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Home My WebLink About10-14-08 (2)15056041114 REV-1500 Ex cos-os> PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box 2eosol INHERITANCE TAX RETURN _ /J/ ~ /J ~ ~ A /., Harrisbur PA 17128-0601 RESIDENT DECEDENT ~t / '/ (J ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 196-18-3552 08082006 05041921 Decedent's Last Name Suffix Decedent's First Name MI CAPONE ALICE (If Applicable) Enter Surviving Spouse's Information Below H Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW QX 1. Original Retum Q 2. Supplemental Return [~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of Prior to 12-13-82) 5. Federal Estate lax Return Required death after 12-12-82) Qx 6. Decedent Died Testate ~ 7. Decedent Maintained a Livin Trust 0 (Attach Copy of Will) g 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) 0 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit date of death ( [~ 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 ROBERT G FREY Firm Name (If Applicable) 71 7-243-5838 FREY & TILEY REGISTER ~~ WILLS USE QI$l.Y First line of address `TG --'r! c~ - 5 SOUTH HANOVER STREET - c ~ _- ~ -+? t -~ - Second line of address :-; ~ .c- _ -_. ~;, City or Post Office State ZIP Code DA JiLED CARLISLE PA 17013 ~ w Correspondent's a-mail address: RFREY@ FREYT ILEY . COM Under penalties of perjury, 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 corn lete. Declaration of re aver other than the ersonal re resentative is based on all information of which re arer has an knowled e. SIGNATURE OF PERSON RE~PC}NSIBLE FOR FILING St~Tit1RN ADDRESS ~ 1 ~ ~ ~ ` SIGNATURE OF P REOO~~~HE~.THAN f~Ef ADDRESS 15056041114 USE RIGINAL FORM ONL Side 1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ~! 17 DATE S,~ .p~cw..~„ Zvz,g- 15056041114 l~ 15056042115 Decedent's Social Security Number ~ecedent'sName: ALICE H CAPONS 196-18-3552 RE CAPITULATION 1. Real estate (Schedule A) ........................................ .. . 1. NONE 2. Stocks and Bonds (Schedule B) ................................... ... 2. NONE 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. NONE 4. Mortgages & Notes Receivable (Schedule D) ........... NONE .............. ... 4. 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ..... ... 5. 10694.00 6. Jointly Owned Property (Schedule F) OSeparate Billing Requested 6 NONE 7. ...... Inter-Vivos Transfers & Miscellaneous Non-Probate Property .. . (Schedule G) OSeparate Billing Requested ...... . . 7. NONE 8. Total Gross Assets (total Lines 1-7) .... ........ .................... .. 8. l O 6 9 4. 0 O 9. Funeral Expenses & Administrative Costs (Schedule H) .................. . s. 5777.20 10. Debts of Decedent, Mortgage Liabilities, i~ Liens (Schedule I) ............ . .. 10. 2219.00 11. Total Deductions (total Lines 9 & 10) ..... ................. .......... . 11. 7 9 9 6 . 2 0 12. Net Value of Estate (Line 8 minus Line 11) .. 13. .... . Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 2 6 9 7 . 8 O an election to tax has not been made (Schedule J) ...... ................ . 13. 0.00 14. Net Value Sub'ect to Tax Line 12 minus Line 13 .... . ................. TAX COMPUTATION -SEE INSTR . 1a. 2697.80 UCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 0 16. Amount of Line 14 taxable 15' O • O O at lineal rate X .0 4 5 17. Amount of Line 14 16. O • O O taxable at sibling rate X • 12 18. Amount of Line 14 taxable 17• O . 0 0 at collateral rate X• 15 2 6 9 7. 8 0 1 g , 405.00 19. TAX DUE ...................................... .................19. REV-1500 EX 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056042115 Side 2 15056042115 405.00 0 REV-1500 EX Page 3 196-18-3552 Decedent's Complete Address: File Number 21-07-0970 1. Tax Due (Page 2 Line 19) 2. Credits/Payments (1) 405 00 A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable Total Credits (A + B + C) (2) 0 00 D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT enalty (D + E) (3) 0 00 Fill in oval on Page 2, Line 20 to request a refund. (4) 0 00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 405 00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 405 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: a. retain the use or income of the property transferred : ..................................... . . X b. retain the right to designate who shall use the property transferred or its income : ................ X c. retain a reversionary interest; or ...................... ^ ................................ ^ X 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 X without receiving adequate consideration? ............................... ^ ^ .... X 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .. X 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..... . ..................................... ... ........ ~ 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)j. 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)j. 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. §911 G(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. Tax Payments and Credits: 217 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER nw~uae >:ne proceeds of litigation and the dare +hp „~.,,.eva~ ........ ____. ` ~ - ---..._........,,,.,,., ~~ ~~~~ aaine size) REV-1511 EX + (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER LICE H CAPONE 21-07-3552 ITEM Debts of decedent must be re orted on Schedule I. NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT ~ • Gaydos Monument 550 2• Pesche's Flowers 284 3• Monogahela Cemetary 85 4• Food 476 B• ADMINISTRATIVE COSTS: ~ • Personal Representative's Commissions Name of Personal Representative(s) Karen Hemzacek Street Address 242 East Washington city Des Planes state IL zip 60016 _ Year(s) Commission Paid: 2008 694 2• Attorney Fees 750 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 94 6• Tax Return Preparer's Fees 7• Storage fees for personal property 300 8• Travel Expenses of Executrix (gas, lodging, meals, tolls) 730 9. Postal expenses 1,458 10• Final medical bills 16 ~ 1 ~ Ohio Casualty Group, insurance 298 42 TOTAL (Also enter on line 9 Recapitulation) I $ 5 777 (If more space Is needed, Insert addltlonal sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ALICE H CAPONE FILE NUMBER Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unreimbursed medical expenses. ITEM NUMBER Balance owed to Citicard 2. Income tax due to IRS DESCRIPTION VALUE AT DATE OF DEATH 492 1,727 (If more space is needed, insert TOTAL (Also enter on line 10, Recapitulation) sheets of the same size) 2,219 2n REV-1513 EX+ (9.00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ALICE H CAPONE SCHEDULE J BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1 Karen Hemzacek 2 Shirley St. Clair 3 John P. Innes 4 William G. Hageman 5. Fred P. Hageman FILE NUMBER 21-07-3552 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE niece niece nephew ~_ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 AS APPROPRIATE ONIREV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 30% 30% 30% 10% 10% TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I (If more space is needed, insert additional sheets of the same size) S L~aST WILL AND_TESTAMENT I, ALICE H. CAPONS also known as ALICE H. CAPt~NECCHIA, a widow, of the Borough of Donora Washington County, Pennsylvania, do make this, my Last Wi11 and Testament, hereby revoking in full any and all Wi11s heretofore made by men. FIRST: I direct my Executrix hereinafter named to pay niy debts and funeral expenses. I also confer upon my Executrix the power to sell my realty and personalty upon such terms and in such way and manner as ma_y be deemed wise in the discretion of my Executrix. SECOND; I direct my Executrix to reduce m y estate to cash and, after payment of expenses and taxes, to distribute the proceeds as follows: (a) Ninety Percent (90%) of the proceeds to be divided equally among KAREN HEMZACEK, my niece; SHIRLEY St.Clair, m_y niece; and JOHN P. INNES, my nephew. (b) The remaining Ten Percent (10%) of the proceeds shall be divided. equally between m_y nephews, WILLIAM G. HAGEMAN and FRED P. HAGEMAN. _ !/~~Ali ~ / "~~s~ ~ ( SEAL ) (SEAL) THIRD: ~- I appoint my niece, KAREN HEMZACEF; the Executrix of this, my Last to be that Wi11 and Testament. .I direct my Executrix sha11 not be required to the performance of her duty. post bond to insure IN WITNESS WHEREOF, I, the said ALI known as ALICE H. CE H. CAPONE CAPONECCHIA also Testament set ~ have to this my hand m_Y Last Wi.11 and and seal this 12th day of May, 2003,. ~~-~ ,~ _ _ (SEAL) _ ,~ -_ (SEAL) Signed, sealed published, and CAPONS also known as declared b_y ALICEE ALICE H. CAPONECCHIA H. named, as and ~ the testatrix far her Last WiI1 above and Testament, in our presence, who, in her presence, at her request each other ~ and in have hereunto the Presence of subscribed witnesses, our names as attesting " ~~t.~.e~~. 2 / ~~~ _..-~.~ ~FTN THIRD BANK (CMIGGO) v.o. eox r~o9oo clrvcwrun off aszs3_oyoo ~~ ESTATE OF ALICE ~P~ECCH~ 242 E WggHINGTON ST ~~ DES PLAINES IL 60016-2926 Sent Period Date: 7/19/2009 - 8/15/2008 Acmunt Type; Club 53 Acmunt Number: 7235986325 0 Banking Center: Des Plaines Customer Service: i-800-972-3030 5590 IrKemet Bar-kiny & Bill Payment: www.53.mm PLANNING A TRIP? ORDER FROM AS THE NEXT BUSINESS DAY! MORE THAN 70 FOREIGN CURRENQES ANO PICK IT UP AT YOUR LOCAL FI LOCAL FIFTH THIRD BANK L NO HASSLES. NO WAIITNG IN LINE. NO COSTLY EX OCATION TO PLACE YOUR FOREIGN CURRENCY CHANGE RATES AT YOUR p .THIRD BANK LOCA7TON AS SOON ORDER TODAY. NATION. SIMPLY STOP BY YOUR Aa'aunt Summa 0/19 rY ' 72359$6325... Beginning Balance Checks ;0.00 Interest Earned Withdrawals / Debits Number of Da 2 ~~~ /Credits Ys in Period $0.38 08/15 Ending Balance $10,694.32 Annual Percentage Yield Earned 28 $10.694,32 Interest Earned YTD 0.0586 Deposits /Credits $0.38 08/15 10,693.94 DEPOSIT, 0.38 INTEREST Daily Balance Summary Date 07/zl A"1Ot"t Date 10,693.94 08/15 YOUR GOALS• FIFTH THIRD BANK WILL HELP YOU P ~' YOUR LOCAL FIFTH THIan c~.~~,.... ___ _ REAC7i An~~ 10,694. 23 2 items totaling $10,694,32 TO FIND OUT HOW H~.H THIRD BANK IS I"-OVING FORWARD WITH Page 1 of 2 Final Medical Expenses Millenium Pharmacy 150 Moffet Heart Group 14 Vital Check 18 Carlisle Regional Medical Center 116 Total medical expenses 298