HomeMy WebLinkAbout07-03-06 (2)
REV-1500 EX + (6-00)
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OFFICIAL USE ONLY
COMMONWEAL TH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
1071
NUMBER
FILE NUMBER
II 05
COVNIY_QQ~~. _YEAR
SOCIAL SECURITY NUMBER
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
i Zigner, Irene M.
iDATE()F DEATH (MM-OO:-YEAR) i-DATE OF BIRTH (MM~DD-YEAR)
10-03-2005 ! 10-04-1934
((IF APPLlCABLE)SURVIVING SPOUSE-SNAME (LAST~-FIRST AND MIDDLE INITIAL)
Zigner, Marlin
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
164-26-8237
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
Xl. Original Return
2. Supplemental Return
3. Remainder Return (date of death prior to 12-13-82)
I I 4. Limited Estate
X 6. Decedent Died Testate (Attach
copy of Will)
9. Litigation Proceeds Received
4a. Future Interest Compromise (date of death after
12-12-82)
7 Decedent Maintained a Living Trust (Attach
copy of Trust)
1 o. ;>f-~~_~~I (date of death between
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
....
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11. Election to tax under Sec. 9113(A) (Attach Sch 0)
Marielle F Hazen
FIRM NAME (If applicable)
Marielle F. Hazen
2000 Linglestown Road, Suite 202
Harrisburg, PA 17110
TELEPHONE NUMBER
717-540-4332
1. Real Estate (Schedule A)
(1 )
OFFICIAL-'USE ONLY
None
1,584.00
None
None
12,628.79
None
None
(8)
6,406.87
19.00
14,212.79
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(5)
(6)
(7)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
(11 )
6,425.87
7,786.92
12. Net Value of Estate (Line 8 minus Line 11)
(12)
13. Charitable 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)
(13)
None
(14)
7,786.92
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, 7,786.92 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
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0 .045 (16)
i= 16. Amount of Line 14 taxable at lineal rate 0.00 x
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Q. 17.Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0
0 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
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~ 19. Tax Due (19)
0.00
0.00
0.00
0.00
0.00
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00;
Decedent's Complete Address:
STREET ADDRESS
4414 Royal Oak Road
CITY 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 )
0.00
0.00
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
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
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5) 0.00
(5A)
(5B) 0.00
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;. ............... ............................. x
b. retain the right to designate who shall use the property transferred or its income;.......... ............... x
c. retain a reversionary interest; or............................................................................................ ..................... x
d. receive the promise for life of either payments, benefits or care?.................................................... x
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.. ........................................................... ......................................... x
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?..................................................................................................................... x
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 penallles 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
comPlet-a. Declaratjonot.E~epar13~ <?ther than the pars_cnal representative is based on all infonnation of which preparer has any knowledge
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Gal L. Zigner ~
SI~~;Z-F~R~OR FILING RETlJRN ADDRESS
x
DATE
4414 Royal Oak Road
Camp Hill, PA 17011
6'; Z. 9/...7 G
DATE
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SIGNA.rtRE OF~EPA ER'd-rHER THAN REPRESENTATIVE
Malrielle F Hazen
ADDRESS
Ie(-
DATE
2000 Linglestown Road, Suite 202
Harrisburg, PA 17110
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. 99116 (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 PS 99116 (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. 99116 (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-15~'3 EX+ (6-98)
.
SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Zigner, Irene M.
FILE NUMBER
21-05-1071
ESTAn: OF
All property jolntly-owned with right of survivorship must be disclosed on Schedule F.
ITEM CUSIP VALUE AT DATE
NUMBEIR NUMBER DESCRIPTION UNIT VALUE OF DEATH
1 32 shares of Metlife - Stock 49.50 1.584.00
TOTAL (Also enter on Line 2, Recapitulation) 1.584.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule B (Rev. 6-98)
Rev.1508 EJ(+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Zigner, Irene M.
FILE NUMBER
21-05-1071
ESTATE OF
Include the proceeds of litigation and the date the proceeds were received by the estate
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Metlife - Dividend
VALUE AT DATE
OF DEATH
16.64
2 Community Bank - #1712417530 Proceeds
12.415.09
Accrued interest on Item 2 through date of death
178.90
3
West Shore Pathology - Refund
18.16
TOTAL (Also enter on Line 5, Recapitulation)
12,628.79
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
REV-11S1 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE: OF
Zigner, Irene M.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-05-1071
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 5,412.23
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees 710.64
See continuation schedule(s) attached
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 100.00
See continuation schedule(s) attached
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 184.00
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 6,406.87
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
Rev-1502 E)(+ (6-98)
*'
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Zigner, Irene M.
FILE NUMBER
21-05-1071
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Dimon Funeral Homes, Inc.
5.243.00
2
Farmer's Wife Rest. - Funeral Reception
169.23
Subtotal
5,412.23
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
Rev-1502 E,X+ (6-98)
SCHEDULE H-B2
ATTORNEY'S FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Zigner, Irene M.
FILE NUMBER
21-05-1071
ESTATE OF
ITEM
NUMBI=R
DESCRIPTION
AMOUNT
1
Marielle F. Hazen - Legal Fees
710.64
Subtotal
710.64
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
Rev-1502 EX+ (6-98)
*'
SCHEDULE H-B4
PROBATE FEES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Zigner, Irene M.
FILE NUMBER
21-05-1071
ITEM
NUMBI:,R
DESCRIPTION
AMOUNT
1
Register of Wills - Probate Filing Fee
84.00
2
Register of Wills - Short Certificates
16.00
Subtotal
100.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B4 (Rev. 6-98)
Rev-1502 E)(+ (6-98)
*'
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Zigner, Irene M.
FILE NUMBER
21-05-1071
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Central Penn - Legal Publication
109.00
2
Cumberland Law Journal - Legal Publication
75.00
Subtotal
184.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
Rev-1512 EJC+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Zigner, Irene M.
FILE NUMBER
21-05-1071
ESTATE OF
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 PA Dept. of Revenue -Income Tax
VALUE AT DATE
OF DEATH
19.00
TOTAL (Also enter on Line 10, Recapitulation)
19.00
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REV-1513 EK+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
NUMBER
Zigner, Irene M.
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal
distributions, and transfers
under Sec. 9116(a)(1.2)]
FILE NUMBER
21-05-1071
ESTATE OF
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
I.
Marlin Zigner
4414 Royal Oak Road
Camp Hill, PA 17011
Spouse
100%
Total
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule J (Rev. 6-98)
LAST WILL AND TESTAMENT
I, IRENE M. ZIGNER, of the Township of Porter, County of
Schuylkill and Commonwealth of Pennsylvania, being of sound mind,
memory and understanding, do make, publish and declare this to be
my Last will and Testament, hereby revoking all Wills and Codicils
heretofore made by me.
FIRST: I direct that my funeral be conducted in a manner
corresponding with my estate and situation in life, and that all
my just debts and funeral expenses be fully paid and satisfied as
soon as conveniently may be done after my decease.
SECOND: I glve, devise and bequeath the whole of my estate,
both real and personal, of whatsoever nature or kind, wheresoever
the same may be situate, to my beloved husband, MARLIN M. ZIGNER,
if he survives me. In the event that my husband, the aforesaid
~~RLIN M. ZIGNER, shall fail to survive me, or that our deaths
should occur simultaneously or in the same cornmon accident or
calamity, then I make the following disposition of my aforesaid
estate:
A. I glve and devise to my beloved son, GARY L. ZIGNER, if
he shall survive me, my residence commonly known as 406
Wiconisco Avenue, Tower City, Pennsylvania, and all
-Page 1 of 3 pages-
rights, easements and appurtenances thereto, for his
own use during his lifetime, so long as he shall use
same for his primary residence, without bond or lia-
bility for waste; provided, however, that my son, the
aforesaid GARY L. ZIGNER, shall keep said real estate
and the buildings thereon adequately insured against
loss or damage by fire or otherwise, shall pay all
premiums and all taxes assessed again3~ said property,
and shall maintain same in good condition and repair.
Upon the death of my son, the aforesaid GARY L. ZIGNER,
or in the event he shall cease to use aforesaid real
estate as his primary residence, I direct that said
real property shall become part of my residuary estate
and be distributed as hereinafter provided.
B. All the rest, residue and remainder of my estate, both
real and personal, of whatsoever nature or kind, where-
soever the same may be situate, I give, devise and
bequeath, in equal shares, unto my beloved children,
GARY L. ZIGNER and LORI A. ZIGNER, their heirs and
assigns forever.
FOURTH:
I direct that no Executor hereinafter named shall be
required to give any Bond, and that if notwithstanding this direc-
tion, any Bond is required by any law, statute or rule of Court,
no sureties be required thereon.
-Page 2 of 3 pages-
FIFTH: I nominate, constitute and appoint my husband, ~~RLIN
M. ZIGNER, as Executor of this my Will. If my husband, the afore-
said MARLIN M. ZIGNER, lS unable or unwilling to act or continue
as Executor for any reason whatsoever, and whether before or after
my death, then I appoint my beloved children, GARY L. ZIGNER and
LORI A. ZIGNER, and/or the survivor or surVlvors of them, as the
case may be, as Executors under this my Will.
IN WITNESS WHEREOF, I, IRENE M. ZIGNER, the Testatrix, have
to this my Will written on three (3) sheets of paper, set my hand
and seal this
" .
/"-1,1-/; day of July, A. D., One Thousand Nine Hundred
and Ninety-Three (1993).
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(SEAL)
SIGNED, SEALED, PUBLISHED and DECLARED by the above-named
IRENE M. ZIGNER, as and for her Last Will and Testament, in the
presence of us, who have hereunto subscribed our names at her
request as Witnesses thereto, in the presence of the said Testa-
trix and of each other.
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-Page 3 of 3 pages-