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Home My WebLink About05-01-06 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 BROTHER DARVIN L 364 VALENTINE ACRES ROAD CLEARVILLE, PA 15535-8642 u______ fold ESTATE INFORMATION: SSN: 191-18-2719 FILE NUMBER: 2105-0258 DECEDENT NAME: BROTHERS ELIZABETH S DATE OF PAYMENT: 05/01/2006 POSTMARK DATE: 05/01/2006 COUNTY: CUMBERLAND DATE OF DEATH: 01/01/2005 NO. CD 006641 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $601 .34 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 564 SEAL INITIALS: MG RECEIVED BY: REGISTER OF WILLS $601.34 GLENDA FARNER STRASBAUGH REGISTER OF WILLS HlV.1W) U (6<<ll REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT ~\Q)\r1f '* COMMONWEALTH OF . PENNSYLVANIA .... DEPARTMENT OF REVENUE DEPT. 280601 .. HARRISBURG, PA 17128-0601 ,. FILE NUMBER 21 05 0258 MJWER YEAR COLtHY ~ ~ DECEDENrs NAME (lAST, FIRST, AND MIDDLE INITIAL) BROTHERS, ELIZABETH S. SOCIAL SECURITY NUMBER 191-18-2719 I- Z W C w o w c DATE OF BIRTH (MM.DD-YEAR) 09f23/1923 DATE OF DEATH (MM-DD-YEAR) 01/0112005 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVMNG SPOUSE'S NAME (lAST, FIRST. AND MIDDLE INITIAL) 1&1 ~ ~'~CI) uo:~ w~8 :J:0:..J Ua.1D a. C ~ 1. Original RebJm D 4. Limited Estate D 6. Decedent Died Testate (Al1adI cqJy d. WI) D 9. Litigation Proceeds Received D 2. Supplemental Retum o u 4a. FubJre Int8rest Comprormse" (dat8 or de8"81l8r'-2~12.a2) o 7. Decedent Maintained a Living Trust (Atlach cqJy d. TI\JI\) o 10. Spousal Poverty Credit (date or dealh between 12-31-91 ard 1-1-95) D 3. Remainder Return (ebB or dedl pliar 10 12-13-12) [JS.FtKi81111 Estate Tax Return Reqtiirad- 8. Total Number of Safe Deposl Boxes o 11. Election to tax under Sec. 9113(A) (AltId'I Sd\ 0) ... z w o z o 0.. en 1&1 0: 0: o U lHlS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFlDENTIAL'TAX INFORMA11ON SHOULD BE DIRECTED 10: NAME COMPLETE MAILING ADDRESS DARVIN L. BROTHERS 364 VALENTINE ACRES ROAD FIRM NAMEpf~icabIol CLEARVILLE PA 15535-8642 TELEPHONE NUMBER (814) 458-3185 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 0.00 0.00 0.00 0.00 90,519.73 z o ~ ..J ::l t- o: < o w 0:: 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & MisceRaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Bllting Requested 7. Inter-VIVOS Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Grou Auets (total Unes 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 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) 0.00 (6) 0.00 (7) 90,519.73 (9) (10) (8) 8,640.69 2,200.25 (11) (12) (13) 10,840.94 79,678.79 0.00 14. Net Value Subject to Tax (Line 12 minus Une 13) (14) 79,678.79 z o ~ .- ::l a.. :E o o ~ SEE INSTRUCnONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (8)(1.2) 0.00 3,585.55 0.00 0.00 3,585.55 0.00 x.O _ (15) 16. Amount of Line 14 taxable at lineal rate 79,678.79 x.O~ (16) 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18) 19. Tax Due (19) 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 < < @ Dec~e~);~ C~:npre.;;'Address: .. STREET ADDRESS' "t,.... t..., . C/O BETHANY VILLAGE , 5225 WILSON LANE CITY MECHANICSBURG I STATEpA I ZIP 17057 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 3,585.55 2,835.00 149.21 3. InteresUPenalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) 2,984.21 TotallnteresVPenalty ( 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. A. Enter the interest on the tax due. (5) (SA) 601.34 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 601.34- 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; .......................................................................................... D ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 liJ c. retain a reversionary interest; or.......... ........................ ........................ ........................................... ..................... D [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... D [iI 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....... ............... ...... ........ .......... ........... ............. .......... ...... ............ ............ D [i] 3. Did decedent own an Win trust for" or payable upon death bank account or security at his or her death? .............. D iii 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ............... ......... .......................... ...... ......................... ............ ............... ............ D ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penlfies of perjury, I dedar8 flat I have 8lUII'Iined ttis nUn, indldng acarnpil'lying schedUes and statements, and 10 1he best d my knowledge and belief, it is N, axrect and COI11JIete. Oedaration of prgparer oller than lie persmaI repretenlaiwe is besed on all information of whid1 Jrf"" _ any knlM4edge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 364 VALENTINE ACRES ROAD CLEA SIGNATURE OF PREPARER OTHER THAN REPRESEI ~ .~ (AA ,~ ADDRESS ~ ~ ~ 1335 OVERLOOK ROAD MIDDLETOWN P, ? ~ DATE For dates of death on or after July 1, 1994 and before January 1, [72 P.S. 99116 (a) (1.1) (i)]. For dates of death on or after January 1,1995, the tax rate impos\ ." U'ansfers to or for the use of the surviving spouse is 0% [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from t ..ufrutOry requirements for disdosure 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 paren~ an adoptive paren~ or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. 99116(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. 99116{a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the deceden~ whether by blood or adoption. 'alue of transfers to or for the use of the surviving spouse is 3% J:\EV-151 t EX+ (12-99) . '\ ,~,'J~'~ ~tr COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & AQMINISTRATIVE COSTS .. ESTATE OF FILE NUMBER ELIZABETH S BROTHERS 2105-0258 ITEM DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: 1. DEIHL FUNERAL HOME-FUNERAL EXPENSES $7505.69 ~ AMBASSOR BIBLE CHAPEL-CHURCH USE $400.00 , GRANIT WERKS- TOMBSTONE $135.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) NONE Social Sec~rity Number(s)/EIN Number of Personal Representative(s) Street Address Cily Slale _ Zip Year(s) Commission Paid: 2. Attorney Fees $600.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Slale _ Zip Relationship of Claimant to Decedent NONE 4. Probate Fees NONE 5. Accountant's Fees NONE 6. Tax Return Preparer's Fees NONE 7. TOTAL (Also enter on line 9, Recapitulation) S $8640.69 Debts of decedent must be reported on Schedule I. ReI 1512 EX . (l.97) ~ -'~.". I J:~f~ ~! J> COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT . SCHEDULE I DEBTS OF DECEDENT, MORTGAGE. LIABILITIES & LIENS ESTATE OF FILE NUMBER ELIZABETH S BROTHERS 2105-0258 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. CREDIT CARD PAYMENT OF BALANCE $611.24 BETHANY VILLAGE PERSONAL CARE BALANCE $1264.19 AMBULANCE FEE $219.03 DOCTOR BILLS $93.80 BANK FEE $11.99 TOTAL (Also enter on line 10, Recapitulation) $ $2200.25 (If more space is needed, insert additional sheets of the same size) ./' cdMMONWEALTH OF PENNSYLVANIA rbr;eAR~MENT OF REVENUE . ~ · BUREAU OF INDIVIDUAL TAXES DEPT. 2806Q1 HARRISBURG. PA 17128-0601 REV.1162 EX(11.96) RECEIVED FROM: PENNSYLVANIA " INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT : BROTHERS DARVIN 364 VALENTINE ACRES RD CLEARVILLE, PA 15535 ---- ..-. fold ESTATE INFORMATION: SSN: 191-18-2719 FilE NUMBER: 2105-0258 DECEDENT NAME: BROTHERS ELIZABETH S DATE OF PAYMENT: 03/18/2005 POSTMARK DATE: 03/18/2005 COUNTY: CUMBERLAND DATE OF DEATH: 01/01/2005 NO. CD 005096 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $2,835.00 I I I I I I I I TOTAL AMOUNT PAID: $2,835.00 REMARKS: CHECK# 503 SEAL INITIALS: JA RECEIVED BY: TAXPAYER GLENDA FARNER STRASBAUGH REGISTER OF WILLS