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Home My WebLink About11-07-13 (2) J 1505610143 REV-1500 Ex(° "' OFFICIAL USE ONLY PA Department of Revenue pennsytvania courmy code year rife Number Bureau of Individual Taxes mearn OF aavr.a PO BOX.280601 INHERITANCE TAX RETURN 21 13 Harrisburg,PA 17128.0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 09 25 2013 08 09 1927 Decedent's Last Name Suffix Decedent's First Name MI RZEZNIKIEWICZ MARY M (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 WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return 2, Supplemental Return 3, Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate 41.Futuna interest Core -miso 5, Federal Estate Tax Return Required (date of death after 12-12-82) El $ DeoedeN Died Testate EJ 7 Decadeppt Maintained a Living Trust 0 $, Total Number Of Safe De Osit Bpxee (Attach Copy of Will) (Attach Gopy of Trust) P 9. Litigation Proceeds Received 10.b�oousal i2�gi ji�ra dit{Dl r Death E] 11.Election to tax under Sec.9113(A) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDWARD P SEEBER 717 533 3280 REt T::0 OF WILLIS U$F Cu o Clir Cu First Line of Address M T V a m Q tT1 SUITE 0400 rn --3 ::D ° i ce' o Ca Second Line of Address C7 Co C> -� G7 Q _,ri =<. 21 555 GETTYSBURG PIKE o c F 4_ City r Post Office TE FILE r` tY State ZIP Code M MECHANICSBURG PA 17055 Ln Correspondent's e-mail address: ePS@jsdc.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. atipn of preparer other than the Personal representative is based On all information of which preparer has any know(edge- SIGNATUR F PERSON NSI E FOR FILING RETURN DATE Frank Rzeznikiewicz I+ S 1 DD 5 Accen amp HiIICPA 17011 StGNATUR PREP ER R THAN REPRESENTATIVE DATE "---J,--'Edward Edward P Seeber ESS Sufte C-4060555 Gettysburg Pike[MechanicsburgLPA 17055 Side 1 1505610143 1505610143 1 1505610243 REV-1500 EX Decedent's Social Security Number Decedent's Name. Rzeznikiewicz, Mary M. RECAPITULATION 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule B)............................................................................. 2. 1 , 649 . 13 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. 100 , 279 . 62 7. Inter-Vivos Transfers&Miscellaneous lyoq-Probate Property (Schedule G) a Separate Billing Requested............ 7, 185, 155 . 59 8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 287 , 084 . 34 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 14 , 632 . 24 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 14 , 632 . 24 12. Net Value of Estate(Line 8 minus Line 11).- - - - -- - - - 272 , 452 . 10 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. 272 ,452 . 10 TAX COMPUTATION-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.00 15. 0 . 00 16. Amount of Line 14 taxable atiinealrateX .045 272 , 452 . 10 16. 12 ,260 . 34 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. 12 ,260 . 34 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 1505610243 1505610243 Rev-1503 EX.(6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rzeznikiewicz Mary M. 21-13 All property Jointly-owned with light of survivorship must be disclosed on Schedule F. ITEM CUSP VALUE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH 1 21 shares of Prudential Financial common stock-valued 78.53 1,649.13 per public listing TOTAL(Also enter on Line 2, Recapitulation) 1,649.13 (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 B(Rev.6-98) Rev-1508 EX.(01-f 0) pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Rzeznikiewicz, Mary M. 21-13 If an asset was made joint within one year of the decedent's date of death,it must he reported on schedule G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. Frank Rzeznikiewicz 5 Accent Circle Son Camp Hill, PA 17011 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY o DATE OF DEATH ITEM LETTER DATE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT /o D' FOR JOINT MADE NUMBER OR SIMILAR IDENTIFYING NUMBER.ATTACH DEED FOR DATE OF DEATH DECD'S DECED NTS NTEREST NUMBER TENANT JOINT VALUE OF ASSE INTEREST JOINTLY-HELD REAL ESTATE. 1 A Various 76 US Series EE Savings Bonds -valued per 7,749.18 50.000% 3,874.59 Savings Bond Wizard 2 A 09/29/2009 Metro Bank Checking Account No.*2344- 192,683.81 50.000% 96,341.91 valued per bank letter dated 10122/13 3 A 09/29/2009 Metro Bank Savings Account No.