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Home My WebLink About08-27-10t 1505610148 REV-1500 EX (°'-'°' OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes PO BOX 28°601 INHERITANCE TAX RETURN 21 ], 0 0 612 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1,88-14-7875 05242010 09081923 Decedent's Last Name Suffix Decedent's First Name M I POLM GENEVIEVE M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH 'THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES 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 (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) ® 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 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 JOHN R• ZONARICH, ESQUIRE 717-233-1000 First line of address 17 S• 2ND STREET Second line of address SIXTH FLOOR City or Post Office State ZIP Code REGISTER OF V~JILLS USE ONLY p ~`.,.~ - _-, - ~, _~ ~ ~ - -.. `.-~ C-.. i DAVE: rv=~D r ~J .: HARRISBURG PA 1,7101 '`~-' ~' ~ '~' -~ f ~.,~ Correspondent'se-mail address: JRZa9SKARLATOSZONARICH - COM ^..? ~ -.' - ~: - 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. SIGNATU F PERSON RESPONSIBLE FOR FI ING RETURN ~ }S Q . ~ DATE ADDRESS ~•---, f °~i ~ oiviwa r r~cr v I n V CrKtJtIV H I t DATE • JOHN R - ZONARICH ~--o„~( _ `d RESS 1 S 2ND STRE _ TH FLOOR HARRISBURG, PA 1,7101 PLEASE USE ORIGINAL FORM ONLY 1505610148 Side 1 9M4647 4.000 1505610148 ~' REV-1503 Eh + (s-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Genevieve M. Polm 21 10 OEil2 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 3wasss ~.ooo (If more space is needed, insert additional sheets of the same size) F~EV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Genevieve M. Polm 21 10 OEi12 Include the proceeds of litigation and the date the proceeds were received by the estate. 3w46AD 1.000 (If more space is needed, insert additional sheets of the same size) J 1505610248 REV-1500 EX Decedent's Social Security Number 1,88-.1,4-7875 Decedent'sName~ POLM GENE VIE VE Cl RECAPITULATION 1. Real Estate (Schedule A) - - 1. 0 • 0 0 2. Stocks and Bonds (Schedule B) . 2. 1, , 17 6 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. Q . Q Q 4. Mortgages and Notes Receivable (Schedule D) 4, 0 . 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 4 , 3 4 0.0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. 0 • 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 0 • 0 0 8. Total Gross Assets (total Lines 1 through 7) g, 5 , 516.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) , - , 9. 11, 3 2 6.0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) - 10. 0 • 0 0 11. Total Deductions (total Lines 9 and 10) , - - 11. 11, , 3 2 6.0 0 12. Net Value of Estate (Line 8 minus Line 11) - - 12. (5 , 810.0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , . 13. 0 • 0 Q 14. Net Value Subject to Tax (Line 12 minus Line 13) , 14. ~ 5 , 810.0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers unSier Sec. 9116 (a)(1.2) x .o - 0.0 0 15. 0.0 0 16. Amount of Line 14 t xable 4 ~ at lineal rate X .0 0.0 0 16. 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17. 0. 0 0 18. Amount of Line 14 taxable at collateral rate X .15 Q. 0 0 18. 0. 0 0 19. TAX DUE ----19. 20. FILL IN THE BOX 1F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610248 1505610248 9M4648 4.000 o•oo J t~EV-1500 EX Page 3 11n~n~lnnt't C`mm~lntn Arlrlrocc• File Number DECEDENTS NAME PO M GENEVIEVE M STREET ADDRESS CUMBER AND CITY MECHANICSBURG STATE PA ZIP 17050- Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments ~ • ~ ~ B. Discount 0.0 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) (1) 0.00 0.00 (3) 0.0 0 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 - 0 0 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; or interest i t i ~ ~~ ; onary n a revers c. re a ~ ~~ d. receive the promise for life of either payments, benefits or care?. 2. If death occurred after Dec. 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? 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 FART OF THE RETURN For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)). For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)J. 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 21 years of age or younger at death to or for the us~° of a natural parent, an adoptive parent or a stepparent of the child is 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 Pineal beneficiaries is 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 12 percent [72 P.S. §9116(a)(1.3)]. P. 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. Total Credits (A + B) (2) 9M4671 2.000 REV-1511 E~+ (10-0s) . pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER G nevieve M Polm 21 10 0612 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: Zimmerman Auer Funeral Home 7,866 1. Total from continuation schedules . B. 1 ADMIN{STRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address Citv State ZIP Year(s) Commission Paid: 527 2. Attorney Fees: 2 , 4 62 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: 71 5. Accountant Fees: 6. Tax Return Preparer Fees: 350 7. 1 Register of Wills - Oath of Office Fee 20 2 Register of Wills - Filing fee for Inheritance Tax Return and Inventory 30 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 11 , 32 6 swasac 2.00o If more space is needed, use additional sheets of paper of the same size. Estate of: Genevieve M. Polm Schedule H Part 1 (Page 2) Item No. Description 2 Penbrook Post 730 Home Association - Wake 21 10 0612 Amount 527 Total (Carry forward to main schedule) 527 REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: FILE NUMBER: Genevieve M. Polm 21 10 0612 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Sandra Polm Wilson 711 Barbara Street New Cumberland, PA 17070 Daughter 0 2 Joseph M. Polm 5026 Amelia Path West Mechanicsburg, PA 17050 Son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1 0 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ $ 0 if more space is needed, use additional sheets of paper of the same size. 9W46AI 2.000 )F 1 , t~l T~ E~~IE;`~''~, l~. i'i~ N:~ ,~~~:: ~l`~~~: ~ ~ t~. { ~r:sac r Co' :~l~iil:a, :.) :>z~~hir.~. (~cu: t~.r, r~~r~.x~s.~1-,r~,c.ic ]. 'i:i] : r I' ,_.;::lE': l;t,~ iE~~~e]~~5~ rc ~r: ~k ~: i : ~'i.rl it za.l, l l€ ~ ~r:i ti l ~ ir- :~ f:; _ ~ t i:~.e ~ r,_f~r,~o:f l~ y r , a~ t ir: y t rrf t : I'C]; v1 _' _ I dit~e~;~~t tl i ~. a.ll r:~~~~,, ;°,u ~t ~. r;] ui~ L~ii ~1 ~:; c ~<: t ~~ ,j a s t~.t~~ b] e: g. ~ , elr.~~ ~~.x~~• lc~:r a ra d _; .. ~ ~ ~~u~i,:i ~Ic~t. .a.~l b,: p.~.d. :f~,,:~rr h•; ~ ~,~c;t_~ ,r.:,f ::r },r ~~: 3f't:r' r ~ d ~,~;~E~~ I.'_tl;l/1 1:~_ -{ l~ivc;;, dt~~ .~f: <~~n.~~. ~~E~q~.,~ '. ~ L. ~ -ict :c ~, :~.:n r :~:f' n r es~:a.t:c_ , Y- l ~ rsc-na.]'. c;r Yi:. , ~ . ~ e~ C ~ .. .. ;~ ]-u~r: -~~ f'.~~~'f: :~i~l ~a.~~~~.~:e <~,nc'. ~~a.al _:~rol.~e:~~., ~. i:c~ v~l_i.:ich :C r : ~ ~ ~~ c: f rn,~,~~ <<~~f: :~~,~ ~,,~~~. E ~ c,f di=_wpX~;~ticr or ail=loi:n.tnn~ ~ ~ ~ ~. ; . ;~ : I ~~f1 ~~~ r.I<~ ~'~ ~a.r~ne tc, rru ~r ~ia.~ z€; hM f ~_ ~ ~.~A:I'~Ti::)F~';.A ]P°'~: ;a ~,, ' ~' II:I ~ : a u ... ,- ~. ~.l h r ' .),:~E1']~ 11.[.. ,_-:~~~I, :r~ Ec ~, ;~ a ~~:,; rE~~~ .rt~.:rl:~e~~. I a~ a t.:, . ~ :,_~~ .. 1~:~c;a~. ~.f: l ~.r ~i. E; rn~~ i.~ s~~E~~ ~~~.:~ tk e_,,. :~.~` ~i.ee, car, i.f itl~~~.~: ~,~~ ~~~ :c~~~~~~: ~ ~ ~~ ~ ~ ii~ ;~~~ ~~ ~r [_ - ]:~i I _.I : is ~~~]:~~h,ofnt n >~,~s,r ]:~x~ec~.utors. ~:~ ~~. ~i~~ ~ :~ ~~~: ~ ~~~ ~;,,,~ ..t I.i ~ ~~ ] ;~ 'I: ~;~ :1~~~~1c ~:~r.~ min~~~~°'s ;x.11 17t-ol~ehty~ ff~~yay~,~~~I~rle; key ~ls::,. ,~~~ ~~;~: ~~~ ~3~ (~~ . ~~~~~~ ~ I .II~.:r~ ~~ a IFa.~; .~11i~„ (l) oj'; :;i~ (6) Page by my Will; (2) after considering the minor's wishes, to retain tangible personal property or deliver it to the person standing in the place of a minor's parent, without bond; (3) to invest the balance of the minor's property and all accumulate income without restriction to investments authorized for fiduciaries; and (4) to use income and principal for the minor's maintenance and education, either directly or by payment to any person selected to disburse it whose receipt shall be a complete acquittance therefor. All unexpended principal and income shall be paid to the minor at majority . My Guardian may, in discharge of all duty hereunder, pay any minor's share deemed impractical of administration to the person standing in place of the minor's parent or deposit it in an interest-bearing account in the minor's name . ITEM IV : No interest of any beneficiary under trus Will or any Codicil hereto shall be subject to anticipation or voluntary or involuntary alienation . ITEM V : In addition to powers given them by law• , my Executor and their successor and any Guardian acting hereunder shall have the following powers, applicable to all property held by them, effective without Court Order and until actual distribution : To retain and to invest in all forms of real and operty, regardless of (i) any limitations imposed by I ~ (2) of six (6) Pages law on investments by executors or trustees; (ii;) any principle or law concerning delegation of investment responsibili by executors or trustees; or (ii.i) any principle of law concerning investment diversification; (B) To compromise claims and to abandon any property which, in my Executors' opinion, is of little or no value; to borrow from, and to sell property to others, and to pledge property as security for repayment of any funds borrowed; (C) To sell at public or private sale, to e~:change or to lease for any period of time any real or personal property and to give options for sales or leases; (D) To join in any merger, reorganization, voting-trust plan or other concerted action of security holders , and to delegate discretionary duties with respect thereto; (E) To use administrative or other expenses of my estate as income tax or estate tax deductions and to value my estate for tax purposes by any optional method permitted by the law in force when I die, without requiring adjustments between income and principal for any resulting effect on income or estate taxes; and (F) To distribute in kind and to allocate specific assets Page three (3) of six (6) Pages among the beneficiaries in such proportions as my Executors may think best, so long as the total market value of any beneficiary's share is not effected by such allocation . These authorities shall extend to all real and personal property at any time held by my Executors and shall continue in full force until the actual distribution of all such property. ITEM VI: All taxes, interest and penalties thereon payable by reason of my death with respect to property comprising my gro:~s taxable Estate, whether or not passing under this Will, shall be paid from the principal of my residuary Estate. ITEM VII: I appoint my daughter, SANDRA POLM WILSON, and my son, JOSEPH M. POLM, as Co-Executors of this Will. I:f either does not act or continue to act for any reason, I appoint the remaining individual in their place with the same powers and duties . No fiduciary acting hereunc shall be required to post bond or enter security in any jurisdicition. IN WITNESS WHEREOF, I have hereunto set my hand and seal and caused this my Last Will and Testament, consisting of six (t~) typewritten pages, including this attestation clause, to be executed, declared and ublished th' ~ ~° '~. p is `,,,~ day of ,,~~,r,..-F~.~~ 1982, at ~'{. ~,~-_.,.~ ~~~~ t.~, ~~ Pennsylvania. __ ,-~ GENEVIEVE M . POLM Page four (4) of six (6) Pages Residin at ~~~ ,~ v~,d1~ ~yl . g ~. Residing at V~~~~ ~ (/1',~.L.~ ~~- ~ ~ ~ ,,~ /, _ _., Residing at ~~ ij ~ /` ~~;~'`,~ 'r--~- ` J (~ //{~// t- '? t / , ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA §~ COUNTY OF DAUPHIN I, GENEVIEVE M. POLM, Testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law , do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. >.. GENEVIEVE M. POLM Sworn or affirmed to and acknowledged before me, by '1 ~. '~ day of ~ i:,-.~, , 1982. GENEVIEVE M. POLM, the Testatrix, this ~ ~~`~ ~ ~ '~. , ,_ ~ ~ . ,. y , ary ublic ~ ~, ~ ,~ r., My Commission Expires: , theryl 1. Fleegal, Notary Pt~biic MY Commission Expires Feb. 5, 1983 Harrisburg, pq Dauphin G~unty Page five (5) of six (6) Pages ~r / ;"° ? e,'Y COMMONWEALTH OF PENNSYLVANIA §~ COUNTY OF DAUPHII~I-_, ~ , :, We, ~ C~ J _~ ~~ ~;~~.,-~ ! ~ : 1 %-,~ t witnesses whose names are signed to the :~ attached or foregoing instrument, being duly qualified according; to law, do depose and say that we were present and saw GENEVIEVE M. POLM sign and execute the instrument as her Last Will; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witnesses; and that to the best of our knowledge the Testatrix was at the time Twenty-one (21) or more years of age, of sound mind and under no constraint or undue in Swor or affirmed to and acknowledged before me Eby ~+ ~ ~ f 1 ~ I L ~ _ ,T e witn es, this i ~,~'.:-z~~. day of ~ j'~..,,;,,y~ ,;~ 1 1982. ~~. i - ,r; -_, ,r,, ~n Expires : ~ ~ ~- ~ ~~~~%/!'~` ~. ~~ 1: Fleegal, Nofa My commission Expires Frb~ ~br~ e S Harrisburg, pp S. 1983 Dauphin County ~~ Citizens Bank Account Number 6220185599 Account Title GENEVIEVE M POLM Date O ened 1/30/2008 Account T e Checkin Principal Balance as of DOD $808.23 Interest from_Last Postin~to DOD __ _ $ .11 Account Balance as of DOD _ $808.34 YTD Interest to DOD $7.52 a~ Citizens Bank Account Number 6220185602 Account Title GENEVIEVE M POLM Date O ened 1/30/2008 Account Tye Checkin Principal Balance as of DOD $2511.27 Interest from Last Posting to DOD $ .28 Account Balance as of DOD $2511.55 YTD Interest to DOD $4.20 T~ Citizens Bank Account Number 6251716984 Account Title GENEVIEVE M POLM Date O ened 1/30/2008 Account Tye Savin s Principal Balance as of DOD $101.55 Interest from Last Posting to DOD $ .O1 Account Balance as of DOD $101.56 YTD Interest to DOD $ .07