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Home My WebLink About03-0662 PETITION FOR PROBATE and GRANT OF LETTERS Estate of' Edward C. Blake No. t~ 1.- i~,.~- ~_~ ~} .~,~ also known as To: Register of Wills for the Social Security No. 016-07-~9~4Deceased' County of 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 execut in the last will of the above decedent, dated October 10, 1997 and codicil(s) dated N/A. Decedent was predeceased by spouse, Pierce Blake on July 12, 2002. The named Executor and hauo_ signed renunciations in favor of the undersigned. in the named Barbara beneficiaries (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in. Cumberland County, Pennsylvania, with h is last family or principal residence at 940 Walnut Bottom Road, South Mictctlot-nn 'I'nwn.qhip: Carli.qlo (list street, number and muncipality) Decendent, then 86 years of age, died April 28, 2003 ,~IR , at Carlisle. Pennsylvania 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: N/A Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: Unknown None WHEREFORE, petitioner(s) respectfully requ~st(.s) .the probate of the last will and codicil(s) presented herewith and the grant of letters. Achhxnxscrwca. on C. T .A. theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) KeiLi, O. Brenneman 44 W. Main Street Mechanicsburq, PA 17055 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OFf 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 trul~ administer the estate according to law. Sworn to or affirmed and subscribed before me this . ~d~0~% ~'44Keithw. MainO' Brennemanstreet /~-/~'-~-~ ~ [. Mecl,anicsburg, Pa 17055 Estate Of DECREE No. Edward C. Blake OF PROBATE AND , Deceased GRANT OF LETTERS AND NOW the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 10, 1997 described therein be admitted to probate and filed of record as the last will of and Letters of Administration C.T.A. Keith O. Brenneman are hereby granted to. 2003, in consideration of the petition on Edward C. Blake Register of Will~ FEES Probate, Letters, Etc .......... Short Certificates( ) .......... Renunciation ................ TOTAL Filed ................................... A~ORNEY(Sup. Ct.I.D. No.) Keith O. Brenneman, Esquire 47077 44 W_ M~in St_; M~h~ni~h~]rg, PA ADDRESS 17055 717-697-8528 PHONE RENUNCIATION In Re Estate of Edward C. Blake deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned Snelbaker, Brenneman & Spare, P. C., named Executor of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration C.T.A. beissuedto Keith O. Brenneman WITNESS my hand this / ! day of ,6'~,~4-( , :l~ 2 0 0 3 Sn~eman & Spare, P.C. Richard C. Snelbaker, ~squ±re, ~res±dent 44 W. Main St., Mechanicsburg, PA 17055 (Address) (Signature) (Address) (Signature) (Address) RENUNCIATION In Re Estate of Edward C. Blake deceased. To the Register of Wills of Cumberland County, Pennsylvania. Theundersigned beneficiaries under the Will of theab~vedecedent~herebyren~unce(s)therightt~administertheestateandrespe~tfu~~yask(s)thatLetters of Administration C.T.A. beissuedto Keith O. Brenneman WITNESS our hand this O~t~ day of ~'tt.44A~ ,~ggt 200.3 (Signature) Hazel Walters 4 Stine Avenue Carlisle, PA 17013 (Address) (Signature) Marlin Walters 4 Stine Avenue Carlisle, PA 17013 (Address) (Signature) (Address) RENUNCIATION In Re Estate of Edward C. Blake deceased. To the Register of Wills of Cumber land County, Pennsylvania. The undersigned- niece and residual beneficiary under the Will of the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters of Administration C.T.A. be issued to Keith O. Brenneman WITNESS my hand this o7l day of ~ , 1~ 200.3 Jane Losada The Columbus School Apartado Aereo 60562 Med~!!in, Colombia ~ . (Address) South ~merxca (Signature) (Address) (Signature) (Address) SNELBAKER, BRENNEMAN SPARE LAST WILL AND TESTAMENT OF EDWARD C. BLAKE I, EDWARD C. BLAKE, of the Borough of Mount Holly Springs, ~umberland County, Pennsylvania, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be paid as soon as practicable after my death by my Executrix or Executor, whichever the case may be, hereinafter named. I direct that all taxes that may be assessed as a consequence of my death shall be paid from my residuary estate as part of the expenses of the administration of my Estate. 2. Ail the rest, residue and remainder of my Estate, real, personal and mixed and wheresoever the same may be situate, i give, devise and bequeath to my wife, BARBARA PIERCE BLAKE, her heirs and assigns, provided my said wife, BARBARA PIERCE BLAKE, shall survive me by a period of sixty (60) days. 3. Should my said wife, BARBARA PIERCE BLAKE, predecease me or fail to survive me by the aforesaid period of sixty (60) days, then in such event, I give, devise and bequeath my Estate as follows: A. I give to MARLIN WALTERS and HAZEL WALTERS, his wife, or the survivor of them, my 1979 Commodore trailer, having vehicle identification number CD1598A and title number A32954604. In the event both Marlin Walters and Hazel Walters should fail to survive me, I direct that the above-referenced trailer be distributed as Be part of the residue of my Estate pursuant to Paragraph 3.B. below. The rest, residue and remainder of my Estate, real, personal and mixed and wheresoever the same may be situate, I give, devise and bequeath to JANE LOSADA. 4. I hereby nominate, constitute and appoint my wife, PIERCE BLAKE, as Executrix of this my Last Will and Testament but in the event she should predecease me or fail to quality, then in such event, I nominate, constitute and appoint SNELBAKER, BRENNEMAN & SPARE, P. C., or its successor, to be Executor of this my Last Will and Testament. I further direct that no person serving as Executrix or Executor hereunder shall be required to post bond and secure the faithful performance of her or his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on Two (2) pages this 10th day of October, 1997. / Edward/C. Bl~ke SNELBAKER, BRENNEMAN & SPARE Signed, sealed, published and declared by EDWARD C. BLAKE, Testator above named, as and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses.~~'~~//~ (SEAL) ~ ~ ~ (SEAL) --2-- COUNTY OF PENNSYLVANIA) : OF CUMBERLAND) SS. We, EDWARD C. BLAKE, KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, the Testator and the witnesses, respectively, whose names are signed to 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 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 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. " / T~s~ator Witness , /9 LAW OFFICES SNELBAKER, BRENNEMAN & SPARE ibed, sworn to and acknowledged before me by EDWARD C. BLAKE, Testator, and subscribed and sworn to before me by KEITH · BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this 10th day of October, 1997. Notary Public Notarial Seal Patricta J. Thomson, Notary Public Iviecha~icsburg Bom, Cumberland Coumy ,My CommissiOn Expires Dec. 31,199~ EDWARD C. BLAKE SNELBAKER, BRENixIEMAIxI ~ SPARE A PROFESSIONAL CORPOI;~,ATIOBI ATTORNEYS AT LAW 44 WEST MAIN STREET MECHANICSBURG, PENNSYLVANIA 17055 P. O. BOX 318 'O3 LAW OFFICES SNEIBAKER. BrENNEmAN & SParE CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Edward C. Blake Date of Death: April 28, 2003 Will No. 21-03-0662 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following sole beneficiary of the above-captioned estate on September 24, 2003 Name Address Jane S. Losada Mr. Marlin Walters Mrs. Hazel Walters The Columbus School Apartado A~reo 60562 Medellin, Colombia South America 4 Stine Avenue Carlisle, PA 17013-9649 4 Stine Avenue Carlisle, PA 17013-9649 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: None. Date: September 24, 2003 Keith O. Brenneman, Esquire Snelbaker, Brenneman & Spare, P. C. 44 W. Main Street Mechanicsburg, PA 17055 (717) 697-8528 Counsel for Personal Representative R£¥-1500 EX (6-00) ~ PENNSYLVANIA ,,~~~:~, DEPARTMENT OF REVENUE FIL NUMBER INHERITANCE TAX RETURN/ o 3 ~HARRISBURG, PA 17128-0601 RESIDENT DECEDENT FIRST, AND MIDDLE INITIAL) ~ SOCIAL SECURI~ NUMBER ~la[e, gdwa~d C. Z LU t"l DATE OF DEATH (MM-DD-YEAR) ! DATE OF BIRTH (MM-DD-YEAR) LU 04-28-2003 ' 02-20-1917 I.LI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) N/A "' ~[ 1. Original Return [] 2. Supplemental Return 016_- - THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER ~.. [] 3. Remainder Return (date ofdeathpda-to 12-13-82) O [] 4. Limited Estate [] 4a. Future Interest Compromise (date o, death after U-U-S2) [] 5. Federal Estate Tax Return Required ,I,- o ~ 6. Decedent Died Testate (Attach Copy of Will) [] 7. Decedent Maintained a Living Trust (Attach copy of Trust) O 8. Total Number of Safe Deposit Boxes < [] 9. Litigation Proceeds Received [] 10, Spousal Poverty Credit (da~e of death bet .... 