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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FilE NUMBER
21 05
COUNTY CODE YEAR
00820
NUMBER
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after
12-'2-82)
o 7. Decedent Maintained a Living Trust (Attach
copy of Trust)
o 10. Spousal Poverty Credit (date of death between
12-3'-9L~nd 1-1-95)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
- ---- ----- .. ..- ------.-..-
NAME COMPLETE MAILING ADDRESS
Michael M. lerominski
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 260601
HARRISBURG, PA 17126-0601
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Clayton, Howard W.
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DATE OF DEATH iMM-DD-YEAR)
DATE OF BIRTH (MM:tD-YEAR)
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SOCIAL SECURITY NUMBER
142-22-4315
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (date of death pnorto '2-13-82)
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5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A)(Attach Seh 0)
28 S. Pitt St.
Carlisle, P A 17013
(1) 62,000.00
(2) None
(3) None
(4) None
(5) 19,996.60
(6) None
(7) None
(8) 8\ ,996.60
(9) 3,245.00
(10) 9,661.68
(11 )
12,906.68
09/01/2005
12/21/1927
(12)
69,089.92
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
(13)
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)
(14)
69,089.92
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
20. 0
15 Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
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"- 17, Amount of Line 14 taxable at sibling rate x .12
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~ 18 Amount of Line 14 taxable at collateral rate 69,089.92 x .15 (18) 10,363.49
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19 Tax Due (19) 10,363.49
~ 1, Original Return
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4. limited Estate
6. Decedent Died Testate (Attach copy
of Will)
9. litigation Proceeds Received
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FIRM NAME (If applicable)
Turo Law Offices
TELEPHONE NUMBER
717/245-9688
1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
3, Closely Held Corporation, Partnership or Sole-Proprietorship
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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)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
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)
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH<<
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-(0)
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Decedent's Complete Address:
STREET ADDRESS
80 Fairview Street
CITY
Carlisle
STATE PA
ZIP 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)
10,363.49
Total Credits (A + 8 + C)
(2)
0.00
3. InteresVPenalty if applicable
D Interest
E. Penalty
TotallnteresVPenalty (0 + E)
4. If Line 2 is greater than Une 1 + Line 3, enter the difference. This is the OVERPAYMENT.
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 the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 10,363.49
(5A)
(58) 10.363.49
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;....... ..................................... ~ I
b. retain the right to designate who shall use the property transferred or its income;..
c. retain a reversionary interes!; or................................ . ................................. .. ......................
d. receive the promise for life of either payments, benefits or care?.................................... ........................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?........................... . ............................. ................ ... ................ 0 t8l
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. 0 t8l
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?.... ........................ . ................................................. 0 181
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 personalrepresentat,ve is based on an informan""ofwhich preparerhasanyknowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS
Ka~n SlUSS. er \'.'
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C.. .. ............ ........ HUU
'IGNA TU~PERS N R SPONSIBLE FOR FlUNG ~URN
DATE
61 Marilyn Drive
Carlisle, 1> A 17013
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ADDRESS
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SIGNATURE OF PREPARER O~THAN REPRESENTATIVE
Michael M. Jeromioski
ADDRESS
( 17 i ;./ >:/-,
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D,t..TE
28 S. Pitt St.
Carlisle, P A 170 I 3
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 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)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
*'
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
tNHERIT ANCE TAX REnJRN
RESIDENT DECEDENT
ESTATE OF
Clayton, Howard W.
FILE NUMBER
21 - 05 - 00820
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 survivorship must be disclosed on
schedule F.
ITEM
NUMBER
I
DESCRIPTION
VALUE AT DATE OF
DEATH
62.000.00
80 Fairview Street
Carlisle. PA 17013
TOTAL (Also enter on Line 1, Recapitulation)
62,000.00
ESTATE OF
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Clayton, Howard W.
FILE NUMBER
21 - 05 - 00820
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
I
DESCRIPTION
VALUE AT DATE OF
DEATH
152.09
Geico
Insurance Refund
2
Checking Account
12,263.08
3
1994 Saturn SL I
VTN# IG8ZH5594RZ250073
2,500.00
4
Members 1st Federal Credit Union Savings Account # 51227
79.70
5
Cash
139.38
6
Federal Income Tax Refund
974.00
7
Console Color Television
25.00
8
Miscellaneous Used Furnishings
100.00
9
Miscellaneous Kitchen Items
75.00
10
Yard and Garden Tools
25.00
11
Jewelry
50.00
12
Compact Discs and VHS Tapes
500.00
13
Washer and Dryer
100.00
14
Comfort Mobility Adjustable Bed
3,013.35
TOTAL (Also enter on Line 5, Recapitulation)
19,996.60
'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clayton, Howard W.
5CI-EDlLE H
Fl.teW.. EXPENSES &
1OJ6S1RA11VE COS1S
FILE NUMBER
21 - 05 - 00820
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Auer Memorial Home and Cremation Services
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
State
Zip
2.
Attorney's Fees
Turo Law Offices
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
I
Other Administrative Costs
Central Penn Business Journal
Advertise Estate
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
85.00
3,000.00
85.00
75.00
3,245.00
COMMONWEALTH OF PENNSYLVANIA
iNHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clayton, Howard W.
2
Cumberland Law Journal
Advertise Estate
SchecUe H
Funeral Expenses &
AdTinistraINe Costs continued
FILE NUMBER
21 - 05 - 00820
75.00
Page 2 of Schedule H
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Cla)1on, Howard W.
FILE NUMBER
21 - 05 - 00820
Include unreimbursed medical expenses.
ITEM I
NUMBER
I
DESCRIPTION
AMOUNT
Geico
Insurance
73.00
2 I Comfort Mobility 3.013.35
. Adjustable Bed
3 PPL Electric 102.35
4 South Middleton Township 99.00
Water and Sewer
5 Comcast Cable 125.96
6 Sprint 12.04
Long Distance
7 Sprint 120.56
Local
8 Waste Management 42.39
9 PPL Electric 48.35
10 Speedy Rooter. Inc. 273.00
Plumber
11 Dauphin Oil Co. 120.45
12 PPL Electric 41.13
I3 H & R Block 90.00
14 Speedy Rooter, Inc. 249.00
Plumber
15 Karen Slusser 24.00
Extra Short Certificates (paid out-of-pocket)
Total of Continuation Schedule(s)
TOTAL (Also enter on Line 10, Recapitulation)
5,022.10
9,661.68
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Clayton, Howard W.
Include unreimbursed medical expenses.
ITEM
NUMBER
16
17
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS continued
DESCRIPTION
Karen Slusser
Register of Wills fees (paid out-of-pocket)
Settlement Charges
80 Fairview Street
Carlisle, P A 17013
FILE NUMBER
21 - 05 - 00820
AMOUNT
205.00
5,022.10
Page 2 of Schedule 1
-
- .--!
LAST wILL AND TESTA&illNT
OF
HOWARD Wo CLAYTON
f'c..J
I, HOWARD W. CLAYTON, Social Security Number 142-22-4315, of the
state of Pennsylvania, declare that this is my LAST WILL AND TESTAMENT
and I revoke all other wills and codicils previously made by me.
FIRST: I appoint KAREN A. SLUSSER as my Personal Representative
concerning this Will.
a. I request that my Personal Representative be permitted to
serve without bond or surety thereon and without the intervention of
any court, except as required by law. I direct that my Personal
Representative act in unsupepvised administration 80 as to administer
my estate with a minimum of court supervision. If it becomes necessary
to have ancillary administration of my estate in any jurisdiction where
my Pe~8onal Representative is unable O~ does not desire to qualify ~~
ancillary legal representative, I appoint as such ancillary legal
representative such individual or corporation as my Personal
Representative shall de8ignate~ In w~iting_
b. I direct my Personal Representative to pay the expenses
of my last illness, the expenses of a runeral appropriate to my station
in lire and custom of living (including a suitable monument or marker
for my grave)! and w~itten charitable pledges which I have made. I
grant my Personal Representative the power to extend or renew any debt
for such time a8 my Personal Representative shall deem appropriate.
c. All estate, inheritance, succession and other death taxes
with respect to all property passing under this my Will shall be paid
from and borne by- the principal of my residuary estate, without regard
to reimbursement, as if such taxes were administration expenses. My
Personal Representative may pay such taxes at any time deemed
advisable, whether or not then due and payable.
d. My Personal Representative is requested to settle my
estate as soon after my death cs may be p~acticable~ and to payor
deliver every legacy or bequest to my beneficiaries without waiting ~n'!
~~liiC that may bE believed to be customary 1~ probate matters.
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Therefore, I direct my Personal Representative to consult with a Legal
Assistance Attorney at the nearest military installation and with the
Department of Veterans Affairs and the Social Security Administration
to ascertain if there are any benefits to which my family members are
entitled by virtue of my military service.
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I give~ devise and bequeath, absolutely and foreve~p all
of my estate and property of which I may be seized or possessed, or to
which I may be entitled, at the time of my death, wherever situated or
of whatever nature, be it real, personal, or mixed, to KAREN A. SLUSSER
as her sole and absolute property if she shall survive me.
THIRD: Except as otherwise provided in this Will, I have
intentionally failed to provide for any other relatives or other /
persons, whether claiming to be an heir of mine or not. Insofar as I
have failed to provide in this Will for any of my issue now living or
later born or adopted, such failure is intentional and not occasioned
by accident or mistake.
FOURTH:
twenty (120)
tHe, and the
Any beneficiary who fails to
hours after my death shall be
gift to that beneficiary shall
survive until one hundred
deemed to have predeceased
be disposed of accordingly.
FIFTH:
Definitions:
a. The term 'children" as used in this Will includes adopted
and afterborn persons. The term 'children" as used in this will shall
also include step-children, the natural born or adopted children of a
person's spouse. A relationship by or through legal adoption shall be
treated the same as a relationship by or through blood for purpose of
succession to property under this Will.
b. The term "descendants" as used in this Will means the
immediate and remote lawful, lineal descendants by blood or adoption
the person referred to who are in being at the time they must be
ascertained in order to give effect to the reference to them.
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c. The term "issue" as used in this Will means all persons
who are descended from the person referred to either by legitimate
birth to or legal adoption by that person, or any of that descendant's
legitimately born or legally adopted descendants.
d. The term .Personal Representative" as 11."~,,,r1 in t.his V<.J:ill
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In.dependent EXcCi-1.t.Or-r ~ UL' 2.ny
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e. The term "per stirpes" as used in this Will means that
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a dist~ibution is to be made to the
desCendantz of ~ny person,
the prope~ty to b~ distributed shall be divided into a8 many 8ha~e8 as
there are (1) living children of the person. and (2) deceased children,
who left descendants who. are then living, of the person. Each living
child (if any) shall take one share and the share of each deceased
child shall be divided among his then living descendants in the same
rnan n e:r .
SIXTH: In addition to any powers granted by the laws of the state
in which this Will is probated, I hereby authorize and empower the
fiduciaries named in this Will, to the extent of the discretion herein
granted, to sell, exchange, convey, transfer, assign, mortgage, pledge,
lease or rent the whole or any part of my real or personal estate, to
invest, reinvest, or retain investments of my estate, to perform all
acts and to execute all documents which my fiduciaries may deem
necessary or proper in regard to my property_ If any of my fiduciaries
elect to receive compensation for services, such compensation will be
that allowed by law.
SEVENTH: If any part of this Will shall be invalid, illegal, or
inoperative for any reason, it is my intention that the remaining
parts, so far as possible and reasonable, shall be effective and fully
operative. My Personal Representative may seek and obtain court
instructions for the purpose of carrying out as nearly as may be
possible the intention of this Will as shown by the terms hereof,
including any terms held invalid, illegal, or inoperative.
IN WITNESS WHEREOF, I have at _~~~21~y__8~~~s~L~s~~______, this
~~~' day of ~~J~~~~~___, 19yJ____ set my hand and seal to this my
LAST WILL AND TESTAMENT, consisting of 4 typewritten pages, each page
b2aping my handwritten signature.
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__)fifJVftjLLLUL~~~____________(SEAL)
HOWARD W. CLAYTON j
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GL1.L;:; _~__ ""y VL !.22_~~-L~'-_'
193J_. signed, sealed, published and
declared by HOWARD W. CLAYTON, the testator, to be his LAST WILL AND
TESTAMENT in the presence of all of us at one time, and at the same
time we, at his request and in his presence and in the ppesence of each
other, have hereunto subscribed our names as attesting witnesses, and
we de 80 verily believe that the said testator is of ~ound and
disposing mind and memory at the date hereof.
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OF ~~~D_~__________ OF _iJ2_L~Jl~~!~_
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