HomeMy WebLinkAbout94-00513
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,~,~ INHERITANCE TAX RETURN
~~ RESIDENT DECEDENT
COMMONWeAlTH 0' mINSYLVAN'^ (TO BE FILED IN DUPLICATE
DEPARTMENT 0' R!lJ!NUf J I
.~A~~~T!~W,c~"?l~WI31', ~~.I~H..REG~STERp<?F y,lIL~S) _ _~.~
-. oeCEOtNi:s- NAME ll"'~', fiRSt, AND MIUOlf INITIAL) [DeCEoeNT'S CQMPlerf ACORESS
! .~~;;~?thF--T:;;~~~:-.._.-t~~==~~: 17011
.. ____ _.....__.. _._______._.__._____...___..._____. .__1
~ [l9 1. Original R.Mn 0 2, Suppl.m.nlal R.turn 0 3. R.malndor R.lurn
iiie (lor datil 01 d.alh prior to 12.13.821
~... I 0 4, llmlt.d E.lal. 0 40, fuluro Intor," Campramil. 0 5, Fodl/al E,tal. To,
02 I I'or dol II 01 d.alh ok.. 12.12.821 R.lurn R.qullld
t;l I [l9 6, DIC.d.nl DI.d T.lla'. rot 0 7, D".d.nl Malnlaln.d a llYlng Trull ...J. 8, Talal NumboralSal. D.pa,1I Bo,"
_.!....._. (Attach copy 01 Will) probated (Attach cap~ ~1.TrUlI) ....... .... ...____
I ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD IE DIAlCTED TO.
NAM1" ----.----. .-..--. 'COM/llIe MAllINO Aiiiiilfi----'-"--
304 Sarerset Drive
Shirem:mstown, PA 17011
lev. 1100 e" 18.'6'
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FILE NUMBER
(711 ., $:'/.3
Richard R. Cairo
me/Ho,i! NUMI!I
717
1 737-7:'551
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1, R.al Ellale ISch.dul. A) ( II
2, Slock. and Band, ISch.dul. 81 ( 2)
3, Clo.oly Held Stack/Partn."hlp Inl'"II (Sch.dule C) (31
4, Morlgagll and Na'" Roe.lyabl. ISchedule 01 ( 41
5, Co.h, 8ank D.pa.I" & Mlsc.llan.aUl P."anal Property I 51 .iLJ,,15. 00
IScn.dul. EI
6. Jalnlly Ownod Praporly (Sch.dul. FI I 6) 814 r 348.72
7, Trandor'ISch.dul. 0) (Sch.dule l) ( 7) $2,013.47
8, Total Gro.. A..." Ilolalllnll 1.7)
9, Funoral E.pen..., Admlnl'lrally. Co.I.. Mlscellan.oUl I 91 $7, 7B8. 30
E'pen,.. (Sch.dule H)
10, D.b", Martgag. llabllltl.., ll.n. (Sch.dul. I) (101 $46.20
11. Talal D.ductlan, (talalllnll 9 & 10)
12, Nil Valu. of Ellat.llln. 8 mlnu.lln. 111
13, Charltabl. and Gomnm.nlal B.quIII. ISch.dule JI
14, N.I Valu. Sub.ct 10 To. IlIn. 12 mlnu.lln. 131
15, An,uunl 01 IIn. 14 'oKabl. 01 6% ral.
(Includ. valulI from Sch.dul. K or Sch.dul. M,)
16. Amount of IIn. 14 ta,abl. 01 15% ral.
(Includ. valulI from Sch.dul. K or Sch.dul. M,I
17, Principal to. duo (Add to. Iram IIno 15 ond from IIn. 16,1
18, Clldll. Prior Paym.nt. Dlleou"
+ $28.92
I\>, If II" 18 I. gllOl1/ ,han IIn. 17, .nllllhe dllll/.nco an IIn. 19, Thl,I'lh. OVSRPAYMSNT,
A,O Choek h... If you all roqulltlng a ..fund of your oUl/paym.nt.
20, If line 171. gllall/lhan line 18, .nllllh. dllloronco on line 20, Thl, I. tho TAX DUE,
A, Enllr Ih. Int....1 an Ih. balanco duo on IIn. 20A,
8, Enll/ the 10101 of lin. 20 and 20A on IIn. 20B, Thh I, Ih. BALANCE DUE.
Mak. ChICk Payabl. tal R.gl.t.. of W~I., Ag.nt
(171 $578.56
(181 ~2B.92
(191 _
120) $549.64
120A)
(20B) .J.549. 64
(OJ $17/477.19
$7,834.50
$9,642.69
(15)
(161
)( ,15.
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. ..... . . . IE.S.l!~~~()~N.~~E~~~L QUESTIONS ON REVE.~S!.!ID8.~N~J'.Cl.RECHECK MATH" ____....
Under plnchl.. of perjury, I declar. ,hell I hove examIned Ihl, r'lurn, In eluding accompanying Ich.dul.. and "allments, and 10 th, bllt of my knowi.dgl and bill,'
It 1,lru., CO",,, and compl.I., I d.c1alllhal all roal .1101. ho. b..n IIpo~.d allrUl mork'l valu., D"larotlon 01 pllparor olh" Ihan Ih. P~i7 J~"'.nlaIIYe I;
balld an all In lor motion of whl,h pllpar" ha. any knowl.dg., '.Y .
IiONAMe 0yi90N'illPON5~"J ',~.~,m'<lo WUIN .'OOA1'fl 304 Saterset Drive rn I-
V /h,(;.J/;..J/ U( U/VI~ Shiremanstown, PA 17011
lfcmA~,'fR1/ARlfiifHe~ fHANRfPiel!NTAIIVe AOOlels' liAT('---.--....--
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PLEASE ANSWER THE FOLLOWING'QUESTIONS BY PLACING A CHECK MARK ("') IN THE
APPROPRIATE BLOCKS. '.' .
FrO
1. Old decedent make a transfer and: . , I .! x
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,
Ix
. . I
c. retaIn a reversionary nterest or .".................".............,.....,................11.........
x
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 conslderation~ If death x
occurred after December 12, 1982, did decedent transfer property within one year of
death wlthout'recelvlng adequate consideration? .................................................
3. Old decedent own an 'in trust for' bank account at his or her deathL....................
x
x
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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SCHEDULE "E"
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Plea.. Print or Type
FILE NUMBER
*
COMMONW~A\TH OP ~NMVYlVANIA
INNIII "NCI TA I IN
I" DINT DIC DI
E~TATE OF Elizabeth F. Cdro
IAII proplrty lolnlly.ownod wllh ,hi RighI 01 Survlvollhlp ",uOl bl dllClo"d on Schldull "P"I
ITIM tlESC:kil'HON VALUE AT
NUMBER DATE OF DEATH
--
1. Refund on Dauphin Deposit Bank Sllfety Dep. Box $11.80
2. Refund from Blue Cross/Blue Shield $228.20
3. Refund on Miracle Ear Hearing Aid $875.00
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S 1,115.00
(A"oc~ oddlllonoI8y" MIl" ,h..I.11 mo" 'po.. I. ...dod,1
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eO~NwlAl'H 0' 'ItlN'YlVANIA
INtlUIWlCI ,,.. UlU..N
..IIDINT DleIDIN'
SCHEDULE F
JOINTLY.OWNED PROPERTY
ISTATI Of
Elizabeth F. Cairo
fiLE NUMIlER
Joint tlnantl'"
NAME
A. Richard R. Cairo
ADDRESS RELATIONSHIP TO DECEDENT
304 Somerset Drive Son
Shiremanstown, rA 17011
Il, Albert S. Cairo
6153 Bluebird Ave. Son
Harrisburg, PA 17111
C. Anthony R. Cairo
318 Somerset Drive Son
Shiremanstown, rA 17011
Jolntly.awnld proporty.
