Loading...
HomeMy WebLinkAbout04-19-07 ..J 15056051058 REV-1500 EX (06-05) PA Department of Revenue '* Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128..()6()1 ENTER DECEDENT INFORMATION BELOW Social Number Date of Death OFFICIAL USE ONLY County Code Year INHERITANCE TAX RETURN RESIDENT DECEDENT File Number 21 06 0893 Date of Birth 193-24-1642 07/20/2006 12/04/1926 Decedent's Last Name Suffix Decedent's First Name MI Brewbaker Elizabeth K (If Applicable) Enter Surviving Spouse's Information Below Last Name Suffix First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1, Original Retum 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate ca> 4a. Future Interest Compromise (date of death after 12-12-82) t::::J 7. Decedent Maintained a Living Trust (Attach Copy ofTrust) c:::::> 10. Spousal Poverty Credit (date of death C::::J 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received J) 8. Total Number of Safe Deposit Boxes r:...:l John C Oszustowicz (717) 243-7437 Firm Name REGISTER OF ~LLS USE '-coO TJ >' (j :;:::~I Law Office of John C Os First line of address :;;:cr 104 5 Hanover 5t PA 17013 \.D Second line of address """r::'l , or Post Office State ZIP Code .r- \..0 Correspondent's e-mail address; Under penalties of pe~ury, 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 complete. Declaration of preparer ot r than the personal representative is based on all information of which preparer has any knowledge. SIGNAT F RS~~SIBLE FOR F RETURN DATE PA II ~L, DATE 110/3 Side 1 L 15056051058 15056051058 .....I ~ -.J 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name: RECAPITULATION Elizabeth K Brewbaker 193-24-1642 1. Real estate (Schedule A). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 118,890.00 7,253.18 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. 32,341.25 6. Jointly Owned Property (Schedule F) c;::) Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) c;::) Separate Billing Requested.. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 8. 158,484.43 14,276.25 11,897.37 26,173.62 132,310.81 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. 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. 132,310.81 TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable at lineal rate X.045 132,310.81 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 15. 16. 5,953.99 17. 5,953.99 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 15056052059 ...J REV-1500 EX Page 3 Decedent's Complete Address: DECEDENrs NAME Elizabeth K Brewbaker STREET ADDRESS 50 Big Spring Ave 93 DECEDENrs SOCIAL SECURITY NUMBER 193-24-1642 CITY Newville STATE PA ZIP 17241 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 5,953.99 2,500.00 131.58 Total Credits (A + B + C ) (2) 2,631.58 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. FiJI in oval on Page 2, Line 20 to request a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,322.41 A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (5B) 3,322.41 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. retain the right to designate who shall use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments. benefits or care? ...................................................................... 0 [iJ 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 [iJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 0 [iJ 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. g9116 (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 zero {OJ percent [72 P.S. 99116 (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 (OJ percent [72 P.S. g9116{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. g9116{1.2) [72 P.S. g9116{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. g9116{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. --I REV-1502 EX+ (6-9. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF Brewbaker, Elizabeth K FILE NUMBER 21-06-0893 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, nenher being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Residence & Land located at 50 Big Spring Ave, Newvlle, PA 17241 ."",..~ 28-20-115-4-0€l1 VALUE AT DATE OF DEATH a 118,890.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 118,890.00 REV-1503 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Brewbaker, Elizabeth K FILE NUMBER 21-06-0893 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION RVS Tax-Exempt High Income Mutual Fund - Class A 1674.638 shares TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 7,253.18 REV-1508 EX+ (6-98). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Brewbaker, Elizabeth K FILE NUMBER 21-06-0893 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survlvoflhlp must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH Orrstown Bank Checking Account #400246 2 Members First Checking Account #111293 3 2002 Ford Van 14,290.00 10,581.00 6,530.00 940.25 4 Refund from Insurance TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 32,341.25 REV-1511 EX+ (12-99. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Brewbaker, Elizabeth K FILE NUMBER 21-06-0893 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT 2 3 FUNERAL EXPENSES; Egger Funeral Home Wayne Noss Flowers Big Spring United Lutheran Church Eby Granite Works 1. 4 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 1,677.50 3. Family Exemption: (If decedenfs address is notlhe same as claimant's, attach explanation) Claimant Street Address City State ,Zip Relationship of Clairnantto Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Legal Advertising 8 Register of Wills Filing Fees 9 Nationwide Auto/Homeowners Insurance 10 Autoshine auto detailing 11 Hoove~s Plumbing - furnace cleaning Total from additional sheet 195.00 1 972.95 132.50 104.50 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 14,276.25 SCHEDULE H CONTINUED Estate of Brewbaker, Elizabeth K File No. 21-06-0893 12 Real Estate Tax 481.28 13 Danatech Security Systems 198.00 14 Koughs Oil 444.91 15 NWSA Sewer & Water 104.61 16 PPL Electric 150.76 17 Suburban Energy 469.37 18 Robert Baker Electric 300.00 Total $2,148.93 REV-l512 EX+ (12-03) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Brewbaker, Elizabeth K FILE NUMBER 21-06-0893 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 2 Orrstown Bank Loan #160028895 8,788.65 Visa Credit Card 100.93 Nationwide Auto Insurance 193.15 Chambersburg Hospital 152.00 MGM Pharmacy 204.03 Real Estate Taxes 1,747.86 Dish Network 11.95 Embarq phone bill 310.36 NWSA water & sewer bill 209.22 PPL 124.18 Waste Management 55.04 3 4 5 6 7 8 9 10 11 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 11,897.37 REV-1513 EX+(9-00) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Brewbaker, Elizabeth K NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)] FILE NUMBER 21-06-0893 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Linda Kennedy Step daughter 1.00 2 Nolan Brewbaker Son 44103.27 3 Norman Shughart Son 44103.27 4 Judy Davis formerly Judy Mae Shughart Daughter 44103.27 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 (If more space is needed, insert additional sheets of the same size)