The URL can be used to link to this page

Home My WebLink About11-24-09--~ REV-1500 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue county code veer Fta tVun+eer Bureau of Irxfividual Texas INHERITANCE TAX RETURN 21 0 9 0 4 3 6 PO BOX.280t301 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 188123395 04032009 11261922 Decedent's Lasl Name 5uftix Decedent's First Name h+fi DOVNARSKY MARY E {If Applicable) Enter Surviving Spouse's Information Below Spouse's last Name Suffix Spouse's First Name Ml DOVNARSKY I. J Spouse's Social Secur~y Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRFATE OVALS BELOW ^ 1. Odginai Relurn ^ 2. Supplemental Return ^ 3. Remainder Retut (date of death prior to f2-iS•82) ^ 4. Limited Estate ^ qa, Fudre fnt•resi Compromise ^ 6. Federal Estate Taz Return Required (dale of death slier 12-1252) ~ g. D•udsnt Dt•d T•atato ^ ~- Decedent MatMa'ned a living 7rusl $, Total Number al Safe Deposit Boxes (AH•ch Copy or N'a) (Aa•ch Gopy of Ttusy ^ s. LNigation Proceeds Received ^ t0. syousei Povr1y crodA ldaie of death ^ f (,Election t0 tax under Sao. 91 f3(A) DaMwn 1231-Df and i-1.95) ~~ ~- O) ~OameESPONDENT . TF115 SECTWN MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX 1NFORMA ON SHOULD BE DIRECTED TO: rryv Daytime Telephone Number FRANCIS A ZULLI 717232148$ Firm Name {!f Applicable) WION, ZULLI AND SEIBERT First tine of address 109 LOCUST STREET Second line of address City or Post Office HARRISBURG Correspondent's a-mail address: WZS State ZtP Code PA 17101 Indspring.com William L. Mllier 1 >t Francis A Zulli PA 17101 V Side 1 1505607120 Road, Grantville, PA rya REGISTER OF V~~;I~USE ONt-~6' °~ ~ ' T z ~ f Yl ::7 A ~ - -~, r-1 r f V ~ r"7 ~ ~ J : DATE~.E~ '" GD ir~c.~ +`,1 C~: r % _a7 C~ ~:~ +,`7 c.:~ ~~ -; ~ -~ ~ >= `:"'a c',~ `_ ,,.,r sand st~~aments, and to the heat of kn and beAef, on alt informaNOn of vrMch preparer ire"s ~y ge. TE 1~~g°9 DATE 1505607120 J 1505607220 REV-1500 EX Decedent's Social Security Number ~aceaenrsName: DOVNARSKY, MARY ELIZABETH 188123395 RECAPITULATION 1 176,500.00 1. Real Estate (Schedule A) .......................................................................................... 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. 4. 5. 6. 7. 8. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... Mortgages & Notes Receivable (Schedule D) .......................................................... Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. Total Gross Assets (total Lines 1-7) ....................................................................... 3. 4. 5. 6. 7. 8. 1 , 5 7 3 . 5 5 1 1 , 1 5 7 . 2 2 5 2 7, 7 2 6. 5 5 7 1 6, 9 5 7. 3 2 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 1 6 , 4 3 5 . 3 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 1 6 , 4 3 5 . 3 7 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 7 0 0 , 5 2 1 . 9 5 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. 7 0 0 , 5 2 1 . 9 5 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.00 194 , 536.42 15. O . 00 16. Amount of Line 14 taxable at linealrateX .045 505 , 985.53 16. 22 , 769.35 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. 2 2, 7 6 9. 3 5 20. FILL IN THE OVAL lF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505607220 150560722,0 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 09 - 0436 Dovnarsky, Mary Elizabeth STREET ADDRESS 2100 Bent Creek Blvd. Apt 257 CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 22,769.35 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 21,835.20 C. Discount 1,138.47 Total Credits (A +B+C) (2) 22,973.67 3. Interest/Penalty if applicable p. 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. (4) 204.32 Check box 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Q , Q Q 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 :.................................................................................. ^ b. retain the right to designate who shall use the property transferred or its income :.................................... ^ ^x c. retain a reversionary interest; or .................................................................................................................. ^ 0 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 "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? ...................................................................................................................... 0 ^ 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 o 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 exemot 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. ~TH~~~~~ MIEMANCE TIUf RETiJRN AESIDEM DECEOENf SCHEDULE A REAL ESTATE FItE NUMt3ER ESTATE OF Dovrtarsky, Mary Elizabeth 21 - 09 - 0436 AI! real propert owned solely or as a tenant in common must be repported at fair market value. Fair market value is defined as the price at which propert~i would be excnangsd between a willing buyer and a wNlinngg seller, neSther being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jolntlyowned with right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Single family residence known as 4614 Abbington Drive, Lower Paxton Township, Dauphin 176,500.00 County, Pennsylvania, bearing Tax Assessment Parcel No. 35-090-154. Decedent received tiNe to teat estate by deed from Robert B. Mumper and Dorothy S. Mumper dated October 10, 1969 recorded in Dauphin County Recorder of Deeds, Book G, Volume 55, Page 621. (decedent was known as Mary E. Miller at time of conveyance). Sae Appraisal report of Wenzier Real Estate Appraisals. Appraised value at Date of Death TOTAL (Also enter on tine 9, Recapitulation) ~ '!76,500.00 ':" SCHEDULE E CASH BANK DEPOSITS, & MISC. ~"~°~~'~~""" PERSONAL PROPERTY rmEarxicErovcneruwi r~ameHroecEO~vr FILE NUIWIBER EsrAYI; o~ Dovnarsky, Mary Elizabeth 21 - os - 0436 Include the proceeds of litigation and the date the proceeds were received by the estate. Ali property jointly-owned with the right of survivorship must be disclosed on schedule F. SCHEDULE F co~otvwEa~TN or PENNSnvAww INNERiTANCETAxRETURN JOINTLY-OWNED PROPERTY RES~EkT DECEOEMY ESTATE OF povnarsk , Ma Elizabeth FILE NUM9ER y ry 21 - 09 -0436 If an asset was made Jofnt within one year of the decedent's date of death, It must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP'f0bECEDENT William L. Miller 1245 Ridge Road Son q Grantville, PA 17028 JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT Include name of tonal ns I o and ban aaount number or slmifar identifying number. Allach deed for joinElyheld real ~fe, DATE OF DEATH VALUE OF ASSET % ~ DECD~S INTEI~ES ~ A~~m aECSO~rms tarEREST 1 A 01!10!2000 PSECU Money Market Account No. 0188123395 19,831.86 50% 9,915.93 2 A 01/10/2000 PSECU Checking Account No. 0188123395 2,482.57 50% 1,241.29: TOTAL (Also enter on line 6, Recap{tulatlon~ 11,1$7.22 ~ SCHEDULE G C° IM~NND E~7ANCET AX RETURNAN~ INTER-VIVOS TRANSFERS & RE8IDENTDECEDEN'f MISC. NON-PROBATE PROPERTY ESTATE OF Dovnarsky, Mary Elizabeth FILE NUMBEti 21 - 09 - 0436 Thts schedule must be completed and flied if the ans~nrer to any of questlona 1 through 4 on page z rs yes. ITEM WUMBER DE8CRIPTION OF PROPERTY InWdalhenanleolUla4anafuee,tJlelrrektlonsh!plodeeadanl DATE OF DEATFI VAlUEOFASSET ~' OF DECD'S INTEREST EXCWSION (IFAPPLICA9LE) TAXABLE VALUE afW the date of uansler. Attach a oopp of ma dead for reW 9atala 1 Revocable Trust of M. Elizabeth Joseph (now M. 203,499.18 203,499.18 Elizabeth Dovnarsky) dated October 19, 1995. Comprised of IDS Annuity No. 93007727584, Benlficaries are: William L. Miller, son, 1245 Ridge Road, Grantvilie, PA 17028 and Kim ion Miller, son, 147 Mountain View Drive, Ashland, OR 97520, to be divided equally between sans named above. 2 Revocable Agreement of Trust of 1. Jack Dovnarsky and M. Elizabeth Dovnarsky dated April 9, 1999, comprised of: 1. Charles Schwab Account 6014-8610 $8,374.08 2. Commerce Bank Account No. 0513092098 $84,671.01 3. Ameriprise Annuity No. 315964304021 $231,182.28. Beneficiaries of the Trust are I. Jack Dovnarsky (spouse) 2100 Bent Creek Blvd, Apt 257, Mechanicsburg, PA X7050, William L, Miller, son and Kim Ian Miller, son. Item VI Testamentary Provisions of the Trust provide that 40°10 of the trust shall be distributed to the Estate of M. Elizabeth Dovnarsky and 60% to t. Jack Dovnarsky (spouse). 60% to spouse 194,536.42 194,536.42 40°~ to Estate of M. Elizabeth Dovnarsky 129,690.95 129,690.95 TOTAL (Also enter on IEne 7, Racapltulatlon) ii27,726.SS S~ULE H FUHE~iALD~QV~S 8~ COAMONNIElLLTH OF PENNSYLVANIA w^'_rcpwT*~ INHERITANCE TAX RETURN /"II.Afrw~T~W 11YC ~~ RESIDENT DECEDENT ESTATE OF Dovnarsk , Ma Elizabeth FILE NUMBER Y rY 21 - 09 - 0436 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. 1 Geigle Funeral Home -Funeral 3,189.17 2 Royers Flowers -Flowers 169.60 3 Expressly Yours Catering -after funeral reception 1,119.36 4 Linglestown Fire Hall -facility rental for after funeral reception 150.00 5 Pastor Jody Sillicker -funeral stipend 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions William L. Miller Social Security Number(s) / EIN Number of Personal Representative(s): 195-38-8741 Street Address 1245 Ridge Road city Grantville state PA zip 17028 Year(s) Commission paid 2. Attorney's Fees Wion, Zulli and Seibert -- Francis A Zulli 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant I. Jack Dovnarsky Street Address 2100 Bent Creek Blvd, Apt. 257 city Mechanicsburg state PA zip 17050 Relationship of Claimant to Decedent SpOUSe 4. Probate Fees Register of Wills Register of Wills -additional short certificates Register of Wills -Filing Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Carlisle Sentinel -Advertising Letter 3,500.00 3, 500.00 3,500.00 302.00 8.00 30.00 208.78 TOTAL (Also enter on line 9, Recapitulation) 16,435.37 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Sd>rrdule H w~,~,,F~,utt~~ralME^xp~er~~se~s ~ ESTATE OF Dovnarsky, Mary Elizabeth FILE NUMBER 21 - 09 - 0436 2 ~ Cumberland Law Journal -Advertising Letter 3 ~ Recorder of Deeds -recording deed to real estate 4 ~ Wenzler Appraisal Services -Real Estate Appraisal 5 ~ William Miller -reimbursement for after funeral reception 75.00 51.50 250.00 181.96 Page 2 of Schedule H REw~a~a ex+ la.oal SCHEDULE J coMl~oNwEAUTKOF PENNSnvANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT OECEUENr ESTATE OF n~„~„r, ~, ~A„~, ~~;,,,~s+,, ~ FILE NUMBER ----------~. ~----, ----------- ~ 29 -08-043 6 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) (SSS) RECEIVING PROPERTY Do Not Wt TnuN~is) j. TAXABLE gISTR{BUTIONS pnctude culright s usal trib d t n f rs di ti s u ons art ra s e under Sec. X116 (a) (1.2)) 1 William L. Miner Son 50% of Residue 1245 Ridge Road Grantvilte, PA 17028 2 Kim lan Miller Son 51)% of Residue 147 Mountain View Drive Ashland, OR 97520 Enter doper amounts for distributions shown above on ilnes 1 5 through 18, as appropriate, on Rev 1500 cover sheet jI NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRI8UT10NS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE D{STRIBUTIONS ON LINE 13 OF REV-1500 COVER 3HEET~ 0.00 DAVID A. WION FRANCIS A. ZULU JEAN D. SEIBERT ~~ LA~~W~~O~FFICE/~S, i~~,.~f %~/ u/%Z ~~~LIAA/ t°.// ~~rGV~/Y/ ~P.O. BoX l 121 HARRISBURG, PA 17108-1121 ------------------ 109 LOCUST $TREET Ha,RRISSURC, PA 17101 (717)236-9301 (717)232-1488 FAx(717)236-6100 EMAIL: WZS@MINDSPRING.COM November 23, 2009 Register of Wills Office Cumberland County Courthouse Carlisle, PA 17013 1 l3 E. MAIN $TREET HUMMELSTOWN, PA 17036 (717) 566-2501 RE: Estate of Mary Elizabeth Dovnarsky No. 21-09-0436 SS# 188-12-3395 Dear Register of Wills: Enclosed please find an original Inventory and PA Inheritance Tax Return, along with two copies and a check in the amount of $30.00 for filing same. Kindly date stamp our file copy and return same in the envelope I have provided. Thank you. Ve trul yours, Fr cis A. Zul ' FAZ/dm Enclosures n N O ~, -,- -moo ~° , ~-: ,_-'.; ~? c ~-~ ~ . t~ ~ e ` ~~' O - '' ) ~~= m ~ _ t,. i _ ~. j j ,,,e ~.Yi 1 -ice ,xlli ~~ 1.V 2009 tdOY 24 FM i ~ Oa CLEP~( ~)~ ~ I ~ ~ ~~ ORP'ri~~! ~ `„)l~~I ? r C~~ r'~;` ;~r,i~ ~;~., P~, C~-~ k.~- ~i3