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Home My WebLink About06-12-07 REY.'soa EX (~Ol REV-1500 '* COMMONWEALTH OF PENNSYLVANIA .. DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W o W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) TREPANIER, HELEN M. -----.-----T---~-. ...--------- . ---------- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) 02/14/2006 J 07/22/1920 ~---'--'----~-'------"-'''---~---'--- ..--..-------.-..--------.. (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) FILE NUMBER 21 06 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 204-03-6264 00285 NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- :lC:$U! olt:ll: wA-O ::r:oo olt:...J A-lll A- <( ~ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of 'Mil) D 9. Litigation Proceeds Received D 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12.12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10. Spousal Poverty Credit (date of death between 12.31.91 and 1-1-95) I- Z w Q Z o A- U! w It: It: o o 'r:flt$ NAME JOSHUA M. GOLDBERGER, ESQ. FIRM NAME (~AppIicable) KREVSKY & ROSEN, P.C. - TELEPHONE NUMBE-R----..- -.-----~-~~-----~----,-. (717) 234-4583 o 3. Remainder Retum (dale of death prior to 12.13-82) o 5. Federal Estate Tax Retum Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Soh 01 .,liAlI · ~INFeR.~$WQl.n.D BJ;DIRECTED TO: COMPLETE MAILING ADDRESS 1101 NORTH FRONT STREET 2ND FLOOR HARRISBURG, PA 17102 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 149,480.57 z o !;i: ...J :) !::: D.. < o w c::: 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. JoinUy Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (6) (7) (9) (10) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ :) D.. :E o o X ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) 4t498.65 x .045 (16) _82l997.30 x .12 (17) x .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C) ;;;0 ]~ :;c,) ::D --I (8) 16,787.00 8,073.00 (11) (12) (13) (14) $QaMtt .RaQfECK MATH < < r-~,.) r-:.'-~-' c:::) --.I L.. c:: ...:i.:... N N w cn 149,480.57 24,860.00 124,620.57 1,867.44 9,959.68 11,827.12 . , Decedent's Complete Address: STREET ADDRESS 208 SENATE AVENUE CllY CAMP HILL I STATEpA I ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 11,827.12 12,550.17 591.36 Total Credits ( A + B + C ) (2) 13,141.53 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. Check box on Page 1 Line 20 to request a refund (4) 1,314.41 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 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;.......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or.......................................................................................................................... 0 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 without receiving adequate consideration? .............................................................................................................. 0 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 No [iJ [iJ [iJ [iJ [iJ IKJ [iJ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ;2t; nPt 200 7 ADORE 1300 DORAL ROAD, SAN ANGELO, 76904 SIGNATURE EPARER OTHER THAN REPRESENTATIVE ~ - TH FRONT STREET, HARRISBURG, PA 17102 :JV7 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 3% [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 0% [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 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 0% [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 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(l)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [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. REV-1508 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF TREPANIER, HELEN M. FILE NUMBER 2006-00285 Indude 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 DESCRIPTION VALUE AT DATE OF DEATH 1. CHARLES SCHWAB - SCHWAB ONE ACCT# 1909-4649 2 PNC CHECKING ACCOUNT - NO. 50-0433-5935 3 METLlFE - MONEY MARKET ACCOUNT 124,004.60 8,113.65 17,362.32 4 5 6 7 8 9 10 11 12 13 14 15 16 17 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 149,480.57 REV.1511 EX+ (12-99. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF TREPANIER, HELEN M. FILE NUMBER 2006-00285 Debts of decedent must be reported on Schedule L ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: HOLY CROSS CEMETERY ROMBERGER MEMORIALS 1,000.00 150.00 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) RONALD L. TREPANIER, EXEC. 7,500.00 Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 1300 DORAL ROAD, SAN ANGELO, TX 76904 City . State Zip Year(s) Commission Paid: 2006 2. Attorney Fees 7,500.00 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 4. Probate Fees 260.00 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. LEGAL ADVERTISING - Wm. J. Mansfield, Inc. 213.00 8 MISC EXPENSES - FRANK FRIESTAK - POSTAGE, CLERICAL, ETC. 164.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 16,787.00 REV-1512 EX+ (12-03) '* SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TREPANIER, HELEN M. FILE NUMBER 2006-00285 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2 MEDICAL - PA NEUROSURGERY 37.90 MEDICAL - QUANTUM IMAGING 23.46 MEDICAL - EAST PENN AMBULANCE 310.97 MEDICAL - INTERNISTS OF CENTRAL PA. 76.15 MEDICAL - PINNACLE HEALTH 952.00 MEDICAL - PINNACLE HEALTH 27.50 MEDICAL - PINNACLE HEALTH 5,272.00 MEDICAL - PINNACLE HEALTH E.R. 29.52 MEDICAL - MOFFITT CARDIO. 35.00 MEDICAL - PULMONARY & CRITICAL CARE 37.92 MEDICAL - EAST PENN AMBULANCE 542.00 MEDICAL - INTERNISTS OF PA. 30.50 SANFORD & ROUMM RHEUM. 22.27 WEST SHORE E.M.S. 617.20 COMCAST CABLE TELEVISION 45.25 VERIZON TELEPHONE 13.36 3 4 5 6 7 8 9 10 11 12 13 14 15 16 8,073.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) . , " REV-1513 EX+ (~) '* SCHEDULE J BENEFICIARIES COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF TREPANIER, HELEN M. FILE NUMBER 2006-00285 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 spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RONALD L. TREPANIER, 1300 DORAL RD., SAN ANGELO, TX SON 0.33 FRANK FRIESTAK, 515 PARK AVE., NEW CUMBERLAND, PA BROTHER 0.33 VIRGINIA FRIESTAK, 515 PARK AVE., NEW CUMBERLAND, PA SISTER IN LAW 0.17 RICHARD FRIESTAK, 601 HARDING AVE., NEW CUMBERLAND, PA BROTHER 0.17 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 $ 0.00 (If more space is needed, insert additional sheets of the same size) Date: May 29,2007 To: Register of Wills, Cumberland County One Courthouse Square Carlisle, P A 17013 Fr: Joshua M. Goldberger, Esq. 1101 North Front Street Harrisburg, PAl 7102 Ph- 717/234-4583 Re: Inheritance Tax Return Estate of Helen M. Trepanier, Dec'd Message: Please find the Inheritance Tax Return and Inventory for the above listed estate. Kindly time-stamp my file copies and return them in the envelope provided for your use. As you are aware, a prepayment was made on or before the 3 month deadline. If you have any questions, please contact me at 717-234-4583. Thank you. JG, Esq. o c- .:;;; 0 -C'=;:O -i~ ['.:) (=:;) (~ -.I f_ ~= .L N --c! ~ r0 (.-.) 0:1 .....~N II~ : ~ '100..... II't .. -~~. 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