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Home My WebLink About03-27-13 --� REV-1500 ;x L5o5610143 EX(64.10) OFFICIAL USE ONLY PA Department of Revenue pennsylvania County code Year File Number Bureau of Individual Taxes DEPAFTVE.rr of a IMS PO BOx.280601 INHERITANCE TAX RETURN 2 1 12 00974 Harrisburg,PA 17128.0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 169 32 6237 09 01 2012 07 30 1941 Decedent's Last Name Suffix Decedent's First Name MI HABIC ARNOLD M (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 ❑ 5. Federal Estate Tax Return Required (dare of death after 12.12.82) 0 ® 6. Decedent bled Testate 7 Decedent tdawa ned a Ltving Trust B. Total Number of Safe Deposit Boxes (Attach Copy of Wig) ❑ (Attach Copy of Trust) c( ❑ 9. Litigation Proceeds Received ❑ 10.=Poverty s1 end Tdate of death ❑ 11,Election to tax under Sec.9113(A) (Attach$ch.0) CORRESPONDENT•THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Dn Imo Telephau gT,'Nunftr M SHELLY J KUNKEL 7 236 3 l6 ki :zr3 r E �OFrMLLS M$B$ QNLY :E -v Q:) First line of address C`s 109 LOCUST STREET > `-' `d Z3 rTT Second line of address O t + 'r'f City or Post Office State ZIP Code DATE FILED HARRISBURG PA 17101 Correspondent's e-mail address: Sjkunkel.wzs @mindspring.com Under penalties of perjury,1 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. SIGNATU E OF P S RESP 3 LE FOR FILING RETURN DATE AW, - Michael F. Habic S 13 ADDRESS 5 hn Potter Road,W. Greenwich, RI 02517 39=HAN REPRESENTATIVE DATE Shelly J Kunkel 3 109 Locust Street, Harrisburg, Pa 17101 Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name! HABIC, ARNOLD M 169 32 6237 RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... 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. 2 , 872 . 16 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested__..... 6. 9 , 555 . 31 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property 4 12 92 (Schedule G) ❑ Separate Billing Requested_... 7. 8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 12 , 840 39 9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 6 , 939 97 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1)................................ 10. 5 , 518 . 36 11. Total Deductions(total Lines 9&10)........__......___......_..._....___................... 11, 12 , 458 . 33 12. Net Value of Estate(Line 8 minus Line 11)............_..........___................ ....... 12, 382 . 06 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, 382 06 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. 16. Amount of Line 14 taxable 382 . 06 16. 17 19 at lineal rate X -045 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due...................................................... ....................................... ..................... 19- 17 . 19 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 - 00974 Decedent's Complete Address: DECEDENT'S NAME Habic, Arnold M STREET ADDRESS 6 Pennsylvania Avenue, Apt. A CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 17.19 2. Credits/Payments A. Prior Payments 250.00 B. Discount 0.86 Total Credits(A +g) (2) 250.86 3. Interest (3) 0.00 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 233.67 Check box on Page 2 Line 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) Make Check Payable to: REGISTER OF WILLS, AGENT. 4 ter. 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;.................................................................................. ❑ ❑ b. retain the right to designate who shall use the property transferred or its income;.................................... ❑ ❑x c. retain a reversionary interest;or.................................................................................................................. ❑ ❑x d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ 7x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................................................................................................... ❑ 0 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 containsa 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. �ts� „_.,,,� �..�x- .l.�a� ..-. �au.,.�z�..,:3..m.+.,.«�..�'*w�€i�..,.,.. .. ,.. , , ...�.�... 5t+ .t Ea?a' ..-:..._ ,.. _'_. ,. ;`L� ;''`".: _• __,�,-� .. s. 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 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.69116(a)(1.3)]. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF SYLVANIA TAX RE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT FILE NUMBER ESTATE OF Habic, Arnold M 21 - 12 -00974 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 OF NUMBER DESCRIPTION DEATH 1 Metro Bank 1,532.76 3801 Paxton Street Harrisburg, PA 17111 Checking Account#537855561 Valuation per Metro Bank correspondence attached hereto as Exhibit E. Metro Bank 0.04 3801 Paxton Street Harrisburg, PA 17111 Checking Account#537855561 Accrued interest through date of death. 