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HomeMy WebLinkAbout08-29-14 1505610143 /� EX REV-1500 (02-11 0 t OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County code Year File Number Bureau of Individual Taxes ob` r «TO aa,`awaa PO 60x.280601 INHERITANCE TAX RETURN 21 14 �t Harrisburg,PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 11 30 2013 08 01 1935 Decedent's Last Name Suffix Decedent's First Name MI NEBROSKI PATRICIA A (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI NEBROSKI NORMAN E Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Retum 2. Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-82) 4. Limited Estate 4a.Futtme interest Compromise S. Federal Estate Tax Return Required ( t (date W death after 12-12-82) t-1 8' Attach Copy of Will)t to !—! 7. tAtladeGopy�o Net)a Living TNSt 0 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 10.sppousal Pove%Credd(Oats of Death �_� 11.Election to tax under Sec.9113(A) befvreon 12-3t- 1 and 7-1-95) (Attach Schedule O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number AMY M MOYA 717 652 7323 r.a R EB.OF WILL•'b�USt{�1R 4_ p First Line of Address �� '¢ rri cn 5011 LOCUST LANE m quo Second Line of Address c7 i 'el r T _ C City or Post Office state ZIP Code DATE Fit -o cc fk> ?a�- HARRISBURG PA 17109 Tr1 m C= c7 0 v Correspondent's a-mail address: Amv(rDLedererlaw.COrn r n1 iV r'n rrI " o Under penalties of perjury,I declare that I have examined this return,including accompanying schedules and statements,and to the best of 4 n6gled'ge and belief, it is true,correct and complete Declaration of preparer othe[,than the personal representative Is based on all information of which preparer h5 n lfnctviedge. C3 SI OF PERSON R 5 FOR LING RETUR �� A Norman E. Nebrosid ADD sS 824 Center Street Enola PA 17025 -13 V ATURE OF P PA OTHER THAN REPRESENTATIVE D TE L/ 2 Amy M. Moya � ADDREp , 5011 Locust Lane, Harrisburg, PA 17109 Side 1 '„` 1505610143 1505610143 J 1505610243 REV-1500 EX - Decedents Name. NebroSki, Patricia A. Decedent's Social Security Number RECAPITULATION 1. Real Estate(Schedule A)................................................................ 2. Stocks and Bonds(Schedule B)............................. ..................................... 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) 4. Mortgages&Notes Receivable(Schedule D)........................................................ q_ 5. Cash, Bank Deposits&Miscellaneous Personal Property(Schedule E)............... 5. 6. Jointly Owned Property(schedule F o Separate 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property Requested..........., g. (Schedule G) U Separate Billing Requested............ T 82, 964 . 79 8. Total Gross Assets(total Lines 1 through 7)............................... 9. Funeral Expenses and Administrative Costs(Schedule H)............ 82, 964 . 79 9. 4, 847 . 54 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)........... 10 11. Total Deductions(total Lines 9 and 10)............................................... ................ 11. 12. Net Value of Estate(Line 8 minus Line 1 1)............................. .. . . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 4 , 847 . 54 78, 117 . 25 an election to tax has not been made(Schedule J)............................................... 13. 14. Net Value Subject to Tax(Line 12 minus Line 13)............................................... TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 14. 78, 117 . 25 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (a)(1.2)X.00 78, 117 . 2$ 15. 16. Amount of Line 14 taxable 0 . 00 at lineal rate X .045 17. Amount of Line 14 taxable 0 00 16. at sibling rate X.12 18. Amount of Line 14 taxable 0 . 00 17. 0 . 00 at collateral rate X.15 0 . 00 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. I_ 150561024 Side 2 3 1505610243 J REV-1500 EX Page 3 File Number 21-14 Decedent's Complete Address: DECEDENT'S NAME Nebroski, Patricia A. STREET ADDRESS ------- ---------- 824 Center Street ---------- -------- — — CITY STATE ZIP Enola PA 17025 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A. Prior Payments _ B. Discount -----i 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 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::..........................................._._............._.._._.._... ❑ x 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?.,_I.....­­I............................. .......... ❑ 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?......._......._.........._._......._........................................................................ ❑ EXI 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 172 P.S.§9116(a)(1.1)(1)]. 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 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 172 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(a)(1)]. •The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings 6s 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. - Rev-1510 EX.(08-09) Pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND RE,51DTANCETAXRETURN MISC, NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF Nebroski, Patricia A. FILE NUMBER This schedule must be wm......and/filed If the answer to any of questions 1 through 4 on page three of the REV- 27-14 1500 is yes. ITEM DSCRIPTION OF P:ROPERTY NUMBER INC DE OF TggNSFRER SAT7gCHTA COPY OFTHOE OEE�OREREALNTAND, DATE OF DEATH %INTERESDTS EXCWSION TAXABLE 1 Individual Retirement Annuity Account No. C741 2479 VALUE OF ASSET (IF APPLICABLE) VALUE -4357, held at Ohio National Financial Services 1 61.964.79 100.000% Contract No. E1445021,Patricia A. Nebroski,owner, 61,964.79 Norman E. Nebroski(spouse), beneficiary 2 Prepaid funeral contract with Auer Cremation Sery ices 11000.00 100.000% 1,000.00 TOTAL(Also enter on Line 7, Recapitulation) (If more space is needed,additional pages of the same size) 62.964.79 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 REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN RESIDENT DECEDENT ADMINISTRATIVE COSTS ESTATE OF Nebroski, Patricia A. FILE NUMBER 21-14 ITEM Decedent's debts must be reported on Schedule I. N MBER DESCRIPTION A. FUNERAL EXPENSES: AMOUNT See continuation schedule(s)attached 3,832.54 B• ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) StreetAddress City State Zio Year(s)Commission Paid 2. Attorney's Fees Law Offices of Susan E.Lederer(estimate) 1,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation) Claimant Street Address City State Zio Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees . 6. Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedules)attached 15.00 TOTAL(Also enter on line 9, Recapitulation) 4,847.54 Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev. 10-o9) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF Nebroski, Patricia A. FILE NUMBER 21-14 ITEM NUMBER DESCRIPTION AMOUNT _Funeral Expenses 1 Auer Cremation Services of Pennsylvania, Inc. 1.441.47 2 Catholic Cemeteries(Interment fee) 935.00 3 Dove release 607.01 4 Hoss's Restaurant(funeral luncheon) 699.06 5 Michael J.Shalonis Funeral Home 150.00 H-A Other Administrative Costs 6 Cumberland County Register of Wills(filing fee-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) RMI519 EX.(01 40( pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES iRESIDENT DECEDENT' ESTATE OF FILE NUMBER Nebroski, Patricia A. 21-14 RELATIONSHIP TO NUMBER NAME AND ADDRESS OF DECEDENT SNARE OF ESTATE AMOUNT OF ESTATE PERSON(S)RECEIVING PROPERTY u NO L I st TmsteNsl (Words) ($$$) Z TAXABLE DISTRIBUTIONS [include outright spousal distributions,and transfers under Sec.9118 a 1.2 1 Norman E. Nebroski Spouse IRA on Schedule 78,117.25 824 Center Street G Enola, PA 17025 Total 78,117.25 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as appropriate. 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 SHEETj Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10) m " e p oa . m r" H WoaaT7yb '-�Om .� ,. my U JN � C ooiQ 3 o <S N = n O w n 3 � N d 7 C Q V d o _H .. a 51 j "O� G] m ° �'o mQo � =>* o• Z22Z � ' 0 9ooa v n�omy_. o Qo"o,�tp b H m C ci ° 2 D On O< 0C o 5o , 0 S Z yAot.L�y _o H^I mQfpHO Hom �'OAy 8'G� .-. AmmD � 8 Z.;, 03 'cH nm � Cs] ��Hyy omo H �t�J 8no � m f) 3Z 0 3 n m S 0 3 ac 9 @m.<3N �i z� �y �! N ;a W 1 , m =�� m:^ HZ o �� c t" °�c3tr °o. 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CD ID 'n o ° �W 0 0 -,W CD CD W 0� CD 0 Cp m U) CD N CD se z CD tr 19 a 0 Sp 0 :a 0 — 0 CD 0. ozm Jo o co CD CD O CL En � M L. x CD M t'n m CL C) • O c» O CDO-vOO NrZm odmg_ 0ma vDUCOy n o amm Jnymm�-D' S�'�° � Q O y+! `!..aImZ 71•: .0 N.. .J mSrJ.o mn m°m'p p p DO n �N 01 W'og Dm m dG r* o.5 mO 'S A C .! a ;S w bp m E t�m �r�i Jt l G C N m m;— iN� mr cgm p,- ynG2ir'�` ZXNymvJimN gym' .< m1^ m m opJvi m63 CA 010 FX C Pyre r;'•-`; O n O m 3 _ - S•: Q,-V tD 5 m a C C y J D Q Qom- <vQa'EX o v aV ;V Z m °.?1 m m. O < S,:w d N v m 6i n m e 3 MM- < am - 11C 9 C m i:i��: .liv: `G� 0� D c�•y` J C C '' : CAS_ j nAD 0 ° g e " m MMD 0, yA zi, S6V ZZN 0 on m O n 6-79 R 1 m D Z Z m' min ° CO t0 'O N O x r N O O ry O N m QO : -i. Fi m@ - 0 no �0 2 m 0 meta c mm 'A3mm' map JgSm ¢¢ �o fo! m Q Q N •O-Oi N 9 !' m C m m�e; a0. 0 mN N fN.-. H m �a / 00 � � / ) 2 = Con \ � }) ) e7 § D \ = z = , / r & } \ \ ( \ \ , / 2 CD � 0 / / \ / ) k } � / ( 7ƒ ( 72 \ ®® 2 ® a w r � ) @y ( } = , / r / / } » e Em 'X c m ; » y® E2E2m � $\ a ± ( ( r / } ( � ; / / CL ` ) } i / / 3 j § \ ( § 00 } � m f \ � m / / k\ƒ \ ® ® mm> a rlD Co $ $ !}\ / * Z)f Page I oft MOhio National . Fiximicial Services. Annuitant: NEBROSKI, PATRICIA A Variable Annuity Contract E1445021 Status; DEATH All data Is as of 01/03/14 or the date shown. Contract Info ONcore Xtra Plan Type Qualified-IRA Contract Issue Date Issue Age 167 Total Purchase Payment $94,651,68 Surrender Value $0.00 (Rider, contract charges and taxes not deducted, If applicable.) Asset Allocation Model INoneSelected ---- ............ ------ --------------- Nursing Home Benefit j Yes Notes THE PREMIUM INCLUDES THE 4%EXTRA CREDIT AMOUNT OFFERED ON NEW CONTRIBUTIONS TO THE CONTRACT.,TERMINATED 12/20/2013 TOTAL PREMIUMS PAID ON CONTRACT$94651.68 Values Asset Allocation Model: I None Selected Access to Values for this policy is currently unavailable. Contact Customer Service for Values for this policy using Contact Us above. Transaction History Annuitant/ Owner I Pa or Information Annuitant Owner Payor Name NA EBROSKI,PATRICIA NEBROSKI,PATRICIA A i NEBROSKI,PATRICIA A I 824 CENTER STREET 624 CENTER STREET 824 CENTER STREET Address ENOLA, PA 17025 ENOLA, PA 17025 t ENOLA, PA 17025 Tax 10 --*-*--r,819 Date e of Birth 08/017193 FEMALE EMALE NORMAN NEBROSKI, HUSBAND Beneficiary Go Paperless Delivery This policy/contract has not been registered or no elections have been made. Rep Info [Firm Name Representative Name littps:ffomct.ohimational.com/porial/siteloniietltcmpl,ite.SOLO/Poiioy_pisplayPjavax.porUct-tpst=dOn943a9e937a265c5957dcOSf1011ca—Nvs.,, 113012014 J�¢CgT,MATIONS�R`c S� t.1, li- csa AVER CREMATION SERVICES OF PENNSYLVANI (� �PP��''• 4100 Jonestown Road • A NNSYLVANII+ Harrisburg, " 17]09 • 1-800-720-8221 • INC• Fax 717-541-9943 • Shawn E. Carper, Supervisor 131242 MO-5 Dec 1 , 2013 Mr . Norman E. Nebroski 824 Center Street Enola , PA 17025 Patricia Ann Nebroski - Deceased SPECIAL CHARGES X Direct Cremation Nationwide Guarantee Program $1 , 795 . 00 Worldwide Travel Protection TOTAL SPECIAL CHARGES PROFESSIONAL SERVICES $1 , 795. 00 X Services of Funeral Director & Staff Other Preparation of the Body Included Facilities & Staff for Memorial Service Staff & Equipment for Memorial Service Witnessing the Cremation Private Family Viewing/Witnessing Cremation Packaging And Forwarding Cremated Remains Personal Delivery of Cremated Remains Scattering of Cremated Remains Medical Documents/Courier Fee TOTAL PROFESSIONAL SERVICES AUTOMOTIVE EQUIPMENT $0 . 00 X Removal Vehicle Lead Car/Clergy Car Included Family Car Service Vehicle TOTAL AUTOMOTIVE EQUIPMENT $0. 00 MERCHANDISE Register Book Memorial Cards Thank You Cards $0 . 00 X Remembrance Package $155 . 00 6% Tax $9 . 30 $164 . 30 Cremation Container X Granitone MK Urn Vault Urn Burial Vault $250 . 00 Veterans Flag Case Grave/Memorial Marker TOTAL MERCHANDISE CASH ADVANCED ITEMS $414 . 30 Grave Opening Cemetery Equipment X Harrisburg Patriot Newspaper $115 . 47 Vault Service Charge Clergy Church/Organist/Soloist Flowers X Crematory Charge X Cumberland County Coroner Fee Included X 8 Certified Copies of Death Certificate $30 . 00 X 3 Additonal Death certificates $48 . 00 $18 ' 5 Additional Death Certificates we have in ha 00 TOTAL CASH ADVANCED ITEMS SUMMARY OF CHARGES $211 . 47 Special Charges $1 , 795 . 00 Professional Services $0 . 00 Automotive Equipment $0 . 00 Merchandise $414 . 30 Cash Advanced Items $211 . 47 SUB TOTAL CREDITS $2 , 420. 77 AMOUNT PREPAID Date Feb 28, -$979 . 30 TOTAL 2000 -$1 , 000 . 00 AMOUNT PAID Date Dec 30 , 2013 $441 . 47 BALANCE DUE -$441 . 47 $0 . 00 THIS STATEMENT MAY NOT REFLECT ALL NEWSPAPER CHARGES August 27, 2014 ry Register of Wills c, Cumberland County Courthouse M 'O o 1 Courthouse_ Square ` ' b ee� 2 Carlisle, PA 1 013 a r- N rrn rn r- M CO CV RE: Estate of Patricia A. Nebroski v C) o SSN: o 3 Date of Death: November 30,2013 ry rr,- rg File Number: NOT YET ASSIGNED Ladies and Gentlemen: Enclosed for filing with your office please find two (2) completed Form REV-1500 with date of death valuations. Also enclosed is a check made payable to Register Wills in the amount of$15.00 for associated filing fees. Please advise if any additional fees or expenses are due with regard to this matter. One (1) additional photocopy of the front page of the completed REV-1500 form has been provided. Please time/date stamp this copy as received and return it to me in the envelope provided. If there are any questions or further requirements regarding this return,please do not hesitate to contact me. o s 'pq Very truly yours, ;� _� c� ll o o n � rn rn rn a G Amy M. Moya © ° 3 ?t f-± ?. crt M Enclosures 5011 Locust Lane • Harrisburg,PA 17109 • Phone 717.652.7323 Fax 717.652.7340 • susan @ledererlaw.com www.ledererlaw.com W N N 09 e � uN ie 40 5 VDLL OF G15TER OF DRILL'S` i GI's o ILAA, 2M RUG-29 Pal 2 48 CCC 4 fl 31 46 CLERK OF C LL•M 0 iL9RPHANS" COURT p, .HAND GO T i�8_E-RL.AND CO., PA CA.. PA µ c Ln 0 Mimi co m ' -n , Low C3 . M� un C3 O I N E3 { \ O i p 7 L i u7 a A 7 fU O ti � N >. ' m c r C3 m O N O cr O M1 _ U 2J o 0 c J Q 0 Irl m o d N N r g N .0 7 N 8) E 0 = H I ( 1 pf I 1 ` August 28, 2014 Register of Wills ATTN: Diane Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Patricia A. Nebroski SSN: Date of Death: November 30,2013 File Number: NOT YET ASSIGNED Dear Diane: Enclosed please find a check made payable to Register Wills in the amount of$15.00 in payment of your filing fee for the Pennsylvania Inheritance Tax Return in the above-referenced Estate. If there are any questions or further requirements regarding this return, please do not hesitate to contact me. N c. s M rn o iii Very truly yours, .V (� .g M ry rn m * CO o n 3 n I Amy M. Moy r~v r n a co _9' Enclosure 5011 Locust Lane • Harrisburg,PA 17109 • Phone 717.652.7323 Fax 717.652.7340 • susan @ledererlaw.com www.ledererlaw.com �I Y a c �.'Pz vi 'm.;- o 6 J fu t aE1'N:?t!� _. It , f., f �f1 0 c�) ✓ h Lu t � � 7 i CJ : �i 4 C] -- N ..mil o � � a W 4W `� ` M cy 0 y pU y.O m fy �9 1 t.