HomeMy WebLinkAbout01-1075
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of M \4 \reI 11\ .:T C ~ rro II
also known as 'K Iq Wl.e .
No. 21-01-1075
To:
Register of Wills for the
County of tlJ~./..(1A4~Lin the
Commonwealth of Pennsylvania
Deceased.
Social Security No. B 10.. C}ro - 7 7~ 1
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/Me-18 years of age or older, applllll1j
for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritate)
the above decedent.
hey-
Decendent, then (0 Z( years of age, died
at /(OVvL So 6(..U"4 lic5/i;.~/
I' .
OCt c9Q
, ~ ~(x)i ,
Decendent at death owned property with estimated values as folllows:
(If domiciled in Pa.) All personal property
(If not 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:
$ X't./I. 6D
$
$
$
c '" 't c/e; V\ 5'
Petitioner_ after a proper search h~ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship
M\
Vor'K- S prl'llcp
THEREFORE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriate form to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
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The petitioner(s) above-named swear(s) or affirm(s) that the
statements in the foregoing petition are true and correct to the best
of the knowledge and belief of petitioner(s) and that as personal
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law. \: ;a
Sworn to or affirmed and sUbscrib.. ed J ~ g~ ~
before me this 26th day of
~. NOVEMBE~ ",,2001 11< " h ".e( 13 ,e h"" "".4 '"
.~t/y(-~~~r#~NN.r~~
. " Register V
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No. 21-01-1075
Estate of
MARCIA J CARROLL
, Deceased
GRANT OF LETTERS OF ADMINISTRATION
AND NOW NOVEMBER 26 ~:ti) 2001, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
lT IS DECREED that MICHAEL L BRENNEMAN
is/are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to
MICHAEL L BRENNEMAN
in the estate of
MARCIA J CARROLL
\?,<~/<,~/<Li?1J~r
ISter of WII s
FEES
Letters of Administration $
Short Certificates( ).......... $
Renunciation ................ $
JCP $
TOTAL _ $
FilecJN9Y... .?~. .... . .... .. .. A.D.
18.00
3.00
ATTORNEY (Sup. Ct. I.D. No.)
5.00
26.00
~2001
ADDRESS
PHONE
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H IOS.80S REV 9/86
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This is to certify that the information here given is correctly copied from an original certificate of death duly flIed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7744430
No.
21-01-1075
143 Rev. 2117
62 ./?:'" ~ 7:"-1?;f:J1--
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Local Registrar ~:Z:
ocr 2 3 ZOO1
Date
COMMONWEALTH OF PENNSYLVANIA. OEPARTMENT OF HEALTH. VITAL RECOROS
CERTIFICATE OF DEATH
NAME Of' DECEDENT (F.... _. l_,
I. MMc..ia J. CMltOU
AGE {I.... -YI UNDER 1 YEAR
MoMhe: ! Doyo
6 Y...
COUNTY Of' DEArH
UNDER I OM
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Vau h.in
DECEDENT' USUAl. ClC:C.-.oH
~"'=:__~"=':::.l:'l'
ilL WMehow,e Pac.keJt Rite-A.ide
DE<:EIlENrS__ADOAES8(S1r_~. _lip~l DECEDENT'S
ACTUAL
AE8IIlENCE
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11.. sa.
Adt1JM
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Bltenneman
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WERE AU1tlPSY F_
~PIlIOIllO"
~Of'CAUSE ~ 0
OF DEAnt1 - Homicide
-.. 0 Ponding"-tion 0
NoB' ....0 NoUY - 0 Couid......_ 0
ORE OF IHJUfIY
1_. Day._l
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CERTIl'IIIlIChock.... onot
-CERTIFYING fIHYSICIAN (Physcaen cer1lfytngcause d cInlh when anoIher physic"", has PJOI'lOUl'1C8d death ana Completed Rem 231
T.........or...,IItnowIIIcIge.....OCICUnWCI.........C8Uee(..andlftllnnerMRaiM. ....................................................
n.
ePflONOUHClHG AND CERTIFYlNQ PHYSICIAN ~ bOIh ptonounang diNIh .oo~eRtfylng 10 c.use 01 dNItIl
Tou.. bNtofm,knowteclge. "'alhoccurred.. ......... da", ancIpIace.and..........c.UM(.)arwlIm.nne'..~...........................
'IIEIIlCAL EllAMlHElIICORONER
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Tu.tE OF INJURY
INJURy R WOllK. IlESCAlllE HOW INJURY OCCUAIIEO.
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CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent:
(lfJlZt2rJLL
dO - C)eJc) I
i
/YJ II tlCJ I II
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Date of Death:
/0
Will No.
N :;1. 0/ - 107-
Admin. o. ~
To the Register:
I certify that notice of (beneficial interest) estate administration 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
Name
Address
/I\/9!) (lJ E
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except
Date:
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Signature
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Name IJJ 10 I-I-ft_ ~L ,/1-12 t:: ,v/uGIYJ!9- ;6
Address $?<iS CJ MT I Jf't) Di!b 02/Zi
~DI2K SPJ7J;{JG5, f/r 1737:1
Telephone (7/"'9 5"';;2~ - )(7 d 7
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Capacity: L Personal Representative
_Counsel for personal representative
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BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
'*
NOTICE OF INHERITANCE TAX
APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESS"ENT OF TAX
REV-1547 EX AFP (01-821
MICHAEL L BRENNEMAN
880 LATIMORE CREEK RD
YORK SPRINGS PA 17372
.02 APr~ 19
DATE
E~TATE OF
DATE OF DEATH
FILE NUMBER
fciiUitt't
ACN
04-15-2002
CARROLL
10-20-2001
21 01-1075
CUMBERLAND
101
MARCIA
J
Allount Rellitted
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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 ~
R'EV=is4j-ix-AFP-{OY:02y-ticifici--OF-YtiHiifiTANCE-TAX-A"PPRA"isiiriNT~--AL:rOWAiicE-OR------------ -- ---
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF CARROLL MARCIA J FILE NO. 21 01-1075 ACN 101 DATE 04-15-2002
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Stock/Partnership Interest (Schedule C) (3)
4. "ortgages/Notes Receivable (Schedule D) (4)
5. Cash/Bank Deposits/"isc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
8. Total Assets
. 00 NOTE: To insure proper
.00 credit to your account,
. 0 0 sublli t the upper portion
. 00 of this forll with your
. 0 0 tax payment.
.00
.00
(8) .00
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/"isc. Expenses (Schedule H) (9)
10. Debts/"ortgage Liabilities/Liens (Schedule I) (10)
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
.00
.00
(11)
(12)
(13)
(14)
00
.00
.00
.00
I~ an assessment was issued previously, lines 14, IS and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
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 DITS:
NOTE:
.00
.00
.00
.00
X 00 =
X 045 =
X 12 =
X 15 =
(19)=
.00
.00
.00
.00
.00
DATE
NU"BER
+
INTEREST/PEN PAID (-)
A"OUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
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.)
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STATUS REPORT UNDER RULE 6.12
D:K
Name of Decedent: M V-:I r-c I'A :r (!'AYv() I \
Date of Death: /0 (,)() ,/dOO )
Will No.: ,;) j-CJ.OO 1- /07S
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 ~ther administration of the estate is complete:
Yes IYl 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 representative file a final account with the Court?
Yes _ No g
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal ~sentative state an account informally to the parties
in interest? Yes W 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: J/l.:;/03
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Signature
f'...
Vh\c.h~'t\ L- t3 rChY\ e YJ,{ 14 vt
Name
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<(to Rof/rkO re
Address
(!r-ee/L 12d. yorK SpflVlCf5
/7371-
(7/7) Sd r- <it?J.!
Telephone No.
Capacity: ~rsonal Representative
o Counsel for personal representative
REV-1500 EX if 110',
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
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FILE NUMBER
~L-..o.L
COUNTY CODE YEAR
_4
INHERITANCE TAX RETURN
RESIDENT DECEDENT
..1.Q..~6.._
NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
ffJ
7 7 ,') I
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NAME
FIRM NAME (If Applicable)
TELEPHONE NUMBER
I-
Z
W
C
W
o
W
C
DATE OF DEATH (MM-DD-YEAR)
SOCIAL SECURITY NUMBER
;;'/0 -:A
-
....J
DATE OF BIRTH (MM-DD-YEAR)
THIS RETURN MUST BE FilED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
/D- 0--0/ 9
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, FIRST. AND MIDDLE INITIAL)
33
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7, Decedent Maintained a Living Trust (Attach copy oITrust)
o 10. Spousal Poverty Credit (dale of dealh between 12-31-91 and 1-1.95)
03, Remainder Return (date of death prior to 12-13.82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec, 9113(A) (Attach Sch 0)
o 1. Original Return
D 4. limited Estate
D 6. Decedent Died Testate (Mach copy of Will)
D 9. litigation Proceeds Received
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)
Z (Schedule E)
0 6. Jointly Owned Property (Schedule F) (6)
~ D Separate Billing Requested
...J (7)
::::l 7 Inter-Vivos Transfers & Miscellaneous Non-Probate Property
!::: (Schedule G or L)
a..
<I: 8. Total Gross Assets (tolal Lines 1-7)
0 9 Funeral Expenses & Administrative Costs (Schedule H) (9)
W
D:: (10)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11, Total Deductions (tala I 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 10 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 15. Amount of Line 14 taxable al the spousal lax
0
!;( rale, or transfers under Sec. 9116 (a)(1.2)
I- 16. Amount of Line 14 taxable at lineal rate
::::l
0.. 17. Amount of Line 14 taxable at sibling rate
::E
0 18. Amount of Line 14 taxable at collateral rale
0
X 19. Tax Due
~ 0
20
COMPLETE MAILING ADDRESS
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r--''JOFFIClhi'uSE ONLY
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(12) c:)
(13) 0
(14) D
x.O_ (15)
x.O_ (16)
x 12 (17)
x 15 (18)
(19) ('J
--
CITY G ZIP/737
Tax Payments and Credits: >5f1-t=: LH'E]) W/T!+ HER. SD;0 -i-;])fltJ6t1Tt:-JItJ-Ll/0
1. Tax Due (Page 1Llne 19) SHE HI'JV /IJ9-Jtl~';;LbJtlS (1) ()
2. Credits/Payments E ~TS I SO'" I II,.., ,.;/1r / I"k> /)
A. Spousal Poverty Credit '-<V ~ "&- 7 K.::J f7'J'--'
B. Prior Payments tV /]) Dw E ]) .51 iI.X!-E 19 g A.
C. Discount
Decedent's Complete Address:
STREET ADDRESS
Total Credits (A + B + C ) (2)
3. InteresVPenalty if applicable
D. Interest
E. Penalty
TotallnteresVPenalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
l)
2J
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()
C)
Make Check Payable to: REGISTER OF WILLS, AGENT
_II" ~Jlmflllr -~" 1ii1l1ilI1I1IIJlUJ.III. ~"'~A 1 . [ "IImlllllll'." II - I fW' 111till' Ii III! ]llll~$!ni lIlllm'"
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and:
a. retain the use or income of the property transferred;..
b. retain the right to designate who shall use the property transferred or its income;.. ..............
c. retain a reversionary interest; or............ ............. .
d. receive the promise for life of either payments, benefits or care?.
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .. ............. .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . .
Yes
....0
....0
.....0
.......0
...0
...0
o
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~
EY
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of pe~ury, I declare thai I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct
and complete
Declaration 01 preparer olher than the personal representative is based on all information 01 which preparer has any knowledge.
."
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
ADDRESS
_. ~~lilllJl1lill!iL_.!i!!l'lElillI.LAn .1__;~Jj!f_~
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after Juiy 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV.'~':''''n _~.
~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
I
FILE NUMBER
ESTATE OF
L
...j,
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sUlVivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
/1)OJUE
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV.151OEX.(1.97l.".
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. '-,'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
QIf ttRjJ LL
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
IV1 fl !2 (2/ fJ
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
.:;r,
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDETHENAMEOFTHETRANSFEREE_~CiEIRREl.Ai'::',HPTOOECEDENTANDTHE DATE OF TRANSFER DATE OF DEA TH DECO'S EXCLUSION TAXABLE VALU
ATTACH A COPY OFTi-IE CEE: '"OR REAL ESTATE VALUE OF ASSET iF APPLICABLE)
NUMBER INTEREST
1. fiJOIUE
TOTAL (Also enter on line 7, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99)
, . -&tJ-
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
I
FILE NUMBER
ESTATE OF
CA 12.-'2_ () L 1...
m If /2.. Qj 17
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. SDN of- J)AUGHTER- /IU.:.. 1../1 tV 0-0
p~ /1) r::-o/2
B ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions tTO
Name of Personal Representative(s)
Social Security Number(s)/EJN Number of Personal Representative(s)
Street Address
City ----------"_______________________ State ____ Zip
Year(s) Commission Paid"
2. Attorney Fees crD
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State ____ Zip
Relationship 01 Claimant to Decedent
4. Probate Fees C70
5. Accountant's Fees ~
6. Tax Return Preparer's Fees o-D
7.
TOTAL (Also enter on line 9, Recapitulation) $ ()
Debts of decedent must be reported on Schedule I.
~r
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00) .
....
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
NUMBER
I
FILE NUMBER
-::T.
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do NOI List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 la) 11.2)]
AMOUNT OR SHARE
OF ESTATE
1.
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
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B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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TOTAL OF PART" - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)