HomeMy WebLinkAbout03-1031PETITION FOR PROBATE and GRANT OF LETTERS
Estate of Hazel H. Brechbiel No.
alsoknownas ~, t"~ozei I~F'e~z]~b/'e/ To:
, Deceased
Social Security No. 195-32-2614
The petition of the undersigned respectfully represents that:
Register of Wills for the
County of Cumberland
Commonwealth of Pennsylvania
Your petitioner(s), who is/are 18 years of age or older an the execut or
in the last will of the above decedent, dated January 27, 2003
and codicil(s) dated
in the
named
(state relevant circumstances, e.g. renunciation, death of executor, etc.)
Decedent was domiciled at death in Cumberland County, Pennsylvania, with
h er last family or principal residence at 30 Cramer Road, Shippensburq, PA 17257
{Southampton Township)
(list street, number and municipality)
Decedent, then 94 years of age, died 12/8/03
at Carlisle, Pennsylvania
Except as follows, decedent did not marry, was not divorced and did not have a child bom or adopted
after execution of the will offered for probate; was not the victim of a killing and was never ajudicated
incompetent:
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
situated as follows:
100,000.00
75,000.00
WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s)
presented herewith and the grant of letters testamentary
thereon. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.)
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA )r SS
COUNTY OF Cumberland
J
The petitioner(s) above-named swear(s) or afl-rrm(s) that the statements in the foregoing petition are
true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen-
tative(s) of the above decedent petitioner(s) will well and truly administer the estate accgxdigg to
Sworn to or affirmed and subscribed C .,,X C-~?'~ ~
before me this 16th day of !
FA December ~ 2003
Donna N. Otto, 1st Deputy Re~ster ~~
No. 21-2003-1031
Estate of Hazel H. Brechbielr a/k/a M. Hazel Brechbiel , Deceased
DECREE OF PROBATE AND GRANT OF LETTERS
AND NOW December 16th, 2003 , in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that the instrument(s) dated '1/27/03
described therein be admitted to probate and filed of record as the last will of Hazel H. Brechbiel
aka M. Hazel Brechbiel
and Letters testamentary
are hereby granted to
E. Eugene Brechbiel
FEES
Probate, Letters, Etc ......... $ 235
Short Certificates (4 ) ...... $ 12.00
Rmx~i~fi~tx. x-Pages. ( 3 ). · $ 9.00
JCP Fee $ 10.00
TOTAL __ $ 266.00
Filed..-I.~ceml2~r. 16th.,.200B ......
Nailed Letters to Attorney on
12/16/2003
· Register of Wills ·
Donna M. Otto, 1st Deputy ~~
H. Anthony Adams
25502
ATTORNEY (Sup. Ct. I.D. No.)
49 W. Orange Street
Shippensburq, PA 17257
ADDRESS
7'17-532-3270
PHONE
his is to certify that the information here given is correctly copied f'rom an original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
Fee for this certificate, $2.00
~cal Registrar
P 9450738
No.
H105.143 Rev 2.'87
BLACK INK
COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS
CERTIFICATE OF DEATH
,. 94 ¥,t i
~,. Cumberland
,,~ Elementary Teacher
30 Cramer Road
,aShippensburg_, PA 17257
,E. Benjamin Heberlig
~.E. Eugene Brechbiel
,Female ,. 195 --32 --2614 ,.Decenb~r8, 2003
Carlisle ~ Carlisle Regional Medical Center ,~.~n.~. J,o. White
~O ~ ~S~E~N~RY ~ ~S ~CEDE~ E~R IN ~CE~NT'S E~AT~
~ ~ U.S ~MEDF~S? I ~h~c~} ~RIT~ST~US-~,~ SU~M~S~
i,Cf6~L "T s
12-13-03
,~. Blanche Killian
[ ~34 Cramer Road, Shippensburg,PA 17257
a,~Spring Hill Cemetery ~,~ Shippensburg, PA 17257
REGIS ....
OATE OF INJURY TIME OF INJURY
¢4o~h. Cay. Yea0
21-2003-1031
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, HAZEL H. BRECHBIEL, of
Pennsylvania being of sound and disposing mind, memory and understanding, do
make, publish and declare this my Last Will and Testament hereby revoking all
prior wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of all my legal debts, funeral expenses
including my grave marker and all expenses of my last illness, state, federal
estate and inheritance taxes and administration costs shall be paid as soon as
may be conveniently done following my decease leaving all specific bequests free
of tax to the legatee.
