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Home My WebLink About04-28-0915056041114 ~' REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ b~ \~b~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 11032008 06141921 Decedent's Last Name Suffix Decedent's First Name MI MOC].~AITIS JR ADOLPH (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 REGISTE R OF WILLS FILL IN APPROPRIATE OVALS BELOW 0 1. Original Return Q 2. Supplemental Return Q 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate Q 4a. Future Interest Compromise (date of Q 5. Federal Estate Tax Return Required death after 12-12-82) Q 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORR',ESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENT IAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number 7172431220 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY RONALD MOCKAITIS First line of address ra ~-~ G i ,m Q `~ 2430 SPRING ROAD .~ Second line of address ~ =' r' ~ ~ _ OG oq , -- -- D City or Post Office State ZIP Code __ -_, . ~__ CARLISLE PA 17013 _, -~~ ~z> _ - Correspondent's a-mail address: Under penalties of perjury, I declare that I ha examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, r ct an m lete. Declaration of a rer other than the ersonal re resentative is based on all information of which re arer has an knowled e. SIC~IIVA R O P ESPONS E F FI 'RETURN DAT ~ < L: ~ ADDRE ~ U ~^ t 2. N SIGNATURE OF PREPA~ OTHER THAN R ESENTATIVE DATE ADDRESSL~ ~J _ //d l2 C}Ae'ClL 3 ~ $ !-rl~lvUVCrt S i - CAYeI-/ SLU l~~a /7~'~3 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041114 15056041114 J C_J 1556042115 REV-1500 EX Decedent's Social Security Number _ Decedent's Name: ADOLPH MOCKAI TI S JR REiCAPITULATION 1. Real estate (Schedule A) ........................................... 1. 0 • 0 0 2. Stocks and Bonds (Schedule B) ...................................... 2. 0 . 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. NONE 4. Mortgages & Notes Receivable (Schedule D) ............................ 4. 0 • 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 13 7 7 9 , 0 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ........ 6. 0 , 0 0 7'. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ........ 7 0 . 0 0 F3. Total Gross Assets (total Lines 1-7) .................................. 8. 13 7 7 9 . 0 0 9. Funeral Expenses & Administrative Costs (Schedule H) ................... 9. 2 8 6 4 . 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... 10. 5 9 2 2 . 0 0 11. Total Deductions (total Lines 9 & 10) ................................. 11. 8 7 8 6 • 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................. 12. 4 9 9 3 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ....................... 13. 0 . O 0 14 Net Value Subject to Tax (Line 12 minus Line 13) ................. 14. 4 9 9 3 . O 0 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 O 15. O. O O 'I 6. Amount of Line 14 taxable at lineal rate x .0 4 5 4 9 9 3. 0 0 16. 2 2 5. 0 0 17. Amount of Line 14 taxable at sibling rate X - 12 17. 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X , 15 18. 0 . 0 0 19, TAX DUE .......................................................19. 20, FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND T Side 2 225.00 0 15056042115 15056042115 REV-1500 EX Page 3 191-14-7735 Decedent's Complete Address: File Number DECEDENT'S NAME ADOLPH MOCKAITIS JR DECEDENT'S SOCIAL SECURITY NUMBER 191-14-7735 STREET ADDRESS 101 WINCHESTER GARDENS CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (i) 225.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable D. 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. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 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. (5) 225.00 (5A) (5B) 225.00 Make Check Payable to: REGISTER OF W1LLS, AGENT PLEA',iE 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 : ...................................... . ^ 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? ...................................................... ^ !F 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'lhe 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 raffle 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 rage 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)j. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 217 REV-1508 EX+(6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) SCHEDULE H COMtvIONWEALTH OF PENNSYLVANIA I FUNERAL EXPENSES & I INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF~ FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. HOFFMAN BOTH FUNERAL HOME 2,864 B. 1 2. 3. 4. 5. 6. 7. V1INISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Zip TOTAL (Also enter on line 9, Recapitulation) ~ $ 2 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ ;12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RIESIDENT DECEDENT ESTATE OF SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. FINAL BILL FOR FOREST PARK NURSING HOME 4,707 2. FINAL UTILITY BILLS 165 3. LEMOYNE SLEEPER LIFT CHAIR 900 4. HOUSE INSURANCE FINAL BILL 150 TOTAL (Also enter on Line 10, Recapitulation) I $ 5,922 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-08) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1. RONALD MOCKAITIS SON 100 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II. I NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, insert additional sheets of the same size.