HomeMy WebLinkAbout11-22-05
REV.'500 EX 16-001 REV-1500 OFFICIAL USE ONLY
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE ,. n. """,_,~"",_,~""~,_,_"_,,_,,,,,",,"""~~__'_"_"""_ ,____~_.~M...' h_'.. .__~...........__....._
INHERIT ANCE TAX RETURN FILE NUMBER
DEPI 280601 (AL-_~?: ,'-
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT _ /J tJ ~ .~ __ _'_
COUNTYCOOE YEAR NUMBER
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOC~SECURITYNUMBER
t- , /'-113 f..-mft II; -~~ - J.ftJ <13
z t
-
W DATE OF DEATH (MM-OO-YEAR) DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPlICATE WITH THE
C
W J I ,. -0 /- ~('-I!>- REGISTER OF WILLS
0
W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
C LJ JgCf - ,~ - 5/d. D
.
III ~ 1. Original Return o 2. Supplemental Return o 3. Remainder Return (date 01 dea1h prior to 12-13-82)
....
ll::$l/) o 4. Limited Estate o 4a. Future Interest Compromise (dale of death after 12-12-32) o 5. Federal Estate Tax Return Required
u~ll:
IIIC1.U
%09 o 6. Decedent Died Testate (AltactJ copy of Wi") 07, Decedent Maintained a Living Trust (AltactJcopyolTrust) L 8. Total Number of Safe Deposit Boxes
U&:Cll
a. o 9. Litigation Proceeds Received o 10. Spousal Poverty Credit (da\e of death belween 12-31-91 and 1,1-95) o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
<
-
FIRM NAME (If Applicable) I;). 7/ C R.&~K RD.
TELEPHONE NUMBER ~. . .3 c. ftRLtSLE Ptt 1'/013
J - If 3 - (P73
1. Real Estate (Schedule A) (1) . -OFf"ltf'ALUSE'ONlY'- --,
i-=>
c'? -::0
(2) (') c..::J n"
2. Stocks and Bonds (Schedule B) ('-1"
0Q -.;~.. c')
~~ ,J~')
3, Closely Held Corporation. Partnership or So\e-Proprietorship (3) . ~l :~:~;:~ ':-") -:0
C)
4. Mortgages & Notes Receivable (Schedule D) (4) !_--:i:Cl .'" ,'\"1
~;2 r-,) ~:J
(S) ) I...J 9 <ZJ.. 03 .', c'.:')
5, Cash, Bank Deposits & Miscellaneous Personal Property -C1 '1'1
(Schedule E) , _ -Tl
Z -''''~ . eM)
0 - ' III
!i 6. Jointly Owned Property (Schedule F) (6) .. ,_/ )
o Separate Billing Requested N
...I Cl
;:) 7. Inter-Vivos Transfers & MisceUaneous Non-Probate Property (7)
t- (Schedule G or L)
0: 8, Total Gross Assets (total Lines 1-7) (8) L~)qR~.D3
c(
0 (9) ----Lj '3' J c.J . %.3
w 9. Funeral Expenses & Administrative Costs (Schedule H)
0:: .
10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11, Total Deductions (total Lines 9 & 10) (11) 1'1_&'14,83
,
12, Net Value of Estate (Line 8 minus Line 11) (12) I (p'l, ~O
13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 1~7.:J..O
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z 15. Amount of Line 14 taxable at the spousal tax
0 1 &, 't . dO x .O...Q. (15) 0
~ rate, or transfers under Sec. 9116 (a)(1.2)
... 16, Amount of Line 14 taxable at lineal rate x .0 _ (16)
::>>
Q. 17. Amount of line 14 taxable at sibling rate x ,12 (17)
:E
0 18. Amount of line 14 taxable at collateral rate x .15 (18)
0
>< 19. Tax Due (19) ()
t! 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Complete Address:
STREET ADDRESS J:;' 7/ CREE
CITY
Tax Payments and Credits:
1, Tax Due (Page 1 line 19) (1) 0
2. Credits/Payments
A. Spousal Poverty Credit
B.PriorPayments
C. Discount
Total Credits ( A + B + C ) (2) 0
3. InterestlPenalty if applicable
D. Interest
E. Penalty ()
TotallnterestlPenalty ( 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) 0
B. Enter the total of line 5 + SA. This is the BALANCE DUE. (5B) 0
Make Check Payable to: REGISTER OF WILLS, AGENT
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 G-
b, retain the right to designate who shall use the property transferred or its income; ............................................ 0 Q-
c. retain a reversionary interest; or..........,.....................................,....,........".......,.................................,.......,.,...... 0 B"
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 B
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .....................,.....,...................,....................................................,......... 0 Cd'
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 B-
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ......,..,.......................",..,..........,.......,..,..........,....,..,,.,..........,....."................... 0 Cd-
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURI
Under penalties of perjury, I dedare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, ~ is true, correct and complete.
Declaration of preparer other than the personal representative is based on an information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPOa~G RETURN, g7U~ DATE
. u)1 V
ADDRESS t PrRJ-l S L E. PA-
'IOI?:;
-l)S
ADDRESS I ;;.. 0 W~4/f~ ~. (~J PA-
/70/3
1f;ji*~~!E_~ ',.. "t
..1\._ , !
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfecs to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (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, ~9116 (a) (1.1)
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable eVE
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-<lne years of age or younger at death to or for the use of a natural parent, an adoptive par
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)1.
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. ~116(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 decedent's siblings is 12% [72 P.S. ~116(a)(1.3)]. A sibling is defined, under Section 9102, a~
individual who has at least one parent in common with the deceden~ whether by blood or adoption.
_~D'~ . SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
H "mA N. J.... I H &-
Include the proceeds of litigation and the date the proceeds were received by the estate. AN property jolntIy-owned with the right of survivorship must be disclosed on Schedule F 0
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. C L A-S5 1(.. C H EC~J ~ G- Acc/)LtN 1-
rn d ot B A-l"J K 13) 73Jv .'17
=Jtd. ~7? o{p() t,DS-
L.J".~h
F- 0 01 L 0(. K E A.. 'R c. t Il~ e IY\ E ~t f J it- N - () N e:. T r:. RRvAJ Ai- !l\ OJ\'ttlLy
~ e ",<;1 eN. ~ A V 'lYH: 1'\ I lS'b
~.;). YS.
. LHItN6.F i>,st~ij,v-t~l> ~y...51
C A-St4 (4 j.. StMt..L d--"~~ /)0
LV eARI'-lG.- ;4~Pfl~ i-L S/~~ ./YO
J~I.C~L~~ IS ~ tl)
-go c 1(5
TOTAL (Also enter on line 5, Recapitulation) $ 1'-1 tj<62. ,03
lIf more soace is needed, insert additional sheets of the same size)
,.1l!<M&TBank
accc:JUNT NO. ACCOUNT TYPE STATE"ENTPERIOD PACE
2678060605 CUSSIC CHECKING NOV.13-DEC.13,2004 1 OF 1
00 3 0434st1 " 021
-- 4581
-- ALMA N LINE
1271 CREEK RD
CARLISLE PA 17013-8931
--
STONEHEDGE
E I
OT ERADDITIONS CHECKS PAID E
NO. AtIOUNT NO. AttOUNT
13,842.65 2 408.06 3 214.68 0.00 14,036.03
ACCOUNT
POST
DATE ION
11-13-04 BEGDltING BAlANCE .13,842.65
11-18- CHECK ....ER 1459 - 55.59
11-18-04 CHECK NUltBER 1460 - 54.09 13,732.97
11- 26- 04 CHECK ....ER 1461 105.00 13,627.97
12-01-04 BANK OF NEW YORK PENS PItTS + 46.06 13,674.03
12-03-04 US TREASURY 303 sot SEC 362.00 14,036.03
ENDING BALANCE $14,036.03
I (;ItECKS . PAID $UMARY I
1459 11-18-04 55.59 1460 11-18-04 54.09 1461 11-26-04 105.00
I"PRESSED BY THE SERVICE YOU RECEIVED AT "IT? IF YOU'D LIKE TO NONINATE AN "IT
BANK E"PLOYEE FOR EXCEPTIONAL CUSTOMER SERVICE, PLEASE COMPLETE OUR "IT SERVICE
EXCELLENCE FORM AT WWW.NANDTBANK.COHIEXCELLENCE. WE APPRECIATE YOUR FEEDBACK!
"IT'S WEBSITE IS A POWERFUL RESOURCE THAT CAN HELP YOU MAKE INFORMED FINANCIAL
DECISIONS. YOU CAN ACCESS YOUR ACCOUNTS I USE PU"'ING TOOLS I OPEN AN ACCOUNT,
OR FIND YOUR NEAREST HIT BRANCH OR ATH. VISIT WWW.KANDT8ANK.COM TODAY!
~
----- ---'--
PSBLDDA0 Customer Service Workstation 1 2 : 1 8 : 37
EBRNTSP Checking Account Balance 05/01/04
Account #: 2678060605 Product: DDA SubCode: A2
M&T BANK
Tit Ie 1: ALMA N LINE SSN/TIN: 162224083
2: Package:
Status : ACTIVE
Overdraft Account : Restraint: N
Start of Day Total : $ 13,720.09 Region : CEPA
Available Balance : $ 13,720.09
ODL Available : $ ATM: Addl Avail Amt:$ 0.00
Merchant Check Auth: $ 13,720.09 Balance to Earn Int:$ 13,720.09
Last Deposit Amount: $ 46.06 Last Deposit Date : 05/01/03
Date Transaction DIC Amount Funds Clearing
01/03 BANK OF NEW YORK PENS PMTS C $ 46 .06 1: $ .00
12/22 REVERSE DIRECT DEPOSIT 0 $ 362.00 2: $ .00
12/03 US TREASURY 303 SOC SEC C $ 362.00 3: $ .00
12/01 BANK OF NEW YORK PENS PMTS C $ ~lfv4j,) 46.06 4: $ .00
11/26 CHECK NUMBER 1461 0 $ 105.00 5: $ .00
11/18 CHECK NUMBER 1460 0 $ 54.09 6: $ .00
11/18 CHECK NUMBER 1459 0 $ 55.59 7: $ .00
F2 Options F3 Main Menu F6 Referral F11 Title F12 Previous
mM!!:~~ OfFICIAL CHECK 23-8711_ 288483363-fl
Issued by Integrated Payment Systems Inc., EngleWood. C.
BUFFALO, N,Y. 14240 Bank One, NA, Denver, Colorado
ORA.WER M & T BANI<
DATE
PAY
-' TO THE : (1~.
.'d .., ./' II> ORDER OF i (to; "I.. f Fli! "t 1 Fl'i'* ~ !)::.. 0' ~l"~
A~SlGNATURE H:l:UHHUU
II> ,t ":l~{Q)W1iA 1~~@@U~~~[L~ !
AUTHORIZED SIGNATURE d, to .
N01lCE TO CUSTOMER: The ~ 01 01\ -..nIIy Bond _be __ __.... _... bO ...- or _In'" -. i& 10ol. ........- Of_.
.-
REV-1511 EX+(12-99) .
~ '* SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Ah-lYlft AJ. I-./A/&
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
H 0 ~f- fN1 N" RotH ru N f/UtL H 0 M E.. g- J. 7 '" .S-o
.I
f" fS'i G-~A/VjtE t)Jo~J(5 ~) 5&7,OD
K {;(E. pt ION Pr ff E R. 'fu. NEI(AL 31;7. ~3
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name 01 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
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant A~+~UIl A LI N E- 3.. SDD.b-t
Street Address J.21l GQ€f-K.. 'j2D
City ('A-~LISlE.... State ---Ek... Zip t7013
Relationship 01 Claimant to Decedent 14 u OS gA fI) D 53 ,-oS-()
4. Probate Fees G I f. tv DA ~. S'tf2..AsgAu.c;.l-t- ~E.c;,IST~~ ~ WILLS
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ If.{ g)tf, ~3
(If more space IS needed, Insert additional sheets of the same size)
-- ~---- ~--- -.-- ---"
Hoffman-Roth Funeral Home, Inc.
~ 219 North Hanover Street
Carlisle, P A 17013
(717)243-4511
December 17, 2004
Arthur A. Line
1271 Creek Rd.
Carlisle, P A 17013-
The Funeral Service for Alma Naomi Line 14410-220
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have any questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
OUR SERVICE:
TrachtlOnal Funeral Service Package . . . . . . $3590.00
FUNERAL HOME SERVICE CHARGES . $3590.00
SELECTED MERCHANDISE:
Cameo Solid Poplar Casket. - . . . . $2475.00
Continental Interment Receptacle . $1260.00
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THATYOUHAVESELECTED . . . $7325.00
Cash Advances
Opening Grave. $420.00
Clergy Offering . . . . . . . . . . $200.00
Certified Copies of Death Certificates. . . $24.00
Flowers. . . $227.50
Hairdresser. . . . . . . . $30.00
Harpist . . . . . . . $150.00
TOTAL CASH ADVANCES AND SPECIAL CHARGES. . . 51051.50
,
Total
Total Cost . . . $8376.50
History
II /29!2004 CREDIT I Clergy _ $-100.00
TOTAL AMOUNT DUE . . . . . $8276.50
-' _._-~--
~IGINAL '. 2861 ACCT. NO. LAST BALANCE ~_~16 ,_!:it)
INTEREST
o LATE PAYMENT
I~
_.- ---~~---_.~---_.-
SUB TOTAL
-_.__..-._--~-_.- --
--"--- -----~- ---
CREDITS
---.-------_.--
~ECKl !q~/ cW~~~__ LESS PAYMENT _8d]~!:5[)
~EDIT
.-
~ .
Eby Granite Works
- P.O. Box 187, Newville, Pa. 17241-0187 ~. . S. 8..t......
Phone: (717) 776-5118 ~
Name /7/:. TA u r }-1 .; (A) <.. Dat~ ~-jb-OS
Address /[;::.7/ 1'1 k.' e~,K)<~/r/ (J /..1.:' /"<, Ie r-'c.:. zip ./7121 3
Phone,~ C;:3 - 8'; (/1 L, 2 2 ; e Comer Post 0
Monument d -4 )( {) -~ V / - (. /;;~. j5-~ Flower Vases 0
Slant
Base 3-a-;. t -() x/)-L J<Jrt &::'1) KindOfGr.anite~7 /.l;:~(jU. '~
, .
Bevel Cemetery\/;'~'I / )'f{' "j.....Lt p
", Grass Marker Name on back FOUNDAnON
Ooesign ~ IEQC] WARRANTY
,
,/
l' 11 ORD
I N L f1 rcTH It..(Z..~!, P.O.~
,,-' I N f;- '._ POS
I l/~, "'--- .
q (). .- . ' ,.., <:: I ('I' I -::::t GRA
. ,.' Ue<L ~<-I IiiII ,
~(.k /j.~ ) " I S VAS .
,} () U ....;; ';). J (.) ,J 4- POSTS
1""'-'\
~ ' . 7-L GAR S
..... ", {--:./ . ' d p. f\ ~ 1---' COM
-;i. ,(:Y-.t.......u......t1:r...~:t.f:x.+.~.:;;::........ take full responsibility for the accuracy B & J
of the above spellings Md:dates. '
o 0 Check How to Letter Letter this way - opposne
. Unit Price $-:?5<g'7 Flower Vase $ Corner Post $ Misc. $
-$ I SO Total$dJ 37 Deposit$/~ J'-/ Balance$'/'a Ix
. (L)(# j4lfr-, . ,
I agree that said memorial, with title thereto and right of possession thereof, shalTii.rlain your personal property untU I have paid fOf
full. In default of any payment hereunder, I Ijcense you to repossess and remove the said memorial, without guilt or trespass or other wr
land authorize and empower you, in my na",", and on my behalf, to apply to the man&gemellt of said cemetery or other premises for a PE
.' for its removal and to take any otheflrteps you may deem necessary or expedient and furt'fl8r agree to save you harmless from any e
repossession and removal; you may retain said memorial or dispose of it at your own discretion without being answerable to me for it or
proceeds therefrom.
Orders subject to canc:eIIation. AI contracts contingent upon strikes, accidents, and other causes beyond our control.
I understandthat30days after placement of the memorial a ANANCE CHARGE will be entered on the billlngdate.ltis~edbya peri
rate of 1 Y.l % per month which is an annual percentage rate of 18 % applied to the previous balance before deducting credits, payments or ad
purchases appearing on this statement. To avoid FINANCE CHA~GE pay the "New balance" before the billing date next month.
. u......."." .......... "I I I rrTCDlUft aNn n&~ r.N~N ON .BOV~ ORDER ARE CORRECT.
~ RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH Receipt Date: 1/04/2005
cumberland County - Register Of Wills Receipt Time: 11:18:04
One Courthouse s~uare Receipt No. : 1038970
Carlisle, PA 17 13
LINE ALMA NAOMI
- -- - -
Estate File No. : 2005-00005
Paid By Remarks: A LINE
VZ
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS ADM 60.00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 8.00 CUMBERLAND COUNTY GENERAL FUN
JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN
----------------
Cash ~83.00
Total Received.. ....... 83.00
- -,
-~
-"-.--
RECEIPT FOR PAYMENT
=============;=====
GLENDA FARNER STRASBAUGH
Cumberland County R . Rece:!-pt Date: 3/29/2005
One ~ourthouse s~~reeg~ster Of Wills Rece:+Pt Time:
Carl~sle, PA 17 13 Rece~pt No.: 11:10:19
1040083
HOUSE ACCOUNT
- --
Estate File No. : 2005-99999
Paid By Remarks: PHOTOCOPIES
JA
------------------------ Receipt Distribution
Fee/Tax Description ------------------------
Payment Amount Payee Name
MISC INCOME
.50 CUMBERLAND COUNTY GENERAL FUND
Cash ----------------
Total Received ~.50
. .. . . " . .. .. . .50