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Home My WebLink About11-29-10 -~ REV-1500 ~`(°'-10) 1505610143 PA De artment of Revenue OFFICIAL USE ONLY p Pennsylvania coumy coos veer File Number Bureau of Individual Taxes DEIMnrEM OI aEKNU[ PO 80X.280601 INHERITANCE TAX RETURN 2 1 10 0 3 4 5 Harrisburg, PA 1712&0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Binh 058 30 7400 03 05 2010 11 Ol 1926 Decedent's Last Name ANDRIUTSA (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name ANDRIUTSA Suffix Decedent's First Name MI DIMITRI Buffet Spouse's First Name MI PAULINE E Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death pnorto 12-13-82) ^ 4. Limited Estate ^ 4a. Fusxe Inrerect Compromise ^ 5. Federal Estate Tax Return Required (data of death after 12-12-82) 1 ® g, Decedent wed Testate ^ ~ Decedent Malydakxtl a Living Tnust B. Total Number of Safe DeposR Boxes (Attach Copy of WNQ (Attach Copy of Trust) ^ 9. Lrogation Proceeds Received ^ 10. spowal Poverty credn (date a death t ~, Election t0 tax under Sec. 9113(A) between 1231 91 and i-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 CRAIG A DIEHL ESQUIRE CPA 717 763 7613p ., ;, First line of address 3464 TRINDLE ROAD Second line of address City or Post Office CAMP HILL Correspondent's e-mail address: C d l e h l State ZIP Cod C'7 is ~ - : ~ ; r REGISTER LS USE~LY r t~~~ N ' r7 " ~ ~ ~- ) L - ..~~ . r ~O~rT 'G _ - O ~ ~ ~ ~• v w DATE FILED ~~ i._.% rr~ w"_? ` . ,, --1 ~ ~~, e PA 170114436 diehilaw.com Under penalties of perjury, I declare that I have examined this return, inGuding accompanying schedules and statements, and to the best oT my knowledge and belief, R is We, correct and complete. DeGaretlon of preparer other than the personal representative is based on all informatlon of which preparer has any knowledge. Andrew Delbert 209 Winding Way, Camp Hill, PA 17011 SIGNATURE OF PREPARER E E/P~EBENTATIVE GATE ~,,,.;,~,. ~, ~~Yi Craig A Diehl Esquire CPA ~/ ~ IC / e 3464 Trindle Road, Camp Hill, PA 170114436 Side 1 L 1505610143 1505610143 J ~_ v 1505610243 REV-1500 EX Decedent's Soclal Security Number o.wa.nP. Nwn.: ANDRIUTSA, DIMITRI 0 5 8 3 0 7 4 0 0 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership orSole-Proprietorship (Schedule C).......... 3. 63,636.50 4. Mortgages ~ Notes Receivable (Schedule D) .......................................................... 4. 9 6 , 8 0 0 . 0 0 5• Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ................ 5. 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) ....................................................................... g, 1 6 0, 4 3 6. 5 0 16,842.99 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 3 , 2 7 3 . 0 3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (fatal Lines 9 & 10) ...................................................................... 11. 20,116.02 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 1 4 0 , 3 2 0 . 4 8 13. Charitable and Govemmentai 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. 1 4 0 , 3 2 0 . 4 8 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 14 0, 3 2 0. 4 8 15 0. 0 0 (a)(1.2) X .00 . 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at wllateral 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 1505610243 1505610243 REV-1500 EX Page 3 File Number 21 - 10 - 0345 Decedent's Complete Address: Andriutsa, Dimitri STREET ADDRESS 4905 E. Trindle Road CITY Mechanicsburg STATE PA ZIP 17050-3662 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credita/Paymenta A• Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box 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) 0.00 Total Credits (A + B) (2) 0.00 (3) 0.00 (4) (5) ~.~~ 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 inwme of the property transferred :.................................................................................. x b. retain the right to designate who shall use the properly transferred or its income :.................................... x c. retain a reversionary interest; or .................................................................................................................. x 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 consideration7 ....................................................................................................................... ^ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death7......... ~ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which contains a beneficiary designation4 ...................................................................................................................... ^ Q 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 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)]. For dates of death on or after Janusry 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent p2 P.S. §9116 (a) (1.1) (ii)]. ~ he statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disGosure of assets and filing a tax retturn afe still applicable even if the surviving spouse is the ony beneficiary. For dates of death on or after July 1, 2000: • The tax rate imposed on the net value of trensfers 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)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent p2 P.S. 69116 (a) (1.3)1. A sibling is defined under Sedibn 91D2, as an individual who has at least one parent in common with the decedent, ether y blood or adoption. SCHEDULE D cawaNwexTNOF~NNSnvnNw MORTGAGES ~ NOTES RECEIVABLE INNERRANCE TN(RETURN RE&DENi ~GEDENT ESTATE OF Andriutsa, Dimitri FILE NUMBER 21 -10 - 0345 Ali property Jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Bob Priar - $107,000.00 Mortgage 63,636.50 Recorded as Instrument #199904445 at Book 1518, Page 614 Cumberland County, Pennsylvania TOTAL (Also enter on Line 4, Recapitulation) I 63,636.50 SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. coMnoNyuenurioFVenNarwnNw PERSONAL PROPERTY MPriERRANCE TAX RETVRN REBXIDlT DECEDENT FILE NUMBER ESTATE OF Andriutsa, Dimitri 21 -10 - 0345 Include the pproceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 ~ Mid Penn Bank -Cash Located in Safe Deposit Box 96, 800.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 96,800.00 SCFE~I~E H Fl1NE1?AL E)~9VSES 8~ MONN4ALTN OF pENNBYLVANu ~~y~~~p~ INNERRANCE TA%RETURN f'1LA~~~71 fY1~ ~~ REBEIENT DECEOENr FILE NUMBER ESTATE OF Andriutsa, Dimitri 21 -10 - 0345 Debts of decedent must be reported on Schedule 1. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Parthemore Funeral Home & Cremation Services, Inc. 10,065.27 B. ADMINISTRATIVE COSTS: ~. Personal Representative's Commissions Name of Personal Representative(s) Andrew Delbert 5,000.00 Street Address 209 Winding Way city Camp Hill State PA zip 17011 Year(s) Commission paid 2010 2. Attorney's Fees Law Offices of Craig A. Diehl 900.00 3. Famiy 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 Register of Wills, Cumberland County 497.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7, Other Administrative Costs 1 Cumberland Law Journal -Estate Advertisement 75.00 TOTAL (Also enter on line 9, Recapitulation) 18,842.99 c. ~Sched~ie H COMMONWEALTH OF PENNSYLVANIA ~ ~p /~~ +,~ INNERITANCE TAX RETURN ~ Wf~ ~1{J{'.L RESIDENT DECEDENT ESTATE OF Andriutsa, Dimitri FILE NUMBER 21 - 10 - 0345 2 I The Patriot-News Co. -Estate Advertisement 3 I The Sentinel -Estate Advertisement 4 Register of Wills, Cumberland County - Filing Fee for PA Inheritance Tax Return 177.02 113.20 15.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE oo~oN~KTMOF~anvnNV~ LIABILITIES, & LIENS pJF1ERRANDE TA% RETURN RESEIENT DECEDENT FILE NUMBER ESTATE OF Andriutsa, Dimitri 21 - 10 - 0345 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, inGuding unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 Hospice of Central Pennsylvania -Medical Care 1,050.00 2 Hospice of Central Pennsylvania -Medical Care 1,750.00 3 Discover -Credit Card Balance 473.03 TOTAL (Also enter on Line 10, Recapitulation) ~ 3,273.03 REV•161] EX~ (11-0!1 SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TA% RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Andriutsa, Dimitri 21 -10 - 0345 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY oo Na u.e TruwN~) I~ TAXABLE DISTRIBUTIONS [include outright spousel distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Pauline E. Andriutsa Spouse 100% 4905 E. Trindle Road Mechanicsburg, PA 17050 Enter dollar amounts for distributions shown above on lines 1 5 through 18 on Rev 1500 cover sheet, as appropriate. II NON-TAXABLE DISTRIBUTIONS: I A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Law Offices of Craig A. Diehl 3464 Trindle Road Camp Hill, Pennsylvania 17011 Craig A. Diehl, Esquire, CPA Thomas L. McGlaughlin, Esquire Telephone (717) 763-7613 Fax (717) 763-8293 www.cadiehllaw.com November 24, 2010 In Spring Grove, Pennsylvania 119 West Hanover Street Spring Grove, PA 17362 Telephone: (717) 225-1929 Glenda Farner Strasbaugh ~ p d :Y x_ -; ~5 ~ 1 Register of Wills . Cumberland County Courthouse iAi n "< <:; , ;- One Courthouse Square ~ ~'-' n ~ ~ ~ ~' `~ ~ ' ~ Carlisle, PA 17013 c 7 7~-~n ~ 3 : ; - RE: Estate of Dimitri Andriutsa `~ ~ N =~ r-r; `~: •~ ~_ Y Estate No. 21 10 0345 -"~' w Dear Ms. Strasbaugh: Enclosed for filing please find the following: Original and two (2) copies of the Inheritance Tax Return REV-1500; and 2. Check in the amount of $15.00 for filing of the Inheritance Tax Return. Please time-stamp and return one copy of the Inheritance Tax Return in the enclosed self-addressed envelope. Should you have any questions, please feel free to contact me. Sincerely, ~•~~ Craig A. Diehl, Esquire, CPA CAD/daf Enclosures