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Home My WebLink About04-29-1015056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes ~ County Code Year File Number INHERITANCE TAX RETURN ............................: ..................: .............................................. PO BOX 280601 21 09 00838 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 193-36-4451 ' 08/27/2009 10/04/1946 Decedent's Last Name Suffix Decedent's First Name MI i TESLAR :STEPHEN p (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 ~.~r"~ 1. Original Return ~ 2. Supplemental Return ~"`~;~ 3. Remainder Return (date of death prior to 12-13-82) ,~~~',:~ 4. Limited Estate ",.,~ 4a. Future Interest Compromise (date of ~;;,~~ 5. Federal Estate Tax Return Required death after 12-12-82) ~`;~ 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust .................. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) t 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death 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 STEPHANIE E. CHERTOK (717) 249-1177 __ _ . Firm Name (If Applicable) First line of address 61 W. LOUTHER STREET Second line of address Correspondent's a-mail address: IaWfirmllC@yahoo.com .. `...~ !:~ .~ ;~ r' ~ ~_3 ;• ~ ..'~ t .. ~. J ~...JY .., .4 _...f~ "3 _. f-r"'t 1. ~, .~ ~ ;- 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, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE ERSO RESPO FO G RETURN ATE > ~ «? a ADDRESS _ /I _ _ _ _ .~ _ /J n SIGNA ti- PRESENTATIVE 0 ADDUrE / ~" ~',/- D ~ 3 PLE E USE ORIGINAL FORM ONLY REGISTER OF WILLS USE O State PA ~~ ~ ~~ ~ ~ I ._~ C`a o- ~C1 ~' ~~ i-n G IN . % DA'r~ ~ _ D ZIP Code -- ~ ..._ .._..__._........, .................. _.~t .. .................... ,~.~.,,-e 17013 -~~' _ ........ ..... .. _.. _ .. ca Side 1 15056051058 15056051058 J 15056052059 REV 1500 EX Decedent's Social Security Number Decedent's Name: STEPHEN D TESLAR :193-36-4451 RECAPITULATION ~ ,-,..,..~.-.-,_._.~...~...~.,~.~...~....~.,..,-.-.-...~..,..H...__,..~.~,._....~.~._........._.m._.~..~.,......,.M...~...._.~. 1. Real estate (Schedule A) . ........................................... . 2. Stocks and Bonds (Schedule B) ...................................... . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 4. Mortgages & Notes Receivable (Schedule D) ............................ . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. 21,300.96 6. Jointly Owned Property (Schedule F) ~`"µ..'~ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~;.F Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1-7) .................................... 8. 22,581.64 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 2,838.71 10. Debts of Decedent, Mortgage Liabilities, 8~ Liens (Schedule I) ................ 10. 3,983.74 11. Total Deductions (total Lines 9 & 10) ................................... 11. 6,822.45 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 15,759.19 .............. ...:. _ .._.........,._H ,..... 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. 15,759.19 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ~ ~~~«~ ~~~~~...,,yR~~~.,,~~~,n.. 15. Amount of Line 14 taxable at the spousal tax rate, or trans ers un er Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of Line 14 taxable at lineal rate X .0 45 14,759.19 16, 664.16 17. Amount of Line 14 taxable at sibling rate X .12 17, 18. Amount of Line 14 taxable ~~~ ~ ' at collateral rate X .15 1,000.00 ' 18 150 00 19. TAX DUE ......................................................... 19. 814.16 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 s 21 ~ 09 ~ :00838 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER STEPHEN D TESLAR 193-36-4451 STREET ADDRESS MANOR CARE HEALTH SERVICE 940 WALNUT BOTTOM ROAD CITY STATE ZIP CARLISLE PA 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 814.16 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments 675.00 C. Discount 35.53 Total Credits (A + B + C) (2) 710.53 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) 103.63 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 103.63 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 : ............................................ ^ 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 "intrust for" or payable upon death bank account or security at his or her death? .............. Q ^ 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)J. 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. (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ {6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER TESLAR, STEPHEN D. 210900838 REV-1510 EX+ (08-09) i pennsylvania _.~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER TESLAR, STEPHEN D. 210900838 _- This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATI~VSHIP TO DECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACHACOPYOFTHEDEEDFORREALESIATE. VALUE OF ASSET INTEREST (rFAPPLICABIF) VALUE _.. 1• .BANK OFAMERICA- ACCOUNT N0.91000082495590 10,682.90 : 100 100.00 ' 0.00 2 BNAK OF AMERICA- ACCOUNT N0.91000082495613 10,557.13 100: 100.00 0.00 3 BANK OFAMERICA- ACCOUNT N0.91000082495668 4,185.65 100 100.00 0.00 '** THE THREE (3) ACCOUNTS LISTED ABOVE WERE POD TO BENEFICIARY STEPHANIE N. TESLAR SEE SCH. J FOR HER ADDRESS** TOTAL (Also enter on Line 7, Recapitulation) $ 0.00 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (10-09) ~.- ~ ~:~ pennsylvarna DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE CASTS ----- ESTATE OF FILE NUMBER TESLAR, STEPHEN D. 210900838 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: 1,130.00 Name(s) of Personal Representative(s) GLENDA CLEMENCE Street Address 4 EAST PORTLAND STREET City MECHANICSBURG State PA zIP 17055 Year(s) Commission Paid: 2010 2. Attorney Fees: 905.00 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: __ __ 167.00 5. Accountant Fees: 6. Tax Return Preparer Fees: ~~ __ ___ __ CUMBERLAND LAW JOURNAL-ADVERTISEMENTS OF ESTATE 75.00 s. __ __ PARTRIOT NEWS- ADVERTISEMENTS OF ESTATE 181.02 s. __ U.S. POSTAL SERVICE- EXPRESS MAILING TO BENEFICIARY __ __ __ __ _ _ _ __ 36.21 ~o-' STOTT FINANCIAL (SERVICES-INCOME TAX RETURN) 300.00 ~ ~. U.S. POSTAL SERVICE- EXPRESS MAILING TO BENEFICIARY _ _ _ ___ _ _ _ _ _ __ __ _ - 44.48 TOTAL (Also enter on Line 9, Recapitulation) $; 2,838.71 If more space is needed, use additional sheets of paper of the same size w REV-1512 EX+ (12-OS) ~~ ~ Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER TESLAR, STEPHEN D. 210900838 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALU E AT DATE NUMBER DESCRIPTION OF DEATH 1• HEARTLAND PHARMACY OF PA- BILL FOR PRESCRIPTIONS 453.87 2. BOLLINGER'S STORAGE- STORAGE BILL 106.00 __ _ _ -_ 3. PUBLIC SCHOOL EMPLOYEE RETIREMENT SYSTEM- REIMBURSEMENT OF BENEFITS ___ PREVIOUSLY PAID ~ , 928.87 4. IRS- 2008 TAXES (AMENDED RETURN) 1,109.00 5. PA. DEPARTMENT OF REVENUE- 2008 TAXES (AMENDED RETURN) 386.00 REV-1513 EX+ (01-10) i~ pennsylvania SCHEDULE J ~~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: TESLAR, STEPHEN D. 210900838 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. STEPHANIE N. TESLAR DAUGHTER REMAINDER _. __ 412 N. BEAVER STREET __ _ _ _ _, ___ _ __ _ _ __ FLAGSTAFF, AZ 86001 2. GLENDA CLEMENCE 1000.00 4 EAST PORTLAND STREET 'MECHANICSBURG, PA 17055 _. ___: ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. If more space is needed, use additional sheets of paper of the same size