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Home My WebLink About01-21-15 J � pennsylvania 15 0 5 614],0 5 �EOAqTMENT OF REVENUE EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN • - Harrisburg, PA 17128-0601 RESIDENT DECEDENT �� /,� /�� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 207-36-4610 01232012 I � DecedenYs Last Name � �O�� _ _ Suffix_ Dece enYs irst Name MI Flaccus Robert __ _ W (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW O 1. Original Return � 2. Supplemental Return p 3. Remainder Return(date of death prior to 12-13-82) � 4 dea�th onror after pt�j 2p�12e of � 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required ) death after 12-12-82) O 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust _ 9. Total Number of Safe De osit Boxes (Attach copy of will.) (Attach copy of trust.) P p 10. Litigation Proceeds Received p 11. Non-Probate Transferee Return p 12. Deferral/Efection of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets O 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Robyn Cardamone (717) 889-1974 First Line of Address 449 Woodcrest Drive Second Line of Address City or Post Office State ZIP Code Mechanicsburg PA 17050 Correspondent's email address: �L��,��g��']��ma.i� 'LC�YY� v REGISTER OF WILLS,�U�SE ONLY C,:�1 REGISTER OF WILLS USE ONLY � DATE FILED MMDDYYYY � � � m � Q C-- t`,� � � "Z7 � f;'� :,�7 F�7 -� �'? ,..,,� C:3 :"=�3 �. i"' �'V �.;.y t-�1 � ''� i--' . £.;7 � �'' n 4�� , � C.�l DATE'FILED ST ,, �`�'t �-j '�i � �> �,,� C.0 C" f�'1 PLEASE USE ORIGINAL FORM ONLY �� -� � � � p � • Side 1 � I I��I�I�I��I�IIII��I��III��II�I I��I��I��I II��I'�I�I��II I��I 1505614105 1505614105 J �� J 1505614205 REV-1500 EX(FI) DecedenYs Social Security Number Decedenrs Name: Robert W Flaccus ' RECAPITULATION 1. RealEstate(Schedule A). . . .. . . . . .. .. . . .. .. . . . . . .. . .. . .. .. . .. . .. ... .. 1. 2. Stocks and Bonds(Schedule B) . . . .. .. .. .. .. .. ... .. .. . .. . .. ... .. . .. . . . 2. _ __ __ _. ... . _ . _ 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .. .. 3. _ _ __ 4. Mortgages and Notes Receivable(Schedule D) . . . .. . .. . .. . . .. . .. .. . .. .. .. 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 29,314.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property - (Schedule G) O Separate Billing Requested... .. .. . 7, ' 8. Total Gross Assets(total Lines 1 through 7). . . . . .. . .. . .. ... . .. . .. .. . . . . . 8. 9. Funeral Expenses and Administrative Costs(Schedule H). . .. ... ... .. . . . . . . . 9. ' 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I).. . . . .. .. . . .. .. 10. 11. Total Deductions(total Lines 9 and 10). . . . .. . . . .. . .. . . .. . .. . . . .. .. . . . . . 11. ' __ _ _ 12. Net Value of Estate(Line 8 minus Line 11) . .. .. .. . .. . .. . . ... .. . .. . . .. .. . 12 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. 29,314.00 , 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. Amount of Line 14 taxable _ __ , _ _ .. _ at lineal rate X.045 29,314.00 �g, 1,319.13 17. Amount of Line 14 taxable _ _ , _ _ _ at sibling rate X.12 » ; 18. Amount of Line 14 taxable __ ._ _ _ at coilateral rate X.15 �$ ; 19. TAX DUE . .. . . . .. . .. .. . . . . . .. . . . .. .. .. .. .. . .. .. .. . .. ... .. . .. .. . .. . 19. __ �,3�9.13_ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT � Under penalties of perjury, I declare 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 person responsible for filing the return is based on all information of which preparer has any knowledge. SIGNA R OF PERSO ES ONSIB FOR FILING RETURN DAT ADDRE � f � t� .�.5�' • l�l CC G �s� btl�' .� �7��d SIGNATURE OF PREPARER OTHER THAN PERS N RESPONSIBLE FOR FILING T E RETURN DATE ADDRESS � I I��I�I II��I��III��I�I�III��I��)II�II��I�II�II��I��III I��I Side 2 1505614205 1505614205 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Robert W. Flaccus STREETADDRESS 245 Winding Way cirv Camp Hill STATE ZiP PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 2. Cretlits/Payments (�) 1,319.13 A.Prior Payments B.Discount (See instructions.) Total Credits(A+B) (2) 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) 1,319.13 Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Ditl decedent make a transfer and: Yes No a, retain the use or income of the property transferred .......................................................................................... � ■ b. retain the right to tlesignate who shall use the property transferred or its income ............................................ � � c. retain a reversionary interest .............................................................................................................................. ❑ � tl. 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. Ditl decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ � 4. Ditl decetlent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ � ■ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994,antl before Jan, 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(ii)],The statute tloes 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 appiicable 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 chiltl 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a step-parent 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 notetl in[72 P.S.§9116(a)(1)). • The tax rate imposed on the net value of transfers to or for the use of the decetlent's siblings is 12 percent[72 P.S. §9116(a)(1.3)j.A sibling is defined, under Section 9102,as an intlivitlual who has at least one parent in common with the decedent,whether by blootl or adoption. REV-iso8 EX+(o8-iz) � pennsylvania SCNEDULE E DEPARTMENTOFREVENUE CASH� BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Robert W. Flaccus 21-12-0183 Include the proceeds of litigation and the date the proceeds were received by the estate, All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH � John Hancock Group Annuity Contract 29,314.00 TOTAL(Also enter on Line 5, Recapitulation) $ 29,314.00 If more space is needed, use additional sheets of paper of the same size. FAMILY SETTLEMENT AGREEMENT THIS AGREEMENT by and between George Andrew Flaccus individually and Robyn L. Cardamone Personal Representative of the Estate of Robert W. Flaccus, Deceased, of Register of Wills File No. 2012-00183, Cumberland County, Pennsylvania. WHEREAS, Robert W. Flaccus, who resided at 245 Winding Way, Camp hill, Cumberland County, Pennsylvania, died on January 23, 2012 having left his/her Last Will and Testament dated September 9th, 2009, which was duly admitted to probate by the Probate Clerk of Cumberland County on February 16, 2012; and WHEREAS, Robyn L. Cardamone has been duly appointed as Personal Representative of the Estate of Robert W. Flaccus, Deceased; and WHEREAS, the Parties in interest under the Last Will and Testament of Robert W. Flaccus, Deceased, are: George Andrew Flaccus Robvn L. Cardamone WHEREAS, new assets of the estate were discovered in October 2014 and each of the parties to this Agreement has been furnished a supplemental listing of the estate assets, receipts and disbursements as set forth on the Supplemental Accounting as attached hereto and marked as Exhibit "A"; and WHEREAS, it is the desire of the parties to this Agreement that final distribution of this estate be accomplished without a formal accounting to the Commonwealth of Pennsylvania Orphan's Court it being the desire of the parties to avoid the expense, delay and publicity of a formal accounting; and WHEREAS, the parties to this Agreement each acknowledge to have received a Supplemental Accounting, which includes a summary of distributions in accordance with the Last Will and Testament related to the newly discovered assets; and NOW, THEREFORE, WITNESSETH, in consideration of the mutual promises, covenants and agreements recited herein the parties do agree as follows: 1. Each of the parties to this Agreement does hereby release and forever discharge Robyn L. Cardamone, Personal Representative, from any and all liability which may from time to time arise in connection with her service as Personal Representative of the Estate of Robert W. Flaccus, Deceased. The parties do further agree to indemnify and hold harmless said Robyn L. Cardamone, Personal Representative, from any and all liability which may arise against the estate from creditors or other claimants. 2. Each of the parties does hereby acknowledge receipt of the assets described in the Supplemental Accounting attached hereto. Page 1 of 2 FAMILY SETTLEMENT AGREEMENT 3. Each party to this Agreement acknowledges that this Agreement shall be indexed and recorded in the estate proceedings and that the terms hereof shall be binding upon their respective heirs, successors, administrators, and assigns. 4. This Agreement shall be governed by the laws of Pennsylvania. Dated at _ lQ this day of U 4� , 20 ls ��1�� .r,r,�r�f� < < George Andrew Flaccus Date � � � I� !S Roby L. Cardamone Date �:ate of Pennsylvania ,��q� �tate of Pennsyivar?ia �,� �-�_ �ounty of Lycoming Ky County of Lycoming a�/ 5 � .Za !S SubscriDed to befo!e me on the y .,�� Subscribed to befote me on the O� � lO da ot a,c ay of eg Acknowledged by Acknowledged b ?rinted name Printed name n� Votary Public - Notary Public ;SF_AL) My Commission ex ires: (S�L) � p �� Q`�(�!� My Commission expires___eA Z ��j�� COMMONWEALTH Of PENNSYI.VANIA � r— NOiARIAL SEAL C�MMOMNEAi1H OF PENNSYLYANIA OAVID D.KOCH,NOTARY PUBLIC NOTARIAL SEAL CITV Of WILLIAMSPORT,LYCOMING COUNTY DAVtD D.KOCH,NOTARY PUBLIC MY COMMISSION EXPIRES SEPTEMBER 2,2018 CITY OF WIIIIAMSPORT,IYCOMiNG COUM�/ MY COMMISSION EXPIRES SEPTEMBER 2,2018 Page 2 of 2 EXHIBIT A IN COMMONWEALTH OF PENNSYLVANIA CUMBERLAND COUNTY REGISTER OF WILLS FILE NO. 2012-00183 SUPPLEMENTAL ACCOUNT OF ROBYN L. CARDAMONE, EXECUTRIX For ESTATE OF ROBERT W. FLACCUS, DECEASED Date of Death: 1/23/2012 Date of Executrix's Appointment: 2/16/2012 Date of First Complete Advertisement: 3/2/2012 Accounting for the period: 8/1/2013 to 1/31/2015 Purpose of Account:The Executor offers this Account to acquaint interested parties with the transactions that have occurred during the Administration. It is important that the Account be carefully examined. Requests for additional information, questions or objections can be discussed with: Robyn L. Cardamone 449 Woodcest Drive Mechanicsburg, PA 17050 (717) 889-1974 Page 1 of 9 SUMMARY OF ACCOUNT PRINCIPAL Page Receipts 3 $ 29,314.00 Net Gains on Sales or Disposition 4 _ $ 29,314.00 less Disbursements: Debts of Decendent 5 _ Funeral Expenses 5 _ Administration Expenses 5 _ Federal, State & Local Taxes 5 _ Prinicpal Balance on Hand before Income and Distributions $ 29,314.00 INCOME Receipts 6 1,861.35 Income Balance on Hand 1,861.35 Balance Before Distributions 31,175.35 Distributions to Beneficiaries 31,175.35 COMBINED BALANCE ON HAND $ _ For Information: Principle Balance on Hand 7 Change in Principal Holdings g Verification 9 Page 2 of 9 PRINCIPAL RECEIPTS Asset Listed in Inventory (Valued as of Date of Death) Bank Accounts John Hancock Group Annuity Contract $ 29,314.00 $ 29,314.00 Total Principle Receipts $ 29,314.00 Page 3 of 9 PRINCIPAL GAINS OR LOSSES ON SALES OR OTHER DISPOSITIONS Amount Gain/(Loss) Total Gain/(Loss) $ _ Page 4 of 9 DISBURSEMENTS OF PRINCIPAL Total Disbursements $ _ Page S of 9 RECEIPTS OF INOCOME Amount John Hancock Group Annuity Contract Interest Received 01/23/2012-01/05/2015 1,861.35 Total Receipts of Income $ 1,861.35 Page 6 of 9 PRINCIPAL BALANCE ON HAND Value at 07/31/2012 Fiduciary Acquisition Value Bank Accounts John Hancock Group Annuity Contract $ - $ 29,314.00 PSECU Estate Checking Account 31,175.35 _ 31,175.35 29,314.00 Total $ 31,175.35 $ 29,314.00 Page 7 of 9 CHANGES IN PRINCIPAL HOLDINGS MutualFunds Dividends Acquisitian Value Reinvested Gain/loss Proceeds from Sale Total S - S $ 5 Page 8 of 9 VERIFICATION Robyn L. Cardamone, Executor of the Will of Robert W. Flaccus, Deceased, herby declares under oath that she has fully and faithfully discharged the duties of her office; that the forgoing First and Final Account is true and correct and fully discloses all significant transactions occurring during the accounting period; that all known claims against the Estate have been paid in full; that all taxes presentaly due from the Estate have been paid; and that the grant of Letters Testamentary and the first complete advisement thereof occurred more than four months before the filing of the foregoing First and Final Account. This statement is made subject to penalties of 18 Pa. C.S.A. Section 4904 relating to unsworn falsification to authorities. � d�rvw�. Robyn L. Cardamone Dated: � ::iate of Yennsylvania `��Y/L � �ounty af Lycoming '4 •?d/s �ubscribed to befote me on the l4 day of��t-�- Acknowledged b � Printed name ,� Notary Public ' �5�� My Commission expires: Z ��!� COMMONWEAtTH OF PEMNSYWANM NOTARIAL SEAL ' OAND D KOCH.NOiARI�PUBLK; CI1Y OF WILLIAMSPORT,LYCOMING COUN11t MY COMMISSION FXPIRES SEPiEMBER 2,2018 Page 9 of 9