SECOND: I give, devise and bequeath my property as follows:
a. I give and bequeath to my son, E. Eugene Brechbiel, an
amount equal to the amount owing for repayment of my
loan to him for land and therefore direct such loan be
marked and considered satisfied and paid in full.
b. I give and bequeath to my daughter, Charlotte F. Coble, my
Conn Organ.
c. I give and bequeath to my son, Lorraine R. Brechbiel, the
three-piece antique bedroom suite.
d. I give, devise and bequeath the rest and residue of my
estate IN FIVE EQUAL SHARES WITH ONE SHARE TO
E. Eugene Brechbiel, per stirpes; one share to Charlotte F.
Coble, per stirpes; one share to Lorraine R. Brechbiel, per
stirpes; one share to the children of Arthur B. Brechbiel, in
equal shares, share and share alike, per stirpes; one share
to the children of 1'4arlene ]. Heefner, in equal shares, share
and share alike, per stirpes.
THIRD: I nominate and appoint my son, E. Eugene Brechbiel, as the
Executor of this my Last Will and Testament. If he should fail to serve or be
unable to serve, then in either of those said events, ! nominate and appoint,
Charlotte F. Coble and Lorraine R. Brechbiel, Executrices of this my Last Will and
Testament.
!N WITNESS WHEREOF, !, HAZEL H. BRECHB!EL, to this my Last Will and
Testament set my hand and official seal this ~ -/day of ~'
~,~/ 2003.
Hazel H. Brechbiel
Sworn to and subscribed, declared and
Published by Hazel H. Brechbiel, as
Her Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at her request,
And in her presence, and in the presence
Of each other.
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND ·
I, Hazel H. Brechbiel, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that !
signed it willingly; and that ! signed it as my free and voluntary act for the
purpose therein expressed.
Hazel"H. Brechbiel -
Sworn to and acknowledged, before me,
By Hazel H. Brechbiel, the Testatrix,
This .2 7 day of ~. 2003.
Notary Public
Notarial Seal
H. Anthony Adams, Notary Public
Shippensburg Boro, Cumberland County
My Commission Expires May 15, 2006
Member, Pennsylvania Association ot Notaries
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND ·
WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testatrix sign and execute the
instrument as her Last Will and Testament; that she 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 the time at
least eighteen (18) or more years of age and of sound mind and under no
constraint or undue influence.
,/
Sworn to and subscribed before me by,
Darlene M. Bigler and Sharon Coleman Adams,
The witnesses, this ~ day of ~.~'W~ 2003
Notary' P~'b~-~-~''~:=~ --
H. Anthony Adams, Notary Public
Shippensburg Boro, Cumberland County
My Commission Expires May 15, 2006
Member, Pennsylvania Association of Notaries
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Hazel H. Brechbiel
Date of Death: 12/8/03
Will No. Admin. No. c~OC) ~ -- ~'~ ! 0 ~"~ /
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on ~e c,~ vv,.(~o ~.c / '7, c~ O ~ ~'-'~_ -
/
Name Address
E. Eugene Brechbiel 34 Cramer Road
Shippensburq, PA 17257
Charlotte F.Coble 9649 Hemlock Drive
Columbia, PA 17512
Lorraine R. Brechbiel 50 Lakeside Drive
Levittstown, PA 19054
Kathy J. Bennett
3999 S. Yampa Street
Aurora, CO 80013
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
Signature
Name: H. Anthony Adams
Address: 49 West Oran.qe Street, Suite 3
Shippensburg, PA 17257
Telephone(717) - 532- 327
Capacity:
X
Personal Representative
Counsel for Personal
Representative
Hazel H. Brechbiel
Continuation of Certification of Notice Under Rule 5.6(a)
Page 1
12/8/03
Names and addresses
Name
Ricky L. Brechbiel
Jeffrey L. Brechbiel
Michael E. Heefner
Margaret J. Bowman
Gregory B.Heefner
Address
385 Elmck Drive
Chambersburg,
231 Walnut Dale Road
Shippensburg,
314 Whitmer Road
Shippensburg,
8396 Rice Road
Shippensburg,
87 Curtis Drive
East Berlin~
PA 17201
PA 17257
PA 17257
PA 17257
PA 17316
REV-1500 EX + (6-00)
UJ
oo
~:_~
UJ
0
0
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Brechbiel, Hazel H.
