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AUG-04-2006 13: 28
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1Inf.~"."" . REV-1500 OfflC~\l llSE ()~,Y !
~TMOfPl*S'/l._ INHERITANCE TAX RETURN FILE NUlIIIIIER OLo C) \\'0
_DF_ RESIDENT DECEDENT 21
0&"'_'
_.PA "_1 COIJN1V COOE YEAR NlJU6ER
.- SOCIAL SECUl'llTY ~R _.-
1l€CED9ITS NA.WE (UoST. FlR$T. AICl...DOle INITIA",
~r. Pauline 204-01-7310
.. ._.__..-..~,
! DAlE OF DEA'Rf (MM.QO.YEAR) DATE OF BIRTH (a&t.QO.\'eAR) THIS 1tE1UIUIllUST lIE fILED "" DUI'LlC"TE WITH THE
0
III 11114/2005 03/0211920 REGISTER OF WlLL~__.. ..__
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~ (If APPlIC;AllLE) SURVIVING SPOUSE'$IWE (I.A6T. "lAST A"l) UIODI.E_TIAlI SOCIAl Sl:CUlttT'l' NUN8ER
i
IR ,. 0tIgInlII Retwm 0 2. SuoolemenlaI ~url'l :J 3. ~_~(_OIdelll~DI\OfIO;2,'HI21
:!! 4 lil'llifed e-le 48. F_ _~ldRof_ aIler 5. Federal Estate Tall Re\um Required
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6 Oecedenl DIed Te~te 1_" COPY
aI Will
O. li1lga1ian Pnlceeds ReI;eived
12-,2-82)
7. DecleOenI Maitllait'1ell it LI\IIn9 TI\ISt (I\lIKII
capyatT_1
10. Spoutel P-"Y ~(d_ at....._
1M' 1 M
8. TOOII Number of Sate Oeposl\ eores
o 1'.Eleclion 10 llIX under See. 9' 13(A) (AlIad> Sch 0)
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13. Chari18bIe and Govemrnemal BequestsISec 9113 Trusts furwhidl an etedion to lBX has nottleefl
made (Sc:heduIe J)
14. Net Value Subject to Tb (Line 12 minuS Une 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14lallable at lhe spousal tax tate.
or nnsfers under Sec. 9116(a)(1.2)
:i Daniel K. Taylor
5 ~ IRIolNAME (1____1
a~ Gray" Patterson Cody lIt Taylor
LIOPWC)NI; NUNKR
717/299-7374
1. Reel Estate (Schedule A)
2. S10cks and Bond6 (Schedule 8)
3. Closely t1eld Corporation. Par1neTship or SoIe-Proprie1orship
4. Mortgages & Nota Rearivable (Schedule 0)
5. Ca$h. Bank Deposits & Miseellaneou$ PeteonaI Propetty
(Schedule E)
6. Jointly 0wn4d Proper1y (SdleduIe F)
o ~ 8iIIng Requested
7. Intef-Vo\IO$ Tran$feta & fIIsceI/aIIeou$ Non-Probate ~
(Schedule G or l)
8. Toeat GraM....... (~t.aI Unes 1-7)
9. Fur\4lta1 EXl*'teS & Admini$ntiW Costs (Sct\edule H)
z
C
S
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i
...
..
..
10. Debts of Decedent. Mortgage Liabilities. & Wens (S<:heduIe I)
11. Tota' Deductions (~tall.lnes 9 & 10)
12. Net Value Of &taM (Line 8 minus Line 11)
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~
...
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16. Amount of Line 14 talc8bIe at hneel ratle
17. Amount of line 14 taxable at sibling rate
18.!Imount of Line 14lall8ble at collaleral rate
1 19. Tp: Due
120.0
~~...~
CopyrigIlt 2000 fvnn softw~ only TIle Lack_ Group. 11M:.
53 North Duke Street
Lanca5Cer, P A 17602
(1 ) NODe
(2) None
(3) None
(4) None
(5) None
(6) 11,674.38
(1) 29,793.54
(9) 1,013.06
(10)
OF/'",r, IA\ \)~ FONt v
(8)
41,467.92
(11)
1,013.06
~9,~~~~_
(12)
(13)
(14)
40,454.86
x .00
(15)
40,454.86 x .045
(16)
1,820.47
" .12
(17)
x .15
(18)
(19) 1,820.47
.. .... -. ~ - ". " . - --
.~'-"'"'"--<'.,-_. -- -"---..--
~ ~~ _'" ...;;;,~ :: i _ .~::- =~::",,[::-, ::.;- _".r :- .;:..~ -= /=::'-~<,'~ :10.....
