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HomeMy WebLinkAbout09-29-10 (2)' 1505607121 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 0 9 0 7 3 6 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 1 7 9 1 4 8 7 1 1 0 7 2 4 2 0 0 9 0 8 1 7 1 9 2 1 Decedent's Last Name Suffix Decedent's First Name MI B r u d o w s k y M a r i a n L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW a 1. Original Return ~ 2. Supplemental Return ~ 3. Remainder Return (date of death prior to 12-13••82) 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal EstatE: Tax Return Required death after 12-12-82) ~] 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Wiil) (Attach Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death ~ 11. Election to tax. under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) C:UKKt,,YVIVUtIV 1 - ~ F11J 5t1. ~ IVn MUl ~ Cft IiVMF'Lt ~ tU. HLL IrVKKtSrVIrUtIYl~t HIYU ~-VIVCIUCIV I IAL I HJl IIYtVKMl~i11V19 AIIVULU 6C ulRtl+ I GU I V: Name Daytime Telephone Number B a r b a r a L W e v o d a u E s q 7 1 7 ~5, 8 2 8 8 3_T ty~ C.~ ~ f 'Y"1 .__ Firm Name (If Applicable) - - :~. REGIST~ LS U~QNL ~ -~=~~~ ` Y r ~ ~ _; ~ I ._ '- _.~ ~~. r-- - ._. _~ First line of address `~ G ~ ~~ ~ ~ '~ _.7 P 0 B o x 4 5 9 r o c ~~ `~~~ ~ r; _ . Second line of address .- ~ ~ ~ _~ ' f ~- ~~ '-r-7 ~~ ~i ~~ 2 6 E a s t M a i n S t r e e t ~ ~~~ ~~' City or Post Office State ZIP Code DATE. FILED N e w B l o o m f i e l d P A 1 7 0 6 8 Correspondent's a-mail address: 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. Declar~ti of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIG E O ON S I,BLE FOR FILING DATE s, ADDRESS 250 Alice Lane New ort PA 17074 SIG E O P PA~ CtiThi~f~• Thy R~PR~7~ ~D ~E~ _ P:0• Box 459, 26 East Main Street New Bloomfield PA 17068 PLEASE USE ORIGINAL FORM ONLY Side 1 1505607121 150560712:1 J ~~'" J 1505607221 REV-1500 EX Decedent's Social Security Number Decedent's Name: Marian L• BrudoWSky 1 7 9 1 4 8 7 1 1 RECAPITULATION 1. Real estate (Schedule A) ........................................ 1 2. Stocks and Bonds (Schedule B) .................................. 2• 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. • 4. Mortgages & Notes Receivable (Schedule D) ........................ 4. • 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... 5. 4 6 4 3 9 . 4 4 6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ....... 6. 2 1 5 7 . 1 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ^ Separate Billing Requested ....... 7. • 8. Total Gross Assets (total Lines 1-7} ........................... 8. 4 8 5 9 6. 5 4 9. Funeral Expenses & Administrative Costs (Schedule H) ................ 9. 7 9 7 ? • 7 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ............ 10. 1 1 1 3 . 6 2 11. Total Deductions (total Lines 9 & 10) ........................... 11. 9 0 9 1 . 3 9 12. Net Value of Estate (Line 8 minus Line 11) ......................... 12. 3 9 5 0 5. 1 5 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) .................. 13. • 14. Net Value Subject to Tax (Line 12 minus Line 13) .................. 14. 3 9 5 0 5 . 1 5 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X.0 0 0 D 15. 16. Amount of Line 14 taxable at lineal rate X .045 3 9 5 0 5. 1 5 16. 17. Amount of Line 14 taxable D 0 0 at sibling rate X .12 17. 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 19. Tax Due ...................................... ... ....... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 L 1505607221 0. D 0 1 7 7 7. 7 3 0. D 0 0. D 0 1 7 7 7. 7 3 1505607221 J REV-1500 EX Page 3 Decedent's Complete Address: File Number 21 09 0736 DECEDENT'S NAME Marian L. Brudowsk~r___ _ . ---------_--------_--_-- STREETADDRESS --- --------_----------------- - ~3 Kelly Court __ CITY STATE i ZIP I, Enola ~ PA 1. 17025 Tax Payments and Credits: ~ . Tax Due (Page 2 Line 19) (1) 1, 777.73 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 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. Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00 5, If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1, 777.73 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) 1,777.73 Make Check Payab/e to.• REG/STER OF W/LLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ...................................................................... ^ X^ b. retain the right to designate who shall use the property transferred or its income; ............................... ^ ^X c. retain a reversionary interest; or ................................................................................................ ^ 0 d. receive the promise for life of either payments, benefits or care? ....................................................... ^ ^X 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................... ^ [X] 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ......... ^ X^ 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. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)], The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent j72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent (72 P,S. §9116(a)(1.3}]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1508 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE E CASH, BANK DEPOSITS, & MISC. e~oen~i ~ i DD/'1DCDTV ESTATE OF FILE NUMBER Marian L Brudowsky 21 09 0736 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Susquehanna Bank, 26 North Cedar Street, P.O. Box 1000, L'itiz PA 17543-7000 11,056.99 Checking Account #4601704809 2. PNC Bank, 1 North 2nd Street, Newport PA 17074; Checking Acct# 5140007979; 19,742.29 Established 02-01-1968 3. PNC Bank, 1 North 2nd Street, Newport PA 17074; Savings Acct# 5001901487; 3,149.15 Established 08-09-1999 4. Western-Southern Life Assurance Company; Contract# W0020210085 5,857.76 5. ~ M&T Bank; Savings Acct# 15004207086825 6. 12004 Ford Focus TOTAL (Also enter on line 5, Recapitulation) I $ (If more space is needed, insert additional sheets of the same size) 2,157.25 4,476.00 46,439.44 REV-1509 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOfNTLY-OWNED PROPERTY ESTATE OF FILE NUMBER Marian L. Brudowsky 21 09 0736 {fan asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SI 1RVIVINC, .InINT TENANT(Sl NAME ADDRESS RELATIONSHIP TO DECEDENT A. Kimberly D. Schardt a Jeffrey O. Sees c Patti M. Buxton JOINTLY-OWNED PROPERTY: 605 South Main Street Marysville PA 17057 250 Alice Lane Newport PA 17074 725 South Main Street Marysville PA 17057 Daughter Son Daughter ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET °!o OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. 03/05/07 Susquehanna Bank, 26 North Cedar Street, P.O. Box 1,296.35 50. 648.18 1000, Lititz PA 17543-7000; CD - Acct# 403300001654 2. B. 03/18/04 PNC Bank; CD - Acct# 31900239234 1,123.13 50. 561.57 3. C. 10/18/96 M&T Bank; Checking Acct# 45916896 1,894.70 50. 947.35 TOTAL (Also enter on line 6, Recapitulation) I $ 2,157.10 (If more space is needed, insert additional sheets of the same size) REV-1511 EX + (10-06) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESfDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER Marian L. BrudowskV 21 09 0736 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Michael J. Shalonis Funeral Home 2. Wake -food/pastor, niece's performance at funera{ B 2. 3. 4 5 6 7 City State Zip ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip R I t' h' f Cla' ant to Decedent Year(s) Commission Paid: Attorney Fees Barbara L. Wevodau, Esquire Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address e a ions ip o ~m Probate Fees Register of Wills Accountant's Fees Tax Return Preparers Fees Short Certificates 40.00 355.00 TOTAL (Also enter on line 9, Recapitulation) I $ 7 977 77 (If more space is needed, insert additional sheets of the same size) 4,778.67 304.10 2,500.00 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF FILE NUMBER Marian L. Brudowsky 21 09 0736 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Postage due 08/20/09 3.60 2. PA American Water; acct# 24-2016238-6 122.34 3. East Pennsboro Township 126.50 4. Verizon; phone 717-732-0450 123.36 5. PPL; acct# 79570-72013 112.73 6. ADT Security Services 83.95 7. Comcast 93.45 8. Tony Bare; cleaning; yard/shrubs 292.50 9. East Pennsboro -sewer and trask 115.00 10. Spirit Phsycian Services; acct# 1735422 (ck# 105) 40.19 TOTAL (Also enter on line 10, Recapitulation) I ~ 1 113.62 (If more space is needed, insert additional sheets of the same size) REV-1513 EX + (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Marian L_ Brudowskv ~~ n4 n7~~ 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 transfers under Sec. 9116 (a) (1.2)] 1. Bonita S. Heisey Lineal 250 Alice Lane 1/5 residue of estate Newport PA 17074 2. Jeffrey O. Sees Lineal 250 Alice Lane '1 /5 residue of estate Newport PA 17074 3. Patti M. Buxton Lineal 725 South Main Street 'I /5 residue of estate Marysville PA 17047 4. Kimberly D. Schardt Lineal 605 South Main Street 11/5 residue of estate Marysville PA 17047 5. Stephen P. Brudowsky Lineal Valley Road 1 /5 residue of estate Enola PA 17025 6. Thomas H. Witmyer, Jr. Lineal 12 Hill Street beer stein Carlisle PA 17013 7. John Schardt Lineal 605 South Main Street 2004 Ford Focus Marysville PA 17057 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 1. 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (It more space Is needea, Insert addltlonal sheets of the same size) REGISTER OF VIfILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE O GRAINY OF LETT S No . 2009- 00736 PA No . 21-~ 09- 0736 Estate Of : MARIAN L BRUDOWSKY (First, Midd/e, Lastl Late Of : EAST PENNSBORO TOWNSHIP CUMBERLAND COUNTY Deceased Social Security No : 179-14-87 ~ 1 WHEREAS, on the 7th day of August 2 0 09 an instrument dated April 3rd 2009 was admitted to probate as the last will of MARIAN L BRUDOWSKY (First, Middle, Lastl late of EAST PENNSBORO TOWNSH/P, CUMBERLAND County, who died on the 24th day of July 2 0 09 and, WHEREAS, a true copy of the wi 11 as probated i s annexed hereto . THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wi 11 s in nd for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: BONITA S HEISEY who has duly qualified as EXECUTOR(R/X) and has agreed to administer the estate according to law, all of whic fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE,:. CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 7th day of August 2009. * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LA~~T) V1' I, MARIAN LOUISE BRUDOWSKY, of 3 Kelly Court, Enola, Perry County, Pennsylvania, being of sound and disposing mind, memory and understanding cio hereby make publish and declare this my Last Wil? and Testament, hereby expressly revoking all other writings in nature testamentary by me at any time heretofore made. FIRST: I direct that all my debts and funeral expenses be paid as soon after my decease as may be practicable. SECOND: I direct that inheritance tax on property disposed of herein shall be paid from my residuary estate. THIRD: I hereby give and devise my German Beer Stein to my Grandson, Thomas H. Whitmyer, Jr. FOURTH: I hereby give and devise my Five ($5.00) Dollar Gold Piece Necklace to my Daughter, Bonita S. Heisey. FIFTH: I hereby give and devise my automobile to my Grandson, John Schardt. SIXTH: It is my wish and desire that each of my Crrandchildren living at the time of my death shall receive Five Hundred ($500.00} Dollars, even if from non-probate assets. ~ ~ 1 MARIAN LOUISE BRUDOWSKY Page one of two SEVENTH: I hereby give, bequeath and devise all the rest and residue of my estate and property, real, personal and mixed, of whatsoever nature and wheresoever situated of which I may own at the time of my death, or to which I may be entitled or of which I may have the right to dispose at the time of my death, to the following children: Bonita M. Heisey, Jeffrey O. Sees, Patti M. Buxton, Kimberly D. Schardt and Stephen P. Brudowsky, in equal shares. EIGHTH: I hereby appoint my Daughter, Bonita M. Heisey, as Executrix of this, my Last Will and Testament, but in the event that she is unable or unwilling to serve, I then appoint my Son-in-Law, Paul R. Heisey, as Executor of this, my Last Will and Testament. I direct that they shall not be required to give bond or other security in any jurisdiction wherein proceedings may be held in connection with my estate. 1N WITNESS WHEREOF, I have hereunto set my hand and seal this 3 ~^ ~ day of April, 2009. WI SS: ...~ ~ `(~~a,.:-L..a--`r' ~~ `~-u'~.~'z' C~~'~~~-~.,~.~~ SEAL ~~( MARIAN LOUISE BRUDOWSKY ~ •- ~ ,~ ~ , . ~, i~ Page two of two R COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF PUBLIC WELFARE BUREAU OF FINANCIAL OPERATIONS DIVISION OF THIRD PARTY LIABILITY ESTATE RECOVERY PROGRAM PO BOX 8486 HARRISBURG, PA 17105-8486 October 20, 2009 BARBARA L WEVODAU ESQUIRE PO BOX 459 NEW BLOOMFIELD PA 17868 Re: MARIAN BRUDOWSKY SSN: 179-14-8711 Dear Attorney Wevodau: Pursuant to your letter dated September 28, 2009, the Department of Public Welfare (DPW), Estate Recovery Program, has reviewed the information you provided regarding the above-referenced individual. It has been determined that this individual did not receive any type of assistance during the questioned period. Therefore, according to the information you provided, the Department's Estate Recovery Program will not seek any recovery from this estate. If your client applied for Medical Assistance and had an application and/or hearing pending at the time of death, please advise us and provide any additional information that may affect a recovery by our Department. If you have any questions, please feel free to contact me. Sincerely, ~~ Carole A. Procope Recovery Section Manager (717)772-6604 NOTICE OF BENEFICIAL INTEREST IN ESTATE c~u~~c BEFORE THE REGISTER OF WII,LS, COUNTY OF ,PENNSYLVANIA In re (~1~ 1~~11 ~U i 5 ~, ,deceased, .~ ~t ~ ~ ~` ~ ~ ~~~ 3Y'l~lC'l U~.sJG~~~{ No. a,l - p~ --p-l-~j~ T0: ~~~~t~ ~ . ~ ~~~~~-t ~E~ ~ 1~~~ Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: cJ~--~ CGctC:~ ~,c-c~ 1~c ~~C~~ (if additional space is needed, use back of page) Name of decedent ~~g,~v1 ~ ~,~ #~~--~~ ws~.~{ Last known address of decedent 3 ~~~y Cc ~~~ Date of death C--~ I ~,~\Lcq Place of death Cw~c~btiv'~c~.'~ ~~~~ County of grant of original letters (~u~ ~'~~~~~ Decedent died testate intestate. A copy of the Wil is is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name Address Telephone c~~ ~u ~1C~~ ~ Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone ~tif~'( CJ~2V~lJ,LEsq. , P.O. Box~{~jq New Bloomfield, PA, 17068 (717582 ~~~ Additional information maybe obtained from the undersigned. Date Signature Name ~~p,p~,, t, . ~~ sE~Ctur~ Address P.O. Box ~~( New Bloomfield, PA 17068 Capacity: Personal Representative X Counsel for personal representative NOTICE OF BENEFICIAL INTEREST IN ESTATE C~U~~~ BEFORE THE REGISTER OF WII,LS, COUNTY OF ,PENNSYLVANIA In re MQV I~UI SOU i 5 ~ ,deceased, .~ ~ll...l ~'` ~, ~~`~ ~rul~l~~~~~{ No. ~,1- ~ _p--7-~j~, To~~~y b . ~--~ a~ ~~~ ~~. ~~~ ~ ~s ~ Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: ~ ~ ~ ~~t~t~ ~~ ~~-lQ~ (if additional space is needed, use back of page) Name of decedent '~ Q ~ ~Y~ ~ ~~~.~ ~ ~~v~ ~LL~ Last known address of decedent ~ ~ ~~ ~ ~ ~ ~ v--f- Date of death d «-~ '~ 1 pct Place of death ~ ~~~~~ ~ ~ ~~~ County of grant of original letters °`~~p~--~ ~c~ ~ ~ ~~1,~--1 Decedent di testate intestate. A copy of the W~is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name y Address Telephone ~~~~ Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone ~bt_ v~Y~ U~v,i Esg. , P.~. Box~{`jq New Bloomfield, PA, 17068 (717)582 ~3~~5 Additional information maybe obtained from the undersigned. Date Signature Name ~u,L.V~i(,~~~squire Address P.O. Box ~!~( New Bloomfield, PA 17068 Capacity: Personal Representative X Counsel for personal representative NOTICE OF BENEFICIAL INTEREST IN ESTATE ~~~~~~ BEFORE THE REGISTER OF WILLS, COUNTY OF ,PENNSYLVANIA In re (Vk~l1r I~u1 L-O~J i 5 ~. ,deceased, .~ ~t l..p ~ a` ~ ~ ~~~ ~r~icx~.~G~1~~{ No. ~,t - pct _p--]-~j~ TO: G~-~, ~ i ~ I'~ Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: ~~ C~51 ~~ ~ e ~~~-~. (if additional space is needed, use back of page) Name of decedent v~`p~~ ~~~~ ~~,~~~~1~.0~5~~-~ ~~ Last known address of decedent ~ l~ r- C ~~~-~' Date of death ~---1 I ~~ 1~ 1 Place of death v~~v~~c~ ~~-~i County of grant of original letters ~~~~ Q-~,,~y^~~~~ Decedent died state intestate. A copy of the W' is 'snot attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name Address Telephone l ~~ ~~ ~~o~~ Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone Pxl~r~ Ul~v~, ESQ. , P.O. Box~59 New Bloomfield, PA, 17068 ,~717~58.2-$$$~ Additional information maybe obtained from the undersigned. Date Signature Name ~aylp,Qir~L.l~~li,~sgui:re ____ Address P.O. Box ~~=1 New Bloomfield, PA 17068 Capacity: Personal Representative X Counsel for personal representative NOTICE OF BENEFICIAL INTEREST IN ESTATE GUlV1S11t~~'L~ BEFORE THE REGISTER OF WILLS, COUNTY OF ,PENNSYLVANIA In re MQ~ Y.~UI I.