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HomeMy WebLinkAbout11-19-07 ---I 15056041147 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 INHERITANCE TAX RETURN RESIDENT DECEDENT 2 1 0 7 File Number 1057 Date of Birth 038058235 02192007 01221916 Decedent's Last Name Suffix Decedent's First Name MI ZIFCAlt MICHAEL J (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix Spouse's First Name MI ZIFCAlt MARY Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW [!J 1. Original Return 0 2. Supplemental Return 0 3. Remainder Retum (date of death prior to 12-13-82) 0 4. Limited Estate 0 4a. Future Interest Compromise 0 5. Federal Estate Tax Return Required (date of death after 12-12-82) lKJ 6. Decedent Died Testate 00 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 0 9. Litigation Proceeds Received 0 10 Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A) . between 12-31-91 and 1-1-95) (Attach Sch. 0) ~ORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: ame Daytime Telephone Number...., EDWARD P. SEEBER 71753~280 g ~c::;:; 0 -.J REGISTER~~~@S USI!CONLY~-;". -7111 - "'"'-- -'-J ~ u3 7;: \.0 , "(jc :C)~ C :.::0 'o-i :::> Finn Name (If Applicable) SUITE 204, 5020 RITTER ROAD -0 ::J:: c.a CJI N JAMES, SMITH, DIETTERIClt & First line of address Second line of address DATE FILED City or Post OffIce MECHANICSBURG State PA ZIP Code 17055 Correspondent's e-mail address:eps@jsdc.com 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. SIG-JfT~RE OF E IBL NG RETURN DATE , '-"\. Mark A. Zifcak ADDRESS 260 st. John Camp PA 17011 51 URE DATE Edward P. Seeber Suite 204, 5020 Ritter Road, Mechanicsburg, PA 17055 Side 1 L 15056041147 15056041147 ---I ESTATE OF Zlfcak, Michael J. PA Inheritance Tax Return Signature of Additional Fiduciaries FILE NUMBER 21-07- Under penalties of pe~ury, 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. Signature #2 Name Address1 Address2 City, State, Zip Date Providence, RI 02906 II-q -o'~ -.J 15056042148 REV-1500 EX Decedent's Name: Michael J. Zlfcak Decedent's Social Security Number 038058235 RECAPITULATION 1. Real Estate (Schedule A)......... ........... ................. ............. ............. ................ ........... 2. Stocks and Bonds (Schedule B)............................................................................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 4. Mortgages & Notes Receivable (Schedule D).......................................................... 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)................ 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested............. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested............. 8. Total Gross Assets (total Lines 1-7)....................................................................... 1. 2. 3. 4. 5. 6. 7. 979,506.77 8. 979,506.77 9. 32,178.09 10. 1,614.18 11. 33,792.27 12. 945,714.50 13. 671,688.90 14. 274,025.60 '9. Funeral Expenses & Administrative Costs (Schedule H)......................................... 1 D. 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 Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J)................................................. 14. Net Value Subject to Tax (Line 12 minus Line 13)................................................. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X .00 2 7 4 , 0 2 5 . 6 0 16. Amount of Line 14 taxable at lineal rate X .045 0 . 0 0 17. Amount of Line 14 taxable atsiblingrateX.12 0.00 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 19. Tax Due..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 15. 0.00 16. 0.00 17. 0.00 18. 0.00 0.00 D 15056042148 -.J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-07- DECEDENT'S NAME Michael J. Zlfcak STREET ADDRESS 260 St. Johns Drive CITY I STATE 1ZIP Camp Hili PA 17011 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 0.00 0.00 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits (A + 8 + C) (2) 0.00 TotallnteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 Line 20 to request a refund 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. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) 0.00 (5A) (58) 0.00 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 No 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 [!] 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 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. ~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 of the decedent'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. Rev.1610 EX+ (6-98) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Zifcak, Michael J. FILE NUMBER 21-07- ESTATE OF This schedule must be completed and filed W the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM DESCRIPTION-oFl'RoPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 1 Auer Memorial Home & Cremation Services, Inc. 935.00 100.000 0.00 935.00 - prepaid funeral account 2 Commerce Bank Account No. 536054067 - titled 4,702.11 100.000 0.00 4,702.11 In the Michael J. Zifcak and Mary Zifcak Living Trust dated 8/211994; valued per letter dated 3/6/07; one-half of total value reported 3 Commerce Bank Account No. 536054067, 0.46 100.000 0.00 0.46 accrued Interest - titled In the Michael J. Zlfcak and Mary Zlfcak Living Trust dated 8/211994; valued per letter dated 3/6/07; one-half of total value reported 4 Janney Montgomery Scott Account No. HB66 617,108.64 100.000 0.00 617,108.64 8952-4826 - titled In the Michael J. Zifcak and Mary Zlfcak Living Trust dated 8/211994; valued per letter dated 3/9/07; one-half of total value reported 5 Janney Montgomery Scott Account No. HB66 3,070.12 100.000 0.00 3,070.12 8952-4826, accrued Interest - titled In the Michael J. Zlfcak and Mary Zlfcak Living Trust dated 8/211994; valued per letter dated 3/9/07; one-half of total value reported 6 Miscellaneous personal property - titled In the 2,500.00 100.000 0.00 2,500.00 Michael J. Zlfcak and Mary Zlfcak Living Trust dated 8/211994; valued per Trustees; one-half of total value reported Total of Continuation Schedule ee attached page TOTAL (Also enter on Line 7, Recapitulation) 979,506.77 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) Rev-1510 EX+ (6"6) . SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY continued COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zlfcak, Michael J. FILE NUMBER 21-07 - ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECO'S TAXABLE EXCLUSION NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 7 Real estate located at 260 St. Johns Drive, Camp 89,529.90 100.000 0.00 89,529.90 Hili Borough, Cumberland County, PA - titled In the Michael J. Zlfcak and Mary Zlfcak Living Trust dated 8/211994; valued per tax assessment * common level ratio (157,070 * 1.14 = 179,059.80); one-half of total value reported 8 USAA Federal Savings Bank Account No. 261,478.58 100.000 0.00 261,478.58 055-7724-1 - titled In the Michael J. Zlfcak and Mary Zlfcak Living Trust dated 8/211994; valued per letter dated 4/13/07; total value reported due to Disclaimer and Renunciation 9 USAA Federal Savings Bank Account No. 181.96 100.000 0.00 181.96 055-7724-1, accrued Interest - titled In the Michael J. Zlfcak and Mary Zlfcak Living Trust dated 8/211994; valued per letter dated 4/13/07; total value reported due to Disclaimer and Renunciation TOTAL (Also enter on Line 7, Recapitulation) 979,506.77 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule G (Rev. 6-98) REV.1151 EX+ (12-88' *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zlfcak, Michael J. Debts of decedent must be reported on Schedule I. FILE NUMBER 21-07 - ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s) attached 9,995.01 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City State Zip - Year(s) Commission paid 2. Attorney's Fees 20,510.00 See continuation schedule(s) attached 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,673.08 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 32,178.09 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (8-98) *' SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TN< RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER 21-07- Zlfcak, Michael J. ITEM NUMBER DESCRIPTION AMOUNT 1 Always & Forever - flowers for Arllngon, VA services 575.00 2 Anthony Curccl - honorarium for organist 100.00 3 Auer Memorial Home & Cremation Services, Inc. - funeral services 1.608.25 4 Globe Advertising - obituary 413.50 5 Good Shepherd - funeral reception 200.00 6 Karen Appel - honorarium for soloist 75.00 7 Mattox Photograpy - funeral services video 495.00 8 The Enchanted - flowers for Arllngon, VA services 174.50 9 The Patriot News - obituary 283.02 10 Travel & hotel expenses for Trustees to attend funeral 6.070.74 Subtotal 9.995.01 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-98) Rev-1102 EX+ (8-98) *' SCHEDULE H-82 ATTORNEY'S FEES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zlfcak, Michael J. FILE NUMBER 21..07- ITEM NUMBER 1 DESCRIPTION James, Smith, Oletterlck & Connelly, LLP - attorney fees for trust administration AMOUNT 6,000.00 2 Pecht & Associates, PC - attorney fees for trust administration 14,510.00 Subtotal 20,510.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B2 (Rev. 6-98) Rev-1602 EX+ (6-96) *' SCHEDULE H-87 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Zlfcak, Michael J. FILE NUMBER 21.07- ESTATE OF ITEM NUMBER 1 DESCRIPTION Commonwealth of Pennsylvania - title transfer fee AMOUNT 28.50 2 James, Smith, Dletterlck & Connelly, LLP - reservation for trust administration closing costs 250.00 3 Postage, phone calls & supplies for Mark Zifcak, Co-Trustee 1,164.78 4 Register of Wills, Cumberland County - filing fee for Return 15.00 5 Travel expenses for Michael Zifcak, Co-Trustee 196.80 6 Vital Records - death certificates 18.00 Subtotal 1,673.08 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) R.v-11112 EX+ (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Zlfcak, Michael J. FILE NUMBER 21-07- Includ. unrelmbursecl m.dlc.1 .xpens... ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 BILo 011 Company - 011 delivery to residence (1/2 of Invoice) 130.94 2 Comcast - cable service for residence (1/2 of Invoice) 24.83 3 Fox Chimney - repairs to residence (1/2 of Invoice) 44.50 4 H&R Block - 2006 Individual Income tax return preparation (1/2 of Invoice) 223.50 5 Hampden Township Sewer Authority - sewer service to residence (1/2 of invoice) 64.27 6 Marie Huber, Tax Collector - 2007 county/borough real estate taxes (1/2 of Invoice) 213.37 7 PA Department of Revenue - 2006 Individual Income tax liability (1/2 of amount due) 207.50 8 PAWC - water service for residence (1/2 of Invoice) 31.20 9 PPL - electric service for residence (1/2 of Invoice) 31.88 10 USAA Mastercard - credit card account (1/2 of value) 633.62 11 Verizon - telephone service for residence (1/2 of Invoice) 8.57 TOTAL (Also enter on Line 10, Recapitulation) 1,614.18 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) . SCHEDULE .. BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Zlfcak, Michael J. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal oistributions, and transfers under Sec. 9116(a)(1.2)] FILE NUMBER 21-07 - ESTATE OF RELATIONSHIP TO DECEDENT Do Not Ust Trustee/a' SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) I. See attached schedule Total 274,025.60 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE See continuation schedule(s) attached 671,688.90 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 671,688.90 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Michael J. Zifcak 038..05-8235 02119/2007 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Mary Zlfcak 260 St Johns Drive Camp Hili, PA 17011 Spouse Commerce Bank; part of the Janney Montgomery Scott brokerage account; real estate 274,025.60 Total 274,025.60 1 Rev-1H2 EX+ (1-18' *' SCHEDULE J-IIA SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE continued CO'-'MONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Zlfcak, Michael J. FILE NUMBER 21-07- ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Janney Montgomery Scott Account No. HB66 8952-4826 - amount disclaimed by spouse used to fund the Family Trust 443.820.63 2 Less: Schedules H & I -33.792.27 3 USAA Federal Savings Bank Account No. 055-7724-1 261.478.58 4 USAA Federal Savings Bank Account No. 055-7724-1, accured Interest 181.96 Subtotal 671.688.90 Copyright (c) 2002 form software only The Lackner Group. Inc. Form PA-1500 Schedule J-IIA (Rev. 6-98) J\\II...\lllll()llllll<llk~(()..dll\111. I III (llllll' J'~')'C November 15,2007 Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, P A 17013-3387 Re: Michael J. Zifcak, deceased Dear Ms. Strasbaugh: Enclosed are an original and two (2) copies of the Pennsylvania Inheritance Tax Return and an original and one (1) copy ofthe Estate Information Sheet to be filed for the above-referenced decedent, along with a check for Fifteen Dollars ($15.00) representing the filing fee. Please time-stamp the extra copies and return them to me in the enclosed self-addressed, stamped envelope. If you have any questions, please feel free to contact me. Sincerely, JAMES, SMITH, DIETTERlCK & CONNELLY, LLP o ~ t~1 ::CO jg~ :u ::u '--1 .:i;. Enclosures cc: Mark Zifcak, Co-Trustee Michael Zifcak, Co-Trustee Reply to: Suite 1M 5020 Ritter Road Mecbanicsburg, P A 17055 Direct Dial: 717-298-2094 TI-IE ESTATE SECURITY FOR~11Jl_A Cheryl L. Baker, CP Certified Paralegal 717-298-2094 clb@jsdc.com I"'-.) c::::, = --J ::;e o "< \.0 " ::r: ~ c.n N c.:-> -~--s -r, (~ '1 134 SIPE AVENUE HUMMELSTOWN, PA 17036 MAILING ADDRESS PO BOX 650 HERSHEY, PA \7033 lOLL ~REE '\.800.942.3660 'TEL 7"\ 7 S33 .3280 fAX. 7"'\7.533.777\ www.jsdc.cOlTl 0\ l- .,.... 0 ~o " .. ("'.\ ('..J. ,\t 0::' $'- , ,\ .:^ f.~ C' .l.~\.;e\-\ u.l ~ ~ o 0.- If) :::> \ \ \ \ \ \ \ \ \ \ d:6 ~ ..... .- .- ~ ~ ~ ~ .- o % u ~'"'".' ~%<,::. $, ~ a-?- ~uifj"" 7-o~..r. "0 ~ 9. p.. .......-. . 'O'O~~ t;~~-':::' .~ ~ H ~ ';IV;~ ~u""'"' if) if) o .- ..... .- .- - - - - -:::::;:- .- .- .- .- .- -=:: ~ .-:;- .- - .- .- -::::::- ~ .- ..~ ~~ .-