HomeMy WebLinkAbout09-19-12` 1505610140
REV-1500 ~ (D,-,e, ra~E X1;4 ~:L :: M~ ,
PA Department of Revenue ~,,,,y code year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po sox zaoso, 2 1 1 1 0 4 6 7
~~ aR pA 77,2gD8Ot RESIDENT DECEDENT- _
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Mu1DOVYYy Date of Birth MWIDDYVrv
0 9 4 2 6 0 9 7 8 0 3 2 0 2 0 1 1 0 1 0 9 1 9 3 4
Decedents Last Name Suffix Decedent's F(rst Marne MI
C H I O V A R O M A R I E C
(N Appfieabla) Enter SurvWiny Spouse's Infom,ation Below
Spouse's 1-eat Name Suffix Spouse's First Name
Spouse's Social Security Number
FILL IN pPpROPRUtE OVALS BELOW
® 1. Original Return
4. Limited Estate
S. Decedent Died Testate
(Attach Copy of WNI)
9. Litlgadon Proceeds Received
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF W{LLS
2. Supplemental Return
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Ttust)
10. Spousal Poverty Credit (date of death
between 12-31-9, and i-1-95)
MI
3. Remainder Return (tlate of death
prior W t2.13.82)
5'.. Federal Estate Tax Return Required
8'~. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9,13(A)
(Attach SGt. O)
CORRESPONDENT -tHiS SECTION MUST SE COMPLETED. ALL CORRESPDNDENCE AND CONFDENTVIL TAl(INFORMATpN SHOULD 8E DIRECTt:u l U:
Name Daytime Telephone Number
K E N N E T H J M C D E R M O T T 7 1 7 7 6 3 1 1 2 1
N
i'T7
V
W
-o
W
REGISTER
First fine of address
3 4 2 5 S I M P S O N
Seca,d Ilne of address
Gry or Post Office
C A M P H I L L
F ERR Y R O A D
Shale ZIP Code
P A 1 7 0 1 1
CorresponWnCs a~mall address: MCDERMOTTSSHUMAKERhIiLLiAM~•CV17
Under peneleea of penury. I declare the, I have examined this return, indudMg accompanying sUtedufae and sfetementa, ant to the beat a my
h is twe, wr*ea eM complete. Dxyaraaon a geperer aher than the pereanal reprecentWVe N based on a1 inlarmetbn avmMh preperer has
f3z
309 OAK MANOR DRIVE, APT• T-4 GLEN BURNIE MD 21061
SIG~.T~tE OF~ARER~ERT , SENTATIVE 9~~ j' 2
iyJVRWJ
3425 SIMPSON FERRY ROAD CAMP HILL PA 17011
PLEASE USE ORIGINAL FORM ONLY
~~
C!~ ~)
~ r~
~~
Stile t
1505610140 1!iD5610140 J
1505610240
REV-1500 EX Decedent's Sodal Security Number
Decedent's Name: MARIE C• CHIOVARO 0 9 4 2 6 0 9 7 8
RECAPITULATION
1. Real Estate (Schedule A) ......................................... .. 1. 1 2 `l 9 0 0 • 0 0
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) ^ Separate Billing Requested ..... .. 6. 4 7 7 0 • 8 0
7. Inler-Vivos Transfers & Miscellaneous N n-Probate Property
(Schedule G) ~ Separate Billing Requested ..... .. 7.
8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 1 3 4 6 7 0 , 8 0
9. Funeral Expenses and Administrative Costs (Schedule H) ................ .. 9. 1 0 9 4 3 . 0 0
10. Debts of Decedent, Mortgage Liabilities, and liens (Schedule I) ........... .. 10. 1 3 1 7 5 . 5 5
11. Total Deductions (total Lines 9 and 10) ............................. .. 11. 2 4 1 1 8 . 5 5
12. Net Value of Estate (Line 8 minus Line 11) .......................... .. 12. 1 1 0 5 5 2 . 2 5
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. 1 1 0 5 5 2. 2 5
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal fax rate, or
transfers under Sec. 9116
(a)(1.2)x.o_ 0.0 0 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .045 1 1 0 5 5 2. 2 5 1s. 4 9 7 4. 8 5
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 1g, 0, O Q
19. TAX DUE .................................................... ..19. 4 9 7 4. 8 5
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610240
1505610240
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 11 0467
DECEDENT'S NAME
MARIE C• CHIOVARO
STREET ADDRESS
7 KIN6SWOOD DRIVE
CITY
MECHANCISBURG STATE
PA ZIP
17055
Tax Payments and Credits:
t. Tax Due (Page 2, Line 19)
2. CreditslPayments
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.
Fill in oval on Page 2, Line 20 to request a refund.
(1) 54,974.85
(4) 90.00
5. If Line 1 +Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 54 , 974 •85
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 dght to designate who shall use the property transferred or its income : ............................ ... ^ ^X
c. retain a reversionary interest; or ............................................................................................. ... ^
d. receive the promise for life of either payments, benefits or care? .................................................... ... ^
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 awn an "intrust for' or payable-upon~eath bank account or securtty at his or her death? ...... ... ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
contains a beneficiary designation? ............................................................................................... ... ^ ^X
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
' .: '- ,x~v.°'~»..a. ~v x+~^ x°v .. "~~... k.x.... a•.fia'..~i: ..i ° .q .. ... :.:® ~ :u ..~ ^td ,..,.. ~.. :: . -~'.°..3tc..._..
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 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 [72 P.S. §9116(a)(1.2)].
• The tax rate imposed on the net value of Vansfers 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 Vansfers 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.
Total Credits (A+B) (2)
(3)
REV-1502 EX+ (01-10)
pennsylvania ~ SCHEDULE A
DEPARTMENT OF REVENUE
REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
MARIE C• CHIOVARO 21 11 D467
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property
would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property that is jolntlyowned with right of survivorship must be disclosed on Schedule F.
Attach a copy of the settlement sheet if the property has been sold.
ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE
NUMBER OF DEATH
DESCRIPTION
1• 7 KINGSWOOD DRIVE 6129,900.00
MECHANZCSBURG, PA 17055
TOTAL (Also enter on Line 1, Recapitulation.) ~ ;
If more space b needed, use additional sheets of paper of the same size.
OMB Approval No. 2502-0265
A. Settlement Statement (HUD-1) FINAL
jsxR!
1 ^ FHA 2. ^ RHS 3. ^Conv. Unina. 8. File Number: 7. Loan Number: 8. Mongaga Insurance Case Number
SL12359 xxldba1073 101060533446
4 ~ VA 5. ^Conv. Ina
C. Nob: Thb form h NmhhsO to glw you • atatameM of atlas! eeklemeM coals. Amounb peW to eM M tlu semamenl egenb ere shown Itama marketl
'(y.o.c)'vnee paW eubida the dpslr~g thsy ns shown hero Por Infprmefionsl Dumone end em not intluded in me toteh.
D. Name 8 Addran of eonovrer. E. Name 8 Addmsa of Seller. F. Name & Address of Lender:
James D. 3allou Eslale of Maria Chbvao 'Ndla Fargo Bank, NA.
9 Pens Ct. Una 154, Dlllabury, PA 17019 710ngssvood Odve, Mechanlpburg, PA 17055 2701 Welh Fargo Way, MinneapoRa, MN
55467AW0
G. Property Looetiort H. Settlement Agent I. Settlement Date: 0 7/1 32 01 2
7 {ingewood Odva Soled Land Transfers, LLC pisburaement pare: 0 7/1 32 01 2
Mechanicsburg, PA 17055 1705 Easl itlndb Road, Mechanlgtnug, PA 17050
Machanicaburg Borough
)17$125365
Place of Settlement TitleExpreas
4705 E. Tdndle Roai, MedlenbeWrg, PA 17050 Printed 0 7/1 32 01 2 al 2:35 Dm
by KL
~mmaR of Rorrmvoi s Transaction _ K Summary of Sellor's Transaeiion
100.
101.
702. Oros Amount Due hom Bomavwr
Cknhad sales price
Personal ro en
i ~, .W 100. Gran AmaurrtOwb3NMr
ontrad nin q
402 Personal
f ,
103. Seklemenl charge to tlartawx (One f/00) 6,133,07 403.
104. 404.
105. qp5,
Ad ushneMe br Mama b esOm In adranu M ustmenh for Mme b b adlsr In nvula
106.
f07. COyRown tarn ro
county taxes 0711312072 ro 12/31/2012
238.90 408.
407, CltyROwn texn to
County tarn 07NJY101z ro 17lJ1,2012
2&6.90
700.
109. Asanamenta (0
Sch~l Taxes 07/13120121008130/2013
1,472.36 400.
409. Assnamm~b b
Scholl Taxes 07113/2012 ro OSPJ02013
1,422.66
11C.
111 J/NS Sever ID113+1012 ro 09/3011012
DINS Iraah 07/131ZOtz to 09/302012 73.91
37.67 110.
411. JINS Sewer 07113/101110 09/30/2012
DINS ibah 07!1312011 ro 0913012072 73.91
37.87
1'1. 112.
120.
200.
10 .
202.
203. Gen Amoum Ow hom Bortoywr
Amowh Pant b or In &heROf Bortower
Depwtt a eamml money
Pnndpa~amanidnew bon(a)
Existin b e bken su act W 177,351.21
1,000.
132,850.00 420.
50g
50 ,
502.
503. Oron Amount oue m &Ilm
Reduckone m Amount Dw to SNbr
tees depaslt sea inatNLllona
SelOement charyesro seller (line l41b)
Exist' la a taken sub'ell to 1N,737.11
20,537.91
201.
275.
Cumhenand County Gant
3,000.00 504.
505. dOrsl mod loan
Payoff of second rtladgage ban
20fi. ~.
207. 507,
208,
209. Seller Credit
Seier Credit for Termite 30500
39500 503.
509. Sella Credit
Salter Credtfor TermM 905.00
395,00
Ad uarmeMa for Mme un sill b eNler Ad uetmenb for Mma un ofd b seller
210. ClryRown lazes b 510. ItY own lexm to
2t t. county tares ro 5!t. County taxn to
i11. Assessmenh b 5!2. Assesamenb to
213. Scrod iax l0 Sr3. Scrod Tax fm
214. 514.
215. 515.
216 518.
217. 517.
278. 513.
219. 519.
120.
]00.
701_
302. Tabl Pant Borrovae
Cseh et Setllemem hortdm Bomorwr
Gross amount due from bortower (IIna 120)
less anpunU Paid lryRor Oonower (IIna 220) 177,850.00
137,85/.21
137,350.00 520.
000.
601.
902. Tobl Rsductlon Amount Dw Ssihr
Cnh d $Mkemnt MRrem SeOa
Gron amount duo to Seiler(Ilne 420)
Less redudians in amount due seller (line 520) 21,737.91
171,721.71
Zi 737.91
707. Cnh ^X From ^ To SeROwer
rarm.~.~..,.„m oue own..,w...e one..eau,...v 4.11
mw:n,m,.,.~.,m..ua..m. 007. Caeh ^X To ^ From Soler
,.e..,e,.a.m.-e.,M.~....,...e......~.......~ ...._..-..~ 109,987.23
W
See attached addendum for additional Information
vrevbus etlkions are obsnieM Page 1 o MUD-l.
roM. TaW Real Eshh arokar Fen 7,722.00
Divisbn dcommissbn line? aldbwa: Pald From
Borrower's Pald From
Seller's
701. 53,861.W to ERA NRT, Ina FU nds a[ Funds a[
702. 83881.00 b M ary Capita Area Settlement Settlement
703. CommUala pad a settlement 7,722
704. esker Canmiss b E NR .Inc. 00
705. Deed Prop fee to E N ,Ina 100,00
/~ ro
M00. Mama P In Connectlon vAN loan
801. Our originatlm charge (InclWa Odginatbn Pdnf aEO. J ham Edi)
802 Your aedil a charge (pdnral the a hderat role chosen 1,6 .13 M2)
803. Your arAusledad9Na8on charge (ham A)
80/. Apprelsal lee to RELS Vauaion (hen Gf )
MOS. Credtt report bRELS Credl 0rorn M3)
8C6. Tea service to from GFE M3
1, .13
775.00
200
807. Flood ceNecaBOn to hen GFE Y3
BOB. b
900. Memo R rdrsd b Lender io M Paid In Menu
801, Daly interest rJtaga hen Iron 7n3f201 b 0 1 12 ~ 13.8300idey (iron FE M 0)
2 Mortgage lna.PreMUm a monlheb dVA (~GF 113)
903. Hanewvna's Insurnce fa 1 months b USM (fian GF 1)
904. maMS b ftan GFE pt 1
25 .97
2,79 .BS
5 .02
i Rao Len
1001. Ini11a OeposM fa your esaow aaounl (ham GFE M9) 438.38
1002. Haneownels insurance 3montha 43.341monM Ei30.D2 bWdls Fa R NA.
1~3. Mangage Insurance monma 232.74/month f fa
1001. City Properly Taa monNa S O.OOImaM S to
1005, County Propamy iex 6 momha E 50.BBImonth 5305.28 to Wdls Fer Bank N.A.
1008. Sdrod Property Tea 2monMa f 125.041mdnb f25008 fo WdbF oBank NA.
1007. Aggregal8 A~usmrem 1247.02 W Wale Fa Bank NA.
110D. TMIe Ch w
1101. Title servba and IerWefa Mlle neumnrz fran GFE M4 1,3 .00
?102. Satllanenf ordering fee b S
1103. Ornate NMe InsureMe -FNdity Natlana Ttle Insurance Canpany ham GFE #5
110/. Laurels Title Insurance - FidelMy NaBOna Title Inarence Company 51,290.00
? 105. Lenders title po8cy limit 5132,850.00 Landers Pdiry
1108. Oxnele 8Ue polry Bmn 5129,900.00 Ornate PWIq
1107. AgenYS portion d Me total mb Insurance premium 51,032.75
1108. UMerwdLLMS ponidnMme tea tkle iruuraice premium 8257.25
1?09. E-Doc Oslivery Fa to Select Land Transfere 525.00
1' 10. CoWer~re Fee b Sded lmd Transfer 515.C0 10.00
1111. Notary fa to Kandi Lenkar 525.00 20.00
7?12. Rehnburae fa Tax CertiSCatian MSeled land irenslere S 10,00
1200. Govammal Racordln end Tnnsfx Cha a
1201. Goammem nxmdlrg charges f (hom GFE MT) 214.00
?202 Deed 582.00 Ma 98.00 Releaef Ice Cumberland Caen Recorder
1703 iransfa loxes E (hom GFE NB) 1,299.00
1201 City/County hax/atampa peed 119900 Mat a to Cumbenand Coun Recorder
1205. Stare 7axiaampe peed E1.199.W Mon a bCumberlantl Count Recede 1,299.00
1208. Deetl S Man e f b
1207. Rarnd Cumb Cty Gmnt Agt 527.90 ro
1208. upfront Grand Rdeaee Fee 52790 to Retarder d Deeds
1]00. Addltlond BsllMmenl Cha a
1301. Required aervkss Mal you can fa Aran G E M6) 11 .00
i az 're ee to Weiler F Rea Estate Tax 00.
1 3. F (Life d U;at) to Wells fa Flood Servlca 1
1304, July/Auy apt rash to dMechanirsbu 128.3
?:105. al due7JMIJ Serer rash to Bar d MachanicsMt
1 ertnif Tare Inspect to Mike Sh Homelm a 5395.00 P,O.C.IB'
1307. Tub ,ishing Io G.P. Dart Relinlahin '3
~
1308. 201 -1 Tat to Ba L Heckaro 1,471.0
1;1179. InnenLyKe Tar Essex to Shumaker 8 Vflliame .768.2
131 Horte'Nananty (o FiretAmencan
,:,,;r , r 6,133.07 20,537.9
'Pad outside d dosing Dy (B)ortowar, (S)eller, (C)areer, (I)nvasb, 3ro(K)er. "Cedit by tenor shorn do page 1. "'Credit to selle~ shown on page t.
See attached addendum for additional information
Prnvlous editions are obsolete Page of 4 HUD-1
REV-1509 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEF
JOINTLY-OWNED PROPERTY
ESTATE OF: FILE NUMBER:
MARIE C• CHIOVARO 21 11 0467
If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. LISA WILSBACH 6217 BLUE STONE AVENUE DAUGHTER
HARRISBURG, PA 17112
B. FRANK CHIOVARO
6617 FAIRDEL AVENUE
BALTIMORE, MD 21206
SON
C.LORETTA HAMILTON (CHIOVARO) 309 OAK MANOR DRIVE
APT• T-4
GLEN BURNIE, MD 21061
JOINTLY•OWNED PROPERTY:
DAUGHTER
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALIIE Of ASSET %OF
DECEDENT'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTERESI
i. A. 112205 MEMBERS 1ST 5606.06 8.333 550.50
SAVING ACCOUNT N0: 35697-01
2• C• 010394 MEMBERS 1ST 5475.24 50. 5237.62
CHECKING ACCOUNT N0: 137410-11
3• C• 010394 MEMBERS 1ST 5692.46 50. 5346.23
SAVINGS ACCOUNT N0: 137410-00
4• A•B.C. 111883 MEMBERS 1ST 54,D00.52 8.333 5333.36
SAVING ACCOUNT N0: 35697-04
5• A•B.C• 111883 MEMBERS 1ST 52,302.76 8.333 5191.89
SAVING ACCOUNT N0: 35697-00
6• A• 121483 MEMBERS 1ST 53,221.88 50• 51,61D•94
SAVING ACCOUNT N0: 35953-00
7• A. 121483 MEMBERS 1ST 54,000.52 SD• 52,000.26
SAVINGS ACCOUNT N0: 35953-04
TOTAL (Also enter on Line 6, kecapitulaticn) S
It more space is needed, use additional sheets of paper of the same size.
PENNSYLVANIA INHERITANCE lAX
`„_ INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21
PD BDx 280601 TAXPAYER RESPONSE ACN 11120934
WIRRISBURG PA 17128-0601
DATE 03-30-2011
REV-1561 ER RFP (I!-OEI
LISA WILSBACH
6217 BLUE STONE AVENUE
HARRISBURG PA 17112
EST. OF MARIE CHIOVARO
SSN 0911-26-0978
DATE OF DEATH 03-20-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKI N6
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Department with the information below, which has boon used in calculating the
potential tax due. Raeo rds indicab thst at tM death of the above-nomad de eetlenb you ware a Point owns r/banef ieiary of this account.
If rou feel the inf ormatian is into meet. please obtain written correction frog the (inane ial inxt itution, attaeA s copy to this fora
and roturn it to the above address. This account is taxable in aeeordanu with the Inheritance 'fax laws of tM Couonw ealth of
Pennsylvania. Pleaze call (7l7) 787-8327 with questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No.- 35697-01
Account Balanea
Poreant Taxable
Amount Subject to Taz
Taz Rato
Potontlal Tax Dua
Dato 11-22-2005
Establishetl
$ 606.06
X 8.333
$ 50.50
X .045
$ 2.27
PART
CHECK
ONE
BLOCK
ONLY
Te en zuro proper endit to the account. two
copies of this notice oust aecompam.
payment 1:o the Repisiar of Wills. Make chock
payable 1:0 "Rapister of Wills, Agent".
NOTE. If tax pavme nts era mods within throe
month of the decedent's dab of doth.
deduct a 5 percent discount on Me tax dw.
Aro Inheritance Tax duo will b¢ou delincuent
nine aonths attar Lhe data of death.
A. ~ The above information and tax duo is eorraet.
Remit payment to the Repisbr of Wit L. with two copies of this notice to oDt do
a discount or avoid iota rest, or chock Dox "A" and roturn thiv notice to the Rep inter of
Wills and an official assessmanL will be issued by the PA Oepa rtment of Revenue.
B. ~ Tha above assek has been or will be raporGd and fez paid with Lha Pannsvlrania Inheritance Tax ntu rn
to be ti lad by tM •staL rapra septa tiva.
C. ~ TM above Snforma son is ineo rrect and/or debts and deductions were paid.
CompleG PART ~2 and/or PART ~ below.
PART If lndicatlnp a tlifforont tax rata, plaasa state (yD '" i° i1~I' Cj ! ~ ~` M ~ i~ilff
~
relationship t0 dacedont: j 11 ' Y J ~
~~~
TAX R ETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~ ~ k~
LINE 1 . Date Establishetl 1 ~
2 . Account Balance 2 S
3 . Percent Taxable 3 X
4 . Amount SuDfeci to Tax 4
5 . Debts and Deduc tf ens 5
6 . Amount Taxable 6 S
7 . Tax Rat• 7 X
e . Tax Du• e $
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Under penalties of pert ury, I declare that the facts I have repprtetl above are true, correct and
complete to the best of my knowledge antl belief. HOME ~ )
WORK ( )
TAXPAYER' SIGNATURE TELEPHONE NUMBER DATE
rcnnart. vfAn afA annonaeftFaVC 1
__~,, INFORMATION NOTICE
~- BUREAU OF INDIVIDUAL TAXES AN D
PO BOX 280601 TAXPAYER RESPONSE
HARRISBURG PA 17128-0601
esv-va ee ur ue-oaf
FILE NO. 21
ACN 11120940
DATE 03-30-2011
EST. OF MARIE (:HIOVARO
SSN 094-26.-0978
DATE OF DEATH 03-20-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
LORETTA CHIOVARO
7 KINGSWOOD DRIVE
MECHANICSBURG PA 17055
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
SAVINGS
® CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Oepartaent with the inforaation below, whi eh has bean used in calculating the
potential tax due. Records intlieat• that at the death of the above •naaed decadent, you were a mini owner/banef ieia rv of this account.
If you foal the inforaation is incorrect, please obtain written correction frog the financial institution, attach a cony to this fora
and return it to the above address. This account is taxable in accordance with the Inheritance Tax laws of the Coaaamvealth of
Pennsylvania. Please call (717) 787'8527 with owstions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 137410-11
Account Balance
Percent Taxable
Amount Subject to Tax
Taz Rate
Potontlal Tax Du•
Dat• D1-03-1994
Establishetl
$ 475.24
X 50.000
$ 237.62
X .045
$ 10.69
To ensurx proper credit to the account, two
eopiea of this noti ca aunt aeeoapafa.
payaant Ro the Repl star of Wills. Make chock
pavab to to "Repisbr of Wills, Agent^.
NOTES I4 tax D+yaenis an aada within thus
aonths otl the daadant's data of tlaath,
deduct a 5 pereeot di seount on Lha taz tlw.
Arw Inhu-itanca Tax due will becow delineumt
nlna aonths afbr the tleG of death.
P
T TAXPAYER RESPONSE
~
1
A. ~ The above infonation and kex due is cornet.
Ruit psywnt to the Register of Wills withtwo copies of thls notice to obtain
CH EC K ~ a di seount or avoid interest, or cheek box "A^ and return thin notice to the Rapistar of
r
I Wills antl an off iei al rise ssaent will be issued by the PA Dep artaent of Revenue.
I ONE I
L BLOC K J B. ~ The above asset has been or will be reported and tax oaitl with the Pennsylvania Inne ritante Tu return
ONLY to be filatl by the estaL more sentetive.
C. ~ The above info ra son is incorrect and/or tlebts and deductions were paid.
Coapleta PART 2 and/or PART ~ below.
PART If in tllcatinp a tllffarent tax rata. please atat•
relationship to decodont:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Eakablished 1
2. Account Balance 2 S
3. Portent Taxable 3 X
4. Amount Subject to Taz 4 S
5. Debts and Detluctlons 5
6 . Amount Taxable 6 $ 'Iti ~~
7 . Tax Rate 7 X
8 . Tax Due 8 ~ ~r
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Untlar penaltlos of perjury, I declare that the facts I have re parted aDOVe are true, correct and
complete to the bast of my knowledge antl Daliaf. HOME C )
WORK C )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
YtNNJYLVANlA 1NNtK11ANLt I
~' INFORMATION NOTICE
l6~REAU OF INDIVIDUAL TAXES AND
PO 90X 280601 TAXPAYER RESPONSE
HARRISBURG PA 17128-0601
asv-uu fa err iae-eo
FILE N0. 21
ACN 11120939
DATE 03-30-2D11
LORETTA CHIOVARO
7 KINGSWOOD DRIVE
MECHANICSBURG PA 17055
EST. OF MARIE I:HIOVARO
SSN 09(i-26-0978
DATE OF DEATH 03-20-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS TO:
REGISTER OF WILLS
1 COURTHOUSE SWUARE
CARLISLE PA :17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU orovidetl the Oepar Lent with the infora anon Dal w, which has bwn used in ealeulatinp the
ooten tial tax due. Reeortls indicate that at the tlea th of the above-naaed decadent, you were a joint owner/banal iciary of this account.
If you feel the inf oraeti on is incorrect, Please obtain written ca traction frog the financial inatitutionr attach a coon to khis fora
and return it to the above atltlrass. This account is taxable in ace ordance wikh khe Inherik ante Tss laws of the Coaao,arealth of
Pennsylvania. Please call (717) 797-8327 with Questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 137410-00
Account Balance
Percent Taxable
Amount Subject Yo Tax
Tax Rate
Potential Tax Due
PART
'L^
Data 01-03-1994
Established
$ 692.46
X 50.000
$ 346.23
X .045
To en surx proper credit to the account, two
copies a4 this notice aunt eccoapany
payu nt Ro the Ragi star of Wills. Make check
payable Ro ^Repister of Wills, Agent".
NOTE, I1F tax payaenta era aade within throe
aonths otl the decvdmt's deb of death,
deduct a 5 pa rcent discount on the tax due.
Amt Inheritann Tax due will becou tlelinauegt
nine aonbhs of tar the daL of death.
A. ~ The ab ova inforastion and tax tlw 35 correct.
Reait payaent ko the Regi star of Willa with two copies of this notice to obtain
C HECK a tli seount or avoid inb re st, or check box "A" and return this notice to the Register of
r Wills antl an official asse ssaent will be issued by the PA Oepartaent of Revenue.
I ONE ~
L BL D(:K B. ~ The above asset has bean or will ba reported and tax paid with the Pennsylvania Inheritance Tax rata rn
ONL Y to be filetl by the estate representative.
C. ~ The above infor a ion is into tract and/or debts and deductions ware paid.
Coaplet• PART 2~ and/or PART 3^ below.
ppRT If Sn dleatinp a different tax rate, please state .
_ ' #~ ~ '~4 ~i Q
relationship to decedent: .
i i~U
~ ~ i
+
~~
~
-
~
.
TAX RE TURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~1 ~~~'~ {#-
LINE 1. Date Established 1
2. Account Balance 2
3. Percent Taxable 3 X
4. Amount Subie<t Yo Tax 4 .S
5. Debts and Detluctlons 5 -
,,~ s. ,
~
6. Amount Taxable 6 $ ~ {
~~3 e~~?~1¢+~
u.
7. Tax Rat• 7 X ~#~~t~i4'~
QI.
8. Tax Due 8 ~ `~` ~~~ r .. ,u
PART DEBTS AND DEDUCTIONS CLAIMED
Under penalties of perjury, I declare that the leafs I have reported above are true, correct and
complete to the Dest of my knowledge and belYef. HOME C )
WORK ( )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
BUREAU OF INDIVIDUAL Taxes AND FILE N0. 21
PD Sea-zBn'de] TAXPAYER RESPONSE ACN 11120931
HARRISBURG PA nlza-oepl DATE 03-30-2011
pfv-~sre ex err iae-pu
LISA WILSBACH
6217 BLUE STONE AVENUE
HARRISBURG PA 17112
EST. OF MARIE CHIOVARO
SSN 094-26-0978
DATE OF DEATH 03-20-2011
COUNTY CllMBERLAND
REMIT PAYMENT ANp FORMS TD:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CNECKIN6
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Oepartunt with the info nation below. which has bane used in caleulatinp tM
potential ta: dw. Records indicab that at the death of the above-nand ancedent, vow wen a !Dint owner/beneHcisry of this aeeoont.
[f You feel the inf oraati on is iota rrnct, please obtain written correction tray the financial institution, attach s copy to this fora
end return it to tM ab ore address. This account is taxable in attordanee with the Inhe ritanee 'fax laws of tM Gouepw •slth of
Pnnnsyl vania. Please call (717> 787-8527 with questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account no. 35697-04
Account Balance
Percent Taxablo
Amount Subloet to lax
Tax Rate
P otnntlal Tax Due
Dat• 11-18-1983
Est abl3shntl
g 4,000.52
X 8.333
g 333.36
Y .045
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
II NE 3. Data Established 1
2. Account Balance 2 $
3. Percent Taxebla 3 X
4. Amount Subject to Tax 4 $
5. Debts antl DoductSOns 5 -
6. Amount Taxable 6
7. Tax Rat• 7 X
e. Tax Dun 8 S
To msuro proper cn dit to Oho account two
copies oT this notice au st aecoapaplY
payannt t:o the Re pi star of Wills. Make check
payable t:a ^Rnpiz br of Wills, Avant".
NOTEp I1' tax payunta an ude within three
amths of tM dwndnnt'a darn of do eth.
deduct e 5 parent diaeount on tM taz due.
Amf I~Mritann Tax due will becow Jelinaumt
nine aonths attar the dab of dnth.
PART uen e a env ucuws. p a vna
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
WORK C )
TAXPAYER SIGNATURE rEi cvunup NtlIMRLR narc
Under penalties of perjury, I dntlare that th• facts I have reported above am true, correct and
comp lute to the best of my knowledgo and bellef. HOME ( )
`!/°' PENNSYLVANIA INHERITANCE TAX
~_ ~1~ st~i INFORMATION NOTICE
auREAU DF 1NDrvmuaL taxes AND FILE N0. 21
PD sox zaosBl TAXPAYER RESPONSE ACN 11120928
HARRISBURG PA 17128-0601
DATE 03-30-2011
vex-i sae [z ur oe-om
1
4~~~,
LISA WILSBACH
6217 BLUE STONE AVENUE
HARRISBURG PA 17112
EST. OF MARLE CHIOVARO
SSN 094-26-0978
DATE OF DEATH 03-20-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
^ CHECKING
^ TRUST
^ CERTIF.
MEMBERS 1ST FCU pravidetl the DapartmanL with the inforution below, which has bean used in calculating the
ootantial tax duo. Racorda indi ute that at the death of the above•noa0 tleadant, veu wen s joint owner/benaticia°v of this account.
if you teal the inf orma lion is into rree t, plc ese obtain written co rraction frog the financial institution, attach a copy to this fora
and return it to the above address. This account is taxable in aeeo rdanea with the Inhe ritanea Tax laws of the Coamonwealth of
Pmnsvlvania. Plaav call 1717) 787-9327 wiM auctions.
COMPLETE PART 1 BELOW ~ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 35697-00
Account Balance
Percent TaxaDla
Amount SuD3ect to Tax
Tax Rata
P otentlal Tax Due
PART
r CHECK
I ONE
L BLOCK
ONLY
Data 11-18-1983
Eatablished
$ 2,302.76
X 8.333
$ 191.89
To an sun proper endit to Me account, two
copies of this notice gust accomparry
oeyunt to tM Regisbr of Wills. Make cheek
payable to "Reelster of Wills, Apent".
NOTES [f tax p+vmanb an made within thrw
eon MS pf the tlecedan t'a date of death,
deduct a 5 percent discount on the tax due.
A,ar Inks ritenca Tak due will become tlelinouent
nine months alter the deb of tlesth.
A. ^ The above iota rmation end tax duo is eor net.
Raait payment to the Register oP Wills with two eoples of this notice to obtain
a disc aunt or avoid iota re at, or chock boz "A" and return this notiea to the Ragistar of
Wills and an official assessunt will be issuatl by the PA Dwmrbent of Revenue.
^ The above asset has bean or will Da reported and tax paid with the Pennsylvania Inheritance Taz return
to be filed by the estate rep rasan ta4iva.
C. ^ Tha above inf oraa ion is ineorr ct and/or tlebts antl tleduetions were paid.
Complete PART ~2 and/or PART 3~ below.
PART If Ind3eaking a different tax rata, please state
~' relationship to decetlent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Data Established 1
2. Account Balance 2 +t
3. Percent Taxable 3 X
4. Amount Su b.7 act to Tax 4 Sa
5.
Debts and Deductions
5 ti, a
6. Amount Taxable 5 S
7. Tax Rata 7 X
e. Tax Dw 8 $ ~ -
1:, ~
PART DEBTS AND DEDUCTIONS CLAIMED
^3
DATE PAID PAYEE DESCRIPTION
eBtnuur porn
Under penalties of perjury, I declare that the fa<ts I have reDOrtetl above are true, correct and
complete to the best of my knowledge and belief. HOME C )
WORK C )
TAXPAYER SIGNATURE TFI FP Hf1NF NIIMRFR nAr~
PENNSYLVANIA INHERITANCE TAX
INFORMATION NOTICE
~EAUDP /NDIVIOUAL TAXES AND FILE N0. 21
PO BOK Z8a601 TAXPAYER RESPONSE ACN L11zo937
HARRISBURG PA 1]128-0601 DATE 03-30-2011
pEV-150] Fr IpP 100-1!)
LISA WILSBACH
6217 BLUE STONE AVENUE
HARRISBURG PA 17112
EST. OF MARIE I:HIOVARO
sex 094-26-0978
DATE OF DEATH 03-20-2011
COUNTY CUMBERLAND
REMIT PAYMENT AND FORMS T0:
REGISTER OF WILLS
1 COURTHOUSE SgUARE
CARLISLE PA Il7013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS LST FCU vrovided the Devartmant with the info rmetion below. which has been used in ealc ulatina the
potential tax due. Records Indic eta that at the death of tM abvvrnaud decadent, vau wan a mint owner/banof ieisrv of this account
tf you feel the information is incorrect, plwv obtsin written correction from the financial institution, attach a copy to this fore
and return it to tN above address. This account is taxable in accortlanc• with t M Inheritan ca 1'ax laws of the Couonwealth of
Pennsvl vania. Pleesa call (717) 787-8327 with qua stiona.
COMPLETE PART 1 6ELOW ^ SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 35953-00 Dste 12-14-1983 To ensure proper ereeit to the account. two
Established copies of this notice moat accompaml
payment to the Resister of Wills. Make chock
A ecount Balance $ 3x221.88 pavabL to "R eeistar of Wills, Apen t".
P arc ant Taxable X 50.000
NOTE, If tax payments an made within throe
Amount Subject to Tax $ 1,610.94 months of the dacedant'a data of de sth.
R
t X .045 deduct a 5 pereenf discount on the tax due.
e
a
lax Aga' Snheritonce Tax due will baeomo tlalinquent
Potential Tax Oue $ 72.49 nine months after the tlat• of death.
u
TAX RETURN - COMPUTATION
LINE 1. Data Established
2. Account Balance
3. Percent Taxable
4. Amount Subioct to Tax
5. Debts and Datluc tfons
6. Ampunt Taxable
7. Tax Rat•
8. lax Du•
OF TAX ON JOINT/TRUST ACCOUNTS
2 $
3 X
4 $
5
6 $
7 X
PART ucD~a nnu ucu w,-~iwna a.~nancr
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
WORK C
TAXPAYER SIGNATURE TFI FPHnuF NIIMRFP next
Under penalties of pa riury, L declare that the facts I have reported above sire true, correct and
comp la to to the bast of my knowladg• and ballet. unMF ! 1
PENNSYLVANIA INNERITANCIE TAX
INFORMATION NOTICE
uUR EAU OF IND1V70WL TAXES AN D
PG BDX 280601 TAXPAYER RESPONSE
NA@y.1gaURG PA 17128-6601
RfV-15f5 EC CFP IOG -O RI
FILE N0. 21
ACN 11120938
DATE 03-30-2011
EST. OF MARIE C:HIDVARO
SSN 094-26-0978
DATE OF DEATH 03-20-2011
COUNTY CUhIBERLAND
REMIT PAYMENT AND 1=0RMS T0:
LISA WILSBACH
6217 BLUE STONE AVENUE
HARRISBURG PA 17112
REGISTER OF WLL.LS
1 COURTHOUSE SCIUARE
CARLISLE PA 17013
TYPE OF ACCOUNT
® SAVINGS
CHECKING
TRUST
CERTIF.
MEMBERS 1ST FCU provided the Oepar boot with the information below, which has bean used in ealculatinp the
oobntial tax dw. Records indicate that aL the death at the above-named deaedant, you wen a joint owner/benef iciafy of this account.
If you teal the information is incorrect, please obtain written correction frog the financial inst itutipn, atkach a cony to th iz form
and roturn it to the above add ra sz. This account iz taxebL in accordance with the Inheritance 1'ax laws o4 the Couorwealth of
Pennsylvania. Please call (717) 767-8327 with questions.
COMPLETE PART 1 BELOW ^ SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS
account No. 35953-04
Account Balance
Percent Taxable
Amount Subject to Tax
Tax Rat•
Potential Taz Dua
Data 12-14-1983
Establlshetl
$ 4,000.52
X 50.000
$ 2,000.26
X .045
S 90.01
To ensure proper credit to the account, two
cosies of this no ties must accompafry
payment to the Regi star of Wills. Make chock
gar able to "Register of Wills, Apmt".
NOTE: If tax gavmenta are made within three
months of the deaden t'z date of death,
deduct a 5 gereent discount on the tax tlua.
Arty Inheritance Tmc tlua will bexou tlelinquent
nine months of tar the data of death.
A. ~ The above information and taz tlua is correct.
Remit pavun4 to the RagisLr of Willa with two copies of thim notice tp obtain
C HECK a tli seount or avoid interest, or chock box •'A" and return this notice to the Register of
ONE Wills and an official assessment will be issued by the PA Department of Revenue.
BLOC K B. ~ Tha above asset has been or will be reported and fax paid with the Pennsylvania Inheritance Tax return
ONL Y to be filed by the estate representative.
C. ~ The above informs son is incorrect and/or debts and deductions ware paid.
Coop le to PART 2~ and/or PART 3^ below.
PART If Sndieatinp a tlifferent taz rate, phase state
relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
~,
LINE i. Date Established 1
2. Account Balance 2
3. Percent Taxable 3 X s
4. Amount Subject to Tax 4 $
5. De bis and Deductions 5
6. Amount Taxable 6 S .;
7.
Tax Rata
7
X i
e. Tax Due 8 $ y~. ~'
~{
PART DEBTS AND DEDUCTIONS CLAIMED
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
Untler penalties of perjury, I declare that the facts I have reported above ore true. correct antl
complete to the best of my knowledge antl belief. HOME C )
WORK ( )
TAXPAYER SIGNATURE TELEPHONE NUMBER DATE
REV-15'17 EX+(10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
MARIE C• CHIOVARO 21 11 D467
Decedent's debts must be repoAed on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MYERS FUNERAL HOME, INC• #4,307.50
2• FUNERAL LUNCHEON #800.00
B.
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
City
Year(s) Commission Paid:
State ZIP
p AtromeyFees: SHUMAKER WILLIAMS, P•C•
9, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant LORETTA HAMILTON (CHIOVARO)
Street Address 309 OAK MANOR DRIVE, APT• T-4
City GLEN BURNIE State MD ZIP
Relationship of Claimant to Decedent D A U G H T E R
4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS
6 Accountant Fees:
6. Tax Retum Preparer Fees: E• BUGOSH
7
#2,000.00
#3,500.00
#315.50
#20.00
TOTAL (Also enter on Line 9, Recapitulation) S
more space is needed, use additional sheets of paper of the same size.
Myers Funeral Home, Inc.
Boyd L. Myers Jr., Supervisor
37 East Main Street
Mechanicsburg, Pennsylvania 17055
(717)766-3421
Fax (717)795-7291
A standard of excellence in Central Pennsylvania since 1910
Saturday, March 26, 2011
Frank Chiovaro
6617 Fairdel Avenue
Baltimore, MD 21206
Dear Frank,
Thank you for selecting our funeral home to provide services for your famiy during your bereavement. I
hope that you found our services to be of the highest standards and that they met your needs and those
of your family and friends.
The following is a summary of the service charges as previously explained and provided in written form
and herein indicated as PAID-IN-FULL.
Marie C. Chiovaro
SUMMARY OF EXPENSES
TOTAL OF SERVICE RENDERED §4,307.50
LESS: Credits granted 772.00
LESS: Total Payments 3,535.50
CURRENT BALANCE E0.00
Credtts Granted: 5772.00 Package Price Discount
If there are any questions or concerns that remain unanswered, please call me.
Sincerely,
f ' ~~~!' ~l`"
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
CHIOVARO MARIE
Estate File No.:
Paid By Remarks:
2011-00467
WZRETTA CHIOVARO
Receipt Distribution
Receipt Date: 4/13/2011
Receipt Time: 10:00:51
Receipt No.: 1065191
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 260.00 CUMBERLAND COUNTY GENERAL FUN
WILL 15.00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN
---
Cash -------------
$315.50
Total Received......... $315.50
~
~_ _ ___ __ _ _ _ ~.~:..:sacu.i+.~w•.N~~~-w~]Unf~~f•]rP~:l~lileH171~11 AM:-•\OICe 1~9Cl~lat~
~
PayaW RRY L HECKARD SR TAX COLLECTOR Office Hours: MAR-APR TU£3 8 THURS t0AM4PM Bill No: 492
t305 SOMERSEt DRIVE JUNE-D£C TUES iDAM-4PM Btll Dete: 311110
MECHANfCSBURG, PA 17055 CLOSED MAR /1, AUG 5208 ALL HOLIDAYS Control No: 18000411
Phone: (717) 788.8205 PHONE (717) 788.8205
MAP NO: 1&72-0519287 tt
Deec: 7 KINGSWOOD DRIVE ~ =a I
Acres .17D Deed: 0030M-0g1p0276
LOT 27 BLK DD BA30 PG'1'76 2 c0, 2
~ry~ Realdepnt~lagqlppBuikfin9
II~~~~~~~AIIB~~~ E3rlRi." ;iLG'
MEGH~, :~;.,,.,
Tax Payer.
CHIOVARO, MARIE
7 KINGSWOOD DR
MECHANICSBURO, PA 170tiS-2781
0
m
e
0
Assessed Vatue: Land: 25,000 Improvement: 04,140 Total: 108,140
Discount Fece Penalty
OUNTY R/E 239900 5258.59 528/.83 5280.01
COUNTY LIB .18000 519.28 519.85 511.62
I IC. R/E 3.25000 7.82 5354.71 5390.18
,1AMOUNT DUE
• ~ • ~~Dtte Of Payment Ys On
3)1N 0 t 5823.47 ~ 5838.19
S7/10 tlIN B/JO170 5898.81
7/1110 or Latsr
RECEIPT DATE o <6/~~t! 1646
RECEIVED FROM ~P~,~/7L~'-!~i)!J-
ADDRESS
h ` _ _ DOLLARS O. OO
r
ACCOUNT HOW PAID
OUNT CASH
AMT. PAID CHECK L(
BALANCE OUE MONEY ORDER BY 4"
REV-1512 EXi (12-06)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TA% RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS Of DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
MARIE C• CHIOVARO 21 11 0467
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. HOSPICE OF CENTRAL PENNSYLVANIA 57,200.OD
CUSTOMER ID~ CHIOVARO
2• REAL ESTATE PROPERTY TAXES 51,455.24
7 KINGSWOOD DRIVE
MECHANICSBURG, PA 17055
3• PPBL 5257.06
ACCOUNT N0: 42879-24505
4• LISA 8 ROBERT WILSBACH 61,305.15
REIMBURSEMENT FOR EXPENSES PAID FOR REPAIRS TO DECEDENT"S HOME
IN ORDER TO PREPARE IT FOR SALE
5• LORETTA HAMILTON (CHIOVARO) 5292.99
REIMBURSEMENT FOR PAYMENTS TO KEEP UTILITIES ON FOR
PURPOSE OF SELLING HOUSE
6• FRANK CHIOVARO 52,665.11
REIMBURSEMENT FOR EXPENSES PAID FOR REPAIRS TO DECEDENT'S HOME
IN ORDER TO PREPARE IT FOR SALE
TOTAL (Also enter on Line 10, Recapitulation) I S
If more space is needed, insert additional sheets o) the same size.
Hospice of Central Pennsylvania
1320 Linglestown Road
Harrisburg, PA 17110
Voice: 717_732-1000
PaX: 717-234-0375
Resident:
Marie Chiovaro
C/O Loretta Chiovaro
7 Kingswood Dr
Mechanicsburg, PA 17055
~1C';~
UP i;A\"rR\L M~VKSYL\i\\L1
2g,~~
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Resident ID: chiovaro
942E
Invoice Date:
3131/11
Page:
1
Payment Terms Due Date
Net 15 Days 9115/11
Description
Amount
esidential Care - March 1-20, 2011
t:s:.~
a 7,200.00 i
I
Please note our new office address -- 1320 Linglestown Road,
Harrisburg PA 17110
Total Invoice Amount 7, 200.00
ChecklCredit Memo No: Payment/Credit Applied
TOTAL 7, 200.00
Invoice
Invoice Number:
Thank you for choosing Hospice of Central Pennsylvania.
Hospice of Central Pennsylvania
1320 Linglestown Road Statement
Harrisburg, PA 17110
Statement Date:
Apr 9, 2011
Voice: 717-73z-loon Customer Account ID:
F aX: 717-234-0375 Chiovaro
Account Of: Marie Chiovaro
C/O Loretta Chiovaro
7 Kingswood Dr
Mechanicsburg, PA 17055
Amount Enclosed
Date Due Date Reference Paid Description Amount Balance
/17!11 4867 ayment -2,000.00 -2,000.00
/28/11 /15/11 371 art 6,120.00 4,120.00
3/15/11 871 ayment -6,120.00 -2,000.00
/31/11 /ls/11 426 7,200.00 5,200.00
Total s,2oo.00
PAYFaIE TO
SARRY L IIECKARD SR
B05 SOMERSET DRIVE 717-76&8208
MECHANICSBURG, PA 17056
OESCnn1aM
A~E~NO - 18000412
MAP NO: t&22-A514267
7 KOVOSVrOOD DRIVE
ACRES .170 DEED 0030M/ 01078
WYNNEWOOD PAPo(
LOT 27 f3LK D PB 30 PQ 118
Reaben0al(Under 10 Acres)
RESIDENTIAL
TIJI W1YEe
CNIOVARO, MARIE
7 KIN6SWOD0 DRIVE
MECHANICSBURO PA 17055-2781
aFflCEXWee
~OC4-3,UZa TUES & THUR 10-4PM
SEPT-DEC TOES 10-4PM
CLOSED ALL HOLIDAYS 8
CLOSED ELECTION DAY
TAX PAYER COPY BIII No:
Conhol No:
Aatea 12.168001 12.168001 12.168001 2
lSDli
TAX AMOUNT DUE -> sf,+ss.2~ st,~ea.st ` s,,1z~+.,al
If Paid Oa or After 7/01/2011 9/01/2011 11/01/2011
If Yaid On or Before 6/31/2D11 10/31/2011 12/31/2011
f1.00 FEE FOR EJ(TRA TAX BILL
RETURN BILL WfTH PAYMENT, ENCLOSE SELF ADDRESS STANP ENV.
IF TAXES ARE IN ESCROW, FORWARD BII.L'i0 NORT. CO.
/
NOTICE OF PROPERTY TAX RELIEF
Your encbsed tax bill includes a tax reductbn for your home sad ardor farmstead
property. As an eligible txuneslead arxYor farmstead props owner, you have receWed
tax re8ef through a estead and/or tartns[ead exclusbn ich has been provided
under the Pennsylvania Taxpayer Relief Act, a law passed the Pennsylvania General
Assembly designed to reduce your properly !axes,
~c~+r~q ~hi~s grnou~l` On
~o n c~~y g laa ~~
I
PPL Electric
Utilities
Electric
Service
For.
MARIE CHIOVARO
7 KIIdGSWQOOD DR
MLCHAMCSHURG PA 17033
Questions about
this bi0? Please
comet[ us Mar 29
at 1-800-34&5775
(1.800-DIAL.-PPL)
or write to-
Customer Service
827 Hausman Rd.
Allemown, PA
18104-9392
www.pplelecttic.com
Electric
Use
This graph shows
your elechic use
over the last 13
months.
Types of
Meter Readings:
Actual -
Adjused
Estimated
Customer Q
pp~ ;: ;~~ 3~a
3
Page 1
i' Yau"t3R1:`X .nu .~ ..ari6er
42879 24505
Summary Page
Balance as of Mar S, 2011
$o.oa
Chazgge~s:
TotaCV>rRDE EDer~y USA Charges $181.OE~
Total PPL Elechic Qhlities Charges $76.OG
Total Charges $257.06
s~`!`liS;AilAtip~; ihit~~<><>£<>`as''<<`f»'s>s"~s..
Account Balance $257.06
KWH -Average Per Day
84
70
56
a2
28
14
0
Meter Reading Wormatian
Meter 1184509329
Mar 4 Ac:tnal 10655
Feb 2 Actual _ 8641
30 Da s KWH Billed 2014
Average -Mar 2010 2011
T erature 32F' 34F
KWH Per Day 71 b7
Yearly Use: 'Total Ave e
Use Month
Apr 2009 -Mar 2010 14235 1186
Apr 2010 -Mar 2011 14494 1208
Other important information on back ~
MAMJJASONDJFM
2010 Months 2011
EXPENSES FOR:
7 KING5WOOD DR.
MECHANICSBURG, PA
**ITEMIZED LIST OF EXPENSES FOR THE PURPOSE
OF TAX FILING AND COMPENSATION**
LISA AND ROBERT WIISBACH:
• Front Storm Door and Rear Sliding Door Replacement and
Installation - $1305.19
Total: $1305.19
More saving.
More doing:"
6000 CARLISLE PIKE, MECH PA 17055
STORE MANAGER CHET KEELEY (717)795-9602
4120 00097 35049 03/08/12 09:42 AM
CASHIER - SPOSOI
CUSTOMER AGREEMENT # 357896
RECALL AMOUNT 1305.19
SALES TAX 0.00
TOTAL $1,305.19
XXXXXXXXXXXX4564 HOME DEPOT 1,305.19
RUTH CODE 008158/2972645 TA
IIIIII I IIIIIIIII III IIIIII~IIIIIIII III
4120 97 35044 03/08/2012 7282
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EXPENSES FOR:
7 KINGSWOOD DR.
MECHANICSBURG, PA
**ITEMIZED LIST OF EXPENSES FOR THE PURPOSE
OF TAX FILING AND COMPENSATION**
LORETTA HAMILTON (CHIOVARO):
• Chk 116- Utility on 5/11/12
• Chk 114- Utility on 5/5/12
• Chk 101- Utility on 2/21/12
• Chk 107- Utility on ???
• Liberty Tax Services-Tax Prep
-$64.00
-$11.08
-$16.91
-$17.00
-$184.00
Total: $292.99
~ 114
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JUNE 17, 2012 Sign OH
Accourlh Trensfsrs BIII Pay Customer Sarvlcs
ACCOUNT$UMMARV > CU5T0_MER.SERVICE> STATEMENTS 8 DOCUMENTS
Statements & Documents QHEL.
Related Links: Statement Copy Request ~ Order Copiesof Cleared Checks ~ View Cleared Checks ~ Delivery Options
Account Date
SoR by: Accounts
View: 60 days
Free Checking 6451
Statements
Insufficient Funds Notice
Relatlonahip Savings 9751
Checking 4451 106/0712.012 ( +~~ }c7
Checking 4451 05/07/2',012 ~ }~
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Questions about your electronic transfers?
LORETTA CHIOVARO
309 OAK MANOR DR APT T4
GLEN BURNIE MD 21061
INTEREST EARNED FOR STATEMENT PERIOD 0.00
ACCOUNT SUMMARY
BEGINNING DEPOSITS b OTHER CURRENT ENDING
BALANCE OTHER ADOnTON9 CHECKS PAID SUBTRACTIONS INTEREST PD BALANCE
NO. AMOUNT NO. AMOUNT NO. AMOUNT
469.4 8 1.219.70 1 30.00 39 1,463.23 0.0 195.9
ACCOUNT ACTIVITY
DEPOSITS.
Q~gIjNG INTEREST CHECKS d OTHER DAILY
DATE TRANSACTION DESCRIPTION 30THER SUBTRACTIO~y EALANCE
ADDITIONS
04-07-12 BEGINNING BALANCE $41
04-09-12 LIBERTY TAX 1749a GLEN BURNIE- $184.00
04-09-12 GIANT FOOD INC #141 GLEN BURNIE $85.39
47 2012 Menutacturero and Tredero Trust Comperry. Users M Nia web site aflr~ ~ be hountl by Ne provisions of the M8T Web Banking Tertna and
Contlrtons. View tha Terms and Conditions, Privacy Policy or Security Information.
C.0 2~T1A I~~I ~Ti~'~
https://onlinebanking.mandtbank.com/DoctunentLibraty/DocumentLibrary.aspa,: 6/17/2012
EXPENSES FOR:
7 KINGSWOOD DR.
MECHANICSBURG, PA
** ITEMIZED LIST OF EXPENSES FOR THF. PURPOSE
OF TAX FILING AND COMPENSATION **
FRANK CHIOVARO:
• Lawn Supplies-Home Depot 4/14/12 -$137.63
• Lawn Supplies-Home Depot 4/6/12 -$58.95
• Lawn Supplies-Home Depot 4/11(12 -$17.27
Lawn Supplies-Home Depot 3/3/12 -$1597.40
• Lawn Supplies-Home Depot 1/28!12 -$182.29
• Lawn Supplies-Home Depot 12/3/11 -$271.57
• Labor (Painter) - No receipt -$400.00
Total: $2,665.11
Mare saving,
~ o Mort; doing;"
~~
GNs~~
2°.i01 CLEANLEIGH vPTVE (rt0>661-8555
STORE MANAGER: TOE LAtOEN
25Ti' 00025 13pfu n4/06~ :2 03:46 PM
CASHIER COT1' C~JO~:.,
071645522011 WEED U FEED •A> r•'
V'IGORO WEED & FEED `M
032247855006 2Cf NS ADV3L ,
2CF SCOTTS NATURESCAPL : ~ ^'i M~'~ C
504.00 0 0
028872401008 BO SPL ?-P ~A 13.{7
B&'J NST2018, NSi1024, " w_
'~ SUBTOTAL '
SALES TAB:
IOTAi_ ~^
XXXXNXX~xNXX3649 VISA
AUTH COD[ 075090/325E4b5 r
~g e~
~~.111 N1'I~~~~~IIj1lflf~lf~ If~~`;,~~~~~0~9~~~lifl~i
k6iUHN PULICY UEFINI110Na
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L
K
H
~
STORE MANAGER
CHET
(717A796
9602
K~EMEY
~~~ r 4120 00008 26487 04/14/12 01:12 PM
CASHIER CHRISTOPHER - CXP4872
G RS~ A~ 716341008406 lIN XL DALE <A>
PURDY 1.0 XL-DALE ALL PAINT BRUSH
36
1
2
' 051
1150
835 2090 2" <A>
537
SCOTCH BLUE 2" PAINTERS 2090
NLP Savings 0.56
743184502945 EC B RCN OT <A> 5.99
ECHO BAR/CHAIN OIL: QUART
049206159440 FG LHSHVLRP <A> 25.97
HUSKY FBGL HANDLE DIGGING SHOVEL
046396861047 HL EL 16" <A> 74.97
SUBTOTAL 129.84
SALES TAX 7.79
TOTAL $137.63
NXXXXXNXXXXX3849 VISA 137.63
AUTH CODE 062084/5080375 TA
NEW LOWER PRICE (NLP)SAVINGS $0.56
4120 08 26487 04/14/2012 4921
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6000 CARLISLE PIKE MECH PA 17055
STORE MANAGER CHET K~ELEY (717)795-9602
4120 00023 74320 04/14/12 04:04 PM
CASHIER KAREN - KGF3738
032247845212 EARTHGRO RED <A>
2CF EARTHGRO BY SCOTTS RED MULCH
03099140879 MASON LINE <A> 12.97
N18 X 225' TWISTED MASON LINE-WHITE
SUBTOTAL 16.29
SALES TAX 0.98
TOTAL $17.27
XX;XXXXXXXXXX3849 VISA 17.27
AUTH CODE 077034/5230517 TA
Vl~ll~ll~~ll~l~l~ulllll~llllll
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6000 CARLISLE PIKE MECH PA 17055
STORE MANAGER CHET K~ELEY (717)795-9602
4120 00010 12590 01/28/12 02:15 PM
CASHIER NATE - NXR1872
SP FL AWH <A>
MATTE FLAT ANT WHT - 4.95
89.74
EZ SAND 20 <A> 11.90
LouE~
LOYE'S NOME CENTERS, INC.
SS00 CAALISCE PIKE
MECHANICSBUAfi, PA 17050 (117) 610-9230
.~ ;_
SASEs. z `'?__?" . ~., ,~,.0.
3B9', PNE ,F _r _
Y ~, 5
`,acNTAi
33.96 TAX• ;. _;
1.98 IN'JOICE V2030 TOTAL' 2". `,~
3.96 I UISR: 27~ S7
3.47
9.27
COV 3PK
6.27
2PK FINE
3.14
1> 3.98
f 1/2 PINT
<A> 4.30
SUBTOTAL 171.97
SALES TAX 10.32
TOTAL $182.29
XXXXXXXXXXXK3849 VISA 182.29
I RUTH CODE 062126/2107217 TA
u ~lul~liigllllllllllllNii~illl fllil~l
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6000 CARLISLE PIKE, MECH PA 17055
STORE MANAGER CHET KEELEY (717)795-9602
4120 00097 33247 03j03j12 01:44 PM
CASHIER - SPOSOI
CUSTOMER AGREEMENT # 357600
RECALL AMOUNT 1597.40
SALES TAX 0.00
TOTAL $1,597.40
XXXXXXXXXXXX1468 VISA 1,597.40
AUTH CODE 06125A/7972451 TA
Ilillllllllll III111IIIIIIIII111111III
4120 97 33247 03/03/2012 2777
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Page 1 of 1
REV-1513 EX+(Ot-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
MARIE C. CHIOVARO
SCHEDULE)
BENEFICIARIES
21 11 0467
RELATIONSHIP 70 DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List 7'ruetee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outr'ght spousal distributions and transfers under
Sec. 9t 16 (a) (12).J
1. LISA WILSBACH Lineal
6217 BLUE STONE AVENUE One Third
HARRISBURG, PA 17112
2• FRANK CHIOVARO Lineal One Third
6617 FAIRDEL AVENUE
BALTIMORE, MD 212D6
3• LORETTA HAMILTON (CHIOVARO) Lineal One Third
309 OAK MANOR DRIVE, APT- T-4
GLEN BURNIE, MD 21061
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18 OF REV-150D COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 5113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 GDVER SHEET. E
u more space Is neeaea, use aaartronal sneers of paper of the same size.
SHUMAKER
WILLIAMSP.~.
LEGAL AND BUSINESS COUNSEL
WRITER'S DIRECT DIAL: 717.909.1624
WRITER'S EMAIL: mcdermott(o)shumakenvilliams.com
Admitted to Pennsylvania Bar
September 18, 2012
Glenda Famer Strasbaugh, County of Cumberland, Register of Wills
CUMBERLAND COUNTY COURTHOUSE
One Courthouse Square N ~
~ ~
Carlisle, PA 17013-3387 ~' ~,
~
~~ ' ~ n
[
RE: Estate of Marie C. Chiovazo
0467
PA Fil
N
21
11
~~-?
e
o.:
-
-
Our File No: 11-697(2) $ -+ w ~rs
aD
Dear Ms. Strasbaugh:
We enclose, for filing, on behalf of our client the Estate of Marie C. Chiovaro, a
completed REV-1500 Inheritance Tax Return, Resident Decedent, with all supporting documents
and the Estate Inventory. We submit the Return to your office in duplicate as requested in the
Department of Revenue's instruction booklet for the same. Attached to the return are two
checks, one for $4,974.85 representing the inheritance tax due and a second check in the amount
of $30.00 representing the filing fee for the tax return and inventory.
We also enclose one (1) extra copy of the Return and Inventory, and request that you
time stamp these copies and return copies in the self-addressed stamped envelope provided.
Please advise the undersigned with any questions.
Sincerely,
~~ ~,~s~-
y Kenneth J. McLlermott
KJM/vae:249509
Enclosures
cc: Loretta Hamilton (w/out enc. -Via Email)
CORRESPONDENCE:
P.O. BOX 88
HARRISBURG, PA 17108
PHONE: 717.763.1121
FAX: 717.763.7419
CAMP HILL, PA 717.763.1121
STATE COLLEGE, PA 814.234.3211
TOWSON, MD 410.825.5223
YORK, PA 717.848.5134
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