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Home My WebLink About01-31-07 REV-1500 EX + (6-00) . I!! ~C~ fdlEg %i..l UA,III ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-Q601 REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2.1 2006 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 1085 NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Brixius, Ethel L. DATE OF DEATH (MM-DD-YEAR) !Z w Q W () w Q 11-03-2006 (IF APPUCABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) [!] 1. Original Return D 4. limited Estate [!] 6. Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received 188-12-1282 DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPUCATE wrTH THE 05-11-1922 REGISTER OF WILLS SOCIAL SECURITY NUMBER D D D D 2. Supplemental Retum 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust(Attach copy of Trust) 10 Spousal PovertY Credit (date of death between . 12-31-91 and 1-1-95) D 3. Remainder Retum (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11. Election to tax under Sec. 9113(A) (Attach Soh 0) i ~ I II: 8 NAME James D. Bogar FIRM NAME (If applicable) Bogar & Hlpp Law Offices TELEPHONE NUMBER 717-737-8761 COMPLETE MAIUNG ADDRESS One West Main Street Shiremanstown, PA 17011 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Reeeivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) D Separate Billing Requested 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 11. Total Deductions (total Lines 9 & 10) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (11 ) (12) (13) (14) 12. Net Value of Estate (Line 8 minus Line 11) 14,853.81 69,302.18 13. Charitable and Govemmental 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) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 20.0 69,302.18 15. Amount of Line 14 taxable at the spousal tax rate, 0.00 x .00 (15) z or transfers under Sec. 9116(a)(1.2) 0 i= 16. Amount of Line 14 taxable at lineal rate 69,302.18 x .045 (16) ~ :::t A. 17. Amount of Line 14 taxable at sibling rate 0.00 x .12 (17) :& 0 () 18. Amount of Line 14 taxable at collateral rate 0.00 .15 (18) >< x ~ 19. Tax Due (19) z o i= :5 :>> l- ii: c () w a: 0.00 3,118.60 0.00 0.00 3,118.60 CHECK HEF~E IF YOU ARE REQUESTING A REF UND OF AN OVFRPA YMENT Copyright 2002 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00: " Decedent's Complete Address: STREET ADDRESS Sarah Todd Memorial Home 1000 West South Street CITY Carlisle ISTATE PA IZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. CredhJPayments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 3,118.60 155.93 Total Credits (A + B + C) (2) 155.93 3. IriterestlPenalty If applicable D. Interest E. Penalty TotallnterestlPenalty (0 + E) . (3) 4. If Une 218 greater than Line 1 + Une 3, enter the difference. ThIs Is the OVERPAYMENT. (4) Check box on pag.1 Line 20 to request a rehmd 5. If Une 1 + Li'le 31s greater than Une 2, en~~r the difference. This Is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Una 5 + SA. This Is. the BALANCE DUE. (58) Make Check Payable to:. REGISTER OF WILLS, AGENT 2,962.67 2,962.67 PLEASE ANSWER THE FOLLOWING QUESTIONS BV PLACING AN "l(" IN THE APPROPRIATE BLOCK 1. Did decedent make a transfer and: Ves a. retain the use or Income of the property trsnsferred;................................................................................ ~ 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 3. =.:...~ ::=;?:;~.~~~.~~.::~:;.~:;.:;.~:.~;.~~;::~::::: g ffi .. ::: ~e:~~:~I:z:~~o~~~~~~~~~.~~~..~:~~I~:.~~.~~.~~.non......~~.~~~~~~.~~~~.~~................. D ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE 0 AND FILE rr AS PART OF THE R N. Ur* peMllI.a 01 peljury.1 dec:Ia,..lhat I have exarrined this re1Um.lncludng lCCCJn1lII'ying 8ChtcIUeI and~. and to the beet 01 my knowledge and belief. It Ie tJue. correct nd . Declardon 01 r oIher than the ,.. va II based on II11nfOlm8lfon 01 v.t1Ich rw haa an knciwI . . . . sa PERSON RESPONSIBLE FOR FlUNG RETURN ADDRESS .8 U 83 Cros8 Highway Redding, CT 06896 DJ ADDRESS t ADDRESS One West Main St....t Shlremanatown. 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 u . e of the surviving spouse Is 3% [72 P.S. 59116 (a) (1.1) (I)]. ' For dates of death on or after January 1, 1995, the tax rate Impoaed on the net value of transfers to or for the use of the survivlng spous, Is 0% [72 P;S. 69116 <a) (1.1) (II)]. The statute does not 9XMrlDt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and flUng a tax retum are stili 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 transfel'8 from a deceased child twenty-one yeal'8 of age or younger at death to or for the use df a natural parent, an adoptive parent, or a stepparent of the child Is 0% [72 P.S. 59116 (a) (1.2)]. The tax rate Imposed on the net value of transfers to or for the use of the decedenfs lineal beneficiaries Is 4.5%, except as noted in 72 P.S. 59116 1.2) [72P.S. 59116 (8) (1)]. The tax rate Imposed on the net value oftransfel'8 to or for the use of the decedenfs siblings Is 12% [72 P.S. 59116 <a) (1.3)]. A sibling's defined under Section 9102, as an Individual who has at least one parent in common with the decedent, whether by blood or adoption. i Rev-1503 EX+ (s-tI) '* SCHEDULE B STOCKS & BONDS COMMONWEALl1i OF PENNSYlVANIA INHERlTAN<lE TAX AETlJRN RESIDENT DECEDENT ESTATE OF Brixius, Ethel L. j FILE NUMBER I 21-2006-1085 I I All property loIntly-owned with right of lurvlvorshlp mull be dllcloled on Schedule F. ITEM CUSIP VA UE AT DATE NUMBER NUMBER DESCRIPTION UNIT VALUE OF DEATH I 1 Wachovla Bank - Brokerage Account No. 4664-1366, 1 80.526.15 date of death balance $79,806.15, accrued dividends and Interest $720.00 I i TOTAL (Also enter on Line 2, Recapitulation) I 80.526.15 (If more space IS needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. I I Form PA-1500 Schedule B (Rev. 6-98) . ~ ~:iI!Q..I;~ Ethel R rix illS Estate Valuation Rep rt Karim Mantoura Wachovla Securl"es 401 South Tryon Street Charlotte, NC 28288 Wac:hCNi1l Securities does not provide tJI)c or 1egaI1dvico. Please COIl5UIt with your own tzIx and I. odvIIors bClfore taking ony ection that auld have tax c:onsequentes . Wac;hoviII Sccultics is the b1ldc nome under which WechoYla Corporation provides brokerage services through two registered broker/__ : WochovNi Sewl Inc., member NYSE/SJpc,. and WllchDvill Securities FinBnCill Network, Inc., momber NASO/SIPC brolcw/daalor Is ill ICpoI'ilIta non-bilnIt IIffl . rI Wachovie r.tlmnnlltinn. Not Insured a., PDIC or Ally May Lo~ VtIIlJtJ Feclerat Government Estate valultion 'thel L. 8rixi~$ UGto of P_~thl 11/03/2006 valuation Dote: 11/03/2006 vrooe:roilllJ tl.ate! 01/101200' Rst4te of; Ethi I Brixiu~ ~CCOUDtl 4664-1366 Rcpott Type I l)fI of Death Numbor ot s. rltiC~: 2 rile I : 4664136G Share. or (Iar Sccurlty D.. "riptiQn l1i9h/A:lk Low/l5id MOa" and/or Div and lnt ftdju.t.-ntu ~~eru.lQ 1) 2700 MAROIN I!1\LNICE IHAIUJIIIII 90000 GENERAL M'fRG ,.CC2P CORP I 3704AORli:t) Financl.al flmsu IntGfacti~ uat~ DTD: 09/21/(,004 HAtl O~/1S/~O~9 &, 1l/0~I2C06 III\:: 09{.I.5/2006 to 11/0312006 2,100.00 Z} e~.673S0 Hkt 85.673500 '~,10fj.l~ '/20.00 Total ValuG I - 'l'ot ill 7\c.t:r\iaI: - .-- -- - '. - - TOLaj: $eO,~26.l~ $79,806. IS """ - r -'"f'P2070o---- - -.- P.g.. 1 TlIi:J repor' w~s produced with BetatoV~I, . pr~~ct of E.tato ValuatioftG 5 Prlci~g SY8t8B8, tne. If you have ..tion:J, ploaso contact IV~ sy.t... at 181el '13-0100 or. www.evp.ys.com. IRevl$ioo 7.Q.41 Rev-1501 EX+ (....) * SCHEDULE F COMMONWEAl. TH OF PENNSYLVANIA JOINTL V-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brixius, Ethel L. 21-2006-1085 If .n ..... wu IMde Joint within one yur of 1M dec:edMt's d... of dutil, It must be reported on schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP T b DECEDENT A. Dennis W. Brixius 83 Cross Highway Son Redding, CT 06896 B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY 0/0 OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT DATE OF DEA[~ DECO'S VALUE OF NUMBER TENANT JOINT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR VALUE OF ASS INTEREST DEPEDENT'S INTEREST JOINTLY-HELD REAL ESTATE. 1 A 2/2112003 Wachovla Bank, N.A. - Checking Account 7.259.68 50.000% 3.629.84 No. 1010071689685, date of death balance $7,259.47, accrued Interest $0.21 TOTAL (Also enter on Line 6, Recapitulation) 3.629.84 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Sched Ie F (Rev. 6-98) - ~:41. ~ - - - _..~ ~.. ~lA ~ ID: J819279 WadaoviI Bmk ~.A.. BaJauce Conf1auation Servh:CK POBox 400lS RC'IatIOkc, VA 2.w21-13 13 Jauuuy 8, 2007 1BANL KOEPFU III It I SUBJECT: Vaifica&iOD / ConfirmatiOll of Act01lDt IDd &1111:8 Iofonualioo provided for. C.llomer: ETHEL L BlUXIlJS (SSN# 188-12.1212) D:t{e of DeatJu NoYember 3, 2006 -' Deoo&tt Aa:oaDt r.formItioa IllIte olDeatl Avetqe Duo MatucUy ~ AaImIed YID Due IAIuco ~ Opaacd Date 1:1.. IatiRU lIl*",PIIid CCIICd S7,1".'" 2J2112OW so.n 57.06 Accaut AaDauAt Typo N.....r amCK....G 101001161968$ UiGAL TJTU: ~"H~LBlUXUS DENNIS WBRJXl.IS .., -. · Die ro 'JlCIm IimilaLiau, 1ft l:aA Olly}Uovi&Ie . l"Mllvc IMDdIIVMltI1NdancD ~ dcposiQy IICCOlIJlta. Revoh-hlt! eMit I.formaU... AceoIJlt 'TY,Pt ~out 'tn_.. Due fIIl>.lb Balucc: Cr.l&t Lmat Duo Opcllcd Dee 'fimcl. Lep1 Ti.. CllJlCd 1.I&c VISA 41642t1464372lI1 QlfA . ~ -.u lI:eDllats arc DO 1__ MliViclld by WlIChoviaBtak. Plcue CCllltxf MflNA :u 1~11-91.)1. T U - ~--<,... , ........ ...... 'WAlan~ 1C.dhtcAcc 10: l1rt279 Mo s.tC r)cpcWt HQII bind for ClIl1to1lw. CAP, BROKERAGE ud SELF~DlUCl'ED Dl'\ ACCOUNTS BA VE DEEN CONVERTED TO W ACBOVIA SE YOURREQUEST HAS BEEN FORWARDED FOR PROCESSING IDd WILL BE MAIlED UNDER sEPARATE CO FOB. QUESnONS REGARDING CAP, BROKERAGE, or SELF.DIRECI'ED IRA ACCOUNTS PLEASE CALL W ACBOVIA SECURITIES at 1-166-874-2717. · Date of doath balance does not lrJc1ude lCCI\Iod iDtCJat ,., I r dace (If'deaIt OCCW'D ora a w~ Ot ;a ldlday. dale "r dealh ba1OD:1I d~ not. i~ludts any lr'.aula(.'dona that W~N made dIaiDa that time paiod. 4,~~ My Graybill ScrviCCllter AIIociatc Pbc.R! (540)~. m) IN; ... REV.1151 EX+ (12-11I) ESTATE OF * SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Brixius, Ethel L. Debts of decedent must be reported on Schedule I. ITEM NUMBER A. B. DESCRIPTION FUNERAL EXPENSES: See continuation schedule(s) attached 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State _ Zip 2. Attorney's Fees Bogar & Hipp Law Offices 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. Probate Fees Register of Wills, Cumberland County 5. Accountant's Fees 6. Tax Retum Preparer's Fees 7. Other Administrative Costs TOTAL (Also enter on line 9, Recapitulation) Copyright (c) 2002 form software only The Lackner Group, Inc. FILE NUMBER 21-2006-1085 r-u- AMC UNT 9,442.86 2,000.00 261.00 1,000.00 12,703.86 Form PA-1500 Schedlle H (Rev. 6-98) Aft 1502 EX+ (H8) - * SCHEDULE H.A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brixius, Ethel L. 21-2006-1085 ITEM NUMBER DESCRIPTION AMOUNT 1 Jo Jo's Restaurant - Funeral Luncheon 701.63 2 Musselman's Funeral Home - Funeral 7.352.80 3 Pastor Paul Siefert - Funeral 250.00 4 Pealer's Flowers - Funeral Flowers 538.43 5 St. John's Cemetery - Grave Opening 500.00 6 St. John's Cemetery - Grave Marker Engraving 100.00 Subtotal 9.442.86 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 SchedulE H-A (Rev. 6-98) Rev-1502 EX+ (HI) '* SCHEDULE H.B7 OTHER ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA continued INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Brixius, Ethel L. 21-2006-1085 ITEM NUMBER DESCRIPTION AMOUNT 1 RESERVE - Costs to conclude administration of Estate Including filing fee for Pa. 1.000.00 Inheritance Tax Return and Inventory; preparation of 2006 personal Income tax returns; and preparation of fiduciary Income tax returns Subtotal 1.000.00 Copyright (c) 2002 fonn software only The Lackner Group, Inc. Fonn PA-1500 Schedule I -87 Rev. 6-98 --r-~- Rev-1512 EX+ (....) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RE1\JRN RESIDENT DECEDENT Brixius, Ethel L. FILE NUMBER 21-2006-1085 ESTATE OF Include unrelmbu....d medical expen_. ITEM VAII-UE AT DATE NUMBER DESCRIPTION OF DEATH 1 Alert Pharmacy - Final Bill 99.03 2 Kelly Services - Final Bill 40.50 3 Mobile X-Ray Imaging - Final Bill 74.19 4 PharMerlca - Final Bill-Prescriptions 129.47 5 Silver Spring Ambulance & Rescue - Final Bill 70.75 6 United Church of Christ Homes - Final Bill 1,342.46 7 West Shore Ambulance Service - Final Bill 393.55 TOTAL (Also enter on Line 10, Recapitulation) 2,149.95 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Sche ~ule I (Rev. 6-98) REV.1513 EX+ (8-00) * SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYlVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Brixius, Ethel L. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS pnclude outright spousal aistributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Nclt u.t TrulltM(s) FILE NUMBER 21-2006-1085 SHARE OF ESTATE AMOUN" OF ESTATE (Words) $$$) ESTATE OF I. See attached schedule Enter dollar amounts for distributions shown above on lines 15 through 18, as appropnate, on Rev 1500 cover sheet ll. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 0.00 Copyright (c) 2002 fonn software only The Lackner Group, Inc. Fonn PA-1500 Sched~le J (Rev. 6-98) BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Ethel L. Brixius 188-12-1282 11/03/2006 Item Name and Address of Person(s) Share of Estate Amol nt of Estate Number Receiving Property Relationship (Words) ($$$) 1 Darryl W. Brixius Son One-half (1/2) of rest, - 723 Summit Lane, Unit 5256 residue and Ellljay, GA 30540 remainder 2 Dennis W. Brixius Son One-half (1/2) of rest, I 83 Cross Highway residue and Redding, CT 06896 remainder 1 SCHEDULE J '\. ~ .~ . " LAST WILL AND TESTAMENT OF ETHEL L. BRIXIUS I, ETHEL L. BRIXIUS, of Lower Allen Township, Cu land County, Pennsylvania, make, publiSh and declare this a and for my Last will and Testament, hereby revoking all other W'lls and Codicils heretofore made by me. FIRST: I devise and bequeath all the rest, resid re~ainder.of my estate of whatever na~ure and wherever situ including 'any property over .which I hold power of appointme togeth~r with any insurance policies thereon, 'in equal shar my children, DARRYL W. BRIXIUS and DENNIS W. BRIXIUS. SECOND: Should my son, DARRYL W. BRIXIUS, predec me, I devise and bequeath his sh~re under this, my Last will Testament, to his children, JENNIFER M. BRIXIUS and WILLIAM BRIXIUS, in equal shares. THIRD: Should'my son, DENNIS' W. BRIXIUS, predecea me, I' devise and bequeath his share under this, my Last will , _.. ... -!Pestament, to his daughter, TRACY E. BRIXIUS,_ FOURTH: In addition to all powers granted law and by other provisions of this Will, I give the acting hereunder the following powers, applicable to ty, exercisable without court approval and effective . . distribution of all property: (A) To sell at pUblic or private sale, or to f~r any period of time, any real or personal property and to options for sales, exchanges ot' leases, for such prices and such terms. (including credit, with or without ~ecurity) or conditions, as are deemed proper. This includes the power to legally sufficient instru~nts for transfer 'of the property to receive the proceeds of. any disposition of it. (B) T9 partition, subdivide, or improve real and to enter into agreements concerning the partition, to the fiducia all pro until i- ., , " sion, improvement, zoning or management of real estate and t impose or ~xtinguish 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, wi hout restriction to investments authorized for Pennsylvania fiduc'- aries, as are deemed proper, without regard to any principle of diversification, risk or productivity. (E) To exercise "any option, right or privilege in insurance policies or in other investments. (F) To exercise any election or privilege given the Federal and other tax laws, including, but not necessarily limited to, personal income, gift and estate or inheritance laws. (G) To make distributions to my herein named bene aries in' cash or in kind or partly in each. (H) To borrow money from themselves or others in to pay debts, taxes, or estate or trust administration expen to protect or improve any property held under ~y will, and inve~tment purposes. (I) To select a mode,of payment u~der any ~alifi retirement plan (pension plan, profit sharing pla~, employee ~tock o~ership plan, or any other type of qualified plan) t the extent the plan or the law permits them to do so, and to exe any other rights which they may ,have under the plan, in what manner th~y consider advisable. FIFTH: I direct that all inheritance, estate, tra fer, suqcession and death taxae, of any kind whatsoever, whi may be 'payable by reason of my death, whether or not with to property passing under this Will, shall be paid out of principal of my residuary estate. , SIXTH: I nominate and appoint DARRYL'W. BRIXIUS a d DENNIS W. BRIXIUS, Co-Executors of this, my Last will ta- 2 <'\'. ,.1 . " . . .ment. I direct that my Co-Executors, and their successors, hall not be required to post security or a bond for the performan e of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand an seal to this, my Last will and Testament, this I~ day of /rr' 1994. if ~/ r/ 63u.~) ETHEL L. BRIXIUS . ( SEAL) Signed, sealed, published and declared by th~abov - named Testatrix as and for her Last Will and Testament in ou presence, who, at her request, in her presence and "in the presence of each.other, have hereunto subscribed our names a attesting witnesses. i '. Addi:'es~ "Address I-'" (~~ 3 ~ .... Register of Wills, Cumberland County, Pennsylvania INVENTORY Estate of also known as 21-2006-1085 Ethel L. Brixius No. I Deceased Date of Death 11/0312006 Social Security No. 18'8-12-1282 Dennis W. Brixius The " n.1 Representatlve(s) of the .bove E8tate, deceaHd, verify that the Items appearing In the following Inven ory Include .11 of the peraon.I..... wherever .ltUate and .n of the real eatate located In the Commonwealth of Penney vania of Mid Decedent, that the valuation pl.ced opposite each Item of Mid Inventory represent. It. fair value a. of the d .. of the Decedent,..death, and that the Decedent owned no real utate outalde of the Commonwealth of Pennlylvanla ex . pt that which appeareln a memorandum at the end of thlllnventory. I/We verify that the etatements made In this Inve ory are true and correCt. VWe und4trstand th.t fal.. etatements herein .re m.de subject to the penalties of 18 P.. C. $. SectIon 4904 relating to unawom f.lslflcatlon to .uthoritles. AttOmey: Jllmes D. Bogar 19415 p-~~ Signature: .. nnls W. Brlxlus Signature: 1.0. No.: Signature: Firm: Boaar & HIDD Law Offices Addre-ss: On. West Main Street Shlreman.town, PA 17011 Telephone: 717-737-8761 Address: 83 Cross Highway' Redding, CT 06896 Telephone: 203-938-7003 Dated: t /.2J 0 10 7 Persc;nal Procertv Cash.... ............. ..................................................... ......................... Personal Property....................................................................~...., StocksILlsted.............. ..~............................ .......................... ~......... . StocksfC'losely Held...................................................................... Bonds.......................................... ................................................... Partnerships and Sole Proprietorships ..................................... Mortgages and Notes Receivable............................................... All Other Property...... ........ ....... ........ ..... ...... ................................. (; ~o :;3~ ,1-1:C) :-""-. ,- 80,~~~ .....(n7' .,~) c)(; (:::J "'Tl C :::D ..-I :02 Total Personal Property......... .......... .............. ........ 80,526.15 Total Real Property....... .............. ............. ........... ... Total Personal and Real Property......................... Total Out-of-State Real Property.......................... \/" I') c:::::> ~ --' L- :.0- Z W J:Ia -- -"'" S? N ,; .. Register of Wills, Cumberland County, Pennsylvania INVENTORY Estate of Ethel L. Brixius No. 21.2006- 1085 also known as Date of Death 11/0312 0)6 , Deceased Social Security No. 188-12.. 1~82 Stock I Listed Wachovla Bank.. Brokerage Account No. 4664-1366, date of death balance 80.526.15 $79,806.15, accrued dividends and Interest $720.00 Total Stock / Listed 80.526.15 (Attach additional sheets if necessary) Total Personal Property and Real Estate 80.526.15