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Home My WebLink About02-0952 PETITION FOR PROBATE & GRANT OF LETTERS Estate of EVELYN M. BREHM also known as , deceased. No. 21-02- 96.:2..- To: Register of Wills for the County of Cumberland Commonwealth of Pennsylvania 189-09-4755 Social Security No. The Petition of the undersigned respectfully represents that: Your Petitioners, who are 18 years of age or older and the Executors named in the Last Will of the above decedent dated April 28 ,1997, and codicils dated none . 19~ The Executor named none died . Renunciation for Vance W. Brehm is allached hereto. Decedent was domiciled at death in Cumberland County, Pennsylvania, with her last family or principal residence at 108 Straver Drive. South Middleton Townshio. Carlisle Decedent, then 89 Jears of age, died Home. Carlisle. PA J October 2 . 2002, at Todd NursinQ Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the Will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in PAl All personal property (If not domiciled in PAl Personal property in PA (If not domiciled in PAl Personal property in County Value of real estate in Pennsylvania, situated as follows: 108 Straver Drive. South Middleton Township. Carlisle. PA 17013 $8.000.00 $ $ $115,000.00 WHEREFORE, Petitioners respectfully requests the probate of the Last Will and Codicil(s) presented herewith and the grant of lellers testamentary thereon. Signature(s) and Residence(s) of Petitio er(s): Donald R. Brehm 710 Mt. Rock Road Carlisle. PA 17013 717-776-7412 ~ . /' i ,f I . .", ,. it"" ..J2~ j:.- Dennis D. Brehm 301 Union Hall Road Carlisle. PA 17013 717-243-5208 ~o "7 / .0../-- OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 55 COUNTY OF CUMBERLAND The Petitioner(s) above named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of Petitioner(s) and that as personal representative of the above decedent, petitioner{s) will well and truly administer ~he estate according to law"k Sworn to or affirmed and subscr:oed _p~U 1P ~ before me thi~.:3',e.,r day of Donald R. Brehm October. 2002. l' /1 /---> / iiJ i^ _..~ [IV. '/J/O'-l~ _ "".....1 )0. /"h-',:> /.LJ/. 13,p/~TY Dennis D. Brehm ~,;(2U ~ Registe 1-'/- '/ b - ? No. 21-02- q6~ Estate of EVELYN M. BREHM , deceased. DECREE OF PROBATE & GRANT OF LETTERS AND NOW, October o:J'/ , 2002, in consideration of the Petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated Acr'I 2B, 1997 described therein be admitted to probate and filed of record as the Last Will of Evelyn M. Brehm ; and Letters Testamentary are hereby granted to Donald R. Brehm and Dennis D. Brehm FEES Probate, Letters, Etc. . , . . . . . $ 235.00 Short Certificates(-2- ) . , , . $ 6.00 Renunciation(s) . . . . . . . . . , . $5.00 JCP .".. . . , . . . . . . . , . . . . $ 5.00 Other Will Paqes (-2-) .... $ 6,00 TOTAL: .... $ 257.00 Filed, IO,-.o::J.8.-,e>.:2/.. . . . . .. " . , . 60 West Pomfret St.. Carlisle, PA 17013 ADDRESS 717-249-2353 PHONE fuu ~~~ t'.. HI0580? RfY'li!;(; This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be. forwarded to the Stare Viral Records Office for permanenr 61iog. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. II'''''#/#''/~~ ilj(~\.\\\ Of pli...~..,. l~~~... ~~'" 1~~...!If<. . ~...e:.\ ~-,' ',.' :.;..\ ~~;- ,,_:',~~ 3 e,..)l ,71i ..)- '.:b.~ \*'" ,:,.~_~-.:., ,~i*l ~* ',_o.~, - ~~~l ":..~ ' /C~l\ ;--)?IMEN1 ~~ ~<<;",i' ,.,........,,/,,/#,##/1111111 ~~.~~~~ Local Registrar Fce for this certificare, $2.00 P 8703202 OCT :3 2002 Date H1ll5.It3R...21f7 COMMONWEALTH OF PENNSYl.VAHIA. DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH - USVAt.OCCU KlHDOF8US STRY ~~:.:."'~::= .. En ra ver Carpet Mill OECEDENT'SWollJNGAODRESS{Slrwr.~.sr...Zlp~ DECEDENT'S """.. lOB Strayer Drive ~~ .. Carlisle, Penna. 1701) ~-.... MtHER'SNAME(F;"I.MidIk~lliam Davis Morrow .. ~s (I"~ Donald R. Brehm . =0 ~"VllII\oIlO ,,--___0 ,. $IONRlJI'f SERVIct: ACTJ'IG suc:H -..,- sw"rs;J'Va"re'; Penna. ""'...- SEllFemale SOC......secuRfTYHUWBEII . . lB9- 09 -4755 Pl.ACEO#DERH~ """'"'" ...-0 ~ 0 'DI\lli:OI'tJe..Vl'I~.o.y.~ .October 2,2002 "'" 'w' .....'" .. .......- lFirtIt.""'-.~ Evelyn -,"'" ~jo.y. M. Brehm "" -.. j'''ot5+1 :="'0 Todd Nursing Home tlECEOE. S White ?-\ """""''''''''' fIl__p..-_ n... Cumberland "" - MO' - 'h. .. -,~..'" , SOUTh M;rln1~+'nn - 17" SUR -'" "" RN -50)-404L REFiARED TO Iol:E EXAM ...0 -'fJ... ".. L ,- '-- \--_..... i ...,. caw........CICIIIdIIoM...............buI 1IlII~.._~_........"""1. n."",1: ~.............."....lXJITIlIIIl:;IlionI"'*"......,IIW-".Da__tlw_oIdylnQ.Ildl_-=--..~__Gl'_!lI..... UIIon1f'__OfI_.... L ((JlAllACONSEOUENCEOFl: OUElO(ORAll"CCltiSEOVENCE~ ..... 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LAST WILL AND TESTAMENT I, EVELYN M. BREHM, of South Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. I. I direct my executors to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executors to sell any realty owned by me at my death and not specifically devised herein at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate to my three sons, Donald, Vance and Dennis, share and share alike. If any of my sons are not living at the time of my death, his share shall be divided equally between his wife and children, share and share alike. 4. I nominate and appoint Donald R. Brehm, Vance W. Brehm and Dennis D. Brehm to be the executors of this my Last Will and Testament; they are to serve as such without bond. 5. I hereby suggest that my personal representatives retain the services of Irwin, McKnight & Hughes, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28TH day of April, 1997. C:t:~/ht ~$f-E-L4EAL) EVE!. YN M. BREHM ,~ / Signed, sealed, published and declared by EVELYN M. BREHM, the above named testatrix, as and for her Last Will and Testament, 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. 2 nr.T-l4-1nnl n!:!RP~ P!flll-I!WIN, Ir.!NIr.HT & HIlr.HF~ IlW nFFlr:F, tTIT/4im4 T-;R4 P nn/lnn/ F-41/ 0.2/-0.,:;. - 'i'6~ RENUNCIATION In regard to the Estate of EVELYN M. BREHM , decea.o;ed. To the Resister of Wills of Cumberllll1d County, Pennsylvania. The undersigned son of the above decedent hereby rcnounce(s) the right to administer the estate and respectfully ask(s) that Letters Testamentarv be issued to Donald R. Brehm ~nrl Denni. D. Brehm WITNESS mv hand(s) this /:5 . day of October , 2002. ~~ It! ~__ SJONATUR:E Vance W. Brehm 2205 Stormy Lane. Bend. OR 97701 ADDRESS SlCNAT1JRE ADDRESS '; ._~ SlCiNATURE ADDRfSS ACKNOWLEDGMENT AND AFFIDAVIT WE, EVELYN M. BREHM, CHERYL L. CLELAND and MARTHA L. NOEL, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being fIrst duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. ~:~~RE~~/~~?/ e~L~~~ ~ ~ ;/?~~.f ~ ~ MARTHA L. NOEL COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by, EVELYN M. BREHM, the testatrix herein and subscribed and sworn to before me by CHERYL L. CLELAND and MARTHA L. NOEL, witnesses, this 28TH day of April, 1997. (2~C3-~ N tary PublIc Notarial Seal R0Q8r B. Irwin. Notary Public Carlisle Bero, Cumberland County My Commission Expires Oct. 3, 2000 Momb,r, Ponnoylvania Association of Notaries .y CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: EVELYN M. BREHM Date of Death: OCTOBER 2. 2002 Estate No.: 21-02-0952 To the Register: I certifY that notice of the beneficial interest 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 November 20. 2002 Name Address Vance W. Brehm Donald R. Brehm Dennis D. Brehm 2205 Stormv Lane. Bend. OR 97701 701 Mt. Rock Road. Carlisle. P A 17013 301 Union Hall Road. Carlisle. P A 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except none. Date: 11/20/02 Name Roger B. Irwin. ESCluire Address 60 Wesl Pomfrel Street Carlisle. P A 17013 Telephone (717) 249-2353 Capacity: Personal Representative x Counsel for Personal Representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96l RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT IRWIN ROGER B ESQ 60 W POMFRET ST CARLISLE, PA 17013 _UUh_ fold ESTATE INFORMATION: SSN: , 89-09-4755 FILE NUMBER: 2102-0952 DECEDENT NAME: BREHM EVELYN M DATE OF PAYMENT: 11/27/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 10/02/2002 NO. CD 001897 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $4,520.23 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: ROGER B IRWIN ESQUIRE CHECK# 19187 SEAL INITIALS: DO RECEIVED BY: REGISTER OF WILLS $4,520.23 MARY C. LEWIS REGISTER OF WILLS OFFICIAL USE ONLY REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT /')-9b- ;:> REV-1500 EX +(6-00) CAPB HpRL EplO CRAC KOTK ES C P o 0 R N R 0 E E S N T c o M P T U A T X A T I o N FILE NUMBER o E C E o E N T COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PI\ 1712.8-0601 DECEDENT'S NAME (LAST, FIRST.AND MIDDLE INITIAL) Brehm Evel DATE OF DEATH (MM-DD-YEAR) NUMBER DATE OF BIRTH (MM-DD-YEAR) 21-02-952 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 189-09-4755 THIS RETURN UUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER 10/26 1912 SPOUSE'S NAME AST, IRST, AND MIDDLE INITIAL X 1. Orig!f\i.l.l Return 4. limited Estate X 6. Decedent Died Testate 3. date of death . Remamder Return prior to 12~ 13-82) S. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes 2. 4a. 7. (Attach copy of Will) o 9. litigation Proceeds Received Supplemental Return Future Interest Compromise (date of death after 12 -12~82) Decedent Maintained a Living Trust (Attach copy of Trust) o 010. Spousal Poverty Credit 0 11. Election to tax under Sec. 9113(A) (date of death between 12-31-91 and. 1-1-95) (Attach Sch 0) 'j:!F.Dllj:iE~T~ff:~!fi.\~l:!~i!idirm,j!~;Il~~iiNeTlIlll!m~JiilENT!"iji1l'~ilNFOl!I~1lI!l"$!I<>~b!IiIi:l:!18~'!Ib::l:Qi;' NAME COMPLETE MAILING ADORESS Ro er B. Irwin Es . FIRM N"ME(\f Applicable) IRWIN McKNIGHT & HUGHES TELEPHONE NUMBER 60 West Pomfret Street West Pomfret Professional Bldg. Carlisle, PA 17013 R E C A P I T U L A T I o N 5 1. Real Estate (Schedule A) (1) 113,000.00 2. Stocks and Bonds (Schedule B) (2) None 3. Closely Held Corporation, Partnership or (3) None Sole-Proprietorship 4. Mortgages & Notes Receivable (Schedule D) (4) None S. Cash, Bank Depos.s & Miscellaneous Personal Property (s) 10,526.23 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) None o Separate Silting Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None (Schedule G or L) 8. Total Gross Assels (totai Lines 1-7) (8) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 14,095.80 10. Debts of Decedent, Mortgage Liabilities. & Lions (Schedule I) (10) 3,693.88 11. Total Deductions (total Linos 9 & 10) (11) 12. Net Value of Estate (Lino 8 minus Line 11) (12) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Sub'ect to Tax (Lino 12 minus Lino 13) (14) 105,736.55 '~_DFFICIAL U$EONLY '-, 123,526.23 17.789.68 105,736.55 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(aX1.2) 16. Amount of Line 14 taxable at lineal rate 105,736.55 17. Amount ot Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due 20. (lS) (16) (17) (18) (19) 0.00 4,758.14 0.00 0.00 4,758.14 x X X X .0 0 .045 .12 .15 CQPyrlght (e) 2.000 ~atm software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-001 Decedent's Complete Address: STREET ADDRESS 108 Strayer Drive CITY I STATE I ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 4,758.14 237.91 Total Credits ( A + B + C) (2) 237.91 3. Interest/Penalty if applicable D. Interest E. Penalty 0.00 0.00 4,520.23 0.00 4,520.23 """""',;iHiii:U1iHiU/'.. o o o [RJ [RJ [RJ 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 pre parer has any knowledge. SIGNATURE OF ~SON RESPONSIBLE FOR FILING R TURN Donald R. Brehm SJ~ fY. VwL' --~i~l ~~i;,':?~~--~ii~i3' ---... --- ---....... -- ----- SIGNATURE OF PREPAREROTHER THAN REPRESENTATIVE IRWIN McKNIGHT & HUGHES 60 West Pomfret Street .. 'carEs i;",-' FA" i 'f613..... --.................... DATE 'tp7/0;z. o TE For dates of death fter 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 (al (1.1) (j)J. 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) (iJ)]. 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 it 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(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 (cl 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) ADDITIONAL Personal Representatives Estate of Evelyn M. Brehm SS# 189-09-4755 10/02/2002 **************************************************** Under penalties of perjury, the undersigned declare that they have examined this return, including accompanying schedules and statements, and to the best of their knowledge and belief, it is true, correct and complete. Signature J2 . j! A?~ Name Address Line 1 Address Line 2 City, State, Zip Dennis D. Brehm 301 Union Hall Rd. Date Carlisle, PA 17013 ///).7h t.. / / REV~ 1502 EX + (1-97) SCHEDULE A COMMONWEALTH OF PENN$YLVANIA REAL ESTATE INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn M. Brehm SS# 189-09-4755 10/02/2002 21-02-952 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seUer, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with riaht of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE DESCRIPTION NUMBER OF DEATH 1 108 Strayer Drive, South Middleton Township, Carlisle - sold 113,000.00 11/18/2002 (settlement sheet attached) TOTAL (Also enler on line 1, Recapilulation) $ 113,000.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1502 EX (Rev. 1-97) REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Evelyn M. Brehm 55# 189-09-4755 10/02/2002 21-02-952 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 NUMBER DESCRIPTION OF DEATH 1 Cash on hand 310.00 SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY 2 Waypoint Bank, checking account #90937806 9,086.23 3 Personal property 1,130.00 TOTAL (Also enter on line 5, Recap~ulatlon) $ 10,526.23 (If more space is needed, insert additional sheets of the same size) Copyright (e) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97) RE'J-1511 EX +(1-97) COMMONWEALTH OF PENNSYLVANIA INHEAITANCETAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Evelyn M. Brehm Debts of decedent must be reported on Schedule l- ITEM NUMBER A. ADMINISTRATIVE COSTS, 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s) / EIN Number of Personal Representative(s) Street Address City State Zip B. 2. 3. SSI! 189-09-4755 10/02/2002 FILE NUMBER 21-02-952 DESCRIPTION AMOUNT 1 FUNERAL EXPENSES, George's Flowers 201. 40 2 Lydia Hazlett, meal 165.00 3 Rev. Eric Shaffer 50.00 Year(s) Commission Paid: Attorney's Fees IRWIN McKNIGHT & HUGHES Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address 6,100.00 City Relationship of Claimant to Decedent State Zip 4. Probate Fees Register of Wills 257.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Other Administrative Costs Cumberland Law Journal - estate notice publication 75.00 2 Linden Hall Antiques 85.00 3 Register of Wills - filing fee 25.00 4 Settlement charges on real estate sale 7,045.40 5 The Sentinel - Legal - estate notice publication 92.00 TOTAL (Also enter on line 9, Recapitulation) $ 14,095.80 (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~ 1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Evelyn M. Brehm SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, AND LIENS SSft 189-09-4755 10/02/2002 FILE NUMBER 21-02-952 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Hirsh Brothers, entry door AMOUNT 842.70 2 Millers Home Improvement, door installation 194.69 3 Omega medical Lab. 36.00 4 PP&L 86.03 5 Sarah A. Todd Memorial Home 2,230.30 6 Smart Clean 144.00 7 South Middleton Township Water Authority 103.95 8 Sprint Telephone 56.21 TOTAL (Also enter on line 10, Rec.p~ul'lion) $ 3,693.88 (If more space is needed, insert additional sheets of the same si2e) Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1512 EX (Rev. 1-97) REV-1513 EX + (9-00) COMMONWEALTH OF PENNSYLVANIA INHEA1TANCETAX RETURN RESIDENT DECEDENi ESTATE OF SCHEDULE J BENEFICIARIES Evelvr M. Brehm SSIf 189-09-4755 10/02/2002 FILE NUMBER 21-02-952 R10LATlUNSHIP TO DECEDENT AMOUNT OK SHARE Do NotListTrustee(s) OF ESTATE NUMBER NAME AND ADDRESS OF PERSON<S) RECEIVING PROPERTY I. T MABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a}(1.2)] 1 Dennis D. Brehm 301 Union Hall Road Carlisle, PA 17013 Son 1/3 remainder 2 Donald R. Brehm 710 Mt. Rock Road Carlisle, PA 17013 Son 1/3 remainder 3 Vance W. Brehm ~~Stormy Lane Bend, OR 97701 Son 1/3 remainder ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 1a, 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 S 0.00 (If more space is needed, insert additional sheets of the same size) Copyright (c) 2000 form software only The Lackner Group, InC. Form REV-1513 EX (Re.... 9~00) LAST WILL AND TESTAMENT I, EVELYN M. BREHM, of South Middleton Township, Cumberland County, Pennsylvania, declare this instrument to be my Last Will and Testament, hereby expressly revoking all Wills and Codicils heretofore made by me. I. I direct my executors to pay all of my debts, funeral and administrative expenses as soon as may be done conveniently after my decease. 2. I authorize and empower my executors to sell any realty owned by me at my death and not specifically devised herein at either public or private sale, and to give good and sufficient deeds therefor, in fee simple, as I could do if living. 3. I devise and bequeath all of my estate of every nature and wherever situate to my three sons, Donald, Vance and Dennis, share and share alike. If any of my sons are not living at the time of my death, his share shall be divided equally between his wife and children, share and share alike. 4. I nominate and appoint Donald R. Brehm, Vance W. Brehm and Dennis D. Brehm to be the executors of this my Last Will and Testament; they are to serve as such without bond. S. I hereby suggest that my personal representatives retain the services of Irwin, McKnight & Hughes, as attorneys in the settlement of my estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this 28TH day of April, 1997. r' ,. /' ;;., .-"'/ - ~ ," '---1.t:.~"/ _ - >:' - vc'.t:e'h,/ 0/ !~)/> F~-yJs'EAL) EVE! YN M. BREHM Signed, sealed, published and declared by EVELYN M. BREHM, the above named testatrix, as and for her Last Will and Testament, 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. 2 ACKNOWLEDGMENT AND AFFIDA VIT WE, EVELYN M. BREHM, CHERYL L. CLELAND and MARTHA L. NOEL, the testatrix and witnesses respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and that she had signed willingly, and that she executed it as her free and voluntary act for the purpose herein expressed, and that each of the witnesses, in the presence and hearing of the testatrix, signed the Will as a witness and that to the best of their knowledge the testatrix was, at that time, eighteen years of age or older, of sound mind and under no constraint or undue influence. r:-I ia. -Vi.. c...,./) - " ..... ((~~~~/~'~dIi~Xj ,'L-Oh!/ e7li // ~.4~~ C~RYL L. CLELAND ~~tto~k(jJ ~ COMMONWEALTH OF PENNSYL VANIA .' SS: COUNTY OF CUMBERLAND Subscribed, sworn to and acknowledged before me by, EVELYN M. BREHM, the testatrix herein and subscribed and sworn to before me by CHERYL L. CLELAND and MARTHA L. NOEL, witnesses, this 28TH day of April, 1997. "3. d"'-. tary Public Notarial Seal Roger B. Irwin, Notary Public Carlisle 80ra, Cumberland County My Commission Expires Oct. 3, 2000 Mambtlf, Pl'Innl!lYIVilnla AssoclallOn of Notaries A. H.U.D. SETTLEMENT STATEMENT B.LOAN TYPE: 115 yr conv fixed @ 5.500% OUR FILE #: RE02-287 LENDER: USAA Federal Savings Bank C.This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked P,O.C. were paid outside closing. D. NAME OF BORROWER: E. NAME OF SELLER: Bruce V. Gronkiewicz Estate of Evelyn M. Brehm Mary F. Gronkiewicz G. PROPERTY LOCATION: H. SETTLEMENT AGENT: i. SETTLEMENT DATE: 108 Strayer Drive Carlisle PA 17013 DUNCAN & HARTMAN, P.C. Monday 18-Nov-02 1 IRVINE ROW South Middleton Township Cumberland County CARLISLE, PA. 17013 4:00 p.m. J. SUMMARY OF BORROWER'S TRANSACTION K. SUMMARY OF SELLER'S TRANSACTION 100 GROSS AMOUNT DUE FROM BORROWER .00 GROSS AMOUNT DUE TO SELLER 101 Contract Sales Price $113,000.00 .01 Contract sa198 price $113,000.00 102 Personal Property 0.00 .02 Persona-l Property 0.00 103 Settlement charges .(line 1400) 3995.96 '03 10. 0.00 .0. 105 Adjustments items prepaid by selllSir: Adjustments items prepaid by seller: .05 Loca-l taxes to 31-09C-02 26.44 10. Local taxes to 31-Deo-02 26.44 .0. Assessments 107 Assessments to .07 School taxes to 30-Jun-QJ 657.59 10. School taxes to 30-Jun-03 657.59 .0. 10' H.O. Assoo. . to 01-080-02 31.56 '0' H.O. Assoo. ta 01-090-02 31.56 120 GROSS DUE FROM BORROWER 117711.55 420 GROSS DUE TO SELLER 113715.59 200 AMOUNTS PAID BY OR FOR BORROWER 500 REDUCTIONS IN AMOUNT DUE TO SELLER 201 Deposit ar Earnest Money 2000.00 501 Excess deposit 202 New Mortgage Amount; USAA Federal Savings 89600.00 502 Settlement charges 7045.40 203 Existing loans takliln SUbjlilct to 503 Existing loans taken 20. SO, 0.00 205 Application Deposit 350.00 50S 20. 50. 207 507 Adjustments far items unpaid by seller SO, 210 Local Taxes to 18-Nov-02 0.00 Adjustments for items unpaid by Seller 211 Asslilssments to 510 Local taxEls 18-Nov-02 0.00 212 School Tax8s to 18-NoY-02 0.00 511 Assessments to 215 512 School taxes to 18-NoY-02 0.00 216 513 217 514 220 TOTAL PAID BY BORROWER 91950.00 520 TOTAL REDUCTIONS SELLER 7045.40 300 CASH FROM/TO BORROWER '00 CASH TO/FROM SELLER 301 Gross amount due from borrower 117711.55 .01 Gross llmount to seller 113715.59 302 Less amounts paid by/for borrower 91950.00 .02 Reductions to seller 7045.40 303 CASttfROM Cl"OF BORROWEA: .. $25,761.55 60~<CASHTO(fROMFSe;~lER: $106,670.19 I have carefUlly reviewed the HUD-l Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or on my behalf and I have received a copy of t(;:J HUD-l for my r:;c~rdl~_ ---'Is.;I.fJJ:!':'Q~JL !f(:L~~_______ ~~~:~~~~~~A~~~L~ ~___ PAGE #2 HUD DISCLOSURE/SETTLEMENT STATEMENT PAID BY BORROWER PAID BY 'SELLER 700 TOTAL REAL TOR'S COMMISSION 5% X $113,000.00 5650.00 701 Listing Agency: ERA-NRT, Inc, $5650.00 702 Selling Agency: 703 Transaction Fee: ERA-NRT, Inc. 100,00 100.00 800 ITEMS PAYABLE IN CONNECTION WITH LOAN 801 Origination Fee USAA Federal Savings Bank 0.00 802 Loan Discount USAA Federal Savings Bank 803 Appraisal Fee USAA Federal SavinQs Bank 145.00 804 Credit Report USAA Federal Savings Bank 11.25 805 Processing Fee USAA Federal Savings Bank 400.00 806 Document Preparation Fee 807 Flood Certification USAA Federal Savings Bank 17.00 808 Tax Service Fee USAA Federal Savings Bank 85.00 809 Application Fee POC $350,00 USAA Federal Savings Bank POC 810 Overnight Mail Charges: Duncan & Hartman, P .C. 0.00 0.00 900 ITEMS LENDER REQUIRES TO BE PAID IN ADVANCE 901 Interest @ $13.69/day from 18-Nov-02 to 01-Dec-02 177.96 902 Mortgage insurance 903 Hazard Insurance 904 1000 RESERVES DEPOSITED WITH LENDER Escrows collected: # mos. due: X $ per mo.: 1001 Hazard insurance 0 0.00 0.00 1002 Mortgage insurance 0 0.00 0,00 1003 County/Local taxes 10 18.70 187.00 1004 School taxes 6 89.29 535.74 1005 Aggregate Adjustment (Inltltal Escrow Deposit $648.00) -74.74 1100 TITLE CHARGES 1101 Settlement or closing fee: 1102 Abstractor title search: 1103 Title Review: 0.00 0,00 1104 Title insu rance binder: 1105 Document preparation: 1106 Notary fees: Notary 10.00 1107 Attorney's fees: Irwin, McKnight & HUQhes 0.00 POC (includes above item numbers): 1108 Title Insurance: WILLIAM A. DUNCAN, AGENT FOR FIDELITY NATIONAL TITLE 1123.75 (includes above item numbers):l 101-1104 End 1003008.1 Condo $200 1109 Owner's coverage $113,000,00 $923.75 1110 Lender's coverage $89,600.00 1111 Insured Closing Letter Fidelity National Title 35.00 0.00 1200 GOVERNMENT RECORDING AND TRANSFER CHARGES 0.00 1201 Deed 38,50 Mortgage 74.50 113.00 1202 Release/Satisfaction 0.00 Assignment/Stip 0.00 0.00 0.00 1202 County/Local transfer tax (1 %) 1130,00 1203 Pa. State transfer tax (t %) 1130,00 1300 ADDITIONAL SETTLEMENT CHARGES 1301 Re-Sale Certificate Property Management Inc, 37.50 1302 Pest/Home/Radon inspection: POC $325.00 South Central Pa Home Inspection POC 0.00 1303 Water & Sewer Reading: #010097 SMTMA 48.95 1304 Homeowners Association Fee Forest Meadow Condo Assoc. 78.95 t400TOTAUSETTLEMENtCHARGES: 3995.96 7045.40 (also entered on line 103 for Borrower; line 502 for Seller) LINDEN HALL ANTIQUES 211 OLD STONE HOUSE ROAD CARLISLE, PA 17013 717-249-1978 To: Roger B. Irwin, Attorney 60 W. Pomfret Street Carlisle, PA 17013 From: William G. Rowe, Appraiser 211 Old Stone House Rd. Carlisle, PA 17013 Re: Personal Property Appraisal Estate of Evelyn M. Brehm 108 Strayer Drive Carlisle, PA 17013 Date: October 17, 2002 LIVING ROOM Sofa/chair $110.00 Nest of stands $30.00 Lamps (3) $15.00 End stands $25.00 Vase $5.00 Round stand $20.00 TVlcabinet $50.00 Knick knacks $15.00 Occasional chair $10.00 Wall hangings (prints) $15.00 CLOSET Sweeper $20,00 Misc. housewares $40.00 KITCHEN Potslpans $10.00 Small appliances $15.00 Halls pottery $35.00 Flatware $5.00 Bakeware $5.00 Antique dishes $30.00 Misc. housewares $1000 DINING ROOM Tablelhutchl4 chairs $175.00 Mahogany stand $25.00 Upholstered chair $10.00 Antique plates $30.00 Wall hangings $10.00 Misc. housewares $10.00 BEDROOM Bedroom set - 5 pc. $150.00 Sewing machine $5.00 Brehm Appraisal 1 1011712002 Lamps Knick knacks Costume jewelry BATHROOM Hamper Bedding Pictures Towels BEDROOM Bedroom set - 3 pc. Chair Wall hangings GARAGE/PATIO Patio set - plastic Gas grill Misc. tools Lawn chairs Misc. household TOTAL $5.00 $10.00 $5.00 $5.00 $10.00 $5.00 $5.00 $125.00 $5.00 $10.00 $25.00 $15.00 $10.00 $5.00 $10.00 $1.130.00 William G. Rowe ......-............--..i-__._ _,-", Brehm Appraisal 2 J" ..I ---,. 10/17/2002 Y'l Way~qi!'Kt LOOK FOR US. WE'LL GET YOU THERE. 10/24/2002 IRWIN MCKNIGHT & HUGHES 60 W POMFRET ST CARLISLE PA 17013 ~~CG~UWa~ OCT 25 2002 The information which you requested on the account(s) of EVEL YN BREHM (Social Security Number 189-09-4755) is/are as follows: IRWIN, McKNIGHT & HUGHES Balance at Date of Death Account Ownership SOLE Name of Joint Owner, if any Date Ownership Was Established 90937806 CHECKING 04/14/99 9086.13 .10 9086.23 Account Number Class of Account Date Opened Principal Balance Accrued Interest Account Number Class of Account Date Opened , Principal Balance Accrued Interest Balance at Date of Death Account Ownership Name of Joint Owner, if any Date Ownership Was Established Additional Information Requested ~;kcl SENIOR SERVICES REP. P.O. 80x 1711. HARRISBURG. PENNSYlVANIA 17105-1711 Toll Free 1-866-WAVPOINT (1-866-929-7646) . IN YORK AREA 717/815-4500 . www.waypointbank.com Inventory of the real and personal estate of EVELYN M. BREHM deceased 1. 108 Strayer Drive, South Middleton Township, Carlisle - Sold 11/18/2002. TOTAL................. . 113,000 00 310 00 9,086 23 1,130 00 1123,526 23 I f I 2. Cash on Hand . . . 3. Waypoint Bank - Checking Account #90937806 4. Personal Property. . . . COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND 'I J 55: Donald R. Brehm and Dennis D. Brehm according to law, deposes and says that they are the Executors of the Estate of Evelyn M. Brehm late of _SO\lt~-':!i<ldlE!.t_oll_ToFI1"h!P .. ___.___~, Cumberland County, Pa., deceased and that the within is an inventory made by Donald R. Brehm and Dennis D.._Brehm, the said Executors of the entire estate of said decedent, consisting of all the personal proparty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. being duly sworn Sworn and subscribed before me, fia~~J~E~- 710 Mt. Rock Road Carlisle, FA 17013 -L2~ t2 LZd Dennis D. Brehm 301 Union Hall Road Carlisle, PA 17013 10 2002 N . Seal SICqueline L. Drawbaugh. Notary Public Carlillo Bero, Cumberland COUDlY M)' Commission Expires Aug. 14. 2003 MImIlII. Pennaylventa_atlonolNolaries 02 Day Month Y.ar Date of Death INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be attached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. -M ..c:: " ~ UJ >- 0 .." '" '" E-< .. 0; I- w $ ~ '" .... <:l .. ..... 0 >- w <( .. ;:l ::0 N a: 0.. .... '" 0 u 0; or) 0 V'I '" ... .. .. '" 0 w w pO '" C '" '" >- ..." I :r: '" .... .. .. N I- 0.. "" 0.. C I- ....J U. .. ~ E-< 0 Z -< 0 ;.: "" 0.. <:l 0 0; I u. ....J -M ..... :t: 0 .... W 0 -< w Z ;.: ,;. '" :>-< H N > Z >< - ... ~ Z 0 ,..., ..c:: c H C '" ... ~ V'I z :> ;:l 0 u .; '" U . ;.: Z w -< '" 0 ... pO 0.. UJ .." . C ... Z .. '" H - -.: ~ 0 " 0 .J> .." ... '" H " E ..! 0 - .. ~ 0 ....J U u: CD \.. /'7-?~ -7 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVlDUAL TAXES INHERITANCE TAX DIVISION DEPT. Z80601 HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEIIENT, ALLOWANCE OR DISALLOIIANCE OF DEDUCTIONS AND ASSESSIIENT OF TAX ROGER B IRWIN ESQ IRWIN ETAL 60 W POMFRET ST CARLISLE PA 17~~~ ~!i I,. -' i DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-28-2003 BREHM 10-02-2002 21 02-0952 CUMBERLAND 101 * REV-150 EXAFP Ul-llS) EVELYN M A.aunt ReMitted MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ...... iiifli=is'4j-EiC"j:jo--foY=03Y-NOT"icniF-YNHEifii'ANCrTAiri.-pjiRAisEi'-EN1:~--"Ll-oiiANCE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BREHM EVELYN M FILE NO. 21 02-0952 ACN 101 DATE 01-28-2003 TAX RETURN liAS: (X I ACCEPTED AS FILED CHANGED I~ an assessment was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect ~i9ures that include the total gf ALL returns assessed to date. ASSESSMENT OF TAX: 15. A.aunt of Line 14 at Spousal rate (15) 16. Aaount of Line 14 taxable at lineal/Class A rat. (16) 17. ~ount of Line 1~ et Sibling rete (171 18. Amount of Line 14 taxable at Collateral/Class Brat. (18) 19. Principal Tax Due TAX C RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. R..l Estat. (Schedul. A) 2. Stocks and Bonds (Schedule B) 3. Closely Held stock/Partnership Interest (Schedule C) 4. Mortgages/Notes Receivable (Schedule D) 5. C.sh/Bank Deposits/Hisco Personal Property (Schedule El 6. ~ointly Owned Property (Schedule Fl 7. Transfers (Schedule Gl 8. Total Assets III (21 (31 (~I (51 (61 (71 113,000.00 .00 .00 .00 10,526.23 .00 .00 (81 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Hisc. Expenses (Schedule Hl 10. Debts/Hartg.g. Liabilities/Liens (Schedule Il 11. Tote1 Deductions 12. Net Value of Tex Return 13. Charitabl./Gover~8ntal Bequests; Non-elected 9113 Trusts (Schedule ~) 14. N.t Value of Estate Subject to Tax (91 1101 14,095.80 3.693.88 (Ill 1121 1131 1l~1 NOTE: .00 X 105,736.55 X .00 X .00 X + INTEREST/PEN PAID (-I 237.91 AIIOUNT PAID 4,520.23 DATE 11-27-2002 NUIIBER CD001897 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. 00 = 045 = 12 = 15 = 119)= NOTE: To insure proper credit to your account, sub.it the upper portion of this form with your tax payment. 123,526.23 17.789 itR 105,736.55 .00 105,736.55 .00 4,758.14 .00 .00 4,758.14 4,758.14 .00 .00 .00 IF TOTAL DUE IS LESS THAN $1, NO PAYIIENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YOU IIAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORtI FOR INSTRUCTIONS. I /?- /y- F \.. BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIYISION DEPT. Z806Dl HARRISBURG~ PA 11128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * UV-IU1EX UP {D1~Ul AMY J MENDELSOHN RHOADS II SINON PO BOX 1146 HARRISBURG ESQ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 01-21-2003 NEAR MAN 09-21-2001 21 01-0952 CUMBERLAND 101 LESLEY E A.OUlf Renitted PA 17108 MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your 8ccountl subnit the upper portion of this forn with your tax p.y..nt. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ Rifv=il.iWEx--AFP--foFo3Y------.iij(-iNHERITANcri'Air-51'ATEHEti;:-(i"-ACCOliNT--;;..--------------------- ESTATE OF NEARMAN LESLEY E FILE NO. 21 01-0952 ACN 101 DATE 01-21-2003 THIS STATEHEHT IS PRDVIDED TO ADVISE OF THE CURREHT STATUS OF THE STATED ACH IH THE HAIlED ESTATE. SHOIIM BELOlI IS A S~ARY DF THE PRIHCIPAL TAX DUE, APPLICATIOH DF ALL PAYHEHTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PRDJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 11-11-2002 PRINCIPAL TAX DUE: .....______......______. 2,462.55 PAYMENTS (TAX CREDITS): PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 09-06-2002 WRITE OFF .00 31.09 11-08-2002 CDOO1827 .00 2,462.55 12-12-2002 CDOO1943 25.45- 25.45 TOTAL TAX CREDIT 2,462.55 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 IF PAID AFTER THIS DATE, SEE REVERSE TOTAL DUE .00 . SIDE FDR CALCULATION OF ADDITIONAL INTEREST. I IF TOTAL DUE IS LESS THAN $1, NO PAYHENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A ''CREDIT'' ICR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) STATUS REPORT UNDER RULE 6.12 (} ~~ Name of Decedent: EVELYN M. BREHM Date of Death: October 2. 2002 No. 21-02-0952 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, 1 report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: --X- 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. I is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes X 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 in interest? X Yes No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of Orphan's Court and may be attached to this report. :.J .,~ 1fl6/4103 N '''.'''<.( .. Ll. ,;;:2(f' ~ IRWIN, McKNIGHT & HUGHES Roger B. Irwin ESQuire Name (please type or print) 60 West Pomfret Street Address Carlisle. PA 17013 City, State, Zip (717) 249-2353 Telephone Number Date: CL ", ::...~, ;~ :;;:a: tr N ~ ) :z ii => -, (iJ ," ..a p .::s= "'- ~::; :;0 Capacity: X Personal Representative Counsel for Personal Representative