HomeMy WebLinkAbout05-09-06
REV-1511 EX + (12-99)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
TAMALAVAGE JOHN J SR
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21 05
Debts of decedent must be reported on Schedule I.
00676
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Malpezzi Funeral Home 8,452.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) John J. TamalavaQe, Jr. 750.00
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees R. MARK THOMAS 1,000.00
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Probate fees: 144.00 Inh. Tax Return Filing Fee: 15.00 159.00
5. Accountanfs Fees
6. Tax Return Prepare~s Fees
7.
TOTAL (Also enter on line 9, Recapitulation) $ 10,361.00
(If more space is needed, insert additional sheets of the same size)
RI!V-1513EX+(9*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
AMOUNT OR SHARE
OF ESTATE
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
MILDRED M. TAMALAVAGE
528 MAPLE STREET
POTTSVILLE, PA 17901
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
NUMBER
1.
Spousal
100%
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. 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 II - ENTER TOT AL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
.A .
LAST WILL AND TESTAMENT
BE IT REMEMBERED THAT
I, JOHN J. TAMALA V AGE, SR., a resident of Cumberland Cou~ty, Pennsylvania,
being of sound and disposing mind, memory and understanding, do make, publish and declare
this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and
Codicils previously made by me.
I
I declare that I am married to MILDRED M. TAMALA V AGE, and that I have two
(2) children, JOHN J. TAMALA V AGE, JR., and JUDITH REMISZEWSKI.
II
I direct that all my just debts and funeral expenses shall be paid from my residuary
estate as soon as practicable after my decease.
III
I direct that all taxes that may be assessed in consequence of my death, of whatever
nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part
of the expense of the administration of my estate.
IV
I give, devise and bequeath all my property, whether real or personal, wherever situate,
including any ,property over which I may have a power of appointment to my wife,
MILDRED M. T AMALA V AGE provided that she survives me by thirty (30) days.
V
If my wife, MILDRED M. TAMALA V AGE, shall predecease or fail to survive me by
thirty (30) days, I hereby make the following specific bequests:
1. To my granddaughter, JILL REMISZEWSKI, I give twenty-five thousand
($25,000.00) dollars;
.'" ,
years, her inheritance, whether by specific bequest or per stirpes, shall be administered
pursuant to the terms of the hereinafter included Trust.
VI
In the event that my wife, MILDRED M. T AMALA V AGE, has predeceased me or
failed to survive me by thirty (30) days, and the specific bequests above have been distributed,
then I give, devise and bequeath all the rest, residue and remainder of my property, whether
real or personal, wherever situate, including any property over which I may have a power of
appointment, to my children, JOHN JAMES T AMALA V AGE, JR. and JUDITH
REMISZEWSKI, in equal shares, per stirpes.
VII
TRUST
In the event that I have any beneficiary who is under the age of twenty-one (21) years
who survive me, I appoint my son, JOHN J. TAMALA V AGE, JR. as Trustee of the property
that I have given to my beneficiary. If JOHN J. TAMALA V AGE, JR. is unable or unwilling
to act as Trustee, then I appoint my daughter-in law, RITA T AMALA V AGE as Trustee.
A. The assets that are transferred to the Trust shall be held by the Trustee under the
terms of this Trust until the beneficiary attains the age of twenty-one (21) years.
B. The Trust estate shall be administered until the beneficiary reaches the age of
twenty-one (21) years. Until that time, the Trustee shall apply all net income and principal of
the Trust estate as follows:
1) So long as my beneficiary is under the age of twenty-one (21)
years of age, the net income of the Trust shall be paid to, or
applied for the benefit of my beneficiary at such times and in
such amounts as the Trustee shall in his discretion deem
necessary for his support, welfare, maintenance and education.
Education shall be defined broadly to include not only that
available in college, but also trade school and other similar
training. In the event that the income shall be insufficient to
provide my beneficiary with adequate maintenance, support,
1 . .L _ I'T"____L_ _' -
of mak. ing payments out of income or
b fi principal to my
. ene clary shall be conclusive on all persons howsoever
mterested in thp 'T'rllf'1-
REV-1509 EX + (6-98)
*
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
TAMALAVAGE JOHN J SR
FILE NUMBER
21 05
00676
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. MILDRED M. TAMALAVAGE
528 MAPLE STREET
POTTSVILLE, PA 17901
SPOUSE
B
C
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DA TE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S V AWE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. MARITAL RESIDENCE (See HUD-1 dated 10/27/2005)888 168,759.90 50. 84,379.95
802 COCKLIN STREET
MECHANICSBURG, PA 17055
2. A. 8/5/62 MEMBERS 1 ST FCU 115.11 50. 57.56
SAVINGS ACCT. #5972-00
3. A. 2/1/01 MEMBERS 1 ST FCU 4,001.97 50. 2,000.99
SAVINGS ACCT. #5972-04
4. A. 10/1/85 MEMBERS 1ST FCU 132,290.20 50. 66.145.10
MONEY MANAGEMENT ACCT. #5972-05
5. A. 12/15/04 MEMBERS 1 ST FCU 425,723.08 50. 212,861.54
CD #5972-41
6. A. 2003 Chevrolet Malibu LS 7.000.00 50. 3,500.00
7. A. PNC Bank 6.143.25 50. 3,071.63
Checking Acct. #51-4023-9868
8 A. 08/05/62 MEMBERS 1 ST FCU 35.83 50. 17.92
C^\IIM~C. A(,(,T :ff1n1H~_nn
this Trust, not to exceed five (50/0) percent of annual
mcome.
7) To distribute property in kind.
8) To do all other acts that are in his judgment necessary or .
desirable for the proper management, investment and
distribution of the Trust estate.
VIII
I nO,minate, constitute and appoint my son, JOHN J. TAMALA V AGE, JR. as
Executor of this LAST WILL, to serve without bond. If JOHN J. TAMALAVAGE, JR. is
unable or unwilling to act in that capacity, then I nominate, constitute and appoint my
daughter, JUDITH REMISZEWSKI, as Executrix of this LAST WILL, to serve without
bond.
IN WITNESS WHEREOF, I, JOHN J. TAMALAVAGE, SR., have set my hand to this
LAST WILL this ;)$ Y1~ay of Jt{ S ' 2002.
-. t ~~(jr~f-€-
A V AGE, SR.
J
Signed, sealed, published and declared by the above-named JOHN J.
T AMALA V AGE, SR., as and for his Last Will and Testament, in the presence of us, who, at
his request and in his presence, and in the presence of each other, have hereunto subscribed our
names as witnesses.
~
,.,^
,a.: ·
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLAND
I, JOHN J. T AMALA V AGE, SR., Testator, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby acknowledge
that I signed and executed the instrument as my LAST WILL; that I signed it as my free and
voluntary act for the purposes therein expressed.
,-'i dL~~
A V AGE, SR.
Sworn or affirmed to and acknowledged before me by JOHN J. TAMALAVAGE, SR.,
Testator, thisdS day of d-~r ,2002.
/}01t.-L ~-~
Notary Public
AFFIDA VIT
Notarial Seal
Anne Carmody, Notary Public
Mechanicsburg Bora. Cumberland County
My Commission Expires Expires Mar. 11, 2006
COMMONWEALTH OF PENNSYLVANIA
ss.
COUNTY OF CUMBERLA~
We, /!~ V ~ and H8a-+her 72o-the'l'---meJ ,
the witnesses whose names are signed to the attached or foregoing instrument being duly
qualified according to law, do depose and say that we were present and saw Testator sign and
execute the instrument as his LAST WILL; that JOHN J. TAMALAVAGE, SR. signed
willingly and that he executed it as his free and voluntary act for the purposes therein
expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses;
and that to the best of our knowledge, the Testator was at the time 18 years of age or more, of
sound mind and under no constraint or undue inflUm~~
H1M-hvL Rd\hQ.J\.mill-
~ittlement Statement
U.s. Department of Housing
and Urban Development
.......
,r
OMS Approval No. 2502-0265
B. Type of Loan
O 0 0 6. File Number
1. FHA 2. FmHA 3. Conv. Unlns.
4. 0 VA 5. 0 Conv. Ins.
7. loan Number
8. Mortgage Insurance Case Number
c. Note: This form is furnished to give you a statement of actual seUlement costs. Amounts paid to and by the settlement agent are
shown. Items marked "(p.o.c.)" were paid outside closing; they are shown here for informational purposes and not
included in the totals.
