HomeMy WebLinkAbout03-10-06
,
,
217
REV-1500 EX (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
21-05-0895
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
COUNTY CODe . YEAR
SOCIAL SECURity NUMBER
I -4
207 -34-560~ ~ .
NUMBER
....
z
w
c
w
o
w
c
THIS~U~N;~UST BE FILED IN DUPUCATE WITH THE
> REGISTER OF WILLS
SOCIAL SECURITY NUMBER
/.
Christ G. Salisbu 714-18-221'1 .
~ 1. Original Return 0 2. Supplemental Return O~. Remainder Return (date of death priorto 12-13-82)
o 4. Limited Estate 04a. Future Interest Compromise (date of death after 12-12-82) .05. Federal Estate Tax Return Required
~ 6. Decedent Died Testate (Attach copy of Will) 0 7. Decedent Maintained a living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes
o 9. Litigation Proceeds Received 010. Spousal Poverty Credit (date of death between 12.31.91 and 1-1-95) 011. Election to tax under Sec. 9113(A) (Attach Sch 0)
1!1~I~~ittH~$~~$g<<rtmJ~!Mij$ti!i~t~Q_iit.jm\ij~lgQllgipQij.N$g]~ijtt$QtmJQiijjjMrtjgJliQ6M*tfQtU$ijQijijQJ.1~mRt&tltffo~W}tr~
NAME COMPLETE MAILING ADDRESS
Robert M. Fre 5 South Hanover Street
FIRM NAME (If Applicable) Carlisle, Pennsylvania 17013
DATE OF BIRTH (MM-DD- YEAR)
3/22/2005 9/12/1924
(IF APPLICABLE) SURVNING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
W
I-
llI::~CI)
o~~
Woo
3:Q:-1
Oa.aJ
a.
c(
....
z
w
c
z
o
a..
(f)
w
EX:
EX:
o
o
717 243-5838
1. Real Estate (Schedule A)
(1)
(2) NONE
(3) NONE
(4) NONE
(5) NONE
28,380
OFFICIAL USE ONLY
r"""",)
~'~.:::,~-
C'./'"\
2. Stocks and Bonds (Schedule B)
C)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
z
o
~
-I
:J
....
0:
<(
o
w
EX:
6. Jointly Owned Property (Schedule F) (6)
Dseparate Billing Requested
7. Inter-Vivos Transfer & Miscellaneous Non-Probate Property
(Schedule G or L) (7) NONE
35,358
e"
8. TOTAL GROSS ASSETS (total lines 1-7)
63,738
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)
21 ,382
42,356
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)
42,356
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) 42,356 x .0 - (15)
Z
0
i= 16. Amount of line 14 taxable at lineal rate x .0 (16)
~ -
:J
a.. x .12
:e 17. Amount of line 14 taxable at sibling rate (17)
0
0
>< x .15 (18)
~ 18. Amount of Line 14 taxable at collateral rate
19. Tax Due (19)
20.0 ..i::.':'.::.,._.(trl~.I$:~~ . ,.. "__1
!1ffff!rJltJt1~1!JrrJrmJItIIf!1!1W1!~tiUt.1!$URettfi!*8$WIRM~ijttQUi$nQN$1!1QNfRgYjR$Gi$Jb~~i*NQtiIQHjQKJjAnUi1!gfff~1!1~11}rfr}f}~tt~IrfI!1J:~;;;;tm1ji'
ece en s omp e e ress:
STREET ADDRESS
197 Goodvear Road .
CITY ../ I~TATE IZIP
I I ~
Carlisle '\ .... .of PA 17013
I ~
...
217
o
Dorothy J Salisbury
d t' C
I t Add
I' ..
( ,
Tax Payments-,~~~'Credits:
1. Tax Due Wage'1 Line 19) (1)
2. Credits/Payments.:
A. sJousal Poverty'C.redit
pc ./.
B. Prior Payments
C. Discount
207-34-5608
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
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)
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.
8. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(4)
(5)
(SA)
(58)
/t~~?~~~~ttt:~::t~~ttt~:t/t~tft~ttt~~~:~i}!tt~~?tttt?~~tir~~;~~r~~~i~~~::~~~~fu~~~~i~~~~~gi~~~~~~:s~~i~0;:~~~~~b~~~:{i~i~is~~~~~~~~:~~~~t~tftt~~tftt~i~~~~~~~tttttt:~t:~?ttt~~t~~tttt~trt~~~~::~:
5.
1.
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and:
a. retain the use or income of the property transferred;
Yes
D
D
D
D
D
D
D
No
~
~
~
o
o
~
~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
b. retain the right to designate who shall use the property transferred or its income;
c. retain a reversionary interest; or . . . . . . . . . . . . .
2.
d. receive the promise for life of either payments, benefits or care?
If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . .
3.
Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?
4.
Did decedent own an Individual Retirement Account, annuity or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . .
DATE
I
197 Goodyear Road. Carlisle. Pennsylvania 7013
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
(,~ ~. r:}?
ADDRESS ~
5 South Hanover Street, Carlisle. Pennsyla via 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. Section 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. Section 9116 (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. Section 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. Section 9116(1.2) [72 P.S. Section 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. Section 9116{a){1.3)j.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.
....
217
REV-1502 EX+ (6-98)
SCHEDULE A
.; REAL ESTATE
": .,
10 .
~ . / FILE NUMBER
. .
Dorothy J Salisbury 21-05-0895
All real property owned solely or as a tenant in common must be r~ported 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 b.eing compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned wIth right of survivorship must be disclosed on Schedule F.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
ITEM
NUMBER
1.
DESCRIPTION
Lots 23 & 23A, West Pennsboro Township, Cumberland County PA
VALUE AT DATE
OF DEATH
28,380
TOTAL (Also enter on line 1, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
28,380
..
~~.
"":
4
.I
l
t-3H
~t1:j
H
CD8'
:J::i.:
tI:l X.
H tx3-:-
L'CD
t"" "
~.
8~'
'Ot:t.1~
I-<
o
c::
~
CI] ..
:3:
o
~
t-3
G)... .
~.
G)
trJ
{J)t-3I-3H
r-':J:::fC:::~
- >=:::tJ
o !2:C:::
O(1t%j2;
t"" t.:P'O
~:l:" ~
. t:zj H 0 I-t
trJ::3C<1::1
t%j
~tIJ::01I1
OC:::: ~
::O:::c18
trJO~
~:t=l N
1::1 c:::: 0.........
1::1- C::::W
:3:~
t"'f tr3.........
trJo
::0 :::c1lJ1
trJ t"'f
o ~1-3
trJ 2:~
I-t 1::1>:
"0 [?:j
t-3 om
C/.l 0
-:E:
::0 H
tIJ L'
lO L'
c:::
tIJ tJj
Cf.l txj
t-3
tr.l
1::1
01-'
):11.0
~~
t""
HG)
eno
t""0
tx:lt:1
~
"t1tIJ
~:t=l
::0
~
~:::c1
00
~:l=i
WI::1
~
rT1
(j)
-1 CJ
-o-if"T1
rn>co
ZXQ
Zo:=o
cno-:J>
OJr-I
Or~
25 rr1 .
d~~
~SJJ~
Z::s
~ C"1"N
- W
-at""
PJ~
::s
o,N
W
:t=l
"0
tr3
0\
N
"t1
G)
0\
1.0
C~r
r.a
~
L'
H
en
tIJ
c::::
~
I-<:
t:1
o
:::c1
o
t-3
=z::
I-<:
~
tJ::I
o
o
8
2:
o
www
COU1~
O'\I-'~
~
0'\
,
o
co
I
o
01
co
~
I
o
N
~
WNI-'
Naco
--
~
>-
c:
G'")
I'-:)
<:::)
<:::)
<..n
t""
:t='
~
::u
tXJ
Z
()
tXJ
t'1
:J::I
Z
t%j
ttl
[?:j~1-f
Z(jCf.l
:l=itx.:Jo ~
L' 0 ~
1-3 c:::
to< Z
1-3
ZOO
Ot:r:Jc::::
<:"Ot""
81-<
I I 1
1::10:l:"
tzjOC::::
OI-3G)
c::::
en
W
0)
0\
W
L\J
~~
o::r::
</.0
~o
Nt"'f
w~
....:J.
