HomeMy WebLinkAbout12-26-06
REV-1500 EX" (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128.{)601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
RATHFON ROBERT L.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICiAl USE ONLY
FILE NUMBER
21 -0 6 0 6 1 2
'COuNTY'Co5E -YEAR- - - NuMBER- -
SOCIAL SECURITY NUMBER
1 7 1 - 3 8 - 8 698
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
03. Remainder Retum (dateofdeathpriortcI2-1~2)
o 5. Federal Estate Tax Return Required
!!.. 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Allach Sch 0)
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OS/27/2006 10/26/1951
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
1Xl1. Original Return
o 4. Limited Estate
IXl 6. Decedent Died Testate (Allach copy of Will)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Allach copy ofTrusl)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
91 ,798.00
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NAME
MURREL R. WALTERS III
FIRM NAME (II Applicable)
COMPLETE MAILING ADDRESS
42,095.28
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54 EAST MAIN STREET
TELEPHONE NUMBER
717.697-4650
MECHANICSBURG
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469.07
(8)
134,362.35
1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
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)
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate. ortranslers under Sec. 9116 (a)(1.2)
X _(15)
36,914.84 X .045 (16)
X .12 (17)
X .15 (18)
(19)
25,217.00
72,230.51
(11)
(12)
(13)
97,447.51
36,914.84
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
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
(14)
36,914.84
1,661.17
1,661.17
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ece en s om Die e ress:
STREET ADDRESS
. 130 W. PORTLAND STREET, UNIT 3
CITY I STATE I ZIP
MECHANICSBURG PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
1,661.17
Total Credits (A + B + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + 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. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
1,661.17
1,661.17
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; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 00 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.
Under penalties of pe~ury, I declare that I have examined this return, includinQ 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 personal representative is based on all Information of which preparer has any knowledge.
SIGNATURE OF SON RESPONSIBLE FO FILING RETURN DATE
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ADDRESS
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MURREL R. ALTERS III
54 EAST MAIN STREET, MECHANICSBURG
ADDRESS
PA 17055
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. 99116 (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. 99116 (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 retum 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)]. 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)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RATHFON ROBERT L. 21 06 0612
All real property owned solely or as a tenant in common must be reported at fair market value. Fair mar1\et 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 prODertv which is iointlv-owned with riaht of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
91,798.00
130 W. PORTLAND STREET, UNIT 3
MECHANICSBURG, PA 17055
SALE PRICE
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
91,798.00
A. Settlement Statement
U.S. Department of Housing
and Urban Development
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OMB Approval No. 2502-0265
B. Type of Loan
1. 0 FHA 2. 0 FmHA 3.0 Conv. Unins. 6.FileNumber
4. 0 VA 5. 0 Conv. Ins.
7. loan Number
8. Mortgage Insurance Case Number
C. Note: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are
shown. Items marked "(p.o.c.)" were paid outside closing; they are shown here for informational purposes and not
included in the totals
O. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender
KENNETH L. KRAMER PATRICIA GEBHART, EXECUTRIX
RITA B. KRAMER ESTATE OF ROBERT RATHFON
43 RED BARBERRY DRIVE
ETTERS PA 17319
G. Property Location H. Settlement Agent
TAX PARCEL NO. 19220519057U1303 MURREL R. WALTERS III, ESQUIRE
130-3 WEST PARTLAND STREET Place of SetlIement I. Settlement Date
MECHANICSBURG PA 17055 54 EAST MAIN STREET 9/11/2006
MECHANICSBURG PA 17055 Disbursement Date
Lot; UNIT 3 Block: 9/11/2006
J. Summary of Borrower's Transaction
100 Gross Amount Due From Borrower
K. Summary of Seller's Transaction
400. Gros. Amount Due To Seller
101. Contract sales price 90,900.00 401. Contract sales price 90,900.00
102. Personal property 402. Personal prooertv
103. Settlement charaes to borrower (line 1400\ 1,832.50 403.
104. 404.
105. 405.
Adlustments for Itams nald bv sener In advance Adlustments for Items peld bv sener In advance
106. Citvnawn taxes to 406. Cltvltawn taxes to
107. Countv taxes 9/11/2006 to 12/31/2006 106.24 407. Countv taxes 9/11/2006 to 12/31/2006 106.24
108. Assessments to 408. Assessments to
109. SCHOOL TAX 9/11/2006 to 6130/2007 778.34 409. SCHOOL TAX 9/11/2006 10 6130/2007 778.34
110. SEWER 9/11/200&0 9/30/2006 13.42 410. SEWER 9/11/200&0 9/30/2006 13.42
111. to 411. to
112. 10 412. to
113. 10 413. 10
114. 10 414. 10
115. to 415. to
120. Gross Amount Due From Borrower 93,630.50 420. Gross Amount DUB To Sener 91,798.00
200. Amounts Paid Bv Or In Behalf Of Borrower 500. Reductions In Amount DUB To Sener
201. Deposit or earnest money 2,000.00 501. Excess denn.'11 Isee instructions) 2,000.00
202. Princloalamount of new loanls\ 502. Settlement charaes 10 seUer lIine 1400\ 996.00
203. Existino loanlsHaken sub'eet to 503. Existino loanls\ taken subiect to
204. 504. Pavnf( of first mortnaae loan
205. 505. Pavof( of second mortaaae loan
206. 506. NATIONAL CITY MORTGAGE #028307-2 66,258.53
207. 507.
208. 508.
209. 509.
Adlustments for items unnald bv seller Adlustments for Items unnald bv sener
210. Cltvltown taxes to 510. Citvltown taxes to
211. Countv taxes 10 511. Countvtaxes to
212. Assessments to 512. Assessments to
213. to 513. to
214. to 514. to
215. to 515. to
216. to 516. to
217. to 517. to
218. to 518. to
219. to 519. to
220. Total Paid By/For Borrower 2,000.00 520. Total Reduction Amount Due Seller 69,254.53
300. Cash At Settlement FromlTo Borrower
600. Cash At Settlement TolFrom Sener
301. Gross Amount due from borrower (line 120) 93,630.50 601. Gross amount due to seUer (Une 420) 91,798.00
302. less amount paid bvlfor borrower llIne 220\ 2,000.00 602. Less reductions in amt. due seller (line 520\ 69,254.53
303. Cash 1&1 From o To Borrower 91,630.S0 603. Cash 1&1 To o From Seller 22,543.47
SUBSTITUTE FORM 1099 SELLER STATEMENT
The information contained in Blocks E, G, H, and I and on fine 401 (or, line 403 and 404) is important tax information and is being furnished to the Internal Revenue
Service. If you are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS determines
that it has not been reported. If this reat estate is your principal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your income tax
return; for other transactions, complete the applicable parts of Form 4797, Form 6232 andlor Schedule 0, Form 1040). You are required to provide the Settlement Agent
(named above) with your correct taxpayer identification number. If you do not provide the Settlement Agent \.Yith your correct taxpayer identification number, you may be
subject to civil or criminal penalties imposed by law. Under penalties of perjury, I certify that the number shown on this statement Is my correct taxpayer identification number.
(Seller's Signature)
L. Settlement Charoes
700. Total SaleslBroker's Commission based on price $ 90,900.00 Iiil %~ 0.00 Paid From Paid From
. Division of Commission (Une 700) as follows: Borrower's Selle~s
Funds At Funds At
701. $ to Settlement Settlement
702. $ to
703. Commission paid at Settlement
704.
800. Items Pavable In Connection With Loan
801. Loan Oriaination Fee 0.00 %
802. Loan Discount 0.00 %
803. Annraisal Fee to
804. Credit Report to
805. lender's Inspection Fee
806. Mortgaae Insurance Application Fee to
807. Assumption Fee
808.
809.
810.
811.
812.
813.
900. Items Required Bv Lender To Be Paid In Advance Exclude last day in cales -line 901
901. Interest from to 11ll$ /dav
902. Mortoaae Insurance Premium for months to
903. Hazard Insurance Premium for ~ors to
904. vears to
905.
1000. Reserves Ceposlted With Lender
1001.
per month
r month
r month
1005.
1008.
1007.
1008.
1100. Title Charaes
1101. Settlement or c10sina fee to
1102. Abstract or title search to
1103. Title examination to
1104. Title insurance binder to
1105. Document oreparation to
1106. Notary fees to CASH 10.00 10.00
1107. Attornev's fees to
(Includes above items numbers: 1
1108. Title insurance to MURREL R. WALTERS III, ESQUIRE 875.00
(Includes above items numbers: 1101-1104,1108 PENN ATTORNEYS TITLE INS. CO. l
1109. Lender's coveraoe $
1110. Owner's coverage $ 90,900.00
1111.
1112. I
1113. I
1200. Government Recordina and Transfer Charaes
1201. Recordino fees: Deed $ 38.50 ; Mortgage $ : Releases $ 38.50
1202. Citv/countv tax/stamps: Deed $ 909.00 ; Mortoaoe $ 909.00
1203. State tax/stamps: Deed $ 909.00 ; Mortgage $ 909.00
1204.
1205. RECORD MORTGAGE SATISFACTION 27.00
1300. Additional Settlement Charges
1301. Survey to
1302. Pest inspection to
1303. TAX CERTIFICATION FEE BARRY L. HECKARD, TAX COLLECTOR 5.00
1304.
1305. RESALE CERTIFICATE W.C. ASSIST & MANAGEMENT COMPANY 25.00
1306.
1307.
1308. FEDERAL EXPRESS MORTGAGE PAYOFF 20.00
1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) 1,832.50 996.00
CERTIFICATION
I have carefully reviewed the HUD-1 Se,ttlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements
y aCCQuI')t or by me in's transactIon. I further certify that I have received a copy of the HUD-1 Settlement Statement.
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RITA B. KRAMER
Seller
Borrower
Seller
Borrower
ent Statement which I have prepared is a true and accurate account of t~f nds v.11ich were received and have been or will
e settlement of this transaction. q, j'
Settlement Agent ~~!f...tJ ? Date
L TERS III, ESQUIRE (
WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and
imprisonment. For details see: Title 18 U.S. Gode Section 1001 and Section 1010.
u.s. GOVERNMENT PRlNnNG OffiCE: 1!1ll90.944-245
REV-1508 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RATHFON ROBERT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER
L. 21 06
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0612
ITEM
NUMBER DESCRIPTION
1. HOUSEHOLD ITEMS
PER SALE PRICE
2. CHUCK BRICKER AUCTIONEER
SALE OF PERSONAL PROPERTY
3. WALMART
REFUND
4. NATIONAL CITY MORTGAGE
ESCROW REFUND
5. LIBERTY INSURANCE
REFUND
6. COM CAST
REFUND
7. AT&T
REFUND
VALUE AT DATE
OF DEATH
2,455.82
740.00
22.47
789.02
5.25
33.35
12.68
8.
AMERIPRISE FINANCIAL
INDIVIDUAL ACCOUNTS. SARA PHILLIPS, MOTHER. BENEFICIARY
18,567.99
9.
AMERIPRISE FINANCIAL
IRA ACCOUNTS. SARA PHILLIPS, MOTHER. BENEFICIARY
19,468.70
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
42.095.28
REV-1509 EX + (6-98)
.
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
RATHFON
ROBERT L.
FILE NUMBER
21 06
0612
If an asset 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. SARA J. PHILLIPS
10 JEFFREY ROAD
MECHANICSBURG, PA 17055
MOTHER
B
c
JOINTLY-OWNED PROPERTY:
LEITER 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 DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. A IT ACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 10/28/75 M&TBANK 938.14 50. 469.07
CHECKING ACCOUNT
TOTAL (Also enter on line 6, Recapitulation) $ 469.07
(If more space is needed, insert additional sheets of the same size)
REV-1514 EX + (12-99)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
RATHFON
ROBERT L.
21
06
0612
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS FUNERAL HOME 8,729.00
2. WOODLAWN MEMORIAL GARDENS. GRAVE OPENING 1,050.00
3. WOODLAWN MEMORIAL GARDENS. GRAVESTONE 3,665.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) PATRICIA GEBHART 6,345.00
Social Security Numbe~s)/EIN Number of Personal Representative(s) 197-4G-5023
Street Address 35 REGENCY WOODS DRIVE
City CARLISLE State PA Zip 17015
Yea~s) Commission Paid: 2006
2. Attorney Fees MURREL R. WALTERS III, ESQUIRE 5,100.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS - CUMBERLAND COUNTY 328.00
5. Accountanfs Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 25.217.00
(If more space is needed. insert additional sheets of the same size)
.
REV-1512 EX + (6-98)
*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RATHFON ROBERT L.
FILE NUMBER
21 06
0612
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
VALUE AT DATE
OF DEATH
1. PP&L
ELECTRIC
102.31
2. UNITED WATER
WATER
26.83
3. PORTLAND COURT CONDO ASSN
ASSN DUES
75.00
4. ROBERT P. ELLIOTT
DRYWALL REPAIR
100.00
5. PAUL MELHORN
HOUSE REPAIRS
127.94
6. ROLAND GESSNER
PAINTING
450.00
7. GARY RADABAUGH
AIR CONDITIONING REPAIRS
243.15
8. CARPET MART
CARPET FOR HOUSE
1,924.41
9. COLT PLUMBING
REPLACEMENT PARTS FOR BATHROOM
50.67
10. WALMART
REPLACEMENT PARTS FOR STOVE
50.53
11. MAID TO PERFECTION
HOUSE CLEANING
119.25
12. HAMPDEN CLEANERS
CLEAN CURTAINS
61.45
13. PINNACLE HEALTH HOSPITAL
MEDICAL
50.00
14. M&T BANK
MORTGAGE & CREDIT CARD PAYMENTS
1,547.35
15. SETTLEMENT COSTS
SALE OF HOUSE
996.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
72.230.51
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Page 1
21 06 0612
File Number
RATHFON
Decedent's Name
ROBERT L.
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. NATIONAL CITY MORTGAGE 66,258.53
MORTGAGE ON 130-3 WEST PORTLAND STREET. PAID AT SETTLEMENT
17. M & T BANK 47.09
LINE OF CREDIT
$94.19 .JOINT WITH SARA.J. PHILLIPS
SUBTOTAL SCHEDULE I 66,305.62
GRAND TOTAL SCHEDULE I $ 72,230.51
_-:~"ax.(*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RATHFC" \I
NUMBER
1.
SCHEDULE J
BENEFICIARIES
....r lH......... I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a)(1.2)]
1.
SARA.J. PHILLIPS
10 .JEFFREY ROAD
MECHANICSBURG, PA 17055
STEVEN W. RATHFON
6280 CARLISLE PIKE
MECHANICSBURG, PA 17055
FILE NUMBER
21 06
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
MOTHER
BROTHER
OR1?
AMOUNT OR SHARE
OF ESTATE
AMERIPRISE IRA
AMERIPRISE ACCOUNT
M & T BANK. .JOINT
RESIDUE
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
2.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
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)
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
GEBHART PATRICIA
35 REGENCY WOODS NORTH
CARLISLE, PA 17013
-------- fold
ESTATE INFORMATION: SSN: 171-38-8698
FILE NUMBER: 2106-0612
DECEDENT NAME: RA THFON ROBERT L
DA TE OF PAYMENT: 12/26/2006
POSTMARK DATE: 12/26/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: OS/27/2006
NO. CD 007607
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,661.17
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 111
SEAL
INITIALS: CJ
RECEIVED BY:
REGISTER OF WILLS
$1,661.17
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS