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Home My WebLink About12-03-12 J 1505610143 REV-1500 EX (02-11) i~ PA Department of Revenue co OFFICIAL USE ONLY pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO BOX.280601 INHERITANCE TAX RETURN 21 12 Harrisburg, PA 17128-0601 RESIDENT DECEDENT Z ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 029 03 4493 08 27 2012 02 22 1916 Decedent's Last Name Suffix Decedent's First Name MI ZIFCAK MARY D (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 0 1. Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return (Date of Death Prior to 12-13-82) ❑ 4. Limited Estate ❑ 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) X1 g Decedent Died Testate Decedent Maintained a Living Trust 0 (Attach Copy of Will) ❑X (Attach Copy of Trust) 8. Total Number of Safe Deposit Boxes ❑ 9. Litigation Proceeds Received ❑ 10. Spousal Povert CreditIDate of Death 11. Election to tax under Sec. 9113(A) between 12-31.l and -1-95) ❑ (Attach Schedule 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDWARD P SEEBER 717 533 3280 REGISTER OF WILLS USE ONLY First Line of Address p c~ SUITE C400 X C> tail r- D Second Line of Address rn O: c7 U: . 555 GETTYSBURG PIKE x" ;MA% ED G City or Post Office State ZIP Code _ MECHANICSBURG PA 17055 Correspondent's e-mail address: ePs@1sdc.com o (A) c~k _n 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. SIG TU SON R SPONSIBLE FOR FILING RETURN DATE E- Mark A. Zifcak I i of l l ADDRESS 260 St. has DriveLICam HIIIDPA 17011 SIGNATUR PREPARER OTHER THAN REPRESENTATIVE DATE Edward P Seeber ss Suite C4000555 Gettysburg Pike EMechanicsburgLPA 17055 Side 1 1505610143 1505610143 J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Zifcak, Mary D. 21-12 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 900-1 Signature #2 Z/~ l E 0r) 7T[- Name ~MXichael ifcak Address1 646 Angell Street Address2 City, State, Zip Providence, RI 02906 Date 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: ZifCak, Mary D. 029 03 4493 RECAPITULATION 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 N Probate Property (Schedule G) u Separate Billing Requested............ 7. 975,470.25 8. Total Gross Assets (total Lines 1 through 7) 8. 975,470.25 9. Funeral Expenses and Administrative Costs (Schedule H) 9. 19,723 . 71 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule 1) 10. 398 • 05 11. Total Deductions (total Lines 9 and 10) 11. 20, 121. 76 12. Net Value of Estate (Line 8 minus Line 11) 12. 955,348 . 49 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. 955,348.49 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. 0.00 16. Amount of Line 14 taxable 955,348.49 16. 42,990.68 at lineal rate X .045 17. Amount of Line 14 taxable at sibling rate X .12 0.00 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 0.00 18. 0.00 19. TAX DUE 19. 42,990.68 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-12 Decedent's Complete Address: DECEDENT'S NAME Zifcak, Mary D. STREET ADDRESS 260 St. Johns Drive CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 42,990.68 2. Credits/Payments A. Prior Payments 40,841.15 B. Discount 2,149.53 Total Credits (A + B) (2) 42,990.68 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 2CLine 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) 0.00 Make Check Payable to: REGISTER OF WILLSFAGENT. 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; ❑ ❑ c. retain a reversionary interest; or ❑x ❑ d. receive the promise for life of either payments, benefits or care? 0 ❑ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without ❑ receiving adequate consideration? x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x 4. Did decedent own an individual retirement account, annuity, or other non-probate property which contains a beneficiary designation? ❑ FX] IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESEYOU 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 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 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 (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 by blood or adoption. Rev-1510 EX+(08-09) SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Zifcak, Ma D. 21-12 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 DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE NUMBER INC DATE OF TRANSFER SATTACNTA COPY OF TI THE DEED DECEDT ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Janney Montgomery Scott Brokerage Account No. 764,537.84 100.000% 0.00 764,537.84 *2189 - titled in the Michael J. Zifcak Family Trust; valued per statement ending 8131/12 - fully taxable as election to tax was not made at the time of Michael J. Zifcak's death on 2/19/07 2 Metro Bank Checking Account No. *0747 - titled in the 13,432.41 100.000% 0.00 13,432.41 Michael J. Zifcak & Mary Zifcak Living Trust; valued per statement ending 8/31/12 3 Miscellaneous personal property - titled in the Michael 2,500.00 100.000% 0.00 2,500.00 J. Zifcak & Mary Zifcak Living Trust; valued by Trustees 4 Real estate located at 260 St. Johns Drive, Hampden 195,000.00 100.000% 0.00 195,000.00 Township, Cumberland County, PA - titled in the Michael J. Zifcak & Mary Zifcak Living Trust; valued per tax assessment * common level ratio (195,000 * 1) TOTAL (Also enter on Line 7, Recapitulation) 975,470.25 (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 G (Rev. 08-09) REV-1151 EX+(10-09) SCHEDULE H COMMONWEALTH OFPENNSYLVANIA FUNERAL EXPENSES AND IN RES,DENTED ~ DENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ZifcakLMary D. 21-12 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 41643.71 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s) Commission Paid 2. Attornev's Fees James CSmithi Dietterick & ConnellyELLP 15CD00.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zia Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 80.00 See continuation schedule(s) attached TOTAL (Also enter on line 91 Recapitulation) 19 223.71 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Zifcak, Mary D. 21-12 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Sheraton - funeral reception 1,271.71 2 Zimmerman Auer Funeral Home - funeral services 3,372.00 H-A 4,643.71 Other Administrative Costs 3 Recorder of Deeds, Cumberland County - filing fee for Deed 65.00 4 Register of Wills, Cumberland County - filing fee for Return 15.00 H-B7 80.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+(12-08) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES AND LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Zifcak, Ma D. 21-12 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 Express Scripts - unreimbursed prescription medication 36.00 2 Jerry F. Cole, CPA - 2011 individual income tax preparation 100.00 3 Overhead Door Company - garage door repair 172.05 4 Wayne Stevenson - garage door repair 90.00 TOTAL (Also enter on Line 10, Recapitulation) 398.05 (if more space is needed, additional pages of the same size) Copyright (c) 2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (01-10) SCHEDULE J COMINHRESDENTEDE EDT RNANIA BENEFICIARIES ESTATE OF FILE NUMBER Zifcak, Ma D. 21-12 RELATIONSHIP TO NUMBER PERSON(S) NAME AND RECEIVING ADDRESS OF PROPERTY DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE (Words) Do Not Lost Trustee(s) - I• TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Mark Zifcak Son 50% of residue 477,674.25 260 St. Johns Drive Camp Hill, PA 17011 2 Meal i fcak o Son 50% of residue 477,674.24 6A% Angell Street Providence, RI 02906 Total 955, 348.49 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate. 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 Copyright (c) 2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 01-10) yt " 1 ~ • ~ OCR iS., 1 ~•t co fi f c~ a~ JAMES SMITH DlETr CK & CONNELLY LLP Cheryl L. Baker, CP Certified Paralegal clb@jsdc.com November 30, 2012 Po. BOX 650 HERSHEY PA 17W3 Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 Re: Mary Zifcak, deceased File No. 2112-1219 Dear Ms. Farner Strasbaugh: Enclosed are the following documents to be filed in the above-referenced decedent: GARY L. JAMES 1. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. MAX J. SMITH, JR. 2. A check made payable to "Register of Wills, Cumberland County" for $15.00 Score A. DETTERICKR representing the filing fee. JAMES F. SPADE MATTHEW CHABAL, III NEIL W. YAHN EDWARD P. SEEBER Please time-stamp the extra copies and return them to me in the enclosed self-addressed, RONALD T. ToMASKO stamped envelope. CORTNEEY K POWELL KIMBERLY A. BONNER KAREN N. CONNELLY If you have any questions, please feel free to contact me. CHRISTINE T BRANN JESSICA E. LOWE GREGORY A. KOGUT, JR. THOMAS J. CAR Sincerely yours, RALPH M. SALVIA TERESA M. REIFSNYDER JAMES D. YOUNG JA S, MITH, DIETTEMCK & CONNELLY, LLP CAYLA B. HENN OF COUNSEL: GORY K. RICHARDS WNARD A. RYAN, JR. ?ertifie 1 L Baker, CP C> r" ,MREw H. BRIGGS Paralegal ~rn C-; f M C'> Enclosures r- = = r w 'I: .7' t=J cc: Mark Zifcak, Co-Trustee Michael Zifcak Co-Trustee En Reply to: Suite C-400 555 Gettysburg Pike Mechanicsburg, PA 17055 Direct Dial: 717-298-2094 Direct Fax: 717-298-2095 E39visoci snI ~1 1 t'J C i ~ ra C`>l ~ ~ f' ii a, c~ 4 °8375)1N # 1~ +Iry+ ^7r°I L~- CD Ll- J C7 u,1 tr f c; ~ v l W -A v w~ OdOa W ~ H W U wU,-~U o a a Q a