HomeMy WebLinkAbout07-19-05
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
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OFFICIAL USE ONLY
INHERITANCE TAX RETURN FILE NUMBER
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RESIDENT DECEDENT COUNTY CODE YEAR
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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NUMBER
SOCIAL SECURITY NUMBER
/71
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3, Remainder Return (date of death prior to 12-13-82)
D 5, Federal Estate Tax Return Required
8, Total Number of Safe Deposit Boxes
D 11. Election to tax under See, 9113(A) (Attach Sch 0)
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COMPLETE MAILING ADDRESS
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'0 1. Original Return
D 4, Limited Estate
D 6, Decedent Died Testate (AIt"h copy of Will)
D 9, Liligatlon Proceeds Received
D 2, Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7, Decedent Maintained a Living Trust (Attach copy ofTresl)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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FIRM NAME (If Appl"'ble)
TELEPHONE NUMBER
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1, Real Estate (Schedule A)
2, Stocks and Bonds (Schedule B)
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(1)
(2)
(3)
(4)
(5)
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3, Closely Held Corporalion, Partnership or Sole-Proprietorship
4, Mortgages & Notes Receivable (Schedule D)
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5, Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
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6, Jointly Owned Property (Schedule F)
D Separate Billing Requested
(6)
.3 G,7i10. t8
7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
(7)
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8, Total Gross Assets (total lines 1-7)
g, Funeral Expenses & Administrative Costs (Schedule H)
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(9)
(10)
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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
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15, Amount of Line 14 taxable at the spousal tax
rate, or transfers under See, 9116 (a)(l.2)
x.O_ (15)
x04~ (16)
x ,12 (17)
x ,15 (18)
(19)
16, Amount of Line 14 taxable at lineal rate
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17. Amount of Line 14 taxable at sibling rate
18, Amount of Line 14 taxable at collateral rate
19, Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(11)
(12)
(13)
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Decedent's Complete Address:
STREET ADDRESS
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CITY
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
D
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(,6: 6 ,
Total Credits (A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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Total Interest/Penalty ( D + E )
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
S If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line S + SA. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
(1)
1300 ,<.1!
G ..5. c. I
(3) 6
(4)
(S) 12.. ~-. 2)
(SA) 0
(58) t:z ~~, :2 (
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;......................................... ............................. 0 [gj
b. retain the right to designate who shall use the property transferred or its income; ............... 0 ~
c. retain a reversionary interest; or........ .......................................... ............................ ..................... .. 0 [id
d. receive the promise for life of either payments, benefits or care? ...................................... ............ 0 00
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ... ........................................... ............................................ 0 [B
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 0 ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................. ..................... 0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
DATE
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 P.S. 39116 (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. 39116 (a) (1.1) (ii)].
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of asset ' . m -"" --"""hlo Q"en if
the surviving spouse is the only beneficiary.
For dates of death on or after July 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 I
or a stepparent of the child is 0% [72 P.S. 39116(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 note
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS. 39116(a)(1.:
individual who has at least one parent in common with the decedent, whether by blood or adoption.
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
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FILE NUMBER
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
RELATIONSHIP TO DECEDENT
ADDRESS
A. ::>itMES R l.. ~'J> I :s
8. JJAJ...E A. LAN;]j 5
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JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly.held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 'f /"1 h 7 l'1 '{\ T .~" tJt<, C- tfc 4& '" '- "l.703.n~1 <'is I C -1- 3';'- r6 ~O s' ~ . /8
1?. A <iJ?fn M ~ T~~Nk ~I\ oJ ,t.)G-5 1.s(Jo'/~O'ii'3~(,< 'I <.\ 2 ~c( S-; 'lIS S-c JI~2.. '$1
1117&/'17 G-.vl-\4 'f.......l> q'1/l<(I.,>-a~ '-( ~j5'G.<I:,c> S't,:' /6'1'lt3. ~
3 A VANlO;.U A(l.,j)
7 '13-30 'r.?s-rz. 31 "'''3 ., 3 S' C' 1,f.-7:z..,. 'lr\
#f 6 ~)'lfJ't \! t<]N "'_.~A. 0 ~ ~M~ Fo/ NQ
TOTAL (Also enteron line 6, Recapitulation) $ 3f.oJ"/o, /8
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(If more space is needed, insert addlllonal sheets of the same size)
REV-1511 EX+ (12-99)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
-;;r U~ I ~ L. ~2.4D
Debts of decedent must be reported on Schedule I.
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: 7 -,S t 00
1. QP~^-II1J~t;JV'l \J~
;.2-::,-, 60
~ "'''I'.. PP...-'clC.. IV Co ,tC~ (,,6 60"
1) m711 CE~71F( <'"lliC-S Q /..('7S. 110
CAS f(e 7.( oGc. \-> ;-'" ,Nt; II.. {P$'. L' 0
Ae<::,-'5'1'': 11. 6oo*, '37'-(O,c;O
.('RGP",SSJ' ",~L,. $e(l..,J Ice s,F Ff'lcr(..)'r,e5 IOO.C,c
c.i.. cRf...~ ';-0,;....., 0 0
1'-1 ~,... ott..'4LNI\~K~ ~
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number ot Personal Representative(s)
Street Address
City State ___Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (It decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City__ State _ Zip
Retationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line g, Recapitulation) $ '7 ~ 'IS: tt<
(If more space is needed, insert additional sheets of the same size)
M& T Web Banking and Bill Pay
5/23/2005
j\tl&rv\tbBanking
ACCOUNT SUMMARY I HELP I CONTACT US I SIGN
OFF
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Account Summary
See \vhafs ne\\'".
M&T WEB BANKING >
Your last sign-on was May 21, 2005 at 10:12 AM.
Deposit Accounts
I Name
IChecking, Savings. and CDs
I Relationship Checking w/lnterest
IM&T Personal Savings
ITotal Deposits
Acct #
Last 4 Digits
Total
Balance
Available
Balance
II
II
5141
6240
II $8,104.3511
II $2,365.7811
II $10.470.1311
I
$8,104.351
$2,365.781
$10.470.131
To add an account, please contact an M&T Online Customer Service
Representative at
1-800-790-9130
(Mon.-Fri. 8am-9pm, Sat.-Sun. 9am-5pm EST).
C> 2004 Manufacturers and Traders Trust Company. Users of this web site agree to be bound by the provisions of the
M&T Web Banking Terms and Conditions. View the Web BankingTerms & Conditions and thePrivacy Policy of M&T.
Security Information.
.,
...IlK TO TO,,"
https://onlinebanking.mandtbank.com/
Page 1/1
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~ THE YORK BANK
A First Maryland Bank
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SOLE/JOINT OWNERSHIP ACCOUNT AGREEMENT
Originating Branch:
Completed By:
Account Number: V
Banking SelVlcesl'lequesled
Em
Savings Suffixes: S (
CONTRACT CODE:
CONTRACT CODE:
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ADDRESS:
ADDRESS:
STA(!J r}
ZIP CODE:
I 7 OS~
WORK PHONE:
Z79DJ'o I I
WORK PHONE:
NAME: CONH1ACT CODE:
ADDRESS: NAME:
ADDRESS: ADDRESS:
ADDRESS: ADDRESS:
CITY: SlATE: ZIP CODE' ADDRESS:
SSN: WORK PHONE: Clry:
E.MPLOYER: SlATE:
SPECIAL MAILING ADDRESS
ZIP CODE:
RESTRICTION:
This agreement applies to all accounts related to the above account number. Related accounts are checking and savings accounts 51-55,
71-75. 11 one owner's name is shown above, the accounts lisled above (Account) at The York Bank and Trust Company (Bank) are
established subject to the sole order of the owner and upon the death 01 the owner the balance shall be paid to the owner's estr>ts. If two or
more owners' names are shown above, the accounts listed above (Account) are established as joint tenants (owners) with right of
survivorship. A joint account is subject to the order 01 anyone owner, unless a restriction has been placed on the account and upon the
death of one owner the balance in the Account shall belong to the surviving owner. By signing this agreement I/we acknowledge receipt 01
and agree to the terms and conditions 01 the Bank's Rules lor Consumer Deposit Accounts and the Bank's Funds Availability, Electronic
Funds Transfer and Account disclosures.
SUBSTITUTE W-9 Under penallies 01 perjury, I certify Ihal: Tax Payer Identification Number: 171 .;)/{- <f7~ (J
(1) The number shown on this lorm is lilY correcllaxpayer idenlification number (or I am waiting lor a number 10 be issued 10 me), and
(2) I am nol subjecllo backup withholding because:
(a) I am exempllroll1 backup withholding, or
(b) I have not been nolified by the Inlemal Revenue Service (IRS) Ihall am subjeclto backup wilhholding, as a result of a lailure
10 report all interest or dividends, or
(c) the IRS has noli lied me thai I am no longer subjeclto backup withholding.
(You must cross oul item (2) above if you have been nolilied by IRS tllal you are currenlly subiect 10 backup withholding because 01 underreporting
inlerest or dividends on your tax relum) The nal and TIN certified will 00 used for IRS reporting on Ihis accoun!.
Signature .., . Dale:
Signature: ~ J..v.l.J ;). ;f R ~
Signature: X. &7 ~VHL~-::> rt I;?;;~
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YS.2800A.9608 (. 'rED VIA FB
Signature~
.
COPY 10 CIS MAil COIJE: 501-120
COpy TO CUSTOMER
Vanguard - Consolidated View
5/22/2005
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Accounts & Activity-Consolidated ViewTM
Total Vanguard Assets $63,010.23 (Compare to year-end balances.)
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Expand name and address information for your accounts.
