HomeMy WebLinkAbout05-06-08
REV-1500 ex + (6-00)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
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BROUGHER
DATE OF DEATH (MM-DD-Year)
ANNA
V.
DATE OF BIRTH (MM-DD-Year)
02110/2008 05/18/1909
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL)
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IX] 1. Original Return
D 4. limited Estate
IX] 6. Decedent Died Testate (Attach copy of Will)
D 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a. Future Interest Compromise (dale of deatll after 12-12-82)
D 7. Decedent Maintained a living Trust (Attach copy of Trust)
D 10. Spousal Poverty Credit (daleofdealh between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 8 0 1 6 9
""'COONTvCOiiE ~ - - NUMBER- -
SOCIAL SECURITY NUMBER
1 70-32-3370
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
D 3. Remainder Retum (dale of dealh prior to 12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME
ROGER B. IRWIN ESQUIRE
FIRM NAME (If Applicable)
IRWIN & McKNIGHT
TELEPHONE NUMBER
717 249-2353
COMPLETE MAILING ADDRESS
60 WEST POMFRET STREET
0.00 X _ (15) 0.00
48.639.36 X .045 (16) 2,188.77
0.00 X .12 (17) 0.00
2.500.00 X .15 (18) 375.00
(19) 2.563.77
CARLISLE
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship {3}
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Cos1s (Schedule H) (9)
10. Deb1s of Decedent Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trus1s for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a){1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at ooIlateral rate
19. Tax Due
CHECK HEF:E IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
PA 17013
OFF l USE ONLY
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61,755.22
3.487.84
4,628.02
(11)
(12)
(13)
8,115.86
53.639.36
2,500.00
(14)
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REV-1509 ~ + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDU~EF
JOINTLY-OWNED PROPERTY
ESTATE OF
BROUGHER
ANNA
v
FILE NUMBER
21 08
0169
If an asset was made joint within one year of the decedents date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. JAMES R. FULTON
911 W. SOUTH STREET
CARLISLE, PA 17013
SON
B
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JOINTL Y-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 12/2000 MEMBERS 1 ST FEDERAL CREDIT UNION 4,150.86 50. 2,075.43
SAVINGS ACCOUNT #200106-00
2. A. 12/2000 MEMBERS 1 ST FEDERAL CREDIT UNION 760.11 50. 380.06
CHECKING ACCOUNT #200106-11
TOTAL (Also enter on line 6, Recapitulation) $ 2.455.49
(If more space is needed, insert additional sheets of the same size)
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REV-1510 I;X + (6-98)
*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BROUGHER ANNA
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
v
FILE NUMBER
21 08
0169
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV -1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INClUDE THE NAME OF THE TRANSFEREE, THEIR RElATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSfER. ATTACH A COPY Of THE DEED FOR REAl ESTATE. VALUE OF ASSET INTEREST (IF APPLICABlE) VALUE
1. WADDELL & REED - ACCOUNT #32261959 21,376.67 100. 21,376.67
IVY ASSET STRATEGY A I CUSIP #466000759
795,8550 SHARES @ $26.86 PER SHARE = $21,376.67
2. WADDELL & REED - ACCOUNT #32261959 21,376.67 100. 21,376.67
IVY HIGH INCOME A I CUSIP #466000668
2,950.9400 SHARES @ $8.10 PER SHARE = $23,902.61
3. WADDELL & REED - ACCOUNT #32261959 8,602.81 100. 8,602.81
IVY PACIFIC OPPORTUNITIES A I CUSIP #465897866
470,8710 SHARES @ $18.27 PER SHARE = $8,602.81
4. WADDELL & REED - ACCOUNT #32261959 7,943.58 100. 7,943.58
IVY GLOBAL NATURAL RESOURCES A I CUSIP #4658974
229,2520 SHARES @ $34.65 = $7,943.58
TOTAL (Also enter on line 7 Recapitulation) $ 59.299.73
(If more space is needed, insert additional sheets of the same size)
REV-1511 ~ + (12-99)
*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
BROUGHER
ANNA
v
21
08
0169
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN-ROTH FUNERAL HOME 555.26
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (5)
Social Security Numbe~5)JEIN Number of Personal Representative(s)
Street Address
City State Zip
Yea~s) Commission Paid:
2. AttomeyFees IRWIN & McKNIGHT 1,800.00
3. Family Exemption: (If decedenfs address is not the same as c1aimanfs, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees REGISTER OF WILLS 298.00
5. Accountanfs Fees KLINGLER & ASSOCIATES 205.00
6. Tax Return Preparer's Fees PATRICIAA. ROSENDALE, CPA 350.00
7. REGISTER OF WILLS - FILING FEE 30.00
8. THE SENTINEL - EST ATE NOTICE 174.58
9. CUMBERLAND LAW JOURNAL - ESTATE NOTICE 75.00
TOTAL (Also enter on line 9, Recapitulation) $ 3 487.84
(If more space is needed, insert additional sheets of the same size)
REV-1512 Ex + (6-98)
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SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BROUGHER ANNA
V.
FILE NUMBER
21 08
0169
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. CHURCH OF GOD HOME - NURSING
VALUE AT DATE
OF DEATH
2,806.25
2. CONTINUING CARE RX - MEDICAL
215.77
3. PA DEPARTMENT OF REVENUE - INCOME TAXES
781.00
4. INTERNAL REVENUE SERVICE - INCOME TAXES
825.00
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
4.628.02
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
AMOUNT OR SHARE
OF ESTATE
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnclude outright spousal distributions. and transfers under
Sec. 9116 (a) (1.2)]
2.
MARY LINDSAY
54 PARSONAGE STREET
NEWVILLE, PA 17241
JAMES R. AND MARTHA S. FULTON
911 W. SOUTH STREET
CARLISLE, PA 17013
Collateral
2,500.00
1.
Lineal
48,639.36
REMAINDER
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.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
FIRST LUTHERAN CHURCH
21 SOUTH BEDFORD STREET
CARLISLE, PA 17013
2,500.00
TOTAL OF PART n - 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)
$
2500.00
LAST WILL AND TESTAMENT
I, ANNA V. BROUGHER, of the Borough of Carlisle, Cumberland County,
Pennsylvania, declare this to be my Last Will and Testament, hereby expressly revoking all Wills
and Codicils heretofore made by me.
1. I direct my executors to pay all of my debts, funeral and administrative expenses as
soon as may be done conveniently after my decease.
2. I authorize and empower my executors to sell any realty owned by me at my death and
not specifically devised herein, at either public or private sale, and to give good and sufficient
deeds therefor, in fee simple, as I could do if living.
3. I give, devise and bequeath all of my estate of every nature and wherever situate as
follows:
(a) $2,500.00 to Mary Lindsay, 54 Parsonage Street, Newville, Pennsylvania
17241.
(b) $2,500.00 to The First Lutheran Church, 21 South Bedford Street, Carlisle,
Pennsylvania 17013.
(c) All the rest, residue and remainder to James R. Fulton and Martha S. Fulton,
share and share alike.
4. Should the gift in Paragraph No. 3(c) not take effect, I give, devise and bequeath all of
my estate of every nature and wherever situate to Paul Sheaffer, of Etters, Pennsylvania.
5. I nominate and appoint James R. Fulton and Martha S. Fulton to be the executors of
this my Last Will and Testament; they are to serve as such without bond. Should they die before
my death, renounce or refuse to serve for any reason, or die leaving any of my estate
unadministered, I nominate and appoint Paul Sheaffer, as substitute executor, also to serve as
such without bond, with the same powers as are given herein to my executors.
6. I hereby suggest that my personal representatives retain the services of Irwin,
McKnight, & Hughes, as attorneys in the settlement of my estate.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 12TH day of
February, 1998.
.,
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ANNA V. BROUGHER
Signed, sealed, published and declared by ANNA V. BROUGHER, the testatrix above
named, as and for her Last Will and Testament, in the presence of us, who at her request, in her
presence and in the presence of each other have subscribed our names as witnesses hereto.
2
ACKNOWLEDGMENT AND AFFIDAVIT
WE, ANNA V. BROUGHER, CHERYL L. CLELAND and MARTHA L. NOEL,
the testatrix and witnesses respectively, whose names are signed to the 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 that she had signed willingly, and that she
executed it as her free and voluntary act for the purpose herein expressed, and that each of the
witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the
best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound
mind and under no constraint or undue influence.
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ANNA V. BROUGHER
, 'LL J;;!
C RYL L. CLELAND
'2f~ X!!1rt!i-
MARTHA L. NO L
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF CUMBERLAND
Subscribed, sworn to and acknowledged before me by ANNA V. BROUGHER, the
testatrix herein and subscribed and sworn to before me by CHERYL L. CLELAND and
MARTHA L. NOEL, witnesses, this 12TH day of February, 1998.
