HomeMy WebLinkAbout10-26-12 (2)~ isos6ioi9o
REV-1500 EX (01-10)
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 1 2 0 0 9 3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 3 2 8 4 6 4 2 0 1 1 8 2 0 1 2 0 5 1 4 1 9 2 9
Decedent's Last Name Suffix Decedent's First Name MI
S C A M B I A D A N I E L V
(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
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)
^X 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
M U R R E L W A L T E R S I I I E S Q 7 1 7 6;~ 7 4 ~z 5 0
f,... r
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REGISTERS LS USE pi~LY - ~ ' ~-'
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C r.; t`~3 ~= ~ ~ .1
First line of address ~'`, _ ~ r ' ~-.`;
5 4 E A S T M A I N S T R E E T ~ ~__„µ; ~ ~~ _~~
Second line of address _.~: r ' ~ :° C~.~
-~ . ,s
~ ~ ~
City or Post Office State ZIP Code DATE FILED C'~~
M 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 tr e, Correct an complet .Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN T R~ ~~P SO P BLE ILI RETURN ~ ~AT~ '
.'
A RESS
NICOLE L. HOOK 301 CHESTNUT ST. HARRISBURG PA 17101
SIGNATURE OF R PAR R OTHER~HAN REPRESENTATIVE DATE , ..-~
.. ~ ~. ,~
;~
1I
ADDRESS i ~~ /
MURREL AL~ R q' 5 E. MAIN ST MECHANICSBURG PA 17055
PLEASE USE ORIGINAL FORM ONLY
~~
Side 1
1505610140 1505610140
J
REV-1500 EX
Decedent's Name: DANIEL V. SCAMBIA
Decedent's Social Security Number
2 0 3 2 8 4 6 4 2
RECAPITULATION
1. Real Estate (Schedule A) 1, 0 0 0
...........................................
2. Stocks and Bonds (Schedule B) ...................................... 2. 1 8 4 7 3 1 6
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. 7 6 3 6 1 9 3 0
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. •
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ....... 7. •
8. Total Gross Assets (total Lines 1 through 7) ........................... 8. 7 8 2 0 9 2 4 6
9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9• 7 2 0 2 9 8 2
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10. 6 1 0 2 7 8
11. Total Deductions (total Lines 9 and 10) ............................... 11. 7 8 1 3 2 6 0
12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. 7 0 3 9 5 9 8 6
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. 7 0 3 9 5 9 8 6
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 •0 0 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X •0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 7 0 3 9 5 9 8 6 18.
19. TAX DUE .................................................... .. 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
1505610240
0 0 0
0 0 0
0 0 0
1 0 5 5 9 3 9 8
1 0 5 5 9 3 9 8
Side 2
1505610240 1505610240 J
REV-1500 EX Page 3
I~pr_erllpnt's C~mnlete Address:
File Number
21 12 0093
DECEDENT'S NAME
DANIEL V. SCAMBIA
STREET ADDRESS
POPULAR CHURCH ROAD
CITY
CAMP HILL STATE
PA ZIP
17011
Tax Payments and Credits:
~. Tax Due (Page 2, Line 19) (1) 105,593.98
2. CreditslPayments
A. Prior Payments 88,000.00
B. Discount 4,400.00
Total Credits (A + B) (2) 92,400.00
3. Interest
(3)
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. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 13,193.98
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 : ................................................................. ..... ^
^
^X
b. retain the right to designate who shall use the property transferred or its income; .......................... .....
^ 0
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? ..................................................................................
h?
"
" .....
^ 0
...
or payable-upon-death bank account or security at his or her deat
in trust for
3. Did decedent own an ......
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 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-1503 EX + (6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
DANIEL V. SCAMBIA 21 12 0093
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PNC 18,473.16
STOCK
TOTAL (Also enter on line 2, Recapitulation) I $ 18,473.16
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (11-10)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE
CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DANIEL V. SCAMBIA 21 12 0093
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. PNC 235,010.12
CHECKING
2. PNC 150,233.37
3 CD'S
3. DREYFUS 177,063.80
MONEY MARKET
4. DREYFUS 42,599.19
5. ETRADE 88,712.58
MONEY MARKET
6. PNC 35,376.85
INVESTMENT ACCOUNT
7. AE-PENNSYLVANIA PLACE ASSOCIATES, LP 223.89
REFUND
8. PINNACLE HEALTH 30.66
OVERPAYMENT
9. FILDELITY 20,762.97
10. FEDERAL EMPLOYEES GROUP LIFE INSURANCE 13,605.87
DEATH BENEFIT
TOTAL (Also enter on Line 5, Recapitulation) I $ 763,619.30
If more space is needed, insert 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
DANIEL V. SCAMBIA 21 12 0093
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES;
1. MYERS-BUHRIG FUNERAL HOME & CREMETORY, MECHANICSBURG, PA 17055 22,824.80
B, ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) NICOLE L. HOOK 23,450.00
Street Address 301 CHESTNUT STREET
City HARRISBURG State PA ZIP 17101
Year(s) Commission Paid: 2012
2. Attorney Fees: MURREL R. WALTERS, III 23,450.00
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 640.50
5 Accountant Fees:
6. Tax Return Preparer Fees: AL WHITCOMB, P.A. 945.00
7. THE PATRIOT NEWS -PUBLICATION 109.52
8. CUMBERLAND LAW JOURNAL 75.00
9. CONFIDENTIAL INVESTIGATIVE -RESEARCH BENEFICIARIES 535.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 72.029.82
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
DANIEL V. SCAMBIA 21 12 0093
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. ASSOCIATED CARDIOLOGIST 25.00
MEDICAL
2. HOSPITAL TELEPHONE AND TELECOM 28.00
TELEPHONE
3. GOLDEN LIVING CENTER 4,008.89
4. PHARMERICA 37.41
PRESCRIPTIONS
5. PHYSICIANS OF REHABILITATION, INDUSTRIAL & SPINE MEDICINE, P.C. 3.58
MEDICAL
6. QUANTUM IMAGING 3.20
XRAY
7. SPECIAL EVENTS EMERGENCY 450.90
AMBULANCE
8. COMMUNITY LIFE EMS 634.25
AMBULANCE
9. EDWARD E. LAMARQUE, M.D. 460.55
MEDICAL
10. PINNACLE HEALTH 451.00
MEDICAL
TOTAL (Also enter on Line 10, Recapitulation) I $ 6,102.78
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DANIEL V. SCAMBIA 21 12 0093
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 [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. DONALD STISH, SR. % ERIC HATZIMEMOS, ESQ. Collateral
1251 AVENUE OF THE AMERICAS, 49TH FLOOR
NEW YORK, NY 1 0020-1 1 04
2. ESTATE OF JOANNE M. SCAMBIA % JOSEPH USTYNOSKI, ESQ Collateral
101 W. BROAD STREET, SUITE 205
HAZLETON, PA 18201
3. ROBERT STISH Collateral
218 E. HIGH STREET, APT # 2
GLASSBORO, NJ 08028
4. RICHARD STISH Collateral
1084 S. CHURCH STREET
HAZLETON, PA 18201
5. JACKIE STISH Collateral
300 W. MINE STREET, APT # 300
HAZLETON, PA 18201
6. NANCY SCAMBIA TOOLE Collateral
124 WHISTLE WALK
WILLIAMSBURG, VA 23188
7. MARY JANE STANZIOLA-HERB, GLENAIRE RETIREMENT COMMUNITY Collateral
3319 GLENHOPE COURT
CARY, NC 27511
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS;
A, SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
1.
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $
If more space is needed, use additional sheets of paper of the same size,
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
DANIEL V. SCAMBIA 21 12 0093
Decedent's Name
Page 1
File Number
Schedule J -Beneficiaries - 1
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).)
8. MARY BEILER Collateral
175 BOTTOM ROAD
BLAIN, PA 17006
9. ANGELA MOORE Collateral
15 E. CAMINO ROAD
HAZLETON, PA 18201
10. VERA JOHNSON Collateral
1113 N.16TH STREET
HARRISBURG, PA 17103
11. THURSTON HENRY Collateral
261 N. ARLINGTON AVENUE, APT C
HARRISBURG, PA 17109-2308