HomeMy WebLinkAbout04-09-15 1505614134
EX(03-14)(F I)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 6 8 9
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
0 7 1 3 2 0 1 4 1 0 1 1 1 9 2 6
Decedent's Last Name Suffix Decedent's First Name MI
P R I E S T H A Z E L A
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
H
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
0 1.Original Return ❑ 2. Supplemental Return ❑ 3. Remainder Return(date of death
Prior to 12-13-82)
❑ 4.Agriculture Exemption ❑ 5. Future Interest Compromise(date of ❑ 6. Federal Estate Tax Return Required
(date of death on or after 7-1-2012) death after 12-12-82)
0 7.Decedent Died Testate ❑ 8. Decedent Maintained a Living Trust 0 9.Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
❑ 10. Litigation Proceeds Received ❑ 11. Non-Probate Transferee Return ❑ 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets only)
❑ 13.Business Assets ❑ 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
D A V I D H S T O N E E S Q U I R E 7 1 7 7 7 4 7 4 3 5
First Line of Address
4 1 4 B R I D G E S T R E E T
Second Line of Address
City or Post Office State ZIP Code r.0
N E W C U M B E R L A N D P A 1 7 0 7 0 �' M
Correspondent's e-mail address: D S T O N E @ S T O N E L A W
- NET
REGISTER-OF jM LMUSE(MLY
co
REGISTER OF WILLS USE ONLY "r C:)
DATE FILED MMDDYYYY '� .� p
I'V GJ)
DATE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
I IIIIII VIII VIII VIII VIII VIII ILII VIII VIII VIII IIII IIII
1505614134 1505614134
a��
1505614234
REV-1500 EX(FI) Decedent's Social Security Number
Decedent's Name: HAZEL A- PRIEST
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 and Notes Receivable(Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 1 2 5 2 2 9 5
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested 6.
7, Inter-Vivos Transfers&Miscellaneous N Probate Property
(Schedule G) Separate Billing Requested . . . . . . . 7.
& Total Gross Assets(total Lines 1 through 7) . . . .. . . . . . . . . . . . . . . . . . . . . . . 8. 1 2 5 2 2 9 5
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9• 1 1 0 8 2 . 7 8
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . .. ... 10. 5 9 1 2 . 6 0
11. Total Deductions(total Lines 9 and 10) . . . .. .. . . . . . . . .. . . . . . ... . . . . .. . 11, 1 6 9 9 5 . 3 8
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. - 4 4 7 2 . 4 3
13. Charitable and Governmental BequestslSec 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. - 4 4 7 2 • 4 3
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 0 . 0 0 15. 0 . 0 0
16, Amount of Line 14 taxable
at lineal rate X 0- 0 . 0 0 16. 0 . 0 0
17, Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 . 0 0
18: Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18, 0 • 0 0
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . 19. 0 - 0 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Under penalties of er
per_�Juej I hive examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
"Y'
m
Ili r
it is true,correct and m,'ete' , a ion of preparer other than the person responsible for filing the return is based on all information of which preparer has
any kncALed9p--
SIG ATUR OF'PSQSON R 0.4SIBLE FOR FILING RETURN DATE
ADDRESS
414 BRIDGE STRdT NEW CUMBERLAND PA 17070
SIGNATURE OF PREPARER OTHER THAN PERSON RESPONSIBLE FOR FILING THE RETURN DATE
ADDRESS
IIN1111111 IIIA VIII 111111111111111 VIII VIII VIII 11111111 Side 2
1505614234 1505614234
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address: 21 14 0689
DECEDENT'S NAME
HAZEL A . PRIEST
STREET ADDRESS
922 SUSAN CIRCLE
CITY STATE 317025-
IP
ENOLA PA
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0 . 00
2. Credits/Payments
A. Prior Payments 150 - 00
B.Discount
(See instructions.) Total Credits(A+B) (2) 150 - 00
3. Interest
(3) 0 . 00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4) 150 - 00
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 ........................................... .. El 0d. receive the promise for life of either payments,benefits or care? ....................................................... El0
2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... ❑ ❑X
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X
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 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 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 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 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 decedent's 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-1508 EX+(08-12)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
HAZEL A . PRIEST 21 14 0689
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
Nestle pension check received 86 . 22
2 PNC Bank-Checking Acct #5140108753 111203 .09
Princ $11,203-09, Int $ . 14
3 PNC Bank-Checking Acct #5140108753 - Accrued Int 0 . 14
4 PNC Bank-received escheat checks due estate 103. 50
5 Veterans of Affairs-pension check received 11130 .00
TOTAL(Also enter on Line 5,Recapitulation) $ 12,522 - 95
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HAZEL A . PRIEST 21 14 0689
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1, Romberger Memorials-services rendered 125. 00
2 Sullivan Funeral Home-funeral expenses 7,184 . 00
B. ADMINISTRATIVE COSTS:
1 Personal Representative Commissions:
Name(s)of Personal Representative(s) D a v i d H S t q n e 11000- 00
Street Address 414 Bridge Street
City New Cumberland state PA zip 17070
Yeaqs)Commission Paid: 2015
2. AttomeyFees: Stone LaFaver & Shekletski 11000 . 00
3, Family Exemption:(If decedents address is not the same as claimants,attach explanation.)