U1tx:l
3:
t-3nwt:1
[:1j:t:'LTltx:l
L'roOtIJ
- L' 0
HtI:l:;O
.-.C/):t:':J::lI
...Jt"'f!:t1::I:
I-'trJ2:
...J... en ~
- 1-3-
N"tI:J::I
.{::lo:l=itD"t1
W t""H
l~tIJt'O
tn~ trJ
t'Vo::o::u
CDJ-lO
t'Vw::t::'
10
~
~
o
N
~
;,
3:
~
;,
3:
rn
o
=z::
o
o
~/".~-r-.~ c-'
3:
OCJ1-38
:l:it-1:I::C::::
rnoc:::tr:1
:z:r:a::om
tXJCJJt.::I
Ot.::lO:l:"
Z :tl'1-<
t-1=Z::to<
t<O
t"" .-q-~
:l:" I-P'tPt:l
~t:1:3::3:
8:t:'
tt:11-<: I ,
~en
~O'\
l-':t:'ttl"O
NZ:3::::C
.........0
N
tn....:J
......... .........
ON
tnJ-l
c .
c
~ .
z.
C)
.... .
:2:
rn
"0
m
~
o
c
~
~ .
.... .
:; i .
en .
>
!: .
0'
c
z
....
1.0
.........
CO
~
I-'
.........
I-'
-J
~ N
~ o~.
~ o~.
~ U1-<
~tI:l I m
~HO~
~G)m
m
~rn~
6 "t:I txj
.. ::u :l:"
Ht'"f
2:
G"ltIl
C/.l
C/.lt-3
O:l=i
:I:: 1-3
Otx3
o
t"'18
:J::.'
0>:
I-t
CJJZ
1-30
::01-3
HH
00
1-3tt:l
*
*
*
,.
~
c::::
t'1c
t<~
m
~
N
o
o
tn
N
CO
>
en
en
m
en
en
3:
m
z
-4
W
CO
o
~
CO
~
CO
OJ
r=
,...
z
~
n
.....
{J)1-3t-3H
r-'~C::~
- ::<~
o zc:::
OOt:t.1z
t"'10"tl
~:l=i :t=l
t:zjHOH
trJ:3:<:t:1
t'%j
)ozjtI1:::c11I1
OC::: .oe:::
!::O~8
tx:20J-l
::t::':l=i N
t:1c:::n.........
tJ-c::::w
:3:J-l
t"1 tIJ.........
t'%ja
!::O ~01
tIJ tot
n ~1-3
tIJ Z::t::'
H tJ::<
"t1 t:r:J
1-3 aen
C/) 0
-~
~ H
tIJ t""
to t""
c::::
t:Ej tIJ
00 t%j
1-3
t:r:J
t:1
)-f- /~0?1
.J1,~
OJ-l [JJ
tb'1.O :J::I ~
~~ t-t m
tot H I
H G'l 00" 0
000 tD 0)
totO c::: I
l:%jt:1 ::0 0
to< I-< U1
t'(jt:z:j CO
tb':t:' -J
:;0 0 1
I-' :I:: 0
-Jl:O ::0 0
00 H ~
I-'~ CJJ
wt:1 t-3
I<
::f Gl
rn
C/) ~
-i CJ
~~
Z~~
(j') ):::>
OJ r+og:r:
g~:E
o~.
