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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX. RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
II 05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
00559
NUMBER
I-
Z
UJ
o
UJ
o
UJ
o
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Gearhart, H. Ruth
DATE OF DEATH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
204-01- 7607
DATE OF BIRTH (MM.DD-YEAR)
06-14-2005
04-16-1915
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
01.
04.
06.
09.
o
D
D
D
4a. Future Interest Compromise (date of death alter
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal Poverty Credit (date of death between
. 12-31-91 and 1-1-95)
Original Return
2. Supplemental Return
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
o 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
Limited Estate
Decedent Died Testale (Attach
copy of Will)
Litigation Proceeds Received
....
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(I)
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NAME
Wm. D. Schrack III
FIRM NAME (If applicable)
COMPLETE MAILING ADDRESS
124 W. Harrisburg Street
P.O. Box 310
Dillsburg, PA 17019-0310
TELEPHONE NUMBER
717-432-9733
1, Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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5
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) D Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(11 )
18,792.45
7,484.13
0.00
12. Net Value of Estate (Line 8 minus Line 11)
(12)
13. Charitable and Govemmental 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)
(13)
(14)
7,484.13
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 10.00 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z
0 7,474.13 .045 (16)
j:: 16.Amount of Line 14 taxable at lineal rate x
cl:
I-
;:) (17)
0- 17.Amount of Line 14 taxable at sibling rate 0.00 x .12
::E
0
0 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
x
~ 19. Tax Due (19)
0.00
336.34
0.00
0.00
336.34
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00:
Decedent's Complete Address:
STREET ADDRESS
116 Regency Woods - North
CITY Carlisle
I STATE PA
IZIP 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 )
336.34
0.00
Total Credits (A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is theOVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
(3)
(4)
(5) 336.34
(5A)
(5B) 336.34
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
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 without
receiving adequate consideration?......... ................... .................. .............. ................. ............. ............... ........ 0
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.
Under penalties of pe~ury. I declare that I have examined this return. including accompanying schedules and statements, and to the best of my knowledge and belief. it is true. correct and
complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
StGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
James L. Gea art
No
[!]
[!]
[!]
[!]
[!]
[!]
DATE
1 Clemens Drive - Apt. 15
Dillsburg, PA 17019
2.. - 010 - D ~-
DATE
ADDRESS
L ~ ({.'. Qj--
ADDRESS
DATE
124 W. Harrisburg Street
Dillsburg, PA 17019-0310
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 transfers to or for the use of the surviving spouse is 0%
[72 P.S. 99116 (a) (1.1) (ii)]. The statutedoes not exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even 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 for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 99116 (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 noted in 72 P.S.
99116 1.2) [72 P.S. 99116 (a) (1 )].
The tax rate imposed on the net value Df transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (a) (1.3)]. A sibling ;s
defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
_// ,------
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Rev.1508 EX+ (8-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gearhart, H. Ruth
FILE NUMBER
21-05-00559
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properly JOlntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Capitol Blue Cross - premium refund
VALUE AT DATE
OF DEATH
115.60
2 Liberty Mutual - refund of premium
71.00
3 M&T Bank- ckg acct #36634093
737.52
4 M& T Bank- savings acct #015004211211856
1.420.24
5 Members 1 st FCU - CD #131980-54
4,191.11
6 Members 1st FCU - savings acct #131980-00
25.00
7 Mutual of Omaha - auto insurance refund
33.19
8 rebate check received
3.26
9 Refund of pro rata share of lot rent and taxes from sale of mobile home
279.66
10 Proceeds of sale of 1981 Atlantic Mobile Home - Title #33782605001 GE
18,000.00
11 Proceeds of sale of 1991 Honda Coupe - VIN 2HGED6459MH536631
800.00
12 Proceeds of sale of personal effects in mobile home by Bricker's Auction
260.00
13 Ruby and diamond ring (see appraisal)
340.00
TOTAL (Also enter on Line 5, Recapitulation)
26,276.58
(If more space is needed. additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group. Inc.
