HomeMy WebLinkAbout09-21-15 J pennsytvania 1505614105
DEPARTM' OF REVENUE EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
Bureau of Individual Taxes INHERITANCE TAX RETURN County Code Year File Number
PO BOX 280601
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
01032015 105121933
Decedent's Last Name _ Suffix Decedent's First NameMI
_
Brown Patricia
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
En/a
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
CD 1. Original Return p 2.Supplemental Return O 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of O 5. Future Interest Compromise(date of C=) 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
CW 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
O 10. Litigation Proceeds Received O 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets O 14.Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name _ Daytime Telephone Number
Adam R. Deluca, Esquire (717) 249-1177
First Line of Address _
61 West LOuther Street
Second Line of Address
F_
City or Post Office _ State ZIP Code
Carlisle PA� E 17013
Correspondent's email address: adeluca@alliedattorneySllc.com c') n 7 t�r1
CD
G C7
REGISTILER OFJWILLS UBE-ONLY— 1
REGISTER OF WILLS USE ONLY J -O t
, p
r- rrn
DATE FI D STAMP
C) `�
PLEASE USE ORIGINAL FORM ONLY
Side 1
111111 IIIII IIIII IIIII IIIII III IIIII IIIII IIIII IIIII IIII IIII
1505 14105 1505614105
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: PATRICIA E. BROWN (
RECAPITULATION
_� -- --�
1. Real Estate(Schedule A). ...... .. .. ........... ... .. ... . . .. .. . .. .. .. .. 1.
2. Stocks and Bonds(Schedule B) .... .. ........ .. .. .. ..... .. .. .. .. ... .. . 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) .. 3.
4. Mortgages and Notes Receivable(Schedule D) .. ... .. ... .. ....... .. .. .... 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). ...... 5. 11,354.34 f
6. Jointly Owned Property(Schedule F) O Separate Billing Requested .. ... .. 6. ` 16,114.09
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. .. .... 7. 130,287.41
8. Total Gross Assets(total Lines 1 through 7). .. .... ... .... ... .... .. .... .. 8. 157,755.84
i
9. Funeral Expenses and Administrative Costs(Schedule H). .... .... .. .. ..... . 9. 4,793.61
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1).. ........ .... .. 10. 20,279.17
11. Total Deductions(total Lines 9 and 10)........ ... .. .... .. .... ...... .. . . 11. 25,072.78
1
12. Net Value of Estate(Line 8 minus Line 11) ....... ... .. .. .. ... .. .. .... . .. . 12. 132,683.06
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. 132,683.06
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_
1 15. 1
16. Amount of Line 14 taxable
at lineal rate X.0 45 132,683.06 16.1 5,970.74
17. Amount of Line 14 taxable -
at sibling rate X.12 17.
18. Amount of Line 14 taxable
at collateral rate X.15 18.
E
19. TAX DUE .... .... ... .. .. .. ......... ........ .... .. ...... ...... . . ... 19.
5,970.74
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNATURE OF P RSON RESPONSIBLE FOR F ING RETURN DATE
ADDRESS
6 Morrison Way, Carlisle, PA 1 015
SIG R �P����TPERSON RESPONSIBLE FOR FILING THE RETURN DAT//E
`C-7
ADDRESS
61 West Louther Street, Carlisle, PA 17013
111111111111111111111111111111111111111 Side 2
1505614205 1505614205
REV-1500 EX (FI) Page 3 File Number l l /q 1 )0/
Decedent's Complete Address:
DECEDENT'S NAME
Patricia E. Brown
STREETADDRESS
6 Morrison Way
CITY STATE 717015
Carlisle PA
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 5,970.74
2. Credits/Payments
A.Prior Payments 4,000.00
B.Discount 210.52
(See instructions.) Total Credits(A+B) (2) 4,210.52
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)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,760.22
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.......................................................................................... ❑ N
b. retain the right to designate who shall use the property transferred or its income ............................................ ❑ 0
c. retain a reversionary interest .............................................................................................................................. ❑ E
d. receive the promise for life of either payments,benefits or care?...................................................................... ❑ N
2. If death occurred after Dec. 12, 1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ 0
3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑
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 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 step-parent of the child is 0 percent[72 P.S.§9116(a)(1.2)].
• The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent,except as noted in[72 P.S.§9116(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-1508 EX+(02-15)
pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
PATRICIA E. BROWN 21-15-0129
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- 2003 Chevrolet Venture:50,000 miles,fair condition 3,400.00
2. Refund from Church of God Nursing Home 7,954.34
TOTAL(Also enter on Line 5, Recapitulation) $ 11,354.34,
If more space is needed,use additional sheets of paper of the same size.
REV-1509 EX+(02-15)
pennsylvania SCHEDULE F
DEPARTMENT REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAXAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
PATRICIA E. BROWN 21-15-0129
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S)NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A.Susan E. Leidy 6 Morrison Way, Carlisle, PA 17015 daughter
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 DECEDENTS VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 07/18/07 Members 1st FCU:Savings Account#310040 1,247.28 50 623.64
2. A. 07/18/07 Members 1st FCU:Checking Account#310040 30,980.90 50 15,490.45
TOTAL(Also enter on Line 6, Recapitulation) $ 16,114.09
If more space is needed,use additional sheets of paper of the same size.
REV-1510 EX+(02-15)
pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PATRICIA E. BROWN 21-15-0129
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF DECD'S EXCLUSION TAXABLE
INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP 1n DECEDENT AND
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. Orrstown IRA Acct#7100002629:Transferee:Susan E.Leidy(daughter)6 42,908.42 100 42,908.42
Morrison Way,Carlisle,PA 17015(transfer May 16,2015)
1. Orrstown IRA Acct#7100002629:Transferee:Debra A.Olson(daughter)485
Lancaster Ave.,Enola,PA 17025(transfer May 16,2015)
1 Orrstown IRA Acct#7100002629:Transferee:David F.Brown(son)118
Hope Drive,Boiling Springs,PA 17007(transfer May 16,2015)
1 Orrstown IRA Acct#7100002629:Transferee:Michael E.Brown(son)38
Fawn Ave., New Oxford,PA 17350(transfer May 16,2015)
2 Orrstown Transfer on Death Acct#4N2935118:Transferee:Susan E. Leidy 87,378.99 100 87,378.99
(daughter)6 Morrison Way,Carlisle,PA 17015(transfer May 18,2015)
2 Orrstown Transfer on Death Acct#4N2935118:Debra A.Olson(daughter)
485 Lancaster Ave., Enola,PA 17025(transfer May 18,2015)
2 Orrstown Transfer on Death Acct#4N2935118:Transferee:David F.Brown
(son)118 Hope Drive,Boiling Springs,PA 17007(transfer May 18,2015)
2 Orrstown Transfer on Death Acct#4N2935118:Transferee: Michael E.Brown
(son)38 Fawn Ave.,New Oxford,PA 17350(transfer May 18,2015)
*The above values reflect the entire account value as of date of death. Each
was subsequently split four ways to the above listed transferees.
TOTAL(Also enter on Line 7, Recapitulation) $ 130,287.41
If more space is needed,use additional sheets of paper of the same size.
REV-1511 EX+ (02-15)
ITY pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PATRICIA E. BROWN 21-15-0129
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Holy Trinity Lutheran Church(funeral luncheon) 169.85
2. Eby Granite Works(headstone) 130.00
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: 4,000.00
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: 175.50
5. Accountant Fees: 75.00
6. Tax Return Preparer Fees:
7, Members I st FCU(fee for estate checks) 2.00
B. Estate Advertisement(Patriot News) 166.26
9. Estate Advertisement(Cumberland Law Journal) 75.00
Z,-
TOTAL(Also enter on Line 9, Recapitulation) $ 4,79161
If more space is needed,use additional sheets of paper of the same size.
REV-1512 EX+(02-15)
pennsylvania SCHEDULE I
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
PATRICIA E. BROWN 21-15-0129
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. Camp Hill Emergency Physicians 45.51
2. Guardian Long Term Care plan premium 168.14
3. Brockie Pharmatech 243.35
4. Goodwill Fire and Rescue EMS 342.50
5. Pulmonary and Critical Care Medicine Associates 173.15
6. PA Department of Revenue(income tax) 175.00
7. United States Treasury(income tax) 241.00
8. Church of God Home(2 months and 1 week room and board) 18,890.52
TOTAL(Also enter on Line 10, Recapitulation) $ 20,279.17
If more space is needed,insert additional sheets of the same size.
REV-1513 EX+(02-15)
pennsylvania SCHEDULE
DEPARTMENT OF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
PATRICIA E. BROWN 21-15-0129
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).]
I. Susan E.Leidy:6 Morrison Way,Carlisle,PA 17015 daughter 1/4+Schedule F
2. Debra A.Olson:485 Lancaster Ave.,Enola,PA 17025 daughter 1/4
3. David F.Brown: 118 Hope Drive,Boiling Springs, PA 17007 son 1/4
4. Michael E.Brown:38 Fawn Ave.,New Oxford,PA 17350 son 1/4
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:
i.
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.
LAST WILL AND TESTAMENT OF
PATRICIA E. BROWN
I,PATRICIA E. BROWN, of Cumberland County, Pennsylvania, declare this to
be my Last Will and Testament and hereby revoke all prior Wills and Codicils.
1. I direct that all my just debts, ftineral expenses, and administrative
expenses shall be paid from my estate as soon as practicable after my death. It is my
wish that upon my death my body shall be buried beside my beloved husband at
Sunnyside Cemetery, York Springs,Pennsylvania 17372,
2. 1 direct that all of my real property and personal property that 1 own at the
time of my death shall be given, devised, and bequeathed in accordance with the
following:
a) All items at my residence that are labeled with my children's names
shall be distributed according to the named designation.
0
b) All jewelry that I own at the time of my death shall be given to my
daughters, Susan E. Leidy and Debra A. Olson, in equal shares, per capita, and they may
distribute items at their discretion, except for the diamond stud earrings set in gold,which
shall be given to my son,David F. Brown.
31. The rest, residue, and remainder of my estate shall be given to my
daughter, and Susan E. Leidy,my daughter,Debra A. Olson, my son,David F. Brown,
my son Michael E. Brown, in equal shares,per capita.
4. 1 appoint my daughter, Susan E. Leidy, as Executrix of this my Last Will
and Testament. In the event that Susan is deceased,unable or unwilling to serve or shall
cease to serve for any reason whatsoever,then I nominate, constitute and appoint my son,
David F. Brown, as alternate Executor of this my Last Will and Testament.
5. The Executrix of this Will shall have the power to distribute my estate in
cash or in kind, or partly in either.
6. 1 direct that no Executrix acting under this Will shall be required to enter
bond in any jurisdiction.
7. . I recommend that my Personal Representative retain the law firm of Allied
Attorneys of Central Pennsylvania, L.L.C.,to probate my estate.
IN WITNESS WHEREOF, I have hereunto set my hand thisday
Of , 2012.
PATRICIA E. BROWN
Page 1 of 4
The preceding instrument consisting of this and three other pages was on the day and date
hereof signed, published and declared by PATRICIA E. BROWN, as and for her Last
Will and Testament in the presence of us, who at her request, in her presence and in the
presence of each other have subscribed our names as witnesses hereto.
Witness tAess
QU
Page 2 of 4
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS
COUNTY OF CUMBERLAND
1, PATRICIA E.BROWN,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 Will and Testament;that
I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein
expressed.
PATRICIA E. BROWN
COMMONWEALTH OF PENNSYLVANIA
S.S.
COUNTY OF CUMBERLAND
171-
On this day of AU 2012,before me personally
appeared PATRICIA E. BROWN, known tY me(or satisfactorily proven)to be the
person whose name is subscribed to the within instrument, and she acknowledged that
she was the declarant who executed the same for the purposes therein contained.
IN WITNESS VyrfIEREOF I hereto set my hand and official seal.
Ao-tar'/tun-ic-
L R. Tel
C C
count E�fjyCo,r,jrjjissi�on Eu�P
Page 3 of 4
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
: SS
COUNTY OF CUMBERLAND
WE, Aly-y, P • WO CCA, and Spa un 0, �ay)e
the witnesses whose names are attached to the foregoing document, being duly qualifie
according to law, do depose and say that we were present and saw testatrix sign and
execute the instrument as her Last Will; that she signed willingly and that she 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 Last Will and Testament as
witnesses and that to the best of our knowledge the testatrix was at the time 18 or more
years of age, of sound mind and under no constraint or undue influence.
Sworn or affirmed and subscribed before me by
^ �uea- and Nl this
tom^
day of_ ' 2012.
Notary Pu omey
NOT, HEAL
STEPHANIE S CHEM!<,!'Motor/Public
Carlisle Qoro, Cumberland County
My Commission Expires March 24,2015
Page 4 of 4