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Home My WebLink About05-18-111505610143 REV-1500 Ex (°,-1°' OFFICIAL USE ONLY PA Department of Revenue pennsytvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE PO 60X.280601 INHERITANCE TAX RETURN 21 10 0 681 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 157 02 6904 04 12 2010 Decedent's Last Name Suffix LJUCA (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix LJUCA Spouse's Social Security Number Date of Birth 06 19 1948 Decedent's First Name MI ZEKERIJAH Spouse's First Name MI JASMINA THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return ^ 2. Supplemental Return ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of death after 12-12-82) ~ g Decedent Died Testate ~ Decedent Maintained a Living Trust ~-I (Attach Copy of Will) ^ (Attach Copy of Trust) ~~ 9. Litigation Proceeds Received ^ 10. Spousal Povertyy Credit (date of death between 12-31 ~J1 and T-1-95) ^ 3 Remainder Return (date of death prior to 12-13-82) ^ 5. Federal Estate Tax F;eturn Required ~ _ 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number SONYA KIVISTO ESQ 717 240 4686 First line of address 1200 WALNUT BOTTOM ROAD Second line of address THIRD FLOOR SUITE 331 City or Post Office State ZIP Code CARLISLE PA 17015 Correspondent's a-mail address: REGISTER OF 1PN~.LS USE ONLY -- __~ i - .. :..~ ~. DATE Ftt..~D , : , _, _r __.., -~; t 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 E 0 PERSON RErSPONSIBLE FO FILING RETURN DATE X^ '~~1i l~ y. J~LIi.C~~ Jasmine Liuca ADDR 6302 Valleybrook Drive, Mechanicsburg, PA 17050 SIGAIATURE OF PR~ ARER OTHER THAN REPRESENTATIVE DATE Sonya Kivisto 1200 Walnut Bottom Road, Third Floor, Suite 331, Carlisle, PA 17015 Side 1 1505610143 1505610143 J J 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name: L~uCa, Zekerijah 157 02 6904 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 & Miscellaneous Personal Property (Schedule E) ............... 5. 7 7 , 3 9 6. 7 7 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers 8 Miscellaneous f~aq Probate Property (Schedule G) LJ S t Billi R epara e ng equested............ 7, 8. Total Gross Assets (total Lines 1-7) ..................................................................... g. 7 7 , 3 9 6. 7 7 9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 12 , 0 6 7 . 8 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 1$ , 8 62.8 5 11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 30 , 930.65 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 4 6 , 4 6 6.12 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• 4 6 , 4 6 6.12 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 .oo 38 , 233.06 15. O. 00 16. Amount of Line 14 taxable at lineal rate X .045 8, 2 3 3. 0 6 16. 3 7 0. 4 9 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 0 19. Tax Due .................................................................................................................. 19. 3 7 0. 4 9 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: File Number 21-10-0681 DECEDENT'S NAME Ljuca, Zekerijah STREET ADDRESS ----- --------- 6302 Valleybrook Drive CITY STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 (1) 370.49 0.00 _____ 370.49 Total Credits (A + 6) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) Make Check Pa able 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 .............................................................................................................. ^ 0 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? ....................................................................... [~ ............................................. x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?....... ~~_~ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................ ...........,,........................................, l_~ ........................................... . 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 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, whether by blood or adoption. Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF uca, Zekerijah FILE NUMBER 21-10-0681 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. ~~~ ~~~..~~ ~NacC ~~ neeaea, aaaluonal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) ' REV-1151 EX+ (10-06) ,. COMMO ~~F,~ALT~I OF PENNSYLVANIA INH IAN T R T RN R IDEN DE ED N r SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Ljuca, Zekerijah 21-10 0681 Debts of decedent must be reported on Schedule I. ITEM N MB R DESCRIPTION AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(sl Commission raid 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 12,067.80 TOTAL (Also enter on line 9, Recapitulation) I 12,067 80 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Ljuca, Zekerijah 21-10-0681 ITEM NUMBER DESCRIPTION AMOUNT Funeral Ex enses 1 Islamic Funeral Services - 251 Dekalb Avenue, Brooklyn, NY 11205 2 Miscellaneous Funeral Expenses in Bosnia H-A 10,000.00 2,067.80 12,067.80 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) • ~ Rev-1512 EX+ (12-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Lju ah FILE NUMBER 21-10-0681 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Bank of America Account No.: 4305 5003 4521 9862 -Credit Card 2,334.97 2 Chase Account No.: 4559 5005 0099 6877 -Credit Card 1,000.00 3 Eldin Ljuca and Eldina Tandir -Loan by children of deceased -advance costs of funeral 12,067.80 4 JASA Travel, Urbandale, IA 50323 -Air fare for wife and children to attend funeral 3 @ 3,460.08 $1,153.36 TOTAL (Also enter on Line 10, Recapitulation) f 18,862.85 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) • 'REV-1513 EX+ (11-08) ,~ COMMONWEALTCcH QF PENN YLVANIA IN RF~RIIDENTEDfE~EDEN~RN SCHEDULE J BENEFICIARIES ESTATE OF Luca, Zekeri"ah NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 a 1.2 1 Eldin Ljuca 6302 Valleybrook Drive Mechanicsburg, PA 17050 2 Jasmina Ljuca 6302 Valleybrook Drive Mechanicsburg, PA 17050 3 Eldina Tandir 1 Mandy Court Camp Hill, PA 17011 FILE NUMBER 21-10-0681 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) ($$$) D N T s e Son Four Thousand 4,116.53 Three Hundred Eighty Nine Dollars and Wife Thirty-Eight 38,233.06 Thousand Seven Hundred Seventy-Nine Daughter Four Thousand 4,116.53 Three Hundred Eighty Nine Dollars and ~ Total Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 46,466.12 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET Copynght (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)