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HomeMy WebLinkAbout07-17-09 15056051058 1 500 REV EJ( cam) - GFFIDYLL GSE GNt.Y PA DepeMaM d Revenl» CouAy Code Year Fb INxllber Bul~rdlMivMUei Taxr INHERITANCE TAX RETURN ro Box 280801 _g ~ OQ . ~~~ Nentrbleg PAnt28aeot R ESIDENT DECEDENT ~-1 J _ ENTER DECEDENT INFORMATION BELOW Soda) SecinXY Number Date or Death Date of Birut 163-07-8349 05/19/2009 04/16/1915 Deceden's Lasl Name SuRhc Decedent's Fast Name hR. Brinkerhoff Mrs Fkxence H lNApplicebb) ErMer SurvNMg BpOYW'a lntontlaDon BNow Spouse's last Name SuROc Spouse's Fiat Nana MI Spouse's 3odal Seasuy Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FlLL IN APPROPRIATE OVALS BELOW (~ 1. Original Realm O 2. Suppkmentel Retum O 3. Remainder RaWm (dale d death prbr to 12-13.82) O 4. Limned Estate O 4a. FuWre Interest ComprOmir (dated O 5. Federal Estate Tax Retum Required dselh a8a 12-12-02) O 6. DecetleM Died Testate O 7. Decedent Mainginetl a Livkg Tmst _ __.. 8. Total Number d Safe Depose Boxes (Attach Copy d W81) (Attach COPY d Tnad) O 9. LiOgatlon Proceeds Received O 10. Spousal Poverty CredX (date d dean O 11. F_NCBOn to tax under Sera 9113(A) between 1231-91 aW 1-t-BS) (Aeadt Sch. O) CORRESPONDENT - 7tY3 BECTIDN IIUBT lE COMPLETFA. ALL DIbENCE AN) CDNRDEMYLL TAX Xi0R11AT10118110ULD BE DIRECTED TO: Name Daytlma Telephone Number Shirley A. LeDane ' (717) 830-1830 Finn Neme (X Applicable) ___. _ - .. ~' REGISTER OF USE ONI~ ~ b v ' r~ U L ml= ~ ~ ~ ~ ~' Fret line d address '. r > t,j v ~ c ~, i 214 Kennedy Ct. _ j ~ ~ v ', ! ~:i ~5i secorWlinedaddress CY ~~ Qg~ ~ I - <`I - ~ ~ y ~ '~7 r1AlE FILED ~ ~ ''TT City Of Poffi tMice State ZIP Code - -- _- ~ ~^" Hanover PA 17331 y CarteapontlatPa eirreN address: Un~br p~Wtly d pagley, l Oadeie 1ha I trove exeminetl tlee rsaxn, induarq aamperyvrp adredaar aid eO~NrnerXS, erxl fo tlra X b true. ma1Er sad mrade0e. DacWaaon d plapeplr dfw Msn IM psraanel rapwrtlelNe N bred an ap Idamallan d whkh 214 Kennedy Ct.(Aianover, PA 17331 SIOIJATURE OF PREPARER OTHER THAN REPRESENTATIVE 07/18/09 DATE FLEAB! U86 ORIGINAL FOAM ONLY Slde 1 15056051058 15056051058 ~t s ~~ ~~~ ~~ J REV-tsoo Ex oeoeaemarranre: Florence RECAPITULATION 15056052059 H Brinkerhoff Decederd's 3oGal SewrBy Number '183-07-8349 1. Real estate (schedule A) ........................................... .. 1. 0.00 2. Stocks and Bonds (Schedule: B) ..................................... .. 2. _ 0.00 ''.. _ 3. Closely Held Corporetbn, Partrrerehlp or Sole~Proprietorship (schedule C) ... .. 3. ' 0.00 _ 4. Mortgages & Notes Receivable (Schedule D) .............. ......... .. 4. _ 0.00 _.. 5. Cash, Bank DepoaNs 8 Miscellaneous Personal Property (Schedub E) ..... ... 5. ... 31,444.09 '. B. JdnBy Owned Properly (Schedule F) O Separate BNNng Requested .... ... 6. 0.00 _..... __ 7. Infer-Vivos Transfers 8 MisceNeneous Noo-Probate Property 0 00 (schedule G) O Separate &Iling Requested..... ... 7. .. . 8. Tdal Graaa Assets (tool Lines 1-7) ................................. ... 8.. .._..... ..... 37,444.09 9. Funeral Expenses &Admirustratlve Costs (Schedule H) .................. ... 9 .... 11,617.40 10. DeDb d Decedent, Mortgage LiaWlitles, 8 Liens (Schedule I) ............. ... 10. 360.86 _ __. 11. Total Dsductlons (total Llres 9 & 10) ................................ ... 11. ' 71,978.26 _. _ _ _. 12. Net Value of Estate (floe 8 minus Line 11) ........................... ... 12. 19,485.83 13. Charitable and Governmental BequestdSec 9113 Trusts for whMJr an ebttlon b tax has rat been made (Schedub J) ..................... ... 13. 0.00 '. 14. Nat Valw SulrJset to Tax (Llne 12 minus Line 13) ..................... ... 14. 19,465.63 '. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount d Line 74 bxable at the spousal tax tab, or transfers under Sec. 9116 0 00 (axt.2) X .0_ . 18. AmouMdlJne t4 taxable _...~ M Nrreal reb x .0 45 _.... ..... 19,465.83 . 17. _ __ AnquM d Line to taxabe __ _ 00 0 at sNrling rare x .1z _ . _ 18. ArtquM d Litre 14 texaWe t 5. 0.00 _,. 16. 875.96 ___ __ _.. n. at copalerel refs X .15 0.00 18. 19. TAX DUE ......................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side2 0.00 __ 0.00 875.96 r~ 15056052059 REV-1500 Ex Page 3 Decedent's Complete Address: Flk. Narnikr_._.. j ~ ~I UE S NAME DECEDENTS SOCIAL SECURRY NUAeER Florence H Brinkerhoff _183-07-8349 sTREETADDRESs 214 Kennedy Ct. _ crrv Hanover srATE PA nP 17331 Tax Payments and Credits: 1. Taz Due (Pape 2 Line 19) 2. CrediffiIPeymenffi 0.00 A. Spousal Poverty CredA e. Price Paymenffi 0.00 C. Recount 43.79 3. InteresflPenaAy fi applicebie D.IMerest E. Penalty (1) Toffilcredns(A+B+c) (z) Total IrdarestlPeneMy (D + E ) 4. M Line 2 is greater than Line t + Line 3, enter Me dAfererrce. This s the OVERPAYMENT. F91 In oval on Paps 2, Lino 20 to ragrrstt a ralund. 5. H L'me t + Line 3 is greeter Men Line 2, err0er'the difiererlce. This is the TAX DUE A. Eller the k1ffirest on Me tax due. B. Enffir the total of Line 5 + SA This is Me BALANCE DUE. 875.96 43.79 (3) 0.00 (4) (5) (5A) (58) 0.00 832.17 0.00 832.77 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTKNi3 BY PLACING AN "X" IN THE APPROPRUITE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use a inooma of lire property transferred :.................................................................................... ...... ^ b. retain lire dgM tD designate who ahaA use Me properly trarrefened a its kaome, ^ ...._.._.._._......_ ............. c. retain a reversionary interest a ........................................................................ ...... ^ d. receive the promise for life of BMer paymems, benefiffi a care? ................................................................ ...... ^ 2. g deaM ocarred atffir Decemtrar 12, i962, did deoedeM transfer property wiMin one year of deaM wiMaa receMrg aderplete cerlsideretlon7 ........................................................................................................ ...... ^ 3. Did decedent awn an'in bust for a payade upon death bank aocourd a secuAy at his a her deaM? ........ ...... ^ 4. Did decedent own an Individlral Retirement Aocounl, annuky, a oMer non-probate properly which mrrtakt6 a benefidary deeigrratiorr? .................................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE R AS PART OF THE RETURN. fw dates of deaM on a aBer Juty 1,1994 and before January 1,1995, Die tau rate imposed on Me net vaNla d transfers to a fw Me use of the surviving ~ce is dxee (3) percent [/2 P.S. §9116 (a) (1.1) (i)]. fa dates d deaM on w after January 1, 1995, Me tax rant imposed on the net value of transfers to a for Me use of Me sundvirg spouse is zero (O) peroard p2 P.S. §9115 (a) (1.1) ('d)]. The statute does not exempt a transfer to a Mxvivkrg spouse from lax, arrd the sghday requirements far dittdosure ~ assets and Ming a tax rehrm are s81 applkable even if the surviNng spouse is the oMy berlefidery. Fa dates of deaM on a after Juy t, 2000: The fax rate imposed on Me rrd value d transfers from a deceased child twenty-one years of age a younger at deaM to a for the use of a naWrel parent, an adaptive parent, a a stepparent of Me ddd is zero (0) percent [12 P.S. §9116(a)(1.2)]. The lax rate imposed on the rlet value of transfers M w fw the use of the decedent's Aneal berrefirieries is four and arre-half (4.5) percent, except as rated in 72 P.S. §9116(1.2) f/2 P.S. §9116(axt)]. The fax rate imposed an the net value of transfers to a fa the use Mthe decedents sibkngs is twehre (12) percent ff2 P.S. §9118(a)(1.3)j. As~ling is defined, under Section 9102, as an individual who has at feast one parent in common vvNh the decedent whether by flood a adogion. ,:. ~~:, :, ~.,. REV-1502 EX+ (11-08) Pennsylvania I SCHEDULE A DEP~RTNENT OF REVENUE REAL ESTATE INHERITANCE TN( RETURN RESIDENT DECEDENT ESTATE OF FILE NUNBER Flon:nce H Brinkerhoff 200&00483 If more space is needed, insert additional sheets of the same size. REV-1503 EX+ (698) scNEODUF s COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF flLE NUMBER Florence Brinkerhoff 2009-00483 REV-1504 EX+ (698) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN RESIDENT DECEDENT SCNEpULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP ESTATE OF FN.E NUMBER Fbrence Brinkerhoff 2009-00483 (H Ilwa apex is needed, ireelt edditlonel eheeb of the same ehx) REV-1507 EX+ (8-90) scNEOU~~ o COMMONWEALTH OF PENNSYLVANIA MORTGAGES & NOTES INHERITANCE TAX RETURN RKENABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Florence Brinkerhoff 2009-00483 AA properly plMlyownM wMh r1yM of suMvonhlp mint M dbdos~d on Sch~duN F. REV-1508 EX+ (5-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAx RETURN RESIDENT DECEDENT E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY E9TATE ~ FlLE Nt1NBER Florence Brinkerhofr 2009-00483 hxtude the preceeds d litlpetlon and tlb date als preaeda were received hY the aetge. Aa preperly JoMtly~vmred Mtll tight d euMvorehip must W dbetaed oe 8eheduM F. fTEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Orrslown Bank Checking Florence H BdnkertlotF Fate #565237; P.O. Box 250, Shippensburg, PA 17257 31,303.04 2. Interest on above account 8/1012009 12.22 3. Cash deposits 128.83 TOTAL (Also enter on Rrle 5, RecapiadaUen) t I 31,444.09 (s nlne apse h neetbd, team attde9nel eheda d the sense sae) ORRSTOWNBANK A 4lradition of Excellersce P.O.9oz 250 o ~~ Shippensburg, PA 1'7257 Tamp-Return Servke Requested ~_ ~_ lurlllrrrlnllrrrllurtllrrrllrrllrrllrullrrrrrllrlrrltl,rll 004719 0.4500 MH 0.382 TR00023 Florence H Brinkerhoff Estate 214 Kennedy Ct Hanover PA 17331-1366 Building? Buying? Remodeling? We can help! 1.B88.oRR,HTOWN - orrstown.com Date 6/25/09 Page 1 Primary Account 103008207 Enclosures C S S C K I N 6 A C C O Q N T S 0 N o, °o N b O Of 4 O 4 0 4 .°fr n ov 4~ ~~ o~ 4:. i~ ~; Account Title Florence H Brinkerhoff Estate Free-Q3eC.L.#8~- -_ _ -_ __.. __._.-._-. _.. CheckSa~fekeeping Account Number 103008207 Statement Dates 5/27/09 thru 6/25/09 Previous Balance .00 Days In The Statement Period 30 1 Deposits/Credits 31,303.04 Average Ledger 30,542.60 6 Checks/Debits 10,545.51 Average Collected 30,542.60 Service Fee .00 Interest Paid .00 Current Balance 20,757.53 Depostta sad Additions Date Deacrlption 5/27 Deposit Amount 31,303.04 rM. /:1«~lr~~ Date Check No Amouat Date Check No Amouat 6/02 290.40 6/05 126.14 6/04 128.00 6/25 9,957.00 6/04 17.98 6/25 25.99 + Denotes missing check numbers Da11y Bslaace Information Date Balance Date Balance Date Balaace 5/27 31,303.04 6/04 30,866.66 6/25 20,757.53 6/02 31,012.64 6/05 30,740.52 THANK YOU POR BANKING WITH ORRSTOWN BANK ORRSTOWNBANK A Tradition of Excellence P.O. Boz 250 o ORRS Shippensburg, PA 17257 Tamp•RSturn Service Requested ~m ~~~u~~u ~~~r~~~~~u ~~ur~~u~~~u ~~~u~~u~~~~u ~~u ~~~r~ 001810 0.6500 AV 0.335 TR00008 Florence H Brinkerhoff 23 West Burd Street Shippenaburg PA 17257-1223 Building? Buying? Remodeling? We can help! 1.888.ORRSTOWN - orrstowri.com C H S C R I N G A C C O U N T S ,o 0 m .y 0 0 4 4 0 4 0 .. m o.n 4~ NN ON 4~ N In 1'N ~~ Account Title Florence H Brinkerhoff Mosey Market Accouat Account Number 825824 Previous Balance 30,976.20 1 Deposits/Credits 33.00 2 Checks/Debits 31,021.42 Service Fee .00 Interest Paid 12.22 Current Balance .00 Overdraft item fees this statement period Overdraft item fees year to date Return item fees this statement period Return item fees year to date Check Safekeeping Statement Dates 5/11/09 thru Days in The Statement Period Average Ledger Average Collected 2nterest 8arned Annual Percentage Yield Earned 2009 Interest Paid Page 1 825824 6/10/09 31 15,980.42 15,980.42 12.22 0.901 135.20 33.00 33.00 .00 .00 Deposits and Additions Date Description 6/01 Refund Individual O/D Fee acct closed/accrued not posted 6/01 Credit to Cloed Account Date 6/10/09 Primary Account Enclosures Amouat 33.00 12.22 Electronic Debits sad l~ithdrawals Date Descriptioa 5/27 Miscellaneous Debit 5/27 Paid Overdraft Check Fee Amouat 30,988.42- 33.00- Orratown Bank Ring Street Office 77 Bast Ring St 3hippenabttrg, PA 17257 (717) 530-3530 Br: 3 OWNERSHIP OF ACCOUNT -PERSONAL PURPOSE ® INDIVIDUAL ^ ^ JOINT -WITH SURVIVORSHIP lantl mr ee [arena In commanl ^ JOINT - NO SURVIVORSHIP lee twnu NI vrrsssal ^ TRUST -SEPARATE AGREEMENT: ^ REVOCABLE TRUST DESIGNATION AS DERNED IN THIS AGREEMENT Name and Adtlrosa of Beneflcfaries: ReSubmitit: Combine: N ewire: OWNERSHIP OF ACCOUNT - BUSKVESS PURPOSE ^ SOLE PROPRIETORSHIP ^ CORPORATION: ^ FOR PROFIT ^ NOT FOR PROFR ^ PARTNERSHIP BUSINESS: COUNTY & TA OF ORGANIZATION: AUTHORRATON DATED: DATE OPENED 05/27/09 By Heather A Fiahe INITIAL DEPOSIT 8 31, 303.04 ^ CASH ^ CHECK ® Transfer HOME TELEPHONE x BUSINESS PHONEx (717) 630-1830 DRIVER'S LICENSE x E-MAIL EMPLOYER MOTHER'S MAIDEN NAME 1060 Nanro and address of someone cant will always know your locatbn: '~ BACKUP WTHHOLDING CERTIFICATIONS TIN: 27-6056786 ® TAXPAYER I.D. NUMBER - The Taxpayer Identification Number shown above KIN) is my correct taxpayer identification number. ® BACKUP WITHHOLDING - I am not subject to backup withholding either because 1 haw not been notified that I am subject to backup withholding as a resuk of a failure to report all interest or dividends, or the Internal Revenue Service has notified me that I em ra longer subject to backup withholding. ^ EXEMPT RECIPIENTS - I am an exempt recipient under the Internal Revenue Service Regulations. SIGNATURE: I arWf tier pdtlts d Priwr LksshYawk ekaekei Y tkb ssedell ant tYst I r a LL$.lerew /sliq a U.& rwWt sirU. X ate W-° 4 O 1982 aeMxe SMeme, Ina., St. Cbud, MN Farm MPSC-LA2AA 4!10/2004 CIF# FBA1267 ACCOUNT NUMBER Free Florence H Brinkerhoff Estate 214 Kennedy Ct Hanover PA 17331 ® NEW ^ EXISTING TYPE OF ®CHECKING ^ SAVINGS ACCOUNT ^ MONEY MARKET ^ CERTIFlCATE OF DEPOT ^ NOW ^ This u your (check or1e1: © Permanent ^ Temporary account agreement. Number of signatures required for withdrawal 1 FACSIMILE SIGNATURE(S) ALLOWED? ^ YES ®NO 1 ~X J SKiNATURE181- TM urldersiplyd ~ to 1M temr stated on scary qpggae of Ulie form erd asknoMdedgerece1pt of a completed copy. TM ulwMralprd furdter sutllorW dle flrlanciY Mdltrtlorl to verify crergt end empbyntsnt history and/or hew a orsdk reportkp agency a credit raga[ on die urldersiprW, ae itdividueb. TM akw acknowledge the receipt of a copy end egroe to the temp Ule faBDVakq dMdowrNsl: ® Deposit Accoum ®Funds Availebitiry ®Truth in Savings ® Electronic Fund Tranafero ®Privecy ®Subatku[e Checks Iii: Florence H Brinkerhoff Estate I.D. x 27-6056786 D.o.6. 121: ~ , Shirley Ann I,eDane I.D. x D.O.B. 131: I.D. x D.O.B. (41: I.D. x D.O.B. ^Autlwrized Signer (IrWiNdwl Accoums Only) a.+~ I.D.x D.O.B. /psxe 1 0/ 2! REV-1509 EXr (&9e) scNEnuuE F COMMONWEALTH OF PENNSYLVANIA JO~~Y-0WNED PROPERTY INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Florence Brinkerhoff 2009-00483 JOINTLY-ONMED PROPERTY: REM NUMBER LETTER FOR JONR 1191ANf DATE MME JqM DESCRIPTION OF PROPERTY INCLUDE NMIE OF RNINCLY MSTIIUIION AND BIN(ACCOUNT NUMBER OR SIMeAA IDEMIFYINO NUMBER ATiMXDFED FOR JgNRKI1ElD RFAL ESTATE DATE aF DFATI VALUE OF ASSET x aF DECO'S INTEREST DATE a: OFATN VALUE OF DECEOENI'S INTEREST (. A. TOTAL (Also enter on Nne 8, RecepikTletion) I f 0.00 (8 more spate is needed. ineen edditlmal eMNe of ere eaTne etze) EV•1511 EX. (12-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEOYLE N FUNERAL EXPENSES 8r ADMINISiRATNE COSTS Florence Brinkerhoff 2009-00483 BaEn d OeeadarR mwt M nporEW an &hadtA L A. FUNERAL EXPENSES: t' Fogelsanger-Bricker Funerel Home, Inc., P.O. Box 336, Sh~pensburg, PA 17257 z. Funer~ refreshments Premier Events B. AOMMIISTRATIVE COSTS: 1. Pereoriel Representative's Commissions Name d Personal Repreaentedve(s) Shirley A. LeDane Sadal Secudry Number(syEIN Number d Personal Regeeentatlve(s) S6eatA~,esa 214 Kennedy Ct. Cary Hanover .state PA Zlp 17331 veer(s) Canmission Paid: 2009 2. Albmey Fees 3. Fondly Ezenptlon: (If decedent's address is nd the same 88 daMreM's, atlach explenetlai) claimant Na 51red Address Cay State .Lp RelaSarehip d Claimant to Decedent 4. Prabete Fees 5. AcmuMaM's Fees e. Tax Retum Preperer's Fees 7. 9,957.00 290.40 1,242.00 128.00 TOTAL (Also enter on Nne 9, Recapitulation) I = 11,617.40 (N moro space is needed, iroart eddiaenN sheet d the same size) REV-1512 EX+ (12-08) pennsylvarria SCHEDULE I DEP~PTMENt OF aEVENDE DEBTS OF DECEDENT, WMERITANCE rRX RETURN MORTGAGE LIABILITIES A LIENS RESIDEM DE[EDEM ESTATE pF - FIIF NUMBER Florence BrinkerfioB 2009-00483 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-OR) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TA% REIURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES ESTATE OF FILE NUMBER Florence Brinkerho8 200&00483 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEMNG PROPERTY Do Not LLN Trvetee(a) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distribudans and transfers under Sec. 9116 (a) (1.2).] 1. Janet L. Tamer, 105 W. Bub St., Shippensburg, PA 17257 daughter 6211.22 2. Shirley A. LeDaLLe, 214 Kennedy CL, Hanover, PA, 17331 daughter 6211.22 3. Chado@e E. Commerer, 211 Lurgan Ave., Shippensburg, PA, 17257 daughter 6211.22 18,633.66 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES IS THROUGH 18 OF REV-1500 COVER SHEET, A S APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. B. CHARIFABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ 0.00 If more space is rceLMed, insert additional sheets of the same size.