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HomeMy WebLinkAbout04-0644 PETITION FOR PROBATE and GRANT OF LETTERS Estate of' David P. Brackbill No. ~t--O~-- ~ also known as To: Register of Wills for the · Deceased. County of Cumberland in the Social Security No. 188-12-3599 Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execu~-4x named in the last will of the above decedent, dated June 13, 2001 ,XlX)X and codicil(s) dated None (state relevant circumstances, e.g. renunciation, death of executor, etc.) .Decendent was domiciled at death in Cumberland County, Pennsylvania, with h ~.s last family or principal residence at 404 Silver Spring Road, (Mechanicsburg) Silver Spring Township (list street, number and muncipality) Decendent, then. 83 years of age, died July 6, 2004 ,~l~. at Holy Spirit Hgspital, East Pennsboro Township, Cumberland County, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: None Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property -.$:- Uncstimated (If not domiciled in Pa.) Personal property in Pennsylvania 175 c~. (If not domiciled in Pa.) Personal property in County -$ ':-~ Value of real estate in Pennsylvania $ Non~ situated as follows: WHEREFORE, petitioner(s) respectfully request(s) the probate of the last wilt-~tnd codicil(s) presented herewith and the grant of letters testamentary theron. (testamentary; administration c.t.a.; administc4tion d.b.n.c.t.a.) 4 Sherwood Drive Carlisle~ PA 17013 ~o OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ] COUNTY OF CI/MBERLAND~ SS The petitioner(s) above-named 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 represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. bSW~°rn t°..or aff!r,med and subscribed c ~/'~~~~/ ~ · etore me..this ~ ~ dav of / ~arue C. Wagner' - ~- .lin ouJ_y, _ ~ ~ ,,~ 1~ J/2 ' ~ / _z Estate Of DAw~) P. Brackbill , Deceased DECREE OF PROBATE AND GRANT OF LETTERS [ ~- 1~2004..., in consideration of the petition on AND NOW July the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated June 13. 2001 described therein be admitted to probate and filed of record as the last will of David P. Brackbill _; and Letters Testamentary Larue C. Wagner are hereby granted to Probate, Letters, Etc .......... $'11~00, BYRic ,b,~a ' ,(,~h~3-~ )" Short Certificates( ) :,~.6:~:i:: $ I :C)0 ic~l~~c~ub~..k~.~l.~, r~o., ~ ..XT. $ t~,~0 44 West Main Street S [0'~() Mochmnicsbur~. PA 17055-0318 ADD,SS TOTAL $140'Oh (7~7) 697-8528 Filed ................................... PHONE t105.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanen[ filing. WARNING: It is illegal to duplicate this cop}, blt photostat or photograph. H105 143 Rev 2/87 COMMONWEALIN OF PENNSYLVANIA · DEPAR'F~ENT OF H~L~ · VITAL RECORD8 ~'""'"* CERTIFICATE OF DEATH B~C~,N~ ~. avid Paul Brackblll js~ Male ~~ 3599 ~m;m~. ~ ~.,~. ~ ~.,~.. ~ ........... P' b -- -- ~""~ I · ],. ~OIq ~,Clt ~OSO,~J[= ...... ~, .... ' White IN~STRY AS DECE~NT E~R IN ~ E~Tt~ . " [lqb. 1t2 ~ (~t21 ~ 0~'1 I vv]u~w~ I · [c~[~um~ ~a~.. s~, ~ ~)lmc~m.r~ ' -' ~} / ~1~. ~-, I ivl~crlanlcsDurg, ~a. 3[UDU I(~s P,imknrl~nA tl~inl ~8. Laurence Brackbill I MOTHER*S ~ME (~ M~e M~h ~) [~. ' Ma~ A. Lamb 2~,. LaRue Wagner J~m ~o~ ~1s~'~.~013 ~ 2~.. Jul 10, 2004 I2~c Mechanicsburg Cemete~ J2~d Mechanicsburg Pa 1705b ,~ FD-012662-L ~. Myers Funeral Home, Inc 37 Easl Main Streel Mechanicsburg Pa 170~ : ~ ' I ~,. I ~e. :, . ..................................................................... u m Z~/~~-7 ........ , ....................................... ' .... ~1-, ~ ~. /~J Zfft~/'~ /~r,J~ LAST WILL AND TESTAMENT I, DAVID P. BRACKBILL, of the Borough of Newville, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I order and direct that all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situated, be divided  into two (2) equal parts, which parts I give, devise and bequeath as follows: A. One (1) such part unto JAMES L. BAILEY, absolutely and in fee simple, if he survives me. If the said JAMES L. BAILEY should predecease me, then and in that event, I order and direct that said part shall be added to and distributed pursuant to paragraph B hereinbelow. B. One (1) such part unto my step-daughter, namely, LARUE C. WAGNER, absolutely and in fee simple. If my said step-daughter should predecease me, then and in that event, I order and direct that the distributive share of my residuary estate attributable to her, shall be distributed unto her issue per stirpes by representation and not per capita. LASTLY. I nominate, constitute and appoint my step-daughter, namely LARUE C. WAGNER, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint her son, namely, BRIAN ARMSTRONG, to be the Executor hereof, each and both to serve without bond-or other security as a condition of qualification hereunder. ~z~: SNELBA[(ER, ~ BRE..EMA" IN WITNESS WHEREOF, I, DAVID P. BRACKBILL, have h~eunto set my SPARE hand and seal to this, my Last Will and Testament which consists of._~wo (2) typewritten pages to each of which I have affixed my signature this 13th day of June, A.D., Two Thousand One (2001). ~ .(SEAL) David P. Brackbill The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by DAVID P. BRACKBILL, the Testator therein named, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence, and in the pr~o~ce of each,_.other, have subscribed our names as witnesses hereto. COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND We, DAVID P. BRACKBILL, RICHARD C. SNELBAKER and JANE J. COONEY, ~he Testa~'~' an~ ~n~ witn~ss~, ~-e~pec~tw~y, wno~e naines are signed ~o the attached or foregoing instrument, being first duly Sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of his or her knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. Subscribed, sworn to and acknowledged before me by DAVID P. BRACKBILL, the Testator, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. COONEY, the witnesses, this 13th day of June, 2001. I Notarial Seal I Sa~'a K. Showem, Notary Public S~^~R. [~t Com~ ~ ,o,. ~-~ -~ Notary Public BRENNEMAN & SPARE Me~:~l', P~I~~ ,/~'m~i'~:~'~ ...."': -2- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE REV-1162 EX(11-96} BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128 0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 004458 SNELBAKER RICHARD C 44 W MAIN STREET MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold : : r 101 $6,000.00 ESTATE INFORMATION: SSN: 188-12-3599 FILE NUMBER: 2104-0644 DECEDENT NAME: BRACKBILL DAVID P DATE OF PAYMENT: 10/04/2004 POSTMARK DATE: 1 0/04/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2004 TOTAL AMOUNT PAID: $6,000.00 REMARKS: CHECK//100 INITIALS: JA SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD OO4727 WAGNER LARUE C 4 SHERWOOD DRIVE CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 $867.95 ESTATE INFORMATION: SSN: 188123599 FILE NUMBER: 2104- 0644 DECEDENT NAME: BRACKBILL DAVID P DATE OF PAYMENT: 12/13/2004 POSTMARK DATE: 1 2/1 3/2004 COUNTY: CUMBERLAND DATE OF DEATH: 07/06/2004 TOTAL AMOUNT PAID: $867.95 REMARKS: LWAGNER CHECK// 102 INITIALS: VZ SEAL RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS ,~ ~EV- 1500 EX (6-00) OFFICIAL USE ONLY COMMONWEALTH OF DEPARTMENT OF REVENUE DEPT. 280601 INHERITANCE TAX RETURN F,'~MBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 -- 04 0644 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECLIRITY NUMBER ~ I-- Brackbill Davict P 188-12-3599 Z LM DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-CO-YEAR) 'n-IlS RETURN MUST BE FILED IN DUPLICATE WITH THE '" "///6/2004 5/15/1921 REGISTER OF WILLS I11 (IF APPLICABLE) SURVIVING SPOUSES NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER E~ 1. Odginal Return ~ 2. Supplemental Return [~ 3. Remainder Retum (date of death pdor to 12-17~82) ~ ~ E~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of death a/tar 12-12-82) [~] 5. Federal Estate Tax Rerun3 Required ~'OO E~ 6. Decedent DiedTestete (AttachcopyofwiII) r~ 7. Decedent UaintainedaLivingTrust (Attach copy of Trust) 1 O ~:' 8. Total Number of Safe Deposit Boxes [~[ 9. Litigation Proceeds Received I I 10. Spousal Poverty Credit (dateofdeathbetw,en12-31-ela,dl-l-~)L.--J 11. Election to taxunder Sec. 9113(A)(Attachsc~o) ~: NAME C;ChM~ MAILING ADDRESS LU o Richard C Snelbaker 44 West Main Street o FIRM NAME (If Applicable) LU = Snelbaker & Brenneman, P.C. Mechanicsburg, PA 17055 ~v 717-697-8528 1. Real Estate (Schedule A) (1) 0 00 .,..%OFFiCiALUSE~ONLY 2. Stocks and Bonds (Schedule B) (2) 1,521 48 3. Closely Held Corporation, Partnership or Sote-Propdetorship (3) 0 00 4. Mortgaoes & Notes Reoeivabie (Sohedu~e D) (4) 0 0 0 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 89,403 02 _ Z 6. O~ Owned Proper[y (Schedule F) (6) ltl~6 00 .'~' ~. [~1 Separate Billing Requested ~ 7. Inter-VivosTransfers&MiscellaneousNon-PrebateProperb/ (7) 81,061.48 ::::) (Schedule G er L) ~' 8. Total Gross Assets (total Lines 1-7) (8) 17 3 ~ 12 1.98 LU 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 13,2 4 3. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Scfledulel) (10) 590 . "/5 11. Total Deductions (total Lines 9 & 10) (11) 13 ! 834.19 12. Net Value of Estate (Line 8 minus Line 11) (12) 159,28"/. "/9 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (13) 0.0 0 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 1,59 ~ 28"/. 79 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax 0.00 0 0.00 ~ rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) O ~ 16. Amount of Line l 4 taxable at lineal rate 159,287.'78 x.0 45 (16) "//16./.95 I- = 0.00 0.00 o. 17. Amount of Line 14 taxabie at sibting rate x. 12 (17) o 0.00 0.00 O 18. Amount of Line 14 taxable at collateral rate. x 15 (18) ~ 7,167.95 ~- 19~ Tax Due (19) 3W4645 1.000 Decedent's Complete Address: .~ i N~l'- I /~(~E,~S 404 Silver Spring Road Silver Spring Twp, Cumberland County CITY ISTATE IZlp Mechanicsburg PA 17055- Tax Payments and Credits: 1. Tax Due (Page I Line 19) (1) 7,167.95 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 6; 000.00 C. Discount 300.00 Total Credits (A + B + C) (2) 6 ~ 300.00 3. Interest/Penalty if applicable D. Interest 0.00 E. Penalty 0.00 Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line I + Line 3 is greater than Line 2, enter the difference. This isthe TAX DUE. (5) 867.95 A. Enter the interest on the tax due. (5A) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 867.95 :~e.. .C...h...e...c..k.. p....ay.~ble to: REGISTER OF WILLS, AGENT :::::::.'.::.%'.::::: ::::::: .¥::::!~:i.9 ~:~ .'.: ~,'.~: ::::::.'.: f:::: ::::.'.-'.:::::: :~-::::~::::: :::!: :: :3 .'.~.'.:. :!:~-%'.~>.'::: ~(<:~::: .'.:~: ,%:.'.': ::::::::::::::::::::::::: ~: ~:i:: .'.:: :::: ~: :.: ::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::::: ..................................... PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred; ....................... ~ [~ b. retain the right to designate who shall use the property transferred or its income; ......... ~ [~ c. retain a reversionary interest; or ................................ ~ {~ d. receive the promise for life of either payments, benefits or care? ................. ~ [~ 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, inciud~lg accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all Information of which preparer has any knowledge. 4 Sh~ood ~ Carlisle, PA 17013 44 West Main Street Mechanicsburg, PA 17055 For dates of death on or after July 1, 1994 and before Janua~/1, 1995, the tax rate imposed on the net value of transfers to or fo~ the use of the surviving spouse is 3% [72 P.S. § 9916 (a) (1.1) (i)]. For dates of death on or after Janua~/ 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the su~ving spouse is 0% [72 PS § 9116 (a) (1.1) (ii)] The statute does not exempt a transfer to a surviving spouse from tax, and the statutor~ requirements for disctosura of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficial/. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased chitd twenb/-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. § 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. § 9116(1.2) [72 P.S. § 9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. § 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 3w4646 1.0o0 REV-150~ EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER David P. Brackbill 21 04 0644 All property jointly-owned with right of survivorship must be disclosed on Schedule F. iTEM VALUE AT DATE NUMBER I~SCRIPTION OF DEATH 1 U.S. Savings Bonds, Series E, 1,521.48 face value $100 and $200 (see attached list) TOTAL (Also enter on line 2, Recapitulation) $ 1,521.48 3W4696 1.000 (if more space is needed, insert additional sheets of the same size) [ U.S. S~vings Bond Values List ~ O~m~~ Bra~'ID: 1 Bond Values For: 07/2004 David Brackbill 188-12-3599 P O Box 321 New Kingston, PA 17072 Teller ID: dlindsay Issue Interest Redemption Serial N~er Series Denom Date Issue Price Earned Value 481926 $75.00 $438. · 200968277-EE 200 06/1976 150.00 857 68 1,007.68 Total n~er of bonds priced: 2 Total I Total [ Total Price Interest Value REV-1508 EX + (6-98) SCHEDULE E COMMONV~ALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC. INHERITANCE TAX RETURN ~E~,D~NT DECEDE~ PERSONAL PROPERTY ESTATE OF FILE NUMBER David P. Brackbill 21 04 0644 Include the proceeds of litigation and the date the proceeds were received by the estate, Ail properb/jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH I 1985 Mercury Grand Marquis Sedan 250.00 Kelly Blue Book value (copy attached) 2 Adams County National Bank 28,652.42 checking account #149888 3 Adams County National Bank 15,883.77 savings account #9631682 4 Cash found in Decedent ts possession 280.70 5 Citizens Bank 43,400.13 checking account #6100900061 6 Philadelphia American Life Insurance Company 620.72 refund on supplemental health insurance policy 7 Rural Valley Electric Cooperative, Inc. 164.94 capital credit account, member #26207 8 Shelby Insurance 37.00 refund on policy # VS00563908 9 Yeager t s Personal Care Home 113.34 refund on resident care TOTAL (Also enter on line 5, Recapitulation) $ 89,403.02 3W46AD t.000 (If more space is needed, insert additional sheets of the same size) Kelley Blue Book - Trade-In Pricing Report - Mercury, Grand Marquis Page 1 of 2 MAK£ YOUR OR£AMS CLICK TRU£ I~ THE TROSTED RESOURCE .... 'ltbb~em BLUE BOOK TRADE-IH VALUE Pennsylvania · July 15, 2004 1985 Mercury Grand Marquis Sedan 4D See Local Listings of This Car List Your Car For Sale Online Engine: V8 302 Buy a New Car Trans: Automatic Free Record Check II4L Drive: Rear Wheel Drive Auto Loans from 3.85% APR CL Mileage: 123,552 Insurance Quote Payment Calculator Equipment - -- Air Conditioning Cruise Control Power Steering AM/FM Stereo Power Windows Cassette Power Door Locks Premium Sound 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 ma~or reconditioning should be deducted from the value. Most recent model cars owned by consumers fall into this category. Trade-In Value List Your Car For Sale Online $250 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 fi~ancing and insurance and standing behind the vehicle for any mechanical or safety problems. Get a Private Party Value Get Invoice & MSRP on New Cars http://www.kbb.com/kb/ki.dll/kw.kc.ur?kbb.PA;471296;PA041 &;sed+t&907;Mercury; 1985 ... 7/15/04 REV-1509 EX + (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA INHERITANCE[TAX RETURN JOINTLY-OWNED PROPERTY ESTATE OF FILE NUMBER David P. Brackbill 21 04 0644 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. Armstrong, Amanda 8 Springfield Avenue, St en- Newville, PA 17241 Great Grandchild B. Armstrong, Brian 8 Springfield Avenue, SteD- Newville, PA 17241 Grahdson C. Armstrong, Heather 8 Springfield Avenue, Step- Newville, PA 17241 Great Grandchild JOINTLY-OWNED PROPERTY: LErrE~ DATE DESC~I~GN OF F~%~O~R~ %OF ~ OF DEA~ ITL M F~ ~ MADE INCLUDE NAME ~ FINANCIAL INSTm. mON KD BANK ACCO{JNT DA~ OF DEATH DECD'S VALUE OF NUMAR ~ ~MI~ ID~I~ NUMBER. A~ACH DEED FOR ~MBER TENN.' JOINT J~¥~E~ REAL E~E. VALUE OF ASS~ INTERE~ DECEDENTS INTEREST i B 12/1/2000 U.S. Savings Bond, 568.00 50.000 284.00 Series EE bond, face value $1,000.00 2 C 12/1/2000 U.S. Savings Bond 568.00 50.000 284.00 Series EE, face value $1,000.00 3 D 12/1/2000 U.S. Savings Bond 568.00 50.000 284.00 Series EE, face value $1,000.00 4 A 12/1/2000 U.S. Savings Bond 568.00 50.000 284.00 Series EE, face value $1,000.00 TOTAL(AIsoenteronline6, Re~tulation) $ 1,136.00 3W46AE 1.000 (If more space is need~, i~e~ additional she~s of the ~me size) F part I (Page 2) Estate of: David P. Brackbill Name Address Relation D Armstrong, Wendy 8 Springfield Avenue, Step- Newville, PA 17241 Granddaughter Savinc 107/2004 Series Denomination Serial Number Issue Date jEE Bonds $1 ,000 i I # Bonds Total Price Total Interest Total Value YTD lw 4 $2,000.00 $272.00 $2,272.00 $33.( Issue Interest Next Final Serial Number Issue Date Series Dehorn Price Interest Value Rate Accrual Maturit3 M75228838EE 12/2000 EE $1,000 $500.00 $68.00 $568.00 2.84% 08/2004 12/203(} M75228839EE 12/2000 EE 1,000 500.00 68.00 568.00 2.84% 08/2004 12/2030 M7..5228840EE 12/2000 EE 1,000 500.00 68.00 568.00 2.84% 08/2004 12/2030 M75228837EE 12/2000 EE 1,000 500.00 68.00 568.00 2.84% 08/2004 12/2030 Note Description NI Not Issued NE Not Eligible for Payment P5 Includes 3-month interest penalty 4-- Cot~o'a~]~a'r~[A[}c./----- ~n tel ~.J/It'-- ME Matured (Exchangeable for HH) MN Matured (Not Exchangeable for HH) Please rate this service. (Please print and/or save this page before submitting your survey) Service Excellent Good Fair Poor Savings Bond Calculator http://wwws.publicdebt.treas.gov/BC/SBCPrice 7/14/04 REV-1510 EX + (6-98) SCHEDULE G COMMONVVEALTH OF PENNSYLVANIA INTER-VIVOS TRANSFERS & INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER David P. Brackbill 04 21 0644 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1 500 COVER SHEET is yes. DESCRIPTION OF PROPERTY I'rEM B~CLI-JOE31'iENN~IEOF~'I~ ]I~a4~SFEREE, TI-IEII~ RELATIO~IP TO DECEDE~IT AND DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE NUMBEI; TI'E DATE OF TR~. ATT. N:3-IA COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPUCABLE) VALUE 1. Adams County National Bank 81,061.48 100.000 0.00 81,061.48 IRA account #9000372. LaRue Wagner is listed beneficiary on this account TOTAL (Aisc enter on line 7, Recapitulation) $ 81,061.48 (If more space is needed, insert additional sheets of the same size) 3W46AF 1.000 REV-15'~1 EX + (12-9~) SCHEDULE H COMMONWEALTH OF PENNSYLV^NI^ FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER David P. Brackbill 21 04 0644 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Giant Food Stores funeral luncheon 68.69 Total from continuation pages 8,194.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State __ Zip Year(s) Commission Paid: 2. Attorney Fees 4,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State ~ Zip Relationship of Claimant to Decedent 4. Probate Fees 140.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Bob Potteiger inspection, license for 85 Mercury 99.00 Total from continuation pages 741.75 TOTAL (Also enter on line 9, Recapitulation) $ 13,243.44 3W46AG 1.000 (If more space is needed, insert additional sheets of the same size) Schedule H part I (Page 2) Estate of: David P. Brackbill Item No. Description Amount 2 James R. Gingrich Memorials inscription on marker 215.00 3 Myers Funeral Home, Inc. funeral expenses 7,979.00 Total (Carry forward to main schedule) 8,194.00 Schedule H part 2 (Page 3) Estate of: David P. Brackbill Item No. Description Amount 2 Cumberland Law Journal advertising Executrix notice 75.00 3 D.C. Treasurer certified death certificate forA da Brackbill 18.00 4 Patriot-News advertising Executrix notice 127.75 5 Register of Wills Short Certificates 6.00 6 Register of Wills filing fee for Inheritance Tax Return 15.00 7 Reserve filing fees, accounting costs associated with the administration of the Dece~ent~s estate 500.00 Total (Carry forward to main schedule) 741.75 REV-1512 EX + (12-03) SCHEDULE I COM~LTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN R~SmN~DECED~N~ MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER David P. Brackbill 04 21 0644 Re )ort debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.' ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Department of Veterans Affairs medical expenses 42.00 2 Metro Med Services medical expenses 46.25 3 West Shore EMS ambulance service 502.50 TOTAL (Also enter on line 10, Recapitulation) $ 590.75 3W46AH 2.000 (If more space is needed, insert additional sheets of the same size) SCHEDULE J coMMo vv , . PENNS 'VAN,^ BENEFICIARI ES ESTATE OF FILE NUMBER David P Brackbill 21 04 0644 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfer~ under Sec, 9116 (a) (1.2)] i James L. Bailey 710 Mountain Road Neville, PA 17241 Step- 50% Residue: 39,113.15 Son-in-law 39,113.15 2 LaRue C. Wagner 4 Sherwood Drive Carlisle, PA 17013 General Bequests: 81,061.48 St ep- 50% Residue: 39,113.15 Daughter 120,174.63 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE al CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART,. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET i $ 0.00 3W46AI 1.000 (If more space is needed, insert additional sheets of the same size) LAST WILL AND TESTAMENT I, DAVID P. BRACKBILL, of the Borough of Newville, County of Cumberland and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at any time heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I order and direct that all the rest, residue and remainder of my estate, real, personal and mixed, whatsoever and wheresoever situated, be divided into two (2) equal parts, which parts I give, devise and bequeath as follows: A. One (1) such part unto JAMES L. BAILEY, absolutely and in fee simple, if he survives me. If the said JAMES L. BAILEY should predecease me, then and in that event, I order and direct that said part shall be added to and distributed pursuant to paragraph B hereinbelow. B. One (1) such part unto my step-daughter, namely, LARUE C. WAGNER, absolutely and in fee simple. If my said step-daughter should predecease me, then and in that event, I order and direct that the distributive share of my residuary estate attributable to her, shall be distributed unto her issue per stirpes by representation and not per capita. LASTLY. I nominate, constitute and appoint my step-daughter, namely LARUE C. WAGNER, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint her son, namely, BRIAN ARMSTRONG, to be the Executor hereof, each and both to serve without bond or other security as a condition of qualification hereunder. LAW OFFICES SNELBAKER, aRE..E"A" IN WITNESS WHEREOF, I, DAVID P. BRACKBILL, have hereunto set my & SPARE hand and seal to this, my Last Will and Testament which consists of two (2) typewritten pages to each of which I have affixed my signature this 13th day of June, A.D., Two Thousand One (2001). ~~~~~J~~(SEAL) David P. Brackbill The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testator, was on the date thereof signed, sealed, published and declared by DAVID P. BRACKBILL, the Testator therein named, as and for his Last Will and Testament, in the presence of us, who at his request, in his presence, and in t~e subscribed our names as witnesses hereto. COMMONWEALTH OF PENNSYLVANIA) : SS. COUNTY OF CUMBERLAND ) We, DAVID P. BRACKBILL, RICHARD C. SNELBAKER and JANE J. · ' respecuvmy wl~Ose are signed to COONEY, ~he Testator an(, the witnesses," ' , names the attached or foregOing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as his Last Will and Testament and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of {he witnesses, in the presence and hearing of the Testator, signed the Will as a witness and that to the best of his or her knowledge, the Testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~Witn~s' ~ Subscribed, sworn to and acknowledged before me by DAVID P. BRACKBILL, the Testator, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. COONEY, the witnesses, this 13th day of June, 2001. S,,L,A~,,, I~~ UO~. ~.~ Notary Public BRENNEMAN ]~-- [ SPARE Member, ~la ~ ...... ~" .... -2- Register of Wills of Cumberland County ,/ STATUS REPORT UNDER RULE 6.12 Name of Decedent: David P. Brackbill Date of Death: July 6, 2004 Estate No.: 21-04-0644 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 0 No Jil 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: Approximately 9 months 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No 0 b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clothe Orphans' Court and may be attached to this report. Date: 3/8/05 ture Richard C. Snelbaker Snelbaker & Brenneman, P.C. Name 44 West Main Street Mechanicsburg, PA 17055 Address (717) 697-8528 Telephone No. Cr", U(; f I~.! ~ j"fiapacity: 0 Personal Representative x.Kl Counsel for personal representative ciJ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE '* BUREAU OF INDIVID~i('t.~~T INHERITANCE TAX DIVISION :,'; PD BOX 280601 HARRISBURG PA 17128-0601 '. NOTICE OF INHERITANCE TAX APPRAISEMENT~ ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP 112-84) /8 Ii: 45 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-21-2005 BRACKBILL 07-06-2004 21 04-0644 CUMBERLAND 101 DAVID P Glenv .LLnl\ OPOLPf\I'" (Y"')I. ".,,:),..T '1I 1,1-'",:) '-' ,_, RICHARQ;L~~~_'~"~~:i ' Ph SNELBAKER 8 BRENNEMAN" 44 W MAIN ST MECHANICSBURG PA 17055 Allount Re.itted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE~ PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV =1!W-EX--AFP--CftY--6J'r-t1o'T-I-ci-OF-1NHEiYflirC'E-i"-Ax-APPRAISEMEN'~--A[Ld'QANcE-oR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRACKBILL DAVID P FILE NO. 21 04-0644 ACN 101 DATE 03-21-2005 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets (1) (2) (3) (4) (5) (6) (7) .00 1.521. 48 .00 .00 89.403.02 1.136.00 81. 061. 48 (8) NOTE: To insure proper credit to your account~ subllit the upper portion of this forll with your tax paYllent. 173 ~ 121. 98 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GovernMental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 13~243.44 590.75 (11) (12) (13) (14) 13.834 19 159~287.79 .00 159~287.79 NOTE: I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total o~ Abh returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. AIlount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 159~287.78 X 045 = 7~167.95 .00 X 12 = .00 .00 X 15 = .00 (19)= 7~167.95 ~ TAX ~RI!DITS. . .......... ....' ...-. l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-04-2004 CD004458 315.79 6~000.00 12-13-2004 CD004727 .00 867.95 03-14-2005 REFUND .00 15.79- TOTAL TAX CREDIT 7~167.95 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 . IF PAID AFTER DATE INDICATED~ SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $l~ NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT'- (CR) ~ YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) P~~('(;c{ncn (,c::::y.,~ nr:: BUIEAU OF INDIVIDU..t:t~1lli ::': v , "c~ '.." IMERITANtE TAX DJVJSJDII,: ,'" PO lOX zal601 HARRISBURG PA 11128-0601 COHHONIlEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE J:NHERJ:TANCE TAX STATEMENT OF ACCOUNT '* REV-16G7 EX AFP (03-05) lOgS ffP 22 AM!1: 54 CLEF!< OF CCJURT (" ;.....:...:. .""" OA RICHARD li:. SNELBAKER '.. . ", SNELBAKER & BRENNEMAN 44 W MAIN ST MECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 03-28-2005 BRACKBILL 07-06-2004 21 04-0644 CUMBERLAND 101 _t _ltt..s DAVID P I: MAKE CHECK PAYABLE AND REMIT PAY~ENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 NOTE: To insure proper credit to your 8CCOUnt# ~it the upper portion of this fo~ with your tax pay-.ni. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ ................................................................................................................ REV-1607 EX AFP (03-05) *** INHERITANCE TAX STATEMENT OF ACCOUNT **_ ESTATE OF BRACKBILL DAVID P FILE NO.21 04-0644 ACN 101 DATE 3-28-2005 THIS STATEI1ENT IS PIOVlDEO TO ADVISE OF THE CUIIENT STATUS OF THE STATED AtN IN THE MAHED ESTATE. BELIlII IS A _IV OF THE PIlINCIPAL TAX 1IlIE. APPLICATION OF ALL PAYllENTS, THE CUIIENT BALANCE. AND, IF APP/..ICABLE, A PIlO.JECTED INTEIEST FI_E. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT. 03-14-2005 PRINCIPAL TAX DUE: 7.167.95 PAYMENTS (TAX CREDITS): ~ PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-04-2004 CD004458 315.79 6.000.00 12-13-2004 CD004727 .00 867.95 03-14-2005 REFUND .00 15.79- TOTAL TAX CREDIT V ,167.95 BALANCE OF TAX DUE .00 INTEREST AND PEN. : .00 IF PAID AFTEI THIS DATE. SEE IEVERSE TOTAL DUE .00 . SIDE FOI CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1. NO PAYMENT IS IlEQUIIED. IF TOTAL IIlIE IS IEFLECTED AS A '"CIEDIT"' ICI). YDU HAY BE DUE A REFUND. SEE IEVERSE SIDE OF THIS FOIN FOI INSTIUCTIIINS. ) COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND l j ss: Larue C. Wagner according to law, deposes and says that die ~s the Executrix of the Estate of David P. Brackbill late of ___~ilver_~prinK_J_Q~!lship_ , Cumberland County. Pa., deceased ..nd that the within is an inventory made by Larue C. Wagner __ _ _, the said Executrix of the entire estate of said decedent, consisting of all the personal propdrty and real estate, except real esiate outside the Commonwealth of Pennsylvania. and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. being duly sworn c::; (L) ) 1<X 2005 ~~~tJk~ Executor - Aaministrator Larue C. Wagner, Executrix 4 Sherwood Drive ~arlisle, pA 17013 Sworn and subscribed before me, Date of Death NOTAlUAL SEAl SHIRLEY A. BEAP.DSl.fV, ,~tarf PuhflC 9iMr ~ lWp., CumbeMnd Co. My Cornri\ISsIOn EXpIn;s Oct. 2:5, 2 t July Address 2004 Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of /949. p. .,-l ..c: tJ) >- $ ." ~ qJ I- W ~ 0 '" 0::: I- III ..j" >- w -( .,-l H Ql ..j" O! a.. I- .D IJ \.0 0 V) .0<: Ql CD ~ 0 0 w w () ~ 0 ClQ) I :c 0::: ell .,-l 1l:I.o<: ..j" ~ a.. u. H H a.. ell Z I- ...J ~ III .D 0 -( 0 a.. I u. ...J U) ~ ....... W 0 -( w ~I >. Q) N > Z 0::: H - c:: Z 0 <lJ C U) 0 :> :l 0 Vl z '~I ~ 0 0::: () Z w < .,-l - U a.. U) ." c '"d III H I - -.: ell 0 QI ..c: A ." ~ () Ql E o .,-l - ...! 00<:: III (5 u: ...J - CD ~ Inventory of the real and personal estate of DAVID P. BRACKBILL, Deceased PERSONAL TY: 1, U.S. Savings Bonds, Series E, face value $100 and $200 2. 1985 Mercury Grand Marquis Sedan, Kelly Blue Book value 3. Adams County National Bank, checking account #149888 4. Adams County National Bank, savings account #9631682 5. Cash found in Decedent's possession 6. Citizens Bank, checking account #6100900061 7. Philadelphia American Life Insurance Company, refund on supplemental health insurance policy 8. Rural Valley Electric Cooperative, Inc., capital credit account #26207 9. Shelby Insurance, refund unused premium, policy #VS00563908 10. Yeager's Personal Care Home, refund on resident care TOTAL PERSONALTY: $ 1,521.48 250.00 28,652.42 15,883.77 280.70 43,400.13 620.72 164.94 37.00 113.34 90,924.50 $ REAL ESTATE: ". 'i:",. ";t ..~v.4 '," "4""'} ""j d. ,........" .... -'. . 1 . Decedent owned no Real Estate at the time of his death : "'\. ..: ;'.; ., ~'~'" ~~,';'.~.~'~';:::' ':'~/;'~~"f' f:..l~2 ';.:vl;~;'i'OO ; :,~~.": ';,\. Z~ 'w:.~.3 ;)i,llH'll;~u) y~ I ..' .., ".--"" ....-- $""- 96:924.50 TOTAL PERSONALTY AND REAL ESTATE: r-' c::; C) \,'-.J Page 1 ;r.. LAW OFFICES SNELBAKER & BRENNEMAN. P.C. ~ RECEIPT AND RELEASE 6'l-~4L\ WHEREAS, David P. Brackbill, late of Silver Spring Township, County of Cumberland and Commonwealth of Pennsylvania, died on July 6, 2004, having first made his Last Will and Testament in writing probated before the Register of Wills of said Cumberland County on July 12, 2004, and Letters Testamentary were issued on the same date to Larue C. Wagner, the Executrix named in the Last Will and Testament of said Decedent; and WHEREAS, said Executrix has entered upon and completed her administration of said Decedent's Estate as set forth in her First and Final Account attached hereto, and intends to distribute the net balance of the assets of said Estate to the persons named in the Statement of Proposed Distribution also attached hereto, both of said documents being incorporated herein by reference thereto; and NOW KNOW ALL MEN BY THESE PRESENTS, that we, James L. Bailey and Larue C. Wagner, being the principal legatees and distributees named in the Will of said Decedent and the persons entitled to share in the residuary distribution of the Estate of said Decedent, do hereby declare and say that we,_ftnd eash of us, , ) ,......-. -'j -! have examined the attached Account and Statement of Proposed- - ..1 Distribution, and find the same to be true and correct, ~~d i.Ii I ,1 _::J ---) 1 --.-1 /- :~ C.:::' ......) strict accordance with the terms and provisions of said Will, and we do hereby acknowledge that we, and each of us, this day have, had and received of and from Larue C. Wagner, Executrix of the Estate of David P. Brackbill, the cash, personalty and/or real estate set opposite our names in the above Statement of Proposed Distribution, in full satisfaction, payment and discharge of all such sum or sums of money, legacies and bequests, share or shares, purports and dividends which were due, owing and payable and belonging to us, and each of us, by any means whatsoever, for or on account of our full share, part or dividend of the Estate of David P. Brackbill, Deceased. NOW, THEREFORE, we, and each of us, the said James L. Bailey and Larue C. Wagner, do by these presents, remise, release, quit- claim and forever discharge the said Larue C. Wagner, her heirs, executors and administrators, of and from our said shares or dividends of the Estate aforesaid, and of and from all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for or by reason thereof, or of any act, matter, cause or thing whatsoever, from the beginning of the world to the day and date of these presents. AND, desiring to avoid the delay and expense of the settlement of said Estate by filing the foregoing Account of said administration in the Office of the Register of wills of said Cumberland County and by having the balance in the hands of the Executrix, as shown by said Account, distributed by the Court of LAW OFFICES SNELBAKER 8: BRENNEMAN, P.C. 2 Common Pleas of Cumberland County - Orphans' Court Division, we, and each of us, do hereby agree that the foregoing Account and Statement concerning the matter of settlement may be recorded with the same effect upon us, and each of us, as if the same had been reported upon by said Court, in a decree of distribution made on such proposed Statement of Distribution by the said Court of Common Pleas - Orphans' Court Division. AND in consideration of the aforesaid settlement being made without the aid of such Court of Common Pleas - Orphans' Court Division, that we, and each of us, the said James L. Bailey and Larue C. Wagner, do hereby agree that if any debts or demands other than those included in the above referenced First and Final Account, as hereinbefore set forth, shall be hereafter recovered against the Estate of said Decedent and be legally payable out of the same, that we, and each of us, will return to the said Executrix such amounts thereof as may be necessary to pay such debts or demands. IN WITNESS WHEREOF, we have hereunto set our hands and seals this I'1H, day of3epte....be~ 2005 WITNESSED BY: ,~ 1 r3Tb James L. Baile (SEAL) ,~l{Jw G.\ 1!!rf/t) arue C. Wagn r (SEAL) LAW OFFICES SNELBAKER & BRENNEMAN, P.C. 3 LAW OFFICES SNELBAKER & BRENNEMAN, P.C. COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND) On this the \ 4""h. day of )e,.+l2I>\.kfL. 2005, before me, a Notary Public in and for said State and County, the undersigned officer, personally appeared James L. Bailey and Larue C. Wagner, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and acknowledged that they executed the same for the purposes therein contained. IN WITNESS WHEREOF, I hereunto set my hand and official seal. ~on~ I-Z ~~ Notary Public COMMONWEALTH OF PENNSYLVANIA Notarial Seal Sandra K. ShowelS. Notary PubIil: MechanicsbUIg Boro. Cumberland Cclunly My CommisSioI1 Expires Nov. 22, 2!Im Member. PennsylvrHlI2 ;.\ssaclatlOft Of Notaries 4 ESTATE NO. 21-04-0644 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY LARUE C. WAGNER, EXECUTRIX OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF DAVID P. BRACKBILL, DECEASED, LATE OF SILVER SPRING TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA Larue C. Wagner, Executrix as aforesaid and Accountant herein, avers as follows: DATE OF DECEDENT'S DEATH: DATE LETTERS TESTAMENTARY ISSUED: July 6, 2004 July 12, 2004 DATES EXECUTOR NOTICE ADVERTISED: Cumberland Law Journal Patriot-News July 23, 30, August 6, 2004 July 27, August 3,10,2004 FIRST AND FINAL ACCOUNT PERSONALTY - PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of the following items of Decedent's Personalty valued as of the date of Decedent's death: 1. U.S. Savings Bonds, Series E, face value $100 and $200 2. 1985 Mercury Grand Marquis Sedan, Kelly Blue Book value 3. Adams County National Bank, checking account #149888 4. Adams County National Bank, savings account #9631682 5. Cash found in Decedent's possession 6. Citizens Bank, checkin9 account #6100900061 7. Philadelphia American Life Insurance Company, refund on supplemental health insurance policy 8. Rural Valley Electric Cooperative, Inc., capital credit account #26207 9. Shelby Insurance, refund unused premium, policy #VS00563908 10. Yeager's Personal Care Home, refund on resident care 11. Cumberland County, death benefit 12. Commonwealth of Pennsylvania, refund on Inheritance Tax TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: PERSONALTY - PRINCIPAL ACCOUNT CREDITS LAW OFFICES SNELBAKER 8: BRENNEMAN, P.C. The Accountant claims credit for the payment of the following items from Decedent's Personalty Account: 1. Metro Med Services, medical services 2. West Shore EMS, ambulance service 3. Myers Funeral Home, Inc., funeral services 4. Bob Potteiger, inspection, license for automobile 5. Larue Wagner, reimburse for opening of grave and funeral luncheon 6. Depl. of Veterans Affairs, medical expense Page 1 $ 1,521.48 250.00 28,652.42 15,883.77 280.70 43,400.13 620.72 164.94 37.00 113.34 100.00 15.79 $ 91,040.29 $ 46.25 502.50 6,400.00 99.00 1,647.69 42.00 7. 