HomeMy WebLinkAbout10-03-05 (2)
~V-l500 EX + (&-00)
*' COMMONWEALTH OF
,~. PENNSYLVANIA
"" DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
2 1 -0 5 0 1 2 3
""CoUNTY'COiiE ---VEAR- - - Nii'MeER- -
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DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
Benn Ra chinskas
DATE OF DEATH (MM-DD-Year)
SOCIAL SECURITY NUMBER
DATE OF BIRTH (MM-DD-Year)
o 2 0 - 1 8 - 0 2 6 3
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
01/14/2005 09/23/1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
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00 1. Original Retum
D 4. Limijed Estate
00 6. Decedent Died Testate (AllachcopyolWdl)
D 9. Litigation Proceeds Received
D 2. Supplemental Retum
D 4a. Future Interest Compromise (date of death after 12.12.82)
D 7. Decedent Maintained a Living Trust (Attach copy ofTrusQ
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
D 3. Remainder Retum (dalll of death prioflll 12.13-82)
D 5. Federal Estate Tax Retum Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Allach SchO)
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\;j"HIS;$E~QN;'MUyttIE,IQM~)lfIp;_OQItRE$poNoeNce.,)AND'CONFIDENTIAL"T'AX.INFQRMA11QN.'SHOUL.O"BEiOIRECT'EOT<i):,')/ii
NAME COMPLETE MAILING ADDRESS
Marielle F. Hazen 2000 Linglestown Road
FIRM NAME (If Applicable)
Law Office of Marielle F. Hazen Suite 202
TELEPHONE NUMBER
717-540-4332 Harrisbur.,flA 17110
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Joindy Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
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(1)
(2)
(3)
(4)
(5)
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OFFICIAL USE ONL'II
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481,971.25
(6)
--.J
(7)
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(8)
481,971.25
(9)
(10)
35,811.81
8,280.10
(11)
(12)
(13)
44,091.91
437,879.34
109,469.83
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
328,409.51
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15. Amount of Line 14 taxable at the spousal tax
rate. or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
0.00 X _(15) 0.00
0.00 X _(16) 0.00
0.00 X .12 (17) 0.00
328,409.51 X .15 (18) 49,261.43
(19) 49,261.43
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
'> >->2'. URE-T:O ANSM:R ALL QUESTIONS ON REVERSE SlOE ANORECHECK MATH' <<"
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ece en s amPI e e ress:
STREET ADDRESS
4905 E. Trindle Road
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
49,261.43
40.000.00
2.105.20
Total Credits (A + 8 + C)
(2)
42,105.20
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E) (3)
4. If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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 the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check to: REGISTER OF WILLS, AGENT
0.00
0.00
7,156.23
7,156.23
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 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?............................................................................................... 0 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS
--I
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PA 17070
DATE
1(1
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 3%
[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 0% [72 P.S. ~9116 (a) (1.1) (ii)).
The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum 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 0% [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 4.5%, 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 12% [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)
'.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Benny Raochinskas
FILE NUMBER
21 05
Include 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.
0123
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
DESCRIPTION
PNC Bank
Certificate of Deposit No. 31700220059
PNC Bank
Certificate of Deposit No. 31600220552
PNC Bank
Certificate of Deposit No. 31000219062
PNC Bank
Certificate of Deposit No. 31400233449
PNC Bank
Checking Acct. No. 51-4005-2307
Federal Reserve Bank
Bond Redemption Check
Comcast Cable
Refund
Verizon
Refund
Dept. of Defense
Final Payroll - Estate Benef.
VALUE AT DATE
OF DEATH
103,893.94
103,893.94
103,893.94
97,220.76
72,717.35
105.09
5.69
3.47
237.07
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
481 971.25
REV-1511 EX + (12-99)
'.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Benn~ Rapchinskas
ITEM
NUMBER
A.
1.
B.
1.
2.
3.
4.
5.
6.
7.
8.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
FILE NUMBER
21
05
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Jerry & Beverly BradiQan
157 -18-2538/160-34-224 7
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 202 RidQeview Road
City New Cumberland
State P A
Year(s) Commission Paid: 2005
Attorney Fees Marielle F. Hazen
Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Probate Fees Register of Wills - Open Probate & Shorts
Accountanfs Fees
Tax Retum Preparer's Fees V. Fleming Tax Service
Cumberland Law Journal - Legal Ad
The Sentinel - Legal Ad
Zip 17070
Zip
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0123
AMOUNT
17,000.00
18,000.00
.~
488.00
90.00
75.00
158.81
35 811.81
.
RE\(-1512 EX: (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Benny Raochinskas
FILE NUMBER
21
05
Include unreimbursed medical expenses.
0123
ITEM
NUMBER DESCRIPTION
1. Country Meadows
Assisted Living Nursing Home
2. Statewide Tax Recovery
Per Capita and School Tax for 2000
3. DFAS Pension
Reclaimed PNC Bank
4. Social Security
Reclaimed
5. IRS - Income Tax - 2003
6. IRS - Income Tax - 2004
7. Department of Revenue - Income Tax - 2004
8. Personal Income Tax - 2005
9. PNC Bank
Check No. 456 (Lowther Manor) posted after the date of death
10. PNC Bank
Check No. 457 (Choice Nursing) posted after the date of death
11. PNC Bank
Check No. 459 (IRS) posted after the date of death
12. PNC Bank
Check No. 460 (PA Dept Revenue) posted after the date of death
13. PNC Bank
Check No. 587 (Elks) posted after the date of death
14. PNC Bank
Check No. 461 (Manor Care) posted after the date of death
15. Statewide Recovery
2001 Personal Tax (Cumberland County)
VALUE AT DATE
OF DEATH
3,104.32
30.50
508.00
164.00
599.28
369.00
50.00
10.00
65.00
221.00
3,000.00
100.00
20.00
8.50
30.50
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
8.280.10
R~-""EX'(.*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
Bennv 21 05 0123
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OFEST A TE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Jerry & Beverly Bradigan Collateral
202 Ridgeview Road 25%
New Cumberland, PA 17070
2. George Poplasky Collateral
85 Campbell Street 50%
Quincy, MA 02169
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
8. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. The Seeing Eye, Inc. -15% 65,681.90
P.O. Box 375, Morristown, NJ 07963-0375
2. Alzheimers Association - 10% 43,787.93
225 N. Michigan Ave., Suite 1700, Chicago, IL 60601-7633
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 109469.83
(If more space is needed, insert additional sheets of the same size)
REV-1500 Discount, Interest and Penalty Worksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death:~_~____40LOOO.00
Discount:
2.105.20
Interest Table
Year
Days Delinquent
this time period
-- -- -- ~-- -------------..---------- --
Balance Due
this year
/-
Interest
this period
Before 1981
---~-------
1982
1983
1984
1985
1986
1987
1988 throu h 1991
1992
1993 throu h 1994
1995 throu h 1998
1999
2000
2001
2002
2003
1~004
L.------- -__.. __~___
___ u____________1
.,
TOTALS
---- -- -----
- -----=:-- =-l.....
Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable amount:
Total Balance Due on January 17,1996: _______
Penalty: _
COMMONWEALTH OF PENNSYLVANIA
. DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 005132
DUPLICA TE
HAZEN MARIELLE F
2000 L1NGELSTOWN ROAD
HARRISBURG, PA 17110
____u__ fold
ESTATE INFORMATION: SSN: 020-18-0263
FILE NUMBER: 2105-0123
DECEDENT NAME: RAPCHINSKAS BENNY
DATE OF PAYMENT: 03/29/2005
POSTMARK DATE: 03/24/2005
COUNTY: CUMBERLAND
DATE OF DEATH: 01/14/2005
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ASSESSMENT AMOUNT
CONTROL
NUMBER
1 01 I $40/000.00
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TOTAL AMOUNT PAID:
REMARKS:
CHECK# 0999
SEAL
INITIALS: JA
RECEIVED BY:
TAXPAYER
$40/000.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
LAST WILL AND TESTAMENT
OF
BRONISLAVAS REPCHINSKAS
I, BRONISLAVAS REPCHINSKAS, a/k/a BENNY REPCHINSKAS, now of
4905 East Trindle Road, suite 33, Hampden Township, Cumberla);ld
County, pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this to be my
Last will and Testament, hereby revoking all other wills and
Codicils previously made by me.
ITEM I: I direct that payment of all my just debts,
expenses of my last illness, and the costs of administering my
estate from my estate as soon after my death as conveniently may be
done. My funeral expenses have been paid to Parthemore Funeral
Home, New C umb 1;[0 I and , Pennsylvania.
ITEM II: I give, devise and bequeath all of the rest,
residue and remainder of my estate, of every nature and wherever
situate, together with all insurance policies thereon, unto JERRY
BRADIGAN and BEVERLY BRADIGAN, in trust for my wife, JOSEPHINE
REPCHINSKAS if living at the time of my death, to be used for her
care and maintl3nance.
ITEM III: Upon the death of JOSEPHINE REPCHINSKAS or in
the event she1.s not living at the time of my death then the
1
remainder of the trust and the rest, residue and rema1nder OI my
property to go to the following named individuals then living as
follows:
A. Twenty-five percent (25%) of the residue to go to JERRY
and BEVERLY BRADIGAN.
B. Fifty percent (50%) of the residue to go to GEORGE
POPLASKY.
c. Fifteen percent (15%) of the residue to go to Seeing Eye
Dog Foundation, Norristown, New Jersey.
':,.....-. ~.. -"
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D. Ten percent (10%) of the residue to go to the Altziemer
Association.
ITEM IV:
I direct that any and all taxes that may be
assessed in consequence of my death, including all inheritance,
estate and transfer taxes imposed upon my estate passing under my
will or otherwise, shall be paid out of the principal of my
residuary estate as a part of the expense of the administration of
my estate.
ITEM V:
I
authorize
and
personal
empower
my
representative to compromise, adjust, release and discharge in such
manner as my personal representative may deem proper, all debts and
claims owed by or to me or my Estate; to sell, lease or exchange at
public or private sale or in such manner, at such prices, and upon
such terms of credit or otherwise, as my personal representative
may deem proper, all or any part of my property, real or personal;
to exec ute, acknowledge and deliver instruments of conveyance,
2
including deeds in fee simple; to borrow money for the'purpose of
paying estate, inheritance or other taxes which are required to be
paid and to secure any such loans by pledge or mortgage of all or
any part of my property and to execute the necessary instruments to
carry out such powers; to distribute my estate in kind or partly in
money or partly in kind, and to determine the fair value at which
any property so distributed in kind shall be received by the
distributees; to conduct any business in which I have an interest
at the time of my death, for such period as my personal 'j
representative may deem proper, power to borrow money and pledge
assets of the business and the power to do all other acts that I,
in my lifetime, could have done, to delegate such power to any
partner, manager or employee without liability for any loss
occurring therein and to organize a corporation to carry on said
business as capital to such corporation and accept stock in the
corporation in lieu thereof and hold such stock for the uses of
this my Will, and to vote said stock or sell the same as to my
personal representative may seem best; to retain all stocks,
assets, bonds and investments owned by me without being confined to
what is known as legal investments; to execute any options to
purchase, to apply for stocks, bonds or other investments, to
purchase or otherwise acquire real estate and to execute the same
powers thereover as hereinbefore provided, to retain indefinitely
any part of my assets, real or personal, which is or may become
unproductive or to make sale thereof; to pay carrying charges and
3
expenses of the property out of other principal or income of my
estate; to invest and reinvest in all forms of property without
restriction to investments authorized for Pennsylvania fiduciaries,
as my personal representative deems proper, without regard to the
principle of diversification or risk; to exercise any law-given
option to treat administrative expenses either as income tax or as
estate deductions, without regard to whether the expenses were paid
from principal or income. The powers herein conferred shall be to
". r
my named personal representative and all successors thereto'"and'
shall be in addition and not in limitation of other powers
conferred on said fiduciary.
Any and all payment or payments of any sum or sums, whether in
cash or in kind and whether for principal or income payable to any
beneficiary shall be made upon the sole receipt of the respective
beneficiary to whom the payment is made and free from anticipation,
alienation, assignment, attachment, and pledge and free from
control by the creditors of any such beneficiary.
ITEM VI:
All shares of principal and income hereby given
shall be free from anticipation, assignment, pledge or obligation
of the beneficiaries and any of them and shall not be subject to
any execution or attachment, levy or sequestration or other claims
of the creditors of said beneficiaries or any of them.
ITEM VII:
I nominate, constitute and appoint JERRY
and BEVERLY BRADIGAN, or either of them, as the sole Executors of
this my Last will and Testament, to serve without bond.
In the
4
event of the renunciation, death, resignation, refusal or inability
to act for any reason whatsoever of the said JERRY BRADIGAN and/or
BEVERLY BRADIGAN, I nominate, constitute and appoint PNC BANK as
the Executor of this my Last Will and Testament.
IN WITNESS WHEREOF, I, BRONISLAVAS REPCHINSKAS, have, to this
my Last Will
r;~~
and
Testament, set my hand this
/4a::. day of
.
, 2001.
~,,,L.'Qd4 (?~SEAL)
BronislavasRepchin as
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sealed, published and declared by . Bronislavas
the above named Testator on the /?/Vk;- day of
,20 p/ , as for his Last Will and Testament,
in t e presence of us, who, in his presence, and in the presence
of each other, have, at his request, subscribed our names as
witnesses hereto.
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residing at)1 C. ... 176" 70
residing
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COMMONWEAL~~F~PENNSY. LVANIA
COUNTY OF ~V-~~ SS
WE, the undersigned, the Testator and the witnesses,
respectively, whose names are signed to the foregoing instrument,
being first duly sworn and qualified according to law, do hereby
declare to the undersigned authority that we were present and saw
the Testator sign and execute the instrument as his Will, and that
he had signed willingly and that he executed it as his free and
voluntary act for the purposes therein expressed, and that each of
the witnesses, in the presence and hearing of the Testator, signed
the will as witnesses and that to the best of their knowledge, the
Testator was at that time eighteen years of age or older, of sound
mind and under no constrain or undue influence, and I, the said
5
.... -- .......-...
Testator, do hereby acknowledge that I signed and executed the
instrument as my Last Will and Testament, that I signed it
willingly, and that I signed it as my free and voluntary act for
the purposes therein expressed.
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Testator Bron' slavas Repchinskas
.cl.r "I' ~ QYl' ~ -.-' j(-
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witness
sworn to and subscribed be~e
me this /tjPa.- day 01; -~
20 0 / .
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Notary l:'u'Glfic U
My commission EXpires:
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NOTARIAL SEAL
MARY D. VER HAGE. Notary Publ'"
Falrvlew Twp.. York County
M Commission Ex ires Ma 7,2082
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