HomeMy WebLinkAbout04-08-13 1 1505610105
�1 REV-1500�`t°2-i"`K'
PA Department of Revenue P OFFICIAL USE ONLY
Bureau f Individual Taxes INHERITANCE TAX RETURN GIufII a Year Five Number
Harrlsburc A 17128-D6ot RESIDENT DECEDENT Q =4 i
ENTER DECEDENT INFORMATION BELOW
' 10/01/2012 04/16/1921
Decedent's Last Name Suffix Decedent's First Name MI
STEFANON DOROTHY M
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
NIA
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
CD 1.Original Return C= 2.Supplemental Return C= 3. Remainder Return(Date of Death
Prior to 12-13-82)
N= 4.Limited Estate tCCS 4a.Future Interest Compromise(date of (= 5. Federal Estate Tax Return Required
death after 12-12-82)
(ND 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
O 9,Litigation Proceeds Received C=) 10.Spousal Poverty Credit(Date of Death C= 11. Election to Tax under Sec.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
ANTHONY STEFANON, EXECUTO {717}761-6162
R!'DISXR of WI SE
to =0 d3 a
`D
First Line of Address a C->
1847 CENTER STREET _ CD
Second Line of Address p '1r!
_ _ In AE ...
City or Post Office State ZIP Code
4D � DATE f JT. k
CAMP HILL PA i 17011 " -
Correspondent's*-mall address:tonyBtefanon @verizdn.net
Under penalaes ,I declare that I have exaMined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
R rs true, plate re WE--other than the personal representative is based on all Information of which preparer has any know ledge.
SIG dF ES FILING RETURN DATE
ice, l 1
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
t 1505610105 1505610105
J 1505610205
REV-1500 EX(Fl)
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 and Notes Receivable(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)..... .. 5. 26,242.29
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ..,,... 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested,....... 7. 30,438.00
8. Total Gross Assets(total Lines 1 through 7)............................. 8. 56,680.29
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. ' 3,326.43
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. 799.00
11. Total Deductions(total Lines 9 and 10). ........................... ..... 11. 4,125.43
12, Net Value of Estate(Line 8 minus Line 11) ............ ........ ! 52,554.86
11 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. 52,554.86
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.045- 52,554.86 16. 2,364.97
17. Amount of Line 74 taxable
at sibling rate X A2 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18,
19. TAX DUE ..... .. ......................... .................... ..... 19. 2,364.97
20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C=
Side 2
1505610205 1505610205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
DOROTHY M STEFANON
STREET ADDRESS
4833 E.TRINDLE ROAD
CITY STATE ---Fz-lp
MECHANICSBURG PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 2,364.97
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+8) (2)
1 Interest
(3)
4. If Line 2 is greater than Line I+Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
& If Line i+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2,364.97
Make check payable to: REGISTER OF WILLS,AGENT.
%
6U" WkIl lftw
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................... ................ F-1 0
b. retain the right to designate who shall use the property transferred or Its income............................................ 17 0
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?..................................................................................................
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? ...........................................................................................................— N ❑
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN,
%40 "'119
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)(11.11)(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
V2 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 decedents 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 decedents 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.
LAST WILL AND TESTAMENT
It DOROTHY M. STEFANCH, of the Township of Upper Allen,
County Of Cumberland and Commonwealth of Pennsylvania, being
of sound and disposing mind, memory and understanding, do make,
publish and declare this as and for my Last Will and Testament,
hereby revoking and making void all former wills and codicils
by me at any time heretofore made.
FIRST. I order and direct that all my just debts and
funeral expenses be paid by my Executor, Executors or Executrix,
as the case may be, hereinafter named, as soon as conveniently
may be done after my decease.
SECCND. I give, devise and bequeath all the rest, residue
and remainder of my Estate, real, personal and mixed, whatsoever
and wheresoever situated unto my husband, SEVERING STEFANGN,
absolutely and in fee simple, if he survives me.
