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HomeMy WebLinkAbout04-11-0815056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN n ~ n Harrisburg, PA 17128-0601 RESIDENT DECEDENT ly[, 08 ~l~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 171-28-6747 01 /13/2008 02/18/1935 Decedent's Last Name BROWNAWELL Suffix Decedent's First Name MI SR. WILLIAM J (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 •' 1. Original Return ~ 2. Supplemental Return m ~;1 3. Remainder Return (date of death 4. Limited Estate prior to 12-13-82) 4a. Future Interest Compromise (date of 4"r ; 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate (Attach Copy of Will) 7. Decedent Maintained a Living Trust _, 8. Total Number of Safe Deposit Boxe: (Attach Copy of Trust) 9. Litigation Proceeds Received ~"~~ 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number WILLIAM J. BROWNAWELL J (717) 319-1127 Firm Name (If Applicable) REGISTEFC'aF WILLS USE~LY f~' A ~ O ~ _ -a :~ First line of address 1 --r~ ~ . ~ te-- ' ~ 7j - ` - 45 FRY ROAD r - ~ ~`; .~. , Second line of address _. ~ `'~ ~!~ ~ !ftryr --l~~ ::7 J .-... ~ ~" `~~ ~_.. City or Post Office State ZIP Code ~~ FILED °; NEWVILLE PA 17241 ~ ~ ' } Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. DeGaration of preparer other th n th a e SIGNATURE OF PERSON PONSIBLE FOR FILIN~rjRETURN personal representative is based on all information of which preparer has any knowledge . -G DATE f~ -- ~ A D DRESS y/~~ / ~ ~ c / // ~1 / /!'~A ~,/ SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 ~~i J 15056052059 REV-1500 EX Decedent's Social Security Number Decedents Name: WILLIAM J BROWNAWELL 171-28-6747 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. 7,210.03 6. Jointly Owned Property (Schedule F) °""'°~ Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Pro ert p y (Schedule G) Separate Billing Requested...... .. 7. 8. Total Gross Assets (total Lines 1-7) .............. .............. . 8. _. __. 7,210.03 9. Funeral Expenses & Administrative Costs (Schedule H) .... . . . ............. . 9. 1,847.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............... . 10, 1,435.96 11. Total Deductions (total Lines 9 & 10) .................................. . 11. $,282.96 12. Net Value of Estate (Line 8 minus Line 11) ............................. . 12. 13. Charitable and Governmental Bequests/Sec 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) ....................... _ ___ _. n~~: mW.__ . . 14. 3,927.07 . ~.__.... ....,~ ._.. ~_ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES .~_~~~ ~~w ~~~~ ~~~~~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 45 15. 176.72 16. Amount of Line 14 taxable at lineal rate X .0 _ 16 17. Amount of Line 14 taxable at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 18 19. TAX DUE ......................................................... 19. 176.72 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 l- 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: WILLIAM J BROWNAWELL STREET ADDRESS CITY Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. InteresUPenalty if applicable D. Interest E. Penalty File Number 08 DECEDENT'S SOCIAL SECURITY NUMBER 171-28-6747 STATE (1) ZIP 176.72 176.72 Total Credits (A + B + C) (2) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.tal InteresUPenalty (D + E) (3) Fill in oval on Page 2, Line 20 to request a refund. (4) 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. (5B) 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 :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income :............................................ ^ c. retain a reversionary interest; or ............................................................................ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ................................... . 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ 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 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)J. The statute does not exempt 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 (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)]. Asibling isdefined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PER50NAL PROPERTY tJlAlt VI' WILLIAM J. BROWNAWELL SR. Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned Wlth fl0ht Of Survivershio moat ho rilerlnend ..., c..~..a..i_ FILE NUMBER ~~~ ~~~~~.. ~Naw w nwucu, uwcn auwuOnal Sr1ee15 OT ine Safne SIZe) .