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Home My WebLink About04-27-12--~ REV-1500 Ex (o1-'°' 1505610143 PA De artment of Revenue ~ OFFICIAL USE ONLY P Pennsylvania County Code Year File Number Bureau of Individual Taxes DEPARTMENT OF REVENUE Po Box.zsoso~ INHERITANCE TAX RETURN 2 1 11 0 7 7 9 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth O1 03 2011 04 17°1946 Decedent's Last Name Suffix Decedent's First Name MI POLLAK JEFFREY D (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW ® 1. Original Retum ^ 4. Limited Estate ^ 8 Decedent Dietl Testate (Attach Copy of Wilq ^ 9. Litigation Proceeds Received THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS ^ 2. Supplemental Retum ^ 4a. Future Interest Compromise (date of death after 12-12-82) ^ ], Decedent Maintained a Living Trust (Attach Copy of Trust) ^ 1 D Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 0 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) I:vKKtSPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number CRAIG A DIEHL ESQUIRE CPA 717 763 7613 First line of address 3464 TRINDLE ROAD Second line of address City or Post Office CAMP HILL State ZIP Code PA 1701144 REGISTER OF WILLS USE ONLY ~ ,-,.. y O r~, ~~ - ;7.~ r~ r- --rn rU G ~7 r J ~ ` DATE Firt ~~ - - ~~ --,-; - =, o ,~._ -~ - --- v ~~ ~~%~ ~~ -T7 Correspondent's a-mail address: C d 1 e h I a~ C a d i e h I l a W. C O m ~' Under penalties of perjury, I declare that 1 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 otherthan the personal representative Is based on all information of which preparer has any knowledge. SIGN~ATURnE OF PERSON RESPO LE FOR FILING RETURN DATE ~~=~`]!7~ ~ Q. A_ COQ c~ ~ JoAnne M Pollak s -~~ _ l a annavcc 5020 East Trindle Road, Mechanicsburg, PA 17050 .,w~^vn rrRCYNRCKw~nEK~KAN REPRESENTATIVE ' Craig A Diehl Esquire CPA ADDRESS 3464 Trfndle Road, Camp Hill, PA 170114436 Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX oeceaenes Name: P O L L A K, JEFFREY D. 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. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... g, 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 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. 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. 16. Amount of Line 14 taxable at lineal rate X .045 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. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 Decedent's Social Security Number 388.00 388.00 1,087.09 1,087.09 -699.09 -699.09 0.00 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - 11 - 0779 D N M Pollak, Jeffrey D. STREET ADDRESS 5020 East Trindle Road cITY ' STATE ZIP Mechanicsburg PA 17050 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 0.0 0 2. Credits/Payments A• Prior Payments B. Discount Total Credits (A + 13) (2) 0.00 3. Interest (3) 0.00 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) Q . 0 0 ,' Make Check Payable to: REGISTER OF WII,.~LLS, AGENT. ,~y ~} ,..~ ~ . kwi- +._ .. _, ~'.nt: isr;{~ ~ ~~ ~ ~t.o~. x ~.~'i~~ a.. ~'~'.~~~I~~ ~'~A%9~~i ..~~ ~9..5,a~ in'~.» ~~7Y[.~a ~ ~:...C:j. ~ ~ ~... 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 :.............................. ^ .. .................................................. x b. retain the right to designate who shall use the property transferred or its income :.................................... c. retain a reversionary interest; or .................................................................................................................. ~ ^ d. receive the promise for life of either payments, benefits or care? ................. . . ........................................... x . If death occurred after December 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?......... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................... ^ ^ ...................................................................... . . ........................ F 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 Jean 1, 1995', theme tax rate imposed on the net~val~ u~ a 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 Januarryy 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 retfurn 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)]. • sibling is definedounder Sectiont9102, as an individual whothas at least one padrent in c~olmmon withPh decedent wfiether by ti ood oAadoption. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMNK)NWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Pollak, Jeffrey D. FILE NUMBER 21 - 11 - 0779 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Pinnacle Health -Refund from Medical Services 204.00 2 Pinnacle Health -Refund from Medical Services 184.00 TOTAL (Also enter on Line 5, Recapitulation) 388.00 COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT SCI-EDIR.E H wFI~AV~ErR~A~L D~~FTJVSES & f'~{.JIY~~ 1 1W I IVC ESTATE OF Pollak, Jeffrey D. FILE NUMBER 21 - 11 - 0779 Debts of decedent must be reported on Schedule I. ITEM NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT A. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal-Representative(s) Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Law Offices of Craig A. Diehl 3. 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 4. Probate Fees Register of Wills, Cumberland County 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 Law Offices of Craig A. Diehl - Reminbursement for Certified Mail Cost for DPW Letter 1, 000.00 81.50 5.59 TOTAL (Also enter on line 9, Recapitulation) 1,087.09 REV-1517 EX+ (11-OS) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES CJIAIC VI' Pollak, Jeffrey D. 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 JoAnne M. Pollak 5020 East Trindle Road Mechanicsburg, PA 17050 2 Ghia (Pollak) Wittfin 1130 Fernwood Avenue Camp Hill, PA 17011 3 Aja Laurie Pollak 920 South 12th Street Philadelphia, PA 19147 RELATIONSHIP TO DECEDENT Do Not List Trusteelsl ~ Spouse Daughter Daughter FILE NUMBER 21 - 11 - 0779 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) First $30,000 plus 50% of residue 1/5 of 50% of residue after first $30,000 1/5 of 50% of residue after first $30,000 Enter dollar amounts for distributions shown above on lines 15 throu h 18 on Rev 1500 coverlsheet, as a ro Hate. 9 PP P II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 0.00 0.00 0.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 REV-1573 EX+ (9-0°) SCHEDULE J COM NOHERITANCETAXRETURNANIA BENEFICIARIES continued RESIDENT DECEDENT ESTATE OF Pollak, Jeffrey D. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I, TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)j 4 Jenna Rachael Pollak 5020 East Trindle Road Mechanicsburg, PA 17050 5 Robbi Olivia Pollak 5020 East Trindle Road Mechanicsburg, PA 17050 6 Andrew Charles Pollak 1919 North Uber Street Philadelphia, PA 19120 RELATIONSHIP TO DECEDENT Do Not Llst trustee(s) Daughter Daughter Son FILE NUMBER 21 - 11 - 0779 SHARE OF ESTATE AMOUNT OF ESTATE (Words) (gg$) 1/5 of 50% of residue after first $30, 000 1/5 of 50% of residue after first $30, 000 1/5 of 50% of residue after first $30,000 0.00 0.00 0.00 Page 2 of Schedule J Law Offices of Craig A. Diehl 3464 Trindle Road Camp Hill, Pennsylvania 17011 Telephone (717) 763-7613 Fax (717)763-8293 www.cadiehllaw.com Craig A. Diehl, Esquire, CPA Thomas L. McGlaughlin, Esquire Ryan P. Mellinger, Esquire Apri125, 2012 In Spring Grove, Pennsylvania 119A West Hanover Street Spring Grove, PA 17362 Telephone: (717)225-1929 Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 RE: Estate of Jeffrey D. Pollak Estate No. 21 11 0779 Dear Ms. Strasbaugh: Enclosed for filing please find the following: 1. Original and two (2) copies of the Inheritance Tax Return REV-1500; and 2. Check in the amount of $15.00 for filing of the Inheritance Tax Return. Please time-stamp and return the copies of the Inheritance Tax Return in the enclosed self-addressed envelope. Should you have any questions, please feel free to contact me. Sincerely, ~' ~~~ Craig A. Diehl, Esquire, CPA CAD/daf Enclosures ~~ n .--~ ~~ `- ~ ,,-_ c~ , ._~ C: _.~~ ~--, ,_; ,, _ - ;._. r --- ~ n `rC ra ,-~s ~, '~ E ,I I~ ~;, ~~ s ±'~ ~ a k~ ~'~ ~~~ ,~ ,~ ~ F k ,~ , i x W Q ~ m d M ~ ~ ~ _ ~ ~ a o W v ~ ~ M ~ U Q w c~ ~ .~ ~ "O n ~ ~ a ~ -~ + ~ c I~ + ~ ~ ~ ~ W ~ ~ U O ~ ¢ wM~ w P -~ ~ob~ O ~' v~~°a ~+, ~ o ~ b u,~U•~ Q ~ ~ ~ ~ v ~ e ~ ~ c b c7 c~ 0 H