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HomeMy WebLinkAbout09-09-13 REV-1500 Ex(01-10) 1505610143 PA Department of Revenue y OFFICIAL USE ONLY p peons Ivania County Code Year File Number Bureau of Individual Taxes M"""'"'E"*°"EvE""• PO 80x.280601 INHERITANCE TAX RETURN 21 Harrisburg, PA 17128-0601 RESIDENT DECEDENT I ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 05 31 2013 04 04 1936 Decedent's Last Name Suffix Decedent's First Name MI CHAPLIK THOMAS D (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI CHAPLIK FREDA J Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW X❑ 1. Original Return 2. Supplemental Return 3, Remainder Return(date of death prior to 12-13-82) 4. Limited Estate 4a,Future Interest Compromise ❑ 5. Federal Estate Tax Return Required (date of death after 1242-82) X❑ g Decedent Died Testate 7. Decedent a Living Trust B. Total Number of Safe Deposit Boxes (Attach Copy of Will) Copy v Trust) 9. Litigation Proceeds Received 10.bpWal P2 3191 anEitt(dattesolf death 11.Election to tax under Sec.9113(A) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytim9enphone Number JERRY A WEIGLE ESQUIRE 717532 738:8 :23 z REGISTER OR WILuS USE ONLY V31 ^ V First line of address O c-= 126 EAST KING STREET o Second line of address a I_s cn n F-_+ 'r1 City or Post Office State ZIP Code DATE FILED SHIPPENSBURG PA 17257 Correspondent's e-mail address: 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 knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN � DAIE / �n !S a 6 ,�_�� Freda J Chaplik S ADDRESS �I - 219 nior Drive Shippensburg, FJA 1725 SIGN TUR OF PREPAR R OTHER THAN REP SE T I E DATE erry A.Weigle Esquire ADDR 126 East King Street, Shippensburg, Side 1 1505610143 1505610143 J 1505610243 REV-1500 EX Decedent's Social Security Number Deadens Name-. Chaplik, Thomas D. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3. 4. Mortgages&Notes Receivable(Schedule D)........................................................ 4. 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 7. Inter-Vivos Transfers&Miscellaneous Nor-a Probate Property (Schedule G) Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1-7)..................................................................... g, 9. Funeral Expenses&Administrative Costs(Schedule H)....................................... 9. 3 ,213 . 00 10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1).............................. 10. 11. Total Deductions(total Lines 9&10)................................................................... 11. 3 , 213 . 00 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. -3 , 213 . 00 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)............................................... 14. -3 ,213 . 00 TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 0 . 00 5. 0 . 00 (a)(1.2)X.00 16. Amount of Line 14 taxable at lineal rate X .045 0 . 00 16. 0 . 00 17. Amount of Line 14 taxable at sibling rate X.12 0 . 00 17. 0 . 00 18. Amount of Line 14 taxable at collateral rate X.15 0 . 00 18. 0 . 00 19. Tax Due..................................................................................... .............. 19. 0 . 00 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 Decedent's Complete Address: DECEDENT'S NAME Chaplik, Thomas D. STREETADDRESS 219 Senior Drive CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments B. Discount 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) Check box on Page 2 Line 20 to request a refund 5. If Line t +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (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;........................................................................ ❑ ❑x b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x c. retain a reversionary interest;or............................................................................................................... ❑ ❑x d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.......................................__........................................................................ ❑ ❑x 3. Did decedent awn 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 Account,annuity,or other non-probate property which contains a beneficiary designation?.................................................................................................................. ❑ ❑x 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)In)]. 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 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,whether by blood or adoption. Rev-1508 EX-16-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENTDECEDENT ESTATE OF FILE NUMBER Chaplik, Thomas D. 21 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned vAth the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ALL ASSETS JOINTLY OWNED WITH SPOUSE TOTAL(Also enter on Line 5, Recapitulation) 1.00 (If more space is needed,additional pages of the same size) Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.6-96) REV-tl51 E%+(10-06) SCHEDULE H COMMON WRIEALTH OFPENNSVLVANIA FUNERAL EXPENSES & IN RESITDENCTOTTECEDENTRN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Chaplik, Thomas D. 21 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 3,123.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zio Year(s)Commission paid 2. Attorneys Fees Weigle &Associates, P.C. 75.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zip RelationshiD of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 15.00 See continuation schedule(s) attached TOTAL(Also enter on line 9, Recapitulation) 3,213.00 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Chaplik, Thomas D. 21 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Dugan Funeral Home 3,123.00 H-A 3,123.00 Other Administrative Costs 2 Register of Wills, Cumberland County-filing Insolvent PA Inheritance Tax Return 15.00 H-B7 15.00 Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98) SCHEDULE J COMMA WREALTCH6Fgp%ENNGUY VANIA BENEFICIARIES IN RES" '� EnTEGEROENTR� ESTATE OF FILE NUMBER Chaplik Thomas D. 21 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSON(S1 RECEIVING PROPERTY DECEDENT {Words} {$$$) �• TAXABLE DISTRIBUTIONS [include outright spousal Do Not U Tmtdsl distributions,and transfers under Sec.9116(a)(1.2)] Not relevant as estate is insolvent Total Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 15C cover sheet,as a ro riate. 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 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev. 11-08) LAST WILL AND TESTAMENT 1, THOMAS D. CHAPLM presently residing at 219 Senior Drive, Shippensburg, Shippensburg Borough, Cumberland County, Pennsylvania, 17257 being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all Wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my beloved wife, FREDA J. CHAPLIK provided that she survive my by a period of sixty (60) days. THIRD. In the event that the said FREDA J. CHAPLIK should predecease me or is not living on the 60"' day following my death, I then give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate to my son, namely, MARK D. CHAPLIK, on a per stirpes distribution basis. FOURTH. I nominate, constitute and appoint my wife, FREDA J. CHAPLIK, to be the Executrix of this my Last Will and Testament. In the event that FREDA J. CHAPLIK be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint my son, MARK D. CHAPLIK to be the Executor of this my Last Will and Testament, FIFTH. I direct that neither my personal representatives shall not be required to give bond for the faithful performance of their duties in any jurisdiction. i IN WITNESS WHEREOF, I, "THOMAS D. CHAPLTK, have hereunto set my hand and seal to this my Last Will and Testament,. written on one (1) page, the first page signed for identification only,this day of 3'vj w/ ,4m7 2010.. (SEAL) WEIGLE a ASSOCIATES, P.C. - ATTORNEYS AT LAW - 125 EAST KING STREET - SNIPPENSSURG, PA 17257-1397 This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in the presence of each other,we believing him to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. Aj Ag- COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND I, THOMAS D. CHAPLIK, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. THOMAS D. CHAPLIK Sworn or affirmed to and acknowledged before me by,-�T�HOMAS D LIK, the T tator, this G/• day of 10. otary aJ COMMON'WA LTH OF PENNS VLVA NIA EofShyi TAII �EA� y,, es Octpber 07,2070 WEIGLE 6 ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG, PA 17257-1397 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND We> I r I rA r 1 re U ]t�S�f( t� t•<. f (17�1Zt and d .,.� f �j�12�w� the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw THOMAS D. CHAPLIK, the Testator, sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator, signed the Will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me bY�� �rICI 1 ✓ F �! Y and �� _/ r �fma witnesses, this day of 1201 Notary 4 COMMONWEALTH 6E PENNSYLVANIA NOTARIAL SEAL Jerry A.Weigle,Notafy.Public [Cemycommission ity of Shippensburg,Cumberland County Expifes°October 07,2010 WEIGLE & ASSOCIATES. P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 / M3M = x290 � j D -u U2 Cl) > Ch 0 " CD § m (D 4 8 G § / — � | ( n r \ \ m 2 § K § Cr) \ � \ , 0 \ \ a rA \ \ / % _ \ ¢ } ! G . f / . ( 4 � j\ m% Fm Ow \ ( � \\� |�� [ 00 7 . /{ L4:!