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Home My WebLink About09-05-13 J 1505610101 REV-1500 EX�°'_'°, C3 PA Department of Revenue pennsylvania OFFICIAL USE ONLY Bureau of Individual Taxes �EP�p'�'E�'�F INHERITANCE TAX RETURN Counry Code Year File Number PO BOX 28o6oi Harrisburg,PA i�i28-o6o�t RESIDENT DECEDENT � d ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ��P� � � , 0 [") � � � � sd iu�euG 7 DecedenYs Last Name Suffx Decedent's First Name MI � � a (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI � Spouse's Social Security Number °°�`°�� oJ'5��;;� THIS RETURN MUST BE FILED IN DUPLICATE WITH THE � �� REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return p 2.Supplemental Return Q 3. Remainder Return(date of death prior to 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) � 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received Q 10.Spousal Poverty Credit(date of death O 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 T0: Name Daytime Telephone Number L r c � a 9,� ROEGiSTER bF'WILIj$�U�ONLY :'"3 �> ";y � ��r � ,� First line of address � �? n � .� + � � ' �� ` r..iry C 1'i J Gr� ;�:x Second line of address ; '� .q.� `, �, f-, .,� �3 , ' , �� .:.s� � ° �.�..A #...... (....� . .. . ..'i City or Post Office State ZIP Code �� DAT�FILED" � � ,L � `. �I CorrespondenYs e-mail address: �e Q � � Q � p 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 inform tion of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN � DATE , ADDRESS�� '�� u 1705D SIGNATURE OF PREPARER OTHER THAN REPRES NTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610101 1505610101 J � 15�5610105 REV-1500 EX Decedent's Social Security Number � ,,, _ _. DecedenYs Name: O�� 6 /� / ,N � -� '�� ' ��° °� , �x ° �� RECAPITULATION �.�.�, � P � 1. Real Estate(Schedule A). ..... . .. � . .. . 1 � u .. . . .. .. . .. . . .. .. ..... .. . . � . . . .. . �..'�.�.�� ,..erm.!i�'�: }�M:_'+,�'P �{�;,�a�d" 2. Stocks and Bonds(Schedule B) . .. .. . ... .. .. .. .. .. . .. .. .. .. . .. .. .. . 2 � � � � � � � ' . . „;�� ;P='„�4� ��;��ws.:..°�°�� ' � � �' � 3. -Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) . .. . 3 � � �,� r��.�y�� " ��`��'"� �s+'.��TE-=�}{�'"" '�Fv'��5��-my,.. _�++� �y �'` . — 3�}?. [� �" � { >� e� "'� 4. Mortgages and Notes Receivable(Schedule D).. .. .. .. .. . .. .. .. .... . .. .. 4 � � � � � � ��';��a;�� ' � � � � 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).. .. . . 5 ' � � y � � � � �� .�� _ 6. Jointly Owned Property(Schedule F) p Separate Billing Requested . . . .. . 6 � � � � � O � �:a �; �.� � ' µ s' 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property � . � � � � � � � (Schedule G) p Separate Billing Requested.. .. . .. 7 ��;,,�-, � � � � � � � ''��v�� 5r 4.:_gs �,�. . �"i'" `� ^"`� 8. Total Gross Assets total Lines 1 throu h 7 . ... . . .. .. . 8 � �� ` � � � � �� g ).... .. .. .. . .. .. . r �� ;� �.� � � 9. Funeral Expenses and Administrative Costs(Schedule H)... .. ... .. .. .. .. . 9 �� ` � �� ,a��,��:�`�. . .� �� ° ��_ � � � � � � 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) ... .. .. .... . 10 ; � � � . ° `��`•°�.:�� : �� _ , u.�� ° �� 11. Total Deductions(total Lines 9 and 10).. . . .. ... . ... . .. . . . .. .. .. .. .. . . 11 � � * � � �� :�� . � 12. Net Value of Estate(Line 8 minus Line 11) . . . .. .. . . .. . .. .. .. .. .. . .. .. . 12 ° � � � � � 13. Charitable and Govemmental BequestslSec 9113 Trusts for which �� `�'� � �� ° � . � E � � . � � 13. � � � . � � an election to tax has not been made(Schedule J) . .. . .. . . . .. .. . . .. . . . .. m � � � �:��"�� , � . '. � �.�=� i ` � � "��' 14. Net Value Subject to Tax(Line 12 minus Line 13) .. . . ... .. .. .. ..... .. .. . 14 t � � �� y� � � � � � TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 � �' � }�°` ° � � °�"�"�. v �` ' ° � � �� 4 � � � �a)�1.2)X.0— � : � - 15.� � � � � � �. �", �'_-��. �a T��ick�.,eF*�4..,.� �;i.��.�a.?.5 ' � _ �__ ' .-�� -.. 16. Amount of Line 14 taxable � � ��' � 1 � � �} � � E � � � 16. � at lineal rate X.0_. ,� � �, � �� `'�,�, ��£�� „Q .�,. r . 17. Amount of Line 14 taxable � � � �� at sibling rate X.12 � � � � .,�� s � 18. Amount of Line 14 taxable � �° � � � �� ,� � � 4 at collateral rate X.15 � _ � �S� -c „xd°., :.�m m:'`.�s?�w��-a�."a;a:� :+u-r�:�-r�.��r .._ � . � - a .� r . � � t � 19. TAX DUE .... .. ....... .... ... .. ... .... ...... .. .. . ......... .. ...... 19. � �� .,�� 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 L 1505610105 15�5610105 J . File Number REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME �� ,�„��w �� 1 �� – — — _ __ _ _ ---� ,1 STREET ADDRESS � � �� Q��p T�/C-- — _ _ _ _ __ __ 1\ 1 V L --- -- — --- — �STATE � - — ZIP� ��5 O -- ��n ��c�-i�► N.�c s �u � Tax Payments and Credits: �� Q* Q� 1. Tax Due(Page 2,Line 19) 2. CreditslPayments D� p� A.Prior Payments -- - B.Discount _ ��--�-- Total Credits(A+B) (2) O+ Q O 3. Interest (3) �� 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENL �4� D� D� Fill in ovai on Page 2,Line 20 to request a refund. 5 � o �,JV 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. � � 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:............................................ � � c. retain a reversionary interest;or.......................................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... � � 2. if death occurred after Dec. 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 contains a 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 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 stili applicable even if the suroiving 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 naturai 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 decedenYs lineal beneficiaries is 4.5 percent, except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)]. . The tax r 102 as�an ndividual who has attleast one parent m common w th t e decedentl�w ether by blood or ad pfion116(a)(1.3)j.A sibling is defined,under Section 9 , REV-i5o8 EX+(11-io) � SCNEDI�LE E � pennsylvania DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT �a��,��,,,� ��L �� FILE NUMBER: ESTATE OF: � ��f�_.��6�� 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. VALUE AT DATE ITEM DESCRIPTION OF DEATH NUMBER ,�a 6 9,�6 9� i635� 3� 1 CA�N M �fiB�ri�K��'HEck1NG Rc�au�7 �, S�y�N�S �3�'��un�rNv. j�oo�/�og65o5�7/ 8�5�6-o0 � aooa D��MOB�L� TN7�IGU� �iN .�G3w�5a�3ZFa1114`t ��°�; � d 3 �A�20�� oo, c�c� t} J�W��R� � �p, ov a' PiANp �. p�,�0 6 �u �r�R q oo�o� � .�'N��`�f �OVM �il/r/V � 1 �� D-pr v n �! $ B��l''1 F�uR.n'��Ll2E � Da�dD g C��s�-,�� o ��S�Es � o Q� av TOTAL(Also enter on Line 5, Recapitulation) $ p�� 3�� l If more space is needed, use additional sheets of paper of the same size. r�u,s�oc•nAn SCHEDULE F COMMONWEALTHOFPENNSY�VANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENt DECEDENT FILE NUMBER ESTATEOF R(�S�R'�'/� • ��l--�C� o�Q/3 - co 6 S.i tf an asset was made jo�M wfthin one year of the decedenYs date of death,it must be reported on Schsdule G. SURVN�NG JOINT TENANTtS)NAME ADDRESS RELATIONSHIP TO DECEDENT a. /Z�D�RiCI�. J: �� )� b3 3 T��"i✓��13�,2v � H'u.�,3ANb�sPous�� RKp FR�D �`. �E F�'L 1 C'� ly�Cf/tJ�U/�.5�� PA /'yD�� B. C, JOINTLY-0WNED PROPERTY: �oF OATE OF DEATH LETTER OATE DESCRIPTION OF PROPERn' OATE OF DEATH DECD'S VAIUE Of REM FOR JOINT MADE Inciude name of finanCi�institution and ba�k a�unt number or similar identifying number.Atlach VAIUE OFASSET INTEREST DECEDENTSINTEREST NUMBER TENANT JOINT deedfajointly-heldrea�est�e• uNeS SUS�D��S«NJ ��t7 �� /v0� 1. A. O�/IQ L�r 18J Kvii�ns $y�� o PA��w Co�s7; ��-o�.��A, F'tA�L��OwNry a, uni�t S�! T�iE /�� ur��-�s 1�a�1�/��'��1 itls7ldq � ��.v�� / 30�' Sa� ��; 650 3�80 Soc�r��C�AfiI �1A�,� `� ' �L.AUL�R i3�A C�, �"L.�v7�� i=LAULFi �L C��t�NT�1' TOTAL(A�so enter on line 6,Recapitulation) S �7j G J� {If more space is needed,insert additional sheets of the same size) REV-1511 EX+(10-06) SCNEDI�LE H COMMQNWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINIS7RATIVE COSTS RESIDENT DECEDENT FIIE NUMBER (� �]� � ESTATEOF Rp(3�RT� AN� ��ELI�L� � / 3 r �� ' Debts of decedent must be reported on Schedule L ITEM AMOUNT NUMBER DESCRIPTION A. FUNERAL EXPENSES: C R�/vJ�YY..rON �o��i3 1��.v C� 1. f�, i,,.tEf{ L'R�'rGr�T"ivjv �SE2(/lC�S r�-�P�I, I1YC.D 9 � y/A� �"on��5'��"0�/�( R.� f-�kR�2��1s'u� GiJ f'A t 71 g. ADMINISTRATIVE COSTS: �. Personal Representative's Commissions Name of Personal Representative(s) _ --- J------ - Street Address ------------- -- _______-- 5tate 2iP City ----.-__ _. Year(s)Commission Paid: _ _-------- -- — ----� 2. Attorney Fees 3. Family Exemption:(If decedenYs address is not the same as c{aimanYs,attach explanation} Ciaimant __.__ - Street Address ____._ -- State Z�P - ---- City Relationship of Ciaimant to Decedent ______ ------ — ------- ge� �' /y.3 . o0 4. Probate Fees 7� 5. AccountanPs Fees 6. Tax Return Preparer's Fees 7. TOTAL(Also enter on line 9,Recapitu�ation) S � �7� (If more space is needed,insert additional sheets of the same size) y::.� ��-.�� .,.., . ,, . _ .. � -�� 41111.7�.111C 11. 1"11V1C11 ELAGLER COUNTY ASSTRACT C0. Inst No:94�05897 Date:04/19/1994 305 E. Moody Blvd. -P.O. Box 398 Doc Stamp-Deed : 35�D.4�0 Bunnell, FL 32110 SY C OSBY FLRGLER Co�anty SS# - GRANTEE 1: 154-30-8599 BY: D.C. Time:14:18: SS# - GRANTEE 2: 051-28-7843 _ _ !"