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Home My WebLink About03-31-08 (2) \) ....J 15056051058 REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security NUmber Date of Death OFFICIAL USE ONLY C?~~trgode Year INHERITANCE TAX RETURN RESIDENT DECEDENT File Number 21 08 0031 Date of Birth 198-18-9283 12/22/2007 03/18/1923 Decedent's Last Name Suffix Decedent's First Name MI D Seletos (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix MI Spouse's Social ~ecurity t-.Jumber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Ce) 1. Original Return (=:J 2. Supplemental Return c::::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estatl3 Tax Return Required (=) c::::> 4a. Future Interest Compromise (date of death after 12-12-82) c::::> 7. Decedent Maintained a Living Trust (Attach Copy of Trust) c::::> 10. Spousal Poverty Credit (date of death C-:':::::; 11. Election to talC 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 BE DIRECTED TO: Name [)aytim~T.elephone NUm.~er 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes 4. Limited Estate (~:::> <"'^'D Z:::::J John M. Eakin . (717) 766-3172 Firm Name (If Applicable) REGISTER First line of address Market Square Building Second line of address City or Post Office State ZIP Code DATE FILED C ) Mechanicsburg 17055 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best (If my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which prepa rer has any knowledge. SIGNATURE OF PERSON RESPONSI~LE FOR FILING RETURN )'\~(.\.,y \..L't)}"- 'f L '- k-L .4,'-- ADDRESS 'I 799 Winterberry Drive, Fredericksburg, VA 22405 SIGNATURE OF PR~)~~EPRESENTATIVE ADDRESS Market Square Building, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY DATI 3 LS/D'6 D~ hI ;'-1 L 15056051058 Side 1 15056051058 -.J .-J 15056052059 REV-1500 EX Decedent's Name: RECAPITULATION Ann o Seletos 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. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedule F) c:::::J Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c:::::; Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 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. 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 .0_ 16. Amount of Line 14 taxable at lineal rate X.O_ 17. Amount of Line 14 taxable at sibling rate X .12 54,686.56 18. Amount of Line 14 taxable at collateral rate X .15 164,059.69 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social 198-18-928~1 15. 16. 17. 18. 15056052059 220,965.67 15,442.34 236,408.01 15,826.76 335.00 16,161.76 220,246.25 24,608.95 31,171.34 c:::::; --.J REV-1500 EX P;lge 3 Decedent's Complete Address: DECEDENT'S NAME Ann D Seletos STREET ADDRESS Manor Care DECEDENT'S SOCIAL SECURITY NUMBER 198-18-9283 1700 Market Street CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 31,171.34 28,000.00 1,473.64 3. InteresVPenalty if applicable D. Interest E. Penalty Total Credits (A + B + C ) (2) 29,473.64 Total Interest/Penalty ( 0 + 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5) (5A) (5B) 1,697.70 A. Enter the interest on the tax due. 1,697.70 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 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ D ~ 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 foi" the use of the surviving spouse is three (3) percent [72 P.S. 99116 (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. 99116 (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. 99116(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. 99116(1.2) [72 P.S. 99116(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. 99116(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-1508 EX + (6-9~) 'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Seletos. Anne. D. ITEM NUMBER 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. FILE NUMBER 21 08 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. 0031 DESCRIPTION Members First Federal Credit Union Savings Account # 17637-00, see attached VALUE AT DATE OF DEATH 78.36 Members First Federal Credit Union Checking Account #17367-11, see attached 3,010.21 Members First Federal Credit Union Money Management Account # 17367-05, see attached 673.79 Members First Federal Credit Union CD # 17367-40, see attached 10,409.27 Members First Federal Credit Union CD # 17367-41, see attached 25,867.49 Members First Federal Credit Union CD # 17367-42, see attached 21,185.32 Members First Federal Credit Union CD # 17367-44, see attached 25,571.03 Members First Federal Credit Union CD # 17367-45, see attached 33,037.00 Members First Federal Credit Union CD # 17367-49, see attached 32,685.03 Financial Network Brokerage Account 5FN490117, see attached 67,548.17 Manor Care- Nursing Home Reimbursement 900.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 220 965.67 MEMBERS 1st FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 17637 -00 08/25/1975 $78.31 $.05 $78.36 None CHECKING ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 17637 -11 09/05/1997 $3,009.82 $.39 $3,010.21 None MONEY MANAGEMENT ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 17637 -05 02/06/1990 $673.69 $.10 $673.79 None CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 17637 -40 03/03/2007* $10,379.47 $29.80 $10,409.27 None 17637 -41 04/16/2007** $25,793.44 $74.05 $25,867.49 None .Opened by transfer of funds from 17637-05 **Opened by redeemed certificate #17637-47, original open date 5/16/06 by transfer of funds from 17637-05 CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 17637 -42 10/26/2006* $21,124.67 $60.65 $21,185.32 None 17637 -43 OS/23/200"7* $30,796.213 $88.41 $30,884.6? Mary Lou Herr OS/23/200? .Opened by transfer of funds from 17637-05 5000 Louise Drive . Po. Box 40 . Mechanicsburg, Pennsylvania 17055 . (800) 283-2328 . \N\Nw.members1st.org CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 17637 -44 07/14/2007* $25,495.78 $75.25 $25,571.03 None 17637 -45 07/24/2007 $32,969.66 $67.34 $33,03700 None .Opened by transfer of funds from 17637-11 CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner 17637 -49 07/24/2007 $32,588.84 $96.19 $32,685.03 None ;m1d2 CREDIT UNION Denise A. Wolfe U Insurance Services su~~so;- February 21, 2008 Estate of: ANNE D. SELETOS Date of Death: 12/22/2007 Social Security Number: 198-18-9283 MAR-04-200e U8:41 AM ANDl\EW STEELE 1111800110 ~. U4/U(j (IJH . iI ~ i ~ f~r 1 1 i 3~1 ~ ~8~ ~~n i g. """,> lil .......z;:tl ::J ~S!i - ~ r- t:1 thVl = Cj g; ~ . =- >V) : t"'@m ~~I ~ ~ r' ~m = >o~ ~ .1 : -~o Ii . == a Vl ~8 ~ :;- - : - f~ II - I - ""-l - en Ii - N . co ~o . - ~z . . ~ \ - ~ . . - - . - . - - - t 0 ~ 1~I::l...i '" @ !~ ~ ~ Ii ;:J g w .n ! ~p ~ ~ i- f fdil !: II ~r ~ii~li f' d ~ S~ti~ " II f~ f if f ~ UI AI ~f ..,dil III ~ ~lB ji? l>> g:::: }"~ ::J ~..., Z:;r S .:. ~J ~ ~ :;' .... "" j >= 0 .. -4 ~ [ 0;' -< !O. if II? Ii )I[ :I "" ~ f fr'il ! ~ it U 'il i' i I i~...~!i ~ .... JllIo ~ ct Sl, ~ g .... b ..~E~~I """- N ~.......... Q N , ::::; MAR~4-2008 TUr= 09; HAM W: PQ(';>=':4 REV-1509 EX + (6-9.8) 'W COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Seletos Anne. D. SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER 21 08 0031 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. Mary Lou Herr B c JOINTL Y.OWNED PROPERTY: ADDRESS 25 Colgate Drive, Camp Hill, PA 17011 RELATIONSHIP TO DECEDENT Friend 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 JOINTL Y.HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 5/23/07 Members First Federal Credit Union CD #14637-43 30,884.67 50. 15,442.34 see attached TOTAL (Also enter on line 6, Recapitulation) $ 15,442.34 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+(14-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Seletos Anne D. SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 08 0031 ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. French Bistro- Funeral Luncheon 223.91 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Nancy M. Pcsolyar 11,400.00 Social Security Number(s)/EIN Number of Personal Representative(s) 176-50-5669 Street Address 799 Winterberry Drive City FredericksburQ State VA Zip 22405 Year(s) Commission Paid: 2008 2. Attomey Fees John M. Eakin 3,500.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Letters Testamentary 406.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 7. The Cumberland Law Journal, estate notice 75.00 8. The Sentinel, estate notice 158.62 9. Register of Wills, Filing Fee 15.00 10. Register of Wills, inventory 15.00 11. Mobilex USA- ambulance 33.23 TOTAL (Also enter on line 9, Recapitulation) $ 15,826.76 (If more space IS needed, insert additional sheets of the same size) REV-1512 EX t (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Seletos. Anne. D. FILE NUMBER 21 08 0031 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1, 2007 State Income Tax VALUE AT DATE OF DEATH 335.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 335.00 ""~""'" ". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER ~ph:'!tn~ nnp. D ?1 OR nn~1 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. Sam Seletos Nephew $500.00 2843 Shipston Avenue New Port Richey, FL 34655 2. Mary Lou Herr Friend $1,000.00 25 Colgate Drive Camp Hill, PA 17011 3. George Dubiansky Brother 1/4 of net residue 4201 Massachusetts Avenue Washington, D.C. 20016 4. Nancy Pcsolyar Niece 1/4 of net reside 799 Winterberry Drive Fredericksburg, VA 22405 5. Robert Butchko Nephew 1/4 of net residue 502 W. Broad Street #418 Falls Church, VA 22406 6. Debra Bell Niece 1/4 of net residue 6940 Windsor Way San Jose, California 95129 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 $ (If more space is needed, insert additional sheets of the same size) . \ . " LAST WILL AND 'I'ES1!AMENT OF ANNE D. SELETOS 1, ANNE D. SELETOS, of Silver Spring To\WShip, Cumberland County, Pennsylvania, being of sound and disposing mind. memory and understandingt'do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. ., .... 1 direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United States, or any state or territory thereof. or by any foreign government ()r political subdivision thereof. in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this will or otherwise. 3. r give and bequeath the sum of Five HWldred ($500.00) Dollars to my nephew, SAM SELETOS. 4. 1 give and bequeath the sum of One Thousand ($I~OOO.OO) Dollars to my good friend. MARY LOU HERR. -I - . r" .'_\:-- T _- - '-, 1._-\". . .--.----." 5. All the rest. residue and remainder of my estate; real., personal and mix.~~ whatsoever and wheresoever situate, I give, devise and bequeath as follows: a.) One-fourth to my brother, GEORGE DUBIANSKY b.) One--fourth to my niece, NANCY PCYSOLAR c.) One -fourth to my nephew, ROBERT BUTCHKO d.) One-fourth to my niece; DEBRA BELL 6. In the event any of the above named legatees predecease me his or her share shall lapse and fall into the residue of my estate to be equally divided ben.veen residuary legatees who survive me. 7. Lastly, I nominate, constitute and appoint my niece, NANCY PCYSOLl\.R, to be the Executrix of this my Last Will and Testament and I direct that she be excused from posting bond or other security for the faithful perfonnance of her duties, in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this:2f41ay of January, 2007. I' , ~(J~ Ir J6itl t:.~5;EAL) ANNE D.. S.ELE - - 2 ~ COMM.ONWEALTH OF PENNSYL VANIA) : SS COUNTY OF CUMBERLAND ) I ANNE D. SELETOS. the testatriXt whQse name is signed to the attached or forego~g instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the same instrUment as my Last WUl and Testament; that I signed it wiUingly. and that I signed it as my free and voluntary act and deed, for the purposes therein expressed. ~ r- JJ ~~(SEAL) Arine D. Seletos .. eoWUONWfALTH OF ~VJ,NIA NOTARIAl. SEAL ...~~dI M. ~leol'l, NoteI)' PubUc My iclburg Borough. Cumbfitlbnd County ~Ofl bpI".h.Ine 2', 2007 COMMONWEALTH OF PENNSYL V ANlA ) : SS COIJNTY OF CUMBERLAND) We, the undersigned, J. Robert Stauffer and John M. Eakin, the witnesses whose names are signed to the attaChed or foregoing instrument, bein~ dul}' 9~lified according to law, depose and say that we were present and saw the testatrix. ANNE Db SELETOS, sign and execute the mstrument as her Last Will and Testament; that the said testatrix ex~uted it as ~er free ~d vo!untary act .for ~e purposes. there~ expressed; that each of us. In the heanng and SI!rl1t of the testatnx, signed the Will as wltnesses; and that, to the best of our knowledge. the testatrix was, at the time. eighteen (I 81.+>r more years of age, of sound mind, and under no constraint, duress or/~nd e inf1u~~ l' ._ II ~ ,YV\' C;.--f~ / //1 <" r--; , . >/'/( ~~J ;n/L~",_ y ,f . . Sworn and subscribed to before me this ..2 9 iii day of January, 2007. I /} lvtk,\dL -. <-/1 ( 1k,t,).{ 'I Notary Public eOMUONWljAl.TH Of rl*m.VANlA NOTARIAL SEAL Hotidl M N$llson. Notaty Public MKhanic&burg Boro\Xlh. Cumbel1l1l\d CourIW My CommlAlon expjlQi June 27, 2007 - 3 - , L I \