HomeMy WebLinkAbout08-21-06
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
i OFFICIAL USE ONLY
I
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i FILE NUMBER
II
0272
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i DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL)
Brion, Ethel M
:-DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR)
03-13-2006
11-11-1908
i (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
-_._--1-------------------
w : Ix] 1. Original Return
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"~l2 il" 4. Limited Estate
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is g: iil :)(1 6. Decedent Died Testate (Attach
... copy of Will)
<( 9. Litigation Proceeds Received
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C.QUNIY. CODE _ _YEAR ______J./\LMjlER
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SOCIAL SECURITY NUMBER
179-16-6246
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
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SOCIAL SECURITY NUMBER
2. Supplemental Return
4a. Future Interest Compromise (date of death after
12-12-82)
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)
LJ 3. Remainder Return (date of death prior to 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
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I NAME
i Robert C. Said:s, Esq.
!FIRMNAM-E(if~PPii~b~----------------- -------1
Said is, Flower & Lindsay
I TELEPHONE NUMBER
________JJ.T!_~) }37-3405
-------'1------------
I 1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) Separate Billing Requested
8. Total Gross Assets (total Lines 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)
2109 Market Street
Camp Hill, PA 17011
(1 ) None
(2) None
-----~
(3) None
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(4) None
---.....-..-.--.---
(5) 12,798.37
(6) None
(7) 10,262.14
(8)
(9) 688.20
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(10) 80.48
OFFICIAL USE ONLY
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23,060.51
12. Net Value of Estate (Line 8 minus Line 11)
(11 )
768.68
(12)
22,291.83
13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has
not been made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
None
(14)
22,291.83
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
20. D
15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) 0.00
z or transfers under Sec. 9116(a)(1.2)
0
j::: 16. Amount of Line 14 taxable at lineal rate 22,291.83 x .045 (16) 1,003.13
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a.. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) 0.00
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0
0 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18)
S x 0.00
19. Tax Due (19) 1,003.13
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00:
Decedent's Complete Address:
STREET ADDRESS
801 N. Hanover St.
CITY Carlisle
STATE P A
ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
1,003.13
0.00
Total Credits (A + B + C)
(2)
0.00
3, Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
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
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.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3)
(4)
(5)
(5A)
(5B)
1,003.13
1,003.13
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. C~ [J
b. retain the right to designate who shall use the property transferred or its income;.................................... [:!J
c. retain a reversionary interest; or.......................................................................................................... ........ [-x]
d. receive the promise for life of either payments, benefits or care? .............................................................. LX]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration? .......................... ............ .................................................................................
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3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?...................... .......... ........... ....................................... ............. ...................... [:!J =:J
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 penalties of peljury, I declare that I have examined this return, including accompanying schedules and statements. and to the best of my knowledge and belief, it is true, correct and
complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERS1jESPONSIBLE FOR FILING RETURN. .. ADDRESS
Donald L Sri " .....p Q ~ 104 Creekview Drive
f 1^~/4- "-~ Carlisle, PA 17013
SIGNATUREOF-PERSON,,*,SPON- FOR FiLING RETURN ADDRESS
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DATE
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ADDRESS
DATE
2109 Market Street
Camp Hill, PA 17011
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. 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 0%
[72 P.S. 99116 (a) (1.1) (Ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a
natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 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 decedenfs 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 decedent, whether by blood or adoption.
Rev-1508 EX+ (6-98)
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMON~THOFPENNSYLVAN~
INHERITANCE TAX RETURN
RESIOENT DECEDENT
ESTATE OF
Brion, Ethel M
FILE NUMBER
21-06-0272
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Orrstown Bank, checking acct. 410802 - opened 7/19/96
VALUE AT DATE
OF DEATH
12.798.37
TOTAL (Also enter on Line 5. Recapitulation)
12.798.37
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
R,ev-1510 EX+ (6-98)
*
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEOENT
ESTATE OF
Brion, Ethel M
FILE NUMBER
21-06-0272
This schedule mJst 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.
ITEM I ION OF ,~, _, "r DATE OF DEATH % OF DECD'S TAXABLE
EXCLUSION
NUMBER INCLUDE NAME OF TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
1 Thrivent Financial for Lutherans, annuity 10,262.14 10,262.14
contract no. 9082387
TOTAL (Also enter on Line 7, Recapitulation) 10.262.14
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule G (Rev. 6-98)
REV.1151 EX+ (12-99)
*'
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brion, Ethel M
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21-06-0272
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
See continuation schedule(s) attached 338.20
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address
City State Zip
-
Year(s) Commission paid
2. Attorney's Fees 350.00
See continuation schedule(s) attached
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
TOTAL (Also enter on line 9, Recapitulation) 688.20
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H (Rev, 6-98)
~ev.1502 EX+ (6.98)
.
SCHEDULE H-A
FUNERAL EXPENSES
continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brion, Ethel M
FILE NUMBER
21-06-0272
ITEM
NUMBER DESCRIPTION
1 Hollinger Funeral Home
AMOUNT
338.20
Subtotal
338.20
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-A (Rev. 6-98)
~ev-15?2 EX+ (6-98)
.
SCHEDULE H-B2
ATTORNEY'S FEES
continued
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Brion, Ethel M
FILE NUMBER
21-06-0272
ITEM
NUMBER
DESCRIPTION
AMOUNT
1
Said is, Flower & Lindsay
350.00
Subtotal
350.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule H-B2 (Rev. 6-98)
Re'l.151.2 EX+ (6-98)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
Brion, Ethel M
FILE NUMBER
21-06-0272
ESTATE OF
Include unrelmbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1 Church of God Home
VALUE AT DATE
OF DEATH
33.35
2 Cumberland Pathologists
8.16
3 Mobile X-Ray Imaging
38.97
TOTAL (Also enter on Line 10, Recapitulation)
80.48
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule I (Rev. 6-98)
REiI.1513 EX+ (9.00)
ESTATE OF
NUMBER
I.
1
2
*'
SCHEDULE ..
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21-06-0272
SHARE OF ESTATE AMOUNT OF ESTATE
(Words) ($$$)
Brion, Ethel M
NAME AND ADDRESS OF
PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [indude outright spousal
aistributions and transfers
under Sec. 9116(a)(1.2)]
RELATIONSHIP TO
DECEDENT
Do Not List Trusteelsl
Donald L Brion
104 Creekview Dr.
Carlisle, PA 17013
Son
1/2 of estate
Lola M Mertes
5810 Kasey Meadows Dr.
Greensboro, NC 27410
Daughter
1/2 of estate
Total
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
Copyright (c) 2002 form software only The Lackner Group, Inc.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Form PA-1500 Schedule J (Rev. 6-98)
0.00
'~rJ ~a</t SnO?;-f/L - {J~ ~ ~
V' Thrivent Financial
for Lutherans™
Death Benefit Information
Settlement Agreement Contract: 9082387
Deceased: Ethel M Brion
Date of Death: 03/13/2006
Date Prepared: 03/20/2006
Claim Number: 363906
Death Benefit
Cost Basis
Taxable Gain
$
$
10,262.14
0.00
Total Death Benefit
$
10,262.14
Beneficiary Designation
Primary: Lola M Mertes, Donald L Brion, Child(ren)-Named
Special Messages
1. To assist the beneficiary in selecting a distribution method, you should refer to FPDA Tax Chart No.
1. This chart can be printed from InfoSource, Customer Service, Claims, Death Claims Tax Charts.
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July 17, 2006
TO: law Offices of
Said is, Flower & Lindsay
2109 Market St.
Camp Hill, PA 17011
FROM: Todd L. Miller
Cust. Service Supervisor
P.O. BOX 250
SHIPPENSBURG PA 17257-0250
RE: ESTATE OF Ethel M. Brion
DATE OF DEATH: March 13,2006
IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE
FOllOWING ACCOUNTS WITH ORRSTOWN BANK:
CHECKING ACCOUNTS
ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST
410802 Ethel Brion 07/19/96 $12,797.81 $0.56
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JEctitt Mill attn m~,tctmt1tt
I, ETHEL M. BRION, of Liberty, Tioga County,
do make, publish and declare this to be my Last Will and Testament,
hereby revoking all former testamentary writings made by me.
ITEM #1: I direct the payment out of my estate of the
expenses of my last illness and funeral.
ITEM #2: All of my property, real and personal, and
wherever situate, I give in two equal shares, one share to my
daughter, Lola M. Mertes, per stirpes, and one share to my son,
Donald L. Brion, per stirpes.
ITEM #3: In addition to the powers vested in fiduciaries
by law, my personal representatives and their successors shall have
the following powers, applicable to all property held by them,
including all property held for minors, both principal and income,
effective without the order. of any court and until the actual dis-
tribution of all such property:
(a) To retain any and all property at any time received
by them;
(b) For the payment of debts or for any purpose of ad-
ministration or distribution, to sell all or any of my real estate,
at public or private sale, for such prices and upon such terms as to
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cash and credit as they deem proper, without liability uri=;: t~e pitt
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of the purchasers to see to the application of the purchasE:!.-IDoneys;
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(c) To compromise any claim by or against my estate
without the consent of any beneficiary;
(d) To make distributions hereunder in cash or in kind or
partly in cash and partly in kind at such valuations as they may
fix;
(e) To give options without obligation to repudiate the
same in favor of a higher offer; and
(f) To carry investments in the name of a nominee or
nominees.
ITEM #4: I appoint my daughter, Lola M. Mertes, and my
son, Donald L. Brion, Co-Executors of this Will and direct that
they shall not be required to give any bond or enter any security
in any jurisdiction in which they may act.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
this )f'~ day of ~~ , 19 ~O.
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(SEAL)
SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named
Testatrix, Ethel M. Brion, as and for her Last Will and Testament,
in the presence of us, who at her request, in her presence and in
the presence of each other, have hereunto subscribed our names as
witnesses.
%~.cnQQ~'\Lm_
7t~~ B. BL
residing at
Qll)IiJO?aYtf? lIJeK'~ 11.
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residing at
JOHN E. SLIKE
ROBERT C. SAIDIS
JAMES D. FLOWER, JR
CAROLJ. LINDSAY
MICHAEL 1. SOLOMON
BRIAN C. CAFFREY
GEORGE F. DOUGLAS, III
THOMAS E. FLOWER
MARYLOU MATAS
SUZANNE C. HIXENBAUGH
LAW OFFICES
SAIDIS, FLOWER & LINDSAY
A PROFESSIONAL CORPORATION
2109 MARKET STREET
CAMP HILL, PENNSYLVANIA 17011
TELEPHONE: (717) 737-3405 - FACSIMILE: (717) 737-3407
EMAIL: attorney@sfl-Iaw.com
www.sfl-Iaw.com
CARLISLE OFFICE:
26 WEST HIGH STREET
CARLISLE, PA 17013
TELEPHONE: (717)243-6222
FACSIMILE: (717)243-6486
REPLY TO CAMP HILL
August 18, 2006
Register of Wills
Cumberland County Courthouse
Carlisle, PA 17013
Re: The Estate of Ethel M. Brion
File No. 21-06-0272
Dear Ladies:
Enclosed please find an original and two copies of an Inheritance Tax Return to be filed
in the above estate. Also enclosed are two checks, one for the filing fee and the other for the tax
due. Kindly return a time-stamped copy of the return in the envelope provided. Thank you.
Very truly yours,
/sly
Enclosures
./
~DI OWER & LINDSAY
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s JF Estate Paralegal
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Glenda Farner Strasbaugh
Register of Wills
and
Clerk of Orphans' Court
Marjorie A. Wevodau
First Deputy
Kirk S. Sohonage, Esq
Solicitor
Register of Wills and Clerk of the Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
(717) 240-6345
FAX (717)240-7797
INVOICE
Bill To:
InvoiceN 0:
Invoice Date:
Estate of:
Estate No:
1014
8/21/2006
ETHEL M. BRION
21-06-0272
SAIDIS, FLOWER & LINDSAY
2109 MARKET ST
JA
CAMP HILL, PA 17011
Qty
1
Fee Description
Additional Probate
Fee
Total
$15.00
15.00
Total:
$15.00
Checks should be made payable to the Register of Wills. Terms: Net 30.
Please return one copy of this invoice with your payment. Thank you.