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Home My WebLink About02-17-10 (3)2EV-.500 EX + (6-00) COMMONWEAL T H OF REV 15 0 0 OFFICIAL USE ONLY PENNSYLVANIA DEPARTMENT OF REVENUE I N H ERITAN C E TAX RETURN FILE NUMBER DEPT. 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2 1- 0 7 1 1 1 4 NUMBER COUNTY CODE YEAR DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z BROWN DOROTHY M. 1 6 2- 2 2- 6 0 2 4 0 DATE OF DEATH (MM-DD-Year) DATE OF BIRTH {MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W REGISTER OF WILLS U 12/05/2007 08/06/1927 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER BROWN ROBERT E. 1 8 9- 0 9- 8 1 8 3 w - ^X 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13-82) r Q N tYi a v ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of deatn after 1z-12-s2) ~ 5. Federal Estate Tax Return Required v a m 0 6. Decedent Died Testate (Attach copy of Will} ~ 7. Decedent Maintained a Living Trust (attain copy of Trust) _ 8. Total Number of Safe Deposit Boxes a a ~ 9. Litigation Proceeds Received ~ 10. SpoUSal POVerty Credlt (date of death between 12-31-91 and 1-1-95) ~ 11. Election to tax under Sec. 9113(A) (Attacn scn o) THIS SECTIUN 11r!fUST Bl* GOMP~,ETEp. AI.L, CaRRESPQNDENGE>AND G4NFIDENTIAL TAX INFQRMATIa-N SIiQUIID BE AIREGTI*p TO. w NAME COMPLETE MAILING ADDR ESS °z JOHN H. BROUJOS 4 NORTH HANOVER STREET FIRM NAME (If Appicable) w p TELEPHONE NUMBER 717-243-4574 CARLISLE PA 17013 h d l A S (1) 0.00 OFFICI SSE ONLY T~ e u e ) 1. Real Estate ( c ~ ; 2. Stocks and Bonds (Schedule B} (2) 0.00 CJ ~' _~ ~ ~ rn '~--~ ,;, -;~ r'n C7 C7v ~ ' ~ , `-, 3. Closely Held Corporation, Partnership or Sole-P roprietorship {3} :.~ ~ rn ~ ..1 (' ~._F ., 4. Mortgages & Notes Receivable {Schedule D) (4) ~~ ~ ~ - - ~ 1 Bank Deposits & Miscellaneous Personal 5 Cash Property (5) 5,352.63 r4 } , .-~ ~ -~-, ~ _ , . ;~ ~:.- "~ . , (Schedule E) r~ C ~j ~ _~~ ~-:~i O 6. Jointly Owned Property (Schedule F) (6) 0.00 .--~ .. ~ ,~- `' `'' F'" a ~ Separate Billing Requested ~ J 7 In+cr_\/ivnc TrancfarC R MICCPIIAr1PnIIQ Nnn-PrnhatP Prnnerty f71 __ i • ~, a Q U 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) {Schedule G or L) 8 Total Gross Assets (total Lines 1-7} (8) 5,352.63 9. Funeral Expenses & Administrative Costs (Schedule H} {9) 5,982.00 10 Debts of Decedent Mortgage Liabilities & Liens (Schedule I) (10} 0.00 (11) 5,982.00 (12) -629.37 (13} (14} -629.37 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z 15. Amount of Line 14 taxable at the spousal tax ~ rate, or transfers under Sec. 9116 (a}(1.2} X (15) H ~ 16. Amount of Line 14 taxable at lineal rate X (16) 0.00 a 17. Amount of Line 14 taxable at sibling rate X 12 (17} ~ 18. Amount of Line 14 taxable at collateral rate X 15 (18) 0.00 U Q 19. Tax Due (19) 0.00 > <~3E S#3RE TO AI~SiAtER ALL QU~STIQNS 1Q~ REI~ERSE SIQE AND RECHECK M/~TH < < )ecedent's Complete Address: sTREETADDRESS 3605 TRINDLE ROAD CITY STATE PA ZIP 17011 CAMP HILL Tax Payments and Credits: 1 0.00 1. Tax Due (Page 1 Line 19) ( } 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) {3} 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. 0 00 Check box on Page 1 Line 20 to request a refund (4) . 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 0.00 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. {56) 0.00 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 ....................................................................................... ........... ^ 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? ............................................................................... ........... ^ 0 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death .... ........... ^ 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation~ ....................................................................................... ........... ^ X^ 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 be Mef, it is true, correct and com plete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF P SON RESP SI LE F RETURN DATE ADDRESS 14 AL N WAY Cq ~ PA 17011 SIGNATURE OF , P E REPRESENTATIVE r. DATE ~.~.~ / _^~ CJ ADDRESS ~..4 N RTH HANOVER S ET C LISLE PA 17013 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. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER BROWN D OTHY M. 21 07 1114 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. Commerce (Metro) Bank, NA, 3201 Trindle Road, Camp Hill, PA 17011 3,411.85 Savings Accounts No. 626875140 2. Commerce (Metro) Bank, NA, 3201 Trindle Road, Camp Hill, PA 17011 1,363.56 Checking Account No. 537607525 3. Sears Credit Cards (Overpayment refund} 173.28 P. O. Box 183081 Columbus, Ohio 43218-3081 4. Highmark (Premium Refund) 403.94 1800 Center Street Camp Hill, PA 17011 TOTAL (Also enter on line 5, Recapitulation) I $ 5,352.63 (If more space is needed, insert additional sheets of the same size} REV-1511 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER BROWN DOROTHY M. 21 07 1114 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Ewing Brothers Funeral Home, Inc., 630 South Hanover Street, Carlisle, PA 243-2421 4,000.00 2. Grave marker Ewing Brothers, Carlisle, PA 17013 1,048.00 B. ADMINISTRATIVE COSTS: ~ Personal Representative's Commissions Name of Personal Representative (s) Kathy M. Kyle 0.00 Social Security Number(s)/EIN Number of Personal Representative(s) 06-6564711 Street Address 149 Allendale Way City Camp Hill State PA Zip 17011 Year(s) Commission Paid: 2 Attorney Fees John H. Broujos, 4 North Hanover Street, Carlisle, PA 17013 850.00 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 Petltl0n, Short Cert, (6) 84.00 5 Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ 5.982.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (P-nrn SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BROWN. NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY j TAXABLE DISTRIBUTIONS [include outright sppousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Robert E. Brown Cumberland County Nursing Home Carlisle, PA 17013 2. Kathy M. Kyle 149 Allendale Way Camp Hill, PA 17011 3. Peggy Ann Rizzuto 1501 West Philadelphia Street • York, PA 17404 4. James Alan Kyle 1201 Campbell Street Williamsport, PA 17701 FILE NUMBER 21 07 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) Spouse Daughter Daughter Son AMOUNT OR SHARE OF ESTATE Insolvent Insolvent Insolvent Insolvent I ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET jj. 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 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) V ,~ _~~ ~~ .~ 1`~ ` ~'~ ~~ ~' ,^ ~ ~~ V~