HomeMy WebLinkAbout06-10-13 � R�V-1500Ex�o,-,o� 1505610143
PA De artment of Revenue p y OFFICIAL USE ONLY
P enns Ivania CountyCotle Year FileNumber
Bureau of Individual Taxes DEPARTMENTOFREVENUE
Po BOxzsoso� INHERITANCE TAX RETURN 21 13 0 5 0 3
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
11 15 2012 O1 04 1963
DecedenYs Last iVame Suffix DecedenYs First Name MI
ANTONICELLI ALYSON C
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M�
ANTONICELLI III FRANK J'
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLIGATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1. Original Return ❑ 2. Supplemental Return � 3.Remainder Return(date of death
priorto 12-13-82)
� 4. Limited Estate � qa.Future I�teresl Compromise � 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
� g Decedent Died Testate � � Decedent Maintained a Living Trust 8. Total Number of Safe De Slt BOX2S
(Attach Copy of Will) (Attach Copy of Trust) P� �.
� 9. Litigation Proceeds Received � 10.Spousal PoveRy Credit�date of death ��.Election to tax under Sec.9113 A
between 1231-91 and 1-1-95) � (Attach Sch.o) � � �
CORRESPONDENT-THIS SECTION MUST 8E COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTEL}, q:
Name Daytime Telephone Number
FRANCIS A ZUI,LI 717 232 14..�8
c� �"' �
REGIWE�F WILLS_USE�L4�
^G
First line of address � �;, r � � � '
r. � m O ,.,.,. �
109 LOCUST STREET �'' cn =� � �
z . � ca ��
� c-� c-, ':� -r; -_�
Second line of address � �} � � �
� �_ ' �'.�; -�
. �:7 h--• ----
City or Post Office State 'o �ATE FILED � +��
ZIP Code
� �
HARRISBURG PA 17101
Correspondent'se-mailaddress: wzs@mindspring.CO(1'1
Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,'°
it is true,correct and complete.DeGaration of preparer other than the personal representative is based on all information of which prepar r h s any knowledge.
SIGNATU OF PERSON RESPO SIBLE fOR LING RETURN ATE '
� Frank J.Antonicelli, ill �
ADD SS
1804 Bridg t et, New Cu rlan , 17070
SIGNATURE F EPAR OTHER THAN R R SE ATIVE D E
Francis A Zulli �
ADDRESS
109 Loc t reet, Harrisburg, 17101
Side 1
� 15U5610143 1505610143 �
,d_
� 150561�243
REV-150Q EX
Decedent's Social Security Number
�eoeaern'SName: ANTONICELLI� ALYSON C.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... L
2. Stocks and Bonds(Schedule B)............................................................................... 2. 9 , 6 7 1 . 8 5 '
3. Closely Held Corpo�ation,Partnership or Sole-Proprietorship(Schedule C)....,..,.. 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5� Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Biliing Requested............. 7,
8. Total Gross Assets(total Lines 1-7)....................................................................... g. 9 , 6 7 1 . 8 5
9. Funerai Expenses&Administrative Costs(Schedule H)......................................... 9. 1 1 , 5 8 9 . 5 0 '
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule I)................................ 10. 1 0 , 9 8 3 . 6 5
11. Total Deductions(total Lines 9&10)...................................................................... 11. 2 2 , 5 7 3 . 1 5 '
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. -1 2 , 9 0 1 . 3 0
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. -1 2 , 9 0 1 . 3 0
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
at linea!rate X .045 16.
17. Amount of Line 14 taxable
at sibling rate X .�2 ��•
18. Amount of Line 14 taxable
at collateral rate X .15 �8�
19. Tax Due..................................................................................................................... 19. 0 . 0 0
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 - 13 - 0503
Decedent's Complete Address:
A E
Antonicelli, Alyson C.
STREET ADDRESS
1804 Bridge Street
CITY STATE ZIP '
New Cumberland PA 17070 '
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) �
( ) j�I�00
,
2. Credits/Payments
A• Prior Payments
B. Discount
Total Credits(A +g) (2) �;`',00
;;
3. Interest
(3) ,�1�00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �q�
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) Q{� I�0
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCK��,'
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:.................................... � � ,
c. retain a reversionary interest;or.................................................................................................................. � O
d. receive the promise for life of either payments,benefits or care?.............................................................. � �
2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without
receiving adequate consideration?....................................................................................................................... � �
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
containsa beneficiary designation?...................................................................................................................... � � ,
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RET N�.
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 survivin '�
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 percenjt;'
[72 P.S.§9116(a)(1.7)(ii)j. 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 refurn 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,am I
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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in
72 P.S.§9116 1.2)[72 P.S.§9116(a)(1)l•
•The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S.§9116(a)(1.3)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether by blooa or adoption.
. _ _ . _ . .. .. . _ . .. . . .. ._ . . . . _ _ . . . n,A..` _
SCHEDULE B
COMMONWEALTHOFPENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Antoniceili, Alyson C. 21 - 13-0503
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT ,�#T'E OF
NUMBER DEAT�f� '�
1 Oppenheimer Brokerage Account 9,6�",h;85
TOTAL(Also enter on line 2, Recapitulation) 9,671.81�' '
. A�,�
St�-�IJLE H
FUNERAL D(PENSE,S 8�
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN ����
RESIOENT DECEDENT
ESTATE OF Antonicelli, Alyson C. FILE NUMBER �
21 - 13-0503
Debts of decedent must be reported on Schedule L T
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Parthemore Funeral Home- Funeral Services 5,984.d� '
2 Harpist and Bagpipe Fee 500.OIq
3 Pine Street Church -After Funeral Reception 817.Op;
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 and Seibert--Francis A Zulli 675.00' '
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant Frank J. Antonicelli 3,500.00 ''''
Street Address 1804 Bridge Street
city New Cumberland state PA zip 17070
Relationship of Claimant to Decedent $pOUSG'
4. Probate Fees Register of Wills 113.50 '
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs
1
TOTAL(Also enter on line 9, Recapitulation) 11,589.50
_ _ �i i
T�,
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMHERWTANCETAXR TURNAN�A LIABILITIES, 8� LIENS
RESIDENT DECEDENT
ESTATE OF Antonicelli, AIyS011 C. FILE NUMBER
�,� �
21 - 13-0503 ;
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expen�
`1
;`
I�, '
ITEM
NUMBER DESCRIPTION AMOUf�
1 Holy Spirit Hospital 75
ii �
2 Pinnacle Health ��'k�l�Q
�i �
3 MS Hershey Medical Center g��� �
, I
4 The Block Center 4�I .I �
5 Bureau of Account Management 5� , 0
6 Capital One Credit Card#1 'I
1,4� .����8
7 Capital One Credit Card#2 � �� 2
�,
,
I� 1
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I,, I
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II I I
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�'�, �I
I, II
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G 'i�
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TOTAL(Also enter on Line 10, Recapitulation) 10 983.
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REV-1513EX+(�1-08) "',.. �I�'i
SCHEDULEJ I'� I
COM N�HERTANCETAXRETURNANIA BENEFICIARIES I�
RESIDENT DECEDENT
�I
ESTATE OF
Antoniceili, Alyson C. I FILE NUMBER ,�
21 - 13 -0503 �
NAME AND ADDRESS OF PERSON S) RELATIONSHIP TO SHARE OF ESTATE AMOUNT O ATE
NUMBER RECEIVING PROPERTY � DECEDENT (Words) ��gg
Do Not List Trustee(s)
I� TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers I
under Sec.9116(a)(1.2)]
1 Frank J. Antonicelli, III Spouse I,
1804 Bridge Street I
New Cumnerland, PA 17070
�I
�i
I
�
,I
I
�
�
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Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. I
II� NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
I
�
li
li
�I
II
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS I
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
I ,