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Home My WebLink About09-20-12 (2)' 150561140 REV-1500 EX (01-10) PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1, L 1, I, 3 7 2 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1, 8 8 3 2 4 6 5 3 1 2 1, 7 2 0 1, L 0 7 2 9 L 9 4 L Decedent's Last Name Suffix Decedent's First Name MI A N T O N I C E L L I M A X I N E 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 WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 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 ~ 5. Federal Estate Tax Return Required death after 12-12-82) QX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10, Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~1 U R R E L W A L T E R S I I I E S Q- 7 L 7 9 7 L' ~.: 4 5 0 r.,s ~ ~ ' ~1 REGISTE~ ILLS USQ'EJNLY ~; J ; >~~ ~ r ~ ~ ~ I ~~ H First line of address Ua ~ ~--' ` 5 4 E A S T M A I N S T R E E T ~~ ± ~ -- ~l Second line of address -~-f ~ ~ ~ t~'1 ~ `r°; City or Post Office State ZIP Code ~ DATE FILED f1 E C H A N I C S B U R G P A 1, 7 0 5 5 Correspondent's a-mail address: 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. SI ATU OF PERS N RESPON L FOR FILING RETURN DATE ''~ I Z I RESS FRANK J ANTONICELLI III, 1,804 BRIDGE ST NEW CUMBERLAND PA 1,7070 SIGNATURE O R AR O I THAN REPRESENTATIVE DAT ~~ ;~ ADDRESS ~1URRE A TE S I~I ESQ, 54 E • MAIN ST ~1ECHANICSBURG PA 1,7055 PLEASE USE ORIGINAL FORM ONLY Side 1 1,50561,01,40 1,50561,01,40 hu.~ Continuation of REV-1500 Inheritance Tax Return Resident Decedent MAXINE R. ANTONICELLI 21 11 1372 Decedent's Name Page 3 File Number Correspondents Name First line of address Second line of address City or Post Office Correspondent's a-mail address: Daytime Telephone Number State ZIP Code 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. TURE OF P S N ESPO SIBLE FOR FI NG RETURN DAT ADDRESS TINA L. ANTONICELLI, 5267 MEADOWBROOK DRIVE MECHANICSBURG PA 17050 J 1,50561,0240 REV-1500 EX Decedent's Social Security Number DecedenYsName: P1AXINE R• ANTONICELLI 1, 8 8 3 2 4 6 5 3 RECAPITULATION 1. Real Estate (Schedule A 1. 1 8 0 0 0 0' 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. I, 4 5 9 1, . 0 0 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. I, 5 4 8 7 6 . 1 2 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. • 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 1 4 9 6 6 5. 8 5 8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 4 9 9 1, 3 2 . 9 7 9. Funeral Expenses and Administrative Costs (Schedule H) .................. g• 1 3 7 5 8 . 2 2 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .... ......... 10. 1 5 9 2 5 . 5 1, 11. Total Deductions (total Lines 9 and 10) .................. . ... ......... 11. 2 9 6 8 3 . 7 3 12. Net Value of Estate (Line 8 minus Line 11) ................... ......... 12. 4 6 9 4 4 9 . 2 4 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. 4 6 9 4 4 9 . 2 4 TAX CALCULATION -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.o 0 0 0 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 4 6 9 4 4 9. 2 4 16. 2 L 1, 2 5. 2 2 17. Amount of Line 14 taxable at sibling rate X .12 0 D 0 17. D. 0 0 18. Amount of Line 14 taxable 0 ~ ~ 0 0 0 at collateral rate X .15 18. • 19. TAX DUE ............................................ .......... 19. 2 1, 1, 2 5 • 2 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 150561,0240 1,50561,0240 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 11 1372 DECEDENT'S NAME MARINE R. ANTONICELLI STREET ADDRESS 5023 LENKER STREET CITY MECHANICSBURG STATE PA ZIP 17050 Tax Payments and Credits: ~ ~ Tax Due (Page 2, Line 19) 2. CreditslPayments A, Prior Payments 19,000.00 B. Discount 950.00 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) 21,125.22 Total Credits (A + B) (2) 19,950.00 (3) (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,175.22 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 : ...................................................................... ^ Q b. retain the right to designate who shall use the property transferred or its income; ............................... ^ c, retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ Q 3. Did decedent own an "in trust for" orpayable-upon-death bank account or security at his or her death? ......... ^ Q 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. 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 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-1502 EX+ (01-10) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF: FILE NUMBER: MAXINE R. ANTONICELLI _ __ 21 11 1372 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 jointly-owned 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. 5023 LENKER STREET (HAMPDEN TOWNSHIIP) 180,000.00 MECHANICSBURG, PA 17050 APPRAISED VALUE TOTAL (Also enter on Line 1, Recapitulation,) ( $ 180,000.00 If more space is needed, use additional sheets of paper of the same size. REV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA -NHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER MARINE R. ANTONICELLI 21 11 1372 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. US SAVINGS BONDS 14,591.00 9 (I) @ $500 & 18 (EE) @ $500 NET REDEMPTION VALUE TOTAL (Also enter on line 2, Recapitulation) ~ $ 14,591.00 (If more space is needed, insert additional sheets of the same size) REV-1508 EX + (6-98) SCHEDULE E BANK DEPOSITS, & MISC. CASH COMMONWEALTH OF PENNSYLVANIA , INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MARINE R. ANTONICELLI 21 11 1372 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2002 HONDA ACCORD 8,000.00 NET SALE PRICE 2. PNC 35,631.28 CHECKING 3. PNC 22,002.91 CD 4, PNC 21,718.40 CD 5. PNC 11,257.96 MONEY MARKET 6. PSECU 50,716.94 MONEY MARKET 7. ERIE 447.00 REFUND -AUTO INSURANCE 8. INTERNAL REVENUE SERVICE 1,134.00 INCOME TAX RETURN 9. PSERS 3,967.63 RETIREMENT TOTAL (Also enter on line 5, Recapitulation) I $ 154,876.12 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (08-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER MARINE R. ANTONICELLI 21 11 1372 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IIP APPLICABLE) TAXABLE VALUE 1. COMMONWEALTH OF PENNSYLVANIA 75,287.00 100.00 75,287.00 DEFERRED COMPENSATION PLAN 50% FRANK J. ANTONICELLI, III 50% TINA L. ANTONICELLI 0.00 2. PSECU 74,378.85 100.00 74,378.85 IRA 50% FRANK J. ANTONICELLI, III 50% TINA L. ANTONICELLI TOTAL (Also enter on Line 7, Recapitulation) I $ 149,665.85 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARINE R. ANTONICELLI 21 11 1372 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES; 1. PARTHEMORE FUNERAL HOME 9,415.72 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions; Name(s) of Personal Representative(s) FRANK J. ANTONICELLI, III Street Address 1804 BRIDGE STREET City NEW CUMBERLAND State PA ZIP 17070 Year(s) Commission Paid: RENOUNCED 2, Attorney Fees: MURREL R. WALTERS, III, ESQ. 3,500.00 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 492.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. SW BARRETT REAL ESTATE -APPRAISAL 350.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 13,758.22 If more space is needed, use additional sheets of paper of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent MAXINE R. ANTONICELLI 21 11 1372 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses & Administrative Costs - B1 ITEM NUMBER DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: Personal Representative Commissions: 2• Name(s) of Personal Representative(s) TINA L. ANTONICELLI Street Address 5267 MEADOWBROOK DRIVE City MECHANICSBURG State PA ZIP 17050 Year(s) Commission Paid: RENOUNCED SUBTOTAL SCHEDULE H-61 REV-1512 EX+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER MARINE R. ANTONICELLI 21 11 1372 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, LANDSCAPES INC. 1,931.35 LAWNSCAPE 2. MANOR CARE HEALTH SERVICES -CAMP HILL 1,212.00 REHABILITATION 3. TRUST AMBULANCE 1,265.00 MEDICAL TRANSPORTATION 4. PPL 1,530.34 ELECTRIC 5. HAMPDEN TOWNSHIP 465.10 SEWER & REFUSE 6. VERIZON 984.06 TELEPHONE 7. PA AMERICAN WATER 170.60 WATER 8. ANDREWS & PATEL ASSOCIATES, PC 15.00 MEDICAL 9. PINNACLE HEALTH HOSPITALS 15.00 MEDICAL 10. HARRY J. LAWALL & SON, INC. 15.00 LEG BRACES 11. HEARTLAND PHARMACY OF PA, LLC 95.56 PRESCRIPTIONS 12. LAWN DOCTOR 368.25 LAWN TREATMENT 13. ERIE 482.00 HOMEOWNER'S INSURANCE 14. NICHOLAS J. TAMANINI 595.00 LAWN SERVICE 15. BETH BURNS 150.00 HOUSE CLEANING TOTAL (Also enter on Line 10, Recapitulation) $ 15 925.51 If more space is needed, insert additional sheets of the same size. Continuation of REV-1500 Inheritance Tax Return Resident Decedent MAXINE R. ANTONICELLI 21 11 1372 Decedent's Name Page 2 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION AMOUNT 16. A TO 2 TAX SERVICE 108.00 TAX PREPARATION 17. MICHAEL LANGAN, TREASURER 1,952.26 2012 COUNTY TOWNSHIP REAL ESTATE TAXES, $405.29 2012/2013 SCHOOL TAXES, $1,547.67 18. YARNELL SECURITY SYSTEMS 1,343.40 SECURITY SYSTEM 19. F.M. BERKHEIMER, INC. 143.00 SERVICE CONTRACT -HEATING SYSTEM 20. R.C. BROSAMER 95.00 BELL APPRAISAL 21. PSECU 2,989.59 REIMBURSEMENT OF EXCESS RETIREMENT PAYMENT SUBTOTAL SCHEDULE I 6,631.25 GRAND TOTAL SCHEDULE I ~ 15,925.51 REV-1513 EX+ (01-10) pennsylvania ~ SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: MAXINE R. ANTONICELLI 21 11 1372 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PER50N(S) RECEIVING PROPERTY Do Not List Trustee(sj OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. FRANK J. ANTONICELLI, III Lineal 50.00 1804 BRIDGE STREET NEW CUMBERLAND, PA 17070 2. TINA L. ANTONICELLI Lineal 50.00 5267 MEADOWBROOK DRIVE MECHANICSBURG, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE, II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 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. $ If more space is needed, use additional sheets of paper of the same size,