HomeMy WebLinkAbout02-27-14 -I REV-1500 4 1505610143
EX(02-11)
PA Department of Revenue ti OFFICIAL USE ONLY
p pennsylvania County Code Year File Number
Bureau of Individual Taxes DEPARTMENT OF REVENUE
PO BOx.280601 INHERITANCE TAX RETURN 21 13 1054
Harrisburg,PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
09 26 2013 05 19 1917
Decedent's Last Name Suffix Decedent's First Name MI
MARTIN ANNA B
(If Applicable)Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
® 1. Original Return ❑ 2. Supplemental Return ❑ 3.Remainder Return(Date of Death
Prior to 12-13-82)
❑ 4. Limited Estate ❑ 4a. Future Interest Compromise ❑ 5. Federal Estate Tax Return Required
(date of death after 12.12-82)
® g Decedent Died Testate ❑ Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
❑ 9. Litigation Proceeds Received ❑ 10.Spousal Poverty Credit(Date of Death ❑ 11.Election to tax under Sec.9113(A)
between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT-THIS SECTION MUST BE COMPLETED.ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number .w
GERALD J BRINSER 717 83C 6348
REGISTER OF.WILLS USE VhY c
' . _ t I
3Y_ _y
First Line of Address
6 E MAIN STREET J A r~
Second Line of Address
-�T
PO BOX 323 '
City or Post Office State ZIP Code DATE FILED
PALMYRA PA 17078
Correspondent's e-mail address: gjbrin@aol.com
Under penalties of p ec re that I have examined this return,including accompanying schedules and statements,and to the best of my knowledge and belief,
it is true,correct an complete. eclaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SI TU OF PER S RESP SIBLE FOR FILING RETURN DATE
Robert Musser
ADDRE S
23 Creekview Drive, Carlisle, PA 17015-9106
SIGNATURE F PREPARER OTHER THAN REPRESENTATIVE DATE
Gerald J Brinser y �.
ADD SS
Brinser,Wagner&Zimmerman
6 E. Main Street, Palmyra, PA 17078
Side 1
1505610143 1505610143
J 1505610243
REV-1500 EX
Decedent's Social Security Number
Deceaeers MaMi MARTIN, ANNA B.
RECAPITULATION
1. Real Estate(Schedule A).......................................................................................... 1.
2. Stocks and Bonds(Schedule B)............................................................................... 2. 320 , 834 . 32
3. Closely Held Corporation,Partnership or Sole-Proprietorship(Schedule C).......... 3.
4. Mortgages&Notes Receivable(Schedule D).......................................................... 4.
5. Cash,Bank Deposits&Miscellaneous Personal Property(Schedule E)................ 5. 289 , 534 . 05
6. Jointly Owned Property(Schedule F) ❑ Separate Billing Requested............. 6.
7. Inter-Vivos Transfers&Miscellaneous Non-Probate Property
(Schedule G) ❑ Separate Billing Requested............. 7. 35 , 427 . 95
8. Total Gross Assets(total Lines 1 through 7).......................................................... 8. 645 , 7 9 6 . 32
9. Funeral Expenses and Administrative Costs(Schedule H)................ 37 , 428 . 82
10. Debts of Decedent,Mortgage Liabilities and Liens(Schedule 1)......................... 10. 9 , 413 . 88
11. Total Deductions(total Lines 9 and 10)............._......-......__.......-......-........ . 46 , 842 . 70
12. Net Value of Estate(Line 8 minus Line 11)........................_..._..._................_....... 12. 598 , 953 . 62
13. Charitable and Govemmental Sequests/Sec 9113 Trusts for which
an election to tax has not been made(Schedule J)........ ........ ...................- 13. 28 , 176 . 30
14, Net Value Subject to Tax(Line 12 minus Line 13)................................................. 14. 570 , 777 . 32
TAX COMPUTATION-SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate,or
transfers under Sec.9116
(a)(1.2)X .00 15.
16. Amount OEM 14 taxable 25 , 594 . 9$
at lineal rate x .045 568 , 777 . 32 16
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 2 , 000 . 00 18. 300 . 00
19. TAX DUE................................................................................................................... 19. 25 , 894 . 98
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ❑
Side 2
1505610243 1505610243
REV-1500 EX Page 3 File Number 21 - 13 - 1054
Decedent's Complete Address:
DECEDENT'S NAME
Martin, Anna B.
STREET ADDRESS
Messiah Village, 100 Mt. Allen Drive
CITY STATE ZIP
Mechanicsburg PA 17055
Tax Payments and Credits:
1. Tax Due(Page 2,Line 19) (1) 25,894.98
2. Credits/Payments
A. Prior Payments 23,750.00
B. Discount 1,250.00
Total Credits(A +B) (2) 25,000.00
3. Interest
(3) 0.00
4. If Line 2 is greater than Line 1 +Line 3,enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2,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. (5) 894.98
Make Check Payable to: REGISTER OF WILLS, AGENT.
