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This is to certify that the certificate hereunto attached is a tine and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health,-for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General Assembly, approved 29 June 1953, P.L.
304.
Date
Auc 1 s Zoos
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Fran eropoli, t
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTH OF PENNSVLIMNIA • DEPARTMENT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
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NAMEOFDECEDEIiTIFirtMidd•.uq sEx SOCIALSECUrarvwn,eEn DATEOiaEAlNU1oIaLDwI-Aw
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,March 29, 1995 „aof PA Cremator Harrisbur PA 17109
aP oR AssucN ucENBENUMaER ANDADDRESSaPRArJLrty Cremation Society o PA
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REGISTRAR'S SIGNATURE AND NUAIBE~
DATE RED (MOnN. 0•Y. 1br1
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- REV-1500 p 1 Q 4 5 4 ~_
coMMDNWEALTH PENNSYLVANIA INHERITANCE TAX RETURN - - - --~-~-
DEPART REVENUE .:
_ _ RESIDENT DECEDENT ~ ~ 9 s ~ ~ 4.4
HARRISBU PA 17128-0601 ;'-:courrvcooE , -_-^`~ n ., ,
use a elect bbckb .
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Q SOCIAL SECURITY NUMBER DATE OF DEATH DATE aF BIRTH ;
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03~ 2 7~ L 9 9 5 1 2 ~l 6 ~1 9 3
W~ pf APPL~cAeLt~ suRVMNC sPaues NAME tLAS1, FlRST, AND -aooLe M~fT1AL- soau sEaiwTr Nt~R ~" THIS RETURN MU8T BE FILED u1 DuPUG-TE wml T-IE
NADEAU, ELIZABETH A. 'r; A ` 1 ~ 5 _- 2 8 8 3 6 7 ~' REGISTER OF WILLS
~ 1.Originai Retum ^ 2. Su lemental Retum
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^ 3. Remainder Retum (oats of death
prlora ~s•~3-e2>
m ~ ~ ^ 4. Limited Estate ^ 4a. Future Interest Compromise toots of dean atbr tza2-alt ^ 5. Federal Estate Tax Retum Required
~ d m ~ 6. Decedent Died Testate (Aeacn copy orwa) ^ 7. Decedent Maintained a Living Trust Wracn Dopy dTnrsQ _ 8. Total Number of Safe Deposit Boxes
a ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (aa~e orxatn ekt+nxn ta3t•et and ~-~-9s- ^ 11. Election to tax under Sec. 9113(A) tanacn sch o)
~ THIS SECTION''IfAU$T BE COMPLETED.AI=L~CORRESPONDENCEAND'CONFIDENTI%~l ~,; INFORMATION SHOULD BE DIRECTED'TO:
W NPDAE COMPLETE MAILING ADDRESS
O
o John H. Broujos, Esquire 4 N. Hanover Street
y fIRMNAME (HAppkade) Carlisle, PA 17013
~ Brow'os & Gilroy, P.C.
0 TELEPHONE NUMBER
~ 717 243-4574
1. Real Estate (Schedule A)
(1)
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- Cri'i~inlNY
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2. Stocks and Bonds (Schedule B) (2)
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3. Cbsely Held Corpora6on,Partnership or Sole-Proprietorship (3) + ~
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4. Mortgages & Notes Receivable (Schedule D) (4) ~
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5. Cash, Bank Deposits & Miscellaneous Personal Property
Z (schedule E) (5) , 2 1 1 7 6
6. Jointly Owned Property (Schedule F) (6) ' ' ,
g 7. Inter-V'nros Transfers b Miscellaneous Non-Probate Property
~ (Schedule G orL) (~)
~ ~
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a 8. Total Gross Assets (total Lines 1-7) ,~ (8)
, , 2 1 1 7 6
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V 9. Funeral Expenses & Administrative Costs (Schedule H) (9) ~ 3
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~ 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ( 10) ~
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11. Total Deductions (total Lines 9 b 10) (11 ~
12. Net Value of Estate (Line 8 minus Line 11) (12) `~ ~ ~ ~ ~ '3--~ -"
13. Charitable and Governmental BequesLslSec 9113 Tnlsts for which an eledion tD tax has not been (13) "
made (Schedule J)
ate ~ ,
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ~ 3 ~ f~ 3 ~ - 3 1 1 ~ 4
7
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15. Amount of line 14 taxable
z at the spousal tax rate ,
3 ~ 1
' 1 5 ~ 5 7 X p (15) , , 0 ~. 0 0
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See instrudiorrs on reverse side (or applicable percentage -• x
16. Amount of Cme 14 taxable ~> 1 ., _ ~ ~,~~~ .~~ , ', ~ ~ ~ ~ F.,o .fn
at 696 rate :~
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~ ~ X .06 (16) ~
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17. Amount ofrure 14 taxable ~'
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O at 15°6 rate ~ ~
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v 18. Tax Due (18) '~ ~
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`50DNC. t.., Y,J, ~+'n.o-n.:..k y
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19. • a •
m~ penalties d perjury. I declaro tlrat I have examined tlris teWm, kldtrdkrp sooompanyYp acheduba and ataiemenb, and b tla Dent d my krlowledpe and tle6er ri Is true. correct and oomplNe.
aegtrer has am knowledge.
arurw l urct ur PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
SIGNATURE F R ARE 0 R REPRESENTATIVE ADDRESS
~• .- 4 N. Hanover St., Carlisle, PA 17013
~.:~ :::
daraaon of preparer Dater
DATE
Z- ~~v/
Tax Payments and Credits:
1. Tax Due (Page 1 Line 18) (1)
2. CredifslFayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
. Total Credits (A + B + C) (2)
3. InteresUPenalty 'rf applicable
D. Interest
E. Penalty
Total InteresUPenalty (D + E) (3)
4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 19 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. Enter the interest on the tax due. (5A)
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) d ~"''
Make Check Payable to: REGISTER OF WILLS. AGENT
- --
A EWER 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 on or before December 12, 1982, did decedent within two years
preceding death transfer property without receiving adequate consideration? 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 death bank account or security
at his or her death? ...................................................................................................................... ^ '~
4. Did decedent own an individual retirement account, annuity, or other non-probate property?....
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN
72 P.S. §9118 (a) (1.1) (~ provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse from 6% to 3% for dates of death on or after July 1, 1994 and before January 1, 1995.
72 P.S. §9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the net value of transfers to or for the use of the surviving
spouse from 3% to 0% for dates of death on or after January 1, 1995. The statute does not exemot a transfer to a surviving spouse
from tax, and the statutory requirements for disGosure 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 JANUARY 1, 1995 - Please answer the following question by placing an "x' in the
appropriate space.
Did the decedent create a trust or similar arrangement which is solely for the surviving spouse's benefit for his or her entire
lifetime? Yes ~ No Q~_
If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second
spouse,. at which time it will be fully taxable at the rate(s)„applicable to the remainder beneficiary(ies). Enter the value of the trust on
Schedule J, Part II, in order to remove it from the calculation of the tax due in this estate. You may wish to file Schedule O in order to
make. the election available under Sectiori 9113. If the election is made, the trust or similar arrangement is taxed in the estate of the
first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse is taxed at the zero tax rate,
and the'remafnder is taxed at the rate(s) applicable to the remainder beneficiarX(ies). If you choose to make the election, you must
attach .Schedule O to atimely-filed tax return, along with Schedule(s) Kand/or M in order to show the apportionment of the trust or
similar arrangement between the surviving spouse and the remainder beneficiary(ies).
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Commonwealth of Pennsylvania
Inheritance Tax Return
Resident Decedent
SCHEDULE E
CASH,. BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Estate of File Number
Alleh J. Nadeau 1995-00344
(All property jointly-owned with the Right of Survivorship must be disclosed on Schedule F).
ITEM DESCRIPTION VALUE AT
NUMBER DATE OF DEATH
1. Blue Cross/Blue Shield of Alabama check ~ 186.00
2. Legionnaire Insurance Trust 25.76
TOTAL (Also enter on line 5, Recapitulation) $ 211.76
~ 1:
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Commonwealth of Pennsylvania SCHEDULE H
Inheritance Tax Return FUNERAL EXPENSES
Resident Decedent ADMINISTRATNE COSTS AND
MI8CELLANEOU8 EXPENSES
Estate of File Number
Alien J. Nadeau 1985-00344
ITEM DESCRIPTION AMOUNT
NUMBER
A.
1.
B.
1.
2.
3.
4.
C.
1.
2.
3.
