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HomeMy WebLinkAbout02-10-121505610101 ~ REV-1500 Ex ~°1.1°' ' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes PO BOX 28o6oi INHERITANCE TAX RETURN ~ E ~ ~ / ~ ~ ~' Harrisburg, PA 1128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ~s6~zp1S6y' ro zy ~~ oyb~38" Decedent's Last Name Suffix Decedent's First Name MI M~-TKo~~~y k~4-T~~~fN P; (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI M RTKa ar I ~Fl ~n 4~ ~T 9-' Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~ 3 ~ ,~ ~ G S ~ ~ REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death ' t 12 13 82 p 4. Limited Estate O 6. Decedent Died Testate (Attach Copy of Will) O 9. Litigation Proceeds Received p 4a. Future Interest Compromise (date of death after 12-12-82) O 7. Decedent Maintained a Living Trust (Attach Copy of Trust) O 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Jo ~~r~F Mft-~- ~a M~Gi2~£Y y ~f~ ~.~3 aay ~ First line of address 3 ~.. S O v T K Second line of address City or Post Office ~ !,}- k t~ ~ S L c Correspondent's a-mail address: (lI~ t f ?' S T ,Z F- ~ T prior o - - ) O 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes O 11. Election to tax under Sec. 9113(A) (Attach Sch. O) REGISTER OF WILLS ONLY T Q ..--y (~l ~ .-~ BCD ~ :_ =~ f- 7 0 -,~~~ _,tJ.-rt _. .- ;JC_ ;« ' D~ FILED ~ ;-i- State ZIP Code ~ ~ /1' 1 ~ ~ L 3 ..,... ~• • 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 oelier, 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGN URE OF PREPARER OTHER THAN REPRESENTATIVE DATE / /oy~n`-- C O !/ AD ~ 3 ~ ~ ~11''.c~ ~ ~ ~~ ~ ~ ~ l3 -" PLEASE USE ORIGI AL FORM ONLY Side 1 1505610101 1505610101 J,--.~ REV-1500 EX 1505610105 Decedent's Social Security Number Decedent's Name: RECAPITULATION 1. Real Estate (Schedule A) ........... : .... . ........................ .... 1. • 2. Stocks and Bonds (Schedule B) ........ ........................... .... 2. • 3. Closely He-d Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages and Notes Receivable (Schedule D) • ........................ ... 4. ~ 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E).... ... 5. 3~ ~a•3© 6. Jointly Owned Property (Schedule F) p Separate Billing Requested .... 6 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ... . • (Schedule G) p Separate Billing Requested..... ... 7. 8. Total Gross Assets (total Lines 1 through 7) ............... . .......... ... $. 59~0.3~ 9. Funeral Expenses and Administrative Costs (Schedule H) ................ / ,,//~~ / j~' ... 9. ~ a • 6 U 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ........... l ... 10. • 11. Total Deductions (total Lines 9 and 10) .... .......................... ... 11. 12. Net Value of Estate (Line 8 minus Line 11) ... ......... . ............... 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 9 ~ q ..12. 1 s~oC'~ an election to tax has not been made (Schedule J) ...................... . . 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) .... .................. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES ..14. O • 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ (9 ~ 15 16. Amount of Line 14 taxable . • ~ at lineal rate X .0 • 17. Amount of Line 14 taxable 16. • at sibling rate X .12 • 17 18. Amount of Line 14 taxable . ~ at collateral rate X .15 • 18. 19. TAX DUE ......... ..................:......................... 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME D~' STREET ADDRESS CITY ~ s ~ ~ n ~ / C~ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. CreditslPayments A. Prior Payments --- B. Discount _ 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. QQ AA ----- ----- - STATE ~~ II ZIP / vIC-~ (1) (3) (4) (5) V O Make check payable to: REGISTER. OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: 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 : ............................................ ^ ~I 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 'intrust 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 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 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)]. 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. Total Credits (A+ B) (2) ~~ REV-i5o8 EX ~ (sI-io) SCHEDI~LE E i pennsylvania ~' DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT FILE NUMBER: ESTATE OF: Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly owned with right of survivorship must be disclosed on Schedule F. TE ITEM DESCRIPTION NUMBER 0 ~ Q~~Q ~, j ~(~ Q ~-~ ~r ~S~ /~~ ~~°~ f} C Go u // 1 VALUE AT DA OF DEATH TOTAL (Also enter on Line 5, Recapitulation) $ I ,s~ ~ O , 3 ~ If more space is needed, use additional sheets of paper of the same size. ~ oooooc o.-oooc ~ ~ o~~ooc ~ - ~ ~~ ~ N ~ M ~ O U Q O U ~ C ~~ p ~ N ~ ~ .«. `" G ~ ~ ~ CQ ~ (~ C~1 ~ U Y ~ ~ v) ~' G C U ~ `~' ~ `:% Q U ~ N > i ~ ~ U c~ .C c6 N G G Cn Q CnUCnU_r~;t N \ N c0 :7 (J (~ N ti rt ~ ~ K 7 N N ~ % N CC CN.`^ ~ ~ N 7 o c N ~' O `'~ o c ~- ~, Lo c _ ~ ^ N ~n `- ° ~ ~ ~ - rn _ o vm - s ~ _ _' .~ ~ _ m v a .a r - - :=3v° u E u `~ J o ~ ~ ~ _ ~ _ boo f~ cLi 3 _LUpm ffi v~ia~ 3 RNQ d ~ ~1 o _ - ~'' _ _ Z _ -=j- Z < - - G Z ~~ --=_ W. ~ ~- - ~_ ~-~-Z w ~= I{I 11 I~ ;-, ;: (~'~ ~ '' °' ~ ~ c `~ '~ ~ m~~ ~ ~ .~ .4 U .a ~ o °~ rn ~ ._ ~t o N l~ 0 N co" Q i Q Z ~ ~'' O ~Q Q (jJ W o :~ y C Q = ~ U Z 1'~ tD W ~ ~ U o 0 ~~ r r N >_ Q' p~ jj ~'-. (V . ~' ~ ~" ^ o N ~ n ~ 4 ~ ~ Or is ° ~o .. o ~ ° \° ~o~ d~ ~ ooa°O r _ V ~ ~ ~ ~Q ~ ~ C ~~W>W a~'i m tLp~~~ ~ V N~ =~~m ~av~om C V U N ~ ~ ~ ~ ~' O QaC.- C ... ~i~eoe o m m a c ~3 4~ C O a Q C C O U REV-1511 EX+ %1D-Q9) pennsylvania DEPARTMENT OP REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER K~Tr~ L ~ ~~/ ~ M ~ 7^Ka V ictl Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. ~V N£le fr ~- DIAL ~a ~ .~~ ~4, o a G,~M L 7Z ~.i''J !.- e 'r' 1 y' 0 0. d p G £M ~ Thy ~ o N u M ~i~ l ~ y o o, o 0 L U~c'tfro n! / ~' ~3 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) _ /eU~G,IL__ ~,~__ ~-/_~ T. /~a ~1~7 Street Address ~ ~_ __G_~~ ~1/Gt/ ~ . -__~~ ~ -~ -~-- - -- { -- City --- _ - - . ~i u~-l Aiv1 cs(fv,~- _ State n~ ZIP ~ ~ 4 SS' Year(s) Commission Paid: __ _._ __ __~_______-- - -________. _.-. --_-- ___- 2. Attorney Fees: Tp ~ ~ ~ ~T£~M ~~ f~ ~~ 3. Family Exemption: (If decedent~sladdress is not the same as claimant's, attach explanation.) Claimant ~ ~ /.~ LILT ~ ~ ~TK O ~ ~ ~' H--- -_ - -_ _ Street Address ~ Cr/Z~f/IrW Q?~-__~ /Z ~ I~ 4Q~. - - City __ MSG N A,-~ l~ QuQ~ __ State ~ZIP1_~ _Sf Relationship of Claimant to Decedent SU l~V~!JG` S PO V S ~" 4. Probate Fees: (7 S. Accountant Fees: ~ ~ ~ 6. Tax Return Preparer Fees: ~ U 7 300,`'0 TOTAL (Also enter on Line 9, Recapitulation) $ ~` j ~ T~ . b If more space is needed, use additional sheets of paper of the same size. I, Kathleen Matkovich, of Cumberland County, Pennsylvania, declare this to be my Will and revoke all prior Wills and Codicils. FIRST: Tangible Personal Property. I give all tangible personal property owned by me at my death, and all insurance policies on said property, to my husband Robert, if he survives me by thirty days; if not, in as --=a- -- e~._a_ ~.__--= ~_ ~_ _-_=~=--= ~~ =~-== ~= -- _`=--_=-- _= survive me by thirty days. SECOND: Residue. I give the residue of my estate to my husband, Robert, if he survives me by thirty days; if not, to such of my descen- dants as survive me by thirty days, per stirpes; and in default of such descendants, in equal shares, to Raymond Matkovich, Anthony Matkovich, Marilyn Bunting and Walter Peterson, per stirpes. THIRD: Spendthrift Provision. Until distributed, no gift or beneficial interest shall be subject to anticipation or to voluntary or involuntary alienation. FOURTH: Death Taxes. All death taxes (and interest and penalties thereon) imposed upon any property passing under my Will and upon proceeds of insurance on my life, but not otherwise, shall be paid out of my residuary estate. --- -- -- --- ~-e : o-~ers. ___~~::~cr shall have the following powers in addition __ _~._-- ~..-.~erred by law until all property is distributed: (a) To retain any real or personal property in the form received and to sell it at public or private sale. (b) To manage real estate. (c) To purchase all forms of property without being confined to so-called legal investments and without retard for the principle of diversification. (d} To exercise any optic:. o-r _- _~_ ~rcm ownership of investments. - (e) To compromise claims without order of court or consent of any legatee. (f) To distribute in cash or in kind. (g) To join with my said husband or his personal representative in filing any joint income tax return, and to join in any gifts made by him for gift tax purposed even if this may result in additional liabilities for my estate. Any income or gift taxes due on such returns and any deficiencies, interest, penalties or refunds thereon shall be allocated between my estate and my said husband or his estate, or all to any of them, in such mannner as my Executor and my said husband or his personal representative may agree. (h) To employ accountants, agents, in- vestment counsel, brokers, bank or trust company to perform services for and at the expense of my estate and to carry or -__-~___ ,:,vestments in the name of the nominee of such agent, _=_ _=- ___-_ .,_ gust company. The expenses and charges for such _-~=_e= stay_ be charged against principal or income or partly -_ _..-~ each as my Executor may determine. My Executor is ex- Uressly relieved of any liability or responsibility whatsoever for any act or failure to act by, or for following and advice of, such accountants, agents, investment counsel, brokers, bank or trust company, so long as my Executor exercises due care in their selection. The fact that an Executor may be a member, shareholder or employee of any accounting, investment or brokerage firm, agent, or bank or trust company so employed shall not be deemed a conflict of interest. Any compensation paid pursuant to this subparagraph shall not affect in any manner the amount of or the right of my Executor to receive commissions as a fiduciary. -2- (i) With respect to the interest vesting _- a beneficiary who is a minor or who, in the opinion of my :~:ecutor, is otherwise incapacitated by reason of age or illness .ental or physical) when such interest vests in him or her: to :_~ld the interest during his or her incapacity and to invest the -terest and all accumulations thereon; to apply so much of the ::come and principal as my Executor deems advisable for such ~e-:eficiary's benefit for any reason without considering other =-.:=ids available to him or her; and to deliver the balance of -:incipal and income to the beneficiary at such time as he or she _~ins capacity. In addition, at any time to pay the entire interest _~ `::e surviving parent of the minor as natural guardian or to the _~~_~:~~ ~` the person or the estate of the minor or incapacitated ---___~ _ ~_ ~~_d for his or her benefit. The receipt of a -~..-- _- _ a_.:.a.. ~_ such other person as .;;a- oe selected b°_: _ _- - _ _: _ __ __ -ss~_-: ~ a d~,.tribution under this sub_ araJrap-_ .. -a-- __ ~ _~_= a:~d complete discharge to my Executor. SIXTH: Definitions. (a) The words "Executor" and "Guardian" :: en used herein shall include all genders and the singular and Aural as the context may require. (b) When distributing residue to my descendants "per stirpes" under this Wi11, such residue shall be divided into as many equal shares as there are children of ~;ine then living and such children then deceased represented by ~~=ce^:dants then living, and each then living child shall receive - . . - __ . ~..~ ____ _ .are or each deceased child shall be divided _. _-_ :-__~ __ ._~_ ~___~.~ :dints in the same manner, repeating this -a.,~=ra ~tiith respect to succeeding generations until all shares are determined. (c) Paragraph headings in this Will are for reference only and shall not affect the meaning, construction or effect of this Will. -3- I appoint my husband, Robert J. Matkovich, Executor. If my said husband fails to qualify or ceases to act for any reason, I appoint my daughters, Eileen Matkovich and Beth Ann Matkovich, Executors in his place. My Executor shall not be required to post security in any jurisdiction. Executed 1989. SEAL) SIGNED by Kathleen Matkovich as her Will, in our presence, who at her request, in her presence and in the presence of each other have signed as witnesses: ~~ ,~~ Address !~~-,~~~.~ - ~-%"~'`'~ 4 G'-.~ ~ ~~a _~ r ^ n n ~ t?,~ ~ , o ,~U ~ ~ ~~° ~ Address ~ ~~ ~ r ~j;,~.;. n ~ i`JGSS -4- " -- Of ~~i -' - - - -'- -- ~ : I, Kathleen Matkovich testatrix, whose name is signed on the _--..::=ed or foregoing instrument, having been duly qualified according to law, __ -.__eby acknowledce that I signed and executed the instruZnent as my last Will _-~ =estament; and that I signed it willingly; and that I signed it as my free _-.~ voluntary act for the purposes therein expressed. ~~~ 1C v~ ( ;- ~ R?YtOd~ J. 2ESiaG'3 P~~~l° ~-UtS~ if AFFIDAVIT tiff r~i . ~,~ E ~~t{ ~ t~L~' ~ . ' .9' ,.~---c:::cealth of Pennsylvania ., ~:: ,, , We, the undersigned, the witnesses whose names are signed to the a~tached or foregoing instrument, being duly qualified according to law, do devose and say that we were present and saw testatrix sign and execute the r.stru*rent as her last Will and Testament; that she signed willingly and that s~':e executed it as her free and voluntary act for the purposes therein expressed; tam eac:, of us in the hearing and sight of the testatrix signed the said Will - .: `-esses; and that to the best of our knowledge the testatrix was at that -.-_~__ =: ..:^re .-ears of age, of sound mind and under no constraint or undue - --- -- - ,._ ~ _, ,, - ~'1 ,~ :~ '~ ' S~o~:: or a~firmed to ar: subscribed to before me by and ' witnesses, this ~ day of ~ ~--'` 198 9 . ~ /,,-r,""~ ,f ~ ,. Notar,~ Publ~ ,/ ;/ r J'v~ s?E'3" '~, - - - ~ t r t~.", n r S i ;; E~ ~ __ ._