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Home My WebLink About07-21-11 (2)1505610148 REV-1500 EX (01-10) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 21 11 0 4 2 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYW Date of Birth MMDDYYYY 197-05-3226 10232010 12111916 Decedent's Last Name Suffix Decedent's First Name M I BRINGMAN JOHN W (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name M I Spouse's Social Securit`; Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death prior to 12-13-82) ^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required death after 12-12-82) ^ 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 Li i i ^ 10 ^ . t gat on Proceeds Received . 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 TO: Name Daytime Telephone Number BRIDGET M • WHITLEY, ~~_, ESQ • 717-233 .-~j000 • ~~~ ., . . REGISTER LLS USE ~Y t~n ~_' .' First line of address ~ ---~ . ~ ".3 = =:? 17 S• 2ND STREET ~ ~ ~-~,~j-,-, Second line of address ~ ~ ~ ; ~ ~ i-~ ~' 6TH FLOOR ~' City or Post Office State ZIP Code DATE TILED HARRISBURG PA 17050 Correspondent'se-mailaddress: BMWa1SKARLATOSZONARICH • COM 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. RE OF PERSON RES IBL FOR FILING RETURN DATE C ~ SUSAN C• MILNES U~) ADDRESS 114 E• KELLER STREET MECHANICSBURG, PA 17055 S!G RE OF PREPARER O ER THAN REPRESENTATIVE D TE BRIDGET M• WHITLEY apl~ ADDRESS 17 S• 2ND STREET, 6TH FLOOR HARRISBURG, PA 17101 PLEASE USE ORIGINAL FORM ONLY 1505610148 Side 1 9M4647 4.000 1505610148 ~~~ J 1505610248 REV 1500 EX Decedent's Social Security Number 19?-05-3226 Decedents Name: B R I N G M A N JOH N W RECAPITULATION 1. Real Estate (Schedule A) 1 0 • 0 0 2. Stocks and Bonds (Schedule B) . 2. 0 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , 3. 0 • 0 0 4. Mortgages and Notes Receivable (Schedule D) _ 4 0 • 0 0 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) 5. 3 8 6.0 0 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested g. 0 . 0 0 7. Inter-Vivos Transfers ~ Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested 7. 12 9 , 3 5 5.0 0 8. Total Gross Assets (total Lines 1 through 7) 8 12 9 , 7 41.0 0 9. Funeral Expenses and Administrative Costs (Schedule H) , . 9 3 , 819.0 0 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) . 10. 0 . 0 0 11. Total Deductbns (total Lines 9 and 10) , 11 3 , 819.0 0 12. Net Value of Estate (Line 8 minus Line 11) 12, 12 5 , 9 2 2.0 0 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) , . 13. 0 • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) , 14. 12 5 , 9 2 2.0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 (a)(1.2) x .o - 0.0 0 15. 0.0 0 16. Amount of Line 14 xable o 4~ at lineal ratex . 125, 922.00 1s. 5, 666.00 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 collateral rate X .15 0. 0 0 18. 0. 0 0 19. TAX DUE 19. 5, 666.00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ^ Side 2 1505610248 1505610248 J 9M4848 4.000 REV 1500 EX Page 3 Decedent's Cemnlete Address File Number ai. i. i. ntla~ DECEDENTS NAME STREET ADDRESS CITY M CHA STATE pA ZIP _ Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments 0.0 0 13. Discount 0.0 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) (1) 5, 666.00 0.00 (3) D • 0 0 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5 , 6 6 6.0 0 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 fife 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)J. 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. Taal credits (A + s) (2) 9M4671 2.000 REV-1508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN RESIOENr DECEOENr PERSONAL PROPERTY ESTATE OF FILE NUMBER John W. Brincxman 21 11 0424 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jotrrtly~n-ned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER rxcrRip-rinti OF DEATH 1 SPA Department of Revenue - Tax Refund 2 Asbury Communities, Inc. - Refund 159 227 TOTAL (Also enter on line 5 Recapitulation) $ ~ 386 3W46AD 1.000 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (08-09) Pennsylvania DEPARTMENT OF REVENUE INF~RITANCE TAX RETURN RESIDENT DECEDENT ATE SCHEDULE G INTER-VIVOS TRANSFERS AND MISC. NON-PROBATE PROPERTY FILE John W. Bringman 21 11 0424 This schedule must tie completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM NUMBS DESCRIPTION OF PROPERTY INCU.OETFENMAEOFTIfTRANSFEREE,TFEIRREWTiONSHPTODECEDENTMD TFE DATE OF7RM6F92 ATTPCHACOPY OF TFE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~• 2,079.67 Shares Ameriprise Columbia Funds Group International Stock Account No. 32223034 021 17,740 100.0000 0 17,740 Transfer on death account; Susan Milnes, daughter, beneficiary 2 Ameriprise Cash Account No. 32223034 021 29,604 100.0000 0 29,604 Transfer on death account; Susan Milnes, daughter, beneficiary 3 4,624.1 Shares Ameriprise Account No. 32223034 021 Columbia Funds Group Stock 47,212 100.0000 0 47,212 Transfer on death account; Susan Milnes, daughter, beneficiary 4 1,656.87 Shares Ameriprise Account No. 32223034 021 - Columbia Funds Group Large Cap Stock 15,508 100.0000 0 15,508 Transfer on death account; Susan Milnes, daughter, beneficiary 5 1,155.12 Shares Ameriprise Short-Term Fixed Income Account No. 32223034 021 19,291 100.0000 0 19,291 Transfer on death account; Susan Milnes, daughter, beneficiary TOTAL (Also enter on line 7, Recapitulation) $ I 12 9 , 355 If more space is needed, use additional sheets of paper of the same size. 9W46AF 2.000 REV-1511 EX+ (1Q09) pennsylvania ' DEPARTNENTOF REVENUE WHERITANCE TAX RETURN RESDENTDECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER John W. Brinaman 21 11 0424 Decedent's debts must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ . None B. 1 ADMINISTRATIVE COSTS: Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address 2. 3. City State ZIP Year(s) Commission Paid: Attorney Fees: Family Exemption: (If decedent's address is not the same as Gaimant's, attach explanation.) Claimant 3,000 Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 305 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. 1 The Sentinel - Estate Advertising 219 2 Register of Wills - Oath of Office Fee 20 Total from continuation schedules ~ 275 TOTAL (Also enter on Line 9, Recapitulation) ~ $ 3 , 819 9W46AG 2.000 If more space is needed, use additional sheets of paper of the same size. Estate of: John W. Bringman Schedule H Part 7 (Page 2) 21 11 0424 3 Cumberland Law Journal - Estate Advertising 75 4 Skarlatos ~ Zonarich LLC 200 Total (Carry forward to main schedule) 275 REV-1513 EX+ (01-10) Pennsylvania ' DEPARTNEPfTOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES rsiAitvr: FILE NUMBER: John W. Brin an 21 1 1 0424 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 [Indude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Susan C. Milnes 114 E. Keller Street Mechanicsburg, PA 17055 All of Residue: 125,922 Daughter 125,922 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. I I NONTAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ 0 it more space Is neeaea, use aaaltlonal sheets of paper of the same size. 9W46AI 2.000