HomeMy WebLinkAbout12-21-091505607121
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
PO BOX 280601 2 1 0 9 0 2 5 1
Hanisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 8 9 1 8 5 5 9 6 0 3 0 8 2 0 0 9 0 5 2 6 1 9 1 9
Decedent's Last Name Suffix Decedent's First Name MI
T R U B I A N I A N N A M A E M
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
0 1.Original Return
4. Limited Estate
^X 6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2. Supplemental Return
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
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CO
Name
S U S A N H C O N F A I R
Firm Name (If Applicable)
R E A L E R & A D L E R P C
First line of address
2 3 3 1 M A R K E T S T R E E T
Second line of address
City or Post Office
C A M P H I L L
AND GDNFIDENTWL TAX INFORMATION SHOULD BE DIRECTED TO:
Daytime Telephone Number
? 1 7 7 6 3 l~3 8 3
State ZIP Code
P A 1 7 0 1 1
--~~ ~
( ..J L.
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EV
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DATE FILED •.a
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Correspondent's a-mail address: SCONFAIRaREAGERADLERPC • 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, r~nect and complete. Declaration of preparer other than the personal representative a based on all information of which pn:parer has any knowledye.
SIG RE OF PERS ESP SIBLE F'OR FILING R TURN DATE
1312 WEL DRIVE CAMP HILL PA 17011
SIGNATURE OF PA E OTHER THAN REPRESENTATNE / ~ _ ~ i DATA
2331 MARKET STREET CAMP HILL PA 17011
PLEASE USE ORIGINAL FORM ONLY
1505607121
Side 1
1505607121
J
1505607221
REV-1500 EX
Decedents Na~rie: A N N A M A E M• T R U B I A N I Decedent's Social Security Number
1 8 9 1 8 5 5 9 6
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 8 Notes Receivable (Schedule D) ........................ 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 1 0 0 9 9. 2 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ....... 7.
8. Total Gross Assets (total Lines 1-7) ........................... 8. 1 0 0 9 9. 2 0
9. Funeral Expenses & Administrative Costs (Schedule H) 9.
................ 5 4 1 1 . 8 7
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 3 6 0 9 4 . 1 8
11. Total Deductions (total Lines 9 & 10) ........................... 11. 4 1 5 0 6 . 0 5
12. Net Value of Estate (Line 8 minus Line 11) .... ..................... 12. - 3 1 4 0 6. 8 5
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. - 3 1 4 0 6 . 8 5
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.045 0. 0 0 15. 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 0 0 0 17 0 0 0
at sibling rate X .12 . .
18. Amount of Line 14 taxable
0
0
0
0
0
0
at collateral rate X .15 . 18, .
19. Tax Due ........................... .............. ....... 19. 0 . 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505607221 1505607221
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 09 0251
DECEDENTS NAME
ANNAMAE M• TRUBIANI
STREET ADDRESS
770 POPLAR CHURCH ROAD
CITY
CAMP HILL STATE
PA ZIP
17011
Tax Payments and Credits:
1 • Tax Due (Page 2 line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InteresUPenalty if applicable
D. Interest
E. Penalty
(1) o • 00
Total Credits (A + B + C) (2) 0.0 0
Total InteresUPenalty (D+E) (3) 0.00
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) 0 • D 0
5. If Line 1 + line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.0 0
A. Enter the interest on the tax due.
(5A)
B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 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 : ...................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^X
c. retain a reversionary interest; or ................................................................................................ ^
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? ....................................................................................... ^ ^X
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... ^ Q
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 or for the use of the surviving spouse
is three (3) percent p2 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)]. 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 childtwenty-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-1508 EX + (8-98)
C011AMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ANNAMAE M• TRUBIANI 21 09 0251
Include the proceeds of litlgation and the date the prooaeds were received by the estate.
Ail property jointly-owned with ngM of survNorship must be discbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. SOVEREIGN BANK X0571135439 - CHECKING 2,538.66
2• SOVEREIGN BANK X1054168326 - MONEY MARKET 6,353.96
3• ANTIQUE DESK - BEQUEST TO ANN MARIE GILCREASE 75.00
4• PERSONAL PROPERTY 100.00
5• PA DEPARTMENT OF REVENUE - RENT REBATE 650.00
6• VERIZON REBATE 6.58
7• CATHOLIC CEMETERIES DIOCESE OF HARRISBURG - BURIAL RIGHTS 375.00
TOTAL (Also enter on line 5, Recapitulation) ~ S 10 , 0 9 9.2 0
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10-08)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF _ FILE NUMBER
ANNAMAE M• TRUBIANI 21 09 0251
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. JOHN E• NEUMYER FUNERAL HOME, INC• 1,546.27
2• EVANS MEMORIAL - HEADSTONE LETTERING 100.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) LINDA C R I B A R I
Street Address 1312 WELL D R I V E
City CAMP HILL State PA Zip ],7011
Year(s) Commission Paid:
2. AttomeyFees REALER & ADLER, PC
3. Fatuity Exemption: (If decedent's address is not the same as daimanl's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4• Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS
5 Accountant's Fees
6. Tax Retum Preparers Fees
7. CUMBERLAND COUNTY REGISTER OF WILLS - PHOTOCOPIES
8• LEGAL ADVERTISEMENT - CUMBERLAND LAW JOURNAL
9• LEGAL ADVERTISEMENT - CENTRAL PENN BUSINESS JOURNAL
10• POSTAGE - SALVATORE CRIBARI/CASH
11• DEATH CERTIFICATES
477.55
3,000.00
91.00
3.00
75.00
85.00
22.05
12.00
TOTAL (Also enter on line 9, Recapitulation) I S
1.87
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
ESTATE OF FILE NUMBER
ANNAMAE M• TRUBIANI 21 09 0251
Report debts Incurred by the decedent prior to death which n:mained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. DEPARTMENT OF PUBLIC WELFARE, ESTATE RECOVERY PROGRAM ~ 36,051.04
2• CHERYL A• MELNICHAKD BEAUTY SALON 32.00
3• VERIZON BILL 11.14
TOTAL (Also enter on line 10, Recapitulation) I S 3 6, 0 9 4
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9.00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
• u u~ r~ r w T ~ 1 1 A T•• I T
AV 1•VY1I'11~1 CL V~ U CJy
RELATIONSHIP TO DECEDENT AMOUNT OR SNARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include ht spousal distributions, and transfers under
9116
S
1
2
ec.
(a (
.
)j
1. ANN MARIE GILCREASE Lineal
7810 HORNWOOD DRIVE
HOUSTON, TX 77036
2• LOUIS TRUBIANI Lineal
608 OAK STREET
SANDY RIDGE, PA 16677
3• LINDA CRIBARI Lineal
1312 WELL DRIVE
CAMP HILL, PA 17011
Lineal
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.
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET S
(If more space is needed, insert additional sheets of the same size)
WILL OF
ANNAMAE M. TRUBIANI
I, Annamae M. Trubiani, Cumberland County, Pennsylvania,
declare this to be my last Will and hereby revoke all prior Wills and
Codicils.
I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shall be paid
from my residuary estate as soon as practicable after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason of my death shall be paid out of my
residuary estate.
3. I direct that my entire estate be distributed as follows:
A. I leave my antique desk to Ann Marie Gilcrease.
B. I leave the remainder of my estate to be divided
equally between Ann Marie Gilcrease, Louis
Trubiani, and Linda Cribari. Should Ann Marie
Gilcrease, Louis Trubiani, or Linda Cribari
predecease me, their share shall lapse and be
divided equally between the survivors.
4. I appoint both Linda Cribari and Louis Trubiani jointly as
Executors of this my last Will.
5. The Executor of this r/Vill shall have the power to
distribute my estate in kind or in cash, or partly in either.
6. I direct that no Executor acting under this Will shall be
required to enter bond in any jurisdiction.
~~i:
IN Wlk ESS WHEREOF, I have hereunto set my hand this ~ day
of ~ , , 2004.
i
LAW OFFICES OF ;!
Gl7i.r-a'~, r..,..~.-.
STEPHEN J. NOGG Annamae M. Trubiani
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
The preceding instrument consisting of this and one other page
was on the day and date hereof signed, published and declared by
Annamae M. Trubiani, as and for her last Will in the presence of us,
who at her request, in her presence and in the presence of each other
have subscribed our names as witnesses hereto.
~ ~ ~ ~-~
WIT ESS TNESS ~~
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
ACKNOWLEDGMENT
State of Pennsylvania
County of Cumberland
ss
I, Annamae M. Trubiani, the testatrix, whose name is signed to
the attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my last Will; that I signed it willingly and as my free
and voluntary act for the purposes therein expressed.
,;.
Annamae M. Trubiani
Sworn to or affirmed and, ~knowledged before me by Annamae
M. Trubiani, the. testatrix, this ~ day of ,.. _ . ,
2004.
~,~ary Public/Attorney
i lvetariai vex>!
AFFIDAVIT ~ Jud'rih A. Skeda, N~ ~r.~'~ry ~~:~+~~
State of Penns Ivania I EasiPennsboroTWp.,C,.m.ie!~~iru:!~~oa:;ty
y s My Commission Expires ~;ct. 2L, :-i't':=
County of Cumberland
,1 / ~ n
We,J~u.Z~anhe ~. Urum6:,,~and~~/1 ' v „%'~~~~f ,~~t~/
witnesses whose names are signed to the attached or foregoing v
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testatrix sign and execute the
instrument as her last Will; that the testatrix signed willingly and
executed it as her free and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the testatrix signed the Will as a witness; and that to the best of our
knowledge the testatrix was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
LAW OFFICES OF
STEPHEN J. HOGG
19 S. HANOVER STREET
SUITE 101
CARLISLE, PA 17013
Sworn to or affirrr~d'and subscribed to before me by witnesses,
this ~ day of ~-~-_ / ~ _. , 2004.
~~ r.-~ frig ,!(,.1'~{!.,~-r~t':(~--
~Cbtary Public/Attorney
Notaral Seal
Judith A. Skoda, Notary Public
j =as; Pennsboro Twp., Cumberland County
My Commission Expires Oct. 22, 2005
P.Q=+n;:~nr Pn,..i;.;h!>nia,:.5.^~.:`^_'.;..}; ~F^.i:^~~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DNISION OF THIRD PARTY LIABILITY
CASUALTY UNIT
P.O.BOX 8486
HARRISBURG, PA 1)105-8486
1
August 8, 2009
LINDA C CRIBARI
X312 WELL DR
CAMP A.LL PA 17011-1236
Re: ANNAMAE TRUSIANl
CAS #: 830196409
Incident Date: 03/08/2009
Dear Ms. Criba r':
You have been Dreviously advised that the Department of Public Welfare
's attempting to recover the monetary value of any and all el_gible assets ir.
r_he subject estate. Although the amount in the estate may be considerably
less than that which is owed to the Department, our claim is against the
estate, no one else. Your responsibilities, as the primary next of kin/
administrator/ executor, is to advise the Department of any assets in the
estate and to insure that the remaining money, after all funeral and
administrative costs are deducted, is sent to the Department.
The Department of Public Welfare maintains a claim in the total amount
o° 553,959.15 against the above-mentioned estate. This claim is for
restitution of medical assistance granted on behalf of the decedent 'or whicr.
the rrobate Estate is now responsible to reimburse the Department according
.o Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95,
effective June 30, 1995. You were previously provided the Departmen.'s
_temized statement of claim.
A portion of this medical expense, namely 536,051.04, was incurred
during the '_ast six _nonths of the decedent's life; therefore, ~t is a Class ?
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 2C Pa. C.S.A. 3392(3). The balance of the claim, namely 5'7,908.1., is
to be entered as ~ priority Class 5.1 claim against the estate.
As requested, enclosed is the form for you to apply for an Undue
Hardship Waiver. Please ensure that you fill in every space on the form. If
the estate contains real estate, provide copies of the deed, the latest tax
assessment and a current appraisal with the completed Undue Hardship Waiver
Request Form. If you have legal questions, you must consult le al counsel
I am not an attorney and I'm not permitted to give you 1 al assistance If
we do not have the documentation to review this Waiver Request within sixty
(60) days we will submit this recovery to an attorney in Cumberland County
to file at the courthouse to collect the $7 260.7,0 that is due and/or handle
this case as an unadministeregd estate.
If you do not qualify for the waiver, you need to submit the balance in
the estate to the Department of Public Welfare. According to the information
you provided to our office regarding the assets of the above-referenced
estate, the Department of Public Welfare will accept the balance, namely
$7,260.70 remaining in the estate for payment of our existing claim.
Please have the check made payable to the Department of Public Welfare
and forwarded to my attention at the above address.
Your cooperation ir. resolving this matter is appreciates.
Sincerely,
e11y J. Chestnut
TPL Program Investigator
717-219-1861
7=7-772-6553 FAX