The URL can be used to link to this page

Home My WebLink About04-20-11J REV-1500Ex (°'-'°' 1505610143 PA De artment of Revenue ~' OFFICIAL USE ONLY P Pennsylvania County Code Year Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 80X.280601 INHERITANCE TAX RETURN 2 1 10 Harrisburg, PA 17128-0601 RESIDENT DECEDENT File Number 00829 tN ~ tK ut~tutN 1 INFORMATION BELOW Social Security Number Date of Death Date of Birth 533 46 0212 08 07 2010 06 10 1933 Decedent's Last Name Suffix Decedent's First Name HAWKINS MEFTUHA (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name 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 ^ 2. Supplemental Return ^ 3. Remainder Return (ciate~ of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ^ g Decedent Died Testate (Attach Copy of Will) ^ ~ Decedent Maintained a Living Trust (Attach Copy of Trust) ____ 8. Total Number Of Safe DepOSlt BOXes ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113 A between 1231-91 and 1-1-95) ^ ( ) (Attach Sch. O) MI MI CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number TIMOTHY C LEVENTRY ESQ 814 266 1'199 First line of address 1397 EISENHOWER BLVD Second line of address RICHLAND SQUARE III City or Post Office JOHNSTOWN Correspondent's a-mail address: State ZIP Code PA 15904 REGISTER OF W~L.S USE ONLY. ~tti) -- ~::~ _~ ,. .~~~ - - , fT? r~, ._ -~, .-~ - 4. - .. g ' ~ r=~ .. DAT~`~IL`E~ - ~~~ ,. r ,. _i_, ., ,- r._~ ~~~ --~ ~ unaer penalises of penury, I declare that I have exam ed this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of pre er other than the personal representative is based on all information of which preparer ha:~ any knowledge. SIGNATURE OF SON RE P SIBLE FOR F G RETURN DATE ~~ Alois Kudlach ~ ~ / S - ~~ Ll ADDRESS f- 127 Terlyn Drive nstown, PA 15904 SIGNATURE OF PREP R O N PRESENTATIVE DATE Timothy C Leventry Esq y'/1, /J ADDRESS 1397 Eisen a Blvd., Johnstown, PA 15904 Side 1 L 1505610143 1505610743 C J 1505610243 REV-1500 EX Decedent's Social ~~ecurity Number Decedents Name: H A W K I N S, M E F T U H A ---- 5 3 3 4 6 () 2 12 - - - RECAPITULATION -------- -- 1. Real Estate (Schedule A) .......................................................................... .... .... 1. 2. Stocks and Bonds (Schedule B) ........................................................................... ... 2. 5 ~~ , 3 19.5 6 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)....... ... 3. 4. Mortgages & Notes Receivable (Schedule D) ..................................................... ... 4. 5~ Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............. ... 5. 3 2 , 2 7 4 . 0 3 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ........... ... 6. 9 ]L , 1 2 3 8 4 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested .......... ... 7. 2 0 9E , 6 7 0 0 2 8. Total Gross Assets (total Lines 1-7) .................................................................... ... g, 3 8 it , 3 8 7 . 4 5 9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... ... 9. 1 ~~ , 4 6 2.11 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. ... 10. 1. , 4 0 1 1 5 11. Total Deductions (total Lines 9& 10) ................................................................... ... 11. 1 8 ,, 8 6 3 2 6 12. Net Value of Estate (Line 8 minus Line 11) ......................................................... ... 12. 3 6 8~ , 5 2 4.19 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. 3 6 8 , 5 2 4.19 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 linealrateX .045 368, 524.19 16. 16, 583.59 17. Amount of Line 14 taxable at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ................................................................................................................... .. 19. 16, 583.59 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: Hawkins, Meftuha STREET ADDRESS 56 Bullock Circle cITY Carlisle Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 15,000.00 789.47 File Number 21 - 10 - 00829 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. STATE ZIP PA 17015 (1> 16,583.59 Total Credits (A + 13) (2- 15,789.47 (3) 0.00 (4) (5)~ 7 9 4.12 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 "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 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 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. §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 u:>e of a natural parent, an adoptive parent, or a stepparent of the child is 0 percent [72 P.S. §9116 (a) (1.2)j. • 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)j. • 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)1. A 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. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Hawkins, Meftuha FILE NUMBER 21 - 10 - 0082!3 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM ' - - NUMBER DESCRIPTION UNIT VALUE ~ VALUE AT DATE OF __ DEATH 1 InvescoNan Kampen PA Tax Free Income A 16.O;i 59,319.56 Account # 0671288250 3,695.923 shares @ $16.05 per share TOTAL (Also enter on line 2, Recapitulation). ~ 59 319.56 i SCHEDULE E ' CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hawkins, Meftuha FILE NUMBER ____ 21 - 10 - 00829 Include the survivorsh proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of ip must be disclosed on schedule F. ITEM -- -- - NUMBER DESCRIPTION VALUE AT DATE OF __ DEATH 1 Cleveland Customer Svc Office :New York Life Refund of Premium Ref # 31786308 9.65 2 Travelers Refund due to Cancellation 4.00 3 Diakon Lutheran Social Ministries Refund 432.18 4 Metlife Total Control Account # 4030862263 14,582.24 5 Delta Dental of California Refund 28 09 6 U-Haul Sales Item invoice Refund 14.47 7 Savings Account with Sovereign Bank Account #1694001874 7,738.38 8 Checking Account with Sovereign Bank Account #1671014456 5,995.50 9 Checking Account with Sovereign Bank Account #1671005651 3,469.52 TOTAL (Also enter on Line 5, Recapitulation) I 32,274.03 ~ I COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY Hawkins, Meftuha FILE NUMBER __ 21 - 10 - 00829 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT Nuria N. Kudlach 127 Terlyn Drive Daughter -- A Johnstown, PA 15904 B JOINTLY OWNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE EESCRIPTIONN F PROPERTY MADE Include name o~~inanclal institu~lon and bank account numbe JOINT or similar identifying number. Attach deed for jointly-held real -- DATE OF DEATH VALUE OF ASSET -- % OF DECD'S -- - DATE OF DEATH VALUE OF 1 A estate. _ INTEREST , DECEDENT'S INTEREST ~ 10/04/2007 Real Property located at 56 Bullock Circle, C li l a3,ooo.oo °% 50 io ~ - 21, 500.00 ar s e, PA 17015 2 I A i 2007 I Regular Savings with Members First Federal 19,940.91 I 50°ro I 9 970 4 6 Credit Union Account # 299599-S0000 . 3 A 2007 Checking Account with Members First Federal i 2,850.79 50°/,~ ~ 1 425 40 Credit Union Account # 299599-S0011 , . 4 A 2007 18 Month Certificate of Deposit Members First 56,27320 50%, 28 136 60 Federal Credit Union Account # 299599-S0042 , . 5 A 2007 9 Month No Penalty Certificate of Deposit with 10,175.36 50°~, ~ 5 087 68 i Members First Federal Credit Union Account # , . 299599-S0043 6 A ~ 2007 Money Management Account with Members 50,oo7.ao I 50% 25 003 70 First Federal Credit Union Account # I , . i j 299599-S0005 i I j I ------- TOTAL (Also enter on line 6, Recapitulation) ~ 91 123.84 ~ i COMMONWEALTH OF PENNSYLVANIA SCHEDULE G INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS & RESIDENT DECEDENT - MISC. NON-PROBATE PROPERTY ESTATE OF Hawkins, Meftuha FILE NUMBER 21 - 10 ~- 00829 i rns scnectuie must be completed and filed if the answer to any of questions 1 throueh a ~., .,~.,e ~ ~Q .,ee ITEM NUMBER DESCRIPTION OF PROPERTY Include the name of the transferee, their relationship to decedent and the date of transfer. Attach a copy of the deed for real estate. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST _ _.--- EXCLUSION I TAXABLE ~/f~~UE (IF APPLICABLE) ~ 1 ;Edward Jones Account # 377-03311-1-8 101,195.02 100% 101,195.02 2 Western National Annuity Contract # W233018 94 641 12 ~ 100% ~ Beneficiary: Nuria N. Kudlach , . 94,641.12 3 Western National Annuity Contract # W221113 s 833 ss ~ Beneficiary: Nuria N. Kudlach i -- - , . ~ j 100% ~ 8,833.88 ~ i ~ i TOTAL (Also enter on line 7, Recanitulationl 204,670.02 SCFfDULE H COMMONWEALTH OF PENNSYLVANIA ~~ ~~ INHERITANCE TAX RETURN ~~~ RESIDENT DECEDENT ESTATE OF Hawkins, Meftuha FILE NUMBER - ------ _ ? 1 - 1 n _ nnR~o Debts of decedent must be reported on Schedule I. - ITEM ----- - -...------- NUMBER FUNERAL EXPENSES: DESCRIPTION I AMOUNT A• 1 Hoffman-Roth Funeral Home and Crematory, Inc. 3,043.46 2 ~ The Peace Centre -Burial Site and Memorial Service 400.00 3 Diakon External Catering Worksheet 490.00 i 4 ' Zankey Memorials -Headstone 235.00 B. 1 2. 3. 4 5. 6. 7. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission paid Attorney's Fees Leventry, Haschak & Rodkey, LLC 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 Probate Fees Cumberland County Register of Wills- Open Estate Cumberland County Register of Wills- Will Cumberland County Register of Wills -Short Certificates ~ Accountant's Fees I Tax Return Preparer's Fees Other Administrative Costs Cumberland County Register of Wills- JCS Fee 12,420.75 460.00 15.00 40.00 23.50 TOTAL (Also enter on line 9, Recapitulation) 17,462.11 Schedule H COMMONWEALTH OF PENNSYLVANIA ~~ INHERITANCE TAX RETURN ~115'~bN~ C~~ RESIDENT DECEDENT ESTATE OF Hawkins, Meftuha FILE NUMBER 21 - 10 - 00829 2 Cumberland County Register of Wills- Automation Fee 3 Cumberland Law Journal -Advertising 4 The Sentinel -Advertising 5 Cumberland County Register of Wills -Filing of Inheritance Tax Return and Inventory 6 ~ Cumberland County Register of Wills -Filing of Release 5.00 75.00 219.40 30.00 5.00 Page 2 of Schedule H SCHEDULEI DEBTS OF DECEDENT, MORTGAGE COMMONWEALTH OF PENNSYLVANIA LIABILITIES & LIENS INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF Hawkins, Meftuha 21 - 10 - 00829 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimburs,ed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 PowerNet Global -Phone Company -Invoice # 22571914 2.56 2 PA Turnpike Fare Receipt -Travel to Carlisle to clean out property 9.05 3 AmeriServ- Signature Guaranteed Medallion 20.00 4 Sheetz -Gas Receipt -Travel to Carlisle to clean out property 59.90 5 U-Haul Rental (removing items from house) August 13, 2010: $170.00 +82.00 = 252.00 and 475.64 August 22, 2010: $223.64 6 Weleski Transfers- Moving supplies 41.00 7 Nina Rudy -Packer 75.00 8 D & B Quick Notary & Messenger Service 17.00 9 Wessel & Company -Invoice # 44061 for tax purposes 470.00 10 Edward Jones - Transfer on Death cost for Account 377-03311-1-8 231.00 I TOTAL (Also enter on Line 10, Recapitulation) I 1,401.15 REV-1613 EX+ (11-08) i SCHEDULE J COMMONWEALTH OF PENNSYLVANIA ~ BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Hawkins, Meftuha FILE NUMBER 21 - 10 - 00829 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) } _ RECEIVING PROPERTY Do Not Llst Trustee(s) I iTAXABLE DISTRIBUTIONS[include outright spousal ~ distributions, and transfers under Sec. 9116 (a) (1.2)] 1 ~ Nuria N. Kudlach Daughter 50% 127 Terlyn Drive Johnstown, PA 15904 2 Alexander P. Kudlach Grandson 50% c/o Nuria N. Kudlach 127 Terlyn Drive Johnstown, PA 15904 ! I i i I Enter dollar amounts for distributions shown above on lines 1 through 18 on Rev 1500 cover i 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 j TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 ---- -- -- L--