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HomeMy WebLinkAbout04-06-06 1 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 21 -0 50639 ""'COUNTY"'Cc5DE --YEAr-- - - NUMBER- - I- Z W C w o w C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) GRAY RUTH A. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) SOCIAL SECURITY NUMBER 1 89- 0 9 - 8 446 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WillS SOCIAL SECURITY NUMBER w .... ~ ~CI) o It:~ W Q.o :z: 00 o fffi Q. 4( 07/06/20 5 04/16/1910 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A 001. Original Return D 4. Limited Estate 00 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received o 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) o 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required Q.. 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS KEITH D. WAGNER 6 E. MAIN STREET FIRM NAME (If Applicable) BRINSER WAGNER & ZIMMERMAN P.O. BOX 323 TELEPHONE NUMBER 717 838-6348 PALMYRA P A 17078 .... Z W o z o Q. CI) LU It: It: o o z o ~ <( ..J ::J I- 0: <( o w n:: 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) D 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) OFFICIAL USE ONLY 47,895.12 17,988.95 14. Net Value Subjectto Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ <( I- ::l 0.. :E o o >< <( I- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 19. Tax Due 0.00 X 0.00 (15) 0.00 X 0.45 (16) 0.00 X .12 (17) 77,399.98 X .15 (18) (19) 25,078.88 (8) 90,962.95 8,015.54 5,547.46 (11 ) (12) (13) 13,563.00 77,399.95 16. Amount of Line 14 taxable at lineal rate (14) 77,399.95 17. Amount of Line 14 taxable at sibling rate 0.00 0.00 0.00 11,610.00 11,610.00 18. Amount of line 14 taxable at collateral rate 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < REV-1503 EX + (6-98) .. SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRAY RUTH A. FILE NUMBER 21 05 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0639 ITEM NUMBER 1. DESCRIPTION PRUDENTIAL FINANCIAL INC. - 281 SHARES COMMON STOCK @ $67.01 PER SH. 2. FIRST ENERGY CORP. - 600 SHARES COMMON STOCK @ $48.44 PER SHARE 3. ZWEIG TOTAL RETURN FUND - 0.2547 SHARES @ $5.13 PER SHARE TOTAL $"'~ ~~ ,~S \)~ -1:\5 ~~\\ <y~ '\\~~\, \<- \( VALUE AT DATE OF DEATH 18,829.81 29,064.00 1.31 'ion) $ 47 895.12 (If more space is needed, insert additional sheets t __....., ~ILt::) REV-1508 EX + (6-98) * SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRAY. RUTH A. FILE NUMBER 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. 0639 ITEM NUMBER 1. DESCRIPTION PNC BANK - CHECKING ACCOUNT #5070099467 2. CHECK(S) ON HAND 3. CASH ON HAND 4. GUIDEPOST - REFUND 5. MISCELLANEOUS PERSONALTY 6. SOVEREIGN BANK - MONEY MARKET ACCOUNT #2331031495 (INCLUDES ACCRUED INTEREST OF $0.53) THE FIRST NATIONAL BANK OF LIVERPOOL - FUNERAL FUND #104250660 (INCLUDES ACCRUED INTEREST OF $1.76) CAPITAL BLUE CROSS - HEAL THCARE REIMBURSEMENTS 7. 8. 9. VETERANS ADMINISTRATION - REFUND OF OVERPAYMENT VALUE AT DATE OF DEATH 10,174.51 403.50 56.13 1.84 250.00 5,649.18 1,385.57 47.22 21.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 17 988.95 . REV-1510 EX + (6-98) . * COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRAY. RUTH A. SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21 05 0639 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 INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE} VALUE 1. MET LIFE - ANNUITY CONTRACT #A2044442 W/FOUR (4) 25,078.88 100. 25,078.88 INDIVIDUALS NAMED AS BENEFICIARIES , . TOTAL (Also enter on line 7 Recapitulation) $ 25 078.88 (If more space is needed, insert additional sheets of the same size) MetLifelnvestors" n Page' of 2 Annual Statement MetLife Investors USA Insurance Company ~~~~~~~~ Annuitant's Name RUTH A GRAY Contract Number A2044442 Annuity Type NonQua I i f i ad Plan Code 158AOO You may address questions to our Customer Service Dept at 1-800-284-4536 from 7:30am to 5:30pm CST (M-Th) and 7:30am to 5:00pm CST (FrO RUTH A GRAY 202 MESSIAH CIRCLE MECHANICSVILLE PA 17055-8619 PNC'/ XRX000282 _111.111,1.II.fll.I..'Jlllt.J.I..1 Beginning Accumulated Value (07/22/2004) Total Payments Total Withdrawals $25,086.03 $0.00 $748.24- Ending Accumulated Value (07/22/2005) Surrender Value (07/22/2005) $0.00 'fltlllllllllll $25,078.88 Total Fees When the contract has accumulated for more than 6 years, a 5% bonus will be applied to the annuity income. . REV-1511 EX + (12-99) * SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRAY RUTH A. FILE NUMBER 21 05 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION FUNERAL EXPENSES: JERRE WIRT BLANK FUNERAL HOME THE GARDEN PATH - FLOWERS CUMBERLAND COUNTY CORONER MESSIAH VILLAGE CHAPEL HONORARIUMS 1. 2. 3. 4. 5. B. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) GERALD J. BRINSER Social Security Number(s)/EIN Number of Personal Representative(s) 186-34-0218 StreetAddress 2360 HORSESHOE PIKE City ANNVILLE State PA Zip 17003 Year(s) Commission Paid: 2005/2006 1. 2. 3. · Attorney Fees BRINSER, WAGNER & ZIMMERMAN Family Exemption: (If decedenfs address is not the same as claimanfs, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State Zip 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. . Probate Fees REGISTER OF WILLS Accountanfs Fees Tax Return Preparer's Fees REGISTER OF WILLS - ADDITIONAL COST OF LETTERS REGISTER OF WILLS - INHERITANCE TAX RETURN FILING FEE REGISTER OF WILLS - INVENTORY FILING FEE THE SENTINEL - LEGAL ADVERTISING CUMBERLAND LAW JOURNAL - LEGAL ADVERTISING JONESTOWN BANK & TRUST CO. - MEDALLION SIGNATURE GUARANTEES BANK CHARGE FOR CHECKS TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0639 AMOUNT 1,815.25 109.12 25.00 100.00 225.00 3,300.00 2,000.00 140.00 45.00 15.00 15.00 93.47 75.00 50.00 7.70 8015.54 . REV-1512 EX + (6-98) *' SCHEDULE. DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF GRAY. RUTH A. FILE NUMBER 21 05 Include unreimbursed medical expenses. 0639 VALUE AT DATE OF DEATH ITEM NUMBER DESCRIPTION 1. ALERT PHARMACY 2. MESSIAH VILLAGE 3. BANKCARD SERVICES - CHARGE CARD 4. MARLIN A. YOHN, TREASURER - SCHOOL TAX 5. VERIZON - PHONE 6. MET LIFE - RETURN OF OVERPAYMENT 7. VETERANS ADMINISTRATION - MEDICAL 8. U.S. TREASURY - 2004 INCOME TAX (FORM 1040) 9. PA. DEPARTMENT OF REVENUE - 2004 INCOME TAX (FORM PA 40) 10. PA. DEPARTMENT OF REVENUE - 2005 INCOME TAXES (FORM PA 40) 288.49 4,375.54 273.80 9.80 5.95 60.88 140.00 146.00 233.00 14.00 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 5 547.46 . REv.,513EX+(* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES FILE NUMBER GRAY R JTH A. 21 05 0639 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. CAROL ANN HAMIL TON Collateral 9,893.75 3804 SUNSET DRIVE, HARRISBURG, PA 17111 2. TERRANCE M. SHINGARA Collateral 9,643.75 5007 OHIO AVENUE, HARRISBURG, PA 17109 3. ANTHONY SHINGARA Collateral 9,643.75 28 THORNWOOD ROAD, HARRISBURG, PA 17112 4. NICOLE SMITH Collateral 9,643.75 5 GLENWOOD AVENUE, NORTHAMPTON, MA 01060 5. KRISTIN DeFRANCISCO Collateral 6,429.16 2154 DATURA STREET, SARASOTA, FL 34239-3911 6. KIM GIACCARDO Collateral 6,429.16 3745 BREEZEMONT DRIVE, SARASOTA, FL 34232 7. CHARLES DUFFY Collateral 6,429.16 1200 BELLEFLOWER STREET, SARASOTA, FL 34232 . 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 11- 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) Continuation of REV-1500 Inheritance Tax Return Resident Decedent GRAY, RUTH A. Decedent's Name Page 1 21 05 0639 File Number Schedule J - Beneficiaries - 1 RELA TIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include outright spousal distributions) 8. DENNIS DUFF Collateral 9,643.75 13130 SANTA YSABEL DRIVE, DESERT HOT SPRINGS, CA 9. JOHN GRAY Collateral 9,643.75 419 EUTAW AVENUE, NEW CUMBERLAND, PA 17070 I . : ." ~..--"0.r....,. I ' ' I ~7' '..- -f WILL OF RUTH A. GRAY I, RUTH A. GRAY, currently of Upper Allen Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. III. I bequeath unto my grandniece, Carol Ann Hamilton, all tangible personal property which I own at my death. IV. All the rest, residue and remainder of my estate, of whatever nature and wherever situate, including property over which I hold a power of appointment, I devise and bequeath as follows: A. Twenty-five percent (25%) to be divided equally between my nephews, Terrance M. Shingara and Anthony Shingara, or the survivor of them. B. Twenty-five percent (25%) to be divided equally between my grandniece, Carol Ann Hamilton, and her daughter, Nicole Smith, or the survivor of them. C. Twenty-five percent (25%) to be divided equally among the children of my niece, Mollie Lou Duffy, who survive me. ~ -1- ~j:mL K. .~ ~ ~ ; ... D. Twenty-five percent (25%) to be divided equally between my niece and nephew, Denise Duffy and John J. Gray, or the survivor of them. V. I appoint Gerald J. Brinser, Esquire, as Executor of this my Will. In the event that he fails to qualify or ceases to act as Executor I appoint Keith D. Wagner, Esquire, Executor in his place. VI. I direct that no bond be required of my fiduciary for the faithful performance of his duties in any jurisdiction. IN WITNESS WHEREOF, I, RUTH A. GRAY, herewith set my hand to this my Last Will, typewritten on two (2) sheets of paper including the attestation clause and signatures of witnesses, this t3ft., day of April, 2004. e,:z:i/ iJ.~ (SEAL) RUTH A. GRA Y Signed by RUTH A. GRAY, by her declared to be her Will in our presence, who have hereunto subscribed our names as witnesses in her presence and at her request, this l:l'f< day of April, 2004. ~~1 ~~~ / ';~/Jul;..~ff~ I residing at a~.,..:J1.. ~ r residing at vJ. ~iJ UA.o} H1- () ; t " . COMMONWEALTH OF PENNSYL VANIA COUNTY OF '1~\:""'t:::> COMMONWEAL TL-' ~~NNSYLVANIA t\: .aa.' Ovistine ~.' . ,IJUD. Notary PubIc Hampden. I ''^;..i.. Cumberland County My ~mlSSlOn Expires Oct 2, 2007 Membe:;':k;"(lsy/vanra Association Of Notaries WE, RUTHA. GRAY, GERALDJ. BRINSER and ::51+#J'e'T ~ ::5tO,1fks , the testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she signed willingly (or willingly directed another to sign for her), and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as witnesses and that to the best of our knowledge the testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. () 1 ~m_ t1, ~CF RUTH ~. ORA Y ~ ~~{~ wfTNESS '" ! I - (7 /7 ~ . ~~~~~~ rf>~Ft~~ Subscribed, sworn or affirmed and acknowledged before me by RUTH A. GRAY, the testatrix, GERALD J. BRINSER and SArlt?--f ~ 6pR,,~I<>- , witnesses, this 13 ~ day of April, 2004. ~~SEAL) Notary Public MMONWEAL TH OF PENNSYLVANIA Notarial Seal Qvlstine M. ChUbb, NotarY Pubic HamPden Twp.. ~1and ~ My CUT'R. isSion ExpIreS Oct. 2, Member. Pennsytvania Aa~ Of HotMtH -3- " REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of GRAY, RUTH A. also known as , Deceased No.21 05 0639 Date of Death 7/6/2005 Social Security No. 189-09-8446 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. l!We verify that the statements made in this inventory are true and correct. l!We understand that false statements herein made are subjeCt to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: KEITH D. WAGNER 1.0. No.: 43891 Address: 6 E. MAIN STREET PALMYRA PA 17078 Telephone: (717) 838-6348 Personal Representative: GERALD J. BRINSER Dated APRIL 5,2006 Description Stocks & Bonds PRUDENTIAL FINANCIAL INC. - 281 SHARES COMMON STOCK @ $67.01 PER SHARE FIRST ENERGY CORP. - 600 SHARES COMMON STOCK @ $48.44 PER SHARE ZWEIG TOTAL RETURN FUND - 0.2547 SHARES @ $5.13 PER SHARE Cash, Bank Deposits, & Misc. Personal Property PNC BANK - CHECKING ACCOUNT #5070099467 (Attach Additional Sheets if necessary) Value Total 18,829.81 29,064.00 1.31 10,174.51 65,884.07 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 RK ~ Continuation of Inventory GRAY, RUTH A. 21 05 0639 Page 1 Description of Inventory Description Value CHECK(S) ON HAND 403.50 CASH ON HAND 56.13 GUIDEPOST - REFUND 1.84 MISCELLANEOUS PERSONALTY 250.00 SOVEREIGN BANK - MONEY MARKET ACCOUNT #2331031495 (INCLUDES ACCRUED INTEREST OF $0.53) 5,649.18 THE FIRST NATIONAL BANK OF LIVERPOOL - FUNERAL FUND (INCLUDES ACCRUED INTEREST OF $1.76) 1,385.57 CAPITAL BLUE CROSS - HEAL THCARE REIMBURSEMENTS 47.22 VETERANS ADMINISTRATION - REFUND OF OVERPAYMENT 21.00 Subtotal $ 7,814.44 65,884.07 Grand Total $ 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 BRINSER GERALD J 6 E MAIN ST PO BOX 323 PALMYRA, PA 17078 _u__h_ fold ESTATE INFORMATION: SSN: 189-09-8446 FILE NUMBER: 2105-0639 DECEDENT NAME: GRAY RUTH A DATE OF PAYMENT: 04/06/2006 POSTMARK DATE: 04/05/2006 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2005 NO. CD 006532 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $557.38 I I I I I I I I TOTAL AMOUNT PAID: $557.38 REMARKS: BRISNER, WAGNER & ZIMMERMAN CHECK# 121 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS II \ \ \ Ii, \ ' \ '., -;Q~ (""llPg.r<'~ ~~~S.6 r ~ I'" lP, ""'" .-' _ -;Q __ r ~~r~-ci r<'~~ ~ r- 0 ~~ -0 lP (""l I'" 7:-\O~';O -;Q c;..-' lP I'" ~ r :-\ I-'~:-\r-p -I ~lPy o lP I-' S oJ ~ c: ~ ~ ~ ::r: ~ % ... 11 ~ ~ ~ ~ (J \J .- ~ ., ~ .. ., .. .- ~ - . '" '" \ o ~ ~' ~ " \ l.!' .. ~ \ ,;t