HomeMy WebLinkAbout02-0752
REV_1500t;1(+(6-00)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Rud Marie W
DATE OF DEATH (MM-DD-Year)
DATE OF BIRTH (MM-DD-Ye.,)
OS/27/2002 02/18/1905
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAl)
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00 1. Original Return
o 4. LimiteO Estate
o 6. Decedent Died Testate (AttachcopyofWil)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date ofdeatll afIer 12-12-82)
o 7. Decedent Maintained a Living Trust (Allach copy of Trust)
o 10. Spousal Poverty Cred" (date of death between 12-31-91 and 1.1-95)
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OFFICIAL USE ONLY
FILE NUMBER
21-020752
""Ci5UNiYCOOE ~--'N'iiM'BER--
SOCIAL SECURJTY NUMBER
1 7 2 - 0 1 - 7 0 3 9
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURJTY NUMBER
o 3. Remainder Retum (dalll ofdeall1 prior to 12-13-82)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Depos" Boxes
o 11. Election to tax under Sec. 9113(A) (AIlachSch0)
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NAME
Jan L. Brown Es uire
FIRM NAME (If Applicable)
Jan L. Brown & Associates
TELEPHONE NUMBER
717.541.5550
COMPLETE MAILING ADDRESS
845 Sir Thomas Court, Suite 12
Harrisbur
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1. Real Estate (ScheOule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Reoelvable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly OwneO Property (Schedule F) (6)
o Separate Billing RequesteO
(1)
(2)
(3)
(4)
(5)
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
g. Funeral Expenses & Administrative Cosls (Schedule H) (g)
10. Debls 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 Bequesls/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subjecllo Tax (Line 12 minus Lina 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, ortransfelll under Sec. 9116 (a)(1.2)
x _(15)
118,581.52 X .045 (16)
X .12 (17)
X .15 (18)
(19)
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 collateral rate
19. Tax Due
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
PA 17109
OFFICIAL USE ONLY
3,945.62
112,270.43
13,928.92
(8)
130.144.97
9.035.44
2,528.01
(11)
(12)
(13)
11 ,563.45
118,581.52
(14)
118,581.52
5,336.17
5,336.17
d . C Add
Dece ents omplete ress:
STREET ADDRESS
4837 E. Trindle Road
Hampden Township
CITY I STATE I ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
5,336.17
5.061 00
266 36
Total Credits (A + B +C)
(2)
5,327.36
3. InteresUPenalty it applicable
D.lnterest
E. Penalty
TotallnteresUPenalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT,
Check box on Page 1 Une 20 to request a refund (4)
5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 8.81
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BAlANCE DUE, (5B) 8.81
Make Check Payable to: REGISTER OF WILLS, AGENT
~IID[I_lllllIIlIlllIlIIlllIlIIlIIlr:'III~lIlllllllll~~~ 1I'llnl'~~"'".".~"IIII_IIll_"!I.lfiJ1r!
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 ofthe property transferred; ........................................................................... 0 IZl
b. retain the right to designate who shail use the property transferred or its income; ........................................ 0 IZl
c. retain a reversionary interest; or ...................................................................................................... D 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 IZl
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration?......................................................................... ..................... 0 IZl
3. Did decedent own an 'in trustfo~ or payable upon death bank account or security at his or her death? ................. 0 IZl
4. Did decedent own an individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ........................... ............................................................................ IZl 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS 15 YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Underpenaltiesofperjury,lrf' :-elhatl have exalT'in-l this retum, Includi",..
Oeclaratlonofpreparetol~ 'epersoo. .. ~b~"
SIGNATUREOFP' ~', tJ;;(
ADDRESS 445 Burlington Avenue
MisSd
SIGNATURE OF PREPA
~panylng schedules and statements, and to the best of my knowledge 81\d belief, it is true, correct and complete.
~on of which preparer has any knowledge.
7 DATE
& 02/24/2003
MT 59801
DATE
02/24/2003
ADDRESS
PA 17109
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net vaiue of transfers to or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (a) (1.1) (i)J.
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 survivin9 spouse is 0% 172 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 disciosure 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 chiid is 0% 172 P.S. ~9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use ofthe decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) 172 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to orforthe use of the decedent's siblings is 12% 172 P.S. ~9116(a)(1.3)J. A sibling is defined, under Section 9102, as an
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REV',"''''''''''''..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Rudv Marie W
FILE NUMBER
21 02
0752
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly.owned wtth the right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Country Meadows Assoc; refund 97.52
2 Hospice of Central PA; refund 2.000.00
3 PA Blue Shield; insurance claim proceeds 395.24
4 Old Guard Insurance; premium refund 24.00
5 National Geographic Society; subscription refund 12.08
6 Conseco Senior Health Ins Co; policy benefits 1,200.00
7 Conseco Senior Health Ins Co; premium refund 195.68
8 Monumental Life Ins Co; premium refund 3.00
9 Catholic Digest; subscription refund 14.97
10 Rosary Council No 8 PCBL refund 3.13
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, Insert additional sheets of the same size)
3945.62
REV150~EX.11.1I.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL Y.OWNED PROPERTY
ESTATE OF
Rudv Marie W
If an aSlet was made joint within one year of the decedenfs date of death, it must be reported on Schedule G.
FILE NUMBER
21
02
0752
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Roberta M. Rudy
445 Burlington Avenue
Missoula, MT 59801
daughter
B
c
JOINTLY-OWNEO PROPERTY:
LETTER DATE DESCRlPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name offinancial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for joinUy.f1eldreal eslete. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 03/1990 206 Tenth Street, New Cumberland, PA 112,150.00 50. 56,075.00
Parcel 10: 26-24-0811-251; see attached assessment
2 A 06/1990 Allfirst Bank 2,664.61 50. 1,332.31
CD # 8-700-800-0153998
3 A 04/1988 Allfirst Bank 1,535.04 50. 767.52
CD # 8-700-800-0146347
4 A 01/1991 Allfirst Bank 1,647.79 50. 823.90
CD # 8-700-800-0154382
5 A 10/1990 Diocese of Harrisburg 21,686.40 50. 10,843.20
Savings # 01-40560
6 A 08/2000 Federated 59,317.90 50. 29,658.95
# 358/9889457
7 A 03/1990 Citizens Bank 2,004.56 50. 1,002.28
CD # 614069854-5
8 A 08/2000 PNC Bank, 331 Bridge St, New Cumberland, PA 244.75 50. 122.38
Safe Deposit Box 890B; contents coins and currency
8 A 6/1995 PNC Bank 2,053.12 50. 1,026.56
CD # 21001015880
9 A 2/1990 PNC Bank 1,601.08 50. 800.54
CD # 21001016314
TOTAL (Also enter on line 6, Recapitulation) $ 112 270.43
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Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Rudy, Marie W
21
02
0752
PaQe 1
Schedule F-2 . Jointly-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 identifying number. Attach DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT deedforjoinUy-held realeslale. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
10 A 9/1990 PNC Bank 2,000.25 50. 1,000.13
CD # 21001016329
11 A 9/1995 PNC Bank 1,735.30 50. 867.65
CD # 21001016427
12 A 1/1998 PNC Bank 2,325.39 50. 1,162.70
CD # 31700115263
13 A 3/1998 PNC Bank 420.33 50. 210.17
Checking # 5000928629
14 A 7/2000 PNC Bank 1,010.58 50. 505.29
Checking # 5003156628
15 A 7/2000 PNC Bank 3,121.71 50. 1,560.86
Savings # 5003144977
16 A 11/1978 PNC Bank 9,021.98 50. 4,510.99
Savings # 5130074713
SUBTOTAL SCHEDULE F.2 9,817.79
GRANDTOTALSCHEOULEF~ $ 112,270.43
""'."10""'''',.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER.VIVOS TRANSFERS &
MISC. NON.PROBATE PROPERTY
ESTATE OF
Rudv Marie W
FILE NUMBER
21 02
0752
This schedule must be completed and filed if the answerta any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY %OF
ITEM INCWDETHENAMEOFTHETRANSFEREE,THEIRRELATIONSHIPTODECEDENTANDTHE DATE OF TRANSFER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH ACOPYOF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST
(IFAPPLICABlE)
1- Lincoln Heritage Life Insurance Company 6,848.90 100. 6,848.90
Annuity 29436060
Roberta M Rudy, daughter, beneficiary
2 Lincoln Heritage Life Insurance Company 7,080.02 100. 7,080.02
Annuity 29435290
Roberta M Rudy, daughter, beneficiary
TOTAL (Also enter on line 7, Recapitulation) $ 13928.92
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REV.""",."." *
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
Rudv Marie W
FILE NUMBER
21 02
0752
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Stone & Murray Funeral Home, 40B Third Street, New Cumberland, PA 17070 6,4B4.00
2. Magaro's - funeral luncheon 522.79
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Numbe~s) I EIN Number of Personal Represenlative(s)
Street Address
City Slala Zip
Year(s) Commission Paid:
2. Attorney Fees Jan L Brown & Associates 2,000.00
3. Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation)
Claimant
Street Address
City Slate Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountants Fees
6. Tax Return Preparer's Fees
7. Express mail fee 13.65
B Register of Wills, inher tax return filing fee 15.00
TOTAL (Aiso enter on line 9, Recapitulation) $ 9 035.44
(If more soace is needed, insert additional sheets of the same size)
REV_~"'-"I''')..
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Rudv Marie W
Include unrelmbursed medlcale.penses.
ITEM
NUMBER
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
FILE NUMBER
21 02
0752
DESCRIPTION
AMOUNT
1.
3.99
2
3
4
5
6
7
8
9
10
11
12
13
14
15
Harrisburg Pharmacy
medical bill; Ck 299; cashed after death
Health South
outstanding medical bill
58_58
TamdotlHomecare Of Harrisburg
outstanding medical bill
47.00
Internists of Central PA
outstanding medical bill
18.41
Snoke Family Practice
outstanding medical bill
279.74
Quest Diagnostics
outstanding medical bill
2.82
Camp Hill Fire Co No 1
outstanding medical bill
523.00
Verizon
outstanding telephone bill
45_10
Associated Cardiologists
outstanding medical bill
5.06
Quantum Imaging & Therapeutic Associates Inc
outstanding medical bill
4.16
West Shore EMS
outstanding medical bill
416.60
West Shore EMS
outstanding medical bill
420.61
Snoke Family Practice
outstanding medical bill
89.42
Internists of Central PA
outstanding medical bill
41.52
Camp Hill Fire Co No 1
outstanding medical bill
572.00
TOTAL (Also enteron line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2 528.01
REV'~513EX'i9.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESiDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
RlJnv ?1 O? 07!'i?
RELATIONSHIP TO OECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [includo outn~ht s~ousal disllibutions, and transfo" undor
Soc. 9116(a (1.)]
1. Robert M. Rudy daughter 100%
445 Burlington Avenue
Missoula, MT59801
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1B, 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 $
(If more space is needed, insert additional sheets of the same size)
THIS IS NOT A TAX BILL
MAILING DATE, July I, 2000 Parcel Identifier:
District. 26 - NEW CUMBERLAND 2ND liD 26-24-0811-251.
School..: WEST SHORE SD
Location:
206 TENTH STREET
ELKWOOD
LOTS 145 & 146 DB 5N PG 29B
2000 Assessed Value Old Assessed Value
Market Value (2000 Markst x 100%) (1974 Market x 25%)
Land 22,200 22,200 950
Buildings 89,950 89,950 5,880
TOTAL 112,150 112,150 6,830
2000 Clean and Green Values
Land NOT NOT NOT
Buildings APPLICABLE APPLICABLE APPLICABLE
TOTAL
Clean and Green values apply to some farm and forest land. Such values
become effective only upon application and approval. All applications must be
received by the Assessment Office by 4:30 p.m. on October 15, 2000. Those
previously approved for Clean and Green do not need to re-apply.
TAXABLE
UNIT/LOT ID..: L-0145 +
Land Size....: .17 acres
Property Type: R
Residential With Buildings
Control No: 26001816
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Pennsylvania law requires that all real estate be valued as of the most recent county-wide reassessment. The iast
reassessment, or tax base year, was 1974. Since the/ast reassessmentin 1974,. properties have been assessed at 25% of the
1974 value (the 'Pre-Determined Ratio". The new tax base year will be the Year 2000, with the new assessed values
becoming effective for the 2001 tax year. The Pre-Determined Ratio has been changed to 100%. Your new assessed value
equals your Year 2000 market value.
It Is very important for you to know that whet> the new 2000 tax base Is determfned after this reassessment all ","xfng
districts are required by law to lower the millage rate by the same proportJ'!n that thO' talC base went up. Thelaw
provides that in the first year after reassessment (2001), the county and all townships and boroughS may not increase overall
revenue by more than five percent (5%) and school districts may not increase overall revenue by more than ten percent (10%).
The county and the other taxing bodies will make these decisions next year, and may choose not to increase overall revenue.
Of course, some individual's taxes will go up or down by more than those percentages. The essential point I.s that an
increase In market values does not necessarily mean a corresponding Increase In taxes. Individual changes In taxes
will depend upon a specific property's change as compared to the overall change for the taxing district.
The ESTIMATED impact statement printed below is our best estimate of change, based on 2000
COUNTY tax figures. This estimate does not include any borough, townShip, or school district impact.
ESTIMATED COUNTY TAX IMPACT,
CUrrent 2000 County mills =
Adjusted 2000 County mills =
27.500
1. 858
$
$
188
208
2000 County Tax BEFORE Reassessment.
2000 County Tax AFTER Reassessment.
~ i .
Pl01 DEED-IND.
ADGR -1
COPYRIGHT 1986 (l BY ALL-STATE LEGAL SUPPLY CO.
9~\:~\J~J07016
Made the
(it 4i1i iJ tt{i'" " """;, iF:,'
'90 I'IRR 21 PI'I 2 33
c1 0 a::. day of JJ1 /9-f(Z C H , in the year
Nineteen hundred and ninety (1990).
lSttwttn MARIE W. RUDY, Widow,
GRANTOR
A
N
D
MARIE W. RUDY and ROBERTA MARIE RUDY. as joint tenants with
right of survivorship and not as tenants in common,
GRANTEES
lIIitntlilittlt. That in consideration of One and 00/100----------------------------
__________________________"__""_ ($1, 00 )~--------------------------------- DollarB,
in hand paid, the receipt whereoj is hereby aclcnowled{Jed, the said grantor
do es
hereby grant and convey to the said gra",:tee 8.
their
heirs and assigns,
ALL~ CERTAIN tracts or parcels of land situate in the Borough of New Cumberland,
Cumberland County, Pennsylvani~, more particularly bounded and described as follows,
to wit:
TRACT NO.1: BEGINNING at a point on the southern line of Tenth Street on the
dividing line between Lots Nos. 145 and 146 on Plan of Elkwood; thence in a southerl
direction along said dividing line, one hundred (100) feet to a ten (10) feet wide
alley; thence in an easterly direction along the northern line of said ten (10)
feet wide alley. thirty-seven (37) feet to a second ten (10) feet wide alley;
thence in a northerly direction along said last mentioned ten (lO) feet wide alley.
one hundred (100) feet to Tenth Street; thence in a westerly direction along the
southern line of Tenth Street. thirty-seven (37) feet to the point or place of
BEGINNING.
BEING Lot No. 145 on the above mentioned Plan of Elkwood. said Plan being recorded
in the Cumberland County Recorder's Office in Deed Book "N", Volume 5. Page 298.
BEING the same premises which Alice Prowell Rudy, single woman, by deed dated
May 3, 1958, and recorded in the Cumberland County Recorder's Office in Deed Book
ilK", Volume lB, Page 172. granted and conveyed unto Robert D. Rudy and Marie W.
Rudy, his wife. The said Robert D. Rudy died December 3, 1960 whereupon title
became vested in Marie D. Rudy, Grantor herein, by operation of law.
TRACT NO.2: BEGINNING at a point on the southern line of Tenth Street on the
dividing line between Lots Nos. 146 and 147 (previously incorrectly referred to
as Lots Nos. 46 and 47) on the hereinafter mentioned Plan of Lots; thence in a
southerly direction along said dividing line, one hundred (100) feet to a ten (10)
foot wide alley; thence in a westerly direction along the northern line of said
ten (10) foot wide alley, thirty-seven (37) feet to a point; thence in a northerly
direction along the dividing line between Lots Nos. 147 and 148, one hundred (lOQ)
feet to Tenth Street; thence in an easterly direction along the southern line of
Tenth Street, thirty-seven (37) feet to the place of BEGINNING.
BEING Lot No. 146 on a certain Plan of Lots called Elkwood, said Plan being
recorded in the Cumberland County Recorder' 8 Office in Deed Book "N", Volume 5,
Page 298.
we. ';j~ 34 ,.tt 932
BEING the same premises which Arvi1la J. Rudy, Widow. by Deed dated May 3, 1958
and recorded in the Cumberland County Recorder's Office in Deed Book "K", Volume 18.
Page 169. granted and conveyed unto Robert D. Rudy and Marie W. Rudy, his wife.
The said Robert D. Rudy died December 3. 1960, whereupon title became vested in
Marie W. Rudy, Grantor herein, by operation of law.
HAVING THEREON ERECTED a single dwelling known as and numbered No. 206 Tenth
Street, New Cumberland. Pennsylvania.
THIS IS A transfer between mother and daughter without consideration.
REGISTERED BY THE
OOROOGH OF EW WMBER1AND
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BGOl'1; 34 rAlE 9J3
Anb the said grantor
does hereby
generally
mumnt
the property hereby conveyed.
1In Dllitntllll Iflttftllf. said grantor
ha s hereunto set he r
hcmd
and seal
the day and year first above written.
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t .<'( ',~. t....<'
Marie W. Rudy
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(!tommonmtult4 of 'ennll11luania
(!tountll of Cumberland
- .fIP
On this, tke.:::'?O "dayof March
~ 1111.
1990 ,before me, a Notary Public
the undersigned officer, personally appeared MARIE W. RUDY, Widow,
)
/
/
known to me (or satisfactorily pr01Jen) to be the person whose rf{~ is . _' subscribed to the iilithin
instrument, and acknowledged that s he executed the same ~r the pu. "pO;e therei ontain:1fil:--.'\',"":': 'I H~1;.'.'.\'."';"
IN ,1I!!!:!!ESS WHEREOF, I have kereu1t s my h~1'~.?J:!!. No ari 1 s~. ql. :.."~. . "'..iI. ..~ ~":'...(i.':':;..
NOTARIAL SEAL .:- <J '? ,: c ,.' ~ . <.
SU2_ H. LEAVELLE. NOTARY PUBLIC ~. _ (/t,.i.. C." ?7d' '/ ~.'. :.'.:.J..,,,.. : ',........:,' . ~.\... .....,
NEW CIJlllERLAND BORO. CUMBERLAND CO. ./,..' u. ,> ",.,' ;; ~ ~""
~Y COMMISSION EXPIRES JANUARY 23. 1991 , I / I. :; :.'. "'.''''' .>~.: ;:;: :;
I . ~. / --'/ ,1 / , . ";;. . .',: <''-'<;
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On this, the
day of
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, before me
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On this, tM
day oj
19
,beforeme
the undersigned officer, personally appeared
kn.oum to me (or satisfactorily PT(wen) to be the person whose name 8'\.l.oscribed to the withi1\.
imtrument, and Mknowledged that he executed the same for the purpose therein contained.
IN WITNESS WHEREOF, I have hereunto set my hand and seal.
