HomeMy WebLinkAbout10-17-13 (2) � 9545$11185
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CAMP NILL PA 17011
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11 D�RBYSHlRE DRIVE, CARUSLE PA
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B� 8 RITTER, CPAS, 211 HQUSE AVE CAMP HiLL, PA 17011
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� 1505611285
REV-1500IX(Fp
Decedent's Sodal Searity Number
DecetlenYeNams BOCCIA NICOLFTTA
RECAPITULATION
1. Real Estete(Sche�le A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . �. �.0�
z. stocks ana s«as cscneau�e e). . . . . . . . . . . . . . . . . . . . . . . . . y, 0.00
3. Closely Held Corporation,Partnership or Sole-Proprieforahip(Schedde C), , , , . 3. �.��
4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , 4. 0.00
5. Cash, Bank Deposils and Miscellaneous Personal Property(Scheduk E) , , , , , 5. �,697.�0
6. Jointly OwneE Property(Schadule F) � Separate Billing Requestad , , , , g, SZ,824.00
7. Inter-Vivos Trensfers&Miscellaneous Non-Probate Property
�s�,�a„ie c� � Separete Billing Requeated . . . . 7. Z4Z,281.00
8. Toql Gross bsets(totel Lines 1 through 7) . . . . . . . . . . . . . . . . . . g. Z96,802.00
9. Fu�eral Expenses antl AdminisVative Costs(Schedule H). . . . . . . . . . . . . g. �H,C64.00
10. Debts ot Decedent, Mortgage Liabilities,and Liens(Schedu�e I) , , , , , , , , . �0. �25.��
1 t. Total Deductbns(lolal Lines 9 and 10). . . . . . . . . . . . . . . . . . . . . 11. �8,789.00
12. Net Valua of EsWe(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . 72. Z7H,013.00
13. Charitable and Governmental Bequests/Sec 9113 Tnuts for which
an election lo tax hes not been maAe(Schedule J). . . . . . . . . . . . . . . . 7 3. 0.�0
14. Net Vslua SubJect to Tax(Line 12 minus Line 13) , , , , , , , , , , , , , , , 14. Z7H,013.00
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 ta�61e
at the spousal tax rate,or
transfers u Sec.9116
(a)(1.2)X.O� �.�� 15. �.��
16. Amount of Line 14��mWe
at lineal rale X.0 4 278,013.00 �s. 12,511.00
17. Amount oi Line 14 te�mble
at sibling rate X.12 0.�� �7. 0.0�
18. Amount of Line 14 taxable O.00
at collaterel rate X.7 5 0.00 �a.
19. TAX WE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. ��L,511.00
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYN�NT �
SIliB 2
� 1505611285 1505611285 �
OM1818 J.000
. . . .... ._.. . ____ . ..._ __._
�
REV-7500 EX(FI) Pape 3 Flla Nulribet
oeeeaerres com ete Address: 21 13 0902
oEC�o�rtrs Natne
O NICOL A
STREEfADDRESS
UMB RLAN
arr sr,a� zia
I CARLI E RA 1701 -
Tax Payments and Credits:
t. Tax4ue{Page2.�iriet9) t1> 12,511.04
Z. Ctedtte7Payments '
A. PrfOr Payments O.00
8.Discrunt 6�J8.��
T«����A�e> �2> sss.ao
3. Inter�at
(3) 0.00
4. df line 2 is�eater than�ine 1+�i�e 3,�#9r the difference.IT+is ie the OVERPAYtA�1T.
Rii in box an Psge 2,Line TO W request a retund. (4} �.�{)
5. If Line 1 +���e 3{a greater than line 2,enter the difference.This is tFre TAX DUE. (5) 11.853.00
M�ce check payable ta: REGISTER O�WlLLS, AGENT.
P#.EASE ANSWER THE FOLLdWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCK3
1. D3d decatlent make a tr�sfer�ct Y� �fl
a. retaia the use or income of the praperty transferted . . . . . . . . . . . . . . . . . . . . . . . . ❑ �
b. retain the right to designate who shall usa the propelty transferretl or fls income . . . . , . . . . : �
aretain a rever8iot�sry intereat . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
d. receive the promtae for iife ot eitlier peyments.ben+atits a care? . . . . . . . . . . . . . . . . . �
2. If death occurred after Dec. 12, 1982,did decetlent transfer properly within one year of tleath
without recaiving adequate conskeratlon? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑ �
3. Did�nt aun an"in t(vst fo!"�payst,�e-upwf-d�Ur�k acr.ou�rt or security�his a�tfet�death? , ❑
4. Did decedent awn an indiviAUal retiremant account,annuity, or Mher non-proGaM properry,whfch
contains a 6eneficiary designetion? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � ❑
IP TFiE ANSWER TO ANY OF TME ABOVE �UESTIONS IS YES, YOU MUST COMPLETE SCHEWLE G AN� FLE IT AS PART OF THE RETURN.
Far d�es of death an or atter July 1, 1994,snd baf�e Jan. t, t 99fi,the taz rate imposed�the net value ot transfers to ar tor tha uee at the survivtag spwee
ts s pereent(72 a.s.§sh�s ta}��,i>ti)y
Fnr dates oT tleath on or atter Jan. 1, 1885, the tax rete imposed on the net velue of transfera to or fw the use of the surviving apouse is 0 parcent
[72 P.S.§81 i 6 ta){1.t)(ii)�.The atatute dom not exempk a transfer to a survivinp apouse from tax,and the atatutay raquirements fa diaclosure of msels a�tl
fiiing a ta�c retum�e stlii�ic�rlB even if the 5utviva�g spouse�the atiy benefid�y.
FOr dates of death on or 8ker July 7,2000:
• The tex tete imposed on the net value M trgnafers from e deceaeed child 21 years of age w younger at death to or fw the uee of a natursl parent, an
stloptive Qarent w a steppareM af the chi10 is tl percent j72 P.S.§9'!18(a}{t.2)}.
• The tax rate imposed on the net vaiue of transfers to or for tha uae tlf the decadent`s tin�d t�enefiGaries i�4.5 percent,e�xept as noted in�72 P.6.§9118(a7(�)I�
* The tau rete impoaed on the net velue of bengfers to ar for the use of the decedenPs siWings is 12 percent[72 p.S.§9118{a)(1.3)]. A sibling fs defineU,
under Section 9102,an�indivlduai who has af leest one parent in cammon with tba dec�t,whether by Dlood or adoptlon.
OM4891 P.000
REV-0508 E%�(0&12)
pennsylvania SCHEDULE E
OEPMn.FNlOF RE4ENUE CASH, BANK DEPOSITS& MISC.
N1BpfANCE TPX RETURN PERSONAL PROPERTY
�!f OECEDENT
ESTATE OF: FILE NUI�ER:
Nicoletta Boccia 21 13 0902
Include t�e procaeAa o(INipMion entl Me d,ta tlro pia'•eed�wae recenad bY Ms esWa�
All ro ointl owned with ht of survhorshl mwt be dbebaed on SeMduk F.
�M VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
t. Capitol Blue Crosa Inaurance Refund 847
2 Personal Property (clothinq, jemelry) - per
executor'e estimate (decedent lived with
executor and did not maintain a reaidence) 850
7pTpL(Aiso enter on line 5,RecapiWladan) f 1,697
2w�enD z.000 If mom space is neetled,use atldilionY s�eeb d p�per dMie�rris s¢e.
_atv-isos oc��oi-���.. _ __ ._. .. . . _ _. .. . . . I
pennsylvania SCHEDULE F
DEPCNTNENTCFREVENIIE I
INHERITANCETA%RETURN � JOINTLY-OWNEDPROPERTY
RESI�ENT DECEDENT �� �
ESTATE OF: FILE NUMBER:
Nicoletta Boccia 21 13 0902
B en essat became joMy owned wiMM one yaer olthe UantleM's Gb of de�th,N mwt ba nportad on 9cMtluN G
SURJNNGJON�iBL1M(5)WlA£tS) A�S ��T�T��
A Boccia, Gino 1128 Wilcox Ave. , Bronx,
NY 10465 Grandaon
B Boccia, Louis G 2700 Wigwam Park Rd, Eaet
Stroudeburg, PA 18301 Son
C Hoccia, Michael 1128 Wilcox Ave, Hronx, NY
10465 Grandson
JOINTLY OWNED PROPERTY:
�,.Ea oo� o�cranonoF�n woF rnrEOFOenrn
� rw�axl M40E ixuuswrearxuxw�wtrtu*wurowa�ccwxrxure�anawun Q47EOFOFAIH OE(S7BlI'S VALUEOF
µ�� 1FHµj � IXMIRIIq1NMFII.ARAEXYEFOWIJVIfLVKKL�MALElT.�TE. VALI�OFASSET WIH�T �SMB�ST
1 L 11/3/200 Membera lst FCU
checkinq Acet #267587 4,788 50.0001 2,394
2 L 7/8/2005 Membara lst FCU -
3avinga Aoct N267567 20,677 50.0000 10,338
3 L 10/25/20 Mambera lst FCU -
Savinge Acet M267587 1,399 50.0004 700
4 L 11/16/20 Membera lat FCU -
3avings Acet k274617 7,443 50.0001 3,721
5 L 11/16/20 Membara lst ECU -
Savings Acet 5274817 24,562 50.0000 12,281
6 L 11/16/20 5 Mambere lst FCCT -
3avinga Acet N276913 17,670 50.0000 8,735
7 L 11/16/20 Mambera let FCU -
9avinqa Acet M274813 5,748 50.0001 2,874
8 L 11/16/20 Members lat FCV -
Savings Acet $274814 829 50.0006 415
9 L li/16/20 Membars lat FCIJ -
Savinga Acet N274814 25 50.0000 13
To 1 from c ntinuation achedulea . . . . . . . . 11,353
TOTAL (Also enter on Line e,Recapituletion) S 52�824
9W�6RE 2.000 H more space ia needeG,uee additional sheets ot papar of the same size.
Eatate of: Nicoletta Hoccia 21 13 0902
Schedule F Part 1 (Page 2)
Name Address Relation
D Cline, Jennifer 79 Washinqton Avenua,
Kingaton, NY 12601 Granddauqhter
E Gesmudo, Anthony 5 Hearthstone Drive,
Wappinger Falls, NY 12590 6randaon
F Geamundo, Margherita 22 Robert Lane, Wappinqer
Falls, NY 12590 Dauqhter
G Geamundo, Vincent 22 Robert Lane, Wappinger
Falls, NY 12590 Grandaon
H Matula, Edward 29 Marple Rd,
Pouqhkeepsie, NY 12603 Grandson
I Matula, Heather 6 Eastman Terrace Apt 4,
Poughkeepaie, NY 12601 Granddaughter
J Matula, Laurs 29 Marple Rd,
Poughkeepaie, NY 12603 Daughter
K Schroader, Andrea 11 Derbyshire Drive,
Carlisle, PA 17015 Granddaughter
L Schroeder, Anna Maria 11 Derbyshire Drive,
Carlisle, PA 17015 Daughter
M Schroeder, Joseph 11 Derbyahire Drive,
Csrlisle, PA 17015 Grandaon
N 3chroeder, Steven 11 Derbyahire Drive,
Carlisle, PA 17015 Grandaon
O Valderrama, Nichole G 30 Kinqa Drive, Middleton,
NY 10941 Granddauqhtar
Estate of: Nicoletta Hoccia 21 13 0902
Schedule F Part 2 (Page 2)
Item Joint DOD Value of Perc DOD Value of
No. Cot. Date Deacription Asaet Int. Intereat
10 JL 10/25/2005 Mambars 1at FCU -
Savinga Acct k273523 3,520 33.3332 1,173
ii JL 10/25/2005 Membera ist Fcv -
Monay t9ct Acet
N273523 13,563 33.3336 4,528
12 E 4/1/1995 1,000 Par
US EE Savinqs Bond
Face Amount $1,000
issued Od/1995 1,030 50.0000 515
13 O 4/1/1995 1,000 Par
US EE Savings Bond
Face Amount $1,000
issued 04/1995 1,030 50.0000 515
14 G 4/1/1995 1,000 Par
US EE Savinqa Bond
Face Amount $1,000
iasued 04/1995 1,030 50.0000 515
15 D 4/1/1995 1,000 Par
US EE Savinga Sond
Face Amount $1,000
isaued 04/1995 1,030 50.0000 515
16 H 4/1/1995 1,000 Par
US EE Savinga Sond
Face Amount $1,000
isaued 04/1995 1,030 50.0000 515
17 I 4/1/1995 1,000 Par
US EE Savinga Hond
Faca Amount $1,000
isaued Od/1995 1,030 50.0000 515
18 M G/1/1995 1,000 Par
US EE Savinga Sond
Face Amount $1,000.
isaued 04/1995 1,03U 50.0000 515
19 N d/1/1995 1,000 Par
US EE Ssvings Bond
Face Amount $1,000
isaued 04/1995 1,030 50.0000 515
Total (Carry forward to main achedule) 9,821
Eatate of: Nicoletta Boccia 21 13 0902
Schedule F Part 2 (Page 3)
Item Joint DOD Value of Perc DOD Value of
No. Cot. Date Deacription Aeset Int. Intereat
20 K 10/1/1995 1,000 Par
US EE Savinga Bond
Face Amount $1,000
isaued 10/1995 1,004 50.0000 502
21 A 4/1/1995 1,000 Par
US EE 8avinqa Sond
Face Amount $1,000
isaued 04/1995 1,030 50.0000 515
22 C 4/1/1995 1,000 Par �
US EE Savinga Bond
Face Amount $1,000
isaued 04/1995 1,030 50.0000 515
Total (Carry forward to msin achedula) 1,532
. . . . . . . _.__...
RE�.,S„�'"°�, SCHEDULE H
pennsylvania
DEPARi1.EMOF REVENUE FUNERAL EXPENSES AND
►lHERRANCETA%RENRN ADMIN�STRATIVE COSTS
RESOEM�EOENT
ESTATE OF FILE NUIYBER
.:__,_.�_ a_.,,,;n 21 13 0902
Decedent's debb muat be reported on Sehatlule I.
REM
NUMBER DESCRIPTION AMOUNT
A. FUNERALEXPENSES:
� John Dormi S Sona Ehneral Home 13,622
Total from continuation achedules . . . . . . . . . 1,836
B. ADMINISiRATNE COSTS:
7. Personal Representatrve Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2. Attomey Fees:
3. Family Exemption:(If decedent's a0tlress is not the same as claimanCS,atlach e�lanation.) 1 697
Ciaimant Anna Marie 3chroeder /
Street Adtlress 11 Dorbvshire Drive
Ciy Carlisle Stete PA ZIP 17015
Relationship of Claimant to Decedent DAUGHTER
4. Probate Fees: 409
5. Accountant Fees:
6. Tax Retum Preperer Fees: 775
7.
1 Anna Maria Schroeder — reimbursa
executor gas 6 tolls 225
Total £rom continuation achedulea . . . . . . . . . 100
TOTAL Also enter on Line 9,R letion) S 18 666
sw�enc z.000 If more space Is needed, uee additiand sheeta of paper ot Me seme size.
Estate of: Nicoletta Boccia 21 13 0902
Schedule H Past 1 (Page 2)
Item
No. Description Amount
2 Tips for funeral drivers 60
3 Other food for funeral attendeae 190
4 US Postsl Service - postage for
acknowledgements 46
5 Venetian Delight Restaurant fvneral meal 1,540
Total (Carry forward to main schedule) 1,836
Estate of: Nicoletta Boccia 21 13 0902
Schedule H Part 7 (Page 2)
2 Hoyer 6 Ritter CPAa - reaerve for final
income tax preparation 100
Total (Carry forward to main schedule) 100
RE"-,5,2�'"x.," SCHEDULE I
pennsylvania
�'��R� DEBTS dF DECEDENT,
�,vaceT�vcasnme MORTGAC+E LtABILI7iES 8� I.IEN3
RESIOENf OECEDENT
ESTATE QF F�LE NUMBER
Nieoletta Booaia 21 13 0902
Raport debt4 ineurred by the deeadant prlor tp daath tbat remainad unpaM at tM data of deafh,Meluding unreimbunad mstlkai azpqnses.
I7EM VALUE AT DATE
M.7MBEtt OESCR�TION ��ATH
� Carlisle Regianal Medical Genter 125
TBTAI{Rieo gn;er on Line 14,RecapiCUWfk�} S 12$
qyybpH Z,pqq If more space is needed� If15BII3CGIKA18)6hBBib Of�hB SB1118 bIZB.
REV-1513EX+(07-10) SCHEDULE J
pennsyNania
OEPMTMEMOF RE�ENUE BENEFICIARIES
INh�RRANCE TAX RENRN
RESIDEM DECEDEM
ESTATE OF: FlLE lA1MBER:
Ni oletta Hoc ia 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER N�W1ElWDADDRESS OF PERSON(S)RECENING PROPERTY Do Not List Trustee(s) OF ESTATE
1 TAXABLE DI57f21BUTIONS(�nUUtla w4qM spouaal tlic4ibulions anE tmehre under
Sec.9116(a)(1.2).]
�. Marqherita Geamundo
22 Robert Lane
Wappingar Falls, NY 12590
254 of Allatate Annuity Daughter 58,840
2 Laura Matula
29 Marple Rd
Poughkeepsie, NY 12603
256 of Allatate Annuity Dsughter 58,840
3 Louis G. Boccia
2700 Wigwam Park Rd
East Stroudabusq, PA 18301
258 of Allatate Annuity Son 58,840
ENfER DOLLAR AMIOUMS FOR DIS7RIBUTIONS SFpWN P80VE ON LIIES 15 M20UGH 1B OF REV-1500 COVER SHEET,AS APPROPRIAIE.
�� NOKTAXABLEDIS'fRIBUTIONS �
A SPOUSAL DISiRIBUiIONS UN�ER SEC710N 8113 FOR WHICH AN ElEC710N TO TAX IS NO7 TAKEN:
t.
8.CHARf�ABLE AND GOVERNMENlAL DIS7ftIBU710NS:
1.
TOTAL OF PART II•EN7ER TOTAL NON-TA7(ABLE DISTRIBlJT70NS ON IINE 73 OF REV-1500 COVER SHEET. f 0
awaeni z.000 I/more apace is neetled.uae ad�lionel sheets of paper ot the same size.
Eatate of: Nicoletta Boccia 21 13 0902
Schedule J Part 1 (Paqe 2)
Item
No. Deacription Relation Amount
4 Anna Maria 3chroeder
11 Derbyshire Drive
Carlisle, PA 17015
25� of Allatate Aanuity
Joint Bank Accounta - paid
all expensea Daughter 88,922
5 Anthony Gesmudo
5 Hesrthstone Drive
Wappingar Falls, NY 12590
Joint EE Savinga Bond and
1/llth Hartford Annuity Grandaon 1,146
6 Nichola G. Valderrama
10 Kinqa Drive
Middleton, NY 10941
Joint EE Savinga Bond and
1/llth Hartford Annuity Granddaughter 1,144
7 Vincent Geamundo
22 Robert Lane
Wappinqer Falls, NY 12590
Joint EE Savinqa Bond and
1/llth Hartford Annuity Grandaon 1,144
8 Janni£er Clina
79 Washinqton Aveaue
Kingston, NY 12401
Joint EE Savinga Bond and
1/llth Hartford Annuity Granddauqhter 1,166
9 Edward Matula
29 Marple Rd
Poughkeepsie, NY 12603
Joint EE Savinqa Bond and
1/llth Hartford Annuity Grandaon 1,164
10 Josaph 3chroeder
11 Darbyahire Drive
Carlisla, PA 17015
Joint EE Savinga Bond and
1/llth Hartford Annuity Grandaon 1,144
Estate of: Nicoletta Boccis 21 13 0902
3chedule J Part 1 (Page 3)
Item
No. Description Relation Amount
11 Steven Schroader
11 Derbyahire Drive
Carlisla, PA 17015
Joint EE Savinga Bond and
1/llth Hartford Annuity Grsndaon 1,144
12 Andrea Schroeder
11 Derbyahire Drive
Carlisle, PA 17015
Joint EE Savinga Bond and
1/llth Hartford Annuity Granddaughter 1,131
13 Gino Boccia
1126 Wilcox Ave.
Bronx, NY 10465
Joint EE Savings Sond and
1/lith Ftartford Annuity Grandaon 1,144
14 Michaal Boccis
1128 Wilcox Ava
Bronx, NY 10465
Joint EE 3avinga Sond and
1/llth Hartford Annuity Grandaon 1,146
15 Heather Matula
6 Eaetman Terrace Apt 4
Pouqhkeopeie, NY 12601
Joint EE Savinqs Bond and
1/llth Hartford Annuity Granddaughter 1,146
WILL OF
NICOLETTA BOCCIA
I, Nicoletta Boccia of Cumberland County, Pennsylvania,
declare this to be my last Will and hereby revoke all prior Wilis and
Codicils.
1. I direct that all my just debts, funeral expenses,
gravemarker and administrative expenses shali be paid
' from my residuary estate as soon as practicatile after my
death.
2. I direct that all inheritance, estate, transfer, succession
and death taxes of any kind whatsoever which may be
payable by reason of my death shall be paid out of my
residuary estate.
3. I direct that my entire estate be distributed as follows:
A. I leave the sum of $1000.00 to my grandson,
Anthony V. Gesmundo.
B. I leave the sum of$1000.00 to my granddaughter,
Nicole Gesmundo.
C. I leave the sum of $1000.00 to my grandson,
- Vincent A. Gesmundo.
D. I leave the sum of$1000.00 to my granddaughter,
Jennifer M Matula.
E. I leave the sum of$1000.00 to my grandson,
Edward J. Matula.
F. I leave the sum of $1000.00 to my granddaughter,
Heather L. Matula.
G. I leave the sum of $1000.00 to my grandson, Gino
C. Boccia.
H. I leave the sum of $1000.00 to my grandson,
Michael A. Boccia.
LAWOFFICESOF I. I leave the sum of $1000.00 to my grandson,
STEPHEN J. HOGG Joseph R. Schroeder.
19 S. HANOVER STREET
SUITE t0t '
CARLISLE,PA 17013 �t�C � �
��l.Q.t7
�G'
�.Kc-
J. I leave the sum of $1000.00 to my grandson,
Steven A. Schroeder.
K. I leave the sum of $1000.00 to my granddaughter,
Andrea M. Schroeder.
L. If any of the above named grandchildren
predeceases me the deceased person's share
shall lapse and go into residuary estate.
M. The remainder of my estate shall be divided
equally between my children, Margherita
Gesmundo, Laura Matula, Gino Boccia and Anna
Maria Schroeder.
N. If any of my children predecease me, the
deceased person's share shall lapse and be
divided equally among my surviving children.
3. I appoint Anna Maria Schroeder as Executrix of this my
last Will. If she should predecease me or cease to act in
such capacity, I appoint Margherita Gesmundo as
alternate.
4. The Executrix of this Will shall have the power to
distribute my estate in kind or in cash, or partly in either.
5. I direct that no Executrix acting under this Will shall be
required to enter bond in any jurisdiction.
IN WITNESS WHE E F, Ik� e hereunto set my hand this
� day of , 2005.
!� '"`—�.0 .�,�,� �jt�cc�
Nicoletta Boccia
uw oFCaes oF
sx�r�N J.Aoc�
19 S.HANOVER STREET
SUITE 101
CARLI3LE,PA 77013 �
The preceding instrument consisting of this and two other pages
was on the day and date hereof signed, published and declared by
Nicoletta Boccia as and for her last Will in the presence of us, who at
his request, in his presence and in the presence of each other have
subscribed our names as witnesses hereto.
' ITNESS I ESS
uw oFCm�s oF
s�p�v J.goc�
19 S.HANOVER STREET
3UITE 101
CARLtSLE,PA 17013
. ._.. _____.
~ ACKNOW�EDGMENT
State of Pennsylvania
ss
County of Cumberland
I, Nicoletta Boccia, the testatrix, whose name is signed to the
attached or foregoing instrument, having been duly qualified according
to law, do hereby acknowledge that I signed and executed the
instrument as my last Will; that I signed it willingly and as my free and
voluntary act for the purposes therein expressed.
" v��� ���
Nicoletta Boccia
Sworn to or affirmedp�'�d acknowl g d be re me by Nicoletta
Boccia the testatrix, this 'o day of ,
waruu�s�x
s��n+�r.nooc.novwr weuc
crwus�soao,cuweenunn co,a�
MY CONYI�IWI E%�E!SEP7EYBER 7,1006
Notar�r PublicfAtt
AFFIDAVIT
State of Pennsylvania
ss
County of Cumberland
We,�USG.� X UcS�ICS and �,��a {�. �, �hor� , the
witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, do depose and say
that we were present and saw the testatrix sign and execute the
instrument as her last Will; that the testatrix signed willingly and
executed it as her ftee and voluntary act for the purposes therein
expressed; that each subscribing witness in the hearing and sight of
the testatrix signed the Will as a witness; and that to the best of our
knowledge the testatrix was at that time 18 or more years of age, of
�s und mind and under no constraint or undue influence.
, �t�`°"�—
worn to or ir e d subscribe to before me by witnesses,
this � day of , 2005.
uwoFF�soF
STEPfiF1vJ. HOGG ruarnAU�s�x
19S.HANOVERSTREET S7EPMENJ.Ippp,►ipTppyp�BUC t8 PubliGAttor y
SUITE 101 C���pO.CUYBERLAHDCO..PA
CARLISLE, PA 17013 ����a��R s,2�
' .��,� oF IlIDIVIOWL T,�ES Pennsy�vania lnheritance Tax � PL'nnS�/LV8111a
PO 60X 260601 DEPARTMENT OFREVENUE
w�wcxssuts r� vize-ocai Information Notice
"""" "' lEY-ISf3 EY OacEXEC t0-IZ1
And Taxpayer Response FILE NO.21
ACN 13143951
DATE OS-19-2013
Type of Account
Esffite of NICOLETTA BOCCIA Savings
SSN Checking
Date of Death 07-30-2013 Trust
ANNAMARIA SCHROEDER CountyCUMBERLAND Certificate
11 DERBYSHIRE DR
CARLISLE PA 17015-9260
MEMBERS isr Fcu provided the department with the information below indicating that at the death of the
above-named decedent ou were a'oint owner or beneficia of the account iden 'trf'ied.
AawuM No.267587 Remit Peyment�d Forms W:
Date EsfabflsMd 11-03-20D5 REGISTER OF WILLS
Account Balance $4,787.59 1 COURTHOUSE 3(�UARE
Percent Taxable X 5p CARLISLE PA 17013
Amount Subject to Tax $2,393.80
Tax Rate X 0.045
Potential Ta�c Due g�p7,7p NOTE': If Tax payments are made within three moMhs of the
decede�Ys date of death,deduct a 5 percent discount on the tax
WRh 5%Discount(Tax x 0.95) $(see NOTE`) due. My inheritaxe tax due will becwme definquent nine months
atter the date of death.
P'� St@p 1 : Please check the appropriate boxes below.
t
A �No ta�c is due. I am the spouse of the deceased or I am the parent ot a decedent who was
21 y�rs old or younger at date of death.
Proceed to Step 2 on reverse. Do not chedc any other boxes a�ml disregard the amount
sfrown above as Potential Tax Due.
g �The information is The above inforrrmation is conect, no deductions are being taken,and payment will be sent
correct. with my response.
Proceed ro Step 2 on re�rerse. Do not chedc any other boxes.
� �The tax rate is incortect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased.
(Select correc[tau rate at
right,and complete Part � �p�, I am a sibling of the deceased.
3 on reverse.)
� 15% All other reiationships(including none).
p �Changes or deductions The information above is incorract and/or debts and deductions were paid.
listed. Complete Part 2 and part 3 as appropriate on the badc oi this form.
E �Asset wNl be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
mherltance tau form Retum fited by the estate represenfa6ve.
REV-1500. Proceed ro Step 2 on r�verse. Do not chedc any other boxes.
Please sign and date the back of the form when finished.
.��u oF ItIDIVIOWL T�ES Pennsylvania inheritance Tax �� pennsylvania
PO !OX 280601
W1rtRIS6Ut6 P� 17128-0601 I(ITOrRIatlOfl NOtICB ` DEPARTMENTOFREVENUE
And Taxpayer Response `��"""�"""`�•.°'
FILE NO.21
ACN 13143949
DATE 08-19-2013
Type of Account
Estate of NICOLETfA BOCCIA Savings
SSN Checking
Date of Death 07-30-2013 Trust
ANNAMARIA SCNROEDER CouMyCUMBERLAND Certficate
11 DERBYSHIRE DR
CARLISLE PA 17015-9260
�EMBERS isT Fcu provided the department with the information below indicating that at the death of the
above-named decedent ou were a joint owner or beneficia of the account identfied.
A�uM� ��7 Rertdt PaymeM afd Forms to:
DaM E�bNshed 07-0&2005 REIiISTER OF WILLS
Account Balance $20,676.86 1 COURTHOUSE S(�UARE
Percent Taxabie X 50 CARLISIE PA 17013
Amount Subject to Tax $10,338.43
Tax Rate X 0.045 NOTE`: If tau payments are made within three months of the
Potential Tax Due $46523 decedent's date of death,deduct a 5 percent discouM on the tax
Wrth S�e Discount(Tax x 0.95) $(see NOTE') due. My inheritance tax due will become delinquent nine months
after the date of death.
Pa� St@p 1 : Please check the appropriate boxes below.
1
A �No tax Is due. I am the spouse of the deceased or i am the parent of a decedent who was
21 yesrs old or younger at date of death.
Proceed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown ebove as Potential Tax Due.
g �The infortnation is The above information is cortect, no deductlons are being taken,and payment will be sent
correct. wfth my response.
Pmceed to SYep 2 on reverse. Do not check any olher boxes.
C �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased.
(Select correct tau rate at
right,and complete Part � ��q, I am a sibling of the deceased.
3 on reverse.)
� 159'e All other relationships(inciuding none).
p �Changes or deductions The informatlon above is incortect and/or debts and deducdons were paid.
listed. Complete Part 2 arrd part 3 as appropriate on the 6ack o/this form.
E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inherftance taz form Retum flteQ by the estate representative.
REV-1500. Proceed to Step 2 on reverse. Do not chedc any other boxes.
Please sign and date the back of the form when finished.
. __ _
eueEnu OF INOIVIDUAL TIUCES Pennsylvania lnheritance Tax � pennS�/LVd1118
Po BOX 2l6607 DEPARTMEN7 OF REVENUE
W1RRI:GUtC PA 17128-06 01 Information Notice .
—" � YEV-156]E[YaeEaE[ [Vl.It)
And Taxpayer Response FILE NO.21
ACN 13143950
DATE OB-19-2013
Type of Account
Estate of NICOLETTA BOCCIA Savings
SSN Checking
Date of Death 07-30-2013 Trust
ANNAXARIA SCHROEDER CountyCUMBERLAND Certificate
11 DERBYSHIRE DR
CARIISLE PA 17015-9260 .
MENEERS isT Fcu provided the department with the information below indicating that at the death of the
above-named decedent ou were a joint owner or benefici of the ac�count identfied.
Re�Nt PaymeM and Forms to:
A�ount No.T67SB7
pets E�sd 10-25.Zppg REGISTER OF WILLS
Account Balance $1,399.13 1 COURTFIOUSE SfiUARE
Percent Taxable X 50 CARLISLE PA 17013
Amount Subject to Tax $699.57
Tax Rate X 0.045
Potential Tax Due $3�,qg ��'� If tax paymeMS are made within three months of the
decederrt's date of death,deduct a 5 percent discouM on the tax
With Sqo Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquerrt nine months
after the date of death.
P i� St@p 1: Please check the appropriate boxes below.
A �No tax is due. 1 am the spouse of the deceased or 1 am the parent of a decedent who was
21 y�rs old or younger at date of deeth.
Proceed to Step 2 on reverse. Do rrot chedc any other boxes and d'�sregerd the amount
shown e6ove as Potentia/Tax Due.
g �The information is The a6ove information is correct,no deductions are being taken,and payment wilfbe sent
correct. with my response.
Proceed to Step 2 on reverse. Do not check any other boxes.
� �The tax rate is incorrect. � 4.5�o I am a lineal beneficiary(paren[, child,grandchild,etc.)of the deceased.
(Select correct tax rate at
right,and complete Part � �p/, I am a sibling of the deceased.
3 on reverse.)
� 15qo All other relationships(inciuding none).
p �Changes or deductions The information above is incorcect and/or debts and deductions were paid.
listed. Complete Part 2 and pert 3 as appropriate on the badc ot this torm.
E �Asset will be reported on The above-identlfied asset has been or will be reported and tax paid with the PA Inheritance Tax
infieritance tax form Refum ftled by the esfate represent�tive.
REV-1500. Proceed to Step 2 on reHerse. Do not check any other boxes.
Please sign and date the back of the form when finished.
_ . _ __ _
BUREIIU OF INOIYIDWL T11%ES ��' pennsylvania
PO !0% 280601 Pennsylvania lnheritance Tax
HutHISBUtG PA 17128-O6o1 Information Notice �� DEPARTMENTOFREVENUE
And Taxpayer Response •`�.,�"`�""�` "•-",
FILE NO.21
ACN 13143952
DATE 08-19-2013
Type of Account
Estate of NICOLETTA I30CCIA Savings
SSN Checking
Date of Death 07-304013 Trust
ANNAMARIA SCHROEDER County CUMBERLAND Certificate
11 DERBYSHIRE DR
CARLISLE PA 17D15-9260
MEMIERS isr Fcu provided the department with the information below indicating that at the death of the
above-named decedeni ou were a'oint owner or benefici of the account identified.
Accax�t No.274817 Remlt Payment�d Forms to:
Dete Es1ffi�d 11-162005 REGISTER OF WILLS
Account Balance $7,q42.57 1 COURTI�IOUSE SQUARE
Peroent Taxeble X yp CARLI3LE PA 17013
Amount Subject to Tau $3,72129
Tax Rate X 0.045
Potential Tax Due $�g7,qg NOTE': If tax paymerrts are made within three moMfis of the
decedent's date of death,deduct a 5 perceM discount on the tax
With 59'o Discount(Tau x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months
after the date of death:
PA� Step 1 : Please check the appropriate boxes below.
1
A �No tax is due. I am the spouse of the deceased or I am the perent of a deeedent who was
21 years old or younger at datie of death.
Prviceed to Step 2 on reverse. Do not chedc any other 6oxes a�disregartf the amount
sFrown above as Potential Tax Due.
g �The information is The above information is correct, no deductions are being ffiken,and payment will be sent
correct. with my response.
Proceed[o Step 2 on re�rse. Do not checlr any other boxes.
� �The tax rate is incorcect. � 4.5Yo I am a lineal beneficiary(parent,child,grendchild,etc.) of the deceesed.
(Select conect tax rate at
right,and complete Part � �p�, I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete PaR 2 and part 3 as appropriate on Me badc of this form.
E �Asset will be reported on The above-identified asset has been or will be repoRed and tau paid with the PA Inheritance Tax
inheritance tax form Retum Nled by the estate represenffitive.
REV-1500. Proceed to Step 2 on re�rerse. Do not chedc any other 6oxes.
Please sign and date the back of the form when finished.
� � ourtewu aF :HOrv:n�� T�ES �� � Pennsylvania lnheritance Tax � � pennS�/�V8111d
PO !Ox 2606D1 � DEPARTMENT OF REVENUE
XIIRRISBIR6 PA 17128-0 601 Information Notice
And Taxpayer Response "`".'"'"°°°""t°e-�z�
FILE N0.21
ACN 13143953
DATE OS-19-2013
Type of Account
Estate of NICOLETTA BOCCIA Savings
SSN Checking
Date of Death 07-30-20i3 Trust
ANNAMARIA SCHROEDER CouMyCUMBERLAND Certificate
11 DERBYSHIRE ➢R
CARLISLE PA 17015-9260
MENDERS isT Fcu provided the department with the information�below indicating that at the death of the
above-named decedent ou were a joint owner or beneficiary of the account identified.
A�M� ��7 Remft Payment and Forms to:
�E�����_�6.pppg REti13TER OF WILLS
Account Balance $24,562.00 � �UpT�U9E SOUAHE
Peroent Tauable X 50 CItRLI3LE PA 17013
Amount Subject to Tax $12,281.00
Tax Rate X 0.045
Potential Tax Due $552.65 NOTE': If tax payments are made within three morhhs of the
decedeM's date of death,deduct a 5 percent discount on Me tau
With 5�e Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months
after the dffie of death.
PA� St@p 1 : Piease check the appropHate boxes below.
i
A �No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date of d�th.
Proosed to Step 2 on reverse. Do not check any other boxes and disregard the amount
shown above as PotenHal Tax Due.
__ _ ... . :,, . .. _ _ .-- -- _ - --- - --___-_ -
g �The infortnation is The above mfortnation is cortect,no deductions are being taken,and payment will be sent
correct. with my response.
Proceed ro Step 2 on reverse. Do not chedc any other boxes.
� �The tax rate is ir�ortect. � 4.5% I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased.
(SBIeCt Correct tex rate at
right,and complete Part � �p� I am a sibling of the deceased.
3 on reverse.)
� 15% All other relationships (including none).
p �Changes or deductions The information ffiwve is incorrect and/or debts and deductions were peid.
listed. Complete PaR 2 and par[3 as appropriate on the back of this/orm.
E �Asset will be r�orted on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inhe�Tance faz form Retum fifed6y ffi8 esfate represenfative.
REV-1500. P�d to SYep 2 on reverse. Do not check any otherlwxes.
Please sign and date the back of the form when finished.
__ _ _ _ _ _ __
e��,o oF INDIVIDWL TAXES Pennsylvania lnheritance Tvc �;�� � pennsytvania
PO 80% 2b0607 DEPARTMEN'f OF REVENl1E
XIIRRISBUt6 PA 17128-06U1 Information Notice __
" REY-156�EY Yecl'%EL (06-I2)
And Taxpayer Response FILE NO.21
ACN 13143955
DATE 0&19-2013
Type of Account
Estate of NICOLETTA BOCCIA Savings
SSN Checking
Date of Death 07-30-2013 Trust
ANNAMARIA SCHROEDER CouMy CUMBERLAND Gertificate
11 DERBYSHIRE DR
CARLISLE PA 17015-9260
MEMHERS isr Fcu provided the department with the information below indicating that at the death of the
above-named decedent ou were a joint owner or beneficia of the account identified.
Remit Payment and Fortns ta:
AccouM No.274813
Date EstaWished 11-162005 flEGI3TER OF WILLS
Account Balance $17,470.02 � CQURTHOI�E Sf]UARE
CARLISLE PA 17013
Percent Tauable X 50
Amount Subject to Tax $8,735.01
Tax Rate X 0.045 NOTE': If tax payments are made wtthin three months of the
Potential Tax Due $393.08 ��M's date of death,deduct a 5 percent discourrt on the tax
With 59'o Discount(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months
after the date of death.
PA� Step 1 : Please check the appropHate boxes below.
A �No tax is due. I am the spouse of the deceased or 1 am the parent of a decedent who was
21 years old or younger at date of death.
Proceed to SYep 2 on reverse. Do not check any other boxes and disregard the amount
shown above as Potential Tax Due.
g �Ttie information is The above information is cortec[,no deductions are being taken,and payment will be sent
corcect. with my response.
Proceed to Step 2 on reverse. Do not chedc any other boxes.
� �The tax rate is incortect. � 4.5�o I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased.
(Select corcect tax rate at
right,and complete Part � �p�, I am a sibling of the deceased.
3 on reverse.)
� 15�o All other relationships(including none).
p �Changes or deductions The information above is incorcect and/or debts and deductions were paid.
listed. Complete PaR 2 and part 3 as apprvpriate on the badc of this form.
E �Asset will be reported on The above-identified asset has been or will be reported and tau paid with the PA Inheritance Tax
inheritance tax form Retum filed by tfie estate repreeentative.
REV-1500. Proceed ro Step 2 on reverse. Do not cheGc any other boxes.
Please sign and date the back of the form when finished.
_ _ _ _ _ _ ___. _ _.
BUREAU OF INDIVIWIIL TAXES Pennsylvania lnheritance Tax �;,� pennsylvania
PO !OX 280601 DEPARTMENTOFHEVENUE
xnwcxsnues ra ���ze-oso� Information Notice
And Taxpayer Response "`�-'�3`Y'."i" "•-'��
FILE NO.21
ACN 13143954
DATE 0&19-2013
Type of Account
Estate of NICOLETTA BOCCIA Savi�gs
SSN Checking
Date of Death 07-30-2013 Trust
ANNAMARIA SCHROEDER County CUMBERLAND Certificate
11 DERBYSHIRE DR
CARLISLE PA 17015-9260
MEMBERS isr Fcu provided the department with the information below indicating that at the death of the
above-named decedent ou were a'oint owner or beneficia of the account identified.
AxauM No.274813 Remit Payment and Forms to:
Date Esf�lished 11-162005 RE(i1.4TER OF WILLS
Account Balance $5,748•49 � �����UARE
Percent Taxable X 50 CARLISIE PA 17013
Amourrt Subject to Tax $2,87425
Tax Rate X 0.045
Potential Tax Due $�2g.3q NOTE': If tax payments are made within three mordhs of the
decedenYs date of death,deduct a 5 percent discount on the tax
With 5%Discount(Tax x 0.95) $(see NOTE') due. My inheritance tax due will become delinquent nine months
a(ter the date of death.
P'�T $t@p 1 : Pkase check the appropNate boxes below.
�
A �No tax is due. I am the spouse of the deceased or I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed to Step 2 on reverse. Do�rot chedc any other boxes and disregard the amount
shown afwve as Potential Tax Due.
g �The information is The above information is correct,no deductions are being taken,and paymeM will be sent
cortec[. with my response.
Pmceed to Step 2 on reverse. Do not check any other 6oxes.
C �The tax rate is incorcect. � 4.5°� I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased.
(Select correct tax rate at
right, and complete PaR � �p�, I am a sibling of the deceased.
3 on reverse.)
� 15qo All other relationships(including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 a�part 3 as appropriate on the badc o/this form.
E �Asset will be reported ai The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inheritariee tax fomi Retum filed by the estate reprexnta6ve.
REV-1500. Proceed to Step 2 on reverse. Do not chedc any other boxes.
Piease sign and date the back of the form when finished.
-_ _ _ _ _ _ _ .___
�
a��� oF IlIDIVIDWL TAXES '� � � pennsy vania
Po em� zeobo� Pennsylvania inheritance Tax I „
WIRRISBUt6 PA 17128-0601 Information Notice �� DEPARTMENT OF REVENUE
And Taxpayer Response I wEVasro ex m.exec ,a.-,z,
' FILE NO.21
�i ACIV 13143956
DAiE OB-19-2013
Type of Account
Estate of NICOLETTA 130CCIA Savings
SSN Checking
Date of Death 0730-2G13 Trust
ANNAMARIA SCHROEDER CouMyCUMBERLANC� Cert�cate
11 DERBYSHIRE DR
CARLISLE PA 17015-9260
MEMIERS isr Fcu provided the department with the information below indicating that at the death of the
above-named decedent yau were a'oint owner or benefici of the account identified.
AccauM No.274814 RemK Payment and Forms to:
Date EsmbHshed 71-16�Z005 REGI3TER OF WILLS
Account Balance $gpg.3� 1 COURTHOU3E SaUARE
Peroent Tauabie x Sp CARLISLE PA 17013
Amount Subject to Tax $414.66
Tax Rate X 0.045
Potential Ta�c Due $�g,� NOTE': If tax payments are made within three months of tfie
decedenYs dffie of death,deduct a 5 percent discourrt on the tex
With SMe Discoun[(Tax x 0.95) $(see NOTE') due. Any inheritance tax due will become delinquent nine months
after the date of death.
P� St@p 1 : Please check the appropriate boxes below.
t
A �No tax is due. I am the spouae of the dec�sed or I am the parent of a decedent who was
21 years old or younger at date of death.
Proceed to Step 2 on reverse. Do not chedc eny other boxes and disregard the amount
shown above as Potential Tax Due.
g �The infortnation is The above information is correct,no deductions are being taken,and payment will be sent
correct. with my response.
Proceed ro Step 2 on reverse. Do not check any other boxes.
� ❑The tax rate is incorreet. � 4.Sqo I am a lineal beneficiary(parent,child,grandchild,etc.)of the deceased.
(Select conect tax rate at
right,and complete Part � 1 pry, I am a sibling of the deceased.
3 on reverse.)
� 15�e All other relationships(including none).
p �Changes or deductions The information above is incorrect and/or debts and deductions were paid.
listed. Complete Part 2 and pert 3 as appropriate on the badc of this form.
E �Asset will be reported on The above-identified asset has been or will be reported and tax paid with the PA Inheritance Tax
inlierita�se tax form Rehun Gled by tha estats reFueserrtative.
REV-7 500. Proceed to Step 2 on reverse. Do not chedr any other boxes.
Please sign and date the back of the form when finished.
_ _ ___- _ __—
S� sa�a����,�: Statement of Accounts
5000 Louise Drlw
PO Box 40
M«"•m�w�.�,�"'os5 Mar 25, 2013 thru Jun 24, 2013
www.membs�st�t.ory
MalnSwttchboertl: (800)283�2328
ezc.n: v»es�-a3reor�aoo�xss-aa�z Account Number. 274814 �
� 7DD: (717)697-5312 or(800)2832328 exl.5312 �
Tel�reneh: (800)237-7288
MEMBERS 1St Balances at a Glance: _
FEDERALCREDITUN[ON Checking: 0.00 —
6057 1 AV 0.360 6057-6057 Savings: 25.00
F� I����Illu��l�i�llqll�'1�111�'�II"'I��II�I"��IJ�I�udul���� Certificates: 0.00 �
NICOLETTABOCCIA Loans: 0.00 �
�+ ANNA MARIA SCHROEDER Money Management: 829.24
r� IN TRUST FOR Swi e 5 YTD Reward: 0.00
� 11 DERBYSHIRE DRIVE P
°� CARLISLE PA 17015-9260
,� Page: 1 of 1
F� Your current Member Loyalty Rewards level is Tkanium.
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SAVINGS ACCOUNTS
0000 -REGUTAR SAVINGS
Dde TrenMdbn De�qbtbn Aiddtlons Subtracdons Belsx�
A4v 25 9�e fov�d 25.00
.Nm 24 6iai�g SsW�ae 25.00
0005-MONEY MAWAGEMENT
pa� Tnr�s�cUan De�abiion AddNbne SubtracUorre Balence
Afv 15 Bef�ncb FarMtud 829.18
Mar 31 Deposit DMdend Tiered Rate 0.04 828:'l7
ArrwN PlaraenC� Yf6dd Fernad O.G19�i hvm Q?/Of/?Df3 Cdvrgh Q?/31/21Df3
Apr 30 D�osit Dividend Tiered Rate �� 0.03 829.20
Airxn/Prerosrfog� YIe�H Eamed O.UlOX hwm 00/OR(210f3 Uxo�gll !X/30/Z!!� � ;
May 31 Deposit Dividend Tiered Rate � t' ' -0.04 829.24
.�✓-f�yrraertle�s-!'!e✓dEetned0>617t9K/inm05/Of/�>3-�dgdf-�5/3f/2101� _.--- -.-_ ,_ __-- - --_-_. _ ->-.—
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TOTAL DMDENDS PAID r+
0000 REGULAR SAVINGS D.00 "" �>
0005 M6NEY MANAGEMENT 0.18 `" ��
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Total Year7n Re�e Qnn�°�d;.�,P,��d 0.18
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BUtFAU OF INDIYIOWI TAXES Penns Ivania lnheritance Tax nns lvania
ro wx zsuoi Y � y
xnaitxs�ues w� i�ize-�soi Informatlon Notice DEPARTMEN�OFREVENUE
And Taxpayer Response '"�""°°""'g"°'""
FILE NO.2113-0902
ACN 13147B37
DATE p8-12-2013
Type ot Axount
Estate of NICALETTA BOCCIA �����
SSN �Chedcing
Date of Death 07-30-2013 T�
LAURA D MA7ULA CouMy CUMBERLAND Certlficate
11 DERDYSHIRE DR
CARLISLE PA 17015-9260 �
NEMlER8 isr Fcu provided the department with the information bebw fndicaUng that at the death of the
above-named decedent u were a'oint owner or benefi of the account identified.
AocouM No.273529 ��+Y�and Fams to:
DW F.t�bahsd 10-�3-2005 REOIS'TER OF YYILLS
AxouM Balence $3,521.� 1 CQUIiTHOUS�SOUi�RE
Percent Texabb X 16.687 CARLISI.E PA.17M8
Amount Subjed to Tax s ggg,gg
Tau Rate X 0.045
Potentiel Tax Due S 26.47 r10TE': H tax paymente are mede within three montha of the
VYith 5%DiscouM(Tau x 0.95) g{see NOTE•) d�"r8 date o}d�,de�ct a 5 percent�unt on the tax
due. My inherttence tau due w�become deAnquerrt nine moMhs
after the de[e ot death.
P j� St@F! 1: Pleass check ths approprlate boxes below.
A Q No tax is due. 1 am the spouse of the deceaeed or I am the parent of a deoedent who was
21 yeare oId or younger at da�pf death.
Prxeed to Sfep 2 on reverae. Do not diedc any ofher boxes end dlsregerc/the amount
sham above as PotenNa/Tax Due.
B �The irdwmation is The above informatlon is correct,no deductio�are being talcen,and peyment wlll ba sent
�a�� with my response.
Pioceed M Step 2 on rewrse. Do not check any oeher 6ares.
C ❑17ie tax rate is Mcorrect. � 4.5% I am a Ifneal beneticiery(parent,chlkl,grendchiW,etc.)of ihe deceased.
(SeleCt correct Tax rete at
ripht,arW wrtiplete Part � 7 p�, I am a sibling of the deceased.
3 on reverae.) .
� 15% All other reladonships(includinp nane).
p ❑��nges or deducGOns The infortnedon above is incorcecl and/or debts and deductions were paid.
Comp/ete PaR 2 and part 8 as qpproprlete on the bedc of thls lomt.
E �Asset will be r�orted pn The above-identified asset has been or will be reported and tax peid widi ttie PA Inhe�itance Tax
inherltance taz form Retum ftled by the estate representative.
REV-1500. Proceed to SYep 2 on reveise. Do not chsck any other fwxea
Please sign and date the back of the form when finished.
iUtFA11 OF IIOIVIDWL TAXES Pennsylvania lnheritance Tax �pennsylvania
PO WX 260f�1
wiRMtssuts pp 17126-osol information Notice DEPAR7MEMOFREVENUE
And Taxpayer Response •°-°"°'.°`.°-„>
FILE NO.211&0902
ACN 13147836
DATE 09-12-2013
Type of Account
Estete of NICALETTA 80CCIA SeNnps
SSN ��i�
Date of Death 07-30-2013 7N�
ANNAMARIA SCHROEDER CouMyCUMBERLAND Cert(Ncete
11 DERlYSNIRE DR �
CARLLSLE PA 17015-9260
NeMS�es isr Feu provided the department with the information below ind(catlng that at the death of the
above-named decedent ou were a' int owner or ben of the aarount identNied.
Accoum No.z736x� ��t and Forms to:
Date EdWqN+rd 70�25-2005 fiEO18TER OF WILLS
AccouM Belence $3,527.06 ��BWIARE
Perc;ent Texade X 16.867 ���� PA 17078
Amount Subject to Tax a 5gg,ge
Tax Rate X 0.045
Potentiai Tax Due $�,q� NOTE': H 1ex paymeMs ere mflde withM three monthe of ltre
With 5%Diecount(Tax x 0.95) $(gee NOTE'1 d��$�°f�am'��a 5 percent dfecouM on the tax
due. My fnheritance tax due wiN become daflr�ent nine months
aR�the date of death.
P�� Step 1: Pl�se chedc the�proprlate boxes bslow.
A �No tex la due. I am the spouse of the deoeased or I am the parent of a decedent who w�
21 years oid or younger et de�oi deat�.
Procoed ro step 2 on reverse. no nar chedc eny aner boxes and dis�eqard u,e emounr
siawn above�PoteMda/Tax Due.
B a The inforinatio'n`is 'f he abo've informatlon ie correct,no deduclions ere befng taken,and paymerrt will be seM
conect. with my response.
Proceed ro Step 2 on reverse. Do not check eny oM�er boxes.
C ❑The tau ra�e is Incorrect. � 4.5% I am a Oneal berreficiary(pereM,child,grandchHd,�c.)of the deceasecl.
(Select correct tex rate at
r(qht,and iwmptete Part � 12% 1 am a si�ling ot the deceased.
3 on reveree.)
� 15% All other relaUonships(ncluding none).
p �Chanpes or deducdons The informatlon above is incorrect and/or debts and declucyioru were p�d,
listed. Corry�lete Part 2 end pan 3 as eppropdate on the badc of tlus/orm.
E �Aaeet will be r�orted on The abovaideMified asset haa been or will be reported end tax paid with Me PA Inheritance Tax
inheritance tax fcrm Retum}iled by Me estate represer�tive.
REV-1500. Proceed to SMp 2 ar iqveise. Do not chedc any oMe�bozes.
Please sign and date the back of the form when finished.
_. _
I Po� =�o�'o',D1'1D1"� T"'�� Pennsylvania lnheritance Tax �pennsylvania
Iw1lqtls�Uxc Pn v12e-�6o1 Information Notice OEPARTMENTOFREVENUE
Md Taxpayer Response '^"���s v x.att<ae�:�
FILE N0.2113-0902
ACN 1314�899
DATE 09-12-2013
Type of AccouM
Estate of NICALETTA BOCCW Savings
SSN �:Chedcing
Date of Death 07-90-2013 Trust
LAURA D MATUTA CoUMy CUMBERLAND CertificatB
11 DERBYSHIRE DR � �
CARLISLE PA 170J.5-9260 .
.. .. _ ... . . _ . _ . . _--.��_. � . ., . � . . . . ._ . � . . _ . .. . _.
h�aEes isr Fcu provided the department with the fnformaUon below indicating ihat at the death of the
above-named decedent were a 'oMt owner or benefici of tFre accouM fdentlfied.
