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HomeMy WebLinkAbout09-02-0915056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box 280601 INHERITANCE TAX RETURN Os-- ~ / ya Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 ~y / ~ ~~--/3 /z.az z.oo y os~ ~ ~ g ~ ~ Decedent's Last Name Suffix Decedent's First Name MI (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 OVALS BELOW ~ 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 w~~~~~M s' 1>~NI L'Ls ~-! ~ 2Y3 3~3~ Firm Name (If Applicable) REGISTfRyDF WILLS U3g:ONLY ~ ,_~ r, ,~ First line of address ~ c"~ U ~ -- r:,r- - , -_ Second line of address _ ~ -n `- rF _ to City Or POSt Office State ZIP Code -~~ATE FILED Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined~jhis~return, including accompanying schedules and statements, and to the best of my knowledge and belief it is true, co nd mp t D atio p e personal representative is based on all information of which preparer has any knowledge. SIGNAT O I URN DATE A ESS SIGNA/TSyRE OF P~R/~P FAO ER THAN ENT T~ ~ DATE ADDRESS 1 w, i~>>: fir' .~.~ . 2~s ~ c~~u~/,~..~~'/,~ /~i 3 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051047 15056051047 J J 15056052048 REV-1500 EX DJecedent~'s/ Social Security Number Decedents Name: ~J,Q..r_yr ~' , ~ ~~ck p~y~~ / 8 / l L~~" 1~ ,!~ RECAPITULATION 1. Real estate (Schedule A) . ......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. • 3. Closely Held Corporation, Partnership or Sale-Proprietorship (Schedule C) .. ... 3. • 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. • 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. „ ?j ~ a Q 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ~ 3 ~.V .~J Ej 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ~ ~ g~ . O 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. ~Q.~~"~ 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. Z/ ~~p g.~j `d 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. -- G - . 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. a' 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 taxabl at lineal rate X .0 ~~ ~ O' ~. 16. .- O ,_. 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 • 18. • 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT A\ ~4 \''~L 15056052048 Side 2 15056052048 O J Sete Address: File Number - __ CI'. __ _ - _ STATE ~fj~ ~~Gt/Vi Y..t / Tax - vents and Credits: 1. Tax (Page 2 Line 19) (1) 2. Crec ?ayments A. Sp sal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InteresUPenalty if applicable D. Interest _ _ _ E. Penalty Total InteresUPenalty (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. (5Aj B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable fo: REGISTER OF WILLS, AGENT -~' G ^-O - "~ ~ - 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 :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... ^ ^X d. receive the promise for fife 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? ........................................................................................................................ ^ 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}]. 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. ZIP i~-Z y( I, MARY E. LEFROWSRI, of North Middleton Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I devise and bequeath all of my estate of every nature and wherever situate in equal shares to my stepsons,- DONALD E. MOFFITT and WILLIAM R. LEFROWSRI, providing they shall survive me by thirty days. II. Should either of my stepsons, Donald E. Moffitt or William R. Lefkowski, predecease me or die on or before the thirtieth day following my death, I devise and bequeath the share of such stepson to his or her issue per stirpes living on the thirty-first day following .my death; and should any of my said adult stepsons leave no such issue living on the thirty-first day following my death, I devise and bequeath the share of such stepson to my other stepson, or to his issue per stirpes living ~ ~~ Q,n the thirty-first .day following my death. p J ~ J III. I direct that all taxes that may be assessed in C~ consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my. estate. IV. I appoint my stepsons, DONALD E. MOFFITT and ,~~ WILLIAM R. LEFROWSRI, co-ex ecutors, or the s urvivor of them executor, of this my last will. VI. I direct that my executors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand this` /~~ day of ~~°'~'~ 1997. MARY LEFKO KI The preceding instrument, consisting of this and one other typewritten page identified by the signature of the testatrix, MARY E. LEFKOWSKI, was on the day and date thereof signed, published and declared by MARY E. LEFKOWSKI, the testatrix therein named, as and for her last will, in the presence of us, who, at her request, in her presence, and in the presence of each o/they ve subs i d our names as witnesses hereto. ~~ ~~~ ~,~.32y ^~ , ~~ ~~ -- . REV4508 EX+(1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. Atl property jointlyowned wkh the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH /era. S'o cJec--~ ~zp, ©d 7 % /~/f / ~,a~ . aQ OP ~ ~ TOTAL (Also enter on line 5, Recapitulation) I ~ ~~ ?J 2~ ~~ (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 Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: B. I ADMINISTRATIVE COSTS 1. Personal Representative's Commissions Name of Personal Representative(s) ~O N /~L !J ~ . rn O~Fi /T~ ~`+~O G/) Street Address JT' / _ Vl ~~~ ~'ur~'~j /QpC C.~~~ v City 8 ~/L17~-'G /lam' State _C~ Zip ~ ~"'3 Z-~ Year(s) Commission Paid: 2. Attorney Fees ~k I~j,~iQ 6C. ~l~-~,S ~~SD' ~~ 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 0/~~J Street Address _ _ _ _ _. City State _Zip __ Relationship of Claimant to Decedent -s'~1, o0 4. Probate Fees ~'~ S ~^,p~-. ~ fit/. ~ J' 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. djs7i.rA~^ ~ !/i7'/.t'~ c.S'~~cl" GG>/L ~ F~'C/a`~~-S ~ 00 i~ 8. .G j.c1 r r ~ Ctii ~~s ~ +' ~ , ~~5 . aO TOTAL (Also enter on line 9, Recapitulation) I $ f ` ~ 9z • ~~' (If more space is needed, insert additional sheets of the same size) REV-1,512 EX+ (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES, & LIENS RESIDENT DECEDENT FILE NUMBER ESTATE OF / L ~-F l~aW~~l /rl~~ C . ~l4.S~ --G/ yam' 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 ~Iit~i~-.a /~G-~L ~ ~/2L~ 7~~ twt~-~ ~ ~~~ ~' Pµ ~/ c `~ r~ ~ c.c.s ~~ c~~sJ s / f~~ ~` ~ ~O ~, ~~!/J9tr PC y~j ovl~~I /•C/i-~ Usti9'T•c. .r.P / ~ S?/, TOTAL (Also enter on line 10, Recapitulation) $ I ~ ~~ (, . 3 Q (If more space is needed, insert additional sheets of the same size) A. H.U ;D. SETTLEMENT STATEMENT B.LOAN TYPE: 6.37596 15 Yrs. Fixed OUR FILE #: RE98-310 Loan #4867850TEM LENDER: Norwest Mortga a Inc. C.This form is furnish®d to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked P.O.C. were paid outside closing. D. NAME OF BORROWER: Barbara A. Hall E. NAME OF SELLER: Mary E. Lefkowski G. PROPERTY LOCATION: 518 Crains Gap Road, Carlisle, PA 17013 North Middleton Twp., Cumberland Co. H. SETTLEMENT AGENT: Duncan & Otto, P.C. 1 Irvine Row CARLISLE, PA. 17013 I. SETTLEMENT DATE: Friday 16-Oct-98 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100 GROSS AMOUNT DU8 FROM BORAONER d00 GROSS AMOUNT DUE TO SBLLER lol Contract solos Price $75,000.00 401 Contract ealoa price $75,000.00 102 Pereoaal property 402 Personal property 103 Settlement Charges (line 1400) 3222.89 403 lOd 404 105 Adjustments items prepaid by sellers Adjustments items prepaid by sellers 405 Local tnxe• to 31-Dee-98 49.53 306 Local taxes to 31-Dec-98 49.53 406 Assesamente 107 Assessments to 407 School taxes to 30-Jun-99 615.66 108 School taxes to 30-Jun-99 615.66 408 109 409 120 GROSS DUE FROM BORROWER 78888.08 420 GROSS DUE TO SELLER 75665.19 200 AMOUNTS PAZD BY OR FOR BORROWER 500 ABDUCTIONS IN AMOUNT DUE TO SELLER 201 Deposit or 8ernest Money 2000.00 501 Excess deposit 202 New Mortgage Amount: 60000.00 502 Settlement charges 2020.38 203 Bxisting loans tekan subject to 503 Existing loans taken 204 504 Payoff let mortgage 205 505 Payoff 2nd mortgage 206 506 207 507 Adjustments for items unpaid by seller 508 210 Local Taxes to 16-Oct-98 0.00 Adjustmonta for items unpaid by Seller 211 Assessments to 510 Local taxes 16-Oct-98 0.00 212 School Taxo• to 16-Oat-98 0.00 511 Assessments to 215 512 School taxes to 16-Oct-9H 0.00 216 513 217 514 220 TOTAL PAIp BY BORROWER 62000.00 520 TOTAL RBDUCTIONS SELLER 2020.38 300 CASH FROM/TO BORROWBR 600 CASH TO/FROM SBLLER 301 Gross amount du• from borrower 78888.06 601 Gross amount to seller 75665.19 302 Lose amounts paid by/for borrower 62000.00 602 Reduationa to sollor 2020.36 303 CASH FRAM (TO} $QF~~1~~1~4i: $16,888 08 6fl3 CgSH 1'E) tFRt>Ni} SEI*k,ER: $73,644.81 I have carefully reviewed the 8UD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or on my behalf nd I have received a copy of this HUD-1 for my records. ~~ .~ Barbara A. Hall Mary E. Lefkowski PAGE #2 HUD DISCLOSURE/SETTLEMENT STATEMENT PAID BY PAID BY BORROWER SELLER 700 TOTAL REALTOR'S COMMISSION 0.00 701 Listing Agency: 702 Selling Agency: 703 Commission paid at settlement 800 ITEMS PAYABLE IN CONNECTION WITH LOAN 801 Loan Origination fee 1.000% Norwest Mortgage Inc. 600.00 802 Loan Discount Norwest Mortgage Inc. 803 Appraisal Fee $360.00 POC LENDERS SERVICE INC. P.O.C. 804 Credit Report $15.00 POC SMS P.O.C. 805 Undervvriting Fee 806 Document Preparation Fee 807 Processing Fee Norvvest Mortgage Inc. 350.00 808 Tax Service Fee NORWEST ELEC. TAX SERVICE 97.00 809 Flood Zone Det. Fee FLOOD DATA SERVICES INC. 16.00 810 Overnight Mail Charges: Duncan 8~ Otto, P.C. 15.00 900 ITEMS LENDER REQUIRES TO BE PAID IN ADVANCE 901 Interest @$10/48/day i6-Oct-98 01-Nov-98 167.68 902 Mortgage insurance 903 Hazard insurance 904 1998-99 School Real Estate Tax Robin K. Sollenberger, Tax Collector 874.38 1000 RESERVES DEPOSITED WITH LENDER Escrows collected: # mos. due: X $ per mo.: 1001 Hazard insurance 3 20.58 61.74 1002 Mortgage insurance 0 0.00 0.00 1003 County/Local taxes 9 19.82 178.38 1004 School taxes 4 71.41 285.64 1005 Aggregate Adjustment (Initial Escrow Deposit $335.46) -190.30 1100 TITLE CHARGES 1101 Settlement or closing fee: 1102 Abstract or title search: 1103 Title examination: 1104 Title insurance binder: t 105 Document preparation: 1106 Notary fees: Notary 6.00 1107 Attorney's fees: William S. Daniels, Esquire P.O.C. (includes above item numbers): 1108 Title Insurance: WILLIAM A. DUNCAN, AGENT FOR FIDELITY NATIONAL TITLE 828.75 (includes above item numbers):1101-1104 Endorsements 100 300 8.1 $150.00 1109 Owner's coverage $75,000.00 $678.75 1110 Lender's coverage $60,000.00 1111 Disbursement fee 0.00 1200 GOVERNMENT RECORDING AND TRANSFER CHARGES 1201 Deed 25.50 Mortgage 31.50 57.00 1202 Release Assignment 0.00 0.00 0.00 1202 County/Local transfer tax (1 %) 750.00 1203 Pa. State transfer tax (1 %) 750.00 1300 ADDITIONAL SETTLEMENT CHARGES 1301 Radon testing: 1302 Pest inspection: Gilbert's Professional Pest Control Inc 70.00 1303 Water Certification or testing: Analytial Laboratory Services Inc 51.00 1304 Septic testing: Peck's Septic Service 275.00 1400 TOTAL S~7TLEMEN.T GHAR~ES: 3222.89 2020.38 (also entered on line 103 for Borrower; line 502 for Seller) REV-,1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF _ FILE NUMBER NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ~~ ~~Tq~ G~/fNrc~ /Q~ ~y ~~~~~.s ~~-- i~-3zy z w,//,~.~ ~, ~~•~k:~s,~, i oc~c~~ ~ ~ ~~ ssa-~ ~~ a / ~i~i3 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, 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 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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)