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Home My WebLink About02-24-10.X + /6-00) COMMONWEAL T H OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) I- w BROWN DOROTHY M. ~ DATE OF DEATH {MM-DD-Year) W W 0 12/05/2007 108/06/1927 (IF APPLICABLE} SURVIVING SPOUSE S NAME {LAST, FIRST, AND MIDDLE INITIAL) BROWN, ROBERT E. Q ~ 1. Original Return v a tYi ^ 4. Limited Estate W Op v a m 0 6. Decedent Died Testate (Attach copy of Will) Q 9. Litigation Proceeds Received z W z 0 a N W a' 0 U NAME JOHN H. BROUJOS FIRM NAME (If Applicable) TELEPHONE NUMBER 717-243-4574 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DATE OF BIRTH (MM-DD-Year) ^ 2. Supplemental Return ^ 4a. Future Interest Compromise (date of deatn after 12-1z-az) ^ 7. Decedent Maintained a Living Trust (Attacn copy of trust) ^ 10. SpOUSaI POVerty Credlt (date of death between 12-31-91 and 1-1-95) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funera- Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) OFFICIAL USE ONLY FILE NUMBER 2 1- 0 7 1 1 1 4 COUNTY CODE y~ NUMBER - SOCIALSECURITY NUMBER 1 6 2- 2 2- 6 0 2 4 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 1 8 9- 0 9- 8 1 8 3 ^ 3. Remainder Return (date of death prior to 12-1382) ^ 5. Federal Estate Tax Return Required _ 8. Total Number of Safe Deposit Boxes ^ 11. Election to tax under Sec. 9113(A) (Attacn scn o) 211A~TInA~ cur,. ~.....~ _:__ _ . ,. COMPLETE MAILING ADDRESS _~ ~~ 4 NORTH HANOVER STREET CARLISLE PA 17013 (1) ~.~~ ~ OFFICI SSE ONLY (2) ;T~ __. 00 ~ '~' 0 ' . (3) ~.~ ~ ~ (4) r~ -?' ~ '~ r ~ ~ ~ ~~ (5) 5 352.63 `~ ~ ~ ~"" _ ; , :.,.. ~ ~ ~ ~ _ _' ~.,.,. 6 () 0 00 ~ ~' " ' . ; 3 zJ"i (7) (8) 5 352.63 (9) 5, 982.00 (10) 0.00 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) SEE INSTRUCTIONS nN oniro~< <.~..... ___ . (11) 5,982.00 (12) -629.37 (13) (14) ---..~~ ~~~~ rvr[ r+rrucABLE 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 -629.37 X -_ (15) X (16) 0.00 X 12 X 15 20. ^ ..-.~ .. ....... ~ %' SE S1E.IFRF>Tn l4ll~txil/cin: w:, ,: (17) (18) 0.00 (19) 0.00 << Decedent's Complete Address: STREET ADDRESS 3605 TRINDLE ROAD CITY CAMP HILL Tax Payments and Credits: ~ Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 17011 {1) 0.00 3. Interest/Penalty if applicable Total Credits (A + g + C) (2 D. Interest ) E. Penalty 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENTtaI Interest/Penalty (D + E) (3) Check box on Page 1 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. (4) 0.00 A. Enter the interest on the tax due. (5) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) Make Check Payable to: REGISTER OF WILLS AG (5B) o.oo ENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY P LACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: a. retain the use or income of the roe transferred ................ Yes No b. retain the right to designate who shall u e the pro a ~•a c. retain a reversionary interest; .or .................. p ~ nsferred or its income;...................................... ^ ................................................................... ~ 0 d. receive the promise for life of either payments, benefits or care?........ .................................. ^ X 2. If death occurred after December 12, 1982, did decedent transfer property within one e without receiving adequate consideration?. y ar of death ................................................................. . .. ................ ~ 0 3. Did decedent own an "in trust for" or payable upon death bank account or securi at his 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate ro eor her death........... .... ^ X contains a beneficiary designation? .... , ... _ . _ p p ty which ...... ... ... ^ ...... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES X under penarties of ~ YOU MUST COMPLETE SCHEDULE G etin ru ~ „~ .., ... __ _ perjury, I declare that I have examined this ro,.,~n ;.,,.~.~:_ _ Declaration ~r ..~.,...,..~_ _ -~ r•~rw,~. ~~~~C~ uian me p ---~•~• °",.,,.~~~y ~:ampanymg schedules and statements, and to the best of my knowledge and befef, it is,true, correctt and o o~etUF THE RETURN. persona re resentative is based on all information of which preparer has any knowledge. NATURE OF~PF~SON RESPCr1SI~LE F~-~~ RFTI lRni SIGNATURE OF 1 NAY REPRESENTATIVE ADDRESS ` ,.4 N RTH HANOVER C~' LISLE DATE PA 17011 DATE 2- `2_~ ~ ~ For dates of death on or after July 1, 1994 and before January 1, 1995, the tax f'H 17013 [72 P.S. §9116 {a) (1.1) (i)]. rate imposed on the net value of transfers to or fo For dates of death on or after January 1, 1995, the tax rate imposed on the net r the use of the surviving spouse is 3% The statute does not exempt a transfer to a surviving spouse from tax, and the statuto re value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a 1.1 ii the surviving spouse is the only beneficiary. ry quirements for disclosure of assets and filin a tax retu 9 rn are still applicable even] if 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 ears or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. Y of age or younger at death to or for the use of a natural ar The tax rate imposed on the net value of transfers to or for the use of the decedents lineal b p ent, an adoptive parent, The tax rate imposed on the net value of transfers to or for the use of the decedent's siblin eneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a 1 . individual who has at least one parent in common with the decedent, whether by blood or ad ){ )] gs is 12% [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an option. ET STATE ZIP PA REV-1508 EX + {6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY --~ ~~- ~ ~ ~ ~ vrcv i h Y M. FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by th~ state. 07 1114 ITEM All property jointly-owned with right of survivorship must be disclosed on Schedule F. NUMBER ~ ~ Commerce (Metro) Bank, NA, 3201 TrDESCRIPTION VALUE AT DATE Savings Accounts No. 626875140 dle Road, Camp Hill, PA 17011 OF DEATH 3,411.85 2• Commerce (Metro) Bank, NA, 3201 Trindle Road, Cam Checking Account No. 537607525 P Hill, PA 17011 1, 363.56 3• Sears Credit Cards (Overpayment refund) P• O. Box 183081 Columbus, Ohio 43218-3081 173.28 4• Highmark (Premium Refund) 1800 Center Street Camp Hill, PA 17011 403.94 (If more space is needed, insert additional heOetAof the saenter on line 5, Recapitulation) $ me size) 5 352.63 REV-1511 EX + (12-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS BROWN DOROTHY M. FILE NUMBER 21 07 1114 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION ~~ Ewing Brothers Funeral Home, Inc., 630 South Hanover S AMOUNT treet, Carlisle, PA 243-2421 2• Grave marker Ewing Brothers, Carlisle, PA 17013 4,000.00 1,048.00 B. ADMINISTRATIVE COSTS: 7. Personal Representative's Commissions Name of Personal Representative (s) Kath M. K le Social Security Number{s)/EIN Number of Personal Representative(s) 06-6564711 0.00 Street Address 149 Allendale Wa city Camp Hill State PA Zip 17011 Year(s) Commission Paid: 2~ Attorney Fees John H. Broujos, 4 North Hanover Street, Carlisl 3. Family Exemption. (If decedent's address is not the same as claimant's, attach ex lanatio @ PA 17013 p ) 850.00 Claimant Street Address City State ~_ Zip Relationship of Claimant to Decedent 4" Probate Fees PetltlOn, Short Cert, (6) I 5. Accountant's Fees 84.00 6• Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5 982.00 RFV-1513 EX + ~ca_nrn COMMONWEALTH OF PENNSYLVAN SCHEDULE ,1 INHERITANCE TAX RETURN IA BENEFICIARIES RESIDENT DECEDENT ESTATE OF BROWN DOROTHY M. FILE NUMBER NUMBER 21 07 1114 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT j. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Do Not List Trustee(s) AMOUNT OR SHARE Sec. 9116 (a} (1.2)] OF ESTATE 1 ~ Robert E. Brown Cumberland County Nursing Home Spouse Carlisle, PA 17013 Insolvent 2• Kathy M. Kyle 149 Allendale Way Daughter Camp Hill, PA 17011 Insolvent 3• Pe99Y Ann Rizzuto 1501 West Philadelphia Street Daughter York, PA 17404 Insolvent 4. James Alan Kyle 1201 Campbell Street Son Williamsport, PA 17701 Insolvent ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15ITH I II. NON-TAXABLE DISTRIBUTIONS: ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHE A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO ET 1 TAX IS NOT BEING MADE I B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 _ (If more space is needed, insert additional sheets of the sa 1500 COVER SHEET $ me size) ~.J ~i~ ~~ ~ ~ ~~~ _.. ~,, ~ ~ \~ . ~~ ~~ ~_ , -__