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HomeMy WebLinkAbout07-18-14 (2) J 1505610143 REV-1500 cot-„) OFFICIAL USE ONLY PA Department of Revenue pennsylvania cWdyCade Ys File Number Bureau of Individual Taxes a�werr�rra. PO BOX.280601 INHERITANCE TAX RETURN 21 14 0251 Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 02 21 2014 09 12 1938 Decedent's Last Name Suffix Decedent's First Name MI GOLDBERG MORDECAI I j(f Applicable)Enter Survtving Spouse's Informadon 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 ' FLU I. Original Return ❑ 2. Supplemental Return ❑ 3. Pan to der Return Pate of Death El 4. Limited Estate 4a,Future Interest Camgmnise 5. Federal Estate Tax Ream ® {die o(�s4»ai2-12 ) ❑ Required 41 6, oecedempycfWW) El' 7. DEM- als"Win3Tneu _-_ & TOWN et Sate Bores 1� (Rhode CaM d Fed t_i at rust) ❑ 9- Litigation Proceeds Racei red ❑ to-b=12 1 1C ttP1 mesh I I.Electien to tax t I nder Sec.9113(A) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JERRY A WEIGLE ESQUIRE 717 532 7388 is T REGISTER OF �USE O q Y C C.� Fri C- First Line of Address CO rf..-... 126 EAST KING STREET Second Line of Address EaCn D C7 City or Post Office State 21P Code DATE FILED Cn SHIPPENSBURG PA 17257 Corresponderd's e-mail address: it is�tnt�rt ct of mm'ete Dadaarraat tion of repo than the personal re resentadve ibased on ell information of which p bast of as any and belief, p pa personal p prepst o has any knowledge S o S RET1RN DATE ✓ SO Marisa J.Tuhy f ADDRESS 1507 Megan Circle Stewartsviile NJ 8886 SIGNATURE REPARER OTHER THAN REPRESE TWE DATE rry A.Weigle Esquire � —/ Aooaess 126 East King Street,Ship nsbu 'PA 257 1505610143 Side 1 1505610143 J �1J�1 PA Inheritance Tax Return Signature of Additional Fiduciaries EOF rg, Mordecai I. FILE NUMBER enalties of perjury,I declare that I have examined this return including accompanying schedules and statements,and to the best of wledge and belief,lt is true,correct and complete.Declaration of preparer other than the personal representative is based on all Gon of which preparer has any knowledge. Signature#2 Name - ames R Tuhy Addressl 1507 Megan Circle Address2 City,State,Zip Stewartsville,NJ 08886 Date 7b-;.11V J 1505610243 REV-1500 EX Decedents Social Security Number o�dacrsN-�: Goldberg, Mordecai 1. RECaPIruLanoN 1. Real Estate(Schedule A)....................................................................................... 1. 2. Stocks and Bonds(Schedule 8)............................................................................. 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. 68, 692 .30 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6. 359. 93 7. Inter-V vos Transfers&Miscellaneous Noq Probate Property (Schedule G) 7 Separate Billing Requested............ 7. 8. Total Gross Assets(total Lines 1 through 7)........................................................ S. 69, 052.23 9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 8,271. 45 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10. 13,424. 16 11. Total Deductions(total Lines 9 and 10)................................................................ 11. 21, 695. 61 12. Net Value of Estate(Line 8 minus Line 11).......................................................... 47,356. 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. 47,356. 62 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. 0. 00 16. Amount of Line 14 taxable at lineal rate X .045 47,356- 62 16. 2,131. 05 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. 2, 131. 05 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. N Side 2 1505610243 1505610243 1 REVA 50D EX Page 3 File Number 21-14-0251 Decedent's Complete Address: DECEDENTS NAME Goldberg,Mordecai t. STREETADDRESS --- ----� --i--- --------� Shippensburg Health Care Center 121 Walnut Bottom Road CITY — ---- -------- STATE ZIP i----- Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Una 19) (1) 2,131.05 2. Credits/Payments A. Prior Payments 0.00 B. Discount — 0.00 Total Credits(A +B) (2) 0.00 3. Interest (3) 4. ff line 2 is greater than line 1+Line 3,enterthe chiffmnoe. This is the OVERPAYMENT. (4) 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) -----2,131.05 Make Check Payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN'W'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;................................ ❑, x Q retain a reversionary interest;or............................................................................................................... ❑ x d. receive the promise for life of either payments,benefits or care?._...._................................................... ❑ x 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?................................................................................_............. .................... ❑ 3, Old decedent own an'in trust for or payable upon death bank account or security at his or her death?......, ❑ 4. Old decedent own an individual retirement account,annuity,or other non-probate property which ��—tt contains a beneficiary designation?.................................................................................................................. ❑ L?1 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.t,1995,the tax rate imposed on the net value of transfersto or for the use of the surviving spouse is 3 percent[72 P.S.§9116(a)(1.1)O). Fordates of death on or after January 1,1995,the tax rate imposed on the net value of transfers to or far the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(u)[. The statute does not exempt a transferto 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 unposed on the net value of transfers to or for the use of the decedents lineal benefidades 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 decedents 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. Pe 4508 EX.(11-10) Pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS, & MISC. INHERrTANCE TAX RE TURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF Goldbe FILE Mordecai 1 MUMBER 21-140251 Indude the Proceeds af IidgaGm and the date Ore All PmWty jdnny-anned 1dr11the ri�or auNV-mh!P-— be dl md�d m the achNUle F. ITEM NUMBER DESCRIPTION VALUE AT DATE Funds OF DEATH 1 from Keystone Guardianship Services 68,548.60 2 Perini Svc.Southampton Manor-Refund from Health Care Ctr. 143.70 TOTAL(Also enter on Line 5,Recapitulation) 68,692.30 (H more space m needed,addi0onal pages of the same size) Copyright(C)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule E(Rev. 11-10) Rev-1509 Dke(01.10) Pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Goldberg,Mordecai 1. 21-14-0251 N an asset waa made)dm VMMn me year afthe decedmr.dale W death,It must be reported on schedde G. SURVIVING JOINT TENANT(S)NAME ADDRESS RELATIONSHIP TO DECEDENT A. James R.Tuhy 1507 Megan Circle Son-in-Law Stewartsville, NJ 08886 B. C. JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY DATE OF DEATH VALUE OF ITEM LETTER DATE N MADE NUMBER Ot R S MOLAR IDENTIFYING N IAL INSTITUTION BER ATTAR BANK DEED FOR DATE OF DEATH DEaGD'`4'' DECEDENPS INTEREST NUMBER TENANT JOINT JOOTLy4iELD REAL ESTATE. ALUE OF AS INTEREST 1 A 04/09/2010 TO Bank Checking Account#424.8740006 719.86 50.000% 359.93 TOTAL(Also enter on Line 6,Recapitulation) 359.93 (N more space is needed.additional pages of the same Size) Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule F(Rev.01-10) REV-1511 EX+(Ia-05) pennsy)vania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE`EDEC DEN"'(`" ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Goldberg,Mordecai 1. 21-14-0251 Decedents debts must be reported on Schedule L ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: B. ADMINISTRATIVE COSTS: I. Personal Representative's Commissions Name of Personal Representative(s) Marisa J.Tuhy James R.Tully Street Address 1507 Megan Circle city Stewartsvilie state NJ zio 08886 Year(s)Commission Paid 2014 3,'`4.58 2. Attorney's Fees Weigle&Associates,P.C. 4,204.55 3. Family Exemption: (If decedents address is not the same as claimants,attach explana0on) Claimant Street Address City State ZiD -- --. RelationshiD of Claimant to Decedent 4. Probate Fees Cumberland County Register of Wills 303.50 5, Accountants Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 308.82 See continuation schedule(s)attached TOTAL(Also enter on line 9,Recapitulation) 8,271.45 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 Goldberg, Mordecai 1. FILE NUMBER 21-14-0251 ITEM NUMBER DESCRIPTION AMOUNT Qiher Administrative Co�*� 1 Cumberland County Register of Wills-(2)Short Certificates 10.00 2 Cumberland County Register of Wills-Filing Family Settlement Agreement 100.00 3 Cumberland Law Journal-Advertising 75.00 4 Miscellaneous Administrative Costs-postage,letters,etc. 50.00 5 News Chronicle-Advertising 73.82 H-B7 Copyright(c)2002 form software only The Lackner Group,Inc. Form PA-7500 Schedule H(Rev.6r98) laaaaaaa�l Rew1512 EX-(12-09) SCHEDULE I pennsy)vania DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES AND LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Goldberg, Mordecai 1. 2144-0251 Repot debts incurred by the decedent pdorta death dad remained unpaid at the date ofdeaft including unreimlwmed medioal expamen. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Cypress Financial ReCoveries-Judgment Number DG122821-11 1,526.99 2 Ford Motor Company,LLC-Judgment Number DJO49962-10 11,697.17 TOTAL(Also enter on Line 10,Recapitulation) 13,424.16 IN more space is needed,additional pages of the same size) Copyright(c)2008 form software only The Lackner Group,Inc. Form PA-1500 Schedule I(Rev. 12-08) REV-1510 EX.(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE DECEDENT TURN BENEFICIARIES INHERI A CE TAX RE ESTATE OF �___L FILE NUMBER Goldberg,Mordecai I. 21-140251 ENAME D ADDRESS OF RELATIO NSHIP TO SHARE OF ESTATE OUNT OF ESTATE NUMBEV ECEMNG PROPERTY DECEDENT ooNaus<r�1 (Words) ($$$) NS [include outright spousal distributions,and transfers under Sec.9116 insberg Daughter One-Third of 15,785.54 sh Place Estate Residuary Basking Ridge,NJ 07920 2 Stephanie L Goldberg Daughter One-Third of 15,785.54 400 East Randolph Avenue Unit#5 Estate Residuary Nune Hill, NJ 07803 3 Marisa J.Tuhy Daughter One-Third Estate 15,785.54 1507 Megan Circle Residuary Stewartsville,NJ 08886 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 covOeasheet,as a date. 47,356.62 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 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHE Copyright(c)2010 form software only The Lackner Group,Ina Form PA-1500 Schedule J(Rev.01-10) r4� " i {YW D Mordecai I. Goldberg Jerry A_ Weigle, Esquire WEIGLE & ASSOCIATES, P.C. ATTORNEYS AT LAW f26 EAST K..S� SHiPPiausBU 0. PA 17257-1397 5� i 1 LAST WYLL AND TESTAMENT 1 L MORDECAI L GOLDBERG, single person, presently residing at Shippensburg Health Care Center, 121 Walnut bottom Road, Shippeasburg, Cumberland County, Pennsylvania j 17257, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all Wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease_ SECOND. I give, devise and bequeath all my estate, real, personal and nixed, whatsoever and wheresoever situate, to my beloved, daughters, namely DANA GINSBERG, MARISA J. TUHY and STEPHANIE GOLDBERG in equal shares_ In the event that one or more of my beloved daughters, predecease me I direct that the share of any deceased child or q children be equally distributed among my surviving children r f THIRD_ I nominate, constitute and appoint my daughter, NLARISA J. TUHY and my son-in-law, JAMES R. TUHY, or the survivor thereof, presently of 1507 Megan Circle, Stewartsville,New Jersey 08886 as Co-Executors of this my Last Will and Testament. f� FOURTH. I direct that my personal representatives shall not be required to give bond i for the faithful performance of their duties in any jurisdiction. { IN VAYN-ESS WHEREOF, I, MORDECAI L GOLDBERG,have hereunto se6my hand and s, to this my Last Will and Testament, written on one (1) page this 2-/W1 --day of 2009_ { E1� F! 4 (jY I 1 1 1NP T.E ea ASSOOA- HC. -ATTORIQEYS AT LAW- 12G F T F G STREET - SHIPPE SBURG. PA 1725T-1397 1 3 { �V , This instrument was by the Testator, on the dale hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in the presence of each other,we believing him to be of sound and disposing mind and memory,have hereunto subscribed our names as witnesses_ zzx� C k r �i f COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND 1, MORDECAI I. GOLDBERG, the person whose name is signed to the 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 _ 1 MORDECAI I. GOLDBERG : 9 t Sworn or affirmed to and acknowledged before me by MORDECAI GO ERG,the T tor, ffiis 74-day of ' 2 � f 1 COMMONWEAL Of PENNSYLVANIA NOT IAL SEAL ferry A.Weigte,Notary Pub1iC - City of Sn pperisburg,Cumberland Count try,,l onunission Expire5'actober 07,2010 WFJG)c" 6 ASSOCIATES_ PC- - ATTORNEYS AT 1 CW - V a en e-`- wr_ C-rvve-f - cwvoPNSii11R(;.-PA AT2STA39T - -4 - ',, ` } X 0 CON tMONAVEALTH OF PENNSYLVANIA SS COUNTY OF CI.I t4BER1?ND We, c� the witnesses whose names are signed to the foregoing instrument,being duly qualified according to law, do depose and say that we were present and saw MORDECAI L GOLDBERG, the 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 r e hearing and sight of the Testator, signed the Will as witnesses; and that to the best of our i knowledge the Testator was at the time eighteen(18)or more years of age and of sound mind and under no constraint or undue influence. Sworn or armed to and subscribed before me by �Oy SS and—H tawaig 1 ZsIes,Z this 17, day of 2009. T COMMONWEALTH/0 _PENNSYLVANIA " )TAR L SEAI.� ferry A.WeFgl ,Notary Publie - Cityryoi Stxppenstiurg.Cumberland Countyl - My Commission ExpiresOctotisr 07.20]0 1'+EeGLE S ASSpCIATES PC. — A1Tp —N S AT �W — 126 EASE fWi 6 STREET— SH PPF SBURG. PA 17257-139T �$'f Jun. 4. 2014 12:39PM No. 0418 P. 9 TD Hank America's Mast Convenient Bank` oPefSitbfl5 Ceatef P.6-36 1377 tdbaaL: LewnTbn,M£04243-1377 T%88 751 9000 June 4,2014 WEIGLE&ASSOCIATES,P.C. ATTONEYS AT LAW 126 EAST KING STREET 8I11PPENBURG,PA 17257 RE: The Estate of 141ORDECAI I GOLDBERG Below please find the Date of Death Verification information you requested on the above referenced name. If you have any questions regarding the information provided,please feel fires to contact the Bank at 888-751-9000_ Account Type: CHECKING Account Number: 4248740006 Date of Death Balance: $719.86 Interest Rate: .02% _Current'Y'ear-to-date Posted Interest up to Date of Deatli. SNIA Accrued Interest up to Date ofbeath_ $0.00 Name(s)on Account: MORDECAI I GOLDBERG;JAMBS R TURY Safe Deposit Box: N/A Addilienal Information: DATE ACCOUNT OPENED:04109110 Sincerely, Deposit Operations TD Bank,N.A. JLB Jun. 4. 201412: 39PM No. 0418 P. 10 ' TD Bank © Op erim's Most Convenient Bank' PO.BoX 1 Center PO.Sox 1377 tD6anksom LMston,ME 04243.1377 T 898 751 9000 June 4,2014 WEIGLE&ASSOCIATES,P.C. ATTONEYS AT LAW 126 EAST KING STREET SHIPPENBURG,PA 17257 RE: The Estate of MORDECAI I GOLDBERG Below please find the Date of Death Verification information you requested on the above referenced name.If you have any questions regarding the information provided,please feel free to contact the Bank at 888-751-9000. Account Type: CHECKING Account Number 7870967770 Date of Death Balance: $0.00 Interest Rate: _02% Current Year-to-date Posted Interest up to Date of Death: SN/A Accrued Interest up to Date of Death: $0.00 Name(s)on Account: JAMES R TU14Y LEGAL CUSTODIAN,MORDECAI I GOLDBERG Safe Deposit Box: N/A Additional Information: DATE ACCOUNT OPENED: 04/20/09.ACCOUNT CLOSED 02/21/14 Sincerely, Deposit Operations TD Bank,NA- Jun. 4. 2014 12:39PM No. 0418 P. 11 Bank AMeHU S Most Comrenlent BMie Op Operations Center PO.Box 1377 td6enk.tom Lewwon,ME 04243-1377 T 838 751 9000 June 4,2014 WEIGLE&ASSOCIATES,P.C. ATTONEYS AT LAW 126 EAST KING STREET SHIPPENBURG,PA 17257 RE: The Estate of MORDECAI I GOLDBERG T-e Whom It May coneem Below please find the Date of Death Verification information you requested on the above referenced name.If you have any questions regarding the information provided,please feel free to contact the Bank at 888-751-9000. Account Type: SAVING Account Number 4784761376 Date of Death Balance: $0.00 Interest Rate: .05% Current Year-to-date Posted Interest up to Date of Death: $N/A Accrued Interest up to Date of Death: $0.00 Name(s)on Account: MORDECAI I GOLDBERG,JAMES R TUHY FIDUCIARY Safe Deposit Banc: N/A Additional Information_ DATE ACCOUNT OPENED:05/21/13.ACCOUNT CLOSED 02/21/14 Sincerely, Deposit Operations TD Bank,N.A.