HomeMy WebLinkAbout00-1012 COMMONWEALTH OF PENNSYLVANIA REV-1162 EXI11-96)
DEPARTMENT OF REVENUE
BUREAU OF INOIY @UAL TAXES
DEPT.280601
HARRISBURG,PA 11126-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 019115
SANDRA LBONCAROSKY
121 FINEVIEW ROAD
CAMP HILL, PA 17011
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
------ f0d
101 f $50.34
ESTATE INFORMATION:
FILE NUMBER: 2100-1012
DECEDENT NAME: JORDAN HOWARD t
DATE OF PAYMENT: 05/06/2014
POSTMARK DATE: 05/03/2014
COUNTY: CUMBERLAND
DATE OF DEATH: 11/24/2000
TOTAL AMOUNT PAID: $50.34
REMARKS: SANDRA L BONCAROSKY
CHECK# 101
INITIALS: WZ
SEAL RECEIVED BY: LISA M. GRAYSON, ESQ.
REGISTER OF WILLS
REGISTER OF WILLS
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PENNSYLVANIA
DEPARTMENT D O601EVENUE INHERITANCE TAX RETURN ��'t�t�ENUMBER�0 l0 f
HARRISSURG,-PA17128-0601 RESIDENT DECEDENT t (mTCpoe_—,0 — – —
DECEDENTS NyAME¢AST,FIRST,AND MIDOIE }
W DATE OF DEATH{MWM YEAR) DATE OF BIRTH OWD-YEAR) THIS RETURN MUST BE FILE}IN DUPLICATE WRH THE
U�d4[�LO� ((5-119 i6 REGIsTBR OF WILLS
W (IFAPPLI CABLE)SURVIVING SPOUSES NAME(LAST FIWANDMIDDLEINITIAL) SO=SECURITY NUMBER
D _
LEI r-OrigirwReturn 2 Supplemental Return F1 3.Remainder Return mwdam vvbi2tsatl
R a z F1 4.Limited Elm 4a.FuBtm Interest Compromise(�donmA IMM 5.Federal Estate Tax Remm Requimd
m
vas E3<O@Cedord tAed Tasude tit. nth final 7.Decedent Manusned a Uvag Trust(A-.h rdT•ml S.Tow Number of Sat Deposit Bores
4
9.Litigation Proceeds;Received � 10.Spousm Poverty(tedd(dmedd�crwamu-nst ma>_aas} � N.Eledmn latex tmdar SOa 9113(A)(Finaiseno7
THts SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX-INFORMATION SHOULD Sit DIRECTED TO:.
E n NAME
� COMPLETE MAILING ADDRESS
49d ra t ncp t�5�b f 1 D =;wev)mu .
i.
FIRM NAME wAmksa=
p �r tt, - 'b+*7
a TELEPHONE NUMBER
0
1.Real Estate(SclieduleA) (1) d �G -
2 Staela and Bolls(SOedula B) (2) 0 nn nn
3.Closely Fuld Corporation,Partisanship aSde-Propdemrsfdp (3) a
�)
4.Mortgages&Notes ReretraMe(Schedule D) (4) C.l �✓t
5.Cask Bamc Deposits 6 Afisceffaneous Personal Property (5) ZP,27 -7 `E) /cx)6
Z (Sdredma
d 6.Jointly Owned PmpWy(Smredma F) (6)
❑Separate slums Requested .... -. ..
7.lim-his Transfers B MisiceBaneeus NOO•Prohate Property (7) -
F- (SsheduteGwQ t -sir
QB.Total Gross Assets(total Lms 1-7) {B} 7, O e2 7. 73
W9.Funeral Expenses&Admimstmtiva Costs(Sat edule N)
lz 1Q Debts of Decedent Mogage LiabfiBas,&Ueas(Sdtedule R (!0) .rf "1 c7 _ t t • o�� q
ti.Total Deductions(total tines 9&10) (11) � .OY t'. 4+
12.Net Value of Estate(Line 8 micas Line fl) (12)
13.Charitable and Governmental Bequests Sec 91131ntsts for which an election to tax has notes (13)
made r4mdlme3) d1
14.Net Value Subject to Tax(Ur o 12 mums Lire 13) (14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
'z 15.Amount of tare l4 taxable at the spouse!tax
0 fate,or transfers under Sea 9116(a)(12) xA— (15)
F
Tom- 16.Amount Of late 14 taxable at lineal rata X .0_ (16)
CL 17,Amomtof Line 14 taxable at sibirg min x .12 (17)
uIS.Amounto tL'mn/4laxabteotWlatamimte xAs (16)
d19.To Dun
~ 2tL • • • s
a i-BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH<< -
dent's Complete Address:
SIREEfADDRESS } y } �yy�.3 bleu)
Tax Payments and Credits:
1. Tax Due(Page 1 Line 19) (1)
2 CreditslPayments
A_Spouset Poverty Credit
B.Prior Payments
C.Discount
3. lnteresllPanatyifapplicable Total Credits(A+B+C) (2)
D.Interest
E Penalty
-. Total Interest/Penalty(D+E) (3)
4. If We 2 is greater than Line 1+Line 3,enter the ddference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1+Line 3 is greater than Line 2,enter the dilferenoL.This is the TAX DUE (5)
A.Enter the interest an the tax due. (5A)
B.Enter the total of Line 5+5A This is the BALANCE DUE. (5B)
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 transfemed:_........__._._.._._..._........__.......... ❑ ZI
b. retain the right to designate who shag use the property transferred or its income;_..............._.......____. . ❑
a retain a reversionary interest;or_..........._...._............._._....._..._..............................__....__._..._.__. ❑
d. receive the promise for fife of either payments,benefits or care?.._................................._.......___._. ❑
2. If death occurred aterDecember 12,1962,did decedent transfer propertywifhin one year of death
without receiving adequate consideraton?..._....---......_......___.._ ._.._..__.._.__...__...._.._.._....._._�.. ❑
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 Acccunt annuity,or other rum-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.
nnderpmal6md perjug 1 dedim than 1 fa exeu ed uis nxim."tea amwnpanwg sdvelLdw and smlmnwdls,and mare batdmy houdedae wd betel,d is ine.dwmdandmrnple
Demmaun 0fpreparer0dWV=arepmsorel rePeSMIAM a bared an 80 ffimutNn ofWNch pmpiw hasaWW*#dq&
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS
Ian Fi lvvle.cm..) Reut), Cry Pitt, PA oott - 9447
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
For dates of death on or after July 1,1994 and before January 1,1995,the tax rate imposed an the net value or transfers to or forthe use of the surviving space is 3%
[72 P.S.§9116(a)(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%[72 P.S.§9116(a)(1.1)
The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and fifmg a tax rrfirm are still applicable even if
the surviving spouse is the only beneffdary.
For dates of death on or aterJuly 1,2000:
The tax rate imposed on the net value of transfers from a deceased child twen"ne 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%[72 P.S.§9116(a)(12)].
The tax rate imposed on the net value of transfers to orfor the use of the decedents lineal beneficiaries is 4.5%,except as noted in 72 P.S.§9116(1.2)[72 P.S.§9116(a)(1)].
The tax rate imposed on the net value of banters to or for the use of the decedents siblings is 12%[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.
SCHEDULE E
COWAONWEALTROFPENNSYLVANIA CASH, BANK DEPOSITS, &MISC.
INHERITANCE TAIL RETURN
RESIDENTDECEDENT PERSONAL PROPERTY
ESTATE OF g FILE NUMBER
0�u3ti.rd P. i.ICt'C4aAi.
Include the proceeds of litigation and the dale the proceeds were received by the estate.At pmpertyjofntlyrowned with the Tight of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
,. psecu , w � dcc-wu�Q-- S, a
P52 ccA, " 1Ca3
Y r ' 9
4. O'clexAs Home, View L.s ar � ra9.da
S. d'&'ct„ Grcr `-'d n u n:sa 3P 30
TOTAL(Also enter on line 5,Recapitulation) 8
(If more space is needed,insert additional sheets of the same Size)
SCHEDULE H
COW0NWMT1t Qf Pe0KMVAW FUNERAL EXPENSES&
INNERITAWE E RE ADMINISTRATIVE COSTS
RES�ENT OECF,DENT
ESTATE OF i ' _�A FILE NUMBER
1"tGfFJtrtQ � �rJr+tudWJ
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
�yre cwiQ, AY' !3-)0 C 3>a��a=�� s�)
r. m+w�, CC^clsc�.rJ ,s �Ca� sf , S�rRacceal; 1J Y /bf 4�2
B. ADMINISTRATIVE COSTS:
1. Personal Representative s Commissions
Name of Personal Representative(s)
Social Severity Numbef(s)I EIN Number of Personal Representative(s)
Street Address
City state Zip
Yea4s)Cmwmss=Paid:
2. AftwMFaes L P �
3. Family ExemPtion4f decedents arldressis not the someasclaiments,attach explanation)
Claimant
Street Address
City Stale ZN
RelaGonsht)of Claimant to Decedent
4. Probate Fees 1�J y C"61hr , go.de)
6. Accountants Fees
6. Tax Realm Preparers Fees /}�y g$ �ry p n j}
7. its tL+saCt n-A ca. L y� CJ' Lvaa7 'V YtL+_¢YJ 6rwf.YA&4 J PA. 7r-da
,001 t l+ I "'jr rtSiAU+1p4, r"" 139. J7
TOTAL(Also enter on line 9,Recapitulation) $
(If more space is needed,insert additional sheets of the same size)
SCHEDULEI
COMMONINEALTH TAX PENNSYLVANIA
DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RESIDENT DECEDENT M
TE OF ORTGAGE LIABILITIES & LIENS
ESTA ttoA
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
1. Ln.n�rOnar:E,�t7'?I �' p AMOUNT
ro+ASyLaLoia, Natjd 6 0e�e 5 +ene
-�,0"- etd co:;n tew.6weu,".T/ t�'3,�� Jet $ 7s:
0".44 .P&C
�. la-UaaAra NOT -Tak, AL-tffmc-L, PA . �
WI JU kdso"ej .
3. Ar. &.ew ale,
TOTAL(Also enter on line 10,Recapitulation)
(If more space is needed,insert additional sheets of the same
_ _ .
,
� 15D561�1�5
REV-1500°`�O2-",��, �
OFFICIAL USE ONLY
PA Departmerrt of Revenue P�'!TM���?a County Cade Year file Number
Bureau of Individuat Taxes INHERITANCE TAX RETURN /� "�
Po Box z8o5o1 RESIDENT DECEDENT O� I O V �U � v'—
Harrishurg PA 17i28-o6oi
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
11/24/2000 04/15/1916
DecedenYs Last Name Suffix DecedenYs First Name MI
Jordan Howard P
(if Applicable)Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Socia�Securiry Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER 4F WILLS
FILL IN APPROPRIATE OVALS BELOW
p 1.Originai Retum � 2.Supplemental Retum O 3. Remainder Retum{Date of Death
Prior to 12-13-82)
p 4.Limited Estate O 4a.Future Interest Compromise(date of O 5. Federal Estate Tax Retum Required
death after 12-'12-82)
p 6.Decedent Died Testate O 7.Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Wili) (Attach Copy of Trust.)
G7 9.Litgation Proceeds Received O 10.Spousal Poverty Credit(Date of Death O 11. Election to Tax unde�Sec.9113(A)
Between 12-3'i-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONfIDENTIAI TAX INfORMATIUN SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Sandra L. Boncarosky (717)761-3544 ti `�"a''
c� � �
�
REGISTER O�l1�S USE ONLY � �
,�� �L7 � Ce7 �
t�? —� �-� --c "_ra :�J
First Line of Address '�' r" �—' �� �
, -��� r_� � ; ;�
121 Fineview Road r� �F' "� e"'
- _. , c�
Second Line of Address ,,-,� � � � �.� -�
c`> C"" C�
� � rn
State ZIP Code � '�M-ED
City or Post Office � F—+ Cn O
Camp Hill PA 17011 � �
CorrespondenYs e-mail address:LsbonCafosky _Gmail.com
Under penatties of pe�jury,l declare that I have examined this retum,including accompanying schedules and statemenis,ar�to the best of my Imowledge and belief,
it is true,corred arni complete.Declaration of preparer other than the personal represeniative is based on all information of which preparer has any krrowledge.
SIGNA E OF PERSON RESPONSIBLE FO FILING RETURN DATE
, ¢ ao
ADDRESS
121 Fineview Road, Camp Hill, PA 17011
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADORESS
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 15056101�5 15056101D5 �
, �
J150561D205
REV-1500 EX(FI} DecedenYs Social Security Number
DecedenYs Name: �"�OWBf(�P.�Of(�8f1
RECAPITULATION
1. RealEstate(Schedule A). ............................................ 1.
2. Stocks and Bonds Schedule B 2�
� ) .......................................
3. Closely Heid Corporation,Partnership or So�e-Proprietorship(Schedule C) ..... 3.
4. Mortgages and Notes Receivabie(Schedule D)........................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5.
1,215.67
6. Jointly Owned Property(Schedule F) O Separate Biliing Requested ....... 6.
7. Inter-Vivos Transfers 8 Miscelianeous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets total Lines 1 throu h 7 ............. 8. 1,215.67
� g )................
9. Funeral Expenses and Administrative Costs(Schedule H)....-....•.-••-.••- 9. 97.05
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I).. ............. 10.
11. Total Deductions(total Lines 9 and 10)................................. 11. 97.05
12. Net Value of Estate(line 8 minus Line 11) ................... . .......... 12. 1,118.62
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• 1,118.62
TAX CALCULATION-SEE INSTRUCTIONS FOR APPUCABLE 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 4 5� 16 50.34
at lineal rate X.0_
17. Amount of Line 14 taxable
at sibling rate X.12 17�
1 S. Amount of Line 14 taxable
at collateral rate X.15 18'
19. TAX DUE ......................................................... 19.
50.34
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 15�5610205 15�56102�5 �
REV-1500 IX(FI) Page 3 Flle Number
Decedent's Complete Address:
DECEDENTS NAME
Howard P.Jordan
STREETADDRESS
121 Fineview Road
c�.� STATE PA Z1P 17011
Camp Hill
Tax Payments and Credits:
1. Tax Due{Page 2,Line 19) (1) 50.34
2. CreditstPayments
A.Prior Payments
B.Discount
Totai Credits(A+B) (2)
3. Interest
(3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in ovai 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) 50.34
Make check payable to: REGISTER OF WILLS,AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPR�PRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
• .... ............................................
a. retain the use or mcome of the properry 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 o�urred after Dec.12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ �
3. Did decedent own an"in trust fo�'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
containsa beneficiary designation? ........................................................................................................................ ❑ �
IF THE ANSWER TO ANY OF THE ABOVE QUESTIQNS 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 transfiers to or for the use of the suNiving spouse
is 3 percent((2 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(aj{1.1)(ii)].The statute does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclasure of assets and
filing a tax retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1,20Q0:
. 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)j.
• The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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-i5o8 EX+(o8-i2)
i � pennsylvania SCNEDULE E
� �EPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
iNHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Howard P. Jordan
Inciude the proceeds of litigadon and the date the proceeds were received by the eskate.
All property jointly owned with right of survivorship must be disctosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIP7TON OF DEATH
1. In September,2013,it was discovered by a relative who lives in New York state that my father,Howard P. 1,215.67
Jordan,owned 20 shares of Midl'rfe,Inc stock that was being held by the Oifice of State Comptrolier,
Office of Unclaimed Funds.Until I received this information,I was not aware that he owned this stock.
After informing the PA Dept of Revenue and the PA Dept of Military Affairs of this stock and asking whether
the Commonwealth of PA had a claim against my father's estate, I was informed that it did not. I therefore
submitted two requests and the required documentation for the stock to the Office of the State Comptroller,
O�ce of Unclaimed Funds. I received two checks from this office dated February 25,2014 for$73.97
and April 14,2014 for$1,141.70. For your information,I am attaching copies of the checks.
The value of the stock had increased since the date of death. At the time of demutualization,April 7,2000,
the initial Public offering price was$14.25 per share. However,the amount paid to each policyholder
varied and was based on length of time the policy had been in force,face value of the policy,and total
premiums paid. $14.25 X 20 shares=$285
TOTAL(Also enter on Line 5, Recapitulation) $ 1,215.67
If more space is needed,use additional sheets of paper of the same size.
RrV-;511 EX+ {08-13)
-� i pennsylvania SCHEDULE H
� DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX REfURN pDMINISTRATIVE COSTS
RESIOENT DECEDENT
ESTATE OF FILE NUMBER
Howard P. Jodan
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMQUNT
A. FUNERAL EXPENSES:
1.
B, ADMINISTRATlVE COSTS:
i. Personai Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
�ity State ZIP
Year(s)Commission Paid:
75.00
2• Attorney Fees:
3. Family Exemption:{If decedent's address is not the same as claimant's,attach explanation.}
Claimant
Street Address
City State ZIP_
Relationship of Claimant to Decedent
4. Probate Fees:
5. Accountant Fees:
6. Tax Retum Preparer Fees:
�• Two Short Cert�cates for State of New York and PSECU for checking Acct 10.00
U.S.Postal Service-postage for submission of forms and documents on two occasions to the Office of 12.05
State Comptroller,Unclaimed Funds
TOTAL(Also enter on Line 9,Recapitulation} $ 97•0�
If more space is needed,use additional sheets of paper of the same size.
FEBRUARY 25, 2014 ��'�r� O� „�E� ���� �
REMITTANCE ADVICE for CHECK NO. 00730816
1 am pleased to be aUle to return these monics to you. A4y Ot�ice has been holding these fimds since they were received from
METUFE INC
I�m very committed to reuniting�eeount o�vners���ith their imclaimed fundc,so feel free to encourage others to check my
Intcrnet�►�ebsite ai:►vr��w.osc.stnte.n��.us or call: In NYS I-800-221-931 I, Outside NYS 518-270-2200.
Thomas P. DiNapoli
State Comptroller
DOCUMENT: U1730732 REPORTED AMOUNT: $73.97
CLAIM: 000000010180883
SETTLEMENT: 000000003256910
• - • • - • ' CHECK TOTAL: $73.97
Payee: tVlail to:
ESTATE OF HOWARD JORDAN SANDRA BONCAROSKY
121 PINEVIEW RD
CAMP HILL PA 17011-S�kl7
DETACH HERE PLEASE CASH
BEFORE CASHING PROMPTLY
_ _ . _
Z 6 4 5.5 5 4 3 �t�rP Of ,�P� �Ox� Cheek 50-937 oo�3os,6
FEBRUARY 25, 2014 COMPTROLLER STATE OF NEW YORK 213 �
. REFUND ACCOUNT KNOW YOUR ENDORSER
****�*******573. 97
Pay to the ESTATE OF HOWARD JORDAN
Oroer oi
�.�..�..��.�o�
JPMORGAN CHASE BANK N�• _ Thomus P.DiNapoli ,
OSC01 U1730732 SYRACUSE,NY State Compirollcr
�i'007308 i6��• �:0 2 L309379�: 88668659 i�i'
001405 W 00730816 OSC01 S
STATE OF NEW YORK Presorted
OFFICE OF THE STATE COMPTROLLER First-C►ass
AIBANY,NEW YORK 12236-0001 U.S.Postage
Paid
NYSOSC
OSC01 Ui730732
SANDRA BONCAROSKY
121 FINEVIEW RD
CAMP HILL PA 17011-8447
APRIL 14, 2014 �,r�re of �e�n ��nr�. W
REMITTANCE ADVICE for CHECK NO. 70012009
I am pieased to be abte to return these monies to you. My Of�ice has been holding these funds since they were received from
METLIFE 1NC
T am very committed to reuniting account ownen with their unclaimed funds,so feel free to encourage others to check my
Intemet website at www.osc.state.ny.us or call 1-800-221-9311.
