HomeMy WebLinkAbout01-04-111505607121
REV-1500 EX (06-OS) OFFICIAL USE ONLY
PA DepartmentoiRevenue
Bureau of Indroidual Taxes County Code Year File Number
P09ox28o6of INHERITANCE TAX RETURN 2 1 0 7 0 3 5 4
_ Hamsburg PA nfz8-0801 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
5 4 8 8 1 4 4 4 4 0 4 0 2 2 0 0 7 1 0 2 4 1 9 7 0
Decedent's Last Name Suffix Decedent's First Name MI
R U K A S M A R K S
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
^X 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)
Q 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 T0:
Name Daytime Telephone Number
H U B E R T X G I L R O Y 7 1 7 2 4 3 3 r.~3 4 1
Firm Name (If Applicable) _ n `__
REGISTE~~ILLS USF
ONLV
M A R T S O N L A W O F F I C E S ~
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First line of address ~
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1 0 E A S T H I G H S T R E E T ~ ~~Q .O `;~'':?
Second line of address ~C T ~ ":mac ~j
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City or Post Office State ZIP Code ~ .DATE FILED
C A R L I S L E P A 1 7 0 1 3
correspondent's a-mail address: H G I L R O Y a M A R T S O N L A W• C O M
Under penalties of perjury, 1 deGare that 1 have examined this return, including accompanying schedules and statements, and fo the best of my knowledge and belief,
rt is true, correct a d complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGN F P SO ESPO LE F FILING RETURN
STUAR
OTHER THAN REPRESENTATIVE
STREET
CARLISLE
PLEASE USE ORIGINAL FORM ONLY
Side 1
A 17109
DATE
PA 170
L 1505607121 1505607121
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1505607221
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: MARK S- R U K A S 5 4 8 8 1 4 4 4 4
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 8 Notes Receivable (Schedule D) ...................... .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ..... .. 5. 8 3 9 8 , 2 2
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous N -Probate Property
(Schedule G) ~ Separate Billing Requested ..... .. 7. ,
8. Total Gross Assets (total Lines 1-7) ......................... .. 8. 8 3 `I 8 , 2 2
9. Funeral Expenses 8 Administrative Costs (Schedule H) ...... ..... .. 9. 5 4 7 4 , 0 1
10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ..... ..... .. 10.
11. Total Deductions (total Lines 9 & 10) ................... ..... .. 11. 5 4 7 4 , 0 1
12. Net Value of Estate (Line 8 minus Line 11) .................. ..... .. 12. 2 9 2 4 , 2 1
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. 2 9 2 4 , 2 1
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.o 2 0 2 4 2 1 15. 0. 0 0
16. Amount of Line 14 taxable
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 0 0 0 18. `~ 0. 0 U
19. Tax Due ......................................... ..... ..19. 0 . ~ 0
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505607221 1505607221 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
21 07 0354
DECEDENT'S NAME
MARK S. RUKAS
- - _ _ __ _-
STREETADDRESS - - - --- --
6206 STANFORD COURT
clrv -- srArE ziP
MECHANICSBURG ' PA 17050
Tax Payments and Credits:
t Tax Due (Page 2 Line 19) (1) 0.00
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits (A + B + C) (2) 0 00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E )
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill /n oval 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.
A. Enter the interest on the tax due.
B. Enter the total of line 5 + 5A. This is the BALANCE DUE.
(3) 0 00
(4) 0.00
(5) 0 00
(5A)
(58)
Make Check Payable to: REGISTER OF WILLS, AGENT
:~~r • ~ ~ ~ ; i , .
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 : ............................................................. ......... ^ 0
b. retain the right to designate who shall use the property transferred or ifs income : ...................... ......... ^ Q
c. retain a reversionary interest; or ....................................................................................... ......... ^
d. receive the promise for life of either payments, benefits or care? .............................................. ......... ^ Q
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
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 7HE RETURN
For dates of death on or affer July 1, 1994 and before January 1, 1995, the fax 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)J.
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 (O) 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 affer July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age oryounger at death to or (or the use of a natural parent, an
adoptive parent, or a stepparent of the child is zero (O) percent (12 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 (12 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.
00
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTA TE OF FILE NUMBER
MARK S. RUKAS 21 07 0354
InGude the proceeds of IRigafion and the date the proceeds were received by the estate.
A!1 propertyJointly-owned with right of survivorship must be dlselosed on Schedule F.
IrEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1. Members 1st Bank checking 3440094765 280 2~
(see attached)
2. US Treasury, 1040 refund, 2007 618.00
3. State Farm Insurance, 1st party benefits ($2,500.00 funeral; $5,000.00 death benefit) 7. x(10.00
4. Wrongful Death Settlement fbo Sydney R. Rukas I 0 00
$40,891.54 (See attached Order dated 3/10/2010)
TOTAL (Also enter on line 5, Recapitulation) I S
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (10.06)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
IN RESIDENT DECEDENTRN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
MARK S. RUKAS 21 07 0354
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: -
1. Myers Funeral Home, Mechanicsburg, PA ~ ~ f ~ ~l~
2. Romberger Memorials, grave marker -a~ OU
3. Spring Creek Cemetery, Hershey, PA, grave opening ~ ~0 00
B.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City
Year(s) Commission Peid:
State Zip
p, AttomeyFees MARTSON LAW OFFICES (estimated)
3. Family Exempfion.• (1(decedent's address is not the same as Gaimant's, attach explanation)
Claimant
2.000.00
Street Address
Cfty State Zip
Relationship of Claimant to Decedent
4. ~ Probate Fees
5 Accountant's Fees
6. Tax Retum Preparer's Fees
7. Filing fee, Inheritance Tax return
8. UPS, shipping of personal effects
I >.00
99.01
TOTAL (Also enter on line 9, Recapitulation) I $ ~ 4 7a O l
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + ~9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
tS~gTE OF FILE NUMBER
MARK S. RUKAS _ _ _
G1 V/ V>J4
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT
Do Not List Trustee(s) AMOUNT OR SHARE
OF EST
T
I
TAXABLE DISTRIBUTIONS (include ouMght spousal dishibutions, and transfers under A
E
Sec. 9116 (a) (1.2)J
1. Kimberly D. Rukas, n/k/a Kimberly D. Neumyer Spousal ~
315 Stuart Place p~q 2 I
Harrsiburg, PA 17109
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET $
pi mvre space is neeoe0, msen aaamonai sneers o1 the same size)
_, _ __
STATEMENTI!PERIOD PAGE','
APR.21-MAY.21,2007 1 OF 1
00 0 04350M NM 017
MARK S RUKAS
6206 STANFORD CT
MECHANICSBURG PA 17050
16558
TRINDIE ROAD OFFICE
errnuuT en~uwnv
;_
R, CH RACYIONS i~fl` `T PI! ;' 8/i `;::
N0. AMOUNT NO. AMOUNT N0. AMOUNT
280.22 0 .00 0 .00 0.00 280.22
U
04-21-07~BECINNING BALANCE
s2eo.zz
IMPRESSED BY THE SERVICE YOU RECEIVED AT M8T? IF YOU'D LIKE TO NOMINATE AN M8T
6AliC EMPLOYEE FOR EXCEPTIONAL CUSTOMER SERVICE, PLEASE COMPLETE OUR M8T SERVICE
EXCELLENCE FORM AT MMN.MTB.CON/EXCELLENCE. ME APPRECIATE YOUR FEEDBACK!
~ooeA ~~ro3j
KIM D. RUKAS, Administratrix of IN THE COURT OF COMMQN PLEAS
the Estate of MARK S. RUKAS, DAUPHIN COUNTY, PENNSYLVANIA
Deceased, and as the Parent and
Natural Guardian of SYDNEY ROSE CIVIL ACTION -LAW
RUKAS,
Plaintiff Docket No. 2007-CV-13471-CV
v.
SEAN PADELSKY,
Defendant
V.
LONNY BLOUGH, Individually and
t/d/b/a CHICK'S HUMMELSTOWN
TAVERN,
JURY TRIAL DEMANDED
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Additional Defendants
ORDER
AND NOW, this ~ day of `2 , 2010, after hearing upon the
Petition for Court Approval of Settlement, it is hereby ORDERED and DECREED that
said Petition is GRANTED as follows:
Defendant, Sean D. Padelsky, shall pay the amount of $50,000.00;
2. Additional Defendant, G. Lonny Blough, shall pay the amount of
$6,000.00;
3. Attorney's fees in the amount of $14,000.00 shall be deducted from the
total settlement amount of $56,000.00;
4. Costs and expenses incurred by Petitioner's counsel in the amount of
$1,108.46 shall also be deducted;
5. The balance of the settlement, $40,891.54, shall be deposited into a
restricted, federally insured, interest bearing savings account for the
benefit of the minor beneficiary, Sydney R. Rukas marked: "no withdraws
prior to age eighteen (18) without prior Court approval;"
6. The entirety of the net proceeds of this settlement are allocated to the
wrongful death claim with no part of the settlement being allocated to the
survival claim;
7. Petitioner shall provide to this Court within thirty (30) days of the date of
this Order, proof of said deposit; and
8. Petitioner shall execute a Full and Final General Release which shall be in
the form of the document attached to Petitioner's Petition as Exhibit D.
BY THE COURT
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Distribution:
Stephen L. Banko, Jr., Esquire, 3510 Trindle Road, Camp Hill, PA 17011
Kevin D. Rauch, Esquire, 100 Sterling Parkway, Suite 306chanicsburg, PA 17050
William J. Peters, Esquire, 2931 N, Front Street; Harrisburg, PA 17110
MAR 1 ~ 70 ,0
~ hereby certify tht~t tre 8cre;;~ti; ~g is a
true ar?r9 correct cap~y of tha original
tiled.
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POLICY NO 7230-847-38G-001 Lo
Cowsc~ad;e Ds+rcrivtion 'Amount::: GOL 4Pay:1
KTENDED PERSONAL INJURY PROTECTION $2,500.00 093 1
REMARKS 4/2/2007 ~ Funeral benefit estate of
Mark Rukas; executrix Kim D. Rukas; no encl.
CLAM NO 38-L2O2c8O$ .POLICY NO 7230-847-38G-001 L
Cowerao~ Aeacri~vCion Mwtu~t`: GOL Pali t
EATH INDEMNITY S5,000.00 117 t
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SS DATE 03-31-2007 PAYMENT NO 1 13 339219 J
DATE 08-01-2007
AMOUNT $2,500.00
T1N
RETAIN STUB FOR RECORDS
AUTHORIZED BY KACZMARSKI, MIKE
PHONE (8881713-4694
OSS DATE 03-31-2007 PAYMENT NO 1 13 339216 J
DATE 08-01-2007
AMOUNT $5,000.00
TIN
RETAIN STUB FOR RECORDS
AUTHORIZED BY KACZMARSKI, MIKE
PHONE (888) 713-4694
REMARKS 4/2/2007 Accidental death benefit
estate Mark Rukas; executrix Kim D. Rukas; no encl.