HomeMy WebLinkAbout05-24-13 (2) J 15U5610105
au.-u�c�n���js�
REV��SOO 1/f OFFICIAL USE ONLY
PA Department of Revenue Pe^^sll�V�nia
8ureauofIndividualTaxes `�"��� `�" CountyCoGe Year PtleNumber
Po sox zao5os INHERITANCE TAX RETURN 7l1 '� j 1�/
HarAsburg,PAi7u8-o6oi RESIDENTDECEDENT 6A � Ip("� -
ENTER DECEDENT INFORMATION BELOW
! 10192012 0108'1923
Deceden['s Las[Nama Sufflx Decedent's First Name MI
Laviska Genevieve ' M i
(If Applkable)Enter SurviWng Spouse's Informadon 8elow � . . ..... .. .. ..... .. ......... .. .. .. .. . .. . . . . .... .......
Spouse's Last Name Suffix Spouse's First Name MI
. . . ... . .. .. .. ... . .. . . ........ ......... ......_. ... . .. .. . . . ........ . ._......
Spouse's Soc�al Secwrty Number � �
, THIS RETURN MUST BE FILEp IN DUPLICATE VYITH THE
_ __ _ ' REGISTER OF WILLS
FILL IN APPROPRIATE OYALS BELOW
p 1.OHginal Relum � 2.Supplemen[al Return p 3. Remalnder Return(tlate of tleam
Prbr to 12-1382)
p 4.Agricutture Exemptbn O 5.Future InMrest Canpranlse(date ot O 6. Fetleral Estate Tax Relum Required
(da[e ofdeath atter7-1-2012) death af[er 12-12-82j
O 7.Decetlent Dletl Testale O 8.Decetlent Malntalnetl a Livlrg Trus[ _ 9. Total Number of Safe Depostt Boxes
(AHaCh mpy ot will.) (AtteCh copy Of hust.)
O 10.Lltlgatlon Proceeds Receivetl O 11.No Taxable Asset ReWrn p 12. Electlon to Tax under Sec.9113(A)
(AMach Sc�etlule OJ
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPOI�DENCE ANU CONFIOENTAL 7AX INfORMA710N SNOULD 8E DIRECTED TO:
Name Daytime Telephone Num6er
. . . . . ... ..._. . .. . .. . ... . . . . .. ......_. ..._........ . . . . . .... ...
Joanne l Slusser (717)254-6272 �_� � !
__ _ _... ___ __ c'a_ . . �.;_ _ �a �
RE TEAOF WILLSM�E Ol�/,.�
� 'O --� (.%: •��
Rl Z C7 f, "" C,�
Firs[Line of Address :� r r n% .
_.__., r -.;, r�i -= ''}
'236 S Pitt St x' a`, '' �., s
-_ • __ _ ;
Second Line of Address ��^" �-' !' � � ';:
........_. . . . ., . _.:.� . � ;.
.___. _._..... __..... .__..... ......... . �. . . � �.
r
, . ;,
City or Post OfflCe.. . ... .. ... ......... ......... .8[ate ZIP Code -flAiE FILED �.��,
Carlisle _ PA , !17013 ; ,
_ __
CorrespondeM�s eman addrass: beach_28403@yahoo.com
lJntler penaHies of perjury,I detlare I�ave eramined ihi5 relum,inGUtling xwmpanying schetlulea and sqtemanis,antl b iha Oest of my krrowleEge arM belie(,it
is irua,conect ana mmplete.Oeclaration ot preparer other ihan Ne personal represenlative is based on all inbrtnation of which preparer has eny knowletlge.
SIGNA 41IiE�JI �N RESbPON L RFILIN�('JL� ��/✓`��� S TZJ(7— I�/
Ll
i j.
AD S �
23 S Pitt St Carlisle PA 17103
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE OR161NA1 FORM ONLY
Side 1
L 15U5610105 1505610105 J
� Lsosblozos
REV-isao Ex(Fq
'
RECAPITULATION
1. Real Estate(Schedule A). ... .. ... ...... ... .. .... ..... ....... _.. ..... 1. '. 0.00 �'�.
._.._... ._..__ ._.__. __..:
2. Stocks and Bonds(Schedule B) ... .... ..... ....... .... ..... .. .. .. ..... 2. '� '�.
3. Closely Held Corpora[ion,Partnership or So1�Proprierorship(Schetlule C) _ .. . 3. '�. 0.00 '�.
._._._ .__._. ..._.__ ...._��.
4. Mortgages and Notes Raceivable(Schedule D)..... .. .. ..... .. .... ..... .. 4. '� �.0� ��
......._ _._..... ......._. ......i
5. Cash, Bank Deposits and Miscetlaneous Personal Pioperty(Schetlule E). . .... . 5. ���. 56,166.00 I
..._..._. ..._._. _._._. .._..:
6. JoinHy Owned Pmperty(Schedule F) Q Separete Billing Requested ... .... 6. i 0.�0 �
7. Inter-Vivos Trensfers&Miscellaneous Non-Probate Property ���--�-�� -�--�-��- ���-��-�� ;
(Schadule G) d Separata Billing Requested....._ . 7 0 00 ;
...__.. ._..__ ._.._.. ........-:
8. Total Gross Asaets(total Lines 1 through 7).. .. ... .. ......... .. ..... .... 8. .��', . . . 56,186.00 '.
9. Funeral Expenses and Adminishative Cosls(Schedule H)... .. .. .. ... .. .. ... 9.��. 1,683.�5 I
10. De6ls of Decedent,Mortgaga Liabilities and liens(Schedule I).... ..... ...... 10. �I 0.00 ��'�.
._..__ ._._._ ._._._ ....._��.
11. Total Deductbns(tofal Lines 9 and 10). ..... .... .. ... .. ... . ..... .. ... .. 11. I 1,663.75 ��..
........._ _._.... ,__..... ....._........;
�z. N�vawa ot esoa�e(une e m�nus��ne») ... .... .. ... .. .... ..... .. ..... �z. I 54,48225 '.
13. Chad[ableandGovemmentalBequestslSec9113Trustsforwhich ��-��-��- -�������� ��-��--�-
an electio�ro tax has not been made(Schedule J) ........ . .. ..... .. .. .. .. 13. '�. 0.00 ��:
.._._.. ._._._ __._.. __.i
14. Net Valua Subject W Tax(Line 12 minus Line 13) ..... ... . .. ..... ... . .... 14. '�. �,�2.2$ �
TAX CALGULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
�5. Amount of Line 14 texable
et Ihe spousal tax rate,or
transfersunderSec.9116 .._..... ......._ ...... ... .. . : . . . . .... . ... . . ..
(a)(t2)X A_ '�. 15. � ',
___.... ._._... ..__... ....i ..._...._.. .__._. .._.__ __.:
16. Amount of Line 14 texable ��. �
at lineal ra[e X.0_ � 16. : ���.
'17. AmountofLinel4[axable �--�- �-��- ��-��- � -���� -���� ��-�� ���� �"�.
at sibling rate X.12 '�. 17. ; '�.
18. Amount of Line 14 taxable -�� � �� ���� �� � � � ��� � '�.
at mllateral rate x.15 �'� 18.: '�.
'�. . . . . . . . . . . . i .............. ........._ _.__.. ._.....;
19. Twc DUE .. .._. . _ 19.! 2,451.70 .
20. FILL IN THE OVAL IP YOU ARE REtlUEBTING A REFUND OF AN OVERPAYMENT p
Side 2
� 1505610205 1505610205 J
REV-'I500 EX(FI)Page 3 FNe Num6ar
DecedenYs Complete Address:
DECE�ENTSNAME
Genevieve M Laviska
STREETADDRESS
Thornwald Nursing Home
442 Walnut 8ottom Rd
---_ _ -----
cin ------- —--- sTnTe ziP
Carlisle � PA 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 2,451.70
2. CredilslPayments
A.Pnor Paymenis
B.Discount
� Tofal Credits(A+B) (2)
3. Inleresl
(3)
4. If Line 2 is grealer than Line 1 r��ne 3,enter the difterence. This is Ue OVERPAYMENT. —
Pill in oval on Page 2,Line 20�request a roTund. (4)
5. It Line 1 i Lirre 3 is grealer than Lina 2,enler lhe diRerence.This is the TAX DUE. (5) 2,45170
Make check payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIAtE BLOCKS
7. Did decedent make a Vansfer and: Yes No
a. retain the use w income M the property lransierred.......................................................................................... ❑ �
b. relain fhe righl lo designale who shall use the pmperty transfarred or its income ............................................ U �
c. retain a reversionary interest.............................................................................................................................. ❑ �
d. receive Uie prorms9 tor lile of either payments,banefils Or care9...................................................................... ❑ ■
2. If death occurtad after Dec.12,7982,did decedent Vansfer propeAy within one year of death
wiUrout raceivirg adequale consideration?.............................................................................................................. ❑ �
3. Did decedent own an'in Wst for"or payable�upon-0eath bank account or security at his or her death7.............. ❑ �
4. Did decedent own an individual reti�emenl account,annuity or olher non�probafe property,which
conlains a beneficiary designationl ........................................................................................................................ U �
F THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN.
Por da;es oi death on or aNer Ju4y 1, 1994,and before Jan.1,1995,the tax rate imposed on the net value of transters to or for�e use of the sunriving spouse
is 3 percent(72 P.S.§9116(a)(1.1){i)].
Pw dates of death on or afler Jan. 1, 7995, the tax rate imposed on the nei value of±ransfers to or tor the use of the surviving spouse is 0 percent
[/2 P.S.§9116(a)(1.1)(ii)j.The statute does not exempt a hansfer ro a surviving spause irom tax,and the staiurory requirements for disdosure of assets and
fiting a tax retum are s511 applipble even'rf the surviwng spouse is the only beneficiary.
For dates of death on or after July 1,2D06:
. The tax rate imposed on the nei value of kansfers trom a deceased child 21 years of age or younger at death ta or tor the use of a natural parent,an
adoptive paren;or a stepparent of the chibf is 0 percen'•.[72 P.S.§9116(a)(12)J.
• The tax rete imposed on the net value of transiers to or for the use of the dece�ienPs lineal beneficiaries is 4S percent,except as noted in[T2 P.S.§9156(a}(7)].
. The tax rate imposed on the rret value of transfers to or far the use of the decedenYs siblings is 12 percent[72 P.S. §9116(a)(1.3j].A sibling is defined,
under Secfion 9102,as an individual who has at least one parent in common with the decedent,whether by bbod or adoption.
i2E4 .._i £:.( � .';S!
�'"pennsytvania SCHEDULE H
� oeNaN�raenruFaeve:rue FUNERAL EXPENSES AND
'""E"t'"��Ei^xRET�R" ADMINISTRATIVE COSTS
RFS[DFIJT pECFDENT
ESTA7E OF FILE NUMBER
Genevieve M Laviska 21121276
DecedeM's debts must be repoRed on Schedule I.
ITEM
NUMBER DESCR!VTION AMOUNT
n. FUNERA:EHPENSES:
1. . . . . . . . .. . .. . .
� . . . . . . . .. . . . . , � . . . . . . . . . . . . . . . �. �
B. ADMIM17STRATNE COSTS:
1. P?rsor.a�Represen:a:ive Ccmmissionr �� � � �
Name(sj of Personal RepresenWtive(sj � � � � � � �
Street Addr2ss
Gh _—_________._..__ _Stdte._._..ZIP _.
Year;s)G�mmis=ion Gaid:
1,68375
2. Attomey Fzes: . .
3. Family ExempSnn:(If decedenc's address is nor tne same as daiman['s;attach explar.ation.) _ .
Ciaimant
Street Address
City ______......_____ State___ZID____
Relarcnship efClaimant[o Deceder•t
4. Probate fees �
5. Accountar:r Fees:
5. Tax Retum Pmnarer fe.er. �
TOTAL{Also enter on Lina 9, Recaptulation} ¢� /Cj � �a7�
If more space is needed,use addi!ia:al shee[s oi paper of the same s�ze.
p�-i5�EX+(o8-iz)
��i�"pennsytvania �NEp1/LE E
�EPARTMEh'TOFREVE4UE �H, BANK DEPOSAS & MISC.
`""Ew�"":�T�""�"'" pERSONAI PROPERTY
Res�or:Nr oer.�oenr
ESTATE Of: FILE NU►IBER:
GENEVIEVE M LAVISKA 21121276
[ndude ihe proceeds d liti9ation and the date the proceeds were received by the esWte.
All propeRy jointly owned with rigM of survivonhip mus[be disdpsed on Sehedule F.
ITEM VALUE AT DATE
NUMBE0. DESCRIPiION GF DEATH
1. Refund from Diakon Lufheran Social Ministries for Cumbedand Crossing Retirement Community, 56,166.00
Cadisle PA 3/10J2013
TOTAL(Aiso enter on Lir.e 5, Recapitulation) � � 56,166.00 ��
if more space is nezded,use aeatiorial sheets of paper of tl�z same size.
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t� v> W r, sings
'W > o` �
[�N U N
C7 O �
ti w Z ° HbURS RA1'E AMOUNT
� �
`W ent re:refund from 0.30 $140.00 42.00
V c� ;; Drafted email to
� o une
'Z w m oa�me Judge,Esquire re: 0.30 $140.00 42.00
Q' H �
'�E Z ;s refund check; Drafted
�w U cker re:same
8
V� ? orney Zucker re: payee oa 030 $140.00 42.00
,Z ° . �gs refund check and
� �O M �Ita fund;Telephone call
Q N re: refund check to be sent
Q N
m client re: status ofeheck 0.20 $140.00 28.00
Crossings �
i
03/21/13 CM7 Conference with Attomey Zucker re:case O.SO $140.00 70.00
update and next acdons and payment to client;
'telephone call witU client re:picking up
check; Drafted email w Attorney Zucker re:
samc
03/22/I3 PC7. lelephone call to Attorney Joamie Judge re; 030 $275.09 82.50
receipt oF check and withdrawal of Praecipe;
review with Paralegal Jurina
i
�,Invoice#: }�37Z55�9 Page 2 Apri130,2013
" Client No.:
, CMJ Received and reviewed Sheriffs Return of 0.i0 $i40.00 14.00 '�
3ervice for Writ of Summons
. 04f02/13 CMJ Drafted Praecipe to�thdraw,Discontinue 030 $14U.00 42.00
and End,for review and execution by
Attorney Zucker
04l03/13 CMJ Telephone call with client re: Cumberiand 1.00 �140.00 140.00 I
Crossings check deposited over a week ago;
Telephone ca1(to Prothonotary's Office re: any
ftling fees;Drafted correspondence to
Prothonotary, for review by Aftorney Zucker
re:filing Praecipe to Withdraw;Drafted email
to Attorney 7udge re: Praecipe to Withdraw
and read reply;Finalized/copied/mailed
Praecipe to Withdraw and letter
04/08/13 CMJ Telepflone call with Prothonotary's O�ce re: 0.30 $140.00 N(C
returned documents;Resubmitted Praecipe to
Withdraw
i
04/16/13 CMJ Reviewed date/time stamped Praecipe to 0.20 $140.00 28.00 �
Withdraw; D�afted email to Attorney Judge re:
same with copies of filed Praecipe for their
files
Totals 3.80 $530.50
EXPENSES
03l21/13 Filing fee-Refund from Cumberland County -S 1.D0
Sheriffs Office
04J30/13 Copying Fee 3.50
Totals -$47.50
RECEIPTS
03 2b/13 $1,200.75
i
Total Payments �1 200.75
,
Invoice#: }�7��9 Yage 3 Apri130,2013
• �Client No.:
Total Fees and Disbnrsements $483.00
� Retainers Used 50.00
Previous Balance $1,200.75
Total Payments Received $1,200.75
TOTAL BALANCE DUE 5483.9A
i
IMI'ORTANT NOTICES �
'I'ERMS: NET DUE UPON RECEIPT OF INVOICE I
A 18%annum interest rate on all outstauding balances existing after
thirty(30)days will commence with this billing statement.
Please note we accept Visa,MasterCard and Discover,
I
f
, DALEYZUCKER
MEiLTON & M1N�R, LLcC
635 N. 12th Street,Suite 101
' Lemoyne,PA t7443
For any questions�agerd'mg this invpiee contsnt
Ianet M.Fi�cr,Biiling Managu�727-724-4821.
Ms. Joaw�e L. Slusser Executrix
236 3.P7tt Street �
Carlisle,FA 17fl13
Pebrusry 28, 2013
Inv #: 137139
RE: Estafe Administration of Genevieve M.Laviska
Contract Matter with Curnberland Crossings
Cfient hTa. ]2-258
Matter IwTo. 001
IiATE LAWYER DESCRTPTT{}N �TOURS RATE AMOUN'T
avosrl� PC`I., Reseazch government regul,ations regarding 3.U0 $2?5.04 825.Q0
contintting c.�re commuuifies;draft snd revise
letter to Cumbexiand Crossings and send to
client for review
CMJ I7rs#ted ernail to olient re:reviewing leiter to a.20 $240A0 2$.00
Cumberland Crossings
OZt11J13 PCZ Telephone ca(1 with clienE re: revisions to 0.40 $2fiS,0t} 11fl.00
letter
CMJ Res�nrched Cumbertand Crt+ssings staff t7.30 $}4U,fl0 42,00
meuibers fax filing action against it
02/12113 PC"L Review anti finalize letter to Cumbertand 2Q0 $215.Od} 554.04 �
Crassiugs re: regulatory and eantractual (,
vialations f
CMJ Drafted emails Wtfmrn elient re:reviewing 2.20 $140.� 3t}%.00 ''
new drafts and Writ of Summons;Retrieved �
voicemail firam Mary Laviskare: comments to ;
letter;Prepared Praecipe far Writ of Sammons j
for review by Attorney Zucker �
d2l13t23 PCZ Telephone call with Mary Margaret Laviska Q.70 $275.UQ 142.5(}
re: Praecipe ta Fite Write agaznst Cumbertand
' y Invoice#: }��1�9 Page 2 February 28,�va.,
Ctsent No.: 2
�
Crossing,review service and proper parties ;
for service with Attorney Gingrich re:
finalizing Wtit of Summons against separate ;
, aor�rorate endties �
02/14/I3 KtvICr Con£erenoes with Attorney Zuckcr re: 4.50 $275.Q0 137.54 �
background and reviewed Secretary of State �
�ilings;conferred with Atkarney Zackar re: j
parti�to be sued
CM7 Researched Department of 5imte records for 2.t7� $14d.40 280.(t0 i
related Diakon companies;Revised Praecipe j
for Wret of Summons; Seazehed serviee fees
for Cumberland and Leigh eoun#ies;
Telephone cali with Mary Snoke re:address
for Jacnes i,aviska;Prepared Civil Cover
Sheet and Sheriff Request for Service forms
02115f13 CM7 Dratted email to elients rc: Pzaecipe for Writ 0.10 $]40.OU NtC
of Summons filed
PSM Travet tolfrom Cumberland County 0.50 $14t}.00 70.00
Cawhhouse fo file Writ of Swnmons against
Cumberland Cirossings
t?2l18/13 CMJ Read and responded to email fmm ciient re: d.20 $140.4() 28.00
Brother being left off Praecipe far Writ of
Summons
02l2T/l3 CM7 T`elephone catl from MaryI..�viska ce: 0.26 $140.QU 28.Ot
�ig�1pSWC5
{}2(22/t 3 CM7 Drafted emai!to Attorney Zncker re: 0.t 0 $140.fl0 N/
teleQhone call&am Mary Laviska
02/25/13 PCZ Review em�il re:payment of refiuid to alients 0.66 $275.00 1fi5
from Cumberland Crassing and discuss with
Paralegat Jurina;tetephone catl to Joanne
Slusser re: same
CMT Read email from ciient re: Cixmberland D.30 $14U.00
Crossin�s request for Short Certificate;
Retrieved voicemail frvm client re:same;
Discussion with Attorney Zueker
Tota(s 13.30 $?
EXI'ENSES
d2l14/13 Filing fee-Prothonotary
, y Page 3 Fe 28,2Q13 �
,..,ont No.: I�•2� b�ry
Piling fee-Sherif�'of Cumberland County 140A0
Filing fee- Sherzff of Lehigh County 3d.04
Totats _ $233.75
� I2ECEIPTS
01311i3 RctainersCarriedForward $I,839.00
Total Paymen#e 50.00
7:otat�'eea and Diabnraeroeats $3,039.75
Retainero Uaed $1,839.00
Previous Bslanee $OAQ i
Total Payments Received $p,pp
T4TAL BAT..ANCE DUE �1,200.75
�
TMl'OR'I'AIdT`NOTICFS
TERMS: ATE7'DUE UVC►N RECEIP'I`OF INVOICE
A 18°lo annum interest rate on all outstarnding balances existing a8er
thiety(3fl)days will commence wifh this billin�staYement. �
Please note we accepti Visa,MasterCarrd and Diseover,
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