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Home My WebLink About06-11-14 • REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Mary Jeannette Brown STREET ADDRESS Elmcroft of Shippensburg 129 Walnut Bottom Road CITY STATE ZIP Shippensburg PA 17257 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) (1) 2,632.40 2. Credits/Payments A.Prior Payments 0.00 B.Discount 131.62 Total Credits(A+B) (2) 131.6.2_ 3. Interest (3) 0.00 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) 2,500.78 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 ❑ U b. retain the right to designate who shall use the property transferred or its income ❑ U c. retain a reversionary interest ❑ ■ d. receive the promise for life of either payments,benefits or care? ❑ I� 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ❑ I� 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ❑ I� 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation? ❑ U 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.§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 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)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[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. ,$ mom.' 1505610205 REV-1500 EX(FI) 4 Oecedent's Social Security Number • Decedent's Name: Mary Jeannette Brown 203-10-7310 RECAPITULATION 1. Real Estate(Schedule A). 1. 0.00 2. Stocks and Bonds(Schedule B) 2. 1 0.00 3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C) 3. 0.00 4. Mortgages and Notes Receivable(Schedule D) 4. 0.00 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E) 5. 73,874.04 6. Jointly Owned Property(Schedule F) CD Separate Billing Requested 6. 0.00 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) C) Separate Billing Requested 7. 0.00 8. Total Gross Assets(total Lines 1 through 7) 8. j 73,874.04 9. Funeral Expenses:and Administrative Costs(Schedule H) 9. 14,204.11 10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule I) 10. 1,172.23 11. Total Deductions(total Lines 9 and 10) 11. 15,376.34 12. Net Value of Estate(Line 8 minus Line 11) 12. 58,497.70 • 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) 13. 0.00 14. Net Value Subject to Tax(Line 12 minus Line 13) 14. 58,497.70 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec.9116 (01.2)X.0_ 0.00 15. 0.00 at lineal rate X.0 45 58,497.70 16. 2,632.40 17. Amount of Line 14 taxable ; at sibling rate X.12 0.00 17. 0.00 18. Amount of Line 14 taxable ; at collateral rate X.15 0.00 18. 0.00 19. TAX DUE 19. 2,632.40 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ft=i Side 2 1505610205 1505610205 1=J • REV-1508 EX+(08-12) lk) pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Mary Jeannette Brown 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Orrstown Bank Checking Account No.500976 40,168.15 2. Amalgamated Life Insurance Company 502.01 3, Orrstown Bank CD Account No.4000016616 2,203.88 4, Orrstown Bank CD Account No.5030057709 7,500.00 5, Orrstown Bank CD Account No.5030057710 7,500.00 6. Orrstown Bank CD Account No.4000036171 10,000.00 7. Orrstown Bank CD Account No.300047489 6,000.00 4 • TOTAL(Also enter on Line 5, Recapitulation) $ 73,874.04 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (08-13) • Pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary Jeannette Brown Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Fogelsanger-Bricker Funeral Home 10,434.78 2. Cumberland Valley Memorial Gardens 1,926.00 3. Walnut Bottom Diner for Memorial Luncheon 206.58 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 1,250.00 2. Attorney Fees: 3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation.) Claimant • • Street Address City State ZIP Relationship of Claimant to Decedent 4. Probate Fees: 223.50 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Cumberland Law Journal to publish estate 75.00 8. News Chronicle to publish estate 88.25 • TOTAL(Also enter on Line 9, Recapitulation) $ 14,204.11 If more space is needed,use additional sheets of paper of the same size. • REV-1512 EX+(12-12) iiv pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• U.S.Department of Veterans Affairs for File No.15103216 1,130.00 2. Care First Pharmacy 22.23 3. Elmcroft of Shippensburg for haircut 20.00 • • TOTAL(Also enter on Line 10, Recapitulation) $ 1,172.23 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) Jpennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Mary Jeannette Brown 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. John Franklin Brown Lineal-Son 50% 2. Tina K.Brown Lineal-Granddaughter 25% 3. David L.Fridinger' Lineal-Grandson 25% ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 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. TOTAL OF PART U—ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ If more space is needed,use additional sheets of paper of the same size. LAST WILL AND TESTAMENT I, MARY JEANNETTE BROWN, a resident of the Borough of Shippensburg, County of Cumberland and Commonwealth of Pennsyl- vania, being of sound mind and memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills by me heretofore made. FIRST: I hereby direct my Executor, hereinafter named, to pay all my just debts and funeral expenses as may conveniently be done after my decease. SECOND: I give, devise and bequeath all my estate, be it real, personal or mixed, to my husband, Clair Franklin Brown, for his own proper use and behoof forever. In the event my husband, Clair Franklin Brown, should predecease me or we should perish in a common disaster, then I give, devise and bequeath my entire estate, be it real, personal or mixed, to my two sons, John Franklin Brown and Terry Lee Brown, equally, share and share alike, or their heirs. THIRD: I hereby nominate, constitute and appoint my husband, Clair Franklin Brown, to be the Executor of this my Las. Will and Testament. In the event my husband, Clair Franklin Brown, should be unable to serve as Executor for any reason whatsoever, then I name, constitute and appoint my son, John Franklin Brown, to be the substitute Executor. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on one sheet of paper, dated +h this —2-G.---- day of June, 1974. 0 1 kt, .• • I m=ft. 4.-1,—.(SEAL) This instrument was by the Testatrix, Mary Jeannette Brown, on the date hereof, signed, published and declared by her to be her Last Will and Testament, in our presence, who at her request and in her presence and in the presence of each other, we believing MCCREA& MCCREA her to be of sound and disposing mind and memory, have hereunto subscribed our names as witnesses. ATTORIICTS AT LAW NEWVIllr SIIIPPLIISUUAG PENNA. e