HomeMy WebLinkAbout02-06-06
REV.1500 EX + (6-00)
'*
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 6 9 1
COuNTY'Co5E -----nA~ - - NuMBER- -
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
HARLIN LOIS A.
DATE OF DEATH (MM-DD.Year)
DATE OF BIRTH (MM-DD-Year)
SOCIAL SECURITY NUMBER
1 1 1 - 1 6 - 7 875
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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05/06/2005 05/31/1926
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
00 1. Original Return
D 4. Limited Estate
D 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
D 2. Supplemental Return
D 4a, Future Interest Compromise (dale of death atter 12-12-82)
D 7, Decedent Maintained a Living Trust (Attach copy oITrust)
o 10, Spousal Poverty Credit (dale of death between 12-31-91 and 1-1.95)
o 3. Remainder Return (date of death prior to 12-13-82)
o 5, Federal Estate Tax Return ReqUired
_ 8, Total Number of Safe Deposit Boxes
o 11, Election to tax under See, 9113(A) (Attach Sch 0)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
JOHN H. BROUJOS 4 NORTH HANOVER STREET
FIRM NAME (If Applicable)
BROUJOS & GILROY, PC CARLISLE, PA 17013
TELEPHONE NUMBER
717 -243-457 4
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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)
(1 )
(2)
(3)
(4)
(5)
OFFICtAl.- USE ONLY
162,641.00
I
)
19,628.00
(6)
379,535.00
(8)
561,804.00
(7)
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)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15, Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
19. Tax Due
X _(15)
534,715.00 X .045 (16)
X .12 (17)
X 15 (18)
(19)
27,089.00
(11)
(12)
(13)
27,089.00
534,715.00
(14)
534,715.00
16. Amount of Line 14 taxable at lineal rate
24,062.18
24,062.1 f
17. Amount of Line 14 taxable at sibling rate
20, D
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
18. Amount of Line 14 taxable at collateral rate
C2/Bl/2006 69:44
7177531888
JACK GREn~WOOD
LOIS A. Harlin Estate
Page 2
BMA-849480: D Oy., -- Q ~\: ~. ;- 'e...2 (l.... c'-~.
Stock/Mu1Lla! Funq
No. Shares
Price ~/6/0~
~
Agere Systems A
Agere Systems B
Prime Fund (money market)
American Balanced A 775.817
American Capital World G&I A 724.638
Fidelity Adv. Balanced T 664.532
American Income Fund of Am. A 4036598
Washington Mutuallnv. A 333.719
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1.24
1.25
26
17.64
33.51
15.79
18.14
30.12
Total
MFS Muni PA Bond Fund, 900144: 1375.823
10.24
Total Nori-qualified accoul'1ts
..---
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If YI..'>u have any questions. please don't hesitate to give me a call.
Sincerely.
PatricIa l. McEvoy, RpSM
Licensed Sales Assistant
cc: John Broujos
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Pt,GE 03/134
June 29, 2005
.I.9ta!
$ 1.24
$ 32.50
$ 16;181.87
$ 13,685.41
$ 24,282.62
$ 10,492.96
$ 73,223.89
L10,051,62
$148,552.11
$ 14.088.43
$ 162,640.54
.. 02/011:;:'00E, 89: 44
71 77S31 880
2~' Sentte ~'1enJe, Suite 303
Canw Mill Pp.nr:syl\'<I~la H011
717.~~3',36,'i r.1Ct :m ,~17_76:F B8D F~x
717-249-3143 Res'de"c~
Igreerw,}Q,)drWfhs\,cs,c".m ' '."Iww.Vlieniten.corr:
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J{~CK GREE~.jl,'JiJOD
July 13. 2005
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\'!JIENI<EN,~,ASSOC ATES
Va Fax 243-8227
Me John H. Broujos
Broujos & Gilroy, PC
4 North Hanover Street
Carlisle, P,A, 17013
Re: Lois Harlin Estc::te
Dear Jotm;
PAGE 12,4/04
.I~ck R. ~rnnwoDd. elU. CFP"
M1nanir'Ci F',lI1!Jcr
.r.As...,mrreflTIeSn:rd-o~y.esterday, listed below is the account value for her
( ~ brokerage account. ~MA-8~64~01 rler date of death.~ 2005:
-- Securitv No. of Share~ ~.EllJe/sh 5/6;05 Value
Agere Sys ! nc A
Agere Sys I nc B
Avaya lnc
Lucent Tech Inc
AF Capitallnc Builder
AF Capital VVorld Gr & Inc
Income Fund of America
Opp Main Street
AF Intermediate Bond
Opp Strategic Inc
Prime Fund (money market)
IRA Account \/a!ue 5/6/2005:
2
52
16
200
1,654"067
2,170.901
2,077.162
1,602.279
6,189.708
10,061.596
S 1.24
51.2.5
$ 8.99
$ 2.58
$51.98
$33.51
$18.14
$34.48
$13.61
$ 4.26
~
$ 2.48
65.00
143,84
516.00
85,978.40
72,746.89
37,679.72
55,24658
84,241 .93
1.2,862.40
51.56
$379,534.80
if you have questions or need further infor~ation, please don't hesitate to call me at
249-6336, ext 338.
Sir; cer~
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pQa 1.:. Me voy, RpSM
Licensed Sales Assistant
cc: Gayle H K!uz, Executrix
James D Harlin, Executor
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\ ,/rck N. GrtJtInwocd If ., !ff(;/~~1.~1 P~~'w~$.!:?rt'ttj-Ia of vnd "ffCr!i ~f!lCll,''lti~.s thrau"h
\ MML :,w~h~ S','Ylt,.", 1.'1(:. 2'~ $m~t: ~\"'rl/P, S:iit83dJ. Camp;.NI. p.~ 17011
\ 71 !-'i'.~S.."'65 1~~'I':~tm""l AtW,SO,1/ Sa.'v:CC$ cff",~;J th:OiJrll' W""kifn & ASS~~,'Rtn
:, M" .1 Wi,ll/ron ~ A:;&Cei;lU FiflMci., S~r /lOr" gl;b~Id!lry. Wip.~~.7 Ii A~.1O;:,'litf.:'. Lfa..
.'t /lOt " t.llbsJd..,', or iffif/m af flAMe !,lNslfm S'rvlc~~, 1{1~. $p.r'l/l.l'~ "rr~rr'~ I'1rov(1l'1
WiOnXM & A$Siit:.Jtn. Ltd., 8,'1/ nQ~ .~~~n~.'Jfl!d (){ Mfmr. 1'l1(JU~'! Mrl4L !"\IC~~!$ .9flVi~~ /,"
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
HARLIN LOIS A.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
21
05
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
HOFFMAN ROTH FUNERAL HOME
1.
s.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s) Gayle Kluz and James D. Harlin, Jr. ($2,500 ea.)
Social Security Number(s)/EIN Number of Personal Representative(s) 513-52-2809 / 072-42-1439
Street Address 71 Partridqe Circle and 505 Greason Road ( respectively)
City Carlisle State PA Zip 17013
Year(s) Commission Paid 2006
1.
2.
3.
Attorney Fees John H. Broujos, BROUJOS & GILROY, P.C., 4 N Hanover St., Carlisle
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant _
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
Probate Fees
5.
Accountant's Fees
6.
Tax Return Preparer's Fees
7.
REGISTER OF WILLS - FILING FEES
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
0691
AMOUNT
5,989.00
5,000.00
15,500.00
550.0C
50.0
27,089.
",,,,,ex.,_
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
HARLIN LOIS A. 21 05 0691
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. DEBORAH DAVIS DAUGHTER 20%
1584 NEWVILLE ROAD
CARLISLE, PA 17013
2. CHRISTOPHER HARLIN SON 20%
2440 NORTH LAKEVIEW AVENUE, APT. 5F
CHICAGO, IL 60614
3. JAMES D. HARLIN, JR. SON 20%
505 GREASON ROAD
CARLISLE, PA 17013
4. GAYLE KLUZ DAUGHTER 20%
71 PARTRIDGE CIRCLE
CARLISLE, PA 17013
5. TRACEY SNYDER DAUGHTER 20%
1471 ST THOMAS I EDENVILLE ROAD
ST THOMAS, PA 17252
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1. k~
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. ~.a.
TOT AL OF PART II - ENTER TOT AL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
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CUtNTS cOP'(
-_._~._---.. '. ._----~,~.._-- ,--
&sf mill auik weshtment
of
mois 2\. ih;arliu
L WIS A. HARLINt a resident of and domiciled in the State of Florida, Social Security No.
111-16-7875, declare this to be my last Will and revoke all earlier Wills and Codicils.
ITEM I
Direction to Pay Claims
I direct that all valid claims against my estate be paid as soon as practicable after my death.
ITEM IT
~
Estate Taxes
~
My Personal Representative shall not pay expenses of my last illness, funeral, claims, costs
of administration and taxes assessed by reason of my death as I have directed for their payment
under the Trust Agreement hereafter mentioned, and I hereby confirm that direction.
ITEM ill
J
Separate Writing Clause
I give those items of tangible personal property to those persons described in a separate writing
dated subsequent to this Will as allowed by the Florida Statutes. If no such separate writing is
discovered within thirty (30) days after my death it shall be conclusively presumed that no such
separate writing exists.
ITEM IV
Residuary Estate
I give my residuary estate to the Trustee of THE LOIS A. HARLIN TRUST dated the same
date as this Will to be administered as part of this Trust. If this bequest and devise is ineffective, I
hereby incorporate said Trust by reference and make it a part hereof.
, .
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ITEM V
Appointment of Personal Representative
I appoint my daughter, GAYLE KLUZ and my son, JAMES D. HARLIN to be the Co-
Personal Representatives under this Will and I direct that they shall serve without bond.
ITEM VII
Powers
By way of illustration and not of limitation, and in addition to any powers granted to personal
representatives generally, my personal representative is specifically authorized and empowered with
respect to any property, real or personal, at any time held under any provision of this will: to allot,
allocate between principal and income, assign, borrow, buy, care for, collect, compromise claims,
contract with respect to, continue any business of mine, convey, convert, deal with, dispose ot: enter
into, exchange, hold, improve, incorporate any business of mine, invest, lease, manage, mortgage, grant
and exercise options with respect to, take possession ot: pledge, receive, release, repair, sell, sue for,
make distnbutions in cash or in kind or partly in each without regard to the income tax basis of such
asset and, in general, to exercise all of the powers in the management of my estate which any individual
could exercise in the management of similar property owned in its own right, upon such terms and
conditions as to my personal representative may deem best, and to execute and deliver any and all
instruments and to do all acts which my personal representative may deem proper or necessary to carry
out the purposes of this my Will, without being limited in any way by the specific grants of power
made, and without the necessity of a court order.
y ~SS WHEREOF, I have hereunto set my hand and affixed my seal this /,f day of'
, 2000.
C.
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WISA.HARLIN
2
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The foregoing Will was signed and declared by the said Testatrix as her Will in our presence,
and we, at her request, in her presence, and in the presence of each other, have subscribed our names
as witnesses on the above date.
Wi~~ ?cyO~
I I t:l 5'1 51./ ~ .s-l-~ ",Joe.}A
Witness Address
~~
itness Signature
RO'14:/ Jb I,p. ~I(d.. "FL 33l./11
~~ "5 fllavel-crt~ /LtI.
Witness Address
6~~~ ~4~r FL
Prepared by:
Kirk Grantham, Esq.
1860 Forest Hill Blvd.
Suite 105
West Palm Beach, FL 33406
(561) 966-6211
3
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- -----_.-....,-~-.----
PROOF OF WILL
STATE OF FLORIDA )
) SS:
COUNfYOFPALMBEACH )
WE, WIS A. HARLIN, c=1(~.K ~ ral1 +ha...... and CrOSS
J. 'T<.~~ fo.. ' the Testatrix and the witnesses respectively, whose names are signed to the
attached 0 foregomg mstrument, haVIng been sworn, declared to the undersIgned officer that the
Testatrix signed the instrument as her Will, that she signed, and that each of the witnesses, in the
presence of the Testatrix and in the presence of each oth~e A. wi# ~
LOIS A. HARLIN
~~ R~~,
/41~ c>
Witness Signature
+...~I<<.
*'JiiJf * ~~~~l~
....~.~~ 8cpir"May.19.2000
"'t Of f\..~
Subscribed and sworn to before me this I gth day of t~ ' 2000.
~K.~
Notary ~c, State ofFlonda
Prim or stamp name of notary public, oommission
number U1d date of expiration
Personally known O~u:J::rtifica1ion X
Type ofIdentification Produced: 0 . ' V"W) t..::1~~
4
REGISTER OF WILLS
CUMBERLAND County, Pennsylvania
CERTIFICATE OF GRANT OF LETTERS
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No. 2005-00691
Estate Of: LOIS A HARLIN
(FIrSt. Middle. ust)
PA No. 21-05-0691
a/k/a:
Late Of:
LOIS BORMAN HARLIN
NORTH MIDDLETON TOWNSHIP
CUMBERLAND COUNTY
Deceased
Social Securi ty No: 111-16-7875
WHEREAS, on the 3rd day of August 2005 an instrument dated
January 18th 2000 was admitted to probate as the last will of
LOIS A HARLIN
(First. Middle. ust)
a/k/ a LOIS BORMAN HARLIN
late of NORTH MIDDLETON TOWNSHIP, CUMBERLAND County,
who died on the 6th day of May 2005 and,
WHEREAS, a true copy of the will as probated is annexed hereto.
THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and
for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby
certify that I have this day granted Letters TESTAMENTARY to:
GA YLE H KLUZ and JAMES D HARLIN
who have duly qualified as EXECUTOR(RIX)
and have agreed to administer the estate according to law, all of which
fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,
CARLISLE, PENNSYL VANIA.
IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal
of my office on the 3rd day of August 2005.
**NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST)