HomeMy WebLinkAbout10-04-12~r>._:.
J REV-1500 Ex,°''°' 1505610143
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania Counq cone veer Fila Number
Bureau of Individual Taxes eeo^^*~~*~r ee~ea~e
PO BDX.2S0601 INHERITANCE TAX RETURN 2 1 1 1 0 1 1 0 3
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
09 28 2011 OS 27 1926
Decedent's Last Name Suffix Decedent's First Narne MI
GARDOSIR ELIZABETH M
(lf Applicable) Enter Survlving 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 Retum ^ 3. Remainder Re[urn (date of death
poor to 12-13-82)
^ 4. Limited Estate ^ qy. Future Interest Compmmiee ^ 5. Federal Estate Tax Return Required
iaate er seam attar 12-12-ezl
0
® g Deceaem Died Testate ® ~ Demaem Maimemed a living Tw! s. Total Number of Safe Deposit Boxes
(Attach Copy or WIII) (Altech Copy of Truet)
^ 9. Litigation Proceeds Received ^ 10 Spousal PoveM Credit (tlete ar tlaem ^ f t, Election to tax under Sec. 9113(A)
1
'
between 12-31-91 ena
-1-95) (Atlach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL'rAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GREGORY M KERWIN 717 362 3215
rte,
REGISTER OF W ~1SE ONL'Y~ ~-
r
O
~
n
First line of address ~ 1
~
f^-~
4245 STATE ROUTE 209 pu'?'~ •c' ~'~
-17 r
~
C7 O `--; _p r-~ ~
'
Second line of address n
~~j °r
DATE FILED Q q
'
City or Post Office State ZIP Code '9
rt
ELIZABETHVILLE PA 17023
correspondents a-mail address: 9 m k e rw i n@ h of m a i l. c o m
Under penalties of perjury. I tleclare that I have examinetl this return, inclutling accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, wrrect antl complete. ObGaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF P RSON RESPON E FOR FIL G RETURN DAT
y[ ~~ 7 • ' Andrew T. Gardosik / o% ~ 2-
ADDRES~~~-T
88 arbob Road, Halifa , P 17032
SIG U O PR A ROTHER TH PRESENTATIVE
- ~ - Gregory M Kerwin AT
~~~,~
A DRESS
4245 fate oute 208, Elizabethville, PA 17023
Side 1
L 1505610143 :6505610143 J~.
1505610243
REV-1500 EX
o~danrs Neme. GARDOSIK, ELIZABETH M
Decedent's Social Security Number
RECAPITULATION
161,098.50
1. Real Estate (Schedule A) ........................................................................................ .. 1.
2. Stocks and Bonds (Schedule B) .............................................................................. . 2.
3. Closely Held CorporaCion, Partnership or Sole-Proprietorship (Schedule C)......... . 3.
4. Mortgages & Notes Receivable (Schedule D) ..........................................._........... .. 4.
775.18
5. Cash, Bank Deposits $ Miscellaneous Personal Property (Schedule E) ............... . 5.
2 , 0 1 6 . 2 7
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............ . 6.
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property 7 5, 0 2 4. 1 7
(Schedule G) ^ Separate Billing Requested ............ . 7.
g. Total Gross Assets (Cotal Lines 1-7) ...................................................................... . g, 2 3 8, 9 1 4. 1 2
34,693.86
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... .. 9.
3 5 , 6 3 3 . 0 4
10. Debts of Decedent, Mbrtgage Liabilities, & Liens (Schedule I) .............................. .. 10.
7 0, 3 2 6 9 0
11. Total Deductions (total Lines 9& 10) .................................................................... ..
11.
168, 587 .22
1z. ..
Net Value of Estate ((_ine 8 minus Line 11) ......................................................... _,
12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which"
an election to taz has'not been made (Schedule J)_.__......._ ................................ . 13.
168,587.22
14. Net Value SubJect toy, Tax (Line 12 minus Line 13)....._....._...._...._ ..................... .. 14.
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rald, or
hansfers under Sec. 9116
(a)(1.2) X .00 15.
16. Amount of Line 14 taxable 1 6 8, 5 8 7. 2 2 1s 7, 5 8 6. 4 2
at lineal rate X .Q45 .
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. ~_
Amount of Line 14 taxable
at collateral rate X .1'S
~_ 18.
19. _ ............
Tax Due ................................................................................................ . .. 1s. 7, 586.42
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
L 150561'0243
a
15D5610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 11 - 01103
_
Gardosik, Elizabeth M
_
STREET ADDRESS
4814 Virginia Road
CITY --~-~ ~-_- ~
Mchanicsburg STATE
PA ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
8,200.00
379.32
(1)
Total Credits (A + B) (2)
7,586.42
8,579.32
(3) 0.00
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.
(a> 992.90
(5)
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 transierred :.................................................................................. ^
b. retain the right to designate who shall use the property transferred or its income :.................................... ^
c. retsina 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 decedeht own an "in trust for' or payable upon death bank account or security at his or her death?......... ^ [x)
4. Did decedept own an Individual Retvement 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. §9176 (a) (1.1) (i)].
For dates of death on or after ~ anuary 1, 1995, the lax 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)]. he statute does not exempt a transfer to a surviving spouse from tax, end the statutory requirements for disclosure of
assets and filing a tax return afe still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after ,)uly 1, 2000:
• The tax rate imposed on the het value of transfers from a deceased child 21 years of age or younger al 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) (7.2)].
• 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, w ether by bloo~ or adoption
CONNpNWEALfH Of PENNSVLVNNIF
INHERITNNCE TM RETURN
RESIDENT OECEOENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
ESTATE OF Gardosik, Elizabeth M 21 - 11 - 01103
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value i;
at which property would be exchanged between a willing buyer and a wilting seller, neither being compelled to buy or sell,
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be
schedule F.
Attach a copy of the settlement sheet ii the property has been solcl.
Include a copy of the deed showing decedent's interest if owned as tenant in common.
price
ITEM I DESCRIPTION I VALUE AT DATE OF
NUMBER DEATH
1 I Real Estate at 4814 Virginia Road, Mechanicsburg, Cumberland County, Pennsylvania, knonw
as tax parcel 19-0~1-0279-317. See copy of settlement sheet attached hereto
2 Real Estate situate in Paint Township, Somerset County, Pennsylvania, known as property ID
341014650, Record Book 1974, Page 366. Assessed value of $22,350.00 multiplied by the
common level ratid of 2.51 = $56,098.50
105, 000.00
56,098.50
TOTAL (Also enter on Line 1, Recapitulation) I 161,098.50
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COM.gNWEAL'IH OF pENNSTLVNNN PERSONAL PROPERTY
INHERRPNCE TF%RETURN
RESIDENT OECEOENT
FILE NUMBER
ESTATE OF Gardosik, Eliz2lbeth M 21 - 11 - 01103
Include the proceeds of litigation and the date the proceeds were received by the estate. All propenty jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1 I Rite Aid Pension
DESCRIPTION
VALUE AT DATE OF
DEATH
276.86
2 ~ Reimbursement of real estate taxes, sewer and trash payment on sale of real estate
498.32
~ TOTAL (Also enter on Line 5, Recapitulation) ~ 775.18
SCHEDULEF
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
ESTATE OF Gardosik, Elizabeth M FILE NUMBER
21 - 11 - 01103
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
David R. Gardosik
A Son
Andrew T. Gardosik
g 88 Marbob Road
Halifax, PA 17032 Son
JOINTLY OWNED PROPERTY:
ITEM
NUMBER
I LETTER
FOR JOINT
TENANT DATE
MADE ~.
JOINT f~F~SCRIPT.lO~(~F PRO~ERT~1'
Include name o Inancial ms I u ion an ban account numbs
or similar identifying number. Attach deed for jointly-held real
estate. ' %pF DATE OF DEATH
DATE OF DEATH VALUE oP
VALUE OF ASSET 'iINTERESTI DeceoENrs INTEREST
_ _ _
_
1~
A
03/25/200 --._-
Checking account #536960859 at Metro Bank, 3,8zg 78
50% ! 1,914.89
3801 Paxton Street, Harrisburg, PA 17111
2 ~ B 06/06/200$ Savings Account #627109705 at Metro Bank, zoz.75 50% : 101.38
i
~I
~I
I
i Harrisburg, Pa
'
I
I
I
ii
TOTAL (Also enter on line 6, Recapitulation) '~ 2,016.27
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT CIECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
ESTATE OF Gardosik, Elizab@th M
FILE NUMBER
21 - 11 - 01103
ITEM
NUMBER
____
1
2
This schedule must tDe completed and filed if the answer to any of questions 7 through 4 on page 2 is yes.
DESCRIPTION 0
Inclutle the name d the transferee (heir relationship to tlecatlant DECD S
and the data of transfer. Attach a F PROPERTY DATE OF DEATH %OF ExausloN TAXABLE VALUE
VALUE OF ASSET INTERFST
copy of lha tleetl for reel e9tete.
-__
NFSlEnvestnet NohQuafied account #HTM088668 ! nsat.z5 17,541.25
with U Financial Group, 100 Corporate Center Drive, I'
Suite 201, Camp hVll, PA 17011
Mass Mutual Odyssey Plus fixed NonOualified annuity 5~,aazsz
with U Financial Gdoup, Camp Hill, PA.
57,482.92
TOTAL (Also enter on line 7, Recapitulation) 75,024.77
SCHEDULE H
FUNERAL DIES 8r
CD~NHERN~TµCE TA%RE~URNpNw
RESIDENT DECEDENT ~'~ "" - '"' - -
I
F1LE NUMBER
ESTATE OF Gardosik, Elizabeth M 21 - 11 - 01103
'Debts of decedent must be reported on Schedule I.
ITEM
-- - _ __-
NUMBER DESCRIPTION - ~ AMOUNT
FUNERAL EXPENSFjS:
A. 1 !i Malpezzi Funeral Home, 8 Market Plaza Way Mechanicsburg, PA 17055, funeral ' 8,548.96
ill
8. ADMINISTRATIVE CASTS:
~. Personal RepresentatiNe's Commissions
Name of Personal Representative(s) I,
~ Andrew T. Gardosik 8,094.00
Street Address $8 Marbob Road
I City Halifax ^' State PA Zip 17032
~ Year(s) Commission paid
z. I Attorney s Fees IKerwin & Kerwin, LLP -- Gregory M Kerwin
3. ~I Family Exemption: (If tJecedent's address is not the same as claimant's, attach explanation)
'~. Claimant
'~ Street Address
~'~I City State Zip
I~ Relationship of Claimant to Decedent
4. ~ Probate Fees Register Of Wills
5. '. Accountant's Fees
6.
7
1
Tax Return Preparer's'~,Fees
Other Administrative posts
Notary fee on RentUnciation
8,094.00
332.50
5.00
-. ----
TOTAL (Also enter on line 9, Recapitulation) 34,693.86
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TA%RETURN
Sd>edule H
Funeral E^~~er~es &
~I{A~
ESTATE OF Gardosik, Elizabeth M
2 I The Sentinel, Estate advertisement
3 ;Cumberland Law Jburnal, Estate advertisement
4 i, Recorder of Deeds„ Somerset County, deed information
5 ', Settlement chargeg on sale of Mechanicsburg property
6 US Postmaster, pgstage
7 Register of Wills, filling return and inventory
8 ,Reserved for closir<g costs
FILE NUMBER
21 - 11 - 01103
83.34
75.00
33.00
9,138.06
60.00
30.00
200.00
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMMONWEALTH OF PENNSYLVANW LIABILITIES & LIENS
INHERITANCE TN%RETURN ~
RESIDENT DECEDENT
ESTATE OF Gardosik, Eliz2lbeth M
FILE NUMBER
21 - 11 - 01103
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM DESCRIPTION
NUMBER
1 Omnicare, accounq payable for medicine
2 UGI, account payable for home heating gas
3 Allstate, account p~yale for homeowners insurance
4 ~ Verizon, account p{syable for telephone service
5 PPL, account payable for electric
6 PA water, account (payable for water
7 Mechanicsburg BoYough, account payable for sewer & trash
8 Mobile x-ray, account payable
9 Real Estate Taxes'
10 Reimbursement to'iSandra Gardosik, payment for dental work on decedent
11 Overpayment of scjcial security
12 Repairs to real estate prior to sale
13 Post Office Box rel~tal fee
14 Bank of America Hlome Loan #171685499, Wilmington, De 19886
AMOUNT
78.92
789.00
501.58
461.44
433.90
307.76
615.10
80.29
326.57
148.00
1,174.00
140.00
29.00
30,547.48
TOTAL tAlso enter on Line 10, Recapitulation) I 35,533.04
REV-161] EX+111-081 IU
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TA%RETURN
RESIDENT OECEOENT
ESTATE OF FILE NUMBER
Elizab@th M
Gardosik
, 21 - 11 - 01103 ___
~ RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER I NAME AND ADpRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEI ING PROPERTY Do Not Lqt Truabepl
-_
- _-
I~ -
TAXABLE DISTRIBUTIONS [include outright spousal
i
d
f
distribut
ons, an
trans
ers
under Sec. 9116 (a) (1.2))
1 Andrew Gardosik Son 116th residue of
88 Marbob Road estate
Halifax, PA 17032.
2 Rita Morrison Daughter 116th residue of
Johnstown, PA estate
3 Michael Gardosik ' Son 116th residue of I
2806 East Standis Avenue ;
8 estate
Anaheim, CA 92
6
Enter dollar amounts fo distributions shown above on lines 15 through 18 on Rev 1500 cover shelet, as appropriate.
II. NON-TAXABLE DISTRI UTIONS:
A. SPOUSAL DISTRIB TIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND (pOVERNMENTAL DISTRIBUTIONS
I
TOTAL OF PART II - E TER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
REV~161J E%~ (94111)
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES continued
I NHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Gardosik, Elizabeth M
NUMBER NAME AND ADDRESS OF PERSON(S)
RECEIuING PROPERTY
j, TAXABLE DISTRIBUTIpNS[include outright spousal
distributions, and transfers
under Sec. 9116 (a) (1.2)J
4 Paul G. Gardosik
53 N. West end A e
~
Lancaster, PA 17 03
5 Sandra M. Gardo ik
~
3030 North 3rd St
jeet
Harrisburg, PA 171110
I
6 David R. Gardosik
Dillsburg, PA
FILE NUMBER
21 - 11 - 01103
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
DECEDENT (Words) ($$$)
Do Not flit Tlustsspl
Son 1!6th residue of
estate
I Daughter 1!6th residue of
estate
Son 1!6th residue of
estate
Page 2 of Schedule J