HomeMy WebLinkAbout09-20-05
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REV-1500 EX + (6-00)
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SHORB PAMELA JO
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
II
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 4 8 2
""'Ccii:iNTYCOOE ----yEA~ - - NUMsER- -
SOCIAL SECURITY NUMBER
2 0 0 - 3 6 - 9 4 1 0
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (dat.oldeathpliorto12-13-82)
o 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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05/08/2005 10/21/1957
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
IX] 1. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (AttachcopyolWiIl)
o 9. Litigation Proceeds Received
o 2. Supplemental Retum
o 4a. Future Interest Compromise (dateoldealh alter 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
COMPLETE MAILING ADDRESS
64 SOUTH PITT STREET
0.00
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0.00':
0.00
16,807.25
i
O:CIA~~ LIE ONLY
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0.00 X _(15) 0.00
0.00 X _(16) 0.00
7,370.80 X .12 (17) 884.50
0.00 X .15 (18) 0.00
(19) 884.50
NAME
HAROLD S. IRWIN III
FIRM NAME (If Applicable)
IRWIN LAW OFFICE
TELEPHONE NUMBER
717 -243-6090
CARLISLE PA 17013
:' (-.....)
-11
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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)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
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 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
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
-"-,
0.00
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16,807.25
9,436.45
7,370.80
0.00
7,370.80
Decedent's Complete Address:
STREET ADDRESS
1416 BRADLEY DRIVE
UNIT H112
CITY
CARLISLE
STATE
PA
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
884.50
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
0.00
Total Interest/Penalty ( 0 + 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. (58)
Make Check to: REGISTER OF WILLS, AGENT
0.00
884.50
884.50
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... 0 [%]
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 [%]
c. retain a reversionary interest; or ...................................................................................................... 0 [%]
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 [%]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
3. ~:~h~~~::~~;~~na~~~~na~;u:~;::~:~a~:yna?~;~. ~~~~ .~~~~~ .~~~.~. ~~~~~.~;. ~'r' ~~~~'r;;~'~; ~;~.~; ~~; ~~~;~.~.::::::::::::::::: B ~
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 IiJ
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 perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is tnue, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
IGNATURE OF PERSON RESPONSI LE FOR FILlN RET
1
DATE
q /7 (,'/
ROAD, CARLISLE, PA 17013;
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. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of trar
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory ree
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
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
P"JA ~) J~
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--.. A-t.\.::./
;e is 0% [72 P,S, S9116 (a) (1.1) (ii)],
a tax return are still applicable even if
of a natural parent, an adoptive parent,
P,S. 99116(1.2) [72 P.S, 39116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings IS 117o [f It. 1"'.0. 9:1 r to\d)\ I.vll. M "'Ul"'~ 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-1502 EX + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
SHORB. PAMELA JO 21 05 0482
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is iointly-owned with riaht of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
NONE
0.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1503 EX + (6-98)
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SHORB. PAMELA JO
FilE NUMBER
21 05
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0482
DESCRIPTION
VALUE AT DATE
OF DEATH
ITEM
NUMBER
1.
NONE
0.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-1504 EX + (6-98)
SCHEDULE C
CLOSEL Y.HELD CORPORATION,
PARTNERSHIP OR
SOLE.PROPRIETORSHIP
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SHORB. PAMELA JO
FILE NUMBER
21 05
0482
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 instnuctions for the supporting information to be submitted for sole-proprietorships.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
NONE
0.00
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-Hm, EX' (6-.
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SHORB. PAMELA JO
FILE NUMBER
21 05
0482
All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
DESCRIPTION
\j!ALUEAT DATE
i OF DEATH
ITEM
NUMBER
1.
NONE
0.00
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0.00
REV-'''' EX' ".
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SHORB. PAMELA JO
FILE NUMBER
21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly.owned with right of survivorship must be disclosed on Schedule F.
0482
ITEM
NUMBER
1.
