HomeMy WebLinkAbout06-12-14 J 1505610143
REV-"1500 EX(02-11) ''
PA Department of Revenue y OFFICIAL Co USE ONLY
P Pennsylvania county cede Year Fne Number
Bureau of Individual Taxes °ET^°*"E"r of aeyEauE
PO BO.280601 INHERITANCE TAX RETURN 21 14 C:�/ �
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
02 11 2014 12 08 1940
Decedent's Last Name Suffix Decedent's First Name MI
MELLERSKI JOHN J
(if Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
MELLERSKI NANCY C
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 12-1282)
g Decedent Died Testate 7 Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of 011) (Attach opyof Trest)
9, Litigation Proceeds Received 10.betoweenP2y3�Cr tlilPom of Death C 11.Election to tax under Sec.9113(A)
(Attach Schedule O)
5
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GEORGE F DOUGLAS III ESQ 717 249 6333
ry
REGISTER t'1�.)WILLS 179E Ofd 'IT
y �O C-
c� .1 c _.
First Line of Address 1771 - c7 2 rn
rr
354 ALEXANDER SPRING RO r z M rev M
Second Line of Address `
c� n
n B
DATr=PILEDW r— MC
City or Post Office State ZIP Code
CARLISLE PA 17015 ' vc N o
Correspondent's e-mail address: gdounlastftsalzmannhucibes.com
Under penalLes of perjury,I declare that I have examined this return,4nctudirg 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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
Nancy C. Meiierski
ADDRESS IF
1117 Rockledge Drive, Carlisle, PA 17015
SIGNATU L N A� i S7 George F Douglas, tit Esq. f Dj A y T E
ADDRE
_tc
354 Alexander Spring Road Suite 1, Carlisle, PA
1505610143 Side 1 1505610143 J
i �5
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Mellerskl, John J.
RECAPITULATION
I. 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.
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Nnq-Probate Property
(Schedule G) LJ Separate Billing Requested............ 7. 127 , 633 . 56
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 127 , 633 . 56
9. Funeral Expenses and Administrative Costs(Schedule H)............
9. 1 , 015 . 00
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10,
11. Total Deductions(total Lines 9 and 10)................................................................ 11 1 , 015 . 00
12. Net Value of Estate(Line 8 minus Line 11)............................. .. ......................... 12. 126, 618 . 56
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. 126, 618 . 56
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec. 9116
(a)(11.2)X.00 126, 618 . 56 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 0 . 00 16. 0 . 00
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 0 . 00
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
1505610243 15056.10243
REV-1500 EX Page 3 File Number 21-14
Decedent's Complete Address:
DECEDENT'S NAME
Mellerski,John J.
STREETADDRESS -
1117 Rockledge Drive
CITY —_ - -- --- - _�— STATE
Carlisle PA 17015
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 0.00
2. CreditstPayments
A. Prior Payments
B. Discount 0.00
Total Credits(A +B) (2) 0.00
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,Line 20 to request a refund -�
5. If Line t +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;.................._......_.......__...._............................._... x
b, retain the right to designate who shall use the property transferred or its income;................I.................
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 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?..__. ❑ (-xj
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains a beneficiary designation?............................ ❑ C,
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)(7].
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
172 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)1.
• 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.§9116(a)(1)].
• The tax rate imposed on the net value of transfers to or for the use of the decedents siblings is 12 percent[72 P,S.§9116(a)(1.3)j. 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-1510 EXa(09.09)
SCHEDULE G
pennsylvania
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF
Mellerski John J FILE NUMBER
21-14
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY
NUMBER INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Pershing, IRA Account No. 5HU089735-Beneficiary is 109,442.81 100.000%
Nancy C. Mellerski,wife 109,442.81
2 Pershing, Roth IRA Account No. 5HU071337- 18,190.75 100.000% 18,190.75
Beneficiary is Nancy C. Mellerski,wife
TOTAL(Also enter on Line 7, Recapitulation) 127,633.56
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev. 08-09)
REV-1511 EX.(10.09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN
RESIDENT DECEDENT ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Metlerski,John J. 21-14
Decedent's debts must be reported on Schedule 1.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
a. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of personal Representative(s)
Street Address
City State Zio
Years)Commission Paid
2. Attorney's Fees Salzmann Hughes, P.G. 1,000.00
3. Family Exemption: (If decedent's address is not the some as claimant's,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 15 00
See continuation schedule(s)attached
TOTAL(Also enter on line 9,Recapitulation) 1,015.00
Copyright(c)2009 form software only The Lackner Group,Inc. Form PA-1500 Schedule H(Rev. 10-09)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF
Mellerski,John J. FILE NUMBER
21-14
ITEM
NUMBER DESCRIPTION AMOUNT
Other Admini trativ Co
1 Register of Wills-filing fee for PA Inheritance tax return
15.00
H-B7 15.00
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
REV-1513 EX.(01.10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
Mellerski, John J. FILE NUMBER
21-14
NAME AND ADDRESS OF RELATIONSHIP TO
NUMBER PERSON(S)RECEIVING PROPERTY DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
(Words) (ggg)
I• TAXABLE DISTRIBUTIONS [include outright spousal _12aa-1111s T.