DATE OF DEATH (MM-DD-Year) I DATE OF BIRTH (MM-DD-Year)
12/08/2003 1 02/21/1909
{IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
OFFICIAL USE ONLY
FILE NUMBER
21 -2o o3 ost
COUNTY CODE YE/~ NUMBER
SOCIALSECURITYNUMBER
1 9 5-3 2-2 6 1 4
TH~ RETURN MUST BE FILED IN DUPL~ATE WITH THE
REGISTER OF WILLS
SOClALSECURITYNUMBER
[] 1. Original Retum
r-1 4. Limited Estate
[~6. Decedent Died Testate (Attach copy of Will)
[] 9. Litigation Proceeds Received
NAME
H. Anthony Adams
FIRM NAME (If Applicable)
TELEPHONE NUMBER
717-532-3270
r--12. Supplemental Retum
D4a. Future Interest Compromise (date ofdeath after 12-i2.e2)
r'-] 7. Decedent Maintained a Living Trust {Attach copy of Trust)
r--] 10. Spousal Poverty Credit (date of death betv~een 12.31-91 and 1.1.95)
COMPLETE MAILING ADDRESS
49 W. Orange Street
Suite 3
Shippensburg,
[~]3. Remainder Retum (date ofdeaffi prior to 12-13-82)
[]5. Federal Estate Tax Return Required
__ 8. Total Number of Safe Deposit Boxes
[-~ 11. Election totax under Sec. 9113(A) (Attoch Sch O)
PA 17257
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 (3 or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H) (9)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11 )
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
140~500.00
97 114 31
18~500.00
OFFICIAL USE ONLY
(8)
256~ 114.31
13~334.39
(11)
13,334.39
(12)
(13)
242,779.92
(14)
242,779.92
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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
0.00 x
242,779.92 x
0.00 x
.045
20.
,12
0.00 X .15
__ (15)
(16)
¢7)
(18)
¢9)
0.00
10,925.10
0.00
0.00
10,925.10
Decedent's Complete Address:
STREETADDRESS
30 Cramer Road
CITY
Shippensburg,
ISTATE PA
IziP
17257
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D * E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
10,925.10
0.00
0.00
0.00
10,925.10
10,925.10
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
b. retain the dght 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, 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 accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct aed 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.,.-7
AD"~RES,~ ~'
ADDRESS
DATE
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. {}9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only 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-1502 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
ESTATE OF FILE NUMBER
Brechbiel. Hazel H.
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, beth having reasonable knowledge of the relevant facts,
ITEM
NUMBER
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
DESCRIPTION
Lot and Hose at 30 Cramer Road, Shippensburg, Cumberland County, PA
(as per HUD-1 attached)
Lot of ground at 34 Cramer Road, Shippensburg, Cumberland County, PA
VALUE AT DATE
OF DEATH
135,500.00
5,00O.00
TOTAL (Also enter on line 1, Recapitulation) $ 140,500.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Br~(;:hbiel.
Hazel H.
FILE NUMBER
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 VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Personal Property sold at public auction (sale settlement sheet attached) 6,747.25
10.
Orrstown Bank
Certificate of Deposit 4000000891
Plymouth Grand Voyager
(sold privately)
Ameriges
P.O.Box 965
Valley Forge, PA
Orrstown Bank
Checking Account 103000983
Orrstown Bank
Checking Account 103003753
Orrstown Bank
Certificate of Deposite 4000000785
Refund of Taxes Paid
Refund from Erie Insurance
Series H Bonds and E Bond
50,000.00
6,000.00
77.00
5,983.09
18,143.29
8,005.40
427.48
178.00
1,552.80
TOTAL (Also enter on line 5, Recapitulation) $ 97,114.31
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE G
INTEE-VlVOS TRANSFEES &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
Brechbiel, Hazel H.
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDETHE NAME OF THE TRANSFEREE. THEIRRELATIONSHIPTO DECEDENTAND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
VALUE OF ASSET INTEREST OF~PUC~LE) VALUE
1. Eugene Brechbiel 6,000.00 100. 0.00 6,000.0C
Cash (son)
2. Charolotte Fay Cobe 6,000.00 100. 0.00 6,000.0C
Cash (daughter)
3. Lorraine Ray Brechbiel 6,000.00 100. 0.00 6,000.00
Cash (son)
4. LaVonna Brechbiel 500.00 100. 0.00 500.00
Cash (daughter-in-law) 11-03
TOTAL (Also enter on line 7 Recapitulation) $ 18~500.00
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX + (12-99)
COMMONWEALTH OFPENNSYLVAN~
INHERITANCETAXRETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
FILE NUMBER
Brechbiel. Hazel H.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION
1.
2.
3.
4.
8.
9.
10.
11.
12.
13.
14.
15.
FUNERAL EXPENSES:
Fogelsanger-Bricker Funeral Home
Shultz Memorial
Spring Hill Cemetary
Funeral Reception Cost
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (s)
Social Secudty Number(s)/EIN Number of Personal Representative(s)
Street Address
City State
Year(s) Commission Paid:
AttomeyFees H. Anthony Adams
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip
Street Address
City State Zip
Relationship of Claimant to Decedent
Pmba~Fees
Accountant's Fees
Tax Retum Preparer's Fees
Hershey Auctioneer (cost of sale)
Crime Intervention Alarm
Waste Management
Taxes on Estate Real Property
H&H Chevrolet (Repair car for sale)
U.S. Postal Service
Sprint
AT&T
Adams Electric
TOTAL (Also enter on line 9, Recapitulation) $
AMOUNT
6,140.00
632.00
600.00
92.20
2,500.00
293.00
1,266.55
150.00
31.95
263.44
52.86
7.40
459.23
48.40
797.36
13~334.39
(Ifmorespa~isneeded, inse~additionalshee~ofthesamesize)
REV-1513 EX + (9-nn~
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF FILE NUMBER
Brechbiel. Hazel H.
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
TAXABLE DISTRIBUTIONS [include outright spousal dis~butions, and transfers under
Sec. 9116 (a)(1.2)]
E. Eugene Brechbiel
34 Cramer Road
Shippensburg, PA 17257
Charlotte Fay Coble
2646 Hemlock Drive
Columbia, PA 17512
Lorraine Ray Brechbiel
50 Lakeside Drive
Levittown, PA 19054
Kathy J. Benett
3999 S. Yampa Street
Aurora, Co 80013
Ricky L. Brechbiel
385 Elmck Drive
Chambersburg, PA 17201
Jeffrey L. Brechbiel
231 Walnutdale Road
Shippensburg, PA 17257
Michael E. Heefner
314 Whitmer Road
Shippensburg, PA 17257
son - Executor
daughter
son
granddaughter
grandson
grandson
grandson
Lineal
Lineal
Lineal
Lineal
Lineal
Lineal
Lineal
1/5
1/5
1/5
1/5
1/5
1/5
1/5
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
NON-TAXABLE DiSiRiBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
(If more space is needed, insert additional sheets of the same size)
Continuation of REV-1500 Inheritance Tax Return Resident Decedent
Brechbiel, Hazel H.
Decedent's Name Page 1
File Number
Schedule J - Beneficiaries - 1
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
[ TAXABLE DISTRIBUTIONS (include outfight spousal distributions)
8. Margaret J. Bowman granddaughter Lineal
8396 Rice Road 1/5
Shippensburg, PA 17257
9. Gregory B. Heefner grandson Lineal
87 Curtis Drive 1/5
Shippensburg, PA 17257
ttl '
.... _ ement Statement u.s. Department of Housing and Urban Development
B. Type of LOan OMB No. 2502-02t
1. i:I~HA , 2. E]FmHA 3. CIConv Unins. I 6. FileNumber [ 7. Loan Number [ 8. Mortgage lnsurance Case Number
4. FIVA 5. i-IConv. Ins. 041079MART N /
his term IS lumlsnefl ,o give you a slatemen et actual settlement COSlS. Amounts pale to aha oy the settlement agent are snown.
C. Note: Items marked "(p.o.c.)" were paid outside Ihe dosing they are shown here for nformatlon purposes and are not included in the totals. I TitleExpress Settlement System
WARNING: I1 is a crime to knowingly make 'else statements o he Un ed S ares on this or any other similar form. Penalties upon
Conviction can include a fine and imprisonment. For details see: Tille 18 U. S. Code Section 1001 and Section 1010. Printed 04/15/2004 at 15:34 RLH
D. NAME OF!BORROWER: Jay Paul Martin and Edna Z. Martin
Glenn N. Martin
ADDRESS: 258 Walnut Bottom Road, Shippensburg, PA '17257
E, NAME OF!SELLER: Estate of Hazel H. Brechbiel
ADDRESS:
F, NAME OF LENDER: Orrstown Bank
ADDRESS: P.O. Box 250, Shippensburg~ PA 17257
G. PROPERTY ADDRESS: Lot '1, along Cramer Road, Shippensburg, PA 17257
Southampton Township
H. SEll LEMENT AGENT: South Central Home Settlements, Inc., Telephone: 7'17-532.7387 Fax: 717-532-6552
PLACE OFi SETTLEMENT: 126 East King Street, Shippensburg, PA 17257
I. SETTLEMENT DATE: 0411512004
J.~ SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION:
100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER
101. Contract sales price '135,500.00 401. Contract sales price 135,500.00
102. Personal Property 402. Personal Property
103. Settlement charges to borrower (line 1400) 1,863.00 403.
104. 404.
105. 405.
Adjustments for items paid by seller in advance Adjustments for items paid by seller in advance
107. County taxes 04/'15/04to1213'1104 188.37 407. County taxes 04/15/04to12/3'1104 '188.37
108. SchooITaxes 04115104to06130104 239.'1' 408. SchooITaxes 041'15104to06130104 239.1'
109. ,
409.
110. i 410.
111. [ 411.
112. 412.
'120. GROSS AMOUNT DUE FROM BORROWER 137,790.48 420. GROSS AMOUNT DUE TO SELLER 135,927.48
200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER
201. Deposit or earnest money 13,550.00 501. Excess Deposit (see instructions) '13,550.00
202. Princil~al amount of new loans 40,000.00 502. Settlement charges to seller (line 1400) 1,618.44
203. Existing loan(s) taken subiect to 503. Existing loan(s) taken subject to
204.
205. i 504. Payoff of First Mortgage Loan
505.
206.
207. i , 506.
507.
208. I 508.
209.
509.
~ Adjustments for iterns~seller Adjustments for items~ seller
213.
~ 513.
214. ~ 514.
215.
515.
216, '
516.
217. 517.
218. 518.
219.
519.
220. TOTAE PAID BY/FOR BORROWER ~ 53 550.00 520. TOTAL REDUCTION AMOUNT DUE SELLER i 15,168.44
300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER
301. Gross hmount due from borrowe~ 137590.48 601. Gross amount due to selle~ '135 927~_~48
302. Less a..mounts aid b/for borrower line 220 53,550.00 602. Less reduction amount due selle~
303. CASH FROM BORROWER 84,240.48 603. CASH TO SELLER '120,759.04
aSUB~TITUTE FOR_M 109,,9 SELLER STATEMENT The information contained herein ls importanl tax information and ~s be~n f r
neg,gence penalty or o[ner sanction will be imoosed on uou it thi- i*~ ~ ..... ,.-~, L .... ' ' g u n shed to the Internal Revenue Ser¥ice. If you are required to file a return,
line 401 above cOnstitutes the Gross Proceeds r ~ .... ~,,, ,~ .~lu ,eM ~o ue reponeo aha the IRS determines that it has no been repealed. The Contract Sales Price described on ; et this transaction.
SELLER INSTRUCTIONS f Ibis rea estate was yourpdnctpal residence, file Form 2119, Sale or Exchange of Principal Residence, for any gain, with your Income tax return; for other transactions,
complete the applicable parts of Form 4797, Form 6252and/or Schedule D (Form 1040).
You are required' by law to provide the settlemenl agent (Fed. Tax ID No: ) wi h ur correct tax ' '
number, you may be subject to civi or criminal pen ' n bv law ~ ~nd..r,r .... Ili~ ~ ~-... ,y~o~. ....... pay_e~r ~den, t~ficaUon n~mber. If you do not provide your correcl tax a r identifi '
_ al,les m~osed . _- ~ .... ~.o .~ P'~u ,x ~.~i~y u~a~ me numoer ShOWn on this slalement is m corr p ye cation
· ~' ~ ' ' y ect taxpeyer identifica(ion number·
TIN: / SELLER(S) SIGNATURE(S): /
SELLER(S) NEW MAILING ADDRESS:
bEPARTME~NT OF HOUSING AND URBAN DEVELOPMENT File Number: 041079MARTIN PAGE 2
;s Settlement System Printed 04/15/2004 at 15:34 RLH
:TTLEMENT STATEMEN I REV. HUD-1 {7,/U~} , ,,~c.'.P .................. , ......................
&TTLEMENT CHARGES PAID FROM PAID FROM
TOTAL SALES/BROKER'S COMMISSION based on price $135,500.00 ~ 0.000 = BORROWER'S SELLER'S
· FUNDS AT FUNDS AT
Divisioh of commission (line 700) as follows: SETTLEMENT SETTLEMENT
~ I to
~ to
703. Commission paid at Settlement
800. ITEMS PAYABLE IN CONNECTION WITH LOAN
801. Loan Origination Fee %
802. Loan Discount %
803. Appraisal Fee
804. Credit Repeal
805. Lender's Inspection Fee
806. Mortqafle Application Fee
807. Assumption Fee
808.
809.
810.
811.
900. ITEMSiREQUIRED BY LENDER TO BE PAID IN ADVANCE
901. Interes't From to ~,,$ /day
902. Mortq~.qe Insurance Premium for to
903. Hazard insurance Premium for to
904.
905.
1000. RESERVES DEPOSITED WITH LENDER FOR
1001. Hazard Insurance mo. ~,, $ /mo
1002. Mort.q~J.qe Insurance mo. ~,, $ /mo
1003. City Prbpert¥ Tax mo. ¢),, $ /mo
1004. County Property Tax mo. ~, $ 21.95/mo
1005. School' Taxes mo. ~,, $ 94.46/mo
1009. Aq~re.qate Analysis Adiustment
1t00. TITLE CHARGES
1101. Settlement or closin.q fee to South Central Home Settlements, Inc. 300.00
1102. Abstra~;t or title search to South Central Home Settlements, Inc. '125.00
1103. T~tle exam nat~on
1104. Title insurance binder
1105. Document Preparation to H. Anthony Adams
1106. Notaff;Fees
1107. Attorney's fees
(includes above ~tems No
1108. Title Insurance
(includes above items No: )
1109. Lenders Coverage $ 40,000.00 -
1110. Owner's Covera,qe $ 135,500.00 -
1111.
1112.
1113.
1200. GOVERNMENT RECORDING AND TRANSFER CHARGES
1201. Recording Fees Deed $ 38.50 ; Mortgage $ 44.50 ; Release $ 83.00 '
1202. City/County tax/stamps Deed $1,355.00 ; Modc~a.cle $ 1,355.00
1203. State ~ax/stamps Deed $1,355.00 ; Mod;laCle $ '1,355.00
1204.
1205.
1300. ADDITIONAL SETTLEMENT CHARGES
1301. Surveyl
1302. Pest In'spection 263.44
1303. 2004 County/Township Taxes to Vivian Coy, Tax Collector
1304.
1305.
1306.
1307.
1308.
1400. TOTAL SETTLEMENT CHARGES (enter on lines 103, Section J and 502, Section K) 1,863.00 1,618.44
HUD CERTIFICATION OF BUYER AND SELLER
have carefu Iv reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me
in Ibis transac(ion. I fudher certify that I have received a copy of the HUD-1 Settlement Statement,
Jay I~a~4am~ i"
Estate of Hazel H. Brechbiel
U,y: b.. hUl~ urecrlbiel
WARNING: IT ISIA CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE
UNITED STATES ON THIS OR ANY SIMILAR FORM. PENALTIES UPON CONVICTION
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18:
U.S. CODE SECTION 1001 AND SECTION 1010.
The HUD-1 Settlement Statement which I have prepared is a true and accurate account of this transaction.
I have ~j,~ed or will cause the funds to be disbuled in accordance with this statement.
14 West King Street
Shippensburg, PA. 17257
Phone 717-532-2814
FARMS - HOMES - BUILDING LOTS - COMMERCIAL
May 25, 2004
Hazel Brechbiel Estate
30 Cramer Rd
Shippensburg, PA 17257
The land to the rear of 30 & 34 Cramer Road and border to the rear by the Keefer Farm..
This plot of land is land locked with no right of way to it.
My opinion for the value of the land is $5,000.00
This is not a Comparative Market Analysis or Appraisal as there are no sales of land
locked land..
LAST WILL AND TESTAMENT
KNOW ALL MEN BY THESE PRESENTS, that I, HAZEL H. BRECHBIEL, of
Pennsylvania being of sound and disposing mind, memory and understanding, do
make, publish and declare this my Last Will and Testament hereby revoking all
prior wills and codicils by me at any time heretofore made.
FIRST: I direct the payment of all my legal debts, funeral expenses
including my grave marker and all expenses of my last illness, state, federal
estate and inheritance taxes and administration costs shall be paid as soon as
may be conveniently done following my decease leaving all specific bequests free
of tax to the legatee.
SECOND: I give, devise and bequeath my property as follows:
a. I give and bequeath to my son, E. Eugene Brechbiel, an
amount equal to the amount owing for repayment of my
loan to him for land and therefore direct such loan be
marked and considered satisfied and paid in full.
b. I give and bequeath to my daughter, Charlotte F. Coble, my
Conn Organ.
c. I give and bequeath to my son, Lorraine R. Brechbiel, the
three-piece antique bedroom suite.
d. I give, devise and bequeath the rest and residue of my
estate :IN F]~VE EQUAL SHARES Wi-I'H ONE SHARE TO
E. Eugene Brechbiel, per stirpes; one share to Charlotte F.
Coble, per stirpes; one share to Lorraine R. Brechbiel, per
stirpes; one share to the children of Arthur B. Brechbiel, in
equal shares, share and share alike, per stirpes; one share
to the children of Marlene ,]. Heefner, in equal shares, share
and share alike, per stirpes.
TH]~RD: ! nominate and appoint my son, E. Eugene Brechbiel, as the
Executor of this my Last Will and Testament. :If he should fail to serve or be
unable to serve, then in either of those said events, ! nominate and appoint,
Charlotte F. Coble and Lorraine R. Brechbiel, Executrices of this my Last Will and
Testament.
IN W]~TNESS WHEREOF, I, HAZEL H. BRECHBIEL, to this my Last Will and
Testament set my hand and official seal this .-~ -7 day of .:~..- 2003.
?,
~/~ ~/~,-~-,~-~~~ (SEAL)
Hazel I~. Brechbiel
Sworn to and subscribed, declared and
Published by Hazel H. Brechbiel, as
Her Last Will and Testament, and so
Done in the presence of we the
Witnesses, who sign at her request,
And in her presence, and in the presence
Of each other.
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND :
:[, Hazel H. Brechbiel, whose name is signed to the foregoing instrument,
having been duly qualified according to law, do hereby acknowledge that !
signed it willingly; and that ! signed it as my free and voluntary act for the
purpose therein expressed.
Hazel H. Brechbiel
Sworn to and acknowledged, before me,
By Hazel H. Brechbiel, the Testatrix,
This .2 '7 day of .0...~..~,----, 2003.
Notary Public
Notarial Seal
H. Anthony Adams, Notary Public
Shippensburg Boro, Cumberland County
My Commission Expires May 15, 2006
Member, Pennsylvania A~oci~tior~ ot Nctades
COMMONWEALTH OF PENNSYLVANIA:
:SS
COUNTY OF CUMBERLAND .
WE, Darlene M. Bigler and Sharon Coleman Adams, the witnesses whose
names are signed to the foregoing instrument, being duly qualified according to
law, do depose and say that we saw the Testatrix sign and execute the
instrument as her Last Will and Testament; that she 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 the time at
least eighteen (18) or more years of age and of sound mind and under no
constraint or undue influence.
/?/ ^
Sworn to and subscribed before me by,
Darlene M. Bigler and Sharon Coleman Adams,
The wi.tnesses, this ~ day of ~ 2003
Notary Pub'ftc
H. Anthony Adams, Notary Public
Shippensburg Boro, Cumberland County
My Commission Expires May 15, 2006
Member, Pennsylvania Ass~ietic~ Of Notaries
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 003983
ADAMS H ANTHONY
49 W ORANGE ST SUITE3
SHIPPENSBURG, PA 17257
........ fold
ESTATE INFORMATION: SSN: 195-32-2614
FILE NUMBER: 2103- 1031
DECEDENT NAME: BRECHBIEL HAZEL H
DATE OF PAYMENT: 05/27/2004
POSTMARK DATE: 05/26/2004
COUNTY: CUMBERLAND
DATE OF DEATH: 12/08/2003
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 $10,925.10
REMARKS:
TOTAL AMOUNT PAID:
$10,925.10
· SEAL
CHECK//107
INITIALS: JA
RECEIVED BY:
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
BUREAU OF INDIVIDUAL TAXES
THHERTTANCE TAX DTVZSZON
DEPT. 2B0601
HARRISBURG, PA 171Z8-060!
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
APPRAZSEHENT~ ALLONANCE OR DZSALLONANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX
REV-16~7 EX AFP (01-05)
H ANTHONY ADAMS
STE $
q9 W ORANGE ST
SHIPPENSBURG
PA 17257
DATE 07-19-Z00q
ESTATE OF BRECHBIEL
DATE OF DEATH 1Z-OB-Z003
FILE NUMBER Z1 03-1031
COUNTY CUHBERLAND
ACN 101
Amount Rem/tted
HAZEL H
HAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND C0 COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE ~ RETA]:N LOWER PORT/ON FOR YOUR REcoRDs ~
REV-1547 EX AFP (01-03) NOTICE OF ZNHERTTANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF BRECH]~IEL HAZEL H FILE NO. 21 03-103! ACN 101 DATE 07-19-200q
TAX RETURN NAS: (X) ACCEPTED AS F/LED { } CHANGED
RESERVATION CONCERNING FUTURE ]:NTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B) (2)
$. Closely Held Stock/Partnership Interest (Schedule C) ($)
~. Mortgages/No,es Receivable (Schedule D) (q)
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5)
6. Jointly Owned Property (Schedule F) (6)
7. Transfers (Schedule G) (7)
B. Total Assets
lq0/500.00
O0
O0
O0
97/11q.31
O0
18/500.00
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
Z56,11q.31
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10)
11. Total Deductions
12. Nat Value of Tax Return
15. Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J)
lq. Net Value of Estate Subjec~ to Tax
NOTE:
13,33q.39
.00
(11) ]3.334.3~
(12) 2qZ,779.92
(13) . O0
(1~) ZqZ,779.9Z
Z~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 #ill
reflect figures that lnclude the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line lq at Spousal rata
16. Amount of Line lq taxable at Lineal/Class A rata
17. Amount of Line lq at Sibling rate
18. Amount of L1ne 1~, taxable at Collateral/Class B rata
19. Princi ~al Tax Due
TAX CREDITS
PAYMENT RECETpT DISCOUNT
DATE NUHBER INTEREST/PEN PAID (-)
05-26-200~ CD003983 .00
IF PAID AFTER DATE IND/CATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
(15)
(16)
(18)
TOTAL TAX CREDIT 10,925.10
BALANCE OF TAX DUEI .00
INTEREST AND PEN. .00
TOTAL DUE .00
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR)~ YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
RESERVATION:
Estates of decedents dying on or before December II, 1981 -- [f any future interest in the estate is transferred
in possession or enjoyment to Class B (coilateraI) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes
at the lawful Class B (coIIateral) rate on any such future interest.
PURPOSE OF
NOTICE:
PAYHENT:
REFUND (CR):
OBJECTIONS:
ADHIN-
ISTRATIVE
CORRECTIONS:
DISCOUNT:
PENALTY:
INTEREST:
To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S.
Section 914D).
Detach the top portion of this Not[ca and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF HILLS, AGENT
A refund of a tax credit, which was not requested on the Tax Return, may ba requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are ava[labia at the Office
of the Rag[star of Hills, any of the Z$ Revenue District Offices, or by calling the special Z4-hour
answering service for forms ordering: 1-800-561-Z050; services for taxpayers with special hearing and ! or
speaking needs: 1-800-447-5010 (TT only).
Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment
of tax (including discount or interest) as shown on this Not[ce must ob[act within sixty (60) days of receipt of
this Notice by:
--written protest to the PA Department of Revenue, Board of Appeals, Dept. zaloz1, Harrisburg, PA 171Ia-lOll, OR
--elect[on to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
Factual errors discovered on this assessment shouId ba addressed [n writing to: PA Department of Revenue,
Bureau of Ind[viduaI Taxes, ATTN: Post Assessment Review Unit, Dept. lBO601, Harrisburg, PA 171za-060l
Phone (717) 787-6505. Sam page S of the booklet "Instructions for Inheritance Tax Return for a Resident
Decedent" (REV-IS01) for an explanation of adaJn[strat[vaZy correctable errors.
If any tax due [s paid a[thin three (5) calendar months after the dacedant's death, a five percent (51) discount of
the tax paid is allowed.
The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 16, 1996, the first day after the and 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 [s charged beginning with first day of delinquency, or n[na (9) months and one (1) day from the date of
death, to the date of payment. Taxes which became delinquent before January 1, I981 bear interest at the rate af
six (61) percent par annum calculated at a daily rate of .000164. All taxes which became delinquent on and after
January 1, 19aZ will bear interest at a rate which alii vary from calendar year to calendar year with that rate
announced by the PA Department of Revenue. The applicable interest rates for 19aZ through Z004 are:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
1982 20Z .000548 ~)'~&-1991 XXZ .000301 ~ 9X .000247
1983 16Z .000438 199Z 9Z .OOOZ47 200Z 6X .000164
1984 XXX .000301 1993-1994 7Z .O0019Z 2003 SZ .000137
1985 13X .000356 1995-1998 9Z .000247 2004 4X .OOOllO
1986 ZOZ .000274 1999 72 .OOOXgZ
1987 XOX .000Z74 ZOO0 7Z .OOOXgZ
--Interest is calcuXated as follows:
ZNTEREST = BALANCE OF TAX UNPAZD X NUHBER OF DAYS DELXNQUENT X DAZLY ZNTEREST 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
Not[ce, additional intarast must be calculated.
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 11/01/2005
ADAMS H ANTHONY
49 WEST ORANGE STREET
SUITE 3
SHIPPENSBURG, PA 17257
RE: Estate of BRECHBIEL HAZEL H
File Number: 2003-01031
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing is due by: 12/08/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
Au .(~~ .147::~~
1: ~".;'_,.. I "/_i',.,~
- " /...i'/~1~/."....,'l ... ..Jt...!"'I_~!.t.,,-_
..,'",_. '>4....<..~ -, .~.. _._ ~_.' . .
'-..,.'
GLENDA FARNER STRASBAUGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
\f1:
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Name of Decedent: ~ 2e. \ ~. :Bf~t.-'" \0, e. \ o..~6-. ~, \\, 7@ \ 'Bfft ~\ \0 I'e I
Date of Death: l ~ \ e:, <b ( ~(')C)3
Estate No.: aorB ~ D \ O?:::, l
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~ether administration of the estate is complete:
Yes ~ No 0
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 0 No 0
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the perso~presentative state an account informally to the parties in
interest? Yes J\ No 0
c. Copies of receipts, releases, joinders and approval of fOffi1al or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report.
Date:~
(J',
(~-)
~
~~~
\
Signature
~\. ~~~~ ~QQ ~ c....,
Name
'19 W 0~p ~~.~,~l;-le3
Address ~\~ . iNS io.N-c~ \ .. 1"7;;) 5 7
I{l~ 53;), ~ 3~ 70
Telephone No.
Capacity: 0 P.ersonal Representative
~ounsel for personal representative
Vh'