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Home My WebLink About08-11-10 (2)1505610101 REV-1500 Ex ~°1.1°' ' OFFICIAL USE ONLY _ PA Department of Revenue Pennsylvania County Code Year File Number Bureau of Individual Taxes oEOaRTMENTOF IVNHERITANCE TAX RETURN PO BOX 28o6oi Harrisburg, PA 1128-0601 RESIDENT DECEDENT ~ f ~ ~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 3 a ~, y~ os ~ o os~3 ~o~ o 09 a ~ ~ ~ ~~ Decedent's Last Name Suffix Decedent's First Name MI (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI ~ R ~ iv ,~ S c1 5 ,4- ~l ~' Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~ 1. Original Return p 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) ® 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. tt113(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 First line of address Co C L D ~ 5 ~ ,~ ~.°,o ~- .a Second line of address /`''/ City or Post Office State ZIP Code REGISTER OF WILLS 1.1S~9NLY t~7 ::~:. -- i"=~ ~= .. -_..t ..~ ~, _. . i. ~.~ ltl,i . , .-. . .~.~ . ` -. .pA}NH FILED I ~:~ is -. ._.,. Correspondent's a-mail address: ~~C.cgr);(_',LLls3(~(/ ~Q~eQe7t"• '~~ ``.. :~ Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledg~s 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. SIGNATURE OF PERSON RESPONSIBLE F (LING RET RN ~~ wDATE - ADDRESS S uS,~4N ~. 4~,~N~ ~~ ~A //'l~lA, ~I ~ --.~_~ ~ ~~ - y ~r , ~a~ /~ P~ t 701 SIGNA R F P ~AR ~ OTHE S ~VE ~ ~~ ~~ ~~DATE ADDRESS li~l ~/IGLG7 ~ es~~~~ ~ CO C O L1,x,/"'~ 4~ChQ~~1 /L'S ~ 7 > r~ ~ ~'~K~ - PLEASE USE ORIGINAL FORM ONLY L 1505610101 Side 1 1505610101 J ~~~ J 1505610105 REV-1500 EX Decedent's Soc~~i11al Security Numbger Decedent's Name: Charl~S L, ~,,Q,n~ ~ ~ ~ T ~ ~ S 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 and Notes Receivable (Schedule D) ........................... 4. 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 6. Jointly Owned Property (Schedule F) p Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) p Separate Billing Requested........ 7. 8. Total Gross Assets (total Lines 1 through 7) ............................. 8 . p0 .DO . p D .O d .OO . OO l I g~,3~~53 Il 8 ~3'~•53 9. Funeral Expenses and Administrative Costs (Schedule H) ................ ... 9. ~ S • 10. Debts of Decedent. Mortgage Liabilities, and Liens (Schedule I) ........... ... 10. • Q 11. Total Deductions (total Lines 9 and 10) .............................. ... 11. ` ,~ O 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. 1 ~ 8 ij ~ ~ y 3 ` 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which l l i h b d S h d J 13 ~ ` ) ..................... an e ect on to tax as not een ma e ( c e u e ... . • 14. Net Value Subject to Tax (Line 12 minus Line 13) ..................... ... 14. l 1 $ ~ ~ ! '• s'3 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 D 16. Amount of Line 14 taxable at lineal rate X .0~ • Q` D 16. p'~> ~ 17. Amount of Line 14 taxable at sibling rate X .12 • CJ D 17. O O 18. Amount of Line 14 taxable ' at collateral rate X .15 ~ O ~ 18. ~ • ~ ~ 19. TAX DUE ...................................................... ...19. *`D C~ 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O Side 2 1505610105 1505610105 File Number ,v2! - ~ ~ ~" I r REV-1500 EX Page 3 Decedent's Complete Address: Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 2. Credits/Payments ~ A. Prior Payments B. Discount ~ Total Credits (A + B) (2) 3. Interest (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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) ~a +~ e~ t~ L7 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 :.......................................................................................... ^ ,~ 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 Dec. 