HomeMy WebLinkAbout94-00739
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COMMONWU,LlltOIl PENNSVLVANIA . OIPAAUIENT OF IlEALTH. VlfAL R!COROII
CERTIFICATE OF OEATH
(Coroner)
11'111.1"'_14
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A!V.1500 EX+ (11,91)
9 '\ ~ INHE:RITANCE TAX RETURN
')~~~;;J' RESIDENT DECEDENT
COMMONWEAL'" 01 PENtllYlVANIA (TO BE FILED IN DUPLICATE
DEPARTMENT 0' R\VENUE
"ARRllfJiu~nl2l.0601 WITH REGISTER OF WILLS) COUNTY COOE 1994 YEAR 00739 1i~0sER
'6CI~~~~~;N~~~::~;~~~;~D ;1~DlEr~::':~,~;,," r::::~::i~::";: 17055
186-50-9958 7/18/94. I 2/16/73 ___ c,~ Cumberland
KJ \. Orlolnal Re'urn [I 2, Supplemenlal Ru'urn 0 3, Remainder Relurn
{for dale. of deo,h prior 10 12.13.021
o 4, limited E,'ole 0 40, fuluro Inle...' Comproml.e 05, federal Ellale To.
(for dalOl of dea,h oller 12-12.821 0 Relurn Required
o 6, Decedenl Oled Te,lole 0 7, Decedenl Molnlalned a living Tru,' _ 8, Tolal Number of Sole Depo.1i Boxo,
(Alloch co of Will) (Allach copy of Tru'l)
ALL CORRUPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD 81 DIRECTED TO.
M MAiliNG ADORUS
300 N. Second Street
P.O. Box 430
Harrisburg, PA 17108
i. Real Ellale (Schedule A) ( I).
2, Slock. ond Bond'15chedule BI ( 21__1,749.66
3, Clo,ely Held Slock/Parlne/lhlp In'erOlI (Schedule q (3)
4, Morl~ooe. and No'.. Recelvobla (Schedule 01 ( 4)
5. Co.h, Bank Depo,lt. & MllCellaneou. Pe/lonal Properly( 51 -2...5illl. 00
15chedule EI
6, Jolnlly Owned Properly ISchedule F) ( 6) 2 ,220.66
7, Tror.fe/l (Schedule G)ISchedule L) ( 71
8, Tolal Groll Aile'. (Io'allln.. 1.7)
9. Funeral'Expanl", Admlnl1lrallve COil., MII~ollanoou.
Exp~n... (Schedule H)
10, Debll, Martgooe Lloblllile" lien. (Schedule II
I\. T 0101 Deducilonl 1'0101 line. 9 & 10)
12, Ne' Value of E.'o'e (line B mlnu.llne 11)
13, Charlioble ond Governmenlo1 Beque," (Schedule J)
14, Nel Value Sub ecllo Toxlllne 12 mlnu.llne 13)
15, Amounl of line 14 loxable 0' 6% role
jlnclude volue. from Schedule K or Schedule M,)
16, Amounl of line 14 loxable 01 15% role
(Indude volu.. from Schedule K or Schedule M,)
17, Prlnclpollox duelAdd lox from line 15 and from line 16,)
18, Credlll Spou.ol Poverly Credll Prior Paymenll Dlscounl Inleresl
---- + --- + -----
19, II line lB I. grea'er Ihon line 17, enler ,he difference on line 19. Thll l'lhe OVERPAYMeNT,
riD
20, II line 17 II orealer lhon line 18, enler ,he dlfferench on line 20, Thll II ,he TAX DUE.
A. Enler Ihe Inleresl on Ihe bolance due on line 20A,
B, Enlor Ihe 10101 of line 20 ond 20A on line 20B, ThI. II Ihe BALANCE OUE.
Moke Check Poyoble tOI Regl.ler of Will., Agent
. .111 SURI TO ANSWER ALL QUESTIONi ~N RIVERSI SIDB AND-TO ReCHICK MAlH...... ...
