HomeMy WebLinkAbout02-14-14 � 1505610105
REV-1500��0�-11)(FI) �
OFFICIAL USE ONLY
PA Department of Revenue pennsylvar►ia
Bureau of Individual Taxes °` "�'��`°R"�`"�` County Code Year Flle Number
INHERITANCE TAX RETURN ���_ "���� ' �- -���� �- ..�__...
PO BOX 28o6oi I � �
Harrisburg PA 1�1z8-o6oi RESIDENT DECEDENT ; ;
_..
ENTER DECEDENT INFORMATION BELOW
Sociai Securiiy Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
09/08/2011 i 04/22/1926
�_. __�._. . ____ �_: _ . .._--- - .._.__ ..._._._. _ ._..: .__�___.. ____ ._____ ._.....
DecedenYs Last Name Suffix DecedenYs First Name MI
SICO "__ _ ._.._ .. LUCILLE ; C ;
�� __._ _ .._ �.__��.,__� ._.. :_.______ ,_�v__. .________.,_ ._ .....__ _,__.. _ � ��
_.._
(If Appiicable)Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name MI
� � __.._.� � f
___ _..__._ ._. ____... __ __-. _____.. ..�m �4__..__�___ �_,___s_._�.� __W.r,.___w_ ....w_w__________m_ _�
spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
� 1.Original Return O 2.Supplemental Retum O 3. Remainder Return(Date of Death
Priorto 12-13-82)
p 4.Limited Estate O 4a.Future Interest Compromise(date of p 5. Federai Estate Tax Return Required
death after 12-12-82)
C� 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 O 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 Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
DANIEL SICO, EXECUTOR , ' (631) 509-4363 '
REGISTER OF WILLS USE Ob$.Y
� _ -1'3
�-.C"`� .." F��.
�
First Line ofAddress ..__ ..__.. ._. _. _ _.. ._. ____._ _.__�. .___._.._ .__. ,._...��._ '�-? ��, ��� -�
460 OLD TOWN ROAD-3M '
�
_ ._... __ _ . .- ---- ___. __. ___.__...... _. .. ,.__ �. � ;
Second Line of Address � � �
, _,: , -..
_ __ �,-, � r=:
_, . .
__. .
... _ .., ..._, . ...._ .__ _. .. .. I � �_: , � � '�il
.__... ...____ _--. . _- . DATE Fl�ED
City or Post Office State ZIP Code _.,-� -- ;_.��-�
-, _..___�_____--__ _..__ . ____
_ _�_... ...... .._w_ .._ __ . ___..___.. -� �.-, --ri
PORT JEFFERSON S�'fj7'�p� NY =, 11776 ---
CorrespondenYs e-mail address:
Under penalties of perjury,I deGare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,cortect and compiete.DeGaration of preparer other than the personal representative fs based on all information of which preparer has any knowledge.
SI RE OF PER N ESPONSIBLE FOR FILING RETURN Df TE
(��CC� /� �L/ 8�/5/
ADDRESS e
ROSENBLA����N;�0��;�OTETZ�C�ESLLpTIV f DATE J ��
#11�Z�19 RESS
1700 JERICN�-���I , (�
E E USE ORIGINAI FORM ONLY
Side 1
� 1505610],05 15056101�5
i � �
J 1505610205
REV-1500 EX(FI)
DecedenYs Social Security Number
oecedent's Name: LUCILLE C. SICO
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1. ' i
2. Stocks and Bonds(Schedule B) ....................................... 2. 1,772.36 ':
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. '
