HomeMy WebLinkAbout09-13-05
REV-l500EJ(+{tHXl) R V 1 0 OFf\C\Al..USEOHLY
COMMONWEALTH OF E - 50
PENNSYLVANIA
DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBE
DEPT. 280601 R
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT C~T'f~ - 0 _5 ..Q... .1.... J,;.RJ!....-
DECEDENTS NAME (LAST, RRST, AND MIDDLE INITIAL) SOCiAl SECURITY NUMBER
...
Z Placzek Stella J, 1 1 0 - 1 8 - 2 1 6 0
:!:: DATE OF DEATH (MM.DD- Year) DATE OF BIRTH (Mld-DO.Year) THIS REtURN MUST BE RlED IN DUPlICA'TE WITH mE
~ 04/03/2005 02/13/1927 REGISTER OF WILLS
:!:: (IF APPUCABlE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INlTlAl) SOCIAL SECURITY NUMBER
- -
I!! 1X]1.0rtglnalRelum 02,SupplemenlalRelum 0 3,RemainderRelum l""'oI"'''''''''~12.1'''1
!SiB 0 4,LimttedEstate 04a,FuturelntereslCompromise(d.."""'...12.,z.821 0 5,FederaIEs\aleTaxRelumRequlred
woo
is B:a:: 0 6. Decedent Died Testate (Attach: CO\Iy ofWil) 0 7. Decedent Maintained a Living Trust (Attach copy of Trust) _ 8. Total Number of Safe Deposit Boxes
..
.. 0 9, LmgaUon Proceeds Received 0 10, Spousal Poverty Credn (...." "'" """'" "."." "'" 1.1-95) 0 11, Election 10 tax under See, 9113(A) 1_' Sch 0)
NAME COMPLETE MAILING ADDRESS
Robert L Fre Es. 1700 Bent Creek Boulevard, Suite 140
FIRM NAME (~Applicable)
Latsha Davis Yohe & McKenna PC Mechanicsburg, PA 17050
TELEPHONE NUMBER
717 761-1880
o 0 OFFICIAL USE ONLY
1,ReaIEstate(ScheduleA} (1) . 0 .....,
,:-) C'~
2. Stocks and Bonds (Schedule B) (2) 274.528,00 ~.:, 5; ,::R
(/) (. "->
3, Closely Held COIporaton, PartnershiporSole.1'roprtetorship (3) 0,00 0 Cti <::';;i
r~- C"]
4, Mortgages & Notes Rece~able (Schedule D) (4) ~ ~j <.:; t9
"./-... _.
5. Cash, Bank Deposits & Misoellaneous Personal Property (5) 260.320.08 ') -0 C;?,
(Schedule E) " 1 ::: '" ::':.1
Z ~
_..\ ~ ---- l-n
o 6, JoinUy Owned Property (Schedule F) (6) . ~-; '.. ' -, -
- '.';)
S 0 Separate Billing RequesWd ':;:' . ''[,
::I 7, Inter.V~os Transfers & Mlsoellaneous Non.Probate Property (7) 54,630,11
... (Schedule G or L)
~ B, To1alGro5s Assets (total Lines H) (8) 589,478.19
o
W 9 Funerai Expenses & Administlative Cosls (Scheduie H) (9) 16,538.00
CI: '
10, Debls of Deoedent Mortgage Liabl/mes, & Liens (Schedule I) (10) 408.81
11, TotaIDeductlon5(lotaILines9&10) (11) 16,946.81
12, Net Value of E5lale (Line 8 minus line 11} (12) 572,531.38
13, Charttable and Govemmental Bequests/See 9113 TlUsls forwhich an alec60n to tax !\as not been (13)
made (Schedule J)
14, NetValue Subjec1\Q Tax (Line 12 minus Line 13) (14) 572,531.38
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
Z 15, Amount of Line 14 taxable at !he spousal tax
o rate, ortlanslers under See, 9116 (a)(1.2) X _ (15)
I-
~ 16,Amo\lntofLine14taxableatlinealrate 572,531.38 X .045 (16) 25,763.91
::I
0. 17,AmountofLinel4taxableatsiblingrate X ,12 (17)
:Ii:
8 1B, Amounto(Line 14 taxable atoollaleral rate X ,15 (IB)
~ 19, Tax Due (19) 25,763.91
...
20. 0 CHECK HERE IF YOU ARE REOUESTING A REFUND OF AN OVERPAYMENT
Decedent's ComDlete Address:
STREET ADDRESS
2100 Bent Creek Blvd Suite 255
CITY I STATE I ZlP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 25,763.91
2, CreditslPayments
A. Spousal Poverty Credit
B, Prior Payments 24 800 00
C, Discount 1.289,67
Total Credits (A +B +C) (2) 26,089,67
3, InteresUPenalty if applicable
0, Interest
E. Penalty
T otallnteresUPenalty ( 0 + E ) (3)
4, If Line 2 is 9reaterthan Une 1 + Line 3, entOlthe difference, This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4) 325.76
5, If Line 1 + Line 3 is greater than Line 2, enterthe difference, This Is the TAX DUE. (5) 0.00
A, Enter the interest on the tax due, (5A)
B, Enter the total of Une 5 + 5A, This is the BALANCE DUE. (58) 0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
. I .- .. IT Fb' L\.., lr:!Jillf!lPtni ~lr'lil'J!Uj;ll1fT'01lrim'1'r)ff: .mill
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: .hhhhhhhhhhhhhhhhhhhhh...hhhhhh.hhhh.hhh. 0 [RJ
b, retain the right to designate who shall use the property transferred ortts income; hhhhh.h.hhh.h.h.h'h...hh' 0 [RJ
c. retain a reversionary interest; or ...................................................................................................... 0 [RJ
d, receive the promise for life of either payments, benefits or care? hhh,hhhhhhhhh'hhhhhhhhhh'h"'hh"'h 0 [RJ
2, If death occurred after December 12, 1982, did decedent transfOl property within one year of death
without receiving adequate consideration?......hh h, h hhh hh h h h h h' h' h h, h", h h h h' h h.... h", h .hh....hh."'" h. 0 [RJ
3, Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? hh..h......... 0 [RJ
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..............h...........h......................,..'........h..'..h...."'................""',,, [RJ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I decla-e that I have examined tI\is return, ir.cludi~ accompanying schedules and statements. and 10 the best of my koowfedge and belief, it is true, correct and complete.
Declaration of prepanlr oIher than the personal representative is based on a11mfoonation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FiLING RETURN DATE
ADDRESS
DATE
~
17 Bent Creek Boulevard, Suite 140
MachanicsburQ PA 17050
! ~. ij ;';lI! liD .&it i!l!'L.. Il. ..~llli~~'B~~"'~"'~~~.d.
'" m.'O. m ~..' "',,:,~/IT!F~_.""'~.,jf..G",J'i3";:g;':..,'~ ?:~,ac,,__.:.. '. 0<''''1","
For dates of death on or after July 1,1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P,S, ~9116 (a) (1.1) (i)),
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% [72 P,S, ~9116 (a) (1,1)(li}j,
The statute does not exemot 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 ff
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 twenty-ooe 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% [72 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 iineat beneficiaries is 4,5%, except as noted in 72 P,S, ~9116{1.2) [72 P,S, ~9116(aX1)],
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S, ~9116{a)(1 ,3)], A sibling is defined, under Seeton 9102, as an
inQividual who has at least one parent in common with the decedent, whether by blood or adoption,
REV-1503 EX + (6-98)
* SCHEDULE B
. COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEOENT
ESTATE OF FILE NUMBER
Placzek Stella J 21 05 0328
All property jolntly-owned with right olsu"ivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRiPTiON OF DEATH
1. U,S. Savings Bonds Series I and EE which are identified by Serial Number and Date 62.028.00
of Death Values which are found on Attachment 1
2. U.S, Savings Bonds Series HH which are identified by Serial Number and Date of Death 212,500.00
Values which are found on Attachement 2
TOTAL (Also enter on line 2, Recapitulation) $ 274528.00
(If more spaoe is needed, Insert additional sheels of It1e same size)
REV.1508 EX< (6-98)
'* SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT OECEDENT
ESTATE OF FILE NUMBER
Placzek Stella J, 21 05 0328
Include the proceeds of Ktigation and the date \he proceeds were received by the estate,
All property jolntly-owned with right of su,",ivorship must be disclosed on Schedule F,
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF OEA TH
1, Orrstown Bank Checking Account # 111800096 86,779.91
2, Sovereign Bank Checking Account # 2331052085 73,030,28
3. Sovereign Bank Certificate of Deposit #2335460909 100,509.89
TOTAL (Also enter on line 5, Recapituiation) $ 260 320.08
(If more space is needed. insert additional sheets of the same size)
REV.151O EX + (6-98)
* SCHEDULE G
INTER.VIVOS TRANSFERS &
COMMONWEALTH OF PENNSYLVANIA MISC. NON.PROBATE PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Placzek Stella J. 21 05 0328
This schedule must be completed and filed n the answer 10 any 01 quesUons 1 through 4 on the reverse side of the REV.1500 COVER SHEET is yes,
DESCRIPTION OF PROPERTY
ITEM INQ.UDE THE IWIE OF THE TRANSFEREE, TtfEIR RflATIONSHlP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER lHE PATE Of lRANSfER_ ATI~A.CQPVOflHEDEroFORREAlESTATE VALUE OF ASSET INTEREST VALUE
{lFAPPllCABtE}
1, GreenPoint Bank IRA Account # 6687333861 ;The 54,630.11 100. 54,630,11
beneficiaries of this Account are Catherine Cozine, Michael
Placzek, Gerard Placzek, and Victoria Campeau
TOTAl (Also enler on line 7 Recapitulation) $ 54630.11
(If more spaoe is needed, Insert ad~monal sheets of the same size)
REV-1511 EX + (12-99)
* SCHEDULE H
COMMONWEAlTH OF PENNSYLVANiA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Placzek Stella J. 21 05 0328
Oebts of decedent must be reported on Schedule I.
iTEM
NUMBER DESCRIPTION AMOUNT
A, FUNERAL EXPENSES:
1, Neill Funeral Home, Inc. 8,628,30
2. Estate expense reimbursement of costs of funeral arrangements and attendance
for Catherine Cozine, Michael Placzek and Gerard Placzek 1,061.70
B, ADMINISTRATIVE COSTS:
1, Personal Represenlatve's Commissions
Name of Personal Representative (s) Catherine Cozine 0.00
SocIeI Security NumbeJjs)IEIN Number of Personal RepresentaUve(s)
Street Address
cny State Zip
Year(s) Commission Paid:
2, Attorney Fees Latsha Davis Yohe & McKenna, PC 6,500.00
3. Family Exemption: (If decedents address is not the same as claimanfs, attach explanation)
Claimant
Slree! Addl'"
cny State Zip
Relationship of Claimant to Decedent
4, Probate Fe.. Cumberland County Register of Wills 348,00
5, Accountanfs Fees
6. Ta)l. Return Preparer's Fees
7,
TOTAL (Aiso enter on line 9, Recapitulation) $ 16 538.00
(If more space is needed, insert additional sheets of the same size)
REV-1512 ~X + (EHl8)
'* SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Placzek Stella J. 21 05 0328
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, Alert Pharmacy Services, Inc. 308.81
Last pharmacy bill for Decedent
2. Associated Cardiologists 100,00
Medicare deductible for Accl. 213370 for Decedent
TOTAL (Also enter on line 10, Recapitulation) $ 408.81
(If more spaoe is needed, insert addiUonal sheeis of \lie same size)
REV.1513EX+I* SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIOENT DECEDENT
ESTATE OF FILE NUMBER
PI""7Ak ;tAlla.l. ?1 n.. n~?~
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 Onclude =ht spousal dlstribuUons, and transfeffi under
See 9116 (a (1.2)J
1, Catherine Cozine Daughter IRA - $13,657.53
10 School Street, P.O. Box 503 1/4 share residuary =
East Boothbay, ME 04544 $129,475.32
2. Michael Placzek Son IRA-$13,657.53
219 Wood Street 1/4 share residuary =
Camp Hill, PA 17011 $129,475.32
3. Gerard Placzek Son IRA - $13,657.53
9340 Victoria Lane 1/4 share residuary =
North Ridgeville, OH 44039 $129,475,32
4. Victoria Campeau Daughter IRA - $13,657.53
826 Tallyho Drive 1/4 share residuary =
Hershey. PA 17033 $129,475.32
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
li. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1,
B, CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1,
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
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{ JUN 1 Z005
North ~ork Bank .
GreenPoint Division
May 24, 2005
Latsha Davis Y ohe
& McKenna,P.C,
Attorneys at Law
PO Box 825
Harrisburg, PA 171108
Attn: Robert Frey
Re: Stella Placzek, Deceased
Individual Retirement Plan
Dear Mr. Frey
This letter is W response to your correspondence dated May 11, 2005. Below is the
balance information you requested.
Account # Date of Death Balance Current Balance
6687333861 $54,630.11 $54,758.22
A review of our records revealed that Ms. Placzek had named a primary beneficiary (ies)
for her IRA Plan. The beneficiaries were contacted under separate cover. If you have any
questions, please call our Telephone Express Banking Center at 1-87-694-9111. Thank
you,
/dM(;
Mel ie Rakpczy
Time Support Specialist
LATSHA DAVIS YOHE
& MCKENNA, EC.
ATTORNEYS AT LAW
PLEASE REPLY TO, Mechanicsburg
WRITER'S E. MAIL rfrey@ldylaw,com
September 9, 2005
Glenda F. Strasbaugh
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013-3387
Re: Estate of Stella T. Placzek
SSN: 110-18-2160
File No: 21-05-0328
Our File No: 620-05
Dear Sir/Madam:
We enclose and file with your office the following:
1. Three copies of the Inheritance Tax Return for the Estate; and
2. Three copies of the Inventory.
Please date-stamp and return the extra copies in the enclosed self-addressed stamped
envelope. If you have any questions or require any additional information, please do not hesitate
to contact us.
Thank you.
/ incerely,
~ /
"
/
/
(
RLF/mlf
Enclosures
1700 Bent Creek Boulevard, Suire 140 . Mechanicsbmg, PA 17050 . (717) 620,2424 . FAX (717) 620.2444
350 Eagleview Bouleva<d, Suite 100 . Exton, PA 19341' (610) 524.8454' FAX (610) 524.9383
3000 Atrium Way, Suire 251' Mr, Laurel, NJ 08054' (856) 231-5351' FAX (856) 231.5341
Maryland Telephone, (410) 727.2810
100869
LATSHA DAVIS YOHE
& MCKENNA, EC.
ATTORNEYS AT LAW
PLEASE REPLY TO, Mechanicsburg
WRITER'S E, MAIL rfrey@ldylaw,com
September 12, 2005
Register of Wills
Glenda F, Strasbaugh
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013-3387
Re: Estate of Stella T, Placzek
SSN: 110-18-2160
File No: 21-05-0328
Our File No: 620-05
Dear Sir/Madam:
Please find enclosed a check in the amount of thirty dollars ($30.00) to file the Inheritance
Tax Return in the above-referenced matter that was previously omitted. If you have any questions
or require any additional information, please do not hesitate to contact us.
Sincerely,
RLF / mlf i:i7~
.....,
Enclosures c::) -'->
C) =
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reI ~',"",:
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cr.
1700 Bent C<eek Bouleva,d, Suite 140 . Mechanbbu,g, PA 17050 . (717) 620-2424 . FAX (717) 620.2444
,50 Eagleview Boulevard, Suire 100. Exton, PA 19341 . (610) 524.8454 . FAX (610) 524.9383
3000 Atrium Way, Suite 251 . Me Lautel, NJ 08054. (856) 231-5351 . FAX (856) 231.5341
Maryland Telephone, (410) 727.2810
100869
Marjorie A. Wevodau First
Glenda Farner Strasbaugh Deputy
Register of Wills
and
Clerk of Orphans' Court Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle. PA 17013
(717) 240-6345
FAX (717)240-7797
I INVOICE I
Bill To: InvoiceNo: 543
Invoice Date: 9/13/2005
LATSHADAVIS YOHE & MCKENNA, PC Estate of: Stella T. Placzek
1700 BENT CREEK BOULEVARD Estate No: 21-05-0328
SUITE 140 R. Keny
MEGIANICSBURG, PA 17050
Qty Fee Description Fee Total
1 Additional Probate 150.00 $150.00
Total: $150.00
GJ.ecks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.