HomeMy WebLinkAbout02-17-10-~ REV-1500 1505607120
EX (O6-OS) OFFICIAL USE ONLY
PA Department of Revenue county code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po aox.z6osot RESIDENT DECEDENT 21 0 9 10 6 7
Harrisburg, PA 77128.0601
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
162505449 12172001 11111901
Decedent's Last Name Suffix Decedent's First Name MI
BRUBAKER ANNA B
(If Applicable) Enter Surviving Spouse's Infomwtion Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 7. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(tlare of death after 12-12-82)
® 8 Decetlent Died Testate ^ ~ Decadent Maintained a Living Trust _0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
^ 9. Litigation Proceeds Received ^ 7p- Spousal Poverty Credit{date of death ^ t t,Election to tax under Sec. 9113(A)
between 12-37-91 and -1-95) (Attach Sch. O)
G(1RRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
KEITH D. WAGNER 7178386348
Firrn Name (If Applicable)
BRINSER, WAGNER ~ ZIMMERMAN
First line of address
6 E. MAIN STREET
Second line of address
P.O. BOX 323
City or Post Office State ZIP Code
PALMYRA PA 17078
M1J
REGISTER ILLS USBJNLY_,
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Correspondent'se{nailaddress: keithl~bWZlaW.com
Under penekies of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
k is true, corraect and complete. Declaration of preparer other then the personal representative is based on all information of which preparer has any knowledge.
Gerald J. Brinser
6 E. Main Street
P.O. Box 323, Palmyra, PA 17078
SIGNATURE OF PREPARER OTHER THAN REPRES~NI-ATVE DATE
Keith D. Wagner
ADDRESS
6 E. Main Street, Palmyra, PA 17078
Side 1
1505607120 1505607120 J
REV-1500 EX
o~aenr:Name: BRUBAKER, ANNA B.
Decedent's Social Security Number
162505449
RECAPITULATION
1. Real Estate (Schedule A) ........................................................................................... 1.
2. Stocks and Bonds (Schedule B) ................................................................................. 2.
194.46
3. Closely Held Corporetion, Partnership or Sole-Proprietorship (Schedule C) .............. 3.
4. Mortgages & Notes Receivable (Schedule D) ............................................................ 4.
2,043.30
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E} .................... 5.
6. Jointty Owned Property (Schedule F) ^ Separate Billing Requested .............. 6.
7 Inter-V'rvos Transfers & Miscellaneous Non-Probate Property
. (Schedule G) ^ Separate Billing Requested .............. 7.
8 2 , 2 3 7 . 7 6
g, Total Gross Assets (total Lines 1-7) ........................................................................ .
1,407.00
9. Funeral Expenses & Administrative Costs (Schedule H) ........................................... . 9.
632.46
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................................... 10.
2, 0 3 9. 4 6
11.
........................................
Total Deductions (total Lines 9 & 10) .............................
. 11.
12 1 9 8 . 3 0
12. Net Value of Estate (Line 8 minus Line 11) .............................................................. .
13 CharRable and Governmental BequestslSec 9113 Trusts for which 1 6 8
5 6
, an election to tax has not been made (Schedule J) .................................................... 13. .
14. Net Value Subject to Tax (Line 12 minus Llne 13) .................................................. . 14. 2 9 . 7 4
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116 15
(a)(1.2) X .00
16. Amount of Line 14 taxable 16
at lineal rate X •~
17. Amount of Line 14 taxable 1 ~
at sibling rate X .12
18. Amount of Line 14 taxable 2 9
7 4 18 4 . 4 6
.
at collateral rate X .15
19.
4.46
19. Tax Due ................................................................................................................... ..
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
1505607220
Side 2
1505607220 1505607220 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21 - 09 - 1067
C E ME
Brubaker, Anna B.
STREET ADDRESS
Messiah Village
100 Mt. Allen Drive
CITY
Mechanicsburg STATE
PA ZIP
17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 4.46
2. Credits/Payments
A. Spousal Poverty CredR
B. Prior Payments
C. Discount ~
3. Interest/Penalty if applicable Total Credits (A + g + C) (2) 0.0 0
D. Interest
E. Penalty
Total InteresVPenatty (D + E) (3) 0.0 0
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
CFreck box an Page 2 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. (5) 4.46
A. Enter the interest on the tax due. (SA)
B. Eller the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 4.4 s
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 :.....................
................................................................
b. retain the right to designate who shall use the property transferred or its income :.........................................
c. retain a reversionary interest; or ..................................................................................................................... ~ x
d. receive the promise for life of either payments, benefits or care7 .................. ^ ^
................................................ x
2. If death occurred after December 12, 1982, did decedent transfer property wfthin 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? ............... ^
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary desi9nation? ......................................................... ^
...............................................................
IF THE ANSWER TO ANY OF THE ABOVEI QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Fw dates of death on or after July 1, 1994 arks 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. §g116 (a) (1.1) (i)].
For dates of death on or after January 7 , 1995,1he 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. §9116 (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 Oling a tax return aAe 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 steppargnt of the child is zero (0) percent [72 P.S. §9116 (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; §9116 (a) (1)J.
The tax rate Imposed on the net value of transfer 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.
conMONwEkrN of PENNSYLVANIA
INHERITANCE TA%RETURN
RESIDENT DECEDENT
ESTATE OF Brubaker, Anna B.
SCHBDULE B
STOCKS ~ BONDS
All properly jointly-owned wkh right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION
NUMBER i~
_- .--- - -
1 6.0 Shares PP&L @ $32.41 Per Share
_~_ _
FILE NUMBER
___ L 21 - 09 - 1067
___ - -__.
UNIT VALUE VALUE AT DATE OF
DEATH
32.41 194.46
- - - ---- -
- - ----
_-. __ ___
TOTAL (Also enter on line 2, Recapitulation) 194.46
SCH~bULE
CASH, BANK DEPOSITS, 8~ MISC.
°O""AON`"'~"`TMOFPEN"151ti"^"'" PERSONAL PROPERTY
INNERRANCE TN(RETURN
RE6IDENT DECEDENT
FILE NUMBER
ESTATE OF Brubaker, Anna B. 21 - 09 -106
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be diaclosed on achedule F.
-- - - - - _
ITEM _ - _ _ _ -
NUMBER DESCRIPTION
1 Brethen In Christ -SIC Account
(Includes accrued interest of $21.84)
2 ~ Messiah Village -Resident Trust Share Account
3 1 P P& L Dividend Checks on Hand
TOTAL (Also enter on Line 5, Recapitulation)
VALUE AT DATE OF
DEATH
1,221.84
632.46
189.00
2,043.30
AEH
COI.fAONWFALTN OF PENNSYLVANIA r~~
INNERrfANCE TAX RETURN Ar1~~~TpA`n~ 1C
RESIDENT DECEDEPTI ~'Y./~~7 ~ ~W ~ ~rG
ESTATE OF Brubaker, Anna B.
Debts of decedent must be reported on Schedule I.
--- -- __
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION
A. 1
B.
1
2.
3.
4
5.
6.
7.
1
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Gerald J. Brinser
Stroet Address 6 E. Main Street, P.O. Box 323
city Palmyra state PA zip 17078
Year(s) Commission paid 2010
Attorney's Fees
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
Probate Fees Register of Wills (Itrs. pd. $20.00 = up to $2,000)
Accountant's Fees
Tax Return Proparer's Fees
Other Administrative Costs
Register of Wills -Additional Cost of Letters
FILE NUMBER
21 - 09 - 1067
_ _ ---
AMOUNT
1,300.00
67.00
10.00
- - _- -
--__
TOTAL (Also enter on line 8, Recapitulation) 1,407.00
C Sdtledule H
COMMONWEALTH OF PENNSYLVANIA I Fir>~ral
INHERITANCE TAX RETURN ~~
RESIDENT DECEDENT l___
ESTATE OF Brubaker, Anna B.
2 Register of Wilfs -Filing Fee for Inventory
3 Register of Wills -Filing Fee of REV-1500
FILE NUMBER
21 - 09 -1067
I~
---
15.00
15.00
Page 2 of Schedule H
COFMONWEALTN OF PENNSYLVANIA
INHERRANCE TA%RETURN
RESIDEPl~ DECEDENT
ESTATE OF Brubaker, Anna B.
SCHEDULEI
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
FILE NUMBER
2~ - os - ~os~
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1 ~ Messiah Village
632.46
TOTAL (Also enter on Line 10, Recapitulation) ~ 632.46
REV-1513 EX+(11-08) ~ ~ ~
SCHEDULE)
COMMONWEALTH OF PENNSYLVANIA
INHERRANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF
Brubaker, Anna B. FILE NUMBEF2
_ 21 - 09 -1067
NUMBER NAME AND ADDRESS OF P RSON S
RECEIVING PROPEF~TY () RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
_ Do Not Llst Tnwtee(s)
I~ TAXABLE DISTRIBUTIONS[include oou~ttright spousal
dlstnbuhohs and tr
f
ans
ers
under Seq. X116 (a) (1.2)]
1 Ronald B. Brubaker None 1/6 of 15% 4.96
3125 E. Avenue, Q-12
Palmdale, CA 93550
2 Nancy J. Hoke None 1/6 of 15% 4.96
508 Messiah Vllage
Mechanicsburg, PA 17055
3 Dr. H. Dale Kreider None 1/6 of 15% 4.96
3241 N. Bouchard Place
Tucson, AZ 85749
Enter dollar amounts for distributions shown above on lines 15 t hrough 18 on Rev 7500 cover she et, as appropriate.
II NON-TAXABLE DISTRIBUTIONS:
. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENI~AL DISTRIBUTIONS
1 Board of Brotherhood Conceals, P.O. Box 290 (35% of Residue) 69
41
Grantham, PA 17027-0290 .
2 Messiah College, P.O. Box 3015 (20°k of Residue) 39
66
Grantham, PA 17027 .
3 The Board of Missions, P.O. Bqx 290 (20°~ of Residue) 39
66
Grantham, PA 17027-0290 .
4 Messiah Vllage, 100 Mt. Allen .Drive (10% of Residue) 19
83
Mechanicsburg, PA 17055 .
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 168.56
REV-1513 EX+~B.°°)
SCHEDULE)
COMMNHERITANCE~AX RETURN ANIA BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF
Brubaker, Anna B. FILE NUMBER
21-09-1067
NUMBER NAME AND ADDRESS OF PERSONS
() RELATIONSHIP TO
DECEDENT SHARE OF ESTATE
(Words) AMOUNT OF ESTATE
($$$)
RECEIVING PROPERTY Do Not ust Truateals)
j~ TAXABLE DISTRIBUTIONS[includeoutrightspousal
dlstnbutiohs and transfers
under Sea. X116 (a) (1.2))
4 Edna Schroeder None 1/6 of 15% 4.96
30099 Canyon Vew Drive
Lebanon, OR 97355-9390
5 Barbara Nissley None 1/6 of 15% 4.96
1113 S. Green Street
Palmyra, PA 17078
6 Kathryn A. Kreider None 1/6 of 15% 4.96
300 W. Maple Street
Palmyra, PA 17078
Page 2 of Schedule J
COO pS'(
WILL
OF
ANNA B. BRUBAKER
I, ANNA B. BRUBAKER, currently of Upper Allen Township, Cumberland County,
Pennsylvania, realizing the uncertainty of this life, but with confidence in God and trust in
His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and rose
again to redeem me and give me eternal life, do hereby make, publish and 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 miy 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 cleaz thereof.
III. All the rest, residpe 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. Thirty-five percent (35%) unto the Board of Brotherhood Concerns,
Brethren in Christ Church, Grantham, Pennsylvania, to be used as it sees best.
B. Twenty-percent (20%) unto The Board of Missions, Brethren in
Christ Church, Grantham, Pennsylvania, to be used as it sees best.
C. Twenty percent (20%) unto Messiah College, Grantham,
Pennsylvania, to be used as it sees best.
D. Fifteen percent (15%) to be divided equally among the following
nieces and nephews of my late husband who survive me: Nancy Hoke, Bazbaza
Kreider Nissley, Dale Kreider, Katharine Kreider, Ronald Brubaker and Edna
Brubaker Schroeder.
E. Ten percent (10%) unto Messiah Village, Mechanicsburg,
Pennsylvania, to be used in its Endowment Fund.
IV. I appoint my PNC Bank (or its successors), Mechanicsburg, Pennsylvania, Executor
of this my Will.
IN WITNESS WHEREOF, I, ANNA B. BRUBAKER, 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 13th day of May, 1997.
L~~ ~~u /~ i a ~~ (STEAL)
ANNA B. BRUBAKER
Signed by ANNA B. BRUBAKER, 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
13th day of May, 1997.
~_ residing ai
l~-FiI' residing a~
-2-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERILAND
WE, ANNA B. BRUBAKER, GERALD J. BRINSER and N ~ti~ T ~{~ ~~ L- ~ ?
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 testaurix, 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 of undue influence.
ANNA B. BRUBAKER
TNESS
~~~li~_
WITNESS
Subscribed, sworn or affirmed and acknowledged before me by ANNA B.
BRUBAKER, the testatrix, GERALD J. BRINSER and u..v A 'z, ~:, ~ : ,e ,
witnesses, this 13th day of May, 1997.
(SEAL) ~ Notary Public
Notarial Seal
Karen M. Turner. No'~ry °ublic
Upper Allen T,:rn., r~;r-,;,~,•!and County
My Co•nr':;sci _x,.irrs Ntuy 29. ?000
Membar, Pennsylvania Ass`, of g~: ~:.:"; ,
-3-
ee
Allentown, PA 18101-1179
Dividend Check
Account Number: 3097026437 Dividend Record Date: 06/10/2004
Payment Date: JULY 1,2004 Check Number: 01633773
Amount: $g,75 Print Number: 33914000154
Number of Dividend Dividend
Class of Stock Shares Rate Amount
PPL 4.50% PRFD (A) 6 1.1250 6.75
You can have your dividends deposited directly into your bank account. To request a
Direct Deposit Authorization form, or if you have any questions regarding your account, visit
the Investor Center at vrww.pplweb.com or call toll free:
1-800-345-3085
To access your account online, please visit www.shareowneronline.com
Please detach and retain this statement for your records. p+
PPL Electric Utilities Corporation • 1~' =f f% • No. olext773 DMDEND CHECK ~-~ ~ ~++
Two North Nikrth Street ~' Date JULr 1,2004
Allentown, PA 10101.1179 pp~ - void alter 180 days
~•,.
""SDC AND 75H00"
PAY.roTHE ;. `ANNA B BRUBAKER
ORDER OF: 100 MT ALLEN DRIVE
MECHANICSBURG PA 17055
MsRon 9a~dc rJ.il
We~ipkn, DE
11•OOOL633?7311' t:031i000471:
~ ~~~~
AWwhar 8lpnAva
3097026437..
a+s+eooorw
2~~~952 80211'
ti,
BICF
Brethren ;n Christ.
FOUND-~TION f~'irranc;«l Services, fir faith fi,l.S1P({yards
=05T OFFICE BOX 290
=31 GRANTHAM ROAD
_RANTHAM, PA 17027
Mr. Gerald J. Brinser.
Brinser, Wagner & Zimmerman
P.O. Box 323
Palmyra, PA 17078
RE: Anna B. Brubaker
Account No.: 1352-12192
Dear Mr. Brinser:
December 23, 2009
The balance of the above account on December 17, 2001 the date of Mrs. Brubaker's death was
$1,200.00. The accrued interest was $21.84 and the total date of death value was $1,221.84. The
actual opening date was September 4, 1980.
Upon receipt of Mrs. Brubaker's death certificate, I will close the account and mail the check payable
to the Estate of Anna B. Brubaker to you.
If I can be of further assistance, please do not hesitate to contact me at 800-726-1448, Extension
#5420, or at klehmania;+bicfoundation.org.
Sincerely,
Nr~J~JM~ ]'\
Kimberly J. Lehman
Account Officer
KJUkj i
Phone: (717) 796-4788 Fax: (717) 697-7714 E-mail: infoC~bicfoundation.org
MESSIAH VILLAGE
100 Mt. Allen Drive
P.O. Box 2015
Mechanicsburg, PA 170552015
(717) 697-4666
Resident: BRUBAKER ANNA B
Account Number
g Description
E ANNA BRUBAKER
N 208 MESSIAH VILLAGE
D MECNANICSBURG, PA 17055-2015
T
O
Date Ref Receipt Comments Deeesitg Withdromala T..b.~
Beginning Balance 571.46
12/03/2001 JF0112SSA SOCIAL SECURITY DEPOSITS 707.00 1
278.46
12/03/2001 JF0112SSA SOCIAL SECURITY DEPOSITS -646.00 ,
632
46
12/31/2001 JF01121NT Interest Earned - 12/31/2001 1.41 .
633,8
Reacirltant T~rrct C+~teme..t
Resident Number Date
000067806 12!31/2001
Page Amount
1 633.87
Total Balance: 633.87
REMEMBER TO KEEP YOUR ACCOUNT BELOW $2000.00
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17613
BRUBAKER ANNA B
Estate File No.: 2009-01067
Receipt Date: 11/18/2009
Receipt Time: 08:45:32
Receipt No.: 1058986
Paid By Remarks: BRINSBR ET AL
JN
------------------------ Receipt Distrib ution ----- -------- ------- ----
Fee/Tax Description Payment Amount Payee Name
PET LTRS ADM OTHER 20.00 CUMBERLAND COUNTY GENERAL FUN
WILL 15.00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 12.00 CUMBERLAND COUNTY GENERAL FUN
RENUNCIATION 5.00 CUMBERLAND COUNTY GENERAL FUN
JCP FEE 10.00 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5.00 CUMBERLAND COUNTY GENERAL FUN
Check# 1548 ----------------
$67.00
Total Received......... $67.00