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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
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RIV.1500 IX> (1l,1I1
1. Real E.la'e ISchedule AI I 11, ,_..__,._. ,._n___m.___. nn
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2, Slack. and Band, (Schedule B) I 2) , _ __ __"_"____'__'_ =:l
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3, Clo.ely Held Slock/Parlnershlp Inlere.1 ISchedule C) I 3) ____,_ __ ,___,_.,.____ _"m_
4, Morlgage. and Nole' Receivable IScnedule 01 ( 4) __._, ___.____,.___,____
S, Ca.n, Bank Depo,its & Miscellaneous Personal Properlyl SI ' -,,,-9-0,0________._, ,
ISchedule EI ,
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6, Jolnlly Owned Prope'ly IScnedule FI 161-,----.--._,______: l,)
7, Tran.lers ISchedule G) (Scnedule LJ I 71 -,______,__,_____,_,._iJ ~,: "i
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B, Tolal Gra.. A..e'.llolalllne,I,71 I B) _.__,_"u_n____
9, Funeral ExpenSOl, Admlnl'lro'lve Co.Is, Mlscellaneou. ( 91, ._n){(Q3.1,____.__
Expen.e. IS,h,dul. H)
10, Debts, Morlgag. lIabllitle., lien. IScnedule I)
11. T 0101 Deducllon. 110101 line. 9 & 10)
12, Nel Value of E,lal'lllne 8 minus line 11)
1J. Charllable and Governmenlol B.que.1s ISchedule J)
____ ~, Nel_Valu~_~je,cl-",T,.,xJII~.!.,I~m!~~lIne ~~L__,
IS. Amounl of line 14 laxable 016% rala
IInclude vnlue. Irom Schedule K or Schedule M,)
16, Amounl of line 14 Inxable 01 15% role
Ilnclude valuo, f,om Schedule K or Scnedule M,I
17. Principal lax duelAdd ladrom line IS and 'rom line 16,)
18. Credits Prior Payments Dhcounl
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COMMONWEALTH OF PENNmVANIA
DEPARTMINT Of REVENUE
Dm. 28060'
HARR'SlURO. PA 17\1Ij)6QI
..._ .on ___ __ ___ uu___u.___
o CEDENT'S HAM llAST, fiRST, AND MIDDle IHIlIA
0""'-\-""- l\\(l,'~ D.. 'S"\ \}\"~ ~..;~,
\08Irri:~N~i';:;-~_~~]O~0:~:i~;~:~.~.[6~;~;l\~~3~ co~~~~)\Jl\~~_~.~~.,__\.~~~_~___,__,,__,__
tiI I, Original Relurn I 1 2, Supplemenlal Relurn [.1 3, Remainder Relurn
liar dale. 01 dealh prior '012.13,821
[Is, Federal E.lale Tax
Relurn Required
_ 8, Tolal Numb.r 01 Safe D.podl Baxe.
94-
100
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COUNTY CODE
Oi-CfOENT'S cOM.puff -ADORE-55
YEAR
_ __~_.__u._____
NUMBER
I] 4,
1.16,
r-.1 4Cl. Futuro Interest Compromiso
Ifar dol.. 01 dealh alter 12.12,821
Decedenl Died Te.lal. [.1 7, Doced.nl Maln'aln.d a Living Trull
IAllach copy 01 Will) IAllacn copy 01 T ru.') _
ALL CO....roNDINCI ANll CONPlDINlIAL TAX INFO.MATlON SHOULD II DII.CTlD TO,
NAMT-' 30MPlETn'JAITiNO ADDR.ESS
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Imp"ONE NUMBER ------'---'- V\(l^,)V\\\~ I I?A
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19, 1/ lino 18 Is grea'e, 'non lI"e 17, enlor the cliff".nce an line 19. Thl.I.ln. OVERPAYMENT,
mill
1181
(19)
Check hOlo if you (110 Joquostillo (I tofund of yOUJ ovotptlymont.
20,1/ line 17 Is greal" Inan line 18, enler Ih. dlff"ence an IIn. 20, Thh 1.lh. TAX DLIE. 1201 '
A, Enla, Ihe in"".1 on Ih. balanco due on Iln. 20A, 120AI
B, Enlor Ih. 10101 of line 20 nnd 20A on IIn. 20B. Thh i, ,ne BALANCE DUE. 120BI
_ ",ak~h.~~Pay~!sI.I~I_R.gl._torof WIII.~AlI..nl _. on _'_' .
-. . .11 SUII TO ANSWIR ALL QUISTlONS ON REVIIII SIDE AND TO RECHECK MATH..
D;;d;r ponoll~oTp;~ry:Tdoclore tholl hovo ellamlnedlhi,r~~j;J~di~o-~;~~~~P~~Yi~g.,~hod~i~; (lnd Itl.lle-;;;~:-cl;dl;ih;;bo" 01 my knowledge and bell(J~
II II true, corrott and complole. I doclare Ihol all rllal ellolo hm been reporlod ollruo markol volul'!, Onclaralion 01 proparer alher Ihan 'he porlonal repreunlallve II
baled on all information of which prep rflr hm any knowledge.
.s-ICfNAY- --OfP-'ISONRTs---N-sfBU{i flLIN-G-R.TfU~N--.------AbbRfSS'. . - - "..---------.-..... bAU-----------
. $~RE,\'-IlW;::?~ lA~~1\'O'" ~ Ii .1'7~'{ \ bAW'. '2. L!J'1_~__,
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (~) IN THE
APPROPRIATE BLOCKS.
1. Old decedent make a tmnsfer and:
n
, i : 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,
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c. retain a reversionary interest or .....,.......,..............,..,.,............,..............1......
d.. receive the promise for life of either payments, benefits or care~ .....,,,..,,,..,,,,,.,,
2. If death occurred on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration~ If death
occurred after December 12, 1982, did decedent transfer property within one year of
death without receiving adequate consideration? "............."."...."................"..".
3. Old decedent own an 'in trust for' bank account at his or her deathL.."".......""".
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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COMMONWIALlH O' "NNSYWANIA
INHIIITANCI !AX InUIN
IIIIDIH! DICIDIHT
SA E
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Plea Ie Print or Type
FILE NUMB R
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IAII p"pollY 111.lly,ow.ld with ,hi II,hl If S...lvI"hlp mull bl dlICr..ld I. Schldull PI
ITlM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
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tl\.)~r .~ 1../00 00
2-) \OI1~ 71,"\"" U-'^~
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COMMONWtAlfH 01 "NNlnVANIA
IHHU""HCI lAX lllUIN
_IlIOtHIO'CIOI"'
SCHEDULE J
BENEFICIARIES
!STATI O.
PILI NUMI"
N~~rlR NAME AND ADDRESS O' 8ENEflCIARY
RlLATIONSHlP
AMOUNT OR
SHARI O' ISTATI
A. Taxabl. B.quo""
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AMOUNT OR
SHARI O' EST A TI
e. Charllabl. and Gav.rnm.nlal BtquOllll
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TOTAL CHARITABLe AND GOVeRNMeNTAL BeQUeSTS lAlla onlOr an IIno 13, Rocapllulallanl S
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RIV-1547 IX AFP 110093*
COMMONWEALTH Of PENNSVLVANIA
DEPARTMENT Of Rf.VENUE
IUREAU Of INDIVIDUAL TAMES
DEPT. 210601
HARRISBURG, PA 17121.0601
UTATI OF SMITH - MARl FILE NO.
DAn OF DIATH 05-07-92 COUNTY CUMBERLAND
HOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPEI, PORTION OF TillS FORH WITH YOUR TAX
PAYHENT TO THE REGISTER OF WILLS. HAXE CHECX PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
Ilf 'U'/--/O
ACN
101
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE DR DISALLOWANCE
OF DEDUCTIONS, AND ASSESSHENT OF TAX
TAX RETURN WAS, I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST 0 SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1, R..l E.t.t. ISoh.dul. Al
2, Stook. .nd Bondi ISoh.dul. BI
S. Clol.l~ H.ld Stook/P.rtn.rlhlp Int.r,"t ISoh.dul. C)
4. Hortg.g,"/Not.. R.o.lv.bl. ISoh.dul. D)
5, C,"h/lonk O.palltI/Hllo. P.rlon.l Prop.rt~ ISoh.dul. E)
6. Jolnt1~ O"n.d Prop.rt~ ISoh.dul. FI
7. Tr.nlf.rl (Soh.dul. 0)
e, Tot.l AII.tl
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Fun.r.l Exp.nl.I/Adnlnlltr.tlv. COlt11
Hllo.ll.n.oul E.p.nl.1 (Soh.dul. H)
10. O.btI/Hortg.g. Ll.bllltl../L1.nl ISoh.dul. II
11. Tot.l D.duotlonl
12, N.t V.lul of T.. R.turn
15. Ch.rlt.bl./Gov.rn..nt.l I.qu.lt. ISch.dul. Jl
14, N.t V.lu. of E.t.t. Subj.ot to T..
NOTEI
RECEIPT
NUHBER
DISCOUNT 1+)
INTEREST I- I
PAUL SMITH
54 VINE ST
NEWVILLE
PA 17241
DATE 05-31-94
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
[~ A~~! R..ltt.d l
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
iiiV: iS47 -Elf" "F'P" i i'ij: 9iT -NilYi or "oF -i"NHEiii'i' AileE" TAX - APPRA"i 9EHE'Nr;-1i Li:owAiicE - 'iili. - - - - -."". - - - - - -"
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SMITH MARIE D FILE NO. 21 94-0100 ACN 101 DATE 05-31-94
If .n .".I.ment wal i..ued previou.ly, lin.. 14, 15 .nd/or 1& .nd 17 will
reflect figure~ th.t include the total of ALL r.tu~n. .......d to d.te.
ASSISSMENT OF TAX: ---
15, Aoount of L1n. 14 t..lb1. .t 6X r.t. llSI
16. A.ount of Lln. 14 t..lbl. .t lSX r.t. (161_
17. Prlnolp.l T.. Du.
TAX CREDITS I
PAYHENT
DATE
I I CNANGED
III ,00
(2) .00
IS) .00
141 .00
151 900,00
16) .00
(7) .00
Ie) 900,00
(9)
llO)
4,637.00
,00
111)
(12)
1151
114)
4,637.00
3,737.00-
,00
,00
.00 X,06 .
,00 x.a .
ll71
.00
.00
.00
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
.00
.00
.00
,00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN 51, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU HAY IE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. I
ADtlIN
ISTRATlYE
CORRECTIONS.
..wrht.n protltt to th_ PA D.p,rt.,nt ('If R'VlnutI, aOlrd of ApPlIlh, DEPT. 241011, H,rrhburg, PA 17128-1021, OR
...110tlon to hlYI the ..tt.r d.t.relnld It ludlt of the IOcoUht of the plrlonal r.prll.ntatlvl, OR
Ulpp..l to the Orphan,' Court.
RESERYATIONI Elt.t.. of dlcld.nt. dvlng on or blfor. Dlo"be, 12, 19'2 ~. if .nv future tnt.r..t In thl I.t,t, I, tr,n'f.rr,d
In po...ulo" or .nJoy..nt to Cla.. a (coUat,raU bln,Uol,rl.. 0' the dlc.dlnt tfter the IlCplr,Uon 0' tnv utat. 'or
11'. or 'or v..r., the C~..onw..lthh.r.bv IKpr...lv r...rv.. the right to Ippr.I.. end ...... trln,'.r t"n.rlt,"cl TIMt.
It the llwful etl.. a (col1.'trlll r.t. on Inv IUeh future lnt.r..t.
PURl'OSE OF
NOTICE I To "uUlll th. rlqulre.tntl 0' Stetlen 2140 01 the Inh.rJt,nc. Ind tlt,tl Tu Aot, Act 22 of 1991. 12 P,S.
Slotlon 2140.
PAVMEHTI Dltloh the top portion of thlt HotJo. end .ub.1t with your ply..nt to tho Righter of Will. prlntld on thl r.v.r.. .1d..
--N... chock cr lIOn.. crdor ~...blo tOl REGISTER GF "%LUl, AGENT
All PlY.lnt. r.e'lv.d shall flr.t bl Ippll.d to any Int.re.t which ..y be due with eny rl.llndlr appll.d to thl tlK.
REFUkD (CR)I A refund of a tlM crld1t, which WI' not r.que.tld cn thl TIH Rlturn, ..y bl rlqul.ted by cc.plltlng an "ApP1lcltlon
for Refund of Plnnulv.nJ. 1nh.rlt.nc. llnd Eltate TeM" (REY.!!!!). AppUc.t1un. IIrl IIvelhbh et thl OffiCI
c, the R.gJ.tlr of Will., Iny of the 21 R'vlnul DI.trlct O"lcI., or by ceiling thl 'Plelel ?'4-hour
en.wer)ng ..rvlee nu.ber. for for.. ord8rlnal In P~nn'YI~anle 1-800-562-2050, out.ldl Penn'Ylvftnl, Ind
within locll Hlrrl.hurg Ir., (717) 717-1094, TOOl (717) 772-2252 (HI.rlng IIp'lr.d Only),
OIJECTIOHSI Any p.rtv In Int.r..t not s,tl,flld with the .ppral....nt, allowencR or dls,llcw.nol of d'duotlon., or ........nt
0' tlX (Including discount or Inttrlstl I' .hown on thls Notlc. .ust obJ.ot within IIHty (60) dlY' of rlcllpt 0'
thll HoUc. bYI
I
.I.
I
OISCOUNT,
Flctu.l .rrort dltccv.r.d on thlt ........nt should b. .ddr....d In writing tOI PA DIPart..nt of R'Vlnu.,
lurelu of Indlvldull Tax.., ATTHI Po.t A.......nt R.vl.w Unit, DEPT. 280601, HarriSburg, PA 17121-0601
Phone (717) 717-6505. S., pag. 5 of the book Lit "In.tr~otlons for Inhlrltlnc. '1M R.turn for I R..ld.nt
Decld.nt" (REY-IS01) for an 'Mplln,tlon of adllnl.tratlv.lY corr.etabl. .rrerl.
If env tlM dul II peld wUhln thr.. (5) c.llnd" lonthl after the dlcedantlldnth, a flvl percent (5:0 dhcount 0'
thl t.H Plld I. allowed,
I,
I
I,
I
I
I
I
INTEREIT I
Intlre.t I. ch.rgld b.glnnlng with 'Ir.t dlv of d.llnqulncy, or nlnl (9) .onths and ana (I) day frol the detl of
d.lth, to thl date of pav..nt, TIMI' which b,o"1 d.llnqu.nt b.for. Janulrv 1, 1982 bl.r intlr'lt .t the r.t. of
.IM (6~) p.rctnt plr annul c.lculatld et t d.lly r.t. of .000164, All taMI. which b,c"1 d.llnquent on Ind Ift.r
J.nulrv 1, 1.12 will b.ar int.r..t It a r.t. which wJII vary fret cal.ndlr y.ar to oal.ndlr Yllr with thlt r.te
announctd by th, PA n.perta.nt of R.v.nu.. Th. .ppl1cabll Int.rl.t rat.. for 1912 through 1'94 Irll
!!!.!: Inter..t Rat. nallv Intlr..t Facter ~ Inter..t Rate nally Int.r..t Facter
1982 m ,000548 1986 10~ ,000274
1915 16X ,000451 1987 9~ ,000247
1914 11% ,000101 1918-1991 11% .000SOI
~985 m .000156 1992 9~ .000247
1991-1994 IX ,000192
....I"ttlr..t 11 caleu1etld II followtl
I
I,"
I
INTEREST' BALANCE OF TAK UNPAID ,K NUHBER GF GAYS DELINQUENT X DAILY INTEREST FACTGR
-"Anv Hotlcl 1..utd e,t.r thl tlM bleo... dlllnqu.nt will r.fllet .n Int.r..t celeul.tJon to fl,te,n (Ii) dlYI
beyond the dati of the ........nt. If pay.ant h ..d. aftlr thl Intar..t calput.tlon dlt. .hown on thl
Hatle., additional Intlr..t IU.t b. c.lculat.d,
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