HomeMy WebLinkAbout05-07-07
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes .
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
(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
__ 1. Original Return ~
2. Supplemental Return
-<::)
C)
4. Limited Estate
x:;:)
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
c:::::)
c:::::) 4a. Future Interest Compromise (date of
death after 12-12-82)
:c::3 7. Decedent Maintained a Living 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 MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
~
REGISTER OF WILLS USE;ONLY
C~) ~_;
:-')
-...J
--._}
Correspondent's e-mail address:
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.
DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
15056051047
....J
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15056052048
REV-1500 EX
Decedent's Social Security Number
Decedent's Name:
RECAPITULATION
9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9.
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) c:::> Separate Billing Requested . . . . . ., 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) c:::> Separate Billing Requested.. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8.
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 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 141~x~
at lineal rate X.O ~'ii!)
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
18.
15.
16.
17.
19. TAX DUE.. . .. . .. .. .. . . . ., . ., . .. ... . .. ., .,. . . . ., . . . .. . . . .. . .. ., ... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
c::>
Side 2
L
15056052048
15056052048
-I
REV-15bV EX Page 3
File Number
Decedent's Complete Address:
DECEDENT'S NAME
STRE~ ~; ~~~fib1d. ~---
CITY ffiechan l cslo~ .,J>R (70.5:)
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1) ~ =it 8tt<i. ~g
f ()5CJ.~3
Total Credits (A + B + C ) (2) d~ . ~O
3. Interest/Penalty if applicable
D. Interest
E. Penalty
- ------.----- 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) 3,LQ% # CfR
(5A)
(5B)
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
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
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. D
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ D
I
~
~
tp
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. 99116 (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. 99116 (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 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)].
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. 99116(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.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATEOF~<:;-e. 1llo.Y'~ N~
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
REV-t503 EX + (1-97)
J..,
3,
Lt,
5,
~,
1,
Z,
~,
\0,
SCHEDULE B
STOCKS & BONDS
FILE NUMBER 7 g:::j
~/-o::J~
DESCRIPTION
IY\MF ~ ~ ~vam
~~b)t +\~h Yield &wvl-hes
A(cc~ ~y*d AW\er\LaN\ IIlv. G,. or A~
~\tu.ocd WTy &m ~
:B\OckYcd\ ~ 3tYo.-t , ~vd
H~t Bo.nK:P~ PI})
lA~l\e ~K l7ID
Ml7s GovT MKis Thco~ T~ SBI'
tf\~5 rV\~rr'Ed,are. I[vrowe Th SRI:
~uTMJ.Y\ VYbsteY Th+ .The T~ SBI.
!
,
i
I
~Q%o..ch~ i
~3b~ .1
.~~ N l ~V\tJ st, ~,; P.~
~\5 bc,~l :Pit r 1/ o. .
bunf-iF /4.\0 -P45"oOlJe- 10\
TOTAL (Also enter on line 2, Recapitulation) $
. . .... I L ~ .a._ _E. .l.L_ __ _ ...:__\
VALUE AT DATE
OF DEATH
:ill. Lf-05.3le
3, CfClt.1Lt
O{O,3GG,Y4
5, 450. co
3, 17{P, CO
3~, ~,OO
,Lt, 3a3,oo
Lt,5&+,CO
Lh 331,00
~le.OO
,f;
2;'
~-(! ~~--
Account Information System Output
fotREGINA DEANGELIS
9 MNY MKT BAL BDPS 7,405 CR
10 MKT VAL CUSTODIAL POSIT 24,293 CR *?
11 TOTAL PENDING DB/CR 20,389 CR
12 TD ACCT VL(1+5+6+9+10-7-8) . __r
13 TD LONG HOLDGS VAL(5+6+10) 88,019 CR
14 TD INVESTABLE FUNDS(1+9-4) 27,794 CR
-- RECAP OF RECENT ACTIVITIES
600 AMERICAN INV CO OF AMER C
4 BANK DEPOSIT PROGRAM
58 BANK DEPOSIT PROGRAM
PUTNAM MASTER INT INC TR SBI
RECEIVED FROM MST
MFS GOVT MKTS INCOME TR SBI
MFS INTERMEDIATE INCOME TR SB
A 410 045026 101
TOT FOR ACCT CSH
REV SUMMARY
1 T.D. CASH BAL
2 S.D. CASH BAL
3 CSH AVAILABLE
4 MTHLY ACC INC
02/06
02/02
02/01
02/01
01/31
01/31
01/31
SLD*
BOT
BOT
DIVN
FND
DIVN
DIVN
2 2/07/07 1
DOB 09/04/14 BLU
HOME (717)834-4998
SWP=AAA/BDPS TYP CASH AAA TEFRA=O
0=JAN07/JAN07 0=JAN07
LONG POSITIONS 63,726.00 CR
LONG OPTIONS 0.00 CR
SHORT POSITIONS 20,388.00 CR
SHORT OPTIONS 0.00 CR
ROSE MARIE NAYMIK
0=FEB06/JAN07
20,389.19 CR
0.00 CR
0.00 CR
0.00 CR
5 MKT VAL
6 MKT VAL
7 MKT VAL
8 MKT VAL
POSIT ONLY
2,414-
95,731CR
95,340CR
308+
92
VAL BELOW FOR PRICED
UNREALZD GAIN/LOSS
ACCT VAL Y.E. 12/06
ACCT VAL M.E'. 01/07
PROJTD CASH MAR/MAY
PERCENT INVESTED (13/12)
33.94
1. 00
1. 00
20,389.19CR
4.02DB
58.99DB
4.02CR
20.84CR
19.60CR
18.55CR
ROSE MARIE NAYMIK
A 410 045026 101 3 2/07/07 2
ASSET ALLOCATION FOR MS POSITIONS
CASH + MMKT = 24% EQUITIES = 16%
02/06
BONDS = 42%
OTHER
YMBL MGN PLAN NR
DIV RE
1. 79
.Al~-- - r
_... .....v or n.L'l.L:.lll ~
POS 1 OF 8
SiD 63,726.00
PRICE UNITS M
O.Cash
20,389.19CR T/D
SECURITY
2
~
1.-
,
0.00
RTG
$30(, (j:!) Q
Ilfi ~?3
Morgan Stanley Dean Witter Confidential Data - not an official statement
Page 1 of 2
Thursday, February 08, 2007
12:26 pm
Account Information System Output
for-REGINA DEANGELIS
A 410 045026 101 END
O.Cash
SECURITY
2/07/07 3 ROSE MARIE NAYMIK
pas 6 OF B
PRICE UNITS
SYMBOL
Morgan Stanley Dean Witter Confidential Data - not an official statement
Page 2 of 2
Thursday, February 08, 2007
12:26 pm
REV.151l6 EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
FILE NUMBER oa
ESTATE OF ~ VV'\ _, ' " L~ acc7 -(X)~ ~
5'€. L!Jat}e ~ ., .
. . . ed ed b the estate All property jointly-owned with the right of survIVorship must be disclosed on Schedule F.
Include the proceeds of litigation and the date the proce s were recelV Y .
VALUE AT DATE
OF DEATH
ITEM
NUMBER
1.
~,
6,
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DESCRIPTION
-\-\ea.~ Imo'{~ 1<e yJ. -+{~hrY\Oil\ ~1l31C
'ROec -B\";d~ J.'Bmt6r~ tbbtd tJvlj
1<e\!OV\ca d-loV+ 107
t€d-ex-a..\ I(\ccvne. TN Re~v-J. - nor Y'ece~veA
&- 0+ je..t
Q5180
L8 5~, \ \
3c>, co
Jt. ~in~ 3!)j,oo
50,00
6. TV\
/q, ~~oIct ~ LlVed ~ 0J0I\ a.SS1~ed '~5ICO
7, f\1;~1\t sk:d \;Vlj f<:\.C, l+'j I hmHeoI 625,00
~, Ap(hYe\ ~\ flY'feYT) 115.00
TOTAL (Also enter on line 5, Recapitulation)
IIf more snace is needed. insert additional sheets of the same size)
REV-1509 EX. (1-97)
SCHEDULE F
JOINTLY-OWNED PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~p> t1)n.Y'~e. rJ~
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
r;c:D7 - t1:);?g3
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
B.
34~5 v;.cul~ Rd,
DuV\c.o..n non \ 114 17 ~o
DaLXjh teY'"
A. rYhnd a... Atl" tlt'.Cl r:
c.
JOINTLY-OWNED PROPERTY:
LETTER
ITEM FOR JOINT
NUMBER TENANT
DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
Include name of financial institution and bank account number or similar identifying number. Attach
deed for jointly-held real estate.
DATE OF DEATH
VALUE OF ASSET
%OF
DECD'S
INTEREST
DATE OF DEATH
VALUE OF
DECEDENT'S INTEREST
1.
A.
3~lo' ?NC Acc.o~50035CXAI3
5 "L ~~ket 3t I
DuV\ca..Y\Y\O~ \ 'PA- rtoao
II \ if~,a 5(10)
571. \~
TOTAL (Also enter on line 6, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF ~ rr1'
~~ Il.r,e....
REV-1511EX+ (1-97)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
~
1
FILE NUMam 7 -(5Q;;? 8: 3
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
~
9,
\0,
It
\d-\
DESCRIPTION
FUNERAL EXPENSES: &\ l)eY-- ~kJe:rrt-h3. \ h:,\'\0\.0..Q -H~ l~~r\o...l 0 H.
me\'c~hd\\ge, -CetS k'.eT\ Vab\t. Me..W\0VI~ Pk'5
TYD4r+~6V\.,Q. ~
1\\'f ~ -h=. 5ktp ~
'Ptece\ ~'Y'~ of 1ie Wlo.\ '05
~I""l Grt..ve
ffi~ CSCQM-
ADMINISTRATIVE COSTS:
Personal Representative's Commissions ~ A~ I
Name of Personal Representative (s) Jt)n...Y'C ~ tL.. 1 r, 1);1-
Sod,IS"",,, N"m",,!.), ElN N"m"";' :'~lr.'''(') .~~ 3fp~:
Street Address 344A Fa . --11C&a()
City ~l ~ y\ {' /H,\ 1'\0 V\. State Zip
-(\-
Year(s) Commission Paid:
AttomeyFees '- 0-
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
Probate Fees
Accountant's Fees - Nt ~
Tax Return Preparer's Fees- LeO(\ Wlll_, em
Jtoc k lSYC t-etLo J7ee.S' -h21 5e \\ s-kc~S'
~pi'&-
'P6~~
~ ~17~~
S~O'rt Ce.Y'-f.\ f" ~
rnl~n^~ -Cot}Vith~ ~~BY'ck~( A5~H-ki L~vln<J
--0-:. ( 4. I
TOTAL (Also enter on line 9, Recapitulati9n) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
34-6!5, 00
I
tX.775.co
550,01
laCtic,OO
8~S, 00
'as 1CO
14,5.oc>
~,6o
100,00
~Y\eru&.. E.~ - L(1ovt~hLed) '&ueY[G-u6enthJL
M.,~ f\cm->..l EI'j r;o.. , 61-\
J;~ .rJettt~
~clJl. Chao
M~ ~O<b1Y\ +0'\... a n '3fu- - fYkreio.- A, j::j "d VI'
'Ra.o\~ <!Ieve\o.wl. 4:rpst
l'l"IEn\s - 'R:td. i5Sch l!leve.la.J; 4;y~
'Ph; \;{>3 b-,~ I Th Pi2Z<L +\uT
mil~ *"Yv\ 01'\C6.IW""V\, f>A- +0 (l be\ru.J I 6+\ -lo
elJ"h, ffi +oY\~ h.OVl'a- I C:eYV\'€.~ I d l"n~
at M +09bV\Cll.V\\\e#\ I 'PA 179. M,' ~(!. $, Lflt5"
R~ - S1"aJon 5' To..c.h r[~ S""P
'1~b.1e-tm*" -A\e,
~~I O!\ LtLt\ol
f(\eW\ario.Q. 1}cr~ +0 dls(XJ *-R.~
l'I\i~lsl +\on-Isb~1 t>~ 171l;;l
-.D1'nheJv ~~~
'Va.) t ~ 3e.rVIC€h-- - Lect\ V I ()..,l f)l\S ten-
1)uV\Ca.V\Y\GY\, f)A 11o&C>
ktu'5 IYbnurnenr- Erqva.ve.. m~ DY\ a.~
9\\ ~6.e~ et-,..J ->
t:l110--, C>hb lii.\e3$
* 85.t'o
1 o&k,(!)C
~Ltalqle
5"3 I 11
~5,31
343,oLt
lLA ,7 c
'3~1 33
If 38', ~'l
.5::!,0 , CX)
Yc\~D
',"",',S,
REV-1512 &X+ (1-93)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES AND LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF M _,' A l^. . 1M .' V
~~ L!Ja.rle ~
Please Print or Type
I FILE NUMBER
" ,:;zyj7 --CORg~
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
~~\\) -HOWIe. ~ 5ewICflv
AI.e,y {. ':ph,*,rno.j Sevvk-ell-
LfuY\ Wo.H-~l ~PA - tete Tft~
$ ~<6tt,Ct)
38.35
lco. CO
J.
3\
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of same size.)
~ u...~...... ....4J:\I.J. ".. u.... "...... ~.,.., ~...... u...... ".-;. .. "......
of
ROSE MARIE NAYMIK
I, ROSE MARIE NAYMIK, of the City of Elyria, County of Lorain
and State of Ohio, being of full age and sound mind and memory, do
make, publish and declare this to be my Last Will and Testament,
hereby revoking and annulling any and all Will or Wills by me here-
tofore made.
rrEM 1.
ITEM 2.
ITEM 3.
ITEM 4.
ITEM 5.
I direct that all my debts and funeral expenses be paid out
of my estate as soon as practicable after my decease.
All the rest, residue and remainder of my property, real,
personal and mixed of every kind and description, whereso-
ever situated which I may own or have the right to dispose
of at the time of my decease, I give, devise and bequeath
to my beloved husband, JOSEPH B. NAYMIK, to be his absol-
utely and forever.
In the event my husband should predecease me, or if my
husband and I die as the result of a common disaster or
accident, then and in that event I give, devise and be-
queath all of my property of every kind and description
to my daughters, JlARCIA ANN ANIRIJOWYCH and JOELLEN NAYMIK
to be theirs in equal shares.
In the event either of my chi14ren predeceases me, lea~ing
issue surviving, then the issue shall take the share the
parent would have taken had the parent survived. In the
event there is no issue, such share will pass to the
surviving child.
I hereby authorize and empower my hereinafter named
Executor to compound, compromise, settle and adjust all
claims and demands in favor of or against my estate, and
to sell at private or public sale at such prices and upon
such terms as he may deem best the whole or any part of
my real or personal property; and to execute, acknowledge
and deliver deeds and other proper instruments of con-
veyance thereof to the purchaser or purchasers.
appoint my husband, JOSEPH B. NAlMIK, Exec-
'J.astWill and TestlUDent, and in the event
')\tlle.D :l.nthat event, I nominate and
,_, AllIIlI30WYCH, and in the
~te
'.IO~ .T.R1q
IJf76-'l~-1JlbL~~'(,/ ~J a/~/4?~;e
The foregoing instrument waS signed by the said ROSE MARIE
NAYMTI< in our presence and by her published and declared as and
for her Last will and Testament, and at her request and in her
presence and in the presence of each other, we hereunto subscribe
",t-
our names as attesting witnesses at Lorain, Ohio, this:t/ -- day of
December, in the Year of our Lord, 1978.
l,_,.'~II;'{/'/' ,,'-) /) , ' '7 .'
'Fl'tt ~l ! ;;7. (/;~~"~,:-/~/A!
".- '-
\....,.:~~.'
Residing at ,',7\ tJ--'Ld,c ':If.
/...// .......
r:'" I
~t~~
();j) iII/)tj
Residing at U/l"AI/J~ O~/a
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