HomeMy WebLinkAbout08-28-06
RE\J-1500
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COMMONWEALTH OF
~ PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
, HARRISBURG, PA 17128-0601
REV-1500
FilE NUMBER
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COUNTY CODE YEAR
INHERITANCE TAX RETURN
RESIDENT DECEDENT
_(J~ ~l._
NUMBER
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SOCIAL SECURITY NUMBER
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DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
n..... ,S - o"f 10 - .S.. z.s
(IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL)
/J/A
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1 Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (date of death after 12-12-82)
D 7. Decedent Maintained a Living Trust (Attach copy of Trust)
D 10. SpoJsal Poverty Credit (date of death between 12-31-91 and t-I-95)
D 3. Remainder Return (date of death pner to 12-13.82)
D 5. Federal Estate Tax Return Required
8. Total Number ot Safe DepOSit Boxes
D 11. Election to tax under See. 9113(A) (Attach Sen 0,
of Wi I!)
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THIS SECTION MLlSTBE COMPLETED. ALL CORRESPONDENCE AND eONFIDeN'ffAI..TAX INFO.RMATtON SHOULD BE DIRECtED TO:
NAME II. \ COMPLETE MAILING ADDRESS
--., L. fV\. ~ I q ~ S' 3\)0 ~
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lAve
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FIRM NAME (If Applicable)
TELEP'-IONE NUMBER e I IQ r u
., \ .., - 1..\1, - .~ ~ ,
Real Estate (Schedule A)
(1)
(2)
(3)
(4)
(5)
-0-
-0-
-0-
-0 -
crq . q 'J
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. CEISh, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
-0-
(6)
6. Jointiy Owned Property (Schedule F)
[J Separate Billing Requested
7. Inler-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
-0-
(7)
c<)
(8)
, ~ -Sq . " ~
q cr. q'f
(9)
(10)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule II
-0-
,\(1&\.'IB
- \; Jtf. S''L-
11. Total Deductions (total Lines 9 & 10)
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)
(11)
(12)
(13)
-0-
(14)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. I\mount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
- I~~". S'i
x .0_ (15)
x.oU (16)
x .12 (17)
x .15 (18)
(19)
16. Amount of Line 14 taxable at lineal rate
17 Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
20. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE . SIDE AND RECHECK MATH < <
~
Decedent's Complete Address:
STREET ADDRESS J ".3 S \1l>O 'I ~ N €
CITY
tA-1U... , S 1.E-
I STATE
fir
ZIP \"70 J.3
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1)
2. Credits/F'ayments
A Spousal Poverty Credit
B. Prior Oayments
C. Discount
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + 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 Line 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. Ente" the interest on the tax due.
B. Enter the total of Line 5 + 5A This is the BALANCE DUE,
(5A)
(5B)
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:
a. retain the use or income of the property transferred;......................... .....................................................
b. retain the right to designate who shall use the property transferred or its income; ..........................
c. retain a reversionary interest; 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? .....................,.....'.....,...........".....,......,....................
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? ....... ............................... ........................ ................................................... 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.
Yes
.....0
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No
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SIGNATURE, OF PERSON RESPONSIBLE FOR FILING RETURN
Under penaltie, of perjury. 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 "reparer other than the personal representative IS based on all Information of which preparer has any knowledge
DATE
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ADDRESS
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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 PS. ~9116 (a) (1.1) (i)J.
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 PS. ~9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, (lnd 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. ~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 PS. ~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+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
:t.. 0 A
L.
CA R..~~
FILE NUMBER
ZI
o~ - 00'12.
ESTATE OF
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
NUMI3ER
DESCRIPTION
VALUE AT DATE
OF DEATH
NONE
TOTAL (Also enter on line 1, Recapitulation) $
-0-
(If more space is needed, insert additional sheets of the same size)
SCHEDULE B
STOCKS & BONDS
"Ji-:'''ITANC, LAX RETURN
RES'~HT DECEDENT
ESTATE OF
:tOA
....
( Ag.E~
FILE NUMBER
2..1
OS" - 00'11.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
--
VALUE AT DATE
OF DEA.TH
1
---!
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i
,
I
DESCRIPTION
NoN'E
I
I
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TOTAL (Also enter on line 2, Recapitulation) $
(If more space IS needed, insert additional sheets of the same size)
-~-
REV-1504 EX. (1-97)
SCHEDULE C
CLOSEL Y.HELD CORPORA nON,
PARTNERSHIP or SOLE.PROPRIETORSHIP
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
FESIDENT DECEDENT
ESTATE OF
IOA
L. CAlLE'"
FILE NUMBER
ZI
tJS- ~VL
Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship
See instructions for the supporting information to be submitted for sole-proprietorships_
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
tJ 0 we:
TOTAL (Also enter on line 3, Recapitulation) $ - (J-
(If more space is needed, Insert additional sheets of the same size)
REV-1507 EX+ (1-97) ~..' t
. ,- 0:
, ,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
TO.
L.
C.A a..e. 'C'
FILE NUMBER
2..,
0," - 00'1 't..
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
l\Jo~
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
-0-
REV-15GB EX. (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RE:SIDENT DECEDENT
ESTATE OF
IDA
L.
U. A..e. '(
FILE NUMBER
21
OS"-dOYl..
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
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
tJe.w
Cu~6eUAt.J) (.cENtL CJuto,. U~~
- 100. O~
CLDTHI"'G-
~ ~,'c. . lE1fS'lW\41 fIFet;ts
Z d " . <J~
.
TOTAL (Also enter on line 5, Recapitulation) $ ~
(If more space is needed, insert additional sheets of the same size)
Send Inquiries To:
STATEMENT OF ACCOUNT
NCFCU
1
LAST CHANCE HOLIDAY LOAN
SPECIAL ENDS DEC. 15,2004
1/2% OFF All LOANS EXCEPT
lINE OF CREDIT & VISA
WISHING YOU HAPPY HOLIDAYS!
NEW CUMBERLAND FEDERAL CREDIT UNION
P.O. BOX 658 · NEW CUMBERLAND, PA 17070
(717) 774-7706. 1 (800) 716-2328
Joint Owners
1,,"111...111......11..11....1111.....11..11..1..1..11...1..11
IDA l CAREY CHESTER A. CAREY
1935 JODY LN MAUREEN M. HOLT
CARLISLE PA 17013-1036
TRA~~iTION EF~~~~VE DESCRIPTION AMOUNT
1101
1115
1116
1130
THE
1130
1101
1101
1101
1103
1105
1108
1109
1109
1108 *
1112
1115
1115
1116
1116
1116
1130
PREVIOUS BALANCE Sl-PRIMARY SHARES
OVERDRAFT TRANSFER -10
OVERDRAFT TRANSFER -30
DIVIDEND
ANNUAL PERCENTAGE YIELD EARNED IS 0 74.
NEW BALANCE DIVIDEND IS CALCULATE
USING A DAILY BALANCE METHOD.
PREVIOUS BALANCE S4-SHARE DRAFTS
PAYROLL DEDUCTION 102
US TREASURY 312 /CIVll SER
PAYROLL DEPOSIT 9038576216
KIMBERLY-CLARK C PPD EFTS
SHARE DRAFT CLEARED 4057
ACH WITHDRAWAL 1526069387
AARP HEALTH CARE PREMIUM
ACH WITHDRAWAL 2360770740
BANKERS LIFE 357 INS PREM
SHARE DRAFT CLEARED 4058
SHARE DRAFT CLEARED 4059
ACH WITHDRAWAL 1500021440
HARLAND CHECKS CHK ORDERS
LOAN ADVANCE TO SHARES
SHARE DRAFT CLEARED 4062
OVERDRAFT TRANSFER
SHARE DRAFT CLEARED 4056
SHARE DRAFT CLEARED 4061
OVERDRAFT TRANSFER
NEW BALANCE
11
18
-100
-3
-8
-14
-1
350
-400
10
-4
-26
30
------------------------- SHARE DRAF SUMMAR
4056 4057 4058 4059 **** 4061 4062
ACCOUNT NUMBE R
008764
SOCIAL SECURITY i'I
STATEMENT PERIOD
From To
110104113004
FINANCE
CHARGE
643a3
I
I
559b3
411 9
399 4
4
6
o
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8
o
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------------------------------------ ------- - ----- - --- - ------ -
1101
1112
1130
\
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PREVIOUS BALANCE L2 UNSECURED
LOAN PROCEEDS
--." -.. .._~
N~WBALANCE-PERIODIC RATE.031232%
>> ANNUAL PERCENTAGE RATE 11.400% <<
**CONTINUED**
350 0
.J
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3500 0
3500 0
L
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TOTAL DIVIDEND YEAR-TO-DATE TOTAL FINANCE CHARGE YEAR.TODATE
for all savings except IRA savings. for 811108n5.
Dividends shown. if over $10. will be reported
to the I nternal Revenue Service for this NOTICE: See reverse side for important information.
calendar year.
.''''nl'''AT~OC:: ~J'J'J'r.TIVE DATE
0803562
REV-1509 EX. (1-97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
I~IHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
lOA-
l.
~ttL 'I
FILE NUMBER
2.,
o.r - ooc.Il..
If an a!;set was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A.
B.
1J 0 tvt
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '!oOF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DE CD'S VALUE OF
NUMBER TE~ANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. J.\.
t'JO~
TOTAL (Also enter on line 6, Recapitulation) $ - 0 -
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET IF APPLICABLE)
NUMBER INTEREST
1.
No~
TOTAL (Also enter on line 7, Recapitulation) $ -() -t7
. .
(If more space IS needed, Insert additional sheets of the same size)
REV-1511 E)(+ (12-99)
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"'\",~.>>....
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
lOA
L. (AttJEy
FILE NUMBER
'2..
oS' .. QO'I L.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
AU'l M&tAo~\" ~ ...U~~ ~""t.s
FA-sr.... -Sfll-IJ( Cow PtW
I S Be;. 'f.t
2."
Sf) . ~ 0
B. ADMINISTRATIVE COSTS:
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 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. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ J""3 q. '" 8
(If more space is needed, insert additional sheets of the same size)
AVER MEMORIAL HOME AND CREMATION SERVICES, INC.
4100]oncstown Road. Harrisburg, PA 17109. 1-800-720-8221 · Fax 717-541-9943. Shawn E. Carper. Supervisor
241282 MB5
11-16-2004
Mrs. Maureen Holt
1935 Jody Lane
Carlisle, PA 17013
Ida Louise Carey - Deceased
SPECIAL CHARGES
X Direct Cremation
Forwarding Remains
Receiving Remains
Immediate Burial
Nationwide Guarantee Program
Worldwide Travel Protection
TOTAL SPECIAL CHARGES
$795.00
$795.00
PROFESSIONAL SERVICES
Services of Funeral Director & Staff
Embalming
Other Preparation of the Body
Facilities & Staff for Viewing ($200/hour)
Facilities & Staff for Funeral Service
Facilities & Staff for Memorial Service
Staff & Equipment for Viewing ($200/hour)
X Arrange/Deliver Ashes To National Cemetery
Staff & Equipment for Memorial Service
Private Family Viewing/Witnessing Cremation
Special 48 Hour/Weekend Cremation Service
Packaging And Forwarding Cremated Remains
Personal Delivery of Cremated Remains
Scattering of Cremated Remains
Medical Documents/Courier Fee
TOTAL PROFESSIONAL SERVICES
$85.00
$85.00
AUTOMOTIVE EQUIPMENT
Removal Vehicle
Casket Coach
Flower Car
Lead Car/Clergy Car
Service Vehicle
Family Car
TOTAL AUTOMOTIVE EQUIPMENT
$0.00
MERCHANDISE
Register Book
X Prayer Cards 200 @ $45.00
Thank You Cards #
Remembrance Package
Casket
X Solid Sheet Bronze Urn/Batesvi
Cremation Container
Urn Burial Vault i.l"".
Veterans Flag Case
Grave/Memorial Marker
Custom Design Photo & Engraving 09FE
Veterans Flag Case
TOTAL MERCHANDISE
CASH ADVANCED ITEMS
Grave Opening
Cemetery Equipment
Vault Service Charge
X Newspapers Patriot-News
Newspaper
Clergy
Church/Organist/Soloist
Flowers
X Crematory Charge
X County Coroner Cremation Approval Fee
X Certified Copies
DNA Preservation
TOTAL CASH ADVANCED ITEMS
SUMMARY OF CHARGES
Special Charges
Professional Services
Automotive Equipment
Merchandise
Cash Advanced Items
SUB TOTAL
$795.00
$85.00
$0.00
$375.00
$434.48
$1,689.48
DISCOUNT
-$300.00
TOTAL
$1,389.48
AMOUNT PAID
12-3-2004
-$1,320.00
BALANCE DUE
$69.48
r~-/
" -.
\,J
$90.00
$285.00
$69.48
$300.00
$25.00
$40.00
, i...-....
\ '}
$375.00
$434.48
, ,
I
REV-1S1? EX-+
ESTATE OF
f~
f~~1~
~5~_~~~
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
(AlL~ '(
FILE NUMBER
~I
OS:OO\(L
COMMmrNEALTH OF PENNSYLVANiA
INHtcRlTANCE TAX RETURN
F:F SIDENT DECEDENT
I\)A
\...
Include unreimbursed medical expenses.
ITEM
NUMBER
1.
DESCRIPTION
NJMGt..O\AS
Y\ '1),,~ \... f.r JJ b
\-\nspLi1rt-
AMOUNT
r, ;LL.s W M,-rli~ 6 ~f 9~ 1t\6
OD <Ko (5 fl('Nf> \~os;~l~
TOTAL (Also enter on line 10, Recapitulation)
(If more space IS needed, Insert additional sheets of the same size)
$ vw Kwo-.nJ
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
IDA
L.. C.A 4..€ "
FILE NUMBER
'2..1
O)-oovJ...
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
[ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
tJO~
I
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
IT NON-TAXABLE DISTRIBUTIONS: I
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. I
B. HARITABLE AND GOVERNMENTAL DISTRIBUTIONS
C
_1m
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
_0-
(If more space is needed, insert additional sheets of the same size)
REV.1514 EX + {1-97)
ESTATE OF
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on Rev.1500 Cover Sheet
FILE NUMBER
lOA- L . (A A.I! '( 1.' OJ" .. dO-lL.
This schedule is to be used for all single life, joint or.successive life estate and term certain calculations. For dates of death
prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5 -1-89.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
D Will D Intervivos Deed of Trust D Other
LIFE EST A TEINTEREST CALCULATION
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS
LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE
D Life or D Term of Years_
~4J~ D Life or D Term of Years _
D Life or D Term of Years _
D Life or D Term of Years
1. Value of fund from which life estate is payable
2. Actuarial factor per appropriate table
Interest table rate - D 31/2% D 6% D 10% D Variable Rate
3. Value of life estate (Line 1 multiplied by Line 2)
ANNUITY INTEREST CALCULATION
$
%
$
NAME(S) OF NEAREST AGE AT TERM OF YEARS
ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE
D Life or D Term of Years _
tJ.Q~ D Life or D Term of Years _
D Life or D Term of Years _
D Life or D Term of Years _
1. Value of fund from which annuity is payable $
2. ChElck appropriate block below and enter corresponding (number)
Frequency of payout - D Weekly (52) D Bi-weekly (26) D Monthly (12)
D Quarterly (4) D Semi-annually (2) D Annually (1) D Other ( )
3. Amount of payout per period $
4. Ag!lregate annual payment, Line 2 multiplied by Line 3
5. Annuity Factor (see instructions)
Intmest table rate D 31/2% D 6% D 10% D Variable Rate %
6. Adjustment Factor (see instructions)
7. Value of annuity - If using 3 1/2%, 6%,10%, or if variable rate and period payout is at end of period,
calculation is : Line 4 x Line 5 x Line 6 $
If using variable rate and period payout is at beginning of period, calculation is :
(Line 4 x Line 5 x Line 6) + Line 3 $
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on
Scl1edules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on
Lines 13,15,16 and 17.
(If more space is needed, insert additional sheets of the same size)
REV.1647 I::X+ (9-00) .
q"rlt
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE M
FUTURE INTEREST COMPROMISE
ESTATE OF
(Check Box 4a on Rev-1500 Cover Sheet)
FilE NUMBER
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This Schedule is appropriate only for estates of decedents dying after December 12, 1982.
This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in
possession and enjoyment cannot be established with certainty.
Indicate below the type of instrument which created the future interest and attach a copy to the tax return.
o Will 0 Trust 0 Other
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I. rBeneficiaries
- I ----- ____n_._ .-
NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO
NEAREST BIRTHDAY
~- --- --~ - -- ------- -
~~~ -- _._--~--_._---
:2.
.------ --f------~---~---
:3.
-- f----------
4.
~-- --
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,).
II. l:Oor decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within
9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse
. .
exercises such withdrawal nght.
o Unlimited right of withdrawal
III. Explanation of Compromise Offer:
o Limited right of withdrawal
IV. Summary of Compromise Offer:
'1. Amount of Future Interest. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$
:~. Value of Line 1 exempt from tax as amount passing to charities, etc.
(also include as part of total shown on Line 13 of Cover Sheet) ......$
:l. Value of Line 1 passing to spouse at appropriate tax rate
Check One 0 6%, 0 3%, 0 0% . . . . . . . . . . . . . . . . . . . . . .$
(also include as part of total shown on Line 15 of Cover Sheet)
4. Value of Line 1 taxable at lineal rate
Check One 0 6%, 0 4.5% ...........................$
(also include as part of total shown on Line 16 of Cover Sheet)
5. Value of Line 1 taxable at sibling rate (12%)
(also include as part of total shown on Line 17 of Cover Sheet) ......$
6. Value of Line 1 taxable at collateral rate (15%)
17. :: ~:~~ed::;"::c: ::,::::,'::: :,oL~:: ;~hO~ ~O::,:::::, Lioe1;.$ . . . . . . . . . . . . . .
(If more space is needed, insert additional sheets of the same size)
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REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
No. 2005-00042
Esta te Of: IDA L CAREY
(First. Middle. Last!
PA No. 21-05-0042
a/k/a:
Late Of:
IDA LOUISE CAREY
NORTH MIDDLETON TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 162-22-6453
WHEREAS, on the 14th day of January 2005 an instrument dated
unOated was admitted to probate as the last will of
IDA L CAREY
(First. Middle. Last!
a/k/ a IDA LOUISE CAREY
la te of NORTH MIDDLETON TOWNSHIP, CUMBERLAND County,
who died on the 15th day of November 2004 and
iWHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH / Register of Wills in and
for CUMBERLAND County, in the Commonwealth of pennsylvania, hereby
cert~tfy that I have this day granted Letters TESTAMENTARY to:
MAUREEN LOUISE HOL T
who llas duly qualified as EXECUTOR(RIXJ
and has agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARUSLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 14th day of January 2005.
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* *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
of
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WILL
Ida Louise Carey
I, Ida L. Carey, of Dauphin County, Pennsylvania, declare this to be my Will and revoke
all other Wills.
ARTICLE I
I authorize my Personal Representative to pay such sums as my Personal Representative
deems proper for my cremation or burial and interment, including the disposition of the
ashes or the acquisition of any burial site and the erection and engraving of monuments
and markers, regardless of any limitation fixed by statute or rule of court and without
order of court.
ARTICLE n
(A) My Personal Representative shall make the following distributions to the
following institutions, and to the following persons who survive me:
All property shared equally among my three children: Ruth M.
McCord, Maureen L.M. Holt, and Lloyd A McCord, Jr.
(B) My Personal Representative shall distribute the rest of my tanglole
personal property not disposed of in Paragraph (A) of this Article IT, or all of my tangible
personal property if there are no specific bequests of tangible personal property, as a part
of the rest of my estate.
ARTICLE ill
I give the rest of my property to the following beneficiaries in the following
proportions:
Ruth M. McCord, Maureen L. M. Holt, and Lloyd A. McCord in
equal shares.
P.,....A 1 of,,
ARTICLE IV
The provisions in this Will for the distribution of my estate shall be supplemented
by the following:
(A) My Personal Representative shall pay all taxes (including inheritance
taxes) owed because of my death (including any interest and penalties) out of my estate.
The payment of the taxes shall be made regardless of whether the taxes are owed on
property passing under this Will or outside of this Will and regardless of whether the
taxes are owed by my estate or by any beneficiary; provide~ however, that my Personal
Representative shall be entitled to reimbursemen~ from each beneficiary for the payment
of the taxes in proportion to the amount of tax generated. by the property received by each
beneficiary. .
(B) Each beneficiary shall be deemed not to have survived me unless the
beneficiary is living on the thirtieth day after the date of my death.
(C) Whenever any beneficiary of my estate is under a legal disability or, in the
judgment of my Personal Representative, is for any reason unable to apply any
distr:t"bution to the beneficiary's own best advantage, my Personal Representative may
nevertheless make the distribution directly to the beneficiary or to the conservator of the
beneficiary's property or to a person with whom the beneficiary resides at the time of the
distn"bution in whatever manner my Personal Representative shall deem best. In the
alternative and if the beneficiary is under twenty-one years of age, my Personal
Representative may, in the discretion of my Personal Representative, distribute the
property to a custodian for the beneficiary under a Uniform Transfer or Gift to Minors
Act. The receipt by the beneficiary, conservator, custodian or other person of any
distribution so made shall be a complete discharge to my Personal Representative
regarding the distribution.
ARTICLE V
In addition to the existing authority of my Personal Representative, my Personal
Representative may:
(A) Sell or grant options with respect to any real or personal property in such
manner, for such purposes, for such prices, and upon such tenDs, credits and conditions as
may be deemed advisable.
(B) Make any division or distribution of my residuary estate in money or in
other property or partly in both upon the basis of fair market value and cause any share to
be composed of money, property or undivided fractional share in property, different in
kind from any other share.
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(C) Permit any beneficiaries of my estate to use any tangible personal property
or real property, without paying any rent, without giving any bond or security and without
liability for any loss or damage. My Personal Representative shall not be liable or
responsible for any injury to, consumption of or loss of any such property so used.
(D) Take charge of any real property as part of the probate administration of
my estate for such period as my Personal Representative shall determine; collect any
income therefrom; and pay the taxes and expenses thereof, including the cost of keeping
such property in adequate condition and repair, in the manner and to the extent that my
Personal Representative shall deem advisable.
ARTICLE VI
(A) I appoint Maureen L. M. Holt, as Personal Representative of my estate. If
such Personal Representative shall fail to qualify or cease to act as Personal
Representative, I appoint the following persons or bank or trust company as alternate or
successor Personal Representative to serve in the order specified below, and if the first
altemate Personal Representative shall fail to qualify or cease to act as Personal
Representative, the second alternate Personal Representative shall serve as Personal
Representative.
Ruth M. McCord - First alternate
Lloyd A. McCord, Jr. - Second alternate
To the extent permitted by law, my Personal Representative shall be authorized, in
the discretion of my Personal Representative, to have my estate administered without
adjudication, order or direction of the court having jurisdiction over my estate.
(B) No bond or surety shall be required of any Personal Representative serving
hereunder.
(C) Throughout this Will the use of any gender shall be deemed to include all
genders, and the use of the singular the plural, and vice versa. The terms "child" and
"descendant" shall include an adopted person and such adopted person's descendants, if,
but only it: the adopted person is not more than twelve years of age on the date of the
court order granting such adoption.
(D) At the date of execution hereof, I have the following children who are now
living: Ruth M. McCord, Maureen L. M. Holt, and Lloyd A. McCord, Jr.
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I, Ida L. Carey, the Testator, sign my name to this instrument this day of
, and being first du1y sworn, do hereby declare to the undersigned
authority that I sign and execute this instrument as my will and that I sign it willingly (or
willingly direct another to sign for me), that I execute it as my free and voluntary act for
the purposes expressed in the will, and that I am eighteen years of age or older, of sound
mind, and under "" constraint or undue influence. ~ v:J ~
tJ J.
Ida L. Carey U
We, the witnesses, at the Testator's request, sign our names to this instrument,
being first duly sworn, and do hereby declare to the undersigned authority that the
Testator signs and executes this instrument as the Testator's will and that the Testator
signs it willingly (or willingly directs another to sign for the Testator), and that each ofns,
in the presence and hearing of the Testator, hereby signs this will as witness tb the
Testator's signing, and that to the best of our knowledge the Testator is eighteen years of
age or older, of sound mind, and under no constraint or undue influence.
of
Witness
of
Witness
of
Witness
State of
County
We, the Testator and the witnesses, respectively, whose names are signed to the
attached or foregoing instrument, being :first duly sworn, do hereby declare to the
undersigned authority that the Testator signed and executed the instrument as the
Testator's will and that the Testator had signed willingly (or willingly directed another to
sign for the Testator), and that the Testator executed it as the Testator's free and voluntary
act for the purposes expressed in the will, and that each of the witnesses, in the presence
and hearing of the Testator, and at the request of the Testator, signed the will as witness
and that to the best of the witnesses' knowledge the Testator was at that time eighteen
years of age or older, of sound mind, and under no constraint or undue influence.
p.,n.. II ".."
Ida L. Carey
Witness
Witness
Witness
Subscri~ sworn to and acknowledged before me by, Ida L. Carey, the Testator,
and subscribed and sworn to before me by
and , witnesses, this day of
(Seal)
(Signed)
(Official capacity of officer)
D<:lI(T,/3, " "of""