HomeMy WebLinkAbout10-28-14 (2) , '
J 1505610105
REV-1500 EX(oz-ii)(PI) �
PA Department of Revenue pennsylvania OFFICIAL USE ONLY
Bureau of Individual Taxes °"°"'»`"� "`„' Counry Code Year File Number
PO BOX 280601 pINHERITANCE TAX RETURN � '1 ,.,�
Harrisburg,PA i�iz8-o6oi RESIDENT DECEDENT � (6J ,� „3
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 Decedent's First Name MI
Orlowsky ' ' James M
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's last Name Suffix Spouse's First Name MI
n/a
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
O 1.Original Return �j 2.Supplemental Return p 3. Remainder Return(Date of Death
Priorto 12-13-82)
p 4.Limited Estate p 4a. Future Interest Compromise(date of p 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 DIRECT�TO: �y,.
Name Daytime Telepf�e Number �
C � � f�
Jacqueline M.Vemey, Esq (717) 243-�� � '�� c-,
. . . ...... . ... . .. .. . . . ... .. ... . .. � f;."J. �.,... . . C�J� .'.�- O
REGIST R:OF�1N1`� USE ONLY " �
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..a � � .:.:7
�....... '., t._,.• C �,.�.a
.- . , . �; �;.�:7
First Line of Address ' :.�
..� __t,
44 S. Hanover Street � '���
:: c=�
Second Line of Address - �V i��"' �yry
, _.. ,.,._.
O Cf� Q
C� '''1
Clty or POSt OffiCe State ZIP Code DATE FILED
'Carlisle PA 17013
CorrespondenYs e-mail address:jfTlV@ffl@y@801.COtll
Under penalties of peryury,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 personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIB�E FOR FILING RETURN DATE
ADDRESS
SIG A URE OF PREPA ER OTHER Ty�REP SENTATIVE DATE
�/l . .�.-K.e_e /o -a�- ��
ADD SS �
�i S. l�.�NaJ�,vS' -S .�- �7U`
PLEASE USE ORIGINAI FORM ONLY
Side 1
� 150561�105 150567,0105 �
J 15�5610205
REV-1500 EX(FI)
DecedenYs Social Security Number
DecedenYs Name:
RECAPITULATION
1. Reai Estate(Schedule A). ....... . .. ............ .... . ... ....... .. ..... 1.
2. Stocks and Bonds(Schedule B) . . . . . . .. . . . . . . .. . . .. . . . . .. .. . . . . . . . .. . . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . . . 3.
4. Mortgages and Notes Receivable(Schedule D) .. . ... .. . ... ... .. . . . ... . .. . 4.
5. Cash,Bank Deposits and Miscellaneous Personai Property(Schedule E).. ... . . 5.
6. Jointly Owned Property(Schedule F) O Separate Biiling Requested . . .. ... 6. 301,394.40
7. inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. . .. . .. 7.
8. Total Gross Assets(total Lines 1 through 7). . . . . .. .. . . . . .. . . . . . . . . . . . 8. 301,394.40
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . .. .. . . .. . .. . . . 9. 665.00
10. Debts of Decedent, Mortgage Liabilities and Liens(Scheduie i)... .. ... .. ..... 10.
11. Total Deductions(total Lines 9 and 10).............. .......... ....... .. 1L ', 665.00 '
12. Net Value of Estate(Line 8 minus Line 11) .. . .. . . .. .. . .. .. . . .. .. . . . . . .. . 12. 300,729.40
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J) . . . . .. . . . . . . . . .. . . . . . . . 13. 0.00
14. Net Value Subject to Tax(line 12 minus Line 13) ... .. . . .. ... . . . . . . .. .. . . 14. 300,729.40
TAX CA�CULATION-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 iineal rate X.0 45 300,729.40 16, 13,532.82
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
19. TAX DUE .. ... ..... ... ... ..... . ... ... .. . .. ...... ...... ..... ... .... 19. 13,532.82
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
Side 2
� 1505610205 150561�205 J
. ' NOTICE OF INHERITANCE TAX , pennsylvania
BUREAU oF INDIVIDUAL TAXES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
INHERI7ANCE TAX DIVISION OF DEDUCTIONS AND ASSESSMENT OF TAX ` DEPARTMENT OF REVENUE
PO BOX 280601 �--- REV-1547 IX AFP C08-13)
HARRISBURG PA 17128-0601
DATE 10-21-2014
ESTATE OF ORLOWSKY JAMES M
DATE OF DEATH 04-18-2010
FILE NUMBER 21 10-0503
VERNEY ESQ JACQUELINM COUNTY CUMBERLAND
44 S HANOVER ST ACN 503
APPEAL DATE: 12-20-2014
CARLISLE PA 17013-3306 (SeereversesideunderObjections)
Amount Remitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
RE6ISTER OF WILLS
1 COURTHOUSE SQUARE
CARLISLE PA 17013
CUT ALON6 THIS LINE __ � RETAIN LOWER PORTION FOR YOUR RECORDS �
---------------------- -----------------------
REV-1547 EX AFP C08-13� NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
-----------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF: ORLOWSKY JAMES MFILE N0. :21 10-0503 ACN: 503 DATE: 10-21-2014
TAX RETURN WAS: C X) ACCEPTED AS FILED C ) CHANGED
APPRAISED VALUE OF RETURN BASED ON: LITI6ATION RETURN
1. Real Estate (Schedule A) �1) .00
NOTE: To ensure proper
2. Stocks and Bonds CSchedule B) Cz� ,QQ credit to your account,
3. Closely Held Stock/Partnership Interest CSchedule C) (3� .00 submit the upper portion
4. Mortgages/Notes Receivable CSchedule D) of this form with your
C4) .00 tax payment.
