HomeMy WebLinkAbout09-29-06
,~
15056051047
REV.1500 EX (06~5)
PA Department of Revenue .
Bureau of Individual Taxes .
PO BOX 280601
Harrisbu ,PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONLY
County Code Year
File Number
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Date of Birth
Suffix Decedent's First Name MI
OJ] III
(If AppUcable) Enter Surviving Spouse's Infonnatlon Below
Spouse's Last Name
Suffix Spouse's First Name MI
OJ] 0
THIS RETURN MUST BE FILED IN DUPUCATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
- 1. Original Return c:::;) 2. Supplemental Return c:::;) 3. Remainder Return (date of death
prior to 12-13-82)
C) 4. Limited Estate C) C) 5. Federal Estate Tax Return Required
C) 6. Decedent Died Testate C) () 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will)
C) 9. Litigation. Proceeds Received C) C) 11. Election to tax under Sec. 9113(A)
-
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Correspondenfs e-mail address:
Under penalties of peIjury. I declare that I have examined this retum, i
it is true. correct Md complete. Declaration of preparer other than
SIGNA lURE OF PERSON RESPONSIBLE FOR FILING RETU
ADDRESS
nyIng schedUles and statements, and 10 the best of my knowledge and belief,
sed on all information of which preparer has any knowledge.
ATE
1- (.H
HOD~
:nVE
PA
I ? ., 19
{J~ ~. ~4~
PLEASE USE ORIGINAL FORM 0
DATE /
. -6'f:'
Pit {7DSS-
Side 1
L
15056051047
15056051047
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.-J
REV-1500 EX
Decedent's Name:
RECAPITULATION
15056052048
1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . ., 5.
6. Jointly awned Property (Schedule F) t::::) Separate Billing Requested. . . . . ., 6.
7. Inter-Vivos Transfers & MiScellaneous Non-Probate Property
(Schedule G) t::::) Separate Billing Requested.. . . . . ., 7.
8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ., 8.
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). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
Decedent's Social Security Number
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) . . . . . . . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . . . . 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate. or
transfers under See. 9116
(a}(1.2) X .O!L
16. Amount of Line 14 taxable
at lineal rate X.O tr
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
I r.
20. FILL IN THE OVAL IF YOU ARE REQUESTINGAREFUNQ OF AN OVERPAYMENT
C=>
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15056052048
Side 2
15056052048
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REV-1500 EX Page 3
File Number
Decedent's Complete Address:
OECEOEN E
rn--1-E- D rJ ]) L E B 0
/tj'b!P mJ'fPLE S-T
STREET ADDRESS
CITY
STATE
EW
Cum ERt....J4-rJD
Tax Payments and Credits:
1. Tax Due (Page 2 Une 19) (1)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
/ /, t-/7'-hc.33
Total Credits ( A + B + C ) (2)
tJ
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E )
4. If Une 2 is greater than Line 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, 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.
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 B'
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 [B'"
c. retain a reversionary interest; or.......................................................................................................................... 0 B'
d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 G"
2. If death occurred after December 12. 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 g-
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 G1'
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................................................................................................................ 0 \Jdi
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) (i)l.
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 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 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 (0) 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. ~9116(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 twelve (12) percent [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.
. REV-l"" ox. <....
'COMMONWEALTH OF PENNSYLVANIA
.. - INHERITANCE TAX RETURN
1 RESIDENT DECEDENT
ESTATE OF FILE NUMBER
m '/ RON 7J t 6:. B 0 . ~ DO (p - 00 0\ ~,~
All rtII propertV owned IOIIIy or .. . IInInt In common must be reported It fair marUt value. Fair mart<et value is defined as !he price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, boIh having reasonable knowledge of !he relevant facts.
... property which IlIoIntJy.owned with right of IUI'VIvorIhIp must be dIICIoIecI on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
~1/1- STofl..Y FRAmE ])(JELL IrJG
~ LJ m It IfJ ST S 1-1 IRE mR tJST D UJ/J (JI/ 1701/
t.,um73cRLfl-Nj) CtJ TA'I ASSESSmENt
f<fcoR.])$" I-ofc
. 7~, 7.~ -
TOTAL (Also enter on line 1, Recapitulation) $
(If more space Is needed, IIl88I1 addltional sheets of !he same size)
~t. 7~11:-
-,,....<
. .
REV-1504 EX+ (6-98.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
ESTATE OF FIlE NUMBER
rn Y RD;J -.J) LE.En ctOO&, - Dt>D,- ~.3
Schedule C-1 or C-2 ~ncIuding aI suppcring information) must be attached for each cIoseIy.f1eld corporationIpartnefshIp Interest of lhe decedent, olher than a
soIe-proprietor. See insIructIons for the suppOl1Ing information to be submItt8d for soIe-proprietorships.
ITEM NUMBER
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
1-{6NSLE'/ :BROA])CAStING IN~
~ W m A I AI ~T SH1REmifNST6 w AI fJR
RADIO STAT (o^' WUJ1.l (f:lmJ
FAIR. mAR-KET EVALUATION 9-1-06
t/{)~ f!} tJ o. -
TOTAL (Also enter on line 3, Recapitulation) $
(If more spac:e Is needed. insert additional sheets of the same size)
405', I')/)m -
. .
REV-1S05 EX+ I.....
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE C-'
CLOSELY~HELD CORPORATE
STOCK INFORMATION REPORT
ESTATE OF
m V f<ON -D L E,R{)
I
1. Name of Corporation U ENS L E 'I
Address >l lU m A IN ~T
City SJ-l I R.EffJAM<;TO u.J N
FILE NUMBER
cloo!P
R 1( 0 A D c A-ST / tJ ~ / III ~te on Incorporation
-0 ~413
(JA
Date of Incorporation ....~ - I 0 - I q 8" 1
State-1A Zip Code / 7 C> / I Total Number of Shareholders CA.
2. Federal Employer 1.0. Number
3. Type of Business R A..D I c. STA riD N
Business Reporting Year
LV t.U.1! (ft M) ProducVService ~ A DID Com m u All CAT I 0 tV
4.
":~::~,' , . ~ . 'toTAL .,.UIIBER Of.,' . ' PAR V
~.u, '~$ OUTSTANDI,.G " . .
, . '",' "'-NU"8Ek'OFi~.:" ,.
':~18VTtlE'~
Common
-----
'II () --
b __SQfL
_~O{)
rJ.. \. ") ()
'-,.";:: -:}-:,-_",,',",.:'.;:vAL~-~/~?;'~:/i;~,;ifX,,'~;'-:;~::-.;~
',",'l)E~$-;~;-"','?"
$__~QSJ () () () -::
$
Preferred
Provide all rights and restrictions pretaining to each class of stock.
5. Was the decedent employed by the Corporation? ................................. ~ Yes 0 No
If yes, Position G 6'" . mAN AGE R Annual SalalY $ J... i . S 08:).- Time Devoted to Business So 70
6. Was the Corporation indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0 Yes ~ No
If yes, provide amount of indebtedness $
7. Was there life insurance payable to the corporation upon the death of the decedent? ..... IX Yes 0 No
If yes, Cash Surrender Value $ Net proceeds payable $ ...5' O} 0 0 O~ -
Owner of the policy HEN5l..f>{ i3RDADCA5TI tJ6
8. Old the decedent sell or transfer an stock in this company within one year prior to death or within two years
if the date of death was prior to 12-31-82?
o Yes a(No If yes, 0 Transfer 0 Sale
Transferee or Purchaser
Attach a separate sheet for additional transfers and/or sales.
Number of Shares
Consideration $
Date
9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....0 Yes ~ No
If yes, provide a copy of the agreement.
10. Was the decedent's stock sold? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 0 Yes ;r No
If yes, provide a copy of the agreement of sale, etc.
11. Was the corporation dissolved or liquidated after the decedent's death? .................... 0 Yes or No
If yes. provide a breakdown of distributions received by the estate, including dates and amounts received.
12. Did the corporation have an interest in other corporations or partnerships? ............. 0 Yes ~o
If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest.
THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDUL E
A. Detailed calculations used in the valuation of the decedent's stock.
B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years.
C. If the corporation owned real estate, submit a 6st showing the complete address/es and estimated fair market value/s. If real estate appraisals have
been secured, attach copies.
D. Ust of principal stockholders at the date of death, number of shares helcl and their relationship to the decedent.
E. Ust of officers, their salaries, bonuses and any other benefits received from the corporation.
F. Statement of dividends paid each year. Ust those declared and unpaid.
G. Any other information relating to the valuation of the decedent's stock.
(If more space Is needed, insert additional sheets of the same size)
. .
MYRON D LEBO FILE #2006-00033
P A REV 1500 SCHEDULE C - 1
A CORPORATION JOINTL Y OWNED BY MYRON LEBO AND CARL KUEHN II
EACH OWNER HAS 250 SHARES, FAIR MARKET EVALUATION IS
810,000. PREPARED BY GREEN MANAGEMENT INC AS OF 09/0112005.
B COPIES ATTACHED
C CORPORATION OWNED NO REAL ESTATE
D MYRON LEBO 250 SHARES DECEDENT
CAR; KUEHN II 250 SHARES CO-OWNER
E NO OFFICERS
F NO DIVIDENDS DECLARED OR PAID
> """"'"
. .
REV-1508 EX.. (8-98)
'*'
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
CASH, 8ANK DEPOSITS, & MISC.
PERSONAL PROPERTY
IY1 Y RON _D LEBo
Include the proceeds of IItlgation and tile date the proceeds were received by the estate,
AU property jointIy-owned with right of .urvlvorship m..t be ditc:IoMd on SChld.. F.
FILE NUMBER
4.oo~ - boo,:?3
ESTATE OF
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
I.
mAS S YYI UTU A L A !\iN () IT \{ :J:I 10j..3 00 rJ--
L{I j 7 7 ~. -
~.
Co rn rYl ERe E :B A rJ k C kG f-l c c:li b 0..3;;J., 0 10 () 7 ()
/1, off.,
~,
C ITiGRoufJ .smiTH l3fJ~JJEY d 7:;fi -/~r1.59 -/~
/~O~(p._
+
PtOtJ€l5R. /1l1D t;flP t;R FUND # ftJt/~ 7frJ. C1
/6, 7 f I,. -
s.
;{ooo PONTI ftC G~ArJ D Pll,''1 -KELL'I6L 81< I~CJ'
~o~~ -
~,
PERSONAL PR{)tP~RT'I
1160.-
,
TOTAL (Also enter on tine 5, Recapitulation) $
(If more space Is needed, Insert additional sheets of the same size)
V'6:'" 7 tff'. -
r-r-- ~
. . REV=151'3 EX+ (9-00)
-
COMMONWEALTH OF PENNSYLVANIA
INiERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE ,
BENEFICIARIES
ESTATE OF
FILE NUMBER
~tJ6 - ~ (JDJ3
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
Do Not LIlt Truetee(1) OF ESTATE
NUMBER
I
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABlE DISTRIBUTIONS (include outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2))
A '" N L t: .B 0 /911 (. In II P I..IE ..sr /lE: fA.) t:. (.h'l1 ~ P.4
17D 70
LII (JR., /.. c.ijt> .J.j~D At> xB el(l!. Y I<.b YtJR.H IIlftJEI'J Pi')
17.37 ()
L'IN N LE.Bo- PLANAS 94511 hUe./<. Sr 1IJ...l1m€7JR c.t(
9<1~-ol
-nmon'f '-ED/) 1/75" FIIIRlLI~'/ 1Jt?. c~mfJlIlLL IVl
o' /70/(
/...I.3SLI vOtiNG r.t Ct..E1?1SoN' /lVE C/fl11iJHllLPIt
f' I 7d II
lolJD LEBo '1ft) PENN ST STEEL 7tJN PIl
/7319
SPOUSE
~fi1, ? ~s.
0-(;1 117-
50, Q'17-
.jtJ, 997.-
..;-t>, Cj 9 7. -
so, 9'11_ -
DfiUf;H T ER
DAUGfl TE R
SCf\i
D AUGHTEK
SDN
ENTER DOllAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-l500 COVER SHEET
n NOM- TAXABLE DlSTRIBUT1ONS:
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 n - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON UNE 13 OF REV.1500 COVER SHEET $
(" more space Is needed, Insert add/IIonal sheets of !he same size)
. . AEV'1S" EX+('....).
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
seNIDULI H
FUNERAL EXPENSl:S &
ADMINISTRATIVE COSTS
m (RON
7)
LEKe>
Debts of decedent must be reported on Schedule I.
FILE NUMBER
dOt) (P - t) 00..13
ESTATE OF
ITEM
NUMBER
A. FUNERAL EXPENSES:
DESCRIPTION
AMOUNT
1.
fVlUS.5EL(VlH~ FUNERAL Hcmf.:.
J~1 ;h/hlYJ1GL fivE LEmoiNE fJl1 ;7043
"9/1- -
(<..oLl-ING GREEtJ CEi'rnET~Rt
I &' II CI1R-I-ISLj; AlJ (!.1I-1I1 iJ If ILL fit 17011
t!Cf7.-
8. ADMINISTRATIVE COSTS:
1. Personal Representative's Commisslons
Name of Personal Representative(s) -r 0 /) l) L E R 0
Social Security Number(s)/EIN Number of Personal Representative(s) t1. 0 g - to d. - SC; /9
Street Address q I 0 PIE tJ tV 5. T
City S -r E IE L- tD lv State ...&L ZIp I 7.E /9
Year(s) Commission Paid:
2.
Attorney Fees
1910. -
3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant 1+ tV AI L E 11 ()
StreetAddress 110 (p m fI PL E ~T
City Jt/ E Ct.) C u m l3 E .1( L A JJ b
Relationship of Claimant to Decedent .s f> 0 U S E
...J -!F () lJ . -
StateltLZiP 17D 10
4.
Probate Fees
14. 1
5. Accountant's Fees
7.
e.L/frJB6/2LffND GooDkJlLl FIR E R.ESCUF-..
eft 1<."'- I SL E. REG I DA/f1L m EO CTR
AAI=\ F/NItf\JC./ItL SERV{C.~S
~~t;)5 FEDE.RIfL -r ~7ftT6 INCDmE 7AYES
ISO. .
3"99
I J-./ 9 t). -
J/f179. -
/ t),5s. -
6.
Tax Return Preparer's Fees
TOTAL (Also enter on line 9. Recapitulation) $ d1 7, S 7 C:!. -
(If more space is needed, insert additional sheets 01 the same size)
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CO 007271
LEBO TODD A
910 PENN STREET
STEEL TON, PA 17319
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---------- --------
101 I $11,474.37
I
I
ESTATE INFORMATION: SSN: 204-30-8795 I I
FILE NUMBER: 2106-0033 I
DECEDENT NAME: LEBO MYRON DEAN I
DATE OF PAYMENT: 09/29/2006 I
POSTMARK DATE: 00/00/0000 I
COUNTY: CUMBERLAND I
DA TE OF DEATH: 12/29/2005 I
I
TOTAL AMOUNT PAID: $11,474.37
REMARKS: TODD A LEBO
CHECK#136
SEAL
INITIALS: WZ
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS