HomeMy WebLinkAbout08-10-05 (2)
ROBERT R. SCBOSTBR
Attorney at Law
1204 Map1e Street
Beth1ehem, Pennsy1vania 18018
Te1ephone (610) 691-0200
Fax (610) 866-8661
August 6, 2005
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ENCLOSURE MEMO
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TO:
Ms. Glenda Farmer Strasbaugh
Clerk of Orphan's Court
1 Court House Square
Carlisle, PA 17013
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Re: Estate of Margaret M. Marsicano 0'
Dear Ms. Farmer Strasbaugh:
Enclosed please find the following:
(XX) Petition for Settlement of Small Estate (original and
copy) (please return a time stamped copy to me in the
envelope provided)
(XX) Estate Information Sheet (original and one copy)
(XX) Inheritance Tax Return )original and one copy)
(XX) Trust Check in the amount of $45.00 for the filing fees
(XX) self-addressed, stamped envelope for your office use
If I have omitted anything necessary to have the Petition
considered and signed by the Judge of the Court, please contact my
office.
Thank you for your kindness and assistance.
TIL :;?/lS;--.
RObe::1f.&schuster
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IN THE COURT OF COMMON PLEAS
ORPHAN'S
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OF CUMBERLAND COUNTY,:PJgJNSI;VAI<f;rJtS
COURT DIVISION . ,>~ C) C)
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No.~ '~95 - 'I ~:~
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In the Matter of the Estate of
MARGARET MARSICANO
deceased
Petition for Settlement of Small Estate Pursuant to
Section 3102 of the Probate, estates and Fiduciaries Code
TO THE HONORABLE, THE JUDGE OF SAID COURT:
The Petition of the Undersigned respectfully represents:
1. The name, address and relationship of your Petitioner to
the above decedent are:
Name: Robert R. Schuster, Esquire
Address: 1204 Maple Street, Bethlehem, PA 18018-2925
Relationship: Pa. DPW Estate Recovery Program (A copy of
the letter from the Commonwealth of Pennsylvania is attached,
labeled EXHIBIT 1.
2. The above decedent died on July 18, 1999, a resident of
Mechanicsburg, Cumberland County, Pennsylvania. A copy of the death
certificate is attached, labeled EXHIBIT 2.
3. Said decedent died intestate.
4. The names, relationships and interests of all parties
interested in the estate are:
NAME
RELATIONSHIP
INTEREST
SUI JURIS
no known heirs
5. The following person is entitled to, and claims, the
family exemption by virtue of being a member of the same household
as the decedent: No one
6. Said decedent died owning property (exclusive of real
estate and of wages, salary, pension or vacation benefits) of a
gross value not exceeding $25,000.00, which is itemized as follows:
ITEM AMOUNT
Federal Employees' Group Life Insurance (19990064639)
$4250.00
7. An itemized statement of all claims against the estate is
as follows:
a. Claims heretofore paid by to the following:
CLAIMANT NATURE AMOUNT
Neill Funeral Home funeral $6780.00
A copy of the funeral bill is attached, labeled EXHIBIT 3.
b. Claims remaining unpaid:
CLAIMANT NATURE AMOUNT
Commonwealth of Pennsylvania long term care $163,810.18
A copy of The Department of Welfare's Statement of Claim is
attached, labeled EXHIBIT 4.
Robert R. Schuster
Robert R. Schuster
Petitioner's fee
$1000.00
$ 30.00
$ 15.00
$1045.00
filing fee (petition)
Robert R. Schuster
TOTAL
inheritance tax return
8. The Petitioner will cause to be paid all Pennsylvania
Inheritance taxes due on all property to be awarded. A copy of the
Inheritance Tax Return is attached hereto, labeled EXHIBIT 5.
9. All parties beneficially interested in the estate other
than the Petitioner have been mailed a written notice of the date
when this Petition will be presented. There are no known heirs.
WHEREFORE, your Petitioner prays that the above property of
the decedent be distributed under Section 3102 of the P.E.F. Code
as follows:
a. On account of the family exemption: Not applicable
b. In reimbursement of claims against the estate
heretofore paid: Not applicable.
c. For payment of claims against the estate remaining
unpaid:
NAME
AMOUNT
Commonwealth of Pennsylvania
$3205.00
$1000.00
$ 45.00
Robert R. Schuster, Esquire (fee)
Robert R. Schuster, Esquire (costs)
d.
In distribution in accordance with the interests in
the estate:
None
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Petiti
PA Bar 0 Number: 23774
1204 Maple Street
Bethlehem, PA 18018-2925
610-691-0200
Fax: 610-866-8661
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VERIFICATION
This day of August, 2005, the foregoing Petitioner hereby
verifies, subject to the penalties of 18 Pa. C.S. 4994 (relating to
unsworn falsification to authorities) that the facts set forth in
the foregoing Petition which are within his knowledge are true, and
as to the facts based on information received, after diligent
inquiry, he believes them to be true.
..
COMMONWEAL1H OF PENNSYLV ANJA
DEPARTMENT OF PUBUC WELFARE
BUREAU OF FINANCIAL OPERATIONS
DIVISION OF 1HlRD PARTY UABlUTY
PO BOX 8486
HARRISBURG, PA 17105
Date: July 26, 2005
ROBERT R SCHUSTER, ESQ.
1204 MAPLE STREET
BETHLEHEM PA 18018
RE:
CIS:
SSN:
000:
MARGARET MARSICANO
100134143
203-10-1098
07/18/1999
Dear Mr. Schuster:
The Department of Public Welfare is responsible for the implementation
and operation of Pennsylvania's Medical Assistance Estate Recovery Program.
(62 P.S. 1412.) The Medical Assistance Estate Recovery Program is a
Federally-mandated program requiring recovery of medical assistance from the
estates of deceased individuals age 55 and older who received nursing home
care, home and community-based services or related hospital and prescription
drug services on or after August 15, 1994.
In operating the program, we must dispose of estates that remain
unadministered throughout the Commonwealth. The Department's new regulations
authorize referral of these cases for administration to the probate and
estates sections of local county bar associations.
In previous conversation with you, you have agreed to handle the cases
for Cumberland County. We are now forwarding to you the unadministered
estate cases; with all the attached information we have in our file.
A reasonable administrator's commission and attorney's fee may be
charged to the estate as expenses of administration, but may not exceed a
combined fee of $1,000, or 6% of the gross assets of the estate, whichever is
greater. (Other administrative costs associated with filing for
administration will be dealt with on a case-by-case basis.)
Thank you for your willingness to cooperate with the Department in this
matter. You may receive referrals at a later date as they are identified. If
you have any questions, do not hesitate to contact Carol Beery at (717) 772-
6245.
Sincerely,
/; . /
{~1CL.i/te,j.. 1t/ ~~/~
Charles Jones f
TPL Administrator
Enclosure
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0292
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GUARANTIED FUNERAl GOODS AND SEIVlaS
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Embalming ~ M;IIIUfacturer: ~alCSViJIe
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NON-GUARANTHD CAsH AOVANCE 11'fMS
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COMMONWEAl.. TH OF PENNSYLVANIA
DEPARTMENT OF PUBLIC WELFARE
BUREAU OF FINANCIAl. OPERATIONS
1PL SECTION. CASUAL TV UNIT
PO BOX 8486
HARRISBURG PA ln05-ll486
June 6, 2001
STATEMENT OF CLAIM SUMMARY
Estate of MARSICANO. MARGARET
100134143
INPATIENT
OUTPATIENT
LONG TERM CARE
DRUG
.00
.00
.00
.00
139,577.98
104.08
.00
.00
23.882.54
163,460.52
349.66
245.58
24,128.12
139,682.06
163,810.18
~ J'. },J, f3 I T <-/
REY-t5aD EX (&881
* COMMONwEH.11'IOF
PENNSYlVANIA
DEPNmIENT rE' REVENUE
DEPT. 2lII8l1
HARRISBURG, PA 1712&-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
_ 05
COOiiiY CllOE Y&\R
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SOCIAL SECURITY NUMIlER
203-10-1098
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DECEDEH1'S NAME (lAST. FIlST. AND MIDOl.E lNlTlAL)
Marsicano, Margaret M.
DAlE OF lEATH ~YEAR) Ilo\lE Of IIIUH (W-OO-VEAR)
07/18/1999 04112/1913
(IF APR.JCABLE) SURVMNG SPOUSE'S NAME (LAST. FIlST, AND MDX.E INITIAL)
none
THm~~W~MRm~~lEMTHTHE
REGISTER OF WILLS
SOCIAL SECURIlY NUMBER
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1. Real EsIaIe (Sc:hetil AI
2. Sb:ks and BcnIs (5cheIUe B)
3. Closely Held CorpoIalIon.I'ln1eI~ or SclIe-I'roIlIieIlll~
4. Mortgages & Noles R8aIIvaIlIe (Sc:I1lltiI 0)
5. Cash. IIIriC Deposits & MIo...lIIl...- I'eIsonaI Propsty
(SdlecUe E)
6. ~ Owned Property (Sc:I1lltiI F)
o SepanIle BIing Requested
7. Inler.Vivos TransfeIs & IolIscsIaneous Non-l'rolJ8le Propsty
(ScheI:IIE G or L)
8. ToW Grass Auelll (lDIaI1.i1es 1.7)
9. FmeraI ElIpIlIIS8S &~ Cosls (Sdledule H)
~ ~ 1.OrIginlIIRelum 0 2.~ReIIm 03.RemailderRelum1d8lool_prio.Io12-13l12)
"'~!i2 0 4.LinIledEslale 04a.f1anInlenlslCompromise('*0I__12-1H2) 05.FederalEstateTaxRellmReqund
~~8
li If ill 0 6. DecedIInIIlied Teslal8 .-_oIW11l 0 7. Decedenl t.IaiIlIined 8 LMngTIUSl.-_oITMQ 8. TOIaI Number 01 Sale DepoeiIllox8s
~ 09.l.iIlgaIIanPnlc8edsRacaived 010.SpousaIPI:NerlyCnldil'-0I__,2-31-91...1'1-95) 011.EJecIiontotaxunderSec:.9113(AI.-SdlOl
!Z .~~IIUST8E COIIPLETED. ALL ccJRRE8PC)NDENC AND CONI'IDEN'fW. tAX lNI'ORIIA.11ON SHOULD !liE: ~ TO:
l!: NAME COMPLETE MAlUNGADDRESS
~ Robert R. Schuster. Esquire 1204 Maple Street
= FIRIoINAME\I".,.,..,..' Bethlehem, PA 18018-2925
II:
I!i lE1.EPHONE NUMBER
u (610) 691-0200
10. DebIs 01 0ec:elIlR. MorIgage UabIIies. & Liens (Sc:hetill)
11. ToW DeductIons (lDIaI1iIes 9& 10)
12. Net Value of Es1aIII (Li1e 8 mIros line 11)
13. 0l8IilabIe and GovemmenlaI BequesIs/Sec 9113 TMls forwlich an eladlan to lax hBsnolbeen
made (ScheI:IIE J)
14. Net Value Subject \0 Tu (Li1e 12 mIros line 13)
(1)
(2)
(3)
(4)
(5)
11,030.00
(6)
(7)
(9)
(10)
(8)
7,825.00
163,810.18
(11)
(12)
(13)
11,030.00
171,635.18
-160,605.18
(14)
0.00
SEE INSTRtICTIONS ON REVERSE SIlE FOR API'\.JCAB\J: RATES
15. Amou1l 0I1..iIe 14 taxaIIle at the spousaIllIX
raIlI. cr lranSfers ooder Sec. 9116 (8)(1.2) ___._.__.._.__..___ 1 .0____ (15)
16. Amou1lofUne 14 taxaIIle atlineel raIlI
_......._________.__....__ ... 1 .0 _ (16)
__1.12
(17)
(18)
(19)
0.00
._.____.___ 1.15
19. Tu Due
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17. Amou1l 01 line 14 taxaIIle at sIlIir'J raIe
18. Amou1l 01 Une 14 taxaIIle at c:oIlal8faI raIe
20.0
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Decedent's Complete Address:
I:-~-
Tax Payments and Credits:
1. Tax Due (Page 1l.i1e 19)
2. CredilslPayments
A. Spousal PtMllty Credit
B. Prior Payments
C. 0iscIllInI
3. InlenlstJPenalIy If appbblB
D.1nleIesI
E. Penally
, SllVEpA
I ZP 17055
(1)
0.00
Total Credits ( A + B + C ) (2)
0.00
ToIaIlnIerestIPenaIl ( D + E ) (3)
4. If l.iIe 21s fjI8BlBr than l.iIe 1 + l.iIe 3. enler!he diII8nInca. This is !he OVERPAYIIENT.
ChecII boll on Page 1 line 20 to NqUeSt . refund (4)
5. If Une 1 + Line 3 is fjI8BlBr than l.iIe 2, enter the diIfeI8nce. This is lIIe TAX DUE. (5)
0.00
0.00
A. Enter the interest 00 !he laX due.
(5A)
B. Enter the total cJ Line 5 + 5A. This Is lhe lW..ANCE DUE. (58)
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 tJan5l'er and: Yes No
a. retain Ihe use or income cJ lhe property lrallsrened;.......................................................................................... 0 [iJ
b. retain !he right to designaIe who shal use lhe property transferred or its income; ............................................ 0 [iJ
c. relain a reversionary inleIBSl; or.......................................................................................................................... 0 iii
d. receive the promise for life of eiIher plIymenls, benefits or care? ...................................................................... 0 [iJ
2. If death occurred aller 0ec:enDlr 12, 1982. did decedent transfer property within one year of death
wilhoul receiving adequate c:oosideraIion? .............................................................................................................. 0 [iJ
3. Did decedenlllWl1 an 'in lrusI for" or payable upon death bank acx:ount or security at his or her death? .............. 0 00
4. Did decedent llWI1 an Individual ReIiemenl Aa:ount. amity. or olher non-probale property whlch
coolains a beneficiary designation? ............................................................._.................................................... 0 [iJ
IF THE ANSWER TO Atf'f OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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0II:lInlI0n ri................- ..........It _...11 infanIIIlIan ri_ ,....................
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1204 ~pIe Street,_8I!Ih1eherrl~fJ,o.J~...!8-2925__......_ .... ....__________.._. ........__..__._..__.
SIGNATURE OF PREPMER OTHER THAN REPRESENTATIVE DATE
0.00
ADDRESS
For dales of death on or alter July 1. 1994 and bebe January 1. 1995. lhe laX I8lB ~ on lhe net value of transfers to or for !he use or lhe SIniYing spouse is 3%
[72 P.S.19116 (a) (1.1) (i)~
FordatBs of dlIaIh on or alter January 1, 1995, the tax 1lIlII...- on !he net value oftlanslars to or for the use of the suIYMng spouse is 0% [72 P.S. 59116 (a) (1.1) (i)~
The statute doss IIIllIlXllllllll a lnI1Sfer 10 a suMving spouse fIlIm lax, and lhe slaIuk:Iy requi"emenls for discIosuIB or assets and ftIing a laX return ara sliI applicable even if
the survMng spouse Is the rriy belleficialy.
For d8Ies II dedi on or aIIer JWy 1. 2000:
The laX rate inposed on lhe net value of transfers from a deceased chid IwenIy-OIle }'BIllS d age or Y\UIQllI' at death to or for lhe use d a natural parent, lI'I adoptive parent,
or a sIllppIIrlInl d the child is 0% (72 P.S. 59116(a)(1.2)1.
1he tax rate inJ,losed on the net value ofllansl'els to or rorthe lIllII oflhe decedelts ineal bellellcialies is 4.5%, except lIS noIed in 72 P.s. 59116(1.2) [72 P.S.59116(a)(1)).
The tax I8lB inposed on the net value d lr81Sfers to or for the \IIlI of lhe dealderts sibIngs is 12% (72 P.S. 59116(a)(1.3)]. A slbIIng Is defined. under SecIIon 9102, lIS lI'I
individual who has alleast one palllllt In common wiIh the dec:8danl. whelhlIr by blood or.......
REV-1508EX+(8-llII} .. .
COMMONWEALTH OF PENNSYLVANIA
INHERI1l'NCE TAX RETURN
RE5IOeIT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTAlE OF
Margaret M. Marsicano
FILE NUMBER
2005-
Indude lie ~ _....._ lie .....1Ie ~ __.... by lie eII8le.
AlII"Il*tr ~ _.Id ... ......of_lII..... -.tilt dIBcIaulIlIIIlIcIIIdlIIe F.
VALUEAT DAle
OF DEATH
6,780.00
4,250.00
ITEM
NUMBER DESCRIP110N
1. FonllhOUght UJeInllllanc:e Co.(Pu/il:y#1282872) (pre-pIId fInraI poky)
2. FedlnI Eal~yees Group UJe In8unIll:e (19990064639)
1UW. (AIIo enler on line 5, Rec8pilJIIsdinn) $
(Jr-..... Is needed. m-t........1IIeIlS -... _..)
11,030.00
~1&11 ex. (1lM1ll)*
COMMONWEALTH OF PEHNSYI.YNIIA
INHEfII1>>ICE 'OOC REnJAN
RESIDENT DECEDENT
ICHIDULI H
FUNERAL EXPENSES &
ADMINIS1IA1IYE COSTS
ESTAlE OF
Margaret M. Marsicano
FLE NUII8ER
2005-
DIllIf fII.......lIIlIIl.. nparIId GIt SaIIeduIlt L
ITEM
NUMBEFl
A.
....,.,.......-,IUI'I
AMOUNT
1.
FUNEIW. EXPENSES:
The Nell Funeral Home (3401 Market SIIeet, c.np tB, PA 17011)
6,780.00
B. ADMINISTRATIVE COSTS:
1. I'lInalIII ~.. CI.no......
NItRe rI,...... """_....WI(s)
Soc:itII S8cldy ~ .....rll'WnanII """........I8(s)
Slnt8tAddl.-
CIy
Yelt(s) CatmIIIIIan PIIId:
. SI8Ie
Z4J
2.
,...,~
1,000.00
3. "."..,~ (If dtJlledIlIll's ___Is 1IIll.. _ .dIIIl81r's.lIIIII:It ............)
CII/n8II
SlnletAdd8s
CiIy
RllIIlIi.o.... Ii CIIIIm-' III DecedeIlI
SI8Ie
.ZIP
45.00
~.
Pnlb8Ie ~
6. ~~
6. 1iIx RsIum ......... ~
1.
1UI'AL (A/lIo enIBr on line 9. Rec:llplbtlalJnn) $
(11-...... need8d. i-' 8dIMlonII....... oI1he .... 8i28)
7,825.00
-...mEX>\1M31 *
CXM<<JJl'iJEN.TH OFPEJNJYlWM
NERI1MCEWtREl'lRl
RESlENTIlBBIBfI"
__DULl I
DEBJS OF DECEDENT,
MOIIGAGE UA8IJTIES, & lENS
ESTAlE OF FIll NUIIIIER
Margaret M. Marsicano 2005-
RIpart dIbl8 IncUrl'Id by .. dIc8dInt prior. dIIIII wNcIt ........1IIlplIId . of lhe ... of'" including lIllIlIImbunlId medIcII......
IlEM VALUEAT DATE
NUIIIlER ~ OF DEATH
1.
PA 0epII1m8Ilt of PubIc WeIfln: Thid ~ I..iBIay (mIdicaI.....;.,.. ..ICe)
163,810.18
TOTAL (Also enIllr online 10, Recapih1lBtPl) $
lI-tp11C8 is.................... of.. ---,
163,810.18
-'15'1SEll+\lloOOl ..
COMMQllIWEN.lH OF PBIISYLWM
IIIIERItW:E we RE1tJRN
IlEliIDENT DECEDeNT
SCHEDULE ,
BENEFICIARIES
ESTATE OF
Margaret M. Marsicano
FR.E NtIII8m
2005-
NUMBER NAME NiD AIlIlRESS OF PER8ON(8) AECEMNG 1'AIOrI:K, r
I mcAII.E IlISTR8ITIONS Ihfuda auIIIgIII........ - . ...............
See. 9118 (8) (1.2))
1. No known be......_
REI.AlJONSHIP TO oeceoeNT
Do Not LlltTruall(s)
AMOUNT OR SHARE
OF ES1lI.1E
ENTER DOUARMKJUml FOR DISTRIlUl10NS SHOWNN/INE ON LINES 151HROUG1f 18.MIiPPROI'RIAlE, ON R!V-15Ol1 COlIER SHEET
D NON-TAXAIIlE IlIlITRIIIUTlON
A. SfIOlJIlAI.. DISTRIlUl10NS UNDER SECnON 9113 FOR WHDIM B.ECl1ON TO '00( IS NOT Il6NG MADE
B. QWlI1MI.ENiD GO'tBVlIIENIN. DISTRIlUl10NS
lOTAL OF PARI" - ENTER TOTAL NON-TAXAIllE DISfRIIlU110NS ON LINE 13 OF REV-1511O COVER SHEET $
(If _ sp.-ls IlllICIlId.Ir-' BdlDnII...... <<the - 8Ize)
0.00
o
RE\L1500 EX (&00)
'* COMMONWEALTHOF
PENNSYlVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARfUS8URG.~171~1
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (lAST. FIRST, AND MIDOlE INITIAl)
Marsicano, Margaret M.
DATE OF DEATH (MM-OO-YEAR)
07/18/1999
DATE OF BIRTH (MM-OO-YEAR)
04/12/1913
FILE NUIIBER
~I--~~
COUNTY CODE YEAR
/2.O-rJL.i
NUMBER
SOCIAL SECURITY NUMBER
203-10-1098
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (lAST, ARST, AND MIDOlE INmAL)
none
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[i] 1. Original Return 0 2 SuppIemenIal Return
o 4.liniI8d EsIale 048. Future Interest Comprorrise (""'''__'2.12-82)
o 6. Decedent Died Testate (__"VIiI) 0 7. Decedent Mainlaileda UvilgTRJSt(Alloch_"T""')
o 9. Utigation Proceeds Received 0 10. Spousal P<werlyCr8ditC....."__'2-31-91...,.'.Q5j
1HI18CmDIf,....,...~AU..
NAME
Robert R. Schuster. Esquire
ARM NAME (W_I
o 3. RemainderRetum (daIo"dealh prb" 12-1:Hl2)
o 5. Federal Estate Tax Return Required
8. Total Number of Sale Deposit Boxes
o 11. EIecIIontotax under Sec. 9113(A)(_SdlO)
l1li
COMPLETE MAILING ADDRESS
1204 Maple Street
Bethlehem, PA 18018-2925
TELEPHONE NUMBER
(610) 691-0200
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held CoIporation, PaI1nership or SoIe-Proprieton
4. Mortgages & Noles Receivable (Schedule D)
5. Cash, Bank Deposits & MlsceIlaneous Personal Property
(Schedule E)
6. JoinUy Owned Property (Schedule F)
o Separate BiIing Requested
(1)
(2)
(3)
(4)
(5)
11,030.00
(8)
(7)
7. Inter-V1YOS Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross AneIs (totall.i1es 1-7)
9. FOO8IllI Expenses & Administrali'le CosIs (Schedule H)
10. DebIs of Decedent, Mortgage Uabililies. & Liens (SdleWle I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 mioos Line 11)
13. Charitable and Governmental BequestslSec 9113 Trusts Inrwhich an election to tax has not been
made (Schedule J)
(8)
7,825.00
163.810.18
(11)
(12)
(13)
(9)
(10)
14. Net Value Subject to Tax (Line 12 minus Une 13)
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SEE INSTRUCTIONS ON REVERSE SIDE 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. AmoI.fIt of Line 14 taxable at lineal rate
x.O~ (16)
17. Amount of Line 14 taxable at sibling rate
x .12
18. AmoI.fIt of Line 14 taxable at coHateral rate
x .15
19. Tax Due
20.0
CHECK HERE IF YOU ARE REQUESTING ^ REFUND OF AN OVERPAYMENT
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(14)
(17)
(18)
(19)
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171,635.18
-160,605.18
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11,030.00
0.00
0.00
Decedent's Complete Address:
SlREET ADDRESS
1000 East SimDllOFl Street
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CITY Mechanicsburg
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CredilsIPayments
A. Spousal Poverty Cred~
B. Prior Payments
C. Discount
I STATEpA
I ZIP 17055
Al, fJ. p ])
(1)
0.00
Total Cred~ (A+ B + C)
(2)
0.00
3. InterestlPenalty W applicable
D. Interest
E. Penalty
~
TotallnterestJPenalty ( D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund
(3)
(4)
(5)
(SA)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
0.00
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + SA This is the BAlANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
[!]
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN nxn IN THE APPROPRIATE BLOCKS
1. Did decedent make a IIansfer and: Yes No
a. retain the use or income of the property IIansferred;.......................................................................................... 0 Ii]
b. retain the right to designate who shaN use the property transferred or ~ income; ............................................ 0 Ii]
c. retain a reversionary interest; or.......................................................................................................................... 0 IiJ
d. receive the promise for life of either payments. benefits or care? ...................................................................... 0 IiJ
2. If death occurred after December 12. 1982. did decedent IIansfer property within one year of death
wilhoul 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? .............. 0
4. Did decedent own an Individual Retirement Account. annuity. or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0
lbIer~dpol)oy, 1_11I8I1_ -lhiII-,1ncIudiV .........~""""**'" 11III........11III III lie belt dmy IcnowIodgo 11III boIIof,llI We, alINCIlIIII ~
IlocIMJIIan d pIllpII8r _lien lie peIIOI1lII...._..... it _ mol _ d wIlIch pIllpII8r"'lITf InMIedge.
~::~~'~GR~RN _________
~~ MII~ ~_~~~~~_'_j:>~_1801!t~~~5______ mn______
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
. Df'TEJ _
._-----------~---_._---_.
DATE
ADDRESS
,~t~
For dates of death on or after July 1. 1994 and before January 1. 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)).
For dates of death on or after January 1. 1995. the tax rate imposed 011 the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. ~116 (a) (1.1) (ti)).
The statute does not exemot a IIanstar to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax retum 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 chUd twenty-one years of age or younger at death to or for the use of a natural paren~ an adoptive paren~
or a stepparent of the child is 0% [72 P.S. ~9116(a)(1.2)).
The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%. except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use.of the decedenfs siblings is 12% [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.
4-.
REV-l508 EX+ (6-98) ..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Margaret M. Marsicano
FILE NUMBER
;),1 - 2005- 07 / :3
InchICle lIle proceeds of Iligation and lIle date lIle proceeds were I1IClII1IIId by lIle estate.
AI property jolndy-ownecl with light of survlwnlllp must be dlscloHd on Schedult F.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
1. Forethought Life Insunn:e Co. (Policy #1282872) (~ funeral parley)
2. Federal Employees Group Life Insurance (19990064639)
6,780.00
4,250.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert addltionaI sheets of lIle same size)
11,030.00
REV.1511 EX+ (12--99)W
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCe TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
RJNERAL EXPENSES &
ADMINISlRATIVE COSTS
ESTATE OF
Margaret M. Marsicano
FD.E NUMBER
::J 1- 2005- 07 I?>
Debl8 of decedInt must be reparted 011 Schedule L
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
The NeNI Funeral Home (3401 ~etSbeet, Camp Hill, PA 17011)
6,780.00
B. ADMINISTRATIVE COSTS:
1. PenIonaI R8pnlser\laIMl's Corrmlssions
Name of PenIonaI Replllselllali'le(s)
SocIal Securlly Ntmler(s)IEIN t<<Jrmer of PenIonaI RepI-*lMl(s)
Streel Address
City
Year(s) Commission Paid:
Slate
~
2.
AlIDmey Fees
1,000.00
3. FamIy Exemption: (If decedenl's address is nollhe same as clairnanl's, allach explanation)
CIeimanl
Streel Address
City
Relationship of CIaimanlIo Decedent
Slate
. Zip
4.
Probate Fees
45.00
5. Al:counlanI's Fees
6. Tax RaIum PnlpaIllr's Fees
7.
TOTAl (Also enter on line 9, RecapituIalion) $
(If more space is needed, insert additional sheets ollhe same size)
7,825.00
.
REV-1512 EX+ (12-<<1)
*'
leNIDULI I
DEBTS OF DECEDENT,
MORTGAGE UABlunES, & UENS
COMMONWEALTH OF PEMISYlVANIA
INHERITANCE TAX RElURN
RfSIlEHT DECEDENT
ESTATE OF ALE NUMBER
Margaret M. Marsicano ;;V - 2005- 07/0
Report debts Incurred by \he deGedent prior to deatll which remalned unJlllId as of the date of death, Including uMllmbursed medlcallXJllIIIUI.
ITEM VALUE AT DATE
NUMBER DESCRIPTlON OF OEAlH
1.
PA 0eplWnent of Public WeIfae: Third Plriy UabiIity (medical assistance)
163,810.18
TOTAL (Also enter on line 10, Recapitulation) $
(If more spac:e is needed. insert additional sheeIs of II1e same siZe)
163,810.18
.
REV.1513 EX. (9-m)
*'
SCHEDULE'
BENEFICIARIES
COMMONWEALlli OF PENNSYlVANIA
INiERlTANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
Margaret M. Marsicano J).J- 2005- () 7 I .~
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERlY Do Mat list Truat8e(1) OF ESTAlE
I TAXABlE DIS1RIIll1T1ONS rllldude oulrighl spousal disIributions. and lIansfels InIer
Sec. 9116 (a) (1.2)]
1. No known beneficiaries
ENTER DOUAR AMOUNTS FOR DIS1RIIll1T1ONS SHOWN ABOVE ON LINES 15 THROUGH 18, ASAPPROPRlAlE, ON REV-I500 COVER SHEET
B NON- TAXABlE DISTRIBUTIONS:
A. SPOUSAl. DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ElECTION TO TAX IS NOT BEING MADE
B. CHARITABlE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAl NON-TAXASlE DISTRIBUTIONS ON LINE 13 OF REV-l500 COVER SHEET S 0.00
(If more spaal is needed, Insert additional sheets of the same size)
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