HomeMy WebLinkAbout07-21-10Spouse's Social Security Number
TH{S RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL INAPPROPRIATE OVALS BELOW
~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
~? 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 T0:
Name Daytime Telephone Number
:.Andrew C. Sheely, Esquire ' 717-697-7050
REGISTER WILLS USE ONhY
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Correspondent's a-mail address:andrewc.sheely@verizon.net
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Under penalties of perjury, 1 declare 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 OF ERSON RESPONSIBLE FOR FILING RETURN [~ATC
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Mary Ann arles, Errx., 90 Nittan Drive, Mechanicsburg, PA 17055
SIGNATU O PREPARER OTHEF7;~~HI~~RESF~JTATIVE
DAT%
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Andrew C. Sheely, Esquire, 1 So h Market Street, P.O. Box 95,Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056101,0], 15056],0],01
J
REV-1500 EX
1505610105
Decedent's Social Security Number
Decedent's Name: Kaminski, StaCia I. 18 4-12 -16 5 3
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 and Notes Receivable (Schedule D) ........................... 4.
5. Cash, Bank Deposits and Miscellaneous Persona! Property (Schedule E)....... 5. $19,064.72;
6. Jointly Owned Property (Schedule F) O Separate BiNing Requested ....... 6. $25,386.19'
7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property
....
(Schedule G} O Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1 through 7) ............................. 8. % $44,450.91=
9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. $8,409.40
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule f) .............. 10.
11. Total Deductions (total Lines 9 and 10) ................................. 11.
12. Net Value of Estate (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 CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers undo cec. 9116 _ _ _ _... __ _ _ _ .
(a)(1.2) X .0. 15.
16. Amount of Line 14 +~,.~ble ........... _.._... w,.. ._ ..... .... ................ .
at lineal rate X .045 $36,036.42 16 $1,621.63
17. Amount of Line 14 taxable
. .... , .r. __
at sibling rate X .12 17,
18. Amount of Line 14 taxable
at collateral rate X .15 1$.
19. TAX DUE ............................
.............................
19. $1,621.63;..
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
O
Side 2
150561U105 1505610105 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-10 - ~~ 4 8 8
DFrFnFNT'C NAAAF
Stacia I. Kaminski
i
g~sa~GT ennrccc -~-
801 North Hanover Street
IT\/
GCarlisle
sTAr PA zi 17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments _ _
S. Discount $81.08
3. Interest
4. 1f 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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
$1,621.63
$81.08
(3)
(~)
__ _ _ _
(5)
$1,540.55
Make check payable to: REGISTER OF WILLS, AGENT.
Y.µ., ~ ...~.. ~; ~,¢
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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? ...................................................................... ^
2. If death occurred after Dec. 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? X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE iT AS PART OF THE RETURN.
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For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is
3 percent [72 P.S. §9116 (a) (1.1) (i)j.
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 child 21 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 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 4.5 percent, except as noted in
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)J.
• The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. §9116(a)(1.3)j. 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.
Total Credits (A + B) (2)
REV-1508 EX+ (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stacia I. Kaminski 21-10-0488
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.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. M&T checking acct.# 9849838207 -Principal and accumulated interest $5,788.55
2. Wachovia Bank account #5111934 $7,420.66
3. Blue Cross refund $ 370.99
4. The Church of God Home, Inc. -refund $4,641.67
5. Pinnacle Health Emergency Services -refund $ 22.85
6. Decedent was a resident of the Church of God Home in Carlisle, PA and had no personal contents. $ 4.00
7. Pinnacle Health -refund $ 74.00
8. Social Security refund $ 746.00
TOTAL (Also enter on line 5, Recapitulation) $ I 19,064.72
(lf more space is needed, insert additional sheets of the same size)
Q M&T&~nk
499 Mitchell Road, Millsboro, DE ]9966 Mail Code DE-MB-12
Phone (888)502-4349
Fax (302)934-2955
May 13, 2010
Attorney Sheely
127 South Market St
PO Box 95
Mechanicsburg, PA 17055
Re: Estate of: Stacia Kaminski
Social Security: 184-12-1653
Date of Death: Mav 1, 2010
Dear Sir or Madam:
Per your inquiry, please be advised that at the time of death, the above-named decedent had on deposit vrith this bank the
following:
l . Type of Account Checking Account
Account Number 9849838207
Ownership (Names of) Stacia Kaminski
Opening Date 09/11/09
Balance on Date of Death $ 5788.52
Accrued Interest $ 0.03
Total . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ . . . . . . . . . .
$
2. Type of Account Savings Account
Account Number 15004194292840
Ownership NNames oj) Stacia Kaminski, joint-primary
Mary Ann Charles, joint-secondary
Opening Date 05/13196
Balance on Date of Death $ 50770.90
Accrued Interest $ 1.49
Total $ 50772.39
Please be advised, there was no safe deposit box fo und for the above decedent.
* If upon reviewing the information above, you believe there are additional accounts not referenced, please provide
us with an account number and/or name of any possible joint account holder. For any additional information on the
above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact
our Mechanicsburg branch call#~ i ~-sao-3~ao.
Sincerely,
.,
~~ ~~~
No issa Sears,
Adjustment Services
THE ESTATE OF STACIA KAMINSKI
90 NITTANY DR
MECHANICSBURG PA 17055-5591
PAiC BAMK, NA ~~i~~~~~i~~~~~~r~~~~~r~~~~s~~~~~~~~~~~~~~~i~~~~r~i~~~~~~~i~~~~
IEANNEITE, PA >,
H ITAL SER C ASSOCIATION
of North s Pennsylvania
Authorized Signatu
li'000 2 L 3? 3 ?11' ~.0 4 3 30 L 6 2 ?~: L00 2 4 20 9 5 L11'
Detach stub before presenting to bank RETAIN FOR YOUR RECORD5 000213737
~. B1ueCross
~•~ of Northeastern. Pennsylvania
~ndea~ae~t ~.~ensee of tnB ex~e t;roae e~ro e~,e shwa a~snon
~ishred Made of the elua does ane Blue shy Aeeods~on
19 North Main Street
Winces-Sarre PA. 18711
THE ESTATE OF STACIA KAMINSKI
90 NITTANY DR
MECHANICSBURG PA 17055-5591
CHECK NO. ~; ~ ~,~'~ ~ ~~,,,, ~~ ;~°~B , w~ ~~~
REFUND
05/13/2010
AGREEIIa11ENTlGROUP NUMBER
103147109001A
PAYMENT DATE
Refund Period ~
From To Reason Amount
05/02/2010 07/01/2010 03 370.99
EXPLANAT[ON OF REFUND
CANCELLED DECEASED
00016
REMARKS:
THE CHURCH OF GOD HOME, INC.
17650
OUR REF. NO. YOUR INVOICE NO. INVOICE DATE INVOICE AMOUNT AMOUNT PAID DISCOUNT TAKEN NET CHECK AMOUNT
013269 REFUND 4/30/201 4,641.6 4,641.6 0.00 4,691.67
.______., _,_...___.____..__ _~ _M
._.._.._.~_...____~_.._~._..__ _._ __~.__.____.__--.-._.,~.._.___._____._._ ~.v..___..___._~.___~._.._________________. ___~_..__.___ _._.___~__._.__~_,__.__.____..__._._.__.._.
17650
~~`~ THE CHURCH OF GOD HOME, INC. Q~Tp~$~g 60-].503-313
H 801 N. HANOVER ST. ~ 73ndiao,a ofd
OF GOD CARLISLE, PA 17013 CHECK DATE CONTROL NO. AMOUNT
(717) 249-5322
'Cgq/rlttlpd b Grb,~'
5/10/2010 017650
PAY Four Thousand Si~> Hundred Forty-One and 67/100------------------------- U.S.
~C
O
$~~*****4, 641. 67
g
Dollars ~
TO THE ESTATE OF STACIA KAMINSKI
ORDER
OF
T1N0 NATURES REQUIRED ,~VER $3000.00 n
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AUTHORIZED S1 TURE
II.O L?65011" x:03 L3 L5036~: L06 L L05 L91t'
REV-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDt~ILE F
JOINTLY OWNED PROPERTY
ESTATE OF FILE NUMBER
Stacia I. Kaminski 21-10-0488
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. 5/13/96 M&T Bank -Saving acct.#15004194292840, Principal and accumulated $50,772.39 .50% $25,386.19
interest
TOTAL (Also enter on line 6, Recapitulation) I $ $25,386.19
(If more space is needed, insert additional sheets of the same size)
If an asset was made joint within one year of the decedent's date of death. it must be reported on Schedule G
REV-1.511 EX+ (1.0-09)
~ pennsylvan~a
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF
Stacia I. Kaminski
Decedent's debts must be reported on Schedule I.
FILE NUMBER
21-10-0488
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' Piszczek-Desiderio Funeral Home $6, 010.00
2~ St. Casmir's Cemetary $ 725.00
3. All Saints Parish -funeral service h $150.00
a. ~ Headstone engraving I $110.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: $ 0.00
Name(s) of Personal Representative(s) Mary Ann Charles
Street Address 90 Nittany Drive
city _Mechanicsburg ^ state PA ZIP 17055
Year(s) Commission Paid:
$650.00
2. Attorney Fees: AridreW C. Sheely, Esquire, as per agreement
3. Family 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
4. Probate Fees: $145.00
5. Accountant Fees:
6. Tax Return Preparer Fees:
~. Filing Fees $ 15.00
$~ Misc. postage $ 4.40
s. Reserves to conclude Estate administration $600.00
TOTAL (Also enter on Line 9, Recapitulation) ~ ~ 8,409.40
If more space is needed, use additional sheets of paper of the same size.
Page 1
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MARY ANN CHARLES
90 NITTANY DR. 717-b9'1-181a
MECNANICSBURG, PA 17055-5591
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RECEIPT FOR PAYMENT
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Sc~care
Carlisle, PA 17613
KAMINSKI STACIA I
Estate File No. 2010-00488
Receipt Date: 5/11/2010
Receipt Time: 13:03:13
Receipt No.: 1061072
Paid By Remarks: MARY ANN CHARLES
SAP
----------------------- - Receipt Distrib ution ------ -------- -----___ ___
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 90.00 CUMBERLAND COUNTY GENERAL FUN
WILL 15.00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23.50 BUREAU OF RECEIPT~~ & CNTR M.D
AUTOMATION FEE 5.00
---
- CUMBERLAND COUNTY GENERAL FUN
Check# 4422 ----------
--
$145.50
Total Received......... $145.50
REV-].512 EX+ (1.2-08)
~ enns lvania SCHEDULE I
DEPARTMENT OF REVENUE
p y DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF
Stacia I. Kaminski
FILE NUMBER
21-10-0488
Rpnert 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.
REV-1513 EX+ (9-00)
SCl~IEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Stacia I. Kaminski 21-10-0488
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 Ann Charles, 90 Nittany Drive, Mechanicsburg, PA 17055 Daughter 100% of Rest, Residue
R RamainrlPr
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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
OF
STACIA I. KAMINSKI
I, STACIA I. KAMINSKI, of 90 Nittany Drive, Mechanicsburg,
(Lipper Allen. Township), Cumberland County, Pennsylvania, make, publish and
declare this as and for my Last Will and Testament, hereby revoking all other
mills and Codicils heretofore made by me.
FIRST: I direct that all inheritance, estate, transfer, succession and
death taxes, as well as my just debts and funeral expenses, of any kind
~~-hatsoever, which may be payable by reason of my death, shall be paid out of the
principal of my estate as the same can conveniently be done.
SECOND: I give, devise and. bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate, including any
property over which I hold power of appointment and together with an.y insurance
policies thereon, unto my daughter, MARY ANN CHARLES, of Mechanicsburg,
Pennsylvania, provided she survives me by thirty (30) days.
THIRD: Should MARY ANN CHARLES predecease me or die on or
before the thirty-first (31st) day following my death, I give, devise and bequeath all the
~~~:-st, ~~~~~i~i~~~: and remainder of my estai~ of whatever nature arld where~~~er situate,
including any property over which I hold power of appointment and together with any
insurance policies thereon, unto my son-in-law, EDWIN K. CHARLES, of
Mechanicsburg, Pennsylvania, per stirpes.
FOURTH: In addition to all powers granted to them by law and by other
provisions of this Will, I give the fiduciaries acting hereunder the following powers,
applicable to all property, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease, for any period of tune,
any real or personal property and to give options for sales, exchanges ar leases, for
such prices and upon such terms (including credit, with or without security ;I or
conditions as are deemed proper. This includes the power to give legally sufficient
instruments for transfer of the property and to receive the proceeds of any disposition.
(B) To partition, subdivide, or improve real estate and to enter into
agreements concerning the partition, subdivision, improvement, zoning or management
of real estate and to impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to abandon any
property which is of little or no value.
(D) To invest in all forms of property, including stocks, common trust.
funds and mortgage investment funds, without restriction to investments authorized ft~~-
Pennsylvania f duciaries, as are deemed proper, without regard to any ~~~ril~~ciple of
diversification, risk or productivity.
(E} To exercise any option, right or privilege granted in insurance policies
or in other investments.
(F j To exercise any election or privilege given by the Federal and other
t~~x la~~~s, including, but not necessarily being limited to, personal income, gift and
estate or inheritance tax laws.
(!Cl j To make distributions to my herein named beneficiaries in cash or in
kind or partly in each.
(H) To borrow money from themselves or others in order to pay debts,
taxes, or estate or trust administration expenses, to protect or improve any property
held under my will, and for investment purposes.
(I) To select a mode of payment under any qualified retirement plan
(pension plan, profit sharing plan, employee stock ownership plan, or arty other type of
qualified plan j to the extent provided for by the plan or the law.
FIFTH: I nominate and appoint MARY ANN CHARLES, Executrix, of
this, my Last Will and Testament. In the event of the death, resignation or inability to
serve for any reason whatsoever of MARY ANN CHARLES, I nominate and appoint
EDWIN K. CHARLES, Executor, of this, my Last Will and Testament. I direct that
~~~}~ Executrix or Executor, as the case may be, shall not be required to post security or
a bond for the performance of their duties in any ,jurisdiction.
IN V~~'ITNESS VII-~IEREOF, I have hereunto set my hand and seal to this, my
I_,ast VG'ill ~~i1d Testament, this ~-~ ~ day of 1Vlarch, 2008.
~~ ~ ,
~. (SEAL)
STACIA L KAMINSKI
Signed, sealed, published and declared by the above-named Testatrix as and #~~r
her Fast Will and Testament in our presence, who, at her request, in her presence and
in the presence of each other, have hereunto subscribed our names as attesting
~~"1tneSSeS.
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