<3. dt~
o ry Public
al Seal
Roger B. Irwin, Notary Public
Carlisle Bore, Cumberland County
My Commission Expires Oct. 3. 2000
Member Pennsylvania AS30r,l;Jtirjn af Notaries
REGULAR SAVINGS ACCOUNT:
Account Number/ Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CHECKING ACCOUNT:
Account NumberlSuffix
Date Account Established
Principal Balance at Date of Death
Accrued I nterest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
Estate of: ANNA V. BROUGHER
Date of Death: February 10, 2008
Social Security Number: 170-32-3370
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RECEIVED
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'kWH\; g McKN!GHT
L./\\V OFfH~ES
MEMBERS 1st
FEDERAL CREDIT UNION
200106-00
12/27/2000
$4,149.84
$1.02
$4,150.86
James R. Fulton
12/27/2000
200106-11
12/27/2000
$760.11
$.00
$760.11
James R. Fulton
12/27/2000
ME~ERS 1ST FEDERAL"CREDIT UNION
lY (l r\ I I tlL t\ - 'lib. \UL-
Danielle A~
Insurance Services Specialist
April 23, 2008
5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (800) 283-2328 · www.memberslst.org
.O~~~
6300 lamar Avenue
Post Office Box 29217
Shawnee Mission, KS 66210-9217
www.waddell.com
February 20,2008
RECEIVED
Law Offices of Irwin & McKnight
West Pomfret Professional Building
60 West Pomfret Street
Carlisle, PA 17013-3222
FEB 2 5 2008
IRWIN & McKNIGHT
tAW OFFICES
RE: Account 32261959
. Estate of: Anna V. Brougher
Date of Death: February 10,2008
Dear Mr. Roger Irwin:
This letter is in response to your request for the date of death valuation. Please be
advised that as of the date of death the account held the following shares.
Fund Name CUSIP Shares Price Total
Ivy Asset Stratgey A 466000759 795.8550 $26.86 $21,376.67
Ivy High Income A 466000668 2,950.9400 $8.1 0 $23,902.61
Ivy Pacific Opportunities A 465897866 470.8710 $18.27 $8,602.81
I vy Global Natural Resources A 465897429 229.2520 $34.65 $7,943.58
T atal $61,825.67
Please be advised account number 32261959 is registered as an Individual TOD account
and was established November 4, 2002. The TOD beneficiary named is James Fulton.
If you have any questions regarding the above infonnation,.p-It!.~.
Client Services at 1-888- W ADDELL (923-3~_~.S)..m"~"""'- .
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Sincerely,
RESIOENT STATEMENT FROM
AC-CHURCH OF GOD HOME,'NC
· 801 N HANOVER STREET
CARLISLE, PA 17013
717 -249-5322
STATEMENr
Statement Date Due Date
01/31/2008 Upon Receipt
$2,806.25
TOTAL BALANCE DUE
AMOUNT PAID $
Please make check payable toAL-CHURCH OF.GO[) HOME, INC
ANNA V BROUGHER
c/o JAMES FULTON
825 N COLLEGE STREET
CARLISLE, PA 17013
Remit To:
AL-CHURC.., .OFGOD HOME, 'HC
801 N HANOVER STREET
CARLISLE,PA 17013
Comments
Please detach and return this portion with your remittance to the address a
$2,784.00
$22.25
$0.00
$0.00
$0.00
$2,806.25
Balance Forward
01/18/08 - 01/18/08 Payment Check # 552
01/31/08 - 01/31/08 Telephone Basic Charges
02/01/08 - 02/29/08 Room & Board
$3,020.25
1
29
$3,020.25
$3,020.25
$0.00
$22.25
725
$2,806.25
$22.25
$96.00
$22.25
$2,784.00
TOTAL BALANCE DUE:
7'
ACILlTY NAME
,L-CHURCH OF GOD HOME, INC
RESIDENT NAME
ANNA V BROUGHER
ACCOUNT NUMBER
802619
-. -- - -_. - -.'- --- -..-...---
April 8, 2~'
James R. Fulton
911 West South Streete
Carlisle, P A 17013
Hoffman-Roth Funeral Home & Crematory, Inc.
219 North Hanover Street
Carlisle, P A 17013
(717)243-4511
/'
The Funeral Service for Anna V. Brougher
15241-36
We sincerely ~ppreciate 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.
OUR SERVICE:
Traditional Funeral Service Package . . . . . .
FUNERAL HOME SERVICE CHARGES
$4150.00
$4150.00
SELECTED MERCHANDISE:
Cameo Rose 18 ga Casket . . . . . . . . . . . . . . . . . . .
Venetian Interment Receptacle. . . . . . . . . . . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . . . . . . . . . . .
$2865.00
$1880.00
$8895.00
.Cash Advances
Opening Grave. . . . . . . . .
Newspaper Obituary Notice- Sentinel . .
Clergy Offering . . . . . . .
Certified Copies of Death Certificates. .
Flowers. . . . . . . . . .
Add'l Death Certificates. . . . .
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
$600.00
$73.26
$150.00
$36.00
$159.00
$24.00
$1042.26
Total
Total Cost.
$9937.26
History
03/06/2008 AlIianz . . . .
03/06/2008 Discount Received. .
$-9195.38
$-186.62
TOTAL AMOUNT DUE .
$555.26
statement is net and payable in full within 30 days of receipt.
----.-------------------.-...--------.-----------------.-..---...
'lease return this portion with your Remittance
Amount Enclosed
Service 10 # 15241.36
Anna V. Brougher