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1505610101
REV-1500 EX t°'-10'
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania
Bureau of Individual Taxes DEPARTMENT OF REVENUE County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN g
Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT 2 1 1 2 0 9 0 ,5
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
! X 0 2 1 2 *2 0_ �fl _-2 z0 $9 2 8 1 9 1 6
Decedent's Last Name Suffix Decedent's First Name MI
� � �u ,�a ,
ID a ma r e �s t
m ma
u ..:'
n vma - -..yea: .,• , r`-. :,n .�»:, . _ cwauk _ six-.a'.o
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouses Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
If A REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return p 2.Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
O 4. Limited Estate p 4a.Future Interest Compromise(date of p 5. Federal Estate Tax Return Required
death after 12-12-82)
M 6. Decedent Died Testate p 7. Decedent Maintained a Living Trust _�Q_ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
O 9. Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death O 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
ill A n t °h o n L. D e L u c a E s q. 717N2 r5j 4 4
i �..
- GiOER OF S U �,
f;t 77 a + O
P 1
First line of address
1 1 3 F r o n t S t r e t ?
w
Second line of address
P O B o x 3 5 8
City or Post Office State ZIP Code DATE ftLFD -71
B o i l i n g S p ;r i n g ,s P A 1 7 0 0 7
Correspondent's e-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.
URE OF PERSVPQKVBLE FOR FILING RETURN DATE
ADD SS
SIGNATURE OF E R R OTHER TH R RESE AT E _ , DATE
A R SS o
PLEAJM USE ORIGINAL FORM 014LY
Side 1
1505610101 1505610101 J
J 1505610105
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Emma E. Demares t
RECAPITULATION
1. Real Estate(Schedule A). . ....................................... 1. 0 0
tiw g�
2. Stocks and Bonds(Schedule B) ........ .......... .... 2. , 1 7 6 ;5 A 6`' 2,
3. Closely Held Corporation, Partnership or Sale-Proprietorship(Schedule C) . .. . . 3. 0 0' 0
m.,
4. Mortgages and Notes Receivable(Schedule D)... . . ........... ........... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5.
p-40-"-
6. Jointly Owned Property(Schedule F) Q Separate Billing Requested .. ..., . 6. 0
7. inter-Vivos Transfers&Miscellaneous Non-Probate Property M�a� °'
(Schedule G) p Separate Billing Requested.. . . . . . . 7.
0 0 0
8. Total Gross Assets(total Lines 1 through 7). .. . . . . .. . . . . .. . . . . . . .. . ..... 8.
9. Funeral Expenses and Administrative Costs(Schedule H).... ............... 9. 0
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1).... .......... 10. 2 4 0` 2 1 $ 6 w
11. Total Deductions(total Lines 9 and 10). . . . . . . . . . . . .. .. . ... 3 6 8 6
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . ... . . . . .. .. . . .. . . . 12. 1 G,211, 2 $ 9 2
11 Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........ .. ... ... ........ 13. } 0 0
14. Net Value Subject to Tax(Line 12 minus Line 13) ..... .......... ...... ... 14. 0 (0
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116 g IT 1 I,
(a)(1.2)X.0____ 15
16. Amount of Line 14 taxable
at lineal rate X.0_ 161
17. Amount of Line 14 taxable h;
at sibling rate X.12 17
41 18. Amount of Line 14 taxable ' ... ,f "&
at collateral rate X.15 18.
19. TAX DUE ....................... f
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Side 2
1505610105 1505610105
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 -12-0905
DECEDENT'S NAME
Emma E. Demarest
STREET ADDRESS
One Lonqdorf
-1_STATE ZIP
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) —0—
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) —0—
3, Interest
(3) —0-
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—
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) —0—
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;....................................................................................... ❑ Y
b. retain the right to designate who shall use the property transferred or its income;........ ...........__...____ ❑ 13d
c. retain a reversionary interest;or............................................................................._......................... ........ El FRI
X
d. receive the promise for life of either payments,benefits or care?............................................ ................. ❑
Z If death occurred after Dec. 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?........................................................................................................... ❑ FX
1 Did 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? .........___......____......__............. ........ ...... ❑ FX
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ppLill I gii iii'viiii i i 111111 11, 11 1
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)].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-1502 EX+ (11-08)
pennsylvania SCHEDULE A
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN REAL ESTATE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emma E. Demarest 21 -12-0905
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 NONE
—0-
TOTAL(Also enter on Line 1, Recapitulation.) $ —0—
If more space is needed, insert additional sheets of the same size.
REV-1503 EX+(6-98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emma E. Demarest 21 -12-0905
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
450 shares of Ingersoll-Rand PLC, CIS
@ $37. 7466 per share $16, 985.97
2. 22 shares of Public Service Electric & Gas 668. 65
CIS @ $30. 3933 per share
TOTAL(Also enter on line 2, Recapitulation) $ 17, 654 . 62
(If more space is needed,insert additional sheets of the same size)
REV-1507 EX+(1-97)
SCHEDULE D
COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES
INHERITANCE TAX RETURN RECEIVABLE
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emma E. Demarest 21 -12-0905
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. NONE;
TOTAL(Also enter on line 4, Recapitulation) $ —0—
(If more space is needed,insert additional sheets of the same size)
REV-1508 EX-(1-97)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Emma E. Demarest 21-12-0905
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Certificate of Deposit, #949, at Springer $2,954 . 64
Financial Corp.