--!-l~
. 0-0
~Q.:::o rn
~ ;0
tJ]~
r" ~ J-l
0. =0 UJ
CD ~
~
rt
f-H
PJ
I-' Gl
o
tIJ 0
~ tJ
r" to<
I-' tIJ
0. ~
p. ::0
~
\Q ::0
o
:J::I
t:l
.J
~
on
n
1-3
z
o
1.0 co co
Q'\-JU1
OWU1
~~I.O
~wO'\
trJ:l='H
ZOoo
:z,.trJo
L1 0
t-3 c::
to< z
t-3
Ot:r:JC::
<:"t1t'1
t-3to<
1 I I
t:lO:J::I
tz;10c:::
OI-3G)
c:::
r:a
../
I
\
l'
~)~
~ ;L_
8nwtjo c
trJ ~ U1 t:tj ~" ::0
t"" ~ 0 tD ~tOl
- tot 0 /,,":-f a
HtIJ~ ~G)m
- 00 :t:':J::I tD
~ tot ::O::I: !;oo ~
J-l t:tj z a I"(j trJ
....:J... co:e: .. ~ ~
-.. 1-3- Htot
N"t:I:t:' Z
~:t:'tIJ"O G'ltrJ
w totH co
I ....., trj ttl [f.u-3
Ul-J t:z:j o::t::'
NO::Ol:O :I::1-3
001-'0 000
NW::t::' 0
It:l t'11-3
~ :t:'
~ t:1>:
o H
N OOZ
1-30
::01-3
HH
00
1-300
W~
..,J
Ultt.:l
3:
::.e
o
."
3:
'Qf.
"0
...",
)to
:t
CJJ
n
::r:
o
o
." .."........... L"
3:
OOt-3t-3
:l='t'1:I::C::
Cf.Ioc:::trJ
:I::OO!:OrJJ
tJ:jCJJtj
Ot:lt:l~
Z :l='t<
t'1:I::.oe:::
1<0
t'1J-l~
:l='H"O"O
t-.rJt:1:3::==
8~
t1jJ< I I
:::c1[f.l
~cn
......:l=''"C1''O
N 2: ===::c.
........t:1 .
N
Ul~
........ .........
ON
UlJ-l
1.0
.........
CD
Ul
0)
a
)to
)to
ot
~
C4
c:::
~'C
1-<':
iT
~
3:
N
o
o
U1
c -
c
~ .
z
CO)
.... .
%
en
"0
m
:tI
o
C
-J
a
~
:J.
~
'l.
.'J.
:3
~
~
~ -
....
:2:
(ii
>
3:
o
c:
z
...
~
co
~
-J
~
J-l
........
~
-J
~
~
('
I-
,
217
REV-1509 EX+ {6-96}
COMMONWEALTH OF PENNSYLVANIA/'
INHERITANCE TAX RETURN /
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
\""'
I ~ .J
ESTATE OF
t
j.: /
Dorothy J Salisbury / : 21-05-0895
If an asset ~as mad~ joint within one year of the decedent's date of death, it must be reported on Schedule G.
/ /0" "., .
SURVIVING JOINT TENANT(S(NAME
FILE NUMBER
ADDRESS
RELATIONSHIP TO DECEDENT
A. Christy G. Salisburg
197 Goodyear Road,
Carlisle P A 17013
Husband
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY % OF 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 DECEDENrSINTEREST
1. A. 2.15.68 Farmers National Bank 135 50.00% 68
2. A. Real Estate, 197 Goodyear Road, W.Pennsboro Township 70.580 50.000/0 35,290
TOTAL (Also enter on line 6 Recaoitulation) $ 35.358
(If more space is needed. insert additional sheets of the same size)
..
~, FARMERS NATIONAL BANK
OF NEWVILLE A Division of Adams COllnt)' National Bank
J
\.....
/, ~. 4
f
November 17, 200~ J
./
'/
-4
~
I
Robert M. Frey, Esquire
5 South Hanover Street
Carlisle, PA 17013
I
J
RE: Estate of Dorothy Jane Salisbury
Dear Mr. Frey:
Mrs. Salisbury had a joint checking account with her husband, Christy
G. Salisbury. It was opened February 15, 1968 and was with right of
survivorship. The balance as of March 22, 2005 was $135.43.
Sincerely"yours,
~-dY.- ~ I
/'Carolyn H. KOUg~
Executive Vice President
1?O. Box 156, Newville, PA 17241 · (717) 776-5312
.
