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HomeMy WebLinkAbout02-0362MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR GRANT OF LETTERS Estate of ELEANOR D. BRININGER also known as No. 21 02 , Deceased Social Security No. 172-01-0605 JEAN B. LAYNE Petitioner(s), who is/are 18 years of age or older, apply)les) for: (COMPLETE "A" OR "B" BELOW:) ~-~ A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut RIX Decedent, dated 2/6/84 and codicil(s) dated N/A named in the Last Will of the State relevant circumstances, e.g., renunciation, death of executor, etc Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incapacitated: B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite, durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his/her last family or principal residence at 498 WOODCREST DRIVE, HAMPDEN TWP., MECHANICSBURG~ PA (list street, number and municipality) Decedent, then 93 years of age, died APRIL 2 ,2002 , at FOREST PARK NURSING HOME (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ lO-., O ~ (if not domiciled in PA Personal property in Pennsylvania .................... $ (if not domiciled in PA Personal property in County .............................. $ Value of real estate in Pennsylvania ........................................................................................ $ Total ..................................................................................................................... $ /~>~ ~) o o Real Estate situated as follows: Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters ~n the appropriate form to the undersigned: Signature Typed or printed name and residence I I lEAN B. LAYNE 498 VVOODCREST DRIVE, MECHANICSBURG, PA 17055 RW-t 1'7- 55 - J Oath of Personal Representative Commonwealth of Pennsylvania County of CUMBERLAND The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent, Petitioner(s) will well and truly administer the estate according to law. Sworn to and affirmed and subscribed JEAN"B. LAYNE before me this 9TH day of -'r MARN C L~IS ' DECREE OF REGISTER Estate of ELEANOR D. BRININGER also known as Deceased No. 21 02 Social Security No: 17~-Q1-0605 Date of Death: AND NOW, APRTT, 9:2(~0:2 , , in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters ~ Testamentary I~l of Administration ((c.ta., d.b.n.c.t; pendente lite; durante absentia; durante minodate) are hereby granted to J~_jS, N B ~YL',,TE in the above estate and that the instrument(s), if any, dated 02-06-19R4 described in the Petition be admitted to probate and filed of record as the Last Will of Decedent. FEES Letters .................................... $ Short Certificates(s) ............... $ Renunciation .......................... $ Extra Pages ( ) ............... $ I.T.R ....................................... $ JCP Fee ................................. $ Inventory ................................ $ Other ...................................... $ 50,00 1?_ilo 6.00 5.00 TOTAL ............................. $ 73.00 mailed to attorney on 4-10-02 Signature Attorney: GERALD J. BRINSER I.D. No: 09655 Address: 6 E. MAIN STREET, P.O. BOX 323 PALMYRA PA 17078 Telephone: (717)838-6348 DATE FILED: 4-09-2002 his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 8204920 No. Local Registrar APR 0 $ 2002 Date 05,143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH AGE (~; Bi~y)I UN~R 1 ~ UN~R 1 D~ D~E OF ~RTH B RTHP~CE C~ a~ I P~E ~ D~H (C~ ~y ~ -- ~ ink.ms on m~ ~ ' } J ~,h. ~ D.. ~m ; Mtnu,. (M~.~y.~r) I S~F~nC~.ry) I~IT~. ]OTHER '- ~-' I~. I~. MARITAL S17~rus - Married Never Mimed, Widov~d. Oivo~ce~ (Specify) ,4. Widowed ,7c.5k~.~ ~i, Hnnr?~n DECEDENT'S USUAL OCCUPATION J KIND OF BUSINESS/INDUSTRY WAS D~Ct:~I=~iT EVER INDECEDENT'S EDUCATION I ,.. Clerk Typist ,b. Governor's Office ,, DECEDENT'S MAlUNG ADDRESS {Street, CiiyF~wn, S~ate, Z~ Code) ' I - 498 Woodcrest Drive Rtm~,~ --- ,3. Mechanicsburg,Pa 17050 I~m'~) ,~.e~ Cumberland ,ovo~,ip? ,8. Izvin H. Dunklegerger a~. J~n Bo Lcmjne ~ ~ c~.o. [] R.~,~S,~.~ (F~sl, Middle, Maide~ Surname) Anna J. Groninc~r 3 ADDRESS (Streel. CiyTown. State, Zip Code) g313,b.' Aoril S. 200:2 ?~ 2~ ~,~[~ by ~TIME OF ~H. -- - I D<E PR~UNCED DEAD (M~th Day Y~r) PLACE OF DISPOSITION - Name of Cerneter/. Crematory 3 Code or Othe~ Place SURVIVING SPOUSE (If wife. give maiden name) Hill, Pa 17011 DATE SIGNED WA~ AN AUTOPSY MANNER OF I PERFORMED? DEATH ~A~o~ OF INJURY TtME OF INJURY DESCRIBE HOW INJURY OCCURRED °~°"~"? I~'' ~ No~' []1 I I ' I*~c~ [] "'"""~' .... '""" ~1... I Y" [] .o[], ,.. [] No~"' [] ~ ~ Is"''*~ ~'" ...... '""~ ~~..~,~ ~ ~~~' 2~. ~ I~. I~lng. ac. ~,fy) / ' ' ~ ~. 1/ ..... ,~ I~'~"~, /'~.~' CENSE NU - D~E S GNED M ~U~I~ ~D C~TI~ PNYSI~ (Ph~n ~th ~o~i~ d~th a~ c~tJfvi~ to ~u~ ~ O~l ~ · ~/ ~ ~ - ~ I J ~ I ~ ( ~ffi. Day. %~) .... -~ ' . ...................... ~ ,,..Iqv [R~) ~" I,,,[~r~[ ~  AME ANDAD~E~ ~N ~O~PL ~H ~ ,-5f / J OF ELEANOR D. BRININGER BE IT REMEMBERED, that I, ELEANOR D. BRININGER, of 1S0 St. John's Drive, Camp Hill, Cumberland County, Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writings in the nature thereof by n~ at any time heretofore made. ITEM 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: Ail the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath as follows: A. I give, devise and bequeath ten (10%) percent of my residuary estate unto my grandson, Craig A. Layne. B. Ail the rest, residue and remainder of my estate, I give, devise and bequeath unto my daughter, Jean B. Layne, provided she survives me for a period of thirty (50) days. ITEM 3: Should my daughter, Jean B. Layne, predecease me, fail to survive me for a period of thirty (30) days, or should we die simultaneously, I then give, devise and bequeath my entire residuary estate unto Jean B. Layne's issue, in equal shares per stirpes. .I.TEM 4: I direct that my hereinafter named Executrix pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing hereunder or otherwise passing by reason of my demise, and may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, or any property required to be included in my gross estate, under the provisions of any state ELEANOR D. BRININGER ~ or federal lawn ow in force or hereafter enacted, shall be prorated among the persons interested in my Estate to whom such property is or may be transferred or to whom any benefit accrues. ITEM 5: I appoint my daughter, Jean B. Layne, as Executrix of this my Last Will and Testament. Should mydaughter, Jean B. Layne, predecease me, fail to qualify, cease to act or renounce probate, I then appoint my sister, Dorothy D. Devenney, as altemate Executrix of this my Last Will and Testament. ITEM 6: I direct that my Executrix, guardian or their successors shall not be required to give bond for the faithful performance of their duties in any ] IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~day of ~,~.. 1984. -2- MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA CERTIFICATION OF NOTICE UNDER RULE 5.6{a) Name of Decedent: ELEANOR D. BRININGER Date of Death: 4~2~02 Estate No. 2002-00362 SSN: 172-01-0605 File No. 21-02-0362 Date Letters Granted: 4/9/02 Will or Administration No. To the Register: 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 4/16/02 Name CRAIG LAYNE Address 498 WOODCREST DRIVE MECHANICSBURG PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except JEAN B. LAYNE, EXECUTRIX Date: 4/16/02 Signature Capacity: t GERALD J. BRINSER Personal RepreS~tative Name (Please type or print) 6 E. MAIN STREET X Counsel for Pers.ca3al , ' Address Representative ~ _.. -, P.O. BOX 323 PALMYRA Pa 17078 Telephone No. (717)838-6348 ' REV-1500 EX + (~-(X)) I-- Z LU OD U.I Z 0 n 0 Z 0 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) BRININGER, ELEANOR D. DATE OF DEATH (MM-DD-Year) 04/02/2002 DATE OF BIRTH (MM-DD-Year) 07/15/1908 OFFICIAL USE ONLY ID 55 _ J.5 .......... FILE NUMBER 2 1 -0 2 0 3 6 2 COUNTY CODE YEAR NUMBER SOCIAL SECURITY NUMBER 1 7 2-0 1-0 6 0 5 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER N/A _ _ [~-]1. Odginal Retum O4. Limited Estate [~]6. Decedent Died Testate (~ach copy ofw~) O9. Litigation Proceeds Received r-~2. Supplemental Retum O 4a. Futura Interest Compromise (da~ ofdeah a'~ 12-12.82) r'-~ 7. Decedent Maintained a Living Trust (A~tach copy of Trust) [-"] 10. Spousal Poverty Credit (da~ o~ dea~ ~etwe~ 12-31-91 and 1-1-95) --]3. Remainder Retum (date o~ pria-to 12-13-82) [~5. Federal Estate Tax Retum Required 0_.. 