HomeMy WebLinkAbout10-28-0815056D41125
REV-1500 Ex (os-05) OFFICIAL USE ONLY
PA Department of Revenue
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 7 1 0 9 0
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
1 7 9 1 0 5 7 1 7 1 0 1 7 2 0 0 7 0 3 1 6 1 9 1 6
Decedent's Last Name Suffix Decedent's First Name MI
B R I E N Z O A R T H U R E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
O 1. Original Return ~ 2. Supplemental Retum ~ 3. Remainder Return (date of death
prior to 12-13-82)
4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required
death after 12-12-82)
OX 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (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 T0:
Name Daytime Telephone Number
C H A R L E S E P E T R I E 7 1 7 c~ 6 1 `~ 9 3 9,
Firm Name If A livable ~-- `"' -' ' '
REGISTE3li ~ WILLS U~ONLY
First line of address '~ m ~
_ J~ -_ .ti
3 5 2 8 B R I S B A N S T R E E T ~~ j~; ~ _
Second line of address `- ' ~ C:.+
_~ .. -
y o
tV
City or Post Office State ZIP Code ____ DATE FILED
H A R R I S B U R G P A 1 7 1 1 1
Correspondent's a-mail address: PetrleLaW(cr7i40L.COm
Under penalties of perjury, I declare that t have examined this return, including accompanying sdiedules and statements, and to the best of my knowk~dge and belief
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowk~dge.
SIGNATURE P SON R POD IBL~y~RI LING RETURN
C! ~,,~~~/ - DATE
10/27/2008
ADDRESS
3528 BRISBAN STREET HARRISBURG PA 17111
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
PLEASE USE ORIGINAL FORM ONLY
Side 7
15D56041125 15056041125
REV-1500 EX Page 3
Decedent's Complete Address:
File Number
1090
DECEDENTS NAME
ARTHUR E. BRIENZO
STREET ADDRESS
4905 E. TRINDLE ROAD
CITY
MECHANICSBURG STATE
PA ZIP
17050
Tax Payments and Credits:
~• Tax Due (Page 2 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
3. InterestlPenalty if applicable
D. Interest
E. Penalty
4.
5.
If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund.
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.
(1) 4,420.77
Total Credits (A + g + C) (2) 0.00
Total InteresUPenalty { D + E) {3) 0.00
(4) 0.00
(5) 4,420.77
(5A)
B. Enter the total of Line 5 + 5A, This is the BALANCE DUE. (5B) 4,420.77
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 : ...................................................................... ^ Q
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ Q
c. retain a reversionary interest; or ................................................................................................ ^
d. receive the promise for life of either payments, benefits or cane? .....................
..................................
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? ......... ^ Q
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. ^
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 (O) 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 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-0ne 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 decedents lineal benefiaaries is four and one-half (4.5) percent, except as noted in
72 P.S. §9116(1.2) (/2 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 is defined, under
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: ARTHUR E. BRIENZO 1 7 9 1 0 5 7 1 7
RECAPITULATION
1. Real estate (Schedule A) ...................................... .. 1.
2. Stocks and Bonds (Schedule B)
................................ 2.
.. 2 5 9 1 2 1
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. 1 0 1 9 1 4 7 1
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6. 3 6 9 1 7 1
7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ..... .. 7.
8. Total Gross Assets (total Lines 1-7) ......................... .. 8. 1 0 8 1 9 7 6 3
9. Funeral Expenses & Administrative Costs (Schedule H} ...... ........ .. 9. 8 8 7 3 3 4
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .. ........ .. 10. 1 0 8 5 0 2
11. Total Deductions (total Lines 9 & 10) .................. ....... .. 11. 9 9 5 8 3 6
12. Net Value of Estate (Line 8 minus Line 11)
................
.......
..12. 9 8 2 3 9 2 7
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) . . .. . . . . . . . .. 14. 9 8 2 3 9 2 7
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.o - 0 0 0 15. 0 0 0
16. Amount of Line 14 taxable
at lineal rate x .045 9 8 2 3 9 2 7 16 4 4 2 0 7 7
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17 0 0 0
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 18 0 0 0
19. Tax Due
....................................... ......
