HomeMy WebLinkAbout10-21-09 (3)~T
1505607120
REV-1500 ~ (06-05) OFFICIAL USE ONLY
PA Department of Revenue county code veer FNe Number
Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 9 0 0 3 7 2
PO BOX.280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
453 26 3317 04 O1 2009 06 04 1921
Decedent's Last Name
FATTORINI
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
X~ 1. Original Return
4. Limited Estate
g Decedent Died Testate ^
(Attach copy of wlq
Suffix Decedent's First Name MI
JUANITA R
Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return ~ 3. Remainder Return (date of death
prior to 12-13-82)
4a. Future Interest Compromise ~ 5. Federal Estate Tax Return Required
(date of death a11er 12-12-82)
~. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Anach copy or Trust)
9. Litigation Proceeds Received ~ 1 p, Spousal Poverty credo (date of death ~ 11. Election to tax under Sec. 9113(A)
between 1231- 1 and T-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
RALPH H. WRIGHT 717 761 4540
Firm Name (If Applicable)
JOHNSON, DUFFIE
First line of address
301 MARKET STREET
Second line of address
P.O. BOX
City or Post Office
LEMOYNE
State ZIP Code
PA 17043
REGISTER OF VWLJLS USE ON
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Correspondent's a-mall address:
Under penal9es of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the bust of my knowledge and belief,
it is true, correct and tbmplete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
ADDRESS
JOSETTE F. WRIGHT
5 MANDY COURT, CAMP HILL, P/- 17011
SIGNATURE F AR//E//R OTHE THAN R ATIVE DATE
-y~~~`~+~~ ~ Ralph H. Wright t~.e~ / ~ j mlr9'
301 Market Street, Lemoyne, PA 17043
Side 1
1505607120 15056D7120 J
J
PA Inheritance Tax Return
Signature of Additional Fiduciaries
ESTATE OF FILE NUMBER
FATTORINI, JUANITA R. 21-09-00372
Under penalties of perjury, I deGare 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.
Signature #2 ~ ~~~ ~ ~ ~~~~
Name JUDITH F. KNIGHT
Address1 326 SUNSET LANE
Add ress2
Clty, State, Zlp CULPEPER, VA 22701
Date IA~ (~ ~O q
Signature #3 ~/~S ~~~
Name JANIS F. SILER
Address1 5511 RAVENELL LANE
Address2
City, State, Zip SPRINGFIELD, VA 22151
Date ~ ° ~ I ~ 1 t7q
1505607220
REV-1500 EX
Decedent's Social Security Number
oeceaeM•gNama: JUANITA R. FATTORINI 4 5 3 2 6 3 3 17
RECAPITULATION
1. Real Estate (Schedule A) .......................................................................................... 1.
723,855.95
2. Stocks and Bonds (Schedule B) ............................................................................... 2.
3.
4.
5•
6.
7.
8. Closet' Held Corporation, Partnership or Sole-Proprietorship (Schedule C)..........
Mortgages 8 Notes Receivable (Schedule D) ..........................................................
Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ................
Joint Owned Property (Schedule F) g Requested .............
y ~ Separate Billin
Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ~ Separate Billing Requested .............
Total Gross Assets (total Lines 1-7) ....................................................................... 3.
4.
5.
6.
7.
g,
5,690.56
2 0 , 6 0 7 . 3 2
6 0 3, 2 1 2 8 3
1, 3 8 3, 3 6 6. 6 6
9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9.
10,305.96
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10.
10,522.10
11. Total Deductions (total Lines 9& 10) ......................................................................
11. 2 0, 8 2 8. 0 6
12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12, 1 . 3 6 2 , 5 3 8 . 6 0
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 , 3 6 2 , 5 3 8 . 6 0
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 .o0 0. 0 0 15. 0. 0 0
16. Amount of Line 14 taxable 1 , 3 6 2 , 5 3 8 . 6 0
at lineal rate X .045 1s. 61 , 3 14.2 4
17. Amount of Line 14 taxable
at sibling rate X .12 0. 0 0 17. 0. 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0. 0 0 18. 0. 0 0
19. Tax Due ..................................................................................................................... 19. 6 1 , 3 14.2 4
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^
1505607220
Side 2
1505607220 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-09-00372
DECEDENTS NAME
JUANITA R. FATTORINI
STREET ADDRESS
5225 WILSON LANE
CITY
MECHANICSBURG STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. Interest/Penalty ffapplicable
D. Interest
E. Penalty
55,000.00
2,894.74
Total Credits (A + B + C)
(1) 61,314.24
(2) 57,894.74
(3)
(4)
(5) 3,419.50
(5A)
(56> 3,419.50
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 2 Line 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 Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRaPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred :.................................................................................. ^
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? .............................................................. ^ x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? ....................................................................................................................... ^
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary 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.