THIRD. If my husband, SEVERING STEFANGN, should not
survive me, and if all of my children have attained the age of
twenty-two (22) years at the time of my death, then and in that
event I give, devise and bequeath my entire Estate in equal
shares unto my children, share and share alike. Should any of
my said children predecease me and leave lawful issue to survive
them, I order and direct that the share or part of my Estate
which such deceased child or children would have received here-
under had he, she or they survived me shall be distributed unto
S..-..- the issue of such deceased child or children per stirpes, said
issue taking his, her or their deceased ancestor's or
ancestors' share or shares hereunder by representation and
not per capita.
I£, however, any of my children are under the age of
twenty-two (22) years at the time of my death and should they
be otherwise entitled to receive my entire estate under the
provisions of the paragraph immediately preceding hereinabove,
then and in that event, I give, devise and bequeath my entire
said Estate unto my daughter, LISA S. KEI%, , and my son, ANTHONY
STEFANON, or the one who may qualify in the event of the prior
death, disability or unavailability of the other, as my Trustees,
in trust, nevertheless,to hold, invest and re-invest the same,
to collect the income, and after paying all expenses incident
to the management of said trust, to use and apply as much of
the net income and principal thereof as may be necessary in
the sole discretion of my Trustees for the support, maintenance,
care and education of such of my children as may be under the
age of twenty-two (22) years, it being my will and intention
to provide for each child who has not attained such age and
who may be dependent and unemancipated (by reason of disability
or full time attendance in a school) at the effective time
hereof with the same or similar advantages and benefits during
his or her dependency which I have provided to my older child
or children together with the privilege of acquiring a college
or other post-high school education, and, upon the youngest of
my children attaining the age of twenty-two (22) years, I order
and direct that the balance of principal and any accumulation
MRRTeON a$NC6HRNCR
RTTORNCYS RT V1W
of income remaining in the hands of the Trustees be distributed
in equal shares unto my said children, share and share alike.
It is my express will and considered thought that
my said Trustees should terminate any benefits under the fore-
going trust for any child under the age of twenty-two (22)
years who has by his or her personal conduct become independent,
completed formal education or otherwise demonstrated his or
her lack of dependency upon the funds under the management
and control of said Trustees. In addition to the foregoing
idirections and general discretion vested in my said Trustees,
the marriage of said children or their persistent display of
lack of personal initiative and industry shall be considered
by my said Trustees as sufficient cause to discontinue the
discretionary distribution provided hereinabove.
it is my further express instruction and direction
that all discretionary payments hereinabove provided shall
, cea.e for each of my aid children upon the attainment by
each said child of age twenty-two (22) years, thus making
available the balance of said trust for use in the purposes
set forth above for my younger child or children.
TIASTLY. I nominate, constitute and appoint my husband,
SEVERINO STEFANON, to be the Executor of this, my Last will
and Testament, but if for any reason he shall fail to qualify
as such Executor or cease so to serve, then I nominate,
constitute and appoint my daughter, LISA S. 'KEIR, and my son,
ANTHONY STEFANON, or the one who may qualify in the event
of the prior death, disability or unavailability of the other,
to serve in his place, each to serve without bond.
IN WITNESS WHEREOF, I, DOROTHY M. STEFANON, have hereunto
set my hand and seal to this, my Last Will and Testament which
consists of four (4) typewritten pages to each of which I have
affixed my signature this 'ir/a14 day of January, A. D., One
Thousand Nine Hundred Sixty-nine (1969) .
(SEAL)
The preceding instrument, consisting of this and three (3)
other typewritten pages, each identified by the signature of
the Testatrix, was on the date thereof signed, sealed, published
and declared by DOROTHY M. STEFANCK, the Testatrix therein named,
as and for her Last Will and Testament, in the presence of us,
who, at her request, in her presence, and in the presence of
each other, have subscribed our nat� as wit t ae reto. /
RTfioN Q BN[tY+lit£R
REV-isoil EX+(o8-f2)
pennsy[vania SCHEDULE E
ail 1pEPAMENTOFREVENUE CASH, BANK DEPOSITS&MISC.
