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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYlVANIA
DEPIIRThlENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 1712ll-06ll1
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DECEDENTS NAME (lAST, FlRST. AND MIDDLE INITIAl)
CRISS, JOHN D.
DATE OF DEATH (M~D-YEAR) DATE OF BIRTH (MM.DD-YEAR)
May 18, 2001 Noveml::ler 25, 1918
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST. ARST. AND MIDDlE INITIAL)
Criss, Nancy A.
('fFICIAL U~E 0111.': ~
-.....---- -
FI~E NUMBER
2 1 _0 1
cOiiriCiiDE YEM
00537
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NUIIIER
SOCIAl SECURITY NUMBER
210 - 10 9292
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAl SECURItY NUMBER
~ Ulriglnal Relum
D4.Urni1e<lEstale
~ 6. Decedent D10dT_......_"""l
o 9. Uti9ation Pn>ceeds ReceIved
o 2. Su"",emenIaI Relum
o 48. Future Interest COmpromise (..ofdldl..... 12-12-12)
o 7. DecedenIMalnlainl!deUvingTNSt......_"'''''l
o 10. Spousal Poverty CledIt (_ardea\ltbllwMn 12-31-11... 1.1-95J
o 3. RemalnderRelum{dolo"_.....12.'>q
o 5. Fedelal Estala Tax Relum Requirad
.1. 8. Total Number of Sala Daposll Boxes
o 11. EIeclIon10 lax under Sec. 9113(A)......Sd>0)
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~rvin Beshore, Attorney
ARM NAME ('_I
. aw & Besh re
TELEPHONE NUMBER
(7l7) 236-0781
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1. RaaI Eslala (Schedule A)
2. 5Illcks and Bonds (Schedul. B)
3. Closely Held CoIpoIaIion. Partnership or SoI..PmprietoIship
4. Mortgages & No,", R_. (Schedul. D)
5. Cash, Bank Daposils & Miscellaneous Personal Property
(Schedule E)
6. JDilIIy Owned Property (Schedule F)
o Sepatalelll1llng Requested
7.lnlar-VivosTransfelS&__Property
(Sd1edula G or L)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
8. Total G....,......(loIaIUnes1-7}
9. Funeral Expenses &_ COsts (Schedula H)
10. Debls 01 Dacedenl. Mortgage Uebilltie.. & liens (Sdtedule 0
11. Total Deductions (loIaI Unes 9 & 10)
12. Net Valu. of Eslala (LIne 8 miNls Un. 11)
13. Charitabla andGoolemmanlalllequesls/Sec9113 TMlslor_ "'_10 lax has nol been
made (Schedule J)
14. Net Value Subject to Tax (LIne 12 minus una 13)
(9)
(10)
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SEE INSTRUClIOIlS ON REVERSE SIDE FOR APPUCABLE RATES
15. Amount 01 Une 14_alll1espousallax 92,907.74
rate. orlransfelS under See. 9116 (eK1.2)
0.00
16. Amount of Un. 14 taxable atlJneal rala
11. AmoonlofUne 14 taxable at sibling Jale
18. AmoonlofUne 14_et_*
0.00
0.00
19. T.xDuI
0.00
0.00
0.00
0.00
99,409.47
0.00
0.00
6,501. 73
0.00
\\
17108-0946
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(8)
99,409.47
(11) 6,501. 73
(12) 92,907.74
(13) 0.00
(14) 92,907.74
0 (15) 0.00
x.O_
0.00
..0_ (18)
. .12 (17) 0.00
x .15 (18) 0.00
(19) 0.00
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
Decedent's Complete Address:
SlREEl AIlDRESS 2202 Parkside Road
CIlY Camp Hi 11 I STAlE PA I ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(I)
0.00
0.00
0.00
0.00
TolaICredils(A+B+C) (2)
0.00
3. Int....stlPenalty if applioable
D. Interest
E. Penalty
TotallnteresUPenelty ( 0 + E)
4. If Una 2 Is greaterlhan Uno 1 + Une 3. enterlhe dilJerenco. this Is Ihe OVERPAYMENT.
Check box on Page 1 Una 20 to requast a refund
0.00
0.00
5. If Una 1 + Una 3 is greaIer Ihan Una 2. enter Ihe dilIerence. This Is the TAX DUE.
(3) 0.00
(4) 0.00
(5) 0.00
(SA) 0.00
A. Enter the interest on Ihe lax due.
B. Enler Ihelotal 01 Uno 5 + SA. This is Ihe BAlANCE DUE. (58) 0 . 00
Make Check Payable to: REGISTER OF WILLS, AGENT
1!tII\\lI!..L.. =..~~~lIU.IIIlU.JL._ ..LI. _ULAtMlllR LI f] IIUIIIU IFlh__1
PLEASE ANSWER THE FOLLOWING QUESnONS BY PLACING AN "J(" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain Iha use or income of Ihe property bansferred;.......................................................................................... 0 19'
b. retain Iha right to designale who shan usa Iha property bansferred or Its income; ............................................ 0 19'
c. retain a reversionary inlerest; or.......................................................................................................................... 0 19'
d. receive the promise for life 01 eilher paymenls. benelils or care? ...................................................................... 0 EJ
2. If dealh occurred after December 12, 1982, did decedent bansfer property within one year of dealh
wilhoul receiving adequate consideration? .............................................................................................................. 0 9
3. Did decedent own an "In tlIIst loI" or payable upon deaIh bank account or seaJrity at his or her dealh? .............. 0 !(J
4. Old decedent own an Individual RetirementAl:count, annuity, or oIher non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 K1t
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
.-.""......"potjuoy.I_1haIl__IhIs.......illWng_.~_..._
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SIGNATURE OF PERSON RESPONSIBlE FOR FILING RETURN
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.
ADDRESS
110 Valley View ~riv , anicsburg, PA, 17050
SKlNATURE7t7(1Jt,lHAN"~ ;(~$ f
ADDRESS
Milspaw & Beshore, 130 State Street, P.O. box 946, Harrisburg, PA, 17108-0946
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For doles oIdealh on or after July I, 1994 and before JanuaJy 1. 1995.lI1e lax rate imposed on Ihe net value 01 banslers 10 or for lheuseoflhe surviving spouse Is 3%
(72 P.S. 59116 (a) (1.1) (il).
Fa- dales 01 deall1 on or aftef Janua<y I, 1995.1he lax rate imposed on Ihe net value of banslers 10 or for Ihe use 0I1he surviving spouse Is 0% [12 P.S. !i9116 (a) (1.1) full.
The statute does not exemot a bansfer to a surviving spouse from faa. and Ihe stalulory requirements for disclosure of assats and lifing a lax relum are still applioable ""'" if
Ihe SUlViving spouse Is the only beneficiary.
For dales of deall1 on or after July 1. 2000:
The faa rate Imposed on Ihe neI value 0I1ransfers from a del:eased child twen\y-<lne years 01 age or younger at dealh to or for Ihe use 01 a na\ural parent an adoptive parent
or a slepparent of the child Is 0% (72 P.S. !i9116(a)(1.2)J.
The lax rate imposed on lI1e neI value 0/ bansfers to a- for the use o/the decedenrsllneal benelioiaries is 4.5%, eacept as naled in 72 P.S. !i9116(1.2) [12 P.S. !j9116(a)(I)].
The lax rate imposed on Ihe neI value 01 bansfers m or for Ihe use 0I1he decedenl's siblings is 12% (72 P.S. 59116{a)(I.3)). A sibl1ng Is defined, under Seclion 9102. as an
1nd"1ViduaI who has at least one parenlln common wiIh Ihe decedent wheIher by biood or adoption.
'''.''~'''''''"'J.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
CRIIS, JOHN D.
FILE NUMBER
21-01-00537
ESTATE OF
Include the proceeds of liIigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Checking Account (Money Market) #50500145, Waypoint Bank 31,073.54
2.
Certificate #554276290, Waypoint Bank
10,643.58
3.
Certificate #7100003164, waypoint Bank
11,684.23
4.
Accrued interest on certificate #7100003164, Waypoint Baak
476. 13
5.
Certificate #7100003318, Waypoint Bank
11 ,461.46
6.
Accrued interest on certificate #7100003318, Waypoint Bank
35.50
7.
Certificate #7100004599, Waypoint Bank
7,739.61
8.
Certificate #31900186166, PNC Bank
12,795.42
9.
2000 Chevy Impala, VIN 2G1WF55E249203265
13,500.00
TOTAL (Also enteron line 5, Recapitulation) $ 99 409 47
, .
(If more space is needed, Insert additional sheets of the same size)
REV-1511EX'(1-97)
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SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE lAX RETURN
RESIDENT DECEDENT
CRISS, JOHN D.
FILE NUMBER
21-01-00537
ESTATE OF
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: it was prepaid 0.00
1. There were no funeral expenses because
8. ADMINISTRATIVE COSTS: n/a 0.00
1. Personal Representative's Commissions
Name of Pewna\ RepresentatiVe (s)
Social Security Numbe~s) I EIN Number of Pe",onal Representative(s)
Street Address
City Stafe Zip
Year(s) Commission Paid:
2. Attorney Fees Milspaw & Beshore, Marvin Beshore 2,500.00
3 Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant Nancy A. Criss 3,500.00
Street Address 2202 parkside Road
City Camp Hill Stale PA Zip 17011 '
Relationship of Claimant to Decedent Wife
4. Probate Fees : Register of Wills (Petition-200; Short Certificate-15
extra pages- 24; JCP fee- 5; Codicil- 10.50) 254.50
5. Accountanfs Fees n/a 0.00
6. Tax Return Preparer's Fees n/a 0.00
7. The Patriot News - Executor's Notice 64.23
8. Cumberland Law Journal - Executor's Notice 75.00
9. Out of pocket expenses of Executors 108.00
TOTAL (Also enter on line 9, Recapitulation) $ 6,501.73
(If more space Is needed, insert additional sheets of the same size)
REV.1513EX.11-97j
ESTATE OF
NUMBER
1.
'*
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21-01-00537
RELATIONSHIP TO DECEDENT
Do Nat Lilt Trustee(s)
Son
Son
Daughter
Daughter
AMOUNT OR SHARE
OF ESTATE
Remainder beneficia~
in Trust u/w of
John D. Criss
Remainder beneficiar~
in Trust u/w of
John D. Criss
Remainder beneficiarl
in Trust u/w of
John D. Criss
Remainder beneficiary
in Trust u/w of
John D. Criss
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 TAXIS NOT BEING MADE
1. Trust under Last Will and Testament of John D. Criss, f/b/o
Nancy A. Criss (100%) 92,907.74
COMMONWEALTH OF PENNSYLVANIA
INHERJTANCE TAX RETURN
RESIDENT DECEDENT
CRISS, JOHN D.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS (include outright spousal distribullons)
1.
James D. Criss, 102 Fetrow Lane,
New Cumberland, PA 17070
2.
Jeffrey D. Criss, 110 Valley View Drive,
Mechanicsburg, PA 17050
3.
Barbara Ann Criss, 420 Canal Street, Apt. 2
Lock Haven, PA 17745
4.
Mary Criss Breen, 2505 Birchwood Court,
Wexford, PA 15090
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOT At OF PART n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert addillonal sheets of the same size)
92,907.74