HomeMy WebLinkAbout09-17-07
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15056051047
REY-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue '*
County Code Year
Bureau of Individual Taxes. INHERITANCE TAX RETURN
PO BOX 280601
Harrisbur , PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
File Number
Decedent's Last Name Suffix
Decedent's First Name
MI
B
(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
_ 1. Original Return
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2. Supplemental Return
c::::>
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::::> 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
-d/J-
8. Total Number of Safe Deposit Boxes
4. Limited Estate.
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-
c::::>
Firm Name (If Applicable)
N
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Correspondent's e-mail address: /V' /~
ies of pe~ury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief,
reet a d co ete. D laration of preparer other than the personal representative is based on all information of which preparer has any kIJowledge.
NSI FOR FILING RETURN
Side 1
L
15056051047
15056051047
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REV-1500 EX
Decedent's Name:
RECAPITULATION
15056052048
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) <=:) Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate 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 Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subjectto 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 14 taxable
at lineal rate X.O_
17. Amount of Line 14 taxable
at sibling rate X. 12
18. Amount of Line 14 taxable
at collateral rate X .15
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
.
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Decedent's Social Security Number
15.
16.
17.
18.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
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15056052048
Side 2
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15056052048
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REV-1500 EX Page"3
Decedent's Complete Address:
DECEDENT'S NAME
File Number ~/ -t::J7' -t1''7.3~
ST EET ADDRESS ~
-~~-;<<tf/r/ r ~I!5W5 1- ~-;I/lfi. ~7t1~7<
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CITY
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
/~/33?!-
/~~
_~-Wk
Total Credits ( A + B + C )
(2)
/t/3/~
r
3. Interest/Penalty if applicable
D. Interest
E. Penalty
----,----.--~ TotallnteresUPenalty ( D + E )
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.
(3)
(4)
(5) /~
,
(5A)
(58) J~
r
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
, . "'___.li.f;Ji~1~~j:tfs~~t~1:1fllit}J~i::l~~fl~:t!:~lr~
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;.......................................................................................... D ~
:: ::~ ::::i::~::.~;.s~~II.~~.~~.~~~~~n~~~rit..i".~~e;::.:::::::::::::::.:.:.:::::::::::::: B m
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
3. ::~':~:::~~:~:~:~:~:;~~.~~~.~~~~~~k.~~~;;;~;~~~~~.~;~;~;;;~~;~~~;~~:::.:.:.::: B i
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ t1 g]
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.
REV-1508 EX + (1-97)
*
SCHEDULE E
CASH, BANK DEPOSITS, _ MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~~
3,
'It j,,1f
,O~ /b~~
#/1d/5e?P A.~rr""L.~/,6- .-Z;V~. a.
#// ~,vr*,k7= k7ff',4 ~7?r
<61 ~,-.
TOTAL (Also enter on line 5, Recapitulation) $ /~ ~-z..;/
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+ (12-99) .
'. *
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
/dr~
.
ESTATE OF
t~q#A .#. ,~~.;-Il &~
, Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
FILE NUMBER f
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DESCRIPTION
FUNERAL EXPENSES:
1. IAlthf~~(9,f~~4-7tA-L ~#~ ~-W t$#;b-1<MNj),!/l
;t. ~HH~c?7#'-/f~;e ~~V/~
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
ff".
~
Name of Personal Representative(s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City
State _ Zip
Year(s) Commission Paid:
2. Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State _ Zip
Relationship of Claimant to Decedent
4.
Probate Fees - tr75d"~l! t?FP/a's - ~P;'f~ kM~ ~P..v7'
Accountant's Fees .. ~~p 11_ t:! ;JJ))<, C ~ /I
Tax Return Preparer's Fees - ~ ~t:.I.>~; (If~?' ($ dfvl )
~~tlXiI( -j(o/Jp;(r-;A, ~t:-J tfJ/.f1dr~~r~~~>
(~~:Z;~~~-n )
~,?,,/ ~ &Y:;C'/'H -&//7&F ~e::kz;;?Xh$e:"'5
( ~ 1-411cS;~Tc)
~(#~CoH;~ k~~_n ~iU1/S7f1k-
5.
6.
7.
TOTAL (Also enter on line 9, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
AMOUNT
/1} /3t6
31;;'
.3 z.,'"
5) ~70
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ptfl::!)
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4~-1 ~Xt:AQ-I u.IJ<-!d:-
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2-~F"Z--
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,
/,,?,I c? L/lV~N/W;($/d(7~&--MJ,
C/rt0s-k-I;Jd
;~ /t--L-~;'I-L cxl:-;v~'S (L5r;~,?dJ
7-e') ~ /gr
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.~ 77rf-L
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RE,V-1513 EX~ (9-00*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
~dJ"7 - e!' ~
RELATIONSHIP TO DECEDENT AMOUNT 0 SHARE
Do Not List Trustee(s) OF ESTATE
NUMBER
I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
1 ;eO' ~7t T ~ ~;;i:.2)1
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c.Mfl/lra, //1 /;7e?//
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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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - 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)
LAST WILL AND TESTAMENT
OF
REGINA M. BURKE alkla JEAN M. BURKE
L REGINA M. BURKE alkla JEAN M. BURKE, of Lemoyne,
Cumberland County, Pennsylvania, do make, publish and declare this to be my Last
Will and Testament, hereby revoking all Wills and Codicils by me at any time made.
ITEM I:
I direct that all inheritance and estate taxes becoming due by
reason of my death, whether such taxes may be payable by my estate or by any
recipient of any property, shall be paid by the Executor out of the property passing
under ITEM III of this Will, as an expense and cost of administration of my estate.
The Executor shall have no duty or obligation to obtain reimbursement for any such
tax so paid, even though on proceeds of insurance or other property not passing under
this Will.
ITEM II: I direct the Executor to pay my just debts and the expenses of my
last illness and funeral expenses from the property passing under this Will as an
expense and cost of administration of my estate. I request a Mass of Christian burial
from St. Patrick's Cathedral with arrangements by Parthemore's of New Cumberland.
I would like to be laid to rest in my plot in Rolling Green cemetery next to my sister,
Margaret.
ITEM III: I specifically devise all jewelry I own at the time of my death to
my niece, Jennifer Burke.
ITEM IV: All the rest, residue and remainder of my estate to my sister,
MARGARET M. BURKE. In the event my sister predeceases me or, in the event she
does not survive me by thirty (30) days, I devise and bequeath my estate to my
brother, ROBERT J. BURKE. In the event my brother predeceases me, his share
shall be paid to his issue, per stirpes.
In the settlement of my estate, my Executor shall possess, among
ITEM V:
others, the following powers:
(a) To retain any investments I may have at my death, as long as the
Executor may deem it advisable to my estate to do so;
(b) To sell either at private or public sale and upon such terms and
conditions as the Executor may deem advantageous to the estate, any or all real or
personal property or interest therein owned by the estate;
(c) To pay all costs, taxes, expenses and charges in connection with the
administration of my estate;
(d) To compromise controversies; and
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(e) To do all other acts in the Executor's judgment deemed necessary or
desirable for the proper and advantageous management, investment and distribution of
the estate.
ITEM VI: Any person who shall have died at the same time as I shall have,
or in a common disaster with me, or under circumstance that the order of deaths
cannot be established by proof, or within thirty (30) days of my death, shall be deemed
to have predeceased me.
ITEM VII: I appoint my brother, ROBERT J. BURKE, to be the Executor of
my Estate. In the event my brother cannot act or refuses to act as Executor for any
reason, I nominate, constitute and appoint my nephew, JEFFREY BURKE, as
alternate Executor. Any Executor is specifically relieved from the duty or obligation of
filing any bond or other security.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my
Last Will and Testament, consisting of this and the preceding two (2) pages, at the end
of each page of which I have also set my initials for greater security and better
C~~
identification this 7 A
(1;/ f f'-.
/ .~'~ . f;)~ (SEAL)
! ~INA M. BURKE alk/a JEAN M. BURKE
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We, the undersigned, hereby certify that the foregoing Will was signed, sealed,
published and declared by the above-named Testatrix as and for her Last Will and
Testament, in the presence of each other, have hereunto set our hands and seals the
day and year first above written, and we certify that at the time of the execution
thereof, the said Testatrix was of sound mind and memory.
~.l /'~~ . ",
,J'wL 7J-J J~'d
LISA ZIZIS {J '
Residing at: 20SA Tenth Street
New Cumberland, PA 17070
~kW-r~
MICHAEL T. STEPHEM
Residing at: 313D Eden Road
Lancaster, PA 17601
4
. '.
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYL VANIA :
: SSe
COUNTY OF CUMBERLAND
:
L JEAN M. BURKE, Testatrix whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I signed and executed the instrument as my Last Will and Testament;
that I signed it willingly, and that I signed it as my free and voluntary act for the
purposes therein expressed.
"-'. 8 J.J
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~~ (SEAL)
NOTARIAl SEAL
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AFFIDA VIT
COMMONWEALTH OF PENNSYL VANIA :
: SSe
COUNTY OF CUMBERLAND
:
We, Lisa Zizis and Michael T. Stephens, the witnesses whose names are signed
to the attached or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw Testatrix, JEAN M. BURKE, sign and
execute the instrument as her Last Will and Testament; that Testatrix signed willingly
and she executed said Will as her free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testatrix signed the Will as
Witnesses; and that to the best of our knowledge the Testatrix was at that time
eighteen (18) or more years of age, of sound mind and under no constraint or undue
influence.
<) /i '
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Lisa Zizis (J
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-----./f # diU. /.., I "
Michael T. Stephens
Sworn to and sUf$;ri/Jed
before me this i <1'1 day
of ,{tl JL~?I tf;-iA"I, 19)8.
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NOTARY PUBLIC
My Commission Expires:
(SEAL)
, NarARIAL,~
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Cor:nrnllllon,~ NOw. 11. 1111
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