HomeMy WebLinkAbout04-29-14 � 1505610105
EX(o2-ii)(FI). �'
REV���OO OFFICIAL USE ONLY
PA Department of Revenue pennsylvania
Bureau of Individual Taxes "`�p'"`��c`p`"�'` Counry Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN -� � `f -,
Harrisburg,PA 1'7128-o6oi RESIDENT DECEDENT ' �� �L �j�),�
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
04/18/2010 04/02/1942 '
DecedenYs Last Name Suffix DecedenYs First Name MI
' ORLOWSKY JAMES ' 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
p 1.Original Return � 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.)
O 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 Schedule O)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
Jacqueline M. Verney,Esq
REGISTER OF WILLS US�NLY
�
�'S � � �j..
First Line of Address � Q � �
c.�� .� —�L, t? �
44 S. Hanover Street �9 �,�- c7 � cn :zx
:.� ;-�. r-- N •-•� C�
Second Line of Address ;,. �"' ��' �p "� M
_ ,,� ... ,.<:r C�
._ . ,, , �,.a �
c.:i r a �? -r°� `r=
City or Post Office State ZIP Code C:'70A_� ED --�
�� �_ �., ._
� �
Carlisle PA 17013 � � � � rn
� � N �
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Correspondent's e-mail address:ji'T1V8t't12y@801.COfT1
Under penalties of pery'ury,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 personai representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
ADDRESS
NATURE OF PREPARER OTHE THAN R�p�ESENTATIVE DATE
-,�-�-��.--.�-- �- V��.-�-5 �l-Lg-I�
DRESE�
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PLEASE USE ORIGINA FORM ONLY
Side 1
� 150561�105 15056101�5 �
� ��
J 15056102�5
REV-1500 EX(FI)
DecedenYs Social Security Number
Decedent's Name: ' '
RECAPITULATION
1. Real Estate(Schedule A). ..... .. . . . ... ............ . ....... ... ........ t ',
2. Stocks and Bonds(Schedule B) .. . . ......... . ..... . ..... .. ... ...... .. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietor hip(Schedule C) ... . . 3. ' '
4. Mortgages and Notes Receivable(Schedule D) ... .... . ................. . 4. '
5. Cash,Bank Deposits and Miscellaneous Personal Prope�ty(Schedule E)..... .. 5. 166,658.61 '
�
6. Jointly Owned Property(Schedule F) O Separate Bil ing Requested .... ... 6. '
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Prop rty
(Schedule G) O Separate Bii ing Requested.. ... ... 7. , ,
i
8. Total Gross Assets(total Lines 1 through 7)..... ... .i................... 8. ' 166,658.61
9. Funeral Expenses andAdministrative Costs(Schedule Hj.. ... ..... ......... 9. , 815.00 '
�
,
10. Debts of Decedent,Mortgage Liabilities and Liens(Schec�ule I)............... 10. '
11. Total Deductions(total Lines 9 and 10)..... . ... ....:... ...... . ......... 11. ' 815.00
; _
12. Net Value of Estate(Line 8 minus Line 11) ... ... .. ..j..... ....... ... ... . 12. ' 165,843.61
13. Charitable and Governmental Bequests/Sec 9113 Trusts�or which
an election to tax has not been made(Schedule J) .. ..:..... . ...... ... ... . 13.
14. Net Value Subject to Tax(Line 12 minus Line 13) .... '.... ..... . .. ....... 14. 165,843.61 '
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICA LE 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 rate X.0 45 � 165,843.61 �g, 7,462.96 ''
17. Amount of Line 14 taxable �
at sibling rate X.12 i 17.
18. Amount of Line 14 taxable
at collateral rate X.15 ' 18•
19. TAx DUE .. ... ... .. ... .. . ...... ... ... .........j.. .. ... ..... ... .... 19.', 7,462.96
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REF ND OF AN OVERPAYMENT O
I
Side 2
� 150561�205 15�561�205 J
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
James M. Orlowsky
_. __ _. _ . __ _ __ -
STREETADDRESS
55 West View
-- -- -- ---_ __ - -
CITY ; STATE ', ZIP
Carlisle, PA ', 17013
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 7,462.96
2. CreditslPayments
A.Prior Payments
B.Discount
Total 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 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) 7,462.96
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.......................................................................................... ❑ �
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 occurred after Dec.12,1982,did decetlent transfer property 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? ........................................................................................................................ ❑ �
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 tleath 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)(12)].
. The tax rate imposed on the net value of transfers to or for the use of the decetlent'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 decedenYs siblings is 12 percent(72 P.S.§9116(a)(1.3)].A sibling is defined,
untler 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-iz)
� pennsylvania SCI�IEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
JAMES M. ORLOWSKY 21-1--0503
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. Georgia Pacific,LLC 166,658.61
TOTAL(Also enter on Line 5, Recapitulation) $ 166,658.61
If more space is needed,use additional sheets of paper of the same size.
_ -�
.• •. . .. . . .• . : •. . . . -.•• :.-.
l . __. ......�..._.:_�_�_.�_....:.�.;_�. _.._,..;._.._. ...... , , CITI9ANK F,S.B.NEW JERSEY ' CIl@CI� NO.
� ISET.IN,�I�>.lERSEY 08830 ��OCOCC
� YIFEIT��LUXENBE�G,t�.C. ' �.,��2,z v vv
; , ' A7Tt}RNEI!'S TRUS7I4CCalJN"� '
` ' 700 BROADW/�Y A C 21,2014
� NEW YORK;NY 10003 _ p
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� RA� *""One Hundred Sixty Six Thc�usand Six Hundred F�fty�igt�t and 61/100 Doflars $166,658.61
�
( ; ; �
, ��'��E � ���u�*l��e Verney �sq. as A�torney f�r the Estat��f J�m Qr(ovusky;= ,
' ORI�ER tO� ,.< _. . , . ; . ,. , _
! ,.
' Jacquefine M Verney Esq. voioiFrroTaaeseNreo�nnrr+u+9annrs
� 44 South Hanover Street ,
� Cstrttste, �A`�7t#�3 . ; ' .
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_______. .._.._^____.__..____.__._____._.._:__
GEORGIA PACIFIC !LC
. . �. . . . � .
� ii'007106066ii' �:0 2 L 27 2655�: ? 59557787ii■ �
Distribution No.: 0 Payment No.: 2484479
WEITZ 8� LUXENBERG, P.C.
ATTORNEY'S TRUST ACCOUNT 7�O6OSG
Apr 21,2014
*`*One Hundrsd Sixty Six Thousand Six Hundred Fifty Eight and 61l100 Doilars $166,658.61
Jacqueline Verney Esq. as Attomey for the Estate of Jim Orlowsky
Jacqueline M Verney Esq.
44 South Hanover Street
Carlisle, PA 17093
Orlowsky,Jim 206368
GEORGIA PACIFIC.LLC
N' E I T Z
� � &
L U X E N B E R G
A I' R O f E 5 5 I O N A L C (7 R P U R A "C I O M1
. L .a W O I� F I C f: S .
� 700 BROADWAI' • tiCW YORK.NY 100U3-95J6 �
PERRY WEITZ '1'EL.212•556•5,5p0 F'AX 212-i{4V61
ARTHUR M LUXEN9EPG ;VV,'}S.4I°.'TZ•!,v rQ�q
R08ERTJ.GORDON1t �
PHAN T ALVARADb ARI FRIEDMAN i KEVIN MULDERIG¶ �,IONATHAN M SEDGH 'o�Cwosei
BENNOASHRAFIi MARYGRABISHGAFFNEY¶ DANAM.NORTHCRAFTtt SHELDON5IWER� YA��oYemqlotlmGl
DAVID J.BARRY ALANI GOLANSKI t TODD OMMEN ROBERT M.SILVERMNN¶ °a�.ao wmmm m F�
JAMES J.BILSBORROYJ DANIELLE M.GOLD}t FRAtJK hfi.ORTIZ 1't DONALD SOUTAF¶ '�g�����'ty����
DANIEL P.BIOUIN LAWRENCE GOLDHIRSCH°' JOSIAH W.PARKER i CARMEN VICTORIA ST.GEORGE tt itA"o.am�ne��w
g n w.eme�m w oc
AMBREJ.BRANDIS KENDRAY.GOLOHIRSCH MICHAELE.PEDERSON TVLER R.STOCKt sacoaemareamoH
EDWARDBRANIFF?Y ROBINI.GREENWAID'§§ PAULJ.PENNOCK PETERTAMBINItt tA4oMmNIMinN.lanECT
JOHN M.BROADDUS£ CARLOS GUZMAN t STUART S.PERRY` JAMES 5.THOMPSON tt -a.a se�Mroa M r+�am vn
VENUS BURNS i ERIKA HEYDER LEE W PREVIANT g§s WILLIAM A WALSH jy' -nko.omm.a uu.l a�aoc
