HomeMy WebLinkAbout06-28-12i 1505610105
REV-1500 EX (oz-ti) (FI) ^ t•)
PA Department of Revenue Pennsylvania OFFICIAL USE ONLY
"`""""`"'°"""'"°° Coun Code Year File_Number
Bureau ofIndividual Taxes ty __ __
PO BOX 28o6ot INHERITANCE TAX RETURN
Harrisburg, PA 19128-0601 RESIDENT DECEDENT ~~ ' I ~ ', j ~~
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
360-38-5013 1 j 01 /08/2012
~ __
Decedent's Last Name
--- -_. ~.V _---- - - _ _
BREZINA
_ l
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name
Spouse's Social Security Number
-____ _ -1
j
_ _ )
FILL IN APPROPRIATE OVALS BELOW
~ 1. Original Return
MMDDYYYY Date of Birth MMDDYYW
_ ---- --
;
03/15/1913 f
Suffix Decedent's First Name MI
_. _ __
~WINIFRED ~ --
I ~R...~
Suffix Spouse's First Nama
__ _..._._.__..--
--.-- ... .__...... .. MI
~
__.___..._._.~_ _
_ I ~._~_ _. __ ___~ _
~ ~ r
~ __~
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
O 2. Supplemental Return O 3. Remainder Return (Date of Death
Prior to 12-13-82)
O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
(~ 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. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name
__._.._ __~_.__ _
r ---
__~___~~_____
_
Daytime Telephone Number
~A. MARK WINTER, ESQ _
- -
_ _ _ __
~, (717) 533-4868 _
1
_ ..
REGISTER OF WILLS U3L+~ILY
N
First Lme of Address ~--
310 W. CHOCOLATE AVE ~
_ _
I ~J
-
Second Line of Address ~
` tCF '-{-{
or Post Office
HERSHEY
State ZIP Code
PA L17033
••
_ n
c.~
Correspondent's a-mail address:
Under penakies 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 prepater has any knowledge.
SIGNAT PERS OR FILING RETURN
ADDRESS D~ ~ I
15 TU~ANY CT, CAMP HILL, PA 17011
SIGNAT O: P ER OTH TI-RN19~gRESE#1T IVE ~`T
~/1V) 6-- fez- tZ
310 W. CHOCOLATE AVE, HERSHEY, PA 17033
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610105 1505610105 J
1505610205
REV-1500 EX (FI)
decedent's Name: WINIFRED R. BREZINA
~ _._... a8,oeo.s7
RECAPITULATION
1. Real Estate (Schedule A) ........................................ ..... t '',,
2. Stocks and Bonds (Schedule B) .................................. ..... 2. ', 7,251.44
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. ' 852,052.07
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ... .. 6 241,565.97
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~"~ m `°" "~~~ ~°"`"°"""' "" ~ ~'°' _~~"
(Schedule G) O Separate Billing Requested.... .... 7. ', ',
8. Total Gross Assets (total Lines 1 through 7) ......................... .... 8. 1,100,889.40
9. Funeral Expenses and Administrative Costs (Schedule H) ............... .... 9. ', 21,356.64
10.
Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ...........
.... 10. __.~.
11,046.70 ',
11.
Total Deductions (total Lines 9 and 10) .............................
.... 11. ', __ .~.,
32,403.34
12.
Net Value of Estate (Line 8 minus Line 11) .......................... -
.... 12. ', -°- --,
1,068,466.10 ',
13 Ch
it
bl .
°"~'""°"°°" """"°""""" ""
. ar
a
e and Governmental Bequests/Sec 9113 Trusts for which """" ~--
an election to tax has not been made (Schedule J) .................... .... 13. ' '
14. Net Value SubJeet to Tax (Line 12 minus Line 13) .................... .... 14. ', 1,088,468.10
•^.~ ~~~~+~.++• •v - via. ow • n~sV ~ •VnJ f VR l11-/'LIVMOLC IViI C`J
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 °'°'°` '"`°`"' ~ -°°-~
(a)(1.2) X .0_ 15
' .
16. Amount of Line 14 taxable
~""'~ !" '""~
at lineal rate X .0 45 1,068,466.10 ~ 16.
17. Amount of Line 14 taxable i ~~ mm~ "~ "'~
at sibling rate X .12
~ 17
18. _
Amount of Line 14 taxable "~m ~"' "`
at collateral rate X .15 ~
_.__.
__ 1 g,
19. TAX DUE ........................................................ . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610205
48,080.97
__.;
Decedent's Social Security Number
..
360-38-5013
1505610205 J
REV-1500 EX (FI) Page 3
FII• Number
VG4CYCIII b VU(il(71ei@ Aaat'eSS: Z" ~,~ OOQ
DECEDENT'S NAME v
WINIFRED R. BREZINA
_._ _--
STREETADDRESS -
MESSIAH VILLAGE
I
STATE ZIP
MECHANICSBURG pA
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
_ 46,082.61
2, 000.00
(1) 48,080.97
3. Interest
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.
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
Total Credits (A + e) (2) 48,082.61
(3)
(41 1.64
(5)
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 .............................................................................................................................. ^
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, annuiiy 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 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
p2 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(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.
REV-15D3 EX+ (y-ii)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
scNEOU~E s
STOCKS & BONDS
ESTATE OF FILE NUMBER
WINIFRED R. BREZINA 2112-0084
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM
OF DEATH
7,251.14
TOTAL (Also enter on Line 2, Recapitulation) ~; ~ 7,251.14 ~°
If more space is needed, insert additional sheets of the same size
REV-15o8 EX+ (11-io)
Pennsylvania
DEPARTMENT Of REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEDIlLE E
CASH, BANK DEPOSITS & MISC.
PERSONAL PROPERTY
CITATE OF: FILE NUMBER:
WINIFRED R. BREZINA 2112-0084
Include the proceeds of litigation and the date the proceeds were received by the estate.
All properly jointly owned with right of survivorship must be disclosed on Schedule F.
~u~ ~o _ __ __ __- _ _ VALU E AT DATE
786,746.84
65, 305.23
TOTAL (Also enter on Line 5, Recapitulation) ; ~~ 852,052.07
If more space is needed, use additional sheets of paper of the same size.
REV-i5og EX+ (oi-so)
Pennsylvania
iil DEPARTMEN70F REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCNEpYLE F
]OINTLY-OWNED PROPERTY
es~w~e vF: FILE NUMBER:
WINIFRED R. BREZINA 2112-0084
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS
RELATIONSHIP TO DECEDENT
A• EDWARD R. BREZINA _. .
15 TUSCANY CT, CAMP HILL, PA 17011
SON
_ _ _ .:
' BONITA K
BREZINA .
_. _..
-
.
I 15 TUSCANY CT, CAMP HILL, PA 17011 DAUGHTER-IN-LAW
C. _
]OINTLY OWNED PROPERTY:
IEITER DATE DESCRIPTION OF PROPERTY
ITEM
FOR ]OINT
MADE % of DATE OF DFATH
INCLUDE NAME OF FINANCIAL INSTRURON AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH
NUMBER
TENANT
JOINT DECEDENTS VALUE OF
[DENTIFYING NUMBER ATTACH DEED FOR 70INTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST
1.
A.
~ y
10/15/87 DECEDENTS INTEREST
_ tRp1S-0 p~8F.1 k . ... BNptliiNl45
PNC BANK CHECKING ACCT # 5005588029
,
18,537 59 I 50%' ;. 9,268.80 ~,
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TOTAL (Also enter on Line 6, Recapitulation) ~ ~
241,565.97
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09J
pennsytvania
YJ DEPARTMENT OF REVENUE
INHERRANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
VVINIFRED R. BREZINA 2112-00$4
Decedent's debts must be reported on Schedule I.
Ni. £+NMC9t1 iN449EULA3tlit114(t6-r+,h ?§qIF ~#A
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li 1 )v+ . f a4.Je41Yf€45H5iBedtTai } `eN,~x..'.T~
2 10,000.00 ~~
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. Attorney Fees: ,
.v.:tlTZ£V:: R ~xmpr+afxu3r#~xn+,5n
r s'as+s dix v yuat~awrsm an ..n~
'
'
3. s, attach explanation.)
s address is not [he same as claimant
Family Exemption: (If decedent ,,,„,.,,,e1~„~,,,a,~„,,.,
Claimant
Street Address
~_ State ZIP `_~_J
City __
__
Relationship of Claimant to Decedent _
(: t nc3CeNtkk \1 135Ei!§, bUNiSiYllFif MCU"i<4
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4. Probate Fees: 793 50
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5. Accountant Fees:
qif°tH4M Fr`~.i.E't4Rt4khkai~lt4#a%}tMW'rv'a'3 t.iti
6. Tax Return Preparer Fees: 290 00
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7• ESTATE ADVERTISING 158.34
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TOTAL (Also enter on Line 9, Recapitulation) 3 ~lif
;~ 21,356.64
..„iuf~~~~.Y ~„~~u~ rrr.~..~a
If more space Is needed, use additional sheets of paper of the same size
REV-1512 EX+ (12-09j
SCHEDULE I
pennsytvania
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
WINIFRED R. BREZINA 2112-0084
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unrelmbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATN
_.. ......_ _._ ......:: .___... ........ . .... ... _.. ___..... ..... F;kSYea...,..t Yd .-r b: •, v-dYiFr44htN1LbN$AGeh U'
1• ;ALERT PHARMACY- FINAL BILL 58.50
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2. !.MESSIAH VILLAGE- FINAL BILL FOR RESIDENCY ~ 10,988.20
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TOTAL (Also enter on Line 10, Recapitulation) I $) .n.•^:~~~ 1,046.70
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (O1-lOj
Pennsylvania SCHEDULE 7
DEPARTMENT OF REVENUE
INHERITANCE TAX RENRN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF. FILE NUMBER:
WINIFRED R. BREZINA 2112-0084
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ARE
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NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY rustee( ;
Do
NotListT O
P EESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
_. _ ... ... ~_.. _..,_. _....-.. ,_.__ ._.__.. .
.. ............. .. ..
1•
EDWARD R. BREZINA 15 TUSCANY CT, CAMP HILL, PA 17011
!SON a+sr a4L R.?..~'+d? mi uiln iW3mXipyyy.. i.!N
~~
66.67%
... ... .... .... _. ..... ............ '._ ..I
•• j
'eiMU 'x:ti'tYr:alMRdYY'v.^.:. 1=
2.,
SCOTT EDWARD BREZINA 65 RIDGEVIEW DR ETTERS, PA 17039 ...••••. _.. I
i
'GRANDSON `,Wh tS iiS%F~'1bi 41Y: € fR/ a .. ~l#Nt, ti CC+Si4E:'
16.67%
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d. .....__._..... ___. s
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htrc41na9ars.WmariiRCtaaslsi3Ctntuwarla>a8srnatra6a;&HYS::{
3.
STAGY LYNN (BREZINA) RARICK 1501 N
18TH ST _.. -. ~..._. _ 7
GRANDDAUGHTER ialz~ra#aaraaiazarnsis?xnsst~aa~:.e-aarrr+nxl r<xaz£ta~.
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. .. 16.67%
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ALLENTOWN, PA 18104 ... ....._.. .... .._. ~ 1+a+sac+" „usxit!:aev. a?x.Annx¢eu.:~:;ni .. i.;
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ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH -- .. .. ~
18 OF REV-1500 COVER SHEET, A SL~zfC4..5 .}n}£f.a.r.'Sh\ a1iNi}it ^AWS4t ^i e .')R
S APPROPRIATE.
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~~~ 5ita.AVihAkbNtiti4ieL}6'::?ti3EdAa:k•ESe`Spi39!ikeF315YNbttPdtjc
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..... .. ... .... __. ksa lil ix .. „C..ILtWk. -FY~hhk :'.i.£r11£ .FhKK y.
_•~ ..••-•_.•..~~••..~ •• -...• a'X}k£r .ua Y..-}"t..,R)l#v `5::k1tL:Y:" dH: f,iil.
-Y I '[!YYYII i i b 41#yk RL#F5i }I IM1ax~;AAM ^'S4
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TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ; G'; 1,
[f more space is needed, use additional sheets of paper of the same size.
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LAW OFFICES
A. MARK WINTER
310 WEST CHOCOLATE AVENUE
P. O. DOX 412
HERSHEY, PENNSYLVANIA 17033
PHONE: 717-533-4868
June 22, 2012
Cumberland County Courthouse
Attn: Heidi
Register of Wills
1 Courthouse Square, Room 102
Carlisle, PA 17013
IN RE: Estate of Winifred R. Brezina
Dear Heidi:
FAX: 717-533-2582
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As per my conversation with you today, I have attached
a check for $15.00 to cover the filing fee of the
Inheritance Tax Return on the above referenced Estate.
I spoke to Attorney Winter regarding the Last Will and
Testament and he would like to have a copy of the original
Will which was filed at the Courthouse to be sent with the.
Inheritance Tax Return to the Department of Revenue.
If you have any questions regarding the above matter,
please do not hesitate to contact me directly. Thank you!
Very truly yours,
~.
Carolyn Raup
Enc.
LAW OFFICES
A. MARK WINTER
310 WEST CHOCOLATE AVENUE
P. O. OOX 412
HERSHEY, PENNSYLVANIA 17033
PHONE: 717-533-4868 FAX: 717-533-2582
June 22, 2012
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Cumberland County Courthouse ~
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Attn: Glenda Farner Strasbaugh _
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Register of Wills
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1 Courthouse Square , 1°t Floor ~ --~ ,;,'
Carlisle, PA 17013 N
IN RE: Estate of Winifred R. Brezina
Dear Glenda:
Enclosed for filing are the original and four (4)
copies of the Inheritance Tax Return on the Estate of
Winifred R. Brezina.
Please return all excess time-stamped copies to me in
the enclosed envelope. Please call me if you require any
further documentation from me.
As alpays, thanks to you and your staff for your
excellent service.
Very truly yours,
~~~
A. Mark Winter, Esq.
ekr
Enc.
cc: Edgard R. Brezina