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01-0352
PETITION FOR PROBATE and GRAS tNTr~O~F/~LETTE~7RS Estate of L~''crrt t4-rt-l~ iS. P~(L~m P~Av~ tl No~ _ 111 -" l/iL' l> ( " 3 ~ L also known as {~~~ To: at Deceased. Social Security No. ~ t -t - 1 a ~- to 23) The petition of the undersigned respectfully represents that: in the Your petitioner(s), who is/are 18 years of age or older an the execut~Q named in the last will of the above decedent, dated Av b,iy-T ra , 9 Z 7 , 19 and codicil(s) dated LL-n.) Gzc.rt~ Ry.{~}-u~ 1 ;7 ~2s v~ ~'~rr~M~ ~vvJ t s 4 c~ (state relevant circumstances, e.g. renunciation, death of executor, -etc.) Decendent was domiciled at death in t'_~ ~,,,~ F5~/t G~.~-~ County, Pennsylvania, w h h }S last family or principal residence at 'tt g E. K ~~~ 6 s- 3ij, p/r s g~,~U ~~ (list street, number and muncipality) Decendent, then_ ~~ yeas ~f aQe_ (a,, s died S~ Register of Wills for the County of e~.~~~,/3~-21sa-~,.~ Commonwealth of Pennsylvania 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: Decendent 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 doticiled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: loon • cac~ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters -r~-S na..s_r„~ t--a.,~,~~ theron. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) y L U C _~ .~ VI ~/ ~ ~ tG ~~' _~° ~ a ~e Na ~ ~ v ~. ~° c COMMONWEALTH OF PENNSYLVANIA COUNTY OF cvtit ~3~->~~,,, OATH OF PERSONAL REPRESENTATIVE S3 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 represen- tative(s) of the above decedent petitioner(s) will wel ruly ad inist the es a according to law. Sworn to r a ed~~1subsc be ofs ~• bV~iaL-L e h to a 0 R iste y No. z-l ~" ~ ~ -3.~ Z Estate of ~~ ovt ~~ ~ ~ ~'""' ~ ~" ~ ,Deceased DECREE OF PROBATE AND GRANT OF LETTERS _ Ll~ AND NOW ~ tl ~` a ~~ ( 19 , in consideration of the petition on the reverse side hereof, sa isfactory proof having been presented before me, IT IS DECREED that the instrument(s) date described therein be admitted to probate and filed of record as the last will of / „~'' ~~ ~` rw m c~-t. ~ , and Letters J n`^" ~` are hereby granted to 'Z' ~-t~~"n' ~" ~ S ` d i f FEES Probate, Letters, Etc......... . Short Certificates(I) ......... . Renunciation \~ , ... TOTAL Filed ............... //'~ $~~U~ $ ~~~ $- 1 . ____'~, ~--, r ~~ ~ ~~~ ~ , v~ y~ ~~ Register of Wills ... ATTORNEY (Sup. Ct. LD. No.) a~ ~~02; ~ 3 z~/a s-. e-.4-~.-c P P,"4 i "7c~ t Z~Z-73"7-~4~~ PHONE ~1~it~ Q.~.c~ ~; ~r~~~ti t ..~~ -~7 -.~~ z codicil (each) a subscribing witness to the will presented herewith, (each) being d law, depose(s) and say(s) that / fied according to . present and saw the testat ,sign the same and that request of testat__ in l~_ presence and other subscribing witness(es)). / Sworn to or affirmed and me this 'before day of 19. Register REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS (Name) (Address) (Name) (Address) REGISTER OF WILLS OF Cvrh ~~~-~-/, COUNTY ,~ OA~'H OF NON-SUBSCRIBING WITNESS IZiu-M~z.~ Sc.aT~ 17C~3~~-e4-t~ ScaTT (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that n{~' y familiar with the signature of L E~'~ ~''~-~ ~~ ~2~ra ~S,~c~G t $ ~odie~l testa vt ~ of (one of the subscribing witnesses to) the will presented herewith and codicil that T7}c y/ believes the signature on the will is in the handwriting of LL'vr ~a-n~ (~ h 2u h.c /~~Csc1 me this ~„1,~..r;l,e,a tiec,..e / signed as a witness at the presence of each other) (in the presence of the ~uC O~D S~ „n„nj ~ame~~~i~'~1T1~ (Address) I7~~r to the best of c' «+Z.~ knowledge and belief. ,, /~ Sworn to or afr;r,,,a.~ ~n~ ~,L,t^~.1T.~'Y ~ ~.1',~/~.~ RENUNCIATION In the Estate of Leonard Brumbaugh, deceased. To the Register of Wills of Cumberland County, Pennsylvania. The undersigned, Diane Scott, of the above decedent, hereby renounces the right to administer the estate and respectfully asks that the Letters Testamentary be issued to Richard Scott. WITNESS hand this day of , 2001. DIANE SCOT 11 Kevin Road Mechanicsburg, PA 17050 i!!o5sas !ie/ ~ii~~ This is to certify that the informatio~~ given is correctly copied from an origin tificate of death duly filed with me as Local Registrar. The original certificai~ill be forwarded to the State Vital Records tce for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 P 6715574 oca gistrar ~o~ Date No. 9TA1F F0.E WYS[R NAME OF DECEDENT Px>v. Mrfaa,LaR1 SEX SOCIAL SECURITY NUMBER DATE OF OEATN,MCrM. Oa•. Mrl Leonard B. Brumbau h E•Male ~• 217 - 10 -6231 '•07 08 2000 AOE rtw 9+MAY) UNDEP 1 YEM UNDER 1 DAY GATE OF SNRN SSRNPIACE IGIy aN1 PUCE OF DEATH (Cnacw ony nna-- w ~nmuclorn nn umal •aN __ _-__ . -_ E,~,N ( D•T• „~, I „~~ ~MOnM.ON hl•I SMtlpFpaAln l'dnary) DTNER: IIDSPRAL: _ 12/08/ 1912 Bedford County Y InpMNIR^ ERpMpFINN ^ ow^ ,e"'"~'0,. ~ ,,.,,,.,,~^ ,.""p,TM,^ N, 81 ,. ., ,_ Woodbur PA F.. DOUNTY Of DERN CRY. SOFq. TWP OF DEATH FACET' NAME IA np mNTAlan, pva W Na ano nMnbw~ WAS Dry1-EECEDENT QF NISPANX:ORIGINi No LR 1M^XY•••Fp•cAy CI~UAn RACE . Amalcan Inban. llY[n, YMaa. alc ISP•cMl IE~Cumberland wMiddlesex Tw Claremont Nurs' & Rehabilitation Center , M"P°"'PIN"°RN'A'~` I0. White ~ DECEDENT'S USUAI OCCUPFEION RIND OF SU9INESSIINDUSTRY VSIS DECEDENT EVERW ARMEDfORCESi U S OECEDENT'S n EdJCIEIDN MARRAL 9TATU8-MnntlO Nmiar ManaM WgfwaO SURYMND SPOUSE In wN o^~•mwrnrwrl IGr•M•tlM ~, ~y ~npl,N„ i d+NEAq NA;mnR Ur rmaPiraal . . Yy® Nn^ ~ , , C•Fapa ONadEISPacM . „Mechanic ,,,~.etterke Arnry Depot ,E, ,x ~'~' 9 "'a5" „Widowed ,,, UECEDEM'S MAEXiD ADDRESS ISbaaL Cay/hw1,SYtl. Zq GOOa1 DECEDENT'S Penns lyanla Y ^ i MF. m[aSFIII EYpEwL_ nv OM th. ACTUAL tfw Sl.tl 418 E. King Street ~ ~ °, ;'„°;' Shippenaburg PA 17257 ' ~ ,, Cumberland '°""'"~T Shipyenabur>; ""N~ h~ ~ ~ , ,~ ,,.• „~ d1yAlbe Fn MFM i FAT14R'S NAME IFirr. MqW. LMR MOTHER'S NAME IF~N. MpW. MAMNn SMwrtll ' !,E-Alva B. Brumbaugh ,~,Nanc L. Bennett INFORMANT'S NAME RrPNP'V•1 INFORMANT'S MAENNi ADDRESS ISWNI. CAyROwn. SMtl, ZOCOm1 Gary Brumbaugh 1603 Myrtle Avenue, Camp Hill, PA 17011 METHOD OF dSPOSITMkF DATE OF 019POSRM]r1 PUCE OF D44POSRION-Name al CalrlMary,DNmMaly LOCATION-Ciy/TOaR, sIw.2locnaF i ^ R MYa &w^ ! S r 1~ C •o.r.wtll o.atlR aMw raIIlM on aRInn n v ~ DaltlYSn^ OYtlrlS,tlcFFI „~ ,,,,07/12/2000 re.Fairview Cemeter Eu.Mann Tw Bedford Co. PA SERVICE NO AB SUCH LICENSE NUMBER NAME ANO AOORESSOF FACILRY , ~,• O 1 1776-L ,~ el er•Bricker F.H. PO Box 336 Shi nsbur PA 17257 (,an~MaAanp only Mlan oaNl/yVls LICENSE NUMBER DdE 516NED N Ane pIFCF M FMe. 1 1 M Um• , M Allla pNaWmy4mwlaopa,mwaccurM 1 PIIF•n:l•n• as INwnwum.amwna / ~ /~ - I / ~ ' ~ p •.na ~nN m / ) !J•-~K QA-vPt/ /'(/v l1 . 1 _ ` IMmMt D•Y.'Mrl I ,,.. iCJ~ ~yts9b „F.on-o8-aooo Mama 241A mlNl oa mnlPl•I•o bF NFE OF DEATH GATE PRONOUNCED DEAD IMOrxn. Dsy. warl VM9 CASE REFER orf on Ne pMq+ICM OFMII RED ID MEDICAL EIUMINERICORONERi . 1 27. MRT 1: EnNIIM Oia1a•N. MIIInIMpcpndkNronaa1111c11 GUDaoIM OaAIn DF nn1 MIN IM ntlm oyHp,f as uroiacpraapxslP7 MraN, FAOCMp MNIAilura IAppoaNntla XaarVNOanvaan MRT p: dn.raXFllncw mllUYpla NlanEIAAInQbbAm. elA nol muX4pnmtl ptlRMnp caw Oryan aI PARTI I 4al payana calM On aAtllWtl. 1 dNN Artl Utltl1 I MRlDIATE CADS[ (Fnal 1 aa.na.peptlaon LI,,,,f4 tA..,IC-EQ CoPD DUE TON71 AS A CONSEQUENCE OFI: s l E X aXN e 1 waall IN .aarla F y naI1,I Me•Istl nltll.ew DIIE iOIai ASA CONSEQUENCE QFy. -- 1 Malt. EnW UNDGLYSq ~ xMF alaiNaE avant OIIE TOpR AS A CONSEQUENCE Of): I ~wxrrq m IN•ml WT e. WAS AN AUTQPSY WERE AUIOISY FINDVIOS _ MANNER OF OEATN GATE OFIWURY---- /IME OFIWURY IFUIIRY AT WgWfi DESCRNIE IgWINJURY OCGURREU PTRFORYEDi AWIASLE PRIOR IO IMOnm.fNry >Ma•I ' C ~E~N7N OF CAUSE NwrN ~ IbmitMF ^ Yaa ^ No ^ Aee+mrA ^ PanOYq MraaopMbn ^ M Mla ^ FFa® Nla ^ Nn ® 9ukloa ^ CauleM MtlalanNNtl ^ . PUCE OFINJQRY-AI Mnu,Mm,Nml. Iatlary, allld LOCAEgN(Snnw.CM/fow1.3W1 bWCMp, aN. ISpFNI Ntl. '2E1. r. ]Sa. ]01. CERTM'IER ICnaCI eNy onal SIGNATURE AND TRLE a CER •CFRTIFYSq PHYSICIAN rynyacon rwuyxq uANaal enm wean rant onrac.an nn panwcM xaln ano compNao nem 271 ^ Te Stl bwlNAry EnoarNaSa.mMSaeeunM dltlbtltl eauaa(aland lllalwen HAIW ..................................................... ~,-. LICENSE NUMBER 9gNEDIMa~, fHy ~b•n •PRONOIRICSIO AND ClRTN'YNNI PHYBN:IAN IPnrxinn nMn pmwncvp tlaaln aritl csnFWq rocwM a Waml T IM EM a/•7En•1•I.4V••CaaSl eeew..eMSM Bma,aw,ane Pl.aa, alleaw tltM cA••N•lFnamennarnal.MS .......................... ® te. MO-04~f..44-1 71a ~~ Tree NAME AMD ADDHESSOF PERSON WNOCOMPLETEDCAUSE OF OEATN (11lm 27) Type a PNM 'MEDN:SL EIIAMNFER/CORONER •LQy~yT WI- JOSL.-F b10 I OR IM ENIS M naminNbn SnNOF InwaElSAtbn, In my oplnbn, B•SIN o:cuHW n Ntl Ilma, dNS, Antl p1ACe, antl 0w to IM eANAa(fl An0 mnnMrnF atatad ^ D ' ............................................................................ ......... ..... ...... .. 4. q 1 701, S 1E30 GOOD 11oPE. RO , L4p11, k. REGISTRAR'93X)NATURE ANO NUMBER /l j\/~•^' ONE FILED IMOnm. Day 1 21A7 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS CERTIFICATE OF DEATH • • t 4 ~ ~, / LAST WILL AND TESTAMENT I, LEONARD B. BRUMBAUGH, a resident of the County of Cumberland and Commonwealth of Pennsylvania, being of sound mind and memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking any and all Wills by me heretofore made. FIRST: I direct my Executrix, hereinafter named, to pay all my just debts and funeral expenses as may conveniently be done of ter my decease . SECOND: I give, devise and bequeath all my estate, be it real, personal or mixed, to my beloved wife, Helen I. Brumbaugh, for her own proper use and behoof forever. THIRD: In the event my wife, Helen I. Brumbaugh, predeceases me or we should perish in a common disaster, then I give, devise and bequeath my entire estate, be it real, personal or mixed, to my son, Gary L. Brumbaugh. FOURTH: I hereby nominate, constitute and appoint my wife, Helen I. Brumbaugh, to be the Executrix of this my Last Will and Testament. In the event my wife, Helen I. Brumbaugh, should be unable to serve as Executrix for any reason whatsoever, then I name, constitute and appoint Richard B. and Diane E. Scott to be the substitute Executors. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and Testament, written on one sheet of paper, dated this /D day of August, .1977. r - ~~ a~ (SEAL) This instrument was by the Testator, Leonard B. Brumbaugh, on the date hereof signed, published and declared by him to be his Last Will and Testament, in our presence, who at his request and in his presence and in the presence of each other, we believing him to be of sound and disposinq mind and memory, have hereunto subscribed our names as witnesses. MCCREA & MCCREA {~ C ,c/'},[//~ ,////~/~ .(//! /`/°/ ~ _ ATTORNEYS AT LAW ~~~1 ~l .J/'E.r / / / ~I ~ !e // / .~~_ `_~.r?~ ~ - 9:t Z•2. ~'..~_~ NE\YViLLE & SNIPPENSRNR6 (• J/~,'-'lam PENNA. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: ~~Af~"Y' F_ 311"{tJM~sA(.![;h-# 1bi;1s IS'iYF2T!,f~: f-~V~:PJUE L_i~M1r-' h#TL_L. F'i7 1?L7T 1_.:396r NO.AA 4 7 8 2 3 REV-1162 EX (11-96) ACN ASSESSMENT CONTROL NUMBER t;a ~ 1 1.~ f-3 3 w' FOLD HERE ESTATE INFORMATION: FILE NUMBER ~y _ G1"~U~73."'U':7~lL uJRI 4~_.~ l~"`E~.~'-fa~..3i NAME OF DECEDENT (LAST) (FIRST) (MI) f3RUM8AUG#-# l._~Ut~lAf2D ~ DATE OF PAYMENT ra1f:~;~!~#:)iJ1 POSTMARK DATE COUNTY (~ ~^ (-~ /~ y~~ C ~1'I~~G.~l_M1~~13 DATE OF DEA T H /( }} CC,, '' `` ~ ~•JV / ~V~..~~~ REMARKS urn r ~- or:uc irtrtt,t~7n I~##CCK# E,£~34 SEAL PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT TOTAL AMOUNT PAID AMOUNT FOLD HERE ~~ ,,,. ,. .L r l ~~r/~ RECEIVED BY ~`"`"~~'~ ~ ~~C..~G~L~--~'!~ -~!~G...-" fWF#R.''~ C . 't....~ : ~ ~~r' __V~`v_~_ REGISTER OFWILLS~~~~~~~ J~ J__ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT.280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT GAf~tY L_ ;~Rk~I~EiAi.f[~.a 16v~ t~Y>~iw~ Aw'~'MU~ iu~h?~' ~ T L.L , F G 1'?Ct ~ 1-39Ey2 No•AA 478234 REV-1162 EX (11-96) ACN ASSESSMENT CONTROL NUMBER ~:).11~~3I~ FOLD HERE ESTATE INFORMATION: FILE NUMBER f{~~ 1 1 !~ 1 ~ : "i1~~ ~ "'. C;+3J%:' Jv'Itil G ,l ~,).... t ~"'CtJ C~.~ 1 NAME OF DECEDENT (LAST) (FIRST) (MI) RfillMF31~tJCt-f i._E.CINt~R,~i }~ DATE OF PAYMENT 4 ! C!;71 c' ~C~ O `i POSTMARK DATE COUNTY CL)1~18EF~~r~tvD DATE OF DEATH REMARKS t~~-ir-t ; i„_ [,rttJril~i-~t_stzt~ SEAL TOTAL AMOUNT PAID AMOUNT ~;~5c? . c}c3 FOLD HERE .. ~35~.49 ~,/ ; ~~ r/~,/,'''/ / ~ f ,. RECEIVED BY ~ ~~~,~ REGISTER OF WILLS env ~,a2~i CO-~IOMiEALTH OF PENNSYLVANIA ~~~ ~ ~~~ INFORMATION NOTICE FILE N0. 21 - (J /- .~ s Z BUREAU of INDIVIDUAL TAXES AND ACN 01113818 DEPT. 280601 NARRISguRS, PA 171zg-oeol TAXPAYER RESPONSE DATE 03-14-2001 TYPE OF ACCOUNT EST. OF LEONARD B BRUMBAUGH ®sAViNGs S.S. N0. 217-10-6231 ^ CHECKINs DATE OF DEATH 07-08-2000 ~ TRUST COUNTY CUMBERLAND ~ CERTIF. REMIT PAYMENT AND FORMS T0: GARY L BRUMBAUGH REGISTER OF WILLS 1603 MYRTLE AVE ~q(~L CUMBERLAND CO COURT HOUSE CAMP HILL PA 17011 ` CARLISLE, PA 17013 ALLFIRST FINANCIAL SERVICES has provided t(w- Departwent with the inforwation listed below which has boon used in ealculatinp tM potential tax due. Their records indicate that at ttw- death of the above decedent, you wero a joint owner/berw-ficiary of this account. If you fwl this inforwation is incorrect, please obtain written correction frog the fin~cial institution, attsch a copy to tfiis fora and roturn it to the above addross. This account is taxable in accordance with the IMwritance Tax Laws of the Coworwealth of Pemsylvania. questions say b. answered by calling (717) 787-8327. COMPLETE PART 1 BELOif ~ ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 87005700172607 Data 05-07-1992 To insuro proper credit to your aceo~nt, two Established (2) copies of this notice oust accowpany your Account Balance 15, 977.29 w~'a°"t to the Resi:tar of (lilla. Naka chadc payable to: ••Repister of Mills, Agent-. Percent Taxable X 50.000 NOTE: If tax paywents are wade within thrw Aso(nt Subject to Tax 7,988.65 (3) sonths of the decedent's data of death, Tax Rate X .045 you way deduct a SX discount of the tax duo. Potential Tax Due 359.49 Aro inheritance tax duo will becowe delinq~wnt nine (9) worths after the dste of death. PART TAXPAYER RESPONSE ^ ~ .~te~~_=~~e~,_~tr~t #._~t~A~.~s~~:~r~ , ,i,~i'~~"~~~ ,~~r~st:~.~~~fa~ri:::~:!re~~~.~~r; A. ~ The above inforsatfon and tax due is correct. 1. You say choose to rewit paywent to the Register of Mills with two copies of this notice to obtain CHECK a discount or avoid interest, or you way chock box ^A" and return this notice to the Register of C ONE ~ Mills and an official assesssent will bo issued by the PA Departwont of Revenue. BLOCK B. ~ The above asset has boon or will be reported and tex paid with the Pennsylvania InFaritance Tax return ONLY to be filed by the deoedent•s reprosentatiw. C. ~ The above inforwation is incorrect and/or debts and deductions wero paid by you. You wust cowplete PART 2^ and/or PART Q below. PART If ou indicate a differw~t tax rate y , P ease s a e your ._..._........_._.. :,,--•.,-......._.... ... ...._K=nt::: "~~""~~~""~~"~~~~ ?'~':":"~'" -__ _,:,:~a Vii' _. •~GY`..; ... ~ ~~ :.__. € ~~°:>~:~: ,,. :._'E , '~_~'€~:?€ -- • ~~~=~'~-~,., ~:- ~ relationshi to decedent: _ a ~ _:, y~.. TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS 4~'~"=°:-- -~ ~~- '°~~'~~='''`='~~~~~>:` LINE 1. Date Established 1 +~, -x~°-'~:y'7 j . -,i. '~unT''e~'~s~i*Y`iL.'~4'~'":._~':'r. , '4'~ 'zT.,,.:.~"vsc-.'c.~`~(i _~:~"~'`=""-`_=-° ~-~~•~• ~ ~'{`~~^-~-=~~~v~~-~F~ 2. Account Balance 2 ._.__... _.... _.~ a- ~: _:~ ..,~__. ~•_ ....: ~ -:-. , .~.~;.::: _ _ . ercent Taxable X ........ ~~...... ............_......_...._::. ,.:._~.. .. z:~ _ ::.;mss. -'•;-~; ;'',•. a .:.s~~`~: ~::=ate: ~' ~~ ~ ~'~'~'~'~~`~''~' . no(nt Subject to Tax 4 .... ............ ...r.,...,_...._,> ,_~~;_; " - ~:~u r~:~ ~> _...r .....__. _. .. ._ __._._..::..:,, >;~ti _:: ~:<~:::~::::::- ~ .~~ =•x.__......~ 5. Debts and Deductions 5 .............._...._.r_.r...... ` ~ 6. Asoun Taxable 6 :.:..az :.::.r : :--r.:'e:: ~_ ~::s: ~r-°:`r'.:Ge..;~rr'.q. =~'i'F'-ii:i=`~''.^:T4`,~''''e~`':-°:t,i,:...._~,.,y.._..;_.....-....._..., ...:.:._:..._:~ ~~,~.,~.,.:.. -; G _:. ..,. .._ ...,u _ . ax Rate 7 X _ ;~e:~;;~ a _'::::.:::'c::c::::::°ic`S:iS 2i 2 -'•_c -~' i}'iY 4'ii''';,i''4~e.~,'•rv n:c>aiz:'^ a': irS: .................. --_ --. _...... ....=,0,5•..~:` ;Qi .z`_h''° _ v~is'r SFe`'~n c 4x... . _......:~ ~ -.{ ;.;.'h.. 3-~e.~r•..-.:~~ ~:...,.,.'ai :_ ~c`F..T:S::~ iv:c.:::::~ :i55: ....... ...... ""~ "~'" '~"•'~ . . . . c- 8 Tax Due 8 _.. __ . ....... . . ~S~;s:'<*;;i~~?~x~~~'~:~~i~ii~'.'i riei'Zip:::.:~~~:xti~t~-4_i5+s::~:'F~?i:~a7~:~.~+i ~^:i$'i'Fi?i:< ._~._...,...., :. ; . _:: ~•::...._ ~ •~`•~ r•--._; ~ r ,t_.~~.. . _ PART DEBTS AND DEDUCTIONS CLAIMED 3 DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and coaplete to the best of ay knowledge and belief . HOME ) w / Z - `j~~ U5 A R SIGNATURE d ;~.~.-- ~`~~%~,~~_ ~~,,,~ TELEPHONE NUMBER ATE ' CDMNDf11iEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1545 EX ~FV C09-00) ~~ ~ ~ 2~~1 INFORMATION NOTICE AND TAXPAYER RESPONSE FILE N0. 21 -'- ~ ~ ~ ~~~ ACN 01113818 DATE 03-14-2001 GARY L BRUMBAUGH 1603 MYRTLE AVE CAMP HILL PA 17011~~9~+y TYPE OF ACCOUNT EST. OF LEONARD B BRUMBAUGH ®SAVINGS S.S. N0. 217-10-6231 ^ CHECKING DATE OF DEATH 07-08-2000 ^ TRUST COUNTY CUMBERLAND ^ CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ALLFIRST FINANCIAL SERVICES has provided the Departaent with the inforeation listed below which has been used in calculating the potential tax due. Their records indicate that et the death of the above decedent, you were a joint owner/beneficiary of this account. If you fool this inforeation is incorrect, please obtain written correction froe the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Coaeonwealth of Pennsylvania. Questions aay be answered by calling C717) 787-8327. COMPLETE PART 1 BELOW * ~ * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 87005700172607 Date 05-07-1992 To insure proper credit to your account, two Established (2) copies of this notice Bust accoapany your pageant to the Register of Nills. Make check ACCOUnt Balance 15, 977 • 29 payable to- ^Register of Nills, Agent^. Percent Taxable X 50.000 NOTE: If tax pageants are cede within three Amount Subject to Tax 7,988.65 (3) aonths of the decedent's date of death, Tax Rate X .045 You aay deduct a 52 discount of the tax due. Any inheritance tax due will becowe delinquent Potential Tax Due 359.49 nine (9) aonths after the date of death. PART TAXPAYER RESPONSE A. ^ The above inforeation and tax due is correct. 1. You aay choose to resit paysent to the Register of Bills with two copies of this notice to obtain CHECK a discount or avoid interest, or you aay check box ^A^ and return this notice to the Register of C 0 N E ~ Mills and an official assesseant will ba issued by the PA Departaent of Revue. BLOCK 8. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return ONLY to be filed by the decedent's representative. C. ^ The above inforeation is incorrect and/or debts and deductions were paid by you. You oust cowplete PART ~ and/or PART ~ below. PART .......................................... If ou indicate a dsfferent tax rate, please state you ..., .. I : ~ 2 relationship to d ~~Is~~~_'~~~ : ,, ,-::::~ :::::::::: a ~ ..' ~ .. ~t . . . ~ ~ ::::::::::::::::::::, - ~: _-,:::-:: _:::::::~ ::::::::::::::: ss~~f~' .~ ~.:.~:~€ii±ii~iis~i€i€i ~.. TAX RE TURN - COMPUTATION OF .................... .:.:.:.:.:.:.:.:.:... ::::-,:::-:~ : .::::::::::::::::::::::: TAX ON JOINT/TRUST ACCOUNTS ..}?,~~.;:: ............. . . .......: ...... :;_ ::::-~? :::r:-.:.:.:::,.,.,._ ~ €'siiiiiis>i;p;;y:,:.::~ :~i€s:[:::sits`€ € €€~ ~"s€i~f€ LINE 1. Date Established 1 2. Account Balance 2 3. Percent Taxable 3 ::~;:~: X ~`~ 4. Sub act to Tax 4 Amount ~ :.....:...:.......:.. °;:.:;:~,:;:.: ,:,:,:,,:;:;:,:,:;~:::,:,,::::::::..: ................................... 5. Debts and Deductions 5 - „ ` 6 . Amount Taxable 6 ..... . ~~ ~s::•::.:.... ........... ... . .. . ...... ~ , ... .......:. . 7. Tax Rate .. ..: : . °"°` 8. Tax Dus 8 ...... _ ............................. .......... . PART DEBTS AND DEDUCTIONS CLAIMED 3^ DATE PAID PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and complete to the best of my knowledge and belief. HOME ( ) WORK ( ) TAXPAYER SIGNA RE TELEPHONE UMB DATE liilll ~~ ~ , ~ ~ ~ o ~ ~"- •~ tV ~s~~a~~ ~~ ~ ~ ~~ o ~ ~~ as ~ ~'~~ 1 1~~~ ~ ~~a~ ~ f ~ ~ ~ ~ 0 J -~ r ,3 ~ a ~-, j ~- J N~ v ~_./ ~, V ;., E'~ t~' ~ .r^1 i...~ •rd COINIOlBiEALTH OF pENNSYwANIA O~PARTMENT OF REVENUE 69REAU OF INDIVIDUAL TAXES • _^§PPT. 280601 HARRISBURG, PA 17128-0601 /~ - ~ z. ~. INFORMA AND NOTICE FILE N0. 21 ~- O ~' '3`{~' TAXPAYER RESPONSE ACN 01113819 DATE 03-14-2001 REY-1545 OI AR (h-08) GARY L BRUMBAUGH 1603 MYRTLE AVE CAMP HILL PA 17011-3Q1o~ TYPE OF ACCOUNT EST. OF LEONARD B BRUMBAUGH ^ SAVINGS S.S. N0. 217-10-6231 ^ cHECKINc DATE OF DEATH 07-08-2000 ^ TRUST COUNTY CUMBERLAND ®CERTIF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ALLFIRST FINANCIAL SERVICES has provided the Departaent with the inforaation listed below which has boon used in calculating tfw- potential tax due. Their records indicate that at the death of tfie above decedent, you wero a joint owner/berwfieiary of this account. If you fwl this inforeation is incorrect, please obtain written correction frog the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inlwritance Tax Laws of the Commonwealth of Pennsylvania. Okwstions .roy be answered by allirq C7171 787-8327_ COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 87009000059534 Date 05-04-1992 To insure Proper credit to your account, two Established (2) copies of this notice oust accoaPanY Your payeent to tM Register of Mills. Make chock Account Balance 1 , 235.61 payable to: -Register of Mills, Agent". Percent Taxable X 5 NOTE: If tax payaents aro cede within three Aaount Subject t0 Tax ~7 •81 (3) eonths of the decedent's date of death, Tax Rate x .045 Yeu aay deduct a 5X disc«nt of ttw tax des. AnY iMeritance tax due will becoee delinquent Pot~tial TeX Due 27 •80 nirw [9) aonths after the date of death. PART TA PAYER RESPON ._ .._ _ ...y~......... _.._......... .,:, ,: ~ ,,;,: A. The above inforeatian and tax rect. 1. You aay choose to resit psyaent to tfw Register of Mills with two copies of this notice to obtain a discount or avoid interest, or you aay ched( box '•A- and return this notice to ties Register of CHECK Mills and an official assessaent will be issued by the PA Departaent of Reve(w,e. ONE ~ C BLOCK B. ~ The above asset has been or will be reported and tax paid with the Pemsylvania INw-ritanee Tax return sentative d t ONLY . s repre en to be filed by the dece C. ~ The above inforeation is incorrect and/or debts and deductions were paid by you. You gust coeplete PART 2^ and/or PART 3^ below. ..._ PART ,. If You indicate a different tax rate, please state your -'• --`- ~ ~ :`- ~.~ v . 2 relationship to decedent: ==' . TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS ~. ~. •~~'-°"~~ •'y~=~`~'~' ` ;''~'~°°:'~`~`"`~' ~zki ='^ :k~•• - ;tin;; ,4. - a:ii:. %i.,r?':a'°::c:: • ~~ LINE 1. Date Established 1 ~:~~~ .:._ . ~~?r=~ ~^_ ',4':~: ~ _ ' ;' ..~:.. :~ = :_ : : : 2. Account Balance 2 3 _ , ,, .. - . .. .~ .. 4--n-_ ~• -=~~:,....-. X ~ 4n: 4~:~;::-~::u~;~:._ a - . •~u .r, - ::' ~ ~: s: ~:_ ; a 3 . Percent Taxable . : : ..._~ ,_._..._ _ : .i~a~.^.i~•,.~.*'a;~e z:zye~?: s,r '~...~r.,.L3=:2~°:~::Y:y „~:i' -:rte:: "~-:'fz + ~..~~ . `~{",~~` "~*"" '"""* 4. Aeount Subject to Tax 4 ~ ~! _ - ^~ .'"r+.i?s. ^,.~ -,Z r „•-~:~~,a ' s42r ,~7p-,v4y':- zi,r_^°a-e:ri c :~'r.'::: `d.-...... i w ~wTi •- ~ 5. Debts and Deductions 5 6 giS Wiiyiww i» - ~ _,... - << _ 6. Arount Taxable ~~.:,~.n..x - ~, ,, ~:~ =;;r~~~ ; 7. Tax Rate ..... _ :..+...:::..::..a..:-...-. ........-..- ..... ... i 8 :::s ....~. i5::~s.` ::,'x'^'-»-.,.- ...~:~-,~,.:S:c:c''rc:~:i:zi.~;.:.^~ztiaa:F i~: ..... .... ax Due PART DEBTS AND DEDUCTIONS CLAIMED ^3 naTF PATD PAYEE DESCRIPTION AMOUNT PAID Under penalties of perjury, I declare that the facts I have reported above are true, correct and ~ coaple~te togthe [bast of ay knoMledge/ and belief. HOME C~ ) ~ ~ !Y~^~Oc,~~" ~ ~`" ~~ r~-~-~~i~~~.~,,.-.~~--. WORK (`71~'f ) C, / 2 --Sso~ ~ z o ~ VDA ro CTGYA~T11 b^-~~a~- TFI PH NE Nl1MB R D TE CONNONNEALTH OF PENNSYLVANIA ' DEPAIjTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT! 280601 HARRISBURG, PA 17128-0601 1~- aa~` INFORMATION NOTICE AND TAXPAYER RESPONSE REV-1545 ER APP C09-00) ~j ~i .. } FILE N0. 21 ~ ~?/-_ 3,i~~ ACN 01113819 DATE 03-14-2001 GARY L BRUMBAUGH 1603 MYRTLE AVE ~ CAMP HILL PA 17011 '"~~~~ TYPE OF ACCOUNT EST. OF LEONARD B BRUMBAUGH ^ SAVINGS S.S. N0. 217-10-6231 ^ CHECKING DATE OF DEATH 07-08-2000 ^ TRUST COUNTY CUMBERLAND X^ cERnF. REMIT PAYMENT AND FORMS T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 ALLFIRST FINANCIAL SERVICES has provided the Departwent with the inforwation listed below which has been used in calculating the potential tax due. Their records indicate that at the death of the above decadent, you were a joint owner/beneficiary of this account. If you feel this inforwation is incorrect, please obtain written correction frow the financial institution, attach a copy to this fora and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Cowwonwealth of Pemsylvanie. Duestions way bo ancwared by calling f717) 787-8327. COMPLETE PART 1 BELOW * * * SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 87009000059534 Date 05-04-1992 To inwre proper credit to your account, two Established C2) copies of this notice east accowpany your Account Balance 1 235.61 Pageant to the Register of Bills. Make check , payable to: ^Register of Nills, Agent^. Percent Taxable X 50.000 NOTE: If tax paywents are wade within three Amount Subject t0 Tax 617 .81 (3) wonths of the decedent's date of death, Tax Rate X . 045 you way deduct a 5% discount of the tax due. Any inheritance tax due will becowe delinquent Potential TaX Due 27.80 Winn C9) worths after the date of death. PART TAXPAYER RESPONSE A. ^ The above inforwation and tax due is correct. 1. You way choose to rewit paywent to the Register of Nills with two copies of this notice to obtain CHECK a discount or avoid interest, or you way check box ^A^ and return this notice to the Register of C ONE ~ Nills and ~ official assess.ent will be issued by the PA Depart.ent of Revenue. BLOCK B. ^ The above asset has been or will be reported and tax paid with the Pennsylvania Inheritance Tax return 0 N LY to be filed by the decedent's representative. C. ^ The above inforwation is incorrect and/or debts and deductions were paid by you. You wst cowplete PART 2^ and/or PART 3^ below. PART If you indicate a different tax rate, please state your 2 relationship to decedent: TAX RETURN - COMPUTATION LINE 1. Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART OF TAX ON JOINTiTRUST ACCOUNTS I# 1 s~'s~€ 2 4 '~?~i 5 s€ 6 7 X ~~s~' 8 ~=~¢ ........................... DEBTS AND DEDUCTIONS CLAIMED Under penalties of perjury, I declare that the facts I have reported above are true, correct and cowplete to the best of wy knowledge and belief. HOME ~ ) WORK ( ) TAXPAYER SIGNATURE T EPHON NUMBER DATE DATE PAID PAYEE DESCRIPTION AMOUNT PAID ~~~ .,. ,, / .\ ,~ ~,, ~ A ' _...~ ..._., la ~ j I~a° j ~~~a ~ ~ ~~~ 1 1~~ ~ ~ ~~~~ V` \ l J ~ ~~ J ~`'J U ~~ ` <J , f ~ `I-' ' tj (`J ~ '~ '!1 i ~1, 3 ,,,., !''•# ~~~ i ~:+ .:.~ ~_':~ .,..~ _ , ~. ~~ ` ~ // COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION NOTICE OF INHERITANCE TAX DEPT. 28D601 APPRAISEMENT ALLONANCE OR DISALLOAANCE HARRISBURG, PA 17128-0601 OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS 5~ REY-1541 EX ~FP (12-00) DATE 05-14-2001 ESTATE OF BRUMBAUGH LEONARD B DATE OF DEATH 07-08-2000 FILE NUMBER 21 01-0352 .,f COUNTY CUMBERLAND GARY L BRUMBAUGH ~ SSN/DC 217-10-6231 ACN 01113819 1603 MYRTLE AVE Aeount Renittad CAMP HILL PA 1~Q11 ,~_ MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALON6_ THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ REV- 1548 EX AFP (12- 00) ----------------------------------------------------------------------------------- NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-14-2001 ESTATE OF BRUMBAUGH LEONARD B DATE OF DEATH 07-08-2000 COUNTY CUMBERLAND FILE N0. 21 01-0352 S.S/D.C. N0. 217-10-6231 ACN 01113819 TAX RETURN WAS: (X) ACCEPTED AS FILED ( ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT N0. 87009000059534 TYPE OF ACCOUNT: C ) SAVINGS ( ) CHECKING C ) TRUST C ~ TIME CERTIFICATE DATE ESTABLISHED 05-04-1992 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 1,235.61 X 0.500 617.81 .00 617.81 X .45 27.80 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 04-02-2001 AA478235 .00 27.80 TOTAL TAX CREDIT 27,80 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE. .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT° ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 GARY L BRUMBAUGH 1603 MYRTLE AVE COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT ALLONANCE OR DISALLONANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY MELD OR TRUST ASSETS REY-15Si EX AFV (u-01) DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN CAMP HILL PA 1701,E ~~ ~' (, . . 05-21-2001 BRUMBAUGH LEONARD B 07-OS-2000 21 01-0352 CUMBERLAND 217-10-6231 01113818 Awount Rsiwittsd 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 1 ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (12-00) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 05-21-2001 ESTATE OF BRUMBAUGH LEONARD B DATE OF DEATH 07-08-2000 COUNTY CUMBERLAND FILE N0. 21 01-0352 S.S/D.C. N0. 217-10-6231 ACN 01113818 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: ALLFIRST FINANCIAL SERVICES ACCOUNT N0. 87005700172607 TYPE OF ACCOUNT: ( ~ SAVINGS C ) CHECKING C ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 05-07-1992 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: 15,977.29 X 0.500 7,988.65 .00 7,988.65 X .45 359.49 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: TMREGISTER OF WILLS, AGENT." PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID 04-02-2001 AA478234 .00 359.49 TOTAL TAX CREDIT 359.49 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 TOTAL DUE .00 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ~ ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A °CREDIT•• ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 REY-35f6 EX AFV (1Y-01) DATE 09-03-2001 ESTATE OF BRUMBAUGH LEONARD B DATE OF DEATH 07-08-2000 FILE NUMBER 21 01-0352 CQ.UNTY CUMBERLAND GARY L BRUMBAUGH SSTIiDC 217-10-6231 ACN 00141432 1603 MYRTLE AVE Anow~t Renitt•d CAMP HILL PA 17011~~: MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE,. PA 17013 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t ---------------------------------------------------------------------------------------------------------------- REV-1548 EX AFP (12-00) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS, AND ASSESSMENT OF TAX ON JOINTLY HELD OR TRUST ASSETS DATE 09-03-2001 ESTATE OF BRUMBAUGH LEONARD B DATE OF DEATH 07-08-2000 COUNTY CUMBERLAND FILE N0. 21 01-0352 S.S/D.C. N0. 217-10-6231 ACN 00141432 TAX RETURN WAS: (X) ACCEPTED AS FILED C ) CHANGED JOINT OR TRUST ASSET INFORMATION FINANCIAL INSTITUTION: FULTON BANK ACCOUNT N0. 2219-20967 TYPE OF ACCOUNT: C ) SAVINGS C ~ CHECKING ( ) TRUST ( ) TIME CERTIFICATE DATE ESTABLISHED 02-25-1995 Account Balance Percent Taxable Amount Subject to Tax Debts and Deductions Taxable Amount Tax Rate Tax Due TAX CREDITS: COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAI5EtlENT ALLOI(ANCE OR DISALLO)(ANCE OF DEDUCTION, AND ASSESSMENT OF TAX ON JOINTLY HE[.D OR TRUST ASSETS 6,552.66 X 0.500 3,276.33 .00 3,276.33 X .45 147.43 NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS NOTICE WITH YOUR TAX PAYMENT TO THE REGISTER OF WILLS AT THE ABOVE ADDRESS. MAKE CHECK OR MONEY ORDER PAYABLE T0: "REGISTER OF WILLS, AGENT.° PAYMENT DATE RECEIPT NUMBER DISCOUNT C+) INTEREST/PEN PAID (-) AMOUNT PAID INTEREST IS CHARGED THROUGH 09-11-2001 TOTAL TAX CREDIT .00 AT THE RATES APPLICABLE AS OUTLINED ON THE BALANCE OF TAX DUE 147.43 REVERSE SIDE OF THIS FORM INTEREST AND PEN 5.68 TOTAL DUE 153.11 IF PAID AFTER THIS DATE, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN !1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A •'CREDIT^ ( CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) s s Q z° M =~ Q ;Fy > W xau.~ .]O ~i0y ~ Q F z> ~o~~ 4. Mp~WWF 1~0 t7i z~m O 2z = o H MOO =Z az~ HW ~.acW QH OC .'i' ~~ Zd E"Wr"~z ~~++ N OW z4~iG1~"~ ~A No"~ O ~o v eo N W a r .~ <~ e .D N N O P O •+ H~ `a {~ We O ~~N~ W ~"~ ~ a~ mf+~= 0 ca ~ ~c ~ a Z Z W O Z W y, J Q ~ W ~ N H ~ O '"~ ~ Z W S ri ONAM + OC ~ o M Q~ ~ ~ o N N A ~ N a N o~ o~ i Z N O O 11 a J O n o~oo~ i ~` ~ ~ i ~ ioi Ens ~ J ZV o~~n,1~~o ¢ OC10NC~N0 o i ~ LL ~ ~, o A F d ~ Q W W J J ~ H N W O S W OZ ~ W ~ Q F ~Q ~ ~ ~ a -F-J~ZZ 1-F ~C AWA V ~ ~ IL f /fQ .-i 0 n ~ ~ a a as Via, J W J } H E _ } M ~ Q ~C Q t9 ~+ V i (' t .~--~. :~ - n~ G- v NO v Q~ to ~~ J x 7 "l ./ ~ `-~ J _. ~~ 91 ~ t V ~ l I 1'.~ f'~~ !'~'f if' i I~ .~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: GARY L BRUMBAUGH 1603 MYRTLE AVENUE CAMP HILL, PA 1701 1 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT REV-1162 EX~11-96) NO. CD 000319 ACN ASSESSMENT AMOUNT CONTROL NUMBER ESTATE INFORMATION: ssN: 217-~o-s23~ FILE NUMBER: 21-2001- 0352 DECEDENT NAME: BRUMBAUGH LEONARD B DATE OF PAYMENT: 09/27/2001 POSTMARK DATE: 00/00/0000 CAN NOT READ COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2000 REMARKS: GARY L BRUMBAUGH CHECK# 730 00141432 ~ $153.1 1 TOTAL AMOUNT PAID: INITIALS: PB 5153.11 SEAL RECEIVED BY: MARY C. LEWIS REGISTER OF WILLS REGISTER OF WILLS IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION CERTIFICATION OF NOTICE UNDER RULE 5.6(a) NAME OF DECEDENT: LEONARD B. BRUMBAUGH DATE OF DEATH: JULY 8, 2000 NO. 2001-00352 ADMIN NO.: 21-01-0352 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on July 21, 2001. Name Gary Brumbaugh Address 1603 Myrtle Avenue, Camp Hill, PA 17011 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except (NONE) Date: October 25, 2001 Austin F. Grog , Esq~tfre 24 North 32n Street Camp Hill, PA 17011 (717) 737-1956 Counsel for Personal Representative ID #59020 ~~l / BUREAU ~ INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT R@CL71'C)C~ ,ems O~ R$C,~i~tCi t; ~~''1iE5 '~~ V 26 Ai 1 :46 GARY L BRU A 1603 MYRTLE AVE CAMP HILL {;~I~J1?411; ..~~:J~.1t`~ Gt~Ttber~ar;t~ ~~., PR ~~ ~i REY-1607 E% ~FP (1P-00) DATE 11-19-2001 ESTATE OF BRUMBAUGH LEONARD B DATE OF DEATH 07-08-2000 FILE NUMBER 21 01-0352 COUNTY CUMBERLAND ACN 00141432 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, submit the uDPer portion of this form with your tax payment. CUT ALONG_ THIS LINE __-___ RE_TAIN LOWER P_ORTI_ON FOR YOUR RECORDS __~ __________________ REV-1607 EX AFP (12-00) ~x* INHERITANCE TAX STATEMENT OF ACCOUNT ~~~ ESTATE OF BRUMBAUGH LEONARD B FILE N0. 21 01-0352 ACN 00141432 DATE 11-19-2001 THIS STATEMENT IS PROVIDED TO ADVISE OF THE CURRENT STATUS OF THE STATED ACN IN THE NAMED ESTATE. SHOWN BELOW IS A SUMMARY OF THE PRINCIPAL TAX DUE, APPLICATION OF ALL PAYMENTS, THE CURRENT BALANCE, AND, IF APPLICABLE, A PROJECTED INTEREST FIGURE. DATE OF LAST ASSESSMENT OR RECORD ADJUSTMENT: 09-03-2001 PRINCIPAL TAX DUE: PAYMENTS (TAX CREDITS): 147.43 PAYMENT DATE RECEIPT NUMBER DISCOUNT (+) INTEREST/PEN PAID C-) AMOUNT PAID 09-27-2001 CD000319 5.68- 153.11 TOTAL TAX CREDIT BALANCE OF TAX DUE INTEREST AND PEN. ^ IF PAID AFTER THIS DATE, SEE REVERSE l TOTAL DUE SIDE FOR CALCULATION OF ADDITIONAL INTEREST. ( IF TOTAL DUE IS LESS THAN tl, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS. ) 147.43 .00 .58 .58 STATUS REPORT UNDER RULE 6.12 Name of Decedent: Leonard B. Brumbaugh Date of Death: 07-08-2000 NO. 2001-00352 ADMIN NO.: 21-01-0352 '(ice ~,.:~~ 1 °;~, t .' ,,, . ;,: 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: No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: January 2003 3. If the answer is No. 1 is Yes, state the following: a. Did the personal representative file a fmal account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties 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. Date ~ 1~s'1 o Z-- ~~~ ~~~~I~ 1//,iJ /., ~ .~ ~ /...L( Austin F. Grogan„Esquirg~ ~ 24 North 32nd Street ~/ Camp Hill, PA 17011 (717) 737-1956 ID #59020 Counsel for personal representative ~~ JRD/June 30, 1992/17858 In Re: Estate of Leonard B. Brumbaugh Late of Shippensburg Borough Estate No.: 21-2001-0352 AUG 0 9 2002 ~~, ORPHANS' COURT DIVISION COURT OF COMMON PLEAS OF CUMBERLAND COUNTY PENNSYLVANIA N0.21-2001-0352 NOTICE OF FAILURE TO FILE STATUS REPORT AND REQUEST TO CONDUCT A HEARING PURSUANT TO RULE 6.12, SUPREME COURT ORPHANS' COURT RULE ~-';:~~t_,Ar~a Fl epa'eseiliistive: Counsel for Personal Representative: Austin F. Grogan, Esquire Date of Decedent's Death: 07-08-2000 Date of Delinquency Notice: 06-13-2002 The undersigned, Mary C. Lewis, 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 Olphans' Court Rules, was given by the Register of Wills on 06-13, 2002, 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. ~ . Date: 08-08-2002 Mary .Lewis, Regi er of Wills Distribution: Personal Representative Counsel for Personal Representative Estate File IOJI~ ~ Z ~ A hearing is scheduled for at In Courtroom No. 3. e t s eport is filed prior to the hearing date, the hearing will automatically be can George E. offer, P.J. Cumberland County - Register Of Wills • Hanover and High Street Carlisle, PA 17013 -- '~ Phone:(717) 240-6345 Date: 6/13/2002 SCOTT RICHARD B 1606 SUMMIT AVENUE CAMP HILL, PA 17011 RE: Estate of BRUMBAUGH LEONARD B File Number: 2001-00352 Dear Sir/Madam: It has come to my attention that you have not filed the Status Report by Personal Representative (Rule 6.12) in the above captioned estate. As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after July 1, 1992, the personal representative or his counsel, within two (2) years of the decedent's death, shall file with the Register of Wills a Status Report of completed or uncompleted administration. This filing will become delinquent on: 7/08/2002 Your prompt attention to this matter will be appreciated. Thank You. Sincerely, ~` ~Z~~ MARY LEWIS ~~ REGISTER OF WILLS (((/// cc: File Counsel Judge ^ Cor*~r~lete items 1, 2, and 3. Also complete A. Signa re item 4 if Restricted Delivery is desired. ^ Agent X ^ Print your~name and address on the reverse ^ Addressee so that we can return the card to you. B. Received by (Printed Na e) C. Dat of live ^ Attach this card to the back of the mailpiece, ~O (,~ (~ ~a'~. or on the front if space permits. b ^ Y es D. Is delivery address different from item 1? 1. Art//icle Addressed to: G~~4~~~~ ~ Y~~~~ ~=j~i If YES, enter delivery address below: ^ No '`~'~ ~~~ ~ 7U1~ ~~ ` 3. Service Type Certified Mail ^ Express Mail ^ Registered ^ Return Receipt for Merchandise ^ Insured Mail ^ C.O.D. r ~~ d ~'3~a 4. Restricted Delivery? (Extra Fee) ^ Yes 2. Article Number (Transfer from service label) ~©Q~ - ~, j j(f ~ ~~ ~j ~, j "~('pa - or Gf0 PS Form 3811, August 2001 Domestic Return Receipt 102595-02-M-0835 O r-~ ...0 rl.l ~ .D Postage $ ~ Certified Fee Postmark ~ Return Receipt Fee Here 0 (Endorsement Required) ~ O Restricted Delivery Fee (Endorsement Required) ~ Total Postage & Fees u7 ~ Sent To l O Street, Apt. o.; ~ ~ or PO Box No - ----- -- o . --- -------------------------!U~~-- --3 -- -- --- -- - - - - -- - ----------- ------ - City, State, ZIP+4 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 1 7 1 28-0601 RECEIVED FROM: GROGAN AUSTIN F ESQUIRE 24 NORTH 32ND STREET CAMP HILL, PA 1701 1 fold PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT ESTATE INFORMATION: SSN: 2~7-io-6231 FILE NUMBER: 2101-0352 DECEDENT NAME: BRUMBAUGH LEONARD B DATE OF PAYMENT: 05/05/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 07/08/2000 REV-1162 EX(11-96) NO. CD 002524 ACN ASSESSMENT AMOUNT CONTROL NUMBER 101 ~ S 1 14.41 TOTAL AMOUNT PAID: REMARKS: AUSTIN F GROGAN ESQUIRE CHECK# 3044 SEAL INITIALS: SK RECEIVED BY: DONNA M. OTTO S 1 14.41 DEPUTY REGISTER OF WILLS REGISTER OF WILLS ~/ d~- STATUS REPORT UNDER RULE 6.12 Name of Decedent: Brumbaugh, Leonard, B. Date of Death: 07/08/00 Will No. 2001-00352 Admin. No. 21-0~ 0352 :~ C':- " ~ r~,, _, ~ , , ~~ ~; ~ ;-~ ~ s~; - ~; wi i '°'t J ...~... W^F O 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 X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer is No. 1 is Yes, state the following: a. Did the personal representative file a fmal account with the Court? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X 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. Date u~l `"/ ~ ~ ~,~~~~~ Austin F. Grogan,"Esq 24 North 32nd Street Camp Hill, PA 17011 (717) 737-1956 ID #59020 Capacity: Personal Representative X_ Counsel for personal representative ~( 'lea ~ REV-15CO E'.~(AW) ,. f / 1500 0 FICIPL USE OLLY ] CDMMONWEALTR ( FPENNSVLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX RETURN ~ ILA D ,~ ~~-~, E , rt- ~:= ;~ ^~ / Ss¢, ~ ~g%~ t ~~ / "' DEPT. 2Fp6°' RESIDENT DECEDENT ~ ~ :-° C HFlRRISBURG, PA 1]128-06°1 ~,., ate .~q NIIMBFR p ECEDENT'8 NAME (LAST, FIRST, AND MIppLE INITIPi) use a blaze bbci la scale wwCs ~ z B R `U M 8 A U G H L E O N A R D B Q SOCIAL SECURITY NUI.6ER CATS CF DEATH PATE OF BIRTH U 2 1 7 -1 0 -6 2 3 1 0 7 ~0 8 ~2 0 0 0 1 2 ~0 8 ~1 9 1 2 QW (IF APMILABLE)SllRVMNG SPOUSE'S NAME (LPST, FIRST, AND MICCLE INf .'il SOCIPL SECURITY NtlMBER ~ THIS RETU Y MUST 9E FILED IN DUPLICATE WITH THE - REGISTER OF WILLS ¢ ®1. Original Return ^ 2. Supplemental Return ^ 3 Ra^.zinder Return (axle or aaam pdorm r2-tae2) m . w i ~ ^ 4. Limited Estate ^ 4a Future Interest Compromise (ease er acatn ~g tau-at1 ^ 5. =moral Estate Tax Return Required ~ a m ^ 6. Decedent Died Testate {ala<n spy aw~u) ^ 7. Cecedent Maintained a living Trust (Aram xor orTmsq 8. ', [:ai Number of Safe Deposit Boxes °d ^ 9. Litigation Proceeds Received _ ^ 70. Spousal Poverty Credit (sale mdealn between uar.sl ane t-t-ss) ^ 11 Er",fan to tax under Sea 9113(A) IAnaen sen o) r I'-THIS SECTION MUSTBE COMPLETEDTALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED`T02 ~ "i' W NAME COMPLETE NVJL!NG ADDRESS o AUSTIN F. GROGAN AUSTIN F. GROGAN, ESQ m FIRM NAME (If AppfcabL) ~ LAW OFFICE OF AUSTIN F. GROGAN 24 NORTH 32ND STREET ~ TELEPHONE NUMBER ° 717-737-1956 CAMP HILL PA 17011 Z O g 1- a U W Z O a Q~ f a U 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) 3_ Closely Held Corporation, Partnership or Sole-Propcete~s4~p 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits 8 Miscellaneous Personal Frcrzrty (Schedule E) 6. Jointly Owned Prcperty (Schedule F) 7. Infer-Vivos Transfers 8 Miscellaneous Non-Probzte ?rcpery (Schedule G or L) B. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses 8 Administrative Casts (Schedule' :) 10. Debts of Decedent Mortgage Liabilities, 8 Liens (Schedo!e') 11. Total Deductions (IOtaI Lines 9 8 10) ' , , = rn .. , ~ ~, (4) ~ ~ ~;., (5) ~ _ s v 2 `' (6) , s) ,5 0 0 .o 0 , ~ 10) , 5, 1 3 : 8 7 3 (11) -'a 12. Net Value of Estate (Line 8 minus Line 11) - (12) . 13. Charitable and Governmental Bequests/Sec 9113 i costs forwhich an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 15. Amount of line 14 taxable ~y at the spousal tax rate _.„, ,,,_» A ,,,, a ,,,,; ; . X .D _ _ (15) See instructions on reverse side for Applicable percentage 16. Amount of I 0 17. Amount of I ne 141axable ; 1 a 9 0 6 7 9 ,. X C6 (16) ~' l sxtft .. _ ~ .. ~.'Y Ine 14 taxable ' ; at 15%rate R,K i ri X _t5 (17)- RA:...~..r. .. .:. .... ...r:'e.u. > .... ... .:... 18. Tax Due (18) 19 • ~ ~ ~ • perjury, I decYra that I hoe examined this return, SIGNATURE OF schedups and statements, end M tle hest o / /r//~ dices S.- ADDRESS , , OFFICIAL USE ONLV O C.C? ~ r ,L lJl ~ ~a ~, AD 7 ~5 8 0 ,6 2 5 6 7 3 8 3 1 ~9 0 6 7 9 1 •9 0 6 .7 9 , , 1 1 4 4 1 r ~1 1 4 j4 1 ,... _•. bekl. a is true. correct ald complete. Dechration of preparer other .~///~~ -..s/z/ ~3 ~ -~ r1 ~ ~ DATE ~d~ Docedent's Complete Addre STREET ADDRESS CITY STATE ZIP Tax Payments and Credits: t. Tax Due (Page 1 Line 18) 2. Credits/Payments A. Spousal Poveriy Credit B. Prior Payments _ C. Discount 3. Interest/Penalty if applicable D. Interest E. Penalty (1) 114.41 Total Credits (A+B+C) (2) Total InteresVPenally (D + E) (3) 4. If line 2 is greater than line 1 + line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 19 to request a refund (4) 5. If line t + line 3 is greater than line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. (SA) 8. Enter the total of Line 5+SA. This is the BALANCE DUE. (5B) 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 : ...........................................................^ ^X b. retain the right to designate who shall use the property transferred or its income : ................^ ^X c. retain a reversionary interest; or ..........................................................................................^ d. receive the promise for life of either payments, benefits or care? .........................................^ ^X 2. If death occurred on or before December 12, 1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ......................................................................................... ...^ ^X 3. Did decedent own an "intrust for" or payable upon death bank account or security at his or her death? ................................................................................................................ ..^ ^X 4. Did decedent own an individual retirement account, annuity, or other non-probate property? .. ...^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN 72 P.S. §9116 (a) (1.1) (i) provided for the reduction of the tax rate imposed on the net value of transfers to or for the use of the surviving spouse from 6%to 3% for dates of death on or after July 1, 1994 and before January 1, 1995. 72 P.S. §9116 (a) (1.1) (ii) provided for the reduction of the rate imposed on the net value of transfers to or for the use of the surviving spouse from 3% to 0% for dates of death on or after January 1, 1995. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995 -Please answer the following question by placing an "X' in the appropriate space. Did the decedent create a trust or similar arrangement which is soley for the surviving spouse's benefit for his or her entire lifetime? Yes ^ No ^X If you answered yes to the above question, the tax on the trust or similar arrangement is postponed until the death of the second spouse, at which time it will be fully taxable at the rate(s) applicable to the remainder beneficiary(ies). Enter the value of the trust on Schedule J, Part II, in order to remove it from the calculation of the tax due in this estate. You may wish to file Schedule O in order to make the election available under Section 9113. If the election is made, the trust or similar arrangement is taxed in the estate of the first decedent spouse, the portion of the trust or similar arrangement which benefts the surviving spouse is taxed at the zero tax rate, and the remainder is taxed at the rate(s) applicable to the remainder beneficiary(ies). If you choose to make the election, you must attach Schedule O to atimely-filed tax return, along with Schedule(s) Kand/or M in order to show the apportionment of the trust or similar arrangement between the surviving spouse and the remainder beneficiary(ies). RERISOA E'~j19n /y~c SCHEDULE E CDMMONWEALTH OF PENNSYLVANIA V„J H, BANK DEPOSITS, & MASC. '""ERR""CE TAX RETURN PERSONAL PROPERTY RESIDEM DECEDENT FILE NUMBER BRUMBAUGH LEONARD B Include the proceeds oflitigation and the date the proceeds were received by the estate. All properly jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH TOTAL (Also enter on line 5, (If more space is needed, insert additional sheets of the same size) REV-1509 E%~ (I-9i.~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULEF JOINTLY•OWNED PROPERTY ti BRUMBAUGH LEONARD B If an asset was made joint within one year of the decedent's date of death, it must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME q. GARY L. BRUMBAUGH 11603 MYRTLE AVENU CAMP HILL, PA 17011 JOINTLY-OWNED PROPERTY: ADDRESS REATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY IncUde name of fnancal instAUlicn and bank arownt number ar similar idenGtying number. Attah deed (or jointN-held reel estate. DATE OF DEATH VALUE OF ASSE ', OF `~'S MEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST 1. A. >1996 CHECKING ACCOUNT 15,161.24 50. 7,560.62 TOTAL (Also enter on line 6, Recapitulation) I 5 ~ San a~ mare space is needed, insert additional sheets of the same HEV459IX~~19~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS RRIIMRAI_ICH LEONARD B Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t_ 0.00 B. 1 2. 3. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) NONE CLAIMED Social Security Number(s) I EIN Numberof Personal Representative(s) Street Address City State _ Year(s) Commission Paid: Attorney Fees AUSTIN F. GROGAN Fatuity Exemption: (If decedents address is not fhe same as claimant's, attach explanation) Claimant NONE Street Address City State Relationship of Claimant to Decedent q, Probate Fees 5, Accountants Fees B, Tax Relum Preparers Fees 7. zip Zip 0.00 500.00 0.00 0.00 0.00 TOTAL (Also enter on line 9, Recapitulation) I S more space is needed, insert additional sheets of the same size) r w REV-1670 EX (6-88) ~~~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 NAME Leonard B. Brumbaugh ANITA MCCULLY ITEM SCHEDULE NO. INHERITANCE TAX EXPLANATION OF CHANGES 2101-0352 101 EXPLANATION OF CHANGES Lineal heirs are taxable at the rate of 4.5% for dates of death on or after 07-01-2000. Row Page 1 FEV-151]EX •119]f COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE( DEBTS OF DECEDENT, GAGE LIABILITIES. & LIENS es I w I t ~r FILE NUMBER BRUMBAUGH LEONARD B Include unreimbureed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1. (SENIOR CARE OPERATORS OF SHIPPENSBURG 710.00 2. COMMERCIAL ACCEPTANCE CO. 404.50 ACCOUNT NO. 053006-26 3. COMMERCIAL ACCEPTANCE CO. 416.50 ACCOUNT NO. 053007-64 4. CHAMBERSBURG ADVANCED LIFE SUPPORT SERVICES, INC 336.00 ACCOUNT NO. CN0084405 5. CHAMBERSBURG ADVANCED LIFE SUPPORT SERVICES, INC 336.00 ACCOUNT NO. CN0084327 6. CHAMBERSBURG ADVANCED LIFE SUPPORT SERVICES, INC. 516.00 ACCOUNT NO. CN9902185 7. CLAREMONT NURSING & REHAB 1,210.00 ACCOUNT NO. 3984 8. CHAMBERSBURG HOSPITAL 534.00 ACCOUNT NO. 2901783 9. CHAMBERSBURG HOSPITAL 458.00 ACCOUNT NO. 2867661 10. CHAMBURSBURG HOSPITAL 25.00 ACCOUNT NO. 4260527 11. PULMONARY ASSOCIATES 187.83 ACCOUNT NO. 13399 12. DIAMOND PHARMACY SERVICES 20.00 ACCOUNT NO. 3984 13. ORTHOPEDIC ASSOCIATES 13.80 ACCOUNT NO. 1013510-/FB 14. CHAMBERSBURG IMAGING ASSOCIATES 6.20 ACCOUNT NO. C524422-03 TOTAL (Also enter on line 10, Recapitulation) $ 5,173.83 (If more space is needed, insert additional sheets of the same size) \ BUREAU OF INDIVIDUAL TAXES "`~~~ INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 AUSTIN F GROGAN A F GROGAN LAW OFFICE 24 N 32ND ST COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REY-1547 EX AFP [31-OS) DATE 11-24-2003 ESTATE OF BRUMBAUGH LEONARD B DATE OF DEATH 07-08-2000 FILE NUMBER 21 01-0352 .~. :' j COUNTY CUMBERLAND ACN 101 Amount Remitted MAKE CHECK PAYABLE AND REMIT PAYMENT T0: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CAMP HILL PA '17011 CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~ ---------------------------------------------------------------------------------------------------------------- REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF BRUMBAUGH LEONARD B FILE N0. 21 01-0352 ACN 101 DATE 11-24-2003 TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) .00 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) .00 credit to your account, 3. Closely Held Stock/Partnership Interest (Schedule C) (3) .00 submit the upper portion 4. Mortgages/Notes Receivable (Schedule D) (4) .00 of this fore with your 5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00 tax payment. 6. Jointly Owned Property (Schedule F) (6) 7,580.62 7. Transfers (Schedule G) [7) .00 8. Total Assets (g) 7,580.62 APPROVED DEDUCTIONS AND EXEMPTIONS: 500.00 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) 5,173.83 11. Total Deductions (11) 5.673.83 12. Net Value of Tax Return (12 ) 1 , 9 06.7 9 13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J] (13) .00 14. Net Value of Estate Subject to Tax (14) 1,906.79 NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17, 18 and 19 will reflect figures that include the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rate (15) •00 X 00 = .00 16. Amount of Line 14 taxable at Lineal/Class A rate (16) 1,906.79 X 045. 85.80 17. Amount of Line 14 at Sibling rate (17) .00 X 12 .00 18. Amount of Line 14 taxable at Collateral/Class B rate (18) •00 X 15 - .00 19. Principal Tax Due (19)= 85.80 reY r-ornrrA;. DATE NUMBER INTEREST/PEN PAID (-) AMOUNT PAID 05-05-2003 CD002524 12.26- 114.41 TOTAL TAX CREDIT 102.15 BALANCE OF TAX DUE 16.35CR INTEREST AND PEN. .00 TOTAL DUE 16.35CR ^ IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN Sl, NO PAYMENT IS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORK FOR INSTRUCTIONS.)