HomeMy WebLinkAbout02-0769Register of Wills of Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estate of Jean W. Brooks No. 2~' ~2.11oq
also known as Jean Watkins Brooks
Deceased Social Security No.186-30-6923
Helen Jean Brooks Rhinehart
Petitioner(s), who is/are 18 years of age or older, apply(ies) for
(COMPLETE "A" OR "B" BELOW:)
A. Probate and Grant of Letters and aver that Petitioner(s) islare the execut r~x named in the Last Will of the
Decedent, dated 211/88 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 the victim of a killing and was never adjudicated incapacitated:
(COMPLETE IN ALL CASES:) Attach additional sheets if necessary.
Decedent was domiciled at death in Cumberland County, Pennsylvania, with his/her last family or principal
residence at Woods at Cedar Run, 824 Lisburn Road, Camp Hill, Lower Allen Township, Cumberland County, PA 17011
(list street, number and municipality)
Decedent, then 80 years of age, died Jt3ne 17 , 2002 , at
(Location)
Decedent at death owned property with estimated values as follows:
(if domiciled in PA) All personal property .........................................
(if not domiciled in PA) Personal property in Pennsylvania ....................
(If not domiciled in PA) Personal property in County ..............................
Value of real estate in Pennsylvania ........................................................................................
g 25,000.00
Totai ..................................................................................................................... $ 25,000.00
Real Estate situated as follows:
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition and the grant of letters in
the appropriate form to the undersigned:
Signature Typed or printed name and residence
Helen Jean Brooks Rhi
1003 Sheffield Avenue
rt
Mechanicsburg, PA 17055
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B. Grant of Letters of Administration
(c.t.a., d.b.n.c.t.a.: pendente life, durance absentia; durante minoritate)
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Oath of Personal Representative
Commonwealth of Pennsylvania
COUnty Of Dauphin
The Petitioner(s) above-named swear(s) and affirm(s) that the statements in the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as personal representative(s) of the Decedent,
Petitioner(s) will well and truly administer the estate according to,Jraw. , ,,---~ ~-
Sworn to and affirmed and subscribed
before me this 23rd ,day of
AUGUST 2002
1.[fl~~v~'.~N t l ~ L..,+•l_lt.. ~ :a: ~ Ali d~a '. I 1 :. 1 . ~. ~i .t.~ ll 7,t..._. .
acting egister ~ `x~.~~,.
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DECREE OF REGISTER
Estate of Jean W. Brooks Deceased No. 21-02-769
also known as Jean Watkins Brooks
Social Security No: 186-30-6923 Date of Death: 6/17/02
AND NOW, AUGUST 26, 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 TR~TAMFNTARV
(c.t.a., d.b.n.c.t.; pendente liter durante absentia; durante minoritate)
are hereby granted to Helen Jean Brooks Rhinehart
in the above estate and that the instrument(s), if any, dated WIT~~: 2-1 1-1988
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Letters ................................ .... $ 60.00
Short Certificate(s) ............. .. $ 18.00
Renunciation ....................... ... $
Affidavit ( ) .................... ... $
Extra Pages ( ) ............ .. $ h _ 00
Codicil ................................ . $
JCP Fee .............................. ... $ 5.00
Inventory & Tax Forms ........ ..... $
Other ................................... ... $
TOTAL ..................... ........$ 89.00
mailed to atty 8-26-2002
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Attorney: Charles J. DeHart, III, Esquire
I.D. No: 15617
Address: 3631 North Front Street
Harrisburg PA 17110
Telephone: (717) 232-7661
DATE FILED: 8-26-2002
~~his is to certify that the information here given is correcrl~- copied from au~ Original certificate of death duly filed with me as
Local Registrar. The original certificate will be forwarded to the Stare Viral Records Office for permanent filing.
WARNING: It is illegal to duplicate this copy by phollostat or photograph.
;- Fee for this certificate, $2..00
P X4539$9
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TYPEJPRINT
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HtO5.u3 Rev. 2187 COMMONWEALTH OF PENNSYLVANIA' DEPARTMENT OF HEALTH' VITAL RECORDS
CERTIFICATE OF DEATH
NAME OF DECEDENT(Fex. MdJk UN) SE% SOCIAL SECURITY NUMBER GTE OF OEATHIMOM. Day. Yexl
,. Jean Watkins Brooks _ 1. Female s. 186 - 30 _ 6923 ..June 17 2002
AGE llaM BeNday) UNDER ,YEAR UNDER t GY GTE Of BIRTH BIRTMIACE (CNy ar10 PUCE OF DEATNCn«A ONy one ~ see ~ndruQbm on aM sele)
MOMS Dap /loses Mxe11b IM«eN. DaY. Yexl State«FOrepn Coumryl
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ill HOSPITAL'
^ OTHER:
s 80 Yn
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" COUNTY a DEATH CITY. BORO, TWP OF DEATH FACILITY NAME Ilf M kWiluion, piva Yreet and rxnrleerl WAS DECEDENT OF HISPANIC ORKiIN7 RACEAmencan InOixl. BIaG, Whk. a<
Is+eaM
~® Yes ^ u rb, speaM Cavan.