��. �.�.���� ��.� �,.�.a �, <.�..� ._r..�.,
4. Mortgages and Notes Receivable(Schedule D)...... ..................... 4. € '
5. Cash, Bank Deposits and Miscellaneous Personai Property(Schedule E)....... 5. � 141,373.72 `,
6. Jointiy Owned Property(Schedule F) O Separate Billing Requested ....... 6. , !
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property � �M���W���m���T�w��,�
(Schedule G) O Separate Biiling Requested........ 7. ,i; '
8. Total Gross Assets(total Lines 1 through 7)............................. 8. i 143,146.08 '
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. � 6,473.77
�..�..�e.F�u.........��,.�....�.._.,v�,.�...�� _
10. Debts of Decedent, Mortgage Liabilities and Liens{Schedule I)............... 10. t� 1,350.28 '
11. Total Deductions(total Lines 9 and 10)................................. 11. t 7,824.05
12. Net Value of Estate(Line 8 minus Line 11) .................... .......... 12. ' 135,322.03 '!
��. _ �.�_ ._ .. ,._._ _ ....�. .. ...�,�.�_ ,,._...,E
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 Tax(Line 12 minus Line 13) ........................ 14. '. 135,322.03 "
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_ ' 15. ,
16. Amountof Line 14 taxable � _., .. ��..__. ,,,._ m,. _�_ _ . .._. „e....,....�.... _..�._.. ,.,, ....., ,. _�,T_� __,._�w
at�ineal rate X.0 45 135,322.03 '' �g. 6,089.49
_
17. Amount of Line 14 taxable
at sibling rate X.12 : 17.
18. Amount of Line 14 taxabie �. "�<.. ,. ,�,.��,�.x.,_.A._,y � _ . _ � �,a.,o..,_.�.. �.._..,. o._s� .,��>�,��,�Y_
at collateral rete X.15 18.;
19. TAX DUE . ................................................. ....... 19.i 6,089.49 ';
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 15056102D5 15056102D5 �
REV-1500 EX(FI) Page 3 Flie Number
Decedent's Complete Address:
DECEDENT'S NAME
LUCILLE C. SICO
STREETADDRESS
208 SENATE AVENUE#619
CITY STATE ZIP
CAMP HILL PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (t) 6,089.49
2. Credits/Payments
A.Prior Payments 4,273.96
B.Discount
Total Credits(A+B) (2) 4,273.96
3. Interest
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (3)
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1+Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,815.53
Make check payable to: REGISTER OF WILLS,AGENT.
�;�.,: .., �.�"'��...�.'�.$�'�°�3��M�'�5�s�m,� °w.��T��.��`;a�"��.,� ,��.�.0 nr..,..�.s'�r.v. '�^�t'�..,i,r�e���� �' � ,<a�<�...�s .�'�.��u�'. z.�"����aea..x._g...����::�. ,„�,�',�`3��
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.............................................................................................................................. ❑ �
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
containsa 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.
;.v��.� :.+,�:svr�``�'����z=;�,..c�e' . 5�-`„s.�`<�.� ��,�` �"' r � .; "g� r�,;�'� �c �sr �a�.E�' ���" 'i� '; � '�k� �' -�-�� `�°c�:€,,''� "�
_ ,,�.. . .,. .. , , :�<�. ., ,;�fa? 4.s., a,.:� 4cab cL�� ... �w"w" ,�f,. . '!ro��'�'�`.. ar...:.x�a� �i, n . .i3s,. �. «
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)j.
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 decedenYs lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(a)(1)].
. The tax rate imposed on the net value of transfers to or for the use of the decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3)J.A sibling is defined,
under Section 9102,as an individuai who has at least one parent in common with the decedent,whether by blood or adoption.
REV-1503 E7C+(6-98) ' '
� SCI�IEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LUGtLLC.' �. S { � � � llf - fd$(
All property Jointly-owned wlth right of survfvorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
,. � ��"� � �� 1, ��� . 3�,
TOTAL(Also enter on line 2, Recapitulation) $ � � �a. , ��`
�
(If more space is needed,insert additional sheets of the same size)
REV-i5o8 EX+(ii-io)
� � pennsytvania ' SC�IEDULE E
DEPARTMENT OF REVENUE ' CASH, BANK DEPOSITS & MISC. �
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
� uc� ��� �. s �c,c� �► rr -�r� �'�
Inciude the proceeds of litigation and the date the proceeds were received by the estate.
All property joinHy owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
� F v L,TD�t1 a/1-lU k- � 5.9�/�N G-.S �'1 f� p��. �
�. �'t,�`�.:�� d�t1�(C., - �:�'�-��t�G-�- '�, 9 7,z . �t
� G-�����..�:.��r �-�r������� � 7t�������� � �G. ���=�t
TOTAL(Also enter on Line 5, Recapitulation) $ � � � ���,��
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+(10-06)
. � � � SCNEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
LVG� �.�� � . .�r � e� �. ► � � — ��� !
Debts of decedent must be reported on Schedule L
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
,: 5 �¢`��.��
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s)Commission Paid: '
2• Attomey Fees
3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach explanation)
Claimant
Street Address
���y State Zip
Relationship of Claimant to Decedent
4• Probate Fees
5. AccountanYs Fees r ���� ��
a
6. Tax Retum Preparer's Fees
7.
TOTAL(Also enter on line 9, Recapitulation) $ � ���j_��
¢
(If more space is needed,insert additional sheets of the same size)
REV-1512 JC+(12-08) � �
� � pennsylvania SCHEDULE I
�DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RENRN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF L() C. � C..(„� �. S��� f',� FIL �� '�R r D$�
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,inciuding unreimbursed medicai expenses.
IfEM VALUE AT DATE
NUMBER DESCRIPTION ' OF DEATH
�. Nt E� t��., � � ��....,� � 3 �• �
TOTAL(Also enter on Line 10, Recapitulation) $ � ��. �-;�
If more space is needed,insert additional sheets of the same size.
.. _ , , .
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX
INHERITANCE TAX DIVISION APPRAISElIENT ALLORANCE OR DISALLONANCE pennsylvania �
PD Box 2so6o1 OF DEDUCTION� AND ASSESS![ENT OF TAX ON
HARRISBURG, PA 17128-0601 SECURI'E'Y ACCOUNTS HELD IN DEPARTMENT OF REVENUE
BENEFICIARY FORI'[ REV-154lA �v ciz-ii�
DATE 03-12-2012
ESTATE OF SICO LUCILLE C
DATE OF DEATH 09-08-2011
FILE NUMBER 21 11-1081
COUNTY CUMBERLAND
SSN/DC 109-20-8934
DANIEL SICO ACN 12500017
844 ALLENVIEW DR APPEAL BY DATE: 05-11-2012
MECHANICSSURG PA 17055-6183 (SeereversesideunderObjections)
Amount Re�sitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 1�013
CUT ALON6 THIS LINE �' RETIIIN LOWER POr�TidN. FOR YOiirZ Rti,u�CDS �
-- - -- - -- - -- - - ---- - --- - - - - - - - - --- -- -- ----- - - - - -- - -- ----- - - - -- - - -- --- - -- - - - - -
REV-1548A AFP C12-11�
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS
AND ASSESSMENT OF TAX ON SECURITY ACCOUNTS HELD IN BENEFICIARY FORM
DATE: 03-12-2012
ESTATE OF: SICO LUCILLE C DATE OF DEATH: 09-08-2011 COUNTY: Cl1MBERLAND
FILE NO. : 21 11-1081 S.S/D.C. NO. : 109-20-8934 ACN: 12500017
TAX RETURN WAS: (X) ACCEPTED AS FILED C )CHAN6ED
BENEFICIARY FORM OF ASSET INFORMATION
NAME OF SECURITY: METLIFE ACCOUNT NO. : 806195528819
TYPE OF ASSET: C ) SECURITIES ( � SECURITY ACC CX) STOCK O BONDS
DOD Valuation 1,772.36 NOTE: TO ENSURE PROPER CREDIT TD
Percent Taxable X 1 .000 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 1,772.36 UPPER PORTION OF THIS NOTICE
Debts and Deductions - .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 1,772.36 REGISTER OF WILLS AT THE
Tax Rate X .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 79.76 OR MONEY ORDER PAYABLE T0:
"REGISTER OF WILLS, A6ENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID C-) AMOUNT PAID
02-07-2012 CD015564 .00 79.76
TOTAL TAX PAYMENT 79.76
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE . 00
* IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ■
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
COMMONWEALTH OF PENNSVLVANIA REV-1162 EX(11-96)
•� '0.�iRR.:��MEN�T.OF REVENUE � •
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HAFRISBURG,PA 1 7 1 28-0601
PENNSYLVANIA
FiECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 015564
SICO DANIEL
844 ALLENVIEW DR
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
""__"' fold '_""'_"' ""_"_
12500017 � $79.76
ESTATE INFORMATION: Ssrv: i09-2o-s934 �
FILE NUMBER: 21 1 1 -1 081 �
DECEDENT NAME: SICO LUCILLE C (
DATE OF PAYMENT: 02/O8/2012 I
POSTMARK DATE: 02/07/201 2 �
coUrvTV: CUMBERLAND �
DATE OF DEATH: 09/OS/201 1 �
�
TOTAL AMOUNT PAID: 579.76
REMARKS:
CHECK# 1012
INITIALS: HMW
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
P4 c� �-�,l�z..—
�� �G�N�NYtE�"TH OF PENNSYLVANIA I,
DEPARTMENT OF REVENUE INFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE N0. 21 11-1�81
Po sox zao6oi ACN 12500017
HARRISBURG PA i�iza-o6oi TAXPAYER RESPONSE
DATE 01-11-2012
REV-154iA AFV (7-00)
TYPE OF ACCOUNT
EST. OF LUCILLE C SICO � SECURITY
S.S. N0. 109-20-8934 ❑ sEC ACCT
DATE OF DEATH o9-08-2011 ❑XTOCK
COUNTY CUMBERLAND ❑ soNDs
REMIT PAYMENT AND FORMS T0:
DANIEL SICO RE6ISTER OF WILLS
844 ALLENVIEW DR 1 COURTHOUSE SQUARE
MECHANICSBUR6 PA 17055-6183 CARLISLE PA 17013
METLIFE has provided the Department with the information listed below which has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you aere a beneficiary of this asset.
If you feel this inforwation is incorrect, please obtain written correction fro� the transfer agent, attach a copy to this form and
return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Comsonwealth of Pennsylvania.
4uestions may be answered by calling (717) 787-8327.
COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 806195528819 7o insure vrover credit to vour account, two
C2) copies of this notice ■ust accowpany your
paywent to the Register of Wills. Make check
DOD ValUetion 1�772.36 payable to: "Register of Wills, Agent".
Percent Taxable X 100.00
NOTE: If tax paywents are eade within three
Amount SubjeCt to Tax 1�772.36 (3) sonths of the decedent's date of death,
Tax Rate X .045 vou �eay deduct a 5Y. discount of the tax due.
Any inheritance tax due will become delinquent
Potential Tax Due 79.76 nine C9) wonths after the date of death.
PART TAXPAYER RESPONSE
�❑ . .
A. �The above infor�ation and tax due is correct.
1. You may choose to re�it pay�ent to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or you may check box "A" and return this notice to the Register of
C0 N E � Wills and an official assessment will be issued by the PA Departoent of Revenue.
B L 0 C K B. �The above asset has been or will be reoorted and tax paid with the Pennsylvania lnheritance Tax return
0 N L Y to be filed by the decedent's representative.
C. �The above information is incorrect and/or debts and deductions were paid by you.
You must complete PART � and/or PART � below.
,<.. .,
PART If you indicate a different tax rate, please state your
� relationship to decedent:
TAX RETURN - COMPUTATION OF TAX ON ABOVE ASSETCS�
LINE 1. DOD Valuation 1
2. Percent Taxable 2 X
3. Amount SubjecY to Tax 3
4. Debts and Deductions 4 - -
5. Amount Taxable 5
6. Tax Rate 6 X
7. Tax Due 7
PART DEBTS AND DEDUCTIONS CLAIMED
�
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I have reported above are true, correct and
�co ete to the be of my knowledge and belief. HOME C 7�� ) � /(� —��/3
f,Ja,�r.�.���i� WORK � �
Y � ' � pennsylvania �
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DEPARTMENTOFREVENUE
REV-1607 DC AFP (12-11� -'- "
INHERITANCE TAX DIVISION STATEMENT OF ACCOUNT
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 02-13-2012
ESTATE OF SICO LUCILLE C
DATE OF DEATH 09-08-2011
FILE NUMBER 21 11-1081
COUNTY CUMBERLAND
DANIEL SICO ACN 11163458
844 ALLENVIEW DR Amount Remitted
MECHANICSBURG PA 17055-6183
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
RE6ISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure proper credit to your account. suhmit the upper portion of this form with your tax payment.
CUT ALON6 THIS LINE � RETAIN LOWER PORTION FOR YOUR RECdRDS �
REV-1607 EX�AFP C12-11� � � *** INHERITANCE TAX�STATEMENT OF ACCOUNT *** � � � �
ESTATE OF:SICO LUCILLE C FILE N0. : 21 11-1081 ACN: 11163458 DATE: 02-13-2012
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL
TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 01-30-2012
PRINCIPAL TAX DUE: 3,767.88
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT C+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
01-18-2012 CD015515 .00 3,767.88
TUTAL TAX PAYMENT 3,767.88
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
.00
� IF PAID AFTER THIS DATE. SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS.
' NOTICE OF INHERITANCE TAX pennsylvania .
BUREAU DF INDIVIDUAL TAXES DEPARTMENTOFREVENUE
INHERI7ANCE 7AX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BoX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX ON REV-1548 IX AFP C12-11) � -
HARRISBURG PA 17128-0601 JOINTLY HELD OR TRUST ASSETS
DATE 02-06-2012
ESTATE OF SICO LUCILLE C
DATE OF DEATH 09-08-2011
FILE NUMBER 21 11-1081
COUNTY CUMBERLAND
SSN/DC 109-20-8934
DANIEL SICO ACN 11163458
844 ALLENVIEW DR APPEAL BY DATE:04-06-2012
MECHANICSBURG PA 17055-6183 (SeereversesideunderObjections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
RE6ISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE � RETAIN LOWER PORTION FOR YOUR RECORDS �
REV-1548 EX AFP C12-11�--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE DF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 02-06-2012
ESTATE OF:SICO LUCILLE C DATE OF DEATH:09-08-2011 COUNTY:CUMBERLAND
FILE NO. : 21 11-1081 S.S/D.C. NO. : 109-20-8934 ACN: 11163458
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FULTON BANK NA ACCOUNT NO. : 1372-01010
TYPE OF ACCOUNT: C �SAVINGS C ) CHECKING C )TRUST C )TIME CERTIFICATE
DATE ESTABLISHED 03-22-2011
Account Balance 90,056.20 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 1.000 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 90,056.20 UPPER PORTION OF THIS NOTICE
Debts and Deductions - 6,325.44 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 83,730.76 RE6ISTER OF WILLS AT THE
Tax Rate x .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 3,767.88 OR MONEY ORDER PAYABLE T0:
"RE�ISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID C—) AMOUNT PAID
PAYMENT MUST BE MADE BY 06-09-2012*. TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE 3,767.88
INTEREST AND PEN. .00
TOTAL DUE 3,767.88
`��� ` ''
�� � �� ���'��
� IF PAID AFTER THIS DATE, SEE REVERSE FDR CALCULATION OF ADDITIONAL INTEREST. � ��+ ,?,;-e
s ;�.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. ,
SEE REVERSE SIDE OF THiS FORM FOR iNSTRUCTTONS. . �
`COMMONWEALTH OF PENNSVWANIA REV-1162 EX(11-96)
" DEPARTMENT OF"REVENUE • '
BUREAU OF�INDIVIDUAL TAXES
OEPT.280607
HARRISBURG,PA 1 7 1 28-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 015515
SICO DANIEL
844 ALL.ENVIEW DR
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold
_""""' """"
11163458 � $3,767.88
ESTATE INFORMATION: ssN: t09-2o-8934 I
FILE NUMBER: 21 1 1 -1081 I
DECEDENT NAME: SICO LUCILLE C I
DATE OF PAYMENT: 01/27/2012 I
POSTMARK DATE: 01/1 8/201 2 I
courvrY: CUMBE�LAND �
DATE OF DEATH: 09/08/201 1 I
�
TOTAL AMOUNT PAID: $3,767.88
REMARKS:
CHECK# 101 1
INITIALS: CJ
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
� - . , � PENNSYLVANIA INHERITANCE TAX
auR�„u oF INDIVIDUAL TAXES INFORMATION NOTICE FILE No. 21
PO BOX 280601 pennsylvania T acN
AND
HARRISBURG PA 17128-06 01 DEPARTMENTOFREVENUE yAYP�YF� ��S`pJ'1NS`� 11163458
* * �t -R ISED rI�' * * DATE 10-20-2011
REV-1543 E%�FP(OS-11)
TYPE OF ACCOUNT
EST. OF LUCILLE C SICO � snviNCs
$$N 109-20-8934 � CHECKING
DATE OF DEATH 09-O8-2o11 ❑ TRUSr
COUNTY CUMBERLAND � CERTIF.
REMIT PAYMENT AND FORMS T0:
** DANIEL SICO RE�ISTER OF WILLS
844 ALLENVIEW DR 1 COURTHOUSE SQUARE
MECHANICSBURG PA 17055-6183 CARLISLE PA 17013
FULTO N BANK NA provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you aPe the spouse of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-787-8321 with questions.
• COMPLETE PART I BELOW � SEE REVERSE SIDE FOR FILIN6 AND PAYMENT INSTRUCTIDNS
Account No. 1372-01 0 10 Date 03-22-2011 7o ensure ProPer credit to the account, two
Established copies of this notice ■ust acconpany
Account Balance $ 9�,056.20 P��ent to the Register of Wills. Make check
payable to "Register of Wills, Agent".
Percent Taxable X 100.00
Amount Subject to TaX $ 9�,056.20 NOTE: If tau payeents are nade within three
■onths of the decedent's date of death,
TaX Rate �( .045 deduct a 5 percent discount on the tax due.
$ 4,0 5 2.5 3 Any inheritance tax due M111 beco�e dalinquent
Potential Tax Due nine nonths after the date of death.
PART TAXPAYER RESPONSE
�
A. � The above infornation and tax due is correct.
Reeit payeent to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E an official assess�ent will be issued by the PA Departeent of Revenue.
B L OC K � g, � The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. � 7he above informa ion is incorrect and/or debts and deductions were paid.
Co�plete PART � and/or PART � below.
PART If indicating a different taz rate, please state
� relationship to decedent:
TAX RETURN - CALCULATION OF TAX N JOINT/TRUST ACCOUNTS
LINE 1. Data Established 1 3 a� o�C3j/
2. Account Balance 2 $ d �• 0
3. Percent Taxable 3 X /�(�
4. Amount Subject to Tax 4 $ �ld�(�• � �
5. Debts and Deductions 5 ' �i�� �y: Y
6. Amount Taxable 6 $ ��� /�• 7�
7. Tax Rate 7 X r d J
8. Tax Due 8__ � ��(07. �
PART DEBTS AND DEDUCTIONS CLAIMED
�
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL CEnter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I reported above are true, correct and
lete to th best of my knowledge and belief. HOME C /7 � 7�i6 f�!/3
Ifv�A.l;L(X 1Ol"� WORK ( )
---- � ��1��-
- � ; - ' � � pennsylvania �
BUREAU OF INDIVIDUAL TAXES NOTICE OF INHERITANCE TAX DEPARTMENTOFREVENUE
INNERITANCE 7AX DIVISION APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
PO BOX 280601 OF DEDUCTIONS, AND ASSESSMENT OF TAX DN REV-1548 DC AFP C12-11) �
HARRISBURG PA 17126-0601 JOINTLY HELD OR TRUST ASSETS
DATE 01-30-2012
ESTATE OF SICO LUCILLE C
DATE OF DEATH 09-08-2011
FILE NUMBER 21 11-1081
COUNTY CUMBERLAND
SSN/DC 109-20-8934
DANIEL SICO ACN 11163457
844 ALLENVIEW DR APPEAL BY DATE:03-30-2012
MECHANICSBURG PA 17055-6183 (SeereversesideunderObjections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE � RETAIN LOWER PORTION FOR YOUR RECORDS �
REV-1548 EX AFP C12-11�--------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAiSEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE: 01-30-2012
ESTATE OF:SICO LUCILLE C DATE OF DEATH:09-08-2011 COUNTY:CUMBERLAND
FILE NO. : 21 11-1081 S.S/D.C. NO. : 109-20-8934 ACN: 11163457
TAX RETURN WAS: CX) ACCEPTED AS FILED C ) CHANGED
JOINT OR TRUST ASSET INFORMATION
FINANCIAL INSTITUTION: FULTON BANK NA ACCOUNT NO. : 3624-75525
TYPE OF ACCOUNT: OSAVINGS C � CHECKING OTRUST C )TIME CERTIFICATE
DATE ESTABLISHED 03-22-2011
Account Balance 9,972.31 NOTE: TO ENSURE PROPER CREDIT TO
Percent Taxable X 1.000 YOUR ACCOUNT, SUBMIT THE
Amount Subject to Tax 9,972.31 UPPER PORTION OF THIS NOTICE
Debts and Deductions ' .00 WITH YOUR TAX PAYMENT TO THE
Taxable Amount 9,972.31 REGISTER OF WILLS AT THE
Tax Rate Y .045 ABOVE ADDRESS. MAKE CHECK
Tax Due 448.75 OR MONEY ORDER PAYABLE T0:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
10-12-2011 CD015058 22.44 426.32
TOTAL TAX PAYMENT 448.76
BALANCE OF TAX DUE .O1CR
INTEREST AND PEN. .00
TOTAL DUE .O1CR
� IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ■
IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPAR"�A�NT OF�EVENUE , .
.��BUREAU O�INDIVIDUAI TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 015058
SICO DANIEL
844 ALLENVIEW DR
MECHANICSBURG, PA 17055
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fo�d
__"'_'"'_ '__'""'
11163457 � $426.32
ESTATE INFORMATION: SsN: �09-20-8934 I
FILE NUMBER: 21 1 1 -1081 (
DECEDENT NAME: SICO LUCILLE C I
DATE OF PAYMENT: 1 O/13/201 1 I
PQSTMARK DATE: 10/12/201 1 I
CouNTY: CUMBERLAND �
DATE OF DEATH: 09/08/201 1 I
�
TOTAL AMOUNT PAID: $426.32
REMARKS:
CHECK# 1003
INITIALS: HMW
SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
� PENNSYLVANIA INHERITANCE TAX
� � ' ' YNFORMATION NOTICE
BUREAU OF INDIVIDUAL TAXES AND FILE NO. 21
PO BOX 280601 pennsylvania ACN
HARRISBURG PA 17128-0601 DEPARTMENTOFREVENUE TAXPAYER RESPONSE 11163457
DATE 09-27-2011
REY-1543 EX AFP (05-11) .
TYPE OF ACCOUNT
EST. OF LUCILLE C SICO � SAVINGS
$$N 109-20-8934 � CHECKING
DATE OF DEATH 09-08-2011 ❑ rRUST
COUNTY CUMBERLAND � CERTIF.
REMIT PAYMENT AND FORMS T0:
DANIEL SICO REGISTER OF WILLS
844 ALLENVIEW DR 1 COURTHOUSE SQUARE
MECHANICSBURG PA 17055-6183 CARLISLE PA 17013
FULT ON BANK NA provided the department with the information below, which was used in calculating the inheritance tax due.
Records indicate that at the death of the above-named decedent, you were a joint owner/beneficiary of this account. If you a�e the spouse of the
deceased and any amount other than zero is reflected below on the Potential Tax Due line, note no tax may be due, but you must
notify the department of your relationship to the deceased by checking Box C in PART 1 below and writing "spouse" in PART 2.
If you believe the information is incorrect, please obtain written correction from the financial institution, attach a copy to this form and return
it to the above address. Please call 717-787-8327 with questions.
COMPLETE PART 1 BELOW � SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 3624-75525 Date 03-22-2011 7o ensure oroPer credit to the account, two
Established copies of this notice nust accowpany
Accou�t Balance $ 9�972.31 vaya�ent to the Register of Wills. Make check
vayable to "Reeister of Wills. Agent".
Percent Taxable X 100.00
Amount Subject to Tax g 9,972.31 NOTE: If tax pay�ents are eade within three
eonths of the decedent's date of death,
TaX Rate X .15 deduct a 5 percent discount on the tax due.
Any inheritance tax due will becone delinquent
Potential Tax Due $ 1�495.85
nine ■onths after the date of death.
PART TAXPAYER RESPONSE
�
A. � The above information and tax due is correct.
Re.it paynent to the Register of Wills with two copies of this notice to obtain
C H E C K a discount or avoid interest, or return this notice to the Register of Wills and
0 N E an official assessment will be issued by the PA Department of Revenue.
B L OC K � g, � The above asset has been or will be reported and tax paid with the Pennsylvania inheritance tax return
0 N L Y filed by the estate representative.
C. �The above informa ion is incorrect and/or debts and deductions were paid.
Cowplete PART 2� and/or PART 3� below.
PART If indicating a different tax rate, please state "
� relationship to decedent: ��"�'�,
TAX RETURN - CALCULATION OF TAX 0 JOINT/TRUST ACCOUNTS
LINE 1. Date Established 1
2. Account Balance 2 $
3. Percent Taxable 3 X ! ,
4. Amount Subject to Tax 4 $
5. Debts and peductions 5 - + �
6. Amount Taxable 6_ $ �9 �{7�• !�
7. Tax Rate 7 X � (� J .
8. Tax Due 8 $ � oZ�+ �J�
PART DEBTS AND DEDUCTIONS CLAIMED �
�
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line 5 of Tax Computation) S
Under penalties of perjury, I declare that the facts I reported above are true, correct and
complete to the best of my knowledge and belief. H OME C )
WORK ( )
rwvnwvrn rrna��r��nr „�. ��..,,,..� ......�__ _ '__
. . . . : _.. _ _
e�': N
.
V S QPI�RSON
JEFF���6�A
POR� F�8�puN� `
P
���230
� /�DSES 1��$ = � .
�
JN45Eq 5 EA�,GE � �3 � � �■
P��� 5 , O �
- ���0 ' � �
�
..� N �
� � �
- O ' � - �
� �
� — � �
; _ o — N
, ,� (� N -
� o � �-+
� _ o � �
-� - N � i � -
'1 � ° ■�
�� rrt � I —
� �� ---
m I ��
� o _
r�
- •�
�
�
� � N
O C �
U � o � I�
� � N �
C�c..� ��'
�.:._ ,,_, � E.N. � � � M
is_; - �•-, �'�- o o � � iT M
r _: - '_ - G� � y t � �
- • .. _�._ :� U �O �
:.I . _. C�.._ _.. r- ��" a °� O (n �
� �
_ � .._ = u 'S � �
<.x > - a C-� p r-
__ �
r -' � � z "pr L Q
' i��1 i �J [r � Y Y� � /1
C.�. � 1' F' o (� � �.�
�._� _�
� �_ S � ,_
c��.. _.�- C_�=' ,r-�` -o F � � N
�_ � � � � V �
f..��.. �j � � U �+
- � � � L C_ '�
� y W � � U U
� � �O U
�.
� � �
� F
_ � �