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Home My WebLink About03-0665 PETITION FOR PROBATE and GRANT OF LETTERS Estate of Ell ZtJ.. k.J-.h M ']." 1t1l-en No. ;2 /--63- 0 ro5 also known as To: Register of Wills for the,' ( , Deceased. County of C I j IY1 be ran c in the Social Security No. L /3 - 67 - 7n() 7' Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or ~an the ~cut CD" vxe(~nie.s nam!d in the last will of the above decedent, dated / f2 rY) .' r- -2-2- , 19~ and codicil(s) dated (state relevant circumstances, e.g. renunciation, death of executor, etc.) C' let Decendent, then , 19 ;:<.J)O 3 at '':< Except as follows, decedent id not marry, was not divorced and did not h' e a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: co//' " (If domiciled in Pa.) All personal property $ ~ ~ J f'lrn.) (If not domiciled in Pa.) Personal property in Pennsylvania $ , (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: WHEREFORE, petitioner(s) respectfully presented herewith and the grant of letters theron. =-tP ~ ~' ~ ' ~ ~ . t:;, ~\ 0 / . .. ~ ~ v;- ~-....e) ('h-y1'/ ~ " . ~T ~)".:t3r;''''''n.. .ot~, ~. @<tt~:;; t{f:;;, .. iJy{O ~.~ :3;26 .--..Ie:). 1-..1:."- nrZ- ' ';:,. I r" ' f'V} ~~ Lees t- d.es+e.r P/1 I q 3g0 l-l-6 d ~ U 1-]1' 07 7 3/ ::l ~ t: 0/) t:Ii OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 1 ss COUNTY OF CUMBERLAND J 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate ~ccording to law. Sworn to or affirTI?fth and subscribed {'J. tfL~~ .~~yV 7i L~ ~ before me this day of ' ~ ST 2003 " e ~ ('};;..Q. <<r {6altdAJIiYI4 st Re 's ~ ~ /7-/5Ji- ~ No. 21-2003-665 Estate of ELIZABETH M. BRINTON , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW August 12th, ~ 200~ in consideration of the petition On the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated nP~~Oer 22nn. 1995 described therein be admitted to probate and filed of record as the last will of ELIZABETH M. BRIN'ION ; and Letters TF.!=;'T'~ARV are hereby granted to ANNE CHRISTINE HOL'ION, n/k/a ANNE BRI10N HOL'ION AND CAOOL ELIZABETH TISON, n/k/ a CAroL TISON ASHv.DRIH FEES b $ 200 .00 Pro ate, Letters, Etc. ......... Short Certificates( 10) . . .. . . . . .. $ 30.00 ATTORNEY (Sup. Ct. 1.D. No.) ~ x-.Pages. .912.).. $ 36.00 JCP $ 10.00 ADDRESS TOTAL _ $ 276.00 Filed . August. .12th.,.2003. . . . . . . . . . . . . . . PHONE Mailed Letters to Executrix Anne Christine Holton on 8/12/03 '\ ~~ ::~: l (j 9- r:c'. [0. 11105,805 IU'V 9/86 T1IS IS to certify rhat rhe information here given is correctly copied from an original certificate of death d,!ly filed with me as ! (lcal R~gisrrar. The original certificate will be forwarded to the State Vital Records Office for permanent tiling. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 J.uM4 0 &-l:'~~J.1t Local Registrar p 9331191 ~61 ,~tM3 No. Date 21-2003-665 rillb i43Aev 2187 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH - 'l'PEiPRINT IN -- STAlE FILE NUMBER )ERMANENT flAME OF DECEDENT (Fits. Middle. lilll) SEX SOCIAL SECURITY NUMBER OATE OF DEATH ,Mcf'lltl. 03)<. -<'earl .RACK INK I. ., Female .. 173 - 07 - 7004 .. July 5, 2003 AGE (last BlfltldaV) UNDER 1 VEAR BCATHPLACE (C.l~ M1d -1 lloyo Stale 01 foreqn CouOllYI 87 v.. Williamsport, E~_O ='r-,.IO . ., COUNTY Of DERH . Cumberland Lower Allen Twp, White .., 10, DECEDENT'S USUAL OCCUPRlON KINO OF BUSINESS/INDUSTRY MARITAl STATUS. Married SURVIVING SPOUSE (~t~~..~:OC:-:::t:T Nevet MMned. W~. lH... ~.... tn.lloen NmlII "'--_I I . I'.. Missiona 11". Widowed DECEDENT'S MAILING AOORESS (SIr.1. Cityflbwn. State.lipCodel DECEDENT'S Pennsylvania Lo'''er Allen ACTUAl '7.. SUlle Did ... 325 Wesley Drive RESIDENCE -- lSeelnSlruCllona ....in. I Mechanicsburg, Pennsylvania 170 OltI"tfSlde) Cumberland _, 17...0 :..~=of 11, 1111. Coun <_ FATHER'S NAME lFlfst, M.ddIe, Lasal MOTHER'S NAME (FilII. Middle. Malden Surname) 11, James L. McAbee ,.. Pearl Devilbiss INfORMANT'S NAME (TVP8/PrinC) INFORMANT'S MAIUNG ADORESS (SIr... CIl'yIbm. s..., Zip COde) Thomas L. ..... PLACE OF DISPOSITION. NamI 0Ic.m..ef)'. CI...woty O!' Other Place d Conolite Crematory SChaefferslown, Pa 17088 " NAMe AND ADDRESS OF AAC!UTY :0 " 1 LICENSE NUMBER DAlE SIGNED 'hlo . .RN5d,~\4L IM:::JQaV' YeiWl I .:Ie. u.\ 5 'MS CASE REFERRED TO ~ EXAMINERlCORONEA1 I >t. ~.W No~ I A(;JpnWmate PART It: 0Ih. aignificant c:ondiaioneoonttlbul:ingrodhth. but '-- noI ,.....inQ in the undtrtying cause QN'" In PA.AT I ~~ ~ I onMt and de.... . /0 DUE to (OA AS A CONSEaUENCE OF): I : DUE 10 (00 AS A CONSEQuENCE Of)" OUE 10 (OA ASACONSEOUENCE Of) WERE .4UlOPSY FINOINGS MANNER OF DEATH DATE OF INJURV TlU. OF INJ AY INJURY AT WORK? DESCRIBE HON INJURV OCCURRED AVAtl.A8LE PRNJR 10 {Month Da..,. "'_I COMPlEllOH OF CAUSE S- O OF DEATH? Nilfur" HomicicM ,...0 NoD .<c_ O Pendingln..,..tigIIllon 0 ,...0 No8 0 o PLACE OF INJURY. AI hamll. farm,....... taclOty. omc. ... SUicide CoutQ not be determined ..., .... . bui6dinQ, etc. ISpec"vl ... '00, CERTIFIER lC~eck Ot'lly ~l I .CERTlFYING PHYllClAH (Phr$lCI&r\C8fWy"'9 cause 01 ueath wtlttfl anolhef phYSiCoan I'lioIs pronouocad oeall'l ana clXTlpteled Item 231 To &hI _at 01 my Itno_ledge, ..th oceuneGl4ut>lo tht' c.t;u(s).nd mlnn.,.s .t.tlld. . ..... . PRONOUNClNQ AND CERTIFYING PHVSICIAN tPhrSIClCln boCI'l OltOOQu'lClf'Ig l.hlolll'1 and cefllfYIl19 10 cause 01 dedlh) ~ To It'I. ~ ~ my knowM6a', d.a"" occur'ed.1 U\e Urn', dele, and plec., and due tQ the c.u.eC') .nd m.nn.,.. ,t.lad . . . . . . . . . . . . . . w 'UEDICAL EXAMINER/CORONER " On the b..is o. ...mfn.'lon and/or Inv..tlg.lIon, In my opinion, de.th oc:cu"ed at Iha tlma, date, and place, .nd dualo Iha c.u..(s. .nd 0 ~ menner.s st.ted.. . . . . . . . . . , , . . . . . . , , . . . . . , . _ . , . . , . , . . . . , . , , . . . , . . . . . . . . . . . . . . . , . . , , . . . . . . " ,..........,......... 31. REGIS ~~I/ ~d ~I :lC. . .. .- _._~-_._----_.._------- --._--..-. - ---_.__..~.' ---.. ("oJ s:~ .- C- .-- ..-- CJ cD ~ \.....-) ,- P c __ .",1'''' _,.,ioo.-A LAST WILL ,~ 1--63 -- (p(p 5 OF ELIZABETH M. BRINTON I, ELIZABETH M. BRINTON, presently of Mechanicsburg, Cumberland County, Pennsylvania, do hereby declare this to be my Last Will, and do hereby revoke all prior Wills and Codicils hereinbefore made by me. 1. I hereby give and bequeath to my husband, HOWARD T. BRINTON (hereinafter referred to as limy husband"), if he survives me, my entire interest in and to any and all furniture, antiques, clothing, jewelry, pictures, statuary, works of art, silver, plate, ornaments, bric-a-brac, tapestry, household goods, utensils and supplies, books, linen, china, glass, automobiles, plants, implements, and tools that may be in, at or about our home at the time of my death, and all of my other tangible personal property, together with all policies of insurance thereon. If my husband does not survive me, all of the property above described in this paragraph 1, except to the extent that certain items thereof are set forth in a memorandum that may be attached to this Will, I hereby give and bequeath to my children, Carol Elizabeth Tyson, Anne Christine Holton, and Thomas Latimer Brinton, who may survive me at the time of my death, to be divided between or among them in as equal shares as may be possible, as they may . mutually agree; should my said surviving children be unable to agree between or G2:.y 1 ~ t... OJ IS r~' among themselves upon such a division of such property, I direct my executor to sell such property and distribute the net proceeds therefrom as part of my residuary estate. In the event that I am not survived at my death by my husband or by any of my above-named children, then all property which they would have taken under this paragraph 1 had they survived me shall pass as part of my residuary estate hereunder. 2. If my husband survives me at my death, I hereby give, bequeath and devise to him all of the rest, residue and remainder of my property and estate, of whatsoever nature and wheresoever situate, together with all policies of insurance thereon. 3. If my husband does not survive me, then all the rest, residue and remainder of my property and estate, of whatsoever nature and wheresoever situate, together with all policies of insurance thereon, I hereby give, bequeath and devise, as follows: (a) Seventy-five percent (75%) thereof to the United Methodist Stewardship Foundation of Central Pennsylvania (the "Foundation"), with its principal office currently located at 900 South Arlington Avenue, Lower Paxton Township, Dauphin County, Pennsylvania, or its legal successor, to be added to the United Methodist Stewardship Foundation Pooled Income Fund (the "Pooled Income Fund"), to be commingled with Q:y: 2 ~ €rnB -p;:r the gifts of other donors who have made or will make similar transfers, and managed and invested under the terms of the United Methodist Stewardship Foundation Pooled Income Fund Plan (the "Plan"). The Foundation shall divide such amount among accounts to be established for the benefit of my children, Carol Elizabeth Tyson, Anne Christine Holton, and Thomas Latimer Brinton, (hereinafter referred to as "my children") as follows: (i) Thirty-three and one-third percent (331/3%) thereof in an account for the benefit of my daughter, Carol Elizabeth Tyson; (ii) Thirty-three and one-third percent (331/3%) thereof in an account for the benefit of my daughter, Anne Christine Holton; (iii) Thirty-three and one-third percent (331/3%) thereof in an account for the benefit of my son, Thomas Latimer Brinton. If any of my children predecease me, his or her share of this bequest shall be divided equally between my surviving children and shall be added to their accounts in the Pooled Income Fund. During the lifetime of each of my children, the Foundation shall pay them from their respective accounts, such account's proportionate share of the Pooled Income Fund's income quarterly. Upon the death of each of my children, the property in Q~ 3 .~ 2n1 B the Pooled Income Fund attributable to the units in said child's account shall be divided and distributed to the accounts of my surviving children to be added to their respective accounts in the Pooled Income Fund. Upon the death of the last surviving child, his or her account shall be distributed by the Foundation in accordance with the provisions of paragraph 4 below. The obligation to pay income to any of my children shall end with the regular periodic payment date next preceding his or her death, and any income earned by the units in the Pooled Income Fund attributable to said child's account in the quarter in which he or she dies shall be paid by the Pooled Income Fund to either my surviving children or the Foundation, as the case may be, at the first regular payment date after the death of my child, and shall be held by the Foundation in accordance with the provisions of paragraph 4 below. Any income allocable to this bequest earned during the estate administration shall be paid to my children in equal shares and shall not be delivered to the Pooled Income Fund, either as principal or as income to be paid by the Pooled Income Fund to my children. (b) Twenty-five percent (25%) thereof to the Foundation to be added to the Pooled Income Fund as the Howard T. and Elizabeth M. Brinton Seminary Fund for the benefit of Kimbulu-Kayeka Theological Seminary, Mulungwishi, Southern Zaire, Africa, or its legal successor, and G:t_y 4 -* [;m6 \7Jff' managed and invested under the terms of the Plan. The Foundation shall pay to the Treasurer of World Division, United Methodist Board of Global Ministries, 475 Riverside Drive, New York, New York, for the benefit of the aforesaid Seminary, the proportionate share of the Pooled Income Fund's income quarterly, and may distribute the principal thereof upon a vote of two-thirds of the Foundation's Board of Directors. No federal estate taxes, state death taxes or any other estate, death or inheritance taxes (" death taxes") regarding these bequests shall be allocated to or be recoverable from the Pooled Income Fund. This provision may be enforced by my children and the Foundation, as charitable remainderman or trustee, acting alone or together. In making these bequests, I intend that my estate shall obtain the full benefit of any estate tax charitable deduction to which it may be entitled under the Internal Revenue Code of 1986, as amended. Accordingly, these bequests shall be interpreted consistent with my intent. 4. Upon the death of the last surviving child, his or her account in the Pooled Income Fund shall be distributed to the Foundation, or its legal successor, who shall hold such funds in trust as the Howard T. and Elizabeth M. Brinton Memorial Fund (the "Brinton Memorial Fund"). The Foundation may invest the Brinton Memorial Fund in such manner as may be determined by the Foundation in its sole discretion without regard to diversification as to kind or amount and without regard to the limitations imposed by law on investments. ~ 5 ( )/) 13 --r>>r The Foundation shall distribute the income from the Brinton Memorial Fund as follows: (1) Fifty percent (50%) thereof to the Camp Hill United Methodist Church, 417 South 22nd Street, Camp Hill, Pennsylvania, or its legal successor, to promote missions in and through said Church; and (2) Fifty percent (50%) thereof to the Neighborhood Center of the United Methodist Church, Inc., 1801 North Third Street, Harrisburg, Pennsylvania, or its legal successor, to be used at the discretion of its Board of Directors. The Foundation may distribute the principal of the Brinton Memorial Fund to the above-mentioned organizations in equal shares upon a vote of two-thirds (2/3) of the Foundation's Board of Directors. 5. In the event that my husband and I die simultaneously or under such circumstances that it cannot be established which of us died first, then my husband shall be deemed to have predeceased me for all purposes under this Will. 6. Should any legatee or devisee under this Will die within sixty (60) days after the date of my death, he or she shall be deemed to have predeceased me for all purposes under this Will. Provided, that if my husband survives me at my death but dies within sixty (60) days thereafter, he shall have for and during that portion of such sixty (60) day period as he in fact is alive after my death the ~ 6 CIne -~- right to the use and enjoyment as a life tenant of all property in which his interest hereunder will fail by reason of his death within said sixty (60) day period. 7. No interest of any beneficiary hereunder in either the principal or income of my estate shall be subject or liable in any manner while in the possession of my executor to anticipation, pledge, assignment, sale, transfer, charge or encumbrance, whether voluntary or involuntary, or for any liabilities or obligations of such beneficiary whether arising from his or him death, debts, contracts, torts or engagements of any type. 8. Except as otherwise restricted, directed or provided in this Will or required by law, in the administration of my estate, the trust estate or guardianship hereunder, the fiduciaries serving under this Will shall have the following powers, which may be exercised without leave of court, in addition to those powers as my said fiduciaries may have by law: (a) To sell, exchange, grant options upon, or otherwise dispose of any property, real or personal, tangible or intangible, or mixed, or interests therein, wheresoever situate, at any time held by them, at public or private sale, for cash or upon credit, in such manner, to such persons, and at such price, terms and conditions as they may deem best, and no person dealing with them shall be bound to see to the application of any funds paid to them. ~ 7 t. II) rS <JXrt-- (b) To distribute in cash or in kind, or partly in each, and in shares different in kind from other shares, upon any division or distribution of any property which they hold. (c) To the extent permitted by law, to exercise any election, right or privilege given by federal tax laws, or the tax laws of Pennsylvania or of any other jurisdiction, including but not limited to the joinder with my husband in filing income tax returns, the joinder with my husband in filing gift tax returns with respect to gifts made by him or by me or by both of us prior to my death, the consent on gift tax returns to have any gift made by him considered as made in part by me for gift tax purposes, the determination of proper taxes, interest and penalties and the payment thereof even though not attributable in whole or in part to income or gifts from my property or estate and without requiring my husband, his estate or his legal representative to indemnify or reimburse my fiduciaries for taxes (or penalties or interest thereon) attributable to my husband, and the election to claim deductions for death tax purposes or for income tax purposes, and for their exercise or non-exercise of any such election, right or privilege to make or not make in their discretion equitable or compensatory adjusbnents as between income and principal of my estate or any part thereof, or as between any beneficiaries thereof or their shares therein, all without the consent of any beneficiary thereunder and without any liability on the part of my fiduciaries for so doing. ~ 8 t /I jL.s <Jl;r (d) To make from time to time partial distributions in varying amounts to the beneficiaries hereunder prior to final settlement and distribution of my estate, and in connection therewith to determine in their discretion the time or times when such partial distributions may require recomputation of said beneficiaries' proportionate interests hereunder for the equitable allocation of income or on account of changing asset values pending final distribution. (e) In general, to exercise all powers in the management of the assets and property held by them which any individual could exercise in the management of similar property owned in his or him own right, upon such terms and conditions as to them may seem best, and to execute and deliver all instruments and to do all acts which they may deem necessary or proper to carry out such management and their duties under this Will. 9. I hereby appoint my daughters, Anne Christine Holton and Carol Elizabeth Tyson, to serve as co-executrices of my estate hereunder. Should both of my daughters be unwilling or unable, fail to qualify, or cease to act as such co- executrices, I hereby appoint my son, Thomas Latimer Brinton, to serve as executor of my estate hereunder. 10. The fiduciaries named or appointed in this Will, including any guardian of the person, shall not be required in any jurisdiction to file, enter or post any bond or other security for the faithful performance of their duties ~ 9 ~n18 hereunder, and shall not be liable for the acts, omissions or defaults of any agent appointed by them with due care. 11. Subject to the restrictions and limitations contained in this Will, I direct that all estate, inheritance, legacy, transfer, succession and death taxes, whatsoever nature or kind and by whatsoever jurisdiction imposed, and all interest and penalties that are on, which may be payable or assessed in the consequence of my death, whether or not with respect to the property passing under this Will, shall be paid out of and charged against the principal in my residuary estate in the same manner as are general administration expenses of my estate so that all property subject to such taxes shall pass free and clear thereof, without apportionment of or reimbursement for such taxes, interest or penalties among any beneficiaries, transferees or other persons interested in such property and without any right of any estate or executor to contribution, recovery or collection for the same. Taxes on any future remainder interest hereunder, shall be prepaid, at and in the election and direction of my executor, to the extent permitted by law. IN WITNESS WHEREOF, I, the said ELIZABETH M. BRINTON, hereby set my hand to this my Last Will, typewritten on and consisting of these ten (10) sheets of paper, at the bottom of each of the preceding pages of which I also have placed my initials, on this :2 A-Nlday of lJaa/}'/k,A.I ,1995. ~. ~~E'L- /)1. l~~ IZABETH M. BRINTON 10 On this 21.. ~day of CD~, 1995, ELIZABETH M. BRINTON declared to us, the undersigned, that the aforegoing instrument was her Last Will, and she requested us to act as witnesses to the same and to her signature thereon. She thereupon signed said Will in our presence, we being present at the same time. We now, at her request, in her presence, and in the presence of each of us, hereby subscribe our names as witnesses thereto and have placed our initials at the bottom of each of the preceding pages. By so doing, each of us declares that he or she believes this testator to be of sound mind and memory. r J~ Lhrri.lb41) GL c- residing at ....."..,...."...--.~ / C.......... residing at C"i: J-J,/I; fA ~ tl.,6ii:J residing at 4.~;; {/r1- ''-- '/ COMMONWEALTH OF COUNTY OF C U/77 bulalJ[{ 58. I, ELIZABETH M. BRINTON testatrix, whose name is subscribed to the attached foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed such instrument as my Last Will, and that I signed and executed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by ELIZABETH M. BRINTON, the testatrix, this ?.J..hd day of J!je.-u-T) ~ 1995. ~~~/l).~ LIZABETH M. BRINTON ~/iil~ ~dL/1U-& Not y P lic My Commission Expires: Notarial Seal Nancy J, Turner, Notary Public Worm1eysburg 80ro, Cumberland County My Commission Expires Jan. 5, 1998 ~i'_li;~=r. P2iinsyivan;aAssociation of Notaries COMMONWEALTH OF COUNTY OF (li/I?!J6e / fiL 1ft SS. We, ~+0.~~=~iJ , the witnesses whose names are signed to e atta ed foregomg instrument, being duly qualified according to law, do depose and say that we were present and saw ELIZABETH M. BRINTON, the testatrix, sign and execute such instrument as her Last Will; that such testatrix signed such instrument willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of such testatrix signed such Last Will as a subscribing witness thereto; and that to the best of our knowledge, such testatrix was at that time 18 or more years of age, of sound mind and under no constraints or undue influence. d subsc~ib~ befor~J11e ~'\W~ C-M-, <-- t 1Jd.A . ~ltnesses, this 22..oJ.. day WITNESSES: ~ ~~(~~ /--~ ~4tl, L ..