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Home My WebLink About05-30-08J 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~- ENTER DEC EDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth ~~~ ~~ 15~ ~ f ~ ~c~a~o5 ~~ ~ D ! ~~~ Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Nanne MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF 1MILLS FILL IN APPROPRIATE OVALS BELOW •~ 1. Original Return O 2. Supplemental Return O 3. Remainder Retum (date of death prior to 12-13-82) C~ 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) C~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DfR[iCTED T0: Name/~ `~ + ~'~".. /( \ ~ Daytime Teleptu~e Number :~~ f'C ~ 1 ~ f ~•~ 1.1 7`~ V ~ ~ ~S ®~ ~ ~ ~,~ ~ ~~ ; Firm Name (If Applicable) REGISTER OF-WIk~S US'~;abNLY ' _ t-r~t First line of address -- ' ' -~_ Seco`nd~line of address ... ,~ 7 Ci or Post Office ~~~~ ~ b~K Correspondent's a-mail address: State ZIP Code ~- ~ y ` db ~ ~~ ~L rC'~)ll DATE FILED l0 Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct ~r)d complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNA)~}~~OF F'~F ~N I~F~PjQN$~L~ IfOR FILING RETURN I,~ATF. ,--~ SIGNATURE OF PREPARER OTHER THAN DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J REV-1500 EX Decedent's Name: Decedent's Social SecurityN~~um/b~e~r ~~ ~ ~ ~ ~-J ~L! 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. ~.~ ~~lJ 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ...... , 6. • 7. Inter-~vos Transfers & Miscellaneous Non-Probate Property (Schedule G) O 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, 8~ Liens {Schedule I) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... 11. 12. Net Yalue of Estate (Line 8 minus Line 11) .............................. 12. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which ao~ad•5~ 3 ~3 y•~3 f ~ 5~•6Z7 aoa~3.i3 ~~~.N ~ 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 16. Amount of Line 1 table ~ y ~ ~ L- ~ ~ ~' at lineal rate X .O~,J , • ~ 16. • 17. Amount of Line 14 taxable at sibling 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 IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052048 O Side 2 15056052248 1.5056052048 J REV-1500 EX Page 3 Decedent's Complete Address: File Number ~ J7~ J`-~ ~ '~ ~ 7" ~ J~ DECEDENT'S NAME ~ ~~~ ~ , 1 ( ~ ~ y--VI STREET ADDRE >~ ~ ~'\~~~Il,~~y i ~V ~~ 1V~ _ CITY ~~ ~ ~, y ~_ STATE ~~~ ZIP f '-]~'• Tax Payments and Credits: 1. Tax Due (Page 2 tine 19) 1 () ~ ~ r f ~..~ ~/ n 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresUPenalty if applipble fi~ ~/ ~ D. Interest (~ E. Penalty ~, ~ ~ Total Interest/Penalty (D + E) (3) , ~ 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 request a refund. (4) 5 This is the TAX DUE enter the difference r than Line 2 3 i reat If Li 1 + Li (5) ~~ ~ . . , . ne ne s g e A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~~a Make Gheck Payable fo: REGISTER OF WILLS, AiGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN TIHE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property Vansferred :.......................................................................................... ^ b. retain the right to designate who shall use the property trdnsfe-red or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ 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? .............................................................................................................. ^ 3. Did decedent own an °in trust for" or payable upon death bank account or security at his or her death? .............. ^ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a benefiaary designation? ........................................................................................................................ ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 1; AND FILE R 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 des 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 benefiaary. 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 benefiaaries 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-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF William A. Gavenas Jr. (SSN 178-22-1569) PA FILE #21-06-0778 inGude the proceeds of litgation and the date the proceeds were received by ire estate. All property jointly-owned with right of survivorship must be discbsed on Schedule F. FILE NUMBER 2006-00778 (ir more space is neetletl, insert adtlitional sheets of the same size) REV-1511 EX+ (12-99) SCNEDI~LE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT TART ESTATE OF FILE NUMBER ~ William A. Gavenas Jr. (SSN 178-22-1569) PA FILE #21-06-0778 2006-00778 Debts of decedent must be reported on Schedule I. ITEM - __ __,__,,,_ , A. FUNERAL EXPENSES: ~. Church fee (St. Mary's, Wilkes-Barre) 300.00 2. Flowers, candles/church decoration (St. Mary's, Wilkes-Barre) 60.00 3. Burial fee (St. Mary's) 350.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Mary LISa G2VenaS Social Security Number(s)/EIN Number of Personal Representative(s) 162-48-0160 Street Address 320 W. 56 St., Apt. 6E city New York _ State NY Year(s) Commission Paid: 2008 2. ~ Attorney Fees zip 10019 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) claimant Mary Lisa Gavenas (decedent incapacitated/died in nursing home) Street Address 320 W. 56 Street, Apt. 6E city New York state NY _z;p 10019 Relationship of Claimant to Decedent only child (decedent was widower) 1,200.00 275.00 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Bank charges (monthly, check printing, statements) 360.00 8. Death notice (Carlisle Sentinel) 107.99 s. Death certificates (for decedent and spouse) for notifications, legalizations, etc.; notary fees 232.00 ~ o. Car rental and tolls for travel to Carlisle (administrator resident out of state) 403.01 ~~ ~ Postage (proofs of delivery), faxes 119.53 12- Posfing bond, filing in Orphan's Court, filing fees 327.00 TOTAL (Also enter on line 9, Recapitulation) $ 3734.53 (li more space is needed, insert additional sheets of the same size) ~- i~,_ Return to top of page. e REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHED~ILE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & I1ENS TART FsrarF nF ~ William A. Gavenas Jr. t;SSN 178-22-1569) PA FILE #21-06-0778 FII F Nl1M8FR 2006-00778 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. 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