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HomeMy WebLinkAbout04-0420 REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA PETITION FOR GRANT OF LETTERS Estate of VIVIAN IRENE BRINTON also known , I~ea~J~ 29 S&c~a~C/E, ecurity No. 182228260 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 ors Decedent, dated 11/8/99 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., db.nc.ta.: 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 122 November Drive, Camp Hill Borou~lh, PA 17011 (list street, number and municipality) Decedent, then 82 years ofage, died April 17 ,2004 , at SCCI Hospital, Harrisbur~h PA (Location) Decedent at death owned property with estimated values as follows: (if domiciled in PA All personal property ......................................... $ (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 ..................................................................................................................... $ Real Estate situated as follows: N/A 43,000.00 43,000.00 Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: I Typed or printed name and residence Signature EDWARD BRINTON 404 BEAVER ROAD, HARRISBURG, PA 17112 NANCY WACKER 70AKWOOD CIRCLE CAMP HILL, PA 17011 Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland ?.e~ The Petitioner(s) above-named swear(s) and affirm(s) that the ~[ements 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.~N. Sworn to and affirmed and subscribed ~ ~.~-,t." ~ EDWARD BRINTON before me this 29th day of C.~ ~;. ~. i-'.. April, 2004 '~' . ..,/ _ ~.., / r NANCY WALKER DECREE OF REGISTER Estate of VIVIAN IRENE BRINTON alsoknownas V~ V l,~ ~J T '~'~lA I Id'~C2 t,~ Social Security No: 182228260 OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA Deceased No. ~//'~ ~" '~-~0 Date of Death: 4/17/04 2004 , in consideration of the Petition on the AND NOW, l°r,op., I ~.-)c~ , reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters I~ Testamentary r-i of Administration ((c.t.a., d.b.n.c.t.; pendente lite; durante absentia; durante minodate) are hereby granted to EDWARD BRINTON and NANCY WACKER in the above estate and that the instrument(s), if any, dated 11/08/1999 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 ...................................... $ TOTAL ............................. $ Signature Attorney: CHARLES E. PETRIE I.D. No: 29029 Address: 3528 BRISBAN STREET HARRISBURG PA 17111 Telephone: 561-1939 DATE FILED: 4/29/04 his is to certify that the information here given is con'ectly 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 [-t~;icertificate, $2.00~ ' '04 fi?R29 ?,7:5~ P ;LO": ;' COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH /,v/ co~..o~. ~ J ~ e~ ,~-x?~ ~ -~z,~*~ "~'~ /~. ~'~ I-. ~z~sb~, ~ / 7//0 ~ ........... H risburg~C?unty of I, VIVIAN IRENE BRINTON, of 1110 penn Stree.~/~ pennsylvania, do hereby make, publish, and declare this to be my Dauphin, LAST WILL AND TESTAMENT, revoking any and all?~i~i~r:'wills and codicils, manner following, that is to say, FIRST, that I direct that my Personal Representative shall pay all of my just debts and funeral expenses as soon as this shall be practicable. sEcoND, that upon my death I give, devise, and bequeath all of my property, real, personal, and mixed in the following manner: a. I direct that the real estate that I own at 1110 Penn Street, Harrisburg, County of Dauphin, Pennsylvania, shall be sold and the proceeds are to be divided among my children, per capita; that is, if any child predeceases me, then his or her share shall pass instead to my surviving child or children. b. I direct that my personal property shall be divided in accordance with the following instructions: ROUND 1: The attorney attending to the legal affairs of my estate shall prepare four (4) cards, the first being marked "1," the seconde 2, and so on. In the first round, each child commencing with the oldest shall select a card from the hand of the attorney. The child drawing the card designated "1" shall have first choice of any item of personal property, the child drawing the card designated "2" shall have second choice, and so on. In ROUND 2 the selection of personal property shall proceed in the reverse order of Round 1. That is, the child drawing the card designated "4" shall have the first choice, and so on. ROUND 3 shall proceed as Round 2, except that the child drawing the card designated "1" shall have the first choice, and so on. ROUND 4 shall proceed as Round 2, except that the child drawing the card designated "1" shall have the first choice, and so on. ROUND 5 shall proceed exactly as Round 1 proceeded. All further rounds shall proceed in a cyclical manner in accordance with the above prescribed pattern. c. The remaining items of personal property shall be sold, and the proceeds shall be divided among my children, CHARLES E. BRINTON, dR., NANCY WACKER, EDWARD BRINTON and DEBRA CARROL, per capita. THIRD, that I hereby appoint my son, EDWARD BRINTON, and my daughter, NANCY WACKER, as the Co-Executors of my Estate. If either is unable or unwilling to perform in this capacity, then I appoint my son, CHARLES E. BRINTON, JR., to act as Co-Executor with my surviving Executor. I direct that none of my Personal Representatives shall be required to post bond in this or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this eighth day of November, 1999. VIVIAN IRENE BRINTON WITNESS WITNESS ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, VIVIAN IRENE BRINTON, testatrix, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I have signed and executed the instrument as my Last Will and Testament; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by VIVIAN IRENE BRINTON, the testatrix, this eighth day of November, 1999. VIVIAN IRENE BRINTON ~)'TARY ~U~'LI C i NOTARIAL SEAL I(EI.LY P. ROBERTS NOTARY PUBLIC PAXTANG BORO., ~UPHIN CO PA AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN WE, CHARLES E. PETRIE and DAVID A. PETRIE, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her LAST WILL AND TESTAMENT; that VIVIAN IRENE BRINTON signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by CHARLES E. PETRIE and DAVID A. PETRIE, witnesses, this eighth day of November, 1999. WITNESS WITNESS (j /0TARY MY COMM,SSlON aP,RES iA.. 27. 2 01 CERTIFICATE OF NOTICE UNDER RULE NAME OF DECEDENT: VIVIAN I. BRINTON DATE OF DEATH: April 17, 2004 WILL NO.: ADMIN NO.: 2004-00420 TO THE REGISTER: I certify that notice of beneficial interest required by Rule 5.6{a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on April 29, 2004: NAME ADDRESS Debra Carroll 5 Dario Drive, Lincoln, Rhode Island Charles Brinton 106 Clark Road, SExton, Pennsylvania Nancy Wacker Edward Brinton 70akwood Circle, Camp Hill, PA 17011 404 Beaver Road, Harrisburg, PA 17112 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE DATE: 4/29/2004 ~ ~'~ SIGNATURE CAPACITY:'h: NAME CHARLES E. PETRIE ADDRESS 3528 Brisban Street Harrisburg, PA 17111 TELEPHONE (717) 561-1939 Personal Representative Counsel for Personal Representative · REV-1500 EX~ (6-00) I--- Z LLI Z Z o COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL BRINTON VIVIAN REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY ~UMSE~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. FIRM NAME (If Applicable) TELEPHONE NUMBER (717) 561-1939 [~2. Supplemental Return [~4a. Future Interest Compromise (date of de~ alter 12-12~82) r--~ 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) [] 3. Rema ]5. Feder 0 8. Total [] 11. Elec COMPLETE MAILING ADDRESS 3528 BRISBAN STREET HARRISBURG 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership 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) Total Gross Assets (total Lines 1-7} Funeral Expenses & Administrative Costs (Schedule H) (9) Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) Total Deductions (total Lines 9 & 10) Net Value of Estate (Line 8 minus Line 11) 9. 