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Home My WebLink About09-22-15 (2) pennsylvania 1505618403 OEVARTMENT EIX(03-14) 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 21 15 0326 ENTER DECEDENT INFORMATION BELOW 01 07 2015 05 06 1983 Decedent's Last Name Suffix Decedent's First Name MI CHIAPPONE PHILIP A (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M1 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return 2. Supplemental Return. 3. Remainder Return(date of death prior to 12-13-82) 4, Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) F1 7. Decedent Died Testate EJ 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 VICKY ANN TRIMMER 717 724 9821 First Line of Address 635 N 12TH ST SUITE 101 Second Line of Address City or Post Office State ZIP Code ,7=1 LEMOYNE PA 17043 cC_r11 r I cra Correspondent's email address: vtrinnnnerAdzmmIaw.com REGISTER OPWILLS IJSE Oril.,y REGISTER OF WILLS USE ONLY C-) I'D DATE FILED MMDDYYYY ri r ri DATE FILED STAMP Side I 11111111111111 IN 1505618403 1505618' 403 1505618411 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A)... .......................... ...... .................... Z 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}.........1 5. 13,305 - 50 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 through 7)....................................................... 8• 13-,305 . 50 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 9-,149 - 20 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 1,5 71 - 4 0 11. Total Deductions(total Lines 9 and ............. ........... 10-,720 - 60 12, Net Value of Estate(Line 8 minus Line 11)... .................................... ................. 12. 2,584 - 90 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. 2-, 584 - 90 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.00 15. 0 . 00 16. Amount of Line 14 taxable at lineal rate X .045 2 ,584 - 90 16. 116 - 32 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0-. 00 18. Amount of Line 14 taxable at collateral rate X .15 0 . 00 18. 0 . 00 19. TAX DUE................................................................................................................ 19. 116 . 32 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT El 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. SIG TU OF P E FOR FILING RETURN Philip J Chiappone DATE !rnc= Abml" ADDRESS 327 Antilles Court, Mechanicsburg, PA 17050 SIGNATCR)OF P RAPAPK OTHER THAN REPRESENTATIVE Vicky Ann Trimmer ATE /Is ADDRESS 635 N 12th St., Suite 101, Lemoyne, PA 17043 11111111111 VIII 111111111111111111111111111111111111111 IN Side 2 1505618411 1505618411 PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Chiappone, Philip Adam 21-15-0326 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#2 4\L I At Name Margaret Chiappone Addressi 327 Antilles Court Address2 City, State,Zip Mechanicsburg,PA 17050 Date REV-1500 EX Page 3 File Number 21-15-0326 Decedent's Complete Address: DECEDENT'S NAME Chiappone, Philip Adam STREET ADDRESS 327 Antilles Court CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) 116.32 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line I +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2,Line 20 to request a refund 5. If Line I +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5) 116.32 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;.........._.................... ..........._.......10 [;] I b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ Exil c. retain a reversionary interest;or......__.....____........_......____........._......._........................___........ 0 d. receive the promise for life of either payments,benefits or care?........................... ............................... Fix] 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....... ......__......._.......... ...... ..........._............_._.............___.......... El 1;1 3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... 0 r-xl 4. Did decedent own an individual retirement account,annuity,or other non-probate property which ❑ X containsa 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 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 January 1,1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72RS,§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 172 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-1608 EX+(08-12) SCHEDULE E ,l Vow pennsylvania CASH, BANK DEPOSITS, & MISC. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Chiappone, Philip Adam 21-15-0326 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 NUMBER DESCRIPTION OF DEATH 1 Delmarva Power&Light-Refund 36.23 2 Progressive Renter's -Refund 120.00 3 TD Ameritrade Account No. 864135630 6.68 4 USAA Checking Account No. 15247872 8,564.15 5 USAA Checking Account No. 15247872-Accrued income 0.02 6 USAA Savings Account No. 25553003 14.19 7 USAA Savings Account No.46767479 1.03 8 2005 Honda Accord 2,500.00 9 Delaware Division of Revenue-Refund 401.00 10 U.S.Treasury-Refund 1,662.20 TOTAL(Also enter on Line 5, Recapitulation) 13,305.50 (If more space is needed,additional pages of the same size) Copyright(c)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev.08-12) REV-1511 EX+(68.13) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RESIDENT DECED NTTURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Chiappone, Philip Adam 21-15-0326 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 4,129.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Philip J Chiappone. Street Address 327 Antilles Court city Mechanicsburg state PA ziD 17050 Year(s)Commission Paid 2015 665.00 2. Attorney's Fees Daley Zucker Meilton & Miner, LLC 1,000.00 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 15.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 3,340.20 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 9,149.20 Copyright(c)2013 form software only The Lackner Group,Inc. Form PA-1500 Schedule N(Rev.08-13) ' ' SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Chiappone, Philip Adam 21-15-0326 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 BuO5850.00Burial 2 Cremation Society ofPennsylvania 1.985.00 3 Headstone 844.00 ' 4 Interment 458.00 H,4 4`129.00 Other Administrative Cost 5 Facsimile expenses'Notification ofCalifornia Department ofChild Services of death, 48.11 Notification of Southwest Credit(Comcast),Account dispute details to Southwest Credit <Comommt. Notification ofProgressive,West Asset Management and FBC8 6 Laga|f000 -Poroum&Heim 2.188J5 ` 7 Mileage reimbursement for trips to Decedent's apartment to clean/close.out-436 miles x IRS 250J0 mileage reimbursmentrate of5T5cents. 8 Progressive4�G Automobi|o|neu»snno .31 9 RnodsideReacue-Reiheva| ofHondafnzmtowingoendoe 225.00 10 U'Hou|'Move items from Delaware apartment 171.43 1-1-137 3.34O.2D . Lackner� Inc. vnnpA4soo�roadu�Hy�ev s�u Copyhgm��2oVu�nn�o�waeon�The�acune mmp. w� �v�o | Rev-1512 EX+(12-12) SCHEDULE pennsylvania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Chiappone, Philip Adam 21-15-0326 Report debts incurred bythe decadent prior to death that remained unpaid atthe date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 2014 Pennsylvania Income Tax 287.00 2 ATAT Wireless 116.43 3 Comcast 29.70 4 Pennsylvania Department of Revenue-Penalty for late payment of 2014 personal income 12.27 taxes 5 USAA Credit Card Account No. 3523130135320434 1,126.00 TOTAL(Also enter on.Line 10, Recapitulation) 1,571.40 (If more space is needed,additional pages of the same size) Copyright(6)2012 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-12) REV-1513 EX+(01-10) - Ivania enns . � p Y SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Chiappone, Philip Adam 21-15-0326 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSONISI RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Trustee(s) I. TAXABLE DISTRIBUTIONS (include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] Jacob Chiappone Son 2,584.90 c/o Collen Conroy 8400 Ancho Way Elverta, CA 95626 Total 2,584.90 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate. NON-TAXABLE DISTRIBUTIONS: II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART Ili-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ;opyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)