HomeMy WebLinkAbout01-12-11__ _ _ _ _. __ 1 ~_
r! 1505610101
REV-1500 °`t°'-'°' 1~1
PA Department Of Revenue pennsytvaMa OFFICIAL USE ONLY
Bureau of Individual Taxes °`""'"°`~"`"""" County Code Year I File Number
PO BOx28o6oi INHERITANCE TAX RETURN ZI C ( O~ 53
.Harrisburg, PA 17iz8-o6o1 RESIDENT DECEDENT I
ENTER DECEDENT INFORMATION BELOW
Social Security. Number .Date of Death MMDDYYYY Date of Birth MMDDYYYY
192-26-3751 i 05/06/2010 01/08/1916
Decedent's Last Name Suffix Decedent's First Name ' ' MI
Diletto ~ Grace a
(ff Applicable] Enter Surviving Spouse's Information Below i L~
Spouse's.Last Name Suffix Spouse's First Name ~ MI
~. ^
Spouse's Soaal Security Number THIS RETURN MUST BE FILED IN DUPLICATE WIT~I T ~
'. REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW j
~ 1. Onginal Retum O 2. Supplemental Retum O 3. Remainder Re rr4 (date of death
prior to 12- 3-8 )
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate a{c Retum Required
death after 12-12-82)
O 6. Dec~deat.Died Testate O 7. Decedent Maintained a Living Trust 8. Total Numt~r o safe Deposit Boxes
(Attach Copy of W71) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax nper Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Scf~ . O
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONflDENTIAC TAX INFORMATION SHO
Name Daytime Telepho
~ Ronald E. Johnson, Esq (717) 243-01
REGISTER
First line of_address
~ 78 West Pomfret Street
Second line of.address
City or Post Office State ZIP Code
Carlisle PA 17013-0000
Cocr~aspondenYE.-majladdress: rejohn,
DIRECTED T0,
s usE owix
c_ ~r
r"r , <
n ~. .
s~:'~
~ iv -x:' ~,-f
~:_ ~ x
c~ °:~~ . ~;~ cry
~
--+
~ z
~
N .
~
~
~
.. i--
Fi1LED - ~''~ Q
under penalties of pequry, I declare that I have examined this return, including accompanying schedules and statements, and to the y knowledge and belief,
tt ~ and complete. Dedaratbn of preparer other than the personal representative is based on all Information of which oa as env knowledge.
ADDRESS
c/o 78 st Pomfret
OF
78 West Pomfret
1505610101
PA 17013
PLEASE USE OR161NAL FORM ONLY
Side 1
150561d11~~r J
i
i I ;
1505610105
REV-1500 EX
Decedent's Social $~curity Number
Decedent'a Name: Grace S. Diletto 192-26-37511
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 Personal Property (Schedule E)....... 5.
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vnos Transfers 8~ Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets (fatal Lines 1 through T) ............................. 8.
9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9.
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 1'0.
11. Total Deductions (total Lines 9 and 10) ................................. 11.
12. Net Value of Estate (Line 8 minus Line 11) .............................. 12.
13. Charitable and Governmental BequestslSec 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 rite, or
transfers under Sec. 9116
(a)(1.2) X .0` 45.
16. Amount of Line 14 taxable
at lineal rate X .0 ., 1 g,
17. Amount of Line 14 taxable
at sibling rate X .12 17,
18. Amount of Line 14 taxable
at collateral rate X .15 1 g,
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYM ENT
1505610105
Side 2
1505611
~~
0.00
0.00
0.00
0.00
6,269.60
0.00
0.00
6,269.60
2,914.40
30,302.86
33,217.26
-26,947.66
-26,947.66
0.00
O
J
REV 1500 F,C Page 3 Ftle Number
Decedent's Complete Address:
DECEDENTS NAME
Grace S. Diletto
STREETADDRESS
1000 West South Street
CITY
Carlisle STATE
PA ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19) (1)
2. CreditslPayments
A. Prior Payments
B. Discount
Total Credits (A + B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 + Line 3, enter the. difference. This is the OVERPAYMENT:
Fill in oval on Page 2, Une 20 to request a refund. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE.ANSWERTHE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPRCIF
1. Did decedent make a transfer and: fie;
a. retain the t,-se 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 or care? .........:............................................................
2. ff death occurred after Dec. 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration? ..............................................................................................................
3. Dki decedent own an "in trust for' or payabie•upon-death bank account or security at his or her death? ..............
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 Il
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 ibr
3 percent [72 P.S, §9116 (a) (11) (~].
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 ofl tF
(72 P.S. §9116 (a) (1.1) (ii)j. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory rt:quiren
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 ort fc
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 frahsfers to or for the use of the dtacedent's lineal beneficiaries ig 4
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 (72 P.S. §91~6(~
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
0.00
0.00
TE BLOCKS
No
a
a
O
D
a
a
~ PART OF THE RETURN.
~e, use of the surviving spouse is
Surviving spouse is 0 percent
njs for disclosure of assets and
tMe use of a natural parent, an
S I percent, except as noted in
x(1,3)]. A sibling is defined, under
SCHEDULE E
CASH, BANK DEPOSITS AND
lIT[~/1TTT •1TTATT[~ TTT\PA1T~T T\T /1TT+T T<1
ESTATE OF FILE ER
Grace S. Diletto
Include the proceeds of litigation and the date the proceeds were received by the estate
All pro rty foi~y-owved with t of Siuvlvots mmt be dbcloaed on Schedule F
ITEM DESCRIPTION VAL ?lT DATE
NUMBER OIF T'H
1 Metro checking account n0; 0537153316 -Metro Bank $ ,265.15
2 Credit for presciption drug charge $4.45
3
4 i
5
6
7
I
TOTAL. (also on-line s, Raxpitulatioa) ,269.60
i
i
SCHEDULE H
FUNERAL EXPENSES, ADMINISTRATIVE
COSTS AND MISCELLANEOUS EXPENSES
A
B
ESTATE OF FILE ~ BER
Grace S. Diletto
Debts of decedent must be re orted on Sebedule I.
ITEM DESCRIPTION 1vI0UNT
NUMBER
Funeral Expenses: I i
1 Griffith Funeral Chapel -funeral expense $ ,205.00
2 SS Peter's Paul Cemetary ~ $1425.00
3 DeChristopher Memorials -grave marker $'195.00
4 Archdiocese of Philadelphia -permit to updat grave marker i .$30.00
Administrative Costs:
1 Personal Representive Commissions
Name of Personal Representative(s)
Social Security Number of Personal Representative: ~~
Street Address:
City: State:. Zip:
Year(s) commissions paid:
2 Attorney fees to Andrews & Johnson i $750.00
3 Family Exemption
i
Claimant I ~
Street:
i
City: State & Zip
Relationship of Claimant to Decedent:
4 Probate Fees to Register of Wills
5 Accountant Fees to Patricia Rosendale, CPA
6 Tax Return Preparer's Fees
7 Register of Wills - PA Inheritance Tax Return -filing fee ~ $15.00
8 Register of Wills -filing fee-Petition to settle a small estate ~ $43.50
9 Delaware County Orphans Court-filing fee. for Guardianship .Report.. ~ $25.00
10 Andrews & Johnson, attys -initial consultation fee $25.00
11 Charles Appleby -reimburse for epxenses incurred ~
I $200.90
'
TOTAL (also on line 9, Recapitulation) ' ,914.40
i
~
'
_ _.
___
SCHEDULE I
bEBTS OF DECEDENT '
MORTGAGE LIABILITIES AND LIENS
ESTATE OF FILE'
Grace S. Diletto MBER
'
Report debts incurred by tho-decedent prior to death which remained unpud as of the daft of death, including unreimbursed medical exp
ITEM
NUMBER DESCRIPTION VALUE
O AT DATE
ATH
I
2
Commonwealth of PA -Department of Public Welfare
(see letter attached)
Sarah Todd Nursing Home I
~2 ,.304.56
$998.30
i
j
i
I!
TOTAL (also online 10, Recapitulation) I $I~p,302.86
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF PROGRAM INTEGRITY
DNISION OF THIRD PARTY LIABILITY
ESTATE RECOVERY PROGRAM
PO BOX 8486
HARRISBURG, PA 17105-8486
October 4, 2010
CHARLES G APPLEBY JR
33 SHERWOOD CIRCLE
ENOLA PA 17025-1838
Re: Grace Diletto
CIS #: 940246777
SSN: ###-##-3751
Date of Death: 05/06/2010'
Dear Charles G. Appleby, Jr.:
Please be .advised that the Department of Public Welfare is ~t ~mpting to
recover the monetary value of any and all eligible assets in thess ject
estate. Although the amount in the estate may be considerably l~s than that
which is owed to the Department, our claim is against the estates o one
else. Your responsibilities, as the primary next of ~
kin/administrator/executor, is to advise the Department of any a~s~ts in the
estate and to insure that the remaining money, after alI funeral a cl
administrative costs are-deducted, is sent to the Department.
The. Department of Public Welfare maintains a claim in the lamp~nt of
$29,304.56 against the above-mentioned estate. This claim is fopr ~stitution
of medical assistance granted on behalf of the decedent for whic,~ the Probate
Estate is now responsible to reimburse the Department according ~tolAct 49, 62
P.S. 1412, effective August 15, 1994, as amended by Act..; 2.0-95, . e'iff.~eGtive June
30, 1995. Enclosed is the Department's itemized statement of cllaill}}~n.
A portion of this medical expense, namely $26,754.56, was incurred
during the last six months of the decedent's life; therefore, it is'a Class 3
claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries
Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely $2,550.00, is
to be entered as a priority Class 5.1 claim against the estate.
Please acknowledge receipt of this letter and advise when ~ay~nent may be
expected. If the estate accounting is complwta, phaase..pzovide•a• c¢~p~r. If
the estate contains real estate, please provide copies- of` t1Ye de~e ;; the
latest tax assessment and a .current appraisal, if available. Ple sje complete
the enclosed Decedent's Assets Itemization Form and return to tk~e Deepartment.
Please include proof of funeral bill, proof of burial account,~;p opf of
personal care account, copies of original life insurance policy 'f zi~es naming
beneficiaries, proof of any and all stocks and bonds, date of d~a ;bank
statements and copies of original signature cards or proof from ',b ing
institution showing ownership of" any and all .bank. accounts. Plea a forward
these documents to the address above no later than October 15, ~0 0'.