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Home My WebLink About04-1157HOWELL C. METTE ROBERT MOORE CHARLES B. ZWALLY PETER J. RESSLER LLOYD R. PERSUN JAMES A. ULSH DANIEL L. SULLIVAN JEFFREY A. ERNICO KATHRYN L. SIMPSON ANDREW H. DOWLING MICHAEL D. REED PAULA J. LEICHT GARY J. HElM THOMAS F. SMIDA JOHN F. YANINEK* VICKY ANN TRIMMER TIMOTHY A. HOY JAMES M. STRONG METTE, EVANS & WOODSIDE A PRO~J~tSION~L OOI~POI~A~ION AT~01~N-~YS AT LAW 3401 NO1;/TH ]~/ONT ST]~-EET P.O. BOX 5950 HA~I;LISB~Go PA 17110-0950 IRS NO. 23-~985005 ~T ,~HOIN-E ]~AX ~ ~8~ (~ ~16 b~p:I/wwW, m~e.c0m MATTHEW E. HAMLIN** KATHLEEN DOYLE YANINEK JENNIFER A. YANKANICH RANDALL G. HURST* MARK D. HIPP RONALD L. FINCK AMBROSE W. HEINZ JAMES H. MCELWAIN~ JR. OF COUNSEL JAMES W. EVANS MARYLAND BAR ~* NEW YORK BAR Glenda Farner Strasbaugh Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 December 15, 2004 Re: Estate of Vivian E. Brensinger Dear Ms. Strasbaugh: Enclosed is an original Oath of Subscribing Witness form signed by Attomey John T. Forry. The Will, petition for letters and related probate documents are already in your office and the Executor has already been sworn in. Please proceed to probate the Will and issue Letters Testamentary. Please mail the Letters and Short Certificates to the attention of Jeffrey A. Emico, Esquire of this office. Please do not hesitate to call with any questions. Thank you for your assistance. Very truly yours, Lisa J. Kno0e~ Paralegal to Jeffrey A. Ernico LJK: Enclosure cc: Terry L. Brensinger, Executor Jeffrey A. Emico, Esquire 412821vl Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of Vivian E. Brensinger also known as , Deceased No. .~.\_q:~_ ~c~ Social Security No. 192-20-4129 Petitioner(s), who is/are 18 years of age or older apply(ies) for: COMPLETE "A" OR "B" BELOW:) [] A. Probate and Grant of Letters and aver that Petitioner(s) is the executor named in the Last Will of the Decedent, dated January 20, 1998 and codicil(s) dated NONE Decedenrs spouse, J. Gordon Brensinger, predeceased her on July 14, 2004. Decedent's daughter, Carol S. Brensinger, predeceased her on February 6, 2000. Decedent's son, Barry L. Brensinger, signed a Renunciation on December 7, 2004, renouncing his right to serve as Executor and requesting the appointment of Terry L. Brensinger as sole Executor. State relevant circumstances, e.g., renunciation, death of executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not the victim of a killing and was never adjudicated incompetent: [] B. Grant of Letters of Administration (c.t.a., d.b.n.c.t.a.: pendente lite; durante absentia; durante minoritate) Petitioner(s) after a proper search has/have ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Relationship Residence (COMPLETE IN ALL CASES:) Attach additional sheets if necessary. L. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or princ'iPal residence at 918 Aspen Avenue, Messiah Villa.qe, Mechanicsbur.q, Upper Allen Township, Cumberland County, PA (list street, number and municipality) Decedent, then 7'7 years of age, died November 15, 2004, at Messiah Villaqe, Upper Allen Township, Cumberland County, PA (Location) Decedent at death owned property with estimated values as follows: (If domiciled in PA) All personal property ................................................................................ $ 198,000 (If not domiciled in PA) Personal property in Pennsylvania ............................................ $ (If not domiciled in PA) Personal property in County ...................................................... $ Value of real estate in Pennsylvania ................................................................................................... $ 20,000 Total ..................................................................................................................................... Real Estate situated as follows: Zionsville, Lehi.qh County1 PA Wherefore, Petitioner(s) respectfully request(s) the probate of the last Will and Codicil(s) presented with this Petition and the grant of letters in the appropriate form to the undersigned: ...../ ~ j~) Signature Typed or printed name and residence I .~///.¢//_~..~)/~/~.~.~ I Terry L. Brensinger 838 Division Street, Grantham, PA 17027 Form RW-1 Page 1 of 2 (Dauphin County - Rev, 9/92) Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner(s) above-named swear(s) and 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 representative(s) of the Decedent, Petitioner(s)will well and truly administer thee. state ac. cording to law. Sworn to and affirmed and subscribed --/ before me this ~.'~ day of DECREE OF REGISTER Estate of also known as Vivian E. Brensinger, Deceased Social Security No.: 192-20-4129 Date of Death November 15, 2004 AND NOW, '~~ ~',"~ ,20 %~, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, __ IT IS DECREED that Letters [] Testamentary [] of Administration are hereby granted to Terry L. Brensin,qer (c,t.a,; d,b.n,c.t; pendente lite; durante absentia; durante minodtate) in the above estate and that the instrument(s), if any, dated January 20, 1998 described in the Petition be admitted to probate and filed of record as the last Will of Decedent. FEES Letters .................................. $ Short Certificate(s) ............... $ Renunciation ........................ $ Affidavit ( ) ......................... $ Extra Pages ( 3' ) .................. $ Codicil .................................. $ JCP Fee ............................... $ Inventory & Tax Forms ........ $ Other .................................... $ $ TOTAL .................... $ "5 A"~-. Register o~ Wills '%, ~ Attorney: Jeffr..ey'A: Ernic~ Esquire I.D. No.: 0798;J ~:" 3401 North Front Street Address: Harrisburg, P,~-~7110-0950 Telephone: 717-232-5000 -~ DATE FILED: Form RW-1 Page 2 of 2 (Dauphin County - Rev. 9~92) 412155vl 12/09/2004 13:04 6108323791 ~ETLIFE PAGE REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUB$CRIBINO WITleSS ~ ~r,4 Tpdd R. Ockovic , (each) a subscribiug witness to th~ La,~ Will ~d Test~'~t da~ed January 20, 1998, presented herewith, (each) baying b~ri duly qualified ~ccofdi~ to law, depose(s) ~td say(s) that they were preseut and saw Vivian B. Brensingcf, tBe T estatr~ sign the sarnc wd that they si~ned as a wimes$ at the request of Tcstatt'ix in her presence and in the presence of each oth~. Sworn to or af//rmed and subscribed bet~orc me this ~ day of ~) ~f Cj ~'c.~, T, l~,, Z ~, ~ 0 0 y _,2004. :~40_Court Str-.x~ P.O. Box.~42. Reading. PA 1960_~_ For t~e-Re~f,t~r A I~ Todam Oc~ (Nam) [ My uommission Expires Oec. 27, 2005 f (Address) Member, Penns~vania As.~Ja~n m~.~l~t~Ho~/~ .~ REGISTER OF WILLS OF CUMBE~AND COIYNTY0 OATH OF NON.SUBSCRIBING WIT1N~S$ ~'-~ D D ;~.t/~ ~ a ~ (each) a subscn'oer h~, (each) ~S b~en duly q~ acco~ to ~w, d~(s) ~ sa~s) ~st i~a~ ~iar ~ ~ si~ of Vt~n E, B~er, T~x of ~e ~t Will a~ ~t da~ I~ 20, 19~8 h~ ~ ~al beli~c(s) ~e si~am~ on ~e ~t Will ~d Testat da~ J~ 20, 1998 is in ~ ~~ of V~ B. B~i~ to ~e best of. ~ow~d~ ~d ~efi Sworn to or affirmed and subscn'bed before mc this _ _ clay of (Name) ..,2004. (Addr~s) FortheRegfs~r 412213vl (Address) Register of Wills of Cumberland County, Pennsylvania RENUNCIATION Estate of Vivian E. Brensinqer No. ~ - ~ ~, 5~ also known as late of Upper Allen Township, Cumberland County, PA , Deceased The undersigned, Barry L. Brensin.qer, Son (Relationship) (Capacity) of the above Decedent, hereby renounce(s) the right to administer the estate and respectfully request(s) that Letters be issued to Terry L. Brensin.qer Witness~'a~ ~,'4g~/$1~:1 this day of (Address) Sworn to or affirmed and subscribed befcl~ me this 7 day of _/)~,-, (~,,- ,2o o<,,'. My Commission Expires: (Signature) (Address) (Signature and seal of Notary or other of notary's commission. official qualified to administe~,t~t~!l.~ow, date of expiration notary's commission) 411993vl Form RW-4 (Dauphin County) - Rev. 9~92 NOTE: Renunciations executed outside of the Office of Register of Wills are required in some counties to be notarized. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE R~Pf{lJlJ!~wrcE TAX APPRAl~~i;rr',~IL~Nt'E L'~ DISALLOWANCE OF D~!lIt$ ilNO,ASS""SHENT OF TAX P 1'1 D~'T1i 5 ESTATE OF DATE OF DEATH , ~LE NUMBER , 'COUNTY ACN 09-13-2005 BRENSINGER 11-15-2004 21 04-1157 CUMBERLAND 101 APPEAL DATE: 11-12-2005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _ REv:is4'-Ex-AFP"io3:osi-NOTICE-OF-INHERITANCE-YAX-APPRAIsEKENT:-ALLowANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX VIVIAN E FILE NO. 21 04-1157 ACN 101 BUREAU DF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX te0601 HARRISBURG PA 17128-0601 2nnr; c::r.p I q '.."u '-'"~ I...... (', ......L JEFFREY A ERNICO METTE ETAL PO BOX 5950 HBG nr'-:L" '~ (':1 ESQ PA 17110 ESTATE OF BRENSINGER '* REY-lS47 EX AFP (06-05l VIVIAN E DATE 09-13-2005 If an assessment 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: IS. ABOUnt of Line 14 .t Spousal rat. (15) 16. A~unt of LIne 14 taxable ai Lineal/Class A rate (161 17. AlIOUI'lt of Line 14 et SibUng ...te 1171 18. A.uunt of Line 14 taxable ai Collateral/Class Brat. t181 19. Principal Tax Due D TAX RETURN liAS: I X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R.el Estate lSc:htocIul. A) 2. Stocks ~d Bonds lSc:htocIule B) 3. CloselY Held Stock/Partnership Inter.st (Schedule C) 4. "ortgages/Note. Receiv.ble (Schedule D) S. Ctlsh/Bank Deposits/Hisc. P.rsonal Property (Schedule E) 6. Jointly Owned Property ISc:htoclul. F) 1. Tr....sf.rs (Schedule G) 8. Total Assets APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ada. Costs/Hisc. Expenses (Schedule H) 10. Dabts/Hortgaga Liabilities/Lions ISchedul. I) 11. Total Deductions 12. Net Value of Tax Return 13. Ch8ritable/GovernmBntal Bequests; Non-elected 9113 Trusts 14. Net Value of Est.t. Subject to Tax NOTE: DATE OZ- 5-2005 06-30-2005 NUIIIIER CD004956 CD005514 INTEREST/PEN PAID I-I 6 1.58 .00 I ) CHANGED (1) (2) (3) (4) IS) 161 (7) .00 78.865.13 .00 .00 166.624.29 .00 136,464.56 (8) 00 = 045 = 12 = 15 = 119)= NOTE: To insure proper creell t to your aceo...,t I sub.it the upper portion of this for. with your tax pay.ent. 381,953.98 2....0:;>5 90; 357,928.03 .00 357,928.03 .00 16,106.76 .00 .00 16,106.76 16,106.76 .00 .00 .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN $1, ND PAYHENT IS REIlUIRED. /I / IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICR), YOU /lAY BE DUE\\ Ie" , A REFUND. SEE RFUFglC:.1: <l::Tru: ..r ........- --_.- --- (9) 110) 21,835.21 2.190 74 111) 112) 113) 114) I Schedule ,I) .00 X 357,928.04 X .00 X .00 X AHOUNT PAID 12,000.00 3,475.18 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE ~* hi, i?, 'o certify that the information here given is con'ectly copied from an original certificate Gl death dtrly filed with me as I.,)(..d 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. Fee for this certificate, $2.00 P 10758188 No. I Reglstra~" -1~ H105.140 Rev. 2/87 TYPE/PRINT PERMANENT BLACK INK I INFORMANT'S NAME (Ty~P¢inl) j~.. Dr. Terry L. Brensinger B~N°°°'°%%'~ c ...... [] ........... s,.,.~ _T COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH '. VCl~ ~[~t'~.~)~o~F' I" Female ,. 192 -- 20 -- 4129 '. Nnvpmh~r 1.~. .. Cumberland .. Mechamcsbur~ ~/~ ~ .... ~.o. ....... ,, WMte .... ~,, ...... ,.r.~> I School I m ~.~ I~ ........ ~ ...... I co~ I o ..... ~s~,~, .... Bus Bmver I-,. ansp. a 1,,. [,,. 1~ I I,,. ~do~ed OECEDENT'S MAILING A~ReSSiStr~.C,~n,~M,Z*C~e} IOECEOENT'S Pennqvl v~ni a ~ II~ M~h.~h.~ PA ~7n55 ~,,,,.o.) Cumberland .... ~,? ~ ,,. Matilda (Althouse) ]=~. ~.0. ~ox 5, ~rangham, P~ ~7027 ~,,,. Nov. 18, 2004 h,,. Milford Cemeterv b,,. Lehioh Coungv 18092 B HMA ,K K, R N FUNERAL m. FD-Ol1662-L ,,,.HOME: 225 Elm ~ree~, ~au~, DUE TO (OR AS A CONSEQUENCE 0~: DUE TO (OR AS A CONSEOUE NCE OF): DUE TO IOR AS A CONSEQUENCE OF): DATE OF INJURY TIME OF INJURY I$,q ,3,6,41 INJURY AT WORK? IDESCRIBE HOW INJURY OCCURRED. I REOISTRAR'S SIGNATURE AND NUMBER REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF SUBSCRIBING WITNESS c') John T. Forrv and Todd R. Ockovic , (each) a subscribing witness to the L~t Will ~m~ dated J~u~ 20, 1998, presented herewith, (each) having been duly qu~ified accordi~ , depose(s) ~d say(s) that they were present ~d saw Vi~ E. Brensinger, the Testatri~ the ~d that they si~ed ~ a witness at the request of Testatrix in her presence ~d in th~ence each other. ~' Sworn to or affirmed ~d subscribed ~~~ ~~... before me this /~ ~ day of (Nme) ~ ~,~ ,2004. ~40 Cour~ Streeg, P.O. Box ~42, Reading, PA 10~08 (Address) For the R~ NOTARIAL SEAL CAROLINE M KASPRZAK Notary Public CITY OF READING, BERKS COUNTY My Commission Expires Jul 5, 2007 Todd R. Ockovic (Name) 450 Plymouth Road, Plymouth Meeting, PA 19462 (Address) REGISTER OF WILLS OF CUMBERLAND COUNTY OATH OF NON-SUBSCRIBING WITNESS (each) a subscriber hereto, (each) having been duly qualified according to law, depose(s) and say(s) that is/are familiar with the signature of Vivian E. Brensinger, Testatrix of the Last Will and Testament dated January 20, 1998 herewith and that believe(s) the signature on the Last Will and Testament dated January 20, 1998 is in the handwriting of Vivian E. Brensinger to the best of knowledge and belief. Sworn to or affirmed and subscribed before me this day of (Name) ,2004. (Address) For the Register (Name) (Address) 412213vl LAST WILL AND TESTAMENT OF VlVIAN E. BREN$INGER I, VIVIAN E. BREN$INGER, of 1480 Butternut Lane, Macungie, Lehigh County and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament and do hereby revoke any and all Testamentary Writings by me at any time here- tofore made. ITEM 1. I order and direct my hereinafter named Executor to pay all my legally enforceable debts and funeral expenses as soon after my decease as conveniently may be done. ITEM 2. I hereby request that my funeral be conducted at a cost and in a manner commensurate with my estate and situation in life. ITEM 3. Ail the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wheresoever situate, which I may own or have the power to dispose of at the time of my decease, I give, devise and bequeath unto my spouse, j. GORDON BRENSINGER, provided he is living sixty (60) days after my decease. ITEM 4. In the event that my said spouse should predecease me or should he die within sixty (60) days after my decease, then, and in either such event, I give, devise and bequeath my residuary estate aforesaid unto my three children, BARRY L. BRENSINGER, TERRY L. BRENSINGER AND CAROL S. BRENSINGER, share and share alike, or to their issue, per stirpes, subject however to the following condition: In the event my daughter CAROL $. BRENSINGER so desires, I direct that she shall have the right and privilege to live in and occupy my one story ranch home with the two car attached garage, situate at 1480 Butternut Lane, Lower Macungie Township, Lehigh County, Pennsylvania, rent free, and have the use of all the household furnishings therein, under the condition that she pays all expenses covering the home, including the taxes, utilities and the repairs and general maintenance of said home. When my daughter no longer lives in my home, said property shall be sold and distributed to my residuary heirs as above provided. In the event any of my aforesaid children should predecease me leaving no issue surviving, then and in that event I direct that said child's share be distributed unto my surviving children or if deceased unto their living issue, as aforesaid. ITEM 5. I hereby nominate, constitute, and appoint my spouse, J. GORDON BRENSINGER, Executor of this, my Last Will and Testament. Should my said spouse be unable, unwilling or cease to act as such Executor, then and in that event, I hereby nominate, constitute and appoint my three children, BARRY L. BRENSINGER, TERRY L. BRENSINGER AND CAROL S. BRENSINGER, or the survivor of them, Executors in his place and stead. ITEM 6. I hereby request that, if available, the services of FORRY, ULLMAN, ULLMAN & FORRY, P.C. be retained in the settlement of my estate. IN TESTIMONY WHEREOF, I, VIVIAN E. BRENSINGER, Testatrix to this, my Last Will and Testament written on three (3) sheets of paper, have signed my name to each page hereof, and to this, the last page, have subscribed my name and affixed my seal this 20~ , A.D. nineteen hundred ninety-m~n day of (199~) . ViVIAN E. BRENSINGER ~] (SEAL) 3 SIGNED, SEALED, PUBLISHED AND DECLARED by the within named Testatrix, VIVIAN E. BRENSINGER, as and for her Last Will and Testament, dated LJ~/z~x?o ~99~ in the presence ~-us, ~ho~ at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses hereto. METTE. EVANS & WOODSIDE A PROli'ESSIONAL CORPORATION ATTORNEYS AT LA'V JEFFREY A. ERNICO 3401 NORTH FRONT STREET P.O. BOX ~9:iO HARRISBURG, PA 1'7110.0950 DIRECT DIAL (717) 231-5206 IRS NO. 23-1985005 EMAIL ADDRESS jaernico@mette.com TELEPHONE (717) 232-5000 FAX (717) 236-1816 http://www.mette.com February IS, 2005 VIA CERTIFIED MAIL RETURN RECEIPT REQUESTED Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 'On,.J c...:', Re: Estate of Vivian E. Brensinger File No. 21-2004-1157 Dear Ms. Strasbaugh: Enclosed is a check in the amount of $12,000 .00 payable to "Register of Wills, Agent" representing a prepayment of Pennsylvania Inheritance Tax in the above-referenced estate proceeding. Please send a receipt for this payment. Thank you for your assistance. Very truly yours, ~'Q.\L 'V\ D <..-t9..-- Lisa J. Kno e Paralegal to Je ey A. Ernico LJK: Enclosure cc: Terry L. Brensinger, Executor 416914vl V- COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU Of INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RE:V-1162 EX{11-96} RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ERNICO JEFFREY A POBOX 5950 HARRISBURG, PA 17110-0950 ~------- fold ESTATE INFORMATION: SSN: 192-20-4129 FILE NUMBER: 2104-1157 DECEDENT NAME: BRENSINGER VIVIAN E DATE OF PAYMENT: 02/16/2005 POSTMARK DATE: 02/15/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/15/2004 NO. CD 004956 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $12,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 509 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS $12,000.00 GLENDA FARNER STRASBAUGH REGISTER OF WillS !"I'I"I'I"("'II"!'I"'II"'f1"'!I"II"""III"'III"'I ;;:.'.7.:;':';'_:='l !:) i. _. _. _ _" ~..' R' M_ . f:~on 'v'd 'aIS!lJe~ aJenbs aSno4l.1no~ aUQ 8sn04l.1nO~ AlunO~ puepaqwn~ sII!M!O J8~S!68~ 46neqseJlS J8UJB::l epu81D 1'1"1'11"11"""111'''111'''1 ., -'--) ; C) {y; . OlieO-OlILI Vd '~t:lnesn:U:tVH Ol;E1Si XOS 'O"d J.3:3t:1..LS J.NOt:l.:il HJ.l::ION lO,,"S MV' .LV SA3N!::I0.1J.V NOIJ.Vt:lOd~O~ 'VNOISS3.l10t:/d v 3:0ISaOOM :Jf' SNVAa "'3:.LL:-i 1J1tlNJl3W1Jl3.a . CERTIFICATION OF NOTICE UNDER RULE 5.6(A) Name of Decedent: Vivian E. Brensinger Date of Death: November 15. 2004 Will No. 2004-01157 Admin. No. 21-04-1157 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 Februarv.Q. 2005 : Name Address Barrv L. Brensinger 400 Whitford Hill. Manchester. NH 03104 Terrv L. Brensinger 838 Division Street. Grantham. P A 17027 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE. Date: Februarv ;2 . 2005 ~~- ~ Signature Jeffrev A. Ernico. Esauire Name 3401 North Front Street Harrisburg. PA 17110 Address (717) 232-5000 Telephone I'd ' L',j lwn',;, wi I'-JJ ,--;V,"10 II''''''''' Capacity: _ Personal Representative r 0'. 0' ....'. x.. Counsel for Personal Representative 415714vl .0"-, " J' ---. r- r4 ~t:O ~Cl =: ~r'- ~ - -:::::::;;. Jl ~ru ~- -:: ~ ~ ~. Jl ~~~g ~O ---- -- ~ ;- .. ":::;. 0 ~--- ~ IfI ~~r4 ~ -E rn ~~ru ~~~ ~.\ ~ , \ ~z ~ ~ ~g. ~ ~ rp~'Z~ $ P ~~~ ~ OO~ID~'; O~~%~4. ~O~Oul~ ~OrJl~o6 tl)i~~~.tt. z,,'hZ~o? \ \\ .~~~~~~ ~'7:tn 0 ~ \~~~'f. ~~ ...~~~ ~~ ~ ~ CM ~ ~4'. ~ ~ r,j) S ~ ~ ...... (:C.>A 2. S~~ ~ 0&...... r,j) '80 ~r,j)~r,j)';. ~';3'P~ r,j)I-'-Sr,j)4 c4,?oSp.. Iil~ ;;p ~O~~~ 4c4~>;:l~ ~1il~0",", 4r-'?:l0~ A~~~~ ~s?'~~00 . t3 ~ 0 METTE. EVANS & WOODSIDE A PROFESSIONAL CORPORATION ATTORNEYS AT LAW JEFFREY A. ERNICO 3401 NORTH FRONT STREET P.O. BOX 5950 HARRISBURG, PA 17110-0950 DIRECT DIAL (717) 231-5206 IRS NO. 23-1985005 EMAIL ADDRESS jaernico@mette.com TELEPHONE (717) 232-5000 FAX (717) 236-1816 http://www.mette.com June 30, 2005 Via Certified Mail Return Receipt Requested Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Estate of Vivian E. Brensinger File No. 21-04-1157 Dear Ms. Strasbaugh: Enclosed for filing are the following documents: 1. The original and one (1) copy of an Inventory; 2. The original and one (1) copy ofRev-1500, Pennsylvania Inheritance Tax Return, plus a copy of the cover page; 3. A check payable to "Register of Wills, Agent" in the amount of $3,475.18 in payment of the Inheritance Tax owed; 4. Our check in the amount of $30.00 in payment of your filing fees; and 5. A postage prepaid envelope for return mail. Please file the Inventory and Inheritance Tax Return. Please return a date-stamped copy of the Inventory and the cover page of the Inheritance Tax Return, along with your receipt for the Inheritance Tax payment, to my attention in the enclosed envelope. June 30, 2005 Page 2 Please do not hesitate to call with any questions. Thank you for your assistance. Very truly yours, ~-D~~ t~o~ Lisa J. Kno e Paralegal to effrey A. Emico LJK: Enclosures 427467vl Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Vivian E. Brensinger No. 21-04-1157 also known as Date of Death November 15, 2004 late of Upper Allen Township. Cumberland County, PA . Deceased Social Security No. 192-20-4129 Personal Representalive(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and 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. IM/e verify that the statements made in this Inventory are true and correct. IM/e understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Personal Representative: Jeffrey A. Ernico, Esquire r Dated: 1.0. No.: 07981 Address 3401 N. Front Street, Harrisburg, PA 17110-0950 (717) 232-5000 Telephone: DESCRIPTION VALUE REAL PROPERTY: None PERSONALPROPERT~ See Attached TOTAL $245,489.42 (Allach Additional Sheets If Necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. 427245v1 ... Form RW-7 (Dauphin County) - Rev. 9J92 Estate of Vivian E. Brensinger Estate Inventory Valued as of Date of Death Cash & Cash Equivalents Allentown Teachers Credit Union Savings Accounts MetLife, Inc. Demutualization (PA) $ PNC Bank Checking Account #5003547952 Interest at Date of Death PNC Bank Savings Account #5002055905 Interest at Date of Death Short Term Income Money Market Fund Total Cash & Cash Equivalents Par Value Bonds, Debentures & T -Bills 25 U.S. Savings Bond, $25, 08/1976, Serial #Q6034508993E Interest at Date of Death $ 25 U.S. Savings Bond, $25, 08/1977, Serial #Q6189900758E Interest at Date of Death 25 U.S. Savings Bond, $25, 08/1978, Serial #Q6269096789E Interest at Date of Death 25 U.S. Savings Bond, $25, 08/1979, Serial #Q6345460659E Interest at Date of Death 50 U.S. Savings Bond, $50, issue 08/1980, Serial #L33382142EE Interest at Date of Death 50 U.S. Savings Bond, $50, 09/1981, Serial #L67805926EE Interest at Date of Death Page 1 (1) 12,136.37 1,979.01 10,517.45 0.83 7,277.98 1.13 330.38 18.75 107.19 18.75 105.28 18.75 72.55 18.75 71.15 25.00 107.00 25.00 86.32 $ 32,243.15 , Estate Inventory Par Value Bonds, Debentures & T -Bills 50 U.S. Savings Bond, $50, 08/1982, Serial #L99169268EE Interest at Date of Death 50 U.S. Savings Bond, $50, 08/1984, Serial #L177837003EE Interest at Date of Death 50 U.S. Savings Bond, $50, 08/1995, Serial #L188441445EE Interest at Date of Death 50 U.S. Savings Bond, $50, 08/1986, Serial #L281139084EE Interest at Date of Death 50 U.S. Savings Bond, $50, 09/1987, Serial #L310859126EE Interest at Date of Death 50 U.S. Savings Bond, $50, 08/1988, Serial #L370923370EE Interest at Date of Death Total Bonds, Debentures & T-Bills Tangible Personal Property One-story frame cottage situate on Lot No. 4E Camp Street in Milford Park Camp Meeting Site in Upper Milford Township, Lehigh County, PA. The decedent owned the structure only, not the real estate it sits upon. Household goods and furnishings and miscellaneous items of personal property Total Tangible Personal Property Page 2 (2) $ 25.00 82.00 25.00 53.60 25.00 49.60 25.00 46.70 25.00 36.96 25.00 34.56 $ 17,000.00 2,000.00 $ 1,127.91 19,000.00 Estate Inventory Miscellaneous GMAC - refund of prepaid auto lease $ 630.67 Messiah Village refund 112,792.06 Uncashed MetLife checks 1,958.41 Total Miscellaneous $ 115,381.14 No. of Shares Mutual Funds 692.829 Amcap Fund $ 12,519.42 976.589 American Balanced Fund 17,803.22 743.556 American Mutual Fund 19,369.63 231.085 Capital World Growth & Income 7,702.06 147.491 Europacific Growth Fund 5,058.94 484.743 Fundamental Investors, Inc. 15,283.95 Total Mutual Funds 77,737.22 Total Inventory $ 245,489.42 Page 3 (3) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ERNICO JEFFREY A POBOX 5950 HARRISBURG, PA 17110-0950 -------~ fold ESTATE INFORMATION: SSN: 192-20-4129 FILE NUMBER: 2104-1157 DECEDENT NAME: BRENSINGER VIVIAN E DATE OF PAYMENT: 07/01/2005 POSTMARK DATE: 06/30/2005 COUNTY: CUMBERLAND DATE OF DEATH: 11/15/2004 NO. CD 005514 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $3,4 75.18 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: CHECK# 519 SEAL INITIALS: JA RECEIVED BY: REGISTER OF WILLS - $3,475.18 GLENDA FARNER STRASBAUGH REGISTER OF WILLS . .. REV-1500 EX (6-00) OFFICIAl USE ONLY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER "gL COUN1Y CODE .....QL 1157 ___ YEAR NUMBER I- Z W o w (,) w o DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Brensin er Vivian DATE OF DEATH (MM-DO- YEAR) OA TE OF BIRTH (MM-OD- YEAR) 11/15/2004 7/19/1927 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INIT1AL) Not A J.icabJ.e CXJ 1. Original Retum D 4. Limited Estate CXJ 6. Decedent Died Testate (AlIach copy of Will) D 9. Litigation Proceeds Received E SOCIAL SECURITY NUMBER 192-20-4129 THIS REllJRN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER W I- ~~1Il Olt:~ wll.O ::1:00 Olt:..J II.lD II. c( D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12-13-82) D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Deposit Boxes D 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAI..TAXINFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS I- Z W C Z o II. III ! Jeffre A. Ernico, Es ire FIRM NAME (If Applicable) METTE, EVANS & WOODSIDE TELEPHONE NUMBER 717-232-5000 3401 N. Front Street P.O. Box 5950 Harrisburg, PA 17110-0950 z o ~ ~ ::J l- ii: <C (,) w Ix: 6. Jointly Owned Property (Schedule F) (6) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 0.00 78,865.13 0.00 0.00 166,624.29 0.00 OFFICIAl USE ONLY 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule 0) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (4) (5) 136,464.56 8. Total Gross Assets (total Lines 1-7) (8) 21,835.21 2,190.74 381,953.98 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) (13) 24,025.95 357,928.03 0.00 11. Total Deductions (total Lines 9 & 10) (11) 12. Net Value otEstate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) (12) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 357,928.03 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) 0.00 357,928.04 0.00 0.00 x.O L(15) x.O 45 (16) 19. Tax Due 20.0 (19) 0.00 16,106.76 0.00 0.00 16,106.76 z o j:: ~ ::l II. ~ o (.J >< ~ 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate x .12 (17) 18. Amount of Line 14 taxable at collateral rate x .15 (18) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER.AL.L.QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < 1645 1.000 . Decedent's ComDlete Address: SlREET ADDRESS 918 Aspen Avenue Cumberland CI1Y I STA1E I ZIP Mechanicsbura PA 17055- Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 16,106.76 0.00 12,000.00 631.58 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 12,631.58 0.00 0.00 TotallnterestlPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 3,475.18 A. Enter the interest on the tax due. (SA) 0.00 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Pa able to: REGISTER OF WILLS, AGENT (5B) 3,475.18 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS Yes No Dog Dog Dog Doa without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D [Jg 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D []I 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. IX] D 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 penallies of perjury, I declare 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 information of which preparer has any ledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN 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 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 Terry L. Brensinger, Executor ADDRESS 838 Division Street SIGNATURE OF PREPARER OTHER THAN REPRESENTAllVE Jeffre A. Ernico, Es ADDRESS 3401 N. Front St., P.O. Box ~ 'j ij..1) i;... / Grantham, DA1E (, f2x:/6.J I PA 17027 Harrisburg, PA 17110-0950 .i 1 _.ll ~ ~illJIIJ . I m 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. 99916 (a) (1.1) (i)J. 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 Sl The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and 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, or a stepparent of the child is 0% [72 P.S. 99116(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 . The lax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% (72 P.S. 9 9116(a)(1.3)]. A sib individual who has at least one parent in common with the decedent, lMlether by blood or adoption. 3W46461.0oo 3"~-r REV-1503 EX. (6-96) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE B STOCKS & BONDS FILE NUMBER Vivian E. Brensinger 21 04 1157 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1.692.829 Shares Amcap Fund DESCRIPTION VALUE AT DATE OF DEATH 12,519.42 2 976.589 Shares American Balanced Fund 17,803.22 3 743.556 Shares American Mutual Fund 19,369.63 4 231.085 Shares Capital World Growth & Income 7,702.06 5 147.491 Shares Europacific Growth Fund 5,058.94 6 484.743 Shares Fundamental Investors, Inc. 15,283.95 7 25 Par U.S. Savings Bond, $25, 08/1976, Serial #Q6034508993E Interest accrued to 11/15/2004 18.75 107.19 8 25 Par U.S. Savings Bond, $25, 08/1977, Serial #Q6189900758E Interest accrued to 11/15/2004 18.75 105.28 9 25 Par U.S. Savings Bond, $25, 08/1978, Serial #Q6269096789E Interest accrued to 11/15/2004 18.75 72.55 10 25 Par U.S. Savings Bond, $25, 08/1979, Serial #Q6345460659E Interest accrued to 11/15/2004 18.75 71.15 11 50 Par U.S. Savings Bond, $50, issue 08/1980, Serial #L33382142EE Interest accrued to 11/15/2004 25.00 107.00 Total from continuation schedules 564.74 '4696 1.000 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 78,865.13 Estate of: Vivian E. Brensinger 192-20-4129 Schedule B (Page 2) Item No. Description Value at Date of Death 12 50 Par U.S. Savings Bond, $50, 09/1981, Serial #L67805926EE Interest accrued to 11/15/2004 25.00 86.32 13 50 Par U.S. Savings Bond, $50, 08/1982, Serial #L99169268EE Interest accrued to 11/15/2004 25.00 82.00 14 50 Par U.S. Savings Bond, $50, 08/1984, Serial #L177837003EE Interest accrued to 11/15/2004 25.00 53.60 15 50 Par U.S. Savings Bond, $50, 08/1995, Serial #L188441445EE Interest accrued to 11/15/2004 25.00 49.60 16 50 Par U.S. Savings Bond, $50, 08/1986, Serial #L281139084EE Interest accrued to 11/15/2004 25.00 46.70 17 50 Par U.S. Savings Bond, $50, 09/1987, Serial #L310859126EE Interest accrued to 11/15/2004 25.00 36.96 18 50 Par U.S. Savings Bond, $50, 08/1988, Serial #L370923370EE Interest accrued to 11/15/2004 25.00 34.56 rotal (Carry forward to main schedule) 564.74 REV-1508 EX ~ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE Of Vivian E. Brensinqer FILE NUMBER 21 04 1157 Include the proceeds of litigation and the date the proceeds were receilled by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Allentown Teachers Credit Union Savings Accounts 12,136.37 2 One-story frame cottage situate on Lot No. 4E Camp Street in ~lford Park Camp Meeting Site in Upper ~lford Township, Lehigh County, PA. The decedent owned the structure only, not the real estate it sits upon. 17,000.00 3 GMAC - refund of prepaid auto lease 630.67 4 Household goods and furnishings and miscellaneous items of personal property 2,000.00 5 Messiah Village refund value of occupancy right of residence at Messiah Village; see attached correspondence 112,792.06 6 MetLife, Inc. Demutualization (PA) Proceeds of funds held in the decedent's name by the PA Treasury Department, Bureau of Unclaimed Property 1,979.01 7 PNC Bank Checking Account #5003547952 Interest accrued to 11/15/2004 10,517.45 0.83 8 PNC Bank Savings Account #5002055905 Interest accrued to 11/15/2004 7,277.98 1.13 9 Short Term Income Money Market Fund 330.38 10 Uncashed MetLife checks 1,958.41 '46AO 1,000 TOTAL (Also enter on line 5 Recaoitulation\ $ (If more space is needed. insert addnional sheets of the same size) 166,624.29 REV-1510 EX ~ (6-98) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vivian E. Brensinqer FILE NUMBER 21 04 1157 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. DESCRIPTION OF PROPERTY ITEM INCU.DE n-E fIWJIE OF TrE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE NUMBEF 1l-E DATE OF TRNEiFER ATTACH A COPY OF TI-E DEED FOR REAl eSTATE. VAlUE OF ASSET INTEREST (IF APPUCABLEl VAlUE 1. MetLife Annuity Contract #078317210; beneficiary is Terry L. Brensinger 14,625.84 100.0000 0.00 14,625.84 2 MetLife Annuity Contract #550037435; beneficiary is Terry L. Brensinger 29,576.93 100.0000 0.00 29,576.93 3 MetLife IRA Annuity Contract #071620364 ; beneficiary is Terry L. Brensinger 11,195.65 100.0000 0.00 11,195.65 4 MetLife IRA Annuity Contract #550023650; beneficiary is Terry L. Brensinger 62,060.21 100.0000 0.00 62,060.21 5 MetLife IRA Annuity Contract #550023664; beneficiary is Terry L. Brensinger 19,005.93 100.0000 0.00 19,005.93 TOTAL (Also enter on line 7, Recapitulation) $ 136 464.56 (If more space is needed, insert additional sheets of the same size) 16AF 1.000 REV-1511 EX+ (12-99) SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vivian E. Brensinger ITEM NUMBER A. B. 4. 1 46AG 1.000 FILE NUMBER 21 04 1157 Debts of decedent must be reported on Schedule I. DESCRIPTION FUNERAl EXPENSES: 1. Bachman, Kulik & Reinsmith Funeral Total from continuation schedules 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 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 Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Cumberland Law Journal Advertise estate notice Total from continuation schedules TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ AMOUNT 7,161.18 279.37 12,000.00 342.00 275.00 75.00 1,702.66 21. 835.21 Estate of: Vivian E. Brensinger 192-20-4129 Schedule H Part 1 (Page 2) Item No. Description Amount 2 Bachman, Kulik & Reinsmith Engraving headstone 235.00 3 Grantham Church Food at memorial service 44.37 Total (Carry forward to main schedule) 279.37 - Estate of: Vivian E. Brensinger 192-20-4129 Schedule H Part 7 (Page 2) 2 Enterprise - rental of van to remove decedent's personal effects from cottage 93.78 3 Messiah Village 711.86 4 Postage and notarial services 13.12 5 PPL Electric 141.17 6 Real estate taxes on cottage in Lehigh County 81. 95 7 Rental of U-Haul to remove decedent's personalty from residence 92.13 8 The Sentinel Advertise estate notice 144.29 9 Verizon - telephone 424.36 Total (Carry forward to main schedule) 1,702.66 REV-1512 EX + (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vivian E. Brensinger SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 04 1157 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM NUMBER 1. DESCRIPTION VALUE AT DATE OF DEATH Messiah Village 917.50 2 Outstanding checks numbered 300 through 304 written prior to death which did not clear decedent's checking account until after death 1,273.24 '46AH 2.000 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2 190.74 REV-1513 EX+ (9-00) SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Vivian E. Brensinaer NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Barry L. Brensinger 400 Whitford Hill Manchester, NH 03104 1 50% Residue: 110,731.74 FILE NUMBER 21 04 1157 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee{s) OF ESTATE Son 110,731.74 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 46A11.000 TOTAL OF PART 11- 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 Estate of: Vivian E. Brensinger Schedule J Part 1 (Page 2) Item No. Description 2 Terry L. Brensinger 838 Division Street Grantham, PA 17027 MetLife Annuity Contract #078317210; beneficiary is Terry L. Brensinger Inventory Value: 14,625.84 MetLife Annuity Contract #550037435; beneficiary is Terry L. Brensinger Inventory Value: 29,576.93 MetLife IRA Annuity Contract #071620364; beneficiary is Terry L. Brensinger Inventory Value: 11,195.65 MetLife IRA Annuity Contract #550023650; beneficiary is Terry L. Brensinger Inventory Value: 62,060.21 MetLife IRA Annuity Contract #550023664; beneficiary is Terry L. Brensinger Inventory Value: 19,005.93 50% Residue: 110,731.74 Son 192-20-4129 Relation Amount 247,196.30 - a o ~ ~ ~ ~ ~ ~ ~ ~ < '1: ~ 1;, >, ~ t C . '?i"~['l ")dA( I / c"'-~ /:> ( " ~;," l.',>(.~J! ..J (_t~) (; c/ '- LAST WILL AND TESTAMENT OF VIVIAN E. BRENSINGER I, VIVIAN E. BRENSINGER, of 1480 Butternut Lane, Macungie, Lehigh County and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declare this to be my Last Will and Testament and do hereby revoke any and all Testamentary Writings by me at any time here- to fore made. ITEM 1. I order and direct my hereinafter named Executor to pay all my legally enforceable debts and funeral expenses as soon after my decease as conveniently may be done. ITEM 2. I hereby request that my funeral be conducted at a cost and in a manner commensurate with my estate and situation in life. ITEM 3. All the rest, residue and remainder of my estate, real, personal and mixed, of whatever nature and wheresoever situate, which I may own or have the power to dispose of at the time of my decease, I give, devise and bequeath unto my spouse, J. GORDON BRENSINGER, provided he is living sixty (60) days after my 1 ITEM 4. In the event that my said spouse should predecease decease. me or should he die within sixty (60) days after my decease, then, and in either such event, I give, devise and bequeath my residuary estate aforesaid unto my three children, BARRY L. BRENSINGER, TERRY L. BRENSINGER AND CAROL S. BRENSINGER, share and share alike, or to their issue, per stirpes, subject however to the following condition: In the event my daughter CAROL S. BRENSINGER so desires, I direct that she shall have the right and privilege to live in and occupy my one story ranch home with the two car attached garage, situate at 1480 Butternut Lane, Lower Macungie Township, Lehigh County, Pennsylvania, rent free, and have the use of all the household furnishings therein, under the condition that she pays all expenses covering the home, including the taxes, utilities and the repairs and general maintenance of said home. When my daughter no longer lives in my home, said property shall be sold and distributed to my residuary heirs as above provided. In the event any of my aforesaid children should predecease me leaving no issue surviving, then and in that event I direct that said child's share be distributed unto my.surviving children or if deceased unto their living issue, as aforesaid. ITEM 5. I hereby nominate, constitute, and appoint my spouse, J. GORDON BRENSINGER, Executor of this, my Last Will and Testament. Should my said spouse be unable, unwilling or cease to act as such ') /" . (~ ,_' {/.-F L' ~) '~<id ,~ _ ->""~ ; /:<' ':>'2 r..l." ,..-j I~ -/dt-~r"{.'L r/ /J 2 ,'" ...~ ,~;/ ,>, ., s.;""\ '. . -iI{,r;'.~tit. ~BRi~~J:~~~R' .,( )VV (SEAL) Executor, then and in that event, I hereby nominate, constitute and appoint my three children, BARRY L. BRENSINGER, TERRY L. BRENSINGER AND CAROL S. BRENSINGER, or the survivor of them, Executors in his place and stead. ITEM 6. I hereby request that, if available, the services of FORRY, ULLMAN, ULLMAN & FORRY, P.C. be retained in the settlement of my estate. IN TESTIMONY WHEREOF, I, VIVIAN E. BRENSINGER, Testatrix to this, my Last Will and Testament written on three (3) sheets of paper, have signed my name to each page hereof, and to this, the last page, have subscribed my name and affixed my seal this :? () f"" 'f~/ "II 1- , A. D. nineteen hundred ninety":-~ (1991) . ~~V'.~.,J\~ v 'J da y 0 f 3 4 SIGNED, SEALED, PUBLISHED AND DECLARED by the within named Testatrix, VIVIAN E. BRENSINGER, as and for her Last Will and Testament, dated\.};t/vvv"''''~A:2G I l (nS in the presence oj us, ~ho, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses hereto. ~~~ REV-4BS EX+ (1-92) . SAFE DEPOSIT BOX INVENTORY COMMONWEALTH OF PENNSYlVMUA DEPARTMENT OF REVENUE INHIRITANCE TAX DIVISION DEPT.2B0601 HARRISBURG, PA 1712B.0601 Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE ADDRESS COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER 21 2004-1157 192-20-4129 . DECEDENT'S NAME (LAST, FIRST, MIDDLE) Brensinger, Vivian E. . ADDRESS OF DECEDENT (STREET) (CITY) 918 Aspen Avenue Mechanicsbur NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) DATE OF DEATH November 15, 2004 (STATE) PA (ZIP CODE) 17055 Jeffrey A. Ernico, Esquire. METTE. EVANS & WOODSIDE (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) 3401 N. Front Street Harrisbur PA 17110-095 NAME. ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RELATIONSHIP) Jeffrey A. Ernico, Esquire Attorney for the Estate (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) 3401 N. Front 'Street Harrisburg PA 17110-095 b. (NAME) (RELATIONSHIP) Terry L. Brensinger Executor of the Estate (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) 838 Division Street Grantham PA 17027 c. (NAME) (RELATIONSHIP) . (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) . NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) PNC Bank, Messiah Village Branch (STREET ADDRESS) 100 Mt. Allen Drive . NAME OF PERSON MAKING LAST ENTRY Terry L. Brensinger DATE OF CONTRACT TO RENT BOX 01/30/03 (STATE) (ZIP CODE) 17055 (CITY) Mechanicsburg DATE AND TIME OF LAST ENTRY 12/06/04 (Will search) . TITLE UNDER WHICH BOX IS REGISTERED Vivian or Gordon Brensinger PA NUMBER OF BOX 56 NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) Vivian E. Brensinger (STREET ADDRESS) 918 Aspen Avenue (CITY) (STATE) Mechanicsburg PA . NAME AND TITLE OF EMPLOYE TAKING THE INVENTORY b. (NAME) (STREET ADDRESS) (STATE) (ZIP CODE) (ZIP CODE) (CITY) 17055 Jeffrey A. Ernico, Esquire, Attorney for the Estate WAS A WILL IN THE BOX? DYES xi.o If yes, a. Date of will: b. Name and address of personal representotive, if named in the will (NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) c. Name and address of a"orney, if any (NAME) (STREET ADDRESS) (CITY) (STATE) (ZIP CODE) ins Page of SAFE DEPOSIT BOX INVENTORY INSTRUCTIONS (1) Cash: Report total only. (2) Stocks: List in detail every common or preferred certificate, warrant or other rights found in box. Stocks are to be designated by name of company, certificate number, date of certificate, name in which stock is registered, and number of shares and class of stock. (3) Obligations of U. S. Government: Number of items, date of issue, face value, names in which registered and type of ownership, Le., jointly held, payable on death, etc. (4) Bonds: Designate by name, amount, serial number, or other designation. (Bearer Bonds) (5) Bank and Savings and Loan Passbooks: State name of depositor, number of book, last date appearing in book, name of bank and branch, and balance. (6) Jewelry, Coins, Stamps, Manuscripts, etc: List and describe as fully as possible. (7) Deeds, Mortgages, Current Insurance Policies or other evidences of indebtedness: List and describe as fully as possible. (8) All other contents. ITEM ITEM DESCRIPTION NO. 1 US Savings Bond, $50, L33382142EE, 09/1980, Vivian Brensinger 2 US Savings Bond, $50, L67805926EE, 09/1981, Vivian Brensinger 3 US Savings Bond, $50, L99169268EE, 08/1982, Vivian Brensinger 4 US Savings Bond, $50, LI77837003EE, 08/1984, Vivian Brensinger 5 US Savings Bond, $50, L188441445EE, 08/1985, Vivian Brensinger 6 US Savinbs Bond, $50, L281139084EE, 08/1986, Vivian Brensinger 7 US Savings Bond, $50, L310859126EE, 08/1987, Vivian Brensinger 8 US Savings Bond, $50, L370923370EE, 08/1988~. Vivian Brensinger 9 US Savings Bond, $25, Q6034508993E, 08/1976, Vivian Brensinger 10 US Savings Bond, $25, Q6189900758E, 08/1977 , Vivian Brensinger 11 US Savings Bond, $25, Q6269096789E, 08/1978, Vivian Brensinger 12 US Savings Bond, $25, Q6345460659E, 08/1979, Vivian Brensinger 13 Bill of sale dated 2/19/64 to J. Gordon and Vivian E. Brensinger for frame cottage erected on Lot No. 4E Camp Street, Milford Park Camp Meeting Site, Lehigh County, P!\ 14 3 membership shares in Milford Park Camp Meeting Association, Zionsville, PA, No. 1624 dated 11/1/80 and No. 1771 dated 10/26/81 15 Presidential Life Insurance Co. Pol. 1/00622106 dated 11/19/97, Vivian Brensinger in~' 16 Farmers & Traders Life Insurance Co. Pol. #0380737 dated 8/28/04, Vivian Brensinger 17 Met Life Insurance Co. Pol. #1624342~A d~ed 9/1/4Q, Vivian Brensinger insured 18 Prudential Insurance Co. Pol. 1/21015819 dated 6/25/57, John G. Brensinger insured 19 Prudential Insurance Co. Pol. 1122696003 dated 2/28/64, John G. Brensinger insured I CERTIFY UNDER~~THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT~ "......PL KNOWLEDGE AND BELIEF. SAFE -OEP.oSIT BOX INVENTORY: SIGN~E ~ I~UR~ ~_. ;...--- (J/, A. ~~lrJ - - PR~AME PRrNT NiME AND FHECK APPROPRIATE BOX BelOW, Jeffrey A. 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S30I~~3S ~l~3d ~3~O~8 ~:s~ S002-p0-83~ ~~.y,~~~ O1C11"'1CC""'lN &fb~~QgCn tlo)glaffi8Qi ~i@~~e ~ PAGE 02/02 i, The Estate of Vivian E BrensingerDate: 03/02/05 CASH P.O. BOX 5 Time: 15:17 BACK: .00 Gt~antham, PA. 17027 Sl!J~~umt:ANN.NN"A.LLEY FEDERAL CREDIT UNION ~ 3850 Hartzdale Drive · Camp Hill, PA 17011 ~ Tel: (717) 737-4152 or (800) 948-1454 ART: (717) 737-1741 or (888) 212-1635 DATE U..:JVLUO TRANSACTION IN J. I t1U"....W....L TELLER. LVKl W ADJUSTMENT REASON AMOUNT BALANCE TYPE OLD BALANCE 5,551.22 AMOUNT SHARE DR.AFT 5,551.22 NEW BALANCE 0.00 CHECK AMOUNT $*******5,551.22 5.551.22 0.00 LESS ADJUSTMENT ~ AllENTOWN W ;REE~~THL~~~ N No. 110652 2900 Hamillon Blvd.' P.O. Box 4388' Allenlown. PA 18105-4388' Phone (610) 820-0145 DATE u,;) U ,(. U ::> TRANSACTION: WJ.IMU"....W....L TELLER. LV" 1 W R.EGULAR SHAR.ES 6,585.15 NEW BALANCE 0.00 ADJUSTMENT REASON AMOUNT BALANCE TYPE OLD BALANCE 6,585.15 AMOUNT CHECK AMOUNT $*******6.585.1S 6,585.15 0.00 LESS ADJUSTMENT @AllENTOWN TEACHERS ~~ .. CREDIT UNION No. 110651 2900 Hamilton Bivd.' PO. Box 4388 . Allentown, PA 18105-4388' Phone (610) 820-0145 ACCOUNT NUMBER 14395 40 Deposit (Checks In ( 12,136.37 .0121 .00 12,759.28 PAY OFF THOSE HIGH INTEREST CREDIT CARDS WITH SVFCU'S ONE AND DONE LOAN WITH RATES AS LOW AS 9.50r....ASK A LOAN OFFICER FOR DETAILS. ,. Ii" .' \' (i' ". I. , I i J ~ 'f \ : :' I.~. . " f. ~{(;'~'~y"i.r l:Jr~~'r;;;i;'~J c~r. F. )({~Cllto r _..__..j01"7 AI.) JUN-03-05 FRI 10:12 AM GRANTHAM CHURCH FAX:7177965086 PAGE' 2 1:.:UU.. OF SJ.\tf: KI\IUVV 1~1.I. MEN BY THESE PRESENTS that Tt;ny ~.o BII'en3ingm', Execl,.\tor 4,)f th~ t:::'.;'u:;;.i.n ui' Vu"l~n I:, fJrttnt;lngoi', deceased, of Upper Allen Township, Cumberland County, (:Ol1l1l1orlwI;'!alth of PC;.lnnsylv8nia, in c;c>nsideration of the QlHn of Soventeen Thousand and i:O/HIO (:jiH,llno.OO) Dt)lIar~ and other valuable consideration to him in h~nd paid by I~ic~han;f " l+!:i1I(''''lrH''a~l, .j;,.. m~d GIW9Still IUI. BaIIflHl"'lnO, husband fJnlt wWt', at and tH~f()re the enseoling and dt.)I!\I(.~(it 11.} 0" the:K) pl'('l~;(:lntt:, the receipt whereof is hbreby acknowletlgad. ll::l~ granted, i:ill!j:.:iil:ld. :;Il:I1, 1"("I:-~:;l13~-)d. LInd (~()nfirm(')d and by thesn presents dom; hereby grant, bL\rnuin, ~;d:, i':'i{::~:a'~, wlcl (;on1'irm unto tho :.;l~id '-<ictJard DoMC;.lnno, Jr. .u\d Christa IVI. DeMenno, : ll.l: ;klll: :..1; III \NifO, elf Uurto, Berlm C~)Unty, Gomrncmwealttl of Penn~ylvania, (;III and singular, the thl,:.-:;i(liY j'r;.:IIl(': 1:01:1:::\9(': erc7:clccJ <Jrl cement pillars situate on Lot No, 'If.: Camp Street in Milford i"i.;';, ~:;M'p i\f!:)l~till!l Site located in Upper Milford Township, Lehigh County, Commonwealth of ; 'etll t~:ylvai\i;t ;')17Ji'iO tht-) same prop~lr1:y which DOf(>\hy IVI. Yeakel, by her Bill of S",lc 01' .':(~fl, 11i:'1I y 'W, WO/.!. fJrw1lelj to ./. Gmdon Brensinger and Vi\lian E. Brem~ingel'. l,i~> wife, and the :), d,: ,J. (.iordorl nrensinger pf(:ld(,)cs}~s(~d Vivian E. Bmmiingcil"", thereby vesting Wlti to the i in II 1t:1 i.~1 in \/iviw I l~.. ::Jnmsinger. : (l \'1/\\11::. I\ND TO HOLD all I,md Dingul::Jr, Ule said pel'5ontJI propGrty or f'rarne coUage : ,!J';ji\:~i nil :ll'ld mlory pt-mmT\ one! per~.()n:, whomsoever and eVGry one of them, by these : ,j"~;:', ll~: !J:~r!l;~in~::d, :;(lId, n,:}leased. granllilo, and confirmed Imto the said, Ril.~hard DeMenno. .Jr. ; illl; .~:; :;'hia IVI. J)(~I\llt.H1no. husbcmd ,:md wit'e, to their only proper US~l flnu behoof, their heirs, : :::: :c:1 :j ('.j": i. ; ldlilillintrator:-;, alld :m$igrl5 forever. '1 l!\j VI/II Nl.:m:; WIIEREOF, I havo tK1rC'3Unto set my hand and seallt1~l _:.~:. . day of , :, .... ..,......... ___.' ).l)05. it Iii i i I ( ~:;: : EST/\TE OF VI,!.IAN E. l:Jnr:l\!HiNGEH I ,c I: Ill( IlllllN( :I:tlitlnf P~mnsylvania: C'''\ ...", ';'JJUiiV I'.: : . ';. . : I ,'. II. . " \ t.'lil till:" tll(1 ....,....~.__ day of -j::...~~.___..._.., 2005, before me, a Nol::lI'Y Public. \!()I! ;1l11:'llly app(~:~rt~d Ten-y 1.. ~knn~ljni~f.tt~ in his capacity W~ ~}t{~t:lil~OL' n~: UII~ E~ltat., of Vovil:.m i :. ::h~tl't...ife!1~~~', (lc~~oa~Gd, kn{lWn to rn<~ (or satisfactorily pfov~m) to bCi the p~rson whose il<.lrY1D i:; : ;'11J:iLtil)(.':d "0 ttlf-) foregoing in~trul"TI<:mt, and acl(nowled~~ed thilt he (:l((J(:lJt<~d the ~:H;Hne for tile ~ Jill: l'l: l< ~:: 111' :1': :ltl (';[.H1iain<~cL .;\l vVl"j NI7.SS WI-IEHl-::OF, I have hereunto SElt my ~fl~d and notarial se~1. I ,.....:... !.I ...:..1 ..... I :~ 1'-" \ \ , ...[ .......... .. t/Notary-iiu6ifc"'~ -''':'~I''-''''-''-'-- t ..' \. My C()lTIrni:~si()n Fxpires: (" 1 ~. OOI.,,'~ .1. "('. '.\ .! '1(1 !'.t,.~ r.........._l.,. . . '-Nlji;;li!;'l:'Sl:.~r' '. ...... M' " ", il In:;! 1'111': \:IlI.l"l.I'IOIMlY I'IJOl.lC \ 1'1.~i'/il\lJS 1l0:l0.,l~lIllil1 (;()Urm' I ..-1~!J:~~~~ID.9.H~l~ll,~~.^VI.H...~Il!}L ..1 essiah 'v'ILL.A.GE Continuing Care Reti'renlent Services - Founded 1896 ~' December 22, 2004 Mr. Terry Brensinger 838 Division St. P.O. Box 5 Grantham, PA 17027 Dear Mr. Brensinger: I am writing to you concerning the refund due for the cottage occupied by J. Gordon and Vivian Brensinger at 918 Aspen Avenue, Messiah Village. The acquisition fee paid for the unit in December 2002 was $138,821.00. The agreement was terminated December 21, 2004. Seventy-five percent of the acquisition fee was amortized over twenty-five months leaving a refund in the amount of$112,792.06 (see enclosed amortization schedule). The payment of the refund will take place in six months or after the unit is acquired by another resident, whichever comes first. If you have any questions regarding the refund, please call me at (717) 790-8220. Sincerely, /1)lUY~Lli_'lY\o. ~ tCI\.G1CUf() Michele Maglich Brown Manager of Financial Operations Encl. lOi) .\It. A!l,,:n Drive . \1echanksburg, PA 17055-6 WI) (717) 69-:"-4(1()() . F~lx (717) 790-820Ci . \V,v'w,l1lessbh~'iI!agt.',org Enhancin2 Life Z00'd d~0lZt S0/60/Z0 SSSSS6LLtL ace I I I'" 4elssaw Commonwealth of Pennsylvania Treasury Department Bureau of Unclaimed Property 11111111111111111111111111111111111111111111111111 99564011 In addition to the requirements on the REQUEST FOR CLAIM page, please also submit: . A copy of Drivers License or valid state identification. · Claim Form, completed and signed · Completed, signed, and notarized Affidavit and Indemnification Agreement. · Original Death Certificate for owner highlighted above. · Original Short Certificate, obtained at the county court house, Register of Wills Office, showing that Letters of Administration or Testamentary were granted and updated within the last two years. (A) Original Owner's Name (B) Original Owner's Address as Reported RR 1 MACUNGIE PA 18062-9800 BRENSINGER VIVIAN E (C) Holder Reporting Funds METLlFE INC DEMUTUALlZATION (PA) (E) Holder Address and Contact OFFICE OF THE CORPORATE SECRETARY ONE MADIS NEW YORK NY 10123 (D) Last Transaction Date 12/15/2003 (F) Type of Funds Reported BRENSINGEVIVIEO (G) Certificate, Policy or Check Number Demutualization Cash (H) Amount Reported $33.01 j;~~~ii;Ek~f!1!rrtzr;; ~~::~::n~~C:~::r:~::l:::::~~2=~ ~~::::;: ~:"'~,~~:~~~:'~-::~}mr~%~it~::~1~1~ti1;J:;~~:::;~ ~ ~,:>~ =':: (A) Original Owner's Name (B) Original Owner's Address as Reported RR 1 MACUNGIE PA 18062-9800 BRENSINGER VIVIAN E (C) Holder Reporting Funds METLlFE INC DEMUTUALlZATION (PA) (E) Holder Address and Contact OFFICE OF THE CORPORATE SECRETARY ONE MADIS NEW YORK NY 10123 (D) Last Transaction Date 04/05/2000 (F) Type of Funds Reported - BRENSINGEVIVIEO (G) Certificate, Policy or Check Number Demutualization Stock (H) Amount Reported $1.946.00 $1,979.01 Total Shares Claimed Total Cash Claimed 0.0000 RETURN CLAIM FORM AND DOCUMENTATION TO: Bureau of Unclaimed Property P.O. Box 1837, Harrisburg, PA 17105-1837 99564011 Shawnell Martin Research JAN-04-2005' 17': 50 412 768 3458 PNCBANK 0PNCBAN< January 5, 2005 Mette, Evans & Woodside Attn: Lisa J Knode 3401 N Front St. POBox 5950 Harisburg, P A 17110-0950 RE: Estate of Vivian E Brensinger (Deceased) SSN: 192-20-4129 DOD: 11-15-2004 sepia! Dear Ms. Knode; In t'esponse to yom request for Dat~ of Dt-ath balances for the customer noted above, our records show the following: Cheeking Accollnt Account #5003547952 Established 01-09-2003 V1VIAN E BRENSINGER DOD balance: $10,517.45 + SO.83 8.CCl'Ued interest S.~g1 Account Account 5002055905 Established 01-30-2003 VIVIAN E BRENSINGER ODD balance: 57,277.98 + $1.13 accrued interest Safe depo.it box The decedent maintained sate deposit box #56 It was in one name, VIVIAN Eo BRENSINGER. It is located at: MESSIAH Vat.AGE Vfi..LAGE COMMONS - 100 MT. ALLEN DlUVE MECHANICSBURG PA 17055 717-691-4090 The deeedellt did not maintain any loans at PNC Bank. Page 1 of2 P.01 TOTAL P. 02 JAN-04-21OIOS. 1'7': S(3 PNCBANK 412 768 3458 . P. 102 Please note that this office only provides date of death balances for d~it accounts (IRAs, CDs, Checking and Savings accounts). We do DOt process ally fiIlancla) transactions or provide statements. If you need assistance with any of these items, please call1-888.PNC-BANK (1-888-762-2265) or stop by your local PNC Bank bnmch office. Sinpere1y, ~ ':1. ~ Erica L Schlegel 1~800-762-1775 P7.PFSC-04-F 500 Firat Ave. Pittsburgh PAl 5219 McmbIlr FDIC Pas- 2 of2 . . Knode, Lisa From: Sent: To: Subject: Todd R Ockovic [tockovic@MetLife.com] Wednesday, February 02, 2005 4:24 PM Knode, Lisa Re: BRENSINGER Lisa Here are the date of death values for Vivian's Annuities: MetLife Contract# 550023650 $62,060.21 IRA MetLife Contract# 550023664 $19,005.93 IRA MetLife Contract# 550037435 $29,576.93 Non-Qualified MetLife Contract# 071620364 $11,195.65 IRA MetLife Contract# 078317210 $14,625.84 Non-Qualified I am still waiting for the MetLife Securities values. Thank you for your patience, Todd Todd R. Ockovic Agency Director Pennsylvania Business Group An Office of MetLife Financial Services 450 Plymouth Road Suite 100 Plymouth Meeting, PA 19462 610-832-3743 610-360-8639 Office Cell Life insurance and annuities offered by Metropolitan Life Insurance Company, New York, NY 10166. Securities offered by MetLife Securities, Inc., New York, NY 10166. Member NASD, SIPC The information contained in this message may be CONFIDENTIAL and is for the intended addressee only. Any unauthorized use, dissemination of the information, or copying of this message is prohibited. If you are not the intended addressee, please notify the sender immediately and delete this message. of the information, or copying of this message is prohibited. If you are not the intended addressee, please notify the sender immediately and delete this message. 1 IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: ESTATE OF VIVIAN E. BRENSINGER, Late of Upper Allen Township, Cumberland County, Pennsylvania, deceased Estate No. 2004-01157 DISCLAIMER I, BARRY L. BRENSINGER, hereby declare that I am the son of Vivian E. Brensinger, who died on November 15,2004. Pursuant to Item 4 of the decedent's Last Will and Testament dated January 20, 1998, I am entitled to receive one-half (1/2) of the residue of my mother's estate. I hereby irrevocably and completely disclaim and refuse to accept any and all rights, title and interests that I am entitled to receive with regard to the one-half (112) interest in the residuary estate. I hereby state and certify that I have not heretofore accepted any benefits or interest in the said residuary estate. This document is intended to qualify as a disclaimer under Section 2518 of the Internal Revenue Code of 1954, as amended, and under Chapter 61 of the Pennsylvania Probate, Estates and Fiduciaries Code. Dated this 2 t:=i2 day of Atu",,1 ./ ,2005. Witness: SEAL) ~~ d ~ \\\\\\\I\,IIIIIIJI//, ~\' X;. KREo\,!1. ~/~ *,.,..rp ......,. D-f. ~ ~!I,.......:<.'~rE o;'::.,.1S' ~ Sc;j/'b ~~. .'. ~ $I : ~ ~ :: ==: rJPIES ::: =: "wL3. UJ: S ii \~ .-n ~.: ;:: ~ .<C'\. 1)1'#' ~.();:: ~ '.;" "A..e'O...." ~ .-.. A. ..... "'T.' ~ ~ ~.,..O.:.........~~ ~ ~" ' -'\RY ~ ",,#, 11/111111111\\\\' ,-.., ~, ;:::;-:, ~, n cj =-~.. c: G-,) (} ''''! ;-.. N = ~, -,i'l" ie; ~) , __".J C') r:l - C-J (, -~;~ -' -': C~) '_. rTl 'J)c:-) il Vi ACKNOWLEDGMENT STATE OF 55. COUNTY OF On this 2d day of Jlj,-'f' U} t ' 2005, before me, the undersigned officer, a Notary Public in and for the said county and state, personally appeared Barry L. Brensinger, who, being duly sworn according to law, deposes and says that the facts set forth in the foregoing Disclaimer are true and correct to the best of his knowledge, information, and belief and that he executed the same as his voluntary act and deed for the purposes therein contained. (i)<>-- \ ~o . Notary Pu c a~ 1.\",,;":i,III/ ~'\" ~ ~HE 1//0.: "''h~~...''''',,?!/() ~ ~,'...'V,rEo,.:',~cl'~ ,. . ,fir{. ". ~ : oour'lt~1OtI ~ ~ i ~ ::: .. ~ -- '~_3. 'h: ie " ~- ~ \ ..,~: lit <f&:."~Iod'!,,",CI Af ~~ .."..~""" ~/~,.;"""",~ 2 ,iI/Ji>" IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION In Re: ESTATE OF VIVIAN E. BRENSINGER, Late of Upper Allen Township, Cumberland County, Pennsylvania, deceased Estate No. 2004-01157 CERTIFICATE OF SERVICE I, Jeffrey A. Ernico, Esquire, Attorney for the Estate of Vivian E. Brensinger, hereby certify that on today's date I delivered a true and correct copy of the fully executed and acknowledged Disclaimer of Barry L. Brensinger via first class, postage prepaid mail, addressed to: Terry L. Brensinger, Executor Estate of Vivian E. Brensinger 838 Division Street Grantham, PA 17027 , Dated this ~~ day of w9c 429255v1 3 METTE. EVANS & WOODSIDE A PROFESSIONAL CORPORATION ATTORNEYS AT LAW JEFFREY A. ERNICO 3401 NORTH FRONT STREET P.O. BOX :59:50 HARRISBURG, PA 1'7110-09:50 DIRECT DIAL (717) 231-5206 IRS NO. 23-198:500:5 EMAIL ADDRESS jaernico@mette.com TELEPHONE (717) 232-:5000 FAX (717) 236-1816 HTTP://WWW.METTE.COM January 10, 2006 Via Certified Mail Return Receiot Reauested Glenda Farner Strasbaugh Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, P A 17013 Re: Estate of Vivian E. Brensinger File No. 21-04-1157 Dear Ms. Strasbaugh: Enclosed for filing are the following documents: 1. The original and one (1) copy of a Supplemental Inventory; 2. The original and one (1) copy of a Supplemental Pennsylvania Inheritance Tax Return, plus a copy of the cover page; 3. A check payable to "Register of Wills, Agent" in the amount of$384.29 in payment of the Inheritance Tax owed; 4. Our check in the amount of$30.00 in payment of your filing fees; and 5. A postage prepaid envelope for return mail. Please file the Inventory and Inheritance Tax Return. Please return a date-stamped copy of the Inventory and the cover page of the Inheritance Tax Return, along with your receipt for the Inheritance Tax payment, to my attention in the enclosed envelope. Wyomissing Office 11105 Berkshire Boulevard, Suite 320 I Wyomissing, PA 19610 I Telephone (610) 374-11351 Facsimile (610) 371-9510 January 10, 2006 Page 2 Please do not hesitate to call with any questions. Thank you for your assistance. Very truly yours, r'N) . ~. \/ 1 \,.,.>>..0 (~ \l rv, () ~ Lisa J. Kno e Paralegal to e frey A. Emico LJK: Enclosures 440754vl COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BRENSINGER TERRY L 838 DIVISION ST GRANTHAM, PA 17027 -------- fold ESTATE INFORMATION: SSN: 192-20-4129 FILE NUMBER: 2104-1157 DECEDENT NAME: BRENSINGER VIVIAN E DATE OF PAYMENT: 01/11/2006 POSTMARK DATE: 01/11/2006 COUNTY: CUMBERLAND DATE OF DEATH: 11/15/2004 NO. CD 006195 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $384.29 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: EST OF VIVIAN E BRENSINGER TERRY L BRENSINGER CHECK# 524 SEAL INITIALS: CM RECEIVED BY: REGISTER OF WILLS $384.29 GLENDA FARNER STRASBAUGH REGISTER OF WILLS Register of Wills of Cumberland County, Pennsylvania SUPPLEMENTAL INVENTORY Estate of Vivian E. Brensinger No. 2004-01157 also known as Date of Death November 15, 2004 late of Upper Allen Township, Cumberland County, Pennsylvania, , Deceased Social Security No. 192-20-4129 Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the personal assets wherever situate and 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. IMle verify that the statements made in this Inventory are true and correct. IMle understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: Jeffrey A. Ernico, Esquire Personal Representative: er, Executor 1.0. No.: 07981 Dated: Address 3401 N. Front St., PO Box 5950, Harrisburg, PA 17110 (717) 232-5000 Telephone: DESCRIPTION VALUE 1. BlackRock Funds Account Number 101-5000734169 $4,804.47 $4,409.88 2. BlackRock Funds Account Number 101-5000734151 3. BlackRock Funds Account Number 021-5000734169 $160.38 TOTAL $9,374.73 C' ,) ( ,., [',~:' (Attach Additional Sheets If Necessary) NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative, include the value of each item, but such figures should not be extended into the total of the Inventory. 438935v1 REV.1500 EX {6-DOl REV-1500 '* COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 . . '. HARRISBURG, PA 17128-0601 w ~ :lI:::$1Il ua::lI:: w~u J:oo ua:... ~al ~ < INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 04 1157 COUNTY CODE YEAR NUMBER ~ Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Brensinger, Vivian E. DATE OF DEATH (MM-DD-YEAR) 11/15/04 SOCIAL SECURITY NUMBER 192-20-4129 DATE OF BIRTH (MM-DD-YEAR) 07/19/27 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Not Applicable o 1. Original Return o 4. Limited Estate o 6. Decedent Died Testate (Attach copy of Will) o 9. Litigation Proceeds Received ~ 2. Supplemental Return o 4a. Future Interest Compromise (date of death after 12-12-82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust] o 10. Spousai Poverty Credit (date of death between 12-31-91 and 1-1-95) o 3. Remainder Return (date of death priono 12-13-82) o 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) ~ Z W o Z o ~ III W a: a: o u COMPLETE MAILING ADDRESS 3401 North Front Street PO Box 5950 Harrisburg, PA 17110-0950 NAME Jeffrey A. Ernico, Esquire FIRM NAME (Ir Applicable) METTE, EVANS & WOODSIDE TELEPHONE NUMBER (717) 232-5000 z o 5 ::> ~ a:: <( (.) W 0:: 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Joinlly Owned Property (Schedule F) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts or Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) (1) (2) (3) (4) (5) 9,374.73 (6) I '.j (7) (9) (10) (8) 1,000.00 9,314.13 (11) (12) (13) 1,000.00 8,374.73 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) (14) 8,314.13 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ ~ ::> Q., :E o (.) >< ~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) _____ x .0___. (15) 16. Amount of Line 14 taxable at lineal rate ___~,~i'.:l,T~_ x .0 ~?_._ (16) 376.86 x .12 (17) (18) (19) 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Decedent's Complete Address: STREET ADDRESS 918 Asoen Avenue Messiah Village CITY Mechanicsburg I STATEpA I ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1 ) 376.86 Total Credits (A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (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. (5) (5A) (58) 376.86 7.43 B. Enter the total of Line S + SA. This is the BALANCE DUE. 384.29 Make Check Payable to: REGISTER OF WILLS, A GENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes a. retain the use or income of the property transferred; .......................................................................................... 0 b. retain the right to designate who shall use the property transferred or its income; ............................................ 0 c. retain a reversionary interest; or.......................................................................................................................... D d. receive the promise for life of either payments, benefits or care? ...................................................................... D 2. If death occurred after December 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?.............. D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? .......... .............................................................................................. ....... ......... ~ No [K] [K] ~ IiJ [K] [K] D 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' 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 rsonal representative is based on all information of which preparer has any knowledge. ;:;~L_ ~SIBLE 'pR FILING RE'"",,-__ . _____ _ . ____ .... _____ ~38 DIvisionStreet, Grantham, PA 17 ________,,____~________,_______ ___.,_____________________ ___.__________ SIGNATURE OF PA SENTATIVE --- Front Street, PO Box 5950, Harrisburg, PA 17110-0950 D~T7 -![J-l O,~___, DATi \ \ \ 0 00 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 PS. 99116 (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. 99116 (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. 99116(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. S9116(1.2) [72 P.S. s9116(a}(1)], The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 PS. 99116(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-1503 EX+ (6-98. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Vivian E. Brensinger FILE NUMBER 21-04-1157 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION BlackRock Funds Account Number 101-5000734169 VALUE AT DATE OF DEATH 3. BlackRock Funds Account Number 021-5000734169 4,804.47 4,409.88 160.38 2. BlackRock Funds Account Number 101-5000734151 TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 9,374.73 REV-1511 EX+ (12-99). COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Vivian E. Brensinger FILE NUMBER 21-04-1157 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: 1. B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees 1,000.00 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 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 1,000.00 REV-1513 EX+ (9-00) . COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Vivian E. Brensinger FILE NUMBER 21-04-1157 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(5) OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. Terry L. Brensinger - 50% Residue Son 4,187.37 2. Camon A. Brensinger - 25% Residue Grandson 2,093.68 3. Evelyn A. Brensinger - 25% Residue Granddaughter 2,093.68 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DiSTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX is NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 0.00 (If more space is needed, insert additional sheets of the same size) .' Jf=lN-03-2006 14: 01 December 28, 2005 LISA KNODE FAX #: 717-236-1816 RE: ACCOUNT #: REG1STRATION: ACCOUNT #: REGISTRAT10N: REFERENCE #: Dear Ms. Knode; PFPC INC. 401 721 8509 P.02 BLACKRoCK BLACKROCK FUNDS 021/101-5000734169 J GORDON BRENSINGER VIVIAN E BRENSINGER IT TEN 101-5000734151 J GORDON BRENSINGER VIVIAN E BRENSINGER IT TEN 6322536852 We are writing in regard to your recent telephone conversation you had with one of our service representatives. As of the close of business On November 15, 2004, the above referenced. accounts were valued as follows; Account Number 021.5000734169 101-5000734169 101-5000734151 Share Balance 14.714 237.963 218.419 NA Y Price Per Share $10.90 $20.19 $20.19 Market Value $160.38 $4,804.47 $4,409.88 As changing market conditions may cause the Net Asset Value (NA V) to fluctuate on a daily basis, the account value is subject to change. Please note that the above accounts were transferred from the Blackrock SSR Mid Cap Value Class A Fund on January 28, 2005. If you have any questions, please contact Shareholder Services at 1-800-441-7762. Our representatives are available Monday through Friday between 8:00 a.m. and 6;00 p.m. Eastern Time and will be pleased to assist you. We also invite you to visit our website at www.blackrockcom. Sincerely, h-#'~ :"Ad /~-"J Brian Mercc..T Investor Services Associate BlackRock Funds clo PFPC, Inc. P.O.Box 9819 Providence, RI 02940 TeI800.441.n62 TOTAL P.02 . .-~;- ;~~~~;:~~~~; ,-'. .' ..... '\ ~ \ ,', - -) c:,.. (,::~- \\\\\:,': ~ \ \ \ \ \ "-..:' \ \"< ,"'..., ~i~'j ..,..L'T'" V\\~I~ .~~ .".., ~_.' , r.i J. . r .-_.~.... i '~,' \ \/'<' i ~~,I \ UJ - \-~... ~ ;' J. ' ,\ ,/ I.;. .... cO ITl S cO S .J] cO ITl ITl ~ Cl - Cl - - - Cl - - Cl - S ~ iiiiiiiii ITl ~ a- ~ a- -i Cl I"- 7106 JMl I ......\ /: ' ~~ i .. ....-_..) I i 32 (H:- '/ ;,- ~ 85 ~ ~ OOt-l ~ 10 ~~ ~ $ o~~~ S Op..~OO~'I""l ~~~z~~ ~oooo~~ OOH>t~O ~ Z~~~=Cl ~o~~o~ ~~~~~~ "'~~z s: E~<~ ~ ~p.. ~ == ~< ~ CJ:l ~ o ::D iJ:l o E-I ~ ~~ i=Q oP::: u:l~ c.:>::!1 ~("I') u:l>-O'~ E-IHE-ICJ:lO u:lHZ r-... H~~..-I P:::;30u:l ~ c.:>~ Z~ O~ P::OOiJ:lP-< ~P:::~~~ ~H~H ~E-IP:::Ou:l Ou:l~c.:>H ZHi=Q H ~0::E:~P::: H::3PZ~ 0.....c.:>Oc.:> .l!, <5 E-c 02-28-2006 BRENSINGER 11-15-2004 21 04-1157 CUMBERLAND 101 APPEAL DATE: 04-29-2006 (See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE --+ RETAIN LOWER PORTION FOR YOUR RECORDS +-- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-0S) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX VIVIAN E FILE NO. 21 04-1157 ACN 101 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX : I DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN JEFFREY A ERNICO METTE ETAL PO BOX 5950 HARRISBURG ESQ PA 17110-0950 ESTATE OF BRENSINGER REV-1547 EX AFP (06-05) VIVIAN E TAX RETURN WAS: (X) ACCEPTED AS FILED CHANGED DATE 02-28-2006 If an assessment 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. 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 RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Stock/Partnership Interest (Schedule C) (3) 4. Mortgages/Notes Receivable (Schedule D) (4) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule f) (6) 7. Transfers (Schedule G) (7) 8. Total Assets NO. 01 .00 9.374.73 .00 .00 .00 .00 .00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequestsj Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 1,000.00 .00 NOTE: (15) (16) (17) (18) .00 366,302.77 .00 .00 x 00 = X 045 = X 12 = X 15 = NOTE: To insure proper credit to your account, submit the upper portion of this form with your tax payment. 9,374.73 (11) (12) (13) (14) 1.000 on 8,374.73 .00 366,302.76 (19)= .00 16,483.62 .00 .00 16,483.62 TAX CREDITS: ~ ..-. ,,-, .--. . l+J AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 02-15-2005 CD004956 631.58 12,000.00 06-30-2005 CD005514 .00 3,475.18 01-11-2006 CD006195 7.43- 384.29 TOTAL TAX CREDIT 16,483.62 BALANCE OF TAX DUE .00 INTEREST AND PEN. .49 TOTAL DUE .49 . If PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION Of ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. , IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE V A REFUND. SEE REVERSE SIDE Of THIS FORM fOR INSTRUCTIONS.) PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF THE ESTATE IS NOT COMPLETED, FILE A 6.12 FORM YEARLY UNTIL COMPLETION. STATUS REPORT UNDER RULE 6.12 Name of Decedent: VIVIAN E. BRENSINGER Date of Death: November 15, 2004 Will No. 2004-01157 Admin. No. 21-04-1157 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate. 1. State whether administration of the estate is complete: Yes ~ No D 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes D No [gJ b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes [gJ No D d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and l~:llY be attached to this report. ~~...... /C.'.._- ..../ . Date: ~ature ./ Jeffrey A. Ernico, Attorney LD. #07981 Name (Please type or print) 3401 North Front Street, P.O. Box 5950 Address Harrisburg, PA 17110-0950 (717) 232-5000 Telephone Capacity: D Personal Representative [gJ Counsel for Personal Representative 450746vl