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Home My WebLink About02-1096PETITION FOR PROBATE and GRANT OF LETTERS Estate of L~Qr/ ~ ~r-ec:/i~ // also known as Deceased. Social Security No. ~~~-~7'" 7~'r`E7 No. '0111- O a1 - too to To: Register of Wills for the County of in the Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/aye-18 years of age or older an the executr.,c named in the last will of the above decedent, dated , 19 and codicil(s) dated /yd~ i3, /997 (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cr~m6~+'/~~d County, Pennsylvania, with h %~ last family or principal residence a~3/6 /`I~ss:Ccli ~'~~ , Tr ~ ~~ (list street, number and muncipality) then ~j years of age, died /L~ Y~.r~.~r /~ ~ .}~ ,~c~ n ~ at j Except as follows, cedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered fox probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as fallows: (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: ~~'~'"~-- WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. v F ye ~5~~/ b~ x~ b o C O.S. a~ ~ •., .~~ N 0. v~ ~o c 00 OATH OF"PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA ~ S3 COUNTY OF CiTMRFRT,ANI~ The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this _ 3rd day of DECENlBE;7 2 0 0 2 19~x I C~QPr1 G~r U U ~ a No. a~-oa-~ogc~ Estate of EARL D BRECHBILL ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW DECEMBER 5 , 2 00 2 x~x , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, 5-13-1997 IT IS DECREED that the instrument(s) datea described therein be admitted to probate and filed of record as the last will of EARL D BRECHBILL ; and Letters are hereby granted to FAYE SHELLY FEES Probate, Letters, Etc.......... ~ 7 0 . 0 0 9.00 Short Certificates( ) .......... $ ~~x, extra, ,~ages~ 6.00 jcp ~ I0.00 TOTAL $95.00 Filed 12-5-2002 ' mailed' to"exec"17=5'=2'CI02 ATTORNEY (Sup. Ct. LD. No.) .ADDRESS PHONE i :;, .,~ ... ~ ,.. This is to certify tEiat the informatir)n here liven ~s c~)~re~ 1~,- , .. ,_ I~ti.. ,_ [.Deal Regis*rar. ~'he ori~ina] certificate v~iil i7e foryN<_rcied r ..;..~ ~. _' ~ <<.:. e( +. .... WARNIwG: It is illega'~ to c~~~a~iC~~e tai ~ ; ~~;,, , a >;~€~~ ~) ~~~~t e. F •e ur rl)is care )..t " y.O;i m os.1 a] Rey. ue7 TY PElPRINT IN PERMANENT BLACK INK u~ ~~,•~ 3y3yp<{ 6 ~ i O f 8777-412 ~U- ~~~ ~\ r ~' f / ~ P. ~ ~~, ;, _ ~~~?2d.2c .c~Ge~ /J COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEDENT (Frcv. MiOtlb. Laf) SEx SOCIAL SECURITY NUMBER DATE OF DEATH iMCnm. Day, Karl ,. Earl D. Brechbill a. 7. - - •. ov AGE (Lev B+aaayl UNDERIYFM UNDERI D/tl DRE OF BIRTH BIRTHPLACE (CNy and PLACE OF OFAH(ChacM OMyoro--ses xegruapeamamn noel • I ~„ „~• I Mhaas IMOnm, Day hNl SIa1a p Fpegn Country) HOSPITAL OTHER: « ^ DDA ^ " ^ ERIO 1 Ni '"°"'0 ~ ^ i ^ sv r $ 5 Yn. ~ 2 /4 / 1917 Auburn IN . p . ,q,, . R•„da,Ka u ro eNl a t • s , T COUNTY OF DEATH CITY, 8080. TWP OF DEATH FACILITY NAME IN re, xeseMan. gave 5oe61 and number) VM3 DECEDEM OF HISPANIC ORIOINt RACE ~ Amarlun Indan, BMCa. Whoa. Md. tyo ® yYa ^ K Y••. ap•clh Cubs.. ISpecM) Cumberland Upper Allen Twp. Messiah Village ;•'in"•"""°R"'"••" ,0 White •d a. DECEDENT'S USUAL OCCUPQION KIND OF BUSINESSIINDUSTRV . VMS DECEDENT EVER IN DECEDENT'S EDUCATION MARfTAL BTATUS-MarnW SURVIVING SPOUSE (Give kxMdvNra dow dlxaxqq nor U.S. ARMED FORCE51 S oN hi <om ed NsvN MNrW. WIdowW. III aVa. qvs maiden name) EwwnurylSawredNy Co•sq DhvrcW )Speedy) I worMirtQ Ma; eo nal uel rMred.) O ro,z, D.«s.l na^ "°~ Ministry rdained Minister _ b „ Widowed 2 ,.. ,s. ,3 ~~• „ . DECEDENT'S MAILING ADDRESS ISbeN.Cary/TOwn,SMts. Zp COde) DECEDENT'S . a.p.dNa Wad Mr UY~Ty~r Allen 01 Y 17e pennsvlvania '" aA' ACTUAL 100 Mt. Allen Drive RESIDENCE . . Die D ,7s. Slate iFi dacedan Mechanicsbur PA 17055 ~ss,omNrepxx,a Iher ease IM In. 1 lowpahiDl l l ^ WN ~ ~ ~ 4F ,.. ,ar il Wrl 17d. n inu 4« ---- crNAwm ,~ Coun ~LTm an0 FATHER'S NAME lfirv. Meddb. Lav) MOTHER'S NAME (FrN. Meddle, MaWan SurrMmN ,.. Albert ,•. Cora Miller INFORMANT'S NAME (iypNPrinn ~ I NFORMANT'S MAILBK] ADDRESS )Spas. Ciryrtown, Sbb. Zp Cpdel tw Faye Shelly 20,511 N. Lewisber Road Mechanicsburg, PA 17055 p N METHOD OF DISPOSITI DATE OF DISPOSITION PLACE OF DISPOSRION-NNns«CSmNary,Cremaory LOCQbN-CMYTmyn, SlNe. Zip Coto F ~ Burial L] CnmMpn^ RernOVal tram 51a1e^ (MOnm. DeY•14a/) or Ollrar PMpa Oowlan^ a"`r(Spe<NY' ^ jgov ember 22 2002 Fairview Cemete Martinsbur PA 16662 :,d 3L. 2t1 t,d. y . ' SIGNAT1NiE FUNE R CE ICEN FOR PERSON ACTING AS SUCH lal(JCLL 1 U K LICENSE NUMBER NAME ANO ADDf1ES5OF fAC1UTY l 33. ~ tm. FD-014889-L ttd. 8 Market Plaza Wa Mechanicsbur PA 170 Camp1 items t ly wMn nni b 1M MN «my Nrawledgs, death occ urred at ma uma, date and place staled. LICENSE NUMBER DRE SIGNED Mean (Monty Day pnyse a veil at uma old lh ld (Sgratpe and Title) . . cen~ry cause of loam. z7a. x]b. zx. hams 2<-26 mustMrompMlad by TIME OF DEATH , DATE PRONOUNCED DEAD (MOnN. Day, Year) VMS CASE REFERRED TO MEDICAL EIUMINEiLCORONERI ~,/ wa^ NoIF~ . - person.ro vrorouncea deal /r•~/s A M ~~ .- /y zvoz 3.. 36 . 3.. 37. PART L Enter Ilea dewasea, inluriaa or romptaalions which caused IM deem. Do not enlar tM mode of dying, such as cardiac «resgratory anesl, stock «head lailure. I AppmaimNa PART 11: L1M! signilkNS mndiuons rontrebuting w dam. but N"^'•1 ~w••n rxN rsudlirq M IM undsdyarp raeua grvM a PAiTT 1. L~sl anh one cause on e¢U lirw. I , pnsN end mom IMMEDIAT E CAUSE IFueai I Jisaase or ConOiliun ~ I .,. esuNiny en dadml-~ a. DUE (OR AS ACONSEOUENCE OF): Seauennaay Nat rorMibona b. deny laadng to emmadials DUE 70lOR AS ACOIJSEOUENCE OFI: 1 --- l I cause Enlar UNOERLYBNi t -_.-...-_ - • CAUSE 11l nru.x nauy c.-_ R A IS ll N E OF)'. O ID - I 1 urwe a E T I /] W rwml LAST d yy 1 41L _'C"- ~ .... U/...1~- I --- ___ _ ----- r - _ VMSANAUIOPSV __- WERE AUTOP6'Y FINDINGS MANNE DEATH DATE OFINJURV TIME OFINJURY INJURY AT WORK? DESCRIBE MOWINJURY OCCURRED. PERFORMED? AMtdLABLE PRIOR IO (Mmm, Oay, Year) COMPLETION OF CAUSE OF OEAMt NN«M VJ Homcide ^ 11a ^ No ^ AccdNe ^ PandVq lnwNigalbn ^ M ~ Y ^ tb Vas ^ No ^ Suaids ^ Could nd M Oetennme0 ^ reN, IMOry, oMU PUCE OF INIURV -A, lame, Iarm LOCATION ($treN. Gy/T . Slalal es 3M 330. 39. ~•. . CERTIFIER lCneca pay pal 'CERTIFYING PNY6ICIAN (Pnysa:an cwNyinq rouse d dean wteen andreer pnyscian has pronounced deals antl cpngeled n«1re 231 daatlr oCCYRaO dw b ma cauayal arW manner as alalad ..................................................... ^ I m arovMd a T M M l SIGNATU EAND TITIE OF CERTIFIER ' 71b. y g . a O o I / DISE SIG I LICENSE _ 'PRONOUNCING AND CFATIFYINO PHYSICIAN IPleysean bah ponwnnng deem and cendyeeg to cause of tleaml Y-1 l., D IN C~ py 71<. ]ld. To Na Mal of mY amwNdga, MaN occurred q lets tlma, Gta, and phlca, srM due to Bea nasals) and manner a a)sled .......................... TED CAUS Of N OMPL E NAME AND ADDRESS OF PERSON WHO C 'MEDICAL EXAMINER/CORONER lltem 271?yPk 1 ant ~~ `' y 1A ~ 11 L l yV~L• pylU. On the buia of aaaminatlon and/or Invaatlpatlon, In my opinion, desN occurred at the,Ima, dale, and place, and due Ip tna cause(s) and ^ r l - msnnarb sistad .................................................... ]la ........................ ...................... 77. . REGIST 'S SIGNATURE ANO NUMBER DATE FILE IMOnm DaY Ya 1 ~. WILL OF EARL D. BRECHBILL ~ ~- oa. ~ /09 ~o I, EARL D. BRECHBILL, currently of Upper Allen Township, Cumberland County, Pennsylvania, declare this to be my Last Wiil and Testament, hereby revoking any and all prior Wills and Codicils made by me. I. I direct that all my just debts and funeral expenses be paid from the assets of my estate as soon as practicable after my demise. II. I direct that all estate and inheritance taxes that may be assessed in consequence of my death, shall be paid out of the principal of my general estate to the same effect as if said taxes were expenses of administration and all property includable in my taxable estate whether or not passing under this Will shall be free and clear thereof. III. I bequeath unto my wife, Ellen K. Brechbill, all tangible personal property which I own at my death. IV. All the rest, residue and remainder of my estate, of whatever nature and wherever situate, including property over which I hold a power of appointment, I devise and bequeath unto my wife, Ellen K. Brechbill. `J. in the event that my wife, Ei1en, does not survive me, I devise and bequeath my entire estate that would have otherwise passed under Paragraphs III and IV above equally unto my four (4) children, namely, Leola Herr, Faye Shelly, Charlotte K. White and J. Albert Brechbill. In the event any of my children owe me money at the time of my death, said child's share shall be decreased by the amount of the balance owed as of the date of my death. ~~ If any child predeceases me, his or her share shall pass unto his or her issue per stirpes. If said child leaves no issue, said share shall lapse and be added to the shares passing to my other children or their issue per stirpes. VI. I appoint my wife, Ellen K. Brechbill, Executrix of this my Will. In the event that she fails to qualify or ceases to act as Executrix, I appoint my daughter, Faye Shelly, Executrix of this my Will. In the event that she fails to qualify or ceases to act as Executrix, I appoint Dallas L. Shelly Executor in her place. VIII. I direct that no bond be required of my fiduciaries for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I, EARL D. BRECHBILL, herewith set my hand to this my Last Will, typewritten on two (2) sheets of paper including the attestation clause and signatures of witnesses, this 13th day of May, 1997. ~_ cs 1~. - ~~~ a (SEAL) EARL D. BRECHBILL Signed by EARL D, BRECHBILL, by him declared to be his Will in our presence, who have hereunto subscribed our names as witnesses in his presence and at his request, this 13th day of May, 1997. C c..~~~-. residing at y ~~w ~ ~ residing at ~~ -~..e~~ -2- COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND WE, EARL D. BRECHBILL, GERALD J. BRINSER and FL~~ .v/~ , ~,~£ ~ N g,~ the testator and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly affirmed, do hereby declare to the undersigned authority that the testator signed and executed the instrument as his Last Will and that he signed willingly (or willingly directed another to sign for him), 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 witnesses and that to the best of our knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence, EARL D. BRECHBILL -~- ITNESS WITNESS Subscribed, sworn or affirmed and acknowledged before me by EARL D. BRECHBILL, the testator, GERALD J. BRINSER andE~`~N K. l3k~e,~ r~,« ,witnesses, this 13th day of May, 1997, (SEAL) Notary Public Notarial Seal Lona Sue Climerthapa, Notary Public Upper Aflen Ywp., Cumt~erland County My Commission Expires Apri128, 200f Member, Pennsylvania Association of Notaries -3- Name of Decedent: Date of Death: ~ t/, /~ CERTIFICATION OF NOTICE UNDER RULE 5.6 ~ ~ ~~~ ~~ ~- ~~~) za~~~~~ Will No. _ ~~oG-O/o9~a Admin. No. To the Register: o-~- ,~ . vCJ2~72/Zd_ Qom" ®~ `~~.~ ~ ~~~ ~. -~~ ~ I certify that notice of (beneficial interest) 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 ~_~~ U~~ irf~}jf-/e~ ve.!' a ~/ Name Address/ / ,~ ~y o~ ~tiar ~~ .Seiz-f' /ate' W/i.'~ emu( .~/rte /yecGx~i~.s~~g . //-s' /7~.ss Notice has now been given to all persons entitled thereto under Rule 5.6(a) except /le-e->~, ~xr/~ a/.P gl Date: ~a2-c._~ ,2 ~ ~d~~ Signature ~ ~~~ Name ~ ~ ~ , ri /~ Address ~~/ Telephone (7~j l9I'- /a -r-s' Capacity: Personal Representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: SHELLY M FAYE 511 N LEWISBERRY ROAD MECHANICSBURG, PA 17055 fold REMARKS: M FAYE SHELLY CHECK#113 REV-1162 EX(11-961 PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 002241 ACN ASSESSMENT AMOUNT CONTROL NUMBER 51,681.00 TOTAL AMOUNT PAID: INITIALS: AC SEAL RECEIVED BY: DONNA M. OTTO REGISTER OF WILLS DEPUTY REGISTER OF WILLS ~l~-~06 -~ COMMONWEALTH OF PENNSYLVANIA BUREAU OF INDIVIDUAL TAXES DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 286601 NOTICE OF INHERITANCE TAX HARRISBURG, PA 17128-0601 APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-1547 EX AFP (01-037 DATE 04-14-2003 ESTATE OF BRECHBILL EARL D DATE OF DEATH 11-18-2002 FILE NUMBER 21 02-1096 COUNTY CUMBERLAND FAYE SHELLY ACN 101 511 N LEWISBERRY RD Amount Remitted MECHANICSBURG PA 17055 MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS -/ _____________________ ------------------------------ -------------------------- ---------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX eeTeTG n~ BRECHBILL EARL D FILE N0. 21 02-1096 ACN 101 DATE 04-14-2003 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Neld Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9,007.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 1.073.00 00 080 11. Total Deductions (11) . 10. 37,353.00 12. Net Value of Tax Return (12) .00 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedu le Jl (13) 37,353.00 14. Net Value of Estate Subject to Tax (14) NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 ed to date and 19 will reflect figures that include the total of ALL returns . assess (1) .00 NOTE: To insure proper (Z) 5,134.00 credit to your account, (3) ,00 submit the upper portion (4) , 00 of this fora with your (5) 42,299.00 tax payment. (6) .00 (7) .00 ($) 47,433.00 ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due 3-03-2003 NUMBER /PEN PAID (-) (15) . 00 X (16) 37,353.00 X (17) . 00 X (18) . 00 X AMOUNT PAID TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE 00 _ .00 045= 1,681.00 12 = .00 15 = .00 (19)= 1,681.00 1,681.00 .00 .00 .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. pFREFUND.DSEEIREVERSECSIDEAOFATHISEFORM FOR)INSTRUCT ONS,DUE '~V.1500E),'6-JOI COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 w "' ~~(/) ,,0::< w"-" ",00 ,,0:-' "-" "- " 1/-I06....:J REV-1500 .......--- i)fHC!AL USE ONl,'1 INHERITANCE TAX RETURN RESIDENT DECEDENT FIL_ ..JMBER ~ L - --.tJ ,;z. COUNTY CODE YEAR ~-P1~_ NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) .6reehhlll E1/'1.D. E,LJ.J "' z w o z o "- '" W 0: 0: o " TELEPHONE NUMBER I- Z W C W o W C SOCIAL SECURITY NUMBER /rb - tJ? ?,?fl DATE OF DEATH (MM-DD-YEAR) Mv~kr /1". ::!t1t7:l.. (IF APPLICABLE) SURVIVING POUSE'S NAME (LAST, FIRST, AND MIDDLE NITIAL) .J)eae<1se cI THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER AlA - [Z;11 Original Return D 4. Limited Estate [l,,}( Decedent Died Testate (Attach copy of Will) D 9. Litigation Proceeds Received DATE OF BIRTH (MM-DD-YEAR) ;:eb/'Ut://' l' /'/11' o 2. Supplemental Return o 4a, Future Interest Compromise (date of death after 12-12-82) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) D 10. Spousal Poverty Credit (date of death betwsen 12-31-91 and 1-1-95) D 3. Remainder Return (date of death prior to 12-13-82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 1. Real Estate (Schedule A) (1) M72L 2. Stocks and Bonds (Schedule B) (2) jI .1;/-.3 f' 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) AIu-7ll. 4. Mortgages & Notes Receivable (Schedule D) (4) M7IIl 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) #~:L .:?<f? (Schedule E) , Z 0 6. Jointly Owned Property (Schedule F) (6) ..(JDJf.L !;;: D Separate Billing Requested ...J (7) #' I7ZIL- :J 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property I- (Schedule G orL) c:: Total Gross Assets (total Lines 1-7) <( B 0 9. Funeral Expenses & Administrative Costs (Schedule H) (9) " ~ M1' w II:: (10) #- -j t17J 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) COMPLETE MAILING ADDRESS J11 I\/, /..etA//:.skrr; ~ad /'1ea.-han/ (!,.:5' LuifJ:/ r?4 /7 as5 - ,hCY 7 Ll (8) J1 fI-'7. ~33 , -f ~ 353 (11) /tJ. tJ$'O - (12) ...37,S5E (13) A/nu'_ (14) J7. 35..3 , x.O_ (15) ,.0K (16) ,(I 167/ x .12 (17) x .15 (18) (19) '/;, 7/ 13. Charitable and Governmental Bequests/See 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 z o ~ I-' :J a.. ::E o o ~ 15 Amount of Line 14 taxable at the spousal tax rate, orlransfers under Sec. 9116 (a)(1.2) 16, Amount of Line 14 taxable at lineal rate 17. Amount of line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: E./2 .t1recAb;/1 {E ar/ LV STREET ADDRESS , CITY 'ye.- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) #/6J'7 Alp" AJ,."L. Total Credits (A + B + C) (2) 7'k,,,, 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty ( D + E ) 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 A/"1/L. Ainu ~ B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) 4. 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. Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS [IT: ~ r;y ~ 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 propelty transferred or its income;.. c. retain a reversionary interest; or... d. receive the promise for life of either payments, benefits or care?.. . 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ..... . .............. ... D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?.. .......... 0 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . Yes ........0 ..........0 ...........0 ......0 .............0 IlY 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 preparer other than the personal representative is based on all informalion of which preparer has any knowledge DATE ~/ <27/~.E , SIGNATURE OF PEI)SON RESPONSIBLE FOR FILING RETURN -m~ ~-~ ADDRESS ~ ' f// n)(~~.. ~;~~~ SIGNATURE OF PREPARER OTHER THA EPRESENTATIVE .-#/ /705S 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. 99116 (a) (1.1) (i)1. 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. 99116 (a) (1.1) (ii) The statute does not exemDt 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 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 natura! parent, an adoptive paren or a stepparent of the child is 0% [72 P.S. 99116(a)(1.2)J. The tax rate imposed on the net value of transfers to or for the use of the decede ' ineal beneficiaries is 45% cept as noted in 72 P.S. 99116(1.2) 172 P.S. 99116(a)(1)]. The tax rale imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as al individual who has at least one parent in common with the decedent, whether by blood or adoption. , , REV.''''''''''''. COMMONWEALTH OF PENNSYLVANIA lNHERlT ANCE TAX RETURN RESIDENT DECEDENT ESTATEOF ~ ".&, [t!;,.9;) ~~ SCHEDULE B STOCKS & BONDS FILE NUMBER .:z/-O.;Z- /O~~ All property jointly.owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. ~~ # / -' .:2.- dr7 # .3 ~/-I-.;;1.... ~#f ~-#5 C7y c# ~ VALUE AT DATE OF DEATH DESCRIPTION ~...d ~- CLJe!. A!v.c..>:r ,r-'U/>d;s ra/'ped E iI'u../+ / IW->d A Ae('~ 74'- Se;o 7:1-.$ 06/,;;1- ~'I I/o< '/"C@ ~ # ~C1 //.y- 6/0 due -k ~~ A~ trf.....c&~ ~ ////9'/0.:2.l ~ ~ ..b'~7'3d. ~...077- 9~/r?..2 ~# SCTJ 7~t:J6/2 riff ' , ~ ~ ~/.J. ~.:J dn I///d.;l. z;{.Ut,,- ~ " OTl- ~,/odL . d-r- /.;J/3I /~ '7. tJ 9'0, ?S J S. &./..3, 6~- ~ ..5-: O.f'f. /0 ~ ~ ~ -# ~ ::;z:;- \.302? 7~..3 CJ.6/,;L ~ //';;'=/AS ~~..d 7~ It' _-n/'~..vD ~ c7ccC: GO 7-<./~ ~ r'o. ~.u~~~rr .# -3; /..3';. 9'tJ TOTAL (Also enter on line 2, Recapitulation) $ ~ /-9..3, f'tJ (If more space IS needed, insert additional sheets of the same size) 'REV.!5OfJE;<:{1.97) '* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 7S~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATEOF t!Jue.4 Ce-4) FILE NUMBER .;2/- C?;;2. -/Of?p Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointty-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. ~ ..1. -f( J: ~ z ;-: DESCRIPTION ~'lI--~~q~ .xk~~-z:k-,/~/u~~ 7~~;::~~~.;e~ ~~7-~/~.7 ~/~? ~ 7'~7,;t ~.?~; -rV<Z"~ ~ 7?UcA-01-v7<-u-U4~ .:z~~ ~J ~~J_ ~L:.-J: --<<./~ ~~ - ~~ y~~ &.a..h -<:17'- '7"L...A--t::L- ~~_~~ #- /,:IN&'?6/~~ c;0ni)AJ7 ~ -tr?l ////?/o.;Z. 4- ~~ Y3..4./2Au/ 7Y? C': xt:-~ft7 ~~7 ~ /"'A /7'oss ~.L.~~~~U"~ /'l"/'l"'azz;:.- ~ ~zC ,#- /cJ?.;z/,{, 3fi)~ UU~~-~~ A2'~rr /9/.5 ~.~/L_ ~ ~>-d'a.... ~ ~.4/Z ~ ~ . ~~~f'~' ~.u~ .~d::#_ .3.:3.y 7' ~ ~'/2:-~- ~ o&t~;o.;ol 7f' ~ -&-y dt~~ ~A /;7tJ.:z..7 ~ C"7"2- ;Z//+Y/J..3 JflA:.Ur~Y:Ja,zUL ~ ~~ ~ c::z;~ ~~ --';L ~ 794 C2cd-.# 6 7.:ZcJ.3 -....a~'-AJ 7f'J+W ~ ~ /.;2/ q <h'2. TOTAL (Also enter on line 5, Recapitulation) (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH ~ '#/.:<5;,:J'tl .:? .y't0,nJ ..1. / Sl), tTtJ 7! ~~. t1tJ ...5:' 9Y';z?' /,f' . #'7,1"5': 71' ~ ra. 6o,:MJ'O ') l~ /J'f'dV $ 7. ~ /5"..3. ;-3 :I # , S; 997, /7 $ fI';;Z .,;;1.f'9, a.s- REV.15n'X'I;"'. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RE1URN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF E ~/ 1), C E:PJ l3redi6/ II FILE NUMBER df/ tI.;l /1:71'6 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. .a, 1i1-a~"r/ dvu~ ~:? ~Z1 ~,/70S5 ~ #J"~?'/. ,jl) au~ ~ -Z:::..u~.~- 'iUd /~;2~ J ~ .%~0~-,hA! c;.:>-~=- , ( ;(, , /~.s; t1~ .G ar - ,Zl.I~ c.r...u~ -' 2 ~~ ~ .<: - /.,gy; ~ .4, ~ .utLk-2 ~J~~ .. AJ' /?7. 61' -L. ~.~~<~ Qt ~;L:!:f.~~ .. . /6'0, rt? B. ADMINISTRATIVE COSTS: 7'/t'71L- 1. Personal Representative's Commissions Name of Personal Representative (5) Social Security Numbe~s) I EIN Number of Personal Representative(s) Street Address City Stal. Zip Year(s) Commission Paid: 2. Attorney Fees 7&7lL-- 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 probateFees-~~ .~~ Jer'F",d' , 4. ~ 9,6;,,~ ~ *~ ~ .n2-~ 5. Accountant's F 5 J ~ 6. Tax Return Preparer's Fees ~~~~y ~; ;44 6- ~,?p 7. TOTAL (Also enter on line 9, Recapitulation) $ ~OCJZ~ (If more space IS needed, Insert additional sheets of the same Size) REV-15ItEX-(1-91) ~ ~ SCHEDULE I COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INH~~;:~~~i DTtc"E:~~RN MORTGAGE LIABILITIES, & LIENS ESTATE OF . ~-.J) Cc. /}.J 7S~ '72nu- FILE NUMBER ~/-~,;f- /O?~ Include unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION .1, ~?"~ 7".3d.e) ~~---:7ld- ~ ~ /a:dO /*0/',</..2 ~ /.0//1/"",,;2..- v# /0/ AMOUNT /. " 9-.:5"9 ..1, /r. ,.IS' v':# /~02- .3. ~<UJ'aA.) ~;6'nu..d. ;t3.LD ~~ /c:0'I/"'<b4 #/a3 S. ~.s;dO ~ tl:Z:4...Y~ ~-0~ ~~ 7"~ ~ /nJ.dV ~ ~ .::::$-~.:z::J J: ~~-J~-~.<D---dR~ ~ /().~ TOTAL (Also enteron line 10, Recapitulation) $ / O;/d4 ?:;?' (If more space IS needed, Insert additional sheets of the same size) REV-1513EX +'{1-g71 SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERI1 ANCE TAX RETURN RESIDENT DECEDENT ESTATE OF r c-tV'I..D NUMBER I. ..3, f. (E;Lf) ~/'t:!e./w//I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 ..::rA, ~/( /OS\3/ Nd;'~ Il~ XL'I /9,,/7 #,uf/and 01./711- /~ Lee/a- lIerr cY..31'lJ uhd<e /?oak... /6'1 /'I~e!JJtJfl-lt!S ,bur! 'l Ohto /A3tJ-'I-'I H!~ &d'i ~/I III Uh.//..s-be./'''7_. Road /'-I~c-IItVv'C!.s "''7 ' 'Y.;"l /70SS FILE NUMBER aJ'-CJ;;:<'- /07'':;' RELATIONSHIP TO DECEDENT Do Not Ust Tmsteols) Sn- D~ D~e/' .J)~ AMOUNT OR SHARE OF ESTATE f/E~ -t /ErJ ~/Erd -t/cr~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTiONS SHOWN ABOVE ON LINES 15 THROUGH 17, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE ...2 CI>ar If> -He.. Vv/1i-le.. /d,5" WA;~ '-lflrd.- ..Dr/'YE- Gw'/./;rd cr CJM(3 'I J 1. 47<-L- B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 AJc7T'-L- TOTAL OF PART II. ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (it more space is needed, insert add~lona' sheets of the same size) Page 1 of 4 e~1 CDC NY~~TFuNDSSM INVESTMENT SUMMARY July 1, 2002 to September 30,2002 (~), ~~Jr Personal Access] _ine,j{ 8()()-225-5478 CI~) CDC IXIS Asset Management Distributors 0009072-0030712 209l'111S67ROOOTNEN y___ (press I for iuformation 24 !tours a d'IY) a www.cdcnvestfunds.com 1",111,..111.."1,1"1,1,,,1.111...,,.11.1,1...,11.1.1,1,,1,1 FAYE SHELLY POA EARL D BRECHBILL 316 MESSIAH VILLAGE PO BOX 2015 MECHANICSBURG PA 17055-2015 Your Representative: Allen W Carr Sit Mmlluvcslors Services Inc. Wesl Shore Office etf SIC 303 214 SemIte Ave Camp Hill PA 17011-2336 Portfolio Overview News and Information Beginning Value Additions \Vithdrawals Change in \/aluc $6,809.49 $0.00 $0.00 -$1,125.84 Market volatility can shake the confidence of any investor, but in times like these, itls importmlt to stay focused. Look to the new edition of Fllmlielterfor six time-tested strategies that can help you manage volatile markets. Ending Value $5,683.65 Portfolio Summary Fund Name ::md ~Umbf"l IkginOlng Change I:lldmg Account Number Value \ddltions W'ithdrawals lt1 Value Value Targeted Equity Fund A (3 1 ) 3007930612 $6,809.49 $0.00 $0.00 -$1,125.84 $5,683.65 -----:-p.,.., (~5,683.6:.;' Total $6,809.49 $0.00 $0.00 -$1,125.84 Asset Allocation as of 9/30/02 Non-retirement Accounts Asset Cl.tss/llIud N.tme !\hrJ...,ot V.dut, 100% !3 Domestic Equity Targeted Equity Fund A 0% IL.J Global & Ioternational Equity OOAl ~ Income 0% 0 Tax Free Income 0% WllWI Money Markets $5,683.65 Total Portfolio Value $5,683.65 Page 2 of 4 ~I CDC NVE~lFUNDSSM CDC IXISAsset Management Distributors @ Historical Fund Performance Average Annual Returns (Please refer to the section entitled Information About Historical Fund Performance) 1-6 Fund Name ''TD I) 0 1 yr OIl) S yr (~I) 10 yr (\;0 1 yr \l/o 5 yr nil) 10 Yl I) I) *SHln'llH;cptlOlI At Net Asset Value At Maximum Sales Charge Targeted Equity Fund A -19.85 -5.72 -1.32 8.36 -11.21 -2.49 7.72 11/27/68 Fund Transaction Detail Targeted Equity Fund A FAYE SHELLY POA EARL D BRECHBILL Account Number 3007930612 Just a reminder, if you haven't already voted your proxy statement for the CDC Nvest Targeted Equity Fund, you may vote by either returning your proxy card or by visiting www.cdcnvcstfunds.com. Trade Transaction Transaction Share Shares This Shares ~larket Date Descnpuon Dollar Amount PrIce Transaction Owned Value Beginning Balance No Activity $7.50 907.932 $6,809.49 Ending Values as of 09/30/02 $6.26 907.932 r:fs;6S3.V More Information from CDC Nvest Funds If you're not already investing in the CDC Nvest AEW Real Estate Fund, talk with your financial advisor about the potential benefits of diversifying your portfolio with a fund that invests in the securities of the real estate industry. It's an asset class that ha.s performed independently of stocks and bonds, making it a solid diversification tool in volatile markets. Because the fUlld invests in reilJ estate investment trusts (REITS), it is sub\ect to th.... ri..ks of the red ......tate m\l.rkets, includi.ng Huc'-u~ting property values, changes in inlen:st rates, property values, and other mortg.age-relnted risks. Beca-use the fund invests primarily in securities of one industry, it may lovolve more risk tha11 more diversified iunds. Page 1 of 2 eclCDC N~2TFuNDSSN' INVESTMENT SUMMARY January 1, 2002 to December 31, 2002 (j) CDC IXIS Asset Management Distributors 11.'"...~l '(;>4'>' Ft" Personal Access LineCilJ 800~225-5478 (press 1 for information 24 hours a day) 001382.3-0041102 2011885678000 TNE N yyy~ Ct ~ www.cdcnvestfunds.com 1,.,111.,.111.,..1,1,.1.1,.,1,111.",..11.1,1",.11.1,1,1..1.1 FAYE SHELLY POA EARL 0 BRECHBILL 316 MESSIAH VILLAGE PO BOX 2015 MECHANICSBURG PA 17055-2015 You.. Representative: Allen W Carr SR Mml Investors Setvices Inc. West Shore Office Or Ste 303 214 Senate Ave Camp Hill P A 17011-2336 Beginning Value Additions Withdrawals Change in Value $7,090.95 $0.00 $0.00 -$2,042.85 News and Information Look inside. Fumitetter for an insightful perspective on last year!s market volatility. Read the cover story that details how the economy, the stock market and fixed-income market fared in 2002. Also, please keep this statement; it might be useful when you prepare your 2002 tax forms. From all of us at CDC Nve" Funds, Happy New Year! Portfolio Overview Ending Value $5,048, I 0 Portfolio Summary I'und Name and Number BeglOning Change Ending Account Number Value Addlhons Withdrawals in Value Value Targeted Equity Fund A (31) 3007930612 $7,090.95 $0.00 $0.00 -$2,042,85 $5,048.10 Total $7,090.95 $0.00 $0,00 -$2,042,85 ---~ ~ Asset Allocation as of 12/31/02 Non-retirement Accounts ,\......et CI.\ss/hIllJ N.unc I\t.uket V.lIue 100% 8 Domestic Equity Targeted Equity Fund A 0% Ittl Global & International Equity 0% ~ Income 0% r:-:I Tax Free Income 0% illI Money Markets Total Portfolio Value $5,048.10 $5,048.10 Page 2of2 0013823_0041103 {iJ ~I CDC NVE~TFuNDSSM ._1.h:". CDC IXIS Asset Management Distributors Historical Fund Performance Average Annual Returns (Please refer to the section entitled Information About Historical Fund Performance) 1-6 Fund Name YTD {)~l 1 yr OIl) 5 yr 110 10 yr 0'-;1 1 yr ();{/ 5 yr <I II 10 Yf II <) *Sincl' Jnn-ptlOll Targeted Equity Fund A Fund Transaction Detail Targeted Equity Fund A FAYE SHELLY POA EARL 0 BRECHBILL Al Net Asset Value At Maximum Sales Charge -28.81 -28.81 -2.64 6.44 -32.93 -3.79 5.82 11/27/68 Account Number 3007930612 Check out the "Newsroom n section of Fundletter to read about your portfolio managerts recent press appearances. $5.56 907.932 ~i5.048.~ Ending Values as of 1213 1/02 More Information from CDC Nvest Funds Have you visited our award-winning website lately? Log on to www.cdcnvestfunds.com or read the enclosed Fundletterto see what you have been missing. Continue Investing with CDC Nvest Funds Invest without writing a check ~ a Personal Access Line@ 800-225-5478 (press 1 for information 24 hours a day) www.cdcnvestfunds.com FAYE SHEllY POA EARL D BRECHBILL .lt6 MESSIAH VIlLAGE PO BOX 2015 MECHANICSBURG PA 17055-2015 D Check box and fill our reverse side for address change .l d \ccount [m-e"tmcfli IRA 'un '\Jumbcf unounl LIX Yem 1:'!,,!!:~I~e,t:l'l~l'Y!'~!'<lAJ~n 3007930612 N I A ;!::,!:::::;:::::::::::,::.,,:,::;,;:::,:::::,<~?~{t:tIft\/t{){ttJitt:!:!t)}}]{((f~rt;/~i!It\ttr)tti(jtrH??::)}:{t::t:t:JiiJ{:i~::}{}{i~~ri:}:}::;::\:::::::::::"':.,.,.',-.- Make your checks payable to: CDC Nvest Funds PO Box 8551 Boston MA 02266-8551 Amount of CheCk .1 $100.00 minimum investment per fund No third party checks 0000000000 11 00000030079306129 13111500001820000031 9 Page 2 of3 CDC lXIS Asset Management Distributors NEW ACCOUNT STATEMENT January 22,2003 ' Personal Access Line@ ~--;1 800-225-5478 t:'~1 CDC ~~~STFuNDS'M (press 1 for information 24 hours a day) OOOOOU-OO~:101 www.cdcnvestfunds.com 1",111",111""1,1"1,1"11"/1",,,,111,1,,,,,11,,,11,1,,11 FAYE SHELLY EXECUTRIX ESTATE OF EARL 0 BRECHBILL 511 N LEWIS BERRY RD MECHANICSBURG PA 17055-6019 Your CDC [XIS Asset Mngmt Distrib. LP Repre$entative: Attn: Patti Reilly 399 Boylston St Fl 9 Boston MA 02116-3305 News From CDC Nvest Funds We ate excited about the opportunity to meet your investment needs. Thank you for choosing CDC Nvest Funds. Targeted Equity Fund-A (31) Account Number 300114610 Trade Dollar Share Shares This Total Date Tlansaction Amount Pncc Tlat1saction Shares 01/21/03 01/22/03 ~ ---- , Transfer From 3007930612....-;:> e1Address Change $0.00 $0.00 $0.00 $0.00 907.932 0.000 907.932 907.932 Account Features and Service Options . Your account is established in the following name(s): FAYE SHELLY EXECUTRIX ESTATE OF EARL 0 BRECHBILL . Your Tax Identification number is: 01-6223120 Your address is: 511 N LEWISBERRY RD MECHANICSBURG PA 17055-6019 Your account is set up to reinvest dividends and capital gains. The registration listed below has been changed to reflect the following information: Old Registration: FAYE SHELLY EST ESTATE OF EARL 0 BRECHBILL 511 N LEWISBERRY RD MECHANICSBURG PA /7055-6019 New Registration: FAYE SHELLY EXECUTRIX ESTATE OF EARL 0 BRECHBILL 511 N LEWISBERRY RD MECHANICSBURG PA 17055-6019 In the event of an address change, a confirmation letter will be sent to your old address to ensure that our records are correct. Also for your protection, if you redeem shares in the next 30 days, you may be required to provide additional information. " Page 1 of1 e.r;;) I CDC NVES;rFuNDSSM CONFIRMATION STATEMENT January 23, 2003 0000565 - OOllO;5~ ~ a Personal Access Line@ 800-225-5478 Q CDC IXIS Asset Management Distributors (press 1 for infomlation 24 hours <l day) 1",111",111""1,1"1,1"11"11",,,,111,1,,,,,11,,,11,1,,11 FAYE SHELLY EXECUTRIX ESTATE OF EARL 0 BRECHBILL 511 N LEWISBERRY RD MECHANICSBURG PA 17055-6019 www.cdcnvestfunds.com Your Representative: CDC IXIS Asset Mngrnt Distrih. LP Attn: Patti Rcillv 399 Bovlston si PI 9 Boston'MA 02116-3305 News From CDC Nvest Funds Make OUf website yours. CDC :t'\vest Funds has lots of useful tools and information to help you manage your investments. Look inside to learn how easy it can be. Targeted Equity Fund-A (31) FAYE SHELLY EXECUTRIX ESTATE OF EARL 0 BRECHBILL Account Number:fOOI1461Q) Trade Dollar Share Shares ThIs Total Date Transaction ~\mount Price Transaction Shares ~2/01 o 2/03 Service Char e Shares Redeemed by Wire $5.00 $5,133.90 $5.66 $5.66 0.883 907.049 907.049 0.000 . Continue Investing with CDC Nvest Funds y.".ii>. ',' ," " ", .... .... .~ a Invest with~ut writing a check Personal Access Line@ 800~225-5478 ;>(p,ressl foririforinat:ion 24 hours a day) \1 COUn! Ymcslmem IR \ I'und Numbcl .\motlot lax\car "'". 300114610-6. N/A Targeted Equity Fund-A (31) www.cdcnvestfunds.com Faye ShellY Executrix Estate of Earl 0 Brechbill 5 II N Lewisberry Rd MechanicsburgPA 17055-6019 D,.\.'Cbe(*~ox, and AA out reverse side for aHdress change Make your checks payable to: CDC Nvest Funds PO Box 8551 Boston MA 02266-8551 Amount of Check I I $100 minimum investment per fund No third party checks 0000000000 11 00000003001146106 13111500001820000031 9 LAW OFFICES BRINSER, WAGNER & ZIMMERMAl'< 6 EAST MAIN STREET - SECOND FLOOR (EAST MAIN & SOUTH RAILROAD STREETS) P. O. BOX 323 PALMYRA, PA 17078 PHONE, (717) 838-6348 FAX, (717) 838.6912 GERALD J. BRINSER KEITHD.WAGNER JOHN M. ZIMMERMAN December 31,2002 Ms. Faye Shelly 511 N. Lewisberry Road Mechanicsburg, PAl 7055 Payable to BRINSER. WAGNER & ZIMMERMAN PROFESSIONAL SERVICES RENDERED: Office conference in reference to father's financial matters. TOTAL AMOUNT DUE $100.0,2 THANK YOU (i) MECHANICSBURG OFFICE MESSIAH VILLAGE 100 MT. ALLEN DRIVE MECHANICSBURG, PA 17055 PHONE/PAX (717) 795-1737 l~oP J'I' Malpezzi Funeral Home 8 Market Plaza Way Mechanicsburg, P A 17055 (717)697-4696 December 27,2002 Faye Shelly 511 N. Lewisberry Road Mechanicsburg, PA 17055 ~f The Funeral Service for Earl D. Brechbill We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT, AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS. I. PROFESSIONAL SERVICES Services of Funeral Director/Staff . 3. AUTOMOTIVE EQUIPMENT Out of town transportation . . . . . . . . . . .. .. _ FUNERAL HOME SERVICE CHARGES m~ 03p/,5J .1'. f'I.j SELECTED MERCHANDISE: , ~ Poplar Casket . . . . . {~. ?:yf . . .1'. #'117. Burial Vault . . . . . ( . ~'. . .~;; . . 1'. ,iI'!..;, . Register, Memorial Cards. Ackn. . (~"""'-:- ./%..fi I) . . 200 additional memorial folders ............. Laminated Obituaries, . " ............. THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE THATYOUHAVESELECTED . . . . , . . . . . . . . $6705.00 AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, WE ADVANCED CERTAIN PAYMENTS TO OTHERS AS AN ACCOMMODATION. THE FOLLOWING IS AN ACCOUNTING FOR THOSE CHARGES. CASH ADVANCES Opening Grave. . . . . (m~ 1,/0). Cemetery Equipment. . . . (.". . . f'../) . Newspaper Notices ~ Local. . (':u. . . W . Clergy/Mass Offering. . . . . . . Organist Donna Martin. . . . . . C(:,rtified Copies of the Death Certificate . Flowers. . . . . . . . . Soloist Bonnie Boyd . . . . Assisting Clergy Steven Munger . Pianist Saundra Wingert Rev. Burgard. . . . Antrim Cafeteria Workers Eber Wingert Video. . TOTAL CASH ADVANCES AND SPECIAL CHARGES. CONTRACT PRICE . . . . . . . . . . . . HISTORY 12/05/2002 Weaver Funeral Home $3260.00 $570.00 $3830.00 $1765.00 $955.00 $45.00 $50.00 $60.00 TOTAL AMOUNT DUE $440.00 $95.00 $226.80 $170.00 $75.00 $20.00 $220.00 $50.00 $100.00 $25.00 $50.00 $100.00 $50.00 $1621.80 $8326.80 -..i!s:P1)~ ;:-599717 i! a<7 I~ /l!!) $2329.63 C..."J,'f 3',,14"'<.<- Due. - .J~.Co .' Z2.9~.{,p3 " ". .. ;:?<.J 'l" Q II 12C 7/fooz... 9;J7gp RECEIPT FOR PAYMENT ------------------- ------------------- dry/f/ Cumberland County - Register Of Wills Hanover and High Street Carlisle, PA 17013 Rece~pt Date Rece+pt Time ReceJ.pt No. 12/05/2002 11:24:52 1031319 BRECHBILL EARL D File Number 2002-01096 Remarks FAYE SHELLY JA ------------------------ Distribution Of Receipt ------------------------ Transaction Description Payment Amount Payee Name PETITION FOR PROBA EXTRA PAGES SHORT CERTIFICATE JCP FEE 70.00 6.00 9.00 10.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D Check# 1911 Total Received.. .... .,. $95.00 $95.00 Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 12/01/2004 SHELLY FAYE 511 N LEWISBERRY ROAD MECHANICSBURG, PA 17055 RE: Estate of BRECHBILL EARL D File Number: 2002-01096 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) 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 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 will become delinquent on: 11/18/2004 Your prompt attention to this matter will be appreciated. Thank You. GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge Cumberland County Reglster ur Wl~~~ One Courthouse Square Carlisle, PA 17013 Phone: (717) 240-6345 Date: 10/11/2005 SHELLY FAYE 511 N LEWISBERRY ROAD MECHANICSBURG, PA 17055 RE: Estate of BRECHBILL EARL D File Number: 2002-01096 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) 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 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: 11/18/2005 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, 4ub_~~ GLENDA FARNER STRASBAUGH REGISTER OF WILLS cc: File Counsel Judge L-if Register of Wills of Cumberland County STATUS REPORT UNDER RULE 6.12 Name of Decedent: E;qo/ D, 23re(1h/)/ /1 Date of Death: ~v~r II} ~17~_ Estate No.: df(t't:7~- ~/~ ?~ 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 ~h}ther administration of the estate is complete: Yes 1M No 0 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lfthe answer to No.1 is Yes, state the following: a. Did the person':!.J,epresentative file a final account with the Court? Yes 0 No 1kj b. The sep~rate Orp9~s' Court No. (if any) for the personal representative's account IS: ~ c. Did the personypresentative state an account informally to the parties in interest? Yes 1.11 No 0 c. 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. Date: ?lP~- /6 .5lf)t1.:!J j .~ :f~/7' SIgnature 11 F7~ ~~/~ Name C") r.., ~ fit N. 1cWi.s1w-Z -;(lacl Address NecAcwt!S tr'?;1 .r'A /7oS'S 7/7-691' -/oS'"S" Telephone No. Capacity: rnPersonal Representative o Counsel for personal representative C'>.J -~. ('oJ if) , II ,