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Home My WebLink About03-30-11 (2) 1505610140 REV-1500 ~` t°'-'°' OFFICIAL USE ONLY PA Department Of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280801 INHERITANCE TAX RETURN 2 1 1 0 0 0 2 1 7 Hertisburg, PA 17128-0801 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 2 0 2 3 6 9 8 4 4 0 2 1 6 2 0 1 0 1 0 0 1 1 9 4 8 Decedent's Last Name Suffer Decedent's First Name MI Sees J e f f r e y O (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix Spouse's First Name MI N / A Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® 1.Original Return ~ 2. Supplemental Retum ~ 3. Remainder Retum (date of death prlorto 12-13-82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tex Return Required death after 12-12-82) 0 ® 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Lkigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax under Sec. 9113(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 T0: Name Daytime Telephone Number Scot t W. Mo r r i son E s q 7 1 7 5 8 2 3 0 0 REGIS N11LL8 ~ ONL ~ „ . ;-~ i 7 ~~rQ ~ C:~- C": First line of address ~ ~ n-I W ` ~ a ~ 6 Wes t Second line of address P O. Ciry or Post Office New B I Mai n S t r e e t Box 2 3 2 State ZIP Code L oomfi eld PA 17068 Correspondent's e-mail address: ~~ _ V ~l --{•. ~J C '-~ ~ r_ _.~ DATE FILED ~.+-' Under penaltlea of perjury, edare that I have examined this return, induding axompanying adredules and statements, and to the beat of my knowledge and belief, R is tie, carted aryFete. Dedaration of preparer other Man the pereona(ropr'neMadve Is based on all Information of which preparer hae arty knowledge. N SPONSIBLE FOR FILING RETURN . ~ , , ~. ~ ~ hA?E_ ._ _ . . 250 Alic~.ane, N~ydport, PA 17074 & 1020 Valley Rd„ Enola, PA 17025 11 6 West Main Street New Bloomfield PA 17068 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 J~ e 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: Jeffrey 0. Sees 2 0 2 3 6 9 8 4 4 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. 4 3 5 8 9. 9 9 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .... .. 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested . .... .. 6. 7. Inter-Vivos Transfers 8 Miscellaneous I~ Q~Probate Property (Schedule G) U Separate Billing Requested . .... .. 7. 4 3 5 8 9 8 9 8. Total Gross Assets (total Lines 1 through 7) ..................... .... .. 8. • 9. ............ Funeral Expenses and Administrative Costs (Schedule H) .... 9. .. 5 7 2 0 ' 2 4 2 0 9 6. 1 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ....... .... .. 10. 11. Total Deductions (total Lines 9 and 10) ......................... .... .. 11. 7 8 1 6. 3 4 12. Net Value of Estate (Line 8 minus Line 11) ...................... .... .. 12. 3 5 7 7 3. 6 5 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. 3 5 7 7 3 • 6 5 TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal taz rate, or transfers under Sec. 9116 0 0 0 15 0. 0 0 . (a)(1.2)x.o _ . 16. Amount of Line 14 taxable 0 0 0 0 . 0 0 at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable 2 8 6 1 8 9 2 17 3 4 3 4. 2 7 . at sibling rate X .12 . 18. Amount of Line 14 taxable 7 1 5 4 7 3 1 0 7 3 2 1 . at collateral rate X .15 1 B. . 19. TAX DUE ......................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 4507.48 Side 2 L 1505610240 1505610240 J REV=15o0 EX Page 3 Decedent's Complete Address: File Number 21 10 00217 DECEDENTS NAME Jeffre O. Sees STREET ADDRESS 1109 A le Drive A t. 3 clTr Mechanicsbur STATE ZIP PA 17055 Tax Payments and Credits: ~• Tax Due (Page 2, Line 19) (1) 4,507.48 2. CreditslPayments A. Prior Payments B. Discount Total Credits (A + B) (2) 3. Interest 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) 55.57 Fill in oval on Page 2, Line 20 to requeat a refund. (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 4.563.05 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 ..................................................................................... ........... ^ 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? .......................................... 3. Did decedent own an "in trust for' or payable-upon~eath 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 _- or ates 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 p2 P.S. §9116 (a) (1.1) (i)). For dates of death on or after Jan. 1, 1995, the fax 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 benefiaaries 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 p2 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. RE1~-1508 EX + (8-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, ~ MISC. IN R SIDE T DECEDENTRN PERSONAL PROPERTY ESTATE OF FILE NUMBER Jeffrey O. Sees 21 10 00217 Include Me proceeds of litigation and the date the proceeds were received by the estate. All Pent to owned with rlgM of survNont ip must be discloeW on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH 1. First National Bank of Marysville Checking Account #100113214 639.93 2. Susquehanna Bank Checking Account #10007733651 300.01 3. Susquehanna Bank Money Market Account #10007738049 10,005.02 4• IOrrstown Bank Certificate of Deposit #4000036518 I 10,003.49 5. AmeriChoiee Federal Credit Union Savings Account#46156-01 500.04 6. PNC Bank Certificate of Deposit Account #31900239234 1,130.38 7. PNC Bank Checking Account #5006430493 441.62 8. PNC Bank Savings Account #5005464915 3;516.61 9. Rowe's Auction Service -sale of personal property 1,446.00 10. L.B. Smith Ford -Warranty rebate 1,481.89 11. (County of Cumberland I 100.00 12. IL. B. Smith Ford -sold automobile I 14,000.00 13. (sale of miscellaneous personal property I 25.00 TOTAL (Also enter on line 5, Recapitulation) ~ ; (If more space is needed, insert additional sheets of the sarrre size) REV-1511 FJ(+ (10-09) Pennsylvania .SCHEDULE H oePnnnneNT of REVeNUe FUNERAL EXPENSES AND INHERITANCE rax REruRN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Jeffrey O. Sees 21 10 00217 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B• ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Bonita S. HeiseV 1,300.00 Street Address 250 Alice Lane city Newport state PA Zlp 17074 Year(s) Commission Paid: 2011 p, AttomeyFees: Scott W. Morrison 2,600.00 3. Fatuity Exemption: (If decedents address is not the same as daimants, attach explanation.) Claimant Street Address Cdy State ZIP Relationship of Claimant to Decadent 4• Probate Fees: Glenda famer Strasbaugh, Register of Wills 151.50 5 Accountant Fees: 6. ~ Tax Retum Preparer Fees: 7. I Cumberland Law Journal -estate advertising I 75.00 8. The Sentinel -estate advertising 293.74 TOTAL (Also enter on Line 9, Recapitulation) ~ S If more space is needed, use additbnel streets of paper of the same sae. Continuation of REV-1500 Inheritance Tax Return Resident Decedent Jeffrey O. Sees 21 10 00217 Decedent's Name Page 1 File Number Schedule H -Funeral Expenses 8 Administrative Costs - 61 ITEM NUMBER DESCRIPTION AMOUNT B• ADMINISTRATIVE COSTS: Personal Representative Commissions: 2• Name(s) of Personal Representative(s) Stephen P. BrudowskV 1,300.00 streetAddress 102®Vallev Road Cary Enola Stagy PA ziP 17025 Year(s) Commission Paid: 2011 SUBTOTAL SCHEDULE H-81 REV-1512 EX+ (12.08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8 LIENS VF Jeffrey O. Sees 21 10 00217 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death, including unrelmbuned medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Rowe's Auction Service -sale of personal property 506.10 2. IHSBC Bank Nevada N.A. -account ending 0399 I 1,590.00 TOTAL (Also enter on Line 10, Recapitulation) I : more space Is needed, insert additlonal sheets of the same size, REV-1513 EX+ (01-10) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF: Jeffre O. NUMBER I. 1. 2, 3. 4. 5. 6. 7. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY E DISTRIBUTIONS [Indude outn'pht spousal dlstributfons and transfers under Sec. 91 f6 (a) (1.2).] Do Not Litt Sibling Sibling Sibling Sibling Collateral Collateral Collateral Bonita S. Heisey 250 Alice Lane Newport, PA 17074 Stephen P. Brudowkky 1020 Valley Road Enola, PA 17025 Kimberly Schardt 605 S. Main Street Marysville, PA 17053 Patti Buxton 725 S. Main Street Marysville, PA 17053 Amy Brudowksy Devins 6280 Carlisle Pike, Lot 516, Salem Church Road Mechancisburg, PA 17055 Ashley Brudowkky Cafe Berlin 322 Massachusetts Avenue NE Washington DC 20002 Nicholas Brudowksy, III 3150 Sunnyside Road Manheim, PA 17545 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 NON TAXABLE DISTRIBUTIONS. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 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, use additional sheets of paper of the same size. AMOUNT OR SHARE OF ESTATE one-fifth one-fifth one-twenty-fifth SHEET, AS APPROPRIATE. S Continuation of REV-1500 Inheritance Tax Return Resident Decedent Jeffrey O. Sees 21 10 00217 Decedent's Name Page 2 File Number Schedule J - Beneficiaries -1 FttLATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONS RECEIVING PROPERTY Do Not Lbt Truabe(s) OF ESTATE I TAXABLE DISTRIBUTIONS (Indude outr~hts usal dlsbibutbns and transfers under Sec. 9116 (a~1.2).] 