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Home My WebLink About02-0546Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS Estate of W. THOMAS BRYAN JR No. 21 ' ~ 2 -J~~"~ ~o Also known as WILLIAM THOMAS BRYAN JR. and WILLIAM THOMAS BRYAN JR. M.D. Deceased Social Security No. 272-24-0124 TERRY L. BRYAN Petitioner Petitioner(s), who is/are 18 years of age or older, apply(ies) for: (COMPLETE "A" OR "B" BELOW:) A. Probate and Grant of Letters and aver that Petitioners are the executors named in the Last Will of the Decedent, dated MARCH 21 1989 and codicil(s) dated State relevant circumstances, e.g. renunciation, death of Executor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted after execution of the documents offered for probate; was not to victim of a killing and was never adjudicated incompetent: ^ B. Grant of Letters of Administration Petitioner(s) after a proper search has/have ascertained that Decedent lefteno Will and was survived by the following spouse (if any) and heirs: Name Relationshi Residence COMPLETE IN ALL CASES: Attach additional sheets if nenPCCarv Decedent was domiciled at death in CUMBERLAND County, Pennsylvania, with his last family or principal residence at 148 Wnnds rlrivc Silvor Gr{nn T.........~.:., e~__~__:__~.__ . _ _ street, Decedent, then 75 years of age, died November 24 2001, at Penn State Milton S Hershev Medical Center Hershey PA Decedent at death owned property with estimated values as follows: (Location) (If domiciled in PA) All personal property .....................................................................$ 15 000 00 (If not domiciled in PA) Personal property in Pennsylvania .....................................$ (If not domiciled in PA) Personal property in County ....................................................$ Value of real estate in Pennsylvania Real Estate situated as Wherefore, Petitioners respectfully request the probate of the last Will presented with this Petition and the grant of letters in the appropriate form to the undersigned: Si nature T ed or rin[ed name and residence TERRY L. BRYAN ~ ~ -~ 148 Woods Drive Mechanicsbur , PA 17050 I 1 ~ lD~' I Oath of Personal Representative Commonwealth of Pennsylvania County of Cumberland The Petitioner above-named swears and affirms that the statements in the foregoing Petition are true and correct to the best of the knowledge and belief of Petitioners and that, as personal representative of the Decedent, Petitioner will well and truly administer the estate according to law, Sworn to and affirmed and subscribed ~„~~ ~/~r~y.~ Before me this 6th TERRA BRYAN ~~- day of Estate of W. THOMAS BRYAN JR. ,Deceased Social Security No: 272-24-0124 AND NOW, ,TrrmF ~ , 2002, in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters / Testamentary ^ of Administration tl.b.n.c.t. a.; pentlente liter tlurente absentia; tlurante minoritate are hereby granted to TERRY L. BRYAN in the above estate and that the instrument(s) dated MARCH 21, probate and filed of record as the last Will of the Decedent. FEES Letters ........................... Short Certificate(s) Renunciation .............. Affidavit ( ) .................. Extra Pages ( )....... Codicil ............................ JCP Fee ....................... Inventory ...................... Other ................. TOTAL......... $ 50.00 1.00 Date of Death: November 24 2001 described in the Petition be admitted to Attorney: JERRY R. DUFFIE I.D. No: 09601 Address. Johnson Duffle Stewart & Weidner 301 Market Street P.O. Box 109 Lemoyne PA 17043 Telephone: 717-761-4540 $-~- $ s_nn $ 91.00 filed 8-7-02 mailed to atty 6-7-02 No. LI- 02- `J~f~O tiro cc1 `v that rvae information here given is correctly copied from an original certificate of death duly filed with me as Irl II Regrsn I The ofigiual certificate will be forwarded ro the State Vital Records Off ~ f Icz or permanent filing, WARNING: It is illegal to duplicate this copy by photostat or photograph. I cr 6,r this certifcate, S2.OG __f 7902400 No. Illu]'~a]ilrv 3(a] IVpEJININ, pENMaxf yr ar,fX I - eOS OfcEOfm i~;w-rn~~l"~-.._- /y~ / 1~, Un--rd na i ~~(FQi~~~Zi~ local Registrar 2~~~_a~ ~e'~~~ IJa[e COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH X - - - sccusfcux ry efp._ - - .. _-_.. William Thomas Brpan, Jr. M.D Male ~jp pq 0124 November 24X2001 GE law tl~nruaYl UHDEfl1YFAq WgEP, pp OREOF N bW EC V(JLE CEAXrfnan v.ry my NmW r~Dax lbui Y w Mnr m. V qx ~M Cw xrvl Mg%UL yan muxe wa, 75 Yr - Dt . - Apr 14 1926 Chtlhcothe, Missoun ,nr f3 ExoMp. em G rop C xma+n IJ q•abm IJ s~[Y, ^ couNrvoF GaDN ~ cn,aoxo. rvmoi DEAN iacxm nnME pl,.,lr„x.Ni,r-.. Y. ~ gn..ar.Xaw ^,.,,"m. vxs DlcEDENr o1 NISW,xlcogwlx] pAE-.rrm N, W.[Y. YnX...rc. • ,° Dauphin Derry Twp. Penn State Mil[on S. Hershey Medical M..~.I°..^, "w^",,;[°`~Ci°'" Ib~l ~ roy~ite DECEOEM'9 V8VA000UMICH XWOCi bUSIHEgbIHdlSipYtl YN80FCEEEm EVEPIN {f~y~~ IG.ve rVdwrYUyvprrvg vcrl[®ECEDENTSE WCA101I MMliil$iAU6. d rvYnlYM. daMw,yrWl US. MMEDFCNLEg'I 5 YanW1 EUW „INgm lauyrpp'rw IMrv 4anr. WYpap. „e. Pediatrician Health Care Y..I~ W^ EW^•^ro!~[Nb.,Y `~ amr[.php.[m °'^' I DEGECENinMgIEINC.IDCNE%rs..x.cp]ramr. ~:. ZpGWe, D°G,~,xi.g 'E- 'b Married „_ TerryvL Heffelbower 148 Woods Drive a BINGE °i s"e-- Pa, - D'^ ]m~4 s1aexmw.fM Rlver SpLfl Two Mp Mechanicsburg, Pa. 17050 ~ax„"ro.; ~~ '" Cumberland iAVfq's N/.MEIFaN. M~pd. a°i - 'm-c°"" ----_- °m"'°' na.L7 "wMr"'0"wYM"0bd _____ I.giNEx'8 N.WErFU Mr1y. Magm Sxnynl -uymmx W. T. Bryan Sr. w ropuwr's xpME nYww^M - „ Betty Lee Chapin vYDquu[rs YMLllgpppgF%w.x.aNmWm. sM.. zYCmal Terry LBryan -- ~ NDDGFWgposlYlDx ,m. 148 Woods Drive Mechanicsbur Pa 17050 . Po81iICN.NamadC•mxNY. Cnma M]q•rr wW^ Cr•nurm~ p•nwMEan SN.^ INm.F CiGq ~YipH q rW ICCAgN C 4r W WG[b a . . M %u[ [brelm~ I 5r~.h _ ^ _ Nov 26, 2001 Conolite Cremato Yc:pMD iuNfael ss E N i,t. rY Schaefferstown Pa 17088 E1°- - __ „ , . Ezwxpcn such TENSE NVMBEx IMME 111DIOUIIE%Cf FKAIIry i -- - h,.. ___ FD-012662-L •^n~e p.xdmYY - ^.,.ana Mrars Funeral Home lne. 3]East Main Streel MeehanicsburD Pa 1]055 ^"*Mep•.erunx[xrrw arrl.rn.. .x...rs ra...+ad l: in [~ ro ~ __ d.e.NUw . r n."ra nraam lWl LKENSE HVMBEq pME SYWED ryuw tlMNn IunW dY. wr ~ •m[taz9 uN pe cem~yrae pY iWEDF OEAN fM. Wmvln prpwr[a. aln / O/ ~ArYD "TEPflO/H~HLEC EaOluwnn, Vey, vurl WBC.tSE gEFENpfOrO EO MMI NEW[ggxEx] m E ~ C P. Mpi l_ m rM W^ " L ca ,S cauu on.vu~ arwMC nn Wmr•vorM nN[ py rara["reypra u SNCY"r n.an M l . r w i~pe pMtu. mrm P '" ;mM 4N"a[n I.YYEpAECEVBE If a r XifnM•mrWrMV[ew M.mr nIYJ(1 r. uNrV 1-+ •. s 1 DUE rDUW ASa[ EN[f __. - __ •^I E YM pLY 11D DIE RI~I/d• EMBE WErypLE , / - _.- __ _ _ [ id~ ' ,b . _. rb I _ __ 'a DVE If/1.54CryrSf WErvCE CF1 - - - T ~ ____ _ ____ 9u rbmll.9i - ' ___ 1 - ° r VNB nx I -- -~~- -~- - . V rpVSY WENE aUIOVSYi NpHGg -- - - - FONUEO] .Iw UBLE VXNK )O WNN CF OEAN OAE NJ ECi pY CpIGLFrpNCi GAU% r,/ IW Ym 1 YN X) GESCq.9E ngYIWUflYIX.CUWiEO. CF CEAr[i xuu4 L~l IJ h'[ON ^ 0.x6M W r~ Yaa ^ ^ .« I ] N^ v.. ^ W I lX smw ^ cpdpro Wa..rm rxp f] Iuc : M E aglwwr x rarm Mr Inm[. [ anny.aXW ICCRIONIya CMiornr,SW I _ SY. tap. ]E. '^IN4 w[ 5 [rl / CENr irEP CtzvuaY Vw - _ tq /// . _ 'G8gi1FYWDIMYSIC aN pnvw[~+nce Myuuteurt•anamnnauewnrran lu5 ~ 81GNAVNEµOtNLECFCEpiF~ /T - ~ - r"W 4naImYYrouupy yarl nw` eJl a[ N . i ~'~~~ . // urr GwbP[uuull ~~ /•'~-- ... ,p. INONOYNCIIW E OIx - ^rrrr ny IICENBE NUMDEp ESpgE W I - T"rr.a e[.[crm mm pn II ___ ~l ,e/N~Q Of LSE ~/p(/1( L/o/ p iNYE.NV AODgE% E 80NW C plErf CAVY OF OFAyy,, -L ~ - 'YEDMNI EX.EMI ! COO E IIwm 2)1lYquR X ~ ~ x/ N /f Cdi~.[~/ Y On m•paala" 1 Wu S mY p p •o[cut 0 I .tux. aala Ey U M-JC ///f / , , ...... Y ua l" uuM1laM y/J ....... ......... ^ // f Q r / / /// ~ 58 ~ ~ U. C/E N OAEF LEV IMm" [fZ4 ,1.; r D D,~_~~ ~ ,..1~o er,~f ]tm.,f6..3z/,i --- ~~c~t i11 ~n~ C~TP~t~rrtPnt ~E W. rHOr>AS BRYAN, JR. I, W. TiRIMAS BRYAN, JR., of Silver Spring Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I. I direct that all my funeral expenses, including my gravemarker and all expenses of my last illness, shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. II. I bequeath my automobiles, household goods and personal effects and other tangible personalty of a like nature (not including cash or securities), together with any existing insurance thereon, to my wife, TERRY L. BRYAN, provided she shall survive me. Should my wife, TERRY L. BRYAN, predecease me, I bequeath such tangible personalty and insurance thereon to my stepchildren, TRACY LYNN REMBISZ and CHRISTOPHER ROBERT REMBISZ, to be divided between them by my Executor with due regard for their personal preferences i.n as nearly equal shares as practical. Any such article allotted to a minor may, as my Executor thinks advisable, either be delivered to the minor or to any person to hold for the minor, or be sold and proceeds paid to the Trustee as property distributable to the minor as herein provided in Paragraph IV hereof. III. I devise and bequeath the residue of my estate of every nature and wherever situate, to my wife, TERRY L. BRYAN, provided she shall survive mP. Should my wife, TERRY L. BRYAN, predecease me, I devise and bequeath the residue of my estate of every nature and wherever situate, in equal shares, to my stepchildren, TRACY LYNN REMBISZ and CHRIS~PHER ROBERT REMBISZ. Should either of my said stepchildren, TRACY LYNN REMBISZ or CHRIS~PHER ROBERT REMBISZ, predecease me then I devise and bequeath his or her share to his or her then living issue, per stirpes, and in default of said issue, his or her share shall be added to the share of the surviving stepchild, or the then-living issue, per stirpes, of any deceased stepchild, as applicable. 1V. Should my stepdaughter, TRACY LYNN REMBISZ, or my stepson, CHRIS~PHER ROBERT REMBISZ, not have attained the age of thirty (30) years at the time of distribution to him or her, I devise and bequeath the share of each such stepchild to DAUPHIN DEPOSIT BANK AND TRUST COMPANY, of hnoyne, Pennsylvania, IN SEPARATE TRUST, for the following uses and purposes: A. If the stepchild is under the age of twenty-one (21) years, to expend and apply so much of the net income (any income not expended or applied to be accumulated and added to principal) and so much of the principal of each trust as Trustee shall, in its sole and absolute discretion, consider advisable for the support and education (including trade school and college education, both graduate and undergraduate) of that stepchild until he or she attains the age of twenty-one (21) years. B. After the stepchild attains the age of twenty-one (2l.) years, thereafter to pay such stepchild the net income together with so much of the principal thereof as Trustee shall, in its sole and absolute discretion, consider advisable for the support and education (including trade school and college education, both graduate and undergraduate) of such stepchild after taking into consideration his or her other readily available assets or sources of income. C. When each such stepchild shall reach the age of twenty-five (25) years, Trustee shall pay the net income from the Separate Trust to such stepchild in such payments as Trustee shall deem convenient, but at least as often as quarter-annually. D. When each stepchild reaches the age of thirty (30) years, then the Separate Trust shall terminate and Trustee shall distribute to such stepchild the then-ranaining principal together with any accumulated or undistributed income. E. If any such stepchild should die before receiving final distribution, the undistributed balance shall be distributed to his or her surviving issue, per stirpes, and in default of such issue, then to the surviving stepchild and provided that if said stepchild is under the age of thirty ( 30 ) years that said share shall be added to and treated as ~x-irt of the Separate Trust for that stepchild. V. Should any person entitled to share of my estate (other than my stepdaughter, TRACY LYNN REMBISZ, and my stepson, CHRIS~PHER ROBERT REMBISZ) not have attained the age of twenty-five (25) years of age at the time of distribution to him or her, I devise and bequeath the share of each such person to DAUPHIN DEPOSIT BANK AND TRUST COMPANY, IN SEPARATE TRUST, to hold, manage, invest and reinvest the share so received, and the accumulation of income thereon, and to use and apply the income and principal, or so much thereof, as in Trustee's sole and absolute discretion, may be necessary or appropriate for such person's support and education (including trade school and college education, both graduate and undergraduate) without regard for his or her parent's ability to provide for such support or education, or to make payments for these purposes, without further responsibility, to such person o:r to such person's parent or to any person taking care of such person. Any principal or income not so applied shall be distributed to such person absolutely when he or she attains the age of twenty-five (25) years. If he or she dies before attaining the age of twenty-five (25) years, the trust shall terminate and such ahare shall be distributed to his or her personal representative. vI. The interest of the beneficiaries hereunder shall not be subject to anticipation or voluntary or involuntary alienation. VII. I direct that all taxes that may be assessed in consequence of my death, of whatever nature or by whatever jurisdiction imposed, shall be paid out of my residuary estate as a part of the expense of the administration of my estate. VIII. I appoint my wife, TERRY L. BRYAN, Executrix of this, my Last Will. Should my wife, TERRY L. BRYAN, fail to qualify or cease to act as Executrix, I appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY, of Lemoyne, Pennsylvania, Executor of this, my Last Will. IX. My corporate fiduciary shall be entitled to compensation based on its regular schedule of fees for such services in effect, from time to time, during the period over which its services are performed. X. I direct that my Executrix and Trustee, or their successors, shall not be :required to post bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal this ~'~ ~ ="`day of ~ r. ~,_-._'`=r'~ 1989. ~ V ri. -(SEAL) W. THOMAS BRYAN, JR. Signed, sealed, published and declared by the above-named Testator, as and for his Last Will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have hereunto subscribed our names as witnesses. ~.~ COMMONWEALTH OF PENNSYLVANIA • ss: COUNTY OF CUMBERLAND I, W. THOMAS BRYAN, JR., Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby aclmowledge that I signed and executed the instrument as n7y Last Will and Testament; that I signed it willingly; and that I signed it as nIy free and voluntary act for the purposes therein expressed. w . Ttitn__vrux~`~/3d4s~~_ W. THOMAS BRYAN, JR. Sworn or affirmed to and aclmowledged before me, by W. THOMAS BRYAN, ,IR., the Testator, this ~` ~-=~ day of Yr., a,,,_`~ ~ 1989. ~~ Notary Public~~~~~~ NDTARIAL SEAL DIANNE LENIG. NDURY PUBLIC LEMDYNE ADRD. CUMBERLAND CD. MY CDMIISSIDN EXPIRES DEC. 21, 7989 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA _ . ss: COUNTY OF COMBERT,AND ~~~'~~._.~ C'__ `Z. ~=__ and~'\,,,s,.,,-,", °~~~ ~~ the witnesses whose names are signed to the foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the foregoing instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our ]mowledge, the Testator was that time at least 18 years of age, of sound mind and under no constraint or undue influence. i I t: Sworn or affirmed to and subscribed to before me ~~ ~:M, i',,<.._,._~...~_ u~u~_. ~' `1--~-- ~`a'~?'s•-. and ;~w~*itxesses, this-J~"~k day oft'°r~a~...v~~ lggg, -~, " ~r~°s ..--. -~ Notary Pudic ~ NOTARIAL SEAL DIANNE LENI6, kOTARV "PUBLIC LENOYNE AORO. CUNBENLAND CO. MY COMIISSION E%-1RES DEC. 21. 1989 CERTIFICATION OF NOTICE UNDER RULE 5 6(a) Name of Decedent: W. THOMAS BRYAN JR. a/k/a William Thomas B an Jr. M.D. Date of Death: November 24 2001 Will No. 2002-00546 Admin. To the Register: I certify that notice of estate administration as required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following testate and intestate beneficiaries of the above-captioned estate on June 19, 2002. Name Address TERRY L. BRYAN 148 Woods Drive Mechanicsburg, PA 17050 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except ninniG Date: June 19, 2002 Signature / ~ Name ERRY R. FFIE Johnson Duffie Stewart & Weidner Address 301 Market Street P.O. Box 109 Lemoyne PA 17043-0109 Telephone 1717) 761-4540 Capacity: Personal Representative X Counsel for personal representative Register of Wills of CUMBERLAND County, Pennsylvania INVENTORY Estate of WILLIAM THOMAS BRYAN, JR. No. 21-02-0546 also known as W. Thomas Bryan Jr. MD Data of Death 11/24/2001 Deceased Social Security No. 272-24-0124 Terr L. BRYAN, Personal Representative(s) of the above Estate, deceased, ver"rfy that the items appearing in the following Inventory include all of the personal assets wherever situate and all o} the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I NJe verify that the statements made in this Inventory are true and correct. I/VJe understand that false statements herein are made subject to the penalties of 18 Pa. C.S. Section 4904 relating to unsworn falsification to authorities. Name of Attorney: JERRY R. DUFFIE I.D. No.: 09601 Personal Representative Signature: ~ ~~LA~ ~~N~~~ Terry I/~ BRYAN Signature: Address: P. 0. Box 109 Lemoyne PA 17043-0109 Telephone: 717/761-4540 Address: 148 Woods Drive Mechanicsbur PA 17050 Telephone: 717/697 -1768 Dated: ~ /y z ~ ~ - Value (See continuation page(s) attached) (Attach additional sheets if necessary) Total: 10 , 957.45 ~~~ ~ ~~ i ne memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election o} the include the value of each item, but such figures should not be eMended into the total of the Inventory. Preparetl by the Pennsylvania Bar Assaclation Copyright (c) 1996 form software only CPSystems, Inc. Form NR W-7 (1992) ,. ~ INVENTORY Estate of: WILLIAM THOMAS BRYAN, JR. Date of Death: 11/24/2001 County: Cumberland PERSONAL PROPERTY: ------------------ 1991 Mazda Miata Convertible 3,700.00 -------------- 3,700.00 STOCKS/LISTED: ----- 19.000 - shares -------- AT&T Corporation 323.47 89.403 shares Bellsouth Corporation 3,541.24 674.000 shares Ronson Corporation 909.90 26.000 shares SBC Communications, 1,013.81 Inc. 30.000 shares Verizon Stock 1,469.03 7,257.45 PARTNERSHIP INTEREST: Liberty Tax Credit Plus - Multi Market Portfolio - Account No. 0000 0098 7107 1468 9 036 TOTAL RECEIPTS OF PRINCIPAL ............... ---------------- 10,957.45 ' k -1- ~500EX .(6-00) CAPB HpRL EplO CRAC KOTK ES REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT o E C E o E N T COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 DECEDENT'S NAME(LAST, FIRST, AND MIDDLE INITIAL) L- OFFICIAL USE ONLY 17-~f--/a FILE NUMBER 21-02-0546 COUNTY CODE YEAR SOCIAL SECURITY NUMBER NUMBER BRYAN, JR. WILLIAM THOMAS DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) BRYAN, TERRY L. X 1. Original Return 4. Limited Estate X 6. Decedent Died Testate (Attach copy of Will) D 9. litigation Proceeds Received 2. 4a. Supplemental Return Future Interest Compromise (date of death after 12-12-82) 7. Decedent Maintained a Living Trust 010. (AttaCh copy of Trust) Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) I 272-24-0124 THIS RETURN MUST BE RLED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER o 3 date of death . RemaInder Return prior to 12-13-82) S. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes o 11. Election to tax under Sec. 9113(A) (Attach Sch 0) C P o 0 R N R 0 E E S N T C o M P T U A T X A T I o N NAME COMPLETE MAILING ADDRESS JERRY R. DUFFIE FIRM NAM E (If Applicable) Johnson, Duffie, Stewart & Weidner TELEPHONE NUMBER P. O. Box 109 301 Market Street Lemoyne, PA 17043-0109 61-4540 Real Estate (Schedule A) Stocks and Bonds (Schedule B) Closely Held Corporation, Partnership or Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D 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) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (line 12 minus line 13) (1) (2) (3) None 7,257.:45 -0- ,OFFICIAL USE ONLY R E C A P I T U L A T I o N (4) (5) None 3,700.00 None None 9,508.00 7,786.90 (8) 10,957.45 (11) 17 .294.90 (12) (6,337.45) (13) (14) (6,337.45) (6) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of line 14 taxable at collateral rate 19. Tax Due 20. (6,337.45) x X X X .0 0 .0 45 .12 .15 (15) (16) (17) (18) (19) 0.00 0.00 0.00 0.00 0.00 CopyrIght (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 148 Woods Drive CITY I STATE I ZIP Mechanicsbura PA 17050 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 Total Credits ( A + B + C) (2) 0.00 3. Interest/Penalty jf applicable D. Interest E. Penalty 0.00 TotallnterestlPenalty ( D + E) (3) 4. If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 5. If Line 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) B. Enter the total of Line S + SA. This is the BALANCE DUE. (5B) Make Check Payable 10: REGISTER OF WILLS, AGENT 0.00 0.00 0.00 0.00 Yes No ~~ D D D ~ ~ ~ Under penalties of perJury, I declare thai I have examined this return, Including accompanying schedules and statements, and to the best of my knowledge and belief, It Is true, correct and complete. Declaration of pre parer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FiLING RETURN TERRY L. BRYAN 148 Woods Drive - - -M~~ha:~ic-sb;:'r- -; - PA - - iioscf - - - - - - - - - - - - - - - - - - -- Johnson, Duffie, Stewart & Weidner P.O. Box 109 -. i~m;; - - - - - - PA- - -i 7043: O-i9iY - - - - - - - - -. - - - - - - - - - -- DATE 8 /2-2-/02- 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) (jil]. The statute does not exemct a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. 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%, except as noted in 72 P.S. 9116{1.2) [72 P.S. 9116(aX1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. 9116{aX1.3)]. 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. Copyright (c) 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) REV-1503 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER WILLIAM THOMAS BRYAN, JR. SSfl 272-24-0124 11/24/2001 21-02-0546 All property jointly-owned with right 01 survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION UNIT VALUE NUMBER OF DEATH 1 19 shares AT&T Corporation, CUSIP #001957109 17.02475 323.47 2 89.4028 shares Be11south Corporation, CUSIP #07986010 39.61 3 , 541. 24 3 674 shares Ronson Corporation, CUSIP #776338105 1.35 909.90 4 26 shares SBC Communications, Inc., CUSIP #78387G103 38.9925 1,013.81 5 30 shares Verizon Stock, CUSIP #077853109 48.9675 1,469.03 TOTAL (Also enter on line 2, Recapitulation) 7,257.45 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1S03 EX (Rev. 1-97) REV-1504 EX. (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCETJ()( RETURN RESIDENT DECEDENT ESTATE OF WILLIAM THOMAS BRYAN, JR. SCHEDULE C CLOSELY-HELD CORPORATION, PARTNERSHIP or SOLE-PROPRIETORSHIP SSfI 272-24-0124 11/24/2001 FILE NUMBER 21-02-0546 Schedule C-1 or C-2 (Including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. ITEM NUMBER 1 DESCRIPTION Liberty Tax Credit Plus - Multi Market Portfolio - Account No. 0000 0098 7107 1468 9 036 VALUE AT DATE OF DEATH 0.00 TOTAL (Also enter on line 3, Recapitulation) $ 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1504 EX (Rev. 1-97) REV~ 1~08 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHER1TANCETAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER WILLIAM THOMAS BRYAN, JR. SS# 272-24-0124 11/24/2001 21-02-0546 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 NUMBER 1 DESCRIPTION 1991 Mazda Miata Convertible VALUE AT DATE OF DEATH 3,700.00 TOTAL (Also enter on line 5, Recapitulation) S 3,700.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1~97) REV-15.11 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF WILLIAM THOMAS BRYAN, JR. Debts of decedent must be reported on Schedule I. ITEM NUMBER A. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) I EIN Number of Personal Representative(s) Street Address City State Zip B. 2. 3. 4. SSff 272-24-0124 FILE NUMBER 21-02-0546 11/24/2001 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES, Myers Funeral Homes, Inc. 3,727.00 Year(s) Commission Paid: Attorney's Fees Johnson, Duffie, Stewart & Weidner Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Terry L. BRYAN, JR. Street Address 148 Woods Drive City Mechanicsburg State PA Zip 17050 Relationship of Claimant to Decedent Spouse 2,000.00 3,500.00 Probate Fees Register of Wills 91.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs The Cumberland Law Journal - Legal Advertising 75.00 2 The Patriot News - Legal Advertising 115.00 TOTAL (Also enter on line 9, Recapitulation) $ 9,508.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1511 EX (Rev. 1-97) REV-1~12 EX + (1-97) COMMONWEALTH OF PEN NSYL VANIA INHERITANCETAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS ESTATE OF WILLIAM THOMAS BRYAN, JR. SSI! 272-24-0124 11/24/2001 FILE NUMBER 21-02-0546 Include unreimbursed medical expenses. ITEM NUMBER 1 DESCRIPTION 1/2 of joint Real Estate Taxes Due at Time of Death AMOUNT 381. 39 2 Charles F. Sullivan, CPA - 1/2 of joint Debt for Preparation of Tax Returns 322.00 3 Commerce Bank Line of Credit Account - 1/2 of Joint Debt with Spouse 3,079.51 4 Johnson, Duffie, Stewart & Weidner - Individual Legal Fees Prior to Death 3,900.00 5 Merck-Medco RX Services 69.00 6 MS Hershey Medical Center 35.00 TOTAL (Also enter on line 10, Recapitulation) S 7,786.90 (If more space is needed, insert additional sheets of the same size) Copyright (c:) 1996form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX +(9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF WILLIAM THOMAS BRYAN, JR. SCHEDULE J BENEFICIARIES SSlf 272-24-0124 11/24 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116{a)(1.2)] 1 Terry L. BRYAN 148 Woods Drive Mechanicsburg, PA 17050 2001 RELATIONSHIP TO uECEDENT Do Not List Trustee(s) Spouse FILE NUMBER 21-02-0546 AMOUNT OR SHARE OF ESTATE Entire Estate ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS, A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, Inc. 0.00 Form REV-1513 EX (Rev. 9-00) Of2/GrI~~ WI LG ~o AJ 0'1' DBretJ V - 11IClst llIill Club QrtStCltlUUt OF W. ~ BRYAN, JR. ! i I I, W. ~ BRYAN, JR., of Silver Spring Township, Cumberland County, Pennsylvania, declare this to be my last will and revoke any will previously made by me. I I I I. I direct that all my funeral expenses, including my gravEm3Iker and all expenses of my last illness, shall be paid from my residuary estate as soon as prac"ticable after my decease as a part of the expense of the administration of my estate. II. I bequeath my autOfOCJbiles, household goods and personal effects and other tangible personalty of a like nature (not including cash or securities), together with any existing insurance thereon, to my wife, TERRY L. BRYAN, " provided she shall survive me. Should my wife, TERRY L. BRYAN, predecease me, I bequeath such tangible personalty and insurance thereon to my stepchildren, TRACY LYNN REMBISZ and CHRIS'IDPHER ROBERI' REMBISZ, to be divided between them by my Executor with due regard for their personal preferences in as nearly .equal shares as practical. Any such article allotted to a minor may, as my Executor thinks advisable, either be delivered to the minor or to any person to hold for the minor, or be sold and pr=eeds paid to the Trustee as property distributable to the minor as herein provided in Paragraph IV hereof. III. I devise and bequeath the residue of my estate of every nature and wherever situate, to my wife, TERRY L. BRYAN, provided she shall survive me. Should my ~ , I J , j I I "1 wife, TERRY L. BRYAN, predecease me, I devise and bequeath the residue of my estate of every nature and wherever situate, in equal shares, to my stepchildren, TRACY LYNN REMBISZ and OiRISTOPHER ROBERr REMBISZ. Should either of my said stepchildren, TRACY LYNN REMBISZ or OffiISTOPHER ROBERr REMBISZ, predecease me then I devise and bequeath his or her share to his or her then living issue, per stirpes, and in default of said issue, his or her share shall be added to the share of the surviving stepchild, or the then-living issue, per stirpes, of any deceased stepchild, as applicable. IV. Should my stepdaughter, TRACY LYNN REMBISZ, or my stepson, OiRISTOPHER ROBERT REMBISZ, not have attained the age of thirty (30) years at the time of distribution to him or her, I devise and bequeath the share of each such stepchild to DAUPHIN DEPOSIT BANK AND TRUST COMPANY, of Lemoyne, Pennsylvania, IN SEPARATE TRUST, for the following uses and purposes: A. If the stepchild is under the age of twenty-one (21) years, to expend and apply so much of the net income (any income not expended or applied to be accumulated and added to principal) and so much of the principal of each trust as Trustee shall, in its sole and absolute discretion, consider advisable for the support and education (including trade school and college education, both graduate and undergraduate) of that stepchild until he or she attains the age of twenty-one (21) years. B. After the stepchild attains the age of twenty-one (21) years, thereafter to pay such stepchild the net income together with so much of the principal thereof as Trustee shall, in its sole and absolute discretion, consider advisable for the support and education (including trade school and college education, both graduate and undergraduate) of such stepchild after taking into consideration his or her other readily available assets or sources of income. _u.._.___________._ ________.___._ ~__. ___________._______._.___._____________._________ ... '-) --1- I I , " I I . 'i ,I C. When each such stepchild shall reach the age of twenty-five (25) years, Trustee shall pay the net income frcnn the Separate Trust to such stepchild in such payments as Trustee shall deem convenient, but at least as often as quarter-annually. . D. When each stepchild reaches the age of thirty (30) years, then the Separate Trust shall terminate and Trustee shall distribute to such stepchild the then-rerraining principal together with any accumulated or undistributed income. E. If any such stepchild should die before receiving final distribution, the undistributed balance shall be distributed to his or her surviving issue, per stirpes, and in default of such issue, then to the surviving stepchild and provided that if said stepchild is under the age of thirty . (30) years that said share shall be added to and treated as part of the Separate Trust for that stepchild. V. Should any person entitled to share of my estate (other than my stepdaughter, TRACY LYNN REMBISZ, and my stepson, CHRISTOPHER ROBERT REMBISZ) not have attained the age of twenty-five (25) years of age at the time of distribution to him or her, I devise and bequeath the share of each such person to DAUPHIN DEPOSIT BANK AND TRUST COMPANY, IN SEPARATE TRUST, to hold, manage, invest and reinvest the share so received, and the acctrrlUllation of income thereon, and to use and apply the income and principal, or so nUlch thereof, as "in Trustee's sole and absolute discretion, may be necessary or appropriate for such person's support and education (including trade school and college education, both graduate and undergraduate) without regard for his or her parent's ability to provide for such support or education, or to make payments for these purposes, without further responsibility, to such person or to such person's parent or to any person taking care of such person. Any principal or income not so applied shall be distributed to such person absolutely when he or she attains the age of twenty-five (25) years. If he or she dies before attaining the age of twenty-five (25) years, the trust shall tenninate and such share shall be distributed to his or her personal representative. ! ~ ci L- C'~.1 ! VI. The interest of the beneficiaries hereunder shall not be subject to anticipation or voluntary or involuntary alienation. VII. I direct that all taxes that may be assessed in consequence of Wlf death, of whatever nature or by whatever jurisdiction ilnposed, shall be paid out of Wlf residuary estate as a part of the expense of the administration of Wlf estate. VIII. I appoint Wlf wife, TERRY L. BRYAN, Executrix of this, Wlf Last Will. Should Wlf wife, TERRY L. BRYAN, fail to qualify or cease to act as Executrix, I appoint DAUPHIN DEPOSIT BANK AND TRUST COMPANY, of Iaroyne, pennsylvania, Executor of this, my Last Will. IX. My corporate fiduciary shall be entitled to compensation based on its regular schedule of fees for such services in effect, from tine to tine, during the period over which its services are perfonnecl. X. I direct that Wlf Executrix and Trustee, or their successors, shall not be required to post bond for the faithful performance of their duties in any jurisdiction. IN WITNESS WHEREDF, I have hereunto set my hand and seal this'? \ ""-"1<:day of -,-" ".-._"1[, , 1989. bV....J}yomY'k1 t5hi1C.li\1 ~. W. THOMAS BRYAN, JR. (SEAL) .. .;.tl I I Signed, sealed, published and declared by the above-narrEd Testator, as and for his Last will and Testament, in the presence of us, who, at his request, in his presence and in the presence of each other have hereunto subscribed our names as witnesses. , l 1 '1O?nv>--,;y - LL.f!.(}l1Lth,,-, ACKNOWLEDGMENT I COMmNWEALTH OF PENNSYLVANIA ss: COUNTY OF CUMBERLAND I, W. THOMAS BRYAN, JR., Testator, whose name is signed to the foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. w . IltnVI'IQ..:J 'tl/ILfGt'Y1 b . w. THOMAS BRYAN, JR. Sworn or affinned to and acknowledged before me, by W. THOMAS BRYAN, JR., the Testator, this:;) \ ,..::l>:. day of Yn w,,-_'J,,\ , 1989. s:::. ~ ~ . ~ ~ .- '~~"""V'~-f'~"'--'.' ,_;~,,~\.. E;: .....) ," Notary Public . NOTARIAl SEAL DIA~~E LENIG. /mARY PUBLIC LEMOY~E BDRO. CUMBERlAND co. IIY CQItlISSIOl/ EXPIRES DEC. Zl. 1!lB9 ..-. .____.__~_____w_________~_.____ "!l ""~1,, '?". AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA ss: COUNrY OF CUMBERLAND we, '~ C \::l......l ~. . , and~...-...... '(>- ~ ~ ~""""=f\ the witnesses whose narres are si~ect to th; foregoing instnmtent;\Jeing duly qualified according to law, do depose and say that we were present and saw the Testator sign and execute the foregoing instrurrent as his Last will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was that tin1€! at least 18 years of age, of sound mind and under no constraint or undue influence. ~~. H'{1z' -"/ d ~ 'fA /fJLtl.. ~. ___ JJ_.~81r1&'-- Swom or affirmed to and subscribed to before me a;'~R.~~ and Y,-",~,_..~'<"". ~'l.;~'Wi-tResses, this',)\'''''' day of"(y,t)..A...l'ir'\ , 1989. ~. ~. . '''''''..,.........t.- '(:5..".~ ~. . "- Notary PUDlic . NOTA~IAl SEAL DIANNE LENIG. ~OTA~Y PUBLIC LOOYNE ~ORO. CIMBERLAND CO. NY C~ISSION EX~lRES PEe. 21. 1989 ~ i - 6a ,~ BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX BIVISIGN DEPT. 280601 HARRISBURG. Pp 17128-0601 CUT JERRY R DUFFIE JOHNSON ETAL PO BOX 109 LEMOYNE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLONANCE OR DISALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-150 FX RFV (O1-On ,. ; i PA 17048'. _~ RETAIN LOWER OF BRYAN W T FILE DATE 10-07-2002 ESTATE OF BRYAN W T DATE OF DEATH 11-24-2001 FILE NUMBER 21 02-0546 :COUNTY CUMBERLAND ACN 101 Anount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 . 21 02-ns5~ TAX RETURN WAS: (X) ACCEPTED AS FILED ;wa~L:D VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3. Closely Held Stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8• Total Assets ~ea~MENT OF TAX ACN 101 DA f ) CHANGED (1)- (z) 7,257 45 f3]_- (4)~- 08 [5) 3.700 00 (6)~= (7)~~00 10-07-2002 NOTE: To insure proper credit to your account, submit the upper portion of this Porn with your tax payment. APPROVED DEDUCTIONS AND EXEMPTIONS: [a) 10,957.45 9. Funeral Expanses/Adm. Costs/Misc. Expenses (Schedule H) [q) 9,508.00 10. Debts/Mortgage liabilities/Liens [Schedule I) 11. To{al Deductions [10) 7,786 12. Net Value of Tax Return (11) )7 T9G 90 13. Charitable/Govarnnental Bequests) Non-elected 9113 Trusts (Schedule J) [13) 6,337:00 14. Nst Value of Estate Subject to Tax NOTE: If an assessment was issuetl previously, refilect figures that include the total o• ASSESSMENT OF TAX: 15. Anount of Line 14 at Spousal rate 16. Anount of Lina 14 taxable at Lineal/Class A rate 17. Anount of Lina 14 at Sibling rate 18. Anount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due 14, 15 and~or 16, 17, 18 and 19 will returns assessed to date. Q5)~ . 