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Home My WebLink About12-01-1011/29/2010 10:59 717-243-1850 MARTSON LAW PAGE 02/02 150sbD7]r21 REV-1500 Ex to~o5) OF~LUSr oNLr PA DaparOr~ant of RIIYariua t)ueUeu wtnaMaud TAt~ Cormgr cow Yiw Fide lumbar tfiIHERITANCE TAX RETURN ~ 1 1 a 0 6 5 0 ~ f7rzs-oeOZ RESIDENT DECE ENTER DBtM:DENT w~aaB~eltorl IaEt.aw SoOgd security Number OeN of Death Cato o! Birth b `1 1 4 6 0 3 3 0 0 3 D 3~ 0 3 0 0 5 2 ~~ 9 5 S Deoedent'a Last Name suRtx Decedent's Rust Name MI M O R O N E S M I T Z I A (~ Applleabh) F,Nter surviving Spousars IrrtormaHon Below Spouaeb bait Name 6uRix 6pouseb Flret Name MI Spouse's soohl 5eoulfly Number THf$ RETURN MU8T PE FILED IN DUPLICATt? WIT~1 THE REGISTER OF VNILLS RILL iN APPRI)PIIIATE t7-VAl.si1 BBLl7'W ® 1.OripLlal Return Q 2. supplertrental Rahxn ~ S. Remainder Rrpt~m (date of death prior to 1 Z 13rs } 4,, Limited Estate ~ 4a. Fui4re Interest COmproRUs• (date of ~ 5. Federal Eatetll ~'ax Rehm Requlrod deetlt slier 12.12.82y 8. Oeoedont Dbd Tesbta ~ 7. Deaedenl Malntainsd a Llvinp Trust ~ t). Total Numtrar', of 8aie Deposit boxes (Attach Copy of 4ViU) (Atteoh Gapy d Trust) [~ 9. Litlpegon Pnooesds Received ~ 10.8pousal Poverty Crodlt (date Ot doath [~ 11. !?t'adon to tic ndar Sea 9713(A) t~oMieen 1231-91 and 1.1.05) (Attaofl Soh. P) CORRItiPONDENT - TIpS t;[CrION AN1ST EE COMPLETER ALL COR1lYrONDV:NCEAND CONFbtglf RAl TAX EVFORNATyON 9I< DllfiECTED 70: Name Daytime Telepflcxre S E r H T M O S E B E Y 7 1 7 2 4,3 3 3 4 1 __ w Firm Name (If AppNcatrle) ~ ~ ~ RE61t7ta VeE t71~ fl A R T S O N L A W O F F I C E S ~ v ~'~ Flrst lire! Qf addrosa ~ n 1 0 E A S T H I G H S T R E E T I ~ r'-' _, '~ second Gne or address i cc~~ ~ _ city or Post OMibe state ZIP Code I . _ ._..._.. ??! W :. ~._.. rs-r C A R L I S L E P A 1 7 0 1 3 ~ ~~~ 1Ntl! 1 1505607I~1 ~,5D56071~~ J 1505607221 REV-1500 EX Decedent's Sobial Security Number Des~edsnYs Name: M I T Z I A• M O R O N E S 1 9 1 4 6 0 3 3 0 RECAPrruLAnoN 1. Real estate (Schedule A) . . ... . . . . ............................... 1. 2. Stocks and Bonds (Schedule B) ............. 2 ..................... . 3. Closely Held Corporatlon, Partnership or Sole-Proprietorship (Schedule C ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............. 4 ........... . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. !~ 9 9 4 . 0 3 6. Jointly Owned Property (Sd~edule F) ^ Separate Billing Requested ...... 6. • 7. . Inter-Vivos Transfers & Miscellaneous N rotate Pn~perty (Schedule G) Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-T) ........................... 8. ~ 9 9 4 _ a 3 9. Funeral Expenses 8 Administratlve Costs (Schedule H) 10. Debts of Decedent, Mortgage Uabilitles, & Liens (Schedule I) 11 Totet Deductions (total Lines 9 & 10 ................ s. X 8 7 2. 3 3 ............ 10. 6 2 5 9. 3 2 • ) ........................... 11. 1 ~+ 1 3 1. 6 5 12. Net Value of Estate (Line 8 minus Line 11) ........................ 12. - ~ ' 1 3 7 6 2 . 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) ...... ........... 1a. - '~ 1 3 7. 6 2 TAX COMPUTATION - 3EE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Une 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Une 14 taxable at lineal ram X .0 _ 16 . 17. Amount of Line 14 taxable at sibling rate X .12 17. • 18. Amount of Une 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 Side 2 L 1505607221 1505607221 0 J REV-1500 6X Page 3 Decedent's Complete Address: MITZI A. MORONES STREETADDRESS 21 North Middleton Road CITY Carlisle Tax Payments and Credits: t. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applcable D, Ir-te-est E. Penalty File Number 21 10 0650 ---- STATE ~ Zip PA 17013 (i) Total Credits (A+ 8+ C) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the dNference. This is the OVERPA 17NENT.T ~~ 1~~~ (D + E) (3) Flll M oral on Page ~ LMs ZO to rrquast a refund. (4) 5. !f Line 1 + Une 3 is greater than Line 2, enter the difference, This is the TAX DUE (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE (~) Make Check Payable to: REGISTER OF WILLS ~I GENT N "~ F ~ ,. ~ ,,' -~; '~,. ~ ~# > .; '~~ 'art ~' z:~i'; ~. aE ' PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRgF~R1ATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : .................. ........................... O ......................... b. retain the right b designate who shall use the property transferred or its income; ............................... c. retain a reversionary interest,' or ................................................................................................ d.. receive the promise for!rfe of either payrnerrts, benefits or care? ....................................................... 2. !f death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................................................................................... ~ a 3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? QX Did decedent own an Individual Retirement Account annuity, or other non probate property which contains a beneficiary designation? .................................................................................................. IF THE ANSWER TO AMY OF THE ABOVE QUESTIONS 1S YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT dSl PART OF THE RETURN. >, ,.,_,,,.s. .. , For dates Of death On Of a/fef July 1, 1994 and before January 1, 1995, the tax rate imposed On the net value`~7 FFof transfers to or fur the use of the surviving spouse is three (3) peroent (72 P.S. §9116 (a) (1.1) (i)J. 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. §9118 (a) (1.1) (ii)). The statute does not exerrmt a transfer to a surviving spouse hom tax, and the statutory requirements for disdas~re of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates ofdeath on orafl`erJuly 1, 2000: The tax rate imposed on the net value of frensfers from a deceased child twenty-0r-e years of age or younger at death to or for the use of a nature! parent, an adopfi-re parent or a stepparent of the ch!!d is zero (0) percent (72 P.S. §9118(8)(1.2) j The tax rate imposed on the net value of transfers b or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, a*cApt as noted in 72 P.S. §9116(1.2) (72 P.S. §9118(x)(1)). The tax rate imposed on the net value of transfers b or for the use of the decedent's siblings is twelve (12) percent (72 P.S. §9116(a)(1.3)). A sUbling is defined, under Section 9102, as an individual who has at least one parerrt in common with the decedent whether by blood or adoption, REV-1508 ~(+ (8-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8 MISC. 'N RESIDENT DECEDENTRN PERSONAL PROPERTY RLE NUABER MITZI A. MORONES 21 10 0650 Indude d-e F ollilig~ion and fhe date the proceeds ware received by the estate. ~P~P1/hl~ ~d wttli rlphtofsurvhrorshlp m~ntM dlscfosad on ScMduN F. ITEM NUMBER DESCR1PT10N VALUE AT DATE 1. State Farm Insurance, refund of premium OF DEATH 37.15 2• (Metro Bank checking 10752327 3• HM Life Insurance, refund of Critical Illness Coverage 4• Trustmark Insurance, refund of premium • 5 • Ahold Financial Services, vacation pay due of date of death 6• Ahold Financial USA, Inc. 401(k) Retirement Savings Plan, beneficiary Estate 7• (Hoffman-Roth Funeral Home, overpayment of funeral bill 8• American General Life Co., Certificiate 84608HOO1,Life Insurance, Estate beneficiary $10,000.00 9• 2003 Jeep Liberty, actual sale value (See attached) TOTAL (Also enter on line 5, RecapihdationJ ~ 3 (!f more apace ~ needed, hisert add~ional sheets of the same she) __ _ -- - - ._ __ - __.__ ~_ i 351.43 57.60 58.44 136.59 652.82 100.00 0.00 7, 600.00 03 REV-1511 EX + (10-08) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8 IN RES DENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF RLE NUA~ER MITZI A. MORONES 21 10 0650 Dells otdecedent must M reporMd on ScheduN I. rrEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: i. Hoffman-Roth Funeral Home, Carlisle, PA 5,845.83 B. ADMINISTRATIVE COSTS: 1 • Persona! Representative's Commissions Name of Personal Representatiu~e (s) Michelle Winters SUeetAddress 622 Woodland Avenue qry, Mt. Holly Sprints State PA up 17065 Year(s) Com-nlssior- Paid: 2011 p, AttomeyFees MARTSON LAW OFFICES 3. Family Exemption: (lf decedent's address is rat the scone as dainaM's, Mach explanation) Garment SfreetAddress ~Y State Zip Relationship of galmant to Decedent 4• probate Foes Cumberland County Register of Wills 5 Accountant's l=ees 6. Tax Retum Prepare-'s Fees 7. Register of Wills, filing fee, Inheriatance Tax Return 8. Additional Probate Fee 400.00 2,700.00 53.50 15.00 25.00 TOTAL (Also enter on line 9, RecaprtulatiorrJ I S (Nnare space ~ --eeded, ~-se-t eddltlwla-el sheets ofthe same sae) 33 - ~_. REV-1512 EX + (12-03) SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, IN RESIDENT DECEDENTRN MORTGAGE UABIUTIES, $ UENS ESTATE OF FILE NUAIBEER MITZI A. MORONES 21 10 0650' Report da6ts Mcumad by the dacadant prior to death whkh rrmaMed unpdd as of the dah of death, fndudbtg un»b~rspd medical expenses. ITEM NUMBER DESCR1PT10N VAOF DEA~HTE 1. Carlisle Regional Medical Center, accounts payable 550.00 2• Robert J. Beaudry, Jr., DMD, account payable 74.00 3. Consumer Portfolio Services, Inc., remaining balance due on account #0012245817, after sale bf 2,718.24 vehicle (see attached) 4• Department of Veterans Affairs, account payable for medical services 2,190.61 5. (Holy Spirit Hospital, account payable I 250.00 6. (Fredrick & Fair, account payable I 114.47 7• Carlisle HMA Physicial Management, account payable 40.00 8• The History Channel Club, balance due account #80072757 318.00 9. Metro Bank, service charge 4.00 TOTAL (Also enter on line 10, Recaprtu/etiorl) ' S 6 259.32 (Nr-pre space h needed, Insert addlUonal sheets of the same she) Sep. 21. 2010 4:O1PM No, 1112 P, 8 Consumer Portfolio 6ervices, Inc. asst lReoorery bapartmeat P.O. Box 57071 Irviaa, California 92619-7071 t Date: 06/17/10 To: Re: MTTZI MORON>rS 622 WOObLAND AVE MT HOLLY SPGS, PA 1706s Accoubt Number: 0012245817 Vehicle: ~ ~ 03 JEEP LIBERTY ' VIN #: 1J4GL48K53W700966 CAT<.C~ATYON OF S~LU'S OYt D~FICYENCY 1. Amonnt'Yoa Owe Ua ..-...w~-~-------------- (including interest, other fees, and ar~y other am0ur~tl added to your debt, as allowed by law) Sg,840.74 2. Sde Prlee of Copaterai ~.~'~'"""'- - _ 5,600.00 3. ---- "--__ ------- " " Unpaid Amoant - -____-------_--.-__w_~...,..-..... $240.74 4. ~ ..........................................._. Total igxpesses -- - -------------------- - ..............- S477.30 s. -- ------------------w------------~-- Toolcram / Rebates •--~---._..~..... sa.0o 6. Amewut of Sat'plw - ------ Thia is the amol2nL we owe you. Sd.00 --- 7. Anoouat of bellcleticy Thl81a the amOtitlL you OwC us. 52,718.24 Future debits, erodits, charges, including additional credit service chaLges or interest, rabatea, and oxpensles may affect the amotmt of the surplus or de5ciency. This balance is due and payable within tea days of the dau of this notice. If you are unable to pay the a6rpunt statod, ooataet our office for oLhar. arrangements. If you have any questions regarding this explsaatiom, you may call us aL 800-342-9243 or write us at P.~D,' Box $7071, Irviat, CA 92619-7071. Hanlauptcy Notice: This notice i9 not an attempt to collect a debt 8'om any baLih ugtcy petitioner, If ypu~ have Sled a bsalauptcy petttion that covers the vehicle desonbed above then your personal liability to pay ~r the vehicle, if any, will be determined in the banhuptcy proceeding. 'I'bis notioe relates to our eaforeemcaL of our lien ags~st the vehicle. zstmt JJ~D ¢.~5. Q~3 ~~ETRO B/~-MMC Metro Bank 3801 Paxton Street Harrisburg PA 17111-1418 1-888.937-0004 mymetrobank.tam -. 13125 6297249 001 092140 MITZI A MORONES PO BOX 1332 CARLISLE PA 17013 Weti+e hats 7 days a week, 24 hours a day at 1-888-937-0004. Fees Summary FUND8 AVAILABILITY: Check deposits made before 6 pm an available on the next business day, provided th k is not subject to a hold. Beginning Feb. 27, 2010, held Items will be delayed until the 2nd buslntass dry (pnvlously the 3th bass dry). Under certain circumstances, funds mry be held until thr 7th business dry (previously the 11th business day). Ybu wig be notMed M a hold Is placed on your funds for any reason. FEES 8~ CHAROEB: Cerpdn fees wig be revised as (otlows efhcdw April 1, 2010: Cash or De Cashbrr•s Chick - 18.00; ClosMg Account (90 Days) - No cha posk kem Retu~ep - i1y,00 per ibm; dwnesdc/i:fo 00 h rge; Closing Account-Mall Request - 540.00; Col e~tion INms - 520.00 Money Order - is.OO; WInnDT-a sh Domestic-0~gio ng ~ 5 0, 0~~~ - iS.00 per month; Dormant Account-8avin',gsl .53.00 per month; 3S Cyels ,~ / / NOTE :SEE REVERSE 31DE FOR IMPORTANT INFORMATIO /,~,~~ ~ page 1 of 2 ~ Member FDIC __ _ _ - _ _ _ _ _ __ ___ i __ ~, s a n Transactions By Date Tha Fees Summary above does not roflect any refunded or waived items credited to your,axount.