8. 9. 10 11. 12. 13. 14. James R. Gingrich Memorials, inscription on grave marker Register of Wills, Agent, estimated Inheritance Tax payment Register of Wills, Agent, Inheritance Tax Register of Wills, filing fee for Inheritance Tax Return Register of Wills, additional probate fee Greenawalt & Company, P.C. preparation of Final Individual Income Tax Returns Snelbaker & Brenneman, P.C., attorney services Snelbaker & Brenneman, P.C., costs advanced: a. Cumberland Law Journal, advertising Executrix notice b. Patriot-News, advertising Executrix notice c. Register of Wills, probate fees d. D.C. Treasurer, death certificate for Ada Brackbill e. Register of Wills, short certificates 15. Reserve for filing fees, accounting fees and other costs associated with the administration of Decedent's Estate TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: 75.00 127. 75 140.00 18.00 6.00 PERSONALTY - INCOME ACCOUNT DEBITS The Accountant charges herself with the receipt of the following income from the investment of Personalty Principal: 1. Orrstown Bank, interest on estate checking account 2. Citizens Bank, checking account #6100900061, interest 3. Adams County National Bank, savings account #9631682, interest TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: PERSONAL TV - INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from the Personalty Principal Account: TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS: REAL ESTATE - PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of Decedent's Real Estate as follows: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: REAL ESTATE - PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from Real Estate Principal Account: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: LAW OFFICES SNELBAKER & BRENNEMAN, P.C. Page 2 215.00 6,000.00 867.95 15.00 85.00 210.00 4,000.00 366.75 1,000.00 $ 21,497.14 $ 117.47 58.31 4.16 179.94 $ $ NONE $ NONE $ NONE $ NONE $ NONE $ NONE LAW OFFICES SNELBAKER & BRENNEMAN, P.C. REAL ESTATE . INCOME ACCOUNT DEBITS The Accountant charges herself with the receipt of the income from the investment of Real Estate Principal Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: $ NONE $ NONE REAL ESTATE -INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from the Real Estate Income Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS: $ NONE $ NONE Page 3 LAW OFFICES SNELBAKER & BRENNEMAN, P.C. RECAPITULATION PERSONALTY: PRINCIPAL ACCOUNT: Oebits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL PERSONALTY REAL ESTATE: PRINCIPAL ACCOUNT: Debits Credits Balance INCOME ACCOUNT: Debits Credits Balance TOTAL REAL ESTATE: TOTAL FOR DISTRIBUTION: Page 4 $ 91,04029 $ 21,497.14 $ 179.94 $ NONE $ $ 69,543.15 179.94 $ 69,723.09 $ NONE $ NONE $ NONE $ NONE $ NONE $ NONE $ NONE $ 69,723.09 LAW OFFICES SNELBAKER & BRENNEMAN, P,C. STATEMENT OF PROPOSED DISTRIBUTION Larue C. Wagner, Executrix and Accountant herein, proposes to distribute the balance of the Estate of David P. Brackbill, Deceased, to wit: $ 69,723.09 in accordance with the Last Will and Testament of said Decedent as follows: 1. James L. Bailey 50% of residue as per Item 2A of Will - Cash $ 34,861.54 2. Larue C. Wagner 50% of residue as per Item 2B of Will - Cash 1985 Mercury Grand Marquis Sedan, In-kind 34,611.55 250.00 TOTAL FOR DISTRIBUTION: $ 69,723.09 Page 5 LAW OFFICES SNELBAKER & BRENNEMAN, P .C. COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Larue C. Wagner, being duly sworn according to law deposes and says: that she is the Executrix of the Estate and under the Last Will and Testament of David P. Brackbill, Deceased, and the Accountant herein; that there are no unpaid creditors or claimants of said Estate; that there are no persons interested in the distribution of said Estate other than as stated in the foregoing Statement of Proposed Distribution; and that the facts set forth in the foreqoing First and Final Account and Statement of Proposed Distribution are true and correct to the best of her knowledge, information and belief. ~ 5ea L~e~/Jr;~ Executrix and Accountant Sworn to and subscri,d before me this ~ r;, day of /fllc!l U So. f 2005 .i/}c.At t. t?"t't a @,PQOfi!.t{)OUJ. tary Publi """'(j Ct(1\tMr,W~~~w.~, HOTAnIt!, ":/:/,i f "'-l""'A r:~-,.t'~r7"':"_"::''''i::h{'{\r 1 ""'''''"''' . ,:::.'."' '" ",..", .~.,... SMr spnngt.<.". r..:;:;;};:;~,::y~:;.)).' My. Commj~~fl t:':~:;{:'~ (~:'(. ij~ .7:';~ia .......-~~-_. Page 6 Register of Wills of Cumberland County t t; STATUS REPORT UNDER RULE 6.12 Name of Decedent: DAVID P. BRACKBILL Date of Death: July 6, 2004 Estate No.: 21-04-0644 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 ~ No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration willbe complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes 0 No UX b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes ~ No 0 c. Copies of receipts, releases, joinders accounts may be filed with the Cle of attached to this report. Date: 9/16/05 l"'- e Sign ture Ric rd C. Snelbaker Snelua~er & Brenneman, P.C. Name 44 West Main Street Mechanicsburg, PA 17055 Address C_) \-{:: '-,;~- ) C"-J - " (17) 697-8528 Telephone No. Capacity: 0 Personal Representative @ Counsel for personal representative eP