HomeMy WebLinkAbout04-24-13 (2) J 1505610140
REV-1500 EX (01-10)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601 2 1 1 2 0 9 4 2
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 7 0 3 2 0 1 2 0 6 0 7 1 9 1 7
Decedent's Last Name Suffix Decedent's First Name MI
G 1 O R G I N I C A T H E R I N E R
(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
0 1.Original Return 2.Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
4.Limited Estate 4a.Future Interest Compromise(date of 5.Federal Estate Tax Return Required
death after 12-12-82)
Q 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 1 8,Total Number of Safe Deposit Boxes
(Attach Copy of Will) (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 Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE,DIRECTED TO:
Name Daytime TelepWe Number s
C L.', r�s
C H A R L E S E P E T R I E 7 1 7 � �' 1 1 9 3�;9 ?
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REGISTWOt*1 USF. NLY =
First line of address
3 5 2 8 B R I S B A N S T R E E T j
Second line of address
City or Post Office State ZIP Code ______.___DATE FILED
H A R R I S B U R G P A 1 7 1 1 1
Correspondent's e-mail address: Petrieaw@AOL.cam
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.
SIGNATURE OF PERS N RESPONSial E FOR FILING RETURN DATE
r
ADDRESS
907 S. PROVIDENCE ROAD WALLINGFORD PA 19086
SIGNATURE OFD ARFyl H REPRESENTATIVE TAE f
ADDRESS
3528 BRISBAN STREET HARRISBURG PA 17111
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
J 1505610240
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: CATHERINE R. GIORGINI
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. 1 4 9 7 . 6 6
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6.
7. Inter-Vivos Transfers&Miscellaneous N�-Probate Property
(Schedule G) Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 1 4 9 7 • 6 6
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 6 3 3 2 . 3 4
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10.
11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 6 3 3 2 . 3 4
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. - 4 8 3 4 6 8
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. - 4 8 3 4 6 8
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 ❑
Side 2
L 1505610240 1505610240 J
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 12 0942
DECEDENT'S NAME
CATHERINE R. GIORGINI
STREET ADDRESS
333 ERFORD ROAD_
CITY STATE ZIP
CAMP HILL PA 17011
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
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; ...................................................................... ❑ IZI
b. retain the right to designate who shall use the property transferred or its income; ............................... ❑ X❑
c, retain a reversionary interest;or ................................................................................................ ❑ 0
d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ X❑
2. If death occurred after December 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ Q
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
contains a 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.
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-1508 EX+(6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE RESIDENT D TAX DECEDENT PERSONAL PROPERTY
ESTATE OF FILE NUMBER
CATHERINE R. GIORGINI 21 12 0942
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ACCOUNT AT PNC BANK 1,497.66
TOTAL(Also enter on line 5,Recapitulation) $ 1,497.66
(If more space is needed,insert additional sheets of the same size)
REV-1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
RESIDENT DE EDEN TURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
CATHERINE R. GIORGINI 21 12 0942
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. C. J. LUCAS FUNERAL HOME 4,710.84
2. MEAL AFTER FUNERAL 800.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attorney Fees: CHARLES E. PETRIE 750.00
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: 71.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 6,332.34
If more space is needed,use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
I, CATHERINE R. GIORGINI, of 333 Erford Road, Camp Hill, County of
Cumberland, 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 direct that my estate shall be divided
into four (4) equal shares. I give, devise, and bequeath one share to each of my
sons: ROBERT A. GIORGINI, DAVID J. GIORGINI, and ARRIGO J. GIORGINI,
per capita; that is, if any of my sons have predeceased me, then his share shall
pass instead to my surviving sons. I give, devise, and bequeath the fourth
share to be divided equally among the following grandchildren: CHRISTOPHER
SUTTON, MARYANN SUTTON, and PETER Z. SUTTON.
THIRD, that I hereby direct that the share of my estate that shall pass to
my grandchildren, shall be held IN TRUST, in accordance with the following
provisions:
a. I direct that a separate trust account be set up for each
grandchild.
b. I hereby appoint my son ROBERT A. GIORGINI as the
Trustee. I direct that no bond shall be required in this or in any other
jurisdiction.
c. I direct the Trustee to pay to each grandchild the sums of his or
her trust account upon his or her twenty-first (21 st) birthday.
FOURTH, that I hereby appoint my son ROBERT A. GIORGINI as the
Executor of my Estate. 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
eleventh day of February, 2002.
CATHERINE R. G ORGINI
WITNESS
WITNESS
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
1, CATHERINE R. GIORGINI, testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified according to law,
do hereby acknowledge that I have signed and executed the instrument as my
Last Will 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 CATHERINE R.
GIORGINI, the testatrix, this eleventh day of February, 2002.
CATHERINE R. GIORGNI
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AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
WE, CHARLES E. PETRIE and ROBERT A. GIORGINI, 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
testatrix sign and execute the instrument as her LAST WILL AND TESTAMENT;
that CATHERINE R. GIORGINI signed willingly and that she executed it as her
free and voluntary act for the purposes therein expressed; that each of us in
the hearing and sight of the testatrix signed the will as witnesses; and that to
the best of our knowledge the testatrix 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 ROBERT A. GIORGINI, witnesses, this eleventh day of February, 2002.
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