HomeMy WebLinkAbout03-18-15 pennrylvania 1505614105
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REV-1500 °`F"'°`°SE°"`"
CoumyCode Vear FileNumber
Bureau of Intliviaual Taxes INHERITANCE TAX RETURN �� �� . � 2;,(' -- '
ao eox asoaoi
H � b g Pn i�ize-o6oi RESIDENT DECEDENT i �v� '�, I ' I I ���
ENTER OECEDENT INFORMATION BELOW
Y �atE o(BSrth MMODYVYV
Social Secudt Numbe� �ate of Da2lh MMOOYYV" . . .
�': .. .. .. � I' 10192013 . ..�- � ,03172015 I
OecedenCs Las�Name �� � SUKix Decetlent s Frst Name _ . MI
_—_ _._.. . . .
_- ._._ I __._ .
BAZAR i I LUCIAN ..... P...��
_._ . ... .__ _ ._ ,
(If Appl cable)Enter Survivinq Spouse's Informatian Below
SpousesLasiNeme SUKix SpousesFrstName MI
_.._—_. _-__ __. -
. _._._.. .. _ .___ . I_ . _, �.. _ _. i I�.
� � �� �' ._ ___—. _.. _ I . . �I
�� � THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FRL IN APPROPRIATE OVALS BELOW
� t Origlnal Ralum O Z, Supplementel ReWm O 3. Remainde�ReWm(tla�o ot tlea;F
prior�0 1243-82)
� C.AgriculWre Exemptim(tlate of � 5. Fulure Interest Compmmise(tla�e of � 6. Federal Estafe Tax ReNm Requiretl
tleatM1 on oe alter 1-0�2012J tlealp atler 124&82)
� ]. Deceden�Oied Testate Q 8. Oecedenl Mainlainetl a Living Tmst 0 9. Total Numberof Sale�eposil9oxe5
(AUachcoDYotwill.) (A��achcopyoflmsL)
0 10.Litigation Pwceetls Received O >>- Non-Probate Transferee ReW m O ��� OeferraVEledion of Spousal Tms�s
(Sc�atlule F entl G Assets Only)
0 �3. BuslnessAssets � ��' �Nowt�molved�nefciary
CORRESPON�ENT- THIS SECTION MUST BE LOMPLETEO.ALL CORRESPONOENLE AN�GONFIDENTIAL TA%MPoRMATION SHOUL�BE DIRECTEO TO�,
Name Daytime Telephone Number _
_ _. . .__._. _ ..__ .... __.
__.__ ..____ .____._
MARK BAZAR ,,(717) 576-4008 . __
.. _ .. . . . . .- _.
First Line ofAtltlress . .____. . .
_-- _ _—__. . . .._. - ��.
5216 DEERFlELD AVE �
__ _ .__. - —_
._____. ...__... ..�
Sacond Line ofAtltlress
._. .._ . ._- _._ _. ..-._ _ _ __ _. __ ,..
J�i
CllyorPostOffce � � � .�.� �� �� S�a�e ZIPCotle
.__ .. .. .. . '._ ____
MECHANICSBURG � ��. PA � �17050 � ���
CorrespontlenCs email atltlress:
��
REGISTER�OFWIL1�51! EONLY
... .. . ". �.) . ::>
. � aEaisrer+oFwiusLsaoNv� - �
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�.�. pATEFILEOMMDDYYYY ;� � � � =v �� ,
. . . , ', � � � GJ �
OATEILLEO STAti1P
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PLEASE USE ORIGINAL FORM ONLY �
Side 1
L II��I��I���I�I�II��IIIOII56I1I4IlIa5�l�ll����l�llll��� y505614105 � �
15
�
J 1505614205
REV-1500 EX(FI) Decetlenfs Sociel Security Number
—_ .— _. .. .__ .. .. ...
��''.041- ..��.
o����aem s Namr
RECAPITOLATION ... _. . ._ . ._ .
1. Real Es�ate(Schetlule A). . . . . ... . ... . . .. . . . . .. . . . . . . .... . . ... . . ... ... L �
2. Stocks antl Bontls�5chedule B) . .. . . . . . ... . .. . . . . . . . . ....... . . . . . . . . . . 2 � �
3. Qosety HeIU Gorpora9on, Partnershlp or Sole-Proprietorshtp(Schetlule G) ____. 3
I
4. Mocga9es and No�es Receivable(ScM1etlule D) . . .... . . . . .. . . . . ... . . .. . ... 4. �
5. Cash,Bank Deposils antl Mlscellaneous Personel Pmpehy(Schatlule E). _. ._. S �_ _.
fi. Jolnlly Ownetl Pmpe�y(Schetlule F) O Separate Billing Requested ..... . 6 52 383 37 '�.
]. In�arVrvos Transfers&Miscellaneous NomProbate Propetly
__—..._—"—. -
(Scnadule G) O Separate B➢Iing Requested. .._.. �- 12,64
8. Total Gmss Assets(to[al Lines 1 [hrough 1). . .. . ...... . . .... . . . ... . . .... B. � 65,023,37 ��
�J. WoeralExpensesantlA�ministrativeCosis(ScheduleH).... . . ... . . ....... . 9. '�, 5,184.00
�0. Debts of peceden�.MortgeBe Gabililies antl Oens(Schedule I). . . .__ ._ ._. 10-
it Total Deduc[ions(lutal Lines 9 and 10).. . . .. ... . . . .. . . . ....... ... .. . . .. 11. j '�
r
12 Net Value of Es[ale(�i�e e minus une n) .. _ . .... . ...... . . ._ . _ ... . _ i2 � 59,839.37,
13. CharilableantlGovemmantalBequeslsl5ec. 9113Tmstslorwhich .
an election to lax has nol been made (Schedule J) . .. ... . ..... . . . .. . ... ... 13. I.
14. Net Value Subject to Tax(line�2 minus Line 13) ... . . ... . . . .... . ...... . . 14 '�. 59,8$9.37
TAX CALCULATION�SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amoun�of Line 14�axable
at fie spousal[ax rate,ar _ .. _ ._ _ --.. .
Vansfers under Sea 9116 � �� � � - - ���. '�.� '
(a1112)XA_ '. 15. ��
ifi. Amounl of Cine 141axable '�, 59 839 3� �6 ��' Z s9Z_�
a�lineal rate X.045
P. Amount of Gne 14[axable '� � ,
at sibling rale X .12 I ��- � ,____
18. Amount of Line 14�axable . � C .
al collaterel rele X .15 _ 18' ! ._ —
_ .. . .__. _-� ,_ �
19. TAXOUE . . _ . .. . . . _ . . _.. . . . _ _._ . __ ... . 19. ... . 2�692.77 �
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT O
llndar penallles oi perlury,I tleclare I M1ave examinetl t�is rewrn,inGutling aocompanying schetlules antl sletemems,end to ine best of my knowlotlge aPna eeliel,
A Is Ime,c raet entl wmplela.Deele�atlon o!preperer o�her IM1en�ne peesOn �esponsiblo�o�(ilin l�e �eNm IS basetl on all In(o�malion o�wM1leh prB M1as
eny knowletlge.
SIGNATURE R SIBLE FOR FlLING RETl1RN $ J� /�
nooaEs L!� �y 2G G vl� � I7�1��� 3 �ll �
V—
SIGNhtURE OF PREPARER OTHER'HAN PEft504 RESPONSIBLE FOH FlLING TME URN �ATE
nooaEss
L imiiiiiiiuiiiu�i��ii��i�i4ii�i�i�iiiiiiiiiiiiumi Side2
1505614205 J
3EV-1500 E% �FI� Page 3
File Number
DecedenPs Complete Address:
oweoenr�s rvnNe
WCIAN P. BAZAR _ _ . _ .-- - -
sraEErnooHEss
5216 DEERFIELD AVE . _._ - - -- - —
. —_. — _ _ . __. �STATE .—... ZIP
drv � pq 17050
MECHANICSBURG
Tax Payments and Credits:
1. 1ax Due(Page 2,L�ne 19) ��� ����� ��
2. CredusiPaymen�s p p39.38
A.Pnor Pa�Tnenis _. _ _ . -. -
B.�iscount .. -� -- TctalCredits(A+B) (2) 2,239.38
(SesinsTUUlons.)
3. In�erest j3� g2g
4. If Gne 21s greater ihan Line 1 +�'ne 3,emer the dlflerence. Thls Is ihe OVERPAYMENL 4
Pill in oval on Page 2,Line YO to request a�efund.
5. I(Line 1 .'.ine 3 is greater than Llne 2,eNer the dlfference.Thls Is iha TA%DUE. (5)
462.68
Make check payable to: REGISTER OF WILLS, AGENT.
. . . __ r rn,• . �m ,_ ..- . . ;�.a� ' . , — . . .
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. �itl decedent make a iransfer and: Yes No
a. relain�he use or income of the properly lransferred_........ ........._._ _................................ � �
b. retain the right to designate who shall use ihe propeM1y Iransferred or its lncome ...._.,........__............._........ ❑ �
c. relain a reve�siona7 m�eres� .._....,...... ,........._.... ......__... ............... ❑ �
.......... ... ❑ �
tl. receive lhe promise for hte oi ei�her paymenfs,benefib or care� .........._ ........ ._.
2. If death ocwned after�ec. 12,1982,ditl decedent iransier pmperty within one year of tleath ❑ ■
without receiving adequate consideration? ,......_........ .._.......... ......_ ....... ......
3. �id decedenl own an"in imsl fof'or payable-upon-death 6ank acwunl or secunty at his or her death7........_.... � ❑
a c�ootans aebe efciary tlesidnatliona!rement account annuityor other norvDmbete pmpeny,which
....._......... ........._
................ ........_.... � ❑
IF THE ANSWER TO ANY OF THE A80VE�UESTIONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For dates of deeth on or aiter Juty 1, 1994.and before Jan 1 1995 tha tax rale imposed on the nat value of iransfers to or for the use oi�he surviving spousa
Is 3 peraent[72 P.S.§9118(e)(1.1)(i)].
For dates of tleath on or atter Jan. 1, 1995, �he tex rate imposed on the net value o(Vansfers �o or for �he use of ihe surviving spouse Is 0 percent
[/2 P.S.§911fi(a)(1,1)(li)].The staWte does nof exemp�a Iransfer to a surviving spoose from tax,and the sta�otory requlrements(or disclosure of assats and
flling a tax reNm are sfill appllcable even If the surviving spouse Is Ihe only beneficiary.
For tlates o(tleath on or after July 1,2000:
. The tax rale imposed on the net value of Irans�ers fmm a deceased child 21 years of age or younger a�Ceath to or for the use of a naWral parent, an
adoptive pa�ent or a step-parent of the child Is 0 percent[l2 P.S. §911fi(a)(12��.
. The lax rate Imposetl on me netvalue of trans(ers to orior Ihe use oithe decetlenPs Ilneal beneficiaries Is 4.5 percenC except as noted In�72 P5.§9116(a��i)J.
. The tax rafe Imposetl on �he net velue of Irensfers to or for the use of the decedenfs siblings is 12 percant(72 P.S. §9116(a)(1.3)].A sibling is define4
unde*Sec�ion 9102, as an Indivitlual who has al least one parent In common wi�h the deceden�,whether 6y blood or adoption.
flEV-ga9E%�(o1-m)
� pennsylvania SCFIEDULE F
ry� oEana,nEri.oraEvenue JOINTLY-OWNED PROPERTY
a�rx:.A�<E.a,a��av
s,oEr o«��„
ESTATE OF: � FILE NUMBER:
W GIAN P. BAZAR 2113-1209
If an asse[became joinHy owned within one year of the tlxetlenPs Ea[e of dea[h,it muaY be reporteE on Schetlule G.
SLRVNING]OINT TENANT(5)NAME(5) ADDRE55 RElATI0N5HIG TO DECEDENT
A.MARK R. BAZAR 5216 DEERRELD AVE � SON
MECHANICSBURG,PA 1]O50
8.
C.
]OINTLV OWNEO PROPERTY:
E„� �rE oEscn�PnarvoFvxOaeatt • � or.ipo.oer.,rv
IiFA f00.10INi MPOE MLLV�EAPMEOFFlNANOPLINSi1N➢ONAN�BPYKACGOUNlXOMBE0.00.51MIUP �PiEOf�FAi1� %CEDENPS VEOF
4LMBP. iENN'li )O1M I�EIiI1fYJIG�UMBfN.PIIPGI�EEDWR]OINiLYHHDPFPIFi'PiE. VPWWFlSR INiFPESI �FCE�ENi51NiEfl�S!
�' A' O6i70104 BELCOCOMMCRE�ITUNIONSAVING51t845a9] 97,80503 50 48,90252
2 A 06/3010C BELCOCOMMCREDITVNIONCHECKMG71845497 6,961.69 50 3,480.85
TOTAL(Also enter on Line 6, Recapitulation) $ 52,383 3�
If more space is needea,use additional shee[s af paper of the same size.
urr-um�s-�ce-csi
`'i�Jpennsylvania SCHEDULE G
�S� oeane,nerv.cFaevevue INTER-VIVOSTRANSFERSAND
xesmai�ANc:*��r�iN MISC. NON-PROBATE PROPERTY
ervro=_ceo�nr
ESTATE OF FILE NUM9ER
WCIAN P. BAZAR Z��3-�2�9
This s[M1Mule'mst be mmpletetl antl OIeO if the znswer to any of questioos 1 tlimugh 9 on page IM1ree or�he REv-6001s yes.
DE�FRIPTION OF PROPERTY DAiF OF DEATM °/a OF�ECO'S IXCWSION TAAABLE
ITEN - - 'cotanEviarv:
fvUM118ER ece'<*e. VNWEOF0.55ET INTE0.EST �nssruaee�l VRWF
� nuibrtxxamnmwor'NEo�+fcne
� AMERICANGEMLLIFESERVICESANNUITYkKB312650 �p,fi60.00 100 12,640.00
TOTRL(Also enter on Llne 7, Recapitulatlon) 5 12,640A0
:f more spzce�is neetled,use addltlonal sheeh o'oaper ol Ihe same size,
REV-1 i L EX- (08-llj
ii�Jpennsylvania SCHEDULE H
Ti7 oEanarmcrvroFaEvervuE FUNERAL EXPENSES AND
:��EaraN�E*AxaE���� pDMINISTRATIVE COSTS
aes�o=rvr oEceoervr
ESTpTE OF FILE NUMBER
LUCIAN P. BAZAR 2113.1209
DecedenPs debts must be reporfeE on Schedule 1.
ITB-0 Ap10UlaT
NI1M'ER DESCR'PTION
a FONERALEXPENSES:
-� FRE�HUNTER MEMORIAL SERVICES 625.00
z. HETRICK FUNERAL HOME CREMATION SERVICES 984.00
e. A�MINISTRATNE COSTS:
�. PermnalRep�uen:ativeCammissla�s'.
NaTe(s)of Personal Represeotative(s) _ . ._ —
Sheet Aatlress _ — � —
CIN ��- _ Stafe_ ZIP
Year�s) Commission Paid: _ _ � �
75.00
2. Attarney Fees�.
s,sao.oa
3. Ftmily ExempUon�. Qf Gece4enPs adGrus is not the same as tlatmanPs,attath explanatlon.)
claimant MARKBAZAR . ._
5treet Aodress 5216 DEERRELD AVE _ _ .
Ciry MECHANICSBURG Stare PA ZIp 17050 _
Relationshlp of Clalmanl to Decedenf S�N _ __.
4. Prchate Fees�.
.. Acccuntant Fees:
6. Ta.e ReNm PreparerFees:
].
TOTAL(Also enter on Line 9, RecapiNla[ion) § 5,184.00
If more space is neeaed, ure aGditlaazl shee's of paper of the same size,
REV-1513 E%+(OIdO)
� pennsylvania SCHEDULE ]
`°"°�"`"T°""`"°` BENEFICIARIES
ixxexnnncc,n.aE.oen
aes�oerv�oeceuEur
ESTATE OF: FILE NUMBER:
LUQAN P. BAZAR 2113-1209
0.ElATI0N5HIPTODECEDENT AMOUNTORSHARf
NiJMBER NAME AM1�AD�RF55 OF PE0.50N;5)RECEIV:NG PROPERtY Do Not Lis[Tms[ee(s) 0'ESTNT�
I TAX.VBIE�ISTRI96TI�N5[In�utle a�hlgM1[s0ousal tllstfibu[ions antl tans(ers under
Sec 9L16(a)(L2).]
1. MARK BAZAR, 5216 DEERFIELD AVE, MECHANICSBURG,PA SON 50%
2 LEONAR�BAZAR31 ROCK LANDWG LANE,HAODAM NECK,CT SON 50%
ENTER COLLAR AMCIINTS FOR�ISTRIBUTIONS SHOWN RAOVE ON LINES 15 THHOOGH 18 OF REV�1500 COVER SHEET,AS APPROPRIAtE.
�� N�N4A%ABLf DISTRIOlITI0N5
F. SPOOSAL�ISTNBUT10N5 UNOE0.SEQION 9t13 PoR WHICH FN ELERICN TO TA%IS NOTTAKEV:
1.
B. ChPR1iABLE A�D GOVERNMEMAL�I5TRI9VilONS:
L
TOTAL OF PART II- ENTER TOTAL NON-TA%ABLE�ISTRIBUTIONS ON LINE t3 OF REV4500 COVER SHEH. $
If morespace Is needetl,use aGaltlonal sM1ee[s of papero(t�e same slve,