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Home My WebLink About07-20-10,- , i , _ - 1505610101 J ~l~-io, ~~ ~ ~~-VV ~ OFFiC1AL U~ ONLY PA Department ol` Revenue ,~ County Cade Year ~ Fib Number 8urww of Indfvidual Taxes INHERITANCE TAX RETURN ~ t ~ ~ +~ (,~ ~ '~ Po 80x a8o6os REl~It~ENT DECANT _ ~ ~ _. _ ~_ L.~...i..Lu .nw r~A ~~l4A~i .i.A~11 - -...._.------`"' f~1MTER ~GIli'E' i1A3K>rN ru~.c~mr Soda) Security Number Dafs of Death MMDDYYYY Die of Birth MIuODYYYY 207-24-5817 ~ 10/17/2009 04!13!1930 _.__.:..__.._..._._._......._...._ ...................... _._~.. . . t N ' Sufffixx r ... .........___..__._..... Decedent's Feet Name ame s Las Decedent ~~ M Deeds ._._ ................ (If Applicable) Et~lrr Stuvlviny Spouse's 1Mormation Detow ' M{ Spouse's Last Name ........................................._w_..........................................................................._. _. Suffix s ^First Name ._~_.. _. Spouse ~ N/A . ........................._..................3 _ ............................................................... .........................................................._...................v_....__._.._....._..........................................._. Spouse's..Saciat s~ecu~i-y, Number ..................... THIS RETURN ilE1ST BE Fll.~? EI t~Ui~~l1TE WITH THE REGIS?ER ~3F WILLS FILL MI ApPROPlkIATE OPALS BIELOW ~ 1. OrtQ{nal Return O 2. Supplements{ Return O 3. Remainder Return (da6e of death prior to 12-13-82) O 4. Limited Estate O 4a. Future hrter~t Compromise (date of O 5. Federal Eatabs Tax Return Required death after 12-12-82) O 6.1)ecedent Died Testate O 7. Decedent Maintained a Livtr~ Trust 4 8. Total Number of Sege i)eposit Boxes (Attach Copy of VY{N) (Attach Copy of ?rust) O 9. Litigatlan proceeds Received O 10. Spousal Poverty Credit (dabs of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) ( ~• O) GORREBpONDENT - TMIE 8ECTK')N MUST BE COMPLETED. ALL CORRESPONDENCE AND Ct)NPIDE~fTIAL. TIIX II~t9111N141'ION s~OtfLD RE ODD TO: iaayt~e Telephone..Namber ...... . Name ................_.........................., ..Michael.Chet'ewka~...Es4_ ...................................................._......................_.............. .. ._717)..232-4701........................_.............................__..._...__............... ___ REC~sTrfe wtLLS use Y ~- ~, t~ ~:: ~~ "~ ~~.~ First !inns of addross ..._. ....._ ........................__._.__......_.................._......_......._....................................................... ~? ....624 North Front Street .: k ..........._............_ ........................._._.__..._........................................._......................_......_ u3 ~ ~~'~'` Second Nne of address ~ ' ~~"~ ~, ~~ ~ ~'~! ~.. City or Past Office State ZIP Code ~,;~, ~ PA ;17043 ~-' Wormleysburg ~~~~~ Corresponalent's a-root sddnes: fY1C~.1l3rOMVK..