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HomeMy WebLinkAbout03-0876PETITION FOR PROBATE and GRANT OF LETTERS' Estate of 14ary E. BrJ_nk also kno~wn as Deceased. Social Security No. 206-32-4q21 The petition of .the undersigned respectfully represents that: ~ Your petitioner(s), who is/are 18 years of age or older an the executor in the last. will of the above decedent, dated Au_mast 27, 2003 and codicil(s) dated To: Register of Wills for the , County of · Commonwealth of Pennsylvania in ~he named ,19 (state relevant circumstances, e.g. renunciation, death Of:~xeca(o?; eicl) . · 'Decendent was domiciled at death in timberland COUrtly, Pennsylvania, with h ~r last family or principal residence at q17 :~ntl gv___ S,~erdale..PA 1700't (list street, number and muncipali/y) Decendent, then 78 . Years of age, died _q,~pr,,mko,- 9R . , ~, at p,-o_~l,wr,~,--~'an u_,~____-.. Carl i ~1 ~_. -Clnnh~rl nntl Co.ur.v: PA Except ~s follows, 'd~A-~id-~,ot m°-'~ry, was not'divorced and did not have a child bgrn or adopted after execution of the will offered for probate; was not the victim Of a killing and was never adjudicated incompetent: decedent ~,ra$ a wido~ Decendent at death owned property with estimated values as follows: (If ^~:~:~ ~ ·.°ay ~ Al! personal .... ~ ' $ ' (If not domiciledi~ Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: 317 2nd Street. Su~.,,erdale. PA 17093 45,000.00 80.000.00 WHEREFORE, petitioner(s) respectfully-request(s), the probate of the last will and' codicil(s) presented herewith and'the grant of letters e~.qw~,,~nw,? (testamentary.; administration c.t.a.; administration d.bS. mc.t,a.) theron. , Robert J, B~nk ~. P~ 17025 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF The petitloncr(s)above-naraed swear(s) or affirm(s) that the statements in the foregoing petition are · true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represem tative(s) of the above decedent petitioner(s) will well and truly administer the est.,ate according tO law. SWorn to or affirmed and subscribed be. fore me tMs c.f~c~/~c~/ day of~ /~- / ~ ~. - ~ ~ ,, Estate of mu~Y ~.. BRTm~ , Deceased 'DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ' October 23 t. 1~ 2003, in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECP~EED that the instrument(s) dated August 27~ 2003 . · described therein be admitted to probate and filed of record as the last will of Nary; v. _ Rr~n]r and Letters Testamentary_ are hereby granted to Robert .l. Brink FEES Probate. ~etters, Etc Short Certificates( ) .......... ?unciafion ................ F~ ~.. ,~... ~ Bruce J. Warsbo~esky _ t~58799 ATTORNEY (Sup. Ct,. I.D. No.) 3211 lq. Front St. 'liarrisbur~, PA 17110 ADDRESS ,. (7,17) 238-8187 PHONE his is to certify that the information here given is correctly copied f}om 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 P 9647762 SE? No. ~ [)ate Local Registrar COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH * VITAL RECORDS CERTIFICATE OF DEATH qlarp (g. rinl I, MARY E. BRINK, of East Pennsboro Township, Cumberland County, Pennsylvania, being of lawful age, sound mind and memory, and under no restraint, do publish this as my Last Will, revoking all other Wills or Codicils previously made by me. FIRST: All expenses, fees, costs, and taxes related to this estate shall be paid from the probate estate assets, including but not limited to funeral expenses, grave marker, the costs of my final illness, Inheritance, Estate and Fiduciary Taxes; and all gifts and bequests shall be paid from the net distributable estate. SECOND: I give, devise, and bequeath my entire estate, real, personal, or mixed, of every kind and nature, and wherever situated, which I may own, or hereafter acquire, or have a right to dispose of at my death, to my three children, DONNA M. CARVER, NORMA GILESPIE, and ROBERT J. BRINK, share and share alike per stirpes. THIRD: I nominate and appoint my son, ROBERT J. BRINK, Executor of my Last Will, granting to him authority to sell and convey any or all of my estate, real and personal, or mixed, upon such terms and prices as he shall deem proper, without obtaining any prior order of the court therefor. 1N WITNESS WHEREOF, I have hereunto subscribed my name, and acknowledge and publish this instrument as my Last Will in the presence of the undersigned witnesses, on August ~ 2003. WITNESSES: TESTATRIX Brink Estate Plan 287295-1 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN I, MARY E. BRINK, Testatrix, whose name is subscribed to the attached Will, being duly qualified according to law, do depose and say that I signed it willingly and that I executed it as my free and voluntary act for the purposes therein expressed. MAR? ./lggn'4K Sworn and subscribed to before me, this _ . ~ay of~August, 2003, No-~ary l~bli~ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA · · SS COUNTY OF DAUPHIN · Notarial Seal Angela M. Miller, Notary Public City of Hnn'isburg, Dauphin County My Commission Expires Oct. 15, 2006 On this date, August ~7'7 , 2003, before me personally appeared Young-suh Koo, known to me or satisfactorily proved to be a member of the bar of the highest court of Pennsylvania, and certified that she was personally present when the foregoing acknowledgmen~gned by the Testator and witnesses· ~xxx ~Q'-~~~ Young-suh Koo in witness whereof, I hereto set my hand and officia~al. / / Nc~tary~ubl~c - [ Not i Seal [ I Angela M. Miller, Notary Public [ Ci~ ~ ~sb~, Dauphin C~nty We,~d&,~~5~ ~ar~ M~ , the ~i~~~'a~ 2~ subscribed to the a~ched Will, being duly qualified according to law, do depose and say that we were present and saw the Testa~ix sign and execute the instrument as her Last Will; that she signed it willingly and that she executed it as her kee and volun~ act for the pu~oses therein expressed; that each of us in the hearing and sight of MARY E. B~K signed the Will as witnesses; and that to the best of our knowledge she was at that time 18 or more ye~s of age, of sound mind and under no cons~aint or undue influence· Sworn and subscribed to before me, this~day of A~st, 2003· // Brink ~state, le~ 287295-1 Notarial Seal An~_!a M. Miller, Notary Public (~ty Of i~u~sburg, Dauphin My ~ammlsslon Expires Oct. ~, MARY E. BRINK Metzger * WICKERSHAM * KNAUSS & ERB, P.C. ATTORNEYS AT LAW 3211 NORTH FRONT STREET P. 0. Box 5300 HARRISBURG, PENNSYLVANIA [7 I IO-O3OO CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent · Date of Death · Will No. · MARY E. BRINK September 28, 2003 2003-00876 Admin. No.: 21-03-0876 To the Register: I hereby 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 October 31, 2003. Name Robert J. Brink Norma Gilespie Donna M. Carver Address 502 North Humer Street, Enola, PA 17025 8 Chatham Court, Dover, DE 19901 800 Shady Lane, Enola, PA 17025 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None Date: October 31, 2003 Name Brace J. Warshawsky, Esquire Address 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 Telephone (717) 238-8187 :_,_ ,~r, ~pacity: Personal Representative X Counsel for Personal Representative 291752-1 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 28060~ HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003378 BRINK ROBERT J 502 NORTH HUMER STREET ENOLA, PA 17025 ........ fold ESTATE INFORMATION: SSN: 206-32-4921 FILE NUMBER: 2103-0876 DECEDENT NAME: BRINK MARY E DATE OF PAYMENT: 12/26/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 09/28/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $4,356.74 REMARKS: ROBERT J BRINK TOTAL AMOUNT PAID' $4,356.74 SEAL CHECK# 9548 INITIALS: AC RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FiLE NUMBER 21 -- 03 -0786 NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Z~' Carbaugh William G 208-24-2115 I~1 DATE OF DEATH (MM-DD-YEAR) DA3E OF BIRTH (MM-DD-YEAR) THIS RE'~IRN MUST BE FILED IN DUPLICATE WITH THE LU 9/25/2003 5/31/1933 REGISTER OF WILLS uJ F APPLICABLE) SURVIVING SPOUSE~ NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER C~ [~ I Original Ratum E~] 2 Supplemental Return [] 3. Remainder Return (date of death prior to 12-t3.82) [~ 4 Limited Estate ~ 4a Future Interest Compromise (date of death aher 12-1282) [~ 5. Federal Estate Tax Return Required E~6. Decedent Died Testate (A~tach copy of W~II) E~ 7. Decedent Maintained a Living Treat (Attach copy of Trust) __ 8 Total Number of Safe Deposit Boxes ~ 9 Litigation Proceeds Received [] 10 Spousal Pover[y Credit (date of death b ...... 12-3191 and 1-1-95) [] I 1. Election to tax under Sec, 9113(A)(Attach 8ch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME Steven J, Fishman, Esquire FIRMNAME(IfAppli~ble) S~LZMANN, HUGHES & FISHMAN PC TELEPHONE NUMBER 717-249-6333 COMPLE~ ~ILING ADDRESS 95 Alexander Spring Road, Suite 3 Carlisle, PA 17013 1, Real Estata (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 Deposf[s & MisceNane~us Pelsonal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) [~] Separate Billing Reduested 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 l) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. Charitable and Governmental Bequeat s/Sec 9113 Trusts for which an election to tax has not been mede (Schedule J) 0 47,237 (8) 181,118 37,106 11,697 (11) (12) (13) 48,803 132,315 0 132,315 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE BIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, ortransfersunderSec. 9116(a)(1.2) 0 x 0 0 (15) 16 Amount of Line14 taxable at lineal rate 0 x 0 45 (16) 17. AmountofLinet4texableatsiblingrate 0 x 12 (17) 18, Amount of Line 14 taxable at collateral rate. 132,315 x.15 (18) 19. Tax Due (18) 0 0 0 19,847 19,847 z > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: iew Drive I C?~'~erland Carlisle Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0 B. Pdor Payments 0 C. Discount 0 3. interest/Penalty if applicable D. Interest 114 E. Penalty 0 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) (1) 19,847 0 114 0 19 r 961 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page I 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. Make AGENT (5B) 19,961 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING'AN "X" IN 'I%IE 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; ......... r~ [~ c. retain a reversionary interest; or ................................ r~ [~ 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 trusl 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 beneficia~ 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. SIGNA'ilJRE Of PERSON RESPONSIBLE FOr FILING RETURN 4501 Valley View Road 95 Alexander Spring Road, Ste 3 Middletown, ~ 21769 DATE Carlisle, PA 17013 [72 P.S.§ 9916 (a) {1.1) {i)]. SCHEDULE A REAL ESTATE COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER William G. Carbaugh 21-03-0786 All real prober['/owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the plice at which pn pedy ~ould be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable kno~edge of the relevant facts. Real proberty which is Joinfly~)wned wifll right of survivorship must be disclosed on Schedule F. VALUE AT DATE OF DEATH NUMBER 1. DESCRI~ION 140 Greenview Drive, Carlisle, PA 17013; South Middleton Township, C,,~herland County (settlement sheet attached) TOTAL (Also enter on line 1, Recapitulation) $ 121,000 121,000 3W4695 1 000 (If more space is needed, insed additional sh~ts ~ the same size) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER William G. Carbaugh 21-03-0786 Include the proceeds of litigation and the date the proceeds w~re re~aved by the estate All property jointly-owned with tile right of survivorship must be disclOSed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DC:ATH 1 2 3 Cash on hand Household goods & automobile PNC Bank, checking account #5140442815 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is n ~:Jed, insert additional sheets of the same size) 375 8,518 3,988 12,881 3W40AD 1000 COMMONWEALTH OF PENNSYLVANIA ~NHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF William G. Carbaugh FILENUMBER 21-03-0786 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 y ~s. L,'t:~L;N~Fq] O N OF PROPERTY ITEM IN~_U:~ T~E ~E DF Tt-~ I~,ANSFEREE THeiR RELATiONSHiP TO DECEDENT Aha) DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBEF T~'E DATE OF TRANSFER ^~"~c~l A COPY OF THE DEED FOR REAL ESTATE VALUE OF ASSET INTEREST (~F/~PPLICABLE) VALUE 1. PNC Bank, IP.A account %75600012443 47,237 100.000 0 47,237 TOTAL (Aisc enter on line 7, Recapitulation) $ 47,237 (If more space is needed, insert additional sheets of the same size) 3W46AF 1000 EV-1511 EX + (12-99) COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RE~JRN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER William G. Carbaugh 21-03-0786 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 5. 6. 7. 1 2 3 FUNEP, AL EXPENSES: Carlisle Memorial Service ADMINISTRATIVE COSTS: Personal Representatiw's Commissions Name of Personal Representative(s) Carol R. Holter Social Security Number(s) / EIN Number of Personal Represent~ive(s) 218-40-3690 Street Address 4501 Valley View Road City Middletown State ~ Zip 21769 Year(s) Corn mission Paid: 2004 Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach e~lanation) Claimant Street Addmss City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees C,~mherland Law Journal Tom Cutter Fluss Flooring Inc. Total from continuation pages 25O 8,200 8,900 272 25O 75 85O 1,069 17,240 TOTAL (Also enter on line 9, Recapitulation) $ 37,10 R 3W46AG 1000 (If more space is needed, insert additional sheets of the same size) Estate of: William G. Item No. Description Carbaugh Schedule M part 2 (Page 2) 4 5 6 10 Carol R. Holter Sam Holter Kenny's Auction commission Lowe's Register of Wills S.W. Barrett Real Estate & Appraisal Services Settlement Charges 3,128 2,930 633 90 4O 275 10,144 Total (Carry forward to main schedule) 17,240 REV-1512 EX + (6-98) COMMONW~_ALTH OF PENNSYLVANIA INHERITANCE TAX RE~JRN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER William G. Carbaugh 21-03-0786 Include unreimbumed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2 3 4 PNC Bank PP&L Sprint Waste Managment 10,606 784 122 185 TOTAL (Also enter on line 10, Recapitulation) $ 11,697 3W46AH 1 000 (If more space is needed, insert additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANC~ TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER William G. Carbaugh 21-03-0786 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) DE ESTA~ TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfer under Sec. 9116 (a) (1.2)] 2 3 Terri J. Cannon-0rtiz P.O. Box 937 Bailey, CO 80421 Mary C. Fleagle 8629B Indian Springs Road Frederick, MD 21702 Carol R. Holter 4501 Valley View Road Middletown, MD 21769 Melody Long 11940 Martins Lane Blue Ridge S~mmltt, PA 17214 Niece Niece Niece Niece 25% 25% 25% 25% ENTER DOLLAR AMOUNTS FOR DISTRIBU~ONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DIS'rRIBUT1ONS ON LINE 13 OF REV-1500 COVER SHEET 0 3W4SA~ t000 (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT OF WILLIAM GEORGE CARBAUGH I, WILLIAM GEORGE CARBAUGH of Carlisle, 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 all other wills and codicils heretofore made by me. FIRST I direct the payment of my debts and the expenses of my last illness and funeral from my estate as soon after my death as conveniently may be done. If there be no cemetery lot available for my interment, owned by me at the time authorize my personal representative to cause title to or ownership of such lot so purchased to be vested in such person as my personal representative shall I[ ~designate. Further, in this connection, I authorize my personal representative to expend consider funds necessary from and desirable, in for the purchase, erection and inscription my estate, such amount as my personal representative shall suitable marker for my grave. ISHMAN & HESS SECOND I give, devise and bequeath all my estate of whatever nature and wherever situate unto my wife, KETA JEANNE CARBAUGH, provided that she survives me by thirty (30) days. THIRD In the event my beloved wife, RETA JEANNE CARBAUGH, does not survive me, or does not survive me by the said Deriod of thirty (30) days, I then give, devise and bequeath all of my estate of whatever nature and wherever situate~ in equal shares, unto: CAROL RETA HOLTER of R. D. #3, BOX 245, Middletown, Maryland 21769; CYNTHIA FLEAGLE and MELODYE McQUEEN, 8629 Indian Springs Road, Frederick, Maryland 21701; TERRI JEANNE CANNON of 7909 Edgewood Fa~ Road, Clover Hill, Frederick, Maryland 21701. Should any of the above desire to select specific property and take the same in kind, then an appraisal shall be made of the property so selected and charged against that person's share in the estate. FOURTH I direct that no trustee, executor, guardian or other fiduciary named, nominated or appointed by this my Last Will and Testament shall be required to post any bond or glve any security of any type for any purpose whatsoever, any law or rule of court of the Commonwealth of Pennsylvania or any other juris- diction to the contrary notwithstanding. FIFTH My executor and trustee shall have the following powers in addition to those vested in them by law and by other provisions of this Will, applicable to all property, real, personal and mixed and wheresoever situate, including property held for minors, whether principal or income, exercisable without cou~t approval, and effective, with respect to each item of said property, until distribution thereof. A. To retain, as investments of my estate or trust, any or all assets of my estate, real, personal, or mixed, without regard to any principal of diversi- fication, and to purchase and acquire real or personal property, and to hold any or ali of such real and personal property retained or acquired without making the same productive of income. B. To permit the heirs, or any of them, to occupy any real estate retained or acquired upon such terms and conditions as my trustee shall deem proper. C. To pay all taxes, charges and expenses of maintenance, upkeep, improve- ments, development, protection, preservation and investment of any retained or! acquired real or personal property, such payments to be made from either I principal or income as my said trustee shall determine. D. To retain or invest any and all funds, whether principal or income, in any real or personal property without restriction to legal invest~ents; to purchase i~vestments at premiums; to exercise all rights of a security holder or share holder in any corporation, and to lease, mortgage, pledge, give option~ upon or sell at public or private sale and without approval of any court and without any responsibility to the buyer or buyers to see to the application of the purchase price, any real or personal property, or portion or portions thereof, irrespective of the manner or means by which the same was acquired by my said trustee. E. TO make payment or distribution herein provided for in cash, kind, or partly in cash and partly in kind, at valuations fixed by my trustee at the time of distribution. SIXTH Any and all payment or payments of any sum or sums, whether in cash or in kind and whether for principal or income, payable to my heirs or any of them, shall be made upon the sole receipt of the respective individual to whom the payment is made, and free from anticipation, alienation, assignment, attachment, and pledge, and free from control by the creditors of any such beneficiary. All shares of principal and income herein given shall be free from anticipationI, assignment, pledge, or obligations of any beneficiary and shall not be subject i to any execution or attachment, i SEVENTH I appoint my wife, RETA JEANNE CARBAUGH, Executrix of this my Last Will and Testament. Should my wife, RETA JEANNE CARBAUGH, fail to survive me or for any reason fail to qualify as Executrix, then I appoint CAROL RETA HOLTER, Middletown, Maryland, Executrix of this my Last Will and Testament~ IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of three (3) typewritten pages, the first two (2) of which bear my signature in the margin for the purpose of identification,! this , day of ~ ~ ,.. , 1983. WILLIAM GEORGE CARBAUGH, as and for his Last Will and Testament, in the presenc~ of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed our names as witnesses. COMMONWEALTH OF PENNSYLVANIA: :SS. COUNTY OF CU~ERLAND : are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to Sworn to and subscribed before me this '~ day of ' '~' ' ' ,- , 1983 ^. Settlement Statement 1. [:]FHA 2. [3FmHA 3. DConv. Un/ns. 6. File Number 7. Loan Numl~er 4. ~VA 5. ~Conv. Ins. I CLT-04-161AH I D. NAME OF BORROWER: ADDRESS: E. NAME OF SELLER: ADDRESS: F NAME OF LENDER: ADDRESS: G. PROPERTYADDRESS: OMB No 2602-0265 REV HUD-1 (3186) lB. Mortgage Insurance Case Numb( Peter Paul Kovaschetz 30 Gig Spring Terrace~ Newvllle~ PA 17241 Estate of William G. Carbaugh 140 Greenvlew Drive, Carllsle~ PA 17013 Primary Residential Mortgage 4750 W. Wiley Post Way~ Ste 200, Salt Lake Cltyr UT 84116 140 Greenview Drive, Carlisle, PA 17013 Titl~fExpress Settlement System Printbd 07/2712004 at 12:46 CW H SETTLEMENT AGENT: PLACE OF SETTLEMENT: Colonial Land Transfer, Ltd., 717.651.1488 fax:717.651.1489 3964 Lexington Street, Suite A, Harrisburg~ PA 17109 I. SETTLEMENT DATE: 07127/2004 J. SUMMARY OF BORROWER'S TRANSAC finN: K. SUMMARY OF SELLER'S TRANSACTIO_I 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 401. 101 Contract sales price 121~000.06 102. Personal Property 105.104'103' Settlement charges to borrower (line 1400) 4~289.64 Adjustments for items paid by seller in advance 107. County taxes 07127104to12131104 I 117.48 108. SchooITaxes 07127104to06130105 I 1~249.92 109. L 110. 111. 1i2. 120. GROSS AMOUNT DUE FROM BORR )WER 126~657.04 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 201. Deposit or earnest money 1~000.00 202. Principal amount of new loans 96~800.00 203. Existing loan(s) taken subject to 204. 205. 2nd Mortgage Proceecls 12~100.00 Fulton Bank 206. 207. 208. 209. Adjustments for Items unpa id by seller 402. 403 404. 405. Contract sales price Personal Properly 121,000.00 407. Countytaxes 07127104to1213t104 117.48 408. SchoolTaxes 07127104to06130105 1~249.92 409. 410. 411. 412. 420. GROSS AMOUNT DUE TO SELLER 122r367.40 500~ REDUCTIONS IN AMOUNT DUE TO SELLER 502. 503. 504. 505. 507. 508. 509. Excess Deposit (see instructions) Settlement charges to seller (line 1400) Existing lean(s) taken subject to Payoff of First Mortgage Loan Adjustments for Items un 10,144.35 id by seller 213. 214 215. 216. 217. 218. 219. 220. TOTAL PAID BY/FOR BORROWER 109,900,80 300. CASH AT SETTLEMENT FROM OR TO BORROWER 301 Gross amount due from borrower (line 120)/ 126,657.04 302. Less amounts paid by/for borrower (line 22(1) 109,900.00 303. CASH FROM BORROWER 16,757.04 514. 515. 516. 517. 519. 520. TOTAL REDUCTION AMOUNT DUE ! ;ELLER 10,144.35 600. CASH AT SETTLEMENT TO OR FROM SELLER 601. Gross amount duo to seller (~ine 420) 602. Less reduction amount due seller (line 520', 663. CASH TO SELLER 122,367.40 US. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT File Number: CLT-04-161 PAGE 2 SETTLEMENT STATEMENEv. HUD-1 (3/86) TiSeExpress Settlement S stem Printed 07/27 L. SETTLEMENT CHARGES ~' .... PA~D FROM PAID FROM 700. TOTAL SALES/BROKER'S COMMISSION based on price $121r000.00 ~ 6.000 = 7~260.00 BORROWER'S SELLER'S Division of commission (line 700} as follows: FUNDS AT FUNDS AT 701.$ 7,260.00 to BH Agency GMAC Realty SETTLEMENT SETTLEMENT 702. $ to I 703. Commission paid at Settlement[ 7~260.B0 800. ITEMS PAYASLE IN CONNECTION WITH LOAN 801. Loan Origination Fee % 802. Loan Discount % 803. Appraisal Fee to Michael Hennigan 300.00 804. Credit Report 805. Unde~vriting Fee to Primary Residential Mortgage LR 195.00 806. Flood Certification Fee to Primary Residential Mortgage LR 13,50 807. Document Prep Fee to Primary Residential Mortgage LR 395.00 808 809. 81o. 900. ITEMS REQUIRED DY LENDER TO BE PAID IN ADVANCE 901. Interest Fron~7/2712004 1o 08101/2004 ~,,$ 15.1250/day 5 Days LR 75.63 902. Mortga0e Insurance Premium for to 903. Hazard Insurance Premium for to 904. 905, -- 1000. RESERVES DEPOSITED WITH LENDER FOR 1001~Hazard Insurance 6 ma. ~. $ 25.83/mo LR 154.98 1902Mort~ape Insurance mo. ~ $ /mo 1003.Cdy Property Tax mo. ~'~ $ /mo 1004.County Property Tax 4 mo, @ $ 24.88/mo LR 99.52 1005.School Taxes 2 mo. ~ $ 112.15/mo LR 224.36 lO09Aggrenate Analysis Adiust~rimary Residential Mort.qage LR -153.04 1100. TITLE CHARGES 1101 ~etBement or closing] fee 1102Abstract or title search 1103.TiSe examination 1104.Ti8e insurance binder 1105Document Preparation 1106Nota~ Fees to Anne E, Houser 25.00 1107Attorney's fees to Belnhaur & Curclllo 300.00 (includes above items No: 1108.Title Insurance to Colonial Land Transfer 963.7! (includes above items No: 1109.Lender's Policy 96=800.00 - 1110,Owner's Policy 121~000.00 - 963.75 1111~nd 100, End 300, End 90aB Colonial Land Transfer 150.01 1113.Closin~ServiceLetter to Colonial Land Transfer 35.0( 1206. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201.Recording Fees Deil~l$60 ; Mod0age ~1~'.50 ; Release $ 109.00 1202.CBy/County tax/stamps Deed $~210.60 ; Mort~age$ 1,210.00 1203State Tax/stamps Deed $,210.00 : Mortgage $ 1~210.00 12042nd Mort~a,qe to Recorder of Deeds 67.50 1300. ADDITIONAL SETTLEMENT CHARGES 1301.Wire Fee to Colonial Land Transfer 12.00 1302~om. ReL Lien Search to Colonial Land Transfer 15.00 30.00 1303.Recording Fees to Colonial Land Transfer 7.50 1304.Overnight Fees to Colonial Land Transfer 30.00 13052004 Cty/Twp Tax to Judy A. Campbell 298.56 13062004 School Tax to Judy A. Campbell 1 [345.79 1307Termite inspection to Penn Past 40.00 1308.Other Disbursements (1520) 20.00 1400. TOTAL SETTLEMENT CHARGE, tar on lines 103, Section J and 502, Section K) 4~289.64 10~14_4.35 Estate of William G. Carbaugh 208242115 U.S. DEPARTMENT Of HOUSING AND URBAN DEVELOPMENT File Number: CLT-04-161 PAGE 3 SETTLEMENT STATEMENI~. HUD-1 (3/86) TitleE> ITEMIZATION OF HUD LINE 1308 1500. SCHEDULE OF DISBURSEMENTS I BUYER SELLER 1501 Appraisal Fee to Fulton Bank (P.O.C.} 150.00 Buyer 1502,Credlt Report to Transunioi3 (P.O.C,) 3.60 Buyer 1503-Mortga~le Papem Prep to Fulton Bank 20.00 1504Fleod Certification Fee to First American Flood Data Services (P.O.C.) 8.00 Buyer 1505,Hazard Insurance Premiurrto Fulton Rank (P.O.C.) 400.00 Buyer 1506Abstract or Tit~e Search to Fulton Bank (P.O.C.) 30.00 Buyer 1507Estimated Future Lien Rele~sEulton Bank (P.O.C.) 35.50 Buyer 1508. 1509. 1520. TOTAL HUD LINE 1308 EXPENSE: 20.00 ~CT-0~-200~ 20:0~ PNC~N~ 4~2 ?~ ~45~ P.O~ PNCBAI October 6, 2003 SalzrrmnnDepaulis~,Fishman, PC Attn: TfishFishman 95Alexand~rSpringRd. Suite 3 Garli~PA 17013 SCP l~statc of William G Cmbaugh (Deceased) SSN: 208-24-2115 DOD: 09-25-2003 Dear Ms. Fishman: In response to your rccluest for Date of Death balances for the customer noted above, our records show the following: Account~5140442815 Established 09-01-I 979 WILLIAM G CARBAUGH DOD balance: $3,987.63 + $0.00 accrued interest I]~AAccou~ Account #75600~ 12443 Established 02- I I- 1999 WILLIAM G CARBAUGH DOD balance: $47,148.43 + $88.61 accrued interest For Benefieim-y or IRA information ple~e call 1-88~-PNC.1RAS. The decedent maintained loan #4001008006361554, For more reformation contact 1-888-762-2265. Page ! of 2 , ~T-~5-~003 20:01 PNC~ANK 41~ ?B~ ~45~ P.02 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savin~s accounts), We do not process any financial transactions or provide statements, l£you need assistance with any of these items, please call 1-888-PNC-BANK (I-888-762-2255) or stop by your local PNC Bank branch office. Siuc~rely, Erica L Schlcgel PNC Dcccdant Reporting Firstside Center 500 First Ave, 4th F1 CIF Pittsburgh PA 15219-3128 1-800~762-1775 Member FDIC Page2 of 2 TOTAL P.02 .. JUN-18-200~ 01:$~ PN¢ I~A 9141280~8033 @.02/02 PNCBAN( Estate of William Carbaugh C/O C~ol Rem Holter 4501 Valley View Road Middletown MD 21769-$604 June 18, 2004 RE: Retirement A¢couut # 7200003135 Dear Estate ofW'flliam Carhaugh, Recently, your inquiry prompted ~esearch of your retiremcat accannc We acknowledge your concern and have thoroughly researched the supporting documentation. Find e~closed the resolution in this matter. Please accept our sincere apology for any inconveniertce this may have caused you. Our records indicate that the Estate of William G. Carbaugh is listed as the sole beneficiary to the above vefc.~uced retirement plan. The Bene, flciaty IRA dooiments has been forwarded to the e~tate ou 6-11-2004 to ensure accurate payout to the eslale. We can a~sure you that we make ~wcry effort to ensure quality servioe to all our Cheats. Ifyou hav~ any questions or wish to discuss this matter further, please contact Retireanent Servieea a~ 1-888-PNC-IRAS. Thank you for your consideration and for your business. Sincerely, Michael D. Bennet~ Retfl=ment Services Specialist Snelosur~s) A Member of T~e PNC ;i~anelal 8erelces Omu~ Rei/rement Se~4cem P.O. 6ox ~499 Pittsburgh Pe~t,.sl~vania 1b'2~0 www.pn~l~ank,oom TOTAL P.02 List of buyer's of Household Goods of The William G. Carbaugh Estate 1. Carol Holter 2. Cindy Fleagle 3. Terri Cannon 4. Kenny's Auction 5. Melody Mc Queen Long $ 1,300.00 $ 4,715.00 25.00 $ 1,174.87 $ 670.00 * * Note This has not been paid. 4401 PHILADELPHIA AVENUE, I commission you t° auction the items above to the hi disposal of any items Special Instructions: ht to sell· I uP t I wil sold on my $75, ~ Commission Fee: Date: Seller's Signature: 0_~ e~,,,,~:, ~ , ~f_.~.~ ~ Thank you for using Kenny's Auction services. We are prou. d to be serving this community for over 20 years! Please keep th~s receipt. Should L! ' you have any q est]ons, please call us at 717-264-6578. COMMONWEALTH OF PENNSYLVANIA '~ ss: COUNTY OF CUMBERLAND ~ Carol R. Holter being duly ~o~n according fo law, deposes and says that she is ~he Executrix of the Estate of Wm. G. Carbaugh late of ~S..__Middleton_~ _Tc~_ ~ship ., Cumberland County, Pa., deceased and that the within is an inventory made by her , the said Executrix of the entire estate of said decedent, consisting of all the personal property and real estate, except real e. state.outside fha Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent ff's fair value as of the date of decedent's death. Sworn and subscribed before me, Ja~li~ L, ~b~, N~ Public [ [ I Date o[ De~th Executor- Admlnlstrafor 4501 Valley View Road Yiiddletown, MD 21769 Address 2003 Month Year 2. 3. 4. INSTRUCTIONS An inventory must be filed within three months after appointment of personal repre~ahve.~ A supplement inventory must be filed within thirty days of d~scovery of additional Additional sheets may be attached es to personalty or realty See Article IV, Fiduciaries Act of 1949. 0 0 Inventory of the real and personal estate of ~±lliam G. Ca~baugh deceased 140 Greenview Drive, Carlisle, South Middleton Township, Cumb. Co. Cash on hand Household goods & furniture PNC Bank, checking account $121,00 375 8,51~ 3,98~ $133,881 .00 .00 .00 .00 .00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVlDUAL TAXES DEPT. 280601 HARRISBURG, PA t7128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004277 FISHMAN STEVEN J 95 ALEXANDER SPRING RD SUITE 3 CARLISLE, PA 17013 fold ESTATE INFORMATION: SSN: 208-24-211 § FILE NUMBER: 2103-0786 DECEDENT NAME: CARBAUGH WILLIAM GEORGE DATE OF PAYMENT: 08/16/2004 POSTMARK DATE: 08/1 6/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/25/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 919,961.00 TOTAL AMOUNT PAID: 9,961.00 REMARKS: · ' SEAL CHECK# 145 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004090 BRINK ROBERT J 502 NORTH HUMER STREET ENOLA, PA 17025 ........ fold ESTATE INFORMATION: SSN.' 206-32-4921 FILE NUMBER: 2103-0876 DECEDENT NAME: BRINK MARY E DATE OF PAYMENT: 06/25/2004 POSTMARK DATE: 06/25/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/28/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,635.63 TOTAL AMOUNT PAID: $1,635.63 REMARKS: ROBERTJ BRINK SEAL CHECK//3136 INITIALS: VZ RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS MARY E. BRINK ROBERT J. BRINK 3136 317 2ND ST.,BOX 5 717-732.-0924 :'" ~' - ~/ lo8 O. PNCBA PNC Bank, N.A. 040 Choice C~ntral PA Plan Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Ma~ E. Brink No. also known as Date of Death , Deceased Social Security No. 21-03-00876 September28.2003 206-32-4921 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We vedfy that the statements made 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. Attorney: BnJc~. J. Wnmhnw~k.v: E-~quire I.D. No.: 58799 Address: 3211 North Front Stm. et. PC) R~ .5300 Hnrd.~hurg PA 17110-0300 obert J. Brink, E~ecutor 503 North Humer Street, Enola, PA 17093 Dated ~ ,, ,~ t_/,.. (~).~ Telephone: _ (717) 23P,-8187 Description Real Estate: 317 Second Street, Summerdale, PA 17903, East Pennsboro Township Cumberland County, Tax Parcel No. 09-12-2995-018 ' Security Equity Fund-Class B: Securities Amedca, Inc., 2322 Broad Avenue, AItoona, PA 16601-1938, Account No. 1022-37099165, CUSIP: 814219200, No. Shares: 699.815 NAV / SHARE: $5.44 (9/26 - $5.41 / 9/29 - $5.47) Security Equity Fund-Class B: Securities America, Inc., 2322 Broad Avenue, Altoona, PA 16601-1938, Account No. 1022-37099191, CUSIP: 814219200, No. Shares: 2,076.814, NAV / SHARE: $5.44 (9/26 - $5.41 / 9/29 - $5.47) Mutual Fund: Templeton Wodd Fund-Class A: Franklin Templeton Investments, P.O. Box 33033 St. Petersburg, FL 33733-8033, Account No. 102-2910025476, No. Shares: 1,157.814, NAV / SHARE: $15.16 (9/26 - $15.15 / 9/29 - $15.17) Mutual Fund: Putnam Investors, 2322 Broad Avenue, Altoona, PA 16601-1938, Account No. A30-1-20-6354921-BBCU Tangible Personal Property of Decedent 2002 Honda Civic 1993 Oldsmobile Delta 88 1975 Oldsmobile Delta 88 Value .... $110,000.00 rcS 3,806.00 :~;~ $ 11,297.87 $ 17,552.45 $ 3,932.55 $ 4,570.00 $ 10,540.00 $ 680.00 $ 295.00 .87 NOTE: The Memorandum of reap 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. 307518-1 Register of Wills of Cumberland County, Pennsylvania Estate of also known as Ma~ E. Brink INVENTORY , Deceased No. 21-03-00876 Date of Death September 28, 2003 Social Security No. 206-32-4921 Personal Representative(s) of the above Estate, deceased, vedfy that the items appearing in the following inventory include all of the personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. I/We vedfy that the statements made 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. Robert J. Bdnk, Executor I.D. No.: 503 North Humer Street, Enola, PA 17093 Address: Dated BnJc~. J_ Warshawsky: Esquire 68799 3211 North Front Street_ PC) B(3x 5300 Hard.~hurg. PA '17110-0300 Telephone: (717) 238-8187 Description Real Estate: 317 Second Street, Summerdale, PA 17903, East Pennsboro Township, Cumberland County, Tax Parcel No. 09-12-2995-018 Secudty Equity Fund-Class B: Securities Amedca, Inc., 2322 Broad Avenue, Altoona, PA 16601-1938, Account No. 1022-37099165, CUSIP: 814219200, No. Shares: 699.815, NAV / SHARE: $5.44 (9/26 - $5.41 / 9/29 - $5.47) Secudty Equity Fund-Class B: Securities Amedca, Inc., 2322 Broad Avenue, Altoona, PA 16601-1938, Account No. 1022-37099191, CUSIP: 814219200, No. Shares: 2,076.814, NAV / SHARE: $5.44 (9/26 - $5.41 / 9~29 - $5.47) Mutual Fund: Templeton Wodd Fund-Class A: Franklin Templeton Investments, P.O. Box 33033, St. Petersburg, FL 33733-8033, Account No. 102-2910025476, No. Shares: 1,157.814, NAV / SHARE: $15.16 (9/26 - $15.15 / 9/29 - $15.17) Mutual Fund: Putnam Investors, 2322 Broad Avenue, Altoona, PA 16601-1938, Account No. A30-1-20-6354921-BBCU Tangible Personal Property of Decedent 2002 Honda Civic 1993 Oldsmobile Delta 88 1975 Oldsmobile Delta 88 Value c5 ~' $110,000.00 r-c $ 3,806.00 ,..., $ 11,297.87 $ 17,552.45 $ 3,932.55 $ 4,570.00 $ 10,540.00 $ 680,00 $ 295.00 Total: ~162~673.87 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. 307518-1 REV-1500 EX (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY FILE NUMBER COLN]3' CODE YF.N~ kLMBER I-- Z LU C] LU 'T'OO n,'-J n Z DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) BRINK, MARY E. DATE OF DEATH (MM-DD-YEAR) I DATE Of BIRTH (MM-DD-YEAR) 09-28-2003 I 03-26-1925 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECUREY NUMBER 206-32-4921 THIS RETURN MUST BE FILED IN DUPUCATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER [] 1. Odginal Ratum [] 4. Umited Estate [] 6. Decedent Died Testate (Attach copy of Wi~ [] 9. Litigation Proceeds Received [] 2. Supplemental Return [] 4a. Future Intere~'t Compromise (~te of death a~ter 12-12-82) [] 7. Decedent Maintained a Living Trust (Attac~ copy of Trust) [] 10. Spousal Poverty Credit (date of death between 12-31-91 axl 1-1-95) [] 3. Remainder Return (date of death pr~ to 12-13-82) [] 5. Federal Estate Tax Return Required ~ 8. Total Number of Safe Deposit Boxes [] 11, Election to tax under Sec. 9113(A) (A~tach Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONF!D_.NTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME / COMPLETE MAILING ADDRESS BRUCE J. WARSHAWSKY Ci 3211 NORTH FRONT STREET FIRM NAME Of Appicabte) METZGER, WICKERSHAM, KNAUSS & ERB, P P.O. BOX 5300 TELEPHONE NUMBER HARRISBURG, PA 17110-0300 (717) 238-8187 110,000.00 36,589.86 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sale-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Joinlly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Pro,ate Property (7) (Schedule G er L) 8. Total Gross Assets (total Unes I - 7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, IVlo~lgage Uabilities, & Uens (Schedule I) (10) 11. Total Deductions (total Unes 9 & 10) 12. Net Value of Estate (Une 8 minus Une 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) 16,085.00 10,010.77 0.00 (8) 23,430.36 1,569.08 (11) (12) (13) (14) SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of Une 14 taxable at lhe spousal tax rate, or transfers under Sec. 9116 (a)(1,2) X .0 (15) 16. Amount of Line 14 taxable at lineal rate 147,686.19 x ,o 45 (16) 17. Amount of Une 14 taxable at sibling rate X .12 (17) 18. Amount of Une 14 taxable at collateral rale X .15 (18) 19. Tax Due (19) 20. OFFICIAL USE ONLY C [] [ CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT [ > > BE SURE TO ANS;;"~P~ ALL QU~--_-3TiONS ON REVERSE SIDE AND RECHECK MATH < < 172,685.63 24,999.44 147,686.19 147,686.19 6,645.88 6~645.88 STF PA42021F.1 Decedent's Complete Address: ISTREETADDRESS 3 17 SECOND crTY SUHHERDALE J STATEpA STREET, BOX 5 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Pdor Payments C. Discount 4,356.74 653.51 Interest/Penalty if applicable D. Interest E. Penalty IZIP 17903 (1) 6,645.88 Total Credits (A + B + C) (2) 5,010.25 0.00 1,635.63 Total Interest/Penalty (D + E) 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 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (SA) (SB) Make Check Payable to: REGISTER OF WILLS, AGENT 1,635.63 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 and complete. STREET, ENOLA, 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 ADDRESS ROBERT J. BRINK, 502 NORTH HUMER PA 17093 SIGN~T-gRE OF PREPARER OTHER THAN REPRESENTATIVE A[:~;i~'ES~' ' ~ ~ BRUCE J. WARSHAWSKY, 3211 NORTH FRONT STREET, P.O. BOX 5300, HARRISBURG, PA 171 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 3% [72 P.S. §9116 (a)(1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate im posed 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 retum 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 RS. §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. STF PA42021F.2 REV-1502 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA SCHEDULE A 'N,ER TA,CE RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY E. BRINK All real pmpeft7 owned solely or as a te,iaii[ in coi~iiiion must be reported at fair i~a¢~st 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, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with dght of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION 317 SECOND STREET SUMMERDALE, PA 17903 EAST PENSBORO TOWNSHIP CUMBERLAND COUNTY TAX PARCEL NO. 09-12-2995-018 TOTAL (Also enter on line 1, Recapitulation) VALUE AT DATE OF DEATH 110,000.00 $ 110,000. O0 STF PA42021F.3 (If more space is needed, insert additional sheets of the same size) REV-1503 EX + (1~97) (I) COMMONWEALTH OF PENNSYLVANIA SCHEDULE B '""E.,T^NCET .ETU.N STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY E. BRINK NUMBER NI pm~ joinfly~ ~th the dght ~ suwiv~hip mu~ ~ di~!__n~d__ on ~h~ule £ ITEM DESCRIPTION 1. SECURITY EQUITY FUND - CLASS B SECURITIES AMERICA, INC. 2322 BROAD AVENUE ALTOONA, PA 16601-1938 ACCOUNT NO. 1022-37099165 CUSIP: 814219200 NO. SHARES: 699.815 NAV / SHARE: $5.44 (9/26 - $5.41 / 9/29 - $5.47) 2. SECURITY EQUITY FUND - CLASS B SECURITIES AMERICA, INC. 2322 BROAD AVENUE ALTOONA, PA 16601-1938 ACCOUNT NO. 1002-37099191 CUSIP: 814219200 NO. SHARES: 2,076.814 NAV / SHARE: $5.44 (9/26 - $5.41 / 9/29 - $5.47) 3. MUTUAL FUND TEMPLETON WORLD FUND - CLASS A FRANKLIN TEMPLETON INVESTMENTS P.O. BOX 33033 ST. PETERSBURG, FL 33733-8033 ACCOUNT NO. 102-2910025476 NO. SHARES: 1,157.813 NAV / SHARE: $15.16 (9/26 - $15.15 / 9/29 - $15.17) 4. MUTUAL FUND PUTNAM INVESTORS 2322 BROAD AVENUE ALTOONA, PA 16601-1938 ACCOUNT NO. A30-1-20-6354921-BBCU TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE OF DEATH 3,806.99 11,297.87 17,552.45 3,932.55 $ 36,589.8~'~ STF PA42021F.4 (If more space is needed, insert additional sheets of the same size) REV-1504 EX + (1-97) (I) SCHEDULE C COMMONWEALTH OF PENNSYLVANIA CLOSELY-HELD CORPORATION, INHERITANCE TAX RETURN RESIDENT DECEDENT PARTNERSHIP or SOLE-PROPRIETORSHIP ESTATE OF MARY E. BRINK FILENUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships, ITEM NUMBER 1. DESCRIPTION TOTAL (Also enter on line 3, Recapitulation) $ VALUE AT DATE OF DEATH STFPA42021F.5 (If more space is needed, insert additional sheets of the same size) REV-1505 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY E. BRINK SCHEDULE C-1 CLOSELY-HELD CORPORATE STOCK INFORMATION REPORT FILE NUMBER Name of Corporation Address City 2. Federal Employer I.D. Number 3. Type of Business State Zip Code ProducFService State of Incorporation Date of Incorporation Total Number of Shareholders Business Reporting Year TYPE TOTAL NUMBER OF NUMBER OF SHARES VALUE OF THE STOCK Voting / Non-Voting SHARES OUTSTANDING PAR VALUE OWNED BY THE DECEDENT DECEDENT'S STOCK Common $ Preferred $ Provide all dghts and restrictions pertaining to each class of stock. 5. Was the decedent employed by the Corporation? [] Yes [] No If yes, Position Annual Salary $ 6. Was the Corporation indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ Time Devoted to Business 7. Was there life insurance payable to the corporation upon the death of the decedent? [] Yes [] No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 8. Did the decedent sell or transfer stock of this company within one year pdor to death or within two years if the date of death was pdor to 12-31-827 [] Yes [] No If yes, [] Transfer [] Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a wdtten shareholder's agreement in effect at the time of the decedent's death? [] Yes [] No If yes, provide a copy of the agreement. 10. Was the decedent's stock sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedenrs stock. B. Complete copies of financial statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of oflicers, their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedent's stock. STF PA42021F.6 REV-1506 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE O F MARY E. BRINK SCHEDULE C-2 PARTNERSHIP INFORMATION REPORT FILE NUMBER Name of Partnership Address City 2. Federal Employer I.D. Number 3. Type of Business 4. Decedent was a [] General State Zip Code Date Business Commenced Business Reporting Year ProductJService [] Limited partner. If decedent was a limited partner, provide initial investment $ PERCENT OF PERCENT OF BALANCE OF PARTNER NAME INCOME OWNERSHIP CAPITAL ACCOUNT A, B. C. D. 6. Value of the decedenrs interest $ 7. Was the Partnership indebted to the decedent? [] Yes [] No If yes, provide amount of indebtedness $ 8. Was there life insurance payable to the partnership upon the death of the decedent? [] Yes [] No If yes, Cash Surrender Value $ Net proceeds payable $ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was pdor to 12-31-827 [] Yes [] No If yes, [] Transfer [] Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet for additional transfers and/or sales. 10. Was there a wdtten partnership agreement in effect at the time of the decedent's death? [] Yes If yes, provide a copy of the agreement. 11. Was the decedent's partnership interest sold? [] Yes [] No If yes, provide a copy of the agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedenrs death? [] Yes [] No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? [] Yes [] No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? [] Yes [] No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. []No THE FOLLOWING INFORMATION MUST BE SUBMITTED WITH THIS SCHEDULE A. Detailed calculations used in the valuation of the decedenrs partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax retums (Form 1085) for the year of death and 4 preceding years. C. If the partnership owned real estate, submit a list showing the complete address/es and estimated fair market value/s. If real estate appraisals have been secured, attach copies. D. Any other information relating to the valuation of the decedent's partnership interest. STF PA42021F.7 REV-1507 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY E. BRINK SCHEDULE D MORTGAGES & NOTES RECEIVABLE FILE NUMBER All property jointly*owned with the right of survivorship must be disdo_ _~d on Schedule F. iTEM NUMBER DESCRIPTION 1. TOTAL (Also enter on line 4, Recapitulation) STFPA42021F.8 (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH REV-1508 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE 0 F MARY E. BRINK SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER Indude the proceeds of litigation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorship must be disc~,_-_,~,,_ j on Schedule F. ITEM NUMBER 2 3 4 DESCRIPTION Tangible Personal Property 2002 HONDA CIVIC 1993 OLDSMOBILE DELTA 88 1975 OLDSMOBILE DELTA 88 of Decedent TOTAL (Also enter on line 5, Recapitulation) VALUE AT DATE OF DEATH 4,570.00 10,540.00 680.00 295.00 $ 16,085.00 (If more space is needed, insert additional sheets of the same size) STF PA42021F.9 REV-1509 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA SCHEDULE F INHERITANCE TAX RETURN JOINTLY-OVVNED PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MARY E. BRINK If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A.DONNA M. CARVER DAUGHTER B. ROBERT J. BRINK 800 SHADY LANE ENOLA, PA 17025 502 NORTH HUMER STREET ENOLA, PA 17025 SON JOINTLY-OWNED PROPERTY: LE~ER DATE DESCRIPTION OF PROPER~ % OF D~E OF D~TH ITEM FOR JOINT MADE I~l~e ~ of fire.al imtiMion a~ bah a~ m~er or si~r ide~i¥~ ~ D~E OF DE~H DECUS NUMBER TENANT JOINT Affa~ d~ for~i~¥~D mai e~te, ~LUE OF ~LUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 1991 SAVINGS ACCOUNT 399.34 50 199.67 ACCRUED INTEREST .30 50 0.15 MEMBERS FIRST FEDERAL CREDIT UNIO~ 5000 LOUISE DRIVE, P.O. BOX 40 MECHANICSBURG, PA 17055 ACCOUNT NO. 118287-00 2. A. 1995 CERTIFICATE OF DEPOSIT 1,000 50 500.00 ACCRUED INTEREST 1.72 50 0.86 MEMBERS FIRST FEDERAL CREDIT UNIO~ 5000 LOUISE DRIVE, P.O. BOX 40 MECHANICSBURG, PA 17055 ACCOUNT NO. 118287-41 3. A. 1995 CERTIFICATE OF DEPOSIT 1,000 50 500.00 ACCRUED INTEREST 1.72 50 0.86 MEMBERS FIRST FEDERAL CREDIT UNIO~ 5000 LOUISE DRIVE, P.O. BOX 40 MECHANICSBURG, PA 17055 ACCOUNT NO. 118287-42 TOTAL FROM ADDITIONAL SHEET 17,618.45 50 8,809.23 ~T~(Alsoenteronline6, R~apitulation) $ 10,010.77 (If mom soac~ STF PA42021F. 10 ets of the sam e size) REV-1510 EX + (1-97) (I) COMMONV~_ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY E. BRINK SCHEDULE G INTER-VIVOS TRANSFERS & MlSC, NON-PROBATE PROPERTY FILE NUMBER 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 C OVER SHEET is yes. DESCRIPTION OF PROPER~ % OF ITEM I~L~E T~ ~E OF T~ T~SFEREE, T~IR RE~TIO~P TO DECEDE~ Am T~ D~E D~E OF DE~H DECD'S ~CLUSION TAXABLE V~UE NUMBEF OF TRANSFER. A~ACH A COPY OF T~ DEED FOR R~ ES~TE, ~LUE OF ASSET INTEREST (IF ~PLIC~LE) 1. SAVINGS ACOCUNT 50.09 100 50 09 0 0( PNC BANK ' ' 500 FIRST AVENUE PITTSBURGH, PA 15219 ACCOUNT NO. 5004134885 JOINTLY HELD WITH: DONNA M. CARVER, DAUGHTER & ALEXANDER CARVER ROBBINS DATE MADE JOINT: 01/10/2003 2. SAVINGS ACCOUNT 50.09 100 50 09 0 00 PNC BANK ' ' 500 FIRST AVENUE PITTSBURGH, PA 15219 ACCOUNT NO. 5004134893 JOINTLY HELD WITH: DONNA M. CARVER, DAUGHTER & NICHOLAS CARVER ROBBINS DATE MADE JOINT: 01/10/2003 TOT~(Alsoenteronline7, Recapitulation) $ (If mom ~n~ i~ n~=¢~l~ in~ ~+;^.^l .k^^,~ -z ..... 0 · 0 () STF PA42021F. 11 sheets of the same size) REV-1511 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER MARY E. BRINK Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 2. 3. 4. 8. 9. 10. 11. FUNERAL EXPENSES: W. ORVILLE KIMMEL FUNERAL HOME FRUIT HILL CEMETARY GRAVE OPENING SUMMERDALE CHURCH ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) ROBERT J. BRYkI~ Social Security Number(s) / EIN Number of Personal Representative(s) Street Address 502 N. HUMER ST. City ENOLA State F~ Year(s) Commission Paid: 2 0 0 4 Attorney Fees Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Zip Probate Fees Accountant's Fees Tax Return Preparer's Fees Publicaiton of Estate Notice RESERVE FOR COSTS AND EXPENSES INCLUDING HOUSE SALE REAL ESTATE APPRAISAL PERSONAL PROPERTY APPRAISAL REAL ESTATE MAINTENANCE COSTS:-QUALITY ROOTER -SADLER OIL -ALLSTATE INS. -CUMBERLAND LAND CLEARING -PP&L -VERIZON -PA AMERICAN WATER TOTAL (Also enter on line 9, Recapitulation) 7,139.75 315 5O 25 5,000 6,000 278 192 61 2,000 00 300 00 135 00 112 50 1,088 17 153 02 34O 00 144 52 60 37 96 42 23,430.36 (If more space is needed, insert additional sheets of the same size) STF PA42021F. 12 REV-1512 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE 0 F MARY E. BRINK SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 2 3 4 5 6 7 8 9 10 AT&T - PHONE BILL DUE AT DEATH EAST PENNSBORO SEWER/TRASH DUE AT DEATH COMCAST - CABLE BILL DUE AT DEATH EAST PENNSBORO AMBULANCE SERVICE PENNSYLVANIA POWER & LIGHT - ELECTRIC BILL DUE AT D LEGAL FEES DUE AT DEATH TO METZGER WICKERSHAM IRS-2003 TAXES FOREST PARK HEALTH CENTER VERIZON - PHONE BILL DUE AT DEATH SADLER OIL - FUEL BILL DUE AT DEATH TOTAL (Also enter on line 10, Recapitulation) AMOUNT 43 62 201 60 124 15 140 00 60 07 245 18 22 95 78 40 123 91 529 20 $ 1, 569. 08 (If more space is needed, insert additional sheets of the same size) STF PA42021F. 13 REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY E. BRINK SCHEDULE J BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLEDiS/NiBUTlONS[includeoutdghtspousaldistdbutions, andtmns~m underS~,9116(a)(1,2)] ROBERT J. BRINK 1. 502 NORTH HUMER STREET ENOLA, PA 17025 2. DONNA M. CARVER 800 SHADY LANE ENOLA, PA 17025 3. NORMA GILESPIE 8 CHATHAM COURT DOVER, DE 19901 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINE,~ FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) SON DAUGHTER DAUGHTER AMOUNT OR SHARE OF ESTATE 33.3% 33.3% 33.3% 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. S'TF PA42021F. 14 NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. 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) REV-1514 EX + (1-97) (I) COMMONWF_ALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY E. BRINK SCHEDULE K LIFE ESTATE, ANNUITY & TERM CERTAIN (Check Box 4 on Rev-'l$00 Cover Sheet) FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death on or after 5-1-89. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. E3 Will [-'] Intervivos Deed of Trust ['-] Other LIFE ESTATE IN i ~-REST CALCULATION NAME(S) OF NEAREST AGE AT TERM OF YEARS LIFE ESTATE IS LIFE TENANT(S) DATE OF BIRTH DATE OF DEATH PAYABLE [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years ue hich life estate is payable 2. Actuarial factor per appropriate table Interest table rate- []3 1/2% []6% I-]10% [-]Variable Rate 3. Value of life estate (Line 1 multiplied by Line 2) ANNUIT~ IN I t:REST CALCULATION NAME(S) OF NEAREST AGE AT TERM OF YEARS ANNUITANT(S) DATE OF BIRTH DATE OF DEATH ANNUITY IS PAYABLE [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years [] Life or [] Term of Years annuity is payable 2. Check appropriate block below and enter corresponding (number) Frequency of payout - [] Weekly (52) [] Bi-weekly (26) [] Quarterly (4) [] Semi-annually (2) []Annually (1) 3. Amount ofpayout per period 4. Aggregate annual payment, Line 2 multiplied by Line 3 5. Annuity Factor (see instructions) Interest table rate [] 3 1/2% []6% [] 10% Adjustment Factor (see instructions) [] Monthly (12) [] Other ( ) [] Variable Rate % Value of annuity- If using 3 1/2%, 6%, 10%, or if variable rate and period payout is at end of period, calculation is: Line 4 x Line 5 x Line 6 $ If using variable rate and period payout is at beginning of period, calculation is: (Line4 x Lines x Line 6) + Line3 $ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting Fife or annuity interest(s) should be reported at the appropriate tax rate on Lines 13, 15, 16 and 17. (If more space is needed, insert additional sheets of the same size) STF PA42021F. 15 REV-1647 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY E. BRINK SCHEDULE M FUTURE INTEREST COMPROMISE (Check Box 4a on Rev-1500 Cover Sheet) FILE NUMBER This schedule is appropriate only for esta~s of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. [] Will [] Trust [] Other I. Beneficiaries AGE TO NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH NEAREST BIRTHDAY 1. 2. For decedents dying on or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedent's death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdrawal right. [] Unlimited right of withdrawal [] Limited right of withdrawal Explanation of Compromise Offer: S.~i~-,aty of Compror~i~e Offer: 1. Amount of Future Interest 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as part of total shown on Line 13 of Cover Sheet) ........... $ 3. Value of Line 1 passing to spouse at appropriate tax rate CheckOne [~6%, []3%, []0% .......................... $ (also include as part of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 taxable at lineal rate Check One J--]6%, []4.5% ................................. $ (also include as part of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 Taxable at sibling rate (12%) (also include as part of total shown on Line 17 of Cover Sheet) ........... $ 6. Value of Line 1 Taxable at collateral rate (15%) (also include as part of total shown on Line 18 of Cover Sheet) ........... $ 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ................................ $ (If more space is needed, insert additional sheets of the same size) STF PA42021F. 16 REV-1649 EX + (1-97) (I) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF MARY E. BRINK SCHEDULE O ELECTION UNDER SEC. 9113(A) (SPOUSAL DISTRIBUTIONS) FILE NUMBER Do not complete this schedule unless the esta[e is making the election to tax assets under Section 9113 (A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arrangement, a separate form must be filed for each trust. This election applies to the Trust (marital, residual A, B, By-pass, Unified Credit, etc.). If a trust or similar ar~a~gement meets the requirements of Section 9113 (A), and: a. The trust or similar arrangement is listed on Schedule O, and b. The value of the trust or similar arrangement is entered in whole or in part as an asset on Schedule O, then the transferor's personal representative may specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule O, the personal representative shall be considered to have made the election only as to a fraction of the trust or similar arrangement. The numerator of this fraction is equal to the amount of the trust or similar arrangement included as a taxable asset on Schedule O. The denominator is equal to the total value of the trust or similar arrangement. PART A: Enter the description and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement. DESCRIPTION VALUE Part A Total $ PART B: Enter the description and value of all interests included in Part A for which the Section 9113 (A) election to tax is being made. DESCRIPTION Part B Total VALUE (If more space is needed, insert additional sheets of the same size) S'IF PA42021 F. 17 fftarp tg. rink I, MARY E. BRINK, of East Pennsboro Township, Cumberland County, Pennsylvania,. · being of lawful age, sound m/nd and memory, and under no restraint, do publish this as my Last Will, revoking all other Wills or Codicils previously made by me. FIRST: All expenses, fees, costs, and taxes related to this estate shall be paid from the probate estate assets, including but not limited to funeral expenses, grave marker, the costs of my final illness, Inheritance, Estate and Fiduciary Taxes; and all gifts and bequests shall be paid from the net distributable estate. SECOND: I give, devise, and bequeath my entire estate, real, personal, or mixed, of every kind and nature, and wherever situated, which I may own, or hereafter acquire, or have a right to dispose of at my death, to my three children, DONNA M. CARVER, NORMA GILESPIE, and ROBERT J. BRINK, share and share ahkeper stirpes. ' THIRD: I nominate and appoint my son, ROBERT J. BRINK, Executor of my Last Will, granting to him authority to sell and convey any or all of my estate, real and personal, or mixed, upon such terms and prices as he shall deem proper, without obtaining any prior order of the court therefor. IN WITNESS WHEREOF, I have hereunto subscribed my name, and acknowledge and publish this instrument as my Last Will in the presence of the undersigned witnesses, on August ~ 2003. WITNESSES: TESTATRIX Brink Estate Plan 287295-1 ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA · · SS COUNTY OF DAUPHIN . I, MARY E. BRINK, Testatrix, whose name is subscribed to the attached Will, being duly qualified according to law, do depose and say that I signed it willingly and that I executed it as my free and voluntary act for the purposes therein expressed. Sworn and subscribed to before me, this :'i ~ _,Q~xlay of August, 2003. Notary ~[;bli~ - ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF DAUPHIN AFFIDAVIT : ss Notarial Seal Angela M. Miller, Not~y Public . City_ of Harrisburg. Dauphin County ~Y Commission Expires Oct. 15, 2006 On this date, August &7 , 2003, before me personally appeared Young-suh Koo, known to me or satisfactorily proved to be a member of the bar of the highest court of Pennsylvania, and certified that she was personally present when the foregoing acknowledgment an davit were signed by the Testator and witnesses. ~~.~ oung-suh Koo . in witness whereof, I hereto set my hand and offici~J~al. N~tary~ubfic ' - [ Not.iai S~al I Angela M, Miller, Notary Public ! City Of Harrisburg, Dauphin County Ma * , the subscribed to the attached Will, being dul~, quahfied according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that she signed it 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 MARY E. BRINK signed the Will as witnesses; and that to the best of our knowledge she was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. W, ess s: Sworn and subscribed to before me, thisfi,0~day of A/~st, 2003. Nota3y P ,lic Brink ~stat. P_lea287295-1 Normal Se. al _An~ia M. Miller, Notary Public C~ty of Harrisburg. Dauphin County Mw i"~mmlt~inn I~anlm~ Oct. 15. 2006 Leon D. Gerlach, Appraiser Commercial, Industrial &. Residential . BRINK-317 2nd Street F~e No. M0403059B APPRAISAL OF LOCATED AT: 317 2nd Street Summerdale, PA 17093 FOR: BRINK, Robert 502 Hummei' SAtreet Enola, PA 17025 BORROWER: Robed BRINK Executor As March 15, 2004 BY: Leon D. Gerlach, MSA, MFLA, GAA, CCRA Pa Certified General Real Estate Appraiser Certification Number GA-000368-L 305 West Shady Lane, Enola, PA 17025-2240~.! .~. ~,? 717-732-5052 Fax 717-732-6646 Leon D. Gerlach, Appraiser Commercial, Industrial & Residential iBR NK-317 2nd Sire6 File No. M0403059B 03/18/2004 File Number: M0403059B Dear Robert: In accordance with your request, I have personally inspected and appraised the real property at: 317 2nd Street Summerdale, PA 17093 The purpose of this appraisal is to estimate the market value of the subject property, as improved. The property rights appraised are the fee simple interest in the site and improvements. In my opinion, the estimated market value of the property as of March 15, 2004 is: $110,000 One Hundred Ten Thousand Dollars The attached report con'tains the description, analysis and supportive data for the conclusions, final estimate of value, descriptive photographs, limiting conditions and appropriate certifications. Respectfully Submitted, A MFLA GAA CCRA Pa Certified General Real Estate Appraiser Certification Number GA-000368-L 305 West Shady Lane, Enola, PA 17025-2240 Phone 717-732-5052 Fax 717-732-6646 · email: gerlachl@vedzon.net 305 West Shady Lane, Enola, PA 17025-2240 Phone 717-732-5052 Fax 717-732-6646 FRANKLIN TEMPLETON INVESTMENTS Franklin Templeton Investor Services, LLC 1 O0 Fountain Parkway St. Petersburg, Florida 33716~1205 tel 800/632.2350 franklintempleton.com January 28, 2004 Metzger Wickersham Attn: David H. Martineau 3211 North Front Street P.O. Box 5300 Harrisburg, PA 17110-0300 SUBJECT: Templeton World Fund - Class A A/C # 102-2910025476 FTB&T CUST For The Rollover IRA Of Mary E Brink Dear Mr. Martineau: Thank you for your recent correspondence. Mary E. Brink held the referenced Individual Retirement Account (IRA) with Franklin Templeton Investments, which was established on January 25, 1991. We wish to confirm the following beneficiary information for the account: Designation Name Percentage Primary Robert James Brink 33.34% Primary Donna M. Carver 33.33% Primary Norma J. Gillespie 33.33% As September 28, 2003, was a non-business day, the fund was not priced. Therefore, we are providing you with the account value based on the price for the prior business day. According to our records, the referenced account held 1,157.813 shares on September 26, 2003. The net asset value of the Templeton World Fund - Class A at the close of market on September 26, 2003, was $15.15 per share, for a total dollar value of$17,540.87. Additionally, no interest had accrued as of September 26, 2003. We welcome any questions that you may have regarding this matter. You may contact a Shareholder Services Associate, Monday through Friday, 5:30 a.m. to 5:00 p.m. Pacific Time, toll fi-ee at 1-800/632-2350, ext. 35900, and refer to identification number: 812-26JAN04. Sincerely, Franklin Templeton Investor Services, LLC Patti Hudson Senior Associate Shareholder Services Templeton World Fund Class A Net Asset Value Date 30-Sep-03 29-Sep-03 26-Sep-03 25-Sep-03 Open 15.16 15.17 15.15 15.26 High 15.16 15.17 15.15 15.26 Low 15.16 15.17 15.15 15.26 Close 15.16 15.17 15.15 15.26 Volume Adj. Close* 0 14.87 0 14.88 0 14.86 0 14.97 DEC.1~.200B 12:26PM C R CASHMAM NO. SG7 P,1/1 December 10, 2003 Metzger Wickersham 3211 North Front Street PO Box 5;300 Harrisburg PA 173.10-0300 RE: Estate of Mary E Brink, Deceased SSN: 206-32-4921 The information you have requested for the above mentioned account is as follows: Putnam Investors - Account #A30-1-20-6354921-BBCU Registered: Mary E Brink TOD Multiple Beneficiaries Account opened .]une 19, 1998 Value as of 9/29/03 - $ 3,932.55 This account is not a daily accrued fund This interest from .lan I to Sept 28, 2003 is $45,14 Security Benefit - Account #37099191 This Is an Individual account for Mary E Brink Value as of g/29/03 - $11360.17 There wasn't any accrued interest for this account along with no interest from -lan I to Sept 28, 2003 Security Benefit - Account # 37099165 TI3is is an :[PA Rollover account for Mary E Brink Value as of 9/29/03 - $ 3827.99 There wasn't any accrued Interest for this account along with no interest from 3an :1 to Sept 28, 2003 If you have any questions, please feel free to call the office at 1- 800-722-0610. Sincerely, Clifford R Cashman DEC. 12.~OOB ~:B?PM C R CASHMAM 2322 Broad Avenue Al~oona, PA 16B01 (814) 944-2747. (B00)722-0610 Fax (814)g42-8694 HO. ~70 P. 1/1 Securities America M.-mb~r NASD/SIPI~ t DATE:. !_~_ _ i~,..o~ T 0 :~~, ~, e ~uz-- ATTENTION: FAX #: ") I-)- ~Hr,-- q'-t') ~ FRO M ¢~OF PAGES INCLUDING COVER: Michael D. Kittell Investment ReprasentatNe Securities America, Inc, Investment Advisor Representative Securities Arrlerlca Advisors, IrlC. Clifford R. Cast, man Branch Manager Securities America, Ir*lc. Investment Advisor Representative Sacurltles America Advisors, Inc, John J. Zerbee investment Representative S~curities America, Inc. Investment Advisor Representative Securities America Advisors, Inc. 'ROBERT ENSMINGER APPRAISERS REAL ESTATE and PERSONAL PR OPER TY 3557 ELMERTON AVENUE HARRISBURG, PA 17109-I 132 PHONE 717-652-4111 FAX 717-541-9444 E-MAIL: threecomps~comcast.net November 19, 2003 Robert Brink 502 N. Humer St. Enola, PA 17025 RE: Estate of Mary E. Brink Dear Mr. Brink: In accordance with your request, I have appraised the personal property of Mary E. Brink, deceased. The property is located at 317 Second St., Summerdale, PA 17093. The values shown have been arrived at after a careful study of the property. I believe it to reflect a true measure of its market value as of November 5, 2003. The value has remained unchanged since the date of death. Market value is defined as being the most reasonable or probable price in terms of money that real or personal property will bring in an open and competitive market under all conditions requisite to a fair sale, the buyer and seller each acting prudently and knowledgeably, and assuming the price is not affected by undue stimulus. Taking into account all of the factors set forth in the pages that follow, it is the opinion of the undersigned that the fair market value of the personal property is Four Thousand Five Hundred Seventy Dollars ($4,570.00.) Employment in and compensation for making this appraisal are in no manner contingent upon the value reported and I certify that I have no financial interest in the property appraised, present or contemplated. Very truly yours, Robert A. Ensminger Estate of Mary E. Brink ~Dry sink $ 125.00 Maple table w/6 chairs $ 350.00 Large maple hutch $ 500.00 Small maple buffet hutch $ 175.00 Milk glass $ 100.00 Misc. contents of small hutch $ 25.00 China - service for 12 $ 200.00 Misc. contents of corner hutch $ 20.00 Corner hutch $ 275.00 Drop leaf maple table w/6 chairs $ 150.00 'Maple rocking chair $ 75.00 Chopping block stand $ 50,00 2 wooden rockers $ 50.00 High table w/2 stools $ 40.00 Wooden swing & frame $ 90.00 2 lawn chairs $ 50.00 Amana refrigerator $ 125.00 Microwave oven $ 15.00 Pots, pans, bakeware $ 30.00 Dishes, glassware, utensils $ 20.00 Misc. small appliances $ 50.00 Crocks $ 50.00 Shop vac $ 45.00 Canning supplies $ 25.00 Loom $ 25.00 Totes $ 25.00 Misc. in basement $ 50.00 Lawn Chief mower $ 225.00 6' aluminum ladder $ 15.00 iY'ard Machine mower $ 75.00 Misc. in garage $ 20.00 Twin beds $ 100.00 Double dresser $ 120.00 Gun cabinet $ 150.00 Student desk $ 45.00 Sewing machine $ 40.00 File cabinet $ 15.00 Hoover canister vac $ 60.00 Double bed $ 100.00 Cedar chest $ 100,00 Tiger maple chest .of drawers $ 15.00 Bedroom Suite - double bed, dresser, chest on chest, night stand $ 300.00 Page 1 of 2 Estate of Mary E. Brink Misc. in first floor bedroom $ 15.00 Console TV $ 40.00 Couch $ 40.00 Oblong maple lamp table $ 40.00 Octagonal maple lamp table $ 40,00 2 table lamps $ 20.00 ,2 recliners $ 100.00 Stereo console $ 10,00 Maple coffee table $ 90,00 Limited edition print- Rockville Bridge $ 40.00 Misc. in living room $ 20.00 TOTAL, $ 4,570.00 Page 2 of 2 Kelley Blue Book Used Car Values Page 1 of 2 BLUE BOOK TRADE.IN VALUE Pennsylvania · June 16, 2004 2002 Honda Civic EX Sedan 4D Engine: 4-Cyl. 1.7L VTEC Trans: 5 Speed Manual Drive: Front Wheel Drive Mileage: 32,000 See Local Listings of This Car List Your Car For Sale Online Buy_ a New Ca_[ Free Lemon Check Auto___Loans fro_m 3.8_5% APR Insurance Quote Payment_Calculator Equipment Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Dual Front Air Bags Cruise Control ABS (4-Wheel) AH/FH Stereo Moon Roof Single Compact Disc Premium Wheels ................................... A~i Consumer Rated Condition: Good "Good" condition means that the vehicle is free of any major defects. The paint, body and interior have only minor (if any) blemishes, and there are no major mechanical problems. In states where rust is a problem, this should be very minimal, and a deduction should be made to correct it. The tires match and have substantial tread wear left. A clean title history is assumed. A "good" vehicle will need some reconditioning to be sold at retail; however major reconditioning should be deducted from the value. HoSt recent model cars owned by consumers fall into this category. Trade-In Value List Your Car For Sale Online $10,540 Trade-in value represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. _Get a Private Party Val~ G__e_t._In__v_p_i_c_.e~. MSRP on._N_ew httt~://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.PA;804588;PA041 & 17025;sed+t&39;Honda;,,, 6/16/2004 Kelley Blue Book Used Car Values BLUE 800K'TRADE.IH VALUE Pennsylvania · June 16, 2004 1993 Oldsmobile 88 Royale Sedan 4D Engine: V6 3.8 Liter Trans: Automatic Drive: Front Wheel Drive Mileage: 87,000 Equipment Air Conditioning Power Steering Power Windows See Local Listings of This Car List Your Car For Sale Online B u y _p._.N_e_ _w__C_a_r_ Free Lemon Check Auto Loans from 3.85% APR Insurance Quote Payment Calculator Tilt Wheel Arvl/FM Stereo ABS (4-Wheel) Consumer Rated Condition: Fair "Fair" condition means that the vehicle probably has some mechanical or cosmetic defects, but is still in safe running condition. The paint, body and/or interior need work to be performed by a professional in order to be sold. The tires need to be replaced. There may be some repairable rust damage. The value of cars in this category may vary widely. A clean title history is assumed. Even after significant reconditioning this vehicle may not qualify for the Blue Book Suggested Retail value. Trade-In Value List Your Car For Sale Online $680 Trade-in value represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. Get a Private Party Value Get Invoice & MSRP on New Cars .... , ....... ,_,_t. ~---n.,.n.: .n~n..., t. .... '>VAN Pa .'TqR'IRT-PAO41 &l 7025:sed+t&278;Oldsm... 6/16/2004 Kelley Blue Book Used Car Values Page 1 of 2 BLUE BOOK IILADLI# VALUE Pennsylvania · June 16, 2004 1984 Oldsmobile Delta 88 Royale Sedan 4D Engine: V8 307 Trans: Automatic Drive: Rear Wheel Drive Mileage: 147,000 Equipment Air Conditioning Power Steering See Local Listings of This Car List Your Car For Sale Online .~p_y a ~_e_w__~_a__r Free Lemon Check Auto _Loans_ from 3.8~5%_ APR Insurance Quote_ Pay_rn en_t Calculator AM/FM Stereo Consumer Rated Condition: Fair "Fair" condition means that the vehicle probably has some mechanical or cosmetic defects, but is still in safe running condition. The paint, body and/or interior need work to be performed by a professional in order to be sold. The tires need to be replaced. There may be some repairable rust damage. The value of cars in this category may vary widely. A clean title history is assumed. Even after significant reconditioning this vehicle may not qualify for the Blue Book Suggested Retail value. Trade.In Value List Your Car For Sale Online $295 Trade-in value represents what you might expect to receive from a dealer for this consumer owned vehicle. Keep in mind that the dealer must then absorb the cost of making the vehicle ready for sale, advertising, sales commissions, arranging financing and insurance and standing behind the vehicle for any mechanical or safety problems. Get a Pr__iy_at_e__Party Value Get In_vo_ic__~_e _&__MS~RB on New .Cars_ MEMBERS 1 FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established CERTIFICATES OF DEPOSIT: Account Number/Suffix Date Certificate Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established 118287 -00 01/04/1991 $399.34 $.30 $399.64 Donna M. Carver 01/04/1991 118287 -41 118287 -42 07/03/1995 07/03/1995 $1,000.00 $1,000.00 $1.72 $1.72 $1,001.72 $1,001.72 Donna M. Carver Donna M. Carver 07/03/1995 07/03/1995 118287 -44 118287 -45 07/03/1995 07/03/1995 $1,000.00 $1,000.00 $1.72 $1.72 $1,001.72 $1,001.72 Donna M. Carver Donna M. Carver 07/03/1995 07/03/1995 ~S lST~-~DERAL CREDIT UNION I n s u ~a n cA~ sWu°~feervis o r ~" December 3, 2003 Estate of: MARY E. BRINK Date of Death: 09/28/2003 Social Security Number: 206-32-4921 5000 Louise Drive · P.O. Box 40 · Mechanicsburg, Pennsylvania 17055 · (717) 697-1161 · wwve. memberslst.org JAN-O~=~00~ 17:~ ~NCBANK PNCBAN< January7,2004 DavidH. Martineau 3211No~h Front S~eet P.O. Box 5300 Harrisburg, PA 17110-0300 Estate of Mary E. Brink, deceased SSN: 206-32-4921 DOD; 9/28/2003 Dear Mr. Martineau: In response to your request for Date of Death balances for thc customer noted above, our records show the following: Checktn~ Account Account #5140111119 MARY E BRINK ROBERT J BRINK DOD balance: $11,778.90 + $.57 accrued interest Interest Paid 1/1/2003 - 9/28/2003 - $10.71 Bstablished 02/01/1970 Savings Accounts Account #5004134885 ALEXANDER CARVER ROBBINS MARY E BRINK DONNA CARVER DOD balance: $50.09 + $.01 accrued interest Interest Paid 1/1/2003 - 9/28/2003 - $.09 Established 01/10/2003 Account #5004134893 NICHOLAS CARVER ROBBINS MARY E BRINK DONNA CARVER DOD balance: $$0,09 +'$,01 accrued interest Interest Paid 1/1/2003 - 9/28/2003 - $.09 F.~tablished 01 / 10/2003 Page 1 of 2 JRN-06u2004 17:24 PNCBRNK P. 02 Account #5130108434 ROBERT J BRINK MARY E BRINK DOD balance: $3,833.65 + $1.89 accrued interest Interest Paid 1/1/2003 - 9/28/2003. $4.90 Established 03/31/1983 For Loan information, please call 1-888-762-2265. (Account) RCA #4003045018009365 Please note that this office only provides date of death balances for deposit accounts (IRAs, CDs, Checking and Savings accounts). We do not process say financial transactions or provide statements. If you need assistance with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by your local PNC Bank branch O~C~. Sincerely, Raehelle Wdls !-800-762-1775 P7-PFSC-04-F 500 first Ave. Pittsburgh PA 152 i 9 Page 2 of 2 Member FDIC TOTAL P.02 2001 MARKET STREET · HARRISBURG, PA 17103 TIMOTHY A. HOBBS, SUPERVISOR (717) 238-2502 STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges arc only for those items that you selected or tllat are required. If we are required by law or by a cemetery or crematory to usc any items, we will explain iii writing below. if you selected a funcra] thnl may require cmbahning, such as a funeral with viewing, you may have to pay for embalming. You do not have to pa). for cmbahning you {lid not approve if you selected arrangements such as a direct cremation or immediate burial. If wc ct!argcd for cmbahning, we will explain why below. For thc Servicc of ]'~_,j-,.,, fi, '-'~r,'~d I~' Date of Death J Charge 1o: A. CItARGE FOIl SERVICI~S SELECTED: I, PROFESSIONAL SERVICES Scr,,iccs of Funeral r)imctor/Slaff ..... $ Embalming ......................................... $ Olhcr prcparalion of body (Dress/Cosmetize) SLIB-TOTAL OF PI.IOI"E,%,$1ONAI, SERVICES ...... Al $ 2.FACILITIES. EQUIPMENT & STAFF Use ol [:atilt/les & Slairf Usc ~ir F;,.:ilidcs & Slaff f'~w Funeral (.e c~ o }. ..... $ ........ Usc nf Facilities & Slaft Ibr Mmnori:fl Service ..................... $ Use of [".quipmenl & tbr Gra,,esidc See',ice ..................... $ Use nr Equipmcltl & .~t;itl' f'o~ Church Service ....................... $ "~...(:~___ OIJICl USe of Facilities SUII-TOTAL O1: FACILITIE.%/EO, U[PMENT .......... 2,\2 $ _~__ 3. AUTOMOT1VLi F. QUIPMI~NT Local ................................................ $ Ilc.arsc (Ca~k¢ Limousine Local ................................................. $ Family Car Local ............................................. $ Fh:,wcr car or floral dislx~sition Local ............. ' ................................... l.cad car/dcsgy car (']ar for palllxzarers Local ............................................... $ Out oI Iown IransFx)rlation ................. $ ! $ $ SUiI-TOTAL OF AUTOMOTIVE EQUIPMENT .... A3 $ TOTAL OF PROFE.~SIONAL SER'VICE.%, FACII.ITIE.'-; AND AUTOMOTIVE EQUIPMEYr ..................................................................... A $ CIL/'.RGE FOR MERCHANDISE SELECTED: (Description) 'l(~..~cl ;,o Other Receptacle ................................ $ __ (Description) (hi{ce burial container ........................ $ ~ Acknowledgment cards ..................... $ J P, cgistcr book(s) ................................. $ Memory folders ................................. $ TcmporaD, grave markcr ................... $ -- Bt. mai clothing .................................. $ -- Address City State Other clothing Cremation m'n .................................... $ (Description) OTI IER $ $ MERCIIANDISE SELECTED .................... B $ .,...~_~" C. SPECIAL CIIARGES: [;c,~varllin§ of remains to $ G:uncral t Iomc) Receiving or rcmah~s from $ (Fro'meal l-tome) llnmcdiate Burial ............................... Direct Cremation .............................. $ $ SUII-TOTAL DF SPECIAL CHARGIaq ................. C $ D. C^Slt ADVANCED Opening grave .................................... $ "~ CcmeteW Equipment ......................... $ __ l'Icadsmnc Engraving ......................... Lot and Dccd ..................................... Ncwspapel Notices - Local ................ $ -- Ncv.'sl'~apc! Notices - Out-of-Town ,.. $ -- TclcF~lonc & Telegrams .................... Airrare ....... ~ ...................................... $ Clergy/M~ss Ofrcrin§ ........................ Organist I hmorarlum ......................... ' Pal]b,e:~rcrs t]onoradum ..................... Vault Sen'icc Charge ......................... $ lqowcrs .............................................. $ $ $ SUB-TOTAL OF ADYANCES ....................................... D $ We charge you [or our services in obtaining: (specify cash advam?es thai are mark. et.up) SUMMARY OF CI'IARGI~'] A. Professional Scn, iccs, Facilities and Equipmcm, ami Automotive Equipment .......................................... $ 7_.~ ~:~0 B. Merchandise ....................................... $ C. Special Charges ................................. D. Cash Advance .................................... $ TOTAL OF ALL SELECTIONS .................................. PAID AT TIME OF OR PRIOR TO ARRANGEMENTS .......................................................... .^~,~cE DuE ......................................... : ..................... $ R~,SO~ ~OR EmALMI~O-- . If any law, cemetery, o~crcrnatory rcqthrcmcms have required thc purchase o~y of thc tiaras lismd alx~vc, t~c law or raquimmcnt is explained tx:low. I agree thai I have examined thc items of goods and services selected above and found thcm to be correct and accordir~g to thc arrangements I have rcqtlcslcd. [ ackuowlcdge receipt of a copy of this Statement of Funeral Goods and Services Selected. I represent thai I have sufficient funds available for payment of tile cash price for thc goods and services selected. I also agree to make payment ors within·days. l agree to be jointly and sevcrally liablewithanyoneelsewhosignsbclow. Alatechargcof 1/'2 % permonthamountingto 6 % pcryearwfllbeapplicdtothcunpaidbalancebeginning 30 days from the date of this agreement. I will also pay [o the Funeral D/rector all reasonable costs paid by the Funeral Director to collect amounts lowc underthis agrccment. Thosccosts mayincludcat!omeys'fees,courtcosBandothercosts. Any adthtional services ormerchandiscordered orrequcstedaftcr thc dale of this agreement will l'm considered part or this agreement and thc cost thereof will be rc[lcaed on thc final bill or statement. (l'urchaser) ,t- ~ (l)¢te) O/ or"-',t~ e ~' (Purchaser) // /(l.i¢~$ed Funeral Director) Leon D. Gerlach, Appraiser Commercial, Industrial & Residential 305 West Shady Lane Enola, PA 17025-2240 Phone 717-732-5052 Fax 717-732-6646 BILL TO BRINK, Robert 502 Hummer SAtreet Enola, PA 17025 INVOICE * Forward to Accounts Payable * REFERENCE Invoice #: Invoice Date: Order Date: Appr. File #: Case #: Client File #: PO #: BRINK-317 2nd Street 03/18/2004 03/14/2004 M0403059B BRINK-317 2nd Street BRINK-317 2nd Street DESCRIPTION Borrower: Property Address: Robert BRINK Executor 317 2nd Street Summerdale, PA 17093 BILLING AMOUNT ~:'~'~ ~-~.~ $ 300.00 Total $ 300.00 Payment 1 Check ~: Date: ( ) Terms; Balance due upon receipt of invoice [ Balance Due $ 300.00 Federal Tax ~: 25-1684027/sp , PLEASE SEND A COPY OF INVOICE OR INCLUDE FILE No. WITH PAYMENT FOR CORRECT CREDIT Container Size: (CmcL~. ONE) ~ Date: 40 cy Delivery Date: PO Date: Cumberland Valley Land Clearing, Inc. Delivery Form Waste Disposal Division Contract Name: ~V~ I'~ Phone Number: -'~ '~ Located In Boro / Township (CIRCLE ONE) Daytime Phone: Quantity Required @ Deliver (Deposit will be., applied to ~31) ~m~ .~~posit Unit Price Total $340/@Del. Check # $160.00/ea $60.00/ton $20.00/wk $2.00/mile  11 Fee for Truck Each Pull ~oll-Off Box ~' Dumping Fee Dumping Fee of $60.00 per Ton ~I£~ot dumped weekly To set on site per week $20/wk -- Mileage If beyond 10 mile radius $2.00 per mile charge Total ~ ~/'~. 0(-') CVLC, WILL NOT be responsible for any damage if the below signed property owner request that the truck be driven over the property. CVLC will be held harmless regarding any concrete, driveways, blacktop areas, grOunds or property there on. All dumping is done under the direction of the below signed property owner. Delinquent charges of 1.5% per month will be added to all invoices that are over 30 days delinquent. Agreed to by ~ r~.~.~,~ ~ .,~.,~.L~ Customer Name Print Customer Name Date ~"~,..~'X~' ~ Employee Signature~ 6820 Wertzville Road, PO Box J, Enola, PA Phone: 717-766,6403 Fax: 717-766-8690 JORDAN D. CUNNINGHAM ROBERT E. CHERNICOFF MARC W. WITZIG BRUCE J. WARSHAWSKY JOHN M. HYAMS KELLY M. KNIGHT CUNNINGHAM & CHERNICOFF, P.C. ATTORNEYS AT LAW P.O. BOX 60457 HARRISBURG, PENNSYLVANIA 17106-0457 TELEPHONE (717) 238-6570 FAX (717) 238-4809 August 3, 2004 HERSHEY TELEPHONE (717) 534-2833 IRS NO. 23-2274135 Street Address: 2320 N. 2nd Street Harrisburg, PA 17110 The Honorable Glenda F. Strausbaug Register of Wills and Clerk of Orphans' Court County of Cumberland One Courthouse Street Carlisle, PA 17013-3387 RE: Estate of Mary E. Brink File No: 604604 Dear Madam: Attached find three (3) copies of the Pennsylvania Inheritance Tax - Schedule F - Jointly Held Property for the above referenced case. Kindly time-stamp and remm two (2) copies our files. Should you have any questions, please do not hesitate to contact me. Very truly yours, Attachments [ Jt/lieanne Ametrano Assistant PENNSYLVANIA INHERITANCE TAX ESTATE OF MARY E. BRINK SCHEDULE F - JOINTLY HELD PROPERTY CONTINUATION Date made Date of Death % of joint Value D~cd's Inte~st 1995 CERT. OF DEPOSIT $1,000.00 50% MEMBERS FIRST, FCU 5000 LOUISE DRIVE P.O. BOX 40 MECHANICSBURG, PA 17055 ACCOUNT NO. 118287-44 5. A. 1995 Accrued Interest CERT. OF DEPOSIT MEMBERS FIRST, FCU 5000 LOUISE DRIVE P.O. BOX 40 MECHANICSBURG, PA 17055 ACCOUNT NO. 118287-45 Accrued Interest $ 1.72 50% $1,000.00 50% $ 1.72 50% Date of death value of Decedeot's Intm~st $ 500.00 $ 0.86 $ 500.00 $ 0.86 6. B. 1970 CHECKING ACCOUNT PNC BANK e- 500 FIRST AVENUE ~,~ !::~'~TTSBURGH, PA 15219 ~ ~i ACCOUNT NO. 5140111119 ,~ ~ .~cmed Interest 7. 1983Z AWN S^CCOU rr '~00 FIRST AVENUE PITTSBURGH, PA 15219 ACCOUNT NO. 5004134885 Accrued Interest TOTAL FOR CONTINUATION PAGE: $11,778.90 50% $ 0.57 50% $ 3,833.65 50% $ 1.89 $17,618.45 5O% $5,889.45 $ 0.28 $1,916.83 $ 0.95 $8,809.23 296328-1 "~ ;i IN RE: ESTATE OF MARY E. BRINK, B Y ROBERT J. BRINK, EXECUTOR Decedent's SSN: 206-32-4921 Date of Death: 09/28/03 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION :DOCKET NO. 21-03-00876 TO: REGISTER OF WILLS AND CLERK OF ORPHANS' COURT PRAECIPE TO ENTER APPEARANCE/CHANGE OF ADDRESS AND LAW FIRM AFFILIA TION OF COUNSEL Bruce J. Warshawsky, Esquire has changed his law firm affiliation and address and will continue to represent Executor of the Estate of Mary E. Brink, Robert J. Brink, in the above captioned action. Dated: Please kindly enter the appearance of Bruce J. Warshawsky, Esquire and the Law Firm of Cunningham and Chernic off,, P.C., on behalf of Executor of the Estate of Mary E. Brink, Robert J. Brink, in the above captioned action. CUNNINGHAM & CHERNICOFF, P. C. PA Supreme Court ID# 58799 CUNN1NGHAM & CHERNICOFF, P.C. 2320 N. Second. St. Harrisburg, PA 17110 Mailing Address: P.O. Box 60457 Harrisburg, PA 17106-0457 (717) 238-8187 Attorneys for Executor, Robert J. Brink PRAECIPE TO WITHDRA W APPEARANCE Kindly withdraw the appearance of Metzger, Wickersham, Knauss & Erb, P.C. on behalf of Robert J. Brink, Executor of the Estate of Mary E. Brink, in the above captioned action. Dated: METZGER, WICKERSHAM, KNAUSS & ERB, P.C. By S~Esquire' ~ PA Supreme Court ID# 38901 Metzger, Wickersham, Knauss & Erb, P.C. 3211 N. Front. St. Harrisburg, PA 17110 (717) 238-8187 CERTIFICATE OF SERVICE I, Julieanne Ametrano, Legal Secretary for the law office of Cunningham & Chemicoff, P.C., do hereby certify that a tree and correct copy of the Praecipe to Withdraw Appearance/Enter Appearance in the above-captioned matter was sent first class U.S. Mail, First Class Mail, postage prepaid on this date, to the following: Steven P. Miner, Esquire METZGER, WICKERSHAM, KNAUSS & ERB, P.C. 3211 North Front Street Harrisburg, PA 17110 Date: CUb~INGHAM & CHERANICOFF, P.C. Julieanne Ametrano 2320 North Second Street P.O. Box 60457 Harrisburg, PA 17110 (717)238-6570 BUREAU OF :'N~TVIDUAL TAXES ZkI'ERZTANCE TAX DZVZSZOfl D~PT, 18060! BRUCE J HARSHANSKY METZGER ETAL PO BOX 5300 HB6 CONNONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT; ALLOffANCE OR DZSALLONANCE OF DEDUCTIONS ANO ASSE$SHENT OF TAX DATE 08-16-Z004 ESTATE OF BRINK NARY DATE OF DEATH 09-28-2005 FILE NUH~ER 21 03-0876 COUNTY CUHBERLAND ACN 101 HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ~-VT--~-_L-.O-_N.~..'r.H.~.~_~. ...... ..~__._.~.T.~_.~.~.~._P.O_RTION FO~.YO~R .R. ECORDS - 1~47 EX AFP (01-032 NOTICE OF ZNHERZTANC~'~,~'~'~'~i~"~y~'~-~ .................. DISALLONANCE OF DEDUCTIONS AND ASSESSNE~T-~-~ ESTATE OF BRINK MARY E FILE NO. 21 03-0876 ACM 101 DATE 08-16-2004 TAX RETURN #AS: (X) ACCEPTED AS FILED ( ) CHANGED ~VAT;ON CONCERNING FUTURE INTEREST - SEE REVER~ APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R~I Estate (S~h~dulo A) 2. Stocks ~d Bor~s (Schedule B) 3, Closely ~ld S~/Pur~rsh/p Zn~oros~ (S~o~lo C) 4. ~r~ps~oe R~olv~lo (S~o~lo D) 5. Cas~B~ ~slts/Hisc. Perm1 Propor~y (Sc~Io E) 6. Jointly ~ P~ort~ (S~1o F) 7. Tr~sfors (S~1o ~) 8. To~ul ksn~s APPROVED DEDUCTIONS AND EXEHPT~ONS: 9. F~ml E~n~A~. Cos~s~l,. Ex--ns (Sc~ls H) 10. ~ts~r*~ L/~ilitlus/Ll~s (~lo Z) 11. Total ~tl~s (1) 110,000.00 (2) 36 589.86 (s) .00 (4) . O0 (s) 16 065.00 (6) 10,010.77 (7) .00 (8) NOTE: To lnmJre proper ormJt~ to your a~mmt; s~dmlt the upper portion of thio form wi/th your 172,685/65 (9) 23,430.36 (10)~ c11) ---Z9.,9.9.9_~_ 12. Net Vnlue of Trax Return (12) 147;686.19 13. C:hmrltmble/governmentul Bequests; Non-ole~ted 9113 Tr~lStS (S~hedulo J) (13) .00 14. Net Velum of Estmtm Std)Jeot to Trax (14) 147,686.19 NOTE= Z~ an assasnerrt #as Issued previously, 11nos 16, 15 and/or 16, 17, 18 and 19 sL reflect figures that include the total o~ AL~ returns assessed to date. ASSESSMENT OF TAX: TNTEREST/PEN PAID (-) 229.30 .00 I~T~KcST Is CHARGED THROUGH 08-31-Z004 AT THE RATES APPLICABLE AS OUTLINED ON THE REVERSE SIDE OF THIS FORM ZF PAZD AFTER DATE INDICATED; SEE REVERSE FOR CALCULATION OF ADDITIONAL I~rrEREST. (1s) .00 x 00 = .00 (16) 147,686.19 x 045= 6,645.88~: (17) .00 x 12 = .00 (18) .00 X 15 = .00 (19)= 6,645.88 ~ PAID [ 4,356.74 I TGTAL~TAX CREDIT I 6;221.67 ]BALANCE OF TAXDuEI 424.21 Z~TE~E~T AND PEN. f 2.99 TOTAL DUE ] 427.20 ( IF TOTAL DUE IS LE~ THAN el~ NO PAYHLrNT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A 'CBEDZTW (CR), YOU HAY BE BUE A REFUND. SEE REVERSE SIDE OF THIS FORte FOR ZNSTRIJCTZON$.) RESERVATION: Estates of decedents dying on or before December 12, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rata an any such future interest. PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZI~O of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (TZ P.S. Section 91~0). Detach the top portion of this Notice 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 be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications are available at the Office of the Register of Hills, any of the Z3 Revenue District Offices, or by calling the special Z~-hour ansaaring service for forms ordering: 1-800-36Z-ZO50; services for taxpayers aith special hearing and / or speaking needs: 1-BOO-qq7-3OZO (TT only). Any party in interest not satisfied aith the appraisement, allowance, or disalloaanca of deductions, ar assessment of tax (including discount or interest) as sheen on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to t~e PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171ZS-iOZ1, OR --election 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 should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. If any tax due is paid aithin three (3) calendar months after tho decedent's death, a five percent (5Z) discount of the tax paid is allowed. The lSZ tax amnesty non-participation penalty is computed on tho total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. Th[s non-participation penalty is appealable in the same manner and in the the same time period as you wouZd appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning eith first day of delinquency, or nine (9) months and one (I) day from the date of death, to the date of payment. Taxes which became deIinquent before January 1, 198Z bear interest at the rate of six (SZ) percent per annum calculated at a daily rata of .O0016q. All taxes which became delinquent on and after January 1, 1982 wilI bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOq are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z 20Z . O00Sq8 ~)'~'8 - 1991 11Z .000301 ~ 9Z .O00Zq7 1983 16Z .000q38 199Z 97. . O00Z~7 2002 6Z . O0016~ 198~ 112 .000301 1993-199~ 72 .O0019Z 2003 5Z .000137 1985 X3Z .000356 1995-1998 92 .0002q7 ZO0~ fiZ .000110 1986 lOX .ooog7q 1999 7Z .00019Z 1987 107. .OOOZ7~, ZOO0 7Z .O0019Z --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUMBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. COMMONWEALTH OF PENNSYLVANIA DEPARTMENTOFREVENUE BUREAU OFINDIVIDUAL TAXSS DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX(11-96) NO. CD 004323 BRINK ROBERT J 502 NORTH HUMER STREET ENOLA, PA 17025 ........ fold ESTATE INFORMATION: SSN: 206-32-4921 FILE NUMBER: 2103-0876 DECEDENT NAME: BRINK MARY E DATE OF PAYMENT: 08/30/2004 POSTMARK DATE: 08/30/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/28/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $427.20 REMARKS: TOTAL AMOUNT PAID: $427.20 SEAL CHECK# 3144 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-15¢7 EX AFP (Ol-03) BRPCE ,J W/~HAWiK¥~~ HEYZ~R ET~.. HBG P:A 17110 DATE 08-16-Z00q ESTATE OF BRINK DATE OF DEATH 09-28-Z005 FILE NUMBER 21 05-0876 COUNTY CUMBERLAND ACN 101 Amount Raa'i t'l:ad HARY E HAKE CHECK PAYABLE AND REHZT PAYHENT TO: REGISTER OF WILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUt ALONG THIS LINE ~DCT~, RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-15gi7 EX AFP [01-03) NOTICE OF INHERITANCE TAX APPRAZSEHENT~ ALLOgANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ESTATE OF BRINK HARY E FILE NO. 21 05-0876 ACN 101 DATE 08-16-200q TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED OH: 1 2 $ 6 ORIGINAL RETURN Real Estate (Schedule A) (1) Stocks and Bonds (Schedule B) (2) Closely Held Stock/Partnership Interest (Schedule C) ($) Hortgages/Notes Receivable (Schedule D) (q) Cash/Bank Doposits/Hisc. Personal Property (Schedule E) ($) Jointly Owned Property (Schedule F) (6) (7) 7. Transfers (ScheduZe G) 8. Total Assets APPROVED DEDUCTIONS AND EXEHPTZONS: 9. Funeral Expansas/Adm. Costs/Hisc. Expanses (Schedule H) 10. Debts/Hortgage LiabiZities/Lians (Schedule 1) 11. Total Deductions 12. Nat VaZua of Tax Return 110z000.00 56~589.86 O0 O0 16z085.00 10;010.77 O0 (8) (9) 23,q50.56 (10) NOTE: To insure proper credit to your account, submit the upper portion of this form with your ~ax payment. 15. NOTE: 172,685.65 1,569.08 (11) 2~ .999. ~ (12) lq7,686.19 Charitable/governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) Net Value of Estate Subject to Tax (Iq) Zf an assessment ~as issued previously, lines 1~, 15 and/or 16, 17, 18 and 19 will IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULAT/ON OF ADDITIONAL INTEREST. (la) .00 X O0 = .00 (la) 1~7,686.19 x OR5= 6,6~5.88 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= 6,6q5.88 AHOUNT PAID ~,556.7q 1,655.65 TOTAL TAX CREDIT I BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYHENT ZS REQUIRED. REVERSE SIDE OF THIS FORM 6,221.67 qZq.21 2.99 ~27.20 IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) INTEREST IS CHARGED THROUGH 08-51-200~ AT THE RATES APPLICABLE AS OUTLINED ON THE ASSESSHENT OF TAX: 1.6. Amoun~ of Line lq at Spousal rate 16. Amount of Line lq taxable at Lineal/Class A rat:a 17. Amount of L/ne lq at Sibling rata 18. Amount of Line Zq taxable a~ CollataraZ/Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT RECETpT DTSCOUNT (+) DATE NUMBER TNTEREST/PEN pATD (-) 12-26-2005 CD005:578 229.50 06-25-200q CD00q090 .00 .00 lq7,686.19 reflect figures that include the total of ALL returns assessed to date. RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. PURPOSE OF NOT[CE: PAYNENT: REFUND (CR): OBJECTIONS: ADH/N- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of Nills 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 be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS13). Applications are available at the Office of the Register of Hills, any of the ZS Revenue District Offices) or by calling the special Z4-hour answering service for forms ordering: 1-800-36Z-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (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 Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. ZBIOZ1, Harrisburg, PA 17128-1021, OR --election 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 should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 171ZB-0601 Phone ¢717) 7B?-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedent's death, a five percent (JZ) discount of the tax paid is allowed. The 1SZ tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner end in the the same tiaa period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (6X) percent per annum calculated at a daily rate of .000164. Al1 taxes which became delinquent on and after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOO4 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor ~ lOX .000548 1988-1991 llZ .000501 2001 9Z .000Z47 1983 162 .000438 1992 92 .000247 2002 62 .000164 1984 11Z .OOO301 1993-1994 7Z .000192 2005 SZ .000137 1985 13Z .000356 1995-1998 9Z .000Z47 2004 4Z .000110 1986 lOZ .000274 1999 7Z .00019Z 1987 IOZ .000274 ZOO0 7Z .O00IgZ --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (IS) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG,, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ZNHERZTANCE TAX STATEHENT OF ACCOUNT REV-I&O? EX AFP (OZ-OS) BRUCE J WARSHAWSKY METZGER ETAL PO BOX 5500 GC[ 25 DATE lO-1Z-ZOOq ESTATE OF BRINK DATE OF DEATH 09-28-2005 FILE NUMBER 21 05-0876 COUNTY CUMBERLAND Amoun~ Remi*~ed MARY E HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~ *he upper portion of ~his form wi~h your *ex paymen*. CUT ALONG THZS L'rNE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV-1607 EX AFP (01-03) xxx INHERITANCE TAX STATEMENT OF ACCOUNT xxx ESTATE OF BRINK MARY E FILE NO. 21 05-0876 ACN 101 DATE lO-1Z-200q THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHO#N BELO# IS A SUHHARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-16-200~ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 6,6~5.88 PAYMENT DATE 12-26-2005 06-25-200fi 08-$0-200~ RECEIPT NUMBER CD005578 CDOOq090 CDO0~$Z5 DISCOUNT (+) INTEREST/PEN PAID (-) 229.50 .00 2.9~- AMOUNT PAID q,556.7~ 1,655.65 q27.20 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE KS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" TOTAL TAX CREDIT 6,6fi5.95 IALANCE OF TAX DUE .05CR /NTEREST AND PEN. .00 TOTAL DUE .05CR YOU HAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. ) PAYMENT: Detach the top portion of this Notice and submit with your payment made payable to the name and address printed on the reverse side. -- If RESIDENT DECEDENT make check or money order payable to: REGISTER OF NILLS, AGENT. -- If NON-RESIDENT DECEDENT make check or money order payable to: COMMONNEALTH OF PENNSYLVANTA. REFUND ¢CR3: REPLY TO: DISCOUNT: PENALTY: A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application far Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications are available at the Office of the Register of Nills, any of the Z5 Revenue District Offices or from the Department's Zq-hour answering service for fores ordering: l-BOO-362-Z050; services for taxpayers eith special hearing and / or speaking needs: 1-BOO-qqT-5OZO (TT only). questions regarding errors contained on this notice should be addressed to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. ZS0601, Harrisburg, PA 171ZB-O601, phone (717) 7B7-650S. If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is allowed. The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and Dna [1) day free the date of death, to the date of payment. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (SZ) percent per annum calculated at a daily rate of .O0016q. All taxes which became delinquent on and after January 1, 198Z wiIl bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZO0~ ara: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Year Rate Factor 198Z ZOX .0005q8 1988-1991 112 .000501 ZOO1 9Z .OOOZq7 1983 162 .000q58 199Z 92 .0002q7 200Z 62 .00016~ 198~ llZ .000501 1993-199~ 72 .00019Z 2003 5Z .00D157 19BS 132 .000556 1995-1998 92 .O00Zq7 ZOOq qZ .000110 1986 IOZ .O00ZTq 1999 7X .O0019Z 1987 9Z .0002q7 ZOO0 8g .000Z19 --Interest is calculated as follows: TNTEREST = BALANCE OF TAX UNPATD X NUHBER OF DAYS DELI'NQUENT X DAftLy TNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of thm assessment. If payment is made after the interest computation date shawn on the Notice, additional interest must be calculated. Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 8/30/2005 WARSHAWSKY BRUCE J ESQ CUNNINGHAM AND CHERNICOFF P.C. PO BOX 60457 HARRISBURG, PA 17110-0457 RE: Estate of BRINK MARY E File Number: 2003-00876 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.1, for decedents dying on or after July 1, 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: 9/28/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~i Y ., ~_e,"~AJ~ /1" / GLENDA FAP~ER STPASBAUGH REGISTER OF WILLS cc: File Personal Representative(s) Judge & r"~:> R~~~!V ~g oq 1 @ f~JflY Estate of BRINK MARY E Late of EAST PENNSBORO TOWNSHIP ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA Estate No.: 21-03-00876 Date: 10/17/2005 NO.: 21-03-00876 WARSHAWSKY BRUCE J ESQ CUNNINGHAM AND CHERNICOFF P.C. PO BOX 60457 HARRISBURG PA 17110 0457 NOTICE OF FAILURE TO FILE STATUS REPOR'!' JUm REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME: COURT ORPHANS I COURT RULE .... Personal Representative: BRINK ROBERT J Personal Representative Counsel: WARSHAWSKY BRUCE J ESQ Date of Decedent's Death: 9/28/2003 Date of Delinquency Notice: 9/28/2005 The undersigned, G~enda Farner Strasbaugh, Clerk of Orhans' Court, in accordance wlth rule 6.12, SUpreme Court Orphans' Court Rules, hereby notifies the Orphans' ,COUrt Division, Court of Common Pleas of Cumberland County, that nelther the above named personal representative nor their counsel, h~ve filed with the Register of Wills or Clerk of Orphans' Court, hlS/her Status Report required by Rule 6.12, Supreme Court Orphans' Court RUle, and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orhans' Court Rules, was given by the Clerk o~ Orphans' Court on 9/02/2005 and that the ten (10) day notice to flle the status report has expired. Accordingly, in a~cordance With Rule 6.12 the Court is hereby notified of such de17nquency and the undersigned requests that a Court conduct a hearlng to determine whether sanctions should be imposed upon the delinquent Personal representative or their counsel. cc: File Personal Representative Counsel ~~~ Glenda Farner Strasbaugh Clerk of Orhans' Court dll A hearing is scheduled for November~, 2005 at 10:00 AM in Courtroom No.2. If the Status Report is fil~r to the hearing date, the hearing will automat~~elled' ~ Bayley'J. STATUS REPORT UNDER RULE 6.12 Name of Decedent Date of Death Will No. Mary E. Brink 9-28-03 Admin No. 2003-~ ~7b Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: 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 account is: b. The separate Orphans' Court No. (if any) for the personal representative's in interest? c. Did the personal representative state an account informally to the parties Yes -L 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. Date: ~.J_'\)i' .C',:- . .'Y' ') Name Bruce J. Warshawsky. Esquire c '~ (-; Address 2320 North Second Street P.O. Box 60457 '-- t ' Harrisburg. PA 17106-0457 Telephone (717) 238-6570 Co '."J {--- ' i._"<} c.-""-J Capacity: Personal Representative X Counsel for Personal Representative F;\J10MEIBJW\DOCSIBRlNKI612FORM. WPD Bj w\docs\fonns\estatead\612fonn L.~ - APPROVAL OF ACCOUNT, RELEASE AND INDEMNIFICATION ESTATE OF MARY E. BRINK, DECEASED TInS AGREEMENT is made this 1)/ day of () c fo hv 2004, by and among Robert J. Brink, Executor (the "Executor"), Robert Brink, Donna Carver and Norma Gillespie, residuary beneficiaries and heirs ("Beneficiaries") of the late Mary E. Brink ("the Decedent"). The Beneficiaries desire that the administration of Decedent's estate be terminated and that the Estate be distributed without the expense, delay and formality of a court accounting. The Beneficiaries, by executing this Agreement, agree to the proposed distribution as set forth in this document. The Executor of the Estate is willing to consent to such a distribution upon receipt of a proper release and indemnification, which it is the purpose of this document to provide. In consideration of the willingness of the Executor to make distribution without the formality of a court accounting and agreeing to be legally bound hereby, the undersigned individually and on behalf of their heirs, personal representatives, Successors and assigns have entered into this Agreement. 1. Decedent died on September 28, 2003, and her estate is in probate, Letters of Testamentary having been duly granted to the Executor by the Register of Wills of Cumberland County on October 24, 2003. Executor has proceeded with the administration of the estate in accordance with the provisions of Pennsylvania Statutes, and more specifically, 20 Pa.C.S.l 01, et. seq. 2. At the time of Decedent's death, her entire eS1'.i!~e consisted of real estate, personal property, depository accounts, cash and cash equivalents. ".' 3. The Executor advertised the Grant of Letters Testamentary on November 14, 2003, November 21,2004 and November 28,2003 in the Sunday Patriot News and on November 18, 2003, November 25, 2003 and December 2, 2003 in the Cumberland County Law Journal, filed a Pennsylvania Inheritance Tax Return and federal and state income tax returns as required, and paid the Inheritance Tax and Income Taxes due. 4. The Executor has paid all the debts and expenses of the estate known to her. The Executor has no knowledge of any unpaid claims, absolute or contingent, which may be asserted against the estate, nor does he have any reason to believe there are any such claims. 5. The Beneficiaries declare that they have examined the attached Summary of Account and have accepted it as an informal accounting, find it to be true and correct in all particulars; approve it with the same force and effect as if it had been prepared as a formal accounting and filed with, audited, adjudicated and confirmed absolutely by a court of competent jurisdiction; and as if the balance of principal and income had been awarded by the Court in accordance with the schedule of distribution; and, they further: 6. Warrant that the beneficiaries are the sole remaining parties in interest in the estate and entitled to receive the entire distribution thereof in accordance with the attached informal account and statement of distribution; 7. Warrant the undersigned know of no outstanding and unsatisfied claims against the estate; 9. Absolutely and irrevocably release and discharge the Executor, and her heirs, personal representatives, successors and assigns of and from any and all actions, liabilities, claims and demands 8. Approve the distribution of the estate as set forth herein, attached as Exhibit "A"; - relating in any way to her administration of the estate and distribution in accordance with the infonnal account and statement/schedule of distribution and without a court accounting and adjudication; 10. Agree to indemnify and hold hannIess, the Execulor, and her heirs, personal representatives, successors and assigns, from and against any claims, liabilities, loss or expense (including costs and counsel fees) arising from any cause whatsoever, which the Executor may incur as a result of the administration of the estate and its distrihotion in accordance with this Agreement inclnding, hnt not limited to, any liability for any federal estate taxes, Pennsylvania Inheritance tax or any other death taxes, and any federal or Pennsylvania income taxes, and Pennsylvania personal property taxes, together with any interest and costs incidental thereto, relating in any way 10 the estate; and also including, but not limited to, any assets received or payments or distributions made by reason of any negligence or mistake of law or fact. 11. Should any proper liabilities of the estate, whether for taxes or otherwise, arise or come to the attention of the Executor or any of the Beneficiaries thereafter, the Beneficiaries agree to be jointly and severally liable therefore. 12. This Agreement may be executed in multiple counterparts, and, when so executed, shall be binding upon all of the parties and their respective heirs, next-of-kin, penonal representatives and assigns, IN WITNESS WHEREOF, the parties have hereunto set their hands and seal the day and year fIrst above written. EXECUTOR: BENEFICIARIES: l<~ C-y. 73~ Rob:~ ~~.J ~~A~c.-. Donna Carver lZ~ J- i3~~ Robert J. Brink ~---..... .-J:1..J OOo~<P' ~ Norma Gillespie - I STATE OF PENNSYL VANIA COUNTYOF ilWfJ/~ ;6J /l~I~ On this, the day of M , 2004, before me the undersigned Notary Public, personally appeared Donna Carver, who acknowledged that she executed the foregoing instrument for the purposes therein contained. : ss F, I have hereunto set my hand and official seal. NOTARIAL SEAL JULlEANNE AMETRANO, Notary Public City of Harrisburg, PA Dauphin County My Commission Expires ~_~b. 22, 2007 - STATEOFPENNSYLV~A COUNTYOF ~~/Uh' :~ On this, the /~ day of ()rifo~ ,2004, before me the undersigned Notary Public, personally appeared Norma Gillespie, who acknowledged that she executed the foregoing instrument for the purposes therein contained. , I have hereunto set my hand and official seal. ary Public Commission Expires: NOTARIAL SEAL JULlEANNE AMETRANO, Notary Public City of Harrisburg, PA Dauphin County My Commission Expires Feb. 22, 2007 JA\JMH\DOCS\BRINK\FAMSET2 . STATE OF PENNSYL VANIA COUNTY OF L()_~ I~ On this, the !~ day of a:h~ ,2004, before me the undmigned Notary Public, personally appeared Robert 1. Brink, who acknowledged that he executed the foregoing instrument for the purposes therein contained. :ss NOTARIAL SEAL JUlIEANNE AMETRANO, Notary Public City of Harrisburg, PA Dauphin County My Commission Expires Feb. 22, 2007 . . Cash and Cash Equivalents on Date of Death: Security Equity Fund #1022-37099165 Security Equity Fund #1022-37099191 Templeton Fund Putnam Fund Refund from Healthsouth TOTAL CASH EQUIVALENTS REAL ESTATE-317 Second St./PROCEEDS OF SALE Personal Property owned (non-Cash) on Date of Death: 2002 Honda Civic 1993 Oldsmobile 1975 Oldsmobile Household Goods 3806.99 11297.87 17552.45 3932.55 700.00 10540.00 680.00 295.00 4570.00 TOTAL PERSONAL PROPERTY NON-CASH DISTRIBUTED IN KIND EQUALLY TOTAL VALUE OF ESTATE AT DOD CASH FROM ASSETS AVAILABLE FOR DISTRIBUTION EXPENDITURES: Funeral expenses Probate Legal Advertisement Attorney Fees paid to Metzger Wickersham Attorney Fees paid to C&C for Estate Admin. Attorney Fees paid to C&C for Real Estate Sale Executor Fee Appraisal Fees Decedent's last debts per Sched. I of Tax Return R.E. Maint. Costs reported on Sched. H of Tax Return Bank Charges/Misc. expenses Law Office Costs: Postage, Mileage, etc. TOTAL EXPENDITURES Inheritance Taxes Paid Interest on Inheritence Tax CASH AVAILABLE FOR DISTRIBUTION Distributions per beneficiary: Security Equity Fund #1022-37099165/Principal Security Equity Fund #1022-37099191/Principal Templeton Fund/Principal Putnam Fund/Principal 29-Jul-04 15-Sep-04 10-Dec-04 TOTAL DISTRIBUTIONS 7529.75 278.00 192.61 4925.00 1560.00 450.00 5000.00 435.00 1569.08 1995.00 66.98 50.74 15000.00 10000.00 3339.32 1269.00 3765.96 5850.82 1310.85 37289.86 108370.12 16085.00 161744.98 145659.98 24052.16 6416.58 2.99 121607.82 45000 30000 10017.96 3806.99 11297.87 17552.45 3932.55 o 121607.82 ,,{;l.. _;I r---,- _ , - ~ ~. lit --1.12 ili ~. =I -..., -,J -.... CJ ::: CJ -- .+: tg f~ I ~ ru .+: [J'"" hlN If I 1iI 000 igff ~ If ~ . !,J tr:'"dO:l8 ~ ~ ~ ~ - ;q;ll-i~i ~ ~ ~ ~ ~gl~f~J ~~~~ II.f.d'~J ~ --.J ~ ~ ~ 151. II........ ~.' ~ ~Q ~fU,i ~ ~i "'1'1 'd n