00 X Q6) ~00 X [17)~ ~pQ X u8)_ ~_po X 00 _ 00 045 12 UO 15 .00 (19)= . DQ AMOUNT PAID ^ IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AL TAX CREDIT NCENCE 0 (REST A p Ery, TOTAL DUE 00 00 00 00 ( IF TOTAL DUE IS LESS TNAN Sl, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A '•CREDIT•• (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF iNIS FORM FOR INSTRUCTIONS.) STATUS REPORT UNDER RULE 6.12 Name of Decedent: W. THOMAS BRYAN, JR. a/]c/a William Thomas B an, Jr., M.D. Date of Death: November 24, 2001 Will No. 2002-00546 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rule, 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 X No Z. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3• If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court'? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's Account is: c. Did the personal representative state an account informally to the parties of interest? Yes No X *Surviving S Ouse was sole beneficiary d• Copies of receipts, releases, joinders and approvals of formal or informal accounts maybe filed with the Clerk of the Orphans' Court and maybe attached to this report. Date: December 16, 2002 J Y R. D ,ESQ. SON, DUFFIE, STEWART & WEIDNER 01 Market Street P.O. Box 109 Lemoyne, PA 17043 (717) 761-4540 Capacity: Personal Representative (x) Counsel for Personal Representative ~/ ,/ REV - 7600 EX . (OJYI) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 ~ HARRISBURG, PA 17128-0801 ~ __ DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL BRYAN, Jr., W. Thomas REV-1500 ~,~:::-_ ~I ~.. - . . INHERITANCE TAX RETURN FILENUMeER RESIDENT DECEDENT ~~ 21 02 00546 COUNTY CODE YEAR NUMBER w DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) 0 W 11/24/2001 04/14/1926 ~ (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) Brvan. Terrv L SOCIAL SECURITY NUMBER 272-24-0124 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _ REGISTER OF WILLS SOCIAL SECURITY NUMBER 1. Original Return ® 2. Supplemental Return ~ 3. Remainder Relurn (dale of death prior to 12-13-82) W a ~ ~ 4. Limited Estate ~ 4a. Future Interest Compromise (date of death after ~ 5. Federal Estate Tax Return Required w a u 12-12-82) ~ ~ ~ ^ 6. Decedent Died Testate (Attach copy ~ 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes a °~ of Will) copy of Trust) a ~ 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death between ~ 11. Election to tax under Sec. 9113(A) (Attacn sch O) ___._- - _ _ __ 12-31-91 and 1-1-95) _ THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFID - - -- - ~ ENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: - - AME COMPLETE MAILING ADDRESS WZ Jerry R. Duffle ~ o IRM NAME (If applicable) P Box 109 O g Johnson Duffle Stewart & Weidner . . , , Lemo ne PA 17043 y , ELEPHONE NUMBER 717/761-4540 ' , 1. Real Estate (Schedule A) (1) Non e 2. Stocks and Bonds (Schedule B) (2) Non e 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) Non e 4. Mortgages & Notes Receivable (Schedule D) (4) Non e 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 5, 516.90 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) Non e ^ S t Billi R t d o epara e ng eques e -- - - -- 5 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) Non e F (Schedule G or L) a 8. Total Gross Assets (total Lines 1-7) U rc 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 230.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for wh ich an ele ction to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15.Amount of Line 14 taxable at the spousal tax rate, 5, 286.90 x .00 or transfers under Sec. 9116(a)(1.2) -- ---- - ~ z 0 i= a f 0 xU Q 16.Amount of Line 14 taxable at lineal rate 17.Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate r;~ FICIAi. iSE OP11.~' - ~: - - - t.. ~ 'rte - - ._: _ -. .,..I :~ . , ~~ ; --- '1 _~.[ i - Wit"' ~ ~ ;- - . (8) (11) (12) (13) (14) (15) c;~ ~ 5,516.50 230.00 5,286.90 5,286.90 0.00 x .045 (16) x .12 (17) x .15 (18) (19) 19• Tax Due » BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH « Copyright 2000 form software only The Lackner Group, Inc. 0.00 Form REV-1500 EX (Rev. 6-00) n Decedent's Complete Address: STREET ADDRESS 148 Woods Drive ctTV Mechanicsburg sTATE PA ztP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. InterestlPenalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 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. (5) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS. AGENT (1) 0.00 0.00 0.00 0.00 0.00 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 :................................................................................0 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? ....................................................................................................................^ 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. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration preparer other than the personal representative is based on all information of which preparer has any knowledge. _ _ __- SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS DATE „Teary L. Bryan 148 Woods Drive /~ 1(/~.~ ~/~.~GJ~~ __ _____ _ _ _ Mechanicsburg, PA_17055 7 ~ ~'7__~_ SIGNATU SON RESPONS LE FOR FILING RETURN ADDRESS DATE SIGNATURE OF PREPARER OT THAN REPRESENTATIVE ADDRESS ~ DATE Jerr u1Ti ~~ ~/ ~ ~-~//~ P.O. Box 109 ~ _ ? ! _ /~ __~ ,~~ ; y ~ % ~ Lemoyne, PA 17043 f- ! U t 1 -- F~r d es of deatt~o 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 su Iving 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 exemota transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §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%, 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 decedent's 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. SCHEDULE E CASH, BANK DEPOSITS, & MISC. COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ESTATE OF BRYAN, Jr., W. Thomas 21 - 02 - 00546 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 Computershare, Inc. Initial Distribution of the Distribution Equity under The Fourth Amended Plan for the Rehabilitation of the Fidelity Mutual Life Insurance Company 5, 516.90 TOTAL (Also enter on Line 5, Recapitulation) ~ 5,516.90 SCHEDULE H FUNERAL DCPEWSES & COMMONWEALTH OF PENNSYLVANIA w ~y p~ T INHERITANCE TAX RETURN ~Y~ "V C RESIDENT DECEDENT ESTATE OF BRYAN, Jr., W. Thomas - - -- - -.. Debts of decedent must be reported on Schedule I. -ITEM -- - NUMBER II DESCRIPTION -I{ FUNERAL EXPENSES: A. B. 1 ADMINISTRATIVE COSTS: Personal Representative's Commissions FILE NUMBER 21 - 02 - 00546 AMOUNT Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Johnson Duffie Stewart & Weidner 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant 200.00 4 5. 6. 7. 1 Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Cumberland County Register of Wills Office -Filing Fees 30.00 TOTAL (Also enter on line 9, Recapitulation) 230.00 RF.V-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE) BENEFICIARIES ESTATE OF BRYAN, Jr., W. Thomas NUMBER ~ NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY l~ TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Terry L. Bryan 148 Woods Drive Mechanicsburg, PA 17055 FILE NUMBER 21 - 02 - 00546 RELATIONSHIP T~ AMOUNT OR SHARE DECEDENT OF ESTATE Do Not List Trusteelsl Spouse Entire Residual Estate Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. !NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHE~T ~~ ,P.~:; ~~.~ ~ _, r , Q _. ~,. ~~ ~ ~ ~~~ fI ~, 3 .- SS 6. U ti v,, k~`Q' ~~ ^ ~~ N N V ~~ i .... L1.. w W F W c~ 0. L ^~ ~ ~ C` } z as O v W o Q ~ ° N O UO~ ~~~ ~ U = "-' ~ C'J O w ~ "' ~ ` w ~ o ~~ ~ _ oZ~- Q J Q ~ m O ~~ wiz rY U O E"+ M 0 Q w J Cn J U JeHiiv R. D~,~FU. R~cffARD ~~'. S~ri~:~~~Airr C. ROY ~~~F.IDhI?R. Jh. FU11Ch'D G. MYI',RS D,1VID 1~' DPLLCr I~~iiu A 5~;~1T~.L.R JP.PFIiRSO~ J. SfIfP11AN JerrRe~~ B. R[srnc K1~.1'IV F.. OSBUKNI? RALi>n H. wiiiciiT. )r,. MARK C. DLPF~ie iotw R. ;vi.vosh~~ !~t~cii,nPa. ). CASSinv Register of Wills Office Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 Dear Register: July 29, 2008 RE: Estate of W. Thomas Bryan Your File No. 21-2002-546 Our File No. 4256-2 Meuss~a PILL Gi~rLVv ROBI?RT M. WALKER 1~-ADP. D.'~1AVLF.v ELIZAfSF.TFI D. SNOVI~:R KEl.L1' L. BOh'A~ti'.VO OF COUNSEL HoracR A. Jonn~son~ F ~l~:r Snrn~iA~ i ~yh~~-2oor,~ . ~ , _..J ~~~ ~ ~~ ~r' r.~ "C_ _ ~ _ ~~'i .~- _ ~~ . -YS ^', ~= - , " W cA Enclosed please find a Supplemental Return for the Estate of W. Thomas Bryan. There was an outstanding legal issue that the Administratrix was not aware of. Enclosed, please find the following 1. 2 Original PA Inheritance Tax Returns. There is no tax due (spousal estate) 2. 2 copies of Pages 1 & 2 of the Pa Inheritance tax return, which we ask that you time-stamp and return to us in the enclosed envelope. 4. Check made payable to the Register Wills in the amount of $15.00 as follows: $15.00 for the Supplemental Return. Should you have any questions, please do not hesitate to contact our office. Thank you for you assistance in this matter. c: Terry L. Bryan, Administratrix :339722 Very truly yours, HNSON, DUFF11,E, (STEWART &WEIDNER W ana L. eseman Estate Administration Paralegal 301 MARKS"I' STREET P.O. BOX 109 LENIOYNE, PENNSYLVAN[.A 17043-0109 Ww'W'.JDSw'.CO!~1 717.761.4540 FAX: 117.761.3015 MAIL@JDSW.COM )o~ivsoN DUFFIE JOHNSON, DUFFIE, STEWART &WEIDNER, P.C. BUREAU OIF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 - HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX .. - i a x. ~ ,.,, ,__ ~..r _ - i JERRY R DUFFIE .^ ~ ' . JOHNSON ETAL PO BOX 109 LEMOYNE PA 17043 REY-1547 EX AFP C06-05) DATE 10-13-2008 ESTATE OF BRYAN W T DATE OF DEATH 11-24-2001 FILE NUMBER 21 02-0546 COUNTY CUMBERLAND ACN 101 APPEAL DATE: 12-12-2008 (See reverse side under Objections ) Amount Remitted -~ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE --! RETAIN LOWER PORTION FOR YOUR RECORDS F- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05~ NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRYAN W T FILE N0. 21 02-0546 ACN 101 DATE 10-13-2008 TAX RETURN WAS: C ) ACCEPTED AS FILED C X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. 01 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) C2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) 5,516.90 6., Jointly Owned Property (Schedule F) (6) .0 0 7,. Transfers (Schedule G] (7) .0 0 8. Total Assets cg) 5,516.90 APPROVED DEDUCTIONS AND EXEMPTIONS: 230.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) C9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .00 11. Total Deductions (11) 230.00 12. Net Value of Tax Return (12) 5,286.90 13. Charitable/Governmental Bequests; Non-elected 9113 Trus ts (Schedu le J) (13) .00 14. Net Value of Estate Subject to Tax (14) 1,050.55- NOTE: If an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate 16. Amount of Line 14 taxable at Lineal/Class A rate 17. Amount of Line 14 at Sibling rate 18'. Amount of Line 14 taxable at Collateral/Class B rate 19. Principal Tax Due TAY T`DCTTTC. c15) .00 X 00 _ .00 c16) .00 X 045 = .00 c17) . oo X 12 _ . 00 c1s) .00 X 15 _ .00 (19)= • 00 PAYMENT DATE RECEIPT NUMBER DISCOU T C+) INTEREST/PEN PAID (-) AMOUNT PAID TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE C IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. FOF; CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" CCR), YOU MAY BE DUE ~-- - ^^^~~•~++ ccc ecvoocr crnc nr TuTC PnRM FOR TNSTRUCTIONSJ REV-1470 EX (6-88) 't,`+k ~% COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 Thomas Bryan Jr Sandra J Eslinger ILE NUM 2102-0546 101 ITEM SCHEDULE NO, EXPLANATION OF CHANGES Accepted additional assets and debts. Applied excess deductions from prior return(s). INHERITANCE TAX EXPLANATION OF CHANGES Row Page 1