HomeMy WebLinkAbout09-04-13 (3) � 1505610143
REV-1500 �"°�-"' '�I'
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania ca,mr cAes ve.r File Number
Bureau of Individual Taxes ^°'"'""^°"E"°"�
Po soX:28oso� INHERITANCE TAX RETURN 21 I.3 �3!�S
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
01 01 2013 02 14 1955
Decedent's Last Name Suffix DecedenPS Firsl Name MI
ARRIGO CAROLYN J
(If Applicable)Enter Surviving Spouse's IMortnation Below
Spouse's Last Name Suffix Spouse's First Name MI
5pouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BEIOW
� t Origmal Retum � 2. Supplemental ReWm � 3. Pn«aa tl2r 3e 2,(Date of Death
� 4. Limiled EsfEte � 4a. Future Interest Com�mmiw � 5. Fede21 Estale Taz ReWm Required
(tlete of Eeeth eRe� 2-12-8P)
� g Oecetlenl Dietl Teatele � nt MeinleineC e Livinp buffi 8. T0181 Nllmbef O(Sefe DBpOSif BOXCS
(AtlachCoPYWWIp� ❑ Atte GoM'ofTNSt)
� 9. LiUgationProceetlsReceived � 10.��P��a�eat{oa�NOmtn � �7_EIeCUOntotexuntlerSeC.9113(A)
. (Attach Schedule O)
CORRESPONDENT-TMIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephona.Number
1�iRK A L�iTEYA 7Ft3 241 650a"' ni
� «'� c�
,
� RB�iBIS,�EROF WIL'LS ljS�QHLV
.A T P
�" � • iT: � - _.
Firat Line of Addreas "� (�� '��� r. - .
55 W CHURCH AVENUE `� � <' _�i ���
r, , :> ,
Second Line ofAddreas `�-' j,,� �.,; � -- �;ri
: _.� �— a
� F_, v� ry�
Ci or Post Offlce DATE MEED
b State ZIP Code
CARLISLE PA 17013
Correspondent'se-malladdress: TBT�fi18t@�/8I8W.00�Il
Untler peneltias of paryury,I tledare thet I have exeminad thia reWm,indudin0 accompenying echedulea arM statemenfs,and to the Ceat of my knaMetlpe and belief,
tt ia true,mireG enE com .Dederatlon of p rer othar Men the peraonal represeMadve is baeed on all infortnetion of which preperer has any knoMedge.
SI RE OF PER SIBLE F R FILIN NRN �ATE
Lori Lee Jakubs �• �y � �°�
�—c �S
81814th treet Vi inia Beach VA 23451
SIGNATUREOF REP ER TMER HANR RESENTATNE DATE
Mark A. Mateya -
ADDRESS
55 W. Church Avenue, Carlisle, PA
Side 1
L 1505610143 1505610143 � \n/v
�v
J 1505610243
REV-1500 EX
. DecedenPs Social Security Number
o�maN�: Arrigo, Carolyn J
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporetion,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages 8 Notes Receivabla(Schedule D)........................................................ 4.
5. Cash,Bank Deposits&Miscellaneous Personal PropeKy(Schedule E)............... 5. 24, 957 . 69
6. Jointly Owned Property(Schedule F) ❑ Saparete Billing Repuested............ 6.
7. Inter-�vos Transfers&Miscellaneous f�{aq-Probate Property
(SChedule G) U Separate Billing Requested......._... 7.
8. Total Gross Aaseb(total Lines 1 through 7)........................................................ 8. 24 , 957 . 69
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 7 �8 60 . 69
10. Debts of Decedent,Mortgage Liebilities and Liens(Schedule I)............................ 10. 1�878 .$4
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 9� 739. 23
12. Net Value of Estate(Line B minus Line t1).......................................................... 12. 15 �218 . 46
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Tarz(Line 12 minus Line 13)............................................... �q. 15 ,218 . 46
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tau rete,or
transfers under Sec.9116 �
(a)(1.2)X.00 �5. 0 . 0 0
16. AmountofLinel4taxable 15 218 . 46 �s. 664. 83
atlinealrate X .045 �
17. Amount of Line 14 taxable 0 . �� 17. 0 . 0�
at sibling rate X.12
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 . 0 0
�s. r�vcoue................................................................................................................ �s. 684 . 83
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
L 1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21
DecedenYs Complete Address:
DECEDENTSNAME
Arrigo, Carolyn J
STREETADDRESS
238 West North Street
CITV STATE ZIP
Cadisle PA 17013
Tax Payments and Credits:
1. Tarz Due(Page 2,Line 19) (1) 684.83
2. Credits/PaymenGs
A. Prior Payments
B. Discount 0.00
Total Credits(A +g) (2) 0.00
3. Interest (3)
q, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �q�
Cheek box on Page 2,Line 20 W request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 684.83
Make Check Payable to: REGISTER OF WIL�S, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
t. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred:............................................................................... � �
b. retai�the right to designate who shell use the property transferred or its income:.................................. x
c. retain a reveisionary interest;or............................................................................................................... x
d. re�ive the promise for IHe of either payments,benefits or care?............................................................ ❑
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of dealh without
receiving adequate consideretion?.................................................................................................................... ❑ ❑x
3. Did decedent own an'in trust fof' 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 MU3T COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994 end before Jan. 1, 1995,the tax rete imposed on the net value of transfers to or for the use of the surviving
spouse is 3 percent[72 P.S.§9716(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 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transfer to a surviving spouse from tau,and the statutory requirements for disclosure of
assets and filing a ta�c retum are atill 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 trensfers 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 chiW is 0 percent[72 P.S.§9116(a)(12)].
. The tau rate imposed on the net value of transfers to or for the use of the decedenPs lineal beneficiaries is 4.5 percent,except as noted in
[72 P.S. §9116(a)(1)1.
. The tax rate imposed on the net value of transfers to or for the use of the decedenPs 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.
Rsv-1608 EX+(H-10)
SCHED�JLE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEOENT
ESTATE OF FILE NUMBER
Arrigo,Carolyn J 21 !3 031v8
InGWe tha procaeCe W IitioNim aM IM dale ihe ptoceatls aere iemivetl Ev Ihe eelete.
All propsrty�dntlyawMA w�M t�a rlBht of surWVOnhip must ba dixlo�adon�ehaAUle F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OP DEATH .
1 Wells Fargo-Liquidation of account 4867-009033 24,857.69
TOTAL(Also enter on Line 5,Recapitulation) 24,957.69
(If more npace is neetleq atlditbnal pages of the same size)
Copyright(c)2010 fortn soflware only The Lackner Group,Inc. Fortn PA-1500 Schedule E(Rev. 11-10)
REV-0677 E%�(70-08)
pennsylvania $CHEDULE H
DEPAR7MENTOFREVENUE FUNERAL EXPENSES AND �
RESIDENTDEC ENT URN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Arrigo, Carolyn J 21 13 03�8
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
p. FUNERAL EXPENSES:
See continuation schedule�s) attached 2,629.38
B. ADMINISTRATIVE COSTS:
1. Personel Repiesentative's Commissions
Name of Personal Representative(s)
Street Add2ss
Ciry State Zio
Year(s)Commission Paid
2. AttomeYS Fees Mark A. Mateya 1,200.00
3. Famiy Exemption: (If decedenPs address is not the same as claimanPs,attach explanation)
Claimant
Street Address
Clry Slete ZID
Relationshio of Claimant to Decedent
4. Probata Fees
5. AccountanYs Fees
6. Tax Retum Preparers Fees
7. OtherAdministrative Costs 4,031.31
See continuation schedule(s) attached
TOTAL(Also enter on line 9, RecapiWlation) 7,860.69
Copyright(c)2009 fortn software only The Lackner Group, Inc. Fortri PA-7600 Schedule H(Rev. 10.09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Arrigo, Carotyn J 21 13 031�8
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Exp�nses
7 Hoffman Roth Funerel Home-Funeral Expenses 2,629.38
H-A 2,629.36
Other Administrative Costs
2 Cumberland County Register of Wills-Filing fee for Petltlon for Settlement of Small Estate 75.00
3 CumbeAand County Register of Wills-Filing fee for Inheritance Tax Retum&Inventory 30.00
4 Jeffrey S.Austin-Expense for clean up of aparfinent 866.37
5 Lori L Jakubs-Reimburse for expenses 3,000.00
6 Stardust Storage-Storage expense for decedenYs personal/household items 120.00
H-B7 4,031.31
Copyright(c)2002 form soRware onry 7he Ladcner Group,Inc. Fortn PA-7500 Schedule H(Rev.&98)
R�v4672 E%«(72-08)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPM7MENT OF REVENUE
INNERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEOENT
ESTATE OF FILE NUMBER
Arrigo, Carolyn J 21 13 03�,Y
Raport C�bH incumtl Dy tM tleeed�M P�or lo MM IMt�xmin�G unp�itl�1 tM tlH�M A�Nh,inclutlhrp unMmbunM mWiol�:p�nw.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Austin Rentals-Repairs and flnal rent due on residence 7,732.67
2 UGI Gas Service-Heating service at residence 145.93
TOTAL(Also enter on Line 70, Reoapitulation) 1,878.54
(If more apece la needed,additional peges of the eame aize)
Copyright(c)2008 form software onty The Lackner Group,Inc. Fortn PA-1500 Schedule I(Rev. 12-OB)
REV-0617 EX�(01-00)
pennsylvania SCHEDULE J
DEPARThIENT OF REVENUE
INHERITANCE TA%RETURN BENEFICIARIES
RESI�ENT DECEDENT
ESTATE OF FILE NUMBER
AM o,Caro n J 21 13 03(pg
RELATIONSHIP TO
NAME AND ADDRESS OF SHARE OF ESTATE MOUNT OF ESTATE
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT �o�s� ($$$�
I TAXABLE DISTRIBUTIONS [inGude outright apousal
distributions,and trensfers
under Sec.9716 a 12
Phillip Arrigo Chiid 7,453.98
21640 Liberty Street
Apt 7808 A
Lexington Park,MD 20653
Lori Lee Jakubs Child 7,453.98
81814th Street
Virginia Beach,VA 23457
Total 14,907.96
Enter do�lar amounts for distributions ahown above on lines 15 throu h 18 on Rev 1500 cover sheet as a 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
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE
Copyright(c)2010 fortn software only The Ledcner Group, Inc. Fonn PA-7500 Schedule J(Rev.01-10)