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HomeMy WebLinkAbout02-0680 F) --:J {; '\- BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE *' NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTION~, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS REV-l~48 EX iF!' (ol~02) ,) DATE 07-29-2002 ESTATE OF LUCKENBAUGH ROBERT DATE OF DEATH 03-19-2001 ~ *' FILE NUMBER .:JI-D.:J. - eftS (tJ COUNTY CUMBERLAND SSN/DC 177-16-0405 ACN 01138698 Allount Remitted W RUTH APT 103 208 SENATE CAMP HILL L LUCKENBAUGH AVE P~\7011 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 ... RE-Y=iS4-i-ix--AFP--fol-=02j------------------------------------------------------------------------------------ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 07-29-2002 ESTATE OF LUCKENBAUGH ROBERT W DATE OF DEATH 03-19-2001 COUNTY CUMBERLAND FILE NO. S.S/D.C. NO. 177-16-0405 TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED JOINT OR TRUST ASSET INFORMATION ACN 01138698 FINANCIAL INSTITUTION, ALLFIRST BANK ACCOUNT NO. 0056506996 TYPE OF ACCOUNT, DATE ESTABLISHED ( ) SAVINGS (Xl CHECKING ( ) TRUST ( ) TIME CERTIFICATE 08-28-1978 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due X 1, 773.49 0.500 886.75 .00 886.75 .15 133.01 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE TO: "REGISTER OF WILLS, AGENT." X TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) INTEREST IS CHARGED THROUGH 08-06-2002 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 133.01 REVERSE SIDE OF THIS FORM INTEREST AND PEN. 5.15 TOTAL DUE 138 . 16 . IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. . [ IF TOTAL DUE IS LESS THAN $1, NO PAVHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ( CRI, YOU MAV BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. I °~,'~ ~ 1505610101 -1 goo ~ co~_so, PA Department of Revenue 0lMRTMENT OF plV81NIE Bureau of Individual Taxes INHERITANCE TAX RETtlRN PO BOk a8o6o1 RES#DENT DECEDENT Harrlsburo. PA 17128-0601 ENTER DECEDENT MIRMATION BELOW Social Security Number Date of Death MMDDYYYY d~ 3 tQ o~ Deced®r~t's Last Mme Suffix ~: '"' {If A,ppliicable) Enbr Bunrlving Spouse's Information Below Spouse`s Last Name Suffix OFFICU-L USE ONLY County Code Year File Number Date Qf Birth MMDDYYYY L d ~ d Decedeaht's First Name Ml f1 ~ ~'" Spouse's First Name Ml Spouse s Social Security Num r THIS RETURN MUST BE FILED IN' DURUCATE WITH THE REGIST C W~I.LS FILL IN APPROPRIATE OPALS BELOW ~ 1. Original Rectum O 2. Supplemental Retum O 3. Remainder Re1um (date of death prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Re#um Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes {Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THEE SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENT!IAL TAX INfOICIIiiPETION SHOULI}' B£ DIRECTED T0: Name D~ytiri^>Ie 'T~ephone (Number S ~ ~ a Correspondent's e-mail address: Under penattiaes of perjury, I dedare that I have examined this return, inducting accompanying schedules and statements, and to the best of my knowledge and belie), it is true, correct and cx~mplete. Declaration of preparer other than the personal representative is based oh all information of which preper8r has any knowledge. SI~GIV~ TORE OF PER N RE~~PONSIBLE FOR FILING RETURN / DATE SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEA8E 118E OR161NAL FORM ONLY Side 1 1505610101 1505610101 J REV 1500 EX Decedent's Name: RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Closely Held Corporation., Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal. Property (Schedule E)....... 5. 6. Jointly Owned Property (Sc~dule F) O Separate Bluing Requested ....... t ' 6. 7. In er-V rvos Transfers ~ Miscellaneous Non-Probais Property. (Schedule G) p Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ........... ................ 8. ~.. 9. Funeral Expenses and Administrative Costs (Schedule H) ............:...... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule 1) .............. 10. 11. Total Deductions (total Lines 9 and 10) ................................. 11. 12. 13 Net Value of Estate (Line 8 .minus Line 11) .............................. Ch 12. . aritable and Governmental $equests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~M ve1LV Yi.r\1 ~VI~ - ~7GG 11~~7I RV\+ I IVI~~ rVR A~'PLfl.A6LC KA{ C5 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 ~ 16, 17. Amount of Line 14 taxable at sibling rate X .12 17, 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE ................................................. ........19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 1505610105 Decedent's Social Security Number O Side 2 1545610105 1505610105 REV 1500 EX Page 3 C~ecedent's ComQiete Address: File Number DE s NAME tt .. '' W. tom. Gf..~, ~.. ~-. ~ ~ STREET ADDRESS ~~ ~~ ~ ~ ~ ~~ ~ CITY STATE ZtP Tax Rayments ar~d Credits: 1, Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments B. Discount 3. Interest 4. ff Line 2 is greater than Line 1 + Line 3, enter the dim. This is the OVElZP/1Y11~NT. F~ Irt oral on Page Z, L.Me 20 to roqueat a refu~ld. 5. g Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX iDUE. (1} Toth Credits (A + B) (2) (3) (4) (5} Make check payable to: REGISTER QF WIL~.S, AGENT. PLEASE ANSWER THE FOLLOWING QUESTItNtS BY PLACING AN "x" IN THE APPROPRIATE BLACKS 1. Did decedent matte a transfer and: Yes No a. retain the use or incorr~ of the property transferred :.......................................................................................... ^ b. retain the right to designate wtm sha11 use the pn~perty transferred or its income : ............................................ ^ c. retain a reversionary interest; ar .......................................................................................................................... ^ d. receive the pnxnise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after Dec. 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 ar her death? .............. ^ 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ........................................................................................................................ ^ ~] fF THE AN~-1lI~R TO AHY ~ TIME ABOVE QUESTI~IS IS YES. YOU. MUST COMF"LETE For dates of death on or after July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net valve of transfers to or for the use of the surviving 3 percent (72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use. of the surviving spouse is 0 percent [72 P.S. §9116 (a} (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assists and filing a tax return an: still applicable even if the surviving spouse is tale only benefiaary. For dates of death on or after July 1, 2000: • The tax rate imposed on ttte net value of transfers from a ceased child 21 years of age or younger at death to or for the use of a natural partent, an adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefiaaries is 4.5 percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a}(1)]. • The tax rate imposed on the net value of transfers to or for the use~of the decedents siblir~s is 12 percent [72 P.S: §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, wt~ther by blood or adoption. REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA ~~ ~~A~ INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Ail real property owned eoleiy or as a tenant In common must bs n~orted ~ falr market v~ue. Fair market value is defined as the price at which property would Abe SIT more space IS n8e4AQ, fr~@R aa0iti0na18h6et8 Of the Same eiZA) ', REV-1503 EX+ (&98) ~~~~~~~ COMMONWEALTH OF PENNSYLVANIA ~~~~ & ~~~~~ ~ , INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NtNABER All oro©ertt- -owned whit right of sutvitrorshlp. must be disdaaed on ~c;he~e F. (If move space is needed, insert addt~oned sheets of the same size) REV-1504 EX+ (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEI~~LE C c~oS~~~r-H~~- c-tv, PaR~ERSr SOtE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for so{e•proprietorships. (If more space is needed, insert additional sheets of the same size) REV-1505 EX+ (6-98) ~~~~~~ ~- COMMONWEALTH Of PENNSYLVANIA ~~~~~~~-~~~ ~~~~ INHERITANCE TAX RETURN ~TC~CK INFORMATION REPOT RESIDENT DECEDENT ESTATE OF FILE NtIµBER 1. Name of Corporation State on Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Employer 1.D. Number Business Reporting Year " 3. Type of Business Product/Service 4. 