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HomeMy WebLinkAbout05-03-1015056041158 J REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number Po Box zaosol INHERITANCE TAX RETURN 21 09 0780 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 187-64-9283 07292009 12311966 Decedent's Last Name BRILLINGER Suffix Decedent's First Name BRETT (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name BRILLINGER AMY MI H MI C Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 2 2 4- 3 3- 0 6 8 0 REGISTER OF WILLS FILL IN APPROPRIATE BOXES BELOW 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death ^ 4 Limited Estate ^ 4 prior to 12-13-82) F t I t ^ . a. u ure n erest Compromise (date of 5. Federal Estate Tax Return Required 6. Decedent Died Testate ^ 7. death after 12-12-82) Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) ^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number G• STEVEN MCKONLY 717-637-8828 Firm Name (If Applicable) G• STEVEN MCKONLY, PC First line of address 11,9 BALTIMORE ST• Second line of address City or Post Office State ZIP Code HANOVER PA 17331 - ~, - ~ ::~ Correspondent's a-mail address: G S M C K- L A W fit C O M C A S T• N E T Under penalties o 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 nd complete. Declaration of preparer other thaF fhe personal representative is based on all information of which preparer has any knowledge. ADDR 5 e 1~7 MCC-0 M~CK RD• (~~, MECHANICSBURG, PA 17055 SIGNATURE OF PF~EPAR OTHER THAN REPRESENTATIVE DATE 'CJ~{ - ~'~-,` ' t ADDRESS 7,1,9 BALTIMORE ST• HANOVER, PA 17331 PLEASE USE ORIGINAL FORM ONLY Side 1 15056041158 6M46473.000 15056041158 ~..~ _`~. t. REGISTER OF WILLS USE ONLY ~., ~..~ :, ~ , _ ,C~ ~_~ _- ~~ . ~-;; ~ i-=~,D --- t _ _~I C: ti r...- ~ ``~ --w.1 - -Y. DATE~ILED t-~'l _. ~~ .. Estate of BRETT H. BRILLINGER Executers (Page 1) Name Amy C. Brillinger Address 1337 McCormick Rd. 187-64-9283 Mechanicsburg, PA 17055- Tax ID 224-33-0680 J 15056042159 REV-1500 EX Decedent's Social Security Number 187-64-9283 Decedent's Name:BRILLINGER BRETT H RECAPITULATION 1. Real estate (Schedule A) 1. 0.00 2. Stocks and Bonds (Schedule B) . 2. 0 • 0 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . 3. 0 , 0 0 4. Mortgages & Notes Receivable (Schedule D). 4. 0 • 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . 5. 9 0 8 8 6 • 0 0 6. Jointly Owned Property (Schedule F) ~ Separate Billing Requested 6. 0 . 0 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ~ Separate Billing Requested 7. 12 71 • 0 0 8. Total Gross Assets (total Lines 1-7). 8. 92157 • 00 9. Funeral Expenses & Administrative Costs (Schedule H) . 9. 4 217 • 0 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I). 10. 15 2 3 7 • 0 0 1 1. Total Deductions (total Lines 9 & 10) . 11. 19 4 5 4 • 0 0 12. Net Value of Estate (Line 8 minus Line 11) 12. 72703 • 00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) . 13. 0 • 0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 7 2 7 0 3 • 0 0 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2)X.O~ 72703.00 15. 0.00 16. Amount of Line 14 taxable at lineal ratex.o4..5 0.00 16. 0.00 17. Amount of Line 14 taxable at sibling rateX.12 0 , 00 17. 0 • 00 18. Amount of Line 14 taxable at collateral rate X .15 0. 0 0 1 g. 0. 0 0 19. TAX DUE 19. 0.00 20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15C]56042159 srnasaez.ooo 15056042159 REV-1500 EX Page 3 Decedent's Complete Address: File Number ai. nq n~nn DECEDENTS NAME BRILLINGER BRETT H STREET ADDRESS R CUMBERLAND CITY STATE ZIP MECHANICSBURG Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit Q . Q Q B. Prior Payments Q . Q Q C. Discount Q . Q Q 3. Interest/Penalty if applicable D. Interest Q . Q Q E. Penalty Q . Q Q (1) Q•QQ Total Credits (A + B + C) (2) Q . Q Q Total Interest/Penalty (D + E) (3) Q , Q Q 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in box on Page 2, Line 20 to request a refund. (4) Q . Q Q 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DuE. (5) Q . Q Q A. Enter the interest on the tax due. (5A) Q , Q Q B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 0 • Q 0 Make Check Payable to: REGISTER OFWILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ^ b. retain the right to designate who shall use the property transferred or its income; ^ c. retain a reversionary interest; or . ^ d. receive the promise for life of either payments, benefits or care? ^ X^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . ^ X^ 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? ~ l_^J ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [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 zero (0) percent [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 use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [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 four and one-half (4.5) percent, except as noted in 72 P.S. 9116(1.2) [72 P.S.F39116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 6M4671 1.000 REV-1508 EX + (6-98) SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, 8c MISC. INHERITANCE TAX RETURN RESIDENT DECEDENT PERSONAL PROPERTY ESTATE OF FILE NUMBER TT H. BRILLINGER 21090780 Include the proceeds of litigation and the date the proceeds were received by the estate. 3wa8AD 1.000 (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 SCHEDULE G INTER-VIVOS TRANSFERS 8~ MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER BRETT H. BRILLINGER 21 09 0780 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. ITEM NUMBER DESCRIPTION OF PROPERTY INCLIAETFEPYW1EOFi}ETRAfySFEREE,THEIRRELATIONSHPTODECEDEMAAD TFEDATEOFTRM&FFR.ATTACHAC,OPYOF7FEDEEDFORREALESTATE. DATE OF DEATH VALUE OF ASSET %OFDECD'S INTEREST EXCLUSION IF APPLICABLE TAXABLE VALUE ~ I E Trade Securities - IRA 1,271 100.0000 0 1,271 TOTAL (Also enter on line 7, Recapitulation) I $ _ _ _ _ (If more space is needed, insert additional sheets of the same size) 3 W 46AF '1.000 REV-1511 EX+(10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER BRETT H. BRILLINGER 21 090780 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: ~ None B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Street Address City Year(s) Commission Paid: State Zip I 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Amy C. Brillinqer Street Address 1337 McCormick Rd. ~ City Mechanicsburq State PA Zip 17055 Relationship of Claimant to Decedent SPOUSE I 4. i Probate Fees I 5. ~ Accountant's Fees 6. ~ Tax Return Preparer's Fees I 7. I None 3,500 717 i TOTAL (Also enter on line 9, Recapitulation) j $ 4 , 217 ~wasar, i.ooo (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) pennsylvania SCHEDULE DEPARTMENT OF REVENUE DEBTS OF DECEDENT, wHERITANCE T,vc RETURN MORTGAGE LIABILITIES $ LIENS RESIDEM DECEDENT ESTATE OF FILE NUMBER BRETT H. BRILLINGER 21 09 0780 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. awasArr 2 00o If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (11-OS) pennsylvania DEPARTMENiOF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES to i ra i t ~r FILE NUMBER BRETT H. BRILLINGER ~~ nn n-~on RELATIONSHIP TO DECEDENT v + v AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE TAXABLE DISTRIBUTIONS (include outright spousal distributions, and transfers under Sec. 2116 (a) (1.2).] 1. Amy C. Brillinger 1337 McCormick Dr. Mechanicsburg, PA 17055 I All of Residue to Amy C. Brillinger 1337 McCormick Dr. Mechanicsburg, PA 17055: 72,703 Surviving Spouse 72,703 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1 8 OF REV-1500 COVER SHEET, AS APP ROPRIATE. II NON-TAXABLE DISTRIBUTIONS: 1. i A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. I III i II i TOTAL OF BART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEEP. ~ 0 ~r more space is neeaea, Insert aaaitional sheets or the same s¢e. 8W46AI 2.000 ;> LAST WILL AND TESTAMENT OF BRETT H. BRILLINGER I, Brett H. Brillinger, a resident of Springettsbury Township, Xork County, Pennsylvania, being of sound mind and disposing memory, and not acting under undue influence of any person whomsoever, do make, publish and declare this my last will and testament, hereby revoking any and all wills by me heretofore made. FIRST: I give, devise and bequeath all of my property, whether real, personal or mixed, of which I shall die seized and possessed, and to which I may be entitled at the time of my decease, and wherever the same may be situated, unto my spouse, Amy C. Brillinger, if she shall survive me by thirty (30) days; provided, however, that if my spouse shall not survive me by thirty (30) days, I give, devise and bequeath all of my property referred to in this paragraph in accordance with Paragraph SECOND hereof. SECOND: If my spouse shall not survive me by thirty (30) days, I give, devise and bequeath all of the rest, residue, and remainder of my property referred to in Paragraph FIRST hereof, unto Ruth W. Brillinger, my mother, hereinafter referred to as "Trustee", in trust, nevertheless, under and subject to the following terms and conditions and for the following uses and purposes: 1. The principal of the trust shall be divided into as many equal shares as there are children of mine then living and children then dead, leaving issue then living. One share shall be paid per stirpes to the living issue of each of my deceased children; provided, however, that if any such beneficiary shall not yet have attained the age of twenty-one (21) years, the Trustee shall hold the same in accordance herewith. The term children shall mean Autumn J. Brillinger. If I have any additional children hereafter, the term children shall also include such afterborn individuals. 2. Except as otherwise provided in this will, the Trustee shall accumulate the income on such shares held in trust until such children attain the age of twenty-one (21) years. As each child becomes twenty-one (21) years old, the Trustee shall pay over to such child such accumulated income. Thereafter, the Trustee shall pay the income arising from the remainder of the principal of each child's trust to the child, quarterly, until such beneficiary shall attain the age of twenty-five (25) years, at which time the Trustee shall pay over to such beneficiary the principal of his or her trust. 3. In any instance where a share in my estate would be distributable to a beneficiary of any trust when received by the Trustee, my Personal Representative may make distribution directly to such beneficiary. 4. If any child of mine shall die before final distri- bution of the principal of his or her trust is made to the child, any income and/or principal that may be payable to the child under his or her trust shall be distributed to the issue then living of such deceased child, per stirpes, and shall be held and be distributed unto such issue in accordance herewith. 5. If any child shall die at any time before final distribution of the principal of his or her trust is made to the child, without the child's leaving any issue to survive him or her to take under the paragraph immediately preceding this one, any income and/or principal that may be payable to the child from his or her trust shall be distributed to my other children equally, or to the issue of such deceased children, if any, such issue to take per stirpes, and such income and/or principal shall 2 be payable in the manner aforesaid as other payments of principal and income are to be made to such persons. 6. If all the beneficiaries of such trust shall die before final distribution is made to them, then any income and/or principal that may be remaining unpaid or undistributed shall be distributed one-half (~) to the persons who would have been entitled to inherit it from me under the Pennsylvania intestate law if I had died intestate at that time, domiciled in that state, and possessed of such income and principal and one-half (~) thereof to the persons who would have been entitled to inherit it from my spouse under the same statute and similar circumstances if my spouse had died at that time; provided, however, that any share which would otherwise pass to the Commonwealth shall instead be paid to a charity or charities selected by the Trustee. 7. The Trustee may, however, in the Trustee's own discretion, from time to time before final distribution of the principal of his or her trust is distributed to any child, pay and/or apply to or for the child's maintenance, support, care and education, the accumulated and accruing net income from his or her trust and so much of the principal of the trust, in whole or in part, in such manner and to such extent as the Trustee shall deem to be for the interest of such beneficiary. The Trustee is authorized to make such payments of principal or income on behalf of such beneficiary without the intervention or appointment of a guardian for such beneficiary. 8. Any share of this trust, income or principal, which becomes distributable to a beneficiary, other than my children, shall be held in trust by my Trustee until such beneficiary be- comes twenty-one (21) years of age. Subject to the provisions herein contained, such share shall be distributed to such beneficiary when he or she becomes twenty-one (21) years 3 of age. If such beneficiary should die before becoming twenty-one (21) years of age, any property or principal or accumulated income so held shall form part of the estate of such beneficiary. My Trustee may apply such amounts of income and principal as the Trustee, in the Trustee's sole discretion, shall deem proper for the support, education and welfare of such beneficiary and shall accumulate any unexpended balance of income. Such amounts of income and principal may be applied directly or may be paid to the person with whom such beneficiary resides or who has the care and control of such beneficiary, without the intervention of a guardian. My Trustee shall not be obliged to supervise or inquire into the application of such amounts by such person and the receipt of such person shall be a complete release of my Trustee. Should the share of such beneficiary, in the sole opinion of my Trustee, be or become too small to warrant continuing such fund in trust, or should its administration be or become impractical for any other reason, my Trustee, in the Trustee's sole discretion, may pay such share absolutely to the parent or other person maintaining the beneficiary or may deposit such share in the beneficiary's name in a savings account in a savings institution of the Trustee's choosing, payable to the beneficiary when he or she attains twenty-one ( 21) years of age . 9. The Trustee shall have the powers as set forth in Paragraph THIRD of this my last will and testament. 10. All principal and income shall, until actual distribution to the beneficiary, be free of the debts, contracts, alienations and anticipations of any beneficiary of any trust created by this will, and the same shall not be liable to any levy, attachment, execution or sequestration while in the posses- sion of the Trustee. 4 11. If Ruth W. Brillinger fails to qualify or ceases to act as Trustee, I appoint Beth Ellen Brillinger, my sister, as successor trustee. THIRD: In addition to all rights and powers conferred by law, I authorize and empower my Personal Representative and Trustee and their successors, in their absolute discretion and without necessity of obtaining court approval: 1. To retain any of the investments composing the principal of this trust in the form in which the same shall have been delivered to the Trustee whether or not the same be in the nature and type legal for the investment of trust funds under the laws of the Commonwealth of Pennsylvania, including the stock of any corporate fiduciary acting hereunder. 2. To invest in all forms of property (including, but not by way of limitation, real estate, all types of stocks and bonds, and participations in common trust funds), without being confined to investments prescribed by statute and without being required to diversify. 3. To buy investments at a premium or discount. 4. To hold property unregistered or in the name of a nominee. 5. To give proxies, both ministerial and discretionary. 6. To compromise claims. 7. To join in any merger, consolidation, reorgani- zation, voting trust plan, or any other concerted action of security holders and to delegate discretionary duties with respect thereto. 8. To lend to, and to buy from, my estate. 9. To borrow from the Trustee or from others and to pledge real and personal property as security therefor. 10. To sell at public or private sale for cash or credit or partly for each, to exchange, or to lease for any period of time, any real or personal property, and to give options for sales, exchanges, or leases. 11. To allocate any property received or charge incurred to principal or income or partly to each, without being obliged to apply the usual rules of trust accounting. 12. To exercise any option permitted by law which they believe to be advantageous from the viewpoint of overall tax reductions, including, without limitation of the foregoing, power and authority to claim administration or other expenses either as income tax deductions or inheritance or estate tax deductions, without regard to whether they were paid from principal or income and without requiring adjustments between principal and income for any resulting effect on income or estate taxes, and a deduction of such expenses for income tax purposes shall be given 5 effect in computing the respective shares of all persons interested in my estate or the trusts set forth herein, even though the effect is to increase the share of one beneficiary or class of beneficiaries hereunder at the expense of another; and to make such adjustments, if any, between beneficiaries with respect thereto as they deem appropriate in view of the nature of the transaction and the amounts involved. 13. When permitted under the internal revenue laws of the United States, or of any state, to join with my spouse in filing a joint income tax return without requiring my spouse to indemnify my estate against liability for the tax attributable to my spouse's income, and to consent to any gifts made by my spouse during my lifetime being treated as having been made one-half by me for the purpose of federal laws relating to gift tax. 14. To distribute in cash or in kind or partly in each. 15. To make appointment of and to pay to or for the benefit of any beneficiary, out of the principal from which income is paid to such beneficiary, such amounts of such principal as the Trustee shall be of the opinion should be paid and applied for the maintenance, care, support and education of such beneficiary, the judgment of the Trustee to be conclusive in each instance as to the advisability of making such payments. The powers granted hereunder shall be exercisable with respect to all real and personal property - including, but not limited to, income and principal held for minors or disabled beneficiaries at any time held by the Trustee and shall continue in full force, even after the termination of the trust hereunder until the actual distribution of all property. All powers, authorities and discretion granted by this trust shall be in addition to those granted by law and shall be exercisable without leave of court. FOURTH: In the event my spouse does not survive me, I appoint Ruth W. Brillinger as Guardian of the person of any minor child of mine. If Ruth W. Brillinger fails to qualify or ceases to act in such capacity, I appoint Beth Ellen Brillinger as successor Guardian. FIFTH: I appoint my spouse, Amy C. Brillinger, as Personal Representative of this my last will and testament. Should my spouse fail to qualify or cease to act in such capacity, I 6 appoint Ruth W. Brillinger, or if she fails to qualify or ceases to act in such capacity, Beth Ellen Brillinger, as Personal Representative of this my last will and testament. No fiduciary named herein shall be required to enter bond or furnish sureties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this day o f ~ ~^~'~-,r.,~~ ~ 19 9 6. Signed, sealed, published tator as and for his last us, who, at his request, ea~~gt ~~ have hereu'~o ~~. .~ ~ ` ~. ____ ~., f,.,,1 ~ ~ ~~, . ;lJ~~`~'G~~.~i•,,_-- ( SEAL ) Brett H. Br'' finger 140 Kings Arms York, PA 17402 and declared by the foregoing tes- will and testament, in the presence of in his presence and in the presence of set our hands as /witnesses thereto. 7 COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF YORK ) I, Brett H. Brillinger, the testator, whose name is signed to the attached or foregoing instrument having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by Brett H. Eri.llinger, the testator, this 1~~ day of ~ s~-fi~-,~~e.;o~ 1996 . hibtari2:i Seal _~/ Selene M. Minsinger, Notary Public ~~~ /.r-~!°ZjJf Hanover Boro, York County My Commission Expires April 5, 7997 Brett H . B 11nger member, Pennsylvania Association Of Notaries ~~ ~~, Notar Publi CO;"~IMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF YORK ) We, L~ ~-;~v u~ ~'~«~~~~~-`~: and L~/'~.`"" ~. ~'dl~~--~=~` 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 the testator sign and execute the instrument as his last will; that the testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the testator signed the will as a witness; and that to the best of our knowledge the testator was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by ~_. a \F- ~ ~ `°3 Y`n(~<~a :~i-`c' and 1~~/A:~.~' ice. Cr L~~~il-~~i~-... , witnesses, this (~ri~ day of ~ ~- '` q 1996. ~~~,~~~ 1 ~ . _" -~ ~ _ _~ ~ mess ~r~~ ~ P `~ ~ r / ..( ,~ '~C_.~,,~,. ~j%~~~~ _ Witness 1 ~~ /`~~"" Notar~i Public Notarial Seal Selene M. Minsinyer, Notary Public Hanover Boro, York Co i 5 7997 My Commission Expires Ap Member, Pennsylvania Association of Notaries 8 :; .,~',~~ _ ,F~ ~- ~ -- . _ . ~ C~~ ~~~ ~ ~'" ~_ April 27, 2010 REGISTER OF WILLS CUMBERLAND COUNTY COURT HOUSE 1 COURTHOUSE SQUARE CARLISLE PA 17013 RE: Estate of Brett H. Brillinger File Number: 21-09-00780 Ladies & Gentlemen: Enclosed herewith are two (2) copies of Form REV-1500, status report, and the Inventory for the above decedent's estate. Also enclosed herewith is a check in the amount of $30.00 to cover the filing fees for these documents. Please mail the official receipt to my office. Very truly yours, G. Steven McKonly N GSM/lam ~ `=~' Enclosures ~` ~ ~ ~ ~ ~ ~~ . , ~_~ r~ ~ ` :4~; , - -=~ w ~ -~ -.,-, ~,~ ~.: ~ ,c _ --, c. . ;, d - syt. g;5?-~.7~. I"S2AriSACTIC7(~a ~ • ~IlSINESS & CORPORATE ~ t.`-~% * IVi~lIVEt.'+,;" ,€ ^~:- r "- ar:! t3 ;1 :_1-Ih9t?R--' 9T.. ~A'*1t~VER. P/a X7331 _ i ~''",'a^:~"~-~;zsk?£? a F'=~,X: 6;717)637-8857 x .~~ Y ~< _~~ ~~ ~a ~, b 3Q ?~ ! ,x ~ ;S ~ <~ td-> ~:: ~ {- ~ , N~'4 ft;~j~.`~~ ~'+1 f ~ ~ `E ~~,~? _ ~~ ~ r' ~ ~ ~ ~~ ri ~`~ _:_ ~ r ~~~"' ~"*. } -. `~ S ~ ..~ ~ ~~. t ° ~ ~F ~_ .~ r ^ ,: Ev ~ ~ ~. ~ ~~ a k . ~~ ~+' ~ ~ .. ~., ~:3 ~,~ wEC 3 r: :~~. :l_t ~ iZ.: ~ ~ o . ~. - ~ N `'