10. 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) 112,534.811 17,525.82 ~ 64,121.37 i (8) 11,876.95 4,179.08 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES X .0 (15) 178,125.97 X .04.5 (16) X .12 (17) X .15 (18) (19) 8,015.67 NAME CHARLES E. PETRIE r~-11. Original Return ]4. Limited Estate ~-]6. Decedent Died Testate (Attach copy of Will) [--] 9. Litigation Proceeds Received inder Return (date of death prior to 12-13-82) Estate Tax Return Required ~umber of Safe Deposit Boxes ion to tax under Sec. 9113(A) (,~ach Sch O) PA 17111 OFFICIAL USE ONLY 194,182.00 16,056.03 178,125.97 178,125.97 8,015.67 IRENE 1 8 2-2 2- 8 2 6 0 DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MIV!-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WEll THE 04/17/2004 09/30/1921 RI-'GISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST. FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY lUMBER Decedent's Complete Address: 122 NOVEMBER DRIVE ISTATE PA I ZIP 17011 STREET ADDRESS CITY CAMP HILL Tax Payments and Credits: 1, Tax Due(Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 400.78 Interest/Penalty if applicable D. Interest E. Penalty Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) 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 If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. 8,015.67 (1) , 400.78 (3) i (4) I (5) I 7,614.89 (5A) I (5B) , 7,614.89 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 properly transferred; ........................................................................... O [] 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? ............................................................. C~ [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............................................................................................... E~ [] 3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. E~ [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ....................................................................................................... [~ [] 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 ~:companying schedules a~d statements, and Io 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. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE 7/7/04 ADDRESS '7OAKWO~D CIRCLE CAMP HILL PAi 17011 SIGNATURE OF PREP~,RER O,,]~I-IER THAN REPRE,,~ENTATIVE DATE 7/7/04 ADDRESS 3528 BRISBAN STREET HARRISBURG PA 17111 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 bf 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 ~ax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. ~REV-1508 EX + (1~)7) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK BEPOSlTS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER BRINTON VIVIAN IRENE , Include the proceeds of litigation and the date the proceeds were received by the estate. All prope~'y jointly-owned with the right of survivorship must be disclosed on Schedule F, ITEM NUMBER DESCRIPTION 1. LINCOLN FINANCIAL INVESTMENTS 10, 11. 12. 13. THE HARTFORD INVESTMENTS MISCELLANEOUS PERSONAL PROPERTY 986 CHEVY CAPRICE {EFUND FROM PA POWER & LIGHT BLUE CROSS/BLUE SHIELD REFUND CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FEDERAL CREDIT UNION REFUNDFROMJOHN HANCOCKINSURANCE REFUND FROM ERIE INSURANCE TOTAL (Also enter on line 5, Recapitulatibn) VALUE AT DATE OF DEATH 31,668.20 11,445.23 1,000.00 500.00 11.50 380.36 8,766.14 10,000.00 21,075.69 26,652.55 857.14 178.00 112,534.81 (If more space is needed, insert additional sheets of the same size) I · REV-tS~g EX +,(1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF BRINTQN VIVIAN IRENE If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. FILE NUMBER SURVIVING JOINT TENANT(S) NAME ADDRESS A. NANCY WACKER C 70AKWOOD CIRCLE CAMP HILL, PA 17011 RELATIONSHIP TO DECEDENT DAUGHTER JOINTLY-OWNED PROPERTY: u- l ~ ER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for joinlly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERE... 1. A. :3/03 SAVINGS ACCOUNT AT MEMBERS FIRST CREDIT 4,913.741 50. 2,456.8; UNION 2. A 3/03 MONEY MANAGEMENT ACCOUNT AT MEMBERS 22,149.65 50. 11,074.8,: FIRST CREDIT UNION 3. A. 3/03 CHECKING ACCOUNT AT MEMBERS FIRST CREDIT 368.07 50. 184.0z UNION 4. A. 12/94 ACCOUNT AT FULTON BANK 7,620.16 50. 3,810.0~ TOTAL (Also enter on line 6, Recapitulation) $ 17,525.8~ (If more space is needed, insert additional sheets of the same size) REV-1510 EX * (1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER BRINTQN VIVIAN IRENE 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 % OF ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER, DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER ATTACH A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST CF ~UC,~.E) 1. CITIZENS BANK ACCOUNT 67,121.37 100. 3,000.00 64,121.37 TOTAL (Also enter on line 7, Recapitulation) $ 64,121.3 [ .~1, insert additional sheets of the same size) ~OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS 'E OF VlVlAN Debts of decedent must be reported on Schedule I. IRENE FILE NUMBER ITEM NUMBER 5. 6. 7. DESCRIPTION FUNERAL EXPENSES: ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) / FIN Number of Personal Representative(s) Street Address 70AKWOOD CIRCLE Cit7 CAMP HILL , State PA Year(s) Commission Paid: 2004 Attorney Fees CHARLES E. PETRIE Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant NANCY WACKER ANn Fr')WARD BRINTON Zip '1 /u I i Street Address City Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees ESTATE CHECKS State Zip , TOTAL (Aisc enter on line 9, RecapitulatiOn) (if more space is needed, insert additional sheets of the same size) AMOUNT 5,800.00 5,800.00 114.00 150.00 12.95 $ 11,876.95 REV-1512 EX + (1-97} ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES~ & LIENS IRENE FILE NUMBER ESTATE OF BRINTON VIVIAN Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1, ASSOCIATED CARDIOLOGISTS 10. 11. 12. 13. 14. 15. CARDIOLOGY DIAGNOSTIC HERITAGE MEDICAL GROUP PINNACLE HEALTH QUANTUM IMAGING ROBERT J. KANTOR ULTRASOUND SERVICES CARY CUMMINGS PATHOLOGY ASSOC. OF CENTRAL PULMONARY CRITICAL CARE RIVERSIDE ANESTHESIA SARAH A. TODD MEMORIAL HOME BELVEDERE MEDICAL CORP. MOFFITT HEART AND VASCU, SYMPHONY DIAG. SVCS. TOTAL (Also enter on line 10, RecapitulatiOn) AMOUNT 6.96 .74 642.54 1,030.00 178.55 161.68 5.08 116.10 25.15 759.08 35.44 109.50 12.03 57.82 17.35 $ 4,179.08 (If more space is needed, insert additional sheets of the same size) Continuation of REV-1500 Inheritance Tax Return Resident Decedent BRINTON VIVIAN IRENE Paqe 1 Schedule I - Debts or Decedent, Mortgage Liabilities, & Liens ITEM NUMBER 16. 17. 18. 19. 20. 21. 22. 23. 24. DESCRIPTION VASCULAR ASSOCIATES WEST SHORE ALS CHAMBERSBURG IMAGING AS. DAVID BRONSTEIN ARLINGTON GROUP INC. HAMPDEN TOWNSHIP JAMIE L. HETTICK, M.D. PA POWER & LIGHT VITERRA SUBTOTAL SCHEDULE I GRAND TOTAL SCHEDULE I AMOUNT 281.14 184.40 1.82 13.92 420.72 51.99 21.44 17.79 27.04 1,020.26 $ 4,179.08 ' REV-~513 EX + ('1-97) ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF BRINTOI NUMBER II. 1. VIVIAN IRENE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) NANCY WACKER 70AKWOOD CIRCLE CAMP HILL, PA 17011 EDWARD BRINTON 404 BEAVER ROAD HARRISBURG, PA 17112 CHARLES BRINTON, JR. 106 CLARK ROAD SAXTON, PA 16678 DEBRA CARROLL 5 DARIO DRIVE LINCOLN RI 02865 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) DAUGHTER SON SON DAUGHTER ' I AMOUNT OR SHARE OF ESTATE 25% OF NET ESTATE PLUS ONE-HALF OF JOINT ACCOUNTS 25% OF NET ESTATE 25% OF NET ESTATE 25% OF NET ESTATE ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, 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 i I TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET1 , i (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, VIVIAN IRENE BRINTON, of 1 1 10 Penn Street, Harrisburg, County of Dauphin, Pennsylvania, do hereby make, publish, and declare this to be my LAST WILL AND TESTAMENT, revoking any and all prior wills and Codicils, in manner following, that is to say, FIRST, that I direct that my Personal Representative shall pay all of my just debts and funeral expenses as soon as this shall be practicable. SECOND, that upon my death I give, devise, and bequeath all of my property, real, personal, and mixed in the following manner: a. I direct that the real estate that I own at 1 1 10 Penn Street, Harrisburg, County of Dauphin, Pennsylvania, shall be sold and the proceeds are to be divided among my children, per capita; that is, if any child predeceases me, then his or her share shall pass instead to my surviving child or children. b. I direct that my personal property shall be divided in accordance with the following instructions: ROUND 1: The attorney attending to the legal affairs of my estate shall prepare four (4) cards, the first being marked "1 ," the seconde "2," and so on. In the first round, each child commencing with the oldest shall select a card from the hand of the attorney. The child drawing the card designated "1" shall have first choice of any item of personal property, the child drawing the card designated "2" shall have second choice, and so on. In ROUND 2 the selection of personal property shall proceed in the reverse order of Round 1. That is, the child drawing the card designated "4" shall have the first choice, and so on. ROUND 3 shall proceed as Round 2, except that the child drawing the card designated "1" shall have the first choice, and so on. ROUND 4 shall proceed as Round 2, except that the child drawing the card designated "1' shall have the first choice, and so on. ROUND 5 shall proceed exactly as Round 1 proceeded. All further rounds shall proceed in a cyclical manner inl accordance with the above prescribed pattern. c. The remaining items of personal property shall be Sold, and the proceeds shall be divided among my children, CHARLES E. BRINToN, dR., NANCY WACKER, EDWARD BRINTON and DEBRA CARROL, per capita. THIRD, that I hereby appoint my son, EDWARD BRINTON, and my daughter, NANCY WACKER, as the Co-Executors of my Estate. If either is unable or unwilling to perform in this capacity, then I appoint my son, CHARLES E. BRINTON, JR., to act as Co-Executor with my survivir~g Executor. I direct that none of my Personal Representatives shall be required to post bond in this or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this eighth day of November, 1999. VIVIAN IRENE BRINTON WITNESS WITNESS ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, VIVIAN IRENE BRINTON, testatrix, whose name is signed tO the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I have signed and executed the instrument as my Last Will and Testament; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to and acknowledged before me by VIVIAN iRENE BRINTON, the testatrix, this eighth day of November, 1999. VIVIAN IRENE BRINTON i~ISTARY I~U~-~LI C NOTARIAL SEAL KEI..LY P. ROBERTS, NOTARY PUBLIC PAX'TANG 80RO., pI~k~.~,PHIN CO PA , AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN WE, CHARLES E. PETRIE and DAVID A. PETRIE, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw testatrix sign and execute the instrument as her LAST WILL AND TESTAMENT; that VIVIAN IRENE BRINTON signed willingly and that she executed it~ aS her free and voluntary act for the purposes therein expressed; that each of Us in the hearing and sight of the testatrix signed the will as witnesses; and that to the best of our knowledge the testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed to and subscribed before me by CHARLES E. PETRIE and DAVID A. PETRIE, witnesses, this eighth day of November, 1999. WITNESS WITNESS (~/OTARY I~uB~,I~ NOTARIAL SEAL KELLY R ROBERTS, NOTARY PUBLIC PAXTANO BORO., DAUPHIN CO. PA. MY COMMISSION EXPIRES JAN. 2~. 200! REGISTER OF WILLS CUMBERLAND COUNTY, PENNSYLVANIA INVENTORY Estate of BRINTON VIVIAN IRENE also known as , Deceased No. 2004 00420 Date of Death 04/17/2004 Social Security No. 182~28260 , i 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 thisi inventory. INVe verify that the statements made in this inventory are true and correct. I/We understand that false statements herein m~de are subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: CHARLES E. PETRIE I.D. No.: 29029 Personal Representative: NANCY WACKER Address: 3528 BRISBAN STREET Dated 0707/2004 HARRISBURG PA 17111 Telephone: (717) 561-1939 Description LINCOLN FINANCIAL INVESTMENTS THE HARTFORD INVESTMENTS MISCELLANEOUS PERSONAL PROPERTY 1986 CHEVY CAPRICE REFUND FROM PA POWER & LIGHT BLUE CROSS/BLUE SHIELD REFUND i I ValUe 31,668.20 11,445.23 1,000.00 500.00 11.50 380.36 I Total (Attach Additional Sheets if necessary) 112,534.81 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the pe,~on I representative, include the value of each item, but such figures should not be extended into the total of the Inventory. , RW-4 ~ Continuation of Inventory BRINTON VIVIAN IRENE Pa,qe 1 Description of Inventory Description CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FEDERAL CREDIT UNION CERTIFICATE OF DEPOSIT AT MEMBERS FIRST FEDERAL CREDIT UNION REFUND FROM JOHN HANCOCK INSURANCE REFUND FROM ERIE INSURANCE Subtotal Grand Total 2004 00420 Value 8,766.14 10,000.00 21,075.69 26,652.55 857.14 178.00 67,529.52 112,534.81 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 004143 BRINTON EDWARD 404 BEAVER ROAD HARRISBURG, PA 17112 fold ESTATE INFORMATION: SSN: 182-22-8260 FILE NUMBER: 2104- 0420 DECEDENT NAME: BRINTON VIVIAN I DATE OF PAYMENT: 07/09/2004 POSTMARK DATE: 07/09/2004 COUNTY: CUMBERLAND DATE OF DEATH: 04/17/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $7,614.89 TOTAL AMOUNT PAID: $7,614.89 REMARKS: E BRINTON SEAL CHECK//105 INITIALS: VZ RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 NAME OF DECEDENT: VIVIAN I. BRINTON DATE OF DEATH: April 17, 2004 WILL NO: ESTATE NO: 2004 - 00420 Pursuant to Rule 6.12 of the Supreme Court Orphan's Court Rules, I repgrt the following with respect to completion of the administration of the aboveXcaptioned estate: 1. 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: a. Did the personal representative file a final account with ~he Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: (Not Applicable in Dauphin County) c. Did the personal representative state an account informally to the parties in interest? Yes X No__ DATE: 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. July 7, 2004 SIGNATURE CHARLES E. PETRIE NAME (PLEASE TYPE OR PRIN'I~) 3528 Brisban Street Harrisburgi PA 17111 ADDRESS CAPACITY: __ Personal Representative (717) 561-1939 TELEPHONE NO. X Counsel for Personal Representative BUREAU OF INDIV/DUAL TAXES INHERITANCE TAX DIVISION DEPT. 28060! HARRISBURG, PA 17128-0601 CHARLES E PETRIE $528 BRISBAN ST HSG PA 17111 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENT, ALLOWANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1G47 EX RFP (01-D3) DATE 09-06-200q ESTATE OF BRINTON VIVIAN DATE OF DEATH 0~-17-200~ FZLE NUMBER Zl.,~'-:O~20 ~ COUNTY CUt4~E-'~LANDC::~ -~m ACN 101 ': · Aeou. Ra..*e__ 1' MAKE CHECK PAYABLE*AND REMZT PAYMENT TO: REGISTER OF W~LLS :=~ i~ii' CUMBERLAND CO,COURT ~SE ~* CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LO~/ER PORTION FOR YOUR RECORDS ~ REV-1547 EX AFP (01-03) NOTICE OF /NHERZTANCE TAX APPRATSEMENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRTNTON VIVIAN T FILE NO. 21 0~-0~20 ACM 101 DATE 09-06-200~ TAX RETURN #AS: (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) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held Stock/PartnershAp In*crest (Schedule C} (3) ~. Hortgagas/Notas Receivable (Schedule D) (~) 5. Cash/Dank DeposAts/NAsc. Personal Property (Schedule E) 6. doAntly O~ned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Tote1 Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Costs/HAsc. Expenses (Schedule H) (9) 10. Dabts/Hortgaga LAabAlit/es/LAans (Schedule I) (10) 11. Total DaductAons 12. Net Value of Tax Return 00 O0 O0 O0 112/53R 81 17z525 82 6~/121 (8) 11,876.95 NOTE: Tb insure proper cred/~"~o your account, subaAt the upper per,Aah of thAs fore ~A~h your tax payment. 13. 1~. NOTE: ASSESSMENT OF TAX: 15. Amount of Line lr~ et Spousal rate 16. Amount of L/ne 1~ taxable at Lineal/Class A rata 17. Aeount of LAne 1~, at SAblAng ra~e 18. Amount of LAne 1~ taxable at Collateral/Class B rate 19. Principal Tax Due TAX CRED/TS: PAYMENT RECEIP I DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 07-09-200~ CD00~1~,$ ~00.78 19~r, 182. O0 q,179.08 (11) 1~ .0~. 03 (12) 178,125.97 .00 AHOUNT PAID 7,61~.89 IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDZT I 8,015.67 BALANCE OF TAX DUEl .00 INTEREST AND PEN. .00 TOTAL DUE . O0 ( ZF TOTAL DUE TS LESS THAN $1, NO PAYHENT IS REgUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE ~ (15) .00 x O0 = .00 (16) 178,125.97 x 0~5: 8,015.67 (17) .00 x 12 = .00 (18) .00 X 15 = .00 (1~)= 8,015.67 reflect figures that /nclude the total of ALL returns assessed to date. CharAtabla/Govornmental Bequests; Non-elected 9113 Trusts (Schedule J) (13) Net Value of Estate Sub.~act to Tax (lq) 178,125.97 ]:~ an assessment ~as ~.ssued previously, 11nes 1~, 15 and/or 16, 17, lS and 19 ~ill RESERVATION: Estates of decedents dying on or before December 1Z, 19BZ -- 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 tho tawful Crass B (cotlatera1) rata on any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act Z5 af ZOO0. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of MiLls printed on the reverse side. --Make check or money order payable to: REGISTER OF MILLS) AGENT 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-IS15). Applications ara available at the Office of the Register of Mills, any of the 22 Revenue District Offices) or by calling the special lq-hour answering service for forms ordering: 1-800-56Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-~7-50Z0 (TT only). Any party in interest not satisfied with the appraisement) allowance, ar 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. Z81021, Harrisburg, PA 17128-lOZ1, OR --election to have the matter determined at audit of the account of the personal representative, OR --appea! to the OrphanF' Court. Factual errors discovered an 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 S of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid within three (2) calendar months after the decedent's death, a five percent (SI) discount of the tax paid is alloaed. The 15Z 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 is charged beginning with first day of delinquency, or nine (9) months and one (I) day from the date of death, to the date of payment. Taxes which became delinquent before January 1) 19az bear interest at the rate of six (6Z) percent per annum calculated at a daily rate of .00016q. All taxes which became delinquent on and after January 1, 19BZ 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 Z00~ are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ ZOZ .0005~8 ~'8-199! IIX .000301 ~ 9Z .O00Z~7 1983 i6Z .000~38 199Z 9Z .O00Z~7 ZOOZ 6Z .00016~ 198q iiZ .000301 1993-199~ 7Z .OOOI9Z 2003 5Z .000157 1985 13Z .000356 1995-1998 9Z .O00Z~7 ZO0~ ~Z .000110 1986 lOZ .O00Z7q 1999 72 .O0019Z 1987 102 .O00Z7~ 2000 72 .O0019Z --Interest is calculated as folloes: INTEREST = BALANCE OF TAX UNPA/D X NUNBER 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, additiona! interest must be calculated.