HomeMy WebLinkAbout05-17-06
, REV. 1500 EX + (8-40)
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REV -1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 05
COUNTY CODE YEAR
SOCIAL SECURITY NUMBER
00778
NUMBER
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
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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)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
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II DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
i BRENNER, JOSEPH D.
! DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR)
i08/17/2005 03/01/1917
(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
182-12-0745
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
~ 1. Original Return 0 2. Supplemental Return 0 3. Remainder Return (date of death prior to 12-13-82)
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~ ~ en 0 4. Limited Estate 0 4a. Future Interest Compromise (date of death after ~ 5. Federal Estate Tax Return Required
o 0:: ~ 12-12-82)
~ ~ 9 ~ 6. Decedent Died Testate (Attach copy 0 7. Decedent Maintained a Living Trust (Attach 1 8. Total Number of Safe Deposit Boxes
o t m of Will) copy of Trust)
oe( 0 9. Litigation Proceeds Received 0 10, Spousal Poverty Credit (date of death between 0 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
12-31-91 and 1-1-95
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
AME COMPLETE MAILING ADDRESS
lh ~ I vo V. Otto III, Esquire
~ ~ IRM NAME (If applicable)
8 ~ Martson Deardorff Williams & Otto
ELEPHONE NUMBER
717/243-3341
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
Ten East High Street
Carlisle, P A 17013
(1 ) 301,500.00
(2) 6,730,164.20
(3) None
(4) None
(5) 1,122,138.17
(6) None
(7) 323,257.52
(9) 200,096.91
(10) 254,897.14
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(8)
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8,~7,059.89
(11 )
454,994.05
8,022,065.84
(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)
(14)
8,022,065.84
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax rate,
or transfers under Sec. 9116(a)(1.2)
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16.Amount of Line 14 taxable at lineal rate
117. Amount of Line 14 taxable at sibling rate
I 18. Amount of Line 14 taxable at collateral rate
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119. Tax Due
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! 20. 0
x .00
(15)
8 ,022 ,065 . 84 x .045
(16)
360,992.96
x .12
(17)
x .15
(18)
(19)
360,992.96
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
>> BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <<
Form REV-1500 EX (Rev. 6-00)
Decedent's Complete Address:
STREET ADDRESS
1051 Trindle Road
CITY
Carlisle
I STATE PA
I ZIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
360,992.96
325,000.00
17,105.26
Total Credits (A + 8 + C)
(2)
342,105.26
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (0 + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
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.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 18,887.70
(5A)
(58) 18,887.70
Make Check Payable to: REGISTER OF WILLS. AGENT
~~c<~~/:if.~. ~;~):t'"':..~/; ~ }y "i r;<., J ~ ''- ",K:: ~ t r (;~~ ~ : 1o:~:M ; 'Y:tl!~ ~ ~.. i~:n ~ <
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?........................ ........................................................ .....................................
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "XU IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. ~ I
~~ ~:::~ ~h~e~~~:i:~~~:~~;~s~~~. .~~~~~ .~~~ .~~.:.~~.~.~.~ .~~~~~~~~~~~. ~.~ .i.t.~. ~~~~~~~~~~~~~~~ ~~~ ~~ ~ ~~ ~~ ~~~~ ~ ~~ ~ ~ ~.' ~ ~ ~ ~ ~~ ~
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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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.
DATE
1306 Sadler Drive
1 Carlisle, PA 17013
ONSIBLE FO FILING RETI,JRN "" ADDRESS
__' Katheri1 B ./~nges 246 ~onway Street
I / .__ '<--< ~I ;~k-'-' /~ Carhsle, P A 17013
THAN EPRESENT A TIVE ADDRESS
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~lPe?1&Mif~5lM
DATE
, I /
/1/1 7/?~
DATE
Ten East High Street
Carlisle, P A 17013
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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 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. ~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.
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SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
I FILE NUMBER
21 - 05 - 00778
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a wimng seller, neither being compelled to buy or sell, both having
reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
BRENNER, JOSEPH D.
