HomeMy WebLinkAbout02-0536PETITION FOR PROBATE and GRANT OF LETTERS
Esmte of _. David F bl-ubaker No. 21-02-536
also known as
To:
Register of Wills for the
Deceased. County of CSnnlx~rlanrl in the
Social Security No. X03-07- ~ "'~,~! Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are IS years of age or older an the execuAr
in the Iasi will of the above decedent, dated NW~r 10 named
and codicil(s) dated _ N/A , 1986 _
(a~iate relevunl circumstances, e.g. renunciation, death of crecutor, etc.)
Decendem was domiciled at death in Ctunberland
County, Pennsylvania, with
~S_- last family or principal residence at 147 South Colle4e Street Carlisler
(3 m'i}wrl and- Cn m ~i nn Vl_ V~1nld 17013
(list sf reel, number and muncipali(y)
Decendent, then 1~ years of age, died Mz; 'Z9 }~ 2002
Except as I ul lows, decedtnt dtd not marry, was not divorced and did not have a child born or adopted
after escrution of the will of~fe~red 'f,,or probate; was not the victim of a killing and was never adjudicated
incotupetenu _ rrted ~_'1ar , ~ _ mQ1ccL 17 1~ `] 5
1 ~.-~hcLY r ~ ill rl r~
Decendent a[ death owned property with estimated values as follows:
(If domiciled in Pa.) All personal property $ J Ot~O
(If not domiciled in Pa.) Personal property in Pennsylvania $
(If not domiciled in Pa.) Personal property in County $
~'aluc of real estae in Pennsylvania $
situated us follow: __-~~ S. Cads S{. P~ L7rt/ I O U6(7
~4HEREFORE, petitioner(s) respectfully request(s) the probate of the last wil] and codicil(s)
presented herewith and [he grant of letters +aatamantarv
Ihcron. Ucsiamem arv; ad mfnist rntfon e.t.a.; administration d. b. n.c.ta.)
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OATH OF PERSONAL REPRESENTATIVE
COM11MONWEAI,TH OF PENNSYLVANIA 1
COI tiTY' OF _ ~mil-,erland _ ~ ss
~ he 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-
tatn~cl~J of the above decedent petitioner(s) will well and truly administer the estate according to law.
Sworn to or affirm~d~hand subscribed -~~_~~~~~
be(orc me thi' _ dap of _ i r"
l,_~ JU E __._- ~~ 2002 ~
ReKisrer
/7 ~~ 3~
O
i
NO. 21-02-536
Estate of DAVID F. BRUB.AKER ,Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
JUNE 6 p~c2002, in consideration of the petition on
AND NOW
the reverse side hereof, satisfactory proof having been presented betorQ me,
IT IS DECREED that the instrument(s) dated Novettlber 10
described therein be admitted to probate and filed of record as the last will of David F. Brubaker
and Letters ~°"-""`°""`"~
are hereby granted to
FEES
Probate, Letters, Etc.......... $ 235.00
Short Certificates( ) .......... $-_.~-~~
x-pages.
Renunciation ................ $
JCP $ 5.00
TOTAL $ 264.00
Filed .... JUNE. 4, , 2002 . .............. .
<'r
7
t~~Y~~ gistec of ~Ils ~Q2E~L~.[~"~.*/
Steven J. Fishtna:t ~'~rnzire #16269
ATTORNEY (Sup. CL LD. No.)
95 Alexander Sprang Poad, Suite 3
Carlisle, PA 17013
ADDRESS
(717) 249-6333
PHONF,
Y\ ')/N(
s s .n ~L `~ t'uv e hT`otmation mere given is correctly copied from an original certificate of death duly filed with me as
luc~d Regi,tilrvl 76e ol~;,inal certificate will be forwarded to the Start Viral Records Office for permanent filing.
11/ARNING: It is illegal to duplicate this copy by photostat or photograph.
Fcr for this cerridcuc, $2.0(I
P _8319785
~~,,.
21-02-536
P-. F .. 0.t;.,ti - -
Local Registrar
JUN 42002
vats
NlPSau q°°' Iryl COMMONWEALTH OF PENNSYLVANIA
DEPARTM
,PRINT ENT OF NEALTH•VITgL RECORDS
N CERTIFICATE OF DEATH
ANENT (Coroner)
NINx NAME DEOECEOENTIii,p, Mtlple. Wq)
I~ David P aEY
Brubaker SCCIALSECURITY NUMBERFR
AGEIIeaBMEry)
UNpEgI YFFR
UNpEgt Dd
pREOE OIRTX :. Male ,. 203-07-75:
Ibnma pvY•
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IMmin, paYMarl BIRTNPULE CAyenn PLACE CFDEATH (G
91aKwFw•ynLW^Iry) CYOnIyoM-bemnucfmrwml
F. 77 Y`
Aug.22, 1924 NQSpIMt'
Lancaster,PA ImMxm ^
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Cumberland CI O pOF pEPTX FPCILITV NAME II rcA bH°ulgn °i
1 qve NrepleM rium~rl
Wg90ELEDEN
• •0• Carlisle
Fc. 147 Sou[h College Street
b "°~ M•~
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147 S. College SC. eEaloiNLE 9i 81e1~--
Carlisle, PA 17013 rsm••'^b~^~•
Coven B. Brubaker
IMAH!'9 NAME(IyCyPnnp
Darcell Brubaker
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V•meol GmM•ry, Gamnory LOCATION ~CMyrtaxn,
Crematory ~ York, PA
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LAST WILL AND TESTAMENT OF
DAVID F. BRUBAKER
21-02-536
I, DAVID F. BRUBAKER of Borough of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding,
~~o hereby make, publish and declare this as and for my last will and test
hereby revoking all other wills and codicils heretofore made by me.
FIRST
I direct that my body be cremated and I direct the payment of
,~
my debts and expenses of my last illness and cremation from my estate as
soon after my death as conveniently may be done. I authorize my personal
representative to expend funds from my estate, in such amount as my personal
representative shall consider necessary and desirable, for the purchase,
erection and inscription of a suitable place of disposal.
SECOND
I give, devise and bequeath my entire estate of whatever nature
and wherever situate to my wife, MARJ.G. BRUBAKER provided she survives me
by thirty (30) days. In the event my said wife shall fail to so survive me,
I give, devise and bequeath my entire estate of whatever nature and wherever
situate to my son, DARRELL R. BRUBAKER.
THIRD
In addition to the powers conferred by law, I authorize my
Executor, in his absolute discretion:
a. to retain in the form received, and to sell either at public
or private sale any real or personal property;
b. to manage real estate;
c. to invest and reinvest in all forms of property without being
confined to legal investments; and without regard to the principal of
diversification;
d. to exercise any option or rights arising from ownership of
investments; and
e. to compromise claims without court approval, and without
the consent of any beneficiary.
FOURTH
I nominate, constitute and appoint my wife, MARJ. G. BRUBAKER
Executrix of this my Last Will and Testament. In the event my said
Executrix fails to so serve for any reason, I nominate, constitute and
appoint my son, DARRELL R. BRUBAKER, Executor hereunder. I hereby relieve
my Executrix or Executor from the necessity of posting security in
connection with her or his duties as such in any jurisdiction in which
he or she may be called upon to act insofar as I am able by law to do so.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
to this, my Last Will and Testament, consisting of two (2) typewritten
pages, the first one (1) of which bears my signature in the margin for
the purpose of identification this ~(~ y of ~~,
da /~'~-+"tsv~~{-~__ 1986.
