HomeMy WebLinkAbout01-23-14 1505610105
REV-1500 EX(m-n) FI'
OFFICIAL USE ONLY
PA Department of Revenue pennsylvama
Bureau of Individual Taxes .. E. County Code Year File Number
PO BOX 28o6o1 INHERITANCE TAX RETURN I I P1� /
Harrisburg,PA 17128-0601 RESIDENT DECEDENT (..J (
ENTER DECEDENT INFORMATION BELOW -
iia7a0 13 v3 2 �- / 1718
Decedent's Last Name Suffix Decedent's First Name MI
D PAA15Z !f£l- ErJ M
(If Applicable)Enter Surviving Spouse's Informatlon 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 O 2.Supplemental Return O 3. Remainder Return(Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Return 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 Will) (Attach Copy of Trust.)
O 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 TO:
Name Daytime Telephone dumber
ROBERT M. OPA�EL 7E3 � 3t7 �'o &
W SCR OF*LLS 4 JgLY
r- z m r V r l r'rT
D W DO S7
First Line of Address 7c O C3
� 5� a s � �PFvkD Rom C> C=
Second Line of Address ::0 P" 1T7
;> fn (n O
C
City or Post Office State ZIP Code DATE FILED
M ik�- cN/Ow/ s B 1/RG PA
Correspondent's e-mail address: 0420M e!/r O Cornea sf he74
Under penalties of perjury,I declare that I hav 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 preparerr has any knowledge.
SIQIN TSPN RE$gpNSIBLE FOR FJIJNG RETURN / / JO"E1IT
A(//SO". PMrI/X%�//o2.CR(/•i•Dl r• r/ ��r
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505610105 1505610105
V J
-I 1505610205
REV-1500 EX(Fl)
1,
RECAPITULATION
1. Real Estate(Schedule A). ............................................ 1. D
2. Stocks and Bonds(Schedule B) ....................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. Q
4. Mortgages and Notes Receivable(Schedule D). .......................... 4. o
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. C�SL f• a 9
6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. ✓ D
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets(total Lines 1 through 7)...................... ....... 8.
9. Funeral Expenses and Administrative Costs(Schedule H)................... 9. /0 O 94
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............... 10. O
11. Total Deductions(total Lines 9 and 10).............. ................... 11. _ ! 0 0 V3• /,�/
12. Net Value of Estate(Line 8 minus Line 11) .............................. 12. Q
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) ........................ 13. Q
14. Net Value Subject to Tax(Line 12 minus Line 13) ...................... .. 14. G
TAX CALCULATION-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.0_ 15.
16. Amount of Line 14 taxable
at lineal rate X.0�t 16. Q
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE ......................................................... 19. Q
20. FILL IN THE OVAL IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT p
Side 2
1505610205 1505610205 J
REV-1500 EX(Fl) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
�E
4/j!5 L
STREETADDRESS
5ia sH o
clry �ECfFfM//CSeJ,�G STATE NC %70SS
Tax Payments and Credits: ^
1. Tax Due(Page 2,Line 19) (1) 0
2. Credits/Payments
A.Prior Payments
B.Discount
Total Credits(A+B) (2) 6
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) Q
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.......................................................................................... ❑
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?.............................................................................................................. ❑
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ to
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
containsa 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)(1)].
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 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 F2 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-1548 EX+(08-u)
�+7 pennsylvania
SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TM RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
/-J L EW Al . D Pfln/EL
include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MEme"S r /fir dREDlT 41W10d 5itV 10yGS Acaoun/T 553/, yf-,
F,Pam Big PA D e-1Z> �a .zd�3 4244. �fS
n/s�ie�.✓c�' ART" �fAD � i�kod6->� ,/
GLOP/ES ENCLOSES I°oR ME7n8�i s I S
jQC U(17— A-ND
"N.k4,4Ca- k o/�
TOTAL(Also enter on Line 5, Recapitulation) $
If more space is needed,use additional sheets of paper of the same size.
l� *zed M, G�i✓�G`S fISS�S DATE FROM DATE TO PAGE ACCOUNT NUMBEiR7
rVf. Mgnbcrs I>t Pedcml Cnrlit Unf.x+ 11!01/2013 11!30/2013 i Of 1 XXXXXXX100
5000 Lnuo-c D ri1r
P0.Box 40 39-4100
Koie hanicsUurg PA 17055-0040
MEMBERS 19 (7 17)597-5312(Hearing Imps red)
rme6ercamrr uKns •+}�w.on.7nhcrslA.otg VISA
ro Gift Cards
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1512 RD Click here or visit:
MECHANICSBURG NICSBURG PA 17055
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ACCOUNT BALANCES
Your aggregate balance as of November 1 St is$7,031.13.
An aggregate balance of$2,500 and having 3 products will place you in the Silver MLR level.
CHECKING 0.00
SAVINGS 5,531.84
CERTIFICATES 0.00
LOANS 0'00
REGULAR SAVINGS 1111
BEGINNING BALANCE: $5,64213
Eff. Post
Date Date Description Deposits Withdrawals Balance
11101 11101 Deposit ACH CMWC TREAS 310 625.00 6,267.13
TYPE: FED ANNU ID_9101036009 CO:CMWC TREAS 310
11101 11101 Deposit ACH XXSOC SEC 764.00 7,031-13
ID:9031736026 CO:XXSOC SEC
11/05 11105 Withdrawal 1,500.00 5,531.13
11/30 11/30 Deposd Dividend 0.150% 0.71 5,531.84
Annual Percentage Yield Earned 0.1509'6 from 11101/13 thru
11/30/13
ENDING BALANCE: $5,531.84
Total Deposits 1,389.71 Total VWWrawals 1,500.00
• SUMMARY
TOTAL DIVIDENDS PAID
0000 REGULAR SAVINGS 9.48
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REV-1511 EX+ (08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Hit/ /Yi, oPAn/E"L
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTIO AMOUNT
A. FUNERAL EXPENSES: of
I. 00VITZ dome 602 F[k)(4CO S - BicG g-rve"S6v
Sti rr mitOs ewh6794eY - 69q✓Fss176 oa
shirr MffRY:5 CNaRCt1- F0r fvre 96-1-414-*l04-s a ✓,cam s ,a
SArnV7- MAAYs cyURCH 012609n/Is7 /v0 . 00
FGORaL Agee kY— Fcojwe& 6b e Fui✓F � 338, /'�
W I C- G//416/U- S6✓iCE 3 &.2. 00
'q i4 pnmlcY Airum rw/i4 �
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City, _State ZIP
Year(s)Commission Paid:
Z. Attorney Fees:
3. Family Exemption:(if decedent's address is not the same as dalmant's,attach explanation.)
Claimant
Street Address
City_ State__ZIP _
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 0073•
If more space is needed,use additional sheets of paper of the same size.
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i.Yr,aa ite lJ<:eeae fctl t Elnn'r,#;.,, I ;i
40 N.Jardm St,Shenandoah,PA 17976
(570)462-9333 (570)462-1710
Stephen F.Cravitz-Presidmt
Bradley J,Oravitc-Supervisor Stephen F.Oravitz 11-Fanrml Dirtclur
tii.ifcm ;i3t
of Goods and `vrvice.s Sclected
Charg•a are only for thou Manta that are used M we are nquired by law to we any Men»,we win explain in writing below.If you Matted a funeral which required embakning,such as
a fun"with a Mewing,you may hereto pay for en4ahning.You do not have to pay tot etnaMabtg you dad not appraea ilyou ulecied amngatwma Soon"*Met 0000dw or
lmmediate bwwN f"CliNged(a"abdraN,we VA expiam the ream below.
