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Home My WebLink About03-22-06 ..J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW ~,?~i.~I.~.~~~.~.ty..~~r.!.I.~~.r........ ... Date of Death OFFICIAL USE ONLY ,~~.~~.o/.g?de.~e~r... . ... INHERITANCE TAX RETURN RESIDENT DECEDENT Date of Birth . 108-09-7632 01/30/2006 01/22/1912 Decedent's Last Name Suffix Decedent's First Name File Number 21 06 0192 MI ZEMANEK JOSEPH (If Applicable) Enter Surviving Spouse's Information Below Last Name Suffix .~P"?'~~~.'~...~!~.!...~~r.!.I.~....h.h h .~.P.9.~.~~'s...~.()?i~.~..~~9.~.~.t'!..f':J~.~~~.~.... F MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS <=> 4a. Future Interest Compromise (date of death after 12-12-82) ~ 7. Decedent Maintained a living Trust (Attach Copy of Trust) t=> 10. Spousal Poverty Credit (date of death c:> 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECtED TO: Name Daytime Telepho~e--:Number ...~~;:C'~'''h .........................n................................';"""'...~.................n..... ! (717) 737-34q~:\~~'1, . ... ... ...........,"':::._..;~;:..:~;.~.\...n.,~~.' ........;..:.......~ rrolSlER OF~i4S-!!r-~'5l FILL IN APPROPRIATE OVALS BELOW C8.) 1. Original Return <=> 2. Supplemental Return c::> 4. Limited Estate ct> 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received c::J First line of address 2109 MARKET STREET Second line of address ~i.~..~.r. ..~.?~~..g~'?~'h"" . CAMP HILL State ZIP Code 17011 Correspondent's e-mail address:TFLOWER@SFL-LAW.COM C) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required C) 8. Total Number of Safe Deposit Boxes c.n I r<" : DATE FILED Under penalties of pe~ury, 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. SI UR F PERSON RESPONSIB RETURN DATE I . 2c:zJ (P ADDRESS RUSSELL J ZEMANEK, 829 HUMER ST., ENOLA, PA 17025 SIG~EPARE 1: HAN REPRESENTATIVE ADDRESS , SAlOIS, FLOWER & LINDSAY, 2109 MARKET ST., CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 ---I --.J 15056052059 REV-1500 EX Decedent's Name: JOSEPH F ZEMANEK P.~.~:9..~~~.'~..~.?~~.~.~...~~.~~.~~o/. Number : 108-09-7632 RECAPITULATION 1. Real estate (Schedule A). ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.; 'P~_P-4__--.-:-n,,.__>>,>,-:-,,,,___~'-l'_.""""_""__""_----"",,",.o_~ 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 2.! 3. Closely Held Corporation. Partnership or Sole-Proprietorship (Schedule C) . . . " 3. i 4. Mortgages & Notes Receivable (Schedule D). . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. . . ~",......~...._"",,___.~:o;t""""'~>>~_'A_k:...____.:...<<-... i 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5. [ 150.00 I t-;---..---.- 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested . . . . . .. 6. 1 40,627.11 ' 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested.. . . . . .. 7. I , ~---""'_"'~.,.---,:_...._-~_..<.<._---;. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 8. i 40,777.11 · 1,996.33 i 9. Funeral Expenses & Administrative Costs (Schedule H). . . . . . . . . . . . . . . . . . . .. 9. i _#--~_......_: 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . . 10. ! 2,451.98 i r--......h'M......_.-:_--"~....._:~-~ 11. Total Deductions (total Lines 9 & 10)................ ................... 11.j 4,448.31 i 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. I 13. Charitable and Governmental Bequests/See 9113 Trusts for which . an election to tax has not been made (Schedule J) .. . . . . . . . . . . . . . . . . . . . . . . 13. ! 36,328.80 : 0.00. __'H........-.....MU,...~.H,""'._~.'"""'____"'.....____..................: 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14. I TAX COMPUTATION. 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_ 16. Amount of Line 14 taxable at lineal rate X.O 45 36,328.80 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 36,328.80 I 15. 16. 1,634.80 17. 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 1,634.80 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C> L 1t::.r\t::.a.r\&::.?II&::'Q ~-J\J-J\J\JoJc...'-J'-'oJ Side 2 1t=r.c::.Cr\t::.'>r\c::.n ~,JV-J\..JVvc-vvv ---I REV-1500 EX Page 3 Decedent's Complete Address: File Number ;------'J r------; r.".--........"..m........._..m...w.."..w.."..--........"......; i 21 !l 06 110192 I ~' ..t' :;....,~......-~...."^'". ."."."...~..~~........",.. "N .-w......,.~...~..~N"'..,"""..~....N.YN....~.N., DECEDENTS NAME DECEDENT'S SOCIAL SECURITY NUMBER JOSEPH F ZEMANEK 108-09-7632 STREET ADDRESS SARA TODD MEMORIAL HOME 1000 W. SOUTH ST. CITY I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 1,634.80 1,553.10 81.74 Total Credits ( A + B + C ) (2) 1,634.84 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 Total Interest/Penalty ( D + E ) (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) A. Enter the interest on the tax due. (SA) (58) 0.00 0.00 0.00 0.00 0.00 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. 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;.......................................................................................... D [K] b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 00 c. retain a reversionary interest; or.......................................... ............................................... ................................. 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [iJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .................. ................ ........ ............ ....... ..... .............................. .............. 0 IKl 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ......... .......... .......................................... .......... ........... ............................... ....... 0 [KJ 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three {3} percent [72 P.S. ~9116 (a) (1.1) (ill. 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 zero (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 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-one 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 zero (O) 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 decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)J. 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-1508 EX+ (6-98) .- COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF JOSEPH F. ZEMANEK FilE NUMBER 21-06-0192 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 NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. 1992 OLDSMOBILE CUTLAS AUTOMOBILE, SALVAGE TITLE, 107,000 MILES TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 150.00 REV-1509 EX+ (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF JOSEPH F. ZEMANEK FILE NUMBER 21-06- If an asset was made Joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT{S} NAME ADDRESS RELATIONSHIP TO DECEDENT A.. RUSSELL J. ZEMANEK 829 S. HUMER ST. ENOLA, PA 17025 GRANDSON B. . C. JOINTLY-OWNED PROPERTY: LETTER ITEM FOR JOINT NUMBER TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECO'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 2. NA TL. BANK savings acct. #1220946520 50 1,984.00 1. A. CITIZENS NA rL. BANK checking acct. #1419452262 20,633.05 CITIZENS NATL. BANK C/O. #1220038225 18,010.06 TOTAL (Also enter on line 6, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 40,627.11 REV-1511 EX+ (12-99). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF JOSEPH F. ZEMANEK FILE NUMBER 21-06-0192 Debts of decedent must be reported on Schedule L ITEM NUMBER A. FUNERAL EXPENSr;$:, 1. DESCRIPTION B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Street Address City Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Publish executor's notices, Sentinel (~1!~.33},gurTlberland Law J?ur~aIJ~!5) TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) AMOUNT 1,500.00 248.00 248.33 1,996.33 REV-1512 EX+ (12-03) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF JOSEPH F. ZEMANEK FILE NUMBER 21-06-0192 Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. AT&T, phone bill 23.18 2. Lunacare, oxygen equipment rental 3. JMI Oxygen supplies, oxygen tank 4. Sara Todd Memorial Home, room & board 5. Storage & utilities TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,451.98 i! U~IA?