HomeMy WebLinkAbout01-0118
Estate of Leona H. Drosey
also known as
PETITION FOR PROBATE and GRANT OF LETTERS
O1I-DI- 111
No.
To:
Register of Wills for the
, Deceased. County of ~1Jmhpr1 r:lnn in the
Social Security No. 196 09 9797 Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who isl}lye;1 8 years of age or older an the execut r ix
in the last will of the above d'eceClent, dated November ? R
and codicil(s) dated
named
"I1fl--2ililO
(statc relevant circumstances, e.g. renunciation, death of executor, etc.)
Decendent was domiciled at death in Cumber land
h p r l~st family or princil?al residence at 24 Oa k ~,r ~~ .
~\(V'o.y do ~ V"\.. \0 ~"''S '-". \' \H!"
(list street, number and muncipality)
County, Pennsylvania, with
Camp Hill. PA
Decendent, then ~~, years of~ge, died .ranuary 21 Iw 2001 ,
at---2.4 Or:lk ~tJ ......,.t) Crlmp H111, P.ll.
Except as follows, decedent did not marry, was not <;livorced and did not have a child born or adopted
after execution of the will offered for probate; was not the victim of a killing and was never adjudicated
incompetent:
Decendent at death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property
(If not domiciled in Pa.) Personal property in Pennsylvania
(If not domiciled in Pa.) Personal property in County
Value of real estate in Pennsylvania
situated as follmvs:
$152,<137.86
$
$
$
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters tcotamontary
I (testamentary; administration c.r.a.; administration d.b.n.c.r.a.)
theron.
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____Terri L. Barr
24 Oak GLrl::l::L ~\)~II-o.~e
- ~r1mp Hi 11. P.ll. 17011
rillL.,d{~~
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--
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEAL TH OF PENNSYL V ANIAi ,~
r :::;:::;
COU NTY OF CUMBERLAND _ J
I~- t2olo - 4
The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirmed and subscribed ~ ~,t. Y3tl..A.A.-/ Vl
before me this ? 5TH day of I e..r r; /..... B Cl-r'- ~.
I::l
....
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f-J'0",}<:nc; ~FV (l!~r:,
This is to certify that the information here given is correctly copied from an original certificate of death dltly filed with me as
Local ~egistrar. The original certificate will be forwarded to the State Vital Records Office for permanent tiling.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
p
7120948
No.
..f~. !r!-JO/, 'W
Local Registrar
1)11--_U~ d~ daD I
Date
NAME OF DECEDENTjF;sr M.ddIe~- -..-.----
COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
STATE I'lL( NlIM8f:R
SOCIAl SECURITY HUMBER
H1051ilJRev 2.'87
TYPElPAIHT
IN
PERMANENT
BLACK INK
.. Leona M. Br05ey
AGE (lil$t Binhoay) UNDER 1 YEAR
- "-
3 196 - 09
21, 2001
89
v..
PlACE 0# DEATH ICI>edr. or>l.,. 0fIe -- ..... ,nSlfl.l(;loOflS l)f'l 0It-eI '.iOdII1
HOSPITAl:
__0
7. ...
FACtuTY NAME (M not onsNUlIon, OllIE' sIl'eet i1nd f1IJmtl8f1
=:.,,0
MARITAl SWUS. Man..
,..,., WM'iecI. WidcMoecI.
--
". Widowed
~ ~en
-
......
Ctlll1ht=!rland -' 11..0 :..."=".:::..
MOTHER'S NAME iF... WtdaIe. Malden Sulname)
11. Theresa Gegg
INFORMANT'S WAIliNG ADDRESStstreet. c:.,tTown. sa... Zip Codet
_~4 Oak Avenue, Camp Hill, PA 17011
Pl.ACE OF D1SPOS1T1OH. N.M otCemetery. CtemMOf'y
........."'-
S.
COUNTY OF OERH
cumber land
DECEOENT'S uSUAl OCCUPRION
(~::=:_:io~:::zt:),
"~ ~ 1~
DECEDENT'S MAILING ADDAESS ($I,.... CilyfbNn, sa.. ZlpCodltl
24 Oak Avenue
camp Hill, PA 17011
...
.....
RACE . Amencan 1nIMn. 8IKk. WMe, _.
'_I
1.. White
SURvMNG SI'OUSE
II .... QlW ~ IWnej
....
coo,_
Rolling Green Cemetery
NAME AND ADDRESS OF F.\CUJTV
....8 Market Plaza Wa
UCENSE HUMBER
OFDERH
... M
27. MItT I: Ent............. in;uriesOfcomplicallOfla-*'ichCIIllHdlhedeath Donat.nt"'lhe
l.. ontw 0IWt l;aUM on ..eII...
?mau~ .
DUE lO~ASACONSEOUENCE Of)'
I:
DUE 10 (OR AS A CONSEQUENCE Of}:
DUE 10 (OR AS A CONSEQUENCE Of)
WERE AUlOPSY FINDINGS
JIitAtlA8lE PRIOR TO
COMPlETlOH 01F CAUSE
"""""""
MANNER OF DEATH
DATE OF INJURV
(Mane.. Day. "arl
~
o
o
PA
PA 17055
2311. 23c.
VMS CASE REFERRED TO:O EXAMlNERlCORONER1 No~
...
l~.
:~~
! 4Th'"
PART..
0IIw stgniftcanl condiIionI t:OfIIJIJuIing 10 duIh. buI
1101""'" in_~cauM gMn inPNn' I
f'~~ti> IktI~
._~.
TIME OF INJURV
IN.AJRV R WORK?
DESCRIBE HOw fHJUAY OCCURRED.
Ace.....
Pendlng .rwesti9il11On
o
o
o PlACE OF INJURV..... home.larm. .....lacIOfy. oIfIc:e U.
building. IIIC. ISpecllv)
_.
lOCATK)H CS--. c.tyIJo.n, Sial"
....w..
Hom_
...0
No ~
Suoadoo
Coutd no! btI delermlned
.... 2".
CERTIFIER IChecll ani., one)
.CERTIFYING PHYSICIAN (PhySOCIMl certltrtng cause oJ deadl when dllOlhtll Ph~Sl(;.an hilS plonovllCe(J dea.lh ano completed Ilem 231
To"", taMI o. my knowtedV-. ..Ih occWNd due to !he cauM(a) and nWllm., a. atatH. . . .
:to.
~
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'PRONOuNCING AND CERTifYING PHVSICIAN tPhyliOl:WIl lJoIt: j)I;)OOutll;'09 lJedth andcertalylflg 10 cao.,se 01 dedlfll
To the ~ of "'y knowledge. ".lIth occUfrN III the....., dilllI. i1nd p.acll. IInd due to !he uuu(.) and mannar a. atatH..
"MEDICAL EXAMINER/CORONER
On Ihe tNeis of e..-minallon end/or inv..,iga,ion. in mv opinion, death occu,.,ed at ItMr lime. dale. and place. and du.lo the ellu"(.) and
manner...te1ed......... ... ..................... ........... ... ..................... . ...... ....... ... ... .....
".
[-<'1 I 1..21 / I~ I
.... 0 NoD
1..
lICENSE NUMBER
o 3'. -<t'P'P.d'''7Pi/''- 31.. /, -.z,.Z 0/
NAME AND AOORE5:S 'Y PERSON WHO COMP~(D CAU 01F DEATH
l.emmT_..p"m,#C~ .Je>~-'f1?
o 32:_~'Otf~j'~~g/. _
DAle flLEaJ(fvIQ1l1h Da~ ....., .
>t. J
11111<(1 f). 3 o1eo
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I
No. 21 - 01 - 118
Estate of
LEONA M BROSEY
, Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW JANUAR Y 29, xj9 2001 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated NOVEMBER (8, 2000
described therein be admitted to probate and filed of record as the last will of
LEONA M BROSEY
TESTAMENTARY,
TERRI L BARR
and Letters
are hereby granted to
1ifooCO ~ mA-l~tM-&
Register of wills ' 7J (7
MARY CLEWIS
FEES
Probate, Letters, Etc. .... . . . . .
Short Certificates(5 ) . . . . . . . . . .
Renunciation ................
X-Pages
JCP
$ 235.00
$
$
$ 18.00
S.OO
TOTAL - $ 273.00
. . . . . . ~.~~V~.R.X . ?~.,. . ?9P.1. . . . . . . . . .
11:) 00
John D Ki 11 i an, S1.lpI"liilIDliil COllrt ID
ATTORNEY (Sup. Ct. I.D. No.) #7080
218 Pine St., P.O. Box 886
ADDRESS
Filed
Harrisburg, PA 17108
PHONE
(717)232-1851
,.--, ...-
,- ..
'-
Mailed letters to attorney on 1-29-01
~
LAST WILL AND TESTAMENT
OF
LEONA M. BROSEY
I, LEONA M. BROSEY, declare this to be my Last will and
Testament and hereby revoke all prior wills and codicils made by
me.
FIRST: My Executor shall pay from the residue of my estate
all my debts, funeral and administration expenses, and all estate,
inheritance, succession and transfer taxes imposed by the United
States or any state, territory or possession, which shall become
payable by reason of my death. It shall not be necessary to file
any claims therefor, nor to have them allowed by any court.
SECOND: I give and bequeath the sum of Ten Thousand
($10,000.00) Dollars to THE GOOD SHEPHERD CATHOLIC CHURCH, 3435
Trindle Road, Camp Hill, Pennsylvania, to be used in the
discretion of its official governing board.
THIRD: I give and bequeath the sum of Five Thousand
($5,000.00) Dollars and all my family pictures to my niece, DONNA
HENRY, if she survives me.
FOURTH: I give and bequeath the sum of Ten Thousand
($10,000.00) Dollars to my caretaker, LORI BECK, if she survives
~
LAST WILL AND TESTAMENT
OF
LEONA M. BROSEY
me.
FIFTH: I give and bequeath the sum of Five Thousand
($5,000.00) Dollars to my friend, CAROL AUGUSTINE, if she survives
me.
SIXTH: I give and bequeath the sum of Ten Thousand
($10,000.00) Dollars to my caretaker, TERRI L. BARR, if she
survives me.
SEVENTH: I give and bequeath the sum of Two Thousand Five
Hundred ($2,500.00) Dollars to my nephew, DONALD LOWNSBERY, if he
survives me.
EIGHTH: I give and bequeath the sum of Two Thousand Five
Hundred ($2,500.00) Dollars to my nephew, DARYL LOWNSBERY, if he
survives me.
NINTH: I give and bequeath the sum of Five Thousand
($5,000.00) Dollars to my friend, MARGARET AUGUSTINE, if she
survives me.
TENTH: I give and bequeath the sum of Five Thousand
($5,000.00) Dollars to my great-nephew, BARRY CUNNINGHAM, if he
survives me.
2
~
LAST WILL AND TESTAMENT
OF
LEONA M. BROSEY
ELEVENTH: I give and bequeath the sum of Five Thousand
($5,000.00) Dollars to my friend, ELIZABETH AUGUSTINE, if she
survives me.
TWELFTH: I give such of my tangible personal property as is
set forth in a separate, dated and unsigned letter of instruction,
which I shall place with my Will, to the persons therein
designated. If I have not left a letter of instruction or for
those articles of property not distributed under this letter of
instruction, I direct that such items be sold and the net proceeds
therefrom added to the residue of my estate.
THIRTEENTH: I give and bequeath the residue of my estate in
equal shares to the following beneficiaries, if they survive me:
A. My caretaker, LORI BECK;
B. My caretaker, TERRI L. BARR;
C. My great-nephew, BARRY CUNNINGHAM.
FOURTEENTH: I nominate, constitute and appoint TERRI L. BARR
Executrix of this my Last will and Testament, to serve without
bond or security, and to make distribution of my estate in cash or
3
~
LAST WILL AND TESTAMENT
OF
LEONA M. BROSEY
in kind, or partly in cash and partly in kind, and in such manner
as she may determine. I authorize, empower and direct her to sell
and convey, by good and sufficient deed, in fee simple estate, any
and all of my real estate, at public or private sale, for such
price or prices, upon such terms and conditions, as in her
judgment is best for my estate, and to that end to sign, seal,
execute, acknowledge and deliver all deeds or other instruments
necessary therefor, as effectively as I could do if I were
personally present.
In the event such person does not survive me, or refuses to
act as Executrix or does not complete the duties of Executrix,
then I nominate, constitute and appoint JOHN D. KILLIAN, ESQUIRE,
as the alternate Executor, to serve without bond or security. My
alternate Executor shall have all of the powers, privileges,
duties and immunities granted to my Executor as provided herein.
FIFTEENTH: I have made bequests to the girls who were our
nurses and caretakers in appreciation of their taking such
wonderful care of Paul and myself so that we could remain in our
own home and avoid having to go to a nursing home.
IN WITNESS WHEREOF, I, LEONA M. BROSEY, the Testatrix, have
4
"
LAST WILL AND TESTAMENT
OF
LEONA M. BROSEY
to this my Last will and Testament, set my hand and seal this
'14L day of November, 2000.
vrJ
~~
LEONA M. BROSEY
Signed, sealed, published and declared by the above named
Testatrix, as and for her Last will and Testament, in the presence
of us, who have hereunto subscribed our names at her request, as
witnesses hereto, in the presence of the said Testatrix, and of
each other. The preceding document consists of this and four (4)
other consecutively numbered typewritten pages.
~
f-k~-A~^rjSiding
residing
at~~(J
at ----'e~~
5
"
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS. :
COUNTY OF DAUPHIN
I, LEONA M. BROSEY, the Testatrix whose name is signed to the
attached or foregoing instrument, having been duly qualified
according to law, do hereby acknowledge that I signed and executed
the instrument as my Last Willi and that I signed it willingly and
as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and~knowledged before me by LEONA M.
BROSEY, the Testatrix, this:L1>~day of November, 2000.
J~r
Testatrix
o~) d. ~t
Notary Public
or
Attorney-at-Law
;)
(SEAL)
Notarial Seal
PatrIcIa L EIImenn, NoI@ry Public
My ~t=~
CommlssIOn 1'88 Nov. 8, 2003
I'
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS. :
COUNTY OF DAUPHIN
We, C-hrisf; Ill!!. R HDI(o."~0r and ~\~a, Wo'a.\It.r,
the witnesses whose names are signed to the at ached or foregolng
instrument, being duly qualified according to law, do depose and
say that we were present and saw the Testatrix sign and execute
the instrument as her Last Will; that the Testatrix signed
willingly and executed it as her free and voluntary act for the
purposes therein expressed; that each subscribing witness in the
hearing and sight of the Testatrix signed the Will as a witness;
and that to the best of our knowledge the Testatrix was at that
time 18 or more years of age, of sound mind and under no
constraint or undue influence.
c- Sworn kO or affirmed and subsc~~d tp be~
hr~~+-; ^){f . th>11(~cl~ and ~,~,,4
witnesses, this 2.1> day of November, 20 .
~A~~ I<. ~~W
Wltness
O~d~
Notary Public
or
Attorney-at-Law
(SEAL)
Notarial Seal
~amenn. ~ Public
MyConvnlaatcii =n~2003
~
ORPHANS' COURT RULE 6.12
REGISTER OF WILLS OF CUMBERLAND COUNTY
No. 00118 of2001
STATUS REPORT
Name of Decedent LEONA M. BROSEY
Social Security Number 196-09-9797 Date of Death 01/21/01
Name of Personal Representative(s): TERRI L. BARR, Executrix
Is the administration of the estate complete? Yes lNo_
If "yes", how was the administration ended ? (check one)
By court accounting
By account stated to parties in interest
Did the parties release the personal representative?
Other (explain)
A-
Yes
Total amount paid to date to creditors and for
funeral and administrative expenses
$ 35.455.77
Total value of distribution to date to beneficiaries
$119.152.14
If administration is not complete, estimated value
of assets still in administration
$-
I certify under penalty of perjury that the foregoing information is correct to the best
of my knowledge, information and belief.
/"
I
Date:
10\~\O\
.
ESTATE INFORMATION: 1
FILE NUMBER
21'-2001-0118 SSN 196-09-9797
NAME OF DECEDENT (LAST) (FIRST) (MI)
BROSEY LEONA i"1
DATE OF PAYMENT
3/29/2001
POSTMARK DATE
0/00/0000
COUNTY
CUMBERLAND
DATE OF DEATH "
1/el/2001
--- FOLD HERE
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
I
KILLIAN JOHN D
218 PINE STREET
HARRISBUHG. FA
17101
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
'*
No.AA 478214 REV-1162 EX (11-96)
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101
1&17,385.00
FOLD HERE --
$i7,885.00
TOTAL AMOUNT PAID
AC
/'/ ..,....
RECEIVED BY .. ....I//~/ c.~/.. ' J,tl....._,)//-;.~~;!./
MAny C. LEW'~ .. /( / / . /
HEGlSTER Of? WILLS;,.)?)/l-(~/,i/
i
/
REMARKS JOHN D KILLIAN ESQuI~E
CHECK*' 111
SEAL
-_._--.----.~---- -- -,---- ------ ---- -- ------ -.'-.- --- -'------"-----'-
"
REGISTER OF WILLS
,.
REV-1162 EX111-961
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 2B060 1
HARRISBURG, PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 000009
RECEIVED FROM:
KILLIAN & GEPHART
218 PINE STREET
HARRISBURG, PA 17101
__nn__ fold ---_.----- --------
101 I $259.00
ESTATE INFORMATION: SSN: 196-09-9797 I
FILE NUMBER: 21 - 2001 - 011 8 I
DECEDENT NAME: BROSEY LEONA M I
DATE OF PAYMENT: 07/03/2001 I
POSTMARK DATE: 00/00/0000 I
COUNTY: CUMBERLAND I
DATE OF DEATH: 01/21/2001 I
I
TOTAL AMOUNT PAID: $259.00
REMARKS: TERRI BARR
C/O KILLIAN & GEPHART
CHECK# 128
INITIALS: VZ
SEAL RECEIVED BY: MARY C. LEWIS
REGISTER OF WILLS
REX;ISTER OF WILLS
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
\, /b-c;2LJ{,-~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISE"ENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESS"ENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
C_O~NTY
ACN
08-27-2001
BROSEY
01-21-2001
21 01-0118
CUMBERLAND
101
JOHN D KILLIAN
KILLIAN 8 GEPHART
218 PINE STREET
HBG PA 17108
AIIount Rellitted
'*
REV-1547 EX AFP 112-00>
LEONA
M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REY=is'4j-EX-AFP--fi'2:olir-NOYiCE--OF-YNHEififiNCE-YAX-APPRAisEiiENT~--Ai'[owiNCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BROSEY LEONA M FILE NO. 21 01-0118 ACN 101 DATE 08-27-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Stock/Partnership Interest (Schedule C)
4. "ortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/"isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
( ) CHANGED
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
154,089.00
.00
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/A~. Costs~isc. Expenses (Schedule H)
10. Debts~rtgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Govern.ental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
re~lect ~igures that include the total o~ ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Allount of Line 14 at Spousal rate (15)
16. Allount of Line 14 taxable at Lineal/Class A rate (16)
17. Allount of Line 14 at Sibling rate (17)
18. Allount of Line 14 taxable at Collateral/Class B rate (18)
19. Principal Tax Due
TAX CREDITS:
PAY"ENT
DATE
03-29-2001
07-03-2001
NOTE:
RECEIPT
NUtlBER
AA478214
CD000009
DISCOUNT (+)
INTEREST/PEN PAID (-)
915.00
.00
PAYMENT MUST BE MADE BY 10-21-2001~.