PATTI BURSHTYN tt MARIE L IANNIELLO t° CAITLIN PRZENICZNY+ DANIEL WASSERBERG i tAaso wmnee i�H�e�
LISA NAl'HANSON BUSCH ERIK JAC08S SHAREEF RABAA• LAUREN A.WEIR •u�o aeminaa nnc w ve
THOMAS COMERFORD tY§ DAVID M.KAUFMAN jt ADAM C.R4FF0 JUSTIN J.WEIR �O tlm�s0��
ADAM R.COOPER TAE-VOON KIM s SUZANNE M.R4TCLIFFE tj NEIDRA S.WILSON•• �N"'ammb n Tz
TERESA A.CURTIN¶¶ GARY R.IQ.EIN PIERRE RATZKI NICHOLAS WISE a0 ��""rtea aay n en
BENJAMIN DARCHE DANNY R.KR4fT,JR ELLEN RELKIN•=f£r DENA VOUNG¶ ���i�o�„i w�PA �
Y
TIA T.DIHN••r � JERRY KRISTAL•�§ JOHN E.RICHMOND ii BRENT ZADOROZNV i [AQTitllC dYyXn DL,MD,PR MYI VA
ADAM S.DREKSLER - DEBBI LANDAU MICHAEL P.ROBERTS ALLAN ZELIKOVIC fEGm4fieE AtlY�NJ Sup�eme Lourt
F.ALEXANDER EIDEN. LEAH LEWIS•• CHRIS RONIANELII tt GLENN ZUCKERMAN *A4o bmibC n PA
MICHAEL FANEILI'r'� MATTHEW MACINTRE DAVID ROSENBAND °��i0°MYO�
JAIME M FARRELL� CURT D.MARSHALL; .PETER SAMBERG tt
LEONARD F.FELDMAN¶ SAMUEL M.MEIROWIR GENNARO SAVASTANO
CHARLES M.FERGUSON JAMES A.MORRIS JR.°°ix C�NDY YOUNG SAXEY i
04/21/2014
Jacqueline M Verney Esq.
44 South Hanover Street
' Carlisle, PA 17013 � �
RE: Jim Orlowsky #206368
Dear Sir/Madame:
Enclosed; please find a check(s} in the amount of�166,658.61,which renresents settlement
proceeds Weitz& Luxenberg, P.C. has received from defendant(s) GEORGIA PACIFIC, LLC.
Please refer to the enclosed balance sheet for the details concerning this settlement payment.
Please note that this estate has full letter status, therefore, in as much as your firm is the attorney
for the estate of this client, it is your responsibility to ensure that these funds are properly distributed. If
all necessary filings have been completed for this estate and you wish to have future checks made
payable to the estate representative, please notify us in writing of such request.
Should you have any questions, please contact our Estates Attorney, David Kaufman at(212)
558 - 5687.
Sincerely,
WEITZ & LUXENBERG, P.C.
Accounting Department
200 LAKE DRNE EAST,SUITE 205•CHERRY HTLL,NJ 08002•TEL 856-755-1115
18A0 CENT[JRY PARK FAST,SiJITE 700 •I,OS ANGF_.LES.CA 900G7 •T'EI,310-247-0921
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� � pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
[NHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
JAMES M. ORLOWSKY 21-10-0503
DecedenYs debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
i. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City-- _ State------ZIP..---- -----
Year(s)Commission Paid: ___ _ _
2• Attorney Fees:
650.00
3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.)
Claimant
Street Address
City --- __— __...... --------- --..._--- ----_ State-------ZIP-
Relationship of Claimant to Decedent
4. Probate Fees: 165.00
5. Accountant Fees:
6. Tax Return Preparer fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 815.00
If more space is needed,use additional sheets of paper of the same size.