~~I"KENS March 9,2006 JOSEPH F ZEMANEK RUSSELL J ZEMANEK 4347 RTE 328 MILLERTON PA 16936 Account number: 1/1/06 Balance 1419452262 $3,967.99 ~ afi ~/~t: ( checking) ?/:z.. 7 /~t/ ......................................................................... STEPHANIE IvIARIE SELLECK JOSEPH F ZEMANEK CUST UNIFORM GIFT TO MINORS ACT RR 1 BOX 181 LAWRENCEVILLE PA 16929 Account number: 8516031302 1/1/06 Balance $5,018.95 40lW-llLt.tJ~ ~ ......................................................................... COLLIN JOSEPH SELLECK JOSEPH F ZEMANEK CUST UNIFORM GIFT TO MINORS ACT RR 1 BOX 182 LA WRENCEVILLE P A 16929 Account number: 8516112701 1/1/06 Balance $3,520.29 (money market) ......................................................................... ~d M b;r/J-T:.. 1/01- 9'1.!'~ JOSEPH F ZEMANEK RUSSELL J ZEMANEK 4347 RTE 328 MILLERTON PA 16936 Account number: 1/1/06 Balance 1220946520 $41,266.10 (savings) ......................................................................... ~ ~ ~ I~T 01F /01 JOSEPH F ZEMANEK RUSSELL J ZEMANEK 4347 RTE 328 MILLERTON PA 16936 Account number: 1/1/06 Balance 1220038225 $36,020.11 Linda L Nowak ~.~L/ Tele-Services Supervisor (certificate of deposit) Nasl JIIill Club ill~sta1lUut OF JOSEPH F. ZEMANEK I, Joseph F. Zemanek, ofLawrenceville, Tioga County, Pennsylvania, declare this to be my Last Will and revoke any and all Wills previously made by me. ITEM I:' I hereby direct my personal representatives to pay all my just debts not barred by any applicable statute of limitations and my funeral expenses as soon as practicable after my death. ITEM IT: All the rest, residue and remainder of my estate whether real, personal or mixed and wherever situate I hereby give, devise and bequeath to my grandson, Russell Zemanek, if he survives my death by sixty (60) days. Ifhe fails to survive my death by sixty (60) days, then all the rest, residue and remainder of my estate whether real, personal or mixed and wherever situate shall bae distributed to Judy Hower. ITEM III: I hereby nominate, constitute and appoint my grandson, Russell Zemanek, of Enola, P A, Executor of my estate. If my grandson should fail to qualify or cease to act as Executor then I appoint Judy Hower, alternate Executrix of my estate. ITEM N: I hereby direct that my personal representatives shall not be required to give bond for the faithful performance of their duties in this or any other jurisdiction... IN WITNESS WHEREOF, I have placed my hand and seal this ~ day of October, 1997. ~ '-?\ep-t.(7&~ (SEAL) The preceding instrument, consisting of this one typewritten page, was on the day and date hereof signed, published and declared by the Testator herein named, as and for his Last Will, in the presence of us, who at his request, in his presence and in the presence of each other, have subscribed our names as witnesses hereto: residingat W~/ f1 /690/ ~~ ....--~.hd.. ~ .;::. residing at ~Q..u.., <'-Q c"-u ~t;\ll.~ ~J PA 1 u ~ 'l..S\ ACKNOWLEDGEMENT I, Joseph F. Zemanek, Testator, whos, name is signed to the attached or foregoing instruments, having been duly qualified according to law, do hereby acknowledge that I signed and executed this instrument as my Last Will and that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~"f cr 3~Y\.- I k of October, 1997. before me by the J.estat, k-~ · C;a s day AFFIDA VIT CO:MM:ONWEAL TH OF PENNSYLVANIA: Notarial Seal Claudia J. Root. Notary Public Wellsboro Boro. Tioga County My Commission Expires Sept. 11, 2001 Member. Pennsylvania Association of Notaries ss: COUNTY OF TIOGA We, Lany Linder and Tina M. Bradshaw, the witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, depose and say that we were present and saw Testator sign and execute the instrument as his Last Will, that the Testator executed it as his free and voluntary act for the purpose therein expressed, that each of us, in the hearing and sight of Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen years or more, of age, of sound . Sworn to and affirmed to and acknowledged October, 1997. Notarial Seal Claudia J. Root. Notary Public Wellsboro 80ro. TIoga County My Commission Expires Sept. 11. 2001 Member, PennS'!I\/<Ulla Association of Notaries