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Home My WebLink About01-12-15 V � � pennsytvania 15 0 5 614 7,0 5 pFPAqTMENTOFREVENUE EX(03-14)(FI) REV�i�OO OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOx 280601 INHERITANCE TAX RETURN �/ �� Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY _. _ _ _ ' 09302014 ' 06121930 _ _ DecedenYs Last Name Su�x Decedent's First Name MI _ ' KOUMPIAS ' MADELINE ; G _ _ (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI _ _ _ _ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW � 1. Original Return p 2.Supplemental Return p 3. Remainder Return(date of death priorto 12-13-82) p 4.Agriculture Exemption(date of p 5. Future Interest Compromise(date of p 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust _ 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) p 10. Litigation Proceeds Received O 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets � 14. Spouse is Sole Beneficiary (No trust involved) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number _ _ _ _ !DIANE FOUTRES ' _ _ _ _ _ First Line of Address i 6349 STEPHENS XING _ . __ Second Line of Address ___ __ __. _ City or Post Office State ZIP Code - __ i MECHANICSBURG PA ' 17050 ' _ CorrespondenYs email address: REGISTER OF WILLS USB�ONLY �7 C'� �i � rt1 REGISTER OF WILLS USE ONLY � Q C� � � C— G'� Gp UATE FILED MMDDYYYY �.,,� :T7 � �� .-.-7 _'i� r�'} _"'l 4� �,, _ ►—� �,n r� _. ; �...� N . � � - , ,.� c� , .. ,-, ,..� r,,$ --r� DdTE PIL�Ed=3TAMP- _ `Yl �„ � ;;� rv i== rn . �� 0 , ,�, � zl PLEASE USE ORIGINAL FORM ONLY ' � Side 1 I I'II�I II'II IIIII III�I IIII��II'I IIIII'I'�I II�II�'III�III II�I � 1505614105 1505614105 J � J 1505614205 REV-1500 EX(FI) DecedenYs Social Security Number oecedent'sName: MADELINE G KOUMPIAS RECAPITULATION 1. Real Estate(Schedule A). . .. . .. .. . .. . .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 2. Stocks and Bonds(Schedule B) .. . . . .. . .. .. . . . . . . . . . .. .. . . . . .. . . . .. . . . 2. 43,458.02 ', 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . .. . 3. 4. Mortgages and Notes Receivable(Schedule D) .. .. .. .. .. .. . . . . . . . . . . . .. . . 4. 5. Cash, Bank Deposits and Miscelianeous Personal Property(Schedule E). . . . .. . 5. 6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. . . . .. 6. 6H4.15 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested.. .. .. . . 7. 8. Total Gross Assets total Lines 1 throu h 7 8. ' 44,142.17 � 9 ). . .. .. .. .. .. .. .. . . . . . . . .. .. . . 9. Funeral Expenses and Administrative Costs(Schedule H). . . . .. .. .. .. . . . . . . . 9. 2,472.60 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I). .. . . .. . . . .. . . . 10. 11. Total Deductions(total Lines 9 and 10). . .. . .. .. .. .. .. . .. . . . . . . . . . . . . . . . 11. 2,472.60 12. Net Value of Estate(Line 8 minus Line 11) .. . . . . . . . . . . . . . .. .. .. .. .. .. . .. 12. 41,669.57 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. ' 41,669.57 ' TAX CALCULATION-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 _ _ I at lineal rate X.0 45 41,669.57 �g, ' 1,875.13 17. Amount of Line 14 taxable _ _ . at sibling rate X.12 17• ' . _ 18. Amount of Line 14 taxable at collateral rate X.15 ' �8• ' 19. TAX DUE .. . .. .. . . . . . .. . .. . . . . .. .. . .. .. .. . . .. .. . .. . . . . .. .. .. .. . .. . 19.; �,875.�3 ! 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Under penalties of perjury,I declare 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 person respon:�ible for filing the return is based on all information of which preparer has any knowledge. SI NAT R�OF PERSON E�S O�N�S,�IB ,E� FOR FILING RETURN DATE ��'/Lt � �s=�Li�GLp� /7��2�0/ZD/� ADDRESS 6349 STEPHENS CROSSING, MECHANICSBURG, PA 17050 SIGNATURE OF PREP.�HER T PERSON RESPONSIBLE FOR FILWG THE RETURN DATE /�--� � �-/ � ADDRESS 4200 CRUMS MILL RD, 2ND FL, HARRISBURG, PA 17112 � I��I�I�I��I��III��I�I�O�I�6II�I�4II2�O��I��I��)��I I�� Side 2 ],5 0 5 614 2 0 5 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME MADELINE G KOUMPIAS STREETADDRESS 6349 STEPHENS CROSSING CITY STATE ZIP MECHANICSBURG PA 17050 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 1,875.13 2. CreditslPayments A.Prior Payments 29.33 B.Discount 93.76 (See instructions.) Total Credits(A+B) (2) 123.09 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) 1,752.04 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 decedent transfer pro;erty within one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payable-upon-tleath bank account or security at his or her death?.............. ❑ � 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 irnposed 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 benEiiciary. 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 step-parent of the child is 0 percent[72 P.S.§9116(a;(".2);. • The tax rate imposed on the net value of transfers to or for the use of the decedenfs 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 d�cedent's 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. REV-i5o3 EX+(8-iz) � pennsylvania SCHEL��.E � DEPARTMENT OFREVENUE INHERITANCETAXRETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER MADELINE G KOUMPIAS All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1' FIDELITY INVESTMENTS 43,458.02 ACCOUNT#W930193 TOTAL (Also enter on Line 2, Recapitulation) $ 43,458.02 If more space is needed, insert adtlitional sheets of the same size - 703 North Broom Street � � . Limestone and Milltown Roads Wilmington, Delaware 19805 � Wilmington, Delaware 19808 302.652.5913 302.654.3005 Toll Free: 800.608.3533 Fax: 302.652.7020 October 3, 2014 Mr. George Koumpias 15 Jamison Street Newark DE 19711 Dear Mr. Koumpias: ; The following expenses were not covered in the Life Insurance Policy we filed for your mother, Madeline Koumpias. Ylease call i¢you have questions about this statement. Transfer from PA $ 400.00 Church 650.00 Obituary 406.50 Saturday cemetcry charge � 300.00 Total $ 1756.50 Less: Credit for obituary ( 84.00) Evening viewing ( 450.00) Limousin� ( 550.00) TOTAL AMOUNZ� DUE $ 675.50 Please make check payable to: Mealey Funeral Homes �' �� P. 0. Box �866 Wilmington, DE 19805-0866 � � / � � / �v�vw.mealevfuneralhomes.com U '_�_ � • � C , ' FOR INQUIRIES CALL: (800)724-2440 ��Q��'ryp� .,.' M&T SELE .... CT WITH INTEREST ' ; ACCOUNT I�U�N8�1� $7AT�M,ENT P'ERIOD , , . ,.: : 9835786725 SEP.16-OCT.15,2014 + y DIANE FOUTRES { MADELINE G KOUMPIAS ACCOUNT ACTIVITY POSTING DEPOSI7S&OTHER WI7'HDRAWALS'& ' ''DAILY TRANSACTION DESCRIPTION DATE ' CREDITS + OTHER DEBIT - BALANCE 10/06/2014 HARRYS SAVOY GRILL WILMINGTON 988.10 1,577.77 10/08/2014 CHECK NUMBER 1479 500.00 10/OS/2014 CHECK NUMBER 1480 175.50 902.27 10/09/2014 DICK'S SPORTINGGOODS MECHANICSBURG 45.00 10/09/2014 ARMITAGE GOLF CLUB MECHANICSRURG 20.00 927.27 10/10/2014 REVERSE DIRECT DEPOSIT 1,312.00 (384.73) 10/14/2014 TJMAXX#0720 MECHANICSBURG 25.59 ^ 10/14/2014 PENNSYLVANIA-AME PAYMENT 17.04 � 0 10/14/2014 INSUFFICIENT FUNDS FEE-REVERSE DIRECT DEPOSIT 38.50 (414.68) a � 10/15/2014 DEPOSIT 934.06 � � 10/15/2014 INTEREST PAYMENT 0.01 b � 10/15/2014 INSUFFICIENT FUNDS FEE-PENNSYLVANIA-AME PAYMENT 38.50 480.89 o ENDING BALANCE 480.89 LL ; CHECKS PAID SUMMARY a CHECK NO. DATE AMOUNT CHECK N0. ' DATE AMOUNT ' CHECK NO. DATE AMOUNT � 1478 09/25/14 157.60 1479 10/08/14 500.00 1480 10/08/14 175.50 0 d N O O � OVERDRAFT AND IdSF FEE SUMMARY � g' TOTAL FlJR THIS' TOTAL FOR GALENDAR TOTAL FOR PRIOR � STATEMEI�T CYCLE YEAR-TO-DATE CALENDAR YEAR TOTAL INSUFFICIENT FUNDS(NSF)FEES $0.00 $0.00 $0.00 TOTAL OVERDRAFT FEES $77.00 $77.00 $462.00 Total Insufficient Funds(NSFI Fees include per item fees charged when we return an item unpaid because there are not sufficient funds in the account to cover the item. Total Overdraft Fees include per item fees charged when we pay an item that overdraws the account as well as any Extended Overdraft Fees charged to the account. PAGE20F4 I,OOBAf,S(6/17) �y \�( O` ` Q � � �1 V � � � tt� � ` � p � '3' �,,... �`,.. t1J J N �:' ! � L�._ � 1.�.. � �— c� G..r `'"' �- `a... " �. � �r-�� e.. � . . c� C�' N 1� �- � � O k;�„� t.�.,� r...� �J " C 1:'= (J M- f.,> -� L..t �r Ct� G n— C;:� r G� (L' � c�.� w �' c' � � W� � � c� (�.,� 1 • . � • \ Y � � ` �: � ...... � r V N -.. 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