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? .............. ^ 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 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 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 12 percent [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. ncv-r~ iv cn ~ i, i-ar; i COMMONWEALTH ()F PENNSYLVANIA INHERITANCE '~~AX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER a ~' ~ D -~ C In, ~.--les L . ~ ran d 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 SNEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE . DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ,. New vonK c.;~ ~su~, .~.e,4-, ,A~n~.;~t y ~ ~ ~~; a3~ s~ Jo~~ -o -- ~/S ~3s~s ~ X583 ~a~ b~ ~ , 3 ~emt.~'c ~ ary -- w; cj oca- ~usgnt E. 13r'aa'tc~ ~'slr.~ ~/a I k a~i o~ ~etf '~,r- a.-f ('ached ~ rx- r,'c~e~ b~ ~a rnes ~ . ~Da~~ TOTAL (Also enter on line 7, Recapitulation) $ ~~8' ~ 3 ~,~~ (If more space is needed, insert additional sheets of the same size) New York Life Insurance Company 4231 ~~arlisle Road Gardners, PA 17324 Bus. 717 486 8866 Fax 71 7 486 8866 Cel. 717 440 3860 Res. 717486 7743 jdday~;t. n ewyorklif e.co m James D. Day, CLU®, ChFC~, LUTCF Financial Services Professional The Comrxmy Ynrr Keep" dune 25, 2010 Mr. Charles E Shields III 6 Clouser Road Mechanicsburg, PA 17055 RE: Charles L Brand DOD value Policy #58362601 Mr. Shields, The Date of Death value for Charles Brand's IRA Annuity Policy #58362b01 was $118,234.53 on May 23 2010. Sincerely, ~~ ames D Day Registered Representative offering securities througiti NYl_(FE Securities LLC Member FINRA/SIPC A Licensed Insurance Agency Licensed Agent New York Life Insurance Company 3401 N Front St, '- st FI, New York Life Insurance and Annuity Corporation Harrisburg, PA 17110 (A Delaware Corporation}, New York, NY 71 7 232 2555 REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF ' Q r~M~ FILE NUMBER ~ ~_/p Car es L., ~J Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) 51JlSQ,M1 E• ~ --- - WO~.,• V~~ Street Address __ City State Zip _ Year(s) Commission Paid: 2. ` Attorney Fees C•harle3 ~' ~1tP.~dS ~- ~ k»de'~'P_x'Mi~'tec,l 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) ~~ ~~~~ ~~ + Claimant ~O ,~ S (,~,/ .~ 1 G(JVriS~ lJ-~b-~ ~O ~~n1r1 ~E-NC r - Street Address _ City State Zip Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. ~~ I ~ n fee ~ ' ~~u- o w ~ l is t` S, o0 TOTAL (Also enter on line 9, Recapitulation) I $ ~~ ~0 (If more space is needed, insert additional sheets of the same size) • REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. ~'usan ~. rand w• ~o~ ~ proib~.t'ez~a ~ ~a i t rt) ~r• ~e/4 on L i s ~-1 eram~ N ~ ! I, P~4 t 10 ~ - scc, s~I G. ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II 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 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) CHARLES E. SHIELDS, III ATTORNEY-AT-LAW 6 CLOUSER ROAD Corner of Trindle and Clouser Roads MECHANICSBURG, PA 17055 GEORGE M. HOUCK (191.2-1991) August 10, 2010 Register of Wills Cumberland County Court House 1 Courthouse Square Carlisle, PA 17013 Re: Estate of Charles L. Brand No. 21-10- Dear Register of Wills: TELEPHONE (717) 766-0209 FAX (717) 795-7473 Please find enclosed for filing 2 copies of the Inheritance Tax Return for the Charles L. Brand Estate as well as Check No.1421, in the amount of $15.00 for the filing fee. Thank you for your kind attention to this matter. Very truly yours, G Charles E. Shields, III Attorney-At-Law CES/mjj Enclosures ~_~ ra .__W ~) -j ~'1 ' ~ _ ~ ~ ' '~~ -- ~~ U ~~ -. ~~ __