8, Edward Brudowsky Collateral 21 W. Main Street one-twenty-fifth Shiremanstown, PA 17011 9. Dana Brudowsky Olson Collateral 123 W. Charleston Street one-twenty-fifth Savanah, GA 31401 ~;; ~~ 1-EA~~IB TH~YIidY Apri127, 2010 Scott W Morrison, Esq. Center Square P O $ox 232 New Bloomfield, PA 1706$ 1tE: Jeffry O Sees SSN: 202-36-9844 DOD: 02-16-2010 Dear Mr. Morrison: In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Certi6cste of Deposit Account # 31900239234 Established: 03-18-2004 JEFFREY (~ SEES DOD balance: S ?,123.13 + 7.25 accrued interest Interest paid 01-OI -2010 thru 02-16-2010 $ 0.00 YTD CheclQng Account Account # 5006430493 Established: 03-04-2009 JEFFREY O SEES DOD balance: $441.62 non interest bearing Savings Aceoaast ~ . Account # 5005464915 Established: 09-21-2009 JEFF}2EY O SEES DOD balance: $ ;,516.4$ + 0.13 accrued interest Intcrest paid 01-Q1-2010 thru 02-16-2010 $ 0.16 Y7'D Please note that this office provides daft of death balances fvr deposit acconnts (IltAs, CDs, Checking and 8s)• We do ~aot process any 19nanclsl traasactb~ or prw~ide sbte®ien~, If you neod assistaaao with ~' of these hews, Alease call 1-888-PNC-BANK (1-888-'762 2265) or stag by your local PNC Bank brnuch office. Sincerely. National Financial Services Center PNC Bank, N.A. Member FDIC Pagc 1 of 2 MAIN OFFICE One Centre Square • P.O. Box B • Marysville, PA 17053 • Phone: 717-957-2196 • Fax: 717-957-4578 March 19, 2010 Scott W Morrison Center Square PO Box 232 New Bloomfield PA 17068 RE: Estate of Jeffrey O Sees DOD: 2-16-10 Here is the information you requested per your letter of March 17, 2010: Checking 100113214 Owner: Jeffrey 0 Sees Open: 2-2-10 Int Rate: 1.49% DOD Bal: $639.70 DOD Int: .23 If you require any further information, please feel free to contact us Sincerely, Barbara Recher, Manager March 23, 2010 SCOTT W..MORRISON, ESQUIRE PO BOX 232 NEW BLOOMFIELD, PA 17068 RE: Jeffrey O. Sees Estate SS#: 202-36-9844 DOD: February 16, 2010 To Whom It May Concern: Susquehanna Susquehanna Bank 26 North Cedar Street P.O. Box 1000 Lititz, PA 17543-7000 Toll free 800.311.3182 In response to your letter of March 17, 2010, here is the above customer account information as of February 16, 2010. Account #1 Account #2 • Account Title: Jeffrey O. Sees Jeffrey O. Sees • Account Type/# Ckg/10007733651 Money Mkt/10007738049 • Date Opened /Maturity 2/2/10 2/3/10 • Interest Rate: .05~ 1.509b • Account Balance*: 300.00 10,000.00 • Accrued Interest: .Ol 5.02 • YTD Interest: .00 00 *Account balance does not include accrued interest . There is no safe deposit box in the name of the deced ent. If I can be of further assistance, please feel free to call . Sincere-y, Dawn M. Berrier Support Services Lead 1-717-625-6546 DMB/LJR Mazch 22, 2010 Scott W Morrison Center Square, PO Box 232 New Bloomfield PA 17068 Attention: Scott W Morrison, Esquire Shirley Wescott Orrstown Bank PO Box 250 Shippensburg, Pa 17257 Phone 717.530.2515 Re: Estate of: Jeffrey O. Sees Date of Death: 2/16/2010 77 East King Street Shippensburg, PA 17257 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT, ON THE ABOVE DATE, HAD THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CERTIFICATE OF DEPOSIT Account # Title of Account 4000036518 Jeffrey O Sees Rest regards, ~~: irley Wescott Receptionist Date opened Principal Accrued Interest DOD Bal 1/30/10 10,000 3.49 $10,003.49 AmeriChoice FEDERAL CREDIT UNION Building Relationships For Life Apri18, 2010 Scott W Morrison, Esquire Center Square, PO Box 232 New Bloomfield, PA 17068 Re: Estate of Jeffrey O Sees Scott, The decedent had one member number 46156. Jeffrey was the sole owner with a regular savings, suffix O1. This account was opened January 30, 2010. Date of death balances were as follows: Savings - $500.04 Interest accrued till DOD - $0.04 (01/31/10) Interest accrued following DOD - 0.24 (02/28/10) The account was closed on March 18, 2010 with a check withdraw of $500.28. Please feel free to contact me directly with any questions you may have. Sincerely, V ~~ Bonnie R. Seagraves Operations Specialist Phone (717)591-1282 Fax (717) 697-3713 Email bseasravesCcr~americhoice ore Main Office: 2175 Bumble Bee Hollow Road • Mechanicsburg, PA 17055 • Phone: (717) 697-3474 • Fax: (717) 697-3713 NCB Website: www.americhoice.org un"oen ~•'~ Equd L E~Np q ~ii..v CREDTT UPIIONS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF PROGRAM INTEGRITY DIVISION OF THIRD PARTY LIABILRY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105.8486 April 6, 2010 SCOTT W MORRISON ESQUIRE P O BOX 232 6 W MAIN ST NEW BLOOMFIELD PA 17068 Re: Jeffrey Sees SSN: ###-##-9844 Dear Attorney Morrison: Pursuant to your letter dated March 11, 2010, the Department of Public Welfare (DPW), Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. If you have any questions, please feel free to contact me. Sincerely, -~- Y ate, Vince A. Porter Recovery Section Manager (717)772-6604