HomeMy WebLinkAbout07-20-15 pennsytvania 1505614105
OEP�PiHEM OF gEVEHUE EX(03-14)(FI)
REV-1500 OFFICIAL USE ONLY
County Code Year File Number
Bureau of Individual Taxes
PO BOX 280601 INHERITANCE TAX RETURN
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
04272015 03111924
Decedent's Last Name Suffix Decedent's First Name MI
BRENNEMAN NANCY E
(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
CD 1. Original Return p 2. Supplemental Return p 3. Remainder Return(date of death
prior to 12-13-82)
O 4.Agriculture Exemption(date of O 5. Future Interest Compromise(date of O 6. Federal Estate Tax Return Required
death on or after 7-1-2012) death after 12-12-82)
COD 7. Decedent Died Testate O 8. Decedent Maintained a Living Trust 9. Total Number of Safe Deposit Boxes
(Attach copy of will.) (Attach copy of trust.)
O 10. Litigation Proceeds Received O 11. Non-Probate Transferee Return O 12. Deferral/Election of Spousal Trusts
(Schedule F and G Assets Only)
O 13. Business Assets O 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
KAY WOODROW (717) 432-4716
First Line of Address
150 STONEY RUN ROAD
Second Line of Address
City or Post Office State ZIP CodeI
DILLSBURG PA 17019
Correspondent's email address: 1C'---_
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REGIS OF WILLS U9�ONLYYi rn
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REGISTER OF WILLS USE ONLY (� , O p
DATE FILED MMDDYYYY Z,
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DTE FILED STAMP
PLEASE USE ORIGINAL FORM ONLY
Side 1
50�iiiiiiii
6 4105 1505614105
1505614205
REV-1500 EX(FI)
Decedent's Social Security Number
Decedent's Name: NANCY E BRENNEMAN
RECAPITULATION
I
1. Real Estate(Schedule A). .. .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . .. . . . . . 1. '
2. Stocks and Bonds(Schedule B) . . . . .. . . . . . . . . . . .. . . . . . . .. .. . . . .. . .. . . . 2.
r
3. Closely Held Corporation, Partnership or Sole-Proprietorship(Schedule C) . . . .. 3.
I
4. Mortgages and Notes Receivable(Schedule D) . . . . .. .. . . . .. . . . . . . . . . . . . . . 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property(Schedule E). . . . . . . 5. 659.06 f
y Property(Schedule F) O Separate Billing Requested . . . . . . . 6.
6. Jointl Owned Pro e I 1 1,251.79 i
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested.. . . . .. . 7. I 30,283.18
8. Total Gross Assets total Lines 1 through 7 8
( 9 ). . . . . .. .. . .. . . .. .. . . .. . . . . .. . 42,194.03
9. Funeral Expenses and Administrative Costs(Schedule H). . .. .. . . . . .. . . . . .. . 9. ffI 1,146.39
I
10. Debts of Decedent, Mortgage Liabilities and Liens(Schedule 1). . . . . . . .. .. . . . . 10. E 9,762.11
11. Total Deductions(total Lines 9 and 10). . . . .. . . . .. .. . . . . . . . . .. . . . . . . . . . . 11. ; 10,908.50
12. Net Value of Estate(Line 8 minus Line 11) . .. . . . . . .. . . . . . . . . . . . . . . . . . . . . 12. } 31,285.53
t _ E
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. i 31,285.53
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.0- 15. 1
16. Amount of Line 14 taxable
at lineal rate X.0 45 31,285.53 . 16. 1,407.85
17. Amount of Line 14 taxable
at sibling rate X.12 17.
18. Amount of Line 14 taxable
t .. . ...... .........
at collateral rate X.15 ._._ _ 18.
19. TAX DUE . .. . . . . . . . .. . .. . . . . . . . . .. .. . . . . . . . .. . . . . . .. . . ... . . .. . . .. . 19. 1,407.85
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT O
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.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE
AD
0 STONEY RUN ROAD DILLSBURG PA 17019
SIGNATURE PREPARE J�pTHER THAM PERSON RESPONSIBLE FOR FILING THE RETURN D/��TE
ADDRESS
PO BOX 6595 HARRISBURG PA 17112
Side 2
50 614205 1505614205 J:
REV-1500 EX (FI) Page 3 File Number
Decedent's Complete Address:
DECEDENT'S NAME
NANCY BRENNEMAN
STREET ADDRESS
210 BIG SPRING ROAD
CITY STATE ZIP
NEWVILLE PA 17241
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 1,407.85
2. Credits/Payments
A.Prior Payments
B.Discount 70.39
(See instructions.) Total Credits(A+B) (2) 70.39
3. Interest
(3) 1,337.46
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2,Line 20 to request a refund. (4)
5. If Line 1 +Line 3 is greater than Line 2,enter the difference.This is the TAX DUE. (5) 1,337.46
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 .......................................................................................... ❑ N
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?...................................................................... ❑ 0
2. If death occurred after Dec. 12,1982,did decedent transfer property within one year of death
without receiving adequate consideration?.............................................................................................................. ❑ 0
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? ........................................................................................................................ 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.
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 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)].
• 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-1.508 EX+(02-15)
i�;pennsylvania SCHEDULE E
DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
NANCY E BRENNEMAN
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 AMERICHOICE 5.99
2. SECURITY BENEFIT INTEREST 53.09
3 MISC REFUNDS(PAYFLEX,UNITED HEALTH CARE ECT..) 599.98
TOTAL(Also enter on Line 5, Recapitulation) $ 659.06
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+(02-15)
pennsylvania SCHEDULE F
DEPARTMENT REVENUE JOINTLY-OWNED PROPERTY
INHERITANCE TAXAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
NANCY E BRENNEMAN
If an asset became jointly owned within one year of the decedent's date of death,it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT
A. KAY WOODROW 150 STONEY RUN ROAD DAUGHTER
DILLSBURG PA 17019
B.
C.
JOINTLY OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY o OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A. 01101111 CITIZENS BANK#6100715388 22,503.58 50 11,251.79
TOTAL(Also enter on Line 6, Recapitulation) $ 11,251.79
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (02-15)
i'<< Pennsylvania SCHEDULE G
DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS AND
INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
NANCY BRENNEMAN
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.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE,THEIR RELATIONSHIP To DECEDENT AND DATE OF DEATH %OF DECD S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1. SECURITY BENEFIT ANNUITY 24,578.18 100 24,578.18
2 PRUDENTIAL INSURANCE 5,705.00 100 5,705.00
TOTAL(Also enter on Line 7, Recapitulation) $ 30,283.18
If more space is needed, use additional sheets of paper of the same size.
REV-1511. EX+ (02-15)
' - SCHEDULE H
pennsylvania
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
NANCY BRENNEMAN
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. MALPEZZI FUNERAL HOME 696.39
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:
150.00
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: 300.00
6. Tax Return Preparer Fees:
7.
TOTAL(Also enter on Line 9, Recapitulation) $ 1,146.39
If more space is needed, use additional sheets of paper of the same size.
REV-1.512 EX-i (02-15)
pennsylvania SCHEDULE I
JNL
DEPARTMENT OF REVENUE DEBTS OF DECEDENT,
INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
NANCY BRENNEMAN
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. SOCIAL SECURITY MONTHLY BENEFIT PAID BACK 1,513.00
2. IBM MONTHLY PENSION PAID BACK 333.45
3. HOLY SPIRIT 45.00
4. FRIENDSHIP FIRE COMPANY AMBULANCE 298.50
5. PULMONERY&CRITICAL CARE 23.98
6. HOLY SPIRIT MEDICAL GROUP 31.83
7. MILLENNIUM PHARMACY 506.93
8. GREEN RIDGE VILLAGE 6,904.84
9. HOLY SPIRIT MEDICAL 31.83
10. PAYFLEX 19.75
11. GINGRICH MEMORIAL 53.00
TOTAL(Also enter on Line 10, Recapitulation) $ 9,762.11
If more space is needed, insert additional sheets of the same size.
LAST WILL AND TESTAMENT
OF
NANCY E. BRENNEMAN
I, NANCY E. BRENNEMAN, of the Borough of Shiremanstown,
Cumberland County, Pennsylvania, make, publish and declare this
as and for my Last Will and Testament, hereby revoking all other
;dills and Codicils heretofore rade bv me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, to my daughter, KAY
Y. WOODROW, or should she predecease me, to her issue per stirpes
by representation.
SECOND: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
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 teras (including credit, with or without security cr
r -
conditions as are deemed proper. . Tlhis --fe - c::e_ -c _
legally sufficient instruments for transfer of the property and
7 to receive the proceeds of any disposition of it.
{ (B) To partition, subdivide, or improve real . estate
1 and to enter into agreements concerning the partition, subdivi-
sion, 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.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
THIRD: I direct that all inheritance, estate, trans-
fer, succession and death taxes, of any kind whatsoever, which
may be payable by reason of my death, whether or not with respect
to property passing under this Will, shall be paid out of the
principal of my residuary estate.
FOURTH: No provision is made in this, my Last Will and
Testament, for the children of my late husband, WILLIAM C.
BRENNEMAN, said children being ROBERT L. BRENNEMAN and WILLIAM C.
BRENNEMAN, JR. , because they are already well provided for.
FIFTH; I nominate and appoint KAY Y. WOODROW,
Executrix of this, my Last Will and Testament. In the event of
the death, resignation or inability to serve for any reason
whatsoever of the said KAY Y. WOODROW, I nominate and appoint
2
DENNIS E. WOODROW, Executor of this, my Last Will and Testament.
I direct that my Executrix or Executor, 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 7 ``day of
e , 1997.
(SEAL)
N 'CY E v lvik'EMAN
Signed, sealed, published and declared by the above-
named Testatrix as and for her Last Will and Testament in our
presence, who, at her request, in her presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
r J
Address
3