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Home My WebLink About03-27-15 .,.._.�.-. � 1505610101 REV-1500 EX�°I_1°> . enns Lvania OFFICIAL USE ONLY PA Department of Revenue PEOAP7ME Y Bureau of Individuat Taxes � ' "`°`"°` County Code Year File Number Po BOx z8o6oi � INHERITANCE TAX RETURN � � � y� �, �� Harrisburg,PA 1�1z8-o6oi RESIDENT DECEDENT �( '� � � ��`,�'� .� �� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY %��'�,�� z, > �=z�c� f � � o,�U � � i ��8 �s � DecedenYs�Last Name Suffix � DecedenYs First Name MI 13 r� y �- nr t' � ;K a: �>> �c�� 4 � � C. � � �, (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI :z�� ,� � ,..� ' � ' ° . . , ri� . , m.��_,. � � a ` 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 p 2.Supplemental Return p 3. Remainder Return(date of death ' prior to 12-13-82) p 4. Limited Estate p 4a. Future Interest Compromise(date of p 5. Federal Estate Tax Return Required death after 12-12-82) p 6. Decedent Died Testate p 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Wiil) (Attach Copy of Trust) p 9. Litigation Proceeds Received p 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 Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number � �' 1 h C-� u- d c�k N / z �7 z � : � ,� z. o REGISTER OF WILLS USE ONLY r�.a c� First line of address � � � � ca rn �7 5 -3 1'..� I cr s 5 p m � i- i v'E' � -� � � �"� .��. Second line of address �;� .. r~ --� �� . 1-;., h� ,,� r��7 �:- ~J �;r e:� , . I , ,' • ,'; '3 CJ City or Post Office State ZIP Code ' e;-, L2Are�D -�• .�� y� ^;�, ` : "'r:i �� G� I`� G l. �' r' . ' � ,�- I �' 3 3' j �' �� "' .,. � :�� . ►---+ i�" r� �' CorrespondenYs e-mail address: � � � �' 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 PE SP �fOR FILING RETURN DATE ��' :.�-/'- %5 ADDRESS � ��.J C�/oS3 G,-n �,-;'v� l�u-r,ov�., , P,4._ � 73.3i SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 � 15�5610101 1505610107, J _........ � 15�56101�5 REV-1500 EX DecedenYs Social Security Number ; /,. � � 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 �� A.� �� . . .: F,: 4. Mortgages and Notes Receivable(Schedule D). . . . . . .. ... .. .. .. .. ... .. . . . 4. +� () � � {�� 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . .. . .. 5 ' F � � � ° r� � _ �:. ,�.��-�a�r�F �,�,�µ'�: ��.�� 6. Jointly Owned Property(Schedule F) p Separate Billing Requested .. .... . 6 ; +�� 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property �'�' ' ��'� '`�` ' �� (Schedule G) p Separate Billing Requested.. . . .. .. 7. � ` � � �,� � � ��; q " „� , . °, : �r _ a, � �- . 8. Totai Gross Assets(total Lines 1 through 7). . . . .. . . . . . . . . . . . .. .. . . . . . .. . 8 , �•�� .� � �: � ��,. 9. Funeral Expenses and Administrative Costs(Schedule H). ... . . . . . .. . . . . . . . . 9 � /_ p �Q �� Clt� ! �� ti�r� , �` 10. Debts of Decedent, Mortgage liabilities,and Liens(Schedule I) .. . . . . . .. .. . . . 10 : � � e.r�r� � � �� 11. Total Deductions(total Lines 9 and 10). . . . . . .. . . . . . . . . . . . . . . . . . . . . . .. . . 11 ; �-7 �O � �, �" �� " '�� = ;� ��. �� ;., ��... : 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . .. .. . . . . 12 " � �yz, �� tl � ��l� � 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which a `�� "� ° �"�^ an election to tax has not been made(Schedule J) . .. .. . . . . . .. . . . . . . . . . . . . 13 - t ` r" � . � �r �� ,.�: P <-� . . � , 14. Net Value Subject to Tax(Line 12 minus Line 13) . .. . . . . . . . . . .. . . . . . . . . . . 14 � '' ` ' � � -��,j„ � �e �� __ � r,. ut TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousai tax rate,or transfers under Sec.9116 � � �r � �� " (a)(1.2)X.0_ �,� ', 15 � � � �� 16. Amount of Line 14 taxable � � �� °�� °� � ��` ��° �'� � �'�'� ��'`�'`�'� �'�� at iineal rate X.0 �^ G�� -7 4 16 1� "..) L..r� z h � � �� + 17. Amount of Line 14 a able T � � �'°� " "' �" s� �'°��' ��" ��*-*_ � �� at sibling rate X.12 �� 17 � �� 18. Amount of Line 14 taxable "" "� �' , _ � '��'`��`�"`'��`�� ``��'��'�� '�`� ��-"��-��`�`��""� at collateral rate X.15 � � � 18 � � � � �� . „ . r �, �a r� � � � .�«. � '��„�� s'�-«��`�' �'�`� 19. TAX DUE .. . . .. . . . . . .. . . . . . . . .. .. . .. . . . . . . . .. . . .. . . . . . . . . . .. .. . . . . 19 4,�.., .�. � .d. , � . . � �.�. ri a , J � > � � �� F �r � ` .-� � -.,< , �^_1 �,2 t1 � 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 � 1505610105 1505610105 � File Number '-1500 EX Page 3 ,acedent's Complete Address: DECEDENT'S NAME � �� __-- ——- ��Lt-f'"I U ---- --e�----- -- __— ------_____– STREET ADDRESS ��h � _ _ — — ____�'/�,_l�r�z_.�, d — -- ---------- --_—------ --i S7ATE il ZIP , � _ CITY `� �z� h�a..n��,61-�-� -�t 1 Tax Payments and Credits: �� 1 �� . Tax Due(Page 2,Line 19) 2. CreditslPayments _ A.Prior Payments ---�---- B.Discount —_.------- Total Credits(A+B) (2) 3. Interest �3� 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �4� Fill in oval on Page 2,Line 20 to request a refund. (5) 1 ` � � � 5, if Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. Make c�ieck payable to REGISTER OF WILLS, AGENT. � :�� $ � ,� *�� `��.�',;':�+ � , �� . , �� ,. ��: � .�:, �� .�,� ��,�*�:�� "` % . , 4a�� PLEASE ANSWER T HE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BL�OCKS Yes 1. Did decedent make a transfer and: ...................... ❑ � . .. ❑ 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;or....................................................................... . within one year of death ❑ d. receive the promise for life of either payments,benefits or care?. � 2. If death occurretl after Dec.12,1982,did decedent transfer property p ... ...................................................................................... ❑ without receiving adequate consideration?.................... • 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or�hn ch eath?............•. � � 4. Did decedent own an individuai retirement account,annuity or other non-probate property, ................................................... contains a beneficiary designation? .....••�••••�•••�•�•••••••�•�� . � .� °�� F THE ABOVE QUESTIONS IS YES,YOU}MUST COMPLETE S�CHED�E��D;FILE IT AS PART OF THE RETUR IF THE ANSWER TO ANY 0 �� _��,. � �� a� * .::� .��"��'��'�'�"�`��,.,�"�y��.��:��,4�.. .+t`a�� , ��'��`��"�`��.,.� ul 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 For dates of death on or after J y 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 vaouse from tax,rand the statutory requirements for disclosu e of assets and [72 p.S. §9116 (a) (1.1) (ii)].The statute does not exempt a transfer to a surviving sp 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: ears of a e or younger at tleath to or for the use of a natural parent, an . The tax rate imposed on the net value of transfers from a deceased child 21 Y g • al beneficiaries is 4.5 percent, except as noted in adoptive parent or a stepparent of the child is�0 p arnsfers to or§or16he)(use)l of the decedent's line • The tax rate imposed on the net value 13 A sibling is defined, under 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)l• x rate im osed on the net value of transfers to or for thcommontw th the decede blin�ethe by blood or ad pt on116(a)( . )� . The ta p Section 9102,as an individual who has at least one parent in REV-1508 EX+(157) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS� a MISC. INHERITANCE TAX RETURN pERSONAL PROPERTY RESIDENT DECEDENT FILE NUMBER ESTATE OF i`C��I � _� � .2�13--��'� � �t r��' 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. VALUE AT DATE OFDEATH ITEM DESCRIPTION NUMBER ,. ��,c�c�i� �cc'rru�f -�-r�-+--A�_ `�, la�l N •�- r 7 S�'dVI/1CS �- L'C'�-Ch C � � TOTAL(Also enter on line 5,Recapitulation) $ (If more space is needed,insert additional sheets of the same size) � .r � NONON � M O M O M O N � M � M � M O � Q t0 � � N N �rj M O a�i a � � O O p C � O O N fl. (n f6 N � � � U.. F� � O N O O N M C O M O O M � � � � � M M � � � [0 �rj c'7 M 3 a� Z u, o0000 0 � o0000 0 � o0000 0 00000 0 = o0000 0 � � o0000 0 � � m � o a _ o N N N O O O M � M M M O O O N U voirnoo � M � � M M V (O (fl CO � �- C MM ('M (n � N � m M � � � � NNNOO � �'`� M M M M O O O N � ¢ N M M � � � M � N N �� 7 M M M � � � N W � � Y N � . Z '++ c � � � m � � � � t> o o . � 3 .v -v � � R �� o � yc� ccma? = N U U C � � � E C L f6 L L � � � .� O (L6 F- F`- UUF- �i � � til- J M M M M �`'� M � e- � r' r' O O N N N N N N N W 0 � � � t� � � � � N N N N N N � W O O O O O 0 � Z � � � 0 � � a O O O O � 0 } O O O O O � m � f� f� (� (� � � ~ M M M M M � M a� � � � � � �9 � NNNNN N � t L) � t n � � � !t c+rn NNNN �1 N O O N N N N N � O� a o0000 0 REV-1511 EX+(10-06) � SCNEDI�LE H � FUNERAL EXPENSES & COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ADMINISTRATIVE COST RESIDENT DECEDENT FILE NUMBER � 2 ESTATE OF '/ j2 �1� 3 � ��'�"�G /� �� U !J��'h �'" Debts of decedent must be reported on Schedule I. AMOUNT ITEM DESCRIPTION NUMBER z �'/8 q. FUNERAL EXPENSES: I �T�� '� C�C e �r ��.nc.�-�� I��---�-- g. ADMINISTRATIVE COSTS: � Personal Representative's Commissions —_______ __._- _ _ _ ___ . Name of Personal Representative(s _ _ - ------ __---___ - -- _ - - Street Address __ ___ - - - - — - -- - State ZiP _ _ City Year(s)Commission Paid: ___ __ --------- -- -- _ __ _ 2. Attorney Fees 3. Family Exemption:(If decedent's address is not the same as claimant's,attach explanation) - -- ____ Claimant --- .____- -_ Street Address _ _ _ - - ---- - ___ __ _ _ _ ____ State p - -- Zi ---- City Relationship of Claimant to Dece en _____ -- -- - _ _____ -- -------- - - 4. Probate Fees 5. AccountanYs Fees g. Tax Return Preparer's Fees 7. { , �U TOTAL(Also enter on line 9, Recapitulation) $ / � �O � � _ (If more space is needed,insert additional sheets of the same size) ( � "� � !'s`:. �',,... 1'(::: ±K:w. . �At.Rose Ave. �ork,PA 17403 - - 717-845-2399 Fax:717-846-5229 FUNERA� �r e m a t i o n Website:www.KefferFH.com HOME pi r e c t Email:KefferFH�aol.com AND CREMATORY INC. . Service ' . of York Cou�ety , . � . �,p`S , ;; y,��+TM S� ,ta�ry�i'l�a�.j.y 4�7q' t� � ��`.��9��,� _, ,� � :A �, ,�° (Ga��`7a� I 1 �cl � � fq� z �� e r�,, ��' fia� � :t y Nek'; y k�h ,. 1�� ` : � q"n h�"�F��1 � ��§� � �'�. �� s��'��s4 � � �,�� ,ti� � � � � �fi �a��"*� �f �,�� 27, 2013 �� ' � '��¢ February ��•� '��`.� �e`�" � ,std § �am��a�f ° � �',;. \ I 5k L;A �C" �'S-'Flg„_- �f. 34 � � y��y " � ��+�' S i �y �^ k`e�. '9 � F , d k ,� ,y� p y y+� Ra...��r� L � {�f'4} i ,�{ �` � .,` ��"; V"t��wR F � d ��T{�"W.��h. NI Frank Arcuri ` `4$ � x � "� � � Y � r. P�`�Y�,,:, ��yP ,� � • � , ,�r� �'�5 ��'w r r �'�� y� _ � ;� 2365 Esbenshade Rd. �a a� r��i: �� 4ai�>� �», �� t� *�t � �� r� ,,. York, Pennsylvania 17408 ��.,� ��ry ; t ,�� '?,,. �w �€�� ,��, For service for: Katiejo Bryant < �� ' ;� t^ ��,�� ., � 3�� * ... :� n r �T�ry �1 ,F.��,.�'"+� ..'�^t'" ... . . Our service including: '�= �. ,�,;,,. Transfer from York Hospital office work Supervision of service and necessary A cremation casket Service van to the crematory Use of funeral home and equipment and service of assistants A register book and prayer cards with a photo �gZp.00 Totai for services and merchandise: _ Items for which we advanced payment: er Obituary 221.66 _ York Newspap _ 247.42 Harrisburg Patriot Obituary ` �20.00 Certified Copies of Death Certificate Q70,00 Crematory Charge ------ �_ g59�08 859.08 $1,67g pg Total advanced Total for service: '� $��679'08 - Balance due Thank you, Mr. Arcuri. � '�"^; ..�k� 1 . -_ _�� , , i 3y n�, �� rh �� s F x F� � a��;,ce�r �;r � — .�� ,i§M � � s. � �e �� k ��a `��'� ��`�-z, ,p'ky!4 ��.� ? �'�5'?��'� �� r� _ � x ��' � s »� '�"`�"k�''� ��,r�i�'�'�`+a� ��5,� — � a�rn"a� t �"��, � 7i t �sd3s�� - h '� Y : �.y� �..�a� tuE"`w�� _ ' a i$ � �� "'-�:.�v � t, �i zk z"�a Y��' v �,d t� . ' � � � �� 3s�',� �r �"sfs��s.� �{a�,i �r � �� d �� ,�� „, � . � ��s�},�,`�Y�`��'".�Ur�'��q� ' ,'��t� x �4',�^'§,�+ � �'�.y��"�� y � w �. s�' z 5� ��>�'�h � � r� "^}° �''3a r !t�T.d � �'J � ;�a` ��'�5�� F'� �� 11 y�';� w �P��'�+,'��q j�`� � �� tC � ; r k`� 1�is �'r'��`�� *`� y� M�a4� ��"T��^4�'�� 3 r� �� '� {� 4 $ ��'�i��'��*��'� �,,� � � ' %'�� - a�,��5 k��•�yk�,�, �`�v ��' � �� i '� b y�' Y�. �' ` ¢d�H"�",�°`� �`��, ,T" • �" ��, G S�d'i� s � w y a z �v� s�f.�i- P �.. � � � � � a*��, �� r ,t„` � ,�+ g�r��u 4 . a � �i�;5 �,� � ��`4 4�r - P t � �� r�'� a � . � P`� . o ,� f ,k w x � .. ��,�i�sr 9 yi. f • . �y �(�r �'�� ti�� t bg�t� �w1� ��. P �iat 'm" „_� �N✓i .�r ryl �: � �qa1,�'}µ k �� {#�,fiy ��'�y�r(�Y,y �� , �". t � "��" �� $ � � Y ti�' � � � r y��r,`te'�k�'7 t�4 � � ..�� P . j `^�'^1°. � Bmf�'`p��y ��r� A � t zA�% � i t ' > �"'�" , ' � ��t .,�� . �� M � i , �r $! � e � �,� i �� i ��1�� 4 � �� s � a jP t'�f� �� # .S � �x��.4�.9�'*��"�y �� 4 � � '� . � �k �y�f� �� *, : � r �: � e r b, � a ��"afh a y^xl£{ � - d� c r.. �:3�, .%��, ,..N� . '�, `�r r�°" � - , �,� � �`