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Home My WebLink About11-15-06 REII-1SOO EX + (8-00) REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 .... Z W C w o w c DE~EDENrs NAME (LAST. FIRST, AND MIDDLE INITIAL) DOULGERIS GEORGE J. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 06/14/2006 09/15/1921 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) LLI ~ ~~U) ult:~ LL1A.U :J: 00 ufi A. c( 00 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Allach copy of Will D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (date of dealh after 12-12-82) D 7. Decedent Maintained a Living Trust (AlIach copy of Trust) D 10. Spousal Poverty Credit (date ofdealll between 12-31-91 and 1.1-95) OFFICiAl USE ONLY FilE NUMBER 21 -0 6 0 56 1 ""CoiiN'rv""COOE -~ - - NUMBeR- - SOCIAL SECURITY NUMBER 1 85- 1 4 - 2 2 9 2 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (daleofdeathprior~12-13-82) D 5. Federal Estate Tax Retum Required _ 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Allach Sch 0) ~ Z LLI Q Z o A. U) LLI It: It: o U 'tHIS'S' .~ilQ'JM\)SIJ8e.COMetleme:;.~\\eo~iE."e'6A'6sfn~.e,lNnIcf)N@jOEAttAe;:t~ii'EijRMAflt)Q,s toijL.&JseiDtR~Q:tEOj;fo~S:i',,'l"".'" NAME COMPLETE MAILING ADDRESS HUBERT X. GILROY ESQUIRE 4 NORTH HANOVER STREET FIRM NAME (If Applicable) BROUJOS & GILROY P.C. TELEPHONE NUMBER 717-243-4574 CARLISLE PA 17013 z o i= c( ..J :J .... 0:: c( o w 0:: 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) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= c( .... :J a.. :E o o >< c( .... 15: Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X _(15) 265,832.14 X .045 (16) X .12 (17) X .15 (18) (19) 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 20. D :~'1;f0$i}~';~!;:SUR OFFICIAL USE ONLY i"-' C:') C? 0....' -'r__ feCr' I (~ (~;< _,,_J :;:~ C::J dlIIl:: ',...~J '.; '2J S:'2 :.jj . ~.~ tn ./........ (-) .':r, :r-..... 57 ,344.40 ro U1 o ._.1 J (8) 284,530.76 16,781.44 1,917.18 (11) (12) (13) 18,698.62 265,832.14 (14) 265,832.14 11,962.45 11 ,962.45 <<. Decedent's Com lete Address: STREET ADDRESS . Cumberland Crossin South Middleton Townshi CITY Carlisle Home STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 11,962.45 Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Pen,alty 4. Total Interest/Penalty ( D + E) If Une 2 is greater than Une 1 + Une 3,enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund If Une 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (3) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check (4) (5) (5A) (5B) to: REGISTER OF WILLS, AGENT 5. 11,962.45 11.962.45 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 ofthe property transferred; ...... ............................... .......... ............................ D 00 b. retain the right to designate who shall use the property transferred or its income; ........................................ D 00 c. retain a reversionary interest; or ...................................................................................................... D 00 d. receive the promise for life of either payments, benefits or care? ............................................................. D 00 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration?....... ............. ... .,............. ........... ...................... ....................... D 00 3. Did decedent own an Oin 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? ....................................................................................................... 00 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 declnthat I have examined this return, includinQ accompanying schedules and statements. and to \he best of my knowledge and belief. it is true. correct and complete. 0ccIarati00 of preparer other than !he personal representative is based 011 allmmation of which prep....er has any kllowle<!g:!. SIGNATURE OF PERSON RESPONSI lE FOR FILING RETURN DATE ~ I -~-<J1o ADDRESS 9 DOUGLAS DRIVE RLlSLE PA 17013 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 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 oftransfers to or for the use of the surviving spouse is 0% [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 0% [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 4.5%, 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 12% [72 P.S. ~9116(a)(1.3)1. 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.1507 ex + (1-9n . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE D MORTGAGES & NOTES RECEIVABLE ESTATE OF DOULGERIS. GEORGE J. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. Georgia Keegan Loan James Doulgeris Loan FILE NUMBER 21 06 0561 DESCRIPTION John Doulgeris Restaurant Mortgage VALUE AT DATE OF DEATH 25,000.00 25,000.00 108,361.70 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 158.361.70 ",...".".. '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF DOULGERIS GEORGE J. FILE NUMBER 21 06 0561 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION M & T Bank Checking Account # 864749 VALUE AT DATE OF DEATH 8,481.15 2. General Investment Account # 12505489 Brookwood Financial Services - Raymond James Fund 57,080.06 3. Refund from Cumberland Crossings Home - trust fund for petty cash 67.36 4. Savings Account # 15004200907523 Joint account in name of Decedent and John Doulgeris 1,232.96 5. Metropolitan Life Insurance Policy 1,963.13 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 68 824.66 ."".".a."." . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF DOULGERIS GEORGE J. FilE NUMBER 21 06 0561 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF ITEM INClUDE THE NAME OF THE TRANSFEREE. THEIR RELA nONSHIP TO DECEDENT AND THE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABlE) 1. IRA Investment Account # 57,344.40 100. 57,344.40 Brookwood Financial Serivces - Raymond James Fund TOTAL (Also enter on line 7, Recapitulation) $ 57 344.40 . . (If more space IS needed, Insert additional sheets of the same size) "","""",."." . COMMONWEAlTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRA liVE COSTS ESTATE OF DOULGERIS GEORGE J FILE NUMBER 21 06 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. 2. 3. 4. 5. 6. B. 1. 2. 3. 4. 5. 6. 7. 8. 9. DESCRIPTION FUNERAL EXPENSES: Donation for Priests English Funeral Home - Burial Ewing Brothers Funeral Home Plum Creek Cemetery - Headstone cutting Kathy Doulgeris - reimburse funeral expenses Family and friends dinner after funeral ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) John N. Doulgeris Social Security Numbe~s) I EIN Number of Personal Representative(s) StreetAddress 2219 Douglas Drive City Carlisle State PA Zip 17013 Yea~s) Commission Paid: Attorney Fees Broujos & Gilroy, PC Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountanfs Fees Tax Return Preparer's Fees Boyer & Ritter - estimated Register of Wills - Filing Final Inheritance Tax Return Filing Family Settlement Agreement Filing TOTAL (Also enter on line 9, Recapitulation) $ (If more space IS needed, insert additional sheets of the same size) 0561 AMOUNT 300.00 3,595.00 5,404.20 220.00 351.68 1,015.56 5,000.00 500.00 360.00 15.00 20.00 16781.44 o. 'fi''''o''''' '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF DOULGERIS. GEORGE J. FILE NUMBER 21 06 0561 Include un reimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 289.08 1. Cumberland Crossing Nursing Home 2. Continuing Care - Medical Expense 182.48 3. Bank Card Services - Charge Card 34.99 4. Cumberland Crossing Nursing Home 1,403.63 5. Continuing Care - Medical Expense 7.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1 917.18 ~~""~.,,~ '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER nn. II I -i...., IWI....... .I. 21 06 0561 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trultee(l) OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1. John N. Doulgeris Son 25% 2219 Douglas Drive Carlisle, PA 17013 2. James Doulgeris Son 25% 3016 Enisglen Drive Palm Harbor, FL 34683 3. Catherine Mel ntire Daughter 25% 240 Lane 100 A Pine Canyon Lake Angola, IN 46703-8716 4. Georgia Keegan Doulgeris Daughter 25% 270 Windsor Road Wood-ridge, NJ 07075 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, 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 TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GILROY HUBERT XAVIER 4 NORTH HANOVER STREET CARLISLE, PA 17013 nnn__ fold ESTATE INFORMATION: SSN: 185-14-2292 FILE NUMBER: 2106-0561 DECEDENT NAME: DOULGERIS GEORGE J DATE OF PAYMENT: 11/15/2006 POSTMARK DATE: 11/15/2006 COUNTY: CUMBERLAND DATE OF DEATH: 06/14/2006 NO. CD 007434 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $11,962.45 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 1011 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $11,962.45 GLENDA FARNER STRASBAUGH REGISTER OF WILLS JOHN H. BaoUJos HUBBKl' X. GILIlOY BROUJOS & GILROY, P. c. ATrORNBYS AT LAw 4 NORI'H HANOVER STRBET CARLISLE, PENNSYLVANIA 17013 1'BLBPHONB: (717) 243-4574 FACSIMILE: (717) 243-8227 jbroujosObroUj08gi1roy.Com hgilroyObrouj08gi1roy.com November 9, 2006 NON-ToLL FOR HAluusBuRc AREA 717-766-1690 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 C) C;o <~~~ ,-){---... - ") C") ::'-1 ?-);; :u--i )> Re: Estate of George J. Doulgeris <tX.Q -fu \ Dear Glenda: /"-..) <=::) = c::n ~ ""'- o ...c: U1 J> ::L co CJ1 o Enclosed for filing is an original and two copies of the Pennsylvania Inheritance Tax Return along with a check made payable to your office in the amount of $11,962.45 as payment on Inheritance Tax. Also enclosed is our $15.00 check payable to you for filing fees. Thank you for your attention to this filing. Sincerely yours, / Po Enclosures Cc: Mr. John N. Doulgeris ~;'f~i ~-'-') (~=) ~T-t t.:-] i-T, ~:=:J C) --, I -='-J .C) rTl