For the Services of: Helen Opanel Date: 11/27/2013
Services of Funeral Directorlstaff $ 2,445.90 Style Signet
Embalming $ 625.00 Manufacturer V-ray
Other Preparation of Berry ; - Material 20g Prot
Dressing,Casketing,Cosmetology ; 195-OD PRICE
3.500.90
Sanitary Core ; - a 1 e
Autopsy Care ; Style Monticello
SUBTOTAL Of PROFFSStONAt SERVICES S 2,315.00 Manufacturer Wilbert
a a Material Concrete
Use of Facilities for a Viewing $ - _ ., A., _ PRICE $ 1,500.00
Use of Facilities far a Funeral $ 300.00 ♦ z ;
Use of Facilities for a Memorial Service $ - Style
Use of Equipment for Graveside Serivca S - Manufacturer
SuBTlyiAtof FACAU f£aMFPM€N7 3=00 Material
• a • PRICE $
Transfer of Remains to Funeral Home ; 175.00 tY L+ a a
Use ofHemse $ 200.00 Acknowledgement Cards $ _
Use of Limousine for Family $ 100.00 Register Book $ 25,00
Use of Limousine for Pallbearers $ 100.00 Memorial Folders $
Lead CorlClergy Car $ SMOD Prayer Cards
$ 50.00
Flower Car $ 50,00 Temporary Grove Marker $
Non Local Milage $ _ Burial Clothing $
Charge far Non local Miloge($3.a'lmll $ - Cmmlowdtfa $ 25.00
SUBTOTAL OF AUTOMOTIVE EQUIPMENT 5 675.00 Cremation Accessories $ _
CC,f& ,p 'S Other Mucegmteaus Merchandise $ _
Grave Opening ; - 'SUBTOTAL OFSEFEC EDAORCHANars€ $ 5,1 .00
CemeterylCrematory Charges $ _ Il - sp
tot and Deed $ - Forwarding of Remains tp:
Newspaper—Local $ 165.00 $
Newspaper--Non-Local $ - Receiving ofRemainsfrom:
Pallbearers $ Theis Funeral Chapel
Clergy)'Ma"Offering $ - hnmedmte Barial $ _
Organist $ Direct Cremation $ _
Certified copies of Death Certificate $ 48.00 SUBTOTAL OFSP€ElAL CHANGES ��5 t�„erl.i -
Hairdressing $ 40.00 +' ,#ik' 2A><,rl t� "a.f U. ?
Flowers $ - Professional Services $ 2,315.00
Mhr. $ Facilities and Equipment
$ 300.00
DISCOUNTS $ 25MOD Auranwhve Equipment $ 675.00
sF1etDMLaFCaSffaai[AiyarrEnPS - _ Merdandne ; 5,100.00
Reason for Embalming: Viewing special Chwges $
Cw'h Advance $ 3.00
e.art...,.,.nr„v...•n.�.t=rv..raw.m�n:ww«w.aex,Pram«a+maa.»nn.ra.e.,.,ms+.. ._ _
kutopsy Care $ - Style Mvrru,.c.ry
SUBT&AUOF7RtaF,65MFtAl� ,$ ?,;25 91t. Manufacturer Wilbert
+ Material Concrete
Use of Facilities for a Viewing $ - PRICE $ 1,500.00
Use of Faciliies for a Funeral $ 300.00 +
Use of Fadfides for a Memorial service $ - Style
Use ofEquipmentfor Growstde seriKe $ Manufacturer
,SUBrOTALaFFACBrTr 'QeNP? r _ `$ •3(lO;DD: Material
• • + PRICE $
Transfer of Remains to funeral Home $ 175.00
Use of Hearse $ 200.00 AC4e1nentCarts $
Use of Umoushie for Fam4 $ 100.00 Ragrster Book $ 2S.00
Use of Limousine for Pallbearers $ 100.00 Memorial Folders $ -
Lead CtalOergyCar $ SOAD PralierCanis $ 50.00
Flower tar I$ 50.00 Temporary Greve Mmher $
Non Local M11We Is - soda!Oohing $ -
ChorgeforNan-Local bFilape ta®lien? $ - CraaslCrudfht $ 25.00
Spa76Te±corAlurc!JlW?,11rkttr1/mifilE,Ni° $ . 7•J -, Cremation Accessories $
. « , Other Miss immous Merchandise $
6raveOpeting $ StalorAL,OFSE1E6tE0 rjt'IDQ.QO_
CemeterylCminotory Charges $ "'
Lot and Deed $ - Forwarding of Remoms to:
Newspaper—Local $ 165.00 $ -
Newspoper—Non-Local $ - Receiving of Remains from:
Pallbearers $ - Theis Funeral Chapd
Ctergylbrass Offeft $ - hnmeckne Burial $
Organist $ - obecrOemation $ -
Cerafted Copies of Death Certtffcate $ 48.00 `" SUaTDTAI.r)FSpEdAL[HARG@$ "
Hairdressing $ 40-04 - - + --- -.
Flowers $ - Profiessional S"Woes $ 2,315.00
Mitt: $ Fdaides and Equipment $ 300.00
DISCOUNTS $ 250.00 Aummadw Equipment $ 675.00
suerartaPCASHtirvAtErrtdls $ 300' Merchandise $ 5,100-00
Reason for EinhaTrninng: ' - " - Viewing Spedal Marges $
Cash Advance $--- -- 3A0-
•wr».ana.a�.+w.•n.r...+N...mw.+a.r.a..«+n«wew..r«+wsu.ie. :-..
rarALaFiuesetacrwnt; $.' 8.393'00
..wa..eR....wiw t.�.
Cemetery repMes v alt Less Payment Received
FINAL TOTAL $8,393,00
lherebyagreethaKlhaseamminad dw abovesmRd aemsandfouudthem to bettrrertandoomni pq mdtemmapemmtsrequestrdand I herebyadmewledge reiriptof
trelsmemomndum amlrtgrtrmmt lherebynpretentdwtrharemf dmtam[konoa OOkforpaymmta fareoahprkrmdherebyoog andmm ntjoin*and
t hw ,mmakefuHpaymmrwFWht 30 dtys AletedimgeafLS%permonfhammmarsm 18%perymrrrappRtdmike unpddbakmorbegmnlag 3adrysslmm the
dareofthlsagreement Anyaddraonat narolatrarme++chandlsroffered nrnquesmd gberdredomafthh WrementwW be amstdened iwrrefthb si;n anentand die cost
dw mf will be reflec rd on the finatHa¢ment
Purchaser: Robert M.Opanel
Purchaser:
Licensed Funeral Director: Stephen F.Oravitz Date: X11/29/13
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TN+►T MARLENE R. OPANEL
S ROBERT M. OPANEL /���p6 '!a'3 3196
7 �E 1512 SHEEPFORD ROAD 7'
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/+ ME CSBURG,PA 17055 D /
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MARLENE R.OPANEL 93��U7v Z OD-OM/2313 3197
ROBERT M.OPANEL
1512 SHEEPFORD ROAD 3
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MECHANICSBURG,FA 17055
PAY
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} I� `� DOLLARS
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423 38224V: 0041138843112 3 &97
MARLENE R.OPANEL 717- e0-8224/12313 3195
ROBERT M. OPANEL ��p�
1512 SHEEPFORD ROAD ?37 , , ,, ., .'C- 15�:
i A 17055 ( /�C�"KM�t $ 1a2 A.rr ne
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F Ot"dl Array Statement
.. Date: 12/02/2013
310 Mahanoy St •Zion Grove,PA 17985 Customer ID: 2713
570-384-2221 • 800-724-3184 Last Payment Date: ii1dT
www.floralarray.com Last Payment Amount: $
Amount Due: 338'14 ;gyp
Amount Paidt 33 , 1
i Bill To: Oravitz Home For Funerals
40 N.Jardin Street
Shenandoah, PA 17976
Please fold on the line above and detach and return with your payment.
Payments Remaining
Date Transaction Ds1a21 Product Description Total . late Fees Applied Balance
30-Nov Inv.#-009156 Ord.#-019165 Casket Spray In Pink $338.14 $0.00 $0.00 $338.14
to Helen Opanel Lavender&Yellow'Dear
Mom'On Ribbon. Carnations
Etc.
Matching Baskets �t
1-Grammy- P'°'�'��J .
1-1G G'On Ribbon
Loose Fresh Flowers-
Something Small For In Her r�fl
Hands
vvx.M CL i�.I X11 i to
Customer ID: 2713 TOTAL DUE: I $338.14
Oravitz Home For Funerals Due Upon Receipt
Thank You For Your Patronage For 26 Years.
New Showroom Hours Monday- Friday 9:30 AM To 3:30PM Or By Appointment. Call And Leave Us A
Message At 570-384-2221. And We Will Return Your Call As Soon As Possible. Thank You For Your Busines:
And Have A Wonderful Day.
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MARLENE R.OPANE
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ROBERT M.OPANEL u �E
1512 SHEEFFORD RO 7055
MECHANiCSB (A 170% $ 3 2Q /
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ITEM
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TAX DEDUCTIBLE ITEM
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REV-1513 EX+ (01-10)
itDEPARTMENT OF REVENUE
pennsylvania SCHEDULE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
#6ZEn/ NI. OPAi✓EG
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. Ro13ETZT (V( , 0P1tM9_L soul 50� of
/51.2 sN-eZ°Fa seD "i+P Asters LisT� on/
a, EaDw�2.D O�P/}i✓EL �oN 5.090 of
i� Pf+Trc�sen�vl�E ,20 uS7Z�D on/
��i✓�aJN, P� l79`7 5�dt� E
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II NON-TAXABLE DISTRIBUTIONS
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX 15 NOT TAKEN:
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
If more space is needed,use additional sheets of paper of the same size.
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