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Home My WebLink About05-13-09~._JMMONWEALTH OF PENNSYLVANIA-J DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPARTMENT 280601 HARRISBURG, PA 17128-0601 May 5, 2009 Mr. bee ~ ~ ~~ c%; ~ ~ ~ ~ , l~~ rv ~l1 ~'~ Register of Wills Schuylkill County Courthouse Pottsville, PA 17901 Telephone 717-787-3930 .% 1 ~. ,1~ ~~ Re: Estate of Eugene Rozenburch File Number: 2108-0559 County: Cumberland Date of Death:04/16/08 Dear Register of Wills: The subject decedent legally resided in Cumberland County as of the date of death. Accordingly, you are authorized to cancel file number 5409-0139. All matters concerning this estate should be maintained under Cumberland County File Number 2108-0559. All original Inheritance Tax documents for the subject decedent should be forwarded to the Cumberland County Register of Wills; however, you may wish to retain a copy, including photocopies of all receipts for the collection of Inheritance Taxes in the subject estate which have been issued by your office. Please contact me at the telephone number above if you have any questions. ~j ~ ~ ~ ~ Claudia Maffei, Supervisor ~-~ r, Document Processir~Unit Inheritance Tax Divi~ ='~ ~~:,~ ~ ',_; Z ~ W _ , ~_ ;-;'= ;-~i -Q _-r~ ~ O Y _..j COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO BOX 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV- 1162 EX No. S0003515 RECEIVED FROM: KATHLEEN A. PALUBINSKY, ESO. 225 NORTH MAIN STREET SHENANDOAH PA 17976 ESTATE INFORMATION: SSN # 077_26-4473 File Number 5409-0139 Name of Decedent ROZENBURGH,EUGENE Date of Payment 02/18/2009 Postmark Date 02/18/2009 County SCHUYLKILL Date of Death 04/18/2008 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 280.38 Total Amount Paid 2$0.3$ Received By GA Seal COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE 150560411(25 REV-1500 EX (06-05) ~ D V ~ iI I .Y~ ~ OFFICIAL USE ONLY PA Department of Revenue V I '~ 1, Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~ U~ ~ ~ ~j ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 7 7 2 6 4 4 7 3 0 4 1 8 2 0 0 8 1 1 1 3 1 9 3 3 Decedent's Last Name Suffix Decedent's First Name MI R. o z e n b u r g h E u g e n e (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 a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ prior to 12-13-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) ~ death after 12-12-82) 7. Decedent Maintained a Living Trust A 8. Total Number of Safe Deposit Boxes 9 Litigation Proceed R i d ( ttach Copy of Trust) . s ece ve ~ 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) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number K a t h l e e n A P a t u b i n s k y 5 7 0 4 6 2 9 6 1 6 Firm Name (If Applicable) a ~-~- , REGISTER OF WILts'USE ONIY,~ -r1 rn -~ O ~ First line of address s~ ; C ,v 2 2 5 N o r t h M a i n S t~ CO ~-y~ Second line of address City or Post Office S h e n a n d o a h Correspondent's a-mail address: kathiep111(c~verizon.net State ZIP Code P A 1 7 9 7 6 o ~' T- C _ cn ~ y> rT , _ ' _~`D'ATEFIL _._. _ J Under penalties of perjury, I declare t ave examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and corn lete De ' n of pn;parer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT RE OF P N E IBLE FOR ,FILING RETURN DATE'' cx / G ADD .ESS 514 a ~S ~~ Middletown PA 17057 SIGNATU E F R A N REPRESENTATIVE DATE / _ 225 ~ Main St. Shenandoah PA 17~37ti PLEASE USE ORIGINAL FORM ONLY 15056041125 „R~- :. .:.. Side 1 15056041125 J 15056042126 REV-1500 EX Decedent's Social Security Number Decedent's Name: EUCJeI12 Rozenbur h 0 7 7 2 6 4 4 7 3 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 2 2 5 U , 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 2 2 5 0 • 0 0 9. Funeral Ex enses & Administrative Costs Schedule H p ( ) .......... g, ...... 3 9 5 • 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ...... ...... 10. 11. Total Deductions (total Lines 9 & 10) ..................... ...... 11. 3 9 5 • 0 0 12. Net Value of Estate (Line 8 minus Line 11) ................... ...... 12. 1 8 5 5 • 0 0 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. 1 8 5 5 • 0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 1Fr. Amount of Line 14 taxable at lineal rate X .0 _ 16 • 17. Amount of Line 14 taxable at sibling rate X .12 17, • 18. Amount of Line 14 taxable at collateral rate X .15 1 g, 2 7 8. 2 5 19. Tax Due .......................................... ......19. 2 7 8. 2 5 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 L 15056042126 15056042126 REV-1500 FX F'age 3 Decedent's Complete Address: File Number 0 0 DECEDENT'S NAME Eu ene Rozenburgh STREET ADDRESS - 632 West South St. CITY Mahanoy City STATE PA ZIP 17948 Tax Payments and Credits: Tax Due (Page 2 Line 19) Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) 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) 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) (1) 278.25 0.00 0.00 0.00 278.25 2.13 B. Enter the total of Line 5 +5A. This is the BALANCE DUE. (5B) 280.38 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 No a. retain the use or income of the property transferred : ...................................................................... ^ Q b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X^ c. retain a reversionary interest; or ................................................................................................ ^ d. receive the promise for life of either payments, benefits or care? ....................................................... ^ X^ 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 "intrust for" or payable upon death bank account or security at his or her death? ......... ^ ^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. 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 childtwenty-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 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1579 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCI'~EDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Eugene Rozenburgh 0 0 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME A. Nancy M. Jones B C JOINTLY•OWNED PROPERTY: ADDRESS 514 Water St. Middletown, PA 17057 LETTER DATE DESCRIPTION OF PROPERTY ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. 1. A. 8/1/07 One-half interest in real estate situate at 632 W. South St. Mahanoy City, PA, UPI No. 48-7-158 DATE OF DEATH VALUE OF ASSET 4,500.00 TOTAL (Also enter on line 6, Recapitulation) (If more space is needed, insert additional sheets of the same size) RELATIONSHIP TO DECEDENT Friend °~ OF DATE OF DEATH DECD'S VALUE OF INTEREST DECEDENT'S INTEREST 50. 2,250.00 REV-1511 EX ~r (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES 8r ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Eugene Rozenburgh 0 0 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. 2. 3. 4. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s)IEIN Number of Personal Representative(s) _ Street Address City State Year(s) Commission Paid: Attorney Fees Kathleen A. Palubinsky, Esq. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS 5 Accountant's Fees 6. Tax Return Preparer's Fees 7. Zip Zip 350.00 45.00 TOTAL (Also enter on line 9, Recapitulation) I $ 395 00 (If more space is needed, insert additional sheets of the same size) vvvn ~~n~ m?vim c ZiD~m ADD n -~ a O z m O n m rn C Z r v °C~ 0 rn O m n - n ~ r ~ rn O c 70 Q ~ ~ s c~ z 2 rn O 0 v rn O m c fi c n m O v z mz cn = ~m ~~ mZ On rn n m c z n O n rn = ~ -o ~ z ~ rn m n ~ v ~ - ~ O O ~ c I ~ Z _ ~ ~ ~ ~ ~ m v ` ~ n ~ ~ ~ n o G ~ Z ~ c ~ ~ ~ ~ ~ ..~ ~ rn r ~,l~orn ~~Nr ~^ W i 0 ~" O sfl~~a -`_ N ~7T' ~D e ti~ •. 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