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Home My WebLink About06-25-08~ 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX.280601 + INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 ~°' RESIDENT DECEDENT 2 1 0 7 0 1 0 7 9 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 198301297 11182007 02031936 Decedent's Last Name Suffix Decedent's First Name MI ZOOK SHIRLEY C (If Applicable) Enter Surviving Spouse's Info rmation Below Spouse's Last Name Suffix Spouse's First Name MI ZOOK ASA M 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) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ^ g Decedent Died Testate ^ (Attach Copy of Will) ~ Decedent Maintained a Living Trust O 8. Total Number of Safe De OSit Boxes (Attach Copy of Trust) p ^ 9. Litigation Proceeds Received ^ 10. Spousal Povertyy Credit (date of death 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 DIRECTED TO: n m a e Daytime Telephone Number FOREST N MYERS t'J 717532046 Firm Name (If Applicable) LAW OFFICE FOREST N MYERS First line of address 137 PARK PLACE WEST Second line of address City or Post Office SHIPPENSBURG State ZIP Cod C; - °- r ~_ REGISTER OF'W[Llr-$ USE,:QiVLY T ' i . tOJ -- = u"i . i ~ ~-,=i ~. Y~ : ~ DATE FILED e PA 17257-9212 Correspondent'se-mail address: fnmyers@embargmail.com U er penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, i i true, correct and complete eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Michelle M SERFF i,. _ iGt - 627 Lancaster Ave, Harrisburg, PA 17112 SIGNATURE OF PREPARER t?THER THAN REPRESENTATIVE DATE ~~-g\]-~-- Forest N Myers ~ - 23 - Zoo>~, ADDRESS 137 Park Place West, Shippensburg, PA 17257-9212 Side 1 15056041147 15056041147 ~~~ ,~ ~~ 15056042148 REV-1500 EX Decedent's Social Security Number oeceaenrs Name: S h I r I e y C Z O O K 1 9 8 3 0 12 9 7 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 . 4 9 6. Jointly C+wned Property (Schedule F) ~ Separate Billing Requested ............. 6. 1 3 6 3 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 1 4 2 . 8 5 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 1 5, 7 0 5 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 1 5 , 0 8 0 5 9 11. Total Deductions (total Lines 9 8 10) ...................................................................... 11 • 3 0, 7 8 5. 5 9 12• Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. - 3 O , 6 4 2 7 4 13. Charitable and Governmental Bequests/Sec 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. - 3 O , 6 4 2 . 7 4 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 .00 0 0 0 15- 0 0 0 16. Amount of Line 14 taxable at lineal rate X .045 0 0 0 16• 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17• 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18• 0 0 0 19. Tax Due ..................................................................................................................... 19. 0 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 15056042148 15056042148 REV-1500 EX Page 3 File Number 21 - 07 - 01 079 nnnnrlon4'c Cmm~{ete Address: ................. __. .r____ - _ DECEDENT'S NAME ZOOK, Shirley C _______ STREET ADDRESS Q3 W Locust Street CITY STATE ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) _ _ _0.00 2. Credits/Payments A. Spousal Poverty Credit ,_ B. Prior Payments C. Discount _ _ _ Tota4 Credits (A + B + C) (2) 0,00 3. InteresUPenalty if applicable p, Interest __ E. Penalty __ Total InteresUPenalty (D + E) (3) 0.00 4, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) _ __ Check box on Page 2 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. (5) _ 0.00 A. Enter the interest on the tax due. (5A} _ g, Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) _ _ Q . ~ Q 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 :.................................................................................. ^ ~^x~~ b. retain the right to designate who shall use the property transferred or its income :.................................... ^ u c. retain a reversionary interest; or .................................................................................................................. ~^ 0 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? ....................................................................................................................... ^ I A V 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... ~_~ 0 1F 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 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 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 zero (0) percent [72 P.S. §9116 (a) (1.2)J. 