Form PA-1500 ScheduleE (Rev. 6-98)
~
,
~ M&TBank
499 Mitchell Road, Millsboro, DE 19966 Mail Code DJ3..MB-12
Phone (&&&) 502-4349
Fax (302) 934-2955
July 05, 2005
Schrack & Linsenbach
Attorneys At Law
124 W. Harrisburg Street
P O.Box 310
Dillsburg, PA 17019-0310
Re: Estate of H Ruth Gearhart
Social Security: 204-01-7607
Date of Death: June 14. 2005
Dear Sir or Madam:
Per yom inquiry dated June 23, 2005, please be advised that at the time of death, the above-named decedent had on deposit
with this bank the following:
1.
Type of Account
Checking Account
Account Number
36634093
Ownership (Names oj)
H Ruth Gearhart *
James L Gearhart, Lynn B Miller, POA 's
Opening Date
08/28/64
Balance on Date of Death
$737.52
Accrued Interest
$ 0.00
.---i737:"52--..---------------------------...---------..---..----------------.--..---.
Total
2.
Type of Account
Savings Account
Account Number
01500421121J856
Ownership (Names oj)
H Ruth Gearhart *
James L Gearhart, POA
Opening Date
03/04/05
Balance on Date of Death
$1,420.06
Accrued lnterest
$ 0.18
.-ii;42Cfi4-------------------------------------------------------------------
Total
SAVINGS 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
CERTIFICATE OF DEPOSIT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued I nterest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Estate of: H. RUTH GEARHART
Date of Death: 06/14/2005
Social Security Number: 204-01-7607
,., 1-
MEMBERS 1st
FEDERAL CREDIT UNION
131980 -00
03/30/1993
$25.00
$.00
$25.00
None
131980 -54
01/24/2003
$4,188.44
$2.67
$4,191.11
None
JJ.BERS 1 ST FEDERAL CREDIT UNION
1t~ /l~
enise A. ~t
Insurance Services upervisor
July 22, 2005
II
5000 Louise Drive · P.o. Box 40 . Mechanicsburg, Pennsylvania 17055 . (717) 697-1161 · www.members1st.org
NUMBER
134239
CERTIFICATE OF VALUE
MANUFACTURED HOUSING
CASE/FILE NO.
S~ &fO'
APPRAISED VALUE:
Cost Guide Edition - Mo.Nr.It'v./lu..; / <!)S-
Yellow Value Chart Page # Jq
Depreciated Replacement Value of Home .... $
Park In Place Location Value (I.P.L.V.) ......... $
Total Value of Accessories (less repairs) ...... $
Indicated Value by the COST APPROACH ., $
Fee Land Value ............................................. $ f.,) A
) Estimated Remaining Physical Life in Year j9-2~>A.i; (R.P.L.)
or
ESTIMATED MARKET VALUE................... $ I ~
N.A.S. SUBSCRIBER 1.0.# 400~ PRINT YOUR NAME n.qA......J/~ 1. j<'h~l...l. PHONE (1l1->"sg-Y/f/
r~'g ~~~~~'~~~ ~~~~~~~~~gsl~1*~~g~~1=DT~~ s~~~~~aired ~Present Condition OCompletion Per Plans & Specifications
SEE REVERSE SIDE OF THIS FORM FOR APPRAISER'S
CERTIFICATION AND STATEMENT OF LIMITATIONS.
PREPARED FOR: or 0 (See below)
Firm Name
Address #
City State
lip Phone # (_)
Ordered By
o BORROWER OCLlENT
Name
Address i CU!;,...~~~ 0./-1
City ..z;JIU_.si8oA4-
lip 17~/q Phone # (::uL)
Ordered By
DESCRIPTION: 0 Park Model
Year 1991 Mfg. of Home
Trade Name A""L .......JTU_ Size
Other OTag-A-Long OExpando OTip-Out Size
Total Est. Living Area ........................................... 11130 Sq. Ft.
I.D./Serial # CHIJ CJ 7-J-a:::> 7-1'77L ONot Verified
Home Overall Condition Rating o Excellent ~ood OFair o Poor
Appraisers Certification and Statement of limitations
I HEREBY CERTIFY THA T(A) I have no undisclosed interest in the herein described manufactured home or its site location. (B) I have no present, nor contemplated
future interest in the property that is the subject matter of this appraisal report. (C) I have not been influenced in any manner whatsoever by race, religion, sex or
national origin of any person residing in the propelty, or in the neighborhood wherein the manufactured home is located. (D) No important facts have been withheld
or overlooked in estimating the subject homes' current market value. (E) It is understood that my compensation for appraisal services rendered is in no way
contingent upon the valuation found, but is dependent only upon the delivery of this completed appraisal report. (F) Neither this report, any portion of its contents,
nor any copy thereof, shall be used for any purpose, (advertising, public relations, news releases, sales, or other media), by any person or entity, including the
recipient client, without prior, written approval of the author of this report and the client. (G) This appraisal is made on the premise that there are no encumbrances
or regulations limiting the utilization of the appraised property, other than those herein reported. (H) The legal description was taken from the identification numbers
on or in the structure, if accessible, or from registration records, if available, and no inspection of the title was made. It is assumed that the registered/legal owners
have right to pass title. (I) No liability is assumed for the legal character or influences affecting the property. (J) No engineering tests have been made, and no
responsibility is assumed, for the soundness of the structure. (K) It is assumed that efficient on-site management and adequate maintenance shall exist in
connection with the future use of this rental/lease park, P.U.D., or fee property, other than those reported. (L) I (we) have personally and thoroughly inspected,
both inside and out, this manufactured home and made a drive-by inspection, with photographs, of each comparable sale used in the market analysis. (M) The
information contained in this report, gathered from reputedly reliable sources, cost estimates obtained from published manuals, or any other figures, values, or
representations, are not in any way guaranteed as to accuracy. (N) To the best of my knowledge and belief, the facts contained in this report and upon which the
opinions expressed herein are based, are correct. (0) I shall not be required to testify, or appear in court by reason of this appraisal report, with reference to the
property described herein, without prior arrangements made with my consent. My consent can be given accordingly, as time permits and for a fee charged for such
expert testimony. (P) Any breach of the above listed provisions shall render the material contained herein invalid and subject the violator to any and all liability
resulting from such actions.
FORMALDEHYDE - Building products or materials normally used in the construction of mobile/manufactured homes may release airborne contaminants or
Formaldehyde vapors into the home. Prior to February 11, 1985, there were no governmental standards or requirements relating to the emission of vapors or
contaminants from residential building products or materials. With no established standards, and not being a trained air quality expert, it is submitted at the time
of this appraisal J did not detect any unusual air emissions or vapors. A Formaldehyde notice is required in all new mobile homes sold per H.U.D. Code Title 24
Part 32-8.
RADON GAS - In certain areas of the United States a naturally occurring radioactive gas may form in or under some site built homes. On September 12, 1998,
the federal public health service issued a lung cancer threat notice. It is submitted at the time of this appraisal, as I am not a trained E.P.A. Air Quality Tester. This
appraisal is based on the assumption this subject home is free os a hazardous radon gas level.
POLLUTION HAZARDS - Some mobile home parks and/or sites have been developed on land fills. This appraisal does not include a report or tests to indicate
whether past or current activities in, on or near the subject home have contaminated its soil, water or facilities. (National Environmental Policy Act 1967.)
~1tA-U~Ci 1.., 1("~,.,.sA.f.'-_
(Appraiser) Print Name
I personally inspected property
(REV. 2/96 V.P.)
(Review Appraiser) Print Name
Date ~/2 4./..,-.o~- Phone (lCL) 'XS';.Ji' 111-
, ,
o did 0 did not inspect property
Address
229 ~~A.'J' ;~uA~ ;P"
.
Signature of Review Appraiser
C,4AL '.:11. ~ J.2,. 17CjJ .~
I ....
Firm Name
City
State
Zip
Copyright@ 1996 by National Appraisal Guides, Inc. All Rights Reserved. No part of this form may be reproduced. stored in a retrieval system, or transmitted
in ~'"Hf fnrm nr hI! ~ml lYle~nc;: j:)1t:>r-trnnir mA('h;:mir:::l1 nhntn('nnl/lnn n~r.orrlinn or ()thp.rwi~A without nrior written oermission of National Aooraisal Guides. Inc.
