The URL can be used to link to this page

Home My WebLink About06-07-121505610143 REV-1500 Ex(°'-'°' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes OEPIIRTMENT OF REVENUE Po Box.2sosoi INHERITANCE TAX RETURN 21 -' ~ , Harrisburg, PA 17128-OS01 RESIDENT DECEDENT I -~- ~~L~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 03 20 2012 10 02 1928 Decedent's Last Name Suffix Decedent's First Name MI DELLAFIORA PHYLLIS R (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE 1NITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ~ 2. Supplemental Return ~~ 3, Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) ~~ 5. Federal Estate Tax Return Required r„~ ~~ nn ~~ 6 Decedent Died Testate (Attach Copy of Wlp ^x T Decedent Maintained a Living Trust 0 (Attach Copy of Trust) -- 8. Total Number Of Safe DepOSlt BOxeS 9. Litigation Proceeds Received ~ 1 °. Spousal Povert Credit (date of death 11. Election to tax under Sec. 9113 A between 12-31 ~1 and 1-1-95) ~~ ( ) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephonic Number GARY L JAMES ESQ 717 533 3280 First line of address 134 SIPE AVENUE Second line of address City or Post Office State ZIP Code HUNlD~LSTOWN PA 17036 Correspondent's a-mail address: gIJ@JSdC.COm uncer penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of 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. NATURE OF RSON RESPO LE FOR FILING RETURN DATE ADDRESS 2115 Creek Hill Road Lancaster PA 17601 SIGNFj.7L1RE OF PREPARER OTHER THAN REPRESENTATIVE Gary L. James Esq. REGISTE~ WILLS UNLY o ~ ~1 = ~.. W ~ ~~ - w ~., ~ c%, ~ , ~-.~ i , FILED N "~ ~~ ~ DATE `? -1~-,-- ~-r> ~ 134 Si a A(ve e, H mmelstown, PA _~ 1505610143 Side 1 150561014:3 J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NINMBER Dellafiora, Phyllis R. 21 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of 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. Signature #2 Name Corliss A. Keller Address1 801 South Ocean Drive Address2 #308 City, State, Zip Hutchinson Island, FL 34949 Date 1505610243 REV-1500 EX Decedent's Social Security Number ~e~ede~e5"ame DellaflOra, Phyllis R. RE CAPITULATION 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested........... . 6. 7. Inter-Vivos Transfers & Miscellaneous -Probate Property ~ (Schedule G) Separate Billing Requested........... . 7. ;>_ 4 9 , 755.63 8. Total Gross Assets (total Lines 1-7) ................................................................... .. g. s`?4 9 , 755.63 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 24 , 02 6.96 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10. 759.6$ 11. Total Deductions (total Lines 9 ~ 10) .................................................................. . 11. 2 4 , 7 8 6.61 12. Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12, 224 969.02 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. 224 , 969.02 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .00 15. O . OO 16. Amount of Line 14 taxable 224 969.02 at lineal rate X .045 r 16. 10 , 123.61 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 18. O, O O 19. Tax Due ............................................................................................................... . 19. 10 , 123.61 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 L, 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21 Decedent's Complete Address: DECEDENT'S NAME Dellafiora, Phyllis R. STREETADDRESS 501 Gale Street CITY STATE ~'IP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 10,123.61 2. CreditslPayments A. Prior Payments B. Discount 506.18 Total Credits (A + g) (2) 506.18 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) 9,6 ~ 7.43 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPf21ATE 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 :.................................. L j c. retain a reversionary interest; or .................................................................................. . ~ ^ . ........................._ 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 consideration? ................................................................................................................... 11 ~J i xJ 3. Did decedent own an "in trust for" or payable 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? .................................................................................................................. x1 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT A;i 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 January 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 requirerrients 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 [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 [72 P.S. §9116 (a) (1.3)]. A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether tay blood or adoption. Rev-1510 EX+t6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Dellafiora, Phyllis R. 21 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TRO4NSFERSATRACH A COPY OF THOE DEIED OR REAEESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Members 1st IRA Certificate of Deposit # 47426-15 - 4,343.07 4,343.07 beneficiary is the Ercole A. Dellafiora (deceased 08/29/2010) and Phyllis R. Dellafiora Living Trust dated March 19, 1999; valued per letter dated Aprit 6, 2012 2 Members 1st Certificate of Deposit # 182814-41 -titled 9,814.96 9,814.96 in the Ercole A. Dellafiora (deceased 08/29/2010) and Phyllis R. Dellafiora Living Trust dated March 19, 1999; valued per letter dated April 6, 2012 3 Members 1st Certificate of Deposit # 182814-41 - 4.09 4.09 accrued interest 4 Members 1st Checking Account # 182814-11 -titled in 17,924.12 17,924.12 the Ercole A. Dellafiora (deceased 08!29/2010) and Phyllis R. Dellafiora Living Trust dated March 19, 1999; valued per letter dated April 6, 2012 Accrued interest on Item 4 through date of death 0.93 0.93 5 Members 1st Checking Account#401961-11 -titled in 4,826.84 4,826.84 the Ercole A. Dellafiora (deceased 08/29/2010) and Phyllis R. Dellafiora Living Trust dated March 19, 1999; valued per letter dated April 6, 2012 Accrued interest on Item 5 through date of death 0.29 0.29 6 Members 1st Money Management Account # 182814 54,703.10 54 703.10 -05 -titled in the Ercole A. Dellafiora (deceased , 08/29/2010) and Phyllis R. Dellafiora Living Trust dated March 19, 1999; valued per letter dated April 6, 2012 Total of Continuation Schedule ee attached page TOTAL (Also enter on Line 7, Recapitulation) 249,755.63 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Rev-1510 EX+ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN continued RESIDENT DECEDENT ESTATE OF Dellafi Phyllis R. FILE NUMBER 21 ITEM NUMBER DESCRIPTION OF PROPERTY THE DATE OF TROANSFERSATTACN A COPY OF T~E DEIED ~OR REAEESTA D. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUF~ION (IF APPLICABLE) TAXABLE VALUE Accrued interest on Item 6 through date of death 12.81 12.81 7 Members 1st Savings Account # 182814-00 -titled in 6.26 6.26 the Ercole A. Dellafiora (deceased 08/2912010) and Phyllis R. Dellafiora Living Trust dated March 19, 1999; valued per letter dated April 6, 2012 8 Members 1st Savings Account # 401961-00 -titled in 11,617.65 11,617.65 the Ercole A. Dellafiora (deceased 08/29/2010) and Phyllis R. Dellafiora Living Trust dated March 19, 1999; valued per letter dated April 6, 2012 Accrued interest on Item 8 through date of death 1.51 1.51 9 Personal Property 1,500.00 1,500.00 10 Real Estate located at 501 Gale Street 145,000.00 145,000.00 Mechanicsburg, Cumberland County, PA -titled in the Ercole A. Dellafiora (deceased 08/29/2010) and Phyllis R. Dellafiora Living Trust dated March 19, 1999; valued per appraisal TOTAL (Also enter on Line 7, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. 249,755.63 Form PA-150() Schedule G (Rev. 6-98) REV-1151 EX+(10-06) COMMONWEALTCCH OF PENNSUYLVANIA IN RESIDENTED CE EDENTRN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Dellafiora, Phyllis R. 21 Debts of decedent must be reported on Schedule I. ITEM N MBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached I 7,505.17 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission paid 2. Attorney's Fees James, Smith, Dietterick & Connelly, LLP 7,500.00 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 15.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 9,006.79 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 24,026.96 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 FILE NUIIIIBER Dellafiora, Phyllis R. 21 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Malpezzi Funeral Home -funeral expense 6,572.20 2 West Shore Elks -funeral luncheon 932.97 H-A 7,505.17 Other Administrative Costs 3 B.E. Shank Contracting Inc -new roof 6,600.00 4 Comcast -service for residence 66.26 5 Comcast -service for residence 66.26 6 James Smith Dietterick & Connelly LLP -reserve for estate administration closing costs 500.00 7 John R. Zimmerman -messenger service to Cumberland County ROW office 50.00 8 Mid Penn Home Inspections -home inspection 300.00 9 PPL -service for residence 52.99 10 Steven D. Woof -real estate appraisal 300.00 11 Tom Young Electric -installation of new breaker 900.00 12 UGI -service for residence 90.00 13 United Water -service for residence 16.91 14 United Water -service for residence 17.01 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150~D Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF (FILE NUIIABER _ Dellafiora, Phyllis R. 21 ITEM NUMBER DESCRIPTION AMOUNT 15 Verizon -service for residence 47.36 H-B7 9,006.79 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150() Schedule H (Rev. 6-98) Rev-1512 EX+(12-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUIIABER Dellafiora, Phyllis R. 21 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Barry L. Heckarr Sr. Tax Collector -real estate taxes 759.65 TOTAL (Also enter on Line 10, Recapitulation) I 759.65 (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. 12-08) REV-1513 EX+(11-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TqX RET~JRN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Dellafiora, Ph Ilis R. 21 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT or ~ ~ (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Coral D. Fassnacht Daughter 50% of residue 112,484.51 2115 Creek Hill Road Lancaster, PA 17601 2 Corliss A. Keller Daughter 50% of residue 112,484.51 801 South Ocean Drive # 308 Hutchinson Island, FL 34949 Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 ovoeasheet, as a to riate. 224,969.02 NON-TAXABLE DISTRIBUTIONS: II. 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 Copynght (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 ~~chedule J (Rev. 11-08)