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Home My WebLink About07-27-121505611185 REV-1500 EX (02-11)(FI) PA Department of Revenue Bureau of Individual Taxes Po Box 2soso~ INHERITANCE TAX RETURN Harrisburg, PA 171213-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYV Date of Birth 207-34-6661 11072011 Decedent's Last Name Suffix HUDAK (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's Social Security Number OFFICIAL USE ONLY County Code Year File Number 21 12 0156 M M DDYYYY 08011921 Decedent's First Name M I DOLORES LORRAINE Spouse's First Name M I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRUITE BOXES BELOW ® 1. Original Return ^ 4. Limited Estate ^ 6. Decedent Died Testate (Attach Copy of Will) ^ 9. Litigation Proceeds Received ^ ^ ^ ^ 2. Supplemental Return 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust.) 10. Spousal Poverty Credit (Date of Death Between 12-31-91 and 1-1-95) ^ 3. Remainder Return (Date of Death Prior to 12-13-82) ^ 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ^ 11. Election to Tax under Sec. 9113(A) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number DAVID A• JONES, ESQU IRE 717-846-~00 REGISTER 0 - S USE O~ - ~ ~~ C r'ri t _. ~~,~ f.-. ~ First Line of Address ; p ~J ZCIi= 221 W • PHILADELPHIA ST • c~~~` :. -t~ Second Line of Address ~.`y D N SUITE E600 cn or Post Office Cit State ZIP Code DATE FILED """' y YORK PA 17401 Correspondent's a-mail address: Under pen ies 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, c r ct a d comp) Declaration of preparer other than the personal representative is based on all infonnation of which preparer has any knowledge. SIGNATU E F O RE PONSIB~FOR FILING RETURN ATE y- ~ ~-r-~C-r~0..d'~r ~-1. ~a-5 ~ 1~-- 221 IIC• PHILADELPHIA ST SIGNATURE OF PREPARER OTHER THAN REPI STOCK AND LEADER BY: ADDRESS 221 W• PHILADELPHIA ST• 1505611185 STE E6 YORK, PA 17401 .NT TIE _ ~l d 1°G1/., L iLS~i r;4/yY STE E60p YORK, PA 17401 _~ 7 C:~ L7 r"1"I LEASE USE' ORIGINAL FORM ONLY Side 1 OM4647 3.000 15 0 5 61118 5 1505611285 REV-1500 EX (FI) Decedent's Social Security Number 207-34-6661 Decedent's Name: HUDAK DOLoRFC LORRATNE RECAPITULATION 1. Real Estate (Schedule A) 1 O • 0 0 2. Stocks and Bonds (Schedule B) . 2 0 • 0 O 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3 O • O 0 4. Mortgages and Notes Receivable (Schedule D) 4 0 • O 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. O • O O 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested g. 2 O , 7 2 5.81 7. Inter-Vivos Transfers & Miscellaneous Non- Probate Property (Schedule G) ~ Separate Billing Requested 7. 4 7 , o 0 0 • 0 0 8. Total Gross Assets (total Lines 1 through 7) 8 6 7 , 7 2 5.81 9. Funeral Expenses and Administrative Costs (Schedule H). g. 11, 2 6 4 •4 2 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) 10 4 , 015.3 9 11. Total Deductions (total Lines 9 and 10) , _ 11 15 , 2 7 9.81 12. Net Value of Estate (Line 8 minus Line 11) 12, 5 2 , 4 4 6 •0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , _ . 13 O • 0 O 14. Net Value Subject to Tax (Line 12 minus Line 13) 14 5 2 , 4 4 6.0 0 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a)(1.z) x .o - 0.0 0 15. 0.0 0 16. Amount of Line 14 xable at linealratex o 4~ . 52,446.00 1s. 2,360.07 17. Amount of Line 14 taxable at sibling rate X .12 O.O O 17. 0.O O 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 0.O O 19. TAX DUE 19. 2 , 3 6 0.0 7 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT X^ 1505611285 Side 2 1505611285 OM4648 3.000 REV-1500 EX (FI) Page 3 Decedent's Complete Address: File Number DECEDENTS NAME H A O R O R STREET ADDRESS AN C TY CITY M CH R STATE PA ZIP 7 - Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 2, 2 4 2. 0 7 B. Discount 118.0 0 3. Interest (1> 2,360.07 Total Credits (A + B) (2> 2 , 3 6 0.0 7 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (3) 0.00 (a) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0 • 0 0 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 property transferred ^ 0 b. retain the right to designate who shall use the property transferred or its income ^ 0 c. retain a reversionary interest ^ 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? . 0 ^ 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. 89116 (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(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. OM4671 2.000 REV-1509 EX+(01-10) pennsylvania DEPARTMEN70F REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY OWNED PROPERTY ESTATE OF: FILE NUMBER: Dolores Lorraine Hudak ff an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURV NtJG JOINT' TBJANi(S) NANE(S) ADDRESS R~,4TIONSHIP TO DECEDETTT A Jones, Susaa P PO Box 65, Newport, PA 17074 Daughter B Miller, Cynthia M Daughter JOINTLY OWNED PROPERTY: ~~ NLIIvBER LETTER FOR JOINT TENANT DATE MODE JOINT DESCRIPTION OF PROP92TY INCLUDE NAM: OF FINANCIAL INSTIT UTION ANp BANK ACCWNT NVM7ER OR SIMLAR IDENTIFYING NUMIE R. ATTACH DEED FOR JOINT LY HELD 0.EAL ESTAT E. DATE OF DEATH VALUE OF ASSET % OF DECEDENT'S INTStEST DOTE OF DEATH VALUE OF DECEDF3JT'S INTEREST 1 A M&T Bank, checking account no. 98231650; joint with Susan P. Jones, daughter 18,232.48 50.0000 9,116.24 2 A M&T Bank, savings account no. 44563345; joint with Susan P. Jones, daughter 7,595.76 50.0000 3,797.88 3 B 1/28/2008 Sovereign Bank, certificat of deposit no. 0765140785; joint with Cynthia M. Miller, daughter 15,520.51 50.0000 7,760.25 Interest accrued to 11/7/2011 8.27 50.0000 4.14 4 B 8/1/1986 50 Par United States Savings Bond, Series EE; joint with Cynthia M. Miller, daughte 94.60 50.0000 47.30 TOTAL (Also enter on Line 6, Recapitulation) S 2 0 , 7 2 5.81 swasAE 2.00o If more space is needed, use additional sheets of paper of the same size. REV-1510 EX + (OS-09) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTA' SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY Dolores Lorraine Hudak This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBE DESCRIPTION OF PROPERTY II~CLI.DETFEI~NMEOFTFETRANSFEREE,TFEIRRELATIONSHPTODECEDEMAPD 7FE D4iEOF7R/NSFFR. ATTACHACOPY OF TFE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE 1~ Cash gift to Susan P. Jones, daughter, dated 11/23/2010 50,000.00 100.0000 3,000.00 47,000.00 TOTAL (Also enter on line 7, Recapitulation) $ 47,000.00 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+ (10.09) Pennsylvania DEPARTMENTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER D9lores Lorraine Hudak Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~. Neill Fuaeral Home funeral expense 10,614.42 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City Year(s) Commission Paid: State ZIP 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant 4. 5. 6. 7. 1 2 Street Address City State ZIP Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Return Preparer Fees: Stock and Leader photocopies and postage Register of Wills 625.00 10.00 15.00 TOTAL (Also enter on Line 9 Recapitulation) ~ $ 11, 2 64 42 swasnc z.ooo If more space is needed, use additional sheets of paper of the same size. REV-1512 EX + (12-08) pennsylvania SCHEDULE I DEPARTN~NTOF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES Dc LIENS RFCIfIFM' f1F!`FIIFNT ESTATE OF Dolores Lorraiae Hudak FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. BW46AH 2.000 If more space is needed, insert additional sheets of the same size. REV-1513 EX+(01-10) SCHEDULE J Pennsylvania DEPARTMENTOF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT Dolores Lorraine Hudak FILE NUMBER: RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Susan P. Jones PO Box 65 Newport, PA 17074 Cash gift to Susan P. Jones, daughter, dated 11/23/2010 Inventory Value: 47,000.00 M&T Bank, checking account no. 98231650; joint with Susan P. Jones, daughter Inventory Value: 9,116.24 M&T Bank, saviags account no. 44563345; joint with Susan P. Jones, daughter Inventory Value: 3,797.88 Less: Debts and Expenses paid in the amount of $15,279.81 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. [I NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. S 0 . 0 0 It more space is neeaea, use aaaltlonal sneers of paper of the same size. 9 W 46AI 2.000 Estate of: Dolores Lorraine Hudak Schedule J Part 1 (Page 2) Item No. Description Relation Amount 1 Daughter 2 Cynthia M. Miller Sovereign Bank, certificate of deposit no. 0765140785; joint with Cynthia M. Miller, daughter Inventory Value: 7,760.25 Accrued: 4.14 Daughter 44,634.31 50 Par United States Savings Bond, Series EE; joint with Cynthia M. Miller, daughter Inventory Value: 47.30 Daughter 7,811.69 r `~711J~~~L~Gt~JP~1\ ATTORN eYH AT LAW $TOac ANO LeAD~t LLP JOHN J. SxoxE MKT.tsm W. KING Tn.torm P. RUTH Wn.uAM T. Harr THOMAS M.SHORe RONALD L. HeRSrEVme JANE H. SCH[rssLme WALTHt A. Tn t Rv III STEVEN M. Hovs JoDY ANOERSOx LE[cHM Prm.rP H. SPARE NEE, A. SLENKER DAVro A. JONES, II JAMES E. CHIARUTCIN['F ALExANDRA C. CHIARUTI7PE 'A450 ADM177'ED IN MARYLAND Direct Dial (717) 849-4118 Register of Wills Cumberland County 1 Courthouse Square Carlisle, PA 17013 SUSQUEHANNA COMMRRCB CHNTER EAST 221 W. PH[unHLPHIA STREET-Burrs 600 YORK, PENNSYWANIA 17401-2994 PHONE (717) 846-9800 FAx (717) 843-6134 www.stockandleader.com July 25, 2012 Re: Estate of Dolores L. Hudak File no. 21-12-0156 Dear Register: "'i7 cn Enclosed for filing is the inheritance tax return in duplicate for the above-referenced estate. Please file the returns, time-stamp the file copy, and return in the envelope provided. Should you require additional information or documentation, please do not hesitate to contact me. Very truly yours, STOCK AND LEADER i ,~~. ~~ ~ n,~ ~,~ G J nnifer M. oung Paralegal STaQC AND LBADBIt, A FROPE6IONAL CORPORATION HENRY B. LeAOER J. Rom McGEaNs RAYMOND L. Hovs BYRON H. LeCATES D. Reed ANDERSON wE.llAM c. Gn~ASCtr, JR. W. BRUCB WALLACE STEPti@I S. RUS6E[.L CRAG W. BREMBR BROOKe E. D. SAY RACHe[, A. CLANCY PATwIX J. FAZE JePPREY C. BRtGHr MncGRECOR J. BR¢LHAta GARETH D. PAHOwxA GREGORY W BAUt, II MCCLEAN STO« (1881-1962) BASE. A. SHatE Oslo-lsss) ~.., ~~ ~ ~~ ~ m `. r [~- ~ r-, F' `~= •~ N .~ U? -J ~.. ~~w O ~1 -a.-_, D mom"` - -~: ~,r- `. r f=; ; -;, ~--~ in ~- c~ Enclosures o~ ~ ~~ m~ r~ ~C~~U ~~~~ in e, rn ti v M (S~ ~a ,® ~ a ~~ ~~'ta#INR v `c~~ '~ ~~ ~ Q ~. Ca: i ~ (~ t ~ C~l_' ^ N ;; ~? c N c, ~~ c-,r R 3 a a ~. c F F Q I1~~~ ~~~~~ w x~ ~~¢~ aHxo azo~~ H~ V]~ 3 O U W ~ w cn a 0~1~ Z O x~xw walla E-~ rx x cn C/]W~H ~-,aaoa C7~U~ W ~ ~ G~ U ~ U