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Home My WebLink About04-28-14 (2) --� REV-1500° '°' 15fl561D143 PA Department of Revenue pennsyItrania OFFICIAL USE ONLY Bureau of Individual Taxes aT^m.,rar�,x,.e< veer Kni°" PO Sox280601 INHERITANCE TAX RETURN 21 14 0 012 Harrisburg,PA 1712E-Ml RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Binh 12 23 2013 07 24 1933 Decedent's Last Name Suffix Decedent's First Name MI MOAN PATSY J (If Applicable)Enter Sumving Spouse's Wormadon 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 ® 1.Ortalnal Return ❑ 2. Supplemental Return ❑ 3.RMSIVIder Retum(date of death prior Io 12-13-82) ❑ 4. Ltmnsd Estate ❑ 4a.F NdsaID W�CwvmfdsO 13 5. Federal Estate Tax Rearm Required ® s' ��alw ❑ T' (A ceDY'al Truol!gnat - S. Total Number of Safe Depose Boxes ❑ 9. Uhigatbn Promods Received ❑ 10.Sa�ouaA 1231 maid#1 V' ❑ II Election to lax under See,9113(A) (Attach Sch.0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED,ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytona Tetephorts Nunes o ROBERT G RADEBACH 717 89C' 2666 m ° rn 0 � `�� REGISTER r m, 41SEMLY ,M . First time of address 1�" � Co C) 912 NORTH RIVER ROAD �°� o c -n Second One of address fV r1T LT CRy or Post swim Slam Code DATE FRED '_ 'n 26* HALIFAX PA 17032 CartaspondeWse.maRaddrasa: MISSyBwartZ5l @aol.COM It hl Under fPPerjury,I declare that 1 have emai..ined this rat urn,Includurg erxem adtedules arM uatmiems,arM toBte lost of mr kno�Ma�.DOIFai. complete.Declaration of prepareroaar then the personal repress=IS based m aA Mformadon of a :h p=*lay arry kn sum M Gary A,1111101,Sr. y—pea -ao/ ADDRESS 7861`1101 N Cumberiand,PA 17070 StGnt P EWAV& to 2= Robe G Radebac AMMSS a j(y 1 912 North River Road,Halffax,PA 17032 Side 1 ISM10143 151175610143 1505610243 REV-1500 EX Decedent's Social Security Number Deo enfsName. MOAN, PATSY JANE RECAPITULATION 1. Real Estate(Schedule A).......................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................... 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3. 4. Mortgages&Notes Receivable(Schedule D).......................................................... 4. 5. Cash,Bank Deposits&Miscellaneous Personal Property 9 , 063 . 94 p p rty(Schedule E)................ 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested............. 7, 8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 9 , 063 . 94 9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 2 , 999 . 24 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1)................................ 10. 30 , 393 . 79 11. Total Deductions(total Lines 9&10)...................................................................... 11. 33 , 393 . 03 12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. - 24 , 329 . 09 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J)................................................. 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. - 24 , 3 2 9 . 09 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. 16. Amount of Line 14 taxable at lineal rate X .045 16. 17. Amount of Line 14 taxable at sibling rate X ,12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due..................................................................................................................... 19. 0 . 00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑ Side 2 L 1505610243 1505610243 J REV-1500 EX Page 3 File Number 21 14 - 0012 Decedent's Complete Address: DECEDENTS NAME Moan, Patsy Jane STREET ADDRESS 801 Harrisburg Pike CITY STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount Total Credits(A +B) (2) 0.00 3. Interest (3) 0.00 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) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;........................................ .............__............... ❑ x b. retain the right to designate who shall use the property transferred or its income:_.................................. ❑ x c. retain a reversionary interest;oc........................_..................._................................................................. . ❑ _x d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ x 2. If death occurred after December 12, 1982,did decedent transfer property within one year of death without receiving adequate considerat ion?....................................................................................................................... ❑ 0 3. Did decedent own an"in trust for' or payable upon death bank account or security at his or her death?......... ❑ I_X:j 4. Did decedent own an Individual Retirement Account,annuity,or other non-probate property which contains a beneficiary designation?...................................................................................................................... ❑ 0 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 Jul yy 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.§91 i6(a)(1.1)(1)]. For dates of death on or after Janus ry 1.1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent 172 P.S.§9116(a)(1.1)tii)]. 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 reiturn 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 irn sed on the net value of transfers from a deceased child 21 yaars 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 172 P.S.§9116(a)(1.2)). .The lax 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 1.2)[72 P.S.§9116(a)(1)]. •The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.49116 ta)(1.3)1. A sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether by blood or adoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH T FENANA PERSONAL PROPERTY INMERRgNCE TM RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Moan, Patsy Jane 21 - 14 -0012 Include the 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 OF NUMBER DESCRIPTION DEATH 1 Integrity Bank Checking Account 851.51 2 Personal Savings Account Held by Nursing Home 1,009.80 3 Refund from Medicines 5,99 4 Refund from Nursing Home 2,189.82 5 AARP Death Benefit 5,006.82 TOTAL(Also enter on Line 5, Recapitulation) 9,063.94 SC ®wULE H FUNERAL EXPENSES & LOMMONWL1N OF PfNNSYVNNN INHERRANCE TM RETURN M1MINICY ME COSTS DECEDENT ESTATE OF Moan, Patsy Jane FILE NUMBER 21 - 14-0012 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Parthemore-Funeral Bill 675.38 2 Food After Services/Expenses Associated with Funeral 634.22 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Gary A. Misiti, Sr. 500.00 Street Address 786 Fishing Creek Road City New Cumberland State PA zip 17070 Year(s)Commission paid 2. Attorney's Fees Robert G. Radebach, Esquire 750.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Fee to Open Estate- Register of Wills 103.50 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Advertising Fee -Cumberland Law Journal 75.00 TOTAL(Also enter on line 9, Recapitulation) 2,999.24 Sdiedule H COMMONWEALTH OF PENNSYLVANIA Fwwal EMmnsm& Ay;,�;� ^� INHERITANCE TAX RETURN _Costs conYy med RESIDENT DECEDENT ESTATE OF Moan, Patsy Jane FILE NUMBER 21 - 14-0012 TCost 7.00 ing Fee-The Sentinel 254.14 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OFPENNURN LIABILITIES INHERITANCE E & LIENS , RESIDENT DECEDENT FILE NUMBER ESTATE OF Moan, Patsy Jane 21 - 14-0012 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Department of Public Welfare Claim Against the Estate-Class 3 Claim 30,393.79 TOTAL(Also enter on Line 10, Recapitulation) 30,393.79 REV-1513 EX+(11-08) SCHEDULE J COMMONWEALTH INHERITANCE OTAX RETURN CIA BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Moan, Patsy Jane 21 - 14-0012 NAME AND ADDRESS OF PERSON RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER RECEIVING PROPERTY (S) DECEDENT i t mstt*s) (Words) ($$$) Do I� TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Mary Theresa Alexander Daughter 308 Weatherstone Drive New Cumberland, PA 17070 2 Monica R. Davis Daughter 403 Independence Court Mechanicsburg, PA 17050 3 Diane Misiti Daughter-in-Law 786 Fishing Creek Road New Cumberland, PA 17070 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1513 EX.(9-00) SCHEDULE ) COMMONWEALTH OF PENNSYLVANIA TAX RE INHERITANCE TAX RETURN BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF FILE NUMBER Moan, Patsy Jane 21 - 14-0012 NAME AND ADDRESS OF PERSON RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER (S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not List TYstee(s) I TAXABLE DISTRIBUTIONS[include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 4 Joseph M. Misiti Son 205 W. 10th Street, Apt. 1C New York City, NY 10014 5 Frank L. Misiti, Jr. Son 113 Victory Blvd. State College, PA 16803 6 Gary A. Misiti Son 786 Fishing Creek Road New Cumberland, PA 17070 Page 2 of Schedule J