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Home My WebLink About12-28-12J 1505610143 REV-1500 Exld2-"'' OFFICIAL USE ONLY PA Department of Revenue Pennsylvania count' code veer File NumSer Bureau of Individual Taxes °E°""'"CNiOf R"~NUE Po Box.2sosot INHERITANCE TAX RETURN 21 12 072 9 Harrisburg, PA 17128-0501 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 7 26 2009 12 30 1956 Decedent's Last Name Suffix Decedent's First Name MI SELEWACH CHRISTOPHER A (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffx 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 ~ Supplemental Return 2 ~ ndZr 3e82) (Date of Death ma' 3. Pe 1. Original Return . o o 4. Limited Estate ~ qa. Future Interest Compromise ldele m deem aner 2-12EZ) ~ 5. Fetlerel Estate Tax Retum Required g oecedem Died Teslale ~ 7. ~an~eche~oP9 i~9ined~ living Trust e. Total Number of Sate Deposit Boxes (Anach copv or will `] 9. Litigation Proceetls Received ^ 1e~b~iweeniyi~ri~~andl{oa~eSOr Deem ~ 11.Election to tax under Sec. 9173(A) (Attach Schedule O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Daytime Telephone Number Name ROBERT C SAIDIS 717 243 6222 REGISTER OF WILLS USE ONLY r.r Q ~-.- : D C ~, iV fn'1 First Line of Address ~ ~ .~ ~ 26 W HIGH STREET m -f;-' ~-, ~~~ ~? Second Line of Address ~ ~ ~ GJ ~ ~; ; ~~ /~l ~`} 5 City or Post Office State 21P Code CARLISLE PA fir, '~a (; . .: ' < ~' y Correspondent's a-mail address: rBaIdIB~SSr-attOrneyS.COtiT Under penalties of perjury, I declare that.! have examined this return, including accompanying schedules and statements, and to the best of my knowledge antl belie!, it is true, wrcecl and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge. 51 ~NATU~R oF PERSON REBPONSIBLE FO FI URNs I ~AT~~ I I l ~//a ~/1 re >~ .( wen Frances A. Shine L ~: Side 1 1505610143 1505610143 J J 1505610243 REV-1500 EX Decedent's Social Security Number o~aa~r:mama. Selewach,ChristopherAdam 1. Real Estate (Schedule A) ....................................................................................... 1. 2. Stocks and Bonds (Schedule 8) ............................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3. 4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4. 5 29,276.17 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... . 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers & Miscellaneous f~oq PSepetraterBileng Requested............ ~ J 7. (Schedule G) 8. Total Gross Assets (total Lines 1 through 7) ........................................................ 8. 2 9 , 27 6.17 s 4,717.97 9. Funeral Expenses and Administrative Costs (Schedule H)........... . 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............................ 10. 1 f . Total Deductions (total Lines 9 and 10) ................................................................ 11. 4 , 717.97 12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 24 558.20 r 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) ...................... 1a. 24,558.20 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or 0 0 0 transfers under Sec. 9116 15 . (a)(1.2) X .00 16. Amount of Line 14 taxable 24 , 558.20 1s. 1,105.12 at lineal rate X .045 00 0 17 . Amount of Line 14 taxable 0.00 17. . at sibling rate X .12 18 . Amount of Line 14 taxable 0 , 00 18. 0.00 at wllateral rate X .15 19 1,105.12 19. TAX DUE 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 REV-1500 EX Page 3 File Number 21-12-0729 Decedent's Complete Aaaress: DECEDENT'S NAME Selewach, Christopher Adam STREET ADDRESS 220 Market Street, Apt. 2 STATE ZIP CITY pA 17070 New Cumberland Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 0.00 3. Interest 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. AGENT 1,105.12 0.00 88.20 (4) (5) 1,203.32 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No 1. Did decedent make a transfer and: x a. retain the use or income of the property transferred :............................................................................... b. retain the right to designate who shall use the properly transferred or its income :.................................. ^ 0 c. retain a reversionary interest; or ............................................................................................................... ....................................... ^ 0 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? .......................................... . 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death?....... ^ ^x 4. Did decedent own an individual retirement acceunt, annuity, or other non-probate property which ^ ^ ...................................................................... x 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 January 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. (1) Total Credits (A + B) (2) (3) Rev-1508 E%~ (11-10) COMMONVrENLTH OF PENN6YLVANIN INHERITANCE TA% RETURN REfiIOENT OECEOENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, 8r MISC. PERSONAL PROPERTY FILE NUMBER ~stopher Adam ~ 21-72-0729 Inclutle the proceetla of lit~etion end Ins tlete the proceeds were received Ey the estate. All proparry loin0y-ownedw N tna rl9ht of survivorship must ba dlxlosad on schedule F. ITEM DESCRIPTION NUMBER 1 Proceeds from Prudential IRA #7000114611 from Decedent's Mother, Virginia E. Selewach's estate VALUE AT DATE OF DEATH 29,276.17 TOTAL (Also enter on Line 5, Recapitulation) I 29.276.17 (If more space is nestled, addttional pages of the same size) Form PA-1500 Schedule E (Rev. 11-10) Copyright (c) 2010 form software only The Lackner Group, Inc. REV-1151 E%t (10.09) COMM~,4?~O~~~IA ESTATE OF SCHEDULE H FUNERAL EXPENSES AND FILE NUMBER 21-12-0729 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT q FUNERAL EXPENSES: 1,789.83 See continuation schedule(s) attached g, I ADMINISTRATIVE COSTS: t. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s) Commission Paid 2,500.00 2. Anornev's Fees Saidis, Sullivan 8 Rogers (estimated) g, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address State Zio City Relafionshio of Claimant to Decedent 126.50 4. Probate Fees 5. Accountant's Fees 5. lax Return Preparer's Fees 301.64 ~. Other Administrative Costs See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 4,717.97 Form PA-7500 Schedule H (Rev. 10-09) Copyright (c) 2009 form software only The Lackner Group, Inc. SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE continued (FILE NUMBER ESTATE OF 21-72-0729 Selewach, Christo her Adam ITEM DESCRIPTION AMOUNT NUMBER Funprel FXDenSes 1,789.83 1 Auer Cremation Services of PA, Inc. H-A 1,789.83 Other Administrative Gosts 40.00 2 Cleaning supplies and parts to clean and repair Decedent's apartment 50.64 3 Davenports Restaurant -dinner for friendslfamily who helped clean Decedent's apartment 211.00 4 Travel to Mobile, Alabama to spread ashes per request of Decedent -Hotel, food and car rental H-67 301.84 Fonn PA-1500 Schedule H (Rev. 6-g8) Copyright (c) 2002 form software only The Lackner Group, Inc. REV-7513 EX. (Ot-70) COMM ID NT DECE~r~ANIA ESTATE O~FN Selewach, Christa SCHEDULE J BENEFICIARIES NAME AND ADDRESS OF NUMBER PERSON(Sl RECEIVING PROPERTY I• TAXABLE DISTRIBUTIONS [include outright spc distributions, and tr .._~_. ee.. 011 R/o11 Frances A. Shine 3416 Canyon Creek Mechanicsburg, PA 17055 FILE NUMBER 21-12-0729 ATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (words) ($SS) Sister 1100°h of residue Total I Enter dollar amounts for distributions shown above on lines 15 Shrou h 1 B on Rev 1500 cover sheet as a ro I NON-TAXABLE DISTRIBUTIONS: II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TA)CArsLt ulo ~ ^'o~ "~^~ "" "-- - Form PA-1500 Schedule J (Rev. 01-10) Copyright (c) 2010 form software only The Lackner Group, Inc.