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Home My WebLink About10-26-121,50561],1,80 REV-1500 ~~02-,,,cFl, OFFICIAL USE ONLY nns vania PA Department of Revenue oE~ rMENroFREVENUE County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~' PO BOX 280601 % Harrisburg, PA 17128-0601 RESIDENT DECEDENT w ~ f `~ ~~ ~~ ~ ,~ 4 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 196-20-9055 0302201,2 11271925 Decedent's Last Name Suffix Decedent's First Name MI ZARICHANSKY JOHN (If Applicable) Enter Surviving 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 1IVILLS FILL INAPPROPRIATE BOXES BELOW 0 1. Original Retum Q 2. Supplemental Return Q 3. Remainder Retum (Date of Death Prior to 12-13-82) Q 4. Limited Estate Q 4a. Future Interest Compromise (date of Q 5. Federal Estate Tax Retum Required death after 12-12-82) Q 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Wild (Attach Copy of Trust) Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (Date of Death Q 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ROBERT G. FREY 717-243-51~u38 ..~ REGISTE ~ :7af~1LLS First Line of Address 5 S. HANOVER ST. Second Line of Address City or Post Office CARLISLE State ZIP Code PA 170],3 ""r'} ~~~ ~ 7 r ~ "~ ~:t_: _, ~-_ _ ~, ~ ;. 1 ~~~~t ~_ ---y-, -" C`~ r _.. rrt -~ o -~, ~ ~~ ~~ r-r~ ~~?~ G_ G ,t rA n `~% c.~ ~' DATE FILED ~~ C'..J SLY -~ rv +~ .~- ~._ Correspondent'se-mail address: RFREYOFREYTILEY.COM 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 knowledae. T~~O~~ERS01~2F,,S~O~N~ ~E F .FILIN~~~UR ~ , ~ c ~ ~ DATE %~~ Z ~.~/ ~ ADDRESS 39 MOUNTAIN ROAD BOILING SPRINGS PA 17007 SIG A RE O ER O ER TH N REPRESENTATIVE DATE /e -, ADDRESS -` 5 SOUTH HANOVER STREE L 1505611180 CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONL ~Z Side 1 150561],180 i J 1505611280 REV-1500 EX (FI) Decedent's Social Security Number DecedenYsName: JOHN ZARICHANSKY 196-20-9055 RECAPITULATION 1. Real Estate (Schedule A) .......................................... 1. N 0 N E 2. Stocks and Bonds (Schedule B) ..................................... 2. N 0 N E 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. NON E 4. Mortgages and Notes Receivable (Schedule D) ......................... 4. N 0 N E 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... 5. 14 4 4 5 . D 0 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. N 0 N E 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested ....... 7 NON E 8. Total Gross Assets (total Lines 1 through 7) ................... 8 14 4 4 5.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) ................ 9. 1131.0 D 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ 10. 113 012.0 0 11. Total Deductions (total Lines 9 and 10) .............................. 11. 11414 3 . 0 0 12. Net Value of Estate (Line 8 minus Line 11) ............................ 12. - 9 9 6 9 8 . 0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... 13. 0 . 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... 14 - 9 9 6 9 8.0 0 TAX CALCULATION -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 .0 0 15. O. O O 16. Amount of Line 14 taxable at lineal rate X .0 4 5 16. O. O O 17. Amount of Line 14 taxable at sibling rate X # # #I 17. ^ . 0 0 18. Amount of Line 14 taxable at collateral rate X # # ~ 18. 0 . 0 0 19. TAX DUE ........................................................ 19. 0 . 0 0 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 0 Side 2 L 1505611280 1505611280 REV-1500 EX (FI) Page 3 Decedent's Complete Address: 21-12-0617 File Number 196-20-9055 DECEDENT'S NAME JOHN ZARICHANSKY STREET ADDRESS 1000 WEST SOUTH STREET CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest Total Credits (A + B ) 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. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (1) 0.00 (2) 0.00 (3) (4) 0.00 (5) 0.00 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 ......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income ........................................... ^ 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" orpayable-upon-death bank account or security at his or her death? ............ ^ ^X 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 decedents lineal beneficiaries is 4.5 percent, except as noted in [l2 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. REV-1508 EX+ (11-10) SCHEDULE E pennsylvania CASH, BANK DEPOSITS, ~ MISC. DEPARTMENT OF REVENUE PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: John Zarichansky 21-12-0617 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. If more space is needed, use additional sheets of paper of the same size. REV-1511 EX + (10-09) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ~ ~~~ ~~v~~~v~~~ John Zarichansky 21-12-0617 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address 500 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 Street Address 4. 5. 6. 7. City State Relationship of Claimant to Decedent Probate Fees: Accountant Fees: Tax Retum Preparer Fees: ZIP 500 131 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 1,131 If more space is needed, use additional sheets of paper of the same size. REV-1512 p(+ (12-08) pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER John Zarichansky 21-12-0617 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. If more space is needed, insert additional sheets of the same size. a~~ 499 Mitchell Road, Millsboro, DE 19966 Adjustment Services Frey & Tiley 5 South Hanover Street Carlisle, PA 17013 Re: Estate of John Zarichansky Social Security 196-20-9055 Date of Death: March 2 201.2 Phone 888-502-4349 Fax (302) 934-2955 June 8, 2012 Dear Sir or Madam: Per your inquiry on June 5, 2012, please be advised that at the time of death, the above-named deposit with this bank the following: decedent had on 1 • Type of Account Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total Savings Account 92593615 John Zarichansky Mark P, Zarichansky(POA) 08/28/1964 $14,445.33 $ .14 $14,445.47 For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, please call the High Street Carlisle at 717-?,AO-453(,. We were unable to locate any safe deposit box for the above-mentioned decedent. This letter does not include any accounts in which the deceased may have been listed as power of Attorney, Custodian of Uniform Transfers, Representafive payee, or Trustee under a Written Agreement. Sincerely, Valarie Mercer Adjustment Services