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Home My WebLink About05-19-08 -.J 15056041125 REV -1500 EX (06-05) PA Department of Revenue*, ~~~~~~~~~~~uaITaxes INHERITANCE TAX RETURN 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 8 File Number o 3 5 7 Date of Birth o 3 1 0 2 0 0 8 072 7 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name M A Z U R I E CLARA MI H (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 00 1. Original Return o 4. Limited Estate 00 o 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 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 BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received o o o o 8. Total Number of Safe Deposit Boxes 2. Supplemental Return o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 845 SIR THOMAS CT STE 1 2 7 1 7 5 4 1 ~5 5 0 ("") = REGIST~~ILLS U~NLY ";i' .1LJ > '--., ..i'T:: () -c; , .1 ,,- ..! ';" gj \.DI :;"~ I ()O -o-~; C_)-n::.tr. .I =0 ~..--I :~ .-,J--1 ~ ..1> JAN L BROWN Firm Name (If Applicable) JAN L BROWN & ASS 0 C First line of address Second line of address City or Post Office State ZIP Code i I DATE FILED -.J I _____~._~J H A R R I S BUR G P A 17109 Correspondent's e-mail address: Under penalties of pe~ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of 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 preparer has any knowledge. SIGNAT OFRERSON RESPONSIBLE FOR FILING RETURN . 5- MECHANICSBURG PA 17050 12 HARRISBURG PLEASE USE ORIGINAL FORM ONLY PA 17109 Side 1 L 15056041125 15056041125 .-J ,~\( .-J 15056042126 REV-1500 EX Decedent's Name: CLARA H. MAZURIE 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. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested . . . . . ., 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 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 Govemmental 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.O _ o . 0 0 15. 16. Amount of Line 14 taxable at lineal rate X.O o . 0 0 16. 17. Amount of Line 14 taxable o . 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable o . 0 0 at collateral rate X .15 18. 19. Tax Due ... . . . .. ....... .... . . .. ......... .. . . . . . . . .. . . . . .19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 Decedent's Social Security Number 10289.67 1 0 2 8 9. 6 7 2 4 3 6 . 5 1 2 1 5 1 . 6 0 4 5 8 8. 1 1 5 7 0 1. 5 6 5 7 0 1. 5 6 O. 0 0 O. 0 0 O. 0 0 O. 0 0 O. 0 0 O. 0 0 o 15056042126 --I RE:V-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME CLARA H. MAZURIE STREET ADDRESS ~~ 1 Stephens Crossing File Number 21 08 0357 --- -------- -------- ----- liampden Township CITY Mechanicsburg I STATE PA [ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 0.00 Total Credits (A + 8 + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 4. T otallnterest/Penalty ( D + E ) If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (3) (4) (5) (5A) (58) 0.00 0.00 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 0.00 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; ...................................................................... 0 00 b. retain the right to designate who shall use the property transferred or its income; ............................... 0 00 c. retain a reversionary interest; or ................................................................................................ 0 00 d. receive the promise for life of either payments, benefits or care? ....................................................... 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 00 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ......... 0 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 00 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. 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 + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF CLARA H. MAZURIE FILE NUMBER 21 08 0357 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. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 1,241.72 M& T Bank Checking 58433643 2 Capital BlueCross; benefit reimb 2,610.00 3 Capital BlueCross; benefit reimb 810.00 4 Highmark; premium refund 424.98 5 Humana Inc 65.04 6 Myers-Harner Funeral Home Inc; funeral prepayment insurance refund 5,137.93 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 10 289.67 REV-1511 EX + (10-06) * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF CLARA H. MAZURIE FILE NUMBER 21 08 0357 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral luncheon 279.51 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Linda M Magnelli 525.00 Street Address 6341 Stephens Crossing City Mechanicsburg State P A Zip 17050 Year(s) Commission Paid: 2008 2. Attomey Fees Jan L Brown & Associates 1,500.00 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 Register of Wills, Cumberland County 132.00 5. Accountanfs Fees 6. Tax Retum Preparers Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 2 436.51 (If more space is needed, insert additional sheets ofthe same size) REV-1512 EX + (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CLARA H. MAZURIE FILE NUMBER 21 08 0357 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including un reimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Country Meadows VALUE AT DATE OF DEATH 1,437.60 2 In Your Home Care 714.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2 151.60 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OFEST ATE 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Linda M Magnelli, daughter Lineal 0.00 6341 Stephens Crossing, Mechanicsburg, PA 17050 1/2 residue 2 Alice M Mazurie, daughter Lineal 0.00 247 Brackett Street, Portland, ME 04102 1/2 residue 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. Market Square Presbyterian Church (Women) 1,254.34 aka English Presbyterian Congregation of Harrisburg Specific bequest U/W $2,000; proration of bequest required (22%) 2 American Diabetes Association 1,254.34 Specific bequest U/W $2,000; proration of bequest required (22%) 3 Market Square Presbyterian Church (Deacons' Fund) 3,192.88 aka English Presbyterian Congregation of Harrisburg Specific bequest U/W $5,000; proration of bequest required (56%) TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 5701.56 .. ""-"" '" ". COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF CLARA H. MAZURIE SCHEDULE J BENEFICIARIES (If more space is needed, insert additional sheets of the same size) FILE NUMBER 21 08 0357 LAST WILL AND TEST AMENT ;' ... OF -') -. ~t.l .-X;p -, j - --' CLARA H. MAZURIE f',.) r..--;;, ~~... .- p--; -- I, CLARA H. MAZURIE, now domiciled in Cumberland County, Pennsylvania, declare- c.-' this to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously made. Article I My just debts and expenses of my last illness, funeral, and administration of my estate shall be paid by my Executor from the principal of my residuary estate as soon as practicable after my death. Article II All inheritance, estate, and succession taxes (including interest and penalties thereon, but not including any generation skipping tax) payable by reason of my death shall be paid out of and be charged generally against the principal of my residuary estate without reimbursement from any person. This provision is not a waiver of any right which my Executor has to claim reimbursement for any such taxes which become payable as the result of any property over which I have the power of appointment. Article III I give, devise and bequeath in accordance with any memorandum which I have either handwritten or signed, located with my will or with my valuable papers and found within 30 days of the probate of my will. Gifts may only be to persons who survive me or to organizations which exist at my death, and if there is a conflict, the memorandum having the latest date shall govern. Article IV I give and bequeath the sum of TWO THOUSAND DOLLARS ($2,000.00) to the ENGLISH PRESBYTERIAN CONGREGATION OF HARRISBURG, or its successor(s), specifically to the Women of Market Square. Article V I give and bequeath the sum of TWO THOUSAND DOLLARS ($2,000.00) to the AMERICAN DIABETES ASSOCIATION, or its successor(s), in memory of Norman H. Mazurie. Article VI I give and bequeath the sum of FIVE THOUSAND DOLLARS ($5,000.00) to the ENGLISH PRESBYTERIAN CONGREGATION OF HARRISBURG, or its successor(s), to be invested with income thereofto be used as part of the Deacons' Fund. Artid VII All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, I give, devise and bequeath IN EQUAL SHARES to my daughter, LINDA M. MAGNELLI, of Cumberland County, Pennsylvania, and to my daughter, ALICE M. MAZURIE, of Portland, Maine. If any of my beneficiaries predecease me or fail to survive me by thirty (30) days, I give, devise and bequeath his or her share to his or her issue who survive me, per stirpes, or ifhe or she has no issue, the share(s) are to be added equally to the other shares. Article VIII I nominate, constitute, and appoint LINDA M. MAGNELLI as Executrix of my Last Will and Testament. In the event ofthe renunciation, death, or inability to act, for any reason whatsoever of my Executrix, I nominate, constitute and appoint ALICE M. MAZURlE as successor Executrix of my Last Will and Testament. I direct that my Executrix or successor Executrix be permitted to serve without bond and in addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or in unlike shares and to file any qualified disclaimer I could have filed if living. My Executrix or successor Executrix shall receive reasonable compensation for services rendered to my estate. Article IX In addition to the powers conferred by law, I authorize my Executrix and successor Executrix, in her absolute discretion: (a) to retain in the form received and to sell either at public or private sale, any real estate or personal property except that which I specifically bequeath herein, (b) to manage real estate, - 3 - (c) to invest and reinvest in all forms of property without being confined to legal investments, and without regard to the principal of diversification, (d) to exercise any option or right arising from the ownership of investments, (e) to compromise claims without court approval and without consent of any beneficiary, (f) to file any federal income tax return for any year for which I have not filed such return prior to my death, (g) to make distributions in cash or in kind, or in both, and to determine the value of any such property, (h) to employ any attorney, investment advisor, or other agent deemed necessary by my Executor; and to pay from my estate reasonable compensation for all their services, (i) to conduct alone or with others, any business in which I am engaged in, or have an interest in at time of my death, and (D to receive reasonable compensation in accordance with their standard schedule of fees in effect while their services are performed. -4- IN WITNESS WHEREOF, I, CLARA H. MAZURIE, hereby set my hand to this my Last Will and Testament, on :;)- :AD 2004, at Harrisburg, Pennsylvania. ~\_<::(-^r~/J iY\\).-.~ CLARA H. MAZURIE CJ In our presence, the above-named CLARA H. MAZURIE signed this and declared this to be her Last Will and Testament and now at her request, in her presence, and in the presence of each other, we sign as witnesses. Name Address /) LjutXU~ C bu ~. [~ ~ ' v tU7da 1,. YI1d 8lI5 S, 'r lllCJ)}l t1 r 61 { 045 S/r 7716)JJt1.f tl I H-bjl~/lWJ ffbj j vJ4 17 Iff} - 5 - I, CLARA H. MAZURIE, Testatrix, who signed the foregoing instrument, having been duly qualified according to law, acknowledge that I signed and executed this instrument as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by CLARA ~MAZURlE, the Testatrix on ,;,1.- ~ 0 2004. ~c- } 4- ~ '( . .~ LJU: . I(f otary/Public \ CO~~l- \1~ CLARA H. MAZURI \ .d!R We, the undersigned witnesses who signed the foregoing instrument, being duly qualified according to law, depose and say that we were present and saw the Testatrix sign and execute this instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of sound mind, and under no constraint or undue influence. Sworn to or affirmed and sub~1bed to before me :;;~~~~~'jt~'tu t, witnesses, on ;t - 01-. () , 2004. Clctf.-l-t f"/u.. ~C~? !litness J/) i 't- . ) ~ /fi:; .1.:;; lllJ( .fL, .:k~ ~~ (l WItness ....a __A. 1181='" ...,..1WP. CGUIR'f MY co.sSIOII iiiii 18.17 - - 6 - ATTACHMENT TO REV-1500 ESTATE OF CLARA H MAZURIE FILE NUMBER 21 080357 Legal fees reflected on Schedule H were incurred in connection with the decedent. Fees covered preparation and filing of the Inheritance Tax Return as well as work involved with probate and estate administration. The attorney's fees are reasonable in amount considering the legal time required and expense involved in these matters. The executrix fee is computed based upon the gross estate value ($10,289.67) as shown on the Inventory filed with the Cumberland County Register of Wills. JAN L. BROWN, ESQUIRE* JACQUELINE A. KELLY, ESQUIRE *ADMITTED IN PA AND DISTRICT OF COLUMBIA JAN L. BROWN & ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW OLOE ENGLISH GAP 845 SIR THOMAS COURT SUITE 12 HARRISBURG, PA 17109 EMAIL jlbassoc@verizon.net 'NWIN. janbrownlaw.com TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 BRENDA F. KEPHART, LEGAL ASSISTANT PAULA K. WHITE. LEGAL ASSISTANT JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT May 16, 2008 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 ('") c= ,~O "":U .-' '\:] 'TO "'C-"r- ',.>"n ~~ '~J-) 32 :3~~ :::0 .:J --j ,r:- r--.') = = = ::R: :Po -:: \.0 -0 ::!: N .. Re: Estate of Clara H. Mazurie File No. 2008-00357 0" Gentlemen or Ladies: Enclosed please find the following items for filing with the Register of Wills: 1. Inventory. 2. An original and one copy ofthe Inheritance Tax Return. 3. Estate Check 1006 payable to Register of Wills in the amount of$15 representing the additional fee calculated to be due for Letters Testamentary. 4. Estate Check 1007 payable to the Register of Wills in the amount of $30 to cover the filing fee for the Inventory and Supplemental Inheritance Tax Return. Please time stamp and return our file copies ofthe Inventory and Inheritance Tax Return. If you have any questions, feel free to contact this office. Sincerely, J?~- J an L. Brown bfk Enclosures cc: Linda M. Magnelli, Executrix I ~ '11,~~g~ ~ (0 r. ,~ m --. ~ > . cow ~"C""""-Cl "'0- (' *,II~~~~ I ~II ~ j 0. t~ ~~- (L -0.~ '_J ~:'oo: ~-- 'A UJ. V~ i-j c:! :($031"(\ S! '? '-f 1"- ....._,Ie.. ~ II :::::- - - ~ - - - - - - :;: '-::;-' J: = ~ ::::- :=: _. - ::::- - - - ::;s - C'-) ~ ~ U o C'-) C'-) < ~ ~ o = ~ . ~ ~ s: ::i I- <( w ~ S~ g~cn.r:: w<.9l-~ (I) a: zvs5<( :::>::JUQ.. OClcn - (.) Z <( Cl oW:iE~ Z w 0 m <(OIcn (l)0r-0::: >- Q;; ~ W WI: Z If) 15 ~ I- ~ N Q) cn ;::l o ..s:: t:: ;::l o U >. - O"r<) cnSU'.:l.-. -OQ)O ~U~~ 4-/"l:;;..8<e 01at::", -:::1- ~ l-< 0 <!) tiiJ5Urn .~ S .~ ~;::lg~ ~UOU