HomeMy WebLinkAbout06-17-10J 1505610140
REV-1500 EX (01-10)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
Po Box zao6D1 2 1 1 0 1 0 1 4
Harriabum, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
SOCIaI Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 6 4 2 4 1 7 9 7 0 1 1 1 2 0 1 0 0 4 1 0 1 9 2 9
Decedent's Last Name Suffix Decedent's First Name MI
R O S A R R O M A I N E A
(If Applicable) Enter Surviving Spouse'a Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return
^ 4. Limited Estate
® 6. Decedent Died Testate
(Attach Copy of Will)
^ 9. Litigation Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
^ 2. Supplemental Return ^
^ 4a. Future Interest Compromise (date of ^
death after 12-12-82)
^ 7. Decedent Maintained a living Trust ~
(Attach Copy of Trust)
^ 10. Spousal Poverty Credit (date of death ^
between 12-31-91 and 1-1-95)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
D A V I D A F I T Z S I M O N S 7 1 7 2 4 3 3 3 4 1
First line of address
M A R T S O N L A W
Sewnd line of address
1 0 E H I G H S T
City or Post Office
C A R L I S L E
O F F I C E S
State ZIP Code ~
P A 1 7 0 1 3
iT OF WILLS U;~ONLY
4-
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DATE FILEa ~
E.:
Correspondents e-mail address: DFITZSIMONS(ct~,MARTSONLAW.COM
Under penalties of perjury, I deGare 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. DeGaretion of preparer other than the personal representative is based on all information or which preparer has any knowledge.
ADDRESS
61 DOGWOOD TERRACE BOILING SPRINGS PA 17007
SI RE -~ .~RyT,HAN REPRESENTATIVE DAT~.r
1 __.. ~"'\V-+-Val ~r -1~- /J.~\`..
10 E• HIGH STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 ~~
1505610240
REV-1500 EX
OecedenraName: ROMANINE A • ROTAR Decedent's Social Security Number
1 6 4 2 4 1 7 9
7
RECAPITULATION
0. 0 0
1. Raal Estate (Schedule A) .......................................... . 1
8 4 8. 2 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.
0. 0 0
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)...... . 5.
B. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ...... . 6.
0.
0
0
7. Inter-Vivos Transfers & Miscellaneous -Probate Property
~ Separate Billing Requested ......
. 7. 0 , 0 0
(Schedule G)
8 8 4 8 . 2 1
8. Total Gross Assets (total Lines 1 through 7) .......................... .
.
9. Funeral Expenses and Administrative Costs (Schedule H) ................. . 9. 0 ~ 0 Q
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... .. 10.
11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 0 ' 0 0
12.
..........................
Net Value of Estate (Line 8 minus Line 11)
..12. 8 4 8 . 2 1
13 Charitable and Governmental BequestslSec 9113 Trusts for which
. an election to tax has not been made (Schedule J) .................... .. 13.
14. Net Valua Subject to Tax (Line 12 minus Line 13) ............. .. ..... .. 14. 8 4 8 . 2 1
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
8 4 2
2
1
15.
0.
0
0
(a)(1.2) x.o _, .
16. Amount of Line 14 taxable Q , Q 0 16 0 ' Q 0
at lineal rate X •045 .
17. Amount of Line 14 taxable 0 ~ 0 0 17. 0 , Q 0
at sibling rate X .12
18. Amount of Line 14 taxable 0 ~ Q Q 18 0 , Q 0
at collateral rate X .15
19. TAX DUE ......................................................18.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
L 1505610240
Side 2
1505610240
0. 0 0
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 10 1014
DECEDENTS NAME
ROMAINE A. ROSAR
STREET ADDRESS
1 LONGSDORF WAY
CITY
CARLILSE STATE
PA ZIP
17015
Tax Payments and Credits:
1 • Tax Due (Page 2, Line 19)
2. CreditslPayments
A. Prior Payments
8. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fiil in oval on Page 2, Llne 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)
(4) 0.00
(5) 0.00
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 income of the property transferred : ............................................................... ....... ^
b. retain the right to designate who shall use the property transfened or its income : ........................ ....... ^
c. retain a reversionary interest; or ......................................................................................... ....... ^
d. receive the promise for life of either payments, benefits or care7 ................................................ ....... ^
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' orpayable-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 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 i.
3 percent [72 P.S. §9116 (a) (1.1) (i)].
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 p2 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 (72 P.S. §9116(a)(1.3)]. 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.
REV-1503 EX + (8-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ATE OF
FILE NUMBER
ROMAINE A. ROSAR 21 10 1014
All property Jolntyowned with right of aurvfvorsMp must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Shazes, MetLife, CUSIP 591568108
TOTAL (Also enter on line 2, Recapitulation) ~ i
(If more space i9 needed, insert additional sheets of the same size)
REV-1513 EXt (01-10)
pennsylvania ~ SCHEDULE J
DEPARTMENTOF REVENUE I BENEFICIARIES
INHERfTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF:
ROMAIN E A. ROSAR 21 10 1014
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 prldude outrioh(spou j;dis6ihutlons and fransfen3 under
Sec. 91 ii6 al 1.2 .
1. Estate of Anthony F. Rosar Spousal 842.21
c/o 10 East High Street
Carlisle, PA 17013
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9t 13 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S
it more space is needed, use adtlitional sheets of paper of the same size.
F:\FILES\Climts\13099 Rorer\I3089.I.w.w01
LAST WILL AND TESTAMENT
I, ROMAINE ROSAR, of South Middleton Township, Cumberland County,
Pennsylvania, being of sound and disposing mind and memory, do hereby make, publish and
F-'i
declare this to be my Last Will and Testament, hereby revoking any and all fot~r3e~ Wills p;
Codicils made by me. ~ ~ T~ ~
.r
1. ~ :? c;.
I direct that all my legally enforceable debts, funeral expenses, testamentary expenses aru~
all death taxes (whether such taxes may be payable by my estate or by any reci~ilent of atly,
property) shall be paid from my residuary estate as soon as practicable after my decease and as
part of the administration of my estate. My Executrix shall have no duty or obligation to obtain
reimbursement for any such tax so paid, even though on proceeds of insurance or other property
not passing under this Will.
2.
If my husband survives me by thirty (30) days, then I give, devise and bequeath all of my
estate, both real and personal property, unto my husband, ANTHONY F. ROSAR, absolutely.
3.
In the event rrry said husband, ANTHONY F. ROSAR, predeceases, or fails to survive
me, by more than thirty (30) days, then I give, devise and bequeath all of my estate, both real and
personal property, in the following manner:
a. I give the sum of One Thousand Dollars ($1,000.00) to each of my
grandchildren, to wit: JENNIFER DESROCHES, NICOLF, SZOSTEK, JASON
SZOSTEK, JOSEPH ROSAR, JR., KRISTINA ROSAR, MICHELLE ROSAR,
LAUREN ROSAR, ADAM CIANFICHI, and CARA CIANFICHI.
b. I give, devise and bequeath all the rest, remainder and residue of my estate
in equal shares unto my daughters, DIANE M. SZOSTEK and DEBORAH A.
CIANFICHI, absolutely; provided, however, that the share ofeither ofmy daughters who
shall predecease me shall be distributed to her issue, per stirpes, and in default of any
Page 1 of 4 Pages
[Initia s]
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such then-living issue, such share shall be distributed to my surviving daughter in
accordance with the terms of this Item 3, b, of this my Last Will and Testament.
4.
If any beneficiary or remainderman under this Will in any manner, directly or indirectly,
contests or attacks this Will or any of its provisions, any share or interest in my estate to that
contesting beneficiary or remainderman under this Will is revoked and shall be disposed of in
the same manner provided herein as if that contesting beneficiary or remaindennan had
predeceased me without issue or heirs.
5.
I nominate, constitute and appoint my daughter, DEBORAH A. CIANFICHI, as
Executrix of my estate. In the event she shall be unable or unwilling to serve in such capacity,
then I nominate, constitute and appoint my daughter, DIANE M. SZOSTEK, as Executrix of my
estate.
6.
I direct that all fiduciaries acting under this Will, whether or not named herein, shall not
be required to give bond for the faithful performance of their duties in any jurisdiction.
7.
I authorize and empower my fiduciaries, in their sole and absolute discretion, to purchase
or otherwise acquire and retain any investments of which I die seized or any real or personal
property of any nature; to sell, lease, pledge, mortgage, transfer, exchange, dispose of or grant
options in regard to any or all property of any kind forming a part of my estate for such terms
and such prices as they may deem advisable; to borrow money for any purposes connected with
the protection and preservation of my estate; to mortgage or pledge any real or personal property
forming a part of my estate or to join in or secure the partition of same; to compromise any
claims or demands of my estate against others or of others against my estate; to make distribution
in kind and to cause any share to be composed of cash, property or undivided fractional shares
in property different in kind from any other share; to employ agents, attorneys and proxies and
to delegate to them such power as my fiduciaries consider desirable and to pay reasonable
Page 2 of 4 Pages
Init~
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compensation for such services as maybe rendered by such agents, attorneys and proxies; and
to execute and deliver such instruments as maybe necessary to carry out any of these powers.
In addition, I direct that my Executrix shall have the power to conduct an inventory of any safe
deposit box necessary to the administration of my estate.
WITNESS WHEREOF I have hereunto set my hand and seal this ~` day of
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named Testatrix,
as and for her Last Will and Testament, in the presence of us, who at her request, have hereunto
subscri ur names as witnesses thereto, in the presence of the said Testatrix and of each other.
.,l~ ~ ~ a~,,CC
~:. ,e,,., ~ a ooh'
CJ (n~.cw~te__. ~i~~L2/ (SEAL)
Romaine Rosar
Page 3 of 4 Pages
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CUMBERLAND )
SS.
We, Romaine Rosar, ~I P_`~t~('ra ~.. n c~_, and ~,t-a. ~_ ~(~~,K. ,
the Testatrix and the witnesses, respectively, whose names are signed to the foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the
Testatrix signed and executed the instrument as her last Will and that the Testatrix has signed
willingly, and that the Testatrix executed it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the
Will as a witness and that to the best ofhis/her knowledge the Testatrix was at that time eighteen
years of age or older, of sound mind and under no constraint or undue influence.
Subscribed, sworn to and acknowledged before me by Romaine Rosar, the Testatrix, and
r ~(~
subscribed and sworn to before me by ~' I ~`iU, tcz ~.- ~ TTU and
~G..i,_ r c~ ~ Ge. ,the witnesses, this 3rG~Q day of Sfy,,~c,,,., ~c~-- ,
-~-
~_
Notary ublic
COTti1iv10N'rVEAL"1'H OF PENNSYLVANIA
\!{1T,4R Iiil, SEAL
i'orrii?e L- Y9ye~ , i+iolary Public
~ariisle Eerough, Cumbcrlan~ Cot:nty
"~!'! commissiti;n ;vpire tt-tay L I, 201 l
Page 4 of 4 Pages
~-/~
-~-
Witness
Estate Valuation
Date of Death: 01/11/2010
Valuation Date: 01/11/2010
Processing Date: 06/14/2011
Shares Security
or Par Description
1) 22 METLIFE INC (591568108)
NYSE
01/11/2010
Total Value:
Total Accrual:
Total: 5898.21
Estate of: Romaine A. Rosar
Account: 10389.1
Report Type: Date of Death
Number of Securities: 1
File ID: 10389.1.romaine.rosar
Mean and/or Div and Int Security
High/Ask Low/Bid Adjustments Accruals Value
38.90000 38.21000 H/L
38.555000 898.21
50.00
5898.21
Page 1
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