8. Total Number of Safe Deposit Boxes ['--~ 11. Election totax under Sec. 9113(A) (Atach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME GERALD J. BRINSER~ ESQUIRE FIRM NAME (If Applicable) BRINSER~ WAGNER & ZIMMERMAN TELEPHONE NUMBER (717)838-6348 COMPLETE MAILING ADDRESS 6 E. MAIN STREET P.O. BOX 323 PALMYRA PA 17078 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnemhip or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested · 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Beductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) OFFICIAL USE ONLY 28,3~7.54 (8) (11) (12) (13) (14) 1,301.65 1,059.24 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 43,165.70 2,360.89 40,804.81 40,804.81 15. Amount of Line 14 taxable at Ihe spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. 0.00 X .00 (15) 40,804.81 X .04.5 (16) 0.00 X .12 (17) 0.00 X .15 (18) (19) 1,836.22 1,836.22 > > BE SURE TO ANSWER ALL QUESTIONS ON R~ERSE$iDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS FOREST PARK NURSING HOME 700 WALNUT BOTTOM ROAD CITY CARLISLE ISTATE PA ziP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B, Prior Payments C. Discount 91.~1 Interest/Penalty if applicable D. Interest E. Penalty (1) Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) (3) 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) If Line 1 + Line 3 is greater than Line 2, enter the difference, This is the TAX DUE. (5) A, Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payab/e to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a, retain the use or income of the property transferred; ........................................................................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........................................ [] [] c. retain a reversionary interest; or ...................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ............................................................. [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. .............................................................................................. [] [] 3. Did decedent own an 'in trust for' or payable upon death bank account or secudty at his or her death? ................. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly which contains a beneficiary designation? ....................................................................................................... [] ' [] 1,836.22 91.81 1,744.41 1,744.41 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 re~m, includi~ accom, ipanyi.ng..sc.bedules a~, slat~, ls,~ to the best of my knowledge and belief, it is flue, con'ect and complete. Declaration of preparer other than the personal representative is Dasea on all mform~on o! wmcn preparer nas any Know~eage. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRF_~S 498 WOODCREST'DRIVE MECHANICSBURG DATE PA 17055 SIGNATURE OF PRE~,~~REPR~ ADDRESS O ~. MAIN STREET~P~. BOX 323 PALMYRA DATE PA 17078 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. {}9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)]. The statute does not 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 benefidary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deoeased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal benefidaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. {}9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. {}9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. R~V-1508 EX + {1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER BRININGER. ELEANOR D. 21 02 Q:~62 Include the proceeds of litigation and the date the proceeds were received by the estate. All prope~j jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. 15,782.10 ALLFIRST BANK - CHECKING ACCOUNT #0017803993 (INCLUDES ACCRUED INTEREST OF $.62) SOCIAL SECURITY CHECK MYERS-HARNER FUNERAL HOME - REFUND 890.00 96.06 TOTAL (Also enter on line 5, Recapitulation) $ 16,768.16 (if more space is needed, inser[ additional sheets of the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER BRININGER. ELEANOR D, 21 02 If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. 0362 SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP 1'0 DECEDENT A. JEAN B. LAYNE 498 WOODCREST DRIVE DAUGHTER MECHANICSBURG, PA 17055 JOINTLY-OWNED PROPERTY: L~- I ~I:R DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial insfitulion and bank account'number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. 1993 PRUDENTIAL FINANCIAL - EATON VANCE HIGH 25,749.13 50. 12,874.57 YIELD INCOME FUND 2. A. 1993 PRUDENTIAL FINANCIAL - PUTNAM HIGH YIELD 27,045.93 50. 13,522.97 CLASS A TOTAL (Also enter on line 6, Recapitulation) $ 26,397.54 (If more space is needed, insert additional sheets of the same size) Securities Account This Period Account History Al~r !. &m ~e, 2002 TOTAL ACCOUNT NET WORTH OPENING ~ Securitle~ Velue ~2,82~ .ge Oemh Bmle~ee 14~g.i4 ?~ml Net ~h l~3,))l.l e m~o~ & DI~T~U~S ~1~ ~E~D PORTFOLIO DETAIL EATON VANCE HIGH INCOME FUND PUTNAM HiGH YIELD TRUST CLASS A PI;UCED BECURIIIE$ VALUE Prudential' Financial ACCOUNT NUMBER: CLo~II~G~ Your Financial ~2.B21.98 · ll3~M.I~ Te;ep~ne ~um~r: yEAR,i,~ D~TE E-Mail Ad<lmm: Your 8mnm Marmger: ~,189.el PAGE t of 2 JACK SPAHR VICE PRE$1OENT INVESTMENTS 3 LEMOYNE DRM~ LEMOYNE PA 17043 717-761-7344 Jack._sl)e hr~pru~ec.com CHRISTOPHER $, MAILLIE ELEANOR O m~JNINOER DECD & JEAN m, LAYNE JTTEN _ 4a~ WOODCRL~$T ORIVE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF BRININGER. ELEANOR D. Debts of decedent must be reported on Schedule I. FILE NUMBER 21 02 036g ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. FUNERAL LUNCHEON ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Secudty Number(s) / EIN Number of Personal Representative(s) Street Address City State Year(s) Commission Paid: AttomeyFees BRINSER, WAGNER & ZIMMERMAN Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Zip Street Address city State Zip Relationship of Claimant to Decedent Probate Fees REGISTER OF WILLS Accountant's Fees Tax Return Preparer's Fees R. WILLIAM WIRE ASSOC. P.C. REGISTER OF WILLS - INHERITANCE TAX RETURN FILING FEE REGISTER OF WILLS - INVENTORY FILING FEE 68.65 800.00 73.00 335.00 15.00 10.00 TOTAL (Also enter on line 9, Recapitulation) $ 1 ~301.65 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (I-97~ ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS ESTATE OF FILE NUMBER BRININGER. ELEANOR D. 21 02 O362 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. 162.00 OUTSTANDING CHECKS AT TIME OF DEATH - MARY SHUMAKER - CARE GIVER (3) CHECKS @ $54.00 EACH MARY SHUMAKER - CARE GIVER FRANCES PORTER - CARE GIVER CONTINUING CARE RX PRESBYTERIAN HOMES YELLOW BREECHES FAMILY PRACTICE 54.00 378.OO 11.92 424.22 29.10 TOTAL (Also enter on line 10, Recapitulation) $ 1,059.24 (If more space is needed, insert additional sheets of the same size) ' REV-1513EX*(I-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF BRINING ER. ELEANQP~ O, NUMBER I. 1, 3. II, 1. 1. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) JEAN B. LAYNE 498 WOODCREST DRIVE, MECHANICSBURG, PA 17055 CRAIG LAYNE 498 WOODCREST DRIVE, MECHANICSBURG, PA 17055 FILE NUMBER 21 02 RELATIONSHIP TO DECEDENT Do Not List Trustee(s) DAUGHTER GRANDSON ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE 0362 AMOUNT ORSHARE OF ESTATE JOINTLY-HELD AND 90%RESIDUE 10% RESIDUE ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (ff mom space is needed, insert additional sheets of the same size) OF ELEANOR D. BRININGER BE IT ~RED, that I, ELEANOR D. BRININGER, of 130 St. John's Drive, Camp Hill,' Cumberland Co~ty, Pe~sylvania, being of sound mind, me~nory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making null and void any and all Wills and Testaments and writinus in the nature thereof by me at any time heretofore made. ITS~ 1: I direct that all my just debts and funeral expenses be paid as soon after my demise as Pay be convenient. .I.T~4 2: Ail the rest, residue and remainder of my estate, of whatsoever nature and ~heresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath as follows: A. I give, devise and bequeath ten (10~/~) percent of my residuary estate unto my grandson, Craig A. Layne. B. Ail the rest, residue and remainder of my estate, I give, devise and bequeath unto my daughter, Jean B. Layne, provided she survives me for a period of thirty (30) days. ITEM 3: Should my daughter, Jean B. Layne, predecease me, fail to survive me for a period of thirty (30) days, or should we die sinultaneously, I then give, devise and bequeath my entire residuary estate unto Jean B. Layne's issue, in equal shares per stirpes. .~.TEM 4: I direct that my hereinafter named Executrix pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my Estate or the transfer of any property passing hereunder or otherwise passing by reason of my denise, and may be subject and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state, or any property required to be included in'my gross estate, under the provisions of any state ELEANOR D. BRININGER ~ or federal law now in force or hereafter enacted, shall be prorated amon~ the persons interested in my Estate to ~hom such property is or may be transferred or to whc~ any benefit accrues. ITEM 5: I appoint my daughter, Jean B. Layne, as Executrix of this my Last Will and Testament. Should my daughter, Jean B. Layne, predecease me, fail to qualify, cease to act or reno~ce probate, I then appoint my sister, Dorothy D. Devenney, as alternate Executrix of this my Last Will and Testament. IT~4 6: I direct that my Executrix, uuardian or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction IN WITNESS WHEREOF, I have here~to set my hand and seal this ~ ~ day of -2- CO~VDNWEALTH OF PENNSYLVANIA : : SS the Tes~trix and the witnesses respectively, whose nsa~ are signed to the attached or foregoing instrument, being first duly s~orn, do hereby declare to the ur~ersigned authority that the Testatrix signed and executed the inst_rl~ent as her Last Will and Testament and that she b~d signed willingly (or willingly directed another to sign for her), and that she executed it, as her free and voluntary act for the purposes therein expressed, ar~ that each of the witnesses, in the presence ar~ hearing Of the Testatrix signed this Last Will and Testament as witness and that to the best of their knowledge, the Testatrix was at the time, eighteen (18) years of age or older, of sour~ mind and urger no constraint or undue influence. Sworn to and subscribed to before me this ~ ~ day of ~. , 1984. My Cc~mission Expires: MARY C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of ELEANOR D. BRININGER also known as , Deceased No. 21 02 0362 Date of Death 04/02/2002 Social Security No. 172-01-0605 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/VVe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: GERALD J. BRINSER, ESQUIRE JEAN B. LAYNE 09655 I.D. No.: Address: 6 E. MAIN STREET PALMYRA PA 17078 Dated JUNE 19, 2002 Telephone: (717)838-6348 Description Cash, Bank Deposits, & Misc. Personal Property ALLFIRST BANK - CHECKING ACCOUNT #0017803993 (INCLUDES ACCRUED INTEREST OF $.62) SOCIAL SECURITY CHECK MYERS-HARNER FUNERAL HOME - REFUND (Attach Additional Sheets if necessary) Total Value 15,782.10 890.00 96.06 16,768.16 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 MAI~Y C. LEWIS, REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of ELEANOR D. BRININGER also known as , Deceased No 21 02 0362 Date of Death 04/02/2002 Social Security No. 172-01-0605 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We verify that the statements made in this inventory are true and correct. I/VVe understand that false statements herein made are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Personal Representative: Name of Attorney: GERALD J. BRINSER, ESQUIRE JEAN B. LAYNE 09655 I.D. No.: Address: 6 E. MAIN STREET PALMYRA PA 17078 Dated JUNE 19~ 2002 Telephone: (717)838-6348 Description Cash, Bank Deposits, & Misc. Personal Property ALLFIRST BANK - CHECKING ACCOUNT #O017803993 (INCLUDES ACCRUED INTEREST OF $.62) SOCIAL SECURITY CHECK MYERS-HARNER FUNERAL HOME - REFUND (Attach Additional Sheets if necessary) To~l 15,782.10 890.00 96.06 16,768.16 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. RW-4 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001324 GERALD J BRINSER ESQUIRE 6 E MAIN STREET 2ND FLOOR P O BOX 323 PALMYRA, PA 17078 ........ fold ESTATE INFORMATION: SSN: 172-01-0605 FILE NUMBER: 2102-0362 DECEDENT NAME: BRININGER ELEANOR D DATE OF PAYMENT: 06/21/2002 POSTMARK DATE: 06/20/2002 COUNTY: CUMBERLAND DATE OF DEATH: 04/02/2002 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,744.41 REMARKS: GERALD J BRINSER TOTAL AMOUNT PAID: 91,744.41 SEAL CHECK# 1130 INITIALS' JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX GERALD J BRINSER ESG BRZNSER ETAL PO BOX $25 ~. PALMYRA PA 170~8 DATE 08-05-2002 ESTATE OF BRININGER DATE OF DEATH 0q-02-2002 FILE NUMBER 21 02-0562 ~,i..i~!?COUNTY CUMBERLAND ACN 101 Amount RemAttad REV-15¢7 El( AFP ELEANOR D MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-02) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DTSALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRZNINGER ELEANOR D FILE NO. 21 02-0362 ACN 101 DATE 08-05-2002 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RE$~RYATZON CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Close/y Held Stock/PartnershAp Interest (Schedule C) (3) q. Mortgages/Notes ReceAvebla (Schedule D) (q) S. Cash/Bank Deposits/MAsc. Personal Property (Schedule E) ($) 6. JoAntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Costs/N/sc. Expenses (Schedule H) (9) 10. Debts/Mortgage L/abAIAt/es/L/ens (Schedule Z) (10) 11. Total Deduct/ohs 12. Nat Value of Tax Return 16t768.16 26~597.5q .00 .00 NOTE: To Ansure proper .00 credAt to your account, .00 sube/t the upper portAon .00 of thAs fore w/th your tax payment. (8) 1,$01.65 15. NOTE: ASSESSMENT OF TAX: 15. Aeount of L/ne lq at Spousal rata 16. Amount of LAne lfi taxable at L/neaZ/Cless A rate 17. Aeount of L/ne lq at SAblAng rate 18. Aeoun4 of L/ne lq taxable at Collateral/Class B rate 19. PrAnc~ ~al Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT BATE NUMBER /NTEREST/PEN PAID (- 06-20-2002 CDOOI$2q 91.81 q$,165.70 (lS) .00 X O0 = .00 (16) qO,80q.81 X Oq5= 1,836.22 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (:].9)= 1,836.22 AMOUNT PAZD 1,7qq.ql TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1,836.22.00.00.00 ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCT/ONS.) IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. CharAtable/governeental Bequests; Non-elected 9115 Trusts (Schedule J) (13) . O0 Net Value of Estate Subject to Tax (lq) qO,80q.81 1'1: an assessment was issued prev/ously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill reflect f/gures that include the total of ALL returns assessed to date. l ,059 (11) 2.360.89 (12) q'O, 80q, .81 STATUS REPORT UNDER RULE 6.12 Name of Decedent' ELEANOR D. BRININGER Date of Death' 4/2102 Will No. 2002-00362 Admin. No. 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' State whether administration of the estate is complete' Yes X No ~ 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete · 3. If the answer to No. 1 is Yes, state the following: account with the Court ? Did the personal representative file a final Yes ~ No X 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 X No ~ 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. Date' 3~29~04 Signature GERALD d. BRINSER Name (Please type or print ) 6 E. MAIN STREET, P.O. BOX 323 PALMYRA PA 17078 Address ( 717 ) 838-6348 Tel. No. Capacity' Personal Representative Counsel for personal representative