~:1~~I~cT Ba~l~ ACCOUNT N0. ACCOUNT TYPE 519782 CLASSIC CHECKING WILLIAM J BROWNAWELL 45 FRY RD NEWVILLE PA 17241 STATEMENT PERIOD PAGE JAN.24-FE8.22,2008 1 OF 1 HIGH STREET-CARLISLE BEGINNING DEPOSITS S "`'`'uu~` ~ ~UI'I19 AKY -BALANCE OTHER ADDITIONS CHEGKS.PAID OTHER' SUBTRACTIONS 7 210 03 ~' A~~+T 0 NO• AMOUNT N0. AMOUNT , . 0.00 0 0.00 0 0.00 rub+~nG DATE TRANSACTION DESCRIPTI 01-24-08 BEGINNING BALANCE ENDING BALANCE 00 0 04319M NM 017 53749 CCOUN_T ACTIVITY CURRENT ENDING INtEREST PD BALANCE 0.00 7,210.03 ~. a~Fa.ryQ 4 Y 1.11C R DAILY SUBTRACTIONS ,BALANCE 57,210.03 $7,210.03 L008A (6107) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE N FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS wrwit yr WILLIAM J. BROWNAWELL SR. FILE NUMBER Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION ~ A• FUNERAL EXPENSES: ~' HOLLINGER FUNERAL HOME AND CREMATORY INC. 2. CUMBERLAND COUNTY REGISTER OF WILLS B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Zip Zip TOTAL (Also enter on line 9, Recapitulation) I $ (If more space Is needed, insert additional sheets of the same size) 1,783.00 64.00 1,847.00 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 BROWNAWELL WILLIAM J SR Estate File No.: 2008-00073 Paid By Remarks: WILLIAM J BROWNAWELL JR JA ------------------- Fee/Tax Description PETITION LTRS ADM AUTOMATION FEE SHORT CERTIFICATE JCP FEE Check## 1776 Total Received......... Receipt Date: 1/22/2008 Receipt Time: 09:20:49 Receipt No.: 1051277 Receipt Distribution _____________ _______ ____ Payment Amount Payee Name 45.00 5 00 CUMBERLAND COUNTY GENERAL FUN . 4.00 CUMBERLAND COUNTY CUMBERLAND COUNTY GENERAL GENERAL FUN FUN - - - 10_00 - BUREAU OF RECEIPTS & CNTR M.D 64.00 64.00 Hollinger Funeral Home & Crematory, Inc. Eric L. Hollinger, Supervisor March 31, 2008 Y".'i!!i m J. BrLwea~,r.~ell, Jr. 45 Fry Road. Newville, PA 17241 The Funeral Service for William J. Brownawell, Sr.: We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. Professional Service Cremation Package A -Direct Cremation $1350.00 Merchandise Urn -Pewter Verdi $275.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. Cash Advances Newspaper Notices -Sentinel $85.00 Certified Copies of Death Certificate (8 @ $6) $48.00 Cumberland County Coroners Authorization $25.00 Total Cost: 1783.00 Less Payments Received: Check #1782 and Unity Financial Insurance Current Balance Paid in Full 501 NORTH BALTIMORE A~7ENllE • MOUNT HOLLY SPRINGS, PENNSYL~7ANIA 170Fi5 • (717) 486-3433 • FAX (717) 486-3215 www.hoIlingerfuneralhome.com 1 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WILLIAM J. BROWNAWELL SR. SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as „f tie ,~~+e ... ae..~~.:__~..~:__ ..___~_~___ .. ~•• •••~•~ ~r~~~ ~~ uccucw ~~~~G~~ auuniunai sneers or me same size) ~. 1if ~' c yvn ~,,,, ~ // 60-295/313 9 4 irr; I(,`r.... 7. ~r.ow-~cvv~•lr :J ~".; ~1V~"iFilt ~rFNY ~'~° . ~/z ~ fir, ~ a N ;P ~ C.G•^~ e~ cc -~ r 1O ®~~OIF i 1C ~ ~ ~ , s-Q ©M&1'Bank Manta Curers aMTratleraT~Cpnpaay ~:031302955i: ~ 98 3 94 36 70 I'0094 Patient Name Patient # Amount Due Legal Representative Name & Address WILLIAM BROWNAWELL 26104 $810.50 BILL BROWNAWELL 45 FRY RD. NEWVILLE, PA 17241 PLEASE MAKE CHECK PAYABLE AND REMIT TO: PLEASE DIRECT ALL QUESTIONS TO: MANOR CARE OF CARLISLE 940 WALNUT BOTTOM ROAD CARLISLE, PA 17015 MANOR CARE OF CARLISLE Business Office Manager (717)249-0085 PLEASE RETURN THIS SECTION WITH REMITTANCE o1D1 ~~ MAKE CH~KS PAYABLE TO: Heartland =- PHARMACY OF PENNSYLVANIA, LLC 7010 SNOWDRIFT RD ALLENTOWN, PA 18106 800-270-6351 EXT 6050 RETURN SERVICE REQUESTED FACILITY: 53720 CARLISLE PAY PLAN: 111IIIIIIIIIIIIIIIIIIIIII III111 ~I1111II'I IIIIIIII II'III II111 WILLIAM BROWNAWELL C/O BILL BROWNAWELL 45 FRY RD NEWVILLE, PA 17241-9610 IF PAYING BY MASTERCARD, DISCOVER OR CHECK CARD USING FOR PA' M^ASTERCARD ® DISCOVER 33978 ,..,.,,,.,,,~ sIG-c MAIL STATEMENT DATE PAYTHIS AMOUNT 2/29/2008 $625.46 PAGE NO. 1 of 1 Please check box if above address is incorrect ^or insurance information has changed, and ~~ indicate change(s) on reverse side. `/V 1 IJ 1 c: rr. Si K0. -~ r ~~ 60-295/313 ~~- ~ d"" 95 ~ DATE PaY to - ~~ ~-~ 4 ~ +~ TAE Otad6td of / ~ w [1 ~ ~1 7 4' /~cls~. ~ /~ lo~DO I A{~ LIB ~. ~Ms1'Bank ~r~~ ~~ ..~ 983943670 110095 r~ s...~~,~..,,_; FILL OUT BELOW. Il~rlti ^ VISA DATE CUSTOMER ID 61458 SHOW AMOUNT ~~~~ , `~ PAID HERE l/1 65286 IIIIIIIIII'lllllll llllllllllll if lllllll llllllllllllll~~III11'I HEARTLAND PHARMACY OF PENNSYLVANIA PO BOX 72413 CLEVELAND, OH 44192-0002 33978'TR818S1VE001524 PI FASF f1FTACH ANfI RFTI IRN Tf1P P(1RTInnI WITH vrn IR RavnnFnl