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Home My WebLink About04-1062 PETITION FOR GRANT OF LETTERS OF ADMINISTRA nON Estate of 1?,~hC{rd :MrvbAh. also kno wn as No. ~1-OY-\()lQ~ To: Register of Wills for the County of ell m. b-r r/IIM in the Commonwealth of Pennsylvania D~ased. Social Security No. ::101-/ f1-?~;J.f? The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older, appl...s for letters of administration on the estate of (d.b.n.: pendente lite; durante absentia; durante minoritate) the ahove decedent. Decendent was domiciled at death in (; V Yl'l f;, r I tJll1 d County, Pennsylvania, with b't.: last family or principal residence at 'I'ltJ 7 :De Ihrook -PM. (Yf. c~"^/ {;.5 h 1/'1 (list !If,rttt, number and municipality) . De'ft,dent, then 7 Jl years if ag~ died at Iy 5o"r''/-' H,.,tn,f-A - eA",,., .. , . ;1ff:+;:A her ~ ,. .;}oo</, Deccndcnt at death owned property with estimated values as folllows: (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 . $ 97; 5'10 situated as follows: '/907 7>e/bf7).l:-1;;>~ t11l"c/'^I1/CSbol'7 Petitioner_ after a proper search ha..::i:- ascertained that decedent left no will and was survived by the following spouse (if any) and heirs: Name r ^ THE~FORE, petitioner(s) .respectfully requcst(s) the grant of letters of -iilininistr~n in the;. appropriate form to the undersIgned.' ~.. ie_~,jI7l'i:fY/A'k )///J) ..:~ = . ~.g ..= -:r&: 'jj'~ ~o ~ in Cr ~~:i ~) --J r,.., , r:,,', <:) OATH OF PERSONAL REPRESENTATIVE ~--. ..- } ~' COMMONWEALTH OF PENNSYLVANIA COUNTY OF (; (jmkr/tI "d . , as" ci ..". CJ c-:i -\ N -.J The petitioner(s) above-named swear(s) or affinn(s) that the statements in the foregoing petition are true and correct to the best of the knowledge end belief of petitioner(s) and that as personal repleseDtative(s) of the above decedent petitioner(s) will weD and truly administer the estate according to law. subscribed J ~Lt2/:Jr//L</L.b//}) - day of ,,_ ]' ~ ~ ter L j ~j o i R I~ No. !1. / - {)4-- / D lP d.. Estate of ii, r m rr:l [""' 'Pn 1 \ryl \~ 0 r ,Deceased GRANT OF LEITERS OF ADMINISTAATION AND NOW~". \ e. .~ in consideration of the petition on the reverse side hereof, satisfaelory proof havina been presented before me, IT IS DECREED that (' h... ry' B,...~ b"I:-..r isfeFo entitled to Letters of Administration, and in a<:cord with such finc:liDjJ, Letters of Administration are hereby granted to C. hI"" 1/ I 13 MJ bed::: t' r I in the estate of ~ k' , i: hoArd? f2v-" bAle t',... ~ES ~ Letters of Administration ..... 35 . Short Certificates( ).......... S ' .enunciation ................ . .\cP SIO.OO T.OTAL _ S,..:Jt,!S.,\) Filed H:-.l::L.Q~........ A.D. '4 ;;}(;)t) 'I t1LI. t'~_~~~ . -);J~n r ;?c/fnrd Y'30j~ ATTORNEY (Sup. Ct. 1.0. No.) 33'1V' ?n;'.I/~ ~rA., ('A~ /1,'/1; fJA ADDRESS 7/7 /,/.2 -/ If, /,tJ ~j7~ =~----.,,~.;._....~;i.,,',:"'''= ..".. ...... ,._~. " ... '- " ~~ ~ RENUNCIATION In Re Estate of RICHARD BRUBAKER, deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned, CYNTHIA SELF, daughter of the decedent, hereby renounces the right to administer the estate and respectfully asks that Letters of Administration be issued to CHERYL BRUBAKER as personal representative. tb " WITNESS my hand this ~ day of November, 2004. ');t Lff- Si ature (; " - 1/ (' ,_'tni-llLct,K. Sel-r Printed name f 8eCh,QYL Sfteet Address '\ /1 V It ; ~C; ,)U~~ ,) /\ II/il C ( r; ~ :vC I '- ' p t"; CD ~ >- :2 ',,,.~ -.:q ...:: p ,I)::: <'.,,.'" ..... _# 111II'_SI1'RJ:\"Ji% This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing, " WARNING: It is illegal to duplicate this copy by photostat or photograph. ;) 1- 04 - /O{P :J..- COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS CERTIFICATE OF DEATH SEX Male '" - Cumberland ~ 11eLD ~~~\:::~ MOTHER'SNAMf(AI'Il,MIdI:II.MIidIn~arolyn Hummel ,", :OR","ro-l\f~~l'Jifl''ST,~rt:'1l/l!ilffitr.l''a 17011 OATEOF OISPOSI110N PLACEOFDlSPOSlTlON.Na/llIo/CIm4IWy.CfImIlDly LOCATION.Cilyrrown, SLlItI, ZipC0d8 (_.Oo)',Y_l O(OItlIrPlacl Sep 13, 2004 Z1c. Conolite Crematory 2id. Schaefferstown, Pa_ 17088 :.ENSE NUMBERFO_012662_l =EAN~;::~~n::~:~~te. Inc, 37 East Main Street Mechanicsburg, Pa 1705 _o/my~.dII'IIOCCI.O'Ndlllhllim<l._endpIICIlllIId LlCENSENUIll9ER o.o.EI.NED (SIgr\IIlnIlll:lTilII) (Monln,Daj,Val/) ,,", nlolE OF DEATH Fee for this certificate, $2,00 rrlll'"""'''''''''''''" "",,";"~\.1" OF Pr,f----_, '~".,,'.f:F.""'\ l~-, ---'-, '. ~\ $~ o~ - - ~i lco ._, ~ c,..), ~ . .:l:oo~ %. * '~ ' " ~ *$ ~.A " _" ..:0... ,~ ~ ~ ' :;,-- -~ - ~~\" "\.~ ~l ~, '!{MfNl \)\ ~;t.i ",,,,,,,,,,11111 P 10667312 No, ~ll05 \43 Re. lIe7 fVPEJPRINT " ~UI.MANENT IlLACKINK 78 ,. Richard NAME OF DECEDENT(Fk"J1, Mi<llh,LUl) , >.GE (Las' BinhclII.~) " BIRTHPLACE (Cl\y and Sl.lmfA!lJ~~IrJ') . COONTY OF DEATH C:umberland .\0-.\ b, .., DECEDENT'S USUAL OCCUPATION lar:"-"':lIh-:do~...r:L-:r KJNDOF BUSlNES$/INOUSTRY DECEDENT EVER IN U,$ ARMEDFONCE5? ,..151I "'0 1ter DECEDENTS EDl.JC.-.nON . u, - ~.. .. fATHER'SN.\ME(FnI.loIlddlI,l.Ut) ,", INFORMAN _ JIMII'Iinll 20.. 1111.Busin 55 Serv own, ,*, Zip ) DECEDENt'S ""'"" RESIDENCE (SeeInIlruCllona onOltlertidl) 111-511II 11b.CounIv Russell S. Brubaker , ~ ~ u . o ~ . > < z !A:111.:ll/d ...- pnylOcianisnat-.aDllllllmlrl*-lhlo ca~_o/dNlh \_2~.2S....." pnonwhopnll'lOUllfllldlllh. 24- M 21. J1.PARTI: _..._...........-...-.__..._.De...._.....-of4 u......._.......__ ._.....-.,...pjnl..".....~""""k..""""_ cPr !: Soq"anhiOly..lo;onc:Ijtiona ,1.ny,laa""'l!to'...........lIIa ,."'.... Enla,UNDERLYlNG CAUSE\D<...U'ur~ury 'nal""tJalodevenlS res"lt~on<lQ.lh)LA$T WAS AN AUToPSY v.ERE AUTOPSY FINOINGS PERFORMED? AVAIlABLE PRIOR TO COMPUTION OF CAUSE OF DEATH? MANNEROfOEATH DATE OF INJURY ("on""Ooj,V,"1 -... o o D~CEOFINJURY ....cIon~.oIc, ($pecl1l'1 ,.., Ill.. o o ....... _m Pending Inve.~gllt"'" eouldnolbedaram",...d VelD NIlJil '1'..0 HI. :mi. CERTIFIER (CF\Id<onty_l .,:~F=J:~=~=:3:'r:.:==~.~a~~.~.~~.~,~.~.~,i.~,~~.l... "'0 "'- D, .PfoO~~':,a~~=~IthPH~=~=~~.='.=I~~~~~~i:~~'::~~8tlaatal....... . 'MEDlCALEllA"~NEIt . On_WllIof...mh\IlIDn.ndIorlnYftIlgMllNl,tnMyoplnloll,daIIhOC:CllITIId.lth.lln1a,dlll,.ndpIICI,lIlddllllolhacIUId!'I.nd "'""".....-.d.. ". .. ~.'~-'9 ~JDh_~;rto Local R gistrar _Jyi-....J!J ~ II d.Od1 I Date ~~ ~"1. . p a c"5 -< N --J -or:) ~ N o IT,o,TEFIl.E.MlMBER SOCIAL SECURITY NUMIliER DATEOFD€ATH(Monln,Daj,Voar) I. (0 A, y!.w;";l.;,- ro " 0_ 001<0 '::'0 WI'S DECl:OENT Of HISPAHlC ORIGIN? Non Ya.nlfY".~. c_ M.~,Puo/i'!l:'RICIIO,1IC """- 0 A..ldm" 0 ~~~'~j 0 RACE.Amencanln<3lil1 Blac. IIIohllo,el (Speed,1 White ,", 2 MARITAl STATUS. M.Ir!lIa. NI'I~~ >< SURVlVINGSPOUSE lU,.'.,g;'.m.....n.....1 ('''orto) l1C..BY..._I~Yedjn .0 cuylI>orn D, :- ,-- :OIIMIInIlOllth TIME OF INJURY INJURY AT 'MJRK? DESCRIBE HOW IUJURV OCCIJRRW noD NoD 3Gb. III _. Alhcm..lerin.Itree1.Iac\<Iry._ -, LOCAT'ON (Streit, C'ljJTcwn. St"'1 KS" SIGHATUREA .........0 31b. LICENSlj.,NUIoI .0 31t'f\.tI NAMEANDADDRESSOF (1l8m2nTyplOfI'rlnl o ';).-", ,. DATEFILED(MlIIlth,OIy.Vaerl Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17013 Phone: (717)240-6345 Date: 02/01/2005 PICKFORD SUSAN K 3344 TRINDLE ROAD CAMP HILL, PA 17011 RE: Estate of BRUBAKER RICHARD E File Number: 2004-01062 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of Wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 02/28/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GL~~~:;r Clerk of the Orphans' Court cc: File Personal Representative(s) Judge Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 phone: (717)240-6345 Date: 02/01/2005 BRUBAKER CHERYL A 18 SOUTH 30TH ST CAMP HILL, PA 17011 RE: Estate of BRUBAKER RICHARD E File Number: 2004-01062 Dear Sir/Madam: It has come to my attention that you have not filed the Certification of Notice Under Rule 5.7 (a) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO.1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within ten (10) days after giving proper notice to the beneficiaries and intestate heirs as required by subdivision (a) of Rule 5.7, shall file with the Register of wills or Clerk of the Orphans' Court his/her Certification of Notice. This filing will become delinquent on 02/28/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, GLE~~~ Clerk of the Orphans' Court cc: File Counsel Judge CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: RICHARD BRUBAKER Date of Death: September 8, 2004 No. fAl-04 -IDLP~ 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 beneficiaries of the above- captioned estate on February 13,2005: Cynthia Self - 8 Stephen Street, Dillsburg, P A Notice has now been given to all persons entitled thereto Under Rule 5.6(a). Date: 02-//31o.r I / K. Pickfor sq. Counsel for Personal R 3344 Trindle Road Camp Hill, PA 17011 (717)612-1660 r-- -,"- U") (~:) :'"") v-- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG. PA 17128-0601 REV-1 162 EX(1 1-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BRUBAKER CHERYL A 18 SOUTH 30TH ST CAMP HILL, PA 17011 ____nn fold ESTATE INFORMATION: SSN: 201-18-8628 FILE NUMBER: 2104-1062 DECEDENT NAME: BRUBAKER RICHARD E DATE OF PAYMENT: 10/28/2005 POSTMARK DATE: 10/28/2005 COUNTY: CUMBERLAND DATE OF DEATH: 09/08/2004 NO. CD 005944 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $6,675.82 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: C A BRUBAKER CHECK# 105 SEAL INITIALS: VZ RECEIVED