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Home My WebLink About02-03-10 (3)J 1505607120 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po Box.2soso~ INHERITANCE TAX RETURN Harrisburg, PA 17128-otio1 ~ RESIDENT DECEDENT 2 1 0 9 0 9 9 7 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 199 34 8439 10 14 2009 05 10 1945 Decedent's Last Name BREWER (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW X^ 1. Original Return ^ ^ 4. Limited Estate ^ g. Decedent Died Testate ^ (Attach Copy of Will) Suffix Decedent's First Name MI RHONDA S Suffix Spouse's First Name MI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required (date of death after 12-12-82) ~. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 1 p, Spousal Poverty Credit (date of death 11, Election to tax under Sec. 9113 A between 12-31-91 and i-1-95) ^ ( ) (Attach Sch. 0) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number EDWARD P. SEEBER 717 533 3280~,,,s Firm Name (If Applicable) JAMES, SMITH, DIETTERICK & CONNELLY, L First line of address SUITE C-400, Second line of address City or Post Office MECHANICSBURG State ZIP Code PA 17055 c .~ REGISTER i ' 11j~7 LS USE1~' ILY i`': ` ~ ~~~ ~ ~' ~~~ r.,, ~ `' W ~~~. ~ ~ ~ . ~ ` -~'- DATE FILED W ~ ~~~: ~ :.~m~ ~_ -, ~~ r T-. ~"'~ ~_,-~ ...:., _~.# -+r-~ Correspondent's a-mail address: e P s G1 s d C. C 01'1'1 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. NA OF PERSO RES E FOR FILING RETURN ~ . Rhonda M. Berg _~ ,~- 6416 Avenue NW, Mini, ND 58703 P ER OTHER THAN REPRESENTATIVE Edward P. Seeber DATE -l~-J(J Suite C-400, 555 Gettysburg Pike, Mechanicsburg, PA 17055 Side 1 555 GETTYSBURG PIKE 1505607120 1505607120 J 1505607220 REV-1500 EX Decedent's Social Security Number Decedents Name: Rhonda S. Brewer 19 9 3 4 8 4 3 9 RE CAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 14 0, 0 0 0. 0 0 2. Stocks and Bonds (Schedule B) ............................................. 2 .................................. . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages 8 Notes Receivable (Schedule D) .......................................................... 4. 5• Cash, Bank Deposits 8 Miscellaneous Personal Property (Schedule E) ................ 5. 3 5 , 9 9 5.11 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested ............. 6. 2 , 8 1 6 . 7 7 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested ............. 7, 5 3 , 5 4 1 . 9 2 8. Total Gross Assets (total Lines 1-7) ....................................................................... g, 2 3 2, 3 5 3. 8 0 9. Funeral Expenses & Administrative Costs (Schedule H) ......................................... 9. 4 4 , 8 3 0 . 4 1 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................ 10. 2 8 , 4 3 6 . 9 9 11. Total Deductions (total Lines 9 & 10) ...................................................................... 11 7 3 , 2 6 7 . 4 0 12. Net Value of Estate (Line 8 minus Line 11) ............................................................. 12, 1 5 9 , 0 8 6 . 4 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................. 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ ......................... 14. 1 5 9 , 0 8 6 . 4 0 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. 0.00 16. Amount of Line 14 taxable at lineal rate X .045 0. 0 0 16• ~ 0. 0 0 17. Amount of Line 14 taxable at sibling rate X .12 0. 0 0 17• 0. 0 0 18. Amount of Line 14 taxable at collateralrateX .15 159, 086.40 18• 23, 862.96 19. Tax Due ..................................................................................................................... 19. 23, 862.96 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ^ Side 2 1505607220 1505607220 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 3. Interest/Penalty if applicable p. Interest E. Penalty 22,606.76 1,189.83 Total Credits (A + B + C) Total Interest/Penalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 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. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) 23,862.96 (2) 23,796.59 (3) (4) (5) 66.37 (5A) (5B) 6 6.3 7 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred :............... ^ ^ ................................................................... x b. retain the right to designate who shall use the property transferred or its income :.................................... ^ ^ c. retain a reversionary interest; or .................................... ^ ^ .............................................................................. x 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? ................................................................................ ^ ^ ....................................... x 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. 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-1500 EX Page 3 File Number 21-09-0997 Decedent's Complete Address: Rev-1502 EX+ (11-08) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERRANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brewer, Rhonda S. 21-09-0997 All real properly owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real properly which is Jolndy-owned with right of survivorship must be disclosed on schedule F. ~~~ ~~w~v a~+a~.c is ncaueu, 27UUIUOrIaI pages OT Lne same SIZe) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 11-08) Rev-1508 EX+ (g.gg) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brewer, Rhonda S. FILE NUMBER 21-09-0997 Include the proceeds of litigation and the date the proceeds were received by the estate. Alt property Jointly-owned with the right of survivorship must be disclosed on schedule F. ~~~ iiw~C space is neeaea, aaaluonal pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1509 EX+ (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brewer, Rhonda S. LE NUMBER 21-09-0997 A. Rhonda M. Berg B. C. 641616th Avenue NW Niece Minot, ND 58703 JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEATH NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASSET JOINTLY-HELD REAL ESTATE. 1 A 2/20/2008 Members 1st Federal Credit Union 5,423.39 Checking Account No. 36971-11 -valued per letter dated 11/5/09 2 A 2/20/2008 Members 1st Federal Credit Union Savings Account No. 36971-00 -valued per letter dated 11/5/09 TOTAL (Also enter on Line 6, Recapitulation) (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Ir an asset was made joint within one year of the decedent's data of death, It must bs roported on schedule f3. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT OF DATE OF DEATH DECD'S VALUE OF INTEREST DECEDENT'S INTEREST 50.000% 2,711.70 210.13 ~ 50.000%~ 105.07 2,816.77 Form PA-1500 Schedule F (Rev. 6-98) Rev-1510 EX+ (g.gg) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brewer, Rhonda S. FILE NUMBER 21-09-0997 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ~~~ ~~~~~~ aNaw is necuCa, aaaiiional pages Oi Ltl@ same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98) REV-1151 EX+ (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Brewer, Rhonda S. 21-09-0997 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION NUMBER AMOUNT A. FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name(s) of Personal Representative(s) Rhonda M. Berg Street Address 6416 16th Avenue NW City Minot State ND Zip 58703 Year(s) Commission paid 2. Attorney's Fees James, Smith, Dietterick & Connelly, LLP 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. ~ Probate Fees 9,183.17 9,700.00 9,400.00 310.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 16,237.24 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 44,830.41 Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06) SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS continued ESTATE OF FILE NUMBER Brewer, Rhonda S. 21-09-0997 ITEM NUMBER DESCRIPTION AMOUNT Funeral Expenses 1 Hollinger Funeral Home & Crematory -funeral services 7,688.17 2 West Minster Cemetery -funeral services 1,495.00 H-A subtotal 9,183.17 Other Administrative Costs 3 American Home Shield -home warranty 514.00 4 Borough of Mt. Holly Springs -water service for residence 36.00 5 Cumberland Legal Journal -estate notice publication fee 75.00 6 Embarq -telephone service for residence 162.61 7 Eric Dyson -electrical repair 1,720.00 8 Exit Realty Group -real estate sales commission 8,400.00 9 Exit Realty Group -transaction fee 150.00 10 James, Smith, Dietterick & Connelly, LLP -reservation for estate administration 250 00 closing costs . 11 Met Ed -electric service for residence 342.59 12 PA Department of Revenue - duplicate satisfaction fee 10.00 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 Brewer, Rhonda S. 21-09-0997 ITEM NUMBER DESCRIPTION AMOUNT 13 Recorder of Deeds, Cumberland County -realty transfer fax 1,400.00 14 Recorder of Deeds, Cumberland County -copy charges 2.50 15 Register of Wills, Cumberland County -filing fee for Return & Inventory 30.00 16 Register of Wills, Cumberland County -short certificates 20.00 17 Robert C. Cairns, Tax Collector -tax certification fee 5.00 18 South Middleton Township Municipal Authority -sewage service for residence 108.60 19 The Sentinel -estate notice publication fee 187.54 20 Travel expenses for Executrix 2,536.40 21 Waste Management - dumpster rental 287.00 H-Br Subtotal 16,237.24 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1512 EX+ (12-08) COMMONWEALTH OF PENNSYLVANW INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Brewer, Rhonda S. FILE NUMBER 21-09-0997 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 AT&T -cellular service 60.21 2 Bank of America -credit card number ending 0719 -valued per payoff 4,700.00 3 BonTon -credit card number ending 4286 -valued per payoff 700.25 4 Borough of Mt. Holly Springs -water service for residence 25.96 5 Dish Network -television service for residence 84.76 6 Embarq -telephone service for residence 69.67 7 Holy Spirit Hospital - unreimbursed medical bill 500.00 8 I Kia Motors -account ending in 6261 -valued payoff I 8,253.67 9 Lowe's -credit card number ending 9503 -valued per payoff 3,013.70 10 Members 1st Federal Credit Union -credit card number ending 0918 -valued per 9,016.14 payoff 11 Met Ed -electric service for residence 165.29 12 RadioShack -credit card number ending 7648 -valued per payoff 274.34 13 South Middleton Township Municipal Authority -sewage service for residence 73.00 14 Wal-Mart Discover -credit card number ending 1515 -valued per payoff 1,500.00 TOTAL (Also enter on Line 10, Recapitulation) I 28,436.99 (If more space is needed, additional pages of the same size) Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08) REV-1513 EX+ (11-08) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Brewer, Rhonda S. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(ax1.2)] 1 Rhonda M. Berg 6416 16th Avenue Minot, ND 58703 FILE NUMBER 21-09-0997 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE DECEDENT (Words) Do Not Llst Truatea(s) ($$$) Niece 1100% of 159,086.40 residue Total 159,086.40 Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet, as appropriate, III NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 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) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08) ~n ~Z~o ~o~ ~ ~2.~ O ~ dJ ~~