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 br 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 p2 P.S. §9116 (a) (1.1) (ii)J. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements
for disGosure 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)]. 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.
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Rw-~aos EXf is-ae>
CO~MONYMEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF FILE NUMBER
FATTORINI, JUANITA R. 21-0900372
All propeRy jolndyowned with Apht of survivorship must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 103.350.39 Shares -Dreyfus Cash Management PL 103.350.39
Investor - Shares ~ $1.00 per share.
2 $50,000 Abbott Labs Corporate Bond dated 5112/06 - 50,765.28
5/15/09 - 5.375% - @ 99.50, plus $1,015.28 accrued
interest.
3 $50,000 American Express Co. Corporate Bond - 44,575.63
07/24103 - 07/15/2013 - - 4.875% - @ 88.1221, plus
$514.58 accrued interest.
4 $50,000 BellSouth Corp. Corporate Bond dated 9/13/04 49,593.33
- 9/15/09 - 4.2% - @ 99.00, plus $93.33 accrued interest.
5 $50,000 - ConocoPhillips Corporate Bond - 02/03/2009 52,454.19
- 02/01/2014 - 4.75°/a - ~ 104.14310, plus $382.64
accrued interest.
6 $50,000 Deere, John Cap. Corporate Bond -4107/06 - 52.124.70
4/07/2010 - 5.4% - @ 101.63940, plus $1,305.00 accrued
interest.
7 $50,000 Disney Walt Co. Corporate Bond -12/04107 - 52,385.73
12/01/2012 - 4.7% - aG~ 103.2048, plus $783.33 accrued
interest.
8 $50,000 Goldman Sachs Group, Inc. Corporate Bond - 50,664.90
06/28/05 - 06/15/2010 - - 4.5% @ 100.00480, plus
$662.50, accrued interest.
Total of Continuation Schedule
See attached page
TOTAL (Also enter on Line 2, Recapitulation) 723,855.95
~^ •••~•~ -r~••Q •a ~~~..~,, auwu~nm pnyes or me same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schedule B (Rev. 6-98)
SCHEDULE B
STOCKS & BONDS
continued
COMMONWEALTH OF PENNSttVANw
INHERRANCE TA% RETURN
RESIDENT DECEDENT
ESTATE OF FILE NWM'BER
FATTORINI, JUANITA R. 21-09!-00372
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
9 $50,000 Home Depot, Inc. Corporate Bond - 3124/06 - 49,466.67
3/01/2011 - 5.2% - @ 98.50, plus $216.67 accrued
interest.
10 $50,000 Kraft Foods, Inc Corporate Bond - 09/25/03 - 52.022.40
10/01/2013 - 5.25% - @ 104.04480 -Full Coupon paid
on 04/01/2009 (Date of Death)
11 $50,000 Pepsico, Inc. Corporate Bond -12/04/07 - 53,412.73
02/15/2013 - 4.65% - @ 106.23130, plus $297.08
accrued interest.
12 $50,000 Pfizer, Inc. Corporate Bond - 02/19/03 - 49,617.75
03/01/2018 - 4.65% - ~ 98.848, plus $193.75 accrued
interest.
13 $50,000 SBC Communications, Inc. Corporate Bond - 53,127.25
8119/02 - 8115!2012 - 5.875% - @ 105.5038, plus $375.35
accrued interest.
14 500 Shares -General Electric Cap Corp. Preferred 10,295.00
Stock - @ $20.59 per share.
TOTAL (Also enter on Line 2, Recapitulation) 723.855.95
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rsv-1blM EX+ (8.88)
SCHEDULE E
CASH, BANK DEPOSITS, ~ MISC.
PERSONAL PROPERTY
CObMONYVEALTH OF PENNSYLVANIA
INHERfrANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FATTORINI, JUANITA R. 21-09-00372
Indude the proceeds of litigation and the date the proceeds were receNed by the estate.
All property Jolrrtlyowned with the Aght of survivorship must ba disclosed on schedule F.
ITEM
NUMBER
DESCRIPTION VALUE AT DATE
OF DEATH
1 Bethany Village -refund 24.17
2 Bethany Village -refund of overpayment 851.75
3 Penn Treaty -nursing home insurance -refund. 420.00
4 The Central Pennsylvania Conference -Promissory Note -x20,000.00 plus - 20,363.64
accrued interest.