-~U i ~ ~, ,deceased, ~ ~.t_.t l.,p ~ ~' ~, ~~ ~r~,tcicx~c~l'~~{ No. ~,1.t - pct _~--t-?j~ TO~ivv~Jl+~ i7 ~~ ~ lop S S .~(Y~c~~v~5~ ~~~ ~~~~~ Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: (if additional space is needed, use back of page) Name of decedent ~ (~,^~,~j1 ~~~.~. ~-~D~~ ~~`~ 1 V~ Last known address of decedent ~ ~ ~ v'"`~ Date of death ~---~ I ~~ I Do~ Place of death ~ ~~ (g.~~,~1. t County of grant of original letters ~ ,~ ~~,~1 ~ ~~~ ~ I Decedent died testate intestate. A copy of the W' is is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Narne ~~~ Address Telephone ~~~ ~~ ~~~7~ Name(s), address(es) and telephone number(s) of all counsel Name Address Telep~,one ~.bl~C~ CA~v~, Esq. , P.O. Box~{~q New Bloomfield, PA, 17068 (717 582-~~~ Additional information maybe obtained from the undersigned. Date Signature Name _ L . i.~~',~ Es uir,~ Address P.O. Box ~~-( New Bloomfield, PA 17068 Capacity: Personal Representative X Counsel for personal representative NOTICE OF BENEFICIAL INTEREST IN ESTATE Gu~~~~ BEFORE THE REGISTER OF WILLS, COUNTY OF ,PENNSYLVANIA In re MQY I~ ~-Ol~ ~ 5 ~ ,deceased, ~ ~t ~ ~` ~, ~~~ 3r~cl~G~lti~( No. a,.t O~ -~-7~1~ ~ ~-~0~.5 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: (if additional space is needed, use back of page) Name of decedent ~~/~~ ~~~~ ~ ~C~,~.~1~ Last known address of decedent Date of death~~ a~ 1 Place of death _ ~~ County of grant of original lE Decedent died A copy of Name(s), ~c..~~~~ ~~~ ~r~.v~c1 ~~ Will is„ i~ not attached. es) and telephone number(s) of all personal representatives appointed Name ,~~S~y Address Telephone t C.s~ ~~ ~~ Name(s), address(es) and telephone numbex(s} of all counsel Name Address Telephone ~xi_v~ic~ c~ev~pu,~ Es4. , P.O. Box~'~9 New Bloomfield, PA, 17068 17171582 ~~~ Additional information maybe obtained from the undersigned. Date Signature Name ~uk~rt~L.V~.~;~:~.I~sg_wi~_ e ___ Address P.O. Box ~~=1 New Bloomfield. PA 17068 Capacity: Personal Representative X Counsel for personal representative NOTICE OF BENEFICIAL INTEREST IN ESTATE GUlVt~1(~t~-~ BEFORE THE REGISTER OF WILLS, COUNTY OF ,PENNSYLVANIA In re MQY Y.~UI ~OV i 5 ~. ,deceased, ~ ~-~..` l..e ~ a` ~, ~~~ 3ruCtUuJG~1~~{ No. a,t - pct _p--1-3~ TO hp~(~G~ ~ . ~~YY~~~,~(Z ~- ~ ~~ ~- Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: Pr~~ ~' ear- S~e~+n (if additional space is needed, use back of page) Name of decedent ~x~1~ ~~~s~ ~-~,o~~.~ Last known address of decedent ~ filly C'oin' ~no~ R~.. ~ ~~s_. t~st5 Date of death 7 ~ a,~' ~~ Place of death ~,,,~~~r~,nu,,-~;~ (p~~fi,( County of grant of original letters ~i.,t,~M~pe..~(1o~v~c` ~o uv1~ Decedent died testate intestate. A copy of the Wi is is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name Address Telephone ~ t't ~~cc~ C.:ar~~ Fx~ ~-~ tau ~t Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone ~,bt~CZ~ ~V,~ Esq. , P.O. Box~Sq New Bloomfield, PA, 17068 (717)582 ~5~~ Additional information maybe obtained from the undersigned. Date Signature Name _ L.U. Es uir; Address P.O. Box ~~( New Bloomfield, PA 17068 Capacity: Personal Representative X Counsel for personal representative NOTICE OF BENEFICIAL INTEREST IN ESTATE G~~~'~J~ BEFORE THE REGISTER OF WILLS, COUNTY OF , PENNSYLVAN]iA In re (~1~ I~V1 1--OU i 5 ~ ,deceased, S ~.t_.~ ~ ~ a` ~ ~ `~'~~ 3~rv~c. i c~u.~G~l~~{ No. ~.,1 C~ -p-7~~ Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate a.s follows: (if additional space is needed, use back of page) Name of decedent (1~u~~1 ~~ `~~ -' ~i~-~ ~-'~ Last known address of decedent ~^~r~. (~~ ^~.-j~ `~~`~ ~ ~~~ ~~ ~ ~ ~ ~ Sr Date of death ~-~ (~ ~.} ~ ~ ~ Place of death ~~~~/~~~'~~ ~ ~~'~ Count of ant of original letters ~~.~nnbe-~"l u~ ~' C~~~ ~ Y ~' Decedent di test testate. A copy of the Willi is of attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name ~~~~~ ~ ~ ~~ Address Telephone ~~~~~ Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone ~bl_ v~C~ Ul~l,),, Esq. , P.O. Box~{~q New Bloomfield, PA, 17068 717)582 ~~~ Additional information maybe obtained from the undersigned. Date Signature Name ~i-~O~L.t~.i~~sg~uire Address P.O. Box ~~( New Bloomfield, PA 17068 Capacity: Personal Represental:ive X Counsel for personal representative NOTICE OF BENEFICIAL INTEREST IN ESTATE C~uu~n~~~ BEFORE THE REGISTER OF WILLS, COUNTY OF , PENNSYLVAN[A Tn re 1 Y l(.~1~ 1~U'1 ~l~ i 5 ~, ,deceased, .S ~l ~ ~ ~, ~~`~ ~rulclc~sJG~~~{ TO: Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: (if additional space is needed, use back of page) Name of decedent Last known address of decedent Date of death Place of death County of grant of original letters Decedent died testate intestate. A copy of the Will is is not attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name Address Telephone NOTICE OF BENEFICIAL INTEREST IN ESTATE GlAV1111(~~'~~+r L~ BEFORE THE REGISTER OF WII,LS, COUNTY OF , PENNSYLVAN~[AA In re f V1Q1r-10~U'1 I.~u + 5 ~ ,deceased, ~ ~t ~ ~ ~ ~, ~~~ ~J~r' U~C.'t Cx~J~~~{ No. ~,~ - C~ _p--7-3~ T0: Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate a.s follows: (if additional space is needed, use back of page) Name of decedent Last known address of decedent Date of death Place of death County of grant of original letters Decedent died testate intestate. A copy of the Will is is not attached. Name(s), address(es) and telephone number(s) of alI personal representatives appointed Name Address Telephone NOTICE OF BENEFICIAL INTEREST IN ESTATE C~~~~ ~ BEFORE THE REGISTER OF WILLS, COLiNTY OF ,PENNSYLVANIA In re 1 ~ ICJI~ I~U1 ~v i 5 ~ ,deceased, ~ ~..~t 1.1 ~ a` ~ , ~~ 7Jtr't~C1cx~~~~~{ T0: Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate a.s follows: (if additional space is needed, use back of page) Name of decedent ~ t,.~'l,~~~~~~~~`~~~ Last known address of decedent ~ ~~ Date of death p--~ 1 ~-~ ~ ~t Place of death ~~~~~ ( 1~1 County of grant of original letters ~ env' ~ u~.~~~-~~1, Decedent di testate intestate. A copy of e W' is snot attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Name Address Telephone 1 t~c~~. ~ Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone C.x~l_,~C~.'t ~J~212~u, Esq. L P.O. Box~Sq New Bloomfield, PA, 17068 (7171582-~~~ Additional information maybe obtained from the undersigned. Date Signature Name L.(~x~sauire Address P.O. Box ~~=( New Bloomfield. PA 17068` Capacity: Personal Representative X Counsel for personal representative NOTICE OF BENEFICIAL INTEREST IN ESTATE BEFORE THE REGISTER OF WILLS, COI:INTY OF , PENNSYLVANIA In re ~Q1(' lQi~l ~v i 5 ~ ,deceased, .~ ~~ l...i ~ ~` ~ , ~~ ~ruclCx.~G~~~ No. a1.1- O~ -p-l~j~„P To: Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. You may have a beneficial interest in the estate as follows: (if additional space is needed, use back of page) Name of decedent ~ ~~_~~~~~~'~~ Last known address of decedent ~ t~ \~0~-S \g 1`~ A copy of tie W' is snot attached. Name(s), address(es) and telephone number(s) of all personal representatives appointed Date of death ~--1 ~~~'~ Place of death ~~e~~v~ ( ~`~~ County of grant of original letters ~~ ~~ ~~~~~ Decedent di testate intestate. Name Address Telephone L~ S t ~~~~ ~ Name(s), address(es) and telephone number(s) of all counsel Name Address Telephone Qrbl_ v~~~ U~2u, Esa.,. P.O. Box~~q New Bloomfield, PA, 17068 (717 582-~~~ Additional information maybe obtained from the undersigned. Date Signature Name L.t~e.~ s uare Address P.O. 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We'd like to hear from vou! i [,~p IA1?talc~ftl fZD0f1t DNW9~ !: µ~"~""""~"~'""""'~"~'"~""~"""""`"'""'"~"""°""'""~""'"""""`"" "°"""`"°"`"°"' `. tJist:4 Yl~lC Check Used Car History . ~~ a ~~°"' 115 charact°''sto'~ `; ` ~':. ~ ..,.. ., ~ s f .. raaTOier ~~ :urtEG. t`~ MAfT •Wi3T10N L +Gnet A iiyREE CARFAX R;~cord Chuck` .,,.,.......~ .............:............_..~._._........................................:....._ ................. _ ... _......... __ . t r V1N Here En e ' ~~ !!~~ NNl ~~`~~i~ Car Loans and Leases You may get a great price on a car, but are you sure you're getting the lowest interest rate on your loan or lease? Leam how to research your credit score and get pre-approved before heading to the Dealer at Edmunds' Car Loans ter. Rates listed below are available to applicants with excellent credit. Car.com offers car loans for people who have lower FICO scores or have had difficulty obtaining credit. Take control of your auto purchase options with an up2drive drive checkT"'. Today's APR Rates 36 mo. 48 mo. 60 mo. 72 mo. New Vehicle 4.99°k 5.29°k 5.49°/a 5.99°k Refinance 5.24°1° 5.44% 5.44% 5.64°k Private Party 6.49°rb 6.69% 6.69% 7.49% Used Vehicle 5.49% 5.69% 5.69°~ 5,99% http://www.edmunds.com/used12004/fordJfocus/100327676Iprices.html 11/3/2009 ~~ Ba~ara Wer~dau, Esquire Attorney At law 26 East Main Street, P.O. Box 459 New Bloomfield, PA 17068 (717) 582-4335 (717) 582-8883 (717) 582-7697 Fax September 28, 2009 M and T Bank 423 N. Enola Road Enola, PA 17025 Newport, PA 17074 Re: Marian L. Brudowsky Acct# 45916896 Date of Death: July 24, 2009 To Whom It May Concern: Enclosed please find a Short Certificate for the above-mentioned party. Please provide date of death balances for any accounts Ms. Burdowsky had with your institution. Thank you. .,. . Sincerely, Barbara Wera~au, Esquire Attomeli At Law 26 East Main Street, P.O. Box 459 New Bloomfield, PA 17068 (717) 582-4335 (717) 582-8883 (717) 582-7697 Fax September 28, 2009 Selman and Company 6110 Park Boulevard Cleveland, Ohio 44124-4187 Re: Marian L. Brudowsky Insured ID: P000196320 Coverage: AD and D Voluntary Insurance Carrier: Life Insurance Company of North America Policy Number: PCA-920000 Sponsor: Americhoice Federal Credit Union Date of Death: July 24, 2009 To Whom It. May Concern: Enclosed please find a Short Certificate for the above-mentioned party. Please provide date of death balances for any accounts Ms. Burdowsky had with your institution. Thank you. .;, . Sincerely, Wevodau, Esq. Barbara~We~odau, E$puire Attorney At law 26 East Main Street, P.O. Box 459 New Bloomfield, PA 17068 (717) 582-4335 (717) 582-8883 (717) 582-7697 Fax September 28, 2009 MetLife Insurance Company Johnstown Data Integrity Unit 500 Schoolhouse Road Johnstown, PA 15904-2914 Re: Marian L. Brudowsky Policy No. 822535049A Date of Death: July 24, 2009 To Whom It May Concern: Enclosed please find a Short Certificate for the above-mentioned party. Please provide date of death balances for any accounts Ms. Burdowsky had with your institution. Thank you. _;, . Sincerely, ar Wevodau, Esq. Ni Barbara We~~dau, Esquire Attorney At law 26 East Main Street, P.O.$ox459 New Bloomfield, PA 17068 (717) 582-4335 (717) 582-8883 (717) 582-7697 Fax September 28, 2009 BNY Mellon Asset Servicing P.O.Box 458 East Syracuse, NY 13057 Re: Marian L. Brudowsky Plan #G55055 Account Name; Foot Locker, Inc and Kinney Shoe Corp Date of Death: July 24, 2009 To Whom It May Concern: Enclosed please find a Short Certificate for the above-mentioned party. Please provide date of death balances for any accounts Ms. Burdowsky had with your institution. Thank you. Sincerely, .., . B Wevodau, Esq. Barbara~Weoodau, Esquire attorney At Law 26 East Main Street, P.Q. Box 459 New Bloomfield, PA 17068 (717) 582-4335 (717) 582-8883 (717) 582-7697 Fax September 28, 2009 Sovereign Bank Mailcode: RI 1-EPV-0218 P.O. Box 831001 Boston, MA 022,83-1101 Re: Marian L. Brudowsky CD # 0925156747 CD#0925156739 Date of Death: July 24, 2009 To Whom It May Concern: Enclosed please find a Short Certificate for the above-mentioned party. Please provide date of death balances for any accounts Ms. Burdowsky had with your institution. Thank you. Sincerely, evodau, Esq. B8fb8f8 W8Y8~80, Esquire Attorney At law 26 East Main Street, P.O. Box 459 New Bloomfield, PA 17068 (717} 582-4335 (717) 582-8883 (717) 582-7697 Fax September 28, 2009 American General Life and Accident P.O> Box 4507 CampHill, PA 17011 Re: Marian L. Brudowsky Fam Grp No. FN 7286 Agency No. 100 Policy No. 5913938019 Date of Death: duly 24, 2009 To Whom It May Concern: Enclosed please find a Short Certificate for the above-mentioned parry. Please provide date of death balances for any accounts and/or policies that Ms. Burdow:>ky had with your institution. Thank you. Sincerely, .:, . Wevodau; Esq. Barbara' Weradau, Esquire Attoreey At law 26 East Main Street, P.O. Box 459 New Bloomfield, PA 17068 (717) 582-4335 -` (717) .582-8883 (717) 582-7697 Fax September 28, 2009 Western-Southern Life Assurance Company Annuity Operations P.O. Box 2918 Cincinnati, Ohio 45201-2918 Re: Marian L. Brudowsky Contract# W0020210085 Date of Death: July 24, 2009 To Whom It May Concern: Enclosed please find a Short Certificate for the above-mentioned party. Please provide date of death balances for any accounts Ms. Burdowsky had with your institution. Thank .you. Sincerely, arb Wevodau, Esq. Barbara W~rodau, Esquire Atternell At law 26 East Main Street, P.O. Box 459 New Bloomfield, PA 17068 (717) 582-4335 (717) 582-8883 (717) 582-7697 Fax September 28, 2009 Susquehanna Bank 9 E. Main Street P.O. Box 1000 Lititz, PA 17543 Re: Marian L. Brudowsky Acct# 4601704809 Date of Death: July 24, 2009 To Whom It May Concern: Enclosed please find a Short Certificate for the above-mentioned party. Please provide date of death balances for any accounts Ms. Burdowsky had with your institution. Thank you. Sincerely, -'' arb Wevodau, Esq. Barbara We~odau, Esquire Attorney Ai law 26 East Main Street, P.O. Box 459 New Bloomfield, PA 17068 (717) 582-4335 (717) 582-8883 (717) 582-7697 Fax September 28, 2009 PNC Bank 1 N. 2"d Street Newport, PA 17074 Re: Marian L. Brudowsky Acct# 51-4000-7979 and Acct # 50-0190-1487 Date of Death: July 24, 2009 To Whom It May Concern: Enclosed please find a Short Certificate for the above-mentioned parry. ]Please provide date of death balances for any accounts Ms. Burdowsky had with your institution. Thank you. Sincerely, Wevodatl; ~ Esq. Susquehannj Susquehanna B 26 North Cedar St P.O. Box 1 Lititz, PA 17543-7 Toll free 800.311.3 September 30, 2009 BARBARA WEVODAU, ESQUIRE PO BOX 459 NEW BLOOMFIELD PA 17068 RE: Marian L. Brudowsky Estate SS # : 179-14-871 1 DOD: July 24, 2009 To Whom It May Concern: In response to your letter of September 28, 2009, here is the above customer account information as of July 24, 2009. Account #1 Account #2 • Account Title: Marian L Brudowsky Marian L Brudowsky Kimberly D Schardt • Account Type/# Ckg/4601704809 CD/403300001654 • Date Opened /Maturity 5/ 18/00 3/5/07 / 12/5/09 Opened Joint • Interest Rate: .15% 2.01 • Account Balance*: 1 1,056.99 1,296.35 • Accrued Interest: .38 1.34 • YTD Interest: 6.09 15.80 *Account balance does not include accrued interest. There is no safe deposit box in the name of the decedent. If I can be of further assistance, please feel free to call. Sinc rely, -~ ~~~. Dawn M. Berrier Support Services Lead 1-717-625-6546 DMB/Ijr ~ I '~ yl 1 .~ ~~ ~ 1, - / 1, J Irt ~ ~ ~~~' 1~ K I~ ~U ~ "~ ~ I~. ~ ! a G ~ r~T ~ ~ v ~ ~ _ _ ~ l~ ~PNC LlADIN9 TN! 9VAY October 5, 2009 Barbara ~JVevoclau, Esy. Attorney ai Law 26 E Main St POBoX4s9 I~"ew 131oornfield, PA 17068 1tE: Marian L Brudowsky SSN: 179-14-8711 DOD: 07.24-2(1x9 Dear Nis. Wevodau: In response t© your request for Date of Death (DOI~~ balances far the customer noted above, our records shc~~v the follu~wing: Certificate of Depo9it Account # 31900239234 Established: q3-1$-2004 h4ARIA1~,' L BRUDORISKY dEP~'REY 0 SEES DOD balance: S 1,123.13 + 0.30 accrued interGSt Checking Account Account # 514(1007979 Established: t)2-0I -1968 MARIAN' L BRUDOWSKY DOD balance: $19,742.29 -~ O.bl accrued interest Saving Account Account # SOnI901487 Established CIS-0~9-1999 IvL~I~AN L BRUDOWSKY DOD b~atance: $ 3,149.1 S + d.30 accrued interest Page 1 of 2 Ir?. .. ~'~~t~~ ~ i S, 1~ Jr ~ ~~_ ~~.,_ ~ ,~. Safe neposit Boa The decedent maintained safe deposit box 504 NI1~EZiAN L BRUDOWSKY Located at: Euola Branch 23 S N Enola Rd En~ola, PA 17025 (~ 17} 732-5388 `r;,~ ,~;J "~ L Please note that this office provides date of death balances fox deposit accounts (IItAs, CDs, Checking and Savings). vVe do not process soy trinancial transsrtlont or provide statements. If you need assistance with any of these items, please call 1.888-PNC-BALK (1-888.762.2265) ox stop by your local P"?vC ~8anlc branch office. SlIICeT'ely, National l~`inancial Services Center F~tC Bank, I~T.A. 1Vlember FDIC Page 2 of 2 p n~sazk 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Barbara Wevodau, Esquire 26 East Main Street P.O. Box 459 New Bloomfield, PA 17068 Re: Estate o,~ Marian L. Brudowsk~ Account Number: 45916896 & 15004207086825 Date of Death: Julu 24, 2009 October 5, 2009 Dear Sir or Madam: Per a memo from Wanda Brown at M8vT Bank, dated September 30, 2009, requesting apt the time of death, the balance on the above referenced account(s) was: 1. Type of Account Checking Account Account Number 45916896 Ownership (Names ofl Marian Bncdowsky* Patti M Buxton* Opening Date Balance on Date of Death Accrued Interest Total 10/ 18/ 96 Closed 8/ 13/ 09 $1,894.63 $ 0.07 $1, 894.70 2. Type of Account Savings Account Account Number 15004207086825 Ownership (Names oj~ Marian Brudowsky* Opening Date 10/ 12/ 00 Closed 8/ 11 / 09 Balance on Date of Death $ 2,157.20 Accrued Interest $ 0.05 Total $ 2,157.25 * For further account information, regarding ownership, closures and/or reimbiursement of funds, etc., please contact the 3ummerdale Plaza Office # ? 17-255-2261. M 8s T Bank DOD Unit /Adjustment Services Western & Southern Life A member of Western & Southern Financial Group Annuity Operatior PO Box 291 Cincinnati, OH 45201-291 toll free 800.926.170 fax 513.629.17 October 2, ?009 BARBARA WEVODAU, ESQUIRE 26 EAST MAIN STREET PO BOX 459 NEW BLOOMFIELD, PA 17068 Dear Ms. Wevodau: Thank you for your request for information on the annuity contract. I hopes the following contract information is helpful to you. Annuitant: MARIAN BRUDOWSKY Owner: MARIAN BRUDOWSKY Western-Southern Life Assurance Company Contract Number: W0020210085 Date of Death Value as of July 24, 2009 $5,857.76 If you have any questions, please call our Annuity Operations Departments at 1-800-926-1702. A representative will be happy to help you. Sin rely, ~f Am Hartke Ann ity Oper "o s Department DC0331-0810 Western-Southern Life Assurance Company 1 :~ ~ovexei~n ~Cowt Ordered 1?,~~cessin~ 1 Dececlcnls - MA1-M8"a-0:-10 - P. O. Box 8{005 - Boston, MA U22A4 October r , X009 26 East ~Aain Street P.O. Box 459 New BI oornf field, PA ~ 7068 VIA FACSIMILE 71?-582-7587 Re: Estate of Marian L. Brudowsky Date of Death; 7124lt~9 pear Barb Wevadau: Ir'Ve have received your request fur date of death balances on the accounts of the above-named decedent. Please refer to the additional item(s) indicated below that are required to complete your request; some of which are required in order to comply with privacy laws affecting bank accounts. We need tv ensure that we provide account information only tv those individuals authorized to receive it. Please send the documentation checked off bElovv to my attention at the address fisted above. X_ _ X20.00 Date of Death Balance Foe payable to Sovereign Bank (effective 611/4g~ Death Certificate ,____ Gaurt Appointment of Executor(trix) pr Administrator(trix) ("Certificate of appointment"} Authorization from Executorfl~dministr2tor/Joint Owner/Beneficiary to rele~ese ___.__ information Other: If you would like to liquidate the accounts, please return certified copies of the [death Dartiflcate, Oertificate of Appointment, if applicable, and a notarized fetter of instruCtipn from the executor, c4-hokfer, ar beneficiary, as appropriate. lfery truly yo~,rs, - Y ~` Laurie lOiGianda enico Tearrl Manager 617,533-'! 789 phone 611-533-1931 fax Metropolitan Life Insurance Company PO Box 330 Warwick RI 02887-0330 00082 MetLife October ;~, 2009 Barbara Wevodau Esq Attorney at Law 26 E Main St PO Box 459 New Bloomfield PA 17068 RE: METROPOLITAN LIFE INSURANCE COMPANY POLICY 822535049A INSURED MARIAN BRUDOWSKY Dear Barbara Wevodau: Thank you for contacting the Claims Department. Enclosed is Form 712 for this policy as requested. If you have any questions, please contact your representative or call our Customer Service Center at _ 1-800-638-5000 Monday through Friday between 9 a.m. and 6 p.m., ET. > _. Sincerely, o ~_ ~ ~ ~~~ Michelle Comery Claims Unit 7981 128 3 '- ~ -- Form 71 2 (Rev.May 2000) Department of the Treasury Internal Revenue Service Life Insurance Statement OMB No. 15 4 -0022 ::Q~;::'j:;:::;:: :~: Decedent -Insured (To Be filed by the executor with Form 706, United States Estate (and Generation-Skipping Transfer) Tax Re Form 706 -NA, United States Estate (and Generation-Skipping Transfer) Tax Return, Estate or nonresident (not a citizens of the United States.) ' rn, or 1 Decedent's first name and middle initial 2 Decedent's last name 3 Decedent's Social Security 4 Date of MARIAN BRUDOWSKY number (if known) 179-14-8;71 1 July 24, 2 eath 9 5 Name and address of insurance company Metropolitan Life Insurance Company PO Box 330 Warwick RI 02887-0330 6 Type of policy 7 Policyy number L90 U 510M F 822535049A 8 Owner's name. If decedent is not owner, 9 Date issued 10 Assignor's name. Attach copy 11 Date as attach copy of application of assignment. MARIAN BRUDOWSKY May 28, 1982 ; gned 12 Value of the policy at 13 Amount of premium (see instructions) 14 Name of beneficiaries the time of assignment 50.00 S 24.60 JEFFREY O SEES 15 Face amount of policy ..................................................................... S 5 00.00 16 Indemnity benefits ....................................................................... S 0.00 17 Additional insurance ....................................................................... S 6 86.73 18 Other benefits ........................................................................... S 0.00 19 Principal of any indebtedness to the company that is deductible in determining net proceeds ........... S 0.00 20 Interest on indebtedness (line 19) accrued to date of death ......... . ........... . .. . .. • • , _ • • .. , , _ S 0.00 21 Amount of accumulated dividends .......................................................... S 0.00 22 Amount of post-mortem dividends ................ . ....... . ................................. S 23 Amount of returned premium .................................................•,,.,,.,••,.,• $ 4 0 24 Amount of proceeds if payable in one sum ................................................... S 1 22.86 25 Value of proceeds as of date of death (if not payable in one sum) ................................. S 26 Polic ~ ~ y provisions concerning deferred payments or installments ...... • t nl m - tl ti ........................... Note: if other ha u sum set emen s authorized for a survivin s s at h u e tac a co 0 f the insuranc l' e is P Po , 9 A y ,~ y ...................... ~~~" `'~' ~`~'~~~`'~~ '~ ................. '`~'~~~'~~ ~~~~ ~ ~' 27 Amount of installments .......................................•••••••••••••••••..•..•....-.. S O.OC 28 Date of birth sex and name of an erson the duration of whose life ma measure the numbe y p r of Y payments. 29 Amount applied by the insurance company as a single premium representing the purchase of installment benefits ................................................................................ S ~~ O.OC 30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits 31 Were there any transfers of the policy within the three years prior to the death of the decedent. ^ Yes x No 32 Date of assignment of transfer: Month Day Year 33 Was the insured the annuitant or beneficiary of any annuity contract issued by the company?• • • • • • • - • • ^ Yes : x No 34 Did the decedent have any incidents of ownership on any policies on his/her life, but not owned by hire/her at the date of death? ..................................................................... ^ Yes 0 No 35 Names of companies with which decedent carried other policies and amount of such policies if this information is disc sed by your records. The undersigned officer of the above-named insurance company (or appropriate Federal agency or retirement system official) hereby ce fies that this statement sets forth true and correct information. Signature~~ /// ~ ' ~~1Z~ Title ~' Claim Approver Date of Certification ~~OCtOber 7, 20 ~~ Sovereign Court Ordered Processing \ Decedents - MAl-MB3-02-10 - P. O. Box 841005 -Boston, MA 02284 October 7, 2009 Barb Wevodau Attorney at Law 26 East Main Street P.O. Box 459 New Bloomfield, PA 17068 VIA FACSIMILE 717-582-7697 Re: Estate of Marian L. Brudowsky Dale cT Deaf ~ i : 7/24109 Dear Barb Wevodau: We have received your request for date of death balances on the accounts of the above-named decedent. Please refer to the additional item(s) indicated bE;fow that are required to complete your request; some of which are required in order to comply with privacy laws affecting bank accounts. We need to ensure that we provide account information only to those individuals authorized to receive it. Please send the documentation checked off below to my attention at the address listed above. X $20.00 Date of Death Balance Fee payable to: Sovereign Bank (effective 6/1/09) Death Certificate Court Appointment of Executor(trix) or Administrator(trix) ("Certificate of Appointment") Authorization from Executor/Administrator/Joint Owner/Beneficiary to release information Other: If you would like to liquidate the accounts, please return certified copies of the Death Certificate, Certificate of Appointment, if applicable, and a notarized letter c-f instruction from the executor, co-holder, or beneficiary, as appropriate. Very truly yours, -~~. Laurie DiGiandomenico Team Manager 617-533-1789 phone 617-533-1931 fax Michael J. Shalonis Funeral Home 206 Maple Avenue Marysville, Pennsylvania 17053 Fax (717)-957-2077 Michael J. Shalonis, Owner Phone (717) 957-3451 We Care About Service To You Tuesday, August 11, 2009 Mrs. Bonita S. Heisey 250 Alice Lane Newport, PA 17074 Dear Bonnie, Thank you for selecting our funeral home to provide services for your family during your time of bereavement. I hope that you found our services, so far, to be of the highest standards that we always try to achieve. The following is a summary of the service charges as previously explained and provided in written form on the services for: MARIAN L. BRUDOWSKY 1. Professional Services Basic Service Of Funeral Director & Staff $ 1225.00 Embalming $ 475.00 Dressing, Casketing, Cosmetics, Details $ 250.00 $1,950.00 2. Use Of Facilities, Staff And Equipment Staff& Equipment For Church Service $ 395.00 $395.00 3. Automotive Equipment Transfer Remains To Funeral Home $ 175.00 Utility Car $ 175.00 Out Of Town Transporation $ NIC $350.00 TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPMENT $2,695.00 Merchandise Casket: Baron Silver $1,075.00 Outer Burial Container Acknowledgement Cards $ included Register Book $ included Memorial Folders 175 $ included $1,075.00 CASH ADVANCES Cemetery Charges $ Prepaid Paid Newspaper Notice $ 367.07 Carlisle Sentinel $ 172.96 Church or Clergy $ Family Certified Copies of Death Certificate 10 $ 60 Flowers $ 225.00 Lebanon Daily News $ 233.64 Organist $ 100.00 Custodian $ 50.00 TOTAL FUNERAL CONTRACT LESS: Credits granted Discount $200.00 BALANCE DUE If there are any questions or concerns that remain unanswered, please call me. Sincerely, /~~~. Michael 3. Shalonis $1,208.67 $4,978.67 $200.00 ~., i i o~ -~ ,' G ~-f ~ ~ ~ ~~ C~ ~~ -~~ ~ -/ i ..~ ~~ ~~ Michael J. Shalonis Funeral Home 206 Maple Avenue Marysville, Pennsylvania 17053 Fax (717)-957-2077 Michael J. Shalonis, Owner Phone (7:17) 957-3451 We Care About Service To You Friday, August 14, 2009 Mrs. Bonita S. Heisey 250 Alice Lane Newport, PA 17074 Dear Bonnie, Thank you for selecting our funeral home to provide services for your family during your bereavement. I hope that you found our services to be of the highest standards and that they met your needs and those of your family and friends. The following is a summary of the service charges as previously explained and provided in written form and herein indicated as PAID-IN-FULL. Marian L. (Sally) Brudowsky SUMMARY OF EXPENSES TOTAL OF SERVICE RENDERED $4,978.67 LESS: Credits granted 200.00 LESS: Total Payments 4,778.67 CURRENT BALANCE $0.00 Credits Granted: $200.00 Discount If there are any questions or concerns that remain unanswered, please call me. Sincerely, i>~~.~. Michael J. 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