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7 pennsylvania 1505618403
DEPARTMENT OF REVENtX(03-14)
REV-150110 OFFICIAL USE ONLY
Bureau of Individual Taxes County Code Year File Number
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 13 1139
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
10 14 2013 09 22 1926
Decedent's Last Name Suffix Decedent's First Name MI
BRAZEN JOHN
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
RX 1. Original Return 2. Supplemental Return 3. Remainder Return(date of death
prior to 12-13-82)
4. Agricultural Exemption(date of 5. Future Interest Compromise(date of 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
RX 7. Decedent Died Testate 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will) (Attach copy of trust.)
❑ 10. Litigation Proceeds Received 11. Non-Probate Transferee Return ❑ 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
13. Business Assets ❑ 14. Spouse is Sole Beneficiary
(No trust involved)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
GREGORY K RICHARDS ESQ 717 533 3280
First Line of Address
134 SIPE AVENUE
Second Line of Address
City or Post Office State ZIP Code
HUMMELSTOWN PA 17036
Correspondent's email address: _9kr@jsdc.com
REGISTFRjOF WILLS USEANLY—,7 tTt
REGISTER OF WILLS USE ONLY --
DATE FILED MMDDYYYY
DATE.FILEDSTAM P3
---3 t.,r
C�o C
c
Side 1
1505618403 1505618403
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1505618411
REV-1500 EX
Decedent's Social Security Number
Decedents Name: Brazen, John
RECAPITULATION
1. Real Estate(Schedule A)....................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................. 2.
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C)......... 3.
4. Mortgages and Notes Receivable(Schedule D).................................................... 4.
5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E).......... 5. 91386 - 99
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............ 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............ 7. 411 ,145 - 95
8. Total Gross Assets(total Lines 1 through 7)........................................................ 8. 420 ,532 . 94
9. Funeral Expenses and Administrative Costs(Schedule H).................................... 9. 7,6 3 7 - 75
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)............................ 10.' 1 , 460 - 00
11. Total Deductions(total Lines 9 and 10)................................................................ 11. 9-,097 - 75
12. Net Value of Estate(Line 8 minus Line 11).......................................................... 12. 411,435 - 19
13. Charitable and Governmental Bequests/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. 411,435 - 19
TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X.00 15. 0 . 00
16. Amount of Line 14 taxable
at lineal rate X .045 411-,435 - 19 16. 181514 - 58
17. Amount of Line 14 taxable
at sibling rate X.12 0 . 00 17. 0 . 00
18. Amount of Line 14 taxable
at collateral rate X.15 0 . 00 18. 0 . 00
19. TAX DUE................................................................................................................ 19. 18 -,514 . 58
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ❑
Under penalties of perjury,I declare 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 person responsible for filing the return is based on all information of which preparer has
any knowledge.
SIGNATUROF RSON RESPONSIBJ..E FOR FIL RETURN LAnne A. Esposito D EP , a-., A7ZZ,
ADDRESS (p p`
5915 eph s Crossing,/N_
rossin , clonicIrg, PA 17050
SIGNATUR PREPARER OT H HANPRES ATIVE Gregory K. Richards Esq. DATE
L
AD135RdiS
134 Sipe e, Hum I own, PA 17036
I IIIIIIIIIIIIII IIIIIIIIIIIIIIILII IIIIIIIII IIIIIIII �� Side 2
1505618411 1505618411
REV-1500 EX Page 3 Fite Number 21-13-1139
Decedent's Complete Address:
DECEDENT'S NAME
Brazen,John
STREET ADDRESS
2100 Bent Creek Blvd.
CITY STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 18,514.58
2. Credits/Payments
A. Prior Payments 17,000.00
B. Discount 894.74
Total Credits(A +B) (2) 17,894.74
3. Interest (3)
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
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. (5) 619.84
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;............................................................................... ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................. ❑ ❑x
c. retain a reversionary interest;or............................................................................................................... ❑ ❑x
d. receive the promise for life of either payments,benefits or care?............................................................ ❑ ❑x
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.................................................................................................................... ❑ ❑x
3. Did decedent own an"in trust for" or payable upon death bank account or security at his or her death?....... ❑ ❑x
4. Did decedent own an individual retirement account,annuity,or other non-probate property which
contains 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 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 January 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 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 21 years of age or younger at death to or for the use of a natural parent,an
adoptive parent,or a step-parent 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)j.
• The 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.§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-1508 EX+(08-12)
SCHEDULE E
pennsylvania CASH, BANK DEPOSITS, & MISC.
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Brazen,John 21-13-1139
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with the right of survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Metro Bank Checking Account#32039174-valued per letter dated December 19,2013 8,361.61
Accrued interest on Item 1 through date of death 1.57
2 Metro Bank Savings Account#626039853-valued per letter dated December 19,2013 23.81
3 Personal Property 1,000.00
TOTAL(Also enter on Line 5, Recapitulation) 9,386.99
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule E(Rev.08-12)
Rev-1510 EX+(08-09)
SCHEDULE G
pennsylvania INTER-VIVOS TRANSFERS AND
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Brazen,John 21-13-1139
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH % DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSE OF FER.SATfACH THEIR COPYOF THE RELATIONSHIP
FOR REAL ESTATEDENT E. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 Investors Insurance Corporation Annuity Contract# 411,145.95 411,145.95
C0022680-beneficiaries are Lynne A. Esposito,
Elizabeth L. Esposito,John C. Esposito,and Joseph
P. Esposito
TOTAL(Also enter on Line 7, Recapitulation) 411,145.95
(If more space is needed,additional pages of the same size)
Copyright(c)2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule G(Rev.08-09)
REV-1511 EX+(08-13)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX
RESIDENT DECEDENT RETURN ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
Brazen,John 21-13-1139
Decedent's debts must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
NUMBER
A. FUNERAL EXPENSES:
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s)Commission Paid
2. Attorney's Fees James, Smith, Dietterick& Connelly, LLP 7,500.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State ZiD
Relationship of Claimant to Decedent
4. Probate Fees 113.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs 24.25
See continuation schedule(s) attached
TOTAL(Also enter on line 9, Recapitulation) 7,637.75
Copyright(c)2013 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.08-13)
SCHEDULE H
FUNERAL EXPENSES AND ADMINISTRATIVE COSTS
continued
ESTATE OF FILE NUMBER
Brazen,John 21-13-1139
ITEM
NUMBER DESCRIPTION AMOUNT
Other Administrative Costs
1 Cumberland County Register of Wills-short certificate 5.00
2 UPS -overnight delivery charges 19.25
H-B7 24.25
Copyright(c)2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H(Rev.6-98)
Rev-1512 EX+(12-12)
SCHEDULE 1
pennsylvania DEBTS OF DECEDENT,
DEPARTMENT OFMORTGAGE LIABILITIES AND LIENS
RET
INHERITANCE TAXAXRETURRNN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Brazen,John 21-13-1139
Report debts incurred by the decedent prior to death that remained unpaid at the date of death,including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Angels on Call-private nurses 1,460.00
TOTAL(Also enter on Line 10, Recapitulation) 1,460.00
(If more space is needed,additional pages of the same size)
Copyright(c)2012 form software only The Lackner Group, Inc. Form PA-1500 Schedule I(Rev. 12-12)
REV-1513 EX+(01-10)
pennsylvania SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Brazen,John 21-13-1139
RELATIONSHIP TO
NUMBER NAME AND ADDRESS OF DECEDENT SHARE OF ESTATE AMOUNT OF ESTATE
PERSON(S)RECEIVING PROPERTY (Words) ($$$)
0 of i ee s
I. TAXABLE DISTRIBUTIONS [include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Elizabeth L. Esposito Granddaughter 20%of Annuity 82,229.19
5915 Stephens Crossing
Mechanicsburg, PA 17050
2 John C. Esposito Grandson 20%of Annuity 82,229.19
301 Chestnut Street
Apt. 1810
Harrisburg, PA 17101
3 Joseph P. Esposito Grandson 20%of Annuity 82,229.19
56 Devonshire Square
Mechanicsburg, PA 17050
4 Lynne A. Esposito Daughter 100%of residue; 164,747.62
5915 Stephens Crossing 40%of annuity
Mechanicsburg, PA 17050
Total 411,435.19
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet as appropriate.
NON-TAXABLE DISTRIBUTIONS:
II. 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-1500 COVER SHEET
Copyright(c)2010 form software only The Lackner Group,Inc. Form PA-1500 Schedule J(Rev.01-10)
r
LAST WILL AND TESTAMENT
OF
JOHN BRAZEN
1, John Brazen (Social Security number '189-20-1577), currently a resident of
Cumberland County, Pennsylvania, being of sound mind and memory and over the age
of eighteen(18) years, do hereby make, publish, and declare this to be my last Will,
hereby revoking all other Wills and Codicils heretofore made by me.
ARTICLE FIRST
IDENTITY OF CHILDREN
I am presently unmarried but, from a previous marriage to Elizabeth J. Brazen,
who died on October 4, 2004, have one living child, whose name and birth date are:
Name Birth Date
Lynne A. Esposito March 30, 1957
have no deceased children.
ARTICLE SECOND
PROPERTY BEING DISPOSED
It is my intention to dispose of all my property. However, I do not intend to
exercise any power of appointment which I now possess or which may hereafter be
conferred on me, unless such power is specifically referred to herein or in any Codicil
hereto.
ARTICLE THIRD
PAYMENT OF BURIAL EXPENSES AND DEBTS
I authorize my Executor to pay all the expenses of(a) a funeral service at Neill
Funeral Home, 3401 Market Street, Camp Hill, PA; (b) the interment of my remains,
including the costs of a gravesite, at the Gate of Heaven Cemetery, 1313 South York
Street, Mechanicsburg, PA; and (c) the installation and inscription of a suitable marker
at, and perpetual care of, the gravesite. Most of such expenses have been pre-paid.
I further direct my Executor to pay all of my debts that my Executor in his or her sole
discretion may allow as claims against my estate.
John Braze
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ARTICLE FOURTH
SPECIFIC BEQUESTS
.Tangible Personal Property
a. If, during my lifetime, I have composed a list setting forth a certain distribution
-among-my daughter and grandchildren of-my tangible-personal--property(including,--but
not limited to,jewelry; clothing, household furniture and furnishings, dishware, silver,
pictures, books, etc.) then I give, devise and bequeath the property that is included on
such list to my daughter and grandchildren direct that my Executor distribute such
property at his or her discretion, but with the recommendation that he or she distribute in
accordance with the list. If no such list has been composed or if such list has been
composed but excludes any of my tangible personal property, then my daughter and
grandchildren who survive me, at the discretion of my Executor, shall alternately select
unlisted items of tangible personal property from my estate with the recommendation
that the aggregate value of such property selected by each person be substantially
equal. Any tangible personal property not included on a list and not selected I by my
children shall be included in my residuary estate for disposition under Article Fifth,
following.
ARTICLE FIFTH
RESIDUE
a. I give, devise and bequeath all my remaining property to my daughter, Lynne.
Lynne not Surviving
b. If Lynne does not survive me, but has surviving issue, I give devise and
bequeath all of my remaining property to her issue in equal shares. If Lynne has no
living issue, then my estate shall be distributed in accordance with the intestate law of
the Commonwealth of Pennsylvania.
ARTICLE SIXTH
PAYMENT OF DEATH TAXES
All estate, inheritance, and succession taxes, together with any interest and
penalties thereon, payable as a result of my death and imposed with respect to any
property, whether or not disposed of by this Will, shall be paid out of the residue of my
estate.
John
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ARTICLE SEVENTH
EXECUTOR
I appoint my daughter, Lynne, as the Executor of this Will. Should she be unable
or unwilling to serve in this capacity, I appoint Dale A. Achenbach, Esq., of York,
Pennsylvania, as Executor. I direct that no action shall be taken in any court in the
administration of my estate other than the probating and recording of this Will and the
return of any inventory, appraisement, and list of claims of my estate.
ARTICLE EIGHTH
POWER OF FIDUCIARIES
All fiduciaries (which term whenever used herein shall include my Executors and
Trustees) serving hereunder shall do so without bond or other security in any
jurisdiction. By way of illustration and not limitation and in addition to any inherent,
implied or statutory powers granted to fiduciaries generally, my fiduciaries are
specifically authorized and empowered with respect to any property, real or personal, or
at any time held under any provisions of this my Will: to allot, allocate between principal
and income, assign, borrow, buy, care for, collect, compromise claims, contract with
respect to, continue any business of mine, convey, convert, deal with, dispose of, enter
into, exchange, hold mortgage, grant and exercise options with respect to, take
possession of, pledge, receive, release, repair, sell, sue for, to make distributions or
divisions in cash or in kind or partly in each without regard to the income tax basis of
such asset and in general, to exercise all of the powers in the management of my estate
or any trust created hereunder which any individual could exercise in the management
of similar property owned in their own right, upon such terms and conditions as my
fiduciaries may deem proper or necessary to carry out the purposes of this my Will,
without being limited in any way by the specific grants of power made and without
necessity of a court order.
ARTICLE NINTH
GENERAL
Effect of Inooerative. Invalid, or Illegal Provision
a. If any provision of this Will or of any Codicil thereto is held to be inoperative,
John Braze
invalid, or illegal, it is my intention that all of the remaining provisions thereof shall
continue to be fully operative and effective so far as is possible and reasonable.
Headings
b. The headings above.the various provisions of this Will have been included
only to make it easier to locate the subject covered by each provision and are not to be
used in constructing this Will or in ascertaining my intentions.
Number and Gender Defined
c. As used in this Will, whenever the context so indicates, the masculine,
feminine, or neuter gender, and the singular or plural number, shall.each be deemed to
include the others.
Simultaneous Death
d. If any legatee, devisee, or belneficiary of any trust shall die simultaneously
with me or there is not direct evidence to establish that such person and I died other
than simultaneously, I hereby declare that I shall be deemed to have survived such
person.
IN WITNESS WHEREOF, 1, JOHN BRAZEN, hereby set my hand to this my last
Will, each page of which has been signed or initialed by me, on this 1-11"'A day of
2006 at Hershey, Pennsylvania.
John Brazv:�'
- 4 -
Attestation Clause
The foregoing instrument (consisting of 7 pages, including this page and the
following Acknowledgement and Affidavit) was in our presence signed by John Brazen
and declared by him to be his last Will. We, at his request and in his presence and in
the presence of each other, all being present-at the same time, have hereunto
subscri ed our names as witnesses on this 2 day of
2006.
6 (9t Residence: r
r b
Lint , Residence: &IIVI
Me,
- 5 -
ACKNOWLEDGEMENT
COMMONWEALTH OF PENNSYLVANIA
: SS:
COUNTY OF Y-0 4 V
1, John Brazen, the testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, hereby acknowledge that I
signed and executed the instrument as my last Will and that I signed it willingly and as
my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and acknowledged before me by John Brazen, the testator,
on this date:
John Brazen
Notary P lic
NOTARIAL$EAL
CHERYL M.KLINEDINST,NOTARY PUBLIC
CITY OF YORK,YORK CO.,PA
I
My COMMISSION EXPIRES DECEMBER 2,2]0
- 6 -
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS:
COUNTY OF
.We, and kafeyl
L) the
witnesses whose names are signed t6 the attached or foregoing instrument, having
been duly qualified according to law, hereby depose and say that we were present and
saw the testator sign and execute the instrument as his last Will, that the testator signed
willingly and executed it as his free and voluntary act for the purposes therein
expressed, that each subscribing witness in the hearing and sight of the testator signed
the Will as witness, and that to the best of our knowledge the testator was at that time
18 or more years of age, of sound mind, and under no constraint or undue influence.
Sworn to or affirmed and subscribed to before me by:
Af and
witnesses, on this date: Z-
A
Witness
W 'v
Kneis
A
o 0
tary 4Public
NOTARIAL SEAL
CHERYL M.KILINEDINST,NOTARY PUBLIC
CITY OF YORK,YORK CO.,PA
My COMMISSION EXPIRES DECEMBER 2,2007
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