-----.,...---...-.-.-.-- ---- ~ ,. -~A a~~ My Commission Expires: Notarial Seal Nancy J, Turner, Notary Public Wormleysburg Boro, Cumberland County Viy Commission Expires Jan, 5, 1998 601.1 ;;:;,H, Pennsy!vaniaAssociation of Notaries """U ,1:J ') ~[: l d 9- OSV m. ,~ Certification of Notice Under Rule 5.6(a) Name of Decedent: Elizabeth M. Brinton Date of Death: July 5, 2003 Estate File Number: 21-2003-665 To the Register of Wills of the County of Cumberland: I certify that Notice of 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 January 21, 2004: Carol Tyson Ashworth, 1 Brunswick Drive, Howell, NJ 07731 Anne Brinton Holton, 320 Joy Lane, West Chester, PA 19380 Thomas L. Brinton, 2340 Wynwood Lane, Aurora, IL 60506 Ms. Sandy Brant, United Stewardship Foundation of Pennsylvania, 303 Mulberry Drive, Ste. 300, Mechanicsburg, PA 17050-3141 Mark Pacella, Esquire, Office of the Attorney General, Charitable Trust and Organizatinal Section, 14th Floor, Strawberry Square, Harrisburg, PA 17120 Notice has now been given to all persons entitl /, January 21, 2004 COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) OEPARTMENT OF REVENUE BUREAU OF INOIVIOUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003772 HOl TON ANNE CHRISTINE N/K/A 320 JOY lANE WEST CHESTER, PA 19380 ACN ASSESSMENT AMOUNT CONTROL NUMBER n_n___ fold ---------- -------- 101 I $484.00 ;:;c:( ESTATE INFORMATION: SSN: 173-07-7004 I FILE NUMBER: 2103-0665 I DECEDENT NAME: BRINTON ELIZABETH M I DA TE OF PAYMENT: 04/06/2004 I POSTMARK DATE: 04/05/2004 I COUNTY: CUMBERLAND I DATE OF DEATH: 07/05/2003 I I TOTAL AMOUNT PAID: $484.00 ~EMARKS: CHECK# 1013 INITIALS: JA ..~, SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH ~ .~-- REGISTER OF WillS REGISTER OF WILLS C HAALAND 1997 .~~om ~~~~m ~ ~ D ~<-~Z> o m-l C")-<r-tlIm - ~);::;!~O - -1Z0Z"Tl 0 en mmO-lm '" S. trj :c ZOr- 0 ~ >Z~ - <!~ )> ~Stll Lr1 C ~ ~ ~ :e !:j !!I -U ;:;I. ~ ~ 00::1: - ~ o :!:jZ3: .. NI!. .., -S' ~ ::I:~tlI - . .; ~m~ . '" m(")~ OJ Os 0 0200 OJ v./~= Z .0 I 5- tD r (;"g In - "'to, W .0 ~ --I -U ::;:.. -U ;::z -.1 :s:n r -Ol Z> t~~ 9.J om I ~~ ~ - I 1;;", \\ OJ I' ..... . ~ ~,' I ~, i~; ;1 K ll:'\! CD -f:fi ':......, t( ~ 1\ '-( ~ I ~ ~..:..: ~ , , B> "'"' 0 cco",;r, w,m "'"' :~ ,.... - ~ :::I~ ~ ~ :~ I'" Estate of L I.jobe J-h 1'1. (3rif>fon , Deceased File Number: Ji 1- D 3-DlPtJJ5 , ~ INVENTORY AND APPRAISEMENT Of all the goods, chattels and credits of L I~~~ H. (jOt) ton late 0 f l OiJ>er tlUen Townsh-o , ounty, Pennsylvania . c.. umb~r/ana Date of Death: b ~ 105/0.3 Year decedent became resident of Ghc3tef County: /qgD f I Cumb~A. Description of Items Included in Inventory and Appraisement (Attach additional pages as necessary) ;:...../t ~ ~. c... :2. --' _.,~) '.~',J . . I, Aflnl- C. HDllon Personal Representative of Estate of [.l ijabd h 1-1- B(I:'j!,~:;;;ed Verify that the statements made in this inventory and appraisement are true and correct. I understand that false statements herein are made subject to the penalties of 18 PA C.S. Section 4904, relating to unsworn falsification to authorities. ~C-. !/0t~ Signature of Personal Representative Signature of Personal Representative s :IFormsllnventory .doc ~ ::y James S Holton 320 Joy Lane HF;( West Chester PA 19380 03 April 2004 '04 {\PR -6 P.11 :1 Register of Wills C '_ Cumberland County ell 1 Courthouse Sq Carlisle PA 17013-3387 Estate of Elizabeth M Brinton File Number 21-03-665 REV-1500 Inheritance Tax Return Original Return Preparers Notes: . Safe Deposit Box inventory not included as it has not been completed as of this date. . No copy of Federal Estate Tax Return Form 706 _ included as estate under limit for filing. . Copy of Federal Forrn1041 not available or filed as of this date, ~ Ja s S Holton PTI N 00241584 ~ '~ .....~..~._....~.~kol~~.J.. P.er:~t~&.t;._.__.._m.. Attorney at Law 1542 McDaniel Drive West Chester, PA 19382 Perefege@PAcivillaw.com 610-719-0737 fax: 610-431-4960 March 24, 2004 Mary C. Lewis .--.. ,... ;"'.1 '1,. ~' :u Register of Wills of Cumberland County :....:. f, g ::'5 - (t 1 Courthouse Square t'J r- Carlisle, PA 17013 = -0 :;:0 Re: Estat-=: of Elizabeth M. Brinton I (J) File Number 21-03-655 -,- ~.,_.. -~ Dear Ms. Lewis: ~ --' Enclosed please find for the above-referenced estate: Two copies of the P A-1500 along with a check for the tax due; The Inventory along with a check for the filing fee; An extra copy of the Return and Inventory; and A serf-addressed, stampe,i el<velope fre,m the Executrix. Please file the Return and Inventory and forward a time stamped copy of each to the Executrix. Feel free to contact me at the above address and telephone number if you require anything ~rther from my office. & Thank you for your assistance in this matter. enclosures cc: Anne Holton, co-executrix ,~EV-1500 EX (6-00) REV-1500 OFFICIAL USE ONLY ~ COMMONWEALTH OF _ PENNSYLVANIA <. DEPARTMENT OF REVENUE INHERITANCE TAX RETURN FILE NUMBER , DEPT. 280601 ' HARRISBURG, PA 17128-0601 J~ --L - -12 l i2~lj__ RESIDENT DECEDENT COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER I- B R I 6J .TO N EL-{~f}BErH M ;73 -07 - 04 z w DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) C THIS RETURN MUST BE FILED IN DUPLICATE WITH THE W 01- () :;-, O? DI- I G .- /q)~ REGISTER OF WILLS 0 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C - - w [XI 1. Original Return o 2, Supplemental Return o 3. Remainder Return (date of death prior to 12-13-82) (-, ll:::!!;C/l o 4. Limited Estate o 4a, Future Interest Compromise (date of death after 12-12.82) o 5, Federal Estate Tax Return Required oll::ll:: wl1.0 J:oo '0 6, Decedent Died Testate (Attach copy of Will) o 7. Decedent Maintained a Living Trust (Attach copy ofTrust) , 8, Total Number of Safe Deposit Boxes oll::.J 11. III 11. o 9. Litigation Proceeds Received o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1.1-95) o 11. Election to tax under See, 9113(A) (Attach Sch 0) < I- Z w NAME AN JJE B H6LTDJJ COMPLETE MAILING ADDRESS c LA- fJE z 3?-0 JO'Y 0 11. FIRM NAME (If Applicable) C/l w ll:: ll:: TELEPHONE NUMBER I () - h q b - 3;;... Lf J- ~E~I (! HJ35 TE ~ fA /93RO 0 b 0 1. Real Estate (Schedule A) (1) N()NE 2, Stocks and Bonds (Schedule B) (2) tV61tJf;; ::n (! 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) rJ D NE 4, Mortgages & Notes Receivable (Schedule D) (4) jJ()I'JE 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) JII 7;05''1 Z (Schedule E) 0 6, Jointly Owned Property (Schedule F) (6) IJJ () ,.; G ~ o Separate Billing Requested (7)~ ..J ~") !?74 ::J 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property !::: (Schedule G or L) D.. (8)$ JLJ't b;Z ft <( 8. Total Gross Assets (total Lines 1-7) t 0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) I IJb~-] w 0::: (10) I)JLf"3 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) (11) $' I:l-.j 79if 12, Net Value of Estate (Line 8 minus Line 11) (12) i f1)~,<? J'+ 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been (13) $. J 2} 0 flLf made (Schedule J) 1 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) rO)7S-J SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Z 15. Amount of Line 14 taxable at the spousal tax 0 - ~ rate, or transfers under See, 9116 (a)(1.2) x ,0 _ (15) $ J D) 7~1 x ,0 I!f.!L (16) ~ Lf'6"lf ~ 16. Amount of Line 14laxable at lineal rate ::J D.. x .12 - :::IE 17, Amount of Line 14 taxable at sibling rate (17) 0 18, Amount of Line 14 taxable at collateral rate x ,15 (18) - 0 t >< 19, Tax Due (19) 4 r; LJ ~ 20,0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT r Decedent's Complete Address: I STREET ADDRESS g ErH /LLIJ-(;c I J)e) fa. ve ljjIJ.f #315' .. {IJ c; I I ?;;J.. T;" kJEc;LEY RIVE CITY MEc. H-IJ-W/~<; f5 IA R. G- STATE pI}- ZIP 70(;'7 , i ii Tax Payments and Credits: 11 $ If <( t{- 1- Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C ) (2) -=-- 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. 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) :I q~4 A, Enter the interest on the tax due. (5A) B, Enter the total of Line 5 + 5A This is the BALANCE DUE. (5B) $ 'f 'rLf 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 ~ I b, retain the right to designate who shall use the property transferred or its income; ........,......"".,..."".""""""". D ~ c, retain a reversionary interest; or..............................."."",,,.,,,,,,,,,.,,.,,,,,,,,,,,,,,,,,,,,,.,,...........,.....................,..,.,.", D g] d. receive the promise for life of either payments, benefits or care? """"""""".".""..................."....."..".""""", r8J D 2, If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..........,.."",,,,,,,,,,.,,.,,,,,,,,,,,,,,,,.,,,,,,,,,,,,,.,,,.......................,.........".".""" D gJ 3- Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? """."."" ~ D 4, Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ..........................,...,.."",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,.,,,....................................... ~ D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, 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, correct and complete, Declaration of pre parer other than the personal representative is based on all information of which preparer has any knowledge, DATE fHJI.,IE B HOL of\J Oy lJ~~+ (lJv ~1JV\ P I CJ.:?g () DATE J 'A-ME5 S; fftlL rlJvL 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. 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 0% [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 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 paren or a stepparent of the child is 0% [72 P,S, 99116(a)(1.2)], I 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. 99116(1,2) [72 P,S, 99116(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, 99116(a)(1.3)], A sibling is defined, under Section 9102, as a individual who has at least one parent in common with the decedent, whether by blood or adoption. Register of Wills of CUMBERLAND County, Pennsylvania Certificate of Grant of Letters No. 2003-00665 PA No. 21-03-0665 ESTATE OF BRINTON ELIZABETH M (LAbT, .t"lKbT, [vlllJ lJ L.t; ) Late of LOWER ALLEN TOWNSHIP , CUIV1J:j.t;KLANlJ CUUNTY, Deceased Social Security No. 173-07-7004 WHEREAS, on the 12th day of August 2003 an instrument dated December 22nd 1995 was admitted to probate as the last will of BRINTON ELIZABETH M (LAbT, .t"lKbT, MllJlJL.t;) late of LOWER ALLEN TOWNSHIP , CUMBERLAND County, who died on the 5th day of July 2003 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, DONNA M. OTTO , Register of Wills in and for the County of CUMBERLAND in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to HOLT9N_A~~ CHRISTINE N/K/A HOLTON ANNE BRINTON and TYSON CAROL ELIZABETH N/K/A ASHWORTH CAROL TYSON who have duly qualified as Executor (rix) and have agreed to administer the estate according to lawr all of which fully appears of record in my Office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYLVANIA. IN TESTIMONY WHEREOFr I have hereunto set my hand and affixed the seal of my Office the 12th day of August 2003. f)~ JJltJ~:a'~ 47 * * NOTE * * ALL NAMES ABOVE APPEAR (LASTr FIRSTr MIDDLE) , LAST WILL OF ELIZABETH M. BRINTON I, ELIZABETH M. BRINTON, presently of Mechanicsburg, Cumberland County, Pennsylvania, do hereby declare this to be my Last Will, and do hereby revoke all prior Wills and Codicils hereinbefore made by me. 1. I hereby give and bequeath to my husband, HOWARD T. BRINTON (hereinafter referred to as "my husband"), if he survives me, my entire interest in and to any and all furniture, antiques, clothing, jewelry, pictures, statuary, works of art, silver, plate, ornaments, bric-a-brac, tapestry, household goods, utensils and supplies, books, linen, china, glass, automobiles, plants, implements, and tools that may be in, at or about our home at the time of my death, and all of my other tangible personal property, together with all policies of insurance thereon. If my husband does not survive me, all of the property above described in this paragraph I, except to the extent that certain items thereof are set forth in a memorandum that may be attached to this Will, I hereby give and bequeath to my children, Carol Elizabeth Tyson, Anne Christine Holton, and Thomas Latimer Brinton, who may survive me at the time of my death, to be divided between or among them in as equal shares as may be possible, as they may mutually agree; should my said surviving children be unable to agree between or UL.y 1 ~ lnl8 ,;f?rr . among themselves upon such a division of such property, I direct my executor to sell such property and distribute the net proceeds therefrom as part of my residuary estate. In the event that I am not survived at my death by my husband or by any of my above-named children, then all property which they would have taken under this paragraph 1 had they survived me shall pass as part of my residuary estate hereunder. 2. If my husband survives me at my death, I hereby give, bequeath and devise to him all of the rest, residue and remainder of my property and estate, of whatsoever nature and wheresoever situate, together with all policies of insurance thereon. 3. If my husband does not survive me, then all the rest, residue and remainder of my property and estate, of whatsoever nature and wheresoever situate, together with all policies of insurance thereon, I hereby give, bequeath and devise, as follows: (a) Seventy-five percent (75%) thereof to the United Methodist Stewardship Foundation of Central Pennsylvania (the "Foundation"), with its principal office currently located at 900 South Arlington Avenue, Lower Paxton Township, Dauphin County, Pennsylvania, or its legal successor, to be added to the United Methodist Stewardship Foundation Pooled Income Fund (the "Pooled Income Fund"), to be commingled with Wy: 2 ~ SrnB 7>>( . the gifts of other donors who have made or will make similar transfers, and managed and invested under the terms of the United Methodist Stewardship Foundation Pooled Income Fund Plan (the "Plan"). The Foundation shall divide such amount among accounts to be established for the benefit of my children, Carol Elizabeth Tyson, Anne Christine Holton, and Thomas Latimer Brinton, (hereinafter referred to as "my children") as follows: (i) Thirty-three and one-third percent (331/3%) thereof in an account for the benefit of my daughter, Carol Elizabeth Tyson; (ii) Thirty-three and one-third percent (331/3%) thereof in an account for the benefit of my daughter, Anne Christine Holton; (iii) Thirty-three and one-third percent (331/3%) thereof in an account for the benefit of my son, Thomas Latimer Brinton. If any of my children predecease me, his or her share of this bequest shall be divided equally between my surviving children and shall be added to their accounts in the Pooled Income Fund. During the lifetime of each of my children, the Foundation shall pay them from their respective accounts, such account's proportionate share of the Pooled Income Fund's income quarterly. Upon the death of each of my children, the property in Q' 3 .~ 2n'1 B . . the Pooled Income Fund attributable to the units in said child's account shall be divided and distributed to the accounts of my surviving children to be added to their respective accounts in the Pooled Income Fund. Upon the death of the last surviving child, his or her account shall be distributed by the Foundation in accordance with the provisions of paragraph 4 below. The obligation to pay income to any of my children shall end with the regular periodic payment date next preceding his or her death, and any income earned by the units in the Pooled Income Fund attributable to said child's account in the quarter in which he or she dies shall be paid by the Pooled Income Fund to either my surviving children or the Foundation, as the case may be, at the first regular payment date after the death of my child, and shall be held by the Foundation in accordance with the provisions of paragraph 4 below. Any income allocable to this bequest earned during the estate administration shall be paid to my children in equal shares and shall not be delivered to the Pooled Income Fund, either as principal or as income to be paid by the Pooled Income Fund to my children. (b) Twenty-five percent (25%) thereof to the Foundation to be added to the Pooled Income Fund as the Howard T. and Elizabeth M. Brinton Seminary Fund for the benefit of Kimbulu-Kayeka Theological Seminary, Mulungwishi, Southern Zaire, Africa, or its legal successor, and Q-y 4 * E-m6 \'ll1'r , managed and invested under the terms of the Plan. The Foundation shall pay to the Treasurer of World Division, United Methodist Board of Global Ministries, 475 Riverside Drive, New York, New York, for the benefit of the aforesaid Seminary, the proportionate share of the Pooled Income Fund's income quarterly, and may distribute the principal thereof upon a vote of two-thirds of the Foundation's Board of Directors. No federal estate taxes, state death taxes or any other estate, death or inheritance taxes ("death taxes") regarding these bequests shall be allocated to or be recoverable from the Pooled Income Fund. This provision may be enforced by my children and the Foundation, as charitable remainderman or trustee, acting alone or together. In making these bequests, I intend that my estate shall obtain the full benefit of any estate tax charitable deduction to which it may be entitled under the Internal Revenue Code of 1986, as amended. Accordingly, these bequests shall be interpreted consistent with my intent. 4. Upon the death of the last surviving child, his or her account in the Pooled Income Fund shall be distributed to the Foundation, or its legal successor, who shall hold such funds in trust as the Howard T. and Elizabeth M. Brinton Memorial Fund (the "Brinton Memorial Fund"). The Foundation may invest the Brinton Memorial Fund in such manner as may be determined by the Foundation in its sole discretion without regard to diversification as to kind or amount and without regard to the limitations imposed by law on investments. ~ 5 (niB '-oJ-r , , The Foundation shall distribute the income from the Brinton Memorial Fund as follows: (1) Fifty percent (50%) thereof to the Camp Hill United Methodist Church, 417 South 22nd Street, Camp Hill, Pennsylvania, or its legal successor, to promote missions in and through said Church; and (2) Fifty percent (50%) thereof to the Neighborhood Center of the United Methodist Church, Inc., 1801 North Third Street, Harrisburg, Pennsylvania, or its legal successor, to be used at the discretion of its Board of Directors. The Foundation may distribute the principal of the Brinton Memorial Fund to the above-mentioned organizations in equal shares upon a vote of two-thirds (2/3) of the Foundation's Board of Directors. 5. In the event that my husband and I die simultaneously or under such circumstances that it cannot be established which of us died first, then my husband shall be deemed to have predeceased me for all purposes under this Will. 6. Should any legatee or devisee under this Will die within sixty (60) days after the date of my death, he or she shall be deemed to have predeceased me for all purposes under this Will. Provided, that if my husband survives me at my death but dies within sixty (60) days thereafter, he shall have for and during that portion of such sixty (60) day period as he in fact is alive after my death the ~ 6 (';J7 e .~ . 1 right to the use and enjoyment as a life tenant of all property in which his interest hereunder will fail by reason of his death within said sixty (60) day period. 7. No interest of any beneficiary hereunder in either the principal or income of my estate shall be subject or liable in any manner while in the possession of my executor to anticipation, pledge, assignment, sale, transfer, charge or encumbrance, whether voluntary or involuntary, or for any liabilities or obligations of such beneficiary whether arising from his or him death, debts, contracts, torts or engagements of any type. 8. Except as otherwise restricted, directed or provided in this Will or required by law, in the administration of my estate, the trust estate or guardianship hereunder, the fiduciaries serving under this Will shall have the following powers, which may be exercised without leave of court, in addition to those powers as my said fiduciaries may have by law: (a) To sell, exchange, grant options upon, or otherwise dispose of any property, real or personal, tangible or intangible, or mixed, or interests therein, wheresoever situate, at any time held by them, at public or private sale, for cash or upon credit, in such manner, to such persons, and at such price, terms and conditions as they may deem best, and no person dealing with them shall be bound to see to the application of any funds paid to them. ~ 7 [f/h rs ,-J)7r'- , , (b) To distribute in cash or in kind, or partly in each, and in shares different in kind from other shares, upon any division or distribution of any property which they hold. (c) To the extent permitted by law, to exercise any election, right or privilege given by federal tax laws, or the tax laws of Pennsylvania or of any other jurisdiction, including but not limited to the joinder with my husband in filing income tax returns, the joinder with my husband in filing gift tax returns with respect to gifts made by him or by me or by both of us prior to my death, the consent on gift tax returns to have any gift made by him considered as made in part by me for gift tax purposes, the determination of proper taxes, interest and penalties and the payment thereof even though not attributable in whole or in part to income or gifts from my property or estate and without requiring my husband, his estate or his legal representative to indemnify or reimburse my fiduciaries for taxes (or penalties or interest thereon) attributable to my husband, and the election to claim deductions for death tax purposes or for income tax purposes, and for their exercise or non-exercise of any such election, right or privilege to make or not make in their discretion equitable or compensatory adjustments as between income and principal of my estate or any part thereof, or as between any beneficiaries thereof or their shares therein, all without the consent of any beneficiary thereunder and without any liability on the part of my fiduciaries for so doing. ~ 8 tl1j8 ~ , (d) To make from time to time partial distributions in varying amounts to the beneficiaries hereunder prior to final settlement and distribution of my estate, and in connection therewith to determine in their discretion the time or times when such partial distributions may require recomputation of said beneficiaries' proportionate interests hereunder for the equitable allocation of income or on account of changing asset values pending final distribution. (e) In general, to exercise all powers in the management of the assets and property held by them which any individual could exercise in the management of similar property owned in his or him own right, upon such terms and conditions as to them may seem best, and to execute and deliver all instruments and to do all acts which they may deem necessary or proper to carry out such management and their duties under this Will. 9. I hereby appoint my daughters, Anne Christine Holton and Carol Elizabeth Tyson, tc serve as co-executrices of my estate hereunder. Should both of my daughters be unwilling or unable, fail to qualify, or cease to act as such co- executrices, I hereby appoint my son, Thomas Latimer Brinton, to serve as executor of my estate hereunder. 