5 Travelers Insurance -premium refund -homeowner's insurance. 116.00
6 United States Treasury -refund -decedent's 2008 Form 1040 9,672.00
7 Furniture -Messiah Village Apartment -date of death value. 1,750.00
8 Jewelry -appraised value - (Copy of appraisal attached). 2,493.00
TOTAL (Also enter on Line 5, Recapitulation) I 35,690.56
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
C~ C~ ~~- ~
This estate jewelry appraisal was prepared by
Henderson & Co. Jewelers, Inc.
Windsor Park Shopping Center
Mechanicsburg, PA 17050
(717) 766-7771
for:
Estate of
Juanita Fattorini
c/o 7osetbe Wright
5 Mandy Ct.
Camp Hill, PA 17011
This appraisal was prepared May 19, 2009.
The following metal prices are from the date of death, April 1, 2009.
The price of gold was approximately $ 924.50 per ounce.
The following equipment was used in preparing this jewelry appraisal:
Binocular Microscope
Dial Gauge
Table Gauge
Electronic Scale
Color Master Stones
Refractometer
The appraiser was David A. Henderson, Gemologist of the Gemologi ~_ -af---~
America, no. 3561240. - _
G.I.A. grading terminology was used in preparing this jewelry appraisal. ~° __._'
This appraisal was prepared for estate purposes only. The values given represent a fair
price that the items could be expected to bring in a reasonable time period if sale was
necessary to settle the estate. This is based on prices obtained for similar items in our
area at the time this appraisal was prepared, or recent auction prices for sim'~ilar items.
The condition of~the gems and their mountings was factored in when arriving at these
values.
This jewelry appraisal does not represent an offer to buy nor does Henderson & Co.
Jewelers have a stake in these items.
DIAMOND CLUSTER RING
There are thirty two round diamonds prong set in this pear shaped cocktail ring. The mounting is of cast
construction in 14 karat white gold. The ring has a three way split shank and a traditional wire cluster
top. The largest diamond and a smaller one are on the highest level of this three level ring. There are 14
diamonds on the next level. The lowest level has 16 diamonds on it. Condition of ring al: time of
examination was very good (prongs an the top level are somewhat worn from exposure). Total weight of
mounting and diamonds is 4.3 dwt. / 6.7 gr.
DIAMONDS: Thirty Two Round Brilliant Cut Genuine Diamonds
Diameters and Weights:
1- 3.9 mm, .22 carat
1- 2.8 mm, .08 Ct.,
16 - 2.5 mm, .06 ct., .96 ct. t.w.
14 - 2 mm, .03 ct ea., .42 ct. t.w.
Total diamond weight 1.68 carat.
Clarity: Il to SIl
Color: G-H
ESTATE VALUE .............................................$725.00
DIAMOND THREE STONE RING IN INSERT RING
A round diamond in a six prong setting is flanked by two round diamonds in four prong settings,
surrounded on the N - S side by curving rows of nine graduated round diamonds. The center is a two
tone, three stone ring, surrounded by an insert ring in yellow gold. The settings of the three stone
engagement ring are die-struck in white gold and the shank was cast in yellow gold. The insert ring
portion was cast in yellow gold. The rings have been soldered together. Condition of rings at time of
examination was good (It appears as if the goldsmith melted part of the inner gallery of the insert ring
while soldering the rings together). Total weight of two rings is 3.6 dwt. / 5.6 gr.
CENTER DIAMOND: One Round Brilliant Cut Genuine Diamond
Diameter: 4.6 mm
Weight:.38 carat
Clarity: SIl
Color: H
SIDE DIAMONDS (in engagement ring) Two Round Brilliant Cut Genuine Diamonds
Diameter: 1- 3.2 mm
1- 3.4 mm
Weights: 1 - .12 ct.
1 - .15 ct.
Clarity: h
Color: H
DIAMOND MELEE: Eighteen Round Brilliant Cut Genuine Diamonds
Diameter: 1.5 mm to 2.5 mm
Weight:.015 to .06 ct. ea., .36 ct. t.w.
Clarity: SIZ/ Il
Color: H
Total diamond weight in rings 1.01 carat
ESTATE VALUE .......................................$575.00
HERRINGBONE CHAIN
This is an Ital'~an chain in 14 karat yellow gold (stamped). The chain measures 18 inches long and 3.84
mm wide and .52 mm thick. A lobster claw secures the chain when worn. At time of examination for this
report the chain was in fair condition. The total weight of this item is 5.9 dwt. / 9.1 gr.
ESTATE VALUE (scrap) ................................$143.00
LADY'S HAMILTON WRIST WATCH
One 14 karat (stamped) yellow goad watch with a diamond bezel. This watch has a solid looking mesh
bracelet with a textured finish (very popular in the 1970's and 80's. The bracelet has bean shortened to 6
~/a inch {ong in the longest position. A two position box snap secures the watch when worn. The watch
has a Swiss Hamilton 768 movement with 17 jewels. The condition of watch at time of examination was
very good (except for the short bracelet). There are 16 round diamonds bead set in the bezel. Total
weight of case and bracelet without movement is 18.2 dwt. / 28.3 gr.
DIAMONDS: Sixteen Round Brilliant Cut Genuine Diamonds
Diameter: 2 mm
Weight:.03 carat each, .48 ct. t.w.
Garity: SI
Color: H-I
ESTATE VALUE .......................................$500.00
RUBY AND DIAMOND BAND RING
Three square rubies accented by four round diamonds are the focal point of the prong set band ring. The
mounting is 14 karat (stamped) white gold. A narrow tapered flat shank is attached to a raised setting
strip. The rubies are set E - W with two diamonds mounted N - S between them. Condition of ring at
time of examination was good. Total weight of mounting with stone is 1.7 dwt. 2.7 gr.
RUBIES: Three Square Step Cut Genuine Rubies
Dimensions:
1- 3.4mmx3mm
2-3mmx3mm
Color: saturated pure red
Clarity: moderate inclusions
DIAMONDS: Four Single Cut Genuine Diamonds
Diameter: 1.1 mm, .007 carat each, .03 carat t.w.
Clarity: Il
Color: I
These are "value cut" diamond melee.
ESTATE VALUE ....................................$135.00
CARTOUCHE ON BOX CHAIN
This yellow gold cartouche was made in Egypt, it is 18 karat (not stamped in English). The cartouche
measures 44 mm x 19 mm with bail. There is a filigree frame around the cartouche. Weight of cartouche
without chain is 5 dwt. / 7.8 gr. Condition at time of examination was very good. Chain is a simple box
link measuring 24 inches long and 1 mm width.
ESTATE VALUE (scrap) ....................................$165.00
CULTURED PEARL STRAND
This is a uniform, knotted strand of Akoya (salt water) cultured pearls. A 10 karat white gold fish hook
clasp.
PEARLS: 68 Akoya Cultured Pearls
Diameter: 5 mm
Color: white ,light rose'
Luster: good
Surface: some spotting
Nacre: thin
ESTATE VALUE .................................$250.00
$ 725.00
575.00
500.00
143.00
135.00
1E5.00
250.00
TOTAL $2,493.00
Rsv-1609 EX+ (8-98)
SCHEDULE F
cobrAONwEnLTH of PENNSnVANUi JOINTLY-OWNED PROPERTY
INHERRANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FATTORINI, JUANITA R. 21-09-00372
Han asset was mods )old within one year of the decedard's date of death, k must bs roportsd on schedule lv.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. JOSETTE F. WRIGHT 5 MANDY COURT Dauglhter
Camp Hill, PA 17011
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
9/e OF
D~CD~S
IN EREST
DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1 6/29/2006 PNC Bank -Checking Account No. 556.02 50.000% 278.01
50-0489-3777 -Date of death balance.
2 6/26/2007 PNC Bank -Checking Account No. 40.658.61 50.000% 20,329.31
50-0489-4307 -Date of death balance.
TOTAL (Also enter on Line 6, Recapitulation) I 20,607.32
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-'1500 Schedule F (Rev. 6-98)
Rav-7870 EX+ (8.88)
SCHEDULE G
INTER-VIVOS TRANSFERS ~
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSriVANIA
INHERRANCE TA% RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
FATTORINI, JUANITA R. 21-09-00372
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side oT the REV-1500 COVER SHEET is yes.
ITEM
NUMBER
INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
INTEREST EXCLUSioN
(IF APPLICABLE) TAXABLE
VALUE
1 AIG Chairman Annuity -Contract No. 0030000719 48.245.01 48,245.01
- Beneficiaries: -Daughters -Judith F. Knight;
Josette F. Wright and Janis F. Siler. Date of
death value.
2 AIG Fixed Annuity -Contract No. CF002825 - 335,554.44 335,554.44
Beneficiaries: -Daughters -Judith F. Knight;
Josette F. Wright and Janis F. Siler -Date of
death value.
3 All State -Annuity Contract No. GA 16598537 - 29,596.03 29,596.03
Beneficiaries: -Daughters -Judith F. Knight;
Josette F. Wright and Janis F. Siler. Date of
death value.
4 Sun Life Financial Annuity -Contract No. 177,612.93 177,612.93
7700145978 -Beneficiaries: -Daughters -Judith
F. Knight; Josette F. Wright and Janis F. Siler.
Date of death value.
5 PNC Bank -Money Market Account No. 15,204.42 100.000 3.000.00 12.204.42
50-0579-8122 -Date of death -balance, plus
accrued interest. Joint as of 3/14/2008 - Josette
F. Wright, Daughter
TOTAL (Also enter on Line 7, Recapitulation) 603,212.83
(K more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98)
r
REV-1161 EX+ (12.98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
FATTORINI, JUANITA R. 21-09-00372
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
COY State Zip
Year(s) Commission paid
2. Attorney's Fees Johnson, Duf~e
3. Famiy 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
9,703.96
4. Probate Fees 564.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 38.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 10,305.96
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
FATTORINI, JUANITA R. 21-09+-00372
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Exaenses
1 Anna Royer -organist 50.00
2 Bethany Village -funeral brunch 314.46
3 Chaplain J. Browning -Memorial Service 200.00
4 Giant Foods -food purchases for funeral 45.02
5 Marker lettering 75.00
6 Musselman's Funeral Home -funeral expenses 6,180.50
7 National Memorial Park -Interment charges. 1,795.00
8 Reverend Heather Baker McAllister -funeral service 100.00
9 Royer's Flowers -Memorial Service 43.98
10 Travel expenses -family members from out of state. 900.00
H-A subtotal 9.703.96
Other Administrative Costs
11 Register of Wills - 2 Short Certificates
12 Register of Wills -file Inventory ~ Inheritance Tax Return.
H-B7 Subtotal
8.00
30.00
38.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rav-1612 EXt (8-88)
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
FATTORINI, JUANITA R. 21-09+-00372
Include unrolmburosd msdipl expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Bethany Village -final nursing home charges. 2,073.77
2 Bethany Village -outstanding nursing home charges 7,592.00
3 Bonnie K. Miller, Treasurer/Tax Collector -decedent's 2009 Personal -Taxes 9.80
4 Citicard -decedent's account balance. 57.63
5 Continuing Care -Pharmacy charges. 154.55
6 PennTreaty - nursing home insurance. 634.35
TOTAL (Also enter on Line 10, Recapitulation) I 10,522.10
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98)
Rev-ta~a ex+ ta.oo~
SCHEDULE J
COMM HERITANCE~ AX RETURN ANIA BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
rA 1 1 VKIIYI, JuAIVI I A K. 21-09-0 0372
NUMBER NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
Do Not ua Trust s
I
' TAXABLE DISTRIBUTIONS [inGude.outright spousal
distributions and transfers
under Sec. ~116(a)(1.2)]
1 JUDITH F. KNIGHT Daughter 1/3 tangible
326 Sunset Lane personalty; 1/$
Culpeper, VA 22701 residue.
2 JANIS F. SILER Daughter 113 tangible
5511 Ravenell Lane personalty; 1/$
Springfield, VA 22151 residue.
3 JOSETTE F. WRIGHT Daughter 1/3 tangible
5 Mandy Court personalty; 1/$
Camp Hill, PA 17011 residue.
Total
Enter dollar amounts for distributions shown above on lines 5 through 18, as appropri ate, on Rev 1500 coye r 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
TOTA L OF PART 11 -ENTER TnTAi Nf1N_TGYORI G r11CTDln1 ITI/'1A~c n~i i iw~r .e r,r nr.. .
__.-.____ ..__..........................~~~~.- ~.+v~ I~~v-IJVVVVVCr[JrICCI I V.VV
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-15 0 Schedule J (Rev. 6-98)
c~or~
~rtt~# tll ttnd ~~stttment
of
J UAN ITA R. FATTO RI N I
1, JUAivITA R. FAiTOr'~iNi, of Lower Aiien Township, Cumberland County, Pennsyivania,
being of sound and disposing mind, memory and understanding, do hereby make, publish and
declare this as and for my Last Will and Testament, hereby revoking and making void any and all
Wills or Codicils at any time heretofore made by me.
ARTICLE I
I direct the payment of my legally enforceable debts and the expenses of my last illness
and funeral from my Estate as soon after my death as conveniently may be done.
ARTICLE II
I give and bequeath my motor vehicles(s), household and personal effects and other
tangible personalty of like nature (not including cash or securities), together with any existing
insurance thereon, unto my daughters, JUDITH F. KNIGHT, JOSETTE F. WVRIGHT and JANIS
F. SILER, to be divided between them by my Executrixes with due regard for their personal
preferences in as nearly equal shares as practical. In the event any of my daughters does not
survive me by thirty (30) days, I give, devise and bequeath her share unto her then-living issue,
per stirpes by representation.
ARTICLE III
I give, devise and bequeath all the rest, residue, and remainder of my Estate, of
whatsoever nature and wheresoever situate, unto my daughters, JUDITH F. KNIGHT, JOSETTE
F. WRIGHT and JANIS F. SILER. In the event any of my daughters does not survive me by thirty
(30) days, I give, devise and bequeath her share unto her then-living issue, per stirpes by
representation.
ARTICLE IV
In the event that any beneficiary of my Will is a minor at the time for distribution of his or
her share, distribution of said share may be made in the discretion of my Executrixes after
considering the age and needs of the beneficiary, either directly to the beneficiary or to a
Custodian under the Pennsylvania Uniform Transfers to Minors Act, 20 Pa. C.S.A § 5301 et seq.,
or the applicable Uniform Gifts to Minors Act or Uniform Transfers to Minors Act in the state of
residence of such beneficiary as the case may be. My Executrixes may designate as such
Custodian any institution or person, including my Executrixes, qualified to act as a Custodian for
such beneficiary under such Act in effect at the time such distribution is made. A receipt for any
payment or distribution so made shall be a full discharge therefor to my Executrixes, who shall not
be responsible to see to, or be liable for, the application of such proceeds thereafter.
ARTICLE V
I name, constitute and appoint my daughters, JUDITH F. KNIGHT, JOSETTE F. WRIGHT
and JANIS F. SILER, Co-Executrixes of this my Last Will and Testament. I direct that no
fiduciary appointed herein shall be required to post bond for the faithful administration of the duties
required in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and
Testament, this ~, day of ~ ~•-, , 1998.
' --~ ~ - (SEAL)
ANITA R. FA ORINI
Signed, sealed, published and declared by the above-named Testatrix, as and for her Last
Will and Testament, in the presence of us, who at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as witnesses.
b~.-
~G~.,
r r
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
. ss.
COUNTY OF CUMBERLAND
We, JUANITA R. FATTORINI, ~D/'f KNp ~, /"lYF'R S and
~ft VI D ~. ~~4~/z.4 ,the Testatrix and the witnesses, respectively,
whose names are signed to the attached or foregoing instrument, being first duly sworn, do
hereby declare to the undersigned authority that the Testatrix signed, and executed the instrument
as her Last Will and that she had signed willingly and that she executed it as her free and
voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence
and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge
the Testatrix was at that time eighteen years of age or older, of sound mind and under no
constraint or undue influence.
,-----
JUANITA R. ATTORINII
r~
Witness
Witness
Sworn to or affirmed to and subscribed to before me JUANITA R. FATTORINI,
Testatrix, and ~r~r,c".~.,n~:. S~ ~~1 ^~!~ and = ~ •~ur-,~,
witnesses, this v ~k'day of `~r~ , 19 `~ ~ .
~~
Notary Public
My Commission Expires:
~ NOTARIAL. SEAL
DIANNE LENIG, Notary Public
Lemoyne Borough Cumberland Co.
My Commission Expires Dec. 21, 2001
TO Register of Wills Office
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
SUBJECT:
Estate of Juanita R. Fattorini
No. 21-09-00372
FROM
JOHNSON, DUFFIE, STEWART & WEIDNER
Attorneys at Law
P.O. Box 109
Lemoyne, PA 17043
(717) 761-4540
Fax: (717) 761-3015
DATE: October 20, 2009
Enclosed for filing in the above-captioned Estate are the following:
1. Original and copy of Inventory.
2. Original and copy of Inheritance Tax Return.
3. Check in the amount of $30.00, filing charges.
4. Check in the amount of $3,419.50, Inheritance Tax.
5. Envelope to mail the receipt and stamped inventory to me. Thank you.
~ SIGNED: Cindy Hubler, Estate Administration Paralegal
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