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Home My WebLink About12-20-121505611185 REV-1500 'Ex X02_„> (FI) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes Po Box 2eoso, INHERITANCE TAX RETURN ` i n ~~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ l 14i ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY D5252012 07171921 Decedent's Last Name Suffix Decedent's First Name M I EURIECK ANITA T (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WfTH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supp!::;: •al Return ^ 3. Remainder Return (Date of Death ^ 4. Limited Estate ^ Prior to 12-13-82) 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required ^ 6. Decedent Died Testate (Attach Copy of Will) ^ death after 12-12-82) 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (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 Schedule O) CORRESPONDENT - TiiIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOU~ByBE DIRECTED TO: N ame Da ime yt T~phone Numb ~ ~ C t'y"t JOHN R• ZONE: :CH, ESQ- 717-~~-100[j.? ~ ~ First Line of Address SKARLATOSZONARICH LLC Second Line of Address 17 S. 2ND ST., 6TH FL City or Post Office State ZIP Code HARRISBURG PA 17],01 correspondent'se-mailaadress: JRZa9SKARLATOSZONARICH - COM r, R~S ~FWILI~ly1SE Oyf~lr zrn ~ C~ CJ ~ --7-. ~ ~~ C] -r7 _,1 C'1 C`3 ~ M~ .~ti~f F....~ ~ .:~ r.~ _~~ -.-.j I.-,.. ;,,,. C.rl t.0 C'7 O ~ DATE FILED Under penalties of perjury, I declare that I have examined this return, induding 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 RE OF PERSO~ RES~SIBLE FOR F ING RETURN DATE ANNETTE C EURIECK ADDRESS g~~HAMB S BEET HARRISBURG, PA 17113 PARER ER THAN EP ESENTATIVE JOHN R. ZONARICH ~,7 ~/ 2ND STP~~, 6TH FLOOR PLEL 1505611185 DATE HARRISBURG, PA 17101 ORIGINAL FORM ONLY Side 1 oMasa~ s.ooo 15 0 5 61118 5 REV-1500 EX (FI) 15D5611285 Decedent's Social Security Number Decedent's Name: E U R I E C K p N T T e RECAPITULATION T 1. Real Estate (Schedule A) . ' 1' 0.00 2. Stocks and Bonds (Schedule B) . 2 0 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3 0 • 0 0 4. Mortgages and Notes Receivable (Schedule D) , ................ a. D 00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) _ 5. ], 5 7 • 0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 8 , 4 0 3.0 0 8. Total Gross Assets (total Lines 1 through 7) . g. 8 , 5 6 0 0 0 . 9. Funeral Expenses and Administrative Costs (Schedule H). 9 . 13 , 9 71.0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 7 5 • 0 0 1 1. Total Deductions (total Lines 9 and 10) , 11 14,046.00 12. Net Value of Estate (Line 8 minus Line 11) 13. , " " " " 12. Charitable and Governmental Bequests/Sec 9113 Trusts for which (5, 486.00 ) an election to tax has not been made (Schedule J) , 13 o.Do 14. Net Value Subject to Tax (Line 12 minus Line 13) , • • • • 1a. (5, 486.00 ) TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a)(1.2)x.o- 0.00 15 D • 00 16. Amount of Line 14 xable 4~ at lineal rate x .0 17. 0.0 0 1 g. Amount of Line 14 taxable 0 • 0 0 at sibling rate X .12 0 • 0 0 18. Amount of Line 14 taxable 17' 0 ' 0 0 at collateral rate X .15 0 • 0 0 18. 0.00 19. TAX DUE 19. 0 • 0 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505611285 1505611285 OM4648 3.000 REV-1500 EX (FI) Page 3 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (3) ~ ~ ~ (4) .oo 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) _ O O ~ Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TH E APPRO PRIAT E BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred b. retain the right to designate who shall use the property transferred or its income c. retain a reversionary interest .. . d. receive the promise for life of either payments, benefits or care? 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . 3 Di " . d decedent own an in trust for" or payable-upon-death bank account or security at his or her death? 4. Did decedent own an individual retirement account, annuity, or other non-probate property, which contains a beneficiary designation? 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(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. File Number 0•~^ Total Credits (A + B) (2) OM4671 2.000 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) Q • ~ O 2. Credits/Payments A. Prior Payments ~ , ~ ~ B. Discount ~ ~ REV-1508 EX+ (7ry-70) Pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY GJIAIt Vt: -- FILE NUMBER: Anita T. Eurieck Include the proceeds of litigation and the date the proceeds were received by the estate. All roe 'ointl owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH t.