HomeMy WebLinkAbout03-27-07
.....J
15056051047
REV.1500 EX (06-05)
PA Department of Revenue .
Bureau c:llndividual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
~ I C) (<6 "0 Co ~
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN '7(' ? M7
RESIDENT DECEDENT or I ~. VU
File Number
c1J
Date of Birth
o '1 I (
I~"~
0(0' 2\)01
Decedent's Last Name
LE.VlrJ
Suffix
Decedent's First Name
TtFF~EY
(If Applicable) Enter Surviving Spouse" Infonnation Below
Spouse's Last Name Suffix
Spouse's First Name .
Spouse's Social Security Number
THIS REruRN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
_ 1. Original Retum
c::> 3. Remainder Retum (date of death
prior to 12-13-82)
c::> 48. Future Inl:8restCompromlse (date of c::> 5. Federal Estate Tax Retum Required
death after 12-12-82)
c::> 7. Decedent Maintained a LMng Trust
(Attach Copy of Trust)
c::> 10. Spousal Poverty Credit (date of death c::> 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION .,ST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
LE. \I I tV 4 to: 01 ~ 0 I 0
c::>
2. Supplemental Retum
c::> 4. Llmll:8d Estate
c::>
6. Decedent DIed Testate
(Attach Copy of WlI)
9. litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
c::>
&~E. fr
fY\
Firm Name (If Applicable)
E. '" E.. c..UT 0 ~ () F
REGISTER OF WILLS USE ONLY
t 5'- A T~
l".')
=
~
--..J
:J!::
:t:;....
::::0
N
-.!
First line of address
,::-)
~~~
Cl) 7~
\ () 0 ~ 0
~~€f\1
,RAIL
"\ L.L S
Second line of address
I\r-r
r ~o (p
(') (-..,
DA TE'"At;EJl:~i'l
:0
--I
N
City or Post Office
State ZIP Code
-0
Au Si'(\)
IX 1"&'('
Correspondenfs e-mail address: (;. Lf. V I rJ @ C. fV\ P. c.. 0 t'\
w
MI
~
MI
Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements. and to the best of my knowledge and belief.
it is we, correct and complete. Declaration of preps... other than the personal representative is based on all infonnation of which preparer has any knowledge.
X SIGNATURE OF PERSON RESPONSI~FOR FILING RETURN 01\
~ Z ~ U
,APDRESS r
\ ~U ~O G-'l2i\' "\ Ll, S "rR.A t L A r \ 11'-<> ~ 1\ VS""I~ IX 1 ~ 1\. ~
,
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ... l)Alf.
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
---l
15056051047
15056051047
..J
15056052048
REV-1500 EX
Decedenfs Name:
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 Properly (Schedule F) c::;) Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & MisceHaneous Non-Probate Property
(Schedule G) c::;) 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 Governmental BequestslSee 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 COMPUTAOON - 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_
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
.
15.
0.0 0
16.
.
17.
18.
.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056052048
Decedent's Social Security Number
~I 0 rl' ~O Co~
.
.
.
.
Ir~t1.~o
.
I (f { 'I . 0 0
'I I b 3.00
~ .~ ~ c.{ . 0 <:)
I (, ~ r. \J 0
(-/30.01))
.
-J3~.O Q
0.0 0
.
.
0.0 0
c::>
15056051D48
.....J
r---
REV-1500 EX Page 3
Decedent's Complete Address:
DECEDENrs NAME
-r€. r=~~6 5 ~
STREET ADDRESS rJ
kEV( R\).
Fie Number 2 0 0,- v v () J. I
LE. V J ,..j
APt
CITY
t~ ~ <. \.~ A r-d c S ~ v 1\ b-
STATE P A
ZIP (1 0 ~ ()
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
\.)
(1)
Total Credits ( A + B + C ) (2)
o
3. InterestJPenalty if applicable
D. Interest
E. Penalty
TotallnterestlPenalty ( D + E ) (3)
4. If Line 2 is greeter than line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Une 20 to request a refund. (4)
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.
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(SA)
(5B)
o
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "r IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and; Yes
a. retain the use or income of the property transferred; .......................................................................................... 0
b. retain the right to designate who shaH use the property transferred or its income; .........."................................ 0
c. retain a reversionary interest; or.............. ......................... .................................................. ............. .................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ~
3. :.~:. ":':' m:;:~~.;;;;;.;;;;;.;;;;;;~.;;;;;;;;;;;..~;.;;;;;,;;.~.:;;~~.;;;:;;;:;;;;;;:::::::::::::: B ~
IFTHE~~::=::::~~~=.~::=:;:~.~.~~.;~~~ ASPAR~EREMN.
I
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate i~ on the net value of transfers to or for the use of the surviving spouse
is three (3) per~nt [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 zero (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 twenty-one years of age or younger at death to or br the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (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 four and one-half (4.5) percen~ ex~pt 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 decedent's siblilgs is twelve (12) percent [72 P.S. ~116(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 bfood or adoption.
REV-'508EX+ (6-96)..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT CECEDENT
SCHIDUU I
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF ~r
.J c.ff=~t '1
LE.VlrJ
FILE NUMBER
~OOl-OOO~(
s
ITEM
NUMBER
I .
:t.
3.
~.
5,
fD.
1.
~.
Include the proceeds d litigation and the date the proceeds were rec:eMld by the estate.
AI praperty jointIy-ClIwned willi rigIIt afsunn.-~.p..... be diIaIased an SaheduIe F.
DESCRIPTION
Pt.i:.So~AL CL\)"~ I t.l G- (ba,JA~ T<> SP.LVA"11.,.J {\I( "''1
tU ~N 1,U R...E. C ~~Nt\~ ~ SALvAIi,,J "~I'\'1
C \~t:..C~, tJ (,. ACCQ\lNT- CV\...., EANk ~t:(.~AN\ C.SfS.j~<>- fA
, {
SAVING-S I\tcQ\lNT- \' \\ \, \,
c.. ~ E.. c..t:.1 ~(;... A c..c ~'.J ~J- P N ~ 8 A N k \\ \\
)
~P.S~
UtJE'N\ r L~'11Y\ E. ~, ~u. ~c..~ ~ 6~ \)~\ S 1\l.1) )
\ ~ \ ~ N \ 5SAN fA ,U PIN D€~ Sf. \l)Lui 60\)1(\ VAL
1('
TOTAL (Also enter on line 5, Recapitulation) . J
(If more space is needed, insert additional sheets of the same size)
VALUE AT DATE
OF DEATH
~OO
) () () 0
\ ~~ ~
S lUL)
t
J 1 0
5;;...
lf~~
-""
1, {p~~
REV-1t11 EX+ (12-99) .
, 'c}'~Q_
. . ~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF '" ".
JE~f="R.t ,
.:5.
LEVt,J
FILE NUMBER . \
2(,\)/'"' OO~2
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
u ~ ,9 ~ l () \)
~ :z 11~~. 00
\
ij (, ~Oo. ()~
J~l\{)\)
;1..
3
q.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
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 .. ~€<;-( S~ ~ ~ \oJ t LlS C All L( S L{:'( P A
1
~
fa, 0 ~
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, Insert additional sheets of the same size)
S(,Ib3
REV-1512 EX+ (12"()3)
1 ----~ --- --
*'
SCHIDULI I
DEBTS OF DECEDENT,
MORTGAGE UABlunES, & UENS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF j E. fr~6 '1 S '- E.. V, rJ :( 0 ~11N~M~~Q ~(
Report debIs incumld bJ the decedent prior to dIBth which nnalned IIIIJIIIId .. of the .... of dINdh, including unnillllnned .....CB1 ........
VALUE AT DATE
OF DEATH
ITEM
NUMBER
1.
:2.,
3.
Lf
DESCRIPTION
f> A Lt\N c.E:. 't>v6 ON f <'i'l <1 N' SSA.J ~A"f W t=", N l) €.~
\0 fW\ .... \" c.R€t>\ "' C. 0 R. P
'3 ~ If\ N (. ~ !::>v €. c:. U1\ S E. g C\ N k:. - I'\A ~-n:.~ Cf\ n..!)
f>t\L~~c~ ~u~,.. "'-.II
BA L f.N C.c ttJe.... P P L (PA. P vW tiR, """ LI ~f""( I
~f\ ~ N<.l \)\)~- V€.R 17-0 tV
B A. LP- ~ c l t)vf: - U b;L (, f,.M C \) .)
B~lP-NC.l ~V~- tJOV~ bE.<.- ~oB~AJE.~v' NI\TT'\)rJAL
S 6.( V I LE ( "" Etll U\ L ~ Q \l 6.Rf'l. ~E. )
H 71 '1 { ~
Jlfu
~~
5f'
~2
Sf
~),l
-"
~,
~
1.
TOTAL (Also enter on line 10, Recapitulation) $ ~ ~ ~ t/
(If more space is needed, insert additional sheets of the same size) I 1
.
1
.
- "
LAST WILL AND TESTAMENT
I, Jeffrey Scott Levin, of Cumberland County, Pennsylvania, being of sound and disposing mind,
memory and understanding, declare the following to be my last will and testament, hereby revoking
any and all wills heretofore made by me.
Item I. I direct my executor hereinafter named to pay all my debts and funeral expenses.
Item II. I give, devise and bequeath all my property, both real and personal, to my two
children Brian Scott and Laura Marie, in equal shares, providing they survive me. If either should
die without issue, I leave my entire estate to my remaining living child.
Item Ill. I appoint Greg Levin, as trustee of said child or children under age 21 at the time
of my death. I give my trustee the right to invest as it sees fit and expend principal as it sees fit,
especially for educational and/or health reasons on behalf of my children. The trust will terminate
when each of my children reaches age 21, at which time the balance of his or her share of the trust
will be turned over to him or her. -,
Item IV. I nominate, constitute and appoint Greg Levin, as my executor, and direct that he
shall serve without bond. If he should be unable to serve, I appoint Todd Levin, as substitute
executor, and I direct that he. should serve without bond.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
twelveth day of June, 1999
~i ; seW
Signed, sealed, published and declared by the above named testator, as and for this last will and
testament, who at his request' his presence, in our presence, and in the presence of each other have
hereunto subs ib eas 'ing witnesses:
2-
....",..0
-:-- ::0
':O.~ CJ
':2 :e h1
,.~ ~:1"J
:::; (/) :;'
~:J Cl 0
..-.~ 0 --n
::.j C.
:~
-;g
'~
~
~
'-
~
Z
\
0::>
-::3
t,<~;
( :'~ :-.~~.. \
:~:~.:': (3
';~;':~ (:~,
'::~:: (~?\
~
--
-
-
C)
0'
. ".... !
... . .;.:: OJ.
..'
'A
. If"..
COMMONWEALTH OF PENN SYLV ANIA
COUNTY OF CUMBERLAND
I, Jeffrey Scott Levin, whose name is signed to the attached or foregoing instrument, having been
duly qualified according to law, do hereby acknowledge that I signed and executed the
instrument as my last will, that I signed it willingly; and that I signed it as my. free and voluntary
act for the purposes therein expressed.
~If;t.. - ~
Sworn to and subscribed before me this
twelveth day of June, 1999
.~~4~d
r- ---
.. .
',.
.
. ',-
C0:M!\10NWEAL TH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
We,:B1ti 0..(\ ~~~ y\"'and -Y~~ ~wlwhose names are signed to
the attached or foregoing instrument, being duly qualified according to law, do depose and say
that we were present and saw testator sign and execute the instrument as his last will, and that he
signed willingly and that he executed it as his free and voluntary act for the purposes therein
contained, that each of us in the hearing and sight of the testator signed the will as witnesses; and
that to the best of our knowledge, the testator was at that time 18 ore years of age, of sound
mind and under no constraint or undue influence
Sworn to and subscribed before me this
twelveth day of June, 1999
~fH, L~1i~./1