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REV-1500 EX + (6-00)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
02/
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COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Broccolo Salvatore M.
DATE OF DEATH (MM-DD-YEAR)
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
168-36-3349
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
DATE OF BIRTH (MM-DD-YEAR)
08/18/2001 08/20/1929
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL
Broccolo, Maria G.
X 1. Original Return
4. Limited Estate
OFFICIAL USE ONLY
01
1031
NUMBER
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
X 6. Decedent Died Testate
2. Supplemental Return
4a. Future Interest Compromise (date of death after 12-12-82)
7. Decedent Maintained a Living Trust
X
o
3. (date of death
. Remarnder Return prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
(Attach copy of Will) (Attach copy of Trust)
D 9. Litigation Proceeds Received 010. Spousal Poverty Credit D 11. Election to tax under Sec. 9113(A)
(date of death b'etween 12-31-91 and 1-1-95) (Attach Sch 0)
U"tfJ~~I$'~ll"N"lmliR:le~~Mp~.Jt.Q~A~~'~QBR'e$:P(),NPeN~$':~,~~NitIPiNm'Agim.iNlf(),BMA1jiQN$a()'g~QQgQlag~!'t'ip!'t'l;r
NAME COMPLETE MAILING ADDRESS
Karl M. Ledebohm
FIRM NAME (If Applicable)
Saidis, Shuff, Flower & Lindsa
TELEPHONE NUMBER
2109 Market St.
Camp Hill, PA 17011
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717 37-3405
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 (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(1)
(2)
(3)
None
None
None
(4)
(5)
None
None
(6)
152,645.00
117,355.56
7,181.00
None
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116(a)( 1.2)
16. Amount of Line 14 taxable at lineal rate
17. Amount of Line 14 taxable at sibling rate
18. Amount of Line 14 taxable at collateral rate
19. Tax Due
117,355.56
145,464.00
x
X
X
X
.0 0
.0 45
.12
.15
Copyright (c) 2000 farm software only The Lackner Group. inc.
OFFICIAL USE ONLY
(8) 270,000.56
(11) 7 ,181. 00
(12) 262,819.56
(13)
(14) 262,819.56
(15)
(16)
(17)
(18)
(19)
0.00
6,545.88
0.00
0.00
6,545.88
Form REV-1500 EX (Rev. 6-00)
, Decedent's Complete Address:
STREET ADDRESS
139 Brindle Road
CITY I STATE I ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
6,545.88
0.00
Total Credits ( A + B + C) (2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E) (3)
4. If Line 2 is greater than line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 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)
A. Enter the interest on the tax due. (SA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
":~,,, !~~li$~i~i!~~~~i8~1~;II~+~W~Li8~IR~'lmmi!
0.00
0.00
6,545.88
0.00
6,545.88
!n!;'li:~i~i~~~~!,~~~~~~:+i~~1~6'tC8~1~~i~d~~+~@:~~~Y:i~C~8il~~'~~'
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? . .....................
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.
Yes No
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Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true.
correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN
Maria Broccolo I?
_ _ -~~ ~_ _~~ ~!'_c!~E:l_ }~'?<:t?_ ~~ _ -Y-l~kO_4
Mechanicsbur , PA 17055
...;~~~i~~r~~~f~~,Fl;!. __ __ __
Camp Hill, PA 17 1
":::::,;.::::,::::.:,::;:,::.:::::::::.:,::.::".::::.::;;':::::::':-::"'::;:::':1:'::':'::"":"0"':"":":':":':";';..:.:.':'
DATE
it- c ~--a J
SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
DATE
;:-t!)t;-ol
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P. S. 9116 (a) (11 ) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[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 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. 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%, except as noted in 72 P. S. 9116( 1.2)
[72 PS. 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% [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.
Copyright (c) 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
REV-1509 EX + (1-97)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Salvatore M. Broeeolo
SCHEDULE F
JOINTL V-OWNED PROPERTY
FILE NUMBER
SS# 168-36-3349
08/18/2001
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
A.
Carlo Broccolo
ADDRESS
139 Brindle Road
Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
son
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 DATE OF DEATH DECO'S VALUE OF
account number or similar identifying number.
NUMBER TENANT JOINT Attach deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'SINTERES
1 A 09/30/12 Real estate located at 305,290.00 50.00% 152,645.00
605 & 607 Bridge St.
New Cumberland, PA
(value based on county
tax assessed value)
TOTAL (Also enter on line 6, Recapitulation) $ 152,645.00
T
(If more space is needed insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems. Inc.
Form REV-1509 EX (Rev. 1-97)
REV-1510 EX + (1-97)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Salvatore M. Broccolo
5S1ft 168-36-3349
08/18/2001
FILE NUMBER
This schedule must be completed and tiled it the answer to any of questions 1 through 4 on page 2 is yes.
DESCRIPTION OF PROPERTY % OF
ITEM RELAW8hMgtp t~ 'b~~~B~MtWJ~~~b"}T~EJF t~~~SFER. DATE OF DEATH DECO'S EXCLUSION TAXABLE VALUE
NUMBER ATTACH ACOPYOF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE)
1 Hartford Insurance, Annuity
contract 110,333.67 110,333.67
(Spouse is beneficiary)
2 Waypoint Bank 5,010.50 3,000.00 2,010.50
Certificate of Deposit
7100009441 joint with spouse
on 6/4/01
3 Waypoint Bank 5,011.39 5,011.39
Certificate of Deposit
7100010744 joint with spouse
on 7/24/01
TOTAL (Also enter on line 7, Recapitulation) $ 117,355.56
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
Form REV-1510 EX (Rev. 1-97)
REV-1511 EX+(1-97)
ESTATE OF
Salvatore M. Broccolo
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
SSif 168-36-3349
08/18/2001
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
A. FUNERAL EXPENSES:
Funeral
Priest
Funeral meal
AMOUNT
5,846.00
300.00
285.00
B.
ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2.
3.
Attorney's Fees Saidis, Shuff, Flower & Lindsay
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
750.00
City
Relationship of Claimant to Decedent
State
Zip
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation) $ 7,181.00
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-'1511 EX (Rev. 1-97)
REV-1513 EX +(9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIAR IES
ESTATE OF
Salvatore M. Broccolo
NUMBER
J.
S Sit 168- 36 - 3349
08/18/2001
1
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and
transfers under Sec. 9116(a)(1.2)j
Maria G. Broccolo
139 Brindle Rd.
Mechanicsburg, PA 17055
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
FILE NUMBER
AMOUNT OR SHARE
OF ESTATE
Benef. of
Annuity Policy
1/2 value of
real estate
as jt. tenant
w/ R/O/S
152,645.00
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
spouse
2
Carlo Broccolo
139 Brindle Rd.
Mechanicsburg, PA 17055
son
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same sjze)
Copyright (c) 2000 form software only The Lackner Group, Inc.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
0.00
Form REV-1513 EX (Rev. 9-00)
I vun IV1Un 1 \::If'\\.:fC '-'UIVIr-'AJ'J r.
PA YA8LE
TO:
ROBIN GASPERETTI, TAX COLLECTOR
1113 BRIDGE STREET
NEW CUMBERLAND, PA 17070-1634
DESC:
MAP NO: 25-24-0811-042
0605 BRIDGE STREET
ACRES .260 DEED 35X 1 332
LOTS 53,54 & 55 DB 6-C PG 600
TOWNHOUSES (6 UNITS)
COMMERCIAL
TAX BROCCOLO, SALVATORE &
PAYER CARLO
139 BRINDLE ROAD
MECHANICSBURG PA 17055
OFFICE PHONE 717-774-7424 APR 30TH 9-4
HOURS: TUES & WED 7:30-11 :30AM & 1-4PM
THURS 2-6PM CLOSED MAY 8-17,AlSO
SEP 6-20 DEC-JAN-FEB TUES 8-11AM
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THESE TAXES ARE DUE AND PAYABLE:
:::'; f,~.hX ,,1" '1" (')
DISCOUNT
~~,) ('.1,,1 FE, r:~ i~\ LiJ E~~ 5
;~::~~. ,8 (:,:1 ~"j {J
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F' el. \l l\ t~ () ",./ e
Assessed Land Improvement Mineral Total
Values 27,430 277,860 0 305,290
COUNTY OF CUMBERLAND Discount Face Penalty
Rates .00177900 .00177900 2 % 10 %
COUNTY R/E 48.80 494.31 532.25 543.11 597.42
Rates .00010300 .00010300 2 % 10 %
COUNTY LIB 2.83 28.62 30.82 31.45 34.60
BOROUGH OF NEW CUMBERLAND
Rates .00150000 I .00150000 2 % 10 %
MUNIC. R/E 41.15 ' 416.79 448.78 457.94 503.73
TAX AMOUNT DUE-> $1,011.85 $1,032.50 $1,135.75
If Paid On or After 3/01/2001 5/01/2001 7/01/2001
If Paid On or Before 4/30/2001 6/30/2001
Control No: 025 - 000044
2001 Statement of Real Estate Taxes
Bill Date'
IF NOT PAID BY 12/31/2001 THIS BILL WILL BE RETURNED TO TAX
CLAIM BUREAU FOR COLLECTION AND FILING OF A LIEN AGAINST
YOUR PROPERTY.
Return Bill with Payment. For a Receipt, Enclose Self Addressed Stamped Envelope.
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THIS DEED,
Made the 3C1~day of September, 1992,
BETWEEN LANDIS J. SHOLLY and CATHERINE 1-1. SHOLLY, husband and
wife, of Etters, York County, Pennsylvania, Parties of the First
Part, hereinafter designated as the GRANTORS,
AND
SALVATORE BROCCOLO, married man, and CARLO BROCCOLO, Joint
Tenants with the Right of Survivorship and not as Tenants in Common,
of Mechanicsburg, Cumberland County, Pennsylvania, Parties of the
Second Part, hereinafter designated as the GRANTEES.
WITNESSETH, that the Grantors for and in consideration
of TWO HUNDRED SIXTY THOUSAND AND 00/100 ($260,000.00) DOLLARS,
lawful money of the United States of America, to the Grantors in
hand well and truly paid by the Grantees, at or before the
sealing and delivery of these presents, the receipt whereof is
hereby acknowledged and the Grantors being therewith fully
satisfied, do by these presents grant, bargain, sell and convey
unto the Grantees forever.
ALL THAT CERTAIN piece or parcel of land si tuate in the
Borough of New Cumberland, County of Cumberland and Commonwealth
of Pennsylvania, more particularly bounded and described as
follows, to wit:
BEING Lots Nos. 53, 54 and 55 in the Rudolph Martin
Plan of Lots, adjoining (and now part of) said Borough of New
Cumberland, laid out by M. B. Cowden, C.E., in 1888; and bounded
on the west by Bridge Street; on the east by Second Alley; on the
north by lot numbered 52; and on the south by Lot No. 56 on said
Plan; then said lots having a width of 75 feet together on Bridge
Street and extending an even width 153.00 feet, more or less, to
said Second Alley, as shown on said Plan which is duly filed
amongst the records in the Office of the Recorder of Deeds in and
for Cumberland County in Deed Book C, Volume 6, Page 600.
-D, -
BEING THE SAME PREMISES which Mary Bonaventura, Widow,
by her Deed dated March 1, 1989, and recorded March 2, 1989, in
the Office of the Recorder of Deeds in and for Cumberland County,
Pennsylvania, in Deed Book V, Volume 33, Page 230, granted and
V'<~. 332
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conveyed unto Landis J. Sholly and Catherine M. Sholly, his wife,
Grantors herein.
UNDER AND SUBJECT to restrictions, conditions,
of ways, easements and setback lines of record.
rights
TOGETHER with all and singular the buildings,
improvements, ways, woods, waters, watercourses, rights,
liberties, privileges, hereditaments and appurtenances to the
same belonging or in anywise appertaining; and the reversion and
reversions, remainder and remainders, rents, issues and profits
thereof, and of every part and parcel thereof; AND ALSO all the
estate, right, title, interest, use, possession, property, claim
and demand whatsoever of the Grantors both in law and in equity,
of, in and to the premises herein described and every part and
parcel thereof with the appurtenances. TO HAVE AND TO HOLD all
and singular the premises herein described together with the
hereditaments and appurtenances unto the Grantees and to the
Grantees' proper use and benefit forever.
AND the Grantors covenant that, except as may be herein
set forth, they do and will forever specially warrant and defend
the lands and premises, hereditaments and appurtenances hereby
conveyed, against the Grantors and all other persons lawfully
claiming the same or to claim the same or any part thereof, by,
from or under it, them or any of them.
In all references herein to
entities or corporations, the use of any
plural or singular number is intended to
gender or number as the text of the
require.
any parties, persons,
particular gender or
include the appropriate
within instrument may
Wherever in this instrument any party shall be
designated or referred to by name or general reference, such
designation is intended to and shall have the same effect as if
the words "heirs, executors, administrators, personal or l~gal;
representati ves, successors and assigns" had been inserted af.ter
each and every such designation.
iV.< s '{: S ~ \)''-- -l
School Dist Comb. eo.. Pa.
1-% Real Estate ltensfwTa
'l- q ri:'
Date t 0-( -/ L Amt I, 3 00'
Robert P Ziegler
Cumb Co, Oist. Col. Aut
'-' h f N~ (,.~ (V"",,6h/~'1 J
tiorouij 0 . I
Cumbo Co., Pa.
L.-T% Real Estate Transfer...
ilJ '1-11. I "':> 00' t12
Dabi ,"'" Ami.: i ..)
Robert P. Ziegkl:'
Cumb. Co. Dfat. Cot Agt.
......
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IN WITNESS WHEREOF, the Grantors have hereunto set their
hands and seals the day and year first above written.
WITNESS:
{ ?bUlf!~~"
~,Il-i/~~
Landi s . Sholl..
"h
Catherine M. Sholl
COMMONWEALTH OF PENNSYLVANIA, COUNTY OF
C \"-\"1'>,-6..: T Lc:t-I'\ J...
)SS.
BE IT REMEMBERED, that on
~~-v 3D, lCj'1~
before me the subscriber personally appeared Landis J. Sholly and
Catherine M. Sholly,
husband and wife, known
to me (or
satisfactorily proven) to be the persons, whose names are
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Hartford Life
October 25,2001
Karl M Ledebohm
2109 Market Street
Camp Hill, PA 17011
Re: Hartford Annuity Contract Number: 226230
Decedent: Salvatore Brocco10
Dear Mr. Ledebohm:
Thank you for your correspondence regarding the above Annuity contract.
The death benefit payable under this contract is not considered "life insurance" reportable on IRS
Form 712, (Life Insurance Statement). Please find below information in response to your request:
Contract Number: 226230
Owner: Salvatore Broccolo
Deceased: Salvatore Broccolo
Owner's SSN: 168-36-3349
Date of Death: August 18,2001
Date of Death Value: $110,333.67
Tax Cost Basis, (if applicable):
Neither Hartford Life nor its agents or employees provide tax or legal advice. We strongly recommend
that you speak with your tax advisor.
Should you have any questions regarding this information, please contract Annuity Client Services at
1-800-862-6668, Monday through Thursday, from 8 a.m. to 7 p.m., Friday from 8 a.m. to 6 p.m., or
Satur/ from 9 a.m. to 2 p.m., Eastern time.
SinQ~re)y,
I. / ~/~._----------
ve-. [/ --~-... h_Ohh
Yuri Kaplun
Investment Product Services
Contract Management (Technical) Team
Hartford Life Insurance Co.
Hartford Life Insurance Companies
200 Hopmeadow Street
Simsbury, CT 06089
Toll Free 1 8008626668
Individual Annuity Operations
Mailing Address: P.O. Box 5085
Hartford, CT 06102-5085
Way~qi!'J
LOOK FOR US. WE'Ll GET YOU THERE.
10/25/2001
SAIDIS SHUFF FLOWER & LINDSAY
2109 MARKET ST
CAMP HILL PA 17011
The information which you requested on the account(s) of SALVATORE BROCCOLO DECEASED
(Social Security Number 168-36-3349) islare as follows:
1800013151
CERTIFICATE
03/16/00
60000.00
192.26
60192.26
Account Number
Class of Account
Date Opened
Principal Balance
Accrued Interest
Balance at Date of
Death
Account Ownership JTO
Name of Joint MARlA
Owner, if any BROCCOLO
Date Ownership 03/16/00
Was Established
7100010744
CERTIFICATE
07/24/01
5000.00
Account Number
Class of Account
Date Opened
Principal Balance 11.39
Accrued Interest
5011.39
Balance at Date of
Death JTO
Account Ownership MARlA
Name of Joint BROCCOLO
Owner, if any
Date Ownership
Was Established
07/24/01 -:1::
1800013170 1800013195 1800013256 1800034769 7100009441
CERTIFICATE CERTIFICATE CERTIFICATE CHECKING CERTIFICATE
04/17/00 06/02/00 08/17/00 03/16/00 06/04/01
5000.00 5000.00 5000.00 595.05 5000.00
15.23 15.23 14.90 .14 10.50
5015.23 5015.23 5014.90 595.19 5010.50
JTO JTO JTO JTO JTO
MARIA MARlA MARlA MARIA MARlA
BROCCOLO BROCCOLO BROCCOLO BROCCOLO BROCCOLO
04/17/00 06/02/00 08/17/00 03/16/00 06/04/01 7\':: v'1 tYJ'4-c;t.,-/
J)/.?i':~
It,[-{, ;r{/!-'-d
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-/...-'
s~e,re.lY~.
f")tltttlf ') ~ty
KATI-W' OUN~__
SENIOR SERVICES REP.
PLEASE COMPLETE W-9
Additional
Information
Requested
P.O. Box 1711. HARRISBURG. PENNSYLVANIA 17105-1711
Toll Free 1-866-WAYPOINT (1-866-929-7646) . www.waypointbank.com
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LAST WILL AND TESTAMENT
OF
SALVATORE BROCCOLO
I, SALVATORE BROCCOLO, of Monroe Township, Cumberland
County, Pennsylvania, make, publish and declare this as and for
my Last Will and Testament, hereby revoking all other Wills and
Codicils heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, unto my wife,
MARIA G. BROCCOLO, provided she survives me by sixty (60) days.
SECOND: Should my wife, MARIA G. BROCCOLO, predecease
me or die on or before the sixty-first (6Ist) day following my
death, I devise and bequeath all the rest, residue and remainder
of my estate of whatever nature and wherever situate, including
any property over which I hold power of appointment and together
with any insurance policies thereon, to my son, CARLO G.
BROCCOLO, provided that should he predecease me, I give and
bequeath his share unto his issue per stirpes by representation.
THIRD: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
1
)
~
y
~
3
~
~
. ~
~
~
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
eE) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FOURTH: I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
FIFTH: I nominate and appoint my wife, MARIA G.
BROCCOLO, Executrix of this, my Last Will and Testament. In the
2
Iii i T
1111111
1,11111
event of the death resignation or inability ~ serve for any
reason whatsoever ~~ the said MARIA G. BROCCOLu, I nominate and
appoint CARLO G. BROCCOLO, Executor of this, my Last Will and
Testament. I direct that my Executrix or Executor, as the case
may be, and their successors, shall not be required to post
security or a bond for the performance of their duties in any
jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
this, my Last Will and Testament, this /~~ day of
, 1996.
seal to
l~ ,f~t
j &/L(7J~~ ~ LUO-to
SALVATORE BROCCOLO
( SEAL)
Signed, sealed, published and declared by the above-
named Testator as and for his Last will and Testament in our
presence, who, at his request, in his presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
, >1; 0 II...
, l~ '1r"
rb-faA~ rf/' &/-J/ut'
Address
Address
3
I I
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'\... I ?-do--.3
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG1 PA 17128-0601
KARL M LEDEBOHM
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
CLOSING LETTER
Recorded.Office of DA TE
RegistHr of Vv'iUs ESTATE OF
DATE OF DEATH
FILE NUMBER
.03 MAY -2 All:54 COUNTY
ACN
*'
REY-75' EX AFP (01-02)
04-28-2003
BROCCOLO
08-18-2001
21 01-1031
CUMBERLAND
202
SALVATORE
".~.....t r-" ,..., 'c> r...._" 'rt
OetK-\...- . ;';11.;> L;Ud..,
P I'....~l::>;nr~ (':0. PA
Atn.&11 ~ L...:..:; ,--'..... \..J "'" . 1
Allount Rellitted
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 forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~
RE-V:736--EX--AFP--[oi~-02i-----.-.-NO-ficE--OF--DETE-iMiN~Tio-N-AN-D-AS-SESS1iENT-----------------------------
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ..
ESTATE OF BROCCOLO
SALVATORE
FILE NO.2l 01-1031
ACN 202
DATE 04-28-2003
ESTATE TAX DETERMINATION
1.
.00
Credit For State Death Taxes as Verified
2.
Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
3.
6,218.59
.00
Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
4.
Total Inheritance Tax Assessed
.00
5.
6,218.59
Pennsylvania Estate Tax Due
6.
Amount of Pennsylvania Estate Tax Previously Assessed
Based on Federal Estate Tax Return
7 .
.00
.00
Additional Pennsylvania Estate Tax Due
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
-IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
\
1:')-0(0 -\.3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
*'
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z8D6Dl
HARRISBURG, PA 171Z8-D6Dl
MARIA BROCCOLO
139 BRINDLE RD
MECHANICSBURG
NOTICE OF INHERITANCE TAX
APPRAISEKENT~ ALLOMANCE OR DISALLOMANCE
OF DEDUCTION~, AND ASSESSKENT OF TAX ON
JOINTLY HELD OR TRUST ASSETS
Recorcc DATE
Registo, ESTATE OF
DATE OF DEATH
FILE NUMBER
.01 [] Ie 17 P12'0 .,cOUNTY
. ~SNI'DC
ACN
REY-1548 EX AFP (12-00)
12-17-2001
BROCCOLO
08-18-2001
21 01-1031
CUMBERLAND
168-36-3349
01148248
SALVATORE
PA 170~rk"(_-
IlnnberiaJ .... d
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 ~
RE-v:i5~i-ix--AFP--(i~:ool------------------------------------------------------------------------------------
NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF
DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS
DATE 12-17-2001
ESTATE OF BROCCOLO
SALVATORE
DATE OF DEATH 08-18-2001
COUNTY
CUMBERLAND
FILE NO. 21 01-1031
TAX RETURN WAS:
S.S/D.C. NO. 168-36-3349
(X) ACCEPTED AS FILED () CHANGED
JOINT OR TRUST ASSET INFORMATION
ACN
01148248
FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICE
ACCOUNT NO.
0017872154
TYPE OF ACCOUNT: () SAVINGS (~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE
DATE ESTABLISHED 03-28-1973
Account Balance
Percent Taxable X
Amount Subject to Tax
Debts and Deductions
Taxable Amount
Tax Rate X
Tax Due
1,353.06
0.500
676.53
.00
676.53
.00
.00
NOTE: TO INSURE PROPER CREDIT TO
YOUR ACCOUNT, SUBMIT THE
UPPER PORTION OF THIS NOTICE
WITH YOUR TAX PAYMENT TO THE
REGISTER OF WILLS AT THE
ABOVE ADDRESS. MAKE CHECK
OR MONEY ORDER PAYABLE TO:
"REGISTER OF WILLS, AGENT."
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
. IF PAID AFTER THIS DATE, 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 REFUND.
SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. )
'\. /? ~ ,---3
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. Z80601
HARRISBURG, PA 171Z8-0601
NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
Recoraec:i
ReGiE't::;'
KARL M LEDEBOHM
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
-02
JAN 11
cHATE
ESTATE OF
DATE OF DEATH
FILE NUMBER
P 3 :~~~NTY
01-07-2002
BROCCOLO
08-18-2001
21 01-1031
CUMBERLAND
101
*'
REV-1547 EX AFP n2-00l
SALVATORE
ClerK.:,
P A 1701 Cu,nberian,i
Allount Rellitted
FA
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 ~
RE-Y-=is4j-ix--AFP--ci'2-:oi.r-NOTici--OF-'rtiHiififiifcE-TAi-jrpPRjrisii'-ENT~--ALi-owiiicE-cfR-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
SALVATORE FILE NO. 21 01-1031 ACN 101
ESTATE OF
BROCCOLO
TAX RETURN WAS: (X) ACCEPTED AS FILED
) CHANGED
DATE 01-07-2002
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:
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)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
(I)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
.00
152,645.00
117,355.56
(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 Bequestsj Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(10)
7,181.00
.00
NOTE:
117 , 355 . 56 X 00 =
145,464.00 X 045=
.00 X 12 =
.00 X 15 =
NOTE: To insure proper
credit to your account,
subllit the upper portion
of this forll with your
tax paYllent.
270,000.56
(II)
(12)
(13)
(14)
7 181 00
262,819.56
.00
262,819.56
(19)=
.00
6,545.88
.00
.00
6,545.88
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
11-09-2001 CDOO0508 327.29 6,218.59
TOTAL TAX CREDIT 6,545.88
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 REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
/'?-~00
'\., BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
DEPT. 280601
HARRISBURG I PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF DETERMINATION AND
ASSESSMENT OF PENNSYLVANIA
ESTATE TAX BASED ON FEDERAL
ESTATE TAX RETURN
*'
REY-483 EX AFP (01-051
KARL M LEDEBOHM
SAIDIS ETAL
2109 MARKET ST
CAMP HILL
Recoraed (YfflCE1 otDA TE
Reoistp; 'Nills ESTATE OF
,J'~'-' DATE OF DEATH
FILE NUMBER
.03 APR 28 P 3 :I~NTY
04-21-2003
BROCCOLO
08-18-2001
21 01-1031
CUMBERLAND
201
SALVATORE
Allount Rellitted
G;s'rk...'- ;;.. \._A.;Ul!
PAl 7 0 1 :CurnberlanU\,.()., FA
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 forll with your tax paYllent.
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR FILES ~
RE-V =48i--E)'CAFP--for:.-o3i-----..-NcifIcE--oF--liETE-iMINATIoti-iifli-is-sESS-MENy------------------------ -- ---
OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ..
ESTATE OF BROCCOLO
SALVATORE
FILE NO.21 01-1031
ACN 201
DATE 04-21-2003
ESTATE TAX DETERMINATION
1. Credit For State Death Taxes as Verified
.00
2. Pennsylvania Inheritance Tax Assessed
(Excluding Discount and/or Interest)
6,218.59
3. Inheritance Tax Assessed by Other States
or Territories of the United States
(Excluding Discount and/or Interest)
.00
4. Total Inheritance Tax Assessed
6,218.59
5. Pennsylvania Estate Tax Due
.00
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
-IF PAID AFTER THIS DATE, SEE REVERSE SIDE (IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE
DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX(11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
LEDEBOHM KARL M
2109 MARKET ST.
CAMP HILL, PA 17011
-------- fold
ESTATE INFORMATION: SSN: 168-36-3349
FILE NUMBER: 21 - 200 1 - 1 031
DECEDENT NAME: BROCCOLO SALVATORE M
DA TE OF PAYMENT: 11/09/2001
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 08/18/2001
NO. CD 000508
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $6,218.59
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS: CARLO BROCCOLO
C/O KARL M LEDEBOHM
CHECK#1552
SEAL
INITIALS: PB
RECEIVED BY:
$6,218.59
MARY C. LEWIS
REGISTER OF WILLS
REGISTER OF WILLS
JAMES D. FLOWER
JOHN E. SLIKE
ROBERT C. SAIDIS
GEOFFREY S. SHUFF
JAMES D. FLOWER, JR.
CAROL J . LINDSAY
JOHNNA J. KOPECKY
KARL M. LEDEBOHM
JOSEPH L. HITCHINGS
THOMAS E. FLOWER
LAW OFFICES
SAID IS, SHUFF, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
2109 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011
TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407
EMAIL: attomey@ssfl-Iaw.com
www.ssfl-Iaw.com
CARLISLE OFFICE:
26 W. HIGH STREET
CARLISLE, PA 17013
TELEPHONE: (717)243-6222
FACSIMILE: (717)243-6486
REPLY TO CAMP HILL
November 6, 2001
Register of Wills
Cumberland County Courthouse
Carlisle, P A 17013
Re: The Estate of Salvatore Broccolo
Joint Asset Tax Return
Dear Ladies:
Enclosed please find an original and copies of an inheritance tax return to be filed for
Salvatore Broccolo, deceased. No estate has been raised as there is on non-probate property to
report. Also enclosed is a Dept. of Revenue Information Sheet and a check for the payment of
tax at discount.
Please return a time-stamped copy of the tax return to our office in the envelope
provided.
Thank you.
Very truly yours,
Isly
Enclosures
SAIDIS, SHUFF, FLOWER & LINDSAY
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!sh:I1,y ~ Yi~g, Estate Paralegal
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