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HomeMy WebLinkAbout05-07-07 .-J 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 .-J 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 ~ ~ r- ~ zo'?~ gJCI~~lt'i~ o.o:zr-o~ '0.5->-<1: lI! ~ ~ ::J CI If) o LnJ, rrll'!! ~ -0 tR-~ 1: 3- ~ ~. ~ --.; ::: ~;' .~ ..., .~ ~"<lOi:;; ".,~ ~/ .~ ~ ~. ,!,-,=. ~,; M f" .j '% ,Pl':..... ~~ If "O~ -a:: 0 ... >or-- 1!!=_ ~~~ uu.1: .. m 0 ~""I: