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Home My WebLink About04-0572Estate of BRICY K. WENDELL Deceased Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS No. Social Security No. 195-16-4791 CHERYL PARKS LEWIS Petitioner, who is 18 years of age or older, applies for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioner is the executrix named in the Last Will of the Decedent, dated April 12,~ 2,004 and codicil(s) dated 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 to victim of a killing and was never adjudicated incompetent: B. Grant of Letters of Administration ' (d.b.n.c.t.a.: pendente lite; durante absenta; durante rninorit~) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survive(f;by the following spouse (if any) and heirs: ._.j Name Relationship Residence COMPLETE IN ALL CASES: Attach additional sheets if necessary. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 208 Senate Avenue, Apartment 1015, Township of East Pennsboro, Camp Hill, Cumberland County, Pa (List street, number and municipality) Decedent, then 80 years of age, died May 27, 2004 Township, Dauphin County, Pennsylvania at C. Croxton Slain Hospice Residence, Susquehanna (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 ........................................................................................ : ................ $ 4,500.00 4,500.00 4,500.00 Real Estate situated as follows: Wherefore, Petitioner respectfully requests the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the undersigned: Signature Typed or printed name and residence CHERYL PARKS LEWIS 30 North Conley Lane Etters, PA 17319 Oath of Personal Representative COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · The Petitioner above-named swears and affirms that the statements in t~e forego~hg Petition are true and correct to the best of the knowledge and belief of Petitioner and that,.as personal rel~r~sentative of the Decedent, Petitioner will well and truly administer the estate according to law. ~ Sworn to and affirmed and subscribed Before me this ~ --'"~+~ ~ day of _k,,, ~.~,~[, ,2004· CHI~YL PARKS LEWIS NO. Estate of BRICY K. WENDELL Social Security No: 195-16-4791 Date of Death: May 27, 2004 , Deceased AND NOW, --~,.-~-- I"-[ ,2004, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters Testamentary d.b.n.c. La.; pendente lite; durante absenfla; durante minodtate are hereby granted to CHERYL PARKS LEWIS in the above estate and that the instrument(s) dated April 12, 2004 described in the Petition be admitted to probate and filed of record as the last Will of the Decedent. FEES Letters ........................... Short Certificate(s) Renunciation .............. Affidavit ( ) .................. Extra Pages ( ) ....... Codicil ............................ JCP Fee ....................... Inventory ...................... Other .............................. TOTAL ......... $ $ $ Attorney: Edmund G. Myers I.D. No: 20558 Address: Johnson, Duffle, Stewart & Weidner, 301 Market Street, P.O. Box 109, Lemoyne, PA 17043- TelephOne: 717-761-4540 his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARHING: It is illogal to duplicate this copy blt photostat or photograph. Fee for this certificate, $2.00 'P 103290130 No. Local Registrar MAY £ :S 2 04 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH :-~ NAME OF DECEDENT, ..t. L.,) 2g~ t.m. . BEicy K. Wendell ], Female ], 195 - 16 -4791 I( Ma- 27 2004 (~y) ~ UN~R. 1 Y~R I UN~R 1 ~Y I DATE ~ ~RTH I BIRTHP~CE(Ci~ ~ IP~cE OF DEATHtC~ ........ I ' ~ I Months I DaysI ~ I Mi~lel I ~Xo=) I S~te~F~gnC~t~) I~RT~. ~ y~ ~ : : : ~ D-lb_Z/, ~ ] ~ ,OT~.: ~' ' I [ I I I, ' I~ Harrisbur~,PAlY"-~ ~,~ ~ I~ n _ m ~- n COUNW OF DEATH ~ CIW, BORO, ~ OF ~TH I FACILIW ~ME (If ~l mstil~, gi~ s~eet a~ num~)IWAS ~CEDENT OF HISPANIC ORIGIN? ]RACE- Amed~ l~an, Bla~, ~ite, ~au ~R . No Y~ ~l y., ~ c~n, (s~y) DECE~NT'S USU~ ~CUPAT ON KI ~ ' = ' I t, ~.~- __ ~ ND~BUSINESSIIN~STRY ~DECEDENTE~RIN8 DECE~'SE~TI~ MARIT~STAIUS M o,~ .... ~.~ I lUS-~~[mc~s* I ~ ~.,~.~ ~ .*.r ..=.. ~ · yesU ~ e.~n~ c~ .~ (S ' ' ' I , ...... ' 'S MAILING A~ESS (Sit. t, O~n, ~t[~, Zip C~) I DECEDENTS ~ >enate Ave. Apt._ 1015 Ilacrmt,~s~m~ ~ sm,. Pennsylvania ~t' ~r~. ~ w,.~,,~ ,~. ~p H~ll, PA 17011 .. ~an ~eener I. ' ' ~rv Frank ~.... ~'~' / ~1-~'" - - I.,~onmg Green Mem Park ],,, Crop ,iii, PA 17011 ~ATURE OF FOCAL SER~CE t~c ~ERSON ACTING AS S~H L CENSE NUMAR [ NAME AND ADDRESS OF FACILITY g~.~,...~~v~. I-~. 012755-L I~..Myers-Harner m, 1903 ~t St, ~, PA 17011 ~ w~ ~oms dea~. I ~ H ~ I DATE ~ED D~D (M~th, Day. Year) I WAS CASE REFERRED TO A MEDICAL . n*,* .m~M~= ~%~'~fe~id~. ~er~e~old~,~U~al~m~a~s~sh~k~a~fai~m. :Ap~o~m~e PARTII' O~si~t~ti~s~l~tOdeath but CAUSE (D~sease ~ injury c ~ WAS AN AUTOPSY I WERE AUTOPSY FINDINGS ] MANNER OF DEATH PERFORMED? I AVAILAI~LE PRIOR TO ~ COMPLETION OF CAUSE I OF DEATH? INatural ~ Yosn NoJ~ Y.so,oc3 IA~'[] : on~ and deal, not result~g in the unde~ying cause given in PART I ' PTRoOtNh eD bU Ne~Ct '~GmAvl~Dn oCw~ eR~uFeTI NdeGatPk ~Y.....~. ~ ~ (_.P?.y_sJ.~_ n ~ p~ono~u,~? ng death and cetlifymg, 3tL ........................................................................................... [] 33. REGISTRAR'S SIGNATURE AN~ /~ ~ SIGNATURE A,N,p TITLE OF CI~TIFIER LICENSE NUMBI~R DATE SIGNED (Mo~th, Day, Year) 3,c. (~b 030£75~ 3~a. ~-2~-O~ NAME ANO A~RESS OF PERSO~O COMPLETED CAUSE OF DEATH (Item 27) Type or P~t l/ ~ ~ ~. - . ~ ._ DATE FILED (M~ay, y~) ' I :tDill anb e tament OF BRICY K. WENDELL C I, BRICY K. WENDELL, of Camp Hill, Cumberland County, Pennsyt-q, ania, being of sound and disposing mind, memory and understanding, do hereby make, publish ~ declare this as 2--' and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS I direct the payment of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and whatever jurisdiction imposed, shall be paid from my Residuary Estate as part of the expense of the administration of my Estate. ARTICLE II SPECIFIC BEQUEST I give and bequeath my china, my crystal, my silverware, and my jewelry unto: CYNTHIA PARKS CAMPBELL, of York, Pennsylvania, and CHERYL PARKS LEWIS of Etters, Pennsylvania, or the survivor of them, to be divided between them in as nearly equal shares as practical. If there be disagreement as to the disposition of any one item or items, I direct that the same shall be disposed of as part of the residue of my estate. ARTICLE III REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever nature and wheresoever situate, in equal shares unto CYNTHIA PARKS CAMPBELL and CHERYL PARKS LEWIS, or the then-living issue, per stirpes of either who predeceases me. ARTICLE IV PERSONAL REPRESENTATIVE I name, constitute and appoint CHERYL PARKS LEWIS Executrix of this my Last Will and Testament. Should CHERYL PARKS LEWIS fail to qualify or cease to so act, I name, constitute and appoint CYNTHIA PARKS CAMPBELL alternate Executrix to complete the administration of my estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNESS.WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, this //.2't~ day of ,/~~ /; ,2004.~,. / ' BRICY,/J~WElqDELL - ----~ Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. 2 AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA · COUNTY OF CUMBERLAND · SS We, BRICY K. WENDELL, '~-?~ f'~ .-x-c,, ..~t_,, _, and ~ ff'X .,..k~ , the Testatrix and the wimesses, respectively,(~ose names are ~gned to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and heahng of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint/r undue influence. RICY I~;~YE N" EL~L Subscribed, sworn to and acknowledged before me by BRICY K. WENDELL, Testatrix, and subscribed and sworn to before me by '~,,-.~ F'~o~-.,x..,.XA,.~ and ~ -~,..O..~.~,-..-,~ , witnesses, this ~ ~'~"day of d~h.~ 2004. 1537972 NOTARIAL SEAL DI^NNE LENIG, Nolary Public Lemoyne Borough Cumberland Co. My Commission Exp}res Dec. 21,2005 Notary Public .CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Will No.: BRICY K. WENDELL May 27, 2004 2004-00572 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 June 18, 2004. Name Address Cheryl Parks Lewis 30 N. Conley Lane Etters, Pa 17319 Cynthia Parks Campbell 1780 Rainbow Circle York, PA 17404 Date: June 18, 2004 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except None. Signature Name: EDMUND G. MYERS Johnson, Duffle, Stewart & Weidner Address: 301 Market St P. O. Box 109 Lemoyne, PA 17043-0109 Telephone: (717) 761-4540 Capacity: Counsel for personal representative JERRY R. DUFFLE RICHARD W. STEWART C. ROY WEIDNER, JR EDMUND G. MYERS DAVID W DELucE IEFFERSON J. SHIPMAN RALPH H. WRIGHT. JR MARK C DUFFLE JOHN R NIN()SRY MICIIAEL ]. CASSIDY MELISSA PEEL GREEVY ROBERT M. WALKER WADE D MANLEY L A W 0 F F I C E S JOHNSON DUFFIE OF COUNSEL IIORACE A. ]OIINSOR E LEE SHIPMAN BRU(E J GROSSMAN: August 26, 2004 Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Dear Register of Wills Office: Re: Estate of Bricy K. Wendell SSN: 195-16-4791 Our File No. 2621-1 Your File No. 2004-00572 ,Sb , Enclosed please find Estate Check No. 1007 in the amount of $1,000.00. This payment represents the three-month prepayment in order to qualify for the discount. The decedent died on May 27, 2004. Please time stamp the enclosed copy of this correspondence, and return to me in the enclosed self- addressed stamped envelope. Thanks for your assistance in this matter. Should you have any questions, or require any additional information, please feel free to contact me. Very truly yours, JOHNSON, DUFFLE, STEWART & WEIDNER Dana L. Wieseman Legal Assistant c: Cheryl Parks Lewis, Executrix #234502 501 MARKET STREET EO. BOX 109 LEMOYNE, PENNSYLVANIA 17043-0109 WWW. JDSW, COM 717,761.4540 FAX: 717.761.5015 MAIL@JDSW. COM JOHNSON, DUFFLE, STEWART & WEIDNER, P.C. LAW OFFICES JOHNSON DUFFIE 501MARKET STREET EO. BOX 109 LEMOYNE, PA 17043-0109 REGISTER OF WILLS OFFICer i~ CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17013 COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO, CD 004315 MYERS EDMUND G 301 MARKET STREET P O BOX 109 LEMOYNE, PA 17043 fold ESTATE INFORMATION: SSN: 195-16-4791 FILE NUMBER: 2104-0572 DECEDENT NAME: WENDELL BRICY K DATE OF PAYMENT: 08/27/2004 POSTMARK DATE: 08/27/2004 COUNTY: CUM BERLAN D DATE OF DEATH: 05/27/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 ~ 1,000.00 TOTAL AMOUNT PAID: $1,000.00 REMARKS: SEAL CHECK//1007 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. CD 004391 MYERS EDMUND G 301 MARKET STREET P O BOX 109 LEMOYNE, PA 17043 ....... fold ESTATE INFORMATION: SSN: 195-16-4791 FILE NUMBER: 2104-0572 DECEDENT NAME: WENDELL BRICY K DATE OF PAYMENT: 09/15/2004 POSTMARK DATE: 09/1 4/2004 COUNTY: CUMBERLAND DATE OF DEATH: 05/27/2004 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $112.02 TOTAL AMOUNT PAID: $112.02 REMARKS: SEAL CHECK# 1008 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS JERRY R. DUFFLE RICHARD 13/. STEWART C. ROY WEIDNER, IR EDMUND G. MYEP,$ DA\'ID W DELucE JEFFERSON l SHIPMAN RALPH H. WRIGHT. MARK C. DUFFLE JOHN R. NINOSKY MlCtIAEL }. CASSIDY MEI,[SSA PEEl, GREEVY ROBERT M. WALKER WADE D. MANLEY LAW OFFICES JOHNSON DUFFLE OF COUNSEL H()RACE A. ]HIINSON E LEE SIIIPMAN RRU(E J GIIHSSMAN E-MAIh dh~ ~'~};jd sw,com Register of Wills Office Cumbedand County Courthouse One Courthouse Square Carlisle, PA 17013 September 14, 2004 Re: Estate of Bficy K. Wendell SSN: 195-16-4791 Our File No. 2621-1 Your File No. 21-04-0572 :, Dear Register of Wills Office: Enclosed for filing please find the following documents for the above referenced decedent: 20dginal PA Inheritance Tax Returns. There is tax due in the amount of $112.02. Estate check no. 1008 is attached to the Return. Our Check in the amount of $43.00 as follows: a. $15.00 Inheritance Tax filing fee b. $13.00 Inventory Fee c. $15.00 for Additional Probate Fees 2 copies of Pages 1&2 of the Pa Inheritance tax retum, which we ask that you time-stamp and return to us in the enclosed envelope. Inventory Inventory copy, which we ask that you time stamp and return to us in the enclosed envelope. Should you have any questions, please do not hesitate to contact our office. Thank you for you assistance in this matter. Very truly yours, f'~40-'~NS61~, DUF, FIE, STEWART & WEIDNER Legal Assistant c: Cheryl Parks Lewis, Executrix ~235303 301 MARKET STREET PO, BOX 109 LEMOYNE, PENNSYLVANIA 17043-0109 WWW. IDS~ECOM 717.761,4540 FAX: 717,7{51.3015 MAIL@}DSW. COM JOHNSON, DUFFIE, STEWART & WEIDNER, P.e. REV- 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 171Z8-0601 D E C E D E N T REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) WENDELL BRICY K. DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM- DD-YEAR) 05/27/2004 , I 05/16/1924 (IF APPLICABLE) SURVIVING SPOUSE S NAME (LAST, FIRST; AND MI DDLE INITIAL) 1. Original Return CA P B 4. Limited Estate HRRL E P I O 6, Decedent Died Testate C R A C (Attach copy of Will) KOTK ES I~. Lltlgatlon Proceeds Received r~lo. spousalPovertyCredlt (date of death between 12-31-91 and 1-1-95) OFFICIAL USE ONLY FILE NUMBER 21-04-0572 COUNTYCODE YEAR NUMBER SOCIAL SECURITY NUMBER 195-16-4791 THIS RETURN MUST BE FILED IN DUFUCATE W~TH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 2. Supplemental Return 4a. Future Interest Compromise (data of death after 1Z. 1~.8Z) 7, Decedent Maintained a Living Trust (Attach copy of Trust) Fdate of death 3 RamalnderReturn prlorto12-13-82) 5. F~deral Estate Tax Return Required 0 5. Total Number of Safe Deposit Boxes i~1 ' Election to tax under Sec. 9113(A) 1 1 (Attach Sch O) NAME C i Edmund G. Myers FIRM NAME (if Applicable) Johnson, Duffle, Stewart & Wetdner TELEPHONENUMBER ~OMPLETE MAILrNG ADDRESS P. O. Box 109 301 Market Street Lemoyne, PA 17043-0109 R E C A P I T U L A T I O N 1. Real Estate (Schedule A) (1) :~. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or (3) Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) ] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) None 10,331.25 ::, None None 2,306.25 260.70 ~ OFFICIAL~E ONLY (5) 10,331.25 (11) 2,566.95 (12) 7,764.30 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) C O M T I 0 N SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) x .0 0 (15) 16. Amount of Line 14 taxable at lineal rate 0.00 X .0 4.5 (16) 17. Amount of Line 14 taxable at sibling rate X .12 (17) 10. Amount of Line 14 taxable at collateral rate 7,764.30 x ,15 (18) 19. Tax Due (19} 7~764.30 0,00 0.00 0.00 1,164.65 1,164.65 Copyright (c) 2000 form software only T he Lackner Group, inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 208 Senate Avenue Apartment 1015 CITY Camp Hill Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments ¢. Discount 3. Interest/Penalty if applicable B. Interest E. Penalty STATE ZIP PA 17011 1,000.00 52.63 1~164.65 Total Credits ( A + B + C ) (2) 1,052.63 0.00 0.00 112.02 0.00 112.02 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. A. Enter the interest on the tax due. (SA) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decadent make a transfer and: Yes No a. retain the use or income of the property transferred; ......................... [] [] b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or .................................... d. receive the promise for life of either payments, benefits or care? ................... 2. If death occurred after December 12, 1982, did decedent transfer properly 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. $1GNATUREOFPERSONRESPON$1BLEFORFILINGRETURN Cheryl Parks LEWIS DATE ~ · 30 North Conle~ Ln . SIGN~E~REPAREROTHERTHANR~P~E~ENTATIVE Johnson, Duffte, Stewart & Weidner DATE //~- - ,~ ~ ~.0. 5ox 109 '* ...................... For dates of death on or after July 1, 1994 and before Janua~ 1, 1995, the tax rate i~osed on the net value of tran~ers to or for the use of tha suwivi~ spouse is 3% [72 P.S. 9116 (a) (1.1) (i)]. For dates of death on or after Janua~ 1, 1995, the ~x 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)I. The statute does not exempt a transfer to a surviving spouse from ~x, and the ~atuto~ require~s for disclosure of asse~ and filing a ~x return are still applicable even if the surviving spouse is the on~ beneficial. For dates of death on or after July 1, 2000: The ~x rate i~osed on the net value of transfers from a deceased child twang-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 ~x ra~ imposed on the net value of Vansfem to or for the use of the decedent's lineal beneficiar~s is 4.5%, except as noted in 72 P.S. 9116(1.2) [72 P.S. 9116(aX 1)]. The ~x rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116(aX1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in com~n w~h the decedent, wheth~ by blo~ or adoption. Cowrlght (¢) 2~ form software only T he Lack~r Group, I~. Form REV-1 ~ EX (Rev. 6-~) REV* 1508 EX + (1-97) COMMONWEALTHOFPENNSYLVANIA INHERITANCETAXRETURN RESIDENTDECEDENT ESTATE OF SCHEDULE E CASH, BANK DEPOSITS,& MISC. PERSONAL PROPERTY FILE NUMBER BRICY K. WENDELL SS~ 195-16-4791 05/27/2004 21-04-0572 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH Tamdot Homecare of Harrisburg, Inc.- Purchase of Scooter Comcast Cable Television Account No. 09547 189423-03-5 - Refund Hospice of Central Pennsylvania ~ Refund on Deposit M&T Bank Checking Account ~38344521 N~P Management, Inc. - Refund from Susquehanna View State Farm Automobile Insurance Policy No. 53 4556-B-25-38 - Refund on Policy State Farm Insurance Refund on Policy No. 38-KY-8397-7 Verizon Telephone Credit Balance Refund - Refund on Telephone 717-737-6189 TOTAL (Also enter on line 5, Recapitulation) 1,000.00 25.90 5,700.00 2,790.41 482.67 195.98 125.79 10.50 $ 10~331.25 (If more space is needed, insert additional sheets of the same size) Copyright (¢) 1996 form software only CPSystsms, Inc. Form REV- 1508 EX (Rev. 1-97) .EV-tStt ;X,~-S~I SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF BRICY K. WENDELL SS~ 195-16-4791 05/27/2004 FILE NUMBER 21-04-0572 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT Bo 3. 2 3 4 5 FUNERAL EXPENSES: Myers-Narner Funeral Nome - Remain§ balance on Funeral costs ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / LIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Attorney's Fees Johnson, Duffle, Stewart & Weidner 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 Probate Fees Register of Wills Accountant's Fees Tax Return Preparer's Fees Oiler Administrative Costs Cumberland County Register of Wills Office - Filing Fees for Inheritance Tax Return ($15.00) and Inventory ($13.00) Cumberland County Re§ister of Wills Office - Additional Probate Fees Reserves: Additional Administrative Costs The Cumberland Law Journal - Notice of Estate Administration The Patriot News Company - Notice of Estate Administration TOTAL (Also enter on line 9, Recapitulation) 1,160.50 750.00 50.00 28.00 15.00 100.00 75.00 127.75 $ 2,306.25 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-151 ! EX (Rev. 1-97) REV-1612 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BRICY K. ~ENDELL SCHEDULEI DEBTS OF DECEDENT, MORTGAGE LIABILITIES~AND LIENS SS:fl 195-16-4791 05/27/2004 FILE NUMBER 21-04-0572 Include unreimburcad medical expenses, ITEM NUMBER DESCRIPTION Harrisburg Pharmacy Holy Spirit Hospital T-Mobile Cell Phone Charges T-Mobile Cell Phone Charges - Remaining charges on Account AMOUNT 138.91 72.79 24.00 25.00 TOTAL (Also enter on line 10, Recapitulation) 260.70 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV- 1512 EX (Rev, 1-97) REV- lS13 EX * (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BRICY K. WENDELL SS~ 195-16-4791 NUMBER 1 I1. SCHEDULE J BENEFICIARIES 05/27/2004 NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [l~l~e o~rlght $~us~l distributions, Cynthia Parks Campbell 1780 Rainbow Circle York, PA 17404 RELATIONSHIP TO DECEDENT Do Not List Trustee(e) Niece Niece Cheryl Parks Lewis 30 North Conley Lane Etters, PA 17319 FILE NUMBER 21-04-0572 AMOUNT OR SHARE OF ESTATE 1/2 of Estate 1/2 of Estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SEC. 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 0.00 (If more space is needed, insert additional sheets of the same size) Copyrl~lht (c) Z(X30 for m software only T he Lackner Group. inc. Form REV-1513 EX (Rev. 9-00) LISTING OF EXHIBITS FOR ESTATE OF BRICY K. WENDELL EXHIBIT A LAST WILL AND TESTAMENT SIGNED AND DATED April 12th, 2004. :235306 : ill anl e tament OF BRICY K. WENDELL I, BRICY IC VqENDELL, of Camp Hill, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all Wills or Codicils at any time heretofore made by me. ARTICLE I DEBTS I direct the payment of all my legal debts, and the expenses of my last illness and funeral from my Estate as soon after my death as conveniently may be done. I direct that all taxes that may be assessed in consequence of my death, of whatever nature and whatever jurisdiction imposed, shall be paid from my Residuary Estate as part of the expense of the administration of my Estate. ARTICLE II SPECIFIC BEQUEST I give and bequeath my china, my crystal, my silverware, and my jewelry unto: CYNTHIA PARKS CAMPBELL, of york, Pennsylvania, and CHERYL PARKS LEWIS of Etters, Pennsylvania, or the survivor of them, to be divided between them in as nearly equal shares as practical. If there be disagreement as to the disposition of any one item or items, I direct that the same shall be disposed of as part of the residne of my estate. ARTICLE III REST, RESIDUE AND REMAINDER I give, devise and bequeath all the rest, residue, and remainder of my Estate, of whatsoever nature and wheresoever situate, in equal shares unto CYNTHIA PARKS CAMPBELL and CHERYL PARKS LEWIS, or the then-living issue, per stirpes of either who predeceases me. ARTICLE IV PERSONAL REPRESENTATIVE I name, constitute and appoint CHERYL PARKS LEWIS Executrix of this my Last Will and Testament. Should CHERYL PARKS LEWIS fail to qualify or cease to so act, I name, constitute and appoint CYNTHIA PARKS CAMPBELL alternate Executrix to complete the administration of my estate. I direct that no fiduciary appointed herein shall be required to post bond for the faithful administration of the duties required in any jurisdiction. IN WITNES~WHEREOF,~ ~ ,~I have hereunto set my hand and seal to this, my Last Will and Testament, this /2*'~ day of /¢r~4~ ,2004.] / BRiC?~,/WEiqDELL ~ Signed, sealed, published and declared by the above-named Testatrix, as and for her Last Will and Testament, in the presence of us, who at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses. 2 AFFIDAVIT AND ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS We, BRICY K. WENDELL, '~k~~ ~. --e-oN ..~t,~_.~ and a'~'~''w'z''~t ~q' -.-k ' . ,file Testatrix and the witnesses, respectively, kW'lose names o the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and that she had signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the wimesses, in the presence and hearing of the Testatrix, signed the Will as witness and that to the best of his/her knowledge the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint/or undue influence. I~RICY ~4EI~DELL Witness Wi'- s - - - Subscribed, sworn to and acknowledged before me by BRICY IC WENDELL, Testatrix, and subscribed and sworn to before me by ~ F'~.-w-r-...,.x~ and 'k-k-~-M-,%--~,--~-.-e-x , witnesses, this t ~'~-~-"day of o.~.,~d_~3 ,2004, 1537972 NOIARIAL SEAL ' DIANNE LENI9, Notary Public Lemoyne Borough Cumberland Co, My Comm?.~.sslo~ Expires Dec. 21,2005 Notary Public 0 0 Register of Wills of INVENTORY County, Pennsylvania Estate of BRICY K. WENDELL also known as No. 2004- 00572 Date of Death 05/27/2004 , Deceased Social Security No. 195-16-4791 Cheryl Parks LEWIS, Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include alt 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 of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements mede in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities. Personal Representative Name of Attorney: Edmund G. Hyers Signature: ~(~)~('L~-. '~ Cheryl ~rks LEWIS I.D. No.: 20558 Signature: Address: P. O. Box 109 Address: 30 North Conley Ln Lemo.yne~ PA 17043-0109 Etters, PA 17319 Telephone: 717/761-4540 Telephone: 717/938- 8940 Dated: ~' ~ Description (See continuation page(s) attached) (Attach additional sheets if necessary) Total: 10,331.25 NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. Copyright (c) 1996 form software only CPSystems, Inc. Form #Ri-7 (tSSZ) Estate of: Date of Death: County: INVENTORY BRICY K. WENDELL 05/27/2004 Cumberland CASH: Comcast Cable Television Account No. 09547 189423-03-5 - Refund Hospice of Central Pennsylvania - Refund on Deposit M&T Bank Checking Account #38344521 N~P Management, Inc. - Refund from Susquehanna View State Farm Automobile Insurance Policy No. 53 4556-B-25-38 - Refund on Policy State Farm Insurance Refund on Policy No. 38-KY-8397-7 Tamdot Homecare of Harrisburg, Inc.- Purchase of Scooter Vertzon Telephone Credit Balance Refund - Refund on Telephone 717-737-6189 25.90 5,700.00 2,790.41 482.67 195.98 125.79 1,000.00 10.50 TOTAL RECEIPTS OF PRINCIPAL ............... 10,331.25 10,331.25 -1- JOHNSON DUFFLE 301 MARKET STREET PO BOX 109 LEMOYNE PA 17043-0109 FIRST CLASS MAIL Register of Wills Office ',0 .rQ ~ ~ Cumberland County Courthouse · oTz Od One courthouse square ~- '~ - Carlisle, PA 17013 BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DZVTSXON PO BOX 18060! HARRISBURG, PA 17118-0601 CONHONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISENENT, ALLO#ANCE OR DISALLO#ANCE OF DEDUCTIONS AND ASSESSHENT OF TAX REV-16G7 EX AFP EDHUND G HYERS JOHNSON ETAL PO BOX 109 LEHOYNE PA 170q$ DATE 11-15-2004 ESTATE OF NENDELL DATE OF DEATH 05-27-2004 FILE NUHBER 21 04-0572 COUNTY CUNBERLAND ACN 101 Amount RemJ.'l'ted BRICY K HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF NILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS REV-1547 EX AFP (01-03) NOTICE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF NENDELL BRZCY K FILE NO. 11 04-0572 ACN 101 DATE 11-15-2004 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) 3. CloseZy Held Stock/Partnership Interest (Schedule C) (3) ~. Mortgages/Notes Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 6. Jo/ntly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9 Funeral Expansas/Adm. Costs/Hisc. Expenses (Schedule H) (9) 10 Dabts/Nortgaga Liabilit/as/L~ens (Schedule ~) 11 Total Deductions 12 Nat Value of Tax Return 10z$$1.25 O0 O0 NOTE: To /nsure proper O0 credit to your account, O0 submit the upper portion O0 of this form w/th your tax payment. O0 (8) 2,306.25 (10) 260.70 lq NOTE: 10,331.25 (11) 2.5~. 95 (~2) 7,764.30 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) Nat Value of Estate Subject to Tax (1~) Zf an assessment ~as issued previously, lines 14, 15 and/or 16, 17, reflect figures that include the totaZ of ALL returns assessed to date. .00 7,764.$0 18 and 19 Nlll ASSESSHENT OF TAX: 15. Amount of L/ne lq at Spousal rate 16. Amount of L/ne lq taxable at Lineal/Class A rata 17. Amount of Line 1~ at S/bl/ng rata 18. Amount of Line 1~ taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PkYHENT RECEIPT DATE NUNBER 08-27-2004 CD004515 09-14-2004 I' "~ DT$COUNT ?~.INTEREST/PEN PAID52.65.00(-) IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (15) .00 x O0 = .00 (16) .00 x 045 = .00 (17) .00 x 1Z = .00 (ZB) 7,764.30 x 15 = 1,164.65 (ia)= 1,164.65 ANOUNT PAID 1,000.00 112.02 TOTAL TAX CREDZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 1,164.65 .00 .00 .00 ( IF TOTAL DUE XS LESS THAN $1, NO PAYHENT IS RE~UIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.) RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADNIN- ZSTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December 12, 1982 -- if any future intarast in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such futura interest. To fulfill the raquireeants of Section 21~0 of the Inhsritanca and Estate Tax Act, Act Z$ of 2000. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Registar of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF HILLS, AGENT A refund of a tax cradit, which was not requested on the Tax Return, may be requested by completing an "Application for Rafund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications ara available online at was.revenue.state.pm.us, any Register of Nills or Revenue District Office, or from the Departeant's Z~-hour ansaaring sarvice for forms orders: 1-800-562-Z050; services for taxpayers with special hearing and/or speaking needs: 1-800-q47-5020 (TT only). Any party in interest not satisfied with the appraisaent, allowance or disallowance of deductions or assessment of tax (including discount or interest) as sheen on this Notice may ab~ect within 60 days of the date of racaipt of this notice by filing one of the following: A) Protest to the PA Departmsnt of Revenue, Board of Appeals. You amy object by filing a protest online at wwa.baardofappsals.stata.pa.us on or before the expiration of the sixty-day appeal period. In order for an electronic protest to be valid~ you must receive a confirmation number and processed date from the Board of Appeals mebsite. You may also send a arittan protest to PA Department of Revenue, Board of Appeals PoO. Sox 281021, Harrisburg, PA 17128-1021. Petitions may not be faxad. 8) Election to have the matter determined at the audit of fha account of the personal representative. C) Appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in ariting to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Reviea Unit, P.O. Box 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Rasident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the dacedant's death, a five percent (52) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is coaputed on the total ortho tax and interest assessed, and not paid bafora January 18, 1996, the first day after tha and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same tiaa period as you ~ould appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from fha date of death, to the date of payment. Taxes which became delinquent befara January 1, 1982 bear interest at the rate of six (62) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquant on and after January 1, 1982 will bear interest at a rate ahich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicabla interest rates for 1982 through Z004 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rata Factor Year Rate Factor 1982 ZOX .0005q8 '~'~'~6-1991 112 .000S01 ~ 92 .000247 1985 162 .000¢~8 1992 92 .0002~7 ZOOZ 62 .000164 1984 112 .000~01 1993-1994 72 .O0019Z ZO0~ 52 .000157 1985 132 .000556 1995-1998 92 .O00Z~7 ZOOq 42 .000110 1986 102 .OOOZ7~ 1999 72 .000192 1987 102 .000274 ZOO0 72 .00019Z --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUIIBER OF DAYS DELINI~UENT X DAILY INTEREST FACTOR --Any Natice issued after tha tax becoaes delinquent ail1 reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after tha intarest computation date shown on tha Notice, additional interest must be calculated. STATUS REPORT UNDER RULE 6.12 Name of Decedent: BRICY K. WENDELL Date of Death: MAY 27. 2004 Will No. 2004-000572 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, I report the following with respect to completion of the administration ofthe above-captioned 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 the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's Account is: c. parties of interest? Did the personal representative state an account informally to the Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. C,I Darei April 29, 2005 ~ fJ /tbr- EDMUND G. MYERS JOHNSON, DUFFIE, STEWART & WEIDNER 301 Market Street P.O. Box 109 Lemoyne, P A 17043 (717) 761-4540 Capacity: Personal Representative (x) Counsel for Personal Representative cJ