12-31-91 and 4-1-95) [] 11. Election to tax under Sec. 9113(A)(Attach Sc~ O) ~- THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDEN~L TAX INFORMATION SHOULD BE DIRECTED TO: NA~eith 0 Brenneman ~ .... ;~_ ~AIk~NGADORESS - -- -- FIRM NAME Cf Applicable) ~ ~ ~ ~ &~~ 44 W. Main Street 717 697 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 4,6 6 9.2 7 (Schedule E) <~, 6. Jointly Owned Property (Schedule F) (6) ~-. ]Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7) (Schedule G or L) 6. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 2,664.69 (lO) 57,726.25 (8) 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14 Net Value Subject to Tax (Line 12 minus Line 13) (11) 02) (13) (14) 4,669.27 60,390.94 (55,721.67) --0-- SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate O 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. [] .......... x o (~5) x .0 . (16) x .12 (17) x .15 (18) (19) -O- : > >:BE SURE TO AN~ERALL QUESTIONS ON R~RSE SiDE,ND RECHECK MATH << Decedent's Complete Address: STREETADDRESS 940 Walnut__Botto~m Road Carlisle lSTATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Pove~y Credit B Prior Payments C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. Total Credits ( A + B + C ) (2) (3) (4) (5) (5A) (5B) (1) -0- B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. -o- Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes 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 revers onary interest' or ................................. [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of prepar,~r other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE,OF/~F_,P, SDN RESPONSIBLE FOR FILING RETURN ADDRESS · Administrator C.T.A. 44 W. Main Street, Mechanicsburg, PA 17055 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS - For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving Spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. 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 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 ~n 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. REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Edward C. Blake SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21--03--00662 ITEM NUMBER 2. 3. 4. 5. 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. DESCRIPTION PNC Bank, checking PNC Bank, checking ManorCare Resident Commonwealth of Massachusetts ManorCare account refund account No. 5003248506 account No. 5003923137 Trust payment pension payment TOTAL (Also enter on line 5, Recapitulation) $ VALUE AT DATE OF DEATH $1,577.17 973.14 769.84 1,239.32 109.80 4,669.27 (If more space is needed, insert additional sheets of the same size) REV-1511 EX+ (12-99) COMMONWEALTH OF PENNSYLVANIA iNHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ITEM NUMBER SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER Edward C. Blake 21-03-00662 Debts of decedent must be reported on Schedule DESCRIPTION FUNERAL EXPENSES: ADMINISTRATIVE COSTS: 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: Att0rneyFees to Snelbaker, Brenneman & Spare, P. C. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent State __ Zip Probate Fees to Register of Wills Accountant's Fees , filing fees and miscellaneous reserve ~~~x~Advertise grant of Letters: expenses/ a. Cumberland Law Journal: $ 75.00 b. Patriot News 205.69 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) AMOUNT waived $2,000.00 59.00 325.00 280.69 $ 2,664.69 REV-1512 EX+ (6-98} COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE I DEBTS OF DECEDENT, MORTGAGE UABILITIES, & LIENS Edward C_~ Blake Include unreimbursed medical expenses. FILE NUMBER 21-03-00662 ITEM NUMBER DESCRIPTION Social Security Administration - re{und of overpayment Commonwealth of Pennsylvania, Department of Public Welfare, Estate Recovery Program claim: TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insed