HomeMy WebLinkAbout01-0450
\'''EV-1500EXjoS-OO)
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
BRlJDERER PHYLLIS H.
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD- YEAR)
02-20-2001 10- 4-2
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
[X11. Original Return
o 4. Limited Estate
o 6. Decedent Died Testate (AtlachcopyofWiIl)
o 9. Utigatkll'l Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after i2-12-82)
07. Decedent Maintained a Living Trust (AlIachcopyofTrusl)
o 10. Spousal Poverty Credit (date ofdealh between 12-31--91 and 1-1-95)
OFFICIAL USE ONLY
c
d ;;/9- I
I tJ-
FILE NUMBER
O?L-.Q~
COUNTY CODE YEAR
__.:t.G..a
NUMBER
SOCIAL SECURITY NUMBER
004 22
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum ltla\eo1liea\11priofto12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sdl 0)
Gre 0 R. Reed Es
FIRM NAME (If ~ic<Wle)
re
COMPLETE MAILING ADDRESS
NAME
TELEPHONE NUMBER
(717) 238-0434
(1)
(2)
(3)
(4)
(5)
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole.Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank. Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total lines 1.7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage liabilities, & liens (Schedule I) ,
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Une B mInus Une 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for whieh an election to tax has not been
made (Schedule J)
2423 N. Third Street
Harrisburg, PA 17110
x.O_ (15)
45 (16)
x.O_
,
,:. .12 (17)
x.15 (16)
(19)
19. Tax Due
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
OFFICIAL USE ONLY
(B)
82,272.34
(6)
82.272.34
(11)
(12)
(13)
750.00
81,522.34
(7)
(9)
(10)
750.00
(14)
81,522.34
14. Net Value Subject to Tax (line 12 minus line 13)
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SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Une 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
3,668.51
3,668.51
16. Amount of Une 14 tax~ble at lineal rate
81,522.34
17. Amount of Line 14 taxable at sibllr1g rate
18. Amount of Line 14 taxable at collateral rate
20.~
ueceaent's Gomptete Aadress:
STREET ADDRESS
CITY
STATE
Mechanicsburg
PA
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Creditslpayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
3,500.00
.1I~.UU
TolaICredits(A+B+C) (2)
3,675.00
3. InlerestJl'enalty W applicable
D. Interest
E. Penalty
TotallnterestJl'enalty ( D + E ) (3)
4. If Une 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund (4)
ZIP 17055
3.668.51
6.49
5. If Une 1 + Une 3 is greater than Une 2. enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
(5)
(SA)
B. Enter the total of Une 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
.r, _~_ ~ _ ,," _ .' ~ "- "" _'. r. _ _ ' _ ~~. ~ ~" _ y _ " ~
. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN .X. IN THE APPROPRIATE BLOCKS
1. Did decedent make a lnlnsfer and: Yes
a. .retain the use or income of the property transfenred:.......................................................................................... 0
b. retain the right to designate who shall use the property transferred or its income; ............................................ 0
c. .retain a reversionary interest; or.......................................................................................................................... 0
d. receive the promise for IWe of either payments, benefits or care? ...................................................................... 0
2. If death occunred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0
3. Did decedent own an "n lrust for" or payable upon death bank account or security at his or her death? .............. 0
4. Did decedent own an 1nd'1ViduaI Retirement Account, annuity, or other non-probate property which
contains a beneficiary designa1iOn? ..................................................................................................m................... 0
No
o
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IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
~U_pen_of~.,_:~~::-..":":~..,::..~~lhebestolmy~;njbolief.ils....""'""andcomplele.
SI JU. F PERSO ES N ISLE 1UNG ~ ;DATE /
_____~ ,rILt-/cJ1
ADDRESS
5012 Apache Drive, Mechan:tcsburq, FA 17050-2563
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE
ADDRESS
For dates of death on or after July 1. 1994 and belcno January 1, 1995. the tax rate imposed IlIl the net value of transfers 10 or for the use of the surviving spouse is 3%
[72 P.S. ~9116 (al (1.1) (Q].
For dates of death on or after January 1. 1995. the tax rate imposed on the net value ofmsfers 10 or for the use of the susviving spouse is 0% [72 P.S. ~116 (a) (1.1) (ii)J.
The statute does not exemot a transfer 10 a surviving spouse from tax, and the s1aMory requirements for disclosure of assets and ffiing a tax return are sb] applicable even ~
the surviving spouse is the only beneficiary.
For dates of death on or atler July 1, 2000:
The tax rate imposed on the net value of translers Iiom a deceased child twenty-one yealS 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. ~9116(a)(1.2)J.
The lax rate imposed on the net value of transfers to or for the use of the decedenrs lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116(1.2) [72 P.S. ~9116(a)(1)J.
The tax rat!! imposed on the net value of lranslers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)]. A sibling is defined, under Sadion 9102. as an
individual who has at least one parent in common with the decedent whether by blood or adoption.
,.-....,-..
ESTATE OF:
SCHEDULE "F"
JOINTLY-OWNED PROPERTY
PHYLLIS H. BRUDERER
A
Douglas R. Ballou
5012 Apache Drive
Mechanicsburg, P A 17050-2563
JOINTLY-OWNED PROPERTY:
Item Date made Description
Number Joint
Date of Death
Value Asset
I. A
Before
2/20100
2. B. Before
2120100
Members 1st Credit Union
checking account
savings account
(see copy of Revenue letter
attached hereto, marked
Exhibit" 1" and incorporated
herein by reference)
$ 977.40
$7,275.22
INVESCO Funds $159,042.94
Acct. #9810300-39
4,931.564 shares @ $32.50/share
(see copy ofletter attached
hereto, marked Exhibit "2" and
incorporated herein by reference)
%of
Deed's
Interest
1/3
1/3
50%
FILE NO.
Son
. Date of Death
Value of
Interest
$ 325.80
$2,425.07
$79,521.47
Total: $82,272.34
ESTATE OF:
SCHEDULE"H"
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
PHYLLIS H. BRUDERER
ITEM
NUMBER
A.
B.
1.
DESCRIPTION
Funeral Expenses:
Administrative Costs:
Attorney Fees
Total
FILE NO.
VALUE AT DATE
OF DEATH
$
Prepaid
$
750.00
(estimate)
$
750.00
SCHEDULE "J"
BENEFICIARIES
ESTATE OF:
PHYLLIS H. BRUDERER
ITEM NAME AND ADDRESS
NUMBER OF BENEFICIARY
RELATIONSHIP
A. Taxable Bequests:
No probate estate
FILE NO.
AMOUNT OR
SHARE OF
ESTATE
05/24/2001 12:20
71 7730071 7
DOUG AND KAT BALLOU
PAGE 03
CDHHflMNE~~TH OF PE~NSVlVAHIA
DEPARTMENT OF RlVE~UE
BUREAU OF INDIVIDUAL TAXES
Df.PT. 140601
HAR~~~G, PA 111Z8-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21
01121785
04-27-2001
.EY.lSUU",,.tM_1I1
TYPE OF
ACCOUNT
IX] SAVINGS
o CHECKING
o TRUST
o CERTIF.
To,
KATHRYNE L BALLOU
5012 APACHE DR
MECHANICSBURG PA 17055
EST. OF PHYLLIS H BRUDERER
S.S. NO. 004-22-6569
DATE OF DEATH 02-20-2001
COUNTY CUMBERLAND
REHIT PAYHENT ANo
REGISTER OF WILLS
CUMBERLAND CO COURT
CARLISLE, PA 17013
fORtIS
HOUSE
MEHIERS 1ST. FEDERAL CU has prOVld.td t:IuII D6PIi...t.....t ..J.th thiro In...a....t1on lid_ InIIOllf Nhich fws haCln u",ed in
eelculating the POtent!al t.~ duel. ThGir r~ards indiea~. that ~t the ~th Qf the above decedent, ~ou were & joint owner'Deneflci8r~ Of
this DQQount. If ygy f..l th18 Infor.~tton ia Incorr.ct~ please obtain wrlttan corractlan fr~ the fl~1.1 in~tltuti~n, attach Ii CDpy
to thIs i'Or. and rllturn Jot to thllll _au* IIddrSlss. This lICCQ\KIt is tUllble in ~COf"danc:8 with the Inherit.,ce Tex law. of the Co.onwealth
r II' III ~..l~'=- 1II~9~\1.,,_ ~~.. b_ ~..~~~. v4 bl vallI.... fTl'f) 1M 85fl'-.-". ,_,. __..
COMPLETE PA~T 1 2ELOW
Account Olo. 184416-00
. . . SEE
Dat.
Est.trJ.i5hed
REVERSE SIDE FOR
05-26-1999
FILING AND PAYMENT INST~UCTIONS
Accoun.t: B.,l....~
PerclU1t T.M_.le
A.oLnt Subj.ct to T.x
T.x RId.
rotentl.l T.x Du8
7,275.22
16.667
1,212.56
.045
54.57
TAXPAYER RESPONSE
'",,,," . . .. "." ...... ... .".,'*.,.,"..""....."'"...,.."'"""'..~"''''_..,.,.qL''''''._~''''''..---ii''_''''''''"'...,._,..,.,""'....,",
,..~~~lim~~~,.~:!ii..;..,.."~..i;,"."~".Js~!!i~~~~!i1~,~i!~,i:[ft!!!~~~i~H,..!i!i"~~~m~[~~~~~~~""J!~lllii~~gffi~~~;r~2~~J~:i~"\i: i~~~
M
Tg j"*Yre pra~r credit to ~QUr .ccount, two
(e) cop!.. of thl. notice ~.t ~co.peny ~our
p~~t to th. ..g15ter of Wilt.. Make c~k
pe~l. tOI ~.&l.t.r vf Hill.. Aaent~.
M
NDTE;J If ~ PQlItIU1b ",ra ~ ...~t,t,i.n thnla
(S) IIIOnth. of the decedent., ..till of CNath,
~ou _>>" d9duct II 5X dbcoUl"lt of the tax dua.
Ar1>>" inlwl"'itllllfll:lil 'bIx ItYe will bill;QM9 delinqwnt
nJMl (9) lIltM'I'ths aftel" tM dete of ..th.
PART
m
A. D Th8 atKIv. inf6r_1:iOl\ Md tiht ~ .. correct..
1. You _w ehoOH to r..it pe~t to the Reght.r of win. with two copi.. of thb notice t.o obtain
II diKount or .yoid int......t, or you IA~ cn.ck boJll: "'..- and .....tum this notiCIIII to th. Register of
Wills and an offiGi.l .ss.ss..nt Mill b. issu.d by th. PA D~.rt.-nt of R.vanull.
