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Home My WebLink About04-29-14 ti , n � 150561�101 REV-1500 EX�°'_'°, � OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Code Year File Number Bureau of IndividualTaxes fl�NHERITANCE TAX RETURN ��'j� POBOxz8o6oi RESIDENT DECEDENT p� � /Q� 0 Harrisburg PA i'7128 0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 03/20/2012 12/24/1939 Decedent's Last Name Suffix DecedenYs First Name MI Jenks Jr. John H (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Jenks Virginia Spouse's Social Security Number THIS RETURN MUST BE FlL.f:D IN DUPL!CATE WITH THE ��-3=�-�y�L REGIST�R t7F WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return O 2.Supplemental Return O 3. Remainder Return(date of death prior to 12-13-82) p 4. Limited Estate O 4a. Future Interest Compromise(date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 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 O 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 Sch.O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Dusan Bratic, Esq. (717)432-9706 , h> REGIST OF WILLS U5E'y�NLY� !�•, 3�:. � � C� . � �7 � G> � r:r. "� First line of address �R � � � te�I r7 � y*.�. i_ N __t C7 101 South US Route 15 ' �'� e'� cr� -`; � " t�;, : .. �; - c'� Second line of address ;;� �., '_' ..� _,� c� �� `;� � -*t ;�:; � E FILED w��•- '� City or Post Office State ZIP Code � �." Dillsburg PA 17019 � � � ..°n .� CorrespondenYs e-mail address: � w � "" �;°;: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; r°^41 it is trus,correct and complete.Declaration of preparer other than the personal representa[ive is based on all information of which preparer has any knowledge. SI�t�T OF PERSOf�I RESPO LE FOR FILING RETURN DATE ADDRE S � ,�f � � � �` SIGNATURE OF PF�EPARE E��ES f„-f ' � � T � !�'i� C,i I ADDRESS �,,�y 1 �l,� �S �Vw� �.t ` S yY� (h+ ��1�� y�� PLEASE USE ORIGINAL FO ONLY Side 1 L 1505610101 1505610101 J y i J 1505610105 REV-1500 EX DecedenYs Social Security Number DecedenYs Name: Jenks, John H. Jr. RECAPITULATION 1. Real Estate(Schedule A). ...... ... ..... ...... ........... ... .. ........ 1. 0.00 2. Stocks and Bonds(Schedule B) . ... ........ ... .................. .... .. 2. �.00 3. Closely Heid Corporation,Partnership or Sole-Proprietorship(Schedule C) ..... 3. 0.00 4. Mort a es and Notes Receivable Schedule D 4. 0.00 9 9 � )........... ........ .... .... 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E)....... 5. 0.00 c�. .;oirdly^vw,�ed P�upeiiy(�ci�eduie�j c� Separate Siliing Reyuested .. .. .. . G. O.UU 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 0.00 8. Total Gross Assets(total Lines 1 through 7).......... ...... ..... ........ 8. 0.00 9. Funeral Expenses and Administrative Costs(Schedule H)....... .. .......... 9. 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I).. .. .......... 10. 11. Total Deductions(total Lines 9 and 10).... .. ........... ... .......... .. . 11. 12. Net Value of Estate(Line 8 minus Line 11) . .. .... ........ .. .......... ... 12. 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. 0.00 I 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_ 15. ( 16. Amount of Line 14 taxable ' at lineal rete X A_ 16. 17. Amount of Line 14 taxable ' at sibling rate X.12 �� 18. Amount of Line 14 taxable a?cof�atefa��ate X.75 1�� 19. TAX DUE .... .. ... ... .... ... .... .... . ............. .. ..... ...... .. . 19. 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 � 15D56101D5 15056101�5 J 1 � REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME John H. Jenks Jr. - - — -- _ _ _ -- - STREET ADDRESS 6 Pocono Drive - _- __ _ ___ _---- - _- ----- - ---__ -------. _— _ -- __ _-. __ _ _ _ ---- STATE I ZIP ciTV pq , 17055 Mechanicsburg � Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. CreditslPayments A.Prior Payments - B.Discount 0.00 Total Credits(A+B) (2) 3. Interest �S) -- 4. If Line 2 is greater than Line 1 +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) 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:.......................................................................................... � 0 b. retain the right to designate who shall use the property transferred or its income:............................................ ❑ � c. retain a reversionary interest;or.......................................................................................................................... ❑ � d. receive the promise for life of either payments,benefits or care?...................................................................... � � 2. If death occurred after Dec.12,1982,did decedent transfer properry within one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 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 containsa beneficiary designation? ........................................................................................................................ ❑ ❑K 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 (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(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 decedenPs siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is defined,under Section 9102,as an intlividual who has at least one parent in common with the decedent,whether by blood or adoption. ��. �REV-15o8 EX+(o8-u) � pennsylvania SCHEDULE E DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN pERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: John H. Jenks, Jr. 21-12-0582 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 �. Estate was opened for Litigation purposes for possible malpractice case but no case filed 0.00 Insolvent Estate I i I TOTAL(Also enter on Line 5, Recapitulation) $ 0.00 If more space is needed,use additional sheets of paper of the same size.