HomeMy WebLinkAbout08-31-07
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
2 1 0 6
File Number
o 1 138
Date of Birth
1 2 0 7 2 0 0 6
07311938
Decedent's Last Name
Suffix
Decedent's First Name
A P A
RUT H
MI
M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
[ZJ 1. Original Return
o 4. Limited Estate
o
o
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of
death after 12-12-82)
o 7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
o 10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD QIRECTED TO:
Name Daytime Telepbmle Number ~g
M E LAN I E W A L Z S CAR I N G I 7 1 7 6~ ~ .7 ii;; /~~ l~_~
.}'~~_.~_:: (,,_:-:? G') (; ---T.-j
- :2
REGISTERge~s US!-CNL Y
'.J.) .:;-:::::
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
Firm Name (If Applicable)
-;,
:t':"'"
SCARINGI
&
SCARINGI
P C
First line of address
)()
-~.-...
2 0 0 0
L I N G L EST 0 W N
R 0 A 0
u,:}
~. ;
w
! :
Second line of address
SUI T E
106
City or Post Office
State
ZIP Code
DATE FILED
H A R R I S BUR G
P A
17110
Correspondent's e-mail address:melanie@scarinQilaw.com
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief,
it i correct and complete. Declaration of pre parer other than the personal representativ . based on all information of which preparer has any knowledge.
GNATU E OF P.ERSON RESPONSIBLE FOR FILING RETURN
RD MECHANICSBURG
SUITE 1 6 HARRISBURG
PLEASE USE ORIGINAL FORM ONLY
PA 17110
Side 1
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15056041125
15056041125
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: RUTH M. APA
RECAPITULATION
1. Real estate (Schedule A)
1.
2. Stocks and Bonds (Schedule B)
2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) 4. 2 7 7 8 1 . 8 4
....................... .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. 3 4 8 0 7 5 . 3 4
...... .
6. Jointly Owned Property (Schedule F) D Separate Billing Requested . . . . . . . 6. 2 8 . 0 8
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property o . 0 0
(Schedule G) D Separate Billing Requested. . . . . . . 7.
8. Total Gross Assets (total Lines 1-7) 8. 3 7 5 8 8 5 . 2 6
.......................... .
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 2 2 3 6 8 . 3 6
............... .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 7 7 4 1 . 4 5
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3 0 1 0 9. 8 1
12. Net Value of Estate (Line 8 minus Line 11) 12. 3 4 5 7 7 5. 4 5
........................ .
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) ................. . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 3 4 5 7 7 5 . 4 5
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.O _ o . 0 0 15. O. 0 0
16. Amount of Line 14 taxable 3 4 5 7 7 5 . 4 5
at lineal rate X .O~ 16. 1 5 5 5 9. 9 0
17. Amount of Line 14 taxable o . 0 0 o . 0 0
at sibling rate X .12 17.
18. Amount of Line 14 taxable o . 0 0 o . 0 0
at collateral rate X .15 18.
19. Tax Due ................................................ 1~ 1 5 5 5 9. 9 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
[Z]
Side 2
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15056042126
15056042126
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REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
RUTH M. APA
STREET ADDRESS
4 RESERVOIR ROAD
File Number
21 06 01138
CITY
MECHANICSBURG
STATE
PA
ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
15,559.90
Total Credits (A + 8 + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
T otallnterest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, 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)
0.00
0.00
15,559.90
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
15,559.90
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: Yes No
a. retain the use or income of the property transferred; ...................................................................... D IXI
b. retain the right to designate who shall use the property transferred or its income; ............................... D IXI
c. retain a reversionary interest; or ................................................................................................ D IXI
d. receive the promise for life of either payments, benefits or care? ....................................................... D IXI
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... D IXI
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... D IXI
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. D IXI
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [72 P.S. ~9116 (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 zero (0) percent
[72 P.S. ~9116 (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 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 zero (0) percent [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 four and one-half (4.5) percent, except as noted in
72 P.S. ~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 twelve (12) percent [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)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
RUTH M. APA 21 06 01138
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 iointlv-owned with right of survivorship must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1503 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
RUTH M. APA
FILE NUMBER
21 06 01138
All property jointly-owned with right of sUlVivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1504 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSEL Y.HELD CORPORATION,
PARTNERSHIP OR
SOLE.PROPRIETORSHIP
ESTATE OF
RUTH M. APA
FILE NUMBER
21 06 01138
Schedule C-1 or C-2 (including all supporting infonnation) must be attached for each closely-held corporation/partnership interest of the decedent, other than a
sole-proprietorship. See instructions for the supporting infonnation to be submitted for sole-proprietorships.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
TOTAL (Also enter on line 3, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
REV-1505 EX + (6-98)
.
