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Home My WebLink About04-07-09J 1505607121 REV-1500 EX O6 OS ( - ) PA DeparMent of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po sox2eD6ot INHERITANCE TAX RETURN h p / Hanisbum. PA 17126-0601 R ESIDENT DECEDENT OC,I ~ o _ ~ ~ 111 ENTER DECEDENT INFORMATION BELOW Sodal Seaaity Number Date of Death Date of Birth 0 1 9 2 0 9 3 3 0 1 0 1 2 2 0 0 8 0 9 2 6 1 9 2 7 Decedent's Last Name Suffix Decedent's First Name MI F E R N A N D E S J O S E P H (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Sutfz Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ^X 1. Original Return ~ ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12.82) ^X 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (AUach Copy of Will) (Attach Copy of Trust) 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. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytlme Telephone Number K E N D R A A. M O H R 7 1 7 9 4 4 1 3 3 3 Finn Name (If Applicable) 1v P A N N E B A K E R & _ M O H R P C REGISTE FjNILLS US LY _ ~ .. ~ FAT First line of address , . . ~ S~. ~ n ~ ~- ' i:,:~ ~ ~~ m I ~` c° 4 0 0 0 V I N E ST REET ~°v>~ -+ `~ ~ c3 Second line of address «Q O a ~~~ ' C~7 ~ ~ P .. ^~ _ 'o'er ' . F::~ City or Post Office State ZIP Code ___ SATE FILED p i'7 M I D D L E T O W N P A 1 7 0 5 TV ' 7 Correspondent's a-mail address: KENDRAQPANNEBAKERLAW.COM Jnder penalties of perjury, I dedare that I have examined this return, indudirg acmmpanying schedules and statements, and to the Vest of my kr t is We, cared and complete. Declaretbn of preparer other than the personal representatlve 5 based on all infortnatbn of which oreoarer has ar Ronald Cormier, 4 Arrow Lane Achushnl SIGNA P AR~HER THAN REPRESENTATIVE n , ADDRESS Pannebaker & Mohr, P.C., 4000 Vine Street Middletov PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505607121 1505607121 ~ `A~ ~ ~~~ ~\^ ,c`~~ ~'~~~~~ 1505607221 REV-1500 EX Decedent's Social Security Number oacedenrs Name: JOSEPH FERNANDES 0 1 9 2 0 9 3 3 0 RECAPITULATION 7. Real estade (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, Bards De osits 8 Miscellaneous Personal Pro P party (Schedule E) ..... .. 5. 7 2 5 ~ 6 • 5 2 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 7. Inter-Vivas Transfers 8 Miscellaneous N-Probate Property ~ 2 1 5 7 0 (Scheduka G) Separate Billing Requested ..... .. 7. 6. 4 3 8. Total Gross Assets (total Lines 1-7) .................... ..... .. 8. 2 8 8 2 8 2, 9 5 9. Funeral Expenses 8 Administrative Costs (Schedule H) ......... ..... 9. .. 2 1 6 1 9, 9 6 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ..... ..... .. 10. 7 8 O 8 , 2 7 11. Total Derwctlons (total Lines 9 & 10) .................... ..... .. 1 t. 2 9 4 2 8. 2 3 12. Net Valus of Estate (Line 8 minus Line 11) .................. ..... .. 12. 2 5 8 8 5 4 , 7 2 13. Charitable and Governmental BequesfslSec 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. 2 5 $ 8 5 4 , 7 2 TAX COMPUTJITION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a>(1.z>x.D _ 0. 0 0 ts. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .0 _ 0. 0 0 16 0, 0 0 17. Amount of line 14 taxable Q 0 0 0 0 at sibling rate X .12 17. . 0 18. Amount of Line 14 taxable 2 5 8 8 5 4 7 2 3 8 8 2 8 . at collateral rate x .t5 18. . 