ITEM LEnER DATE
fOR TOTAL VALUE DECO'S DOLLAR VALUE Of
NUMIlE~ JOINT MADE DESCRIPTION OP PROPERTY OP ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A /1/74 Checking Acct. 514000894' $98.68 1/2 X $49.34
PNC Bank
2. A,B,C /3/85 CD #1063240074486, PNC Bk $2,019.42 1/4 $504.85
3. A,B,C /13/8€ CD U063240077038, PNC Bk $G,558.98 1/4 $1,639.75
4. A,B,C /25/8€ CD #1063240079852r PNC Bk $6/852.57 1/4 $1,713.14
5. A,B,C /13/8€ CD #1063240079874, PNC Bk $3,017.02 1/4 $754.26
6. A,B,C /3/86 CD #1063220083354, PNC Bk $3,014.88 1/4 $753.72
7. A,B,C /3/87 CD U063220087694 r PNC Bk $3,016.14 1/4 054.04
8. A,B,C /3/89 CD #1063240106243, PNC Bk $2,517.29 1/4 $629.32
Dauphin Deposit Bank
9. A,B,C ~/12/9 CD #8000163454 $15/100.60 1/4 $3,775.15
10. A,a,C '1/12/9 CD #8000163462 $15,100.60 1/4 $3,775.15
,
TOTAL (AI.o Inllr on IInl 6, RlCapltulatlan) S 14 348,72
(II moro .paco I. ""d,d Inllrl addillonal thll" 0' 'ami lilO)
..v.ull.....jJ,UI
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SCHEDULE "H"
FUNERAL EXPENSES,
ADMINISYRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Plea.. Print or T .
COMMONweALTH 0' 'INNIYLVANIA
INHII\TANCIIAX mURN
RlIlDeNT DlceUINT
Elizabeth F. Cairo
I PILE NUMBER
UTATI OP
ITEM DESCRIPTION
NUMBER
AMOUNT
A. Funeral IMp.nl."
1.
Neill Funeral Horne, Camp H~ll, PA
$7,486.30
$276.00
$11.00
2.
Funeral Lunoheon, The Iron Kettle Restaurant
ZK Thank Your Card Stamps
3.
B. Admlnllt,atlv. COltll
1. Pe"onal Rlp,..entotlve Commlulon. none
Social Security Number of Pe"onal Repre.lntatlvel
Year Commission. paid
2, Attorney Fee.
3, Family EXlmptlon
Claimant Relatlon.hlp
Addreu of Claimant at decldent'. death
Street Address
City . Stale __ Zip Cod.
4, Probate Fel.
Filing Fee For Inh. Tax- Reg. of Wills Curnb. Co. $15.00
C. M1IClllan.auI !Jcp.nlul
1.
TOTAL IAI.o enter an line 9, Recapitulation) . $7,788.30
III ml.. 'pa.. I, """d"d, '"'lit addllla"al,h,," .1 ,ami 'In)
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.., C~lrt1fiof~ Lt:' ,01; DO))DSH Aocol\ll,t; No.
'ln t;htl' l)ameS of Eli;~~\bttl:h 11 C:u:l.I'O 01'
Anth'OI'lyR CI~1rO. nld,t\lIt'O' (It dld',o',o,[
i~l? 2D.
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4, eel.tifJ,cl,lta of DepolJ1,t Aboo\.lllL ~Ic>.
1h the ,\IBm6e' of El:l.~abBth F Oairo or
of Anl.1\Ony ,H Dall'o. I ,Bu,lanOE)' at
Intol'I:JElt': "iP16..t4,
I
:I. f. I t.'1I1l l;>e, of
oOI\t.ac I; lilt) <It:
tiny
(7.1." )
\063;~2()OO?084 opene,oe,\03j.03/0,/
Rloh'1I'rJ R Gah'o 01' ,'A, f.l CiaNi
date, Qf; c\r.laql: ",' $3.000.00.
,
1003240160243 apenud
IUdllH'cl '01.\:1.1>6 01' A ,8
d~uLh: $~i500.00.
O~1/03/fjFJ
Cllll'O Clr
In.tel'est:
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. Dt'ow' J. Khlhbl\7
A(ltliBLallt Vlc(:\ PI'U:'ildl'illt,
Bank Optill't\t:J.OI\B
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LAST WILL AND TESTAMENT
OF
ELIZABETH F. CAIRO
I ,ELIZABETH F . CAIRO, of Hampden Township, Cumberland
Oounty, Pennsylvania, do deolare this to be my Last Will and
Testament hereby revOking all pI'ior Wills heretofore by me made.
ITEM I. I give, bequeath and devise my entire estate, ~eal,
presonal and mixed, and wheresoever the same may be situate, I
give, bequeath and devise to my husband, David A. Oairo.
ITEM II. In the event my said husband, David A. Cairo, does
not survive me, I give and bequeath the sum of Five Hundred
Dollars ($500.00) to eaoh of my grandohildren. In the event that
my grandchildren should not survive me, then to their issue per
stirpes.
ITEM III. In the event my said husband, David A. Cairo,
does not survive me, I give bequeath and devise all the rest,
residue and remainder of my estate, real, personal and mixed,
and whtresoever the same may be situate, to my sons, Albert S.
Cairo, Riohard R. Cairo and Anthony R. Cairo, in equal shares
their heirs and assigns forever.
ITEM IV. I nominate, oonstitute and appoint my husband,
David A. Cairo, Exeoutor of this my Last Will and Testament and
if he predeoeases me, I nominate constitute and appoint my son
Riohard R. Cairo, Exeoutor of this my Last Will and Testament.
IN WITNESS WHEREOF, I, the Testat;ix, have hereunto set
my hand and seal this 30tA day of /ffJ/f/L , A.D., 1979.
[' 1..( '7.ci-1 hlFC LL.i a. I-
(SEAL)
Signed, sealed, published and declared by the above named
Testatrix as and for her Last Will and Testament, in the presenoe
of us, the sUbsoribing witnesses, who at her instance and request
and in her presence and the presence of each other have hereunto
set our hands and seals the day and year aforesaid.
t7cE'
(SEAL)
'M '. !2~-P-
1 1Ui'/~ IIt,y(SEAL)
c:< I L,
REV-1547 EX AFP (10093*
COHHONWEAlTH OF PENHSVlUANIA
OEPARTNENl OF REVENUE
BUREAU OF INDIVIDUAL TAMES
OEPT, la0601
HARRISBURO. PA 1112a-0601
@
ACN 101
NOTICE OF INHERITANCE TAN
APPRAISEHENT. ALLOWANCE OR DISALLOWANCE
OF OEDUCTIONS, AND ASSESSHENT OF TAN
DATE 10-11-94
-
FILE NO.
DATE OF DEATH 04-23-94 COUNTY CUMBERLAND
NOTE. TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITH YOUR TAN
PAVHENT TO THE REGISTER OF WILLS. HANE CHECN PAVABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAVMENT TO:
RICHARD R CAIRO
304 SOMERSET DR
SHIREMANSTOWN PA 11011
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 11013
L
AMount RIMI tt.d
-
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV: i5'47. EX "A i: p"f i 0-: m--iiiificE" "OF - "fNHEiii i'AiicE"YA"X" iiP'jiilA"i BEMEiiT"; "A t UiWANCE' oli" on -.. 0 0."""""""
DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX
ESTATE OF CAIRO ELIZABETH F FILE NO. 21 94-0513 ACN 101 DATE 10"11-94
If an a.....m.nt wa. i..u.d previou.1Y, line. 14, 15 and/or 16 and 17 will
reflect figure. that includ. the total of ahh r.turn. a......d to dat..
ASSESSMENT OF TAXI
15. AMount of Llnl 14 tl,.b11 II 6% r.11
16, AMount of Llnl 14 tl,"b1" II 15% rill
17. Prlnalpl1 TI' DUI
TAX CREDITS I
PAVHENT
DATE
TAN RETURN WAS I I X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST . SEE REVERSE
--
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN
1. Rlol Eltoto ISohldulo A) III
2. Slaoks Ind Bondi ISahldul1 Bl 121
3. C1au1y Hold Sloak/Pwrlnlrlhlp Intor..1 ISchldu11 C) (3)
4. Hartglgll/Natl1 Rlcllvlb11 ISahldu1. 0) (4)
5, Cllh/Blnk Dlpaoltl/Hllc. Plrlanl1 Praplrly (SOhldu11 E) 151
6. JointlY OWnld Praplrly (S.hldu11 F) 161
7. Trlnlflrl IS.hldu11 G) (7)
D. Tatl1 AIIIII
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funlrl1 E,plnlll/AdMlnlltrlllvl Callll
HII.1111nlaul E,plnlll (Sohldu1. H) 191
10. Dlbh/Hartglgl LllbUHI.I/Lllnl IS.hldulo 1) 110)
11, Totol Dlduotl.nl
12. Nit Volu. of To> Rlturn
13. Chlrltlbll/GavlrnMlntl1 Blqu.ltl ISohldul. J)
14. Nit V.lu. of E.t.t. Subjl.t to TI'
NOTE I
115)
1161
RECEIPT
NUHIER
DISCOUNT (+ I
INTEREST (.)
06"08-94
886156
28.93
) CHANGED
I ~,
.00
.00
,00
,00
1,115,00
14,34LU,
2.013.41
(8)
11,411.19
1,188.30
46.20
lll)
112)
113)
1141
1,834.50
9.642.69
.00
9.642,69
9.642,69 N.06 .
.00 N.n .
117)
518.56
,00
518,56
AHOUNT PAin
549,64
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
J
518,51
,0ICR
,00
,0ICR
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS LESS THAN II. NO PAVHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR) I YOU HAV IE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUC!IONS.)
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RESERVAT ION I E,tit" of ~.dtnt' d~l~ on or b.for, D,c,.blr'12, 1982 -- If .n~ futurl lntlr..t In thl ..t.t. 1, tr.ntf.rred
In pOQ.,..lon or .njov'lnt to Cla.. I (0011.t.r,1) b,n'flol,rll' of thl dlcldent Iftlr thl Ixplr.tlon of In~ 'Ite'l for
Ilfl or for VI.rl, the Co"onw'11th hlr.bv Ixprl..lv r"lrv.. the right to Ippr.l.. Ind ...... tranlf.r Jnh.rlt~. TIH..
It thl Ilwful CI'I' . (c011It.r,l) r.t. on Inv .uch future Int.r'lt.
PIJlllIOIE OF
NOTICE I Ta ful'111 the rlqulr..lnt. of SlOt Ion 21~O 0' thl Inhlrltancy .nd E.t.t. T'H Aot, Aot 220' 1991. 12 P,S.
"oUon 2140.
PAVMENTI Olt.oh thl top portion of thl. Notlol and tub.lt with your ply..nt to the Rlgl.tlr of ~III. prlnt.d on thl rIVlr.. .Ide,
..HIl<I chICk or .on.. ordll pIY'b11 to, REOISTER OF NILLB, AOENT
All pI~..nt. recllvld Ih.ll flrlt bl Ippllld to any lntlrllt which 'IY b. dUI with any rl.llndtr .pplied to thl tlH,
REFUND (CA)1 A refund 0' , tlH arldlt, which Wit not r.queltld on the Tlx Rlturn, .ay bl r.qu..tld by ooapl,tlnt In "Appllaltlon
for Rlfund of Plnnlvlvanl, Inhlrltlnc' and Eltlt. ,ax" (RE~~13IS). Ap~lloltlon. Ir' Iv.Jltbl, It thl Offlo,
of tht Rlgllt,r of Will., any of the ZS R.v.nu. Ol.trlot Of'Ic,., or by o,lllng thl 'Plol'l 24-hour
Intwlrtng .Irvlol nulbtr. for for.. ordlrlngl In P.nn'Ylvlnll lRBOO.36Z.Z050, outllde Plnnlvlvlnll and
within 10011 H.rrl.burg ,rl' (717) 787..094, TOOl (717) 772RZZ52 (H.lrlngl.pllrld Onlv).
OIJECTlOH'1 Anv pertv In lnter..t not uUlf1ld with thl IPPrlh"l"t, 111ow.no. or dlullowlnc, of d.ctuoUonl, or ''''''Mnt
of tlX (Including dheount or InterllU II shown on thlt Notlel IUlt objeot wlthJn Ihttv (60) dav. of reollpt of
thlt HoUcl bVI
~.wrlttln protl.t to the PA OIPlrt..nt of Rlv.nu., laird of ApPI.II, DEPT, Z11021, H,rrllbur., PA 1712a~1021, OR
-RIIIOtlon to h.v. thl ..ttlr dltlrtln.d It ludlt of th. Icoount of thl Plr.on.1 r.prlltnt,tlvl, ON
.-.,p..1 to thl Orph.nl' Court.
ADlnH
"'RAllY!
CDtlRfCTIllltt I
Flctu.1 errOrt dhoover.d on thlt ........nt .hould bl Iddrt..ed In writing tal PA Olp"t.."t of R.VINII,
Iurl.u of Individual T'MI', ATTNI POlt AII.llllnt R.YI,w Unit, DEPT, 280601, Harrl.burg, PA 17128-0601
Phone (711) 717~6505. S.. pig. 3 of the book lit "lnltruottonl for Inherltenol TIK R'turn 10r . R..ldent
DlGldent" (REY~1501) for In ,xplan.tlon of .d.lnlltrltlvtlv corr.ot.bll Irror..
DIICIlUIH I
If tnV tex dUt II Plld within three (3) o.llnd,r ~onth. 'ft.r the dtOtdlnt'. d..th, . flv. p,rolnt (IX) dl.oount of
thl ttK P,ld II "U owed , ,
Inttrllt it oher"d bl.lnnlng with fir" day of dlUnquenov, or nln. (9) lenthl Ind ant (lJ d.y fr08 thl date of ,
de.th, to thl dltl 0' PIV""t. T.xII ..hlch blOI'1 dellnqu.nt blfore JlllUtrV 1, 1912 bur Int,,"t .t the rat. fl'
IIx C6X) PtrOlnt per IMUI clloul.t.d .t . dlllv rat. 0' ,0001''', All t.MII Which ble... delinquent on 1M eUer'
Jenu,rv I, 19.2 will bl,r Int.r..t .t . r.t. whleh will vlrv frol cII.nd.r Y'lr to ell.nd.r ve.r with th't r.t.
I~td bv thl PA OIP.rtlent of Rlv,nut. Thl .ppllolbl. tnt.rllt rlt.1 for 1912 throuth 1994 Irll
IHTERfIT I
'!!!! Intlr..t Nltt D.lh tnterllt f.otor !!!r Inter..t Rlt. Dltlv tnter..t Flctur
1912 IU .00014' 1916 lOX .001l74
1911 16X .D00451 1917 'X ,000147
1914 IlX .0DOIOl 1'11.1991 IIX .000101
1911 ' IlX .000116 1991 'X .000147
1991-1994 7X ,000191
ulntlfltt II o.lculltld " followll
INTEREtT . BALANCE OF TAX UNPAID X NUNIER OF OAYS DELlNQUEI/T X DAILY INTEREST FACTOR
..An~ Notlol Illu.d "ter the tlM bleGLl1 alllnquent will rlfllot an Int.r..t c.loulltlan to flft,IO (111 dl~'
blvond the dlt, of thl...e....nt. If p.y..nt II ..d, ,'ter thl Intlrl,t cOlpUtltlon d.t, lhown on t~
Hotlol, .ddltlonll lnt.rllt tult bl calcul,ted.