HomeMy WebLinkAbout04-06-06
1
REV-1500 EX + (6-00)
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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
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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
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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
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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)
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
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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
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
$"'~ ~~
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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
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$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
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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.
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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.
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COMMONWEALTH OF PENNSYL VANIA
COUNTY OF '1~\:""'t:::>
COMMONWEAL TL-' ~~NNSYLVANIA
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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.
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RUTH ~. ORA Y ~
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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
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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.
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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
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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
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