~Capital Blue Cross - Refund 157 TOTAL (Also enter on line 5, Recapitulation) S 157 OwaBAD 2.000 If more space is needed, use additions sheets of paper of the same size. REV-1510 EX +~(0&09) pennsylvania DEPARTMENT OF REVENUE INHERITAN(~ TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER Anita T. Eurieck 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. DESCRIP110N OF PROPERTY ITEM INp1pE7FEµM1EpF7}EAR,ygFEREE,TFEIRRELATIOMSHPTODECEOEMMD DATE OF DEATH %OFDECD'S EXCLUSION TAXABLE NUMBS 7FEOAiEOFTRat~ER ATTM.FiACOPY OF TFE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST IF APPLICABLE VALUE ~• M&T Bank Checking Account No. 950387333 8,403 100.0000 0 8,403 "In Trust For" bank account, f/b/o Nicholas W. Eurieck, decedent's son TOTAL (Also enter on line 7, Recapitulation) $ If more space is needed, use additional sheets of paper of the same size. 8 4 9w46AF 2.000 REV-1511 EX+ (10-0s) pennsylvania ' DEPARTW~NTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ~~~nic yr FILE NUMBER Anita T. Eurieck Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Wiedeman Fackler Funeral Home 11,846 Total from continuation schedules . B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address Clty State ZIP Year(s) Commission Paid: 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 5. Accountant Fees: 6. Tax Retum Preparer Fees: 7. 1 Register of Wills - Filing Fee TOTAL (Also enter on Line 9, Recapi swasac 2.00o If more space is needed, use additional sheets of paper of the same size. 600 1,500 25 13,971 Estate of: Anita T. Eurieck Schedule H Part 1 (Page 2) Item No. Description 2 Prince of Peace Funeral Luncheon Committee Amount 600 Total (Carry forward to main schedule) 600 REV-1512 EX+ (1~L-OB) Pennsylvania LIEPAR1MENiOF REVENUE INHERITANCE TAX RETURN SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES ~ LIENS ESTATE OF FILE NUMBER Anita T. Eurieck Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ~••-~~~ ~ ~ ~~~ ~~ ~~~..~ c aNacG is neeaea, insert aooltlonal sheets of the same size. REV-1513 EX+,(01-10) • pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES t51ATt oF: FILE NUMBER: Anita T. Eurieck RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS (Indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Annette C. Eurieck 929 Chambers Street Harrisburg, PA 17113 Daughter 0 2 Elizabeth C. Stoy 585 Cloverleaf Circle Killen, AL 35645 Daughter 0 3 Elaine V. Eurieck Thurmont, IrID Daughter p 4 Nicholas W. Eurieck 929 Chambers Street Harrisburg, PA 17113 Son 0 5 Frederick N. Eurieck 5 Joshua Circle Derry, NH 03038 Son 0 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. 6. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0 9W46AI 2.000 ~~ iiwic aNacC is neeuea, use aaamonal sneers of paper of the same size. Estate of: Anita T. Eurieck Item No. Description 6 Thomas Eurieck 428 S. 25th Street Harrisburg, PA 17104 Schedule J Part 1 (Page 2) Relation Amount Son 0 ~ ~~1~ 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Phone 888-502-4349 F ax (302) 934-2955 November 1, 2012 Skarlatos Zonarich LLC 17 South Second Street, 6~' Floor Harrisburg, PA 17101-2039 Re: Estate of Anita T. Eurieck Social Security: 203-10-2058 Date of Death: May 25, 2012 Dear Sir or Madam: Per your inquiry on October 24, 2012, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Inxerest Total Checking Account 950387333 Nicholas W. Eurieck(Beneficiary) Anita T. Eurieck(Trustee) Annette Carol Eurieck(Trustee) OS/08/1000 $8,403.09 $ .00 $8,403.09 For any additional information on the above accounts, including ownership and any changes, dosures and/or reimbursement of funds, please call the Paxton Street at 717-255-2240. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not indude any aooounts in which the deceased may have bey listed as Power of Attorney, Custodian of iJniform Transfers, Representative Payee, or Trustee ands a Written Agreement. Sincerely, Valarie Mercer Adjustment Services 062S0006654622 OIWV)~N o~y~~ ~~~ ~~J~ ~N~~~ Ef~aNOV ~LL~o ~- ~ ~,_ . _ h7 G::. C"7 C,~ Ca ~ -.~. 'Q ~. Z W ~ ~ ~ ~ O ~ _ ~ _= U ~ r _- ~ ~ O ~ ~ M ~ ~ i = N ~ to ~ (n ~ ~ O ~ ~ N ~U ~~ °0=~ ~>,~a~ ~ ~ ~ N 0 'orn ~ ~ ~ '~