1NM°`rT"NCE T""RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DOROTHY M STEFANON 21-12-1125
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property johKiy owned with right of survivorship must be disclosed an Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION
OF DEATH
1. CASH ON HAND
211.00
1 PNC CHECKING ACCOUNT 5070085831 25,315.14
3. COUNTRY MEADOWS AT HOME REFUND 48.00
4, COUNTRY MEADOWS REFUND 160.00
5. NATIONWIDE INSURANCE RETURN OF PREMIUM 94 00
6. CAPITAL BLUE CROSS RETURN OF PREMIUM 410.65
7. QUANTUM IMAGING REFUND
3.50
TOTAL(Also enter on Line 5, Recapitulation) 26,242.29
If more space is needed,use additional sheets of paper of the same size.
Free Checking Account Statement t
PNC Bank ( FNCBANK
Primary account number:50-7008-5831
Pape 1 of 3
For rho period 11/24/2012 to 12121/2012 Number of ertcosures:0
000379 ®For 24-hour banking,and transaction or
DOROTHY STEFANON DECD 8Interest raft lnformatlok sign onto
C/O ANTHONY STEFANSON ATTY PNC Bank online Banking at pne com.
1847 CENTER ST 'a For customerservicecall t-88e-PNC-BANK
CAMP HILL PA 17011-1703 Monday-Friday: 7AM-10 PM ET
Saturday&Sunday: 8 AM-5 PM ET
Para servido on espalloi,1-866-I#LA-PNC
Moir± Please contact us at 1-886-PNC-BANK
110 Write to:Customer Service
PO Box 609
Pittsburgh PA 15230-9738
Visit us at pne.com
® MD terminal:14K*-531-1648
For hesraut acpawed clients only
NOTICE OF EXPIRATION OF THE TEMPORARY FULL FDIC INSURANCE COVERAGE FOR
NON-INTEREST BEARING TRANSACTION ACCOUNTS
Unless theta is a change in federal law,beginning January 1,2013,funds deposited in a non-interest bearing transaction account(for example,
a non-interest bearing checking account),including an Interest on Lawyer Tnnst Account,no longer will receive unlimited deposit insurance
coverage by the Federal Deposit Insurance Corporation(FDIC).Beginning January 1,2013,all of a depositor's accounts at an insured
depository institution,including all non-interest bearing transaction accounts,will be insured by the FDIC up to the standard maximum deposit
insurance amount($250,000),for each deposit insurance ownership category.For more information about FDIC insurance coverage of
non-interest bearing transaction accounts,visit:www.fdic.itov/deposit/deaosits hmhniited/expiratiou.html
kM IZ.'MOO` Dorothy Stsfanon Decd
Anti~numbers 50-7008-5831
Owrdratt Probretlea has not been established for this account.
Pkwse contact us i
Free Checking Account Statement
For auto pod" 11/2412012 to,a/21//"112
For 24-hour information,sign on to PNC Bank Online Banking DOROTHY STEFANON DECD
on pnc.com. Primary amount number.50-7008-5831
Account number:50-7005-5881-continued Page 2 of 3
AcdWty Deftd
004w Deduadme There were 2 Other Deductions totaling
Data Amount Description ' d.31d.t4,
12/11 .00 Outstanding Item Close
12/11 25,315.14 Debit Memo Reference No. 502002830
Daffy Salome Data
Date Balance Data Balance
11/24 25,315.14 12/11 .00
Stock Up on PNC Hank Visa*Gift Cards this IIofiday
The PNC Bank VisaO Gift Card is perfect for everyone on your gift list.PNC Bank Visa Gift Cards are easy to purchase at most of our branch
locations.They come with a gift card carrier of your choice to highlight the special occasion. To learn more,visit your local PNC Bank
branch or pnc.comtgilicard.
VisaO is a registered trademark of Visa USA,Inc.
r
wunuy meawym nt rime 4r
Pay to: ESTATE OF DORtr 1 8T WANON Da 1012M 1 ' Amt: 848.00""" ua
MEMO aiY,pATi! '' alY.NUMBt ails.mwu D18C011NTr. NETAMOUNt
CLIENT REFUND 10/1.7/2012. 8T8FANOW: I3
DOROTHY $TEFANON
50 0 01672 9 ,OE) 48.0Q
1
Es"Tit or DWOrHY s?6FANQif
Cho ANTHONY STEFANOIf
1047 CEMW STREET- ..
CANF HILL: PJM 17011S. >,
- wn+r.r�wr+'wwrtn+.wwwa rr..
Country Mosdowo At Nuns;15V w,E .s HJl 3206
830 Chal Drive
Hershey PA 0033
DATE CHECK NO, AMOUNT
10/2612012 3200 $48,00""'
Pay FORTY-EIGHT AND 00/100 DOLLARS
TO THE
or- ESTATE OF DOROTHY ST'EFANON
S'
C/O ANTHONY EFANON
1847 CENTER STREfl,
CAMP H1Ll,PA 17041 ` �I� /
"12 111-M F1' F FEMINISM INC lH)M DITARA ON EACH. ® OOROVt COWAM NICAMANOW
99000 3 20 69'" i:0 3 1000 50 31: 20000 30080 1 2 too
t
Pep to: if OF DCIROTHY BTEFANw Daw. 10t28=a Aft $160.00id'
MEEk1 N V.DAT11. WV.NUinvi " NW.AMOUNI 0000UNT N!T AMOUNT
RESIDENT`' RUM, 10/0112022"$TSON01ti, D*`
DORppT Y 3'P FAf40I�i. 160.0Q 160,00
9043' 1 4834
ESTATR Of DOFkOM mfAt m
C/o AUTHOR ST*fANO
2947 CEW"* STR T
CAMP MILK, PA 17012'
r,oaron.�srrww...swaut....,.r
Country Meadows Associates w.1orB Efantc,N A 205864
830 Chary pli4
Hershey PA 17033
DATE CHECK NO. AMOUNT
10/2512012. 205864 $160.00***
Pay ONE HUNDRED SIXTY AND 001100 DOLLARS
! TO THE
ORDER ESTATE OF DOROTHY STEFANON
C/O ANTHONY STEFANOM
1847 CENTElt STREET . «b,
CAMP HILL, PA 17011
SECUHrrT PBA7UB98 INCLUO9M DIUMLS ON BACK.
+g0 20 586 40 1:0 3 &000 50 34 20 0t 20 12 7088 5"s
! t
NATIONWIDE MUTUAL INSURANCE COMPANY
RALEIGH SERVICE CENTER DATE CHECK NO
4401 CREEDMOOR RD 101SC
RALEIGH NC 27612 0000459247 01/04/13 0940165281
DATE INVOICE NUMBER/DESCRIFr*N GROSS DISCOUNT NET
12/31/12 5837ho398219 61 94.00 94,00
replacing tt*#0058568323
n
e-
O
a
0
0
0
0
in
N..
O
p. QUESTIONS? CONTACT: (919) 420-7082 TOTAL 94.00 94.00
IMPORTANT NOTICE
VENDOR PRIVACY STATEMENT
Natorrwid•respects the privacy of inotviduers personal Irdo rmedion. Service prodders must comply with state and federal privacy Isom,including the Privacy prw dons of the Gramm-Leach-9lley Act
and with NadonwhMs Privacy Matoment. Accordingly,any perecnal Wormaton shared with or obtained by service providers shall be used safely for the purpose for which I was provided and for no
amw purpose whateceve.
- - - - - -- - - -- - -- - - -- - - - - - - - - --- - - - - - -- -- -- - - - - - - - - - - - - -- Fold top down to dashed line - - -- --
G-2002.21)(042012)
ex.,: r�1 j���� yr goy ry } I .s
1�wow r
' 4 r M QM N�ggtl 041,4; e l
PAI NINEY'Y-iROtlA bOLLAF*A Nb iV1Iw(.
