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Home My WebLink About07-02-13 (2) � 1505611184 REV-1500 EX(oa-u)(FI) � OFFICIAL USE ONLY PA Department of Revenue P�� County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 Po eox s8o6o1 RESIDENT DECEDENT �,I ' � �>`� �� Harrisburg PA i�i2&o6oi ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY Suffix Decedent's First Name MI BROMMER MARY E (If Appllcable)Enter Surviving Spouse's Infortnatfon Below � Spouse's Last Name Suffix Spouse's First Name MI , Spouse'a Social Securiry Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVAL3 BELOW + � 1.Original Retum Q 2. Supplemental Retum Q 3. Remainder Retum(date of death prior to 12-13-82) ' Q 4.Limited Estate Q 4a. Future Interest Compromise(date of Q 5. Federal Estate Tax Retum Required death after 12-12-82) Q 6. Decedent Died Testate 0 7. Decedent Maintained a Living Trust _ 8. Total Number of Safe Deposit Boxes (Attach Copy of WIII) (Attach Copy of Trust) Q 9.Litigation Proceeds Received O 10.Spousal Poverty Credit(date of death p 11. Election to tax under Sec.9113(A) between 12-31-91 and 1-1-95) (Attach Schedute O) CORRESPONDENT- THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE UtRECTED T0: Name Daytime Telephone Number KELLY FINANCIAL SERVICES INC 71�.0774 . 7�:36 �� (xR , ISTER OIF-YIIILL3-� �NLY � � C"'� ' . ' =� �' � ' f'='E t� �-w F's'. �`� �...w First line of address ;� G� wr;, � ° .�_ : �z� �. _. 400 BRIDGE STREET, SUITE #4 �" '�, '� � '" - ' ,-� � , Second line of address ��> L== R� -_: �:7 •-- ►--' �Y�7 . � �� _.� C► City or Post Office State ZIP Code '"'" D�FILED `s7 NEW CUMBERLAND PA 17070 Correspondent'a e-mail address:FRANKKELLY@KELLYTAX.COM U er akies ot pery'ury,I declare that I have examined this retum,including accompanying schedules and statements,and to the best of my knowledge and belief, it i true, and complete.DeGara n preparer other than th personal representative is based on all information ot which preparer has any knowledge. SI RE R'�RS R�$P,ONSI OR FILING RETURN DATE N�`. 07 . 02 . 2013 ADDRESS 3016 MAYFRED LANE CAMP HILL PA 17011 ATU EP R THAN REPRESENTATNE DATE 07 . 02 .2013 A 0 BRIDGE STREET, SUITE #4, NEW CUMBERLAND, PA 17070 PLEASE USE ORIGINAL FORM ONLY Side 1 � 1505611184 1505611184 � �Z�� 1505611284 REV 1500 EX(FI) pecedenYs Social Security Number �ecedent's Name:MARY E BROMMER RECAPITULATION 1. Real Estate(Schedule A). .. . .. . ... . ..... ...... .. . .. ... ... .. ..... . .. .. 1. . 2. Stocks and Bonds(Schedule B) .. . . ... .. ...... ..... .. . .. . ..... .. .. .... 2. 12 O, 9 9 9.0 0 3. Closey Held Corporation,Partne�ship or Sole-Proprietorship(Schedule C) ... .. 3. . 4. Mortgages and Notes Receivable(Schedule D) . .. ...... . .... . . .. ... .. . .. . 4. . 5. Cash,Bank Deposits and Miscellaneous Personal Property(Schedule E). ...... 5. 6 3, 6 7 3.0 0 6. Jointly Owned PropeAy(Schedule F) O Separate Billing Requested .. . .. . . 6. . 7. Inter-vvos Transfers&Miscellaneous Non-Probate Property (Schedule G) O Separate Billing Requested..... ... 7. 5 2, 3 8 0.0 0 8. Total Gross Assets(total Lines 1 through 7)........... ... .. ....... ... ... 8. 2 3 7, 0 5 2.0 0 9. Funeral Expenses and Administrative Costs(Schedule H). . .. ... ....... . . . .. 9. 2 4, 2 7 8•0 0 10. Debts of Decedent, Mortgage Liabilities,and Liens(Schedule I) .. ..... .. . ... . 10. 7 7.0 0 11. Total Deductions(total Lines 9 and 10)... .. .... ....... ... ... .. .. .. . ... . 11. 2 4, 3 5 5.0 0 12. Net Value of Estate(Line 8 minus Line 11) . .... .. .. .. ... ....... ... .. .... 12. 212, 6 9 7.0 0 13. Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made(Schedule J) . ... .. ... ... .. ... .. ... ... 13. . 14. Net Value SubJect to Tax(Line 12 minus Line 13) . .. ..... .. . ..... .. .. ... . 14. 212, 6 9 7.0 0 TAX CALCULATION-SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate,or transfers under Sec. 9116 (a)(�.2)x.o45 212, 697. �5. 9, 571.37 16. Amount of Line 14 taxable at lineal rate X.0_ . 16. . 17. Amount of Line 14 taxable at sibling rate X.12 . 17. . 18. Amount of Line 14 taxable at collateral rate X.15 • 18. . 19. TAX DUE ........ .. . .. .. .... . .. . .. .. . .. .. .. .. .. ... .... ... .. ... .... 19. 9, 571.37 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 � 1505611284 1505611284 � REV-1500 EX(FI) Pape 3 fii�Number 21. 13.0 3 4 4 Decedent's Complete Address: DECEDENTS NAME Mar E Brommer STREETADDRESS 3016 Ma fred Lane CITY STATE ZIP Cam Hill PA 17011 Tax Payments and Credits: 1. Tax Due(Page 2,Line 19) ��) 9, 571.3" 2. Credits/Payments A.Prior Payments B.Discount Total Credits(A+B) (2) 0.0( 3. Interest (3) 4. If Line 2 is greater than Une 1 +Une 3,enter the difference. This is the OVERPAYMENT. Fili in oval on Page 2,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. (5) 9, 571.3" Make check payable to: REGISTER OF WILLS, AGENT. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred:.......................................................................................... ❑ � b. retain the right to designate who shall use the property transferred or its income:............................................ ❑ Q c. retain a reversionary interest .......................................................................................................................... ❑ � d. receive the promise for�ife of either payments�benefits or care?...................................................................... ❑ � 2. If death occurred after Dec.12,1982,did decedent transfer property within one year of death without receiving adequate consideration?.............................................................................................................. � ❑ 3. Did decedent own an"in trust for"or payable-upon-death bank account or security at his or her death?.............. ❑ � 4. Did decedent own an individual rebrement account,annuity or other non-probate property,which contains a beneficiary designation? ........................................................................................................................ ❑ � IF THE ANSWER TO ANY OF THE ABOVE QUESTiONS IS YES,YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994, and before Jan. 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spous� is 3 percent[72 P.S.§9116(a)(1.1)(i)]. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviv ing spouse is 0 percen [72 P.S.§9116(a)(1.1)(ii)j. The statute dces not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets anc filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1,2000: . The tax rate imposed on the net value of transfers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, ar adoptive parent or a stepparent of the child is 0 percent[72 P.S.§9116(a)(1.2)�. . The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal benefiaaries is 4.5 percent,exc ept as noted in[72 P.S.§9116(a)(1)j. • The tax rate imposed on the net value of t�ansfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)].A sibling is definec under Section 9102,as an individual who has at least one parent in common with the decedent,whether by blood or adoption. REV-1502 EX+(01-10) pennsylvania SCHEDULE A DEPARTMENT OF IIEVENUE REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OR FILE NUM$ER Mary E Brommer 21. 13.0344 All re�l property own�d:ohly or as a tenent In common muK bs roported at feir ma�ket value.Fair market value is deRned as the price at which property would be exchanged between a willing buyer and a wflling seller,netther being compelfed to buy or seti,both having reasonable knowledge of the relevant fads. Raal property thst b iointlyowned wkh riqht of survlvonhip must b•dl�lo:ed on Schedule F. Attach a copy of the settlement sheet if the property has been soM. �M Include a copy of the deed showfng decedenYs interest if owned as tenant in common, VALUE AT DATE NUMBER OF DEATH DESCRIPTION 1, None TOTAL(Also enter on Line 1, Recapitulation.) � If more space is neede0,insert additional sheets of the same size. m.e„�a..�..=�:� _ . _ _ . .,�, _. _ __ REV-1503 EXi(&12) - pennsylvania SCHEDULE B DEPARTMENT OFREVENUE � INHERITANCE TAX RETURN STOCKS & BONDS RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary E Brommer 21. 13.0344 All properly jolntly owned with right of survNorahip muat be diaclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH �• H D Vest Investment Account 120, 999 TOTAL(Also enter on line 2,Recapftulation) ; 12 0, 9 9 9.0 0 Ii more space is needed,insert additional sheets of the same size REV 1504 EX+(8-88) SCHEDULE C CLOSELY-HELD CORPORATION, COMMONWEALTH OF PENNSYLVANIA PARTNERSHIP OR INHERITANCE TAX RETURN SOLE-PROPRIETORSHIP RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary E Brommer 21.13.0344 Schedub C-1 or C-2(including all supporting information)must be altached for each closeyheld corporation/partnership interest of the decedent,other than a sole-proprietorship.See instructions for the supporting information to be submitted for sole-proprietorships. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None TOTAL(Also enter on line 3,Recapitulation) $ (If more space is needed,insert additional sheets of the same s¢e) REV-1505 EX+(11-11) °y�� pennsylvania SCH E DU LE G 1 DEPARTMENT OF REVENUE CLOSELY-HELD CORPORATE INHER[TANCE TAX RETURN STOCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary E Brommer 21.13.0344 1. Name of Corporation None State of IncorporaUon Address Date of Incorporation City State ZIP Code Total Number of Sharehoide�s 2. Federal Employer ID Number Business Reporting Year 3. Type of Business ProducUService 4• TYPE T07AL NtlMBER QF NUMBER-0F SHARES VALUE OF THE STOCK yoqngMlon�Votiny SHARES OUTSTANDING PAR VALUE OWNlD BY THE DECEDENT DECEDENT'S STOCK Common S P��, a Provide all rights and restrictions pertaining to each class of stock. 5. Was the decedent employed by the corporation? . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No If yes, Position Annual Salary $ Time Devoted to Business 6. Was the corporation indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ❑Yes ❑No If yes, provide amount of indebtedness$ 7. Was there life insurance payable to the corporation upon the death of the decedent? . . . . . ❑Yes ❑No If yes, Cash Surrender Value$ Net proceeds payable$ Owner of the policy 8. Did the decedent sell or transfer stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? �Yes O No If yes, O Transfer ❑Sale Number of Shares Transferee or Purchaser Consideration$ Date Attach a separate sheet for additional transfers and/or sales. 9. Was there a written sharehotder's agreement in effect at the time of the decedenYs death? ... . �Yes ❑No If yes, provide a copy of the agreement. 10.Was the decedenYs stodc sold? ......... ....... . .... .............................. .. ❑Yes ❑No If yes,provide a copy of the agreement of sale,etc. 11. Was the corporation dissolved or liquidated after the decedenYs death? .......... .... .... .. O Yes ❑No If yes,provide a breakdown of distributions received by the estate,including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? . . . . . . . . . . . . . ❑Yes ❑No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • •� � • � � A. Detailed calculations used in the valuation of the decedenYs stodc. B. Complete copies of financial statements or federal corporate income tax retums(Fortn 1120)for the year of death and four preceding years. C. If the corporation owned real estate,submit a list showing the complete address/es and estimated fair market value/s.If real estate appraisals have been secured,attach copies. D. List of principal stodcholders at the date of death,number of shares held and their relationships to the decedent. E. List of officers,their salaries, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relatir�g to the valuation of the decedenYs stock. (If more space is needed,insert additional sheets of the same size.) REV-1506 EX+ (12-11) "'�' pennsylvania SCHEDULE G2 OEPARTMENT OF REVENUE PARTNERSHIP INHERIfANCETAXFtETUfiN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER Mar E Brommer 21.13.0344 1. Name of Partnership None Date Business Commenced Address Business Reporting Year ��ty State ZIP Code 2. Federal Employer ID Number 3. Type of Business Product/Service 4. Decedent was a D General ❑Limited partner. If decedent was a limited partner, provide initial investment$ 5• PARTNER NAME PERCENT PERCENT BALANGE OF QF INCOME OF OWNERSHIP CAPITAL AGCOUN7 A. B. C. D. 6. Value of the decedenYs interest$ 7. Was the partnership indebted to the decedent? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 Yes ❑No If yes, provide amount of indebtedness$ 8. Was there life insurance payable to the partnership upon the death of the decedent? ... ... ❑Yes O No If yes,Cash Surrender Value$ Net proceeds payable$ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ❑Yes ❑No If yes, O Transfer ❑Sale Percentage transfened/sold Transferee or Purchaser Consideration$ Date Attach a separate sheet for additional transfers and/or sales. 10.Was there a written partnership agreement in effed at the time of the decedenYs death? .. .... ❑Yes ❑No If yes, provide a copy of the agreement. 11. Was the decedenYs paMership interest sold? ........ ........ .................... ..... ❑Yes ❑No If yes,provide a copy of the agreement of sale,etc. 12.Was the partnership dissolved or liquidated after the decedenYs death? .................. .. ❑Yes O No If yes,provide a breakdown of distributions received by the estate,including dates and amounts received. 13.Was the decedent related to any of the partners? ....... .... .... ....................... ❑Yes ❑No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships?........... . .. . 0 Yes ❑No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. • • •- � • � � A. Detailed calculations used in the valuation of the deoedenYs partnership intenest. B. Complete copies of finanaal statements or federal partnership income tax retums(Form 1065)for the year of death and four preoeding years. C. If the partnership owned real estate,submit a list showing the complete address/es and es6mated fair market value/s.If real estate appraisals have been secured,attach copies. D. Any other information relating to the valuation of the decedenYs partnership interest. REV-1507 EXi(8-98) SCHEDULE D MORTGAGES � NOTES COM NHERV ITANCE�TAX RETURNAN� RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER Mar E Brommer 21.13.0344 All propaRy JoinUy-owned with right of aurvivorahip muat be disctosed on Schedula f. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. None TOTAL(Also enter on line 4,Recapitulation) ; (If more space is needed,insert addftional sheets of the same size) REV-1508 EX+(OB-12) N pennsylvania SCNEpuLE ! � DEPARTMENT OF REVENUE CASH, BANK DEPOSITS 8� MISC. INHERRANCE TAX RETURN PERSONAL PROPERTY kESIDENT DECEDENT ESTATE OF: FILE NUMBER: Mary E Brommer 21. 13.0344 Include the proceeds of Iitlgation and the date the proceeds were received by the estate. All property iointty owned with right of survivorship must be disclosed on Schedule F. �M VALUE AT DATE NUMBER DESCRIP'T10N OF DEATH 1. Citizens Bank Account 1000523045635 63,273 2. Personal Property - minimal as the deceased lived with her son and daughter-in-law. The deceased had linens and clothing and some small personal items. The reported amount is what was 300 received from a consignment shop. 3. Gold plated wedding band 100 TOTAL(Also enter on Line 5, Recapitulation) ; 63, 673.00 If more space is needed,use additional sheets of paper of the same size. REV 1509 EX+(01-10) � pennsylvania SCHEDULE F DEPARTMENT OF REVENUE JOINTLY-OWNED PROPERTY [NHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Mary E Brommer 21. 13.0344 If an aaaet was made)oiM within one yesr of the decedent'a date of death,it m uat be reported on Schedule G. SURVIVING JOINTTENANT(S)NAME ADDRESS RELATIONSHIPTO DECEDENT A• None B. C. JOINTLY-0WNED PROPERTY: LETTER OATE DESCRIPTION OF PROPERIY %OF DATE OF DEATH ITEM FOR JOINf MADE WCLUDE NAME OF FINANCLIL INSTRUTIONAND BANKACCOUNT NUMBER OR SIMILAR DATE OF DEATH DECEDENTS VALUE OF NUMBER TENANT JOINT IDENTIFYING NUMBER.ATTACH DEED FOR,pINTIY+IELD REAL ESTATE. VALUE OF ASSET INTERES7 OECEDENTS INTEREST 1. A. TOTAL(Also enter on line 6,Recapitulation) S (if more space is needed,insert additional sheets of the same size) REV-1510 EX+(08-09) �� - pennsylvania SCHEDULE G DEPARTMENT OF REVENUE INTER-VIVOS TRANSFERS � INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF FIIE NUMBER Mary E Brommer 21.13.0344 This schedub must be completed and fAed if the answer to any of questiona t through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY ITEM INCLUDE THE NAAtE OF THE TRANSFEREE,THEIR REUTIONSHIP TO OECEDENTAND DATE OF DEATH °h OF DECD'S EXCLUSION TAXABLE NUMBER THE DATE OF TRANSFER.ATTACH A COPV OF THE DEED FOR REAL ESTATE. VALUE OFASSET INTEREST (IF APPLICABLE) VALUE t. Transfer on 12.06.12 from HDV Account 7903.6052 52, 380 100 052, 380.00 to HDV Account 1646. 1975 Account for Robert Brommer. TOTAL(Also enter on line 7,Recapitulation) = 5 2, 3 8 0.0 0 (If mwe space is needed,insert additional sheets of the same s¢e) Rev-�s��ex+��aoa> SCHEDULE H pennsylvania FUNERAL EXPENSES 8� DEPARTMENT OF REVENUE [NliER1TANCE TAX 0.ENRN ADMINISTRATIVE COSTS RESIDENf OECEDENT ESTATE OF FILE NUMBER Mar E Brommer 21.13.0344 Debb of dec�M m�ut b�roporbed on Schedule[. �M DESCRIPTION AMOUNT NUMBER A. FUNERAL EXPENSES: �� Clyde W Kraft Funeral Home Inc. , Columbia, PA 17512 Funeral 14, 133 2. Clyde W Kraft Funeral Home Inc. , Columbia, PA 17512 Tombstone 125 e. ADMINISTRATNE COSTS: 1. Persooal Repreae�ative's Commasans Name of Personal RepreseMative(s) StreetAddress ��, State ZIP Year(s)Commiaabn Paid: 2. Attomey Fees 3. Famiy Exemptbn:(H decedent's address is not the same as claimanYs,attach explanation) 3,5 0 0 Claimant Robert Brommer StreetAddress 3016 Mayfred Lane Cily Camp Hi 11 State PA ZIP 17 O 11 Relatbnship of Claimant to Decedent S on 4. Probate Feea 3 9$ 5. Accountar�'s Fees 3, 5 5 7 6. Tax Retum Preparer's Fees 67 4 7. Wake Fees - food, hall etc 76� 8. Clyde W Kraft Funeral Home - Excess costs Minister etc 910 9. Clyde W Kraft Funeral Home - Excess Costs for Flowers 64 10 Cumberland County Law Journal 75 11 Patriot News Advertising 75 TOTAL(Also enter on line 9,Recapitutation) s 2 4,2 7 8.0 0 (If more space is needed,insert additional sheets of the same size) REV-1512 EX+(12-08) � �y pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, INNERITANCE TAX iiETURN MORTGAGE LIABILITIES 8� LIENS RESIDENT OECEDENT ESTATE OF FILE NUMBER Mary E Brommer 21,_13.0344 Report debta incuned by the decedent prior to death that remained unpatd at the date of death,inciudtng unreimbursed medical expense�. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Spirit Physicians, Camp Hill, PA �� TOTAL(Also enter on Line 10, Recapitulation) ; 77.00 If more space is needed,insert additional sheets of the same size. REV-1513 EX+(01-10) pennsylvania SCHEDULE ] OEPARTMENT OFREVENUE INHERITANCE TAX RETUitN BENEFICIARIES RESIDENT DECEDENT ESTATE OF: FILE NUMBER: Mar E Brommer 21.13.0344 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S)RECEIVING PROPERTY Do Not Ltat Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS(Include outright spousal distributions and transfers under Sec. 9116(a) (1.2),] 1. Robert Brommer 50 3016 Mayfred Lane Camp Hill, PA 17011 2. Barry Brommer 50 7505 West Ave Melrose Park, PA 19027 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV•1500 COVER SHEET,AS APPROPRIATE. II NON-TAXABLE DISTRIBlITI0N5 A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 fOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. # If more space is needed, use additional sheets of paper of the same size. REV-1514EX+(4-09) SCMEDYL� K i � pennsylvania DEVANTMENT OF REVENUE LIFE ESTATE,ANNUITY BureauofIndlvidualTaxes &TERM CERTAIN PO Box s8060i Harrisbu�g PA s�u8-o6oi (CHECK BOX 4 ON REV•�50o COVER SHEEn ESTATE OF FILE NUMBER Mary E Brommer 21. 13.0344 This schedule should be used for all single-life,joint or successive Ufe estate and term-certain calculations. For dates of death pnor to 5-1-89, actua�ial factors for single-life calculations can be obtained from the Department of Revenue. Actuarial factors can be found in IRS Publication 1457,Actuarial Values,Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5-1-99 and thereafter. Indicate below the type of instrument that created the future interest and attach a copy of it to the tax retum. ❑ Will ❑ Intervtvos Deed of Trust ❑ Other . , � NAM�`OR LIfE TENANT DATE OF BIRTH ��REST AGE A't TERM QF YEARS ' DATE OF DE14TH LIPE ESTATE tS PAYABLE None ❑ Life or ❑Term of Yea�s p Life or ❑Term of Years ❑Life or ❑Term of Years O Life or ❑Term of Years ❑Life or ❑Term of Years 1. Value of fund from which life estate is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .$ 2. Actuarial factor per appropriate table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . Interest table rate-p 3.5% p 6% ❑ 10% p Variable Rate % 3. Value of life estate(Line 1 multiplied by Ltne 2) . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . .$ , . . � NAMl�CF LIFE ANNUITANT DATE OF BIR7H NEAREST AfiE AT TERM OF YEARS DATE OF bEATH ANNUITY IS PAYABI.E ❑Life or ❑Term of Years ❑Life or ❑Term of Years ❑Life or ❑Term of Years O Life or O Term of Years 1. Value of fund from which annuity is payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .$ 2. Check appropriate block below and enter corresponding number . . . . . . . . . . . . . . . . . Frequency of payout-❑ Weekly(52) ❑ Bi-weekly(26) ❑ Monthly(12) ❑ Quarterly(4) ❑ Semi-annually(2) ❑ Annually(1) ❑Other( ) 3. Amountofpayoutperperiod . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Annuity Factor(see instructions) Interest table rate-❑3.5% ❑6% ❑ 10% ❑Variable Rate % 6. Adjustment Factor(See instructions.) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. Value of annuity-If using 3,5,6,or 10%,or if variable rate and period payout is at end of period,calculation is Line 4 x Line 5 x Llne 6 . . . . . . . . . . . . . . . . . . . . . . . . . . .$ If using variable rate and period payout is at beginning of period, calculation is (Line4xLineSxLine6) + Line3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ NOTE; The values of the funds that create the above future interests must be reported as part of the estate assets on Schedules A through G of the tax retum.The resulting life or annuity interest should be reported at the appropriate tax rate on Lines 13 and 15 through 18 of the retum. If more space is needed,use additional sheets of the same size. REV-1844 EX+(Ot-10) �'pennsylvania lNHERITANCE TAX DEPANTMENTOFREVENUE SCHEDULE L INHERITANCETAXRETURN REMAINDER PREPAYMENT RESIDENTDECEDENT OR INVASION OF TRUST CORPUS I. ESTATE OF FILE NUMBER Mar E Brommer 21. 13.0344 This schedule ts appropriate only for estates of decedents dying on or before Dec. 12, 1982. This schedule is to be used for all remainder returns when an election to prepay has been filed under the provisions of Section 714 ot the Inherttance and Estate Tax Act of 1961 or to report the invasion of trust corpus (principal). II. REMAINDER PREPAYMENT: A. Election to Prepay Filed with the Register of Wills on None (Date) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Yea�s Income or Annuitant(s) of Election or Annuity is Payable C. Assets: Complete Schedule L-1 1. Real Estate . . . . . . . . . . . . . . . . . . . . . . . . . . .$ 2. Stocks and Bonds . . . . . . . . . . . . . . . . . . . . . .$ 3. Closely Held Stock/Partnership . . . . . . . . . . . . .$ 4. Mortgages and Notes . . . . . . . . . . . . . . . . . . . .$ 5. Cash/Misc. Personal Property . . . . . . . . . . . . . .$ 6. Total from Schedule L-1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities . . . . . . . . . . . . . . . . . . . . . . .$ 2. Unpaid Bequests . . . . . . . . . . . . . . . . . . . . . . .$ 3. Value of Non Includable Assets . . . . . . . . . . . . .$ 4. Total from Schedule L-2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ E. Total Value of Trust Assets (Line C-6 minus line D-4) . . . . . . . . . . . . . . . . . . . . . . . . . . .$ F. Remainder Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . G. Taxable Remainder Value (Multiply Line E by Line F) . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) III. INVASION OF CORPUS: A. Invasion of Corpus (Month, Day, Year) B. Name(s) of Life Tenant(s) Date of Birth Age on Date Term of Years Income or Annuitant(s) Corpus or Annuity is Payable Consumed C. CorpusConsumed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .$ D. Remainder Factor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E. Taxable Value of Corpus Consumed (Multiply Line C by Line D) . . . . . . . . . . . . . . . . . . . .$ (Also enter on Line 7, Recapitulation) REV 1845 EX+(11-09) �"�� ,�pennsylvania zNHERiTAr�cE T�►z � DEPARTMENT OF REYENUE SCH EDU LE L�� [NMERITANCETAXRETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -ASSETS- I. ESTATE OF FILE NUMBER Mar E Brommer 21. 13.0344 II. ITEM N0. DESCRIPTION VALUE A. Real Estate (Please describe.) None Total Value of Reat Estate $ (Include on Section II, Line C-1 on Schedule L.) B. Stocks and Bonds (Please list.) Total Value of Stocks and Bonds $ (Include on Section II, Line C-2 on Schedule L.) C. Closely Heid Stock/Partnership - Please list. (Attach Schedule C-1 and/or C-2.) Total Value of Closely Held/Partnership $ (Include on Section II, Line C-3 on Schedule L.) D. Mortgages and Notes (Please list.) Total Value of Mortgages and Notes $ (Include on Section II, Line C-4 on Schedule L.) E. Cash and Miscellaneous Personal Property (Please list.) Total Value of Cash/Miscellaneous Personal Property $ (Include on Section II, Line C-5 on Schedule L.) III. TOTAL (Also enter on Section II, Line C-6 on Schedule L.) $ If more space is needed, attach additional sheets of paper of the same size. REV-1848 EX+(11-09) 9�` p21111Sy�Vd11�8 INHERITANCE TAX DEPMTMENTOFREVENUE SCHEDULE L�� [NHERITANCETAXRETURN REMAINDER PREPAYMENT ELECTION RESIDENT DECEDENT -CREDITS' I. ESTATE OF FILE NUMBER Mar E Brommer 21.13.0349 II. ITEM NO. DESCRIPTION AMOUNT A. Unpaid Liabilities Claimed against Original Estate and Payable from Assets Reported on Schedule L-1 (please list) None Total Unpaid Liabilities $ (include on Section II, Line D-i on Schedule L) B. Unpaid Bequests Payable from Assets Reported on Schedule L-1 (please list) Total Unpaid Bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of Assets Reported on Schedule L-1 (other than unpaid bequests listed under"B"above) that are Not Included for Tax Purposes or that Do Not Form a Part of the Trust. Calculation as follows: Total Non Includable Assets $ (include on Section II, Line D-3 on Schedule L) III. TOTAL (Also enter on Section II, Line D-4 on Schedule L) $ If more space is needed, attach additional sheets of paper of the same size. REV•1647 EX+(02-10) pennsylvania SCHEDULE M DEPARTMENT Of REVENUE FUTURE INTEREST COMPROMISE INHERITANCE TAX RETURN RESIDENT DECEOENT (Check Box qa on REV-i$00) ESTATE OF FILE NUMBER Mary E Brommer 21.13.0344 Th(s'chedule is appropriate only for estates of decedenb who died after Dec. 12, 1982. This schedule is to be used for all future interests where the rate of tax that will be applicable when the future interest vests in possession and enjoyment cannot be established with certainty. Indicate below the type of instrument that created the future interest and attach a copy to the tax retum. ❑ Will ❑ Trust ❑ Other I. Beneflciaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1.None 2. 3. 4. 5. II. For decedents who died on or after luly 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within nine months of the decedent's death, check the appropriate box below and attach a copy of the document in which the surviving spouse exercises such withdrawal right. ❑ Unlimited right of withdrawal ❑ Limited right of withdrawal III. Explanation of Compromise Offer: IV. Summary of Compromise Offer: 1. Amountoffutureinterest . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . $ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (Also include as part of total shown on Line 13 of REV-1500.) . . . . . . . . $ 3. Value of Line 1 passing to spouse at appropriate tax rate Check one. ❑ 6%, ❑ 3%, ❑ 0% . . . . . . . . . . . . . . . . . . . . $ (Also include as part of total shown on Line 15 of REV-1500.) 4. Value of Line 1 Wxable at lineal rate Check one. � 6%, ❑ 4.5% . . . . . . . . . . . . . . . . . . . . . . . . . . $ (Also include as part of total shown on Line 16 of REV-1500.) 5. Value of Line 1 taxable at sibling rate(12%) (Also include as part of total shown on Line 17 of REV-1500,) . . . . . . . , $ 6. Value of Line i taxable at collateral rate(15%) (Also include as part of total shown on line 18 of REV-1500.) . , . . . , . . $ 7. Total value of future interest(sum of Lines 2 thru 6 must equal Line 1) . . . . . . . . . . . . . . . . . . . . . . . $ If more space is needed, use additional sheets of paper of the same size. REV-1&18EX(02-09) SCHEDULE N ` `� pennsylvanta SPOUSAL POVERTY CREDIT OEP�PTMFNT Of REVENUE PuOre�ofZ�idualTaxes FOR DATES OF DEATH Ol/Ol/92 TO 12/31/94 Hartisbu PA 1 1z8 ESTATE OF FILE NUMBER Mar E Brommer 21.13.0344 This schedule must be completed and filed if you checked the spousal poverty credit box on the cover sheet. . , . , , � � • � � 1 , Taxabie assets total from lJne 8(cover sheet) .. . . . .... .... . . . ... . . . ... . . . ... . . . . . . .. . . . . . . 1 . None 2. Insurance proceeds on life of decedent . .. . . ... . . . ... . .. . . . . . .. . . .... . . . ... . . . . . . ... . . . . . 2. 3. Redrementbenefits . . . . .. . .. . .. .. . . . . . . . . .. . .. . . . . . . .. . .. . . . . . . . . .. . . ... . . . . . . . . . . . 3. 4. Joint assets with spouse . ... .. ... .. . . . . . . . . .. . . . . . . . . . . . . . .. . . .. . . . . . . . . . .. . . . . . . . . .. 4. 5. PAlotterywinnings ... . .. . .. ... .. . . . . . . . . . . . . . . . . . . 5. . ... . . .. . . . ... . . . . . .. . . . . . . . . . . .. 6a. Other nontaxable assets: List and attach schedule if necessary . . 6a. 6b. 6c. 6d. 6. SUBTOTAL(Lines6a, b,c,d) . . ... ... .. . . . . . . . . . . . . . ... ... . .. . . . . ... . . . . . . .. . . . . . .. .. . . 6. 0.00 7, Totalgrossassets(AddLineslthru6) . . . . . . . . . . .. . . ... ... . .. . . . ... . . . ... . . . . . .. .. . . . . . . . 7. 0.00 8, Totaladualliabilities .. . ... . . . .. . . . . . . .. . . . ... ... . . . . . . . . . . ... . . .... . . . . . . . . . . .. . .. . . 8. 9. Netvalueofestate(SubtractLineBfromUne7) . . .. . . . . .. ... ... . . . . . . ... . . . . ... .. . . . ... . . . . 9. If Une 9 is greater than;200,000-STOP. The estate!s not NlgJble to dalm the credlt If not,continue ro Part IL 0.0 0 • � • � � • � • • � � � � • •� • • � � •� • � �� Income: 1. TAX YEAR:19 2. TAX YEAR: 19 3. TAX YEAR: 19 a. Spouse . , , .. . . .. . .. la. 2a. 3a. b. Decedent .. ,... ,.. . lb, 2b, 3b. c. Joint . . ... . . . . .. . . lc. 2c. 3ci d, Tax-exempt income .. , . ld. 2d. 3d. e Other income not listed above . , .. . . . . Se. 2e. 3e. f. Total lE 2f. 3f. 4, Average joint exemptlon income calculation 4a. Add joint exemption income from above: (lf) +(2f) +(3f) _ (-3) 4b.Averageiointexemptionincome . . .. . .. . .. .. . . . . . .. . .. . . . .. . . . . .... ... . . . . . . . .. . . . . . . . . . _ If line 4 b is greater than.�40,000-STOP. The estate is not eli ible to claim the credit.If not,continue to Part 111. � . • , � � � • � . • • • � • • � � � • � � 1. Insert amount of taxable transfers to spouse or$100,000,whichever is less .. . . . .. . . . . . . .. . . . . . . . . . 1. 2. Mulaply by credit percentage(see instructions) . . . .. . . . . .. . . . . . . .. . . .. ..... . . . . . . . . . .. . . . . . 2. 3. This is the amount of the Resident Spousal Poverty Credit.Include this figure in the calculation of total credits on Line 18 of the cover sheet. . . .. . . . . ... .... . . . . . . . . . .. . . .. . . 3. 4. For nonresidents,enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 5. Multiply Line 3 by Llne 4 and enter the total here.This is the amount of the Nonresident Spousal Poverty Credit.Include this figure in the calculation of total credits on Line 18 of the cover sheet. . . . . . . , . . . 5• REV-1849 EX+(8-88) SCHEDULE O COMMONWEAITH OF PENNSYWANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN (SPOUSAL DISTRfBUTIONS) RESIDENT DECEDENT ESTATE OF FILE NUMBER Marv E Brommer 21. 13.0344 Do not complete thb schedule unieaa the eatate is making tha election to tax aaseb under Secdon 9113(A)of the Inheritance�Estate Tax Act If the ebctbn appibs to more than one trust or sim�ar artangement,a separate form must be filed for each trust. This election applies to the None Trust(marital,residual A,B,By-pass,Unified Credit,etc.). N a trust or similar arrangement meeta the requirements of Section 9113(A),and: a. The tNSt or senilar artangemant ia listed on Schadub 0,and b. The velue of the trust or similar arcangement is entered in whofe or in part as an asset on Schedule 0, then the transferor's personal representative may specificaly identify the trust(all or a Iractronal portion or percentage)to be included in ihe election to have such trust or similar propeRy treated as a taxabb Uansier in this estate.It less than the entire value of the trust or similar property is included as a taxable Vansier on Schedule 0,the personal represenNative shau be considered to have made the eledion ony aa to a fraction ot the trust or similar arrangement.The numerator of this fraction is equal to the amount of the trust or similar anangement included as a taxable asset on Schedub 0.The denominator is equal to the totel value oi the trust or similar arrangement. Part A: Enter the description and value of all interests,both taxable and non-taxable,regardless of location,which pass to the decedenYs surviving spouse under a Section 9113(A)trust or similar amangement. Deacription Value Part A Total $ Part B: Enter the description and value of all interests included in Part A for which the Section 9113(A)election to tax is being made. �eacrip6on Value Part B Total $ (If more space is needed,insert additionai sheets of the same size) ��N a �'�y $ ui v�i�tL � G�1 �a �f�'0� � O � �p p� at� � � o =c� a=E � � y � �Z � � � � a > w O� u`��ui > m Z y �°n =v E� � N °tf M- � � v �n�� Z � � w w W � a ZLL� �-Mm � M � C7 � E � �oo y� �, � `- 0 � � V 'L'�'> �j W~ �y'f�0 Z yY N �°° °o � w � x ?�Z cn.�m �w r � � v (AZ � o Oaa c� � � m W W N L � N LWi.Z �OO � m � ,� 3 ��_ y � r� p � � o �ZW �•�o � � � � Om o wh � a�� Q00 �C � � O J � C^O 3� �� S U= �y�U � C `'' �� LL ~a� j a m �� C � � o � �Y� io�� z � °° m � O �W> �=tiz � � _ Z=g t,�� o �� U O�'I- � C O � .y `° � °' p �mv~i �°o�� E— '` tii m v ti � o � a w> �$F y � � y � � Q � m �, -{o m Z g tn a Q � n �' ►� `o � d a�� m�— T = z z mJ � Ew p� x � �, �ci N C Z �- � W� >o � w°0a �nO°� G a a� > > oY � L � � o00 .��,� �, � Z � V O = Z� o � o � w=o �•Z�m ° y (,� Q ¢ � t�ia w c � �mz inu�itiU Z � to .� v 0 3 � O � W Q U � — R L > ��Z9-L 60L 6 `dd lliH dW`d� y � 3N`dl a321�At/W 960£ � W 213WW0218� c � �121bt18'8 213WW02�9 W 1a3802i 001 � 2i3WW02�8 3�lb`dW � J � fA Q � �U �Z a z � '��76�� g��:E� �,�� 3� �m �� Y �� ..� �'�N s� �. � ° � � i C �� m N• A�.� � a EL(p p� �E•- � �� € C�� S•�p= �^C U�:��11'��:¢a� �8 �'s�� lL � �. � � � � �� '�� ° �� '�� ' �� a �'�g��. �� +�y� �� . � v� �s� _ �� .�� s � � � �� _ �� . .��E� �,�� .�.� c�� LL$� ,�aLL � �� -�'� o�C �'�a.G N� ��.��gs�� .�� .��», �� Cy�:�� g�. 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C;9 2Ct13 MF 5!nuestrticant M�nayerrit:n,�',MF;3''r�a�stcrEd irvesKrnent pro�urKS ar�otferx�d th�o4�gh�rti`S f=uric��::sti it;uir?�y;,Inr.:.11':N;.ir:t;ngton,.v��:iuU,3o5tor�.'i:a 0219KJ-7Fi3?. s:B;nn:P82;pn:uslnv.Producb_end_PsAormancs.VlewProductUne97;buid:;dab:Jul 01,2013 72:52:47 PM https://www.mfs.com/wps/portal/mfs/us-investor/products/mutual-funds/!ut/p/c5/04_SB 8K... 7/1/2013 MFS Pennsylvania Municipal Bond Fund Page 1 of 1 Financial Advisor/Unitstl Sfrtes Investor!Unfted Statoa Other MFS SRea r�■�+� home proxy voting careers contact us help � INre+�ItrtS►��o�n1N I Pta�ua4l� M�tla�t�utiaaiM Cl�ti�menl�,Gaii�yt�Pl�nninp ( �dt�aatfnn�Piw+ninp I Forrn��,8ppil�Mipn�4 RqautMi� MFS� PENNSYLVANIA MUNICIPAL BOND FUND Select another fund A Shares * MFS Pennsylvania MuNcipal Bond Fund • Fact Sheet Symbol:MFPAX CUSIP: 55273N798 N�wspapar Abbrovlatlon:MuPAA Fu�d number.30 Dally NAV: i10.13 (as oi 8/28/13) Characleristkx Fund Proflb Perfortnance Portfolio Management Dividends and Capital Gaina Price History Fund Reports/Prospectus Insightful Investing _ _ _ _ _ HISTORICAL NAV LOOKUP Back to Price Hirtory w►v.t�„w Historical NAV Lookup d Tradlnp on: N�t Au�t Vtlw(NA1n 3l20H3 S 10.82 Enter date tor which you wish to obtain a Historical NAV for this fund Month � Day � Year � Hfstorical NAV may not be available for all datea. Privacy 7erms of Use 8usineas Contlnuity Program Cookies Polkcy S(te Comments Careers Contact Us C"his site is intrndeU ror use by U.S.r'rsider:ts.If you are nat a;J.`.'i.res�denf:rVea>e v�s:t:'?h:r?A{`.5itr�s. �2013 MF5 Investrnent Managerr�enta'.MF 5''r�;g�ster�tl invesfinent proci�FCts ar::offered thro�i,yn Mr5 f urx�'u�5tr:butc�r�,.inc.t 1?F�urst;ngtor�;�.ve.:nu�.3eslor;.Mk 02195J'�532. s:B;nn:P82;pn:uslnv.Produ�and PeAormane�.VlewProduetLin�87;buid:;dab:Jul 01,201�12:b2:09 PM https://www.mfs.com/wps/portal/mfs/us-investor/products/mutual-funds/!ut/p/c 5/04_SB 8K... 7/1/2013 Crown Classic B�nking• Account number:100052304s63s ■ March 19,2013-April 16,2013 ■ Page 1 of 3 EODCKTDTES 020857 Qu�stionsT i�nini�i��lhli�u��nulii�ilhi��lili��n��l�l�illi�i�l��i �'''� MARY E BROMMER Available by phone 24 hours a dny,7 days a week: �� ROBERT M BROMMER POA 1-800-742-4932 3016 MAYFRED LN TTY: 1-80a877-4833 CAMP HILL PA 1 701 1-5244 En espanol: t-877-727-2932 �o� t-800-288-2288(6 am io 7 pm PT,M-F) Online:welisfargo.com Write: Wells Fargo Bank,N.A.(345) � P.O.Box 6995 Portland,OR 9722&6995 ,,, 0 0 0 � 0 -i m _ � You and Wells Fargo Account options o Thank you for being a loyal Wells Fargo customer.We value your trust in our A check mark in the box indicates you have these � company and look forward to continuing to serve you with your financial needs. convenienrse►vices wirh you►occounr. �o ro Z wellsforgo.com or call the number above if you have Z questions or if you would like to add new services. Z z Online Banking � Dired Deposit � Z Online Bill Pay � Auto Trensfer/Payment� Z z Online Statements � Overdraft Protection � Z z Mobile Banking � Debit Card Z My Spending Report � Overdreft Service � o 0 0 w w Activity summary Account number: 1000523045635 A Beginning balance on 3/t9 $63,341.18 MARY E BROMMER � Deposits/Additions p,�2 ROBERT M BROMMER POA � Withdrawals/Subtradions - 63,34130 Pennsylvnnia account te�ms and conditions apply , 0 Clodng balanc�on 3/26 sp,pp For Direct Deposit and Automatic Payments use � Routing Number(RTN): 031000503 °� w Ovordraft Protoction This account is not currently covered by Overdraft Protedion. If you would like more infwmation regarding Overdreft Protection and eligibiliry requirements please call the number listed on your statement or visit your Wells Fargo stae. Account number.10005230�1�i3S ■ March 19,2013-Aprit 16,2013 ■ Paqe 2 of 3 Int�hst summary Interfst pald this ststement 50.12 a�.ay.�a�e.a�e $63,327.19 Annusl percents9e yfeld earnad 0.01% Interest earned this statement period SO.i2 Interest paid this year S 1.66 Transactbn hlstory ChecJr Deposiis/ �Mdrawn/s/ Ending daily Onte Numbe► Descriptlon AddJtlons Su6dacNons 6alonce 3/19 iW6 CF�eck 4.90 63,336.28 ' 3/25 1W7 � � 63.60 63,272.68 3/26 Intarest Pa ment 0.12 � 3/26 Withdnwal Made In A&anch/Stae 63,272.80 �'� 0.00 Endln�bal�nc�on 4/1� 0.00 Totab s0.f2 Si3,341.30 The fnding Onily Balance does not refkct ony pending wfthdrow�als a holds on deposited funds that mcy have 6een outsta�d/ng on your accoun[when yow trartsart/orts poste�d/1 yoer had inwNkient availobk lunds when a tronsocdon posted fees moy hove ban ozsesscd Summary of cMcks writt�n(checks lisred are clso displayed in the prrceding Trcnscction history) Numbei DWte Amount Num6er Date Amount 1 W6 3/19 4.90 1047 3/25 63.60 � IMPORTANT ACCOUNT INFORMATION � � � Please note the Terms&Conditions for Weils Fargo Consumer Oebit Cards,the section titted"Use of your Card",and Consume� Account Agreement section titled'ATM transactions and point-of-sale purchases'are changing to clarify that the Bank may limit the number of authorizations it alicws during a period of time and reserves the right to deny certain transactions for any reason(e.g., susperted fraudulent or unlawful activity,indication of increased risk related to the transaction). For more detaiis,refer to the Consumer Atcount Agreement Addenda at we!lsfargo.com/wfonline%onsumer_deposit_acct fee or co�tact your Ixal banke�. Effective June 18,2013,American Express•Travelers Cheques,Cheques for Two,and Gift Cheques witl no longer be available through Wells Fargo. � �HD VE.ST� FINANCIAL SERVICESe P.O.Box 142829 Irving,TX 75014-9948 Apri125,2oi3 ------ — Transaction Notice o»e�s L7TRGD17 7803 206 40?BOT I _ Accourt number ending in 6052 � MARY E BROMMER �- - — -- �� TOD ROBERT M BROMMER& BARRY �� L BROMMER � 3016 MAYFRED LANE � CAMP HILL PA 17011-5244 � � � � � � This notice crnifirms tlie foll�wing iraTisaction(s}were rE�cently cnade:n yuur account basec3 uti y�ur instructions. � Please review the transaction(s)below.Thank you for the privilege of serving your investment needs. � � If this informatbn is corrnct: • No action is necessary. � if this information is incorrcct: • Call us at: 888-�38-3781 � � � • Write us at: H.u. Vest.nvestment ServicessM P.O. Box 142829 Irving, 7X 75014-2829 ---------------- ------- -- --Y---- — If you have general questions • p�e�se contact your H.D. Vest Advisor or need to make chanyes to � your account: Ny 7.7 � V o „� , .. . _., _.. . ��xc`�' � ; '� �#�i g ��y�y �.?�s;� ��,� h�Y�' � �.'g�a �'a� ..y xE � �� ,�__.. n � ��; �+ ��_� � "�� '��z�'��"�,.,� �Z� °A ,� ;�f b �;(I �� 3 �� y � �, . j .. . , . � .' , ': . �- � � � �ks��<��'�'�. z �. x � y � :a.. �5�..,� � � .. : .. -...,.�.��.. ,: . � .� , �5�.,: :�:. .:..a,:k�r�.� .ky �':��'�w�,� ,:��'�.... -'.�x3, i'Ss`'�...x..�k�.�: -, ,. -.�% . � .,u.., � � Asset Transfer 04/25/2013 MFS MUN SER TR -,* 1627.320000 � PA MUN BD FD CL A � CUSIP: 55273N798 _ Z Payee Information Receiving Account Number: ****8391 = ReciNl��iC: ROBERT M BROMr+fFR ` z _ . �.... ..........�.. ...�_,...... .�,...._.......,.,....�. .,,.,. .,....,.,,_... .....,..._.. .. ...,..__.. ....,... ... ,..._.:,......, _�.: . .,:,, . ..,. „ , ,,.:,. ..., .�.,..,.. Z Asset Transfer 04/25/2013 MFS MUN SER TR �* 1627.330000 = PA MUN BD FD CL A = CUSIP: 55273N798 � Payee Information Receiving Account Number: ****0850 � Rec�pfent BARRY L BROMMER & � �:�. �,.,,....�, ,,.�. ,..»,�,_ . �.,..., .. .,.... .. .,_,.-..�,....,,.�..,.m._. .,. .. _._.. ..M....�� ....;...m�w._..:,,�,....., ... _.�......... �. ,,... ._.. a....,,....�. . � Asset Transfer 04/25/2013 MFS SER TR V �* 2668.379000 n TOTAL RETURN FD CL A 0 CUSIP: 552981300 wPayee Information Receiving Account Nurnber: ****8391 Recip'sent: ROBERT M BROMMER Securities offered through H.D. Vest Investment ServicesSM, Member SIPC, Advisory services offered through H.D. Vest Advisory ServicesSM, 5333 N. State Highway 161, Fourth Fioor, Irving, 7X 75038, 972-870-6000. Brokerage account(s) carried by First Clearing, LLC, Member FINRA/SIPC. investments and insurance roducts are: NOT FDIC-INSURED NO 6ANK GUARANTEE MAY LOSE VALUE Paqe 1 of 2 OPSM-0017 '�'� t�,.'. a:-" �, � ,m X ,.'�S �:s�?r � ��,... �s t �s `�.1s. �;. �� y� m �s r�'`�' t ak�,� .�; .�F s�, �' ,i � � � .i � ��yo �.� �P� � ��`i s"'�'��,:�� k g�.k� `�?��,� � �' �`9'a � h s '� �� ,'� '�� w' ., � .: Asset Transfer 04/25/2013 MFS SER TR V �* 2668.380000 TOTAL RETURN FO CL A CUSIP: 552981300 Payee Informatfon Receiving Account Number: ****0850 Recipient: BARRY L BROMMER & � � � � � — � � � G � � V O � V � oV f Tl N � V Z 2 Z 2 2 2 Z 2 Z 2 2 Z 2 2 Z 2 � � � D 0 N � N A Paae 2 of 2 v W W N N N W � b Z O N � W �p � M M � � LL "r'�� C O� M I� t� > c�� M H'O � O f� x N9 Z U � J N Q � � N lL �s a `�2 � 7 �� . @ U � � � ac � �a ( /� N M � �� \ ; \ � o 0 o t a 2` V � � o �n ° � � � �r, �3`0 w � cv a � E �y- y � W � N `` �' p` y �U � � 7 WS NN �� ODO �� w cia a.,� a am W WM "` oo � � �2 � �'�" C Y - � m0f • C � U Z � � �n W � �c00 W QZ O W .. � �o�o mw W m W W a �' �.0 C �� a�im OF'� �> > �v� � Z c— ►- m Wqqq�� W f,., w y�� Z �¢� Wp w n "�� a W �0� UV c ¢ � �am z z Q m lll(,� f0 J r. >fA t6 �F-J DQ b V W F� .5vrn � Wa' >, ,�t,°', °� � `.� O� w z.-p F �'�c y �jnm @t�li� � O �W�� C� w MC�7 7� F- W pC UG W Y RV' (nQ'W �= N � r-� W m (� aN�Q 0pQ� � t� LLF- .. .Op C �Z �-r"'. LL`a� VJ m o ��0� C�� ~D�ry ZQj f"� f6 �L m Z m wLLC+ia ��a0 Q^ f�p U N� ° Z �m '��'' i"w a � � °c �io F�L- ►= z �� w � � o �� ai��q,o Ni�g z�,, � o n c'aci� Z o�r, N O O m �d.�,-Q �F�� m� � st yNC � C0� � M V�� MM ,� CyC f0 t0 a C � N .0�� Q C � y U � C7 � UO> � •� Z � N'O� � N O W 'O��p W n' � U (n �T+�-� y y 3 ��m n. V � a� a�� — c�i � �w'm Z 3 � � � � �O� � � �cm mtn w � W � o o N � ��o � ?w � z z '> m � a Z o � � 0 0 � — U �� (�j ZY W �p O C� � U' Z F- O 0 Z y 7�� 0 maa0 J ,N c �� y yH Q � � �` �� = W = �� 0 C� w � a +.+ E�w z � a y O =Z ��0 z V y z � o�� Q � T � a Qy yZ Z Q � = L L L � a � � � � a,0� Z � '� U ty0 fN0 f�0 � y � Q U � d V d � � _ � Q U U U y c O 3 3ym �+" � � � y ��L u. .' v •� � _ ��m }� � M M � C N! C f0 � C�d� �� Qaa °a a O L � Q � � =3yQa°a � Qo � � .- Z t- H o .- V O!�� o �.- P.O. 13ox 231 � P.O. I3ox 21�1 5'�19 Walnut Street 247 Main b'treet Columbia, PA 17512 Landisville, PA 17538 717 684-2370 ; 717 898-2240 Kevin M. Kraft. Sr. — Supervisor Patrick M. Bransby— Supervisor �.., Clyde W. Kraf t Funeral Home, Ine. Apcil 34,2413 ,.� � _ , . . �Q��rQ�i�r ° '3�16�1'��3rfred Lana , eamp I��,Pt� I 7411 � � � i�ear 1'Vf�. Bromrnet', r�. ��"�� . �'��`�� We gr�t�fi�lly acknowledge the recent payment in full of your account for � �� ,� �.�� ; ,� � � ��;��. : , . the funer�a�IS±Iar�E Brommer.; '� j� � 4 : �e atsc�wish t��xpress ow s�ttcere thar�cs for�he friendship and good-will you � �; � �- � °° ' '��1ave accorded us. <�,:� - . . �, � � � � � � � � - , r _ � . ��'*�:�� ",. f� �f..w�, : - -. , �,,. . . � � ; �t is our�petrpcyse et aH times to rencter consideraite and thoughtful service that may continue to merit�our highest esteem. If we may be of any further service please feel free to call us. Very t a : . � � Patrick M. Bransby Clyde W. Kraft Funetal I-iome "Our Family Se�ving Your Family Sinee 1954." P.O. l�ox 231 P.O. Box 21 N �1 y Walnut Street 247 Main Street Columbia, PA 17512 Lanc�iswille, PA 1753R 717 684-2370 717 �i98-2240 Kevin M. Kraft, Sr. - Supervisor Patrick :�1. Bransby- Supervisor ,;x' �'lyde W. Kraf t Funeral Home, Inc. April 30, 2013 ` See�vices for: N��rv �: B�gmmer ' � _ �,v�� o _ � , � L�n�P�a�el�5eruic,e. . . . . . 4,575.00 .. _ ,. ,.,��e��o�.. .t�F'' . y .. '«., . , . . . . 40.00 � Acl�wwl�ed�tta�nt Cardsy , . . . . . . . . . . . ; . . . 30.00 � h�arial �r��ets: . . . . . . . . . . . . 44.00 ��°' C?ut�Bur3sl�antainer. . . . . . . . . . . : . . . . . . ... . . . . . 1,475.00 , �� Casket. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6,345.00 ��, �`'> Grave O�nin� . . . . . . . . . . . . . . . . . . . . . . . . . . . 750.00 � '��.�:�� I.an�,aster N�p�p�r. . . . � . . . �, . . . . 179.20 , . . . . . . . . . . . . . . . . . . . . . , „A - �,�� .,��. ° 1��ath Ce�tificat�s. . . �. : . . . . . . . . . � . . . . 60.00 ,. _ , , . : . . . . . . . . �, �, � � ,�� l�i�i�ter, . . . - . . . . . . . . 100.00 � �, ; �.Herr�sburg NewsF�P"�. . . . . . #. . . . 170.00 ��'� ' ,'x��,'�ter�r�t��. . . . . . . . . . . , .. . . . . 240.00 Engraving. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125.00 Services Total 14,133.20 Less Payment Received: 14,133.20 Balance Due on Accoir�.;.' • , � � . � ..��` "Our Family Se�ving Your Family Sinee 1954." ;. P..�. I3ax 2.31 P.O. I3ox ?1��3 .� ,51,9 Walnut S'treet 247 Main .5'treet Columhia, PA 17512 La�ncliswille, PA 175.38 717 684-2.370 717 H9N-22�0 Kevin M. Kraft. Sr. — Supervisor ��' Patrick M. Bransby— Supervisor C�yde W. Kraf t Funera� Home, Ine. Agri116, 2013 RQ�ert�rommer 3,Q1;6,Mayfred i,ane � �nn,�r I�i��;��4�.�,7��2': , D!e�Rvb: 4 > �� F � :_ '�� Th�+�ngra�irig f�r the gr�vestone of Mary E. Brom�ner has been completed. �� x�� `�'�� The cost for the engravfng is$125.00. �� `� �-�. � :� � A.�eck m�I��e made payable to the C�rd�W. K��t Funeral Home, Inc. for ' �¢� . ' t�e`�mQun��$125.p0 and rriailed to P.�.Bo�231;Co�umbia, PA 17512. 'd 3R ., .�': , e. � � � . . . z�� l��c��e�,�e an�r quesrians,please giuE us a call. � �. .T° k : : . - :; , �: .. : _ Sin , i Patrick M.Bransby Funeral Director PMB/kb , - . : "Our Family Serving Your Family Sinee 1954." 1 P,�). I3a� 2,31 w� � f I'.O. 130�� ?1 S' � 5.1� �Yalnict Street � ?47 .Nuin. .Street C��licrn.hia, P� 17�12 � Lccnclis�uille. Y��l 175�3�5' 7l7 684-2370 � 717 �5'9�S'-?2-�f1 Ke��in 1��[. Kratt. 5r. —Supervisor -�°�'� Patriek �I, I3ransb<<— 5uper�-isor �`lyde W. Kraf t Ficneral Home, Inc. Apri116, 2013 Robert Brommer 3U16:Mayfred Lane f.amp Hi11 PA 17011 Dear Rob: The engraving for the gravestane of Mary E.Brommer has been completed. The cost for the engraving is$125.00. A check ma�be made payabte to the Clyde W. Kraft��neral Home,Inc. for the amount of$125.OQ and mailed to P.O.Box 231,Cotumbia, PA 17512. Should you have any questions,please give us a call: Sin , ...�..��.�,�,,� Patrick M.Braasby Funeral Director PMB/kb ESTA't"E OF MARY E BROMMER �� ROBERT M BiiOMMER.EXEC �y�� 3016 MAYFRED LN � � �� CAMP HiLL,PA 170t1-5244 ate Pay to the �' t,� � ��°_---- Orcler of .----� llars �+ �"^ ��: � . . . � � � 4 �- . . . . � �. 1MaYFaqel�k,l'Ut . � ��,�":. � � �,,;_ � �R M � For �:03 L000503�' 9 23 �086 209u' 00 106 April 18, 2013 Decr Sir: Enclosed pleasc find my check in the amount of $125.00 to cover the expe�tse for engroving the grcrvestone of Mary E. nnd Paul O. Brommer per your letter of April 16, 2013. Sincerely. Robert M. Brommer te the will. Bi�t was paid e�, �o�s incurred to proba �e�k to o°�,i check. with pers ESTATE OF MARY E BROMMER �I O4 ROBER7 M BRGMMER,EXEC �,o eoas 30i6 NLAYFREQ LN , {� � �� i� �,� CAMP Hlll,PA 17011-82M1 �,(/ �" Date Pay ta the �� {� _� oT of `�' v�-1 � rtn v+� mE'�C�...... 1 $ �.�rr__r_� ,q �,�.,�, Da t.1 �Ha. �� "flliii�pMkNa. ':r° , - �` . . ��.�. .�� . ,��, :�� .. :.� . _. . � �. . :�; � �� -. �' � . :' �� , �.�..::.� �� . �:03 i0d0SC13�: 9: 23 it786209U' oo �o� RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Receipt Date : 3/26/2013 Cumberland County - Register Of Wills Receipt Time : 12 :28 : 03 One Courthouse S uare Receipt No. : 1073563 Carlisle, PA 17�13 BROMMER MARY E Estate File No. : 2013-00344 Paid By Remarks : ROBERT M BROMMER HEA ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 310 . 00 CUMBERLAND COUNTY GENERAL FUN WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 15 . 00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5 . 00 CUMBERL�ND COUNTY GENERAL FUN INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 10082 $398 . 50 Total Received. . . . . . . . . $398 . 50 P.O. Box ?31 � P.U. I3ax 2�H 519 Walnut Street ; 24 7 Main Str�et Calumbia, PA 1�512 Landisville, PA 17538 717 684-2370 717 898-2240 Kevin M. Kraft, Sr. - Supervisor Patrick M. Bransby- Supervisor G'lyde W. Kraf t Funera� Home, Inc. March 27, 2013 Robert Brommer 3Q16 Mayfred Lane Cam��ill$A 1701 l ��Rc��ert.. �� _.. �,� �s �� As y�m�+aw; y�rur mother hac�pre-arranged and pre-patid funeral instructions with our funeral hat�. At th�tit�e o�funding her�ontraGt,,sl�e set�de $5�9 for non guazanteed cash advanced itet��. ! , _ _ ��''�� However, at the time ofher death these items were not fiill�funded by her contract: ��,�.�.: ��.� s , : Cost��I)eath.. , i., ,, l f!Gertified De�ath Certificate $60 G�ve�Qpe�g' $75ft _ M Gezia�t�,�E4�ment �`24U � �.�: M�ust�'!�i�ity ��OQ ` �Ia�rris�rg�eevuw�spaper�it�iary $17(�.UD Lancaster Newspaper Obituary 179.20 Total $1,499.20 The difference ($589 at contract minus $1,499.20 at time of death) that is payable to the funeral home is $910.20. A check for$910.20 may be made pay�bk ta the C�yde V�. Km#��'�e�l��y,��c. and mailed to PO Boz 231, ColumbLa,PA �7512. Should you have any questiain�,please do nat hesitate to call. Sincerely, �" Patrick . Bransby PMB/kb "Our Family Se�ing Your Family Since 1954." P.O. Box 2.31 �srAr�of�nr E�� .��alnut Street ROBERT M BFtOMMER,EXEC 3ots r�,+�a�u�t "3.,�s. GAMP HiLL.PR 17011-5244 ' � 92siU Columbia, PA 17512 717 6�44-23 70 ate Pay ro the �} � � � Ke��in �i. Kraft. Sr.-Super�risor Or eraf...._.�.,,��!� 1 G� � � _ � _- �r� �a�� a�"� s �W � ' �w.r/rynmr,e - , t.��- , , .. . . �. M�11'C�1 27�2013 � For�/1 t�a�rrs,�:=�' �� ,L�:r,t , � Robert Brom.mer ��0� �000 5 0 3+: 9 � � L p 8 6 20 9 u� QO i 01 3416 Mayfred Lane Camp Hill PA l 7011 Dear Robert: As you know, your mo�her hac�pre-amanged artc�pre=paid fiznerat insmactions with our fiuieral home. At the time of funding her contract,:she set aside 5589 for non guarantced cash advanced items. However,at the time of her death these items were not fiilly funded by her canh�act: Cost a#Death 10 Certified'I7eath Certificate $64 Cnave Qpening ��SQ Cemetery Equipment $�40 Minister Gratuiry , $104 Hazrisburg htewspaper pbituar3' $I'70.00 Lancaster Newspaper Obituar3' 179.20 Total $2,499.Z4 The differeace($589 at contract tninus$1,499.20 at time vf death)that is payable to the funerai home is$910.20. A check for$91Q.20 may be made payable to the Clyde W.Kraf�Fnnerat Ho�me,Iac. and maited to PO Bog 231., CoInmbia, P:al 17522. Should you have any questions,please do not hesitate to ca1L Sincerely, �� Pamck . Bransby PMB/kb "O�cir Family Servirtg Yo�ur Fam�7,� .��•�� - �� O. I3ox 2.31 P.O. Box 218 519 Walnt�t .Street 247 Main S'treet C,olum�iia, PA 17512 Landisville, PA 175.3<4 717 <84-2�370 7�� 898-2240 Kevin :�1. Kraft, Sr. - Supervisor Patrick 1�1. Bransby- Supervisor G'lyde W. Kraft Funeral Home, Ine. April 4, 2013 Robert Brommer 3Q'16 Mayfred Lane Catnp HiII PA 17411 � =.T��r��b�� . V�e are.in re�eipt of the cash advance pa�rtnent og$91;0.20 from the Estate of Mary E. ,��,. � Brq�nmer. 'f�ank yvu for your prvmpt pa�ment on this�account. ,�� . _ ��$��. Today,we received the flower bill from Royer's Flower Shop with the purchased flowers ;�,�� , � for the funeral cost s�f$277.72. � K,�x y. Y��i . . . f�'�. s 5'�„ ... � �;�::�,,;. I��been broughf to my attention tha�the obituary ncitice did not hit the paper properly r a�d yot�We�e ch�rg�d $17�.Qd as vr�e�l as�44�.OU. Therefore, the account on Mary Brommer � , �� w��,�,a�e�Credit of�Z14.0�. j��i`f�A��4 /�y ��`� . . . '` Vtt�t�i tI�i�f��v�'ef s�osts��f$�77:72 minus the a�count cr�dit of$214.00 the balance due on - the account of Mary E. Brammer services is $63.72. A check may be made payable to the Clyde W. Kraft Funeral Home, Inc. for$63.72 and mailed to PO BOX 231, Columbia, PA 17512. If you should have any further questions please:cantact m�di��tly at 68��.3��-., _ �_ �, , , Sincerel . Kelly Brommer Office Manager "Our Family Serving Your Family Sinee 1954." _�__ _ _ . .._._ _ P�O. Box 231 __.. . 105 519 Walnut .S't�-eet ESTa�oF��Y�8�� " ��"��'��:' ' � ROBERI'M BROMMER.EXEC � � ;:° . �-`,..', �� C�lu.�nbicr., P�1 17512 3o,e►�u►Y��w °� �,�� r,�`.S�o+1=52+14 _ "�`�5'a� 717 <84-2.3 7� :a{. �'�'� � �w :;, . � �_ I(e�•iu �l. Kraft. Sr. - Super�•isor ; pgytocha � �.� . ' ✓7 e�� $ Orcter of � ''"� �� "�" ; ,;; • - � .t uy"« ,. :.��, '�� ...� , .. , . ;. ., :-�� .. � a�rn«.. .. ,� �'::�' ' . � .wc' . . �.iu.�� _ �a� � � �dUi � G�""`� 4�� ._ �fr �� :� . �.��. . . .... .° « 1�� {:,.�� .. . . � , ., i , �j , � ,,,AV w Apri14,2013 � "`'A � _F�r' , Robert Brommer �:0 3 L000 50 �". 9 �� p86 209�` �0 i0 5 3016 Mayfred Lane Camp Hill PA 17011 Dear Robert, We are in receipt of Che cash advance payt�ent af�910.20 from the Estate of Mary E. Brommer. Thank you for your prompt payment on this account Today,we received the flower bill fram Royer's Flower Shop with the purchased flowers for the funeral cost of�277.72. It has been bcought to my attention that the obituary notice did not hit the paper properly andyouu were charged $17U.00 as well as$44.00. Therefore,the account on Mary Brommer will have�credit of�214.00. With the flowers costs of�277.72 minus the account credit of$214.00 the balance due on the account of Mary E.Brommer services is$63.72. A check may be made payable to the Clyde W.Kraft Funeral Home,Inc.for$63.72 and mailed to PO BOX 231,Columbia,PA 17512. If you should have any further questions please contact me directl�at 684-2370: Sincerel Kelly Brommer Office Manager "Our Family Sera�ing Your Family Sinee 1954:' Check to cover cost of supplies to mnke picture dispiny for funeral home. Bill wns pnid with personal cash. ESTATE OF MARY E BROMMER �O3 R�BERT M BROMIIAER.EXEC �� 3o,s�,r�Ea u� l �, ,� CAMP HiLL,PA ilOf1-52�4 {�.� ate Pay to the � cC.c3�t 1'�.en/" � �� .3' Oider ll s �e °�.r �»� ...- � �"" �� '�� ""''"a'°°°°" - � k For "p i:0 3 1000 5� 3�. 9 3 iOB 6 20 9u' 00 LQ3 Check to cover restaurant biii for luncheon nfter services. Bill was paid with persor�i credit card. E8TATE OF MARY E BROMMER 'I O2 ROBERT M BROMIiAER.EXEC a� 3ws n�►v�eo w �� C�1�:k1�$,.P�4.t tiEt#1=b44t �� at� . k , F8 t0 t�e �" Order of��' �. , �'�'�� ` � � �7-------"`; �� i ` �� :;' . .. ` y. �` Dollars •�. o� d...: `'° :,��t:3 �� a �� . � � � �� " �,�_ � .. . : For ��'�+1C45� �)�� :03 L000503�: 9 23 LD86 209�' 00 i0 2 Kelly Financial Services, Inc. Invoice 400 Bridge Street, Ste 4 New Cumberland, PA 17070 Date Invoice# 717.774.7536/717.774.4802 (fax) �i�i2o�3 to266 EIN 23.2874776 Bill To Estate of Mary Brommer c/o Robert Brommer,Executor 3016 Mayfred Lane Camp Hill,PA 17011 Description Amount Preparation of Final U S Individual Income Tax Retum for tax year 299.50 Preparation of U S Estate/Fiduciary Income Tax Return for tax year 375.00 Preparation of PA DOR Inheritance Tax Form 3,557.00 Tota l $4,231.50 The Patriot-News Co. �� • 2020 Technology Pkwy e a O ~ �� Suite 300 Mechanicsburg, PA 17050 Now you know Inqulrtes - 717-255-8213 BROMMER 3016 MAYFRED LANE CAMP HILL PA 17011 THE PATRIOT NEWS THE SUNDAY PATRIOT NEWS � � roo o u lication Under Act No. 587, Approved May 16, 1929 Commonwealth of Pennsylvania, County of Dauphin} ss Marianne Milier, being duly sworn according to taw, deposes and says: That she is a Staff Accountant of The Patriot News Co., a corporation organized and existing under the laws of the Commonwealth of Pennsylvania, with its principal office and place of business at 2020 Technology Pkwy, Suite 300, in the Township of Hampden, County of Cumberland, State of Pennsylvania, ovmer and publisher of The Patriot-News and The Sunday Patriot-News newspapers of general circulabon, printed and published at 1900 Patriot Drive, in the City, County and State aforesaid; that The Patriot-News and The Sunday Patriot-News were established March 4th, 1854, and September 18th, 1949, respectively, and all have been continuously published ever since; That the printed notice or publication which is securely attached hereto is exactly as printed and published in their regular daily and/or Sunday/Community Weekly editions which appeared on the date(s)indicated below. That neither she nor said Company is interested in the subject matter of said printed notice or advertising, and that all of the allegations of this statement as to the time, place and character of publication are true; and That she has personal knowledge of the facts aforesaid and is duly authorized and empowered to verify this statement on behalf of The Patriot-News Co. aforesaid by virtue and pursuant fo a resolution unanimously passed and adopted severally by the stockholders and board of directors of the said Company and subsequently duly recorded in the o�ce for the Recording of Deeds in and for said County of Dauphin in Miscellaneous Book"M", Volume 14, Page 317. PUBLICATION COPY This ad# 0002260679 ran on the dates shown below: May 28,2013 _ -- --.-_ � y � y June 04,2013 Ess�r�NoT�cE /- �1 June 11,2013 STATE OF:NWrY E.8rommer . �//j�/, `Y=/�� WTE OF:30t6 MoYfree!Lane. �/i.': .�� CamR H04 Pn I7911 �!,� (�'. . . . . . �. . . . . . DIECsMurch2D.1013 • . . . .i— . � .G EXECUTQh;RoWttM.Brommer " 3olblfl�Yir+�d Lortt, C(�mp HTlb PA 17VI11 � �� Swom t and subscribed befor e this 11 day of June, 2013 A.D. ry Pu ' COMMONWEALTH�F P�NSYLVANIA Notarta�seat tially Lyrm Warfel�NOferY P�� Washin9tort TwP•��u�1Cour�tY 6 My Comrrtission�P► MEMBER,PENNSYIYANIA ASSOQATION OF NOTARIES , The Patriot-News Co. ''�" '~`• • 2020 Technology Pkwy e a rio ~ �� Suite 300 Mechanicsburg, PA 17050 Now you know Inquiries - 717-255-8213 BROMMER 3016 MAYFRED LANE CAMP HILL PA 17011 STAT E M E N T ALL CHARGES ARE NET ACCT# bApQE AQ ORDER# DATE EDITION ADDTL.INFO. TYPE OF CHARGE AMOUNT 241815 BROMMER 0002260679 05/28/13 METRO WEST BASIC AD CHARGE $23.29 241815 BROMMER 0002260679 06/04/13 METRO WEST BASIC AD CHARGE $23.29 241815 BROMMER 0002260679 06/11/13 METRO WEST BASIC AD CHARGE $23.29 AFFIDAVIT CHARGE $5.00 '`-�_ TOTAL: �74,g\ �� L� This is not an invoice. Please do not remit payment from this Statement. An invoice will be generated at the end of the month. --Thank you. NOTE: This Statement replaces the Order Confirmation which we previously sent with Proofs of Publication t . PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (LTnder Act No. 587, approved May 16, 1929), P. L.1784 COtirI:K4�Tt'VEALTH OF PENNSYLVANIA : . ss. COU�iTY OF CL�iBERLA�'�iD . �. Lisa Marie Coyne,Esquire, Editor of the Cumberland Law Joumal,of the County and State aforesaid,being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of CarIisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the o�cial legal periodieal for the publicarion of all legal notices, and has, since Januar�� 2, 1952, been regularIy issued«�eekly in the said Count�F, and that the printed notiee or pubiieation attached h�reto is e�actiy the same as was printed in the regular editions and issues af the said Cumberland Latt� Journa! on the follow�ing dates, �=iz: Mav 31. June 7, and 3une 14, 201 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal,a legal periodical of general circulation,and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that a11 allegations in the foregoing statements as to time,place and character of publication are true. � (i1f�... ,--�--- isa Marie Coyne, ' r SWORN TO AND SUBSCRIBED before me this 14 day of June. 2013 �� ' Notary ��,�y�.,a�a. Late a�'3016 Mayfred Lane, Camp �- *l07ARIAL SEAL Executor: Robert M. Brommer, pEgpqRH A COLi.INS 3016 Mayfred Laae,Camp H�71,PA 17011. t�totary Public Attarney:Noaa CARL{5lE BOR�J6H,CUS�?BEfiLA�iD COUNTY t�y Commission Ex.ires Apr 2$,2Q1� �� . . � CUMBERLAND LAW JOURNAL 32 34UTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717)249-3188 Fax:(74n 249-2883 June 14, 2013 Cumberland Law Jouma! is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the officiaf legal publication for Cumberland County and ff�e legal newspaper for publication of legaf notices. TO: Robert M. Brommer RE: Mary E. Brommer Estate Legal advertisements must be received by Friday Noon. All legal advertising mus# be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on folfowing dates: May 34, June 7, and June 14, 2013 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Secand Proof Request � Payment received $ 75.00 `� � l � Total Amount Due $ 0.00 Becky H. Morgenthal, Executive Director ESTATE NOTICE ESTATE OF: Mary E.Brommer LATE OF: 3016 Mayfred Lane,Camp Hill,PA 17011 DIED: March 20,2013 EXECUTOR/ADMINISTR.ATOR: Robe�t M Bmmmer Representative's Address: 3016 Mayfred I,ane,Camp Hill, PA 1701.1 ATTORNEY: Attorney's Address PIease submit a check in the amount of$?5.00 with tius farm. Checks should be made pa.yable to: The CUMBERLAND COUNTY LAW JOURNAL Return ta: 32 South Bedford Street, Cariisie,PA I 7013 NOTE: Estate notices are automatica[ly run for three(3)consecutive weeks. You must also publish a notice with a paper of genera.i circuta�ion. r;r., s. . •, �_._...___,--___r._m.___. ._ ... _ _,, __,.. E3TA'fE OF 111AAY�BR014[ir1ER '�O$ )N ROBERT M BRO#AMER,EXEC: ��'�°� 3016 WU0.YFRED LN ��A �'� CRMP HILI„PA 17011-5244 r YI al < <t� ate Pay to the � � ��q,0�.. ��--�""__ OrtIer.of: ' Heyriry Dalla (g �e. �� + a� �i `pyMy� �N11' � 'r't '`�l� F * . � . � � �� .. . .. ` . � � . . � �! �1hfN�, R For��-t��i1J!!"t� - — � �.0 3 iQ00 SC�3�: 9 C 3 1086 �09�* 00 L08 � Kelly Financial Services, Inc. I n vo i ce 400 Bridge Street, Ste 4 Date Invoice# New Cumberland, PA 17070 717.774.7536/717.774.4802 (fax) �i�i2o�3 10266 EIN 23.2874776 Bill To Estate of Mary Brommer c/o Robert Brommer,Executor 3016 Mayfted Lane Camp Hill,PA 17011 Description Amount Preparation of Final U S Individual Income Tax Return for tax year 299.50 Preparation of U S Estate/Fiduciary Income Tax Return for tax year 375.00 Prepazation of PA DOR Inheritance Tax Form 3,557.00 Tota i $4,231.50 ,, ___.....� _�____ , r MAKE CHECKS PAY.4BLE TO: � ' V :�+F�n�%a�aa usi�c rc� �av��n�ia -- — _...____ IRIT PHYSIC I, �� r�;;� ,<.��,�, -°;:>�,�:�� -�,., �� ^ .---------__._-_____-- ------ ----- ;n.K;i:�unnt�i.F; �;>�c rvni u�r c.coE: ASERVIC80PHOLYSPIRIT THSY3?Fat t-----_------_____.._..--�..__------------ M _�— n� ru�+r_ �:xr c;ar- 205 GRANDVIEW AVE � ' � � !` •.•• SUITE 210 3e3s-�SH ' --- ----.— CAMP HILL, PA 'I 7O�'I-'I 7OS SFATLMEfdT Dt,1 F � E�nv r��s a,n�xou�vr �ccT.� ; �-------.----i-- G 04/26/13 I $77.15 , 4531 000sea o�o� �._--------------_ _-----l---_—�_� � _____ �___ S�foW�,M�UNT `�'J PAGE: 1 �� " ` �=– �_.___—____ — ;�;�:.:��:>. i�lli��yiln��u��ni��l�ih�pnnli�l�lih��ln�ili4ill�i� Iil�Hli��ninl�li��i�n�l�inll�ul�n�i�ili�nil�ininl� MARY BROMMER SPIRIT PHYSICIANS SERVICES INC 3016 MAYFRED LANE 205 GRANDVIEW AVE CAMP HILL, PA 17011-5244 SUITE 210 CAMP HILL, PA 17011-1708 3838-MHSH`SRUOSPTJX002208 �Please check box if address ie incortect or ineuronce STATEMENT p�,EqSE DETACH AND RETURN TOP PORTION WITH YOUR PAYII�NT infom�stion ha�chanped,end indicats chanye(s)on revene sida. �" RECEIPT RECEIPT IN3. PAT. DATE PATIENT DOCTOR CPT4 DESCRIPTION CHAHGE FROM INS. FROM PAT. ADJ. BAL BAL 03/i�/�3 :+"3zy :s<n3:: 99233 �u�5�4'.%�'!vT �iOSz:TAL �P_i� $U8.00 $21.88 ${8.97 $0.00 $47.15 ESTATE OF MARY E BROMM�R ROBERT M BFIOMMER,p(�C '�a� 301B MAYFRED W �'�� CAMP HILL,PA 17p11-52�q � � Pay to the -----+ ate , Order of ►�" � 7�+.�-�-,—�' Da'll B+ � � �'" � �� ! � �sr ! �:0 3 1000 50 3�: 9 23 i086 20qN� pQ 1O? � , CURREI�IT 30-60 DAYS 60-90 DAYS 90-120 DAYS OVER 120 DAYS TOTAL ACCOUNT BALANC DUE FROM PATIENT $77.15 $0.00 $0.00 $0.00 $0.00 $77.15 $77.15 Thsnk You For Your Payment. For Bilqng Questions, Please Call: 1717) 972-4490. 1��1��11�� ` _ , `' REC6IPT RECEIRT INB. PAT. DATE PATIENT DOGTOR CPT4 DESCRIPTION CHARQE FROMI IN8. fROM PAT. ADJ. BAL BAI. 03/15/13 MaTy Iemail 44233 3UB3EQUENT HOSPITAL CARE �1t�.00 OZ1.9• ¢�9.47 ¢0.00 ¢77.33 CURRENT 30-80 DAYS 80�SQ DAYS 80-120 DAYS OVER 120 DAY8 TOTAL ACCOUNT BALANC — DU� FROM PATIENT ��.�s so.00 $o.00 so.00 $a.00 $��.�5 �7a.15 Thank You For Your payment. For Bi1Bng auesdons, Piease CaH: (7171 572-4490. i��r�� J REGISTER OF WILLS CERTIFICATE OF CUMBERLAND COUNTY GRANT OF LETTERS PENNSYLVANIA � No. 2013- 00344 PA No. 21- 13- 0344 Es ta te Of: MARY E BROMMER lFiist,Midd/e,Last) La te Of: CARLISLE BOROUGH CUMBERLAND COUNTY Deceased Social Security No: WHEREAS, on the 26th day of March 2013 an instrument dated September 24th 2007 was admitted to probate as the last will of MARY E BROMMER (Firsf,Middle,Lastl late of CARL/SLEBOROUGH, CUMBERLAND County, who died on the 20th day of March 2013 and, WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND Coun ty, in the Commonweal th of Pennsyl vani a, hereby certify that I have this day granted Letters TESTAMENTARY to: ROBERT M BROMMER who has du�y qualified as EXECUTOR(R/XI and has agreed to administer the estate according to law, all of which ful l y appears of record in my offi ce a t CUMBERLAND COUNTY COURT HOUSE, CARL/SLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 26th day of March 2013. � ( A � � e rst�r o \ eputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) � . _ . , , � 'CLIENTTfSS�BAOMMER,Roba�c�Rush\Wilt-Mary � , , � �.t �t�.C. � t`�.��'x�:t�xt# ' � � ::F: ! OF � ° `"' r� ^? ` a, � c� y W _� � G7 � � L C'� =a �f7 JY MARY E. BRONxMER � � � � -, r; ', �n ..� ::,. �:+ I � c a _. :_ -�,t p .-� ` BE IT REMEMBERED,that I,MARY E.BROMMER,presently 3016 Ma}dred��.�ie,�a�p�3.rtl;;:i ; I i.� r., . - ..... Cumberland County,Pennsylvania,being ofsound mind,memory and understan�yng�do malf�;pui51'istirY� � Y (\� �.7 � �I and declare this as and for my Last Will and Testament,hereby revoking and making null an�void anj� ; and all Wills and Testaments and writings in the nature thereof by rne at any time heretofore made. I ITEM l: I direct that my hereinafter named Executor pay all my just debts,my funeral expenses, and the expenses of the administration of my estate. With this direction, I authorize and j empower my Executor to e�cpend for my funeral expenses and interment such amounts as may be considered necessary and proper,without regard to any limit that may be prescribed by a court of law. IT�M 2: I direct my Executor to pay all inheritance,estate,succession,and legacy taxes of whatsoever nature and kind,to which my estate,or the transfer of any property passing hereunder or otherwise passing by reason of my demise, may be subject, and to charge such taxes against my residuary estate, it being my intention that none of the aforesaid taxes, either federal or state,on any � property required to be included in my gross estate,under the provisions of any state or federal law now in force or hereafter enacted,shall be pzorated among the persons interested in my estate to whom such i property is or may be transferred or to whom any benefit accrues. ITEM 3: All the rest, residue and remainder of my estate, of whatsoever nature and � wheresoever situate,whether it be real,personal or mixed,including property over which I have a power � of appointment,I give, devise and bequeath unto my sons, ROBERT M. BROMMBR and BARRY L. BROMMER,in equal shares,per stirpes. ITEM 4: If either of my sons should predecease me, I direct that the shaze of such deceased son shall be distributed to his spouse;and i further provide that should his spouse predecease him,the share of my deceased son should be distributed to his issue,in equal shares,per stirpes. , � I � -- - -- - _ _— -- � , � � , . . � � i ! j i I � ; TTEM 5: I nominate, constitute and appoint my soa, ROBERT M. BROMMER,as ' I Executor of this my Last Will and Testament. ; I I � I1'EM 6: I direct that my hereinbefore named Executor shall not be required to give bond � ' i � for the faithful performance of duties in this or any jurisdiction. ! IN WITNESS WHEREOF I have hereunto set m hand and seal this��:." " da of � � Y Y ,2007. � � i � � MARY E. B MMER � : i � , � The preceding instrument,consisting of this and one(1)other typewritten page,was on the day ; � and date thereof signed,sealed,published,and declared by the Testauix herein named,as and for her i � i � ' Last Will and Te.stament,in the presence of us,who,at her request,in her presence and in the presence � � of each other,have subscribed our names as witnesses heret . ' � � , i r � OF I � ' oF � I : I � � ; i � � � i j � � � ; � i ; Page-2- � � , � I i -- -- —.._ i y --__..._-- � � . . ' � i � COMMONWEALTH OF PENNSYLVAI�TIA : � . SS. COUNTY OF YORK , �� , We, MARY . R�MMER, and , • � ,the Testatrix and the witnesses, � I respectively,wh e es signed to the attached or foregoing iastrument, being first duly sworn, ! ' i do hereby declare ta the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament,and that she signed willingly, and that she executed it as her&ee and i voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and ; hearing of the Testatrix signed the Will as witnesses, and that to the best of their knowledge, the i Testatrix was at the time eighteen(18)years of age or older,of sound mind,and under no constraint ar � � undue influence. � f � i I , • ; MaxY i _ i I � _ . � , � I I S�V�.?ItN TO AND StTBSCRISED BEFO ME TfiIS Z�� DAY � 0 6. / I � zoo�. ! r . i i i I � Y P LIC ' ,�. �� ..�o:�vliN� i "�"'v��w::r.:. :�.r�. � f�'�:::�1889i ' ,l3116tL.Cw:a.��iPtlOFC i �x'�.i;:O,VC.'�C� ��3�x'�a0d.26��t0 NkIplbYr�PB�ex�ertif ttc+�.�MDIt d NOdIM j � � � I I i �f