� Q� [Space Above This Liue for flecording Uata� �j W A R R A N T Y D E E D � -------------------------- File No. 8487-PC w � � THIS INDENTURE, made this ��_ day of April , A.D. 1994 between .r.i Rollins Dunes Development, Inc., a Florida Corporation lC� G �� a corporation existing under the laws of the State of Florida having its principa o� place of business in the County of and State of Florida, Grantor*, whose address is: 601 North Oceanshore Boulevard, Ormond Beach, Florida 32174, and oberta A. Forster, a single person and Fred J. DeFelice, a single person Grantee*, whose address is: 6343 Pennsboro Drive, Mechanicsburgh, PA 17055 WITNESSETH: That the Grantors, for and in consideration of the sum of TEN AND NO/100 DOLLARS ($10.00) and other valuable considerations to said grantors in hand paid by said grantees, the receipt whereof is hereby acknowledged, has granted, bargained and sold to the grantee and grantee's heirs forever the following described land located in the County of Flagler, State of Florida, to-wit: Lot 18, Rollins Dunes Subdivision, a sul�division according to the plat or map thereof described in Plat Book 29, at page(s) 22, of the Public Records of Flagler County, Florida. SUBJECT TO THE FOLLOWING: Taxes for the year 1994 and subsequent years. Restrictions, Covenants, Easements, Dedications, Reservations, Resolutions and Conditions of record, if any. Balances due on utility assessments, if any. GRANTOR WARRANTS THAT THIS IS NOT HOMESTEAD PROPERTY. Property Tax ID Number: 17-10-31-5400-00000-0180 Said grantor does hereby fully warrant the title to said land, and will defend the same against the lawful claims of all persons whomsoever. *Sinqular and plural are interchanqeable as context requires. IN WITNESS WHEREOF, Grantor has caused these presents to be signed in its name by an executive officer, and its corporate seal affixed the day and year first above written. Witnesses Rollins Dunes Development, Inc. WITNESS 1 � ��yQ PAINT OA TYPE HA :/4�8� T Nti £��'�� '"� C C�_—� Gerald Ehringer, Presid nt (WITNE - 21 ��a PRI6T OA TYPB HAHE,ti��,��.� C �}(•�!'t'� CORPORTE SEAL State of Florida County of UQ(J�f�L The fareqoing instrument tras acknovledged hefore me on thie L,_day of April, 19y4 hy Gecald 6hringer Preaident of Rollins �unes Oevelopment, Inc., a Florida corporation, an behalf of the corporation. Hels�e is sona y aarrn to m or has Qroduced as identification and did _taka an ry • '?' � ' . . ��--�--�� /� My Commission Expires: � : NOTARY PUBLIC `.` ;(�SEpi,)- PRINP OR TYPB �AMB:�„yA-e�e� � • �� Qc�-�� 3� ��i cS :,� _ ._ C G� 97c��1C� • �� FREDDIE MAC LOAN # 330742507 � Prepared�3y and Return To: , ;� Name: KIM LINSKY , 1 WATSON TITLE INSURANCE AG�NC�Y, INC. h 1901 W. CYPRESS CREEK ROAD 3RD FLOOR FT. LAUDERDALE, FL 33309 WTI 29-06480-FL inst No:2ooso3s369 �2�i5i2oos F lio Number: 2°1-\2-3Z-L1510-000n�0-0$O1 03:06PM�ook:1748 Page:1761 Total Pgs:2 Doc Stamps-Deed$1093.40 GAIL WAIDSWORTH,FLAGLER Co. _.._..___ __ _- . __ __ __ �� • Special Warranty Deed o� �� /� ��THIS INDENTURE, made this � day of ��VL/�� ,� , FEDERAL HOME LOAN MORTGAGE CORPORATION, Hereittafter called the Grantor, whose address is 8200 JONES BRANCH, MCLEAN, VA 22102. and FREDERICK DEFELICE, A SINGLE MAN AND ROBERTA FORSTER, A SINGLE � WOMAN, AS JOINT TENANTS ViIITH FULL RIGHTS OF SURVIVORSHIP, hereinafter � � called the Grantee whose address is 6343 PENNSBORO DRIVE, MECHANICSBURG, PA r � 17050. �� [Wherever used herein the terms "Grantor and Grantee" include the parties to this � (�-instrument and their heirs, legal representatives and assignees of individuals, and assigns S" d�of corporations� JQ WITNESSETH: the Grantor, for and in consideration of the sum of TEN AND 00/100 DOLLARS ($10.00) and other good and valuable consideration, receipt whereof is hereby acknowledged by these presents does grant, bargain and sell, alien, remise, release, convey and confirm unto the Grantee, all that certain land situate in FLAGLER County, Florida, viz: UNIT 801. THE NAUTILUB CONDOMINNM. A CONDOMIIVIUM TOGETHER WITFI AN UNDIVIDED INTEREST IN THE COMMON ELEMENT3 ACCORDINC4 TO THE DECLARATION OF CONDOMINIUM THEREOF RECORDED IN OFFICIAL RECORDS BOOK 186 PAGE 241 A3 AMENDED FROM TIME TO TIME, OF THE PUBLIC RECORDS OF FLAGLER COUNTY FLORIDA A/K/A 3580 SOUTH OCEANSHORE BLVD S, FLAGLER BEACH FL 32136 Subject to: Restrictions, limitations, conditions, resernations, covenants and easements of Record, if any, all applicable zoaing ordinances, and Taxes for qear 2009 and all subsequent years. TOGETHER with all the tenements, hereditament and appurtenances thereto belonging or in otherwise appertaining. AND the Grantor hereby covenants with said Grantee that it is lawfully seized of said land in fee simple, that it has good right and lawful authority to sell and convey said land, that it hereby 'fully warrants the title to said land and will defend the same against the lawful claims of all persons cla.iming by, through or under the said Grantor. The undersigned Agent further sates that the below-described Limited Power of Attorney has not been heretofore revoked by the Principal and is still in full force and effect. . . .� .. . IN WITNESS WHEREOF the Grantor has caused these presents to be executed in its' name, and its' corporate seal to be hereunto aff�ed, by its proper officers thereunto duly authorized, the day and year first above written. Wherever the text in this Deed so requires, the use of any gender shall be deemed to include all genders, and the use of the singulax shall include the plural. Signed, sealed and delivered in our presence: FEDERAL HOME LOAN MORTGAGE CORPORATION BY: LAVf1 OFFICES OF MARSHALL C. WATSON P.A It's Attorney-in-Fact,pursuant to Limited Power of Attorney. BY: KIMBERLY DAZZO, as thorized Signatory, pursuant to Corporate Resolution. �'NESS t��h� S� S' e I ESS: _��J�1 (Printed Signature) STATE OF��i'(yV SS: COUNTY OF f� KJ ' The foregoing instrument was acknowledged before me this of'�, 2009 by KIMBERLY RANDAZZO as Authorized Signatory, for the LAW OFFICES OF MARSHALL C. WATSON P.A., AS ATTORNEY-IN-FACT FOR THE FEDERAL HOME LOAN MORTGAGE CORPORATION, who executed same on behalf of the last said corporation and who is personally known to me and who did take oath. (SEAL� -- �I uio;��v.�,an� ;_ �n`I COD'1htlISSION q DD 666240 OTARY PUBLIC (SIGNATURE} 4� ::�:� i.,`,'riRES.Apn123,2011 '`��"""'�'�,� eaitletlThruNOtaryPWlicUrMenvnters ��/�� wh�. \I PRINT NAME