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HomeMy WebLinkAbout06-11-091505607121 -' REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 2aosol INHERITANCE TAX RETURN 2 1 0 5 0 9 1 6 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 5 2 2 6 1 7 1 8 0 7 2 3 2 0 0 5 0 9 0 6 1 9 3 0 Decedent's Last Name Suffix Decedent's First Name MI G O R D O N FLORENCE J (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 Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) ^X 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 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 T0: Name Daytime Telephone Number MARK A. MA T E YA ESQUI RE 717 241 65 00 Firm Name (If Applicable) MAT EYA AW F RM N REGIST F WILLS US~NLY '_77 © ~; ~ ~ ~ 4~;7~" 3 First line of address ~ ~:;~:~ _.T _ _~ C:~ P O BO X 1 2 7 ~! cn - -r1 f a~ =~ ,~..~ Second line of address ~ ~ _ ~~.~ ~ -.~-i `~ I Ci P Offi ATE F1LED , St t ZIP C d ~` ~, _ ty or ce ost ~ a e o e _ B O I L I N G S P R I N G S P A 1 7 0 0 7 Correspondent's a-mail address: MAM@MATEYALAW.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 representative is based on all information of which prepan:r has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS ' r 111 MAPLE DRIVE, MECHANICSBURG PA 17050 S NATURE OF~PA EPA R OTHER THAN REPRESENTATIVE DATE P.O~ BOX 127 ~ BOILING SPRINGS PA 17007 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 1505607121 J 1505607221 REV-1500 EX Decedent's Social Security Number Decedents Name: FLORENCE J. GORDON 0 5 2 2 6 1 7 1 8 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. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 9 3 2 9 6 2 4 8 9. Funeral Expenses & Administrative Costs (Schedule H) . ........ ..... . .. • 3 9 6 4 2 2 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ..... ..... .. 10. • 11. Total Deductions (total Lines 9 & 10) ............ ........ ..... .. 11. 7 2 6 0 4. 7 5 12. Net Value of Estate (Line 8 minus Line 11) .......... ........ ..... .. 12. - 7 2 6 0 4 • 7 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ... ........ ..... .. 13• - 7 2 6 0 4 7 5 14. Net Value Subject to Tax (Line 12 minus Line 13) ... ........ ..... .. 14. . TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable 0 0 0 0 0 0 at lineal rate x .0 _ 16 . 17. Amount of Line 14 taxable 0 0 0 0 0 0 at sibling rate X .12 17. • 18. Amount of Line 14 taxable 0 0 0 0 0 0 at collateral rate X .15 18 . 0 0 0 19. Tax Due .................................. ....... ..... ..19. . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505607221 1505607221 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 05 0916 DECEDENT'S NAME FLORENCE J. GORDON ___ STREET ADDRESS 111 MAPLE STREET __ _ -- - - - CITY STATE ZIP MECHAN ICSBU RG PA 17050 Tax Payments and Credits: 1• Tax Due (Page 2 Line 19) (1) 0.00 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E ) 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. 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. (3) 0.00 (4) 0.00 (5) 0.00 (5A) (5B) 0.00 Make Check Payab/e to: REG/STER Of W/LLS, 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 : ................................................................ ...... ^ X^ . b. retain the right to designate who shall use the property transferred or its income; ^ Q ::::::::::::::::::: ::::: c. retain a reversionary interest; or ............................................................ :::::: ^ Q 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? ................................................................................. ...... ^ Q 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ... ...... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............................................................................................ ...... ^ X^ 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 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 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-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER FLORENCE J. GORDON 21 05 0916 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. BIRNBAUM FUNERAL SERVICES 8,476.59 2. KARL LUTZ MONUMENT CO -MONUMENT 1,048.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) ADAM GORDON Street Address 111 MAPLE DRIVE City MECHANICSBURG State PA Zip 17050 Year(s) Commission Paid: 2007 2. Attorney Fees MARK A. MATEYA, ESQ. 3. Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4. ~ Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 8,700.00 14,000.00 350.00 5 Accountants Fees 6. Tax Return Preparer's Fees 7. CUMBERLAND COUNTY REGISTER OF WILLS -LITIGATION FILING FEE 15.00 8. CUMBERLAND LAW JOURNAL -LEGAL ADVERTISEMENT 75.00 9. CUMBERLAND COUNTY REGISTER OF WILLS -SHORT CERTIFICATES 44.00 10. THE PATRIOT NEWS -LEGAL ADVERTISEMENT 206.64 11. F & M TRUST COMPANY -CHECKS AND CHECKBOOK FOR ESTATE ACCT. 17.25 12. CUMBERLAND COUNTY REGISTER OF WILLS - INH TAX RETURN & INVENTORY 30.00 TOTAL (Also enter on line 9, Recapitulation) I $ 32.962. Zip (If more space is needed, inseR additional sheets of the same size) REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER FLORENCE J. GORDON 21 05 0916 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. CAPITAL ONE CREDIT CARD 193.00 ACCOUNT NO 9585 2. CITIBANK USA NA (SEARS) 13,615.17 ACCT NO. 3133 3. LOWE'S 117.16 CREDIT CARD ACCT NO. 6275 4. BOSCOV'S 36.06 CREDIT CARD ACCT NO. 1815 5. BON TON 272.97 CREDIT CARD ACCT NO. 3701 6. HOME DEPOT 744.74 CREDIT CARD ACCT NO. 2719 7. JC PENNY 186.74 CREDIT CARD ACCT NO. 7651 8. CHASE BANK USA NA 10,675.00 CREDIT CARD ACCT NO. 2545 9. USA BANK 9,100.00 C/O WEST ASSET MANAGEMENT CREDIT CARD ACCT NO. 0020 10. HOUSEHOLD RETAIL SERVICES 545.94 CREDIT CARD ACCT. 4018 11. US DEPARTMENT OF TREASURY 1,207.00 PERSONAL FEDERAL INCOME TAX FOR 2005 12. M&T BANK 2,948.49 LINE OF CREDIT ACCT NO. 7407 TOTAL (Also enter on line 10, Recapitulation) I $ ,~ ~,,,, ,,~ (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (g-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER FI C1RFNrF .I C~(~RI~nN 21 05 0916 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. 9116 (a) (1.2)] 1. ADAM GORDON Lineal 111 MAPLE DRIVE MECHANICSBURG, PA 17050 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11 -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) LAST WILL AND TESTAMENT OF FLORENCE J. GORDON I, Florence J. Gordon, of 111 Maple Drive, Mechanicsburg, Cumberland County, Pennsylvania, make this my will. I revoke any other wills or codicils to wills made by me. ARTICLE I. DISTRIBUTION OF MY ESTATE A. I give my personal property, including my jewelry and all personal effects that I may own at the time of my death to my son, Adam Gordon. B. If my son Adam predeceases me, I leave my personal property, including my jewelry and personal effects that I may own at the time of my death, to my daughter-in-law, Bonnie Kimble-Gordon. C. I leave my shares of the Mandon Partnership to my son, Adam Gordon. If my son, Adam Gordon predeceases me, then I leave my shares of Mandon Partnership to mydaughter-in-law, Bonnie Kimble-Gordon. D. Whenever property is to be distributed to the descendants of a person (the "ancestor"), such property shall be divided into equal shares, one share for each then living descendant in the first generation below the ancestor in which at least one descendant is living, and one share for each _.,_, _., _, - - _~ deceased descendant in such generation wino has a descendant tlien living. Each share created for a - living descendant shall be distributed to such descendant. Each share created for a deceased :~ desceidGlit Silaii ue dlVidcd aild ulStributed aC~vrdiiit; tii uie uireCtFE3it3 lit :lie t'vJ;i ;~rei.G'uii:,~; ' ' ' _ _ _ ~~ 1 sentences until no property remains undistributed. E. Any beneficiary or the legal representative of any deceased beneficiary shall have the right, within the time prescribed by law, to disclaim amp benefit or power under my will and the interest so disclaimed shall be distributed as if such beneficiary predeceased me. F. Gifts of specific items of property mentioned in this will or any separate writing that is binding upon my Executor shall fail to thf; extent that I, or any duly authorized agent of mine, dispose of such property prior to my death. My Executor shall not substitute cash or any other assets for any such property. G. I give my residuary estate to m.y son, Adam Gordon. H. If my son Adam Gordon predecease me, I give my residuary estate to mydaughter-in- law, Bonnie Kimble-Gordon. ARTICLE II. PROVISIONS FOR INTERESTS VESTING IN BENEFICIARIES UNDER AGE TWENTY-FIVE Notwithstanding the foregoing provisions, whenever any interest in my estate vests absolutely in a beneficiary under age twenty-five, my Trustee may retain the interest upon a separate trust and pay to the beneficiary as much of the net income or principal as my Trustee may deem appropriate to provide for the beneficiary's support, other needs, or education until the beneficiary reaches age twenty-five, when the interest shall be paid outright to the beneficiary. If the beneficiary dies before reaching that age, the interest shaii constitute a part of the beneficiary's estate. 2 ARTICLE III. PAYMENT OF EXPENSES AND OTHER CHARGES I direct my Executor to pay my funeral and burial expenses (including the cost of a monument or marker over my grave). The estate, inheritance and similar taxes assessable on my death (including taxes on assets not passing under this will) shall also be paid as a cost of administering Irly estate and my Executor shall not request any beneficiary to pay any part of such tax. ARTICLE I V. APPOINTMENT OF FIDUCIARIES AND POWERS A. I name my son, Adam M. Gordon, to be my Executor(hereinafter "Executor" and "Trustee"). Should he fail or cease to act, Iname mydaughter-in-law Bonnie Kimble-Gordon, to be my Executrix. If administration of my estate or trust should be necessary in any jurisdiction where my Executor or my Trustee is unable to qualify, [or if my Executor or my Trustee deems it necessary for any other reason,] I give to my Executor and my Trustee the power to designate any individual or corporation with trust powers to serve with my Executor or my Trustee or in my Executor's or my Trustee's stead. I request that no security be required of any Executor or Trustee, including an Executor or Trustee named pursuant to the preceding sentence. References in my will to my "Executor" and my "Trustee" are to the one or ones acting at the time, except where otherwise specifically provided. B. Any corporate Executor or Trustee shall receive for its services the compensation for JJIIICI'i It iS WIIIing t0 iAnoertat:e SIrnllar Sei VICes fC3r Clners ut ti2e ti;.1e suC11 services are rendered, ?.s evidenced by its published fee schedule in effect from time to time, unless it is willing to agree upon r ~~. 4 •~~..« '• 4 A . ' .7~ ,'.7 1 .b, rn TJrvoni.4 r nr Trr. te° h~ll lie a iec C1iG. IS less uiai. i:5 c:L:S:vi:Iai }~ fee. ~c~.i'c;y iil~siE I~:uai i-v iav Sei v vS c°u& 1~v:.~:C_ _ _ ~ ~.5 • S 3 entitled to receive reasonable compensation for his or her services and, whether or not such individual receives compensation, shall be entitled to be reimbursed for expenses incurred for such services. C. I grant my Executor and my Trustee the powers set forth in 20 Pa.C.S. § § 3311-3332 and 20 Pa.C.S. §§ 7131-7143 respectively. In addition, my Trustee may merge any trust under this will with any trust having the same trustee and substantially the same dispositive provisions. If at any time after my death the size of any trust under this will is so small that, in the opinion of my Trustee, the trust is uneconomical to administer, my Trustee may terminate the trust and distribute the assets to the person or persons authorized to receive the trust income in such shares as my Trustee may deem appropriate. No Trustee who is also an income beneficiary of the trust at issue shall exercise any discretion granted in the preceding sentence. My Executor and my Trustee may distribute tangible personal property passing to a minor to any adult person with whom the minor resides, and that person's receipt shall be a sufficient voucher in the accounts of my Executor and my Trustee. ARTICLE V. MISCELLANEOUS PROVISIONS If any beneficiary in any manner, directly or indirectly, contests this will or any of its provisions, any interest in my estate given to the beneficiary is revoked and shall be disposed of in the same manner as if the beneficiary had predeceased me without leaving surviving issue. THIS SPACE LEFT BLANK INTENTIClNALLY 4 ARTICLE VI. FINAL DISPOSITION I desire to have a modest Jewish burial, and direct the payment of my final expenses to come from my estate, at my Executor's final discretion. Executed this ~ ~~ day of , 2005. ~~ ~ ' (SEAL) Florence J. Gordo Signed, sealed, published, and declared for and as her last will and testament by the testatrix in our presence, we all being present at the same time; and we, in her presence and at her request and in the presence of each other, have subscribed our names as witnesses whereof, all on the date last above written. ' U ~ ~ ~ 007 1 , - ~ ~~`~S COMMONWEALTH OF PENNSYLVANIA DAUPHIN COUNTY, to wit: c.~Before me, the undersigned authority, on this date personally appeared Florence J. Gordon and f ') ~t.~. ~ • ,and ~ ~.~ known to me to be the testatrix and witnesses, respectively, whose names are signed to the foregoing instrument and, all of these persons being by me first duly sworn, Florence J. Gordon, the testatrix, declared to me and to the witnesses in my presence that said instrument is her last will and testament and that she had willingly signed and executed it in the presence of said witnesses as her free and voluntary act for the purposes therein expressed, that said witnesses stated before me that the foregoing will was executed and acknowledged by the testatrix as her last will and testament in the presence of said witnesses who in her presence and at her request and in the presence of each other did subscribe their names thereto as attesting witnesses on the day of the date of said will and that the testatrix, at the time of the execution of said will, was over the age of eighteen years and of sound and disposing mind and memory. Sworn and acknowledged before me by Florence~.,Gordon, the statrix, Q • ~ ,witness, and / ~ ~ ,witness, ~- this ~~day of , 200 ~. Flore ce J. Gordon ?I~- Witness ~, i fitness FA A~ r ,_ _ ~~ iJotariai,jS~ji'Lf/Yvi~f;~-~: Trances A. Aumifler, N~li~ub• ~ Ci',y of Harrshur~ Oyu ~ F !vty Go.^.~missier ^4sr. ?~, i'J!'e etc, Penn~;yPrc~ i~ ~ Assoaation pt[~ 1~1V Con1i~l~JsiUn Gi~~JtGJ: 6 ~~ ~1J1~ 'N+~~