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HomeMy WebLinkAbout04-15-08 (2) --1 15056051058 REV-1500 EX (06-05) PAOeparImentcX R8venu8 Bureau of lndiYidual Taxes PO BOX 280601 Harrisburg, PA 1712&0001 ENTER DECEDENT INFORMATION BELOW Social Security Number Dale of Death 01/1512008 OFFICIAl. USE ONLY County Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT File Number 21 08 0192 Date of Birth 03/19/1915 Decedent's Last Name Suffix Decedent's First Name MI PEECHATKA LILLIAN M (If ApprlGabIe) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix N/A Spouse's First Name MI Spouse's .~. SecuriIyNumber . THIS RETURN MUST BE FILED IN DUPUCATE WJTH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW '.) 1. Onginal Retum f"""''''i 2. SUpplemental Retum ';::::'1 3. Remainder Retum (dare of death prior ID 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate ;,.c....""""". ""~.,"~ '.",,,i 4a. Future Interest Compromise (date of death alter 12-12-82) C:::.: 7. Decedent Maintained a Living Trust (Attach Copy of Trust) '-oj 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 - TIfIS 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 .~ 8. Tala! Number of Safe Deposit Boxes c:) (':::~ VVALTERN.PEECHATKA Fwm Name (If Applicable) (717) 737-0407 CAMP HILL PA 17011 H?~~~;; "::1 --j }> """0 :x 1-\3 +" c:7' ~TI fT1 C-) C") ~":~) C;:J in ;::::J () " C-i', .,.-, ~ 9 5 LANTERN LANE REGISTER OF WILLS USE O"\l.U >:2 gg ",,,,0 <= =0 :l> -::J -0 :=: p ;:0 .:>rTl 0; ~~ U1 First line of address Second line of address City or Post Office State ZIP Code Correspondent's e-mail address: Under penalties ~ perjury, t declare that I have examined this relum, including accompanying schedules and statemenls, and to the best of my knowledge and belief, it is true, correct and compteIe. Declaration of preparer other than the personal represenIaIive is based on all information ~ which preparer has any knowledge. ~T~~lwroRFl1~N tJ ;!3,/tt'fr ADDRESS 5 LANTERN LANE, CAMP Hill, PA 17011 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 --I ...J 15056052059 REV-1500 EX Decedent's Name: RECAPfl'ULATION LILLIAN M PEECHATKA 1. Real estate (SChedule A). .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held GoJporation, Partnership or So!e-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Person at Property (Schedule E) . . . . . . .. 5. 6. Jointly Owned Property (Schedu18 F) C:::.l Separate Bilfmg Requested .. . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) C) Separate Billing Requested. . . . . . .. 7. a. Total Gros&Assets (total Lines 1-7). . . . . . .. . .. . .. . . . .. . . . . .. . . . . . . .. . .. a. 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). . . . . . . . . . . . . . . . 10. 11. Tocal DeductIons (tolaf Lines 9 & 10).. .. .. . .. .. . . . . . . . . .. . . .. . .. . . . .. . . 11. 12. Net Value of Estate (L-ine 8 minus line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmentat Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tn (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 _ 15. 16. Amount of Line 14 taxable at lineal rate X.o 45 38,858.48 16. 17. Amount of Line 14laxable at siOOng rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Dealdent's Social Security Number 15056052059 0.00 38,147.68 0.00 0.00 15,118.34 53,266.02 10,142.30 4,2E>5.24 14,407.54 38,858.48 0.00 38,858.48 1,748.63 1,748.63 c;::: --.J REV-1500 EX Page 3 Decedent's Complete Address: a:lENT LILLIAN M PEECHATKA StREEf ADDRESs 770 POPLAR CHURCH RD. f~NYm~c . ... :0192 DECEDENT'S SOCIAl SECURITY NUMBER 205-10-7079 CITY CAMP HILL STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CredilsJPayments A. Spousal Poverty Credit B. Prior Payments C. Disrount (1) 1,748.63 87.43 3. InteresllPenalty if applicable D. Interest E. Penally ToIal Credits ( A + B + C ) (2) 87.43 ToIaIlnterestIPenaIty ( 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 I1lqtI8St a refund. B. Enter the total Of Line S + SA. This is the BALANCE DUE. (3) 0.00 (4) 0.00 (5) 1,661.20 (5A) 0.00 (58) 1,661.20 5. If Line 1 "" line 3 is greater than line 2, enter IIJe 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 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 [iJ b. retain the right 10 designate who shan use the properly transferred or its income; ............................................ 0 [iJ c. retain a reversionary interest; or.......................................................................................................................... 0 iii d. receive IIJe promise for life of either payments, benefits or care? ...................................................................... 0 iii 2. If death occurred alter December 12, 1982, did decedent transfer properly within one year of death witl'lool receiVIng adequate consideration? .............................................................................................................. 0 [iJ 3. Did decedent own an "in rrust for" or payable upon death bank account or security at his or her death? .............. 0 [iJ 4. Did decedent l7lYIl an Individual Retirement Account, annuity, or other non-probale properly which contains a beneficiary designation? ........................................................................................................................ 0 ~ F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND ALE 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 !he net vakJe of transfers to or for the use of the surviving spouse is three (3) pen:ent (72 P.S. ~9116 (a) (1.1) (i)t For dates of death on or after January 1, 1995, !he tax rate imposed on the net value of transfers to or for !he use of the surviving spouse is zero (0) percent (72 P.S. ~16 (a) (1.1) (iin. The statute doesJlotexemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and fing a lax relum are slill applicable even if !he surviving spouse is !he only beneficiary. For dates of death on or after July 1, 2000: The fax t.lte imposed on the net vakJ~ of transfers from a deceased child twenty-one years of age or younger at death to or for !he use of a nalural 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 !he net value of transfers to or for the use of !he decedenfs lineal beneficiaries is four and one-haIf (4.5) percent, except as noted in 72 p.$. ~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 !he 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 adopoon. REV-1503EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECECENT ESTATE OF Lillian M. Peechatka ITEM NUMBER 1. SCHIDUU B STOCKS & BONDS AD property jolntly-owned with right of survivorship must be dlsclosed on Sc:hedule F. DESCRIPTION Dryden Active Allocation Fd CI A, held through Prudential Securities, P.O. Box 9654, Providence, o I O?<lAn . Dryden ft.tIninicpal8on~ High Income Series CL A,held through Prudential Securities, P.O. Box Ql;1;.i P..,ui~ P I O?QJI.n a 2. TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) FILE NUMBER ZI-o~- DIQZ. VALUE AT DATE OF DEATH 8,766.31 29,381.37 38,147.68 REV-1508 EX+ (6-98) . SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONII'oEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATe Of Ullian M. Peechatka Include the proceeds of litigation and the date the proceeds were received by the estate. AI property jointIy-owned with right of survivvrship must be disclftecl on Schedule F. ITEM NUMBER DESCRIPTION 1. Money Market Accoun~ Prudential Securities, P.O. 9654, Providence R.I. 02940 2. Citizens Bank, P.O. 789, Providence, R.J 02901 3. Personal Properly (ClolhinWFumiture) TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) fILE NUMBER 21-08-0192 VALUE AT DATE OF DEATH 1,906.51 12,711.83 500.00 15,118.34 REII-1511 EX+ (12-99). COMMONWEALIH OF PENNSYLVANIA IMiERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINIS1IATIVE COSTS ESTATE OF Lillian M. Peechatka FILE NUMBER 21-08-0192 Debts at dIIc:edenI must be reported on Schedule L ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAl EXPENSES; 8oIock Funeral Home, Mt Pocono, PA Messiah Lutheran Church, 6th & Commonwealth SIs., Hbg., PA 17102 Mat Berger, P.O. Box 186, E1hurst, PA 18416 (enQlClVing mooument) Smuggler's Cove, Tannersville, PA (wake) Imaginations, Tannersville, PA (Flowers) 7,908.00 250.00 211.00 613.04 397. 50 2. 3. 4. 5. B. ADMINISTRATIVE COSTS: 1. PelSOnal Representative's Commissions 0.00 Name of P8ISOnal Representalive(s) Social Security Number(s)lEIN Number of PeISOl1aI Represenlative(s) Str8et Address City . State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is notlhe same as claimant's, attach explanation) Claimant Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 155.00 5. Accountanfs Fees 6. Tax Return Preparer's Fees 50.00 7. PSERS Reimbursement for final mooth 457. 76 8. Pinnacle Health Hospice 100.00 TOTAL (Also enter on line 9, Recapitula1ion) $ (If more space is needed, insert additional sheets of !he same size) 10,142.30 REV-1512 EX+ (12-03) . CClMMONWEAlTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIOENT DECEDENT seMEDUU I DEBTS OF DECEDENT, MORTGAGE UABlLmES, & UENS ESTATE OF Lillian M. Peechatka FILE NUMBER 21-08-0192 Report debts incurred by the decedent prior to death which I'lImained unpaid 85 of the date of death, including unnlimbursed medicIIl ellpllRSeS. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Church of God Home, Carlsle, PA ( balance of final months rent) Phannaceutical Costs 4,042.24 213.00 2. 3. Dr. James Hardy, Carlisle, PA (Physician Bill) 10.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additiOllal sheets of the same size) 4,265.24 REV-1513 EX.. (9.00) *' COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Lillian M. Peechatka SCHEDULE J BENEfICIARIES FIlE NUMBER 21-08-0192 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not list Trustee(s) Of ESTATE I TAXABLE DISTRIBUTIONS [mcIude outright spousal distributions, and transfe~ under Sec. 9116 (a) (1.2)) 1. Walter Peechalka, 5lantem In., Camp Hill, PA 17011 son 50 2. Beverly Youngken, 13471 Shelly Dr., Madison, Alabama 35757 daughter 50 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET n 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-l500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size)