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Home My WebLink About04-15-13 REV-1500 EX(02-„)`� 1505610105 OFFICIAL USE ONLY PA Department of Revenue pennrAvaMa Bureau of Individual.Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN j{ + ! %J t _.^} Harrisburg,PA 17228-0601 RESIDENT DECEDENT 10118/2012 01/1811919 Decedent's Last Name Suffix Decedent's First Name MI Desso Mrs Margaret M (H 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 CID 1. Original Return C) 2.Supplemental Return Q 3. Remainder Return(Date of Death Prior to 12-13-82) O 4,Limited Estate t=> 4a.Future Interest Compromise(date of O S. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7.Decedent Maintained a Living Trust 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 ® 11. Election to Tax under Sac.9113(A) Between 12-31-91 and 1-1.95) (Attach Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name; Daytime Telephone Number Thomas D. Desso (717)91-9000 w RE Tits OF WILLMSE CP C7 T Q --! Q First Line of Address lit? 2 En M 1810 Silver Pine Circle v, ;X: 4=� o Second Line of Address o "art = --n :EI City or Post Office State ZIP Code F 0,3 rf Mechanicsburg PA 17050 CorrespondenCs ebnait address:tdde$So@ CO Cast.net Under penalties of perjury,i ded that I have examined this rectum,including accompanying schedules and statements,and to the best of my knowedge and belief, it is true,correct and complete. ration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIONA PONS18LE Ft}R FILDJO U DATE ADDRESS / ro StC31ATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE O/kiOfNAL FORM ONLY Side 1 1505610105 1505610105 J _! 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: Margaret Mae Desso RECAPITULATION 1. Real Estate(Schedule A). . . . . . . . . . . . .............. ... . . . . . . . . . . . . .... 1. 0.00 2. Stocks and Bonds(Schedule B) .. .. .. . . ... . .......... . . . . . . . . . . . . ..... 2. 6,077.67 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .... 3. 0.00 4. Mortgages and Notes Receivable(Schedule D) . . ........... . . . . . . . . . .. .. . 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . .. ... 5. 0.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . . ... 6. 266.29 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) C=D Separate Billing Requested.. . . . . . . 7. 0.00 8. Total Gross Assets(total Lines 1 through 7). . . . . . . . . ............. . . .. ... 8. 6,343.96 9. Funeral Expenses and Administrative Costs(Schedule H). . .... . . . . . . . . . . . . . 9. 6,950.00 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)......... ... .. . 10. 11. Total Deductions(total Lines 9 and 10). . . ............. ... .. ..... ....... 11. 12. Net Value of Estate(Line 8 minus Line 11) .. ... ..... . . . ................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) ....... . . . .. . .... ..... . . 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . ............. .. 14. 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- 15. 16. Amount of Line 14 taxable at lineal rate X.0_ 16. 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 L 1505610205 1505610205 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENTS NAME Margaret Mae Desso STREETADDRESS 1100 Grandon Way (Room#602 Emeritus at Creekview—Senior Living) CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 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) 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. ;',ir rxrz ' ) .i,P'r ' ,-.? A1 �C, ..2°,: + 2,% ," 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.......................................................................................... ❑ 0 b. retain the right to designate who shall use the property transferred or its income ..........................................- ❑ N 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?.............................................................................................................. ❑ 0 3. 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? ........................................................................................................................ ❑ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ,",T. R s' ak v .qe" „. ',0* 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)].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. RE -1503 EX+(8-12) pennsytvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Margaret MAe Desso All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' 67 Shares of Tyco International(TYC)@$27.76/share 1,859.92 2 67 Shares of TE @$33.851share 2,267.95 3 33 Shares of ADT(ADT) @$37.96 1,252.68 4 16 Shares of Pentair(PNR)@$43.571share 697.12 Mean Value of the stock per the instructions; (The mean value of the stock as of 10-18-2012 was determined by utilizing the fidelity.com website.) TOTAL(Also enter on Line 2, Recapitulation) $ 6,077.67 If more space is needed, insert additional sheets of the same size Margaret Mae Desso Stock Values as of 10/18/2012 Stock Symbol IShare Quantity jPrice/share—High I Price/share—Low Price/share close Ilylean Value TYC 67 $27.94 $27.58 $27.84 $27.76 TEL 67 $34.05 $33.65 $33.69 $33.85 ADT 33 $39.00 $36.91 $38.56 $37.96 PNR 16 $44.04 $43.09 $43.14 $43.57 Stock Quantity X Mean Value Total$/share TYC 67 X $27.76 $1,859.92 TEL 67 X $33.85 $2,267.95 ADT 33 X $37.96 $1,252.68 PNR 16 X $43.57 $697.12 Grand Total $6,077.67 Note: Stock values from Fidelity REV-i"EX+(oi-ao) B pennsylvania SCHEDULE F ❑EPARTMENT OF REVENUE INHERITANCE TAX RETURN JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Margaret Mae Desso (Deceased October 18th,2012) If an asset became jointly owned within one year of the decedent's date of death,It must be reported on Schedule G. SURVIVING)DINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A•Thomasn D. Desso 1810 Silver Pine Circle Son Mechanicsburg, PA. 17050 (Power of Attorney) B. (See Attachment) 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 DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 04/04/12 Wells Fargo Checking Account#1000603183284 266.29 100 266.29 TOTAL(Also enter on Line 6, Recapitulation) 266.29 If more space is needed,use additional sheets of paper of the same size. Custom Management Checking Account number: 1000603183264 ■ October 11,2012-November 9,2012 ■ Page 1 of 3 Questions? MARGARET M DESSO Available by phone 24 hours a day,7 days a week: THOMAS D DESSO 1-800-TO-WELLS (1.800-8e9-3557) 1810 SILVER PINE CIR TTY:1-800-8774833 MECHANICSBURG PA 17050-855 En espe t:1.877-727-2932 1-800.288.2288 (6 am to 7 pm P7 A#-F) Online: wefisfafgo.com Writs: Weft Fargo Bank.N.A.(345) P.O.Box 6995 Portland,OR 97228.8995 You and Wells Fargo Account options Thank you for being a Wolfs Fargo customer.We appreciate your business and A clack mark in are box indicates you have arese understand that you are entrusting us va81 your banking needs.Lot us assist you - convenient sarvkes wan yanattwnt. Go to in finding the right accounts and sarvims to help you reach your financial goals. wellsfergo.can�'car me numbarabove a you have Please visit us online at wetlsfargo.can,call us at the number at the top of your liwaaons or-if you would like to add new ser moss. statement.or visa any Wells Fargo store-wa'd love to hear from yid Online Banking Z Direct Deposit ❑ Online eel Pay ❑ Auto Transf sriPayment [) Online Statements ❑ Overdraft Protection Q Mobile Banking ❑ Debi Card My Spending Report 0 Overdraft Service ❑ Activity summary Accownwinter. 100DS83183284 Beginning balance on 10111 S44.T7 MARGARET M DESSO DepoeltsiAddkans 221,52 THOMAS D DESSO WdldrawaWSuboacWna - 0.00 Pannsywania accent tsrms and owxWeris apply Ending balance on 1119 120629 For Direct Deposit and Automatic Payments use Routing Number(RTN): 031000503 Overdraft Protection Ywr account Is linked to the following for Overdraft Protection: a Savings - 000005945854445 Shell Sao a 0019997 Sheet 00001 of 00002 Account number. 1000603183284 ■ October 11,2012-November 9,2012 a Page 2 of 3 Transaction history Check DepumTst 4WthdAw" Edug da0y Date Number Descdp0on Addttions Subbac0ons, balance 10116 Deposit Made In A BranOdSturs 21.52 66.20 10116 Deposd Made In A BranctdStom 200,00 26&29 EndkV balance on 11W 266M Totals $221,52 $0.00 The Endhrg Daffy Belanoa does not reflect any pmdkg wNidmwals or hods on depoWadf uds that mayhem been ouletandkrg on yowaccormt when yow trammodonsposted If you had ktsu7kdent ames6te Curds when a transw6wpostad tees mayhem been assessed. Attachment to Schedule F Attachment to Schedule F The Wells Fargo Checking account#1000603183284 was established as a joint checking account between Margaret Mae Desso and Thomas D. Desso for the purpose of paying expenses incurred by and care for Margaret. Margaret resided at Emeritus Senior Living, 1100 Grandon Way, Mechanicsburg, PA, 17050 from 02/25/2011 until her date of death on 10/18/2012 at 93 years of age. Her monthly expense for living at Emeritus Senior Living was$3129.00, her Capital Blue Cross Insurance Premium was$156.80 and her Verizon phone bill was$19.77 . Margaret's income was$1494.00/month from Social Security and $115.24/month from a small pension. In February of 2012, my brother, sister and I started contributing monthly to pay the differential between her income and the cost to continue to live at Emeritus as well as pay for her other expenses.. My sister and I also paid for some of her prescription drugs on a monthly and quarterly basis as well as her co-pays for Doctor's appointments. Since all monies deposited into her checking account were to be used exclusively for her care and expenses,the%of decedent's interest is listed as 100%. Thomas D. Desso John T.Freeberg, Supervisor 200 David Street • Houtzdale,PA 16651 Telephone: 814-378-8661 STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that are required. I£we.are required by law or by a cemetery or crematory to use any items,we will explain in writing below. If you selected a funeral that may require embalming, such as a funeral with viewing,you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or immediate burial. If we charged for embalming, we will explain why below. For the Service of—M r e� [j - Date of Death /Ca11'�K /I Charge to: Nma Ad CAry '�53¢ A. CHARGE FOR SERVICES SELECTED: Other Clothing 1. PROFESSIONAL SERVICES $ Services of Funeral Director/Staff.._..... $�_ $ Embalming_................__......._............. $ 4 Cremation um....................................... $--- Other preparation of body (Description) --------�—_ Other $ _.......................................................I—. $ $- SUB-TOTAL OF PROFESSIONAL SERVICES.........Al $ TOTAL MERCHANDISE SELECTED............. B $ 2., FACILITIES AND SERVICES C. SPECIAL CHARGES: Use of facilities and services for Forwarding of remains to viewing(Visitation/Wake)................. $ A/,4 $__ Use of facilities and services ---v —u--"-- --- for funeral ceremony.......................... $_-- !_ Receiving of remains from Use of facilities and services for — ——————— $----- Fmuiy Home Memorial Services............................. $ Immediate Burial................................... $ Use of equipment and services Direct Cremation................................... $ for graveside service.......................... $ _ $ Other use of facilities SUB-TOTAL OF SPECIAL CHARGES.................C $ D. CASHADVANCED Opening Grave................................. ... -- Cemetery Equipment ....... $ Lot and Deed......................................... $ SUB-TOTAL OF FACILITIES/EQUWMENT............A2 $ Newspaper Notices-Local..�Y.astr'.t, $--ri j 3. AUTOMOTIVE EQUIPMENT Newspaper Notices-Out-of-town ........ $ Vehicle to transfer remains to Funeral Home. Telephone&Telegrams....._-.—. ..... $ Local ........................—...___............. $ Airline—..............................................- $ Hearse(Casket Coach) Clergy/Mass Offering.................. $_ /p4j.un Local..................................................... Pallbearers.................................. $_. Limousine Certified Copies of the Death Local.....___......................................- $ Certificate 14..t�....4.r1..6n................ $ f7 0 . Family car Police Escort................................ $ Local...............___.............................. $ - Flowers............._............_.........._....... $ Flower car or floral disposition Vault Service Charge....................: $ ' LCLCL Cho Local..................................................... $— 4 —_ e�5t ------ $- _ i Load car/clergy car......_........................ $ .L�y.l, o c.- ..t,,csac_.. $�- -�1- �. ka Local____........ $ Car for pallbearers Local................................................... $ �— $ Out of town transportation.................... $ „_.—.__.-----_ __ $ SUB-TOTAL OF ADVANCES........ .......... ...................D $ --.-- $ We charge you for our services in obtaining: T SUB-TOTAL OF AUTOMOTIVE EQUIPMENT......A4 $--_-- (specify cash advances that are marked-up) TOTAL OF PROFESSIONAL SERVICES, — ----_ FACILITIES AND AUTOMOTIVE �� --.---- EQUIPMENT................................................... .......A $ SUMMARY OF CHARGES _>..L, B. CHARGE FOR M�E,RCHAN,t}ISE SELECTED: A. Professional Services,Facilities and t 'CC a4 Equipment,and Automotive Casket....lY1t2.$;;,L..diS..... .;t7 ..'..... $ Equipment............................................. (Description) 1a.,r„(,I6��i('>r,4 r> }.�r B. Merchandise................._...................... $—��--t-�t biF --- — C. Special Charges..........._.__........_......... $ Other Receptacle............................... r .... . ...................................... {Description)_----,_--_-- D Cash Advances $ , r, TOTAL OF ALL SECTIONS..................................$ PAID AT TIME OF OR PRIOR ........................................$ (Description)_ ;:� „ , .!Alaf I TO ARRANGEMENTS -- BALANCE DUE........................................................$ Acknowledgement cards._................._. $�_ REASON FOR EMBALMING Register book(s)....................___........ $ _ i t I sw L1; 7n Memory folders .................................... $ If any law,cemetery or crerrlatory requirements have required the purchas Prayer cards ....___..........—................... $ _ of any of the items listed above the law or requirement is explained below Temporary gave marker....................... Burial clothing....—................................ I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requested. I acknowleO receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent that I have sufficient funds available for payment of the cash price for the goods e services selected. I also agree to make payment of$ _within days. I agree to be Jointly and severally liable with anyone e who signs below. A late charge of j%z°I per month amounting to 18%oer veer will be applied to the unpaid balance beginning 30 days from the date of this agreement will also pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement. "loose costs may include attome fees,court costs and ter costs. Any additional services or merchandise ordered or requested after the date of this agreement will be considered part of this agreement the cost thereof a reflected on the final bill op atd@ment. (Seal). comz (Seal)_ .—_—.---.—.—.---.—_ •.. 4iC1- -i —.—._.—.._.�.__. (�+Wd _. aMaosm Fwaaitl WEffrE-Funeral Director YELLOW-FU¢ezein r PINK-CUSwma