HomeMy WebLinkAbout04-21-14 (2) REV-1500 EX(01-10) 1505610143
PA Department of Revenue OFFICIAL USE ONLY
P Pennsylvania County cone year File Number
Bureau of Individual Taxes DEPARTMENT orREVENUE
PO 60x.280601 INHERITANCE TAX RETURN 2 1 13 00943
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
07 22 2013 04 08 1924
Decedent's Last Name Suffix Decedent's First Name MI
ZACK MARIE L
(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 ❑ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
® 8 Decedent Died Testate ❑ 7. Decedent Maintained a Living Trust 0 B. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Toren
❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit{date of death ❑ 11.Election to tax under Sec.9113(A)
between 12-31-91 and -1-95) (Attach Sch.O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
DEBRA R WALLET 717 737 1300,
C'' c r�i1
REGISTER]OF?ILLS US�NLVG-1
rn N -
rn � C-) -i
First line of address n r N M rn
24 NORTH 32ND STREET
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CD -o -ml -n
Second line of address O C -n 3 � n
N r m
r
City or Post Office State ZIP Code DA3EIFILED O O
CAMP HILL PA 17011
Correspondent's e-mail address: walletdeb @aol.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.
51 NAT RE OF PERSON RESIP94SIBLE FOR FILING RETUR D TE
William Francis Zack r/
ADDRESS
1504 Capitol View 4ve, New Cumberland, PA 17070
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
0,.6M {•, 6J&XA a Debra K Wallet 4 Ix I L4
ADDRESS
24 North 32nd Street, Camp Hill, PA 17011
Side 1
1505610143 1505610143 ( /
1 1505610243
J REV-1500 EX
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................... 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 365 , 993 . 07
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6. 10 , 489 . 65
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7,
8. Total Gross Assets(total Lines 1-7)....................................................................... 8. 376 , 482 . 72
9. Funeral Expenses&Administrative Costs(Schedule H)......................................... 9. 8 , 155 . 84
10. Debts of Decedent,Mortgage Liabilities,&Liens(Schedule 1)................................ 10. 19 , 546 . 54
11. Total Deductions(total Lines 9&10)...................................................................... 11. 27 , 702 . 38
12. Net Value of Estate(Line 8 minus Line 11)............................................................. 12. 348 , 780 . 34
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. 348 , 780 . 34
TAX COMPUTATION-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 .00 15.
16. Amount of Line 14 taxable
at lineal rate x .045 348 , 780 . 34 16. 15 , 695 12
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. 15 , 6 9 5 . 12
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑X
Side 2
1505610243 1505610243 J
REV-1500 EX Page 3 File Number 21 - 13 - 00943
Decedent's Complete Address:
DECEDENT'S
Zack, Marie L.
STREET ADDRESS
1504 Capitol View Drive
CITY STATE ZIP
New Cumberland PA 17070
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 15,695.12
2. Credits/Payments
A. Prior Payments 15,000.00
B. Discount 784.76
Total Credits(A +B) (2) 15,784.76
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4) 89.64
Check box on Page 2 Line 20 to request a refund
5. If Line 1 +Line 3 is greater than Line 2,enter the difference. This is the TAX DUE. (5)
Make Check Payable to: REGISTER OF WILLS, AGENT.
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "V IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. ❑ Fx
b. retain the right to designate who shall use the property transferred or its income;.................................... ❑ ❑x
c. retain a reversionary interest;or.................................................................................................................. ❑
d. receive the promise for life of either payments,benefits or care?.............................................................. ❑ ❑
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?......... ❑ 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 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 January 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 retturn 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 1.2)[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.G9116(a)(1.3)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether y blood or adoption.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TM RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Zack, Marie L. 21 - 13-00943
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 Members 1st checking acct. #354053-11 1,606.17
2 Members 1 st savings acct. #354053-00 5.00
3 Members 1st acct. #35405340 -CD 46,637.70
4 Members 1st acct. #354053-49 -CD 24,100.24
5 Members 1 st acct. #354053-50 -CD 26,667.52
6 Members 1st acct. #354053-51 -CD 63,537.25
7 Members 1 st acct. #354053-52 -CD 20,704.59
8 Members 1 st acct. #354053-53 -CD 25,729.66
9 Santander Bank(formerly Sovereign) checking acct. #0571203175 1,374.02
10 Santander Bank (formerly Sovereign) money market acct. #2334089117 27,439.30
11 Santander Bank(formerly Sovereign) savings acct. #0574107835 1,577.90
12 Santander Bank(formerly Sovereign) CD acct. #0575539002 60,175.46
13 Santander Bank (formerly Sovereign) CD acct. #7675790979 37,304.30
14 Wells Fargo checking acct. #1000615423026 26,547.18
15 US Treasury deposit 2,461.86
16 Renter's insurance refund 97.64
TOTAL(Also enter on Line 5, Recapitulation) 365,993.07
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TM RE JRN
RESIDENT DECEDENT continued
FILE NUMBER
ESTATE OF Zack, Marie L. 21 - 13 - 00943
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
17 Alert Pharmacy Services refund 27.28
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Page 2 of Schedule E
SCHEDULE F
COMMONWEALTH OF SVIVANIA
TAX RE JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Zack, Marie L.
21 - 13-00943
If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT
William Francis Zack 1504 Capitol View Drive Son
A New Cumberland, PA 17070
JOINTLY OWNED PROPERTY: pE NN� p
ITEM LETTER DATE Include name of financial natitution and bank account numbe DATE OF DEATH %OF DATE of DEATH
NUMBER FOR JOINT MADE or similar identifying number.Attach deed for jointly-held real VALUE OF ASSET DECD'S Deceo ALU WrEREST
TENANT JOINT estate. INTEREST
1 !, A 06/08/2012 Wells Fargo Checking Acct. #8814191436 100.01 50% 50.01
2 A 10/04/2010 Wells Fargo CD#247402074010776 20,879.28 50% 10,439.64
it
I
I
TOTAL(Also enter on line 6, Recapitulation) 10,489.85
SCHEDULE H
FUNERAL EXPENI,SES&
COMMONWEPL OF PENNSYLVMIA
INHESIDEN ETT%RENFN ADMINISMME COSTS
RE&DENT DECEDENT
FILE NUMBER
ESTATE OF Zack, Marie L. 21 - 13-00943
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Catholic Cemeteries 1,085.00
2 Metalaye Enterprises(funeral reception) 1,537.34
B. ADMINISTRATIVE COSTS:
1, Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Debra K. Wallet, Esq. 5,000.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 473.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7, Other Administrative Costs
1 Postage, photocopies, etc. 40.00
TOTAL(Also enter on line 9, Recapitulation) 8,155.84
G�Sch' edule H o
COMMONWEALTH OF PENNSYLVANIA 1"��N «
INHERITANCE TAX RETURN Achninisba Costs cortfimued
RESIDENT DECEDENT
ESTATE OF Zack, Marie L. FILE NUMBER
21 - 13 -00943
2 Santander Bank (charge to prepare statement of date of death values) 20.00
Page 2 of Schedule H
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
COMNRERTNNCECTM RE RN�IA LIABILITIES, & LIENS
RESIDENTDECEDENT
FILE NUMBER
ESTATE OF Zack, Marie L. 21 - 13 -00943
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Alert Pharmacy 364.23
2 Messiah Lifeways 9,655.85
3 Messiah Lifeways (final bill) 7,064.60
4 Office of Personnel Management(US Treasury) - refund of 7/13 payment 2,461.86
TOTAL(Also enter on Line 10, Recapitulation) 19,546.54
1
REV-7613 E%-(11-08)
SCHEDULE )
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Zack, Marie L. FILE NUMBER
21 - 13- 00943
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not Ust Trustees)
I� TAXABLE DISTRIBUTIONS[include outright s ousal
distributions,and Pransfers
under Sec.9116(a)(1.2)]
1 William Francis Zack Son 1/3 of residuary
1504 Capitol View Drive Estate
New Cumberland, PA 17070
2 Gerard Matthew Zack Son 1/3 of residuary
7 Shipwright Court Estate
Gaithersburg, MD 20877
3 Raymond Andrew Zack Son 1/3 of residuary
7804 Rainbow Falls Drive Estate
Frisco, TX 75034
Enter dollar amounts for distributions shown above on lines 15 through 18 on 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
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
LAST WILL AND TESTAMENT
I, Marie L. Zack, a resident of Lower Allen Township, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding, do
make, publish and declare this as and for my last Will and Testament, hereby re-
voking and making null and void any and all Wills and Testaments, or writings in
the nature thereof, by me at any time heretofore made.
