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Home My WebLink About09-04-0915056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 9 0__0 2 6 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 7 1 6 2 5 8 1 0 3 0 8 2 0 0 9 0 4 2 4 1 9 2 2 Decedent's Last Name Suffix Decedent's First Name MI C H I P R I A N O J O H N L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI C H I P R I A N O MARY J Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) p 4. Limited Estate Q 4a. Future Interest Compromise (date of p 5. Federal Estate Tax Return Required death after 12-12-82) 1 C~'7 6. Decedent Died Testate C.:a 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Ct 9. Litigation Proceeds Received C.',~ 10. Spousal Poverty Credit (date of death C',~ 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 Daytime Telephone Number KEITH 0. B R E N N E M A N 7 1 7 6 9 7 8 5 2 8 Firm Name (If Applicable) _-_.__...__..__..._.____..._..-._ .............._.__~-_. _. REGISTER OF WILLS USE ONE S N E L B A K E R & BRENNEMAN P C .r.+ First line of address ~ 44 WEST MAIN ST REET ~ P r1 ~ "o I Second line of address ~~ '~ City or Post Office State ZIP Code DA~# ~ M E C H A N I C S B U R G P A 1 7 0 5 5 ~ Correspondent's a-mail address: Under penalties of perjury, 1 declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. D laration of preparer other than the personal rep sed on all information of which preparer has any knowledge. SIG RE OF ON ON BLE FOR FILING RETURN DATE Executor '9~ 3 ~4'9 40 Royal Palm 'Drive, Mechanicsburg, PA 17050 IGN/~ fi~F PfjEPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 44 West Main Street, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 i3 i } { LJ~) :- _~ c ~~ at i ?r"J C:"? t"1 -~ ^~' ~~ ' F"'j `t C~ ~ M v (~ N ~~~ ~ ~ -~ ~ r~~ ~ ~ --. ~ ~~ ~ ~ ~ ~ ' ~ J 15056052048 REV-1500 EX Decedent's Social Security Number Decedent's Name: JOhn L. Chipriano l RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. • 2. Stocks and Bonds (Schedule B) ....................................... 2. S , 8 2 3 ' 8 8 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. 9 3 0 5 0 • 2 1 6. Jointly Owned Property (Schedule F) O Separate Billing Requested .... ... 6. 3 3 8 2 1 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) o Separete Billing Requested..... ... 7. 2 2, 4 4 8 0 6 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 1 _2= 1 . ~ 6 0 3 6- 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 5 s_ 1 1 6 8 9 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. 2 , 3 0 ~ 8 1 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ~ , 4 2 4 • 7 0 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 1 1 4 , 2 3 5 6 6 13. Charitable and Governmental Bequests/Sec 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. 1 1 4 , 2 3 5 '• 6 6 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.p_ 1 1 4, 2 3 5. 6 6 15. 16. Amount of Line 14 taxable at lineal rate X .0 _ 16. '' 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable 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 15056052048 15056052048 0.00 • • 0 •-0 0 G~ REV-1500 EX Page 3 File Number Decedent's Complete Address: 21-09-00261 DECEDENTS NAME John L. Chipriano STREET ADDRESS 40 Royal Palm Drive CITY STATE 'ZIP Mechanicsbur PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) - 0 Total Credits (A + B + C) (2) - 0 - 3. InteresUPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: f d t Yes ^ No Q :.................................................................................. erre rans a. retain the use or income of the property ........ b. retain the right to designate who shall use the property transferred or its income :.................................... ........ ^ c. retain a reversionary interest; or .................................................................................................................. ........ ^ ^ d. receive the promise for life of either payments, benefits or care? .............................................................. ........ If death occurred after December 12, 1982, did decedent transfer property within one year of death 2 . without receiving adequate consideration? ...................................................................................................... ? " ........ ^ ^ ...... or payable upon death bank account or security at his or her death 3. Did decedent own an "in trust for ........ Did decedent own an Individual Retirement Account, annuity, or other non-probate property which 4 . contains a beneficiary designation? ................................................................................................................ ........ Q ^ 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)]. 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)]. Asibling 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-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER John L. Chipriano 21-09-00261 All property jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV-1506 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER John L. Chipriano 21-09-00261 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. (If more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF FILE NUMBER John L. Chipriano 21-09-00261 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~Mary Jane Chipriano Thornwald Home Surviving Spouse 442 Walnut Bottom Road Carlisle, PA 17013 B. C. JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ~~ A. 1/1/79 PNC checking account No. 5070021088 $676.42 50~ $338.21 TOTAL (Also enter on line 6, Recapitulation) I S 338.21 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER John L. Chipriano 21-09-00261 THIS ~~nPH~~IP miict ha rnmoleted and filed if the answer to anv of Questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFQRREALESTA7E. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IFAPPLICABLE) TAXABLE VALUE ~~ John Hancock Mutual Life Insurance Company, Policy No. 7 595 901; Beneficiary Mary Jane ,355.06 1001 ~ Chipriano, surviving spouse, Date of transfer: March 8, 2009 (date of death) 2. Sovereign Bank IRA account No. 1688165594: Beneficiary Mary Jane Chipriano, surviving 15,264.63 1001 $15,264.63 spouse, Date of transfer: March 8, 2009 3. PNC Bank IRA account No. 75200027526; Beneficiary Mary Jane Chipriano, surviving spouse, Date of transfer: March 8, 2009 $7,183.43 1001 $7,1&3.43 TOTAL (Also enter on line 7 Recapitulation) $ 122 , 448.06 (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 FILE NUMBER John L. Chipriano 21-09-00261 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral luncheon and pastor honorarium $904.83 2. Stephenson's Flowers 139.66 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) _ waived Street Address City State Zip _ Year(s) Commission Paid: 2. Attorney Fees t0 Snelbaker & Brenneman, P.C. 3: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 4. 5. 6. ~. Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Initial fee paid: $128.00; additional fee: $150.00 Total: Accountant's Fees and reserve for miscellaneous administration costs and filing fees: Tax Return Preparer's Fees Advertise grant of Letters Testamentary: a. Cumberland Law Journal: $ 75.00 b. The Sentinel: 219.40 Total: 2,750.00 278.00 750.00 294.40 TOTAL (Also enter on line 9, Recapitulation) I $ 5.116 (If more space is needed, insert additional sheets of the same size) Ri?V-'.572 F..X?.~!2-~R) ~ pennsylvania SCHEDULE I ~'~- DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER John L. Chipriano 21-09-00261 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. _.. _ -__. ___ --... _ _. T _ REV-I.51.~ EX+ ~': t-CIR) ~j j Pennsylvania SCHEDULE ~ ~- DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER John L. Chipriano 21-09-00261 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, Mary Jane Chipriano Surviving 100 of residue Thornwald Home Spouse 442 Walnut Bottom Road Carlisle, PA 17013 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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. LAST WILL AND TESTAMENT .l U ~ ; _. L/1W OFFICES SNELBAICER, BRENNEMAN & SPARE T, JOHN L. CHIPRIANO, of the Township of Monroe, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposi_rrg mind, memory and understanding, do make, publish and decJ.ar_e this as and for my Last Will and Testament, hereby revol.i..rrg and malting void all former wills and codicils by meat any time heretofore made. FIRST, I order and direct that all my just debts and funeral expenses be paid by my Executrix, hereinafter named, as i soon as conveniently may be done after my decease. SECOND. I give, devise and bequeath all the rest, residue and. r_emai_nder of: my Estate, real, personal and mixed, whatsoever a.nd wlteresoeve.r situated unto my wife, MARY JANE CHIPRIANO, absolutely grad in fee simple, if she survives me by as many as s.i_xty (6(1) days. THIRD. If my wife, MARY JADTE CHIPP.IANO, does not survive me by as many as si_rty (GO) days, then and in that event, I give, devise and bequeath aJ_1 the rest, residue and remainder of my Estate, real, personal and. mixed, whatsoever and wheresoever situated, in equal shares unto my three children, namely, NANCY M. CART SON, RODTALD J. CHIPRIANO and ROBERT G. CHIPRIANO, share and share a_lil:e, absolutely and in fee simple. T_f any of my said children should predecease me, I order and direct that the foregoing share of my estate attribul-able to such deceased child shall be distributed among laic or her. lawful. issue i,er stirpes by representation and not per capita, subject, however, to the protective trust provisions as contained in Item Fourth hereinbelow with respect to any i % a ~ __ - `j < ~nw oFFicss SNF_LBAKER, BRENNEMAN & SPARE benefici_a..r_y wh.o has not attained the age of twenty-two (22) years at the time for distribution. FOURTH. If any beneficiary hereinabove kras not attained the age of twenty-two (22) years at the time of distribution, I order and direct that the distributive share of such person shall be paid over and delivered unto FNC BANK, N.A., (or its successor by merger, conso]_i_dation or other corporate reorganization) as my testamentary Trustee, IN TRUST, NEVERTHELESS, to hold, manage, invest, accumulate income and reinvest until said beneficiary + attains the age of twenty-two (22) years, at which time said trust shall be terminated and the net proceeds thereof be paid over to the beneficiary absolutely. l authorize and empower_ my said Trustee to invest the assets of said trust in any reasonable manner and not be limited or_ restr_icted to so-called "legal" or statutory investments for f iduci.aries , I designate any trust hereunder to be a spend-thrift trust. The beneficiary shal.7_ have no right to invade, pledge, assign or otherwise dispose of the assets of said trust (including income) nor shall any cxeditor of a benef iciary have any ri_gktt to seize, levy or Q~£ ce ute upon. saifl assets by reason of any pledge, assignment or_ o,~her transfer, voluntarily or b i_nvolunta.rily, made by saiK beneficiary. i I further authdrize and empower my said Trustee to use, h consume, expend and apply''.from time to time such amounts of principal and income of and from said trust which in the exercise of its sole discretion shall.. be'~letermined to be reasonable and necessary for the beneficiary's education. The term "education" sha]_]_ be const.r.ued and interpreted to mean college or other post- higb.schoo]_ training which is intended tc?•._improve the benef_icia.ry's productivity as an adult or `enhance the quality of -2- ,.,\ ~~ _ _ _ _ _ - _ ~ I his or her life. In consi_deri.ng what is reasonable and necessary, mY said Trustee shall take into consideration the pr_imar_y responsibility of the benef_iciary's surviving parent to provide suc}r education. It is my will and intention that the foregoing discretionary provisiort for education shall be supplementary to the parent's primary responsibility. a LASTLY. I nominate, constitute and appoint my wife, I~7ARY JANE CPTIPRIANO, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint my daughter, namely, NANCY M. CARLSON, to be 'the Executrix hereof, each and both to serve without bond or other security as a condition of qualificatiC~n h.ereurrder. IN FdITtdESS WHEREOF, i, JOHN L. CHIPRIANO, have hereunto set my hand ar~d seal ~to this, my Last FTil_l and Testament which consists of three (3) typewritten. pages to each of which I have tY~ affixed my signature this ~~ day of C'~C~iT13~= ~~- A.D., One 'r.T.,ousand Nine Hundred Ninety-eigkrt (1998) . ~, -;{yaL ~i C-~c-~:L,t..--f-~.,:.~ (SEAL) !John L. Chipriano i ; ':Che preceding instrument, consisting of this and two (2J otk~~r typewritten pages, each identified by the signature of the Testator, was on the date thereof_ signed, sealed, published and declared by JOHN L. CHIL~RIA.PTO, the Testator therein named, as and for b.is Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other, have subscribed our names as witnesses rereto. - ~,. 1_l1W OF FIC« -~ SNELBAI;.ER.. ~/~ // ff /(/~ 1 ~' _ r~RENNEMAN ~''UtF_y~~fL^aG/) 0 ~~ 1 VT J ~~'l-~~ i & SPARE -~. 3 __. _. _._ __ _ _ 7 _. _. -_ _ _. _ _. _ fOMMONT^]EALTH OF PENNSYLVANIA ) SS. :OUIdTY OF CUMBERLAND ) We, JOHN L. CHIPRIANO, RT_CHARD C. SNELBAKER and CHRISTINE M. NHI']'E, t}ie Testator and the witnesses, .respectively, whose names are signed to the attached or foregoing instrument, being first a du7.y sworn, do hereby declare to the undersigned authority that the Testator signed and e~;ecuted the instrument as his Last Will and. Testament and that he had signed willingly, and that he _~ ----- executed--it'as his f_re~e.and voluntary act for the purposes ; _ d therein expressed, and that each of~-.the witnesses, in the presence and hearing of the Testator, signed the Will as a wl_tI1P_SS and that to the best of his or he~~r knowledge the Testator was at. that time eighteen years of age ox1 older, of sound mind and under no constraint or undue influen~e. ' ,-~ e ator .. ' ~= / i ~~--~' Witness {~ ) ~~. x - ~~~~r~ ~ 1. W1.tness Subscribed, sworn to and ac}.nowledged before me by JOHN L. CHIPP.IANO, the Testator, and subscribed and sworn to before me by RICIIARD C, S}dELBAY.ER and CHRISTINE M, WHITE, witnesses, this (~,' ;`- , 1998. 4 day of ~t. _ r..-- . ,1 , '..~, ~.. ~ " ' ~`'i ~r''.~.4,L.C-'t v`;~` ~f~'Lt';s-p`zta•7.~y-L,.r~ Notary Public LAW DFFICEF S NEL.BAICER. efi F_NNENI AIJ D SPAP.E ~~ ~,..~~.,,-...,,s N~lal9eed _ ..,.,,~..,a. Pat+scta J. Tixnrtson, [•dUtarp P; IY;2ciienic9i+urg Enro, GrNnld~ettantl ~iwr~}' iViri Gvmmtsa n Explies fJec. 37, 1998 .. .Cv;f. °z.P'i'a,'Flp7?z~r~f:4 Ft A~r,.x. a