./
../ /
/ ~ ~
\ ": 4
/, ..
J .; r-I
oof ~f
) ('I"')C"'- Q U N Q
I .
I l:- I- oQ'r- ['xl 0 r:- ('I"') ['xl
z
-. C"'- .. r-l :;:) 8 z CO r-i 8
/~ 0
~ ; ~-~ ......... . ::e ['xl tJ) ..J ~ ......... lO r.a tJ)
CO" r-i < ~ r.a ..J CO r-i CO ~ riJ
i A r-l . en ::::J a5 r-l r-l ('I"') ::J
. . s:
I- ~ 0 ...:J 0
CO - ~ ~ riJ CO ~ r.a
......... a. H ~ ......... H o:i
- ..0 C1 ~ . .... 0 0\ ~ .
z
~ CO 0 OJ w CO lJ) 0 tf.l
I.'
r Ln r-lLn tf.lU 8 ~ ('I"') r-lLO lO tJ)U 8
f.. 0 tf.l r.a 0... CJ'J NO 0 (J) Iil p.,
;., NO 0 CJ'J 0
0 ......... ......... it: :;:J Q ~O H W 0:> ......... ......... if ::;:J r:a C} >::0 H
r. CJ'J ILl
r:- r:-Ln LU t!;)80 .::x: .::x:Z ri1 CJ'J N I:-Ln (!)8U Z 0... r:t::z; ['xl
r. a. a.
:. N en :;:J()['xl 0 8~ U < N en ::;JUr:r:J r:t: E-f~ 0
0......... s: .::x: 0 0 ~ ~ .-1 r:r:J 0......... s: .::x: 00 .....:/ N ...J rx:J
:ilE:::E:ZN . l- I 1 I 1.00:; 0:; ::E:::E:ZN . l- I I I lO 1.t'l0:4 0:::
0 ~ 0
o...o...~r-t z >t8 0::: o,-f Olil O.dl~ ~ r-l .z >48 r:a opa
\Dr:- . 2 ~~> .::x: res .........t:O .....:/ lOt' . it: ...:J~> t) m .........a:l ...:l
rno::: :;:) ~ri10 rx:J r-l::E: LO rno::: ::l ::;:JIilO Z ~ r-l::E:
LO 0 r-l . Q
0 I 1>tr:r:J >4 o,-f C"1:;::J .0 0 I 1>tr:r:J mz riJ C"1::J .0
0 ~8 ::E 0 ::s .........U::;JO 0 ~E-I ::E 0:; .........U::JO
N :E:::E:OIJ:. 0 CQ N .::x:.:x: N :E:::E:O~ ~ .:x: N r:t:.:x:
o...P-lH!d: 0 r-lOril ~~H,::C .:x: ('I") r-lor:a
r-i r-lr-i.....:/ 8 t!;) r-l 80::0:: r-l r-lr-i...:J E-f ...:J Nrc1 80:::0:::
0>4 :z; :>t ro >t ~O w O:>t :z; :>t s:: :>t ::JO
>4 :>t::I::...:J ~ 8 o,-f m~mr:r.. t;::>t :>t::I::.....:/ :::J 8 t2Sro mo:it:CIJ:.
:...:l :>t.::x: Z a. 0 .....:/ +J r.:a c.....:/ >rr:t: Z 0- 0 ..;J .....:/e.. Iil
::;:J .:x: cu:~ 0 of. Of.xJ.::x: ~ O>::E:riJ :::. ,::COO 0 rf. t..>r:a !d: ('I"') - O>:E:rxJ
t'J 0tJ)['il rnt):Z: r:- 0) HOHriJ ~ ornrit UJU:zt N+J :c H 0 t-n:;iJ .
Cl)o::rn~ H.::x:ri1 0"1 CL'd ,::C r:t:r:r.. rno:::rn::x:: H.:x:r:iJ ,:::Cf) .::x: .::x:IJ:.
riJ:::.O(J) r-l ~o,-f P-lO...:l ri1;::JOCl) P-l i~~ o..o...J
~ :::J::I::.....:/~ ::E :2:'CIl zr:at)o ~ ~tt:...:I.:x: Lt") Zri]t)o
~ 88t)t) 0: ~ OJ ~Z 0 ~ E-f8t)() c;::) :::lZ 0
c;::)
w a::~ 0::>:: . __....Jo-Jit~'J.. ~ C'J .~o 0:::>:: .
...:I .......~,..f4"'I. IJ:.:::lId:r-l .....:/ ~~.:x:r-f
0... 0 I c.!) 3:-10:::
0 o:.-r- HE-tE-toUl- 0 ~ :::> -10 H88oUl-
0 .~O 0 <t :COCO
::c 3 'f:S ~ <I:uCf)
t) U 0::: :z
U,) :c~ co rn oxz
.a:: (/) ...- CO<(W
0:: Z WI-a..
~ ~~ ~ o .-
~ ""... iC =: Cf)
0 w
~ I- 3
Cil8 (/) r:a8
u.J
()() (!) 3 U() ~
HH HH
80:: 0- >4 80:: 0- :>t
08 rf. 8 0('1"') 08 ff. ::I:: 0('1")
:z;rn N rn ,::Cr-i ZtI) N 8 ,::Cr-l
H 0 r:- H 00 H 0 ~ 0 00
:<0 oQt 0 0::: 0:;1:- >::0 qt N o:i O::t'
~ r- ::E 0 ::z= r-i .::x: t' ::e 0 0 r-l
~...:I 01 I U 0::; E-f...:l 01 I 0 ~
0 .::x:('I"')N r:- .:x:1d:: 0 .::x:('I")N r:- ~~
~O Or-lCD CO r:ao.. MO Or-tco CD Cilo..
;.t::I:: o:io:iON LO >4 >r E-f:I:: o:4Cl::ON LO >r >t
~t) Cil 1:'--10 0 o:i or:a .::x:U r:a t'LO 0 ~ or:a
~rn o..ri1r-iJ 0- 1 ~ 0.....:/ E-fCl) o..riJr-f1 0- J :;=J 0.....:/
f'J H...:J C"'1 rf. CO a:l 000 CJJ H...:J ('I") rf. CO c:o om
at!) o...c:o~~ 0 .CJJ t!>H pat!) o.d:Q tCt: ~ 0 00 t!)H
:zc .::x:o..N J H .-1 Z ~p..N J H .....:/
,JH .8 --. lO ....J 1:'--0:; riJO ...:JH .>.8 - lO .....:/ C"'-o:i :MO,
x: 0::;.. :::coo ...C"'- :lE \O('I"')r:- ~ .::x: mid:: .~8 ,::x:~ :31:1) ...t' :l: COON oQt ~ lJ)~ .~8
J 0..12 :Z;Mr-f paLO O'\~t' u.l r-lU -tCt: pa ~g zPar-l filLO r-fN('l') OJ r-tt) tCt:
~ t1J~ ~O::....Jt' t' . . ...J o:i CI) ~ :::I:o:i.....:/r:- I:'-- .. .....:/
lD ~~u.l- o:iC"'1 LO('I"')O 0 . . trJ ...J '. ~ ~ ,::x: 0:)'-' ~('l') qtr-ilO 0 CJJ...:I
<
) C>~ t):fr::QH LOt'lO Z : !xl H . \,Irt!) ~ O::t:QH ~lOOJ :z; .:.r:a H
)HIl- 0 ....J. ...:IN CD co 0"1 - .:< c:o ~OH~ 0 ,...:I . .....:/N ('I")('l')('l') . - >:: lI:l
t:Q~ roOO:::~ Ora:f 8 -ir::X: ~ .I m~ ~Oo:f.....:/ Orgi 8 . - F:l::
Co)
) w PaLO,::x:t:iJ Off. t) 800 Ln W rx:JLO~r:a Off. u
:t: Xo .5 800
) Co) Q('l')t)E-f :x:: 0 t) .' H 0('1")08 ::r::o t)
w . w::::. w H
) lll:: Ur-f ~ ~::I:: . r'.... 0 ~ ~r-i .::x: ~::I::
<
I ~ HE-! N :: HE-f
. i
t (
.~
",/
~1r 1~
f~~(;\ --I
~/ - p / . --g--t-f UC
.
