HomeMy WebLinkAbout10-16-07
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15056041125
REV-1500 EX (06-05)
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
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
2 1 0 7
File Number
o 8 9 3
Date of Birth
194449593
1 2 302 0 0 6
04131953
Decedent's Last Name
Suffix
Decedent's First Name
B ROW N
DAN A
MI
L
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's 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
[ZJ 1. Original Return
o 4. Limited Estate
o
o
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Clecedent Maintained a Living Trust
(Attach Copy of Trust)
10. Slpousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
~etween 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETJD. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
r
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
8. Total Number of Safe Deposit Boxes
2. Supplemental Return
o
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
R 0 G E R M M 0 R G E NTH A L
717 -9094383
Firm Name (If Applicable)
City or Post Office
State
ZIP Code
~~~_._--~-~...........__--'--1-_..____ _ _ ___________
I REGISTER OFWII,LS US~bNLY
I
I
I -,
I t'.)
l____~ _~~A~~ ~!~E:l)__~;
First line of address
251 5 NOR T H FRO N T S T R E E T
Second line of address
H A R R I S BUR G
P A
17110
Under penalties of perjury, I declare that I have examined this retur ,including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than t e personal representative is based on all information of which preparer has any knowledge.
SIGNA OF PERSON RESPONSIBLE FOR FIL RETU N DATE
. 10/16/07
ADDRESS
755 MT. ROCK ROAD
CARLISLE
PA 17015
DATE
10/16/07
PA 17110
HARRISBURG
PLEA E USE ORIGINAL FORM ONLY
Side 1
L
15056041125
15056041125
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: DANA L. BROWN
RECAPITULATION
194449593
1. Real estate (Schedule A)
1.
3700000
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.
10000
6. Jointly Owned Property (Schedule F) 0 Sepllrate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probclte Property
(Schedule G) 0 Separate Billing Requested. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7) 8. 3 7 1 0 0 0 0
....... . ............. .
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 8 2 5 4 2 9
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . 10. 2 4 2 4 4 3
11. Total Deductions (total Lines 9 & 10) ......11. 1 0 6 7 8 7 2
......... . .......... .
12. Net Value of Estate (Line 8 minus Line 11) 12. 2 6 4 2 1 2 8
....... . ................ .
13. Charitable and Governmental Bequests/See 9113 Trusts for which 0 0 0
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . 14. 2 6 4 2 1 2 8
.......... .
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 0 0 0
(a)(1.2) X.O _ 0 0 15. 0
16. Amount of Line 14 taxable 2 6 4 2 1 4 8 1 1 8 8 9 7
at lineal rate X .O~ 16.
17. Amount of Line 14 taxable 0 0 0 0 0 0
at sibling rate X. 12 17.
18. Amount of Line 14 taxable 0 0 0 0 0 0
at collateral rate X .15 18.
19. Tax Due 19. 1 1 8 8 9 7
................................. .
20. FILL IN THE OVAL IF YOU ARE REQUESTING AI REFUND OF AN OVERPAYMENT
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Side 2
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15056042126
15056042126
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REV-1S00 EX Page 3
Decedent's Complete Address:
DECEDENT'S NAME
DANA L. BROWN
STREET ADDRESS
755 MT. ROCK ROAD
File Number
0893
~--~---
CITY
CARLISLE
: STATE
! PA
1 Z1P-
117110
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8, Prior Payments
C, Discount
(1)
1,188,97
1 ,255.00
Total Credits (A + 8 + C) (2)
1 ,255.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This i~ the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refuhd. (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This ils the TAX DUE. (5)
0.00
66.03
0.00
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
0.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and : Yes No
a. retain the use or income of the property tran$erred; ...................................................................... D 00
b. retain the right to designate who shall use th$ 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 ~ecedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... D 00
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... D 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ......... ...... .,........ .......................... ................. ................. .............. D 00
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS 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, 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. !l9116 (a)(1.1) (i)],
For dates of death on or after January 1,1995, the tax rate imposed on Ithe net value of transfers to or for the use of the surviving spouse is zero (0) percent
[72 P,S. !l9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to ~ 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 nly beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased chi! 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. !l9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of th decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in
72 P.S. !l9116(1.2) [72 P.S. !l9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of th decedent's siblings is twelve (12) percent [72 P.S. !l9116(a)(1.3)]. A sibling is defined, under
Section 9102, as an individual who has at least one parent in common iththe decedent, whether by blood or adoption.
REV.1,.502 EX + (6.98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
DANA L. BROWN
FILE NUMBER
0893
ITEM
NUMBER
1.
DESCRIPTION
REAL ESTATE PREMISES 755 MT. OCK ROAD, CARLISLE, PENN TOWNSHIP,
CUMBERLAND COUNTY, PA, SOLD ON 10/12/07 TO DARRELL W. DEWALT.
COPY OF SETTLEMENT SHEET ATTACHED.
VALUE AT DATE
OF DEATH
37,000.00
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
37,000.00
.. ;&.,
...
B. Type of Loan
I. D FHA 2. D FmHA
4. D VA 5. D Conv. Ins.
u.s. [jlepartment of Housing
and Urban Development
I
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1r
'A. Settlement Statement
3. D Conv. Dnins.. 6. File Number
3418.2
OMB No. 2502-0265 (Page I)
7. Loan Number
8. Mortgage Insurance Case Number
C. Note:
Thil fonn .. fUl'1IlIhe4 to Ihle you a atatem.t or achlallddement ~b. Amoantl paid to ...d by dle.e CAI a,eat an .bowa. hem. marked "'{p.o.c.)" "ere,.id ..tlide the dOI.1i they an Ibown here for
lnformadoD" purp..a aad are not induded ia die 'otala.
D. Name and Address of Borrower
Darrell W. DeWalt
370 Meadows Road
Newville, PA 17241
755 Mount Rock Road, Carlisle, P A 17015
Penn Township, Cumberland County
E. Name, Address, and Taxpayer identifica ion # of Seller r' Name and Address of Lender
Estate of Dana L. Brown N/ A - CASH
by Kevin J. Brown, Administrator
H. Se lement Agent Name, Address and Taxpayer Identification Number
H .lton C. Davis
201 East Burd Street, Suite 6
P.O. Box 40 25-1530888
Place of Settlement I. Settlement Date
37'S. Hanover Street, Carlisle, PA 17013 10/1212007
K. S mmary of Seller's Transaction
400. Gross Amount Due To Seller
37,000.00 401. Contract sales price 37,000.00
402. Personal Property
1,254.25 403.
404.
405.
G. Property Location
J. Summary of Borrower's Transactions
100. Gross Amount Due From Borrower
10 1. Contract sales price
102. Personal Property
103. Settlement charges to borrower (line 1400)
104.
105.
Adjustments for items paid by seller in advance
106. City/town taxes to
107. County taxes 10/12/07 to 12/31/07
108. Assessments to
109. School Tax 10/12107 to 06/30/08
110. Garbage Fee
Ill.
112.
Adjustments for items paid by seller in advance
406. City/town taxes to
23.07 407. County taxes 10/12/07 to 12131/07 23.07
408. Assessments to
385.94 409. School Tax 10/12/07 to 06/30/08 385.94
410. Garbage Fee
411.
412.
120. Gross Amount Due From Borrower
38,663.26 420. Gross Amount Due To Seller 37,409.01
200. Amounts Paid By Or in Behalf Of Borrower
SOO. Reductions in Amount Due To Seller
201. Deposits or earnest money 3,044.43 501. Excess deposit (see instructions) 3,044.43
202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) 1,512.93
203. Existing loan(s) taken subject to 503. Existing Ioan(s) taken subject to
204. 504. Payoff of first mortgage loan
205. 505. Payoff of second mortgage loan
206. 506. Escrow for Estate Finalization to: Roger 10,000.00
207. Post-Settlement Lease Rental Payment ($375x3) 1,125.00 507. Post-Settlement Lease Rental Payment ($375x3) 1,125.00
208. 508.
209. 509.
Adjustments for items unpaid by seller ~djustments for items unpaid by seller
210. City/town taxes to 510. City/town taxes to
211. County taxes to 511. County taxes to
212. Assessments to 512. Assessments to
213. School Tax to 513. School Tax to
214. 514.
215. 515.
216. 516.
217. 517.
218. 518.
219. 519.
220. Total Paid By/For Borrower 4,169.43 520. Total Reduction Amount Due Seller 15,682.36
300. Cash At Settlement Fromffo Borrower 600. ,Cash At Settlement To/From Seller
301. Gross Amount due from borrower (line 120) 38,663.26 601. ! Gross Amount due to seller (line 420) 37.409.01
302. Less amounts paid by/for borrower (line 220) ( 4,169.43 602. 'Less reductions in amI. due seller (line 520) ( 15,682.36 )
303. Cash [XJ From o To Borrower $ 34,493.83 603. Cash [XJ To o From Seller S 21,726.65
I bave carefully rc:v'~ed the ~ I Settlement ~tatement and to tb~ best of my knowledge and belief, it is a rr-+~ and accurate statement of all receipts and disbursements made on my
accoUD. .t Oyb). Y m.c. m this, b"anS~Cbon. I furth....P'certifY tb~ I~ve recclVed a completed copy of pages I an:&2 of.! I.Settlement Statement.
(/ / . / . . ",0/, ../,.-::: ../~____.
/...,-(:,-.{.'~'-_./ ,,-.(t, .//:~;.ct".<,""""t.::,(;.::/ ./ .----1._ _
Borrower Darrell W. DeWalt /Sell rEstate of Dana L. Brown, K.....iftJ. Brown, Admin
~/
Borrower
SETTLEMENT AGENT CERTIFICATION
The HUD-l Settlement Statement which I have p'~red il a true and accuRte account of this 1nnsaction. 1 have
~ed~dstobedi5bu~U1acco.~t;:eW!th .,~sltaternenl " /
~""'""Ai""I,j .,} ,.l~ ,of!: i,'j 't'.'ll: .'/t' I
Settlement Agent Date
r:~8'r8~ ~~~~:nt~i~:i~3~YI '3~e.:~~r:~=~~:.oi~ J~I: ~~~tl:l~~.Sr cJd~~r~~jlloof~d
eUer's Taxpayer Identification Number Solicitation aDd Certification
You Tl,quired by law to provide the Settlement Ase!'1t named above with you, COrTect ~payer identification
I:";ub tJfuci~~ ~~tJri~i~~ ;:':l:~mr':~ = tf:~~.al~rr ~~;~n~~~l~::m~
shown on thiS statement is my correct taxpayer identification number.
HUD - I 3/91
Seller's Si ature
Date
RESPA, HB 4305.2
701.
702.
703.
704.
800.
801.
802.
803.
804.
805.
806.
807.
808.
809.
810.
811.
900.
901.
902.
903.
904.
905.
1000.
1001.
1002.
1003.
1004.
1005.
1006.
1007.
1008.
1100.
II0l.
1102.
1103.
1104.
1\05.
1106.
1107.
L. Settle......! Chartes
700. Total Sales/Broker's Commission based on $
Division of Commission (line 700) as follows:
$ ro
$ ro
Commission paid at Settlement
@
0/0_
Paid From
Borrower's
Funds at
Settlement
Page 2
Paid From
Seller's
Funds at
Settlement
Items Payable in Connection With Loan
Loan Origination Fee
Loan Discount
Appraisal Fee
Credit Report
Lender's Inspection Fee
Mortgage Insurance Application Fee
Assumption Fee
Flood Certification Fee to:
%
%
to
to
to
to
Items Required By Lender To Be Paid In Advance
Interest from to @ $
Mortgage Insurance Premium for
Hazard Insurance Premium for
/day
months to
years to
Reserves Deposited With Lender
Hazard Insurance
Mortgage Insurance
City property taxes
County property taxes
Annual assessments
School Taxes
s
per
per
per
per
per
per
per
1\08.
Aggre ate Reserve Adjustment
Title Charges
Settlement or closing fee
Abstract or title search
Title examination
Title insurance binder
Document preparation
Notary's fees
Attorney's fees
(includes above items numbers:
Title insurance
(includes above items numbers:
Lender's coverage
Owner's coverage
ro
to
to
to
to
to
to Roger M. Morgenthal, Esquire
500.00
500.00
to Hamilton C. Davis, Esq, Agent for CTIC($125POC)
345.75
1109.
1110.
1111.
1112.
1113.
1200.
1201.
1202.
1203.
1204.
1205.
1300.
1301.
1302.
1303.
1304.
1305.
1306.
1307.
1308.
1309.
1400. Total Settlement Char es enter on lines 103, Section J and 502, Section K 1,254.25 1,512.93
Initial Escrow Account Statement Reqnired by Section I (e) (I) of tbe Real Estate SeUlement Procednres Act (RESPA)
If checked. 0 the terms afyauT loan requrre you to have an escrow account to assure that the Clrtam obligations relating to the mortgaged property, such as taxes, msurance
premIUms Bnd other charges are paid The amount specified below will be collected, along With y ur mortgage pnnclpal and mterest payments, durmg the first 12 months after
your account 15 opened to pay these anticipated expenses Escrow Aa:otmt
Beginning Date: Your escrow account payment will b $ prr
Payee Purpose I Anticipated Due Date Estimated Amount
~
~
$
$
37,000.00
Government Recording and Transfer Charges
Recording fees: Deed $ 38.50; Mortgage $
City/county tax/stamps: Deed $ 370.00 ; Mortgage $
State tax/stamps: Deed $ 370.00 ; Mortgage $
; Releases $
38.50
370.00
0.00
0.00
370.00
Additional Settlement Char es
2007 Countyffownshi Real Estate Taxes to: Mabel Stitt, Tax Collector
2007-08 School Real Estate Taxes to: Mabel Stitt, Tax Collector
105.26
537.67
HUD-13/91
RESPA, lIB 4305.2
REV-': 508 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
~CHEDULE E
CASH, $ANK DEPOSITS, & MISC.
PE SONALPROPERTY
ESTATE OF
DANA L BROWN
ITEM
NUMBER
1.
FILE NUMBER
0893
Include the proceeds of liti ation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
2,
DESCRIPTION
1984 FORD L TD STATION WAGON" VIN 1FABP4039EG115674,
JUNK CONDITION, 413,600 MILES <PN ODOMETER, APPRAISED BY DEWALT'S
APPRAISAL SERVICE, COpy OF ARPRAISAL ATTACHED
MISCELLANEOUS HOUSEHOLD GOODS, FURNITURE AND FURNISHINGS, POOR
CONDITION, HAD TO BE HAULED /1WAY AS CONDITION OF HOUSE SALE,
NO VALUE.
VALUE AT DATE
OF DEATH
100.00
0.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is n eded, insert additional sheets of the same size)
100.00
~10/2007 15:25 7177759413
DEWALT'S APPRAISAL
PAGE 02
DEWALT'S
P.o. BOX 35
PHONE 717-77
"$
October to, 2007
I
I
I
VEmCLE APPRAISAL FOR l~ FORD L TD STA nON WAGON" . DR
3.8 LITRE V""' AUTOMATIC I
MILEAGE: 413600 V.I.N.IF~P403'EGt1~74
i
OwIIecI by : DANA BROWN (defeued)
7SS Mottat Rock Ro~d
C....ae, Pa.
Baed 0.. vis... iDs:j' OB of the ear, I would eo.sider the eeadition ratiag
as poor. Dad tape eoven y rust $pO.., paint displays extreIIle f.de, illterior
eoaditieD is heavily toiled, fad 4 tom. OwJaen SOD states revene iI bIoperable in
tile tnuIJ_llliOD. i
I HI of the opiaion, thillvehicle lVould qualify as . cnult piece .t . 1aIv.
yard, with. valwe of $100.80.
~$. tkl/~
DarreU W. DeWalt
1....13
motor veb Ie physieaJ dam.. .ppnaise..
REV-l511 EX + (12-99)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
A MINISTRA TIVE COSTS
ESTATE OF
DANA L. BROWN
FILE NUMBER
0893
Debts of decede~t must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
EGGER FUNERAL HOME, INC., NEWVILLE PA, FUNERAL AND CREMATION
2,513.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) gVI N J. BROWN
Social Security Number(s)/EIN Number of P~rsonal Representative(s)
Street Address 755 MT. ROCK RPAD
City CARLISLE State PA Zip 17015
0.00
Year(s) Commission Paid: N/A
2.
3.
Attomey Fees ROGER M. MORGENTHAL, ESQUIRE
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant KEVIN J. BROWN
Street Address 755 MT. ROCK RpAD
City CARLISLE State PA
Relationship of Claimant to Decedent liQjN AND ONLY HEIR
I
2,000.00
3,500.00
Zip 17015
4.
Probate Fees REGISTER OF WILLS, dUMBERLAND COUNTY
LETTERS OF ADMINISTRATION AND SHORT CERTIFICATES
113.00
5.
Accountant's Fees
6.
Tax Return Prepare~s Fees
7.
8.
9.
10.
REGISTER OF WILLS, CUMBERLA~ND COUNTY, FILE INH. TAX RETURN
CUMBERLAND LAW JOURNAL, A VERTISE LETTERS
THE VALLEY TIMES-STAR, ADVE TISE LETTERS
15.00
75.00
38.29
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is eeded, insert additional sheets of the same size)
8 254.29
REV:1512 EX + (12-03)
'*
SCHEDULE.
DEBTS OF DECEDENT,
MORT AGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DANA L. BROWN
i
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
FILE NUMBER
0893
ITEM
NUMBER
1.
DESCRIPTION
2005 AND 2006 DELINQUENT TAX~S OWED BY DECEDENT ON REAL ESTATE
OWED TO PENN TOWNSHIP AND ElIG SPRING SCHOOL DISTRICT
VALUE AT DATE
OF DEATH
1,539.43
2.
LOAN FROM BARRY AND BELINDA BROWN, 911 MT. ROCK ROAD, CARLISLE
PA 17015
885.00
TOTAL (Also enter on line 10, Recapitulation) $
2 424.43
(If more space is nee ed, insert additional sheets of the same size)
'''~''''~.(*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DANA L. BROWN
SCHEDULE J
BENEFICIARIES
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) REC61VING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
FILE NUMBER
0893
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
AMOUNT OR SHARE
OF ESTATE
1.
KEVIN J. BROWN
755 MT. ROCK ROAD
CARLISLE, PA 17013
Lineal
26,421.28
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
1. 0.00
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTI$NS
1.
0.00
TOTAL OF PART II - ENTER TOTAL NON-TAXABL DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is eeded, insert additional sheets of the same size)
$
0.00