. .. 19. 4 4 2 0 7 7
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^
Side 2
15056042126 15056042126
REV-1503 EX + (g_98)
SCHEDULE B
CoINMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ARTHUR E. BRIENZO 1090
All properly jointly-owned with right of survivorship must be discbsed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. 59.8432 SHARES OF NATIONWIDE STOCK 2,591.21
TOTAL (Also enter on line 2, Recapitulation) i 2.591.21
(If more space is needed, insert additional sheets of the same size
REV-1508 EX + (6.98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERrrANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ARTHUR E. BRIENZO 1090
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. 2 CERTIFICATES OF DEPOSIT AT COMMERCE BANK -EACH VALUED AT $2,201.16 4,402.32
2. SOVEREIGN BANK ACCOUNT 10,441.32
3. WACHOVIA ACCOUNT 9,653.66
4. COUNTRY MEADOWS REFUND 1,355.34
5. FULTON BANK CERTIFICATES OF DEPOSIT 75,450.27
6. CAPITAL BLUE CROSS HEALTH INSURANCE REFUND 111.80
7. 1995 PONTIAC TRANS-AM 500.00
TOTAL (Also enter on line 6 Recapitulation) I : 101 914 71
(If more space ~ needed, insert additional sheets of the same size)
REV-1509 EX + (B-98)
SCHEDULE F
COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUN~ER
ARTHUR E. BRIENZO 1090
Man 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. ARTIS BRIENZO 1401 17TH STREET NW APT 701 DAUGHTER
WASHINGTON, D.C. 20036
13 JEANIE BRIENZO 12817 PULPIT HILL COURT (DAUGHTER
WOODBRIDGE, VA 22191
C
JOINTLY-OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR
IDENTIFYING NUMBER ATTACH DEED FOR JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTERES7
1. A, B 12/1996 CERTIFICATE OF DEPOSIT AT FULTON BANK 2,263.28 33.33 754.35
#182-0093486
2. A. 10/1997 CERTIFICATE OF DEPOSIT AT FULTON BANK 2,937.36 50. 1,468.68
#183-0032026
3. B 1011997 CERTIFICATE OF DEPOSIT AT FULTON BANK 2,937.36 50. 1,468.68
#183-0032027
TOTAL (Also enter on line 6, Recapitulation) I S 3 691 71
(If mole space is needed, insert additional sheets of the same size)
REV-1511 EX+(12-99)
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ARTHUR E. BRIENZO 1090
Det-ts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HETRICK FUNERAL HOME 166 84
B. ADMINISTRATIVE COSTS:
~. Personal Representative's Commissions
Name of Personal Representative (s) CHARLES E. PETRI E 4,250.00
Social Security Numt>er(syEIN Number of Personal Representative(s)
street Address 3528 BRISBAN STREET
City HARRISBURG state PA Zip 17111
Year(s) Commission Paid: 2008
p, Attorney Fees CHARLES E. PETRIE 4,250.00
3. Family Exemption: (If decedents address is not the same as claimants, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4• Probate Fees 166.00
5 Accountants Fees
6. Tax Return Preparer's Fees
7. PA VITAL RECORDS 18.00
8. PA DEPT OF TRANSPORTATION 22.50
TOTAL (Also enter on line 9, Recapitulation) I S 8 873 34
(K more space is needed, insert additional sheets of the same size)
REV-1512 EX + (12-03)
SCHEDULE 1
COMMONWEALTH OF PENNSYLVANw DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES ~ LIENS
RESIDENT DECEDENT ~
ESTATE OF FILE NUMBER
ARTHUR E. BRIENZO 1090
Report debts incurred by the decedent prior to deatlr which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. HEALTHSOUTH REHAB 20.00
2. PINNACLE HEALTH 50.00
3. BURICK AZIZKHAN INTERNAL MEDICINE 89.00
4. WEST SHORE EMERGENCY SERVICE 926.02
TOTAL (Also enter on line 10, Recapitulation) I ;
(If more space is needed, insert additional sheets of the same size)
REV-1573 EX + (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
ARTHUR E. BRIENZO ~nnn
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Tn~ee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS (mdude outright spousal disUibu6ons, and trar~ers under
Sec. 9116 (a} (1.2)]
1. ARTIS BRIENZO Lineal 49,119.64
1401 17TH STREET NW APT 701
WASHINGTON, DC 20036
2. JEANIE BRIENZO Lineal 49,119.63
2817 PULPIT HILL COURT
WOODBRIDGE, VA 22191
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 T HROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS 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 ;
~~~ nnnG ,y~x ,s neeoea, insert aaamonal srleets m me same size)
LAST WILL AND TESTAMENT
I, ARTHUR E. BRIENZO, of 3525 Canby Street, Harrisburg, County of
Dauphin, Pennsylvania, do hereby make, publish, and declare this to be my
LAST WILL AND TESTAMENT, revoking any and all prior wills and codicils, in
manner following, that is to say,
FIRST, that I direct that my Personal Representative shall pay all of my
just debts and funeral expenses as soon as this shall be practicable.
SECOND, that upon my death, I give, devise, and bequeath all of my
property, real, personal and mixed to be divided equally between my two
daughters, JEANIE BRIENZO CINDER and ARTIS KAY BRIENZO, per capita;
that is, if either of my daughters has predeceased me, then I direct that her
share of my estate shall pass instead to my surviving daughter.
THIRD, that I hereby appoint my daughter, ARTIS KAY BRIENZO, as the
Executrix of my estate. If Artis is unable or unwilling to perform in this
capacity, then I hereby appoint my daughter, JEANIE BRIENZO, as the
Executrix of my Estate. I direct that my Personal Representative shall not be
required to post bond in this or in any other jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
22nd day of June, 2006.
ARTHUR E. BRIENZO
~~ Cr~
WIT,N.I~~SS
1~""" ~- /r '~
WITNESS i ~-
ACKNOWI.EDGtrMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
I, ARTHUR E. BRIENZO, testator, whose name is signed to the attached
or foregoing instrument, having been duly qualified according to law, do hereby
acknowledge that I have signed and executed the instrument as my Last Will
and Testament; that I signed it willingly and that I signed it as my free and
voluntary act for the purposes therein expressed.
Sworn or affirmed to and acknowledged before me by ARTHUR E.
BRIENZO, the testator, this 22nd day of June, 2006.
Gam- ~ ~ ~ -~ ~ ~ 1 / ~ n~'`~
ARTHUR E. BRIENZO
1
TARY BLIC
COMMON~YEALTH OF PENNSYLVANIA
Notadai Seal
Kelly P. Roberts, Noway Public
Paxlang Boro, D CourNy
My Corrrnisslon E~ires Jan. 27, 2009
Member, PonnsvA~2~~a association c,f Notaries
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
WE, CHARLES E. PETRIE and RICHARD E. BRIENZO, the witnesses
whose names are signed to the attached or foregoing instrument, being duly
qualified according to law, do depose and say that we were present and saw
testator sign and execute the instrument as his LAST WILL AND TESTAMENT;
that ARTHUR E. BRIENZO signed willingly and that he executed it as his free
and voluntary act for the purposes therein expressed; that each of us in the
hearing and sight of the testator signed the will as witnesses; and that to the
best of our knowledge the testator was at that time 18 or more years of age, of
sound mind and under no constraint or undue influence.
Sworn or affirmed to and subscribed before me by CHARLES E. PETRIE
and RICHARD E. BRIENZO, witnesses, this 22nd day of June, 2006.
WITNESS
WITNESS
TARY P BLIC
COMMONWEALTH OF PENNSYLVANIA
Paxtt3r~ Soto, ~~ ry Public
MY Ct~rnrntselon E~lres Jan. 27~, 2008
Member, Pennsylvania Association of Notaries