The URL can be used to link to this page

Home My WebLink About01-0519 PETITION FOR PROBATE and GRANT OF LETTERS Estate of ~V4. /t.14/ 1/ also known as ~ ~ st. "-y'" ~ A./ j '" ---.-.'- No. To: 21-01-519 Register of Wills for the . Deceased. County of CUMBERLAND in the Social Security No. l7l.( - c, 5" - "J c,A'J- Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut in the last will of the above decedent, dated D (I (-_ C1.iV1 1, ~.... .:2.1 and codicil(s) dated named , 19~ (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in County, Pennsylvania, with h last family or principal residence at i 0 (1 (') IA.-' QLI r~~.U-rt, CI'yClt:'T [yo l:>b Ho~ '0 c ~ d. It' e/.. I P /).. i Ii) (.3>> :,/ (list street, number and muncipality) /). 00 I Decendent, then ~C; years of age, died WI b.~ ;2 I , 19 at Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution oftpe 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 domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: .:l.$,o OD, DO , $ $ $ $ WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) theron. ""' '" 'tr u c: (l) -0 ""' Otn ~ (l) .... ~(l) c: -00 c:'O ro'~ 3~ (l) <- So <ii c: 01) en ~~J. ~~ R~MA IJ L. 5"rp I1J -'\JA1l.d Q I I ~'4(:~ f~;r,~/ 1;Y.r7;~'1 / OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF CUNBERLAND J 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 well and truly administer the estate according to law. ..~"f~ ~~/l~4/Y7/LUYt'LI Ih-c:;;gS- /a Sworn to or affirmed and before me this 31 s t MA C'-l ~. ::s l::l - s:::= ~ ~ No. 21-01-519 Estate of EVELYN V SHERMAN , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW JUNE 1 f9::2001 ,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 DECEMBER 21, 1982 described therein be admitted to probate and filed of record as the last will of EVELYN V SHERMAN TESTAMENTARY RONALD L BROWNAWELL and Letters are hereby granted to ~J7 (7 9f:(/~~L)L1P) ~4!1 ester of Wills FEES Probate, Letters, Etc. ......... Short Certificates( ).......... ..){-pag,es. KenUnClatlon ................ JCP $ 60.00 $ 15.00 $ 3.0Q $ 5.00 TOTAL_$ 83.00 . . . . . . . . . . . ~Y. .~ ~ , . ;Z Q Q L . . . . . . . . . ATTORNEY (Sup. Ct. 1.0. No.) ADDRESS Filed PHONE ~~~d J 110~.80~ R;~J;;!l is to certify that the information here given is correctly copied from an original certificate of death d~r filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent 1 mg. WARNING: It is illegal to duplicate this copy by photostat or photograph. No. 2i-~.~~~~ Local Registrar Fee for this certificate, $2.00 p 7401966 MAY 2 2 2001 Date 21-01-519 ..-:-- ~.r ~k\ t'l ~ (eoc\'. <1h~ ~~ ~e.~\ ..5 ~a.~\ l f,\1~, Hl05.;43 R.... 2IlI7 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH RlNT NAME OF DECEDENT (For... _. "_' I. Evel n Vi..ota Shellman AGE (l..llorlI>cleyI UNClEi'll YEAR UNDER I o.w -- c..,. -l-" SlATl 'I\.E_A ----- SEX SOC'Al SECUAITY NUMBEA 2. Female :I. 774 - OS DATE OF OEAfH ,_, c... ._. May 27,2007 'lENT INK ~.o .~I . __ Cumbellland ... Callti..-6le . DECEDENT'S USUAl. OCCUPRIOH ~":=:~"='::::zt.::r . . ilL La b OIl ell Il~ Manu6ac.tull-<.ng DECEDENT'S MAIUHG AODfIESS (SIr....~. s...l'lIl Codel DECEDENT'S ACTUAl. RESIDENCE (See trlIIruCIIllna on _ SIdeI SUfMV1HG SPOUSE I" _. gn.e"""""""", 17.. SIMa PPI'lI'lJ.y.Jual'lia Did - Ilww .. . -.aIlip? 17..00 ::"-=-=01 MOTHEA'S NAME IF.... _ _Sutrwne) It. Cec.ila Ri..c.h.llode tNfORMAHT"S MAIIJN$J AODfIESS~ ClIy/'bMl.~. Zip~l . 12 Cl-<.6ton Tellllac.e c-<.Ilc.~e PlACE OF IllSPOSmOH. ~ 01 C:-e<y. CramalClfy LOCRIOH. c~. -.. rop CCIde or OIlIer Place I.. He.D ..__.. lWIJ. Cumbelllnad Callti..-6te 1711. ""Y- M. 21. NJn' I: e.,.., the ....... iftiuriH Of' c:ornpIications which caused lhe ctealh. 00 not .nt... lhe mode 01 ct(mg, such as c.rdiac Of ,e..tory In"t, shoc1t or he." tailure. ""'""",__on.__. NO~ I :. d. WERE AUlOPSY FIHOIHGS ~LA8LE PAIClR 10 COUPLETlOH 06' CAUSE 06' DEATH? 2t. I AppI'oJum.t. '-- l--...,. I l PART .: Olher",- _c:onlribullng 10 "III. bul _.-;ng in'" ~_g;... in PNn I, DUE 10 lOA AS A CONSEOUENCE Of): HaluraI - jJ( o o DATE OF INJURV (lAonIIl. Day. _I TIME OF IHJUAY INJURV III WORK? MANNEA OF DEIIlH _ 0 No? . D No 0 __ 2.... CUIT_" ICI'<<* only one! "CUlTFYJNG PHYSICIAN lPI\y<sooan ee<1lIylng cauw "'<ld1ll _ ....,.... Ilfl...."", haSl>'ono'''lCOCl dea'" ana comOlelOCl "em 231 To..._ot....,.......Iedge..'""occu....._..lhocauH\.I_"'.n...'...'.t.........,.,........................................ _.. Suicide Could _bede.__ o o D 1'lACE000INJURV."'_.I......_.lactory._ M. ~-.ISpec"1 3Oe. Ham_ P-..g _lglO'ion 21. "~ING AND CEATIFYING ,"YSICIAN (~.... bol~ ;><"""""""'0 oeal11 and c""tfvo"9lO cauoe '" ""at~\ To 1M .... or My knowteclgft. deaU. occurrwcl.' ............ d.'.. .nd place. anet due to the cause(it anet mann., .. I.ated.. . . . . . . . . . . . . . . . . . . . . . . . . 'Jt/1) "MEDICAl EXAMlNIR/CORONER ~":::::::=.~~.~~~'~.~/~ ~~~~~'~~'.~~: ~~ ":.Y. ~~i.n.i~~: ~~~~~ ~~~~~~ ~~ ~~ ~I~~..~~'~: ~~.~I~~~: ~~.~~~ ~~ ~~ ~~~~~~~I.~~ 0 31.. REGISTRAR'S SIGNATURE AND NULlBE lat II~ \ to I 3.. w.. ~OO l ) 21-01-519 WILL AND 'TESTAMENT I, Evelyn V. Sherman of 309 Zion Road, South Middleton Township, CUmberland County, Pennsylvania, declare this to be my Will and Testarrent and revoke any Wills previously made by me. FIRST: I direct that all of my just d~bts and funeral expenses shall be p3.id fran the assets of my estate as soon as practicable after my death. SECOND: I give, devise and bequeath all of my property of whatever kind and wherever located to my son, RONAlD L. BROWNAWELL of R. D. 1, Boiling Springs, Pennsylvania, providing he survives me by 30 days. 'IHIRD: In the event that my son, RONALD L. BROWNAWELL, shall not be living m the 31st day following my death, I give, devise and bequeath all of my prop- erty of whatever kind and wherever located to my two grandchildren, RONDA LEE mOWNAWELL and CHRISTA LEE BROWNAWELL, both of R. D. 1, Boiling Springs, Pennsylvania, to be theirs absolutely, share and share alike. In the event that either of my granddaughters shall not survive me I give, devise and bequeath FORTH: I appoint my daughter-in-law, NANCY L. BROWNAWELL, of Boiling Springs, ~ ~ ..J ~\~ " <, , all of my property of whatever kind and wherever located to the survivor of them. Pennsylvania, as guardian of any property which passes under this Will to CHRISTA LEE BROWNAWELL in the event that she is under the age of 21 at the time of my fran time to time for her support and education (including college education, ~ "~' - I' death. Such guardian shall have the power to use the principal as well as incane 1:x>th graduate and tmdergraduate); to make payment for these purposes without further responsibility to the minor or any person taking care of the minor; and to tum over any remaining principal and accumulated income to CHRISTA LEE BROWNAWELL at such time as she reaches the age of 21. FIF1H: I appoint my son, RONALD L. BROWNAWELL, as executor of this Will and in the event that he shall fail to qualify or cease to act as executor for any reason I appoint CCNB Bank, N.A. as executor of this Will. SIX1H: I direct that no executor shall 'be required to give bond for the fai thful performance of his or its duties in any jurisdiction. IN WITNESS WHEREOF, I have heretmto set my hand this .;2-/ day of 122-t!... , 1982. [~~'f /1 j') . 