HomeMy WebLinkAbout04-29-11. r
'J REV-1500 ~`(°'-'°'
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes OEYMTMEM OF aevExaE
Po sox.zaosol INH
Harrisburg, PA 17128-0601 F
1505610143
ORIGINAL
OFFICIAL USE ONLY
County Code Year File Number
'ANCE TAX RETURN 21 /D o y q g
)ENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
468 04 0893 04 20 2010
Decedent's Last Name
UMIAIJA
(If Applicable) Enter Surviving Spouse's Information Below
Date of Birth
03 27 1953
Suffix Decedent's First Name
ANIEFIOK
Spouse's Last Name Suffix Spouse's First Name
UMANA ROSE
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
MI
J
MI
FILL IN APPROPR4,4TE OVALS BELOW
Cl t. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-132)
^ 4. Limited Estate ^ qa, Future Interest Com romise
(date of deem after ~2-t2-ez)
^
5. Federal Estate Tax Return Required
^ 6. Decadent Died Testate
(Adach Copy or win) fr ~~
~J ~ ppacetler~t Maint ned a Living Trust
(Attach Gopy oi~rust7
8. Total Number of Safe Deposit Boxes
^ 9. LibgaLOn Proceeds Received ^ f D, b~hveen 72 31 y1 ~dit,~datge5pi deam ^ 11. Election to tax under Sec. 9713(A)
(Attach Sch. 0)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
DIANE G RADCLIFF ESQUIRE (717) 737 0100
First like of address
3448 TRINDLE ROAD
Second line of address
City or Post Office State ZIP Code
CAMP HILL pA
REGISTER O.S USE QpiILY
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DATE FILED
Correspondent's a-mail address:
Under penalties of pequry, I declare that I have examined this return, including accompanying schedules and statements, and to the best oT 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.
sir_uen oe nr uroen.~ o~~.....~..~..~ ~ _.... -.. ..._ ___.._..
umana -~~Zfl~j
' URE OF PREPARa T THAN RE RESEN ATIVE DATE
r Diane G Radcliff, Esquire !~/,~ //~
-~--^ t _
H
Side 1
I,,,~ 1505610143
1505610143
J~
J
1505610243
REV-1500 EX
Decedent's Social Security Number
oe~da^c•sNama: Umana, Aniefiok James 468 04 0893
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 & Notes Receivable (Schedule D) .................................................. ...... 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .......... ..... 5. 1 , 92 0 . 2 7
6. Jointly Owned Property (Schedule F) . ^ Separate Billing Requested....... ..... 6.
7. Inter-Vivos Transfers & Miscellaneous lyoq Probate Property
(Schedule G) ~J Separate Billing Requested........ .... 7.
8. Total Gross Assets (total Lines 1-7) ............................................................... ...... g, 1 , 920.27
9. Funeral Expenses & Administrative Costs (Schedule H) .................................. ..... 9. 11, 635.68
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......................... ..... 10. 2 6 , 923.8 9
11. Total Deductions (total Lines 9 & 10) .............................................................. ..... 11. 38 , 559.57
12. Net Value of Estate (Line 8 minus Line 11) ..................................................... ..... 12. -3 6 , 63 9.3 0
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. -3 6 , 63 9.30
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(t2)X.OO 0.00 15. 0.00
16. , Amount of Line 14 taxable
at lineal rate X .045 0. 0 0 16. O, Q O
17. ', Amount of Line 14 taxable
at sibling rate X .12 0 . Q 0 17. 0.00
18. Amount of Line 14 taxable
at collateral rate X .15 0.00 18. 0.00
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
Decedent's Complete Address:
File Number 21
DECEDEN 'S NAME
U ana, Aniefiok James
STREETA DRESS
22 3 Orchard Road
CITY STATE ZIP
C mp Hill PA 17011
Tax Pay ents and Credits:
1. Tax Du (Page 2, Line 19)
2. Credits Payments
A. Prio Payments
B. Dis ount 0.00
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.
Make Check Payable to:
(1)
Total Credits (A + B) (2)
(3)
(4)
(5)
OF WILLS. AGENT.
0.00
0.00
0.~0
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 :...............................................................................
b. retain the right to designate who shall use the property transferred or its income :.................................. ^ n
c. retain a reversionary interest or ............................................................................................................... ^ x
d. receive the promise for life of either payments, benefits or care? ............................................ ^ a
2. If death occurred after December 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?....... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................. ^
IF THE ANS ER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of Bath 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 rcent [72 P.S. §9116 (a) (1.1) (i)].
For dates of eath on or after January 1, 1995, the tax r to imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S. §91 6 (a) (1.1) (ii)]. The statute does not exam~pt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of
assets and fil ng a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of each on or after July 1, 2000:
• The tax ra a 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 p rent, or a stepparent of the child is 0 percent (72 P.S. §9116 (a) (1.2)].
. The tax ra a 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. § 116 1.2) [72 P.S. §9116 (a) (1 )].
. The tax ra a 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)]. A
sibling is d fined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
Rev-1508 EXa 18-98)
CpMMONNIEALTM OF pENNSVLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE
Aniefiok
SCHEDULE E
CASH, BANK DEPOSITS, 8t MISC.
PERSONAL PROPERTY
FILE NUMBER
21 1b d `r< 9 fS
Include the proceeds of liti0anon end the date the proceeds were received by the estate.
All property Jo ni tly-owned with the right ofsurvivorship must bs disclosed on schedule F.
t~~ nlu~e space Is neeaeD, aaaRlonal pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
REV-1161 EX+(10-081
connr"~f~~r~rANin
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COST:
ESTATE OF FILE NUMBER
Umana, Aniefiok James 21 / O d ~ 9
Debts of decedent must be reported on Schedule I.
ITEM
DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
B.
1
See continuation schedule(s) attached
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(sl Commission paid
2. Attorney's Fees Diane G Radcliff, Esquire
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparers Fees
7. Other Administrative Costs
10,185.68
1,450.00
TOTAL (Also enter on line 9, Recapitulation) I 11 635.68
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF
James
FILE NUMBER
21 / O O
ITEM
NUMBER DESCRIPTION AMOUNT
Parthemore Funeral Home 8 Cremation Services, Inc.
H-A
10,185.68
10,185.68
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev1512 EX. }12-0a)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, 8r LIENS
ESTATE OF FILE NUMBER
Umana, Aniefiok James 21 / D D ~c/8
Report debts Incurred by Me decedent prior to death that romainetl unpaitl at W e date of death, Ineludinp unrolmburoed medical eapensee.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Advanta Credit Card 4,703.35
2 District Magistrate William C. Wenner 98.00
3 Hamilton Health Center 564.00
4 Hamilton Health Center Dental 45.00
5 Holy Spirit Hospital -11/08/09 -11/09/09 17,659.30
6 Moffitt Heart and Vascular 2,370.87
7 Pendrick Capital Partners 1,013.00
8 Spirit Physician Services 298.00
9 T Mobile 172.37
TOTAL (Also enter on Line 10, Recapitulation) I 26,823.89
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. t2-08)
REV•181~ EXr (11-08)
SCHEDULE J
coMr~~n~;~D ^g~~ANIA BENEFICIARIES
ESTATE OF
Umana. Aniefiok James
FILE NUMBER
~~ r ,, .. ,J a Sr
NUMBER NAME AND ADDRESS OF
PERSON(Sl RECEIVING PROPERTY RELATIONSHIP TO
DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
(VHords) ($$$)
I
' TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 12
Emem Umana Child
1202 Summit Way
Mechanicsburg, PA 17050
Imeime Umana Child
1202 Summit Way
Mechanicsburg, PA 17050
Ini Umana Child
1202 Summit Way
Mechanicsburg, PA 17050
Nsima Umana Child
1202 Summit Way
Mechanicsburg, PA 17050
Rose Umana Wife
1202 Summit Way
Mechanicsburg, PA 17050
Total
Enter dollar amounts for distributions shown above on lines 1 5 throw h 18 on Rev 150 0 wver sheet as a r o riate.
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTA L OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER sHEET
Copyright (c) 2009 form software only The Lackner Group, Inc.
Fonn PA-1b00 Schedule J (Rev. 11-08)
PSEC~k
September 15, 2010
Diane G Radcliff
Attorney at Law
3448 Trindle Road
Camp Hill, PA 17011
Re: Aniefiok J Umana, Deceased.
Account # 8502044863
Dear Ms. Radcliff:
Enclosed is a check in the amount of $ 1,045.27, the last remaining funds in the account of
Aniefiok J Umana.
I have also enclosed a Notice of Claim of Creditors for the outstanding Visa balance.
PSECU does hold offset rights to satisfy the Signature loan from his Share balances. The
Signature loan has been satisfied.
If you have any questions, please contact me at (717) 234-8484 or toll-free at (800) 237-
7328, then press 6, extension 3120.
Si rely,
`~n Viers
Service Advisor
PSECU
Pennsylvania State Employees Credit Union
Main Address: 1 Credit Union Place, Harrisburg, PA 17110.2990 • 717.234.8484 • 800.237.7328
Mailing Address: P.O. Box 67013, Harcisburg, PA 7 71 06-701 3 • 717.777.2100 (TDD) • 800.472.1967 (fDD)
psecu.com
This credit union Is federally insured by the National CrediT Union Adminishation. Equol Opportunity lender
~~'2536795~~' ~:23i38iiL6~: 6i26i26L24~~' 44
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ADVANCE PROCEEDS VOUCHER
AND SECURITY AGREEMENT
ANIEFIOK UMANA
258 JOYA CIR
HARRISBURG, PA 17112-2945
~~
Pennsylvania State
Employees Credk Unton
P.O. Box 67013
Harrisburg, PA 17108-7013
(717) 787-7328
(800) 237-7328
5/30/200318502044863 / L10 1 315358
URPOSE:
Dealer~Purchase ,
~ 11. ~ NEW LOAN 2. a LO~MIN DANCE 3. ^ (DE8CRIBE) 4. ~ EOURY ADVANCE _ 1
ruu NAVE PREVIOUSLY ELECTED To NAVE THIS AwANCE YES ^ ~ ~ ~ ~ ^X ^ ~~ No ~
INSURED wrrN THE FOLLOVVINO covERAOE
oAILr rERloole LuTa ANNUM. PER- INTEREST RATE Is AMOLINr REaueSTED AMOUNT ADVANCED PREVIOUS BALANCE NEW BALANCe
(c~lAroae IN TEIMAS ONLY) CENTAGE RATE ~D vAR418LE + + OTHER CHARGES
.013671 4.990 % [~ ^ 3.,500.00 0.00 - 3,500.00
R~vMENr oLtE oATE R+vMe+r FREQUENCY PROJECTED.LOAN TERM
104.89 6/29/2003 MONTI~LY
IF THIS IS A HOME EaU1TY ADVANCE, TLE~ OMLYSECURITY FOR THE ADVANCE 13 THE REAL PROPERTY (IN MOST CASES YOUR HOME) WIiK7N 4AVE AS SECUMY WHEN YT)UR ACCOUNT
WAS ESTAaLI8FIE0. ~ .
IF THI6 IS MOT A HOLD EOUrTY ADVANCE. W ADDRI[]N m nu PI Ftf[ic tx wur~ca w ~ ~o i ruw wew rteervr ~noeeueur Luc rn , tr~nun mrocerv nvr.e~e ta.,e ..~...,.. -
+• TOYOTA CAMRY 1992 4T1SK12E9NV00030 SDN 4,575.00
z.
a
4.OTHER
YOU PLEDGE SHARER ANDA7R DEP081T8 OF $ IN ACCOUNT NUMBER • .
OLD ACCOUNfA.OMI NUMBER PAYOFF NC. + INi. OLD ACCOUNTAAAN NUMBER RYYOFF PRINC.+ INL OLD ACCOIAYTAAAN NUMBER 'PAYOFF INC. + INL
OLD ACCOUHTADAN NUMBER PAYOFF PRINC.+INT. OLD ACCOUNTAAAN NUMBER PAYOFF RINC.+INT. OLD ACCOUNTA.OAN NUMBER M PfBNC. +.INL)
6Y acoepang ule proceeca or OY uslDg vie runes eavarxjed and deposited into your shere/sfrare draft acoouM, you agree (1) that the property referenced above
will secure the advance and any other advances you have now or receive in the future under the LOANLINER' Credit and Secu.
rily Agreement (the Plan) aRd
arty other arflourlls you owe us for any reason now or in the future in accordance with the terms of the Plan and (2) to'make payments as discbsed.above In
accordance with the terms of the Plan. .
ANA MUTVa INSURANCE soclETV, raeo. e2, e4. ee, re, ALL RIQHTS RESERVED PSECU FORM #3176 (1At10),NX)(0/00.1 OCf7-2092=1 (tA0) '
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PS
Parthemore Funeral Home & Cremation Servic~c~ w /~~c~
es, Inc.
P.O. Box 431
1303 Bridge Street
New Cumberland, PA 17070-0431
(717) 774-7721
Ini A. Umana
i2oa sw,>m~rway
Mechanicsburg, PA 17050
For the Service of Aniefiok James Umana
Statement
DATE
1/18/2011
AMOUNT DUE ~ AMOUNT ENC.
$1,033.71
DATE TRANSACTION AMOUNT BALANCE
12/31/2009 Bala
f
d
04!27/2010
04/28/2010
05/06/2010
09/16/2010
10/08/2010
1 1 /1 5120 1 0 nce
orwar
MV #2072.
PMT#1202.
CHK #12032.
PMT #1242. rce from Rose Umana
PMT #1251. Received from Rose Umana
PMT#1258. nec from Rose Umana
10,185.68
-8,101.97
0.00
-350.00
-350.00
-350.00 0.00
10,185.68
2,083.71
2,083.71
1,733.71
1,383.71
1,033.71
1-30 DAYS PAST 31
D
CURRENT 0
AYS PAST
DUE DUE 61-90 DAYS PAST
DUE OVER 90 DAYS
PAST DUE
AMOUNT DUE
0.00 0.00 0.00 0.00 1,033.71
$1,033.71
Please don't hesitate to call our office if we may be of assistance. Thank you.