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REV .1'00 EX ... (6.00)
OFFiCIAL USE ONL'{
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
00715
NUMJ!~~
FILE NUMBER
21 05
COUNTY COD~ _ YEAR _____
SOCIAL SECURITY NUMBER
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128.0601
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BRANDT, MARY R.
397-28-9991
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DATE OF BIRTH (MM-DD-YEAR)
DATE OF DEATH (MM-DD-YEAR)
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
07/21/2005
01/22/1934
REGISTER OF WILLS
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
SOCIAL SECURITY NUMBER
BRANDT, A. WILBUR
~ 1. Original Return 0 2. Supplemental Return
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.... 0 0 Future Interest Compromise (date of death after
l<:~Ul 4. Limited Estate 4a.
ul>:l<: 12-12-82)
wl>.U ~ 0
zOO 6. Decedent Died Testate (Attach copy 7. Decedent Maintained a Living Trust (Attach
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1>.11I of Will) copy of Trust)
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<l: 0 9. Litigation Proceeds Received 0 10. Spousal Poverty Credit (date of death between
12-31.91 and 1.1.95
356-24-3667
o 3. Remaincfer-Return(dateof-death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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NAME
EDMUND G. MYERS
,COMPLETE MAILING ADDRESS
FIRM NAME (If applicable)
JOHNSON, DUFFIE, STEWART & WEIDNER
301 Market St.
Lemoyne, PA 17043-0109
(1 ) None
(2) 3,402.80
(3) None
(4) None
-----.------..--
(5) 76,942.81
(6) None
(7) 169,246.4 7
TELEPHONE NUMBER
717/761-4540
OFF!C!Al. U~~NLY
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01
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
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3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
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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)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10,332.90
734.50
(8)
249,592.08
(9)
(10)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
(11 )
11,067.40
238,524.68
12. Net Value of Estate (Line 8 minus Line 11)
(12)
13. Charitable and Governmental Bequests/Sec 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)
10,000.00
228,524.68
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate, 80,126.08 x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z 148,398.60 .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
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<(
....
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I>. 17. Amount of Line 14 taxable at sibling rate x .12 (17)
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0 -.. .-.---------
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)( 18. Amount of Line 14 taxable at collaternl rate
<( x .15 (18)
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19. Tax Due (19)
0.00
6,677 .94
6,677.94
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
Depedent's Complete Address:
STREET ADDRESS
1101 COLUMBUS AVENUE
CITY
LEMOYNE
STATE PA
: ZIP 17043
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1 )
6,677 .94
5,900.00
310.53
Total Credits (A + B + C)
(2)
6,210.53
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is thEOVERPAYMENT. (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 theTAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is theBALANCE DUE (5B)
0.00
467.41
467.41
Make Check Payable to: REGISTER OF WILLS, AGENT
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?............................. __............................oo..................................................
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;............................................................................. ~ I
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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?.......................................................... on............................ -...................... D
D
~
~
~
D
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 perjury, I declare that 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
preparer other than the personal representative is basedC?n _all !':1!:or_rT'l~_tio~_orwhi_~h__pre~~~r:.....~i!~Zkl1_owledge. ___n _________
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS ESSEX HOUSE #113 DATE
A. WILBllR BRANDT 20 N. 12TH STREET
SIt! ~~~SPO:S:7F~II__~R~Kr' ~ ADDRESS LEMOYNE,PA 17043
pk_
GNATURE OF PREPAR~~T::;; THAN REPRESENTATIVE
EDMllND G. MYERS
/z~ L- ~_F
--- ---- DATE
ADDRESS
/2-2-~C
DATE
301 Market St.
Lemoyne, PA 17043-0109
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. ~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%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statutedoes not exemota 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. ~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%, except as noted in 72 P .S. ~9116
1.2) [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% [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.
ESTATE OF
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
BRANDT, MARY R.
SCHEDULE B
STOCKS & BONDS
! FILE NUMBER
21 - 05 - 00715
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1
2
3
4
1 - $1,000.00 - Series EE Bond
dated December 1988.
Date of death value
1 - $1,000.00 - Series EE Bond
dated May 1989.
Date of death value
40 Shares - Ohio Casualty Corporation
Common Stock @ $24.92 per/share
20 Units - American Leasing Investors IV-C
Limited Partnership - No Value
DESCRIPTION
UNIT VALUE
VALUE AT DATE OF
DEATH
1,214.80
1,191.20
996.80
0.00
3,402.80
TOTAL (Also enter on line 2, Recapitulation)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRANDT, MARY R.
FILE NUMBER
21 - 05 - 00715
Include the proceeds of litigation and the date the proceeds were received by the estatEAII property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
4,158.49
Sovereign Bank - Checking Account No. 1051071526
Date of death balance, plus accrued interest.
2
MassMutual Financial Group - Brokerage Account No. BMA 783790
Date of death value.
72,784.32
3
Silver and China - Article II of Will- adeemed
0.00
TOTAL (Also enter on Line 5, Recapitulation)
76,942.81
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRANDT, MARY R.
21 - 05 - 00715
ITEM
NUMBER
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
DESCRIPTION OF PROPEfUV - n DATE OF DEATH 11 % OF T - 1 ---
Include the name of the transferee, their relationship to decedent and the date of transfer. DECD'S EXCLUSION I TAXABLE VALUE
Attach a copy of the deed for real estate VALUE OF ASSET I' (IF APPLICABLE)
. . INTEREST
------ --------
MassMutua1 - IRA Annuity - VA 08456249
Beneficiaries: David C. Brandt, Son
Wendy B. Hefflefinger, Daughter
27,606.43
27,606.43
2
MassMutual - IRA Annuity - VA 10080662
Beneficiaries: David C. Brandt, Son
Wendy B. Hefflefinger, Daughter
21,102.85
21,102.85
3
MassMutua1- NQ Annuity - PAS 9017505
Beneficiaries: David C. Brandt, Son
Wendy B. Hefflefinger, Daughter
55,230.661
55,230.66
4
Jefferson Pilot - Annuity - JP4203462
Beneficiary: A. Wilbur Brandt, husband.
17,809.691
i
!
17,809.69
5
Jefferson Pilot - Annuity - SC04985
Beneficiary: A. Wilbur Brandt, husband.
47,496.841
47,496.84
TOTAL (Also enter on line 7, Recapitulation) ,
169,246.47
.
SCHEDULE H
AJNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT OECEDENT
ESTATE OF
BRANDT, MARY R.
ITEM
NUMBER
A.
B.
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Parthemore Funeral Home - funeral expenses
2
Reverend Tim Roach - Memorial Service
! FILE NUMBER
21 - 05 - 00715
AMOUNT
1,806.50
200.00
200.00
200.00
150.00
191.86
3,500.00
3,500.00
271.00
75.00
119.94
118.60
10,332.90
3
Reverend Ed Trask - Memorial Service
4
Lou Ann Potter - Organist - Memorial Service
5
Christ Presbyterian Church - funera11unch
6
An 01de Town Florist - flowers - Memorial Service
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
2.
Street Address
City
Year(s) Commission paid
Attorney's Fees Johnson, Duffie, Stewart & Weidner
State
Zip
3.
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant A. Wilbur Brandt
Street Address 1103 Columbus Ave.
City Lemoyne
Relationship of Claimant to Decedent
State P A
Husband
17043
Zip
4.
Register of Wills - Cumberland County
Probate Fees
5. Accountant's Fees
6. Tax Return Preparer's Fees
7.
1
Other Administrative Costs
Cumberland Law Journal - Legal Advertisement
2
The Patriot-News - Legal Advertisement
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRANDT, MARY R.
Schedule H
Funeral Expenses &
Adninistrati\ie Costs continued
3
Register of Wills - file Inventory and Inheritance Tax Return
4
Sovereign Bank - Estate checks
5
Reserve for close-out costs
FILE NUMBER
21 - 05 - 00715
Page 2 of Schedule H
30.00
13.60
75.00
ESTATE OF
'.
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
BRANDT, MARY R.
Include unreimbursed medical expenses.
ITEM
NUMBER
1
2
3
4
5
6
DESCRIPTION
R. L. Magarg1e, M.D. - decedent's account balance
Pinnacle Health - decedent's account balance
MBNA America - decedent's credit card balance
Central PA MRI - decedent's account balance
WSO Imaging - decedent's account balance
Kunkle Surgical Group - decedent's account balance
FILE NUMBER
21 - 05 - 00715
TOTAL (Also enter on Line 10, Recapitulation)
AMOUNT
10.05
355.08
149.04
204.72
8.55
7.06
734.50
REV-1513 EX+ (9-00)
, .
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRANDT, MARY R.
FILE NUMBER
21 - 05 - 00715
NUMBER
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
RELATIONSHIP TO
DECEDENT
Do Not List Trustee(s)_
AMOUNT OR SHARE
OF ESTATE
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
A. Wilbur Brandt
Essex House #113 - 20 N. 12th St.
Lemoyne, P A 17043
Husband
Automobiles;
Tangible
Personalty; Annuities;
25% residue.
2
David C. Brandt
6919 Prince Georges Ave.
Takoma Park, MD 20912-5413
Son
37.50 percent of
Residue.
3
Wendy B. Hefflefinger
3 Dorchester Rd.
Hummelstown, PA 17036
Daughter
37.50 percent of
Residue.
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheEjt
[
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
The Delta Community (f/n/a Delta Housing, Inc.)
2041 N. Second St., P. O. Box 5342, Harrisburg, PA 17102
10,000.00
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEf
I
10,000.00
NAPD
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