HomeMy WebLinkAbout12-07-07 (2)
~EV .1fOl1 EX. (1-00)
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OFFiCIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
COUNTY CODE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
OEPT. 280601
HARRISBURG, PA 17128-0601
06 00098
YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
LANDT, MARION L. 1 8 5- 1 2 -942 8
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z DATE OF DEATH (MM-DD-YEAR) 1 DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
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~ 1 2/04/2 00 5 1 0/3 1 / 1 92 0 REGISTER OF WILLS
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
- 0 181 0 Remainder Retum (date of death prior to 12-13-82)
1. Original Return 2. Supplemental Return 3.
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!;( Ul 0 4. Limited Estate 0 4a. Future Interest Compromise (date of death after 0 5. Federal Estate Tax Retum Required
it! ll: 12-12-82)
... 8
0 0 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes
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... ID of Will) copy ofTrust) -
...
<( 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between 0 1 1. Election to tax under Sec. 91 13(A) (Attach Sch 0)
-- 12-31-91 and 1-1-95)
THlS'.SECTIONMUST BE C()..,pl.ETeD:AL.i,;.C()A..pbNDENCEA"'J)!.C()NFI!815N'I'lAI....'l'~!!lfl;..~mli:.SI()bl..!8.serlfiR.j;)rm: ;d!:!;i:',!':ii i,);:;:;/[:>,:,,,,1': :;'h~i:it;7ui"i;miPl:i:i;"
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~AME COM PLETE MAILING ADDRESS
I- EDM ND YER
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~ JOHNSON, DUFFIE, STEWART & WEIDNER
P. 0, BOX 109
LEMOYNE, , PA 17043-0109 CJ
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ELEPHONE NUMBER
717/761-4540
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
_'dFJE\8UUSE om
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no
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-1
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(1 )
(2)
(3)
(4)
(5)
(6)
(7)
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(S-::hedule E)
6. Jointly 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)
(9)
None
None
None
None
87,169,84
None
None
(8)
1,015.00
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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ex:>
87,169,84
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11 . Total Deductions (total Lines 9 & 10)
(11 )
1,015.00
86,154,84
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)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
86,154,84
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
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... 17.Amount of Line 14 taxable at sibling rate x .12 (17)
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S 18. Amount of Line 14 taxable at collateral rate 86,154,84 x .15 (18) 12,923,23
19. Tax Due (19) 12,923,23
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
2203 PAGE STREET
I STATE PA
IlIP 17011
CITY
CAMP HILL
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
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
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
(1 )
12,923.23
(2)
0.00
(3) 0.00
(4)
(5) 12,923.23
(5A)
(5B) 12,923.23
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;.................................................................................. ~ I
:: ~:~::~ ~h~e~~~:i~~~~:~~;~s~~~. .~~~.I~. ~~~. ~~~. ~~~.p.e.~ .t.~~~~~~rr~~. .~~ .i.t.~. ~~~~~~::::::.'::::::::::::::::::::::::::::::
d. receive the promise for life of either payments, benefits or care?.............................................................
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 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.
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
~,,!per~r other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSiBLE FOR FILING RETURN ADDRESS
LIND L. NIZIOLEK
68 OCHS AVENUE
MILL TOWN, NJ 08850-1464
ADDRESS
DATE
SIGNATURE OF PREPARER OTHER THAN REPRESENTATiVE
ED D G. MYERS
ADDRESS
DATE
P. O. BOX 109
LEMOYNE" PA 17043-0109
I ~ 11
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. 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 0%
[72 P.S. 99116 (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 0% [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 4.5%, 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 12% [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.
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF LANDT, MARION L.
FILE NUMBER
21 - 06 - 00098
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Cash - Unclaimed Property - Treasury Department 87,169.84
Claim No. 996267683 - Check dated November 15,23007
(See attachments)
TOTAL (Also enter on Line 5, Recapitulation) 87,169.84
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7325902505
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TO:717 761 3015
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NOV-20-200~ 11:06, FROM:SCC CASH MGT
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TO THE OROER OF
V:()I[)"~FTE~ 1$!I'DAYS
LANOT MARION L ESTATE Or
LINOA L NIZIOLEK ADMIN
68 OCHS AVENUE
MILL TOWN
$. fi:*-i!iiji.~.:m::.':::':"\.:':":,'::l:""'&"":I'" :':::8':' ';4' :.;
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00 NOT ACCEPT WITHOUT HOLDING TO LIGHT 1'0 VE~IFV WATERMARKS,
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P.3/3
000269 51 13618243
NOV-20-200G 11:0~ FROM:SCC CASH MGT 7325902505 TO:717 761 3015
, Commonwealth of Pennsylvania
Remittance Advice
Acet. Pu rchase Order Invoice I nvoh:e
Control Number Number Date Number
WE ARE PRESENTING THIS CHECK FOR YOUR UNCLAIMED PROPERTY..CLAIM #99626783
o 0 11/0612007 99626783
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Payment
Alnount
$87,169.84
Total Payment Amount - $87,169.84
'F..!Cl.1J. HAV~.~.N~..alJ~.~TIO~S c;:.C?~!=,Ii.~.~'N~.l]-Il~!'~YM_ENT ,~l!-....t::!!'Q.Q:?"~~~Q4!5... . .P~~.~,ftl~~..A!..P.~Ff.!~TIQt..l . ..
SEP-25-2007' 09:24' FROM:~CC CA?H MGT
7325902505
TO:717 761 3015
P.2/2
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Robin L. Wiessmann
State Treasurer
Treasury Department
Commonwealth of Pennsylvania
Harrisburg, Pennsylvania 17105
September 18, 2007
Landt Marion L Estate 0 :
Linda L Niziolek Admin
68 Ochs Avenue
Milltown, NJ 08850
In reference to: Claim 9S626783 - UNCLAIMED PROPERTY
Dear Ms. Niziolek:
Enclosed please find the original documents that you provided to the Bureau of
Unclaimed Property to s Apport your claim. A copy ~fill be maintained for our records.
Your claim will bEi referred to a claims examil1er for review in the order it was
received for processing. If it is determined that additional documentation is required to
approve your claim for p3yment, your claims examirler will contact you directly.
If you have any c,uestions, please contact this office, referencing your claim number
listed above, at 1-800-2~12-2046, Monday through Friday, 7:30 a.m. - 4:30 p.m. If you
initiated your claim on TI easury's Web site. you can follow its progress by logging on with
the Web ID and passwo'd that was provided to you when you filed your claim.
~.
Amita~ah
as hah@patre~lsury. org
717-705-4501
7:30 a.m to 3::30 p.m.
08/20/21)0710:33,FAX 717 781 3015
JDS&'N
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Bureau of Unclaimed Property
P.O. Box 1837, Harrisburg, PA 17106-1837
1-800-222-2046
Robin L. Wiessmann
Treasurer
Treasury Dtpartmeat
CommoDwealth of PtllD*J'lvaIDlI
Humburg, Pen.sylvania 17120-0018
IIIIIIIIIII~ I ~~ IIIII~ ~IIIII
99626783
OWNER CLAIM FORM
l CLAIMANT INFORMA rlOH PLEASE PRINT
PLEASE COMPLETE AlL INFORMATION BELOW:
NAME OF CLAIMANT: Linda L. Niziolek, Administratrix of the Estate of Marion L.
SOCIAL SECURIT'- NUMBER OR ~ EIN: 20 - 6797070 DATE OF BIRTH: Adul t Land t
CURRENT MAILING ADDRESS: 68 OCHS AVENUE
CllY: MILLTOWN STATE: NJ ZIP: 08850-1464
DAYTIME PHONE NUMBER: (732) 590-2545 CELL PHONE NUMSER:
HOME PHONE NUMBER (732 \ 246 - 2 7 ~ 7 EMAIL ADDRESS:
I certify that I am legally entitled to claim the property, as stated, that has been reported and delivered to the Treasury
Department, Bureau of Unclaimed Property.
I further certify that the il1fol111ation provided. herein, is true and correGt and subject to the penalties of 18 C.S. Sec.
4904, relating to unswom falsification to ~horities. ~A. a~4
'i SIGNATURE OF CLAIMANT (IN IN (It J-, DATE: 8' -P?J -D1
n a e , A mLnlstratriK
SIGNATURE OF ADDITIONAL ClAIMANT (IN INK): DATE:
State law limits the fee a third party can charge an owner for the recovery of unclaimed property to 15 percent of the
property value. Please contact the Bureau of Unclaimed Property at 1-800-222-2046 with any additional questions.
Ulf You Paid A Fee To Claim Your ProP8rty, Please Complete The Following'"
The Pennsylvania Treasur'y Department does not charge a fee to claim or recover undaimed property. Third parties
who assist with the recovery of unclaimed property are subject to requirements set forth under Section 1301.11 of
Pennsylvania's Unclaimed Property Act. They must disclose the nature and value of the property as well as where it is
being held (Pennsylvania Treasury Department). The fee a third party can charge to assist with the recovery of
property cannot exceed 15% of the total value of the property_
Waslls a third party involved in providing this claim form to youlthe claimant or assisting with the claim in any way?
_ Yes -:4- No
Name, address and phone number of third party
RETUR~ CLAIM FORM AND DOCUMENTATION TO:
Bureau of Unclaimed Property P.O. Box 1837, Harrisburg, PA 17105-1837
Page 5
99626763
8/1612007
08/20/201)7 10 :33' FAX 7J7 781.3015
JDS&YI
~ 003/003
Treuurer
C~;:::~:;~~:r:::ia IIII~ 11111111111111111111111111111111
JlllfrishuTg, hnD~JvlllDia 17120-0013 99626783
AFFIDAVIT & INDEMNIFICATION AGREEMENT
Bureau of Unclaimed Property
P.O. Box 1837, Harrisburg, PA 17105-1837
1-800-222-20,(8
Robin L. Wiessmann
--,
THAT Claiment{s), in exchange for paymem by the Treasury Department of said claim, agrees 10 at ail limes indemnity, save,
defend, and keep harmless the Treasury Department, its employes and represeniatives, from and egsrnst any and all claims,
demands, actions, or suits against them, whether grouncllesa or otherwise, and any and allloSGes. (.ii;l'l"lage$, liabilitie$, costs
and fees arising out of or in any way connected with the payment of the claim, particularly by rea!..:m .,f III claim for pay~nt to
any third person claiming all ownership interest therein Of who may hereafter corne into pol;;sesslo;; '.if r~,e vriginal security,
regardless of whether such claims, ectloi'lS, losses, damages, Gults or liability arise in whole or il'l f.:n.... lrl)m .he gross
negligence or willful misconduct of the ireasury Department;
TH,Ilo,T Claimant{s) agrees that \hi$ Affidavit and Indemnification Agreement shall be conslrued in ace',;' ;:sncs with tI1e laws of
the Commonwealth of Pennsylvania; and
TJ-iAT Claimant(s) acknowledges and undllrstands that any Information andJor documentation l>upplled with tI1e
cia-1m, If false, will subject Claimant to prosecuticm under 18 Pa. C.S.~04, relating to unSW(lm falsmcatlon to
authorities; the convl~tlon of which could subject Clai.m.m w . P",D"~;: . fme of Dp W
$6,000. ~ - {j~
-, 51 na of C I an~. 1: . 1:- '
. lS r8 rjX
BEFORE ME, the undersigned authority, on this day personally appeared Linda L. Niziolek ,
known to me (or Introduced to me by l, to be the person whose name is
subs~ribe<! to the foregoing Instrument, and acknowledged $0 heJshe executed the s~m~ fO~ltn~ purpO$es and
co denalOn there n IIxpressed and SUBSCRIBED AND SWORN TO ME this the ;1 ,;,L", IJ day of
A.D. 20 07 . .
-....... ...n.tu~' 7r., ~ rX ~ HJ.I '..}.",,,,,1
Prin". Nom. Dr Notary ,.:;;r \j (. K...,i l'- -In " r.J:.
.... eomm...,," Expl..., 7-'+ .djj~,;)O 07
\
NOTARY STAMP
ReTURN CLAIM FORM AND DOCUMENTATION TO:
Bureau of UnclaImed Property P.O. Box 1837. Harrisburg, PA 17105-1837
Page 3
99626763
8/1712007
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMNISTRATIVE COS1S
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF LANDT, MARION L.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 - 06 - 00098
ITEM AMOUNT
NUMBER FUNERAL EXPENSES: DESCRIPTION
A.
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. i Attorney's Fees Johnson, Duffie, Stewart & Weidner 1,000.00
I
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
Register of Wills - File Supplemental Inheritance Tax Return.
15.00
TOTAL (Also enter on line 9, Recapitulation)
1,015.00
RJ:V-'l611 EX" ('-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LANDT, MARION L.
I FILE NUMBER
21 - 06 - 00098
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
Do Not List Trust..(a)
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Linda L. Niziolek Niece Residue
68 Ochs Avenue
Milltown, NJ 08850-1464
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria e, 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