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Home My WebLink About02-0331PETITION FOR PROBATE and GRANT OF LETTERS Eleanor I. Brown Estate of also known as Deceased. Social Security No. 18 0 - 0 7 - 6 8 ~ 5 No. ~-'J- O~'~-t_~{~l To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/~ 18 years of age or older al} the e t r ix in the last wilt of the above decedent, dated Uetober , f~ and codicil(s) dated none in the named (state relevant circumstances, e.g. renunciation, death of executor, etc.) D ........... Cumberland ,.el~enaent was Qomlcneo at aeam ~n ....... ~ County, Pennsylvania, wiL_h ~ e: _last,familyor.p~inc. jl~t~,r_e~idenceat Zlt4~ Merr~_mac ~ve.~/>~._-~ /9~t~v ?/xa/.a ~ecnan~csourg, vA I/UDD (list street, number and muncipality) Decendcnt, then 83 ._year%pf age, died November 21, 2001 ,t~. , at Woodmanct Center for ~urs~.ng, Lewisberry, PA 17339 Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: none 3,000.00 WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Te s t ament ary (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. Brenda Augus {ine 214q Morr~m~e Avo_ Mech~nicsburg, PA 17055 OATH OF' PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA -I COUNTY OF CIJMBERLAND f ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estate according to law. Sworn to or affirmed and subscribed before me this ]sL dg'K°f [% IIl · ~ C g~IS -~ - Reg~ter Estate Of EL.F~,NOR I. BROW~ , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW APRIL 2, 2002 I~ , in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 9,1998 described therein be admitted to probate and filed of record as the last will of ELEANOR I BRO~2q Eleanor I. Brown and Letters Tes tammntmrv are hereby granted to Brenda Augustine FEES 25.00 Probate, Letters, Etc .......... $. Short Certificates( ) .......... $. 15.00 ~ e:~za, parJes... $ 6.00' jcp'~ $ 5.00 TOTAL__ $ 51.00 Filed ...4=0..27.2.0.0..2 ...................... called attoryney on 4-2-02 ATTORNEY (Sup. Ct. I.D. No.) Sup Ct. No. 06350 ADDRESS P. O. Box 314 Mechanicsburg, PA 17055-0314 PHONE 717-697-1918 I, ~.~tNOR I. BROWN, of the County of Cumberland and Commonwealth of Pennsylvania, being of sound mind, memory and understanding, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking and making null and void any and all Wills and Codicils, or writings in the nature thereof, at any time heretofore made by me. 1. As my personal representative, I appoint my daughter, BRENDA AUGUSTINE, as the Executrix of my Last Will. In the event BRENDA AUGUSTINE is unable to qualify or ceases to act for any reason as Executrix, then I appoint my daughter, CLAUDIA HAVENS, to succeed as Executrix of my Last Will. In the event CLAUDIA HAVENS is unable to to qualify or ceases to act for any reason as Executrix, then I appoint my daughter, STEFFANI HUEBNER, to succed as Executrix of my Last Will. 2. I direct that my funeral and burial expenses, and my just debts, be paid from my estate as part of the administration of my estate. 3. I direct that all taxes assessed and payable because of my death, be paid from my residuary estate as part of the administration of my estate. 4. For all purposes of this Last Will, my Estate shall mean and include all real and personal property of any kind and every nature whatsoever, wherever situate, in which I may have any interest at the time of my death, including any property over which I may have power of appointment. 5. I give, devise and bequeath all of my Estate, both real and personal, wherever situate, including any property over which I may have a power of appointment to my daughters, BRENDA AUGUSTINE, STEFFANI HUEBNER, and CLAUDIA HAVENS, in equal shares, per stirpes. B. If any legatee, beneficiary or devisee, shall fail to survive me by thirty (30) days, I direct that I shall be deemed to have survived such legatee, beneficiary or devisee and that this Last Will and all its provisions, except where specifically stated otherwise, shall be construed on this assumption notwithstanding the provisions of any law establishing a contrary presumption. 7. I direct that no Executrix or Guardian appointed by this Last Will shall be required to give any bond, notwithstanding any provision of law to the contrary; but if any bond shall be necessary no sureties shall be required. 8. Whenever any Personal Representative or fiduciary nominated and appointed by the provisions of this Last Will need legal counsel or advice concerning the administration of my estate or the provisions of this Last Will, it is my preference that Albert Z. Bogert, Esquire, be consulted, if he survives me, he having intimate knowledge of my affairs, views and wishes in matters concerning my estate. IN WITNESS WHEREOF, I have subscribed my name and affixed my seal this ~ day of ¢~¢¢~¢ , 1998. Eleanor I. Brown COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND SS: I, ELEANOR I. BROWN, Testatrix, whose name is signed to the attached or foregoing instrument, havlng been duly qualified according to law, do hereby acknowledge that I slgned and executed the instrument as my LAST WILL, that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. ~OR I. BROWN, COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND Sworn or affirmed._.to and ackn~'wlp~gegj before me by ELEANOR I. BROWN, of I ~{'}'~['~J , '~998. ,~ ~} , Notary Publ ~c , ' I w~ s. oms~o, ~t,~ry ~c I AFFIDAVIT [ Lower _. : SS: We, Albert Z. Bogert, Esq. and , the witnesses whose names are signed to the attached or foregoing instrument being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her LAST WILL, that ELEANOR I. BROWN signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearlng and sight of the Testatrix slgned the Will as witnesses and that to the best of our knowledge, the Testatrix was at the time eighteen (18) years or more of age, of sound mlnd and under no constraint or undue influence. to and acknowledged before me this -{~'Oday of Sworn f~r ~lirmed ESTATE OF ELEANOR I. BROWN, Deceased, Late of Upper Allen Township, Pennsylvania COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA NO. 21-02-0331 ORPHANS' COURT DIVISION CERTIFICATION OF NOTICE TO THE REGISTER OF WILLS,CUMBERLAND COUNTY: I certify that Notice of Beneficial Interest required by Rule 5.6 ( a ) of the Pennsylvania Orphans' Court Rules was served of the beneficiaries identified below by United States Mail, first class postage prepaid. DATE of Service: April 11, 2002 Albert Z. Bogert, Esq. Attorney for the Estate BENEFICIARIES Claudia Havens 314 Maple Ave. Marysville, PA 17057 Steffani Myles 532 Salmon Rd. Mechanicsburg, PA 17050 Brenda Augustine 2149 Merrimac Ave. Mechanicsburg, PA 17055 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 Z DJ DJ DJ REV-1 500 INHERITANCE TAX RETURN RESIDENT DECEDENT DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL) Brown, Eleanor I. DATE OF DEATH (MM-DM-YEAR) DATE OF BIRTH (MM-DM-YEAR) Rovember 21, 2001 Jar,..u. ary 8, 1918 (IF APPLICABLE)SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) ':.~ ;' It'b':.,L UbE ONLY ~ FILE NUMBER 2 1 _ 0 2 0 0 3 3 1 COUNTy CODE YEAR NUMBER SOCIAL SECURITY NUMBER 180 - 07 - 6825 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 1. Original Return --"]4. Limited Estate r--] 6. Decedent Died Testate IAItacn copy of Will) --']9, Litigation Proceeds Received r~2, Supplemental Return F-'] 4a, Future Interest Comprom,se !dale of dealh after 12.12.82) '--']7. Decedent Maintained a Living Trust IAttach copy of Trust) [-~ 10. Spousal Poverty Credit ~;¢a~e ¢ death belween 12.31.91 and 1.! .95( --"] 3, Remainder Return (date of death pr~ to 12-13-82) [-~5 Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes J---j 11. Elecbon to tax under Sec. 9113(A) ~i~'~EdyION,' MU$'i~;BE CoMpLETED, ALLrlCORRESPONDENCE AND'CONit, iDENTiAL T~ I'NFORMATjON SH'OU[~B~~~ ~NAME Albert ..Z _~ogert,B Esq. ] COMPLETE MAILfNGA~ORESS '' ~'"' ~ ..... FIRM NAME Cf~pli~b~e) ~ '1 ' P. O. Box 314 .... 1 Mechanicsburg, PA 17055-0314 .... P ........... ~ 717 69 1 1 ,, , -,, ,7- 9,8 ~ , ~C , ri ~ bY~"~d~AL 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 D) (4) 5, Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6, Jointly Owned Properly (Schedule F) (6) ~] Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8, Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities. & Liens (Schedule I) (10) 1t. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11 ) 13. $ 9.,548.78 2,452.54 36,484.74 $ 10,099.87 15.00 Charitable and Govemmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) (8) $ 48,486.06 m) $ 10,114.87 (12) $ 38:37].19 (13) 14. Net Value Subject to Tax (Line12 minus Line13) (14) $ 38 ,371. 19 15. SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES Amount of Line 14 taxable at the spousa~ tax rate, or transfers under Sec. 9116 (a)(1.2) x .0 (15) 16. Amount of Line 14 taxable al lineal rate S 38,371. 19 x .0 .45 (16) $ 1,726. 70 17. Amount of Line 14 taxable at sibling rate x ,12 (!7) 18, Amount of Line 14 taxable at collateral rate x .15 (18) .... 19. Tax Due (19) $ ];726.7,0 Decedent's Complete Address: STREET ADDRESS 2149 Merrimac Ave CITY Mechanicsbur~ Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D, Interest E, Penalty iSTATE PA Total Credits ( A + B + C ) (2) Total Interest/Penalty ( D + E ) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 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, Iz~P .17055 1,726.70 (3) (4) (5) (5A) B. Enter the total of Line 5 + SA This is [he BALANCE DUE. (SB) $, 1:726.7D 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; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ................................................................ : ..... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ........................................................................................................... [] E~ 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 Retirement 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 PARTOFTHE RETURN. Under penalties of perjury, t declare that t have examined this return including accompany~n9 schedules and sta!e.,en!s apd to the best of my knowledge and balzaC, it is lrue correcl and complete Declaration of preparer other lhan the personal representative is based om all information of which preparer has a'"y kqoMedge PA 17055 SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS {~ 2149 Merrimac Ave., Mechanicsburg, SIGNATURE OF~~~.~~PREP N R ENTATIVE '~ ADDRESS /~. P. O. Box 314, Mechanicsburg, PA 17055-0314 DATE For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [;'2 P.S. §9t16(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedenrs siblings is 12% [72 P.S, §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC, PERSONAL PROPERTY ESTATE OF ......... Eleanor I. Brown FILE NUMBE'R ' 21-02-331 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of sun~ivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1, Tax Refund - 2001 Federal Income Tax - Form 1040 Proceeds:Life Insurance Policy Homesteaders Life Ins. Co. Assignee and Payee: James A. Reed Funeral Home Proceeds: Sale of miscellanous household furniture Refund: Capitol Blue Cross/Shield Premium Refund~ Susquehanna View Nursing Home TOTAL (Also enter on line 5, Recapitulation) 832.00 7,727.63 619.00 106.15 264.00 $ 9,548.78 REV-1509 EX · (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE NUMBER Eleanor I. Brown 21-02-331 If an aaeet 45 made ~int ~hin one year of the decedent's date of death, ~ must ~ repo~ on Schedule G. SURVIVINGJOINTTENANT(S)NAME ADDRESS RE~TIONSHIPTODECEOENT A.Brenda Augustine Daughter 2149 Merrimac Ave. Mechanicsburg, PA 17055 JOINTLY. OWNED PROPERTY: L,5 ~ ~-~ DATE DESCRIPTION OF PROPERTY % OF m ' DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECD'S VALUE OF NUMBER TENANT JOINT deed for jointly-held real estate. VALUE OF ASSET INTEREST DECEDENT'S INTERES 1. A. 12/lZ 1982 Waypoint Bank Checking Acct $2,797.. 68 50% $1,398.84 ~/0505000178 2. A 7/17 1998 Waypoint Bank Checking Acct. $2,107.40 50% $1,053.70 ~/1000026079 TOTAL (Also enter on line 6, Recapitulation) $ 2,4 5 2.5 4 W LOOK FOR US WELL GET YOU THERE 04/22/2002 ALBERT BOGERT P O BOX 314 MECHANICSBURG PA 17055 The information which you requested on the account(s) of ELEANOR BROWN DECEASED (Social Security Number 180-07-6825) is/are as follows: Account Number 0505000178 1000026079 Class of Account CHECKING CHECKING Date Opened 12/14/82 07/17/98 Principal Balance 2797.68 2107.02 Accrued Interest .38 Balance at Date of 2797.68 2]07.40 Death Account Ownership JTO JTO Name of Joint BRENDA BRENDA Owner, if any AUGUSTINE AUGUSTINE Date Ownership 12/14/82 07/17/98 Was Established Account Number Class of Account Date Opened Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested PLEASE COMPLETE W-9 S!/~cerely,// SEN O . SERWCES P.O. Box 171 I, HARRISBURG. PENNSYLVANIA 17105-1711 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Eleanor I. Brown SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY I FILE NUMBER 21-02-331 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 % OF ITEM ~.CLUDE THE NAME O¢ 1HE TRANSCE~[E, T~FIq RE[AT!ONSHIP TO DECEDENT AND THE DATE OF TRANS':ER DATE OF DEATH DECD'S EXCLUSION TAXABLE VALUE NUMBER VALUE OF ASSET INTEREST, I~, ,~.t~c^~L~:) 1. Anchor National Life Ins. Co. $36,484.74 100% -0- $36,484.7 Anchor Advisor Variable Annuity #P 1598546268 TOTAL (Also enter on line 7, Recapitulation) $ 3 6,4 8 4.7 4 (If more space is needed, insert additional sheets of the same size) Keeler & Danner Financial Services, LLP (717) 790-9059 John R. Keeler, CFP Registered Investment Advisor Agent 50 Wcxl Main Slrccl, Suite B Mcchanicshurg, PA 17055 I (800) 373-5452 Fax (717) 790-9268 Dale E. Danner, RFP Registered Investment Advisor Agent Registered Principal May 22, 2002 Albert Z. Bogert, Esq. PO Box 314 Mechanicsburg, PA 17055-0314 RE: Eleanor I. Brown SSN: 180-07-6825 Dear Mr. Bogen; The lbllowing is information that you have recently inquired about for the date of death value of the Anchor Advisor Variable Annuity for Eleanor I. Brown. November 2 I, 200 I Date PI598546268 Account# $36,484.74 Account Value This information was obtained by contacting Anchor National Life Insurance Company. Please let me know if any further information is needed. Respectfully, Patricia Juliana, Office Mgr. Securities offered through Hackett Associates, Inc. Member NASD, SIPC REV-1511 EX.,~ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVECOSTS RESIDENT DECEDENT ESTATE OF F~leanor I, Brown FILE NUMBER 21-02-331 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A 1, 5, 6. 7. 8, 9. FUNERAL EXPENSES: James A. Reed Funeral Home ADMINISTRATIVE COSTS: 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: Attorney Fees Family Exemption: (if decedenrs address is not the same as claimant's, attach explanation) Claimant Street Address City __ State__Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees ~xReturnPreparer'sFees Charles F. Sullivan, CPA 1513 Cedar Cliff Dr., Camp Cumberland Law Journal - publication The Sentinel - publication Inheritance Tax Return - file fee Hill, PA 17011 TOTAL (Aisc enter on line 9, Recapitulation) $ 7,328.00 2,400.00 106.00 95.00 75.00 80.87 15.00 s 10~099.87 (ff more space is needed, insert addi!icr*a! sheets of the same size) James A. Reed Funeral Home Chestnut and Market Sts. Pillow PA 17080 570-758-4294 James A. Reed, Sr., F.D. Monday, December 3, 2001 Mrs. Brenda L Augustine 2149 Merrimac Ave Mechanicsburg, Pa. 17055 Dear Mrs. Augustine, Thank you for selecting our funeral home to provide services to you during your time of bereavement. I hope that you found our services, so far, to be of the highest standards that we always try to achieve. Eleanor I Brown 1. PROFESSIONAL SERVICES Services of Funeral Director and Staff $1095.00 Embalming $ 365.00 Dressing, Casketing $195.00 2. USE OF FACILITIES, STAFF AND EQUIPMENT Use of Facilities for Funeral Ceremony Use of Prep. Room & Equipment 3. AUTOMOTIVE EQUIPMENT Transfer Remains to Funeral Home Hearse (Funeral Coach) Utility Car / Service Car $1,655.00 $ 225.00 $150.00 $375.00 TOTAL SERVICE CHARGES MERCHANDISE Casket: Elpaso Oak Outer Burial Container: Con-Elite Acknowledgcmcnt Cards 25 Register book Memorial Folders M205 E. Maid Gown Ivory 75.00 50.00 50.0O CASH ADVANCES 33 Flowers 35 Cemetery/Crypt Opening and Closing Clergy Honorarium Allowance for monument Funeral Meal 30 (~ 12.00 $2,295,00 $995.00 $ I 0.00 $ 20.00 $ 30.00 $178.00 TOTAL OF SERVICES LESS: Total Payments PLUS: Items ordered later Duplicate Death Certificates LESS: Items deleted later Actual Cost of Stone $689.00 Funeral Meal $195.00 $ 200.00 $ 295.00 $100.00 $ 700.00 $ 360.00 $0.00 $16.00 16.00 $176.00 11.00 165.00 $275.00 $2,305,00 $1,655.00 BALANCE DUE .~ ~ . $7,328.00 ff ~crc ~e ~y questions or ~n~ms tn~t remain unanswcr~, I~Case call me. t ~.~ -~ COMMONWEAL] H OF P[NNSYLVANb', INHERITANCE TAX RETURN RESIOENT OECEDENT ESTATE OF Eleanor SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES1 & LIENS I. Brown FILENUMBER 21-02-331 AMOUNT Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1, Lane Bryant Department Store Balance Due on Account TO'[AL (Also enter on line '~0, Recapitulationl (If more space is neeOed, inseri aOditionat sheets of the same size) $ 15.00 15.00 REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT 'ESTATE OF Eleanor I. Brown SCHEDULE J BENEFICIARIES FILE NUMBER 21-02-331 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I 1. !1 1. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1,2)] Brenda Augustine 2149 Merrimac Ave. Daughter Mechanicsburg, PA 17055 Claudia Havens 314 Maple Ave. Marysville, PA Steffa Miles 532 Salmon Rd. Mechanicsburg, 17053 PA 17050 Daughter Daughter One-third One-third One-third ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE. ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TOTAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE t3 OF REV-1500 COVER SHEET (If more space is needed, inserl additional sheels of the same size) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 001407 BOGERT ALBERT Z PO BOX 314 MECHANICSBURG, PA 17055-0314 ........ fold ESTATE INFORMATION: SSN: 180-07-6825 FILE NUMBER: 2102-0331 DECEDENT NAME: BROWN ELEANOR I DATE OF PAYMENT: 07/15/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 11/21/2001 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1,726.70 TOTAL AMOUNT PAID: $1,726.70 REMARKS: ALBERT Z BOGERT ESQUIRE SEAL CHECK# 1 OO4 INITIALS: JA RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS BUREAU OF TNDZVZDUAL TAXES TNHERZTANCE TAX DTV3[SI'ON DEPT. Z80601 HARR'rSBURG, PA 171Z8-060'1 ALBERT Z BOGERT ESQ PO BOX $1R HECHANZCSBURG CONNONHEALTH OF PENNSYLVANZA DEPARTHENT OF REVENUE NOT/CE OF ZNHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSHENT OF TAX R£V-I$47 EX AFP PA 17Q55 DATE ESTATE OF DATE OF DEATH FZLE NUHBER ~: *.~?COUNTY ACH 08-12-2002 BRONN 11-21-2001 21 02-05:51 CUMBERLAND 101 Amount Remitted ELEANOR HAKE CHECK PAYABLE AND RENZT PAYNENT TO: REGI'STER OF gILLS CUHBERLAND CO COURT HOUSE CARLI'SLE, PA 1701:5 CUT ALONG THZS L/NE ~ RETAZN LO#ER PORT/ON FOR YOUR RECORDS -~ REV-1547 EX AFP (01-02) NOT/CE OF ZNHERZTANCE TAX APPRAZSEHENT, ALLOWANCE OR DZSALLO#ANCE OF DEDUCTZONS AND ASSESSHENT OF TAX ESTATE OF BROWN ELEANOR ! FZLE NO. 21 02-0551 ACN 101 DATE 08-12-2002 TAX RETURN WAS: (X) ACCEPTED AS F/LED ( ) CHANGED RESERVATZON CONCERNZNG FUTURE ZNTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: OR/GZNAL RETURN 1. Reel Estate (Schedule A) (1) 2. Stocks end Bonds (Schedule B) (2) $. Closely Held Stock/Partnership Znterest (Schedule C) ~. Hortgages/Notes Receivable (Schedule D) (4), 5. Cash/Bank Deposits/Hisc. Personal Property (Schedule E) (5) 6. Jointly Owned Property (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. Total Assets APPROVED DEDUCTZONS AND EXEHPTZONS: 9 10 11 lq Funeral Expenses/Adm. Costs/Nisc. Expenses (Schedule H) Debts/Hortgege Liabilities/Liens (Schedule 1) Tote1 Deductions Net Value of Tax Return (9) (10) Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) Net Value of Estate Subject to Tax 9~5~8.78 2~52.5~ (8) 10,099.87 15.00 .00 NOTE: To insure proper .00 credit to your account, .00 submit the upper portion .00 of this form with your ~ex payment. q8,~86.06 (11) 10 (12) (15) . O0 (14) :58, :571.19 NOTE: Zf an assessment was issued previously, 1/nas 14, 15 and/or 16, 17, 18 and 19 w111 reflect figures that /nclude the total of ALL returns assessed to date. (1~) .00 x O0 = .00 (16) $8,:571.19 x OR5= 1,726.70 (17) . O0 x 12 = . O0 (18) .00 x 15 = .00 (19)= 1,726.70 ASSESSHENT OF TAX: 15. Amount of Line 14 at Spouse1 rate 16. Amount of Line 14 ~axable at Lineal/Class A rate 17. Amount of Line lq mt Sibling rate 18. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAX CREDZTS: PAYNENT RECEzrl DATE NUNBER DISCOUNT ZNTEREST/PEN PAZD (-) ANOUNT PAZD .00 1,726.70 1.70 1,728.~0 ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUZRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU HAY BE DUE A REFUND. SEE REVERSE S/DE OF THZS FORH FOR ZNSTRUCTZONS.) ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. /NTEREST /S CHARGED THROUGH 08-Z7-ZOOZ TOTAL TAX CREDZT AT THE RATES APPL/CABLE AS OUTL/NED ON THE BALANCE OF TAX DUEI REVERSE S/DE OF TH/S FORH ZNTEREST AND PEN. TOTAL DUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG,, PA 171Z8-0601 ALBERT Z BOGERT ESQ PO BOX $1~ HECHANICSBURG PA 17055 COHNONWEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE INHERITANCE TAX STATEHENT OF ACCOUNT DATE 08-26-2002 ESTATE OF BROWN DATE OF DEATH 11-21-2001 FILE NUHDER 21 02-0331 COUNTY CUHBERLAND ACH 101 Amount Remitted ELEANOR HAKE CHECK PAYABLE AND REHIT PAYHENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To Ansur. proper credit to your account, submit the upper port/on of thAs for. with your tax payment. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS REV-1607 EX AFP (01-02) ### INHERITANCE TAX STATEHENT OF ACCOUNT ESTATE OF BROWN ELEANOR I F'rLE NO. 21 02-0551 ACN 101 DATE 08-26-2002 THIS STATEMENT TS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHO#N BELON TS A SUHHARY OF THE PRINCIPAL TAX DUE, APPL/CATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED 'rNTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 08-1Z-ZOOZ PRINCIPAL TAX DUE: ........................................................................................................................................................................................................................... PAYMENTS (TAX CREDITS): 1,726.70 PAYMENT RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 07-15-2002 CD001~07 .00 1,726.70 IF PAID AFTER THIS DATE, SEE REVERSE SIDE FOR CALCULAT/ON OF ADDITIONAL INTEREST. IF TOTAL DUE [S LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), TOTAL TAX CREDIT 1,726.70 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 YOU NAY BE DUE A REFUND. SEE REVERSE STDE OF THIS FORM FOR INSTRUCTIONS. ) PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE ESTATE. IF ESTATE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION f~, STATUS REPORT UNDER RULE 6.12 Name of Decedent: Eleanor Date of Death: Nnvmrnhor Pl Will No.: 2002-00'331 I. Brown Admin. No.: 21-02-0331 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: State whether administration of the estate is complete: Yes XX No If the answer is No, state when the personal representative reasonably believes that the administration will be complete: If the answer to No. 1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No XX B. The separate Orphans' Court No. (if any) for the personal representative's account is: (MAH:rmffAM3) Did the personal representative state an account informally to the parties in interest? Yes XX No Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this Albert Z. Bogert, Esq. Name(Please~peorpfint) P. O. Box 314 Mechanicsburg, PA 17055-0314 Ad&ess 717-697-1918 Telephone No. R.W. - 27 Capacity: Personal Representative Counsel for Personal Representative