIABILITIES 8� LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JEAN M. CROLL 21 15 0117
Report debts incurred by the decedent p�ior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MEMBERS 1ST FEDERAL CREDIT UNION 10,552.55
HOME EQUITY LOAN
2. MEMBERS 1 ST FEDERAL CREDIT UNION 4,243.00
LOAN
3. MEMBERS 1ST FEDERAL CREOIT UNION 1,890.83
LOAN
4. MEMBERS 1ST FEDERAL CREDIT UNION 1,557.86
CREOIT CARD
5. UNITED WATER 79.81
WATER
6. COMCAST 9,76
CABLE
8. GREAT LAKES CREDIT UNION 1,380.79
LOAN .
9. LIFE ALERT EMERGENCY RESPONSE 95.00
MEDICAL
10. BRIGHTON PLACE CONDOMINIUM ASSOCIATION 1,516.25
ROOF ASSESSMENT-$518; 2 MONTHS HOA @$165 PER MONTH &8/25 LATE FEE
HOA MONTHLY ASSESSMENT @$165 PER MONTH X 4
11. REPUBLIC 45.45
TRASH
12. UPPER ALLEN TOWNSHIP 112.00
SEWER
13. PPL 1,049.17
ELECTRIC
14. HOLY SPIRIT HOSPITAL 50.00
MEDICAL
15. SYNERGY HOMECARE OF MI� PENNSYLVANIA 78.00
HOME CARE
16. HERITAGE FIRST ENT 115.00
MEDICAL
TOTAL(Also enter on Line 10,Recapitulation) $ 22 775.47
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REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JEAN M. CROLL 21 15 0117
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
� TAXABLE DISTRIBUTIONS [Include ouVight spousal distribuGons and Vansfers under
Sec.9116(a)(1.2�.]
1. KAREN J. UNITIS Lineal
1340 KUHN ROAD
BOILING SPRINGS, PA 17007
2. MELVIN C. CROLL Lineal
14108 BOYDTON PLANK ROAD
DINWIODIE, VA 23841
3. ERIC C. GARCIA Lineal
7035 W. 160TH PLACE
LOWELL, IN 46356
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
[j. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART I[-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
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