Claimant
Street Address
City state ZIP
Relationship of Claimant to Decedent
4. Probate Fees: See *3 below
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. PNC Bank-service charge 20 .00
2 PNC Bank-check charges 6 . 00
3 PNC Bank-service charge 20 .00
4 Stone LaFaver & Shekletski-Reimb for probate 158 . 50
5 Cumberland Law Journal-adv grant of letters 75.00
6 The Sentinel-advertising grant of letters 148 .06
7 Nestle - Pension Trust - return of check 86 . 22
8 US Treasury-return of VA pension check 1,130 .00
9 Stone LaFaver & Shekletski-Reimb for filing returns 30 . 00
10 Reserve for closing expenses 100 . 00
TOTAL(Also enter on Line 9,Recapitulation) $ 11,082 -78
If more space is needed,use additional sheets of paper of the same size,
REV-1512 EX+(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
HAZEL A . PRIEST 21 14 0689
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
Community Life Team-services rendered 105.60
2 East Pennsboro Ambulance Sery-services rendered 96 .00
3 Jewish Family Services-services rendered 780.00
4 Brockie Pharmatech-services rendered 739 . 86
5 Homeland Center-living expenses 4 ,191-14
TOTAL(Also enter on Line 10,Recapitulation) $ 5,912 - 60
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(01-10)
pennsylvania. SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
HAZEL A - PRIEST 21 14 0689
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).)
1. THELMA BILLOW Collateral 0 .00
C/O ROSEMARY DIEHL 709 JENNA COURT
MECHANICSBURG PA 17055-
2 CINDY PETRETTO DIFIDRE Collateral 0 . 00
1636 FALLBROOK AVENUE
SAN JOSE, CA 95130
3 ROY JOHN SITES Collateral 0 .00
2812 NEW JERSEY AVENUE
SAN JOSE, CA 95124
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF 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:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $
If more space is needed,use additional sheets of paper of the same size.
Fm
4441111 i t �F,
NM
LAST WILL AND TESTAMENT
OF
HAZEL A. PRIEST
I, HAZEL A. PRIEST, of East Pennsboro Township, Cumberland
County, Pennsylvania, declare this to be my last will and revoke any
will previously made by me.
ITEM I : I direct that my Executrix hereinafter named shall pay
all my just debts and funeral expenses as soon as conveniently may be
done after my decease.
ITEM II : I bequeath Twenty Thousand {$20, 000 . 00} Dollars to
THELMA BILLOW, provided she survives me.
ITEM III : I devise and bequeath all the rest, residue and
remainder of my estate, of every nature and wherever situate, as
follows :
A. One-half thereof to my niece, CINDY PETRETTO, or to her
issue, per stirpes.
B. The remaining one-half thereof to my nephew, ROY JOHN
SITES, or to his issue, per stirpes .
ITEM III : I direct that my Executrix retain the law firm of
Stone LaFaver & Shekletski to aid in the administration of my estate.
Page 1 of 4
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.. ,.. .. r ��f
_ _ .. 8'
ITEM IV: I appoint THELMA BILLOW Executrix of this my last will .
Should THELMA BILLOW fail to qualify or cease to act as Executrix, I
appoint DAVID H. STONE Executor of this my last will .
ITEM V: No fiduciary acting hereunder shall be required to post
bond or enter security for the faithful performance of his/her duties
in any jurisdiction.
IN WITNESS WHEREOF, I , HAZEL A. PRIEST, have hereunto set my hand
and seal this Ora day of 1999 .
HAZEL A. PRIEST
SIGNED, SEALED, PUBLISHED and DECLARED by HAZEL A. PRIEST, the
Testatrix above named, as and for her Last Will and Testament, and in
the presence of us, who at her request, in her presence and in the
presence of each other, have subscribed our names as witnesses .
Witness VAddress
Witness Address
Page 2 of 4
COMMONWEALTH OF PENNSYLVANIA:
SS .
COUNTY OF CUMBERLAND
I, HAZEL A. PRIEST, the Testatrix whose name is signed to the at-
tached or foregoing instrument, having been duly qualified according
to law do hereby acknowledge that I signed and executed this instru-
ment as my last will ; that I signed it willingly and that I signed it
as my free and voluntary act for the purposes therein contained.
HAZEL A. PRIEST
Sworn to or affirmed to and acknowledged before me by HAZEL A.
PRIEST, the Testatrix, this day of 1999 .
r
NOTARIAL SEAL � r
• f
CONST! ICE L. KARLI, Notary Public Notary Public
New Cumberland,PA Cumberland Co.
My Commission Expires April 13,2003
COMMONWEALTH OF PENNSYLVANIA
SS .
COUNTY OF CUMBERLAND
We, 'c' /c La - CSC . _ and
the witnesses whose names are signed to the attached or foregoing
instrument, being duly qualified according to law, depose and say that
.we were present and saw Testatrix sign and execute the instrument as
Page 3 of 4
her last will; that Testatrix signed willingly and that she executed
it as her free and voluntary act for the purposes therein expressed;
that each of us in the hearing and sight of the Testatrix signed the
will as witnesses; that to the best of our knowledge, the Testatrix
was at that time eighteen or more years of age, of sound mind and
under no constraint or undue influence .
� � L
Witness
Witness
Sworn to or affirmed to and acknowledged before me by
and
r t,
witnesses, this day of
Notary Public k
NOTARIAL SEAL
CONSTMCE L. KARLI, Notary Public
Now Cumberland,PA Cumberland Co.
My Commission Expires April 13,2003 r
Ik
Page 4 of 4
!r
I..
1
.Sep. 5. 2014 3: 19PM PNC Bank No, 2141 P. 1/1
; ` .PNC
.L1 DING TRE WAX
September 5, 2014
David H Stone Esquire
Stone LaFaver& Shekletski
414 Bridge Street
PO Box E
New Cumberland,PA 17070
RE: Hazel A Priest
SSN:
DOD: 07/13/2014
Dear Mr. Stone:
In response to your request for Date of Death(DOD)balances for the customer noted above,our
records show the following:
Checlang Account
Account#5140108753 Established: 02/01/1970
HAZEL A PRIEST DECD
JEWISH FAMILY SERVICE GDNUCO
DOD balance: $ 11,203.09+0.14 accrued interest
Interest paid 01/01/2014 thru 07/13/2014 -$1.75 'YTD
Please note that this office provides date of death balances for deposit accounts(U As,CDs,Checking and
Savings). We do not process any financial transactions or provide statements. If you meed assistance with
any of these items,please call 1-888-PNC-BANK.(1-888-762-2265)or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
This message is intendedfor the use of the individual or entity to which it is addressed and may
contain information that is privileged, confidential and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient,you are hereby notified that any disseminarion,
distribution or copying of this communications is strictly prohibited. If you have received this
communication in error,please note me immediately by reply or by telephone at 800-7621775 and
immediately destroy this faxed document.