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Home My WebLink About03-07-12i REV-1500 EX (02-11)(FI) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number Po eox z8trsot INHERITANCE TAX RETURN 2:1 11 0 6 3 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 166-16~-2711 04112D11 03141923 Decedent's Last Name Suffix Decedent's First Name M I MCCLENACHAN BLAIR (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last. Name Suffix Spouse's First Name MCCLENACHAN MI EILEEN H Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~~~ Je ~o~y REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW ® 1. Original Return ~ 2. Supplemental Return ^ 3. Remainder Return (Date of Death ^ ^ Prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of ^ death after 12-12-82) 5. Federal Estate Tax Return Required 6. Decedent Died Testate 7. Decedent Maintained a Living Trust - 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) ^ (Attach Copy of Trust.) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (Date of Death ^ 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone umber r~.~ ~:~.-, KEITH 0. BRENNEMAN 71'x-697-$~~ '`•' r -ta REGISTER SE Oily' First Line of Address 44 WEST MAIN STREET Second Line of Address P•0. BO:X 318 City or Post Office MECHANICSBURG Correspondents a-mail address: Under penalties of perjury, 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. SIGI~IA~.IR~OF PERSON RESPOMSIRI F Fnlo Fu min orn ior.i _ 1. • ~ - Vy l!/c~i ~/d .S'~r`'T /XC2~llNi<;t~l~.~ ~ 7 ~/~ ADDRESS KEITH 0. BRENNEMAN / ADMINISTRATOR C.'P.A- SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 1505611185 State ZIP Code PA 17055 ,, ~ t l_7 ~ ~ ? .. t'-; C7 - ~ ~ '~ _ ~ i-' ~ 'YZ ' r.,. ~i PLEASE USE ORIGINAL FORM ONLY (,,,~ 15 0 5 61118 5 Side 1 1505611185 OM4647 3.000 r 1505611285 REV-1500 EX (FI) Decedent's Social Security Number ' 166-16-2711 Decedent s Name• B d ~. R MCC NACHAN RECAPITULATION 1 . Real Estate (Schedule A) . ........... 1 0•DO 2 . Stocks and Bonds (Schedule B) . . .............. 2. 32,144•DO 3 . Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) , , 3. 0.00 4 . Mortgages and Notes Receivable (Schedule D) . ................ a. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) , • • • 5. 3,085.00 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6 7. , . . Inter-Vivos Transfers & Miscellaneous Non-Probate Property 0.00 (Schedule G) ~ Separate Billing Requested 7. D • D D 8. TotaN Gross Assets (total Lines 1 through 7) .. ................ 8. 35,229.00 9. Funeral Expenses and Administrative Costs (Schedule H). g. 9,675.66 10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) , •••••...10. 282.25 11. Total Deductions (total Lines 9 and 10) , . .11. 9,957.91 12. Net Value of Estate (Line 8 minus Line 11) 13. , Charitable and Governmental BequestslSec 9113 Trusts for which 12 2 5 , 2 71.0 9 an election to tax has not been made (Schedule J) , , ..13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) . ' • • • 1a. TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 25, 271.09 15. Amount of Line 14 taxable at the spousal tax rate, or transfers un~er Sec. 9116 i6 (a>(1.2>x.o_ 8,699.09 15. 0 00 . Amount of Line 14 t xable 0 4~ at lineal rate x . 17. . 16 , 0 7 2• D D Amounnt of Line 14 taxable 16. 7 2 3.2 4 at sibhing rate X .12 D • D D 18. Amount of Line 14 taxable 17' D ' D D at collateral rate X .15 5 D D• D D 18. 75.00 19. TAX DUE 19. 7 9 8.2 4 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505611285 1505611285 J OM4648 3.000 REV-1500 EX (FI) Page 3. File Numhar Total Credits (A + B) (2) ~ • Q 0 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (3) O • 0 0 Fill in box on Page 2, Line 20 to request a refund. (4) - a • () a 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) - 798.24 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 reversionaryinterest d. receive the promise for life of either payments, benefits or care? 2. If death occurred after Dec. 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? ^ 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. For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 n°quirements 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 21 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 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 4.5 percent, except as noted in [72 P.S. §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 percent [72 F.S. §9116(a)(1.3)j. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. OM4671 2.000 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) - 7 9 8.2 4 2. Credits/Payments A. Prior Payments Q • 0 B. Discount ~ • O 0 REV-1503 EX+ (8.98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS Vt Blair McClenachan 21 11 0634 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION 1.800 Shares Exelon Corporation common stock valued at $40.18 per share TOTAL (Also enter on line 2, Recapitulatioin) ~ $ 3wasss i.ooo (If more space is needed, insert additional sheets of the same size) -L OF DEATH 32,144.00 32,144.00 J2EV-1508 EX+ (11-10) Pennsylvania SCHEDULE E DEPARTMENiOF REVENUE CASH, BANK DEPOSITS INHERITANCE TAX RETURN ~ ~ MISC. RESIDENTDECEDENT PERSONAL PROPERTY ESTATE OF: FILE NUMBER: Blair McClenachan Include the proceeds of litigation and the date the proceeds were received by the estate. 21 11 0 634 All property jointly owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER VALUE AT DATE DESCRIPTION OF DEATH ~ 1999 Pontiac Sunfire Kelly Blue Book value 3,085.00 (see attached appraisal) TOTAL (Also enter on line 5, Recapitulation) $ I 3, 085.00 ownsgo 2.000 If more space is needed, use add'Rional sheets of paper of the same size. REV-1511 EX+ (10.09) pennsylvania DEPARTMEM'OF REVENUE INHERITANCE: TAX RETURN RESIDENrDECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Blair McClenachan .?111 0634 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Hoffman-Roth Funeral Home funeral services 4,193.92 Total from continuation schedules . B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Stl'eet Address City State ZIP Year(s) Commission Paid: 2. Attorney Fees: Snelbaker & Brenneman, P.C. 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 Fees: 6. Tax Return Preparer Fees: 7. 1 Cumberland Law Journal Advertise Administrator's Notice Total from continuation schedules . TOTAL (Also enter on Line 9, Recapil swasnc z.ooo If more space is needed, use additional sheets of paper of the same size. 1,323.08 3,755.00 113.50 75.00 215.16 9,675.66 Estate of: Blair McClenachan Schedule H Part 1 (Page 2) Item No. Description 2 Sir D's Catering memorial luncheon 3 The Carlisle Vault LLC funeral expense Total (Carry forward to main schedule) 21 11 0634 Amount 973.08 350.00 1,323.08 Estate of: Blair McClenachan 21 11 0634 Schedule H Part 7 (Page 2) 2 Register of Wills filing fee for Inheritance Tax return 15.00 3 The Sentinel advertise Administator's Notice 200.16 Total (Carry forward to main schedule) 215.16 12EV-1512 EX+ (12-pg) Pennsylvania SCHEDULE I DEPARTMENiOF REVENUE DEBTS OF DECEDENT, RESIDENTDECE ENTTURN MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Blair McClenachan c:l 11 0634 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM NUMBER DESCRIPTION VALUE AT DATE 1. OF DEATH Christian Companion Senior Care nursing care 282.25 TOTAL Also enter on Line 10, Reca itulation) I$ 282 25 awasarl2.ooo If more space is needed, insert additional sheets of the same size. REV-1513 ~X+(01-10) pennsylvania DEPARTMENTOF REVENUE INHERITANCE. TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES 1MBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY [ TAXP,BLE DISTRIBUTIONS [InGude outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Eileen H. McClenachan 1880 Douglas Drive Carlisle, PA 17013 All of Residue: 8,699.09 2 Scott Whittington 1106 Sage Brush Court Burlington, KS 66839 General Bequests: 500.00 FILE NUMBER: 21 11 0634 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Surviving Spouse None ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NONTAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SEC710N 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. 8,699.09 500.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER ;iHEET. I S 0 00 swasai z.ooo If more space is needed, use additional sheets of paper of the same size. Estate of: Blair McClenachan Schedule J Part 1 (Page 2) Item No. Description 3 Sarah M. Mortimer 56 Ryder Road North Attleboro, MA 02760 200 Shares Exelon Corporation Inventory Value: 8,036.00 4 Anne McClenachan 7 Dublin Road Ext. Orford, NH 03777 200 Shares Exelon Corporation Inventory Value: 8,036.00 Relation Daughter Daughter 21 11 0634 Amount 8,036.00 8,036.00 1999 Pontiac Surefire SE Sedan 4D Trade In Values, Reviews -Kelley Blue Book Page 1 of 3 - '~ ~1~t7r ~ F,nd rar vahp cr fe3hr S'L ~ , ^it~,~ T#iE YRU3TED BESt>AIftCE ` _ _ v y _.. ~, ~ car values ~ CaCS foC_sate ~. 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Apply Witt, a sir-c:ialist. ru,w V,ew ac a +, i;notc, .rrnp~r., r.mccs, and Luy your next .:z~r I want to list my car for sale Gel: your free SeJler's'I'txaikit Pontlac Surefire _ _ _ I want help selling my car tip tc 75 Miles away r:nm'r_tN 17015 search Read i0 tips to sell your czar _ __ Get Prepareid to Buy Your Next Car _ __ _ ___ Top 10s £t News ' ~ ~ ~ BankofAmerlca •~~ Check a car's history Know yoi]pEf@dit scoFEir~t App1~lbRgff!g~d My Saved Cars save My KBB ZIP Cade: 17015 Sign In hnGn.n .•n.. Fw •., i.a>fn.......• • h, •.i ~ia.h~..n a. '> L'CO[. - http://www.kbb.com/pontiac/surefire/ 1999-pontiac-surefire/se-sedan-4d/?vehicleid=5966&in... 6/8/2011 I, BLAIR McCLENACHAN, a legal resident of North Middleton Township, 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 all other wills and codicils heretofore made by me. FIRST: I direct that all my just debts and funeral e~cpenses, including my grave marker, shall be paid from the assets ofmy estate as soon as practicable after my decease. SECOND: I direct that all taxes that maybe assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as a part of the expense of the administration of my estate. THIRD: I devise and bequeath the sum of Five Hundred Dollars ($500.00) to SCOTT V4'HITTINGTON. FOURTH: I make the following specific bequests to the persons indicated: A. I devise and bequeath all ofmycameras, binoculars and telescopes, to include all lens accessories, to DAVID MORTIMER. B. I devise and bequeath 200 shares of Exelon Corporation, or any successor company, to my daughter, ANNE McCLENACHAN. C. I devise and bequeath 200 shares of Exelon Corporation, or any successor company, to my daughter, SARAH McCLENACHAN MORTIl~~ER. If any of the above persons shall predecease me or refuse to accept his or her specific bequest herein, I direct that such bequest shall lapse and said item or items shall be considered a part of the residue of my estate. FIFTH: I devise and bequeath the residue of my estate, of every nature and wherever situate, to my wife, EILEEN H. McCLENACHAN, provided my wife shall survive me by one hundred twenty (120) days. Should my wife, EILEEN H. McCLENACHAN, predecease me or die on or before the one hundred twentieth day following my death, I devise and bequeath the residue of my estate, of every nature and wherever situate, to my daughter, Al~]NE McCLENACHAN, and my daughter, SARAH McCLENACHAN MORTIMER, equally, provided that the share of any daughter who predeceases me or dies on or before the one hundred twentieth day following my death initials i 1 ~ . J shall be distributed to her issue, per stirpes, living on the one hundred twenty-first day following my N death, and in default of any such then-living issue, such share shall be added to the share or shares for my other daughter. SIXTH: I nominate, constitute and appoint EDWARD L. SCHORPP ,Executor, of this, my Last Will and Testament. In the event of the renunciation, death, resignation, or inability to act for any reason whatsoever of the said EDWARD L. SCHORP]?, I nominate, constitute, and appoint my daughters, ANNE McCLENACHAN and SARAH McCLENACHAN MORTIMER, or the survivor, co-Executrices, of this, my Last Will and Testament. I hereby relieve my Executor or his successors from the necessity of posting security in connection with their duties as such in any jurisdiction in which they maybe called upon to act, insofar as I am able bylaw so to do. II1 ~wITNESS WI-IERE0F,1 have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two (2) typewritten pages, each of which bears my initials, this .?'s~~ da.y of /~y~.-.~T ,,,~~. ' .wa. (SEAL) Blair Clenachan, Testator Signed, sealed, published, and declared by the above-named T estator, Blair McClenachan, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. ../ ~~ ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA ) COUNTY OF CUMBERLAND ry ~y. I, Blair McClenachan, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~ Sworn or affi ed to ~d acknowledged before me by Blair McClenachan, the Testator, this .~ ~~~ day of - ,~ ,) NOTARIAt SEAL VICTORIA t. OTTO, NOTARY PUBtIC CARLISLE BORO. CUMBERLAND COUNTY UV !~A\A\AIQMn~{ rvntnro nrn n nnnn Notary Public ~ f .ti ~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS. We, Edward L. Schorpp and /1/ja.r~.~.~-. ~ ~ w~r_~ d~ ,the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will; that Blair McClenachan signed willingly and that Testator e~s:ecuted it as his free and voluntary act for the purpose therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound mind, and under no constraint or undue influence. Sworn or affirmed and subscribed to before m~ by Edwar L. Schorpp and ~~ Lirt ~r'. ~~ ~ ta~~ ,witnesses, this -~ ~/~ day of _ ,ti. , ~_~ ~- _, ~-~, ~. _ ~ (SEAL) Witness, Edward L. chorp:p ~~ G'rl.cr~--- l ~~-t^'~ ~ (SEAL) Wit s~' ~ _ ~,, /C_- `1i92.C1`~ C.: k'-~ C,1J (SEAL) Notary Public NOTAR1At SEAL VICTORIA L. OTTO, NOTARY PUBLiC CMY COMMISSI01~ ~(PIRES DECD2 2006