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 195,218.49
6. Jointly Owned Property (Schedule F) C6� .00
7. Transfers (Schedule G) ��� .00
8. Total Assets
ca) 195 � 49
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) �9) 750 00
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions C11) 750.DO
12. Net Value of Tax Return �1z� 194,468.49
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) .00
(13)
14. Net Value of Estate Subject to Tax �ly� 194,468.49
NOTE: If an assessment was issued previously, Lines 14, 15, 16, 17, 18 and/or 19 wiil
reflect figures that include the total of all returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at spousal rate C15) .00 X 0 0 - .00
16. Amount of Line 14 taxable at lineal rate �16� 7 94.46R G9 X 045 = 8,751.09
17. Amount of Line 14 at sibling rate C17) -(l0 X 12 = .0 0
18. Amount of Line 14 taxable at collateral rate (18) .00 X 15 = .00
19. Principal Tax Due �19�= $,753.78
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID
05-08-2013 CD017573 .00 57.54
04-09-2014 CD018991 .00 8,753.78
TOTAL TAX PAYMENT g,g11.32
BALANCE OF TAX DUE 57.54CR
INTEREST AND PEN. .00
TOTAL DUE 57.54CR
� IF PAID AFTER DATE INDICATED, SEE REVERSE IF TOTAL DUE IS REFLECTED AS A CREDIT CCR), YOU MAY BE DUE
FOR CALCULATION OF ADDITIONAL INTEREST. A REFUND. SEE REVERSE SIDE FOR INSTRUCTIONS.
, REV-i5o8 EX+(o8-iz)
� pennsylvania SCHEDULE E
DEPARTMENTOFREVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
James M. Orlowsky 21-10-0503
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. Honeywell Corp,f/k/a Allied Signal, Inc 301,394.40
TOTAL(Also enter on Line 5, Recapitulation) $ 301,394.40
If more space is needed,use additional sheets of paper of the same size.
ri�v-lsii �x+ {o8-is}
� , ������.:� pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
--�P�M ES N1 . Q�jc.ciS��� �1 —�o —CJ Scj�
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
__ _ __
CitY _ ___—_ _ _ . _ _.. State ZIP
_ _ _
Year(s)Commission Paid:
2• Attorney Fees:
500.00
3. Family Exemption: (If decedenYs address is not the same as claimant's,attach explanation.)
Ciaimant
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(Aiso enter on Line 9, Recapitulation) $ 665.00
If more space is needed, use adtlitional sheets of paper of the same size.
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7U0 HRC)ADWA1' • N}:\4 Y'ORK,NV IOOU3-9536
TCL.211-558-g50U �AX 212-344-5461
PERRY WEITZ W W W.��f IT7.I.UX.COM
AR7HUR M.LUXENBERO
ROBERT J.GORDUN tT
PHAN T.ALVARADO ARI FRIEDMAN F KEVIN ML1lDERIG¶ JONA7HAN M.SEOGH 'oiCwnee�
BENNO ASHRAFI i MARY GRA8ISH GAFFNEY¶ DANA Nl.NORTHCRAFT tY SHELOON SILVER' lA�so etlmiliea InCT
DAVID J.6ARRY ALANI GOLANSHI i TODD OMMEN ROBERT M.SIWERMAN 9 "awaam,u.xa mF�
JAMES J.BIlSBORROW DANIELLE M.GOLD iy FRANK M.ORTIZ tt �ONALD SOUTAR¶ §4��Nuw�oniyin it
DANIEL P.BLOUIN LAWRENCE GOLDHIRSCH°' JOSIAH W.PARKER i CaRMEN VICTORIA 5T.GEORGE tT ft�honamuoemni
AMBRE J.BRANDIS KENDRA Y.GOLDHIRSCH MICHAEL E.PEDERSON TVLER R.S70CK� §�a""�vN1'`"�1O'X'
EDWARD BRANIFF f} ROBIN L.GREENWALD'§§ PAUL J.PENNOCN PETER TAMBINI tt •A�•�^^���ninr.,i inoH
JOHN M.BROADDUS f CARLOS GUZMAN� STUART S.PERRY' JAMES S.THOMPSON Tf t a¢o.amuwi in a�a�a r,r
.•nun mmnen in N.I n�M!'P
VENUS BURNS 1 ERIKA HEYDER LEE W PREVIANT§3� WIILiAM A.WALSH ft .qib��p„qidy i„N�e„��;
PA7TI BURSHTVN tt MARiE L.IANNiELLO t" � CAITUN PRZENICZNY� OANIEL WASSERBERG i y�awwimu.am N�6 M[
LISANATHANSONBUSCH ERIKJACOBS SHAREEFRABAA• LAURENA.WEITZ elUscaJmllealnIX:mMVn
THOMAS COMERFORD Yt§ DAVID 61.KAUFMAN t� ADAM C.RAPFO JUSTIN J.WEITZ �^Nui,Mm�nml in C9
ADAM R.COOPER ThE-YOON KIfA+ SUZANNE M.RA7CLIFFE tf NEIDRA S.WILSON•• ,r�sooamiuw�n*x
TERESA A.CURTIN¶¶ GARY R.KLEIN YY PIERRE RATZKI NIGHOLAS WISE°° awmine.a nmy����Cn
BENJAMINDARCHE DANNVR.KRAFT,JR ELLENREIKIN'=£Er DENAYOUNG¶ AnnmivaaauynN�aman
UNDSAV M�ECICCO tt JERRY KRISTAL••§ JONN E.RICHMOND if BREN7 ZADOROZNV{ +namuua miyin 1u
AOAMS.DREKSLER DEBBIIANDAU MICHAELP.ROBERTS ALIANZELIKOVIC �A�Mb��CACO.NY,PA,eMT%
F.ALEXANDEREIDEN. LEAHLEWIS- CHRISROMANELLItt GLENNZUCKERMAN CAUm1:eJOnlyinUC.MU,PFBnCVA
MICHAELFANEILItt MATTHEWMACINTYRE DAVIpROSENBAND tr.conn�niry.Nasuwomocouri
JAIME M FARRELI a CUR7 D.MARSHA�L# PETER SAMBERG?i �AbuadmU�w�,vn
,f AEmMIeO mly i��MA
LEONARO F.FELOMAN¶ SAMUEL M.MEIROWI7Z GENNARO SAVASTANO
CHARLES M.FERGUSON JAMES A.MORRIS JR.•- CINDY VOUNG SAXEY i
10/20/2014
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$301,394.40, which represents settlement
proceeds Weitz& Luxenberg, P.C. has received from defendant(s) HONEYWELL CORP., f/k/a
ALLIED SIGNAL, INC., as successor in interest. 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
2U0 LAKE DRIVE EAST,SUITE 205•CHEf2R1 HILL,NJ 080G2•'I'EL 85G-755-1115
l A80 CENTiJRY PtaRl{P:\ST.SiJITF 700 •I.OS I\NGL:1a�S.CA 90007 •TTI.310-247-0921
Distribution No.: 0 Payment No.: 2564911
. � ' WEITZ 8� LUXENBERG, P.C.
ATTORNEY TRUST ACCOUNT-IOLA 5478666
Oct 20,2014
""'Three Hundred One Thousand Three Hundred Ninety Four and 40/100 Doilars $301,394.40
Jacqueline Verney Esq. as Attorney for the Estate of Jim Orlowsky
Jacqueline M Verney Esq.
44 South Hanover Street
Carlisle, PA 17013
Orlowsky,Jim 206368
HONEYWELL CORP.,f/k/a ALLIED SIGNAL.INC.,as successor in interest
�' •• � �� � • e' � : •� o • r •�•• :o•e
� CITIBANK,N.A. �._.�..'8.,.,, CFl@CIC NO.
I W�IT�+& LUXEN$E�G,F.�. ' n�EwroRK Nv ,00a3 21p
AT7"t'�RNEY TRUST ACCflUN'�-!l�LA S47SGG6
i '�00 BROADWAY '
� NEW YORK, NY 10003 OCt 20,2014
�
I
i
; PAY , *`*Tk�ree Hundred One Thousand;Three Hundred Ninety Four and 40/100 Dollars $301,394.40
�
; rq TH� ' Jacqueline Verney Esq. as Attorn�y ft�r the Estat�of.�1m Qrlpwsky,
! ORDER'b�
i
I
�I . JaCryue�ine M tle�ney Esry. � � . . . � VOIDIFNOTPRESENTEDWITHIN�OOAYS
.� ,�
I 44 South Hanover Street
� C�rlisle, RA h 7p13 �
� : ,, ' ;: . , `
�, ° ...... ....... :................................ . .. ...... .... ..... ........
HONEYWELL CORP.,f/k/a ALLIED SIGNAL,INC.,as successor in interest
. . �. . . . .
i�'00 54 78666i�' �:0 2 �000089�: 497388 2335ii'