HomeMy WebLinkAbout08-16-06
COMMONWEALTH OF PENNSYlVMJIA
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
BROWN BLAINE M
1834 BASIN HILL BLVD
CARLISLE, PA 17013
___n___ fold
ESTATE INFORMATION: SSN: 201-16-5900
FILE NUMBER: 2106-0336
DECEDENT NAME: BROWN AMY B
DA TE OF PAYMENT: 08/16/2006
POSTMARK DATE: 08/16/2006
COUNTY: CUMBERLAND
DA TE OF DEATH: 04/11/2006
NO. CD 007104
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $969.00
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
REMARKS:
CHECK# 2115
SEAL
INITIALS: MW
RECEIVED BY:
REGISTER OF WILLS
$969.00
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
,.'.. -~....
--I
15056041114
REV -1500 EX (06-05)
OFFICIAL USE ONLY
County Code Year File Number
PA Department of Revenue
Bureau of Individual Taxes
PO BOX 280601
Harrisburg, PA 17128-0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Q\ QoO~ ,~
Date of Birth
201-16-5900
04112006
07101926
Decedent's Last Name
Suffix
Decedent's First Name
MI
BROWN
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
AMY
B.
Spouse's First Name
MI
BROWN
Spouse's Social Security Number
BLAINE
225-18-9541
FILL IN APPROPRIATE OVALS BELOW
DU 1. Original Return D
D 4. Limited Estate D
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
2 Supplemental Return
D
CJ
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
DU 6. Decedent Died Testate CJ
(Attach Copy of Will)
D 9. Litigation Proceeds Received CJ
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death
between 12-31-91 and 1-1-95)
8. Total Number of Safe Deposit Boxes
D
11. Election to tax under Sec. 9113(A)
(Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
ROBERT M. FREY
Firm Name (If Applicable)
(717)243-583
REGISTER.Of WILLS USE ~L Y
5 SOUTH HANOVER STREET
VI
FREY AND TILEY
(---,
(:.~,
First line of address
Second line of address
:---'''
City or Post Office
State
ZIP Code
DATE FILED
o
CARLISLE
.0;-
PA
17013
BLVD, CARLISLE PA 17013
PREPARER OTHER THAN REPRESENTATIVE
~ /).....
ADDRESS
5 SOUTH HANOVER STREET,
CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
1505604i1~4
15056041114
--I
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--.J
15056042115
REV-1500 EX
Decedent's Name: AMY B. BROWN
RECAPITULATION
1. Real estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . . .
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . . .
6. Jointly Owned Property (Schedule F) DSeparate Billing Requested. . . . . . . .
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) DSeparate Billing Requested. . . . . . . .
8. Total Gross Assets (total Lines 1-7) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
201-16-5900
Decedent's Social Security Number
1.
2.
3. NONE
4. NONE
5.
6.
7.
8.
9.
76320.00
208102.00
7587.00
56264.00
60242.00
408515.00
21016.00
9. Funeral Expenses & Administrative Costs (Schedule H) . . . . . . . . . . . . . . . . . . . .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . . . . 10. NONE
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11.
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12.
13. Charitable and Governmental Bequests/See 9113 Trusts for which
an election to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . . . . .. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . . . . .. 14.
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable at
the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.O L
16. Amount of Line 14 taxable
at lineal rate X .0 ~
17. Amount of Line 14
taxable at sibling rate X . 12
18. Amount of Line 14 taxable
at collateral rate X . 15
15 9 3 4 1 . 0 0 15.
228158.00 16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
L
15056042115
15056042115
21016.00
387499.00
0.00
387499.00
0.00
10267.00
0.00
0.00
10267.00
CJ
--.J
REV-1500 EX Page 3 201-16-5900
Decedent's Complete Address:
DECEDENTS NAME
IAMY B. BROWN
STREET ADDRESS
File Number
21-06-0336
1834 BASIN HILL BLVD
CITY
CARLISLE
STATE
PA
ZIP
17013
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
10267.00
8833.00
465.00
Total Credits ( A + B + C ) (2)
9298.00
3. InteresUPenalty jf applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
0.00
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
969.00
A. Enter the interest on the tax due.
(5)
(5A)
B. Enter the total of Line 5 + 5A. This is the 8ALANCE DUE. (58)
Make Check Payable to: REGISTER OF WILLS, AGENT
969.00
PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred; . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0
b. retain the right to designate who shall use the property transferred or its income; . . . . . . . . . . . . . . .. 0
c. retain a reversionary interest; or . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 0
o
o
o
d. receive the promise for life of either payments, benefits or care? . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? . .
No
o
o
o
o
o
o
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " 0 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 three (3) percent [72 P .S. 99116 (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 zero
(0) percent [72 P.S. 99116 (a) (1.1) (ii)). The statute does not exempt 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 zero (D) percent [72 P.S. 99116(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 four and one-half
(4.5) percent, except as noted in 72 P .S. ~9116(1.2) [72 P.S. s9116{a)(1)).
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)). A sibling
is defined, under Section 9102. as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
217
REV-1502 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
FILE NUMBER
Amv B. and Blaine M. Brown 21-06-0336
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 property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRiPTION
Real Estate, 1834 Basin Hill Boulevard, North Middleton Township, Cumberland
County, One-Half (1/2) interest as equal tenants in common and not as tenants by
the entirety.
VALUE AT DATE
OF DEATH
76,320
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
76,320
/fcJ~p;f I ;--1
Tax Parcel No. 29-17-1585-201
THIS DEED,
MADE THE 13th day of May in the year of our Lord one thousand nine hundred ninety-
eight (1998).
BETWEEN BLAINE M. BROWN and AMY B. BROWN, husband and wife, of North
Middleton Township (mailing address: 1834 Basin Hill Boulevard, Carlisle, Pennsylvania
17013), Cumberland County, Pennsylvania, parties of the first part,
Grantors,
and BLAINE M. BROWN and AMY B. BROWN, husband and wife, of North Middleton
Township (mailing address: 1834 Basin Hill Boulevard, Carlisle, Pennsylvania 17013),
Cumberland County, Pennsylvania, parties of the second part,
Grantees:
WITNESSETH, that in consideration of One and no/lOO--- ($1.00) m Dollar, in
hand paid, the receipt whereof is hereby acknowledged, the said Grantors do hereby grant
and convey to the said Grantees, their heirs and assigns, as equal tenants in common and not as
tenants by the entirety,
ALL THAT CERTAIN tract of land with the improvements thereon erected, situate in the
Township of North Middleton, County of Cumberland, and State of Pennsylvania, more
particularly bounded and described as follows:
BEG INNIN G at a point on the Southern line of Basin Hill Boulevard, which point is at the
Westerly line of Lot No. 21 on the h~reinaftermentioned Plan of Lots; thence in a Westwardly
direction along the Southern side of Basin Hill Boulevard, 75 feet to a point at line of lands now or
formeriy of Glenn Tritt; thence along said land in a Southerly direction, 200 feet to a point at line
of lands now or formerly of T. H. Nelson; thence along said lands now or formerly of Nelson and
lands now or formerly of Lloyd Young, in an Eastwardly direction, 75 feet to a point at the
Southerly line of Lot No. 21; thence in a Northerly direction along the Westerly line of Lot No.
21,200 feet to a point; the Place of BEGINNING.
HA VING thereon erected a one and one-half story brick dwelling house known as and
numbered 1834 Basin Hill Boulevard, Carlisle, Pennsylvania.
BEING one half of Lot No. 19 and the whole of Lot No. 20, of Block "A" on the Plan of
Basin Hill Heights, which Plan is of record in the Office of the Recorder of Deeds in and for
Cumberland County, Pennsylvania.
BEING the same premises which Francis X. Bender, Jr. and Dorothy K. Bender, husband
and wife, by deed dated May 17, 1965, and recorded May 17, 1965, in the Office of the Recorder
of Deeds in and for Cumberland County, at Carlisle, Pennsylvania, in Deed Book "0", Volume
21, Page 1145, granted and conveyed to BlaineM. Brown and Amy B. Brown, husband and
wife, the Grantors herein.
UNDER AND SUBJECT to building and use restrictions as set forth in deed to Grantors
dated May 17, 1965, and recorded May 17, 1965, in the aforementioned Recorder's Office in
Deed Book "0", Volume 21, Page 1145.
THE within conveyance is from husband and wife to husband and wife and is therefore
exempt from realty transfer taxes imposed by the Commonwealth of Pennsylvania and North
Middleton Township and the Carlisle Area School District.
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AND the said Gra~tors hereby covenant and agree that they will warrant SPECIALLY
the property hereby cOltveyed.
IN WITNESS WHEREOF, said Grantors have hereunto set their hands and seals
the day and year first above written.
Signed, Sealed, and Delivered
in the Presence of
~ In, ~~
.~~
/..~.., EAL)
Maine M. Brown ..
~#rfi/:2Q~SE.H)
Amy Brown . .
State of Pennsylvania
} ss.
County of Cumberland
On this, the 13th day of May, 1998, before me, the undersigned officer, personalty
appeared Blaine M. Brown and Amy B. Brown, husband and wife, known to me (or
satisfactorily proven) to be the persons whose names are subscribed to the within
instrument, and acknowledged that they executed the same for ilie purposes therein
contained.
IN WITNESS WHEREOF, I hereunto set my hand and official seal.
~A
NOTARIAL SEAl ;
ROBERT G. FREY. NOTARY PUBLIC i
CARLISLE. CUMBERLAIIIl COUNTY PA ~
MY COMMISSJOrl EXPIRES JUNE 27: 1995 ,i
I do hereby certify that the precise residence and complete post office address of the
within named Grantees is 1834 Basin Hill Boulevard, Carlisle, Pennsyl~ania 17013.
~)". 7.9
Attorney for Grantees
COMMONWEALTH OF PENNSYLVANIA
hs.
COUNTY OF CUMBERLAND
RECORDED on'this exo day of
YYlAJ, 1998, in the Recorder's Office of the
said County in Deed Book I r7, Page ~~ I .
il.:~~~tz.r~_~.~, .
.. ...."'~,;)f..,..l:..
Given under my hand and seal of the said
office, the date above written. .
~~%~',
. Recorder
lI-otfr.. of ..,,,, .f" C. ('.\~ n
..'..t.:t 11...r 'oWll~Y
..
217
REV-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE 8
STOCKS & BONDS
ESTATE OF
Amy B. and Blaine M. Brown
FILE NUMBER
21-06-0336
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
VALUE AT DATE
OF DEATH
Fidelity I nvestments-679-255670
Exxon Mobil Corp(280 shares@62.00)
Nationwide Finl Svcs Group(121 shares @43.45)
PNC Finl Svcs Group(361 shares @66.07)
PPG Industries(352 shares @62.62)
17,360
5,257
23,851
22,042
Ford Mtr Cr Co Mtn BE(20,000 7.5% 4/25/2011 Call Ba2/BB-)
17,275
AIM Municipal Bond Class A(2,610.165 shares @8.01)
Delaware Tax Free PA Class A(4,257.813 shares @8.02)
Dreyfus Premier Worldwide Growth A(342.825@36.83)
20,907
34,148
12,626
Fidelity Investments-679-255670
Core Account-Cash
52,405
2.
I-PA06, Account 02614467
1,369
3.
Q-PA02,Account02614467
862
TOTAL (Also enter on line 2 Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
208 102
':::J06-0T-Z~ 10:48ilm FlolT-SNY
3:5-414-3458
r-021 P.002/002 F-QZ8
%eBANK
of'NEWVORK.
July 28.2006
Frey & Tiley
Attention: Carol
Ft'x: (717) 249-2599
Phone: (7l7) 448-8197
RE: PENNSYL V ANLA INSURED\IDNIClP AL INCOME TRUST SERIES 6
PENNSY1.V A.c1\,fIA INVESTORS QUALITY TA.X EXEMPT TRUST SERIES 2
Ale: 02614467
N/O: AMY B BRO,^,~
Dear Ms. Carol:
TImnk you for your recent inguiry i~onceroing the referenced (J nit Investment Trusts.
The date of death values of the referenced funds were as follows:
Fund & Series
Tl'!HklliB
~
Bid Price
Accrued Inret~t
Total
I-PA06
Q-P A02
411112006
4/1lf2006
10
5
$134.09
$168.87
$2.80
$3.58
$1,368.90
$862.25
We trust this information will be of assistance to you. If you have any further questions, please
call our Customer Service Depa.rt:n1ent at (800) 856-8487.
Very truly yours,
oJ 4---
Jamie SchleiGher
Unit Investment Trust
Customer Service Department
P.O. BOX 4(3 EA~7 S\'RACl>.E. ~;EW YORK ! ~OS1 " J.163
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5/3/06 9:54 AM
Date
4/11/06
Price
High
62.73
(NYSE) U.S. Dollar
Low Volume
61.8 14,726,500
2 Mlnth (Daily)
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1/2/1970
Symbol: Date: I041111?9Q~:
Apr. t1a))
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Please see our Terms of Use. Historical and current end-of-day
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WSJ.com Stock Charting for NFS
5/3/06 9:55 AM
Nationwide Finl Svcs Inc (NFS)
(NYSE) u.s. Dollar
Date Price High Low Volume
2 M:mth (Daily)
(Sl8igCharts.com
4/11/06
43.45 43.85 43.42
237,600
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43.5
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43.0
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1/2/1970
Symbol: Date: 1()4/11{?()Q~!
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[B
1 mo 2mo 3mo 6mo .!t!: ~ ~
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WSJcom Stock Charting for PNC
5/3/06 9:55 AM
he PNC Financial Services Group, Inc. (PNC)
(NYSE) U.S. Dollar
Date Price High Low Volume
4/11/06
66.07 66.88 65.77
1,211,300
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1/2/1970
Symbol: Date: 19~n~/~qQ!3J
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Page] of]
. .
WSJ.com Stock Charting for PNC
6/13/066:57 AM
he PNC Financial Services Group, Inc. (PNC)
(NYSE) u.s. Dollar
Date Price High Low Volume
2 Ivbnth (Daily)
@BigCharts.com
3/1/06
70.91
71.12 70.37
1,601,600
. r--v--., "'vV'- 70
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64
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1/2/1970
Symbol: L____.._J Date: l03/01/20061
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Page 1 of I
-' .
WS.l.com Stock Charting for PPG
5/3/06 9:57 AM
Date
4/11/06
Price
High
(NYSE)
Low
U.S. Dollar
Volume
2 t.bnth (Dail-y")
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1/2/1970
Symbol: L-----. _.J Date: 1.9_"!L!1!10061
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.' .
WSJ.com Stock Charting for AMBDX
5/3/06 9:57 AM
1M Inv:Muni Bond;A (AMBDX)
(FUND) U.S. Dollar
Date Price High Low Volume
:2 M:lOth (Daily)
@8igChatts.com
4/11/06
8.01 nla
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8.05
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8.00
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1/2/1970
Symbol: I Date: IO~111/~2Q~f
Apr' 11ay
(B
1 mo 2mo 3mo 6mo lYE ~ ~
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..
WSJ.com Stock Charting for DEUX
5/3/06 9:58 AM
Delaware Tx-Fr PA;A (DEUX)
(FUND) U.S. Dollar
Date Price High Low Volume
2 t,,~nth (Dail"y")
@BigCharts.co m
4/11/06
8.02 n/a
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1/2/1970
Symbol: Date: ~04!~_:!{?006i
Apr' r1ay
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.THE"~\LLSTR.EEr.JOURNAL. FREE 10..DAY
CElESMTIIO<l1<l "'EARSOttLl~E OPEN HOUSE
~ CLICK HERE TO VISIT TODAY ...
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~. .
WSJ.com Stock Charting for PGROX
5/3/06 9:58 AM
Dreyfus Prem WW Gro;A (PGROX)
(FUND)
Date Price High Low
4/11/06
36.83
n/a
n/a
No Splits
Get another quote any day after 1/2/1970
1/2/1970
Symbol: Date: 1Q..:t!11/~Og6
U.S. Dollar
Volume
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rEJ
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@8igCharts.c")m
,)
I
...,,",,-J
f\JV
2 tvbnth (Daily)
Apt-. tiay
38.00
37.75
37.50
37.25
:37.00
1 mo 2mo 3mo 6mo .!l!: ~ 2Y!:
Copyright @ 2006 Dow Jones & Company, Inc. All Rights Reserved
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Page I of I
~ .
217
REV-1508 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Amy B. and Blaine M. Brown
Include the proceeds of litigation and the date the proceeds were received by the estate.
All orooertv iointlv-owned with right of survivorshio must be disclosed on Schedule F.
FILE NUMBER
21-06-0336
ITEM
NUMBER DESCRIPTION
1 1998 Ford Van
VALUE AT DATE
OF DEATH
7.500
2 Refund. Genworth (Long Term Care)
40
3 Refund, Lane Bryant
47
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed. insert additional sheets of the same size)
7,587
-' .
DEPARTMENT OF TRANSPORTATION
C ERTlFICA TE OF TITLE FOR A VEH lCLE
971900015008178-001
2FMOA51~OHBA7bq~4
VEHICLE IDENTIFICATION NUMBER
98
YEAR
fORD
MAKE OF VEHICLE
15101:,9'081201 DR::
TITLE NUMBER
8/01/97
DATE PA TITlED
8/01/91
DATE OF ISSUE
I
I
UNLADEN WEIGHT
I
I
8101/~1 DOO030 I 0
ODOM. PROCD. DATE OooM. MILES OooM. STATUS
GVWR GCWR I TITLE BRANDS
BODY TYPE
o
DUP SEAT CAP
PRIOR TITLE STATE
SW
FIRST LIEN FAVOR OF:
SECOND LIEN FAVOR OF:
ODOMETER STATUS
o = ACTUAL MILEAGE
1.. MILEAGE EXCEEDS THE MECHANICAL
. "...UMtTS. .d-'"
2:. Nor THE ACTUAL MtLEAGE
3. NDTTHE ACTUAUIlLEAGE.OOOMETER
TAMPERING VERIFIED ',~.
.. EXEMPT FR~M OOOMET~R DISCLOSURE
TITLE BRANDS
A . ANTIQUE VEHICLE
C .. CLASSIC VEHICLE
o . COLLECTIBLE VEHICLE
F .. OUT OF COUNTRY
G .. ORIGINAl.LY MFGO. FOR NON.U.S.
DISTRIBUTION
H .. AGRICULTURAL VEHICLE
L .. lOGGING VEHICLE
P .. FORMER\.. Y A POLICE VEHICLE
R .. RECONSTRUCTEQ
S . STREET ROO
T = RECOVERED THEFT VEHICLE
v .. VEHIClE CONT A)NS REiSSuED VIN
W . FLOOD VEHICLE
x = 'FOAMEAL Y A TAXI
;"
t:~-.~:
i:~
REGISTERED OWNER(S)
AMY 8
183lf BASIN
CARLISLE
BROWN
HILL BL VO
PA 17013
FIRST LIEN RELEASED
DATE
~
::e~~~:n~u~lnt~=:d l~hi~s~~le ufgth:a~s~iec~~no,o~~~~r (e~'h~r~ ~~ f:t:
appropriate IOfm and (ee,
BY
SECOND UEN RELEASED
AUTHORIZED REPRESENTATIVE
:7" ;', ,:;~r:....::!, :^;"--J:::.;-~'~It"-'C', .~_.' c....
DATE
~'''';~'.-:.'',''1:~.::!;<:-'', .r:':,~',:,:''''.r.'_. -.'- ,"
MAILING ADDRESS
BY
AUTHORIZED REPRESENTATIVE
AMY B BROWN
183~ BASIN HILL BLVD
CARLISLE PA 17013
I certify as 01 the date at issue, the ofUciat records 01 the Pennsylvania Oepanmenl
01 Transportation ,eflecllhat the person{s) Of company named herein is lhe lawful owner
of the said vehicle.
BRADLEY t.
MO.
DAY
YEAR
When appJying 'ar tille with a co.owner, other than your spouse, check on8 of
th....blocks. II no block Is chock.d. UII8 will be i..uod as "Tenants In Common".
A 0 Joint Ten.nl. wtlh Righi of Survivorship (on death. of one owner. 'hie g08S
to the surviving owner).
B 0 Tenanls In Common (on death of on. owner, lnteresl 0' deceased owner
goes to his or her heirs or as'a'.).
SIGNATURE OF PERSON ADMINISTERING OATH
LIEN
DATE:
FIRST LlENHO~OER:
IF NO LIEN
CHECK BOX
o
NAME
STREET.
CITY
STATE
LIEN
DATE:
The unden.igned nereby makes BipplicatiOl1 lor Certificate of Title 10 the vehicle described SECOND t..IENHOLOEA:
above. subject to the encumbHmC8S and Oltler legal claims sellorth here.
ZIP
IF NO LIEN
CHECK BOX
o
NAME
STREET'
SIGNATURE OF APPLICANT OR AUTHORIZED SIGNER
CITY
STATE
ZIP
..' .
217
REV-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
FILE NUMBER
Amy B. and Blaine M. Brown
21-06-0336
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Blaine M. Brown
1834 Basin Hill Blvd
Carlisle PA 17013
Spouse
B.
C.
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 DECD'S VALUE OF
TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTL V-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENTS INTEREST
NUMBER
1. A. Orrstown Bank, Checking Account #108005729 2,989 50.00% 1 ,495
2. A. Orrstown Bank, Savings Account #108210436 56,314 50.00% 28,157
3. A. Orrstown Bank, Certificate of Deposit #40000005647(18month) 51,723 50.00% 25,862
4. A. Household Contents 1,500 50.00% 750
TOTAL (Also enter on line 6. Recapitulation) $ 56 264
(If more space is needed, insert additional sheets of the same size)
,
..... I. ~
~
ORRSTOWN
BANK
April 24, 2006
Law Offices of Frey and Tiley
5 South Hanover Street
Carlisle, P A. 170 13
Dear Attorney Frey.
Blaine Brown has requested that we send you some infOlmation dn the joint accounts that
he and Amy have with us here at Orrstown Bank. We were very sorry to hear 6fher
demise, as she was a favorite customer here at North Middleton Office, as is Blaine.
Here are the accounts that they have with our bank, and the balances as of April 11, 2006,
the date of Amy's death. All 3 of the accounts were jointly held:
Account #
Type of account:
Balance:
108005729
. Checking
$2,988.80
108210436
Savings
$56,314.15
4000005647
18 month C.D.
$51,722.62
Please don't hesitate to contact us if we can be of further assistance in this matter.
Sin~
Carol A. Ram!;fb
Branch Executive Officer
North Middleton Office
cc: Blaine M. Brown
PO Box 250 · Shippensburg, PA 17257 . (717) 532-6114 · (717) 532-4143 Fax. WWW.orrstown.com
"
217
REV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
FILE NUMBER
21-06-0336
Amy B. and Blaine M. Brown
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 THE OATE OF DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER TRANSFER. ATTACH A COpy OF THE DEEO FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. Individual Retirement Account #35004201762546, M&T Bank 49,325 100.00% 49,325
2. Individual Retirement Account #35004201913280, M& T Bank 10,917 100.00% 10,917
TOTAL (Also enter on line 7 Recapitulation) $ 60.242
(If more space is needed, insert additional sheets of the same size)
'd~J~~:~
High Street-Carlisle
April 28, 2006
2117
AMY B BROWN
1834 BASIN HILL BLVD
CARLISLE PA 17013-1110
.I
Dear Amy B Brown,
ent account was closed or
If you are receiving scheduled distributions, the above account has been closed and
internally transferred to another Individual Retirement Account in your plan to
accommodate your next distribution.
We'd like to remind you that M&T Bank is committed to providing you with solutions to
all your financial heeds. To find out more about the many ways we can help you with
those needs, simply stop by any M&T Bank office or call the M&T Telephone Banking
Center at 716-626-1900 or 1-800-829-1924. Or if you'd like, visit the M&T website at
www.mandtbank.com.
Thank you for banking with M&T Bank:
Sincerely,
M~ehele Cole-Heetok
Michele Cole- Hector
Customer Service Manager
SMACCL AZRRS 1
.
r~'oM~:~
High Street-Carlisle
April 28, 2006
2116
AMY B BROWN
1834 BASIN HILL BLVD
CARLISLE PA 17013-1110
Re: Retirement Account Closing Notice
Account # 35004201762546
Dear Amy B Brown,
We are writing to confirm that on 04/27/06, your Retirement account was closed or
transferred. At that time, the balance was $49,325.30.
If you are receiving scheduled distributions, the above account has been closed and
internally transferred to another Individual Retirement Account in your plan to
accommodate your next distribution.
We'd like to remind you that M&T Bank is committed to providing you with solutions to
all your financial needs. To find out more about the many ways we can help you with
those needs, simply stop by any M&T Bank office or call the M&T Telephone Banking
. Center at 716-626-1900 or 1-800-829-1924. Or if you'd like, visit the M&T website at
www.mandtbank.com.
Thank you for banking with M&T Bank.
Sincerely,
M~chele Cole-Hecto~
Michele Cole- Hector
Customer Service Manager
SMACCL AZRRSI
'"
217
REV-1511 EX + (12-99)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Amy B. and Blaine M. Brown
21-06-0336
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Fogelsanger-Bricker, Funeral 2,806
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney Fees 14,331
3. Family Exemption: (If decedent's address is not the same as claimant's. attach explanation)
Claimant Blaine M. Brown
Street Address 1834 Basin Hill Blvd
City Carlisle State PA Zip 17013
Relationship of Claimant to Decedent Spouse 3,500
4. Probate Fees 352
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Register of Wills, (3) Short Certificates 12
8. Register of Wills, Filing Fee for PA Inheritance Tax Return 15
TOTAL (Also enter on line 9 Recapitulation) $ 21 016
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
...
217
REV-1513 EX+ (9-00)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF
FILE NUMBER
8
d 81
M 8
21 06 0336
Amv . an aJne rown - -
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 81aine M. Brown Spouse 100% of residue of estate
1834 8asin Hill Boulevard
Carlisle, Pennsylvania 17013
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
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
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)
LAST WILL AND TESTAMENT
OF
AMY B. BROWN
-
/
..
I, AMY B. BROWN, of North Middleton Township (mailing address: 1834 Basin Hill
B.oule~ard, c;arlisle, Pennsylvania 170 13~, 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 and making void any and all Wills by me at any time
heretofore made.
.
....,~.. .
1. I direct my hereinafter named personal representative to pay all of my just debts and
funeral expenses as soon after my death as may be found convenient to do so. I further direct that
all inheritance, transfer, succession, estate and death taxes which may be payable on account of my
death, including interest and penalties thereon, shall be paid from the residue of my estate regardless
of whether the assets upon which such taxes are based are included in my probate estate.
2. All of the furniture and household furnishings and tangible personal property generally
located in the home occupied by my husband, Blaine M. Brown, and me are owned jointly by us as
tenants by the entirety.
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3. If my husband, Blaine M. Brown, survives me, in such event I give, devise and bequeath
to my hereinafter named Trustees, in Trust, for the uses and purposes hereinafter set forth. A sum
equal to the amount which will exhaust the Unified Credit to which my Estate may be entitled for
purposes of Federal estate tax, but not more than $1,000,000,00, which Unified Credit is presently
equal to approximately $675,000.00 and presently scheduled to increase to $1,000,000.00 on
January 1,2002, which sum shall be less the total amount, if any which may be payable to the
Trustee on account of insurance on my life, it being my intention that the provisions of this
paragraph No.3 shall completely exhaust, but not exceed, the Unified Credit for federal estate tax,
and therefore the amount to be held in trust shall be increased by any increase hereinafter enacted
for rhe Unified Credit up to $1,000,000.00. In making the computations necessary to determine the
amount of this trust, the final determinations for Federal estate tax purposes shall control.
During the lifetime of my husband, Blaine M. Brown, the income arising from said Trust
shall be paid to him or for his benefit at regular intervals at least annually so long as he sha1llive
and at his death said Trust shall be disposed of as fpllows:
The principal thereof shall be divided into three (3) equal shares, one share for my
daughter, Debra B. Richcreek, which shall be distributed in accordance with subparagraph "a" of
paragraph No.4 hereinafter set forth; one share for my daughter, Cinda B. Grove, which shall be
distributed in accordance with paragraph "b" of paragraph No.4 hereinafter set forth; and the third
share shall be distributed in accordance with subparagraph "c" of paragraph No.4 hereinafter set
forth and distributed as therein provided.
4. All of the rest, residue and remainder of my estate, real, personal and mixed, and
wheresoever the same may be situate, I give, devise and bequeath to my hisband, Blaine M. Brown,
his heirs and assigns, provided he shall survive me by a period of ninety (90) days, but should he
fail to so survive me then in such event I give, devise and bequeath the same as follows:
a) one-third to my daughter, Debra B. Richcreek, her heirs and assigns, provided she
shall survive me by a period of ninety (90) days, but should she fail to so survive me then to such of
her legitimate issue as shall survive me by a period of ninety (90) days, their heirs and assigns, per
stirpes, and if there be no such issue the same shall lapse.
b) one-third to my daughter Cinda B. Grove her heirs and assigns, provided she shall
survive me by a period of ninety (90) days, but should she fail to so survive me then to such of her
legitimate issue as shall survive me by a period of ninety (90) days, their heirs and assigns, per
stirpes, and if there be no such issue the same shall lapse.
c) The remaining one-third thereof shall be paid in equal shares to such of my five
grandchildren, their heirs and assigns, as shall survive me by a period of ninety (90) days, per
stirpes, but should any grandchild of mine fail to so survive me then the share such deceased
grandchild would have received shall pass to such of his or her legitimate issue as shall survive me
by a period of ninety (90) days, per stirpes, and if there be no such legitimate issue the same shall
lapse and be added proportionately to the shares of the other grandchildren, per stirpes. My five
grandchildren are Christopher A. Richcreek, Jessica E. Ellis nee Richcreek, Rebecca L. Grove,
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Robert Lee Grove, II, and Michael David Brown.
5. The meaning of "legitimate issue" as used in this Last Will and Testament shall be
limited to a child or children born to a female descendent of Testatrix regardless of whether the
mother is married to the father of such child or children, and shall be limited to a child or children
born to a male descendent of Testatrix where the father of such child or children is married to the
mother either before or after the birth of the child or children. In any case the meaning of "child"
or "children" or "legitimate issue" as used above shall NOT include any adopted child or
children.
6. No title, in any trust herein created, or in the income accruing therefrom, or in its
accumulation, shall vest in any beneficiary and no beneficiary shall have the right or power to
transfer, assign, anticipate or encumber his or her interest in said trust, or the income arising
therefrom, prior to the actual distribution thereof by the Trustee to the beneficiary. Further, neither
the income nor the principal of said trust shall be liable in any manner, in the possession of the
Trustee, for the debts, contracts or engagements of any of the beneficiaries.
7. Should any person less than 21 year of age be entitled to distribution from my estate, or
any trust herein created, in such event I nominate, constitute and appoint my husband, BLAINE M.
BROWN and my daughter DEBRA B. RICHCREEK and my daughter CINDA B. GROVE and
the survivors of them as Guardians of the Estate of each such person and authorize and direct them
to receive and to invest the same, and to pay the income arising therefrom together with so much of
the principal thereof as in their opinion is necessary or desirable to be expended for the proper
maintenance, education or medical and hospital expenses of such person, to or for the benefit of
such person, and upon such person attaining 21 years of age to pay to him or her the then
remaining principal together with any undistributed income.
8 I hereby nominate, constitute and appoint my husband, Blaine M. Brown and my
daughter Debra B. Richcreek and my daughter Cinda B. Grove and the survivors of them as
Trustees of each trust created under this Will and I direct that none of them shall be required to post
any bond to secure the faithful performance of his or her duties in the Commonwealth of
Pennsylvania or in any other jurisdiction.
9. The compensation t.o which the Trustees of any trust are entitled shall not exceed six-
tenths of I % of value of the trust calculated annually and if the within named Trustees or their
successors are pnwilling to accept the trust hereinbefore established, then an alternate trustee or
successor trustee who is willing to accept such maximum compensation shall be appointed and be
approved by the court having jurisdiction.
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10. I nominate, constitute and appoint my husband, Blaine M. Brown as Executor of this my
Last Will and Testament but should he predecease me or fail to qualify or cease serving as such,
then in such event I nominate, constitute and appoint my two daughters, Debra B. Richcreek and
Cinda B. Grove, or either of them, as alternate or successor Executrices. I further direct that none
of them shall be required to post any bond to secure the faithful perfonnance of his or her duties in
the Commonwealth of Pennsylvania, or in any other jurisdiction.
II. In addition to the powers conferred by law, my hereinbefore named Executors and
Trustees and Guardians, and their successors, are empowered:
a. To invest any part of the trust corpus in such securities, investments, or other
property as may be deemed advisable and proper, irrespective of whether the same are authorized
for the investment of trust funds under the laws of any governing jurisdiction.
b. With respect to any corporation, the stocks, bonds, or other securities of which may
be held, to vote in person or by proxy on any shares of stock; to consent to the merger,
consolidation or reorganization of such corporations; to consent to the leasing, mortgaging or sale
of the property of any such corporations; to make any surrender, exchange or substitution of such
stocks, bonds or other securities as an incident to the merger, consolidation or reorgar.izatioll of
such corporati0lls; to pay all assessments, subscriptions and other sums of money which may be
deemed wise and expedient for the protection and maintenance of the proportionate interest of the
investment in such corporations; to exercise any option or privilege which may be conferred upon
the holders of such stocks, bonds, or other securities of such corporations either for the conversion
of the same into other securities or for the purchase of additional securities, and to make any and all
necessary payments which may be required in connection therewith; and generally to have and
exercise as to all such stocks, bonds and other securities, the powers of an individual owner who is
not under trust obligation.
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c. To hold the trust corpus in one or more consolidated funds in which separate shares
shall have undivided interests.
d. To sell at public or private sale for cash or upon credit, or partly for cash and partly
on credit, and upon such terms and conditions as shall be deemed proper, any part or parts of the
trust ~state, and no purchaser at any such sale shall be bound to inquire into the expediency or
propnety of any such sale or to see to the application of the purchase moneys arising therefrom.
e. To keep on hand and uninvested such money as may be deemed proper and for
such period as may be found expedient.
f. To compromise, settle or arbitrate any claim or demand in favor of or against the
trust estate.
g. And authorized in the discharge of fiduciary duties, to employ counsel and to
determine and to pay such counsel reasonable compensation which shall be charged against the
principal or income of the trust fund, and shall further be entitled to charge against the principal or
income such other reasonable expenses and charges as may be necessary and proper to incur for
the proper discharge of fiduciary duties and for the proper management and administration of the
trust estate.
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h. In making any division of property into shares for the purpose of any distribution
thereof directed by the provisions of the trust, to make such division or distribution, either in cash or
in kind, or partly in cash and partly in kind, as shall be deemed most expedient, and in making any
division or distribution in kind may allot any specific security or property or any undivided interest
therein to anyone or more of such shares, and to that end may appraise any or all of the property so
to be allotted and the judgment as to the propriety of such allotment and as to the relative value for
purposes of distribution of the securities or property so allotted shall be final and conclusive upon
all persons interested in the trust or in the division or distribution thereof.
i. And authorized to register any shares of stock or other assets of any trust in their
own names or in the name of a nominee.
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J. To retain and invest in shares of stock of the Trustee.
k. To retain any investments including mutual funds which I may own at the time of
my death and in addition to invest any part of the Trust corpus in such mutual fund or mutual funds
as may be deemed advisable or proper, irrespective of whether the same are authorized for the
investment of trust funds under the laws of any governing jurisdiction.
1. To detennine from time to time whether all or some portion of realized capital gains
shall be treated as ordinary income for distribution to a beneficiary or treated as principal to be
retained as part of the corpus, and such designation need not be consistent from one year to
another.
IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and
Testament written on three (3) pages, this 2.,04day of ~""'2001.
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Amy B. own
Signed, sealed, published and declared by AMY B. BROWN, the Testatrix above-named, as
and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the
presence of each other, have hereunto subscribed our names as attesting witnesses.
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REV-1514 EX+ (12-03)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE K
LIFE ESTATE, ANNUITY
& TERM CERTAIN
Check Box 4 on REV-1500 Cover Sheet
ESTATE OF FILE NUMBER
Amy B. and Blaine M. Brown 21-06-0336
This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to
5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit.
Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99,
and in Aleph Volume for dates of death from 5-1-99 and thereafter.
Indicate the type of instrument which created the future interest below and attach a copy to the tax return.
D Will D Intervivos Deed of Trust D Other
Blaine M. Brown
12/6/1921
85
[X] Life or D Term of Years
D Life or D Term of Years
D Life or D Term of Years
D Life or D Term of Years
D Life or D Term of Years
1. Value of fund from which life estate is payable .................................. $
2. Actuarial factor per appropriate table .........................................
Interest table rate - D 31/2% 06% 010% OVariable Rate 6%
3. Value of life estate (Line 1 multiplied by Line 2) ...............................$
385,335
0.2675
103.077
D Life orD Term of Years
D Life or D Term of Years
D Life or D Term of Years
D Life or D Term of Years
1. Value of fund from which annuity is payable ....................................$
2. Check appropriate block below and enter corresponding (number) ..................
Frequency of payout - D Weekly (52) 0 Bi-weekly (26) 0 Monthly (12)
o Quarterly (4) D Semi-annually (2)~ Annually (1) 0 Other ( )
3. Amount of payout per period ................................................$
4. Aggregate annual payment, Line 2 multiplied by Line 3 ...........................
5. Annuity Factor (see instructions)
Interest table rate - D 3 1/2% D 6% 0 10% D Variable Rate
6. Adjustment Factor (see instructions) ..........................................
7. Value of annuity - If using 3 1/2%, 6%, 10%, or if variable rate and period
payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 .................. $
If using variable rate and period payout is at beginning of period, calculation is:
(Line 4 x Line 5 x Line 6) + Line 3 .......................................... $
NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through
G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18.
(If more space is needed. insert additional sheets of the same size)
...
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.,
217
REV-1649 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DE EDENT
SCHEDULE 0
ELECTION UNDER SEC.9113(A)
(SPOUSAL DISTRIBUTIONS)
ESTATE OF FILE NUMBER
Amy B. and Blaine M. Brown 21-06-0336
Do not complete this schedule unless the estate is making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act.
If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust.
This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.).
If a trust or similar arrangement meets the requirements of Section 9113(A), and:
a. The trust or similar arrangement is listed on Schedule 0, and
b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule 0,
then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar
property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative
shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar
arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement.
Part A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the
decedent's survivin souse under a Section 9113 A trust or similar arran ement.
Description Value
Life Estate of Blaine M. Brown, Date of Birth
in Trust Fund of $385,335 to $103,077
Schedule A - Real Estate ($76,320)
103,077
Schedule B - Stocks & Funds ($205,871)
Schedule E - Cash,Bank Deposits, & Misc. Personal Property ($7,587)
Schedule F - Jointly Owned Property ($56,264)
Scheduel G - Inter-Vivos Transfers & Mise Non-Probate ($60,242)
Part A Total $
103,077
Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A) election to tax is being made.
Description Value
Part B Total $
(If more space is needed, insert additional sheets of the same size)