HomeMy WebLinkAbout02-09-07
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 1712B-0601
OFFICIAL USE ONLY
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENrs NAME (LAST. FIRST, AND MIDDLE INITIAL)
Brown, Judith Louise
DATE OF DEATH (MM-DD-YEAR)
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07-31-2006
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
06-29-1948
[!] 1. Original Return
04. Limited Estate
[!] 6. Decedent Died Testate (Attach
copy of Win)
o 9. Litigation Proceeds Received
DATE OF BIRTH (MM-DD-YEAR)
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2. Supplemental Return
FILE NUMBER
.u 06
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
193-26-4179
00715
NUMBER
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
4a. Futura Interest Compromise (date of death after
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Trust)
10 Spousal PovertY Credit (date of death between
. 12-31-91 and 1-1-95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
B. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113{A) (Attach Sch 0)
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NAME
Jan M. Wiley
FIRM NAME (If applicable)
Wiley, Lenox, Colgan, & Marzzacco, P.C.
TELEPHONE NUMBER
717 -432-9666
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
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11. Total Deductions (total Lines 9 & 10)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
12. Net Value of Estate (Line 8 minus Line 11)
COMPLETE MAILING ADDRESS
130 W. Church St
Dillsburg, PA 17019
(1) 151,561.05
(2) None
(3) None
(4) None
(5) 7,941.43
(6) 2,108.36
(7) 42,446.08
OFFICIAL USE ONLY
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(8)
(9)
(10)
33,216.04
164,247.87
(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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
(14)
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 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 2,612.16 x .12 (17)
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0
0 18. Amount of Line 14 taxable at collateral rate 3,980.85 x .15 (18)
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~ 19. Tax Due
(19)
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2<<f4,056.92
197,463.91
6,593.01
0.00
6,593.01
0.00
0.00
313.46
597.13
910.59
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00;
T
'l t Decedent's Complete Address:
STREET ADDRESS
515 Chickadee Drive, Mechanicsburg, PA
CITY Mechanicsburg
ISTATE PA
/ZIP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditS/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
910.59
0.00
3. InteresUPenalty if applicable
D. Interest
E. Penalty
Total Credits (A + 8 + C)
(2)
0.00
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
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. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58)
910.59
910.59
[
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. retain the right to designate who shall use the property transferred or its income;.................................... 0 [!]
c. retain a reversionary interest; or.................................................................................................................. 0 [!]
d. receive the promise for life of either payments, benefits or care?.............................................................. 0 [!]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?....................................... ............................................................................... 0 [!]
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 which
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 retum. including accompanying Schedules and statements, and to the best of my knowledge and belief, it is true, correct and
Iete. Declaration of preparer other than the personal representative is based on all information of which re arer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Barbara Jane Gilbert
Make Check Payable to: REGISTER OF WILLS, AGENT
~
DATE
1400 Bent Creek Boulevard, Apt. 208
Mechanicsburg. PA 17055
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DATE
07
ADDRESS
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RE OF PREPARER OTHER THAN REP SENTATIVE
M. Wiley
130 W. Church 5t
DiIIsburg, PA 17019
07
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. 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 exemDt 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. 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.
99116 1.2) [72 P.S. 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.
!
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llins! mill nnn QIes!nffiPut
OF
JUDITH LOUISE (CRULL) BROWN
BE IT REMEMBERED, that I, JUDITH LOUISE (CRULL) BROWN, of515
Chickadee Drive, Mechanicsburg, Cumberland County, Pennsylvania, being of sound mind,
memory and understanding, do make, publish and declare this as and for my Last Will and
Testament, hereby revoking and making null and void any and all Wills and Testaments
and writings in the nature thereof made by me at any time heretofore.
ITEM 1:
I direct that all my just debts and funeral expenses be paid as soon
after my demise as may be convenient.
ITEM 2:
All the rest, residue and remainder of my estate, of whatsoever nature
and wheresoever situate, whether it be real, personal or mixed, including property over
which [ have a power of appointment, I give, devise and bequeath unto my sister,
BARBARA JANE GILBERT.
ITEM 3:
I direct my hereinafter named Executrix to pay all inheritance, estate,
succession and legacy taxes of whatsoever nature and kind, to which my estate or the
transfer of any property passing hereunder or otherwise passing by reason of my demise,
may be subject and to charge such taxes against my residuary estate, it being my intention
that none of the aforesaid taxes, either federal or state, on any property required to be
included in my gross estate, under the provisions of any state or federal law now in force
or hereafter enacted, shall be prorated among the persons interested in my estate to whom
such property is or may be transferred or to whom any benefit accrues.
WI1NESS:
"w~
i ~SEAL)
ITH LOUISE (CRULL) BROWN
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ITEM 4:
I appoint my sister, BARBARA JANE GILBERT, as Executrix of
this my Last Will and Testament.
ITEM 5:
I direct that my Executrix or her successor shall not be required to
give bond for the faithful performance of their duties in any jurisdiction.
ITEM 6:
My Personal Representative shall have the following powers in
addition to those vested in them by Law and by other provisions of this, my Last Will and
Testament, exercisable without court approval, and effective until distribution of all
property:
WITNESS:
1.
To retain any or all of the assets of my estate, real or personal,
without restriction to investments authorized for Pennsylvania
fiduciaries, as they from time to time may deem proper, without
regard to any principle of diversification or risk.
2.