10. The fiduciaries named or appointed in this Will, including any guardian of the person, shall not be required in any jurisdiction to file, enter or post any bond or other security for the faithful performance of their duties ~. 9 t: 111 B / ./ .. " . hereunder, and shall not be liable for the acts, omissions or defaults of any agent appointed by them with due care. 11. Subject to the restrictions and limitations contained in this Will, I direct that all estate, inheritance, legacy, transfer, succession and death taxes, whatsoever nature or kind and by whatsoever jurisdiction imposed, and all interest and penalties that are on, which may be payable or assessed in the consequence of my death, whether or not with respect to the property passing under this Will, shall be paid out of and charged against the principal in my residuary estate in the same manner as are general administration expenses of my estate so that all property subject to such taxes shall pass free and clear thereof, without apportionment of or reimbursement for such taxes, interest or penalties among any beneficiaries, transferees or other persons interested in such property and without any right of any estate or executor to contribution, recovery or collection for the same. Taxes on any future remainder interest hereunder, shall be prepaid, at and in the election and direction of my executor, to the extent permitted by law. IN WITNESS WHEREOF, I, the said ELIZABETH M. BRINTON, hereby set my hand to this my Last Will, typewritten on and consisting of these ten (10) sheets of paper, at the bottom of each of the preceding pages of which I also have placed my initials, on this :2 ..2..NLday of [j$~-PJ<<L/V ,1995. ~. ~~u.J2'- /;1. f~h~ IZABETH M. BRINTON ,'7 10 I COMMONWEALTH OF COUNTY OF C[~//?!Jtt /tLDti SS. ~ " j ',-/-'---A2fj ~ ' itL We, I '-l8lw (' &,z S----.,----~ '," ~~ , the witnesses whose names are signed to the attacnecnoregoing instrument, being duly qualified according to law, do depose and say that we were present and saw ELIZABETH M. BRINTON, the testatrix, sign and execute such instrument as her Last Will; that such testatrix signed such instrument willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of such testatrix signed such Last Will as a subscribing witness thereto; and that to the best of our knowledge, such testatrix was at that time 18 or more years of age, of sound mind and under no constraints or undue influence. --- ."-- <- WITNESSES: ~ ~o/(lfl~ c--:::_:_=~_..-=f-~ -~~ adk~ My Commission Expires: Notarial Seal Nancy J. Turner, Notan) Public i Worm!e:/sburg Bora, Cumb~rl2.nd County ~Iiy Commission Expires Jan. 5, 1998 , 601.1 ' ~;:'~"~8r, Penns)':vaniaAssociation of Notsiies . On this 22- ~\day of G)'k9~'-, 1995, ELIZABETH M. BRINTON declared to us, the undersigned, that the aforegoing instrument was her Last Will, and she requested us to act as witnesses to the same and to her signature thereon. She thereupon signed said Will in our presence, we being present at the same time. We now, at her request, in her presence, and in the presence of each of us, hereby subscribe our names as witnesses thereto and have placed our initials at the bottom of each of the preceding pages. By so doing, each of us declares that he or she believes this testator to be of sound mind and memory. ~=.___.~~ ~c:'';J'CC--f/I.--- residing at !:ft:tl'/'iJbLt') G1. C__ - ._-;.~._---c - i- _ "'vB residing at .J Ce;'''f: /-fr '/ II tB4 ~ .~-t// ,2;(/tU~'L/!Cr' //+- C-G - t.te - residing at "'-~--" C/ . , COMMONWEALTH OF C ' !- '~f"[ SS. COUNTY OF I CU71 tJC<'! LILlf.> , I, ELIZABETH M. BRINTON testatrix, whose name is subscribed to the attached foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed such instrument as my Last Will, and that I signed and executed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me, by ELIZABETH M. BRINTON, the testatrix, this ?..hhd day of j!JbU--n ~~ 1995. ~~tAt~ 1/). ~~ LIZABETH M. BRINTON lJr;/~dv / - //{,{7; /' - '.l!~l'u>> Not yP lic My Commission Expires: Notarial Seal Nancv J. Turner, ~Jotary Public Worm!ey.sburg Bora, Cumberland County ~,/ly Commission Expires Jan. 5, 1998 ~J:';'-;;:,-C2r, P2;insy:vanic:Asscciaucn of Notaries ."" * ..' .,. .~ ~ . :""'~1'~"}"'" " .", ""~,,,";:' ;,:~<(' ,:\ .';~': ".,;."",;... ': ,', :;';','".:r', " ,/,,;,', ,J,",;. ,"''' " ,:!',,,:r...,,, '::'c",t": :,"' ,';,i;;'",,;::/,> ',' ""./ '~.f "" '> :', (.> " '. ",., ,';.' :' .:,:-' '7:,t ",;,;',1/(":' ~";> :: ;, , '. ',~ ",\, , . ,,' ,:" ,:.: :'-'.0 ",:", ".;i~ ," , ' I' . " ,., t, , ",. ,';../ " " " . ,:'" :,'" ,,', , ,..., " " ,~::..: ::', , .. j' ", i. ," " " " , ! ,; '''' " ".' "'" .:.., )'..'., :"", , ,'1~:\3. 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"~I'? ;'" '; ;': .;;~..;,..j': ,.,,;~.: :~:"'.', "'; '," \"~:;:.~I.z.;)t.:;i!"t'\;::~~~\~"~:';:/~~'~{~Z'~~;~j~...),:: :",~:;:, . . ,co" , ."....,;..",.:.;:':'.;'-:~~, ,~.~ ... , "",,,-, > ",~_, '", J' I~;~i..,. ~>,,:' "-"""~,,, ',,,....,_ 1". " --~."." '*' SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INH~:~;~~~~ 6:2E~~~~RN PERSONAL PROPERTY ESTATE OF FILE NUMBER ~ R. I N r 0 oJ [ L ( =t:- It f5 E' 1- fJ tV1 :;2.) '~O '5 ~ & 5"' ~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, p{\Jc' ekeb-.'(lj,i).cc<OUol1+ t(P(7f,~ r;-O 70 () '7 5""'4- , 'f t J'-)i?7tJ. .:t P !If fl "^ 0 VI e ';J f/1 Y1- R. t(E I It- (. C D v. VI t f'6 .-j5Lf t -b 7/'j ''3, 0 $ /3) 0 b !;"" ptvC ~ 31 q-O()g }931 LJ II, +r ~ I p~ Yl 1'\ ~ Y (1/ (it I'll 'q ~{) r> [Vl.(>.1'\ (;..L 'f -1 ~' g I.> Lf f ii -) u., , . - Ci A r ve~ ~ U (l fe~ j.l\e f-IvJ i'5t ~ ..-n . ..:r c.o~ ).. J _ P R () f f.Il. r G J-/(} LA. S I Yl 5 f\ 1> $) ~ .> ~b I I UNl ,F1/IV FIAY'J II '+9 (~-.).. II) S~ TOTAL (Also enter on line 5, Recapitulation) $ ) \ 70 1) Lf (If more space is needed, insert additional sheets of the same size) 'c..,~,.,,,, ,., "".,- .. ".., ""..." '''~''''''^,'''T?'",'' c"~;':"":r"',{;":::",';;;7, :';';;:'S:';'3.,i;;',T'i"i'\:It~i1:;i,,;<r~J~~~~\~~.lltl 1"'" ;'1J_~J. ,kj'.;~~"~ ~~'~, r; f~ o }.Ji\jCBi\T\K ~ .' ~ f; 11 ~~, 1", .. I: ,]., ;2- f'rimary ilccount number: 50..7007,5414 Pilge 1 of 4 ~'nr tl"" i,'ari<oct {J7/(1~/;!OOJ to 08/07/2003 Number of enclosures: 2 .J r.1 ELIZI-\F,ETH M BF~ I NTON Ie]' For 24,hour banking, customer service and " 320 JOY LN L3 interest rate information, sign-on to 'ft' Account Link @ by Web on pncbank,com ~iFST :::H[STE;~ f'A 19380-5110 or call 1-888-PNC-BANK Moving? Please contact us at 1-888-PNC-BANK ~ Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 [Q Visit us at pncbank.com L~' ~ iii TOD terminal: 1-800-531-1648 - fOI ht',tIing imp:lired clients onl" -,.. -- . _--.To Relationship Ovelrviellll -'- Bank Deposit ACCOUll1tS DeSCription Account Number Deposit Balance InteH"" (:\wckiI1CT 'io-/oo7-'),1 II 6,5~~_45 ,~ PClf',nn:lIl'"(' M01H'" i\hrkel :~fi. l') 1l1-(i 7\ t) 1 ~,57'i()-l (:"llific"lc(') ()f Deposit '1'01<11 nf \ 1:\()617s rotal Ikposit.~ 32,162.27 '-1:.'._._ Important Account Infurmation - Amendment to the Account Agreement for Personal Checking and Savings Accounts The in[ormatilln stated below rlcscrihe, changes to our Account Agreement fur Personal Ched::ing and S;nings Account (",\gleelllcnl ")_ Changes in th' cncloscd Supplement amend the Account .\greemcnt for Personal Checking and Savings . \ccounl s 'Vit hdrawals Section ('Supplemcnt ") and are effect in' Oct oher 6, 200;}. ,\11 other information in our Agreement, as c1lTlelldcrl, continues to ~Ipply t.l your account PIe::ISC I('view the following infonnation and the enclosed Supplelllent allll retain them for your records. The Supplement to the Account Agreellle~lt for Personal Checking and Sayings Accoullts is encloser!, PNC may receive electronic , ' notification of checks; dehits to ~'our account from other fin;l1lcial institutions, awl as a result, P:\'C lI1a~' debit your account for IIle item S(llllll'r than in the pa'ir. \Ve wanl you to be aware of this changc to ensure sunicient funds are available in your account. You m:I~' Iw charged an overdraft fee if the fun(ts ~Ire not available, If you haye any questions, please stop h~' your branch or call us ~It the numher listed un the top ofvour statement \Ve ;Ire happ~' to answer an\' questioIIS you may have. Thank you, ... - Find out How Account Unk@ by Web .lust Got More Convenient Sign on to Account Link hy \Veh at pnchank.com ;\!llltry olll ;tll the great new features, 1'\'lor(' ways to 1ll0\'(' Illone\' hetw('('n your J>:\'C ::ICCOIUlts, improved hill p::lyment fnnctions, and gre::lter access to your PNC In\'t'stments accounts. Account Link b~' 'Veb- it's not just onlinc h::Hlking - it's ~'lIur online, 24x7 connection to ~ICC01Hlt managemcnt, hanking services and financial information, Sign on {o.by ::11 pn(:hank.com, 2.. '-O~-,,',(' Your individual account statements begin on the following page FORM953R Tot~ B~ng Statement I For the period 07/09/2003 to 08/07/2003 g For 24-hour customer service information, sign-on to Account Link @ ELIZABETH M BRINTON 1-] "--" by Web on pncbank.com or call 1-888-PNC-BANK Primary account number: 50-7007-5414 Page 2 of 4 Premium Plan Elizabeth M Brinton Interest Checking Account Summary Account number: 50-7007-5414 Account Link @ number: 0173077004 Balance Summary Please see the Activity Detail section for Ending additional information. Beginning Deposits and Checks and other balance other additions deductions balance 6,178.76 1,161.60 817.91 6,522.45 Average monthly Charges balance and fees 5,687.43 .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 Interest Summary As of 08/07, a total of $27.66 in interest was Annual Percentage Number of days Average collected Interest Earned ea rned this year. Yield Earned (APYE) in interest period balance for APYE this period 0,20% 30 5,687.43 ,93 Activity Detail Deposits and Other l_dditions There were 2 Deposits and Other Additions Date Amount Description (.. .f-II,.W totaling $1,161.60. (J8/01 1,160.67 Direct Deposit - Pens Pmts t-u 6 Bank Of New Y mk 173077004H6001 08,/07 .93 Interest Payment Checks Check Date Reference Check Date Reference number Amount paid number number Amount paid number 1867 5.91 07/09 022179012 1872 * 800.00 07/11 029691653 . Gap in check sequence There were 2 checks listed totaling $805.91. Other Deductions There was 1 Other Deduction totaling Date Amount Description $12.00. 07/15 12.00 Direct Pymt Rental Fee Safe Dep Box H Daily Balance Detail Date Balance Date Balance Date Balance 07/09 6,172.85 07/15 5,360.85 08/07 6,522.-15 07/11 5,372,85 08/01 6,521.52 2.1 -0 ~ ..t 5~-' '1" , ntai LC'Ulenl ~ -;:):\irBAI\K . , 1 , 4'0_ for tho poriori 07/09/2003 to 08/07/2003 R 'nr :l'l IV:H!r CI;st()'~lr:'r '32rV;I-,'(;' infonnatron, siqn-cl1 to I\ccount Link ;,;. ELlZM3ETH rv1 BRINTON 1- ~.~ hy Web on pncbc1llk,coiTl or ",1111 888Fr\Jc.8/~NK PrilllillY ilccount number: 50-7007-5,t 14 Ann""l nllmlH'r:;O-7{)07-~l,111 - n>l11inll'~d Pilge 3 of it -, Are you looltinglol' a better way to manage YOllr banking and investing? 1''-;(' 111\ ",'IIlH'llb' hl\T'!Il!',; 1'1Tk!re,] ,\C(,(l1llll" Illl\\, gin's YUU (IlII\Tllielll ,Icce" to dcpllsil ,II .\T\ls. tLlllskr lllOIH'\' ,1ll101lg \1)111 1','\,(: Ibllk ,ICCllllllh ,llld 11lllch 11I01'1'. COIlLlrl ,I I'NC 1m eSlll1ellts FiIl,lllci,r1 (:oIl>lIil.llll to<\.IY III 1c,II11 more <lhollt 11',\, PNC 111\T'lllJi'III.' FilLlllci,r1 C:lltlsllll.lllh CIII he re,lched through OUt Cuslolller Scnice CeIlIC! ,It 1-800-7ti2-filll. ils \\'eh,ile <It 1\1\'1\',jll1'lIl\\','lllH'llls.COlll u! ,11l~'l':\C hl<IIlCh office, "'1'11,' li,,'e"nr', rrde-ITer! ..\cro\ll1' is.l brnk<:r,l,,!c :'](rO\l111 ofkre-d by p",c: [nw'S'nH'nts. :1 division of JJB. Jlilli"rcl \\" [.\'ons, [I1L and is not FD[C: ins\1r<:(L may lose \'.1111(' ,Illd j.... 1101 ~lUrJlll('cd b\- P:-\C B,-Ink or its hank ,-dTiliat{''). Are you taking advantage of all the benefits you get with your PNC Bank Premium Plan@? ,\s <I Premilllll PLlll ellSloIller, you can henefit from the most cumprehen,in' set of accollnt services ~1tI,1 features P~C has to otTer. You (';111 lil1k ,ill ~'our accotll1ts to your Premium Pbll ,l1ld receive one comhined nlOnthlv sLllement: up 10 ~~ fr('e s;wings or mon('~' Ill,ukl't :I('(Olll1ls plm one ,Idclitioll<ll free checkillg account; Free Select Style Checks; ,I free (;old Check Canl that gi\'es you free ,\T\llr~lllS,lctiom. illcluding no fee from PNC when ~'ouuse another hallk's AT\-I"; Free "fran'lns Checks fur 1, rlisCOllllt 011 tl a\Tlns checks for 2; Free Online Ballkillg with Account Link'R) hy \\'eb or Quicken'R,** Bill P,lyment; Free Stop Payment orders; S;,fe Deposil Box Discount; and free awl unlimite,l auto transfers to your savings or mOlley market accounts to help you save. \hk,' 'lilT ~'uu're Ilot missing out on these great features. Stop hy ~'our local PNC bl<lTlch office or GIll 1-888-PNC-BANK today to sig-II ul' rill' ,111\' of the ,lCcomlts ,lTld serl'ices you don't already 11<1\'1'. Thallk ~'ou for heing a most value,l customer. '()'I1<:r fin,llic;,i1 institutions :Indor AT:\[ oper.1Iors 111,1\' ch~rg<: for using their AT:\ls. 1--~Quick(,ll is.:J rC':[is1ercd tr;ldenl.~Hk 0fllltuil'~" fnc. Premium Plan Elizabeth M Brinton Performance Money Market Account Summary ^r.count numher: 86-1546-6719 Account Link @ number: 0173077004 t3.dance Summary Please see the Activity Detail section for additional information. Beginning Deposits and Checks and other Ending balance other additions deductions balance 12,57021 I.S3 ,00 12,575,01 Average monthly Charges balance and fees 12,570:1i 00 Interest Summary As of 08/07, a total of $60.91 in interest was Annual Percentage Number of days Average collected Interest Earned earned this year. Yield Earned (APYE) in interest period balance for APYE th i, period tU7% 30 12,570.37 483 Activity Detail Deposits and Other Additions There was 1 Deposit or Other Addition Date Amount Description totaling $4.83. Ocj,'07 U3 lnten:st PaYlllent Daily Balance Detail Delle Balance Date Balance f17 Oll 12,57021 08/07 12,57~,()1 Certificates of Deposit Elizabeth M Brinton Investment Description Maturity date Interest Original or Current !lumber rate renewal value value '\ I 'iOOOcjl ~13 I Rt'~dy ,\ccess CD 0]'02/2001 2.00 % 12,658.] 1 13,061.78 5.. 1- O',~ -{,' r-f FORM953R , Total Banking Statement . , For the period 07/09/2003 to 08/07/2003 IQ For 24-hour customer service information, sign-on to Account Link @ ELIZABETH M BRINTON L..:::!. Primary account number: 50-7007-5414 by Web on pncbank,com or call1-888-PNC-BANK Account number: 86-1546-6719 - continued Page 4 of 4 Certificates of Deposit - continued Total current value 13,064.71- ~ I-D3--' 'i"f;,~ . CENTRAL PENNSYLVANIA CONFERENCE THE UNITED METHODIST CHURCH 303 MULBERRY DRIVE / P,O, BOX 2053/ MECHANICSBURG, PA 17055-2053/ TELEPHONE (717) 766-5275 2-10225 February 28, 2004 Estate of Elizabeth M. Brinton, % Anne Christine Holton 320 Joy Lane West Chester, PA 19380 Our auditors, Diana M. Reed & Associates, P.C., are conducting an audit of our financial statements. The audit includes confirmation of account balances. Please confirm your investment balance at December 31,2003 which is shown on our records as $81,489.40. Please indicate in the space provided below whether this information is in agreement with your records. If there are differences, please provide any information you have that will help our auditors reconcile the difference. Please sign and date your response and mail your reply directly to Diana M. Reed & Associates, P.C., 1505 East Chocolate Avenue, Hershey, PA 1"1033 In the enclosed return envelope. Thank you for your prompt attention and reply to this request. Very truly yours, Central Pennsylvania Conference The United Methodist Church To: Diana M. Reed & Associates, P.C. Our investment with the Central Pennsylvania Conference of the United Methodist Church of $81,489.40 as of December 31,2003 is correct with the following exceptions (if any): Signature: Date: COUNCIL ON FINANCE AND ADMINISTRATION ~ I - 0 5,- 6 f.-t,- unl,:lrra,:l TRANSFER CONFIRMATION FOR UNIPROP MFG. HOUSING COMM. INCOME FUND 2401 Kerner Boulevard San Rafael, California 94901-5529 Howard & Elizabeth M Brinton (800) 541-7767 C/O Anne Brinton Holton 320 Joy Lane Westchester, PA 19380-5110 . The requested trustee/title transfer on the investment referenced below has been completed. Please review the information and contact the Investor Services Department at (800) 541-7767 if there are any discrepancies. Previous Titleholder Previous Broker -------------------- --------------- Howard & Elizabeth M Brinton Robert L. Beard C/O Anne Brinton Holton Salomon Smith Barney 320 Joy Lane Strawberry Square Westchester, PA 19380-5110 11 N. Third St., 2nd Floor Harrisburg, PA 17101-1702 Investor Number: 2903 Subscription: IF1-001942 Investor Type: Joint Tenants Units: 10.0000 IRS Tax ID: 220-16-1688 Transfer Date: 01/31/04 Transfer Number: 6182 Current Titleholder ------------------- I G Holdings Ine Subscription: IF1-006187 Units: 10.0000 Start Date: 02/01/04 ?- J -Os -bS-~- . AMERICAN PARTNERSHIP BOARD@ ---..- ._~----_._-~-~~-~~--~~ ~--~ -- -~~-- CONFIRMATION 1------- PARTNERSHIP UNITS SOLD PRICE PER UNIT i j------Uniprop Manufactured Housing Income Fund I A (Tax) 1 $421.76 I L_" J r----PRIN CIPAL TRANSACTION ,- APBITCAN ----- l:LIE-NTBROKER ' DIS-TRlfiuttONS I COST COMMISSION COMMISSION . 0 bU:"OD 1--mrrsil.LE =1 T~~~~~ON InIST~~I()N ..ISETF~i1ENT IT=LE~~~ ~ Pi~~i~S-~ 2./1/U4 TCAdvisors Network Inc. acted as agent in this transaction. Registration: Howard Brinton & Elizabeth M. Brinton JTWROS Howard Brinton CONFIRMATION: C/o Ann Holton This Confirmation shall be deemed 320 Joy Lane correct in all respects unless written Westchester, PA 193805110 notice of any discrepancy is sent to our compliance department. A Division of TCAdvisors Network Ine, A Registered BrokerIDealer, Member NASD/SiPe :2. I - 0 .~- , ~~- . R.EV-1510 EX+ (6-98* SCHEDULE G COMMONWEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF B YI n+on E J,~~be+L FILE NUMBER M ~ 1- D3-0b" ~ 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO OECEDENT ANO DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER ATTACH A COpy OF THE DEEO FOR REAL ESTATE, VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE 1, PrlA~t) J rR~ ,I., If , ~rto7770 'i3 17. lOO - $ t~ 7.) s7f 2 1)5 7Y TOTAL (Also enter on line 7 Recapitulation) $ :;z 7) !J7Lf (If more space is needed, insert additional sheets of the same size) ct ,?--(tJ-tZ:: 0 -. '" In",r--C\J (W) ~: ~~~~ ~ .'. . '" ~~ ~OC\Jr-- '0 !S ~ ~ 1! p! lO c;; ;;'; ~ .... ,<00- ~ ~ en;: ~...t..t..t l!l,>~, C\J r-- <0 0 <II , ;~, ~ 1:::. '0 a. i!:o,:' , I- ,'<II.:lI), ::ii,c:(.:' ,', '..,': "<t C ~:;;~ "l!!:G>, '" ::J , , , . :1!..g ~ ~ ~ ~ c;; o (/)a.... c:( ~ ~ ~ ~ o.~ C\J _ C':S I- l:O: "M :! ..... (/) C"l ~:L. r--: C.;) :J J, _ ,.....~ r-- = c: LL It): ':'1!'''~:'. '". ~ I- 0 0 ~ . (/).C,:' "<t ,g .-..III ..... _ , ";:'" -g Ie'" 0 ...... . - : .1;,0::: C ~ = ..... 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"0 00)> ~ ~ -;0- z)>C/) oa ,c:c tT 05' C/)Q:E CD ::nc o:co ~ Pl 0 z-iJJ ~ m-i CD :Jc JJ:c - ~. lC.... ~: = (1)0- 2:~ D) ~ ""'l (/)(1) '< ~ a:[ 0 o Pl ~ -. 3-< D) e=.. Pl _0 - .....:J -.- '< 00 :J.... 0 - 3 C '<Pl 00:, ""'l co D) 0:J n PlQ' n :J.... 0 ~.~ c .....-. ~ (I).... - (I) t/) 03 c;:. e(l) (/);:!. .. PlPl .....0 -00 ....0 Cc O-:J (I)..... :J~ C!:. Pl-i -::r s: (ijO e _. .....:J c_ PlO -.... 113 CPl ::l~ 0..0 en:J (I):E <= o'Pl (1)"'0 (/)"0 rCD rPl 0.... _ 0 -o:J 02: . (/) llJ'lj OPl XlC oo~ .... 01-0 (0- - CD -oPl ::r(/) _.(1) ii).... O-CD (I) :::0 -CD -g.:E iij...... _ ::r -c (ij. )> 50 <eQ -'-3 OPl .... ..... . o' ~:J 01- (00 "'C . .... III lC III Co) a ~ :LJ- D J-t~-~r REV-1511 EX+ (12-99) , . ~~ SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, FUNERAL EXPENSES: 1. , I' / " , $ 1,;;>-06 r::Mm .1'1 C;....+-~ n.-S /fJrt1f)er~,-FJ.-. ~I/I~ - ~6& F IOvv€.^A- c,e.."., -e +u. 0",-/ F..<2-~ S I ~ F t). {UA &-. ( J+c rn<2- - fj ~ J I <=t ,. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) A '" (I-#!. IJ.b 1+0 '1 J (t.V'c , .4 k l.NO.~ fl $ ~ b (j) 0 , Social Security Number(s)/EIN Number of Personal Representative(s) i tr If- '3 q - '7t.S-1 Street Address '5.2 D 1G y L u r-€- City WQ....<;. f- (!. ~ f-fbt.. State f If Zip /7 ~ ~ tJ Year(s) Commission Paid: ;). 00 'f 2. AttorneyFees tVieole. r fe.V'efe.,,<t.. bID"'?/7-D73? fN....rt(.h.esh...jOIJ <j;~)()() 0 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, Probate Fees $ J-. '7 (. AJ/A 5. Accountant's Fees 6, Tax Return Preparer's Fees T tit; I/v.v, / p () 0 :1 'f ( S~i.f- N /11 7, b "7 f~ ~ ~i 6 i M M-d... J-l)CJ "-f- ~ ;). 5- ~ M.I,,-y- w,-II ?"."'~ (f~0 1;))~ / {lit:fvr-/ <!9Y+IS;C"~ $( Aj P t>Sf-~ 3;t tI CI TOTAL (Also enter on line 9, Recapitulation) $ j I \ b ~~ I (If more space is needed, insert additional sheets of the same size) Rf:V-1512 EX+ \~-98) *' SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT INHERITANCE TAX RETURN MORTGAGE LIABILITIES, &' LIENS RESIDENT DECEDENT ESTATE OF Brlt,+on EJJ=t~b~fi M FILE NUMBER '- I - tJ] - (){,{,f) ITEM Include unreimbursed medical expenses, NUMBER DESCRIPTION VALUE AT DATE 1, Foo!- ~ OF DEATH (! ~ r~ 5'kff~+.wn Ffvr'o'/Y ~ ' & (, . M~~,'" ~"^1 ~ ~ I I B~ ft-, y 1/ I II ~Y- Sk. I 1/..) ~ Un;+ C{ ) , . ItleJ+ pJu,.yty\-tl-rj \ S-3 ~ VU\I~" ~/~r~ Lf ( . TOTAL (Also enter on line 10, Recapitulation) $ ,. IIf '3 (If more space IS needed, insert additional sheets of the same size) . 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J. --.J 'L~ \~1' - 3 er ~- 12) .3 INSURANCE ADJUSi~r:::~,rr B:213041211B -E,. 17 Ii) 4. ..- 2. iZ:"- i{~' j INSURANCE PAYMENT BI;D:~1Z:401 B 1 '3. :lE. ii..h:, - L IZI -- iZi :3 TRI~MING NONDYST NPI_S B03051121A 22.00 3,DD .Zi )' -~. ~J 'l --~ IZ~ ,~, .l r~ SLJ l~j=1j"~C.E PiJJUS '~.i:E:\iT E\0.3iZ1t:; 1 :ZIt=; c.::.. .:.:.; it) )"7 -. Qi"/ -.- C~':~~.; I ,\ISLJr-~m,jcc: ;:'f:;Yl'r1E:,\j-'" BiZl:;li1511Z!f4 -L? ell I ~;~~ I:;; -.. .~ l.~l".. IZ' _-.'.' DLBR I DEj'v!ENT ,-,1-- 1'-~;:1 I L_5 1----5 ~:<~:,:3;Zlb 1. ;ZiB :3QI. .ti,,:, ~.11 ~.l- j,: -"L.: ;' "'L-._i ~ 1"~5~.Jr~!:::-1i\4CE ~1:L) ~;. L..: S -i" ril E r'.t-r E:,~i~?0E 1 iZ1B -is. 17 IZ:'7 _. iZ: ,'..- tZl2:' I NSUR;-"'I\ICE~ PAYI~1EI\iT E\iZi3iLlS 1 il: D - ~ '3. ,i:lb , , i i ~ I r::oo+ ~ I I i I I I j : , , " j ! ~-----------------------------------------------------------------------------+ ~ l 1 ----------+---------+---------+---------+ +------,-------+ C u r~.r-' e n t , 30 Days I 5il1 Days I '3il1 Days I Total Det ail 15.54 IBalance Due I 1 I , ---------+---------+---------~---------+ ;:t a s t Due ,Z.. ('%:: 1 ~ I I I I Total Balance 1:J.:i4 , . c. ;::'.: , I J..J. .J'+ I 1 ~---------+---------+---------+---------+ +'------------+ ! I='LEASE RE:vJIT Balance I)ue ~ i 1 :2.. , - D3 _,~-1;; + , , , - , " ,-'.-,....,.' -. "''''",. '<1--". -........ .~. - --~:~~:.::.~ T- .~-~-..,--v::.'_-~~~~.~--.~:~...;.' .~~ . -- ------- ..-, . " . ..~ - ,;. ~ {, ' .. '. ".' 'r: ",,' ,', :~:. '.'. ,~" \ :.c:~'~-~,; ::,;~::. i ..' \~V;.;:~~ :<,:/;"':'.(V '. ' :',751~t.~:;i:~~:r5;:;...,. r '..~~: ~- -, , .~' ;, . " ~ . '..' .. '; .' '. -;.....c' ., ,..; " f ... I" 'f.' ".' ~ ' . i :;. ,I ,.., ., <. ~ . .' " .' .~. .j , . , " fl t ',' !'.'. ;, I . . ~ ' I . Date I Dr. I Patient Name I Proc. Code I . Description I Diagnosis I Chrgs./Credits I Item Balance Q15/:30j03( .., ") ',lizaiJeth 93.311 I~Llrsin(J H om8 :; SUtJ,:>Qquen 32.0 4i3.0(d ~:) 0 ~~ 1 \Dc.. '2) /' ,-) 'J OJ lan Payment: 10'18077 ?3.66- G."- 07 " ,n, 0:3 dj: ~1edica((~ l.Jriteof U3.43- i_ ..... 5 0-' co in,; . _, .L loi,g/~ I i f (/~D/A. 5,1 j1illpPi , "," "-'rift ,,"'"~,.'~;{,~ ,,,,,,,",,,,.J "Prom .pa men ,.C)'thfs(/' 'bal'.'" ~''d'''y.'','''''"".,l " 8DC' ae; , ~"'~ Shephel'd: to'"", Family .iiyou'~!t~~'" , "~ng~~r;; T'x Id:23 : 933(2)75 214(2) F is I 18 I' 'oad iii";i'0,i\;;;\~~l't"~';',';a~'~i&td ~;",~~M9Y'lf:~~ ~tr1..;~,~Y;:;j 1'1ectHHlic, bur ,PA 17055 i'\S~(::;i;('~~6t.)tfV:~~P;:'..< ~:i~ir.l!$ _:i~}~'~;\Y~~:.i' Plone:117-, 66--'1795 Payment is due I,.,lithin two weeks of ~'eceipt. PLEASE RETAIN THIS PORTION OF PAY THIS AMOUNT ~ 5.91 STATEMENT FOR YOUR RECORDS . Account Analysis Total Current 30 - 60 61 - 90 91 - 120 120+ PATIENT i Insurance Balance 0.0(,3 0.00 0.00 0.00 0.012) 0. (~0 BALANCE Patient Balance 5.91 0.00 0.00 5.91 0. (2)0 0. (/)0 AMOUNT DUE It Account Balance 5 . 9 1 ~ ,'1 ..........,.-.':. ~ J -~?-6'>lJ . ' . ," , ..5-~ 'J - E 0- I ?: d1)\iub T ' 1/1, III {I Iff 'I'~!, \ ;r-., #- > '0 *!'>.!tf h ..-4- /'- I- r;)* ;!:' * t (~ E:. " *.' ."..I.u ;";""; " ".....} , , (,:. L: ";Jf' f<"'1J' ,"', 4 ;;;,) .- ,.~., ,-' ** ~ ;-'''--'{.,) , f ~'.,'",' /-, ," , " f ,:5 L'~~i .~ , ,_ "'''''1'' .-,,.JI-.' I ~, f . ~A' ",_J . / ' ~ ~.~ I r ::~- ".:', ~~~5: I ;;r;? " '" I ~;.'T .\"i " ""J.':> f' (.tJj I c._'''1- ,..,.. _ I. " ....J. ,~ .::;E {r, r", ',- , ~t .," , . ..~_. -" .J;<-...{ ~ (:c:: c~ "~ >,' '~.. ,-:1 """ r~. i '~-- I' ,~,;'" :\" ,I 1, ~~~~J'" ,.,;",::.-::;:-1:,-, . l~ j 1'-4-:'" :c :..;._.J':'- ~ ~. (\j C) l( ~r;'~ ~r, I - ~ - l ~ lu )~ ~~f j, " r~~ Ii' , J;::4, f I')~ i ' ;;C .I5~ I I"~, ..' i:r: 2; } li;t...., ! .,~ .I..utc~ ct }',-,', ''','" -J ~ }C. 01._: -iN ' , ~,i.:: ....r 0 ~/>i I ~I,', ',;;'~ t ~ (( ,3 i llit" I,J. - ' t --JJ\r; .~~ "" "! /""1 i .....'::;,.c3E. ,... 1 0 ,~"" .....1 c~ <1:' ~ "," , :> ,', . ;J "~).~ (b.. I '::1 :-':',C?~ (. - co "'-..,'" ,,'. <0( ""; -'- .', - ~ ' ~ Jo: Cf ~~i,:;;-:' , " :') ~ ;;' r--:_,. :::J ,'] ~', I" I,...,""'. ,\f.> .c. (".." , ,', ,., _ '/, _', ' 1"w" ..... i:-~ l.LJ ;"1' ~ ~ ! ~} .;, ,.: ~i ..', ' f () ",_, lLJ I- h ..". l ~ __ f... cc """.fit.-.,.! I ':~' I- ::; c-. ;:.- I ',,) Or"." '.L} ~<" .~ I >- Z ':'1 g 1.-''-' " , ""1 ...1 "'" lLJ c.,"':''' " _ '" c., CI) I, "","- ;- -...J <:(' .,"~ lu I !..!_.' '." .-- .., I- :.:; iE 1(J_r~ c... '-----. ' I -~--, I . - ------_J ":> 8d~1. S;":ll S l:J'Ir:..rc2~jd .. ST; ('It' . . [~~.-"--:J)-a~::=:~:-::~I=:'.=.:=:.2..~=:_I:)~~~IP!~()1l:",---,:~:~::-::=-':II:)~y~1~11]~_!t::==_:~~h<tr9Ef.,:,:::][-=~~Y'&~I1~~!~~ltd[::'=.==~aJ:aI)C~jl_jjJ 07/01/2003.07/01/2003 Oral Nutritional Supplements 1,00 0,88 915,80 TOTAL: 0.88 0.00 915.80 ,VV \ ~j 00" ~ ~ ~ j\\ \} y(f .J; 'X ( CJ q}V , u 0""(; Please make checks payable to: Bethany Village BETHANY SKILLED NURSING: ELIZABETH BRINTON 160 :2. FII' - --. ,- . () 3 -6~-t:i , ' ' j /- . . . ** AMOTl I ,h it I OJ 2-- fJiv-~ ~I 1 /~/03 . I I ~ I -- ------~ l I I 1 ()-;-8-7'J I Ie I ~ YTD FIN ~ f.\l'ill'l!J.~"~~ ",r"""""~::J """...~ I'" "lr".1;I.j;l~ C."""'''''~'~'''''J''1 = L...l5l_2n_ + L___ + I 2.2.LJ=1 15 3~7-.J - . 00 153.47 :Z-' -GJ'? -t~s- .. '~"~ ,... ',' . ,,' . . . 1 '~~' Page 2 of 19 "~r;~()!I 717 766-1257-433 44Y ,--,-,-""",.,'n_".__~_=_~,~_,__.""._~_."",.., "".'~"""""~""""""'""'""''''''>'''''~''''m.,''......... July 30, 2003 This information is required by the Public Utility Commission. "Basic" service includes the I ine charge, local call ing and TOUCH TONE service (if applicable). "Non- Bas i c" service includes optional services, other than Touch Tone, such as Maintenance agreement for inside wire and Guardian and does not include toll services. Non-payment of any past due basic charges could result in suspension \6) of your local service after you receive a separate written statement. \~' ^ ,j v ' Past Due Current Totals l \\V Balances Charges i)L ,\tY BASIC $.00 $.07 $.07 \ ~ TOll $.00 $41. 14* $41. 14 \ \ v NON-BASIC $.00 $.00* $.00 \ 0 TOTALS $.00 $41.21 $41.21 0! , i The following pages provide additional details. * (Includes Verizon and other service provider(s) charges.) :2 } - D 3 - 6 ~-~...., REV,1513 EX+'(9,OO) '* . , SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF B '= J J ~h b ~ 11 FILE NUMBER Y" J f\ +0 f'\ M :LJ-()3- ~6'S- RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under See, 9116 (a) (1.2)] r~~ _P~IJ s~~ C S e-wv.k G-) Y3 llu,~ L . 8 y-) n t-crY\ ~~ It 1'1 Yl~ e. H () 1-/-,.." DA-~S ~ Y3 e4.V"O( j ~~Lwovf'L () A '^-fj k fRA Y3 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 h f Vt M ~ c~;t:LL r~G-I1A-(l()I,A..' I~~ ~ $+ewIlMlS~;fC~~ (..lJOf4S"" .- B (' If't-O tf r PlI f-o Bt.-~j v.1I c..p- 4.)8'11 - Bi'ln-\-o >>T~)... /--0 e e~y' VIlIa.5JL t > (39 _ Br,n+&1 (,frf1~ h B~~';I VIH~ 05"w E # l.j (I. 1\.. ~ .:r ~ f?1,j Ifg q d- [ p.. '" ~',"A. <1 ).t...t e ~ ',:>- J '. " ~ J.,p~ ;2.<3..)';>00 _ i-tI TVlI.rl- o..J m.'rll...-I-u.J L1 U6. ~f UM C- U ")flOA J J b.j ~J/II v TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ J;l I, t) 8-t/ (If more space is needed, insert additional sheets of the same size) ':\"OSHlf:O Fe 7Z l' ' I 1I I r ,:-y" 06 .JC'JllfC(: . et .JO( Isf ffiJ) ~,~;.,~ ~~~'~!:)~~\k~~,~;;:e~~~E~ 2,~ .';~ eel/1m! Pt'll/tS)'!I'''l/h~ .. planned g;v;ng ( / 17) ! 66-! ,./H:\ . (:-i00) 2 i 2-0 11:\ . bx: (71 /) ! 66-1675 . EmaIl: stcpai!llnetrax, net is Joyful sharing August 12,2003 Anne Christine Holton 320 Joy Lane West Chester PA 19380 Dear Anne: Thank you for sending us the death certificate for your mother. In 2003, there were two payments made on the annuity dated March 19, 1992 (BRINTOHT01), two on the annuity dated March 24, 1997 (BRINTOHT02), and two on the annuity dated June 18, 1999 (BRINTOHT03). We will send two 1 099R's for these payments, one for the two annuities (01 and 03) contributed through The Stewardship Foundation and one for the annuity (02) contributed through Wesley Affiliated Services, before the end of January 2004 to the address above. Because your parents did not receive the complete amount of their investments under these gift annuities, your mother's estate is entitled to a deduction for unrecovered investment on her final income tax return. . . IRC SEC 72 (b) (3). The total of unrecovered investment is $7,286.76, with the breakdown as follows: BRINTOHT01 BRINTOHT02 BRINTOHT03 Original Actuarial Value $12,385.00 $5,726.00 $2,528.20 Excluded from taxable income 8,931 .82 3,139.50 1,281.12 Unrecovered investment $ 3,453.18 $2,586.50 $1,247.08 For your information, the distribution of the residues of these gift annuities was as follows: BRINTOHT01 $12,994.81 Bethany Village Care Assurance Endowment Fund BRINTOHT02 $ 4,811.34 Bethany Village Care Assurance Endowment Fund BRINTOHT03 $ 1,838.54 Camp Hill United Methodist Church "Investment Managenzent and Stewardship Services)) LI-6) ].-6'))- \:::::::/ ~ u u Certification of Notice Under Rule 5.6(a) . Name of Decedent: Elizabeth M. Brinton Date of Death: July 5, 2003 Estate File Number: 21-2003-665 To the Register of Wills of the County of Cumberland: I certify that Notice of 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 January 21, 2004: Carol Tyson Ashworth, 1 Brunswick Drive, Howell, NJ 07731 Anne Brinton Holton, 320 Joy Lane, West Chester, PA 193-80 Thomas 1. Brinton, 2340 Wynwood Lane, Aurora, IL 60506 Ms. Sandy Brant, United Stewardship Foundation of Pennsylvania, 303 Mulberry Drive, Ste.300,Mechar.Ucsburg,P~~17050-3141 Mark Pacella, Esquire, Office of the Attorney General, Charitable Trust and Organizatinal Section, 14th Floor, Strawberry Square, Harrisburg, PA 17120 .1 ' ; -, - -' - --" . . . . . . . J J : , , . . ~ 4 <;>,E'\'- ~<.:..'< COMMONWEALTH OF PENNSYLVANIA '* BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-I547 EX AFP <Dl-03l DATE 07-26-2004 ESTATE OF BRINTON ELIZABETH M DATE OF DEATH 07-05-2003 FILE NUMBER 21 03-0665 COUNTY CUMBERLAND ANNE B HOLTON ACN 101 320 JOV IN I ......t I_Itt.. I WEST CHESTER PA 19380 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV=is47-E3f-AFP-foY:oiY-NOYicE--OF-YNHEifiTAifcE-TAX-A-PPfiA-isEi"-ENT~--ALi-owAifcE-crR------------ -- --- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRINTON ELIZABETH M FILE NO. 21 03-0665 ACN 101 DATE 07-26-2004 TAX RETURN WAS: (X) ACCEPTED AS FILED () CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this form with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 117 , 054.00 tax payment. 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) 27 .574.00 8. TotalAssets (8) 144,628.00 APPROVED DEDUCTIONS AND EXEMPTIONS: 11 ~OO' ".::0 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) , ~_" ~ :-L f!::. 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 1. ,.,~. 00 Jg, ~:; 11. Total Deductions gi. " Ul)e (1i-i 794 00 12. Net Value of Tax Return ~:; (12),])3;1:,834.00 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J)::: (13fj l:i21~ 084 . 00 14. Net Value of Estate Subject to Tax () .. . (14);;l:;::?1,li~" 751.00 ," ',. ,', ~ ',,',;<.. '.;,~ NOTE: I~ an assessment was issued previously, lines 14, 15 and/~",~ -,~,>,16, if, 18t~~d", 19 will re~lect ~igures that include the total o~ ALL returns assJS!ed t@:) date.. _;~ ASSESSMENT OF TAX: ~ 15. Amount of Line 14 at Spousal rate (15) .00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 10,751.00 X 045 = 484.00 17. Amount of Line 14 at Sibling rate (7) .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (9)= 484.00 TAX CREDITS: DATE 'NUMB-fR' INTEREST /PEN P~+~D (_) AMOUNT PAID 04-05-2004 CD003772 .00 484.00 TOTAL TAX CREDIT 484.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 · IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE J"r. A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) t/ RESERVATION: Estates of decadents dying on or bafore December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOTICE: To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of 2000. (12 P.S. Section 9140). PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of Wills printed on the reverse side. --Make check or money order payable to: REGISTER OF HILLS, AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Wills, any of the 23 Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and I or speaking needs: 1-800-447-3020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administrativelY correctable errors. DISCOUNT: If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (57.) discount of the tax paid is allowed. PENALTY: The 157. tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (67.) percent per annum calculated at a dailY rate of .000164. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor rm ~ ~ Im-1991 -nr- ~ run ~ ."IIOm'r 1983 167. .000438 1992 97. .000247 2002 67. . 000164 1984 117. .000301 1993-1994 77- .000192 2003 57. .000137 1985 137. .000356 1995-1998 97. .000247 2004 47. . 000110 1986 107. . 000274 1999 77- .000192 1987 107. . 000274 2000 77- .000192 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. I.... UlllJ.Jt:::L..L cLllU LoU Ull L Y .Kegls"Cer UI Wl.L1S One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/06/2005 HOLTON ANNE CHRISTINE N/K/A 320 JOY LANE WEST CHESTER, PA 19380 RE: Estate of BRINTON ELIZABETH M File Number: 2003-00665 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: 7/05/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~4~Mj~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge uA Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 NameofDecedent: f 1130 hI' f-lL IV(, (~rl/)fDn Date ofDeath: -7- /:-J / D i~ , Estate No.: ~I - d O{),j-lol 0.:) 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 a~stration of the estate is complete: Yes 0 No 2. If the answer is No, state when the per~ represi:tative reasonably believes that the administration will be complete: ,7 ') /0 (0 , 3. If the answer to No.1 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 offormal or inf=al accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ?/:.~pI., >rl/./)f j<, )" 4f, Date: (y / i'/ / D~/ Sature C ,L v ~ (f)!r-> , T a Ie r;, 7&' ) Name q fI / /Z:'( )nr1 t}1H'__F/'kft"' Address /Va.u Cas/Ie, D(jrj- J-,}b 30d-57-5 -/399 Telephone No. Capacity: 0 Personal Representative cJ ~ounse1 for personal representative In Re: Estate of BRINTON ELIZABETH M ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2003-00665 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: HINTON ANNE BRINTON Counsel for Personal Representative: PEREFEGE NICOLE J Date of Decedent's Death: 7/05/2003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 7/28/2006 ~L~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distlibution: Personal Representative Counsel for Personal Representative Estate File In Re: Estate of BRINTON ELIZABETH M ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA NO. 2003-00665 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: ASHWORTH CAROL TYSON Counsel for Personal Representative: PEREFEGE NICOLE J Date of Decedent's Death: 7/0512003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. Ifthe required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 7/2812006 ~ Co';, L.' 6;a' "'-" . .' 0'" . ~ . }', ' 1:"-z;.r-- I'~ ,;CtUAuI~ ~uu/.) Jd/~"1Ur Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribu tion: Personal Representative Counsel for Personal Representative Estate File In Re: Estate of BRINTON ELIZABETH M ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLV ANIA NO. 2003-00665 NOTICE OF FAILURE TO FILE STATUS REPORT Personal Representative: HINTON ANNE BRINTON Counsel for Personal Representative: PEREFEGE NICOLE J Date of Decedent's Death: 7/05/2003 The Orphans' Court record indicates that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12" Supreme Court Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report. If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of such delinquency and the undersigned will requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: 7/2812006 ,~~~Ja1i-~ Glenda Farner Strasbaugh Clerk of the Orphans' Court Distribution: Personal Representative Counsel for Personal Representative Estate File Register of Wills of Cumberland COWlty Name ofDecedent: -.tJ ~'1 a be fh Date of Death: ~3. Estate No.: Q J-()DD~-&(pb STATUS REPORT UNDER RULE 6.12 H. Br/() fDn 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 a~stration of the estate is complete: Yes 0 No jl}.. 2. If the answer is No, state when the personal repres tative reasonabl believe that , the administration will be complete: U~ .. btuJ1 C/U [) n j;;>.l 3. If the answer to No. 1 is Yes, state the follo~ we- WU-f.. Wt::U 'h o/}!I !JPL fI; a. Did the personal representative file a final account with the Court? Yes 0 No)&1 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the perso~epresentative state an account informally to the parties in interest? Yes' jZi. No 0 c. Copies of receipts, releases, joinders and approval offonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date:.1o C"') ...::t 0'? ....0 =;) c;;::) c:--.J ~::r7Urner Lan~ AddressLJafChesJ-.er, Pit jq38t [P/t>-~/q- ti]3~ Telephone No. ,","'- 0- <"9 =:'I .;!\j;::( Capacity: g Personal Representative ~unsel for personal representative Cumberland County- Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/31/2006 HOLTON ANNE CHRISTINE N/K/A 320 JOY LANE WEST CHESTER, PA 19380 RE: Estate of BRINTON ELIZABETH M File Number: 2003-00665 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 I 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: 7/05/2006 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, Jg4l6~ ~J~J~ Glenda Farner StrasbaughJ Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of wills One Courthouse Square Carlislel PA 17013 Phone: (71 7) 240 - 6345 Date: 5/31/2006 HOLTON ANNE BRINTON RE: Estate of BRINTON ELIZABETH M File Number: 2003-00665 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 I NO. 103 SUPREME COURT RULES DOCKET NO. 11 for decedents dying on or after July 11 19921 the personal representative or his counsell within two (2) years of the decedent's deathl shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 7/05/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report I please disregard this notice. SincerelYI l~h~t~:AJ~~ Glenda Farner Strasbaugti/ Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/31/2006 TYSON CAROL ELIZABETH N/K/A 1 BRuNSWICK DRIVE HOWELL, NJ 07731 RE: Estate of BRINTON ELIZABETH M File Number: 2003-00665 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 is due by: 7/05/2006 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, .I", I ~ i~~..~ ,0 ~JuUfv0~~.~c Gl'enda Farner StrasbaugK/ Clerk of the Orphans' Court cc: File Counsel Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 5/31/2006 ASHWORTH CAROL TYSON RE: Estate of BRINTON ELIZABETH M File Number: 2003-00665 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. 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(I) ~ "... ~ alJ)oi~i ~ ~%~3~.3 0. ~o.~(I)~(j) ? ~C)~~a=;' ~S-3o.~. ~(I)r'!:a:::r-~ -oiiQ-~o. ~~o$.:2.(J) ~ 9.. a 6 ~'l . :fC)~(I)O (I) -<: :f \e. 0 3g~!% e..' ~.-o .g. i (I) 00 %t --.J 15056051058 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 21 03 -0655 Date of Birth 173-07-7004 07/05/2003 01/16/1916 Decedent's Last Name Suffix Decedent's First Name MI Brinton Elizabeth M (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. Rernainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax Return Required 4. Limited Estate 4a. Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust (Attach Copy of Trust) 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 8. Total Number of Safe Deposit Boxes .. 6. Decedent Died Testate (Attach Copy of Will) 9. Litigation Proceeds Received 11. Election to tax under Sec. 9113(A) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Anne B Holton (610) 696-3242 Firm Name (If Applicable) 'f'_.' REGISTER~ WILLS USE ~1y ( .) First line of address ') i . i - , -~ ~~I 320 Joy Lane Second line of address City or Post Office ZIP Code . :j DA:rE'Jf'iVE 0 i - ") ,'I ") State en f'.) West Chester PA 19380 Correspondent's e-mail address: Under penalties of perjury, 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, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATUR.')9lj p. ERSON. RESP~S~Y:: ,FOR FILlNp RSJUR,N DATE G0 N- -'-( ~ (1-IA..J E;~ <.. . 08/14/06 ADDRESS3.ti> , J~ y L~ ,_~ LJe,t~~J:&-.-l13f r2_,~~=----~'--- SIGNATURE OF PRE PARER 6THER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 L 15056051058 15056051058 -1 q) .-J 15056052059 REV-1500 EX Decedent's Name: Elizabeth M Brinton RECAPITULATION Real estate (Schedule A). 2 Stocks and Bonds (Schedule B) . . 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 4. Mortgages & Notes Receivable (Schedule D) . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6 Jointly Owned Property (Schedule F) Separate Billing Requested . . . 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested. . . 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). .. . 10. 11. 12. Net Value of Estate (Line 8 minus Line 11) . . . . . . . . . . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) 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) XO_ 16. Amount of Line 14 taxable at lineal rate X.O 45 6,057.00 17. Amount of Line 14 taxable at sibling rate X .12 18. Amount of Line 14 taxable at collateral rate X .15 19. TAX DUE . . . . . . . . 14. 15. 16. 17. 18. . .. . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 173-07 -7004 Decedent's Social Security Number 1. 2. 3. 4. 5. 6. 7. 8. 9. 0.00 0.00 0.00 0.00 134,453.00 0.00 27,574.00 162,027.00 16,272.00 2,304.00 18,576.00 143,452.00 137,395.00 6,057.00 273.00 273.00 . 15056052059 ....J REV-1500 EX Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Elizabeth M Brinton STREET ADDRESS Bethany Village - Skille Care Unit 21 03 0655 DECEDENT'S SOCIAL SECURITY NUMBER 173-07 -7004 325 Wesley Drive CITY Mechanicsburg I STATE I PA ; ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 273.00 484.00 Total Credits ( A + B + C ) (2) 484.00 3. Interest/Penalty if applicable D. Interest E. Penalty 211.00 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) (5A) (5B) A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 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 a. retain the use or income of the property transferred;........ ........................................... .... D b. retain the right to designate who shall use the property transferred or its income; ....... D c. retain a reversionary interest; or.................................................................................................................. ....... D d. receive the promise for life of either payments, benefits or care? ...................................................................... D 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .. ..... ....... ..... ........ ...... ..... ........ ......... ..... ....... ....... .............. ......... ............. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which t . b f" d' t' ? Ivl con alns a ene ICIarY eSlgna Ion. ........................................................................................................................ ~ No ~ ~ [i] [i] [i] D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. D 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. S9116 (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. S9116 (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. s9116(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. S9116(1.2) [72 P.S. S9116(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. s9116(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 EX+ (6-98) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brinton, Elizabeth M FILE NUMBER 21-03-0655 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1 DESCRIPTION VALUE AT DATE OF DEATH none 0.00 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 ~Cb REV-1504 EX+ (6-98) SCHEDULE C CLOSElY-HElD CORPORATION, PARTNERSHIP OR SOLE-PROPRIETORSHIP COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brinton, Elizabeth M FILE NUMBER 21-03-0655 Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER NUMBER DESCRIPTION 1. none VALUE AT DATE OF DEATH 0.00 - TOTAL (Also enter on line 3, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1507 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brinton, Elizabeth M SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER 21-03-0655 ITEM NUMBER All property jointly-owned with right of survivorship must be disclosed on Schedule F. DESCRIPTiON VALUE AT DATE OF DEATH none 0.00 TOTAL (Also enter on line 4, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 0.00 REV-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISe. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brinton, Elizabeth M FILE NUMBER 21-03-0655 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 PNH Checking Account # 5070075414 at death later transferred to #6 VALUE AT DATE OF DEATH 6,858.49 2 PNC Money Market #80-1546-6719 at death later transferred to #6 c 12,564.46 3 PNC CD #31500081931 at death later transferred to #6 14,277.47 81,489.40 4 Central Pennsylvania Conf United Methodist Church Investment # N/A at death 5 REIT UNIPROP MFG houseing Income Fund #49152 10 Shrs FMV at death Dividends to #6c 3,751.00 -33,700.42 33,421.00 6 Edward Jones Estate Account #196-04877-1-6 consolidation of #1 ,2,3 6a EJ amounts transfered from #1,2,3 6b EJ deposited interest from #4 & 6a 6c EJ deposited dividends from #5 15,671.64 120.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 134,453.04 REV-1510 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brinton, Elizabeth M SCHEDULE G INTER-VIVOS TRANSFERS & MISe. NON-PROBATE PROPERTY FILE NUMBER 21-03-0655 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. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO OECEDENT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE OEED FOR REAL ESTATE VALUE OF ASSET INTEREST (IF APPliCABLE) VALUE 1. Prudential IRA # 280777053 24,57400 100 0.00 27,574.00 TOTAL (Also enter on line 7 Recapitulation) $ 27,574.00 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Brinton, Elizabeth M FILE NUMBER 21-03-0655 Debts of decedent must be reported on Schedule 1. ITEM NUMBER A. DESCRIPTION AMOUNT 1. FUNERAL EXPENSES: Family Gathering I Dinner after services Flowers 1,500.00 206.00 150.00 194.00 116.00 2 3 Cemetery Fees 4 Funeral Home - Final 5 Collins memorial - grave stone B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Anne B Holton / Carol Ashworth Social Security Number(s)/EIN Number of Personal Representative(s) Street Address 320 Joy Lane 6,298.00 202-34-5832 City West Chester Year(s) Commission Paid: 2006 State P A Zip 19380 2. Attorney Fees 3,000.00 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. Probate Fees 276.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 7. Executrix reimbursable costs 788.00 115.00 424.00 3,205.00 8 safety deposit box ($72) Notary fees ($8) Register of wills ($35) Inheritance Tax - initial payment REV 1500 Income Taxes: 2003-04-05 ($2224) 2005-6 ($971) 2006-7 PA41 ($10) & 1041 (0) 9 10 TOTAL (Also enter on line 9, Recapitulation) $ 16,272.00 (If more space is needed, insert additional sheets of the same size) ~i~t REV-1512 EX+ (12-03) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Brinton, Elizabeth M FILE NUMBER 21-03-0655 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 3 Foot Care Center 16.00 Sheppardstown Family Center 6.00 Mechanicsburg Personal tax 11.00 Bethany Village - Skilled Care Unit 916.00 Alert Pharmacy 153.00 Verizon Telephone 41.00 Collins Pension repayment 1,161.00 2 4 5 6 7 TOTAL (Also enter on line 10, Recapitulation) $ 2,304.00 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-001 SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Brinton, Elizabeth M FILE NUMBER 21-03-0655 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1 IRA Prudential Securities (Sch G) Thomas L Brinton son 1/3 Anne B Holton daughter 1/3 Carol T Ashworth daughter 1/3 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 Charitable Trust Gift Annuities for UMC Stewardship Foundation BrintoHT01 to Bethany Village 12945 BrintoHT02 to Bethany Village ($4811) & BrintoHT03 to Bethany Village ($1839) to Bethany Village 6650 New Trust Admin by CentPAConf UMC specified by will - Sched E#4 Cent PA Conf Investment 81489 Remainder of Sched E #6 Edward Jones Estate Account after final expenses 36105 Refund of excess Rev-1500 Inheritance Tax overpayment 206 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 137395 (If more space is needed. insert additional sheets of the same size) 06/13/2006 22:20 717-771-4512 PA DEPT OF REVENVE PAGE 11)3/08 / (,40NWeAlTHOFPiNNs~VANI'" I C:::AS:~ nS::POS,T BOX I PLEASE PRINT OR TYPE I DEPT. OF REV. INHERITANCE r"... I ........ · - - -. .., .~~~~~~~~~~~':OA ~.~~~__" -..._--___-=~_-I~YJ:Nl~O.Lt'(.....~~--=~~...- _,,1~. ~-._ -- .., _ ~~~~""7 """M"uSfB"eco'MPLeTED 8YREPR!8i:NTATtW OFFINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS .. . '.... M" ':':i '"... .. ; .'~!" :\. . M.... 213136 22:213 717-771-4512 PA DEPT OF REVENVE PAGE el4/08 SAFE DEPOSIT BOX INVENTORY IN TRueTI NS (1) CASH: REPORT TOTAL ONLY. (2) STOCKS: LIST IN DETAIL EVERY COMMON OR PREFERRED CERTIFICATE, WARRANT OR OTHER RIGHTS FOUND IN BOX. STOCKS ARE TO BE DESIGNATED BY NAME OF COMPANY. CERTIFICATE NUMBER. DATE OF CERilFICATE, NAME IN WHICH STOCK IS REGISTERED. AND NUMBER OF SHARES AND ClASS OF STOCK. (3) OBLIGATIONS OF U.S. GOVERNMENT: NUMBER OF ITEMS. DATE OF Issue, FACE VALUE, NAMES IN WHICH REGISTERED AND TYPE OF OWNERSHIP, ie.. JOINTLY HELD. PAYABLE ON DEATH, EeT. (4) BONDS: DESIGNATE BY NAME, AMOUNT, SERIAL NUMBER, OR OTHER OESIGNATlON. (BEARER BONDS) (5) BANK AND SAVINGS AND LOAN PASSBOOKS: STATE NAME OF DEPOSITOR. NUMBER OF BOOK, LAST DATE APPEARING IN BOOK, NAME OF BANK AND BRANCH. ANO BAlANCE. (8) JEWELRY, COINS, STAMPS, MANUSCRIPTS, ECT~ LIST AND DESCRIBE AS FULLY AS POSSIBLE. (7) DEEDS, MORTGAGES, CURRENT INSURANCE POUCIES OR OTHER EVIDENCES OF INDEBTEDNESS: LIST AND DeSCRIBE AS FULLY AS POSSIBLE. 8 ALL OTHER CONTENTS. ITeM NO I CERnFY UNDeR PENALTY OF PERJURY THAT THE ABOVE ZRSON RECEIVING COPY OF SAFE OEPOSIT BOX INVENTORY: RECORD IS CORRECT AND COMPLETE TO THE BeST OF MY I/} Y) A J r/} r'" /) /l //1 /2...... ~ h K EDGE.ANt) BEUEF. 1/11///1 (;1 1"'1 l/f..-.f.../U/~ I NA: :~.:'." . ,- .~:'"t"""I.'.... .'.r.:.i~~:.: f ( \ Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esquire Solicitor One Courthouse Square Carlisle, Pa. 17013 Glenda Farner Strasbaugh Register of Wills & Clerk of the Orphans' Court (717) 240-6345 FAX (717) 240-7797 OFFICES OF l\egiS'ter of millS' anti ClClerk of tl)e erpbanS" ClCourt <!tountp of <!tumbedanb Date: q- 1- OLp Weare unable to process the enclosed document. It is being returned to you for the following reason: )ll Must be filed in duplicate. (; (Made pay~b~to .... C) ,- ~....-.) ..:.:..:::.) .~-;) Q"\ ~ Did not include the filing fee of$ /5' - cD Register of Wills) (/) C8 Ii) Other: V~Q,QJL. fY\~ i -to \ e O-t1L t h. o:'u <i;e Scp 1(1 'LJ.. ~0.1 ~ r. of' L-c; ! 15 "..".:,c::; l} -}~: (10-.-\ VA.-oll Y ~ llO I ~ !:':~ -,::-' " U1 N If you have any questions or concerns, please call the office at 717-240-6345 between 8:00 a.m. and 4:30 p.m. i~.v t.j ~ crl f.j 'tf o 6 Z Cl W !\p tt g r;'~ ~ ~ .,..1 A 5" ~ 0... r-' i.Jl 1"'" -~ ,......i !"/1 "f cr. 1 r.-."r; ~.. ~ ~ ~ '~ ~. 1 ~ ~ ~ ~ ~ , "-1 ;~ ~ .~ ~;'-.. .~ ~.~ "- ~ ~ ~ ~ ~.~ ~ ~:t. ~~~ rJ ~ tv) c,."'1 "C :j \10 l' j VJ {'- ~ q, :-J "- ~ ~ ~ ~ ~ ~ \__ 'Y ~ V) (3 'J '- ~'- ~ ..- .- ('.l () () I...! 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(/)(1)0 (/)r-- ~~~ ota.... l.-::J _ (1) 0 (1) en 0 (/) '6> (1) I..- (1) C ro 0:::00 ~ ~ ~ '1J ijlj 15 IX: ~ <( e 0:g fa 1lI.~ IX:Ea;~ g.2E~ <(e.e~ !.II - C v ~t'iiq5 ~ 5 ~ .!;!l~ :iQ)~~a o ~'1J '- o ~ <<I.S 0 ..: I~ ..: ~ ~ 2~ .~ 15 _.c '" .... iil.c o ... .g> o ~ ~ ffi 5 & :i Q) ::> I- ~.s Zt:)b wo.!!! :::E Q. '" i~~ II <( '- (-.j I In.- I ::::- 'tJ c: ~l5,g Q ()) <<I Q..~ 8 Q.~~ ii:\.l'la; 113'q)C <::[ .Q .!;!l .J~~ :Z:~'1J ~ 0 ,S t-: E ,~ I-lIl't:: <(....<<1 (Y) rTlJ ..:- ,~ <Ii ~ .~ iil ~ III ~ o:t::Q..s~ -~:S"tJCI) }~lif <.) "'!;l. '"' ~2.e~;!:: =::::~-Q)~ ~'EQ;.Q). < Q) ,.. :....... ~e~~~<;j ,gQ.~"",:>(Q) ~.~~~.8s 5:a~'2.~~ ~ 1i) :-:::: Q.. '0 -. g>o~~~c: di ~5Ci) 8s "Ii Ib-J Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/22/2007 HOLTON ANNE CHRISTINE N/K/A (") GO ~Oj~ ....XC) J. ,T-~: Fn "':.. ::0 ~...::. ':0 ^ J(?O (" ....\.._) /1 J':-- , -' ::n :-0 --I .X> f'o.,) <:::::> = --.. <- c::: Z N 0"\ :r-] IT-" ( " c-) :'5 " ,'J Tl ,.-.:J 320 JOY LANE. WEST CHESTER, PA 19380 :z:,. =r ~ ) '..i } c. C') RE: Estate of BRINTON ELIZABETH M File Number: 2003-00665 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 is due by: 7/05/2007 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, ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel w Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 6/22/2007 TYSON CAROL ELIZABETH N/K/A o S:;o '~j;g .:-,,("") -r':;r- ~7rn ~:n 0');>-: C)Q Q-n :n --I t'V 0:::::> <= -... <- ,- Z N O"'l -D 6~~ ~:3 I,J J I~__) t-i~ ~.~ C:J 'T1 -" C':"") i~_~ l".T::::! )> :::r 1 BRUNSWICK DRIVE HOWELL, NJ 07731 0"\ RE: Estate of BRINTON ELIZABETH M File Number: 2003-00665 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 RULESr 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: 7/05/2007 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, ~~~ /" ' ... Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel qr p,,.,. 0, C R' r 6 1"" ST. AT' U' S RE' p' '0,' ,nT . aLo . .'0: c '. tile '~: ~, I.l.-:i;.. l: , .; ; . -.l'\~ ; REGISTER OF WILLS OF c""....k f~A fOVl"1 }y' COUNTY, PENNSYLVANIA / Date of Death: 05' 13", I "" + en ) Tv... I-.J 2.uoj , ~ 1 \ ~~b~tL File Number: M ).001 - 0 Db & S Name of Decedent: Pursuant to P a. O. C. Rule 6.12, I report the follo\7iling with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: . . . . . . . . . . .. . . . . . . .. !RYes DNo 2. If the answeris No, state when the personal representative reasonably believes thatthe adrrtinistration will be complete: 3. If the answer to No.1 is YES, state the following:' a. Did the personal representative file a finar' account with the Court? . . . .,. DYes DNo b. The separate Orphans' Court No. (if any) for the personal representative's account is: e. Did the personal representative state an account infom1ally to the parties in interest? ..............,............... .ISZlYes DNo d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Dme or/oSlo? ,....'.'. \' ol~(l8 \jd Bn6gS\\\~dBO 1 jQ )\'dj\8 11' n _ 1\\\ l{\~7, 9 \ ~t, ,,0 J Capacity: ~ersonal Representative D Counsel Y'ne. cJ;;5 ~e t N me of Pel'SOI1 Filil1g this Form , 3::2o:T~ ~C- Aad,'ess txs I- C/.-e ~-h- r fi /13Ro b/O-t7b~3'2V~ Te.lepho!1e Fonii RH..'-/O Estate of Elizabeth M Brinton DOD: July 05,2003 Thursday, July 05, 2007 SSN 173-07-7004; Fed ID # 42-6640872 Estate: 2003-0655, County of Cumberland, Pennsylvania The estate is complete. . All known debts, taxes, submitted administrator, legal counsel expenses and fees are paid. . All expected income is received and final and amended tax returns filed. . All necessary 1099 forms for executor fees were filed. . Estate assets were transferred to the administrator designated by the will, United Methodist Stewardship Foundation of Central Pennsylvania. The administrator has reviewed with and received agreement from the beneficiaries of the financial methods to distribute estate asset income and eventual distribution of assets/income to various charitable recipients. . The Estate REV 1500 was previously filed including missing safety deposit box inventory and is complete. . Report from Counsel Representative indicated the Estate financial audit is complete and approved by the appropriate Pennsylvania agency. Attached are: . List of Beneficiaries for Estate income & contact information of Stewardship Foundation. . Letter sending bulk of estate assets to Stewardship Foundation. . Copy of 2006 Estate Status Report filed with Orphans Court. . Final and amended (2x) tax forms. US 1041 & P A41 Updated counsel contact information: Nicole J Perefege, Esq. West Chester, PA Office: 610- 719-073 7 Cellular: 302-345-9526 For the Estate James S. Holton Complete proper name Address and seasonal address if applicable - including zip code Telephone number(s) Social Security number Birth date Full name: Legal Name: Birth Date: SSN Address: Phone (cell) Full Name: Legal Name Birth Date SSN Address Phone: Full Name Legal Name Birth Date SSN Address: Phone (cell) Carol Elizabeth (Brinton) Tyson Ashworth Carol Tyson Ashworth 28 December 1942 202 34 5832 1 Brunswick Drive Howell, NJ 07731 732-513-9773 Anne Christine (Brinton) Holton Anne B. Holton 28 April 1947 18438- 5659 320 Joy Lane West Chester, PA 19380-5110 6106966342 Thomas Latimer Brinton Thomas L Brinton 04 November 1948 176404217 PO Box 2035 Springfield, IL 62705-2035 630-484-4167 Funds c/o Mr. Arthur E. Davis, Consultant "The United Methodist Stewardship Foundation of Central Pennsylvania" 303 Mulberry Drive, Suite 300 Mechanicsburg PA 17050-3141 717-766-7343 or 1-800-272-0113 717-766-1673 FAX sfcpa@netrax.net adavis@cpcumc.org www.umstewardship.org Estate of Elizabeth Brinton 320 Joy Lane West Chester, PA 19380-5110 Saturday, March 17, 2007 Mr. Arthur E. Davis, Consultant The United Methodist Stewardship Foundation of Central Pennsylvania 303 Mulberry Drive, Suite 300 Mechanicsburg, PA 17050-3141 Dear Art, Enclosed is a check for $121,000 from the Estate of Elizabeth Brinton for investing per her Will by The United Methodist Stewardship Foundation ofCentraI Pennsylvania. This amount is the bulk of the estate and the remainder, a few hundred dollars, will be sent as the income tax matters are cleared. This additional amount should be sent by the end of March or the beginning of April this year. I will send under separate cover the details you requested about the beneticiaries. With best regards, Anne Holton Executrix ESTATE OF El.lZA8ETHM BRINTON ANtlE. BRINTON HOLTON EXEC II f:oRJf,~ ~N ASHWORTH EXEc 1032 WEST CHESTER. P' ,.... . fil.o. n ~~? 'i;\' @~4~l1n,fd~+tJJ<;f~~st.(l-t;<<~~~ J ~TITOt>{; 1 I On.f.I~l",'n~f_ ffu-..J DiL...J_ ~ :---~ A -2 E ~~Jones -~ L!J ~':. cD & ~~Since1871 ~~~~,\;%N?git.WJ~ t98048'nt8 ~ ~,I( ':0 ~ . .00 .51.: .a8 cU. . q 11 "". .o~ ~ .. I ." \ , . Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 NameOfDocedenl:-J;rl~~fb 11. Brin/-Dn Date of Death: Estate No.: Q J-aDD~-&1P5 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the adTninis1ration of the above-captioned estate: 1. State whether ~stration of the estate is complete: Yes 0 No ~ 2. If the answer is No, state when the perso . , the od1nUrls1ration will be comp1ete: ~ bau1 CIU %J.1:f 3. If the answer to No. 1 is Yes, state the following: ~ UM..t.. wai".n9 -!fR-~. .a. Did the personal representative file a final account with the Court? Yes 0 No)?J b. The separate Orphans' CourtNo. (if any) for the persona1 representative's account is: c. Did the pers~tative state an account informally to the parties in interest?Yes"ja No 0 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. . Date: !iJ/.EIalo Cdb' d:tWrner Lanp- AddressWtdCheskr, IJIF]l438D {J/b-rlq- o'13?- Telephone No. Capacity: Q ~ersonal Representative ~unsel for personal representative F, n ~I E 1041 Department of the Treasury-Internal Revenue Service ~@O6 I 0 U.S. Income Tax Return for Estates and Trusts u. OMB No. 1545-0092 A Type of entity (see instr.): For calendar year 2006 or fiscal year beginning 07/01/2006 , and ending 06/30/2007 [g] Decedenfs estate Name of estate or trust (If a grantor type trust, see page 12 of the instructions.) C Employer Identification number D Simple trust 42-6640872 D Complex trust Estate of Elizabeth Brinton D Date entity created D Qualified disability trust Name and titie of fiduciary 09/29/2003 D EST. (S portion only) Anne Brinton Holton exec / Carol Tyson Ashworth exec E Nonexempt charitable and split- D Grantor type trust Number, street, and room or suite no. (If a P.O. box, see page 12 of the instructions.) interest trusts, check applicable boxes (see page 13 of the instr.): D Bankruptcy estate-Ch. 7 320 JOY Lane D Described in section 4947(a)(1) D Bankruptcy estate-Ch. 11 City or town State ZIP code D Not a private foundation D Pooled income fund West Chester PA 19380 D Described in section 4947(a)(2) B Number of Schedules K-1 F Check D Initial retum [g] Final return D Amended return D Change in trust's name attached (see applicable D D Change in fiduciary's name D Change in fiduciary's address instructionsl . 0 boxes: Change in fiduciary G Pooled mortgage account (see page 14 of the instructions): D Bought D Sold Date: 1 Interest income I 1 312 2a Total ordinary dividends. I 2a b Qualified dividends allocable to: (1) Beneficiaries ___ ______n_n.(2) Estate or trust_ n ____ ____ lIIIpI G.l 3 Business income or (loss). Attach Schedule C or C-EZ (Form 1040) . E 0 4 Capital gain or (loss). Attach Schedule 0 (Form 1041) . 4 u 5 Rents, royalties, partnerships, other estates and trusts, etc. Attach Schedule E (Form 1040) . 5 .5 6 Farm income or (loss). Attach Schedule F (Form 1040) . 6 7 Ordinary gain or (loss). Attach Form 4797 . 7 8 Other income. List type and amount .____n_n_n_n_n________nn__n____nnn______ 8 9 Total income. Combine lines 1, 2a, and 3 throuah 8. .~ 9 312 10 Interest. Check if Form 4952 is attached ~ D 10 11 Taxes 11 189 12 Fiduciary fees. .. 12 6298 VI 13 Charitable deduction (from Schedule A, line 7) . 13 c 14 Attorney, accountant, and return preparer fees. .. 14 0 15a Other deductions not subject to the 2% floor (attach schedule) . 15a ;::: u b Allowable miscellaneous itemized deductions subject to the 2% floor . 15b ~ 'C 16 Add lines 10 through 15b . . . . .~ 16 6487 G.l . .f 1'7 '1 . -6,1751 C 17 Adjusted total income or (loss). Subtract line 16 from line 9 18 Income distribution deduction (from Schedule B, line 15). Attach Schedules K-1 (Form 1041. 18 19 Estate tax deduction including certain generation-skipping taxes (attach computation) . 19 20 Exemption. . . 20 21 Add lines 18 throuah 20. .~ 21 0 22 Taxable income. Subtract line 21 from line 17. If a loss, see page 20 of the instructions. 22 -6,175 23 Total tax (from Schedule G, line 7) . 23 0 .!! 24 Payments: a 2006 estimated tax payments and amount applied from 2005 return . 24a c b Estimated tax payments allocated to beneficiaries (from Form 1041-T) . 24b G.l Subtract line 24b from line 24a . 24c ~ c 0 d Tax paid with Form 7004 (see page 20 of the instructions) . 24d CG Federal income tax withheld. If any is from Form(s) 1099, check ~D. D.. e 24e 'C f Credit for federal telephone excise tax paid. Attach Form 8913 . 24f c CG Other payments: 9 Form 2439 O' h Form 4136 ; Total ~ 24i 0 , ------------..-. >< .......---....----.... CG 25 Total payments. Add lines 24c through 24f, and 24i . .~ 25 0 I- 26 Estimated tax penalty (see page 20 of the instructions) . 26 27 Tax due. If line 25 is smaller than the total of lines 23 and 26, enter amount owed . 27 0 28 Overpayment. If line 25 is larger than the total of lines 23 and 26, enter amount overpaid 28 0 29 Amount of line 28 to be: a Credited to 2007 estimated ta. . b Refunde~ 29 0 Under penalties of perjury, I declare that I have examined this retum, induding accompanying schedules and statements, and to the best of my knowledge and Sign belief, it is true, correct, and complete. Dedaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. May the IRS discuss this return Here ~ Signature of fiduciary or officer representing fiduciary 1 08/14/2006 I. with the pl8Jlllfllr shown below Date EIN of fiduciary if a financial institution (see instr.)? DYes D No ~ Preparer's k;Date Dod Check if self- Preparer's SSN or PTIN Paid signature Self Preoared Return XXXXXXXXX employed D XXXXXXXXXXXXX Pre parer's Firm's name (or ~ xxxxxxxxxxxxx EIN XXXXXXXXXXXXX Use Only yours if self-employed), XXXXXXXXXXXXX Phone no. XXXXXXXXXXXXX address, and ZIP code XXXXXXXXXXXXX State XX ZIP code XXXXXXXXXXXXX For Privacy Act and Paperwork Reduction Act Notice, see the separate Instructions. (HTA) Form 1041 (2006) Estate of Elizabeth Brinton 42-6640872 Charitable Deduction. Do not complete for a simple trust or a pooled income fund. Amounts paid or permanently set aside for charitable purposes from gross income (see page 21) 1 Tax-exempt income allocable to charitable contributions (see page 21 of the instructions) . . .. 2 Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 3 Capital gains for the tax year allocated to corpus and paid or permanently set aside for charitable purposes . 4 Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Section 1202 exclusion allocable to capital gains paid or permanently set aside for charitable purposes (see page 21 of the instructions). . . . . . . . . . . . . . . . . 7 Charitable deduction. Subtract line 6 from line 5. Enter here and on a e 1, line 13. . . . Income Distribution Deduction Adjusted total income (see page 22 of the instructions) . ................ Adjusted tax-exempt interest. . . . . . . . . .. ................ Total net gain from Schedule D (Form 1041), line 15, column (1) (see page 22 of the instructions) . Enter amount from Schedule A, line 4 (minus any allocable section 1202 exclusion) . . . . . . Capital gains for the tax year included on Schedule A, line 1 (see page 22 of the instructions) . Enter any gain from page 1, line 4, as a negative number. If page 1, line 4, is a loss, enter the loss as a positive number. . . . . . . . . .. ................ 7 Distributable net income (DNI). Combine lines 1 through 6. If zero or less, enter -0- . . . . . 8 If a complex trust, enter accounting income for the tax year as determined under the governing instrument and applicable local law . 8 Income required to be distributed currently. . . . . . . . . . .. ........ Other amounts paid, credited, or otherwise required to be distributed. ...... Total distributions. Add lines 9 and 10. If greater than line 8, see page 22 of the instructions Enter the amount of tax-exempt income included on line 11 . . . . . . . . . . . . . Tentative income distribution deduction. Subtract line 12 from line 11 . . . . . . . . . Tentative income distribution deduction. Subtract line 2 from line 7. If zero or less, enter -0-. . . Income distribution deduction. Enter the smaller of line 13 or line 14 here and on pa e 1, line 18 Tax Computation (see page 23 of the instructions) 1 Tax: a Tax on taxable income (see page 23 of the instructions) . b Tax on lump-sum distributions. Attach Form 4972 . c Alternative minimum tax (from Schedule I, line 56) . d Total. Add lines 1a through 1c. . . 2a Foreign tax credit. Attach Form 1116. . . . . . . . . . b Other nonbusiness credits (attach schedule). . . . . . . c General business credit. Enter here and check which forms are attached D Form 3800 D Forms (specify) ~ _____________mm___" d Credit for prior year minimum tax. Attach Form 8801 . . . . . . 3 Total credits. Add lines 2a through 2d. . . . . . . . .. . . . 4 Subtract line 3 from line 1d. If zero or less, enter -0-. . . . . . . 5 Recapture taxes. Check if from: D Form 4255 D Form 8611 . 6 Household employment taxes. Attach Schedule H (Form 1040). . . . 7 Total tax. Add lines 4 throu h 6. Enter here and on a e 1, line 23. . . . . . Other Information 1 Did the estate or trust receive tax-exempt income? If "Yes," attach a computation of the allocation of expenses Enter the amount of tax-exempt interest income and exempt-interest dividends ~ $ 0 2 Did the estate or trust receive all or any part of the earnings (salary, wages, and other compelrisation) "ot" any- - - -" individual by reason of a contract assignment or similar arrangement? . . . . . . . . . . . . . . . . 3 At any time during calendar year 2006, did the estate or trust have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? . . . . . . . . . . . . . . . . See page 25 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes," enter the name of the foreign country ~ 4 During the tax year, did the estate ortrustreceive"adistributioj,-from~-or-wasit-ttie-gra-rito-r"CiCCirtransfero-r-to-'---- a foreign trust? If "Yes," the estate or trust may have to file Form 3520. See page 25 of the instructions. . . . 5 Did the estate or trust receive, or pay, any qualified residence interest on seller-provided financing? If "Yes," see page 25 for required attachment. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . If this is an estate or a complex trust making the section 663(b) election, check here (see page 25). . . ~ D To make a section 643(e)(3) election, attach Schedule D (Form 1041), and check here (see page 25). . ~ D If the decedenfs estate has been open for more than 2 years, attach an explanation for the delay in closing the estate, and check here . ~ D Are any present or future trust beneficiaries skip persons? See pa e 25 of the instructions. . . . . . . . Form 1041 (2006) 1 2 3 4 5 6 1 2 3 4 5 6 9 10 11 12 13 14 15 1a 1b 1c . . . . . . .~ 2a 2b 2c 2d . . . . . . . ~ 6 7 8 9 Page 2 o o 6 7 o 1 2 3 4 5 6 7 o 9 10 11 12 13 14 15 o o o o o ~ 3 4 5 6 7 o o Schedule B (Form 1040) 2006 Name(s) shown on Form 1040. Do not enter name and social security number if shown on other side. Estate of Elizabeth Brinton OMB No. 1545-0074 Page 2 Your .oclal .ecurity number 42-6640872 Part I Interest (See page B-1 and the instructions for Form 1040, line 8a.) Note. If you received a Form 1099-INT, Form 1099-0ID, or substitute statement from a brokerage firm, list the firm's name as the payer and enter the total interest shown on that form. Part II Ordinary Dividends (See page B-1 and the instructions for Form 1040, line 9a.) Note. If you received a Form 1 099-DIV or substitute statement from a brokerage firm, list the firm's name as the payer and enter the ordinary dividends shown on that form. Schedule B-Interest and Ordinary Dividends Attachment Sequence No. 08 Amount 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see page B-1 and list this interest first. Also, show that buyer's social security number and addres. _~~~C}~~ _J_<?r:!~~_~~!C}t~ Aqqq':lD! l!:1!~~~~t ..!.~Iy_ ~!lJl ?Qq~ _ _ 00 _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 312 1 ------------------------------------------------------------------------------ 2 Add the amounts on line 1 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815 4 Subtract line 3 from line 2. Enter the result here and on Form 1040, line 8a .. Note. If line 4 is over $1,500, you must complete Part III. 2 312 3 4 312 Amount 5 List name of payer . 5 6 -Ad,i the -ciriiounts ,in iine 5~ -Enter the -totai he-re an,j oj,- F,irm -1-040: iij,-e .~ia - - - - -.- ~ 6 o Note. If line 6 is over $1,500, ou must com lete Part III. a You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; or (b) had Foreign a forei n account; or c received a distribution from, or were a rantor of, or a transferor to, a forei n trust. Accounts 7 a At any time during 2006, did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial and account? See page B-2 for exceptions and filing requirements for Form TD F 90-22.1. . . . . . Trusts b If "Yes," enter the name of the foreign count~ __________________ _000000_00_________00____00____ (See 8 During 2006, did you receive a distribution from, or were you the grantor of, or transferor to, a page B-2.) forei n trust? If "Yes," ou ma have to file Form 3520. See a e B-2 . . . . . . . . . . . . X For Paperwork Reduction Act Notice, see Form 1040 Instructions. Schedule B (Form 1040) 2006 (HTA) --.J 0604113159 L PA-41 - 2006 Pennsylvania Fiduciary Income Tax Return ENTER ONE LETTER OR NUMBER IN EACH BOX. Do Not Use Your Preprinted Label 426640872 173077004 6106963242 N Extension Enclosed. Y.Yes N=No ESTATE OF ELIZABETH BRINTON N Amended PA-41 Y=Yes N=No ANNE BRINTON HOLTON EXEC / CAROL TY Y Fiscal Year Flier. Y=Yes N=No from 070106 to 063007 320 JOY LANE R Residency Status. RaPA Resident N=Nonresldent If "N" Name of State F=Flnal Return. N=No Final Return. Enter Ending Date: 0 6 3 0 0 7 WEST CHESTER PA 19380 F Estate or Trust Identification Change. If any of the identification or filing infonnation you entered is different from the 2005 PA-41, or if the estate or trust did not file a 2005 PA-41. Y=Yes N=No Do You Want a 2007 PA-41 Booklet? Y=Yes N=No Submit all required Pennsylvania supporting schedules. 14 TOTAL OTHER CREDITS from PA Schedule OC. 15 2006 PAYMENTS and CREDITS. Add Lines 11, 12. 13 and 14. 16 TAX DUE. If Line 10 is more than Line 15, enter the difference here. 1 312 2 0 3 0 4 0 5 0 6 0 7 312 8 0 9 312 10 10 11 0 12 0 13 0 14 0 15 0 16 10 1 PA TAXABLE INTEREST INCOME. See instructions 2 PA TAXABLE DIVIDEND INCOME. See instructions. 3 NET INCOME or LOSS from the Operation of a Business, Profession, or Farm. 4 NET GAIN or LOSS from the Sale, Exchange, or Disposition of Property 5 NET INCOME or LOSS from Rents, Royalties, Patents, or Copyrights. 6 ESTATE or TRUST INCOME. 7 TOTAL TAXABLE INCOME. Add only the positivelncome from Lines 1, 2, 3, 4, 5, and 6. Do not add losses 8 DEDUCTIONS from PA SCHEDULE DD. 9 NET PA TAXABLE INCOME. Subtract Line 8 from Line 7. 10 TOTAL PA TAX LIABILITY. Multiply Line 9 by the tax rate of 3.07% (0.030?; 11 2006 ESTIMATED PAYMENTS and CREDITS. See instructions. 12 NONRESIDENT TAX WITHHELD from PA SCHEDULE(S) NRK-1. 13 TOTAL CREDITforTAXES PAID by PA RESIDENT ESTATES or TRUSTS to OTHER STATES or COUNTRIES. EC Page 1 of 2 FC L 0604113159 D:J rr::r::IIIJ D:J 0604113159 --.J --.J 0604213165 L PA-41 - 2006 Federal EIN or Decedent's Social Security Number. 426640872 Name(s) as shown onPA-41 ESTATE OF ELIZABETH BRINTON 17 PENALTIES AND INTEREST. Mark the box if REV-1630F is attached. 18 TOTAL PAYMENT - Add Lines 16 and 17. Make check or money order payable toPA DEPT. OF REVENUE. Use your PA-V Form See the instructions on HOW TO PAY. 19 OVERPAYMENT. If Line 15 is more than the total of Line 10 and Line 17, enter thl difference here. The total of Lines 20 and 21 must equal Line 19. 20 REFUND - AMOUNT of LINE 19 you want as a check mailed to the estate or trust. 21 CREDIT - AMOUNT of LINE 19 you want as a credit to the 2007 Estimated Tax Account of the estate or trust. Signature(s). Under penalties of pe~ury, I have examined this retum, induding all accompanying schedules and statements, and to the best of my belief, it is true, correct and complete. Signature of Fiduciary I Date N 17 18 o 10 19 20 21 o o o FIRM'S FEIN 08/14/06 Pre parer's Name XXXXXXXXXXXXX Preparer's Telephone No. PA-41 SCHEDULE OC Other Credits for PA Fiduciary Income Tax Purposes You must submit the certificate or notification that approved each credit you are c1aimil or the PA RK-1 or NRK-1 that includes the credit. 1 PA Employment Incentive Credit. See Instructions. 2 PA Jobs Creation Tax Credit. See Instructions. 3 PA Research and Development Tax CredllSee Instructions. 4 PA Film Production Tax Credit. See Instructions. 5 PA Organ and Bone Marrow Donor Tax CredilSee Instructions. 6 Total PA Other Credits. Add Lines 1 through 5. Enter here and on Line 14 of'A. 41. PREPARER'S SSN/PTIN 1 2 3 4 5 6 o o o o o o PA SCHEDULE 01 1 Is this a revocable trust? 2 Is this an irrevocable trust? 3 Does the estate/trust receive income from, or pay income to a foreign entity? If yes include statemel 4 Has the federal government made an additional assessment on the income of this estate/trust in the last four year 5 Did this estate/trust receive income from a partnership, S corporation, LLC, or another estateltrust? If "Yes," list all sue partnerships, S corporations, LLCs, estates/trusts, showing the FEIN, name and address of each below FEIN Name & Address 1 2 3 4 5 A B C D 6 Name of Grantor: Address of Grantor: Page 2 of 2 L 0604213165 0604213165 --.J --.J 0604310011 PA SCHEDULE A/B/J Interest and Dividend Income Income from Estates and Trusts PA-41 AIBIJ(09-06) PA Department of Revenue 2006 OFFICIAL USE ONLY If you need more space, you may photocopy these schedules. Name as shown on the PA-41 Estate of Elizabeth Brinton Federal EIN or Decedent's SSN 42-6640872 Caution: Federal end PA rules for taxeble interest and dividend income ara different. You cannot use the Federal schedules to report PA Interest or dividend income. Read the Instructions. If either the taxable interast or dividend income is $2.500 or less. the fiduciary must raport the incoma. but need not submit any schedule. If either the interast income or dividend income is more than $2.500. the fiduciary must submit a schedule. List the name of each payer and the amount of PA taxable interast and dividend income you received in 2006. PA-41 A(09-06) PA SCHEDULE A - PA Taxable Interest Income 1. Seller-Financed Mortaaae Interest Income 1. $ 312 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 2. Total Interest Income. Add all amounts listed lincludina amounts on additional schedules). 2. $ 312 3. Interest income from partnership!s). from PA Schedule!s) RK-1. 3. $ 4. Interest income from PA S corooration!s). from PA Schedule!s) RK-1. 4. $ 5. Total PA Taxable Interest Income. Add Lines 2 3 and 4. Enter on Line 1 of the PA-41. 5. $ 312 IMPORTANT. Capital gain distributions are dividend income for PA purposes. PA SCHEDULE B PA T bl D' 'd d I &C 't IG ' D' t 'b f PA-41 B (09-06) - axa e IVI en ncome apla ams IS rl u Ion 1. 1. $ $ $ $ $ $ $ $ 2. Total Dividend Income. Add all amounts listed lincludina amounts on additional schedules). 2. $ 0 3. CaDital Gains Distributions. 3. $ 0 4. Dividend income from DartnershiD!s) from PA Schedule!s) RK-1. 4. $ 5. Dividend income from PA S corooration!s). from PA Schedule!s) RK-1. 5. $ 6. Total PA Taxable Dividend Income. Add Lines 2 3 4. and 5. Enter on Line 2 of the PA-41. 6. $ 0 PA-41 J (09-06) PA SCHEDULE J - Income from Estates or Trusts 2006 Read the Instructions. List the name. address. and identification number of each other estate or trust of which this estate or trust is a beneficiary. If this estate or trust received a Federal Schedule K-1. instead of a PA Schedule RK-1 or NRK-1. see the instructions. Check box if income is reported from PA Schedule RK-1 or NRK-1. (a) Name and address of each estate or trust PA Schedule (b) Federal EIN (c) Income Amount RK.1 or NRK.1 D D D D D D Estate or trust income from partnership(s). Estate or trust income from PA S corporation(s). Total Estate or Trust Income, Add Column (c). Enter on Line 6 of the PA-41. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 L 0604310011 0604310011 --.J PIY\J !+fYle"U /1:L E 1041 Department of the Treasury-Internal Revenue Service ~@()6 I . 0 U.S. Income Tax Return for Estates and Trusts u. OMB No. 1545-0092 A Type of entity (see instr.): For calendar year 2006 or fiscal year beginning 07/01/2006 , and ending 06/30/2007 00 Decedent's estate Name of estate or trust (If a grantor type trust, see page 12 of the instructions.) C Employer identification number D Simple trust 42-6640872 D Complex trust Estate of Elizabeth Brinton D Date entity created D Qualified disability trust Name and title of fiduciary 09/29/2003 D EST. (S portion only) Anne Brinton Holton exec / Carol Tvson Ashworth exec E Nonexempt charitable and split- D Grantor type trust Number, street, and room or suite no. (If a P.O. box, see page 12 of the instructions.) interest trusts, check applicable boxes (see page 13 of the instr.): D Bankruptcy estate-Ch. 7 320 Jov Lane D Described in section 4947(a)(1) D Bankruptcy estate-Ch. 11 City or town State ZIP code D Not a private foundation D Pooled income fund West Chester PA 19380 D Described in section 4947(a)(2) B Number of Schedules K-1 F Check D Initial retum 00 Final return 00 Amended return D Change in trust's name attached (see applicable D D Change in fiduciary's name D Change in fiduciary's address instructions) . 0 boxes: Change in fiduciary G Pooled mortgage account (see page 14 of the instructions): D Bought D Sold Date: 1 Interest income I 1 4444 2a Total ordinary dividends. I 2a b Qualified dividends allocable to: (1) Beneficiaries . _ _ _ __ _ __ __ __ _ _ .(2) Estate or trust n _ n _ n __, ~ CI) 3 Business income or (loss). Attach Schedule C or C-EZ (Form 1040) , j 4 Capital gain or (loss). Attach Schedule D (Form 1041). 4 5 Rents, royalties, partnerships, other estates and trusts, etc. Attach Schedule E (Form 1040) , 5 6 Farm income or (loss). Attach Schedule F (Form 1040) . 6 7 Ordinary gain or (loss). Attach Form 4797 . 7 8 Other income. List type and amount ~t~_t~ J~_~ r~!t!l}(L ___ ___ _ __ _ n n _ _ _ _ n _ _ _ _ _ _ _ __ n __ _, 8 120 9 Total income. Combine lines 1 2a and 3 throuoh 8 . ~ 9 4564 10 Interest. Check if Form 4952 is attached ~ D 10 11 Taxes 11 510 12 Fiduciary fees. 12 6298 13 Charitable deduction (from Schedule A, line 7) . 13 ~ 14 Attorney, accountant, and return preparer fees, .. 14 0 15a Other deductions not subject to the 2% floor (attach schedule). . . 15a ts b Allowable miscellaneous itemized deductions subject to the 2% floor , 15b ::::l '0 16 Add lines 10 through 15b . . . . i 17'1' ~2.244r 16 6808 ~ 17 Adjusted total income or (loss). Subtract line 16 from line 9 . 18 Income distribution deduction (from Schedule B, line 15). Attach Schedules K-1 (Form 1041) 18 19 Estate tax deduction including certain generation-skipping taxes (attach computation) , 19 20 Exemption. . . 20 21 Add lines 18 throuoh 20 . .~ 21 0 22 Taxable income. Subtract line 21 from line 17. If a loss, see page 20 of the instructions, 22 -2 244 23 Total tax (from Schedule G, line 7) , 23 0 24 Payments: a 2006 estimated tax payments and amount applied from 2005 return . 24a ~ b Estimated tax payments allocated to beneficiaries (from Form 1041-T). 24b ~ c Subtract line 24b from line 24a . 24c 0 d Tax paid with Form 7004 (see page 20 of the instructions) . ';'0. 24d a. e Federal income tax withheld. If any is from Form(s) 1099, check 24e '0 f Credit for federal telephone excise tax paid. Attach Form 8913 , 24f Ii Other payments: 9 Form 2439 O' h Form 4136 ___________n__ ; Total ~ 24i 0 .__________.......... I ~ 25 Total payments. Add lines 24c through 24f, and 24i , ~ 25 0 26 Estimated tax penalty (see page 20 of the instructions) . 26 27 Tax due. If line 25 is smaller than the total of lines 23 and 26, enter amount owed . 27 0 28 Overpayment. If line 25 is larger than the total of lines 23 and 26, enter amount overpaid 28 0 29 Amount of line 28 to be: a Credited to 2007 estimated tax ~ : b Refunded~ 29 0 Under penalties of perjury, I declare that I have examined this retum, including accompanying schedules and statements, and to the best of my knowledge and Sign belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. May the IRS discuss this return Here ~ Signature of fiduciary or officer representing fiduciary I 03/23/2007 I. with the pre~r shown below . Date EIN of fiduciary if a financial institution (see instr.)? DYes D No ~ Preparer's I Date I Check if self- D Preparer's SSN or PTIN Paid signature Self PreDared Return employed XXXXXXXXXXXXX Preparer's Firm's name (or ~ XXXXXXXXXXXXX EIN XXXXXXXXXXXXX Use Only yours if self-employed), XXXXXXXXXXXXX Phone no. XXXXXXXXXXXXX address, and ZIP code XXXXXXXXXXXXX State XX ZIP code XXXXXXXXXXXXX For Privacy Act and Paperwork Reduction Act Notice, see the separate instructions. (HTA) Form 1041 (2006) Estate of Elizabeth Brinton 42-6640872 Charitable Deduction. Do not com lete for a sim Ie trust or a ooled income fund. Amounts paid or permanently set aside for charitable purposes from gross income (see page 21) . Tax-exempt income allocable to charitable contributions (see page 21 of the instructions). . . . Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Capital gains for the tax year allocated to corpus and paid or permanently set aside for charitable purposes . Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Section 1202 exclusion allocable to capital gains paid or permanently set aside for charitable purposes (see page 21 of the instructions). . . . . . . . . . . . . . . . . Charitable deduction. Subtract line 6 from line 5. Enter here and on a e 1, line 13. . . . Income Distribution Deduction Adjusted total income (see page 22 of the instructions). . ..... . . . . . . . . . . . . Adjusted tax-exempt interest. . . . . . . . . . .. ............... Total net gain from Schedule D (Form 1041), line 15, column (1) (see page 22 of the instructions). . Enter amount from Schedule A, line 4 (minus any allocable section 1202 exclusion) . . . . . . . Capital gains for the tax year included on Schedule A, line 1 (see page 22 of the instructions) . Enter any gain from page 1, line 4, as a negative number. If page 1, line 4, is a loss, enter the loss as a positive number. . . . . . . . . . .. ....... . . . . . . . . 7 Distributable net income (DNI). Combine lines 1 through 6. If zero or less, enter -0- . . . . . . 8 If a complex trust, enter accounting income for the tax year as determined under the governing instrument and applicable local law . . . 8 Income required to be distributed currently. . . . . . . . . . . . .. ......... Other amounts paid, credited, or otherwise required to be distributed . . . . . . . . . Total distributions. Add lines 9 and 10. If greater than line 8, see page 22 of the instructions Enter the amount of tax-exempt income included on line 11 . . . . . . . . . . . . . Tentative income distribution deduction. Subtract line 12 from line 11 . . . . . . . . . Tentative income distribution deduction. Subtract line 2 from line 7. If zero or less, enter -0-. . . . Income distribution deduction. Enter the smaller of line 13 or line 14 here and on a e 1, line 18 Tax Computation (see pa e 23 of the instructions) 1 Tax: a Tax on taxable income (see page 23 of the instructions) . b Tax on lump-sum distributions. Attach Form 4972 . c Alternative minimum tax (from Schedule I, line 56) . d Total. Add lines 1a through 1c. . . 2a Foreign tax credit. Attach Form 1116. . . . . . . . . . b Other nonbusiness credits (attach schedule). . . . . . . c General business credit. Enter here and check which forms are attached: D Form 3800 D Forms (specify) ~ on on.... on on on _ __ __ d Credit for prior year minimum tax. Attach Form 8801 3 Total credits. Add lines 2a through 2d. . . . . . . . . .. . . . 4 Subtract line 3 from line 1 d. If zero or less, enter -0-. . . . . . . . 5 Recapture taxes. Check if from: D Form 4255 D Form 8611 . 6 Household employment taxes. Attach Schedule H (Form 1040). . . . . . 7 Total tax. Add lines 4 throu h 6. Enter here and on a e 1, line 23. . . '. ..... Other Information 1 Did the estate or trust receive tax-exempt income? If "Yes," attach a computation of the allocation of expenses Enter the amount of tax-exempt interest income and exempt-interest dividends ~ $ 0 2 Did the estate or trust receive all or any part of the earnings (salary, wages, and other com~;ensaiion) -ciiany.... -- on individual by reason of a contract assignment or similar arrangement? . . . . . . . . . . . . . . . . . . 3 At any time during calendar year 2006, did the estate or trust have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? . . . . . . . . . . . . . . . . . See page 25 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes," enter the name of the foreign country ~ 4 During the tax year, did the estate or trust- receive~; dlstrit)utlon -ffom: or was -it the -grantor- or or transferc)r -to~ on -- on a foreign trust? If "Yes," the estate or trust may have to file Form 3520. See page 25 of the instructions. . . 5 Did the estate or trust receive, or pay, any qualified residence interest on seller-provided financing? If "Yes," see page 25 for required attachment. . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. If this is an estate or a complex trust making the section 663(b) election, check here (see page 25). . ~ D To make a section 643(e)(3) election, attach Schedule D (Form 1041), and check here (see page 25). . . . ~ D If the decedenfs estate has been open for more than 2 years, attach an explanation for the delay in closing the estate, and check here. . . . . ~ D Are an resent or future trust beneficiaries ski persons? See a e 25 of the instructions. . . . . . . . . . 1 2 3 4 5 6 1 2 3 4 5 6 1a 1b 1c . . . . . . . ~ 2a 2b 2c 2d . . . . . . . .~ 6 7 8 9 1 2 3 4 5 6 7 1 2 3 4 5 6 7 9 10 11 12 13 14 15 ~ 3 4 5 6 7 Page 2 o o o o o o o o o o o Estate of Elizabeth Brinton Amended Return Explanation of Changes (1041) 1 ~~t.?~~ _~!?!?~!~ .?!~_ t~ !~l!I}~t~r.t~ ~!1.?!lt.?_I:!.I~_tr~~L .1~l!I}!?t~r_ ~_l!~ ~2<P_~~~_q!Q _~~~~~ !>y_ ~[I5l_ 9f A~g_~Q9~" _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 2 A~~~ts_ ~~r~_ [IP.t _t!liI[1~fE!~r~_c! .?_n..c! .?!~_ ~~p~_~t~5l_ tr.?_n_s.t~!~9_1iI! ~_n_c! p! _~.?!~!1_ ?9.9.7_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 3 !I}.1_ .i!l~~r~l?! ~!1.?_n..gE!g .f!9!!} _~~ 1? .t9_ ~~~_~4 ~~rQ~gh. M~~ 7.9_Q~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 4 In 8 includes PA refund of estate taxes of $120 5 I~ ~1j ~ t~~~~ p-~i~~ 9! ~~1~~~ ~~~r!~9!~~)~ ~~IQ f9r l$j ~~ ~~~~~'I P!9~~t~~ t~~ ~ ~~{~~ ~~~61 p-~i~~!q p.~ ~~~ri~R [I~~I y~~rj~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ 6 !I} _1_~ _1]9 _ ~1]1iI!l9..~ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _'_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 7 ~~~E!g _ ~~ _I]~~ 1I}te!~!~~!.trQ~ f~l]!r.?J? J:._ 9p_n..f~!~!l_~~ !-!~_q'p'~ _q~r:!l]g_ fj!?~! Y'?.?!_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 8 Sched B: additional interest from Edward Jones 9 Ali income is -federai and Os-tate -taxabIE;- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- 10 --------------------------------------------------------------------------------------------------------------------- 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 42-6640872 --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------~--~---~--~--~--~~----~-~------------~----~---~--~-------~---~---- ---~~--~~~---~--~--~~------------~---------------~--~--~~--------------~-----~-------~------------~---~----~-~----~~- -~--~~~~~-----~~-~-~~~-~-----~-~---------~-----~----------------~-----~-----~------------~-~~-~--~--~---~~~--~~-----~ ---~-------~~-----~---------------~-----~-----~----------------------------~------------~--------~------------------- ~--~~~--~~------~-----~--~-----------~-~---~~----~-----~~--~--~--~-------------~--~----~--------~----------~~~--~--~- ----~-----~------~-------~------------------------~----------~--------------------~--------~-------~---~~------~---~- ~----------~~-----~---~-~-~-----~---------------------~------------~~----------------~--~-~--~---~--------~---------- ---~-----~~-----~--------------------------~~----~--------------------------------------------~-------------------~-- -~-~~-~-~~~------~~--~-~-~-----~-----------~~--~-------~~----~--------~-~---~----~~------~-~--~-~--~--~~------~~~--~- -~-----~--------------------~-----------------------------~-----~--------~-----------------------~------------------- ~----~-~--------~------------------------------------------~----------------~------------------------------------~~-- ---------------------------------------------~------------------------~------------------~-------------------~------- ~~-~---~~-------~------------~------------------------~--------------------------------------------------~----------- -------------~------~------------------------------------------------------------------------------------------------ ---~-------~--------------------------------------~----------~-------------------------------------------~----------- ----------------------------------~--------------------------------~~-------------------------------------~---------- ~-------~----~------------------------------------------------~-------------------~-------------------------------~-- ----~~----------------------------------------------------------------------------.----------------------------------- Schedule B (Form 1040) 2006 Name(s) shown on Form 1040. Do not enter name and social security number if shown on other side. Estate of Elizabeth Brinton OMB No. 1545-0074 Pa e 2 Your social security number 42-6640872 Seauence No. Part I 1 List name of payer. Ifany interest is from a seller-financed mortgage and the Amount Interest buyer used the property as a personal residence, see page B-1 and list this interest first. Also, show that buyer's social security number and address . (See page B-1 and the instructions for -------------------------------------------------------------------------------- Form 1040, _G~Q!C~I_~~_9_q~f~r~_~~_~~9_____________________________________________________ 2 259 line 8a.) _~gyv_~rp_J9~~~__________________________________________________________________ 2 185 -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- Note. If you -------------------------------------------------------------------------------- 1 received a Form ------.-.-.-.-----.-----.--.----.-.----.--.--.--..----.------.-.-----------.-.-- 1099-INT, Form -.--.-.--------.-.-------.-.-------.---.--.---.-...------.------------.-.-.----- 1099-010, or -------.-.-.--.------.-.----.-.--.--..--.---.----------.----------------------.- substitute ---.-.---------------.-------.-.-.--....----.------.--.-----.-----.------------- statement from ------.---------------.-.-------.------.--------------------.------------------- a brokerage firm, -.-----------------------.-.--------------------..-----------.------------------ list the firm's name as the -..--------.---------.-.----.-.------.--.--.--.----.-.-.-.--------------------.- payer and enter -------------------------------.-.----.--.-----.--------.---.-----.----.-----.-- the total interest -.------.---.-----.--------.------.-------.--.--..-----------.-.---------------- shown on that --.-.-.------.-.-.---.---.----.--.-----------.--.---.------.-------------------- form. 2 Add the amounts on line 1 2 4,444 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815 3 4 Subtract line 3 from line 2. Enter the result here and on Form 1040 line 8a ~ 4 4444 Note. If line 4 is over $1 500 you must comolete Part III. Amount Part " Ordinary 5 List name of payer . -.-------------.-----.------.--------------------------- Dividends -.-------.--------------------.--.------.-----.---.------.--------------.-.---.- ---------.-----------------------.----.--.-----.---.-.---------------.--------.- (See page B-1 and the ---.--.-------------.--------.-----------..-----.-------.---.--.--.--------.-.-- instructions for -.----------------------------------------------------.-----.------------------- Form 1040, -..------.-.-------.-.----.-.----.------.--.-----.-----.-.-.-------.----.------- line 9a.) ---.---.-.--------.--------------.----.--.-----.---.-.------------.--.---------- ---.--.---.-.-----------.--.------.-------.-----..----.-----..-------------.---- Note. If you ----.----------------.--------------------.------.------------------------------ received a Form -..------.-------.-.------.------.------.-----.------.---.----.------.--.-.---.- 5 1 099-01V or -----.-.-------------.-----------.--...-----.------.-------------------------.-- substitute ---.------------.-.-.------.------.----.--------.-----.------.-.-----------.---- statement from brokerage firm, ------.--------.--------------.------------------..------.--------------.------- a list the firm's -.-----------------------.-------.------------.------.---------------.---------- name as the --.------------------.------.-------..------.---------------------.------------- payer and enter -------------------------------------.------------------.----------------------- the ordinary -.----------------------------------------------..-----------.------------------ dividends shown -..------.------------------------------------.--------------------------------- on that form. -----------------------------------------------.-------------------------------- 6 Add the amounts on line 5. Enter the total here and on Form 1040. line 9a . 6 0 Schedule B-Interest and Ordinary Dividends Attachment 08 Note. If line 6 is over $1 500 ou must com lete Part III. You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; or (b) had a forei n account. or c received a distribution from or were a rantor of or a transferor to a forei n trust. 7 a At any time during 2006, did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? See page B-2 for exceptions and filing requirements for Form TD F 90-22.1. . . . . . b If "Yes," enter the name of the foreign country. __ _ nn __ U n ___ _ _ n___ n_ Un n Un_ _ nn __ n____ (See 8 During 2006, did you receive a distribution from, or were you the grantor of, or transferor to, a page B-2.) forei n trust? If "Yes" ou ma have to file Form 3520. See a e B-2 . . . . . . . . . . . . . X For Paperwork Reduction Act Notice, see Form 1040 Instructions. Schedule B (Form 1040) 2006 (HTA) Part '" Foreign Accounts and Trusts --1 0604113159 L PA-41 - 2006 Pennsylvania Fiduciary Income Tax Return ENTER ONE LETTER OR NUMBER IN EACH BOX. Do Not Use Your Preprinted Label 426640872 173077004 6106963242 N Extension Enclosed. Y=Yes N=No ESTATE OF ELIZABETH BRINTON Y Amended PA-41 Y=Yes N=No ANNE BRINTON HOLTON EXEC / CAROL TY Y Fiscal Year Filer. from 070106 Y=Yes N=No to 063007 320 JOY LANE N Residency Status. R=PA Resident N=Nonresldent If "N" Name of State R F=Flnal Return. N=No Final Return. Enter Ending Date: 0 6 3 0 0 7 WEST CHESTER PA 19380 F Estats or Trust Identification Change. If any of the identification or filing information you entered is differentfrom the 2005PA-41, or if the estate or trust did not file a 2005 PA-41. Y=Yes N=No Do You Want a 2007 PA-41 Booklet? Y=Yes N=No Submit all required Pennsylvania supporting schedules. 14 TOTAL OTHER CREDITS from PA Schedule OC. 15 2006 PAYMENTS and CREDITS. Add Lines 11, 12, 13 and 14. 16 TAX DUE. If Line 10 is more than Line 15, enter the difference here. 1 4444 2 0 3 0 4 0 5 0 6 0 7 4444 8 0 9 4444 10 136 11 10 12 0 13 0 14 0 15 10 16 126 1 PA TAXABLE INTEREST INCOME. See instructions 2 PA TAXABLE DIVIDEND INCOME. See instructions. 3 NET INCOME or LOSS from the Operation of a Business, Profession, or Farm. 4 NET GAIN or LOSS from the Sale, Exchange, or Disposition of Property. 5 NET INCOME or LOSS from Rents, Royalties, Patents, or Copyrights. 6 ESTATE or TRUST INCOME. 7 TOTAL TAXABLE INCOME.Add only the positive Income from Lines 1, 2, 3, 4, 5, and 6. Do not add losses. 8 DEDUCTIONS from PA SCHEDULE DO. g NET PA TAXABLE INCOME. Subtract Line 8 from Line 7. 10 TOTAL PA TAX LIABILITY. Multiply Line g by the tax rate of 3.07% (0.0307). 11 2006 ESTIMATED PAYMENTS and CREDITS. See instructions. 12 NONRESIDENT TAX WITHHELD from PA SCHEDULE(S) NRK-1. 13 TOTAL CREDIT for TAXES PAID by PA RESIDENT ESTATES or TRUSTS to OTHER STATES or COUNTRIES. EC Page 1 of 2 FC L 0604113159 ITJ=ITJ 0604113159 --1 ~ 0604213165 PA-41 - 2006 Federal EIN or Decedent's Social Security Number. 426640872 L Name(s) as shown on PA-41 ESTATE OF ELIZABETH BRINTON 17 PENALTIES AND INTEREST. Mark the box if REV-1630F is attached. 18 TOTAL PAYMENT - Add Lines 16 and 17. Make check or money order payable to PA DEPT. OF REVENUE. Use your PA-V Form. See the instructions on HOW TO PAY. 19 OVERPAYMENT. If Line 15 is more than the total of Line 10 and Line 17, enter the difference here. The total of Lines 20 and 21 must equal Line 19. 20 REFUND - AMOUNT of LINE 19 you want as a check mailed to the estate or trust. 21 CREDIT - AMOUNT of LINE 19 you want as a credit to the 2007 Estimated Tax Account of the estate or trust. Signature(s). Under penalties of pe~ury, I have examined this return, including all accompanying schedules and statements, and to the best of my belief, it is true, correct and complete. Signature of Fiduciary I Date 03/23/07 Preparer's Name XXXXXXXXXXXXX Preparer's Telephone No. PA-41 SCHEDULE OC Other Credits for PA Fiduciary Income Tax Purposes You must submit the certificate or notification that approved each credit you are claiming or the PA RK-1 or NRK-1 that includes the credit. 1 PA Employment Incentive Credit. See Instructions. 2 PA Jobs Creation Tax Credit. See Instructions. 3 PA Research and Development Tax Credit. See Instructions. 4 PA Film Production Tax Credit. See Instructions. 5 PA Organ and Bone Marrow Donor Tax Credit. See Instructions. 6 Total PA Other Credits. Add Lines 1 through 5. Enter here and on Line 14 of PA - 41. N 17 18 o 126 19 20 21 o o o FIRM'S FEIN PREPARER'S SSN/PTIN 1 2 3 4 5 6 o o o o o o PA SCHEDULE 01 1 Is this a revocable trust? 2 Is this an irrevocable trust? 3 Does the estate/trust receive income from, or pay income to a foreign entity? If yes include statement. 4 Has the federal govemment made an additional assessment on the income of this estateltrust in the last four years? 5 Did this estate/trust receive income from a partnership, S corporation, LLC, or another estate/trust? If "Yes," list all such partnerships, S corporations. LLCs, estates/trusts, showing the FEIN, name and address of each below. FEIN Name & Address A B C D 6 Name of Grantor: Address of Grantor: Page 2 of 2 L 0604213165 1 2 3 4 5 0604213165 ~ ---1 0604310011 PA SCHEDULE A/B/J Interest and Dividend Income Income from Estates and Trusts PA-41 AIBIJ (09-06) PA Department of Revenue 2006 OFFICIAL USE ONLY Name as shown on the PA-41 Estate of Elizabeth Brinton If ou need more space, ou ma photocopy these schedules. Federal EIN or Decedent's SSN 42-6640872 Caution: Federal and PA rules for taxable interest and dividend income are different. You cannot use the Federal schedules to report PA Interest or dividend income. Read the Instructions. If either the taxable interest or dividend income is $2.500 or less, the fiduciary must report the income, but need not submit any schedule. If either the interest income or dividend income is more than $2,500. the fiduciary must submit a schedule. List the name of each payer and the amount of PA taxable intarest and dividend income you received in 2006. PA-41 A (09-06) PA SCHEDULE A - PA Taxable Interest Income 1. Central PA Conference UMC 1. $ 2259 Edward Jones $ 2185 $ 0 $ 0 $ 0 $ 0 $ 0 $ 0 2. Tota/lnterest Income. Add all amounts listed (includinn amounts on additional schedules\. 2. $ 4444 3. Interest income from oartnershiofs\ from PA Schedulels\ RK-1. 3. $ 4. Interest income from PA S coroorationls\ from PA Schedulels\ RK-1. 4. $ 6. Total PA Taxable Interest Income. Add Lines 2 3 and 4. Enter on Line 1 of the PA-41. 5. $ 4.444 IMPORTANT. Capital gain distributions are dividend Income for PA purposes. I PA-41 B (09-06) - axa e IVI en ncome aplta ams Istri ution 1. 1. $ $ $ $ $ $ $ $ 2. Total Dlv/dend Income. Add all amounts listed (includinn amounts on additional schedules\. 2. $ 0 3. Caoltal Gains Distributions. 3. $ 0 4. Dividend income from oartnershiD(sl. from PA Schedulelsl RK-1. 4. $ 5. Dividend income from PA S coronrationfs\ from PA Schedulels\ RK-1. 5. $ 6. Total PA Taxable Dividend Income. Add Lines 2 3 4 and 5. Enter on Line 2 of the PA-41. 6. $ 0 PA SCHEDULE B PA T bl D' 'd d I &C IG ' D' b PA-41 J (09-06) PA SCHEDULE J - Income from Estates or Trusts 2006 Read the Instructions. List the name, address. and identification number of each other estate or trust of which this estate or trust is a beneficiary. If this estate or trust received a Federal Schedule K-1. instead of a PA Schedule RK-1 or NRK-1, see the instructions. Check box if income is reported from PA Schedule RK-1 or NRK-1. (a) Name and address of each estate or trust PA Schedule (b) Federal EIN (c) Income Amount RK.1 or NRK.1 D D D D D D Estate or trust income from partnership(s). Estate or trust income from PA S corporation(s). Total Estate or Trust Income, Add Column (c). Enter on Line 6 of the P A-41. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 L 0604310011 0604310011 ---1 hflJ t1- n1 ~ 4-l J-oj 2- E 1041 Department of the Treasury-Internal Revenue Service ~@O6 I ~ U.S. Income Tax Return for Estates and Trusts OMB No. 1545-0092 A Type of entity (see instr.): For calendar year 2006 or fiscal year beginning 07/01/2006 , and ending 06/30/2007 00 Decedenfs estate Name of estate or trust (If a grantor type trust, see page 12 of the instructions.) C Employer identification number D Simple trust 42-6640872 D Complex trust Estate of Elizabeth Brinton 0 Date entity created D Qualified disability trust Name and title of fiduciary 09/29/2003 D ESBT. (S portion only) Anne Brinton Holton exec / Carol Tvson Ashworth exec E Nonexempt charitable and split- interest trusts, check applicable D Grantor type trust Nurnber, street, and room or suite no. (If a P.O. box, see page 12 of the instructions.) boxes (see page 13 of the instr.): D Bankruptcy estate-Ch. 7 320 Jov Lane D Described in section 4947(a)(1) D Bankruptcy estate-Ch. 11 City or town State ZIP code D Not a private foundation D Pooled income fund West Chester PA 19380 D Described in section 4947(a)(2) B Number of Schedules K-1 F Check D Initial return 00 Final return 00 Amended return D Change in trust's name attached (see applicable D D Change in fiduciary's narne D Change in fiduciary's address instructionsl ~ 0 boxes: Change in fiduciary G Pooled mortgage account (see page 14 of the instructions): D Bought D Sold Date: 1 Interest income 1 I 4972 2a Total ordinary dividends. .. b Qualified dividends allocable to: (1) Beneficiaries . _ u _ _ u _ u u u .(2) Estate or trust ,_ u U u _ __. CD 3 Business income or (loss). Attach Schedule C or C-EZ (Form 1040) . 3 j 4 Capital gain or (loss). Attach Schedule 0 (Form 1041) . 4 5 Rents, royalties, partnerships, other estates and trusts, etc. Attach Schedule E (Form 1040) . 5 6 Farm income or (loss). Attach Schedule F (Form 1040) . 6 7 Ordinary gain or (loss). Attach Form 4797 . 7 8 Other income. List type and amount ~t~_t~_ta_~r~NI}(t_ _ __ _ _ __ u _ __ u __ _ _ _ _ _ _ u _ U _ u _ u_. 8 120 9 Total income. Combine lines 1. 2a and 3 throuah 8 . ~ 9 5092 10 Interest. Check if Form 4952 is attached ~ D 10 11 Taxes 11 526 12 Fiduciary fees. 12 6298 13 Charitable deduction (from Schedule A, line 7) 13 ~ 14 Attorney, accountant, and return preparer fees. .. 14 0 15a Other deductions not subject to the 2% floor (attach schedule) . 15a :g b Allowable miscellaneous itemized deductions subject to the 2% floor . 15b ~ 16 Add lines 10 through 15b . . . . . .' . i 17' I' .. . ~ 16 6824 17 Adjusted total income or (loss). Subtract line 16 from line 9 . -1 7321 18 Income distribution deduction (from Schedule B, line 15). Attach Schedules K-1 (Form 1041) 18 19 Estate tax deduction including certain generation-skipping taxes (attach computation) . 19 20 Exemption. . . 20 21 Add lines 18 throuah 20 . .~ 21 0 22 Taxable income. Subtract line 21 from line 17. If a loss, see page 20 of the instructions. 22 -1 732 23 Total tax (from Schedule G, line 7) . 23 0 24 Payments: a 2006 estimated tax payments and amount applied from 2005 return . 24a ~ b Estimated tax payments allocated to beneficiaries (from Form 1041-T) . 24b ~ c Subtract line 24b from line 24a . 24c 0 >- d Tax paid with Form 7004 (see page 20 of the instructions) . ~d. 24d C'lI e Federal income tax withheld. If any is from Form(s) 1099, check 24e a.. i f Credit for federal telephone excise tax paid. Attach Form 8913 . 24f Other payments: 9 Form 2439 . u u _ U __ _ u _ 9_ ; h Form 4136 _u____u____u ; Total ~ 24i 0 ~ 25 Total payments. Add lines 24c through 24f, and 24i . ~ 25 0 26 Estimated tax penalty (see page 20 of the instructions) . 26 27 Tax due. If line 25 is smaller than the total of lines 23 and 26, enter amount owed . 27 0 28 Overpayment. If line 25 is larger than the total of lines 23 and 26, enter amount overpaid 28 0 29 Amount of line 28 to be: a Credited to 2007 estimated tax ~ : b Refunded~ 29 0 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and Sign belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. May the IRS discuss this return Here ~ Signature of fiduciary or officer representing fiduciary I 03/23/2007 I. with the prep;lrer shown below Date EIN of fiduciary if a financial institution (see instr.)? D Ves 0 No ~ Preparer's I Date I Check if self- 0 Preparer's SSN or PTIN Paid signature Self Preoared Return employed XXXXXXXXXXXXX Pre parer's Firm's name (or ~ XXXXXXXXXXXXX EIN XXXXXXXXXXXXX Use Only yours if self-employed), XXXXXXXXXXXXX Phone no. XXXXXXXXXXXXX address, and ZIP code XXXXXXXXXXXXX State XX ZI P code XXXXXXXXXXXXX For Privacy Act and Paperwork Reduction Act Notice, see the separate Instructions. (HTA) Form 1 041 (2006) Estate of Elizabeth Brinton 42-6640872 Charitable Deduction. Do not com lete for a sim Ie trust or a ooled income fund. Amounts paid or permanently set aside for charitable purposes from gross income (see page 21) . Tax-exempt income allocable to charitable contributions (see page 21 of the instructions). . . . Subtract line 2 from line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Capital gains for the tax year allocated to corpus and paid or permanently set aside for charitable purposes . Add lines 3 and 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Section 1202 exclusion allocable to capital gains paid or permanently set aside for charitable purposes (see page 21 of the instructions). . . . . . . . . . . . . . . . . Charitable deduction. Subtract line 6 from line 5. Enter here and on a e 1, line 13 Income Distribution Deduction Adjusted total income (see page 22 of the instructions). . . . . . . . . . . . . . . . . . . Adjusted tax-exempt interest. . . . . . . . . . .. ............... Total net gain from Schedule 0 (Form 1041), line 15, column (1) (see page 22 of the instructions). . Enter amount from Schedule A, line 4 (minus any allocable section 1202 exclusion) . . . . . . . Capital gains for the tax year included on Schedule A, line 1 (see page 22 of the instructions) . Enter any gain from page 1, line 4, as a negative number. If page 1, line 4, is a loss, enter the loss as a positive number. . . . . . . . . . .. ........... . . . . 7 Distributable net income (ON I). Combine lines 1 through 6. If zero or less, enter -0- . . . . . . 8 If a complex trust, enter accounting income for the tax year as determined under the governing instrument and applicable local law . . . 8 Income required to be distributed currently. . . . . . . . . . . . .. ....... Other amounts paid, credited, or otherwise required to be distributed . . . . . . . . . Total distributions. Add lines 9 and 10. If greater than line 8, see page 22 of the instructions Enter the amount of tax-exempt income included on line 11 . . . . . . . . . . . . . Tentative income distribution deduction. Subtract line 12 from line 11 . . . . . . . . . Tentative income distribution deduction. Subtract line 2 from line 7. If zero or less, enter -0-. . . . Income distribution deduction. Enter the smaller of line 13 or line 14 here and on a e 1, line 18 Tax Computation (see page 23 of the instructions) 1 Tax: a Tax on taxable income (see page 23 of the instructions) . b Tax on lump-sum distributions. Attach Form 4972 . c Alternative minimum tax (from Schedule I, line 56) . d Total. Add lines 1a through 1c. . . 2a Foreign tax credit. Attach Form 1116. . . . . . . . . . b Other nonbusiness credits (attach schedule). . . . . . . c General business credit. Enter here and check which forms are attached: D Form 3800 D Forms (specify) ~ __ __ _ ___ _ ___ _ ___ _ _ _ ___ __ d Credit for prior year minimum tax. Attach Form 8801 3 Total credits. Add lines 2a through 2d. . . . . . . . . .. . . . 4 Subtract line 3 from line 1d. If zero or less, enter -0-. . . . . . . . 5 Recapture taxes. Check if from: D Form 4255 D Form 8611 . 6 Household employment taxes. Attach Schedule H (Form 1040). . . . . . 7 Total tax. Add lines 4 throu h 6. Enter here and on a e 1, line 23. . . . . ..... Other Information 1 Did the estate or trust receive tax-exempt income? If "Yes," attach a computation of the allocation of expenses Enter the amount of tax-exempt interest income and exempt-interest dividends ~ $ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 9_ 2 Did the estate or trust receive all or any part of the earnings (salary, wages, and other compensation) of any individual by reason of a contract assignment or similar arrangement? . . . . . . . . . . . . . . . . . . 3 At any time during calendar year 2006, did the estate or trust have an interest in or a signature or other authority over a bank, securities, or other financial account in a foreign country? . . . . . . . . . . . . . . . . . See page 25 of the instructions for exceptions and filing requirements for Form TO F 90-22.1. If "Yes," enter the name of the foreign country ~ . _ _ _ __ _ _ _ __ __ _ __ _ _ _ _ _ _ _ _ __ _ _ __ __ _ _ __ __ __ _ _ _ __ __ __ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ __ _ __ _ __ 4 During the tax year, did the estate or trust receive a distribution from, or was it the grantor of, or transferor to, a foreign trust? If "Yes," the estate or trust may have to file Form 3520. See page 25 of the instructions. . . 5 Did the estate or trust receive, or pay, any qualified residence interest on seller-provided financing? If "Yes," see page 25 for required attachment. . . . . . . . . . . . . . . . . . . . . . . . . . . .. .. If this is an estate or a complex trust making the section 663(b) election, check here (see page 25). . ~ D To make a section 643(e)(3) election, attach Schedule 0 (Form 1041), and check here (see page 25). . . . ~ D If the decedenfs estate has been open for more than 2 years, attach an explanation for the delay in closing the estate, and check here. . . . . ~ D Are an resent or future trust beneficiaries ski persons? See a e 25 of the instructions. . . . . . . . . . Form 1041 (2006) 1 2 3 4 5 6 1 2 3 4 5 6 9 10 11 12 13 14 15 1a 1b 1c . . . . . . . ~ 2a 2b 2c 2d . . . . . . . .~ 6 7 8 9 1 2 3 4 5 6 7 1 2 3 4 5 6 7 9 10 11 12 13 14 15 ~ 3 4 5 6 7 Page 2 o o o o o o o o o o o X Form 1041 (2006) Estate of Elizabeth Brinton Amended Return Explanation of Changes (1041) 1 ~~t~J~ _~!?!?~!~ ~!~_ tl? t~t}!?te!_tl? ~!l~!it~.t~I~_t..r~~L J~~t}!?t~.r_ ~_a_~ ~2<'p'~~~_q!Q _q~~l;!~ py_ ~r'~_ 9f Al;!9_~Q9~" _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 2 A~~~ts_ ~~r~_ r'P.t.t!~r'~f~rr~_q ~_n_q ~!~_ ~~P~_~~9_ tr~_n_~f~!~9_~! ~.n..q P!.~~!~!l_ ?9P.7_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 3 !t}.1_ .ir'J~r~!?t ~!l~_n.9~9 .f!9rQ _~~ 1? _tp_ ~~_~4 J~rQl:Ig!l_ M~~ ~P_(E _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 4 In 8 includes PA refund of estate taxes of $120 5 I~:H: ~~~~ p'~i~: 9f ~):~~ :~qr!~~~~)9: ~~:{Q fQ~ {~~~:~ ~~:~~'I P!9P:~t~: f~~ ~ ~:{~~ ~:~~6j p'~i~:!q f~:~~~iDa ~~~! y~:~6::::::::::: 6 !t}.1_~_~9_gQ~r'Sl~_____________________________________________________________________________________________________ 7 ~~~~9 _ ~~ _ ~~~ it}t~r~!~~J JrQ'!!. f~~tr~J _~ ~_ 9~t}f~!~.!1_~ Y.fYI_G.P.C;! _ql!rJ~g_ fj!?C?~~ y~~!_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 8 Sched B: additional interest from Edward Jones 9 Ali iricome is -federai -a-rid -state -tax~ible - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - 10 sEe-oND -AMENDED- FilING- -MAY -2007- - - - - - - - - - -. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -- 11 M~ X ~:QQ? ~ A~~~Q~~! ]6!~r~~(iD~9:~~ ~9:~ ~ 9~~tr~[ p~ ~G9Df ~QM9 ~ @~r ~~9~~~ ~~ {r~!l~f~r ~~~~~!~!c? :~~~a!~~I~ !r~~~t~: ~~?~~ ~ ~: ~ ~ ~ ~ 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 42-6640872 --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- ----------------------------------------------,----------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- Schedule B (Form 1040) 2006 Name(s) shown on Form 1040. Do not enter name and social security number if shown on other side. Estate of Elizabeth Brinton Part I Interest (See page B-1 and the instructions for Form 1040, line 8a.) Note. If you received a Form 1099-INT, Form 1099-01D, or substitute statement from a brokerage firm, list the firm's name as the payer and enter the total interest shown on that form. Part II Ordinary Dividends (See page B-1 and the instructions for Form 1040, line 9a.) Note. If you received a Form 1099-DIVor substitute statement from a brokerage firm, list the firm's name as the payer and enter the ordinary dividends shown on that form. OMB No. 1545-0074 Pa e 2 Your social security number 42-6640872 Schedule B-Interest and Ordinary Dividends Attachment Sequence No. 08 Amount 1 List name of payer. If any interest is from a seller-financed mortgage and the buyer used the property as a personal residence, see page B-1 and list this interest first. Also, show that buyer's social security number and address . -------------------.------------------------------------------------------------ _GEll~!~~I_':>t._ 9_qlJt~r~_I'!~ _4MQ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _~gyv_~r9_J9P~~__________________________________________________________________ _GEll~!~~I_~~9_qlJt~_~~l~~~Jl_____________________________________________________ 2259 2185 528 -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- 1 -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- 2 Add the amounts on line 1 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989. Attach Form 8815 4 Subtract line 3 from line 2. Enter the result here and on Form 1040 line 8a ~ Note. If line 4 is over $1 500 you must comolete Part III. 2 4972 3 4 4972 Amount 5 List name of payer . -------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- 5 -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- -------------------------------------------------------------------------------- 6 Add the amounts on line 5. Enter the total here and on Form 1040 line 9a . 6 o Note. If line 6 is over $1 500 ou must com lete Part III. You must complete this part if you (a) had over $1,500 of taxable interest or ordinary dividends; or (b) had a forei n account' or c received a distribution from or were a rantor of or a transferor to a forei n trust. 7 a At any time during 2006, did you have an interest in or a signature or other authority over a financial account in a foreign country, such as a bank account, securities account, or other financial account? See page B-2 for exceptions and filing requirements for Form TD F 90-22.1. . . . . . . b If "Yes," enter the name of the foreign country ~ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ __ _ _ __ __ _ __ _ __ _ _ _ __ _ ___ (See 8 During 2006, did you receive a distribution from, or were you the grantor of, or transferor to, a page B-2.) forei n trust? If "Yes" ou ma have to file Form 3520. See a e B-2 . . . . . . . . . . . . . X For Paperwork Reduction Act Notice, see Form 1040 Instructions. Schedule B (Form 1040) 2006 (HTA) Part III Foreign Accounts and Trusts .-J 0604113159 L PA-41 - 2006 Pennsylvania Fiduciary Income Tax Return ENTER ONE LETTER OR NUMBER IN EACH BOX. Do Not Use Your Preprinted Label 426640872 173077004 6106963242 N Extension Enclosed. Y=Yes N=No ESTATE OF ELIZABETH BRINTON Y Amended PA-41 Y=Yes N=No ANNE BRINTON HOLTON EXEC / CAROL TY Y Fiscal Year Flier. Y=Yes N=No from 070106 to 063007 320 JOY LANE N Residency Status. R=PA Resident N=Nonresident If "N" Name of State R F=Final Return. N=No Final Return. Enter Ending Date: 0 6 3 0 0 7 WEST CHESTER PA 19380 F Estats or Trust Identification Change. If any of the identification or filing information you entered is differentfrom the 2005 PA-41. or if the estate or trust did not file a 2005 PA-41. Y=Yes N=No Do You Want a 2007 PA-41 Booklet? Y=Yes N=No Submit all required Pennsylvania supporting schedules. 14 TOTAL OTHER CREDITS from PA Schedule OC. 15 2006 PAYMENTS and CREDITS. Add Lines 11, 12, 13 and 14. 16 TAX DUE. If Line 10 is more than Line 15, enter the difference here. 1 4972 2 0 3 0 4 0 5 0 6 0 7 4972 8 0 9 4972 10 153 11 10 12 0 13 0 14 0 15 136 16 17 1 PA TAXABLE INTEREST INCOME. See instructions 2 PA TAXABLE DIVIDEND INCOME. See instructions. 3 NET INCOME or LOSS from the Operation of a Business, Profession, or Farm. 4 NET GAIN or LOSS from the Sale, Exchange, or Disposition of Property. 5 NET INCOME or LOSS from Rents, Royalties, Patents, or Copyrights. 6 ESTATE or TRUST INCOME. 7 TOTAL TAXABLE INCOME. Add only the positive Income from Lines 1,2,3,4,5, and 6. Do not add losses. 8 DEDUCTIONS from PA SCHEDULE DD. 9 NET PA TAXABLE INCOME. Subtract Line 8 from Line 7. 10 TOTAL PA TAX LIABILITY. Multiply Line 9 by the tax rate of 3.07% (0.0307). 11 2006 ESTIMATED PAYMENTS and CREDITS. See instructions. 12 NONRESIDENT TAX WITHHELD from PA SCHEDULE(S) NRK-1. 13 TOTAL CREDIT for TAXES PAID by PA RESIDENT ESTATES or TRUSTS to OTHER STATES or COUNTRIES. EC Page 1 of 2 FC L 0604113159 ITJ=ITJ 0604113159 .-J ~ 0604213165 PA-41 - 2006 Federal EIN or Decedent's Social Security Number. 426640872 L Name(s) as shown on PA-41 ESTATE OF ELIZABETH BRINTON 17 PENALTIES AND INTEREST. Mark the box if REV-1630F is attached. N 18 TOTAL PAYMENT - Add Lines 16 and 17. Make check or money order payable to PA DEPT. OF REVENUE. Use your PA-V Form See the instructions on HOW TO PAY. 19 OVERPAYMENT. If Line 15 is more than the total of Line 10 and Line 17, enter the difference here. The total of Lines 20 and 21 must equal Line 19. 20 REFUND - AMOUNT of LINE 19 you want as a check mailed to the estate or trust. 21 CREDIT - AMOUNT of LINE 19 you want as a credit to the 2007 Estimated Tax Account of the estate or trust. Signature(s). Under penalties of perjury, I have examined this retum, including all accompanying schedules and statements, and to the best of my belief, it is true, correct and complete. Signature of Fiduciary I Date 03/23/07 Preparer's Name XXXXXXXXXXXXX Preparer's Telephone No. PA-41 SCHEDULE OC Other Credits for PA Fiduciary Income Tax Purposes You must submit the certificate or notification that approved each credit you are claiming or the PA RK-1 or NRK-1 that includes the credit. 1 PA Employment Incentive Credit. See Instructions. 2 PA Jobs Creation Tax Credit. See Instructions. 3 PA Research and Development Tax Credit. See Instructions. 4 PA Film Production Tax Credit. See Instructions. 5 PA Organ and Bone Marrow Donor Tax Credit. See Instructions. 6 Total PA Other Credits. Add Lines 1 through 5. Enter here and on Line 14 of PA. 41. 17 18 o 17 19 20 21 o o o FIRM'S FEIN PREPARER'S SSN/PTIN 1 2 3 4 5 6 o o o o o o PA SCHEDULE 01 1 Is this a revocable trust? 2 Is this an irrevocable trust? 3 Does the estate/trust receive income from, or pay income to a foreign entity? If yes include statement. 4 Has the federal government made an additional assessment on the income of this estateltrust in the last four years? 5 Did this estate/trust receive income from a partnership, S corporation, LLC, or another estate/trust? If "Yes," list all such partnerships, S corporations, LLCs, estates/trusts, showing the FEIN, name and address of each below. FEIN Name & Address A B C D 6 Name of Grantor: Address of Grantor: Page 2 of 2 L 0604213165 1 2 3 4 5 0604213165 ~ ---.J 0604310011 PA SCHEDULE A1B/J Interest and Dividend Income Income from Estates and Trusts PA-41 AIBIJ (09--06) PA Department of Revenue 2006 OFFICIAL USE ONLY If ou need more space, Name as shown on the PA-41 Estate of Elizabeth Brinton Federal EIN or Decedent's SSN 42-6640872 Caution: Federal and PA rules for taxable interest and dividend income are different. You cannot use the Federal schedules to report PA Interest or dividend income. Read the Instructions. If either the taxable interest or dividend income is $2,500 or less, the fiduciary must report the income, but need not submit any schedule. If either the interest income or dividend income is more than $2,500, the fiduciary must submit a schedule. List the name of each payer and the amount of PA taxable interest and dividend income you recaived in 2006. PA-41 A (09-06) PA SCHEDULE A - PA Taxable Interest Income 1. Central PA Conference UMC 1. $ 2259 Edward Jones $ 2185 Central PA Conf UMC Mav 2007 (final) $ 528 $ 0 $ 0 $ 0 $ 0 $ 0 2. Total Interest Income. Add all amounts listed lincludinn amounts on additional schedules\. 2. $ 4972 3. Interest income from oaltnershiols). from PA Schedulels\ RK-1. 3. $ 4. Interest income from PA S coroorationlsl. from PA Schedulels) RK-1. 4. $ 6. Total PA Taxable Interest Income. Add Lines 2 3 and 4. Enter on Line 1 of the PA-41. 5. $ 4972 IMPORTANT. Capital gain distributions are dividend income for PA purposes. PA-41 B (09-06) - axa e IVI en ncome aDlta ams Distribution 1. 1. $ $ $ $ $ $ $ $ 2. Total Dividend Income. Add all amounts listed lincludinn amounts on additional schedules\. 2. $ 0 3. Caoltal Gains Distributions. 3. $ 0 4. Dividend income from DaltnershiD(s). from PA Schedulels\ RK-1. 4. $ 6. Dividend income from PA S coroorationlsl. from PA Schedulels\ RK-1. 5. $ 6. Total PA Taxable Dividend Income. Add Lines 2 3 4 and 5. Enter on Line 2 of the PA-41. 6. $ 0 PA SCHEDULE 8 PA T bl D"d d I &C IG' PA-41 J (09-06) PA SCHEDULE J - Income from Estates or Trusts 2006 Read the Instructions. List the name, eddress, end identification number of each other estate or trust of which this estate or trust is a beneficiary. If this estate or trust received a Federal Schedule K-1, instead of a PA Schedule RK-1 or NRK-1, see the instructions. Check box if income is reported from PA Scihedule RK-1 or NRK-1. (a) Name and address of each estate or trust PA Schedule (b) Federal EIN (c) Income Amount RK.1 or NRK.1 D D D D D D Estate or trust income from partnership(s). Estate or trust income from PA S corporation(s). Total Estate or Trust Income. Add Column (c). Enter on line 6 of the PA-41................................................. oD L 0604310011 0604310011 ---.J , ; ! ~ C iJ H o-e1?-LAr0J:> COURT OF COMMON PLEAS O~ ~umOmBR COUNTY ORPHANS' COURT DIVISION STATUS REPORT UNDER RULE 6. 12 ESTATE OF~I / Z Q-,tb-,e;;t-k M . BnJ;,toh- ,DECEASED FILE NUMBER: 2-1 -.2-.00-::> -Gb..J DATE OF DEATH: 7/ o...rl 0 ~ Pursuant to RULE 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to the completion of the administration of the above captioned estate: 1. State whether admi~stration of the estate is complete: YEs:1 V I NO: I 2. If NO, state when the personal representative reasonably believes that the administration will be complete: 3. If YES, state the following: A. Did the personal representative file a final account with the Court: /' YEs:1 l NO: I V B. Has final distribution to the beneficiaries been made: YES:! V' I NO: I C. Has an account been stated informally to the parties in interest: YEs:1 V' I NO: I -I If copies of receipts, releases, joinders or approvals of formal or informal accounts are attached as exhibits to this report, the originals must first be filed with the Clerk of ,~erence must be ~de to the ~;;;;.;:~~g i;:; ;~ ;2..2--..1 S. Cht>~. St,.-yeet-- Street Address OJ. 0 c, , ;LCXJ7 Date / Personal Representative V Counsel ',I,' ('.!,n,.:;i\lflJ vG '\...),,-,1 ".....,-,...... ltln08 SJNHdtlO jO lItl3lJ ~ ~ :21 Wd 6 - 1l1f LGOl G (0 - ::tl Cf O=f 31- Telephone Capacity: ~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX '-A~PRAIS~HENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX 02-18-2008 BRINTON 07-05-2003 21 03-0665 CUMBERLAND 101 APPEAL DATE: 04-18-2008 ( See reverse side under Objections) Amount Remittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 n'1 r'''''r> ?2 ; ,')' ,.;- ~r. _ w' l _v_ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN r: ~~ I" '4 ri~ ! . i. : ANNE B HOLTON 320 JOY LN WEST CHESTER PA 19380 REV-1547 EX AFP (06-05) ELIZABETH M TO: CUT ALONG THIS LINE ...... RETAIN LOWER PORTION FOR YOUR RECORDS ~ ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRINTON ELIZABETH M FILE NO. 21 03-0665 ACN 101 DATE 02-18-2008 TAX RETURN WAS: (X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 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. 13. 14. Net Value of Tax Return CHANGED NO. 01 .00 .00 .00 . DO 134,453.00 .00 27,574.00 (8) (9) (10) 16,272.00 2.304.00 (11) (12) (13) Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of !bh 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 Net Value of Estate Subject to Tax NOTE: (15) ( 16) (17) (18) 19. Principal TAX CREDITS: PAYMENT DATE 04-05-2004 02-09-2008 Tax Due RECEIPT NUMBER CDo03772 REFUND DISCOUNT (+) INTEREST/PEN PAID (-) .00 .00 .00 6,057.00 .00 .00 X DO X 045 = X 12 X 15 (14) NOTE: To insure proper cre1it to your account, submit the upper portion of this form with your tax payment. 162,027.00 ]8.576.00 143,452.00 137,395.00 6,057.00 (19)= .00 273.00 .00 .00 273.00 AMOUNT PAID 484.00 211.00- TOTAL TAX CREDIT 273.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF TOTAL DUE IS LESS THAN tl, NO PAYMENT IS REQUIRED. (", IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE ;mt) A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX OIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE -T': Cfit.NJ.iERITANCE TAX -_: SvTAT~MENT OF ACCOUNT *' REV-1607 EX AFP (03-05) 2008 APR 28 PM I: 14 ANNE B HOLTON 320 JOY LN WEST CHESTER CLEHi< OF ORPHA,I\!'~) COt JRT eli'..JC-" ,-,""" , _I. '_if-', DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-03-2008 BRINTON 07-05-2003 21 03-0665 CUMBERLAND 101 ELIZABETH M Amount Remitted PA 19380 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 BRINTON ELIZABETH M FILE NO. 21 03-0665 ACN 101 DATE 03-03-2008 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: 02-11-2008 PRINCIPAL TAX DUE: 273.00 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 04-05-2004 CD003772 .00 484.00 02-09-2008 REFUND .00 211.00- TOTAL TAX CREDIT 273.00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 " IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 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. ) ~