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Home My WebLink About06-18-12EX (Ot-1pj y~ ~ REV-1500 ~ 1505610143 '!-yi OFFICIAL USE ONLY PA Department of Revenue Pennsylvania County Cotle veer Fiie Naml»r Bureau of Individual Taxes oEP^^TMFeTOF aEUEN~E PO 80X.280601 INHERITANCE TAX RETURN 21 12 0 4 8 4 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Dafe of Binh 02 2010 OB 07 1915 Decedent's Last Name Suffix Decedent's First Nartie MI MARTIN JOHN Z (lf Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI MARTIN ANNA B Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL INAPPROPRIATE OVALS BELOW ® t. Original Return ^ 4. Limited Estate ® g Dacetlent Dietl Testate (Amech Copy of Will) ^ 9. Liagaaon Proceeds Received ^ 2. Supplemental Return ^ 4a Future Interest Compromise (tlete of death after 12-12-92) ^ ~ Decetlant Meinteinetl a Living Tmst ' (Attach Copy of Tmsp ^ 1 D Spousal Poverty Cretlit (tlata of tleath beNreen 1231-B1 antl 1-1-95) ^ 3. Remainder Retum (date of death prior to 12-13-82) ^ !i. Federal Estate Tax Return Required ~ 9. Total Number of Safe Deposit Boxes ^ '11.Election to tax under Sec. 9113(A) (Adach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Tele a Number GERALD J BRINSER 7:17 83 ~C3348` m n- ~ ~~J REGISTER f.~ ~ USEBNLY -- _~~_ ' C' r ~ Cl` ~ -- ,: fl C> : y C.? Firet line of address . . CJC: -° . T; 6 E MAIN STREET O c- ~j rv m ~ ~ Second line of address ~^, PO BOX 323 DATE FILED City or Post Office State ZIP Code PALMYRA PA 17078 Correspondent's a-mail address: 91 b r a n@ a O I. D O m schedules and statements, and to the best of my knowledge and Delief, is based on all information of which preparer has any knowledge. Robert Musser 23 Cr4ekview Drive, Carlisle, PA 17013 Gerald J Brinser ~, /~ ,, 6 E. Main Street, Palmyra, PA 17078 Side 1 L 15U5610143 1505610143 J J 1505610243 REV-1500 EX Decedent's Social Security Number oacaeam•s rvama. MARTIN, JOHN Z. 206 10 8243 RECAPITULATION 1. Real Estate (Schedule A) .......................................................................................... 1. 5 , 4 31.2 O 2. Stocks and Bonds (Schedule B) ............................................................................... 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).......... 3. 4. Mortgages & Notes Receivable (Schedule D) .......................................................... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ................ 5. 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ............. 7. 8. Total Gross Assets (total Lines 1-7) ....................................................................... 8. 5 , 4 3 1 . 2 0 7 5 6 . 5 0 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) ..................................................................... . 11. 7 5 6 . 5 0 12. Net Value of Estate (Line 8 minus Line 11) ........................................................... .. 12. 4 , 6 7 4 . 7 0 13. Charitable and Governmental Bequesis/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ................................................ . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ............................................... .. 14. 4 , 6 7 4 . 7 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable al the spousal tax rate, or transfers under Sec. 9116 6 7 4. 7 0 o0 4 x 1s. 0. 0 0 , (a>(1.z) . 16. Amount of Line 14 taxable 16 at lineal rate X .045 . 17. Amount of Line 14 taxable 17 al sibling rate X .12 . 18. Amount of Line 14 taxable 18 at collateral rate X .15 . 19. lax Due ...................... ...................................................................................... .. 19. 0 . 0 0 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 1505610243 1505610243 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 - '12 - 0484 Martin, John Z. STREET ADDRESS Messiah Village, 100 Mt. Allen Drive CITY Mechanicsburg :iTATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) 2. Credits/Payments A. Prior Payments B. Discount 3. Interest 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on 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. Total Credits (A + B) (1> 0.00 (2) 0.00 (3) 0.00 (4) (s> 0.00 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 properly transferred or its income :.................................... x c. retain a reversionary interest; or .................................................................................................................. ^ 0 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 censideration? ....................................................................................................................... ^ ^x 3. Did decedent own an "in trust tor" or payable upon death bank account or security at his or her death?......... ^ Q 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which wntains a beneficiary designation? ...................................................................................................................... ^ ^x 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 valve: 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 January 1, 1995, the tax rate imposetl on the net value of transfers to or for the use of the surviving spouse is 0 percent p2 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 filing a tax reiurn 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 beneticiade~s is 4.5 percent, except as noted in 72 P.S. §9116 1.2) [72 P.S. §9116 (a) (1)]. •'1'he tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent [72 P.S. 69116 (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 t y bloo~ or adoption. CONNIONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS FILE NUMBER ESTATE OF Martin, John Z. 21 - 12 - 0484 All properly jointy-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 (146) Trust Shares of MetLife @ $37.20 Per Share 37.20 5,431.20 TOTAL (Also enter on line 2, Recapitulation) 5,431.20 CONNxINWEPITH OF PENNSTLVANN INHERRANCE TA%RETURN RESIDENT DECEDENT SCFEDUL.E H ~FII~ERALE)D'ENSES& /"~I.dl~nw 1 f W I IYG WJ 1 J FILE NUMBER ESTATE OF Martin, John Z. 21 - 12 - 0484 Debts of decedent must be reported on Schedule I. ITEM DESCRIPTION AMOUNT NUMBER FUNERAL EXPENSES: __ A B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Robert Musser 275.00 Street Address 23 Creekview Drive city Carlisle State PA zip 17013 Year(s) Commission paid z. Attorneys Fees Brinser, Wagner & Zimmerman -- Gerald J. Brinser 350.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address Ciry State Zip Relationship of Claimant to Decedent a. Probate Fees Register of Wills (Ctrs. Pd. $30.00 = $2,001 - $5,000) 86.50 5. Accountant's Fees 6. Tax Return Preparers Fees 7. Other Administrative Costs 1 Register of Wills -Additional Cost of Letters 15.00 TOTAL (Also enter on line 9, Recapitulation) 756.50 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN ESTATE OF Martin, John Z. Sd>edtde H w Funeral^E>q~enses & I'IY 1 w oYaY~ ~I{JOO Filing Fees -REV 1500 and Inventory 21 - 12 - 0484 Page 2 of Schedule H 30.00 REV-1313 EX4111-0e) SCHEDULE) COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Martin, John Z. 21 - 12 - 0484 RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$) RECEIVING PROPERTY Do Nat List Truseee(s) I~ TAXABLE DISTRIBUTIONS(include outright spousal distnbuhons, and pransfers under Sec. 9116 (a) (1.2)] 1 Anna B. Martin Spouse Entire Residue 4,674.7( 222 Messia hCircle, #201 Mechanicsburg, PA 17055 Enter dollar amounts for distributions shown above on lines 15 t hrough 18 on Rev 1500 cover sh eet, gas appropriate. II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-151X1 COVER SHEET 0.00 WILL OF c~Q r=~ _. ~')~ - '_ ~ ~- JOHN Z. MARTIN '-' ~ Fn ra - _ ~ ..- - ;-,:- 1;~~_ I, JOHN Z. MARTIN, currently of Upper Allen Township, Cumberlacid'~ounty.; Pennsylvania, realizing the uncertainty of this life, but with confidence in God and trust i~,; 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 my 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 maybe 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. I bequeath unto my wife, Anna B. Martin, all tangible personal property which I own at my death. IV. All the rest, residue 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 unto my wife, Anna. V. In the event that my wife, Anna, does not survive me, I devise and bequeath my entire estate that would have otherwise passed under Paragraphs III anti IV above as follows: A. I intend to keep with this my Will a separate memorandum concerning disposition of certain items of tangible personal property. I bequeath the items on said memorandum to the persons designated. B. The remainder of my personal effects and tangible personal property I bequeath unto my daughter, Penelope Popp. If she predeceases me, ~r^ /~ / ~' t /~ -„ T, , __,~ , ~__ ~~ c•: G ._~~ IN WITNESS WHEREOF, I, JOHN Z. MARTIN, herewith set my hand to this my Last Will, typewritten on three (3) sheets of paper including the attestation clause and signatures of witnesses, this ~ ~.t day of _%~ ~- z: , 2003. Z. Signed by JOHN Z. MARTIN, by him declared to be his Will in our presence, who have hereunto subscribed our names as witnesses in his presence and at his request, this 3. z-( day of .i ~- ,~- z 2003. -~~ ~~~..-c--s.,..a.~, residing at--~,~ ~z--LU•~:~ ~ f / ~-y~~~~4 /~~ /)7r~7 ; residing at ~L~ ~,~,~ ,c- ~ s ~ (~ -3- COM~4ONWEALTH OF PENNSYLVANIA COUNTY OF CuMbP~I~~~- WE, JOHN Z. MARTIN, GERALD J. BRINSER and ~ h•,~.~ ~ .~/~~-" ,:..~ , the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declarf: to the undersigned authority that the testator signed and executed the instrument as his ]Last Will and that he signed willingly (or willingly directed another to sign for him), and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testator, signed the Will as witnesses .and that to the best of our knowiedge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~.. .-..~ JOI-IN Z. ARTIN !l ///f, ~C ~ WITNESS WITNESS Subscribed, sworn or affirmed and acknowledged before me by JOHN Z. MARTIN, the testator, GERALD J. BRINSER and F?.v.N~ rs ~i~:~~~.~ > witnesses, this 3 ~- day of fk.. ~ , 2003. ~/ yh ~/t4.rru/.a5 (SEAL) `~~-Notar}~ Public Notarief Seal Vicky M. MICW'Aa, Notary P~b6c UpperAllen Twp„ CurnberleridCamty My Cormrdssion Expires DecenAer 31,2005 Member, ?eensNvania Asso`,iation 0! Notaries -4- `~ey~t'~":P~r~:+~;~~d^~~--^ ~ tom'. _ ''. ~r JOHN Z MARTIN Axourrt Market Value Stock Price as M 9o[al Market 11 09 2011 ~ Value 332.050 - + - 34,679.30 The aggregate amourn. paid to ~I Trust Beneficiaries in ihiis tlistribuliun is $158,212,336.53. Investor II~62 5016 5856 2011 Divlrrsne Summary ~~!-_-.-~-~__- Record Dete Total Trust Imerrrets Dividentl per Trust Interest ~Duirrer» Distribullor 11/09/2011 116.0000 3t1-74 $1(18.04 Payable Date Tax WghEttlld Nan OistrlDUllon Prbr Year Distribtnign 12/14/2011 30A0 3108.04 3108.04 Trust Bawadary Irforrmtlan Vou may purchase or sell shares of MetLife. Inc. common stock through the Metlae PolicynoWer Trust (the 'Trust'), hee of any commissions w other fees, under the MetLihr Purchase and Sale Program, as amended. A copy of iha brochure descriibing the program is available on the Imemet at www.me[lifecom by selecting Investor Relations end than [he Shareholder Semces Information page, or by calling the number listed above- You are permitted to hansfer your Trust Imerests only in the circumstances described in the brochure. Vou may also instruct that all (but no[ less than alp of your shares W MetLife. Inc. common stock 11eW by the Trust be withdrawn hom the Trust. IMOrmation regarding your w4hdrawal rigma may be round in the Purchase antl Sale Brochure or by calling the number listed above. OOSe547 G3 An annwl eharoholdars' meeting to elect members of the aoare of Dkectors W MetLife, Int. end for the trargel;tion M rMfler business is expected to De hEtW on April 24, 2012. Tlkr deadline for sldunitting ahareholtler proposals for considertion at Mis~~ meeting is November 29. 2011. A copy of MMtJfe. Irlc.'s annual report a11d proxy tdatemem will be avail~le hee of eharge on or before Mamh 31, 2012. along whh other MetLife. Inc. and Trust Xlfngs under ftderal :tecuri[ies taws. (i) on the IrderrlM tl www•metlNe.com by selectng /lbout MslLae, Corporate Governance, under Related links, (u) by wri[in41 to McLL4e, Inc., c/o BNV Malbn Shuaownr Services. PO Box 356447, Pittsburgh, PA 15252-8447 or (iii) by caging the number listed above. These and other SEC filings by MelLife end the Tntat are also available on the Internet m www.sec.gov. Please Note: Important 2011 Tax Information MetLJte FORM 1099-DIV. U.S. TAX INFORMATION FOR 2011 OMB NO.1545-0110 DIVIDENDS/DISTRIBUTIONS CC,OPY 8 FOR -• RECIPIENT REGPIENT'S TOTAL ORDINARY QUALIFlED DMDENDS IDENTIFICATION NUMBER DMDENDS F1~BipL.INCOME TA%WITHF6D ~a x/a x,b a4 $1ae.oa _ taao $1ae.oa I L- 43~ PAYER'S NAME PAYER'S FEDERAL IDENTIFlCATK)IN NUMBER BNY MELLON SMAREOWNESi SERVICES AS CUSTODIAN OF THE METLIFE POLICYHOLDER TRUST 5165116987 SECURITY DESCRIPTION TO WHOM PAID ,-- TRUST INTERESTS ] ~ ~ T0 M (REPORTED BV \` M SS D4 Fi 1R ~ APT 201 j THE BANK OF NEW YORK MECHANICSBURG PA 170558819 / MELLON 480 WASHINGTON 1 BOULEVARD ~ JERSEY CITY, NJ 07310 IMPORTANT 2011 TAX INFORMATION FOR INFORMATION REGARD~N THE ABOVE:, CALL 1-8008493fi1Xi is Irnpotant fez information antl is being turnlshed m. the Internal Revenue Servlca. m a,e rzquired to file a return, a negligence penalty or other sanction may he ,setl on you if this income is taxable antl the IRS determines root it has no[ been Iced. to ~ Shows total ortlinnry tlividentls that are taxable. Innlutle this amount nn line 9a of Farm or 10aCA. Also, report It on Schetlule B (Form 1040 or Farm t040A), If requlretl. The :n± show may be tlivitlentls a corporation paid tlirectly m you es a partcipflni (or bene!i- ol a pzeieipant) in an employee stock ownership plan (ESOP). Repcd It as a tlivitlantl on Form 1 C40/10a0A, but treat It es a plan disttlbuaon, noc as investaiant Income, for any pUlppsE 1 Box a ~ Shows backup witlrnoltling. A prayer must backup witM:ol] on certain pzyrta~rts if you tlitl not give your taxpayer rtlentillcation number [o the payer. Sae Form VJ-9, Fle loos, Icr'Sex- payer Itlenti!icaticn Numbsr anc Cenificatipn, (or information on backup withhc ltllrg. Inclutle this amount on your incom^, tan return as tax withheltl. Nomineea. If this form inc utles amounts belonging to another person, you ere ccm;itlnrEa a nominee recipient. Veu must file Porm 1p99-OP/ with the IRS for each of the other owr errs to show their share of the inrume, antl you muss furnish a Form 1099-DIV to eon. A I-usbartl or wife is not requiratl tp flla a nominee return to show amowrls ownetl by the othor. Sea tM~. 1011 (ienerel instructions for CS rtain Infprme<ion Returns. 1b -Shows the portion of the amount in box ta, (hat nay be eligible for the 15% or zero al gains 'ales. See the Form 1040/1040A ibsVUC':ipns for now to tlalermina this amount. ,Y. me slioible amount on line 9b. Form 1040 or 1040.1. For account inquiries, you may visit www.bnyrrtellon.com/shart3owner/equityaccess, tx call t-B00•Ei49$593. When contacting us please have your Investor ID available, located in the upper right hand corner of this document. RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 MARTIN JOHN Z Estate File No.: 2012-00484 Paid By Remarks: ANNA B MARTIN HEA ------------------- Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE RENUNCIATION JCS FEE AUTOMATION FEE Check# 1533 Total Received......... Receipt: Date: 4/24/2012 Receipt: Time: 13:08:32 Receipt: No.: 1069640 Receipt Distribution ----- Payment Amount Payee Name 30.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 8.00 CUMBERLAND COUNTY GENERAL FUN 5.00 CUMBERLAND COUNTY GENERAL FUN 23.50 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- 86.50 86.50 LAW OFFICES BRINSER, WAGNER &ZIMMERMAN 6 EAST MAIN STREET -SECOND FLOOR (EAST MAIN & SOUTH RAILROAD STREETS) P. O. BOX 323 PALMYRA, PA 17078 PHONE: (717) 838-6348 FAX: (717) 838-6912 GERALD J. BRINSER KEITH D. WAGNER JOHN M. ZIMMERMAN KATHY G. WINGERT CALEB .I. ZIMMERMAN June 14, 2012 Register of Wills Cumberland County Courthouse 1 Courthouse Squaze Carlisle, PA 17013 In Re: John Z. Martin Estate File No. 21-12-0484 Deaz Register of Wills, MECHANICSBURG OFFICE MESSIAH VILLAGE 100 MT. ALLEN DRIVE MECHANICSBURG, PA 17055 PHONE/FAX (717) 697-066( - T.) 6Y ~ /Y `- ~~ J ill C Z 1 JI 1 c." f"-7 ~~; 00 r-,*' ~ r% cr' e~,~ '= ;--, , !V -- CJt ~.n c: Enclosed you will find two (2) copies of the PA Inheritance Tax Return for the above- captionedestate. Also enclosed are two (2) checks: one in the amount of $15.00 in payment of the additional cost of letters and one in the amount of $30.00 in payment of the filing fees. If you have any questions, please feel free to contact me. Thank you. Very truly yours, BRINSER, WAGNER &ZIMMERMAN ~. l~"rt~~'-~ Gerald J. Brinser (/ GJB/wlc Enclosures c: file ~.. =_ .--.p > ~ O W W V Y ~ VI 4 a ~- ~~ ~,. ~.. '~ ~ .~~ LL' _~i (~ .I G u ~~ C L) a- s __ ems. :... 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