HomeMy WebLinkAbout06-18-07
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15056051047
REV-1500 EX (06-05)
PA Department of Revenue '*
Bureau of Individual Taxes .
PO BOX 280601
Harrisbu ,PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Securi Number Date of Death
o? IJ ?;.
File Number
, G3
OFFICIAL USE ONLY
County Code Year
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Decedent's Last Name Suffix
Decedent's First Name
MI
o
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
o
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
C:::) 1. Original Retum
c:;:)
c::;)
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
<::)
l:) 4a. Future Interest Compromise (date of
death after 12-12-82)
c::>> 7. Decedent Maintained a Living Trust.
(Attach Copy of Trust)
(:) 10. Spousal Poverty Credit (date of death (:) 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
4. Limited Estate
:C::)
.C)
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
8. Total Number of Safe Deposit Boxes
(:)
CJ
0)
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Correspondent's e-mail address:
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ZMK{zne 1@t''/,;If/fOO, eon.
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
'.
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056051047
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15056051047
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15056052048
REV-1500 EX
Decedent's Name:
RECAPITULATION
1. Real estate (Schedule A). .... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. $tocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Sctiedule 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.
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 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 AP.PLlCABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X .0_ 15.
16. Amount of Line 14 taxable
at lineal rate X.O _ 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
(7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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Side 2
15056052048
~ "
Decedent's Social Security Number
c:::::)
15056052048
~
REV-1500 EX Page 3 File Number
" ,
Decedent's Complete Address:
DECEDENTS NAME e It F 11 /vtJ V / C /I fit /1- R K
STREETADDRES~ S E /1/ /f ff AVE /1 ,/J T tJ 3
C
C/!-J>1P II I))
CITY
STATE ;VA
ZIP/ 7?J/ /
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19) (1)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C ) (2)
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)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(5)
(5A)
(5B)
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.
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QU.ESTIONS 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 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 0
c. retain a reversionary interest; or.........................................~.:............................................................................. 0 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 0
.,
2. If death occurred after December 12, 198,2, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 0
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 0
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 0
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 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 be,neficiary.
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 ofthe dececlent'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.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF M /f,€K' RIl Fl1tOV ICH
'*
RfII.l508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntJy-owned with the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. ~ IIf7ll3J..,E t/ NJJdJeLlI1E/lIrEJJ
TAl iHE HO~O{!/!t(ST VIC!Tlfr/
116$E-TS ~.lTIc;/i TIDAl,
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
RECEIPT FOR PAYMENT
==============~====
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
\~ .
iRece1.pt Date:
~Rece~pt Time:
'Rece1.pt No. :
3/20/2007
13:16:43
1047725
RAFALOVI CH f'/TARK
Estate File No. :
Paid By Remarks:
2007-00263
ZHANNA KORSUNSKY
WZ
20.00
5.00
4.00
10.00
5.00
----------------
$44.00
$44.00
------------------------
------------------------
Fee/Tax Description
PETITION LTRS ADM
RENUNCIATION
SHORT CERTIFICATE
JCP FEE
AUTOMATION FEE
Check# 583
Total Received.........
Name
COUNTY GENERAL FUN
RLAND COUNTY GENERAL FUN
RLAND COUNTY GENERAL FUN
U OF RECEIPTS & CNTR M.D
RLAND COUNTY GENERAL FUN
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Claims Resolution Tribunal- New YoA Office
Holocaust Victim Assets Litigation, Case No~ CV 96-4849
P.O. Box 1877 Old Chelsea Station, New York, tN 10113, USA
25 April 2007
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Estate of Mark Rafalovich
c/o Zhalma Korsunsky
121 North Lakcview Drive
Harrisburg. PAl 711 0
Dear Mrs. Korsunsky.
The Claims Resolution Tribunal - New York Office previou y sent to you notice of
approval for a Plausible Undocumented Award with respect your claim(s) made to the
Claims Resolution Tribunal. The notice letter contains an ex lanation ofthe decision and
the arrangements for payment.
ofUSD $5,000.00 by wire
rm.
Please note that the Special Masters authorized payment tod
transfer to the account designated in your acknowledgement
If you have any questions regarding this payment, p~ase con act Valerie Fischer at + 1-
646-519-8742.
Sincerely,
Claims Resolution Tribunal- New York Office
Ref. Number: 26713
Claims Resolution Tribunal- New Yor* Office
Holocaust Victim Assets Litigatiqn
Case No. CV 96-4849
P.O. Box 1877 Old Chelsea Stati,n
New York, NY 10113, USA I
The Estate of Mark Rafalovich
c/o Mrs. Zhanna Korsunsky
121 North Lakevlew Dr.
Harrisburg, PAl 7110
March 28, 2007
Dear Mrs. Korsunsky. ~.
The Claims Resolution Tribunal - New York Office iJpleased to inform you that the
claim(s) of the Estate of Mark Rafalovich is/are eligible for a Plusible Undocumented Award in
the amount of US S5.000.00. This award has been approve by the Honorable Edward R.
Korman, the presiding judge in the Holocaust Victim Assets Liti ation.
The Court has recognized that of the approximately 6.8 illion accounts that were open
or opened between 1933 and 1945, the subsequent destruction documents by the Swiss banks
has eliminated the records for nearly 2.7 million ~ccounts As the Vo1cker Committee
recognized in its December 6, 1999 Report on its audit of iss banks, this destruction of
records has created an "unfillable gap" that can now never known or analyzed for their
relationship to victims of Nazi Persecution. Of the approxi tely 4.1 million Holocaust-era
Swiss bank accounts for which records still exist, the Claims solution Tribunal ("CRT") has
been provided access to approximately 36,000 of these acc unts. These 36,000 accounts
comprise the "Account History Database" ("AHD").
The CRT took utmost care in matching the n~mes of ersons identified in the claim
form(s), including the person(s) identified as owning a Swi bank account and that/those
person(s)'s immediate relatives, to names of account owners id ntified in the AHD. The CRT
used advanced name matching systems and computer proams. Additionally, the CRT
considered any variations of names submitted in the clnim(s) d name variations provided by
Yad Vashem. the Holocaust Martyrs' and Heroes' Rem~branc Authority, in Jerusalem, Israel,
to ensure that all possible name matches were identified. PIe be assured that the claim was
carefully reviewed. Unfortunately, to date the CRT Was unab to locate any accounts in the
AHD to which the Estate of Mark Rafalovich is entitled.
Recognizing that the destruction of documents by the S . ss banks means that, for many
thousands of claimants. no documents remain to prove their enti ement to a Holocaust-era Swiss
bank account, Judge Korman has directed that all the Deposite Assets Claims be analyzed to
determine whether an award should be recommended even in e absence of bank records or
other documentation proving the existence of an account. Alt ugh to date the CRT has been
unable to locate any accounts to which the Estate of Mlark Rat: ovich is entitled, the claim has
been determined to contain sufficient information to warrant a ausible Undocumented Award.
The CRT will continue to carry out further research on the c aim to determine whether any
1/2
accounts may be located and whether an award to any locateq. accounts may be made. In the
event that the CRT locates a Swiss bank account to which tte Estate of Mark Rafalovich is
entitled, the sum of 55.000.00 shall be deducted from any future award that may be made in
connection with such account. Should the CRT ultimcj.tely det4nnine that no accounts to which
the Estate of Mark Rafalovich is entitled can be located! in the AiIn or through other sources, the
CRT will mail a final decision to the Estate. Jr
The Plausible Undocumented Award is for a total paym tofUS $5,000.00. Please have
the Executor and aU the beneficiaries of the Estate . gn and return the enclosed
acknowledgement fom1. and mail and/or fax it to the CRT. In dition, please have the Executor
or Representative of the Estate send a copy of his/her dentification document. The
Identification document may be in the form of a Driver's Licens , Passport, Social Security Card
or Government-Issued Identification Card. The address of t Claims Resolution Tribunal _
New York Office is P.O. Box 1877, Old Chelsea Station, New rk, NY 10113, USA, the phone
number is +1-646-519-8742, and the fax number is +1-212-2 -0598. After the CRT - New
York Office receives the signed Acknowledgment form, the S cial Masters will be authorized
to make the payment.
Please note that the Estate of Mark Rafalovich s eligible for one Plausible
Undocumented A ward only, regardless of the number of ac . unt owners Mark Rafalovich
believed to have owned Holocaust-era Swiss bank accounts, r the number of Holocaust-era
Swiss bank accounts that might have been claimed. Please als note that if the Estate of Mark
Rafalovich has received an award based upon account documen identified by the CRT, it is not
eligible for a Plausible Undocumented Award payment.
Please find enclosed information pertaining to US tax egulations with respect to this
award. If you are not subject to US tax law, we suggest that you ontact your local tax authorities
to investigate any similar exemptions within your jurisdiction.
Sincerely,
Claims Resolution T unal- New York Office
Enclosures
2/2
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