I. I nominate, constitute and appoint my husband, William P. Zack, as Exe-
cutor of this, my last Will and Testament. Should a. substitute or successor be
required, I nominate, constitute and appoint as Cc-Executors my sons, William
Francis Zack, Raymond Andrew Zack and Gerard Matthew Zack. I direct that my said
husband, or my said sons, shall not be required to give bond for the faithful per-
formance of his or their duties hereunder in this or any other jurisdiction, and
that if, notwithstanding this direction, any bond is required by any law, statute
or rule of court, no surety be required thereon.
II. I give, devise and bequeath all of my property and estate, of whatsoever
kind and wheresoever situate, of which I shall die seized or possessed, or of
which I shall be entitled to dispose at the time of my death, to my husband, Wil-
liam P. Zack, the same to be his absolutely.
III. Should my said husband, William P. Zack, not be living at the time of
my death, or should my said husband and I die as the result of a common accident
or disaster, then, and in either event, I give, devise and bequeath all of my prop-
erty and estate, of whatsoever kind and wheresoever situate, of which I shall die
seized or possessed, or of which I shall be entitled to dispose at the time of my
death, in equal one-third shares to my sons, William Francis Zack, Raymond Andrew
Zack and Gerard Matthew Zack, or their issue per stirpes.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my last
Will and Testament, this
Will of July, 1878_
//,�f+✓�>. -�- �.{,/-/ Seal)
Marie L. Zack
SIGNED, SEALED, PUBLISHED AND DECLARED by Marie L. Zack, the above named
Testatrix, as and for her last Will and Testament, in our presence, who, in her
presence, at her request, and in the presence of each other, have hereunto sub-
scribed our names as attesting witnesses.
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Address i
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Name Address
ACKNOWLEDGEMENT
Commonwealth of Pennsylvania:
: SS.
County of Cumberland
I, Marie L. Zack, whose name is signed to the attached or foregoing instru-
ment, having been duly qualified according to law, do hereby acknowledge that I
signed and executed the instrument as my Last Will; that I signed it willingly
and that I signed it as my free and voluntary act for the purposes therein ex-
pressed.
Testa'triV
Sworn or affirmed to and acknowledged before me by Marie L. Zack, the Testa-
trix, this fjk�day of July, 1978.
' Notary Public
E11EI41n.pETr_,,n ,401P..3e runur.
CAMP HILL HOnu,WIA9ERLAHO OOUN.1'
AFFIDAVIT
PAY GOMiA 1951VN ESPlu" 01Y 21.,P2
PAeu1Lel,Pexrsylve nia ASwcialoa oEhkhslr~y
Commonwealth of Pennsylvania:
SS.
County of Cumberland
We, S. Joseph Moomaw and Carol Ann Moomaw, the witnesses whose names are
signed to the attached or foregoing instrument, being duly qualified according to
law, do depose and say that we were present and saw Testator sign and execute the
instrument as her Last Will; that she signed it willingly and that she executed it
as her free and voluntary act for the purposes therein expressed; that each of us
in the hearing and sight of the Testatrix signed the Will as witnesses; and that to
the best of our knwoledge the Testatrix was at that time 18 or more years of age,
of sound mind and under no constraint or undue influence. /
! Witness
f it
Witness
Sworn or affirmed to and supscribed before me by S. Joseph Moomaw and Carol
Ann Moomaw, witnesses, this '14A-' day of July, 1978.
Notary Public
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DEBRA K.WALLET
24 N.32nd STREET
CAMP HILL,PA 17011-2917
PHONE:(717)737-1300 Email:Walletdeb @aol.com FAX:(717)761-5319
April 17, 2014
Lisa M. Grayson, Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
RE: Estate of Marie L. Zack
Will No. 2013-00943
Dear Ms. Grayson:
Enclosed are an original and one copy of the Pennsylvania Inheritance Tax Return, one
copy of an Inventory of the Estate, and one copy of a Status Report Under Rule 6.12 for filing
in the above-captioned estate.
I have enclosed a copy of the first page of each to be stamped in and returned to me in
the pre-addressed envelope provided. Thank you.
Sincerely yours,
aw W. tjAA,+-
Debra K. Wallet
DKW/mm o
a m
Enc. n m n
cc: William Francis Zack, Executor
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