r:: 6
Pay ESTATE OF DOROTHY A STEFANON *********94.00`
To The 907 FOX HOLLOW RD
Order SHERMANS DALE PA 17090
Of
The Huntngtan NaiionH Bane•WesteMle OH By Authorized Signature
o"0940 16S 213 111' 1:04411S 1261: 0189 009001ne
CAPITAL ADVANTAGE INSURANCE COMPANY
HARRISBURG,PENNSYLVANIA 17177 REMITTANCE"VOUCHER
Check Date: 15-JAN-2013
30031067 11-JAN-13 REISSUE CH CK#30031067 0.00 410.85
TOTAL 0.00 410.65
x r'
77f �p HARIi1$"13 E�V
t hi01�{,VANI 1 1Z?
si .ind7jwfUiltl�MrNtllh♦�Wi1♦n♦rY ebi jMl�ii JM .t 3 k 1 1
T77" 77
t.
DATR. W CM$CK lt' AMOUNT,'
15-JAN-2013 91403-` ••:•••410.85. :
PAY`.. ESTATS of DOROTHY A ST11FANODi
TO THE CO ANTHONY STEPANON ATTY .
ORDER OF 1947 CENTER ST
CAM0 HILL.PA 17011
Manufwturm and Yradsrs Tnu4 Company
Altoona,PA 16601
11'97403114 1:0313029551: i0290303al
N N
O N
O
V 8 0
S $
N N
Y
Z �
O
7
C1I
IL
1 L13
® $ V r
)
Z
cr I � LL
c to
.. c If d
U1 w c.) w
Ln
K
r
ru O o 0 0 ~Z
O
g 0 a
rm
r„
O
LU
g
a
1,0 Z N
of r�1
LL w u
W a LL O w
i a O
O N O Z of ~Z
~ 3
LL
O w W
S _ w a:
LL
w f 0
a: w ~z zr 0
F-0 a 0 w F
Oct 0 a a � d a � a �
W
a0 �
REV-1510 EX+(08-09)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER—VIVOS TRANSFERS AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF
DOROTHY M STE FILE NUMBER FANON 21-12-1125
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
NUMBER
INCLUDE THE NAK DP THE TRANSFEREE,n+EIR REIATIDNSHIP m DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
THE DATE OF TAIw$FER.ATr1CH A COP/OF THE DEED FM REAL ESTATE. VALUE OF ASSET INTEREST 6 AFRIDABIE VALUE
1, GREAT AMERICAN ANNUITY:BENEFICIARY ANTHONY STEFANON
(SON)FIXED TERM OF YEARS(VALUATION LETTER ATTACHED) 30,438.00 30,438.00
TOTAL(Also enter on Line 7,Recapitulation) $ 30,438.00
If more space is needed,use additional sheets of paper of the same size.
r
GREATAMERICAN.
FINANCIAL RESOURCES
December 13,2012
Anthony Stefanon
1847 Center Street
Camp Hill PA 17011
RE: Great American Life Insurance Company
Policy Number: 06008115
Deceased: Dorothy Stefanon
New Payee: Anthony Stefanon
Dear Mr.Stefanon:
Your death benefit election to resume the annuity payments has been processed.Shortly you will receive two
checks in the amount of$568.41 each,representing the missed payments from November 5 to December 5,2012.
The remaining payments will be made monthly beginning January 5,2013 in the gross amount of$568.41 until
May 5,2017. Future payments will be sent by check.
Per your request,taxes will be withheld from your payments,as follows:
Federal Income Tax Withheld: -$0.00
State Income Tax Withheld: -$0.00
Therefore,net payments will be distributed in the amount of$568.41. The taxable amount of each payment is
$270.98.
Our records indicate that your Primary Contingent Payee(s)and Secondary Contingent Payee(s)are:
Primary Contingent Payee(s):Estate of Anthony Stefanon
Secondary Contingent Payee(s): N/A
You listed yourself as the Primary Contingent Payee. Upon your death,any payments remaining will be due to
your estate. If you wish to change this election,please complete and return the enclosed Contingent Payee
Designation form.
If you have any questions,please contact our office at(800)854-3649.