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. §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+ (8-98) SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSriVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF - (FILE NUMBER ZOOK, Shirley C 21-07-01079 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the Nght of survivorship must be dlaclosed on schedule F. (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) _ SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ZOOK, Shirley C FILE NUMBER 21 - 07 - 01079 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Michelle M SERFF 627 Lancaster Ave Daughter q Harrisburg PA 17112 JOINTLY_OWNED PROPERTY: ITEM LETTER DATE Include name of financialTnOsf tulio nanOd bank account number DATE OF DEATH %o OF DATE OF DEATH NUMBER FOR JOINT MADE for similar identi in number. Attach deed for'ointl -held real VALUE OF ASSET DECD'S VALUE OF fY 9 ) Y ~ DECEDENT'S INTEREST TENANT JOINT restate. INTEREST 1 A 10/13/2005 Members 1st; savings 189995-00 150.10 50% 75.05 i I 2 A 10/13/2005 Members 1st; checking 189995-11 122.62 ~i 50% I 61.31 TOTAL (Also enter on line 6, Recapitulation) ~ 136.36 REV-1151 EX+(12_gg) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER ZOOK, Shirley C 21-07-01079 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER AMOUNT A. FUNERAL EXPENSES: Malpezzi Funeral Home; funeral bill 11,113.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Law Office Forest N Myers 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Asa ZOOk Street Address city Mechanicsburg State PA Z;p 17055 Relationship of Claimant to Decedent husband 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1,000.00 3,500.00 92.00 0.00 TOTAL (Also enter on line 9, Recapitulation) I 15,705.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX REYURN RESIDENT DECEDENT ESTATE OF ZQQK, Shirley C SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 -07-01079 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Members 1st; signature loan 2 Members 1st; VISA 3 Frederick Lorenzo, MD; medical bill 4 Pinnacle Health Hospitals; medical bill 5 Quantum Imaging; medical bill 6 QCard; consumer loan 7 Pinnacle Health Emergency; medical bill 8 Wells-Fargo Financial; consumer loan 9 Wells-Fargo Financial; consumer loan 10 Bank of America; consumer loan 11 Pinnacle Health; medical bill 12 Special Event Emergency Med Svcs; medical bill 13 Vascular Assoc; medical bi{I 14 Roy Monsour, MD; medical bill AMOUNT 2,903.07 7, 380.95 260.00 35.28 65.30 133.44 72.69 1,576.46 869.98 1,417.57 197.22 153.23 6.49 8.91 TOTAL (Also enter on Line 10, Recapitulation) I 15,080.59 REV-1513 EX+ (9-00) r COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF ZOOK, Shirley C -- - 1 _ -- - - ---- NUMBER NAME AND ADDRESS OF PERSON(S) i RECEIVING PROPERTY I, TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 Asa M ZOOK 43 W LocustSt Mechanicsburg PA 17055 II. 2 I~ Phillip M ZOOK ' 2937 Adams Dr Chambersburg PA 17201 I 3 Brian K ZOOK 105 Stone Head Rd 'I Dillsburg PA 17019 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Husband Son Son FILE NUMBER 21 -07-01079 SHARE OF ESTATE i AMOUNT OF ESTATE (Words) ($$$) - --- -~- - Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS 'I NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SH 0.00 REV-7513 EX+ (g_00) '~~ ' ~ ~ SCHEDULE J ' COMMONWEALTH OF PENNSYLVANIA ~ BENEFICIARIES continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ZOOK, Shirley C 21 - 07 - 01079 ----- - -- RELATIONSHIP TO SHARE OF ESTATE I AMOUNT OF ESTATE NAME AND ADDRESS OF PERSON S NUMBER ( ) DECEDENT (Words) ~ ($$$) RECEIVING PROPERTY Do Not List Trustee(s) I, TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 4 Lisa I STROHECKER Daughter 43 W Locust St Mechanicsburg PA 17055 5 Michelle M SERFF 627 Lancaster Ave Harrisburg PA 17112 Daughter Page 2 of Schedule J