[CHECK ]
ONE
BLOCK
ONLY
J.. D The ebova asut ha. biten 0,. wJn bit rapo!"ted 8I"ld tax paid wltlt the PeMtylV8nle I~r1tanca TBII: !"Cltu...'"
to bll f=i1ad by thlll dDCIIad...t"s r11p...II_nt.tlvlI.
c. 0 The abov. lnfor..tiM is it'J(;(f""*C't end/or d4lIIbt. arld deduc'tions ....... Pllld b~ ~ou.
Vgy ",",st collPleb PART [!] end/or PAil [!] below.
If YOU indicat. a different taM rat.J pl..sa at.t. your
relationship to dec.dBnt:
PART
@J
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PART
~
TAX ~!iT1.!ml - COMPUT AnON
lINe 1. Oat. Established
2. ACQour"It Balanc.
3. Per-cant: Taxable
4. A.Junt Subject to Tax
.5. Debt. IiII1d U.duct ion.
6. AMount Tax~l.
7. Tax Rat.
S. Tax Due
O,,_.IAlLQtI.. ,/OINT /TRU.ILAl;~
1
2
3
~
!i
.
7
8
M
M
PAYEE
DESCRIPTION
AMOUNT PAID
I
.
I
TOTAL (Enter on Line 5 01 T.x COMPUt_tion)
t.lnd.r pwl.lti.. of ..rjury, I: d.cl..... t....t 'the f~t. I
CO_lat. to tt. baWit of .Y knowladge and bell.f.
h..WI r~,.ted
HOME (
WORK (
It:.Lt:.PHDN~
-.ov. are t~ I oor-....-ot and
)
)
NUMBt:.K DATE
TAXPAVER SIGNATURE
1::::)(\,,;,(0\\ " I"
05/~4/2001 12:20
71 7730071 7
DOUG AND KAT BALLOU
PAGE 04
CDMKOHNEALTH OF PfNNSYLVANIA
DEPARTMENT OF REveNUE
BUREAU OF INOIVIDlJAL TAXES
O'e:PT. ~.D&t11
HARRISBURG, PA 111Za~0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
nLE
ACN
DATE
NO. 21
01121784
04-27-2001
TYPE OF ACCOUNT
IX] SAVING$
o CHl:CKINC
o TRUST
o CERTlF.
'EY~15U U UP CD-Ill
EST. OF PHYLLIS H BRUDERER
S.S. NO. 004-22-6569
DATE OF DEATH 02-20-2001
COUNTY CUMBERLAND
DOUGLAS R BALLOU
5012 APACHE DR
MECHANICSBURG PA 17055
REMIT P~YHENT AND FORMS TO;
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
"EHBERS 1ST FEDERAL ClJ hn providlld t:hli n.p...tlHlftt with the fn/orlllilUon Uated bellilM liftI.tatl halt bctan used In
calculating the pot~nti.l t.~ d~_ Thgl~ r*~ord!l Indlc.~ tha~ .t the deeth Gf the ~v. ~t, YOU war. 8 joint ownerlbenefici.r~ gf
this account. If ~ou feel thi~ infQr~tiDn Is Incorract, pleese obtain written corr~tjaq *r~ t~ ftftanClal InBtltutJon~ attach. QDpY
to "Jli$ oJor. IIf'Jd rllturn It to t.... above ecIdra... Thh ~ount i.. baxllbl. {" ~al"dent:.. with th.- 1nherl"tence TM L.IIII"''' at: U. ea.--aw".lth
..' r-.'.,a~........,I.. ........~l...".. ...., "'" ",,~....4 b7 ~..llI..'W "('1'11') 7"''' 6~...,.
CO"PLETE PART 1 BELOW.
Account No. 184416-00
. . SEE REVERSE SIDE FOR
Data 05-26-1999
f:$UtDlhh.d
FILING AND PAYHENT INSTRUCTIONS
Aeoount Balance 7 J 275.22
P_nt T""OIbla X IIi. 667
AItount Subject ta Tax 1 J 212. .56
T.x Rata X .04S
Potentbll T.x Due 54. 57
PART TAXPAYER RESPONSE
[!] ~~IN_'!~rllggJlI~~1 J~}m"~~~rd1ill!I~:III!~~~,~,,,~~r~!t' ,..~..;~;,,~~~N~J.f~fIII~~l~.~ ...
A. 0 The above infor..t:~"" .ul bx dUe Is totll"l'Ht.
1. You ~ c:hGas.. to .._it JNI!fltWlt to u.. Regishr of "HI!!: .tl'ttl twe eopJell of this notic. ta iXlt.i...
. dlsaaW\t (II' avoid .Interest.. or )'0101 MY ..~ box ",... .nd ...turn thl. notiee to tM RlO1iI'htlll'" of
Willa and an officl~l .SSIlSS.-nt will be issued by the PA Depart-.nt ~f Allv.l'lu..
fljt J,ntl\lNll prapllr a..4Kli't to ya"'l" ae:.eount. two
(If) c:opJIIlo" ..., this notlo. .ust _"IIIl"Il/ )'Our-
~YIMIlt to ttMI RtII.1star Of Nllb. Hek. check
pa~le to: "R4gister of Will!!:, ~t".
NOn:, Jf tax PQ--.nts .1'* ..de within three
(5) IIOflthll of the dllllell.-.,t:. S dab of lHoath..
:fOU .... dedul:t " S2 d.i.seo...,t of tht. tax duA.
Any inhllritanc. tax dua will b6~ delinquent
nIne (9) .vnths after the d.te 04 d.ath.
[CHECK ]
ONE
BLOCK
ONLY
B. D The 81)OV. Iiit.~t: hils biNlf'l 0.. will bill r...,Drted and telll peid with the PiIrWIsyJveni. Inharltanc. Tilx return
to blto f11ed by ttw: dec.d.nt.s rllprll=-ntBtiv..
C. 0 Thea 1dJ0VII infD..at!on b JncorrltCt and/ljt~ts ..... dIlducHOo'II. WlItU peld bY You.
You .uet COIIpllltg PART [!] and/or PART ~ below.
3. P....cent T_)(abl. 3
4. Mount Subject '10 T.x 4
;;. Debts and Decluci ion" ;;
6. A.ount Tax.1. .
7. Tax ""ta 7
8. T",,_ 8
X
If you indicat. _ different ta)( rat.1 pl..se st.t. your
~elatlon$hlp to decedent:
PART
~
TAX REIIlB.H...-=. _COHPUT,\UOH. O.F.-YAX-.a!t J!Hf!:[/TRUST
LINE 1. nat. Esiab118hed I
2:. Account Balance 2
x
PART
~
DATE PAID
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line , of T~ eo.put.tlon)
I
.
~r pen_lttes of P.~jurYI I ~l.re thet the f~t. I
oo~lete to th. ~st of MY kno"Ledve ~ ~ltef.
hav. r-epor-ted above are fruit" oorrBCt and
HOME ( l
WORK ( l
TELEPHONE NUMBER DATE
TAXPAYER SIGNATURE
05/~4/2001 12:20
71 7730071 7
DOUG AND KAT BALLOU
PAGE 02
COHHQHWEALTH Of PEHHsvlvANIA
DEPjRTHENT OF REVENUE
8URE~ Of INDIVIDUAL TAXES
DEPT. 2806Q1
HARRIS8URG~ PA 17128-DGOl
'*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATI!
NO. 21
01121782
04-27-2001
.EV~15<1J EIr .\f'? 16'_11>
EST. OF PHYLLIS H BRUDERER
5.5. NO. 004-22-6569
DATE OF DEATH 02-20-2001
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVIN.S
IX] CHECKIN.
o TRUST
o CERrIF.
DOUGLAS R BALLOU
5012 APACHE DR
MECHANICSBURG PA 17055
~~IT PAYHENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
"EHBERS 1ST FEDERAL CU h.s pTQv.i,dlad the DIIP_rt.lIl"lt with thII info"'llHItion UstAd balttw ""'tell has been used In
calculating *h9 potential tax due. l'helr ,....,vrd. indlcllt.. tt,;jIt ;lit the d_th of thII .baVII dcaaDd....t, you _no . joInt D","*l"IbarMiflc1el'"~ of
tMls aCQOUOt. If ~ou fe81 this infor..tion is inCQrr-et, pl..58 obt.in Mrittlll"l DDrr.~tlgn fr~ ~ flnanel~l Instltutl~n~ attach 8 eo~
to ~h f'or. end ,..tUI'ft H: to tt\a above 8ddr.ss. Thla account 18 tBl(Bbl. In 8CeorRnce with the Inhovit~ r.- t.... ",f t.... C_OI"lloHl:ll'ttl
..f P JJ !;.1 I.~h. " aJ.!._t1~.. .6j1 h_ 8II.3ft_. _4 h,. _Ill.... (fly) Y'8f' estf'. .n~..
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDI FOR FILING AND PAYMENT INSTRUCTIONS
Ae."""t No. 184416-11 ~ta 06-03-1999
E.tabli8hed
Account 8al..,ce
f'Brcant TSXBbla
AMount Subject to
Tax lI:ate
Potential Tax Due
x
577.40
16.667
96.24
.045
4.33.
TAXPAYER RESPONSE
Tv jl'JlNf". pl'"optIIt' er.dit to your BCCOWlt~ two
(2) eupi.~ !;If this not1~ IIILIst at;eallPany your
paYMent ta the Aeglster of Wills. ~e Qh~
pBy~l. tal ~.gist.~ 0# Wjlla~ A..nt".
x
NOTE I If todC Ii'dYII6I'ItS are III1MN1 "I thin thrH
<:5) IIOf'lths of tho ~OQdDn1;'s d.tll of tknroth~
lfOU -l' dllKluot . 5X d.i,saaunt gf th. b~ due.
Any jnt.rit.JHlII tlD: dug NUl Ht;DlI. MJ1nQuent
n.lno (9) 1IKII1tf1111 lII#tll" th. d.t. of d..th.
Tax
PART
I!J
j.. 0 Thcro IIbDV. inkl....tian IInd tax du., is CO....llGt.
1. 'fQU "'lIlY cho'iI5e to I'fNIJt Pllnent tq the Reg.tster of WUls wUh two capJu of tt',l,s: I'lI;JtiCNI 'to obbin
III d!~c~t ar avald Intgr.st;~ ar you .~y che~ ba~ "A" ~d r.turn this ftOtic. ta thg Reglst.r of
Will. and an official es.es~t will be I_sued b~ the PA Depar~t of Re~enue.
[CHECK ]
ONE
BLOCK
ONLY
B. 0 The ebave .a~.t has beo.'" or will b. rillHrted and tee paid with the P6N'IIsylvanla Inh.,.lteooe Tal( ,.eturn
to b. ofU-.cI by th. dec..-nt.. I"gpl"..."tatlv..
c. 0 The above Infor..tlon h: il'lcor,.~t and/or debt. and d.~tJoo. w..... paid b)f )fou.
Yi;lu .w,:t 1;:0..,.1111;. PAAT 0 IIII"Id/ol" P,IRT [!] bcroJ,,,,I;.
PART
o
TAX RETURN . COMPUTATION~ TAX
LINE 1. Date EsiAbl1s~~ 1
:2. .coovnt "lance 2
S. r.rc....i: Taxable 3: X
4. A~t Subjact t~ Tax 4
5. Debt. and D8ducilo"s S
6. AIJouni: Taxable 6
7. Tax Rat. 7 X
8. Tax Due 8
ON o!OINT/TRUST
If you IndIcate a dlff.~ent tax ~~t.) ~l.Q~. .t.te
~l&tio"ship to de=ed.nt;
PART
~
DATE PAID
PAVEE
DESCR I PH ON
AMOUNT PAID
I
TOTAL (Erlt.,. an Line 5 of Tax CoIlPU'tatlanJ
I
.
Under .,..,...1 ti.. of "r jur)' I :I cS.cl..... that thtl facte I
c~l.t. to the best of .Y knoWl... Bnd belief.
h.~ r.port..
HOME (
WORK (
TELEPHONE
-.0.,. .,.. true.. oor"*Ot and
)
)
NUMBER
DATE
TAXPAYER SIGNATURE
o INVESCO FUNDS
INVE5CO funds Group, Ine.
7800 East Union Avenue
Denver, Colorado 80237
Tel: 800.525.8085
www.invesco.com
A Member of the AMVESCAP Group
April 3, 2001
Phyllis H, Bruderer
Douglas R Ballou
5012 Apache Dr.
Mechanicsburg, PA
17050-2563
Account(s):
9810300-39
PHYLLIS H BRUDERER
DOUGLAS R BALLOU JT TEN
Reference #:
00259256
Dear Ms. Bruderer and Mr. Ballou,
Thank you for you recent request to receive an account balance for your noted
INVESCO account. We appreciate the opportunity to assist you.
On February 20, 2001, the above account contained the following amounts:
Account Number
9810300-39
Number of Shares
4,931.564
Price Per Share
$32.50
Dollar Balance
$159,042.94
Since the Net Asset Value (NAV) is subject to change daily according to the value
of the securities held in the portfolio of the Fund, the future value of the shares may
be more or less than this amount. We hope this information is helpful.
Thank you for choosing INVESCO. If you have questions, please call us toll-free at 1-
800-426-8085 and a Preferred Services Representative will be happy to assist you.
We are committed to providing you with outstanding service, Ms. Bruderer and Mr.
Ballou, and look forward to helping you with your investment needs.
Sincerely,
9cJI~
Jeremy Tempel
Correspondence Representative
L~h.bH "2"
.
IAST WILL AND TESTAMENT
OF
PHYLLIS H. BRUDERER
I, PHYLLIS H. BRUDERER, residing in the county of sarasota,
State of Florida, do hereby make, publish and declare this my Last
will and Testament, hereby revoking and annulling any and all prior
wills and Codicils to Wills made by me heretofore.
ITEM I: Burial
I desire and direct that my body be buried in an appropriate
manner.
ITEM II: Debts. Taxes and Funeral Expenses
I direct my Personal Representative, hereinafter named, to pay
all my legally enforceable and duly presented debts, my funeral ex-
penses, the expenses of my last illness, and the costs of adminis-
tration of my estate, including any costs of ancillary administra-
tion: provided, however, that my Personal Representative shall not
be required to pay any obligation in advance of its maturity.
I direct my Personal Representative, hereinafter"named, to pay
from the residue of my estate as an administration expense thereof,
without apportionment, all State and Federal, estate, succession,
inheritance and transfer taxes (excludi'l19, however, any tax on any
"generation-skipping transfer" imposed under Chapter 13 of the
Internal Revenue Code of 1986, as amended, or a corresponding
provision of state law) assessed by reason of my death, together
with interest and penalties thereon, whether such taxes are imposed
upon or with respect to any property which passes under the
.
provisions of this will or passes or has passed otherwise, or
imposed upon or with respect to any recipient thereof; it being my
intention that all of my devisees, joint owners, appointees and
beneficiaries of any insurance policy or policies on my life
receive full benefit thereof without diminution.
My Personal Representative shall make such elections under the
tax laws as my Personal.Representative deems advisable, without re-
gard.to the relative interest of the beneficiaries, and no adjust-
ment shall be made between principal and income, or in the relative
interest of the beneficiaries, to compensate for the effect of
elections under the tax laws made by my Personal Representative.
ITEM III: Specific Beauests
I give and devise to each of the following of my then-
surviving grandchildren, to-wit:
JOHN BALLOU, DAVID LEE HAGAR,
SUZZANE HAGAR, TRAVIS REECK and AUSTIN REECK, the sum of FIVE
for e"tlca/io,,,,! P"'f"Sf!$,
THOUSAND DOLLARS ($5,000.00) each, payable in cash or in kind, or
part in cash and part in kind.
In .the event an above-named
beneficiary shall predecease me, then in that event, such deceased
beneficiary's devise shall lapse and pass as a part of the residue
of my estate.
2 .
ITEM IV: Tanqible Personal Property
A. I give and devise all stones, rocks, minerals and
antiques at my residence to my son, DOUGLAS BALLOU, if then
surviving. In the event my said son shall predecease me, then in
that event, this devise shall lapse.
.
B. I give and devise any silverware and items pertaining to
the Boy Scouts located in my safe deposit box at NationsBank, 3600
Bee Ridge Road, Sarasota, Florida, to my son, DOUGLAS BALLOU, if
then surviving. In the event my said son shall predecease. me, then
in that event, this devise shall lapse.
C. . I direct my Personal Representative to sell all of my
remaining tangible personal property (excluding such/tangible
personal property otherwise herein specifically devised), wherever
situated, including, but not limited to, my jewelry, articles of
personal use, household .furnishings and fixtures, silverware and
any automobiles (and insurance policies thereon) that I may own at
my death, and to add the proceeds therefrom to the residue of my
estate, to be held, managed, administered and distributed as a part
thereof.
ITEM V: Residence
In the event that my spouse, ERNEST P. BRUOERER, shall survive
me, I give and devise to my said spouse, during his lifetime, the
use of my residence located at 4444 Rum Cay CirCle, Sarasota,
Florida, until such time as the earliest to occur of the following
events:
(i) he shall marry; (ii) move from said residence, or
3 .
(iii) otherwise breach the terms and conditions as set forth
herein. My said spouse shall not be charged any rental fee for the
use of said residence. However my said spouse shall, at his sole
cost and expense, make all ordinary repairs required to keep such
home in good order and condition, pay all premiums required to
.
maintain adequate casualty insurance upon such home and its
contents, and pay all taxes and assessments levied against the
premises; provided, further, that during the continuance of his
residence such home shall not be subjected to the lien of any
mortgage nor otherwise serve as security for any loan other than
the mortgage on said residence that is in place at the time of my
death, if any; provided, further, that my said spouse shall be
responsible for the payments on any such mortgage. Upon the death
of my said spouse, or in the event he shall marry, move from said
residence or otherwise breach the terms and conditions as set forth
herein, then in any of those events, such home and its contents
shall be sold, and the proceeds therefrom shall be distributed in
accordance with the terms and conditions of ITEM VI hereof.
ITEM VI: Residue
I give and devise all of the rest, residue and remainder of my
estate, of whatever nature and wherever situated, including any
property over which I may have testamentary power of disposition
and any life insurance proceeds paid to my estate, as follows:
A. FORTY-THREE PERCENT (43%) shall be distributed to my son,
DOUGLAS BALLOU, outright and free of trust. In the event my said
4 .
son shall predecease me, then in that event, such portion shall be
distributed to his spouse, KATHERINE BALLOU, provided, however,
said spouse shall have been married to my said son at the time of
his death.
In the event KATHERINE BALLOU shall not then be
surviving, or shall not have been married to my said son at the
.
time of his death, then in either event, said portion shall be
distributed in equal shares to my said son's then surviving lineal
descendants, per stiroes.
B. FORTY-THREE PERCENT (43%) shall be distributed to my
daughter, DIEDRA REECK, outright and free of trust. In the event
my said daughter shall predecease me, then in that event, such
.- portion shall be distributed in equal shares to my said daughter's
then surviving lineal descendants, ~ stiroes.
C. FOURTEEN PERCENT (14%) shall be distributed to my son-in-
law, DAVID HAGAR, outright and free of trust. In the event my said
'son-in-law shall predecease me, then in that event, such portion
shall be distributed in equal shares to my said son-in-law's then
surviving lineal descendants, per stiroes.
D. To the extent the foregoing provisions of this ITEM may
provide for final distribution of any portion of my estate to any
beneficiary who shall not have attained the age of twenty-one (21)
years at the time of such distribution, said provisions are subject
to the proviso that such portion of my estate to which any such
.beneficiary would become entitled shall vest in said beneficiary
but shall be retained by my Personal Representative until such
beneficiary attains the age of twenty-one (21) years; my Personal
5 .
Representative being authorized and directed in the meantime to pay
to or for the use and benefit of such beneficiary such amounts from
income or principal, or both, from his or her said portion of my
estate as my Personal Representative may deem necessary or desir-
able for the health, support, maintenance and education of such
.
beneficiary.
In the event of the death of any such beneficiary
prior to attaining the age of twenty-one (21) years, my Personal
Representative shall forthwith distribute the remaining portion of
my estate as then held for such beneficiary to the estate of such
beneficiary.
ITEM VII: Failure:-of Beneficiaries
In the event there shall be no beneficiaries hereunder who
survive me for a period of thirty (30) days, then in that event, I
give and devise the whole of my estate to my then living heirs at
law in accordance with the intestacy laws of the state of Florida
in full force and effect on the date of my death.
ITEM VIII: Prenuotial Aqreement
I hereby acknowledge that I have entered into a prenuptial
agreement dated October 5, 1988 with my spouse, ERNEST P. BRUDERER,
and that the terms and conditions of said prenuptial agreement are.
hereby confirmed and maintained in full force and effect.
6 .
ITEM IX: Disclaimer
I authorize any beneficiary under this will to renounce and
disclaim, in whole or in part, any devise to or for the benefit of
such beneficiary. Any such renunciation and disclaimer shall be
made in accordance with state law. In the event of any such renun-
.
ciation and disclaimer, the devise (or portion thereof) so re-
nounced and disclaimed shall be disposed of in accordance with the
terms of this will as if the beneficiary renouncing and disclaiming
had predeceased me~ provided, however, that any beneficiary who
shall so renounce and disclaim a devise under one provision of this
Will shall not (unless such beneficiary so specified in the instru-
ment delivered to my Personal Representative) thereby be deemed to
have predeceased me for purposes of construing and applying any
other provision of this Will.
ITEM X: Definitions
L Unless otherwise clearly indicated, words in the singular
or plural shall include the plural and singular respectively, where
they would so apply. Words in the feminine, masculine or neuter
gender shall include the feminine, masculine or neuter gender where
applicable.
2. Unless otherwise clearly indicated, the terms "child" or
"children" as used in this Will shall mean lawful first generation
offspring of the designated Ancestor; the terms "issue" or "linea]/
descendants" shall mean the lawful blood descendants of all degrees
of the individual de~ignated; provided however, that (i) adopted
7 .
children of mine and of my lineal descendants (whether or not
adopted) adopted before the age of eighteen (18) years shall be
considered and treated in all respects as children or lineal
descendants hereunder, and (ii) any child in gestation, later born
alive, shall for purposes of this will be considered as a child in
.
being.
3. Unless otherwise stated, all statutory references in this
Will are to sections of the Internal Revenue Code of 1986, as
amended, and include any corresponding provisions of the Federal
Tax Law which may, from. time to time; be in effect.
4. Wherever the term "Personal Representative" is used
herein, the same shall be deemed to include the Personal
Representative, any successor Personal Representative, or any Co-
Personal Representatives.
5. Whenever the term "Fiduciary" is used herein, the same
shall be deemed to include the Personal Representative or the
Trustee.
ITEM XI: simultaneous Death
In the event that my spouse and I die under circumstances
creating any doubt as to the order of our deaths, then in that
event, I shall be conclusively presumed to have survived my spouse,
and my estate shall be adll!.inistered accordingly. :J;n the event that
any other beneficiary named herein and I die under circumstances
creating any doubt as to the order of our deaths, then in that
8 .
event, said beneficiary shall be conclusively presumed to have
predeceased me, and my estate shall be administered accordingly.
ITEM XII: Fiduciarv AppOintments
I hereby nominate and appoint my son, DOUGLAS BALLOU, as
.
Personal Representative of this my Last will and Testament. In the
event my said son shall predecease me or be unwilling or unable to
serve or continue to serve as such Personal Representative, then in
that event, I hereby nominate and appoint my daughter-in-law,
KATHERINE BALLOU, as alternate Personal Representative of this my
Last Will and Testament.
ITEM XIII: Fiduciarv Powers
I hereby direct that no bond shall be required of any of the
herein named parties who may serve as my Personal Representative,
and they shall each have full power and discretion to do any and
all things necessary for the complete administration of my estate,
including but not limited to the power and discretion to retain
such property for so long as they may deem advisable, to abandon
such property or to lease, mortgage or sell such property for cash
or credit at public or private sale, to grant options, to lease
real property regardless of the fact that the term of such lease
may extend beyond the period of administration of my estate, and to
compound, compromise or otherwise settle or adjust any and all
claims, charges, debts and demands, whatsoever against or in favor
of my estate, as fully as I could do if living; to distribute such
9 .
property in cash or in kind or both and to value such property to
the extent permitted by law, to invest in any property regardless
of . whether authorized by law for investment of trust funds, to
borrow money from any lender to settle claims and to do all acts
although not specifically listed herein deemed necessary and advis-
.
able for the proper management, investment and distribution of such
property, all without order of court. No purchaser need see to the
application of the purchase money, but the receipt of my Personal
Representative shall be a complete discharge and acquittance
therefor.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to
this my Last will and Testament consisting of eleven (11)
typewritten pages, this the G
day 01' AJtv~:U"-
, 1998.
'fI/{P'q4.t//khfA-
PHY IS H. BRUDERER
The foregoing instrument was signed, sealed, declared and
published by the said Testatrix as and for her Last Will and
Testament, in the presence of us, the undersigned, who, at her
special instance and request, do hereby attest as witnesses after
the said Testatrix signed her name thereto, and in her presence and
in the presence of each other, this the (" day of
IV.....,~- , 1998.
/:I ~ e. ~ >>..I RtkL
.
residing at
58A a M.,t., lA":;ti
- I -
L.l.. ~l~.<0z.b.,.
6 r
residing at
~~ ~~;'c\'A. ,
.
residing at
10 .
STATE OF FLORIDA )
COUNTY OF SARASOTA )
We, PHYLLIS H. BRUDERER, J.J4NN~'<lf- t<:,,,F-
f'r..--.F.AA ~~ .-S>~......c.p , and ,
the Testatri and th witnesses respectively, whose names are
signed to the foregoing instrument, having been sworn, declared to
the undersigned officer that the Testatrix, in the presence of
witnesses, signed the instrument as the Testatrix's last will that
she signed vQluntarily, and that each of the witnesses, in the
presence of the Testatrix, at her request, and in the presence of
each other signed the will as a witness and that to the best of the
knowledge of each witness, the Testatrix was at the time eighteen
years or more of age, of sound mind, and under no constraint or
undue influence.
~A( ~&~~
PHY S H. BmmERER
fJ. QA. _ ^ ,.I1kR J2 /n.J.-.
]tness
QtW.J. ~111M.\:\:J'A' .
witness (j (S"
witness
STATE OF FLORIDA
COUNTY OF SARASOTA
Subscribed and sworn to before me by PHYLLIS H. BRUDERER, the
Testatrix, who is personally known to me or who has produced
as identification and who did not take an oath,
~nd subscribed and sworn to before me by #,'UI.,F.(M9t: /(. .F ,
j"'>-"I.E.U> ~uc\.\- DA\'-.~ and , the
witnesses, who are personally known to me, on the (."
day of ~~ , 1998. ~ nH-9 A ___ _____
~
Print Name:
My Commission expires:
#306384. ,
11
.
W~!JjJ !7kx/
Attorney At Law
2423 N. Third Street
Harrisburg, Pennsylvania 17110
Phone: (717) 238-0434 . Fax: (717) 238-8469
e-mail: gregrreed@prodigy.net
July 30, 2001
Mary C. Lewis
Register of wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013-3387
RE: Estate of Phyllis H. Bruderer
Dear Ms. Lewis:
Enclosed please find the original and two copies of an
inheritance tax return together with a check in the amount of
$15.00 for the filing fee. Please return a "clocked" copy to me
in the enclosed self-addressed stamped envelope.
GRR/cjw
Enclosures
c, \secretary\FormS\Estates\Bruderer, Phyllis\Register of wills Itr 01-07 -30 .doc
\. /h -,;2Ob9-~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
GREGORY R REED
2423 N 3RD ST
HBG
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-17-2001
BRUDERER
02-20-2001
21 01- 0450
CUMBERLAND
101
ES~
'*
REY-1547 EX AFP 112-00)
PHYLLIS
H
PA 17110
Allount Rellitted
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 ~
REV=iS47-EX-AFP-C!'2=ooY-No'TicE--oF-INHERiTANCE-YAX-APPRAisEMENT~--AiloWANCE-OR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BRUDERER PHYLLIS H FILE NO. 21 01-0450 ACN 101 DATE 09-17-2001
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
NOTE: If an assessment was issued previously. lines 14. 15 and/or 16. 17. 18 and 19 will
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
IS. Allount of Line 14 at Spousal rate (IS)
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:
.00 X 00 = .00
81,522.34 X 045 = 3,668.51
.00 X 12 = .00
.00 X 15 = .00
(19)= 3,668.51
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. Mortgages/Notes Receivable (Schedule D)
S. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. 40intly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(1)
(2)
(3)
(4)
(S)
(6)
(7)
.00
.00
.00
.00
.00
82,272.34
.00
(8)
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule 4)
14. Net Value of Estate Subject to Tax
(9)
(10)
750.00
.00
(11)
(12)
(13)
(14)
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
82,272.34
7150 00
81,522.34
.00
81,522.34
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-07-2001 AA496565 183.43 3,500.00
09-10-2001 REFUND .00 14.92-
TOTAL TAX CREDIT 3,668.51
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REflECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A D~~IINn ~FF RFVI=RSI= SIDI= OF THIS FORM FOR INSTRUCTIONS.)
v-- /6.. c:2~O - XE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG, PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
INHERITANCE TAX
STATEMENT OF ACCOUNT
'*
REY-I'07 EX AFP <12-00)
GREGORY R REED ESQ
2423 N 3RD ST
HBG PA 17110
DATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
COUNTY
ACN
09-24-2001
BRUDERER
02-20-2001
21 01-0450
CUMBERLAND
101
PHYLLIS
H
Amount Remitted
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, submit the upper portion of this form with your tax payment.
CUT ALONG THIS LINE __ RETAIN LOWER PORTION FOR YOUR RECORDS ~
REv=i&"ifj-'Ex-AFP-fi'2:ooY------...-iNirERITANcE-fAx-sTAfEMENf-OF-ACCouiff--.i.---------------------
ESTATE OF BRUDERER PHYLLIS H FILE NO.21 01-0450 ACN 101 DATE 09-24-2001
THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW
IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-10-2001
P R I NCI PAL TAX DUE: ._........................................................................................................................................................................................................-.............
3,668.51
PAYMENTS (TAX CREDITS):
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
05-07-2001 AA496565 183.43 3,500.00
09-10-2001 REFUND .00 14.92-
TOTAL TAX CREDIT 3,668.51
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
!Ii IF PAID AFTER THIS DATE, SEE REVERSE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE IS LESS THAN $1,
NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRJ,
un" ..AV DC nllc A Dl=l=lINn ~FF REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
.~
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG. PA 17128-0601
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
*'
No.AA 496565 REV-ll62 EX (11-96)
RECEIVED FROM:
r
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
GREGORV R REED
101
.3.500.00
2423 NORTH 3RD STREET
HARRISBURG, PA 17110
..
-- FOLD HERE
FOLD HERE -_.
ESTATE INFORMATION: I
FILE NrSER
~, 1-200 1-0450 SSN 004-ee-oesoc;'
NAME OF DECEDENT (LAS~ (FIRST) (MI)
BRUDERER PH LLIS H
DATE OF PAYMENT
5/07/2001
POSTMARK DATE
0/00/0000
COUNTY
CUfitBEAL.AND
DATE OF DEATH
2/20/2001
"H , nn T '''Co l..
-a,300.00
TOTAL AMOUNT PAID
DO
REMARKS
c/o GREGOR V R REED ESQ.
CHECK. 301
SEAL
RECEIVED BY
fitAR
REGISTER
REGISTER OF WILLS
.___.__ __-____---.. ______..___,_--",..-.....oi,~.'-~.~~~..-:-,~..-.....J'L......o.'- _.._~'_'-_._.__,_,__,_,_,---....