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Home My WebLink About05-23-13 J 15�56101�5 REV-isoo EX�o=_��,tF�, PA department of Revenue pennsytvania OFFICIAL USE ONLY Bureau of Individual Taxes °`""'"`"`°`"`"`"°` County Code Year File Number Po eox 28o6oi INHERITANCE TAX RETURN �y, p Harrisburg,PA i�128-o6oi RESIDENT DECEDENT �`-�! ��` V ��'? ENTER DECEDENT INFORMATION BELOW � Social Security Number Date of Death MMDDYYYY pate of Birth MMDDYYYY 01 117/2013 05/1811937 Decedent's Last Name Suffix Decedent's First Name MI NIKOLAUS ROBERT C (If Applicabie)Enter Surviving Spouse's Information Below Spouse's Last Name Su�x Spouse's�irst Name MI Spouse's Social Security Number THIS RETURN MUST BE FIIED IN DUPUCATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE C)VALS BELOW � 1.Original Return Q 2.Supplemental Return O 3. Remainder Retum(Date of Death Prior to 12-13-82) O 4. Limited Estate p Aa.Future Interest Compromise(date of p 5. Federat Estate Tax Reiurn Required death after 12-12-82� O 6.Decedent Died Testate O 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Wii�) (Attach Copy of Trust.) C7 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 Schedule O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Nathan E. Sa�on (717) 684-4422 @�G�TER OF W4t't5 US�` I�h I�'t� _ ' _ -} First Line of Address ��► -°- C. - - : :� ��,:.. C-- -. � � ' 327 Locust Street , {..; Second l.ine of Address ' " - _ C= ` City or Post Office State ZIP Code DATE FILED Columbia PA 17512 _ , CorrespondenYs e-mail address: Under penalties of perjury,I declare that I have exami�ed this retur�,including accompanying schedules and statements,and to the best of my kno ledge and belief, it is true,corcect and complete.Declaration of preparer other than the personai representative is based on all information of which preparer ha y kno ledge. IG ATUR F PEFtSO SPONSIBLE R FI�I TURN ADDRESS � � � RE OF PREPA THAN E R NTATIVE DATE r� ADD �, - «�? �7 B Ct;� PLEASE USE ORIGINAL FORM O LY Side 1 � 15�56101�5 15�5610105 � � �� 1505610205 REV-15�0 EX(FI) Decedent's Social Security Number �ecedent's Name: Robert C. Nik0laus RECAPITULATION 1. Reai Estate(Sr,hedule A). .... . .. . .. ......... ...... .. .... .. .... .. . .... 1. 2. Stocks and Bonds(Schedule B) ... .. . ... ..... ..... . . .... ... . .. ... . . 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Scheduie C) . .. . . 3. 4. Mortgages and Notes Receivable(Schedule D),,, ,,,,, , , ,,,, , d 5. Cash,Bank Depasits and Miscellaneous Personal Property{5chedule E),. .. . . . 5. 8,099.96 6. Jointly Owned Praperty(Schedule F) O Separate Billing Requested .. . . . .. 6. 7. Inter-Vivos Transfers 8�Miscellaneous Non-Probate Property (Schedule G) Q Separate Bilting Requested.. .. . .. . 7. B. Totai Gross Assets(total Lines 1 through 7)........ .. . ... .. . - .. . .. . .. ... . e. 8,099.96 9. Funeral Expenses and Administrative Costs(Schedule H).... . .. .. . . . ._. . . . s. 1,693.99 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I). .. .. . . . ... . . . . 10. 76,892.38 11. Total Deductions(total Lines 9 and 10)... ...... . .. .. .. . ... .. . . .. .. . 11 78,586.37 12. Net Value of Estate(Line 8 minus line 11} ...... . .., 13. Charitable and Governmental BequestslSec 9113 Trusts for which 12 -�0,486.41 an etection to tax has not been made(Schedufe J) ..... ,._ .. . ... .. . .. . ... . 13. 14. IVet Vatue Subject to Tax(Line 12 minus Line 13) ...... ,... , .. .. . . .... . . 14. O.QO TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABIE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under 5ec.9116 (a)(1.2)X.0_ 16. Amount of Line 14 taxabie �5' at lineal rate X A 17. Amount of Line 14 taxabie i6" at sibling rate X.12 18. Amnunt of Line 14 taxable �� at collateral rate X.15 '; 18. Y 19. TAX DUE .. . .. . .... .. . . . . . ..... . .. . .. .. . .. ... ... . ....... . i . ...... . 19. 0.00 � 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O ` LSide 2 150561D205 1505610205 � REV-15�00 EX(FI) Page 3 Pile Number Decedent's Complete Address: DECEDENT'S NAME Robart C. Nikolaus - ---- - --- __ . _ _ '. __ _. ______--_____ STREETADORESS _ . ___----_ 940�Nafnut Bottom Road . _ .. _ . _ _. _ . . . _ ___ -- ----------- ---- - ----- ----- -- CITY - - - — ----- — -- - _ STATE -ZIP------____ Carlisle PA 17015 Tax Payments and Credits: 1. Tax due(Page 2,Line 19) (1? 0.00' 2. Crediis�Payments — A.Prior Payments .___ _ ___ __ B.Disr,ount 3. Interest -- --------- -- Totai Credits(A+B) (2) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. �3� Fil!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. (5) 0.00 Make check payabie to: REGISTER OF WILLS, AGENT. , .� .t�� yE �= � � . . . . . . . . a r e.h� . PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent mak�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?............................................................................................... ............... ❑ � ;9. Did decedent own an"in trust for"or payabie-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? ........................................................................................................ ............... ❑ � lF THE ANSWER TO ANY OF THE ABOVE QUESTf4NS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART QF THE RETURN. ` ��s��.� ��, �; .��;: < � z � , For dates of death on or afler 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 I�.S.§9116(a){1.1)(ii)j.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 oniy beneficiary, '� For dates of death on or after July 1,2000: � • The tax rate imposed on the net value of transfers from a deceased chiid 21 years of age or younger at death to ar for the use of a naturaf 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 decedenPs 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. 4 � REV-1511 EX+ (10-09) � � '� pennsylvania SCHEDULE H :� DEPARTMENT OF"REiVENUE FUNERAL EXPENSES AND . mHerurnNCe Tnx aEruRN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Robert C. Nikolaus 21-13-0248 Decedent's debts must be reported on Schedule I. ITFM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES 1' Glyde W,Kraft Funeral Home 321.00 �' 2. Royers Fiowe�s 185.50;' 3. Memorial Service:Columbia Family Restaurant 203.99 '' B. ADMINISTRATIVE COSTS 1. Personal Representative Commissions; 400.00 Name(s)of Gersonal Representative(s) Sand�a B8tld2f street address 6130 Sprin�ford Driv_e Apartment F1 city Harrisburg _ . ____ -- stace PA zta 1711.1 _ Year(s)Commission Paid: 2013 2. Attorney Fees: 450.00 3. Family Exemption:(It decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City_-- __ _ ___ __.--- ---_---__--- ___ . State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 133.50 5. Accountant Fees: 6. Tax Retum Preparer Fees: ��c 7. ;� 8. 9. 10. k � t TOTAL(Rlso enter on Line 9, Recapitulation) $ 1,693.99 If more space is needed,use additional sheets of paper of the same size. REV-iso8 EX+(o8-i2) '�s pennsytvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX REfURN PERSONAL PROPERTY RESIDENT DECEDENT � ESTATE OF: FILE NUMBER: Robert C. Nikolaus 21-13-0248 Include the proceeds of litigation and the date the proceeds were received by the estate. AII property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION — OF DEATH 1. M&T Checking Account 7,929.21 ' 2, Continentaf General Insurance Premium Refund 160.65 3, Imaging Associates Refund 10.10 � : � � � TOTAL{Riso enter on Line 5, Recapitulation) $ 8,099.86 If more space is needed,use additional sheets of paper of the same size. ;• REV-2512 EX+(12-08) ;� '`, ��r�,=�pennsylvania HEDULE I � .. ., DEPAPTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RENRN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT . ESTATE OF FILE NUMBER Robert C. Nikolaus 21-13-0248 ^ Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUhiBER _ DESCRIPTION OF DEATH 1� PA Department of Pubiic Welfare 76,892.38 � , j; _ TOTAL{Also enter on Line 10, Recapitulation) $ 76,892.38 If more space is needed,insert additional sheets of the same size. & � r i NIKOLAUS & HOHENADEL, LLP DONALD H.NIKOLqUS ATT�RNEYS AT LA�/�/ .IOHN P.HOHENADEL �+�ATTHEW J.CREME,JR. 327 LOCUST STREET JOHN F.MARKEL COLUMBIA, Pq.1 7512 �UNSEL , RICHARD G. JOSEPH J.LOMBARDO I GREINER BRYAN D. JIEFFREY q.MILLS ��7/684-qq22 CUTLEq I� MICHAEL S.GRAB FqX 7 PAU�D. MUNSON ��' ��/684-6099 JOSEPH G.MUZIC,JR.* I �C3A J.McCOY 2�2 NORTH OUEEN STREET I BARBqRA REIST DILLON �NCqSTER, Pq,�7g03 BqRRY A. SOLODKY �17/29g�7pg JOHN C. HOHENADEL F� �"17/299-1811 BEFiNADET7p M,HOHENADEL ANTHONY MAqC HOPKINS 2�5 EAST STq'fE STREET WANDA S.WHAqE SUITE q �U'4RRWiLLE, Pq, 17566 ROHERT S.CRONIN,JR. MANDY LLOYD HEINZ ��/806-5139 FqX 717/g06-5426 ANC;EL E.TORRES C. EDWqRD BROWNE D. LYNNE FERGUSON 'Certified Civil Trial Specialist NqTHAN E. SAX7'pN BY Netional Board of Trial qd�ocecy Cumberland County Register of Wills May 2Z� 2�13 c� - One Courthouse Square `��' '"` �",�� c ::L, � �' , . Carlisle, PA 17013 c� =,.: -- }: �.-� n� ;-. _ � �: ,._ a `� f__ ,_, . � �„ "~ �=; ° . _ RE: Estate of Robert C. Nikolaus � � �. File Number: 2013-00248 -- � � Dear Register: � � � .. . _.� :..:; Enclosed herewith, please find two signed original Pennsylvania ln and Inventories. As administration for this estate is complete, leas properly filed on behalf of the executor. heritance Tax Returns p e have these documents Should you have any questions or concerns, please do not hesitat above address. e to contact me at the Very truly yours, —_� � a .s-�''`� ,�%�-�', . ___. �� -.._-�..�-, �� -- Nathan E. 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