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Home My WebLink About07-29-091505607120 --~ REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO 60X.280601 2 1 0 8 110 2 Harrisburg, PA 17128-0601 ~ ' RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 10 27 2008 12 10 1928 Decedent's Last Name Suffix Decedent's First Name MI MCMURTRIE BERTHA E (If Applicable) Enter Surviving Spouse's Information Below 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 tN APPROPRIATE OVALS BELOW X^ 1. Original Return ~ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ qa. Future Interest Compromise (date of death after 12-12-82) ~ 5. Federal Estate Tax Return Required X ^ 8 Decedent Died Tesfate (Attach Copy of Will) ~ 7. Decedent Maintained a Living Trust (Attach Copy of Trust) ~ 8. Total Number of Safe Deposit Boxes 9. Litigation Proceeds Received 1p. 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 TO: Name Daytime Telephone Number JOHN S DAVIDSON 717 533 5101 Firm Name (If Applicable) First line of address 320 WEST CHOCOLATE AVENUE Second line of address P.O. BOX 437 City or Post Office HERSHEY State ZIP Code REGISTER OF WILLS USE ONLY n.~ c-s ~ e.a ...~ x.7 - ' ~ r ~ _ ~ - 1' ~~ r; _. ~ -,~ ,~ PA 17033-0437 Correspondent'se-mail address: yOSt.daVldSOn@VerIZOn.net 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 representatwe Is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE H. Thomas Brewbaker ADDRESS 519 Spruce,$treet, Middletown, PA .17057 SIGNA URE Of PR PA ER OTHER THAN REPRESENTATIVE ,,~~ ~~ DATE .~~~,, ~,, ~,Vl~.~ John S Davidson i~`-'``~- =~ 7, a1~ t7~ West Chocolate Avenue, Hershey, PA 17033-0437 Side 1 1505607120 :~ 1 _~ _> .. z-t -~ ^~- 1505607120 C REV-1500 EX Decedent's Name: Bertha E M C M U rt r l e 1505607220 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 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. 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7, 8. Total Gross Assets (total Lines 1-7) ....................................................................... g. 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12. 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. 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 .00 0 0 0 15. 16. Amount of Line 14 taxable at lineal rate X .045 0 0 0 16. 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 1 ~• 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 18. 19. Tax Due ..................................................................................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Decedent's Social Security Number 155,000,00 1,258,75 392.62 156,651,37 48,793.62 141,303.36 190,096,98 -33,445.61 -33,445.61 0.00 0,00 0.00 0,00 0.00 Side 2 1505607220 1505607220 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-08-1102 DECEDENT'S NAME Bertha E McMurtrie STREET ADDRESS 808 Windsor Place CITY Mechanicsburg STATE PA ZIP 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 0.00 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.0 0 Total Credits (A + B + C) (2) 0.00 3. InteresUPenalty if applicable p, Interest E. Penalty Total InteresUPenalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box 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. (5) 0.0 0 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5g) ~ . Q 0 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" tN 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 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?......... ^ ^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 O F 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)]. 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-1502 EX+ (6-98) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF (FILE NUMBER McMurtrie, Bertha E 21-08-1102 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 seiVer, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) (If more space is needed, additional pages of the same size) Rev-15o8 EX+ ((,-9S) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER McMurtrie, Bertha E 21-08-1102 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on schedule F fir more space Is neeoea, aoaltlonai pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev1509 EX+ (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER McMurtrie, Bertha E 21-08-1102 H 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 RELATIONSHIP TO DECEDENT A. Brian T Brewbaker 519 Spruce Street Grandson Middletown, PA 17057 B 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 DECEDENT'S INTEREST 1 A 9/9/1993 Wachovia Bank checking account 785.24 50.000% 392.62 #1000630100065 TOTAL (Also enter on Line 6, Recapitulation) I 392.62 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (Rev. 6-98) REV-1151 EX+(12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER McMurtrie, Bertha E 21-08-1102 Debts of decedent must be reported on Schedule 1. ITEM DESCRIPTION AMOUNT NUMBER A, FUNERAL EXPENSES: Matinchek and Daughter Funeral Home 8,638.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions H. Thomas Brewbaker Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 519 Spruce Street City Middletown State PA Zip 17057 Year(s) Commission paid 2, Attorney's Fees John S Davidson 3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. I Probate Fees 7,750.00 7,750.00 298.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 24,357.62 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 48,793.62 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER McMurtrie, Bertha E 21-08-1102 ITEM NUMBER DESCRIPTION AMOUNT Other Administrative Costs 1 Allstate Insurance Company -homeowner's insurance premium for real estate 42.51 pending sale 2 Cumberland County Law Journal -estate notice 75.00 3 H. Thomas Brewbaker -reimburse cleaning materials used to prepare real estate for 235.09 sale 4 H. Thomas Brewbaker -reimburse costs of material used to repair real estate prior 92.66 to sale 5 PPL -electric utility service pending sale of real estate 368.85 6 Settlement charges for sale of 808 Windsor Place -see HUD - 1 settlement 23,360.95 statement attached 7 The Sentinel -estate notice 182.56 H-B7 Subtotal 24,357.62 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (6-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER McMurtrie, Bertha E 21-08-1102 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 AFSCME Advantage Platinum -credit card account #3199 3,483.19 2 Allstate Insurance Company -homeowner's insurance premium 42.51 3 Capital One -credit card account #3894 429.64 4 CitiBank Sears Card -credit card account #4363 2,343.30 5 CitiBank (South Dakota) N. A. Sears Roebuck ~ Co. -credit card accont #7327 8,043.16 6 EMC Mortgage Corporation -loan secured by mortgage on decedent's 808 Windsor 87,763.64 Place real estate 7 HSBC Bank -credit card account #167733606 18,121.00 8 Kohl's Charge -account #029-2996-329 557.34 9 Lower Allen Township -sewer and refuse charges due 87.50 10 PPL -electric utility bill 181.00 11 PSECU -Visa loan account secured by judgment lien on real estate 12,107.24 12 Sears Card -credit card account #2028 65.06 13 Verizon -telephone bill due 33.54 14 Wachovia FiA Card Services -credit card account #7241 7,897.25 15 Wal*Mart -credit card account #0196 147.99 TOTAL (Also enter on Line 10, Recapitulation) I 141,303.36 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) i COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER McMurtrie, Bertha E 21-08-1102 NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER PERSONS RECEIVING PROPERTY DECEDENT (Words) ($$$) ( ) Do Not List True s I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] 1 2 3 4 5 II. Brian T. Brewbaker 519 Spruce Street Middletown, PA 17057 H. Thomas Brewbaker 519 Spruce Street Middletown, PA 17057 Tracey E Brewbaker 519 Spruce Street Middletown, PA 17057 Pamela McMurtrie Lovejoy Riverton, UT Sandra Kay McMurtrie Plymouth, NC Grandson specific bequest of $6,000.00 Son real estate and tangible personal property Granddaughter jewelry and specific gift of $6,000.00 Stepchild $1.00 Stepchild ~ $1.00 See continuation schedule attached Continuation Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET ~ 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE J The BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Bertha E McMurtrie 10/27/2008 194-26-6963 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) Vickie McMurtrie Stotesburg Stepchild $1.00 Pantego, NC Total POST & DAVID/SON ~~o wi~ar cFiocot.A~ri~: wr.NUtt r>.o. ~3oxa3~ HERSHEY, PENNSYLVAMA 17033-0437 ['-Moil: ~osCdavidsun(dveria>n.nct JO's ,~. 1"OS I~ JOfIN S l).~Vlf)SON July 27, 2009 n~-i ~ f~iumt 717-i3:-5101 inx ~»-s3~-i~~r Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 RE: Estate of Bertha E. McMurtrie No. 2108-1102 Dear Register Strasbaugh: Enclosed is the original inheritance tax return to be filed in the captioned estate. I also enclose a copy of the return for the Pennsylvania Department of Revenue and a copy of the return which I ask that you time stamp and mail to me in the self-addressed, stamped envelope which is provided. I also enclose our escrow check in the amount of $25.00 in payment of the filing fee for the inheritance tax return. Thank you. Very truly yours, YOST & DAVIDSON ~--~ .~.. S. Davidson ~~ _~ _ JSD/rlb ~a + Enclosures ; ~ « c_., ~ cc: H. Thomas Brewbaker -~"r-=,~ r _ rv ;~ ~ `c7 ~ -. -~~ _ ~ .. ~~ :, C... '~ ...~ GT ,s ,.'.'. ~ ~ _. ~ ~_~; :'tiS tt! ~- - ~ ~, ~= c~ ~:...~ ~ ". O ,~ U4 ~., ~ ~ ~ ~ O ,,~ O C W ~ ~ m CD ~ C~ O O G' ~'1 ~. ..« n d y I~ ~~ i x m x .~~ o h ~ C 2 v -~ ••• ~~~ ~ r°o C ~~~ ~ a ~' o z v w m O ~` J `t5 - b, ~,n ~ 7 I m A ~ ,~;