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Home My WebLink About04-27-07 ---I 15056041125 REV.1500 EX (06-05) PA Department of Revenue. ~~~~:~=uaITaxes INHERITANCE TAX RETURN Harrisbulll, PA 1712~1 '"'- -- RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year ~\ 01 File Number (y-tD9 Date of Birth 03005 574 5 o 2 102 007 08051916 Decedent's Last Name Suffix Decedent's First Name C I U K THOMAS MI W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 00 1. Original Return D 4. Limited Estate D D D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach Copy of Trust) D 10. Spousal Poverty Credit (date of death D 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 D D 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes JAN L BROWN 71754 1 555 0 Firm Name (If Applicable) 1 2 (-) REGISTER~~~L~S US~1L Yl I I r......._..r JAN L BROWN & ASS 0 C First line of address 845 SIR THOMAS C T S T E -I Second line of address City or Post Office State ZIP Code DATE FILED H A R R I S BUR G P A 17109 Correspondenfs e-mail address:brendailb@verizon.net Under penalties of pe~ury, I declare that I have examined this return, induding accompanying schedules and statements, and to the best of my knowledge and belief, it is true, coned and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 51 OF PERSON R PONSIBLE FOR.F ING RETURN DATE 4/25/2007 ADDRESS 845 SI Lewisberry PA 17339 DATE 4/25/2007 PA 17109 omas Ct Ste 12 Harrisburg PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 ---I --.J 15056042126 REV-1500 EX DecedenfsName: THOMAS W. CIUK 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. Decedent's Social Security Number 030055745 4. Mortgages & Notes Receivable (Schedule D) ....................... . 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. 2 2 8 7 6. 4 9 ...... . 6. Jointly Owned Property (Schedule F) o Separate Billing Requested . . . . . . . 6. 7 5 0 0 8 . 6 0 7. Inter-Vivos Transfers & Miscellaneous NEtrobate 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.O _ 16. Amount of Line 14 taxable at lineal rate X .04.2.- 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 o . 0 0 15. 83569.15 16. o . 0 0 17. o . 0 0 18. 19. Tax Due ........................ ..... . ... ............. . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 97885.09 10923.23 3392.71 14315.94 83569.15 83569.15 O. 0 0 3760.61 O. 0 0 O. 0 0 3760.61 o 15056042126 -.J REV-1500 ac Page 3 Decedent's Complete Address: File Number o 0 DECEDENrs NAME THOMAS W. CIUK STREET ADDRESS 1000 Claremont Road Middlesex Township CITY I STATE --~- I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 3,760.61 188.03 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + 8 +C) (2) 188.03 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 0.00 3,572.58 A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 3,572.58 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 transfer and: Yes No a. retain the use or income of the property transferred; ...................................................................... 0 !XI b. retain the right to designate who shall use the property transferred or its income; ............................... 0 !XI c. retain a reversionary interest; or ................................................................................................ 0 !XI d. receive the promise for life of either payments, benefits or care? ....................................................... 0 !XI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 !XI 3. Did decedent own an .in trust for" or payable upon death bank account or security at his or her death? ......... 0 !XI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 !XI 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 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. ~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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure 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 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. ~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) percent, 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 decedent's siblings is twelve (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. Rt:v -1508 e;* + (6-98) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF THOMAS W. CIUK FILE NUMBER o 0 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 NUMBER 1. DESCRIPTION Delaware Investments check payable to Thomas W Ciuk VALUE AT DATE OF DEATH 7,903.13 2 PNC Bank; Checking Account 51-4001-1695 9,573.36 3 United States Treasury; 2006 1040 refund 5,400.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 22 876.49 Rev-1509 E;X + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF THOMASW. CIUK FILE NUMBER o 0 If an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Theresa A Scheib 565 Pleasant View Road Lewisberry PA 17339 daughter B c JOINTL Y-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 DECEDENrSINTEREST 1. A. 2000 Members 1 st Federal Credit Union 25.72 50. 12.86 Regular Savings Account 4658 00 2 A 2000 Members 1 st Federal Credit Union 2,854.55 50. 1 ,427.28 Money Management Account 4658 05 3 A 1983 PNC Bank 85,492.54 50. 42,746.27 Money Market Account 51-3021-1124 4 A 1993 PNC Financial Corp (PNC); 826 shs @ $74.63/sh 61,644.38 50. 30,822.19 TOTAL (Also enter on line 6, Recapitulation) $ 75 008.60 .. (If more space is needed, insert additional sheets of the same size) REV-1511 ox + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF THOMAS W. CIUK FILE NUMBER o 0 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Funeral Home 9,423.23 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 Jan L Brown & Associates 1,500.00 3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountanfs Fees 6. Tax Return Prepare(s Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 10.923.23 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (12-03) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF THOMAS W. CIUK FILE NUMBER o 0 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Mobile X-Ray Imaging Inc VALUE AT DATE OF DEATH 83.67 2 Claremont Nursing and Rehabilitation Center 3,218.04 3 PA Department of Revenue; 2006 PA-V 91.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3392.71 ...".''',."... COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF THOMAS W. CIUK SCHEDULE J BENEFICIARIES FILE NUMBER o 0 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pndude outright s~usal distributions, and transfers under Sec. 9116 (a)(1. )] 1. Theresa A Scheib, daughter and next-of-kin Lineal 565 Pleasant View Road, Lewisberry, PA 17339 100% share Sch E and Sch F ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART n - 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) JAN L. BROWN, ESQUIRE. JACQUELINE A. KELLY, ESQUIRE *AOMITIED IN PA AND DISTRICT OF COLUMBIA JAN L. BROWN & ASSOCIATES ATIORNEYS AND COUNSELORS AT LAW OLOE ENGLISH GAP 845 SIR THOMAS COURT SUITE 12 HARRISBURG, PA 17109 EMAIL jlbassoc@verizon.net V'IWW. janbrownlaw.com TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 BRENDA F. KEPHART, LEGAL ASSISTANT PAULA K. WHITE, LEGAL ASSISTANT JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT April 25, 2007 .:,") Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PAl 7013 r"',,".) Re: Thomas W. Ciuk, deceased Social Security No. 030-05-5745 -~.. -\:" , Gentlemen or Ladies: Enclosed please find the following items for filing with the Register of Wills: 1. An Estate Information Sheet 2. Inheritance Tax Return in duplicate. 3. A check payable to Register of Wills, Agent in the amount of$3,572.58 to cover the Inheritance Tax liability. 4. A check payable to the Register of Wills in the amount of $15 to cover the filing fee for the Inheritance Tax Return. Please time stamp and return our file copy. A return envelope is provided. If you have any questions, feel free to contact this office. Sincerely, ~da.- t ~aJ:; Brenda F. Kephart Legal Assistant btk Enclosure ~ Illi~~~ l"li ~ N~ II a:Oet:O (~II~~i ~ vet: ... 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