To invest in all forms of property without restriction to investments
authorized for Pennsylvania fiduciaries, as they from time to time
may deem proper, without regard to any principal of diversification
or risk.
3.
To sell at public or private sale, to exchange, or to lease for any
period oftime, any real or personal property and to give options for
sales, exchanges or leases, for such prices and upon such terms or
conditions as they from time to time may deem proper.
4.
To allocate receipts and expenses to principal or income or partly to
each as they from time to time may deem proper.
5.
To borrow money from persons or institutions, themselves included,
and to mortgage or pledge any or all real or personal property as
they in their sole discretion shall choose, without regard to the
dispositive provisions of this instrument.
~l ~
'~EAL)
JU H LOUISE (CRULL) BROWN
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6. To compromise any claim or controversy asserted by or against my
estate or trust estate.
7. To make distribution in cash or in kind or partly in cash and partly
in kind, and in such manner as they may determine, and at
valuations finally to be fixed by them.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~y
of hille, 2006.
i~ (SEAL)
"'
.
,
COMMONWEALTH OF PENNSYL VANIA
: SS
COUNTY OF YORK
We, JUDITH LOUISE (CRULL) BROWN, JAN M. WILEY, ESQUIRE and
JULIE A. RUDY, the Testatrix and the witnesses respectively, whose names are signed
to the attached or foregoing instrument, being first duly sworn, do hereby declare to the
undersigned authority that the Testatrix signed and executed the instrument as her Last Will
and Testament and that she had signed willingly (or willingly directed another to sign for
her), and that she executed it as her free and voluntary act for the purposes therein
expressed, and that each of the witnesses, in the presence and- hearing of the Testatrix,
signed this Last Will and Testament as witness and that to the best of their knowledge the
Testatrix was at the time eighteen (18) years of age or older, of sound mind and under no
constraint or undue influence.
Sworn to and subscribed
before me this ~ay of
~s;:-- - LJ. ! ,
~hLifu1s
WI SS
June, 2006.
~~P/i:Nv
NOTARY PUBLIC
MY COMMISSION EXPIRES:
COMMONWEALTH OF PENNSYLVANIA
NoIariaI Seal
S. DaYm Gladfelter, NoIa1y Public
0iIIslug Bora, York Cou1ly
My CommIssIon Elcplres May 17, 2009
Member. Pennsylvania Association 01 Notaries
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\ Rev-1502rtx+ (6-98)
.
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESlOENT OECEOENT
ESTATE OF
Brown, Judith Louise
FILE NUMBER
21-06-00715
All real property owned solely or as a tenant In common must be reported at fair market value. Fair marnel value is defined as the price at which property would be
exchanged between a wilfing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which Is JolnUy-owned with right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Sale of real estate situate at 515 Chickadee Drive, Mechanicsburg, PA:
VALUE AT DATE
OF DEATH
150,500.00
2 Tax proration due estate from sale of real estate:
1,061.05
TOTAL (Also enter on Line 1, Recapitulation)
151,561.05
(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 A (Rev. 6-98)
1e/3e/2006 12:24
7173030323
CAPITALAREAABSTRACT
PAGE 02/64
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A. Settlement Statement
U.S. Department of HouolnQ
end Urban o."lcpmtnl.,n..
,r
OMS No. 2!m.0265
a. Type of loan
1. 0 I"HA 2. 0 F.mHA 3. 0 Cony. Unlns FOe NUmber
C&A-~amUD..-8741
4. 0 VA 5. 0 CO"". Ins. ': 42
C. NOTE:This form .. furnlsl1ed 10 g!Ye )'IlU . _emenl of actual selllement coets. Amounts peid 10 and by the .elllemen! agent are shOwn.
Items marked 'P.o.c' weni paid outside of closing; they are shown here for informsliOll4l purJlOSltS and 8re ncl included In the totals.
Loan Number
CaR lI.."l
Mortgage Irl$u"nce Cue Number
.PA
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107. CounlyTa_ 10/30/2006,~ l2/J1/2006 '65." 407. OlunlyT....s 10/30/2006 III 12/31/20OG ,65.83
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109. ReLul1. (Oct 30 - Dee :':0 '27.20 409. .R..tu.. (ot!t 30 _ Dee: J1J f~1.20
ii'~~iiii!;i;;i;;;ii);!j;!~~;:;i;i!:,;,j@;ji;iiiii;iiiijm]mfr::m1i1iii;1;;~i;i~m;;i;;:~;!ii;iH!i;i;i!;!;!j;;;;i!!)j;:m;iigii;j;i~1~i;ijijj!!)!;j;f;iEiiig1ii!;j;!!;;;i;;~mjl);;mii;m!m!!i;!i;iiijij;:!ji!:;mj)ii;;;':t!:;iji!!;i)i;!;;;::i!i;)H));ii;iiii;i
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_154,201.17
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209.
ADJUSTMENTS FOR ITEMS UNP'AIO BY SELLER:
210. Cllyl\own _s..1o 510. CIlyI\own ta...
iiiji~~~:!~~~ij!iE2i,,"i(i(ififi:~!iii!i!i~, :'ifi~ii;iiii'!iW!i;iii[!!!iiiiiii i;i:mi:iii"!!i!ii'!ii!iiii!,ii(!j! !im!~~K':':"'''''~ii:i:"iiiliiii;:;iii!i!i;ii!if;iiiiliSiH;,i!H~imii:;:;i.ii!iiiiif,i: !imi'!';;;!;;iiifHfH'[i!ii'ii
212. Assossmentll:., 512. AsMssm.nta to
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ADJUSTMENTS I"OR ITEMS UNPAlO BY SelLER:
to
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214.
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514.
216.
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516.
.-:
518.
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$157,946.36
( 0 TGt:..~ BORROWER:
$1.39,207.17
HUD.1 (3-86) - RESPA, HB 4305.2
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10/30/2006 12:24
71 73El30323
CAPITALAREAABSTRACT
PAGE 03/04
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HlJl).1 (ROY. JIBS)
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........ .::::::::::::::::::::;:;:;:;:::::~:::;::::::::::;:::;:;::::;:::;:;:;:::::SEm~~:CH;.It;RGES::;::::::::::;::::::::::;:::;::::::::::::;::::::::::::;:;;;:;;:::::;:;::::::::::::;:::;:;:::;:::::::::::::::::::::::;::::
700. TOTAL SALE:SIBROKER'S COMMISSION
IlA8m ON PRICli
C!I
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PAID FROM
BORROWER'S
FUNDS
AT
SETTlEMENT
PAlO FROM
SELLER'S
FUNDS
AT
Sttn.EMENT
DIVISION OF COMMISSION (UNE 700) AS FOUOWS:
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702. 10
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~. I!l;LMS PAYABLE IN-.WNNeCTION WI I'f LOAN:
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804. ~,..... ""
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108.
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820
. ....... ......... ".
" ".. ,;.:.;.;.:.:.~.~.;.>;.>>:-:.:.:.;.>:-:-;.>::. ........,.:.:..; ":';'.
. . . . . ". '..
: :' ::::
: .-:;::::;:-:-:.;':;;::::::::
. " . .
. " . ,
IlOO. ITE~REIolU~13Y LEN~Rj U I'E PAID IN ADVAlI/CE:
~;:~m;:::::::::::::::::;:':'::::::::::::;::::;:::;:;:::::;fl!:::;:::;:';':':'::::;:;:::::::::::::::::::::::::::::::::::::O:::;::::::::;:::::::'::::;::::::::::;:::::~~.;{.::::::;:;:::::::::.::;:::::: .:.:::. : ..
902. ....... -co _ fat moo. 10
~::l!i!i;Ii!<llllli~~~i!bI\\:ir:::;::::::;:;:;::':::':::':;::::::;:::~~::::::.;:;;:::::;:;::::::::::::>;::::::;:;:::::.:.:.:::::.:.::;;::::::::::>:::::.:.:::;:::::::.;:;:::::::;;:;:;:::.:.:::;::::
904................_,.,. _..
~:::::::::::;;:;:::::::::::::::::::::::::::::;-:::::::::::;:;:::;::::::::::::::::::::::::::::::::::::::::;::;::::::::;:::::::::::;:::::::::::::::::::::::::::::::::::::;::::::::::::::::::::::::::::::::::::::;::::::::::::.:::::::::::::::::::::::::::::::::;:;:::::::::::::::::::::::::::::::::
1000. RESERVES D 'TI'\LENDE~
.~,..~~~::;:;:::::::::::::::::::::;:;::::::;:~:;:::;:.;.:::::::~0::::;:;:::::::::::;:::::::::;::;:::::::::;.::::::::;::;;.:.:::;:::::i>:i!'!ilO!ifl1:::':::;;':::::':':';:;::-:::::;:;:;:;:, '. :: ;: ::
lOOil.MoI1OO........... ,. -0 1lV_
'DO:l:.'i"Ji:~~::::::::::::>:::::::;:::.:.:.:::.:.,;.::::::::::::::'rOilfti!:O:':;:::;:;:::::::::::::-:;:;:::::::::,:::::::,:;:;:;::::::;:;::::::::~~.::;:;:;.:::.:.:.:.:::.:.:.:.;.:.:::. :.:;::::::::;:::;:;::::::-:.:::.;.:.
l004.CounIy__ "'C"'lIlla ""''''''nlh
:lojlil<~~~t:.:.:::::;:::::::::::::.:.:::.:.:.:.:.:::::::::-:.:~..::;.:.;.;.:::.:::::;:::.:::.;-:-:.::::::::::::;::::.:::':::::::::':i>:i!'~.:.:.:.:::.:.;.;.:.:.:.:.:.:::::.::;.: : : ::
100II. Flood ......... 'monoh, .. OIl""'"
:1Dl7:::;;::;::::::;::.;.;.;.;:::;::;:;:::::.:-:-:.;.;.;:::::::::.::::-:';';':'::::::;:~.JI:::::::::::::::::':';';':':'::::;::::;:::,:';';';:::::::;::>:::-:'~IilOillj>:.:.:.:.:.:.;::.;::<::::;::-:-:.:.. :: . .... ....
10ll8. _a ~_
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1100. !lTlE CHARG~;
"01'_"~"'1a
:~!~~~~~~~;:::;:.;:::;:;::::;;;;;:::.::::::::::;::::::;::::::::::::::::;::::::;:;:;:-::::::;::;::::::;;:;::::::::::::;::::::;:':'::':::..::::::::;.:.;::;:':':,:::::'::::;:;.:':':::;.;.;.:'.
1103. TiUR UlmlnllUClft Ia
:':"!J4;~~~~~.:;:::;::;.:.::::::;::-:.:.:::::;:::::::;;::::::.:.:::;:::;:;::::;;:::::::.:.:.::::::::::;::.;.:::-:;:::::::::::,:;:::::::::::-::;':':::':::':':;:::':':::::::::::;:;::;::;:::-:-:-:.: :..;" :.....
110S. Docu-.t_..... :
:t11JO:~~Ido:::':;::::;::::::::~~~"2::;:,t.,:.!'T..t;aiUi~:;:uqW;-t-.!:: :;:::::::.:: :.:::
, 107. MDmoyo I.....
-.Llnck.IcSM *",1\emI Nu~ ~ ,
J~'1)IIiI"''''''''''''''';t'''''l''''f'~'li'.l:'i.'~;t:/i;ll'~'Ab'''''''''':z:.;.;''''''''''''"............ ........~. $110262
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t1OQ. Land", CO\W'l1;tl ':'
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''''''1
1200. GOVeRNMENT RECORDINCO AND TKAN5FER CHARGES;
:~6;::!i..,,;g~::::;:;:::;::::;::::11iIid:::::::::::.::::::::-t).;:$:IL:~..:;:::::::::::::::::-:;:.;;::::::::::;:;:;:;::;::::;~Ot':.;.;:::::::::;::::::::::::;::::::::::::;=:: :':';:::::;:::::::::$t.a:':$fI;: .. : : ........
1%02.CIt)t__"",., 0.,.. 13.010.00'....__ $1.5UIS.OU $1.50!J.0(
:~tI:l;"ialo:ioirM.r;.;,;:::::::::':;::::::::;:;::=:-:.:.:::bMi:::::::::::::::::::::::;::::::::::=:;::M~:.:::::.:::::::::::::::::;:::::::::::::::::::::::::::;:::::::::::::.:.:;:-:':.::::;:;::::::::::' .:::::.;.:.:.;.:.:.:.:.::::::::::::; :::::::::::::::::;:::::::;:::::::
1204.
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lJOO. -"lJOITI'-'NALISI::TTLEMEN CHARGES:
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1302. ,.... InIlP8CtIon 10 ,
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1301. 2'ax Cert. ,.. to lol3rie BUbar 85.0C
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1306. llU'lUre .8lJJ to B'&IlIpd"'~~ahi'p (Oat Z - DtK: n) $31. 7~
,~~;:::::::::;::::::::;;:::;:::;:::::::.:::::::::::::::;:::::::::;:::::::::::::;:::::::::::::::::::.::::::::;::::::::::::::::;:;:::::::::::::::::;:::::::::::::::::::::::::::::;::::::::;:::::::;::.:.:::.:::::::::::;:;::: :::::::::;::::::::::::::::::::::::::: .................
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1400. TOTAL SEml;MENTCHARGES
$2.646.12
$3.536.5;
~.
1:
i;
, Revo1508,tX+ (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brown, Judith Louise
FILE NUMBER
21-06-00715
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 Comcast refund:
VALUE AT DATE
OF DEATH
4.30
2 Final paycheck received:
2.699.80
3 Haar's Auction (sale of personal property):
1.360.05
4 Homeowners insurance refund:
188.70
5 Sale of paintings:
858.75
6 TO Ameritrade Account Number 766-237218:
2.829.83
TOTAL (Also enter on Line 5, Recapitulation)
7.941.43
(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)
FORM AD-33.
USDA
(REV. 10/97)
BOND ACCOUNT
YEAR TO DATE LEAVE STATUS
AUTH
NO
DENOM-
INATION
DEDUC-
TIDN
BALANCE
AVAIL.
NO.
ISSUEO
ISSUE
DATE
TYPE
ACCRueD
USED
BALANCE
PRO.JECTEO
USE OR LOSE
PT. HRS
UNAPP
MAX. c/o
12.00
o
ANN 746.00
SICK 16.00
862.00
COMP
NAME AND ADDRESS
$ 2864.97 GRO ADJ-PP 0607-0614
$ 2171.54 NET ADJ-PP 0607-0614
USDA MANAGEMENT SUPPORTS TELEWORK ARRANGEMENTS.
YOU MAY BE ELIGIBLE. CONTACT YOUR AGENCY
COORDINATOR AT HTTP://WWW.USDA.GOV/DA/SHMD/
TELEWORKCOORD.HTML
8
REMARKS
OFFICIAL PAY DATE
08 17/2006
1.1.111...111....1.1111111111111111111.11..1.1.1111.1111111111
T-1433 09736 07 4946
LlUDITH L BROWN
515 CHICKADEE DR
MECHANICSBURG, PA 17050
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. Revo15ofEX+ (5-98) *'
COMMONWEAl. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Brown, Judith Louise
FILE NUMBER
21-06-00715
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
A. Barbara J. Gilbert
ADDRESS
1400 Bent Creek Blvd.
Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
Sister
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET INTEREST DECEDENTS INTEREST
JOINTLY-HELD REAL ESTATE.
1 A 2/4/1987 Navy Federal Credit Union Checking 2.427.85 50.000% 1,213.93
Account:
2 A 2/4/1987 Navy Federal Credit Union Savings 1,788.85 50.000% 894.43
Account:
TOTAL (Also enter on Line 6. Recapitulation) 2,108.36
(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 F (Rev. 6-98)
.
,
IV aUj f=e d -Bred
15 September 2006
74698
Ms. Barbara Gilbert
1400 Bent Creek Blvd Apt 208
Mechanicsburg, P A 17050
Dear Ms. Gilbert:
On behalf of Navy Federal's staff and membership, I wish to extend our heartfelt sympathy to
you and your family on the loss of your sister. We have completed settlement of her accounts
and I hope that the following information is of assistance to you.
Your sister established her share savings and checking accounts with Navy Federal on
4 February 1987. On 31 July 2006, her share savings account reflected a balance of$1,788.85,
with Life Savings Insurance coverage of$1,341.63. The enclosed flier includes detailed
information regarding the complimentary Life Savings Insurance coverage that we provide as a
benefit to our members. Dividends credited to the account on increased the balance to
$1,791.67.
Your sister's checking account had a balance of $2,427.85 on 31 July. The funds in a checking
account do not earn Life Savings Insurance. Transactions involving the checking account since
the date of death led to a balance of $2,244.69 as of 11 September. For the purpose of
disbursement, the funds in the checking account have been transferred to the share savings,
increasing the share savings balance to $4,036.36.
You are the joint owner of your sister's accounts and no other payee of the Life Savings
Insurance has been designated. Therefore, you are entitled to her combined balances and the
insurance proceeds. Our checks are enclosed. The check for the insurance proceeds includes
dividends of$9.52 for a total insurance benefit of$1,351.15.
Your sister's Visa account did not reflect a balance on 3 August. Her "01" loan account was
paid off prior to her death. Her accounts are now closed and the final statement(s) will be
forwarded at a later date.
.
, Access Number 74698
Page 2 of2
Should you have any questions, please call me toll-free at 1-800-883-3323, extension 43171,
between 8:00 a.m. and 4:30 p.m., Eastern time, Monday through Friday. You may also reach me
by fax at 1-703-255-7963.
Sincerely,
Rawin Chanchaivit
TP:rl
Enclosures:
Insurance Flier
Check No. 2600493593
Check No. 0801026605
cc: Ms. S. Dawn Gladfelter
The Wiley Group
Attorneys at Law
130 W Church Street, Suite 100
Dillsburg, PA 17019
Rev-151~ EX+ (6-98)
.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brown, Judith Louise
FILE NUMBER
21-06-00715
This schedule must be completed and filed W the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER St:lEET is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S TAXABLE
EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COpy OF THE DEED FOR REAL ESTATE.
1 DWS Scudder IRA Account Number: 2.561.52 2.561.52
00159359686 (Ex-husband, John W. Brown,
beneficiary):
2 Thrift Savings Plan (Sister, Barbara J. Gilbert, 32.432.40 32.432.40
beneficiary):
3 USDA Death benefit (Sister, Barbara J. Gilbert, 6.032.83 6.032.83
beneficiary):
4 Wells Fargo IRA Account Number: 01202104337 1.419.33 1.419.33
(Ex-husband, John W. Brown, beneficiary)
TOTAL (Also enter on Line 7, Recapitulation) 42.446.08
(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 G (Rev. 6-98)
.
. ,
P.O. Box 219669
Kansas City MO 64121-9669
1-800-728-3337
tJ'..".
r .... ./, ....<I,A:'~
. : ~. .~.v~v.-:a
'-.-.~;;~~~~~
September 29,2006
The Wiley Group
Attorneys at Law
Attn: S. Dawn Gladfelter
130 W. Church Street, Suite 100
Dillsburg, P A 17019
Fund:
Account #:
Registration:
D'vVS Large Company G~nwth Furid-S
00159359686
DWS Trust Company Custodian
For the IRA of Judith L. Brown
Dear Ms. Gladfelter:
I am writing in response to your recent letter regarding the DWS Scudder IRA account referenced above. Please
extend our condolences to the family of Judith L. Brown.
Below I have provided the number of shares, share price, and dollar value in this account as of July 31, 2006.
Fund Name (Class S)
DWS Large Company Value Fund
Number of Shares
103.038
Share Price
$24.86
DolJar Value
$2,561.52
There is no accrued interest on this account.
This account was established on March 22, 2001, and is registered as follows:
DWS Trust Company Custodian
For the IRA of Judith L. Brown
515 Chick A Dee Dr.
Mechanicsburg, PA 17050-2512
The beneficiary designation on this IRA account is as follows:
Name
John W. Brown
AlJocation
100%
Since Mr. Brown is a non-spousal beneficiary, he has the following options for filing a death claim on Judith L.
Brown's IRA since there have been no Required Minimum Distributions (RMD) taken on this account:
· Mr. Brown may take distributions from an account registered in the name Judith L. Brown for the benefit
of Mr. Brown as the beneficiary, based on his life expectancy.
· The assets can be redeemed and purchased at NA V into a non-retirement account with DWS Scudder.
in each.circumstance mentioned above, Mr. Brown must inform DWS Scudder of his tax withholding option. The
income received would be taxed at his ordinary income level. However, due to the sensitivity of surrounding this
issue, it may be helpful to consult a tax advisor regarding additional tax implications of the transaction.
To keep the assets in the account registered to Judith L. Brown for the benefit of Mr. Brown as the beneficiary,
please submit the following:
1) A signature guaranteed Inherited IRA Registration and Beneficiary Designation form. This form is
enclosed for your convenience.
A signature guarantee will protect the account by assuring us that each person signing the request is
authorized to do so. Before the letter or form is signed, it must be taken to a local bank, credit union, or
brokerage firm to obtain a "signature guarantee". A representative will verifY the identity, witness your
signature, stamp the letter or form, and sign hislher name and title. It is important to remember that a
"signature guarantee" is different from a Notary Public's stamp.
2) If you choose to take life expectancy payments or redeem the entire account please complete the Inherited
IRA Distribution Request form. One is enclosed for your convenience.
3) A certified copy of the death certificate for Judith L. Brown.
Please submit this documentation in the postage paid envelope provided or mail to:
DWS Scudder Investments Service Company
P.O. Box 219669
Kansas City, MO 64121-9669
If youJIave additional questions or if we can be of further assistance, please contact our Shareholder Services
Department at (800) 728-3337. Our representatives will be happy to assist you Monday through Friday, 8:00 a.m.
to 5:00 p.m. Central Time.
SincerelY,
Kudtncu ()V.LJ7~,t(;
Kristina Overholtzer
T earn Coordinator
20699646
Enclosure(s): Inherited IRA Registration and Beneficiary Designation Form
Inherited IRA Distribution Request Form
Postage Paid Envelope
o
"
>~
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THRIFT
SAVINGS
PlAN
Thrift Savings Plan
P.O. Box 385021
Birmingham, AL 35238
('~
010425102 MB 0.563 "AUTO H7 0 404017050-185258 345
111.11I.1111 1.11.1.1.1111I.1.111..11.1.111.1.1.1.1.11.1.1..1.1
GILBERT, BARBARA
1400 BENT CREEK ROAD
APT208
MECHANICSBURG, PA 17050-1852
08/2512006
-- -. . -
RE: Estate of JUDITH BROWN
Dear Sir or Madam:
The Thrift Savings Plan (TSP) has determined that you are a beneficiary of the TSP account
of the deceased participant named above. You are entitled to receive 100.00 percent of the account
balance. As of 08/2512006 the vested account balance was $32,432.40. The account balance at
the time of disbursement may differ from this amount as a result of earnings, late deposits, or other
adjustments.
A payment made to you as a beneficiary is subject to 10 percent Federal income tax
withholding. You may choose to waive this withholding by completing Line 1 of the enclosed IRS
Form W-4P, Withholding Certificate for Pension or Annuity Payments, or you may request to have
an additional amount withheld by completing Line 3 on Form W -4P. The completed form should be
sent to the TSP Service Office at the address on the letterhead within 60 days of the date of this
letter. See the enclosed notice for detailed tax information.
A check will be issued to you within 60 days. This payment will be sent to the address
shown above. If this is not your correct address, notify the TSP Service Office of your current
mailing address on the enclosed Change of Address for a TSP Beneficiary form. Checks issued to an
incorrect address may be lost and take several months to replace. If you submit a Form W -4P, your
address on that form will be sufficient.
If you would like to receive your payment v-ia direct deposit, complete1:'!ld return the enclosed
Form TSP-74, Request for Direct Deposit, to the TSP Service Office at the address on the letterhead.
If you would like to expedite payment of your benefit by waiving the tax notice period, please
complete the enclosed Waiver of Tax Notice Period form and return it to the TSP at the address on
the letterhead.
If you have questions, call the ThriftLine number shown below. Callers outside the United
States and Canada should call (404) 233-4400 (not a toll-free number). The TSP Service Office
hours are Monday through Friday 7 a.m to 9 p.m. eastern time. You c~ also write to the TSP
Service Office. Please include your daytime telephone number and your entire Social Security
number on all correspondence. Note: If you are a member of the uniformed services, do not
provide your Defense Switched NetVv'Ork (DSN) telephone number.
Web Site: www.tsp.gov
ThriftLine: 1- TSP- YOU.FRST (1-877-968-3778)
Fax number: 1-866.817-5023
TOO: 1-TSP-THRIFT5 (1-877-847-4385)
Notice: DC4021
.
,
BARBARA GILBERT
APT 208
1400 BENT CREEK BLVD
MECHANICSBURG PA 17050
: . ..;.'...
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i I! II H 111/1/11!1 I! illlll!,!,/ll, ,J I! II 1111/' Iii Ii I II! I! I II i,i
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BARBARA GILBERT
APT 208
1400 BENT CREEK BLVD
MECHANICSBURG PA
17050
09 CSF LUMPSUM
$***6032*83
REQIOl4 AI. DIS8ORSlNO OFA:;ER
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L___
FINAL STATEMENT OF LUMP SUM DEATH BENEFIT PAYMENT
You are entitled to a lump sum payment because of the death of a former employee. This payment, shown in Block 5, covers
only benefits due from the Civil Service Retirement and Disability Fund and consists of any unused contributions the former
employee made to the Fund or any accrued annuity payable at the time of his or her death, or the Basic Employee Death Benefit
payable to a surviving spouse under the Federal Employees Retirement System.
1. Name of Deceased Federal Employee 2. Claim Number 3. Date of Birth 4. Da~e
BROWN JUDITH CSF 7077021 06/29/48 11/21/06
5. You Will Receive a Lump Sum Payment For 6. To Be Sent By 7. Interest (Included in Item 5) 8. Tax Withheld
$ 6032.83 12/05/06 $ 2,518.92 $ 125.95
9. Remarks
THIS IS CONTRIBUTIONS PLUS INTEREST THAT JUDr
TH PAID INTO THE FUND FEDERAL TAX HAS BEEN WI
THHELD
w
See reverse side for important information.
ftI25.'7
CR2S17DJ
04120101
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THRIFT
SAVINGS
PlAN
Thrift Savings Plan
P.O, Box 385021
Birmingham, AL 35238
*****~
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*
*
0101531 01 MB 0.326 hAUTO H50 4059 1705(}.185258
111,11111111111,,1,1,"111,"1111,1"',1111',',',1,1,,',1,,',1
BARBARA GILBERT
1400 BENT CREEK BLVD
APT208
MECHANICSBURG. PA 17050-1852
Dear Sir or Madam:
09/21/2006
A death benefit payment has been processed from the Thrift Savings Plan (TSP) account of:
Participant's Name: BROWN, JUDITH
Date of Payment: 09/21/2006
Total Amount of Payment:
Minus Amount withheld:
Net Amount Paid to You:
Payment Method: Check
$32,545.01
$3,254.50
$29,290.51
The amount paid to you by check or direct deposit will be reported to the Internal Revenue
Service on Form 1099-R, Distributions from Pension, Annuities, Retirement or Profit Sharing Plan,
IRAs, Insurance Contracts, etc. You will receive a copy of this form by January 31 of next year.
If your address shown is not correct, please notify the TSP immediately. Materials mailed
to an incorrect address may not reach you. Mail your address information to the address on the
letterhead.
If you have questions, call the ThriftLine number shown below. Callers outside the United
States and Canada should call (404) 233-4400 (not a toll-free number). The TSP Service Office
hours are Monday through Friday 7 a.m to 9 p.m. eastern time. You can also write to the TSP
Service Office. Please include your daytime telephone number and your entire Social Security
number on all correspondence. Note: If you are a member of the uniformed services, do not
provide your Defense Switched Network (DSN) telephone number.
Web Site: www.tsp.gov
ThriftLine: 1-TSP-YOU-FRST (1-877-968-3778)
Fax number: 1-866-817-5023
TOO: 1-TSP-THRlFT5 (1-877-847-4385)
N'nti...."". nrAflt;l
, .....I'L..
FERS.
DESIGNATION OF BENEFICIARY
Form AppIMId; 0I0lB No. 3206-
IMPORTANT
Ae8d 8ft IMIrucIIons before
filling In ..... form.
~EmpIoyea
~S,....
SECTION A-IDENTIFICATION
Name (lAst. FtrSt. Middle)
Federal Employees Retirement System
. h
Place an .. X" In the appropriate box below:
An employee
Retired or applying for retirement
Former employee eligible for retirement in !he future
Department or agency in which presently employed (or former department or agency)
Department or agency a..rea.. Division
6 29 48
If you are retired, give your claim number
Social Sec:vfry Number
193 36 4179
lDcarlon (City. StaIII and ZIP Code)
Navy
NISE WEST
Business Directorate
San Diego, CA 92110
I, the individual named above, designate the beneficiary or beneficiaries named below to receive any lump-sum benefit which may
become payable under the Federal Employees Retirement System (FERS) after my death. I understand that this designation of beneficiary
is also for any lump-sum benefit which may become payable under the Civil Service Retirement System (CSRS) after my death. I under-
stand that this designation of beneficiary cancels any previous FERS or CSRS designation of beneficiary, and that it remains in effect
until I cancel it in writing or I receive payment of my employee deductions for FERS (and CSRS, if applicable).
I direct, unless otherwise ioolCaled below, that if more than one beneficiary is named, the share of any beneficiary who may predecease
me or who may be disqualified for any other reason, shall be distributed equally among the stated beneficiaries, or entirely to the survivor.
If none of the beneficiaries are alive and eligible to receive payment when a lump-sum payment becomes payable, this designation is
void, and payment will be made accorcJing to the order of precedence set by law.
SECTION B-INFORMATION CONCERNING THE BENEFICIARY OR BENEFICIARIES (See Examples of ~}-TYPE OR PRINT
First name, middle initial, and last name Address, including ZIP Code, Relationship Share to be paid
of each beneficiary of each beneficiary
------------------------- ----------------------------- ------- ----------
389 Sample Bridge Rd.
Barbara J. Gilbert Enola, PA 17025 Sister 100%
if deceased, then to:
------------------------- ----------------------------- ------- ----------
Mr. & Mrs. Lewis R. CRULL
1065B Allendale Rd.
Mechanicsburg, PA 17055 Parents 100%
-------------------------
----------------------------- ------- ----------
------------------------- ----------------------------- ------- ----------
Date of Designation (Month. Day, Year)
Total = 1 ()()OAJ
9/14/92
SECTION C-W1TNESSES TO SIGNATURE (A Wltne . IneligIble to recelvep yment a. a beneficiary)
We e undersigned, certify that this stafeaQent was signed in our presence.
:~~,--~~-- j7'<2:,U--&_c:_~_&0~______ ~:M2_~E-9__
e of Wit Street Address . T ...: CIty, lUId ZJP Code
- / . q v.e . . . (6
E RETURN OF COpy
r-Judith L. BROWN
2451 Chicago St.. #3
San Diego, CA 9211D
I
ECEIVING AGENCY CERTIfICATION
I have reviewed this designation and ceriify that Ihe designated shares
total 1000/0 and that no witnesses are designated as beneficiaries.
Date Received
See back otemployee ~py for insbuctions
on where to file these. forms.
NSN 754O'G1.:i!48<<!52
DIife
09-14-92
ORIGIN
(Retain until employe I ves Federal
service and then 8 d to OPM)
SF 3"lQZ "-y 11/87
U.B. ~ "'............ ~
5CFRIIoI3
I
W,"lIs F3rgo f\d antge Funds'"
P.O. BOI( 3266 ,. st ',Massachusetts 02266
1 ;
wvvw.weilsfargo "om dvantagefunds
.
r
,
September 28, 2006
The Wiley Group
130 W Church Street Ste 100
Dillsburg PA 17019
Attn S Dawn Gladfelter
Reference: 02994383
Wells Fgo Avtg Growth And Income-Inv
Account Number: 01202104337
State Street Bank & Trust CO
Cust For The IRA Of
Judith L Brown
Dear Ms. Gladfelter:
We are contacting you in regard to the above referenced Wells Fargo Advantage Funds
account.
The value of the Wells Fargo Advantage Growth and Income Fund-Investor Class
account, as of July 31,2006, was $1,419.33. The value was determined by multiplying
the number of shares in the account, 69.507, by the net asset value (NA V) price per share
on that day, $20.42. Please be aware that the account value can fluctuate each business
day depending on the value of the securities in a Fund's portfolio. The account was
established on March 19,2001.
Our records indicate the account was transferred to the beneficiary, John W. Brown, on
August 21,2006 and is closed with a zero balance.
If you have any questions or require further assistance, please call us at 1.800.222.8222.
Representatives are available 24 hours a day, 7 days a week.
Sincerely,
~~
Jeannine Assad
Client Relationship Team
I NOT FDIC INSURED' NO BANI< GUARANTEE. MAY LOSE VALUE i
: ~-11tJf EX+ (12-99)
.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brown, Judith Louise
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-00715
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 2,770.40
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 10,000.00
2. Attorney's Fees Wiley, Lenox, Colgan, & Marzzacco, P.C. 10,000.00
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 314.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 10,131.64
See continuation schedule(s) attached
TOTAL (Also enter on line 9, Recapitulation) 33,216.04
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev. 6-98)
~ R~V-160:rEX+ (6-98)
*'
SCHEDULE H.A
FUNERAL EXPENSES
continued
COMMONWEAlTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brown, Judith Louise
FILE NUMBER
21-06-00715
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Hoffman-Roth Funeral Home:
2.630.20
2
Hoffman-Roth Funeral Home (obituaries):
140.20
Subtotal
2.770.40
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
: ~V-150f EX+ (6-98)
.
SCHEDULE H-B7
OTHER
ADMINISTRATIVE COSTS
continued
COMMClNWEAI. TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brown, Judith Louise
FILE NUMBER
21-06-00715
ITEM
NUMBER DESCRIPTION AMOUNT
1 Cumberland Law Journal (advertise estate): 75.00
2 Frank Zeplin (mowing & lawn maintenance): 185.50
3 Real Estate Settlement Closing Costs: 6.385.31
4 Register of Wills (add' I short certs): 28.00
5 Register of Wills (filing fee): 30.00
6 The Patriot News (advertise estate): 173.33
7 Withholding from Thrift Savings Plan: 3.254.50
Subtotal
10.131.64
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B7 (Rev. 6-98)
. R:V-151fEX+ (6-98)
*'
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brown, Judith Louise
FILE NUMBER
21-06-00715
InClude unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Claremont Nursing Home:
VALUE AT DATE
OF DEATH
9.669.95
2 First Horizon (payoff mortgage):
154.409.84
3 Pinnacle Health Hospital:
21.44
4 PP&L (electric):
146.64
TOTAL (Also enter on line 10, Recapitulation)
164,247.87
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 fonn software only The Lackner Group. Inc.
Fonn PA-1500 Schedule I (Rev. 6-98)
"'.. ..
REV.1513 EX+ (9..00)
.
SCHEDULE .J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Brown, Judith Louise 21-06-00715
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do No! Us! TRlstee(s)
I. TAXABLE DISTRIBUTIONS [include outright sgousal
Clistributionsg and ransfers
under Sec. 116(a)(1.2)]
1 John W. Brown Other 3,980.85
PA
2 Barbara Jane Gilbert Sister one hundred
1400 Bent Creek Blvd. percent of
Apt. 208 residue
Total 3,980.85
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" - 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)
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jan M. Wiley
David j. Lenox
Timothy j. Colgan
Christopher j. Marzzacco
David E. Hershey
Thomas M. Clark
Angelica L. Revelant
Paul j. Kovatch
THE WILEY GROUP
Attorneys at La-w-
February 8, 2007
Wiley, Lenox, Colgan & Marzzacco, P.c.
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, P A 17013
In Re: Estate of Judith Louise Brown, deceased
File Number 21-06-00715
Dear Register:
Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status
report with regard to the above captioned estate. Also enclosed is a check in the amount of
$910.59 representing the tax due, and a check in the amount of$30.00 representing the filing fee.
Please return the recording receipts to my attention in the enclosed envelope.
Thank you for your cooperation.
Sincerely,
fl~ ftL.dl ; /i Ii)
Dawn Gladfelter/ Assi;~~ ~~
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130 W. Church Street, Suite 100 · Dillsburg, PA 17019 · Phone: (717) 432-9666 . (800) 682-4250 . Fax: (717) 432-0426
Offices in Harrisburg · York. Carbondale
www.wileygrouplaw.com