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Home My WebLink About01-1074 Register of Wills of Cumberland County, Pennsylvania PETITION FOR GRANT OF LETTERS E~~e~ RICHARD VINCENT BRUBAKER, III No. 21-01-1074 also known as of Silver Spri.rq 'It::Mn91ip , Deceased Social Security No. 160-70-8144 Peooone'1s). wno ISlare 18 years of age or olOer, appry(les) tor: (COMPLETE 'A' OR 'S' BELOW:) o A. Probate and Grant of Letters Testamentary and aver that Petitioner(s) is/are the exeCtlt ---,-n~ed in the last Will of the Decedent, dated and codicil(s} dated State relevant ar'CUlTWtanc.-. ..~ renunC-Ulon, c:Ioaln of uea.nor, etc. Except as follows, Decedent did not marry, was not divorced, and did not have a child born or adopted atter execution of the documents oHered for probate; was not ltie victim of a killing and was never adjudicated incompetent: I]J 8. Grant of Letters of Administration (d..b.n.c.La.; penoeme rt.,; auranle aDSefIla; ourante mnontaxe Petitioner(s) after a proper search hasihave ascertained that Decedent left no Will and was survived by the following spouse (if any) and heirs: Name Rid:ard V. l3rul::al<er, Jr. Relationshio Resioence Fatter fl.7 ~ Driw ~csturg, PA 17055 . Mckie Brul::Bker 1'-tth:r (COMPLETE IN ALL CASES:) Allad1 aadloonaJ sheets If necessary. Decedent was domiciled at dealti in C1.ntErlarrl . County, Pennsylvania, wilti hisiher last family Silver Sprinq Township ~:- pri;-:c:~a! if:;~:da~ca c;.: 47 Sycamore Drive, MechanicRburg, (lISt street, nlJrTl08r and mUllIcpaJlty) years of age, died Sept. 29, 2001 , ~ at 100 I.aJm Imd, Dillstmg, P/\ (Location) Decedent, then 19 Decedent at death owned property with estimated vaJues as follows: (If domiciled in PAl An personaJ property (If not domiciled in PAl PersonaJ property in Pennsylvania (If not domiciled in PAl PersonaJ property in County VaJue of reaJ estate in Pennsylvania $ $ $ $ ~.oo 0.00 0.00 0.00 situated as follows: Wherefore, Petitioner(s} respectfully request(s} letters in ltie appropriate form to ltie undersigned: the grant of nnted name and residence Richard V. Brubaker, Jr. 47 Sycamore Drive, Mechanicsbur , PA 17055\ FO/TTl #AW-1 Page 1 of 2 Prepared by the Pennsylvania Bar Association 1991 Oath of Personal Representative C'Jmmonwealth of Pennsylvania 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(s) of the Decedent, Petitioner(s) will well and truly mini r the estate a rdi to aw. ~ fI belaremethis 21st day a! ~ c/1~ Z ~~n ~OOI y >r ~ - RICHARD V. BRUBAKER, JR. Y '1' "JA,"<U1//~ Fa the RegIster Sworn to or affirmed and subscribed No. 21-01-1074 Estate of Richard Vincent Brubaker, III Deceased Social Security No: 160-70-8144 Date of Death: Sept. 29, 2001 AND NOW, NOVEMBER 26 ,X1a 2001 ,in consideration of the Petition on the reverse side hereon, satisfactory proof having been presented before me, IT IS DECREED that Letters 0 Testamentary U Of Administration cUl.n.c.u..; ;:>onoeme lite; durallta aosentJa; aurante mlnonUle are hereby granted to Richard V. Brubaker, Jr. in the above estate FEES Letters ..................... $ 18.00 Short Certificate(s) .... $ 6.00 '>pu'r(l~<~fJfu~~e J~uy R Istar Of lis Renunciation ............ $ 5.00 Attorney: Marvin Beshore Affidavits ( ) ............. $ Extra Pages ( ) ......... $ Codicil ...................... $ JCP Fee ................... $ 1.0. No: 31979 130 State Street; P.O. Box 946 Harrisburg, PA 17108-0946 (717) 236-0781 Address: 5.00 Telephone: Inventory .................. $ Other ....................... $ TOTAL ............. $ 34.00 PQ - (" 3~ g"""". ....,,~; " n~ 5. ~ N --" d --" ~l tC! 0 ~ff ~, FOITTI #RW-1 Page 2 at 2 Prepared by the Pennsylvania Bar Association 1991 -0 VJ i..i1 -J H 105.805 REV 9/86 This is to certify that the information here given is correctly copied from an original certificate of death dul~ filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 p 7742931 {.~~?;. ...',- ..{' ?"; .-i--~"I! ,.. /.> /1 !/.: 6't' 1~.J6 ...../1 d-----, ,~" -:.,.." I" ~j. .-c;t-..,. ~- Local Registrar , OCT 0 2 ZOO1 No. Date 21-01-1074 105.144Rev.1Il11 T COMMONWEALT" OF PENNSYLVANIA · DEPARTMENT OF HEALTH. VITAL RECORDS CERTIFICATE OF DEATH (Coroner) T NAMe OF DECEDENT (FirII. -.loot) 1. Richard Vincent Brubaker AGE CLoolBifthdoI1 UNDER 1 YEAR UHIlER 1 OM - Iloyo Houro _ I. male .. 160-70-8144 PLACE OF DEATH lC'*" only <>no - _ _ucloonson _ _) HOSPITAL; OTHER: Inpotlonl 0 :::a 0 York NT' ION ~...=aol~,=,~.,. x SlATE FILE NUMBER SOCIAL BECURITY NlJM8ER 1 DECEDENT'S IlAlUNG ADDRESS (SIr.... CiI){bon. _. ZipCodo) 160 Logan Rd.. Apt 4D Dillsburg. PA 17019 lL _R'S NAME IFni. ~ loot) 1'. Richard Vincent Brubaker Jr. INFORMANT'S NAMe (Typo/Prir<) Richard Vincent Brubaker. Jr. MrnlOO Of' DISPOSITION -iii eron.-o -....._.0 0IIw lSPociIyI DECEDENT'S ACTUAl RESIDENCE (500_ 011__' 17.. .,. MARITALSTRUS.""'" ~~ 1 ever Married 17.XJ....__ln r.""'1Cnl 'I't.,p "'P. 1'/b. York Did - Min. -..p? - COroner 11M CASE REFERRED TO MEDICAL E ...Xl II 'Ajlpn>- :inlemI between fonMllnd death r MATH: OIhor~_contrlbuIlnglo_.buI not......1ng In... u-..ytng _ givon In PAAT I. TIME 01' l"'JURY INJURY R WOfU(7 DESCRf8E HOW INJURY OCCURRED. '~AND~-(Phv-._lJrOIl<lunCIng__~Io__"'_1 ro...-...""..-..--.....-._._.....__to...._l__.._... ....... ............... 'IIEIIICAL~R OIttlle_of_ _orlnvwllgatlon.1n "" opInton. __.. tllellme. _. _...-. --lOtllecauoo(O)_ -..-................................................................................................. . 11.. REGISTIWI'S _AND NUMBER ... ~Al/ /"JP;:J ~ '.~.~ \::lI'Vf"1'I/( I ... ~ Register of Wills of CUMBERLAND County, Pennsylvania RENUNCIA TION Estate of RictBrn viI'x:a1t Brul:al<er, m No. 21-01-1074 also known as late of Silver ~ '1't:MrS1ip , Deceased The undersigned, vickie Brul:Bker of Silver ~ 'b.nSlip hereby renounces the right to administer the estate and respectfully requests that Letters Adninistratirn be issued to RidmU V. BnLb:lker, Jr. Witness my hand this day of ,2001 ~ .6~~-,,-_ (Name) VICKIE BRUBAKER 47 Sycamore Drive Mechanicsburg, PA 17055 (Address) Sworn to or affirmed and subscribed before me this day of ,200 Notary Public My Commission Expires: on ,... _.. =~ ::S A' 0" ' 0) .., rii ~ CJ d - :na? Cl>O r,c'} 0 ".-. """"I: ~~.j' ::':; ~ N - F:\DOCS\EST A TES\FORMS\Renunciation :-0 (. ).:. :~.:l -0 I..J i.J1 o / CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Richard Vincent Brubaker. III Date of Death: September 29.2001 Will No. Admin. No. 2001-01074 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on February 26. 2002 Name Address Richard V. Brubaker. Jr. 47 Sycamore Drive. Mechanicsburg. PA 17055 Vickie Brubaker 47 Sycamore Drive. Mechanicsburg. PA 17055 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except -_./ NONE ~~. ~~ Sig ture ' Name: Marvin Beshore State I.D. #31979 Address: 130 State Street. P.O. Box 946 Harrisburg. PA 17108-0946 Telephone (717) 236-0781 Capacity: _ Personal Representative _X_ Counsel for personal Representative Date: 5/2.2/02- N i....',.' o -- t' "+ .... ........~ ...J] ru ?"- M Postage i $ Certified Fee I Return Receipt Fee Ll1 (Endorsement Required) ru CJ CJ Ll1 tT" Ll1 M Restricted Delivery Fee (Endorsement Required) CJ CJ ...J] CJ Total Postage & Fees $ CJ CJ CJ -Ci;y,-Siiiie,-Z(p:;:r-------- oooo_m oooo____m_ - -- -- ---- I"- .J/-OI SENDFR: COJdPLETE THIS SECTION . Complete items 1, 2, and 3. Also complete item 4 if Restricted Delivery is desired. . Print your name and address on the reverse so that we can return the card to you. . Attach this card to the back of the mail piece, or on the front if space permits. 1. Article Addressed to: MARVIN BESHORE ESQ 130 STATE ST PO BOX 946 HARRISBURG PA 17108-0946 2. Article Number (TIansfer from service label) PS Form 3811, March 2001 -~ i "-1 -~ tt'il;;' - . --- _1 th ...(.,. -roo iUh 111'11'lilt ---.-..- .-.-.- : L St~r,!j. I'! Type 1:1'c;e .ti'ied M.ll [J fie :!i~;tered _~~~:.: I~ed M~!_ D Express Mail D Return Receipt for Merchandise DC.O.D. '. HE.S:ri :t'ld Del" ery? (Extra Fee) Dyes 700() - Din illL~ll~'~ Domestic Roturr nnceip1 -, f,19CJ J7~b 102595-01-M-1424 " " JRD/June 30, 1992/17858 .. f"W APR 1 1 2002 ./ In Re: Estate of RICHARD VINCENT BRUBAKER: ORPHANS' COURT DIVISION Late of COURT OF COMMON PLEAS OF CUMBERLAND COUNTY Estate No.: 21-01-1074 PENNSYLVANIA NO. NOTICE OF FAILURE TO FILE CERTIFICATION AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 5.6(e), SUPREME COURT ORPHANS' COURT RULE Personal Representative: RICHARD V BRUBAKER JR Counsel for Personal Representative: MARVIN BESHORE ESQ Date of Grant of Original Letters: NOVEMBER 26, 2001 Date of Delinquency Notice: MARCH 8, 2002 The undersigned, Mary C. Lewis, Register of Wills, in accordance with Rule 5.6, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its certification required by Rule 5.6(e), Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 5.6(e), Supreme Court Orphans' Court Rules, was given by the Register of Wills on MARCH 8, 2002, and that the ten (10) day notice to file the certification has expired. Accordingly, in accordance with Rule 5.6(e) the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Date: APRIL 10,2002 , illSfJm~. Distribution: Personal Representative Counsel for Personal Representative Estate File A hearing is scheduled for ( Certification of Notice is filed cancelled. ( .?At 9 :11J.&Ji} Courtroom No.3. If the 'or to the hearing date, the heari g will automatically be t 'It- r". ~ \' " Ii! 6;J,i..'.I.,1 ("- ":11, gL'I" ru ..0 <tl Ll'I ..0 Re' l' 0 (Endors e 0 Restric I 0 (Endors e' o ..-=l Ll'I ru Total I , st, Sent TQ. '~1 /I/i_(/,,; ..-=l 'Stre,'-C I " I o orPOE' Ii /- o ("- 'city:si ' ~ I', .' I' .. I:Ji It II ?-t '~'11 ; ill :li 11. II Hi s 1, 2, and 3. Also complet,. 'ctad Delivery is def.,reC e and address on the r>1\'8',.',' return the card to you d to the back of the mailpi'Y, if space permits. V &~u.'!- l.J. t- flVl..-RRY:.~ 9'1', "'J I fJtt-, /7/ C' y~ './ , "I"" 1t dt 1 l II- I, i~<.t-N\/,." :. 'r U H .--1 : I i i I Li=::;=::::::=':::~:::= : :'" S(;f'ViCf~ f'FS, lyt,:~,. :,1 11 [:" H:l::'~~i:S'i~:"li [:. 11I1Sl.we,J M a__MII Cl "-'n.... for M.td... a c.o.o. " /1 (EdIt FIlII} 12 Cer:lh,j'. Ii 11'..stricIEd ? (J U 1. ,::'!i ::.1 'Jl IJ IJ I: !'1 i~, 00 b 7 0_ [j'Jl11:-':iti: rleturr I::(e'cipt I 1.H~' " ... JRD/June 30, 1992/17858 OCT I] 6 2003 ~ ~ Estate No.: 21-2001-1074 ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA In Re: Estate of Richard Vincent Brubaker, III Late of Silver Springs Township NO. 21-2001-1074 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE Personal Representative: Counsel for Personal Representative: Marvin Beshore Esquire Date of Decedent's Death: 09-29-2001 Date of Delinquency Notice: 08-01-2003 The undersigned, Donna M. Otto, Register of Wills, in accordance with Rule 6.12, Supreme Court Orphans' Court Rules, hereby notifies the Orphans' Court Division, Court of Common Pleas of Cumberland County, that neither the above named personal representative nor the above named counsel for the personal representative have filed with the Register of Wills or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court Orphans' Court Rules, was given by the Register of Wills on 10-06, 2003, and that the ten (10) day notice to file the Status Report has expired. Accordingly, in accordance with Rule 6.12 the Court is hereby notified of such delinquency and the undersigned requests that a Court conduct a hearing to determine whether sanctions should be imposed upon the delinquent personal representative or counsel for the delinquent personal representative. Distribution: Personal Representative Counsel for Personal Representative Estate File Date: 10-06-2003 1?~r-03 9;3,jA/If. A hearing is scheduled for at in Courtroom No.3. If the Status Report is filed prior to the hearing date, the hearing will automatically be cance ed. ,/iJ " \~) \)~ [// tJ~ STATUS REPORT UNDER RULE 6.12 Name of Decedent: Richard Vincent Brubaker, III Date of Death: September 29, 2001 Will No.: Admin. No.: 2001-01074 Pursuant to Rule 6.12 ofthe Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration ofthe above-captioned estate: 1. State ~ether administration of the estate is complete: Yes If:i' No 0 2. lfthe answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. lfthe answer to No.1 is Yes, state the following: a. Did the personal r~resentative 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 !spresentative state an account informally to the parties in interest? Y es ~ No 0 ~. Date: ~. c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed with the Clerk of the Orphans' Court '2- and may be attached to thi14rep [t. _~ rz, 2003 _tA:J ~ S gna e Marvin Beshore, Esquire Name 110 ~:::t~;:!t"" St , H;:!rrie1:)11rg. PA 17101 Address 717-236-07Rl Telephone No. t- '1.,'0' 0~ \ Capacity: 0 Personal Representative ~Counsel for personal representative BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX OIVISION 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 * REV-1547 EX AFP (06-05) .", , " COUNTY CUMBERLAND MARVIN BESHORE ESQ ACN 101 130 STATE ST APPEAL DATE: 06-08-2007 PO BOX 946 ( See reverse side under Objections) HBG PA 171 08 Allount Rellittedl I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE ..... RETAIN LOWER PORTION FOR YOUR RECORDS +-- ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRUBAKER RICHARD V FILE NO.21 01-1074 ACN 101 DATE 04-09-2007 TAX RETURN WAS: ( X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN I. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, .00 submit the upper portion 3. Closely Held Stock/Partnership Interest (Schedule C) (3) of this form with your 4. Mortgages/Notes Receivable (Schedule D) (4) .00 tax payment. 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (S) .00 6. Jointly Owned Property (Schedule F) (6) .00 7. Transfers (Schedule G) (7) .00 S. Total Assets (S) .00 APPROVED DEDUCTIONS AND EXEMPTI ONS : 344.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) ClO} .00 II. Total Deductions (ll) 344.00 12. Net Value of Tax Return Cl2} 344.00- 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) Cl3} .00 14. Net Value of Estate Subject to Tax Cl4} 344.00- NOTE: If an assessllent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of !b.b. returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate ClS} .00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate ClID .00 X 045 = .00 17. Amount of Line 14 at Sibling rate Cl7} .00 X 12 = .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due Cl9}= .00 TAX CREDITS: PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) TOTAL TAX CREDIT .00 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 .. IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. ~ FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE D A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . - I) C~ ," 1 I : t-: J DATE ESTATE OF ,',r- DATE OF DEATH n~ FILE NUMBER v 04-09-2007 BRUBAKER 09-29-2001 21 01-1074 RICHARD V . T Of ....J 15056051058 REV-1500 EX (06-05) PA Department cI Revenue '* Bureau of Individual Taxes PO BOX 280601 HaIrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death INHERITANCE TAX RETURN RESIDENT DECEDENT OFFICIAL USE ONLY CotIlty Code Year 21 01 File Number 1074 Date of Birth 160-70-8144 09/2912001 03/04/1982 Decedent's Last Name Suffix Decedent's First Name MI Brubaker III III Richard v (If Applicable) Enter Surviving Spouse's Infonnatlon Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW <aJ 1. Original Retum 2.Su~men~IR~um <=:) 4. Limited Es~te c:::::l 48. Future Interest Compromise (date of death after 12-12-82) c:::::l 7. Decedent Main~lned a Living Trust (Attach Copy of Trust) c:::::l 10. Spousal Poverty Credit (date of death C) 11. Election to m under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. 0) CORRESPONDENT - THIS SECTION MUST BE COMPlETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORIIATION 8HOULD BE D1R~D TO: Name Daytime T~~ber ~ . :-Tl ~~g Marvin Beshore, Esquire (717) 236-078i;g i;; ~}8 8 ) -r ("") Z ,'~7-S .:XJ Firm Name (If Applicable) ~.. '-'REG'STERci;~lISE<my ~~~! 29 '~~j ~: ~.(~~? 0 .,).-') -0-, i --1 ~; ~ --n ::z: :=~ i:J ..0 :l:J - ....0 ~~-1 ~ ;~~S N I{ N c::> 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Tax R~um Required c=:) 6. Decedent Died Testate (Attach Copy of Will) C::) 9. Litigation Proceeds Received o 8. Total Number of Safe Deposit Boxes First line of address 130 State Street Second line of address P.O. Box 946 City or Post Office Harrisburg S~te ZIP Code DATE FILED PA 17108-0946 Correspondenfs e-mail address: Under penalties of perjury, I dedare 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. DecIaratlon of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE ADDRESS S__TU~THER~TM ADDRESS DATE PLEASE USE ORIGINAL FORM ONLY L 15056051058 Side 1 15056051058 -...I -.J 15056052059 REV-1500 EX Decedenfs Name: Richard V Brubaker III 160-70-8144 Decedent's Social Security Number RECAPITULATION 1. Real estate (Schedule A). ............................................ 1. 2. Stocks and Bonds (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . . . .. 3. 4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . .. . . . .. 5. 6. Jointly Owned Property (Schedule F) Separate Billing Requested. . . . . .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Separate Billing Requested. . . . . . .. 7. 8. Total Gross Assets (total lines 1-7). .. . . . .. . . .. .. .. . . . . . . . .. .. .. . . . . . .. 8. _"".''''''__,'>>''''''',oo._,,_,._.........,.,,='_m'___'''=-''''''_=~~_,~~___,_,'_~,~_'"_''''_~__"__,_,___",,._'''___''",'''''''''''''_~~ 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). . . .. . .... .......... '" ..... . ... . . . 11. 12. Net Value of Estate (line 8 minus line 11) . . . . . .. . . . . . . .. . . . . . . . . . . . . . . . 12. 13. Charitable and Governmental BequestslSec 9113 Trusts for which an election to tax has not been made (Schedule J) ........ . . . . . . . . . . . . . . . . 13. 14. Net Value Subject to Tax (line 12 minus line 13) .. . . . . . . . . . . . . . . . . . . . . . . 14. TAX COMPUTATION. SEE INSTRUCTIONS FOR APPUCABLE RATES 15. Amount of line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 15. 16. Amount of line 14 taxable at lineal rate X .0_ 16. 17. Amount of line 14 taxable at sibling rate X .12 17. 18. Amount of line 14 taxable at collateral rate X .15 18. 19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT L 15056052059 Side 2 0.00 0.00 0.00 0.00 0.00 0.00 0.00 0.00 344.00 0.00 344.00 -344.00 0.00 15056052059 c::) -I REV-1500 EX Page 3 File Number Decedent's Complete Address: ! 21J [~01J1074 DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUt/BER Richard V Brubaker III 160-70-8144 STREET ADDRESS 47 Sycamore Drive CITY I STATE I ZIP Mechanicsburg PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount 0.00 Total Credits ( A + B + C ) (2) 0.00 3. InterestlPenalty if applicable D. Interest E.Penalty TotallnterestJPenalty ( D + E ) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. All in oval on Page 2, Une 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Une 2, enter the difference. This is the TAX DUE. (5) 0.00 0.00 A. Enter the interest on the tax due. B. Enter the total of line 5 + SA. This is the BALANCE DUE. (SA) (58) 0.00 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... 0 . ~ b. retain the right to designate who shaH use the property transferred or its income; ............................................ 0 ~ c. retain a reversionary interest; or.......................................................................................................................... 0 [i] d. receive the promise for life of either payments, benefits or care? ...................................................................... 0 [i] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. 0 ~ 3. Did decedent own an rill 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 ALE IT AS PART OF THE RETURN. 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 three (3) percent [72 P.S. S9116 (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 zero (0) percent [72 P.S. S9116 (a) (1.1) (ii)]. The stab.rte does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retlm 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 zero (0) percent [72 P.S. S9116(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 four and one-half (4.5) percent, except as noted in 72 P.S. S9116(1.2) [72 P.S. S9116(a)(1)J. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. S9116(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. . . ......,... EX. (....) .. COMMON\l\lEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULI I CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Richard V. Brubaker, III FILE NUMBER 21-01-1074 ITEM NUMBER Include the proceeds of litigation and the date the proceeds were received by the estate. All property jolntly-owned with right of survivorship must b. disclosed on Schedule F. DESCRIPTION NOTE: A death benefit was obtained from the decedent's employer. In order to obtain this death taxable value for this benefit. benefit, an estate needed to be opened. This was the only reason for opening an estate. There is no TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) VALUE AT DATE OF DEATH 0.00 0.00 REV-'S11 EX+ ('2-991* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ICHIDULI H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Richard V. Brubaker, III FILE NUMBER 21-01-1074 Debts of decedent mUlt be reported on Schedule L ITEM NUMBER A. FUNERAL EXPENSES: 1. DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representallve(s) Social Security Number(s)/EIN Number of Personal Representalive(s) Street Address City _ State Zip Year(s) Commission Paid: 2. Attorney Fees 300.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State . Zip Relationship of Claimant to Decedent 4. Probate Fees 34.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Filing fee to Register of Wills, Cumberland County for Inheritance Tax Return and Inventory 10.00 TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets ot the same size) 344.00 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO lOX 210601 HARRISIURG PA 17121-0'01 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE , ':!',[i~ciiJ:~(:~F"INHERITANCE TAX APPRAUEMIiNT iA,LLOWANCE OR DISALLOWANCE OFDEI!lUCTIONS AND ASSESSMENT OF TAX '* REV-1547 EX AFP (0'-05> MARVIN BESHORE 130 STATE ST PO BOX 946 HBG 2001 APR -9 Artll: 50 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CLER!< OF ORDf-!.l~,;. I'e:. ''''('l.J'''T I I !' \i \ d \J\) ill f'11\.lf':I'-'"' ...."..\ 0.\ v~..... ' . i i-l. 04-09-2007 BRUBAKER 09-29-2001 21 01-1074 CUMBERLAND 101 APPEAL DATE: 06-08-2007 ( See reverse side ""der Objectio"s) A.ount Re.1ttedl I MAKE CHECK PAYABLE AND REMIT PAYMENT REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 RICHARD V ESQ PA 17108 TO: CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ..... ------------------------------------------------------------------------------------------- REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRUBAKER RICHARD V FILE NO. 21 01-1074 ACN 101 DATE 04- 09-2007 T AX RETURN WAS: (X) ACCEPTED AS F I LED ( ) CHANGED lESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED 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 S) 8. Total Assets 0) (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 .00 .00 .00 (8) NOTE: To insure proper credit to your account, subMit the upper portion of this form with your tax pay.ent. .00 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) 10. Debts/Mortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (0) 344.00 .00 (1) (2) (3) (4) 366 nn 344.00- .00 344.00- NOTE: If an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. AMount of Line 14 at Spousal rate (15) 16. AMount of Line 14 taxable at Lineal/Class A rate (16) 17. Amount of Line 14 at Sibling rate (17) 18. Amount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X DO .. .00 .00 X 045. .00 .00 X 12 .. .00 .00 X 15 .. .00 (19).. .00 AMOUNT PAID DATE NUMBER + INTEREST/PEN PAID (-) TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE .00 .00 .00 .00 * IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN .1, NO PAYMENT IS REQUIRED. O-b IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE D A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.) . ---'~