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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1-.
DATE OF BIRTH (MM-DD-YEAR)
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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 of Trust)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
ONLY
FILE NUMBER
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COUNTY CODE YEAR
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NUMBER
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DATE OF DEATH (MM-DD-YEAR)
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
~ 1. Original Return
o 4. Limited Estate
~ 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
SOCIAL SECURITY NUMBER
7/7 - 09
5{POJ'
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
i 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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TELEPHONE NUMBER
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4. Mortgages & Notes Receivable (Schedule D)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
14. Net Value Subject to Tax (Line 12 minus Line 13)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
COMPLETE MAILING ADDRESS
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(2)
(3)
(4)
(5)
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(6)
(7)
(9)
(10)
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(11)
(12)
(13)
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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)
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)
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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
IS
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x .0_ (15)
x .0 'is: (16)
x12 (17)
x .15 (18)
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(19)
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Decedent's Complete Address:
STREET A RESS
STATE
Pft
CITY
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Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
Total Credits (A + B + C ) (2)
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
-II I /.f. tJ?
4.
Total Interest/Penalty ( D + E )
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
(3)
(4)
(5)
(5A)
5.
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 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
ZIP / 7/)02-5
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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
No
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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 true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN~TURE OF PERSON RESPONSIBL~ FgJ3,FILlNG RETURN
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
PA 17/.).;2. D
DATE
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DATE
ADDRESS
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)l.
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 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 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 of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
REV.1508 EX+ (1.97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
, PERSONAL PROPERTY
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I
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOlve 1J )... .
DESCRIPTION
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VALUE AT DATE
OF DEATH
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TOTAL (Also enter on line 5, Recapitulation) $ 3 3 j 3 7 '1. 'I~
(If more space ;s needed, insert additional 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
L.
bAKER
NEb
FILE NUMBER
ITEM
NUMBER
A.
Debts of decedent must be reported on Schedule I
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Vi ue (' fflQmc.fl~1 Herne... 1>4- Cr ectmo--fIDIlJ 6erv1c.es, rIVe.
(l ~/DD ..Jc.1e s-I-b.<:>,-v Ro(, J-I1::.7) PA f7fO[j
........ '(' eo.. YY\ 0..-+ , 0 f"\ c: 0 s.T
r0b+I~e. of d...Qa...fh /N !lJe.w~~pl+per
TLJ I. n /7 i/c,ehe_Ke- 67-. fY)Rl2us;,I/e, jJA /7v,s'3
,,/{I)ITV LA. e._I..:... J 7 '
fYle.a...l a.'P+ev- de('Vic..e..,
/ 76 9~
Ilt / .:3 3.5-: OD
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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
3.
2. Attorney Fees
Year(s) Commission Paid:
4.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant -.a D n n I-e.... ,-. 13 A Ke r
Street Address ~ D S- tV H t 'j h 6 -I-
City ~ LA- Y\ C 4. Y\ t1 () ^
~ :3S0(). DD
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Relationship of Claimant to Decedent
State ~ Zip
clo..~ h. t~ r
17t)OZD
Probate Fees
If; 03.. DO
5. Accountant's Fees
7.
6. Tax Return Preparer's Fees
-
TOTAL (Also enter on line 9, Recapitulation) $ S; .;2 '1,1. 9 ~
(If more space IS needed, Insert additional sheets of the same size)
To Whom It May Concern:
In May of 2004 I moved in with my father, Ned L. Baker, at 96
Autumn Lane, Enola, Pa to assure he received the proper medicine,
meals and had transportation for his numerous medical
appointments, etc. He decided he would move in with me in
Duncannon, so I could return to my home and then both his and my
expenses would decrease. We were to move into my home on
January 29, 2005, the day he died.
REV.1512 EX... (1-97)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
13 A- Kt:~
FILE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
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)...,
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
1.
d3CL(\)Kc!'-QC-cL Se\uIC€S (UISIt
U e. 'r/ z. D tV (Pht;/Ue ~;- II')
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5r~rL;-mcjIJ7 )
AMOUNT
-4 Lj' J>;;. It SJ
". /9, 77
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0.
A.:55 DC:...~ QfecL ~,.c!.'.O ID 9' 'sf:s
gilt). ()C)
TOTAL (Also enter on line 10, Recapitulation) $ Ie / ;Z, ~::<.
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
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FILE NUMBER
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NUMBER
I
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not LislTrustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)J
J3 D '(\ () I e.. J.....'B f+ K e ~
8'D5 f\J. H ('f"- 6+ ~;tIA.Lf~ f e t
DiAn <'..QY)f1bY"\) PA J7b::1..D
1.
dl. Re e,{ L.'J3 f1ke-12
7 rI / II ;(DCLcL
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.
AMOUNT OR SHARE
OF ESTATE
1/ cJ.
1/0/
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.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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 size)
REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
No. 2005-00106
Estate Of: NED L BAKER
PA No. 21-05-0106
(First. Middle. Last!
Late Of:
EAST PENNSBORO TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 717-09-5608
WHEREAS/ on the 2nd day of February 2005 an instrument dated
23rd 1978 was a~~itted to probate as the last will of
NED L BAKER
(First, Middle, Last)
la te of EAST PENNSBORO TOWNSHIP, CUMBERLAND County,
who died on the 29th day of January 2005 and/
WHEREAS/ a true copy of the will as probated is annexed hereto.
THEREFORE/ I, GLENDA FARNER STRASBAUGH / Register of Wills in and
for CUMBERLAND County/ in the Commonwealth of pennsylvania/ hereby
certify tha t I have this day granted Letters of ADMINISTRA nON c. TA. to:
BONNIE L BAKER
who has duly qualified as ADMINISTRA TOR(RIX) C. T.A.
and has agreed to administer the estate according to law/ all of which
fully appears of record ~n my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF/ I have hereunto set my hand and affixed the seal
of my office on the 2nd day of February 2005.
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* *NOTE* * )1.LL NAIVJES _4EOVE APPEAR (FIRST/ ~I1;JIDDLE/ LAST)
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LAST WILL AND TESTAMENT OF NED L. BAKER
I, NED L. BAKER, of R.D. #3, Box 850, State Road 11 & 15,
Duncannon, Perry County, Pennsylvania, being of sound mind,
memory and understanding, do hereby make, publish and declare
this to be my Last Will and Testament, hereby revoking any and
all wills by me heretofore made.
ITEM I.
I direct that my funeral be conducted in a manner
corresponding with my estate and situation in life and that all
my just debts and funeral expenses be fully satisfied as soon as
may be after my decease.
ITEM II.
I give, devise and bequeath all that rest, residue
and remainder of my estate, whether real, personal, mixed, of
whatsoever kind and wheresoever situate, unto my loving wife,
RUTH L. BAKER.
In the event that my said loving wife, RUTH L.
BAKER, should predecease me, I give devise and bequeath all that
rest, residue and remainder of my estate unto my children:
BONNIE L. BAKER and REED L. BAKER, in equal shares, share and
share alike.
ITEM III.
I nominate, constitute and appoint my loving wife
RUTH L. BAKER, to be and act as Executrix of this my Last Will and
Testament. And ~he shall serve in such capacity without havin~r to
post any security bond for the performance of her duties as my
Executrix.
L
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IN WITNESS WHEREOF, I have set my hand and seal hereunto
this 23 Jt..l-day of , 1978, A. D.
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(SEAL)
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NED L. BAKER
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Page 1 of 2 pages
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The preceding instrument, consisting of this and one other
typewritten page, each identified by signature of the Testator,
was on the date thereof signed, sealed and published and declared
by NED L. BAKER, the Testator therein named, as and for his Last
Will, in the presence of us, who at his request, in his presence,
and in the presence of each other, have subscribed our names as
witnesses hereto.
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NED L. BAKER
( SEAL)
Page 2 of 2 pages