Sincerely,
Trisha Schoonover
Life&Annuity Claims Department/Extension 11826
cc: AA447
P.O. Box 5420,Cincinnati OH 45201-5420, 1-800-854-3649
� I IIII
April 4,2013
Anthony Stefanon, Esquire
1847 Center Street
Camp Hill, PA 17011
Re: Value of Term Certain Annuity
Dear Tony:
You requested that I value a term certain annuity which you are eligible to receive from Great American
Life Insurance Company. You are the beneficiary of this annuity since your mother passed away on
October 1,2012,with certain annuity payments remaining. The facts which I base my valuation on are as
follows:
1. You are entitled to receive continuing monthly payments of$588.41 per month payable from
November 5,2012,until May 5,2017. You are guaranteed to receive 55 monthly payments.
2. In the event of your death prior to receiving 55 payments,your estate will receive any remaining
payments. As such,receipt of the annuity payments is not contingent on your survival.
Based upon the instructions for Pennsylvania Inheritance Tax Return Form Rev-1500,valuation of team
certain annuities for inheritance tax purposes should be based upon 120%of the Federal mid-tern
annual rate in effect for the month in which the date of death occurred. These rates are published in
Internal Revenue Code§7520. The Internal Revenue Code§7520 interest rate for October 2012 was
1.20%.
The present value of 55 monthly payments of$588.41 to be paid to you using an interest rate of 1.20%
equals$30,438.
If you have any questions regarding the computation made herein,please contact me.
With best regards,
Yours sincerely,
Jonathan D. Cramer, F.S.A.
JDC:kad Consulting Actuary
Encl.
REV-1511 EX+(10.09)
pennsytvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL. EXPENSES AND
RESIDENT DE ED NTTLtiRN ADMINISTRATIVE COSTS
nE51DENT DECEDENT
ESTATE OF FILE NUMBER
DOROTHY M STEFANON 21-12-1125
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1' AUER CREMATION SERVICES 90 00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 2,834.01
Name(s)of Personal Representative(s) ANTHONY STEFANON
Street Address 1847 CENTER STREET
City CAMP HILL _ State PA zip 17011
Year(s)Commission Paid: 2013
2. Attorney Fees:
3. Family Exemption:(If decedent's address is not the same as claimants,attach explanation.)
Claimant
Street Address
city State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 148.50
51 Accountant Fees: -
6. Tax Return Preparer Fees:
7. THE SENTINEL ADVERTISEMENT 17&92
CUMBERLAND LAW JOURNAL ADVERTISEMENT 75.00
TOTAL(Also enter on Line 9,Recapitulation) $ 3,326.43
If more space is needed,use additional sheets of paper of the same size.
Ns
P -R CREMATION SERVICES OF PENNSYLVANU, INC.
4100 Jonestown Road•Harrisburg,PA I7109• 1-800-720-8221 •Fax 717-541-9943•Shawn E.Carper,Supervisor
SYLpAI�Th^, .
121034 MCR-5
Oct 1 , 2012
Anthony Stefanon
907 Fox Hollow Road
Shermansdale, PA 27090
Dorothy Mae Stefanon - Deceased
SPECIAL CHARGES
X Direct Cremation $1,595.00
X Nationwide Guarantee Program $295, 00
Worldwide Travel Protection
TOTAL SPECIAL CHARGES $1 ,890.00
PROFESSIONAL SERVICES
X Services of Funeral Director & Staff Included
Other Preparation of the Body
Facilities & Staff for Memorial Service
Staff & Equipment for Memorial Service
Witnessing the Cremation
Private Family Viewing/Witnessing Cremation
Packaging And Forwarding Cremated Remains
Personal Delivery of Cremated Remains
Scattering of Cremated Remains
Medical Documents/Courier Fee
TOTAL PROFESSIONAL SEPVICES $0.00
AUTOMOTIVE EQUIPMENT
