HomeMy WebLinkAbout08-11-11J 1505610143
REV-1500 Ex(°'-'°'
OFFICIAL USE ONLY
PA Department of Revenue pennsylvania County Code Year File Number
Bureau of Individual Taxes UEYARTMENT OF REVENUE
Po Box.2sosot INHERITANCE TAX RETURN 21 10 1162
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
133 30 4477 11 09 2010 08 10 1925
Decedent's Last Name Suffix Decedent's First Name Mf
KLAR ANTONIE T
(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 WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
1. Original Return ^ 2. Supplemental Return
^ 4. Limited Estate ^ 4a. (date of death afternP2-12 82)
g Decedent Died Testate
(Attach Copy of Will)
^ ~ Decedent Maintained a Living Trust
(Attach Copy of Trust)
3. Remainder Return (date of death
prior to 12-13-82)
^ 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
^ 9. Litigation Proceeds Received ^ 1 D. Spousal PovertY Credit /date of death 11. Election to tax under Sec. 9113 A
between 12-31-J1 and T-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
J RONALDO LEGASPI 717 234 4161
First line of address
320 MARKET STREET
Second line of address
P O BOX 1268
City or Post Office
HARRISBURG
State ZIP Code
PA 17108
Correspondent's a-mail address: 1rl@goldbergkatZman.COm
REGISTER OLS USE ONLY
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DACE FILED ~ - ` -
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Under penalties of perjury, I declare that I have examined thi return, i cluding accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and plete. Declaration of arer other~an the ~ersonal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PER ESPO I OR F N DATE
Ronald M. Katzman ~'- -/
ADDRESS
320 Market Street Harrisbur PA 17108
SIGNATU P AR QTHER THAN REPRESENTATIVE ~ DATE
^ ^ ~ _ ` J. Ronaldo Legaspi ,~ ~ (~ /~ ~
320 Market Street, Harrisburg, PA 17108
Side 1
^ 1505610143 1505610143 J
J 1505610243
REV-1500 EX
Decedent's Social Security Number
DecedenrsName K~ar, Antonie T. 133 30 4477
RECAPITULATION
1. Real Estate (Schedule A) ..................................................................................... .. 1.
2. Stocks and Bonds (Schedule B) ........................................................................... .. 2. 2 4 6. 7 0
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. 23 , 143 . O1
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 25.44
7. Inter-Vivos Transfers & Miscellaneous i on,-Probate Property
(Schedule G) a Separate Billing Requested............ 7.
8. Total Gross Assets (total Lines 1-7) .................................................................... . g, 23 , 415.15
9. Funeral Expenses & Administrative Costs (Schedule H) ...................................... . 9. 1 , 702.50
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............................. . 10. 105.43
11. Total Deductions (total Lines 9 & 10) .................................................................. . 11. 1 , 807.93
12~ Net Value of Estate (Line 8 minus Line 11) ......................................................... . 12. 21 , 607.22
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. 21 , 607.22
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. 0.00
16. Amount of Line 14 taxable
0.00
at lineal rate X .045 16. 0.00
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 21, 607 .22 18. 3 , 241.08
19. Tax Due ................................................................................................................. . 19. 3 , 2 41.0 8
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 21-10-1162
DECEDENT'S NAME
Klar, Antonie T.
STREET ADDRESS --
1435 Hillcrest Court
CITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3,300.00
162.05
(1)
3,241.08
3,462.05
220.97
Total Credits (A + B) (2)
3. Interest
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.
Make Check Payable to: REGISTER OF WILLS, AGENT.
(3)
(4)
(5)
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 ............................................................................................................... ^ ^x
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?....... ^ ^x
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................................. ^ ^x
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-1503 EX+~6-98)
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OP PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Klar, Antonie T. 21-10-1162
All property jointlyowned with right of survivorship must be disclosed on Schedule F.
~~~ ••~~~~ oHa~.a ~~ i~aouau, auwuonal pages or me same s¢e)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (8-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Klar, Antonie T. 21-10-1162
--•• r•~ra• •r rv•~••v-....,~Q~ ..~~n uin nynr or survrvorsnlp must oe msclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Highmark Blue Shield -Refund of premium 320.00
2 PNC Bank, Checking account, #5005032805 -DOD value 19,006.57
3 1996 Oldsmobile -net of sale to private buyer 500.00
4 Tangible personal property of the decedent -Sold by Red Door Consignment 3,316.44
TOTAL (Also enter on Line 5, Recapitulation) I 23,143.01
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+18-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF FILE NUMBER
Klar, Antonie T. 21 10 1162
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• g~rTC C~.trn~:NS
B.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER
LETTER
FOR JOINT
TENANT
DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSE
% OF
DECD'S
INTEREST
DATE OF DEATH
DECEDENT'S INTEREST
1 PNC Bank, Checking account, #5140034846 50.88 50.000% 25.44
TOTAL (Also enter on Line 6, Recapitulation)
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
I 25.44
Form PA-1500 Schedule F (Rev. 6-98)
REV-1151 EX+(10-06)
COMMO ~wEALTti OF PENN$yLVANIA
INH ITAN E T R T RN
R IDEN DE ED N
SCHEDULE H
FUNERAL EXPENSES 8~
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Klar, Antonie T. 21-10-1162
ITEM
N MB R DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(sl Commission paid
2. Attorney's Fees J. Ronaldo Legaspi 1,200.00
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
177.50
5. Accountant's Fees
250.00
6. Tax Return Preparer's Fees
7. Other Administrative Costs 75.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 1,702.50
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
Klar, Antonie T. 21-10-1162
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Cosh
1 Cumberland County Bar Association -Legal advertising 75.00
H-B7
75.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev1512 EX+ (12-08)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Klar, Antonie T. 21-10-1162
Report debts incurred by the decedent prior to death that remained unpaid at the date of death- includ:nn ..~.o:...r....aea ..,e..:..~. -...._____
~~~..~~ ~a~ Naycs of ule 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)
COMMONWEALTH OF PENN YLVANIA
INHERITANCE Tq~ RET RN
RESIDENT DECEDEN
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Klar, Antonie T. 21-10-1162
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(Sl RECEIVING PROPERTY DECEDENT (Words) ($$$)
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116 a 1.2
Bette Clemens 25.44
PA
Gerilynn K. Henshell
2003 Alexis Drive
Harrisburg, PA 17110
Friend
~ ~ Total
Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 cover sheet, as a ro i
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
25.44
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
ANTONIE T. KLAR
SSN: 133-30-4477
INDEX
PENNSYLVANIA INHERITANCE TAX RETURN
EXHIBIT SCHEDULE OF RETURN DESCRIPTION
A Death Certificate (copy) DOD:
11/9/10
B Certificate of Grant of Letters
C NYSE Report dated 8/1/11 for Alico,
Inc. Stock
D Valuation of PNC Checking Accounts
558950.1
~~fE:.E~F4R[~`~~: ~~ F~ €~E~€~ri~ x~ ~Ltr'~E~at~ ~~tF.~ ~:~E~~r ~~ ~a4:€~ar~t ~r ~~~~~~r~~€~., .
P 17024795
Certification 1~Iumher
REV Ifll006
PRINT IN
MANFNT
~CK INK
'This is to certify that the iuforination here given
correctly copied from ail original Certificate of Dea
duly filed with me as Local Registrar. The origin
certificate will he 'r~rwarded to the State Vi;
itecords O fi ~e for ,~ I~nauent filing.
Local Reg+strar Date Issued
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
(Sea instructions and examples on reverse) STATF FII F NUMBER
I. Namr d DeredrY IFrsl nWd4, last sWlia) 2. Ssa ]. Soaal Saaairy Norther s. Dm d OeaIN (MOSah, my, Yrar)
Antotue T. Klan Female 133 - 30 - 4477 November 9 2010
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S
REGISTER OF WILLS
CUMBERLAND COUNTY
PENNSYLVANIA
No . 2010- 01 162
Estate Of : ANTONIE T KLAR
CERTIFICATE OF
GRANT OF LETTERS
PA No . 21- 10- 1 162
(First, Middle, Lastl
Late Of : CAMP HILL BOROUGH
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 133-30-4477
WHEREAS, on the 24th day of November 2010 an instrument dated
August 8th 2006 was admitted to probate as the last will of
ANTONIE T KLAR
(First, Middle, Lastl
1 a to of CAMP HILL BOROUGH, CUMBERLAND County,
who died on thE= 9th day of November 2010 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
RONALD M KA TZMAN
who has duly qualified as EXECUTOR(R/X)
and has agreed to administer the estate according to law, all of which
fully appears of record in my office a t CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I I~iave hereur_ ~o s~ t my hard an_d affixed the seal
of my office on the 24th day of November 2070.
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)
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Alico Inc.
NASDAQ: ALCO Like
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Market open
X24.66 Compare: Indexes Add MarketWatch News on ALCO
Monday's biggest gaining and declining stocks
Change +0.25 +1.02 % zs oo r s a n,. , ui
1 io, 2~7:. - tdara~l'A'atul
Volume 1,114 DOE to invest $385 million for 6 biorefinery projects
Aug 1. 2011, 11:54 a.m. - _... .._ __. .. ..._ t:,;P.n1. FeL+2A. 200-~~3ahrl=l Mar„vav
Quotes are delayed by 20 min I 24.ao
Alico names Dan Gunter president, COO
PrevfOU$ CIOSe $ '24.4. 1D 2I a.m. 4l arch Iv. 2006 Micnaei Baron
Day low Day high Alico hires presidenUoperating chief
52a.s1 $2a.as 2aso
1Dr15 a.m. `Aa~ch I5. 200E ~ 7FI031aS A-tiddl=ion
Alico gets 1st cash payment from Ginn for property sale
Open: 24.72 _. _..... _. _..... _. 1 T.as a n1. J~q- 13 21U5 -::are yc Frrchard
24.40
52 week low 52 week high Sa 9a t0a t1a iz
P tp 2p 3p Alico receives $6.3M from Ginn, places money in escrow
$20.17 $2s.ss 10 30 a.m. Jay 13. 7~tl5 -'~arolyr. Pritchard
I d Sd 3m 6m 1 y 3y Sy Set Alico gets 1st cash payment from Ginn for property sale
Market cap $180.71M
Average volume 9,065 Sentiment on ALCO Get more info »
P!E ratio 90.07
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EPS 0.27 ~.t, _ `~[[~1
Dividend 0.10 Community »
Div yield N!A CFo
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10-Q: ALICO INC MetL'Ife's Alico Buy Makes It Top 3 Contender in Japan's...
4;;,'y ;+ n t•~ay 10, 2::11 - Eoeai Crlne - tEC;:; = tOC~. 10t:i 10:13am- A.M. Best
Chiquita Brands Earnings Cheat Sheet: Turnaround Spirit Yields MetLife Growth on Track with ALICO -Analyst Blog
Profitable Quarter D ,.7Jn: rzs - sh,iyhl.?uJs
`' ='.: a m ..".Say 5, 2^11 - :'doll SL Cheat SY:eet
MetLife Growth On Track With ALICO
Insiders Own a Majority Stake in These Large-Cap Stocks Now '~ z.o"' ;"r+- D,iy r„a~x~{,
',..35 a m r,n:i 2e. 2011 ~ :4',-,II ;;t. Ch=at SCeel
;~ n.ncl MetLife shares surge on 2nd-quarter earnings beat
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April 21, 2011
12onald M Katzman
Goldberg Katzman
320 Market St -Strawberry Sq
PO Box 1.268
Harrisburg, PA 17105
RE: Name: Antonie T Klan
SSN: 1.33-30-4477
DOD: 11-09-2010
Dear Mr. Katzman:
No.44/~ P. 1/2
Ire xesponse to your request for Date of Death (DOD) balances for the customer noted above, our
records show the foho~ving:
Checking Account
Account # 5005032805 Established: 09-27-2006
ANTONIE T KLAR
DOD balance: $19,006.57 non interest bearing
Accouztt # 5140034846
ANTONIE T KLAR
BETTE CLEMENS
DOD balance: $50.88 + 0.00 accrued interest
Interest paid 01-01-2010 thru 11-09-2010 $ 0.00 YTD
Established: 01-01-1968
Page 1 of 2
^~,r, 2`. ~'~'1 ~ ~yF"~"~ F"!~ EAN~~ 412-10-~'l47
~1~0. X475 P. 2/2
Please note that tt;iis office provides date of death balances for deposit accounts (IRAs, CDs, Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance with
any of these iterra5, please call t-888-pNC-.BANK (1-888-762-2265) or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank, N.A.
Member FDIC
'this message is intended for the use of the individual or entity to tivhich it is addressed and may
contain information chat is privileged, confidential and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient, you are hereby notified that any dissemination,
distribution or copying of this communications is strictly prohibited. If you have received this
communication in error, please notes me immediately by reply or by telephone at SDO-762-1775 and
immediately destroy this faxed document
Page 2 of 2