Funeral Expenses
Cremation Society of Pennsylvania -Pre-paid except: 51.00
4100 Jonestown Road, Hamsburg, PA 17109
George's Flowers 138.33
101 G Street, Carlisle, PA 17013
Administrative Costs:
Personal Representative Commissions -Elizabeth Ann Nadeau
Social Security Number of Personal Representative:
Year Commissions paid: 1995 500.00
Attorney Fees: Broujos, Gilroy ~ Houston, P.C.
4 North Hanover Street, Carlisle, PA 17013 500.00
Family Exemption --
Claimant -Elizabeth Ann Nadeau Relationship -Wife ~ a~~ ~~
Address of Claimant at decedent's death: same
Probate Fees -Register of Wills, Cumberland County, PA 96.00
Miscellaneous Expenses:
Register of Wills, Cumberland County, PA -Inheritance Tax Return 15.00
Register of Wills, Cumberland County, PA -Inventory 10.00
Register of Wills, CumbeNand County, PA -Family Settlement Agreement 17:00
TOTAL {Also enter on line ~, Recapitulation)
.~,3~7~:33"
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BROUJOS & GILROY, P.C.
ATTORNEYS AT LAW 717-243-4574
JOHN H. BROUJOS 4 NORTH HANOVER STREET 717-766-1690
HUBERT X. GILROY CARLISLE, PENNSYLVANIA 17013 FAX: 243-8227
E-MAIL: brgilroypc@aol.corn
February 12, 2001
Department of Revenue
Dept. 280601
Harrisburg, PA 17128-0601
Re: Estate of Allen J. Nadeau; File No. 21-95-00344; DOD: March 27, 1995
Dear Department:
This is an estate where all assets were jointly held except the listed $211.76.
We previously had sent a letter indicating that this was a no asset case, where everything was
jointly held and there was no tax of any assets that would have existed in husband's name.
The Executrix, Elizabeth A. Nadeau, moved to Seattle, Washington. We are filing the return
now and sending a copy of the return to her to sign and return to our office, which should be
consummated within the next two weeks.
I represent the facts to be true as set forth herein.
~~cereiy
/j s
c: Elizabeth A. Nadeau
~' _ -_..~
Jo H. Broujos
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DTVISIDN NOTICE OF INHERITANCE TAX
DEPT. 280601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
HARRISBURG, Pa 17128-0601 OF DEDUCTIONS AND ASSESSMENT OF TAX
REV-1567 E% AFP (12-00)
DATE 03-26-2001
ESTATE OF NADEAU ALLEN J
DATE OF DEATH 03-27-1995
FILE NUMBER 21 95-0344
COUNTY CUMBERLAND
JOHN H BROUJOS ESQ ACN 101
4 N HANOVER ST
CARLISLE PA 17013-0029 Amount Renitt®d
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -~
----------------------------------------------------------------------------------------------------------------
REV-1547 EX AFP (12-00) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
_ DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF NADEAU ALLEN J FILE N0. 21 95-0344 ACN 101 DATE 03-26-2001
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper
2. Stocks and Bonds (Schedule Bl (2) .00 credit to your account,
3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion
4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fora with your
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 211.76 tax payment.
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule Gl (7) .00
8. Total Assets (g) 211.76
APPROVED DEDUCTIONS AND EXEMPTIONS:
1,539 .09
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00
11. Total Deductions (11) 1 .5 9 _ 09
12. Net Value of Tax Return (1P ) 1 , 327 .33-
13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedule J) (13) .00
14. Net Value of Estate Subject to Tax (14) 1 , 327 .33-
NOTE: if an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) •00 X 00 _ .00
16. Amount of Line 14 taxable at Lineal/Class A rate (16) .00 X 06 - .00
17. Amount of Line 14 at Sibling rate (17) .00 X 0 0 .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) •00 X 1 5 - .00
19. Principal Tax Due (191= .00
TOY CQFnTTC•
PA NT
DATE RECEIPT
NUMBER DISCOU T (+)
INTEREST/PEN PAID (-) AMOUNT PAID
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A '•CREDIT" [CR), YOU MAY BE DUE
.•
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• REV-7470 EX (6-88)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
ENT'S NAME
ALLEN J NADEAU
JED BY
John Kealy
INHERITANCE TAX
EXPLANATION
OF CHANGES
FILE NUMBER
2195-0344
101
SCHEDULE ITEM EXPLANATION OF CHANGES
NO.
B H-3 Reduced to $211.76. Family exemption can only be claimed against assets subject to will
or intestacy.
FILE
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