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HomeMy WebLinkAbout02-0035 P TITION FOR GRANT OF LETTERS OF ADMINISTRATION Estate if Jeffrey L. Brandt also kn wn as No. To: ~ I.O~...35 Deceased. Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania Social S curity No. 187-58-2044 The p tition of the undersigned respectfully represents that: Your etitioner(s), who S/are 18 years of age or older, appl t for letters of administration on the estate of (d.b.n ; pendente lite; durante absentia; durante minoritate) the abov decedent. ent was domiciled at death in last family or principal residence at Cumberland COUIlty, Pennsylvania, with 19 Beecher Drive, Carlisle, Penn Township, (list street, number and municipality) \ PA Center Hershe ,~ Decenden at death owned property with estimated values as folllows: (If domici ed in Pa.) All personal property (If not do iciled in Pa.) Personal property in Pennsylvania (If not do iciled in Pa.) Personal property in County Value of r al estate in Pennsylvania situated a follows: 1 g Beecher Drive. Carlisle , Penn $ 20,000.00 $ $ $ 100,000.00 Township, Pennsylvania Petition r--S.-.. after a proper search ha ve ascertained that decedent left no will and was survived by the followi g ~ heirs: Name Brandt Brandt Relationship Father Mother Residence 2055 Walnut Bottom Rd., Carlisle 2055 Walnut Bottom Rd., Carlisle /' THEREF IRE, petitioner(s) respectfully request(s) the grant of letters of administration in the appropriate orm to the undersigned. ~ '" ~ Q) u C Q) '" ~ 'V;~ Q) ~ oq~ ",0 ",';:: cd":: 3~ Q),- 30 (;j '" 00 Vi harles W. Brandt Walnut Bottom Road Car isle PA 17013 ~~~~ lJ;/Jt2-?>dt:- Suz ne W. Brandt ' 2055 Walnut Bottom Road Carlisle, PA 17013 /7- 33 - .b OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumberland } 55 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal representative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. </\ affirmed and: subscribed ~- - 1/ . '. ~ day of .'-. o!~::A;;fl~~r~~d* ..... '" '-' Q) ... =' ... cU c: 1lO 00 No 21-02-35 . Estate of Jeffrey L. Brandt , Deceased GRANT OF LETTERS OF ADMINISTRATION in the estate of AND NOW JANUARY 14, }IJ 2002 ,in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, (') (j .. :0 IT IS DECREED that CHARLES W. BRANDT AND SUZANNE W. BRANna; (tI ~ :D (l) is/are entitled to Letters of Administration, and in accord with such finding, ~i"s of AdministtiiiiP m \"t,1 '- ;a. 0 OJ'; ~ we are hereby granted to CHARLES W. BRANDT AND SUZANNE W. BRANDT-, ~.,;. ..... c..., o. f';> ~ Q. ;.~) ...., <~ ;;:::;~' ~'(\ -0 :::;:';a; .. c N en .' "1J {oO . . 9.. '-n?'J.A~{'. ~n~ r' P.tr.~~.~Qf"d::i:i.. Register of Wills. (J . JEFFREY L. BRANDT ocri' FEES Letters of Administration $ 235.00 Short Certificates(l(~ .. . .. .. ... $ 30 . 00 Renunciation ................ $ JCP $ ') . 00 TOTAL _ $ 270.00 Filed . .~~~~~. .1.~! . ~.qq? A.D. n: 2002 Hubert X. Gilroy, Esq. (29943) ATTORNEY (Sup. Ct. J.D. No.) 4 North Hanover St~geearlisle, PA ADDRESS (717) 243-4574 PHONE CALLED ATTORNEY JANUARY 14, 2002 " ~~ r: ,~.f ~:. 1/' ; ~,-" "'{" .,. ". :1 I 'I .' /' .... c .... " '. / , ~"~~/::';:,i:J~~:::J::.~'.>tj5fJ:~; ::'C>,'. 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N 3 d ~ o H 1 , II ,.~ '0 IN I!II o o a I:l o o 3 I:l , 'I 1 I A II I N II A , A S N N 3 d ~ o H 1 , II 3 M M o N W E A L T H o F P E N N 5 y L V A N , A V I T A L R E C o R o C o M M o N W E A L T H o F P E N N 5 y L V A N I A V I T A L R E C o R o C o M M o N W E A L T H o F P E N N S Y L V A N , A V I T A L R E C o R o C o M M o N W E A L T H o F P E N N N o 'IN W o o o I:l o o 3 I:l , II 1 I A II I N ~l ~I N 3 d ~ o H 1 , II 3 N o IN ,IN o o o I:l o o 3 I:l , II 1 I A 'I I N II A , A 5 N N 3 d ~ o H 1 , II 3 N o W 11II " CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Deced nt: Jeffrey L. Brandt Date of Death: Januar 6 2002 'J- Will No. Admin. No. 2002 - 00035 To the Regi,'." \ I certify that no1tIce of (beneficial interest) estate administration reqUIred by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April 29. 2002 Name Charles W. Brandt Suzanne Bra dt Address 2055 Walnut Bottom Road Carlisle(' PA 17013 2055 Walnut Bottom Road, Carlisle, PA 17013 Notice has now bee given to all persons entitled thereto under Rule 5.6(a) except :nOlle Date: "t':"' Q ''1 ~~~, ~ :5 :'.J .?.:2 6 01 o (\) (j)C;C cr: a:: 0- .::::: N P 00( Signature Name Hubert X. Esquire Broujos & Gilroy, P.C. Address 4 North Hanover Street "f:J i~ Carlisle, PA 17013 a3 ~. ..0 ..~ ~ (I) ::: __ oJ .... ".... .-.-#'-'" Telephone (717) 243-4574 Capacity: _ Personal Representative -X-Counsel for personal representative JRD/June 3 , 1992/17858 MAY 1 6 200t) Estate No.: 21- 02-00035 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: E tate of Jeffrey L. Brandt Late of NO. , NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal R presentative: CharEl es W. Brandt Counsel for Personal Representative: Hubert X. Gi 1 ray Esq. Date ofGra t of Original Letters: January 14, 2002 April 24, 2002 The ndersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Co rt Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common PIe s of Cumberland County, that neither the above named personal representative nor the above na ed counsel for the personal representative have filed with the Register of Wills or Clerk of the rphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Co rt Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Co Rules, was given by the Register of Wills on 4-24 ,2002 , and that the ten (10) day notic to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is h reby notified of such delinquency and the undersigned requests that a Court conduct a hea . ng to determine whether sanctions should be imposed upon the delinquent personal repre entative or counsel for the delinquent personal representative. Date: May 5, 2002 Distribution: Personal Representative Counsel for Personal Representative Estate File 0..., /). . A hearing is sch duled for () -Oor--tJ C1- at 7- /" -3tf A AIt1 Courtroom No.3. If the Certification of otice is filed prior to the hearing date, the hearing ill automatically be cancelled. . _~i( ~~________J{ ___30__ 0.2-_ mu JOHN H. BROUJOS HUBERT X. GILROY BROUJOS & GILROY, P.c. ATIORNEYS AT LAW 4 NORTH HANOVER STREET CARUSLE, PENNSYLVANIA 17013 Register f Wills Cumberla d County Courthouse .One Cou house Square Carlisle, A 17013 RE Estate of Jeffrey L. Brandt File No: 21-02-0035 Dear Sir 0 September 6, 2002 TELEPHONE: (717) 243-4574 FACSIMILE: (717) 243-8227 jbroujos@broujosgilroy.com hgilroy@broujosgilroy.com NON-ToLL FOR HARRISBURG AREA 717-766-1690 Enclosed is a check in the amount of $7,179.19 as payment on inheritance taxes in the above refe nced estate. bc cc: Mr. and rs. Charles Brandt Hubert X. Gilroy .~~ ~r ." " d N C/) r1 -0 I 0'1 ......-. ::::::i - d ~ ,"I :::0' J-";CD (~) (; (f'''': ~.. J ;,' :"1 .~ '. .' (,; -L' -" ~. " <. ~. ", COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVEN E BUREAU OF INDIVIDUAL AXES DEPT. 2B0601 HARRISBURG, PA 1712B- 601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GILROY HUBE RT X 4 N HANOVEf STREET CARLISLE, PA 17013 ACN ASSESSMENT CONTROL NUMBER -------- fold 101 ESTATE INFORMATI( N: SSN: 187-58-2044 FILE NUMBER: 2102-0035 DECEDENT NAME: BRANDT JEFFREY L DATE OF PAYMENT: 09/06/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 01/06/2002 TOTAL AMOUNT PAID: REMARKS: SUZANNE BRANDT C/O HL BERT X GILROY ESQUIRE CHECK# 0099 SEAL INITIALS: DO RECEIVED BY: MARY C. LE REGISTER 0 REGISTER OF WILLS "'<:,. ...,." ';, I J _) ~ ",., \ ~ I J I I I I till' ' \ \ \ REV-1162 EX(11-96) NO. CD 001594 AMOUNT -------- I $7,179,19 I I I I I I I I $7,179.19 WIS F WI LLS un COMMONWEALTH OF P NNSYlVANIA DEPARTMENT OF REVEN E BUREAU OF INDIVIDUAL AXES DEPT. 280601 !" HARRISBURG. PA 17128 601 ~. . R:~~EIVED FROM: ....." . PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GILROY HUBI RT X 4 N HANOVE R STREET CARLISLE, Pi 17013 ___un_ fold . '. ;1!r:.( . .ESTATE INFORMATION: SSN: DUPLICA TE 187-58-2044 FILE NUMBER: 2102-0035 BRANDT JEFFREY L DECEDENT NAME: DATE OF PAYMENT: 01/02/2004 00/00/0000 CUMBERLAND 01/06/2002 POSTMARK DATE: COUNTY: DATE OF DEATH: Hi::;;~' ~ "'.+ !'"l~ . ACN ASSESSMENT CONTROL NUMBER 101 TOTAL AMOUNT PAID: . REMARKS: HUBE RT X GILROY ESQUIRE CHECK# 5655 SEAL ::;f:' !. "f j) , f'I, :, ",\\ / J , ,; "II i\ \ \ INITIALS: VZ RECEIVED BY: REGISTER OF WILLS REV-1162 EX(11-96) NO. CD 003401 AMOUNT -------- I $9,000.00 I I I I I I I I $9,000.00 GLENDA FARNER STRASBAUGH DEPUTY REGISTER OF WILLS STAtuS REPORT UNDER RULE 6.12 ~. / e of Decedent: JEFFREY L. BRANDT 0r./06/02 Will No.: Admin, No,: ;;.ooJ... .. .~-00035 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the follo . g with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes 0 No ~ 2. . If the answer is NO,state when the personal representative reasonably believes that the administration will be complete: <.L A. rJ/L. -K, ) 3. If the answer to No, 1 is Yes, state the following: a Did the personal ~entative file a final account with the Court? Yes _ No ~ b. The separate Orphans' Court No, (if any) for the personal representative's account is: c, Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 Date: /2/04 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the. Orphans' Court and may be attached to this report. 0I'f Signature X. Gilroy Name ;Y) N M CL 4 North Hanover Street Carlisle, PA 17013 N i Address 717-243-4574 ""- :=') '} . ~l 1..'.. ".j' ? ,~ , "'t... .... -::! Telephone No. Capacity: 0 P~al Representative Q-Counsel for personal representative . .- ~.~ -'" :..) G Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 2/01/2005 GILROY HUBERT X 4 N HANOVER STREET CARLISLE, PA 17013 RE: Estate of BRANDT JEFFREY L File Number: 2002-00035 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration, This filing will become delinquent on: 1/06/2005 Your prompt attention to this matter will be appreciated. Thank You, z:e~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge uJ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/16/2005 BRANDT SUZANNE W 2055 WALNUT BOTTOM ROAD CARLISLE, PA 17013 RE: Estate of BRANDT JEFFREY L File Number: 2002-00035 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate, As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent1s death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/06/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, Ik. ~ ~ . d~; i. . ) l' '-""'-""- ,v<.-"~--t...< - "_I GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge \r~ Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/16/2005 BRANDT CHARLES W 2055 WALNUT BOTTOM ROAD CARLISLE, PA 17013 RE: Estate of BRANDT JEFFREY L File Number: 2002-00035 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO, 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 1/06/2006 Your prompt attention to this matter will be appreciated. Thank You. Sinc~~el~, ~~~ '. ' GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge v~ JOHN H. BROUJOS HUBERT X. GILROY BROUJOS & GILROY, P.e. ATIORNEYS AT LAW 4 NORTH HANOVER STREET CARLISLE, PENNSYLVANIA 17013 January 17,2006 Ms. Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Estate of Jeffrey L. Brandt No. 2002 - 00035 Dear Glenda: Enclosed for filing is a Status Report in the above matter. Sincerely yours, Pn Enclosure TELEPHONE: (717) 243-4574 FACSIMILE: (717) 243-8227 jbroujos@broujosgilroy.com hgilroy@broujosgilroy.com NON-ToLL FOR HARIusBURG AREA 717-766-1690 ~_~__.'t.~-....~ _~~^'T!~"i]_ ___~I!"""l...,___._-a____~11_....,_...3 .1"'""l-........--,..q...;._ K(ClSJl.~Illi;:;!I: VI l{w JUlJl.~ UJi. .....UJlJUliUiC.I1. JI.","-U\UL 'L-\UlUUu.y STATUS REPORT UNDER RULE 6.12 Name of Decedent: .lp-ffn~y To Brnndt Date of Death: January 6, 2002 Estate No.: 21-02-0035 . Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes n No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: h months 3. If the answer to No. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be flied with the Clerk of the Orphans' Court and may be attached to this report. ~. 01/17/2006 ~ Signature Date: ~,. Hubert X. Gilroy, Esquire Name 4 N. Hanover street C-nrlisle, FA 17011 Address 717/ 243-4574 Telephone No. rr .Capacity: 0 Personal Representative ug Counsel for personal representative \(t Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013' Phone: (717) 240 - 6345 Date: 12/06/2005 GILROY HUBERT XAVIER 4 NORTH HANOVER STREET CARLISLE, PA 17013 RE: Estate of BRANDT JEFFREY L File Number: 2002-00035 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/06/2006 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~5r-v~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge ~.t ~V-1500 EX + (6-00) '*' COMMONWEALTH OF , PENNSYLVANIA , DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV -1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER 2 1 -0 2 0 0 3 5 "'CciUNTYCOOE --VEAR- - - NUMaER- - DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- Z w C w o w C BRANDT JEFFREY L. DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) 1 87- 5 8 - 2 044 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 01/06/2002 04/23/1969 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ ~ -U) U o:~ wQ.u :I: 00 U g:~ Q. c( IXJ 1. Original Retum D 4. Limited Estate D 6. DecedentDied Testate (Attach copy of Will) D 9. Litigation Proceeds Received D 2. Supplemental Retum D 4a. Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach cOPyofTrust) D 10. Spousal Poverty Credit (date o/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 Retum Required _ 8. Total Number of Safe Deposij Boxes D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) ... z w o z o Q. U) w 0: 0: o U THI.seCT'ON."UST.~I.t..I.D..ALL..CGRA.EaPQNQENCEANQQo"'leNl'fAL't.JNFOR_f1'ON.SH()tJ~D.E..OIReCTEO'O: NAME COMPLETE MAILING ADDRESS HUBERT X. GILROY ESQUIRE 4 NORTH HANOVER STREET FIRM NAME (If Applicable) BROUJOS & GILROY P.C. CARLISLE, PA 17013 TELEPHONE NUMBER 717-243-4574 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (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) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 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) 13. Charitable and Govemmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) z o i= c ..J ::) I- Q: c o w 0::: OFFICIAL USE ONLY (1 ) 116,900.00 (2) 11,015.74 (3) (4) 0.00 (5) 138.754.71 (6) (7) l"--,) <<::::) <<::::) c::J"\ o rr1 (""") ("') S:::o ;:;;g . <~ :I (") L_~~ ~ ~ '](")0 , ) (-.J "T1 '':''c --'::J5 -0--; )::> .::0 --'-J rn IT10 (;')0 ::.-? ::0 '::.:..::jt.7 rnm :XJ CJ ('JO -.,..., -n ~~ri :::-.:~ rTl (/) C) -"1""; N ;:po :x o 0'\ (8) 266,670.45 (9) (10) 9,596.00 80,437.91 (11 ) (12) (13) 90,033.91 176,636.54 / 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o i= c I- :;) Q. :IS o o >< ~ 15, Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due (14) 176,636.54 X _(15) 179,864.46 X .045 (16) X .12 (17) X .15 (18) (19) 8,093.90 8.093.90 20. 0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > SE SURE TO ANSWER ALL QuestIONS ON 'aVERSE SIDE AND RECHlCKMATH < < \ .& _.~ d I C I t Add Dece ents ompl e e ress: STREET ADDRESS 19 BEECHER DRIVE . CITY .... I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 8,093.90 16.179.19 Total Credits (A + 8 + C) (2) 16,179.19 3. Interest/Penalty if applicable D. Interest E. Penalty T otallnterest/Penalty ( D + E ) (3) 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 (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (5A) 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 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; ........................................................................... D 00 b, retain the right to designate who shall use the property transferred or its income; ........................................ D 00 c, retain a reversionary interest; or ...................................................................................................... D 00 d. receive the promise for life of either payments, benefits or care? ............................................................. D 00 2, If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................. D 00 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. D 00 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... D 00 8,085.29 0.00 0.00 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. ~ ADDRESS PA 17013 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. w,~~"., '* COMMONWEALTH OF PENNSYLVANIA '" INHERITANCE TAX RETURN I SCHEDULE A REAL ESTATE ESTATE OF FILE NUMBER BRANDT JEFFREY L. 21 02 0035 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 willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which Is jolntly-owned with right of survivorshlD must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION 19 BEECHER DRIVE, CARLISLE, PA 17013 As per sale price on May 2, 2003 (Settlement Sheet attached) VALUE AT DATE OF DEATH 116,900.00 TOTAL (Also enter on line 1, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 116900.00 ~".~:"<n '* COMMONWEALTH OF PENNSYLVANIA ~ INHERITANCE TAX RETURN RE I ENT DE EDENT ESTATE OF BRANDT JEFFREY L All property jointly-owned with right of survivorship must be disclosed on Schedule F. SCHEDULE B STOCKS & BONDS FILE NUMBER 21 02 0035 ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH 11,015.74 TYCO 401-K AS PER ATTACHED STATEMENT TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 11 015.74 .~~~."'" '* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF BRANDT JEFFREY L. FILE NUMBER 21 02 0035 Indude 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 1993 TRUCK - DEALER BLUE BOOK VALUE 7,000.00 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 HOUSEHOLD FURNITURE 3,500.00 METAL LATHE AND TOOLS 2,000.00 RIDING MOWER 700.00 KAWASAKI DIRT BIKE 600.00 BICYCLE, SKIS, GOLF CLUBS 200.00 PENSION FUND - ADAM WHOLESALERS 11,968.73 M&T SAVINGS ACCT #15004200904636 3,206.43 M&T CHECKING ACCT# 1181181 371.27 FEDERAL INCOME TAX REFUND FOR 2001 808.00 TYCO PAYCHECK DATED 01/17/02 658.55 UNEMPLOYMENT CHECK 01/19/02 343.00 UNEMPLOYMENT CHECK 02/19/02 430.00 SURVIVAL ACTION - #2002-3868 CUMBERLAND COUNTY - $120,000.00 LESS FEES OF $30,000.00 - SEE ATTACHED 8/14/02 COURT ORDER 90,000.00 CENTRAL PA TEAMSTERS PENSION FUND BENEFIT 5,984.36 CENTRAL PA TEAMSTERS PENSION FUND BENEFIT 5,984.37 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 138754.71 Continuation of REV-1500 Inheritance Tax Return Resident Decedent BRANDT, JEFFREY L. 21 02 0035 PaQe 1 Schedule E - Cash, Bank Deposits, & Misc. Personal Property ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 17 TYeO DEATH BENEFIT 5,000.00 SUBTOTAL SCHEDULE E 5,000.00 GRAND TOTAL SCHEDULE E $ 138,754.71 ~EV1511EX+1197) '* . ' .. COMMONWEALTH OF PENNSYLVANIA .. INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF BRANDT JEFFREY L FILE NUMBER 21 02 0035 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. HOFFMAN-ROTH FUNERAL HOME 5,465.00 2 CEMET ARY EXPENSES 2,614.00 3 CARLISLE CATERING / TWO MILE HOUSE 1,200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative (s) Charles W. Brandt and Suzanne W. Brandt 0.00 Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address City Carlisle State P A Zip 17013 Year(s) Commission Paid: 2. Attorney Fees BROUJOS & GILROY, P.C. 0.00 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 5. Accountanfs Fees 6. Tax Return Prepare~s Fees 7. Register of Wills - Filing 270.00 8 Short Certificates 15.00 9 Final Inheritance Tax Return 15.00 10 Estate Settlement Agreement 17.00 TOTAL (Also enter on line 9, Recapitulation) $ 9596.00 (If more space is needed, insert additional sheets of the same size) ;EV"512 EX + (1,971 '* . lt~' . . ~OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF BRANDT JEFFREY L. FILE NUMBER 21 02 0035 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 309.00 1. HOMEOWNERS INSURANCE - NATIONWIDE - PAID 4/04/02 2 COUNTY REAL ESTATE TAXES - PAID 4/25/02 191.77 3 SCHOOL REAL ESTATE TAXES - PAID 8/20/02 866.22 4 MORTGAGE TO VNB MORTGAGE SERVICES, INC. 65,213.00 5 WOLF'S FURNITURE 1,000.00 6 HOME DEPOT 1,092.00 7 VISA 240.00 8 H&R BLOCK - 2001 INCOME TAX PREPARATION 115.00 9. EXPENSES IN CONNECTION WITH SALE OF REAL ESTATE, INCLUDING REALTOR'S FEES OF $7,014.00, TRANSFER TAX OF $1,169.00, SEPTIC CERTIFICATION OF $250.00, COURIER'S FEE OF $15.00, SELLER'S ASSISTANCE OF $2,900.00 AND ADVANCED COUNTY TAXES ON PRO-RATION OF $62.92 11 ,41 0.92 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 80437.91 HUD -1 UNIFORM SETTLEMENT STATEMENT OMB Approval No. 2502-0265 A. _ U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT B. TYPE OF LOAN 6. File Number: 7. Loan Number: I. FHA 2. FmHA 03-334628 0030559724 3. Cony. Unins. 4. VA 5. Conv. Ins. 8. Mortgage Insurance Case Number C. NOTE: This fonn is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing: they are shown here for infonnational purposes and are not included in the totals. NOTE: TIN = TaxDayer's Identification Number D. NAME AND ADDRESS OF BORROWER: E. NAME, ADDRESS AND TIN OF SELLER: F. NAME AND ADDRESS OF LENDER: WAYNE A. ZINN Estate of Jeffrey L. Brandt USDA, Rural Housing Service JENNIFER A. DARR Executors: Charles W. Brandt 124 Pleasant Acres Road 1010 Harriet Street and Suzanne Brandt York PA 17402 Carlisle, PA 17013 19 Beecher Drive I Carlisle, PA 17013 G. PROPERTY LOCATION: H. SETTLEMENT AGENT NAME, ADDRESS AND TIN 19 Beecher Drive PA Real Estate Services, Inc, Carlisle, PA 17013 PLACE OF SETTLEMENT I. SETTLEMENT DATE Parcel 1.D. 31-12-0332-045 10 West Pomfret Street 05/02/2003 Carlisle PA 17013 J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100, GROSS AMOUNT DUE FROM BORROWER: 400. GROSS AMOUNT DUE TO SELLER: 101. Contract sales price 116 900.00 40 I. Contract sales price 116 900,00 102. Personal prooerty 402. Personal orooerty 103. Settlement chanzes to borrower (Line 1400) 12 920.72 403. 104. 404. 105. 405. Adjustments for items paid bv seller in advance Adiustments for items paid bv seller in advance 106. Citv/town taxes 406. City/town taxes 107. Countv taxes 407. County taxes 108. Assessments 408. Assessments 109. School taxes 5/2/03-7/1/03 142.20 409. School taxes 5/2/03-7/1/03 142.20 110. 410. III. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 129 962.92 420. GROSS AMOUNT DUE TO SELLER 117.042.20 200. AMOUNTS PAID BY OR IN BEHALF OF BORROWER: 500. REDUCTIONS IN AMOUNT DUE TO SELLER: 20 I. Deoosit or earnest money 1 000.00 501. Excess deposit 202. Princioal amount of new loan(s) 126 000.00 502. Settlement chanzes to seller (Lin~ (400) 17 433.00 203. Existinu loan(s) taken subiect to 503. Existinu loan(s) taken subiect to 204. 504. Payoff of first morttlaue loan * VNB 64 215.87 205. 505. Pavoff of second morttlaue loan 206. 506. Courier Exnense 15,00 207. 507. 208. Sellers I Assistance 2 900,00 508. Sellers I Assistance 2 900,00 209. 509. Adiustments for items unoaid bv seller Adiustments for items unoaid bv seller 210. Citvitown taxes 510. City/town taxes 211. County taxes 01/01/2003 - 05 / 02/2003 62.92 511. County taxes 0 1 / 0 1 / 2 0 0 3 - 0 5 / 0 2 / 2 0 0 3 62.92 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 129 962.92 520. TOTAL REDUCTION AMOUNT DUE SELLER 84 626.79 300, CASH AT SEITLEMENT FROMffO BORROWER 600. CASH AT SETTLEMENT FROMffO SELLER 30 I. Gross amount due from borrower (Line (20) I 129 962.92 601. Gross amount due to seller (Line 420) I 117 042.20 302. Less amount paid by/for borrower (Line 220) I 129 962,92 602. Less reduction in amount due seller (Line 52m I 84 626.79 303. CASH FROM BORROWER I 603. CASH TO SELLER I 32 415.41 SELLER'S STATEMENT The infonnation contained in Blocks E, G, H, and I and on line 401 (or, if line 401 is asterisked, line 403 and 404) is important tax infonnation and is being furnished to the Internal Revenue Service (see Seller Certification). [fyou are required to file a return, a negligence penalty or other sanction will be imposed on you if this item is required to be reported and the IRS detennines that it has not been reported. You are required to provide the Settlement Agent with your correct taxpayer identification number. If you do not provide the Settlement Agent with your correct taxpayer identification number, you may be subject to civil or criminal penalties imposed by law. Under penalties of perjury. I certify that the number shown on this statement is my correct taxpayer identification number. (Seller's Signature) Estate of Jeffrey L. Brandt (Seller's Signature) Executors: Charles W. Brandt ~ EASY SOFT, Inc. 2001 Previ L. SETTLEMENT CHARGES 700. TOTAL SALES/BROKER's COMMISSION based on orice $ 116 900.00 @ 6.000\ PAID FROM PAID FROM Division of Commission (line 70m as follows: BORROWER'S SELLER'S 701. S 3 532.00 to Georae L. Ebener and Associates FUNDS AT FUNDS AT 702.$ 3 482.00 to Re/Max Sterlina Associates Inc, SETTLEMENT SETTLEMENT 703. Commission naid at Settlement 7 014.00 704:- 800, ITEMS PAYABLE IN CONNECTION WITH LOAN 80 I. Loan Orillination Fee $ 802. Loan Discount S 803. Anoraisal Fee to Rural Housina Service 325,00 804. Credit reDOrt to 805. Lender's Insoection Fee 806. Tax Service Fee to Rural Housina Service 101. 00 807. Renairs Escrow held bv Rural Housina Service B 000.00 808. Initial Escrow ~nosit to Rural Housina Service 755,72 809. Courier Exnense.(2) to PA Real Estate Services Inc. 30.00 810. Princinal Pavment to Rural Housina Service 610.65 811. 812. 813. 900. ITEMS REOUlRED BY LENDER TO BE PAID IN ADVANCE 90 I. Interest from 902. Mortl>a"e Insurance Premium for 903. Hazard insurance Premium for 904. 905. 2003 CoiTwn Taxes to Mable Stitt Tax Collector 195.60 1000, RESERVES DEPOSITED WITH LENDER 1001. Hazard insurance 1002. Mortllalleinsurance 1003. Citv Pronertv Taxes 1()()4.CountvPro~nvTaxes 1005. Annual assessments 1006. 1007. 1008. Allllrellate AccountinlZ Adiustment 1100, TITLE CHARGES 110 I. Settlement or c10sinll fee to 1102. Abstract or title search to Niven J, Baird 1103. Title Examination to 1104. Title insurance binder to 1105. Document nrenaration to 1106. NotaN fees to Denise Pinamonti 14 .00 1107. Attornev's fees to Hubert X, Gilrov ESQuire POC (includes line numbers: 1101 11051 1108. Title Insurance to Conestoaa Title Ins/PA Real Estate Services 988.75 (includes line numbers: 1102 -1105) 1109. Lender's coveralle $ 126 000.00 1110. Owner's CO\'eralle S 126 000.00 1111. Endorsements: 100 300 8,1 150.00 1112. 1113. 1200, GOVERNMENT RECORDING AND TRANSFER CHARGES 120 I. RecordinlZ fees: Deed S 38,50 Mortllalle $ 44,50 Release S 83.00 1202. Citv/cntv ta'l. 'stamos: Deed S 1 169.00 MortlZalle S 1 169.00 1203. State tax./stamns: Deed S 1 169.00 Mortllalle S 1 169.00 1204. 1205. 1300. ADDITIONAL SETTLEMENT CHARGES ,. 130 I. Survey to 1302. Pest insoection to HomeChek 40,00 1303. Water Test to HomeChek 35,00 1304. Whole House Insnection to HomeChek 235,00 130S.Seotic Certification and Service to D.E.W. &. Sons 188.00 250.00 1306. PA Inhe::-itance Tax to Reaister of Wills 9 000.00 1400, TOTAL SElTLEMENT CHARGES (enter on lines 103 Section J and 502 Section K) 12 920.72 17 433.00 CERTIFICATION: I have carefully reviewed the HUD-I Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receIpts and disbursements made my ~ount or by me in t' nsacti. I further certify that [ received a copy of the HUD-I Settlement Statement. Sell<< 4:J. Bstate 0 Jeffrey L. Brandt B!6hU> ~~ d~~A..;)/. 7~d *h\l\ll~.\.. f\\luAJ Seller' Executors: Charles W, Brandt Borro er 1;- JENNIFER A. DARR The HUD-I Setllcn~ent Statement which I have prepared is a true and accurate account of the funds disbursed or to be disbursed by the undersigned as part of the settlement of this transaction. ! 05/02/2003 Set ent A t PA Real Estate Servic Inc. Date WARNING: t is a crime to knowingly make false statements to the United States on this or any other similar fonn. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. (Q EASY SOFT, In..:. 2001 Previ 1 I I . ! ~ I I I :\ tqeD I ! Tyco Retirement Savings and Investment Plan Account Statement October 1, 2001 - December 31,2001 Account Number: 187582044 #BWNFXPQ ENV#KG007783 MG 37662 35732 A JEFFREY l BRANDT 19 BEECHER DRIVE CARLISLE, PA 17013-7907 tz Tyco Benefits Center: 1-888-222-TYCO (8926) Representatives are available from 8:30am to 8:00pm ESI any business day, Account information is also available 24 hours a day through the benefits line or www.401k.com A Message From TYCO Two Ways To Boost Your Retirement Savings: If you'd like to save more for retirement, the Economic Growth and Tax Relief Reconciliation Act of 2001 (EGTRRA) gives you two ways to make it happen. First, EGTRRA increases the amount you may elect to contribute to your TYCO RSIP account on a pretax basis. The maximum annual elective pretax contribution will increase to $11,000 in 2002. Second, EGTRRA increases the amount of total contributions that can be allocated to your account during 2002. For 2002 the total amount of employee and employer contributions that may be allocated to your account is $40,000. Now is a great time to take advantage of these historic opportunities by increasing your retirement plan contributions to your TYCO RSIP account. To learn more about saving and planning for retirement or to change your deferral amount, please log onto www.401k.com. or contact the Tyco Benefits Center at 1-888-222-TYCO (8926), Representatives are available to assist you Monday through Friday from 8:30 a.m. to 8:00 p.m. E.T, Your Account Summary Your Asset Allocation Beginning Balance Your Contributions Tyco's Contributions Change in Account Value Ending Balance Additional Information . Vested Balance . Dividends & Interest $9,347.64 327,14 272.61 1,068.35 $11,015.74 $11,015.74 $130.02 . Stocks 83% . BondlMangd Inc 170{ Your Personal Rate of Return This Statement Period 11.3% Year to Date -11.7% Your Personal Rate of Return is calculated with the time-weighted fonnula, a formula widely used by financial analysts to calculate the Investment earnings of a portfoUo. It reflects the results of your investment selections as well as any activity in the account. There are other Personal Rate of Return formulas used that may yield different results. Remember that past perfonnance is no guarantee of future results. Your investments are allocated among the displayed asset classes as of the end of this statement period. Changes made after the end of this statement period Will be reflected in your next statement. Percentages and totals may not be exact due to rounding. The Additional Fund Information section lists the allocation of your blended funds. Please read this statement carefully. Any error must be reported to Fidelity Investments within 90 days. 7783 MG007783 0001 20020118 MG4K Fidelity Employer Services Company, P.O. Box 770003, Cincinnati, OH 45277-0065 18758204 Page 1 of: i Tyco Retirement Savings 'I and Investment Plan I i I I , Statement Period: 10/01/2001 to 12/31/2001 Account Number: 187582044 Market Value of Your Account Displayed in this section is the value of your account for the statement period, in both shares and dollars. Shares/Units on 09. Shares/Units Price on Price on on 12/31/2001 09. 1 Market Value a Savings and Investment Plan I e~d1d;:EijJ.tli:"I~lHm:j:l:i:Hm;;:if.f.mi;j:if.i:::U:mmi:f.i:mi:j:lHt:i:j:i:j:!:!:mmii;iij:J:ii:J:i:i:!:i!:!:i!:!:mj:!:f.ii:1:mm!:;:!;i:!;m:j;!:!:ji:f.::j:f.!:j:!:W;i:~!:!Wi!l!:fiMi:i:!:i:l:!;mmf:mmf::.~m~M:i!;ml:f:f.j:i:mm!j:!lI:~:~.l$~l1lj: FidFreedom203O 818.532 877.049 $11.42 $12,56 9,347,64 11,015.74 Remember that a dividend payment to fund shareholders reduces the share price of the fund, so a decrease in the share price for the statement period does not necessarily reflect lower fund performance. *Some of your investments are classified as a Blended Fund Investment. Blended Investments may include a mixture of stocks, bonds anellor short-tenn assets. Please refer to the "Additional Fund Infonnadon" section to detennine the allocation of your blended investments' underlying assets. The asset breakdown of your portfolio is reflected in the pie chart in the . Asset Allocation" section. Your Contribution Elections as of 01/17/2002 This section displays the funds in which your future conbibudons will be invested. Savings and Investment Plan I Investment Fid Freedom 2030 Total Percent 100%, 100% Employee Employee Tyco Company Contribution Summarv Pre Tax Basic Pre Tax Vol Match This Period $54.52 $272.62 $272.61 Fidelity to Date $726.10 $8,043.66 $3,630.67 Vesting Percent 100.00 100.00 100.00 Your Account Activity Use this section as a summary of transactions that occurred in your account during the statement period. Savings and Investment Plan I Activitv Beginning Balance Your Contributions Tyro's Contributions Change in Account Value Ending Balance Dividends & Interest Fid Freedom 2030 $9,347.64 327.14 272.61 1,068,35 $11,015.74 $130.02 7783 MG007783 0001 20020118 MG4K Fidelity Employer Services Company, P.O. Box 770003, Cincinnati, OH 45277-0065 187582044 Page 2 of 6 ... CHARLES W. BRANDT and : IN THE COURT OF COMMON PLEAS OF SUZANNE W. BRANDT, Administrators: CUMBERLAND COUNTY, PENNSYLVANIA of the Estate of JEFFREY L. BRANDT, Plaintiff v : NO. 2002- 386 ~ KENNETH C. HAIR, Defendant COURT ORDER AND NOW, this --i.!:L day of August, 2002, upon consideration of the attached Petition for Settlement of Wrongful Death Claim filed pursuant to Pennsylvania Rule of Civil Procedure 2206 and Settlement of Survival Action filed pursuant to 20 Pa.C.S.A. Section 3323, it is ordered and directed as follows: 1. The above captioned action is hereby ordered settled and discontinued. 2. The settlement amount of $300,000.00 is hereby approved, with said amount allocated in the amount of $250,000.00 from the Nationwide Insurance Company liability policy provided to Defendant Kenneth C. Hair and $50,000.00 from the Nationwide Insurance policy for underinsured motorist benefits provided to the Decedent Jeffrey L. Brandt. 3. The Administrators for the Estate of Jeffrey L. Brandt are hereby authorized to execute releases in favor of Nationwide Insurance Company and Kenneth C. Hair in connection with all liability claims relating to the accident involving the Decedent Jeffrey L. Brandt which occurred on January 6, 2002, and the Administrators are also authorized to execute all necessary releases in favor of Nationwide Insurance Company in connection with any underinsured motorist benefits owing pursuant to the automobile policy issued by Nationwide Insurance Company to Jeffrey L. Brandt. 4. The total settlement of $300,000.00 is allocated with $180,000.00 payable to the wrongful death claim and $120,000.00 payable to the survival action claim. 5. A legal fee in the amount of $75,000.00 is hereby approved payable to the law firm of Broujos & Gilroy, P.C. This fee is allocated with $45,000.00 to the wrongful death claim and $30,000.00 to the survival action claim. ~ 6. Petitioners Charles W. Brandt and Suzanne W. Brandt, who are the surviving parents of the Decedent Jeffrey L. Brandt, shall equally share the proceeds from the wrongful death action. 7. The proceeds from the survival action shall be payable to the Estate of Jeffrey L. Brandt and shall be administered as an asset of the Estate and distributed in accordance with appropriate law. BY THE COURT, /s/ By: ~+^ ~. I3Gl:l~d ' J. cc: Hubert X. Gilroy, Esquire ~ ~~O~~ $">ok ~ .JoJ~.1 'f f.l~ f f;~: ~'?'('T\~";,~V FROM RECORD ~ ~~. (,,v. - 'o!;-:.~ ..dI '..",+ .J ! ~ \1 T i~~~1~(~ny ~Jii~~r~ I I t4sre unto set my hano ;'.'~"$i i" 0",...2 of said Cri\CJrt at Carlisle. PI. r,~i.. ~ ~z- .....------.......... Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S, Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 1195 12/12/2006 T effrev L. Brandt 21-02-0035 JOHN BROUJOS 4 NORTH HANOVER STREET mw CARLISLE, P A 17011 Qty 1 Fee Description Additional Probate Fee Total 75.00 $75.00 Total: $75.00 VJ. ",\{)\6lP~v',L f J4) .1 &~g~ \c/ . ~ \ ') 10 '1 \, ^ l~ \,~ (\ ~ ),,1 l fie ( Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (71 7) 240 - 6345 Date: 12/27/2006 GILROY HUBERT XAVIER 4 NORTH HANOVER STREET CARLISLE, PA 17013 RE: Estate of BRANDT JEFFREY L File Number: 2002-00035 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 1/06/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~., , V,; ,.If, f If . - f _ _ ,';,^ ! -,:,~ ,t", It/~ ,~~~J__ V~~iL;'U i~""':'4:tr4:.f,/;ct~_/ t ~. -,' Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) \ Lff Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/27/2006 BRANDT CHARLES W 2055 WALNUT BOTTOM ROAD CARLISLE, PA 17013 RE: Estate of BRANDT JEFFREY L File Number: 2002-00035 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: 1/06/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, c., "~ .f"" I' /J , ",'~ " 'i' i, 7":/'i!h.....,. J !,..if//.J""./I."~, " \:....ir;:J;-'V"i::fj'.,/':-' ...Jt'_~..;.i.A';:",,~ ,/'1. l.../ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/27/2006 BRANDT SUZANNE W 2055 WALNUT BOTTOM ROAD CARLISLE, PA 17013 RE: Estate of BRANDT JEFFREY L File Number: 2002-00035 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing lS due by: 1/06/2007 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ~':" ~.t{!t' /".. t') F" ., . ,/. f _ _ _ '. f. _~ .1',/ '" ' "//iJ,..F'A I ;,..'h~v..<./ / ',.A.I'''.,.../1'7~y /' ~,'i;/~";"""" .......1.- ...........t:"~-(.\-:;/,-'" /~~" - '~ V ! Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel " - ) C<<" "\ Pa. D.C. Rule 6.12 STATUS REPORT REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Name of Decedent: JEFFREY L. BRANDT Date of Death: 01/06/2002 File Number: 21-02-0035 Pursuant to Pa. O.c. Rule 6.12, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: . , . . . . . . . . . . . . . . . . .. IX) Yes 0 No 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lfthe answer to No.1 is YES, state the following: a. Did the personal representa~iyefile a final account with the Court? . . . . , .. 0 Yes ~o b. ,The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account / informally to the parties in interest? ................"....,........ lla'Yes 0 No d. Copies of receipts, releases, joinders and approvals of formal or informal ac ts may be filed with the Clerk of the Orphans' Court and mched thi port. Date January 2, 2007 Signature of Person Filing this Form Hubert X. Gilroy, Esquire Capacity: 0 Personal Representative Hubert X. Gilroy, Esquire Name of Person Filing this Form 4 N. Hanover Street ,:nt.....r .1.-' '\I h...' r .,,, 1""0 :;,1\';:' dtJ J\ " \ '"rJi-I") Jj j,U 'J Address Carlisle, PA 17013 717/243-4574 12 :f; Wd 2- NVr LUOl Telephone Form RW-JO rev, JOY)6J'Ji:UC "9 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE <'r~"'\ {,'I~qJI,F~ OF INHERITANCE TAX .APPRArs~Jjt.E~T, ALLOWANCE OR DISALLOWANCE --;OF'DEDUCTIONS AND ASSESSMENT OF TAX *' DATE 03-05-2007 ESTATE OF BRANDT JEFFREY L DATE OF DEATH 01-06-2002 FILE NUMBER 21 02-0035 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 05-04-2007 ( See reverse side under Objections) A.ount Re.ittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~~!_~~~~~_!~!~-~!~~------~--_!~!~!~-~~~~!_~~!!!~~-~~!-!~~!_!~~~!~!_-~-------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRANDT JEFFREY L FILE NO. 21 02-0035 ACN 101 DATE 03-05-2007 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280'01 HARRISBURG PA 17128-0'01 "fln7 "'4 fI D Ii :I r ~ f'';'j. I; i ,'1' . J... .. '.;~ i. ,. id' " .,. M-'j 8: 22 CLEr~i:< ORH!/\\.::::~: HUBERT X GILROY E"H' . .-' BROUJOS & GILROY 4 N HANOVER ST CARLISLE PA 17013 REV-1547 EX AFP (0'-05> ) CHANGED TAX RETURN WAS: (X) ACCEPTED AS F I LED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax If an assess.ent was issued previously, lines 14, 15 and/or 16. 17. 18 and 19 will reflect figures that include the total of Abb returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate NOTE: 19. Principal Tax Due C A N DATE 09-06-2002 01-02-2004 116,900.00 11,015.74 .00 .00 138,754.71 .00 .00 (8) (1) (2) (3) (4) 0)) (6) (7) NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 266,670.45 (9) UO} 9,596.00 80.437.91 (11) (2) (3) (14) 9D.D~~ 91 176,636.54 .00 176,636.54 (5) (16) (17) (18) .00 X 176,636.54 X .00 X .00 X 00 045 = 12 = 15 = .00 7,948.64 .00 .00 7,948.64 (19)= I NUMBER CD001594 CD003401 (+) INTEREST/PEN PAID (-) .00 49.50- AMOUNT PAID 7,179.19 9,000.00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 16,129.69 8,181.05CR .00 8,181.05CR ( IF TOTAL DUE IS LESS THAN .1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DU~ A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) , BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 2B0601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STAt~HENT OF ACCOUNT *' REV-1607 EX AFP (03-05) 'n I 3D" If). :; (1 \ iI ;:'.' '-':) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 04-02-2007 BRANDT 01-06-2002 21 02-0035 CUMBERLAND 101 JEFFREY L HUBERT X GILROY ESQ BROUJOS & GILROY 4 N HANOVER ST CARLISLE PA 17013 \- , Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS +- --------------------------------------------------------------------------- REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT ... ESTATE OF BRANDT JEFFREY L FILE NO. 21 02- 0035 ACN 101 DATE 04 - 02-2007 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 02-26-2007 PRINCIPAL TAX DUE: 7,948.64 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-06-2002 ~DOO1594 .00 7,179.19 01-02-2004 CD003401 49.50- 9,000.00 03-16-2007 REFUND .00 8,181.05- TOTAL TAX CREDIT 7,948.64 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) .~v