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Home My WebLink About01-27-15 � � pennsytvania 15 0 5 61410 5 DEaAPTMENTOF NEVENI� EX(03-14)(FI) REV-1500 OFFICIAL USE ONLY Bureau of Individual Taxes Counry Code Year File Number INHERITANCE TAX RETURN ^�-- � -------"-' —�------ PO BOX 280601 ' Harrisburg, PA 17128-0601 RESIDENT DECEDENT �`� � ' �� ; � �� ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY ;------------------ ---, .._.____---...-�--------------�-----: � r_----------....-------� ; ' ; 06082014 ; ; 10 171968 ----------------------.._: �._----... _._...-------------._....---._� _.-------------- --- DecedenYs Last Name Suffix DecedenYs First Name MI 3 j � � Padamonsky i � Theresa � M i (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI -------....----._........._....-----------..__....___-------� --------._, -------.....----------------- ---- ,-.... i , � --_ , � ; ; ! 1 ; i � , ; ------� =-----._.._.... ------------_.._.....__...._..._....____ �_; 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 Retum(date of death priorto 12-13-82) p 4.Agriculture Exemption(date of 0 5. Future Interest Compromise(date of � 6. Federal Estate Tax Return Required death on or after 7-1-2012) death after 12-12-82) p 7. Decedent Died Testate p 8. Decedent Maintained a Living Trust 0 9. Total Number of Safe Deposit Boxes (Attach copy of will.) (Attach copy of trust.) p 10. Litigation Proceeds Received p 11.Non-Probate Transferee Return p 12. Deferral/Election of Spousal Trusts (Schedule F and G Assets Only) O 13. Business Assets O 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 ;Ronald E. Johnson, Esq ;(717)243-0123 t First Line of Address 78 West Pomfret Street Second Line of Address _____---_---------._._.._........-----._.........-----.....--------..__..._..----._....__----------------........._. 1 € � [ i__...��_.__..____._..._......._.._____.___...._..__._...._'__'__...........__.____"_._____._.�..___.._........____'_'__�..__.___F City or Post Office State ZIP Code , '--___._..___.__....._..---.._._._._......—._—, ;Carlisle i PA ` '17013 ; Correspondent's email address: f2)Oh11S011@pe.I12t REGISTER OF WILLS USF��ILY � � REGISTER OF WILLS USE ONLY � n � � '� � rn rn �u��`DA"fE FILEd INMDL1WY11 � � � �.�:> �r r.�,z��+r 't.n. � C._ ��:��.5�� C� � �7 �_,��,,.��". �.��,�� -'�- � � �� 4"J ' ,,,. f--- N €..,� r�1 , _ _'' � .� --�] ; i .,,� ,� � f`l DATE FI�ED"$fiAM -� -�� s 1 < � _ , ;�.; .'_:: C'� r i �V - � �...� r� C7 PLEASE USE ORIGINAL FORM ONLY � �-� �� . � Side 1 I IIIIII Ilill IIIII IIIII IIIII IIIII IIII�IIIII IIIII IIIII IIII IIII � 1505614 05 1505614105 � ) � 1505614205 REV-1500 EX(FI) DecedenYs Social Security Number _ _.. -- DecedenYs Name: Theresa M. Padamonsky � RECAPITULATION 1. Real Estate(Schedule A). ............................................ 1. ; 0.00 ;�.._ 2. Stocks and Bonds(Schedule B) ....................................... 2. ; 0.00 i 3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) ..... 3. ; 0.00 i 4. Mortgages and Notes Receivable(Schedule D) ........................... 4. `[, 0.00 5. Cash,Bank Deposits and Miscellaneous Personai Property(Schedule E)....... 5. ; 0.00 6. Jointly Owned Property(Schedule F) O Separate Billing Requested ....... 6. � 0.00 7. Inter-Uvos Transfers&Miscellaneous Non-Probate Property ; (Schedule G) O Separate Billing Requested........ 7. E 14,314.94 8. Total Gross Assets(total Lines 1 through 7)............................. 8. ; 14,314.94 i 9. Funeral Expenses and Administrative Costs(Schedule H)............. ...... 9. ; 6,573.75 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I)............... 10. ; 2,495.36 11. Total Deductions(total Lines 9 and 10)................ ................. 11. � 9,069.11 12. Net Value of Estate(Line 8 minus Line 11) ............... ............... 12. ; 5,245.83 13. Charitable and Govemmental 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. � 0.00 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_ 0.00 ; 15. ' 0.00 16. Amount of Line 14 taxable ; ; ; at lineal rate X.0 45 0.00 ; �g, ; 0.00 17. Amount of Line 14 taxable � at sibling rate X.12 0.00 ` �7. ; 0.00 18. Amount of Line 14 taxable � at coliateral rate X.15 0.00 i �$ ' 0.00 19. TAX DUE ...................................... ................... 19.; 0.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Under penaities of perjury,I declar I have exa 'ned t s retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it is true, corre compl te.D laration of e r other than the person re onsible f the return is based on II ' forr�' n of which preparer has any knowledge 5 SIGNATURE OF PERSON PONSIBLE FOR FILING RETURN D E ADDRESS SI EP O H ON RESPONSIBLE FOR FILING THE RETURN ATE c D ES I��'I�I��II��I�I��I��I'�(I�II�I'I�(��II��I�I�III I�'I Side 2 � 1505614205 1505614205 J REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Theresa M. Padamonsky STREETADDRESS 221 B South 3rd Street CITY STATE ZIP Lemoyne PA 17043 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payments A.Prior Payments 0.00 B.Discount 0.00 (See instructions.) Total Credits(A+g) (2) 0.00 3. Interest (3) 0.00 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) 0.00 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. � � �� ;�t�~��,�,�� ,�-�� ,��- �-- � �w`�,.��;,::�;�.�:��;.:��.�:a�,a::,;:��<`.�`.;�,��..�.d_ F�_.__.>....,.�w �..�F<,_,�,._,,� ..,. ��..�,. Aa�.�.., �,.,�..�� ti :� � �, � � � � - � � �:, � ' u,�.,�� . �.�r�, __.�..F.�ti,...,.�� _ _ _ ..,»a.�x��..�-=_ �...�n ss..., r ... .� 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 property within one year of death without receiving adequate consideration?.............................................................................................................. ❑ � 3. Did decedent own an"in trust for"or payabie-upon-death 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. ��F��..��..::r x�r��- .., _.�_.rs 7 _y...^x,., : 1'�'"' :: "'Fc r"�� w"""�T,- .: a r ��%'�o-.�'�""` �:?` .:��u.i..,..wu,..:n-...ala:....se°�.4L�%»as�a.�Muv'�.,3,ry.�,..,.:c.�..u._�c..,w„�.�.w..w� c:x&..��ec,,.u.��iwa,.>.._.._:l_.r...:r:'�v�.✓«:uz.w�' .. ...:.........�,.....a:�zxv�wi'.«.v.u.e�,,...s.�......�.....�..��✓uxcwJ�mSiw�.�L.aa�.wu2:;µ:..�.,H�..u.....�'��.,.c�a_.-.�'a��s:�.�.a.._,.,.:�'�_..:.,..,;'� 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)(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 stiil 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 step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs 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 decedenYs sibiings 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-1510 EX+(�8-G9) � pennsylvania SCHEDULE G DEPARTMENTOFREVENUE INTER-VIVOS TRANSFERS AND INHERITANCETAXRETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Theresa A. Padamonsky 21-14-0978 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. DESCRIPTION OF PROPER7Y ITEM INCLUDE THE NAME OF THE TRANSFEREE,THE1R RELATIONSHIP TO DECEDENT AND DATE OF DEATN %OF DECD�S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COW OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFAPPLICABL� VALUE 1. AHOLD USA hourly 401 K-payable to Estate of Theresa M.Padamonsky , Decedant was 45 years old at time of her death 14,314.94 94 i 14,314.94 TOTAL(Also enter on Line 7,Recapitulation) $ 14,314.94 ' If more space is needed,use additional sheets of paper of the same size. ` REV-1511 EX+{08-13) �� pennsylvania SCHEDULE H DEPARTMENTOFREVENUE FUNERAL EXPENSES AND INHERITANCE TAX REfURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Theresa M. Padamonsky 21-14-0978 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: . . .. _ . .... 1. _ .:. . 4,683.75 e. ADMINISTRATIVE COSTS: 1. Perso�al Representative Commissions; Name(s)of Personal Representative(s) ' Street Address City State ZIP Year(s)Commission Paid; z• Attorney Fees: 1,500.00 ' 3, Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4• Probate Fees: 140.50 :: 5• Accountant Fees: 6. Tax Return Preparer Fees: .. . . .., . . . _. �• 'Reserve for closing&accounting 250.00 TOTAL(Also enter on Line 9, Recapitulation) $' 6,573.75 ' If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) � pennsylvania SCHEDULE I DEPARTMENTOFREVENUE DEBTS OF DECEDENT� INHERIiANCE TAX RE7URN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OP PILE NUMBER Theresa M. Padamonsky 21-14-0978 Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH _.. ..,�..., __._ ..... . _._.... ..... ... _,. . �.. _.. 1• Holy Spirit Hospital-hospital bill 100.00 2.' PP&L-electric bill 78.00 '� 3.� ��Fairview Township EMS-patient transport 707.50 '�' : 4. Quantum Imaging-medical bill 166.03 I 5.: Harrisburg Pharmacy 194.63 6. East Pennsboro Ambulance Service Inc 83.20 ; ' 7.` Carolyn Croxton Slone Hospice Residence 1,050.00 8.': `Hanger Orthopedic 116.00 ' TOTAL(Also enter on Line 10, Recapitulation) $ '; 2,495.36 If more space is needed,insert additional sheets of the same size, REV-1513 EX+(01-10) � : pennsylvania SCHEDULE ] ' DEPARTMENT OFREVENUE INHERITANCE TAX RENRN B E N E FICIA RI ES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Theresa M. Padamonsky 21-14-0978 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS[Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] _ i. Angela Padamonsky :daughter 1/2 - I 635 Hummel Avenue,Lemoyne,PA 17043 2. 'Katherine Padamonsky 'daughter 1/2 '. '519 Herman Avenue,Lemoyne,PA 17043 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV•1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 fOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. _ _.. _. .. __ _........ . . ... . _..,..,.. . _. .. ..... . ,. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS; 1 _... __._._. _. . _..__ ___...... ... ........ . ............ _..... .. ........._ TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET, $' If more space is needed,use additional sheets of paper of the same size.