6 t;-Pp-~erYnv. ~~ The preceding instrument consisting of this and one other typewritten page, identified by the signature of the testatrix, was on the day and date thereof signed, published and declared by Evelyn V. Sherman, the testatrix therein named, as and for her Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses thereto. 3/ ~sf I~f(f;~f sf Ce(~J5/e- / ~0v-~() \ \ .,.);1)~ (~ ~ K'\:)~J 'I 'i~]l\~J~~ - 2 - REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS codicil (each) a subscribing witness to the will presented herewith, (each) being duly qualified according to law, depose(s) and say(s) that present and saw the testat , sign the same and that signed as a witness at the request of test at in h presence and (in the presence of each other) (in the presence of the other subscribing witness(es)). Sworn to or affirmed and subscribed before me this day of 19_ (Name) (Address) Register (Name) (Address) REGISTER OF WILLS OF CUMBRRT.AND COUNTY OATH OF NON-SUBSCRIBING WITNESS --.i?oNA lei t.. I ;g Y-n U/ /I/~",v ell (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that he is familiar with the signature of , cv.../J; .n./ 1/, .s.h o:t r M. AA/ , ~ testattf'tr- of (one of the subscribing witnesses to) the will presented herewith and codicil that ~ e believes the signature on the will is in the handwriting of to the best of h { c I:I/,-I:? M t J S; ~ G.'r"'" III ~/ knowledge and belief. Sworn to or affirmed and sub~cribed before me this 31st day of MAY ~ 2001 7jy9PJ~f'k~#J.4:~ Register .~~ X!3 ~(p"J.h'fr (Name) ,,~ (lL/FloA/ tC.VYAt 0" C;l:}/{/,~/(,. 1119 1761.1 (Address) (Name) (Address) REGISTER OF WILLS OF COUNTY OATH OF SUBSCRIBING WITNESS ------"" ............. "'., / ;// col'ijcil (each) a subscribing witness to the will\presented herewi ,( each) being duly qualified according to law, depose(s) and say(s) that present and saw signed as a witness at the (in the presence of each other) (in the presence of the \ \ \ \ \ \ (Name) \ \ \ the testat , sign the same and that request of testat_ in h presenct;"in other subscribing witness(es)). I Sworn to or affirmed and subscribed' before me this / day of // 19_ \ \ \ \ \ \" , , (Address) / / /" / Register (Name) (Address) REGISTER OF WILLS OF CIlMRF.RT.AND COUNTY OATH OF NON-SUBSCRIBING WITNESS . N.4NCt, L, ~roIBNAI..J ell <7 (each) a subscriber hereto, (each) being duly qualified according to law, depose(s) and say(s) that she is familiar with the signature of Eve 1 yn V Sherm,qn modim testat~ of ~x_x:mec~~5x~xt()) the will presented herewith and codicil that she believes the signature on the will is in the handwriting of Evelyn V Sherman to the best of her knowledge and belief. //~ ~~ / (Name) Sworn to or affirmed and subscribed before me this 31st day of ~ MAY U2001 - - -'/r~~e~~4!J /17i1J",,,'1 Register (Address) (Name) (Address) ..- t:::- --- CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Evelyn Viola Sherman Date of Death: May 21,2001 Will No. 519 of 2001 Admin. No. 21-01-00519 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 June 27,2001. Name: Ronald Brownawell Address: 12 Clifton Terrace Carlisle, PA 17013 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except NONE Date: ~ -;).. 7 -0 I 717-258-3973 Tel. No. Capacity: X Personal representative Counsel for personal representative COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT BROWNAWELL RONALD L 12 CLIFTON TERRACE CARLISLE, PA 17013 -------- fold ESTATE INFORMATION: SSN: 174-05-3685 FILE NUMBER: 21 - 2001 - 051 9 DECEDENT NAME: SHERMAN EVEL YN V DA TE OF PAYMENT: 07/26/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: OS/21/2001 NO. CD 000086 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,372.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: RONALD BROWNAWELL CHECK# 483 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $1,372.00 MARY C. LEWIS REGISTER OF WILLS /6-013:3- /0 / REV-1500 EX + (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 DEPARTMENT OF REVENUE DEPT. 2B0601 INHERITANCE TAX RETURN FILE NUMBEA HARRISBURG, PA 1712B-0601 RESIDENT DECEDENT 21 01 519 COUNTVCODE YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER SHERMAN EVELYN VIOLA 174-05-3685 DECE- DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE DENT OS/21/01 01/29/1917 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 3. Remainder Return CHECK ~' Original Return ~' Supplemental Return 8 (date of death prior to 12-13-82) APPRO- 4. Umited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (dateof death after 12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Maintained a Living Trust B. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach acopyofTrust) BLOCKS 9. Utigation Proceeds Received 10. Spousal Poverty Credit (date of death between 0 11. Election to tax under Sec. 9113{A) 12-31-91 and 1-1-95) (Attach Sch 0) jjjj~~9fjQlijM~~PQMpg.'ttpiAUipbRRe$#6j.jp!1NP!1?iiibtlNi;jip!1NtiAtTAXiNi;jQ!jMAfiON'$ijbU!iQ~QI!l~!tQ:. NAME COMPLETE MAILING ADDRESS COR- RONAID BRCMNAWELL 12 CLIFTON TERRACE RE- FIRM NAME (If Applicable) CARLISLE SPON DENT PA 17013 TELEPHONE NUMBER 717-258-3973 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) None 2. Stocks and Bonds (Schedule B) (2) None_ 3. Closely Held Corporation_ Partnership or Sole-Proprietorship (3) None . 4. Mortgages & Notes Receivable (Schedule 0) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) (5) 28,542.00 6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested (6) None RECA- PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 16,073.00 y 8, Total Gross Assets (total lines 1-7) (8) 44,615.00 9. Funeral Expenses & Administrative Costs (Schedule H)(9) 8,715.00 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) (iO) 3,811.00 11. Total Deductions (total lines 9 & 10) (11) 12,526.00 12, Net Value of Estate (Line 8 mInus line 11) (12) 32,089.00 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value Subject to Tax (Une 12 minus line 13) (14) 32 089.00 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amountof line 14 taxable at the spousal tax rate, or transfers under Sec. 9116(a)(1.2) X .0 (15) TAX 16. Amount of line 14 taxable at lineal rate 32,089.00 X .0 45 (16) 1,444.00 - COMPU- 17. Amountofline 14taxableatsibring rate 0.00 X .12 (17) 0.00 TATION 1B. Amounlofline 14taKableatcoltaterafrate 0.00 x.15 (1B) 0.00 19. Tax Due (19) 1,444.00 20. 0 lififliicKHtl\jj:)FYdI:!Atllliji$!;lQtsfii.jq,4t1tfQi-IPPfA!iQV!1I!PAXMIlNf! ... ............ .... '. .'. . .>~ Bli: SURE TOANSWltR ALL QUESTIONS ON. PAGE ;: ANO RECHECK MATH.. . ..............'.>:,...... ....-...-'.-.-....-..........,...",.;..."-...,.;-;.,,,..-,.,.,.'.,.,.;.'-""""'",:" o PA15001 NTF 29755 Copyright 2000 GreatfandlNelco LP - Forms Software Only Estate of: EVELYN VIOLA SHERMAN 21-01-519 SUMMARY OF ALLOCATIONS 'ID BENEFICIARIES Taxable at lineal rate mNAlD L BRa'INAWELL 32,089.00 PA REV-1500 EX (6-00) Page 2 Decedent's Complete Address: STREET ADDRESS c/o RONAlD BRCmNAWELL 12 CLIFTON TERRACE CITY I STATE I ZIP CARLISLE PA 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Une 19) 2. Credits/Payments A. Spousal Poverty Credit S. Prior Payments C. Discount (1) 1,444.00 72.00 Total Credits (A + B + C) (2) 72.00 3. Interest/Penalty if applicable D. Interest E. Penalty (3) 0.00 (4) (5) 1,372.00 (5A) 0.00 (5B) 1,372.00 Total Interest/Penalty (D + E) 4. If Una 2 is greater than Une 1 + Une 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 line 20 to request a refund 5. If Une 1 + Une 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check to: REGISTER OF AGENT BY PLACING AN "X" IN THE APPROPRIATE Yes No ~ i B ~ 1. Did decedent make a transfer and: a. retain the use or income of the property transferred; . . . . . . . . . . , . , . . . . . . . . . . . . . b. retain the right to designate who shall use the property transferred or its income; ........... c. retain a reversionary interest; or. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . , . . . . d. receive the promise for life of either payments, benefits or care? .............,...,.,... 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . . . . . .. ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. Under penalties of perjUl)', I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and behef, it is true, correct and complete. Declaration of preparer other than the personal representative is based on information of which preparer has any knowledae. SIGNAT E OF PERSON SPONSIBLE FOR FILING RETURN DATE -;;L 3. 4. D ADDRESS See Schedule attached Si'tV~F PArV'~iER TfjA~ REPRESENTATIV~ ADDRESS F 0 BOX 668, CARLISLE, FA 17013 -kL' (l O,...ll..-' '1 ......-......-........................:.:.:-:.:.:-:.:.:-:...:.:.:.'.:.:.,.:.:.:.:.,.,.:.:.:.:.:.:.:-,-:.,-:.:.:.;.:.:.:.:.:-:.:.:....,-,.:.:.:.:.:-:-:.,.,.:<<-:-,. :"'::'::::':':'-':':"':"""':::"'::":'::"'::'"":":":':"::':":""",,:,:,,::,:,,:,,:::,,:,,:,:,":"':::"":",,:,,,,::,:,,:::::,:,::,::,,:,:,::,,:,"":':':"':'::":"':':':::':':':":::""':"::::":'::":-:":':::' :::":"""':'::":':".:::::,:.:,:,:"<:::":'::::':::::::":::':"":":'.:,:,:,:,:,:,:,:'::":':::'::":'::":""':""::':':':':':':':"'::'':-:"::'::':::':::::':":"::""':':::':':::':':'::'::':':"'::":"-:""':':':' :""':':':"""':':"':-,-:.,-:.:.:-,.,.:.,.:.:.,.:.:.:...... For dates of death on or after July 1, 1994 and before January 1. 1995. the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 P.S. II 9116{a)(1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate is imposed on the net value of transfers to Of for the use of the surviving spouse is 0% [72 P.S. Ii 9118 (a){1.1)(ii)]. The statute nn..", not "YArnnt a transfer to a surviving spouse from tax. and the statutory requirements for disclosure of assets and filing a tax return are stilt applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% 172 P.S.1I9116(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. Ii 9116(1.2) (72 P.S.1I9118(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. Ii 9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. o PA15002 NTF 29758 Copyright 2000 Greatland/Nelco LP - Forms Software Only Estate of: EVELYN VIOlA SHERMAN 21-01-519 '!he following person(s) are signing the return as representative(s) of the estate: RONAID L ~ 12 CLIFTON TERRACE CARLISLE, PA 17013 REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EVELYN VIOLA SHERMAN SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-01-519 Include proceeds of litigation & date proceeds were received by the estate. All prop. Jointly-owned with right of survlvorshla:l must be disclosed on Sch. F. ITEM VALUE AT NO. DESCRIPTION DATE OF DEATH 1 1,701. 00 PNe BlINK - Checking 2 FAHNESTOCK - PRIME CASH SERIES 26,841. 00 TOTAL (Also enter on line 5, Recapitulation) $ 28 542.00 7 CPA81 NTF 10908 Copyright Forms Software Only, 1997 Nelco, Inc. (If more space is needed, insert additional sheets of the same size) ^. .FT fMT CO ACTION '.oD CODE DDA STFD 40 OP PAGE 2 ACCOUNT 1 THF TRANSACTION STATEMENT FORMAT 01/05/29 9.07.41 50 MS 50852 ACTION COMPLETE SEARCH FROM 01/03/23 THRU 01/05(15 5140191171 SHORT NAME SHERMAN EVELYN V ACTN POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION * 05/03 695.00 C 1,840.21 00020011212618148 174053685A SSA SOC SEC US TREASURY 303 * 05/04 1583 51. 81 D 1,788.40 022636002 CHECK 1583 REFERENCE NO. 022636002 * 05/15 1584 87.45 D 1,700.95 024082998 CHECK 1584 REFERENCE NO. 024082998 PF: 4-TOP 5-BOTTOM 6-INQ 7-SB 8-SF 9-ASUM 10-TRIG ll-CUTO 12-XTFD -STSM DEPRESS Ctrl/F7 TO RETURN TO BANCSTAR E 7 FAHNE8TOCK ESTABLISHED 1881 _ .lhnestock & Co. Inc. 1015 Mumma Raad Wormleysburg, PA 17043 (717) 763-8200 (800) 722-2294 (717) 763-1765 FAX Members of All Principal Exchanges June 4, 2001 Ronald Brownawell 12 Clifton Terrace Carlisle, PA 17013 Re: A25-0028394 Dear Mr. Brownawell, In regards to your letter requesting the date of death value for Evelyn V. Sherman, the account value as of 5/21/01: $26,841.08 , j'; .i ..,.,;;.'l:;;' If you have any further questions, please do not hesitate to call. Very respectfully, . JlCLlL ~'-' IL( II i ,j.., Shana L. Morris Sales Assistant REV-151Q EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EVELYN VIOIA SHERMAN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-01-519 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. DESCRIPTION OF PROPERTY %OF EXCLUSION ITEM INCLUDE NAME OF THE TRANSFEREE, THEIR DATE OF DEATH DECD'S (IF TAXABLE VALUE RELATIONSHIP TO DECD & DATE OF TRANSFER. NO. ATTACH COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST APPLICABLE) 1 16,073.00 GLENBROOK LIFE ANNUITY - Contract # GA 109534 TOTAL (Also enter on line 7, Recapitulation) $ 16,073.00 7 CPAGI NTF 10910 (If more space is needed, insert additional sheets of the same size) Copyright Forms Software Only, 1997 Nelco, Inc. Glenbrook Life and Annuity Company P.O. Box 94212 Palatine, IL 60094-4212 GLENBROOK LIFE A Member of Allstate Financial Group July 5, 2001 Ronald L. Brownawell 12 Clifton Terrace Carlisle, PA 17013 Re: Contract Number: Claim Number: Evelyn V. Sherman GA 109534 GA12945 Dear Ronald L. Brownawell, We, at Glenbrook Life and Annuity Company, are sorry to hear of your loss and extend our sympathy. Enclosed please find a check in the amount of $16,170.16 for the proceeds payable under the referenced annuity This payment is computed as follows: Annuity Value as of 7/5/2001 Portion Payable to You: Federal Withholding: State Withholding: Total Net Proceeds: $16,170.16 $16,170.16 $0.00 $0.00 $16,170.16 This annuity is subject to federal income taxes (on non-qualified annuities, only the interest earned is taxable). A 1099 tax statement reflecting $3,670.76 as your taxable income will be sent next January to assist you in preparing your tax return for 2001. The annuity value on the date of death, 05/21/01 was $16,073.19, this may be necessary for estate purposes. If you have any questions or need further assistance, please contact me at 1-877-499-6418. Sifll;erely, .j~{(lo "1 l /'1 'v ;~} , -~:- Isela Balderas Life and Annuity Claims Enclosures REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF E\lELYN VIOLA SHERMAN SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-01-519 Debts of decedent must be re~rted on Schedule I. ITEM NO. A. FUNERAL EXPENSES: DESCRIPTION AMOUNT 1 FUNERAL 7,632.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) SOcial Security Number(s}/EIN No. of Personal Representative(s) Street Address City State 0.00 Zip Year(s) Commission Paid: 2. Attornev Fees 3. Familv 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 0.00 0.00 4. Probate Fees 0.00 5. Accountant's Fees 1,000.00 6. Tax Return Preparer's Fees 0.00 7 REGISI'ER OF WILlS-PROBATE FEES 83.00 7 CPA11 NTF 10911 Copyright Forms Software Only, 1997 Nelco, Inc. TOTAL (Also enter on line 9, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 8 715.00 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF EVELYN VIOlA SHERMAN Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-01-519 DESCRIPTION AMOUNT 1 CUMBERlAND EAR, NOSE, 'lliROAT 6.00 2 UCC HCMES, 'IODD lDIE 3,732.00 3 PHARMERICA- DRU:;S 73.00 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 3 811.00 Copyright Forms Software Only, 1997 Nelco, Inc. V'lJ'U... p.ND T:::ST}*~;;1\\'f ;:'-"velvn V. Sh~~:-'Ti1! Dt ',':,0<;1 Z:i.<:tl :::()ad, ~~:O',::t~i ".t1cUh'":('')J -,~.ry1'oL"1~~:I,),:':', Cl fih;;':O'};,"..n::: "::c:nt":.'. ::"~'r"ln;:;,/l~/f'lI1ia. c:V>:.::lr:.:>,'t'>: t:.'1.:U:; t-o be ru i.,'t}1 An,' TE"~?"':"~i+-'l1t, '::u:x: :.'e\lrn',(' ~iryJ .:: 1.~,~1 pr-:~,iic.t1.~,.lv J1B<,ie I~' r;lf:~. r::RS':-': I (;:ir%':,:; th.:.....t 1"11'1 ('.f r.~~ j:"..J':. df.::ht.::ian.:-l -funer'a1 ~.:;:e5 ~~~;",:..l; ,,,.C,.'.' fl"'~':n; t1:'JA.-:;! a.,o:;:,(>,e{'S o:f inv::-~tct-;~ 0;:.' SQ(m a-:-; ?r0.ct.~..cahlfl ,,If+,.m' FT-f c'.ea~r,. ':'.8Xt~): I cri~"C, .::.evc',se an::', ~.}..,';'i'~'. :"1.1 "'i ',-.'>{ :'!"~"'.! :-,~ 'd'J.l":','-',-:'" ":"(' ':nl -o\-c;~-rT";'('r In('~'1'~~,l:~~. ":'~' ;yo:;;- "t.n, n:J!"'.~,:l' .... ;:i~(;'1..!j,'.t-:,;': '!l .>..l' '-, 1. r'.:.j.:.s ,r.'; (~~"--:'t'i.1;Y ':'/:;':'\(,""vl,-":,--,;:,j" ;I"O"..r~l~:ir.rJ h'2 ., ".,:::,.,....:": '\..:', tw 3~) .it"'l'\."E. ~~;'l ~~K) ~,"d.-~1.i.. ~,}':<: )'. ':C~j.\ R(~\l';:'([) L. Pf<.i"'.Tl.r,~.r:~:,. [1~laIJ ",,;, ';-,';=' }j:'-.rLJli c. 'l<b,~ ?-,l '--~ ,,~ ' 0' ~~i;io.;',,,-(p::: '-. ";)It~: ''1,'E;-'. k,".1j'3~"', err~ ~.\(.;{.?__i.;:3"';"" ati ,''( ':~:>- ",,1,.-, ,,,,, :o....-~'; x>.c" '.;1~, "~""',-,,:'r" L". ':J.) ; y '<~~\:1 '.:..T'h:'Y.:k."oilO:'t.~'!,n;\'7:F~ ~,; "I.' }.',2:..-1 "',,/' '':'::PJ';;T'. 1/<::': r.'?:::::-r]" 'X';'." c:f(. D. ), :;'~~Ljy't,' ~~'~"IJ:"iJl,=L:'. '." \ "i.-5,.:1,", ,,' -j" :' p tJ"1:~ir;' f.l)C;.:"'~~-ct:-,:,l' ' !:,rd~ , ,F:,~"'--', j~;:" . . '1 '~~"::-; '.,'V?; '.' ....',.~ ~,..., T",~~,;"1rt',t-r-~,:"''''''.,,.11 ":'"t;-;"" ,.,...., ':y' :--:<.""'~' c, "tl-~ -;,' ...... "i'-' ',:" (~./ .,.~,,;,,~ ;,~ , in ~ ';ff", ..i :CV,;:'f' ',~':)c:",'~,-y! ,l) ";',,'-' ::'u-::':rt~,.~"":" C':." F'CF-,'i'd: I', .():i :;~.: rl;~, .~,\::-,'.: ;' '-'it!,-',; ~?:~L I )-( 1'>:li.l 'L:~ ,,-?' ~}-"~"V-'S:.r\V<:!t1E\ " ;;)5 ,).Jr.r~. ):~?n ,:,";.1 r,;I1V ;""'.:1:;<;"'" :,,~,' '.11~.'~~i' ;Ji.'(.;t;...:, pl'},--l;.;.-.'!'" i~U.::'; '411.11 -:1:: ";tf:.:1.:_ ~, '. tF:l' jY::O~:r-.\[JAFr.!. in 1h~ .'i)'v"':!..'7;'; "U1.~t ~~, :i~ t"l'-<"''f' tl'le ',',dE Qf 2} f<: th",' -t:i.m-:; of ~r1'-l ,-v~:t.h. :':'Li--:'~l (f,~"!. ..jt~; ':;r",;,"~;_l b"',,'~) -, ;',,' (.s: "':~l". "I;~'~,.',;.r;F.il ,:'i; ,,*~ll ,?..;.'5 t"1!"~L,.; \:.',." >.< ne['~:'.:n;",,: ":;Ii".:, 'y,.,,-,, (b,:;'.,}': '~,(:,ll';~~Ji'; .;:<Jvcat .t.."- \<' "..,-..)3t\~ un,~ ,:':,..m\il:'c:ldt.lZ<t~c:: t() 'i\:::;'~~ ;)i.l)'!',P.rl.t fcr -::tk:::::;;.;~ rll;.:::tX,;".U$ \\"j,;~:;~":t.:,: ""CS,-..on::.::..bil:i.t:V :n t:'le rm..ilOr Of' ,-?.:::1/ ~P'\-,O'~\ t.al~:ng ca:'C ,-,'[she IDlr;(,~{"':, ':>H L:r", ev!:/' axr; r€[;\:1i;lin':' p~~~~::.,~),;,<~ ,;",:' :'.c':':...m'1'>:~:f'!o,i il'Y~"Cf1C t"':-J c:::,'nST.~_ U:~"'.: ;:'uL at 5\."'-;> ":i7'" M sho\".;: re~oJ;.'tl<:;G ~:.h:_i:I a.-:::('! ef 21. :;~3~~[.):!: I ,,~ppo:,i.',' my ri:.{xl. !,:..'ON.'\1'/' to, Bffl:M"Lr,WE"tJ.., .;IS u<,,<ec"Utor (')f this t~'i.l] ('j;--'- ';0 1'!','ent '-.,;'"8t: he ;;)')<,1J.1 :ff.,~,l to 'lllal:t:f\' i)" n".;>Ise t-D."'.ct ?'S eX.eX",,''!.wr f"c' L",n:v re~,)~:..cr'J I ~,;:otn+: (i:::'~,~' ;?;,f':,.\:,. 'l./.. a~ ex."r.;';" .::t' this v}ill. i.::.1:::xv;C'': r~h~;:l ,:J e.;r:::'_ ":.:~.:X);:. -~),; ,,'~.l ":',-',: ';.' "i.(' ':-.,:';:y' .:'~'r 'i-F':' ',. :\.;111':.:': -..fi";"'.:c,\r\G2 C't' x..i.'~ <Jr' jt-,~-;;'::t'J':::':'f"! ;,c' j'x~:c.;(.~_:J.<.:~. ~'. ri',' ~'Tl-jF:;.'<'-': lfIiERI-n:', r ;..,,~v~ herco,'n+:o ~<..:. l-,;;>:yl Thi"';;2/ .:':::;": 0\" D~,,- '- _I:'{" ___si1::'k:d'/Jd__hL_ -,,'i6fL<<1'..iL!:L-__ :<:"VC1'./!1 v.. Cbqnhi."ln 'fl.,,'; j,"ll'<x.::'c.:0l.!".IIJ :.nstnl((,:'1t ccn~.:;i~~U:,-.<:.~ 0: thi~ .:ilcf (1\",; :::"cl,,~ 0Jj.l<:.,;.rciU:o.."tl. ~_\."j,~~-;;__:I idal..,i!':~i-::::':I 0:' tt:(~ 2i',Tli.t;Ll.;.\t' ,;.f:j,,:-! L;~st.a.tr:!./" lrkJi!. ,"':,"} i::~ (iflY- <'!i::~d Gi.t~ ~:1;;T'o.:",)f ~-,tLn:1j,d, jX.iblished r.,Gd d:: ,~1w:'.:.U by Evelyn ',,'-. ~-,-.:~ ft)'>;'l, 't:lv: tR-.;;.ti:i,t:~'i.::< ::~';:'l:y,L\ rl~:t'-'l':":O:", .e:,.s ,~).i for h.=r' Hill, t"1 t"k> r!"e3~-;c,:,::);f t'G, -,..1')0, at ~,Jc'::' l'(f~,:D:;;', -j r.ec ~r::'~-~:-.? anJ in tho-.... ~)re".{';lYX'_ of ecd"~ O':bec, ';-1a-Il\C' stt..""J;'Scr-t):x;~d ()I.~l' ::Jio'~,~~S <:'~', i'~'-Ltnessc:c-' t.hei:'C't.,). ,! {;/;arle> D /2. "'1 j"Jl, I Y_L.1:~"-5f j{",;f.d .<;1. _('"y h..k./~ 5!... Kar/" J /.1./; S,,; v ii'. f) #.2_ ,rl,!<..."j/~ f?, / 6-o-'7~~.A~'-/C> COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG. PA 17128-0601 NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX RONALD BROWNAWELL 12 CLIFTON TERR CARLISLE PA 17~13 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 09-03-2001 SHERMAN 05-21-2001 21 01-0519 CUMBERLAND 101 *' REV-1547 EX AFP 02-08> EVELVN v Allount Rellitted 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:i54j-Ei-AFP--fi2:0(..r-No'~"-icE--oF-'rtiHEifiTAiicE-TAx-jrpPRAisEii"ENT~--AiLOWAiicE-OR----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF SHERMAN EVEL VN V FILE NO. 21 01- 0519 ACN 101 DATE 09- 03-2001 TAX RETURN WAS: (X) ACCEPTED AS FILED ) CHANGED NOTE: I~ an assessment was issued previoUSly, lines 14, 15 and/or 16, 17, 18 and 19 will re~lect ~igures that include the total ~ ALL returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 16. Anount of Line 14 taxable at Lineal/Class A rate (16) 17. Allount of Line 14 at Sibling rate (17) 18. ADOunt of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 32,089.00 X 045 = 1,444.00 .00 X 12 = .00 .00 X 15 = .00 (19)= 1,444.00 RESERVATION 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 G) 8. Total Assets (ll (2) (3) (4) (5) (6) (7) .00 .00 .00 .00 28.542.00 .00 16.073.00 (8) APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Adll. Costs/Misc. Expenses (Schedule H) 10. Debts/Hortgage Liabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. Charitable/Governllental Bequests; Non-elected 9113 Trusts (Schedule J) 14. Net Value of Estate Subject to Tax (9) (10) 8,715.00 3.811.00 (11) (12) (13) (14) NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. 44,615.00 1?526 00 32,089.00 .00 32,089.00 TAX ~REDITS: PA YMTNT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 07-26-2001 CDOOO086 72.20 1,372.00 TOTAL TAX CREDIT 1,444.20 BALANCE OF TAX DUE .20CR INTEREST AND PEN. .00 TOTAL DUE .20CR . IF PAID AFTER DATE INDICATED, 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.) c STATUS REPORT UNDER RULE 6.12 Name of Decedent: Evelyn V. Sherman Date of Death: 5-21-01 Will No. 21-01-0519 Admin. No. 21 01 0519 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 reasonable believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties of interest? Yes 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: q - iJ...t -- 0 ,_ ,~~e/Z~o~~~ Signature Ronald Brownawell 12 Clifton Terrace Carlisle, P A 17013 Capacity: X Personal Representative Counsel for personal representative