~'~r:r~ererva~tuser.c:~u~- Under penaNiss of perry, !I declru+s that i haw eooernitwd the reebuum. irnp awompenyin9 scheduiss and starmente, and t4 the bast d my tono~wMdpe and t~sNef, it is file, ccxiecx and aarr~MtP. DecMratlam d p~roperor otMr thin the psraonad repressntatiw is tossed on aN inforimafon d whk~ prsparor hps any knaMadp~. g ~, ~ stBLE FOR FILING RETURN 07/09110 ,... 806 Division Stt+ewt, Gt~ltntham, PA 17027 THNi REPRESENTATIVE DATE . °~ ., ~, ~/ 07/09/10 !'VMS-Y-/~ 8'14 North Front Street, Wormleysburg, PA 17043 ufaE ol{~~rMU ~~ t~.Y 81de 1 1505610101 1505610101 ,J J REV 1500 EX raame__ Jacgtael~ne M. Deeds b5~561~105 1. Real Estate (Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. 3. Cbsely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. AAortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and MlsceNaneous Personal Property (Schedule E)....... 5. s. Jointly Owned Pr~terty (Schedule F) O Separate Billing Requested ....... 6. 7. inter=Vivog Transfers 8 MisceNaneous Non-Prot~ate Property (Schedule G) O Separate BlNing Requested........ 7. 8. Total Gross Asseb (total Liners 1 through 7) ............................. 8. 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 11. Total Dedwctions (total Lines 9 and 10) ................................. 11. 12. Net Valw of Estate (Line 8 minus Line 11) .............................. 12. 13. Charlt~le and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Vslw iSurb~ect to Tax (Line 12 minus Line 13) ........................ 14. TAX CALCULAiT10N -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Liter 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ~ ........................................_.._.......................................................................................................................: 16. Amount of line 14 taxable at lineal rage x .o ~ 29,609.70: 1 s. 17. Amount of litre 14 taxable at sibling rape X .12 17. 18. Amount of line 14 taxable at collateral rate X .15 18. 19. TAX DUE ......................................................... 19. 20. FILL Mi THE OVAL iF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Social Sscurity Number 207-24-5817 0.00 0.00 ~~ 0.00 ~.~ 0.00 0.00 11,884.60 42,116.56 54,001.16 5,206.48 _~.-. 49,184.98 u,3s1.46 29,609.70 0.00 ,~~ bi,~alr7~ U alas s L 1505610105 1505610305 J REV 1500 EX Page 3 Decedent's Ctxrtp~te Address: 0.00 C Jacqueline M. [)eels sTREETU~oRESs 806 Division Street C Grantham srATr:PA 17027. Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payrrietrts A. Prior Payments ~. B. Discount 3. Interest 0.00 d. If line 2 is greater than t.kte 1 + Line 3, enter the di~renoe. This is the OVERPAYMENT. FNI ~ oval on Page 2, Line. 29/o squat a refund. 5. If Line 1 + Line 3 is than line 2, eerier the difference. This is the TAX DUE. ~r. r~wnaer ,~.1-" 10 - o ~ 3t (1) Total Credits (A + B) (2) (3) (d) (5) Make c~~eck payable to: REGISTER OF IM~L~LS, AGENT. 1,332.44 0.00 0.00 0.00 1,332.44 PLEASE ANR THE FOLLOVI~IG QUESTi~iS BY PLACING AN " liC" IN THE APPRdtATE BLOCKS 1. Did decedent make a transfer and: Yes No a. re#sun the use or income of the property trar~sfemed :.......................................................................................... ^ b. retain the right to designate who shall use the property trerr+ed or its income : ............................................ ^ c. retain a reversionary iryterest; or .......................................................................................................................... ^ d. receive the peonies for like of either paytnerrts, benefits or care? ...................................................................... ^ 2. ff death oaxxred after Dec. 12, 1982, dki decedent transfer property whin one year of death witlxxd receiving adequate consideratiion? .............................................................................................................. ^ 3. Did decedent own an "in frost for" or payable-upon~eath bank account or security at his or her death? .............. ^ 4. Did decedent own an indhridual retirement account, annuity or other non-probate property, wl~ch contains a benefiaary designaation? ........................................................................................................................ ~ ^ IF TF~ ~R TO itiriY OF TIC i~ t~lENS IS YES, YOU Mt~ST C4MP1.~1'E SGH~ltSE O i ~E ~ ~ OF T~ i'RN. For dates of death on or aftierr July 1,1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of fire surviving spouse is 3 pen±ent (72 P.S. §9116 (a) (1.1) C)l• For dates of death on or after Jan. 1, 1995, tl~ tax rate on the net vale of bansfers to or for the use of the suuvivir~g spouse is 0 percent [72 P.S. ~911t3 (a) (1.1j (~}l. The statute dos rat exempt a transfer to a surviving spaase from tax, and the statlrtory requirem~-ts for disclosure of and filing a tax rettxn 8re stfil tie even if the surviving spouse is the only benefiaary. For dates of dsatt- on or after July 1,2000: • The tax rate wed on the net value of transfers from a deceased child 21 years of age or younger at death a or for the use of a nat~ual parent, an adoptive pant or a steppar+e~nt of the child is 0 pendent [72 P.S. §9118(a)~1.2)j. • The tax rate imposed on the net value of transfers to or for the use of the decedents lineal beneficiaries is 4.5 percent, except ~ rested in 72 P.S. §9116(1.2) p2 P.S. §9116(a)(1)]. • The tax rate imposed on the net value of transfers to or for the use of the deoed~ts ' gs a~ 12 pent [72 P.S. §9116(a)(1.3)}. A sibling is defined, under Section 9102, as an ir~rridual who has at least one parent in common with the decedent~~ wihether by blood or adop~on. REV-1502 EX+ (11-08) If more space is needed, insert additional sneers of the same size. RE~1503 EX+ (6-98) CoMMON~-~TH ~ i~NNSnVANa STOCKS & BONDS INHERITANCE TAX RETURN F8lSiOENT DECEDENT ESTATE OF FN.E ~ Jacqueline M. Deeds 21-10-0131 -. _ __ !U1 P~PKh- ~oblt~osn~sd t~ ri0ht of sWrW~rorship mwt be di~doMd inn F. ITEM VALID AT DATE (Ii more tpsce it needed, ~uert addilionai atwett of Ihs cams. tine) ^ REV 1507 EX+ (8-96) coMUloNw~Tw of P~NNSYwANw MCIRTGAG'ES 8c NOTES INHEf~TANC7E TAX RETURN ~E~ RESIDENT DECIA~NT ESTATE QF FN.E NtJ Jacqueline ~, Deeds 21-01-0131 Aa p la~Y~«I with ~t of euwhrotshtp mutt be dMt~oeed on F. AT DATE (If more apace b needed, I~t addiNonai ehee~ of the Dante site) REV 1506 EX+ (6-96) CAMMf3NWEALTH 01~ PENN6YLVANIA INHERITANCE t~UC RETURN RE8IDENT DFEEDENT ~~~ CASM, BANK D~pC~tTS, & MISC. ~~ ESTATE OF F11E ~ J~~ ~, Deeds. 21-10-0131 - k~ciude ~+e prnoeedsa of Mtipahon end me drltethe pnooeeds were t'eeeitNd b!i tpe aet#b. Atl prol~!- with right of slwrrfMO~ip mint be dlild0Md o>A F. AT DATE TOTAL (Aho enter on ~e 5, Recapituledon) i O.Oa (tf mor+e spsa is needed, Msert sddt~arnd •heeta of the s~ fie) REV 1737-b EX + (5-06) pY{vana s~ct~~u~t E, ~ DEPARTMENT OF REVENUE ~~~~~~~~~ ~~~~~~. INHEttTANCE TAX FIFTIIRN NOf 015CEN~EWT ESTATE ~ fFN.E NUMi!{SR Jacqueline M. Deeds 21-14-0131 Part 1 must ~ jetty-owned real estate and t~+gibte P located in Pennsyivanla. r Part ~. on nw~ae sidei to ine~wda all ' ~ ibeid whe~wwr ioe~rd 41N,.~!' the proporltofaM nr~~~~ hoc ion ~t aiectrd. M an aasrt w ~M one ywr o! tihe,d~ede~s drMs of dr~th~ K moot !~ rid on 4. A.' SURVIIIINQ JOINT TENANTS) NAIi+E Cynthia A. Strini 8. _ _ __ C. ~~• ~ REUITIONSHIP TO DECEt~ENT REM ~ FOR JOINT l'lJ1TE DESCRIPTION aF PROPERTY MADE DATE Of DEATH ~' ~ DECDS u~rc ur~ urw~~n VALUE OF NUMBER TENANT JbI~R Attach dyed for red eetsoe. VAt.1,lE OF A$~Ef IN1'Ei~ST DECEDENT'S 1. A. " ............... ....... a CamputerShare, #00000637113, 450.67 Stns Verizon ~ 528.90 g 13,024 36 ~ 5096 ~ '' 6, 512.18 ......, ~:.. 2. A BNYMeIbn, JACQZ0100, $.15 shrs Fairpk>irtt Cottnrwn, Inc. Q 50.40 ..,,. , ,.., ., ,.~,w ,„_ .............t g 3.26 ,:` 50°k 1.63 3.: ; A s..,._,,._~.,w.~. ,_._..~.,,__.,..,,,,,,,._,,,..._„_,~,__,...,.,_,..~,.,...~ ... . ........ ....... .... . Ortstown Bank, Checking Account #149000289 .... ~, _ 10,741.57 ' ,._ ~ 5096 : 5,370.79 ; - <v~ ~ £F>ZtFftA ~t, t~Q£t ~,N~FF~'&`.tkE.,: ifitkkf£!Ki ~.~L.. ? :F , x, ,.F ; r. F 3 t ~. y. .,. ..,.. ... e .... .. .... ... ~ j x 5 S . ... F F ;:. . .~.. ...:,.,..~ ..... .. ..:...... ...... .. ... .. F ;F ~ ,. «. .... ,.. ~ ,..... ... .. , , Pr rtbnate Method On (From reverse side.) .:f~£;s ~~~ ~~; TO TAL (Also enter on Line 6, Reca pitulation.) ,, • ~'11'~'~ (if more spstce is needed, use additional sheets of paper of the same siz®) REV 1737-6 EX + (8.08) Penr~Ylti~a DEPARTMENT Of REVENUE INF113tITANt~ TAX RETURN NDtt{~EWT DECEDENT ~CN~q~! ~~~,~~~ ,~~ ~ Use Schedule G, Part 2, ONLY for ~~. ~ proportionate method of tau computation. _- _- ESTATE OF ialLE NUR Jacqueline M. Duds 21-10-0131 Part 1 must Include ail transfiers of real es#ete and #Engible personal property located in Penr~yhrania. Co»I~-M4e Part 2 ONLY whin >~ prop~ortt m~thad of tax comp~ation is elected. Include in the desr~iption of p~ropsrty the date the transfer. w-as made and the name and relatlortshiip of the transfieree. This schedule must be P artd'f~d if the at~tywer ~o questfar~ ,1 thr 4 on the _y _~. g side of the, RE1l--1737 cover sheet is yes. ,, revIM~ ITEM DE9CRIt~T10N OF RROPEFCf'Y Include the Heine of the t~dine, tht nledorahip b Deceder~ and the date of trader. DATE OF DEATH % OF DECD'S EXCLUSION NUS Altach a of the deed br net estate. VALUE 4F ASSET INTEREST I!` SiiF~#:fi.'{£f3.its3,~#£, .: i ... i E `3fiiF;Ck ....._. .._:~~ .,..... z4 1 First National Bank, Act X5968282, Tr~litionai IRA E 8,548.00 % <~s. 100E :~ 0.00 ~ComputeErShare tfb00003250857, 32.92 Shrs AT8~T ~ $25.93 ~ 853.62 ` 50°i6 426.81 ComputerShare 11pC2008758096, 30 Shrs AT8~T ~ $25.93 . : 777.90 5096;:: ... _ 388.95 ., ..~... Y. CompufierShare dC3001544836, 1066.93 Shr ATBT~ $25.93 k .: ~ 27,665.50 ' r 5096 13,832.75 . :.........: 'CartputerShare #000032250849, 468.65 Shr AT8~T (~ $25.93 12,152.09 5096: 6,076.05 ..:.:.,. (AII ATBT Stock transten~ed on January 27, 2009) ....:.. :...~ IRA 248F 0 ~~ ,, ... 12 84400E .., ..,. . 100; , 1 :American General life #A36 , I (K more space is neec~d, use additional sheets of paper oif the same size) 42,116.56 .F ~ .F;~..~~.~~.,~ , Name(s) ~ Perea~al Reproantafiv~a~ ...... ............:.........:... _.,. _ ......... .,......: ...,. .,:...:.. ....... , , ............... (Snbn~it nequ~ted infomatlon for additloned personal repreaer~ive's on add~fonal aheeta) Social Securky ~bnr~ber(s) a EIN Nwnber(s) of Peraatal Repreaentadve(a~.........:....... _ _. Sb+eet Addreas(e:)~.,.,,., ....... :.:. .... _ .. , ...:...::, __ ._ ........, . _ ........:. .., Cityr(lea) ,.. ... ..:... { Stafe(s~_ _ _. !ZIP(') ' __ Year(s) Commia~on Paid ......... :...... . :...,.. ... ,...,. , .. : _ .... ........: ::.. ,. _ ....... .. _ ..._ ,....., 2. Atfaasy Fees 2, 700.00 '! 3. Proba6s Fees 112.50 4• axou~'s Fees 200.00 TOTAL (Abo enter on Line 9, Recapltuta#ion.) ; 5,206.48 (If more space is needed, use additional sheets of paper of the same size) RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Sqquuare Carlisle, PA 17Q13 DEEDS JACQUELINE M Receipt Date: 2/11/2010 Receipt Time: 15:10:51 Receipt No.: 1059978 Estate File No.: 2010-00131 Paid By Remarks: C A STINI JN ----------------------- - Receipt Distribution -------------------- ---- Fee/Tax Description Payment Amount Payee Name PETITION LTRS ADM 60.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 24.Q0 CUMB RLAND COUNTY GENERAL FUN AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D Check# 1020 ---------------- $112.50 Total Received......... $112.50 ~j~~ AUER CREMATTON SERVICES OF PENNSYL~i1NIA, INC. 4100 Jonestown Road • Harrisburg, PA 17109 • 1-800-720-8221 • Fax 717-541-9943 • Shawn E. Carper, Supervisor O ~ , p YA ' ,~ ~~ oct is, 2009 -. . - Ms. Cynthia A. Strini -~ 806 Division Street ~~ Grantham, PA 17027 ~..~ = ~ ~ ~' .. .. Jacquelin® M. Deeds - ;. r .. Deceased~.~.. ; SPECIAL -CHARGES ~ ~ T - ~~ ~~~ . = .. - - X Direct Cremation $1,495.00 Nationwide Guarantee Program Worldwide Travel Protection Program '- T{?TAL SPECIAL CHARGES ;, $1,495.00 PROFESSIONAL SERVICES X Services of Funeral .Di.rector & Staff Included Dressing/Cosmetizing - P'aci 1 sties & Staff fox Memorial Servi..ce :. Staff & Eciu i pment fo.r Memor i a 1 Service Private ID Family Viewing :, Witnessing the Cremation Paekag i ng/Forwarding of Cremated Recta i ns _ _ ~. Personal Delivery~of Cremated Remains Scattering of Crtemated Remains - .. TOTAL PROFESS30NAL SERVICES _ . ~ ,, . $0.00 AUTOMOTIVE EQUIPMfENT X Remove 1 Veh~i c•1 e ~ Inc 1 uded Lead Car/Clergy Car Family Car Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT $0.00 M~RCxA~DISE . Register Book X Memorial Cards 100 @ $55.00 6~ Tax $3.3Q Thank You Cards , Remembrance Package Aiternatiue Container X Angel Urn Urn Burial Vault Container Veterans Flag Case Graue/Memorial Marker X Personalization TOTAL MERCHANDISE CASH ADVAi~1CED ITEMS Grave Opining Cemetery Equipment X Greensburg Tribune Review Newspaper Notice Newspaper Notice Clergy Church/Sexton/Organist/Soloist F 1 aw~er s : _ X Crematory Charge X County Coroner Fee X 20 Certified Copies of Death Certificate $58.30- $165.00 $100.00 $323.30 .. Included $25.00 $120.00 TOTAL CASH ADVANCED ITEMS. ~ .. _.$145.00 CHARGES SUMMARY OF Special Charges ~ $1,495..00 .- Professional Services $0.00 Automotive Equipmen.t~ _ $0.00 ~ - Merchandise $323.30 _._ Cash Advanced Items $1.45..00. SUB TOTAL ~ ~ '$1,963.30 CREDITS ~ ~ $ 0.0(~ AMOUNT PREPAID Date ~ -$0.00 ~~ ~ . TOTAL $1,963.30 AMOUNT PAID Date Oct 18, 2009 -$1,963.30 BALANCE DUE -$0.00 . THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER~CHARGES REV-1512 EX+ (12-08) Jacqueline M. [)serfs 21-10-0131 ,~ Repat debts inarrrrfi b1- tha daaedaat prbr to da~th that rem~sd u~id at the data e~ dMth, Md~a! vnruraed medical mcpe~a. TTCV t/11 ~~!'. 1T ~~Tr r~ylvan~a SCHEDULE I DEPARTMENT OF REVENUE $~ OF ~ INHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS RESIDENT ClECEdENT ESTATE OF FILE t~llR 1 • _ East Pennst~oro Township 51.99 2 ''Pinnacle Health 91.00 ': 3 ;Todd Pelleschi, Pactietrist? 14.92 4 :Pinnacle Health 96.63 S ;Smith RaC~ology 1.78 6 Richard Pacaynski, MD 29.89 7. Cardidogy Diagnostic, LLC 3.54 8 Pulmonary 8 Critical Cane Medical Assoclates, PC 96.29 9.. :PRISM 25.40 10 Caniiovascular Sun~c~il Institute _ _ 6.91 11 Hershey Kidney Speclalists, Inc. 50.01 12 Moyle X-Ray Imaging, Inc. 5.34 13.: Int~ernists of Centre PA 153.16 '; 14 ;Cynthia A. Strini, Loan 16,308.12 15.' `:Michael Cherewka, Esq. 250.00 TOTAL (Also enter on Une 10, Recapitulation) $ 19,184.98 `` If more space is needed, insert additional sheets of the same size. Law Offics~ of Michael Cherewka 6241Vortlt Front Street Wormleysbur~, Pennsl-lvania 17043 (717) 232-4701 Fax (717 232-4774 July 15, 2010 Register of Wills Cumberland County Courthouse ,~ ~~ ~' 1 Courthouse Square rte... , ~ > ~•~..! Carlisle, PA 1?013 ~ r-~~~{ ~. ~ f RE: Estate of Jacqueline M. Deeds ~. ~= Y -- ~ ;~„ Our File No. 2893.00 ~ cn ~~' ,. Enclosed please find REV 1500, Inheritance Tax Return for Resident Decedent and Inventory. Enclosed you will also find an Estate check in the amount of $1,332.44 made payable to "Register of Wills, Agent" to cover the tax dwe and our check in the amount of $30.00 to cover the cost of filing the Inventory and the Return. If you have any questions, please call the undersigned. Thank you for your consideration in this matter. Very truly yours, `~m Michael Cherewka~`' MC/ll Enclosures