Thomas P. DiNapoli
State Comptroller
DOCUMENT: U1774780 REPORTED AMOUNT: $1,141.70
CLAIM: 00000001�180883
SETTLEMENT: 000000003303057
. - . • _ • - CHECK TOTAL: $1,141.70
Payee: (viail to:
EST OF HOWARD JORDAN SANDRA L BONCAROSKY
121 FINEVIEW RD
CAMP H1LL PA 17011-8447
DETACH HERE BEFORE CASHING PLEASE CASH WITHIN 18Q DAYS
_ _ _ ___
____ __ _ _ __ . __._._ .
` Check No. 70012009
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s NOTICE OF INHERITANCE TAX ." pennsylvarna
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE - DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES OF DEDUCTIONS AND ASSESSMENT OF TAX --. -.--
INHERITANCE TAX DIVISION REV-154] IX AFP (08-13)
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 09-22-2014
ESTATE OF JORDAN HOWARD P
DATE OF DEATH 11-24-2000
FILE NUMBER 21 00-1012
COUNTY CUMBERLAND
BONCAROSKY SANDRA L ACN 101
121 FINEVIEW RD APPEAL DATE: 11-21-2014
CAMP HILL PA 17011 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS H
--------------------'------------------------------------
REV-1547 EX AFP (08-13) NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: JORDAN HOWARD PFILE NO. :21 00-1012 ACN: 101 DATE: 09-22-2014
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01
1. Real Estate (Schedule A) (1) •00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
00 submit the upper portior
3. Closely Held Stock/Partnership Interest (Schedule C) (3) . of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) •00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1 ,215.67
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 1 .215.67
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 97.05 (
30. Debts/Mortgage Liabilities/Liens (Schedule I) (30) .00
ry
°
11. Total Deductions n (11]
7697.05
12. Net Value of Tax Return ; @12) ' 8.62
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) �13) m 1� . 00
14. Net Value of Estate Subject to Tax M -1, 4rP � /4,"9.09-
77 D' r- N M ( 1
NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17,-=IrandYor 1:9c]Rill
reflect figures that include the total of all returns asses3e� - to date. C.>
C7 C7
ASSESSMENT OF TAX: 0 -D
-D -n
15. Amount of Line 14 at spousal rate (15) . 00)�Orl = �:z .00
16. Amount of Line 14 taxable at lineal rate (16) - OR X: 45 = t--+ r- fT) . 00
17. Amount of Line 14 at sibling rate (17) . 00-JX 12 = rrT (A O 00
18. Amount of Line 14 taxable at collateral rate (18) .06>X 15 = CJ 0
19. Principal Tax Due (19)= .00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) - AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-J
05-03-2014 CDO19115 . 00 50.34
TOTAL TAX PAYMENT 50.34
BALANCE OF TAX DUE 50.34CR
INTEREST AND PEN. .00
TOTAL DUE 50.34CR
e IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.
REV-14MEX(01-ID)
It I
pennsylvarna INHERITANCE TAX
DEPARTMENT OF REVENUE EXPLANATION
BUREAU OF INDIVIDUAL TAXES OF CHANGES
PO Box 280 60'i
HARR6jRQRQ-E&jjjZ�M- Q1 --
DECEDENT'S NAME FILE NUMBER
Howard Jordan 2100.1012
REVIEWED BY ACN
Alan—Agent 99 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
Applied excess deductions from prior return(s).
ROW Page 1
s NOTICE OF INHERITANCE TAX ." pennsylvarna
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE - DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES OF DEDUCTIONS AND ASSESSMENT OF TAX --. -.--
INHERITANCE TAX DIVISION REV-154] IX AFP (08-13)
PO BOX 280601
HARRISBURG PA 17128-0601
DATE 09-22-2014
ESTATE OF JORDAN HOWARD P
DATE OF DEATH 11-24-2000
FILE NUMBER 21 00-1012
COUNTY CUMBERLAND
BONCAROSKY SANDRA L ACN 101
121 FINEVIEW RD APPEAL DATE: 11-21-2014
CAMP HILL PA 17011 (See reverse side under Objections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALONG THIS LINE RETAIN LOWER PORTION FOR YOUR RECORDS H
--------------------'------------------------------------
REV-1547 EX AFP (08-13) NOTICE OF INHERITANCE TAX APPRAISEMENT. ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: JORDAN HOWARD PFILE NO. :21 00-1012 ACN: 101 DATE: 09-22-2014
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN NO. 01
1. Real Estate (Schedule A) (1) •00 NOTE: To ensure proper
2. Stocks and Bonds (Schedule B) (2) .00 credit to your account,
00 submit the upper portior
3. Closely Held Stock/Partnership Interest (Schedule C) (3) . of this form with your
4. Mortgages/Notes Receivable (Schedule D) (4) •00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 1 ,215.67
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7) .00
8. Total Assets (8) 1 .215.67
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 97.05 (
30. Debts/Mortgage Liabilities/Liens (Schedule I) (30) .00
ry
°
11. Total Deductions n (11]
7697.05
12. Net Value of Tax Return ; @12) ' 8.62
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) �13) m 1� . 00
14. Net Value of Estate Subject to Tax M -1, 4rP � /4,"9.09-
77 D' r- N M ( 1
NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17,-=IrandYor 1:9c]Rill
reflect figures that include the total of all returns asses3e� - to date. C.>
C7 C7
ASSESSMENT OF TAX: 0 -D
-D -n
15. Amount of Line 14 at spousal rate (15) . 00)�Orl = �:z .00
16. Amount of Line 14 taxable at lineal rate (16) - OR X: 45 = t--+ r- fT) . 00
17. Amount of Line 14 at sibling rate (17) . 00-JX 12 = rrT (A O 00
18. Amount of Line 14 taxable at collateral rate (18) .06>X 15 = CJ 0
19. Principal Tax Due (19)= .00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) - AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-J
05-03-2014 CDO19115 . 00 50.34
TOTAL TAX PAYMENT 50.34
BALANCE OF TAX DUE 50.34CR
INTEREST AND PEN. .00
TOTAL DUE 50.34CR
e IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT (CR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.
REV-14MEX(01-ID)
It I
pennsylvarna INHERITANCE TAX
DEPARTMENT OF REVENUE EXPLANATION
BUREAU OF INDIVIDUAL TAXES OF CHANGES
PO Box 280 60'i
HARR6jRQRQ-E&jjjZ�M- Q1 --
DECEDENT'S NAME FILE NUMBER
Howard Jordan 2100.1012
REVIEWED BY ACN
Alan—Agent 99 101
ITEM
SCHEDULE NO. EXPLANATION OF CHANGES
Applied excess deductions from prior return(s).
ROW Page 1
bz-o
pennsylvania
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX REV-1607 EX AFP (12-13)
INHERITANCE TAX 6DIVISION
PO BOX RR (�STATEMENT O F ACCOUNT
HARRISBURG PA 17128-0601`E C O R D E D OFFICE OF-
REGISTER
FREGI tER Of Vill-f S DATE 11-10-2014
n �i!� � ESTATE OF JORDAN HOWARD P
L201� U 17 (ffi; l 1-1 23 DATE OF DEATH 11-24-2000
FILE NUMBER 21 00-1012
CLE R:'� OF COUNTY CUMBERLAND
BONCAROSKY 0RPH9ANDRA f 1-r
ACN 101
121 FINE�E �RD: F Amount Remitted
CAMP HILL 1 -PA, 170`11-,8447
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
NOTE: To ensure proper credit to your account, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE - RE �
RETAIN LOWER PORTION FOR YOUR RECORDS
REV-1607 EX P C12-13)_ _ _ x; _INHERITANCE TAX STATEMENT OF ACCOUNT _ X;; - - - - - - - - - - - - - -_ _ _ _ _ _ _ _ _ _ _ _ _
ESTATE OF:JORDAN HOWARD P FILE NO. : 21 00-1012 ACN: 101 DATE: 11-10-2014
THIS STATEMENT PROVIDES CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. BELOW IS A SUMMARY OF THE PRINCIPAL
TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-15-2014
PRINCIPAL TAX DUE: .00
PAYMENTS (TAX CREDITS) :
PAYMENT RECEIPT DISCOUNT C+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID C-)
05-03-2014 CDO19115 .00 50.34
10-24-2014 REFUND .00 50.34-
TOTAL TAX PAYMENT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE
.00
* IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM
FOR INSTRUCTIONS.