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Home My WebLink About10-06-08J 15056041147 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box.2soso~ INHERITANCE TAX RETURN ~~ ~ ~ / Harrisburg, PA 17128-0601 i RESIDENT DECEDENT 2 1 (r, ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 194 44 9016 09 O1 2006 10 16 1953 Decedent's Last Name Suffix Decedent's First Name MI KOSLOV STEVEN p, (If Applicable) Enter Surviving Spouse's Information 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 Retum I~ 2. Suoolemental Return 4. Limited Estate ~ qa, Future Interest Compromise (date of death after 12-12.82) ~! 8, Decedent Died Testate ~ ~ Decedent Maintained a Living Trust (Attach Copy of Wilp ~-- (Attach Copy of Trust) 3. Remainder Return (date of death prior to 12-13-82) _' 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 9. Ldigahon Proceeds Received ~ 1 p. Spousal Poverty Credit (date of death r - 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: Name Daytime Telephone Number EDWARD P. SEEBER ESQ. 717 533 3280 Firm Name (If Applicable) JAMES, SMITH, DIETTERICK & First line of address 134 SIPE AVENUE Second line of address City or Post Office State ZIP Code HUMMELSTOWN PA 17036 Correspondent's a-mail address: REGISTER QF~WILLS USE!'f~ILY -~ _r; ~ _ .~ I G"t ,_~ ~ - - .:gib: DAT€ AILED C,,; r=- ~.,I P~~ ~_~~~~~ ~~ penury, I ecl a tnat I nave examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it i rue, correct and compl e. ration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. SI T E OF P SO RES L OR FILING RETURN ' DATE ^ Steven C. Koslow ~ I1 d d 6500 Unyblypeposit Road, Harrisbu ~IGNATURE F P ARER OTHER THAN REPRESENTATIVE PA 17111 Edward P. Seeber Esq. /:~ ipe Avenue, Hummelstown, PA 17036 Side 1 15056041147 15056041147 J PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Koslov, Steven A. 2007-00876 Under 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, 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. Signature #2 ~'~ ~ ~~ Name Address1 Address2 City, State, Zip Date Andrew M. Koslov anion uepostt Raod narnsourg, F'A 17111 ~`~~w~~ .J 15056042148 REV-1500 EX Decedent's Social Security Number Decedent's Name: Steven A. Koslov -- - 19 4 4 4 9 016 _-- 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. ~- • 2 0 8 7 5 6. Jointl Owned Pro ert Schedule F y P Y ( ) _ 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) ..................................................................... --- .. g. 1 , 2 0 $ . 7 5 uneral Expenses & Administrative Costs (Schedule H) ....................................... -- - .. 9. - ---------- ---- 7, 4 0 9 4 6 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 1 , 3 8 0 . 0 0 11. Total Deductions (total Lines 9 & 10) .................................................................... .. 11. 8 , 7 8 9 . 4 6 12. Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12. - '] , $ $ 0 '] 1 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) ....................................... . ~---.- . 1a. - 7, 5 8 0. 7 1 _ _ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES __ 15- Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(12) X .00 ~~ ~ ~ 15. 0. 0 0 16. Amount of Line 14 taxable at lineal rate X .045 Q ~ ~ 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 1 g- 0. 0 0 19. Tax Due ..................................................................................................................... 19- 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 15056042148 15D56042148 J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENT'S NAME Steven A. Koslov -- - --- - -- - __ STREET ADDRESS 7B Richland Lane CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable p. Interest E. Penalty File Number 2007-00876 STATE ZIP---- - PA 17011 Total Credits (A + B + C) Total InteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REG/STER OF W/LLS, AGENT (1) 0.00 (2) 0.00 (3) ('t) - (`>) 0.00 (5.A) (5~B) - 0.0 0 - 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 :.................................._ c. retain a reversionary interest; or ........................... ....................................................................................... _' ~• X I' 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?......... x- x. 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. -- - - _ -- -- Fordates 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)J. 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. 0.00 Rev-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, ~ MISC. PERSONAL PROPERTY Ca~iait c~t- Koslov, Steven A. ILE NUMBER 2007-00878 Include the proceeds of litigation and the date the proceeds were receivetl by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION 1 Prudential Financial -refund of premium 2 Personal Property -valued per executor VALUE AT DATE OF DEATH 1,108.75 100.00 TOTAL (Also enter on Line 5, Recapitulation) 1 208.75 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-150(1 Schedule E (Rev. 6-98) REV-1151 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS t51ATE OF Koslow, Steven A. FILE NUMBER 2007-00876 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. 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 James, Smith, Dietterick 8c Connelly 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 7,009.46 400.00 TOTAL (Also enter on line 9, Recapitulation) I 7,409.46 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 ;ichedule H (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Koslov, Steven A. 2007-00876 Copyright (c) 2002 form software only The Lackner Group, Inc_ Form PA-1500 :>chedule H-A (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, ~ LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT tSTATE OF Koslov, Steven A. FILE NUMBER 2007-00876 Include unreimbursed medical expenses. " ~~~-• ~ ..r...,., ~~ ~~oo~c~, nuUmVndl pa(~e5 OT TliB S8fT1Q SIZ@~ Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule i (Rev. 6-98) REV-1513 EX+ (9-001 SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER f~VA1V Y, JICV CII h. ZOO7-00 876 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT SHARE OF ESTATE: AMOUNT OF ESTATE Do Not List Trustee(s) (Words) ($$$) I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Terrah Bass Daughter 25% of residue 6501 Heatherfield Way Harrisburg, PA 17112 Z Andrew M. Koslov Son 25% of residue 6500 Union Deposit Road Harrisburg, PA 17111 3 Steven C. Koslov Son 25% of residue 6500 Union Deposit Road Harrisburg, PA 17111 4 Tanya Koslov Daughter 25% of residue 320 Buckley Drive Harrisburg, PA 17112 Total Enter dollar amounts for distributions shown above on lines 5 through 18, as appropri ate, 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O OO Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) C.~"~~ ~r ~~ d ~"~ .. '~ ~ ~".' ~7 ~. ~ ~~ ~ ( ~. :.~, e ~~.~w .,,;~'. 6 ~~''~ d J J T N C C O Uo~ xs~o Y v X ~ma p0~ w r n. _ ~ ~ w V1 = E ~ . t 7 c~ ~ ~ O ~ L U ~ iotS ~M N N C N O L - ev r~ ~~ aNr- ao`~a ~ ~~s ~ H ~ ~ H ~ 'v~ ~ ° .L _m Uev C~~U~U October 3, 2008 Glenda Farner Strausbaugh Register of Wills & Clerk of Orphans' Court 1 Courthouse Square Carlisle, PA 17013 RE: ESTATE OF STEVEN KOSLOV, DECEASED FILE N0.2007-00876 Dear Ms. Strausbaugh: Enclosed are the following documents to be filed in the above-referenced Estate: 1. An original and two (2) copies of the Pennsylvania Inheritance Tax Return. 2. An original and one (1) copy of the Inventory. 3. A copy of the will. 4. A check made payable to the Register of Wills in the amount of Thirty Dollars ($30.00) representing the filing fee. 5. There is no tax due. Please time-stamp the additional copies of the Return and Inventory and return them to me in the enclosed self-addressed, stamped envelope. Denise M. Long dml@jsdc.com If you have any questions, please feel free to give me a call. ~-= Sincerely, '~ _ -~ ~ _ ~ C~ ~ ~ ~ _ JAMES, SMITH, DIETTERICK & CONNELLY, LLP ~~ ; _~ ~~ 1!? ~'' -- ,, Denise M. Long = `T, G? J _:~ .r~ _s Enclosures 134 SIPE AVENUE HUMMELSTOWN, PA 17030 MAILING ADDRESS P O BOX 650 HERSHEY. PA 17033 x: ~_ ESTATE SECURITY TOLL FREE 1.800.9423660 TEL. 717.533.3280 FAX 717.533.7771 www.jsdacom