HomeMy WebLinkAbout03-17-091505607121
REV-1500 EX (06-05) OFFICIAL USE ONLY
PA Department of Revenue Coun Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN ~
PO BOX 280601 2 1 0 8 0 1 6 `)
_ Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Dafe of Birth
1 7 0 3 2 3 3 7 0 0 2 1 0 2 0 0 8 0 5 1 8 1 9 0 9
Decedent's Last Name Suffix Decedent's First Name MI
B R O U G H E R A N N A V
(If Applicable) Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
FILL tN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
1. Original Return ~ 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
R O G E R B I R W I N E S Q U I R E 7 1 7 2 4 9 2 3 5 3
Firrn Name (If Applicable)
I R W I N &
First line of address
6 0 W E S T
Second line of address
City or Post Office
C A R L I S L E
State ZIP Code
REGISTEI~OF WILLS USNLY
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ATE FILED
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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. Declaration of preparer other than the persona{ representative is based on all information of which preparer has any knowledge.
SIG URE OF PERSON RESPONSIBLE FOR FI RE~ ~ n/j _ /J /J ,~ ~ DIj7~ ~.,
X11 W • SOUTH STREET CARLISLE PA 17013
SI RE OF P ft ROT 1=R THAN REPRESENTATIVE ATE
6t] WEST POMFRET STREET CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
M c K N I G H T P C
P O M F R E T S T R E E T
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REV-150rJ E;< Page 3
Decedent's Complete Address:
Flle Number
21 08 0169
DECEDENT'S NAME
ANNA V. BROUGHER
___ __
-------- -- -
TREET ACIDRESS
825 N. COLLEGE STREET
~,iTY --- -- -- -----------
CARLISL.E I PATE 1117013
Tax Payments and Credits:
' Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit _
B. Prior Payments _
C. Discount
3. Interest/Penalty if applicable
D. Interest
E. Penalty
(~) 2 970 08
Total Credits (A + B + C) (2) 0.00
Total Interest/Penalty (D + E )
4. 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.
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.
B. Enter'lhe total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4) 0.00
(5) 2,970.08
(5A)
(5B) 2,970.08
Make Check Payable fo: 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 : ...................................................................... ^ X^
b. retain the right to designate who shall use the property transferred or its income; ............................... ^ X~
c. retain a reversionary interest; or ........................................................................................:....... ^
d. receive the promise for life of either payments, benefits or care? ....................................................... ^ Q
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consitleration? ....................................................................................... ^ ^X
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... ^ ^X
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) pera=nt [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 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 j72 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-15'0 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NOMBEFC
ANNA V. BROUGHER 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-15G0 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCPJOETHENAMEOFTHEiRANSFEREE,THEIRRELATIONSHIPTOOECEDENTAND
THE DATE OF TRANSFER ATTACHACOPVOFTHEDEEDFORREALESTATE.
DATE OF DEATH
VALUE OF ASSET
%OFDECD'S
INTEREST
EXCLUSION
IIFAPPLICABLE)
TAXABLE
VALUE
1. M&T BANK CORPORATION 67,066.80 100. 67,066.80
754.4921 SHARES @ $88.89 = $67,066.80
TOTAL (Also enter on line 7 Recapitulation) ~ $ 67,066.80
(If more space is needed, insert additional sheets of the same size)
REV-1511 LX + (10-06)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
ANNA V. BROUGHER 21 08 0169
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B.
2.
3.
4.
5.
6.
7
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Street Address
City State _,
Year(s) Commission Paid:
Attorney Fees IRWIN & McKNIGHT
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
Probate Fees
Accountant's Fees
Tax Return Preparer's Fees PATRICIA A. ROSENDALE, CPA
ADDITIONAL FIDUCIARY TAX RETURN
REGISTER OF WILLS -FILING FEE
Zip
Zip
700.00
350.00
15.00
TOTAL (Also enter on line 9, Recapitulation) I $ 1,065.00
(If more space is needed, insert additional sheets of the same size)
REV-153 EX ~ (9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANNA V. BROUGHER 21 08 0169
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
t`;UMBER NAME AND ADDRESS OF PERSON(S) RECEI'/ING PROPERTY Do Not List Trustee{s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)!
1. JAMES R. AND MARTHA S. FULTON Lineal 66.001.80
911 W. SOUTH STREET REMAINDER
CARLISLE, PA 17013
II
1
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)
LAST WILL AND TESTAMENT
I, ANNA V. BROtiGHER, 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 maybe 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, Inominate 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.
•;
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.
~/` ~ ~~"~" r /
~; ~ ~ ~
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.
}--}; { ,
AN'.\TA V. BROUGHER
'~ C RYL L. CLELAND
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.
~'2--~'~ ~~ - C- -~'~ ~,~._
~No ry Public
~Nota al Seal
Roger B. Irwin, Notary Public
Carlisle Boro, Cumberland County
My Commission rrxpires Oct. 3, 2000
Memuer Fennsylvani~ q~,~r,iati~in of Notaries
SAVE THIS STATEMENT FOR TAX PURPOSES
~ M&T Banlc Corporation
If you have any questions regarding your
account, please contact Investor Relations at
1-800-368-5948 or at infoCrtco.com.
Internet: rtco.com
PNNA V BROUGHER TOD ~
JAMES R FULTON '
825 N COLLEGE ST ~' Issue# Account# Stock Symbol
CARLISLE PA 17013 = rt~~ ~ 5236 0343111004 MT3
~t ~\V
\J
Dividend Reinvestment Information ~'
Record Date: 12 17 07 Payable Date: 12 31 07 Reinvestment Option: FULL REINVESTMENT
RECORD DATE SHARES ENROLLED IN REINVESTMENT Amount Withheld From Gross Net Amou
t
Security
Common Stock Certificate and Book Shares Plan Shares
748.0904 Total Reinvestment Shares
748.0904 Rate($)
0.70000 Gross Amount($)
$523.65 Tax($)~ ~Fee($)
$2,50_ n
Reinvested(3)
$52.15
Flan ACCOUrit ACtlVlty
Date Description Fees and/or
Commissions $ Net Dollar
Amount $ Price per
Share $ Transaction
Shares Total
Shares in Plan
Balance Forward
735
3191
03/30 INVESTOR SERVICE CHARGE $2.50 .
03/30 SHARES PURCHASED / DIV. $438.69 116.538200 3.7643 739.0834
05/29 .INVESTOR SERVICE CHARGE $2.50-
06/29 SHARES PURCHASED / DIV. $440.95 108.458600 4.0656 743.1490
09/28 INVESTOR SERVICE CHARGE $2.50
09/28 SHARES PURCHASED / DIV. $517.70 104.768900 4.9414 748
0904
12/31 INVESTOR SERVICE CHARGE $2.50 .
12/31 SHARES PURCHASED / DIV. $521.16 61.409500 6.4017 754.4921
L~~~ ~~
~ ~
_ ~`
~~
Year-TO-Date tnvestment Summary '
Total I Tax OptionalNoluntary Fees and/or Commissions Tax Reportable Company Paid
Dividends($) Withheid($) Investments($) Paid by You($) Fees and/or Commissions($) Total
$1,928.50 $1,^i.^vu
I r~ n2o 5n
Yi i -'
Total Holdings and Market Value (Value of all shares are- based on last purchase price
iecurity Certificate Shares Book Shares Plan Shares Total ~ha-es -` - rice per Share($) Market Valuef$1
COMMON STOC'~ ~
754.4921 754.4921 1.409500 $61,22.82
ACCESS YOUR ACCOUN NE! l.i~ ~ ((,+y~ ~iJ
You can access and manage your account online through the Registrar and Transfer Company website. To login simply go to
www.rtca.com and click on "Online Services" to apply for a User ID and password.
ANNA V BROUGHER TOD
JAMES R FULTON
825 N COLLEGE ST
CARLISLE PA 17013
Optional Investment
Make check payable to:
Registrar and Transfer Company
Amount enclosed in U.S. DoUars:(~ ~
Your Optional Investment can u
be a minimum of $10.00 per investment and a
maximum of $1 „000.00 per month
Investment Plan Statement for Shareholders of 523
Transaction Form
Partial Withdrawal Continue Plan participation
Issue a certificate for
this number of shares
Sell this number of shares
(A $10.00 fee will be deducted
from proceeds)
Full Withdrawal Terminate Plan participation
^ Issue a certificate for alt full shares and
a check for fractional shares
^ Sell all Pian shares
(A $10.00 fee will be deducted from proceeds)
~ M&T Banlc Corporation
Issue#: Account#:
5236 0343111004
Signature(s) for issuance or sale and/or
change of address.
~~~`;,,Aedallion Signature Guarantee required for sale request of
$1 d 000 or higher.
Atl joint owners must sign. Names must be signed exactly as
shown on this statement. (Partner/Officerlrrustee must sign as
Partner/Office r/Trustee. )
Address change or share transfer ~~
Mark box and complete the appropriate
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