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Home My WebLink About09-12-13 1505610140 REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 3 Q 7 S Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Dale of Birth MMDDYYYY 1 0 2 7 2 0 1 2 1 2 1 3 1 9 1 9 Decedent's Last Name Suffix Decedent's First Name MI D r A G 0 S T I N 0 K A T H R Y N M (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 n 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) ❑X 6. Decedent Died Testate 7.Decedent Maintained a Living Trust _ 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. Ehction to Tax antler Sec.91.13(A) Between 12-31-91 and 1-1-95) Q=a8 Schedulb O) m m CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INEORMATION SHOULD BE_61RECTED T0: Name Daytim�7elephdrie Number `� y n r t_. M U R R E L W A L T E R S I I I E S Q 7 1�7� 6'� 9 17� 416 75 0 . „ R EGI�TT�ER_OF WILLS USE'ONLQ C C'7 :7l W First Line of Address ..O b CI-1 G7 O 5 4 E M A I N S T R E E T 00 �1 Second Line of Address City or Post Office State ZIP Code DATE FILED M E C H A N I C B U R G P A 1 7 0 5 5 Correspondent's e-mail address: murrelC&waltersfaalloway.com 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 PERSON RES ONSIBLE FOR FILING RETURN DATE 1 ADDRESS BARBARA A . P AGOSTINO, laot GROSS DR MECHANICSBURG PA 17050 SIGNATURE OF PREPARE O ER A PR NTATIVE TE ADDRESS MURREL R W ER I I, 54-- E . MAIN ST MECHANCISBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J J_ - , I 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedent'SName: KATHRYN M . PA60STIN0 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 6 4 0 1 , 0 0 P p rty(Schedule E). . .. ... 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested .. . . ... 6. 7. Inter-Vivos Transfers&Miscellaneous N -Probate Property (Schedule G) b Separate Billing Requested . .. . .. . 7. 8. Total Gross Assets(total Lines 1 through 7) . .. . .. .. . .. . . . . . . .. . .. ... .. 8. 6 4 0 1 , 0 0 9. Funeral Expenses and Administrative Costs(Schedule H) . .. . .. . .. ..... . .. . 9. 7 6 3 . 5 0 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . .. . . . .. . .. .. 1o. 1 4 8 9 8 5 . 7 1 11. Total Deductions(total Lines 9 and 10) .. ... .. ..... ... . . . ... .. .. . .. . .. 11. 1 4 9 7 4 9 . 2 1 12. Net Value of Estate(Line 8 minus Line 11) . .. .. .. . .. . .. ... . .. .. . . . . .. . 12. - 1 4 3 3 4 8 . 2 1 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 4 3 3 4 8 . 2 1 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 _ 0 . 0 0 15. 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X.0_ 0 . 0 0 16. 0 . 0 0 17. Amount of Line 14 taxable at sibling rate X.12 0 . 0 0 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X.15 0 . 0 0 18. 0 , 0 0 19. TAX DUE . .. ... . .. . .. . .. . . . . . . .. .. ... .. . .... . ..... . . . . ... . .. . .. 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 L 1505610240 1505610240 J REV-1504 EX(Fi) Page 3 Fite Number Decedent's Complete Address: 21 13 0 q DECEDENT'S NAME KATHRYN M. WAGOSTINO STREETADDRESS 1000 W. SOUTH STREET CITY STATE ZIP CARLISLE PA 17013 Tax Payments and Credits: I. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0,00 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) - 0.00 5, If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 0.00 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 ...................................................................... ❑ b. retain the right to designate who shall use the property transferred or its income .......I....................... ❑ Q c. retain a reversionary interest ..................................................................................................... ❑ d, receive the promise for life of either payments,benefits or care? ....................................................... ❑ FXI 2. If death occurred after December 12,1962,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ ❑X 3. Did decedent own an"intrust for'or payable-upon-death bank account or security at his or her death? ......,.. ❑ nX 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ❑ MR 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 is 3 percent[72 P.S.§9116(a)(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 [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 172 P.S.§stts(a}(iyl. • 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+(08-12) pennsyivania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RESIDENT DECEDENTTORN PERSONAL PROPERTY ESTATE OF: FILE NUMBER: KATHRYN M. WAGOSTINO 21 13 00-7-5' Include the proceeds of litigation and the date the proceeds were received by the estate. All propertyjointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CITIZENS BANK 6,401.00 CHECKING TOTAL(Also enter on Line 5,Recapitulation) S 6 401.00 If more space is needed,use additional sheets of paper of the same size. REV-1511 EX+(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER KATHRYN M. D'AGOSTINO 21 13 0 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representafive(s) BARBARA A. D'AGOSTiNO 320.00 Street Address 1206 GROSS DRIVE City MECHANICSBURG State PA ZIP 17050 Year(s)Commission Paid: 2013 z, Attorney Fees: MURREL R.WALTERS, 111 320.00 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: CUMBERLAND COUNTY REGISTER OF WILLS 123.50 5 Accountant Fees: 6. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9,Recapitulation) $ 763.50 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12.12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER KATHRYN M. DWAGOSTINO 21 13 0 q 7 tr Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. PA DEPARTMENT OF WELFARE,RECOVERY SECTION 148,985.71 P.O. BOX 8486 HARRISBURG,PA 17105-8486 TOTAL(Also enter on Line 10,Recapitulation) $ 148 985.71 if more space is needed,insert additional sheets of the same size.