SCHEDULE C-1
CLOSELY-HELD CORPORATE
STOCK INFORMATION REPORT
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RUTH M. APA
FILE NUMBER
21 06 01138
1. Name of Corporation
Address
City
2. Federal Employer I.D. Number
3. Type of Business
State
Zip Code
State of Incorporation
Date of Incorporation
Total Number of Shareholders
Business Reporting Year
Product/Service
4.
Common
Preferred
$
$
Provide all rights and restrictions pertaining to each class of stock.
5. Was the decedent employed by the Corporation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes 0 No
If yes, Position Annual Salary $ Time Devoted to Business
6. Was the Corporation indebted to the decedent? ....................................... 0 Yes 0 No
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? ............... 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
DYes 0 No If yes, 0 Transfer 0 Sale Number of Shares
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? . . . . . . . . . . . . 0 Yes 0 No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? ................................................. 0 Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? ....................... 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . . . . . .. 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent.
E. List of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. List those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
(If more space is needed, insert additional sheets of the same size)
REV-1506 EX + (9-00)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-2
PARTNERSHIP
INFORMATION REPORT
ESTATE OF
RUTH M. APA
FILE NUMBER
21 06 01138
1. Name of Partnership
Address
Date Business Commenced
Business Reporting Year
~ ~
2. Federal Employer I.D. Number
3. Type of Business Product/Service
4. Decedent was a 0 General 0 Limited partner. If decedent was a limited partner, provide initial investment $
Zip Code
5.
A.
B.
C.
D.
6. Value of the decedent's interest $
7. Was the Partnership indebted to the decedent? ................................ 0 Yes 0 No
If yes, provide amount of indebtedness $
8. Was there life insurance payable to the partnership upon the death of the decedent? ........ 0 Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $
Owner of the policy
9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was
prior to 12-31-82?
DYes 0 No If yes, 0 Transfer 0 Sale Percentage transferred/sold
Transferee or Purchaser Consideration $ Date
Attach a separate sheet for additional transfers and/or sales.
10. Was there a written partnership agreement in effect at the time of the decedent's death? . . . . . . . 0 Yes 0 No
If yes, provide a copy of the agreement.
11. Was the decedent's partnership interest sold? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes 0 No
If yes, provide a copy of the agreement of sale, etc.
12. Was the partnership dissolved or liquidated after the decedent's deat h? ................. 0 Yes 0 No
If yes, provide a breakdown of distributions received by the estate, including dates and amounts received.
13. Was the decedent related to any of the partners? ................................ 0 Yes 0 No
If yes, explain
14. Did the partnership have an interest in other corporations or partnerships? . . . . . . . . . . . . . . . . 0 Yes 0 No
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOllOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDUILE
A. Detailed calculations used in the valuation of the decedent's partnership interest.
B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years.
C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Any other information relating to the valuation of the decedent's partnership interest.
REV-1507 EX + (6-98)
*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
ESTATE OF
RUTH M. APA
FILE NUMBER
21 06 01138
All property jointly-owned with the right of sUNivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
PRIVATE MORTGAGE. MORTGAGOR WAS THE ESTATE OF BOYD E. DILLER.
MORTGAGEES WERE THE FOUR CHILDREN OF THE ESTATE OF BOYD E. DILLER.
SEE ATTACHED MORTGAGE FROM THE ESTATE OF BOYD E. DILLER TO M&T
TRUST COMPANY AND ASSIGNMENT AND ASSUMPTION OF LOAN DOCUMENTS
FROM M&T TRUST CO. TO THE FOUR CHILDREN OF BOYD E. DILLER (ONE OF
WHOM WAS RUTH APA). ORIGINAL PRINCIPAL $100,000.00. PAYOFF BY THE
ESTATE OF BOYD E. DILLER ON MARCH 16, 2007 WAS $111,127.36. SEE
ATTACHED HUD. ESTATE OF RUTH M. APA RECEIVED 1/4 OF PAYOFF AMOUNT
VALUE AT DATE
OF DEATH
27,781.84
TOTAL (Also enter on line 4, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
27781.84
REV-1508 EX + (6-98)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RUTH M. APA
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
FILE NUMBER
21 06 01138
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.
DESCRIPTION
MEMBERS FIRST FEDERAL CREDIT UNION, ACCOUNT #184632-00
5000 LOUISE DRIVE, POBOX 40
MECHANICSBURG, PA 17055
MEMBERS FIRST FEDERAL CREDIT UNION, ACCOUNT #184632-11
5000 LOUISE DRIVE, POBOX 40
MECHANICSBURG, PA 17055
1995 MERCURY SABLE LS WAGON 4 DR,
KELLEY BLUE BOOK VALUE $1595. SOLD FOR $1500.00
VALUE AT DATE
OF DEATH
25.00
236.34
1,500.00
PERSONAL PROPERTY (LIMITED BIC EVERYTHING SOLD SEVERAL YEARS PRIOR
TO DATE OF DEATH WHEN DECEDENT MOVED IN WITH DAUGHTER)
FIRST DISTRIBUTION -INHERITANCE FROM THE ESTATE OF BOYD E. DILLER
(THE DECEASED FATHER OF RUTH M. APA). RECEIVED JUNE 20,2007. SEE
ATTACHED WILL AND FEDERAL ESTATE TAX RETURN FOR BOYD E. DILLER.
ANTICIPATED FUTURE DISTRIBUTIONS -INHERITANCE FROM THE ESTATE OF
BOYD E. DILLER. RUTH M. APA'S SHARE OF THE RESIDUAL ESTATE OF BOYD
E. DILLER IS ESTIMATED TO BE $203,640. HOWEVER, THE RESIDUAL OF THE
BOYD E. DILLER ESTATE IS RESPONSIBLE FOR PAYING FOR THE CAPITAL GAINS
TAX FOR A SALE OF PROPERTY FROM THE BOYD E. DILLER ESTATE. RUTH M.
APA'S SHARE OFTHE RESIDUAL DILLER ESTATE WILL THEREFORE BE REDUCED
BY AN ESTIMATED $32,526 TO PAY SAME. THUS, THE FINAL DISTRIBUTIONS
FROM THE BOYD E. DILLER ESTATE ARE ESTIMATED TO BE $203,640 LESS
$32,526, OR $171,114. SEE ATTACHED LETTER FROM THE ATTORNEY
REPRESENTING THE ESTATE OF BOYD E. DILLER. SAID LETTER INDICATES
THAT THE FIRST $175,000 DISTRIBUTION WAS REDUCED BY THE $32,526
RATHER THAN THE SECOND DISTRIBUTION BEING REDUCED BY THE $32,526.
HOWEVER, BECAUSE THE RUTH M. APA ESTATE RECEIVED THE $175,000
OUTRIGHT, IT IS LISTED AS AN OUTRIGHT DISTRIBUTION HEREIN, AND THE
REDUCTION DUE TO CAPITAL GAINS TAXES IS LISTED AS A REDUCTION TO
THE SECOND DISTRIBUTION WHICH HAS NOT YET BEEN RECEIVED.
200.00
175,000.00
171,114.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
348 075.34
REV-1509 EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RUTH M. APA
SCHEDULE F
JOINTLY-OWNED PROPERTY
FILE NUMBER
21 06 01138
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
A. CHELSEA R. APA
B GLORI A. APA
c
JOINTL Y.OWNED PROPERTY:
ADDRESS
4 RESERVIOR ROAD
MECHANICSBURG, PA 17055
4 RESERVIOR ROAD
MECHANICSBURG, PA 17055
RELATIONSHIP TO DECEDENT
GRANDDAUGHTER
DAUGHTER
LETTER 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. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. V AWE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.&B. 8/28/03 MEMBERS FIRST FEDERAL CREDIT UNION 75.02 33.33 25.00
ACCT #234760-00, 5000 LOUISE DRIVE, POBOX 40
MECHANICSBURG, PA 17055
2 A. & B. 8/28/03 MEMBERS FIRST FEDERAL CREDIT UNION 9.23 33.33 3.08
ACCT #234760-11, 5000 LOUISE DRIVE, POBOX 40
MECHANICSBURG, PA 17055
TOTAL (Also enter on line 6, Recapitulation) $ 28.08
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
'*
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBA TE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RUTH M. APA
FILE NUMBER
21 06 01138
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
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAl ESTATE VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1.
TOTAL (Also enter on line 7 Recapitulation) $ 0.00
(If more space is needed. insert additional sheets of the same size)
REV-1511 EX + (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RUTH M. APA
ITEM
NUMBER
A.
1.
2.
FILE NUMBER
21 06 01138
Debts of decedent must be reported on Schedule I.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
MYERS FUNERAL HOME, INC., 37 E. MAIN, MECHANICSBURG, PA (717)766-3421
BRACHENDORF MEMORIALS, INC., 2131 HERR ST., HBG. PA 17103 - ENGRAVING
7,570.00
325.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) FRANKLYN G. APA, JR. & GLORI A. APA
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 131 E L1SBURN ROAD & 4 RESERVOIR ROAD
City BOTH MECHANICSBURG State PA Zip 17055
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
Year(s) Commission Paid:
AttomeyFees SCARINGI & SCARINGI, P.C. RCPTS $10,847.36 LESS DISBS. $611.31
10,236.05
3,500.00
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant GLORI A. APA
Street Address 4 RESERVOIR ROAD
City MECHANICSBURG State PA
Relationship of Claimant to Decedent DAUGHTER
Zip 17055
Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS
67.00
Accountanfs Fees
Tax Return Prepare(s Fees
SCARINGI & SCARINGI, P.C. FOR CERTIFIED COpy OF DIVORCE DECREE- DISB
SCARINGI & SCARINGI, P.C. FOR COPY, FAX & POSTAGE 12/06 - 6/10/07-DISB.
THE SENTINEL, NEWSPAPER PUBLICATION (ADVANCED BY S&S,PC - DISB.)
THE PATRIOT NEWS, NEWSPAPER PUBLICATION (ADVANCED BY S&S-DISB)
CUMBERLAND LAW JOURNAL - LAW JOURNAL PUB. (ADVANCED BY S&S-DISB)
NATIONWIDE INSURANCE COMPANY, CAR INSURANCE, POLICY #5837C869112
9.00
78.01
158.81
290.49
75.00
59.00
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
22.368.36
REV-1512 EX + (12-03)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RUTH M. APA
FILE NUMBER
21 06 01138
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. DEPARTMENT OF THE TREASURY, INTERNAL REVENUE SERVICE, ATLANTA, GA
39901-0025; 1040A; TAX YEAR DECEMBER 31,2004 - PAYOFF FIGURE
2. HSBC - ORCHARD BANK CREDIT CARD ( ADVANCED BY FRANKLYN G. APA, JR.
THEN REIMBURSED TO HIM ($725.00 + $21.75 PROCESSING FEE)
VALUE AT DATE
OF DEATH
6,238.53
746.75
3. CAPITAL ONE CREDIT CARD (ADVANCED BY FRANKLYN G. APA, JR. - THEN
REIMBURSED TO HIM ($400.00 + $12.00 PROCESSING FEE)
4. BOSCOV'S CREDIT CARD (PAYMENT ADVANCED BY GLORI A. APA - THEN
REIMBURSED TO HER)
5. HOLY SPIRIT HOSPITAL (DOD SERVICES NOT PAID BY MEDICARE)
412.00
231.58
112.59
TOTAL (Also enter on line 10, Recapitulation) $
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7 741.45
'''.''''''.'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
RUTH M. APA
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 06 01138
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. FRANKLYN G. APA, JR. Lineal 172,873.68
131 EAST L1SBURN ROAD
MECHANICSBURG, PA 17055
2. GLORI A. APA Lineal 172,887.73
4 RESERVOIR ROAD
MECHANICSBURG, PA 17055
3. CHELSEA R. APA Lineal 14.04
4 RESERVOIR ROAD
MECHANICSBURG, PA 17055
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
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