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HomeMy WebLinkAbout07-20-12J 1505610101 REV-1500 Ext01.1°' ~` PA Department of Revenue pennsylvarria Bureau of Individual Taxes ~""p'~E~.o. INHERITANCE TAX RETURN PO BOX 280601 Harrisburg, PA 1128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Securit Numb OFFICIAL USE ONLY County Code Year File Number a y er Date of Death MMDDYYYY Date of Birth MMDDYYYY e .._,{ Decedents Last Name Suffix Decedent's First Name ~ MI ...:. x (If Applicable) Enter Surviving Spouse's Information Below M ~. Spouse's Last Name Suffix Spouse's First Name MI ~~ i ~/ ~ e`~ ~;s~yL yr ~ ~ i . .~ fl _a Spouse ti Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ® 1. Original Return p 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate p 4a. Future Interest Compromise (date of p 5. Federal Estate Tax Return Required death after 12-12-82) ~ 6. Decedent Died Testate (Attach Copy of Will) O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (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 B E COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number C , h' ~¢ , 2 ~ F ~ ~°~;~ „ < . ~ ..,. ,~ First line of address ~ C L O l~ s ~~ c2 0 ~,~ Second line of address ` ' ~~/ /~ City or Post Office State ZIP r 1~ ~~ ~r.~ ~=;-:r --, ~`i'7 --n .~..~ ~u~ . l 7 0 '.SS' Correspondent's a-mail address: G~e.S/~(~SV ~! CD/yJ ~QS/,/Jet 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 preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAT~~E OF~~ERSON RESrP~ONSISC^ OR FILING RETI~RN DATE YLl/!i¢ ~P, ihiNic,/~ X7/8 ~/uir,6•ir .4ve., p ~/,ii, P,~ ~7ni~ THAN ~SENU IyE / DATE nUURCJJ ~,~~ ~ ~rE2l~s ~ ~~~. 6 C/ouser 6?~4~ ~echQn~es6 rte, ~/>t /7os~- PLEASE USE ORIGINAL FORM ONLY L 15056101D1 Side 1 1505610101 J ~~ J REV-1500 EX 1505610105 Decedent's Name: ~EiTN ~. //!~/V~!/~ 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 and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ....... 6. 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. 9. Funeral Expenses and Administrative Costs (Schedule H) ................... 9. Decedent's Social Security Number •D4 •Cp .ao ~ Fi' _ ~ ,oD • ~ 8~ ~7p.+p0 ~~ ~~ D.ca S.oo 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .............. 10. Of O 11. Total Deductions (total Lines 9 and 10) ................................. 11. / ~• ~ ~ ,. 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. ~ ~ ~' S ,5 D D .,, 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which D . QO an election to tax has not been made (Schedule J) ........................ 13. L~ 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 p~ ,cam ~ 16. Amount of Line 14 taxable . O O at lineal rate X .0~ 17. Amount of Line 14 taxable d O at sibling rate X .12 18. Amount of Line 14 taxable ~~ ~ ~ at collateral rate X .15 15. 16. 17. 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ,~ p~0 ~.D~O s ~ O ,ADD ~~ O Side 2 1505610105 1505610105 REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME _ ~Dt~~ ~_ ~~yie ~ STREET ADDRESS ---- ------ ciTY -- - Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments O A. Prior Payments __. B. Discount O 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. STATE ~d Total Credits (A + B) (2) (3) (4) (5) ~~-~z zIP ~ 7D// D O D D 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 income of the properly transferred :.......................... 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? ................................................................ ...... ^ 0 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? ........ ...... ^ 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)j. • 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. REW-1510 EX • (191) COMMONWEALTH 01= PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS 8 MISC. NON-PROBATE PROPERTY FILE NUMBER ?~~- /Z This schedule must be completed and filed if the answer to any of questions t through 4 on the reverse side of the REV-1500 COVER SHEET is vPc DESCRfPTION OF PROPERTY ITEM NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIPTO DECEDENT AND THE DATE OF TRANSFER ATTACH A CDPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE VALUE VALUE OF ASSET INTEREST IFAPPLICABLE ~. ~R~ /1~'t'o,rlgf' -~i~k `~i SG1ef~-Trtde off' , ~ f6 3S /Yi ti Porn ~e T3"/rc~ , ,Sfe ~3 6 Na,rr~ s ,r y, ,4~4 i 9i~ i- ~~ o ~GAG~'ua ~5 S/wNSe~' sy~r~~r 11. /yl:r,~c,~ ~8'y ~7D. ~p /oo~n _o _ ~ SI g7a ma TOTAL (Also enter on line 7 Recapitulation) I S ~ 9 8 '7D, 00 (If more space Is needed, insert addltlonal sheets of the same size) REV-1511 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES ~ ADMINISTRATIVE COSTS ESTATE OF /~iNicK, D~~ n~ k. Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1. B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address FILE NUMBER 21-iz ~. AMOUNT City Year(s) Commission Paid: State Zip 2. Attorney Fees C~ R r/GS ~ ,Sh ~,Gl ~S ~~ LCrI p~/~/yt i/1Ga+{ 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant _ /~/ PiP.pB~TE AsSE75_f~jQp/1~ lt/ ~-~ T Ay~g.~' /brJ.~lE Street Address ~Ny /~ - --- City State Zip __ ____ _ __ Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees Cr~cdon fin man ls-ne~na half ~ Ce., >~ 8. Tax Return Preparer's Fees m~han. Csbur~ - u,„ae{Lrr~,„~1 ~~; ~ TOTAL (Also enter on line 9 Recapitulation) I $ /s DIr7 (If more space is needed, insert additional sheets of the same size) REV-1573 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF DE~`/ /YI/N/CK, /~ K. 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 ~ 5 yc.vi~- Q. MINI CK a7/B Coy-am~~ ~4r~~ C~FMp NIcL. ~ J~al/ FILE NUMBER ~-i.~ - RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE SPousC 1000 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF DEAN K. MINICK I, DEAN K. MINICK of the Borough of Camp Hill, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I. I direct the payment of all my just debts and funeral expenses out of my estate as soon as may be practical after my death. II. I devise and bequeath all of my estate of whatever nature and wherever situate unto my wife, SYLVIA R. MIlVICK, provided that she survives me by sixty (60) days. III. Should my said wife fail to be living on the sixty-first (61S`) day following my death, then I devise and bequeath all the rest, residue and remainder of my estate in the following manner: A. The residue of my estate shall be divided equally among my four daughters, SYLVIA M. KELLER, ANDREA MIlVICK-RUDOLPH, CYNTHIA M. HURRAY and TAMARA 1vIIVICK-S.COKALO, the share of a deceased daughter to SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEYS•AT•IA W 2109 Market Street Camp Hill, PA be paid to her issue, per stirpes. B. In making distribution of my articles of personal or household use, including family heirlooms, I direct that my Executrices shall develop an equitable method to distribute said items among my four daughters so that they are charged the fair value of said items against their individual shazes of the residue. Any items not selected by my daughters shall be sold at public or private sale and the proceeds distributed with the balance of the residue of my estate. IV. I authorize my Executrices: A. To retain any investments I own at my death and to invest in all forms of real and personal property, without being confined to investments authorized by a statutory list, without being required to diversify and regardless of any principle of law limiting delegation of investment responsibility by executors; B. To join in any merger, reorganization, voting-trust plan or other concerted action of security holders, and to delegate discretionary duties with respect thereto; C. To make loans to, and to buy property from, my wife's executor or SAIDIS SNUFF, FLOWER & LINDSAY ATTQRNEYS•AT•lAW 2109 Market Street Camp Hill, PA administrator; D. To employ and to rely upon advice given by investment counsel, to delegate discretionary authority to make changes in investments to investment counsel, and to pay investment counsel reasonable compensation in addition to any fees otherwise payable to my executors; E. To employ a custodian, to hold property unregistered or in the name of a nominee (including the nominee of any institution employed as custodian), and to pay reasonable compensation to the custodian in addition to any fees otherwise payable to my executors; F. To distribute in cash or in kind; G. To exercise all elections which they may have with respect to income, 2 gift, estate, inheritance and other taxes, including without limitation, execution of joint income tax returns, election to deduct expenses in computing one tax or another, election to split gifts and election to pay or to defer payment of any tax in all events without their being bound to require contribution from any other person. H. My executors may join with my spouse or her personal representative in a joint income tax return covering any period of time for which an income tax return has not been filed up to the time of my death or any gift tax return on gifts made by my spouse prior to my death for which a gift tax return has not been filed and in conjunction therewith, to determine what taxes, interest and penalties are proper and to pay the same, even though such payment may result in additional liability to my estate. These authorities shall extend to all property at any time held by my executors and shall continue in full force until the actual distribution of all such property, except- as otherwise specifically stated. All powers, authorities, and discretion granted by this will shall be in addition to those granted by law and shall be exercisable without court authorization . V. I appoint SYLVIA M. KELLER and ANDREA MIlVICK-RUDOLPH, Executrices of this, my Last Will and Testament. Neither of my personal representatives shall be required to post bond in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the SAIDIS SHUFF, FLOWER & LINDSAY ATTONNEYS•AT•lAW 2109 Market Street Camp Nill, PA 2 / day of ~ /~ L y , 2003. f' ~~ ,~~SEAL) D 1~I K. MINICK 3 Signed, sealed, published and declazed by DEAN K. MINICK herein named, on this and four (4) other sheets of paper as and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEYS•AT•LA W 2109 Market Slree[ Camp Hill, PA ~ ~~ ~ ~ ~' Name Address Name Ad ess COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND WE, the undersigned, the Testator and the witnesses, respectively, whose names aze signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he signed willingly (or willingly directed another to sign for him), and that he executed it as his free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator signed the will as witnesses and that to the best of their knowledge the Testator was at that time eighteen years of age or older, of sound mind, and under no constrain or undue influence. .. _ DEAN K. MINICK, estator _ ~~ Witnes Witness Subscribed, sworn to and acknowledged before me by the Testator, and subscribed and sworn to before me by both witnesses, this -~ of , 2003. Notary Public Notarial Notary Public $g{lie Ailshouse. 4 Cartiste goro. Cur~:~adaruf Count 1 ion E~pues Mar. 29. 2 - My Commis w ~ Q~ ~ ~. ~~_ r~ ::_ ~ ~" 7 J . C1 , C~1...~. N t ` ' ,~~ ll ~ ' ~ N V ~ ~ ~ - ~ ~ d (O W ~ Q N r - s oo a ~ O ~ ~ N o '- W ~ -o ~ ~ W -o t~ _~.. Li ~ N .~i~ ~ /~ V • ~ ~ N ~ ~ Q ~ J O ~ N U W ~ C's ~,;~~'~ Q N m ~ ~ M ~z~M J~~ r ~ H p(j U ~ -~ Q W p =_ O) ~ tE a ~ i~ ~ ~ ~ ~ (n r ~ ~ ~ ~ QaQa ~~ = ~ ~ _I = W A Q ~m~-~. a ~ ~ ~~oo~ W ~ U Q ~ wow = =gym O ~ ~ U w W fn Z Q _ = O ~ W U m ~ ~