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Home My WebLink About10-31-07 .. --.J 15056041114 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisbu PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY County Code Year File Number ~I OCfl Date of Birth 193-14-6374 Decedent's Last Name 02192007 03202022 Suffix Decedent's First Name MI SABATHNE (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix ELEANOR E. Spouse's First Name MI Spouse's Social Security Number FiLL iN A?PRO~RiATE OVALS aELOW W 1. Original Retum THIS RETURN MUST BE FilED IN DUPLICATE WITH THE REGISTER OF WILLS 4. Limited Estate CJ CJ o CJ 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 1 O. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes 2. Supplemental Retum CJ o o 3. Remainder Retum (date of death priorto 12-13-82) 5. Federal Estate Tax Return Required CJ CJ CJ 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received CJ 11. Election to tax under See 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number BRIDGET M. WHITLEY, ESQUIRE Firm Name (If Applicable) ~""'" SKARLATOS & ZONARICH LLP First line of address "+-...-1 ,r'"'' 17 SOUTH SECOND STREET Second line of address I. . SIXTH FLOOR City or Post Office r~ C, State ZIP Code DATE FILED HARRISBURG PA 17101 BMW@SKARLATOSZONARICH.COM HAMPSTEAD, MD 21074 ADDRE S BRIDGET M. WHITLEY, ESQ., 17 S. 2ND ST., 6TH FL., HBG., PA 17101 PLEASE USE ORIGINAL FORM ONLY DATE fll~ 07 L Side 1 15056041114 15056041114 --.J ~ ~ 15056042115 REV-1500 EX Decedent's Social Security Number Decedenfs Name: ELEANOR E. SABATHNE RECAPITULATION 193-14-6374 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . . . . . . . 1. NONE 2. 3. NONE 4. NONE 5. 6. 7. 8. 9. 1820.00 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . . 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . . 6. Jointly Owned Property (Schedule F) DSeparate Billing Requested. . . . . . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) DSeparate Billing Requested. . . . . . . . 1446.00 8485.00 8. Total Gross Assets (total Lines 1-7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7745.00 19496.00 13708.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 3331. 00 17039.00 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . .. 13. 2457.00 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . 14. 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 L 16. Amount of Line 14 taxable at lineal rate X .0 ~ 17. Amount of Line 14 taxable at sibling rate X . 12 18. Amount of Line 14 taxable at collateral rate X . 15 0.00 2457.00 15. 0.00 18. 111.00 0.00 0.00 2 4 5 7 . 0 0 16. 17. 19. TAX DUE... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. . . . ., . . . . . . . . 19. 111.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT D Side 2 L 15056042115 15056042115 ~ REV-1500 EX Page 3 193-14-6374 Decedent's Complete Address: DECEDENTS NAME ELEANOR E. SABATHNE STREET ADDRESS File Number DECEDENTS SOCIAL SECURITY NUMBER 193-14-6374 735 DELBROOK ROAD APARTMENT 2 CITY MECHANICSBURG STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 111.00 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty TotallnteresUPenalty ( 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) 0,00 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 111.00 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 111.00 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . .. 0 o o o 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. 0 No o o o o o o 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 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. 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 exemot 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. 217 REV.1503 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B . STOCKS & BONDS ESTATE OF ELEANOR E. SABATHNE FILE NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 28 Shares MetLife, Inc. at $64.9875 DESCRIPTION VALUE AT DATE OF DEATH 1,820 TOTAL (Also enter on line 2 RecaDitulation) $ (If more space is needed, insert additional sheets of the same size) 1820 217 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER ELEANOR E. SABATHNE Include the proceeds of litigation and the date the proceeds were received by the estate. All Drooerlv iointlv-owned with rioht of survivorshiD must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. Personal Property and household goods 2. Allstate Indemnity Company - refund of automobile insurance 3. 1988 Dodge Aries 4. Pension Benefit Payment VALUE AT DATE OF DEATH 500 220 600 126 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,446 217 REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER ELEANOR E. SABATHNE 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. Bonnie L. Moore 824 Century Street Hampstead, MD 21074 Daughter B. C. JOINTLY -OWNED PROPERTY: 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 DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 4/14/83 PNC Bank Certificate of Deposit No. 21001013347 (per 0 verification attached as Schedule F) 6,000 50.00% 3,000 2. A. 4/14/83 PNC Bank Certificate of Deposit No. 21001013347 (accrued 0 interest to DaD per verification attached as Schedule F) 8 50.00% 4 3. A. 4/14/83 PNC Bank Checking Account No. 5070115703 (per 0 verification attached as Schedule F) 10,960 50.00% 5,480 4. A. 4/14/83 PNC Bank Checking Account No. 5070115703 (accrued 0 interest to DaD per verification attached as Schedule F) 1 50.00% 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 6 Recaoitulation) $ 8485 (If more space is needed, insert additional sheets of the same size) 217 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF ELEANOR E. SABATHNE FILE NUMBER DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABlE) VALUE 1. Allstate Annuity transferred at death to decedent's daughter, 0 Bonnie L. Moore 7,745 100.00% 7,745 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 TOTAL (Also enter on line 7 RecaDitulation\ $ 7745 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. (If more space is needed, insert additional sheets of the same size) . REV-1511 EX + (10-06) COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF ELEANOR E. SABATHNE FILE NUMBER Debts of decedent must be reDorted on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Coble Reber Funeral Home 11,333 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees 2,000 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees 350 7. Fee to file Inheritance Tax Return 25 TOTAL (Also enter on line 9, Recaoitulation) $ 13,708 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12~3) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN R NT ENT ESTATE OF ELEANOR E. SABATHNE Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 1. York Hospital 552 2. Quest Diagnostics 44 3. Pinnacle Health Hospital - Account No. 270175923 550 4. Pinnacle Health Hospital - Account No. 270184676 550 5. West York Ambulance Service 88 6. Holy Spirit Hospital 49 7. Manoreare Carlisle 270 8. Andrew Patel Associates 31 9. University Internal Medicine 3 10. Lineare 24 11. Manoreare Health Service - York 720 12. Rent 290 13. PPL 113 14. Verizon 42 15. Comeast 5 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3,331 '. 217 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER ELEANOR E SABATHNE 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)] Bonnie L. Moore, 824 Century Street, Hampstead, MD 21074 Daughter 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 TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0 (If more space is needed, insert additional sheets of the same size) '* ESTATE OF ELEANOR E. SABATHNE INHERITANCE TAX RETURN - SCHEDULE F .. AP~-15-2007 18:22 PNCBANK 412 768 3458 P.01 ~ G PNCBAN< April 13, 2007 Bridget M. Whitley Skar1atos & Zonarich Building 17 South Second Street, 61n floor Harrisburg, PA 17101-2039 RE: Estate of Eleanor E. Sabathne, deceased SSN: 193-14-6374 DOD: 2/1912007 Dear Attorney Whitley: In response to your request for Date of Death balances for the customer noted above, our records show the following: Certificate of Deposit Account #21001013347 Established 04/14/1983 EI..EANOR E SABATHNE BONNIE L MOORE DOD balance: $6,000.00 + $8.04 8.CC11led interest Interest Paid 1/1/2007 - 2/1912007 - $11.33 Checking Account Account #5070115703 Established 04/14/1983 ELEANOR E SABA THNE BONNIE LEE MOORE DOD balance: $10,960.48 + $1.35 accrued interest Interest Paid 1/1/2007 - 2/19/2007 - $.93 The decedent maintained Investment Account (INV #8145486') For further infonnation, you may contact the Brokerage Department at 1-800-762-6111. ~~~~ Page 1 of2