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Home My WebLink About12-18-12 150561,0105 REV-1500EX (o2-11)(FI) I OFFICIAL USE ONLY PA Department of Revenue pennsylvania County Cade Year F le Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX 28o6o1 RESIDENT DECEDENT I I?~ Harrisburg PA 17128-o6o1 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 194-28-8870 12/29/2010 04/02/1914 Decedent's Last Name Suffix Decedent's First Name MI Bretz Violet A (If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name M1 's Last Name Spouse Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW cD 1. Original Return O 2. Supplemental Return C=:) 3. Remainder Return (Date of Death Prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) O 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust.) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (Date of Death O 11. Election to Tax under Sec. 9113(A) Between 12-31-91 and 1-1-95) (Attach Schedule O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number Joseph D. Buckley, Esq. (717) 249-2448 CREGISTER OF WLS L &MY 7- ;0 r ri co _V1 First Line of Address MT n N rte- t~A y•Y tk I 1237 Holly Pike CO Second Line of Address v t CJ T' t y Cdr _Z w C.- City or Post Office State ZIP Code DATE FILED ~ C,) Carlisle PA 17013 Correspondent's e-mail address: JoeBLaw@aol.com 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 preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS 123 170 SIG E OF P RE OT R THA NTATIVE DATE )1~7 815 ESS J G~ dL/~ ~-z i> L /w / -21 PLEASE USE ORIGINAL FORM ONLY Side 1 L 1505610105 1505610105 J v' 150561,0205 REV-1500 EX (FI) Decedent's Social Security Number Decedent's Name: Violet A. Bretz 194-28-8870 RECAPITULATION 1. Real Estate (Schedule A) 1. 115,000.00 2. Stocks and Bonds (Schedule B) 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. 0.00 4. Mortgages and Notes Receivable Schedule D 4. 0.00 5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)....... 5. 25,119.48 6. Jointly Owned Property (Schedule F) O Separate Billing Requested 6. 5,657.93 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested........ 7. 0.00 8. Total Gross Assets (total Lines 1 through 7) 8. 145,777.41 9. Funeral Expenses and Administrative Costs (Schedule H) 9. 20,408.40 10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) 10. 7,240.54 11. Total Deductions (total Lines 9 and 10) 11. 27,648.94 12. Net Value of Estate (Line 8 minus Line 11) 12. 118,128.47 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) 14. 118,128.47 TAX CALCULATION - 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_ 15. 0.00 16. Amount of Line 14 taxable at lineal rate X .0 45 118,128.47 16. 5,315.78 17. Amount of Line 14 taxable at sibling rate X .12 17. 0.00 18. Amount of Line 14 taxable at collateral rate X .15 18. 0.00 19. TAX DUE 19. 5,316.00 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT C8D Side 2 1505610205 1505610205 REV-1500 EX (FI) Page 3 File Number Decedent's Complete Address: DECEDENT'S NAME Violet A. Bretz STREETADDRESS 531 West Penn Street CITY - - - STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 2, Line 19) (1) 5,316.00 2. Credits/Payments A. Prior Payments 6,750.00 B. Discount 266.00 Total Credits ( A+ B) (2) 7,016.00 3. Interest (3) 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) 1,700.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 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 No a. retain the use or income of the property transferred ❑ 0 b. retain the right to designate who shall use the property transferred or its income ❑ 0 c. retain a reversionary interest ❑ 0 d. receive the promise for life of either payments, benefits or care? ❑ 0 2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ❑ 0 3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ❑ E 4. Did decedent own an individual retirement account, annuity or other non-probate property, which contains a beneficiary designation? ❑ N 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 Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 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 21 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 percent [72 P.S. §9116(a)(1.2)]. • The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in [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 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-1502 EX: ct ; pennsylvania SCHEDULE A DEPARTMENT OF REVENUE INHERITANCE TAX RETURN REAL ESTATE RESIDENT DECEDENT ESTATE OF FILE NUMBER Violet A. Bretz 21-11-0038 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property that is jointly-owned with right of survivorship must be disclosed on Schedule F. Attach a copy of the settlement sheet if the property has been sold. ITEM Include a copy of the deed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1 531 West Penn Street, Carlisle, PA 17013 115,000.00 TOTAL (Also enter on Line 1, Recapitulation.) $ 115,000.00 If more space is needed, insert additional sheets of the same size. OMB Approval No. 2502-0265 HUD-1 * r, A. Settlement Statement (HUD-1) f+J Page 1 of 3 ;r r: i~ B. Type of Loan 1. FX] FHA 2. ❑ RHS 3. ❑ Conv. Unins. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number: 4. ❑ VA 5. ❑ Conv. Ins. 401200233-SK 7123716149 446-1094104-703 C. NOTE: This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. Name and Address of Borrower E. Name and Address of Seller F. Name and Address of Lender CHAD A. BRIGGS AND MEGAN L. BRIGGS NANCY V. HOWE, EXECUTRIX OF ESTATE OF ERA HOME LOANS 402 BRIAN COURT VIOLET A. BRETZ 1 MORTGAGE WAY, MECHANICSBURG, PA 17050 C/O LAW OFFICES OF JOSEPH D. BUCKLEY MOUNT LAUREL, NJ 08054 1237 HOLLY PIKE CARLISLE, PA 17013 G. Property Location H. Settlement Agent SECURED LAND TRANSFERS, LLC 531 WEST PENN STREET, 485 ST. JOHNS CHURCH ROAD, CARLISLE, PA 17013 SHIREMANSTOWN , PA 17011 Phone : (717) 901-8342 COUNTY: CUMBERLAND Placer of Settlement I. Settlement Date 03/05/2012 PARCEL ID: 05-20-1796-008 TOWNSHIP: CARLISLE BOROUGH 1068 HARRISBURG PIKE Disbursement Date 03/05/2012 CARLISLE, PA J. Summary of Borrower's Transaction K. Summary of Seller's Transaction 100. Gross Amount Due from Borrower 400. Gross Amount Due to Seller 101. Contract Sales Price $115,000.00 401. Contract Sales Price $115,000.00 102. Personal Property 402. Personal Property 103. Settlement charges to borrower line 1400 $5,387.14 403. 104. 404. 105. 405. Adjustment for items aid b seller in advance Adjustment for items aid b seller in advance 106. City/Town Taxes 406. City/Town Taxes 107. Count Taxes 635.32/ r 3/5/2012 to 1/1/2013 $524.23 407. Count Taxes 635.32/ r 3/5/2012 to 1/1/2013 $524.23 108. Assessments 408. Assessments 109. School Taxes 1,397.80/ r 3/5/2012 to 7/1/2012 $450.66 409. School Taxes 1 397.80/ r 3/5/2012 to 7/1/2012 $450.66 110. 410. 111. 411. 112. 412. 120. Gross Amount Due from Borrower $121,362.03 420. Gross Amount Due to Seller $115,974.89 200. Amounts Paid by or in Behalf of Borrower 500. Reductions In Amount Due to Seller 201. Deposit or earnest money $2,500.00 501, Excess Deposits 202. Principal Loan Amount from ERA Home Loans $112,084.00 502. Settlement Charges to Seller $9,684.80 203. Existing loans taken sub ect to 503. Existing loans taken subject to 204 504. 205. 505. 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for items unpaid b seller Adjustments for items unpaid b seller 210. City/Town Taxes 510. City/Town Taxes 211. Count Taxes 511. Count Taxes 212. Assessments 512. Assessments 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. Total Paid by/for Borrower $114,584.00 520. Total Reduction Amount Due Seller $9,684.80 300. Cash at Settlement from/to Borrower 600. Cash at Settlement to/from Seller 301. Gross amount due from borrower line 120 f$121,362.03 601. Gross amount due to seller line 420 115,974.89 302. Less amounts aid b /for borrower line 220 14,584.00 602. Less reductions in amount due seller line 520 $9,684.80 303. Cash ❑ From To Borrower 6,778.03 603. Cash X To El From Seller $106,290.09 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. Initials j ;',~vim? GA6 401200233-SK HUD-1 Page 2 of 3 L. Settlement Charges 700. Total Real Estate Broker Fees $6900.00 Paid From Paid From Division of Commission line 700 as follows: Borrower's Funds Seller's Funds 701. $3450.00 to Keller Williams of Central PA At Settlement At Settlement 702. 3450.00 to ERA-NRT, LLC 703. Commission aid at settlement $6,900.00 704. 800. Items Payable in Connection with Loan 801. Our origination charge $710.00 from GFE #1 802. Your credit or charge (points) for the specific interest rate chosen -$900.00 from GFE #2 803. Your adjusted origination charges from GFE A -$190.00 804. Appraisal Fee to STARS from GFE #3 $415.00 805. Credit report to CBC INNOVIS, INC. from GFE #3 $10.47 806. Tax Service from GFE #3 807. Flood Cert. Fee from GFE #3 808. Scoring Fee to FNMA $15.95 900. Items Required by Lender to Be Paid in Advance 901. Daily interest charges from 03/05/12 to 04/01/12 @ 12.86/day ERA Home (from GFE #10) $347.22 Loans 902. Mortgage Insurance Premium Department of HUD from GFE #3 $1,109.75 903. Homeowner's Insurance NRT Insurance Agency POC B $433.00 from GFE #11 1904. 1000.Reserves Deposited with Lender 1001. Initial deposit for our escrow account from GFE #9 $963.50 1002. Hazard Ins. Reserve 3.0000 month(s) @ 36.08 / month(s) to ERA Home $108.24 Loans 1003. City Property Taxes 1 Months @ 52.94 per Months ERA Home Loans $52.94 1004. School Taxes 10.0000 months @ 114.15 / months to ERA Home Loans $1r14 .50 1005. Aggregate Accounting Adjustment to ERA Home Loans -$339.18 1006. 1007. 110O.Title Charges 1101.Title services and lender's title insurance to Secured Land Transfers LLC from GFE #4 $1,393.75 1102. Settlement or closing fee to Secured Land Transfers, LLC $225.00 1103. Owner's title insurance to Secured Land Transfers, LLC from GFE #5 $10.00 1104. Lender's title insurance to Secured Land Transfers, LLC $1,073.75 1105. Lender's title policy limit $112,084.00 1106. Owner's title policy limit $115,000.00 1107. Agent's portion of the total title insurance premium to Secured Land $975.37 Transfers, LLC 1108. Underwriter's portion of the total title insurance premium to TRGC 108.38 1109. Notary fee to Shirley Keys, Notary Public $20.00 1110. Insured Closing Protection Letter to TRGC $75.00 1200.Government Recording and Transfer Charges 1201. Government recording charges from GFE #7 $142.00 1202. Deed $62.00 Mortgage 80.00 Releases 1203. Transfer taxes from GFE #8 $1,150.00 1204. City/County tax/stamps Deed $1150.00 Mortgage $ 1205. State tax/stamps Deed $1150.00 Mortgage $ $1,150.00 1206. 1300.Additional Settlement Charges 1301. Required services that you can shop for from GFE #6 $19.50 1302.Tax Services to STARS POC L 85.00 1303. Flood Certification to STARS $19.50 1304. Home Warrant to American Home Shield $600.00 1305. Notary Fee to Shirley Keys, Notary Public $10.00 S 1306.Tax Cert Processing Fee to Secured Land Transfers - Mechanicsburg $10.00 i 1307. Final Sewer/Water to Carlisle Borough Office $64.80 1308. Escrow for 2012 County/Twp Taxes to Secured Land Transfers - $950.00 Mechanicsburg 1400.Total Settlement Charges (enter on lines 103, Section J and 502, Section K) $5,387.14 $9,684.80 If you have any questions about the settlement charges and loan terms listed on this form, please contact your lender. Settlement agent is not responsible for content of lender's assessments on HUD. The seller's and borrower's signatures hereon acknowledge their approval and signify their understanding that tax and insurance prorations and reserves are based on figures for the preceding year or supplied by others or estimated for the current year, and in the event of any change for the current year, all necessary adjustments will be made between borrower and seller directly. Any deficit delinquent taxes or mortgage payoffs will be promptly reimbursed to the settlement agent by the seller. I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. BUYERS SELLERS j;" - G. 1) 6 = Estate of Violet A. Bretz Chad A. Briggs p y By: Nancy V. H 'e, Executrix Meg L. rig The UD-1 Settle Went Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in -ff accordance %A ith this statement. A [I ettI e t gent Date 03/05/2012 Violet A. Bretz Estate Inventory Living Room Short Clock 50.00 Old, old TV 10.00 Old couch & chair 50.00 2 End tables 50.00 3 Side Chairs 50.00 Plant stand 10.00 Floor Lamp 5.00 Table lamps 20.00 Wall hanging 75.00 Mirror 50.00 Dining Room Table & 4 chairs 250.00 Corner cupboard and buffet 250.00 Side Table 25.00 Office Small desk & chair 75.00 Desk 200.00 Bookcase & books 50.00 Kitchen Pots & pans 50.00 Refrigerator 50.00 2 Barstools 30.00 Plate service 4 50.00 Stemware 30.00 Flatware 15.00 3 Phones 30.00 Bedrooms Bedroom suite (chest of drawers, double bed, vanity) 300.00 Mattress/Box Springs 25.00 2 Night stands 30.00 Three clocks 30.00 Blanket Chest 200.00 Chest of drawers 25.00 Old bed 5.00 Lamps 10.00 2 Chairs 20.00 Table 10.00 Bedding, Pillows and clothing (donated to Good Will) 0.00 Basement Tools/stuff 50.00 Table lamp 5.00 Floor lamp 10.00 Table 10.00 3 Chairs 30.00 Highboy 550.00 Chair & table 50.00 Knicknacks 100.00 TOTAL INVENTORY 2,925.00 REV-15o8 EX+ (08-12) i pennsylvania SCHEDULE E DEPARTMENT OF REVENUE CASH, BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Violet A. Qre.tz Z(-It-0038 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. M & T Bank checking Account 20,944.32 2. Personal Property (See Attached inventory list) 2,925.00 3. Refund- Lincoln Life Insurance Co. 100.19 4. Refund- The Sentinel 40.38 5. M & T Bank (Interest) 77.72 6. Refund - Kinectic Imaging 11.81 7. Refund - Carlisle Petroleum 556.87 8. Refund - Prudential Insurance 52.20 9. Refund - Century Link 15.28 10. Refund - State Farm 144.56 11. Refund - Insurance 251.15 i TOTAL (Also enter on Line 5, Recapitulation) $ 25,119.48 If more space is needed, use additional sheets of paper of the same size. Violet A. Bretz Estate Inventory Living Room Short Clock 50.00 Old, old TV 10.00 Old couch & chair 50.00 2 End tables 50.00 3 Side Chairs 50.00 Plant stand 10.00 Floor Lamp 5.00 Table lamps 20.00 Wall hanging 75.00 Mirror 50.00 Dining Room Table & 4 chairs 250.00 Corner cupboard and buffet 250.00 Side Table 25.00 Office Small desk & chair 75.00 Desk 2E5O. .00 Bookcase & books 00 Kitchen Pots & pans 50.00 Refrigerator 50.00 2 Barstools 30.00 Plate service 4 50.00 Stemware 30.00 Flatware 15.00 3 Phones 30.00 Bedrooms Bedroom suite (chest of drawers, double bed, vanity) 300.00 Mattress/Box Springs 25.00 2 Night stands 30.00 Three clocks 30.00 Blanket Chest 200.00 Chest of drawers 25.00 Old bed 5.00 Lamps 10.00 2 Chairs 20.00 Table 10.00 Bedding, Pillows and clothing (donated to Good Will) 0.00 Basement Tools/stuff 50.00 Table lamp 5.00 Floor lamp 10.00 Table 10.00 3 Chairs 30.00 Highboy 550.00 Chair & table 50.00 Knicknacks 100.00 TOTAL INVENTORY 2,925.00 REV-15o9 EX+ (o1-1o) s; pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Violet A. Bretz 21-0-0038 If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME(S) ADDRESS RELATIONSHIP TO DECEDENT A. Nancy Howe 1233 Holly Pike, Carlisle, PA 17013 Daughter B. C. JOINTLY OWNED PROPERTY: LETTER DATE DESCRIPTION OF PROPERTY % OF DATE OF DEATH ITEM FOR JOINT MADE INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENT'S VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY HELD REAL ESTATE. VALUE OF ASSET INTEREST DECEDENT'S INTEREST 1. A. 01/01/05 Sovereign Bank Account 1674065418 11,315.86 50 5,657.93 TOTAL (Also enter on Line 6, Recapitulation) $ 5,657.93 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX* ;10-09? pennsylvania SCHEDULE H DEPARTMENT OF REVENUE FUNERAL EXPENSES AND INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Violet A. Bretz 21-11-0038 Decedent's debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. Funeral Meal 200.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: 9,000.00 2. Attorney Fees: 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: 550.00 5. Accountant Fees: 6. Tax Return Preparer Fees: 7. Real Estate Commissions 6,900.00 8. Transfer tax on rela Estate 1,150.00 9 Real Estate Closing costs 684.00 10. Advertising Fees (Legal Notices) 294.40 11. Clean up and trash removal at house 1,480.00 12. Appraisal fee - Diversified Appraisers 350.00 TOTAL (Also enter on Line 9, Recapitulation) $ 20,408.40 If more space is needed, use additional sheets of paper of the same size. R--V-15'2 EX+'1.2-u8' pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE OF FILE NUMBER Violet A. Bretz 21-11-0038 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Real Estate Taxes 1,992.45 2. Carlisle Petroleum 572.89 3. Comcast 86.60 4. PPL 486.54 5. Century Link (phone Service) 504.26 6. Carlisle Borough Water and Sewer 356.44 7. Hilton Lock Service 69.62 8. Cumberland Goodwill Fire & Resue EMT 53.25 9. Alexander Spring Emergency Phys. 34.89 10 Appalachian Orthopedic 259.78 11. Kinetic Imaging 45.51 12. Sarah Todd Home 1,697.28 13 Medical & Cosmetic Dermatology 40.20 13 Phillip Carey, MD 37.02 14. Carlisle Digestive Disease Assoc. LTD. 49.38 15. Blue Mountain Anesthesia 20.10 16. George Branson MD 32.61 17. Carlisle HMA Physician Mangmt. 47.90 18. Mt. Rock Impatient Services 97.44 19. Lincoln Financial Group 200.38 20. State Farm Insurance 556.00 TOTAL (Also enter on Line 10, Recapitulation) $ 7,240.54 If more space is needed, insert additional sheets of the same size. REV-1513 EX+ (01-10) `pennsylvania SCHEDULE J DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Violet A. Bretz 21-11-0038 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. Nancy V. Howe 1233 Holly Pike, Carlisle, PA 17013 daughter 100 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 0.00 If more space is needed, use additional sheets of paper of the same size. fast Will anb CPStament of VIOLET A. BRETZ I, VIOLET A. BRETZ, of 531 West Penn Street, Borough of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this as and for my Last Will and Testament, hereby revoking any and all other wills and codicils heretofore made by me. FIRST. I direct that all my just debts and funeral expenses be paid from my estate as soon after my death as practically and conveniently may be done. SECOND. I direct that my remains be interred within my family's burial plot. THIRD. I authorize my personal representative to expend funds from my estate, in such amounts as my personal representative shall consider necessary and desirable for the purchase, erection and inscription of a suitable marker for my grave. FOURTH. I give, devise and bequeath any and all tangible personal property owned by me at the time of my death unto my husband, Joseph W. Bretz, provided he survives me by thirty (30) days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all said tangible personal property unto my daughter, Nancy V. Howe. FIFTH. I give, devise and bequeath any and all real estate owned by me at the time of my death, unto my husband, Joseph W. Bretz, provided he survives me by thirty days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all said real estate unto my daughter, Nancy V. Howe. SIXTH. I give, devise and bequeath all the rest., residue and remainder of my estate unto my husband, Joseph W. Bretz, provided he survives me by thirty (30) days. In the event he fails to survive me by thirty (30) days, I give, devise and bequeath all the rest, residue and remainder of my estate unto my daughter, Nancy V. Howe. SEVENTH. I direct that any and all Inheritance, Estate and Transfer taxes imposed upon my estate passing under my will or otherwise, shall be paid out of the principal of my residuary estate. EIGHTH. I hereby nominate, constitute and appoint my husband, Joseph W. Bretz as Executor of this my Last Will and Testament. In the event of renunciation, death, resignation or inability to act for any reason whatsoever of Joseph W. Bretz, I nominate, constitute and appoint Nancy V. Howe as Executor of this my Last Will and Testament. I hereby relieve my Executor from the necessity of posting security in connection with his duties, as such, in any jurisdiction in which he may be called upon to act insofar as I am able by law to do so. In addition to the powers conferred by law, I authorize my Executor, in his absolute discretion, to retain in the form received, and to sell either at public or private sale any real or personal property owned by me at the time of my death. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this, my Last Will and Testament, consisting of two typewritten pages this 12th day of February, 1992. VIOLET A. BRETZ Signed, sealed, published and declared by the above named Testatrix VIOLET A. BRETZ as and for her Last Will and Testament, in the presence of us, who, at her request, in her sight and presence and in the sight and presence of each other, have hereunto subscribed our names as witnesses. i T 71 COMMONWEALTH OF PENNSYLVANIA: ss. COUNTY OF CUMBERLAND I, VIOLET A. BRETZ, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. x VIOLET A. BRETZ Sworn or affirmed to and ck?o rler?~Pd before me, by VIOLET A. BRETZ this 12th day of February, 1992. % i--. 7 v!: r 3.:'; n t;m0: 92 A_ tug .~3_, _1•9- Notary Pub1 i ( SEAL) 11 COMMONWEALTH OF PENNSYLVANIA: ss. COUNTY OF CUMBERLAND We, William A. Duncan and Joseph W. Bretz the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw VIOLET A. BRETZ sign and execute the instrument as her Last Will; that VIOLET A. BRETZ signed willingly and that VIOLET A. BRETZ executed as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at that time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. r Sworn or affirmed to and subscribed before me by William A. Duncan and Joseph W. Bretz, witnesses, this 12th day of February, 1992. ~ n Notary Public `,r(-tEAL) r.l, 1 r~'1"l1:J803.; it", s- 1C1i'y'