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HomeMy WebLinkAbout07-18-13 1 1505610143 -J REV-1500 �"02-1' OFFICIAL USE ONLY PA Department 6f Revenue pennsylvania coumr Coae Vear File Number Bureau of intlividual Taxes °E°"'*"�'�OOR�"'� ao eox.zaoso� INHERITANCE TAX RE'CURN 21 12 0023 Harrisburg,PA t7t26-o60t RESIDENT DECEDEEJT ENTER DECEDENT INFORMATION BELOW Social SecuNty Number Date of Death Date of Birth 10 12 2011 02 03 1938 DecedenYs Last Name Suffix Decedent's First Name MI ROSAS JEANNE P (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THI3 RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original ReNrn � 2. Supplemental Retum � 3. Remaintler ftetum(Date of Death , Priorto 12-13-82) � 4. Limited Estate � 4a F'm're m�eresi Comwwn�se � 5. Federal Estate Tax Retum Reqoired '(date�deathafter12d2-82) � 6 Decadent Dietl Testate � 7, DeceEent Main ained�LiWng Trust � 8. Total Number of Safe Deposit Boxes (AnacA Copy o5 Wilp (Attach Gopy�Trust � 9. LitlgationProceedsReceived � iD.bg���P9��3�cr�i,�0��roeatt, � �7.ElediontotaxuntlerSec.9713(A) (AHach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE OfRECTEO TO: Name Daytime Telephone Number EDWARD P SEEBER 717 533 3280 REGISTER OF WILLS USE ONLY � First Li�e of Address � SUITE C400 n C `; Second Line of Address � � � � ( ..r� � 555 GETTYSBURG PIKE � ��f� ,r.� ;�? �� c� City or Post Office SWte ZYP Code �T��1` � � c C.� � � .ti C,t MECHANICSBURG PA 17055 " r-> "r ='� r ,� �-, o "c� o � c.: . �;t ,i .Tr ` ,} �, r CorrespoadenPS e-mail address: QP$�SdC.COm �« "' �, Under penalties of pery'ury,I tleWare that I have examined ihis return,including accompanying schedules and statemenis,antl to the best of my etlgB�a dbelief, it is true,correct antl wmplete.Declaration of preparer other Nan Me personal represent26ve is basetl on all information of which preparer h s y knaw}edge. SIGN OFP RSON PO FORFILINGR N �� DATE ry ��� � "r �'��•�Joseph P. Rosasa,)r. "'°�(6 /� � nyuRESS r _ _ " ��^ 512 Snuth Pitt StreetCCarlisle�A 17013 SIG URE P PAREROTHERTHANftEPRESENTATIVE OATE , Edward P Seeber Z��6 / t5 �ooaESS y'_ Suite C-400dVlechanicsburgCPA 17055 Side 7 � 1505610143 150561D143 J � � 1505610243 REV-1500 EX Decedent's Social Security Number DecetlenfsNeme: R0385� Jeanne P. RECAPITUlAT10N 1. Real Estate(Schedule Aj....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Heltl Corporation,Partnership or SoleProprietorship(Schedule C)......... 3. 4. MoRgages&Notes Receivable(Schedule D)........................................................ 4. 5, Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 6 , �.13 . 71 6. Jointly Owned Property(SChedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous t�q Probate Property (Scmedule G) U Separate Billing Requestetl............ 7, QQj, 484 . 88 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 227 , 598 . 59 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 8. 24� 126 . 14 10. Debts of Decedent,MoRgage Liabilities and Liens(SChedule 1)............................ 10. 12 , 632 . 81 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 3 6, 758 . 95 12. Net Value of Estate(Line 8 minas�ine�t).......................................................... t2. 190 � 83 9. 64 �3, Cfiaritable and Governmental 8equests/Sec 9113 Trusts for which - an eledion to tax has not been matle(Schedule J)............................................... 13. 14. Net Value Subject to T�(Line 12 minus Line 13}............................................... 14. 190 ,83 9 . 64 TAX COMPUTATION-SEE INSTRUCTIONS FOK APPIICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 15 Q . Q p {a)��z)x.00 16. Amountof Line 14tazable 190 , 839. 64 �s. 8� 587 . 78 at lineal rate X .045 1�. Amount of Line t4 taxable at sibling rate X.12 0 . 00 17. 0 .00 18. Amount of Line t4 taxable at collateral rate X.15 0 . 0 0 18. 0 . 0 0 19. TAX DUE................................................................................................................ 19. 8 � �J87 . 78 20. FILL IN THE OVA�IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. � Side 2 � 150561�243 1505610243 � REV-1500 EX Page 3 File Number 21-'IZ-0023 DecedenYs Complete Address: DECEOENTS NAME Rosas,Jeanne P. STREETADDRESS 512 South Pitt Street GTY - STATE ZIP Cartisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) ��� $'587��$ 2. CreditslPayments A. PriorPayments �.�59•2$ B. Discou�t 388.38 Total Credds(A +B) (2) 8,147.66 3. Inierest �3) q. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2LLine 20 to request a refund g, If Line t +Line 3 is greater than Line 2,enter the d'rfference. This is the TAX DUE. (5) 440.�Z Make Check Pa able to: REGISTER OF WILLSOAGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"fN THE APPROPRIATE BLOCKS 1. Did deoedent 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 propeM1y transferretl or its inwme:........................._....... c. retain a reversionary interest;or............................................................................................................... d. receive the promise for life of either payments,bene5ts or care?............................................................ x 2. If tleatb occurred afler Dec. 12, 1982, did decedent hanster propeRy within one year of death without receiving adequate consideration9.................................................................................................................... � ❑ 3. Did decedent own an"in t�ust for or payable upon death bank account or security at his or her tleath?....... ❑ Q 4. Ditl tlecedent own an indivitlual retirement account,annuiry,or othe�non-probate property which contains a beneficiary designation?.................................................................................................................. � ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESGYOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of tleath on or after July 1, 7994 and before Jan.1, 1995,the taz rate imposed on the net value ot 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 transters to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)51.1)(ii)]. The statute dces not exempt a transfer to a surviving spouse from tax,and the statutory requirements for tlisclosure of assets and filing a taz 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 pa�nt,an adoptive parent,or a stepparent of the child is 0 percent pZ P.S.§9116(a)(1.2)]. . The tax rate imposed on the net vaiue of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as�oled in (72 P.S.§91 i6(a)(1)1. . The tax rate imposetl on the net value of transfers to or for the use ot the decedenFs siblings is 12 percent[72 P.S.§9116(a)(1.3)]. A sibling is defined under Sedion 9102,as an individual who has at least one parent in common with lhe decedent,whether by blood or adoption. Rev-0508 EX+(11-00) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, 8 MISC. DEPARTMENT OF REVENUE INHERITANCETAXRETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Rosas,Jeanne P. 27-72-0023 Inclutla the proceeds W litigation entl�he dete�he proceeES were received by Ihe estate. All property jointly�ownetl vriM the rlgM ot eunivorohip must be Eisclosed on sc�etlule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 JP Morgan Chase Savings Account No.x0104-valued per bank letter dated 12/14/11 2,070.67 2 JP Morgan Chase Savings Account No.x0104,accrued interest-valued per bank letter dated 0.07 12/14/11 3 PNC Bank Checking Account No.x2753-valued per bank letter dated 11/21/11 894.19 4 Medicare-refund 18.18 5 Miscellaneous refund 1,100.62 6 Vanguard -pension payments 2,090.04 TOTAL(Also enter on Line 5, Recapitulation) 6,113.71 pf more space is neetled,additional pages of the same size) � Copyright(c)2010 form soflware only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-7570 EXF(pe-09) SCHEDULE G pennsylvania lNTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Rosas,Jeanne P. 27-12-0023 This schetlule must be v�mpleied and filed if ihe answer lo any of questions 1 ihmugh 4 on page three of�he REV-0500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH �oF oeco�s EXCLUSION TAXABLE NUMBER THE�ATE OF TR.�4NSFERSATTACFiTA COPVEOF TI�E DEIED�OR REAL ESTATE VAWE OF ASSET �NTEREST (IF APPLICABLE) VAWE 7 SunAmerica Annuity No. PSSD0572729-beneficiary is 212,547.88 100.000% 0.00 212,547.88 the Jeanne P. Rosas Living Trust;valued per letter dated 77/9/11 2 Cash gifts to Joseph Rosas,Jr.