19,422.00
846.00
(11)
(12)
(13)
(14)
(9)
(10)
.00 X
.00 X
.00 X
123,820.00 X
00 =
045 =
12 =
15 =
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax payment.
154,089.00
20.?68 00
133,820.00
10,000.00
123,820.00
(19)=
.00
.00
.00
18,573.00
18,573.00
A"OUNT PAID
17,385.00
259.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN..
TOTAL DUE
18,559.00
14.00
.00
14.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO.PAY"ENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A ..CREDIT'. (CR), YOU "AY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FO~ FOR INSTRUCTIONS.)
\, /6 - c2CJ6- Y
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
RECORD ADJUSTMENT
..
- ,
ReCOf
He;- -
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
'02 FEB 25 m 1 :58
JOHN D KILLIAN
KILLIAN I GEPHART
PO BOX 886 G:erh
HBG ~nt1~D8
02-07-2002
BROSEY
01-21-2001
21 01-0118
CUMBERLAND
101
A.ount R_i tted
*'
lEV-iS'S EX IFP 112-101
LEONA
M
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, sub.it the upper portion of this for. with your tax pay.ant.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
RE-,;=is93-ix--AFP--fi'2-:ooy-----..-iNHEiYfANCi-=rifi-ii:-COiD-Ai..~fUs=ri.-iN=r-..-----------------------------
ESTATE OF BROSEY
LEONA
M FILE NO. 21 01-0118
ACN 101
n.......... . I"'J AItOUNT PAID
DATE NUttBER INTEREST/PEN PAID (-)
03-29-2001 AA478214 915.00 17,385.00
07-03-2001 CDoooo09 .00 259.00
EREST IS CHARGED THROUGH 02-22-2002 TOTAL TAX CREDIT 18.559.00
THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 14.00
ERSE SIDE OF THIS FORM INTEREST AND PEN. .37
TOTAL DUE 14.37
ADJUST"ENT BASED ON:
VALUE OF ESTATE:
PROTEST BOARD DECISION
1. Real Estate (Schedule A)
2. Stocks end Bonds (Schedule B)
3. Closely Held Stock/Partnership Interast (Schedule C)
4. ~rtg&ges/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/"isc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Ad.inistrative Costs/
"iscellaneous Expanses (Schedule H)
Debts/"ortgage Liabilities/Liens (Schedule I)
Total Deductions
Net Value of Tax Return
Charitable/Governeental Bequests; Non-elected 9113 Trusts
Net Value of Estate Subject to Tax
10.
11.
12.
13.
14.
TAX:
15. ABOunt of Line 14 at Spousel rate
16. ABOUnt of Line 14 taxable at Lineal/Class A rate
17. Amount of Line 14 at Sibling rate
18. A.ount of Line 14 taxable at Collateral/Class B rate
19. Principal Tax Due
TAX CREDITS:
INT
AT
REV
(1)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
154,089.00
.00
.00
(8)
DATE
02-07-2002
(9)
llO)
19,422.00
846.00
(11)
ll2)
(13)
ll4)
154,089.00
20,268.00
133,820.00
10,000.00
123.820.00
.00
.00
.00
18.573.00
18.573.00
· IF PAID AFTER DATE INDICATED, SEE REVERSE (IF TOTAL DUE IS LESS THAN $1, NO PAY"ENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A ""CREDIT"" (CR), YOU MY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FO~ FOR INSTRUCTIONS.)
(Schedule J)
ll5)
ll6)
ll7)
ll8)
.00Xoo =
.oox 045=
.oox 12 =
123.82o.oox 15 =
ll9)
BOARD OF APPEALS
DEPT. 281021
HARRISBURG. PA 17128-1021
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
" .
PHONE: 717-783-3664
FAX: 717-787-7270
JOHN D KILLIAN ESQ
KILLIAN & GEPHART LLP
PO BOX 886
HARRISBURG PA 17108-0886
IN RE ESTATE OF:
LEONA M BROSEY
DOCKET NO.: 0120155
TAX TYPE: INHERITANCE
APPEAL TYPE PROTEST
FILE NUMBER: 2101-0118
ACN: 101
APPRAISEMENT: 08-27 -01
PETITION FILED: 09-06-01
EXAMINER: LISA GARLAND DIAZ
MAILING DATE:
~N 23 am
DECISION AND ORDER
The Departmental appraisement and assessment of August 27,2001 reflected
an early payment discount in the amount of $915.00. Petitioner argues the Department
should have allowed an early payment discount of $928.65.
Section 2142 of the I nheritance and Estate Tax Act of 1991 specifically limits the
discount to "the extent that the inheritance tax is paid" within the three month discount
period. In this estate, the Board concurs with Petitioner that the maximum allowable
discount was $928.65 or 5% of the $18,573.00 inheritance tax obligation. Such a
discount could have been earned by the payment of $17,644.35 ($18,573.00 minus
$928.65) within the discount period. However, as only $17,385.00 was paid within three
months of decedent's death, the estate is only entitled to a discount of $915.00.
Page 1 of 2
-;.. , .~
. .
ESTATE OF LEONA M BROSEY
BOARD DOCKET NO. 0120155
Page 2 of 2
Accordingly, it is hereby, Ordered that the protest is denied.
The August 27,2001 appraisement and assessment shall stand.
FOR THE BOARD OF APPEALS
~~:e. ~
Joseph R. Sleek, Board Member
A STATEMENT OF ACCOUNT WILL BE MAILED TO YOU BY THE BUREAU OF
INDIVIDUAL TAXES.
ANY APPEAL FROM THIS DECISION MUST BE FILED WITH THE ORPHANS'
cou.\f.)li;W}THUXJ~.iIXTY (60) DAYS OF RECEIPT OF THIS DECISION.
IF YOU REQUIRE THIS INFORMATION IN AN ALTERNATE FORMAT UNDER THE
PROVISIONS OF AMERICANS WITH DISABILITIES ACT OF 1990, PLEASE CALL
(717) 783-3664, OR FOR SERVICES FOR TAXPAYERS WITH SPECIAL HEARING
AND SPEAKING NEEDS: 1-800-447-3020 (TT ONLY)
.:;...~
,.
s
~
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Leona M Brosey
Date of Death: January 21, 2001
Will No.: 2001 - 00118
Admin. No.:
To the Register:
I certify that Notice of Beneficial Interest required by Rule 5 .6( a) of the Orphans' Court Rules
was served on or mailed to the following beneficiaries of the above-captioned estate on February
22,2001 :
Name:
Address:
Good Shepherd Catholic Church
3435 Trindle Road
Camp Hill, PA 17011
Elizabeth Augustine
13 Oak Avenue
Camp Hill, PA 17011
Margaret Bow ley
2503 North Second Street
Harrisburg, PAl 711 0
Carol Kehoe
1344 Aspen Drive
Boiling Springs, P A 17007
Donald L. Lownsbery
1313 Central Monor Road
Washington Boro, PAl 7482
Darryl R. Lownsbery
3647 River Road ,~.
Conestoga, PA 17516
Donna M. Henry
109 Carol Drive !-
Washington Boro, PA 175-82
.
Barry K. Cunningham
Lori N. Beck
Terri L. Barr
34489 Alberta Terrace
Fremont, CA 94555
1550 Williams Grove Road Lot 100
Mechanicsburg, PA 17055
24 Oak Avenue
Camp Hill, PA 17011
ow been given to all persons entitled thereto under Rule 5.6(a) except.
(
Date:
-v1'"V7/( 0 )
r
Name: John D. Killian
Address: Killian & Gephart
218 Pine Street
Harrisburg, PA 17108
Telephone: (717)232-1851
Capacity: _ Personal Representative
X Counsel for Personal
Representative
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"
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
KILLIAN JOHN 0
218 PINE STREET
HARRISBURG, PA 17101
____u__ fold
ESTATE INFORMATION: SSN: 196-09-9797
FILE NUMBER: 2101-0118
DECEDENT NAME: BROSEY LEONA M
DATE OF PAYMENT: 02/27/2002
POSTMARK DATE: 02/26/2002
COUNTY: CUMBERLAND
DATE OF DEATH: 01/21/2001
REMARKS: JOHN 0 KILLIAN ESQUIRE
CHECK# 242
SEAL
ACN
ASSESSMENT
CONTROL
NUMBER
101
TOTAL AMOUNT PAID:
INITIALS: AC
RECEIVED BY:
REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 000898
MARY C. LEWIS
REGISTER OF WILLS
AMOUNT
$14.37
$14.37
\, -b -~L~6"-'V
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REV-liD7 EX AFP Ill-Un
JOHN D KILLIAN
KILLIAN & GEPHART
PO BOX 886
HBG
'02
APt{ -1
ilDATE
ESTATE OF
DATE OF DEATH
!J. 1'"1 .~~LE NUMBER
I i L .t:bUNTY
ACN
03-25-2002
BROSEY
01-21-2001
21 01-0118
CUMBERLAND
101
Amount Rellitted
LEONA
M
HOc
GiS:
PA 17108 Gwnb
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subllit the upper portion of this forn with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV=i6"ifj-iif-AFP--foY:02y-----...--fNifE'RITANcE--TAX--STATEME-NT-O-F'-Accouiff--...---------------------
ESTATE OF BROSEY LEONA M FILE NO. 21 01-0118 ACN 101 DATE 03-25-2002
THIS STATE"ENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NA"ED ESTATE. SHOWN BELOW
IS A S~ARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAY"ENTS, THE CURRENT BALANCE, AND. IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-06-2002
P R I NC I PAL TAX DU E : ....._........................._......._.........................................................................._..........................................................._......................................
18,573.00
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
03-29-2001 AA478214 915.00 17,385.00
07-03-2001 CDOOOO09 .00 259.00
02-26-2002 CDOO0898 .37- 14.37
TOTAL TAX CREDIT 18.573.00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .01
IF PAID AFTER THIS DATE. SEE REVERSE TOTAL DUE .01
If
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1.
NO PAY"ENT IS REQUIRED.
,
IF TOTAL DUE IS REFLECTED AS A "CREDIT"" (CRJ.
YOU "AY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS. J
C--
REV-1500 EX + (6-00) OFFICIAL USE QNL Y
COMMONWEALTH OF PENNSYLVANIA REV-1500 I .;2 C0,- I~
DEPARTMENT OF REVENUE V -
DEPT. 280601 INHERITANCE TAX RETURN FILE NUMBER
HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 2001-00118
COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
Brosey
Leona M 196-09-9797
DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE
DENT
01/21/2001 07/24/1911 WITH THE REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
- -
3. Remainder Return
CHECK ~ 1. Original Return ~ 2. Supplemental Return B (date of death prior to 12-13-82)
APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required
~ateofdeathafter12-12'82)
PRIATE 6. Decedent Died Testate 7. ecedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) ~Attach a copy of Trust}
BLOCK S 9. Litigation Proceeds Received 10. pausal Poverty Credit (date of death between D 11. Election to tax under Sec. 9113(A)
12-31-91 and H-95) (Attach Sch O}
tHi$)~jQNMU$tilgC_Wljl!Q;~'WCQtji'!ij~~ij$CQNfib$\ttitMtN!ii~fQi'!M4jIQN:$8QUUll;jilbjI!lroij~!tdt
NAME COMPLETE MAILING ADDRESS
COR- John D. Killian, Esquire 218 pine Street
RE- FIRM NAME (If Applicable) Harrisburg, PA 17108
SPON
DENT Killian & Gephart
TELEPHONE NUMBER
717-232-1851
OFFICIAL USE ONLY
1. Real Estate (Schedule A) (1) 0
2. Stocks and Bonds (Schedule B) (2) 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 0
4. Mortgages & Notes Receivable (Schedule D) (4) 0
5. Cash, Bank Deposits & Miscellaneous Personal
Property (Schedule E) (5) 154,089
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested (6) 0
RECA-
PITULA- 7. Inter-Vivos Transfers & Miscellaneous
TION Non-Probate Property (Schedule G or L) (7) 0
8. Total Gross Assets (total Lines 1-7) (8) 154,089
9. Funeral Expenses & Administrative Costs (Schedule H) (9) 19,422
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule l) (10) 846
11. Total Deductions (total Lines 9 & 10) (11) 20,268
12. Net Value of Estate (Line B minus Line 11) (12) 133,820
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) 10,000
has not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 123,820
SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES
15. Amount 01 Line 14 taxable at the spousal tax
rate, or trans1ers under Sec. 9116 (a)(1.2) 0 X .0 00 (15) 0
16. Amount of Line 14 taxable at lineal rate 0 X .0 0.045 (16) 0
TAX -
COMPU- 17. Amount of Line 14 taxable at sibling rate 0 X .12 (17) 0
TATION 18. Amount of Line 14 taxable at collateral rate 123,820 X .15 (18) 18,573
19. Tax Due (19) 18,573
20. ~ IHCKHj;ji'!j;j'fYQljA,*R~mjj;jG4iWjjNQPf~QveRl!AlIM~1
.. ...(.....................>~..'*..$Ql1,l;;mQl\Nl$W~!'J.A@qQ~$'t!@i!$PN.RA!l~2li1\lPR~CBl!QKMATH~i(.............
o PA 15001
NTF 29755
Copyright 2000 GreatlandlNelco LP - Forms Software Only
PA REV-1500 EX (6-00)
Page 2
Decedent's Complete Address:
STREET ADDRESS
24 Oak Avenue
Cumberland
CITY I STATE I ZIP
Camp Hill PA 17011-
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
18,573
o
17,385
929
Total Creoits (A + 8 + C)
(2)
18,314
3. Interest/Penalty if applicable
D. Interest
E. Penalty
o
o
4.
TotallnteresVPenalty (D + E)
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on pa.ge 1 Line 20 to request a refund
If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
Make Check Payable to: REGISTER OF WillS, AGENT
(4)
(5)
(SA)
(56)
(3)
o
5.
o
259
o
259
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.-..,......,-,..-,-...-,....',....,......._,-..._,_...-................-.....-,-.'...................
.......pCEASE.ANSWERfHE..FOCCoWiNC...OUESfi6NSBy...pLAcfNG.AN'."::X::'.'fNfHE'.'APPROPRiATE."BCOCKS'" .
1.
Did decedent make a transfer and:
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; or. . . . . . . . . . . . , . . . . . . . . , . . . . . , , . . . . . . . . . . . . . . ,
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? .........,........, ....."................,
Did decedent own an "in trust for. or payable upon death bank account or security at his or her death?
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.
Under penalties of periUlY, 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 information of
which preparer has any knowledae.
SIGNATURE 0 PERSON RESPO 16LE FOR FILING RETURN DA E
. 7~
3.
4.
Yes No
~ I
B ~
o
~
j;
Camp
PRESENTATIVE
7011
Harrisburg, PA 17101
[72P.S. Ii 9116(a)(1.1){i)].
For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to or for the use of the sUlViving spouse is 0% [72 P.S. !l 9116 (a) (1.1) (ii)].
The statute does not AXAmnt a transfer to a sUlViving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if
the sUlViving 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 twenty-one 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% [72 P.S. li9116(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%, except as noted in 72.P.S. !l 9116(1_2) [72 P.S. %9116(a)(1)].
The tax rate imposed on the net value of transfers to orforthe use of the decedent's siblings is 12% [72 P.S. !l9116(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.
o PA15002
NTF 29756
Copyright 2000 GreatlandfNelco LP - Forms Software Only
REV-1508 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Leona M. Brosey
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
US Treasury
FI LE NUMBER
2001-00118
All prop. jointly-owned with right of survivorship must be disclosed on Sch. F.
VALUE AT
DATE OF DEATH
2,300
Include proceeds of litigation & date proceeds were received by the estate.
ITEM
NO.
1.
DESCRIPTION
Federal Income Tax Refund
Waypoint Bank
151,789
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
154,089
9 PA15081 NTF10875
Copyright 1999 GreatlandfNelco LP Forms Software Only
~
REV-1511EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Leona M. Brosey
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
2001-00118
Debts of decedent must be reported on Schedule I.
ITEM
NO.
A.
1.
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Malpezzi Funeral Home
3,590
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) Terri L. Barr
Social Security Number(s)/EIN No. of Personal Representative(s)
Street Address 24 Oak Avenue
City Camp Hill State PA Zip
10,000
Year(s) Commission Paid: 200\
2.
3.
Attorney Fees
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
5,000
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
273
5. Accountant's Fees
6.
Tax Return Preparer's Fees
147
7.
Cumberland Law Journal
K&G Administrative Expenses
Kathryn Fetrow, Treasurer
Patriot News
75
24
219
94
9 PA15111 NTF10878
Copyright 1999 Grealland/Nelco LP. Forms Software Only
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
19,422
REV-1512 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Leona M. Brosey
Include unreimbursed medical expenses.
ITEM
NO.
1. Central Medical Equipment
Frances Perna, MD
Hampden Township
Herbert Solles, MD
Holy Spirit Hospital
Pennsylvania Department of
Revenue
PA G.1. Consultants, PC
Quantum Imaging
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
FILE NUMBER
2001-00118
DESCRIPTION
AMOUNT
152
47
108
44
159
242
88
7
9 PA 15121
NTF 10874
TOTAL (Also enter on line 10, Recapitulation)
(If more space is needed, insert additional sheets of the same size)
$
846
Copyngnt 1999 GreallandlNe\co LP - Forms Software Only
REV-1513 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
Leona M. Brosey
No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1. Elizabeth Augustine
13 Oak Avenue, Camp Hill, PA
17011
Terri L. Barr
24 Oak Avenue, Camp Hill, PA
17011
Lori N. Beck
1550 Williams Grove Road Lot
100, Mechanicsburg, PA 17055
Margaret Augustine Bowley
2503 North Second Street,
Harrisburg, PA 17110
FI LE NUMBER
2001-00118
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
None
None
None
None
AMOUNT OR
SHARE OF ESTATE
5,000
10,000
1/3 of Residue
10,000
1/3 of Residue
5,000
Total from continuation pages 20,000
ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS,
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1 1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 1. Good Shepherd Catholic Church
2
10,000
9 PA1S131
NTF 10880
TOTAL OF PART II.. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV lS00 COVER SHEET $
10,000
(If more space is needed, insert additional sheets of the same size)
Copyrigllt 1999 GreatlandlNe\co LP - Forms Software Only
Estate of: Leona M. Brosey
Item
No. Description
Barry K. Cunningham
34489 Alberta Terrace,
Fremont, PA 94555
Donna Henry
109 Carol Drive, Washington
Boro, PA 17582
Carol Augustine Kehoe
1344 Aspen Drive, Boiling
Springs, PA 17007
Daryl R. Lownsbery
3647 River Road, Conestoga,
PA 17516
Donald L. Lownsbery
1313 Central Monor Road,
Washington Boro, PA 17582
Schedule J part 1 (Page 2)
Relation
Amount
Nephew
5,000
1/3 of Residue
Niece
5,000
None
5,000
Nephew
2,500
Nephew
2,500
Total (Carry forward to main schedule)
o