2 1 19. Tax Due ................................................ 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 1505607221 Side 2 3 8 8 2 8.2 1 a 1505607221 J REV-1500 EX Page 3 . Decedent's Complete Address: File Number 00 DECEDENTS NAME JOSEPH FERNAN_DES _____ STREET ADDRESS --- - ---- 14_MALLARD COURT ..CITY ---- STATE ZIP MECHANICSBURG PA 17055 Tax Payments and Credits: t. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount 3. Interest/Penalty ifapplicable D. Interest E. Penalty 4. 15,529.99 If Linen is greater than Line 1 +Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval an Page 2,ilna 20 to request a refund. 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. B. Enter the total of Une 5 +5A. This is the BALANCE DUE. (1) 38 828.21 (2) 15.529.99 (3) 0.00 (4) 0.00 (5) 23.298.22 (5A) (5B) 23,298.22 Make Check Payable to: REGISTER OF WILLS, AGENT i`. a'~a~a`~; '~~4t"'~'ir~`.~Fi~ . ~`.~~a~~~:~~„~h'~~ 6 ~I-.., ~.~n~!~l,r„~~f~ib~i~(r~"~~~~," „ ~k"'~5,~`~~"n~).t.. "'. ~I;- ~ ~ :.. h~.~~6~ai'su 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 b. retain the dght to designate who shall use the property transfened or its income : ......................... ...... ...... ^ ^X c. retain a reversionary interest; or ........................................................................................ ^ Q .. d. receive the promise for life of either payments, benef is or care? ................................................. ...... ...... ^ 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? .... ..... X^ ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefciary designation? ............................................................................................. ..... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 9'~"!>~~m`4~'~'~' ~s'~;";~~°~~1~~.;~~p~~~~~i~~~u~~i'~~~~~°C;F`!';P.)~'I~'a~uu,'4tr~~~°'11i~,E,i~"~,~ii;F~«~t,,~~'~,=~~~I.~i f,.<~~~'lii9:~i'?[r~,,;~.s~i~;". ~~ir~,~i~!`:i~ Far 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 (O) 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 fling 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-0ne years of age or younger at death to or for the use of a natural parent, an adaptive parent, or a stepparent of the child is zero (O) percent ]72 P.S. §9116(a)(1.2)l. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is tour 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) pemenl (72 P.S. §9116(a)(1.3)]. Asibling is defned, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. Total Credits (A + B +C ) Total Interesf/Penalty (D + E ) REV-7508 EX + (6-98) r COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY `°' ^' ° "~ FILE NUMBER JOSEPHFERNANDES 0 0 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with dght of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. ~PAPtR MONEY FROM SAFE DEPOSIT BOX- 1 $1 BILL, 15 $2 BILLS 33nn 2. FRANKLIN MINT COIN SET FROM SAFE DEPOSIT BOX 3. SOVEREIGN BANK ACCOUNT 4. ~M&T BANK ACCOUNT 5. PENTAGON FCU ACCOUNT 6. ~VERIZON REFUND 7. SIRS- REFUND 2008 PERSONAL INCOME TAX 8. IPA DEPARTMENT OF REVENUE- REFUND 2008 PERSONAL INCOPAE TAX TOTAL (Also enter online 5, Recapitulation) I E (It more space is needed, insed additional sheets of the same size) 15.00 20,299.79 4,259.79 47,205.86 9.08 529.00 225.00 REV-1570 EX+(g_gg) I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER•VIVOS TRANSFERS 8 MISC. NON-PROBATE PROPERTY JOSEPH FERNANDES 0 0 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. ITEM NUMBER DESCRIPTION OF PROPERTY INpUOE THEWJAE OFTE iPM18FEREE, TIEla 0.ElAlI0N8HIPi00ECE0ENTAN~ THE GATE OF TRWSfER ATTAGNACOPVOFTNE OEEO FIXi PEAL EbiATE DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION pFASPUCAe~I TAXABLE VALUE 1. AMERICHOICE FCU- POD ACCOUNTS TO GARY ENDRES 106,584.13 100. 106,584.13 (NON-RELATIVE) 2. SOVEREIGN BANK MONEY MARKET ACCOUNT- POD 109,122.30 100. 109,122.30 TO CHERYL PIERCE (NIECE) TOTAL (Also enter on line 7 Recapitulation) I S 215 706 43 (If more space us needed, insert additional sheets of Ne same size) REV-1511 EX+(10-0e) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSESB INHERITANCE TAX RETURN RESIDENT nECEOENT ADMINISTRATIVE COSTS JOSEPH FERNANDES 0 0 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. MYERS FUNERAL HOME 5,360.00 8. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Pelsonal Representative (s) RONALD CORMIER Street Address 4ARROW LANE city ACHUSHNET State MA Zip 02743 Year(s) Commission Paid: 2009 2. 3. Attorney Fees PANNEBAKER 8 MOHR, P.C. Family Exemption: (If decedenCs address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent 4. State Zip Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 5. ~ AaountanCs Fees 6. I TazRelumPreparersFees STEVEN W. FAHNESTOCK, CPA 7. THE SENTINEL- ESTATE AD 8. POSTAGE 9. CUMBERLAND COUNTY LEGAL JOURNAL- ESTATE AD 10. VITAL RECORDS- DEATH CERTIFICATE 11. CHECK ORDER 12. ALICE JANEK- REIMBURSE ADMINISTRATION EXPENSES 13. CHERYL PIERCE- REIMBURSE ADMINISTRATION EXPENSES 14. RONALD CORMIER- REIMBURSE ADMINISTRATION EXPENSES 12, 13, AND 14 ARE EXPENSES RELATED TO CLEANING OUT DECEDENT'S APARTMENT, DISPOSAL, PACKING, HAULING OF PERSONAL PROPERTY, TELEPHONE, HOTEL, MILEAGE, ETC. 3,628.82 5,500.00 114.00 200.00 190.54 11.36 75.00 9.00 3.38 512.34 4,313.51 1, 702.01 (If more space is needed, insert TOTAL (Also enter on line 9, Recapitulation) 15 sheets of the same size) REV4572 EX+(12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES. & LIENS JOSEPH FERNANDES _ 0 0 Report debts incurred by fha decedent prior to death which remained unpaid as of the date of death, including unreimbureed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. IPPL ELECTRIC UTILITIES 82.06 2. ~ WESLEY PARK TOWNHOUSES- RENT 3. ~PPL ELECTRIC UTILITIES 4. 5. (SOVEREIGN BANK- US TREASURY RECLAMATION OF BENEFITS PAID 660.00 35.00 75.96 6,955.25 TOTAL (Also enter on line 10, Recapitulation) I S (If more space is needed, insert additional sheets of the same size) Continuation of REV-7500 Inheritance Tax Return Resident Decedent JOSEPH FERNANDES Decedenrs Name Schedule J -Beneficiaries - 1 File Number NUMBER NAME AND ADDRESS OF PERSON S RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. GARRY FERNANDES Collateral ~ y~~% 311 LOWRY RD b ERIE, PA 16511 9. ELAINE C. HALLE Collateral ~,yS r'jb 36 HART AVE BUCHANNON, WV 26201 10. RONALDCORMIER Collateral _ ~,l-I~J~Ib 4 ARROW LANE ACHUSHNET, MA 02743 11. ALICE G. JANEK Collateral ~ ~ y 5 C'I p 21 PERSHING AVE ACHUSHNET, MA 02743 12. DOREEN DEMELLO Collateral _ LJ ~ ~ 5 bf p 5296 FREEPORT DR SPRING HILL, FL 34606 ~~ ~J W LL 0 u ~. 0 ll A v n~ U v ~+ ~~ ~~ ~~ oa ~ ~y U Y .-~ U