2. Checking account, #1000931869898, at Wells Fargo 1 ,R13.98
3. Schwab one account, #1504-8574, at Charles Schwab 684.70
TOTAL(Also enter on line 5,Recapitulation) $ 5,4 5 3.3 2
(If more space is needed,insert additional sheets of the same size)
REV-1509 EX.(1-97)
SCH�/EDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emma E. Demarest 21 -12-0905
If an asset was made joint within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME: ADDRESS RELATIONSHIP TO DECEDENT
A. NONE
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number.Atlach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A.
TOTAL(Also enter on line 6,Recapitulation) $ —0—
(if more space is needed,insert additional sheets of the same size)
REV-1510 EX+ (08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emma E. Demarest 21 -12-0905
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE, VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. NONE
TOTAL(Also enter on Line 7, Recapitulation) $ —0—
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+(10-06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emma E. Demarest 21 -12-0905
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City _ State Zip
Year(s)Commission Paid:
2. Attorney Fees Anthony L. DeLuca, Esquire 300.00
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
5. Accountant's Fees
6• Tax Return Preparer's Fees
7. Filing fee for Inheritance Tax 15. 00
TOTAL(Also enter on line 9, Recapitulation) $ 315. 00
(If more space is needed,insert additional sheets of the same size)
REV-1512 EX+ (12-08)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emma E. Demarest 21 -12-0905
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. Nursing Home bill owed to: Cumberland Crossings $23, 946. 00
Retirement, 1 Longsdorf Way, Carlisle, PA 17015
2. Continuing Care RX - Medication 11 . 64
3 . McGlauglin and Associates - Medical 64. 22
TOTAL(Also enter on Line 10, Recapitulation) $ 2 4, 0 21 .8 6
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+(11-08)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Emma E. Demarest 21 -12-0905
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. 2116(a)(1.2).)
1. Janet F. Catarino Daughter 100%
1211 Kuhn Road
Boiling Springs, PA 17007
I
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE,
II NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS 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, $ -0-
If more space is needed,insert additional sheets of the same size.
V N=V of 06, Awtt
I, EMMA E. DEMAREST, residing at 1703 Kenyon Avenue, in the
Borough of South Plainfield, County of Middlesex, New Jersey,
being of sound mind and disposing mind, memory and understanding
do make, publish and declare this to me my Last Will and
Testament, hereby revoking any and all prior Wills and Codicils
by me made.
FIRST: I order that all my just debts and funeral
expenses be paid as soon as the same may be practicable after my
decease.
SECOND: I hereby give, devise and bequeath all the rest,
residue and remainder of my property, of whatsoever kind and
wheresoever situate, of which I may die seized or possessed, or
to which I may be entitled at the time of my death, over which I
have a power of appointment or any interest to my daughter, JANET
F. CATARINO.
THIRD: I hereby nominate and constitute and appoint my
daughter, JANET F. CATARINO, as Executrix under this my Will and
Testament. I direct that no bond or other security be required
of her for the faithful performance of her duties hereunder. I
authorize and empower my Executrix to sell, lease, mortgage and
pledge all of my real or personal property on such terms as she
may deem fit, either at public or private sale.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this 11th day of JUNE, 2001.
(L.
EMMA E. DEMAREST
Wu aub #rtf-rrvurb Ambauff
IN WITNESS WHEREOF,I have hereunto set my hand and seal this 11 th day of June 20 01
EMMA E. D AREST
This Will was SIGNED, SEALED, PUBLISHED and DECLARED by the above named Testator
(or Testatrix),as and for his or her Last Will and Testament in the joint presence of us,who,at his or her request
and in his or her presence and in the presence of each other,have hereunto subscribed our names as witnesses,
this 11th day of June 20 01
Signatures Names of Witnesses
Irma Morales
...........-........................ ... ..................... ..............................................................................................
Katherine Lindeman
.................................A......................................................... ...............................................................................
I, EMMA E. DEMAREST the Testator(or Testatrix)
sign my name to this instrument this 11th day of June 2001 ,and being duly
sworn,do hereby declare to the undersigned authority that I sign and execute this instrument as my Last Will;that
I sign it willingly;that I execute it as my free and voluntary act for the purposes therein expressed;and that I am
18 years of age or older,of sound mind and under no constraint or undue influence.
EMMA E. DEMAREST -8��r'(.r.................
e Testatrix)
We, the above-named witnesses, sip our names to this instrument, and, being duly sworn, do hereby
declare to the undersigned authority that the Testator(or Testatrix)signed and executed this instrument as his or
her Last Will and that he or she signed it willingly;that each of us,in the presence and hearing of the Testator(or
Testatrix),hereby sips this Will as witness to the signing thereof by the Testator(or Testatrix);and that to the
best of our knowledge the Testator(or Testatrix)is 18 years of age or older,of sound mind and under no constraint
or undue influence.
............ . .. . .....3.04....Ma.p.l.e....A...v...e...n...u...e...,o....S.....P..l...a...i...n...f...i...e...l..d....,...NJ.
........r I Wa- i6
wit Address
304 Maple Avenue, S. Plainfield, NJ
................... ...................................................................................................................
................... .......................
Witness Ka*dhe xne Lindeman Address
STATE OF NEW JERSEY
COUNTY OF MIDDLESEX SS:
Subscribed,sworn to and acknowledged before me by EMMA E. DEMAREST
the Testator(or Testatrix),and subscribed and sworn to before me
by Irma Morales and Katherine Lindeman the witnesses,this
11th day of June 2001•
..t 95..........................
07016-Will Pap-Signing and Self-Proved Affidavit A T T 0 R N E4A S ;E A**W J ER
S E Y
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