Mbinn. PuMO Rion, eb.
ae. Cumberland k.Lower Allan lad. Woods At Cedar Run +. ++.White
DECEDENTS USUAL OCCUPATION KIND Of BUSINESSnNDUSTRY WAS DECEDENT EVER IN DECEDENTS EDUGTION 1MRITAL STATUSAIxned SURVIVING SPOUSE
ARMED FORCESi S nee tom b Nwx Mimed. Wi00eed, pl woe. lave maden rlxnel
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leNe eam a "°"' atek °""° "m" Ins . Co . o f North lern.raxv arolud Ispeofy)
a wenkq aN; eo rw,u,e ra+b.l rb ^ NO ® 14,x) (,~ « •1
" ,,. Su ervisor ,America ,:. ,1. +.. Widowed ,s.
DECEDENr$MAtLING ADDRESS (Slraa. CeyRMl, SUk. 2iD COaeI OCNDENrS
,TC.® Yb, dsudra wedb Lower Allen
PA
824 Lisburn Road ~
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FATHERS NAME (fYaL AlidOk, lash MOTHER'S NAME IFkx. MEdk. Madan $umame)
,a Norman Conrad Watkins ++. Elizabeth M. Moore
INFORMMT'S NAME ITyWPr,rt) INFORMANTS IMILING ADDRESS (51rM. DayRM, SM,a. AP CoOel
1d..Jean Brooks Rhinehart lae.1003 Sheffield Ave., Mechanicabur PA 17050
METLaDD Of DISPOSfT
8t%la~ Cramawn ^ Remora from $tae ^ GTE OF D,SPOSITION
(MOM,Day. Yea) PLACE OF DISPOSITION -Name Ot CMMery. Crgnalory
«ONw Pfau LOCATION - Cilyytoaar. Stale. ZNr Coda
DOrumn ^ ONw (SpeoNl ^
,,,- „a. June 21, 2002 ,,..Rolling Green Memorial „d, Camp Hill, PA 17011-
S,WYITUREO ta+E ERVI N;ENSEE PERSON LICENSE NUMBER NAME AND ADDRESS OF FACILITY Je88e H. Gelgle Funeral Home,
,,. ;~,- FD-010628-L „~, 210-0 Lingleatown Road, Harrisburg, PA 17110-
COr,lPleb verb 21st slay rwl To a my m,onedNe, baA oaaarad a dle Nme. Oaa and eau stal•d. LICENSE NUMBER GTE SIGNED
pMaiDan is mt arYaae a little b ( and TNk) (M«dL Dar. Year)
brefY orb W dash. „e_ lle. iX.
TIME OF DEATH GTE PRONOUNCED DEAD (M«N, Day. Yex) WAS CASE REFERRED TO MEOI~,B~ E%ANINER/COR Ri
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P.rbn rdn prormeYaa a.xn.
la. 10 :15 P M. s. June 17 , 2 0 0 2 le.
~ PART N: OrMr spnf a tplprme merAWrq m dexA, Due
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WAS M AUTOPSY WERE AUTOPSY FNAINGS MANNER OF DEATH DATE Of INJURY TIME Of INJURY INUURY AT WORKi DESCRIBE NOW IKIURY OCCURRED.
PERFORMED? AVANABIE PRNM TO (MOM. Day. Yexl
COMPLETION OF GUSE
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' NATU TITLE Of CERTIFIER
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CERTIFYING PNYSICUW (Physlaan cemying muse a death when andher physiaan nas prmdunce0 death and cony)
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'PRONOUNCING AND CERTIFYING PHYSICU111 (Physl,tian Dolh pronoungng deaN aM txrtifying ID Ouse W OeaN) //'' ~~// ~~ ~
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To lM bast o! my kmwNdge, death occurred at tM tlme, data, and place, and dw to 1M cause(s) and manner ae stated - . - - .. - . ^
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NAME AND ADDRESS OF PERSON WNO COMPLETED GUSE
'MEDICAL EXAMYNERK:ORONER loam ZYI ryb «Pwa
On tM Oaab o/ eaaminadon anNOr Irnntlgatlan, In my oplnlon, death occumd at tM tlma, date, and place, and dw to tM causelsl and
marNwr as aUted--------------------------~--.--------.-.___-__-.---______- ^
,,, ,,. 4410 Linglestown Road, Hbg, Pa. 17112
REGISTRM'S SIGNATURE AHD NUMBER ~ DATE FILED IM«en. Day. YeYI
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LAST WILL AND TES'.CAMENT
OF
JEAN W. BROOKS
21-02-769
I, JEAN W. BROOKS, of Harrisburg, Dauphin County,
Pennsylvania, being of sound mind, memory and understanding, do
make and publish this my Last Will and Testament, hereby revoking
and making void all former Wills by me at any time heretofore
made.
ITEM I:
I direct that all my just debts
and funeral expenses be fully paid and satisfied as soon as
'conveniently may be after my decease.
ITEM II: I give all the rest, residue and
I remainder of my estate, whatever the nature of such property may ',
', be, whether real, personal or mixed, unto my daughter, Helen Jean
jBrooks Rhinehart, provided she survives me by thirty days.
i
ITEM III: In the event my daughter, Helen
Jean Brooks Rhinehart, does not survive my death by said period of '.
thirty days, I then give all the rest, residue and remainder of my
estate in three equal shares to my grandchildren, Tammy Jean ',
Robertson, Gary C. Rhinehart, Jr. and Kristin Nicolle. If any
grandchild should predecease me, the share of that grandchild
shall be distributed among the surviving grandchildren and the
issue of any deceased grandchild, per stirpes, as the case may
be.
n
ITEM IV:
All principal and income shall b
free from anticipation, assignment, pledge or obligations of
beneficiaries, and shall not be subject to attachment, execution
or other legal process.
ITEM V:
It is hereby di rected that my
Executrix hereinafter named shall pay all inheritance, state,
succession and legacy taxes to which my estate or the transfer of
any property hereunder may be subject and to charge such tax as
part of the administration payable out of my residuary estate.
ITEM VI:
I nominate, constitute and
appoi nt my daughter, Helen Jean Brooks Rhinehart, to be and act a
my sole Executrix of this my Last Will and Testament. In the
event of renunciation, death, resignation or inability to act for
any reason whatsoever of my daughter, I nominate, constitute and
appoint my granddaughter, Tammy Jean Robertson, as Executrix of
this my Last Will and Testament. My Executrix shall not be
required to post bond or security.
IN WITNESS WHEREOF, I have hereunto set my hand and seal thi
/ day of _~lu.-~~~ 19 88 .
LG~ • ~ ~~ ~ ~ S E AL
Jean W. Brooks
The preceding instrument, consisting of this, and one other
typewritten page, was on the date thereof signed, published and
declared by JEAN W. BROOKS, the Testatri x therein named, as and
for her Last Will, in the presence of us, who at her request, in
her presence and in the presence of each other, have subscribed
~ our names as witnesses hereto.
I ~ ~'
~~~~ -~- .,~-~C~~1 _ Residing at
Residing at
REGISTER OF WILLS OF COUNTY
OATH OF SUBSCRIBING WITNESS
(each) a subscribing witness to the
law, depose(s) and say~s,~ that
the testat ,sign the sa a and that
request of testat in l~_ resen
other subscribing witness(es)). ~
Sworn to or affirmed and subscribed before
me this day of
19
(Name)
(Address)
(Name)
(Address)
(ea a subscriber hereto, (each)~beng duly qualified (according t law, depo\\s ah ay(s) that
G.1\Q, familiar with the signature of °_~e~ ~1.1 ~ V ,
codicil
testat ors of (one of the subscribing witnesses to) the ( wi presented herewith and
~--°`~ codicil
that ~~~ believes the signature on the will is in the handwriting of
aka jean_watkins brooks
to the best of _~.~Y~___ knowledge and belief.
Sworn to er affirmed and subscribed before ~
me this 23ra~ day of !Name) /~ ~ ~05~
AUGUST 2 t~ 0 2 1 ~ ~(~ a~Y~yn-~v Q~fi`e . `~cc
-'1 ~ '~ % ~ ~~ i ' ~ ~_ (Address)
acting eegr~~~
ame) ~
(Addres
codicil
will presented herewith, (each}'being duly qualified according to
present and saw
signed as a witness at the
and (in the pf~sence of each other) (in the presence of the
REGISTER OF WILLS OF ~r RFRr~nm COUNTY
OATH OF NON-SUBSCRIBING WITNESS
21-02-769
RE~'-1500 EX. (B-oOO)
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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
.
COMMONWEALTH OF
PENNSYLVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
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DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL)
Brooks, Jean W.
DATE OF DEATH (MM.-DD-Year)
DATE OF BIRTH (MM-DD-Year)
06/17/2002
09/15/1921
(IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST. AND MIDDLE INITIAL)
None
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00 1, Original Return
o 4. Limited Estate
[g] 6. Decedent Died Testate (Attach copy of Will)
o 9. Litigation Proceeds Received
o 2, Supplemental Return
o 4a. Future Interest Compromise \da\eof lIea\h af\e112-12-32)
o 7. Decedent Maintained a Living Trust (Attach copy ofTrusl)
o 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95)
OFFICIAL USE ONLY
1/
FILE NUMBER
i.,k-~A?>- ~ ~ :k,.k- ~
SOCIAL SECURITY NUMBER
186-30-6923
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
o 3. Remainder Retum (dateofdeathpriorro12.13-B2)
o 5. Federal Estate Tax Return Required
_ 8. Total Number of Safe Deposit Boxes
o 11. Election to tax under Sec. 9113(A) (AtlachSch0)
COMPLETE MAILING ADDRESS
3631 North Front Street
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NAME
Charles J. DeHart, III, Es uire
FIRM NAME (If Applicable)
CALDWELL & KEARNS
TELEPHONE NUMBER
717 232-7661
Harrisbur
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1. Real Estate (Schedule A) (1)
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule 0) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5)
(Schedule E)
6. Joint~ Owned Property (Schedule F) (6)
o 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/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (line 12 minus Line 13)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
X _(15)
9,683.31 X ~(16)
X .12 (17)
X .15 (18)
(19)
16. Amount ot 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
20.0
CHECK HERE IF YOU ARE REQUESTING A REFUNO OF AN OVERPAYMENT
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH <: <:
PA 17110
OFFICIAL USE ONLY
4,590.00.
,
11,871.89 i
3,121.30
(8)
19,583.19
9,879.61
20.27
(11)
(12)
(13)
9,899.88
9,683.31
(14)
9,683.31
435.75
435.75
Decedent's Complete Address:
STREET ADDRESS 824 L. R d
Isburn oa
CITY . I STATE PA I ZIP 17011
Camp HIli
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
435.75
Total Credits (A + B + C) (2)
3. InteresUPenalty if applicable
D. Interest
E. Penalty
T otallnteresUPenalty ( 0 + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Pagel Une 20 to request a refund (4)
5. If Line 1 + Line 3 is greaterthan 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. (58)
Make Check to: REGISTER OF WILL$, AGENT
435.75
435.75
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; ........................................ 0 ~
c. retain a reversionary interest; or ..............n. ....................................................... .............................. D [Z]
d. receive the promise for life of either payments, benefits or care? ............................................................. 0 ~
2. If death occurred after December 12,1982, did decedent transfer property within one year of death
without receiving adequate consideration?...................... n.. ............................................. ........................ 0 [Z]
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ................. 0 ~
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 of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATUR ERSON RESPONSIB FOR FIL T N
ADDRESS
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
C~ k~~.
ADDRESS '
DATE
Charles J. DeHart, m
3531 r~urIrl r-ront ~treet
Harrisburg, Pennsylvania 17110
y<",.;,.<'>"'"
For dates of death on or after July 1,1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 PS. 99116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net vaiue of transfers to or for the use of the survivin9 spouse is 0% [72 P.S. 99116 (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 dealh on or afler 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 PS. 99116(a)(1.211.
The tax rate imposed on Ihe net value ot transfers 10 or for the use of the decedent's lineai benetielaries is 4.5%, except as noted in 72 P.S, 99116(1.2) [72 P.S, 99116(a)(1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% 172 P.S. 99116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption.
. .
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COMMONWEALTH OF PENNSYLVANIA
INHERIT ANCE TAX RETURN
RESIDENT CEO T
SCHEDULE B
STOCKS & BONDS
ESTATE OF
Brooks Jean W.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
FILE NUMBER
ITEM
NUMBER
1
DESCRIPTION
45 shares common stock, Cigna Corporation @ $102 per share
VALUE AT DATE
OF DEATH
4,590.00
TOTAL (Also enter on line 2, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
4,590.00
R~:'~"."m,.
COMMONWEALTH OF PENNSYLVANIA
INHERIT p.NCE 1 P.X RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF
Brooks Jean W
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointfy-owned with the right of survivorship must be disclosed on Schedule F.
FILE NUMBER
ITEM
NUMBER
1
DESCRIPTION
The Woods at Cedar Run - Nursing home refund (see attached statement)
VALUE AT DATE
OF DEATH
893.00
2.
Verizon - Telephone refund (see attached statement)
3.64
3.
Cigna Corporation - Uncashed dividend checks (see attached statement)
30.00
4.
T. Rowe Price Reserve Account #1841372-8 - Date-of-death balance
(see attached statement)
10,938.83
Accrued dividend
6.42
5. Miscellaneous Personal property - None - Nursing home
TOTAL (Also enler on hne 5, Recapilulalion) $
(If more space is needed, insert additional sheets of the same size)
11,871.89
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COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF
Brooks Jean W
If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G.
FILE NUMBER
SURVIVING JOINT TENANT(S) NAME
ADDRESS
RELA T10NSH1P TO DECEDENT
A. Helen Jean Brooks Rhinehart
1003 Sheffield Avenue
Mechanicsburg, PA 17055
Daughter
B
c
JOINTL Y.OWNED PROPERTY:
LETTER DATE OESCRtPTION OF PROPERTY %OF DATE OF DEATH
ITEM FOR JOINT MADE Include name of financial institution and bank account number or similar identifying number. Attach DATE OF DEATH DECO'S VALUE OF
NUMBER TENANT JOINT deed for jointly-held real eslale VALUE OF ASSET INTEREST DECEDENT'S INTEREST
1. A 1964 Allfirst checking account #0017905117 - Date-of-death 936.76 50. 468.38
balance (see attached statement)
2. A. 1985 Allfirst account #0094352003 - Date-of-death balance 5,305.83 50. 2,652.92
(see attached statement)
TOTAL (Also enter on line 6, Recapitulation) $ 3121.30
(If more space is needed, insert additional sheets of the same size)
"'''';'''''''''',.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTATE OF
FILE NUMBER
Brooks Jean W.
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Jesse Geigle Funeral Home - Funeral services 6,131.80
2. Rolling Green Cemetery - Memorial and grave 2,287.00
3. Rev. Zeisloft & Staff - Funeral services 300.00
4. Family luncheon 338.74
B ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Helen Jean Brooks Rhinehart - Waived
Social Security Number(s) I EIN Number of Personal Representative(s)
Street Address
City Slate lip
Year(s) Commission Paid:
2. Attorney Fees Caldwell & Kearns 500.00
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant None
Street Address
City Slate Zip
Relationship of Claimant 10 Decedent
4. Probate Fees Register of Wills 150.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Cumberland County Law Journal - Legal advertising 75.00
8. Carlis/e Sentinel - Legal advertising 97.07
TOTAL (Also enler on line 9, Recapitulation) $ 9,879.61
(If more space is needed, insert additional sheets of the same size)
';v';';',.,''''.
COMMONWEALTH OF PENNSYLVANIA
lNHERI1 ANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES & LIENS
ESTATE OF
Brooks Jean W.
FILE NUMBER
Include unreimbursed medical expenses.
ITEM
NUMBER
DESCRIPTION
AMOUNT
1.
Verizon - Final telephone bill
20.27
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
20.27
REVf511EX.'.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICIARIES
FILE NUMBER
-'""nW
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I. TAXABLE DISTRIBUTIONS [include outright spousal distributions. and transfers under
Sec. 9116 (aJ (1.2)]
1. Helen Jean Brooks Rhinehart Daughter (a) Jointly owned prop.-
1003 Sheffield Avenue $3,121.30
Mechanicsburg, PA 17055 (b) Residuary-
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
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1. ,
TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(\f mOTe space 'IS needed, insert additional sheets of the same size)
T. Rowe Price Services, Inc.
October 14, 2002
P.O. Box 89000
Baltimore. Maryland 21289.0250
10090 Red Run Boulevard
Owings Mills, Maryland 21117
www.troweprice.com
Charles J DeHart III
Caldwell & Kearns
3631 N Front St
Harrisburg PA 17110-1533
Subject: Date of Death Valuation
Prime Reserve Fund Account 1841372-8
Dear Mr. DeHart:
Thank you for contacting T. Rowe Price about the fund account shown above, which is
registered to the late Jean W. Brooks.
As of June 17, 2002, the above account held 10,938.830 shares, all on deposit. The closing
net asset value of the Prime Reserve Fund as of the close of business on that day was $1.00,
and the total account value on that day was therefore $10,938.83. In addition, an unpaid
dividend of $6.42 had been earned from June I through June 17, 2002. The account's
dividends and capital gains payments, if any, were being reinvested in the account.
If you have any questions, please call a customer service representative at 1-800-225-5132.
Representatives are available Monday through Friday from 7 a.m. to 12 a.m. ET and Saturday
and Sunday from 8:30 a.m. to 5 p.m. ET.
Sincerely,
\~~
Terry MacKay
Senior Account Services Representative
Correspondence Number: 00590657
1:~fti~~
COMMONWEAL nI OF PE~SYlVAMIA
DEPARfHENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPl' . ,2.6\)601
HARRISBURG~ PA 17128-0601
*'
INFORMATION NOTICE
AND
TAXPAYER RESPONSE
FILE NO. 21 02-0769
ACN 02139001
DATE 09-10-2002
.EV-15U~o\F'u"'''1
EST. OF JEAN W BROOKS
S. S. NO. 186-30-6923
DATE OF DEATH 06-17-2002
COUNTY CUMBERLAND
TYPE OF ACCOUNT
o SAVINGS
IX] CHECKING
o TRUST
o CERTIF .
JEAN B RHINEHART
1003 SHEFFIELD AVE
MECHANICSBURG PA 17055-5748
REHIT PAYHENT AND FORHS TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
ALL FIRST BANK hIlS provided the Dapar'tftnt with the info,...Uon Usted below which has been used in
calculating tha potential ta~ due. Their records indicata that at the ~ath of the above dec.dant~ you were. joint ownar/beneficiary of
this account. If yoU fael this inforll8tion is incorrllCt~ plea.e ebbin written corr.ction fro. the financial institution, atbch a COpy
to this fa... and raturn it to ttw. aboVe eddrass. This account is ulCllbla in accordl!ltlCe with the Inheritance Ta,c La.,. of thll Co..~n.,.alth
of PlHU1sylvania. Questluns MY ba answered by call111g {7171 787-8327.
COMPLETE PART 1 BELOW
Account No. 0094352003
. .
. SEE REVERSE SIDE FOR
D.t. 03-28-1985
Estllblish.d
FILING AND PAYMENT INSTRUCTIONS
Account B.1."c. 5,305.83
P.rc."t T.x.b1. X 50.000
AIIount SubjKt to T.x 2,652.92
T-x R.t. X .15
PotMt1.1 T.x au. 397.94
PART TAXPAYER RESPONSE
mll!lllil_~I~m1r~_!III.~~IIIII_~r.I(\'I~~g~II..t.:,~~t.~_["~ll.li"~J~[;~.~Di~l:
To insure proper credit to your account, two
(2) copies of this notioe .ust acco.pany your
pa~ent to the Register of Wills. Make check
payable to: "Register of Nills~ Agaot".
NOTE: I f t81~ pay.ents ara .ade wi thin three
(3) ~nths of the dacadent.s date of death,
you ..y deduct a 5% discount of the ta,c due.
An~ inheritanca ta,c due will baeo.. delinquent
niM (9) .anths aftar the date of de.th.
[CHECK ]
ONE
BLOCK
ONLY
A. 0 The above infor..tion and ta,c dull is corrac:t.
1. You ..y ChOOD to r_it pay..nt to the Register of WUls with two copies of this notice to obtain
a discount or avoid interest, or you ..y check balC "A" and return this notice to the Register of
Wills end an official asses..ent will be issued by the PA Dapartaant of Ravenue.
8. 0 The above asset has b.en or will be r.ported and talC paid with the Pennsylvania Inheritance Ta,c return
to be filed by the decedent's representative.
C. 0 The abOve infor..Uon is incorrect 8nd/o~ebts and deductions ware peid by YOU.
You .ust cDeplew PART [!] and/or PART l!J below.
PART
[!I
TAX RETURN - COMPUTATION OF TAX
LINE 1. D.t. Est~lish.d 1
2. AccOW'tt SalBnce 2
3. Percent raxable 3 X
~. AIoaunt Subj_t to T_ ~
5. Debts and Deductions 5
6. AlKNI\t Taxable 6
7. Tax Rate 7 X
8. Tax 0.... 8
ON JOINT/TRUST ACCOUNTS
If you indicate a different tax rat., pl.ase st.t. your
relationship to decedent:
PART
~
DATE PAID
DEBTS AND DEDUCTIONS CLAIMED
PAYEE
DESCRIPTION
AMOUNT PAID
I
TOTAL (Enter on Line 5 of Tax Conput.tion)
I
$
Under penaltl.s of perjury, I declare that the f.cts I have r.ported &bOY. are true, correct and
complet. to th. best of .y knowl.dge and b.l1ef.
HOME (
WORK (
TELEPHONE
)
)
NUMBER
DATE
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LAST WILL AND TESTAMENT
OF
JEAN W. BROOKS
21-02-769
I, JEAN W. BROOKS, of Harrisburg, Dauphin County,
Pennsylvania, being of sound mind, memory and understanding, do
make and publish this my Last Will and Testament, hereby ;:evckir:g
and making void all former wills by me at any time heretofore
made.
ITEM I:
I direct that all my just debts
and funeral expenses be fully paid and satisfied as soon as
conveniently may be after my decease.
ITEM II:
I give all the rest, residue and
remainder of my estate, whatever the nature of such property may
be, whether real, personal or mixed, unto my daughter, Helen Jean
Brooks Rhinehart, provided she survives me by thirty days.
I TEM I II :
In the event my daughter, Helen
Jean Brooks Rhinehart, does not survive my death by said period of
thirty days, I then give all the rest, residue and remainder of my
estate in three equal shares to my grandchildren, Tammy Jean
Robertson, Gary C. Rhinehart, Jr. and Kristin Nicolle. If any
grandchild should predecease me, the share of that grandchild
shall be distributed among the surviving grandchildren and the
issue of any deceased grandchild, per stirpes, as the case may
be.
ITEM IV:
All principal and income shall b
free from anticipation, assignment, pledge or obligations of
beneficiaries, and shall not be subject to attachment, execution
or other legal process.
ITEM V:
It is hereby directed that my
Executrix hereinafter named shall pay all inheritance, state,
succession ana legacy taxes to whi~h my Gstate or the transfer of
any property hereunder may be subject and to charge such tax as
part of the administration payable out of my residuary estate.
ITEM VI:
I nominate, constitute and
appoint my daughter, Helen Jean Brooks Rhinehart, to be and act as
my sole Executrix of this my Last Will and Testament. In the
event of renunciation, death, resignation or inability to act for
any reason whatsoever of my daughter, I nominate, constitute and
appoint my granddaughter, Tammy Jean Robertson, as Executrix of
this my Last Will and Testament. My Executrix shall not be
required to post bond or security.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this
II day of 2f~a ' 1988.
/
Jean
i).
w. Brooks
~/
( SEAL)
The preceding instrument, consisting of this, and one other
typewritten page, was on the date thereof signed, published and
declared by JEAN W. BROOKS, the Testatrix therein named, as and
j
for her Last Will, in the presence of us, who at her request, in
her presence and in the presence of each other, have subscribed
our names as witnesses hereto.
i\ 1dLi.. (). Jkv-oJ
r /
/3J....5. 0/~/S/
Residing at
(la--"~p f.4.)..fl
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6A~hV;hJ
4 s(.. L,,-t_
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Residing at
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<;;~ rf lJ'nl ("
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REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Jean W. Brooks
Date of Death: 6/17/02
Will No. 2002-00769 Admin. No.
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 9/19/02
Name Address
Helen Jean Brooks Rhinehart 1003 Sheffield Avenue
Mechanicsburg PA 17055
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:
Date: 9/19/02
Capacity:
) r----_
/~"y'~
Signature
Name: Charles J. DeHart. III. Esauire
Address: 3631 North Front Street
Harrisburg PA 17110
Telephone(232) - 7661
Personal Representative
X Counsel for Personal
Representative
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 1 71 28-060 7
RECEIVED FROM:
DEHART CHARLES J III ESQ
3631 NORTH FRONT ST
HARRISBURG, PA 17110
-------- fold
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
ESTATE INFORMATION: ssN: ass-3o-ss23
FILE NUMBER: 2102-0769
DECEDENT NAME: BROOKS JEAN W
DATE OF PAYMENT: 03/20/2003
POSTMARK DATE: 03/ 1 9/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 06j17/2002
ACN
ASSESSMENT
CONTROL
NUMBER
AMOUNT
101 ~ 5435.75
TOTAL AMOUNT PAID:
REMARKS: JEAN B RHINEHART
C/O CHARLES J DEHART III ESQ
CHECK# 3219
SEAL
INITIALS: CW
RECEIVED BY: DONNA M. OTTO
5435.75
DEPUTY REGISTER OF WILLS
REV-1162 EX(11-96)
NO. CD 002316
REGISTER OF WILLS
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CALDWELL & KEARNS
A PROFESSIONAL CORPORATION
JAMES R. CLIP PIN GER ATTORNEYS AT LAW OF COUNSEL
CHARLES J. DENARY. III RICHARD L. KEARNS
JAMES D. CAMPBELL. JR. CARL G. WA55
3631 NORTH FRONT STREET
JAMES L. GOLDSMITH
STANLEY J. A. LA SKOW SKI HARRISBURG, PENNSYLVANIA 17110-1533 THOMAS D. CALDWELL. JR.
JEFFREY T. McGUIR E•
119 2 8-2 0011
DOUGLAS K. MAR SICO
BRETT M. WOODBURN
DOUGLAS E. HERMAN
RAY J. MIC HALOWSKI
•ALSO A MEMBER OF NJ BAR March 19
2 0 0 3
, 717-232-7661
FA X: 717-232-2766
thefirm~caldwellkearns.com
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
Re: Estate of Jean W. Brooks
No. 21-02-0769
Dear Sir/Madam:
I am enclosing herewith the following documents for recordation:
1. Two (2) copies of an Inventory.
2. Two (2) copies of a Pennsylvania Inherit=ance Tax Return, with
attachments.
3. The face page of the Pennsylvania Inheritance Tax Return and
a stamped, self-addressed envelope for returning the clocked-
in copy of the face page.
4. A check made payable to the Register of Wills in the amount of
$435.75, representing the balance of the inheritance tax due
and owing.
Thank you for your cooperation.
Very truly yours,
/;/
1`
Charles J. DeHart, III
CALDWELL & KEARNS
CJD/nb
/Enclosures
02-594/59173-1
CALDWELL & KEARNS
A PROFESSIONAL CORPORATION
JAMES R. CLIP PIN GER ATTORNEYS AT LAW OF COUNSEL
CHARLES J. DEHART. III RICHARD L. KEARNS
JAMES D. CAMPBELL. JR. CARL G. WASS
JAMES L. GOLDSMITH 3631 NORTH FRONT STREET
STANLEY J. A. LASKOW SKI HARRISBURG
PENNSYLVANIA 17110-1533
JEFFREY T. McGUIRE• , THOMAS D. CALDWELL. JR.
(192 B - 20011
DOUGLAS K. MAR SICO
BRETT M, WOODBURN
DOUGLAS E. HERMAN -
RAY J. MICHALOWSKI
•ALSO A MEMBER OF NJ BAR March 21, 2 0 0 3
717-232-7661
FA X: 717-232-2766
thefirm®caldwellkearns.com
Register of Wills
Cumberland County Courthouse
1 Courthouse Square
Carlisle, PA 17013
Att: Cheryl
Re: Estate of Jean W. Brooks
No. 2102-769
Dear Cheryl:
As you requested, enclosed is our check in the amount of $28 to
cover the filing cost for the Inventory and Inheritance Tax Return.
in the above estate.
I have enclosed a self-addressed, stamped envelope for your
convenience in returning a receipt to us for this filing fee.
If you require anything further, please advise.
Very truly yours,
c•
~/4 c.C1~i.~~~J ~ ~ ~ '~' i~~~'r ~,Ua
Charles J. DeHart, III
CALDWELL & KEAF:NS
CJDIII:nb
/Enclosures
02-594/54345-1
j REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
f NVENTORY
Estate of Jean W. Brooks No. ~- ~ ~ ~ ~ `" ~ ~ y
also known as Date of Death 6/17/02
Deceased Social Security No. 186-30-6923
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the rea- 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 the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. IiWe
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 1S Pa. C.S. Section 4904 relating to unsworn falsification to authorities.
Name of
Attorney: Charles J. DeHart, 111, Esquire
I.D. No.: 15617
Address: 3631 North Front Street
Harrisburg PA 17110
Telephone: (717) 232-7661
Description
1. The Woods at Cedar Run -Nursing home refund
2. Verizon -Telephone refund
3. Cigna Corporation - Uncashed dividend checks
Personal Representative:
Helen Jean Brooks Rhinehart
Dated r~J~fZ~~3
4. T. Rowe Price Reserve Account #1841372-8 -Date-of-death balance
Accrued dividend
5. Miscellaneous Personal Property -None -Nursing home
(Attach Additional Sheets if necessary)
Total
Value
893.00
3.64
30.00
10,938.83
6.42
16,461.89
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
R W-4
Continuation of Inventory
Jean W. Brooks
Palle 1 __
Description of Inventory
STATUS REPORT UNDER RULE 6.12
~~
Name of Decedent : Jean W. Brooks
Date of Death : 6/17/02
Will No . 21 02-0769 Admin . No
Pursuant to Rule 6.12 of the Supreme Court Orphans '
Court Rules, I report the following with respect to completion of
the administration of the above-captioned estate
1 . State whether administration of the estate is complete
Yes ~_ No
2 . If the answer is No , state when the personal
representative reasonably believes that the administration will be
complete
3 . If the answer to No . 1 is Yes , state the following:
a . Did the personal representative file a final
account with the Court ? Yes No _~S-
b . The separate Orphans ' Court No . (if any) for
the personal representative ' s account is
c . Did the personal representative state an
account informally to the parties in interest ? Yes _~ No _
d . Copies of receipts , releases , joinders and
approvals of formal or informal accounts may be filed with the
Clerk of the Orphans ' Court and may be attached to this report .
4/30!03
Date ~,
~--~ `~' 1 L ~ ~`~~'
Signature
Charles J. DeHart, III, Esquire
Name (Please type or print )
3631 North Front Street
Harrisburg PA 17110
cv - Address
~'~
`-=~
G~ _ ~ 232) - 7661
Tel . No .
i
- ~
~
Capacity : Personal Representative
~ <<`~
.~
,,~ . ~
_1S- Counsel for personal
`~- o >~ ~; representative