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Home My WebLink About03-0129 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-150 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) DATE OF DEATI-,I (MM-DD-YEAR) I DATE OF BIR. TH (MM-DD-YEAR) (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ~'1. Odginal Retum I--1. Limited Estate II-I 6. Decedent Died Testate (Aach copy of wi,) --]9. Litigation Proceeds Received [--]2. Supplemental Return --] 4a. Future Interest Compromise (date of death afl~ 12-12-82) I---] 7. Decedent Maintained a Living Trust (^ltech c~oy of'rltst) i'--I0. spousal Poverty Credit (date of dea~ between 12-31-9t and 1¢95) TELEPHONE NUMBER SOCIAL SECURITY NUMBER - --7 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER I [---~ 3. Remainder Return (date of daath ~ te 1:)-13.82) [~]5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes ---]11. Election to tax under Sec. 9113(A) (Att,~c~ S,:h O) COMPLETE MAILING ADDRESS 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) '-]Separate Billing Requested 7. Inter-Vivos Transfem & 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) 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. OFFICIAL USE ONLY Charitable and Govemmental Bequests/Sec 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) (14) (11) (13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) 16. Amount of Line 14 taxable at lineal rote x .0 (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) ~ ~) 20. D Decedent's Complete Address: ISTATE '~">7~ Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits (A + B + C ) (2) 3. InterestJPenalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I Line 20 to request a refund (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (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 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 ................ . ......................................................................................................... [] [] 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 secudty at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ [] 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 perjury, I declare that I have examined this return, induding 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 representstive is based on all infom~ation of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS SIGNATUR~EP.,~,,~ OTHER~THAN REPRESENTATIVE ADDRESS ~'-~ ~,.~.~_.~._ ~l:)~.~ ~ DATE 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 FS. §9116 (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 RS. §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 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 adoptNe parent, or a stepparent of the child is 0% [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 4.5%, except as noted in 72 RS. §9116(1.2) [72 RS. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §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. REV. I$02 EX+ (12-85) ~,..~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE (Property jointly-owned with Right of Survivorship must be disclosed on Schedule F) All real estate should be reported at fair market value which 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. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ,,.-- O '""- TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of same size.) EX* (1~7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT EST^TEOF C_~I~ SCHEDULE E I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ~[--,e~*~, v~.~***~,.,,.c~,c,,,... FILE NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All prope~/jointly.ow, ned with the right of survivorship must be disclosed on Schedule ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. TOTAL (Also enter on line 5, Recapitulation) (If more s~ace is needed, insert additional sheets of the same size) SCHEDULE H COUIVlONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX REr~RN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. 1. FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Pemonal Representalive (s) Social Security Number(s) I EIN Number of Personal Representative{s) Street Address C~y State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address RelalJonship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparers Fees State __Zip TOTAL (Also enter on line 9, Recapitulation) $ ~.~--~' (If more space is needed, insert additional sheets of the same size) Ri~V-1512 EX + (1-97) (I) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT '~ -& '-fo olB oq3"{ o7'7S~ ~q ~ TOTAL (Also enter on line 10, Recapitulation) $ ~' ~ I ~'~ I (If more space is needed, insert additional sheets of the same size) REV-1513 EX * (1-97) ~ SCHEDULE J COMMO.W .T. BENEFICIARIES "ESlOENT DECEOE~ ESTATE OF FILE NUMBER 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 outdght spousal distributions) ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE~ 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET 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 Ir]. 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) Waup i.n LOOK FOR US. WE'LL GET YOU THERE. P.O. Box 1711, Harrisburg. PEnnsuIvanla 17105-1711 Member FDIC CLYDE K BRENNEMAN DECD 1720 PINE RD NEWVILLE PA 17241-9543 6322 STATEMENT DATE FOCUS 10/08/02 PAGE 1 ACCOUNT TYPE OF ACCOUNT: INTEREST PAID ANNUAL PERCENTAGE YIELD DAYS IN CYCLE AVERAGE BALANCE YEAR TO DATE EARNED (APYE) 0090930025 FOCUS 50 FREE INTEREST 3.60 .53 ~ 30 206.55 PREVIOUS BALANCE DEPOSITS WITHDRAWALS CHARGES INTEREST ENDING BALANCE 206.55 .00 '.00 .00 .09 206.64 DATE ACTIVITY DESCRIPTION DEPOSITS WITHDRAWALS BALANCE 10/08/02 INTEREST EARNED .09 206.64 Need to start saving for your child's education, a new home, a vacation. or a new car? Ask us how we can help you set up Automatic Savings Deposits so you can start saving today -- because a little at a time really adds up) Stop by your local branch to find out. more. or call our Customer Service Center at 1-866-WAYPOINT. In Yorkj Call 815-4500. ~0D-502 (2/02) Customer Service Toll-Free 1-866-WAYPOINT (I-866-9E9-7646) · In York Area 717/815-4500 vvww. wagpointbank.com 90 -12002 TRL~ ! ~.' DATE O~ 16~UE !~'DoHETER~oISCLD MNUNG AODRE~ ~, CLYDE'K BRENNEMAN ~ 27,26 -RI?NER .HIMY- *~AI~LISLE PA 17013 t certify u d the dine of issue, tr~ ~ rmx~ds of t~e Pe~me/tvania Department TranSport m~lect t~at the pee~(~ ~ ¢~mpam/named he[Mn I~ the laMfUl mv~e~ of ~e ~akl vehl~e, APPLICATION FOR TITLE AND LIEN INFORMATION- SIGN IN PRESENCE OF A NOTARY zip MADE this 90' THIS INDENTUI day of April , 1999. Parcel #31-12-0332-027A BETWEEN S'IfiPHEN BUCHER, Executor of the Last Will and Testament of Esther M. Bucher, Ivte of South Middleton Township, Cumberland County, Pennsylvania; GRANTOR AND CLYDE K. BRENNEMAN and FAYE L. BRENNEMAN, husband and wife of Shippensburg, Pennsylvania; GRANTEES WHEREAS Esther M. Bucher died January 1, 1999, testate seized of certain land situate in Penn Township, Cumberland County, Pennsylvania; and WHEREAS the Will of the said Esther M. Bucher dated March 10, 1988, was duly probated in the Office of the Register of Wills in and for Cumberland County, Pennsylvania, on February 1, 1999, and Letters Testamentary were granted to Stephen Bucher, the above named Executor to//21-99-0086; and WHEREAS Section 3351 of the Probate, Estates and Fiduciaries Code (20 PS. 3351) confers upon Executor(s) the power to sell at public or private sale, any real estate not specifically devised; and WHEREAS the hereinafter described premises were not specifically devised; and WHEREAS the said Executor was not required to file any bond to secure f,.ithful performance of his duties. NOW THIS INDENTURE WITNESSETH that the said Stephen Bucher, Executor of the Estate of Esther M. Bucher, deceased, for and in consideration of the sum of One Hundred Four Thousand Nine Hundred and 00/100 Dollars ($104,900.00) in lawful money of the United States, to him in hand paid by the said GRANTEES at and before the sealing and delivery hereof, the receipt whereof is hereby acknowledged he has granted, bargained, sold, aliened, released and confirmed, and by these presents does grant, bargain, sell, alien, release and confirm unto the said GRANTEES, their heirs and assigns as tenants by the entirety: ALL THAT CERTAIN tract of land, including improvements thereon erected, situate in the Township of Penn, County of Cumberland, Pennsylvania, more particularly bounded and described as follows, to wit: BEGINNING at an existing nail in the centerline of S.R. 3006, also known as Pine Road, at corner of lands now or formerly of Pennsylvania Fish Commission, thence along said lands of the Pennsylvania Fish Commission South 02 degrees 28 minutes 13 seconds East 257.68 feet to an existing iron pin, thence continuing along land now or formerly of the Pennsylvania Fish Commission South 17 degrees 15 minutes 43 seconds East 37.41 feet to an existing iron pin; thence along lands now or formerly of Penn Township Volunteer Fire Company South 76 degrees 26 minutes 14 seconds West 240.62 feet to an existing iron pin; thence continuing along lands now or formerly of Penn Township Volunteer Fire Company North 14 de~rees 56 minutes 10 seconds West 339.60 feet to an existing nail located in the ce~terline of S.R. 3006, also known as Pine Road; thence along the centerline of Pine Road North 85 degrees 53 minutes 48 seconds East 300.00 feet to an existing nail in Pine Road, the place of BEGINNING. CONTAINING 1.92 acres and being residue lands of Esther M. Bucher Estate as shown on a Land Survey prepared for the Esther M. Bucher Estate by William A. Brindle Associates Inc. dated April 28, 1999. BEING the remaining real estate which Daniel M. Bucher, by his Deed dated May 18, 1977, and recorded in Cumberland County Recorder of Deeds Book "E", Vol. 27, Page 408, granted and conveyed unto Daniel M. Bucher and Esther M. Bucher, his wife. The said Daniel M. Bucher died February 26, 1988, thereby vesting full title in Esther M. Bucher. TOGETHER with all and singular ways, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging, or in anywise appertaining, and the reversions and remainders, rents, issues and profits thereof; and also, all the estate right, title, interest, use trust, property, possession, claim and demand whatsoever, in law, equity or otherwise howsoever, of, in, to or out of the same. BUREAU OF INbIVIDUAL TAXES INHERII'ANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 ROBERT L OBRIEN ESQ OBRIEN ETAL 17 W SOUTH ST CARLISLE PA 17O115 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 04- 07-2003 ESTATE OF BRENNEMAN DATE OF DEATH 08-16-2002 FILE NUNBER 21 03-0129 COUNTY CUMBERLAND ACN 101 Amount Remitted REV-tS47 EX AFP CLYDE K MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF NILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-1547 EX RFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRENNEMAN CLYDE K FILE NO. 21 03-0129 ACN 101 DATE 04-07-2003 TAX RETURN WAS: C } ACCEPTED AS FILED C X} CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN I. Real Estate CSchedule A} C1} 2. Stocks and Bonds CSchedule B} $. Closely Held Stock/Partnership Interest (Schedule C} 4. Mortgages/Notes Receivable CSchedule D} 5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) 6. Jointly Owned Property CSchedule F) 7. Transfers CSchedule G) C7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/N/sc. Expenses CSchedule H) C9) 10. Debts/Mortgage Liabilities/Liens CSchedule I} ClO} 11. Total Deductions 12. Net Value of Tax Return .00 .00 .00 .00 346.55 .00 .00 C8} 5,525.00 NOTE: To insure proper credit to your account, submit the upper portion of this form w/th your tax payment. 15. 14. NOTE: ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15} 16. Amount of Line 14 taxable at Lineal/Class A rate C16) 17. Amount of L/ne 14 at Sibling rate Cl7} 18. Amount of Line 14 taxable at Collateral/Class S rate C18} 19. Prtnci)a! Tax Due TAX CREDITS PAYMENT RECEIPT DISCOUNT C+} DATE NUMBER INTEREST/PEN PAID C-} 346.55 .00 x O0 = .00 · 00 x 045 = .00 · O0 x 12 = . O0 · O0 x 15 = . O0 AMOUNT PAID IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. reflect figures that include the total of ALL returns assessed to date· TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE (19>= .00 .00 .00 .00 .00 C IF TOTAL DUE IS LESS THAN ~1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CA}, YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.} Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) C15) .00 Net Value of Estate SubSect to Tax C14) 61,379.45- If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will 56r201.00 c[1) ti2) 61,379.45- RESERVATION= PURPOSE OF NOTICE= PAYMENT= REFUND CCR)= OBJECTIONS= ADMIN- ISTRATIVE CORRECTIONS= DISCOUNT= PENALTY: INTEREST= Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B CcoZlateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawfu! Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 25 of 2000. C72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to= REG~S~ OF NILLS, A~ A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" CREV-1313). Applications are available at the Office of the Register of Nills, any of the 23 Revenue District Offices, or bv calling the special 24-hour answering service for forms ordering= 1-800-3&2-2050; services for taxpayers with special hearing and / or speaking needs= 1-800-447-3020 CTT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax Cincluding discount or interest) as sho~n on this Notice must object within sixty C&O) days of receipt of this Notice by= --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to= PA Department of Revenue, Bureau of Individual Taxes, ATTN= Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" CREV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent CSX) discount of the tax paid is allo~ed. The 15X tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and tn the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one C1) day from the date of death, to the date of payment. Taxes which became delinquent before Januar~ 1, 1982 bear interest at the rate of six C6X) percent per annum calculated at a daily rate of .000164. AIl taxes which became delinquent on and after JanuarY 1, 1982 wil! bear interest at a rate which wil! vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable ~nterest rates for 1982 through 2003 are= Interest Daily Interest Daily Interest Daily Year Rate Factor Y ea.~.r Rate Factor Yea.~r Rate Factor 1982 20Y. .000548 1987 9Y. . O00247 1999 7Y. .000192 1983 16Y. .000458 1988-1991 IIX .000501 2000 8Y. .000219 1992 9Y. .000247 2001 9X .000247 1984 11~. .000~,01 1993-1994 7X .000192 2002 &y. .000164 1985 13X .000556 1995-1998 9Y. .000247 2003 Sr. .000137 1986 10X .000274 --Interest is calculated as follows= INTEREST = BALANCE OF TAX UNPA/D X NUI~BBR OF DAYS DELINIIUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen C15) days beyond the date of the assessment. If pavment is made after the interest computation date sho~n on the Notice, additiona! interest must be calculated, ~EV-1470 EX (6-8~.)' INHERITANCE TAX EXPLANATION COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE OF CHANGES BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME FILE NUMBER Clyde K. Brenneman 2103-0129 REVIEWED BY ACN ANITA MCCULLY 101 ITEM SCHEDULE NO. EXPLANATION OF CHANGES The value of the estate has been adjusted as the result of the correction of an error in arithmetic. Row Page 1 IN RE: ESTATE OF CLYDE K. BRENNEMAN SEP 11 ZOO3 : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA : ORPHANS' COURT : NO.21-03-0129 )RDER OF ~ AND NOW, this day of review of the Petition to Settle A Small Estate filed by Faye L. , 2003, after Brenneman, the Court orders and directs Waypoint Bank to close Mr. Brenneman's account, and deliver the balance therein to Faye Jo L. Brenneman. BY THE COURT, IN RE: : IN THE COURT OF COMMON PLEAS : CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF : CLYDE K. BRENNEMAN : ORPHANS' COURT : NO.21-03-0129 : PETITION TO SETTLE A SMALL ESTATE 1) Petitioner is Faye L. Brenneman, an adult individual, residing at 2179 Newville Road, Carlisle, Pennsylvania, 17013. 2) Petitioner is the surviving spouse of Clyde K. Brenneman. Mr. Brenneman died August 16, 2002. 3) Mr. Brenneman's entire estate consists of an account with Waypoint Bank # 0090930025, with a balance of $206.55. 4) Ail of Mr. Brenneman's bills have been paid and attached hereto is the acceptance by the Department of Revenue in reference to the inheritance tax return. 6) Mrs. Brenneman is the heir entitled to the funds in the bank account as Mr. Brenneman died intestate. 7) Attached hereto is Mr. Brenneman's Death Certificate. WHEREFORE, Petitioner requests that the Court order Waypoint Bank to close Mr. Brenneman's account and pay any balance Faye L. Brenneman. Respectfully submitted, O'BRIEN, BARIC & SCHERER ob . Esquire I.D. # 28351 17 West South Street Carlisle, Pennsylvania 17013 (717) 249-6873 I verify that the statements made in the foregoing Petition to Settle a Small Estate are true and correct to the best of my knowledge, information and belief. I understand that false statements herein are made subject to the penalties of 18 Pa. C.S. ~ 4904, relating to unsworn falsification to authorities. Faye ~. Bren~neman J ' Dated: LOOK FOR US. WE'LL GET YOU THERE. P.O. Box 1711. Harrisburg, Pennsglvanla 1710S-1711 Member FDIC CLYDE K 8RENNEMAN DECD 1720 PINE RD NEWVILLE PA 17241-9543 6322 STATEMENT DATE 10/08/02 PAGE 1 FOCUS ACCOUNT 0090930025 TYPE OF ACCOUNT: INTEREST PAID ANNUAL PERCENTAGE YIELD YEAR TO DATE EARNED (APYE) FOCUS 50 FREE INTEREST 3,60 ,53 ~. DAYS IN CYCLE 3O AVERAGE BALANCE 206,55 PREVIOUS BALANCE DEPOSITS WITHDRAWALS CHARGES INTEREST 206,55 ,00 ,00 ,00 ,09 DATE 10/08/02 ACTIVITY DESCRIPTION DEPOSITS WITHDRAWALS INTEREST EARNED ,09 Need to start saving for your child's education,- a new ~o~e, a vacation, or a new car! Ask us how we can help you set up Autom~)C Savings ENDING BALANCE 206,64 BALANCE 206,64 Deposits so you can start saving today -- because a Httle at a time really adds upi Stop by your local branch to find~ut more or call our Customer Service Center at 1-866-WAYPOINT, In io6k~j'6~ll 815-4500, (2/O2) Customer Service Toll-Free I-B66-WAYPOINT (I-866-9;=9.7646) . In York Area 717/815-4500 vwvvv, way poi ntba n k.com REAU OF INDIVIDUAL TAXES -''IRHERIT~NCE TAX DIVISION D~PT. ~,80601 · k~RRISBURG, PA 17128-0&01 ROBERT L OBRIEN ESQ OBRIEN ETAL 17 W SOUTH ST CARLISLE PA 17015 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE 04'07-2005 ESTATE OF BRENNEMAN DATE OF DEATH 08'16-2002 FILE NUMBER 21 05-0129 COUNTY CUMBERLAND ACM 101 Amount Remitted CLYDE K MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS -~ REV-1547 EX AFP C01-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRENNEMAN CLYDE K FILE NO. 21 05-0129 ACN 101 DATE 04-07-2005 TAX RETURN WAS: C } ACCEPTED AS FILED C X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate CScheduie A) 2. Stocks and Bonds CSchedule B) $. Closely Held Stock/Partnership Interest CSchedule C) 4. Mortgages/Notes Receivable (Schedule D] 5. Cash/Bank Deposits/Misc. Personal Property CSchedule E) C5) 6. Jointly Owned Property CScheduie F) 7. Transfers CSchedule G) C7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses CSchedule H) 10. Debts/Mortgage Liabilities/Liens CSchedule I} ClO} Total Deductions 12. Net Value of Tax Return 346.55 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper Port/on .00 of this form with your tax payment. .00 .00 5,525.00 15. 14. NOTE: ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of L/ne 14 taxable at Lineal/Class A rate 17. Amount of L/ne 14 at Sibling rate 18. Amount of L/ne 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT C+) DATE NUMBER INTEREST/PEN PAID C-) :,: IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. C15) .00 X O0 = .00 C16) .00 X 045 = .00 Ct?) .00 X 12 = .00 c18~ .00 x 15 = .00 C19)= . O0 AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE Charitable/Governmental Bequests; Non-elected 9115 Trusts CSchedule J) C15) . O0 Net Value of Estate Sub3ect to Tax C14) 61,579.45- If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 wt11 .00 .00 .00 .00 C IF TOTAL DUE IS LESS THAN ~1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) reflect figures that Include the total of ALL returns assessed to date. 56~20[.00 C11~ gl.72&.no Cll) 61,579.45-