BY: REGISTER OF WILLS $6,675.82 GLENDA FARNER STRASBAUGH REGISTER OF WILLS Register of Wills Cumberland Inventory County, Pennsylvania Estate of Richard E. Brubaker Also known as No. 20-04-01062 Date of Death Social Security No. Personal representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory indude all of the personal assets The personal assets wherever situate end all of the real estate in the Commonwealth of Pennsylvania of said, Decedent that the valuation placed Opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate Outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. l!We verify that the Statements made in this inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to auth Attorney I.D. No.: Address Telephone: Description 1. 4907 Delbrook Road, Mechanicsburg, PA 17050 2. AmeriChoice Federal Credit Union Savings Accou 3. M & T Bank Checking Account No.: 9836495961 (Date C~ 4. 1995 Chrysler New Yorker 5. Myers Funeral Home, Inc. (Prepaid) 6. Miscellaneous Personal Property Value Total from continuation page(s) $ 0.00 (Attach additional sheets if necessary) Total: $147,797.77 NOTE: The memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. $120,000.00 $12,770.33 $6,303.91 $2,400.00 $4,823.53 $1,500.00 ::n- _..."of- .-.... -Y:J F, C) (,:J ~o (::J ,"'\I CJ (:::::> -'T1 " c'5 rn ~=? W N Vi; COMMONWEALTH OF PENNSLYVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 OFFICIAL USE ONLY REV-,5oo EX (6-00) INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER COUNTY CODE 04 YEAR NUMBER DECEDENT'S NAME (LAST, Brubaker, Richard E. DATE OF DEATH (MM-DD-YEAR) 09/0812004 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 1. Original Return 4. Limited Estate 2. Supplemental Return 4a. Future Interest Comprise (date 01 death after '2-'2-82) 3, Remainder Relum(OaIeol_l"alo12-'J.ll2) 5, Federal Estate Tax Return Required 6. Decedent Died Testate (Attach copy of Will) 7. Decedent Maintained a Living Trust (Attach a copy 01 Trust) 0 8, Total Number of Safe Deposit Boxes 10, Spousal Poverty Credit (date 01 death between '2-3'-9' and '-',95) D 11. Election to tax under Sec, 9113(A) .. ... (A"ach Sch Q) 9, Litigation Proceeds Received NAME John J. McNally, III, Esquire FIRM NAME (If Applicable) Thomas, Thomas & Hafer, LLP TELEPHONE NUMBER (717) 237-7116 6, Jointly Owned Property (Schedule F) ~ Separate Billing Requested 7. Inter-Vivos Transfers & Misc, Non-Probate Property (Schedule G or L) $ 0.00 .....~J c::> 5. Cash, Bank Deposits & Misc, Personal Property (Schedule E) (1) (2) (3) (4) (5) (6) $120,000,00 $ 0,00 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3, Closely Held Corporation, Partnership or Sole-Proprietorship $ 0,00 ~ - "1 -~..~. :..--... 4. Mortgages & Notes Receivable (Schedule D) $ 0,00 $27,797,77 (, ~) c...:> (7) $5,000.00 (8) $4,939,17 $2,337,95 (11) (12) (13) (14) $152.797.77 8. Total Gross Assets (total Lines 1-7) 10, Debts of Decedent, Mortgage Liabilities & Liens (Schedule I) (9) (10) 9, Funeral Expenses & Administrative Costs (Schedule H) 11, Total Deductions (total Lines 9 & 10) $7,277.12 13, Charitable and Governmental BequestslSec 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) 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) $145,520.65 $ 0,00 12, Net Value of Estate (Line 8 minus Line 11) $145,520,65 18. Amount of Line 14 taxable at collateral rate x (15) x .045 (16) -' x ,12 (17) x .15 (18) $ 0,00 $6,548.43 $ 0,00 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate $ 0,00 19. Tax Due 2o.D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT (19) $6,548,43 Decedent's Complete Address STREET ADDRESS CITY Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount $6,548.43 Total Credits (A + B + C) (2) $ 0.00 3. InterestlPenalty if applicable D. Interest E. Penalty 4. TotallnterestlPenalty (0 + E) (3) If line 2 is areater than line 1 + line 3. enter the difference, This is the OVERPAYMENT Check box on Page 1 Line 20 to request a refund (4) $ 127.39 $ 0.00 5. If line 1 + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) $6,675.82 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE (5B) Make Check Payable to: REGISTER OF WILLS, AGENT $6,675.82 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: 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 revisionary 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 on year of 3. ~~h~::e~i::; ;~~nq:;;::;~:~~ deaU, bank a<xnJnt or seaJnty at hLs or her deaU,? li....i.il 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? I X 'il c=J IF THE ANSWERTO ANY OFTHE/IBOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE GAND ALE IT AS PART OF THE RETURN. Yes No ; Ea Under penalties of pe~ury. I dedare that I have examined this retum, 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 the Information of which preparer has any knowledge. DATE DATE AD ". '....... John J. McNally, I ,Esquire, Thomas, Thomas & H Street, P.O. Box 999, Harrisburg, PA 17108 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 exemot 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 on the net value of transfers to or for the use of the decedent's siblings Ls 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-1502EX + (1-97) (I) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Richard E. Brubaker FILE NUMBER 21-04-1062 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 which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. TOTAL (Also enter on line 1, Recapitulation) (If more space is needed, insert additional sheets of the same size) $120,000.00 REV,1508 EX + (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Richard E. Brubaker FILE NUMBER 21-04-1062 Include the proceeds of I~igation and the date the proceeds were received by the estate, All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. 2. 3. 4 VALUE AT DATE OF DEATH $ $2,400.00 $4,823.53 TOTAL Also enter on line 5, Reca (If more space is needed, insert additional sheets of the same size) $27,797.77 REV-1510 EX + (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Richard E. Brubaker FILE NUMBER 21-04-1062 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER 1. DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE. THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER ATTACH A COPY OF THE DEED FOR REAL ESTATE, EXCLUSION (IF APPLICABLE) TAXABLE VALUE $5,000.00 TOTAL Also enter on line 7, Reca itulation (If more space is needed, insert additional sheets of the same size) $5,000.00 REV-1511 EX + (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF 21-04-1062 Richard E. Brubaker FILE NUMBER Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. B. 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address State Zip City Year(s) Commission Paid: Attorney Fees 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 Register of Wills of Cumberland County, Pennsylvania Accountant's Fees ship AMOUNT $2,500.00 $265.00 $60.00 $75.00 $126.50 $128.04 $1,006.33 TOTAL (Also enter on line 9, Recapitulation) $4,939.17 (If more space is needed, insert additional sheets of the same size) REV-1512 EX + (1-97)(1) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Richard E. Brubaker FILE NUMBER 21-04-1062 Include unreimbursed medical expenses. ITEM NUMBER 1. 2. 5. 6. 7, 8. 9. AMOUNT $35.00 $3.21 $876.00 $214.89 $76.18 $43.84 $329.72 $11.65 $18.06 12. 13. 14. 15. 16. 17. .15 $40.95 TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) $2,337.95 REV-1513 EX + (9-00)) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF NUMBER FILE NUMBER RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AM:ll.NT OR SHARE OFESTATE 50% 50% II. ENTER DOLLAR AMOUNTS FOR DISlRIBUTlONS SHCM'N ABOVE ON LINES 15 THROUGH 18, ASAPPROPRJATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1, B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed, insert additional sheets of the same size) $ 0.00 01-03-2006 BRUBAKER 09-08-2004 21 04-1062 CUMBERLAND 101 APPEAL DATE: 03-04-2006 ( See reverse side under Objections) A.ount R_itted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLEI PA 17013 CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- Riy:is4,-ix-AFP-ioi:osi-NOTici-OF-iNHiRiTANCi-TAX-APPRAisEMENT:-ALLOWANCi-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RICHARD E FILE NO. 21 04-1062 ACN 101 BUREAU OF INDIVIDUM.,~[{H~~'=~: (;'TCF INHERITANCE TAX DIVISION .._,.- PO BOX Z806Dl . HARRISBURG PA 171z8-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEHENTI ALLOWANCE DR DISALLOWANCE OF DEDUCTIONS AND ASSESSHENT OF TAX ZD% DATE ESTATE OF DA TE OF DEATH FILE NUMBER COUNTY ACN -6 I: 09 (:IJT1< C1FF;..:/ . (' ::~!..T~T JOHN J ~~ALLV In ESQ THOMAS ETAL PO BOX 999 HBG PA 17108 ESTATE OF BRUBAKER '*' REV-1547 EX AFP (06-05) RICHARD E TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED DATE 01-03-2006 If an assess.ent was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. ~t of Line 14 at Spousal rate (15) 16. Aaount of Line 14 taxable at Lineal/Class A rate (16) 17. Aaount of Line 14 at Sibling rete (17) 18. ~t of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due T : RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R_l Estate (Schedule A) 2. Stocks end Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cesh/Benk Deposits/Hisc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. TrBnsfers (Schedule G) 8. Total Assets (1) (2) (3) (4) un (6) (7) 1201000.00 .00 .00 .00 27.797.77 .00 51000.00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/A~. Costs/Hisc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/GovennDBntal Bequests; Non-elected 9113 Trusts 14. Net Value of Estate Subject to Tax 41939.17 (9) UO) 2.337.95 (1) (2) (3) (4) (Schedule .n NOTE: .00 X 1451520.65 X .00 X .00 X AHOUNT PAID 61675.82 DATE 10-28-2005 NUttBER CD005944 INTEREST/PEN PAID (-) 127.39- TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE NOTE: To insure proper creeli t to your account I submit the upper portion of this for. with your tax pay.."t. 1521797.77 7.?77 I? 1451520.65 .00 1451520.65 00 = 045 = 12 = 15 = .00 61548.43 .00 .00 61548.43 (9)= 61548.43 .00 .00 .00 . IF PAID AFTER DATE INDICATED I SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $11 NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR)I YOU HAY BE DUE~ A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS.) L,..... THOMAS. THOMAS & HAFER, LLP John 1. McNally, Esquire Identification Number: 52661 305 N. Front Street P.O. Box 999 Harrisburg, P A 17108 (717) 441-7069 jmcnally@tthlaw,com Counsel for Cheryl A. Brubaker Administratrix of the Estate of Richard E. Brubaker INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ORPHAN'S COURT DIVISION RICHARD E. BRUBAKER NO. 2004-01062 Deceased FAMILY SETTLEMENT AGREEMENT THIS AGREEMENT is made on the ---y'-th day of,--1t f7V ,2006, by and between CHERYL A. BRUBAKER, individually and as Administratrix of the Estate of RICHARD E. BRUBAKER, Deceased, and CYNTHIA K. SELF, as heirs of the said Estate (hereinafter collectively referred to as the "heirs") under the laws of the Commonwealth of Pennsylvania. In accordance with their desire that the administration of the Estate of RICHARD E. BRUBAKER be terminated without the expense and delay of a court accounting, the parties hereto, in consideration of the mutual covenants herein expressed, and intending to be legally bound thereby, agree that: ;--, 1. RICHARD E. BRUBAKER (the "Decedent"), who resided at 4907pelbrookC;1 Road, Mechanicsburg, Cumberland County, Pennsylvania, died intestate on September:8:, 2004. 1 ,:.) 2. On November 18,2004, CYNTHIA K. SELF, daughter of RICHARD E.' BRUBAKER, Decedent, formally renounced her right to administer the estate and resp~ctfully.'-? N \.C} 424760,1 .;:; -0 c~ TO., '\:~~ \-t requested that Letters of Administration be issued to CHERYL A. BRUBAKER, daughter of RICHARD E. BRUBAKER, deceased. 3. On November 18,2004, Letters of Administration were duly granted to CHERYL A. BRUBAKER by the Register of Wills of Cumberland County at the above number and term. 4. Notice of Estate Administration was served on all the heirs and a Certification of Notice was filed on February 13,2005 in the Office of the Register of Wills of Cumberland County. 5. On October 28,2005, CHERYL A. BRUBAKER, as Administratrix ofthe Estate of RICHARD E. BRUBAKER, deceased, filed a Pennsylvania Inheritance Tax Return, with an inheritance tax owed, and subsequently paid for, by the estate in the amount of$6,675.82. 6. It is the desire of the parties to this Agreement that final distribution of this estate be accomplished without a formal accounting to the Orphans' Court Division of the Court of Common Pleas of Cumberland County, and be it further the desire of the parties to avoid the expense, delay and publicity of a formal accounting. 7. CHERYL A. BRUBAKER, individually and as Administratrix of the Estate of RICHARD E. BRUBAKER and CYNTHIA K. SELF are the parties hereto and are the sole heirs of the Estate of RICHARD E. BRUBAKER, deceased, and accordingly, are the only persons who could object to the distribution of the Estate of RICHARD E. BRUBAKER, deceased. NOW, THEREFORE, WITNESSETH, the parties hereto, intending to be legally bound, mutually agree as follows: A. Represent and warrant that they have read and understand this Agreement and confirm that the facts set forth above are true and correct, to the best of their knowledge, information and belief. 424760,1 B. Declare that they have sufficient information to make an informed waiver of their right to a formal accounting with the Court, and do hereby waive the filing and auditing of the same. C. Acknowledge that the distributive share or amount set forth on the Schedule shall be in full satisfaction of their respective entitlements under the Intestate Succession laws of the Commonwealth of Pennsylvania. D. Release, remise, quitclaim and forever discharge the Administratrix, her heirs, personal representatives, successors and assigns, from and against all claims that they, as heirs of the Estate, and in connection with the Estate, had, now have or may in the future have in connection with the Estate. E. Agree to refund, on demand, all or any part of any aforesaid distribution, which has been determined by the Administratrix, or by the Court, or by any court of competent jurisdiction, to have been improperly made. F. Agree to indemnify and hold harmless the Administratrix, her heirs, personal representatives, successors and assigns, from and against any and all claims, loss, liability or damage (whether or not related to the negligence of the Administratrix) that may hereafter be asserted against the Estate or against the Administratrix. G. Agree to execute such other or additional documents as may be necessary to effectuate the agreements set forth herein. H. Acknowledge that this Agreement shall be governed by and construed in accordance with the laws of the Commonwealth of Pennsylvania. 1. Consent to the Court exercising personal jurisdiction over them in any suit or action arising out of the enforcement of this Agreement. IN WITNESS WHEREOF, the parties hereto, intending to be legally bound, have placed their hands and seals on the attached Consents to Family Settlement Agreement. Respectfully Submitted, ally, I ntification No.: 52661 305 N. Front Street P.O. Box 999 424760.1 Date: 424760,1 Harrisburg, P A 17108 (717) 237-7116 Attorney for Cheryl A. Brubaker Administratrix of the Estate of Richard E. Brubaker r,,!C:lO{, INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ORPHAN'S COURT DIVISION RICHARD E. BRUBAKER NO. 2004-01062 Deceased CONSENT TO FAMILY SETTLEMENT AGREEMENT AND RECEIPT FOR DISTRIBUTION I, CHERYL A. BRUBAKER, Individually and as Administratrix of the Estate of RICHARD E. BRUBAKER, deceased, hereby acknowledge receipt of the tangible personal property of the Decedent, and the distribution in the amount shown on the Proposed Schedule of Distribution. I hereby consent to and join in the Family Settlement Agreement relating to the Estate of RICHARD E. BRUBAKER, deceased, a copy of which, including exhibits, has been provided to me. ~~~ATRIX COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF DAUPHIN On this, the / I / day of riA Ct. t/B ' 2006, hefore me, the undersigned officer, personally appeared CHERYL A. BR AKER, known to me (or satIsfactonlyproven) to be the person whose name is subscribed to the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. 0JtJ1fUJ.J;lriLfJ- Notary Public 424760.1 : ,\k'!ann1 ;-:;':'di U1 C' Gwen M. ClOCk. "b1arv Put!;;; M ity Of rm~Sb! !/g. Da, uptlln Cuunty Y CommlsSlOll Ey.pre<; Oc 27 "001:' rtlf~rn~;;:~::~"~;;'~;;_\~~~~;;';;f'._:~"~' - .J INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ORPHAN'S COURT DIVISION RICHARD E. BRUBAKER NO. 2004-01062 Deceased CONSENT TO FAMILY SETTLEMENT AGREEMENT AND RECEIPT FOR DISTRIBUTION I, CYNTHIA K. SELF, hereby acknowledge receipt of the tangible personal property of the Decedent, and the distribution in the amount shown on the Proposed Schedule of Distribution. I hereby consent to and join in the Family Settlement Agreement relating to the Estate of RICHARD E. BRUBAKER, deceased, a copy of which, including exhibits, has been provided to me. COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF DAUPHIN On this, the ~ day of , 2006, before me, the undersigned officer, personally appeared CYNTHI K. SELF, known to me (or satisfactorily proven) to be the person whose name is subscribed t the within instrument, and acknowledged that she executed the same in the capacities and for the purposes therein contained. IN WITNESS WHEREOF, I hereunder set my hand and official seal. Ow. Jl7l&L Notary Public'/ COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL ELAINE S.M. BECK, Notary Public City of Harrisburg, Dauphin County My Commission Expires Feb. 12, 2010 ~-~------.........._~ 424760,1 INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ORPHAN'S COURT DIVISION RICHARD E. BRUBAKER NO. 2004-01062 Deceased VERIFICATION I, CHERYL A. BRUBAKER, hereby certify that the statements made in the foregoing Family Settlement Agreement are true to the best of my knowledge, information and belief. I understand that any false statements made herein are subject to penalties for perjury under 18 Pa.C.S. 9 4904. ~/~, c&YJ~ DAT r / 424760.1 INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ORPHAN'S COURT DIVISION RICHARD E. BRUBAKER NO. 2004-01062 Deceased RECEIPT. RELEASE. REFUNDING AND INDEMNIFICATION AGREEMENT I, CYNTHIA K. SELF, heir to the Estate of RICHARD E. BRUBAKER, deceased, hereby: 1. Acknowledge receipt of the sum of Sixty Thousand Seven Hundred Forty-Five Dollars and Seventeen Cents ($60,745.17), as outlined in the Proposed Schedule of Distribution attached hereto as Exhibit "B". 2. Releases CHERYL A. BRUBAKER, Administratrix of the Estate of RICHARD E. BRUBAKER, and her heirs and personal representative, from all liabilities, whether due to the Administratrix' negligence or otherwise, which she may have by reason of her administration of the Estate; 3. Agrees to refund to the Administratrix any portion of the distribution to which she is not properly entitled and, to the extent of said distribution, to indemnify the Administratrix for claims made against her as Administratrix, and to reimburse to her all expenses and costs incurred in connection with any such claims; and 4. Declares that this instrument will be legally binding upon her, her personal representative, successors, and assigns. W~TNESS WHEREOF, I have hereunto set my hand and seal this (/cf/1.......-/ ,2006. day of I EREBY CERTIFY that the statements made in the foregoing instrument are true to the best of my knowledge, information and belief. I understand that any false statements made herein are subject to penalties ofpetjury under 18 Pa.C.S. S 4904. /1114Jr7! !d ~S COMMONWf.ALrH Of PENNSYLVANIA NOTARIAL SEAL E~INE S.M. BECK, Notary Public City of Harrisburg, Dauphin County 'Mv Commission Expires Feb. 12 2010 ....-..._..~.,._- .-..--.--.... ........-- ' fbJ!J~CY~ C THIA K. SELF 424760. : EXHIBIT A --a.......- INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ORPHAN'S COURT DIVISION RICHARD E. BRUBAKER NO. 2004-01062 Deceased INFORMAL. ACCOUNT Date of Death: September 8,2004 Date of Appointment: November 18, 2004 RECEIPTS Assets 907 Delbrook Road echanicsburg, P A 17050 eriChoice Federal Credit Union Savings Account No.: 16905 (Date Created: May 29, 1970) & T Bank Checking Account No.: 9836495961 (Date Created: January 7, 1983) 1995 Chrysler New Yorker yers Funeral Home, Inc. (Pre aid) iscellaneous Personal Property BM Personal Pension Plan 0.: 00009982047 otal Value of Assets: Value as of Date of Death $120,000.0 $12,770.33 $6,303.91 $147797.7 424760,1 DISBURSEMENTS OF PRINCIPAL EXDenses Amount of EXDenses Unreimbursed Medical Expense (1112004) $35.00 Omega Medical Laboratories Unreimbursed Medical Expense (11/2004) $3.21 Susquehanna Surgeons Unreimbursed Medical Expense (11/2004) $876.0C Pinnacle Health Hospitals Unreimbursed Medical Expense (11/2004) $214.89 Holy Spirit Hospital Unreimbursed Medical Expense (11/2004) $76.18 Harrisburg Gastroenterology Unreimbursed Medical Expense (11/2004) $43.84 Moffitt Heart and Vascular Group Unreimbursed Medical Expense (12/2004) $329.72 OSCI Unreimbursed Medical Expense (12/2004) $11.65 Quantum Imaging and Therapeutic Unreimbursed Medical Expense (1212004) $18.01 Lehigh Anesthesia Associates, P.C. Unreimhursed Debt of Decedent (06/2005) $95.00 IBM Employee Services Center Unreimbursed Medical Expense (0712005) $16.15 WSO Imaging Center, LP Administrative Expense (11/2004) $127.0C State Farm Insurance (Homeowner's Insurance) Administrative Expense (05/2005) $127.00 State Farm Insurance (Homeowner's Insurance) Administrative Expense (11/2005) $84.24 State Farm Insurance (Homeowner's Insurance) Administrative Expense (03/2006) $84.24 State Farm Insurance (Homeowner's Insurance) Administrative Expense (0112005) $559.71 IBM (Refund of Pension) !Administrative Expense (01/2005) $255.80 State Farm Insurance (Automobile Insurance) !Administrative Expense (0312005) $45.00 State Farm Insurance (Umbrella Insurance Policy) !Administrative Expense (04/2005) $22.50 PennDOT (Car Title) [Administrative Expense (0712005) $40.95 Callen-Kinback, Inc., Goodyear Tire Center Utility Expense - Trash and Sewer (1212004) $126.50 Utility Expense - Trash and Sewer (0512005) $126.5C Utility Expense - Trash and Sewer (0612005) $128.04 Utility Expense - Trash and Sewer (0912005) $126.86 424760,1 Utility Expense - Trash and Sewer (11/2005) $122.0 Utility Expense - Trash and Sewer (02/2006) $ 136.4C Probate Fees (10/27/2004) $265.00 Cumberland County Register of Wills Cumberland Valley School DistrictlHampden $254.28 Township Real Estate Tax (05/2005) Marie Huber, Treasurer Cumberland Valley School District/Hampden $1,006.33 Township Real Estate Tax (11/2005) Marie Huber, Treasurer Funeral Expense (11/27/2004) $395.0C Myer's Funeral Home, Inc. Tax Return Preparer's Fee (03/07/2005) $60.0C Robert Shannon, CPA Administrative Fee (03/19/05) $45.00 Payment of Final Tax Return Administrative Fee (06/2005) $95.00 IBM Employee Services Center (Insurance Payment for September 2004) Attorneys Fees (07/2005) $2,500.00 Thomas, Thomas & Hafer, LLP k\dvertising Fee (03/2005) $75.0C Cumberland Law Journal [Advertising Fee (08/2005) $256.8C The Patriot-News !Advance Payment to Heir (09/2005) $1,200.OC Cynthia K. Self - Sale of Automobile !Advance Payment to Heir (09/2005) $1,200.0C Cheryl A. Brubaker - Sale of Automobile rPennsylvania Inheritance Tax (10/28/05) $6,675.82 Register of Wills, Agent Filing Fee - Pennsylvania Inheritance Tax (10/28/2005) $15.00 Cumberland County Register of Wills Filing Fee - Inventory (10/28/05) $15.00 Cumberland County Register of Wills Advance Payment to Heir (12/2005) $1,OOO.OC Cynthia K. Self Advance Payment to Heir (12/2005) $1,000.00 Cheryl A. Brubaker Administrative Expense (05/2006) $620.00 Dishwasher repair for house Administrative Expense (05/2006) $577.00 House Settlement Filing Fee - Family Settlement Agreement (05/2006) $20.0C Cumberland County Register of Wills ~otal Administration Exnenses: $21.107.62 424760.1 EXHIBIT B ----- INRE: IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ESTATE OF ORPHAN'S COURT DIVISION RICHARD E. BRUBAKER NO. 2004-01062 Deceased PROPOSED SCHEDULE OF DISTRIBUTION Balance Available for Distribution 4907 De1brook Road, Mechanicsburg, P A 17050 AmeriChoice Federal Credit Union Savings Account No.: 16905 M & T Bank Checking Account No.: 9836495961 1995 Chrysler New Yorker (Less Administrative Expenses - See "Disbursements of Principal") Total: $120,000.00 $12,770.33 $6,303.91 $2,400.00 ($21,107.62) $120.366.62 To: Chervl A. Brubaker Principal Cash: Income Cash: Additional Cash: Total: $60,183.31 $0.00 $561.86 $60.745.17 To: Cynthia K. Self 4907 Delbrook Road, Mechanicsburg, P A 17050 Principal Cash: Income Cash: Additional Cash: Total: $60,000.00 $183.31 $0.00 $561.86 $60.745.17 424760.1 Cumberland County - KeglSL.eI Vl. V~J..J..J..;:) One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/27/2006 PICKFORD SUSAN K 3344 TRINDLE ROAD CAMP HILL, PA 17011 RE: Estate of BRUBAKER RICHARD E File Number: 2004-01062 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing is due by: 9/08/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, I: reV /J ~~~ Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Personal Representative(s) " -1C Cumberland County - Register ur Wl~~S One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 7/27/2006 BRUBAKER CHERYL A 18 SOUTH 30TH ST CAMP HILL, PA 17011 RE: Estate of BRUBAKER RICHARD E File Number: 2004-01062 Dear Sir/Madam: This notice is to serve as a reminder that the Status Report by Personal Representative under Rule 6.12 is due on the below listed date. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after July I, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of wills a Status Report of completed or uncompleted administration. This filing is due by: 9/08/2006 Please feel free to contact this office with any questions you may have. If you have already filed your Status Report, please disregard this notice. Sincerely, ,r .., ~ " I...7'P , ,f/ I' 0~ j/> '-Y?UraAJ k!ii~ . /,-:tI/t/w-v:.._, Vl , /! . ~ I Glenda Farner Strasbaugh Clerk of the Orphans' Court cc: File Counsel c...... / '-.,- u_, c." L. - C-) , Register of Wills of Cumber.and County STATUS REPORT UNDER RULE 6.12 NameofDecedent:_P\~hQY'ol ~. ~('LA.bo..ik(oJ Date of Death: ~Q.rt' ~ I c9.D0~ Estate No.: ~ I -()~lO{o~ 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 .(g No 0 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? (Fll e c;l..cxle to/ cR /:100- Yes ~ No 0 / b. The separate Orphans' Court No. (if any) for the personal representative's account is: ciLO() N- - (') l () 0~ c. Did the personal representative state an account informally to the parties in interest? Yes ~ No 0 c. Copies of receipts, releases, joinders and approval offonnal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date:~1o ~." ~.ia ~:;"'LbnkbU Slgnatur Chprj \ ~ n Aba. \(e-r Name ' \ <( ~. .)30-\-h~~+Y~e:l Address O-Y"Y'\ P H, \ ) A- I'" 0 I ( .2>03 - 5~ ~O Telephone No. co C'<J ('.;-", I ( ....( .... ::.:,- Capacity: ~Personal Representative o Counsel for personal representative c__ ~ s~~, p~ ~ at LaID 3344 7'1tdle 7i?"ad . e-.tz. ?lat. 'PrI 17011 pk.u 717-612-1660 . !a~ 717-612-0375 August 15,2006 Cumberland County - Register of Wills One Courthouse Square Carlisle, P A 17013 Phone: (717) 240-6345 To whom it may concern: This letter is to inform you that the Office of Attorney Susan K. Pickford no longer represents the Estate of RICHARD E. BRUBAKER, file number: 2004-01062. The Estate if RICHARD E. BRUBAKER is now being represented by John McNally, Esq., P.O. Box 999, 305 N. Front Street, Harrisburg, PA 17108. Thank you. With thanks, Susan K. Pickford Jaimie Arnold-intern. c') CO) \/'