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Home My WebLink About03-25-10 (2)REV-15 0 0 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 15056051058 OFFICIAL USE ONLY Cou ode Year File Number INHERITANCE TAX RETURN ~ ~ O ~ ~ RESIDENT DECEDENT ! V ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 172-18-2850 12/26/2009 s Decedent's Last Name Suffix I i l~ Bodek ~ ` (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix ~ i ! I ~ ~ t Spouse's Social Security Number Date of Birth 02/08/1921 Decedent's First Name MI Martha ~ ~ B Spouse's First Name MI j -- - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW :":ri;~ 1. Original Return A 2. Supplemental Return ,;. 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after 12-12-82) a"„. 6. Decedent Died Testate 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received - 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ,,, 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number 717 243-0123 ~~ Ronald E. Johnson, Esq. ~ ( ) Firm Name (If Applicable) Andrews & Johnson ~ _ _ First line of address ~~ _~ r------------------------ 78 West Pomfret Street Second line of address i -- - - City or Post Office State ZIP Code ..; ~a ;. r~ ,_..y .J ,,__, -r--. ~.~ r~ 'Carlisle ' PA 1 17013-0000 Correspondent's a-mail address: rejohnson@pa.net 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, is ,cone and corn late. Dedarati of reparer other than the personal representative is based on all information of which preparer has any knowledge. I }2, A RS R P NSI j OR FILING RETURN ~ ~ ~`iE ~ ~( ADDRESS c/o 78 st P mf tr t, rlisle, PA 17013 SI DFBR R REPRESENTATIVE DATA c/b78 West PomfjfexStreet, Carlisle, PA 17013 / V PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 J 15056052059 REV 1500 EX Decedent's Social Security Number ---- - Martha B Bodek 172-18-2850 .,~~ Decedent's Name: ~ ~......M».w..m.~....~....~... ~....... RECAPITULATION 1. Real estate (Schedule A) . ............................................ 1. _ 2. Stocks and Bonds (Schedule B) ....................................... 2. ~ ~~-~ .~~__ __ ___ _ __ _,W,~_w„ - - - _... - - - ... __- _ n, 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. . .-._~---~__________~_...e~.-_~.....__.....~._.., 4. Mortgages ~ Notes Receivable (Schedule D) ............................. 4. ; ~-_ ~~ 5. Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ........ i 5. ~-- 6. Jointly Owned Property (Schedule F) ° Separate Billing Requested ....... 6. 7 ransfers & Miscellaneous Non-P y r I l " 7 _ 91 55 876 ule t Re nested........ Billin Se arate Sched '' P 9 q ( ) . ... , . 8. Total Gross Assets (total Lines 1-7) .................................... 8. j 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 13,595.93 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule 1) ................ 10. 11. Total Deductions (total Lines 9 & 10) ................................... ' 11. 13,595.93 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ' 78,280.62 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which -- j - ---- ~---~- ..-m.._...~_.----- ------ -..._- ----- -- --~ an election to tax has not been made (Schedule J) ........................ 13. ' ------------___~.__ _nYS__________ 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 .0_ 15. j 16. Amount of Line 14 taxable ~~'~~~~'~~~~.~~_~.--~ 280 62 78 i.~..-~._M~.. 3 522.63 16 . , at lineal rate X .0 _ , , 17. Amount of Line 14 taxable ~~~~-~ ~~~~~ ~~-~ at sibling rate X .12 -- - ~ - - 17. _...~._......_-.-- Y., 18. Amount of Line 14 taxable at collateral rate X .15 18. ~ ~ 522.63 3 E 19. TAX DUE ......................................................... , 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV 1500 EX Page 3 Decedent's Complete Address: File, Number... F. DECEDENTS NAME DECEDENT'S SOCIAL SECURITY NUMBER Martha B Bodek 172-18-2850 STREET ADDRESS 28 Wheatfield Drive CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 3, 522.63 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 176.13 Total Credits (A + B + C) (2) 176.13 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (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) 3,346.50 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 3,346.50 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 :.......................................................................................... ^ ^x b. retain the right to designate who shall use the property transferred or its income : ..............:............................. ^ c. retain a reversionary interest; or .......................................................................................................................... ^ 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? .............................................................................................................. ^ 3. Did decedent own an °in trust for" or payable upon death bank account or security at his or her death? .............. 0 ^ 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)]. 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. SCHEDULE G TRANSFERS ESTATE OF Martha B. Bodek FILE NUMBER This schedule to be completed and filed if the answer of the question on the reverse of the cover is ves. ITEM 7~TT T ,~p 1~ V l`'1DER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEiR RELATIONSHIP TO DECIDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEID FOR REAL ESTATE. TOTAL VALUE OF ASSET DECD.% INT EXCLUSION (if applicable) TAXABLE T 7~ VAL V ~ 1 Mutual of Omaha Acct No: 810-00169. Payable upon death equally to Michael J. Bodek (son) and J. David Bodek (son) (see letter attached) $50,351.26 100.0% $50,351.26 2 Lincoln National Life Ins Company Annuity - contract no: EN5350765 payable upon death equally to Michael J. Bodek (son) and J. David Bodek (son) (see letter attached) $28,185.40 100.0% $28,185.40 3 MetLife Insurance Co of Connecticut Annuity IRA contract no: 0428502 payable upon death equally to Michael J. Bodek (son) and J. David Bodek (son) (see letter attached) $13,339.89 100.0% $13,339.89 TOTAL (also on line 7, Recapitulation) $91,876.55 Feb 05 2010 9:42AM MUTUAL OF OMRHR 4023512353 p.3 MUTUAL Of OA3AHA INVESTOR $ERVICBS, ING. Mutual of Omaha Plaza Omaha, NE 68175 402 351577Q mutualofamaha.com February, 03 2010 To: Jeff Swope 2595 Interstate Dr. Ste 1041 Harrisburg, PA 17110-9378 REFERENCE: Acct #810-00169 Account opened 09j30j03. To Whom It May Concern: MuTUa~Omae~ Thank you for notifying us of the death of Martha Bodek. We would like to extend our belated condolences to Martha's family. The value of the above account on Dec 26, 2009 was $50,351.Zfi 12/26/09 DAD Fund Name # off` Shares NAV Price Value Prime Money Market Fund 4.04 1.00 4.04 Dreyfus Alpha Growrth Fd BSFB 995.447 15.44 $15 369.70 Evergreen Equity Tr ESPBX 271,120 17.29 4 687.66 Federated Equity Funds (KAUBX 1,079.267 $4.41 $4,759.57 Principal Invs Fd Inc (PQUBX} 986,339 $15.48 $15,2b8.53 Thornburg International (THGBX~ 440.6Q8 $23.29 $10,2b1.7fi TOTAL: $50,3 51.26 This information may be needed for tax reporting purposes and does not necessarily reflect the value of the account upon redemption. Share prices Fluctuate daily and shares are redeemed at the net asset value in effect at the time the request is received in good order. If you need additional information regarding this account, please contact the Registered Representative, 3eff Swope (717} 735-0220. If you have any questions, please feel free to contact our Marketing Support department at (800} 2Z8-9596, Monday through Friday, 7:30 am - 4:00 pm tC~ Regards, Amey J. Ngambi Sales Support Consultant Mutual of Ornaha Investor Services, Inc. cc: Kevin Smith C~ Lincoln Financial Group® February 4, 2010 ANDREWS & JOHNSON ATTORNEYS AT LAW ATTN RONALD E JOHNSON ESQ. 78 WEST POMFRET STREET CARLISLE PA 17013 RE: Martha B. Bodek The Lincoln National Life Insurance Company, Contract/Policy Number EN5350765 Claim Number 649883 Dear Mr. Johnson: Thank you for your correspondence dated January 21, 2010. The value as of the date of death of Martha Bodek, December 26, 2009, was $28,185.40. Please call toll free (800) 487-1485, ext. 8584, or write to me at the above address if you have any questions. Sincerely, ~~ r ~~,~~ ~ --- C~ t Karen IRussell Claims Examiner Greensboro Claims Department MetLife P.O. Box 14592 Des Moines IA 50306 MetLife March 10, 2010 Andrew & Johnson Attorneys at Law Attn: Ronald E Johnson, Esq 78 West Pomfret Street Carlisle, PA 17013 RE: METLIFE INSURANCE COMPANY OF CONNECTICUT CONTRACT 0428502 OWNER MARTHA B BODEK Dear Ronald E Johnson, Esq: Thank you for your recent inquiry regarding the contract referenced above. Our records indicate that the date of death and the account value on that date are: Date of Death: December 26, 2009 Account Value: 13,339.89 If you have any questions, please contact our Customer Service Center at 1-866-547-3793, Monday through Friday between 8:30 a.m. and 6:30 p.m., ET. Sincerely, Deidra Scates Sr. Annuity Representative -Client Services MetLife Annuity Operations and Services SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER Martha B. Bodek Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER A. Funeral Ezpenses: 1 Ewing Brothers Funeral Home, Inc. 2 B. Administrative Costs: 1 Personal Representive Commissions Name of Personal Representative(s) Social Security Number of Personal Representative: Street Address: City: State: Zip: Year(s) commissions paid: 2 Attorney fees to Andrews & Johnson 3 Family Exemption Claimant Michael J. Bodek Street: 28 Wheatfield Drive City: Carlisle State & Zip PA 17015 Relationship of Claimant to Decedent: 4 Probate Fees to Register of Wills 5 Accountant Fees to Patricia Rosendale, CPA 6 Tax Return Preparer's Fees 7 Register of Wills -filing fee 8 9 10 11 12 13 14 15 16 17 18 19 AMOUNT $9,220.93 $860.00 $3,500.00 $15.00 ~ TOTAL (also online 9, Recapitulation) $13,595 93 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Martha B. Bodek ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distribution, ead nansfen under Sec. 9116(x)(1.2)] 1 Michael J. Bodek 28 Wheatfield Drive, Carlisle, PA 17015 son 50% 2 J. David Bodek 20401 Cool Fern Square, Ashburn, VA 20147 son 50% II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE Charitable and Governmental Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter online 13, Recapitulation) $~