Vanguard Investments
Portfolio of Julia L Read, James R. Landis
! .... Julia L Read, James R. Landis-Joint Account
I Buy & Sell I Transaction History I Cost Basis
. ;
Pnce as of OS/20/2005 !
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[Name
Value
3,035.250 $10.40 -$0.01 $31,566.60 i
___i.-
Subtotal $31,566.60:
I
Julia L Read, James R. Landis Portfolio Total $31.566.60 i
Portfolio of Julia L Read, Dale A. Landis
I ---.-
i .... Julia L. Read, Dale A. Landis-Joint Account
Buy & Sell I Transaction History I Cost Basis
Price as of OS/20/2oo5!
I
( Name
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..w_JFund & Acc.o~nt Shares i Price & Change i
Value
, 0036- .
! Vanguard GNMA Fund Investor Shares 09933075Ul 3,023.426 $10.40 -$0.01 $31,443.63
~' i
Subtotal $31,443.63'
Julia L. Read, Dale A. Landis Portfolio Total $31.443.63
Outside Investments
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https://flagship2.vanguard.comNGApp/hnw/TPView?g...
Page 1/2
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1.,.111.,,111.,.,1,1,.1.1,.1,.1,.11.1,..1...11...111..1.1..1.1
JULIA L READ &
JAMES R LANDIS
JT TEN WROS
18 ROBIN CT
HECHANICSBURG PA 17055-4371
NOVEMBER 28,1997
PAGE 1 OF 1
ACCOUNT OPTION PROFILE
FUND NUMBER 36
ACCOUNT NUMBER 9911975034
STATEMENT NUMBER ~rr26-
~~~
SECURITIES FUND
GNMA Portfolio
Vanguard sends you a nl;lW profile every time you change your account's options. These changes are shaded, with
explanations of all options on the reverse side. Please call 1-800-662-2739 for additional information.
IMPORTANT INFORMATION:
YOUR TAX 10 NUMBER IS 171-28-4780.
DIVIDEND AND CAPITAL GAINS PAYMENT
YOURINCOMEDIVIDENPSAND CAPITAL GAINS ARE
MAILED TO YOUR ADDRESS OF RECORD.
CHECKWRITING
YOU HAVE NOT CHOSEN THIS OPTION.
TELEPHONE EXCHANGE
THIS PRIVILEGE IS AVAILABLE WITH YOUR ACCOUNT.
TELEPHONE MAIL REDEMPTION
REDEMPTIONl'ROCEEpS MAY BE MAILED TO YOUR
ADDRESS OF RECORD.
WIRE REDEMPTION OPTION
YOU HAVE NOT CHOSEN THIS OPTION.
003196
01-01
x
4
11111111111111111111111111111111111111111111111111111111111111111111111111111111
May 17, 1999
ACCOUNT OPTION PROFILE
Vanguard GNMA Fund
Page I of 1
----
THNanguantJRooP.
1".11I",11I",,1,1,.1,1,.1.,1,,11,1..,1,"11,.,11 1,.1.1.,1,1
JULIA L READ &
DALE A LANDIS
JT TEN WROS
16 ROBIN CT
MECHANICSBURG PA 17055-4371
Fund number: 36
Account number: 9933075572
Statement number: 12033752
Vanguard sends you a new profile every time you change your account's options. These changes are shaded, with
explanations of all options on the reverse side. Please call 1-800-662-2739 for additional information.
IMPORTANT INFORMATION:
YOUR TAX 10 NUMBER IS 171-28-4780.
DIVIDEND AND CAPITAL GAINS PAYMENT
YOUR INCOME DIVIDENDS AND CAPITAL GAINS ARE
MAILED TO YOUR ADDRESS OF RECORD.
CH ECKWR ITING
YOU HAVE NOT CHOSEN THIS OPTION.
TELEPHONE EXCHANGE
THIS PRIVILEGE IS AVAILABLE WITH YOUR ACCOUNT.
TELEPHONE MAIL REDEMPTION
REDEMPTION PROCEEDS MAY BE MAILED TO YOUR
ADDRESS OF RECORD.
WIRE REDEMPTION OPTION
YOU HAVE NOT CHOSEN THIS OPTION.
007984
01-01
'l
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COMMONWEALTH OF PENNSYLVANIA REV-' '62 EX(11-961
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT, 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CO 005589
I
lANDIS JAMES R
527 BRIGHTON PLACE
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
H__nn told ---------- -------
101 I $1,235.27
ESTATE INFORMATION: SSN: 171-28-4780 I
FILE NUMBER: 2105-0638 I
DECEDENT NAME: READ JULIA l I
DATE OF PAYMENT: 07/19/2005 I I
POSTMARK DATE: 07/19/2005 I
COUNTY: CUMBERLAND I
,
DATE OF DEATH: OS/20/2005 I
I
TOTAL AMOUNT PAID: $1,235.27
REMARKS:
CHECK#1823
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WillS
REGISTER OF WILLS