HomeMy WebLinkAbout08-13-07 (2)
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15056041125
REV-1500 EX (06-05)
PA Department of Revenue '*
~~~~;~~~~~~uaITaxes' INHERITANCE TAX RETURN
Harrisburq, PA 17128-0601 - -- RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death
OFFICIAL USE ONL V
County Code Year
File Number
2 1 0 6
1 1 6 3
Date of Birth
181389086
1 1 132 0 0 6
1 0 1 1 1 9 5 0
Decedent's Last Name
Suffix
Decedent's First Name
MI
BREWER
S USA N
C
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix
Spouse's First Name
MI
Spouse's Social Security Number
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 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT. THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
FILL IN APPROPRIATE OVALS BELOW
[Z] 1. Original Return
o 4, Limited Estate
[Z]
o
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
6. Decedent Died Testate
(Attach Copy of Will)
9, Litigation Proceeds Received
o
o
o
o
8. Total Number of Safe Deposit Boxes
2. Supplemental Return
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
R. MAR K
THOMAS,
E S QUI R E
717 7c~6 21~~00
=
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REGISTER of"iwgLS USE q"Rtv
. ~ ;:1:: Q (75
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...',
C_.)
Firm Name (If Applicable)
First line of address
1 0 1
SOUTH
MAR K E T
STREET
(~;
'1
c'
Second line of address
_::~
=:~
City or Post Office
State
ZIP Code
DA TE FILED
N
o
M E C H A N I C S BUR G
P A
17055
MECHANICSBURG
PA 17050
THAN REPRESENTATIVE
DATE
S"; ',;($ ~"7
PA 17055
MARKET STREET MECHANICSBURG
PLEASE USE ORIGINAL FORM ONLY
Side 1
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15056041125
15056041125
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15056042126
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: SUSAN C. BREWER
RECAPITULATION
181389086
1. Real estate (Schedule A)
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B)
............. ................. .... 2.
310.68
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
4. Mortgages & Notes Receivable (Schedule D) ....................... . 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. 7 0 8 1 . 3 9
...... .
6. Jointly Owned Property (Schedule F) o Separate Billing Requested. . . . . . . 6. 6 5 5 9 5 . 6 0
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 7 7 1 7 . 0 4
(Schedule G) 0 Separate Billing Requested . . . . . . . 7.
8. Total Gross Assets (total Lines 1-7) 8. 8 0 7 0 4 . 7 1
.......................... .
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 7 3 9 9 8 . 0 9
............... .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 1 8 8 1 . 3 2
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 7 5 8 7 9. 4 1
12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . . 12. 4 8 2 5. 3 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an ejection to tax has not been made (Schedule J) . . . . . . . . . . . . . . . . . . 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . . . . . . . . . . . . . . . . . . 14. 4 8 2 5 . 3 0
TAX COMPUTATION - 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 _
16. Amount of Line 14 taxable
at lineal rate X .012..-
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
3152.00
16.
1 4 1.8 4
17.
1673.00
18.
2 5 0.9 5
19. Tax Due
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
392.79
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
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15056042126
15056042126
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REV-1500 ~ Page 3,
Decedent's Complete Address:
File Number
21 06 1163
DECEDENT'S NAME
SUSAN C. BREWER
STREET ADDRESS
1195 KINGSLEY ROAD
CITY I STATE I ZIP
CAMP HILL i PA 17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
392.79
247.00
Total Credits (A + B + C) (2)
247.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( 0 + E) (3)
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)
0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
0.00
145.79
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5A)
(58)
145.79
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; ...................................................................... 0 [K]
b. retain the right to designate who shall use the property transferred or its income; ............................... 0 [K]
c. retain a reversionary interest; or ................................................................................................ 0 [K]
d. receive the promise for life of either payments, benefits or care? ....................................................... 0 [K]
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... 0 [K]
3. Did decedent own an 'in trust for' or payable upon death bank account or security at his or her death? ......... 0 [K]
4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. [K] 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
is three (3) percent [72 P.S. 99116 (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 zero (0) percent
[72 P.S. 99116 (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 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 zero (0) percent [72 P.S. 99116(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 four and one-half (4.5) percent, except as noted in
72 P.S. 99116(1.2) [72 P.S. 99116(a)(1)].
The tax rate imposed on the net value of transfers to orfor the use of the decedent's siblings is twelve (12) percent [72 P.S. 99116(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-1503 ~ + (6-98).
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
SUSAN C. BREWER
FILE NUMBER
21 06 1163
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. i3 Series EE Bonds each with face value of $100.00: 53.40
C787178967EE (issued 08/2004)
2. C791147241 EE (issued 01/2005) 52.76
3. 802209954EE (issued OS/2005) 52.20
4. C804933871EE (issued 10/2005) 51.48
5. C84945063EE (issued 03/2006) 50.68
6. 816146792EE (issued 07/2006) 50.16
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
310.68
REV-150l\EX + (6-98)
'*
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
SUSAN C. BREWER
ITEM
NUMBER
1.
FILE NUMBER
21 06 1163
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right ofsurvivorship must be disclosed on Schedule F.
DESCRIPTION
VALUE AT DATE
OF DEATH
1,120.00
Household Furnishings (see attached appraisal)
2. 990 Chevrolet Lumina
3. 1994 Ford pick-up truck
4. Assorted pieces of jewelry
5. 006 IRS Tax Refund
6. ast paycheck (see attached)
7. Car insurance refund
350.00
1,347.00
1,740.00
876.00
1,620.39
28.00
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
7.081.39
REV-'''! EX. ".
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
SUSAN C. BREWER
FILE NUMBER
21 06 1163
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A. Richard L. Yarlet
195 Kingsley Road, Camp Hill, PA
riend
B
C
JOINTLY-OWNED PROPERTY:
LETIER DATE DESCRIPTION OF PROPERTY 'Io0F DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATIACH DEED FOR JOINTLY-HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. ~. ~/15/03 ~eal property at 1195 Kingsley Road, Camp Hill. PA 127,900.00 50. 63.950.00
he property is under a sales agreement for a sales price of
1li127,900.00. According to the joint tenant, by the time he has paid
~II of his closing costs plus outstanding liens against the property, 0.00
re will net approximately $53.00. We will provide a copy of
ettlement sheet upon our receipt of same.
2. f\. Vlembers 1st F.C.U., 5000 Louise Drive, P. O. Box 40, 3,291.19 50. 1,645.60
Vlechanicsburg, PA 17055
o..ccount No. 268664 - checking
-
TOTAL (Also enter on line 6, Recapitulation) $ 65.595.60
(If more space is needed, insert additional sheets of the same size)
REV-15lO. EX. '6_.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
ESTATE OF
SUSAN C. BREWER
I
FILE NUMBER
21 06 1163
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OFTHE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND DA TE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER ATTACH A COPY OFTHE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPUCABLEj VALUE
1. RA Account with Waddell & Reed, 6300 Lamar Avenue, 7,717.04 rOO. 7,717.04
P. O. Box 29217, Shawnee Mission, KS 66201-9217 (see attached)
2. :itate Employee Retirement 00. 0.00
TOTAL (Also enter on line 7 Recapitulation) $ 7.717.04
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
(If more space is needed, insert additional sheets of the same size)
"'
REV-1511 EX + (12-99)
O.
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
I
FilE NUMBER
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SUSAN C. BREWER
21 06 1163
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Parthemore Funeral Home (paid by children) 8.626.09
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s)
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attomey Fees R. Mark Thomas. Esquire 900.00
3. Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees 137.00
5. Accountant's Fees
6. Tax Retum Preparers Fees
7. Publication fee - Cumberland County Law Journal 75.00
8. Publication fee - Sentinel 70.00
9. Appraisal of personal property - Chuck E. Bricker Auctioner 100.00
10. U-Haul/storage 164.00
11. Closing costs and mortgage payoff for real property 63.926.00
TOTAL (Also enter on line g, Recapitulation) $ 73.998.09
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV-151.2 EX + (12;03)
*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
I
FILE NUMBER
21 06 1163
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SUSAN C. BREWER
ITEM
NUMBER
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
DESCRIPTION
VALUE AT DATE
OF DEATH
1.
Midwestern Regional Medical Center Pharmacy
2520 Elisha Avenue
bion, IL 60099
Armor Systems Corporation
700 Kiefer Drive, Suite 1
Zion, IL 60099
Camp Hill Emergency Physicians
P. O. Box 13693
Philadelphia, PA 19101
incare, Inc.
P. O. Box 764
Sharon, PA 16146
50.49
2.
440.00
3.
1,347.00
4.
43.83
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
1.881.32
Calculate the Value of Your Paper Savings Bond(s)
. .
fvDirect.
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Page I of 1
H<Jrne
Caiculi;lt,;; U-I;;; \:alwe C>1' Your pi)p'~r Savings bond(s)
1'"iclivk1udl ~ :',~,(~,;<;
Calculate the Value of Your Paper Savings Bond(s)
SAVINGS BONO CALCULATOR
I Value as of:
1112006 I UPDATE I
D
Ho:lp
Series:
Denomination:
Bond Serial Number:
Issue Date:
EE Bonds
; HOW TO SAVE YOUR INVENTORY;
Calculator Results for Redemption Date 11/2006
gr:;~::a.TJ';"~ _~_:.tirn~ lIIfr:iflil.."!,l'/;..
Instructions
~ How to I J~e th.~ SdVi;"I{':, '"30m]
C~i("uiat,)r
......................................---...........-..-.
Notes Description
NI Not Issued
NE Not eligible for payment
PS Includes 3 month
interest penalty
MA Matured and not earning
interest
Total Price Total Value Total Interest YTO Interest
$300.00 $310.68 $10.68 $7.28
Bonds: 1-6 of 6
Serial -# Series Denom Issue Next Final Issue Interest Interest Value Note
Date Accrual Maturity Prke Rate
CB0494S063EE EE $100 03/2006 12/2006 03/2036 $50.00 $0.68 3.20% $50.68 Ht; -I
C816146792EE EE $100 07/2006 1212006 07/2036 $50.00 $0.16 3.700/0 $50.16 liE -,
Ca02209954EE EE $100 OS/2005 12/2006 OS/2035 $50.00 $2.20 3.50% $52.20 r2 _I
C78717896EE EE $100 08/2004 12/2006 08/2034 $50,00 $3.40 4,11'% $53.40 .22 _I
C791147241EE EE 5100 01/2005 12/2006 01/2035 $50.00 $2.76 4.11% $52.76 PI) -I
CS04933871EE EE $100 10/2005 12/2006 10/2035 $50.00 $1.48 3.50% $51.48 .22 _I
CALCIJL~,TE ANOTHER BOND
Excellent
Good
Fair
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http://www . treasurydirect. gov/BC/SBCPrice
8/1 0/2007
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- SUSAN C BREWER TRB\SURER ',~
~195 ,KINGSLEY J~OAD~_. COMMONWEALTH OF,
CAMP HILL PA 170~1 PENNSY'n~ ':
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TREASURER,
COMMONloJEALTH'OF
PENNS~'VANJ:A
HARRISBURG, PEL
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SUSAN C BREWER.
1195 KINGSLEY ROAD
. CAMP HILL PA 170 n
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FROM"ISSU~ DA-TE.-
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ROBERT P-_~;.IR~
TREASURER ",
SUSAN C BREWER COl"'lM.ONWEBLTH OE;
~19S KINGSLEY-ROAD::_ p~,.
CBMP HILL FA .1L~?~:;~-,c HBRR:t.SBtJRG~,pa::
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APPRAISAL
Personal Property of S USAf\) RFEL\J E(~ JI CfS K/A)/3s U-y'
Appraised by Chuck E. Bricker AU094-L
ITEM
Pel, C./-}-I1/J /fILL- ~4.
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MV..3 (07..03)
MOTOR VEHICLE VERIFICATION
OF FAIR MARKET VALUE BY
THE ISSUING AGENT
Commonwealth of Pennsylvania
Department of Transoortatlon
Bureau of Motor Vehicles
Harrisburg, PA 17104-2516
This form is used in conjunction with Forms MV-1, MV-4ST,
MV-217 A and an on-line processin Aoplicant Summa Statement.
TYPE OR PRINT ALL INFORMATION AS REQUESTED
FOR DEPARTMENT USE ONLY
MOdLLlrn , A.J A
\ II ~5 :}
PURCHASE
PRICE
6tD.W
o I certify that the average Fair Market Value for the vehicle descnbed above is $
as venfieo by the current edition of a PENNDOT approved publication.
o This vehicle or the fair market value for this vehicle was not listed in a current edition of a
PENNDOT approved publication in my possession.
Signature of Authonzed Agent
Agent Number
Oale
Middle Initial
rn
D PURCHASER/SELLER EXPLANATION
Explain in detail why the purchase pnce listed on Form MV-1, MV.4ST or MV-217 is Jess than 80% of the average Fair Market Value, or If the vehicle is over 15 years ala and
the purchase pnce is less than $500. explain how the purcnase pnce was determined, or if the vehicle is not listed in a PENNDOT approved publication. explain how the
purcnase pnce as listed In Section A was determined. Please use additional paper if more space is required. NOTE TO PURCHASER: An additional audit of this vehicle
sale bv the Deoartment of Revenue mav OCcur Please retain copies of this form, your cancelled check or original cash receipt, and your receipt from the seller of
this vehicle, along with either your copy of the Application for Certificate of Title (MV-1), the Vehicle Sales and Use Tax Return/Application for Registration (MV-4ST)
or the Application by Financ/allnstitutions for Certificate of Title After Default by Owner (MV-217A).
.~ ofter
E SEAL AND SIGNATURE OF SELLER - NOT REQUIRED FOR VEHICLES PURCHASED OUT-OF-STATE
DAY l~
YEARC'1
IIWe state chat I/we have read and Signed thiS form atter its completion, and IIwe
swear or affirm that the statements made herein are true and correct. and that any
statement made on or pursuant to this form is SUbject to the penalties of 18 PA C.S.
Section 4903(a)(2)(relating to false sweanng), which shall Incluae punishment of a
fine not exceeding $5,000, or to a term or impnsonment of not more than two years,
or both.
i"n~re of Seiler.. .
^ -J\..tSCln ,
nat of Co-Seiler I J.
':=t:b '-e.-^---.l. eXe ([,l rv r
l1e Number ('7l( ) (.,q l -O~~ tl
ING OATH
E
A
L
F SEAL AND SIGNATURE OF PURCHASER
ISUBSCRIBED AND SWORN
TO BEFORE ME: MONTH DAY YEAR
PENNSYLVANIA
S;GNATURE OF PERSON ADMINISTERING OATH
IIWe stale that I/we have reaa ana Signed thiS form after Its comcletlon. ana I/we
swear or affirm that the statements made herein are true and correct. ana that any
statement made on or pursuant to this form IS subject to I.he penalties of 18 PA C.S.
Section 4903(a)(2)(relating to false sweanng), wnich shall include pUnishment of a
fine not exceeaing $5.000. or to a term or Impnsonment of not more than two years.
or both
Signature- of Purchaser
S
E
A
I
LI
DO NOT NOTARIZE UNLESS
SIGNED BY THE PURCHASER IN
PRESENCE OF NOTARY
Signature of Co-Purchaser
THIS FORM MAY BE PHOTOCOPIED
I Telepnone Numoer (
i Messenger No.
I
*'
COMMONWEALTH OF PENNSYLVANIA
OFFICE OF THE BUDGET
COMPTROLLER OPERATIONS
March 29, 2007
Scott E. Brewer
13 Briarwood Court
Mechanicsburg, PA 17050
BUREAU OF COMMONWEALTH
PAYROLL OPERATIONS
P.O. BOX 8006
HARRISBURG, PA 17105-8006
FAX: (717) 772-3104
Dear Mr. Brewer:
The enclosed check represents payment to you on behalf of Susan C. Brewer
as the executor of her estate.
Please note that you as the executor will receive a "Form 1 099-Misc." in the amount of
$1,723.83 at year's end. The form will be in the name of the ESTATE OF SUSAN C. BREWER
and the TIN# 20-7206040 and should be kept along with this letter for tax filing purposes.
PAYMENTS (PAY DATE AFTER DATE OF DEATH)
PPE DATE I PAY DATE DEDUCTION
TYPE PAY HOURS GROSS AMOUNT* NET
11/10/06 i Salary 75.00 $1,575.00
11/24/06 I 3/29/07 Salary 7.50 $157.50 $112.11 $1,620.39
I
I
I
LESS NON-TAXABLE GROSS DEDUCTIONS:
AMOUNT
EXPLANATION OF NON-TAXABLE DEDUCTION
Pre Tax Medical
$8.67
Oeceased Employee Estate Payment
. March.29, 2007
Page 2
*EXPLANATION OF DEDUCTIONS TAKEN FROM PAYMENTS:
AMOUNT EXPLANA TION OF DEDUCTIONS TAKEN
$5.00 Bond
$98.44 Retirement
Should you have any questions regarding this letter, please contact Mr. Edmund Brenner,
at telephone number (717) 772-5368.
Enclosure
Sincerely,
. / v~___~ . { --~-~~L:-=:.--'
c'"....:--.C- 1_ _ .~
Sharon Wentling, Chief
Special Pay Processing
/" For the year Jan. 1-Oeo. 31, 2006. or other lax year beglnnrng , 2006. ending ,20 '" OMS No. 1545-0074
Label L Your first name and inioal Last name Your social security number
A Susan C Brewer 181-38-9086
(See B If a JOint return, spouse's first name and initial Last name Spouse's socia' security number
instructions.) E
L
Use the IRS H I Apt. no.
label. E Home address (number and street). If you have a P.O. box, see instructions. .. You must enter ..
Otherwise, R 1::.95 Kingsley Road your SSN(s) above.
please pnnt E City. town or post office. state. and ZIP code. If you have a foreign address. see instructions.
or type. Checking a box below will not
"- Caron Hill PA 17011 ./ change your tax or refund
11 040
Presldent.al
ElectJon Campaign
Filing Status
Check only
one box.
Department of the Treasury-Intemal Revenue Service
U.S. Individual Income Tax Return
DECEASED S Brewer 11/13/2006
2006/
(99)
IRS Use Onlv-oo not wnte or staple in this soaca.
~ Check here if you, or your spouse if filing jointly, want $3 to go to this fund (see instructions) . 0 You 0 Spouse
~ Single 4 0 Head of household (with qualifying person). (See instr.) If
the qualifying person is a child but not your dependent. enter
2 0 Married filing jointly (even if only one had income) this child's name here. .
3 0 Married filing separately. Enter spouse's SSN above
and full name here. .
6a
5 0 Qualifying widow(er) with dependent child (see instructions)
Exemptions
1
7 Wages, salanes. tips, etc. Attach Form(s) W-2
8a Taxable interest. Attach Schedule B if required
b Tax-exempt interest. Do not include on line 8a
9a Ordinary dividends. Attach Schedule B if required . . r
b Qualified dividends (see instructions) . . . . . . . . . 9b !
10 Taxable refunds. credits, or offsets of state and local income taxes (see instructions)
11 Alimony received .
12 Business income or (loss). Attach Schedule Cor C-EZ .
13 Capital gain or (loss). Attacn SChedule 0 if reoulred. If not required. Check here
14 Other gains or (losses). Attach Form 4797 . .
15a IRA distributions. . . . 115a I I b Taxable amount (see instructions)
16a Pensions and annuities 116a! I b Taxable amount (see instructions)
17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E
18 Farm income or (loss). Attach Schedule F . .
19 Unemployment compensation .
20a Social security benefits /20a I I b Taxable amount (see instructions)
21 Other income. List type and amount (see instructions) _______________________
22 Add the amounts in the far ri ht column for lines 7 throu h 21. This is ourtotal income . .
23 Archer MSA deduction. Attach Form 8853. . . . . . . 23 i 0
24 Certain business expenses of reservists, performing artists, and
fee-basls govemment officials. Attach Form 2106 or 2106-EZ
25 Health savings account deduction. Attach Form 8889
26 Moving expenses. Attach Form 3903
27 One-half of self-employment tax. Attach Schedule SE
28 Self-employed SEP, SIMPLE, and qualified plans
29 Self-employed health insurance deduction (see instructions)
30 Penalty on early withdrawal of savings
31a Alimony paid b Recipient's SSN .
3, IRA deduction (see instructions)
33 Stuaent loan interest deduction (see instructions)
34 Jury duty pay you gave to your employer
35 Domestic production activities deduction. Attach Form 890:;
36 .'::'cd lines 23 through 31 a and 32 through 35
37 Subtract line 36 from line 22. This is your adjusted gross income
Fc;- Disclosure, Privacy Act, and Paperwork Reauction Act Notice, see instructions.
If more than four
dependents, see
instructions.
Income
Attach Form(s)
W-2 here. Also
attach Forms
W-2G and
1099-R if tax
was withheld.
If you did not
get a W-2,
see instructions.
Enclose, but do
not attach, any
payment. Also.
please use
Form 1040-V.
Adjusted
Gross
Income
f{l.::'
~ Yourself. If someone can claim you as a dependent, do not check box 6a
o Spouse. . . . . . . . . . . . . . . . . . . . . . . . . . .
. }
c
Boxes checked
on Sa and 6b
No. of children
on 6c who:
· lived with you
· did not live with
you due to divorce
or separation
(see instnJctlons)
DependentS on 6c
not entered above
Q
b
Dependents:
11) First name
I (2) Deoenoent's
I social security number
I
I
I
(3) Dependent's
relationship to
you
~M(f~rq~\~t~
creolt (see Inslr. i
Last name
d Total number of exemptions claimed
Add numbers on
lines above.
7 I 38,008
8a I
'Oo<,j
I~~;"'I
. oh~'1
I 11 I
. . 12 .
· 0113
14 I
15b
16b
17 !
18 I
19 i
20b I
21
8b r
o
o
"
oJ
"
'..i
'J
o
o
24
25
26 !
27
28 i
29
30
I 31a .
I 32
33
34
o
38,008
o
35
o
36
.
38,002
37
Form 1040 (20010)
Form 1040'(2006) -Susan C Brewer 181-38-9086
38 Amount from line 37 (adjusted gross income) . . . . . . . . . . . . . . . . . . . I 38 !
39a Check r 0 You were bom before January 2,1942, 0 Blind. } Total boxes ~
if: L 0 Spouse was bom before January 2, 1942, 0 Blind. checked ~ 39a 0
L b If your spouse ItemIzes on a separate retum, or you were a dual-status alien, see instructions and cI1eck here ~ 39b
40 Itemized deductions (from Schedule A) or your standard deduction (see left margin) I 40
r 41 Subtract line 40 from line 38 . . . . . . . . . . . . . . . . . I 41
42 If line 38 is over $112,875, or you provided housing to a person displaced by Hurricane Katrina,
I see instructions. Otherwise, multiply $3,300 by the total number of exemptions claimed on line 5d I 42
43 Taxable income. Subtract line 42 from line 41. If line 42 is more than line 41, enter -0- , 43
44 Tax (see instructions). Check if any tax is from a 0 Form(s) 8814 b 0 Form 4972 44
45 Alternative minimum tax (see instructions). Attach Form 5251 I 45 i
:~ ::~:~:e:a~c~:~t~~tt~c~ ~~~ ; 1'1~ i~ ;e~u;r~d' . '. '. '. '. '. '. '. '. . . . . '1 47 ~ I 46
48 Credit for child and dependent care expenses. Attach Form 2441 48 I
49 Credit for the elderly or the disabled. Attach Schedule R . . . . 49 I
50 Education credits. Attach Form 8863 ............. 50
51 Retirement savings contributions credit. Attach Form 8880 . . . 51
52 Residential energy credits. Attach Form 5695 ......... 52
53 Child tax credit (see instructions). Attach Form 8901 if reEir.ed ..... 53
54 Credits from: a B Form 8396 b B Form 8839 c Form 8859 54
55 Other credits: a Form 3800 b Form 8801 c I Form _ 55
56 Add lines 47 through 55. These are your total credits
57 Subtract line 56 from line 46. If line 56 is more than line 46. enter -0-
58 Self-employment tax. Attach Schedule SE . . . . . . . . .
59 Social security and Medicare tax on tip income not reported to employer. Attach Form 4137
60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required
61 Advance eamed income credit payments from Form(s) W-2, box 9
62 Household employment taxes. Attach Schedule H . . .
63 Add lines 57 throu h 62. This is our total tax
Tax and
Credits
Standard
Deduction
for-
. People who
checked any
box on line
39a or 39b or
who can be
claimed as a
dependent,
see in sir.
. All others:
Single or
Married filing
separately,
$5,150 i
Married filing/ '
jointly or
Qualifying
widow(er),
$10,300
Head of
household,
$7,550
Other
Taxes
If you have a
qualifying
child, attach
Schedule EIC.
Paid
Preparer's
Use Oniy
KIA
Page 2
38,008
5,150
32,858
3,300
29,558
4,059
o
4,059
o
o
o
.
56
57
58
59
60
61
62
63 !
Payments 64 Federai income tax withheld from Forms W-2 and 1099
'- 65 2006 estimated tax payments and amount applied from 2005 retum
66a Earned income credit (EIC) . . . . . . . . . . . . . .
r b Nontaxable combat pay election . 66b I
67 Excess social security and tier 1 RRTA tax withheld (see instructions)
68 Additional child tax credit. Attach Form 8812 .
69 Amount paid With request for extension to file (see instructions) . . .
70 Payments from: a 0 Form 2439 b 0 Form 4136 c 0 Form 8885
71 Credit for federal telephone excise tax paid. Attach Form 8913 if required
72 Add lines 64, 65, 66a, and 67 throu h 71. These are our total payments
Refund 73 If line 72 is more than line 63, subtract line 53 from line 72. This is the amount you overpaid
Direct deposit? 74a Amount of line 73 ou want refunded to ou. If Form 8888 is attached, check here . . " . 0
See instructions. b Routing number XXXXXXXXX . c Type: 0 Checking 0 Savings
and fill in 74b,
74c, and 74d, . d Account number I XXXXXXXXXXXXXXXXX I
or Form 8888. 75 Amount of line 73 you want applied to your 2007 estimated tax ~ : 75 I
Amount 76 Amount you owe. Subtract line 72 from line 63. For details on how to pay, see the instructions
You Owe 77 Estimated tax penalty (see instructions) . . . . . . . " I 77 !
Third Party Do you want to allow another person to discuss this retum with the IRS (see instructions)?~ Yes. Compiete the following 0 No
Designee Designee's c: cot t E Br"'wer Phone ..., 17- 6 91 _ 0 889 Personal indentification I 1 1 1 '6
name · ~ . ~ no. . I . number (PIN) ~ . _ _ ~_
Sign Under penalties of peIJury, I declare that I have examined this retum and accompanYing schedules and statements, and to the best of my knOwledge and
Her belief, they are true. correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
e ~ Your ~nature ./] . I Date . i Your occupation Daytime phone number
~~~n,~~7r~~?:"s. C': -, ,-/''('' f..J...L~'<-:~.1r1 ,3/.;Z-5/a7IAccounting Supervisor (717\ a~ -C!~
Keep a copy (SpoySe's sigr1<l~f a JOint return, bOth must sign. i Date . ! Spouse's occupation I
~~~6?~;. .,--,,' ! i !
.
4,905
o
o
o
30
.
72
73 I
74a I
o
.
76
Preparer's ...
SJgnature ,
Firm's name (or ~
~surs If. self-emOiOY;d),
:uores_. and ZIP cude
Date
i Preparers SSN or PTIN
I
IEIN
,
!Phone nc.
Check if n
self-employed '-'
o
4,059
o
o
v
4,
_:J
4 a,c;
. I -' ~....'
816
876
Form 1040 (2006'
.~
""
1\)',
- I :J.7/~
This Indenture
MADE the IS1h day of t1JA~ctf I 2<X2l.,
'::':.'~~Ati~145-148
: :~~OHDER Or DEEDS
'fGSRLANO OOUNTY-l',',
03 FlfiR 18 Prl 2 11
BETWEEN Susan C. Brewer, sincle, Grantor, party of the first part
AND
Susan C. Brewer, singlet and Rlc:bard L. Varlet, single. as joint temmts with the right of
survivorship and not as tenants in common, Grantees. parties of the second part;
WITNESSETH, that the said party of the first part. in consideration of$l.00 (One dollar) to her now
paid by the said parties of the secoDd part. does grant. bargain. sell and convey unto the said parties
of the second pan, their heirs and assigns,
ALL TIIA T CERTAIN lot of land sibJate in the Township of Lower Allen. County of Cumberland
and State of Pennsylvania, bounded and described as follows:
BEGINNING at a point on the southeasterly line of Kingsley Road 100 feet North of the northeast
comer of Kingsley and Norman Roads and at the northerly line of Lot No.1. Block "T" on the
hereinafter mentioned Plan of Lots; thence along Kingsley Road nonheasrwardly by a curve to the
east having a radius of 221.49 feet, 55. S3 feet to a point; thence continuing northeastwardly along
Kingsley Road 25.49 feet to a point at line of Lot No. 15, Block "T" on said Plan; thence
southeastwardly along the latter lot 75.SS feet to a point on the northerly line of Lot No.2. Block
"T"; thence along the latter lot southwestwardly 44.85 feet to a point at line of Lot No.1, Block tiT";
thence along the latter lot North 74 degrees 6 minutes West. 66 feet to the place of BEGINNING.
BEING Lot No. 16. Block "T" on the Plan of Lots of a portion of Highland Park, which Plan is
recorded in the Cumberland County Recorder's Office in Plan Book 5, Page 39.
HA VING THEREON ERECTED a single frame dWelling house No. 1195 Kingsley Road. Highland
Park, Camp Hill, Pennsylvania.
BEING THE SAME PREMISES WHICH Roy G. Wilt. single person, by Deed dated May 31, 2000,
recorded June 1, 2000, in Book 222, page 489, in the Office of the Recorder of Deeds in and for
Cumberland County, Pennsylvania. granted and conveyed unto Susan C. Brewer, single person,
Grantor herein.
Under and subject to any and ALL covenants, conditions, reservations, restrictions, limitatiom. right-
of-ways. objections, easements, agreements, etC.. as they appear of record.
With the appurtenances: TO HA VB AND TO HOLD the same unto and for the use of said panie.s
of the second part their heirs and assigns forever,
And the said Grantor fOf her heirs, executors and administrators covenants with the said parties of
~ 218 ~t! 731
........'y-,.,.~._.',-"._".. .
10 39'ii'd
llIH~3aNn H'ii'IW3~3r
59017EG8L 1L
0E:17T L00G/90/L0
the second part their heirs and assigns against AU. lawful clail1Ulnts the same and every part thereof
to Specially Warrant and Defend.
WITNESS the: hand. and seal of the said party of the first part.
~
jL1fl.M-~ ~
.
Susan G. Brewer
e.J
(Seal)
COMMONWEALTH OF PENNSYLVANIA )
COUNTY OF CVMhE-,(L.~,v.b )
ON THIS the (5~ day of ~C~ , 20.l2J... before me, the W1dersigned
officer, personally appeared Susan G. Brewer, known to me (or satisfactorily proven) to be the
person whose name is subscribed to the within instrument and. acknowledged that she executed the
same for the purposes therein contained.
IN WITNESS WHEREOF. I hereunto set my band and official seal.
~6<-~
. Notary Public .
.~y Commission Expires:
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CERTIFICATE OF RESIDENCE
I hereby certify that the Grantees' precise residence is JJ q oS
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*'
RlALTY TRANS'.. TAX
STATlMINT OF VALUI
c:oMMONWU1TH OF 'INN$YLV.t.NlA
'i:lt'MTMtNT O. R!\I!NU!
..,..,.., or INIIIftIIW. TAXa
HAAa",Du:Q: ;~21.0e03 See Ifter... for Inetructlon. - I - " :J
Camp_ eodt -=Hon ana fIl. In dup/leo,. with a.conIet cI Deed. ..hen l1J ... !vI volu.l_~ I. IIOt Ief form In m. dHd, (2) wheft t!le d.ed
i. wlthllUl _lIderarIcMI CIf by vift, Of 3) 0 IIIK tIllMplIon i, dailMd. A Sio~ of Vallie r. not r.qIIlred If 1M tron,"" Is wllolly .lWIIIp' from lGJ<
baaed 011' , faD r;rolf_hle or 2 bill; urn 10__. If mOl'8 J i, nMded attodl addllklMl.hMt , _
A COR.UPONDINT . AU Inaul,.. may b. directed 'to the following ~el'lOn:
..- T........ HUlIMr.
~D~~ Financial Services. Inc. _ .,.. Code
.- ~
4720 Jd Ge bu Road Site 209 ~
. TIANS.I. DATA
Road
-
ICamo Hili ) (f6J
C 'IOP..TY LOUnOH
1195 Kin sle Road
~
ICumbertand
D VALUATION DATA
~~:;
E IXIMPTION DATA
io~ .hx...... Cal:
!~ =
1 I
: It ~<O;:~ ~
I x 11.01
:r~
I . 151:00
1:~962.4~
. ~:
~ LrIr-',,!In-'~
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d
2. a.s _........ ... ..,.. for be......... eler,,""
o Will or ,.... ~c:quion I
o Tranllw Iv Induatllol D~ Ag.ncy.
o TronJ. 10 ClItwt. IAltodl compJ... copy 01 lrutl Q~ IdMrifyilJllI all bentflc/ari...)
o TrandW Mrw..n prlncip.,d cmd ogont. (Attach complet. copy of agoncy/strGw perty ag.....,..",.)
o Trandwa '0 the eoIWllIonwHltll, Ih. U~lt.a $~J olld INltVm.ntQllrias by gift, dtd!c_OfJ, aJnd.....naT\o.. or 'n UMI of .:ond.....llOtlon.
(If flOftdoMllClltlOft or In lieu 01 cond.IlIMtion, attach t:Opy of _Iulian.)
o Trana.r from IllOngolor to G haldor of 0 mortgage in defauk. MortllOlle look Number L~ I, Pall- Numb... I _~ l,
o Cortedlv. Qr conflrmatory cH.d. (Attoc:n compl.,. .:opy of th. prior dHd being CC1rroct.d or conflrmed.1
o $1QI1ory CI:Irparo,. coftllOlldotlon, "*'ger or dlvi'loA. (Attach copy of CIl'tIcJ...1
~ 0tfIet Pleo.... lain... Ion d 'med f I thallllrtod oboy transfer one-half interest from individual to
IN- ;j 1Iit.........
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Un_ peftCIItMa of low, I Oeda... that I how. lI11ermlnod ft." Stor__nt, lfIduc1l.. occomplln,~ .........., OM Ie ....IMIt of my lruwled..
4IMI MatI, It ..~, ~ tNMI .....,.Iet.. ~
~ of <:-11$ ...JJ11 .. "'iI..j."~. Party -.; ~ i ~ J I
U"- Financial Se"'ices~nc. $y ~ ;}z<(_> ~ -=-_~_ I; iff ~ " 'J J
BOOK 256 PAGf 733
E0 39\1d
llIH~3aNn H\1IW3~3r
6901:>E2:BL TL
0E:1:>1 L002:/901L0
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f'i'e(1bn.\\ic<;bo(~; PA I:;;;;' -
Decedent Name(s): ~ 1.~ e. braver
Date: '+- / ~ - Dq..
6300 Lamar Avenue
Post Office Box 29217
Shawnee Mission, KS 66201-9217
This is written in response to your request for a date of death valuation for the above person(s).
We have no accounts on record in the name/social security number of the deceased.
X We show the foHowing account(s) in the name of the deceased
(The following shares and net asset prices are provided as of the date of death:.1bv /3 , tJ{PJ
,
Account/Fund
Number Shares
Price-per-Share
Re2istration
3O~3g/..t;
1009
(084
~~g:~~~
$/.LJ.{) q.
$. JD.49
-r eA-
Beneficiary of record (if applicable):
In order to transfer* (change registration) or redeem these funds, please provide:
Letter of instructions from the surviving owner, executor, beneficiary
Certified copy of the death certificate
Letters T estamentary/Appointment (current within 60 days)
Inheritance Tax Waiver (Consent to Transfer)
Stock Certificate for shares
Copy of Trust document
Other:
Thank you for the opportunity to be of service. Additional questions may be directed to our
Client Services Representatives at 800-366-5465.
CLIENT SERVICES DIVISION
WADDELL & REED SERVICES COMPANY
*New registration instructions
must include the social security
number and date of birth for new
account owner(s).
Parthemore Funeral Home & Cremation Services, Inc.
P.O. Box 431
1303 Bridge Street
New Cumberland, P A 17070-0431
(717) 774-7721
Mr. Scott E. Brewer
13 Briarwood Court
Mechanicsburg, P A 17050
Statement
For the services of Susan C. Brewer
DATE
4/6/2007
AMOUNT DUE AMOUNT ENC.
$1,510.43
DATE TRANSACTION AMOUNT BALANCE
12/31/2004 Balance forward 0.00
11/14/2006 INV#1069. Due 12/14/2006. 8,535.10 8,535.10
12/22/2006 !NY #FC 269. Due 12/22/2006. Finance Charge 28.06 8,563.16
01/03/2007 PMT #2302. received from Scott E. Brewer -7,115.66 1,447.50
03/14/2007 INV #FC 283. Due 03/14/2007. Finance Charge 48.78 1,496.28
04/06/2007 !NY #FC 290. Due 04/06/2007. Finance Charge 14.15 1,510.43
/~'C l ,
!.-f . :;2
,~ /610,Lf:J" .
" '~teW
L ({sin .3'0 I
1
CURRENT 1-30 DAYS PAST 31-60 DAYS PAST 61-90 DAYS PAST OVER 90 DAYS AMOUNT DUE
DUE DUE DUE PAST DUE
14.15 48.78 0.00 0.00 1,447.50 $1,510.43
Please don't hesitate to call our office if we may be of assistance. Thank you.
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17G13
Receipt Date:
Rece+pt Time:
Recelpt No. :
12/29/2006
09:11:01
1046814
BREWER SUSAN C
Estate File No. :
Paid By Remarks:
2006-01163
SCOTT BREWER
JA
------------------------ Receipt Distribution -----------_____________
Fee/Tax Description PaYment Amount Payee Name
PETITION LTRS TEST
WILL
AUTOMATION FEE
SHORT CERTIFICATE
JCP FEE
Check# 2300
Total Received...... . . .
60.00
15.00
5.00
24.00
10.00
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
CUMBERLAND COUNTY GENERAL FUN
BUREAU OF RECEIPTS & CNTR M.D
$114.00
$114.00
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Recetpt Date:
Rece=!-pt Time:
Recelpt No. :
7/05/2007
16:19:17
1049057
BREWER SUSAN C
Estate File No.:
Paid By Remarks:
2006-01163
ATTY MARK THOMAS
CJ
------------------------ Receipt Distribution ----------______________
Fee/Tax Description Payment Amount
SHORT CERTIFICATE 8.00
----------------
Cash $8.00
Total Received......... $8.00
Payee Name
CUMBERLAND COUNTY GENERAL FUN
Jul 08 2007 1:18PM
LAW OFFICE OF JOHN P NEBL (717) 671-8838
10.2
.
PROOF OF PUBLICATION
State of Pennsylvania, County ofCurnberland
Tammy Shoemaker, Classified Advertising Manager, of The Sentinel, of the County
and State aforesaid, being duly sworn, deposes and says that THE SEN1.1NEL, a
newspaper of general circulation in the Borough of Carlisle, County and State
aforesaid, was established December 13th, 1881, since which date TI-IE SENTINEL has
been regularly issued in said County, and that the printed notice or publication
attached hereto is exactly the same as was printed and published in the regular editions
and issues of THE SENTINEL on the following dayes)
Januarv 25, February 01, 08, 2007
COPY OF NOTICE OF PUBLICATION
Affiant further deposes that hel she is not
interested in the subject matter of the
aforesaid notice or advertisement, and that
all allegations in the foregoing statement
as to time, place and character of
~~~
Sworn to and subscribed before me this
14th. day of February, 2007.
LY)lJd7do-a ~
0/~"
t]./
N otary.-Pub ...
My commission expires: q (l lOR
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
O"Inslna L. Wolfe, Notary Public
Cariisle Boro, Cumbel1and County
My Canmlssion Expires $apt. 1, 2008
Member. Pennsyllla"ia ASl!ocia1ion or Notarles
Jul os 2007 1:18PM
lAW OFFICE OF JOHN P NEBl (717) 671-SS38
p.3
.
PROOF OF PUBLICATION OF NOTICE
IN CUM8'ERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEALTH OF PENNSYL VANIA
COUNTY OF CUMBERLAND
SS.
Lisa Marie Coyne, Esquire, Editor of the Cmnberland Law Journal, of the County and
State aforesaid,..being. duly Sw.ol'Dy according to..l.aw,..deposes.and.says.that the Cumberland. Law.
Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
VIZ:
~ February 2, and February 9, and February 16, 2007
Affiant further deposes that he is authorized to verify this statement by the Cumberland
Law Journal, a legal periodical of general circulation, and that he is not interested in the subject
matter of the aforesaid notice or advertisement, and that all allegations in the foregoing
statements as to time, place and character of publication are true.
Bl'ew0l'. Suaa C., dee'd.
Late oftbe Borough of Camp HiD.
Executor: Scott E. Brewer c/o
John p, Neblett. EsqUire. Law
Office of John p, Nebletl 2000
Linglestown Road. SUite 204.
Harrisburg. PA 17110.
Attorneys: John p, Neblett. Es-
qUire. Law Office of John P.
Neblett, 2000 Unglestown Road,
SUite 204, Harrisburg, PA
17110.
· t /Y _
arie Coyne, EdirorF
AND SUBSCRIBED before me this
day of Februarv. 2007
SWO
16
NOTARIAL SEAL
LOIS E. SNYDER, Notary Public
Carlisle Boro, Cumberland County
~! Commission Expires March 5. 2009
.
~
LAST WILL AND TESTAMENT
OF
SUSAN C. BREWER
I, Susan C. Brewer, of 1195 Kingsley Road, Camp Hill, PA 17011-6113,
Cumberland County, Pennsylvania, being of sound and disposing mind, memory and
understanding, do hereby make, publish and declare this as and for my Last Will and
Testament, hereby revoking any and all prior Wills and Codicils made by me at any time
heretofore.
ITEM I:
I direct that the expenses of my last illness and my death,
including all costs and expenses of administration of my estate, my funeral, and all taxes
arising by reason of my death be paid from the residue of my estate as soon as practicable
after my death.
ITEM II:
I give, devise and bequeath all of the rest, residue and
remainder of my estate of whatsoever nature, whether real or personal, to my children, in
equal shares, to be distributed as follows:
A. One-third (1/3) unto my son, SCOTT E. BREWER, or his issue per
stirpes. If no such issue exists, then the remainder shall be paid to my remaining issue, per
stirpes.
B. One-third (1/3) unto my daughter, SARA E. BREWER, or her issue per
stirpes. If no such issue exists, then the remainder shall be paid to my remaining issue, per
stirpes.
C. One-third (1/3) unto my daughter, SHEILA SHARADIN, or her issue
per stirpes. If no such issue exists, then the remainder shall be paid to my remaining issue,
per stirpes.
INITIALS: M
. . ..
ITEM III: In addition to all powers conferred herein upon my Executor or
personal representative, or vested in them by law, my said Executor or personal
representative shall have the following powers applicable to all property, real,
personal and mixed, wheresoever situate, exercisable without Court approval and
effective with respect to each item of said property until actual distribution thereof:
(a) To pay all taxes, charges and expenses of maintenance, upkeep,
improvement, development, protection and reservation of any obtained or acquired
real or personal property. Such payments may be made either from principal or
income as my said Executor shall determine;
(b) To retain or invest any and all funds, whether principal or income,
and any real or personal property without restriction to legal investment;
(c) To purchase investments at premium;
(d) To exercise all rights of a security holder or shareholder in any
corporation;
(e) To lease, mortgage, pledge, give options upon or sell at public or
private sale and without approval of any court and without any responsibility to the
buyer or buyers to see to the application of the purchase price, any real or personal
property or portions thereof, irrespective of the manner or means by which the same
was acquired by my said Executor;
(f) To make any payment or distribution herein provided for in cash, in
kind or partly in cash and partly in kind, except as herein otherwise specifically
provided at valuations fixed by my Executor at the time of distribution.
-2-
INITIALS: ~
. .
ITEM IV:
I direct that no interest of any beneficiary in the income or
principal of any Trust created by this Will or in any property distributable to a beneficiary
hereunder may be anticipated, assigned or encumbered or be subject to any creditor's
claims or legal process prior to its actual distribution to the beneficiary.
ITEM V:
I hereby nominate, constitute and appoint SCOTT E. BREWER
to be the Executor of this, my Last Will and Testament. In the event that SCOTT E.
BREWER has predeceased me or cannot qualify or, having qualified, cannot or does not
continue to serve as my Executor then, in that event, I appoint SHEILA SHARADIN as
substitute Executor of this, My Last Will and Testament. It is my specific intent that my
Executor be provided with reasonable compensation for services provided to my estate.
ITEM VI:
No fiduciary acting hereunder shall be required to post bond or
enter security in any jurisdiction, but if bond is nevertheless required it shall be without
surety.
IN WITNESS WHEREOF, I have set my hand and seal to this, my Last Will and
Testament, this 7ltv-,< 4~1 day of cl &vi"t-l/'1t1i..u.A.J , 2006.
(
Jj~'-- c/lw~J
Nam'e
..,
-.)-
INITIALS: .J4!J
r' ~ . ...
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAlJo\.1', '---.
55.
We, the Testatrix and Witnesses, whose names are signed to the foregoing
instrument, being first duly sworn do hereby declare to the undersigned that the Testatrix
signed and executed the instrument as her Last Will, that she signed willingly, and executed
it as her free and voluntary act for the purposes therein contained, and that each of the
witnesses, in the presence and hearing of the Testatrix, was at the time eighteen (18) years
of age or older, of sound and disposing mind and under no constraint to undue influence.
~ c~liu~
SUSAN e .BREWER
~5
~~~
Witness
Sworn and subscribed to
before me this ,;. 3""'::1 day
of OC1'i)her- , 2006.
..... ~ f /
Vf y~ ;/ J;;1 //.'
~;...('A; I ," ,.)~
Notary Public
My commission expires:
COMMONWEALTH OF PENNSYLVANIA
Notarial Seal
Melissa M. Kain, Notary Public
Susquehanna Twp., Dauphin County
MyCommlsslon ExpIres Aug. 11, 2010
-5-
INITIALS: ~