HomeMy WebLinkAbout04-10-08
REV-1500 EX + (6-00)
*'
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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KOSHEBA REGINA M.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
FILE NUMBER
2 -07 04
COuN"TY"CoiiE -YEA~ - - N'UMBER- -
SOCIAL SECURITY NUMBER
171-16-1150
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (date of death poor to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 01
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11/07/2007 01/31/1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
PA 15068
3,690.00
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N/A
IX] 1. Original Retum
o 4. Limited Estate
o 6. Decedent Died Testate (AttachcopyoIWill)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy 01 Trust)
o 10. Spousal Poverty Credit (date 01 death between 12-31-91 and 1-1-95)
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NAME
J. RAYMOND AMBROSE JR. ESQ.
FIRM NAME (II Applicable)
AMBROSE LAW CENTRE
TELEPHONE NUMBER
724-339-3111
COMPLETE MAILING ADDRESS
801 FREEPORT RD.
NEW KENSINGTON
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212,928.60
205,761.92
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D 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)
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(9)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
0.00 X _ (15)
205,761.92 X .045 (16)
0.00 X .12 (17)
0.00 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. D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Decedent's Com lete Address:
STREET ADDRESS 325 WESLEY DRIVE
CITY
MECHANICSBURG
STATE
PA
ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
9,259.29
8.500.00
447. 36
Total Credits (A + 8 + C)
(2)
8,947.36
3. InteresVPenalty if applicable
D. Interest
E. Penalty
0.00
TotallnteresVPenalty ( 0 + 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)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A, Enter the interest on the tax due, (5A)
8, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check to: REGISTER OF WILLS, AGENT
0,00
311.93
311,93
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 00
b, retain the right to designate who shall use the property transferred or its income; .....................................,.. 0 00
c, retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2, if death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?............... ...... ........ ....., ... .........,.....,..... ......". ..............,.....,..,.. 0 00
3, Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4, Did decedent own an individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..............,..............,......... ......................,...................."................... 00 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, includin~ 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 representalive is based on all Information of which preparer has any knowledge.
SIGNATURE OF ~?N RESPONSIBLE ~OR Fill RETYRN I) DATE
- . t "7t .,It. ./[. ~ 4/8/2008
ADDRESS Edward J. Kosheb
1205 B man Court Mechanicsbur
SIGNATURE OF e THER T~ ~EPRESEN I\T1VE
a --I~-u,
aymond Ambrose, Jr., Esquire
ADDRESS
PA 17055
DATE
4/8/2008
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 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 0% [72 P,S, ~9116(a)(1 ,2)].
. \~ 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)(1 )].
l'M~pe 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
~n9,,:c0 who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503,EX + (6-98)
. '.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KOSHEBA REGINA M.
FILE NUMBER
21 07
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
1041
ITEM
NUMBER
1.
DESCRIPTION
41 Shares Prudential Financial Common Stock (approximately $90/Shr.
VALUE AT DATE
OF DEATH
3,690.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
3690.00
REV-150~ EX + (6-98)
, '.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KOSHEBA REGINA M.
FILE NUMBER
21 07
Include 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,
1041
ITEM
NUMBER
1.
DESCRIPTION
PNCBANK Certificate of Deposit No. 31100302115
2.
PNCBANK Certificate of Deposit No. 31200301018
3.
PNCBANK Certificate of Deposit No. 31100302156
4.
PNCBANK Checking Account NO.1 017971 027
5.
PNCBANK IRA Account No. 65000082636
VALUE AT DATE
OF DEATH
5,512.92
5,512.92
5,209.91
4,865.12
2,077.39
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
23 178.26
REV-151~ EX.".
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KOSHEBA. REGINA M.
FILE NUMBER
21 07
1041
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INClUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. Merrill Lynch Mutual Funds 107,481.99 100. 107,481.99
American capital Income Builder
1,617 shrs. @ $66.47/share
2. Merrill Lynch Mutual Funds 76,966.80 100. 76,966.80
American Income Fund
3,720 shars. @ $20.69/share
3. Merrill Lynch Bank Deposit Program 1,611.55 100. 1,611.55
1,611.55 @ $1.00/shr.
TOTAL (Also enter on line 7 Recapitulation) $ 186 060.34
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX+(12-99)
. '.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KOSHEBA. REGINA M.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
Grave opening
Funeral Flowers
Funeral Wake
Postage for "thank you" notes
1.
2.
3.
4.
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Add ress
1.
City
State
Yea~s) Commission Paid:
2.
3.
Attorney Fees J. Raymond Ambrose, Jr.
Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City
State
Relationship of Claimant to Decedent
4.
Probate Fees Petition Ltrs.Test-$20, Will-$15, Automation Fee-$5, Shorts-$40,
JCP-$10
5.
Accountanfs Fees
FILE NUMBER
21
07
Zip
Zip
Tax Return Preparer's Fees Hamilton & Musser, PC, CPAs for 2007 Federal and State
Income Tax Returns
11/14/07 Carlisle Sentinal - estate advertising
11/14/07 Cumberland County Legal Journal for estate advertising
01/07/08 J. Raymond Ambrose reibursemt. for FedEx USA Airbill
01/24/08 J. Raymond Ambrose owed addt'l monies for FedEx Airbill
03/12/07 PA Dept. of Revenue - 2007 taxes
04/08/08 Postage re: estate correspondence to Merrill Lynch, sister, attorney
04/08/08 Mileage for 3 trips to Lowr Burrell re: est. business (50.5 x 1,320)
04/08/08 Toll reimbursmt. to executor for 3 trips - $22.00/Trip x 3
04/08/08 Balance due on letters to Register of Wills of Cumberland County
Filing Family Settlement Agreement and Release with Register of Wills
J. Raymond Ambrose, Jr., Esq.-reimbursement for postage
Register of Wills of Cumberland County fee for filing Inventory
6.
7.
8.
9.
10.
11.
13.
14.
15.
16.
17.
18.
19.
1041
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
900.00
200.00
468.29
9.84
3,722.71
90.00
249.25
134.68
75.00
15.00
3.65
184.00
2.46
726.00
66.00
70.00
25.00
16.93
15.00
6 988.81
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
KOSHEBA. REGINA M.
Decedent's Name
Page 1
21 07 1041
File Number
Schedule H - Funeral Expenses & Administrative Costs - 87.
ITEM
NUMBER
DESCRIPTION
AMOUNT
20.
Register of Wills of Cumberland County fee for filing inheritance tax
15.00
SUBTOTAL SCHEDULE H.B?
15.00
. REV-151:1 EJl:+ (6-98)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
KOSHEBA. REGINA M.
FILE NUMBER
21
07
1041
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. 12/14/07 East Pennsboro Ambulance Svc., Inc. - transport decedent from Holy Spirit
Hospital
VALUE AT DATE
OF DEATH
33.00
2. 12/14/07 Millenium Phcx. Svc., Inc.- balance due on pharmacy bill
144.87
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
177.87
'~_"'m:(*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
"OSnE"BA REGINA M.
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21 07
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1.
Edward J. Kosheba
1205 Bauman Ct.
Mechanicsburg, PA 17055
Joyce A. James
3215 South Peach Hollow Circle
Pearland,TX 77584
Lineal
2.
Lineal
1041
AMOUNT OR SHARE
OF ESTATE
98,698.68
98,698.67
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)
J. RAYMOND AMBROSE, JR.
AMBROSE LAW CENTRE
801 FREEPORT ROAD
NEW KENSINGTON, PA
15068
724-339-3111
1-ROO-49R-n79~
LAST WILL AND TESTAMENT
I, REGINA M. KOSHEBA, single, now or formerly of
Lower Burrell, Westmoreland County, Pennsylvania, do make this
my Will hereby revoking any and all Wills at any time
heretofore made by me.
FIRST: I direct payment of my just debts, the
expenses of my last illness and my funeral expenses, including
my gravemarker, shall be paid from my residuary estate, as
soon as practicable after my decease, as a part of the
expenses of the administration of my estate.
SECOND:
property, real
situate, I give,
as follows:
All the rest, residue and remainder of my
and personal, whatsoever and wheresoever
devise and bequeath in three (3) equal shares
A. One (1) share to my son, Edward J. Kosheba, now
or formerly of 646 Allenview Drive, Mechanisburg,
Pennsylvania;
B. One (1) share to my daughter, JOYCE A. JAMES, now
or formerly of 15715 Havenhurst, Houston, Texas; and
C. One (1) share to my daughter, LOIS J. KOSHEBA,
now or formerly of Three Fountains III, Houston,
Texas.
THIRD: I direct my Executor to payout of the
principal of my residuary estate, all estate, inheritance and
other taxes in the nature thereof imposed upon or with respect
to my estate or any property in which I have an interest
including any property included in my gross estate for tax
purposes, whether or not such property passes under this Will,
at such times and in such manner as my Executor deems
advisable; and no portion of such taxes shall be collected
from or refunded by any other person by way of apportionment
or otherwise.
FOURTH: I appoint my son, EDWARD J. KOSHEBA,Executor
of my Will. I give and grant to my Executor, in addition to
the authority conferred by law, the power to sell any or all
of my property, real or personal, or in his discretion to
retain the same for distribution in kind.
. .
J. RAYMOND AMBROSE, JR.
AMBROSE LAW CENTRE
801 FREEPORT ROAD
NEW KENSINOTON, PA
15068
724-339-3111
1-800-498-6793
FAX: 724-339-0809
e-mail: oBo@ambroselegal.com
FIFTH: I direct that no bond or other security shall
be required of any fiduciary herein named or any fiduciary
acting as successor of any fiduciary as provided in this Will,
for any cause whatsoever.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal this 11th day of November, 2002.
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E NA M. KOSHEB
Signed, sealed, published and declared by the above
Testatrix, REGINA M. KOSHEBA, as and for her Will, in the
presence of us, who, at her request, in her presence, and in
the presence of each other have hereunto subscribed our names
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Addr e S S(.~.l "~I"',: ,./' ~. 1~.",', '.~, i.A,.,./~..,A... ',',' p.... '.' ./4-,' i/ .~. ., ,t'.",..i. ,~,,', .
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J. RAYMOND AMBROSE, JR.
AMBROSE LAW CENTRE
801 FREEPORT ROAD
NEW KENSINGTON, PA
15068
724-339-3111
1-800-498-6793
FAX: 724-339-0809
a-ma.il: oso@ambroselegal. com
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF WESTMORELAND
ss:
We, REGINA M. KOSHEBA,
Maegan Susa Filo
and
Martina Heavner
, Testatrix, and the witnesses,
respectively, whose names are subscribed to the attached or
foregoing instrument, being first duly sworn, do hereby declare
to the undersigned authority that the testatrix signed and
executed the instrument as her Last Will and Testament and
that she had signed willingly, and that she executed it as her
free and voluntary act for the purposes therein expressed, and
that each of the witnesses, in the presence and hearing of the
testatrix, signed the Will as witnesses and that to the best
of their knowledge, the testatrix was at the time eighteen
years of age or older,of sound mind and under no constraint or
undue influence.
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Subscribed, sworn to and acknowledged before me
M. KOSHEBA, the Testatrix, and subscribed and sworn
me by Maegan Susa Fila and Martina Heavner
this 11TH day of November, 2002.
by REGINA
to before
My Commission Expires:
~~:1:0~:fif!U
.; NOTARIAL SEAL
JUOrniW PfERCHALsKf. =:1. PubIc
orHlw~wr. IdCo.
~~Oct.2,20C8
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