217
REV-1511 EX + (12-99)
SCHEDULE H
FUNERAL EXPENSES &
...: AO'MINISTRATIVE COSTS
. 4
l. ~ ..
I. ,/
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Dorothy J Salisbury
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
----" .".
Debts of decedent must be reported on Schedule I.
I
/
/ ,DESCRIPTION
FUNERAL EXPENSES:
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State
FILE NUMBER
21-05-0895
Zip
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant Christy G. Salisburg
Street Address 197 Goodyear Road
City Carlisle State PA Zip 17013
Relationship of Claimant to Decedent Spouse
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees
Register of Wills, Filing Fee for PA Inheritance Tax Return
TOTAL (Also enter on line 9 Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
400
3,500
35
15
3950
.
REV-1512 EX+ (12-03) 217
SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, ../0 .
INHERITANCE TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS I i "-
ESTATE OF FIt.E NUMBER
Dorothy J Salisbury 2i1 ~O.5~0895
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unniimbu..sed medical expenses.
ITEM
NUMBER
1.
2.
I
DESCRIPTION 1/ ," .
VALUE AT DATE
OF DEATH
Recorder of Deeds
Commonwealth of Pennsylvania, Department of Public, Welfare, Medical
39
17,393
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
17,432
. .
217
REV-1513 EX+ (9-00)
COMMONW~L TH'OF PENNSYLVANIA
INHERITANCE TN< RETURN
RESIDENT D.ECEDENT
ESTATE OF jl : /'
o th J S r b / .
SCHEDULE J
BENEFICIARIES
FILE NUMBER
oro 'v als urv
I .~ 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 Christy G. Salisbury Husband 100% of residue of estate
197 Goodyear Road, Carlisle, Pennsylvania 17013
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
TOTAL OF PART 11- 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)
f
h~;
.. ~
:;:1'
....
': :f
~(
I'
"'; ~
::..~
If;;~
,
saJl8d f: JO "[ a~Bd
08 tOl. t -elUBlqAsuuad 'aIsn.rB;) 'g .0 "H 'sPBolIH: 4+aa .s.rW oq
'UlAOlUlunw 'EL XOS:
../ . "S90L"[ BluBAIAsuuad
~a+n6 H .r'B1S",. '}l'Ba.rn A.I'BW "S.IW "-e
. ~ 4
l .
)' .:
.f
:3UIM.OHO]
aTn 03.1"8 .ra:}.112nBp-dalS pUB ua.rpuq~ <3AlllW "Sa.rBqs 3uJUIBwa.r aq+ 0+ pappB
I ;'
aq pu-e asdBl HBqs sa.rBqs 'LpnS fnsSl/?~,.C3q. a.rcnn 11 pUB 'sad.rns Jad anssJ .rat{
.10 sI4 oi SSBd Ol paAJa~a.r aABl{ PlnoM. PU40 paSBaoap AUB a.IBlls alIi 'su~lSSB
