HomeMy WebLinkAbout04-14-14 (2) 1505610140
REV-1500 EX (02-11)(FI)
OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 4 0 0 3 6
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
1 1 0 2 2 0 1 3 0 3 2 5 1 9 1 7
Decedent's Last Name Suffix Decedent's First Name MI
L E N D A I R E N E 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
❑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(date of ❑ 5.Federal Estate Tax Return Required
death after 12-12-82)
❑X 6.Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust.)
❑ 9.Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 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
S U S A N H C O N F A I R 7 1 7 7 6 3 1 3 8 3 '�:
REGWrER OF WILLnZE O$bY m
C) S n
First Line of Address m = n Q
i
2 3 3 1 MARKET ST R E E T ny �m s "' m
r � o
Second Line of Address Try o
o C�
c7 o T n
City or Post Office State ZIP Code `DATE FILHDJ 1"' Frt CD
CAMP HI L L PA 1 7 0 1 1 Cn � n
Correspondent's e-mail address: SCONFAIR .REAGERADLERPC.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.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SlQf^TURE OF PERSON RESPO LE OR FILING RETURN 3D7E
3
ADDRESS
21 AMHERST DRIVE CAMP HILL PA 17011
SIGNATURE O PAR HAN REPRESENTATIVE "3//
ADDRESS
2331 MARKET STREET CAMP HILL PA 17011
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140
1505610240
REV-1500 EX(FI)
Decedent's Social Security Number
decedent's Name: IRENE M. LENDA
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . .. . . . . . . .. . . . . . . . . . . .. . . . . . . . . 1.
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . .. . . . . . . . . .. . . . .. . . . . . . .. . 2. 3 1 6 6 , 4 1
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . .. . . 3.
4. Mortgages and Notes Receivable(Schedule D) 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). . . .. . . 5. 1 3 7 0 9 • 0 0
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 6 5 8 8 • 0 2
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested . . . .. . . 7.
8. Total Gross Assets(total Lines 1 through 7) 8. 2 3 4 6 3 , 4 3
9. Funeral Expenses and Administrative Costs(Schedule H) . . . . .. . . . . . . . . .. . . 9. 5 9 8 3 . 5 7
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) .. . . . . . . . . . . . 10. 8 3 7 , 3 9
11. Total Deductions(total Lines 9 and 10) . . . . .. . . . . . . . . . . . . . . . . .. . . . . . . 11. 6 8 2 0 . 9 6
12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 1 6 6 4 2 . 4 7
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. 1 6 6 4 2 . 4 7
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 0 . 0 0 15. 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate x.045 1 6 6 4 2 . 4 7 16. 7 4 8 . 9 1
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 0 0 17. 0 , 0 0
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 0 0 18. 0 , 0 0
19, TAX DUE . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . .. . . . .. . . . . . . . . 19. 7 4 8 . 9 1
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L 1505610240 1505610240 J
REVA 500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 14 0036
DECEDENTS NAME
IRENE M. LENDA
STREET ADDRESS
21 AMHERST DRIVE
CITY STATE ZIP
CAMP HILL I PA 17011
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 748.91
2. Credits/Payments 728,63
A.Prior Payments
B.Discount 37.45
Total Credits(A+B) (2) 766.08
3. Interest
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT. (3)
Fill in oval on Page 2,Line 20 to request a refund. (4) 17.17
5. If Une 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 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 ............................... ❑ 0
c. retain a reversionary interest ..................................................................................................... ❑
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? ....................................................................................... El Q
3. 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?.................................................................................................. ❑
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 lax 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
[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(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-1503 EX+(8-12)
pennsylvania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
IRENE M. LENDA 21 14 0036
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. PRUDENTIAL FINANCIAL, INC. - 39 SHARES WITH A DATE OF DEATH 3,166.41
VALUE OF $81.19 PER SHARE
TOTAL(Also enter on Line 2,Recapitulation) $ 3,166.41
If more space is needed,insert additional sheets of the same size
REV-1508 EX-(08-12)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
IRENE M. LENDA 21 14 0036
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. FULTON BANK-CHECKING ENDING IN#54003 1,118.00
1 PENN SQUARE
LANCASTER, PA 17603
2. VA BENEFITS -ACCURED BENEFITS UNDER VA FORM 21-601 12,091.00
3. PERSONAL PROPERTY 500.00
TOTAL(Also enter on Line 5,Recapitulation) $ 13 709.00
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
IRENE M. LENDA 21 14 0036
If an asset was made jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.GENEVIEVE COLLINS 21 AMHERST DRIVE DAUGHTER
CAMP HILL, PA 17011
B.
C.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FORJOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'SINTEREST
1. A. 8/1997 LAFAYETTE AMBASSADOR BANK-CHECKING 13,171.03 50. 6,585.52
ACCOUNT ENDING IN 205
2. A. 1012013 FULTON BANK- CHECKING ACOCUNT 5.00 50. 2.50
ENDING IN 012
TOTAL(Also enter on Line 6,Recapitulation) $ 6,588.02
If more space is needed,use additional sheets of paper of the same size.
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
IRENE M. LENDA 21 14 0036
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES: 774.07
1. MORELLO FUNERAL HOME
2. PHILLIPSBURG MONUMENT 195.00
3. FUNERAL LUNCH -GENEVIEVE COLLINS 1,391.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Represehtalive(s)
Street Address
City State ZIP
Year(s)Commission Paid:
2, Attorney Fees: REAGER &ADLER, PC 3,500.00
3, Family Exemption:(If decedent's address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City Stale ZIP
Relationship of Claimant to Decedent
4. Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS 123.50
5 Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9,Recapitulation) $ 5,983.5
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX-(12-12)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
IRENE M. LENDA 21 14 0036
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. DIAMOND PHARMACY- PRESCRIPTION 51.30
2. COUNTRY MEADOWS - NURSING HOME 378.45
3. JEFFREY MARKS, DPM - DOCTOR BILL 35.00
4. SENIOR BLUE- INSURANCE BILL 63.70
5. GIFTS FOR STAFF AT COUNTRY MEADOWS 223.42
6. TAX FORMS 20.00
7. CELTIC HEALTHCARE-MEDICAL BILL 60.00
8. CHASE VISA-CREDIT CARD 5.52
TOTAL(Also enter on Line 10,Recapitulation) $ 837.3`
If more space is needed, insert additional sheets of the same size.
REV-1513 EX.(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
IRENE M. LENDA 21 14 0036
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSONS)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
1 TAXABLE DISTRIBUTIONS [include outright spousal distributions and transfers under
Sec.9116(a)(1.2).]
1. GENEVIEVE COLLINS Lineal 9,101.64
21 AMHERST DRIVE
CAMP HILL, PA 17011
2. JOSEPH LENDA Lineal 2,513.61
342 MOUNTAIN CHICKADEE ROAD
HIGHLANDS RANCH, CO 80126
3. MICHAEL LENDA Lineal 2,513.61
8805 TERRACE LANE
ROSWELL, GA 30076
4. EVE REESE Lineal 2,513.61
139 MORGAN PLACE
KEARNY, NJ 07032
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 IS NOT TAKEN:
1.
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART 111-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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OF
IRENE M. LENDA
I, IRENE M. LENDA, of the County of Northampton and State of
Pennsylvania, being of sound and disposing mind, memory and understanding, do
hereby make, publish and declare this to be my Last Will and Testament, hereby
revoking any and all former wills heretofore made by me.
FIRST: I direct that my funeral and testamentary expenses shall be
paid as soon after my death as shall be convenient.
SECOND: All of the rest, residue and remainder of my estate, of
whatsoever kind and nature, real, personal or mixed, and wheresoever situate,
of which I may die seized or possessed or to which I may be entitled at the
time of death, I give, bequeath and devise to my husband, ALEXANDER A. LENDA,
absolutely and forever.
THIRD: In the event that my said husband, ALEXANDER A. LENDA, shall
predecease me, or in the further event that we shall die simultaneously, I
give, bequeath and devise all of the rest, residue and remainder of my estate
in equal shares to my children surviving me or to the issue, per stirpes, of
any child of mine who fails to survive me leaving issue surviving.
FOURTH: I do hereby nominate, constitute and appoint my said husband,
ALEXANDER A. LENDA, as the Executor of this my Last Will and Testament. I
give to my said Executor full power and authority to sell, mortgage, lease,
exchange or otherwise encumber or dispose of at public or private sale, and
upon such terms and conditions, as he may see fit, any and all real estate and
personal property of any kind wheresoever situated, at any time forming part
of my estate, and to execute and deliver good and sufficient deeds and any
other instruments that may be necessary therefor and to distribute the
proceeds thereof in accordance with the provisions of this, my Last Will and
Testament. In the event that my said husband predeceases me, or shall, for
any reason, be unable or unwilling to serve as Executor of this my Last Will
and Testament, then I hereby appoint my daughter, GENEVIEVE COLLINS, as
Alternate Executrix, with the same powers as previously given. In the event
that my said daughter is unable or unwilling to serve as Alternate Executrix
for any reason, then I hereby appoint my son, JOSEPH LENDA, as Alternate
Executor with the same powers as previously given.
FIFTH: I direct that no bond or other security shall be required of my
said Executor in any court or jurisdiction where it may be necessary to
probate this, my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 7/day of
An moo, 1990.
(SEAL)
IRENE M. ENDA
SIGNED, SEALED, PUBLISHED and DECLARED by IRENE M. LENDA, the
above-named Testatrix, as and for her Last Will and Testament, in the presence
of us, who, at her request, in her presence and in the presence of each other,
all being present at the same time, have hereunto subscribed our names as
witnesses.
NME ADDRESS
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ADDRESS