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HomeMy WebLinkAbout04-08-13 1505610140 REV-1500 EX (01-10) PA Departrnent of Remus Bureau of Individual Taxes Couinty Code Year Fib Number MTPo BOx 2110601 INHERITANCE TAX RETURN 2 1 1 3 0 0 3 1 5 .B.2 ro,PA 17126-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW 041 5201 2 ag13 /1`0( DecedenPs Last Nana Suffix OecediWa First Name MI BROTZ MAN EARL F (If APPlkeble)Enter Summm Spouee'a Infomratlon Below Spouse's Last Nerve Suffix Spouse's First Narne NI BROTZMAN JEAN 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 El 2.Suppbmantaf Retum 3.Remainder Return(date of death prior to 12-13-62) 4.Limited Estate 4a.Future Interest Compromise(date d 0 5,Federal Estate Tax Return Required death after 12-12-92) ® 6.Decedent Died Testate 7.Decedent Maintained a Living Trust 0 S.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 0 9.Lirigatlon Proceeds Received 10.Spousal Poverty Credit(date of death C] 11.Election to tax under Sec.9113(A) between 1231-91 and 1-1-95) (Attach Sch.O) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFDENTIAL TAX MFORMT10N SHOULD BE=tECTED TO: Name Daytlnu Telephone Number H DAVI D H RADCLI FF 717 97C 961E at"M ca RE(;ISTERI>F CfLY I Gaza f Q First Una of address at rif 40 in M 1 0 1 1 M O M M A RD C 2 c Second line of address S U T E 2 0 1 'pIrrr. City or Poet Office state ZIP Code D' OLEO ft` _ _ car L E M O Y N E PA 1 0 7 4 3 Correspondenirss+nailaddrsas: DRADCLIFFQ.i?C-WLAW.COM U at pet rY,1 that I have axerrrkted this return.' *,,is p accompanying schadala and shills iernb,and to the bat or my krgabdpe and beeer, it Is ,correct and oomplale.Pedwation of WWW other then hire personal repraanLdve is Need on Y k*xmadon of which propmer has any knowledge. SIG l R F FKING RETURN 20/ ADDRESS 2279 BENDERS 6RIVE BATH PA 18014 OF ATIVE DAYE ADDRESS 1011 MUMMA RD ST 01 LEMOYNE PA 17043 PLEASE USE ORIMNAL FORM ONLY Side 1 1505610140 1505610140 J 1505610240 REV-1500 EX RECAPITULATION 1. Real Estate(Schedule A) ........................... 2. Stocks and Bonds(Schedule B) .... ................................ 2. 3. Closely Held Corporation,Partnership or Sots Proprietorship(Schedule C) ..... 3. 4 MMUMM and Notes RacaW"(State D) .......................... 4. 5. Cash.S"Deposits and MiscaMneoua Personal Property(Schadule E)....... 5. 3 6 6. 8 2 6. Jointly Owned Property(Schedule F) p Separate MV Requested....... 6. 7. Inter-Vlvos Transfers&MiscaManeous Np%Pmba%Property (Schedule G) U SeParate SRf9 Requested-...... 7. a. Total Grose Assets(teal Unes 1 through 7) ........................... a. 3 6 6. 8 2 9, Furrersi Expanses and Administr ifto Coats(SChedide H) .................. 9. 6 3 3. 5 0 10. Dads of Decadent,Mortgage Liabilities,and Liens(Schedule 1) ............. 10. 11. Total DaduoOorta(total reins 9 and 10) ...............................11. 6 3 3. 5 0 12. Net VA*of Eetats(Line 6 mime tine 11) ............................ 12. - 2 6 6. 6 8 11 and Governmental SequeststSec 9113 Trusts for which an election to tax has not been made(Schedule J) ...................... 13. 14. Not value Subject to Tax(Line 12 minus t,ire 13) ......................14. ° 2 6 6. 6 8 TAX CALCULATION-BEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Una 14 taxable at the spousal tax rate,or transfers under Sec,9116 (s)(1.2)X.0_„ 0 . 0 0 15. 0. 0 0 116, Amount of Line 14 taxable at I rata x.0 i 0 . 0 0 16. 0. 0 0 17. Amount of Linn 14 taxable at rate X.12 0 . 0 0 17. 0. 0 0 18. Amount of Line 14 WOW at Collateral rate x.15 0 . 0 0 1 a. 0. 0 0 19. TAX DUE ._...................................................19. 0. 0 0 { 20. FILL IN THE OVAL IF YOU ARE REQUESTM A REFUND OF AN OVERPAYMENT Q SNde 2 1505610240 1505610240 REV-1500 EX Paps 3 FNS Hurnbar- Decedent's Complete Address: 21 13 00315 DECEDENPSNAME EARd_F.BROTZMAN 1132 MOUNTAIN ROAD CITY STATE i ZIP NEVVBURG PA 17240 Tax Paymenis and Credits: 1. Tax Due(Page 2,Line 19) (1) 0.00 2. Credits/Payrnents A.Prior Paymer is 6.oisootint Total Credits(A+g) (2) 0.00 3. Interest 4. If tine 210 greater than lkre 1+tie 3,enter the dittererrce.This Is the OYERPAYMM. (3} FM In oval on Page Y,Lkw 20 to squat a refusal. (4) 0.00 5. t line 1+Line 3 at greater than Line 2,an*the difference.This is the TAX DUE. (5) 0.04 Make check payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN"X"IN THE APPROPRIATE BLOCKS 1. Did decadent make a transfer and: Yes No a. retain the use or income of the property l rred: ...................................................................... ❑ b. retain the right to designate who shall use the property transferred or its income: ............................... c. retain a reversionary or --.............--..........--............................ .....,...-............-...... d. revive the promise for rte of ever payments,benefits or care? .............--.......................... El............ 2. If death ocomed after December 12,1982,did decedent transfer property wftn one year of death Y~receiving adequate consideration? ..................................................--................................ 3. Did decedent own an 1n trust fo'or payable-upon-death bank account or security at his or her death? ......... 4. Did decedent own an indivklual retirement account,annuity or other non-probate property,which contains a beneficiary desotaton?...--.............--............-......-................--.................................. ❑ 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.§9115(a)(1.1)(1)l, For dates of death on or after Jan.1,1995,the tax rate imposed on the not value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S.§9116(a)(1.1)(G)).The sfakrte does not exempt a transfer to a surviving spouse from tax,and the statutory requirements for disclosure of assets and Sg a tax return are still applicable every if the survtw tg spouse is the only beneiicdrey. 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(aX1.2)]. • The tax rate Imposed an the not value of transfers to or fa the use of rho decedent's kneel beneficiaries is 4.5 percent,except as noted in 72 P.S.§9116(1.2)(72 P.S.§9116(axt)}. • The tax rate imposed on the net value of transfers to or for the use of the decedents sit>M is 12 present(72 P.S.§9116(a}{1.3)).A sthtng is defined,udder Section 9102,as an individual who has at least one parent in common with the decedent,whelfter by blood or adoption. R"-1605"+(05.12) pennsyivanis SCHEDULE E DEPAMMEur of RMNUE CASH,BANK DEPOSITS&MISC. nESOWDECED PERSONAL PROPERTY ESTATE OF: FLE Ntlit1IC EARL F.BROTZMAN 21 13 00315 Include the proceeds of Wp OW and the date the procsed5 were rec*wed by the adeb. AN property Jointly awned wph right of survivvrehip must be disclosed an Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Pension check 22.56 2 Adams Electric Cooperative Inc 344.26 Member's account i TOTAL(Also erder on{Line 5,RScapk isdon) ; 3W.$2 K more space Is needed,use addltbnal shears of paper of the seine sins. REV•1SOe EX+(01-10) pennsylvanis SCHEEDULE F DEPARTMENT OF REVEU JON TL y4)WNEV PROMM ffiEWANMTAXRETURN RESIDENT DECEQENT ESTATE OF: FILE NIIMMM EARL F.BROTZMAN 21 13 00315 Ran aaaet waa node join ft owned vAdn one ym of ft doosdWa date of do*,k must be worMd on Schedule O. SURVMNO JOINT TENANTS)NANIE(S) ADDRESS RELATIONSHIP TO DECEDENT A.Jean L Brotmm 1132 Mountain Road Spouse Newburg,PA 17240 B. C. JONtMY-OWNED PROPEM. LETTER DATE DESC9$r"OFPliOFERTY %OF DATE DFDEATH ITEM FORJONiT MADE RMICE NAM OFnN ANCK04T1AtM AND SWAC(btWKIMBERORMAR DATE OF DEATH DECE';DENPS VAUEOF NIMER TENANT XWTT WENT"INGKWER,ATTACHDEEDFCXt AMY-WADME'/d.ESTATE VAUEOFASSET INTEREST DECEDENTS INTEREST 1. A. All property not separately Misted In this return is joint with suMvng Spouse TOTAL(AkoenW on U*6,RecapWafim) S If mm spree is"Be"Um Adsr bW ftm of Pow Of ft acme abn. REV-1611 1FX+(10-oe) pennsylvania SCHEDULE H °°'"'TMMTCWRM" FUNERAL EXPENSES AND RESIDME TAX M RE ADMINISTRATIVE COSTS rrESUEtrt oecEOENr ESTATE OF FLE NMfIAMM EARL F. BROTZMAN 21 13 00315 Deoedmrs debts must be reported on Sd"Ie t. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Persatal Repeserdabw Cornirmum: Neme(s)of POMW Repreeeiks i*) SMM Adams City State ZIP Years)Coimiebn Paid: 2. AtlomaY Fees: Cipriani&Werner PC 500.00 3. Fansly BmvdDn:(If deoedeiks address is not the same as d~s,abech esptsne m) Clement Sheet Addms Ciy sw ZP Retsl mft of Ctsmam 1D Deoederd 4. Pmbak Fees: 103.50 5. ADd Fees: 6. Tax Rem Preparer Fees: 7. Register of Wills—Filing Inventory and Inheritance Tax 30.00 TOTAL(Also wow on Line 9,RecaoMaBm) S 633.50 M more speoe a needed,use addit rW sheets of paper of Im same sites. REV-1513 EX*(01.10) pennsyivania SCHEDULE J MPAWPAEW OF RVEHM BENS ICMES "IEWAMM TAX AET1BiI`i RESO M DECEDENT ESTATE OF: FILE NWABM EARL F. BROTZMAN 21 13 00315 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSONS}RECEIVING PROPERTY De Mat L8t Treksw OF ESTATE I. TAXABLE DISTRISUTI(N1S iIndwe nou�i�N opt ddbbuto�a and btenkis wider Sae stf8(a () 1.2)•1 1. Joan L.Brotzman Spousal 0.00 1132 Mountain Road Newburg, PA 17240 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-15M COVER SHEET,AS APPROPRIATE. II. NON-TAXABLE DISTRIBUTIONS: A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. I TOTAL OF PART H-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-15W COVER SHEET. t IF more space is needed,use add'oval sheers of paper a10*same sire. r , LAST WILL AND TESTAMENT" I, Earl F. Brotzman, presently residing at 1132 Mountain Road, Newburg, Upper Mifflin Township, Cumberland County, Pennsylvania 17240, being of sound mind, memory and disposition, do hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void all Wills by me at any time heretofore made. FIRST. I order and direct the payment of all my legally enforceable debts and funeral expenses as soon as may be convenient after my decease. SECOND. I give, devise and bequeath all my estate, real, personal and mixed, whatsoever and wheresoever situate, to my beloved wife, Jean L. Brotzman, provided that she survive me by a period of sixty(60)days. THIRD. In the event that the said Jean L. Brotzman should predecease me or is not living on the 60" day following my death, I then give, devise and bequeath all my estate, real, personal and mixed,whatsoever and wheresoever situate as follows: A. I give and bequeath the full sum of Two Thousand ($2,000.00) Dollars to Tammy Bower; and B. I give, devise and bequeath all of the rest, residue, and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situate, to my daughter, Tara Faulkner,absolutely. In the further event that Tara Faulkner should predecease me or is not living on the 60a` day following my death, I then give, devise and bequeath all my estate, real, personal and mixed,whatsoever and wheresoever situate to Timothy Gallaway. FOURTH. I nominate, constitute and appoint my wife, Jean L. Brotzman, to be the Executrix of this my Last Will and Testament. In the event that she be unable to fulfill the duties of Executrix, I then nominate, constitute and appoint Tara Faulkner to be the Executrix of this my Last Will and Testament. FIFTH. I direct that my personal representative(s)shall not be required to give bond for the faithful performance of their duties in any jurisdiction. eani (SEAL) WEIGLE 6r ASSOCIATES. RC. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSSURG, PA 17257.1397 SIXTH. I hereby direct that all federal, state and other death taxes payable because of my death,with respect to the property forming my gross estate for tax purposes,whether or not -_-- passing under this Will, including any interest or penalty imposed in connection with such taxes, shall be consi eyed a part o e expense o administration o my estate an t such be paid out of the rest and residue of my estate. IN WITNESS WHEREOF,1, Earl F.Brotzman,have hereunto set my hand and seal to this my Last Willnd Testament, n two (2)pages,the first page signed for identification only, this day of�� ,2005. (SEAL) . i WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST }LING STREET - SNIPPENSBURG, PA 17257-1397 This instrument was by the Testator, on the date hereof, signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in the presence of each other we. believing him to be of sound and disposing mind and memory have hereu o �tssced_,___ our names as witnesses. 1 COMMONWEALTH OF PENNSYLVANIA SS COUNTY OF CUMBERLAND : I, Earl F. Brotzman, the person whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will;that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by Earl F. Brotzman,the Testator, this t�4 day of c .��!, '. 2005. ` WTAMWA WWL JA:.MtNARYP118,ttS appowm St1R+:.CIMNiERtMIDCw" WMLMISSON EXPIRES JULY 15?!qG WEIGLE & ASSOCIATES. RC. - ATTORNEYS AT LAW - 126 EAST KINQ STREET-5jUPPENSBURG. PA 17257-1387 w •• a COMMONWEALTH OF PENNSYLVANIA SS _ COUNTY OF MB BLAND we, 1d,C1C,� ;� 1��Q.� {�A�ie�cif+ L 7 me and . --��'Q-A( C. (1 [-Q C Lit , the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Earl F. Brotzman, the Testator, sign and execute the instrument as his Last Will; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator, signed the Will as witnesses; and that to the best of our knowledge the Testator was at the time eighteen(18)or more years of age and of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by tome_ , and Le LEI P witnesses,this day of 92005. R oNil 11Y WEIGLE & ASSOCIATES, P.C. - ATTORNEYS AT LAW - 126 EAST KING STREET - SHIPPENSBURG. PA 17257-1397 i r p � f o? 0 �h � � a a� ; r ��3iavn o o :F I r p � i 1 { I m N 7 O s Z O U � H � o clr) 4) CD � o M0voa .�..� co LL I'- L Ln 41 ru o co C t� E O L ��■ 4t ev U co o C7C Ur- U C3 M C3 rR 0 a ru o o zN p� UoT q ova 31 o CIPRIANI & WERNER A PROFESSIONAL CORPORATION ATTORNEYS AT LAW Pittsburgh Office: Telephone(412)563-2500 DENNIS CULLEN 1011 Mumma Road,Suite 201 Philadelphia Office: dcullen @c-wlaw.com Lemoyne,Pennsylvania 17043-1145 Telephone(610)567-0700 DAVID RADCLIFF Telephone(717)975-9600 Scranton orrice: dradcliff @c-wlaw.com Fax:(717)975-3846 Telephone(570)347-0600 www.C-WLAW.com Markon Office: Telephone(856)761-3800 wheeling office: Telephone(304)232-3600 Charleston Office: Telephone(304)341-0500 April 4,2013 Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse p ° m rn 1 Courthouse Square C o 0.o Carlisle, PA 17013 CIO RE: Estate of Earl F.Brotzman t ©D Co C� File No.21-13-00315 0 ca C11 " r177 9" Dear Mrs. Strasbaugh: a Cn CA pa 30 Enclosed for filing are the following for the above estate: t' 1. An original and one copy of the REV-1500,PA Inheritance Tax Return; 2. An original Inventory; 3. Check in the amount of$30.00 for the filing fee. Also enclosed are additional copies of the REV-1500 and the Inventory to be clocked in and returned to our office in the enclosed envelope. If you need additional items,please contact our office. Ve truly yoursr David H. Radcliff Enclosure Cc: Tara Faulkner,Executor(without enclosure) (via e-mail only)