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QI:ommonwealtlt of lIlennIi111ua:nia: I
QI:ountl1of C,wvv-flu,Lv,A c! (lili. (
lteclIfbeb in the Office for Recording ofDeeda in andfor _ cAjVlI' (i
Cc'-'~'r'{'J inDeed Book ,{ NO.}/
page 13,), Etc. .. ,t
B1Uness my hand and seal of Office this .:)/,,)
daYOf9~:':~ ~ .~::ini19 c;c,
Jan L. Brown, Esquire*
Jacqueline A. Kelly, Esquire
*ADMITTED IN PA AND DISTRICT OF COLUMBIA
JAN C BROWN & ASSOCIATES
ATTORNEY AND COUNSELOR AT LAW
OLDE ENC~ISH GAP
845 SIR THOUAS COURT
SU~T~ 12
HARR)SBURG, PA 17109
Email: jlbassoc@verizon.net
TELEPHO. E (717) 541-5550
FACSiMIlE (717) 541-9223
May 17, 2004
Brenda F. Kephart, Legal Assistant
Paula K White, Legal Assistant
Judilh A. Ebersote, Administrative Assistant
Register of Wills
Cumberland County Courthouse
One Courthouse Square
Carlisle, PA 17013
Re:
Marie W. Rudy, deceased
Social Security No. 172-01-7039
Gentlemen or Ladies:
Enclosed please find the following items for filing with the Register of Wills:
1. An original and one copy of the Supplemental Inheritance Tax Return together with a
check payable to Register of Wills, Agent in the amount of $105.24 to cover the tax
liability.
2. A check payable to the Register of Wills in the amount of $15 to cover the filing fee for
the Supplemental Inheritance Tax Return.
Please time stamp and return our file copy. A return envelope is provided.
If you have any questions, feel free to contact this office.
Sincerely,
Brenda F. Kephart
Legal Assistant
bfk
Enclosure
REV-15OO EX + (6-0~)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17126-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
~ILE N~MB~R
2 1 -0 2 0 7 5 2
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL SOCIAL SECURITY NUMBER
z RudyMarieW 1 7 2- 0 1 - 7 0 3 9
f"'t DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
U.I REGISTER OF WILLS
(,1 05/27/2002 02/18/1905
III (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
ILl
Z
0
DJ
0
E~]I. Odginal Return
E~]4. Limited Estate
E~]6. Decedent Died Testate (Attach copy of Will)
[---~ 9. Litigation Proceeds Received
r~2. Supplemental Return
[] 4a. Future Interest Compromise (d~ of death after 12-12-82)
E~7. Decedent Maintained a Living Trust (Attach copy of Trust)
[~] 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
[--'~ 3. Remainder Retum Idate of death pdor to 12-13-82)
r"-~ 5. Federal Estate Tax Return Required
__ 8. Total Number of Safe Deposit Boxes
~-~ 11. Election to tax under Sec. 9113(A) (A~tach Sch O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL T~ INFORMATION SHOULD BE DIRECTED TO:
NAME
Jan L Brown Esquire
FIRM NAME (If Applicable)
,Jan L Brown & Associates
TELEPHONE NUMBER
717-541-5550
COMPLETE MAILING ADDRESS
845 Sir Thomas Ct Ste 12
Harrisburg PA 17109
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)
~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
Total Gross Assets (total Lines 1-7)
Funeral Expenses & Administrative Costs (Schedule H) (9)
Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
Total Deductions (total Lines 9 & 10)
Net Value of Estate (Line 8 minus Line 11)
9.
10.
11.
12.
13.
Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
3,238.12
OFFICIAL USE ONLY
(8)
3,238.12
1 ~026.00
(11)
1 ~026.00
(12)
(13)
2,212.12
(14)
2,212.12
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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 collateral rate
19. Tax Due
20.
0.00 X __ (15)
2,212.12 X .045 (16)
0.00 X .12 (17)
0.00 X .15 (18)
(19)
0.00
99.55
0.00
0.00
99.55
> > BE SURE TO ANSWER ALL QUESTIONS;ON REYERSE SIDE AND RECHECK MATH < <
Decedent's Complete Address:
ISTREET ADDRESS 4837 E Trindle Road
Hampden Township
crrY Mechanicsburg
ISTATE PA [ ZIP 17050
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C, Discount
Interest/Penalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E ) (3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
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
99.55
0.00
0.00
0.00
99.55
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 premise 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? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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,.~f preparer other than the personal representative is based on all information of which preparer has any knowledge.
Bothell.,..
SIGNATURE OF PREPA~I~iiN ~1~
ADDRESS 845 ~r ~homas Court Suite 12
Harris~rdfg
WA 98021
DATE
PA 17109
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 3%
[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 0% [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 0% [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 4.5%, 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 12% [72 P.S. §9t 16(a)(1.3)]. A sibling 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-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF FILE NUMBER
Rudy Merle W 21 02 0752
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. 3,238.12
M&T Bank
Certificate of Deposit 31003914381535
TOTAL (Also enter on line 5, Recapitulation) $ 3,238.12
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Rudy Marie W 21 02
07~2
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s)/EIN Number of Personal Representative(s)
Street Address
City. State
Year(s) Commission Paid:
AttomeyFees Jan L Brown & Associates
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City State Zip
Relationship of Claimant to Decedent
Pmbata Fees
Accountant's Fees
Tax Retum Preparer's Fees
Register of Wills, Cumberland County; filing fee Supplemental Inheritance Tax
Return and Petition for Settlement of Small Estate
1,000.00
26.00
TOTAL (Also enter on line 9, Recapitulation) $ 1 ~026.00
(if more space is needed, insert additional sheets of the same size)
REV-1513 EX + (g.nm
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
Rudy Ma 'ie W
NUMBER
I.
1.
]I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a)(1.2)]
Roberta M Rudy
23708 Locust Way #20-A, Bothell, WA 98021
FILE NUMBER
21 O~
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
07~Z
AMOUNT OR SHARE
OF ESTATE
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 tS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
2,212.12
TOTAL OF PART II - 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)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV-1162 EX(11-96)
CD O03945
BROWN JAN L
845 SIR THOMAS COURT
SUITE 12
HARRISBURG, PA 17109
........ fold
ESTATE INFORMATION: SSN: 172-01-7039
FILE NUMBER: 2102-0752
DECEDENT NAME: RUDY MARIE W
DATE OF PAYMENT: 05/18/2004
POSTMARK DATE: 05/1 8/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/27/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $105.24
REMARKS:
TOTAL AMOUNT PAID:
$105.24
SEAL
CHECK# 2159
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
ORPHANS' COURT DIVISION
Estate of Marie W. Rudy, Deceased
PETITION FOR SETTLEMENT OF SMALL ESTATE
UNDER PENNSYLVANIA STATUTES 20 § 3102'
I, ROBERTA M. RUDY, state:
'7!
1. Marie W. Rudy, a widow, died on May 27, 2002, and was a resident of Cumberland
County, Commonwealth of Pennsylvania, at the time of death. A death cert~cate is
attached hereto.
2. Marie W. Rudy is the owner of a Certificate of Deposit Account 31003914381535 at
M&T Bank with a date of death value of $3,238.12 and an account balance as of
February 20, 2004, of $3,333.10.
3. The gross value of decedent's Estate does not exceed Twenty-five Thousand Dollars
($25,000).
4. Two years have elapsed since the death of Marie W. Rudy.
5. The Pennsylvania Transfer Inheritance Tax Return reporting said Certificate of Deposit
No. 31003914381535 at M&T Bank has been filed with the Register of Wills, and
petitioner has paid the inheritance tax shown to be due; said cover page of the Inheritance
Tax Return and the tax receipt are attached hereto.
6. There are no unpaid claimants of whom petitioner has notice or knowledge.
7. Petitioner is entitled to Certificate of Deposit No. 31003914381535 at M&T Bank as heir
of the decedent, because there are no other heirs that have preference.
-1-
8. The next-of-kin and heir of the decedent is listed below.
Name 5A6ge I Relationship to Decedent
Roberta M. Rudy Daughter
WHEREFORE, petitioner respectfully requests the Court to direct liquidation of the
Certificate of Deposit Account 31003914381535 at M&T Bank to the decedent's daughter and
heir, Roberta M. Rudy.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
! ~ day of
ROBERTA M. RUDY
STATE OF WASHINGTON
COUNTY
SS:
ROBERTA M. RUDY, being duly sworn according to law, does depose and say that she
is the petitioner in the foregoing petition, and the facts set forth therein are tree and correct to the
best of her knowledge, information and belief.
Swom to and subscribed before me this
2004.
, ~ day of fi/)~
-2-
his is to certify that the information here given is correctly copied fi'om an original certificate of death duly filed with me as
Local Registrar. The original certificate will.be forwarded to the State Vital Records Office for'permanbnt filing.
Fee for this certificate, $2.00
P 8208040
No.
Local Registrar
MAY 13 0 2.002
Date
3 Rev 2/87
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
]~.~emale 3. 172 --01 --7039 ,. Hal/ 27, 2002
'eb18,1905 arrlsburg,P
Marie W. Rudy
AGE (Lara 8.'lr'a3a¥) UNDER t YE,AR
97
COUNTY OF DE.A~H
)hin
O~CEO~'S usu^t OCCO~,O.
UNDER ! DAY
Insurance
4837 E. Trindle Road
Mechanicsburg,PA 17050
Isquehanna Twp. ~.arolyn Croxton Slane ~{esl~enc~. ~.
','~,S OECEDENT EVER INI OECEDENT'S EDUCATION I
U S. AFtMEO FORCES? I
{1 '(~,} Widowed '
,~.c~ Cumberland '~? ,,,,.I-1
ford Ins.
,,. White
SU,qVIVING
Edward Weiss
,,.Clara Becker
1~.445 Burlinoton Ave.. Missoula. MT 5980~
I PLACE OF OISPOSITION. Nam~ ~1 C~ ~e~/. Clemal~y I LO(:AI'ION. C~y/Tow~. ~al,. Z~ C.~
I
,,~.ay 31, 2002 ~,91y Cross Catholic Ceml~l,.Harrisburg,PA 17111
~a,. FD 012342-L ~.one&MurrayFH408 3rd St NewCumberlan~,~A
TNA~ AN AUTOPSY MANNER OF DEATH
REC~R'S SIGNATURE ANO NUMOE~
REV-1500 EX + (6-00)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
Z
L,U DATE OF DEATH (MM-DO-Year)
0 05/27/2002
DECEDENT'S NAME (LAST. FIRST. AND M DOLE INITIAL
Marie W
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DATE OF BIRTH (MM-DO-Year)
02/18/1905
(IF APPLICABLE) SURViViNG SPOUSE'S NAME (LAST, FIRST, AND MIDDLE iNiTiAL)
FILE NUMB~u-~"Y ......
2 1 -0 2 0 7 5 2
COUNTY CODE YEAR NUMBER
SOCIAL SECURITY NUMBER
I 7 2-0 1 -7 0 3 9
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
ILl
~") ~- ~D
[~1. Odginal Return
[--~ 4. Limited Estate
F-J6. Decedent Died Testate (AUachcopyofWill)
~-'--~ 9. Litigation Proceeds Received
r~2. Supplemental Return
[] 4a. Future Interest Compromise (date of death after 12-12-82)
~--'~ 7. Decedent Maintained a Living Trust (A~tach copy of Trust)
r--I 10. Spousal Poverty Credit {date of death between 12-31-91 and 1-1-9§)
] 3. Remainder Return (dateofdeathpdorto 12-13-82}
]5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
E~I 1. Election to tax under Sec. 9113(A) (A~ach Sch O)
Z
ILl
Z
O
G.
U.J
O
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME
L Brown Esquire
FIRM NAME (If Applicable)
~an L Brown & Associates
TELEPHONENUMBER
7-541-5550
COMPLETE MAILING ADDRESS
845 Sir Thomas Ct Ste 12
Harrisbur§
PA 17109
Z
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)
r-~ 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 Costs (Schedule H) (9)
10. Debts of Decedent, Modgage 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/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(8)
1,026.00
(11)
(12)
(13)
(14)
3,238.12
1,026.00
2,212.12
2,212.12
Z
O
X
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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 collateral rate
19. Tax Due
20.
0.00 x
2,212.12 x
0.00 x
0.00 x
__ (15)
.045 (16)
.12 (17)
.15 (18)
(19)
0.00
99.55
0.00
0.00
99.55
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
Decedent's c°m Pinta"Ad,l'eggs:
STREE'~'ADDRES¢ ' *-
' 483:7 E.Td¢dle
Hampden Township
CITY
Mechanicsburg I STATE PA I ZIP 17050
Tax Payments and Credits:
1. Tax Due(Page I Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
lnteresllPenalty if applicable
D. Interest
E. Penalty
(1)
Total Credits ( A + B + C ) (2)
Total Interest/Penalty ( D + E )
(3)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
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. (SA)
B. Enter the total of Line 5 + EA. This is the BALANCE DUE. (EB)
Make Check Payable to: REGISTER OF WILLS, AGENT
99.55
0.00
0.00
0.00
99.55
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 Becember 12, 1982, did decedent transfer properly 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? ....................................................................................................... [] []
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penalties of perjury, I declare that I have examined Bis return, including accompanying schedules and statements, and 1o the best of my knowledge and belief, it is true, correct and complele.
Oeclaration,,~f preparer other than the personal representative is based on all information of which preparer has any know~edge
ADDRESS 23708 Locust Way/#20oA % _.~ ~///~/~
Bothell,,.., --
SIGNATURE OF PREPA?~~N ~
ADDRESS 845 ~r ~.homas Court Suite 12
Harris-~:r~q -
WA 98021
DATE
PA 171O9
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 3%
[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 0% [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 0% [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 4.5%, except as noted in 72 P.S. §9116(1.2) [72 PS. §9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
.'BUREAU Qi~ INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO.
REV~1162 EX(,11-96)
CD 003945
BROWN JAN L
845 SIR THOMAS COURT
SUITE 1 2
HARRISBURG, PA 17109
........ fold
ESTATE INFORMATION: SSN: 172-01~7039
FILE NUMBER: 21 02-0752
DECEDENT NAME: RUDY MARIE W
DATE OF PAYMENT: 05/18/2004
POSTMARK DATE: 05/1 8/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/27/2002,
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $105.24
TOTAL AMOUNT PAID:
$105.24
REMARKS:
SEAL
CHECK# 2159
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
J~JN 0 1' 2004
IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY
O WSION g0 g--
Estate of Marie W. Rudy, Deceased
DECREE
Now, this ~ day of ~ ,2004, upon consideration of the
Petition for Settlement o£ Small Estate filed with the Court o£ Common Pleas of Cumberland
County, it is hereby ordered that liquidation o£ the Certificate o£ Deposit
Account 31003914381535 at M&T Bank and titled to Marie W. Rudy who died on May 27,
2002, be made to the decedent's daughter and heir, Roberta M. Rudy.
By the Court:
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONNEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOT[CE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
JAN L BRONN ESQ
JAN L BRONN & ASSOCS
845 SIR THOMAS CT 12
HBG
PA 17109
DATE 06-28 -2004
ESTATE OF RUDY
DATE OF DEATH 05-27-2002
FILE NUMBER 21 02-0752
COUNTY CUMBERLAND
ACM 101
Amount Remitted
MARIE W
MAKE CHECK PAYABLE AND REMIT PAYMENT TO;
REGISTER OF MILLS
CUMBERLAND CO COURT HOUSE
CARLTSLE, PA 17015
CUT ALONG THIS LINE I1~ RETAIN LONER PORTION FOR YOUR RECORDS -~
REV-1547 EX AFP C01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR
DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF RUDY MARIE N FILE NO. 21 02-0752 ACN 101 DATE 06-28-2004
TAX RETURN NAS: C X) ACCEPTED AS FILED C ) CHANGED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN
1. Real Estate (Schedule A}
2. Stocks and Bonds (Schedule B> C2>
$. Closely Held Stock/Partnership Interest (Schedule C>
4. Mortgages/Notes Receivable (Schedule D>
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E> (5>
6. Jointly Owned Property (Schedule F> (6>
7. Transfers (Schedule G>
8. Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/M/sc. Expenses (Schedule H> (9>
lO. Debts/Mortgage Liabilities/Liens (Schedule
11. Total Deductions
12. Net Value of Tax Return
NO. 01
O0
O0
O0
O0
3r258.12
O0
O0
C8)
1,026.00
.00
NOTE: To insure proper
credit to your account,
submit the upper port/on
of this form with your
tax payment.
5,258.12
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
05-18-2004
08-19-2002
02-25-2005
CD001546
CD002224
CD005945
266.57
.00
5.70-
PAYMENT RECEIPT DISCOUNT
AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID
5,061.00
8.81
105.24
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) C15)
Net Value of Estate Subject to Tax C14) 120,795.64
If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 w111
.00
.00
5,455.72
.00
.00
5,435.72
5,435.72
.00
.01
.01
C IF TOTAL DUE IS LESS THAN 41, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA>, YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
1:5.
14.
NOTE:
reflect f~gures that ~nclude the total of ALL returns assessed to date.
ASSESSMENT OF TAX: .'~-uu
00L
15. Amount of L/ne 14 at Spousal rate C15> X =
16. Amount of L/ne 14 taxable at Lineal/Class A rate Cl6> 120,795.&4 X 045 =
17. Amount of Line 14 at Sibling rate C17> .00 X 12~ =
18. Amount of Line 14 taxable at Collateral/Class B rate CI8> .00 X 15':=
19. Principal Tax Due (19~=
TAX CREDITS:
Cll> ].O~&. 00
c12) 2,212.12
RESERVATION=
PURPOSE OF
NOTICE=
PAYMENT=
REFUND CCR)=
OBJECTIONS=
ADMIN-
ISTRATIVE
CORRECTIONS=
DISCOUNT
PENALTY=
[NTEREST=
Estates of decedents dying on or before December 12, 1982 -- if an~ future interest in the estate is transferred
in possession or enjoyment to Class B Ccollateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (collateral) rate on any such future interest.
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. C72 P.S.
Section
Detach the top portion of this Notice and submit with your payment to the Register of Ni113 printed on the reverse side.
--Hake check or money order payable to= RBGZS~'~ OF MILLS) AGENT
A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-ISIS). Applications are available at the Office
of the Register of Mills, any of the 23 Revenue District Offices, or b~ calling the special 24-hour
answering service for forms ordering= 1-800-362-2050; services for taxpayers with special hearing and / or
speaking needs= 1-800-447-$020 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax Cincluding discount or interest) as shown on this Notice must object within sixty C60) days of receipt of
this Notice by=
--written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021,
--election to have the matter determined at audit of the account of the personal representative,
--appeal to the Orphans' Court.
OR
Factual errors discovered on this assessment should be addressed in writing to= PA Department of Revenue,
Bureau of Individual Taxes, ATTN= Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone C717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of administratively correctable errors.
If any tax due is paid within three (3) calendar months after the decedent's death, a five percent CSX) discount of
the tax paid is allo~ed.
The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before danuar~ 18, 1996, the first day after the end of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of
death, to the date of payment· Taxes which became delinquent before January 1, 1982 bear interest at the rate of
six C6X) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue· The applicable interest rates for 1982 through 2004 are=
Interest Daily Interest Daily Interest Daily
Rate Factor Year Rate Factor Year Rate Factor
20X .000548 ~r8-1991 ll~ .000301 ~ 9X .000247
I6X .000458 1992 9X .0002~7 2002 6X .000164
IIX .000501 1995-1994 7~ .000192 2005 5X .000137
1995-1998 9X .000247 2004 4X .000110
1999 7~ .000192
2000 7X ·000192
Year
]983
198~
1985 13X
1986 10X
1987 10X
--Interest is calculated
ZNTEREST= BALANCE OF
· 000356
· 000274
· 000274
as follows =
TAX UNPAXD
X NURBER OF DAYS DELZNI~UENT X DAXLY INTEREST FACTOR
--Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days
beyond the date of the assessment. If payment ~s made after the interest computation date sho~n on the
Notice, additional interest must be calculated.