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Home My WebLink About01-22-10 (3)J REV-'~ J~~O 1505607120 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 6 ~ ~ (~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Binh 051091284 04252009 07201915 Decedent's Last Name Suffix Decedent's First Name MI BUGDONIS ALBERTA (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 Retum ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa, Future Interest Compromise ^ 5. Federal Estate Tax Return Required (dale or death after 12-12-82) ® B Decedent Died Testate ^ ~ 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. be~twueen 12V31 y91C andt (dat~e5~f death ^ 11. Election to tax under Sec. 9113(A) 1 (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFOR ATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number TERRENCE J. RERWIN 7173623215 Firm Name (If Applicable) REGISTER OF WILLS USE ONLY KERWIN AND RERWIN rv c~ First line of address ~Q ~, `; ~ i ~` 4245 ROUTE 209 `?~~ s>b <:- Z3~r '"~ ~-'' ~r Second line of address r- ~~x t_. -y City or Post Office State ZIP Code - `~" ELIZABETHVILLE PA 17023 ~~ E;,`-i O t,C) Correspondent's a-mail address: Under penalties of perjury, t deGare that. I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, corcect and complete. DeGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI TURE F EI~SON RESPON LE FOR FILING E URN DATE ~,~ ~ ~,~ 1~ ~, Q~~ .Cynthia D. Rudisill ~ r ~, Qj' ~ l_~ 215 North Second Street, Lykens, PA 17048 SIGNATURE OF PREPARER OTHER THAN REPRESENTATNE DATE Terrence J. Kerwin 4245 R6fite 209, Elizabethville, PA 17023 Side 1 L, 1505607120 1505607120 REV-1500 EX 1505607220 oecedern~sName BUGDONIS, ALBERTA __ 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 Gwned Property (Schedule F) ^ Separate Billing Requested ....... ...... 6. 7. Inter-Vivos Transfers 8 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 BequestslSec 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 15. 16. Amount of Line 14 taxable at lineal rate X .045 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, 0 3 9, 7 8 4. 4 0 16. 19. Tax Due .............................................................................................................. .....19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 051091284 914,164.68 192,156.40 1,106,321.08 66,536.68 66,536.68 1,039,784.40 1,039,784.40 _____ 155,967.66 155,967.66 Side 2 1505607220 1505607220 REV-1500 EX Page 3 File Number 21 Decedent's Complete Address: Bugdonis, Alberta _ _ STREET ADDRESS Country Meadows Retirement Home 4833 East Trindle Road cirY Mechanicsburg STATE. _ ZIP PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 120,000.00 C. Discount 6,315.79 3. Interest/Penalty if applicable Total Credits (A + B + C) p, Interest E. Penalty Total InteresUPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. q, Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1> 155,967.66 (2) 126,315.79 (3) 0.00 (4) __ (5) 29,651.87 (5A) (5B) 29,651.87 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 :.................................................................................I._ ~ i z] - f b. retain the right to designate who shall use the property transferred or its income :.................................... x c. retain a reversionary interest; or ...............................................................................................................~.. , z .~ .__ , „.--,. 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 • i X contains a beneficiary designation7 ....................................................................................................................._• i , IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETUR . ~. .. 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 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)J. 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. SCHEDULE B COMMONWEALTH OP PENNSYLVANIA ' v • O`~•~~ ~ BO~DS INHERITANCE TAX RETURN ~~. RE8IDENT DECEDENT 'I, _-.1------ ---_ - _.._- --__.. _.__. --._ --_.. ~ FILE NUMBER ESTATE OF Bugdonis, Alberta ~ 21 __ All property jointly-owned with right of survivorship must be disclosed on Schedule F. ___ i - _._- ___ ___ __ _ --- - ' UNIT VALUE VALUE AT DATE OF ITEM DESCRIPTION '~ ~ NUMBER ' ', DEATH 1 659 U.S. Savings Bonds Series EE. See attached listing. 914,164.68 ~, , TOTAL (Also enter on line 2, Recapitulation) ~ 914,164.68 j SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TA% RETURN RESIDENT DECEDENT __.. i... - _.--------- FILE NUMBER ESTATE OF Bugdonis, Alberta ~ 21 Include the proceeds of litigation and the date the proceeds were received by the estateAll property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM DESCRIPTION NUMBER 1 Checking Account #6215379852 -Citizens Bank 2 Savings Account#6243925159 -Citizens Bank 3 Certificate of Deposit - Account #6254637716 -Citizens Bank 4 Certificate of Deposit -Account #6255985742 -Citizens Bank 5 Refund -Country Meadows Associates 6 NYC retirement benefit 7 Refunds -Camp Hill Emergency and Country Meadows 8 PA Property Tax Rebate VALUE AT DATE OF DEATH 8,998.33 4,007.21 3,824.37 142, 033.49 32,503.76 253.03 36.21 500.00 TOTAL (Also enter on Line 5, Recapitulation) ~ 192,156.40 SCFEDIAE H FUNERAL Dff~BVSES ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ~. ADMNSTRA'i1VE VW 1 S RESIDENT DECEDENT ESTATE OF Bugdonis, Alberta Debts of decedent must be reported on Schedule I. __ ITEM NUMBER ,FUNERAL EXPENSES: DESCRIPTION A. 1 Pastor, for funeral service B. AMOUNT 100.00 ADMINISTRATIVE COSTS: '~ 1. Personal Representative's Commissions Cynthia D. Rudisill 39,658.03 Social Security Number(s) ! EIN Number of Personal Representative(s): street Address 215 North Second Street it city Lykens state PA zip 17048 Year(s) Commission paid 2009 2. Attorney's Fees Kerwin and Kerwin -- Terrence J. Kerwin 25,000.00 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. Probate Fees 310.00 5. Accountant's Fees I 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Country Meadows - 9 days' personal care ', _.. i-- ------ ------___. _ _.. '~ FILE NUMBER ~ 21 346.75 __ TOTAL (Also enter on tine 9, Recapitulation) 66,536.68 _r SchCed~~e H COMMONWEALTH OF PENNSYLVANIA f~{~ I~w INHERITANCE TAX RETURN ~~ RESIDENT DECEDENT i -- _ -- --- - - _ _ ~, FILE NUMBER ESTATE OF Bugdonis, Alberta ~ 21 ___ _ _ __ 2 Holy Spirit Hospital -account payable 33.12 3 Cumberland Law Journal -estate notice ~~ 75.00 4 The Sentinel -estate notice 5 ' Register of Wills -Releases 6 ', Register of Wills -filing of Inventory and tax return 7 ~' Register of Wills -additional probate fee 8 Vital Records -Death Certificates 9 Postage 10 Notary fees 11 Closing costs, e.g. additional postage for transfer and redemption of savings bonds, copies 208.78 10.00 30.00 670.00 27.00 8.00 10.00 50.00 Page 2 of Schedule H REV-1613 EXrl9-00) SCHEDU/LpE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ___ - __-_ ESTATE OF Bugdonis, Alberta ~ FILE NUMBER 21 RELATIONSHIP TO SHARE OF ESTATE ~ AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) ' DECEDENT Words ~ ($$$) ,RECEIVING PROPERTY oo Not ust Trustesls) t_._ _. - -- - ---- - -- _ -- ---_ ,_. _ - __ I. TAXABLE DISTRIBUTIONS[include outright spousal i distributions, and transfers under Sec. 9116 (a) (1.2)] I ', 1 Cynthia D. Rudisill ', Niece I, .50 215 North Second Street ', Lykens, PA 17048 I, 2 Donna Chance ', 2200 Merrimac Avenue Mechanicsburg, PA 17055 Niece I .50 I Enter dollar amounts for distributions shown above on lines 15 through 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEl~T 0.00