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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT 280601
HARRISBURG, PA 17128-0601
DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL)
LANDT MARION L.
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DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
12/04/2005
10/31/1920
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST. FIRST AND MIDDLE INITIAL)
~ 1 Original Return 0 2, Supplemental Return
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f- 0 0 Future Interest Compromise (date of death after
~~(I) 4 Limited Estate 4a.
Uo:>: 12-12-82)
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IOO 6. Decedent Died Testate (Attach copy 7 Decedent Maintained a Living Trust (Attach
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a.Dl of Will) copy of Trust)
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<! 0 9 Litigation Proceeds Received 0 10 Credit (date of death between
COMPLETE MAILING ADDRESS
301 Market St.
Lemoyne, PA 17043-0109
(1 ) None
(2) None
(3) None
(4) None
(5) 90,035.52
(6) None
(7) None
(8)
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NAME
EDMUND G. MYERS
FIRM NAME (If applicable)
JOHNSON, DUFFIE, STEWART & WEIDNER
TELEPHONE NUMBER
717761-4540
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Scrledule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
(10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
FILE NUMBER
21 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
00098
NUMBER
185-12-9428
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3 Remainder Return (date of death pilar to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11 Election to tax under Sec. 9113(A) (Attach Sch 0)
90,035.52
6,757.67
40,968.37
(11 )
47,726.04
(12)
42,309.48
(13)
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax(Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
42,309.48
15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a}(1.2)
z x .045 (16)
0 16. Amount of Line 14 taxable at lineal rate
;::
<!
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::J (17)
a. 17. Amount of Line 14 taxable at sibling rate x .12
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0
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>< 18 Amount of Line 14 taxable at collateral rate (18) 6,346.42
<! 42,309.48 x .15
f-
19 Tax Due (19) 6,346.42
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
-- - ---;';BE-SURE TOANSWER-ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH<<
Form REV-1500 EX (Rev. 6-00)
Copyright 2000 form software only The Lackner Group, Inc.
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Decedent's Complete Address:
STRIFT ADDRESS
2203 Page Street
(lfy
Camp Hill
STATE PA
ZIP 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
6,346.42
5,500.00
289.47
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C)
(2)
5,789.47
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPA YMENT
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is theTAX DUE.
Make Check Payable to: REGISTER OF WILLS, AGENT
(3) 0.00
(4)
(5) 556.95
(5A)
(5B) 556.95
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE
3. Did decedent own an "in trust for" or payable 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?.. ........................... .............................. __"" ........................ ................ .......
Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;............................................................................. ~ ~
~. ;:::: :h~e:~~;~~:~':~~~::~:~ 'h~""'e the. p,op~rty .h'"fecce'.o'. 'I'. ;poome;................................................. ~
d. receive the promise for life of either payments, benefits or care?..............:............................................ ~
2. If death OCcurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?................. .......................................................... ................ ............ 0
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PLEASE ANSWER THE FOLLOWING QUEST/ONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Under penalties of perjury. I declare thai 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
preparer other than the personal representative IS based on all information of which preparer has any knowledge.
ADDRESS
IF THE ANSWER TO ANY OF THE ABOVE QUEST/ONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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SIGNATURE o~ ~ERSON RESPON~E FOR FILING RETURN
1.~lt"'l ~ L. '\IZ;IOLE~: -2 .'
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SIGNA URE OF PERSON RESP NStBLE FO~G RETURN
ADDRESS
68 OCHS A VENUE
MILL TOWN, NJ 08850-1464
DATE
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ADDRESS
301 Market St.
Lemoyne, PA 17043-0109
DATE
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. S9116 (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. S9116 (a) (1.1) (ii)]. The statutedoes not exempta 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 0% [72 P.S. S9116 (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 4.5%, except as noted in 72 P.S. S9116
1.2) [72 P.S. S9116 (a) (1)]
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. S9116 (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.
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LANDT, MARION L.
FILE NUMBER
21 - 06 - 00098
Include the proceeds of litigation and the date the proceeds were received by the estatEAII property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
2,014.22
PNC Bank - Savings Account No.5 1-3006-8954
Datc of death balance
2
PNC Bank - Checking Account No. 80-2379-0259
Date of death balance
346.29
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Promissory Note dated April 22, 2005 in the amount of$87,000.00
Interest: 6 1/2'% - due February 28, 2005
Marion L. Landt and I1da A. Perna
Date of death balance, plus accrued interest.
87.675.01
TOTAL (Also enter on Line 5, Recapitulation)
90,035.52
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
21 - 06 - 00098
LANDT, MARION L.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A, FUNERAL EXPENSES:
Myers-Harner Funeral Home
DESCRIPTION
AMOUNT
2
Rolling Green Cemetery - Cemetery charges
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
1.
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City
Year(s) Commission paid
Zip
State
2.
Attorney's Fees
Johnson, Duffie, Stewart & Weidner
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills - Cumberland County
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
Other Administrative Costs
Cumberland Law Journal - advertising letters
2
The Patriot-News - advertising letters
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
130.00
1,195.00
4,000.00
256.00
75.00
116.67
985.00
6,757.67
Schedule H
Funeral Expenses &
Administrative Costs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LANDT, MARION L.
,
.'
Insurance and Surety - Bond Premium
-1-
Register of Wills- file Inventory and Inheritance Tax Return
:'
Rescrve for close-out costs
FILE NUMBER
21 - 06 - 00098
Page 2 of Schedule H
880,00
30.00
75.00
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LANDT, MARION L.
FILE NUMBER
21 - 06 - 00098
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
Claim - Department of Public Welfare
Class 3 Claim - $20,680.23
Class 6 Claim - $19.909.80
40,590.03
2
ManorCare - balance due - decedent's account
378.34
TOTAL (Also enter on Line 10, Recapitulation)
40,968.37
REV-1 513 EX+ (9.00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
LANDT, MARION L.
FILE NUMBER
21 - 06 - 00098
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Linda L. Niziolek
68 Ochs Avenue, Milltown, NJ 08850-1464
Niece
Residue
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
11. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Register of Wills of Cumberland County, Pennsylvania
INVENTORY
Estate of
LANDT, MARION L.
, Deceased
No. 21 - 06 - 00098
Date of Death 12/4/2005
Social Security No. 185-12-9428
also known as
LINDA L. NIZIOLEK
The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory
include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania
of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the
Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that
which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true
and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904
relating to unsworn falsification to authorities.
Attorney:
EDMUND G. MYERS
Personal Representative
8;9n,'",e U~~~i&E(( ~~-Aj
Signature:
I.D. No.:
20558
Signature:
Address:
Address: 68 OCHS AVENUE
MILLTOWN, NJ 08850-1464
301 Market St.
Lemoyne, PA 17043-0109
Telephone: 717/761-4540
Telephone: (732) 246-2757
Dated:
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Personal Property
PNC Bank - Savings Account NO.5 1-3006-8954
Date of death balance
1
"'2,014.22
PNC Bank - Checking Account No. 80-2379-0259
Date of death balance
.. 346.29
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Promissory Note dated April 22, 2005 in the amount of $87,000.00
Interest: 6 1/2% - due Febmary 28, 2005
Marion L. Landt and Ilda A, Perna
Date of death balance, plus accrued interest.
87,675.01
Total Personal Property
$90,035.52
(Attach additional sheets if necessary)
Total Personal Property and Real Estate
$90,035.52
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT 2B060 1
HARRISBURG, PA 1712B-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 006512
DUPLICA TE
NIZIOLEK LINDA L
68 OCHS AVENUE
MILL TOWN, NJ 08850-1464
____un fold
ESTATE INFORMATION: SSN: 185-12-9428
FILE NUMBER: 2106-0098
DECEDENT NAME: LANDT MARION L
DATE OF PAYMENT: 04/03/2006
POSTMARK DATE: 03/31/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 12/04/2005
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $556.95
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$556.95
REMARKS: L L NIZIOLEK
CHECK#106
SEAL
INITIALS: VZ
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS