HomeMy WebLinkAbout12-09-13 (2) � 1505610140
REV-1500 EX (02-11)(FI)
Department of Revenue
OFFICIAL USE ONLY
, Bureau of Individuai Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOk 280601 2 1 1 3 0 5 4 2
Harrisburo,PA 17128-060� RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number � Date of Death MMDDYYYY Date of Birth MMDDYYW
0 4 2 0 2 0 1 3 0 5 2 0 1 9 1 8
Decedent's Last Name . Suffix Decedent's First Name MI
B R I N T 0 N G E R A L D S
(If Applicable)Enter Surviving Spouse's information Below
Spouse's Last Name Suffix Spouse's First Name M�
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
D 1.Original Return � 2.Supplemental Return � 3.Remainder Retum(Date of Death
Prior to 12-13-82)
� 4.Limited Estate � 4a.Future Interest Compromise(date of � 5.Federal Estate Tax Retum 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 Wili) (Attach Copy of Trust.)
� 9.Litigation Proceeds Received � 10.Spousal Poverty Credit(Date of Death � 11.Election to Tax under Sec.9113(A)
BeMreen 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE bIRECTED T0:
Name Daytime T�ephone Num er
D A V I D H S T 0 N E , E S Q U I R E ? 1 ,� p7 7 4c�`',�,'? ,� �r5
m � r� �
R R�WI SE ' L ,�,
r— � r� � �r
�" c�n .� tt� � +�
First Line of Address � , � � �
4 1 4 B R I D G E S T R E E T � o �' '� -°�, '�'
� � � � �
Second Line of Address � � � � �
�• � � +'�
City or Post Office State ZIP Code DA�ILED� �"
N E W C U M B E R L A N D P A 1 7 0 ? 0
Correspondent's e-mai�address: D S T 0 N E a S T 0 N E L A W•N E T
Under penalties of perjury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge au�d belief,
it is true,conect and complete.Declaration of preparer other than the personal representative is based on all information of which preparer haa arry knowledge.
SI /�T RE OF PE SON S ONS LE FOR FILING RETURN DATE
w 'P V�l�.
ADDRESS
72? 16TH STRE T NEW CUMBERLAND PA 1?070
SIGNATU Of AR�R THER THAN REPRESENTATIVE DATE
" '1�
AD ESS
414 IDGE TREET NEW CUMBERLAND PA 1707�
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505610140 15056],0140 J
���s� INHER�'��NC:E TAX ItETU�N RESIDENT DECEI�ENT
Estate of Gerald S.Brinton File No.21-13-0642
�dditional Signature and Address of CaExecutrix
�ro-�o����'C�, Co-��
Carol L.B.Allan 147 W Fifth S�. Con�ing,NY 14834
J 150561D240
REV-1500 EX(FI)
Decedent's Social Security Number
oecedenes Name: G E R A L D S • B R I N T 0 N -
RECAPITULATION
1. Real Estate(Schedule A) .. .. . . .. .. .. . . ... .. . .. ... . . . . ... .. . .. ...... 1. •
2. Stocks and Bonds(Schedule B) . .. .. . . . .... .. . .. .... . . .. .. .. . ....... . 2. 5 7 5 7 1 1 . 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 Property(Schedule E). .... . . 5. 1 7 0 9 4 5 . 1 2
6. Jointly Owned Property(Schedule F) ❑ Separate Bitling Requested . . . . .. . 6. - 3 6 8 . 7 2
7. Inter-Vivos Transfers 8 Miscetlaneous N�Probate Property
(Schedule G) Separate Billing Requested . . . . . . . 7.
.
8. Total Gross Assets(total Lines 1 through 7) . . .... . . .. .. . . .. . .. . . .. . . . . 8. ? 4 6 2 8 � . 6 �
9. Funeral Expenses and Administrative Costs(Schedule H) . .. .... ... ... .... . 9. 3 3 6 8 7 . 5 2
10. Debts of Decedent,Mortgage Liabilities,and Liens(Schedule I) . . . .. . . . . .... 10. 5 4 1 2 . 2 0
��. Total Deductions(total Lines 9 and 10) . . . .. . . .. . .. . . . ... . . . ... . . . .. . . 11. 3 9 0 9 9 . � 2
12. Net Value of Estate(Line 8 minus Line 11) .. . .. .. .. .. . . .. . . . ... . .. . . . . 12. 7 0 7 1 8 7 . 9 5
13. Charitable and Govemmental 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. ? 0 7 1 8 7 . 9 5
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxab�e
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.0 � . 0 O 15. O . 0 0
16. Amount of Line 14 taxable
at lineal�ate X.04� 7 0 ? 1 8 7 . 9 5 �s. 3 b 8 2 3 . 4 6
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. 3 1 8 2 3 • 4 6
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT �
Side 2
� 15056],0240 1505610240 �
REV-1500 EX(FI) Page 3 File Number
Decedent's Complete Address: 21 13 D 5 4 2
DECEDENTS NAME
GERALD S • BRINTON
STREET ADDRESS
325 WESLEY DRIVE
��TM STATE Z�p
MECHANICSBURG PA 17055—
Tax Payments and Credits:
�� Tax Due(Page 2,Line 19) (�) 31,8 2 3 •4 6
2. Credits/Payments
A.Prior Payments 3 0,0 0 0•0 0
B.Discount 1,5 7 8•9 5
Total Credits(A+B) (2) 31,5 7 8 •9 5
3. Interest
4. If Line 2 is greater than Line 1+Line 3,enter the difference.This is the OVERPAYMENT. �3� 0 •0 0
Fiil in oval on Page 2,Line 20 to request a refund. (4) 0 •0 0
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 2 4 4 • 51
Make check payable to: REGISTER OF WILLS, AGENT
PLE�SE 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 ..................................................................... �
................................ a
d. receive the promise for life of either payments,benefits or care? ....................................................... � �
2. 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? ......... ❑ []X
4. Did decedent own an individual retirement account,annuity or other non-probate property,which
contains a beneficiary designation?..................................................................................
................ ❑ 0
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
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 suroiving spouse from tax,and the statutory requirements for disclosure of assets and
filing a tax retum are still applicable even if the surviving spouse is the only beneflciary.
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)J.
• 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[�2 P.s.§9116(a)(1}J.
• 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.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-1503 EX+(8-12)
pennsylvania SCH�DULE B
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN STOCKS & BONDS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
GERALD S • BRINTON 21 13 0542
All property jointiy owned with right of sunrivorship muat be disclosed on Schedule F.
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
�. 3500� US Treasury Note Dtd ?-15-2011, Mat 7-15-2021 39,879•35
4-19-13 $113.7734, 4-22-13 $114 •1094 w/avg �113.941
2 35000 US Treasury Note - Accrued Interest 58 .01
3 5000 US Treasury Bond Dtd 4-15-1999, Mat 4-15-2029 8,232•25
4-19-13 �164 . 4375, 4-22-13 $164 •8516 w/avg $164 .645
4 5000 US Treasury Bond - Accrued Interest 3•18
5 56583•93 shs 5003 Alliani Global Invs Mng Act Tr 56,583• 93
a $1•000 each Fixed Inc Shrs R Mut Fund
6 60�� US Treasury Bond Dtd 2-15-2013, Mat 2-15-2043 6,243. 30
4-19-13 $1�3•8203, 4-22-13 $104 .2891 w/avg $104 .055
7 6000 US Treasury Bond - Accrued Interest 6•73
8 8000 US Treasury Note Dtd ?-15-2005 Mat 0?-15-2015 8,653•76
4-19-13 �108 •1719, 4-22-13 $108•1719 w/avg �108 .1,72
9 8000 US Treasury Note - Accrued Interest 39•78
10 456 shs Abbvie Inc stock (ML) 4-19-13 High $42.58, 19,663•86
Low �42•20 w/avg $42•39 and 4-22-13 High $44 •83, Low
�42•88 w/avg $43.855 w/avg $43.1225 per share
11 Abbvie Inc stock (ML) - Accrued Dividend 182 • 40
12 248 shares Altria Group Inc stock (ML) 4-19-13 High 8,693•64
�35•21, Low $34 .?2 w/avg �34 •965 84-22-13 High $35•34,
Low $34 .95 w/avg $35•145 w/avg of $35•055 per share
13 336 shares ATBT Inc stock (ML) 4-19-13 High �38•36, 12,870 • 48
Low $37.76 w/avg $38•O6 and 4-22-13 High $38 •?6, Low
�38 .34 w/avg �38•55 w/avg �38.305 per share
14 ATBT Inc stock (ML) - Accrued Dividend 151•20
15 277 shares BCE Inc stock (ML) 4-19-13 High $45•96, 12,694 •22
Low $45•53 w/avg $45• 745 and 4-22-13 High $46 .06,
Low �45.76 w/avg �45• 91 w/avg �45• 8275 per sh
16 354 shares Bristol-Myers Squibb Co stock (ML) 4-19-13 14,578 •16
High �41•255, Low $40.52 w/avg $40•8875 and 4-22-13
Hi h $42•00, Low$40• 95 w/av �4],. 475 w/av $41•1813 er sh
TOTAL(Also enter on Line 2,Recapitulation) s 5 7 5,711•2 7
If more space is needed,insert additional sheets of the same size
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GERALD S. BRINTON 21 13 0542
Decedent's Name Page 1 File Number
Schedule B -Stocks& Bonds
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
1? Bristol-Myers Squibb Co stock (ML) - Accrued 123.90
Dividend
18 143 shares Chevron Corp New stock (ML) 4-19-13 High 16,651.28
�116.95, Low $115•83 w/avg $116 •39 and 4-22-13 High
�117.10, Low $115•89 w/avg $116• 495 w/avg $116 • 4425 per sh
19 476 shares CMS Energy Corp stock (ML) 4-19-13 High 13,776 •63
$29•09, Low �28 •62 w/avg $28 •855 and 4-22-13 High
�29•18, Low �28•88 w/avg �29•03 w/avg �28• 9425 per sh
20 528 shares �onagra Foods Inc stock (ML) 4-19-13 High 18,932•69
#36•10, Low $35• 44 w/avg $35•77 and 4-22-13 High $36•10, Low
Low $35•7895 w/avg �35.9448 w/avg $35.8574 per sh
21 5D0 shares Carning Inc stock 4-19-13 High �13•10, 6,430.00
Low $12.84 w/avg �12•97 and 4-22-13 High �12.86, Low
�12•64 w/avg �12•75 w/avg �12•86 per share
22 242 shares Digital Rlty Tr Inc stock (ML) 4-],9-13 17,700• 49
High �73•81, Low $?1.85 w/avg $?2•83 4-22-13 High
�74 .00, Low $?2•91 w/avg $?3• 455 w/avg �73.1425 per sh �
23 166 shares Du Pont E I DE Nemours 8 Co stock (ML) 8,219• 49
4-19-b3 High �49•30, Low $48•?4 w/avg $49•02 4-22-13
High $50•?4, Low�49•28 w/avg $50•01 w/avg �49• 515 per s
24 363 shares Eaton Corp Plc stock (ML) 4-19-13 High 20,577. 56
�5?•19, Low $55.69 w/avg $56• 44 and 4-22-13 High
�57. 42, Low �56. 45 w/avg $56 •935 w/avg �56•6875 per sh
2� � ?22 shares General Electric Co stock (ML) 4-19-13 High 15,6�0 . 62
;�22.03, Low $21•61 w/avg $21•82 and 4-22-13 High
�21•68, Low $21.11 w/avg $21•395 w/avg $21•6075 per sh
26 General Electric Co stock (ML) - Accrued Dividend 137. 18
27 ?50 shares Intel Corp stack (ML) 4-19-13 High 16,865• 63
$22• 45, Low $22.21 w/avg �22.33 and 4-22-13 High
�22•94, Low �22• 35 w/avg $22•645 w/avg $22• 4875 per sh
28 292 shares JP Morgan Chase 8 Co stock (ML) 4-19-13 13,754 • 95
High $4?•364, Low $46•70 w/avg �47•032 4-22-13 High
;�4?• 49, Low $46 •87 wlavg $4?•18 w/avg $4?•106 per sh
29 JP Morgan Chase & Co stock (ML) - Accrued Dividend 8?• 60
30 189 sh Kimberly Clark Corp stock (ML) 4-19-13 High ],9,880• 53
�106•541, Low $103.88 w/avg $105•2105 4-22-13 High
�],05•72, Low $104 •611 w/avg �105•1655 w/avg $105• 188 per sh
31 262 shares Kraft Foods Group Inc stock (ML) 4-19-13 ],3,192• 68
High �50•72, Low �49 .86 w/avg $50•29 and 4-22-13 High
�50•81, Low$�50.025 w/avg $50• 418 w/avg $50•3538 per sh
SUBTOTAL SCHEDULE B 181,9 31• 2 3
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GERaLD S. BRINTON 21 13 0542
Decedent's Name Page 2 File Number
Schedule B -Stocks� Bonds
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
32 176 shares McDonalds Corp stock (ML) 4-19-13 High 1?,552 .92
�101• 44, Low �99. 45 w/avg �100• 445 and 4-22-13 High
�99•66, Low �98.38 w/avg �99.02 w/avg $99. 3725 per sh
33 178 shares Merck & Co Inc stock (ML) 4-19-13 High 8,423 .85
�47. 49, Low $46•66 w/avg �47.075 and 4-22-13 High
�47•97, Low �47.18 w/avg $47•575 w/avg $47•325 per sh
34 561 shares Microsoft Corp stock (ML) 4-19-13 High 17,012 •33
$30•24, Low �29.61 w/avg $29•925 and 4-22-13 High
�31.18, Low $30. 2? w/avg �30.725 w/avg �30•325 per sh
35 174 shares Nextera Energy Inc stock (ML) 4-19-13 High 13,867 •80
�80.12, Low �78. 97 w/avg �79.545 and 4-22-13 High
#80•28, Low �79• 43 w/avg �?9•855 w/avg $?9.70 per sh
36 183 sh Occidental Pete Corp Del stock (ML) 4-19-13 14,617.1?
High �80•6�, Low $79 .16 w/avg �79.88 and 4-22-13 High
$80•736, Low�79.005 w/avg �79•8705 w/avg $?9.8753 per sh
37 404 sh Paccar Inc stock (ML) 4-19-1,3 High $48• 425, 19 474 32
, .
Low �4?•24 w/avg $47.8325 and 4-22-13 High $49.19,
Low $47.96 w/avg �48 •575 w/avg $48•2038 per sh
38 89 sh Philip Morris Intl Inc stock (ML) 4-19-13 High 8,203• 91
�92•60, Low �91•50 w/avg $92•05 and 4-22-13 High
�92•945, Low#91.6699 w/avg �92•3075 w/avg �92.1787 per sh
39 182 shares Sempra Energy stock (ML) 4-19-b3 High 14,962.68
�82•79, Low �81•23 w/avg �82•01 and 4-22-13 High
� �82•78, Low �82•OS w/avg �82• 415 w/avg $82.2125 per sh
40 552 shares Spectra Energy Corp stock (ML) 4-19-13 16,879 . 47
High �30•70, Low �30 •35 w/avg �30.525 & 4-22-13 High
�30•?3, Low�30•535 w/avg �30•6325 w/avg �30•5788 per sh
41 315 shares Thomson Reuters Corp stock (ML) 4-19-13 10,162 •65
High �32• 41, Low $32•00 w/avg $32.205 & 4-22-13 High
�32• 4795, Low�32•16 w/avg $32.3198 w/avg �32•2624 per sh
42 147 shares Toronto Dominion Bk Ont stock (ML) 4-19-13 11,518 •04
High �78• 49, Low �??-81 w/avg $78•15 & 4-22-13 High
�79•02, Low �78 .096 w/avg �78•558 w/avg $78 •354 per sh
43 Toronto Dominion Bk Ont stock (ML) - Accrued 119 •0?
Dividend
44 255 shares Ventas Inc stock � �78 • 552 each 4-19-13 20,030 •B9
High $?9•10, Low $7?- 41, w/avg $78 •255 & 4-22-13 Nigh
�79•26, Low $78• 44, w/avg �78•85 w/avg �78 •5525 per sh
45 359 shares Verizon Communications Inc stock 4-19-13 18,648 .61
High $52•35, Low $51•255 w/avg $51•8025 & 4-22-13 High
�52•289, Low�51•89 w/avg $52•0895 w/avg $51•946 per sh
46 Verizon Communications Inc stock - Accrued Dividend 184 •88
SUBTOTAL SCHEDULE B 191,6 5 8 -5 9
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GERALD S. BRINTON 21 13 0542
Decedent's Name Page 3 File Number
Schedule B -Stocks� Bonds
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
47 440 shares XCEL Energy Inc stock 4-19-13 High �3],• 09, 13,587•20
Low �30.52 w/avg $30 .805 and 4-22-13 High $31•13, Low
Low �30•78 w/avg $30•955 w/avg $30 •88 per sh
SUBTOTAL SCHEDULE B 13,5 8?•2 0
GRAND TOTAL SCHEDULE B S 575,711.27
REV-1508 EX+(08-12)
pennsylvania SCHEDULE E
QEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN
RESIDENT DECEDENT PERSONAL PROPERTY
ESTAT�OF: FILE NUMBER:
GERALD S • BRINTON 21 13 0542
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER VALUE AT DATE
DESCRIPTION OF DEATH
�. Asbury Community-refund from Bethany nursing home 2,44?• 47
2 Bankers Life-refund on long term care polic
Y 3,14?• 75
3 Bethany Village-cottage refund 73,353• 71
4 Cumberland County Veterans-check received 100 • 00
5 Donegal Insurance-premium refund 507.00
6 ML Bank Deposit Program 6,701•00
7 ML Bank Deposit Program 6,637.00
8 ML Cash Account ��78
9 ML Cash Acct 0 .33
10 PA Dept of Treasury-check received 2,162 •16
11 PNC Bank Savings Acct #5b13?30395 23,197•84
Princ• �23,197•84, Int $•88
12 PNC Bank Savings Acct #5113730395 - Accrued Int 0• 88
13 Public School Employees Ret System-check received 747•82
14 State Farm Insurance-apartment insurnace refund 63• 92
15 Susquehanna Valley FCU-Savings Acct 37,98� •87
16 Susquehanna Valley FCU-Share Certificate 11„993•23
TOTAL(Also enter on Line 5,Recapitulation) S 17�,9 4 5•12
If more space is needed,use additional sheets of paper of the same size.
-- — _ ,
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
GERALD S. BRINTON 21 13 0542
Decedent's Name Page 4 File Number
Schedule E-Cash, Bank Deposits, �Misc. Personai Property
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
17 ML Bank Deposit Program 1,903.00
18 ML �ash Account 0•36
SUBTOTAL SCHEDULE E 1,9 0 3•3 6
GRAND TOTAL SCHEDULE E s 170,945.12
REV-1509 EX+(01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GERALD S • BRINTON 21 13 0542
If an asset waa made jointly owned within one year of the decedenYs date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATtONSHIP TO DECEDENT
A. CAROL L • B. ALLAN 147 W• FIFTH STREET
Daughter
CORNING, NY 14830-
B.
c.
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTERESt DECEDENT'S INTEREST
�• A. 01/30/12 PNC Bank Checking Acct #5140007346 -?37• 43 50• -368 •72
joint w/Carol B. Allan dtd 1-30-12
Princ �-?37• 43, Int �•04
This account had a negative bal
at time of death
TOTAL(Also enter on Line 6,Recapitulation) S -3 6 8•7 2
If more spaoe is needed,use addi�onal sheets of paper of the same size.
REV-1511 EX+(10-OS)
pennsylvania SCHEDULE H
DEPARTMENTOFREVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT pECEDENT
ESTATE OF FILE NUMBER
GERALD S • BRINTON 21 13 0542
Decedent'�debta muat be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
�. Parthemore Funeral Home-funeral expenses 13,270.0?
Mt Olivet Cemetery-services rendered 1,250•00
Gingrich Memorials-services ?40.00
Addison Post-bulletins 8 flowers for funeral 655. 41
B• ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(sj of Personal Representative(s)
Street Address
�� State _ ZIP
Year(s)Commission Paid:
2, AttomeyFees: David H Stone, Esquire 15,000.0�
3, Family Exemption:(If deoedent's address is not the same as claimanCs,attach explanation.)
Claimant
Street Address
�� State _ ZIP
Relatlonship of Claimant to Decedent
4• ProbateFees: Register of Wills Cumberland County 588 •50
5 Accountant Fees:
6. tax Retum Preparer Fees:
�. Easy Moves-moving furniture out of apartment 380 • 34
2 Miscellaneous expense 350•00
3 Stone LaFaver & Shekletski-Reimb on advertising 307.02
4 PA State Retirement System-return of check 516•18
5 Anne Heefner-Reimb on storage costs 400•00
6 Filing Inheritance tax return and Inventory 30 •00
? Reserve for closing expenses 200.00
TOTAL(Also enter on Line 9,Recapitulation) S 3 3,6 8 7• 5 2
if mo�e space is needed,use addiiti�onal sheets of paper of the same size. .
REV-1512 EX+(12-12)
pennsyivania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES�LIENS
RESIDENT DECEDENT
ESTATE OF
FILE NUMBER
GERALD S . BRINTON 21 13 0542
R�port debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenaea.
ITEM
NUMBER DESCRIPTION VALUE AT DATE
OF DEATH
� Home Instead Nursing-private duty nurse serv
1,893• 40
2 Bethany Village-sklled nursing charges
3,411. 00
3 Community Life Team Inc-services rendered
1D7.80
TOTAL(Also enter on Line 10,Recapitulation) �
If more space is needed,insert additional sheets of the same size. 5,412•2 0
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE '
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
GERALD S • BRINTON 21 13 0542
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 out n'ght spousal distributions and transfers under
Sec.91�6(a)(1.2).]
�. CAROL L BRINTON NKA CAROL L B ALLAN Lineal 353,593• 98
147 W• FIFTH STREET
CORNING NY 14830-
2 BETSY B HEEFNER Lineal 353,593. 9?
72? 16TH STREET
NEW CUMBERLAND, PA 17070
ENTER DOUAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET,AS APPROPRIATE.
II.� NON-7AXA�LE 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. s
If more space is needed,use additional sheets of paper of the same size.
L1Vf/OFFICES
� Jov F. L.�F���it
3V THIRD STREET O
NEW CUMBERLr1ND,PENNSYLVANU 17070
LAST WILL AND TESTAMENT
OF
GERALD S. BRINTON
I, GERALD S. BRINTON� of New Cumberland, Cumberland
County, Pe�Bylvania. being of sound mind, memory and understand-
ing� do hereby make� publish and declare this as and for m La$
Will and Teatament hereby revoking and making void an y t
other wills by me at anq time heretofore made y and all
I.
I direct that my Executrix hereinafter named shall pay
all my just debts and funeral expenses as soon as convenientl
maY be done after my decease, y
`� I I.
.�
All the rest, residue and remainder of my estate� whether
,,:. real, personal or mixed, and wheresoever situate
, I hereby give,
� � deviae and bequeath unto my wife, MILpRED S, gRI
NTON, if she
,�' survives me by a period of thirty days. If my said wif
survive me b e e does not
� Y period of thirty days, then this gift to h
•° er shall
, e diveated, and I then give, devise and bequeath my entire esta
te
`�,�j' s follows:
,
A• One-half (1/2) unto my daughter, BETSY B. HEEFNER.
B• �e-half (1/2) unto my daughter, CAROL L. BRINTON.
III.
I hereby nominate, constitute and appoint my wife,
ILDRED S. BRINTON, as Executrix of this, my I,ast Will and Test -
ent. If the said Mildred S. Brinton should a
predecease me, or
therwise fails to qualify, or ceases to act as such� then I
ominate, constitute and appoint my two daughters, BETSY B,
EEFNER and CAROL L. BRINTON, as Coexecutrices. If either of m
Y
��w or►�eis
�N F.L�RAV[R Page one OL tj�0 PageS
�1 tN111C sr�ct�
�cuw���t�we,��.
said Coexecutrices should predecease me, or otherwis
qualif e fails to
Y. or ceasea to act as such, then the other Executrix s
act alone, hall
IV,
No fiduciary acting under this Will shall be re uir
to post bond in this 9 ed
jurisdiction or in any jurisdiction in which
. he may act,
IN WITNESS WHERI?OF� I, Gerald S. Brinton
have unto this, m , the Testator,
Y Last Will and Testament, aet my h�nd 8nd Se81
this � 9 '—" day of July, A. D. , 1977. �
�n = .� �:l�---�--_ ..._��� --
. ,,1 , _ cs�,�,,
SIGNED� SEALED� pUgLISHED and DECLARI;D b
Brinton, the above-named Testator, as and f y Ger81d S.
or his Last Will and
Testament in the presence of us, who have hereunt
names as witnesses at his request, in the re � $ubscribed our
Testator and of each other, p 8ence of the said
1 ��� ;- �^
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Mechanicsburg, PA 17055
— O:717.591.8072
- www.Bethan Vilta e.or
Harris, Ste �
. �.._ _
� _.__ . . .
Fron�: _
_ .
fanie(Asbury) �__ .
__ .
�__ _.. ._.... .. �
Sent: Tuesday,�0�o�r 22, 2013 9;29 AM
. .. _ _.. :�...__ .._ __._ �.
To: Merkel, Beth (BV)
Subject: RE: Can you please call....
Beth,
I show he paid $104,800 at settlement. If this i
s correct,,,he �,ould be due $73 353.71,
BRINTON Standard Entrance Fee
Multi 1 $ 104,800.00
Sub total 1.667%
Times Nurr�ber of Months $ �'747'02 11/18/11 -04/27/13
Total to be subtracted from 18
Entrance Fee
Totaf Refund Due $ 31,446.29
$ 73,353.71
Stefanie Harris
Senior Accountant-Treasury M mt.
g
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UR�
A�t icipate Mare
20030 Century Blvd.,Suite 300
Germantown,MD 20874 —
2 -
- May. 21. 2013 3;03PM ---
, PNC Bank
_— No, 5188 p, �/�
- , �#. �
_ �ay 21,2013
Dawid�Stone�sq.
Stane Lafa�e����l�t,ski,
414 Br�dg,�Sf
�'OBoxE
N'ew C��.1��pA 17070
1�: C`rerald S Brinton
��� lg1-32-5393
�D=�-20 2013
�'Mr. Stonc:
1'n respo��your r
records s�ho�v the follo��for 1'�ate of,17eath(Dp��b�anccs
�: fQr tbe cust�mer no�d a���� aur
Cbec���ccount
A�count#5140p07346
GBRALI�S BR,IN�ON Es'tabhshed_pi-30-2012
DOD bala,nce: �...737.43+p,p4 ��t�L B ALLAN
�tere�st pa�d p 1-01�2013 t,��20�crucd interest
T�S Ac�ou�t�ad s N�gati�ve 8�013 �0.39 'Y^�
.
ce at t�e t1me af death,
$''�$s Accou�nt
�a�nt#Sl 1373p3q5
�D balance: ���AY,1�S B�r�N E�blishod: 1 I-�6 2012
$23 197.84+0.88 acc�ued interest
��t paid U�-0�-2013 �U4-2
Q-'2p 13 $ 17.71 �
S$fe Depb�ft Bax
T`hc dc�td�t���S��� . �
pasit box#p730B
, CL��.A,r,l�S B�NTON
Located�t; CA�tp�,$1qY,��.
N�Cumberla�nd Branch
331 Bridge St _-
N'evv Cumberland, p,q 17070 =
f?17) 774-29$2
page 1 of 2 -
- _
�ay. �a. 7013 �:a3P� PNC - -
_ � Bank
No, 5288 p, 2/�
- Please note t��o�cc
Savings)- 'GV'e do not p�u aa S date oifdea�b�� �t
an�of these i Y 8nancfs�q� �for d�po.s accouzats(
of�Ce. �DS'pl��1-888-PIVC-$�ns or pt,�►r�ide st�temenb�CDs' (�ec,ic���d
�1 888 762-2�65)or sto �°�'����js�nce wvith
p b�'�'oux�oGaI PNC Ba�nk bra,�ch
Sincerel�,
N�4�Fina�aci�1 Ser�ces Cent
pN�Bank,N.A, e�r
M�m�r��rc
T�iY.s rnessage is iri�e�ded for the
contain r d use oftl,e rr��vrdual or erih'
'�rm�ron t�ar Ys prri,il'ege� con �'to wju'ch it zr
�t1�l�e�r p ft1�iS»r�xS�g�iS n pt .1�d'ential�exerr�pt or,s �`essed��
del�vering this me,�sage to ty� - the intended r�cipier�t or t� d�'sclosure ur��.aPPrrca�re r
d�str�b�ri'on or cp �n mterrded r�ci i�� employee or a$en�re aw
�' g n}`thi,s comm�� p '�'�a''e�erebY rzolifred t1� �P°°r�sible fo,r
��ri��catfon fn error,p1e�e notf �O�is slr�ctly proh�b#e� �Y dissemi�a� � ..
drQtely destr�oy th�'s 1S'me�m�sedtatel '�.)'ou have rec��Ved th�,r �
,f'axed doc�me� Y�y reply or by telephone at gOp-�� _
Z 1'�7'S�
Pa$e 2 of 2 -_
- �
us 3850 Hartzdale Dr.C�
QUEHA P H�,PA 1701 _
NNA 339 1 �g�
East Park Dr.Harrisburg,PA 17�,11-27_
A,L
F E o LEY . ���:��7_�3 _ -
ERAL CREp � �- 7415
U N I O N Toll Free:800-948-145
Fax:717-737-058
�u�y 18,2013
David H.Stone, Esquire
Stone LaFaver&Shekietski
414 Bridge Street
PO Box E
New Curr�berland, PA 17070
Re: Estate of Gerald S. Brinton
Dear Mr.Stone:
,
I apologize for the delay in getting this to you. The following is the in
regarding the Estate of Gerald 5. Brinton. formation that you requested
Mr. Brinton's accounts at SVFCU inciuded a savings account '
and a share certificate,with a date of death balance of$11,993.23.Tate of death balance of$37,ggp,87,
M�Y Z1,1970. The certificate was opened on May 4,2012. There he savings account was opened on
accounts, were no joint owners on these
Please let me know if you need a�y additional information.
Kind regards,
Kathy 10 cCabe
Member Services Supervisor
www, s vFC U
. org
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