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Fonn Rev-1501 EX (Rev. 6-00)
~
AUG-04-2006 13:28
Decedent's Complete Address:
STREET ADDRESS
~.tl"'/<:Jt:l
820 Lisburn Road
CITY
IST/\TE PA
IZIP 17011-7427
Camp Hill
Tax Payments and Credits:
Tall Due (Page 1 Line 19) (1)
2. Credits/Payments
A. Spousal Poverty Crll1fi1
e, Prior Payments
C DisCOunt
) ,82047
Tolal Credils (A + B + C) (2)
000
3. l"teresllPenalty if appliuble
D. Interest
E Penalty
0.00
TolallnteresllPenalty (0. E)
4 If Line 2 is greater ltlan line 1 . Line 3. enter the difference, Th,s is the OVERPAYMENT.
Check box on Page 1 line 20 to re(lUeSl a refund
5. If ltne 1 . Line 3 is greater lhan line 2. enter the difference. This is the TAX DUE.
A. Enter tile interest on the lax due.
B. Enter Ihe IOtal of Line 5 + SA. Tnis is the BALANCE DUE.
(3)
(4)
(5)
(SA)
(58)
1,820.47
1,820.47
Make Check Payable 10: REGISTER OF wrus, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BV PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: VOIi No
a. retain the U~ or income of Ihe property transferred: .. ....... ....... .......................... ~ I
b. retain the right to designate who shall use the Pf'OC)eI1ytransferred or its il'lCOme:..................................
c. retain a reversionary interest: or................................. ....................................................,.............
d. receive the promise for life of either pa)'Nlnts. benefies or care?......................................................,......
2 If death OCCUlTed after December 12. 1982, did decedent transfer property wilhil'l one year of death WIthout
receiving adequate eonsidera1ionLd d',' dnnnnnn nnn.n . .mn.n dnn......................."......... 0 cgJ
3. Did decedent awn an "in trust for" or payable upon deelh bank GCOOunt Of sewhty at hiS or nerdeath?...... 0 ~
4. Did decedent own an Individual Retirement Account. annuity, ()( olher non.probate property wllich
contains a beneficiary designation?...............................d. d",..d.. ......... ..d.........d...d.. . 'dd" .......d....."......... 181 0
If THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES. YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
~; penMiOl-" ".~. I -""1IIa! I ft_ _ tIIIa ,_. olIClucl;"g ~"_ _ .-.ene. ~d to me be.. tI/ my k~ M" bel.,. it '. I'lle. correct ~<l CO"'P",t;o.,,':;;'.;;;;;' a/
P"'P.."O_,....""'~-_..._.._l>dan.."""'-af""''''l'tPl_...."''l'~. "." __.__...
S IGI'lA TURf Of I'fRSON REsPQr.lSI8I.E FOR Ftl,ING RETURN AOORESS DI\ TE
Sf hen M
307 North 30th St.
Harrisburg, P A 17109
fJ.-;o -0 b
DAn;:
SIGN...TUIIE OF PRe.....RER OTHER THAIt REPRESENT...TIVE
AllORESS
OAT~
F'or dales of death on or after Julv 1.1994 and before January 1.1995. the tax rate imposed on !he net value of transfers to or for the use of the
surviving spouse is 3% (72 PS. !i9116 (8) (1.1) (il).
For dales of death on ()( after January 1. 1995, the laX rate imposed on the net value of transfers to or for the use of the surviving spouse IS 0%
(72 P.S, S9116 (8) (1.1) (ii)). The statute does no.t exemot 8 transfer to a surviving spouse from fall. end the statulDry requirements for dIsclosure
of assets and filing a lax relum are slill applicable even if the surviving spouse is the only benefICIary,
For dates of death on or after July 1, 2000;
The tax rale imposed on the net value of transfers from a deceased child twenty~ years of age or younger at death to or fof lhe use of 3 "atural
parent. al'l adoptive parent or II stepparent of the child is 0% (72 P.S. g9116 (a) (1,2)).
The talC rate imposed on the net value of transfers 10 Of for \he use ofti'le decedent's lineal benefiCiaries is 4.5%. except as noted in 72 PS. ~9116
1.2) 172 PS 59116 (a) (1)].
The lax rete imposed on the net value of transfers to or for the use 01 the deudent's siblings is 12% (72 P.S. 5{l116 (a) (1.3)). A sibling is defined.
und9l' Section 9102. 8S an individual who has at least one parent in common with lhe decedent. whether bV blood or adoption.
AUG-04-2006 13:29
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SCHEDULE F
J~NTLY-oWNEDPROPERTY
CO~T" Of PENNSYLVANIA
INHI;IlIT AHCE TAX REnIAN
RESIDE\IIT ctCEDEHT
ESTATE OF
I FILE NUMBER
21 - -
-"-
ff an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
MadeJ, Pauline
SURVIVING JOINT TENANT(S) NAME
A Steven Mader, son
ADDRESS
RELATIONSHIP TO DECEDENT
B Barbarll Pennock, daughter
307 North 30th Street
Harrisburg, P A
::1_50 c9 J:. f-PI., r SC'} s':I,
l.Eadi r}J- ~ p6l. I q bO 9
q if.s.- mJC/J~f}J)f Sf
RfdcL '7,jJ-, p~. /9,=,0 J
son
daughter
C Pauline Smither, daughter
Daughter
JOINTl Y OWNED PROPERTY:
....,..,..- I
DATE OF DEATH ~~;.s DA~~~ED~TH
VALUE OF ASSET [INTEREST OECED~NT'S INTEREST
A
DESCRIPTION OF PROPeRTY
DATE Include name of financial in$titution and bank accoont number
~ Of Similar identi~9 num_ AIlach dHd for joinlly-held real
estate.
More than Sovereign Bank. Savings 924027121
one year
from dare 01
death
3.586.93
1,793.47
ITEM lETTER
NUMBER FOR JOINT
TENANT
B
More than PNe account 5140320199
one year
ifrom date of
I death
~I More than II Sovereign Bank CD OS75 137146
one year
om date otl
! death !
I' I Sovcrcij'lhn Bank CD 0575137153
I I Sovereign Bank CD 0575514997
Sovereign Bank CD 0575137161
2,617.531
I
I
3333331
I
&72.51
2
A,B
3
i
3.000.731
i
i
I
i
1,500.37
"
c
5.000_00
5.016.05
5,000.00
2.500.00
2,50&.03
2,500.00
5
A
6
B
l
TOTAL (Also enter on line 6. RecapitulBtion)
11.674.38
AUG-04-20(j6 13:29
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.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMOHWEAlTHOF PENHSYLVANlA
INHERlT~ TA,l(ReTURN
IUlSUNToer;:l!IlaR
ESTATE OF
Mader, Pauline
RLE NUMBER
21 - -
ITEM
NUMBER
This sc....... .._ .,. and filed if the answer to any of
DESCRIPTION OF PROPERTY
Inck.dethe.- oIt1l111lNll-' _~ 19 dee.... ~ 1he .. r1..~,,",< DAlE OF DEATH
_"_of..._",,,..._ VAlUE OF ASSET
1 4 Oft page 2 Is ws.
"" OF I EXCLUSION
DECO'S (I' Al'l'l.1~E) T AXABI.E VALUE
INTEREST
A1G Amluity BX2040 17 payaable to
daughter Pauline Smither
8,549.51
8,549.51
2
AlG ADouity 8X2040 17 payable to
daughter Barbara Pennock
8,549.51
8,549.5t
3
AlG ADnuity BX2040 17 payaable to
son Stephen Mader
12,694.52
12,694.52
4
5
6
7
TOTAL (Also ..... on line 7, Rec8pitaNUOft) I
29,793.54
AUG-04-2006 13:29
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SCI-EDUlEH
FUNERAL EXPENSES &
ADatS1'RA1NE UJ::SI::S
e~"'THOf PENNll'lVNf"
_....ce TAl<RET.-
AUUNT OEC&D(Jj"/
ESTATE OF M~..i- P I'
......,r. au me
I FILE NUMBER
21 - -
Debts of decedent must be reportlId on Schedule I.
ITEM I DESCRIPTION
t<<JMBE"1
/4. FUNERAL EXPENSES:
. 1 Myers-Hamer FUneral Home
I
I
I
i
I
I
I
I
I
-I
I
I
1.013,06
AMOUNT
B, I ADMINISTRATIVE COSTS:
1. Personal Represenlative's Commissions
Social Security Nurnbe1(.) 'EIN Number of Personel R~ve(s):
Street Address
City
Year(s) Commission paid
2 Attorney', Fees
3. Family ExemptiOn; (If decedent's address is not the same as claimant's, allBch ~plan.lion)
State _ Zip
Claimant
S1I'e8t Address
City
Relationship of C1&imant to Decedent
4. Probate Fees
State _ Zip
5. Aooo~tant's Fees
8. Tax Relllm Preparer's Fees
7 Oller Admlnishtive Costs
t
l
TOTAl (Also enter on line 9, Rec;apitulallon)
l,0J3.06
AUG-i2)4-2006 13: 30
t' . 1Qlj / 1Qlj
...,.t511 0. (toC01
.
SCHEDULE J
BENEFICIARIES
~TW 01' lleNNSYLVoUIlA
IHHERIT!\NCE TM ~
RES IDEHT DECEJ)l;HT
eSTATI! OF
Mader, Pauline
I RLE NUMBER
! 21 - -
!\ElATIONSH'P TO I AMOUNT OR SHARE
DECEDENT OF ESTATE
__u...---'., I
son \ 18,927.23
I
1
i
NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
---i-----l TAXABlE DISTRIBUTIONS (include outright spousal distr~)
1 Steven Mader
307 N. 30th Street
Harrisburg, P A
3
Barbara p~
7a;:L';!&'P:r~cl) Sd.
p~ S~ther ~ JCj b tFt
945 McNight Street
Reading. P A 1960 1
daughter
13,985.77
2
daughter
13,549.51
4
Enretdolar amou~ fordi$tfibutions shOwn abOve on lines 15 "rough 18, as appropriate. on Rev 1500 cover sheet
ll. NON- TAXABLE DISTRIBUTIONS:
A. SPOVSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH Nl ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL OISTRI8U"ONS
TOTAL OF PART. - ENTER TOTAL NON-TAXABlE DISTRIBUTIONS ON LINE 13 OF REV.1SOO COVER SHEET
TOTAL P.OO