Loading...
HomeMy WebLinkAbout05-02-14 1505610140 REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 2 1 1 3 1 3 0 3 Harrisburg PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1 2 0 3 2 0 1 3 0 5 0 1 1 9 3 2 Decedent's Last Name Suffix Decedent's First Name MI Z E I S L 0 F T E D W A R D J (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 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 _ 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 M U R R E L W A L T E R S I I I E S Q 7 1 7 6 9 7 4 6 5 0 REGISTER OF WILLS USE ONLY f First Line of Address W A L T E R S & G A L L O W A Y P L L C Rz C> M CIO Second Line of Address M S <7 —c cn n r 1n 5 4 E M A I N S T R E E T =, z co a, City or Post Office State ZIP Code C -DATE FILED C, CJ o M E C H A N I C S B U R G P A 1 7 0 5 5 " =' W r- m > CD fn o Correspondent's e-mail address: murrel(G7waltersgalloway.com co —1. a 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 Ue,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. 51 RE OF RSq.1RE5 BLE FOR FILING RETURN I ZAT ADDRESS --//LL WILLIAM E ZEISL T, 111 CAMBRIDGE DR MECHANICSBURG PA 17055 SIGNATURE'. R�T R THAN REPRESENTATIVE qTE _ _/ ADDRESS / 5 MURREL R - WALTERS , III, 54 E . MAIN ST MECHANICSBURG PA 17055 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX(Fl) Decedent's Social Security Number Decedent's Name: EDWARD J . ZEI$LOFT RECAPITULATION 1. Real Estate(Schedule A) ... . .. . .. . . . . .. .. . .. . .. . .. . . . . . . . . . . . . . .. . . 1. 9 9 7 0 0 . 0 0 2. Stocks and Bonds(Schedule B) . . . . . . .. . . . . . . . . . . . . .. . .. . .. . .. . .. . .. . 2. 4 8 4 8 . 0 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. 2 4 6 4 6 9 . 5 2 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 0 . 0 0 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . .. 7. 1 7 8 5 1 9 . 8 9 8. Total Gross Assets(total Lines 1 through 7) . . .. . . . . .. . .. . .. . .. . .. . .. . . 8. 5 2 9 5 3 7 . 4 2 9. Funeral Expenses and Administrative Costs(Schedule H) . .. . .. . .. . .. . .. . . . 9. 2 5 0 5 1 . 7 3 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . .. .. . . .. . .. 10. 3 1 3 2 . 8 1 11. Total Deductions(total Lines 9 and 10) . . .. .. . ... . . . .. . .. . .. . .. . .. . . . . 11. 2 8 1 8 4 . 5 4 12. Net Value of Estate(Line 8 minus Line 11) . .. . .. . .. . .. .. . . . . . .. . .. . .. . 12. 5 0 1 3 5 2 . 8 8 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. 5 0 1 3 5 2 . 8 8 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 5 0 1 3 5 2 . 8 8 16. 2 2 5 6 0 . 8 8 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. 2 2 5 6 0 • 8 8 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 J REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 13 1303 DECEDENT'S NAME EDWARD J. ZEISLOFT STREET ADDRESS 680-16 GENEVA DRIVE CITY STATE 21P MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 22.560.88 2. Credits/Payments A.Prior Payments 21,000.00 8,Discount 1,050.00 Total Credits(A+B) (2) 22,050.00 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) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 510.88 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 ............................... ❑ 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? ....................................................................................... ❑ ❑X 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?.................................................................................................. ® ❑ 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 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 p2 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.get 16(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-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF: FILE NUMBER: EDWARD J. ZEISLOFT 21 13 1303 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1. 680-16 GENEVA DRIVE 99,700.00 MECHANICSBURG, PA 17055 COUNTY ASSESSED VALUE TOTAL(Also enter on Line 1,Recapitulation.) $ 99,700.00 If more space is needed,use additional sheets of paper of the same size. REV-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD J. ZEISLOFT 21 13 1303 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, MET LIFE 3,953.18 STOCK 77 SHARES @$51.34 2. CENTURYLINK 607.40 STOCK 20 SHARES @$30.37 3. U S SAVINGS BONDS 160.32 IN NAME OF SHIRLEY M. ZEISLOFT REDEMPTION VALUE 4. ALCATEL-LUCENT 78.46 17112 SHARES @$4.42 5. AIG 48.65 1 SHARE @$48.65 TOTAL(Also enter on Line 2,Recapitulation) $ 4,848.01 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 RESMENT OECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: EDWARD J.ZEISLOFT 21 13 1303 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. PNC 22,641.72 CHECKING 2. MEMBERS 1ST FEDERAL CREDIT UNION 1,906.20 SAVINGS 3. JANNEY MONTGOMERY SCOTT 188,226.65 INVESTMENT ACCOUNT 4. ING 3,252.30 MUTUALFUND 5. M &T BANK 29,841.51 CHECKING 6. COINS 314.14 SALE PRICE 7. BAYER COMBINATION ASPIRIN PRODUCTS LITIGATION 4.00 SETTLEMENT 8. PENNSYLVANIA DEPARTMENT OF REVENUE 283.00 2013 INCOME TAX REFUND TOTAL(Also enter on Line 5,Recapitulation) $ 246 469.52 If more space is needed,use additional sheets of paper of the same size. REV-1510 EX+(OM9) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD J.ZEISLOFT 21 13 1303 This schedule must be completed and fled if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % DECD'S EXCLUSION TAXABLE NUMBER THE DATEOFTRANSFER.ATfACHACOPY OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPUCABLE) VALUE 1. AMERICA GENERAL 93,642.72 100.00 93,642.72 IRA BENEFICIARY-SON,WILLIAM E.ZEISLOFT 2. AMERICAN GENERAL 84,877.17 100.00 84,877.17 IRA BENEFICIARIES- 80%-SON-WILLIAM E.ZEISLOFT 20%-GRANDDAUGHTER-LAURA A. ZEISLOFT TOTAL (Also enter on Line 7,Recapitulation), $ 178 519.89 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 EDWARD J.ZEISLOFT 21 13 1303 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. PARTHEMORE FUNERAL HOME&CREMATION SERVICES, NEW CUMBERLAND 14,24017 2. GINGRICH MEMORIALS-INGRAVE DATES&INSTALL BRONZE VETERAN MEMORIAL 218.00 3. FUNERAL LUNCHEON -PHYLISS MIHALICH 325.06 8. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: i• Name(s)ofPersonalRepresentative(s) WILLIAM E.ZEISLOFT StreetAddress 111 CAMBRIDGE DRIVE City MECHANICSBURG State PA ZIP 17055 Year(s)Commission Paid: (RENOUNCED) 2. AtlomeyFees: MURREL R.WALTERS, III 9,400.00 3, Family Exemption:(If decedent's address Is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimantto Decedent 4. Probate Fees: 6 Accountant Fees 6, Tax Return Preparer Fees: ROBERTA. ROMAKO,CPA 300.00 2013 INCOME TAX RETURN PREPARATION 7. CUMBERLAND COUNTY REGISTER OF WILLS 568.50 TOTAL(Alsoenteron Lines Recapitulation) $ 25051.73 If mom Space is needed,use additional sheets of paper of the same size. REV-1512 EXt{12-12} pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, lNHERiTANCE TAX RETURN MORTGAGE LIABILITIES& LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD J.ZEISLOFT 21 13 1303 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. PINNACLE HEALTH 419.85 MEDICAL 2. GOLDEN LIVING CENTER 296.00 RESIDENTIAL CARE 3. SUNGUILD CONDOMINIUM ASSOCIATION 465.00 CONDO ASSOCIATION FEE 4. UPPER ALLEN TOWNSHIP 112.00 SEWER 5. DENNIS ZERBE,TAX COLLECTOR 410.04 COUNTYITOWNSHIP TAXES 6. ROTO-ROOTER PLUMBING 150.00 TOILET REPAIR 7. VERIZON 248.30 TELEPHONE 8. PPL 515.62 ELECTRIC 9. UNITED STATES TREASURY 516.00 2013 INCOME TAX I TOTAL(Also enter on Line 10,Recapitulation) $ 3,132.81 If more space is needed,insert additional sheets of the same size. REV-1513 EXt(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: EDWARD J. ZEISLOFT FILE NUMBER: 21 13 1303 NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY RELATIONSHIP TO DECEDENT AMOUNT T SHARE Do Not List Trustees) OF ESTATE I TAXABLE DISTRIBUTIONS (Include outright spousal distnbutions and transfers under Sec.9116(a)(1.2),I 1. WILLIAM E. ZEISLOFT Lineal 111 CAMBRIDGE DRIVE MECHANICSBURG, PA 17055 2. LAURA A.ZEISLOFT Lineal 111 CAMBRIDGE DRIVE MECHANICSBURG, PA 17055 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 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.