2 Karnes Food - Decedent's final paycheck 519.17 3 SBG Global.com 820.19 Online gambling account- refund of remaining balance on decedent's account TOTAL(Also enter on Line 5, Recapitulation) 2,872.16 SCHEDULEF COMMONWEALTH RITANC TAX RETURN JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Habic, Arnold M 21 - 12 - 00974 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 Michael F. Habic 54 John Potter Road Son A W. Greenwich, RI 02817 JOINTLY OWNED PROPERTY: LETTER DATE LF�SCRIPTIOI C�F PROdPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE include name o Inanclal Ins Itu ion an bank account number DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT or similar identifying number.Attach deed for jointly-held real VALUE OF ASSET estate. INTEREST DECEDENT'S INTEREST 1 A 08/21/2012 Metro Bank 9,555.31 100% 9,555.31 3801 Paxton Street Harrisburg, PA 17111 Savings Account#7760480693 Valuation per Metro Bank correspondence attached hereto as Exhibit E. No accrued interest because decedent died on the first day of the month. TOTAL(Also enter on line 6, Recapitulation) 9,555.31 COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Habic, Arnold M FILE NUMBER 21 - 12 - 00974 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION NUMBER Include the name of the transferee,their relationship to decedent VALUE F ASSET DECD'S (IF APPLICABLE) TAXABLE VALUE and the date of transfer. Attach a copy of the deed for real estate. INTEREST 1 Residual balance of decedent's previously redeemed 412.92 100% 412.92 Karns Foods 401(k) Paid directly to Michael F. Habic, son and sole beneficiary I i I i I II, i i i i i i i I TOTAL(Also enter on line 7, Recapitulation) 412.92 SCHEDULE H FUNERAL EXPENSES& COMMONWEALTH OF PENNSYLVANIA �A 'c�p� INHERITANCE TAX RETURN AJ.JNNIS 1�'1�E COSTS RESIDENT DECEDENT ��v-� vw ESTATE OF Habic, Arnold M FILE NUMBER 21 - 12 -00974 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: A. 1 Buse Funeral Home - Funeral bill 2,279.00 2 Travel expenses of Executor from Rhode Island to Harrisburg to arrange funeral and 708.97 subsequent intermnent of ashes in Pittsburgh, with return trip to Rhode Island. Total mileage: 863 miles x .555/mile = $478.97 One night hotel stay- Hampton Inn -$130.00 Gas and food during funeral trip = $100 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Wion, Zulli & Seibert-- Shelly J. Kunkel 2,934.00 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 115.50 5. Accountant's Fees 6. Tax Return Preparer's Fees Kelly Tax Service- Decedent's 2012 (final) 1040 and PA 40 229.00 7. Other Administrative Costs 1 The Cumberland Lasw Journal -estate advertisement 75.00 TOTAL(Also enter on line 9, Recapitulation) 6,939.97 Schedule H C l COMMONWEALTH OF PENNSYLVANIA r & INHERITANCE TAX RETURN A,ckninisshaatm Costs confined RESIDENT DECEDENT ESTATE OF Habic, Arnold M FILE NUMBER 21 - 12 -00974 2 The Central Penn Business Journal -estate advertisement 150.00 3 Cumberland County Register of Wills - Filing fee for PA 1500 15.00 4 Cumberland County Register of Wills- Filing fee for PA Inventory 15.00 5 Van rental and refuel charge to remove decedent's belongings and empty apartment 363.00 6 Mileage for Executor handling lease termination, pension contacts, hospital charges 55.50 and other administrative travel while in Harrisburg. i Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERITANCE TAX RETURN 7 RESIDENT DECEDENT FILE NUMBER ESTATE OF Habic, Arnold M 21 - 12 -00974 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION AMOUNT NUMBER 1 LMB Investments- Retained security deposit on decedent's apartment to cover cleaning fees 595.00 2 Checks uncleared from decedent's checking account at date of death 131.00 3 Orchard Bank- HSBC -credit card balance 925.03 4 Credit One-credit card balance 379.75 5 Merrick Bank-credit card balance 1,914.84 6 West Shore Emergency Services-Ambulance bill for transport to hospital 1,572.74 TOTAL(Also enter on Line 10, Recapitulation) 5,518.36 REV•1513 EX+(11-08) SCHEDULE ) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Habic, Arnold M FILE NUMBER 21 - 12 -00974 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I� TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Michael F. Habic Son 100% Residuary 54 John Potter Road Estate W.Greenwich, RI 02817 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 WPM T"N,. .. ffifinamosm LAST WILL AND TESTAMENT I, ARNOLD M. HABIC, of 2514 Rivington Terrace, Harrisburg, County of Dauphin, Pennsylvania, do hereby make, publish, and declare this to be my LAST WILL AND TESTAMENT, revoking any and all prior wills and codicils, in manner following, that is to say, FIRST, that I direct that my Personal Representative shall pay all of my just debts and funeral expenses as soon as this shall be practicable. SECOND, that upon my death, I give, devise, and bequeath all of my property, real, personal and mixed to my son, MICHAEL F. HABIC. THIRD, that if my son has predeceased me, then I give, devise and bequeath all of my property, real, personal and mixed to be divided equally among my two sisters, RHONDA LEE and LINDA EARLY, and my brother, FRANK HABIC. FOURTH, that I hereby appoint my son, MICHAEL F. HABIC as the Executor of my estate. If Michael is unable or unwilling to perform in this capacity, then I hereby appoint FRANK HABIC as the Executor. I direct that my Personal Representative shall not be required to post bond in this or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this third day of July, 2002. AN D M. HABIC o Q WITNESS U3 WITNESS cr- J ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, ARNOLD M. RABIC, testator, whose name is signed to the attached or j foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I have signed and executed the instrument as my Last Will I and Testament; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by ARNOLD M. RABIC, the testator, this third day of July, 2002. - 6 A' NOLD M. HABIC ARY�'UBLIC Notarial S041 IV*Po Nary A,y��nwrder9tan ins Jinn�`r',� Member,FefxwfiM to AgOdamn of tWOM F AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN WE, CHARLES E. PETRIE and DAVID A. PETRIE, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testator sign and execute the instrument as his LAST WILL AND TESTAMENT; that ARNOLD M. HABIC signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testator signed the will as witnesses; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by CHARLES E. PETRIE and DAVID A. PETRIE, witnesses, this third day of July, 2002. WITNESS. WITNESS 1,(XTAR PUBLIC Notarial Seal P Rd)em Not^- 1 AAen�fer,Per�r�yh►aMa Associati�d es EXHIBIT E METRO 3801 Paxton Street 888.937.0004 BANK Harrisburg, Y, PA 17111 m metrobank.com ® 9/24/12 Wion Zulli & Seibert P0 Box 1121 Harrisburg PA 17108 RE: Estate of: Arnold M. Habic Tax Identification Number: 169-32-6237 Date of Death: September 1, 2012 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: CK Account Number: 537855561 Date Opened: 1/28/2009 Primary Owner: Arnold M. Habic Date of Death Balance: $1532.76 Account Type: SV Account Number: 7760480693 Date Opened: 04/26/2012 Primary Owner: Arnold M. Habic Secondary Owner: Michael Francis Habic Date Account Became Joint: 08/21/2012 Date of Death Balance: $9,555.31 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincere Jennifer Jacobs Research Associate Metro Bank EXHIBIT F METRO 3801 Paxton Street 888.937.0004 BANK Harrisburg, PA 17111 mymetrobank.com 9/24/12 Wion Zulli & Seibert P O Box 1121 Harrisburg PA 17108 RE: Estate of: Arnold M. Habic Tax Identification Number: 169-32-6237 Date of Death: September 1, 2012 To Whom It May Concern: This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: CK Account Number: 537855561 Date Opened: 1/28/2009 Primary Owner: Arnold M. Habic Date of Death Balance: $1532.76 Account Type: SV Account Number: 7760480693 Date Opened: 04/26/2012 Primary Owner: Arnold M. Habic Secondary Owner: Michael Francis Habic Date Account Became Joint: 08/21/2012 Date of Death Balance: $9,555.31 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincere Jennifer Jacobs Research Associate Metro Bank LAW OFFI(CCEE/S/S ��yf DAVID A.WION P.O.BOX 1121 113 E.MAIN STREET FRANCIS A.ZULLI HARRISBURG,PA 17108-1121 HUMMELSTOWN,PA 17036 JEAN D.SEIBERT ---------------------- (717)566-2501 SHELLY J.KUNKEL 109 LOCUST STREET HARRISBURG,PA 17101 (717)236-9301 (717)232-1488 FAx(717)23 6-6100 EMAIL:WZS @MINDSPRING.COM March 26, 2013 Register of Wills Office Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Arnold M. Habic No. 2012-0974 Dear Register of Wills: Enclosed please find an original and two copies of the Inventory and PA Inheritance Tax Return for the above-referenced estate. Also enclosed is a check in the amount of$30.00 to cover the cost of filing same. Kindly date stamp and return the two copies to me in the envelope I have provided. If you have any questions or concerns, please do not hesitate to contact me. Thank you. r_: , truly yours, VA__.' Shelly J. Kunkel Cn SJK/kd ? -} ; tea Enclosures M _U Cl) C) �I / \ / - \ / ƒ $ � I t7l & � \ z � G S ® S * ES § 2 2 � » S § . 2 ƒ 2 , §