additional sheets of the same size) VALUE AT DATE OF DEATH $ 258.00 57,468.25 57,726.25 R:V-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Edward C. Blake 21-03-00662 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE ! TAXABLE DISTRIBUTIONS [include outfight spousal distributions, and transfers under e Sec. 9116(a)(1.2)] Jane S. Losada Apartado AAreo 60562 Medellin, Columbia South America Mr. and Mrs. Marlin Walters 5 Stine Avenue Carlisle, PA 17013-9649 Niece None ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS (if more space is needed, insert additional sheets of the same size) Residue (value = $0) Bequest Adeemed TOTAL_ OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET LAW OFFICES SNELBAKER, BRENNEMAN & SPARE LAST WILL AND TESTAMENT O_E EDWARD C. BLAKE I, EDWARD C. BLAKE, of the Borough of Mount Holly Springs, Tumberland County, Pennsylvania, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void any and all wills by me at any time heretofore made. 1. I direct that all my debts and funeral expenses be paid as soon as practicable after my death by my Executrix or Executor, whichever the case may be, hereinafter named. I direct that all taxes that may be assessed as a consequence of my death shall be paid from my residuary estate as part of the expenses of the administration of my Estate. 2. All the rest, residue and remainder of my Estate, real, personal and mixed and wheresoever the same may be situate, I give, devise and bequeath to my wife, BARBARA PIERCE BLAKE, her heirs and assigns, provided my said wife, BARBARA PIERCE BLAKE, shall survive me by a period of sixty (60) days. 3. Should my said wife, BARBARA PIERCE BLAKE, predecease me or fail to survive me by the aforesaid period of sixty (60) days, then in such event, I give, devise and bequeath my Estate as follows: A. I give to MARLIN WALTERS and HAZEL WALTERS, his wife, or the survivor of them, my 1979 Comm]odore trailer, having vehicle identification number CD1598A and title number A32954604. In the event both Marlin Walters and Hazel Walters should fail to survive me, I direct that the above-referenced trailer be distributed as LAW OFFICES SNELBAKER. BR£NNEMAN & SPARE part of the residue of my Estate pursuant to Paragraph 3.B. below. The rest, residue and remainder of my Estate, real, personal and mixed and wheresoever the same may be situate, I give, devise and bequeath to JANE LOSADA. 4. I hereby nominate, constitute and appoint my wife, ~ARBARA PIERCE BLAKE, as Executrix of this my Last Will and Testament but in the event she should predecease me or fail to quality, then iii such event, I nominate, constitute and appoint SNELBAKER, BRENNEMAN & SPARE, P. C., or its successor, to be Executor of this my Last Will and Testament. I further direct that no person serving as Executrix or ~xecutor hereunder shall be required to post bond and secure the faithful performance of her or his duties in the Commonwealth of Pennsylvania or in any other jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this my Last Will and Testament written on Two (2) pages this 10th day of October, 1997. / Edward, C. Bl~ke Signed, sealed, published and declared by EDWARD C. BLAKE, the Testator above named, as and for his Last Will and Testament, in our presence, who, in his presence, at his request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. / ~/...~/~ (SEAL) -2- LAW OFFICES SNELBAKER, BRENNEMAN & SPARE COMMONWEALTH OF PENNSYLVANIA) : ~OUNTY OF CUMBERLAND) SS. We, EDWARD C. BLAKE, KEITH O. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, the Testator and the witnesses, respectively, whose names are signed to 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 Nill and Testament and that he had signed willingly, and that he executed it as Ills 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 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. Testator Witness .],..:.:,;. ..... :: '2 · ~ ~ ,'~/,,.:, Witng~'g~ ]ubscribed, sworn to and acknowledged before me by EDWARD C. BLAKE, Testator, and subscribed and sworn to before me by KEITH ~. BRENNEMAN, ESQUIRE and SUSAN L. ZYCH, witnesses, this 10th ~ay of October, 1997. Notary Public I[ Notarial Seal [ Patxicts J. Thomson, Notary Public I l~cha~icsburg Bom, CumbeHand Cou~ll¥ [ My Commission Expires Dec. 3 l, 199~ Inventory of the real and personal estate of Edward C. Blake deceased II. PERSONALTy A. PNC Bank, checking account No. 5003248506 B. PNC Bank, checking account No. 5003923137 C. ManorCare Resident Trust payment D. Commonwealth of Massachusetts pension payment E~ ManorCare'account'refUnd Total: TOTAL VALUE, PERSONALTY: REAL ESTATE NONE TOTAL VALUE, ALL PROPERTY: $1,577.17 973.14 769.84 1,239.32 109.80 $4,669.27 $4,665 NONE $4 COMMONWEALTH OF PENNSYLVANIA ,L COUNTY OF CUMBERLAND Keith O. Brenneman being duly swor.~t., according to law, deposes and says that he is the Administrat. or C.T.A. of the ~tate of Edward C. Blake S. Middleton Townshi~ ., Cumberland County, Pa., deceased and that the late of within is an inventory made by Keith O. Brennema~t , the said Aclm~ n~ ~t-t-~-_n~- of the enHre estate of said decedent, consisting of all fhe personal property and real estate, except real estate outside fhe'Gommonwealfh of Pennsylvania, and fhaf the figures opposite each item of fha Inventory represent i*'s fair value as of fha date of decedenf'sdeafh. ~~ ~ and subscribed before me, /~ Executor - A~minisfrator ~~'~ ~ ~ ~x 2003 , -- ~echanicsbur~, ~ 17055 Date of Death Address April 2003 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 1949. , I I BUREAU OF TNDTVTDUAL TAXES XNHERXTANCE TAX DXVXSTON DEPT. 18060! HARRZSBURG, PA 17118-0601 COMMONNEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLO#ANCE OR DISALLOHANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-Ii47 EX AFP (01-05) KEZTH 0 BRENNEMAN ESQ SNELBAKER ETAL qq N MAIN ST MECHANICSBURG PA 17055 DATE ESTATE OF DATE OF DEATH FILE NUHBER COUNTY ACN 12-15-2005 BLAKE 0q-28-2005 21 05-0662 CUMBERLAND 101 Amount Remitted EDNARD C MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-154? EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BLAKE EDNARD C FILE NO. 21 05-0662 ACN 101 DATE 12-15-2005 TAX RETURN HAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: 0RZGINAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Hold Stock/Partnership Interest (Schedule C) (3) q. Mortgages/Notes Racaivab/a (Schedule D) $. Cash/Bank Deposits/Misc. PersonaZ Property (Schedule E) ($) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expensas/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 11. Total Deductions 12. Nat Value of Tax Return qz669.27 .00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion .00 of this form with your tax payaant. .00 (8) 2,66~.69 13. lq. NOTE: 57~726.15 (11) (12) Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) Net Value of Estate Subject to Tax (lq) Zf an assessment was issued previousZy, Zines ~q, ~5 and/er ~6, ~7, reflect figures that include the total of ALL returns assessed to date. q,669.27 60.390.9q 55,721.67- .00 55,721.67- ASSESSMENT OF TAX: 15. Amount of Line lq at Spousal rata 16. Amount of Line lQ taxable at Lineal/Class A rata 17. Amount of Line lq at Sibling rata lB. Amount of Line lq taxable at Collateral/Class B rata 19. Principal Tax Due TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 18 and 19 will IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR ZNSTRUCTZONS.) TOTAL TAX CREDZT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE AHOUNT PAID · °°I .00 .00 .00 (15), .00 X O0 = .00 (16) .00 X oq. 5= .00 (17) . O0 X 12 = . O0 (18) .00 X 15 = .00 (19)= . O0 RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decadents dying on or before December 1Z, 1981 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the CoaaonweaIth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act 25 of ZOO0. (72 P.S. Section 91¢0). Detach the top portion of this Notice and submit with your payment to the Register of Nills printed on the reverse side. --Make check or money order payable to: REGISTER OF NXLLS, AGENT A refund of a tax credit, ehich was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inherltanca and Estate Tax" (REV-I31:5). Applications ara avaiIabla at the Office of the Register of Wills, any of the Z:5 Revenue District Offices, or by calling the special Iq-hour ansmaring service for fores ordering: 1-800-:56Z-ZOSO~ sarvlces for taxpayers with special hearing and / or speaking needs: i-800-qqT-:5020 (TT only). Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object mithin sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17118-1011, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit~ Dept. Z80601, Harrisburg, PA 17128-0601 Phone (717) 787-6SOS. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the dacedent's death, a five percent (5Z) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and Dna (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1981 bear interest at the rate of six (6Z) percent par annum calculated et a daily rate of .00016~. AIl taxes which became delinquent on and after January 1, I982 wiiI bear interest at a rate ahich will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1981 through Z00:5 ara: Interest DaiZy Interest Daily Interest Daily Year Rate Factor Yaa.~r Rate Factor Year Rate Factor 1982 ZOZ . OOOSq8 1987 9Z . O00gq7 1999 7Z .000191 198:5 167, ,OOOq.38 1988-1991 111 .000:501 2000 87. .000~'19 198q. 111 .000:501 1991 97, , OO OZq.7 :'001 97, , OOO Iq7 1985 1:5Z .000356 199:5-199q 72 .000192 ZOOZ 62 . O0016q 1986 lOZ . O00Z7~, 1995-1998 9Z . OOOZq7 200:5 5Z .0001:57 --Interest is calculated as follows: XNTEREST= BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DALLY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be caXcuIatad. LAW OFFICES SNELBAKER. BRENNEMAN & SPARE FIRST AND FINAL ACCOUNT OF KEITH O. BRENNEMAN, ADMINISTRATOR C.T.A. OF THE ESTATE OF EDWARD C. BLAKE, DECEASED, LATE OF SOUTH MIDDLETON TOWNSHIP, CUMBERLAND COUNTY, PENNSYLVANIA KEITH O. BRENNEMAN, Administrator C.T.A. and Accountant herein avers as follows: Date of Decedent's Death: Date Letters of Administration C.T.A. were issued: Date of Rule 5.6(a) Certification: April 28, 2003 August 12, 2003 September 24, 2003 LETTERS OF ADMINISTRATION WERE ADVERTISED AS FOLLOWS: The Patriot-News Co.: August 20, 27 and September 3, 2003 Cumberland Law Journal: August 29 and September 5, 12, 2003 PERSONALTY - PRINCIPAL ACCOUNT DEBITS The Accountant charges himself with receipt of the Decedent's goods and personalty described in the Inventory and Appraisement filed with the Register of Wills of Cumberland County, Pennsylvania on October 24, 2003 and as more fully set forth below: PNC Bank, checking account No. 5003248506 ?NC Bank, checking account No. 5003923137 VlanorCare Resident Trust payment $1,577.17 973.14 769.84 LAW OFFICES SNELBakER, BrEnNEMaN & SParE Commonwealth of Massachusetts pension payment ManorCare account refund TOTAL, PERSONALTY PRINCIPAL ACCOUNT, DEBITS: PRINCIPAL CONVERSIONS INTO CASH NONE PERSONALTY - PRINCIPAL ACCOUNT CREDITS Fhe Accountant claims credit for payment of the following items and those to be paid in the order set forth in Section 3392 of the Probate, Estates and Fiduciaries Code, from personalty principal upon confirmation of the account: Checks written and bank charges of Decedent prior to death and posted ~fler death: ~LASS I. Costs of Administration: 1. Snelbaker, Brenneman & Spare, P. C.' Reimbursement for advance of the following costs/expenses: a. Probate fee to Register of Wills $ 59.00 b. Advertise grant of letters (i) Patriot News 205.69 (ii) Cumberland Law Journal 75.00 280.69 c. Certified mail postage: 4.42 Total Reimbursement: 2. Register of Wills - filing fee for Inventory/Inheritance Tax Return -2- 1,239.32 109.80 $4,669.27 NONE $25.00 344.11 25.00 LAW OFFICES SNelbaker. BRENNEMAN & SParE 3. Snelbaker, Brenneman & Spare, P. C., attomey's fees 4. Reserve for filing fees, accounting fees and miscellaneous expenses: CLASS II. Family Exemption: CLASS III. Costs of Decedent's Funeral, Burial, Medicines, Medical, Hospital and Nursing Services Within 6 Months of Death: Commonwealth of Pennsylvania, Department of Public Welfare, restitution of medical assistance, total Class III claim amount: $16,074.65. Amount to be paid (balance of Estate): CLASS IV. Cost of Grave Marker: CLASS V. Rents for Occupancy of Decedent's Residence for Six Months Prior to Death: CLASS VI. All Other Claims: Commonwealth of Pennsylvania, Department of Public Welfare, restitution of medical assistance, total Class VI amount: $41,393.60 Amount to be paid: Social