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Home My WebLink About05-29-08 .....I 15056051058 REV-1500 EX (06-<l5) 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 1\ RESIDENT DECEDENT File Number b~ oS~\ Date of Birth 288-16-3725 05/05/2008 11/26/1921 Decedent's Last Name Suffix Decedent's First Name MI Kowalski Mr. Vincent L (If Applicable) Enter Surviving Spouse's Infonnation Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW . 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death 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 8. Total Number of Safe Deposit Boxes Vincent C. Kowalski (717) 528-4396 Firm Name (If Applicable) PO Box 8 REGistER OF WILLS USE ON~ Q g "",0 = ~~;Q ~ ! ->~Q ~ iTI N .:-TJ \.D .....- ,~ First line of address Second line of address 212 Lindy Ave. City or Post Office York Springs State ZIP Code ;.~() .=:! 'l OAtt='~1J --; ::r".. ::r: C5 PA 17372 r- o Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and belief, it Is lrUe, correct and oomp/elJIl. DecIamlIon at preparerolh<<than 1tle personal RlPIeselllaliW! Is based on all ir",,",,1allon at which preparer has any knowledge. SIGNATU~~ZK=I~zr:.__..__.._,~.,__..____.___~l~.i;.2~_.._.. ADDRESS ,P.2. Bo~..l~2 Lin_qy Ave...."'.orkSprings. P~ 1737~,__~,_______,May ~~,~OQ.~n___ n___ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 --.J ..J 15056052059 REV-1500 EX Decedenfs Name: Vincent L Kowalski RECAPITULATION 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 Subject to 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 15. 16. 17. 18. 19. TAX DUE. . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 Decedent's Social Security Number 288-16-3725 17,916.41 17,916.41 17,916.41 17,916.41 15056052059 -I REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Vincent L Kowalski _._------_._----"---_._---~."-----------------_._------------~----~--~---_._---._---------- STREET ADDRESS 1700 Market St. File Number DECEDENT'S SOCIAL SECURITY NUMBER 288-16-3725 ...... ---..----..- CITY Camp Hill I STATE PA ..--.----TiiP-------- I 17011 Tax Payments and Credits: 1. Tax Due (Page 2 line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Crecits ( A + B + C ) (2) 3. InterestJPenaIt if applicable D. Interest E. Penalty TotallnterestlPenalty ( D + E ) (3) 4. If line 2 is greaterlhan line 1 + line 3, enter1he diIfen!nce. This is the OVERPAYMENT. FlI in oval on Page 2, 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 1he intenlst on 1he lax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58) 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 1he use or income of 1he property lranSfemld;.......................................................................................... 0 ~ b. retain the right to designate who shan use the property transferred or its income; ............................................ 0 Ii! c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receNe lhe promise for life of either paymenIs, benefits or care? ...................................................................... 0 (i] 2. If death oca.rred after December 12, 1982, did decedent transfer property within one yetJI of death without receMng adequate consideration? .............................................................................................................. 0 [i] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 Ii! 4. Did decedent own .. k1cMkIlII Relirement Acamt, amity, or other non-probaIe property which contai1s 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 d death on or after January 1, 1995, the tax rate imposed on the net value d transfers to or for the use d the surviving spouse is zero (0) percent [72 P.S. ~116 (a) (1.1) (i)l. The statute does not exemot a transfer fD a surviving spouse from tax, and the statutDry requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For daleS of death on or after July 1, 2000: The tax rate irnpo$ed on the net value d 1ransfers from a deceased child ~ years d age or younger at death fD or for the use d a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~116(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. ~116(12) [12 P.S. ~116(a)(1)}. The tax rate imposed on the net value of transfers to or for the use of the dec:edent's siblings is tweIYe (12) percent [12 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.