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Home My WebLink About03-03-09J 15056041125 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number PO BOX 280601 Harrisbur , PA 17128-0601 RESIDENT DECEDENT 2 1 0 7 0 1 0 1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 8 2 2 2 7 3 6 0 0 1 2 0 2 0 0 7 1 0 2 0 1 9 2 8 Decedent's Last Name O' B R I E N (If Applicable) Enter Surviving Spouse's Information Below Suffix Decedent's First Name L I L L I A N MI C 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 0 2. Supplemental Return ~ 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) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 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 S T E P E H N J H O G G E S Q U I R E 7 1 7 2 4 5 2 6 9 8 Firm Name (If Applicable) First line of address 1 9 S H A N O V E R Second line of address City or Post Office C A R L I S L E S T S T E 1 0 1 Correspondent's a-mail address: SHOGG@NEXSPOT.COM State ZIP Code P A 1 7 O l_ -.- -_~ REGISTE@ OF WILLS U NLY i~ ~ t~ ~ ~ ' ~ U ~ i ~ " ~ ~ ~ ;+~ ;, I ~i, ~i C` ! ~-=-`I ,-=~ U t~c:7 k - - ^, ~~~ - A'T~ FILED ~ Y r::~,I!"'tea :` C1 ~ a ~ 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. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSG)N O SIBLE FOR FILING RETURN ~L~4. ~ ~~ ~~ ~~'~~-...---_ PX ~ DATE~1 ADDRESS Z' ~ / L / SIGNATURE OF PREPARER-~THER THAN ESS ~ ~~ NH I -7 0 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041125 DATE 15056041125 J ~~ 15056042126 REV-1500 EX Decedent's Social Security Number ~ecedent'sName: LILLIAN C. 0' BRIEN 1 8 2 2 2 7 3 6 0 RECAPITULATION 1 1 4 2 0 0 0, 0 0 1. Real estate (Schedule A) ...................................... . . 2. ................................ Stocks and Bonds (Schedule B) .. 2. 2 8 ~ 4 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .. ... 3. 4. Mortgages & Notes Receivable (Schedule D) ..................... ... 4. ~ ~ 4 7 , 8 4 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) .... ... 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested .... ... 6• 3 9 8 , 1 3 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested .... ... 7. 8. Total Gross Assets (total Lines 1-7) ........................ ... 8. 1 5 0 1 7 4, 7 1 9. Funeral Expenses & Administrative Costs (Schedule H) ............. ... 9. 1 2 7 7 3 , 4 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ......... ... 10. 1 1 9 8 0 3 , 7 9 11. Total Deductions (total Lines 9& 10) ........................ ... 11. 1 3 2 5 7 7, 2 6 12. Net Value of Estate (Line 8 minus Line 11) ...................... ... 12• 1 7 5 9 7 , 4 5 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. 1 7 5 9 7 , 4 5 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 15 0 0 0 (a)(1.2) x.0 _ . 16. Amount of Line 14 taxable 1 7 5 9 7 4 5 7 9 1. 8 9 at lineal rate X .045 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 7 9 1, 8 9 ......................................... 19. Tax Due ..... ..19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ ,~ 15056D42126 Side 2 15056042126 REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 07 0101 DECEDENT'S NAME LILLIAN C. O'BRIEN -_ __ STREETADDRESS - -_ - 240 MCALLISTER CHURCH ROAD - -- -_ __ CITY - _ - ARLISLE _. _ __ _ i -_ -_ - - ISTATE ZIP j PA ' 17015 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments (1) 79189 A. Spousal Poverty Credit B. Prior Payments 612.30 C. Discount 3. Interest/Penalty if applicable Total Credits (A + B + C) (2) 612 30 D. Interest E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT Total InteresUPenalty (D + E) (3) 0 00 Fill in oval on Page 2, Line 20 to request a refund. (4) 0 00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 179 59 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 +SA. This is the BALANCE DUE. (56) 179.59 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 : .............. .................................................. ...... ^ a b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ ^X c. retain a reversiona interest; or ry ...................................................................................... ... ...... ^ 0 d. receive the promise for life of either payments, benefits or care? .................. .............................. : ...... ^ a 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 "intrust 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)]. 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 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-1502 EX + (6-98) SCHEDULE A COMMONWEALTH OF PENNSYLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LILLIAN C. O'BRIEN 21 07 0101 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real roe which is 'ointl -owned with ri ht of survivorshi must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. REAL ESTATE - 240 MCALLISTER CHURCH ROAD, CUMBERLAND COUNTY, OF DEATH CARLISLE, PA 17015 - 142,000.00 CUMBERLAND COUNTY COURTHOUSE -DEED BOOK V20, PG 619 (DOD DEED) TOTAL (Also enter on line 1 Recapitulation) ~ $ 142 000 (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS w ~ r~ ~ L v r LILLIAN C. O'BRIEN FILE NUMBER 21 07 0101 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1, U.S. SAVINGS BOND L598318366EE TOTAL (Also enter on line 2 Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 28.74 28.74 REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAY pcTi ions ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER LILLIAN C. O'BRIEN 21 07 0101 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 1. AUCTION PROCEEDS FROM SALE OF PERSONAL PROPERTY 2. VET LIFE REFUND 3. GERBER LIFE REFUND 4. PEOPLES LIFE REFUND 5. COMCAST REFUND 6. STATE FARM REFUND 7. PROPERTY TAX REFUND 8. CASH CHRISTMAS GIFTS 9. ESTATE CHECKING ACCOUNT # 303172 -MAY 2007 INTEREST 10. ESTATE CHECKING ACCOUNT # 303172 JUNE 2007 INTEREST 11. ESTATE CHECKING ACCOUNT # 303172 JULY 2007 INTEREST 12. ESTATE CHECKING ACCOUNT # 303172 AUGUST 2007 INTEREST 13. ESTATE CHECKING ACCOUNT # 303172 SEPTEMBER 2007 INTEREST 14. ESTATE CHECKING ACCOUNT # 303172 OCTOBER 2007 INTEREST 15. COUNTY TAX REFUND FOR TAXES PD. IN ADVANCE (SETTLEMENT DATE 8/28107) $243.58/YR. 8/28/07 TO 1/1/08 16. SCHOOL TAX REFUND FOR TAXES PD. IN ADVANCE (SETTLEMENT DATE 8/28/07) $1,290.80/YR. 8/28/07 TO 1/1/08 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 7, 747.84 REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LILLIAN C. O'BRIEN 21 07 0101 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS A. MICHAEL O'BRIEN 4600 WARRINGTON AVENUE, APT. 3 MECHANICSBURG PA 17055 B LEILANI BRANDY C JOINTLY-OWNED PROPERTY LETTER DATE ITEM FOR JOINT MADE NUMBER TENANT JOINT 1. ~A., B 2. ~A, B 3. ~ A, B SCHEDULE F JOINTLY-OWNED PROPERTY 832 MOUNTAIN ROAD NEWVILLE, PA 17241 DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. MEMBERS 1ST FEDERAL CREDIT UNION CHECKING ACCOUNT# 49432-11 MEMBERS 1ST FEDERAL CREDIT UNION SAVINGS ACCOUNT # 49432-00 MEMBERS 1ST FEDERAL CREDIT UNION SAVINGS ACCOUNT # 49432-00 -INTEREST 779.941 ~ 259.98 1.11 I ~ 0.37 TOTAL (Also enter on line 6, Recapitulation) I $ 398 13 (If more space Is needed, insert additional sheets of the same size) RELATIONSHIP TO DECEDENT SON DAUGHTER DATE OF DEATH DE ~D'S D VALUE OF TH VALUE OF ASSET INTEREST DECEDENT'S INTEREST 413.36 137.78 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDFNr ESTATE OF LILLIAN C. O'BRIEN SCHEDULE H FUNERAL EXPENSES 8~ ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 07 0101 ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: 1. HETRICK CREMATION SERVICES AMOUNT 1,032.96 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Michael E. O'Brien Social Security Number(s)/EIN Number of Personal Representative(s) 182-46-4481 Street Address 4600 Warington Avenue city Mechanicsburg state PA Z;p 17055 Year(s) Commission Paid: 2, AttomeyFees Stephen J. Hogg, Esquire 3. Family Exemption: (If decedents address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4• ~ Probate Fees 5 Accountants Fees 6. Tax Return Preparer's Fees 7. Advertising Cumberland Law Journal Carlisle Sentinel 8. Filing Inheritance Tax Return 9. Filing Accounting (est) 10. Filing Supplemental Return TOTAL (Also enter on line 9, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) 7,508.74 3,500.00 302.00 75.00 129.77 30.00 180.00 15.00 12,773.47 REV-1512 EX + (12-03) SCHEDULE 1 COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, IN RES DENT DECEDENTRN MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER LILLIAN C. O'BRIEN 21 07 0101 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 VALUE AT DATE OF DEATH 1 COMMIS SION FROM SALE OF REAL ESTATE 8,520.00 2. BARRETT REAL ESTATE APPRAISAL 325.00 3• SETTLEMENT TRANSACTION FEE 195.00 4. SECURED LAND TRANSFERS -MECHANICSBURG DEED PREPARATION 75.00 5. NOTARY FEE AT SETTLEMENT 10.00 6. REAL ESTATE TAXES 243.58 7. SECURED LAND TRANSFERS -MECHANICSBURG PROCESSING/TAX CERTIFICATION 10.00 8. SECURED LAND TRANSFERS -MECHANICSBURG OVERNIGHT MAIL 25.00 9. REALTY TRANSFER TAX 1,420.00 10. 2007/2008 SCHOOL TAXES 1,290.80 11. SELLER PAID BUYER CLOSING COSTS 4,000.00 12. MEMBERS 1ST FED. C.U. -HOME EQUITY LOAN PAYMENT -FEB 2007 . ACCOUNT #49432-02 524.00 13. MEMBERS 1ST FED. C.U. -HOME EQUITY LOAN PAYMENT -MARCH 2007 ACCOUNT #49432-02 524.00 14. MEMBERS 1ST FED. C.U. -HOME EQUITY LOAN PAYMENT -APRIL 2007 ACCOUNT #49432-02 524.00 15. MEMBERS 1ST FED. C.U. -HOME EQUITY LOAN PAYMENT -MAY 2007 ACCOUNT #49432-02 524.00 TOTAL (Also enter on line 10, Recapitulation) ~ $ (If more space is needed, insert additional sheets of the same size) 119,803.79 Continuation of REV-1500 Inheritance Tax Return Resident Decedent LILLIAN C. O'BRIEN Decedent's Name 21 07 0101 Page 1 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, St Liens ITEM NUMBER DESCRIPTION 16. MEMBERS 1ST FED. C.U. -HOME EQUITY LOAN PAYMENT - JUNE 2007 ACCOUNT #49432-02 17. MEMBERS 1ST FED. C.U. -HOME EQUITY LOAN PAYMENT -JULY 2007 ACCOUNT #49432-02 18. MEMBERS 1ST FED. C.U. -HOME EQUITY LOAN PAYMENT -AUGUST 2007 ACCOUNT #49432-02 19. MEMBERS 1ST FEDERAL CREDIT UNION -MORTGAGE LOAN PAYOFF 20. PEOPLES LIFE INSURANCE COMPANY -PREMIUM JANUARY 2007 21. PEOPLES LIFE INSURANCE COMPANY -PREMIUM FEBRUARY 2007 22. SEARS - (AGREED TO ACCEPT 60% OF THIS AMT.) $168.90 (NOTICE OF CLAIM FILED FOR FULL AMOUNT) 23. AMERICAN EXPRESS (NOTICE OF CLAIM FILED FOR FULL AMOUNT) 24. FASHION BUG (NOTICE OF CLAIM FILED FOR FULL AMOUNT) 25. BON TON (NOTICE OF CLAIM FILED FOR FULL AMOUNT) 26. KMART (NOTICE OF CLAIM FILED FOR FULL AMOUNT) 27. WELLS FARGO 28. HFC (SETTLEMENT AGREED AT $7239.40) (NOTICE OF CLAIM FILED FOR FULL AMOUNT) 28. LOWES (AGREED TO 50% OF BAL. OF $652.83) 30. WAL-MART AMOUNT SUBTOTAL SCHEDULE I Continuation of REV-1500 Inheritance Tax Return Resident Decedent LILLIAN C. O'BRIEN Decedent's Name 21 07 0101 Page 2 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION 31. DISCOVER (NOTICE OF CLAIM FILED FOR FULL AMOUNT) AMOUNT 14,791.70 32. BANK OF AMERICA (NOTICE OF CLAIM FILED FOR FULL AMOUNT) 1,455.88 33. ESTATE CHECKING ACCOUNT #303172 CHECK FEE 10.95 34. PP&L -JANUARY 2007 342.67 35. PP&L -FEBRUARY 2007 315.32 36. PP&L -MARCH 2007 324.45 37. PP&L -APRIL 2007 160.04 38. PP&L -MAY 2007 68.74 39. PP&L -JUNE 2007 33.32 40. PP&L -JULY 2007 34.28 41. PP&L -AUGUST 2007 26.76 42. PP&L -SEPTEMBER FINAL BILL 9.86 43. EMBARQ -JANUARY 2007 31.15 44. EMBARQ -FEBRUARY 2007 31.15 45. ~EMBARO -MARCH 2007 SUBTOTAL SCHEDULE I 31.07 17,667.34 Continuation of REV-1500 Inheritance Tax Return Resident Decedent LILLIAN C. O'BRIEN Decedent's Name 21 07 0101 Page 3 File Number Schedule I -Debts of Decedent, Mortgage Liabilities, & Liens ITEM NUMBER DESCRIPTION 46. EMBARQ -APRIL 2007 AMOUNT 31.07 47. EMBARQ -MAY 2007 14.15 48. PINNACLE HEALTH - CO-PAY 25.00 49. WALNUT BOTTOM RADIOLOGY - CO-PAY 25.00 50. WALNUT BOTTOM RADIOLOGY - CO-PAY 25.00 51. TUCKEY MECHANICAL SERVICES -HEATING SYSTEM MAINTENANCE 161.82 52. TUCKEY MECHANICAL SERVICES -HEAT PUMP REPLACEMENT 135.32 53. OUTDOOR WORLD -TIMESHARE ANNUAL DUES 102.00 54. TIME SHARE ADVERTISING 399.00 55. STATE FARM INSURANCE 272.46 56. TORY ROCKWELL -ESTATE LAWN MAINTENANCE (7 VISITS @$30.00) 210.00 57. TRACTOR SUPPLY COMPANY -WATER SOFTENER SALT 21.12 58. JEFF SANDERSON -CONTRACTOR -HOME REPAIR ON ESTATE 1,681.00 SUBTOTAL SCHEDULE I 3,102.94 GRAND TOTAL SCHEDULE I $ 119,803.79 REV-1513 EX + (g-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER LILLIAN C. O'BRIEN 21 07 0101 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 [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J 1. MICHAEL E. O'BRIEN Lineal 4600 WARRINGTON AVENUE, APT. 3 MECHANICSBURG PA 17055 2. LEILANI J. BRANDY Lineal 832 MOUNTAIN ROAD NEWVILLE, PA 17241 3. JODY L. GILBERT Lineal 26 CHESTNUT STREET NEWVILLE, PA 17241 4. RICHARD A. OBRIEN Lineal 2501 PERTH DRIVE EDMOND, OK 73013 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 I $ (If more space is needed, insert additional sheets of the same size)