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Home My WebLink About05-25-11 J 1505610105 REV-1500 Itx t°Z-11't~' m enns OFFICIAL USE ONLY PA Department of Revenue P ylvania Coun Code Year File Number DfPPRiMtNL OE RfvENJE Bureau ofIndivtdualTaxes b _ PO BOX 28o6oi INHERITANCE TAX RETURN j Harrtsbura, PA iyi28-o60> RESIDENT DECEDENT ~ ~ i ~ ~ O / ENTER DECEDENT INFORMATION BELOW -* Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYV 202-48-4422 11 /02/2010 07/13/1965 Decedent's Last Name Suffix Decedent's Firsl Name MI __ . __ _ Borsuk _._ Mr. Drew ~ ' q .__. - (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI __.__ Borsuk _. !Mrs I, Denise g ! i Spouse's Social Security Number _ _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 1820-8451 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Onginal Return O 2. Supplemental Retum 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 Retum Required death after 12-12-82) O 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 Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTWL TAX INFORMATION SHOULD BE DIRECTED T0: Name __ __ _ Daytime Telephone Number ;Michael A. Scherer, Esq First Line of Address Baric Scherer Second Line of Address 19 W. South Street City or Post Office State ZIP Code Carlisle PA 17013 Correspondent's e-mau address: mschererCcabaricschereccom _ _ :.,, REGISTER S USE 0~ ~ QQ a -s Fn N ~~ ~ W ,y Ogg FILED r _ C, I^rl _c~ C~~ -f ~~ Under penalties of perjury, I deGare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, cortecl and wmplete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SI URE 0~~~10N R~SPON LE FOR FI ING RETURN ~ ~T` • ~' !U~ f. f7r - Z$° IEc Ro Rd G r lifslt PA ~ T or t' SIGN~UF~ OF PREPfR~iR OTHER THAN REPRESENTATIVE DATE i Side 1 1505610105 S~ ~ I~ 'A r7et3 II ONLY 1505610105 J REV-1500 EX (FI) Decedent's Name: D~@W A. BOfSUk 1505610205 Decedent's Social Security Number '202-48-4422 RECAPITULATION ............... .................. .... . _ 1. Real Estate (Schedule A) ........................................... .. L . 0.00 2. Stocks and Bonds (Schedule B) ..................................... . . 2. ' 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 0.00 4. Mortgages and Notes Receivable (Schedule D) ......................... .. 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 0.00 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1 through 7) ........................... .. 8. 0.00 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............... 10. 11. Total Deductions (total Lines 9 and 10) ............... . ................. 11. 12. Nat Value of Estate (Line 8 minus Line 11) .............................. 12. 13. Chadtable and Governmental Bequests/Sac 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. TAX CALCULATION -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 .OQQ 15. 16. Amount of Line 14 taxable _. .,..,. ,... _.... ... ... : ~.. ~...._ _..... .......,_, ......_ . at lineal rate X .0 _ 18, 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. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610205 1505610205 J REV-1500 EX (FI) Page 3 Decedent's Complete Address: Fila Number DECEDENTS NAME Drew A. Borsuk STREET ADDRESS 280 Echo Road CITY STATE Carlisle PA ZIP 17013 Tax Payments and Credits: 1. 2. Tax Due (Page 2, Line 19) CreditslPayments A. Prior Payments _ B. Discount 3. Interest (1) 0.00 Total Credits (A+ B) (2) (3) 4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. (4) 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 inwme of the property transferced ........................................................................................ .. ^ b. retain the right to designate who shall use the property transferred or its income .......................................... .. ^ c. retain a reversionary interest ............................................................................................................................ .. ^ 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 considerationl ............................................................................................................ .. ^ 3. Did decedent own an "in trust for" orpayable-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 beneficary designation? ...................................................................................................................... .. ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. ,: ~ li'..`:"!tatl~id~~h~t'~~'''~''v,"1 - ?Jf~l`~f~14~1~~fN"fit.?1.:.i`~ii.JaXlT~t~f{fi~~; ~) +.. ~.'1 '.i:.i~,pr'ikl{IH°'i1N. YR~na. ~ Ipr~.. t11~ i 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 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 disdosure 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 [/2 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)]. 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. All of the decedent's assets were owned jointly with his surviving spouse. This estate was opened so that the surviving spouse could be appointed Executrix so that she was able to access certain records belonging to the decedent.