*4757- 126.23 50.000% 63.12 valued per bank letter dated 10/22/13 TOTAL(Also enter on Line 6, Recapitulation) 100,279.62 (If more space is needed,additional pages of the same size) Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule F(Rev. 01-10) Rev-1610 EX+(08.09) SCHEDULE G pennsylval INTER-VIVOS TRANSFERS AND DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Rzeznikiewicz, Mary M. 21-13 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECO•S EXCLUSION TAXABLE INLUDE NAME OF TNFEREE THEIR NUMBER THE DATE OF TRANSFERS ATTACH A COPY OF TIHE DEED DECEDENT FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1 Genworth Annuity No.410503051 -beneficiary is son; 60,926.19 100.000% 0.00 60,926.19 valued per letter dated 10126/13 2 Tillinghast Funeral Home-prepaid funeral 7,665.00 100.000% 0.00 7,665.00 3 84 US Series HH&22 US Series EE Savings Bonds- 56,729.60 100.000% 0.00 56,729.60 beneficiary is son;valued per Savings Bond Wizard 4 Nuveen Intermediate Duration Muni Bd I held in 59,834.80 100.000% 0.00 59,834.80 Nuveen Investments Account No.`3573-beneficiary is son;valued per statement and public listing TOTAL(Also enter on Line 7, Recapitulation) 185,155.59 (If more space is needed,additional pages of the same size) Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09) REV-1511 EX-(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX TURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Rzeznikiewicz[Mary M. 21-13 Decedent's debts must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: See continuation schedule(s)attached 90117.24 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State ZiD Year(s)Commission Paid 2. Attornev's Fees JSDC Law Offices 51500.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationship 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 9ERecapitulation) 14532.24 Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Rzeznikiewicz, Mary M. 21-13 ITEM NUMBER DESCRIPTION AMOUNT Funeral xo n 1 Maggie McFly's-funeral luncheon 523.93 2 Tillinghast Funeral Home-funeral services 8,593.31 H-A 9,117.24 Other Administrative costs 3 Register of Wills, Cumberland County-filing fee for 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) REV-1513 EX.(01.10) pennsytvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER Rzeznil iewicz, Mary M. 21-13 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER pERSONfS!RECEIVING PROPERTY DECEDENT (Words) ($$$) Do Not List Tms�sl I TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9116(a)(1.2)] 1 Frank Rzeznikiewicz Son Joint accounts& 272,452.10 5 Accent Circle savings bonds; Camp Hill, PA 17011 annuity&POD bonds Total 272,452.10 Enter dollar amounts for distributions shown above on lines 15 through to on Rev 1500 cover sheet,as approp 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 tI-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEE Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10) REV-1500 EX Page 3 File Number 21-13 Decedent's Complete Address: DECEDENT'S NAME Rzeznikiewicz, Mary M. STREETADDRESS 5 Accent Circle CITY STATE ZIP Camp Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2, Line 19) (1) 12,260.34 2. Credits/Payments A. Prior Payments 11,647.32 B. Discount 613.02 Total Credits(A +B) (2) 12,260.34 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 2FLine 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 Payable to: REGISTER OF WILLSa4GENT. 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;or............................................................................................................... ❑x d. receive the promise for life of either payments,benefits or care?............................................................ x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.................................................................................................................... ❑ ❑ 1 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 account, annuity,or other non-probate property which contains a beneficiary designation?.................................................................................................................. ❑x ❑ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YESDYOU 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)(1)], 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 172 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 i,r", 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. `11