8'tt~ ~ ~ ` ~ ~~ Common $ Preferred $ Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? ................................. ^ Yes ^ No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ................................... ^ Yes ^ No If yes, provide amount of indebtedness $ 7. Was there life insurance payable to the corporation upon the death of the decedent? ..... ^ Yes If yes, Cash Surrender Value $ Net proceeds payable $ _ Owner of the policy 8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to t2-31-82? ^ Yes ^ No if yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedents stock sold? ..................................................... ^ Yes ^ No If yes, provide a campy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? .................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 oar C-2 for each interest. A. Detailed calculations used in the valuation of the decedents stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete addresses and estimated fair market valuels. ff real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. ^ No (lf more space is needed, insert additional sheets of the same-size) REV-1506 EX+ (9-00) COMI~NWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF 1. Name of Partnership Address City 2. Federal Employer I.D. Number _ 3. Type of Business Date Business Commenced Business Reporting Year State Zip Code 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ................................. ^ Yes ^ No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes ^ No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9 Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedents death? ...... ^ Yes ^ No If yes, provide a copy of the agreement. 11. Was the decedents partnership interest sold? ....................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedents death? ................ .. ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .................................... ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed cakxalations used in the valuation of the decedents partnership interest. B. Complete copies of financial statemerrts or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete addressJes and estimated fair market valueJs. If real estate appraisals have been secured, attach copies. FILE P~RTfi~I~lP 11VFORMATION Rf PORT ProductlService D. Any other information relating to the valuation of the decedents partners interest. REV-1507 EX+ (1-97) scr~E~-u« o COMMONWEALTH OF PENNSYLVANIA MORTCsAGE~ & ~IE)TES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER All property }ointiy-owned with right of survivorship must be disclosed on Schedule F. (if more space is needed, insert additional sheets of the same size) REY-1508 EX ~ (7-07) SCHEDt~LE E COMMONWEALTH of PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX R ~~RN PERSONAL PROPERTY ESTATE OF FILE tAIMBER Indude the proceeds of litigation and the date the pmc~eds were received by the estate. All property joindy~awne~ with the right of sum nwst be dlscbsed on Schedule F. ITEM VALUE AT ATE NUMBER DESCRIPTION OF DEATIH TOTAL (Also enter ~ line 5, Rec~itulation) I Z (If more space is needed, insert additional sheets of the satrre size) REV•1509IX • t1~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF JOINTLY-OWNED PROPERTY IAIN~ER Han asst was mute joiet ts> one year of lla decedent's date of death, it mwt bs reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. B. C. JOINTLY-0WNED PROPERTY: RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Inckide name of financial institution and bank acxount number a similar identifying number. Attach d~ for I~Y-~ ~ ~~, ~ DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE pF DEATH VALUE OF DECEDENl~'S INTEREST 1. A. TOTAL (Also enter on line 6, Rec~rtulation) ~ ; (If more space is needed, insert additional sheets of the same size) REV-1510 EX * (197) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS ~ DISC. NON~PROB~4TE pI~~I~ERT~' FILE NUINBER This schedule must be completed and filed if the answer ~ any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER __ DESCR~TIC~1 OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, TNEIR REUTIONSFNP TO DECEDENT AND THE DATE of TRANSFER. arracH a coPr OF T}IE DEED FoR REAL ESTATE . DATE OF DEATH VALUE OF A ET ~ pF DECD'S INTERS T EXCLUSION iF aPPUCaeLe TAXABLE VALUE 1. TOTAL (Also enter on line 7, Recapitulatia~) _ (If more spave is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~r w FI~NERAL Ex~r ADMINISTRATIVE COSTS FILE IVtJMBER Debts of decedent must be n~ported on ScFmdule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip 2. Attorney Fees 3. Fami{y Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address 4. 5. 6, 7. City State _ Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Zip TOTAL (Also enter on line 9, Recapitulation) I $ (lf more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ~CNi~L11LE 1 DEB'S Of: DECEt3ENT, MORTGAGE LIABILITIES, & IJENS ESTATE OF FILE NUMBER Reuort debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (if more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) ~1~11Q~ J COMMONWEALTH OF PENNSYLVANIA BENEFiCIAi~IES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Doi Not Llst Trustss(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV».1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same sire) REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT :~NEOVLE K UFE .ESTATE, A~Nt~t~ITY & TE~t1111 C~~I~~~V heck Box 4 on REV-1500 Cover Shea ESTATE OF FILE NUMBER This schedule is to be used for all. single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Alpph Volume #or dates of death from 5-1-99 and thereafter. Indicate the type of instrument which. created the future interest below and attach a copy to the tax retum. ^ Wili ^ Intervivos Deed of Trust ^ Other ,, _= t~°~~~ dA~~'44 t» `'N ~ l;~ ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term. of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ..........................................$ 2. Actuarial factor per appropriate table ................................................ . Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 3. Value of life esta#e (Line 1 multiplied by Line 2) ......................................$ a ,~ ,. :... . ,. _, .~.. k _ . tlll~ ~~~ , ~. .. ,: ... ~ ~~ . ., ~; : ~, Y ~ , ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ............................................$ 2. Check appropriate block below and enter corresponding (number) ......................... . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1/2% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (see instructions) ................................................. . 7. Value of annuity - If using 31/2%, 6%, 10%, or if variable rate and period payout is at .end of period, calculation is: Line 4 x Line 5 x Line 6 ..........................$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) . , ITV 1644 EX + (3-04) COMMONWEALTH OF PENNSYWANIA iNH~RRANCE TAJC RETURN REStOENT DECEDENT I. I ESTATE OF IN~R~tANCE ~~~ L RF.rMA~N~EI~~ RR-EPAYM~NT ~~~~~~~ FILE. NUMQ9R I i~.ast one) (First Name) _ (R~dN- Iti) This schedule Is appropriate only fc~r estates of decedents dying'on or before [~ec~srnber 1~, 1982. This schedule is to be used for all remainder retumswhen an election to prepay has been flied under the provisions of _3ection ?14 ~ tha trtt~erit~nCe and Es#~e Ta~c Act of 1961 or to report the ~vssion of trust principal. II. REMAINdER PftEP~-NT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on date Term of years inoorne or Armuitan#(s) of election or annuity is payable C. Assets: Compl~e Schedule L-1 1. Real Estate ...............................$ 2. Stocks and Bonds ..........................$ 3. Closely Held Stock/Partnership ...............$ 4. Mortgages and Notes .......................$ 5. Cash/Misc. Personal Property ...............$ 6. Total from Schedule L-1 ..................................................... .$ D. Creditss: Complete Schedule L-2 1. Unpaid Liabilities ...........................$ 2. Unpaid Bequests ...........................$ 3. Value of Unirrcludable Assets .................$ 4. Total from Schedule L-2 ...................................................... $ . E. Total Value of trust assets (Line C-6 minus Line D-4) ................................. $ F. Remainder factor (see Table I or Table tl in Instruction Booklet) ........................ . G. Taxable Remainder value (Line E x Line F) ......................................... $ . (Also enter on Line 7, RecapitWation) ~, INVASION OF CORPUS: A. Invasion of corpus (Month, Day, Year) B. Narrw(s~ of Life Tenant(s) Date of Birth Age on date or Annurtant(s) Tenn of years. income corpus or annuity is payatNe consumed C. Corpus consumed ............................................................ $ D. Remainder factor (sae Table I or Table II in Instruction Booklet) ........................ . E. Taxable value of corpus consumed (Line C x Llne D) ................................. $ (Also enter on Line 7, Redapituiation) R:FV-aas ~x+ n.esi INHERITANICE TAX SCIMiEDULE L-1 coww~lTH ~ ~FNNSYIVANiA INHERlTANG'E TA1f RlTURN REMA~l~IQER P~R~PAYMfifT ELECTItiN RESIDENT tlLCEOENT -ASS~- FILE NUMBER (lost Nonce) (1~1fst Nonw) (Middy Initivl) It. i#Nn No. Deitcri ..ion Va#w- A. Rsat Estate (purse describe) Totol vesiue of reel t~stote $ terclade: ext Section ti, litre C-1 an Schsduls B. Stocks and Bonds (pleoss list) Testol value esf stock: and bonds $ tnducle on Stchofl 11, line C-2 FNI Schedule L C. Cletsely Held Stock/Portnersh~ (ottQth Schedule C-1 and/or G2j (pieose het) Toro! value of Cle::ei~r l~leki/P'artes~hip S tndue~e on Seexiem ti, line C-3 a-n gchedrrls L D. Mortgages and Notes (please list) Te~tol wcrhrs e~ o+rd Nobs ~ $ indve~r on Sae#iQn It, l~ C-4 on " dindahe ly E. Cosh e~u+d MisceHonewus 'P~rsonai Property (please list Tenon veshie o Cush/Misc. Pis. Pr ~~pp ~ indvd• ott Sections 11, Lies C-5 em~S+ dMdule itl. T~'AI. (Also enter on Section li, Uns C-6 on Sd~sdule L $ (If mgrs :pace is needed, attach odditione~i 83+4 x 11 sheNs.) REV-1646 EX+ (3-84 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT INHERITA~IVCE TAX SCHEDULE L-2 REMAINDER PREPAYMENT ELECTION -CREDITS- FILE NUMBER I. Estates of (lost Nome) (First Nome) (Middle Initial) II. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities $ include on Section II, Line D-1 on Schedule L) B. Unpaid Bequests payable from assets reported on Schedule L-1 (please list) Total unpaid bequests $ (include on Section II, Line D-2 on Schedule L C. Volue of assets reported on Schedule L-1 (other than unpaid bequests listed under "B" above) that are not included for tax purposes or that do not form a part of the trust. Computation as follows: Total unincludable assets $ (include on Section II, Line D-3 on Schedule L 111. TOTAL Also enter on Section II, Line D-4 on Schedule L $ (If more space is needed, attach additional 8%z x 11 sheets.) REV-1647 EX+ (9-00) SCNEpi~lLE M FUTURE INTEREST CC)hARROMISE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT (Check Box 4a on Rev-1500 Cover She9t) ESTATE OF FILE NUIIABEA This Schedu~ is appropriate only for estates of decedents dying after December 12,1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Wili ^ Trust ^ Other I. Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within i ving spouse 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surv exercises such withdrawal right. ^ Unlimited right of withdrawal ^ Limited right of withdrawal III. Explanation of Compromise Offer: N. Summary of Compromise tiller: 1. Amount of Future Interest .........................................................$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ......$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ~ 69'0, ^ 3%, ^ 0% ......................$ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One ^ 6%, ^ 4.5% ...........................$ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ......$ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$ (If more space is needed, insert additional sheets of the san7e s~zel REV-1648 EX (11-ss) SCHEDULE N ' SPOUSAL POVERTY CRED-tT COMMONWEALTH OF PENNSYLVANIA (AVAILABLE FOR DATES OF DEATH 01Io011'92 TO i?J31/94) INHERITANCE TAX QIYISl~ON__ ESTATE OF FlLE NUMBER This schedule must be completed and filed if you checked the spousal pover~y credit box on the cover sheet.. 1 . Taxable Assets total from line 8 (cover sheet) ............................................ 1 2. insurance Proceeds on Life of pecedent ................................................ 2. 3. Retirement Benefits ................................................................ 3. 4. Joint Assets with Spouse ............................................................ 4. 5. PA Lottery Winnings ............................................................... 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6b. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ........................................................ 6. 7. Total Gross Assets (Add lines 1 thru 6) ................................................. 7. 8. Total Actual Liabilities .............................................................. 8. 9. Net Value of Estate (Subtract line 8 from line 7) ...... .... .. ............. ........... 9. If lute 9 ~ ~AO.f10tf - STtP. 71tt saetaile is r-af el~ble to claim the cnac~ N n~ ~ ' . ~q Part ll. Income: Spouse .......... a 1. 1a. TA7~ Y AR: 18 . b. Decedent ......... 1 b. c. Joint ............ 1 c. d. Tax Exempt Income .. 1 d. e Other Income not listed above ....... 1 e. f. Total 1 f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: + (3f) _ (+ 3) 4b. Average Joint Exemption Income ..................................................... if /tr,n er~,~.i: r th~r~ ~L? ~EIO - STEP.. The estate is ~tOt elialble to dairy tltA,c, 11 11~~ _~... 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ..................... 1. 2. Multiply by credit percentage (see instructions) .......................................... 2. 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet . .............................. 3. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ............................................................ 4• 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit .include this figure in the calculation of total credits on line 18 of the cover sheet....... 5• i 2c. 2f. REV-1648 EX (11-99) SCHEDULE N SPOUSAL PO~/ERTY CREDIT COMMONWEALTH OF PENNSYLVANIA {AVAILABLE FOR DATES OF DEATH 01I~011'92 T01?l31/94) ESTATE OF FlLE NUMBER This schedule must be com eted and filed if ou checked the ~ sheet. pl y spousal pove credit box on the cover 1 . Taxable Assets total from line 8 (cover sheet) ............................................ ~ 1 2. Insurance Proceeds on Life of Decedent ................................................ 2. 3. Retirement Benefits ................................................................ 3. 4. Joint Assets with Spouse ...........:................................................ 4. 5. PA Lottery Winnings ............................................................... 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6b. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, d) ........................................................ 6. 7. Total Gross Assets (Add lines 1 thru 6) ................................................. 7. 8. Total Actual Liabilities .............................................................. 8. 9. Net Value of Estate (Subtract line 8 from line 7) ........................ ................. 9. K ftne 9 fs tt~ ~IEtD, 4aD • 8't'OP 71fe esfst8 is not elle tq darns the N t>o~ con~Mre ~ Part 11. Income: 1. T X Y ~ AR: 19 a. Spouse .......... 1a. b. Decedent ......... 1 b. c. Joint ............ 1 c. d. Tax Exempt Income .. 1d. e Other Income not listed above ....... 1 e. f. Total 1 f. 4. Average Joint Exemption Income Calculation 4a. Add Joint Exemption Income from above: (1 f) + (2f) _ + (3f) (+ 3l 4b. Average Joint Exemption Income ..................................................... _ If I~ d1h11~ c ~ ~ rm _ !~'rAa r~ ~~~ :Q ...~.~ ~;..;~ s., „~~;... sae ...,s.~s ~ .,,,. ,.,...W_..._ .., o_i 1. Insert amount of taxable transfers to spouse or $100,000, whichever is less ..................... I 1 2. Multiply by credit percentage (see instructions) .......................................... 2. 3. This is the amount of the Resic~nt Spousal Poverty Credit. Include this figure in the calculation of total credits on line 18 of the cover sheet . .............................. 3. 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ............................................................ 4. 5. Multiply line 3 by line 4 and enter the total here. This is the amount of the Nonresident Spousal Poverty Credit .Include this figure irr the calculation of total credits on line 18 of the cover sheeet....... 5• 2b. 2c. 2f. REV•1649 EX ~ (t-0~ ~ ~ • COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE 0 ELECTION UNDER SEC. 9'~1~(A) FILE Do not complete this schedule unless the estate is making the electlon to tax assets under Se~ion 91 f 3~A) of the Mheritance 8 Esfiate Tax Acct. If the election applies to more than one trust or similar arrangement, a separate form must be filed for peach trust. This election applies to the _ Trust (marital, residua! A, B, By-pass, Unified Credit, etc.). If a trust or similar arrangement meets the requi~+em~ts of Section 9113(A), and: a. The trust or similar arrangement is listed on Schedule 0, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal representative may spedfically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equaal to the amount of the trust or similar arrangement included as a taxable asset on Schedule 0. The denominator ins equal to the total value of the trust or similar arran ~ment. PART A: Enter the description and value of all interests, both #axable and non-taxable, regardless of location, which pass to the decedent's (If more space is needed, insert additional sheets of the game size) -' ~ 1 INHERI TANCE TAX i ~ RORD ADJUSTMENT Van n~ ~ r.~.,`.-.~r~i r'~-. f~:HELD ~` ' ~ ~ E ''` DR TRUST ASSETS DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES ~ ,~M,. ~ -•=~ ~ i > t 1 *~ r ` ' REV-1604 EX AFP C12-09) INHERITANCE TAX DIVISION t : ,; ,-,.~~ . ~r~ ~! -t,-'J ~ ' l Po iox isi~ol Lk l ,~ of tl.,, ~ ~ HARRISiURB PA 17128-0601 ~~~~ `~~~'"' ~6 P~ ~r ~~ ESTATE OF LUCKENBAUGH ROBERT W AT 03 19-2001 CLE~'r~ ~~V©T pRPH~~ S ~ 4l RUTH L LUCKEN~~~~~~ >~`~~~~ r~•~ P1~.., 810 PENNSYLVANIA AVE LEMOYNE PA 17043 DATE OF DE H FILE NUMBER 70 0296423 a~ _.~ -~~ COUNTY CUMBERLAND SSN/DC 177-16-0405 ACN 01138698 Amount Ra~aittod MAKE CHECK PAYABLE AND REMIT PAYMENT TOs REGISTER OF WILLS 1 COURTHOUSE SQUARE CARLISLE PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS !~ REV-1604 EX AFP C12-09) ** INHERITANCE TAX RECORD ADJUSTMENT JOINTLY HELD OR TRUST ASSETS ~* DATES 06-18-2010 ESTATE OF: LUCKENBAUGH ROBERT W DATE OF DEATH: 03-19-2001 COUNTY: CUMBERLJ4ND FILE NO.: 70 0296423 S.S/D.C. N0.:177-16-0405 ACN: 01138698 ADJUSTMENT BASED ON : ADMINISTRATIVE CORRECTION JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ALLFIRST BANK ACCOUNT NO.: 0056506996 TYPE OF ACCOUNT: C ) SAVINGS C ~ CHECKING C ) TRUST C ) TIME CERTIFICATE DATE ESTABLISHED 08-28-1978 Account Balance Percent Taxable Aitount Subject to Tax Debts and Deductions Taxable A~iount Tax Rate Tax Due TAX CREDITS: .00 X~ 0.500 .00 .00 .00 X .15 .00 NOTE: TO ENSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILDS AT THE ADDRESS SHOWN ASOYE. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID C-) AMOUNT PAID TOTAL TAX PAYMENT .p0 BALANCE OF TAX DUE INTEREST AND. PEN. TDTAL DUE IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ~ 1 ~w,so ~c ~ COMMONYYEALTH OF ~NNB1r1.VANlA DLPIIRTMENT OF REV'EN1JE BUREAU OF INOMOUAL TAXES PO Box ~O~Of Robert W. Luckenbaugh INHERITANCE TAX EXPLA-NATIC~N oa= cHANOEs 8hnon E. Baker !~~ 01138098 SCHEt'~JLE pM EXPLANATit'~N ~ CFUINIGES Souse predeceased. Account to be reported on Schedule E of the 101 Probate Re~urr~. R~- Page 1