Security Administration, claim for refund of overpayment of $758.00. Amount to be paid: ?OTAL, PERSONALTY PRINCIPAL ACCOUNT, CREDITS: -3- 2,000.00 300.00 NONE $1,975.16 NONE NONE NONE NONE $4,669.27 LAW OFFICES SNELBAKEr. BrENNEMaN & SpAre PERSONALTY - INCOME ACCOUNT DEBITS The Accountant charges himself with receipt of the following items of income from personalty: TOTAL, PERSONALTY INCOME ACCOUNT, DEBITS: PERSONALTY - INCOME ACCOUNT CREDITS The Accountant claims credit for payment of the following items from personalty income: TOTAL, PERSONALTY INCOME ACCOUNT, CREDITS: REAL ESTATE - PRINCIPAL ACCOUNT DEBITS rhe Accountant charges himself with receipt of the Decedent's Real Estate as follows: I'OTAL, REAL ESTATE PRINCIPAL ACCOUNT, DEBITS: -4- NONE NON~EE NONE NON____E_E NONE NONE LAW OFFICES SneLBaKEr. BrENNEMAN & SPaRe REAL ESTATE - PRINCIPAL ACCOUNT CREDITS The Accountant claims credit for payment of the following items from real estate principal: TOTAL, REAL ESTATE PRINCIPAL ACCOUNT, CREDITS: REAL ESTATE - INCOME ACCOUNT DEBITS The Accountant charges himself with receipt of the following income from real estate: TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: REAL ESTATE - INCOME ACCOUNT CREDITS The Accountant claims credit for payment of the following items from real estate income: TOTAL, REAL ESTATE INCOME ACCOUNT, CREDITS: -5- NONE NON____~E NONE NON____~E NONE NONE LAW OFFICES SNELBAKER. BRENNEMaN & SParE SCHEDULE OF PROPOSED DISTRIBUTION Specific bequest to Marlin Walters and Hazel Walters per Item 3.A of Will (adeemed): Residue of Estate to Jane Losada per Item 3.B of Will: Payment of expenses and debts per First and Final Account upon confirmation: Class I Administration Expenses: Class III Claim: Commonwealth of Pennsylvania, Department of Public Welfare: Class VI Claims: Commonwealth of Pennsylvania, Department of Public Welfare: Social Security Administration: Total Distributions: $ 0.00 0.00 2,694.11 1,975.16 0.00 0.00 $4,669.27 LAW OffICES SNElbAker, BRENNEMAN & SPARE COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND ) SS. Sworn to and subscribed before me this 24th day of December, 2003. KEITH O. BRENNEMAN, being duly sworn according to law deposes and says: that he is the ADMINISTRATOR C.T.A. of the Estate of EDWARD C. BLAKE, Deceased; that he is the Accountant herein; that the foregoing Accounting is true and complete; that the attached list or schedule [*] contains the names and addresses of all persons who have given notice of their claims, and whose claims remain unpaid; that the attached list or schedule [**] contains the names of all persons interested in the distribution of said Estate; and that the facts set forth in the within Account are true and correct to the best of his knowledge, information and belief. Keith O. Brenneman (Administrator and Accountant) Notary Public COMMONWEALTH OF PENNSYLVANIA No~adal Seal Susan I Ma~zi, Nola{y Pubic MY Comn~ssion Ex,res Nov. 24. 2(}07 Member, Pennsylvania Association Of Notaries * Persons having claims against Estate: Social Security Administration 115-10 Jamaica Avenue Jamaica, NY 11432 Commonwealth Pennsylvania Department of Public Welfare Bureau of Financial Operations Division of Third Party Liability Estate Recovery Program P. O. Box 8486 Harrisburg, PA 17105-8486 ** Persons interested in distribution of Estate: Mr. Marlin and Mrs. Hazel Walters 4 Stine Avenue Carlisle, PA 17013-9649 Jane S. Losada The Columbia School Apartado A6reo 60562 Medellin, Columbia South America STATUS REPORT UNDER RULE 6.12 Name of Decedent: Edward C. Blake Date of Death: Will No.' April 28, 2003 21-03-0662 Admin. No.: 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 [-] 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes b. The separate Orphans' Court No. (if any) for the personal representative's accoUnt is: Did the personal representative state an account informally to the parties in interest? Yes 1--[ No [--] Co Date: March 2, Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. 2004 ~ Signature Capacity: Keith O. Brenneman Sa/ne 44 W. Main Street Mechanicsburg, PA 17055 Address (717) 697-8528 Telephone No. [k-] Personal Representative [] Counsel for personal representative