D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender
RANDALLJ.MARBURGER MILDRED M. TAMALAVAGE JP MORGAN CHASE BANK NA
P. DIANE MARBURGER
319 RAIVLE DRIVE 802 COCKLIN STREET 512 TOWNSHIP LINE ROAD
DUNCANSVILLE PA 16635 MECHANICSBURG PA 17055 BLUE BELL PA 19422
G. Property Locellon H. Selllement Agent
TAX PARCEL NO. 17..24..0791..048 MURREL R. WALTERS III ESQUIRE
802 COCKLIN STREET Place of Salllement I. SelUemenl Data
MECHANICSBURG PA 17055 54 EAST MAIN STREET 10/27/2005
MECHANICSBURG PA 17055 Disbursement Dale
Lot: 5 Block: NO. 3 10/27/2005
J. Summary of Borrower's Transaction
100 Gross Amount Due From Borrower
K. Summary of Seller's Transaction
400. Gross Amount Due To Seller
101. Contract sales price 180,000.00 401. Contract sales price 180,000.00
102. Personal property 402. Personal property
103. Settlement charaes to borrower (line 1400) 5,292.79 403.
104. 404.
105. 405.
Adjustments for Items paid by seller In advance Adlustments for Items paid by seller In advance
106. Cltv/lown taxes to 406. Cltv/town taxes to
107. County taxes 10/27/2006 12/31/2005 127.15 407. County taxes 10/27/200612/31/2005 127.15
108. Assessments to 408. Assessments to
109. SCHOOL 10/27/2006 6/30/2006 1,398.06 409. SCHOOL 10/27/2006 6/30/2006 1,398.06
110. SEWER 10/27/200612/31/2005 81.69 410. SEWER 1 0/27/20QG 12/31/2005 81.69
111. to 411. to
112. to 412. to
113. to 413. to
114. to 414. to
115. to 415. to
120. Gross Amount Due From Borrower 186,899.69 1420. Gross Amount Due To Seller 181,606.90
200 A
P Id
I B h
mounts a Bv Or n e alf Of Borrower 500. ReducUons In Amount Due To Seller
201. Deposit or earnest money 3,000.00 501. Excess deposit (see Instructions)
202. Principal amount of new loan( s) 144,000.00 502. Settlement charges to seller (line 1400) 12,847.00
203. Exlstina loan(s) taken subject to 503. Exlstlna loan(s) taken sublect to
204. 504. Payoff of first mortaaae loan
205. 505. Payoff of second mortgage loan
206. 506.
207. 507.
208. 508.
209. 509.
Adjustments for Items unpaid by seller Adjustments for Items unpaid by seller
210. Cltv/town taxes to 510. Cltv/town taxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. to 513. to
214. to 514. to
215. to 515. to
216. to 516. to
217. to 517. to
218. to 518. to
219. to 519. to
220. Total Paid By/For Borrower 147,000.00 520. Total Reduction Amount Due Seller 12,847.00
300. Cash At Settlement FromlTo Borrower
600. Cash At Settlement TolFrom SAIIAr
.... ...
.Iettlemant Charges
dO. Total Sales/Broker's Commission based on price $ 180,000.00 @ 8.00 0/. I:; 10,800.00 Paid From Paid From
Division of Commission (line 700) as follows: Borrower's Seller's
701. $ 5,425.00 to RE/MAX REALTY ASSOCIATES, INC. Funds At Funds At
Settlement Settlement
702. $ 5,375.00 to JACK GAUGHEN/ERA
703. Commission paid at Settlement 10,800.00
704. TRANSACTION FEE TO ERA/NRT, INC. (BUYER); RE/MAX REALTY (SELLER) 125.00 125.00
800. Items Payable In Connection With Loan
801. Loan Orlainatlon Fee 144,000.00 %
802. Loan Discount 144,000.00 %
803. Appraisal Fee to SELLARS APPRAISALS 300.00
804. Credit Report to KTCN 1.35
805. Lender's Inspection Fee
806. Mortgage Insurance Application Fee to
807. Assumotion Fee
808. TAX SERVICE CONTRACT fEI! FIRST AMERICAN REAL ESTATE TAX sve 69.00
809. PROCESSING FEE JP CHASE MORGAN 195.00
810. FLOOD CERTifiCATION FEE JP CHASE MORGAN 18.00
811.
812.
813.
900. Items Reaulred By Lender To Be Paid In Advance Exclude last day In cales ~ line 901
901. Interest from 10/27/2005 to 10/31/2005 (d}$ 24.16 / day 120.80
902. Mortgage Insurance Premium for months to
903. Hazard Insurance Premium for 1 YR years to ($466.00 P.O.C.)
904. years to r
905. I
1000. Reserves Deposited With Lender
1001. Hazard insurance 3
9
months
months
months
months
months
months
38.83 116.49
59.50 535.50
ar month
176.39 ar month 881.95
ar month
-626.30
1006. SCHOOL TAXES 5
1007.
1008. A
1 h
100. Title C arges
1101. Settlement or closing fee to
1102. Abstract or title search to
1103. Title examination to
1104. Title Insurance binder to
1105. Document preparation to RE/MAX REAL TY ASSOCIATES. PREP DEED 100.00
1106. Notary fees to CASH 10.00 5.00
1107. Attorney's fees to
(Includes above Items numbers: )
1108. Title Insurance to MURREL R. WALTERS III, ESQUIRE 1,298.00
(Includes above Items numbers: 1101-1104, 1108 PENN ATTORNEYS TITLE INS. co. )
1109. Lender's coverage $ 144,000.00 ENDORS. 100, 300 & 8.1
1110. Owner's coverage $ 180,000.00
1111.
1112.
1113. CLOSING PROTECTION LETTER 35.00
1200 G
tR
dJ
dT
overnmen Geor ng an rans er Charaes
1201. Recording fees: Deed $ 38.50 ; Mortgaae $ 64.50 ; Releases $ 103.00
1202. Cltv/county tax/stamps: Deed $ 1,800.00 ; MortQaga $ 1,800.00
1203. State tax/stamps: Deed $ 1,800.00 ; Mortgage $ 1,800.00
1204.
1205. RECORD POWER OF ATTORNEY 17.00
ona e amant arges
1301. Survey to
1302. Pest Inspection to
1303.
'.
1304. HOME INSPECTION - AK VENTURES 290.00
1305.
1300 Addltl I S ttl Ch
1~()R
. '.
000-000-00000
JAN 20,2006 04:48
page 2
Midulel J. Malpew, Owner · Jerem, J. Shal'tl.er. I'untral Director
8 Market Plaza Way · Mechani.c,f;b",rg, PA 17055 · Phone: (711) 697-4696
^ugust 7~ 2005
Mrs. Mildred M. Tamalavage
802 Cocklin Street
Mechanicsburg~ PA 17055
The FLlflCr'al Service for John J. Tamalavag~ Sr.
We sincerely apprcciate the confidence you have placed in u~ and will continue to a..;sist you in every way we can.
feel free to contact liS if you h4ivC any questions in regard to this ~l8t.cmcnt.
nIl:: FOI,LOWIN(j IS ^N ITF,MI7.ED s'rATEMI~NT or TJ IE SER VICt,~S. FACIU'l'lES. Al1T()MOTIVr rOl HPMLN'L
AND MERCIIANDISE THAT V01J SPI.F.CTbD WilEN MAKIN(j TilE FUNERAL ARRANClEMENTS.
I. PROFESSIONAL SF.RVICf,s
Services of Funel'al Direclor/Sta.lT
3. AlITOMOTIVE EQIJlrMENT
I ,im~)usine
FlINERAL ttOMK Sl!:ltVICF. CIIARGF:S
Sr.Lf~C'I'[l) MERCHANDISE:
Oal, Cilsl..~t
Grave LilleJ'
100 Additional Thank)'l)U Card~
Register. Memorial Cards. Ackll.
100 Addilionnl Pnly(,.~r CClHis
Oak [-hr, c. a:-i~
THF. C.OST OF OIJR SF.RVICf,S, .~QlllI'MJ::NT~ AND MERCHANDISIL TIIA T YOll "AVE SELECTED
AT THl:: TIME FUNJ::RAL ARRANOEMENTS WERE MAnE. WE AnV ANCI':I) CU'UAIN PA YMENTS TO OTHERS ^S AN
ACCOMMOOATION. THE FOLLOWING IS AN ACCOlJNTlNG FOR TIIOSE CHARGES.
CASH ADVANCES
Cemetery Equipment
Cl;rtificd nt~Hlh Ccrtitkatcs
Ncw:-irmp~r Nol,i(:l,:s - P~ltri,H
NeWSpiLpl:r Nn1.icc~ - Po\.lsvilk
Clcrgy/Ma..",s Oftet'jnp,
Orgttn1!)t
Mililul)' J ImHlr (i\llud
fh'lw(:J's
TOTAL CASH AOVANCF.S AND SPECIAL CHAltGES
Sl m-TOTA I,
INITIAl. PAYMeNT / lJlSCOtJNT I CREDITS
TOTAL AMOliNT DUE
Please
$3545.00
, $285.00
$3830.00
$25b5.00
SMO.OO
$14.00
$45.00
$23.0U
$95.00
$7112.00
$ , 10.00
$60.00
$264.00
$1 :l 5 ,00
$100.00
$100.00
$lOU.OO
$371.00
$ I 240.00
S8452.00
S8452.00
www..n.alpezz~funeralhome.com.
· ~ Kelley Blue Book - Trade-In Pricing Report - Chevrolet, Malibu
8~r!!oIle~
ad'Jertisernent
2003 Chevrolet Malibu LS Sedan 40
BLUE BOOK9 TRADE-IN VALUE
Condition
Value
Excellent
$7,350
-.I Good
(Selected)
$6,825
Fair
$5,940
Vehicle Details
Engine:
Transmission:
Drivetrain:
Mileage:
V6 3.1 Liter
Automatic
FWD
7,000
Selected Standard Equipment
Air Conditioning Tilt Wheel
Power Steering Cruise Control
Power Windows AM/FM Stereo
Power Door Locks Single Compact Disc
Selected Optional Equipment
Rear Spoiler
Dual Front Air Bags
ABS (4-Wheel)
Power Seat
Alloy Wheels
Blue Book Trade -In Value
Trade-in Value is what consumers can expect to receive from a dealer for a
trade-in vehicle assuming an accurate appraisal of condition. This value will
likely be less than the Private Party Value because the reselling dealer incurs
the cost of safety inspections, reconditioning and other costs of doing
business.
Vehicle Condition Ratings
Excellent
~ $7,350
"Excellent" condition means that the vehicle looks new, IS in excellent
mechanical condition and needs no reconditioning. This vehicle has
never had any paint or body work and is free of rust. The vehicle has a
clean title history and will pass a smog and safety inspection. The
engine compartment is clean, with no fluid leaks and is free of any wear
or visible defects. The vehicle also has complete and venfiable service
records. Less than 5% of all used vehicles fall into this category,
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C Lief>' HEF.E TO LEMF,t~ t1C.F;E
-
RE~'-1500 EX + (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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TAMALAVAGE JOHN J. SR.
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Year)
OFFICIAL USE ONLY
FILE NUMBER
21 -05 00676
COUNTYCOOE --YEA~ - - NUMBER- -
SOCIAL SECURITY NUMBER
1 9 4 - 1 2 - 6 3 6 5
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
- l4'B2-
07/19/2005 06/23/1924
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
D 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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COMPLETE MAILING ADDRESS
101S.MARKETSTREET
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PA 1105 J'?
0.00 X _ (15) 0.00
0.00 X _ (16) 0.00
0.00 X .12 (17) 0.00
0.00 X .15 (18) 0.00
(19) 0.00
TAMALAVAGE MILDRED M.
[X] 1. Original Return
D 4. Limited Estate
00 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12-12-82)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrust)
D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
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NAME
R. MARK THOMAS ESQ.
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717-796-2100
MECHANICSBURG
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non.Probate Property (7)
(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)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
r::)
\...,:>
374,035.68
(8)
374,035.68
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
10,361.00
(11 )
(12)
(13)
10,361.00
363,674.68
(14)
363,674.68
.
D
d t' C
I t Add
ece en s ampl e e ress:
STREET ADDRESS
802 COCKLIN STREET
CITY I STATE I ZIP
MECHANIC5BURG PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
0.00
Total Credits (A + 8 + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
Make Check to: REGISTER OF AGENT
0.00
0.00
0.00
0.00
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; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ................. ................................................................. .................... 0 lKJ
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?....... ..... ............ .......................... ....... ... .................. ................ 0 00
3. Did decedent own an Min trust for" or payable upon death bank account or security at his or her death? ................. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... 0 00
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 declare that I have examined this retum, includinQ 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 alllOformation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR Fill RETURN DATE
2/7/2006
ADDRESS 528 MAPLE STREET
POTTSVILLE
SIGNATURE OF PREPARER OTHER THAN REPRESE
ADDRESS
1015. MARKET STREET
PA 17901
DATE
217/2006
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. 99116 (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 0% [72 P.S. 99116(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. 99116(1.2) [72 P.S. ~9116(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. ~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.