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Home My WebLink About10-29-07 --' 15056041125 REV -1500 EX (06-05) PA Department of Revenue .. ~~~~~~~~~~ual Taxes INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year 2 1 0 7 File Number 068 3 Date of Birth 06309 893 9 04292 007 05311917 Decedent's Last Name Suffix Decedent's First Name PIN K FRANCIS MI A (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 00 1. Original Return o 4. Limited Estate o o o 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach Copy of Trust) o 10. Spousal Poverty Credit (date of death 0 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 o o 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes JAN L BROWN 71754 1 555 0 ""._..,) Firm Name (If Applicable) J A N L BROWN & ASS 0 C REGISTER ILLS USE ~Y :~ S3 :~, ,'c, C) ,'1 -\-~ (-") ~ First line of address 845 SIR THOMAS C T S T E 1 2 N \.D Second line of address (-) ',1 -0 City or Post Office State ZIP Code . ..~ DAlE FILED <:::) I' i ~J HARRISBURG P A 17109 Correspondent's e-mail address:brendailb@verizon.net Under penalties of pe~ury I dedare 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. Dedaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE ERS SIBLE FOR FILING RETURN DATe:J I (OI2.f,Il,()Or ADDRESS 30 Kell Carlisle PA 17015 DATE I PA 17109 N REPRESENTATIVE ADDRESS 845 Sir 12 Harrisburg PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056041125 15056041125 --.J ~ -.J 15056042126 REV-1500 EX Decedent's Name: FRAN CIS A. PIN K RECAPITULATION 1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1. 2. Stocks and Bonds (Schedule B) .................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. . " 3. 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested . . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested. . . . . .. 7. 8. Total Gross Assets (total Lines 1-7) ........................... 8. 9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . .. 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPLICABLE RATES 15. 16. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.O _ o . 0 0 15. Amount of Line 14 taxable 1 9 3 4 6 3 . 2 6 at lineal rate X .O~ 16. Amount of Line 14 taxable o . 0 0 at sibling rate X .12 17. Amount of Line 14 taxable o . 0 0 at collateral rate X .15 18. 17. 18. 19. Tax Due . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 15056042126 Decedent's Social Security Number 063098939 184408.98 26860.55 211269.53 9216.96 8589.31 17806.27 193463.26 193463.26 O. 0 0 8705.85 O. 0 0 O. 0 0 8705.85 00 15056042126 --.J Decedent's Complete Address: DECEDENTS NAME FRANCIS A. PINK STREET ADDRESS 30 Kelly Drive_ File Number 21 07 0683 REV-1500 EX Page 3 ------- -------- I STATE PA I ZIP 17013 --.-- -- - --. - CITY Carlisle Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 8,705.85 8,300.00 435.29 Total Credits (A + B + C) (2) 8,735.29 3. (3) (4) (5) (5A) (58) 0.00 29.44 0.00 4. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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 transferred; ...................................................................... 0 IXI b. retain the right to designate who shall use the property transferred or its income; ............................... 0 IXI c. retain a reversionary interest; or ................................................................................................ 0 IXI d. receive the promise for life of either payments, benefits or care? ....................................................... 0 IXI 2. If death occurred after December 12,1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... 0 IXI 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ......... 0 IXI 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .................................................................................................. 0 IXI IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. ~9116 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. ~9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116{a)(1)). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a}(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX + (6-98) '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FRANCIS A. PINK FILE NUMBER 21 07 0683 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. American Funds Grth Fund of Amer F (GFAFX) 21,970.58 632.065 shs @ $34.76/sh 2 Davis Opportunity Y (DGOYX) 11,389.72 390.594 shs @ $29.16/sh 3 Julius Baer International Equity A (BJBIX) 15,803.30 337.461 shs @ $46.83/sh 4 Royce Premier Inv (RYPRX) 11,198.48 564.724 shs @ $19.83/sh 5 T. Rowe Price Equity Income (PRFDX) 24,258.01 782.264 shs @ $31.01/sh 6 Third Avenue Real Estate Value (TAREX) 10,472.32 282.349 shs @ $37.09/sh 7 Vanguard Short-Term Investment-Grade (VFSTX) 62,603.23 5,911.542 shs @ $10.59/sh 8 Wells Fargo Advantage Ultra SIT Inc Inv (STADX) 26,713.34 2,935.532 shs @ 9.1/sh TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 184408.98 REV-1508 EX + (6-98) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FRANCIS A. PINK FILE NUMBER 21 07 0683 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. M& T Bank Checking 1411810202 12,428.97 2 M& T Bank Market Adv 15004211211624 2,548.73 3 Multi-Financial Securities Corp Acct 08Z-086848 6,105.36 Cash (ING Caissie Money Fund) 4 Multi-Financial Securities Corp Acct 08Z-086848 2,500.00 Credit on 9/17/07 for check not negotiated 5 Kinetic Imaging; Account 7679932 refund 121.41 6 Sarah A Todd Memorial Home; credit balance refund 290.81 7 United States Treasury; 1040 refund for 12/06 2,865.27 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed. insert additional sheets of the same size) 26860.55 REV-1511 EX + (12-99) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FRANCIS A. PINK FILE NUMBER 21 07 0683 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Malpezzi Funeral Home 285.28 2 Funeral luncheon 1,000.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Numbe~s)IEIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attomey Fees Jan L Brown & Associates 6,338.00 3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees Register of Wills, Cumberland County 416.00 5. Accountanfs Fees 6. Tax Retum Preparer's Fees 1040 & 1041 500.00 7. Cumberland Law Journal; legal advertising 75.00 8 The Sentinel; legal advertising 206.50 9 M& T Bank; bank charges 44.85 10 Multi-Financial Securities Corp; advisory fees 351.33 TOTAL (Also enter on line 9, Recapitulation) $ 9216.96 (If more space is needed, insert additional sheets of the same size) REV-1512 EX... (12.Q3) '* SCHEDULE. DEBTS OF DECEDENT I MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FRANCIS A. PINK FILE NUMBER 21 07 0683 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1. Checks written predeath and cashed postdeath VALUE AT DATE OF DEATH 520.00 2 American Express 840.91 3 Bryce Arndt DDS 1,164.86 4 Elite Staffing Services Inc; date of service 12/29/06-1/19/07 5,555.25 5 Millennium Pharmacy Systems Inc 120.58 6 Pharmerica 70.44 7 Pinnacle Health Hospitals 300.00 8 Silver Spring Ambulance 17.27 TOTAL (Also enter on line 10. Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8.589.31 R8'-"""" ',* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FRANCIS A. PINK SCHEDULE J BENEFICIARIES RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I. TAXABLE DISTRIBUTIONS pnclude outright spousal distributions. and transfers under Sec. 9116 (a) (1.2)) 1. Judith Anne Gorra, daughter Lineal 12 Winston Dr, Washington Depot, CT 06794 one-sixth residue 2 Diane M Cox, daughter Lineal 1786 County Route 18, Wellsville, NY 14895 one-sixth residue 3 Stuart B Pink, son Lineal 30 Kelly Dr, Carlisle, PA 17015 one-sixth residue 4 Carole F Pink, daughter Lineal 508 Kent St, Salinas, CA 93906 one-sixth residue 5 Scott W Pink, son Lineal 5017 Castle Combes Ct, Granite Bay, CA 95746 one-sixth residue 6 Melissa Martin, daughter Lineal 204 Hulett Hill Rd, Sheffield, MA 01257 one-sixth residue 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. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ .. FILE NUMBER 21 07 0683 (If more space IS needed, Insert additional sheets of the same size) JAN L. BROWN, ESQUIRE" JACQUELINE A. KELLY, ESQUIRE "ADMITTED IN PA AND DISTRICT OF COLUMBIA JAN L. BROWN & ASSOCIATES ATTORNEYS AND COUNSELORS AT LAW aLOE ENGLISH GAP 845 SIR THOMAS COURT SUITE 12 HARRISBURG, PA 17109 EMAIL jlbassoc@verizon.net WNW.janbrownlaw.com TELEPHONE (717) 541-5550 FACSIMILE (717) 541-9223 BRENDA F KEPHART, LEGAL ASSISTANT PAULA K. WHITE, LEGAL ASSfSTANT JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT October 26, 2007 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Estate of Francis Albert Pink File No. 2007-00683 PA File No. 21-07-0683 N \...D -0 ....--c_ oo C) Gentlemen or Ladies: Enclosed please find the following items for filing with the Register of Wills: 1. Inventory. 2. An original and one copy of the Inheritance Tax Return. 3. Estate Check 999 payable to the Register of Wills in the amount of$30 to cover the filing fee for the Inventory and Inheritance Tax Return. Please time stamp and return our file copies ofthe Inventory and Inheritance Tax Return. If you have any questions, feel free to contact this office. Sincerely, ~~~f- ~cUt Legal Assistant bfk Enclosure 1'" V> o 00 1'\ 0 ;:, ~ ('i _" ;. <!) U1 -:-~{ 8~ 0;:,. <:' o;:~ trFt ~ ~ S ~ C'1 U ~ ~O"> o '5~ ~I"< CUo 0. (/) r- ..,~.. 4: 'ii <" i:rl <.9 ?.::( ~ ~ 8 0.._ -~ 6 ~ ~ ~ QO o&5~ ~ ~'t\:t:<& 4: :J r- a:: rJ) 0 ;]) 1- o ~ U"> ~ ~ ~ ~ 0 . 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