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Home My WebLink About08-03-10-.-,I REV-1$~~ Ex `01-70' 1505610143 r ' PA Department of Revenue penn~anla OFFICIAL USE ONLY y County Code Year File Numl»r Bureau of Individual Taxes oev~mreEM Or 11EVENUE Po sox.zsa6D1 INHERITANCE TAX RETURN 2 1 10 0 2 6 1 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 205 26 2115 02 25 2010 07 02 1928 Decedent's Last Name Suffix Decedent's First Name MI BONIN MARTHA G (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 INAPPROPRIATE OVALS BELOW ^ 1. Original Return ® 2. Supplemental Return ^ 3. Remainder Return (date of death prior to t 2-13-82) ^ 4. Limited Estate ^ qa. Future Interest Canpromise ^ 5. Federal Estate Tax Return Required (date a aeatn anx ~z-~z-ez) 0 ^ e Decedent Died Teatale ^ ~ Decedent Maintained a LIWng Trust 8. TOfal Nllmher Of Safe De alt BOXes (Adam Copy of Will) (Attach Copy of Trust) ~ ^ 9. Litigation Proceeds Received ^ t p, Spousal Pwarty Crean (date of death 1 t .Election t0 tax under Sec. 9113(A) between 12J1 B1 and i-1-06) ^ (Attach SCh. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number RICHARD J MARUSAK 570 455 3683 First line of address 101 WEST BROAD STREET S Second line of address City or Post Office HAZLETON State ZIP Code PA 18201 REGISTER O~ILLS USE ~'LY -~. p o ~ ~" r ?~=n ~C-~ ~.; r- ~n.~^~ t .-" Cri X W - c' Q~ ~ - ~ nwre~ cn A) - N , '- '.....J7 .~ a -;~ <~ :r:_: -n ('r3 _~, Correspondent's e-mail address: Under penaRies 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. Daniel A. Palermo, Jr. 70 West J_uniper70 West Juniper Stre~Apt. 3, Hazleton, PA 182013, Hazleton, PA 18201 '~IOr~IQ'URE~ Pl~ER OTHER N REPRESENTATIVE Richard J Marusak DATE 101 West woad Street, Suite 205, Hazleton, PA 18201 Side 1 1505610143 1505610143 J 1505610243 ' ' REV-1500 EX oeceaanra llama: BONING MARTHA GLORIA Decedent's Social Security Number 205 26 2115 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 8 Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property 1 3 7, 2 0 2. 2 8 (Schedule G) ®Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 13 7 , 2 0 2 . 2 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) ...................................................................... 0 . 0 0 11. 137,202.28 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 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. 1 3 7 , 2 0 2 . 2 8 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 1 3 7, 2 0 2. 2 8 at collateral rate X .15 18. 19. Tax Due ................................................................................................................... .. 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 20,580.34 20,580.34 Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decpdent's Complete Address: File Number 21 - 10 - 0261 Bonin, Martha Gloria STREET ADDRESS 3541 March Drive CITY Camp Hill STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 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. Total Credits (A + B) (1) 20,580.34 (2) 0.00 (3) 0.00 (4) (5) 20,580.34 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: 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 properly within oni receiving adequate consideration? ................................................................................... Yes No .................................... x .................................... x .................................... x .................................... x year of death without 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 PART OF THE RETURN. For dates of death on or after July 1, 1994 and before Jan. 1, 1995, the tax rate imposed on the nel value of transfers to or for the use of the surviving spouse is 3 percent p2 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 0 percent [72 P.S. §9118 (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 retturn are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after Juty 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 use 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 lineal 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) . A sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, w~ether by bloo~ or adoption. ~ COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY ESTATE OF Bonin, Martha Gloria FILE NUMBER 21-10-0261 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. ITEM NUMBER DESCRIPTION OF PROPERTY InUUde the name of the trsnsteree, their reletionanip to deeetlent and the date of hanafer. Attach a copy of the Geed for real estate. DATE OF DEATH VALUE OF ASSET ~' OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1 Allstate Annuity -Account No. AC1085653A - 137,202.28 137,202.28 beneficiary: Daniel A. Palermo, Jr., nephew - Annuity amount:: TOTAL (Also enter on line 7, Recapitulation) 137,202.28 REV-1513 E%+ )11AE) SCHEDULE J ~ COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bonin, Martha Gloria 21-10-0261 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Not LIN Tnutw(s) I, TAXABLE DISTRIBUTIONS [inGude outright spousal f i ib ti d ons an trans ers str u d under Sec. X116 (a) (1.2)] 1 Daniel A. Palermo, Jr. Nephew 137,202.28 70 West Juniper Street Apt. 305 Hazleton, PA 18201 Enter dollar amounts for distributions shown above on lines 1 5 through 18 on Rev 1500 cover sheet, as appropriate. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET O.OO