.5�", 6.
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;.................................................................................. ❑ ❑x
b. retain the right to designate who shall use the property transferred or its income;.................................... ❑ ❑x
c. retain a reversionary interest;or.................................................................................................................. ❑ ❑x
d. receive the promise for life 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?....................................................................................................................... ❑ 0
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?...................................................................................................................... 0 ❑
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
spouse is 3 percent[72 P.S.§9116(a)(1.1)(1)].
For dates of death on or after January 1, 1995,the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent
[72 P.S.§9116(a)(1.1)(ii)]. The statute does not exempt 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 21 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 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 decedent's lineal beneficiaries is 4.5 percent,except as noted in
[72 P.S.§9116(a)(1)].
•The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 percent[72 P.S.§9116(a)(1.3)1. A
sibling is defined under Section 9102,as an individual who has at least one parent in common with the decedent,wfiether by blood or adoption.
REV-1503 EX+(6.98)
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Martin, Anna B. 21 - 13- 1054
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION UNIT VALUE VALUE AT DATE OF
NUMBER DEATH
1 Vanguard - Individual Account#88052057696 301,758.79
2 Wells Fargo Advisors-Individual Account#2580-2473 17,725.53
3 (100) Shares Dell Stock @$13.50 1,350.00
TOTAL(Also enter on line 2, Recapitulation) 320,834.32
pennsylvania SCHEDULE E
DEPARTMENT NCETA RETURN CASH BANK DEPOSITS AND MISC.
INHERITANCE TAX RETURN �
RESIDENT DECEDENT PERSONAL PROPERTY
FILE NUMBER
ESTATE OF Martin, Anna B. 21 - 13- 1054
Include the proceeds of litigation and the date the proceeds were received by the estate.All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM VALUE AT DATE OF
NUMBER DESCRIPTION DEATH
1 PNC Bank-Checking Account#5070102136 9,262.16
(Includes accrued interest of$0.02)
2 PNC Bank-Savings Account#5002056596 182,922.88
(Includes accrued interest of$6.46)
3 BIC Foundation -TAP Account#6026270 94,808.71
(Includes accrued interest of$50.59)
4 Genworth -Long-Term Care Insurance 1,760.00
5 Asbury University- Final Annuity Payment 740.00
6 Highmark Blue Shield - Premium Refund 37.72
7 Health Spring -Medicare D Refund 2.58
I
TOTAL(Also enter on Line 5, Recapitulation) 289,534.05
REVA510 EX+(08-09)
pennsylvania
' DEPARTMENT OF REVENUE SCHEDULE G
INHERITANCE TAX RETURN INTER-VIVOS TRANSFERS &
RESIDENT DECEDENT MISC. NON-PROBATE PROPERTY
ESTATE OF Martin,Anna B. FILE NUMBER
21 - 13- 1054
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM DESCRIPTION OF PROPERTY DATE OF DEATH %OF EXCLUSION
Include the name of the transferee,their relationship to decedent VALUE OF ASSET DECD'S IF APPLICABLE) TAXABLE VALUE
NUMBER and the date of transfer. Attach a copy of the deed for real estate. INTEREST
1 MetLife Investors-Non-Qualified Annuity,with 33,427.95 100% 33,427.95
daughter, Penelope Popp, named as beneficiary
2 Charles Honeywell -Cash gift given within a year of 5,000.00 100% 3,000.00 2,000.00
death
TOTAL(Also enter on line 7, Recapitulation) 35,427.95
REV-151i EX+(10-09)
pennsylvania SCHEDULEH
DEPARTMENT OF REVENUE FUNERAL EU*MES MD
INHERITANCE TAX RETURN
RESIDENT DECEDENT ArywC p WE a)sTs
ESTATE OF Martin, Anna B. FILE NUMBER
21 - 13- 1054
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Cocklin's Funeral Home 10,848.79
2 Pastor's Honorarium 50.00
3 Hoss's Restaurant- Funeral Luncheon 411.71
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s)
Robert Musser 10,000.00
Street Address 23 Creekview Drive
city Carlisle State PA zip 17015-910
Year(s)Commission Paid 2013/2014
2. Attorney's Fees Brinser, Wagner&Zimmerman --Gerald J. Brinser 15,260.00
3. Family Exemption: (If decedent's address is not the same as claimant's,attach explanation)
Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Register of Wills (Ltrs. Pd. $260.00 = $100,000-$200,000) 383.50
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1 Register of Wills-Additional Cost of Letters 250.00
TOTAL(Also enter on line 9,Recapitulation) 37,428.82
Schedule H
C
COMMONWEALTH OF PENNSYLVANIA uneW tenses
INHERITANCE TAX RETURN Administrative Costs continued
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Martin, Anna B.
21 - 13- 1054
2 Cumberland Law Journal - Legal Advertising 75.00
3 The Sentinel- Legal Advertising 115.20
4 Vital Records- Death Certificates for John Z. Martin 18.00
5 Bank Fee for Certified Checks 16.62
I
Page 2 of Schedule H
' pennsylvania SCHEDULE I
DEPARTMENT NCE TA RETURN REVENUE DEBTS OF DECEDENT MORTGAGE
INHERITANCE TAX RETURN f
RESIDENT DECEDENT LIABILITIES & LIENS
NNUMBER
BER
ESTATE OF Martin, Anna B. FILE
- N - BER
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION AMOUNT
1 Messiah Lifeways @ Messiah Village 8,450.30
2 Verizon -Phone 20.28
3 Outstanding Checks Cleared After Death 943.30
. I
TOTAL(Also enter on Line 10, Recapitulation) 9,413.88
REV-1513 EX+(01-10)
,I f,- pennsylvania SCHEDULE J
'4L►� , DEPARTMENT OF REVENUE
iiilll���iii��� INHERITANCE TAX RETURN BENEFICIARIES
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Martin,Anna B.
21 - 13- 1054
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I� TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)]
1 Penelope Popp Daughter Personalty; 512,424.77
10107 Chester Drive Schedule G, Item 1;
Carmel, IN 46032-4021 85% Residue
2 Sydney Burkholder Grandchild 5% Residue 28,176.29
4821 39th Street
San Diego, CA 92116
3 Jon Burkholder Grandchild 5% Residue 28,176.29
7613 Blanche Place
Roscoe, IL 61073
Enter dollar amounts for distributions shown above on lines 15 through 18 on Rev 1500 cover sheet,as appropriate.
II. NON-TAXABLE DISTRIBUTIONS:
A.SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B.CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 Brethren in Christ World Missions, 431 Grantham Road 9,392.10
Mechanicsburg, PA 17055-5812 1/3 of 5% Residue
2 Grantham Brethren in Christ Church, 421 Grantham Road 9,392.10
Mechanicsburg, PA 17055 1/3 of 5% Residue
3 Messiah College,Attn: Bob Brown 9,392.10
One College Avenue, Suite 3013, Mechanicsburg, PA 17055 1/3 of 5% Residue
TOTAL OF PART 11-ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 28,176.30
REV-1513 EX+(01-10)
pennsylvani SCHEDULE J
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN BENEFICIARIES continued
RESIDENT DECEDENT
ESTATE OF Martin,Anna B. FILE NUMBER
21 - 13- 1054
RELATIONSHIP TO SHARE OF ESTATE AMOUNT OF ESTATE
NUMBER NAME AND ADDRESS OF PERSON(S) DECEDENT (Words) ($$$)
RECEIVING PROPERTY Do Not ListTrustee(s)
I. TAXABLE DISTRIBUTIONS[include outright spousal
distributions,and transfers
under Sec.9116(a)(1.2)j
4 Charles Honeywell None Schedule G, Item 2 2,000.00
2105 Beacon Circle
Mechanicsburg, PA 17055
Page 2 of Schedule J
a
WILL -
OF
ANNA B. MARTIN
I, ANNA B. MARTIN, currently of Upper Allen Township, Cumberland County,
Pennsylvania, realizing the uncertainty of this life, but with confidence in God and trust in
His Son, my Lord and Savior, Jesus Christ, who died for my sins upon the cross and rose
again to redeem me and give me eternal life,do hereby make,publish and declare this to be
my Last Will and Testament,hereby revoking any and all prior Wills and Codicils made by
me.
I. I direct that all my just debts and funeral expenses be paid from the assets of my
estate as soon as practicable after my demise.
II. I direct that all estate and inheritance taxes that may be assessed in consequence of
my death, shall be paid out of the principal of my general estate to the same effect as if said
taxes were expenses of administration and all property includable in my taxable estate
whether or not passing under this Will shall be free and clear thereof.
III. I bequeath unto my husband, John Z. Martin, all tangible personal property which
I own at my death.
IV. All the rest, residue and remainder of my estate, of whatever nature and wherever
situate,including property over which I hold a power of appointment,I devise and bequeath
unto my husband, John.
V. In the event that my husband, John, does not survive me, I devise and bequeath my
entire estate that would have otherwise passed under Paragraphs III and IV above as follows:
A. I intend to keep with this my Will a separate memorandum
concerning disposition of certain items of tangible personal property. I
bequeath the items on said memorandum to the persons designated.
B. The remainder of my personal effects and tangible personal
property I bequeath unto my daughter,Penelope Popp. If she predeceases me,
I .
this bequest shall lapse and these items shall pass as part of my residuary
estate under Sub-Paragraph C below.
C. The remainder of my estate I devise and bequeath as follows:
(1) Eighty-five percent (85%) unto my daughter,
Penelope. If she predeceases me, this share shall be divided
equally among my granddaughter, Sydney; my grandson, Jon;
Messiah College, Grantham, Pennsylvania, to be used as it
determines best; and Messiah Village, Mechanicsburg,
Pennsylvania, to be used in its Endowment Fund. If either
grandchild predeceases me, his or her share shall be divided
equally among the remaining beneficiaries mentioned in this
Sub-Paragraph.
(2) Five percent (5%) unto my granddaughter,
Sydney. If she predeceases me, this share shall pass unto
Messiah Village to be used in its Endowment Fund.
(3) Five percent (5%) unto my grandson, Jon. If he
predeceases me, this share shall pass unto Messiah College to
be used as it determines best.
(4) Five percent (5%) to be divided equally among
the Brethren In Christ Board for World Missions, Grantham
Brethren In Christ Church, and Messiah College, all of
Grantham, Pennsylvania, to be used as they determine best.
VI. I appoint my husband, John Z. Martin, Executor of this my Will. In the event that
he fails to qualify or ceases to act as Executor,I appoint Robert Musser Executor of this my
Will. In the event that he fails to qualify or ceases to act as Executor, I appoint Gerald J.
Brinser, Esquire, Executor in his place. In the event that he fails to qualify or ceases to act
as Executor, I appoint Keith D. Wagner, Esquire, Executor of this my Will.
VII. I direct that no bond be required of my fiduciaries for the faithful performance of
their duties in any jurisdiction.
r-- -2-
IN WITNESS WHEREOF,I,ANNA B.MARTIN,herewith set my hand to this my
Last Will, typewritten on three (3) sheets of paper including the attestation clause and
signatures of witnesses, this 3.,< day of i-L, N E , 2003.
(SEAL)
ANNA B. MARTIN
Signed by ANNA B. MARTIN, by her declared to be her Will in our presence, who
have hereunto subscribed our names as witnesses in her presence and at her request,this
3,4 day of _.Tu,v € , 2003.
V,,,�77e ` residing at
r residing at
-3-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF
WE, ANNA B. MARTIN, GERALD J. BRINSER and -ou- �
the testatrix and the witnesses, respectively, whose names are signed to the attached or
foregoing instrument, being first duly affirmed, do hereby declare to the undersigned
authority that the testatrix signed and executed the instrument as her Last Will and that she
signed willingly (or willingly directed another to sign for her), and that she executed it as
her free and 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 our knowledge the testatrix was at that time eighteen years of age or older, of sound mind
and under no constraint or undue influence.
ANNA B. MARTIN
.r
WITNESS
V� ESS
Subscribed, sworn or affirmed and acknowledged before me by ANNA B.MARTIN,the
testatrix, GERALD J. BRINSER and Sd,�N z_ h� , witnesses, this 3
day of Tom.,e , 2003.
(LL„ (SEAL)
Notary Public
Notarial Seal
Vicky M.Mici ta,Notary Public
Upper Allen Twp.,Cumberland County
My Commission Ewes December 31,2005
Member,Pennsylvania Association Of Notaries
-4-
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(I 1-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT.280601
HARRISBURG,PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 018558
MUSSER ROBERT
23 CREEKVIEW DRIVE
CARLISLE, PA 17015-9106
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
-------- fold ---------- --------
101 $23,750.00
ESTATE INFORMATION: SSN:
FILE NUMBER: 2113-1054
DECEDENT NAME: MARTIN ANNA B
DATE OF PAYMENT: 12/23/2013
POSTMARK DATE: 12/21/2013
COUNTY: CUMBERLAND
DATE OF DEATH: 09/26/2013
TOTAL AMOUNT PAID: $23,750.00
REMARKS: RECEIPT TO ATTY
CHECK# 1001
INITIALS: WZ
SEAL RECEIVED BY: GLENDA FARMER STRASBAUGH
REGISTER OF WILLS
TAXPAYER
n
E
Vangnaard®
S
P.O.BOX 2600 c
November 11, 2013 valley Forge, PA 19482-2600
www.vanguard.com
{
GERALD J BRINSER
BRINSER WAGNER & ZIMMERMAN
PO BOX 323
PALMYRA PA 17078
Re: Estate of Anna B. Martin
Dear Mr. Brinser:
We are responding to the letter we received requesting a valuation of Anna B.
Martin's Vanguard account. The mutual fund valuation is included in table below.
As of September 26, 2013, the number of shares, the price per share, the value
of the funds, and the accrued dividends (if applicable) were as follows:
Anna B. Martin – Individual Account 88052057696
Fund Name Shares Price Value Accrued
Dividends
Dividend Growth Fund 2,097.363 $20.01 $41,968.23 —
Health Care Fund Inv 147.199 $180.75 $26,606.22 —
Ltd-Term Tax-Exempt Adm 4,602.990 $ 11.01 $$50;678.92 $62.64
Mid-Cap Index Fund Adm 336.546 $127.69 $42,973.56 —
_Prime Money Mkt Fund 301886.390 $1.00 $30,8_86.39_ $0.22
I-Short-Term Invest=Gr Adm 7,963.102 $10.70 $85,205.19 $120.90
Wellington Fund Inv 623.246 $37.61 $23,440.28 —
If you have any questions, please call Vanguard Voyager Services® at
800-284-7245. You can reach us on business days from 8 a.m. to 10 p.m. and on
Saturdays from 9 a.m. to 4 p.m., Eastern time.
Sincerely,
Retail Investor Group
Vanguard
hsm
52488034
j
Wells Fargo Advisors,LLC
Three Lemoyne Drive
• • Lemoyne,PA 17043
Tel:717-761-7344
Fax:717-975-8426
Toll Free:800-468-8685
November 12, 2013
Gerald J Brinser
Brinser, Wagner& Zimmerman
6 E Main St—2nd Floor
Palmyra PA 17078
RE: Anna B Martin
Dear Attorney Brinser,
In response to your request, approved by Executor Robert J Musser, for values related to the date
of death for Anna B Martin I have enclosed the following documents:
• Statements for her individual account for September and October 2013.
• Closed tax lots after securities were moved from the individual account to the estate
account. This shows security values as of 9/26/2013. Three securities had no value.
Global Beverage Solution is in Reorganization at this time.
There have been 3 dividends that were credited to the account after her death:
09/30 $0.01 interest on her Bank Deposit money market funds
10/25 $57.00 dividend on 300 shares of General Electric Company stock
11/1 $90.00 on 200 shares of AT&T stock.
The account was an individual account in Anna Martin's name. It was transferred to an Estate
account in her name.
Sincerely,
'Z
Sherry Davis
Client Associate
Encl. Tcge her we'll go far
Member FINRA/SIPC _ J -
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CHECK NO 403351268 �,i: b0 J37
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Payable at:JPMorgan Chase Bank, N.A. Syracuse,NY 13206
CHECKKDATE. 07/22/2013
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CHECK VOID AFTER SIX MONTHS
PAY: ****EIGHT AND 00/100
- _ •-�.- I I .I C° 1.i, r 'I � III•I 'il Diu - aa i t I P ,, i I I i
TO THE.'
ORDER 01734 90000313029 4033 5 1268
OF:
JOHN Z MARTIN &
ANNA B MARTIN
JT TEN
222 MESSIAH C1201
MECHANICSBURG, PA 17055-8619 "I =
l I
II't,0335L26811' f:02L3093791: 630152L492 50911'
Detach Here Detach Here
AMERICAN STOCK INFORMATION STUB Operations Center
Transfer&Trust Company,LLC ..... 6201 15th Avenue
LINK GROUP network
Don't-want to wait for your dividend check? Sign-up for Brooklyn, NY 11219
Direct. Deposit at www.amstock.com or complete. the Telephone: 877-739-9991
form below and return it to AST to enroll. Web: www.amstock.com
Record Date Payable Date
07/01/2013 07/22/2013 Current Distribution Year-to-Date
Record Date Position Distribution Rate Gross Amount Gross Amount
100.000 0.080000 8.00 24.00
Account Number Tax Withheld Tax Withheld
9000036029 0.00 0.00
Check Number Check Amount
403351268 8.00 JOHN Z MARTIN &
01734 DELL INC
Detach Here Detach Here 833
Direct Deposit Enrollment and/or Address Change transactions may also be submitted online at www.amstock.com.
Please see the reverse side for address change form.
Dividend Reinvestment Enrollment Direct Deposit Enrollment -
No;v. 26. 2013 10, 55AM PNC Bank No. 0577 P. '1/2
November 26,2013
Gerald J Brinser Esq_
Law Offices Brinser Wagner
& Zimmerman
6 E Main St 2nd Fl
P O Box 323
Palmyra, PA 17078
RE: Anna B Martin
SSN: 557-56-8580
DOD: 09-26-2013
Dear Mr_ Brinser:
In response to your request for Date of Death (DOD) balances for the customer noted above, our
records show the following:
Checking Account
Account# 5070102136 Established 1005-1989
ANNA 13 MARTIN
DOD balance: $ 9,262.14+ 0.02 accrued interest
Interest paid 01-01-2013 thru 09-26-2013 $ 0.56 YTD
Savings Account
Account#5002056596 Established: 06-28-2005
ANNA B MARTIN
DOD balance: $ 182,916.42+6.46 accrued interest
Interest paid 01-01-2013 thru 09-26-2013 $ 406.26 YTD
Please note that this office provides date of death balances for deposit accounts(IRAs, CDs,Checking and
Savings). We do not process any financial transactions or provide statements. If you need assistance wirh
any of these items,please call 1-888-PNC-13AN1,(1-888-762-2265)or stop by your local PNC Bank branch
office.
Sincerely,
National Financial Services Center
PNC Bank,N.A.
Member FDIC
Page I of 2
N 26. 2013 10: 55AM PNC Bank No. 0577 P. 2/2
This message is intended for the use of the individual or entity to which it is addressed and may
contain information that is privileged, confidential and exempt from disclosure under applicable law.
If the reader of this message is not the intended recipient or the employee or agent responsible for
delivering this message to the intended recipient,.you are hereby notified that any dissemination,
distribution or copying of this communications is strictly prohibited. 1f you have received this
communication in error,please notify me immediately by reply or by telephone at 800-762-1775 and
immediately destroy this faxed document
page 2 of 2
L
Bic
F
Brethren in Christ
FOUNDATION Financial Services forFaithful Stewards
POST OFFICE BOX 290 �.
431 GRANTHAM ROAD November 8,2013
GRANTHAM, PA 17027
Mr. Gerald J. Brinser
Brinser, Wagner&Zimmerman
P.O. Box 323
Palmyra, PA 17078
RE: Anna B. Martin
Account#6026270
Dear Mr. Brinser:
At the time of her death on September 26,2013, Anna B. Martin had Thrift Accumulation Plan(TAP)
Account with the Brethren in Christ Foundation. A TAP account can be added to or withdrawn from
at any time without penalty.
TAP Account 42627 had a balance of$94,758.12 as of Mrs. Martin's death. The accrued interest was
$50.59 with a total date of death value of$94,808.71. There were no joint owners or beneficiaries on
the account.
If I can be of further assistance,please do not hesitate to contact me at 717-796-4788,Extension
#5420, or at klehman@,bicfouiidatioii.org.
Sincerely, -
Kimberly J. Lehman
Account Officer
KJL/kj 1
Phone: (717) 796-4788 Fax: (717) 697-7714 E-mail: info @bicfoundation.org
5154574219 04:05:45 p.m. 11-20-2013 1 /1
MetLife
P.O.Box 10366
'Des Moines IA 50306-0366
November 20, 2013
GERALD J BRINSER Copy to:
VIA FAX: 717-838-6912 CHARLES LITTLE
Via email: charles.little @pnc.com
RE: METLIFE INVESTORS USA INSURANCE COMPANY CONTRACT 940160544
OWNER ANNA B MARTIN
Dear Mr. Brinser:
This letter is in response to your inquiry on the above referenced contract.
The value of this contract as of September 26, 2013, was$33,427.95.
The initial purchase payment on Ms. Martin's contract was $25,000.00 and there were no withdrawals
processed on the contract while she was living.
If you have any questions; please contact your representative or call our Customer Service Center
at 1-800-709-2906 (I3anK Channel) Monday through Friday between 8:30 a.m. and 6:30 p.m., ET.
Sincerely,
R
Molly Fairchild
Sr. Annuity Representative-Client Service
MetLife Annuity Operations and Services
Help us May connected: Please keep us updated with respect to all who are associated with this+vontract,including the ownert the
annuitant,and any sen0f€c!20PS. iVAPe Sure that rA=have the following information?for all persons or entities: ramie,adtimss,
phor ,e number,date of birth,and social Security or tax identification number, Change:,May be Submitted to the address provided
above,by calling our Customer Service Center at the phone number provided above.,or by contacting your l'representative,
Cocklin Funeral Home, Inc. Acct: Contract# 223
MEMORANDUM OF SERVICE
SERVICES OF: Anna B. Martin DATE: 10/1/2013
(A) Services:
Traditional Service Package $3,925.00
Hanover-Crepe $3,775-00
Graveliner $940.00
Total (/ ) $M40.00
(B) Cash Advance Items:
Flowers $268.18
Certified Copies $60.00
Opening and Closing Grave $800.00
Cutting Date on stone- ........ $200.00'
Cemetery Equipment $200.00
Newspaper Notice-Harrisburg $480.61
Clergy Honorarium $100.00
Organist Honorarium $1 00.00
Total (B) $2,208.79
At
,,V,� r
Total Amount $10,848.79
Less Amount Paid $0.00
Due $10,848.79
(CO 998 ESSELTE CORP.GARDEN CITY,NY
RECEIPT FOR PAYMENT
-------------------
GLENDA FARNER STRASBAUGH Receipt Date : 10/02/2013
Cumberland County - Register Of Wills Receipt Time : 12 : 01 :20
One Courthouse Square Receipt No. : 1075765
Carlisle, PA 17613
MARTIN ANNA B
Estate File No. : 2013-01054
Paid By Remarks : DBINSER WAGNER & ZIMMERMAN
------------------------ Receipt Distribution ------------------------
Fee/Tax Description Payment Amount Payee Name
PETITION LTRS TEST 260 . 00 CUMBERLAND COUNTY GENERAL FUN
WILL 15 . 00 CUMBERLAND COUNTY GENERAL FUN
SHORT CERTIFICATE 50 . 00 CUMBERLAND COUNTY GENERAL FUN
JCS FEE 23 . 50 BUREAU OF RECEIPTS & CNTR M.D
AUTOMATION FEE 5 . 00 CUMBERLAND COUNTY GENERAL FUN
INVENTORY 15 . 00 CUMBERLAND COUNTY GENERAL FUN
INH TAX RETURN 15 . 00 CUMBERLAND COUNTY GENERAL FUN
----------------
Check# 4292 $383 . 50
Total Received. . . . . . . . . $383 . 50
Fr .
D
�Rassoc�P�`°
CUMBERLAND LAW JOURNAL
32 SOUTH BEDFORD STREET
CARLISLE, PA 17013
Tele: (717)249-3166 Fax:(717)249-2663
November 15, 2013
Cumberland Law Journal is published every Friday by the Cumberland County
Bar Association and is designated by the Court of Common Pleas as the official legal
publication for Cumberland County and the legal newspaper for publication of legal
notices.
TO: Gerald J. Brinser, Esquire
RE: Anna B. Martin Estate
Legal advertisements must be received by Friday Noon. All legal advertising
must be paid in advance. Make all checks payable to: Cumberland Law Journal.
Advertisement inserted on the following dates:
November 1, November 8, and November 15, 2013
Advertising Cost $ 75.00
Proof of Publication $ 0.00
Second Proof Request $ 0.00
Payment received $ 0 .00
Total Amount Due $
Payment received by �
PROOF OF PUBLICATION OF NOTICE
IN CUMBERLAND LAW JOURNAL
(Under Act No. 587, approved May 16, 1929), P. L.1784
COMMONWEALTH OF PENNSYLVANIA :
ss.
COUNTY OF CUMBERLAND
Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, 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 Carlisle in the County and State aforesaid,
was established January 2, 1952, and designated by the local courts as the official legal
periodical for the publication of all legal notices, and has, since January 2, 1952,been regularly
issued weekly in the said County, and that the printed notice or publication attached hereto is
exactly the same as was printed in the regular editions and issues of the said Cumberland Law
Journal on the following dates,
viz:
November 1 November 8, and November 15, 2013
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 all allegations in the foregoing
statements as to time,place and character of publication are true.
) 4'
ZiseaMarie Coyne, rtor
SWORN TO AND SUB CRIBED before me this
15 day of November, 2013
Notary
Martin,Anna B.,deed.
Late of Upper Allen Township.
Executor: Robert Musser, 23 ]�2014
Creekview Drive, Carlisle, PA [CARLISLE'°°' """ ����
17015. N01ARIAL SEAL
Attorney: Gerald J. Brinser, Es- DEBORAH A COLLINS
quire. Notary Public
BOROUGH,CUNAMERLAN
My Commission Expires Apr 28,
f
�s
nei Sentinel ZIMMERMAN BRINSER,WAGNER& AD NUMBER PAGE NO.
w w w-c u m b e r l i n I .c o m 6 E. MAIN STREET,2ND FL. 425958 1 Of 1
P.O. BOX 323 BILL DATE SALESPERSON
PALMYRA,PA 17078
CAUSLE SHIPPE COU�QY 717-838-6348 11/05/13 wolfc
START DATE I STOP DATE
10/22/13 11/05/13
AD NUMBER AD DESCRIPTION CLASS LINES
425958 NOTICE NOTICE IS HEREBY GIVEN THAT 10 PUBLIC NOTICES 20 * 2 cols
Publication Insertions Rate Net Amount Gross Amount
3 THE SENTINEL-LEGAL 3 LGL $106.20
TOTAL AD CHARGE $106.20
3 PROOF OF PUBLICATION 01PRF $7.00
3 MOBILE SITE MOB2 $2.00
Purchase Order Est. AnnaMartin PAY THIS AMOUNT 15.20 $138.24*
*AFTER 11/30/13
Lee Enterprises no longer accepts credit card payments sent via e-mail. Iry
Emails containing credit card numbers will be blocked. Please use the coupon /
below to send credit card payment to our lockbox. E SENTINEL
You may also send the coupon to a secure fax at 319-291-4014. THE
LEE NEWSPAPERS
Thank you for advertising with The Sentinel! Deadline for PO BOX 540
in-column legal ads is 4:00 p.m. two business days prior to WATERLOO IA 50704-0540
date of insertion. For questions, call (717)240-7130.
PROOF OF PUBLICATION
State of Pennsylvania, County of Cumberland r
Tackie Cox,Director of Sales,of The Sentinel, of the County and State aforesaid,being
duly sworn, deposes and says that THE SENTINEL,a newspaper of general circulation
in the Borough of Carlisle, County and State aforesaid, was established December 13th,
1881, since which date THE SENTINEL has been regularly issued in said County, and
that the printed notice or publication attached hereto is exactly the same as was printed
and published in the regular editions and issues of
THE SENTINEL on the following day(s): t
October 22,29,November 5, 2013
COPY OF NOTICE OF PUBLICATION
Affiant further deposes that he/she is not
Notice is hereby given that Letters Testamentary on the Estate of ANNA B.
interested in the subject matter of the
MARTIN,Deceased,late of Upper Allen Township,Cumberland County, aforesaid notice or advertisement, and that
Pennsylvania,have been granted to the undersigned Executor. ,
all allegations in the foregoing statement as
All persons therefore indebted to said estate are requested to make immediate
payment,and those having just claims will please present the same,duly' to time,place and character of publication
authenticated,for settlement,without delay.Robert Musser,23 Creekv_lew
Drive,Carlisle,PA 17015,Executor;Gerald J.Brinser,Attorney. are true.
Sworn to and subscribed before me this
Not4 Public
My commission expires:
COMMONWEALTH OF PENNSYLVANIA
No seal
Bethany M.H01try,Not Public
Carlisle eoro,Cumberland county
My Commission Expires Sept 26,2015
MEMBER,PENNSYLVANIA ASSOCFATION OF NOTARU 1
' MESSIAH � �`�' �+' � .�t ..., ... ._ �{ Form PB-Ot
ewa
Y at MESSIAH VILLAGE s,-100 MT.ALLEN DRIVE,MECHANICSBURG,PA 17055 RESIDENT# I UNIT STMT. DATE
108903 053 W 09/30/2013
RESIDENT(S)
CHARLES HONEYWELL Mrs. ANNA B.MARTIN
2105 BEACON CIRCLE
MECHANICSBURG,PA 17055-6170 TOTAL AMOUNT DUE $8,450.30
DATE DUE 10/31/2013
DATE DESCRIPTION RATE Days/ CHARGES CREDITS BALANCE
Units
Balaii ce Fd and 10;800.80
9/20/2013 PAYMENT RECEIVED-THANK YOUM 10,800.80 0.00
9/30/2013 PAYMENT RECEIVED -THANK YOU!!! 350.00 -350.00
09107-09/14/13
*** Nursing Care ***
9/01/2013 MEAL CREDIT -12.00 2.00 24.00 -374.00
9/01/2013 HEALTH SHAKES (PER CONTAINER) 0.30 49.00 14.70 -359.30
9/06/2013 BARBER/BEAUTY SHOP 25.00 1.00 25.00 -334.30
SET/STYLE/CUT
9/13/2013 BARBER/BEAUTY SHOP 16.00 1.00 16.00 -318.30
SET/STYLE
9/13/2013 BARBERIBEAUTY SHOP 15.00 1.00 15.00 -303.30
MANICURE
9/14/2013 GUEST ROOM -APARTMENT 50.00 7.00 350.00 46.70
GUEST ROOM 9/7-9/14/13
9/20/2013 BARBER/BEAUTY SHOP 16.00 1.00 16.00 62.70
SET/STYLE
9/25/2013 RM/BRD -NURSING-SEMI-PVT 09/01-0912 310.00 25.00 7,750.00 7,812.70
9/25/2013 AIR MATTRESS 09/01-09/25 5.00 25.00 125.00 7,937.70
9/25/2013 PREVAIL BRIEF 1.40 29.00 40.60 7,978.30
*** Enhanced Living *x*
9/02/2013 ELHS SUSQUEHAN�tA SINGLE 09/01-09%0 236.00 2.00. 412.00 8,45010
RESIDENT# CURRENT =OVER30 OVER 6 0 OVER 90 OVER 120 TOTAL AMOUNT DUE
108903 -8;450.30 `� 0.00 0.4Q O.OQ
X8;450.30
.ESt£?EtVT NAME Mrs.ANNA B. MARTIN
.ease make check payable to Messiah Lifeways at Messiah Village. Form PS.ot
1%finance charge may be assessed on accounts for which payment has not been received by the due date. Thank You?
If you have any questions or concerns about your bill,please address them directly to Fiscal Services at 790-8220. Thank You!