HomeMy WebLinkAbout04-30-14 � 1505610143
REV-1500 Ex`°�_"> ��
PA De artment of Revenue OFFICIAL USE ONLY
P pennsylvania County Code Year File Number
Bureau of Individual Taxes DEFqRTMENTOFREVENUE
PO BOX.280601 INHERITANCE TAX RETURN 21 12 1052
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
189 09
Suffix DecedenYs First Name MI
CANTONE LOUIS g
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
LX� 1. Original Retum u 2. Supplemental Retum �I 3. Remainder Retum(Date of Death
Prior to 12-13-82)
�� 4. Limited Estate �-'i qa �uture Interest Compromise� I`� 5. Federal Estate Tax Retum Required
� date of death after 12-12-82
i X I 6. Decedent Died Testate I �I � Decedent Maintained a Living Trust 8. Total Number of Safe De Osit BOXeS
(Attach Copy of Will) L__. (Attach Copy of Trust) --. p
� J 9. Litigation Proceeds Received `^ �p.Spousal Poverty Credit(Date of Death 11.Election to tax under Sec.9113 A
- _J between 1231 91 and 1-1-95) I� (Attach Schedule O) � �
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
JEFFREY R BOSWELL ESQUIRE 717 23`6 9377 'M�',`,�
N
C� ��A
REGIS�I�F WILLS�SE�X'1 �
c� � -v -..._ C>
First Line of Address rr� � � � cn �
3"� .'��. I i C"� R"�,i fTt
315 NORTH FRONT STREET *> v� �� q .::�r c�
. _ �` r� c�
Second Line of Address C._� n -fl ..,� -�
� � � � � �
.. :C7 �"� �-- �
City or Post Office D#TE FIL� r �
State ZIP Code �, ,
HARRI SBURG PA 17101 �"'' � '
CorrespondenYs e-mail address: �boswell(a�btpalaw.com
Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
ATE
� � � Sadie C. Pounder f
ADDRESS
238 Sprinqs Avenue, Gettvsburq, PA 17325
SIGNATURE OFPREPARER OTH THAN REPRESENTATIVE DATE
Jeffrey R. Boswell, Esquire o�r Zr 2u�
ADDRESS
315 North Front Street, Harrisburg, PA 17101
� Side 1
1505610143 1505610143 � �
� 1505610243
REV-1500 EX
DecedenYs Social Security Number
Decedent's Name: C111t011@� Louis B.
-- --- -._ . _- -- �-- -- --- -
RECAPITULATION
1. Real Estate(ScheduleA)....................................................................................... 1. 172 , 684 . 41
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages&Notes Receivable(Schedule D)........................................................ 4.
5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 2 7 , 518 . 68
6. Jointly Owned Property(Schedule F) �� Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous f�l�q-Probate Property
(Schedule G) I_I Separate Billing Requested............ 7,
8. Total Gross Assets(total Lines 1 through 7)........................................................ g. 2 0 0 ,2 03 . 0 9
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 93 , 4 8 7 . 15
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............................ 10. $ , 2 3 6. 64
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 1 O Z , 72 3 . 7 9
12. Net Value of Estate(Line 8 minus Line 11).......................................................... �2. 9$ , 4 7 9 . 3 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)............................................... 13.
14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... �4. g$ , 4 7 9 . 30
- --- --_ - - -
----_ -
TAX COMPUTATION-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.00 15. 0 . 0 0
16. Amount of Line 14 taxable 9 g 4�g , 3 0 16. 4
at lineal rate X .045 � , 431 . 57
17. Amount of Line 14 taxable
at sibling rate X.12 0 . �0 17. � . 0 0
18. Amount of Line 14 taxable
at collaterai rate X.15 0 . 0 0 18. 0 . 0 0
19. TAX DUE................................................................................................................ 19. 4 , 431 . 57
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. �
Side 2
� 150561�243 1505610243 J
_ __
REV-1500 EX Page 3 File Number 21-12-1052
Decedent's Complete Address:
DECEDENT'S NAME
Cantone, Louis B.
--_ . _ _ __- -- - -- - - — - —- _
STREETADDRESS
425 Poplar Church Road
___ __ —
CITY
_
� -- —
STATE ZIP
Wormleysburg PA I 17043
Tax Payments and Credits:
1. Tax Due(Page 2, Line 19) (1) 4,431.57
2. Credits/Payments
A. Prior Payments
B. Discount 0.00
Total Credits(A +g) (2) 0.00
3. Interest (3) 120.54
4, If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �4�
Check box on Page 2,Line 20 to request a refund -
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 4,552.11
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:............................................................................... ��� x
b. retain the right to designate who shall use the property transferred or its income:.................................. � ��
c. retain a reversionary interest;oc.............................................................................................................. � x�
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?.................................................................................................................... �.I i�
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 aryindiv9 ual retirement account,annuity,or other non-probate property which ❑ �
contains a beneficia desi nation............ . . . . . ... X'
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 January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt a transferto a surviving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,2000:
• The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[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)]. A sibling is defined,
under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption.
Rev-1502 EX+(Ot-10)
SCHEDULE A
pennsylvania REAL ESTATE
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF IFILE NUMBER
Cantone, Louis B. 21-12-1052
All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts.
Real property that is jointly-owned with right of survivorship must be disclosed on schedule F.
Attach a copy of the settlement sheet if the property has been sold
Inctude a copy of the deed showing decedent's interest if owned as tenant in common.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Real Estate-425 Poplar Church Road, Camp Hill, Cumberland County, PA-($171,500 plus 172,684.41
adjustments of$1,168.41)see Settlement Statement(HUD-1)attached -Settlement Date:
March 28, 2014
TOTAL(Also enter on Line 1, Recapitulation) 172,684.41
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule A(Rev.01-10)
Rev-1508 EX+(17-10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF IFILE NUMBER
Cantone, Louis B. 21-12-1052
Include ihe proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Citizens Bank-Checking Account No.XXXXXXXXXX075-4 17,734.25
2 Personal Property -per Summary Appraisal ReportlPersonal Property Estate, dated 1,620.25
November 4, 2012, prepared by Ibis Appraisal Services(attached),adjusted for sale of
personal property by Rowe's Auction Service, less commission paid (attached), and items
distributed to family members
3 Donegal Insurance Group-insurance refund 174.00
4 Donegal Insurance Group-insurance refund 292.00
5 Insurance Refund 382.00
6 Mid-Atlantic Insurance Group-refund 11.84
7 Ohio National -refund 42.78
8 U.S. Treasury-1040A-2012 federal tax refund 565.71
9 U.S. Treasury -unclaimed property 78.00
10 United Healthcare -refund 42.50
11 United Healthcare-AARP benefit 2,121.75
12 United Healthcare-AARP benefit 2,567.25
13 West Shore ALS-refund 16.32
14 West Shore ALS-refund 109.50
15 West Shore EMS -overpayment 1,056.62
Total of Continuation Schedule See attached page
TOTAL(Also enter on Line 5, Recapitulation) 27,518.68
(If more space is needed,additional pages of the same size)
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
Rev-1508 EX+(t1_10)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
continued
ESTATE OF FILE NUMBER
Cantone, Louis B. 21-12-1052
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
16 Commonwealth of Pennsylvania-State Retirement Payment 474.63
17 PSERS-08/31/12 payment 114.64
18 PSERS -09/29/12 payment 114.64
TOTAL(Also enter on Line 5, Recapitulation) 27,518.68
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev. 11-10)
REV•1511 EX+(10-09)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Cantone, Louis B. 21-12-1052
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
q, FUNERAL EXPENSES:
See continuation schedule(s) attached 12,541.77
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Sadie C. Pounder
StreetAddress 238 Springs Avenue
City Gettysburg State PA Zio 17325
Year(s)Commission Paid 2014 10,000.00
2. Attorney's Fees Boswell, Tintner& Piccola 10,600.00
3, Family Exemption: (If decedenYs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationshi�of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 315.50
5. AccountanYs Fees
6. Tax Return Preparer's Fees Boswell, Tintner& Piccola 1,200.00
7. Other Administrative Costs 58,829.88
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 93,487.15
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Cantone, Louis B. 21-12-1052
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Exaenses
1 East Harrisburg Cemetary-stone inscription 235.00
2 Fackler-Weidner Funeral Home-funeral 12,306.77
H-A 12,541.77
Other Administrative Costs
3 Borough of Wormleysburg -sewer/trash - 1,129.10
October-December-$155.10
January-March -$191.00
April-June-$191.00
July-September-$191.00
October-December-$191.00
January-March -$210.00
4 Boswell, Tintner&Piccola-disbursements 150.00
5 Boswell,Tintner&Piccola-closing costs 500.00
6 Cumberland Law Journal -legal advertising 75.00
7 Donegal Insurance Group-auto insurance 503.00
8 Donegal Insurance Group-auto insurance 394.00
9 Douglas Griffiths-windows 6,351.13
10 Douglas Griffiths -repairs 402.14
11 Douglas Griffiths-carpet replacement 690.00
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Cantone, Louis B. 21-12-1052
ITEM
NUMBER DESCRIPTION AMOUNT
12 Eaglemark Insurance-Agis Surety Insurance Company-homeowner insurance 818.50
13 Gene R. Peifer-painting 650.00
14 Harland-estate checking account checks 23.68
15 Healthport -medical records 68.67
16 Ibis Appraisal Services-personal property appraisal 375.00
17 J.W. Mumper Construction, Inc. -repair porch posts 285.85
18 Jeff Dostalik-painting 510.00
19 Journal Publications-legal advertising 185.00
20 Linlo Properties-landscape repair/maintenance 625.00
21 M.S. Hershey Medical Center-medical records 15.00
22 Nick Cantone-reimbursement for appraisal 225.00
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF IFILE NUMBER
Cantone, Louis B. 21-12-1052
ITEM
NUMBER DESCRIPTION AMOUNT
23 Pennsylvania American Water- 313.30
November-$49.35
December-$8.46
January -$14.21
February -$14.21
March -$23.62
April -$14.28
May -$14.28
June-$14.28
July -$14.31
August-14.31
September-$14.31
October-$14.56
November-$24.19
December-$14.56
January -14.44
February -$15.00
March -$15.00
April (final)-$19.93
24 PPL Electric Utilities- 3,670.43
October, November, December,January-$405.10
February -$222.00
March -$201.78
April -$201.52
May -$199.00
June-$166.00
July-166.00
August-$166.00
September-101.00
October-$101.00
November-$45.31
December-$167.00
January -$338.21
February, March -$167.00
April(final) -$1023.51
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
_ _ _
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Cantone, Louis B. 21-12-1052
ITEM
NUMBER DESCRIPTION AMOUNT
25 Real estate closing costs-for sale of 425 Poplar Church Road(March 28, 2014), as per HUD 38,966.24
-1 attached
26 Sadie Pounder-reimbursement for dehumidifier and repairs 223.84
27 Thomas L. Cantone-reimbursement for cleaning and painiting 1,150.00
28 William Decker-mowing 50.00
29 William Decker-lawn care-2 times 80.00
30 William Decker-lawn care-2 times 80.00
31 William Decker-lawn care-2 times 80.00
32 William Decker-lawn care-2 times 80.00
33 William Decker-lawn care-2 times 80.00
34 William Decker-lawn care-2 times 80.00
H-B7 58.829.88
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 6-98)
__
Rev-1512 EX+(12-08)
SCHEDULE i
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OF REVENUE
INHERITANCETAXRETURN MORTGAGE LIABILITIES AND LIENS
RESIDENT DECEDENT
ESTATE OF I FILE NUMBER
Cantone, Louis B. 21-12-1052
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Comcast-cable 68.21
2 Continuing Care RX-Newport-prescriptions 110.80
3 Jewish Home of Greater Harrisburg -nursing home 6,655.45
4 Jewish Home of Greater Harrisburg -nursing home 5.33
5 Pawc Payment 37.54
6 Pharmerica -prescriptions 108.38
7 PPL Electric Utilities -September 139.99
8 PSERS-reimbursement for overpayment 80.25
9 United Healthcare-medical 21.25
10 Verizon-phone g2 2�
11 Vohra Health Services-medical 33.39
12 Vohra Health Services-medical 48.48
13 West Shore EMS -medical 845.30
TOTAL(Also enter on Line 10, Recapitulation) 8,236.64
(If more space is needed,additional pages of the same size)
Copyright(c)2008 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-08)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPFtRTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES �
RESIDENT DECEDENT �
ESTATE OF FILE NUMBER
Cantone, Louis B. 21-12-1052
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(Sl RECEIVING PROPERTY (Words) ($$$)
Do Not List Trustee s
I� TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116 a 1.2
Nicholas T.Cantone Son 25% of residuary
2533 Wicklow Drive estate
Harrisburg, PA 17112
Thomas L.Cantone Son 25% of residuary
288 Elm Street estate
Noank, CT 06340
Lois Ann Griffiths Daughter 25% of residuary
5576 Edsel Street estate
Harrisburg, PA 17109
Sadie C. Pounder Daughter 25% of residuary
238 Springs Avenue estate
Gettysburg, PA 17325
Total
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet,as a ro riate.
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 01-10)