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Home My WebLink About08-09-06 Rt:V-1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DE'PARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT I- Z W C W U W C w >- ><: Sen 011::><: w~u :J:o::g o 0-1Il 0- 0:[ DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) DERMODY DOROTHY A DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) CJ OFFICIAL USE ONL Y FILE NUMBER 2 1 -0 5 0 3 5 6 rouN'hC05E -n:A~ - - NUMBER- - SOCIAL SECURITY NUMBER o 7 7 - 2 4 - 9 0 7 3 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER D 3. Remainder Return (dale or death prior to 12-13-82) D 5. Federal Estate Tax Return Required _ 8. Total NurnberofSafe Deposit Boxes D 11 Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS JOHN H. BROUJOS ESQUIRE BROUJOS & GILROY, P.C. FIRM NAME (If Applicable) BROUJOS & GILROY, P.C. 4 NORTH HANOVER STREET TELEPHONE NUMBER 717-243-4574 CARLISLE PA 17013 z o i= <( ...J :::> l- e: <( u W 0:: z o j:: <( I- :::> a.. :E o U >< <( I- 03/16/2005 01/13/1926 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST. AND MIDDLE INITIAL) DERMODY, JOHN M. [Xl 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy or W,II) D 9. Litigation Proceeds Received D 2. Supplemental Return D 4a. Future Interest Compromise (dateordealh after 12.n82) D 7. Decedent Maintained a Living Trust (Attach copy OfT,usl) D 10. Spousal Poverty Credit (date or dealh belweec 12.31.91 acd r.1-95) >- Z w C Z o 0- en w II:: II:: o o 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) (8) 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) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES (14) 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 41,12800 X ~ (15) 11,128.00 X 45 (16) 0.00 X 12 (17) 0.00 X .15 (18) (19) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 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 < < OFFICIAL USE ONLY 40,236.00 33.00 000 4,184.00 ~.-, --1 , ~, ~ ,., ., ,--) ,-"., ~J . ) "'1 .:J .,j 13,095.00 {r) '. ,1 -'11 -~) :-,.1 10,00000 "",) 67,548.00 13,32300 1 ,97000 (11) (12) (13) 15,293.00 52,255.00 0,00 52,255,00 0.00 501.00 0.00 0.00 501.00 Decedent's Complete Address: STREET ADDRESS , 55 CHERRY LANE CITY CARLISLE STATE PA ZIP 17013 Tax Payments and Credits: 1 T ax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit B. Prior Payrnents C. Discount (1) 501.00 000 50t..00 000 Total Credits (A + B + C) (2) 501..00 3. Interest/Penalty if applicable D. Interest E, Penalty 0.00 000 5. Total Interest/Penalty ( 0 + E) (3) 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) If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF WILLS, AGENT 0.00 4 0.00 0,00 rJ1r:: 0.00 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; .................. .............................................. 0 [ZJ b retain the right to designate who shall use the property transferred or its incorne; ..... ...''''.''................ 0 [ZJ c. retain a reversionary interest; or ..........................,............... "."."".."""...,,,,"...............,....... 0 [ZJ d. receive the promise for life of either payments, benefits or care? """."..." "...."."""....................... 0 [ZJ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?....................................... """....""" ""."".................. 0 [ZJ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ""............ 0 [ZJ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? """............................,............... ... ,,".... ". "...... ". "................ [ZJ 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. DATE 8/9/2006 ADDRESS PA 17012 PC. DATE 8/9/2006 PA 17013 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 PS 39116 (a) (1.1) (i)l. 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 surVlVlnq spouse IS 0% 172 P S ~9116 (a) (1 1) (il)] The statute does not exempt a transfer to a survIving spouse from tax and the statutory reqUlfernents for disclosure of ?/! C ble even If the survIving spouse is the only benefiCiary Df) _ . For dates of death on or after July 1, 2000 - ( . n ill f d The tax rate Imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death I Q r:.. live parent, or a stepparent of the child IS 0% [72 PS 39116(a)(1.2)]. 1 () ~ The tax rate imposed on the net value of transfers to or for the use of the decedent's lineai beneficiaries is 45%, exce~ The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS 39116(a)1 individual who has at least one parent in common with the decedent, whether by blood or adoption. C"il-.., 116(a)(1)]. )2, as an REV-1503 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF DERMODY DOROTHY A FILE NUMBER 21 05 All property jointly-owned with right of survivorship must be disclosed on Schedule F. 0356 ITEM NUMBER 1. DESCRIPTION BURLINGTON NORTHERN SANTA FE CORP 189 Shares VALUE AT DATE OF DEATH 10,02300 2. CATELLUS DEV CORP (REIT) 41 Shares 1,521.00 3. PUBLIC SERVICE ENTERPRISE GROUP INC. 129 Shares 6,943.00 4. VANGUARD WELLINGTON FUND 718.749 Shares 21,749.00 5. 6. TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 40236.00 Rl:V-1504 EX + (6-98) '.' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP OR SOLE.PROPRIETORSHIP ESTATE OF DERMODY DOROTHY A FILE NUMBER 21 05 0356 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 33.00 HEARTLAND PARTNERS, LP 8 UNITS TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 33.00 REV-15GB EX + (6-9B) *' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF DERMODY DOROTHY 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. 0356 ITEM NUMBER 1. DESCRIPTION LIBERTY US GOVERNMENT MONEY MARKET FUND VALUE AT DATE OF DEATH 1,73500 2. PNC BANK - SAVINGS AlC # 5030031871 2,449.00 3, TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 4,184.00 REV-1509 EX + (6-98) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DERMODY DOROTHY A SCHEDULE F JOINTL Y.OWNED PROPERTY FILE NUMBER 21 05 0356 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 A. DERMODY, KEVIN M. B c JOINTLY-OWNED PROPERTY: ADDRESS 928 Susquehanna Street Harrisburg, PA 17102 RELATIONSHIP TO DECEDENT SON LETTER DATE DESCRIPTION OF PROPERTY %OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDF NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER ATTACH DEED FOR JOINTL Y-HELO REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 6/1/90 PNC BANK - Checking Accl. # 5070062015 10,824.00 50. 5,412.00 2. A 7/6/89 PNC BANK - Checking Acel. # 5070096848 5,234,00 50. 2,617.00 3. A. 2/27/84 TRI-CONTINENTAL - 568.457 Shares 10,133.00 50. 5,066.00 TOTAL (Also enter on line 6, Recapituiation) $ 13095.00 (If more space is needed, insert additional sheets of the same size) REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DERMODY DOROTHY A. SCHEDULE G INTER-VIVOS TRANSFERS & Mise, NON-PROBATE PROPERTY FILE NUMBER 21 05 0356 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 DECEDE!\JT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATT!",CH A COPY OF THE DEED FOR R:::A: FSTATF VALUE OF ASSET INTEREST VALUE (I~ APPLICABLE) 1, TIM-CREF ANNUITY # IP05982-8 10,00000 100. 000 10,000.00 TOTAL (Also enter on line 7 Recapitulation) $ 10,000.00 (If more space is needed, insert additional sheets of the same size) R"EV-1511 EX + (12-99) '.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DERMODY DOROTHY A SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. FILE NUMBER 21 05 0356 ITEM NUMBER DESCRIPTION AMOUNT A FUNERAL EXPENSES 1. Ewing Brothers, 630 South Hanover Street, Carlisle, PA 17013 1,92300 B. ADMINISTRA TIVE COSTS 1. Personal Representative's Comrnissions Name of Personal Representative (s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. AttorneyFees John H. Broujos, Broujos & Gilroy, P.C., 4 N.Hanover St., Carlisle, PA 3,00000 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant Kevin M. Dermody Street Address 928 Susquehanna Street City Harrisburq State P A Zip 17112 Relationship of Claimant to Decedent Son 4. Probate Fees 5. Accountant's Fees Boyer & Ritter, 141 West High Street, Carlisle, PA 17013 1,500.00 6. Tax Return Preparers Fees 7. Reserve 1,00000 Wienken & Associates, 100 Corporate Center Dr, Suite 201, Camp Hill, PA 17011 2,400.00 TOTAL (Also enter on line 9, Recapitulation) $ 13323.00 (If more space is needed, insert additional sheets of the same size) REV_1513EX+I.. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DERMODY DOROTHY A SCHEDULE J BENEFICIARIES NUMBER I. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)J JOHN M. DERMODY - CIO Lebanon Vet. Medical Center 1200 S. Lincoln Avenue Lebanon, PA 17042 KEVIN.M~ERMODY . K \J D 928 Susquehanna Street ~ Harrisburg, PA 17102 1. 2. FILE NUMBER 21 05 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) HUSBAND SON 0356 AMOUNT OR SHARE OF ESTATE 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 II - 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) COMMONWEALTH DF PENNSYLVANIA REV-1162 EX(11-96) 'I UEPAIlTfvlENT OF REVENUE BUREAU OF INOIVIDUAl TAXES DEPT ~80601 . H,ARRISBURG, P,A 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 006829 BROUJOS JOHN 4 NORTH HANOVER STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER --- kid ---------- -------- 101 I $501.00 ESTATE INFORMATION: SSN: 077-24-9073 I FILE NUMBER: 2105-0356 I DECEDENT NAME: DERMODY DOROTHY ANNE I DATE OF PAYMENT: 06/13/2006 I POSTMARK DATE: 06/1 2/2006 I COUNTY: CUMBERLAND I DATE OF DEATH: 03/16/2005 I I TOTAL AMOUNT PAID: $501.00 REMARKS: CHECK# 1637 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS TAXPA YER