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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF F'!EVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 28060'
HARRISBURG. PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
FLOWER THOMAS E
2109 MARKET STREET
CAMP HILL, PA 17011
u__n__ fold
ESTATE INFORMATION: SSN: 209-28-8364
FILE NUMBER: 2105-0172
DECEDENT NAME: SHATTO SHIRLEY A
DATE OF PAYMENT: 05/11/2005
POSTMARK DATE: 05/10/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 02/12/2005
NO. CD 005313
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $952.45
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TOTAL AMOUNT PAID:
$952.45
REMARKS:
CHECK# N/A
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
,~EV.l500 EX 16<)0)
REV-1500
'* COMMONWEALTH OF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
oEPT. 280601
HARRISBURG, PA 17128-0601
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~FILE NUMBER05-'~~~~~~-~~
21 .. 0172
COUNTY CODE YEAR
NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SHATTO, SHIRLEY A
SOCiAl SECURITY NUMBER
209-28-8364
DATE OF DEATH (MM-DD-YEAR)
02/12/2005
DATE OF BIRTH (MM-DD-YEAR)
06/06/1935
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SHATTO, JOHN L.
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~ 1. Original Retum
o 4. limited Estate
o 6. Decedent Died Testate (Attach copy of WiU)
o 9. Utigatloo Proceeds Received
o 3. Remainder Retum (dateotdealhpliorlo12.13-B2)
o 5. Federal Estate Tax Retum Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under See, 9113{A) (Mach Sell 0)
o 2. Supplemental Return
o 4a. Future Interest Compromise (dale of death after 12-12-62)
o 7. Decedent Maintained a living Trust (Attaell copy of Trust)
o 10. Spousal Poverty Credit (dateofdealhbe1weeo 12-31-91 and 1,1-95)
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NAME
THOMAS E. FLOWER
FIRM NAME (If Applicable)
SAlOIS, SHUFF, FLOWER & LINDSAY
TELEPHONE NUMBER
(717) 737-3405
COMPLETE MAILING ADDRESS
2109 MARKET STREET
CAMP HILL, PA 17011
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IX
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partners/1ip or Sole-Proprietorship
4. Mortgages & Notes Receivable {Schedule 0)
5. Cash, Bank Deposits & Miscellaneous Persona! Property
(Schedule E)
6. Jointly Owned Property (Sc/1edule Fl
o Separate Billing Requested
1. Inter-VIvos Transfers & Miscellaneous Non-Probate Property
(Schedule GorL)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses &. Admiriistrative Costs (Schedule H)
10. Debts of Decedent, Mortgage LiabiliUes, & Liens (Sch.edule I)
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estate (Une 8 minus Une 11)
13. Charitable and Governmenlal Bequests/Sec 9113 Trusts for whic/1 an election 10 tax has not been
made (Schedule J)
187,020.00
(1)
(2)
(3)
(4)
(5)
19,043.03
(6)
23,967.62
(7)
(8)
230,050.65
(9)
(1Q)
(11)
(12)
(13)
230,050.65
0.00
14. Net Value Subject to Tax'(Line 12 minus Line 13)
(14)
230,050.65
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at t/1e spousal tax 210,557.30 x .0 .Q!L.
rate, or transfers under Sec. 9116 (a)(1.2) (15)
16. Amount of Une 14 taxable at lineal rate 17,821.69 x.O~ (16)
17. Amoor.t of line 14 taxable at sibling rate 1,671.66 x.12 (17)
18. Amount of Une 14 taxable at coUateral rate x .15 (18)
19. Tax Due (19)
0.00
801.98
200.60
1,002,58
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Decedent's Complete Address:
STREET ADDRESS
139 Second Street
CITY West F airview I STATEpA I ZIP 17025
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPaymenls
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
1,002.58
952.45
50.13
Total Credlls ( A + B . C ) (2)
1,002.58
3. InteresUPenalty if applicable
D.lnterest
E. Penalty
TotallnteresUPenalty ( 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 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.
0.00
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
A. Enter the interest on the tax due.
0.00
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. relain the use or income of the property translerred;......................................................................................... 0 [19
b. retain the right to designate who shalf use the property transferred.or its income; ...............................,............ 0 [i}
c. retain a reversionary interest; or.......... ................................... ................................... ........................ 0 [iJ
d. receive the promise for life of either payments, benefits or care? .."....................................."........................... 0 [i]
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 (il
3. Did decedent own an "in trust for" or payabie upon death bank account or security at his or her death? .............. 0 [19
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.
Under penaltles of perjury, (declare that I ha~e ell.amil'l&d this return. including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete.
Declaration of preparer other then the personal representati~e is based on all information 01 which preparer has any knowledge.
B OR FILING RETURN DATE
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ADDRESS
SAlOIS, SHUFF, FLOWER & LINDSAY, 2109 MARKET ST., CAMP HILL, PA 17011
For dates of death on or after July 1, 1994 and before January 1, 1995, lhe lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. S9116 (a) (1.1) (i)].
For dates of dea1h on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the sUNiving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)J.
The statute does not exernot 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 twenty-one years of age or younger at death to or for the use '
or a stepparent of the child is 0% [72 P.S. S9116(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.
The tax rate imposed on the net value 01 traoslers \0 or for the use 01 the decedenrs siblings is 12% [72 P.S. s9116(a)(1.3)]. A sibling
individual who has at least one parent in common with the decedent, whether by blood or adoption.
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REV-'502 EX+ 16-9*
COMMONV\lEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
SHIRLEY A. SHATTO
FILE NUMBER
21-05-0172
All real property owned solely or as a tenant in common must be reported at fair market value, Fair mark.et value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled 10 buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is Jolntly-owned with right of survivorshIp must be dIsclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Dwelling house on 0.08 acres, 415 Fairview St., East Pennsboro Twp., Cumberland Cy., PA
Dwelling house on 0.1 acres, 132 Second St., East Pennsboro Twp, Cumberland Cy., PA
2.
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
81,910.00
105,110.00
187,020.00
REV-1508 EX. (6-98) ..
COMMONVVEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
SHIRLEY A. SHATTO
FILE NUMBER
21-05-0172
Include the proceeds of litigation anti the nate the proceeds were receIved by the estate.
All property jointly-owned with rIght of survivorshIp must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1 Twenty (20) US Savings Bonds, $200 denom., purchased 08/94: each worth $159.60 on date of death
3,192.00
13,951.03
1,000.00
900.00
2. PNC Bank ace\. #5140300833 - principal balance: 13,950.95 plus accrued interest: $0.08
3. 1989 Dodge Caravan, 93,899 miles
4. 1969 Chevrolet pick-up truck, 24,421 miles
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
19,043.03
REV-'SD9 EX. 16-9.*
COMMONINEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
SHIRLEY A. SHATTO
FILE NUMBER
21-05-0172
If an aust waf made Joint within one year of the- dacedent', date of death, It must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Evelyn G. Burkey
67 Second Street
West Fairview, PA 17025
mother
B. John L. Shatto
139 Second Street
West Fairview, PA 17025
surviving spouse
C.
William E. Burkey
67 Second Street
West Fairview, PA 17025
brother
JOINTLY-DWNED PROPERTY:
LETTER DATE- DESCRIPTION OF PROPERTY %OF CATEOF DEATH
ITEM FOR JOINT MADE. INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMIlAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTlY.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INIERESI
1. A. 05/07/59 New Cumberland FCU acct #000676: $5,811.50 plus $3.34 acerued int. 5,814.84 1/2 2,907.42
2. B 02/01170 PNC Bank acet. #5140112445: $8,988.50 plus $0.04 accrued interest 8,988.54 1/2 4,494.27
3. A,C 04/01/73 PNC Bank acct. #5140115734: $10,029.90 plus $0.08 accrued interest 10,029.98 1/3 3,343.33
4. A 08/01/94 Seventy-five (75) US Savings Bonds, $200 denomination@$159.60 11,970.00 1/2 5,985.00
5. A 07/01/92 Seventy (70) US Savings Bonds, $200 denomination @ $207.36 14,515.20 1/2 7,257.60
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
23,987.62
REV-1513 EX+ (9-00)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
SHIRLEY A. SHATTO
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under
Sec. 9116(.) (1.21)
JOHN L. SHATTO, 139 2nd St., W. Fairview, PA 17025
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21-05-0172
AMOUNT OR SHARE
OF ESTATE
SURVIVING SPOUSE
210,557.30
2
EVELYN G. BURKEY, 67 Second St., W. Fairvlew, PA 17025
MOTHER
17,821.69
3
WILLIAM E. BURKEY, 67 Second St., W. Fairview, PA 17025
BROTHER
1,671.66
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
0.00
{If more space is needed, insert additional sheets of the same size}