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J 1505611185
REV-1500 EX�°2-,,,�F'>
PA Department of Revenue OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
Po Box zsoso� INHERITANCE TAX RETURN 21 1,2 0 4 0�
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Sociai Security Number Date of Death MMDDYYYY D8t2 Of Birth MMDDYYYY
03232012 06151927
DecedenYs Last Name Suffix Decedent's First Name MI
COOK MARGARET E
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name M I
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
- - REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
� 1. Original Return � 2. Supplemental Return � 3. Remainder Return(Date of Death
Priorto 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise(date of ❑ 5. Federal Estate Tax Return Required
death after 12-12-82)
� 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 Tele�ne Number ;:�
KEITH 0 - BRENNEMAN 717-69�—�528 .� m �
REGI Fi�F WILLS IFS�ONL�j �
r- �' r` �-,-� :�.
�. +�' 1TI �" m�... r
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First Line of Address �„� %� � ��'
44 WEST MAIN STREET , .^ � --f? � �z `
_., : :,
Second Line of Address � r c�=� ��`
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T . l,,� C�� �
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City Of POSt Office State ZIP COde DATE FILED
MECHANICSBURG PA 17055
CorrespondenYs e-mail address:
Under penaities of perjury, I declare that I have examined this retum,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.
SIGNAlURE OF PER,�N SPONSIBLE FOR FILING RETURN DATE
�ri��!- ��—�C��� SI.�3/�Dl� ,
ADDRESS
CONNIE L - GRAZIER, EXECUTRIX P •0 • BOX 697, MILLHEIM, PA 16854 '
SIGNA� RE OF PREPARER OTHER THAN REPRESENTATIVE DATE
� d ���z�� �
ADDRESS
44 WEST MAIN STREET MECHANICSBURG, PA 1,7055
PLEASE USE ORIGINAL FORM ONLY
Side 1
� 1505611185 1505611185 J
OM4647 3.000 , ! �
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� 1505611285
REV-1500 EX(FI)
DecedenYs Social Security Number
RECAPITULATION
1. Real Estate(Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 0 • ��,
2. Stocks and Bonds(Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . 2. ],0,9 7 8 • 2 4
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C), , , , , 3. � • 0�
4. Mortgages and Notes Receivable(Schedule D) , , , , , , , , , , , , , , , , , q. � •Q� ,
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E) , , , , , 5_ � • �0
6. Jointly Owned Property(Schedule F) � Separate Billing Requested , , , , 6. Q •Q Q' '
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) � Separate Billing Requested . . . . 7. 0 .�� '
8. Totai Gross Assets(total Lines 1 through 7) . . . . . . . . . . . . . . . . . . $ ],O,9 7 8 • 2 4
9. Funeral Expenses and Administrative Costs(Schedule H). . . . . . . . . . . . . g. ],5• �a
10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) , , , , , , , , , �0. � •��
11. Total Deductions(total Lines 9 and 10), , , , , , , , , , , , , , , , , , , , , ��. 15• 0�
12. Net Value of Estate(Line 8 minus Line 11) , , , , , , , , , , , , , , , , , , , �2 ],O,9 6 3 • 2 4i '
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J), , , , , , , , , , , , , , , , �3. � •��
14. Net Value Subject to Tax(Line 12 minus Line 13) . . . . . . . . . . . . . . . �q ],�,9 6 3 •2 4
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of�ine 14 taxable
at the spousal tax rate,or
transfers un�er Sec.9116
(a)(1.2)X A- � • �� 15. � • �p.
16. Amount of Line 14 xable
at�inea�ratex.o 4� 10,963 - 24 �6. 493. 35'
17. Amount of Line 14 taxable
at sibling rate X.12 � • 0� 17. � - ��'
18. Amount of Line 14 taxable
at collateral rate X.15 � • 0 0 18. � • �Q
19. TAX DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 4 9 3• 3 5
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT X❑
Side 2
� 1505611285 1505611285 �
OM4648 3.000
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REV-1500 EX(FI) Page 3 File Number
DecedenYs Com lete Address: 21 12 0 4 0 0
DECEDENTS NAME
COOK MARGARET E
STREETADDRESS
C MB RLAND CO TY
C�N STATE ZIP
MECHANICSBURG PA 17 55-
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 4 9 3• 3 5
2. Credits/Payments
A. Prior Payments � • 0�
B. Discount 0 • D 0
Total Credits(A+g) (2) �-�Q
3. Interest
(3) 6 • 14
4. If Line 2 is greater than Line 1 +Line 3,enter the difference.This is the OVERPAYMENT.
Fill in boz on Page 2,Line 20 to request a refund. (4) � • O�
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 4 9 9 • 4 9
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 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . � �
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, 1 g95,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 atter Jan. 1, 1gg5, 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.§91 16 (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 trom 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 decedenYs 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 decedenYs siblings is 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.
OMa671 2.000
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REV-1503 EX+(&12)
pennsy�vania SCHEDULE B
DEPARTMENT OF REVENUE
INHERITANCETAX RETURN STOCKS 8� BONDS
RES�ENT DECEDENT
ESTATE OF FILE NUMBER
Margaret E. Cook 21 12 0400
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Principal Financial Group 10,978.24
377 shares of common stock valued at $29.12 per share
TOTAL (Also enter on Line 2,Recapitulation) 5 10,978.24'
zwasss z.000 If more space is needed,insert additional sheets of the same size
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REV-1511EX+„o-�, SCHEDULE H
pennsylvania
DEPARIMENfOF REVENUE FUNERAL EXPENSES AND
�NHERITANCETAXRETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Margaret E. Cook 21 12 0400
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1.
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s)of Personal Representative(s)
Street Address
City State ZIP
Year(s)Commission Paid:
•
2. Attorney Fees:
3. Family Exemption:(If decedenYs address is not the same as claimanYs,attach e�lanation.)
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees
5. Accountant Fees:
6. Tax Return Preparer Fees
7.
1 Register of Wills
filing fee for Supplemental Inheritance Tax Return 15.Oa .
TOTAL(Also enter on Line 9,Recapitulation) $ 15.00 '
swasAC 2.00o If more space is needed,use additional sheets of paper of the same size.
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REV-1513EX+(01-10) SCHEDULE J
pennsylvania
DEPARTMENTOF REVENUE BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDEM
ESTATE OF: FILE NUMBER:
Mar aret E. Cook 21 12 0400
RELATIONSHIP TO DECEDEM' AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS[InGude oulright spousal distributions and transfers under
Sec. 9116(a)(1.2).]
i. Todd A. Grazier
5332 Caleb Drive
Columbus, OH 43220 Grandson 57 of Estate
2 Steven A. Grazier
P.O. Box 346
Millheim, PA 16854 Grandson 5� of Estate
3 Daniel R. Grazier
57905 Desert Gold Drive
Yucca Valley, CA 92284 Grandson 5� of Estate
4 Karen R. Noble
20711 Citation Drive
Ashburn, VA 20147 Granddaughter 5� of Estate
ENTER DOLLAR AMOUNTS FOR D�STRIBUTIONS SF iOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET.AS APPROPRIATE.
�� NO�TAXABIE DISTRIBUTIONS
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN:
1.
B CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
1.
TOTAL OF PART II-ENlER TOTAL NON-TAXABLE DISTRIBUTIONS ON�INE 13 OF REV-1500 COVER SHEET. � S 0.OO
9W46AI 2.000 If more space is needed, use additional sheets of paper of the same size. �
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Estate of: Margaret E. Cook 21 12 0400
Schedule J Part 1 (Page 2)
Item
No. Description Relation Amount
5 Connie L. Grazier
P.O. Box 697
Millheim, PA 16854 Daughter 40� of EState
6 Darlene A. Bruner
4982 Patillo Church Road
Burlington, NC 27217 Daughter 40� of Estate
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�� i::�s�r wu�i.:�Nn�rrsr��hirN�i �
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I. \•I�VZGARIiT E.COOK,cif thc Boruu�;h u(Niechanicsbur��,Cuunty of Cumberlan�l,
;uul Cumnumweallh�,f Peuns�fvania,being oI s��i.inJ an�l disposing mind,memory ancl
urnlci:tilanilin��.�lo m:�ke.�iublish�Illtl�CCIQI'C llll5 as�incl liir iny 1.ast �Vill and 7�estament.I�ereMr
rcvokin�and making vuid all turmer wills and ce�dicils by n�e at anytirne herelotu�e made.
i
IFIRST. 1 ix�ler nnil dircct Uiat all my jusl eiehts an�l Luneral ezpcnses be paid by my
Ezecutriccs or Fixecutrix,as the cas�inay be,herzinafler namecf.as suun as conveniently may b�
done al'ter my�eccasc.
�I
I 51-:(;UND. [�ive:�nd bcquealh a sum uf rciouey eyual t� tive per centum(5%)of my net
I �
idistrihutablr estatc un�c,niy�randson.n�ne(y. I'c)DD A. GftA"LILiR.a?,solutely,if he survives
�
�
,I me.
�
� T�IIIZD. I�ive an�l h�yuca[h a sum ol�uioney cyual lo five per cen[utn(5°ii�)of my ne(
�
i �iistribu�abl�estu�c unto my grandson.namely,S'CG�'LN i1. GRAZIF..R, absulutely,if�he
i surri���>iur. I
,r•rJi i,�TH. I ��it•e an�b::c;u�all:a suin oFmoi;ey��I:�a� ta t;oc�er::.�rti:m(i°/�j of my ne� (
ilistrihut:ihle eslate un�o my;rsn�lson,namely,D,3NIL;L 2 GRA7_ILiIZ,absolutely,il'he survives %
I n�c.
f_I(="fH. I give and bequeath a swn of monev eyual tu tive per ccntum(5'%j of my net
� i
distribui;ihlr es�al�untc,my granddaughter,namely, K!�REti R. NO13LE,absolutel f she �
y,i
survivcs ii��.
SfXTFI. f gi�c.dcvise and beyueath alf the rest,resiciue and remainder uFmy Gstate,real.' i
persnn.il.in�l mire�l, whatsoc��er�nd wheresnever situated,ii�equal sfiar°S lllll0 III�'lbVp(�)
aaughters,namely.CONNIE i... GEtA"I.IER and DARLENF,i\. (3RUN�R,share and sha.re alike, �
I i�' dl�SC�)Ulclb':ind in lec simnle,if Ihey survive me.
I �
II�m��dau�.?Ilter.CONNfi:I.. GR11"./.IGR,sl�ouid preclecelse me, 1 order att�l direct thal I�er I
I..\•n�t�FFiCCS I �� �
SNElBAKER(� � .haro ul�rny resi�lu.u�y estale ali�resai�l shall be clistribute� in equal shares unto her then living i
BFrIJ'JEMAN,P.C. I I
I�hiltirrn.shure.ui�shar�alike.
I I m� ci;wrh(er. DAItLEiNL;1. I�RI JNL-:IZ..prc�lccease me. I orcler and direct that her
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sharc ol�itt� resi�{uarv cstatc aS�oresaiel sli�ill bc di��rihuled in cyuai shares u��to her tlien living ��
chil�ren.xhare Eltl(I SIl£If��III(C. If�II1V saicl�laughter shoul�l le,n�e nu c!1ildren w survive her, thcn '
a�i�l in ISial���eni. I c�rcler anJ�irect that hrr share��I'my residuary estate aloresaid shall be i
ilisu-ihul�d in equa!shares unl�,the Ihcn living chileiren c�f snv uther dauehter,Connie 1..C;razier,
sl�ar�an�i share alil:c.
!_;\S'l�l.l'. I nantinate,constitute and.ip{�uint my claughters,namely,CpNNiL L. �
CiIZALCE(t.�nii Ui\RLE{NI_i r\. 13RLJNI:tL to be Lhe F,>:eculrices.oi�this.my Last Will and I
fcstamem, hui il�I<ir any reason ci�her oC�ai�i�2augh�ers shuuld I�ail u,qualit;y as said Executrix
or ccnse su ti�ser�e.tlien an�t in that e�ent. 1 nemiiu:ue.cunslitute and apPuiut die daug(tter so
qualilyin�:��r survi��in�te>i�e lhr sole�:xecuiriz herru(.�ach aincl both to sen�e��ithout bond or
uther securily as a conclilion ut yuali(ic.�tion hereui;�ier
f�l Wf"fNt:Sti���t{�RF:OP. I,h1�\RC'rARE1'E.C'c)OK. Isavc liereunto set my hand and
se:�l t��thit ym Lttsl�Vill:�nd T�stament, �a�hich consists ul�theee(31 typewritten pages to each oC
which I h:i�e aftixccl mv si�natur�tfiis 9'�'�la� c�f(�c�ul�rr. :\.11., 1�wu'FhuusanJ 5ix(2006).
�sr���'�.� ^_(SE�aL)
_----�%� �``I.A1:C3:�12J�i'E.COOK
I'he preceding instrunieut,consisting of diis aiid two(2)ud�er typewritte�i pages,each
identilied by the si�uature c�t the'i�esla[rix,was on the dat�therec�f�signed,scalcd,published and I
declare�l bJ'(�l�1RGARF"f E. COOK, the'I�estatrix therein namec7,as�rid for fier Last Wili and
��es(.unru(, in dir pre�enc�i�f us,whu,at her reyurst. in her presence and in �he presence ot each I
olher.havc�ubscrihed our namcs.is witnesses hereto
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[L.P.AY.ER� '
NEAIAN, P.C. .
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� c,OA-i�-IQN�VI`.;�I,-fFl t)1'PLNNSYLV�IN1:\ )
SS.
� Cc)li\�'I'1'OF CUMl3L1tLAND �
\1 r. ��f;\R(;r\RE"f f:,COOK. R[CEff�Rll C. S��LBnKER and JnNE J.COONEY.�hc
�T��lahix ancl ilt��vimesses,r�spectively,whuse narnes are signed�o the�itlached or(ore�oing
instrumcnl.bein� lirst dul�•s�vurn.�Io hereb�'�ieclare io the unelersignc;�l auihority iltat the
Tes�a�rix si�necl and esecuted Ihe insU�wnent as her i zisi bVill ancl Tes�ameut anel that she had
sigi�cd�villin�ly.auel tha[she�xeaur� il as hcr ii�ec and���>luntary act for ttie purposes therein
i czpresscd.anil that each ul'thc�vi�nesses, in the prescilce and hcaring ot tlie Testutrix,signecl the
41�i11 as a�vitness and that tu Ihe best ofl�is or her knou�l��l��e. thc"l�estatrix��as al Ihat time
eighteen�cars cil':�`�e or ul�er,uf suund miitd ancl under no c��nstraint or un�fue inIluence.
�'�.��� _
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IIlll'S'S " "-- �-
Subs�rib��l,s�-vurn lir and acknowledged before me by MARGF\R1:'I�E. COni{,the I
Teslatrix,and subscribea and s��•orn to befure me b��RICH;\RD C. SNELBA[�k,R tuld JANE!.
CnONf:Y'.thc�vitnesses. thi.ti 9'�'dav ol'Uctober.20U6.
� COh1MONWEAITH QF PENNSYLVAfJ6'. � //��
� �Y�tari�I 5eal �� �y
Susan L Malra.Nolary PuWic I _�y� p�
v-,v.�ce=_ iJ�eCianicsGugBae.CumbeAandCounry t ` Not� Public.
My Camm�ssim E,�irts Nov.24.2007 I �3'
i o,vcEr.& � IA1ember,Penn<ylvenia AsSOCistion a Nolecie �
�._n;an�.P_C. �
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