2.
3.
4.
5.
.6.
7.
9.
10.
DESCRIPTION
IRA T HORN ESTATE (21-05-0235)
One-fourth Interest (Not distributed as of date of death)
Exhibit "B"
1992 GEO PRISM
Value based on sale price
Exhibit "C"
MEMBERS FIRST FEDERAL CREDIT UNION
Checking Account No. 138876
See Exhibit "0"
MEMBERS FIRST FEDERAL CREDIT UNION
Savings Account No. 138876
See Exhibit "0"
CAPITAL BLUE CROSS
Refund Check
SPRINT
Refunds
REIMAN PUBLICATIONS
Refund
ERIE INSURANCE
Car Insurance Refund
THE UNION CENTRAL LIFE INSURANCE COMPANY
Uncashed Check
VALUE AT DATE
OF DEATH
13,510.88
1,000.00
1,089.25
25.00
46.11
43.39
21.03
29.00
1,042.59
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
16.807.25
REV-1509 EX + (6-98)
'*
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SHORB. PAMELA JO
FILE NUMBER
21
05
0482
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
ADDRESS
RELATIONSHIP TO DECEDENT
A.
B
c
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY 'Io0F DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. NONE 0.00 0.00
TOTAL (Also enter on line 6, Recapitulation) $ 0.00
(If more space is needed. insert additional sheets of the same size)
REV-1510 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
SHORB. PAMELA JO
FILE NUMBER
21 05
0482
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST VALUE
(IF APPLICABLE)
1. NONE 0.00 0.00
TOTAL (Also enter on line 7 Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+(12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
SHORB. PAMELA JO
FILE NUMBER
21
05
0482
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HETRICK FUNERAL HOME, INC. 1,331.00
2. WESTMINSTER CEMETARY - Grave Opening 640.00
3. OSIRIS HOLDING - Grave Marker 730.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s}/EIN Number of Personal Representative(s}
Street Address
City State Zip
Year(s} Commission Paid:
2. Attorney Fees IRWIN LAW OFFICE 2,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs. attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 91.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7. ERIE INSURANCE - Car Insurance Premium 62.00
8. CUMBERLAND COUNTY REGISTER OF WILLS - Filing Costs 30.00
TOTAL (Also enter on line 9, Recapitulation) $ 4 884.00
(If more space is needed, insert additional sheets of the same size)
REV-"".EX' C'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
SHORB. PAMELA JO
FILE NUMBER
21
05
0482
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. KELLER BROTHERS
Car Repairs
VALUE AT DATE
. OF DEATH
46.19
2. ESTATE RECOVERIES, INC. ARMS0000014287
American Express Balance 371501294731003
4,180.97
3. NORTH MIDDLETON AUTHORITY
Utility Bills
79.90
4. SPRINT
Utility Bills
68.19
5. PP&L
Utility Bills
177 .20
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
,
4,552.45
''''-''''~ .'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
SHORB PAMELA JO 21 05 04R?
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. DARLENE E HEBERLlG Collateral
11 Ridge Avenue ONE-THIRD RESIDUE
Carlisle PA 17013
2. KAREN J GETTYS Collateral
314 Old Stonehouse Road ONE-THIRD RESIDUE
Carlisle PA 17013
3. T K HORN Collateral
8008 Sacks Drive ONE-THIRD RESIDUE
New Tripoli PA 18066
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500iCOVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. NONE 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. NONE 0.00
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
(If more space IS needed, insert additional sheets of the same size)
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EXHIBIT 'A' INTENTIONALLY BLANK
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REV-1513 EX + (8-nm
cmJ~1C).NWEALTH OF PENNSYLVANIA
· - INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
HORN IRA T. 21 05 02':\5
RELA TIONSHIP TO D:::CEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. DARLENE E HEBERLlG Collateral
11 Ridge Avenue 25% R/=SIDUE
Carlisle PA 17013
2. KAREN J. GETTYS Collateral
314 Old Stonehouse Road 25% R/=SIDUE
Carlisle PA 17013
3. PAMELA J SHORB ESTATE Collateral
64 South Pitt Street 25% RI=SIDUE
Carlisle PA 17013
4. T K HORN Collateral
8008 Sacks Drive 25% RI=SIDUE
New Tripoli PA 18066
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. NONE 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. NONE 0.00
,
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00
. .
(If more space IS needed, Insert additional sheets of the same size)
RE V-1500 EX + (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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HORN, IRA T.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
03/05/2005 02/16/1922
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
!XJ 1. Original Return
o 4. Lirnited Estate
!XJ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
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 ofTrust)
o 10. Spousal Poverty Credit (dale of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 2 3 5
"'COuNTY"Co5E -YEA~ - - NUMBER- -
SOCIAL SECURIT'Y NUMBER
1 88- 1 2 - 5 678
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURIT'Y NUMBER
o 3. 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 und~r Sec. 9113(A)rAttach Sch 0)
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THIS"SEcnON\MUSTBECOM8I:l1ErI"E[j':i~1JiLCORREsl?ONDENCEWANilC()N!iJDENTIAL:.TAX .'NFORMATIONtSHaUl.!iefBei DIRECTED'ifFo:
NAME COMPLETE MAILING ADDRESS
HAROLD S. IRWIN, III 64 SOUTH PITT STREET
FIRM NAME (If Applicable)
IRWIN LAW OFFICE CARLISLE PA 17013
TELEPHONE NUMBER
717 -243-6090
0.00 X _(15) 0.00
56,590.10 X .045 (16) 2,546.55
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 2,546.55
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)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/Sec 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
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
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
. >>'" BESURE.TOr'ANSWER';:AJ.:.L: QUES:rIONS~:ONjREVERSE;SIDEANDRECFlEQK'MATH1!.<<hl;
(8)
(11)
(12)
(13)
(14)
81,000.00 I
410.071
0.00
0.00
21,247.84
0.00 I
i
OFFldlAL USE ONLY
0.00 L~___
102,657.91
18.098.93
27,968.88
46,067.81
56,590.10
0.00
56,590.10
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5J\\.~ PROCtt~
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Car Sales
The cars were just sitting on Lebo's lot. Larry did not sell them. He called me when
someone was interested and I /we sold them.
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As executrix, I sold mom and dad's car on Saturday, July 2nd. We went to Sollenberger's
Messenger Service to complete the transaction. We sold the car, 1990 Geo Prizm, for
$1,000.
TK, Karen and I sold Pam's car on Friday, July 15th. We completed this transaction at
Lebo's garage using the notary Larry usually uses. We sold the car, a 1992 Geo Prizm,
for $1000. ~ brought in $1,000 in cas~om this sale to your office the following week.
I think it was on either Tuesday the 19 or Wednesday the 20th of July.
5?r~
f] 1J~).
Darlene E. Heberlig
Kell~y Dhl~ Dook
Private: Party Pricing R ~port
C~O Prizm
,
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~'l"'8"'::' iI
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Kelley Blue Book
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BLUE BOOK-' PRIVATE PARTY REPORT
Pennsylvania · May 18, 2005
1992 Geo Prizm Sedan 40
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Engine: 4-Cyl. 1.6 Liter
Trans: Automatic
Drive: Front Wheel Drive
Mileage: 108,000
Equipment
Air Conditioning
AM/FM Stereo
Consumer Rated Condition: Fair
"Fair" condition means that the vehicle has some mechanical or cosmetic defects and
needs servicing but is still in reasonable running condition. This vehicle has a clean title
history, the paint, body and/or interior need work performed by a professional. The
tires may need to be replaced. There may be some repairable rust damage.
Private Party Value Search Local ListinQs I List This Car for Sale $1,130
Private Party Value is what a buyer can expect to pay when buying a used car from a
private party. The Private Party Value assumes the vehicle is sold "As Is" and carries
no warranty (other than the continuing factory warranty). The final sale price may
vary depending on the vehicle's actual condition and local market conditions. This
value may also be used to derive Fair Market Value for insurance and vehicle donation
pu rposes.
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http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.PA;307514;P A041&17... 5/18/2005
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EXHIBIT '0'
-.. . f ..
SEP-16-85 81:28 PM MEMBERS1ST Feu INS. DEPT 7177955178
P.81
tv.-
MEMBERS 111
PEDERUCREIlIT UNION
SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest tg Date of Death
Total Principal and Accrued Interest
Name gf Joint Owner
138878 -00
03/28/1994
$25.00
$.00
$25.00
None
CHECKING ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
138876 -11
03/28/1994
$1,089.25
$.00
$1,089.25
None
~~i.i.
M~B:~EDERAL CREDIT UNION
~A.WOlf~
Insurance Services Superylsor
September 16. 2005
Estat. of: PAMELA J. SHORB
Date of Death: 05/08/2005
Sgelal Security Number: 200-38-8410
soon Louise Drive · PO. lJo;.; 40 · Mech<1nksburg, PctlllsylV3nia 171155 . (717) 697-1161 . www.ll1emblrrs1st.org
,
.....
REIGSTER OF WILLS
CUMBERLAND COUNTY
INVENTORY
Estate of PAMELA JO SHORB
also known as
, Deceased
No.21
0482
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuatioh
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IflNe
verify that the statements ma e in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa, C.S. Sec n 4904 relating to unsworn falsification to authorities.
Name of
Attorney: HAR
1.0. No.: 29920
Address: 64 SOUTH PITT STREET
CARLISLE
PA 17013
Telephone: 717-243-6090
Description
IRA T. HORN ESTATE (21-05-0235)
One-fourth Interest (not distributed as of date of death)
1992 GEO PRISM
Value based on sale price
MEMBERS FIRST FEDERAL CREDIT UNION
Checking Account No. 138876
MEMBERS FIRST FEDERAL CREDIT UNION
Savings Account No. 138876
CAPITAL BLUE CROSS
Refund Check
SPRINT
Refunds
(Attach Additional Sheets if necessary)
~,51 0.88:r::1
"1:, ;'-T.
~o,]-r~i S
~ ,OOO:O:<2J
'1 ::--)
~. : =-f.l
,:.:51,089.2~~~
..r:-t ~,~
"'I
05
Date of Death 5/8/2005
Social Security No. 200-36-9410
&:Z:Pfs1Lt~~i~~:/ ~):J.--
DARLENE E. ~~L1G TK HORN,
'7/( ~_____ -:::Y. 6.e
KAREN J. GETTYS
Dated SEPTEMBER 16, 2005
Value
)
;'-j
~
Total
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
25.00
46.11
43.39
16,807.25
I
Continuation of Inventory
~
PAMELA JO SHORB
21
05
0482
PaQe 1
Description of Inventory
Description
Value
REIMAN PUBLICATIONS
Refunds
21.03
ERIE INSURANCE
Car Insurance Refund
29.00
THE UNION CENTRAL LIFE INSURANCE COMPANY
Uncashed check
1,042.59
Subtotal $
1,092.62
16,807.25
Grand Total $
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B0601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
IRWIN HAROLD S III
64 SOUTH PITT STREET
CARLISLE, PA 17013
__dun fold
ESTATE INFORMATION: SSN: 200-36-9410
FILE NUMBER: 2105-0482
DECEDENT NAME: SHORB PAMELA JO
DATE OF PAYMENT: 09/20/2005
POSTMARK DATE: 09/20/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 05/08/2005
REMARKS:
CHECK# 09885
SEAL
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX! 11-96)
NO. CD 005815
AMOUNT
$884.50
$884.50
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS