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Home My WebLink About09-25-09J 1505607120 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code near file Numrer Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 2 1 0 7 0 0 8 1 6 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 193 64 2941 09 30 2005 Decedent's Last Name Suffix KLEEMAN (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number Date of Birth 09 16 1982 Decedent's First Name MI BRYAN A Spouse's First Name MI 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 5. Federal Estate Tax Return Required (date of death after 12-12-82) g 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 1 p. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113iA) 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 BRUCE J. WARSHAWSKY 717 238 6570 Firm Name (If Applicable) CUNNINGHAM & CHERNICOFF, P.C. First line of address 2320 NORTH SECOND STREET Second line of address City or Post Office HARRISBURG Correspondent'se-mail address: bjW@CCIaWpC.COm State ZIP Code PA 17110 REGISTER OF WILLS USE ONLY __ .^ --1 ~, DATE FILED -. c~ cn '~ Under Wallies 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 tr correct and c plete. Declaratip{1 p~eparer other than the personal representative is based on all information of which preparer has any knowledge SIGN E OF PERS, RESPC7NSIB F G R N DATE h i ~ ~ ,,' ~ .~" ~~ ,% ,~ ,,: ,~~ Bruce Jeffrey Warshawsky ~ ,~ , ; .',,;~- ADDRESS / v 23 N. 2nd St, Harrisburg, PA 17110 SIG AT R -~jREPARER.PjHER TF~RN RJ2P SEN TIVE DATE ~ ,~~/ ~ ~ '~ ~`~~ ruce J. Warshawsky ~~ , ' i` RESSi ~,, ~, '232`0 North Second Street, Harris g, PA 17110 Side 1 1505607120 1505607120 l'~( L: '~ 1505607220 REV-1500 EX Decedent's Name: Bryan A. K l e e m a n 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) j 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. Funeral Expenses & Administrative Costs (Schedule H) .................................... ..... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................ .... 10. 11. Total Deductions (total Lines 9 & 10) ................................................................ ......11. 12• Net Value of Estate (Line 8 minus Line 11) ....................................................... ......12. 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. 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 .00 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 0 . 0 0 16. 17. Amount of Line 14 taxable at sibling rate X 12 0 . 0 0 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 19. Tax Due .............................................................................................................. .....19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 193 64 2941 0.00 476.98 476.98 -476.98 -476.98 0.00 0.00 0.00 0.00 0.00 Side 2 1505607220 1505607220 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-07-00816 Bryan A. Kleeman STREET ADDRESS 413 4th St. - ---_ - -- --T---- - --_ CITY STATE P New Cumberland PA 17070 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.0 0 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable p. 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. (4) Check box on Page 2 Line 20 to request a refund 5. If tine 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.0 0 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Q , Q Q Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" tN 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 :.................................... x -. c. retain a reversionary interest; or ................................................................................................................_ x 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? ....................................................................................................................... x 3. Did decedent own an "in trust 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? ..................................................................................................... ............... 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 exemat3 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. REV-1151 EX+~12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Kleeman, Bryan A. 21-07-00816 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid z. ~ Attorney's Fees Cunningham 8 Chernicoff, P.C. 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. I Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 102.00 7. Other Administrative Costs 374.98 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 476.98 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Kleeman, Bryan A. 21-07-00816 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Death Certificate-cost to obtain 36.00 2 Filing Fees for Litigation 127.00 3 Law Office Costs 45.98 4 Legal Advertising 166.00 H-87 Subtotal 374.98 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) CUNNINGHAM 8~ CHERNICOFF, P.C. Expenses Bryan Kleeman Estate Administration 608407 Date Amount Description 9/21/07 117.00 Prothonotary -Filing fee 10/5/07 3.98 Postage 11/1/07 20.00 Cumberland County Register of Wills -Citation 12/4/07 1.99 Postage 12/13/07 12.00 Register of Wills - 3 short certificates 12/13/07 20.00 Register of Wills -Petition for Grant of Letters 1/23/08 75.00 Cumberland Law Journal -Publication Kleeman Estate 2/14/08 10.00 Prothonotary - Praecipe to Settle 9/2/08 1.00 Postage 8/5/09 1.49 Postage SubTotal 262.46 Bryan Kleeman Personal Injury Claim 608507 no expenses Estate of Bryan Kleeman 607807 9/5/07 50.00 Register of Wills -Filing fees 9/12/07 36.00 Vital Records -copies of certified death certificates 9/12/07 13.64 Overnight Postage 9/12/07 13.12 Overnight Postage 12/31/07 10.76 Postage 1/22/07 91.00 Journal Publications -Proof of Publication SubTotal 214.52 9/22/2009 TOTAL 476.98 THE CENTRAL PENN BUSINESS JOURNAL Proof of Publication Under the Pennsylvania Newspaper Advertising Act 45 Pa.C.S. §101, et seq. Commonwealth of Pennsylvania } ss} County of Dauphin } Jera-rte Zary, being duly sworn according to law, deposes and says: That he is the Accountant of and duly authorized agent for JOURNAL PUBLICATIONS, INC., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 101 N. Second Street, in the city of Harrisburg, County of Dauphin, State of Pennsylvania; that the THE CENTRAL PENN BUSINESS JOURNAL, a newspaper of general circulation distributed and circulated in Dauphin, Ctunberland, Lancaster, Lebanon and York counties , is published by the said JOURNAL PUBLICATIONS, INC. at 101 N. Second Street, in the City, County and State aforesaid; and that THE CENTRAL PENN BUSINESS JOURNAL was established September 9th, 1984 and has been continually published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in the weekly editions/issues of the CENTRAL PENN BUSINESS JOURNAL which appeared on the 4e', I la' and 18te day(s) of January 2008. That neither he nor said Corporation is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and This is a statement published by JOURNAL PUBLICA S, INC. PUBLICATION '` COPY Jer Z ~~. , NOTICE IS HEREBY GIVEN that Letters of I ~/ / Administration have been granted in the following Estate. All persons indebted to the said Estate are required to make payment and those having claims or demands to present the same without delay to the Administrator or attorney named below. ESTATE OF BRYAN A. KL.EEMAN, late of New Cumberland, Cumberland County, Pennsylvania (died September 30, 2005}. Administrator -Bruce J. Warshawsky, Esquiere, Cunningham & Chernlcoff, P.C., 2320 North Second Street, Harrisburg, PA 17110 Swom to and subscribed before me this~U day of ~7~f~Q2008 A.D. 6 htOTARY ~ BLIC C MMONWEALTH OF PENNSYLVANIA Nottuial Seal Donna Schankweiler, Notary Public City of Harrisburg, ,Dauphin Cody My Cottunis9ion Expires Mar. 10, 2WS Publisher's Receipt for Advertising Cost JOURNAL PUBLICATIONS, INC., publisher of the CENTRAL PENN BUSINESS JOURNAL, newspaper of general circulation, distributed and circulated in Dauphin, Cumberland, Lancaster, Lebanon and York counties, hereby acknowledges receipt of the aforesaid notice and publication costs and certifies that the same have been duly paid. Re: Estate of Bryan A. Kleeman Cunningham & Chemicoff, P. C. 2320 North Second Street Harrisburg, PA 17110 Attn: Bruce J. Warshawsky, Esquire THE CENTRAL PENN BUSINESS JOURNAL By ....... .................................. J:............ PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, viz: December 28 2007 January 4, and January 11, 2008 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ~. Li Marie Coyn Editor SWORN TO AND SUBSCRIBED before me this HIeemaa, Bryan A., deed. Late of New Cumberland. Administrator: Bruce J. War- shawsky, Esquire, Cunningham ~ Chernicoff, P.C., 2320 North Second Street, Harrisburg, PA 17110. Attorneys: Bruce J. Warshawsky, Esquire, Cunningham & Cherni- coff, P,C., 2320 North Second Street, Harrisburg, PA 17I10. 11 day of January. 2008 r Notary NOTARIAL SEAL DEBORAH A COLLINS Notary PubtlC CARLISLE BORO, CUMBERLAND COUNTY My Commission Expires Apr 28, 2010 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse S ware Carlisle, PA 1713 KLEEMAN BRYAN A Estate File No.: Paid By Remarks: 2007-00816 CUNNINGHAM & CHERNICOFF PC AJW ------------------- Fee/Tax Description PET LTRS ADM OTHER SHORT CERTIFICATE Check# 044290 Check## 044289 Total Received......... Receipt Date: 12/14j2007 Receipt Time: 13:53:02 Receipt No.: 1050930 Receipt Distribution ------------------------ Payment Amount Payee Name 20.00 CUMBERLAND COUNTY GENERAL FUN 12.00 CUMBERLAND COUNTY GENERAL FUN ---------------- $20.00 $$12.00 32.00 Date: g/2g/2007 Dauphin County NO. 0142074 Time: 03:27 PM Receipt Page 1 of 1 Received of: Cunningham 8~ Chernicoff $ 117.00 One Hundred Seventeen and 00!100 Dollars Case: 2007-CV-10142-CV Defendant: Bruce J Warshawsky, eta!. vs. IK Second Street Associa Amount Writ of Summons 117.00 Total: 117.00 Check: 043973 Payment Method: Check Stephen E Farina ,Prothonotary Amount Tendered: 117.00 By: Clerk: JMAURER Deputy Clerk