distributions,and transfers
under Sec. 9116 a 1.2
1 Nancy C. Mellerski Spouse Entire Estate
1117 Rockledge Drive 126,618.56
Carlisle, PA 17015
Total
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 1500 cover sheet,as appropriate. 126,618.56
NON-TAXABLE DISTRIBUTIONS:
II. A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group, Inc. Form PA-1500 Schedule J(Rev.01-10)
LAST WILL AND TESTAMENT
OF
JOHN J. MELLERSKI
I, JOHN J. MELLERSKI, of 1117 Rockledge Drive, Carlisle,
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 revoking and making void any and all former Wills, Codicils, or
writings in the nature thereof, by me at any time heretofore made.
FIRST: I hereby order and direct my Executrix or Executor,
hereinafter named, to pay all my just debts, funeral expenses, testamentary
expenses and all Inheritance, Estate, Transfer and Succession Taxes, as soon as
may be conveniently done after my death, out of my residuary estate.
SECOND: I have made, or may from time to time make, a written
memorandum expressing my desire to give certain items of personal property to
specific persons. I urge my Executrix or Executor and beneficiaries to respect these
wishes. Such a memorandum, if made, shall be stored in conjunction with this Will.
THIRD: I give my residuary estate to my wife, NANCY C.
MELLERSKI, provided she survives me by thirty (30) days.
FOURTH: in the event that my wife, NANCY C. MELLERSKI, fails
to survive me by thirty days, I hereby give, devise and bequeath my residuary estate
as follows:
A. Twenty (20%) percent to GREENPEACE, of 702 H. Street NW,
Suite 300, Washington, DC 20001 (Telephone: 1-800-326-0959);
B. Twenty (20%) percent to DOCTORS WITHOUT BORDERS, of
333 Seventh Avenue, 2nd Floor, New York, NY 10001 (Telephone: 1-212-697-
6800);
C. Twenty (20%) percent to OXFAM, of Oxfam House, John
Smith Drive, Oxford OX4 2J Y, United Kingdom;
D. Ten (10%) percent to WORLD WILDLIFE FUND, of 1250
Twenty-Fourth Street NW, Washington, DC 20037 (Telephone: 1-888-993-9455);
E. Ten (10%) percent to ASPCA, of 424 East 92nd Street, New
York, NY 10128 (Telephone: 212-876-7700);
F. Ten (10%) percent to ENVIRONMENTAL DEFENSE, of 257
Park Avenue South, New York, NY 10010 (Telephone: 1-877-6771-7397); and
G. Ten (10%) percent to INTERNATIONAL FUND
FOR ANIMAL WELFARE, of 411 Main Street, Yarmouth Port, MA 02675
(Telephone: 1-888-251-0253).
LASTLY: I nominate, constitute and appoint my wife, NANCY C.
MELLERSKI, to be the Executrix of this my Last Will and Testament. In the event
that my said wife, shall be unable to serve as Executrix for any reason, I appoint,
KENNETH ZIRKMAN, of 1123 Empire Road, Atlanta, GA 30329, as Executor. No
Executor or Executrix shall be required to file bond in this or any other jurisdiction.
2
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
day of
2007.
John J. Mellerski
SIGNED, SEALED, PUBLISHED and
DECLARED in the presence of:
do
3
COMMONWEALTH OF PENNSYLVANIA
ss
COUNTY OF CUMBERLAND
I, JOHN J. MELLERSKI, Testator, whose name is signed to the
attached or foregoing instrument, 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 expressed.
Sworn or affirmed to and acknowledged before me, by JOHN J.
MELLERSKI, the Testator, this l TP day of rWj.
2007.
John J. Mellerski, Testator
N t ry Public
NOTARIAL SEAL
MERLENE J. MARHEVKA, NOTARY PUBLIC
CARLISLE, CUMBERLAND COUNTY, PA
MY COMMISSION EXPIRES JUNE 8, 2010
4
COMMONWEALTH OF PENNSYLVANIA.
ss
COUNTY OF CUMBERLAND
We, bs2z < "
and ,)/
nd
the witnesses whose names are signed to the att6Whed 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 his Last Will; that he signed
willingly and that he executed it as his free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testator signed
the Will as witnesses; and that to the best of our knowledge the Testator was at that
time 18 or more years of age, of sound mind and under no constraint or undue
influence.
Sworn or affirmed to and su scribed bkfore me by
and [e c. l/ this
Tti /
day of 2007.
Witness
i
Witness
o ary Public
NOTARIAL SEAL
MERLENE J. MARHEVKA, NOTARY PUBLIC
CARLISLE, CUMBERLAND COUNTY, PA
MY COMMISSION EXPIRES JUNE 8, 2010
5
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