HomeMy WebLinkAbout02-14-06
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
PEROCCHI RONALD R
2118 DOUGLAS DRIVE
CARLlSE, PA 17013
_u_____ fold
ESTATE INFORMATION: SSN: 176-32-5318
FILE NUMBER: 2105-0468
DECEDENT NAME: BROWN GLENWOOD
DATE OF PAYMENT: 02/14/2006
POSTMARK DATE: 02/14/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 05/18/2005
NO. CD 006323
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1,514.32
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TOTAL AMOUNT PAID:
REMARKS: RONALD R PEROCCHI
CHECK#1018
SEAL
INITIALS: CM
RECEIVED BY:
REGISTER OF WILLS
$1,514.32
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REV-1500 EX + (6-00)
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Brown Glenwood alkla Brown Sr. Glenwood
DATE OF DEATH (MM.-DD-Year) DATE OF BIRTH (MM-DD-Year)
05/18/2005 09/23/1922
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
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00 1. Original Return
o 4. Limited Estate
00 6. Decedent Died Testate (AttachcopyofWdl)
o 9. Litigation Proceeds Received
o 2. Supplemental Return
o 4a. Future Interest Compromise (date of death after 12- 12-82)
o 7. Decedent Maintained a Living Trost (Attach copy of Trust)
o 10. Spousal Poverty Credit (dale oddea\ll between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
FILE NUMBER
2 1 -0 5 0 4 6 8
COUNIY"'CciiiE ----vEAA- - - NuMBER- -
SOCIAL SECURITY NUMBER
1 76- 3 2 - 5 3 1 8
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Return (dateofdeatl1priorto12-13-82)
D 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach SGh 0)
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THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
NAME COMPLETE MAILING ADDRESS
William A. Duncan E Duncan & Hartman, P.C.
FIRM NAME (If Applicable)
Duncan & Hartman P.C. One Irvine Row
TELEPHONE NUMBER
717-249-7780 Carlisle PA' 17013
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash. Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Jointly Owned Property (Schedule F) (6)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7)
(Schedule G or L)
8. Total Gross ASS8t$ (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. Charttable 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)
X ~(15)
33.651.65 X .045 (16)
X .12 (17)
X .15 (18)
(19)
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
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
:>:> RI= ~IIRr= Tn AN~WI=R All nlU:~TlnN~ nN RFVr=R~F ~lnF ANn Rr=~I-fF~K MATI-f <. <.
127.392.25
OFFICIAL USE ONLY
0.00
29.707.10
,"i
21.694.30
'-
8.000.00
(8)
186.793.65
21 ,299.11
131,842.89
(11)
(12)
(13)
153,142.00
33,651.65
(14)
33.651.65
0.00
1.514.32
1 ,514.32
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Decedent's ample e ress:
STREET ADDRESS .
2122 Douglas Dnve
CITY I STATE I ZIP
Carlisle PA 17013
C It Add
Tax Payments and Credits:
1. Tax Due (Page 1 Une 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
1.514.32
Total Credits ( A + 8 + C) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
T ota/lnterest/Penalty ( 0 + 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 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 S + SA. This is the BALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................ 0 00
c. retain a reversionary interest; or ...................................................................................................... 0 00
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 00
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?................. .................... ,............................. ........................... 0 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. !Xl 0
4. Did decedent own an /ndividual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....... ........................................ ..................... ........ ..... ...................... 0 00
0.00
1,514.32
1,514.32
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
ADDRESS William A. Duncan, Esq.
One Irvine Row, Carlisle
PA 17013
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) (1.1) (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 exemot 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 P.S. ~9116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116(a)(1.3)). A sibling is defined, under Section 9102, as an
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REV-1502 EX + (6-98)
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Brown Glenwood alkla Brown. Sr Glenwood 21 05 0468
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
, exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real Drooertv which is iointlv-owned with riaht of survivorshlD must be disclosed on Schedule F.
SCHEDULE A
REAL ESTATE
ITEM
NUMBER
1.
DESCRIPTION
Property located at 2122 Douglas Drive, Carlisle, North Middleton, PA
See attached settlement statement
VALUE AT DATE
OF DEATH
127,392.25
TOTAL (Also enter on line 1, Recapitulation) $
127 392.25
REV-1508 EX + (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Brown Glenwood a/kla Brown ~r Glenwood 21 05
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
0468
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
See Attachment Page(s)
TOTAL (Also enter on line 5, Recapitulation) $
(If more sDace is needed. insert additional sheets of the same size\
29.707.10
Continuation of REV..1500 Inheritance Tax Return Resident Decedent
Brown, Glenwood, alkla Brown, Sr., Glenwood
Decedent's Name
Page 1
21 05 0468
File Number
Schedule E - Cash, Bank Deposits, & Misc. Personal Property
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14,
15.
DESCRIPTION
Personal Property, appraised by Ibis Appraisal Services (see attached summary).
VALUE AT DATE
OF DEATH
2,818.52
1994 FordlWinnebago VIN no. 3FCMF53G4RJB00765 (see attached Bill of Sale).
13,250.00
Members First Federal Credit Union, savings account no. 23874-00
39.45
Members First Federal Credit Union, checking account no. 23874-11
Principal - $4,125.23
Interest - $.50
Members First Federal Credit Union, Certificate of Deposit no. 23874-42
Principal- $1,186.60
Interest - $.64
Sovereign Bank, savings for minors account no. 1694005396
4,125.73
1,184.24
37.97
1990 Chrysler Automobile, proceeds of sale.
1,350.00
Currency & Coin.
2,758.24
M&T checking account no. 3740877133.
529.91
Metlife payment.
1,619.00
Metlife interest.
15.18
American Express travelers checks.
100.00
Erie Insurance Auto refund.
7.00
Erie Insurance Homeowners refund.
450.00
Countrywide Home Loans, escrow balance refund.
1,349.02
SUBTOTAL SCHEDULE E
29,634.26
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Brown, Glenwood, a/kla Brown. Sr.. Glenwood
Decedent's Name
Page 2
21 05 0468
File Number
Schedule E - Cash, Bank Deposits, & Misc. Personal Property
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
16. Comcast refund. 16.95
17. Sprint refund. 55.89
SUBTOTALSCHEDUlEE 72.84
GRAND TOTAL SCHEDULE E $ 29;707.10
REV-1509 EX + (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTL V-OWNED PROPERTY
ESTATE OF
Brown Glenwood a/kla Brown Sr Glenwood
FILE NUMBER
21 05
0468
If an asset was made joint within one year of the decedenrs date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Chris Junior Brown
c/o laura Lawrence
1109 5th Ave.- # 303
New Kensington, PA 15068
Grandson
B Glenwood Brown, Jr.
c/o Cumberland County Prison
1101 Claremont Road
Carlisle, PA 17013
Son
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECD'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 1/1999 United States Savings Bond L5743562741EE 32.20 50. 16.10
Face Value ($50.00)
2. A. 1/1999 United States Savings Bond C661837831EE 64.40 50. 32.20
Face Value ($100.00)
3. A. 11/1999 United States Savings Bond M73429157EE 620.00 50. 310.00
Face Value ($1,000.00)
4. A. 11/1999 United States Savings Bond M73429156EE 620.00 50. 310.00
Face Value ($1,000.00)
5. A. 10/2000 United States Savings Bond D56488725EE 296.40 50. 148.20
Face Value ($500.00)
6. A. 12/2000 United States Savings Bond D56578448EE 290.80 50. 145.40
Face Value ($500.00)
7. A. 5/2001 United States Savings Bond V5781440EE 2,838.00 50. 1,419.00
Face Value ($5,000.00)
8. A. 5/2001 United States Savings Bond X5661748EE 5,676.00 50. 2,838.00
Face Value ($10,000.00)
9. A. 5/2001 United States Savings Bond X5661749EE 5,676.00 50. 2,838.00
Face Value ($10,000.00)
10. A. 4/2004 United States Savings Bond M80085382EE 511.20 50. 255.60
Face Value ($1,000.00)
TOTAL (Also enter on line 6, Recapitulation) $ 21 694.30
(If mnr" .::n,,('Q i.:: "",,",," in.::,," ""Iii/inn". .::h",,'" nf Ih" .::"m" '::;7")
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Brown, Glenwood, aJkJa Brown, Sr., Glenwood
Decedent's Name.
Page 3
21 05 0468
File Number
Schedule F-2 - Jointly-Owned Property
LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL Y.HELD REAl ESTATE. VALUE OF ASSET INTEREST DECEDENrSINTERES
11. A 3/2004 United States Savings Bond M80085383EE 512.40 50. 256.20
Face Value ($1,OOO.00)
12. A 4/2004 United States Savings Bond V6346053EE 2,556.00 50. 1,278.00
Face Value ($5,000.00)
13. A 4/2004 United States Savings Bond V6346050EE 2,556.00 50. 1,278.00
Face Value ($5,000.00)
14. A 4/2004 United States Savings Bond V6346052EE 2,556.00 50. 1,278.00
Face Value ($5,000.00)
15. A 4/2004 United States Savings Bond V6346051 EE 2,556.00 50. 1,278.00
Face Value ($5,000.00)
16. B. 1/1995 United States Savings Bond M64758395EE 779.60 50. 389.80
Face Value ($1,000.00)
17. B. 3/1992 United States Savings Bond M43908711 EE 1,057.60 50. 528.80
Face Value ($1,000.00)
18. B. 5/2001 United States Savings Bond V5781439EE 2,838.00 50. 1,419.00
Face Value ($5,000.00)
19. B. 5/2001 United States Savings Bond X5661751 EE 5,676.00 50. 2,838.00
Face Value ($10,000.00)
20. B. 5/2001 United States Savings Bond X5661750EE 5,676.00 50. 2,838.00
Face Value ($10,000.00)
DOCUMENTATION ATTACHED FOR ABOVE
SAVINGS BONDS
0.00
SUBTOTAL SCHEDULE f-2 13,381.80
GRAND TOTAL SCHEDULE f-2 $ 21,694.30
REV-1510 EX + (6-98)
'*
SCHEDULE G
INTER..vIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brown Glenwood aJkla Brown Sr. Glenwood
FILE NUMBER
21 05
0468
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INQUDE THE NAME OF lHE TRANSfEREE. lHEIR RElATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE OEED fOR REAl ESTATE. VALUE OF ASSET INTEREST VALUE
(If APPliCABlE)
1. Chris Junior Brown 5,000.00 100. 3,000.00 2,000.00
United States Savings Bond X632205EE
Face Value ($10,000.00)
2. Chris Junior Brown 5,000.00 100. 0.00 5,000.00
United States Savings Bond X6232204EE
Face Value ($10,000.00)
3. Chris Junior Brown 500.00 100. 0.00 500.00
United States Savings Bond M41211842EE
Face Value ($1,000.00)
4. Chris Junior Brown 500.00 100. 0.00 500.00
United States Savings Bond M41211843EE
Face Value ($1,000.00)
DOCUMENTATION ATTACHED FOR ABOVE
SAVINGS BONDS
TOTAL (Also enter on line 7 Recapitulation) $ 8000.00
REV-1511 EX+ (12-99)
'*
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
FILE NUMB R
21 05
Brown -.
a/k/a Brown Sr. Glenwc>od
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
DESCRIPTION
FUNERAL EXPENSES:
Hoffman-Roth Funeral Home, professional services.
1.
B.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (5) Ronald R. Perocchi
Social Security Number(s)/EIN Number of Personal Representative(s)
StreetAddress 2118 DouQlas Drive
City Carlisle
Zip 170131
1.
266-90-4409
,
State P A
2.
3.
Year(5) Commission Paid: 2005
AttomeyFees Duncan & Hartman, P.C.
Family Exemption: (If decedenf5 address is not the same as c1aimanfs, attach explanation)
Claimant
,
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
Probate Fees to date: $162.00
In Reserve: $500.00 - First & Final Accounting Costs for Court Approval
Accountanfs Fees
5.
6.
Tax Return Prepare!'s Fees
7.
8.
9.
The Sentinel - Legal, advertise Letters
Cumberland Law Journal, advertise Letters
Ibis Appraisal Services Fee
i
TOTAL (Also enter on line 9, Retapit lation) $
(If more space is needed, insert additional sheets of the same size)
0468
AMOUNT
5,665.40
5,000.00
9,339.68
662.00
137.03
75.00
420.00
21299.11
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Brown, Glenwood, a/kla Brown, Sr., Glenwood
Decedent's Name
Page 4
21 05 0468
File Number
Schedule I ~ Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
DESCRIPTION
Countrywide Home Loans, mortgage payment.
AMOUNT
971.83
Hilton's Lock Service, drill safe open.
65.00
Silver Spring Ambulance, invoice.
41.25
Central Penn Medical Group Emergency, invoice.
29.20
North Middleton Authority, water/sewer invoice.
83.90
Sprint. telephone invoice.
55.89
Comcast, cable invoice.
16.95
PPL Electric Utilities, invoice.
150.00
PPL Electric Utilities, final invoice.
576.29
Sprint, final invoice.
52.12
Sollenberger's Messenger Service, Winnebago registration fee.
93.00
Neighborcare Pharmacy Services, Inc. (see attached invoice).
787.03
AT&T Wireless - Palisades Collection LLC (see attached invoice).
1,648.99
ManorCare Carlisle 372 (see attached invoice).
5,397.22
Bank of America acct. # 4305500395588042 (see attached letter).
2,836.37
SUBTOTAL SCHEDULE I
12,805.04
Continuation of REV.1500 Inheritance Tax Return Resident Decedent
Brown, Glenwood, alkla Brown, Sr., Glenwood
Decedent's Name
Page 5
21 05 0468
File Number
Schedule I - Debts of Decedent, Mortgage Liabilities, & Liens
ITEM
NUMBER DESCRIPTION AMOUNT
16. Family Practice Associates - Credit Collection Services (see attached invoice). 270.92
17. Countrywide Home Loans, account #020191351 - Home Mortgage (see HUD-1). 113,074.51
18. Notary Fee - Sale of Home (see HUD-1). 4.00
19. Realty Commission - Sale of Home - Dawn Realty (see HUD-1). 3,600.00
20. Transaction Fee - Sale of Home - Dawn Realty (see HUD-1). 175.00
21. Attorney's Fees - Sale of Home - Duncan & Hartman, P.C. (see HUD-1). 250.00
22. OvernightIWire Fee - Sale of Home (see HUD-1). 15.00
23. Transfer Fees - Sale of Home (see HUD-1). 1,272.00
24. Final WaterlSewerBilling - Sale of Home (see HUD-1). 262.16
25. School Tax Liability - Sale of Home (see HUD-1). 114.26
SUBTOTAL SCHEDULE I 119,037.85
GRAND TOTAL SCHEDULE I $ 131,842.89
REV.''''''''"
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
21
RELATIONSHIP TO DECEDENT
00 Not List Trustee(s)
NUMBER
I.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS pnclude outright Spousal disbibutions. and transfers under
Sec. 9116 (a) (1.2)]
Glenwood Brown, Jr. c/o Cumberland County Prison
1101 Claremont Road
Carlisle, PA 17013
Chris Junior Brown c/o Laura Lawrence
1109 5th Ave.- # 303
New Kensington, PA 15068
Grandson
1.
Son
2.
AMOUNT OR SHARE
OF ESTATE
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.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
GLENWOOD BROWN, Sr.
I, Glenwood Brown, Sr., of Cumberland County, Pennsylvania, being of sound
and disposing mind, memory and understanding, do hereby 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 direct the payment of my debts and the expenses of my last illness and funeral
from my estate as soon after my death as conveniently may be done.
Further, in this connection, I authorize my personal representative to expend
funds from my estate, in such amount as my personal representative shall consider
necessary and desirable for the purchase, erection and inscription of a suitable marker for
my grave.
SECOND
I give to my daughter Susanne Clemens, Haupt Strasse 50, 56379 Singhofen,
Germany, telephone 011-49-2604-954335, a Diamond Ring Set.
My Executor shall set aside for my Son, Glenwood Brown, Jr., SSN
A sum of $5,000 to be distributed as the Executor sees fit once my Son, Glenwood
Brown, Jr. has been drug free for 3 years.
The balance of my entire estate, real, personal or mixed, wherever situate, I give,
devise ansl-..pe.., --j;}.~ ~~a.~lf'100%.o to~dsO:~~i..S J~or Br~wn. ' ~) 508, born
~~V~~-:7--~~/ '_.. .~ ~./~~ Vi fr/ ~;j
l/
November 21,1998.
My Trustee shall hold the property for my grandson until he reaches the age of
Twenty-one (21) years. In order to receive any funds, my grandson must submit to
random drug tests and be free of drugs for a period of three years. Ifhe does this, my
Executor, in his sole discretion, may distribute some or all of the property in his trust,
provided that all the property be distributed within three years.
This money is not be used for the health, education, maintenance and support of
my Grandson, Chris Junior Brown.
In the event that my grandson dies or fails to remain free of drugs, for the relevant
time frame, at the time he attains the ago of35, his trust shall be divided equally between
my son, Glenwood Brown, Jr., and my daughter Susanne Clemens. My son has to be
drug free for 3 consecutive years. Random drug testing will be done at my Executor's
discretion.
TIDRD
I appoint, Ronald R. Perocchi, 2118 Douglas Drive, Carlisle, PA 17013, as my
Executor. I appoint Raymond Kosciolek of 501 Mountain Rd., MarysvilIe, PA. as the
Alternate Executor. The Executor Fee shall be the amount offive thousand dollars
($5000).
FOURTH
In addition to the powers conferred by law, I authorize my Executor, in his
Absolute discretion:
A. T,o~r ,t . jp,the fi,,~orm,., ~~d, and to sdl either a,,1,fm, bli(( or,pr.ivate sale
/'" I - /~ _ - ;;t;;:r..-r~'--~ A<!: ~r / ~ ~~ .?
. 'I4-(.-tr,;-u-"..;- .?' , ~ <' .'. - , "Y c3
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any real or personal property.
B. To purchase Government Savings Bonds for Chris Junior Brown.
C. To exercise any option or rights arising from ownership of investments.
D. To compromise claims without court approval, and without the consent of
any beneficiary.
FIFTH
I have served in the Armed Forces of the United States. I therefore request that
My Executor make appropriate inquiries to ascertain whether there are any benefits to
which I, my dependents or my heirs may be entitled by virtue of any military affiliation.
I specifically request that my Executor consult with a retired affairs officer at the nearest
Military installation, the Department of V eterans Affairs, and the Social Security
Administration.
IN WITNESS WHEREOF, I GLENWOOD BROWN SR., sign my name and
t1t
e day
publish and declare this instrument as my last will and testament this
of Itf'r d
,2005. I also have affixed my signature on the bottom of each
of the preceding pages hereof.
..--;7
~~~~R.~
A. SETTLEMENT STATEMENT
U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT
HUr
OMB No. 2502-0:
B. T e of Loan
1. o FHA 2. OFmHA 3. DConv. Unins.
4. OVA 5. DConv. Ins.
6. File Number:
RE05-144
7. Loan Number:
0507224222
8. Mortgage Insurance Case Numbei
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items
marked "(p.o. c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals.
D. Name and Address of Borrower(s):
Jennifer Machin
E. Name and Address of Seller(s):
Estae of Glenwood Brown
234 Marion Avenue
1 Irvine Row
475 Kilvert Street, Suite 300
Warwick, RI 02886
Piace of Selllement:
1 Irvine Row, Carlisle, PA 17013
G. Property Location:
2122 Douglas Drive, Carlisle, Pennsylvania 17013
North Middleton Township, Cumberland County
29-16-1 094-300
F. Name and Address of Lender:
Accredited Home Lenders
H. Name of Settlement Agent:
Duncan & Hartman, P.C.
I. Settlement Date:
7-28-2005
Funding Date:
7-28-2005
103.
104.
105.
106. Cit ftown taxes
107. Count taxes
to
7-28-2005 to 12-31-2005
12-31-2005
192.25
5578.16
24,635.B6 113,074.51
205. 505. Payoff of second mortgage loan
206. Seller credit to Bu er
7200.00 506. Seller credit taBu er
7 200.00
20B.
209.
508.
509.
"r:~{q;1~~'~~f%!?fJ~~4~~
210. CII ftown taxes
211. Coun taxes
212. Assessments
510. Ci ftown taxes
511. Count taxes
512. Assessments
214.
215.
127 392.25
1,42532
100 .,"",' .,,' ,.,' 'i": :"">'::"'>:""';'">"""" Paid From Paid From
based on nrice!!. (,'j) % - Borrowers Seller's
-' fHft~ 7nm ~o '~II~,",o' Funds al Funds al
701, $ 3 600.00 to Dawn Realtv Settlement Settlement
702. $ to
~M "I ROO.Q
70.1 ~. -".- 1=,... R
801. Loan Orioination Fee % to American Advantane Mortnaoe Services LLC 1 667,60
"n? , ~~ft n;O~~"ft' 01.. In
803. Appraisal Fee American Advantaoe Mortnaoe Services LLC 300.00
804. Credit Renort American Advantaoe Mortoaoe Services LLC 14.16
"n~
806. Document Preoaration Fee
807, Flood Certification
808. Tax Service Fee
"no L"n"'" .C::""'ir" 1""" ,,- '-~-ro 77n "n
810.
811.
"'?
813
814
'&;',,c
901. Interest from 7-28-2005 to 8- 1-2005 (,'j) $ 20.2100 /dav 80.84
902. Mortnane insurance "remium for months to
903. Hazard insurance nremium for vearl S \ to
anA
on"
.'"rit\';.
1nn1 1-1""" ;M."~n~" ." " "'" ",nnlh
1002. Mortnane insurance months (Q) $ ner month
1003, Citv nronerlv taxes months (Q) $ ner month
1004, Countv nronerlv taxes months (Q) s: oer month
<M' mnnlh~ (,'j) s: n", ",nft.h
1006: School taxes months (Q) $ ner month
1007. months @ $ ner month
,nno
,e'
1101. Settlement or closinn fee to
1102. Abstract or title search to
11n~ T;II"
1104. Title insurance binder to
1105. Document nrenaration to
11nl': , In (,~.h 1n nn .I nn
1107, Attorney's fees to Duncan & Hartman, P.C, 250.00
(jncludes above item numbers: I
1108. Title insurance to William A. Duncan, Agent for Fidelity National Title 998.75
{;M'''.....:;, """'...~.o. 111'11-111'1.1 \ --
1109. Lender's coverane $ 101 760.00 Premium $
1110. Owner's coverane s: 127200.00 Premium $ 998.75
<<" ~nn '" In l=i""litv N,,'inn,,1 Tal~
1112. Closino Protection Letter to Fidelitv National Title 35,001
1113. OverninhlANire I"ee In Duncan' . . PC . 1!i.OO
<Mn. ?
1201. Recordino fees: Deed 38.50 Mortoaoe 64.50 Release 0.00 103.00
1202. Citv/countv tax/stamns: 1 272.00
1203. State tax/stamns: 1 272.00
1?nd
1?n<;
s
1"1n1 ~~ nn
1302,2005 School RE, Taxes Robin Sollenberoer Tax Collector 1 544.68
1303. Final Water/Sewer North Middleton Townshin 262.16
1304
1305,
1400. Total Settlement Charaes lenter on lines 103 Section J and 502 Section K\ 7,216.53 5,578.16
CERTIFICATION: I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and
accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I received a copy
.--oiJhe HUD-1 Settlement Stat~ent.
/ i // /-,p~ ....
l .. ,,:-/ .____. .. ;/'7IJ
:"'0 .... ./ (,;\..,,,--,-F\!'--7'\- // C-8-c-C'jL--,--_
Signature of Beriower Signature of Borrower
Signature of Seller
O'...--4tJ t' ,~-,.:-.--i, ('if 6C
<B,...c~u.-1 t&::,.k.Lz..
Signature of Seller
The HUD-1 Settiement Slatement which I have prepared is a true and accurate account of the funds disb<vsed or to be disbursed by the
undersigned as p of It s ttlem nt of this transaction, . j.:"-- / _ ~
-r '.",,\ /- J ':7"
r /// . L /./!,; / V 1
( Oa(\!
WARNING It is a crime to knowingly make false statements to the United States on this or any other similar form, Penalties upon conviction
can include a fine and imprisionment. For details see: Title 18 U,S, Code Section 1001 and Section 1010.
APPRAISAL SUMMARY
It is in my opinion, that as of d.o.d. May 18,2005, the Fair Market Value of the personal
property of Glenwood Brown, Sr., deceased:
(Two Thousand Eight Hundred Eighteen Dollars and Fifty Two Cents)
($2818.52)
The report must be read in its entiretv. The Appraisal Summarv ONL Y is
not the appraisal report.
4
Duncan & Hartman, P.C.
Attorneys at Law
One Irvine Row
Carlisle, Pennsylvania 17013
William A. Duncan
Susan 1. Hartman
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INTEREST CEASES 30 YEARS
FROM ISSUE DATE
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~GLEN~OOD aROWN JR
21?2 Jl0lJ,GLAS DR
CARLISLE, .. . PA170 13-1023
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DAYS OUTSTANDING
AGED BALANCE
~tJ:J NeigR!?f!E~i~~TM
. 3419 CONCORD RD.
YORK, PA 17403
CPDP#: 3972634
HONE: 888-565-6708
HOURS: M-F 8:30 AM - 5:00 PM
Bill FOR SERVICES PAGE: 1 of 1
787.03
0.00 $787.03
'11I1ti 1111111111111 In 11111111111 1111111 llti 1111 11111 111111111 11111 11111 II~ liD
STATEMENT OF PHARMACY CHARGES
~ NeighborCareTM
~ Pharmacy Services
· 3419 CONCORD RD.
YORK, PA 17403
NCPDP#: 3972634
IF PAYING BY MASTERCARD, DISCOVER, VISA OR AMERICAN EXPRESS, FILL OUT BELOW.
CHECK CARD USING FOR PAYMENT
o .' 0 ~O
MASTERCARD DISCOVER: Sf VISA
. .
CARD NUMBER
SIGNATURE
ru
rr-
......
w
w
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TEMP-RETURN SERVICE REQUESTED
PHONE: 888-565-6708
HOURS: M-F 8:30 AM - 5:00 PM
o Please check box if below address is incorrect or insurance
information has changed, and indicate change(s) on reverse side.
ADDRESSEE:
09/20/05
ACCOUNT NO.
21-24251
08/31/05
AMOUNT DUE
$787.03
. .
'. .
30713'1M20XB9PB000329 PLEASE DETACH AND RETURN THIS PORTION WITH YOUR PAYMENT
MAKE CHECKS PAYABLE TO: 652546A
,
-::;
11..111...111" II. .11..11"111.11... '11111.1" III", ,,11,1. .11
GLENWOOD BROWN
C/O WILLIAM DUNCAN, ESQ
1 IRVINE ROW
CARLISLE, PA 17013-3019
I. ..111.111' ..111 ".1.1.1.1. .1.1.11111.11111111111.111.1111..1
NEIGHBORCARE PHARMACY SERVICES, INC.
BOX 8900
PHILADELPHIA, PA 19175-8900
45100000021-2425100000000000000000000000787038
Account #:
Creditor:
Original Creditor:
Client Account #:
fIJAIliedlnterstate
Inc
3000 Corporate Exchange Dr 5th Floor Columbus. OH 43231
Toll Free (877) 350-9713 Fax (614) 865-2827
P21530530
PALISADES COLLECTION LLC
AT&T Wireless
0032680603
Amount Due: $1648.99
Date: January 06, 2006
Dear Glenwood Brown:
Allie~ Il)terstate has .b~en ~etained to r~~over the outst~nding amo.unt that is owed ~s referenced above. Your creditor
has rndlcated that thiS IS a Just and legItimate debt and IS takrng thiS matter very senously. In turn, they trust that you will
do the same.
Our collection agreement with our client mandates that we conduct collection activity in accordance with applicable state
and federal laws. This initial letter is the beginning of our collection process designed to focus upon the consequences of
your failure to pay this debt.
However, we believe that if we both work together we can help you change the status of this delinquency. Therefore, we
propose one of the following:
1) Your check for $1648.99 will change the status of this account to reflect full payment. All inquiring credit
grantors will be advised by your creditor that this debt has been satisfied.
2) Your check for $989.39 will change the status of this account to reflect that this matter is settled. This offer of
settlement will expire in 35 days from the date of this letter. If you choose this option you will be released of
any further liability with regard to this account and all inquiring credit grantors wifl be advised by your creditor
accordingly.
Take advantage of this exceptional opportunity by returning this notice with your payment in the envelope provided.
Unless you notify this office within 30 days after receiving this notice that you dispute the validity of this debt or any
portion thereof, this office will assume this debt is valid. If you notify this office in writing within 30 days from
receiving this notice that you dispute the validity of this debt or any portion thereof, this office will obtain verification
of the debt or obtain a copy of a judgment and mail you a copy of such judgment or verification. If you request this
office in writing within 30 days after receiving this notice, this office will provide you with the name and address of
the original creditor, if different from the current creditor.
We are a debt collector attempting to collect a debt and any information obtained will be used for that purpose.
Please note that if your financial institution rejects and returns your payments for any reason, a service fee - the
maximum permitted by applicable law - may be added to your balance.
Sincerely,
Consumer Services Department
-------------------------------------------------------------------------____iQ~i~f.~_9_I]QL~i!!!!LIM!~_B91rD~[tU_________________________________________________________________________
Undeliverable Mail Only: DCC99
P.O. Box 1954
Southgate, MI 48195-0954
/11111111111111111111111111111111111111111111111111111111111111111III/
CCD/P21530530/DCC99 002110626922 001804010064
I..." 1...1 11......11..1111'" .11""1111I.11111'11...11.1..11
Glenwood Brown
Glenwood Brown
1 Irvine Row
Carlisle, PA 17013-3019
Regarding: PALISADES COLLECTION LLC
Client Account #: 0032680603
Amount Due: $1648.99
Date: January 06,2006
Amount Remitted $
P21530530
Allied Interstate, Inc.
P.O. Box 361774
Columbus, OH 43236
1.1..1..11...1.1..11,.11"11,1" ,..11...1,1..1..11.1
HCReManorCare
MANORCARE CARLISLE 372
940 WALNUT BOTTOM ROAD
CARLC'::~Lt, P(~
( l .1 / ) '''.- ? 4 9 ~~. (; (, f3 !S
1. l ~~I:I. :3
(-.IJLLlfiM DtJNC/\N
fHE ESTATE OF GLfNNWOOO BROWN
1 TP\lIN HOl.oJ
C;,\F(LTSLF, PA
HOSPICE
PHI\"I~TE
POO~lj 1'18 /)j
17013
f3ROt,.JN., GLENlrJOOD
,;!42':=)1
04/04/05 05/18/05 10/31/05
":-.;;':;.(.:_:~)l-;~~::,
li3/0:L/~jS
(~I)j3'j/Q)5
\)4 j:JI:) !f'C;
Br~LANCf FOrd,.JAr?!)
ADJ REV R & B 4/22-4/30
AOJ R & B 4/21-4/30-05
5,le4,29
1'l9J..S",7f!
2,12B.67
1:, :f~
PAYMENT DUE UPON RECEIPl
f:J!, :";9'-/ y 2.?
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WELTMAN, WEINBERG & REIS CO., L.P.A.
.~
BURLINGTON, NJ
609.914.0437
CHICAGO,IL
847.9409812
CINCINNATI,08
513.723.2200
COLUMBUS, 08
614.228.7272
DETROIT, MI
248.362.6100
PHILADELPHIA, PA
215.599.1500
PITTSBURGH, PA
412.434.7955
ATTORNEYS AT LAW
323 W. Lakeside Avenue, Suite 200
Cleveland, Ohio 44113-1099
216.685.1000
www.weltman.com
July 6, 2005
CERTIFIED MAIL
Ronald Perocchi-Executrix
2118 Douglas Dr
Carlisle P A 17013
Re: Estate of Glenwood Brown
Case No. 212005
Our Client: Bank of America, N.A.
Account No. 4305500395588042
Balance Due: $2,836.37
Our File No. 4390049
Dear Sir or Madam:
This law firm represents Bank of America, N.A. with respect to the claim which we wish to file in the estate of Glenwood
Brown. It is our understanding that you are the Attorney of the estate.
We are asking that you please accept our client's claim which is based upon its account number 4305500395588042 in the
amount of$2,836.37. As of the date ofthis letter, this is the amount due. '.
Please direct all correspondence and disbursements with respect to this estate directly to our office. It would also be
appreciated if you contact us to advise us when you anticipate making disbursements in this matter so that we may mark our
file for follow-up at that time.
Thanking you in advance for your cooperation in this matter.
This law firm is attempting to collect this debt for our client and any information obtained will be used for that purpose.
Lastly, do not hesitate to contact us to further discuss this matter.
Sincerely Yours, '.
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Legal Assistant
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Enclosures
cc: Ronald Perocchi-Executrix
William Duncan- regular mail
WWR#4390049
FORM 93-0.C. DIVISION
IN THE COURT OF COMMON PLEAS
of
CUMBERLAND, REGISTER OF WILLS, PENNSYLVANIA
ORPHANS' COURT DIVISION
IN RE: ESTATE
OF
No. 212005
G lenwood Brown
Deceased
For a credit card with Bank of America, N.A.,
Account No. 4305500395588042
CLAIM
To the Clerk of Orphans' Court Division:
Index and make proper entry in your official records of the claim of Bank of America. N.A.
c/o Weltman. Weinberg & Reis Co.. L.P.A.. 323 West Lakeside Avenue. Suite #200. Cleveland. Ohio 44113-1099
. (Claimant)
in the amount of $2.836.37
against the estate of the above named decedent.
This claim is filed under Section 3532 (b) (2) of the Probate, Estates and Fiduciaries Code.
The said decedent, who resided at 2122 Douglas Dr Carlisle P A 17013 , died on 05/17/05
(Address)
Written notice of this claim was given to Ronald Perocchi-Executrix & William Duncan on
(Personal representative, if any, or counsel)
2] 18 Douglas Dr Carlisle. P A 17013 & 1 Ervine Row Carlisle P A ] 70 13
Address or Personal Representative, if any, or counsel
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... '-" (Claimant)
Geraldine Cooper, Agent for the Claimant
c/o Weltman, Weinberg, & Reis Co., L.P.A.
323 W. Lakeside Ave., Suite200
Cleveland. Ohio 44113
(Claimant's Address)
Q;tji4'-
~
CREDIT COLLECTION SERVICES
(800) 697-2767
Address: Two Wells Avenue, Newton, MA 02459
Monday - Friday: 8:30AM-5:00PM E.S.T.
Touch-Tone Service: 24 hours-a-day. 7 days-a-week (Se Habla Espanol)
.
ACA
InlKAationaJ Atiod.zuio.
of Couuo.,.;.J cuu-....In<.
1/11111111/11111111111111111111111
Date: 09/15/05
File Number: 08008818274
#BWNBPRZ***17013
#0088182749800943#
GLENWOOD BROWN
2122 DOUGLAS DR
CARLISLE, PA 17013-1023
'11.11111111111111111111"111 II II. 1111'.'11"1111.' "I .11111.1
Test(s) ordered'by: FAMilY PRACTICE
ASSOC
DOS: 02104/2004
2778045452
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005602.0094, lOT01
.. NOTICE.. NOTICE.. NOTICE.. NOTICE ., NOTICE ..
FEDERAL LAW
Unless you notify this office within 30 days after receiving this notice that you dispute the validity
of the debt or any portion thereof, this office will assume this debt is valid. If you notify this office
in writing within 30 days from receiving this notice, this office will obtain verification of the debt or
obtain a copy of a judgment and mail you a copy of such judgment or verification. If you request
this office in writing within 30 days after receiving this notice, this office will provide you with the
name and address of the original creditor if different from the current creditor. This is an attempt
to collect a debt and any information obtained will be used for that purpose. This communication
has been sent by a debt collector.
Se Habla Espanol: Para su conveniencia, nuestro sitio para pagos en la red, el sistema de
respuesta de 24 horas con teltafono de tonos, y el personal bilingue de Representantes de
Servicio estan disponibles para asistirlo. Sfrvase visitar www.c~spa)'lIl.enlcQffi para pagar con
cheque 0 tarjeta de credito 0 lIame directamente al (800) 697-2767. Gracias.
EASY PAY: You can pay by check, credit card and/or establish a payment plan on-line via our
website: wWIN.c.c.spayment.~. Otherwise, call toll-free to either self-service your file or receive
live assistance from a CCS Service Representative.
MAILING INSTRUCTIONS: Payment should be remitted as referenced below. 81LQtbeL
corresPQodet:lce should be directed to: CCS, P.O. Box 9136. Needham Heights, MA 02494-9136.
Important: include your file number as referenced below to properly identify your file.
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