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REV.'S::lO-&_;~5) FILE NUMBER
, , '* INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYlVANIA (TO BE FILED IN DUPLICATE 2178254
DEPARTMENT OF REVENUE
POST OFFICE 80X 8327 WITH REGISTER OF WILLS)
HARRIS8URG, PA 17105.8327
DECEDENT'S NAME (LAST, FIRST. AND MIDDLE INITIALI DECECbNT'S COMPLETE ADDRESS
... 6 Meadow Drive
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w Grab, Robert W. Jr. Camp Hill, PA
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w SOCIAL SECURITY NUM8ER DATE OF DEATH Cumberland
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w 229-04-6679 10-23-77
0 County
W 1291. 03.
... Original Return 0 2. Supplemental Return Remainder Return
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uo::lIe 04. Limited Estate 040. Future Interest Compromise 05. Federal Estate Tax
wQ.u
:cOO Return Required
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Q.lQ 06. Decedent Died Testate 0 7. Decedent Maintained a Living Trust _8. Total Number of Safe Deposit Boxes
Q.
c( (Allach copy of Will) (Allach copy of Trust)
ALL CORRESPONDENCr: AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
I ... NAME COMPLETE MAILING ADDRESS
"'z Fields,
w.., L.M. Esq. 831 Market Street
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o::z TELEPHONE NUMBER P.O. Box 222
00 --
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uQ. ) Lemoyne, PA 17043
( 717 761-2121 -' ,
1. Real Estate (Schedule A) ( I)
2. Stocks and Bonds (Schedule B) ( 2)
3. Closely Held Stock/Partnership Interest (Schedule q ( 3)
4. Mortgages and Notes Receivable (Schedule D) ( 4)
5. Cash, Bank Deposits & Miscellaneous Personal Property( 5) 15,000.00
(Schedule E) .
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0 6. Jointly Owned Property (Schedule F) ( 6)
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:5 7. Transfers (Schedule G) (Schedule L) ( 7)
:) 8. Total Gross Assets (total lines 1-7) ( 8) 15.000.00
...
a: 4.409.48
c( 9. Funeral EXEenses, Administrative Cosls, Miscellaneous ( 9)
u Expenses ( chedule H)
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10. Debts, Mortgage Liabilities, Liens (Schedule I) (10)
11. Total Deductions (total lines 9 & 10) (11) 4,409.48
12. Net Value of Estate (line 8 minus line 11) (12) 10.590.52
13. Charitable and Governmental Bequests (Schedule J) (13)
U. Net Value Subject to Tax (line 12 minus line 13) (1.4) 10.590.52
15. Amount of line -14 taxable at 6% rate (15) 10,590.52 X .06 = 635.43
(Include values from Scliedule K or Schedule M.)
16. Amount of line 14 taxable at 15% rate (16) X .15 =
z (Include values from Schedule K or Schedule M.)
0 17. Principal tax due (Add tax from line 15 and from line 16.) (17) 635.43
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:! 18. Credits Prior Payments Discount Interest
:) + - (18)
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~ 19. If line 18 is greater than line 17, enter the difference on line 19. This is the OVERPAYMENT. (19)
0
u A. 0 Check here If you are reque.tlng a refund of your overpayment.
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:! 20. If line 17 is greater than line 18, enter the difference on line 20. This is the TAX DUE. (20) 635.43
A. Enter the interest on the balance due on line .lOA. (20A)
B. Enter the total of line 20 and 20A on line 20B. This is the BALANCE DUE. (20B)
Make Check Payable to: Register of WlI1s, Agent
... ... BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH" ..
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it :s 'rot!. '::::!~ -md '::::!mtl~e''''' <:I..dar.. 'hat .,11 "!<II '!state I,as been r'!oorted at 'roe market value. Declaration of preparer other than the personal representa'ive
is
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A1J1JRE:>~
ADDRESS
630 Lowther Road, Lewisberry, PA
1J~
~I/.p Iff-
DATE
/6 -/~o-7
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (V') IN THE
APPROPRIATE BLOCKS.
c. retain a reversionary interest or ....................................................................
YES NO
X
X
X
X
X
v
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,
d. receive the pro~is~ for life of either payments, benefits or care? .......................
2. If death occurred on <;?r before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? 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' bank account at his or her death?......................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE 11 AS PART OF THE RETURN.
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Robert W. Grab, Jr.
Supplement to PA
Inheritance Tax Return
Line 20A
Although this return is being filed after nine months from the
date of death, interest is not payable on the balance of $635.43
because the decedent's only asset was realized on March 4, 1986.
The decendent had no assets on the date of death.
1_
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SCHEDULE "E"
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
I Please Print or Type
FILE NUMBER
21-78-254
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.ATE OF
Grab, Robert W. Jr.
(All property jointly-owned with the Right 01 Survivorship must be disclosed on Schedule "F")
ITEM
NUMBER
DESCRIPTION
VALUE AT
DA TE OF DEATH
1.
Cash
15,000.00
(This amount, $15,000.00, was paid to the estate March 4,
1986, by State Farm Insurance as a settlement in litigation
of a wage loss claim).
TOT At (Also enter on line 5, Recapitularion) $L 5,000.00
(Attach additional 8Y." )( II" sheels if more space is needed.)
.
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SCHEDULE "H"
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Please Print or Type
..fATE OF
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Grab, Robert W. Jr.
FILE NUMBER
21-78-254
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
Funeral Expenses:
1.
Jack W. Richardson, Funeral Director
1,809.48
B.
Administrative Costs:
1.
Personal Representative Commissions
Social Security Number of Personal Representative:
Year Commissions paid
2. Attorney Fees
Kallas, Costopoulos & Foster, Attorneys
Family Exemption
2,300.00
3.
Claimant
Relationship
Address of Claimant at decedent's death
Street Address
City
State
Zip Code
4.
Probate Fees
C.
Miscellaneous Expenses:
1.
Harrada & Wilcox, Public Accountants
300.00
TOTAL (Also enter on line 9, Recapitulation)
$4 409.48
(II more .pace I. needed, In.ert addltlonal.hee" of .ame .In)
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fiE:~Al TH OF PENNSYLVANIA
,~ERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE "J"
BENEFICIARIES
,TE OF
Grab, Robert W. Jr.
FILE NUMBER
21-78-254
ITEM AMOUNT OR
NUMBER NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP SHARE OF ESTATE
A. Taxable Bequests:
1.
Frances M. Brown Mother 9,955.09
500 South 26th Street
Arlington, VA 22206
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ITEM
NUMBER
NAME AND ADDRESS OF BENEFICIARY
AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests
1.
IIf more spece Is needed Insert eddltlone. sheets of 18me llze)
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) $