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RE\l-1500 EX (6<10)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
"2 \ - ~ 5
COUNlYCOOE YEAR
~~\;:)~:L
NUIlBER
'* COMMONWEALTH OF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENrs NAME (LAST, FIRST, AND MIDDLE INITIAL)
ASH Goldie M
SOCIAL SECURITY NUMBER
208-24-0628
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Return (dale of death prior III 12-1U2)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. EIeclion to tax under Sec. 9113(A) (AlIacl1 Sd1 0)
NAME
David Ash
FIRM NAME (K Applicable)
40,000.00
2,157.60
OFFICIAL USE ONLY
DATE OF DEATH (MM-DD-YEAR)
12/18/04
DATE OF BIRTH (MM-DD-YEAR)
01/08/15
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6,581.48
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
N/A
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~ 1. Original Return
D 4. LilTited Estate
D 6. Decedent Died Testate (AlIacl1 copy of WiI)
o 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale of doolh alIer 12-12-82)
D 7. Decedent Maintained a Living Trust (AlIacl1copy ofTIIJSI)
D 10. Spousal Poverty Credit (daleof_~ 12-31-91 and 1-1-95)
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(8)
3,884.15
894.06
(11)
(12)
(13)
48,739.08
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COMPLETE MAILING ADDRESS
1110 Foxianna Road
Middletown, PA 17057
TELEPHONE NUMBER
(717) 944-4706
4,778.21
43,960.87
20,000.00
(14)
23,960.87
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. JoinUy Owned Property (Schedule F)
D Separate B~ling Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total GI'08S Assets (lolal Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liab~ilies, & Uens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estata (Line 8 minus Line 11)
13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
1,078.23
(19)
1,078.23
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
(10)
14. Net Value Subject to Tax (line 12 minus Line 13)
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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)
._9.0<t x .0 ___ (15)
16. Amount of line 14 taxable at lineal rate
_____.______~_~960.8L x .0 _._ (16)
x .12 (17)
x .15 (18)
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
pt
Decedent's Complete Address:
STREET ADDRESS
6 Chester Road
I ZIP 17025
CITY Enola,
I STATEpA
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
-_._----~
Total Credits ( A + B + C ) (2)
3. InteresVPenalty if applicable
O. Interest
E. Penalty
TotallnteresVPenalty ( 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 Une 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 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 Accoun~ 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 peljury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowtedge and belief, n is 1rue. correct and complete.
Declaration of preparer the personal represeniaOVe is based on aU information of which preparer has any knowledge.
SIGNATURE OF PE 0 RESPONSIBL R F~,G R~
ADDRESS Il ~
------Lt/~_ .~~~_ ~t!_--/?h.'. ~(/J1-1/'4_L7(JS-7______________
SIGNATURE OF PREPA~ER OTHER THAN REPRESENTATIVE ' DATE
ADDRESS
DATE
02/08/06
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. ~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) (ii)].
The statute does not exempt a transfer to a surviving spouse from lax, and the statutory requirements for disclosure of assets and filing a tax retum 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 paren~
or a stepparent of the child is 0% [72 P.S. ~9116(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. ~9116(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. ~9116(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.
REV-1502 EX+ (609*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GOhO/~ /7l !l.5H
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 jointly-owned with right of S,urvlvorshlp must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
6 Chp...! rc.#_ '~<JA-'>
E""J<:>l...4, _)'~NNs7 L. V4NI,4
'/3 .:r;tJ ,-e7Le.t r
/70 ~S"
t./ 4 o~o. (,)CJ
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
Yt:J 000.0 c;
REV.I503 Ex. (1-97)
SCHEDULE B
STaCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
00i:O(fi. f'/l fl.s H
FILE NUMBER
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
10- -1;<00, #- $E /.2,1&".5 6E g"qUI/Vr-.!: .Ljd/fYO"'-
:<. /5? roo
TOT At (Also enter on line 2, Recapitulation) $;;1 / SZ (0 0
(If mnrA !;nar.e is needed. insert additional sheets of the same size)
REV-l508 EX _('_97)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
GcJ /-OrE;J1. Ils H
FILE NUMBER
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1.
JJ C)U..! G ~CU D
,/0
f :!"1 ."""1....,' /,/'::: _
/ E rt i. is. l' II ((' l. '-I 4u C;Z C!JI'~ 5:E~u t' c.t!!'
3/ '75/. /5
P fit-- EIlI'JL fJ-J~ .s(V041;A;;(~5 3 I 30,33
TOTAL (Also enter on line 5, Recapitulation) $ 0, 6' B /. <fB
(If more space is needed, insert additional sheets of the same size)
RE\I.1S11 EX+ (12.99)
~k
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
(~':1.; l)(E Ilr Hs. H
FILE NUMBER
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. PI C. f.J IJ,K I) ,f.cr! /~ /. t €.K>:i (.. JJO/YlE. ~ ENO/..A) 01
1/ ..") (J.5. ;' b
...,'
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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
Year(s) Commission Paid:
2. Attorney Fees .3 ;;J. ?. 39
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(' -00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. 1... e () IV G 6"/l..t..Ac.f'1. ;:; II~ hI $EIt_ $00.00
TOTAL (Also enter on line 9, Recapitulation) $ ~ 8EY/. IS
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV.tS'2 EX. (..97)
SCHEDULE!
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
) .:,..i I ~ ;' j 1/ ;l...st-i
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
11/ /tT/ON!-<-"/oF J/\/5LOL;CI./...)G€,
;l.,O.&:8CJ
<>?
I ~I "'!~1.S
. /)t; .c'- ':"'htJ/Le. C-/'
'i
6/(' /2.. ()J>.1
1'1- 3 =<
/38./ ~
;( 7. gd
1a.7'()~
.3 t..f /. 0 .;\,
3
P ?~ L-
.s
r;(~S loJ
b
~
ffJ.tJfQ,t-T'1 I,A-'"
TOTAL (Also enter on line 10, Recapitulation) $ 8 74f, rJ~
(If more space is needed, insert additional sheets of the same size)
RE:V-1513 EX+ (9-00*,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
(POL-DIE fYJ- /).5/1
FILE NUMBER
NUMBER
I
RELATIONSHIP TO DECEDENT
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s)
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
AMOUNT OR SHARE
OF ESTATE
1.
S e-e J)crfi/t.. 1I"7~trlGrl&D
lip; 000 O~,
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 J? _ . J
C olt../(cl<~nNE :Z:;:,;v,oEj'I!F/IJ.PE'JV1" ..,.Q/f,?r/.sr ehu.A:t:.J1
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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)
L./{)otJ,o 0
C. 1& r~re-
Or
Co.:JJ-D,e ,4s rJ
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... V.4LeNc..IA1 ell ql.J81
GAit-II:) Q~N
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1000.00
(0 C cCc LI'fi Il.sl'i
tf/~I (f) Ff/WN D I!.llJe
#AAA/S,BLlL.3, f'/J /7/1.;1.
(b ~rr/V I) f".frf.lflJ it: If-
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7. {!, #A./sr/NE ;7. !30e.oE/:!$
... 3.s: J)NNerTE lJlt./vE
E/VIJL/1 f.IJ 17{);z..:5
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f. m. .8ox ~.3 () Y
. ~ H /,<. C fnlt/'l.$ r,:UQ;v, /A 17011
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7 if 4:, Sv OI<,Q J( 0 H a
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/0 J;;- jC.;e, y J.... 4 ~ H
1080 (;WN;'./I'(..,- /<0.17.0
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RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17G13
Recetpt Date:
Rece:J-pt Time:
Recelpt No. :
2/09/2006
15:31:17
1043340
ASH GOLDIE
Estate File No. :
Paid By Remarks:
2005-00047
DAVID ASH
RSK
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
INH TAX RETURN
Check# 2437
Total Received.........
15.00
----------------
$15.00
$15.00
CUMBERLAND COUNTY GENERAL FUN