N.A.S. FORM #3
SETTLEMENT STATEMENT
1"/ 11~4r
, ATE
Sellers: r., 1'"A""~ 6 ~ If. ,f7.qTf4 6~ r(ARr
Buyers: 0J -4 (?, E"..tA7
SELLERS TRANSACTION
SALE PRICE :
LESS Commlslon:
lESS Payoff:
LESS Other: 6..'5?DC. s;".-. h.
LESS Other: O'-/1:IiJcf.! 1.L>r- KE...sr
LESS other:
PLUS Proration of Lot Rent:
PLUS Proration of Taxes:
PLUS other:
DUE TO I FROM SELLERS
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*********.**************************************************************************************************
BUYERS TRANSACTION
SALE PRICE:
Title Fees:
I
C,AjU4L7 Insurance
Closing Fees: IE
Proration of Lot Rent: Jd"...y~
Proration of Taxes:
School U2.l1Ay4 1f".1I.1 County a/rIA"-' ].",
Other !.J,AIJ lj.q<tj..ttYI' F.... "
Other -1PJOA '.4A.. Faa
Other .(l-v u.... ,- 1''''.....:1
Other ;.:'J.LX;>I) Ct;LlT.
Other
SUBTOTAL
Less Deposit Received:
lESS Amount Financed:
TOTAL CREDITS
DUE TO I FROM BUYERS
DISBURSEMENTS
fflOCEEns b E-S7"A/tGOF H ~T?JC;~MIfAKI
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Job #
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06' - i31
Years
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/7 71:].,1);(:)
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;; ;:J 79, 0~
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MUNN'S DIAMOND GALLERY, LTD.
Leading In Diamond Styles
1203 Market Street
lEMOYNE, PENNSYLVANIA 17043
(717) 761-8310
TO WHOM IT MAY CONCERN:
This is to certify that we are engaged in the jewelry business, appraising diamonds, watches, jewelry and
precious stones of all descriptions.
We herewith certify that we have this day carefully examined the following listed and described
articles, the property of:
NAME J~ ('~art I The Estate ofH. Rulli GearlJart
ADDRESS I Clemens Drive, Apt. #15, Dillshur.g, PA. 17019
We estimate the value as listed for insurance or other purposes at the current retail value, excluding
Federal and other taxes. In making this Appraisal, we DO NOT agree to purcbase or replace the
articles.
The foregoing Appraisal is made with the understanding that the Appraiser assumes no liability with respect to
any actio t may taken on the basis of this praisal.
Octoher 20, 2005
DATE
..~~~...><IIilt: _.~,,-::,-,_._ ~
REV.1151 EX+ (12.99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gearhart, H. Ruth
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-00559
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 7,937.11
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees Wm. D. Schrack III 3,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 4,181.60
TOTAL (Also enter on line 9, Recapitulation) 15,618.71
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev.1502 EX+ (6.98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gearhart, H. Ruth
FilE NUMBER
21-05-00559
ESTATE OF
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Malpezzi Funeral Home
6.942.11
2
Rolling Green Cemetery - interment fee
995.00
Subtotal
7.937.11
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule H-A (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-87
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Gearhart, H. Ruth
FILE NUMBER
21-05-00559
ITEM
NUMBER DESCRIPTION AMOUNT
1 Carpet Mart - replace soiled carpeting in mobile home prior to sale 718.81
2 Cost of sale of mobile home 2.700.00
3 Cumberland Law Journal - estate advertisement 75.00
4 Oerr's Hauling - removal of debris from mobile home 155.00
5 Harrisburg Patriot News - estate advertisment 113.61
6 Liberty Mutual homeowners insurance - debt of decedent 71.00
7 Liberty Mutual. homeowners insurance premium 71.00
8 Lowe's - painting supplies, etc. to prepare mobile home for sale 38.20
9 Members 1 st FCU . ckg acct and CO research fee 39.00
10 Munn's Jewelry Store - appraisal of ring 25.00
11 PP&L - final bill 44.98
12 Register of Wills. additional Short Certificate 4.00
13 Register of Wills. probate fee 126.00
Subtotal
4.181.60
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H.B7 (Rev. 6-98)
Rev-1512 EX+ (6-98)
.
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Gearhart, H. Ruth
FILE NUMBER
21-05-00559
ESTATE OF
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Com cast Cable - debt of decedent
VALUE AT DATE
OF DEATH
18.49
2 George K. Shaninian, MD, LLC - last illness
23.65
3 Lynn B. Miller - repayment of monies borrowed for dental work
1.332.50
4 M&T Bank loan pay-off - debt of decedent
61.02
5 PP&L - debt of decedent
45.00
6 Regency Parks - August 2005 lot rent
295.00
7 Regency Parks - July 2005 lot rent
295.00
8 Regency Parks - September 2005 lot rent
295.00
9 Silver Spring Beverage - balance due
65.00
10 Suburban Gas - debt of decedent
198.69
11 Verizon - debt of decedent
17.49
12 West Shore EMS - last illness
526.90
TOTAL (Also enter on Line 10, Recapitulation)
3,173.74
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
. '
REV-1513 EX+ (9-00)
*'
SCHEDULE ..
BEN EFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
NUMBER
Gearhart, H. Ruth
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
Clistributions, and transfers
under Sec. 9116(a)(1.2)]
I.
Linda L. Champlin
34440 Dogwood Drive/Pot Nets - Bayside
Millsboro, DE 19966
James L. Gearhart
1 Clemens Drive - Apt. 15
DiI\sburg, PA 17019
Judith C. Gearhart
565 S. Shell Rd., Lot C-12
Debary, FL 32713
Michael Gearhart
4212 Roush Road
Middletown, PA 17057
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
FILE NUMBER
21-05-00559
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
Daughter
1/4 of residuary
estate
Son
1/4 of residuary
estate
Daughter
1/4 of residuary
estate
Son
1/4 of residuary
estate
Total
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
0.00
Copyright (c) 2002 fonm software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Fonm PA-1500 ScheduleJ (Rev. 6-98)
~~ qo .Oel
Po Coo ,ou
1-\ P .b 20. 00
~-~
((y 5(0 )
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 006070
SCHRACK WM Dill ESQ
124 W HARRISBURG ST
POBOX 310
DILLSBURG, PA 17019
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
____nn fold ---------- --------
101 I $336.34
ESTATE INFORMATION: SSN: 204-01-7607 I
FILE NUMBER: 2105-0559 I
DECEDENT NAME: GEARHART H RUTH I
DA TE OF PAYMENT: 12/07/2005 I
POSTMARK DATE: 12/07/2005 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 06/14/2005 I
I
TOTAL AMOUNT PAID: $336.34
REMARKS:
CHECK#123
INITIALS: JA
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
PLEASE FILE THIS REPORT WITmN TWO YEARS OF DATE OF DEATH REGARDLESS OF
THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY
UNTIL COMPLETION
STATUS REPORT UNDER RULE 6.12
Name of Decedent:
Date of Death:
Estate No.:
H. Ruth Gearhart
June 14. 2005
21-2005-00559
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect
to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal representative reasonably believes
that the administration will be complete:
(date)
3. If the answer to No.1 is yes, state the following:
A.
Did the personal representative file a final account with the court?
Yes No X
The separate Orphans' Court No. (if any) for the personal representative's
account is: (Not Applicable in Dauphin County)
Did the personal representative state an account informally to the parties in
interest? Yes X No
Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of the Orphans' Court and may be attached
to this report.
B.
c.
D.
Date: Dec 6. 2005
"61l>~~ oc.Jlcu-1
Sig, r
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o
c:.:
f i.
r-
1
James L. Gearhart
Name (Please type or print)
c/o Wn. D. Schrack, III
P. O. Box 310. Dillsburg. PA 17019
Address
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(MAH:rmt/ AM3)
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717-432-9733
Telephone No.
Capacity:
~
I
Personal Representative
R.W. . 58
Counsel for Personal Representative
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