X Removal Vehicle Included
Lead Car/Clergy Car
Family Car
Service Vehicle
TOTAL AUTOMOTIVE EQUIPMENT $0.00
MERCHANDISE
Register Book
Memorial Cards
Thank You Cards
Remembrance Package
X Arrange/Deliver Ashes To National Cemetery $0.00
X Solid Sheet Bronze Urn.with Satin Finish $125 .00
Urn Burial Vault
Veterans Flag'Case
Grave/Memorial Marker
Veterans Flag Case
TOTAL MERCHANDISE $125 .00
CASH ADVANCED ITEMS
Grave Opening
Cemetery Equipment
Newspapers
Newspaper
Vault Service Charge
Clergy
Church/Organist/Soloist
Flowers
X Crematory Charge Included
X Dauphin County Coroner Fee $30.00
X 10 Certified Copies of Death Certificate $60.00
TOTAL CASH ADVANCED ITEMS $90.00
SUMMARY OF CHARGES
Special Charges $1,890.00
Professional Services $0.00
Automotive Equipment $0.00
Merchandise $125.00
Cash Advanced Items $90.00
SUB TOTAL $2 , 105 .00
CREDITS -$670. 00
AMOUNT PREPAID Date Mar 4 , 1999 -$1 ,345 . 00
TOTAL $90.00
AMOUNT PAID Date Oct 3, 2012 -$90.00
BALANCE DUE , $0.00
THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES
RECEIPT FOR PAYMENT
GLENDA FARNER STRASBAUGH Receipt Date: 10/17/2012
Cumberland County - Register Of Wills e : 12 :55 : 19
Time :Receipt T
One Courthouse Square Receipt Tim 1071763
Carlisle, PA 17613
STEFANON DOROTHY MAE
Estate File No. : 2012-01125 ---
Paid By Remarks : ANTHONY STEFANON
CJ
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 60 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 40 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 .50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
RENUNCIATION ----------5_00 CUMBERLAND COUNTY GENERAL FUN
Check# 7008 148 . 50--
Total Received. . . . . . . . . 148 . 50
T e Sentinel ANTHONY STEFANON AD,NUMBER PAGE NO.
w Ww.CVmbarI1nk.C*M 1847 CENTER STREET 415774 1Of1
CAMP HILL,PA 17011 BILL DATE SALESPERSON
�. 717-7818182 11/19112 wolfs
CAada rsat;RG vlan COUNN
START DATE STOP DATE
11105112 11/19112
AD NUM UR I AD DESCRFTION CLASS I LIN
415774 1 ESTATE NOTICE LETTERS TESTAMENTARY 10 PUBLIC NOTICES 132 ` 2 cols
Publication Insertions Rate Not Amount Gross Amount
3 THE SENTINEL-LEGAL 3 LGL $189.92
TOTAL AD CHARGE $189.92
3 PROOF OF PUBLICATION 01PRF $7.00
3 MOBILE SITE M082 $2.00
PREVIOUSLY PAID ($178.92)
Purdrwawordwr Est.D.Stefanon $0.00 $0.00
THE SENTINEL
Thank you for advertising with The Sentinel! Deadline for c/o LEE NEWSPAPERS
In-column legal ads is 4:00 p.m,two business days prior to PO Box 540
date of insertion.For questions,call(717)240-7130. WATERLOO IA 50704-0540
It h-MN pwv-wo yowp.-+W Legal
THE SENTINEL ❑ Check# F Credit Card Ad Number 415774
c1a LEE NEWSPAPERS ❑ ® ❑ ® ❑ ® ❑ - Billing Date 11/19112
PO BOX 544
WATERLOO U\ 50704.0540 Amount $ 00
EV.Date:m m
Nam on credo crowd $
9igmaure
memo make amcks paysbN w: THE SENTINEL
• 000+ar+ THE SENTINEL
ANTHONY STEFANON cla LEE NEWSPAPERS
1847 CENTER STREET PO BOX 742543
CAMP HILL,PA 17811 CINCINNATI OH 45274-2546
215402000000041577400000000000000D0000000000000007
REV-1512 EX+(12-12)
�pennsylvania SCHEDULE I
DEPARTMENToFREvENUE DEBTS OF DECEDENT,
RESIDENT INHERITANCE ED RETURN MORTGAGE LIABILITIES& LIENS
RESIDENT DECEDENT
ESTATE OF
DOROTHY M STEFANON FILE NUMBER
21-12-1125
Report debts incurred by the decedent prior to death that remained unpaid at the data of death,including unreimbumed medical expenses,
ITEM
NUMBER DESCRIPTION VALUE AT DATE
1' SARA TODD MEMORIAL HOME OF DEATH
799.00
TOTAL(Also enter on Line 10, Recapitulation) $ 799.00
If more space is needed,insert additional sheets of the same size.
' STATEMENT
Sarah A Todd Memorial Home Statement Date: 10/10/2012
1000 West South Street
Carlisle, PA 17013-2798 Due Date: 10/25/2012
Telephone: (717)245-2187
Amount Enclosed$
Amount Due: $ 799.00
Account#: 102451
RE: Dorothy A Stefanon
Anthony Stefanon
907 Fox Hollow Road
Shenmansdale,PA 17090
"12i/1 1 Laundry Services 1 25. 25. 799.00
(
V
current 31-60=Doi 6 1-90 Do" Over 90 Do" Amount O
799.00 .00 w 100
NOTE: *****PAYMENT IS DUE UPON RECEIPT*****BUT NO LATER
THE 25TH OF THE MONTH***** Please rwNt the LAST AMOUNT
your statement.Indude the ACCT# from the statement on the MEMO ent /10/2012
of your d>edc.PaMm is after 10/5/12 do not rertect on statement Due Date: 10/25/2022
NOTE:**LATE PAYMENTS ARE SUBIECT TO A 1.25%LATE CHARGE PER
MONTH **A$10.00 FEE WILL BE CHARGED for RETURNED CHECKS
Dorothy A Stefanon-Account#: 102451
Sarah A Todd Memorial Home
1000 West South Street
Carlisle,PA 17013-2798
Telephone: (717)245-2187
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT TA REVENUE BENEFICIARIES
INNERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
DOROTHY M STEFANON 21-12-1125
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.9116(a)(1.2).)
1• AntDnina S Weaver,121 Hassinger Road,Newburg,PA 17240 Daughter one seventh
2. Lisa S Keir,13907 Longnecker Road,Reisterstown,MD 21136 Daughter one seventh
3. Jennffer Hem,98 Berwick Plaoe,Norwood,MA 02062 Granddaughter one seventh
4. Anthony Stefanon,907 Fox Hollow Road,Shermans Dale PA 17090 Son one seventh
5. Kristine S.Prengaman,339 N.Sandusky Street,Delaware,OH 43015 Daughter one seventh
6. Aame Stefanon,561 Criswell Drive Ext.,Boiling Springs,PA 17007 Son one seventh
7. Timothy Stefanon,168 Tuckahoe Road,Dillsburg,PA 17019 Son one seventh
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE,
11 NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 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 $
If more space is needed,use additional sheets of paper of the same size.
ANTHONY
STEFANON
ATTORNEY
Anthony Stefanon �o
April 5, 2013 ars -� rrs
r ,� co ;0,9
CA
A � at
Register of Wills
Cumberland County Courthouse cs *
One Courthouse Square °
Carlisle, PA 17013 ,
Attention: Wanda
Re: Estate of Dorothy Mae Stefanon
File No.: 2012-01125
PA File No.: 21-12-1125
Dear Wanda:
Enclosed herewith is my check drawn payable to your office in the
amount of$15.00 for the filing fee for my Inheritance Tax Return which was
previously submitted.
Please contact me if you have any questions.
V y your
AS/kr
Enclosure
1847 Center Street
Camp Hill
Pennsylvania 1 701 1-1 703
tonystefanonc verizon.net
fax:717.761.6164
phone:717.761.6162
Itl1 0 ri
I ;Coo
r 0 O p
0 I,-,U
` 40
N
N f •"�
3 f�LL
N
d N W ^n
�tINC1 0 o f r
y ^�
f!1 "=
O
O � r
U
Q
ONM
NU c
o � �
O
NFU �
rn E c
WUO t
m
tit
i7
�w.
r4
M
n
v �
U p•
E c
Z
Z Q W
Q Z Z
tY
lJ
Z � Oo
.�C SP. .y x
{[{''
S'
4
€: