HomeMy WebLinkAbout01-1029
PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Tabitha M. Gross
also known as
No.
To:
Social Security No.
, Deceased.
199-05-7137
~\-D\ - \D~q
Register of Wills for the
County of Cumberland in the
Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioners, who are 18 years' of age or older and the Executors named in the last will of the
above decedent, dated Februarv 6,1989 and codicil(s) dated
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or
principal residence at 442 Walnut Bottom Road. Carlisle. PA 17013
(list street, number, and municipality)
Decedent, then..!L years of age, died October 16,2001, at Carlisle BoroulZh. Cumberland County.
Pennsv lvania.
Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent: Decedent was married to Paul E. Gross who died on October 14. 1980
Decedent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(lfnot domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follows: N/ A
$
$330.000.00
$
$
$
WHEREFORE, petitioners respectfully request the probate of the last will and codicil(s) presented
herewith and the grant of letters testamentary thereon
(testamentary, administration c.t.a.; administration d.b.n.c.t.a.)
~ka. a ~jjJ1
Barbara J. MarIlt'ey
5 Wedgewood Drive
Carlisle, P A 17013
~Q c! )$~l
J c . Moser
14 Bayley Street
Carlisle, P A 17013
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND
SS
)
The petitioners above-named swear or affirm that the statements in the foregoing petition are true
and correct to the best of the knowledge and belief of petitioners and that as personal representatives of the
above decedent petitioners will well and truly administer the estate according to law.
~~LA Q P ~~joI7
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/
Sworn to or affirmed and subscribed
before me this 7TH day of
NOlfEMB R ,2001 tfJm~-
Register f
\ '\ - a u- \
Estate of
NO. 21 - 01 - 10~9
TABITHA M GROSS
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW NOVEMBER 8 ,2001, in consideration of the petition on the
reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instruments dated February 6. 1989
described therein be admitted to probate and filed of record as the last will of TABITHA M. GROSS;
and Letters Testamentary are hereby granted to BARBARA J. MARKLEY and JOYCE E. MOSER.
~,
FEES
Probate, Letters, Etc. ........... $
Short Certificate(s) ....ft...... $
Renunciation ....................... $
X-Pages (3) $ y.OO
JCP TOTAL $ 5.00
Filed........... .t'J.9. YJ.~~~.R.. a,.. . ?9. 9. J.......:. ~ ~. :.~O
305.00
12.00
Richard L. Webber, Jr., Esquire
Attorney I.D. No. 49634
19 Brookwood Avenue, Suite 106
Carlisle, P A 17103-9142
(717) 249-5373
F:\User Folder\Firm Docs\Estates\1930-2petition.letters.wpd
Called attorney on 11-9-01.
1 ()qlfl" ~fV Ol~(.,
This is to certify that the information here given is correctly copied fro~ an original certificate of deathdul~ filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7714141
No.
2:i- ~~c~~~{-~'-..~
OCT 1 72081
Date
t1105.l4J R.... 2117
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
STATl f'l.f "UMeER
SOCI"l SECURI"T'f NUM8ER
DAlE Of DEATH .Mcnol'l. 0... ._,
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COUN"T'f OF OERH
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DECEDENT., USUAL OCCUMIOH
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MS Of CEDENT EVER IN
U.S. ARMED f'ORCES7
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ACTUAL
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(See_lION
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MOTHER'S NAIAE ,1'... _. ""- Suo........)
CIlyIllDn>.
17a. SIal.
442 Walnut Bottom Rd
'" Carlisle, Pa
fRllER"S NAME IF". MidcIe. la)
1111.
(l?tf,ft~R"i/,Y; c vU ~ A-L"c, t1P~
DUE 10 lOR AS A CONSEOU€NCE 01'):
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DUE 10 lOR AS" CONSEOUENCE Of):
DUE 10 lOR AS "CONSEOU€NCE 01'):
WEAE AUlOPSY FINDINGS UANNER Of DEATH
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COMPLETIOH OF CAuSE 0
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TIME OF INJURY
INJURY I(f WORK? DESCRIBE HOW INJURY OCCURRED.
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.-- AND CERTIFYING ~Y5IC1AH l~ llOItl ;lronounono .,..'" MId cer1olyoncj 10 causo of ""a""
T... __ of my knoMltcl9l1t, cteae. occurred at the 1IIne. cUlt.. and plKe,.net due to t.... cauM(at and man""r.. -'.'rd..
.MEDICAI. EXAMlHERlCOROHEII
On - be... "" ...rnlnltllon _or Inv.lli~lioft. in my opinien. dn'" ocC..".<I.II". time. dat.. and plac.. and <llIelo '''. callse(l) and
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AEGISTRAR'S SIGNATURE "NO
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SIGNATURE AND TIT\.I1
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NAME AHO ADDRESS OF PERSON WHO COMPI.ETf"D ~$E OF DEATH
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11Inst Dill nub QIestmntul
OF
TABITHA M. GROSS
I, TABITHA M. GROSS, of Carlisle, Cumberland County,
Pennsylvania, declare this instrument to be my Last Will and
Testament, in manner and form following:
1. I hereby expressly revoke all Wills and Codicils
heretofore made by me.
2. I hereby direct my Executrices to pay all my just
debts, funeral and administrative expenses out of my estate, as
soon as practicable after my death.
3. I give and bequeath all the residue of my estate in
equal shares to my children, RICHARD A. GROSS, BARBARA J.
MARKLEY, JOYCE E. MOSER, STANLEY P. GROSS, and DAVID L. GROSS.
4. In then event my son, DAVID L. GROSS, survives me, I
direct that his share shall be held by my Trustees hereinafter
named, in trust, to be administered as follows:
(a) The net income therefrom shall be paid to my
son, DAVID L. GROSS, for and during the term of his natural
life;
,( b) As much of the principal of said trust as my
Trustee may from time to time think advisable for the
welfare, comfort 'and support of my said son, or during
illness or emergency, shall be either paid to him or else
",
"
",
applied directly for his benefit;
(c) My Trustees may apply the net income of this
trust for the maintenance and support of my said son,
should he by reason of age, illness or any other cause, in
the opinion of said Trustees, be incapable of disbursing
it.
(d) Upon the death of my said son, the then
remaining principal shall be districuted to his estate.
5. I nominate, constitute and appoint as Executrices of
I this my Last Will and Testament and as Trustees of the trust
created for my son, DAVID L. GROSS, in the event he survives me,
my daughters, BARBARA J. MARKLEY and JOYCE E. MOSER~
6. I direct that my personal representatives and Trustees,
as well as their successors, shall not be required to file bond
or security in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this
6th day of February
, 1989.
rf
,j oJJ.J:/}~ m .~ A-Ij~_
Tabitha M. Gross
(SEAL)
SIGNED, SEALED, PUBLISHED qnd DECLARED
in the presence of: !
",/,\ (, \ !
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.
-,
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COMMONWEALTH OF PENNSYLVANIA
SS. :
COUNTY OF CUMBERLAND
f--
, I
I, TABITHA M. GROSS, Testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and
executed the instrument as my Last Will; that I signed it
willingly; and that I signed it as my free and voluntary act for
the purposes therein expressed.
Sworn or affirmed to and acknowledged before me, by TABITHA
M. GROSS, Testatrix, this 6th day of February
1989.
.1~~/fhl)J~~
Tabitna M. Gross, Testatrix
~~, ./11 ,II
C 01 UN~&i~!fu~ fl L~ - " >1
NOT~,RIAL SC:Al
LA~RA A. BIS111NE. Nlltary Publlo
Carlisle. Cumberland C"lirty
My COtT\lT:i~si~n Expires March 26, 1989
-T --
."
COMMONWEALTH OF PENNSYLVANIA )
: 55 . :
COUNTY OF CUMBERLAND )
We, JM1ES D. FT-IOWER and l(oitr M ' MtJY'".....~
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and
say that we were present and saw Testatrix, TABITHA M. GROSS,
sign and execute the instrument as her Last Will; that she signed
willingly and that she executed it as her free and voluntary act
for the purposes therein expressed; that each of us in the
hearing and sight of the Testatrix signed the Will as witnesses;
and that to the best of our knowledge the Testatrix was at that
time 18 or more years of age, of sound mind and under no
constraint or undue influence.
Sworn or
FLOW:F.R
6th day
affirmed to and AUbSC. ribed to.. before me by JMMES D.
and -'.S.o;...... 11-t. 1\10.':l..... ~11..fi.,.A , this
of Fehrlln ry , 19 Rf'.
y1 ~ ~(l/rb+ (h eN l.; It
/ WJ. tnes s
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__ /"0 Wi tness' / .' 1
C .\> ,'" /.) f. It-/lo
_J rt L ( ).(f ! (/, i{'j l--,/...C .{((. fCr.
Notary Public .
NOTARIAL SEAL
LAURA A. BISTLINE. Notary Public
Ca.rli~le. CurntJerland County
My Commission Expires tvlarch 26. 1989
r
-
F: \U ser F older\Firm Docs\Estates\ 1930-2cert, not. wpd
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Tabitha M. Gross
Date of Death: October 16, 2001
WillNo.2001- 0 1'-10)..'1
To the Register:
I certify that notice of beneficial interest required by Rule 5.6(a) of the Orphans' Court
Rules was served on or mailed to the following beneficiaries of the above-captioned estate on
November J', 2001.
Name
Address
Stanley Gross
7153 Gold Nugget Drive, Niwot, CO 80503
Richard Gross
688 Water Station Road, Sylvania, GA 30467
David Gross
c/oJoyceE. Moser, 314 Bayley St., Carlisle,PA 17013
Joyce E. Moser
314 Bayley Street, Carlisle, P A 17013
Barbara J. Markley
5 Wedgewood Drive, Carlisle, PA 17013
Notice has not been given to all persons entitled thereto under Rule 5.6(a) except - N/A
~ tI)
Dat~~, :=
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Name - Richard L. Webber, Jr.
Address - 19 Brookwood Avenue, S
Carlisle, PA 17013-9142
Telephone (717 ) 249-5373
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Capacity:
Personal Representative
X Counsel for personal representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
WEBBER RICHARD L JR
126 EAST KING STREET
SHIPPENSBURG, PA 17257
__n____ fold
ESTATE INFORMATION: SSN: 199-05-7137
FILE NUMBER: 21 - 2001 - 1 029
DECEDENT NAME: GROSS TABITHA M
DATE OF PAYMENT: 01/15/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 10/16/2001
NO. CD 000750
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $10,000.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: JOYCE E MOSER
C/O RICHARD L WEBBER JR ESQ.
CHECK#1002
SEAL
INITIALS: CW
RECEIVED BY:
RmTS'FE'F' 'OF WILLS .
$10,000.00
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RICHARD L WEBBER JR ESQUIRE
126 EAST KING STREET
SHIPPENSBURG, PA 17257
_u_u__ fold
ESTATE INFORMATION: SSN: 199-05-7137
FILE NUMBER: 2101-1029
DECEDENT NAME: GROSS TABITHA M
DA TE OF PAYMENT: 08/02/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 10/16/2001
NO. CD 001471
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $2.83
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: RICHARD L WEBBER JR ESQUIRE
CHECK# 4715
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
$2.83
MARY C. LEWIS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.2B0601
HARRISBURG. PA 17128-0601
REV-1162 EX! 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
RICHARD L WEBBER JR ESQUIRE
126 EAST KING STREET
SHIPPENSBURG, PA 17257
______u fold
ESTATE INFORMATION: SSN: 199-05-7137
FILE NUMBER: 2101-1029
DECEDENT NAME: GROSS TABITHA M
DA TE OF PAYMENT: 08/02/2002
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 10/16/2001
NO. CD 001472
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $616.13
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: JOYCE E MOSER
C/O RICHARD L WEBBER JR ESQ
CHECK# 1017
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
$616.13
MARY C. LEWIS
REGISTER OF WILLS
/-?- ~t::J-/
\, BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
*
REV-1U7 EX AFP (81-02)
~lr-
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
08-26-2002
GROSS
10-16-2001
21 01-1029
CUMBERLAND
101
TABITHA
M
RICHARD L WEBBER JR ESQ
WEIGLE & ASSOCS
126 EKING ST
SHIPPENSBURG PA 17257
Allount Rellitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-V =i6"ifj-iX--AFP-llff=oz.r------...--iNHiiiiTANC'E-YAX--si'7rfEME-tiY-"ifF"-ACCouiff--.-..--------------- - -----
ESTATE OF GROSS TABITHA M FILE NO. 21 01-1029 ACN 101 DATE 08-26-2002
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW
IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 07-29-2002
P R I NC I PAL TAX DUE: ......................................................................................................__...................................................................................................................
11,142.45
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
01-15-2002 CDOO0750 526.32 10,000.00
08-02-2002 CDOO1471 .00 2.83
08-02-2002 CDOO1472 1.72- 616.13
TOTAL TAX CREDIT 11,143.56
BALANCE OF TAX DUE 1.11CR
INTEREST AND PEN. .00
. IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE 1.11CR
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR),
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. )
'\ /'}-~-/
~ BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
.U? r:U;~J-2
RICHARD L WEBBER'-JR "ESQ -
WEIGLE & ASSOCS
126 EKING ST I,.,.
SHIPPENSBURG C\PA 17257
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
07-29-2002
GROSS
10-16-2001
21 01-1029
CUMBERLAND
101
*'
REV-15U EX AFP (01-02)
TABITHA
M
Allount Rellitted
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=is4-j-Ex--AFP--(fff':o21--NoTicE--oF-'rtiHEifiTANci-TAX-A-PPRAIsEirENT~--Aii-owANci-crR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF GROSS TABITHA M FILE NO. 21 01-1029 ACN 101 DATE 07-29-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Allount of Line 14 at Spousal rate (lS)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. Hortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Hisc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
.00
.00
306~945.68
11~639.56
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Hisc. Expenses (Schedule H)
10. Debts/Hortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
26,251.36
44.723.94
(11)
(12)
(13)
(14)
NOTE:
.00 X 00 =
247,609.94 X 045=
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
318,585.24
70.975 30
247,609.94
.00
247,609.94
(19)=
.00
11,142.45
.00
.00
11,142.45
.-ft'nl;n. 1'C~l,;~.u.1 II l+ J AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
01-15-2002 CDOO0750 526.32 10,000.00
INTEREST IS CHARGED THROUGH 08-13-2002 TOTAL TAX CREDIT 10,526.32
AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 616.13
REVERSE SIDE OF THIS FORM INTEREST AND PEN. 2.83
TOTAL DUE 618.96
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "'CREDIT"' (CR), YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.)
STATUS REPORT UNDER RULE 6.12
~K
,/
.
Name of Decedent: Tabitha M. Gross
Date of Death: October 16, 2001
Will No.:
2001-1029
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State whither administration of the estate is complete:
Yes ~ No 0
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
3. If the answer to No.1 is Yes, state the following:
a. Did the personal reP.~tative file a final account with the Court?
Yes _ No 0'---'
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal rep~~entative state an account informally to the parties
in interest? Yes 13' No 0
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this report.
Date: r{rd07 ~ '7-.~ /
Signature
~ -",
: 'J
Richard L. Webber, Jr., Esquire
Name
126 East King Street
Shippensburg, PA 17257
Address
(717) 532-7388
Telephone No.
Capacity: QPersonal Representative
o Counsel for personal representative
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
c
REV-1500 . 0
~~L~__~._~~-~-~l~--~....~..~- .~..
INHERITANCE TAX RETURN FILE NUMBER
RESIDENT DECEDENT C~NTYC~DE- 0 YEA~ ~ N~MBER~ ~ ~
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Gross, Tabitha K
DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
10 16 01 12/5/18
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
B/A
SOCIAL SECURITY NUMBER
199
- 7137
[i] 1. Original Return
D 4. limited Estate
[!] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of dealh atter 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrusl)
D 10. Spousal Poverty Credit (dale ofdealh between 12-31-91 and 1-1-95)
- 05
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (dale of dealh prior 10 12-13-82)
o 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
NAME
COMPLETE MAILING ADDRESS
126 East King Street
Shippensburg, PA 17257
Richard L. Webber, Jr., Es uire
FIRM NAME (lfAppli",,~le)
weigle & Associates, P.C.
TELEPHONE NUMBER
(717) 532-7388
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 306,945.68
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F) (6) 11,639.56
~ D Separate Billing Requested
..J (7)
~ 7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property
!:: (Schedule G or l)
D..
<( 8. Total Gross Assets (total Lines 1-7)
0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 26,251.36
W
et:: (10) 44,723.94
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
z
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 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
$247,609.94
x.o_ (15)
45 (16)
x.O_
x .12 (17)
x .15 (18)
(19)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20.0
~ 318,585.24
(11)
(12)
(13)
70,975.30
247,609.94
(14)
247,609.94
11,142.45
11,142.45
, .
REV-150B EX+ (2-87)
%-~t
~~
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Please Print or Type
FILE NUMBER
21-01-1029
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tabitha H. Gross
(All property ;ointly-owned with the Right of Survivorship must be disclosed on Schedule F)
iTEM
NUMBER
DESCRIPTION
VALUE AT
DATE OF DEATH
1.
Allfirst Honey Fund Alternative
Account 10950766632, including accrued interest
to date of death
$103,108.80
2.
Allfirst Certificate of Deposit
Account #80000002241326~ including accrued interest
date of death
5,538.42
3.
HBNA Account 57-403310-6
100,908.31
4.
Capital Blue Cross - refund of premium
158.45
5.
TelHark LLC - Certificate IQw 302
1.000.00
6.
Agway Honey Market Certificate ILC408
5~000.00
7.
Mellon Bank Account #355-238292
91,231. 70
TOTAL (Also enter on line 5, Recapitulation) S 306.945.68
(Attach additional 8%" X 11" sheets if more space is needed_l
, .
REV-1509 EX. (12-88)
.
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tabitha M. Gross
FILE NUMBER
21-01-1029
Joint tenant(s):
NAME
ADDRESS
5 Wedgewood Drive
Carlisle, PA 17013
RELATIONSHIP TO DECEDENT
Child
A.
Barbara J. Marklay
B.
Joyce E. Moser
314 Bayley Street
Carlisle, PA 17013
Child
C.
Jointly-owned property:
LETTER DATE
ITEM FOR TOTAL VALUE DECO'S DOLLAR VALUE OF
NUMBER JOINT MADE DESCRIPTION OF PROPERTY OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A, B 2/28/81 Allfirst checking account $34,922.19 33.33 $11,639.56
100328892359
I I I
i
TOTAL (Also enter on line 6, Recapitulation) S
(If more spoce is needed insert additional sheets of same size)
, .
REV.1511 EX+ (7.881
~
.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tabitha M. Gross
Please Print or Type
I FILE NUMBER
I 21-01-1029
i
ITEM
NUMBER
A.
B.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
DESCRIPTION
Funeral Expenses:
l.
2.
Egger Funeral Home
Carlisle Memorial Service, Inc.
A.
Barbara J. Marklay
Joyce E. Koser
Administrative Costs:
1.
Persona.' Representative Commissions
Social Security Number of Personal Representative:
B.
Year Commissions paid
2002
2.
Attorney Fees
Richard L. Webber, Jr., Esq.
3. Family Exemption
Claimant
Relationship
Address of Claimant at decedent's death
Street Address
City
State
Zip Code
Probate Fees
Miscellaneous Expenses:
I Allfirst - bank charge
Ach - internal ReBit
The Sential
Cumberland Law Journal
Cumberland County Register of Wills - filing fee for
inheritance tax return
Smith, Elliott, Kearns & Co. - preparation of final personal
income tax returns
Cumberland County Register of Wills - short certificate
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of same size.)
AMOUNT
$6,193.00
2,680.00
IA. $6,278.78
lB. $6,278.77
$3,500.00
$331.00
$10.00
$8.50
$100.31
$75.00
$15.00
$775.00
$6.00
S 26,251.36
REV-1512 EX+ (1-93)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
Please Print or Type
I FILE NUMBER
I 21-01-1029
I
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Tabitha M. Gross
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
United Church of Christ Homes
$ 3,547.94
2.
Pharmarica
$
125.00
3.
u.s. Treasury- 2001 personal income tax
$35,650.00
4.
Pa. Dept. of Revenue - 2001 personal income tax
$ 5,391.00
TOTAL (Also enter on line 10, Recapitulation)
$44,713.94
(If more space ;s neededl insert additional sheets of same size.)
REV-1513 EX+ (2-87}
-~.
~
SCHED'ULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESI DENT DECEDENT
ESTATE OF
FILE NUMBER
Tabitha M. Gross "
21-01-1029
ITEM
NUMBER
1.
2.
3.
4.
5.
NAME AND ADDRESS OF BENEFICIARY
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
A_ Taxable Bequests:
Stanley P. Gross
7153 Gold Nugget Drive
Niwot, CO 80503
Child
One-fifth (1/5)
Richard A. Gross
688 Water Station Road
Sylvania, GA 30467
Child
One-fifth (l/5)
David L. Gross
305 South Hanover Street, Apt. 3
Carlisle, PA 17013
Child
One-fifth (1/5)
Barbara J. Markley
5 Wedgewood Drive .
Carlisle, PA 17013
Child
One-fifth (1/5)
Joyce E. Moser
314 Bayley Street
Carlisle, PA 17013
Child
One-fifth (l/5)
ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
,
-
F,
AMOUNT OR
SHARE OF ESTATE
1.
B. Charitable and Governmental Bequests:
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS rAlso enter on line 13, Recapitulation) $
(If more space is needed, insert additional sheets of same size)
.
Il allfirst
Allfirst Financial Center N .A.
PO. Box 900
Millsboro, DE 19966
December 6,2001
Law Office of Michael J. Hanft
Attorneys & Counselors At Law
19 Brookwood Avenue Suite 106
Carlisle, PA 17013-9142
RE: Estate of Tabitha M. Gross
Date of Death: October 16, 2001
Social Security Number: 199-05-7137
Dear Mr. Webber:
In response to your request, please be advised that at the time of death, the above-
named decedent had on deposit with this bank the following accounts.
1. Account Type........................... Checking Account
Account Number....................... 0038892359
Ownership (Names of)....... ....... Tabitha M. Gross (or)
Barbara J. Markley (or)
Joyce E. Moser
Opening Date.......................... .02/28/81
Balance on Date of Death....... ..$34,922.19
Accrued Interest
$
0.00
Total................................... ....$34,922.19
2. Account Type.. ......... ............. ... Money Fund Alternative
Account Number.. ............ ......... 0950766632
Ownership (Names of).... .......... Tabitha M. Gross
Opening Date.......................... .04/02/01
Balance on Date of Death ....... ..$1 03,080. 90
Accrued Interest
$
27.90
Total. . .. . .. . .. . .. . .. . .. . .. . . . . .. . .. . . . . . .. . $103, 108.80
. Page 2
December 6, 2001
3. Account Type........................... Certificate of Deposit
Account Number. . . . . .. . .. . .. . . . . .. .... 80000002241326
Ownership (Names of).............. Tabitha M. Gross
Opening Date......................... ..08/17/01
Balance on Date of Death....... ..$5,500.00
Accrued Interest
$ 38.42
Total................................... ....$5,538.42
TIlls letter does not include any accounts in which the deceased may have been listed as power of attorney,
custodian of uniform transfers, representative payee, or trustee under a written trust agreement.
For any additional information on these accounts, please contact our branch at:
255 South Spring Garden Street
Carlisle, PA 17013-2706
Phone:Tt 17f240~6734 u___
Sincerely, .
{J~tJ~
Charlene Warrington, Associate I
(302) 934-2722
-fcr,~~~~':i.'5:';:~~~T .
MBNA AMERICA BANK, N.A.
P. O. BOX 15103
WILMINGTON, DE 19850-5103
1-(800)-348-4632
ACCOUNT NUMBER
57-403310-6
-
,- .
-
-
-
-
-
\
MINt..
AMERICA"
TABITHA M GROSS
BARBARA J MARKLEY POA
5 WEDGEWOOD DR
CARLISLE PA 17013
-
--
-
-
-
FOR CHANGE OF ADDRESS, PLEASE USE THE REVERSE SIDE OF THIS FORM.
NEA-SPONSORED FDIC-INSURED MONEY MARKET ACCOUNT
-- ----- ---
STATEMENT PERIOD FROM 9/20/01 THROUGH 10/19/01 ACCOUNT NUMBER
NUMBER OF DAYS 30
PAGE 1
57-403310-6
ACCOUNT SUMMARY INFORMATION
ACCOUNT SUMMARY:
BEGINNING BALANCE
TOTAL S DEPOSITS/CREDITS
TOTAL S WITHDRAWALS/DEBITS
ENDING BALANCE
AVERAGE BALANCE
NUMBER OF DEPOSITS/CREDITS
NUMBER OF WITHDRAWALS/DEBITS
100,941.56
319.48
33.25-
101,227.79
100,924.93
1
1
INTEREST SUMMARY:
ANNUAL PERCENTAGE YIELD EARNED
INTEREST EARNED THIS PERIOD
AVERAGE BALANCE FOR YIELD CALC
CALENDAR YTD INTEREST PAID
CALENDAR YTD INTEREST WITHHELD
3.92%
319.47
100,924.93
1,718.04
0.00
TRANSACTION HISTORY INFORMATION
POST EFF TRANSACTION
JATE DATE DESCRIPTION
9/20 BEGINNING BALANCE
10/05 10/05 CHECK WITHDRAWAL 1004
10/19 10/19 INTEREST PAYMENT
10/19 ENDING BALANCE
TRANSACTION
AMOUNT
BALANCE
33.25-
319.48
100,941.56
100,908.31
101,227.79
101,227.79
INTEREST RATE HISTORY
IMPORTANT NEWS
DATE
9/20/01
9/24/01
10/01/01
10/08/01
10/15/01
INTEREST
RATE
4. 12%
3.93%
3.83%
3.73%
3.09%
MAKE YOUR SAVINGS WORK EVEN HARDER FOR YOU-OPEN
AN NEA-SPONSORED FDIC-INSURED GOLDCERTIFICATE
CO FOR YIELDS THAT HAVE BEEN AMONG THE HIGHEST
NATIONWIDE. ITIS A GREAT AND SAFE WAY TO SAVE!
FOR MORE INFORMATION OR TO OPEN AN ACCOUNT, JUST
CALL NEA FINANCIAL SERVICES TODAY AT
1-800-348-4632.
3490 90G
FDIC INSURED
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HARRISBURG, PA. 17177
CHECK NUMBER
261709
THE ESTATE OF AGREEMENT NUMBER
TABITHA GROSS 175105087
314 BAYLEY ST
CARLISLE PA 17013-3103
************************* EXPLANATION OF REFUND *************************
PERIOD OF REFUND
FROM: 11/01/2001
TO: 12/01/2001
REFUND REASON: CANCELLED DECEASED
TYPE OF COVERAGE:
REFUND AMOUNT:
SECURITY 65
$158.45
TOTAL REFUND AMOUNT:
$158.45
II- 2 b . ? 0 q fi!J [:]0 3 . 3 0 0 B :1 ~ I: . 0 III 0 3 3 q 5 5 II_
+: CITIZENS BANK
P.O. Box 7899
Philadelphia, PA 19101-7899
January 02,2002
Law Office of Michael J Hanft
Attorneys & Counsellors at Lm'i'
19 Brookwood Avenue
Suite 106
Carlisle, PA 17013-9142
Estate Of Tabitha M Gross
Date of Death: 10/16/2001
SSN 199-05-7137
Dear Sir/Madam:
In accordance with your request, the attached information sheet has been provided in the
above decedent's 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.
Sincerely,
~ J" l
~ Lrrc~ \.. ....A..J
~na Tillman
-.
Deposit Support Services 199-5355
Page 1 of 2
+: CITIZENS BANK
Wednesday, January 02,2002
Account
Number Account Title
00355-238292
Tabitha M Gross
Date Opened: 06/07/2001
Principal Sal Int from Last
as of DOD Posting to DOD
$91,089.59 $142.11
Account Type: SA
Account Sal YTD Int to
as of DOD DOD
$91,231.70 $1,231.70
Page 2 of 2
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
1. Professional Services
Funeral Director & Staff
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Oak
#5 Reg
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THAT YOU HAVE SELECTED
AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN
ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES.
CASH ADVANCES
Cemetery Charges
Certified Copies
Clergy Honorarium
Organist
TOTAL CASH ADVANCES AND SPECIAL CHARGES
.
Egger Funeral Home, Inc.
15 Big Spring Ave.
Newville, PA 17241-
(717)776-3414
October 25,2001
Joyce E. Moser
314 Bailey st.
Carlisle, P A 17013
The Funeral Service for Mrs. Tabitha M. Gross
SUB-TOTAL
INITIAL PAYMENT I DISCOUNT / CREDITS
TOTAL AMOUNT DUE
~ ...!Mi) '_' III.! r-J ...hL:.. 1'''1" 1.'-_
1.
Page 1
..; "~_H',,.,-:,...._.,
$2345.00
$2345.00
$2350.00
$843.00
$5538.00
$500.00
$20.00
$100.00
$35.00
$655.00
. $6193.00
$6193.00
f
Carlisle Memorial Service, Inc.
Please design and build the following memorial
DESIGNERS AND BUILDERS OF
ep-.aJA~~ M~
~7 (1'. n (fO (1 A If'vEtfJ
41 South Bedford Street .fJ...) ,..u~ , .17
Carlisle, PA 17013 [)i:.A-/ Cil;{;~:::-~-,/
/(fo):e ~o til,
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8.0 0,(1
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Total Price '_~ ,_,-,-_!~~, ~~--~
Price
Carlisle Memorial Service, Inc.
Carlisle, PA.
Telephone 243-5480
")~), ) I -I .::): II) ~ ~J j>' -
For ,.. ~j ~ .r;, 'by~ /. Ln ' ,. ." J.. J-.. ). .~:'C., tj ".
Address ,. 1'>' . . j r (-'.I.i. f- i_.Ii). t Q,L). . . . 1-.,,~/.'\i.11 . .
Design Not:(~ )" ;..j-).) .c',d. ~"jl~/Zf' -l~>.~
. ",....,) 'I. /i,.) " '
Material ../....f.t.n I.c .e.. . <.&i ~..I, I ':r
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Ole '-,..... .(.{/. .r:-. ...O..,:~.
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Base . .i. . .... .... ?.. oJ.
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/( .' -j' - / ,-}.J,
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7 {.; '?~ ( l....:'~>. .-,;~.::;;. .t~.. /~-j~I' :' > ~- /
l.;..!:~ is.....
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Markers
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Posts ....8 tJ'~.t? .
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pnce(J'-" . \ax ....,;.....t t!J:-
. ,<)' 't) "'. ~ ("..--
DepOSit . ~. .U? .b._"...!.._ . . . .
,-...-..~-----
Balance Due . D.I? P: .
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" it.
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..........
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---.....
Family Name
Inscription
! /j. / '1 -- -. / c:.".
;' '-7 ,; /
I [/ X
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.\
~~ L- ;_~.' i
/ t.;:I...~/ "'~'.'
. . . . . . .. .. ''';''') . . . . . :'.' c
$tyl~ of Letters .t.t:: (/ . j ,,/,-/
_L> ,.J /1 \ ,:. ...."' --7-<", OJ j I,' ..' ..' /. , - .~.'
Foundation to be furnished by ......... . . . . . /. . h.. '. >-',1' '. f: .i;. /. . . . ~ .I."; (. .'-;-. . .'. I I i .II.,. ". ..c....'<!:". j I f/ .C. .I '.J ....
Material to be best selected monumental grade and to be free from imperfections and first class in eVllry way. Work to be finished in a wor~manlike
'~.
manner.
, ,..J ~
- . (... j I .
This memorial to be erected in . . . . . . . . . . . f~. / ;~'. c . /J-f<. ,'J:-r. ../ f- ,.(...-: ::--7": . . . . . . . . . . . . . . . . . . . . . Cemetery
in or near . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . during the month of . . . . . . . . . . . . . . . . . . . . . . . . . ., .......
unless unavoidably delayed by labor troubles and other contingencies beyond our control and then as soon as possible. Additional lettering and other
work on this memorial in the future is not included in the Contract Price.
Title and right of possession and removal of said stone. monument or appurtenances shall remain for all purposes in Carlisle Memorial Service
until work and materials ordered are fully paid by purchaser or purchasers. In consideration of the acceptance by Carlisle Memorial Service of this
order, the undersigned (hereinafter known as the purchaser) agrees to pay Carlisle Memorial Service. . . . . . . . . . . . . . . . . . . . . . . . . Dollars
on or before the 15th day following the billing of the work or job upon completion thereof by Carlisle Memorial Service said billing to be notice of
completion thereof. this order shall become a contract between the purchaser and Carlisle Memorial Service upon acceptance thereof in the space
below by a duly authorized representative of said Carlisle Memorial Service; it being understood that this instrument upon such acceptance covers
all of the agreement between the purchaser and Carlisle Memorial Service and that no agent or representative of Carlisle Memorial Service has made
any statements or agreements, verbal or written, modified or adding to the terms and conditions herein set forth.
It is further understood that upon the acceptance of this order the contract so made cannot be cancelled. altered, or modified by the purchaser
or by any agent of Carlisle Memorial Service or in any manner except by agreement in writing between the purchaser and Carlisle Memorial Service,
and it is hereby understood and agreed by all parties involved that in case of default by purchaser or purchasers, twenty,five per cent of the total
original cost of the work or work and materials ordered, as the case may be, shall be specified correct sum as liquidated damages which purchaser
shall owe Carlisle Memorial Service. less any payment on account made prior to such default, this specification of damages to be due regardless of
removal and taking possession of stone. monument or materials from purchaser or purchasers by Carlisle Memorial Service upon following such
default.
.:.1 l ,"1 r1ti. 1.: ~
...... .~'1.j,d!(./I..LLd..:~:;r... ,,,'l.... .It.(Lkt....:.r.:.:. ":r~' '~''-;. . i
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.~/ -C~-:-' ,.J. .'. . . ,i.:..~.t.<-.-../__.c:. ~.'o(:'.J.r c:..-:_..~~...~.......
Carlisle Memorial Service Approval By ...' .'. ,(.,,;:~.), 1->. :'{,~l"r; ..' ~ <. ~..: ~.
White: Office Copy; Canary: Custt>~er Copy; Pink: Salesman Copy; Gold: Office Copy
.................... .......................,................................... ....... ......... (SEA L)
...........................................(SEAL)
. . . . . . . . . . . . . (SEAL)
.*\ .. I
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I.:......~~~.......:....~._.....~_.._., _...._~,_, .Co..>.._" ..-, -_..~~ '-...--,--_.,-.~",...._-_.-
"
2001
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TABITHA GROSS
U.S. INDIVIDUAL INCOME TAX RETURN
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Prepared by:
Smith Elliott Kearns & Company, LLC
Certified Public Accountants
19 Brookwood Avenue. Suite 101
Carlisle. P A 17013
Telephone (717) 243-9104
Fax(717)243-1177
. .
.
-
II
- Prepared for
II Prepared by
I
Amount of tax
I
I
Overpayment
I Make check
payable to
I Mail tax return
and check (if
II applicable) to
Return must be
I mailed on
or before
Special
I Instructions
I
I
I
I
100081
07-18-01
.._. . .__.._.,...._'._.,........"'....~.............-______.___"......._,,_____._.~~_4__ -- _,__,,~......__.. ....."-......'..--...<.._''''"''''0 .~. ...-""Co..,........... .__~_.
2001 TAX RETURN FILING INSTRUCTIONS
u.s. INDIVIDUAL INCOME TAX RErURN
FOR THE YEAR ENDING
p'~g~.mb.~.rn.JJI.... .400J.
Tabitha M. Gross Estate
c/o Joyce Moser, 314 Bayley Street
Carlisle, PA 17013
Smith Elliott Kearns & Company, LLC
19 Brookwood Ave., Suite 101
Carlisle, PA 17013
Total tax
Less: payments and credits
Plus: interest and penalties
Balance due
$
$
$
$
........... ~.? f.. ().~.().
o
20
........... ....
.. ...}?,()?()
Miscellaneous Donations
Credited to your estimated tax
Refunded to you
o
n.b
.".0
$
$
$
United States Treasury
Internal Revenue Service
P.o. Box 80101
Cincinnati, OH 45280-0001
April 15, 2002
The return should be signed and dated.
Also enclose Form 1040-V and a check for $35,650.
attach Form 1040-V or your payment to your return
other. Please leave Form 1040-V and your payment
the envelope.
Do not
or to each
loose ln
Include your social security number, daytime phone number and
the words "2001 Form 1040" on your check.
I
'2001
Form 1040-V
Department of the Treasury
Internal Revenue Service
I
I
Paperwork Reduction Act Notice.
We ask for the information on Form 1 040'Y to help us carry
out the Internal Revenue laws of the United States. If you use
Form 1040-Y, you must provide the requested information.
Your cooperation will help us ensure that we are collecting the
right amount of tax.
You are not required to provide the information requested
on a form that is subject to the Paperwork Reduction Act
unless the form displays a valid OMS control number. Soaks
or records relating to a form or its instructions must be
retained as long as their contents may become material in the
administration of any Internal Revenue law. Generally, tax
returns and return information are confidential, as required by
Internal Revenue Code section 6103.
The time needed to complete and mail Form 1 040.Y will vary
depending on individual circumstances. The estimated average
time is 19 minutes. If you have comments about the accuracy
of this time estimate or suggestions for making Form 1040.Y
simpler, we would be happy to hear from you. See the
Instructions for Form 1040.
I
I
I
I
I
I
I
I
Form 1040-V(2001)
I
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _! ..?~a~h.-H!r':. a~d_M~i~W1t~ y~~ ~tm.!n..!. 3..!!~R.!t~n_! _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
~ 1040-V Payment Voucher OMS No. 1545-0074
2001
Department of the Treasury ~ Do not staple or attach this voucher to your payment or relurn.
Internal Revenue Service (99)
1 Your social security number (SSN) 2 If a ioiot return, SSN shown second 3 Amount you Dollars Cents
on that retu rn are paying by
19910517137 I I check or
money order 35.650
4 Your first name and initial Last name
TABITHA M. GROSS
If a joint return, spouse's first name and initial Lasl name
Home address (number and street) I Apt. no.
C/O JOYCE MOSER, 314 BAYLEY STREET
;;
'"
N
~
City, town or posl office, slale, and ZIP code
CARLISLE, PA 17013
LHA
,;;
~
E U.S. Individual Income Tax Return 2 1(99)
0 IRS Use Only - Do not write or staple in this space.
u-
For the year Jan. l-oec. 31, 2001, or other tax year beginning , 2001, ending 20 OMS No. 1545-0074
Label
L Your first name and initial last name (DEC. 10/16/01) Your socjaJ security number
(See A TABITHA M. GROSS 199:05:7137
instructions
on page 19.) B If a joint return, spouse's first name and initial Last name Spouse's social security number
E :
Use the IRS L .- :
label. H Home address (number and street). If you have a P.O. box, see page 19. I Apt. no. ... Important! ...
Otherwise, E C/O JOYCE MOSER, 314 BAYLEY STREET You must enter
please print R City, town or post office, state, and ZIP code. if you have a foreign address, see page 19. your SSN(s) above.
or type. E
Presidential CARLISLE, PA 17013
I
,
1040
I
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DECEASED
001
You Spouse
...... ~ DYes [J[] No 0 Yes D No
Election Campaign ""-
(See page 19.) ~
1 X
Filing Status 2
3
4
I
I
Check only
one box.
il
Exemptions
I
I
If mo re than six
dependents,
see page 20.
I
Income
Attach
Forms W-2 and
W.2G here.
Also attach
Form(s)
1099-R II tax
was withheld.
I
I
I
If you did not
get a W-2,
see page 21.
I
Enclose, but do
not attach. any
payment. Also,
please use
Form 1 040-V.
I
I
Adjusted
Gross
Income
I
I
I
110001
".27.01
I I-lA ~nr ni"dn<;llrp Privar.v Ar.t. and Paoerwork Reduction Act Notice. see paqe 72.
Note. Checking 'Ves' will not change your tax or reduce your refund.
Do you, or your spouse if filing a joint return, want $3 to go to. this fund?
Single
Married filing joint return (even if only one had income)
Married filing separate return. Enter spouse's social security no. above and full name here....
Head of household (with qualifying person). (See page 19.) If the qualifying person is a child but not your dependent, enter this child's
name here. ...
5 Qualifying widow(er) with dependent child (year spouse died ... ). (See page 19.)
6a X Y oursell. If your parent (or someone else) can claim you as a dependent on his or her tax retum, do not check box 6a
bD~~.........................................................
O d t (3) Dependent's
C epen en s: (2) Dependent's social relationship to
(1) First name Last name security number you
d
7
8a
b
9
10
11
12
13
14
15a
16a
17
18
19
20a
21
Total number of 6xem lions claimed
Wages. salaries, tips, etc. Attach Form(s) W-2
Taxable interest. Attach Schedule B if required
Tax-exempt interest. Do not include on line 8a
Ordinary dividends. Attach Schedule B if required
Taxable refunds, credits. or offsets of state and local income taxes
Alimony received
Business income or (loss). Attach Schedule C or C-EZ ....
Capital gain or (loss). Attach Schedule 0 if required. If not required, check here
Other gains or (losses) Attach Form 4797 ...............................
TotallRA distributions ~ b Taxable amount (see page 23)
Total pensions and annuities ~ b Taxable amount (see page 23)
Rental real estate, royalties, partnerships, S corporations. trusts. etc. Attach Schedule E
Farm income or (loss). Attach Schedule F ..................
Unemployment compensation ..............
Social security benefits I 20a I 7 ,322 .1 b Taxable amount (see page 25)
Other income. Listlype and amount (see page 27)
7
8a
8b
........ ......"
....... D
9
10
11
12
13
14
15b
16b
17
18
19
20b
22 Add the amounts in the far right column for lines 7 through 21. This is your total income
23 IRA deduction (see page 27) 23
24 Student loan interest deduction (see page 28). ............ 24
25 Archer MSA deduction. Attach Form 8853 25
26 Moving expenses. Attach Form 3903 26
27 One-half of self-employment tax. Attach Schedule SE 27
28 Self-employed health insurance deduction (see page 30) 28
29 Self-employed SEP. SIMPLE. and qualified plans 29
30 Penalty on early withdrawal of savings 30
31 a Alimony paid b Recipient's SSN ... 31 a
32 Add lines 23 through 31 a
33 Subtract line 32 from line 22 ThiS is our adjusted ross income
...
3.
32
... 33
No. of boxes
checked on 6a
and 6b
No. of your
children on 6c
who:
. lived with you
1
. ~id not live with
you due to divorce
or separation
(see page 20)
Dependents on 6c
not entered above
Add numbers
entered on
lines above'" 1
6,837.
184,284.
1 407.
6,224.
198 752.
3 .
198 749.
Fem'l 1 040 120(1)
34 Amount from line 33 (adjusted gross income) ............... ...........................................................
35a Check if: 00 You were 65 or older. 0 Blind; D Spouse was 65 or older, 0 Blind.
Add the number of boxes checked above and enter the total here ........................ ............ .. 35a
If you are married filing separately and your spouse itemizes deductions, or you were a dual-status alien .. 35b
. Itemized deductions (from Schedule A) or your standard deducllon (see left margin) .................................
Subtract line 36 from line 34 ............................................................................................................
If line 34 is $99.725 or less. multiply $2,900 by the total number of exemptions claimed on line 6d.lf line 34
is over $99,725. see the worksheet on page 32......... .......... ............. .......... ..... ..... ....... ............. .............
39 Taxable income. Subtract line 38 from line 37. If line 38 is more than line 37. enter -0- .................................
40 Tax. Check iflax from aD Form(s) 8814 bD Form 4972...............................................................
41 Alternative minimum tax. Attach Form 6251 .... ..................................................................................
42 Add lines 40 and 41 ...................................................................................................... ..
43 Foreign tax credit. Attach Form 1116 if required ........................................ 43
44 Credit for child and dependent care expenses. Attach Form 2441 .................. 44
45 Credit for the elderly orthe disabled. Attach Schedule R .............................. 45
46 Education credits. Attach Form 8863 ...................... .............................. 46
47 Rate reduction credit. See the worksheet on page 36 ................................. 47
46 Child tax credit (see page 37)............. ............................... ............... 46
49 Adoption credit. Attach Form 8839 ......... ............................................. 49
50 Other credits from: a 0 Form 3800 b 0 Form 8396
c 0 Form 8801 d D Form (specify)
51 Add lines 43 through 50. These are your total credits ............................
52 Subtract line 51 from line 42. If line 51 is more than line 42 enter -0- .....
53 Self-employment tax. Attach Schedule SE ........ ........................ ............. .......................
54 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137
55 Tax on qualified plans. including tRAs, and other tax-favored accounts. Attach 5329 if required
56 Advance earned income credit payments from Form(s) W-2 ..............
57 Household employment taxes. Attach Schedule H ..................
56 Add lines 52 through 57. This is your total tax .............. ................
Payments 59 Federal income tax withheld from Forms W-2 and 1099
60 2001 estimated tax payments and amount applied from 2000 return
61 a Earned income credit (ErC)....... .
b Nontaxable earned income ~I
62 Excess social security and RRTA tax withheld (see page 51)
63 Additional child tax credit. Attach Form 8812........................
64 Amount paid with request for extension to file (see page 51)...................
65 Other payments. Check if from a 0 Form 2439 b 0 Form 4136.........
66 Add lines 59, 60, 6ia. and 62 ihrou h 65. These are your iota I a ments .
Refund 67 If line 66 is more than line 58, subtract line 58 from line 66. This is the amount you overpaid.
~:P~~it? 68a Amount of line 67 you want refunded to you..........................................
Routing D D Pttount
S.... page 51 .. b number .. C Type: Checking 5.J..ngs .. d number
and nil in 68b,
6ac, and 6ad. 69 Amount of line 67 au want a lied to our 2002 estimated tax . ....... .. 69
Amount 70 Amount you owe. Subtract line 66 from line 58. For details on how to pay. see page 52
You Owe 71 Estimated tax enal . Also include on line 70 ......................... 71
Third Party Do you want to allow another person to discuss this return with the IRS (see page 53)?
. DeSignee's Phone
DeSIgnee name" PRE PARER no. ..
II
Form 1040 (2001)
, Tax and
Credits
II
Standard
Deduction for-
I
. People who
checked any
box on line 35a
or 35b or who
can be claimed
as a dependent.
I
. All others:
Single,
$4,550
Head of
household,
$6,650
I
Married nling
jointly or
Qualifying
widow(er),
$7,600
I
Married filing
separately,
$3,800
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Other
Taxes
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" you have
a qualifying
child, attach
Schedule EIC.
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Sign
Here
Joint return?
See page 19
Keep a copy
for your
records.
I
TABITHA M.
GROSS
199-05-7137
Page 2
198,749.
b
36
37
38
36 5 650.
37 193,099.
38 1,334.
39 191,765.
40 35,630.
41 O.
42 35,630.
50
..
51
52
53
54
55
56
57
56
35,630.
35,630.
..
59
60
613
650.
62
63
64
65
...
~
..
..
20.
00 Yes. Complete the following.
Personal identification
number (PIN) ..
Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and belief, they are troe. correct,
and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
Your signature Date Your occupation
Daytime phone number
~ Spouse's signature. if a Joint retum, both must sign.
ECEASED
Date
Spouse's occupation
Preparer's
Paid Signature
Preparer's
Finn's name ( r
Use Only yours If self-em-
ployed). address,
and ZIP code
{/4 D~
SMITH ELLIOTT EARNS & COMP
~19 BROOKWOOD AVE., SUITE 101
CARLISLE, PA 17013
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110002
11.21.01
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Sched.fles A&B (Form 1040) 2001
N~me(s) shown on Form 1040. Do not enter name and social security number if shown on page 1.
OMB No. 1545-0074 Page 2
Your social security number
I
TABITHA M. GROSS
199'05:7137
Schedule B - Interest and Ordinary Dividends
Attachment 08
Sequence No.
I
Part I 1 Ust name of payer. If any interest is from a seller.financed mortgage and the buyer used the Amount
Interest property as a personal residence, see page B-1 and list this interest first. Also,show that
buyer's social security number and address ~
MELLON 1,896.
ALLFIRST 6,092.
TELMARK LLC 80.
Note: If you AGWAY INC 567.
received a Form LESS AMOUNT REPORTED BY ESTATE (25-6801855) <1,798.
1099-INT,
Form 1099-010, 1
or substitute
statement from
a brokerage firm,
list the firm's
name as the
payer and enter
the total interest
shown on that
form.
"
2 Add the amounts on line 1 ., ......... ........ ....... . ....... ............ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 6,837.
3 Excludable interest on series EE and I U.S. savings bonds issued after 1989 from Form 8815,
line 14. You must attach Form 8815 .., .......... .. ............ .............. ....... 3
4 Subtract line 3 from line 2. Enter the result here and on Form 1040, line 8a .,.. ...... ~ 4 6,837.
>
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Part II 5 Ust name of payer. Include only ordinary dividends. If you received any capital gain distributions, Amount
Ordinary see the instructions for Form 1040, line 13. ~
Dividends
Note: If you
received a Form
1 099-DIV or
substitute
statement from
a brokerage firm.
list the firm's 5
name as the
payer and enter
the ordinary
dividends shown
on that form.
6 Add the amounts on line 5. Enter the total here and on Form 1040, line 9 ~ 6
Note. If line 4 is over $400. you must complete Part III.
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Part III
Foreign
Accounts
and
Trusts
Note. If line 6 is over 400. ou must com lete Part III.
You must complete this part if you (a) had over $400 of taxable interest or ordinary dividends; (b) had a foreign account;
or (c) received a distribution from, or were a grantor of, or a transferor to, a foreign trust.
7a At any time during 2001, did you have an interest in or a signature or other authority over a financial
account in a foreign country, such as a bank account, securities account, or other financial account?
b If 'Yes: enter the name of the foreign country ~
8 DUring 2001. did you receive a distribution from. or were you the grantor of. or transferor to. a foreign trust?
If 'Yes.' you may have to file Form 3520. See page B-2
For Paperwork Reduction Act Notice, see Form 1040 instructions.
Yes
No
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x
127501
10,23.01
x
.
LHA
Schedule B (Form 1040) 2001
I
Department of the Treasury
Intemal Revenue Service (99)
Name(s) shown on Form 1040
~ Attach to Form 1040.
~ See Instructions for Schedule 0 (Form 1040).
OMS No, 1545-0074
2001
~lla~~:~n~o. 12
Your social security number
I-
.SCHEDULE D
(Form 1040)
Capital Gains and Losses
I
199.05:7137
(d) Sales price
4
(a) Description of property
(Example: 100 sh. 'iIYl CO,l
(e) Cost or
other basis
(I) Gain or (loss)
Subtract (e) from (d)
1
-
-
I
2 Enter your short-term totals 2
3 Total short-term sales price amounts.
Add lines 1 and 2 in column (d). ..... ...... 3
4 Short-term gain from Form 6252 and short-term gain or (loss)
from Forms 4684, 6781, and 8824 ............. ..............
5 Net short-term gain or (loss) from partnerships, S corporations, estates, and trusts
from Schedule(s) K-1
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6 Short-term capital loss carryover. Enter the amount, if any, from line 8 of your
2000 Capital Loss Carryover Worksheet
6
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Net short-term capital gain or (Ioss)_ Combine lines 1 through 6 in column (f). 7
Long-Term Capital Gains and Losses - Assets Held More Than One Year
(a) Description of property i~)uD'redate (e) Cost or
(d) Sales price
(Example: 100 sh. x:-rz Co.) C) Date sold other basis
(I) Gain or (loss)
Subtract (e) from (d)
(g) 28% rate gain
or (loss) *
(see instr. below)
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9 Enter your long-term totals 9
10 Total long-term sales price amounts.
Add lines 8 and 9 in column (d) 10
11 Gain Irom Form 4797, Part I; long-term gain from Forms 2439 and 6252; and
long-term gain or (loss) from Forms 4684, 6781. and 8824 ....S~~S.'J:'bT~.l'1~NT.. :3. 11
12 Net long-term gain or (loss) from partnerships, S corporations, estates, and trusts
from Schedule(s) K-1 . 12
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184,284.
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13 Capital gain distributions.
14 Long-term capital loss carryover. Enter in both columns (f) and (g) the amount, if any, from
line 13 of your 2000 Capital Loss Carryover Worksheet
13
14
184,284.
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15 Combine lines 8 through 14 in column (g)
15
16 Net long-term capital gain or (loss). Combine lines B through 14 in column (f)
Next: Go to Part III on page 2.
* 28% rate gain or loss includes all 'collectibles gains and losses' and up to 50% of the eligible gain on qualified small business stock. See instructions.
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LHA For Paperwork Reduction Act Notice, see Form 1040 instructions.
Schedule D (Form 1040) 2001
.
120511110-26.01
ScheduleD (Form 1040)2001 TABITHA M. GROSS
Taxable Gain or Deductible Loss
17 Combine lines 7 and 16 and enter the result. If a loss, go to line 18. If a gain, enter the gain on Form ,1040,
line 13, and complete Form 1040 through line 39.. ............................................... ..........................................
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199 -05 - 7137 Pa e 2
184,284.
Next: · If both lines 16 and 17 are gains and Form 1040, line 39, is more than zero, complete Part IV below.
· Otherwise, skip the rest of Schedule D and complete Form 1040.
18 If line 17 is a loss, enter here and on Form 1040, line 13, the smaller of (a) that loss or
(b) ($3,000) (or, if married filing separately, ($1,500)). Then complete Form 1040 through line 37
20 Enter your taxable income from Form 1040, line 39 ,.... ,.. .....................
21 Enter the smaller of line 16 or line 17
of Schedule D.., ..........
22 If you are deducting investment interest expense
on Form 4952, enter the amount from Form 4952,
line 4e. Otherwise, enter -0- 22 0 .
23 Subtract line 22 from line 21. If zero or less, enter .0- 23
24 Subtract line 23 from line 20. If zero or less, enter -0- 24
25 Figure the tax on the amount on line 24. Use the Tax Table or Tax Rate Schedules, whichever applies
26 Enter the smaller of:
. The amount on line 20 or
. $45,200 if mamed filing jointly or qualifying widow(er}; }
$27,050 if Single;
$36,250 if head of household; or
$22,600 if married fiiing separately
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Next: · If the loss on line 17 is more than the loss on line 18 or if Form 1040, line 37, is less than zero,
skip Part IV below and complete the Capital Loss Carryover Worksheet on page D-6 of the
instructions before completing the rest of Form 1040.
· Otherwise, skip Part IV below and complete the rest of Form 1040.
Maximum Ca ital Gains Rates
Enter your unrecaptured section 1250 gain, if any,
from line 17 of the worksheet on page D- 7 of the
instructions ..... ........... .. .......... ......., ......... 19
If line 15 or line 19 is more than zero, complete the worksheet on page 0-9
of the instructions to figure the amount to enter on lines 22, 29, and 40
below, and skip all other lines below. Otherwise, go to line 20.
21
184,284.
If line 26 is greater than line 24, go to line 27. Otherwise, skip lines 27
through 33 and go to line 34.
27 Enter the amount from line 24
28 Subtract line 27 from fine 26. If zero or less, enter .0- and go to line 34
29 Enter your qualified 5.year gain, if any, from line 7
of the worksheet on page 0.8 ,..,~TMT4 29 184,284 .
30 Enter the smaller of line 28 or line 29
31 Multiply line 30 by 8% (.08)
32 Subtract line 30 from line 28 32
33 Multiply line 32 by 10% (.10)
191,765.
184,284.
7 481.
1,121.
7 481.
19 569.
19,569.
1,566.
If the amounts on lines 23 and 28 are the same, skip lines 34 through 37 and go to line 38.
1:'051;"! '~)-:'i' -.1'
34
35
36
184,284.
19,569.
164,715.
37
38
39
32,943.
35,630.
55,891.
34 Enter the smaller of line 20 or line 23
35 Enter the amount from line 28 (if line 28 is blank. enter -0-)
36 Subtract line 35 from line 34
37 Multiply line 36 by 20% (.20)
38 Add lines 25. 31,33. and 37
39 Figure the tax on the amount on line 20. Use the Tax Table or Ta'( Rate Schedules. whichever applies
40 Tax on all taxable income (including capital gains). Enter the smaller of line 38 or line 39 here and on
Form 1040. line 40
40 I 3 5 , 6 3 0 .
Schedule 0 (Form 1040) 2001
I. .S'Cf.lEDULE E
(Form 1040)
I Department of the Treasury ~
Internal Revenue Service (99)
Name(s) shown on return
Supplemental Income and Loss
OMS No. 1545-0074
(From rental real estate, royalties, partnerships,
S corporations, estates; trusts, REMICs, etc.)
Attach to Form 1040 or Form 1041. ~ See Instructions for Schedule E (Form 1040).
2001
Attachment
Sequence No. 13
Your social security number
I
TABITHA M. GROSS 199-05~7137
[pari:n Income or Loss From Rental Real Estate and Royalties Note. If you are in the business of renting personal properly, use
Schedule C or C-EZ (see page E-1). Report farm rental income or loss from Form 4835 on page 2, line 39.
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1 Show the kind and location of each rental real estate property: 2 For each rental real estate properly listed Yes No
A FARM HOUSE on line 1, did you or your family use it
125 NEALY RD during the tax year for personal purposes A X
8 FARM SHED AND ACREAGE for more than the greater of:
125 NEALY RD. . 14 days, or X
. 10% of the total days rented at fair 8
C rental value?
(See page E-1.) C
Income: Properties Totals
A .8 C (Add columns A, 8, and C.)
3 Rents received .... ........ . . . . . . . . . . . 3 1,050. 500. 3 1,550.
....... ......
4 Rovalties received ............. ............ 4 =
Expenses:
5 Advertising ................. 5
6 Auto and travel (see page E-2) . . .. . .. ....... . 6
7 Cleaning and maintenance 7 '.
8 Commissions 8 >
... .......................
9 Insurance ....... 9
10 Legal and other professional fees 10
11 Management fees . 11 ....
12 Mortgage interest paid to banks, etc.
(see page E-2) 12 12
13 Other interest 13 .....
14 Repairs 14
15 Supplies 15
16 Taxes 16 <409. >
17 Utilities 17
18 Other (list) ~
18
.....
19 Add lines 5 through 18 ........ 19 <409.> 19 <409.
20 Depreciation expense or depletion
(see page E-3) 20 523. 29. 20 552.
21 Total expenses. Add lines 19 and 20 21 114. 29.
22 Income or (loss) from rental real estate
or royalty properties. Subtract line 21
from line 3 (rents) or line 4 (royalties).
If the result is a (loss), see page E-3 to
find out if you must file Form 6198. 22 936. 471.
23 Deductible rental real estate loss. Caution. /ENTIRE DISP
Your rental real estate loss on line 22 may ENTIRE DISP
be limited. See page E-3 to find out if you
must file Form 8582. Real estate professionals
must complete line 42 on page 2 23
24 Income. Add positive amounts shown on line 22. Do not include any losses 24 1,407.
25 Losses. Add royalty losses from line 22 and rental real estate losses from line 23. Enter total losses here 25 ( )
26 Total renlal real estate and royalty income or (loss). Combine lines 24 and 25. Enter the result here
If Parts II, III. IV, and line 39 on page 2 do not apply to you, also enter this amount on Form 1040,
line 17. Otherwise, include this amount in the total on line 40 on page 2 26 1,407.
>
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c..... D.......~un,.it' Dortllrtinn Art Nntir.p. !'\P.P. Form 1 n4n in~trll,.tinn~
Schedule E (Form 104012001
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ILHA
.
For~ 4797
Sales of Business Property
(Also Involuntary Conversions and Recapture Amounts
Under Sections 179 and 280F(b)(2))
.. Attach to your tax return. .. See separate instructions.
OMS No. 1545-0184
2001
~~~~~~n~o 27
Identifying number
Department of the Treasury
Internal Revenue Service (99)
Name(s) shown on return
TABITHA M. GROSS
199-05-7137
....... /1
1 Enter the gross proceeds from sales or exchanges reported to you for 2001 on Form(s) 1099-8 or 1D99.S
(or substitute statement) that you are including on line 2,10, or 20 ...............................................................
!partln Sales or Exchanges of Property Used in a Trade or Business and Involuntary Conversions From
Other Than Casualty or Theft-Most Property Held More Than 1 Year (See instructions.)
(e) Depreciation (f) Cost or other
allowed or basIs, plus
allowable since improvements and
acquisition expense of sale
(a) Description of property
(b) Date acquired
(mo., day, yr.)
(g) Gain or (loss)
Subtract (~ from
the sum of (d) and (e)
(e) Date sold
(mo., day, yr.)
(d) Gross sales
price
2
3 Gain, if any, from Form 4684,line 39 ....... ...... . ............ ....................... ...................... .......................
4 Section 1231 gain from installment sales from Form 6252, line 26 or37... ............... .................. ...................
5 Section 1231 gain or (loss) from like-kind exchanges from Form 8824........... ............................................................
6 Gain, if any, from line 32, from other than casualty or theft. ...................... ..................................
7 Combine lines 2 through 6. Enter gain or (loss) here and on the appropriate line as follows:
Partnerships (except electing large partnerships). Report the gain or (loss) following the instructions for Form
1065, Schedule K, line 6. Skip lines 8, 9,11, and 12 below.
S corporations. Report the gain or (loss) following the instructions for Form 1120S, Schedule K,lines 5 and 6.
Skip lines 8, 9, 11, and 12 below, unless line 7 is a gain and the S corporation is subject to the capital
gains tax.
All others. If line 7 is zero or a loss, enter the amount from line 7 on line 11 below and skip lines 8 and 9. If line 7 is
a gain and you did not have any prior year section 1231 losses, or they were recaptured in an earlier year, enter the
gain from iine 7 as a long-term capital gain on Schedule 0 and skip lines 8, 9,11, and 12 below.
8 Nonrecaptured net section 1231 losses from prior years (see instructions) ............... . .. . ................ 8
9 Subtract line 8 from line 7. If zero or less, enter -0-. Also enter on the appropriate line as follows (see instructions): 9
5 corporations. Enter any gain from line 9 on Schedule 0 (Form 112DS), line 15, and skip lines 11 and 12 below.
All others. If line 9 is zero, enter the gain from line 7 on line 12 below. If line 9 is more than zero, enter the amount from line 8 on line 12 below,
and enter the gain from line 9 as a long-term capital gain on Schedule D.
I Part" I Ordinary Gains and Losses
10 Ordinary gains and losses not included on lines 11 through 17 (include property held 1 year or less):
Loss. if any, from line 7
Gain. if any, from line 7 or amount from line 8, if applicable
Gain, if any, from line 31 .
Net gain or (loss) from Form 4684, lines 31 and 38a
Ordinary gain from installment sales from Form 6252. line 25 or 36
Ordinary gain or (loss) from like-kind exchanges from Form 8824
Recapture of section 179 expense deduction for partners and S corporation shareholders
from property dispositions by partnerships and S corporations
Combine lines 10 through 17. Enter the gain or (loss) here and on the appropriate line as follows:
a For all except individual returns. Enter the gain or (loss) from line 18 on the return being filed.
b For individual returns:
(1) If the loss on line 11 includes a loss from Form 4684, line 35, column (b)(ii), enter that part of the loss
here. Enter the part of the loss from income-producing property on Schedule A (Form 1040), line 27, and
the part of the loss from property used as an employee on Schedule A (Form 1040). line 22. Identify as
from 'Form 4797, line 18b(1).' See instructions
(2) Redetermine the gain or (loss) on line 18 excluding the loss. if any. on line 18b(1). Enter here and on
Form 1040. line 14
11
12
13
14
15
16
17
11
12
13
14
15
16
17
18
18
For Paperwork Reduction Act Notice, see separate instructions.
Form 4797 (2001)
118011/11.08.01
I.
,r.orr;,4797(2001)TABITHA M. GROSS 199-05-7137 Page 2
. F~:ml Gain From Disposition of Property Under Sections 1245,1250,1252,1254, and 1255
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*
19 (a) Description of section 1245, 1250, 1252, 1254, or 1255 property: (b) Date acquired (c) Date sold
(mo.. day, yr.) (mo.. day, yr.)
A FARM AND HOUSE / /77 04/03/01
B
c .-
D
These columns relate to the properties on
lines 19A through 19D. ~ Property A Property B Property C Property D
20 Gross sales price (Note: See line 1 before completing.) 20 295,000.
21 Cost or other basis plus expense of sale ........... 21 152,592.
22 Depreciation (or depletion) allowed or allowable .. 22 41,876.
23 Adjusted basis. Subtract line 22 from line 21 .... 23 110,716.
24 Total gain. Subtract line 23 from line 20.. ..... 24 184,284.
25 Ifsection 1245 property:
a Depreciation allowed or allowable from line 22 25a
b Enter the smaller of line 24 or 25a .......... 25b
26 If section 1250 property: If straight line depreciation
was used. enter -0- on line 26g, except for a corporation
subject to section 291.
a Additional depreciation after 1975 (see instructions) 26a
b Applicable percentage multiplied by the smaller
of line 24 or line 26a (see instructions) ..... . 26b
c Subtract line 26a from line 24. If residential rental
property or line 24 is not more than line 26a, skip
lines 26d and 26e 26c
d Additional depreciation after 1969 and before 1976 _'_ 26d
e Enter the smaller of line 26c or 26d 26e
f Section 291 amount (corporations only) 26f
g Add lines 26b. 26e. and 26f 26a
27 II section 1252 property: Skip this section if you did not
dispose of farmland or if this form is being completed for
a partnership (other than an electing large partnership).
a Soil, water, and land clearing expenses 27a
b Line 27a multiplied by applicable percentage 27b
c Enter the smaller of line 24 or 27b 27c
28 If section 1254 property:
a Intangible drilling and development costs. expenditures
for development of mines and other natural deposits.
and mining exploration costs (see instructions) 28a
b Enter the smaller of line 24 or 28a 28b
29 If section 1255 property:
a Applicable percentage of payments excluded 29a
from income under section 126 (see instructions)
b Enter the smaller of line 24 or 29a (see instructions) 29b
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Summary of Part III Gains. Complete property columns A through 0 through line 29b before going to line 30.
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30 Total gains for all properties. Add property columns A through D. line 24
30
184 284.
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31 Add property columns A through D, lines 25b, 26g, 27c, 28b, and 29b. Enter here and on line 13 31
32 Subtract line 31 from line 30. Enter the portion from casualty or theft on Form 4684, line 33. Enter the portion
from other than casualt or theft on Form 4797, line 6 32 1 84 2 84 .
Part IV Recapture Amounts Under Sections 179 and 280F(b)(2) When Business Use Drops to 50% or Less
(See instructions.)
I
la) Section (b) Section
179 280F(b)(2)
33 Section 179 expense deduction or depreciation allowable in prior years 33
34 Recomputed depreciation. See Instructions 34
35 Recapture amount. Subtract line 34 from line 33. See the instructions for where to report 35
Form 4797 (2001)
* ENTIRE DISPOSITION OF PASSIVE ACTIVITY
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118012
.
Department of the Treasury
Intemal Revenue Service (99)
Name(s) shown on retum
SCHEDULE E- 1
Depreciation and Amortization
(Including Information on. Listed Property)
~ See separate instructions. ~ Attach this form to your return.
Business or activity to which this form relates
OMS No. 1545-0172
'FO~" 4562
2001
Attachment
Sequence No. 67
Identifying number
ARM HOUSE - 125 NEALY
TABITHA M. GROSS D 199-05-7137
:PHrl::[ Election To Expense Certain Tangible Property Under Section 179 Note: If you have any 'listed property,' complete Part V before you complete Part L
1 Maximum dollar limitation. If an enterprise zone business, see instructions .............................................. 1 24,000 .
2 Total cost of section 179 property placed in service (see instructions) ........................................................ 2
3 Threshold cost of section 179 property before reduction in limitation ............................................................. 3 $200,000
4 Reduction in limitation. Subtract line 3 from line 2. If zero or less, enter -0- ............................................. 4
5 Dollar limitation for tax year. Subtract line 4 from line 1. If zero or less, enter -D,. If married filing
se aratel see instructions .................................. ................. 5
6
(a) Description of property
(b) Cost (business use only)
Ie) Elected cost
7 Listed property. Enter amount from line 27............................... ........ ........................... 7
8 Total elected cost of section 179 property. Add amounts in column (c), lines 6 and 7 ............. 8
9 Tentative deduction. Enter the smaller of line 5 or line 8 ..................................... 9
10 Carryover of disallowed deduction from 2000 ........ ....... .......... ... ....................... 10
11 Business income limitation. Enter the smaller of business income (not less than zero) or line 5 11
12 Section 179 expense deduction. Add lines 9 and 10, but do not enter more than line 11 ................ 12
13 Carryover of disallowed deduction to 2002. Add lines 9 and 10, less line 12 . ... ~ 13
Note: Do not use Part /I or Part /II below for listed property (automobiles, certain other vehicles, cellular telephones, certain computers, or property
used for entertainment, recreation, or amusement). Instead, use Part V for listed property.
IJ>aHIII MACRS Depreciation For Assets Placed in Service Only During Your 2001 Tax Year (Do not include listed property.)
Section A - General Asset Account Election
14 If you are making the election under section 168(i)(4) to group any assets placed in service during the tax year into one or more general asset
accounts, check this box. See instructions .... ... .......... ..... ..... ........ ..... ..... ..... ........... .................. ..... ....... ..... .......... ................ ....
... ..... .... ~ D
Section B - General Depreciation System (GDS) (See instructions.)
(a) Classification of property
(b) Month and
year placed
in service
(c) Basis tor depreciation
(businesslinvestment use
only - see instructions)
(d) Recovery
period
(e) Convention (~Method
(g) Depreciation deduction
S/L
S/L
S/L
S/L
S/L
25.
10.
Nonresidential real property
1/01 2,800. rs. MM
1/01 1,090. MM
I MM
I MM
Section C - Alternative Depreciation System (ADS) (See instructions.)
S/L
S/L
S/L
h Residential rental property
16 a Class life
b 12. ear 12 rs.
c 40-year I 40 yrs. MM
Part III Other Depreciation (Do not include listed property.) (See instructions.)
17 GDS and ADS deductions for assets placed in service in tax years beginning before 2001
18 Property subject to section 168(f)(1) election
19 ACRS and other depreciation
Part I Summary (See instructions.)
20 Listed property. Enter amount from line 26
21 Total. Add deductions from line 12. lines 15 and 16 in column (g), and lines 17 through 20. Enter here
and on the appropriate lines of your return. Partnerships and S corporations - see instructions
22 For assets shown above and placed in service during the current year, enter the
ortion of the baSIS attributable to section 263A costs 22
:~6ff~.6, LHA For Paperwork Reduction Act Notice, see the separate instructions.
17
18
19
488.
20
21
523.
Form 4562 (2001)
I.
ForIVl4562(2001)TABITHA M. GROSS 199-05-7137Page 2
Listed Property (Include automobiles, certain other vehicles, cellular telephones, certain computers, and property used for entertainment,
recreation, or amusement.)
Note: For any vehicle for which you are using the standard mileage rate or deducting lease expense, complete only 23a, 23b, columns (a)
throuqh (c) of Section A, all of Section B, and Section C if applicable.
Section A - Depreciation and Other Information (Caution: See instructions for limits for passenger automobiles.)
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23a Do you have evidence to support the businesslinvestment use claimed? DYes DNo 23b If 'Yes' is the evidence written? DYes D No
(a) (b) Date (c) (d) (e) (f) (9) (h) (i)
Type of property placed in Business/ Cost or Basis for depreciation Recove ry Methodl Depreciation -- Elected
(list vehicles first) se rvice investment other basis (business/investment period Convention deduction section 179
use percentage use only) cost
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24 Pcop,rty",'" mom 'hi 50% '0 a rat''''d b""O[1 "00'
25 Pro rt used 50% or less in a ualified business use:
%
%
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26 Add amounts in column (h). Enter the total here and on line 20, page 1 ..........................
27 Add amounts in column (i). Enter the total here and on line 7, page 1 ... ................
Section B - Information on Use of Vehicles
Complete this section for vehicles used by a sole proprietor, partner, or other 'more than 5% owner,' or related person.
If you provided vehicles to your employees, first answer the questions in Section C to see if you meet an exception to completing this section for
those vehicles.
S/L-
S/L-
S/L-
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(a) (b) (c) (d) (e) (f)
28 Total business/investment miles driven during the Vehicle Vehicle Vehicle Vehicle Vehicle " Vehicle
year (do not include commuting miles) .
29 Total commuting miles driven during the year
30 Total other personal (noncommuting) miles
driven .
31 Total miles driven during the year.
Add lines 28 through 30.
Yes No Yes No Yes No Yes No Yes No Yes No
32 Was the vehicle available for personal use
during oft.duty hours?
33 Was the vehicle used primarily by a more
than 5% owner or related person?
34 Is another vehicle available for personal
use?
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Section C - Questions for Employers Who Provide Vehicles for Use by Their Employees
Answer these questions to determine if you meet an exception to completing Section 8 for vehicles used by employees who are not more than 5%
owners or related persons.
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Yes No
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35 Do you maintain a written policy statement that prohibits all personal use of vehicles, including commuting, by your
employees?.. .
36 Do you maintain a written policy statement that prohibits personal use of vehicles, except commuting, by your
employees? See instructions for vehicles used by corporate officers, directors, or 1 % or more owners
37 Do you treat all use of vehicles by employees as personal use?
38 Do you provide more than five vehicles to your employees. obtain information from your employees about
the use of the vehicles, and retain the information received?
39 Do you meet the requirements concerning qualified automobile demonstration use?
Note: If your answer to 35, 36. 37, 38, or 39 is "Yes, .. do not complete Section B for the covered vehicles.
Amortization
(a)
Description of costs
(c)
Amortizable
amount
(d)
Cooe
section
(e)
Amo<1Jza D 00
penod or pelC1:ntloe
(f)
AmortizatIOn
tor tnis year
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41 Amortization of costs that began before your 2001 tax year
42 Total. Add amounts in column (f). See instructions for where to report
41
42
Form 4562 (2001)
116252
12,29-01
I. ~:aITHA M. GROSS
199-05-7137
SOCIAL SECURITY BENEFITS WORKSHEET
STATEMENT 1
fORM 1040
CHECK ONLY ONE BOX:
Ix A. SINGLE, HEAD OF HOUSEHOLD, OR QUALIFYING WIDOW(ER)
B. MARRIED FILING JOINTLY
C. MARRIED FILING SEPARATELY AND LIVED WITH YOUR SPOUSE
AT ANY TIME DURING 2001
D. MARRIED FILING SEPARATELY AND LIVED APART FROM YOUR SPOUSE
FOR ALL OF 2001
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2 .
I 3.
I 4.
I 5.
6.
I 7.
8.
I 9.
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10.
ENTER THE TOTAL AMOUNT FROM BOX 5 OF ALL YOUR
FORMS SSA-1099 AND RRB-1099. . . . . . . . . . . . . . . .
ENTER ONE HALF OF LINE 1 . . . . . . . . . . . . . . . . .
ADD THE AMOUNTS ON FORM 1040, LINE 7, 8B, 9 THROUGH 14,
15B, 16B, 17 THRU 19, 21 AND SCHEDULE B, LINE 2. DO NOT
INCLUDE ANY AMOUNTS FROM BOX 5 OF FORMS SSA-1099 OR RRB-1099
ENTER THE AMOUNT OF ANY EXCLUSIONS FROM FOREIGN EARNED
INCOME, FOREIGN HOUSING, INCOME FROM U.S. POSSESSIONS,
OR INCOME FROM PUERTO RICO BY BONA FIDE RESIDENTS OF
PUERTO RICO THAT YOU CLAIMED . . . . . . . . . . . . .
ADD LINES 2, 3, AND 4. . . . . . . . . . . . . . . . .
ADD THE AMOUNTS ON FORM 1040, LINES 23, AND 25 THRU 31A, AND
ANY AMOUNT YOU ENTERED ON THE DOTTED LINE NEXT TO LINE 32.
SUBTRACT LINE 6 FROM LINE 5 ...............
ENTER: $25,000 IF YOU CHECKED BOX A OR D, OR
$32,000 IF YOU CHECKED BOX B, OR
$-0- IF YOU CHECKED BOX C. . . . . . . . . . .
IS THE AMOUNT ON LINE 8 LESS THAN THE AMOUNT ON LINE 7?
[ ] NO. STOP. NONE OF YOUR SOCIAL SECURITY BENEFITS ARE
TAXABLE. YOU DO NOT HAVE TO ENTER ANY AMOUNTS ON LINES
20A OR 20B OF FORM 1040. BUT IF YOU ARE MARRIED FILING
SEPARATELY AND YOU LIVED APART FROM YOUR SPOUSE FOR ALL OF
2001, ENTER -0- ON LINE 20B. BE SURE YOU ENTERED 'D' TO
THE LEFT OF LINE 20A.
[X] YES. SUBTRACT LINE 8 FROM LINE 7 . . . . . . . . . . .
ENTER $9,000 IF YOU CHECKED BOX A OR D,
$12,000 IF YOU CHECKED BOX B
$-0- IF YOU CHECKED BOX C . . . . . . . . . . . .
SUBTRACT LINE 10 FROM LINE 9. IF ZERO OR LESS, ENTER -0-.
ENTER THE SMALLER OF LINE 9 OR LINE 10 . . . . . . . .
ENTER ONE HALF OF LINE 12. . . . . . . . . . . . . . . . .
ENTER THE SMALLER OF LINE 2 OR LINE 13 . . . . . . . . . .
MULTIPLY LINE 11 BY 85% (.85). IF LINE 11 IS ZERO, ENTER -0-
ADD LINES 14 AND 15. . . . . . .. ... . . .
MULTIPLY LINE 1 BY 85% (.85) . . . . . . . . . . . . . . .
Ill.
12.
113.
14.
15.
116.
17.
118.
TAXABLE BENEFITS. ENTER THE SMALLER OF LINE 16 OR LINE 17
* ENTER THE AMOUNT FROM LINE 1 ABOVE ON FORM 1040, LINE 20A
* ENTER THE AMOUNT FROM LINE 18 ABOVE ON FORM 1040, LINE 20B
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7,322.
3,661.
192,528.
196,189.
3.
196,186.
25,000.
171,186.
9,000.
162,186.
9,000.
4,500.
3,661.
137,858.
141,519.
6,224.
6,224.
STATEMENT(S) 1
I . TABrTHA M. GROSS
199-05-7137
rORM 1040
PERSONAL EXEMPTION WORKSHEET
STATEMENT
2
,I.
12.
13.
4 .
IS THE AMOUNT ON FORM 1040, LINE 34, MORE THAN THE AMOUNT SHOWN ON LINE 4
BELOW FOR YOUR FILING STATUS?
NO. STOP. MULTIPLY $2,900 BY THE TOTAL NUMBER OF EXEMPTIONS CLAIMED ON
FORM 1040, LINE 6D, AND ENTER THE RESULT ON LINE 38.
YES. GO TO LINE 2.
MULTIPLY $2,900 BY THE TOTAL NUMBER OF EXEMPTIONS CLAIMED
ON FORM 1040, LINE 6D . . . . . . . . . . .. .... 2,900 .
ENTER THE AMOUNT FROM FORM 1040, LINE 34 . .. 198,749.
ENTER THE AMOUNT FOR YOUR FILING STATUS 132,950.
MARRIED FILING SEPARATE $ 99,725
SINGLE $132,950
HEAD OF HOUSEHOLD $166,200
MARRIED FILING JOINT OR WIDOW(ER) $199,450
SUBTRACT LINE 4 FROM LINE 3 .. . . 65,799.
IF LINE 5 IS MORE THAN $122,500 ($61,250 IF
MARRIED FILING SEPARATE) ENTER ZERO
ON FORM 1040, LINE 38.
DIVIDE LINE 5 BY $2,500 ($1,250 IF MFS) 27.
MULTIPLY LINE 6 BY 2% (.02) AND ENTER THE RESULT
AS A DEC IMAL . . . . . . . . . . . . . . . . . . 0 .54
MULTIPLY LINE 2 BY LINE 7 . . . . . . . . . . . . . . 1,566.
1
5.
I
16.
7.
8.
19.
SUBTRACT LINE 8 FROM LINE 2. TOTAL TO FORM 1040, LINE 38.
1,334.
1
SCHEDULE D
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NET LONG-TERM GAIN OR LOSS FROM FORMS
4797, 2439, 6252, 4684, 6781 AND 8824
STATEMENT
3
DESCRIPTION OF PROPERTY
IFORM 4797
GAIN OR LOSS
28% GAIN
184,284.
ITOTAL TO SCHEDULE D, PART II, LINE 11
184,284.
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STATEMENT(S) 2, 3
I . T~]THA M. GROSS
199-05-7137
fCHEDULE D QUALIFIED 5-YEAR GAIN WORKSHEET
1. ENTER THE TOTAL OF ALL GAINS THAT YOU REPORTED ON LINE 8,
COLUMN (F), OF SCHEDULE D FROM DISPOSITIONS OF PROPERTY HELD
I MORE THAN 5 YEARS. DO NOT REDUCE THESE GAINS BY ANY LOSSES
2. ENTER THE TOTAL OF ALL GAINS FROM DISPOSITIONS OF PROPERTY
HELD MORE THAN 5 YEARS FROM FORM 4797, PART I, BUT ONLY IF
I FORM 4797, LINE 7, IS MORE THAN ZERO. DO NOT REDUCE THESE
GAINS BY ANY LOSSES . . . . . . . . . . . . . . . . . . . . . .
3. ENTER THE TOTAL OF ALL CAPITAL GAINS FROM DISPOSITIONS OF
I PROPERTY HELD MORE THAN 5 YEARS FROM FORM 4684, LINE 4;
FORM 6252; FORM 6781, PART II; AND FORM 8824. DO NOT REDUCE
THESE GAINS BY ANY LOSSES . . . . . . . . . . . . . . . . .
114. ENTER THE TOTAL OF ANY QUALIFIED 5-YR GAIN REPORTED TO YOU ON:
* FORM 1099-DIV, BOX 2C;
* FORM 2439, BOX IC; AND
* SCHEDULE K-l FROM A PARTNERSHIP, S CORPORATION,
I ESTATE, OR TRUST . . . . . . . . . . . . . . . . .
5. ADD LINES I THROUGH 4 . . . . . . . . . . . . . . . . . . . . .
16 .
STATEMENT
4
184,284.
184,284.
ENTER THE PART, IF ANY, OF THE GAIN ON LINE
* ATTRIBUTABLE TO 28% RATE GAIN OR
* INCLUDED ON LINE 6, 10, 11, OR 12 OF THE
UNRECAPTURED SECTION 1250 GAIN WORKSHEET
5 THAT IS:
7. QUALIFIED 5-YEAR GAIN. SUBTRACT LINE 6 FROM LINE 5
184,284.
S'1'A'1'FMPWT' I ,C: \ L1
-
. t
Prepared for
Prepared by
Amount of tax
Overpayment
Make check
payable to
Mail tax return
and check (if
applicable) to
Return must be
mailed on
or before
Special
Instructions
100081
07.1B 01
_~""_""'H....,,;..",..._~.>,r_'.L..."<-"""J.."""'<.a,,......~~_.,,,~,~.;..,...,.~,.'-"'O"_"..,....:.:..,-..,.....-_.._.:c;.._--.;..~.......l._',;..--.:;..~~,.......,....._._'"'
2001 TAX RETURN FILING INSTRUCTIONS
PENNSYLVANIA INCOME TAX RETURN
FOR THE YEAR ENDING
p~q~.mP..~):".... :3.ll..... 2 (). () l
Tabitha M. Gross Estate
c/o Joyce Moser, 314 Bayley Street
Carlisle, PA 17013
Smith Elliott Kearns & Company, LLC
19 Brookwood Ave., Suite 101
Carlisle, PA 17013
Total tax
Less: payments and credits
Plus: interest and penalties
Balance due
$
$
$
$
.?/.:3.9.J.
o
.... ..........
o
.5., :3~)
Miscellaneous Donations
Credited to your estimated tax
Refunded to you
$
$
$
o
o
o
PA Department of Revenue
PA Department of Revenue
Payment Enclosed
1 Revenue Place
Harrisburg, PA 17129-0001
April 15, 2002
The return should be signed and dated.
Enclose Form PA-V with the return. Do not attach payment or
Form PA-V to the return.
Include your social security number and the words "2001 PA
Tax" on your check.
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---------------1 2001 PA-V
199-05-7137 GR
-j----------------
P A PAYMENT VOUCHER _
0100915057 ---,
PAYMENT AMOUNT
$ 5,391.00
GROSS
TABITHA M
C/O JOYCE
STREET
CARLISLE
PA
17013
MOSER, 314 BAYLEY
Make check or money order payable to the
Pennsylvania Department of Revenue
DEPARTMENT USE ONLY
IT] IT] IT]
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174461
12-27-01
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PLEASE
DO NOT USE YOUR
LABEL
0100115054
2001
PA-40
PAGE 1 OF 2
L
199-05-7137 GR
GROSS
TABITHA
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c/o JOYCE MOSER, 314 BAYLEY STREET
CARLISLE PA 17013
LA 0.00 lB 0.00
2 6834.00 3 0.00
5 184284.00 6 1407.00
8 0.00 9 192525.00
11 192525.00 12 5391.00
M
EX 0 RS
A 0 FS
FY 0
XX
SC 21830
PN
R
'F
lC
4
7
10
0.00
0.00
0.00
0.00
I
PLEASE FOLD PAGE ALONG THIS LINE
Extension, (Mark this space)
Amended Return, (Mark this space)
Fiscal Year Filer, (Mark this space)
Type Filer. (Fill-in only one choice)
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F
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Local Information. Enter where you lived as of 12/31/2001
School District: SOU T H MID D LET 0 N
School Code: 21830
County: CUMBERLAND
Municipality: CAR LIS L E
Residency Status. (Mark the Correct Space)
R X Pennsylvania Resident
NR Nonresident
P Part Year Resident
From:
To:
o
Date of Death:
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X
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Single
Married, Filing Jointly
Married, Filing Separately
Final Return. Indicate Reason:
Deceased
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1a Gross Compensation. See the instructions.
1 b Unreimbursed Employee Business Expenses. See the instructions
1c Net Compensation. Subtract Line 1b from Line 1a.
2 Interest Income. Complete and submit PA Schedule A, if over $2,500.
3 Dividend Income. Complete and submit PA Schedule 8, if over $2.500.
4 Net Income or Loss from the Operation of Business. Profession. or Farm.
5 Net Gain or Loss from the Sale, Exchange. or Disposition of Property.
6 Net Income or Loss from Rents, Royalties. Patents, or Copyrights.
7 Estate or Trust Income. Complete and enclose PA Schedule J.
B Gambling and Lottery Winnings.
9 Total PA Taxable Income. Add only the positive income amounts from Lines 1c. 2. 3.4.5,6.7, and 8.
DO NOT ADD any losses reported on Lines 4,5, or 6.
10 Contributions To Your Medical Savings Account. See the instructions.
~ 11 Adjusted PA Taxable Income. Subtract Line 10 from line 9.
c,.
N
~ 12 PA Tax Liability. Multiply line 11 by 2.8% (0.028). Also enter on line 13, page 2. .
1a 0.00
1b 0.00
1c 0.00
2 6,834.00
3 0.00
4 0.00
5 184,284.00
6 1,407.00
7 0.00
8 0.00
9 192,525.00
10 0.00
11 192,525.00
B
12 5,391.00
EC
FC
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0100115054
CD =CD
0100115054
---'
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0100215052
2001
PA-40
PAGE 2 OF 2
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M 199-05-7137
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GROSS TABITHA
13 5391.00 14 0.00
16 0.00 17 0.00
19 0.00 20A 0
21 0.00 22 0.00
24 0.00 25 0.00
27 0.00 28 5391.00
30 0.00 31 0.00
33 0.00 34 0.00
36 0.00
15
18
20B
23
26
29
32
35
0.00
0.00
o
0.00
0.00
0.00
0.00
0.00
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Total PA Tax Liability.
Enter you r P A Tax Liability from Line 12 on Side 1. .........
Total PA Tax Withheld. See the instructions ...............
Credit from your 2000 PA Income Tax Return. .................................
2001 Estimated Installment Payments. ..... ............... ................
2001 Extension Payment..................... .............
Nonresident Tax Withheld on your PA Schedule(s) NRK-1. (Nonresidents only)
Total Estimated Payments and Credits. Add Lines15, 16, 17, and 18. . .
TAX BACK/Tax Forgiveness Credit. Complete lines 20a, 20b, 21, and 22. Read instructions.
Filing Status: Unmarried or Separated Married Deceased
Oependents, Part B, Line 2 PA Schedule SP.
Total Eligibility Income, Part C, Line 11, PA Schedule SP.
TAX BACK!Tax Forqiveness Credit from Part D, Line 16, PA Schedule SP.
Total Credit for Taxes Paid to Other States or Countries. Submit your PA Schedule G or RK-1.
PA Employment Incentive Payments Credit. Submit your PA Schedule W, RK-1 or NRK-1.
PA Jobs Creation Tax Credit. Submit your certification or PA Schedule RK-1 or NRK-1. .
PA Research and Development Tax Credil. Submit your certification or PA Schedule RK-1 or NRK-1. .. ..
Total Payments and Credits. Add lines 14 and 19 and 22 through 26. . .
TAX DUE. If Line 13 is more than Line 27, enter the difference here.
OVERPAYMENT. If Line 27 is more than Line 13, enter the difference here.
The total of Lines 3D through 36 must equal line 29.
Refund -- Amount of Line 29 you want as a check mailed to you.
Credit - Amount of Line 29 you want as a credit to your 2002 estimated tax account.
Donation -- Amount of Line 29 you want to donate to the Wild Resource Conservation Fund.
Donation -- Amount of Line 29 you wanf to donate to the United States Olympic Committee.
Donation -- Amount of Line 29 you want to donate to the Governor Robert P. Casey Memorial
Organ and Tissue Donation Awareness Trust Fund.
Donation -- Amount of Line 29 you want to donate to fhe KoreaNietnam Memorial Inc.
Donation -- Amount of Line 29 you want to donate to the Breast and Cervical Cancer Research Fund.
13
14
15
16
17
18
19
5,391.00
0.00
0.00
0.00
0.00
0.00
0.00
14
15
16
17
18
19
20a
20b
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
20a
20b
21
22
23
24
25
26
27
28
29
o
o
0.00
0.00
0.00
0.00
0.00
0.00
0.00
5,391.00
0.00
Refund 30
31
32
33
0.00
0.00
0.00
0.00
34
35
36
0.00
0.00
0.00
Under penalties 01 perjury, I (wel declare that I (we) have examined this return, including all accompanying schedules and statements, and to the best of my
(our) belief they are true, correc and complete.
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Spouse"s Occupation"
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Your Signature: Date:
Spouse's Signature, jf filing jointly: Date:
re arer or om an ame 0 er an ax a er sase on a In orma Ion 0 W IC e re arer
reparer or Company Name (Please Print):
SMITH ELLIOTT KEARNS & COMPANY, LLC
174002
12.27.01
~ /S~",IOPtional) ~ C ,/~
~ --------
L
0100215052
Your OccuoatJon'
DECEASED
elepnone Number
(717)243-9104
0100215052
~
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PA SCHEDULE A & B
Interest and Dividend Income
PA-40 AlB/UE-1 09-01
0101215051
OFACIAl USE ONLY
10/16/01
our own schedules in these formats.
Social Security Number:
199-05-7137
Caution. Federal and PA rules for taxable interest and dividend income are different. Read the instructions. If either your taxable interest or dividend income is $2,500 or less, you
must report the
income, but you do not need to submit any Schedule. If either your interest income or dividend income ;5 more than $2,500, you must submit a schedule. If you must adjust your federal
income, enter
your federal amount on line 1, and make your corrections and explain them in the space under Rling Option 3.
Rling options: 1. Submit a copy of your federal schedule - you do not need this PA schedule.
2. Enter your federal taxable interest and/or dividend income - do not submit your Federal Schedule B.
3. Otherwise, list the name of each payer and the amount of PA taxable interest and dividend income you received in 2001.
PA Schedule A - PA Taxable Interest Income
Filing option 2. Enter the amount from your Federal Schedule B (Form 1040) or Schedule I (Form 1040A).
1. 1$
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Filino oDtion 3. PA Taxable Interest Income. Read the instructions.
$
$
SEE STATEMENT 1 $
$
$
2. Total PA Taxable Interest Income. Add the amounts and include the total on Line 2 of your PA tax return. 2. $ 6,834.00
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IMPORTANT. Capital gain distributions are dividend income for PA purposes.
PA Schedule B . PA Taxable Dividend Income
Filing option 2. Enter the amount from your Federal Schedule B (Form 1040) or Schedule I (Form 1040A).
1. 1$
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Filino ootion 3. PA Taxable Dividend Income. Read the instructions.
$ ..
$
$
$
$
2. Total PA Taxable Dividend Income. Add the amounts and include the total on Line 3 of your PA tax return. 2. :t
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PA-40 AlB/UE-l (09/01)
PA SCHEDULE UE-1 Allowable Employee Business Expenses
2001
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Name of taxpayer claiming expenses: IMPORTANT. You must submit a PA Scheduel UE-1 or UE for each jOb - ~n':::,;:'';;ions Social Secunty Number ot taxpayer claiming expens"'l
Employer's name and address:
Employer's Federal EIN:
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Describe the duties of the jab in which you incurred these expenses:
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You mav not combine exoenses for more than one iob or Drofession. Soouses may not file ioint PA Schedule(sl UE-1.
Mileage. Use either Option (a) Dr Option (bl - not both.
1 a) Enter your total business miles , and multiply by the federal standard mileage rate $0. _; OR
bl Enter your amount from your Form 2106 or Form 2106-EZ. 1 $
2 Parkino fees. lolls and Iransoortation Enter the amount from your Form 2106 or Form 2106-EZ. 2 $
3 Awav from home overnioht. Enter the amount from your Form 2106 or Form 2106-EZ. 3 $
4 Meals and entertainment exoenses. Enter the amount from YOur Form 2106 or Form 2106-EZ. 4 $
5 Union Dues. List union name(s) and amount(s) paid Enter total. Attach additional sheets, if needed.
Name of union(s) and arnountls\. 5 $
6 Work Clothes and Uniforms. Required as a condition of your employment and not suitable for everyday use.
Descriotion: 6 $
7 Small Tools and Supplies. Required as a condition of your employment and not provided by your employer.
Descriotion: 7 $
8 Total Allowable PA Emolovee Business Exoenses. Add Lines 1 throuQh 7. 8 $
9 Reimbursements. Enter amounts that your emolover DID NOT reoort on your Form W-2. 9 $
10 Net Exoense or Reimbursement. Subtract Line 9 from Line 8. 10 $
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III
If Line 8 is MORE than Line 9, include your excess expenses on Line 1 b, Unreimbursed Employee Business Expenses.
If Line 9 is MORE than Line B, include your excess reimbursement on Line 1a, Gross PA Compensation.
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0101215051
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PA SCHEDULE D
Sale, Exchange,
Dr Disposition of Property
0101315059
If ou need more s ace our own schedules in these formats.
Name as shown first on the PA tax return: Social Security Number shown first:
GROSS, TABITHA M. DEC. 10/16/01 199-05-7137
Read the instructions. Enter all sales, exchanges, or other dispositions of real or personal tangible and intangible property. Amounts from Federal Schedule 0 may not be
correct for PA income tax purposes. Spouses should file separate PA Schedule(s) 0, unless selling jointly owned property. Nonresidents should carefully read the
OFFlCIAl USE ONLY
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instructions concernino intanoible Dronertv.
(a) I (b) (e) (d) (e) (f)
Describe the property: Date acquired Date sold Gross sales price Cost or Adjusted Gain or loss
100 shares of XVZ stock, or Month/day/yea r Month/day/year less expenses of Basis ofthe (d) minus (e)
10 acres in Dauphin County sale property sold If a loss,
1. LOSS fill in the box
FARM AND HOUSE / /77 04/03/01 291,753 107,469 184,284
2. Net gain or loss from above sales. If a net loss, fill in the box. ....-......... ... ...... ....... ..... ........... -- ...... lOSS 0 2. 184,284
3. Gain from installment sales from PA Schedule 0-1... . ........ ... ...... ....... r dl::3=d .3.
4. Taxable return of capital distributions. . Enter total distribution
........- . Minus Adjusted Basis 4.
5. Net gain or loss from the sale of 6-1-71 property from P A Schedule 0-71. If a net loss, fill in the box. .. ............ .... ... lOSS 0 5.
6. Net gain or loss from partnerships and PA S corporations. PA Schedule(s) RK-1 or NRK-1. If a net loss, fill in the box. .. LOSSO 6.
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I Taxable gain from the sale of your prinCipal residence. Complete Columns (a) through (e) and enter your total gain on Line 7.
(a) Address of residence (b) Date acquired: (c) Date sold: (d) Gross sales price (e) Cost or Adjusted (f) Gain or loss
month/day/year month/day/year less sale expenses Basis (d) minus (e)
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7. Taxable gain from the sale of your prinCipal residence. If you realized a net loss on the taxable portion 7.
of the sale of vour nrincinal residence. enter a zero.
8. Total PA taxable aain or lass. Add Lines 2 throuoh 7. Include the amount on Line 5 01 vour PA.40 If. net loss fill In the box lOSS 0 8. 184,284
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PA-40 D/J (09-01)
PA SCHEDULE J - Income from Estates or Trusts
2001
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Name shown first on the PA tax return:
Social Security Number shown first:
Read the instructions. List the name, address, and identification number of each estate and trust. For PA purposes, the estate or trust gives you a PA Schedule L. If you
received a Federal Schedule K-1, instead of a PA Schedule L, submit it with your PA-40 and enter the amount of your PA taxable income Indicate if the beneficiary is the
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taxoaver IT) or the SDouse IS). Use IJ) if you and your spouse are ioint beneficiaries.
fal Name and address 01 each estate or trust T/S/J (hI Federal EIN (cllncome Amount
-
-
- .-
Income from partnership(s), lrom your PA Schedule(s} RK-1 or NRK-1. -
Income from PA-S corporation(s), from your PA Schedule(s) RK-1 or NRK-1. -
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Total Estate or Trust Income.
Add Column c and enter the total here and on Line 7 of our PA-40.
174701/12.27.01
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PA SCHEDULE E
Rents, Royalties, Patents,
and Copyrights
P A-40 09-01
0101415057
2001
OFFICIAL USE ONLY
If you need more space, you may photocopy these schedules or prepare your own schedules in this format.
Name as shown first on the PA tax retum: Social Security Number shown first:
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GROSS, TABITHA M. (DEC. 10/16/01) 199-05-7137
Read the instructions. Report the income and expenses for the use of your personal property by others. Also report the income you received for the extraction of oil,
gas, and other minerals from your property and the use of your patents and copyrights. Use PA Schedule E unless you are in the business of renting property,
extracting minerals, or producing products from your patents and copyrights - if in business, complete PA Schedule C.
Part A. Property Description:
Description and address of each rental real estate property, and/or each source of royalty, patent, or copyright income.
FARM HOUSE
A 125-NEALYRD----------------------------~-- C
FARM SHED AND ACREAGE
B 125-NEALYRD~------------------------------ D
Part B. Enter the corresponding initial of the property from Part A, and fill in the appropriate box. T = taxpayer S = spouse J = joint ownership.
(A ) (B ) ( ) ( )
Gross Receipts rXlT [ ls r lJ IXJT I JS I JJ r IT r ls r lJ r IT r ls r lJ
1. Rent .... ---....... ......... ........ 1. 1,050 500
2. Royalties.... . .... ........ .... ......... "... 2.
3. Patents . -........ ...... .. 3.
4. Copyrights .. .. .......... ........... ....... ... 4.
5. Total receipts. Add Lines 1 through 4. 5. 1,050 500
Part C. Expenses: Itemize expenses being claimed.
6. Advertising .... ........ ......... 6.
7. Automobile and travel . 7.
8. Cleaning and maintenance 8.
9. Commissions. . 9.
10. Depreciation expense .. 10. 523 29
FILING TIP. If using federal depreciation, fill in the box. fXJ fXJ D D
You do not need to complete Part E or submit your federal depreciation schedule if you use your federal depreciation amount.
11. Insurance
12. Legal and professional fees
13. Management fees
14 Mortgage interest paid to banks
15. Other interest .
16. Repairs
17. Supplies
18. Taxes - not taxes based on gross or net income
19. Utilities
20. Other (itemize):
20.
21. Total Ex enses. Add Lines 6 throu h 20. 21. 114
Part D. Net Income or loss from Rents, Rovalties. Patents, or CoPvriQhts.
LOSS LOSS LOSS
22. Net Income or loss. Sulltract Line 21 from Line 5. I D D D D D
Ilaloss,fil/inthellox. ........................ 22. 936 471
23. Total Net Rent, Royalty, Patent & Copyright Income or loss. Add the net income or loss from line 22for each property.
Enter here and on your PA-40. If a net loss, please fill in the box.
29
PART E. Depreciation Expense: Depreciation Method of I Depreciation
Classification of property and the Date Cost allowed in prior computing life expense
applicable initial from above. acquired or other basis years depreciation or rate this year
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LOSS
D
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1,407/
LOSS
D
174101 12-27.01
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A SCHEDULE A
..
TAXABLE INTEREST
STATEMENT
1
~ESCRIPTION
MELLON
IrlliLFIRST
~LFIRST - FORFEITED INTEREST
TELMARK LLC
IAGWAY INC
ILESS AMOUNT REPORTED BY ESTATE (25-6801855)
AMOUNT
1,896.00
6,092.00
<3.00>
80.00
567.00
<1,798.00>
ITOTAL TO SCHEDULE A
6,834.00
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STATEMENT(S) 1