Under pinelli.. of p.rjury, I d.clar. thai I have eKamlnld Ihlt relurn, Including accomponylnu IChe'dule. ond .Ialomenll, and 10 Iho bill of my knowlodge and h~~i;nl
II It trUI, corrocl and compllto. I declare thai all roal ellal. has been reporled allrue markel v]lue. O.dorollon of preparer olhor than thll penonol roprolonlnlivo i
bated on alllnlormallon of whIch propar.r hOI any knowledge.
"OfWUIE O. PEISONmPOll!1ilfTCiR-fillNO RErum-'-"oo.!\r--'-2'1--o';;-ki:i'~-~(i - ^V~ ~~'I~-"-- - .-- .--.. - - .--. - PAir'-'. .
.' 110~-mw~O~~'-----;I;;iDI1m--~Iill1.!JU!.~lIrgJ--~....! 7055___.._____ ' lillU-,,-9-~ ~A_
__l."'ea~-~--~-~---_~--m_-~~~r~~!i~~~~n~^Sti 7J~~~' Box 430 .......A// /9/fY
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'OA DATIl O' DIATH AmA 12/31/91 CHICK HIAI
" A IPOUSAL
POVIRTY CalDIT II CLAIMID 0
ffii NUMBU 2I91i~01:rg--"-'-
Roria1d D. Butler, Esquire
i!lEPHONE NUMIER
.-LIlLI
z:l~8.s
(
z
o
~
E
~
..
( B)
6,470.32
( 91..:.J.Q.,478~64
(101 .._....__n~,n_____ ..-.
10,803.37
(4,333.05)
(II)
(121
(13)
(14)
(4_L~33,05)
(15)
K .06..
(16)
K ,15..
z
o
~
!;
...
2E
8
><
~
(17) .---.-=.:.::=-----------
(lB) __._--=:.:=..._________.. .
(19) ------------....--.
tbe(~ IlInl! if you UfU ,O(luo~tinn U .olund of you, ovolfloirncnl.
(201 _._.____.________._
(20A) _____-.::.:::.::_____ ---.
120BI __
IIV.UI>lI..II""1 j
~j$. SCHEDULE F
COMMONWEAlTH 01 PENNSYlVANIA JOINTL Y -OWNED PROPERTY
INHERIIANCE lAX mURN
RUIOENI OICEO/NI
---- ---- --_0______--
ESTATE Of
Harcarik. Thomas J._
Joint tonantl')1
PILI NUM~ER .
2194.::.0739 ______
___h -~-'-'--_._____'___.h.__~__.._..... .__ _+__.__."_ __.
.. ____u. _ __.._._.u. _. _____.._ .
ADIlRESS____ RELATIONSHIP TO DECEOEN!__
21 Oakwood Avenue Father
Mechanicsburg, PA 17055
NAME
A. James T. Harcarik
8.
Dorothy T. Harcarik
21 Oakwood Avenue
Mechanicsburg, PA 17055
Mother
C.
Jolntly.owned plopeltYI
-
ITEM LEnER DATE
NUMBER fOR MADE DESCRIPTION Of PROPERTY TOTAL VALUE DECD'S OOLLAR VALUE OF
JOINT, JOINT OF ASSET % INT. DECEDENT'S INTEREST
TENANT
1. A-B 1/12/77 Regular savings - IlBFCU 2,719.26 3 1/3 906.42
2. A-B 1/12/77 Christmas ssvings - IlBFCU 2,606.38 P3 1/3 868.79
3.. A-B 1/12/77 Money management savings 1,245.32 P3 1/3 415.11
4. A-B 1/12/77 Checking savings 91.01 3 1/3 30.34
.. :.
,.
.,
,
, ,
,
"
, :
, ,.
.,
, .
, ,
, ,
,
I
----.---- ---- ....--. '-.
TOTAL IAI'Q Qnlor on IIno 6, Rocophulallonl S 2,220.~~___
-- ..-.-------.
(II moro 'poco I, n.odod In.orl oddili.nol,lio.', of .0010 .i.o)
U\I.1I111h17.lll
~:f~'~~
.,,~JH
COMMONWIAlTH 0, PINNlYlVANIA
INHUITANCI !AX RETURN
R!IIOINIO!CIO[NI
.'___H .._.___..._.___
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
_ _ ___. _ on Pleal.. PI'.!'I ~I !y~.!
I FILE NUMBER
__________.__________ 2194-0739
ESTATE OF
Harcarik, Thomas J.
ITE~
NUMBER
A.
1.
2.
3.
4.
5.
6.
7.
B.
1.
2,
3.
4.
C.
1,
2.
3,
4,
5.
6,
7,
8.
DESCRIPTION
Funoral Exponsell
Halpezzi Funeral Home
Hichael Malpezzi
Piledggia Restaurant - Burial luncheon
Refreshments after funeral moss
Rev. Leo Brody - Mosses
Sacred Heqrt Cemetary - Grave opening
H. J. Judge Ce., Inc. - Grave marker
Administrative Coshl
POllonol Represontotive Commlnlons
Soclol Socurlty Numbor of Personal Ropresentotlve:
Year Commissions paid
Allornoy FOOl
Ronald D. Butler, Esquire
Famtly ExomptlonJ T d D th T
ames . an oro y .
Clalmonl Harcarik Rolotlonshlp
ParentA
AddrolS of Clalmont at docedont's death
Stroot Addren _ 21 Oakwood Avenue
City Hechanicsburg. 5tato ~_ Zip Codo 17055
AMOUNT
6,380.90
100.00
216.90
50.00
45.00
300.00
650.00
550.00
2,000.00
Probato fOOl 57.00
MIscellanoous Exponsell
Cumberland Law Journal - Eetate advertising 40.00
The Sentinel - Estate advertiaing 68.84
Register of Wills - Filing inventory and insolvent inheritance
tax return 20.00
TOTAL IAlso ontor on IIno 9, Rocapllulatlon) $ 10,478.64
(If more space Is noodod, Insell addltlonalshee.. of sunle llze.)
L~
ACN
101
HHOHWEAllll Of I't1IHSYlVAHU
EPARlIltN! Of .tVENur NOTICE OF INHERlTANr.E TAX
URUU Of INDIVIDUAl wrs APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
.":::~~;'-mm.r--"'1f,"'~ .-;'~~::~"::'::''':~''~~~L;;''; ~~~~~:~;;.
DATE OF DEATH 07-18-94 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO yOUR ACCOUNT, SU8HIT THE UPPER PORTION OF THIS FORH WITH YOUR TAX
PAytlENT TO THE REOISTER OF WILLS, HAKE CHECK PAyABLE TO "REOISTER OF WILLS, AOENT"
REMIT PAVMENT TOI
REGIST~~ WI.I,~S :n
CUMBERG\Nb CO ~URT "aPSE
CARLISLE, PA t.?013' ,.1
_,-,
r::..... __A~~~~~onl~\od
L . (/,\
..;..._-~.- .
~~_T_ _ ~~ P!!~ _ Jii ~! _ _L_ ~ ~~_ _ __... ~ _ _ _ _ ~.~ 1 ~ ~!! _ ~ P!!.~~. !_~~!_I.~~ - !..~~ - J. ~~~_. ~ ~~.!!.~ ~".M - ~ -'~:.. - -' j~~~. -" . - -..,
REV-1S47 EX AFP (u8-94) NOTICE OF INHERITANCE TAX APPRAISEMENT, AL:L\IlIANCE ,OR '0,
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX L~
THOMAS J FILE NO. 21 94-0739 ACN 101
If an allellment wal illued previoUl1Y, linll 14, lS and/or 1&, 17 and 18
reflect figurel that include the total of akh returns alselled to date.
ASSESSMENT OF TAXI
15. Anount of Llno 14 It Spoulol roto 1161
16. Anount of L1no 14 IoNOblo ot L1nool/Clul A rolo ll&l_
17, Anount of Llno 14 tONoblo ot Collotorol/Clolo 8 roto 1171
le. Prlnolpol TON OUI
TAX CREDITS I
PAyHENT
DATE
RONAL D D BUTlER
300 N 2ND 51
PO BOX 430
HBG
ESQ
PA 17108
ESTATE OF HARCARIK
TAX RETURN WAS, I X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTi!FlIfST - SEE REVER~
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL
1. Rool Elloto (Sohodulo Al II I
2. stookl ond Bondi IS,hldulo B I 121
3. ClolOh Hold stock/Plrlnorlhlp Inlorut ISohodulo C I 13 I
4, Hortgogu/Hotu RI,oIvoblo I Sohodulo n I 141
5. cuh/eonk Oopolltl/HllO. porlonol Proporty I Schodulo E I 161
6. Jointly Ownod ProplrlY I Schodulo F I 16 I
7, Tronlforl ISohodulo 01 171
B. Totol Alloh
APPROVED DEDUCTIONS AND EXEMPTIONS I
q. Funorol ENPonIOl/Adn, COlh/Hllc. E,ponou ISohodulo HI Iql__
10, Dobh/Horlgogo Lhblll UOI/L1onl I Sohodulo I I llO I
11. Totol Olduo\lono
12. Not VoIuo of To< Roturn
13. Chorlhblo/Govornnonhl Boquuh ISchodulo JI
14. Not Voluo of Elloto Subjoct to To.
NOTE I
-
-:]
....-
DATE
01-30-95
I CHANGED
,00
1.749,66
,.Q..lL
,00
2.500,00
2,220,66
,00
181
6.470.32
10.478,64
324,73
1111
lI21
lI3l
lI4 I
In.Rn~.31
4.333,05-
,00
4,333,05,-
will
,00 X .03.
,00 X .06.
.00X.15.
lIal
,00
,00
,00
.00
RECEIPT
NUHSER
DISCOUNT 1'1
INTEREST I-I
---
AHOUNT PAID
TOTAL TAX CR~
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
,00
,00
,00
.00
. IF PAID AFTER DATE IHOICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST,
I IF TOTAL DUE IS LESS THAN tl, NO PAyHENT IS REqUIRED,
If TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, yOU HAY 8E DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIDNS.l
"
, I
ReSERVATION I Eltat.. 0' deo.dent. dvln. on or bl'or. Dte.aber 12, 191Z .. l' any future Int.r..t In thl I.t.t. II "In'farr,d
In pOI....lon or .nJov..nt to ell.. I (oolll,.r.l) bln,flet,rl,. of the dlcldtnt .,t.r the .xplretlon of Iny I.t.t. for
llf. or for VI.r., thl Co..on~..lth hlrebv ,xpr...lv ,...rv.. thl right to .p~r.I.. and III'" trln.,.r Inhtrltlnc. tIK..
It the lawful ct.,. . (col11..rsl) r.t. on anv luoh future lnt.rl.t.
PURPOSE Of
NOTJCEI To fulfill th. ,,,qul,..."t. of Station 211i0 of the lnn.rUane. and Eltlt. TlIC Act, Act 22 of 1991, 72 P.S.
I'otlon 21"0,
PAYMENT, Dat,oh thl top portion of 'nil Hotlcl and tub.1t with your PIV.."t to thl R.ght,r of Willi prlnhd on tM rev,r.. ,Id'.
--HIk. chock or ..n" "lIor p"obl. tOI REGISTER OF MILLS, AGENT
All Ply,ent. r.o.lvtd ,hall flrlt b. .ppll.~ to .ny Int.r..t which ..y b. due with any r...lndlr .ppll.d to thl tlM.
REFUND (CR)l A rlfund of I tlM orld't. which WI' not r.qua.t.d on tha Tax R.turn, .~y b. r.qua.tld by co.,latlng an "Applla.tlon
for Rafund of Plnn.ylvanla InharJtlnc. and E.tltl T.x" (REV-iJIJ). Application. ar. IVllllbl, .t the Off Ie.
of tha R.tllhr of Wllh, Ii'lY of thl 2J R.v.nuI olltrlot OffiCII, or by c,Ulng thl .p.ohl 24-hour
an~M.rlng ..rvlo. nueb.re for for.. ord.rln;1 In P.nn'Ylvanla 1-800-362.2050, out.lde Penn.ylvanll and
within 10011 Herrl.burg .r.. (717) 7a7-809~, TDD' (717) 712-2252 (H.erlng Iapalr.d Only),
DlJECTIONSI Any Plrty In Int.r..t not .,tl.fl.d with tha bppr.I....nt, Mllow.nca or dl'.llow.nca of d.ductlon., or ........nt
of tlX (inoludlng dltoount or Intar..t) a. shown on thlt Hotlc:. IU.t obj.ct within Ihcty (60) d.V' of r.c.lpt (If
thit HoUce bYI
.-wrlthn prot..t to the PA D.part.ant of RtVlnul, loard of Appnl., DEPT. l81021, Harr-Itburg, PA 11128.1021, OR
..'I.otlon to havI the ..tt.r d.teraln.d at ,udlt of the account of the p.r.onal r.pr.,.ntatlvl, OR
.-"p.,1 to the Orphan,t Court.
ADltIN
ISTRATlYE
CORRECTIONS,
Flatull .rror. dl.cav.r.d ~n thl. a.......nt .huuld bl addr....d In writing tOI PA D.part..nt of Rlvenue,
Burltu of Indlvlduel TIM", ATTHI Po.t A.......nt Hlyllw Unit. DEPT. 180601, Harri.burg, PA 17128-0601
Phone (117l 181-6505. S.. pig. J of thl booklet "In.truetlon. fer Inh.ritanaa TaM Aeturn fer I RI.ldtnt
OICtdtnt" (REV-ISOI) fDr an .~planltlon of adalnl,tr.tlv.lv corr.etlble .rror..
DISCOUNT,
If Iny tl~ due I. ~lld within thr.. (!) c.l.ndar lonthl aftar the d.e.dlntt. d.ath, I fly. plre.nt (S~) dl.count of
th. ta~ Plld II .lloM.d.
INTERUT,
Intarllt It chttl'g.d blglnnlnll with flret day of dllllnqu.ncy, or nln. (9) .onth. Ind ona (1) dlY fro. thl det. of
del'h, to th. dltl of p.v..nt. T'M" which ble.., dlllnquent blfor. Januarv I, 19&2 blar Inter..t It thl rlt. of
11M (6X) Plrclnt p.r annUl alleula'ed It . dillY rlt. of .000164. All tlMII Mhleh blelR, d.llnquent on and .ftlr
JtnUtry I, 1982 wlU bltr In"rllt It II rat. whlah Mill varv froe cII.nder l'ler tu oll.ndar Yllr with thlt rat.
Innounc.d by thl PA DIPart..nt of Rlv.nut. Th. IPPllcabl. Int.r..t rat.. fer 19&2 through 1995 I'll
'!!!r Interllt A,t. D.llv tntlr..t Flator ~ Int.r..t Rltl ~nt.r'lt Fletor
1911 lOX .000141 1911 OX .000141
1915 lOX .000451 1011-1991 m .000501
I'" IIX .000501 1991 OX .000141
1.11 lSX .aaOlS6 1995-1994 IX .000191
I'" lOX .000114 1995 OX .000141
u Inttrllt II c.lculat.d .. faUOWIl
IMTEREST . SALANCE OF TAX UNPAID X NUHSER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
-.Any Hotlcl Illued Ift.r thl ta~ bloOll. d.llnquent will r.flact In tnt.r..t allcul.tlon to fl~t"n (IS) dlVI
blvond the d.t. of thl ........nt. If p'VI.nt 1, lid. Ift.r thl Intlr..t coaput.tlon dlt. lhown on thl
Notlel, addltJonl1 Int.r..t lU.t b. olleulltad,
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