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HomeMy WebLinkAbout09-16-08 (2) 15056051058 06 REV-1500 EX 05 PA Department of Revenue ( - ) OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 08 0804 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 06/28/2008 02/12/1918 Decedent's Last Name __ __ Suffix Decedent's First Name MI ......... - __ _ _ BRINKERHOFF HELEN L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~' 1. Original Return ~':;,`~+ 2. Supplemental Return .€ :°„~ 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate !'~;',~ 4a. Future Interest Compromise (date of „;,~„ 5. Federal Estate Tax Return Required death after 12-12-82) • 6. Decedent Died Testate ~ ;~; 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) __., 9. Litigation Proceeds Received ,~:~ 10. Spousal Poverty Credit (date of death €~: ~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name _ Daytime Telephone Number - THOMAS E. FLOWER - __ _ r.,~ (717) 737-34~ Firm Name (If Applicable) __ ,~ Q _ __. ~ ~.I ~ ~,, ~ REGISTER Of` tN1L.t~9~1SE ~,L~ SAIDIS, FLOWER, LINDSAY ;,'t. __ First line of address - _._. -_ _,, ~, . ~, ~ ,.. ; 2109 MARKET STREET. __ _ - ~ , ~ ~ Second line of address ; ~ -~- -t .. i ~ '. City Or POSt Office.. State....... ZIP Code DATE FILED _- CAMP HILL _ PA 17011 Correspondent's a-mail address: Under penalties of per'ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, Corr tan CI ation of preparer o r than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE PER R SPON IBLE (LING RETURN ATE --_ __- _ _ _ - --. -~_b!_~ 8 - ADDRE - - WILL M W. BEIBL , 805 ROSEWOOD DRIVE, CHESTER SPRINGS, PA 19425 - - - - - - - __ - I RE OF PREPARER OT AN REPRESENTATIVE DATE ADTSRESS - - -- - - --- _ ~- SAIDIS, FLOWER & LINDSAY, 2109 MARKET STREET, CAMP HILL, PA 17011 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number ............._....... . _. decedent's Name: HELEN L BRINKERHOFF _......., M._......... RE __.. .,~.._......... _ ~............ __.... _....., CAPITULATION ,_..,___....._..__ _~._ ~..,_ ___...... _......_ ............._~ 1. Real estate (Schedule A) . ......................................... ... 1. 2. Stocks and Bonds (Schedule B) .................................... ... 2. 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. 177,105.35 6. Jointly Owned Property (Schedule F) ~ ""::; Separate Billing Requested .... ... 6. ', 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property `" (Schedule G) Separate Billing Requested..... ... 7. 23,546.16 __ _. 8. Total Gross Assets (total Lines 1-7) ................................. ... 8. 200,651.51 9. Funeral Expenses & Administrative Costs (Schedule H) .................. ... 9. 6,538.56 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............. ... 10. ' 1,334.53 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ' 7,873.09 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. 192,778.42 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ...................... .. 13. 0.00 14. __. Net Value Subject to Tax (Line 12 minus Line 13) ...................... ~... ww.-_ _e.._ ___... _-~ _ _ _ ...... _ .. 14. 192,778.42 . . ~ . _ 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_ 15. 16. _. Amount of Line 14 taxable at lineal rate X .0 _ 16. 17. Amount of Line 14 taxable _.. at sibling rate X .12 17 18. Amount of Line 14 taxable at collateral rate X .15 192,778.42 18 ', 28,916.76 '' 19. TAX DUE ....................................................... .. 19. 28,916.76 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 REV-1500 EX Page 3 File Number uCl.C4Cr11, VVIr1~716T~ /'~1QQf@55: DECEDENT'S NAME HELEN L BRINKERHOFF __ STREETADDRESS 770 S. HANOVER STREET ___ CITY CARLISLE Ll UtS VtSU4 DECEDENTS SOCIAL SECURITY NUMBER 207-07-6126 STATE zlp PA 1 17013 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 28,916.76 2. CreditslPayments A. Spousal Poverty Credit 6. Prior Payments 27,471.00 C. Discount - - _ _ 1,445.80 Total Credits A + B + C 2 ( ) O 28,916.80 3. Interest/Penalty if applicable D. Interest -- E. Penalty - - Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, 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) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0.00 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 :.......................................................................................... ^ b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ 0 c. retain a reversionary interest; or .......................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. ^ ^x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ ^x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ ^x ^ 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. §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 zero (0) percent [72 P.S. §9116 (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 (O) percent [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 four and one-half (4.5) percent, 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 twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling 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-1508 EX+ (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, Ot MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN L. BRINKERHOFF 21-08-0804 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. PNC Bank acct. #51-4000-7194 1,856.95 2. PNC Bank acct. #50-0317-3137 1,335.97 3. Refund of overpayment, Chapel Pointe 633.03 4. Refund of overpayment, Highmark 167.90 5. $50 SERIES EE US SAVINGS BOND DATE 04/1992, N0. L480907944EE, REDEMPTION VALUE 59.56 6. SMITH BARNEY BANK DEPOSIT PROGRAM ACCOUNT, CASH ON DEPOSIT 12,134.76 7. CERTIFICATES OF DEPOSIT, PRINCIPAL ($159,000.00) PLUS ACCRUED INTEREST ($1,917.18) 160,917.18 (FOR CERTIFICATES OF DEPOSIT VALUATION SEE ATTACHED SMITH BARNEY STATEMENT) TOTAL (Also enter on line 5, Recapitulation) $ I 177,105.35 (If more space is needed, insert additional sheets of the same size) Total Banking Statement PNCBANK PNC P,~trtk For the period 06/05/2008 to 07/03/2008 N ****** 114 HELEN L BRINKERHOFF 10 SHOVER DR o CARLISLE PA 17013-8480 Primary account number: 51-4000-7194 Page 1 of 4 Number of enclosures: 0 ~ For 24-hour banking, and transaction or interest rate information, sign on to 'Q PNC Bank Online Banking at pnacom. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espaRol, 1-866-HOLA-PNC Moving? Please contact us at 1-888-PNC-BANK ~ Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 ror hearing unpaired clients otil~• Relationship Overview Bank Deposit Accounts Description Account Number Deposit Balance Interest Chet~kin~ ri1-4000-'7194 Perfunnance Afune}~ Market 50-0317-5157 Total lleposits .1,5!'15.3 1 I,33G.5ri 4,fi89.89 I1~IPORT ANT INFORI\IATIO'~I ABOUT YOUR ACCOUNT Effective September 19, 2008 we will change the way we detet~nnte if you have sufficient available fiulds to pa}~ checks or other withdrawals from your account. Please see the enclosed insert for snore details regarding these changes. OVERDRAFT PROTECTION for your PNC Bank checking account If you haven't already done so, stop into yo1.u• local PNC Bank branch today to open and enroll yourPNC Bank Select Rewards Visa Plati7nun Card. ~~l/hat could he better than the safety- and comfort of ]mowing you4•e protected? Senior Premium Plan Helen L Brinkerhoff Interest Checking ~c~ount Sumirary Account number: 51-4000-7194 Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 7,306.43 1,496.39 !'i,949A8 3,3!13.34 Average monthly Charges balance and fees 5,55 i.7] .00 Transaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 2 0 0 Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 0 0 0 Please see the Activity Detail section for additional information. FORM953R-1005 Total Banking Statement For th• prariod 06/Off/Z008 to 07/03/Z008 For 24•hour information, sign on to f'NC Bank Online Banking HELEN L BRINKERHOFF on pnc.cortt. Printery account number: 51-4000-7194 Ae•count nuntlxrr: K (.41)OU-7 t 44 • corttinue•d Page 2 of 4 interest SumMary As of 07/03, a total of $2J9 In interest was paid this year, Annual Perpntaga Number al days Average collected IMerost Pald Yield Earned (APYE- In Interest period balance for APYE this period 0,04-Y, '.4t ~i,!'i!i7.•] l .a<r Activity Detail Deposits and Other Additions Dais Amount Description U7,~t)I 1,0~t1,(N1 Uircct llct>nsil - ~':\ Renc•fit t?S'lleasut)•'3`3t) t);~SG8~1:~~1 lt) lU 07,!0`. 405.0(.) 1?irrct Urlxsit • Ann ['~•utt htetlili~ tnvr;tur A'207I04)1 O7!Og ,g9 Intcrrst Pa~•ment There were 3 Deposits and Other Additions totaling $1.496.38. Cheeks and Substitute Checks Check Date Referonce Check pate Reference number Amount paid number number Amount pied number _'_' I l 5,179.10 (k ~_3 tk~kyt2575o ?'21'~ 7iU.gf3 lN~! 1 R iiy~>~t2 { t.~yj " Gap in check sequence Tltere ware 2 checks listed totaling $5,949.48. Daily Balance Detail Dais Balance Date Balance Date Balance tki,'t)~i j,r;Oti.~l:i O(ij~;i t,$Sti.`1°i i)~,'(i'~ `)')a'.:.'a:~ O(i' I$ i,l);tli,l)[i I)']; bl °,41~17.41;i (Y]; t)`t ;i,a~i;),:)~1 Your Aioncy. Four I3usincss. YOUR Ft?Tt?ltl:. PNC Investnrenatc cwn help ~~ou get n-ore nri/mge from lwar financial rrlaNonchip, 3l'e aro a talrrable parnrcr ors ynurfrrrarrcial jounrey. No matter tti~-cther your destination is cdncariort or rt^tiroment xr hati+c the products acrd services to he/p you map your >•tay to a sccunc financial firturc. For mono inforntatiorr stop by a PNC Branch or visit p-rc.com. Not FDIC Incarccl * ~lu~• [.ose ~'>atae `~ No bunk Gnuruntec Luporfs~nt [m•estor lafortmation; Securilics and ltrokcrnge services an provided by PNC Invesbnents I.I.C, ntetnher F1NR:\ and S1Pt', :\nnuities and other insurnrn~: products art; ollemd by PNC' Illsllrn116'l` Ser,•itxs, Ia,C a li~`ensed iusurnnce regency. Our FHA Home Loans Can Help You Achieve Your Goals More Easily tl1hetltcr it's your first hame or your fiwrih - an rI I:\ loan can place your goat tt•ithin closer mach, -Ptttrhase a home ~~•ith little ntoncy do~~7t, -(~•erconu credit challenges, including a limited or Icss-than-perfect cmdit history, for qualified applicants. for mom infannation on mortgage products: Stop at your local batik brnrtclt Visit us at pncmorigagc,com Call our ntortcacc team at 300-773-0,674 Senior Premium Ptan Helen 1. Brinkerhoff Performance Money Market Account Summary Account number: 50-0317.3137 Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 1,03~i,9'] 4(x).~i3 ,(K) I,R3ti.!i~i Average monthly Charges balance and lees 1,2Y`~. I9 .00 Please see rite Activity Detail section for additional information. Total Banking Statement PN C BANK For tl>re period 06!05/2008 to 07/03/2008 ~, For 24-hour information, sign on to PNC Bank Online Banking HELEN L BRINKERHOFF on pnc.cotn Primary account number: 51-4000-7194 Account number: 50-(1317-3137 -continued Page 3 of 4 Interest Summary As of 07/03, a total of $37.97 in interest was Annual Percentage Number of days Average collected Interest Paid paid this year. Yield Earned (APYE) in interest period balance for APYE this period 0.601 29 1,`'22.7 9 . r,5 Activity Detail Deposits and Other Additions There were 2 Deposits and other Additions Date Amount Description totaling $300.58. OG; 1(i 300.00 Deposit Reference No 042195514 ~ 0'703 .55 Interest. Pa~~ment Daily Balance Detail Date Balance Date Balance Date Balance 0ti!05 1,03ri_97 06, IG 1,335.97 Ol/03 1,336.55 FORM953R-1005 Total Bankuig Statement For th• period 08/OS/Z008 to 07/03/Z008 For 24-hour information, sign on to PNC Bank Online BAnkinq IIELEN L BRINKERHOFF on pnc.com. 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NON-PROBATE PROPERTY ESTATE OF FILE NUMBER HELEN L. BRINKERHOFF 21-08-0804 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER.ATTACHACOPYOFTHEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE t. MET LIFE INVESTORS ANNUITY CONTRACT#A2072092 , 23,546.16 100 23,546.16 DEATH BENEFIT PAYABLE TO NEPHEWS WILLIAM W. BEIBLE, JR. and RONALD B. BEIBLE TOTAL (Also enter on line 7 Recapitulation) $ I 23,546.16 (If more space Is needed, Insert additional sheets of the same size) ~ M C ~ ~ ~ O V O ~ Q ~ '- '- W *- '.~ ~~11~ Z F- .- ao ~ ~`~Ha .... O 7 fl ~ ~ ~l T Z ~ YJ d W ~~ ,~' ~ C fA ZQS ~ O v ~ a o ~ _ m Q Oac~U E h `~ +l = ' C ~ " 1 ~1 v c ,ti Z a ° ~ f o t7C ~ ~ ~ N ! ! ` C ~ `~ c° O `-"° ~ o v . ~ " z _ ~ ~,, ~ ~ ~ Q LJ <? ~ v (~ ' > r U m ~ ~ n N Z ~zr. oo ~ m v } ~n U r Q s , n N ~ C7 ~ _ _~ r (O ~ z ~~ Q = o °Nx ~ O u ~~Q Wzo~ ~ _~JO~ EO .~ ~ Z W Q ~a N m ~w co I ~ -~ ~ Cn W ~~+ ~ o -zQOF- = w - oC cn _ J J ~ W ='S°mU 0 o cD 0 0 ~- 0 o co ~ c~ v ~i N H3 .N. W ~, m .~ ~ ~ ~ ~'" N c,,U > 'a ~ N ~ L O w ~, v ~ a~ N N ~ U Q T. f Qi Z Q W Uf c v Z N t O a~ N Q c0 r cc M C3 O N M d 7 l0 d Q io O F- ca v ~ ~ co i.ti co ao ~ rn ri ri N N ~ ~ O O pp N 0 coy m _ ~ m s~ i U c0 d O p ~ ~ m > > ~ J C ~ ~ 7 Q Q ~ ~ F~ H L_ N 3 ~ a ~ o ~ .~ ~ Q °-' a aroi nS ~. ~ ~ N t i ~ O O U ~ ~ .yam. ~ _~ N U o -a ~ c o ~ r~ C ~ ~ (d 7, ~ t ~ ~ _ cd 'a LL 7 ~ ro ~ ~ ~ O ~ ~ ~ U m ~ ~ ~ N +"~. U Z ~ ~ ~ =v"= ~ O ~ 1+ ~ ~ ~ 0 N ~ ?. !~ i ,Ww -/ H 4 c c~ c ~ 3 0 U ~°c~ m c ~U ~ C ~ w ii ~- O N m N ~ ~ m ~ ~ ~ ~ c U ~ Z `~ ~ ~ O O 3 a ~ s °y~ U m -,m m O O ~~ ~- O N Q ~ ~ ~ ~ ~ U 0 0 0 a~ .~ a O Q Y ~z ~ ~ ~m O --~ ~ Z ~ W '~ _ z ~, ~^ ~~ ~ W v ens ~ a ~ '~ ~ a ~~~~~ ~~ 9 ~_ Q0. ~ a O LLa U y ' a a v a '- > E ~ ~ d ~ ~ 6 B ' ~ QQQ S ~ ,°, ~ ~ W ~ ~ ~ ~ ~ ~ ~ ~ v n ~ ~ H ~_~ ~ ~ a ~~ c ~Y ~ p1 '¢ s W ~ u ,n .~ -: A u a` ~, 2 REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN L. BRINKERHOFF 21-08-0804 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~' GINGRICH MEMORIALS, HEADSTONE AND ENGRAVING 975.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City .State .Zip Relationship of Claimant to Decedent 4. I Probate Fees 5. Accountant's Fees 6. Tax Retum Preparer's Fees ~. PUBLISH EXECUTOR'S NOTICES TOTAL (Also enter on line 9, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 5,000.00 306.00 257.56 6,538.56 REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER HELEN L. BRINKERHOFF 21-08-0804 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. fir more space is neetletl; insert atltlitional sheets of the same size) REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER HELEN L. BRINKERHOFF 21-08-0804 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE t TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 ~ RONALD B. BEIBLE, 1875 SURREY LANE, LAKE FOREST, IL 60045 NEPHEW 1 /2 2• WILLIAM W. BEIBLE, Jr, 805 Rosewood Dr, Chester Sprgs., PA 19425 NEPHEW 112 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF HELEN L. BRINKERHOFF I, HELEN L. BRINKERHOFF, of Carlisle, 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 all other Wills and Codicils heretofore made by me. FIRST I direct the payment of my just debts and the expenses of my last illness and SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEYS•AT•IA1N 2109 Market Slreet Camp Hill, PA funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment owned by me at the time of my death, I authorize my personal representative to purchase such cemetery lot with a contract for perpetual care, using therefor funds from my estate in such amount as he shall consider necessary and desirable, and I authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall designate. Further, I authorize my personal representative to expend funds from my estate, in such amount as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. SECOND I give, devise and bequeath all the rest, residue and remainder of my estate, in equal shares, unto my nephews, WILLIAM W. BEIBLE, JR. and RONALD B. BEIBLE, per stirpes. THIRD I direct that any and all inheritance, estate, and transfer taxes imposed upon my estate passing under this Will or otherwise shall be paid out of the principal of my residuary estate. FOURTH I hereby nominate, constitute and appoint my nephew, WILLIAM ~!' BEIBLE, JR., to act as Executor of this my Last Will and Testament. Provided that, if WILLIAM ~!I! BEIBLE, JR. is unwilling or unable to act as Executor, I direct that the duties of Executor be performed by my nephew, RONALD B. BEIBLE. FIFTH I direct that no personal representative appointed under this instrument shall be required to give bond for the faithful performance of his duties in any jurisdiction. SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEYS•AT•(.A W 2109 Market Streel Camp Hill, PA 2 IN WITNESS WHEREOF, I, HELEN L. BRINKERHOFF, have hereunto set my hand and-s-eal to this my Last Will and Testament, this ~ day of r~c,~--~ , 2005. `~ ~ ,~,.{ i' r i ~~ -~ _ HELEN L. BRINKERHOFF Signed, sealed, published and declared by the above-named HELEN L. SAIDIS SHUFF, FLOWER & LINDSAY A'1TORNR}'S•A'PLAW' 2109 Market Slreet Camp Hill, PA BRINKERHOFF, Testatrix, as and for her Last Will and Testament in the presence of us, who have hereunto subscribed our names at her request as witnesses thereto, in the presence of said Testatrix and of each other. ADDRESS ~ ~~ ej /~L vvitness e- ~ /~. , Pit ~ ~'~/ ADDRESS ~G GU. ~7~t ~ Witne ,~' G~c~J' !~ / 7u ~j~ 3 COMMONWEALTH OF PENNSYLVANIA ss. COUNTY OF CUMBERLAND We, HELEN L. BRINKERHOFF, ~~~ ~• ~[~u+/eu- and SAIDIS SHUFF, FLOWER & LINDSAY Z1D9 Market Slreet Camp Hill, PA ~a-v. y ~ L-- • W ~ rte. ,the Testatrix and witnesses, respectively whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly and that she executed the instrument as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses and that to the best of their knowledge the Testatrix was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. f~~ HELEN L. BRINKERHOFF 4 V~ C \ fitness ,~~ ~-= itn s Subscribed, sworn to and acknowledged before me by HELEN L. BRIN ERHOFF the Testatrix, and subscribe to ands orn or affirmed to before me b ~~-,~r.ra ~_ anc~. witnesses, thisday of , 2005. Notary~yblic NOTARIAL SEAL AAERLENE J. MARHEVKA, NOTARY PUBLIC CARLISLE, CUMBERLAND COUNTY, PA MY COMMISSION EXPIRES JUNE 8, 2008 SAIDIS SHUFF, FLOWER & LINDSAY ATTORNEI'S•AT•lAW 2109 Market Street Camp Hill, PA 5