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REV-1500 OFFICIAL USE ONLY
INHERITANCE TAX RETURN FILE NUMBER
21 05
RESIDENT DECEDENT COU~ODE YEAR
SOCIAL SECURITY NUMBER
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NUMBER
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128..()601
DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
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Brackbill, Edward L.
DATE OF DEATH (MM-DD-YEAR)
THIS RETURN MUST BE ALED IN DUPUCATE WITH THE
195-32-1118
DATE OF BIRTH (MM.DD-YEAR)
01-01-2004
04-10-1938
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST AND MIDDLE INITIAL)
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o 1. Original Return D 2. Supplemental Return
O 4. Limited Estate D 4a. Future Interest Compromise (date of death aftar
12-12-82)
[!J 6. Decedent Died Testate (Attach D 7. Decedent Maintained a Living Trust (Attach
copy of Will) copy of Trust)
D 9. Litigation Proceeds Received D 10. ~f.~J:~I:~~~1~5?redit(data of death between 0 11. Election to tax under Sec. 9113(A)(Attach Soh 0)
~~ECl'ION!...t.1~IS.ec\5oMR~4ci;i.~~iBe$~~6ENPE::ANp:caIliFiO_~Thi.iriiRMimloN'SHOl!fLt)lBEiolRECl'EI5''TO:.' :.......::I~.:')..w! .!
NAME COMPLETE MAJUNG ADDRESS
James D. Bogar
FIRM NAME (If applicabla)
Bogar & Hipp Law Offices
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3. Remainder Return (date of death poor to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
One West Main Street
Shiremanstown, PA 17011
TELEPHONE NUMBER
717-737-8761
1. Real Estate (Schedule A)
OFFICIAL USE ONLY
(1 )
None
None
None
None
9,824.71
None
None
(8)
0.00
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
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4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L) 0 Separate Billing Requested
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
(9)
(4)
(5)
(6)
(7)
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9,824.71
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
(11 )
0.00
12. Net Value of Estate (Line 8 minus Line 11)
(12)
9,824.71
0.00
13. Charitable and Governmental Bequests/See 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)
(13)
(14)
9,824.71
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 9,824.71 x .00 (15)
z or transfers under Sec. 9116{a)(1.2)
0 (16)
i= 16. Amount of Line 14 taxable at lineal rate 0.00 x .045
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a. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17)
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0
(,) 18. Amount of Line 14 taxable at collateral rate 0.00 x .15 (18)
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... 19, Tax Due
(19)
0.00
0.00
0.00
0.00
0.00
20.0
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CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
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Copyright 2002 form software only The Lackner Group, Inc.
Form REV-1500 EX {Rev. 6-00:
Decedent's Complete Address:
STREET ADDRESS
69 Clouser Road
CITY Mechanicsburg
jSTATE PA
!ZIP 17055
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
0.00
0.00
Total Credits (A + B + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 1 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)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
0.00
0.00
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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;................................................................................ ~ ~:x
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? ... ...... .................. ............ .......... ... ....... ...... ... '" .., ...... ..... ........_.. '" ...... ... ........
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3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... 0 [!]
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..............................................................-.................................................... 0 [!]
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 pe~ury. I declare thaI I have examined this retum. including accompanying schedules and statements. and to the best of my knowledge and belief. n is true, correct
and
complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knOwledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
Car L. Brackbi
DATE
69 Clouser Road
Mechanicsburg, PA 17055
"'l19-l4f"
ADDRESS
DATE
ADDRESS
'it el~-
DATE
One West Main Street
Shiremanstown, PA 17011
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 P.S. 99116 (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 P .S. 99116 (a) (1.1) (ii)]. The statute does not exemot 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 adoptive parent, or a stepparent of the child is 0% [72 P .S. 99116 (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 P.S.
99116 1.2) [72 P.S. 99116 (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. 99116 (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-1508 EX+ (6-98)
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DecEDENT
ESTATE OF
Brackbill, Edward L.
FILE NUMBER
21-05-0045
InClude the proceeds of litigation and the date the proceeds were received by the estate.
All property Jolntly-owned with the right of survivorship must be disclosed on schedule F.
ITEM
NUMBER DESCRIPTION
1 Land O'Lakes, Inc. - Equity Reserve Credits - Sale of Milk
VALUE AT DATE
OF DEATH
9.824.71
TOTAL (Also enter on Line 5, Recapitulation)
9.824.71
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA-1500 Schedule E (Rev. 6-98)
Land O'Lakes, loe.
4C011.EX1NGl'ON Ave. N. ARDEN HIllS. MINNESOTA
Mailing Addnr.l3: P.O. b 84101, St. Paul. MN S51&400101
TeJeo/1one: (6S1) 4814222
November 29, 2004
James D. Bogar
1 West Main St.
Shiremanstown, P A 17011
Rc:: Edward L Brackbill, Deceased
LOL #2008671
Dear James D. Bogar:
In response to your recent inquiry regarding the equity reserve credits of the above subject
account, please be advised that those credits total $9,824.71 as they appear on our records.
Land O'Lakes has a policy of retiring in full the entire equity reserve account of any of its
deceased patrons upon presentation of the proper legal documents regarding an estate.
1. lfthe estate was probated, please send us a certified copy oithe Letters Testamentary.
2. If the estate is closed, send us a copy of the Final Decree.
3. If there were no probate proceedings, we enclosed an Affidavit of Heirship and
Agreement of Indemnification, which may be used. This form lists the heirs and to
whom payment should be made. Ifused, it should be filled in (both pages), signed.
witnessed, notarized and returned to our office in the enclosed envelope.
Upon receipt of the appropriate documents listed above, we will then petition the board of
directors to obtain formal approval of this redemption. Payment wilt be mad~promptly
thereafter. The next board meeting is scheduled for February 22,2005. In older to be
considered at that meeting you must have these forms returned to us no later than February 8,
2005.
S7};;;)!1.)
Alan Hot;;T
Equity Manager
Enc.
REV.1513 EX+ (9-00)
SCHEDULE ,J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Brackbill, Edward L. 21-05-0045
NAME AND ADDRESS OF RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
Do Not Ust Trusteelsl
I. TAXABLE DISTRIBUTIONS [include outright spousal
aistributions, and transfers
under Sec. 9116(a)(1.2)]
1 Carol L Brackbill Spouse All of the rest,
69 Clouser Road residue and
Mechanicsburg, PA 17055 remainder
.
Total
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
II. 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 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00
Copyright (c) 2002 form software only The Lackner Group, Inc.
Form PA.1500 Schedule J (Rev. 6-98)
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11Last 3!IlIill attb Qftstamtttt
OF
EDWARD L. BRACKBILL
I, EDWARD L. BRACKBILL, of Monroe Township, Cumberland
County, Pennsylvania, 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 give and bequeath my household furniture and
furnishings, my personal effects, jewelry, clothing, automobiles
and all other tangible personal property, including all insurance
policies covering those items, to my wife, CAROL L. BRACKBILL,
provided she survives me by sixty (60) days; or, if she does not
so survive me, to my children who survive me, to be divided
between or among them equally as they may agree.
SECOND: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
together with any insurance pOlicies thereon, unto my wife, CAROL
L. BRACKBILL, provided she survives me by sixty (60) days.
THIRD: Should my wife, Carol L. Brackbill, predecease
me or die on or before the sixty-first (61st) day following my
\ death, I devise and bequeath all the rest, residue and remainder
,\
~ of my estate of whatever nature and wherever situate, together
~ with any insurance pOlicies thereon, unto my children, CINDY L.
'\,
, BRACKBILL, BONNIE L. KAUCHER, KIMMY L. BRACKBILL and TRACY L.
YOST, or their issue, per stirpes, in equal shares.
~. FOURTH: In addition to all pow~rs granted to them by
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law and by other provisions of this Will, I give the fiduciaries
-,.
\ acting hereunder the following powers, applicable to all property,
exercisable without court approval and effective until actual
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distribution of all property:
(A) To sell at public or private sale, or to lease, for
any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms or conditions as are deemed proper.
(B) To partition, subdivide, or improve real estate and
to enter into agreements concerning the partition, subdivision,
improvement, zoning or management of real estate and to impose or
extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(D) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
FIFTH: I direct that all inheritance, estate, transfer,
succession and death taxes, of any kind whatsoever, which may be
'....1
payable by reason of my death, whether or not with respect to
property passing under this Will, shall be paid out of the princi-
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pal of my residuary estate.
SIXTH: All interests hereunder, whether principal or
income, which undistributed and in the possession of the fiduci-
>,
aries acting hereunder, even though vested or distributable, shall
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not be subject to attachment, execution or sequestration for any
debt, contract, obligation or liability of any beneficiary, and
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furthermore, shall not be subject to pledge, assignment, convey-
ance or anticipation.
SEVENTH: I nominate and appoint my wife, CAROL L.
BRACKBILL, Executrix of this, my Last Will and Testament. In the
event of the death, resignation or inability to serve for any
2
reason whatsoever of the said Carol L. Brackbill, I nominate and
appoint CINDY L. BRACKBILL, BONNIE L. KAUCHER, KIMMY L. BRACKBILL
and TRACY L. YOST, or the survivors thereof, Co-Executrixes of
this, my Last Will and Testament. I direct that my Executor or
Executrix, as the case may be, and their successors, shall not be
required to post security or a bond for the performance of their
duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
to this, my Last Will and Testament, this c.lv.{1 day of /}}'<'./-
1987.
?/&.'~ ,-L 'iC~./;-I.r~-r:_d41L-L'
Edward L. Brackbill
(SEAL)
signed, sealed, published and declared by the above-
named Testator as and for his Last Will and Testament in our
presence, who, at his request, in his presence and in the presence
of each other, have hereunto subscribed our names as attesting
witnesses.
~x. l8MdfillJ
Address
rJ<l'~ t71()a<.--
Address
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