pUB s..qaq .rlal{l '.rall{~nBp-da:}.s AUI snld ua.lpnq~ (g) aA1J AW o:}. Sa.lEl{s IEnba uJ
If:reanbaq PU'B as!Aap 'aAl~ I 'alBnlJs aq ABw aWBS aql .raAaOSa.laqM. pUE 'paxIW
pUB IBuos.rad 'rea.r 'alBlsa Aill JO .rapuIBwa.l pUB anplsa.r 'lSa.l a111 HE luaAa
qons ul uaq:j. 'SlEP (06) A:}.aUJU JO pOl.Iad P1Esa.roJB aq:). Aq am aA1AJns 01 nBJ
.r0 as-eaoap-a.1d 'A.lnqsll-es "0 AlSJ.lq;) 'puEqsnq PIES Aill PlnoLIS 08
.skep (06) AlauIu JO P01.lad B Aq aur aAIA.lns
UBtJS pUBqsnq pres AID pap!Ao.xd 'u..roqun pUB u..roq ua..rPULlo AID JO u01snF)xa
all:j. 0+ 'SU3!SSB pUB S.rl aq sIq , A.rnqsHES "0 A:j.Sl.rq;) 'pUEqS nll Aill O:}. LI1Banbaq
pUB aSIAap 'aAI~ I 'cq:en:ns aq .keUI aWBS all:j. .raAaosa.raqM. pUB 'paxJlU pUB
leuos .rad 'rea.r 'a:j:els a AW JO .1apupnua.r pUB anpJsa.r ':j.sa.1 aq:j. n'if 0 G
.OS op
0+ :}.uaJuaAUOO punoJ aq ABill SB q:}.Bap AUI .laUE uoos SB sasuadxa 1B.raunJ pUE
s:j.qap :}.snC AUI JO HB ABd O:j. .rOlnoax3: paWBU .raUBuIa.raq AUI l~a.rIP lor
"apBUI a.1010la.1aq awn AUB lB aUI Aq sHJM Ire pUE AUB PloA 3Ul~BW
PU'B 3U11\oAa.1 Aqa.1aq :j.uaUIB:j.sal. pUB nJl~ :j.SB'1 AUI .r0] pUB SB SlLIl a.1BI~ap
put? llsnqnd 'a}!8UI Aqa.1aq op '3UIPU8lS.1apun PU8 A.Iomaur 'PU1UI ~U1sods1P
pUB punos JO .:3uJaq '81UBAl-AsUuad 'Aluno.) pUBl.1aQUIn;) (a1811.1B.) 'SSt: Xos:
't 00 0 H) d!llSUM.ol. 0.1oQ8uuad lsalt\ JO '.l.HnS:SI'1VS or ,XH.LOHOO 'I
.l.HnaSI'1VS or AH.LOHOO
i[O l.N3:WV.LS3::l. ONV '1'1IM l.SV'1
(-()
c--.
~
~
"'~~
" '~
,:'
G'r;.:
,--
(~~~
C>c
f
~
";'~
..;..~:'.
~.v
...-:.".. ':it~..~..../..rt.~. ::...~.:'~.:.~'~::r:..~ ~I ~\~:,... .....,?~.:t:+-.....~t~~~~. .~:~~.~~'!I..,..7'..I!OI~,..~!..~~....... ~ '-tip "....~. , I'r' .....~n: :.5e . . ,~ i~'~":':..
:"\~'; , ':.;"l :'.,.'f.. ,. .' ".?:.:>:: ?i~r~.: ":..:,,::',, ~::!'~:'r~:,.,:::-~... ",'-: ; "" 'C .~ :~;;',: t: . ,,-';" ':~~:,' ,'I' I"':;", :~ .,,'" 1:\" '.' "
~
f ..
\ ~..;
;&i;l.t
I
11
.iI
~: -'~
j~-::~"t::~
I
sai3Bd t: JO E a1JBd
I
. ,
o Il
'^' v E 9 """"''''v
L--e ''Y__~
'sassautIM.. 3UnsanB SB saWBU .Ino paqJ.Iosqns o:}.una.Iaq dABq '.zaqlo
qOBa JO aouasa.Id al..Jl U1 pUB 'lSanbd.I .raq lB 'aouasa.Id .Iaq u1 'ot{M. "aouasa.Id
.lno u1 '+uaWB:j.SdL pUB IU.lY\ +SB'1 .laq .IOJ pUB SB 'paumu aAoqE Xl.I:j.B:j.sa.L aq:}..
.. XHnS:SI'lVS of XH.LOHOa Aq pa.IBl0ap pUB "paqsnqnd "palBas 'paui31S
-_.....~........---- ,...
f.. ':: .I
(, ....t.
L: .f)
t;: :;!
t. I
;
i
~:.:.tJ
:".:.~.;;,
t.~,
~
..-,:/.;;'