-10/12/10 to 12/31N0 940.00 100.000°/, 9a0.00 0.00 3 Cash gifts to Joseph Rosas,Jr. -1/1/17 to 70/11N1 11,937.00 100.000% 3,000.00 8.937.00 TOTAL(Also enter on Line 7, Recapitulation) 221,484.88 (IF more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-7500 Schedule G(Rev.08-09) ftEV-0511 EX�(t0-09) ' pennsylvania SCHEDULE H �EPARTMENTOFREVENUE FUNERAL EXPENSES AND R SIDENT�EC ENTURN pDMINISTRATIVE COSTS ESTATE OF FILE NUMBER Rosasaleanne P. 21-12-0023 DecedenYs debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT A: FUNERAL EXPENSES: See continuation schedule(s)attached 3t654.80 B. ADMINISTRATIVE COSTS: 1. PersonalRepresentative'sCommissions � Name of Personal Representative(s) Joseph P. Rosasalr. Street Address 512 South Pitt Street City Carlisle State PA Zio 77013 Year(s)Commission Paid 9[525.00 z. Attornev's Fees JamesCSmithmietterick 8 Connelly�LP 1or287.31 3. Family Exemption: (If decedent's address is not the same as claimanYS,attach explanation) Claimant Street Address City State Zio Relationshio of Gaimant to Decedent 4. Probate Fees 96.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 562.53 See continuation schedule(s)attached TOTAL(Also enter on line 9dtecapitulation) 24C126.14 Copyright(c)2009 form soflware only The Lackner Group,Inc. Fortn PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Rosas,Jeanne P. 21-12-0023 ITEM NUMBER DESCRIPTION AMOUNT Funerel Exoenses 1 Clarke Piatt Funeral Home-cremation services 2,023.00 2 Wommack-monument 1,631.80 H-A 3,654.80 Other Administrative Costs 3 James,Smith, Dietterick&Connelly, LLP-reservation for estate administration closing 350.00 costs 4 PNC Bank-wire transfer fee 25.00 5 PNC Bank-checkbook order fee 72.53 6 PNCBank-wiretransferfee 25.00 7 PNC Bank-wire trensfer fee 25.00 8 PNC Bank-wire transfer fee 25.00 9 Regisker of Wills,Cumberland County-filing fee for Return&Inventory 30.00 10 Register of Wills, Cumberland County-£ling fee for Satisfaction 10.00 H-67 562.53 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-�500 Schedule H(Rev.6-98) Rev-051YEX�(72�8) SCHEDULE 1 pennsylvania DEBTS OF DECEDENT, DEPARTMENT OFREVENUE INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS RESIDENT OECEDENT ESTATE OF FILE NUMBER Rosas, Jeanne P. 21-12-0023 Repotl tlebfs ineurtetl by fhe tlecedent prior to death that remainetl unpaitl at Me da[e of death,inclutling unreimbunetl medical ezpenue. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH � 7 Berwick Area Ambulance Association-unreimbursed ambulance bill 172.22 2 ' Berwick Area Ambulance Association-unreimbursed ambulance bill 81.12 3 Berwick Hospital Center-unreimbursed medicai bill 228.68 4 Berwick Hospital Center-unreimbursed medical bill 1,132.00 5 Bohn Nursing Center-final nursing home bill 7,693.00 6 Franchise Tax Board-California income tax for 2010 45.00 7 , Geisinger Health System -unreimbursed medical bill 605.00 8 Jurta Larinski Associates, PC-unreimbursed medical bill 8.33 9 Masland Associates, Inc.-unreimbursed medical bill 58.28 10 Tirnity Pharmacy Services-unreimbursed pharmacy bill 157.75 11 United States Treasury-2010 individual income Wx 2,463.00 12 United States Treasury-2010 individual income tax 48.43 TOTAL(Also enter on Line 10, Recapitulation) 72,632.87 (If more space is needed,additional pages ot the same size) Copyright(c)2008 form soRware only The Lackner Group, Inc. Form PA-7500 Schedule I(Rev. 12-OS) REV-1513 E%+�Ot•t0) pennsylvania $CHEDULE J DEPARTMENT OF REVENUE INHERITANCE TA%RETURN B ENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Rosas,Jeanne P. 21-12-0023 RELATIONSHIP TO NAME AND ADDRESS OF SHARE OF ESTATE AMOUNT OF ESTATE NUMBER pERSON(Sl RECEIVING PROPFRTY DECEDENT (Words) ($$$) I TAXABLE DISTRIBU710NS [include outright spousal distributions,and transfers under Sec.9116 a 1.2 1 Angela Alemania Daughter 25°/,of the 45,475.66 1328 Graynold Avenue residue Glendale,CA 91202 2 Rebecca M. Passey Daughter 25%ofthe 45,475.66 4830 Rayneal Way residue Antelope, CA 95843 3 Joseph P. Rosas,Jr. Son Gifts 8 25%of 54,412.66 51Z South Pitt Street the residue Carlisle, PA 17013 4 Valerie D. Rowley Daughter 25°/,of the 45,475.66 115 W. 78th Street,Apt. 15 residue Bartlesville,OK 74003 Total 190,839.64 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet as a ro riate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOiAL OF PARi II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET Copyright(c)2010 form soflware only The Lackner Group,Inc. Fortn PA-7500 Schedule J(Rev.01-10)