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Home My WebLink About07-10-15 � pennsy�vania 15 D 5 61814 8 DEPAR�MENTOF REVENUE EX(03-14) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po aox zaosoi INHERITANCE TAX RETURN "', 7 Harrisburg,PA 17128-0601 RESIDENT DECEDENT �''�� J`� �� / ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 05142015 11221966 Decedent's Last Name Suffix DecedenYs First Name MI BARANISITYN—STAKE MELISSA A (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI STAKE THOMAS R THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW Q 1. Original Return Q 2. Supplemental Return � 3 Remainder Return(date of death priorto 12-13-82) Q 4. Agriculture Exemption(date of Q 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) � 7. Decedent Died Testate Q 8. Decedent Maintained a Living Trust � 9. Total Number of Safe Deposit Boxes (Attach copy of will) (Attach copy of trust.) Q 10. Litigation Proceeds Received Q 11. Non-Probate Transferee Return 0 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) � 13. Business Assets 0 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 ROBERT G. FREY 717-243-5838 First Line ofAddress 5 SOUTH HANOVER STREET Second Line ofAddress City or Post Office State ZIP Code CARLISLE PA 17013 0 Correspondent's email address: R F R E Y a F R E Y T I L E Y . C 0 M c `~j' rn � � a �— c� REGI €�F�ILLSO�SE ONICY) � --i REGISTER OF WILLS USE ONLY � � r � � � DATE FILED MMDDYYYY � (J3 �^ „ , c� C� EJ � � � 'rl '�'1 �7 � `tl 3 � � r;� C:� � —. G']� : � � r rrt —{ r "ATE FILED ST,R11� Cn � PLEASE USE ORIGINAL FORM ONLY Side 1 ��I��I�� L 1505618148 1505618148 J � .,,�,�o�� ,. ��„�� 1505618155 REV-1500 EX Decedent's Social Security Number �ecedenrsName: MELISSA A BARANISITYN-STAKE RECAPITULATION 1. Real Estate(Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . 1. � • �� 2. Stocks and Bonds(Schedule B). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. � • 0� 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C). . . . . . . 3. �• �� 4. Mortgages and Notes Receivable(Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. � • 0� 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . . 5. 5 4 S 3 5. 7 2 6. Jointly Owned Property(Schedule F) �Separate Billing Requested. . . . . . . . 6 1691 . 73 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) OSeparate Billing Requested. . . . . . . . 7. 39500. 00 8. Total Gross Assets(total Lines 1 through 7). . . . . . .. . . . . . . . . . . . . . . . . . . . . . . 8. 9 S 7 2 7. 4 5 9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . . . . . . . . g. 0 . 0 0 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule I) . . . . . . . . . . . . . . . . �p. � . �� 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11. 0 • 00 12. Net Value of Estate(Line 8 minus Line 11). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 95727. 45 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J). . . . . . . . . . . . . . . . . . . . . . . . . .13. 0 • �0 14. Net Value Subject to Tax(Line 12 minus Line 13). . . . . . . . . . . . . . . . . . . . . . . . . 14. 9 S 7 2 7 . 4 5 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(�.2)x.o� 95727. 45 �5. 0 . 00 16.Amount of Line 14 taxable atlinea�rateX.o 45 0 . 00 �6. 0 . 00 17. Amount of Line 14 taxable at sibling rate X � 12 17. � . �0 18. Amount of Line 14 taxable at collatera�rate X . 15 �8. 0 . D 0 19. TAXDUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 0 . 00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 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 an knowled e. SIGNATURE OF PERSO SPONSI F FILI RETURN DATE i- � � (_S ADDRESS 130 FROST ROAD GARDNERS PA 17324 SIGNATURE OF P, EP ER OT A PERSON R SPO SI E FOR FILING THE RETURN DATE ` . r� ADDRESS 5 SOUTH HANOVER STREET CARLIS E PA 17013 ��I�� Side 2 L 1505618155 1505618155 J REV-1500 EX Page 3 File Number 163-54-3221 Decedent's Complete Address: 21-15-0557 DECEDENT'S NAME MELISSAA BARANISITYN-STAKE STREET ADDRESS 130 FROST ROAD CITY STATE ZIP GARDNERS PA 17324 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 76.13 2. Credits/Payments A. Prior Payments B. Discount (See instructions.) Total Credits(A+B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. Fill in box on Page 2,Line 20 to request a refund. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 76.13 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.................................................................................................................. ❑ � d. receive the promise for life of either payments,benefits or care?.......................................................... ❑ QX 2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................. ❑ 0 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?............................................................................................................. ❑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 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 decedenYs 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-1508EX+(02-15) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENTOFREVENUE PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Melissa A Baranishyn-Stake and Thomas R Stake 21-15-0557 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 1. Cornerstone Federal Credit Union,Account 7534-01 1,032.87 2. Cornerstone Federal Credit Union,Account 7534-07 3,952.76 3. Cornerstone Federal Credit Union,Account 7534-18 47,006.63 4. Cornerstone Federal Credit Union,Account 7557-01 2,543.46 TOTAL(Also enter on Line 5, Recapitulation) $ 54,535.72 If more space is needed, use additional sheets of paper of the same size. REV-1509 EX+(02-15) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Melissa A Baranishyn-Stake and Thomas R Stake 21-15-0557 If an asset became jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G. SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Thomas R. Stake 130 Frost Road Spouse Gardners, PA 17324 B. Nathan Baranishyn Son C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOIN7 MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANKACCOUNT NUMBER OR SIMILAR CATE OF DEA7H DECEDENTS VALUE OF NUMBER 7ENANT JOIN7 IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VnLUE OFASSET INTERES7 DECEDENTS INTEREST 1. A. 9/17/09 130 Frost Road, Gardners, Pennsylvania, assessed value, 0.00 50.00% $174,500; mortgage owed, $188,300 2. B 5/6/02 Cornerstone Federal Credit Union,Account 77557-01, 2,182.53 50.00% 1,091.27 Disclaimed in favor of surviving spouse Cornerstone Federal Credit Union,Account 77557-07. 3. B 10/22/04 Disclaimed in favor of surviving spouse. 1,200.91 50.00% 600.46 TOTAL(Also enter on Line 6, Recapitulation) $ 1,691.73 If more space is needed,use additional sheets of paper of the same size. ,�ii�.r_n m-n�r � REV-1510EX+(02-15) SCHEDULE G pennsylvania lNTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Melissa A Baranishyn-Stake and Thomas R Stake 21-15-0557 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDETHENAMEOFTHETR4NSFEREE,THEIRRELATIONSHIPTODECEDENTAND DATE OF DEATH %OF DECD�S EXCLUSION TAXABLE NUMBER THEDATEOFTRANSFER.ATfACHACOPVOFTHEDEEDFORREALESTATE. VALUE OFASSET INTEREST (IFAPPLIGABLE) VALUE 1. 401(k)plan 39,500.00 100.00% 0.00 39,500.00 TOTAL Also enter on Line 7, Reca itulation $ 39,500.00 If more space is needed, use additional sheets of paper of the same size. .•.-„v uuir��ru��mr�c � r CORNERSTONE I F e d e r a I C r e d i t U n i o n P•O. Box 1181, 5 East Gate Drive, Carlisle, PA 17015 Telephone (717)249-1661 FAX(717) 249-8208 Member founded—Service based www.cornerstonefcu.coop Dear Robert, Below you will find the information regarding Melissa Baranishyn-Stake's account holdings with Cornerstone FCU as of her date of death. Account# Account Balance Balance As of Date Date A/C Opened Ownership 7534-01 $1,032.87 5/14/2015 4/7/2000 Single Owned 7534-07 $3,952.76 5/14/2015 4/7/2000 Single Owned 7534-18 $47,006.63 5/14/2015 4/19/2000 Single Owned 7557-01 $2,543.46 5/14/2015 4/19/2000 Single Owned 77557-01 $2,182.53 5/14/2015 5/6/2002 Joint with Nathan Baranishyn 77557-07 $1,200.91 5/14/2015 10/22/2004 Joint with Nathan Baranishyn Please let me know if any additional information is required. For informational purposes, I can confirm that a Notice of Decedent Account was filed with the State of PA for accounts on which Melissa was joint with Nathan. Sincerely, (� , 1��.�� Rebeka Landon CFO Cornerstone FCU 717-249-1661 x256 MEMBER SAVINGS ACCOUNTS FEDERALLY INSURED TO$250,000 BY THE NATIONAL CREDIT UNION ADMINISTRATION :�"Illf'?','`'"11711'flll` , �u►icke�Lvar�� ,[,IN� STATEME�3' Engineered to Amaze' �,,� 1050 Woodward Avenue I Detroit,MI 48226 STATEMENT ENCi.OSED �./'1��! � + 0538191 �00009534 04QL11 0098670 P1 P6 StatementDate DueDate AmountDue MELISSA A BARANISITYN-STAKE I azinns Qatett+rr $t,aoe.oa 130 FROST RD GARDNER5 PA 17324-9019 �tpaymeaS57581atefeewli8l�bech ra 9�04/16M5, i�l�i�li�l��ll�ll��li��l�l��liiili�lulil��ih��l�l�l�il�lll��i � . , �. • • . �• Loan I�nfornnatio� Payment His#ory Current Payment Breakdow�s �. ..s� .�._.,_._ Loan Number 3316573924 Last Paid** Principal $424.31 Principal Balancet $188,720.99 Principal $615•89 Interest $727.36 Escrow Balance ��,789,23 Interest $729•74 Escrow Interest Rate 4.625% Escrow(Tax&Insurance) $254.37 Taxes $156.20 Advances on Your Behalf $0.00 Insurance �981 Future Rate Change Possible N/A Fees $0.00 Mortgage ins.(PMI/MIP) $0.00 Totai Paid $1,600.00 Overage/Shortage $0.00 Property Address: _...—.__ Other $0.00 130 FROST RD Year to Date Regular Monthly Payment $1,406.04 GARDNERS,PA 173249019 Principal $1.129•8� Advances on Your Behalf $0.00 Interest $1,461.46 Fees Advances on Your Behalf $0.00 Late Fees $0.00 Fees $0.00 Other Fees $0.00 Total Paid Year to Date $2,599.26 Funds in Suspense* $0.00 � Escrow Disbursements Past Due Amount $0.00 � Taxes Paid $0.00 �, insurance Paid $0.00 _,"� Mortgage ins.(PMI/MIP)Paid $Q00 �� tThis is not your payoff amount.Please con[act us Total Escrow Disbursements ��.�� at(S00)508-0944,option 3 to request a payoff. TOtBI AfIIOUflt DU2 $�,406.�4 m..o.,�. �� "Activity since last statement on back. *Funds in suspense wlll be applied upon receipt of your monthly mortgage payment due. �� Quick and Easy Pay Options �C�n��ct Us �w Pay online at MYQ�-•cot�• � Email us at�ei�@Quicka�ri�.oan�.c�rr. VPay-by-Phone with 24/7 access by calling (i�04)508•0944,optian 9. Call tSaO?50II-A94=�,opt9o�a 3 � Monday-Friday,8:30 a.m.-9:00 p.m.ET �� 5end check payable to Quicken Loans Inc. and Saturday,10:00 a.m.-4:00 p.m.ET. by mail using the coupon below. ��9Cd�'�'i�$��5��.��5 Never Thii�lt About Your Payment Again! With recurring payments you set it once and forget it!Choose a day to have your payment withdrawn and we'll do the rest. Visit MyQL.com or call 800-508•0944,option 3. Sign Up Far Paperless Statexnents Today! .-".._... 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'( g�� 4"'3d t�' ��'R�m � hs N My '1�` 1L ••�,� ��M.k� Y•iF�v �"'}d C f C A � ,+*».' � � �+,";�"� °�'"��F Y�Fy�j„.� i 'f S.Mf ,1`'�*� �; ,��,�" �$��}*��` a�,#�y,Y;;M��,�,,� �.'� Tt` � e^t �j� �P� �''�Y,�ro1 4 V{ ,}'�„ $rs" 8"�.�`��#'-T7' �.., f t«'�c,��„'.-.�r�•,w ,r�# �. .r f i+;�� 5 � �� _ ��#�j �� 1 y�� 4 � k �,� �i'M�.�� `¢��x�d:F '7!pyt��"�'.�p�,�i�44�e A� �•��. 5A,� 'y,H �{� .'4.. �i y _'�' �Ws t �'ti� '":� * �' . '`'�, 7i �1, ��,�`��.,�*��9"�. � �'�+�..../t��.�� a. � ��0� �qJ'��i��;ti. �,,. �� . . >��- �ee' �"'�Cx" �-� �4�''� ��`'3 ,�� „�x `.��; �z.� c.'�"�,. '.e I I DISCLAIMER I, NATHAN BARANISHI'N, the person designated as beneficiary of the retirement plan for MELISSA A. BARANISITYN-STAKE, and as an intestate heir of MELISSA A. BARANISITYN-STAKE absolutely disclaim and renounce any right, title, and interest in the following properry: 1. Any portion of the probate estate. 2. My right to any portion of the 401(k) retirement plan as a named beneficiary. I have not in any way acted to accept the property or any of its benefits. This Disclaimer is irrevocable and unequivocal, and constitutes a complete and unqualified refusal to accept any right, title and interest in the property. 2 st' I NDING TO BE I.EGALLY BOUND, witness my hand and seal this � day of , Z� l Witn - ,_:J � '-:�� `�z�— (SEAL) NATHAN BARANISITYN State of Pennsylvania }ss. County of Cumberland � On this, the 2.� 5day of May,201 S , before me, the undersigned o�cer,personally appeared NATHAN BARANISITYN.,known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he executed the same for the purposes therein contained. IN WITNESS WHEREOF,1 hereunto set my hand and official seal. COMMONYVEALTH OF PENNSYLVANIA NOTAR�AL SEAL (SEAL) ROBERT G.fREY,Notary Pubiic ' Borough of Carlisle,Cumberland Counry,PA My Commission Expires June 27,2018 owledgment of Receipt I, THOMAS R. STAKE, Executor of the Last Will and Testament of MELISSA A. BARA1vISITYN-�TAKE, do hereby acknowledge receipt of the foregoing Disclaimer, this�day of May, 2015. :�� T OMAS . 5TAKE