Loading...
HomeMy WebLinkAbout07-11-0815056051047 REV-1500 EX (06-05) OFFlCIAl. USE ONLY PA Department of Revenue Bureau of tndividuat Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN - _ Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 ~3 0 0 3 7 2 ENTER DECEDENT INFORMATION BELOW `~ `e4V'-`"-°~°°`°`°""~"" Social Security Number Date of Death Date of Birth 03 22 2008 1206 J920' Decedent's Last Name Suffix Decedent's First Name MI M A C H U S A K ELIZABETH E (Nf Applicable) Enter Surviving Spouse's Information Below ~5pouse's Last Name Suffix Spouse's First Name ~5pouse's Social Security Number MI THIS RETURN MUST 8E FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL tN APPROPRIATE OVALS BELOW r:~ 1. Original Return t~3 2. Supplemental Return t~ 3. Remainder Retum (date of death prior to 12-13-82) s;~? 4. Limited Estate L~ 4a. Future Interest Compromise (date of t~ 5. Federal Estate Tax Retum Required death after 12-12-82) +~j 6. Decedent Died Testate CD 7. Decedent Maintained a Living Trust _~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death Ct 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 INFORMATIO~OULD Bfc DIRF~D T0: -- 7r Name Daytime Telephot el~nnber ~ -`_ +~.'' --_ ~ 7 KEITH 0. BRENNE`MAN 7 17 6g~'~c78.~ 8'~-' Firm Name (If Applicable) s ~-- ,; _ ;:31 --- _" =~ I ..._--REGISTER fYF ~'~!,)SE [7t4?±Y ~--} S N E L B A K E R & B R E N N E M A N ~ ~. -~ - `= - First line of address _ ~ , , , ~ `~ ~~ i ~ ~ --- ,_. -_- ' 4 4 WE'ST MAIN S'' T R E E T ' =:!3 ~` ' ~_. ~ ...-~ .~ --;, Second line of address C?a City or Post Office M E C H A N I C S B`U R G State ZIP Code P A 1 7 0 5 5 Correspondent's a-mail address: Under penalties of perjury, 1 declare that I have examined this return, including 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 representative is based on all information of which preparer has any knowledge. ~..~ SIGN -OF PE SO~ONSIBL FOR FILING RETURN BATE 1.,~ Executrix _ ____ ~~~~ / a~ ADDRESS OTHER THAN REPRESENTATIVE T/~I, ADDRESS _ -____ _ ___.. 44 W. Main Street, Mechanicsburg, PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 l ~ DATE FSLEt) 15056052048 REV-1500 EX Decedent's Name: Elizabeth E. Machusak RECAPITULATION 1. Real estate {Schedule A) ............................................. 1. 2. Stocks and Bonds (Schedule B) ....................................... 2. Decedent's Social Security Number 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages i£ Notes Receivable (Schedule D) .......................... ... 4. -- 5. Cash, Bank Deposits & Miscellaneous Personas Property (Schedule E) ..... ... 5. ~ e 4 5 6 • 0 4 6. Jointly Owned Property (Schedule F) t~ Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 4 5, 6 1 5. 5 2 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. ,, 9. Funeral Expenses Z?< Administrative Costs (Schedule H) .................. ... 9. 1 0 , 7 $ 3 • 5 8 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I} ............. ... 10. 1 , 0 2 2 , 3 Q 11. Total Deductions (total Lines 9 & 10) ................................ ... 11 • 1 1 , 8 0 5 • $ 8 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 4 1 2 6 5 •6 8 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. 4 1 , 2 6 5 •6 8 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 t~xabie 5 4 l 2 6 , 5. 6 8 at lineal rate X .0 1s. 1, 8 5 6.9 6 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. 1, 8 5 6 •9 6 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Cwt Side 2 15056052048 REV-1500 E:x Page 3 Decedent's Complete Address: File Number 21-08-00372 DECEDENT'S NAME Elizabeth E. Machusak _ _ STREET ADDRESS 1051 Allendale Road A t. F CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 1 , $Sh _ Ah 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable 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. Pill 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) 1 , 856.96 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) l , 856.96 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 PJo a. retain the use or income of the property transferred :.................................................................................... ...... ^ L~ b. retain the right to designate who shall use the property transferred 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 beneficiary designation? ................................................................................................................. ....... ~ ^ 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, 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)]. 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)]. Asibling is defined, under Section 8102, 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 Ep COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Elizabeth E. Machusak 21-08-00372 J Indude 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH J 1. PNC Bank, N.A., checking account No. 51-4017-2114 $3,772.55 2. Rent deposit refund 265.80 3. PNC Bank, N.A., money market account No. 5001893341 2,217.33 4. U.S. Treasury -economic stimulus payment 300.00 5. Verizon -credit balance refund 9.73 6. Patriot News -subscription refund 63.25 7. Prudential dividend payment 327.57 8. Prudential, balance of Alliance account 6.81 9. Fidelity Merck & Co. Medicare benefit refund 18.00 10. Miscellaneous personal property and furnishings 475.00 TOTAL (Also enter on line 5, Recapitulation) S 17 , 456.04 (If more space is needed, insert additional sheets of the same size) REV'-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Elizabeth E. Machusak FILE NUMBER 21-08-00372 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. ITEM NUMBE DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIPiO DECEDENT AND THE DATE OF TRANSFER. ATTACHA COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET °k OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE ~i. Prudential Life Insurance Policy No. 0,363.92 100 100 -0- 4351002773198, beneficiary: Estate of Elizabeth E. Machusak. Date of transfer: March 22, 2008 (date of death) 2.. Prudential Mutual fund account, designated as 45,615.52 100 100 45,615.5: payable upon death to Susan I. Meadows, daughter of Decedent. Date of transfer: March 22, 2008 (date of death) TOTAL (Also enter on line 7 Recapitulation) $ 145 , 615.52 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-0s) SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT _ Elizabeth E. Machusak .~~ ~v,.~ 21-08-00372 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t. Brady Funeral Home, funeral services $6,864.00 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip 2. AnomeyFees to Snelbaker & Brenneman, P. C. 2,500.00 3. Fatuity Exemption: (If decedent's address is nol the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees to Register of Wills 110.00 5. Accountant's Fees , tax preparer fees , reserve for miscellaneous 1, 000.00 probate fees and costs s. ~axitecxe~iKS Appraisal fee (personalty) to 60.00 Chuck Bricker, Auctioneer ~. Advertise Letters Testamentary: a. Cumberland Law Journal: $ 75.00 b. The Sentinel: 174.58 249.58 TOTAL (Also enter on line 9, Recapitulation) $10 , 783.58 (If more space is needed, insert addftional sheets of the same size) REV'-1512 EX+ (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Elizabeth E. Machusak _ _ Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Verizon payments on account ($23.53; $23.66) $ 47.19 2. Physician's Rehab, payment on account 108.70 3. Holy Spirit Hospital, payment on account 102.41 4. Neurology Center, payment on account 37.64 5. Quantum Imaging, payment on account 28.59 6. West Shore EMS, payments on account 274.50 ($194.65; $79.85) 7' Camp Hill Emergency Physicians, payment on account 16.72 8. Well Span Medical, payment on account 19.54 9. PP&L, payments on account ($75.09; $27.74; $2.34) 105.17 10. AT&T, payment on account 54.84 11. Church of God Homes, payment on account 227.00 TOTAL (Also enter on line 10, Recapitulation) 3 I 1 , 022.30 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES iNHERiTANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Elizabeth E. Machusak 21-08-00372 -- RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Llst Trustee(s) OF ESTATE J I TAXABLE DISTRIBUTIONS [ncfude outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Susan I. Meadows Daughter Bedroom set and 1/3 3807 Chippenham Road, Mechanicsburg, PA residue 17050 Patrick S. Machusak Son Baskets and lj3 937 Hickory Ridge Circle, Milford, MI 48380 residue Jeffrey L. Machusak Son 1/3 residue 257-2D Gemini Drive, Hillsborough, NJ 08876 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THRO UGH 18, AS APPROPRIATE, ON R EV-1500 COVER SHEET I[ NON-TAXABLE DISTR{BUT{ONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I S (If more space is needed, insert additions{ sheets of the same size) LAST WILL AND TESTAMEN`T' ~~ O F ELI_ZABE'1'H E. MACHUSAK --,,~ U ~'_ I, ELIZABETH E. MACHUSAK, of 105]_ F Allendale Road, ,i~ ~:~ Mechanicsburg, Cumberland County, Pennsylvania, being of sound ~•~ and disposing mind, memory and understanding, do hereby make, ~~ publish and declare this as and for my Last, Will and Testament, P hereby revoking and making void any and all wills by me at any ` ~ time heretofore made. 1. I direct that aal my debts and funeral expenses be paid as soon as practical after my death by my Executrix or Executor, whichever the case may be, lrerei.nafter named. I direct that all taxes that may be assessed as a consequence of my death shall be paid from my residuary estate as part of the expenses of the administration of my estate. 2. I give my white bedroom set to my daughter, SUSAN :1. MEADOWS, and a11. of my Longaberger baskets to my son, PA'PRICK S. 1~lACHUSAK . 3. All the rest, residue and remainder of my estate, real, personal. and mixed, and wheresoever the saute may be situate, I give, devise and bequeath in equal shares to my following children: MIKE MACHUSAK, II, PATR:CCK S. MACHUSAK, SL]SAN I~ MEADOWS and JEFFREY L. MACHUSAK. If any of my children identi.-.tied above shall fail. to survive me, I direct that- the property and/or share of my estate to which said deceased child would otherwise been enti_t].ed shall be divided equally between or among my surviving children as LAW OFF'IC ES S t•IEL6AKE12, Bt2erlrlEmAN specifically identified here:inabove in this Paragraph. & SPARE 3. Although I am not unmindful. of my daughter, CHARLOTTE ]J. S'PETLER, i.t is my intention i;hat sire not lae a beneficiary of any property of mine, real., personal or_ mi.xed under this my Last Will and Testament or that she in any way share in my estate. 4. I hereby nominate, constitute and appoi-nt my daughter, SUSAN I. MEADOWS, as Executrix of this my Last Will. and `T'estament, but- should she predecease me or. fai."I. to qualify, then in such event, I nominate, constitute and appoint my son, MACE MACHiJSAK, II, as Executor of this my Last Will and Testament. I further direct that no person serving as Executrix or Executor hereunder shall be required to post any bond to secure the faithful performance of her or his duties in the Commonwealth of Pennsylvania. or i.n any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on Two (?.) pages this 22nd. day of October, 1998. /f ,J ~ ~ 7 (',.~i.~'~.~=-E.G?t~f~c~'' I;~,~.q_,~1(SEAL) E;li~abeth Is. Machusak Signed, sealed, published and declared by ELIZA13ETlI E. MACHUSAK, the Testatrix above named, as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. ~j (~ ~,~~=111 F ~ `,Q~~f/~1 - -~ - GZ/-L-.. ---(SEAL) LqW UFFIC ES StJ EL BA KE R. I3RENNEMAN & SPARE 1 ~1' /__=_~ c.t~ „i._ f -£~{~ (SEAL ) V -2- I_I1W (I~FICES Sr1Er.©Ar, Ea, B h'ErINEMAM fk ~F'AftE CObIMONWEALTII OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) We, ELIZABETH E. MACHUSAK, KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYC1I, the Testatrix and the witnesses, respectively, whose names are signed 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, i.n the presence and hearing of the Testatrix, signed the WiL1 as witness and that to the best of his or her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. I'estatr_ rx ~i Witness ~~ .n ~~ ~ ; J n_ W.i t~1e~~s Subscribed, sworn to and acknowledged before me by ELISABE;'PiI E. MACHUSAK, Testatrix, and subscribed and sworn to before me by KEI1'lI O. BRENNEMAII, ESQUIRE and SUSAN L. ZYCII, witnesses, this 22nd day of October., 1998. Notary Public i'rOlarial5'?ei '_ CErrrsfine r1A 1~4hife. Pdcfanf Public P;fechanrrgburg g~:ro. Cunrberfanr1 {.oufriy P~Ay C;ainrrlisssort E,pires $apt 17 ~~0'I AAsniher. Pennsylvania ,~soci~fion o'f M1lofariea