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Home My WebLink About06-27-06 RE\150GEX \5-JO; COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 W I- ~~Ul uO::':: wc..u :I:oo uO:..J c..aJ c.. <( to- Z W o W U w o DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL) Siodlowski, Aaron J. FILE NUMBER d'-- C ~ COUNTY CODE YEAR i SOCIAL SECURITY NUMBER ! 205-68-5377 {-: r- (yIL --- - NUMBER INHERITANCE TAX RETURN RESIDENT DECEDENT -----+----~---~-------- --TDATE OF-BIRTH(MM-DD-YEAR)-~ 102/24/1985 DATE OF DEATH (MM-DD-YEAR) 06/18/2005 , THIS RETURN MUST BE FILED IN DUPLICATE WITH THE I REGISTER OF WILLS ._-_.-~---+--_._~-_...._---~_._-----------_.~ i SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) ~] 1. Original Return [] 4. Limited Estate [] 6. Decedent Died Testate (Atta" copy 01 Wi!!) [] 9. litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise Idate 01 dealh after 12.12.82) D 7. Decedent Maintained a Living Trust (Attach copy at TrusI) D 10. Spousal Poverty Credit (date of dealo ae'ween 12-31.91 aod 1.1.95) D 3. Remainder Return Ida'e 01 dealn DIIC':O D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) IMach Sch I- Z W C Z o c.. Ul W 0: 0: o U HilS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME P. Ri~~ard VVagn~'. ES~Llir~_______~ _~_~___~ Fi1~M NAME (If ApPIICaDtei Mancke, Wagner & Spreha TETI:-PH6NE-NU~rBER ------..---,-- -~---~-- ------,--------~----.---~-- (717) 234-7051 I COMPLETE MAILING ADDRESS 2233 North Front Street Harrisburg, PA 17110 1. Reai Estate (Schedule A) 2. Stocks and Bonds (Schedule B) ,'. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) S. Cash, Bank Deposits & Miscellaneous Personal Property Z (Schedule E) 0 6. Jointly Owned Property (Schedule F) ~ D Separate Billing Requested .J ::l l. Inter-Vivos Transfers & Miscellaneous Non-Probate Property to- (Schedule G or L) a.. <( B. Total Gross Assets (total Lines 1-7) U 9. Funeral Expenses & Administrative Costs (Schedule H) W c::: 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) (1) 0.00 (2\ 0.00 (3) 0.00 (4) 0.00 (5) 345,833.34 (6) (7) 345,833.24 (9) (10) (8) 21,992.18 2,062.00 (11) (12) (13) 24,054.18 321,779.06 13. Chantable and Governmental Bequests/See 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) (14) 321,779.06 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::l a.. :E o U X ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) 321,779.06 X.o 45 (16) 14.480.06 16 Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18 Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 2.0 D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS _L<ill2r~SS tlgH9':N Roa~_~____~_____~__________~__ .---~----------_...- --~-----------'------~-----~----r--~--~--' T CITY E I STATE ~------ zW'---- no a PA 17025 Tax Payments and Credits: 1. Tax DUI, (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 14,480.06 3,000.00 Total Credits ( A + B + C ) (2) 3,000.00 3. Interest/Penalty If applicable D. Interest E. Penalty 4. TotallnterestiPenalty ( 0 + E ) If Line:Z 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 (3) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (4) (5) (5A) (5B) 11.480.06 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 11.480.06 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:.... .... ................................. .. .............. ................. 0 [K] b. retain the right to designate who shall use the property transferred or its income; ................. ... .. .......... 0 [K] c. retain a reversionary interest: or..................... .. ................... ..... 0 [K] d. receive the promise for life of either payments. benefits or care? .. .............. .. ......... 0 [K] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................. 0 [K] 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 whicf', contains a beneficiary designation? 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 declare that I have examined thiS return. including ac panying schedules and statements, and to the best of my knowledge and belief. It is true, correct and complete. rmation of which preparer has any knowledge. ~/,kzt:) R!)~ro ,/ b/.e~,q- , DATE / . f;? . xl! v tJ? /, (/77 1;b2'S- 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 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 still applicable even if the survivin'g 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. REV-15CiSEX+(6-9S) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER ESTATE OF Siodlowski, Aaron J. ITEM NUMBER 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. DESCRIPTION VALUE AT DATE OF DEATH 1 . Settlement from automobile accident - All State 66,666.67 The decedent was in an automobile accident on 6/16/05 that resulted in a claim against the operator of the motor vehicle and the receipt of gross proceeds of $100,000.00, less legal fees and costs, resulting in net proceeds of $66,666.67, confirmed by the Honorable Judge Hess, Court of Common Pleas of Cumberland County, Pennsylvania, at No. 00698 Orphans' Court Division, 2005, in an Order dated 1/9/06. 2. Settlement from underinsured motorist claim - State Farm 266,666.67 The underinsured motorist claim resulted in gross proceeds of $400,000.00, which, after legal fees and costs were paid, netted the estate $266,666.67, which was approved by the Honorable Judge Hess in a Court Order dated 4/5/06, at No. 00698 Orphans' Court Division, 2005, Court of Common Pleas of Cumberland County. 3. State Farm Accidental Death and Funeral Benefits 12.500.00 TOTAL (Also enter on line 5, Recapitulation) $ 345,833.34 (If more space is needed, insert additional sheets of the same size) REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Siodlowski, Aaron J. FILE NUMBER ITEM NUMBER 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. DESCRIPTION VALUE AT DATE OF DEATH 1 . Settlement from automobile accident - All State 66,666.67 2. Settlement from Uniderinsured Motorist Claim - State Farm 266.66667 3. State Farm Accidental Death and Funeral Benefits 12,500.00 TOTAL (Also enter on line 5, Recapitulation) $ 345.833.34 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Siodlowski, Aaron J. FILE NUMBER Debts of decedent must be reported on Schedule 1. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Richardson Funeral Home, Inc. 2. Church Funeral Expenses 3. Catholic Cemeteries 2.86400 300.00 1,300.00 B. ADMINISTRATIVE COSTS 1. Personal Representative's Commissions Name of Personal Representative(s) Robert J. Siodlowski Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 7 Cypress Hollow Road 16.666.67 City Enola Year(s) Commission Paid: 2006 State P A Zip 17025 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State .Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Register of Wills 8. Register of Wills 9. Advertising Fees 10. Transportation Fees 74.00 15.00 19751 575.00 TOTAL (Also enter on line 9, Recapitulation) $ 21,992.18 (If more space is needed, insert additional sheets of the same size) REV.1512 EX+ (12-03) SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Siodlowski, Aaron J. Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. FILE NUMBER ITEM NUMBER DESCRIPTION 1 West Shore EMS VALUE AT DATE OF DEATH 616.00 2. Hershey Medical Center 1,446.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,062.00