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HomeMy WebLinkAbout04-19-13 (2) REV-1500 EX (01-10) 1505610140 OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 2 0 8 0 3 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Suffer Decedent's First Name MI B R 0 T Z M A N J E A N L (If Applicable)Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ❑X 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 E] 5.Federal Estate Tax Return Required death after 12-12-82) ® 6.Decedent Died Testate 7. Decedent Maintained a Living Trust 0 8.Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received 10.Spousal Poverty Credit(date of death El 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 1` DAVI D H RADCLI F 71 7,C=1 075 6a(�0 rrI RE OF WILLS�SE NYC 2 n M o C.c n fr1 First line of address Z N = d 40 C:1 1 0 1 1 MU M M A R OA D oo Z-3 Second line of address F-• h S U I T 201 -' N r � _ r City or Post Office State ZIP Code a DATE FILED _n L E M O Y N E P A 1 7 0 4 3 Cc pondent's e-mail address: DRADCLIFFOC-WLAW.COM Und penal ies 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 e,correct and oomplo te.Declaration of preparer other than the personal representative is based on all information of which p rer has ay knowledge. SIG TURE OF P`E SO iESPON BL FOR FILING RETURN rDATE r 1`F- ADD ESS 22 9 BENDEREC DRIVE BATH PA 18014 SIGNATURF2E PA ` DAO T . �N Z�r A j4p/3 ADDRESS 1011 MUMMA ROAD, STE 201 LEMOYNE PA 17043 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 1505610240 REV-1500 EX Decedent's Social Security Number Decedent's Name: JEAN L. BROTZMAN RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 1 8 2 4 0 0 , 0 0 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. 5. Cash, Bank Deposits and Miscellaneous Personal Pro ) 6 2 4 3 0 • 5 3 p party(Schedule E . . . . . . . 5. 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous N -Probate Property (Schedule G) t Separate Billing Requested . . . . . . . 7. 7 2 8 5 0 • 2 3 8. Total Gross Assets(total Lines 1 through 7) 8. 3 1 7 6 8 0 . 7 6 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 1 5 6 4 7 . 1 6 10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 2 8 8 9 . 4 6 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 8 5 3 6 . 6 2 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 2 9 9 1 4 4 . 1 4 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. 2 9 9 1 4 4 . 1 4 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec.9116 (a)(1.2)X.0 _ 0 , 0 0 15. 0 , 0 0 16. Amount of Line 14 taxable, at lineal rate x.045 2 9 9 1 4 4 . 1 4 16. 1 3 4 6 1 . 4 9 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. 1 3 4 6 1 . 4 9 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505610240 1505610240 J REV-1500 EX Page 3 File Number Decedent's Complete Address: 21 12 0803 DECEDENT'S NAME JEAN L. BROTZMAN STREET ADDRESS 132 MOUNTAIN ROAD CITY STATE ZIP NEWBURG PA 17240 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 13,461.49 2. Credits/Payments A.Prior Payments 12,500.00 B.Discount 657.88 Total Credits(A+B) (2) 13,157.88 3. Interest (3) 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. (4) 0.00 5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 303.61 Make check payable to: REGISTER OF WILLS, AGENT rT 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; ............................... El X c. retain a reversionary interest;or ................................................................................................ ❑ ❑X d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ ❑X 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ❑ ❑X 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ ❑X 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ❑X ❑ 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 i; 3 percent[72 P.S.§9116(a)(1.1)(1)]. 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)].A sibling 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-1502 EX+(12-12) pennsylvania SCHEDULE A DEPARTMENT OF REVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JEAN L. BROTZMAN 21 12 0803 All real property owned solely or as a tenant in common must be reported at fair market value.Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller,neither being compelled to buy or sell,both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survNOrship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 1132 Mountain Road, Newburg, PA 182,400.00 TOTAL(Also enter on Line 1,Recapitulation.) $ 182 400.00 If more space is needed,use additional sheets of paper of the same size. REV-1508 EX+(08-12) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: JEAN L. BROTZMAN 21 12 0803 Include the proceeds of litigation and the date the proceeds were received by the estate. All property joirdly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Social Security check 1,386.00 2 Adams County National Bank checking 34,045.62 3 Adams County National Bank Savings 7,669.73 4 Household Furnishings (See attached list) 2,225.00 5 Chevrolet Trail Blazer(2008) 13,687.00 6 Federal Income Tax Refund (2012) 2,999.00 7 Highmark Insurance Refund 207.18 8 Erie Insurance Premium Refund 66.00 9 Erie Insurance Co. - Homeowners Insurance Refund 145.00 TOTAL(Also enter on Line 5,Recapitulation) $ 62 430.53 If more space is needed, use additional sheets of paper of the same size. Estate of JEAN L. BROTZMAN File No. 21-12-00803 Bath Linens $ 5.00 Full Length Mirror $ 10.00 Misc. Racks and Storage $ 20.00 N Cabinet $ 10.00 N $ 10.00 Jewelry Box $ 5.00 Engagement Ring $100.00 Wedding Bands $ 50.00 Bed $ 30.00 Misc. Bedroom Furnishings $ 40.00 Cedar Chest $ 75.00 Bed $ 10.00 Bed $ 10.00 Misc. Lamps & Decorative Items $ 15.00 Dresser $ 10.00 Luggage $ 10.00 Bedding $ 20.00 Home Safe $ 20.00 Holiday Decorations $ 20.00 Sofa $ 25.00 Love Seat $ 25.00 Corner Hutch $ 10.00 Corner N Case $ 10.00 N $ 25.00 Side Table $ 10.00 Misc. Decorative Items $ 50.00 Dry Sink $ 15.00 Hutch $ 20.00 Table &Chairs Set $ 20.00 Wood Cabinet $ 10.00 Set Mixing Bowls $ 20.00 Collector Plates $ 50.00 Misc. Decorative Items $ 50.00 Amana Refrigerator Freezer $ 40.00 Kenmore Freezer $ 40.00 Microwave $ 10.00 Misc. Small Appliances $ 50.00 Pots& Pans $ 20.00 Misc. Plates, Bowls $ 20.00 Tupperware $ 10.00 Flatware $ 5.00 Misc. Utensils $ 10.00 Bakeware $ 10.00 Table $ 10.00 Misc. Kitchen Furnishings $ 50.00 Washer/Dryer Set $100.00 Linens $ 5.00 Misc. Decorative Items $ 10.00 Seatee & Furnishings $ 10.00 Garden tools& Lawn Chairs $20.00 Recreation and Hobby Equipment $995.00 TOTAL $2,225.00 REV-1510 EX-(08-09) pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN L. BROTZMAN 21 12 0803 This schedule must he completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NPME OF THE TRANSFEREE,THEIR RELATIONSHIP TO DECEDENTAND DATE OF DEATH % DECUS EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IFA ICA5LE) VALUE 1. Individual Retirement Account 72,850.23 100.00 72,850.23 TOTAL (Also enter on Line 7,Recapitulation) $ 72 850.23 If more space is needed,use additional sheets of paper of the same size. REV-1511 FX-(10-09) pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN L. BROTZMAN 21 12 0803 Decederd's debts must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERALEXPENSES: 1. Egger Funeral Home 2,281.67 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representafive(s) Street Address City State ZIP Years)Commission Paid: 2. Attorney Fees: Cipriani &Werner PC 12,600.00 3, Family Exemption:(If decedents address is not the same as claimants,attach explanation.) Claimant Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 369.50 6 Accountant Fees: 6. Tax Return Preparer Fees: Glenn H. Miller&Associates 275.00 7. Recorder of Deeds 73.00 8 PNC Bank-check printing 17.99 9 Register of Wills- Filing Fees 30.00 TOTAL(Also enter on Line 9,Recapitulation) $ 15 647.16 If more space is needed,use additional sheets of paper of the same size. REV-1512 EX+(12-12) pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES&LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER JEAN L. BROTZMAN 21 12 0803 Report debts Incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbumed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Real Estate Taxes 2,082.04 2 Sprint 17.63 3 Dish TV 12.03 4 Adams Electric Cooperative 158.48 5 Holy Spirit Hospital 50.00 6 Cipriani &Werner, PC-Balance due on Earl F. Brotzman bill 569.28 TOTAL(Also enter on Line 10,Recapitulation) E 2,889.46 If more space is needed,insert additional sheets of the same size. REV-1513 EX-(01-10) pennsylvania SCHEDULE J DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: JEAN L. BROTZMAN 21 12 0803 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 [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1. Tammy Bower Lineal 2,000.00 2 Tara Faulkner Lineal 297,144.14 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE. Il. 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. TOTAL OF PART II-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ONLINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size.