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HomeMy WebLinkAbout04-09-14 (2) 1505610105 REV-1500 Ex(e2-I1)(FI)`,t�j" OFFICIAL USE ONLY PA Department of Revenue Pennsylvania Bureau of Individual Taxes """"`" ""`" County Code Year File Number PO BOX28o6o1 INHERITANCE TAX RETURN - Harrisburg,PA 17128-o6o1 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMODYYYY 04/18/2010 04/02/1942 Decedent's Last Name Suffix Decedent's First Name MI - - - ORLOWSKY JAMES 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 O 1,Original Return C@D 2.Supplemental Return C=) 3, Remainder Return(Date of Death Prior to 12-13-82) C=) 4.Limited Estate O 4a.Future Interest Compromise(date of t= 5. Federal Estate Tax Return Required death after 12-12-82) C=:) 6.Decedent Died Testate C=) 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) C=) 9.Litigation Proceeds Received C=3 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 Number Jacqueline M. Verney, Esq « O REGISTBRpF WILLS US6&LY rn M to 7 O First Line of Address rri S C) =:C; Cn _,0 44 S. Hanover St. A z n ca m rn .. co_ :a :uo Second Line of Address ;� p O n O T CD c '1 3 ' _W FILED •` City or Post Office State ZIP Code • D (p n Fn Carlisle PA 17013 ll_' o co -n Correspondent's e-mail address: Under penalties of perjury,1 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 DATE ADDRESS NATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE DDRE S �fk S l � A Sr PLEASE USE ORIGINAL FORM ONLY Side 1 1505610105 1505610105 J 1505610205 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name RECAPITULATION 1. Real Estate(Schedule A). .... . . . ......... . .......... ... ... . ........ .. 1 1 2. Stocks and Bonds(Schedule B) .. . . .. .... ... .. 2. 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) ... . . 3. 1 4. Mortgages and Notes Receivable(Schedule D) ... ... ... . ..... . . ... ... .... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E).... ... 5, 195,218.49 6. Jointly Owned Property(Schedule F) C=) Separate Billing Requested . . ..... 6. L 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C=) Separate Billing Requested..... ... 7. 8. Total Gross Assets(total Lines 1 through 7).. . .... .. ... .... .. . ... .... . 8. 195,218.49 9. Funeral Expenses and Administrative Costs(Schedule H)....... ... . ....... . 9. 750,00 10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1)... . .. . . 10 11. Total Deductions(total Lines 9 and 10)... ........... . .. . ..... . ....... . . 11. 1 750.00 12. Net Value of Estate(Line 8 minus Line 11) ..... . ... ................ . ... . 12. I 194,528.49 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. 194,528.49 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 16. Amount of Line 14 taxable ............ at lineal rate X.0 45 194,528.49 i; 16.1 8,753.78 17. Amount of Line 14 taxable at sibling rate X.12 17. l& Amount of Line 14 taxable at collateral rate X.15 1 19. TAX DUE ..... . ...... . . . .... . . .... . . .. . ... ... ... ... . .. . ... . 19. 8,753.78 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 1505610205 1505610205 REV-1500 EX(FI) Page 3 Fire Number Decedent's Complete Address: DECEDENT'S NAME James M. Orlowsky STREET ADDRESS -- --- - -- ------- --� - 55 West View ATE I ST PA 1 GTY -� __._ 7�P Carlisle 17013 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 8,753.78 2. Credits/Payments A-Prior Payments _ B.Discount _ Total Credits(A+B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 14 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) 8,753.78 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.................................................................-.................__ ❑ E b. retain the right to designate who shall use the property transferred or its income..................................___... ❑ N c. retain a reversionary interest............................................................................................................................. ❑ E 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 considermon?.......-............__............................._......._..........._..................._......_... ❑ 3. Did decedent own an"in trust for"or payable-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? ........_.._.._............_..............___...................., ❑ E 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 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 172 P.S.§9116(a)(1.1)(ii)].The statuto 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(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-15o8 EX+(oe42) t Mpennsytvania SCHEDULE E ' DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: James M. Orlowsky 21-10-0503 Include the proceeds of litigation and the date the proceeds were received by the estate. Ail property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1.' Kaiser Gypsum Company 195,218.49 L _ C� t t E f t 4 TOTAL(Also enter on line 5, Recapitulation) $ _195,218A9 If more space is needed,use additional sheets of paper of the same size. W E I T Z L U X E N B E R G A PR g P C S N1 V N Ai. CORPORATION • 1. A W O F F I C F, $ PERAY WEiTZ 700HROAADWAY • NEWYONK.NYigWJ--!KW TEL.212-SMLSNF PAN 212,3 !JIM ARTHUR M.LUKENSERG xvW W,N'E)TZU!%. 0m ROBERT J.GORDON tj PHAN T.ALVARADO AR FRIEDMAN* KEVINMULDERIGQ JONATHAN M SEWN 'O'FUnfl BENNO ASHRAFI• MAHYGNABISHGAPFNEYQ DANA M.NORTHCRAFT tt SHELDON SILVER' iuow�nnencY DW0J.BARRY ALAN GOIANSKIT TODDOMMEN ROBERT M.SRVERMANQ •MeeumxenR JAMES J.BILSBORROW DANIELLE M.GOLD jt FRANK ORTIZ" DONALD SOUTARQ 45.wmvwo.,en DANIEL P.BLOUIN LAWRENCE GOLDHIRSCH°' JOSIAH W.PARKER* CARMEN VICTORIA S,GEORGE fit i}°w wmuav,rm AMBRE J.BRANDIS KENDRA Y.GOLDHIRSOH MICRAELE.PEDERSON TYLER R STOCK AAxe.emn•uxoc EDWARD BRANIFF tj ROBIN L.GREENWALD'§§ PAUL J.PENNOCK PETER TAMBINI it •.we.emaw eox ,n:•e•emawnxJ matt JOHN W BROADOUSE CARLOSGUZMAN• STUART S.PERRY JAMES$,THOMPSON tt -ANrvMmatlnw xa oA VEN4JS BURNS* ERMA HEYDER LEEWPREViANP g§s WILUAMA WAL$N Tt ..+wsemaanwmvoc PATTI BURSHTYN tt MARIE L.LANNIELLO Y' CAITLIN PRZEMCZNY. DAMELWASSERSERG1 1tAw.e^nxenwern[ USANATHANSONBUSCH ERIKJAGOBS SHAREEF RAW LAUREN A.WEIR •Axaeemm.eaDC ma vA THOMAS COMERFORD tt§ DAVID M.KAUFMAN Tt ADAM C.RAFFO JUSTINJ.WEITZ ^Anernurmnro ADAM R.COPPER TAE-YOON KIM. SUZANNE M.RATCLIFFE tt NEIORA S.WILSON•• w0•em6° TERESA A,CURDN IM GARY R.KLEIN" PIERRE RAT2KI NICHOLASWISE- •ramrseemou BENJAMIN DARCHE DANNY R.KRAFT,JR EUERREUKINIUF DENA YOUNG t °6p'Y^w'envA TUT ORIN-) JERRYKRJSTAL-•§ JOHN E RICHMOND tT SPENT ZADOROZNY i .wwmmpax, t Aw;werya�M.W.iA W Va ADAM S.ORER EIRE DEBBI CHRIS MICHAEL RROMANE ROBERTS ALLAN ZUCKERM *t cmmn^ar.w4apnrmtwn MICHALFANELIV LEAHLEWIS• CHRIS ROMANEW 71 GLENN ZUCKERMAN •qe Nmir rM MICHAELARELLI tt MATT D.MARSHALL DAVID SAMSE ROSENSAND GT a^P^w^ah HxA JAIME M LEONARFF.FELM CARTEL MARSHALLI PETER SAMAVASTA LEONARD F.FEtDMANQ SAMUEL A,M RRMJ .Z GENNARO YOUNG CHARLE$M.FERGUSON JAMESAMORRI$JR.dtt CINDY YOUNG SAREYi 03/31/2014 Jacqueline M Verney Esq. 44 South Hanover Street Carlisle, PA 17013 RE: Jim Orlowsky #206368 Dear Sir/Madame: Enclosed,please find a check(s) in the amount of$195,218.49, which represents settlement proceeds Weitz&Luxenherg, P.C. has received from defendant(s)KAISER GYPSUM COMPANY, INC.. Please refer to the enclosed balance sheet for the details concerning this settlement payment. Please note that this estate has full letter status,therefore,in as much as your firm is the attorney for the estate of this client, it is your responsibility to ensure that these funds are properly distributed. If all necessary filings have been completed for this estate and you wish to have future checks made payable to the estate representative,please notify us in writing of such request. Should you have any questions, please contact our Estates Attorney, David Kaufman at(212) 558 - 5687. Sincerely, WEITZ,& LUXENBERG,P.C. Accounting Department 200 LAKE DRIVE EAST,SUITE 205 CIIERRY HILL,NJ 08002±TEL 856-755-1115 1880 CEI\ITIJRY PARK EAST.SUITE 700 •LOS ANGELES•CA 91067 •ML 310-247-0921 ; p ( A ( g � ( ; XD . � x*© \ R [ \ \ \ \ . o �£ 2 �2 D / �& k :n _ ) ;2 A . . . / � ;3 � A _ t � G < -{ AAAA (- T� mmmmo0000 ( y M m m m c m m O --: M m m m m m m m m A m m m m 0 K o 0 K 3 K 3 t N N A A O M 00 0 0 0 0 0 0 0 0 , Z Z Z Z C C m m m m ..1 .1 :q3NOo -goommmmmmmoDD ➢ DAAA AA m m A V m m D m A A D O o A A A A A A ➢ .� ,� n O n 3 't j 1 1 p 3 � m m - Fj m m m m m m m � c c c c O O z z z v mm ZZ 'Ar ZT➢. DT. m AA xxxxx -XO V n � GZi GZi G� cCiJ � k kx . n Z Z A A O A N N A A A A A A A o m m A A A � -i m m * A � m m m m m m m m m c r r A A A O O A N p A ANN N N N N N 'p m m m m m ,a m mm007 T < GNNNNNNNp G7 G7 NNN H zzAA { 0550 0000Oz DDNNN MMzz 3v W AAAAAAA NN ,'^ 9 () G) DrrATATTTT mm /VII OO [ o o ,'lm7 m Am x .Tml .'fml ,TmJ < < \V 00 m -0 'U m � � -i -i m m K v z 55555 z z z z r r 00 Ix N n n 3 N N a N CL 0 N - o v to m V N V (W O V Ca iI N O + O JN � A � O W J A R A N O N O (T VW O W J J O O A A A O N N N OD A W W O O V Ut fJ O Vt J O <O O O W A O A Co N A O Iv 0 Cn N V O (O (T (T O O Ut O A 0 0 W (O CD W J N OI O O W N (O Ut O N O N ° � 3 N V N In O. V W J+ A A Ut G9 N Vt 19 di di di O Vt ER O tit fA EA W OD (O (p N cow IJ m A W W O O J <T <.J O Vt J O t0 O G W A O A 00 N A (Ji IJ f0 Ut IV 2 m O � p P 07 W AAZC73 � m 'ov � � 3 ➢ 3333DDD (rJg � ADD 2 - O O m m O O m m m A O N N N a (m/� x F 0 0 N (J p� m N N N d N N N y N C pj O N N m m m J m m m �j m m m m m Q7 N N N N m m m m m m A m °m °m m m x m m m m x m m _ m °a. m m m m"m m m m 0 o m m °o m C') n 2 2 N N m O (n N N (J Z, Z, Z N N m N CD N mN N N O W 0 ON N W m J J C n m c> 3 o � 0 o W � W m � m F ❑z N S �T O a C) g 3 i I. Distribution No.: 0 Payment No.: 2471690 WEITZ&LUXENBERG, P.C. 710601 ATTORNEY'S TRUST ACCOUNT Mar 31,2014 '"One Hundred Ninety Five Thousand Two Hundred Eighteen and 49/100 Dollars $195,218,49 Jacqueline Verney Esq. as Attorney for the Estate of Jim Orlowsky Jacqueline M Verney Esq. 44 South Hanover Street Carlisle,PA 17013 Orlowsky,Jim 206368 KAISER GYPSUM COMPANY.INC. FOR SECURITY PURPOSM THE FACE OF THISDOCUNIENT CONTAINSACOLORED BACKGROUND AND MICROPRINTING IN THE BORDER i . . .. . . .. CITIBANK F.S.B.NEW JERSEY - Check No. ./—,�J }-WEI.T,Z& L'UXE NB ERG,,P—.r G. IS.ELIN,.I NEW.JE.R.S EY 08830 l ' 5-272 - 7106016 ATTORNEYS TRUST ACCOUNT. N,-700-BROADWAY NEW YORK,NY_1003 i " ~- Mar 31,2014 PAY, r"'One Hundred Ninety FiviiThousand Tvio Huiideed Eighteenand.491100 Dollars $195,218,49 TO THE " as Aomey or the Estate'of Jim Orlowsky,l E i , - ORDER-oF- ! .„ Jacgaeline_M Veifiey Esq vac FNgrvRESEN EaxmaNmwra 44 South Hanover Street '"' "`�' Carlisle PA�7013 � '�' r "� • L KAISER GYPSUM COMPANY,.INC u■00 ? 1060160 1:0212 ? 26550 75955 ? ?IS ?It' i REV-1511 EX+(08-13) pennsytvania SCHEDULE H ; .1 DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER James M. Orlowsky 21-10-0503 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES:_, B. ADMINISTRATIV€COSTS: I. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: I rr 750.00 —j 2. Attorney kes: - ,,•� A. 1. eri 3. Family Exemption: (If decedent's address is not the same as clalmant's,attach explanation.) ` Claimant r Street Address qty State ZIP Relationship of Claimant to Decedent 4. Probate Fees: S. Accountant Fees: b. Tax Return Preparer Fees: 7. TOTAL(Also enter on Line 9, Recapitulation) $y _ 750.00 If more space is needed,use additional sheets of paper of the same size.