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Home My WebLink About05-01-06 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX( 11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT FOGLE TERRY WILLIAM 358 MOORE STREET MILLERSBURG, PA 17061 _____n_ fold ESTATE INFORMATION: SSN: 167 -40-1824 FILE NUMBER: 2105-0488 DECEDENT NAME: FOGLE MAGDA DATE OF PAYMENT: 05/01/2006 POSTMARK DATE: 05/01/2006 COUNTY: CUMBERLAND DATE OF DEATH: 05/08/2005 NO. CD 006630 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $7,000.00 101 I $1 , 111 .54 I I I I I I I TOTAL AMOUNT PAID: $ 8, 111 .54 REMARKS: TERRY FOGLE CHECK# 6127/252033 SEAL INITIALS: CM RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS --.J 15[]56[]51[]47 REV-1500 EX (06-05) ~~~!.~~l~;l::::~~._~~~~~L~~_L ii~iTERNDEC~EDEI\'-T^I'NFORMATION^BEi..OW . ^ Social Security Number Date of Death Date of Birth 1 (p f) Lj 0 r .~L ~ Decedent's Last Name o ~ of DO S' Suffix l1>1ZL }.q. z .<7 Decedent's First Name MI ~ fJb L[ (Y. (f bf) .//.L.'C..C..J...IC (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ '1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate 4a. Future Interest Compromise (date of death after 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) 8. Total Number of Safe Deposit Boxes 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 11. Election to tax under Sec. 91 '13(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPlETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ('\ ~<l-fL () F-D6L c ~{ r'1 J~) ]! J 7 Firm Name (If Applicable) First line of address s=? -:: (::-') t'''-.,) c;::::> c:) t,:,,;,.-" 'J} 1'2Lf--tlk) Second line of address ~ODO () lTu.c ~. l"":...J po kJJ lUG TO tV fA , '1....] 3 ---- ) :.;..'*"'- ~-~ City or Post Office State ZIP Code (..,) o Correspondent's e-mail address: .. >'.'" 'n _'n"," "....._ ,'c.-' ,,,,.",,", ... ," "",".'-', d"'~~".^""""".'''''''''.,...~._.''"",-,~",''''''''-....T'''''W''''''''-'''''_~''''-...<.''''''~'',.....-""".,.".."~^,~.."""'''-...~.~~"................,.,,..,._.>....,........<...>h''''~''....,',-"-...."..,'_~>'^,":....^~-..,<...~"....-._~,."..,. .""....'w.,.'.." '.,,' ,~.'.',,,,,,,,,,,,',".,''',,, ,....'..'...., .~_.~>...."...'._>.'h.~"_.,."..., "'., ..,. ,-",''''''''',.' ., ". . Under penalties of perjury, I declare that I have examined this return, indudtng accompanying schedules and statements. and to the best of my knowledge and belief. ~~~~:~~~~~~~~~- II . ~{tl."'-I..Lv.'!.o___~tJ.~l!~q"^ _mLJY~k~,"^_Rg4.n__-.",',"<.~~_ ~J ~~ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~ M DATE /J "',...,'., .... ""^'W'~"_~W"W"'~"_~"M'"'''''~''^"''^''_M__''''',_'.^"..^'',,~-'_..^~,_~_.._~J"""~_M}~':!.~_'~__W__,_~^"_.,_",,<f_~'.N~'''&ktE-(~r/!1'^"'N! ,701.; I ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056[]51047 15056051047 ---I o Cj-45f d- Co 0 ?eU pi ~ (pD pu~ .~.,~ dfJP 0 C,.. ~tV\ 5/' --.J 15056052048 Decedent's Social Security Number REc1:J'-Jcl:f!~if:--~J&U1>2L__J;,-oL_______.____~ki._itlL___L~~'L. REV-1500 EX 1. Real estate (Schedule A). . . . . . 1. DL 2. Stocks and Bonds (Schedule B) .................................... 2. . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. ~? 9&:] <= L 6. Jointly Owned Property (Schedule F) Separate Billing Requested 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) (.:::::J Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. ,- ~.S- "L7) b ~o .rL 10 C./L eYL 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). .. . . . . . . . . . . . . . . . . . .. 11. I I Tl> '2~~ 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.O.l:(...S;; 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. t:lll-;;Y . 17. 18. 19. TAX DUE . . . 19. rl I.J.~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056052048 15056052048 --1 REV-1500 EX Page 3 Decedent's Complete Address: DECEDENTS AME File Number z~ rr CITY STAT19#- Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditsiPayments A. Spousal Poverty Credit B. Prior Payments C. Discount '671/~C71 (1 ) Total Credits ( A + B + C ) (2) If / 3. InterestlPenalty if applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (3) (4) (5) t'// 51 (5A) (58) KIll ,>y 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 S + SA. This is the BALANCE DUE. 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;..............................................."'........................................ D a : ;:::;~ :h:~;~s~~:~Si~I~;::I~:~. '.h.all~~.t~~~~~~t~~~.~.~rll~.I~COrn";... ........ .............. ...... ........... ........ B d. receive the promise for life of either payments, benefits or care? ...................................................................... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 3. ~;:h~~:::;~;:~~~a:::~:~:a:;~bl~~;;;;;; .~~~~ .~~~~;;;;~f~; ~~~.~; ~.~;;;;;; ~;,.,~;................. B 9 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .............................. ... .................................... ...... .................................. ........... 0 l}D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 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 three (3) percent [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 zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)). The statute does not exemot 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 jf 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 zero (0) percent [72 P.S. 99116(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. S9116(1.2} [72 P.S. s9116(a)(1}]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [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.: :,()2 EX" 16-::'8\ '{". 0..,- If /.c,. SCHEDULE A REAL ESTATE cc.,r,i1MC'f-j'/JEA.LTH OF FEf,JHSYLV,Lj'..jL[, !f'iHERITpJJCE r..;\ RETU~'r,j RESiDEr' iT DECEDENT ESTATE OF (i FILE NUMBER Z D o:S:D 0'-11 All real property owned solely or as a tenant ~ mnon 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 survivorship rmast be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH ) ~5[' f < s', (JeW (/{ ,ShI) l II -: )7- D'~~ ( ) I / DO t;) <~C-~~ 0~Zj ..::-/9 i <1 'I~ 9 ~ TOTAL (Also enter on line 1, Recapitulation) $ ) 57 ~ LJ () ,') 0 7 (If more space is needed, insert additional sheets of the same size) C:;EV-1:,C'S E/.+ (6-:~(B\ .e..-. ~- ,.0 1i!{.. '~l\ .~. . SCHEDULE E CASH, BANK DEPOSITS, & MISC~ PERSONAL PROPERTY cr:A'.1!\11Cr,J//Et,LTH OF PEl~r'JSYLv'A}jL.cc ;!"'JHER1Tf\I'.lC:E TP...,:( F~ETIJRi"J F-?ESiDEUT DEC':EDENT ESTATE OF {1iT-b s of litigation and the date the proceeds were received by the estate. -owned with right of survivorship must be disctosec:l on Schedwe F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 5Dvt:Lo...- '--:E:~L S~M, r (J:L/, P-C(.'7 t! I to Y l( 01/ Z l'L )]Lf JJ 2~J7 }bYI71v~7 19 l )1, 'l ( N fl".J~ { '1/ q 7, Ill) (Z JI,qJ) C{1-j ,-,+ (L,.y /. I 0 \ '<..- t<- ~~ "'-' l j iC.) r) 7 () 0 I L~ f ~ V'9 L'N(OL.,'\J C"'-',,~ il') Y ~ Y Sl--(it C::xlPv.s A J Lj 00 li) lauo H-v"":'l( '~.o ~4A-"1'l,y(( o JD D · 0, vJ\ JVb L..,v"--> Li,),,,",, <<~ lz 5o~ \ L()J(~ iT CrJJ ~ '(J. (<. ~Ll~ 'v cI) t.:;.:, ........ ~~ o . "-..Ie:" C S e ,", TOTAL (Also enter on line 5, Recapitulation) $ , ~ ,~ (If more space is needed, insert additional sheets of the same size) "EV-jC,11 EX' 112-9:1'. (/.'if.-Hv1Cf,Jv\!E/-',LTH C)F F'Et'.lf'1SYLi/,IJ'J!.t- ;t\JHEP!TldlCE T/:J.X FiETURhl ~~ESfC!Ei-.-iT [,~E:,='E[JEr'.lT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF n ~(2ffLE ,vL FILE NUMBER ~I LDOSOOLtV.y (J (Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. 77~C~ ~ ~lh (ke&-1C C' -Z7~ ~ B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name ot Personal Representalive(sl 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 Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees J1L( Cb 5. Accountants Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9. Recapitulation) $ ~3~5. Go (If more space is needed, insert additional sheets of the same size) REV.,512 EX. <12-{}31 * SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ( FILE NUMBER Wi) Do ITEM NUMBER 1. L J ~ 1.-1, ent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. VALUE AT DATE OF DEATH DESCRIPTION ttO"->c WIh L ~~ U .v~1 h Itv:) ~ ~"'-L IbL ~ LcP,f-h1L {~S( ~{~tiL-t f-bvSL fL..pf)-)lL ~'1/V'l-I [j ~L-~::#-- 2 ( f f II G-fC-l.IC jk L ~ l(-nL-m[,> I U-c.P/ T (iu ~~ /LfJJlt L1S:~ I 7 )~ oor LJ Fbl )) TOTAL (Also enter on line 10, Recapitulation) $ 01 / b) !:;"c (If more space is needed, insert additional sheets of the same size)