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HomeMy WebLinkAbout11-10-0815D56D41169 REV-1500 EX (Oti-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO Box 290601 INHERITANCE TAX RETURN ~ 0 ~~~ Harrisbur ,PA 17128-0601 RESIDENT DECEDENT ~ \ F ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 203-48-8700 05162006 03021964 Decedent's Last Name Suffix Decedent's First Name MI KOVELESKI JOHN A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return 4. Limited Estate 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return 4a. Future Interest Compromise (date of death after l2-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE Name DIRECTED TO: Daytime Telephone Number DEBORAH L WARTELL, EA (717)838 --2387 Firm Name (If Applicable) ~~ ~ - REGISTER;Q ILLS USE~NLY - PARKS AND COMPANY ~~ ~ First line of address "iTF - ~' .=1 815 E ARCH STREET __ . r? ~~ o .. ~~ ~ ~ - c ~ - , . ,-, _~, A l __:. 1 ' Second line of address U ~~_? t_ - = _ !~:} --~ r City or Post Office State cn ZIP Code DATE FILED PALMYRA PA 17078-1903 Correspondent's a-mail address: DEBW@ PARKSANDCO . COM 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 re resentati i b p ve s ased on all information of which preparer has any knowledge. SIGt~URE O nJ ~ RESpOt~S1gLE FOR FILING RETURN DATE ~ C~ ADDRESS 853 BRAEBURN ROAD, ELIZABETHTOWN, PA 17022 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE ~ - _ r DATE ADDRESS ~ 3`~ 815 E ARCH STREET, PALMYRA, PA 17078 PLEASE USE ORIGINAL FORM ONLY Side 1 15D56D41169 15D56D41169 ~g ~'~ ~~ J 15056D42160 REV-1500 EX Decedent's Social Security Number ~ecedent'sName: JOHN A KOVELESKI 203-48-8700 RECAPITULATION 1 . Real estate (Schedule A) ......................................... .... 1. 110 , 0 0 0 . 0 0 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. 9 , 19 8 „ 62 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ... .... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested . , . .... 7. 0 . 0 0 8. Total Gross Assets (total Lines 1 - 7) ................................ ... 8. 119 , 19 8.62 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 18 , 4 5 5. 2 3 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. .. 10. 91 , 4 21.8 7 11. Total Deductions (total Lines 9 & 10) ................................ .. 11. 10 9 , 8 7 7.10 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 9 , 3 21.5 2 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. 9 , 3 21.5 2 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 taxable at lineal rate x .0_ 16 17. Amount of Line 14 taxable at sibling rate x .12 9 , 3 21.5 2 17. 1, 118.5 8 18. Amount of Line 14 taxable at collateral rate x .15 18 19. TAX DUE ....................................................... . 19. 1 , 1 1 8 ..5 8 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15D56042160 15D56042160 ` `REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA n D CERTIFICATE OF v GRANT OF LETTERS _. ADMINISTRATION No . 2008- 00147 PA No . 21- 08- 014 7 Estate Of : JOHN A KOVELESKI (First, Middle, Lastl Late Of : LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 203-48-8700 WHEREAS, JOHN A KOVELESKI (First, Middle, Last) late of LOWER ALLEN TOWNSHIP CUMBERLAND COUNTY died on the 16th day of May 2006 and, WHEREAS, the grant of Letters of Administration is required for the administration of the estate. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi11s in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, have this day granted Letters of Administration to: DAN/FLEE BRINSER who has duly qualified as ADMINISTRATOR(RIX) of the estate of the above named decedent and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 11th day of February 2008. ~: ~ ~ A f~_ ' Register of W epuYy * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) REV-1502 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT tJ IA l t Ut- SCHEDULE A REAL ESTATE FILE NUMBER John A Koveleski Estate 21-08-0147 _ All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchange between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge nrtna ralav~nr r~~r~ ,,, ~~w,c aNa~c is nccucu, msen aaamonai snee[s or the same size) ,% AMENDED SCHEDULE OF DISTRIBU'CION ~ oO ~~ SALE NO.73 Date Filed: October 3, 2007 Writ No. 2006-3545 Civil Term JP Morgan Chase Bank, NA, Successor by Merger with Bank One NA VS ht, Title Unknown Heirs, Successors, Assigns, and all Person, Firms, or Associations Claiming Rig and Interest From or Under John A. Koveleski 17 Neponsit Lane Camp Hill, PA 17011 Sale Date: June 13, 2007 Buyer: Daniel Sabolchick Bid Price: :$110,000.00 Real Debt: $82,185.14 Interest: Attorney Writ Costs: Total: $82,185.14 per order of court dated September 28, 2007 DISTRIBUTION: Receipts: ~~ ~ ~~``~ ~ ~ Cash on account (03/13/2007): $~1.,50a.00=~- ~ ~ Q t~ ~, ~ - °"~~ - Cash on account (06/13%2007): 11,000.00 . __ _ Cash on account (06/28/2007): 100;0,00:00-_. Cash on account (06/28/2007): ~,, 4,439.76 Total Receipts: $116,939.76 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER John A Koveleski Estate 21-08-0147 Include the proceeds of litigation and the date the proceeds were received by the estate. All prapertyjointly-owned with right of survivorship must 6e disrlosed nn s~nan~~io F i~~ mule space is neeaea, insert aaamonal sneers of the same size) y 1-888-910-4100 Call Citizens' PhoneBank anytime For account information, current rates and answers to your questions. US259 BR307 1 1 JOHN A KOVELESKI 17 NEPONSIT LN CAMP HILL PA 17011-7917 !° Checking Account Statement © or 2 Beginning May 04, 2006 through June 05, 2006 Checking SUMMARY JOHN A KOVELESKI Balance Calculation Green Checking Previous Balance 610077-808-8 3,192.46 Checks 100.00 - Withdrawals 590.17 - Deposits & Additions .00 + Current Balance 2,502.29 = TRANSACTION DETAILS Checks' there is a break in check sequence Check # Amount Date Check # Amount Date 935 100.00 05/08 Withdrawals ATM/Purchases Date Amount Description 05/10 05/10 500.00 64.27 ATM Withdrawal - MI6276 Hamppd~en/Camp Hill, Camp Hill PA MMC Purchase - 999999 Glenn Mi I let's Beelemo ne PA 05/11 25.90 y MMC Purchase - 999999 Twx*aol Service 05800-827-63 64 NY Daily Balance Date Balance Date Balance Date Balanee 05/08 3,092.46 05/10 2,528.19 05/11 2,502.29 I NEWS FROM CITIZENS --At Citizens Bank, we are always striving to improve at keeping you informed about your account. Nowhere is this more important than on your monthly statement, and we are pleased that so many of you have taken advantage of our recent enhancements. Check Imaging and Online Banking have provided concise and flexible tools for reviewing your account activity. If you are not currently taking advantage of either of these free services, call us to learn more! Our latest improvement is underway. Over the next several months your statement will begin to be printed on both sides of each sheet of paper. This wil I save you space when fi ling statements and conserve paper, benefiting our environment. Your statement can be optimized to include other accounts you have with us. To make sure you are getting the most out of your statement and your banking relationship, visit your local Previous Balance 3,192.46 n Total Checks 100.00 n Total Withdrawals 590.17 n Current Balance 2,502.29 ~~ ,~,, DEALS ON WHEELS AUTO SALES 304 East Main Street Middletown, Pa 17057 - Phone:717-944-5212 Fax:717-9445272 LEASE ENTER MY ORDER FQR THE FOLLOWINQ NAME `~ ^ NEW or ~11SED ^ DEMO ~^`~ ^ TRUCK ~ R ~.,.,,'r'~ •~ % (., t ~'I C 'R. _ ~ ~M~DEL TYPE STREET ~ _.. _ ~ .• ,..__ ''t" ~ TRIM r MILEAGE $~ ` ~,r ` ~.- `~I ~ .- . • .. _ PHONE F :~ ~..,._..,• ___e~.~~,.;., "_.. RES. :''x /~`F~ ' '', °- c - ,f, - .t~ ,1 r- CrC N0. -'9 f ~ LE&AAN TO BE OEIIVERED ON On A ~ A ~'n 'r~ to N0. ^ z: ~. ~ ~ ~ ~ ~ ~ ~.C~'' R. MAKE MODEL •rypE DLOR TRIM ~~'"~'`'~ t MILEAGE of _: ~ :F ~ ,.,y~ ~,. ~r C~OG°'1~ r -DATE / r ~`~ ~x r; ~~ ~ f G T ~ sE ~;i!'-cam ~ "'/7 ff t `S21P .. _ t ~ -. . us: ~ ~.., ~,., ewe i ~ ~ , ~ . ~ . ^ FACTORY WARRANTY- The iactaywarramy e~sntutos 811 el tla wrmuu enlh ~ ~~~ , ~_ ~ ~ ~ ~" - iternfilems, The aeAer trey a respBCt ro ttre ade of tide n ir>tv8ed vrerranly ar ~ ~ disdain ~ ararranlies, aWrer expreaeed or implied including prry .. authwiras ~ or btneas !a s pedicWar purpose, prrd the seNer neither easwaes nor ~ ~ ,. arry der perWn to asstane tar 8 arty Ifabtldy in ronneNion with the sale of this BenUitlrhK. .:. ~ u = [] USED CAR WARRANtY • Used car is covered by a Gmked warranty delal7ed M a aeprate document Q AS tS • This motor vehicle bt sold "AS IS" wlthorrt any warranty elgrer axpessed M impfiad. The punAraser „• _ t will hoar the entire expense of repairing or correcting any defect that pvesentiy axiets or that may ocar M ~ ~ ~ ~ ` the Yehkle. ''° - / , z ~~ ~~` '"mow _ PURCHASER'S' ~ ~ ' --r' SIGNATURE X ~ ~ ~ ' `~ ~` ~ ~ °" ~ , ur ,k., ~ ,«;,p,. USED CAR CONTRACTUAL DISCLOSU~3E STATEMENT ' THE tNFORMATION YOU SEE ON THE WINDOW FORM FOR THIS ~ ,r.,~ss `xoff ~~ ' VEHICLE IS PART OF THIS CONTRACT. INFORMATION ON THE ~~`~ I f °• ~ ~~ ,•t~Y~ WINDOW FORM OVERRIDES ANY CONTRARY PROVISIONS IN THE ~ ~~-~ CONTRACT OF SALE. I It you cancel this purchase agreement or refuse to take delivery of the vehicle • ~ r~ + ~ Y. _ _ ordered, except as permitted by law, you shall at our option, forfeit es dame s u s'' "Gas ' °` `r the amount of ~ ~ ~7~, ~ = ~ r , PURCHASER S ~ '~"°' _ .~s_' ~ ~-- €~y` °n SIGNATURE X L ~' ~ ~ `~~ ~`'' r;rdt~~~T4t~PJ)ovlnt~ PaVment~' ~~, - vwcatanrhat6r adnawlmmau~e ubow Wuae -.~--~. -..,~- ~~= gcs,~ :. ~ -.' .;-a .~". ^,. :; ;.; •.. Purchaser agrees that this order includes alt of the terms and condihons on both the ace and reverse side hereof, that this order cancels and supersedes any` prior agreement and as of the date hereof comprises the complete and exclusive statement of the terms of agreement relating to the subject matters covered hereby. This order shag not become binding unUf accepted by the dealer or his authorized representative You, the bt,yel may caneef this contract and receive a fup releind an me-before reset t of a copy of this contract signed by an authorized dealer re resentative b PrJrch p Y giving written-Tttatice at canceli8tion to the dealer. n Ihts order acknowledges that he has read tls fakrTts and conditions and has recelved_ ~~` ' PUR. ER'S } ~ _ 1:• i ~, ~,.~`4 . ~ru ~y ot,,this"~` er:~ "_ ~~cf - { DA~' '1~ ;' )~ ACCEPTED BY _ ~~._....rDaT~ 1,~; ~ t~ _ ' I_r ; REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER John A Koveleski Estate 21-08-0147 This schedule must be completed and filed if the answer to any of questions 1lhrough 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIRRELATIONSHIPTODECEDENTAND THE DATE OF TRANSFER ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUEOFASSET %OFDECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. IRA Acct, First Clearing LLC Acct # 42446783, beneficiary D. Brinser 5 4,487.27 0 0.00 TOTAL (Also enter on line 7, Recapitulation) $ 0 . 0 0 (If more space is needed, insert additional sheets of the same size) ' ` REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER John A Koveleski Estate 21-08-0147 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Neill Funeral Home 2,078.39 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions NameofPersonalRepresentative(s) Danielle BrlnSer street Address 853 Braeburn Road city Elizabethtown Year(s) Commission Paid: 2 0 0 8 State PA ZIP 17022 7,500.00 2. Attorney Fees 7, 5 8 5. 0 0 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant StreetAddress City State ZIP Relationship of Claimant to Decedent 4. Probate Fees 10 9 . 0 0 5. Accountant's Fees 5 0 0. 0 0 6. Tax Return Preparer's Fees 9 7 . 0 0 ~. Administrator's expenses (mileage, postage, cleanup) 400.10 8 Estate Advertising exp 185.74 TOTAL (Also enter on line 9, Recapitulation) I $ 18 , ~4 5 5. 2 3 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ~aiHi~ yr FILE NUMBER John A Koveleski Estate 21-08-0147 Report debts incurred by the decedent prior to death which remained unpaid as of the dare ~f dcorh ~n~i~~,~~,,,, ,,,,,,,;,~~.,......,, __.,:__~ _.._ ___ _ _ ~~~ ~~~~~~ ~Naw ~~ ucwcu, ~~~~c~, aaamonai snee[s ortne same srze) REV-1513 EX+ (g-00) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER John A Koveleski Estate ~~-nR-nTa~ NUMBER NAME ANDADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE [ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 Michelle Komara Sister 1/6 201 W Mulberry St, Apt 301 Shamokin, PA 17877 2 Paulette Snyder Sister 1/6 15 Popps Ford Rd York Haven, PA 17036 3 Denise Kerr Sister 1/6 255 Nyes Road Hummelstown, PA 17036 4 Gregory Koveleski Brother 1/6 6691 Jonestown Road Harrisburg, PA 17112 5 Danielle Brinser Sister 1/6 853 Braeburn Road Elizabethtown, PA 17022 6 Shannon R Santor Sister 1/6 8091 Evelyn Street Hummelstown, PA 17036 ENTER DOLLARAMOUNTS FOR DISTRIBUTIONS SHOWNABOVE ON LINES 15 THROUGH 1 8,ASAPPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICHAN ELECTION TO TAXIS 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 $ (If more space is needed, insert additional sheets of the same size) USA FIRST-CLASS FORE\EI S USA FIRST-CLASS FORFI~E USA FIRST-CLASS FOREVFF I I USA FIRST-CLASS FOREVER :. $` ~ j'.1y + ~d~ 1 s ~~,~ ~~ 5 ~; s~ 7t ~`. t F f~ ~ -~ ~ ~. `~ ~ S' '~ ~, ~=~ ~ ~~ ~ .~ ~..,r.~ _ , W 0 o U m >. ~ M ~ ~ M cn p a' O ~~ N 5 k; ~; a N w-. ~ ~ Q ~ o a L L ,~ ,~ ~ L Q~ N ~ ~ ~ .~ ~ O ,L U ~ U .--i U ~-~ ~_