~ / ~~
/Lt `' /r ~~Lti2/7~t.-~. (SEAL)
DADA IDLER
Signed, sealed, published and declared by the above named
testator, DAVID F. BRUBAKER, as and for his last will and testament,in
the presence of us, who at his request, in his sight and presence, and
in the sight and presence of each other, have hereunto subscribed our
names as witngs~es:
~_~ ~~~`C~-.~.,_ ADDRESS C~~~J c~~ .L.[;L~ c Sf ' "~
-~ n ( ~ ADDRESS~~~t~°l()J/ 7~/ / I ~./~ry/N ./ l~'~
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COMMONWEALTH OF PENNSYLVANIA:
:SS,
COUNTY OF CUMBERLAND
We, DAVID F, BRUBAKER, ~2~ ~~J ,~~~-~l.~+nG.~,d
Cam'=c" {,
the testator and the witnesses, respectively,
whose names are signed to the attached or foregoing instrument, being first
duly sworn do hereby declare to the undersigned authority that the testator
signed and executed the instrument as his last will, and that he signed
willingly and that he executed as his free and voluntary act for the purpose
therein expressed, and that each of the witnesses, in the presence and
hearing of the testator, signed the will as witnesses, and that to the best
of their knowledge, the testator was at the time eighteen (18) years of
age or older, and of sound mind and under no constraint or undue influence.
Sworn to and subscribed
before me this ~ Q t-~
day of G.2_ L'y, 1986.
/-,
/ - _~.
RENEE L HURRAY, NOEAry p
CAR!!5=E Rc~4N CUMRERLA?,D UYYIY
MiY CC~',+~;gS ~ EXPIRES ctr
'~e~nber, Fonnsylvania Associati ~ of'Nl ~9
atarres
REV-1162 EX111-961
~~OMMONWEALTH OF PENNSYLVANIA
DEPA~iTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1]128-0601
RECEIVED FROM:
FISHMAN STEVEN J
95 ALEXANDER SPRING RD
SUITE 3
CARLISLE, PA 17013
----- ,old
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssN: 203-o~-rasa
FILE NUMBER: 2102-0536
DECEDENT NAME: BRUBAKER DAVID F
DATE OF PAYMENT: 03/18/2004
POSTMARK DATE: 03/17/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/29/2002
N0. CD 003695
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ 51.00
TOTAL AMOUNT PAID:
.REMARKS:
CHECK#1124
SEAL
INITIALS: JA
RECEIVED BY:
REGISTER OF WILLS
51.00
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
%.
REV-1500EX (Ij.OO)
REV-1500
. COMMONWEALTH OF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21 02
0536
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
BRUBAKER, DAVID F.
COUNTY CODE YEAR
I SOCIAL SECURITY NUMBER
203-07-7534
NUMBER
1---
DATE OF BIRTH (MM-DD-YEAR)
, 08/22/1924
.L
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
DATE OF OEATH (MM-DD-YEAR)
OS/29/2002
I THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
, REGISTER OF WILLS
-----..- - --- - -- --
SOCIAL SECURITY NUMBER
~ 1. Original Return
04,LirnitedEstate
o 6. Decedent Died Testate (Attadl copy of Will)
o 9. Litigation Proc~~ds Rece\'1ed
o 2. Supplemental Return
o 4a. Future Interest Compromise (date ofdeall1l1fter 12-12.82)
o 7. Decedent Mainlaineda Living Trust (AltlIdlcopy of Tru5t)
o 10. Spousal Poverty Credit (date ofdeall1 between 12-31.91 and 1.1-95)
03. Remainder Relum Idate of death prior to 12-1H2)
o 5. Federal Estate Tax Return Required
JL.- 8. Tolal Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (Attach Sch 0)
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TtII$$$CT!QNlofQ$rlllilqQNPLmO.AA.Lt;:l:lRIlll$!'OIllJif.lqlO!\:IIlJ.i!QI'II'II\l!il't'V'!\:Ii-r.t,l('!II~gA~~~(.i(~iL
NAME COMPLETE MAILING ADDRESS
STEVEN J. FISHMAN, ESQUIRE 95 ALEXANDER SPRING ROAD, SUITE 3
FIRM NAME IIfAppl;~bl'l CARLISLE 13
SALZMANN, HUGHES & FISHMAN, P.C. ' PA 170
'TELEPHONE 'NUMBER
(717) 249-6333
1. Real Estate (Schedule A)
2 Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedul~ D)
(1)
(2)
(3)
(4)
(5)
163,707.00
0.00
0.00
0.00
11,084.54
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5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(ScheduleGorL)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10 Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Une 8 minus Line 11)
14,953.00
161,728.31
1 ,300.00
(6)
1,889.77
(7)
0.00
176,681.31
(9)
(10)
(6)
5,876.00
9,OnOO
(11)
(12)
(13)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (ScheduleJ)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(14)
160,428.31
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spollsa( tax
rate, or transfers under Sec. 9116 (a)(1.2)
X.O (15)
160,428.31 x.o 45 (16)
7,219.27
16. Amount of Line 14t8xable at lineal rate
17. Amount of Line 14 taxable at sibling rate
x .12 (17)
18. Amount of line 14 taxable at collateral rate
x .15 (18)
19. Tax Due
(19)
7 ,219.27
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
> > EIIii IlM:lREi TO AIlSW~ALL QUE$TlONSOIil RMRlIlUIDII "ND IlllCHll(lK!oIAm < '" .
">"oi< ;<;:<LH nrnn;;\HEF\
'-,
Decedent's Complete Address:
STREET ADDRESS
147_S0UTH COLLEGE STREET
CITY CARLISLE
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
STATE P A
ZIP 17013
(1)
7,219.27
Total Credits (A + B + C ) (2)
0.00
3. InleresVPenally if applicable
D.lnteresl
E. Penalty
313.56
B. Enter the total of Line 5 + SA This is the BALANCE DUE.
(SA)
(5B)
313.56
0.00
7,219.27
313.56
TotallnteresUPenalty ( 0 + E) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
7,532.83
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
Ves
...0
.....0
.......0
o
o
.0
..0 ~
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
1. Did decedent make a transfer and:
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 security at his or her death?
4. Did decedent own an Individual Retirement Account, annui1y, or other non-probate property which
contains a beneficiary designation? .... ................ ...... ..........
No
~
~
~
~
~
~
Under penalties of perjury, I <ieclare that I have examined this fetum, including accompanying schedules and statements. and 10 Ihe besl of my knowledge artd belief, il is true, correct
and complete.
Decjarelion ofpreparerolherlhan the personal representalive is based on all i nformationofwhich preparer has any knowledge.
SIGNATURE o~ PERSONu~?~Z:;~~RN
. . 'liS/" i<;cI"~~"dJ'i""o, fA '70d"
S.IGN~OFPREPJ\aER~.T ERTHANRE..PRESEN UII,IE ., _ /.. r'-.-
::::5 L~~''''
.. . . ____ - _ . . . _ _ ._~. _~. ..u .. _ _
ADDRES~? ~ /J-{ J kif - /_j(. . (It
- S e )L~ Cikl ....fJ::J .- ..J - - lE: ._l13
DATE
il ~J:J :l.os1~n
~~7/,+lcd -
For dates of death on or after July 1, 1994 and before January 1, 1995, the lax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
172 P.S. 99116 la) (1.1) (ill.
For dales 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 exernDt a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax return are still applicable even if
the survi\ling 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 10 or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. 99116(1.2) [72 P.S. s9116(a)(1)J.
The tax. rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS. g9116(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-1502 EX+ (6-98)
.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF
DAVID F. BRUBAKER
FILE NUMBER
21-02-0536
All real property owned solely or as a tenant in common must be reported at fair market value. Fair marKet ....alue is de1ined as the price at which property would be
exchanged between a willing buyer and a willing seifer, neither being compelled 10 buy or serr, both having reasonable knowledge of Ihe relevant facts,
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
1.
DESCRIPTION
Residence - 147 South College Street, Carlisle, Pennsylvania
Sold September 30, 2003 (copy of HUD-1 settlement statement attached)
VALUE AT DATE
OF DEATH
$163,707.00
TOTAL (Also enter on line 1, Recapitulation) $
163,707.00
(If more space is needed, insert additional sheets of the same size)
.' - '11"
A. B. TYPE OF LOAN:
U.S. DEPARTMENT OF HOUSING & URBAN DEVELOPMENT 1-DFHA 2-DFmHA 3. ~CONV. UNINS. 4-DVA 5.DCONV. INS.
ij. ~IL~_ : 17. LOAN :
SETTLEMENT STATEMENT PA2003711
8. MORTGAGE INS CASE NUMBER:
C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown.
ttems marked "[POC]" were paid outside the closing; they are shown here for Informational purposes and are not included in the totals.
1.. 3198 (PA2003711.PFOIPA2003711/10)
D. NAME AND ADDRESS' : E. NAME AND A ;OF : F. NAME AND ADD F LENDER:
Thomas S. Pedersen and Commerce Bank
Donna K. Pedersen Husband and Wife Darrell R. Brubaker, Executor 100 Senate Avenue PO Box 8599
147 South College Street of the Estate of David Frantz Camp Hill, PA 17011
Carlisle, PA 17013 Brubaker
G. PROPERTY LOCATION: H. SETTLEMENT AGENT: I. SETTLEMENT DATE:
147 South College Street Service 1st Settlement Agency, LLC
Carlisle, PA 17013 September 30, 2003
Cumberland County, Pennsylvania PLACE OF SETTLEMENT
Jeck Geughn Realty
1068 Harrlsburg Pike, Carlisle, PA 17013
J. ,( O~ ;, K. ru, ,~ "UN
100. GROSS TDUE ORROWER: 1400, f/T'lll1E,05EITER:
!ll1.""Conlfact S8fesPnce 110, I 4Ul. Contracl Sales F nce 179,
102. '''-ersonal Piopeify I 4U2. Personal Propiiify
103. Settlement Charges to Borrower (Line 1400) 4, 14U3.
lU4. Payoff 1st Mortgage 14u4.
lU5. 14uo.
Adjustmen s f or /terns f aid /jy Seller In aavance AOJus,menrs f or Items Paid By Seller In advance
lU6. Cityrrown Taxes 10 I 4Uij. <;IIYII own I axes 'to
107. City/County Taxes to 2U8.50 4Uf. nty axes -to
108.AssessmerllS 10 1, 408. Assessments 10 "
l1llf.' 4U9.
Tl0~ 41U.
TIT. .. II.
112. ' .U.
120. GROSS AMOUNT DUE FROM BORROWER 186,396.62 420. GROSS AMOUNT DUE TO SELLER 181,548.57
200, AMOUNTS PAID BY OR IN BEHALF OF BOR : 500. REDUCTluNS IN'AMOUNlDUElO :
-w.1-:-rreposn or eameSf money 2,UOO.Uu I 5U1. Excess DeposlflSBe Instructions)
'2UT.VrlnclparAmoumo! New Loanls) 1<0, I :lU"'. ~etllemen arges 10 Seller (Line 14UUI 12,
~ISlingToaiilSll8Ken sUbjeCllo I :IV". t:X SlOg loan(s) taken SUbject to
= I ,u.. t ayorT or .rs. Mortgage
'205~ I :;IVO. t'ayoTT Or second Mortgage
206. 15Uij.
207. , 5U7. (Ueposll dlsb. as proceeasr
'2D8. 1 'uo.
209. C'redil fo Borrower -Inspecllan , I 5U9. Credit 10 Barrower- nspec Ion 5,UUU.UU
7\cJjuSfments For Items lFnpaldBy Sii/lar AOJusrments f or Items Unpsl f By Seller
~fa:-ciIYTrown Taxes to 1510. l..iuY/lownTaxes 10
211. City/County Taxes to I 511. <;Ityf<;ounly axes To
212. Assessments to I 512. AssessmenlS To
'213: 1 ,,~.
'21<- 10,..
215. I alO.
216. I 51ti.
217. lOll.
218. 1010.
= 1010.
220. TOTAL PAID BYIFOR BORROWER 132,930.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 17,640.86
3UU. CA"HAI5EI : '"uu. <;A"H AI "1:1 :
-mJ-r.-GrosSAmounrr:fue From !:Sorrower (Line UUJ ltsb..:n:ltu;:.! I au1. <;iross Amount Due To Seller {L1ne'l20f HSl,:J4ts.Of
~ess Amount aid ttYII-or ttorrower (Line :.t:;tU) 132, I aU~. Less Keaucuons Due S'elleRLlne:i20f 11 ,l>'lU.O"
303. CASH ( X FROM) ( TO) BORROWER 53,466.82 603. CASH ( X TO II FROM) SELLER 163,707.71
OMB NO 2502 0265 ..,..,
The undersigned hereby acknowledge receipt of a completed copy of pages 1&2 of this statement & any attachments referred to herein.
,"",- :r$;; ~~
s . e ersen .~
o e ersen
L. SETTLEMENT CHARGES
700. TUTAL e;uMMI""luN Based on >'rlce
IAVISlon 01 ....,omml$SIOn lllne fUU) as OlfOWS:
fU ,.. ',OL'.UU ,0 o.n "gency """"" "ea, CSlale
IUL.' 0,01 L.UU '0 c"'^ ,eCK ",augnn "eellor
IU'. ,",omm'ss,on ..-elo al "ememem
fUq. I ransae Ion t"eB
aDO. ITEMS PAYABLE IN
UU1. Loan unglnauon r-ee
I UUL. Loan ulscoum
OU,. "ppralsalt ee
OU.. uocumem , reparauon
OUO. unoe!Wnllng , ee
!:SUb. Couner fee
ou I. "000 e;erll 'callon
!:SUI:). l"'fOCessmg t"ee
ow.
OlU.
011.
900. ITEMs REQUIRED BY LENDER TO BE
901. Inlerest From 09/30103 to 10/01/03 @ $
tN"'. MOllgage nsurance rrernlum,or monms to
!:JU::J, Hazara Insurance ....remlum lor 1.U years to
\lU..
\lU~.
100U. KE"CKVE" ucPu"'TcLl WITH
1 001. Hazard Insurance
-IUU~. Mortgage Insurance
lUU'. ,,"y/Town Taxes
'UU4. ""YI"ounly I axes
1 UUO. "ssessments
lUUO.
lUUf.
1 UUO. "ggrega e "oJusUTlenl
110u. llTLE e;HAKuES
1101. Settlement or Closing Fee
11U2. [Jead ,",reparation
1103. Tille Examinalion
llU.q. III1B Insurance tslnder
11 U:>. uocumem t" reparallon
llUO. NOtary 'ees
11 U I. AltOrney s ,ees
mCIUu8S Buove Irem numoers:
11U8. llUelnsurance
mClUaes 800ve Icam numDsrs:
. llUIl. ~en ,ers ,",overage
"'u. vwnelsc;overage
II t,. !:.noorsem60\s
"'L.
I I I'.
12uu. ; AND'
1201. Recording Fees: Deed $ 38.50; Mortgege $ ;
I <u<. v"yt,",oumy ,a",,,,ampsveeo ; Mongage
1 LU~. ,,'ale I e",,,,amps: "evenue "lamps ; Mortgage
uu.. ,rans,er 'ax 10 Cumbertand Counly Recorder of Deeds
1 LU~. "anster I a. 10 ,",umDenano ,",oumy Recorder of Deeds
13uu. ADD" ,"Ell
1301. Survey
l~UL. >,est 'nspecllon
'''U~.
1~U4.
,'UO. "ee addll" dlsD. eXlliDII to
1400. I uTA~"c IT~CMCNT e;"AKuc" (Enler on Line. 103, secllon J and 502, section K)
By signing pagel ollhls statement, the s gnatories aCKnowledge recelpt of a completed copy of page 2 of !hIs twO page !llatemlNll.
$
179,900.00 @ 5.0000 %
8,995.00
10 ct<" ,aCK uaugnn t<eallor
,"vn WITH LOAN
1.UUUU "10 to liommerce tlSnK
% to
10 ,ne "ppra,sa' rlnn, ,nc.
10 "ommerce "anK
10 c;ommerce "anK
to Airborne Express
10 ,",reall "-'US "mullons
10 lIommerce IjSnK
21.430000/day
1 days
%)
3.000 months ""'ill
monthS "i
8.0UO monllls <<!
montns
4.000 monllls
momns
months
months
$
~
~
~
~
~
$
~
35.50 per month
per montn
lJtU:5H per monm
per montn
1~0./3 per monlll
per momn
per month
per month
to
to 1II0mas". >'adersen
to
to
to
10
'0
to Via HepUDIIC Nauonal 1mB Insurance l,;ompany
}
I~O.4U POC
)
"'.'0
lL1.~U >'UC;D
.
~
to VIa KepuD"c NatlOna' 'llIe 'nsurance ,",ompany
lLO,.'U,UU
Releases $
to
10
PAID FROM
aORROWER"S
FUNDS AT
SETILEMENT
lUU.Ul.
1,LOIl.O"
ao.uu
1 "".UU
L'~.UU
25.UO
10.UU
10.UU
21.43
106.50
~~~.U.
OLD.IlL
-491.1<
133.48
LL.OU
899.50
899.50
4,848.05
~~ ~([~
' rv ce 5 e emen Agency.
Settfement Agent
Certified to be a true copy.
Pagel
PAlO FROM
SELlfR'S
FUNDS AT
SETIlEMENT
8,1l1l0.U"
75W
38.50
899.50
"
12,840:861
(PA2003711 f PA2003711 , 10)
REV.15OB EX+ (6.98) *'
COMMQN\NEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
DAVID F. 8RU8AKER
FILE NUMBER
21-02-0538
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
1. CASH
2. CHECKING ACCOUNT - Members 1st Federal Credit Union - Account #151285-00
3. SAVINGS ACCOUNT - Members 1st Federal Credit Union - Account #151285-11
4. 1997 VW GOLF - Blue Book Value
5. PERSONAL LIBRARY
6. MISCELLANOUS PERSONAL FURNISHINGS
VALUE AT DATE
OF DEATH
$80.00
3,212.60
566.94
5,425.00
1,300.00
500.00
TOTAL (Also enter on line 5, Recapitulation) $
11,084.54
(If more space is needed, insert additional sheets of the same size)
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, Pl 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE
ACN
DATE
NO. 21 02-0536
02133083
07-18-2002
m-U4SElAfPU,-on
DARRELL R BRUBAKER
1156 RIDGE RD
ELIZABETHTOWN PA 17022
TYPE OF ACCOUNT
EST. OF DAVID F BRUBAKER 0 SAVINGS
5.5. NO. 203-07-7534 !XJCHECKING
DATE OF DEATH 05-29-2002 0 TRUST
COUNTY CUMBERLAND 0 CERTIF.
REMIT PAYNENT AND FORNS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
MEMBERS 1ST FCU hils pravid8d the D.partaent with the info....tion Usted b.low which h.s b..., used in
calculating the potential ux du.. Their records indic.t. th.t .t the death of the .bove decedent, YOU w.r. . joint OMn.r/bwwfici.ry of
this account. If you feel thi. info,...tion is incorr.ct, pl.... Obuin written carr.ction f~ the finenci.l institution, attach. copy
to this fo... and r.turn it to the above IKkIr.... This account is taxabl. in .ccordanc. with the Inh.ritanc. Tax L... of the Coa.onw..lth
of Pennsylvanl.. Qu.stions _y be an....nd by caUing (717) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 151285-11 Data 05-04-1995
Estllbl1sMcl
Account 8al...ca 566.94
Parcsnt T_lIbla X 5 D . 000
-.nt SubjKt to T_ 283.47
T_ Rats X .045
Pot_Ual T_ Due 12.76
PART TAXPAYER RESPONSE
[!] ~~!.~_~II__Mrllllllll::::..:.'
To insu... prop.r credit ta your account, two
(2) capi.. of this natic. ....t 8CCOlIP8f1y your
PIIY1181'1t ta the Register of IUUs. MIlk. chftCk
PII)'IIbl. to: '"R.glst.r af WiU., Ag....t".
NOTE: If tax pa)"llents .re .ad. wi thin thr..
(3) ~th. of tha dec8d8nt"s date of d..th,
YOU _y d8duct . S% discount of the tax due.
Any inhIIri tanca tax due wiU beco.. deUnquent
ni,.. (9) ...,ths .n.r the dab af d..th.
[CHECK ]
ONE
BLOCK
ONLY
A. 0 Th. IIbov. infa....t!an and tax du. is correct.
I. You ..y chaos. tD r.it pay.ant to U. Register of Wills with two capi.. of this notice to obtain
a discaunt or avoid int.r.st, or YOU ..,. cta.ck box fllfI and r.turn this notice to the Register of
Wills and an affici.l ........,t will b. baled by U. PI DeIP.rtaent af R.vllnUll.
B. IVl Tha llbav. ....t has b..n or will b. reported and ux paid .,ith th. Pennsylv....i. Inh.ritanc. Tax r.tum
~ to be filed by the Mc.dant" s nprannuth,..
c. r:J Th. ebov. infar..tian i. incorr.ct and/or debt. and d.duction. w.,.. p.id by you.
Vou BUst coeIPl.t. PART 0 l!II1d1ar PART [!] balaw.
PART
~
TAX RETURN - COMPUTATION OF
LINE 1. Data Establ1shad 1
2. Account Balance 2
3. Percent Taxable 3 X
4. A.ount Subjact to Tax 4
5. Dabts and Deductions 5
6. A.ount TaKable 6
7. Tax Rata 7 X
8. Tax Du. 8
TAX ON JOINT,TRUST ACCOUNTS
If you indicate . diffarent tax rate, pl..s. stata your
relationship to decadent:
PART
[!]
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
$
I
TOTAL (Enter on Line 5 of Tax Comput.tion)
Under pan8ltl.. of parjury, I declare that the facts I
complate to th, ba~~Nladg~nd balief.
/- ).~/ 7\" /~
TAXPAYER SIGNATURE
have reported above are tru., correct and
HOME (~/"7 >5c;/-' 7.?;7S
WORK (7/7) 31;;/- ,7,,73 :73tb/:/?'~
TELEPHONE NUMBER DATE
.-
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. ZlD60l
HARRISBURG, Pi 171Z8.0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
NO. 21 02-0536
02133078
07-18-2002
TYPE OF ACCOUNT
EST. OF DAVID F BRUBAKER IXJ SAVINGS
S.S. NO. 203-07-7534 DCHECKING
DATE OF DEATH 05-29-2002 D TRUST
COUNTY CUMBERLAND D CERTIF.
REIIIT PA YIlENT AND FORMS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
FILE
ACN
DATE
1Ev..1SUUlF' (01-11)
DARRELL R BRUBAKER
1156 RIDGE RD
ELIZABETHTOWN PA 17022
HEHBERS 1ST FCU hils provided the D8pt1rb...t with the infa....t1an llstad below which has bHn used In
calcuhtlnll the potential tax due. Thalr r~Drd. indicate ttult lit the dIIeth of the .baM decedent, YOU ...ra II joint QIlInllr/bllnllflc1ary of
this account. If YOU fe.l this Infa~tlDn 1. Incarrect, pl.... obt81n ..ritt... carrection f~ tha fln~l.l institution, attach II copy
to this forti and return It to th8 l!Ibova l!IdcIr.... This .ocaunt Is taxebla In IIccordanca with the Inharitmcll Tm( L.._ of tlw CO.EI......lth
of PtlftnsylVllnla. Qua.tions d1' be ..........d by caUlng (n7) 787-8327.
COMPLETE PART 1 BELOW . . . SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS
Account No. 151285-00 Dat. 05-04-1995
Eat.a.l1_
Account I.lance
Percent Tex_l.
Mount SUbjsct to Tax
Tax R.t.
Pct..,tial Tax Du.
x
3,212.60
50.000
1,606.30
.045
72.28
To insure prope" credit to your IICCDUI'It, tNo
(2) copl.. of this notice ..n aacallP8"Y your
P8Y11ent ta the Aqishr of NUIs. MM_ check
"YllbIB to: "Rqiater of WiUs, AgMt"".
x
NOTE: If tax P8Yl1enb ara IIIld8 Nl thin thne
(5) _nth. of U. decadent"S chlb of duth,
you -v deduct. 5% discount of the tax due.
Any I""'rl anc. blx due NUl bile... daUnquant
nintl (,) aonths .fta,. the ct.b of death.
PART TAXPAYER RESPONSE
[!]li"Ii!!lini'ii'mi....._~I...
~ ~__~.i~m'.l;:~~..: '~:~'~~i~m.. .':.. $.' ~ ".: '..". I r ~.1..' ," . ,.. ~~'~~'~:~'.. ", ~;~~'~i~'!'" ':~..~. . :~~~,~~ ~i" :.,~'...:'~
[CHECK ]
ONE
BLOCK
ONLY
A. 0 TI1II IIbove lnfo....tlon MIl tax due is co~t.
1. You... chou. to .....It p~t to the Ragbur of NUb with two capi.. of thls notl~ to obtain
. discount or avoid Inbr..t, Dr YOU ... check box "A" and I"atum this notice ta the Ragiste,. af
lUll. and an afflci.l .......-nt "ill b. b......:t by th8 PI Departawat af Rev......
I. [2g The above a...t h.. bHn or ..Ul M rllPortlld IInd ux paid with the P.nnsylvania Im.ritanc. Tl!IJC ntum
to b8 fUIId b)' tn. d.C8C18nt" s rIlPNI.....tIltiv..
c. D TtHI IIbDv. inforlllltion is incarr80t ..star dllbts l!Iftd d8ductions ...NI paid b)' )'OU.
You IlUst coIlPI.t. PART 0 and/or PART [!] b.lo...
PART
~
TAX RETURN - COMPUTATION
LINE 1. Oat. Estsbl1shsd
2. ACCOW'1t Balanc.
5. P.rcent Taxebl.
4. Asount Subj.ct to Tax
5. Osbts and Osductiona
6. AIIount Taxable
7. Tax Rat.
8. TaxDu.
OF TAX ON JOINT'TRUST ACCOUNTS
1
2
5 l(
4
5
6
7 X
8
If you indieat. a diff.rent tax rat.1 pl.... stat. your
relationship to d.:edent:
PART
!!l
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tex COMPutetion)
Under penalti.. of perjury I I declare th.t the facts I
coaplete to the best of~ knowledge belief.
_,' X
TA PA AT R
I
.
have reported above are true I correct and
HOME C7/7>3h/-7;;?;l3
WORK C 7/7 > 3'/-'/- 7;;2;;3
TE HO E NUMBER
~-g-j. ~
~ ~VC.r
REV-1509 EX+ (6-98)
'*
COMMONIlJEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
DAVID F. BRUBAKER
FilE NUMBER
21-02-0536
If an asset was made joint within one year of the decedent's. date of death, it must be nportetl on Schedule G.
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELATIONSHIP TO DECEDENT
A DARRELL R. BRUBAKER
1156 Ridge Road, Elizabethtown, PA 17022
SON
B
C
JOINTLY-OWNED PROPERTY:
LETTER DATE DESCRIPTION OF PROPERTY '10 OF DATE OF DEATH
ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT IDENTIFYING NUMBER. ATIACH DEED FOR JOINTLY-HELD REAL ESTATE. VM..UEOFjl.,SSET INTEREST DECEDENT'S INi"EREST
1. A. 5/4/95 MEMBERS 1 sl FEDERAL CREDIT UNION - SAVINGS 3,212.60 50% $1,606.30
ACCOUNT -ACCOUNT #151285-11
2. A 5/4/95 MEMBERS 1st FEDERAL CREDIT UNION - CHECKING 566.94 50% 283.47
ACCOUNT - ACCOUNT #151285-00
TOTAL (Also enter on line 6, Recapitulation) $ 1,889.77
(If more space is needed, insert additional sheets of the same size)
REV.1511 EX+ 112.991.
COMMONINEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
DAVID F. BRUBAKER
FILE NUMBER
21-02-0536
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. HOFFMAN ROTH FUNERAL HOME $1,625.00
B. ADMINISTRATIVE COSTS:
,. Personal Representative's Commissions
Name of Personal Represenlative{s)
Social Securit'y Number{s)/EIN Number of Personal Representative(s)
Street Address
City Stale _Zip
Year(s) Commission Paid'
2. Allorney Fees SALZMANN , HUGHES & FISHMAN, P.C. 3,500.00
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 264.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. ADVERTISING - GRANT OF LETTERS - CUMBERLAND LAW JOURNAL 75.00
8. ADVERTISING - GRANT OF LETTERS - THE SENTINEL 97.00
9. FILING FEE -INHERITANCE TAX RETURN 15.00
10. RESERVE FOR MISCELLANEOUS CLOSING EXPENSES 100.00
TOTAL (Also enter on line 9, Recapitulation) $ 5,876.00
Debts of decedent must be reported on Schedule I.
(If more space is needed, insert additional sheets of the same size)
REV-1512 EX+ (&98)
'*
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DAVID F. BRUBAKER
FILE NUMBER
21-02-0536
Include unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
I REAL ESTATE TAXES - 2002 & 2003 MUNICIPAL AND COUNTY
2. REAL ESTATE TAXES - 2002/03 SCHOOL
3. REPAIRS TO PROPERTY PRIOR TO CLOSING
4. PEST TREATMENT TO PROPERTY
5. HOMEOWNERS INSURANCE - L1TITZ MUTUAL INSURANCE CO.
6. ELECTRIC - PP&L
7. CAR LOAN PAYOFF - VW CREDIT
B. HEATING FUEL - DAUPHIN OIL
9. MEDICAL SERVICE - BELVEDERE MEDICAL CENTER
10. PRESCRIPTIONS - MGM PHARMACY
11. PRESCRIPTIONS - CVS PHARMACY
12. CREDIT CARD - SUN OIL CO.
13. CREDIT CARD - JCPENNEY
14. TELEPHONE -SPRINT
15. WATER & SEWER - CARLISLE BOROUGH
16. MORTGAGE PAYMENTS - MELLON BANK
VALUE AT DATE
OF DEATH
$1,575.00
1,744.00
626.00
55.00
427.00
256.00
274.00
1,235.00
48.00
188.00
7.00
23.00
84.00
115.00
328.00
2,092.00
TOTAL (Also enter on line 10, Recapitulation) $
9,077.00
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX+ (9-00)
..
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
DAVID F. BRUBAKER
FILE NUMBER
21-02-0536
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(SI RECEIVING PROPERTY Do Not I..lst Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116{,) (1.2)]
1. DARRELLR.BRUBAKER SON 100%
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
1. DICKINSON COLLEGE - GIFT OF PERSONAL LIBRARY $1,300.00
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REY-1500 COYER SHEET $ 1,300.00
(If more space is needed, insert additional sheets of the same size)
DEPARTMENT OF THEATRE AND DANCE
November 10, 2003
,
Mr. Darrell Brubaker
1156 Ridge Road
Elizabethtown P A 17022
Dear Darrell:
On behalf of our department - and especially our students - I want to express our formal thanks
for the thoughtful donation of your Dad's library. It is in place now in our lovely Conference
RoomlLibrary, and students are beginning to acquaint themselves with the content of this
wonderful collection of books. This is yet another way in which Dave's legacy continues in our
theatre program here.
I have consulted with Laura Erfle of Pomfret Street Books regarding fair market evaluation for
tax purposes. Estimated value for tax purposes is $1,300.00.
We are honored to be the recipients of these books, and are pleased that we can provide them
with a good, useful new home.
Thanks again for your thoughtfulness.
;;~
Todd Wronski
For the Depart~ent of Theatre and Dance
TW;~jdr;l4(;4~r~
H~ ~/j)~
W
Dickinson College
P.O. Box 1773
Carlisle, Pennsylvania 17013~2896
PHONE 717-245-1239
FAX 717-245-1145
EaMAIL theatre&dance@dickinson.edu
WEB www.dickinson.edu/
departmentsldramaJ
The first college chartered in
the newly recognized nation
September 9. J783
,
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LAST WILL AND TESTAMENT OF
DAVID F. BRUBAKER
I, DAVID F. BRUBAKER of Borough of Carlisle, Cumberland County,
Pennsylvania, being of sound and disposing mind, memory and understanding,
~1o hereby make, publish and declare this as and for my last will and testament,
hereby revoking all other wills and codicils heretofore made by me.
FIRST
I direct that my body be cremated and I direct the payment of
my debts and expenses of my last illness and cremation from my estate as
soon after my death as conveniently may be done. I authorize my personal
representative to expend funds from my estate, in such amount as my personal
representative shall consider necessary and desirable, for the purchase,
erection and inscription of a suitable place of disposal.
SECOND
I give, devise and bequeath my entire estate of whatever nature
and wherever situate to my wife, MARJ.G. BRUBAKER provided she survives me
by thirty (30) days. In the event my said wife shall fail to so survive me,
I give, devise and bequeath my entire estate of whatever nature and wherever
situate to my son, DARRELL R. BRUBAKER.
THIRD
Ii
I!
i ~
In addition to the powers conferred by law, I authorize my
Executor, in his absolute discretion:
,
a. to retain in the form received, and to sell either at public
or private sale any real or personal property;
I.
I!
b. to manage real estate;
i
I
I
being!
c. to invest and reinvest in all forms of property without
confined to legal investments; and without regard to the principal of
diver sif ication;
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"
i i investments; and
"
d.
to exercise any option or rights arising from ownership of
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in the sight
II names as witn
, -~~~"~
II
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!
e. to compromise claims without court approval, and without
the consent of any beneficiary.
FOURTH
I
{
I
I
;
I nominate, constitute and appoint my wife, MARJ.G. BRUBAKER
Executrix of this my Last Will and Testament. In the event my said
Executrix fails to so serve for any reason, I nominate, constitute and
appoint my son, DARRELL R. BRUBAKER, Executor hereunder. I hereby relieve
my Executrix or Executor from the necessity of posting security in
I
,
I
'I
I
!I
II
\1
connection with her or his duties as such in any jurisdiction in which
he or she may be called upon to act insofar as I am able by law to do so.
IN WITNESS WHEREOF, I have hereunto set my hand and seal
to this, my Last Will and Testament, consisting of two (2) typewritten
pages, the first one (1) of which bears my signature in the margin
c/
the purIX>se of identification this /" day of /._1.. I ,~"./(, I 1986.
for
I
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!
:1
!
-- J,
-nh~ifF /1~~J/c-.
DAVID F. BRUBAKER
(SEAL)
Signed, sealed, published and declared by the above named
testator, DAVID F. BRUBAKER, as and for his last will and testament,in
the presence of us, who at his request, in his sight and presence, and
and presence of each other, have hereunto subscribed our
I
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y/ ,-' ,. I
ADDRESS'_~//:'" ...::C-',C((C"l'~ ./ (':;' 1("
_ _r ..~ '. .~ -,';f ..,~ v.:.'(
~-rG ~v.,jJ~_~ }') ud ]'1_ ADDRESS /..}f)1( L'1ox 7;' Ilk" OJ'/ /.< '
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COMMONWEAL'll! OF PENNSYLVANIA:
:SS.
COUNTY OF CUMBERLAND
(\
BRUBAKER,8-r If'llJ ,-/-l.shiLl{i.~-and
We, DAVID F.
--\ c"
);.~ I~" c f). Ltd. CA_
, the testator and the witnesses, respectively,
whose names are signed to the attached or foregoing instrument, being first
dUly sworn do hereby declare to the undersigned authority that the testator
signed and executed the instrument as his last will, and that he signed
willingly and that he executed as his free and voluntary act for
I
the purposesi
,
i
therein expressed, and that each of the witnesses, in the presence and
hearing of the testator, signed the will as witnesses, and that to the best
of their knowledge, the testator was at the time eighteen (18) years of
age or older, and of sound mind and under no constraint or undue influence.
II
Sworn to and subscribed
/u d,
I
I
,
i
"
,
I,
I,
!!
,
I
before me this
~-
day of ")'1 L'f. , 1986.
/) ("'1/
///1 //
ten,Lt_) 1/1~llCA,-.
( , )
CA~~!.E< ~o~;RP.AY. NOTARr PU8UC(;
MY CC;:~;""laN' ;xUp'l~eEnl"'m COUNTY
",,,,,.., ,IRE. en
Member, FoonoYlv"i A " :,I,2J. 1989
'" a $SOtlalieR of Notaries
,
,
I
I
II
STATUS REPORT UNDER RULE 6.17~
Name of Decedent:
DAVID F. BRUBAKER
Date of Death:
June 6, 2002
No. 21-02-0536
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete: X Yes 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:
a. Did the personal representative file a final account with the Court?
__ Yes X No
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? X Yes No
Date:
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphan's Court and may be
attached to this report.
6/16/04 ~
Signature NN ~
Capacity:
SALZMANN HUGHES & FISHMAN
Stephen J. Fishman, Esquire
Name (please type or print)
95 Alexm~der Spring Road, Suite 3
Address
Carlisle, PA 17013
City, State, Zip
(717) 249-6333
Telephone Number
X
Personal Representative
Counsel for Personal Representative
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DZ¥ZSIDN
DEPT. 280601
HARRTSBURG, PA 17128-0601
COHHONWEALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-IS47 EX AFP (01-05)
'04 H~R 12 P1 :~3
STEVEN J FISHHAN ESQ
SALZHANN ETAL
95 ALEXANDER SPG RD
CARLISLE pA{~)/~_ ~ _
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
COUNTY
ACN
05-15-2004
BRUBAKER
05-29-2002
21 02-0556
CUHBERLAND
101
Amoun'l: Ram,J,~md
DAVID R
HAKE CHECK PAYABLE AND REHZT PAYHENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE I1~ RETAIN LOWER PORTION FOR YOUR RECORDS 4
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX
ESTATE OF BRUBAKER DAVID R FILE NO. 21 02-0556 ACN 101 DATE 05-15-2004
TAX RETURN NAS: (X) ACCEPTED AS F/LED ( ) CHANGED
RESERVATZON CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Es~a~a (Schmdula A)
2. S~ocks mnd Bonds {Schmdulm B}
$ Closely Held S~ock/Par~narship Zn~mres~ (Schedule C)
Not,gages~No,es Rmce/vabla (Schedule D)
$ Cash/Bank Deposits~Misc. Personal Propar~y (Schedule E)
6 Jointly Owned Propar~y (Schadula F)
7 Transfers (Schedule G)
8 To~a~ Assa~s
APPROVED DEDUCTIONS AND EXEHPTZONS:
9. Funeral Expanses/Adm. Cos~s/H~sc. Expenses (Schedule H)
10. Oab~s/Hor~gagm L~mb~l~as/L~mns (Schedule Z)
11. To~al Deductions
12. Na~ Value of Tax Rm~urn
(1)
(2)
($)
($)
(6)
(7)
165/707.00
O0
O0
O0
11/084.54
1/889 77
O0
(9)
(8)
5,876.00
(10)
NOTE: To insure proper
cradi~ ~o your account,
submi~ ~hm upper portion
of ~his form wl~h your
~ax payment.
1S.
lq.
NOTE:
ASSESSHENT OF TAX.'
15. Amoun~ of L/ne 1~+ a~ Spousal ra~a
16. A.oun~ of L1nm lq ~axable a~ Lineal/Class A ra~e
17. A.oun~ of Line 1~ a~ Sibling ra~e
18. Amoun* of Llne lq ~axable a~ Collateral/Class B rm*e
19. Prlnclpal Tax Due
TAX CREDITS:
PAYHENT RECEIPT DISCOUNT (+J
DATE NUHBER INTEREST/PEN PAID (-)
176,681.$1
9,077.00
(11) 1~, gg:~ - §0
(12) 161,728.~1
1,:500.00
01-15-2004
CD005442
313.56-
BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-16-2004
7,532.83
IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
TOTAL TAX CREDIT I 7,219.27
BALANCE OF TAX DUEl .00
INTEREST AND PEN. 1.00
TOTAL DUE 1. O0
( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS RE;)UZRED.
ZF TOTAL DUE ZS REFLECTED AS A "CREDTT' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
AHOUNT PAID
(15) .00 X O0 = .00
(15) 160,428.$1 X 045 = 7,219.27
(17) . O0 x 12 = .00
(18) .00 X 15 = .00
(19)= 7,219.27
Charitable/Governmental Bequests; Non=elected 9113 Trusts (Schedule J) (13)
Nm~: Value of Esta~:e Subject: to Tax (1~) 160,428.$1
Tf an assessment ~as Assued prev$ously, lanes 14, 15 and/or ~6, 17, 18 and 19
reflect fSgures that $nclude the total of ALL returns assessed to date.
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 003695
FISHMAN STEVEN J
95 ALEXANDER SPRING RD
SUITE 3
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 203-07-7534
FILE NUMBER: 2102- 0536
DECEDENT NAME: BRUBAKER DAVID F
DATE OF PAYMENT: 03/18/2004
POSTMARK DATE: 03/17/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/29/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 I $1.00
REMARKS'
SEAL
CHECK//1124
TOTAL AMOUNT PAID:
$1.00
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
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 003695
FISHMAN STEVEN J
95 ALEXANDER SPRING RD
SUITE 3
CARLISLE, PA 17013
........ fold
ESTATE INFORMATION: SSN: 203-07-7534
FILE NUMBER: 2102-0536
'DECEDENT NAME: BRUBAKER DAVID F
DATE OF PAYMENT: 03/1 8/2004
POSTMARK DATE: 03/1 7/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 05/29/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $1.00
REMARKS:
~"- SEAL
4'.
CHECK//1124
TOTAL AMOUNT PAID:
$1.00
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF ZNDZV'rDUAL TAXES
ZNHER/TANCE TAX DIVISION
DEPT. 280601
HARRISBURG; PA 17128-0601
COHHON~/EALTH OF PENNSYLVANIA
DEPARTHENT OF REVENUE
INHERITANCE TAX
STATEHENT OF ACCOUNT
DATE
ESTATE OF
DATE OF DEATH
FILE NUHBER
'04 APR 26 ~ ] ;~)UNTY
STEVEN J FISHHAN ESQ ACN
SALZHANN ETAL
95 ALEXANDER SP$ RD
CARLISLE PA
REV-1Gn7 EX AFP (01-03)
04-1Z-ZOO4
BRUBAKER DAVID R
05-29-2002
Z1 02-0536
CUHBERLAND
101
Amount Remitted
HAKE CHECK PAYABLE AND REHZT PAYNENT TO:
REGISTER OF WILLS
CUHBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To lnsure proper credit to your account, submit the upper portLon of this form ~ith your tax payment.
CUT ALONG THIS L'rNE ~ RETAIN LO~/ER PORTION FOR YOUR RECORDS
REV-1607 EX AFP (01-03) ### 'rNHERZTANCE TAX STATENENT OF ACCOUNT
ESTATE OF BRUBAKER DAVID R FILE N0.21 02-0536 ACN 101 DATE 04-12-2004
THIS STATEHENT ZS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN ZN THE NAHED ESTATE. SHONN BELO#
ZSA SUHNARY OF THE PR/NCZPAL TAX DUE, APPLICATION OF ALL PAYNENTS, THE CURRENT BALANCE, AND, ZF APPLICABLE..
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSHENT OR RECORD ADJUSTHENT: 03-15-2004
PRINCIPAL TAX DUE: ...........................................................................................................................................................................................................................
PAYHENTS (TAX CREDITS):
7,219.27
PAYHENT RECEIPT DISCOUNT (+) AHOUNT PAID
DATE NUHBER INTEREST/PEN PAID (-)
313.56-
01-15-2004
03-17-2004
CD003442
CD003695
1.00-
7,532.83
1.00
1F PA/D AFTER THIS DATE, SEE REVERSE
S/DE FOR CALCULATION OF ADDITIONAL INTEREST.
( IF TOTAL DUE ZS LESS THAN $1,
NO PAYHENT 1S REgUZRED.
ZF TOTAL DUE 1S REFLECTED AS A 'CREDIT' (CR),
TOTAL TAX CREDIT
7,219.27
BALANCE OF TAX DUE .00
ZNTER~ST AND PEN. .00
TOTAL DUE .00
YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF THIS FORH FOR INSTRUCTIONS. )
STATUS REPORT UNDER RULE 6.12
Name of Decedent: DAVID F. BRUBAKER
Date of Death: June 6 2002
No. 21-02-0536
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
1. State whether administration of the estate is complete: X Yes _ 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:
a. Did the personal representative file a final account with the Court?
Yes X No
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties
in interest? X Yes No
d. Copies of receipts, releases, joinders and approvals of formal or informal
accounts may be filed with the Clerk of Orphan's Court and may be
attached to this report.
Date: 6/16/04
Capacity:
Signature
SALZ.MANN HUGHES & FISHMAN
_ Stenhen J. Fishman Esquire
Name (please type or print)
95 Alexander Snrine Road Suite 3
Address
Carlisle PA 17013
City, State, Zip
(717) 249-6333
Telephone Number
Personal Representative
X Counsel for Personal Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT of REVENUE REV-7162 EXI11-96)
6URFAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 1 71 2 8-0601
RECEIVED FROM: PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 003442
FISHMAN STEVEN J
95 ALEXANDER SPRING RD
SUITE 3
CARLISLE, PA 17013
ACN
ASSESSMENT AMOUNT
CONTROL
_____ ,o,d NUMBER
ESTATE INFORMATION
FILE NUMBER:
DECEDENT NAME:
DATE OF PAYMENT:
POSTMARK DATE:
COUNTY:
DATE OF DEATH:
SSN: 203-07-7534
2102-0536
BRUBAKER DAVID F
01/15/2004
00/00/0000
CUMBERLAND
05/29/2002
TOTAL AMOUNT PAID:
REMARKS: RECEIVE OF DARRELL R BRUBAKER
IN C/O STEVEN J FISHMAN ESQ.
CHECK#1754
INITIALS: JA
SEAL RECEIVED BY:
57,532.83
GLENDA EARNER STRASBAUGH
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL raxes COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TA% 9IVISION DEPARTMENT OF REVENUE
9Epr. zaoa9l
HpRRISBIIRG, Pp 17129-9601 INHERITANCE TAX
STATEMENT OF ACCOUNT
REY-160] EN ,FP (O1-OS)
.L~:: la-~ ~..::.
STEVEN J FISHMAN ESp
SALZMANN ETAL
95 ALEXANDER SPG RD 3
CARLISLE PA 1701~'~
DATE 04-12-2004
ESTATE OF BRUBAKER DAVID R
DATE OF DEATH OS-29-2002
FILE NUMBER 21 02-0536
';::COUNTY CUMBERLAND
ACN 101
Anount Renitted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
NOTE: To insure proper credit to your account, subnit the upper portion of this forn rich your tax peynant.
CUT ALONG THIS LINE __-___ RETAIN LOWER PORTION FOR YOUR RECORDS -~
-------------- ----------
REV-1607 EX AFP (O1-03) xix INHERITANCE-Tnv-etnrr..~.(~ ....
ESTATE OF BRUBAKER DAVID R FILE N0. 21 02-0536 ACN 101
THIS STATEMENT IS PROVIDED i0 ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTA ETESHOWN BEL w004
IS A SUMMARY OF THE PRINCIPAL TAX DUE, gppLICATIDN OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE,
A PROJECTED INTEREST FIGURE.
DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: D3-15-2004
PRINCIPAL TAX DUE:
PAYMENTS (TAX CREDITS):
DATE
01-15-2004
03-17-2004
IPT
CD003442
CD003695
7 (+)
I PAID (-) AMOUNT PAID
313.56- 7,532.83
1.00- 1.00
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
* IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE
SIDE FOR CALCULATION OF ADDITIONAL INTEREST.
f IF 70TAL DUE IS LESS THAN S1,
NO PgYNENT 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. )
7,219.27
7,219.27
.00
.00
.00
BUREAU OF INDIVIDUAL TAXES COMMONWEALTH OF PENNSYLVANIA
INHERITANCE rnx BlvlsleN DEPARTMENT OF REVENUE
DEPT. 288601
Hp RR ISBHRG, pa 1712a-obol NOTICE OF INHERITANCE TAX
APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
OF DEDUCTIONS AND ASSESSMENT OF TAX
~r-yy e[v-tsa ex xrv cot-on
Il'.:Cl.' .:.
F'; : r.
STEVEN J FISHMAN ESQ 04 ~~~P ~~ ~~ ~ '~3
SALZMANN ETAL
95 ALEXANDER SPG RD l3.
CARLISLE PAf~VD13
CUT ALONG THIS LINE - RETAIN LOWER
--------------
REV-1547 EX AFP-iei-nii'u~t.-:.~ ::~ ----------
YOUR RECORDS ~
ua~wLLOwANCE OF DEDUCTIONS AND ASSESSMENT~OF~TAXye uM
iTATE OF BRUBAKER DAVID R FILE NO. 21 02-0536
ACN 101 Herr nZ_IC_~nni
TA% RETURN MAS: (X) ACCEPTED AS FILED
AISED VALUE OF RETURN BASED ON:
1. Raal Estate (Schedule A) ORIGINAL RETURN
2. Stocks and Bonds (Schedule B)
3. Closely Neld S{ock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable f5chetlule D]
5. Cash/Bank DeDOSits/Misc. Personal Property (Schedule E)
b. Jointly Owned Property (Schedule F)
7. Transfers f8chedule G)
8. total Assets
( ) CHANGED
fl) 163 .707 00 NOTE: To insure proper
(z) .OD credi{ to your account,
(3) .00 subni{ {he upper portion
(4) .00 of this fore with your
ts) 11. 084 54 tax payment.
[b) 1, 889 77
t7) .00
APPROVED DEDUCTIONS AND EXEMPTIONS: (87 6,681 .31
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 5,876 .00
30. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deduc{ions flo) 9.077 00
12. Net Value of Tax Return fll) 74.95; 00
13. Charitable/Governmental Bequests) Non-elected 9113 Trus t
(S 161,728.31
14. Net Values of Estate Subject to lax s
chedule J) (13) 1,30D.00
NOTE:
if an assessment was issued previously, lines
refil
t
14
15
d (14) 160,428.31
ec
figures that include the total of
ALL ,
an
ior
returns a 16, 17, 18 and 19 will
ASSESSMENT OF TAX: ssess ed to date.
15. Amount of Line 14 at Spousal rate (15) 00 00
16.
Amount of Line 14 taxable at Lineal/Class A ra{e
(16) ~~
160,42831 %
_
045 .DO
17. Amount of Line 14 at Sibling rate %
= 7,219.27
18. Anount of Line 14 taxable at Collateral/Class B rata (18) DO 15
19.
Principal Tax Due _~~ X
- .00
i~~eR[F ~D~TT_ tl9)= 17
7,219.27
) ~ AMOUNT PAID
BALANCE OF UNPAID INTEREST/PENALTY AS OF 01-16-2004
-++1 ,* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
4L TAX CREDIT I 7,219.27
VCE OF TAX DUE .00
REST AND PEN. 1.00
TOTAL DUE 1.00 //
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. ~ j'l
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
DATE 03-15-2004
ESTATE OF BRUBAKER DAVID R
DATE OF DEATH 05-29-2002
FILE NUMBER 21 02-0536
COUNTY CUMBERLAND
ACN 101
Anount Rani{ted
MAKE CHECK PAYABLE AND REMIT PAYMENT T0:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013