ITEM
NUMBER
1
DESCRIPTION
VALUE AT DATE OF
DEATH
301,500.00
Residence at 1051 Trindle Road, Carlisle, North Middleton Township, Cumberland County, P A, Parcel
No. 29-21-0316-008; conveyed by Deed dated 8/13/1971 to decedent and Jane W. Brenner recorded in
Cumberland County, PA, Deed Book "F", Volume 24, Page 710; Jane W. Brenner died on 10/24/1997.
Value is assessed value.
TOTAL (Also enter on Line 1, Recapitulation)
301,500.00
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SCHEDULE B
STOCKS & BONDS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF BRENNER, JOSEPH D.
I FILE NUMBER
21 - 05 - 00778
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM I DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 5064 sh, common, Allied Irish Bks PLC (019228402) 43.97 222,664.08
2 396 sh, common, Alltel Corp (020039103) 61.40 24,314.40
3 1292 sh, common, Fedders Corp (313135105) 2.335 3,016.82
4 1335 sh, common, M&T Bank Corp (55261FI04) 107.595 143,639.33
5 500 units, Northern Border Partners LP (664785102) 48.05 24,025.00
6 47 sh, common, SBC Comm, Inc (78387GI03) 24.29 1,141.63
7 4740.0847 sh, common, Sprint Corp. (852061100) 26.265 124,498.32
1686 sh Sprint PCS which became 843 sh Sprint FON 26.265 22,141.40
8 384 sh, common, Thomas & Betts Corp (884315102) 33.90 13,017.60
9 5404 sh, common, Tyco (902124106) 28.50 154,014.00
10 21 sh, common, Verizon Comm (92343VI04) 33.035 693.74
11 Accrued Dividends on Item 1 above 2,853.26
12 Financial Network, Account No. 4N2-619266 (see Exhibit B-13) 107,499.02
13 JB Hanauer Account No. 1778-2121 (see ExhibitB-14) 3,782,862.10
14 Legg Mason Account No. 360-00227 (see Exhibit B-15) 1,314,297.24
15 Smith Barney Citigroup Account No. 658-14589-13 (see Exhibit B-16) 116,649.01
16 Smith Barney Citigroup Account No. 658-21839-16 (see Exhibit B-17) 467,746.36
17 200,000 Miami-Dade Cnty Fla Aviation Rev 4.75% Bond (59333PHR2)Bank of 100.731 205,050.89
America, Money Manager Account, investment #W61-062014, transfer on death to
Margaret B. Bushey, Joseph Brenner, Jr., Nancy Blakely and Katherine B. Menges
18 1 sh Frog Switch & Manufacturing 40.00
TOTAL (Also enter on line 2, Recapitulation) 6,730,164.20
'*
SCHEDULE B
STOCKS & BONDS continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRENNER, JOSEPH D.
I FILE NUMBER
21 - 05 - 00778
All property Jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
19 Dominion Jubilee (no value)
DESCRIPTION
UNIT VALUE
VALUE AT DATE OF
DEATH
0.00
20
1 sh Agway Inc. (no value)
0.00
21
5 sh, common, Trans World Airlines Inc (893349837) (no value
0.00
Page 2 of Schedule B
*'
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRENNER, JOSEPH D.
I FILE NUMBER
21 - 05 - 00778
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
NUMBER
1 Cash in safe deposit box
20
DESCRIPTION
VALUE AT DATE OF
DEATH
3,540.00
2
Orrstown Bank, Money market checking # 1 06800 161
591,567.30
3
Orrstown Bank, Money maker checking #106002874
221,879.29
4
Bank of America, checking #001627828938
3,391.50
5
Bank of America, Money Manager Account, checking #3665668004, transfer on death to Margaret B.
Bushey, Joseph Brenner, Jr., Nancy Blakely and Katherine B. Menges
25,792.54
6
Financial Network Account #4N2-619266, federal capital reserves
1.56
7
JB Hanauer Account #1778-2121, cash balance
3.03
8
GMS Group, Account #55R-027735, cash balance
1.61
9
SmithBarneyCitigroup Account #658-21839-16, money market fund
49,478.37
10
Legg Mason Account 360-00227, cash balance
4,040.68
11
Legg Mason Account 360-00227, Tax-Exempt Money Market fund
3,654.45
12
Northern Borders Partnership, 8/12/05 dividend check
400.00
13
JB Hanauer, 8/1/05 interest check
8,456.25
14
JB Hanauer, 8/2/05 Tyco dividend check
3,162.40
15
Tyco Corp., 8/2/05 dividend check
540.40
16
ill Hanauer, 7/15/05 interest check
5,075.00
17
SmithBarney, 8/2/05 interest check
4,000.00
18
Legg Mason, 7/15/05 dividend check
1,386.57
19
Social Security benefit checks for June and July 2005
3,976.00
Dickinson-Brenner Unitrust, accrued income to date of death
656.25
Total of Continuation Schedule(s)
TOTAL (Also enter on Line 5, Recapitulation)
191,134.97
1,122,138.17
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRENNER, JOSEPH D.
I FILE NUMBER
21 - 05 - 00778
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
NUMBER
21
DESCRIPTION
VALUE AT DATE OF
DEATH
107,014.62
Dickinson-Brenner Charitable Remainder Unitrust, interest of income beneficiaries
22
99 Series E or EE U.S. Savings Bonds (see Exhibit E-22)
18,888.50
23
The Fidelity Mutual Life Insurance Co., Policy No. 959010, Owner: Decedent; Insured: Joseph D.
Brenner, Jr.; Cash value
14,244.85
24
Jane W. Brenner Trust B Under Will, accrued income
4,035.00
25
Jane W. Brenner Trust C Under Will, accrued income
9,158.00
26
Commonwealth of P A, refund
224.00
27
P A Dept. of Revenue, 2005 income tax refund
48.00
28
U.S. Treasury, 2005 income tax refund
19,172.00
29
1984 Cadillac Sedan
350.00
30
1991 Cadillac Sedan
2,000.00
31
Rolex Watch, appraised value
1,000.00
32
Household property
15,000.00
Page 2 of Schedule E
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SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRENNER, JOSEPH D..
FILE NUMBER
21 - 05 - 00778
This schedule must be com Dieted and I ed i the answer to any 0 auestions 1 trough 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION ,
NUMBER Include the name of the transferee, their relationship to decedent and the date of transfer. VALUE OF ASSET DECO'S (IF APPLICABLE) I TAXABLE VALUE
Attach a copy of the deed for real estate. INTEREST
1 Transfer on 8/1/05 of 25000 PASt Tpk Comm Rev BIE 25,917.00 100% 3,000.00 22,917.00
bond (CDSIP 709222BD4) to Katherine B. Menges
( daughter)
2 Joseph D. Brenner Profit Sharing Plan No. 705136, 300,340.52 100% 300,340.52
11041.931 shares T. Rowe Price Growth Stock @ 27.20;
beneficiaries: Children of decedent
TOTAL (Also enter on line 7, Recapitulation) 323,257.52
fil f
f
h
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SCHEDULE H
FUNERAL EXPENSES &
ADIVIINISlRATIVE COSTS
ESTATE OF
COMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
BRENNER, JOSEPH D.
I FILE NUMBER
I 21-05-00778
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER
A.
B.
6.
7.
1
DESCRIPTION
AMOUNT
FUNERAL EXPENSES:
Hoffman-Roth Funeral Home, Carlisle, P A
2
Westminster Cemetery, grave opening
3
Salamandra, Carlisle, P A, food for gathering after funeral reception
4
Georges' Flowers, funeral flowers
5
Second Presbyterian Church, funeral reception
6
Carlisle Memorial Service, monument
ADMINISTRATIVE COSTS:
1.
Personal Representative's Commissions
Joseph D. Brenner, Jr. Margaret B. Bushey Katherine B. Menges
Social Security Number(s) I EIN Number of Personal Representative(s):
Street Address 1306 Sadler Drive
City Carlisle
Year(s) Commission paid
State
PA
Zip 17013
2.
Attorney's Fees
Martson Deardorff Williams & Otto (estimated)
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Register of Wills, Cumberland CoUnty, PA
Probate Fees
5. Accountant's Fees
Tax Return Preparer's Fees
Boyer & Ritter, preparation of 2005 income tax returns
Other Administrative Costs
Register of Wills, short certificates
2
Register of Wills, exemplified copies of probate documents
Total of Continuation Schedule(s)
TOTAL (Also enter on line 9, Recapitulation)
9,028.10
1,245.00
752.60
318.00
277.05
211. 00
83,750.00
83,750.00
460.00
1,575.00
40.00
40.00
18,650.16
200,096.91
*'
Schedule H
FmeraI Expenses &
AministratiYe Costs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRENNER, JOSEPH D.
I FILE NUMBER
21 - 05 - 00778
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
UPS, overnight mail
EVP Systems, Inc., stock valuation reports
Cumberland Law Journal, advertising Letters Testamentary
The Sentinel, advertising Letters Testamentary
Aero Energy, price protection program, pending disposition of real estate
U.S. Postal Service, supplies and postage for administration
Aero Energy, heating oil/propane service during administration
Sprint, telephone service during administration
PPL, electric service during administration
North Middleton Twp. Authority, water/sewer during administration
York Waste, trash service pending administration
ADT Security, security service pending administration
George Almsbaugh, maintenance of real estate
Mellott Construction, snow plowing/lawn maintenance
Comm of P A, vehicle registration renewal
Grove Insurance, vehicle insurance renewal
State Auto, homeowner's insurance renewal
Township/County real estate taxes pending disposition
Register of Wills, filing fee, inheritance tax return
Register of Wills, estimated additional probate fee
Register of Wills, reserved for filing fees, account/releases; brokerage commissions on sale of
securities to pay inheritance and federal estate tax
J
14.00
271.00
75.00
158.81
29.95
39.47
3,835.00
647.00
839.00
218.00
160.00
528.00
250.00
250.00
36.00
592.00
977.00
964.93
15.00
3,750.00
5,000.00
Page 2 of Schedule H
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SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
BRENNER, JOSEPH D.
I FILE NUMBER
21 - 05 - 00778
Include unreimbursed medical expenses.
ITEM
NUMBER
1
DESCRIPTION
AMOUNT
20,000.00
Anmar Builders, check #690 Orrstown Bank, cleared after date of death
2
M&T Bank, account payable, check #125 Orrstown Bank, cleared after date of death
195,000.00
3
Corncast, account payable
144.00
4
North Middleton Authority, account payable
61.00
5
Sprint, account payable
144.82
6
PPL, account payable
543.03
7
Lakeview Home Health Services, account payable
320.00
8
United States Treasury, 2005 income tax estimated payment
18,520.00
9
Cingular, account payable
79.69
10
Tonken Torp LLP, attorney fees and disbursements for lawsuit and estate planning, balance on account
19,794.60
11
Cumberland Pathology, account payable
290.00
TOTAL (Also enter on Line 10, Recapitulation)
254,897.14
REV.1513 EX+ (9-00)
*'
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
BRENNER, JOSEPH D.
ESTATE OF
I! FILE NUMBER
21 - 05 - 00778
RELATIONSHIP TO
DECEDENT
On Nnt I
NUMBER I
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
Katherine B. Menges
470 Old Mill Road, Erie, P A 16505
Daughter
2 Margaret B. Bushey
246 Conway Street, Carlisle, P A 17013
3 Joseph D. Brenner, Jr.
1306 Sadler Drive, Carlisle, P A 17013
4 Trustees fbo Nancy B. Blakely
3143 West 32nd Street, Erie, P A 16506
Daughter
Son
Daughter
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
AMOUNT OR SHARE
OF ESTATE
$22,917 (Sch. G, Item
1); 1/4 estate residue
1/4 estate residue
1/4 estate residue
1/4 estate residue
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
1 DlI~ j"O ,ot)
Ft\ 4 (0 . (.0
f\P P l~oo.<50 ~11C,l.;,J
t",t'::' P 0
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1162 EX( 11-96)
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
OTTO IVO VICTOR III
10 E HIGH STREET
CARLISLE, PA 17013
__nuU fold
ESTATE INFORMATION: SSN: 182-12-0745
FILE NUMBER: 2105-0778
DECEDENT NAME: BRENNER JOSEPH D
DATE OF PAYMENT: 05/17/2006
POSTMARK DATE: 05/17/2006
COUNTY: CUMBERLAND
DATE OF DEATH: 08/17/2005
NO. CD 006704
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $18,887.70
I
I
I
I
I
I
I
I
TOTAL AMOUNT PAID:
$18,887.70
REMARKS:
CHECK#196
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS