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HomeMy WebLinkAbout12-12-14 (3) 1505610140 REV-1500 EX (02-11)(FI) 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 3 0 5 4 2 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 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 MI 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 RX 2. Supplemental Return 3. Remainder Return(Date of Death Prior to 12-13-82) El 4. Limited Estate F� 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required death after 12-12-82) ❑ 6. Decedent Died Testate F-I 7. Decedent Maintained a Living Trust 1 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 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule 0) CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number D A V I D H S T O N E E S Q U I R E 7 1 7 7 7 4 7 4 3 5 4 REGISTER OF WILLfFgSE ONLY. n --A :�a M First Line of Address ? C3 r-.1r 2 G31 `O C] Cn = 4 1 4 B R I D G E S T R E E T 7i y„ r- N M M Second Line of Address x Cn r 71 r1 f^V r. O C) a C;, .fl "r1 _z i City or Post Office State ZIP Code TSE FILED rV r- M N E W C U M B E R L A N D P A 1 7 0 7 0 y cn � rn Correspondent's e-mail address: D S T O N E a@ S T O N E L A W• N E T Under penalties 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 true,correct and complete.Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG NAT RE OF PERSON RESPONSIB E FOR FILING RETURN DATE (3Q Q . ►, L y ADDRESS 727 16TH STREET NEW CUMBERLAND PA 17070 SIGNATU R Q T4 REPRESENTATIVE DATE ADDR 414' B TR ET NEW CUMBELAND PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 1505610140 �� REV 1500 INHERITANCE TAX RETURN RESIDENT DECEDENT Estate of Gerald S. Brinton File No. 21-13-0642 Additional Signature and Address of Co-Executrix 0:4 Carol L. B. Allem 147 W. Fifth St., Corning,NY 14830 1505610240 REV-1500 EX(FI) Decedent's Social Security Number Decedent's Name: GERALD S - B R I N T O N RECAPITULATION 1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 2. Stocks and Bonds(Schedule B) 2. 4 2 8 1 4 . 5 4 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. 9 8 0 ' 0 0 6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested . . . . . . . 6. 7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property (Schedule G) ❑ Separate Billing Requested . . . . . . . 7. 8. Total Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . 8. 4 3 7 9 4 • 5 4 9. Funeral Expenses and Administrative Costs(Schedule H) . . . . . . . . . . . . . . . . . . 9. 1 3 0 • 0 0 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule 1) . . . . . . . . . . . . . 10. 11. Total Deductions(total Lines 9 and 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 1 3 0 • 0 0 12. Net Value of Estate(Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12. 4 3 6 6 4 . 5 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. 4 3 6 6 4 . 5 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 • 0 4 5 4 3 6 6 4 . 5 4 16. 1 9 6 4 . 9 0 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 9 6 4 . 9 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑ Side 2 1505610240 1505610240 REV-1500 EX(FI) Page 3 File Number Decedent's Complete Address: 21 13 0542 DECEDENT'S NAME GERALD S • BRINTON STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: I• Tax Due(Page 2,Line 19) (1) 11964 - 90 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0 . 00 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) 1,964 -90 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 ...................................................................... ❑ X❑ b. retain the right to designate who shall use the property transferred or its income ............................... ❑ c. retain a reversionary interest ..................................................................................................... El0 d. receive the promise for life of either payments,benefits or care? ....................................................... ❑ 0 2. If death occurred after December 12,1982,did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... El 0 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death? ......... ❑ Q 4. Did decedent own an individual retirement account,annuity or other non-probate property,which contains a beneficiary designation?.................................................................................................. ❑ 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 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 p2 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-1503 EX+(8-12) pennsylvania SCHEDULE B DEPARTMENT OF REVENUE INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER GERALD S . BRINTON 21 13 0542 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 • 7 US Savings bonds in the decedent ' s name and 421814 . 54 Mildred S . Brinton who died 12-10-04 (See attached list) TOTAL(Also enter on Line 2,Recapitulation) $ 42,814 - 54 If more space is needed, insert additional sheets 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: 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 . IRS-refund on decedent ' s 2013 income tax return 980 . 00 *Note : The Susquehanna Valley FCU accounts mentioned on the safe deposit box inventory were already accounted for on the original Inheritance tax return and will not be listed on the supple- mental return . TOTAL(Also enter on Line 5,Recapitulation) $ 980 - 00 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 GERALD S . BRINTON 21 13 0542 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 • B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s)of Personal Representative(s) Street Address City State ZIP Year(s)Commission Paid: 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: 5. Accountant Fees: 6 • Tax Return Preparer Fees: 7 • Register of Wills-filing Supplemental Ret & Inv 30 . 00 2 Reserve for closing expenses 100 . 00 TOTAL(Also enter on Line 9,Recapitulation) $ 130 - 00 If more space is needed,use additional sheets of paper 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: 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 [Include outright spousal distributions and transfers under Sec.9116(a)(1.2).] 1 • CAROL L BRINTON NKA CAROL L B ALLAN Lineal 21,832 . 27 147 W • FIFTH STREET CORNING NY 14830 2 • BETSY B HEEFNER Lineal 21,832 . 27 727 16TH STREET NEW CUMBERLAND PA 17070 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 II-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. s, S L.Aw OFFICES .Tax F. LAFAVE11 O 317 THIRD STREET NEW CUMBERLAND,PENNSYLVANIA 17070 LAST WILL AND TESTAMENT OF GERALD S. BRINTON I, GERALD S. BRINTON, of New Cumberland, Cumberland County, Pennsylvania, being of sound mind, memory and understand- ing, do hereby make, publish and declare this as and for my Last Will and Testament hereby revoking and making void any and all other wills by me at any time heretofore made. I. I direct that my Executrix hereinafter named shall pay all my just debts and funeral expenses as soon as conveniently may be done after my decease. II. All the rest, residue and remainder of my estate, whether ` real, personal or mixed, and wheresoever situate, I hereby give, devise and bequeath unto my wife, MILDRED S. BRINTON, if she survives me by a period of thirty days. If my said wife does not survive me by a period of thirty days, then this gift to her shall e divested, and I then give, devise and bequeath my entire estate s follows: 1 A. One-half (1/2) unto my daughter, BETSY B. HEEFNER. B. One-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 Last Will and Testa- ent. If the said Mildred S. Brinton should 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 my LAW offices Page one of two Pages ON R. LAFAVBR 17 x1Aa atsssT Y CUM119111.A016,PA. said Coexecutrices should predecease me, or otherwise fails to qualify, or ceases to act as such, then the other Executrix shall act alone. IV. No fiduciary acting under this Will shall be required to post bond in this jurisdiction or in any jurisdiction in which he may act. IN WITNESS WHEREOF, I, Gerald S. Brinton, the Testator, have unto this, my Last Will and Testament, set my hand and seal this 4 94 day of July, A. D. , 1977. (SEAL) SIGNED, SEALED, PUBLISHED and DECLARED by Gerald S. Brinton, the above-named Testator, as and for his Last Will and Testament in the presence of us, who have hereunto subscribed our names as witnesses at his request, in the presence of the said Testator and of each other. w or ncu -. LAFAVER -D srex.T Page two Of two Pages wa � A�n.rA, 1 STONE LAFAVER & SHEKLETSKI ATTORNEYS AT LAW 414 BRIDGE STREET DAVID H. STONE POST OFFICE BOX E OF COUNSEL GERALD J.SHEKLETSKI NEw CUMBERLAND.PA 17070 CHARLES H. STONE www.stonelaw.net JON F.LAFAVER TELEPHONE(717)774-7435 FACSIMILE (717).774-3869 July 9, 2014 Pennsylvania Department of Revenue Harrisburg District Office Lobby, Strawberry Square Harrisburg, PA 17128-0101 Re: Estate of Gerald S. Brinton Date of Death: April 20, 2013 Social Security No. : Estate No: 21-13-0542 Greetings: Please find enclosed an original Safe Deposit Box Inventory for Box No. 730B. Thank you for your attention in this matter. Should you have any questions, please feel free to contact me . Very truly yours, STONE LaFA �R SHEKLETSKI ton Esquire DHS/jam Enclosures cc : Betsy B. Heefner, Co-Executrix Carol L. B. Allan, Co-Executrix Jackie Seitz, PNC Bank A REV-485 EX(05-04) 48500041046 SAFE DEPOSIT BOX INVENTORY PA Department of Revenue PLEASE USE ORIGINAL FORM ONLY Social Security or Death Certificate Number Date'of Death County Code Year File Number _.. 04/20/2013 21 13 0542 Decedent's Last Name Suffix First Name MI Brinton Gerald S ©ADDRESS OF DECEDENT STREET: - CITY: STATE: ZIP CODE: 325 Wesley Drive Mechanicsburg PA 17055 NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX NAME' David H. Stone, Esguire STREETADDRESS: -- CITY: STATE: ZIP CODE: 414 Bridge Street New Cumberland PA 17070 NAME,ADDRESS AND RELATIONSHIP(IF ANY)TO DECEDENT,OF PERSON(S)PRESENT AT THE BOX OPENING a. NAME: RELATIONSHIP: Betsy B. Heefner daughter/Co-Executrix STREETADDRESS: CITY: STATE: ZIP CODE: 72716th Street New Cumberland PA 17070 b. NAME: RELATIONSHIP: Carol L.B.Allan daughter/CD-Executrix STREETADDRESS: CITY: STATE: ZIP CODE: 147 W. Fifth Street Corning NY 14830 c. NAME: RELATIONSHIP: STREETADDRESS: CITY: STATE: ZIP CODE NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME: _ PNC Bank STREETADDRESS: CITY: STATE: ZIP CODE: 331 Bridge Street New Cumberland PA 17070 NAME OF PERSON MAKING LAST ENTRY DATE AND TIME OF LAST ENTRY Gerald S. Brinton 10/11!11 0:00 am DATE OF CONTRACT TO RENT BOX • NUMBER OF BOX 1 TITLE UNDER WHICH BOX IS REQUESTED 08/13/1992 7308 Gerald S. Brinton NAME AND ADDRESS OF PERSONS)HAVING ACCESS TO BOX a. NAME: b. NAME: Gerald S. Brinton STREETADDRESS: STREETADDRESS: 325 Wesley Drive CITY: STATE: ZIP CODE: CITY: STATE: ZIP CODE: Mechanicsbur PA 17055 NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY Jackie Seitz WAS A WILL IN THE BOX? ❑ YES ® NO If yes, a. Date of will: b. Name and address of personal representative,if named in the will NAME: STREETADDRESS: CITY: STATE: ZIP CODE: c. Name and address of attorney,if any NAME: STREET ADDRESS: CITY: STATE: ZIP CODE: 48500041046 48500041046 J i REV-485 EX SAFE DEPOSIT BOX INVENTORY Page of INSTRUCTIONS (1) Cash:Report total only. (2) Stocks:List in detail every common or preferred certificate,warrant or other rights found in box.Stocks are to be designated by name of company,certificate number,date of certificate,name in which stock is registered,and number of shares and class of stock. (3) Obligations of U.S.Government:Number of items,date of issue,face value,names in which registered and type of ownership, i.e.,jointly held,payable on death,etc. (4) Bonds:Designate by name,amount,serial number,or other designation.(Bearer Bonds) (5) Bank and Savings and Loan Passbooks:State name of depositor,number of book,last date appearing in book,name of bank and branch,and balance. (6) Jewelry,Coins,Stamps,Manuscripts,etc:List and describe as fully as possible. (7) Deeds,Mortgages,Current Insurance Policies or other evidences of Indebtedness:List and describe as fully as possible. (8) All other contents. (9) Return completed form to: DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT.280601 HARRISBURG,PA 17128-0601 ITEM ITEM DESCRIPTION NO. 1 Paperwork for(4)CD's with Susquehanna Valley Federal Credit Union,Certificate#7718,6656,6615,and 8073 2 EE Savings Bonds: -$50,dated 11-1994,C198582608EE -$5000,dated 7-1992,V2347839EE -$5000,dated 7-1992,V2347834EE -$5000,dated 7-1992,V2347837EE -$5000,dated 7-1992,V23117838EE -$5000,dated 7-1992,V2347835EE -$5000,dated 7-1992,V2347836EE *Shown on ITR and will be shown on supplemental ITR. I CERTIFY UN P ALTY OF ERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORK ND CO TE TV I HE BEST OF MY KNOWLEDGE AND BELIEF. SAFE DEPOSIT BOX INVENTORY: URE SIGNATURE P 4TNAME PRINT NAME AND CHECK APPROPRIATE BOX BELOW: Davl . Stone, Es it PRINT TITLE DATE CHECK APPROPRIATE BOX: Attorney for Estate ❑Executor(trix) [—]Administrator(trix) - Estate Representative tJ Joint owner of safe deposit box NOTE:Attach additional 8112"x 11"sheet(s) if necessary or use duplicates of this page of form. The Department is authorized by law,42 U.S.C.§405(c)(2)(C)(i),to require disclosure of Social Security numbers in connection with administering state tax laws.The Department uses the Social Security number to identify the decedent and personal representatives of the estate.The Commonwealth may also use the information in exchange of tax information agreements with Federal and local taxing authorities.The state law prohibits the Commonwealth's personnel from disclosing confidential tax information except for official u oses. Calculated Value of Your Paper Savings Bond(s) Page 1 of 1 Calculated Value of Your Paper Savings Bond(s) Calculator Results for Redemption Date 04/2013 Total Price Total Value Total Interest YTD Interest $15,025.00 $42,814.54 $27,789.54 $840.00 Bonds: 1-7 of 7 Serial # Series Denom Issue Next Final Issue Price Interest Interest Value Note Date Accrual Maturity Rate V2347839EE EE $5,000;07/1992:07/2013;_07/2022; $2,500.00: $4,618.00: 4.00%. $7,118.00: V2347838EE EE i$5,000:07/1992:07 2013 07/2022: $2,500.00; $4,618.00i 4.00% $7,118.00: V2347837EE; .EE '$5,000 07/1992107/2013. 07/2022 $2,500.00: $4,618.00' 4.00%. $7,118.00' V2347836EEE ; 0 079207/2013; 07/202 $2,500.00 $4,674. 00% $7,118.00 ;_, .V2347835EE EE $5,000.07%199207/2013' 07/2022 $2,500.00 $4,618.004.00% $7,118.00 V2347834EE; EE $5,000.07/1992:07/2013 07/2022; $2,500.00. $4,618.00 4.00%. $7,118.00: L"198582668,* . EE $50:11/198405/2013. 11/2014' $25.00 $81.54 4.00% $106.54: _ Totals for 7 Bonds 15 025.00 $27,789.5C $42,814.54 Notes NI Not Issued NE Not eligible for payment P5 Includes 3 month interest penalty 'A Matured and not earninginterest http://www.treasurydirect.gov/BC/SBCPrice 10/10/2014