Loading...
HomeMy WebLinkAbout06-22-11 1505610101 REV-1500 Ex ~°1.1°' ~' OFFICIAL USE ONLY' PA Department of Revenue Pennsylvania --- DEPARTMENT OF REVENUE Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO Box 280601 2 1 1 11 0 4 3 6 Harrisburg, PA 1']128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW _ Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 0 4 6 0 7 13 6 5 0 4 0 2 2 0 1 1 0 8 2 3 1 9 1 8 Decedent's Last Name Suffix Decedent's Firs t Name MI B a l k u n a s B e r t h a A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITFI TIRE 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 oaf 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 TelephonE: Number A n t h o n y L. D e L u c a 'E s q. 7 1 7 2~ 8 6 $~; 4 4 REGISTER O~jIKS USE O,~1LY ~- j ~~~ ~~ FT:_' _~y ,_ ~~~ First line of address ~ rrn t^,.~ ~ _ ~-~ r- a~ ~ , "` l.~ ~ ~ --'- ~- 1 1'3 F r o n t `S t r e e t , _ ~~ O ~ --ra ='~ ' - :~~ Second line of address - ,. ~ .~_. ~ ~ ~-a . -: P O B o x 3.5.8 . .~ :.~ ,~ ,~-~ City or Post Office State ZIP Code DA,1'IE FILE[) ---- --~~ -~- B o i 1 i n g S p r i'n g s P A 1 _7 0 0 7 Correspondent's a-mail address: 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 prepares other than the personal representative is based on all information of which prepares has any knowledge. SIGN E OF P N PONSIBLE FOR FILING RETURN DATE ADD SS ®~~~ /3v D ' ~~.'1 0..2 _._-_.___.._ SIGNATU F P~R~EP,ARER OT E HA/N~REPR~rSE ATIVE ~ DATE ADDRESS ®-- ""7`"-- PLEASE USE ORIG AL FORM LY ~T-~~ Side 1 1505610101 150561010:L J J 1505610105 REV-1500 EX Decedent's Social Security Number Decedent's Name: Bertha A. Balkunas 0 4 6 0 7 1 3 6 5 RECAPITULATION 1. Real Estate (Schedule A) ............................................. 1. 0 ~ 0 0 2. Stocks and Bonds (Schedule B) ....................................... 2. 1 6 ` 1 6 7 2 • 6 7 r 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0 , 0 0 4. 9 9 ( ) ........................... Mort a es and Notes Receivable Schedule D 4. 0 ~ 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 7 5 , 9 4 7. 6 5 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. 0 . 0 0 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested........ 7. 0 ~ 0 0 8. Total Gross Assets (total Lines 1 through 7) ............................. 8. 2 3 7 , 6 2 0 • 3 , 2 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. 1 0 , 8 5 6 ' 1 3 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. 8 7 5 ~ 8 9 11. Total Deductions (total Lines 9 and 10) ................................. 11. 1 1 , 7 3 2 ~ 0 2 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 2 2 5 8 8 ~ ' 3 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0 ` 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 2 2 5 , $ $ $ • 3 0 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.045 2 2 5, 8' 8 8 3 0 15. 1 0, 1 6 4 '~ 9 7 16. Amount of Line 14 taxable at lineal rate X .0 _ r 16. ~ 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. .1 O , 1 ` 6 4 ; 7 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1502 EX+ (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bertha A. Balkunas 21-11-0436 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. (it more space is needed, insert additional sheets of the same size) REV-1503 EX+ (6-98) :~ scHE~u~E s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bertha A. Balkunas 21-11-0436 All property jointly-owned with right of survivorship must be disclosed on Schedule F. - ITEM -- NUMBER VALUE AT DATE DESCRIPTION __ OF DEATH 1' 26 679 5500 shares of Franklin Income Fund ' '$60,295.78 CLA @ $2.26 per share 2. 8,427.0070 shares of Franklin Utility Fund '101,376.89 Class A @ $12.03 per share TOTAL (Also enter on line 2, Recapitulation) I $ '1 61 , 6 7 2 . 6 7 (!t more space is needed, insert additi©nal sheets of the same size) REV-1504 ~cX+ (1-97) -~ SCHEDULE C ~~' CLOSELY HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN RESIDENT DECEDENT SOLE-PROPRIETORSHIP ESTATE OF - FILE NUMBER - Bertha A. Balkunas 21 -1 1 -043Ei Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER - NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 ~ NONE -0- TOTAL (Also enter on line 3, Recapitulation) ~ $ - 0 - (If more space is needed, insert additional sheets of the same size) REV-1507 EX+ (1-97) ~. ~l COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ACHE®I~LE MORTGAGES & NOTES RECEI~/ABLE EST,~7E ~F ~ FILE NUMBER Bertha A. Balkunas 21-11-0436 A11 property jointly-owned with right of survivorship must be disclosed on Schedule F. tir more space is needed, insert additional sheets of the same size) REV•1508 EX * (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Bertha A. Balkunas FILE NUMBER 21-11•-0436 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 ~. Checking account, #2000059625049, at Wells Fargo ,11,885.81 Bank 2. Savings account, #2000059625052, at Wells Fargo Bank 46,149.27 3. Cash and Sweep Money Market Funds, account #3087-5830, 14,860.79 at Charles Schwab. 4. I Checking account, #440013285463, at Charles Schwab I 3,051.78 Bank. TOTAL (Also enter on line 5, Recapitulation) ~ $ 7 5 , 9 4 7 . 6 5 (If more space is needed, insert additional sheets of the same size) ~- REV-1509 EX i (1.97} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bertha A. Balkunas FILE NUMBER 21 -1 1 --0436 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 A, NONE B C _+- JOINTLY-OWNED PROPERTY; LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. NONE _ 0 _ SCHEDULE F JOINTLY-OWNED PROPERTY TOTAL (Also enter on line 6, Recapitulation) I $ _ 0 _ (If more space is needed, insert additional sheets of the same size) REV-1510 EX+ (t-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY Bertha A. Balkunas FILE NUMBER 21 -1 'I -0436 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. 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 ~P,4PPLICABLE TAXABLE VALUE 1 ~ NONE TOTAL (Also enter on line 7, Recapitulation) $ - ~ - (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (10-06) ., .gym COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bertha A, Balkunas SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-11-0436 Debts of decedent must be reported on Schedule I. ITEM - NUMBER DESCRIPTION _ AMOUNT A. FUNERAL EXPENSES: ~ Secombe Brothers - Engraving $153,70 1732 Wakelee Avenue Ansonia, Connecticut 06401 2 Petal Pusher Florist - Flowers 318.00 450 Howe Avenue Shelton, Connecticut 06484 B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City __ Year(s) Commission Paid: State Zip 2 3 4. 5. 6. 7. 8. 9, 10. 11, 12. Attorney Fees Anthony L, DeLuca, Esquire 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 Accountant's Fees Tax Return Preparer's Fees Ewing Brothers Funeral Home, Inc., Carlisle, PA Death Certificates John J, Sullivan's Restaurant - Funeral Luncheon Ansonia, Connecticut Legal Advertising - Cumberland Law Journal Legal Advertising - The Sentinel Filing Fee for Inheritance Tax/Inventory Additional Probate fees 8,500,00 377,50 500.00 36,00 617.15 75.00 208,78 30.00 40,00 TOTAL (Also enter on line 9, Recapitulation) I ;6 1 0 , 8 5 6 . 1 3 (It more space is needed, insert additional sheets of the same size) REV-1512 EX+~ (12.03) a COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHE®l~LE 1 DEBTS OF DECEDENT, M®RTGAGE LIABILITIES, & LIENS ESTATE QF FILE NUMBER Bertha A. Balkunas 21-11-0436 deport def?t~ incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. (If rnore space is needed insert additional sheets of the same size) NEV-1513 EX+ (9-00) ~. SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Bertha A. Balkunas 21-11-0436 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under __ Sec. 9116 (a) (1.2)) 1. Ann B. Cummings Daughter 100 1309 Kuhn Road Boiling Springs, PA 17007 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. NONE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ - 0 - (If more space is needed, insert additional sheets of the same size) _ --- __ t LAST WILL AND TESTAMENT n ~ +_: _~~ - ; -,-, .. ~' -~~~~ OF . ~ - ~= BERTHA A. BALKUNAS ~- .= __.. -r-, :.1~ --~ ~.. ~ ~) ~~ ~` I, BERTHA A. BALKUNAS, a resident of 1309 Kuhn Road, Boiling Springs, Cumberland County, Pennsylvania being of sound mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking ;1.1.1 Wills and Codicils heretofore made by me. ITEM 1: I direct that all my just debts, the expenses of my last illness and. funeral expenses be paid as soon after my decease as the same can conveniently be done;. ITEM 2: I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by thc~ government of the United States, or any state or territory thereof, or by any foreign government or political subdivision thereof, in respect to all property required to be included in my gross estate for estate, inheritance or like tax purposes by any of such governments, whether the property passes under this Will or otherwise, excluding, however, any property over which I have a taxable power of appointment, provided, however, that no residuary beneficiary shall by reason of this provision be denied thc; benefit of any deduction, credit, favorable rate of tax or other benefit which by law enures to such beneficiary. ,~_ __ BERTHA A. BALKUNAS 1 __- _ __ _ _ LA,S~'"'~i~iLL ~~ T~ST`Al~f'ENT" OF BERTHA A. BALKUNAS ITEM 3: I give, devise and bequeath all of the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever kind and nature, and wheresoever situate at the time of my death, unto my daughter, ANN B. CLTMMINGS, provided, however, that she survives me and is living sixty (60) days after the date of my death. ITEM 4: If and in the event that my daughter, ANN B. CUMMINGS, does not survive me and is not living sixty (60) days after the date of my death, then and. in such event, I give, devise and bequeath all of the rest, residue and remainder of my estate:, real, personal and mixed, of whatsoever kind and nature, and wheresoever situate at the tirrie of my death, in equal shares, unto the issue of my said daughter, ANN B. CUMMING~S. ITEM 5: I hereby nominate, constitute and appoint my daughter, ANN B. CUMMINGS, Executrix of this my Last Will and Testament, with full power to do amy and all things necessary for the complete administration of my estate, and direct that no bond or other surety is required of her in this or any other jurisdiction for her performance of this office. -: ~~ ., F , , ~ ~- .,~ -, ~--zit ;: t -1~ . ~:__., __r .; , _ BERTHA A. BALKUNAS ` ~' ~~ `~ 2 LAST WILL AND TESTAMENT OF BERTHA A. BALKUMAS If and in the event that my daughter, ANN B. CLTMMINGS, does not survive; me and is not living sixty (60) days after the date of my death, or does not complete her duties as Executrix, then and in such event, I hereby nominate, constitute and appoirrt my son-in-law, FRANCIS J. CUMMINGS, Executor of this my Last Will and Testament, with full power to do any and all things necessary for the complete administration of'my estate, and direct that no bond or other surety is required of him in this or any other jurisdiction for his performance of this office. ITEM 6: If any provision of this Will or of any Codicil hereto is held to be inoperative, invalid or illegal, it is my intention that all the remaining provisions thereof shall continue to be fully operative and effective, so far as is possible and reasonable:. IN WITNESS WHEREOF, I, BERTHA A. BALKUNAS, the Testatrix, haves to this my Last Will and Testament, typewritten on four (4) consecutively numbered pa~gE;s, subscribed my name and affixed my seal this ~ `' day of ;:~;...~~,,~~~ , 2008. f t~: ~: BERTHA A. BALKUNAS 3 ' ~~- OF BERTHA A. BALKUNAS Signed, sealed, published and declared by the above named BERTHA A. BALKt1T1AS, as and for her Last Will and Testament, in the presence of us, who have hereunto subscribed our names at her request, as witnesses hereto, in the presence of the saidl Testatrix, and of each other. ~ ~~~:. ~- t :~ ~' residin at ~ ' ~ ~~ ..~ rx-c r ..~~ . ~~,r ' -~ ~/ ~ ~ . ~ r ~~ .. g ; . ^,,. .. r ~ , r . ~ ~ ~ ~ ~~ , y / ~ - r ,~ '''-. ~ ,~ ~~-t,1~'~~•~.-~:'~ ,~ -- , _.i~~ ..~'~ ~r~~residing at ~ ..~'~~, ~`~ ..;F.~ ~,~ ~Y~ ~~~.~ J ~ , ~ _ <<7~r~ ~-:~ ~~-. ~ ' a~_ ~ 4 REV-1500 EX Page 3 Decedent's Complete Address: -0- Bertha A. Balkunas STREETADDRESS 1000 West South Street ciTY - - -- Carlisle, ziP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments ____ B. Discount $ 5 0 8.2 5 3. Interest 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. File Number 21 -1 1 - 0 4 :3 6~ (1) Total Credits (A + B) (2) (3) (4) (5) Make check payable t0: REGISTER OF WILLS, AGENT. $10,164.97 508.25 -0- $9,656.72 .., . , ,... ,. ,. r<!h K~~r c 'y..: .. ';. ,."ts ~-'. _ a, ~,'.~ ~ ~..'M~,yYa ~ * `'. x, `s ~' r- We^r, ..1.~.. .~, .. s:.-... ... "';, `.+~'.,..-.-~'~: ws ~, ~` r Rr,`` .. ~'.n ~yt »~! ~:,. ar.-.-.~~~ ~+< ~~ '^t: ts;;'" ,i. N<. ~y~'.6. r m.:~~~~"-`x .~Yf.~ ~r.:,. . ,' 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 : ............................................ ^ ^X' 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? .............................................................................................................. ^ 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 THE RETURN. .. . . ,. r.r ~,~. ~~ 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 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 lines! 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.