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Home My WebLink About01-18-07 CHARLES W. RUBENDALL II ROBERT L. WELDON EUGENE E. PEPINSKY. ..JR. ..JOHN H. ENOS m GARY E. FRENCH DONNA S. WELDON BRADFORD DORRANCE ..JEFFREY S. STOKES ROBERT R. CHURCH STEPHEN L. GROSE R. SCOTT SHEARER ELYSE E. ROGERS CRAIG A. LONG YEAR ..JOHN A. FEICHTEL DONALD M. LEWISlII STEPHANIE KLEINFELTER ERIC R. AUGUSTINE TODD 1". TRUNTZ CAROL L. VERISH KEEFER WOOD ALLEN & RAHAL, LLP ATTORNEYS AT LAW 635 NORTH 12TH STREET, 4TH FLOOR LEMOYNE. PA 17043 ESTABLISHED IN 1878 01" COUNSEL: HEATH L. ALLEN N. DAVID RAHAL SAMUEL C. HARRY PHONE 717-612-5800 FAX 717-612-5805 EIN No. 23-0716135 www.keeferwood.com HARRISBURG OFFICE: 210 WALNUT STREET HARRISBURG, PA 17101 PHONE 717-255-8000 901-7786 255-8037 skleinfelter@keeferwood.com Fax: 612-5805 January 18, 2007 Cumberland County Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Ann Mazzarella, Deceased P A Inheritance Tax Return No. 21-06-00962 Dear Sir/Madam: I have enclosed for filing two original Pennsylvania Inheritance Tax Returns and one Inventory. I have also enclosed a $34.12 check in payment of the balance of the tax and a $30 check in payment of your filing fees. Please file these documents and date stamp and return the enclosed copies thereof for my records. Thank you in advance for your assistance in this matter. SK/waw Enclosures cc Wallis Ann Wirth Sincerely, ,.....::) KEEFER WOOD ALLEN & Rl\lJA.L, LLPfg ~- ~ (0 ~ . : --)J ~.;: By s~;;~Lnfe;ter' '. ~.~ ~ -u -, -- r:-:" .!=" N -I 15056051058 REV-1500 EX (06-05) PA Department of Revenue . Bureau of Individual Taxes ' PO BOX 280601 Harrisburg, PA 17128-{)601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT File Number 21 06 00962 Date of Birth 167 -03-4838 10/14/2006 12/08/1917 Decedent's Last Name Suffix Decedent's First Name Mazzarella Ann (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW :.:> 1, Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2, Supplemental Return 3, Remainder Return (date of death prior to 12-13-82) 5, Federal Estate Tax Return Required 4, Limited Estate 4a, Future Interest Compromise (date of death after 12-12-82) 7, Decedent Maintained a Living Trust (Attach Copy of Trust) 10, Spousal Poverty Credit (date of death 11, Election to tax under Sec, 9113(A) between 12-31-91 and 1-1-95) (Attach Sch, 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number ~ n = co; 0 -.J REGISTER OF ~~~.~. ONL~:: . -I-rl - _oj CO c.:: 6, Decedent Died Testate (Attach Copy of Will) 9, Litigation Proceeds Received 8, Total Number of Safe Deposit Boxes Stephanie Kleinfelter Firm Name (If Applicable) Keefer Wood Allen & Rahal, LLP First line of address 635 N, 12th Street Second line of address Suite 400 City or Post Office Lemoyne State DATE FILED ZIP Code PA 17043 Correspondent's e-mail address: 17055 ad Allen & Rahal, LLP, 635 N. 12th Street, Suite 400, Lemoyne, PA 17043 PLEASE USE ORIGINAL FORM ONLY o L 15056051058 Side 1 15056051058 --1 -0 '" .1:- w: MI MI -', 9 --1 15056052059 REV-1500 EX Decedent's Name: Ann Mazzarella 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 & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. 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 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 8. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10)................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Govemmental Bequests/See 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. TAX COMPUTATION - 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_ 16. Amount of Line 14 taxable at lineal rate X.O!iS' 187,704.20 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 167-03-4838 Decedent's Social Security Number 0.00 0.00 0.00 0.00 13,858.76 150,109.03 35,033.63 199,001.42 9,708.78 1,588.44 15056052059 11,297.22 187,704.20 0.00 187,704.20 8,446.69 8,446.69 --' REV-150e EX Page 3 Decedent's Complete Address: File Number ... DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER Ann Mazzarella 167-03-4838 STREET ADDRESS 1100 Grandon Way #406 CITY I STATE ZIP Mechanicsburg I PA 17055 I 21 06 00962 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 8,446.69 7,968.02 444.55 3. InteresVPenalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) 8,412.57 Total Interest/Penalty ( D + E ) (3) 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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 34.12 0.00 34.12 0.00 34.12 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 00 c. retain a reversionary interest; or.......................................................................................................................... 0 [iJ d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 00 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 00 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 ~ 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 three (3) percent [72 P.S. 99116 (a) (1.1) (i)J. 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 zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)J. 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. 99116(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 four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use ofthe decedent's siblings is twelve (12) percent [72 P.S. 99116(a)(1.3)J. 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..508 EX+ (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Ann Mazzarella FILE NUMBER 2106-00962 ITEM NUMBER 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. DESCRIPTION VALUE AT DATE OF DEATH 1. Commerce Bank Checking Account #0537153652 Principal $13,857.86 .90 13,858.76 Accrued Interest TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 13,858.76 REY-""" EX. '0_"'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF Ann Mazzarella A. Wallis Ann Wirth SURVIVING JOINT TENANT(S) NAME If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER 21 06-00962 ADDRESS RELATIONSHIP TO DECEDENT 680-13 Geneva Drive, Mechanicsburg, PA 17055 Daughter 8, C. JOINTLY-OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 01/14/98 Parkvale Bank-Certificate of Deposit No, 104096542 Principal $21,999.00 Accrued Interest 6.48 22,005.48 50 11,002.74 2. A 01/14/98 Parkvale Bank-Savings Account No. 56630 Principal $11,816.92 Accrued Interest 2.75 11,819.67 50 5,909.84 3. A Parkvale Bank-Checking Account No. 22438208 13,580.86 50 6,790.43 4 A Commerce Bank-Premier Savings Account No. 0626815963 Principal $126,273.33 Accrued Interest 132.69 126,406.02 100 126,406.02 TOTAL (Also enter on line 6, Recapitulation) $ 150,109.03 (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (6-98) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Ann Mazzarella This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. FILE NUMBER 2106-00962 DESCRIPTION OF PROPERTY ITEM INCLUOE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO OECEOENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1. Parkvale Bank-Certificate of Deposit NO.1 08005242 ITF Wallis Ann Wirth-Daughter Principal $30,433.08 Accrued Interest 574.58 31,007.66 100 0.00 31,007.66 2. Parkvale Bank-Certificate of Deposit No. 108005243 ITF Wallis Ann Wirth-Daughter Principal $3,999.00 Accrued Interest 35.97 4,025.97 100 0.00 4,025.97 TOTAL (Also enter on line 7 Recapitulation) $ 35,033.63 (If more space is needed, insert additional sheets of the same size) REV-1,511 EX+ (12-99* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Ann Mazzarella FILE NUMBER 2106-00962 ITEM NUMBER A. Debts of decedent must be reported on Schedule I. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: John F. Slater Funeral Home, Inc., Pittsburgh, PA Enterprise Rent-a-Car, Pittsburgh, PA-Funeral expense Pittsburgh burial Comfort Inn, Pittsburgh, PA-Funeral expense incurred by daughter/Executrix for Pittsburgh burial 7,727.91 195.59 328.28 2. 3. B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions WatvE'd 0.00 Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City . Slate Zip Year(s) Commission Paid: 2. Attomey Fees KE'E'fE'r Wood AllE'n & Rahal, LLP 1,200.00 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 0.00 60.00 4. Probate Fees 5. Accountant's Fees 125.00 6. Tax Return Preparer's Fees 7. Cumberland County Register of Wills Short Certificates, JCP fee, Will, Automation Fee Cumberland County Register of Wills-PA Inheritance Tax Retum and Inventory filing fees 42.00 30.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9,708.78 . . REV.1512 EX+ (12-{)3) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Ann Mazzarella Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH FILE NUMBER 2106-00962 1. West Shore-ALS-Medical expense 2. West Shore-ALS-Medical expense 640.38 3. West Shore EMS-Medical expense 625.70 4. Verizon-telephone service 70.12 5. Roy Monsour, MD, PC-Medical expense 22.00 6. Lower Allen Township Emergency Medical Service 61.69 7. Susquehanna Internal Medicine-Medical expense 25.00 8. Neighborcare York-Medical expense 15.00 128.55 . TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,588.44 . . REV-1~13 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Ann Mazzarella SCHEDULE J BENEFICIARIES FILE NUMBER 2106-00962 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE r TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Wallis A. Wirth, 680-13 Geneva Drive, Mechanicsburg, PA 17055 Daughter 187,704.20 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II 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-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Ann Mazzarella No. 21-2006-00962 also known as Date of Death October 14, 2006 Social Security No. 167-03-4838 , Deceased Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/W e verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Stephanie Kleinfelter 1.0. No.: 80089 Address: Keefer Wood Allen & Rahal, LLP 635 N. 12th Street, Suite 400 Lemoyne, PA 17043 Telephone: 717-901-7786 Dated: January 17, 2007 Description Value Commerce Bank Checking Account No.: 0537153652 Principal $13,857.86 Accrued Interest .90 $13,858.76 (j r-- ri; '::'l"J .../'. (Attach Additional Sheets if necessary) Total: $13.858.76 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Form RW-7 (Cumberland County - Rev. 9/92) I'J = = -.J L. ~I~.~ -,.,.. .a- co I:J :J.t N .j:"" W C;\ r ,/39'tflSOd sn I ! M?/ 01 .... 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