AcaouM Na 273�i Flemit Payment and Fams to:
Date F.�ished 1426-2005 RC�IBTER OF WILLS
PuxouM Belence $13.586.38 1 COIlRT1WU&E BGIIARE
PercentTaxaWe X�g,667 �RLIS�E PA 17013
AmouM Subjeet to Tax $p,26q.qq �
Tax Rete X 0.045 Np7E': If tex
PotenUai Tax Due $101.90 PaYme^a ere mede w�hin tliree monthe of the
With 5%Diacount(Tax x 0.95 decedenPa date W death,�duct n 5 percent diecourrt on the tex
I $(see NOTE'1 due. My inheritance teic due will tiecome deii�eM nine moMhs
after Cre date of deeth.
oP� 1 : Plsese check the a
�, �o�,a��x���.
A ❑No tax la due. I am the spouse of the deceas�d or I am the peront of e decedent who was
21 yean old or yaunger at date of dee�h.
Pmceed to SYep 2 on rererae. Do�rot q�eck any otl�erbc�res and dfaregerd Me amount
shown abore�Potentlel Tax Due.
_
g �The infoimafion ia The above infomiaGwi is cortect,no deducdons are being taken,and payment wIH be sent
corred. with my response.
Proceed to SYep 2 on reverse. Do not check any other bexes.
� �The tax rate is incorrect. � 4.5% I am a lineal beneficiary(pereM,child,grendctiild,etc.)of the deceased.
(Select cotrect t9x rate at
rigM,end complete Pert � 12% I am a s�ling M tFie deceaeed.
3 on reveise.)
� 15% All other reletionships(includinp non�e).
p �Charqea or daductlons The informatfon above is Incorroct andlor debts and deductions were paid.
listed. Comp/ete Part 2 and pert 3 a8 approprlBtB an tNe back Ot thls/ortn.
E �Aseet will be reported on The above-identlfied asset has been or will be reported and tax peid with the PA Inheritance Tex
Mheri[ance tax(ortn Retum fll�i by the estete representetive.
REV-1500. Proceed to Step 2 on rpverae. po npt ahech any other bnxes.
Please sign and date the back of the form when finished:
eua�u oF :�m7vmu.� raxES Pennsylvania lnheritance Tax �Pennsylvarria
Po emc 2sesn DEVARTMEM OP REVENUE
� iuoasemic rn vize-eeoi Information Notice �-�a���< <u-:
And TaxpayerResponse
FILE N0.2113-0902
ACN 13147838
DATE 09�12-2013
Type of Account
Estate of NICALETTA BOCCIA Sevings
SSN �Checking
Dste of Death 07-30-2013 Tn�st
ANNAMARIA SCHROEDER Co�MyCUMBERLAND Ce111fiCet9 �
11 DERBYSHIRE �R �
CARLISLE PA 17015-9260. -
MEMI6RS isr Fcu provided the deparbnent with the information below indicating that at the death of the '��
above-named decedent u were a oint owner or ben�ci of the aocouM identi8ed.
Axaan No.273s23 ��Y���d Forms to:
Dele FsN�hsd 1M2SZ005 REOISTER OF YYILLS
P�courrt Belence $13,688.38 1 COtJRTNOIISE BpUARE
Percent Taxable X 16.867 CANLI$LE PA 17013
Amount Subject to Tax $2,264.44
7ax Rate �X 0.045 NOTE•: If tax
Potential Tax Due s 101.90 �Cs dam oyf d� � a� ��mfBB months of the
With 5%Dis<wunt(Tex x 0.95) $(aee NOTE') due. An mheritence tax due wlll becom���unt on the tau
af[er Hx date of death. ^��t nine moMhs
PA� St9F1 1: Please check the approprlate boxes below.
1
A Q No tax fa due. I am the spouse of the deoeased or I em the parent ot a decedent who was
21 yeen old or younqer at d�e of dsath.
Proceed M SYep 2 on re►erse. Do rrot chedc eny other boxes aM disregard the amount
sFawn�ove as PoteMlal Tar DrM. .
.: . _,. . . .. . . . . . . . . .
B �71�e Inio'ma8on is The above information ie correq,no deductions are 6eing taken,and payment wiN be sent
correct. with my response.
Proceed to Step 2 on re�eiee. Do not check any other boxea.
C �The tax rate Is Incorrect. � 4.5% I am a lineal beneficiary(parent,chikl,grendchild,e[c.)of the deceaeed.
(Sebct correct tex rate at
�9h4 and complete PaK � 1296 I am a sfWing of the deceased.
3 on reverse.)
� 159'e All other relatlonships(including rwne).
p �Chanpes or deductions The intormation ebove is incorrect anMor debts and deductions were peid. -
listed. Complete Part 2 and paR 3 as appropriete on the back o/M/s lorm.
E �Aatet wNl be reportod on The above-idendfled asaet hec been or will be reported arM tax paid with the PA Inheritance Tax
inheritance tax form Retum filed by the eatate represoniaUve.
REV-1500. Proceed ro Sfep 2 on rpv�srse. 'Do not check any other boaes.
Please sign and date the back of the form when finished.
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You're in good hands.
September 16, 2013
Kathleen Nissley
Invest Financial Corp.
1166 Walnut Bottom Rd.
Carlisle, PA 17015
Re: Nicotetta Boccia
Contract No: GA19258223
Dear Ms. Nissley:
We received a request to complete IRS Form 712 for the above referenced contract. The purpose of Form
712 is to provide an estate or donor with the value of a life insurance contract or its proceeds as of a certain
date(usually the owners date of death or date of transfer of the contract).
Because this contract is an annuity, it is not reportable on IRS Form 712. I can, however, provide the
following information for estate purposes:
Date of Death: July 30,2013
Annuity Value as of Date of Death: $235,361.38'
Cost Basis: $200,000.00
Named Beneficiary: 'Margherita Gesmundo, Gino Boccia, Laura Matula, 8 Annamaria Schroeder
'The actual amount paid may differ due to Market Value Adjustments and/or any applicable Surrender
Charges.
If you have any questions, please contact me at 1-877-499�6�418 Ext.24369.
Sincerery,
Alicia Edwards
Sr. Claims Examiner
Allatate Life Insuranee Company
life and Annulty Claims
P.O. Box 94212, Palatine, IL 80094-4212 Phone 877-499-8418 Fax 866-635-4523
_
THE
HARTFORD
Septetnber 24, 2013
Anna Mazie Schroeder
11 Derbyshire Drive
Carlisle PA I7015
�
Reference: The Hartford Annuiry 710690259
Nicoletta Boccia,Decedent
Dear Ms. Schroeder,
Thank you for your correspondence mgarding the above annuity contract.
T'he death benefit payable under this contract is not considered`9ife insurance"reportable on IRS Form 712,(life
insurance statement). Piease find the below information in response to your request.
Contrect Number 710690259
Owner Nicoletta Boccia
Decedent Nicoletta Boccia
Social Securiry Number XX-XX-8947
Date of Death used for values July 30,2013
Cash Value on the date of death $6,782.42
Death Benefit Value on the date of death 56,920.22
7he Dath Brnefit Velue on tl�e dete of deeN di�l�yed abovo mey include a Deelh Be�wfit Adjuelmmt u ouUioad in thc Aaouity Ca�tract.TAis 8gurc is being
provided for illustration purpoxs end is na equivdcet to the 5ml dWh bemflt.T7�e de�h benafrt will�be ctleul�qn all cmuepa a�ociokd with this client
the dey we mceive due proof of death. O�the desth beneffi is calcuiakd,tlm brneSt mwum raneW imd0ed�p�d is aibject to market flucluetion uMil
complete xttlement instructions ere rcaived. �
Please contact your Investment Professional or one of our Annuity Speeialists with aoy questions or concerns. You
may reach 1'he Hartford by calling t-800-862-6668, Monday through Thursday from 8 a.m. to 7 p.m. end Friday
from 9:I S a.m. to 6 p.m., Eastern Time.
Thank you for the opportunity to help provide for your fmancial needs.
Sincerely,
lnvestment Product Services 7UeHUHuM WetllhMry�nent-GlobalMnui6es
ICS Annuity Benefit Services Team 745 Wmt Naw Cirok Road
Hartford Life Insurance Company B�g2�'���OOf
gWn,KY 405I1
Meiling Addresa:
. PO Box i4293
Lexington,KY 40512-4293
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