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Home My WebLink About01-20-10 (2)15056051058 _~ ~~~-1500 Ex (os-o5) oFFICU4L USE ONLY PA Departrrment of Revenue County Code Year FYe Number Bmxeau of Irmdivmdual Taxes INHERITANCE TAX RETURN PoeoX28aso, ,~ ~ e9 09~~ Harrisbug, PA 17128-O6p1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 000-00-8698 10/03/2009 02/17/1917 Decedent's Last Name Suffix Decedents First Name MI Serviente Martha E (If Appllcable) Enter Surviving Spouse's Irrfornwtion Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL INAPPROPRIATE OVALS BELOW ~' 1. Original Retum ~==j-' THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Retum ti=..::~ 3. Remainder Retum (date of death prior to 12-13-82) 4. Limited Estate ~~;~ 4a. Future Interest Compromise (date of ~~ ~~ 5. Federal Estate Tax Retum Required ....__ death after 12-12-82) ~? 6. Decedent Died Testate .'..: 7. Decedent Maintained a Living Trust __ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) z 9. Litigation Proceeds Received '~ 10. Spousal Poverty Credit (date of death ~~,"~1 11. Election to tax under Sec. 9113(A) ~~~~ between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTN)N MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Pat Fischer . (717) 226-0~6 6~ ~-~/~J Firm Name (If Applicable) _ __ _ a;; Q_ _ S USL~ILY l L REGISTE~;f~~ll , _ , i C _ ' ~. . ~ , r -; ~Y1 ~ 4•+~ First line of address c!> T i" ~ C'.'~ 606 Woodland Avenue tij`-~r't ~ '-; Second line of address - - ~ :__. `= ,~ ~ -c m - O City or Post Office State ZIP Code _ _ DATE FILED Mount Holly Spri PA 17065 Correspondent's e-mail address: fiSCher755@aOI.COm Under penalties of perjury, l declare that I have examined this return, including accompanying schedules and statements, and to the best of my Ivmowledge and belief. it is true. correct and complete. Declaration of preparer other than Ume personal rm~resentative is based on all information of which preparer has any knowledge. S~^t~ OF PERS ~N RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIQINAL FORM ONLY Side 1 15056051058 15056051058 ~~ REV 1500 EX 15056052059 ~ecedenrs Marne: Martha E Serviente 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 8 Miscellaneous Personal Property (Schedule E) ........ 5. 6. Jointly Owned Property (Schedule F) ~:. Separate Billing Requested ....... 6. 7. Inter-Vvos Transfers & Miscellaneous Non-Probate Property (Schedule G) Ca~s Separate Bllling Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule i} ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. 12. Net Value of Este (Line 8 minus Line 11) .............................. 12. 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. 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 .0_ 15. 16. Amount of Line 14 taxable at lineal rate x .0 45 103,347.55 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 15056052059 Side 2 Decedents Social Security Number 000-00-8698 0.00 105,020.00 0.00 0.00 5,590.00 2,100.55 112,710.55 5,126.00 4,237.00 9,363.00 103,347.55 0.00 103,347.55 4,6S-o,~3 4,650.63 w ~~ 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Martha E Serviente 000-00-8698 STREETADDRESS 507A South West Street GTY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 4,650.63 2. Credits/Payrrtents A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. Irrterest/Penalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FII in oval on Page 2, Line 20 in 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) 4,650.63 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4,650.63 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 :.......................................................................................... ^ 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 ~ care? ...................................................................... ^ 2. If death occurred after December 12,1982, did decedent transfer properly within orre year of death withalt receiving adequate consideration? .............................................................................................................. ^ 3. Did decedent own an "in trust foi' 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 throe (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)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even if the surviving spouse is the only benefidary. 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 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 decedents lineal benefidaries 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 decedents siblings is twelve (12) percent [72 P.S. §9116(aj(1.3)]. Asibling isdefined, 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+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCEIEpt~LE E CASH, BANK DEPOSRS, ~ MISC. PERSONAL PROPERTI( ESTATE OF FILE NUMBER Martha E. Serviente 2009-00956 Indude the proceeds of Gtitigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must bs disclosed on Schedule F. (If more space is needed, insert addidonai 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 Martha E. Serviente 2009-00956 If an asset was made joint within one year of the decedents date of death, k must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME I ADDRESS ~ RELATIONSHIP TO DECEDENT A• Patricia Fischer 606 Woodland Avenue Mount Holly Springs, PA 17065 Daughter B. C. JOINTLY-0WNED 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+IELD REALESTATE. DATE OF DEATH VALUE OF ASSET % of DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST ~• A• 07~01~Oq PNCBank;Account#50-0463-5866 4,201.11 50 2,100.55 1'1liKtnH n JCRV 1CpIC PAT FISCHER 507A S WEST ST CARLISLE PA 17013-3857 ~' interest rate information, sign on to PNC Bank Online Banking at pnacom. 'a For customer service salt 1-888-.PNC-BANK Monday - Friday: 7 AM -10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para serviao en espan'o1,1-866-HOLA-PNC Nbvingt Please contact us at 1-888-PNC-BANK _ ®Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 - -_ . _ _ ----- - _ __ _ __ Y~stt us at pnccom ®TDD terminal 1-800-531-1648 For hearing impaied clients only __ There is an additional $15 #ee for Telephone Cus#omer Service Representative-assisted outgoing wire transfers. This fee is not charged for Performance Se{ect Checking and PNC Complete Accounts. iPA!"!)'o!'~pA11iCO ~AC Miittha H Serviente interest Checiung account S~nmary Pitt Fischer Account number. 50-0463-5866 Overdraft Protection Provided By: Contact PNC to estabrah Overdrah Protection Bafaititce Sutgstairy ,,,_._.__._,, Beginning Deposits and. Checks and other. Ending - balance other additions deductions balance _ _ _ 10,318.97 4,004.56 12,281.81 2,041,72 i~ecks and Sabstitate /:hacks Check Date number Amount paid 1131 50.00 ~ / 09/29 , 1133 '~ 158.80 la/02 1134 2.75 / 09/30 1195 30.00 / 10/02. 1136 682.00 / 10/Ol 1137 17.04 / 09/30 ll38 30.00 / 10/05 1139 5,000.00 / . lU/U2 'Gap in check sequence 'T' Teller Cash ~~~~s 1 Date Amount Description 09/25 21.11 Direct Payment - Central PA Gomcast Centra136&41303 ~~ ~/~J 57r} , /~'yz 10/Ol 107.00 /Payment,E-CheclcPayments Discover ARC 1132 / ~ 10/Ol 19.66 ~ irect Payment _Elec Svc Ppl Eu XX~ZXXX0022Ws i ~~ /~ 7 ~~ (~ ~ y /~-~ ro-~-o~ REV-1511 EX+ (10-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Martha E. Serviente 2009-00956 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1' Ewing Brothers Funeral Home 2,626.00 2 Rillo's Restaurant -Celebration of Life 1, 700.00 3 Colvin Funeral Home -Indiana Interment 600.00 a Hazleton United Methodist Church - Lunc~Ieon after Interment 200.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address State ZIP 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant City Year(s) Commission Paid: Street Address City State Relationship of Claimant to Decedent ZIP 4. 5. 6. 7. Probate Fees: Accountant Fees: Tax Return Preparer Fees: 89.00 TOTAL (Also enter on Line 9, Recapitulation) I $ If more space is needed, use additional sheets of paper of the same size. 5,215.00 REV-1512 EX+ (12-08) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Martha E. Serviente 2009-00956 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. VALUE AT DATE ITEM nccrororrnu OF DEATH 1 ~ Bank of America (for long distance calls) 9.73 2. Bronstein Jeffries, PA (cancer center) 3,539.72 3 Carlisle HMA Physician Mgmnt 30.00 4 Carlisle Medical Pathology 79.98 5 Carlisle Regional Medical Center 546.60 6 Kinetic Imaging 30.74 TOTAL (Also enter on Line 10, Recapitulation) I # 4,236.77 if more space is needed, insert additional sheets of the same size. REV-1513 EX+ (il-OS) Pennsylvania SCHEDULE 7 DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Martha E. Serviente 2009-00956 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. Michael A. Serviente, 511 Headtown Road, Jonesborough, TN 37659 Son 21,004.00 2 E. Bany Serviente, 844 Opossum Lake Rd., Carlisle, PA 17015 Son 21,004.00 3 Sandra Dee Weber, 41 Abbey Ct., Carlisle, PA 17015 Daughter 21,004.00 4 Patricia Fischer, 606 Woodland Ave., Mt. Holly Spgs., PA 17065 Daughter 21,004.00 5 I Tony Serviente, 66 Muzzy Dr., Ithica, NY 14850 Son 21,004.00 ~! 1 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS If more space is needed, insert additional sheets of the same size. 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