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HomeMy WebLinkAbout01-18-11~ 1505610101 REV-1500 Ex ~°i_1°' ~r OFFICIAL USE ONLY PA Department of Revenue Pennsylvania DEPARTMENT OF REVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 280601 ~ ~ ~ © ©©~ Harrisburg, PA 1'7128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~~~ lo3ys"~" r~,~~~009 ~2~~ig/7 Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI l Spouse's Social Security Number - - - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 Teleph Number ~- ~-,, -~t.+~ .r ~~,N,1 REGISTER'ESF``S USE'bNLY ~- ~...., .. <7 -r-3 -- - ~ 7 ..: ~ :__~ First line of address _, _- =.. W _1 r .. E Second line of address 'ly `_-~' `'~ Q Y _ -r~ / A City or Post Office State ZIP Code DATE FILED Correspondent's a-mail address: yYle$ I~~C COh1CQS~' 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, 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 ~i~~~ NRE~NS~~ ^I~I/G TURN DATE ~ p ~1 / ~ l/~~ " ~ ~ .~stic~rv ADDRESS ~ Y[.~IS' ~. 4'I ICk Io Fairf•~/4/ gsf~-'iCE ~ ~/~tvl~i//e, P~ ~?z~/-/3D~o SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE N/A- ADDRESS PLEASE USE ORIGINAL FORM ONLY 1505610101 Side 1 1505610101 J J REV-1500 EX Decedent's Social Security Number Decedent's Name: T~~~ff~ic ~ ~", ~~Jr~~/~ d' fD:9 ~ C~'- ~ 7 S-J RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. ~ ~'F 2. Stocks and Bonds (Schedule B) ....................................... 2. .; Q ~ (~ 3. Glosely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. .: (? O :. 4. Mortgages and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. ' ~` a~ o 6y~'~~~ ~~ Q~ _ ~ y ~ * ~ ~2 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. <:, 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 3 3 7 ; ,'~ ' ~ : S~.~T 10. Debts of Decedent, Mort a e Liabilities, and Liens Schedule I 10. ~ Qp ' ~I .~ 11. Total Deductions (total Lines 9 and 10) ................................. 11. f ~ `7 f C'' ~ ~; (~ 12. Net Yalue of Estate (Line 8 minus Line 11) .............................. 12. ~_ .. .. 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which + "`'~~'` ~j- ~ "~"' ~ ~~°~3'?~ an election to tax has not been made (Schedule J) ....................... 13. y ~ ~ ,~ ~"~ ~< 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. ~, (~ (~, r TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 x ~~•~ ~ ~ 16. Amount of Line 14 table - ~ ' `Y~ ~ "~~'~'s~'~'~`"~` at lineal rate X .0 ~ ~ ~` © 16. 17. Amount of Line 14 taxable ~ Amy"-c".~~t+~t.~~i2~ at sibling rate X .12 ' 17. 18. Amount of Line: 14 taxable ~ ~`'~ ~~` '~?# ~ ~''"'~ at collateral rate X .15 "•, 18. .. _ . ....~- 36 y 4~ Ott :u,•,sn +,~` 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT rc Side 2 1505610105 1505610105 1505610105 O J REV-1508 EX + (1-97) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS & MISC. INHRESIDENTDECEDENTRN PERSONAL PROPERTY - ESTATE OF ~~1~' ~D~~~ ~ FILE NUMBER a/_ ~O Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~ . W ovde~, l~~c/ and vr~ ssrr~ ~i°a, nfea/ w!•"~ J ~' 7s, o0 a. /1?ed: ~erra~lean ~~/~ ~ ~lrea~~tid) w,~ n22f~sS a•X~ ~aXSClri'/I,Q ~.~b, Bo 3, l~ re 5Si llcb/e ~..5t~, o~ ~, ~i~esser hi.rror g,~, oa ,S. ,~11d q'rrh S~~ C'~f e~ d~,tkru,~ i~press ~-ma~ ~ Sao. o0 6 . ~~ u ~~ /~s,C~ ~,oa•~a/~ Q/,:sas~c~ "blc.~ r x~l ,moo % h.S~7-~ccl~ianS ~r I~°ASS~/w~b~~ '~35; OD 7- ~orne~ade Ci/o/Jia/ ~s/~ - 3 ~vria`/ ~l/~~tsd~ ~~ ~S`~ lyin a~C' fair - L! ri ne a~QA?il!l~c° ~/~. S~ T !~. G~tie~~•' ~-r,~ a~ FArm~r /l~a~iok~/ /~~~ o~ /1/ew/r.%/e X33, bz ~2p.00 I y• m;~~. T•It,,oes ~,~ CiDs ~ ,o~ ~s' ~ G, o`t heaf-c~ Tv sf~/ v~a~ ~/'- ~r,~ Si~"r'a~ztieu~ a~e~ply /O. o a ~ ~~s~ oa ~ ~'. t1 ~ G'o,,~,~Kl~ Pr~n f~•- ~unQ,b/e ~ sel/ c%s~~~ Qa~s> ~~o 0 0 ~. ~i~7l,`~1'. , ~/D , 00 TOTAL (Also enter on line 5, Recapitulation) $ (0 7 ~ ~,?i (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF m ~/~ /SOW/~ ~.. FILE NUMBER ~ Z~'~° "U Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If more space is needed, insert additional sheets of the same size) RI=V-1500 EX Page 3 t~p~pr~pnt'c Cemelete Address: File Number ~ f -~Q ^ ('(~~~ DECEDENT'S NAME STREET ADDRESS CITY S /I~Fcv,v! c c ~ TATE t'~i~ ZfP ~7z~/ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditsiPayments A. Prior Payments B. Discount O (1) ~ Tatal Credits (A + B) (2) ~ 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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 :.................................................................................... i ...... ^ ncome : ...................................... b. retain the right to designate who shall use the property transferred or its ...... c. retain a reversionary interest; or .................................................................................................................... ...... ^ ^ 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? ........................................................................................................ h? " ...... ^ ^ ........ or payable-upon-death bank account or security at his or her deat 3. Did decedent own an "in trust for ...... 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ................................................................................................................. ....... ^ 1F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE lT AS PART OF THE RETURN. _ _ _ ~. x''.. ~~ .. fix` xy ~ .. . , . 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 far the use of the surviving spouse is 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 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)]. 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. D REV-1511 EX+ (10-06) SCl~IEDVLE N COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN FUNERAL EXPENSES & ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF ~ ~S l C/~~ fi~0l~r1A-~Z.v T, FILE NUMBER ,Z / ` /O 10~~~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~gg~ ~u.~~ ~tor~1G, inc.. ~'~, 9~/. 97 ~S~ 6; ir- ~ ~~~r~ '~ ~. ~'bys - To~,,bs~-ahe ~n~rnw~n, ~ ~ ~ o, 00 ~~ fi~iP,r~ds1~: p host, ~. of AJeu~vi Ile , ~sr Abe, a>~ ~ia.ll ~ir B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ~Cf /~~! ~~ ~ w a,+'ve~ ____ _____ ~___ . _ Name of Personal Representative(s) Street Address /O, FQ% r~l,G~~_ _rJJ~'!"GP~~ 1re(,~/I// l ~C State ~ Zip _~_ 7 ~~ City Year(s) Commission Paid: _ ~~"'____ 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as ciaimant's, attach explanation) Claimant /V`D C~h'/~l!/~',NT Street Address City State ^ Zip _ __ ___ _ Relationship of Claimant to Decedent 4. Probate Fees (~ Ori tt~~ ~IS3~ et' Shbr~ ~Gf'~"'t dj~c~,~S ~ ~ ~~. J`~ 5. Accountant's Fees lJ 6. Tax Return Preparer's Fees 7. l~; ~ ; r~ fte tv t~Ga ; s3'~Gr ~r- Gu; ~1 s d ~t ~ J rr /' I S, oa ~' ~orl'~S:C~2 ~P~2X'1110.r~t ~~ i n i c - ~ v~.~n 0.x 0.x5 i 0. ®t G1,Oq W ~, i G U '~' V1Cl0kS ~O~ dCa~ Ot' ~~~t,,wt' ~ u I I ~i, ! D TOTAL (Also enter on line 9, Recapitulation) $ ~~ 37a. S7 (If more space is needed, insert additional sheets of the same size) 15 Big Spring Avenue NEWVILLE, PENNSYLVANIA 17241 F. CHARLES EDGER, Supervisor 717-776-341.4 FRANK C. EDGER, Funeral Director January 22, 2010 Funeral Bill for Howard Mesick Date of Service January 2, 2010 Professional Services $2,050.00 Sentinel Obituary $101.97 Valley Times $35.00 Cemetery Opening $400.00 Public Opinion Obituary $13 5.00 Urn $220.00 Total $2,941.97 REV-1513 EX+ (9-00) SCI~IED~lLE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~~/C~ FILE NUMBER ~ ~_ O w NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] ,. ,~.{ ow/~-n. D ~: ~tFS~c~, T,~, soh ~Z. 33 'f3ow m Q,n (rid /yQ.N. v ~~~ ,~i¢ /7 •~• ~HyLL/S ~• /llEslC~ d~L11~t.~" y2 ~~ ~ ~ /'n e~ osf: Nrw v;~/~, ~~ ~~ ~ y~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 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. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ fir more space is needed, insert additional sheets of the same size) ~a~Ct flr a~ ~c~cta~t~t OF Howard J. Mesick I, HOWARD J. MESICK, of the Borough of Newville, Cumberland County, Pennsylvania, being of sound mind and body, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me: 1. I nominate and appoint Phyllis Ann Mesick and Howard J. Mesick Jr. to be the Executors of this my Last Will and Testament. If either one of them cannot serve, I hereby nominate and appoint Noelle Suzanne Shack as alternate. They are to serve as such without bond. 2. I hereby grant to my Executors all powers and authority which in their best judgment may be necessary for the proper and advantageous management, investment, and distribution of my estate and that power may be exercised as often as is deemed necessary or advisable, without application to or approval by any courts in any jurisdiction. 3. I hereby bequeath the following: to Phyllis Ann Mesick, my daughter, and Howard J. Mesick, Jr., my son all of my property located at 10 Fairfield Street, Newville, PA., home of Phyllis A. Mesick where I have been residing. This property is located in the rear ground floor bedroom, a bed and chest of drawers located in the middle bedroom on the second floor, and a bed and two (2) chests of drawers located in the rear bedroom of the second floor. All other property in .the house or shed is the property of Phyllis Ann Mesick. They shall have the privilege of giving, selling or keeping this property according to their wishes. ' 1 x : ~, ~. 4. I give my residuary estate, that is the rest of my property not specifically disposed of by this Will or in any other manner, in equal shares, to HOWARD J. MESICK JR. AND PHYLLIS ANN MESICK. 5. There being no real estate to dispose of as I had previously given the property at 10 Fairfield Street, Newville, Pa. as follows; To Phyllis Ann Mesick a sixty (60) percent share, controlling interest, of the above mentioned real estate. To Howard J. Mesick, Jr. the remaining forty (40) percent share of the above mentioned real estate. 6. If any beneficiary under this Will, in any manner, directly or indirectly, contests this Will or any of its provisions, any share or interest in my estate given to the contesting beneficiary under this Will is revoked and shall be disposed of in the same manner provided herein as if that contesting beneficiary had predeceased me. 7. Except as specifically stated otherwise in this Will, I instruct my executors to first pay my just debts, and expenses necessarily incurred after my death, from my residuary estate. 8. I direct my Executors to take all actions legally permissible to have the probate of this Will, if necessary, done as simply as possible and as free of court supervision as possible under the laws of the state having jurisdiction over this Will, including filing a petition in the appropriate court for the administration of my estate. 9. Under no circumstances will any real or personal property be sold at public sale. 10. I hereby direct my Executors to retain the services of Charles E. Shields,III, 6 Clouser Road,Mechanicsburg,PA. 17055 as Attorney in the settlement of my estate. 1 2 IN WITNESS WHEREOF, I hereunto have signed my name to this my Last ' tin of t~irtQl+ ~ written a es, this Will and Testament, consis g ( ~ yP P g ~~ day of 2009. /~ n / 1 I e Howard J. Mesi~k; Testator In our presence, the above-named Testator signed this and declared it to be his Will, and now, at his request and in his presence and in the presence of each other, we sign as witnesses: 'G ..~~-- s STATE OF PENNSYLVANIA ) )ss COUNTY OF CUMBERLAND ) I, HOWARD J. MESICK, having been duly qualified according to law, acknowledge that I signed the foregoing instrument as my Will and that I signed it as my free and voluntary act for the purposes therein expressed. 7 oward J. Me Testator We, having been duly qualified according to law, depose and say that we were present and saw HOWARD J. MESICK sign the foregoing instrument as his Will; that he signed it as his free and voluntary act for the purposes therein expressed; that each of us in his sight and hearing and at his request signed the Will as witnesses; that to the best of our knowledge he was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. y x Subscribed, sworn to or affirmed, And acknowledged before me by the Above-named Testator and by the witnesses whose names appear opposite on this ~//`t day of 2009. ~ ~~~ Notary Public CQ~pN1NEA1-TH ~ pE~~Y1.VANIA Nom ~'; ~ E sty «i. cater Manson T~-. ~'~ 20, zap a Membe-Ca~~ ~ ~ 1~~ 4