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HomeMy WebLinkAbout01-0740 PETITION FOR PROBATE and GRANT OF LETTERS e:l1-OI - 71/0 Estate of MARY BRODHECKER MILLER also known as No. To: Register of Wills for the . Deceased. County of Cumberland in the Social Security No. 209-12-7~26 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 rix in the last will of the above decedent, dated Jul y 6 and codicil(s) dated None named ,~ 2001 (state relevant circnmstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h er last family or principal residence at Seidle Memorial Hospital. South Filbert Street, Borough of Mechanicsburg. Cumberland County, Pennsylvania 17055 (list street, number and muncipality) Decendent, then 94 years of age, died August 6 ,>>!) 2001 at Holy Spirit Hospital, East Pennsboro Township. Cumberland County, PA 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 domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: Unestimated $ $ $ $ None WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters Tes tamen tary (testamentary; administration c.La.; administration d.b.n.c.La.) theron. - Vl 'ij) u ::: Q) "'0- ._ Vl Vl_ Q).... c.:::Q) ::: "'00 r:: ";: roO: 3~ Q) ..... ::;0 ~ ::: OIl (;5 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA I ss COUNTY OF CUMBERLAND 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 an truly administer the estate according to law. 'J. Sworn to or affirmed and before me this 9tn A!USt (YJa1 C- fL-fi~ 1(P -:J. 4 q .- '7 subscribed { day of 1~ zOOl Register V:l ~. ;:s ~ .... l::: ~ ~. No. 21-01-740 Estate of MARY BRODHECKER MILLER , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW AUGUST 10 ~ 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 July 6, 2001 described therein be admitted to probate and filed of record as the last will of Mary Brodhecker Miller and Letters Testamentary are hereby granted to Julie Shover x-pages JCP Probate, Letters, Etc. ......... $ 235.00 (3 $ 9iQO Short Certificates ).......... Renunciation ................ $ $ 3.00 5.00 TOTAL _ $ 252.00 Filed ....... .AUGUST .10.,.2001 . . . . . . . . . . FEES (717) 697-8528 PHONE .~~ ~_~~. f-10_-0J This is to certifY that the information here given is correctly copied from an original certificate of death dl!l~ filed with me as Local R~gistrar. The original certificate will be forwarded to the State Vital Records Office for permanent lilmg. WARNING: It is illegal to duplicate this copy by photostat or photograph. 21-01-740 No. ~M~' l Ju.', t(d!~~ Local~R~glstrar Fee for this certificate, $2.00 p 7555585 ~~ ? dtJO/ Date Hl05. ;4JR.. 2187 COMMONWEALTH Of PENNSYLVANIA. DEPARTMENT Of HEALTH · VITAL RECORDS CERTIFICATE OF DEATH HPfJPRINT IN PERMAIOfNT BLACK INK z w ~ ~ a () w ~ . z . ... Cumber land DECEDENT'S USUAl OCCUPRION (~=:~~'::''::::.1.:::r II Clerical 1t~ state DECEDENT'S MAIUHG ADOAESS(Slr.....~. _. Z.,Code' 120 South Filbert street ... Mechanicsburg, PA 17055 FRltER.s NAME (firsl. _. LasII II, Frederck Mil ton Brodhecker 1Nf000000'S NAME (T ypelPrirWI 200. Julie Shover MeTHOD Of' IIlSPOSITIOH O IIuneIXl er_.... 0 ~ 0lIler~ 21L SlGHRUAEOf'~. ENSEE ORPE ~~- only- ~. noli av...... at ..me of dNIh to . -"'Y_olde..... Ie. Hill KINO Of' BUSlNESS/INOUSTRY STATE FIlE :<llIol8ER SOC'Al SECURITY HUMBER NAME Of DECEDENT If... Mod<lIe. Las, I.Mar Miller UNDER I YEAR ......... Oeye 2. Female 3. 209 - 12 - 7326 ...... ... t "",-" -. ""'''''''' <. - "". E OfF DEATH lCl>ec. only l)f'8.- -- '''''''.cia.. on'- - _ I loIInuIee ,.1.10"'/1. Day ....1 31aoe or Fcreq1 CounuYI HOSPITAL ! Nov 16 190 Lancaster PA Inpooa_ 00 . , ~ , k CITY. BORO. TWP Of DEATH FACILITY NAME (I' nol """,""""'. go.. ".eeI and num_, DENT'S ACTUAL RESIDENCE (5ee~ on 0111...... MARITAL STATUS.__ __iecl._. 0M0rced (SpeoIyI 14. Widowed I7C.O .....__.. SUlMYlHG SPOUSE \.-.--- 171t. Cmlber land llicl - 11M"'. .......7 ..... ~ ) '-- ~1~ - Ile., (.hi. J-~ DUE TO (OR AS A CONSEQUENCE Of): r- I q- 2311. _. VMS CASE REFERRED TO MEDICAL EXAMlHERICOAOHER7 .~ --.0 No a. t At>IlR>........ PART II: 0IIler 19'- _--.g 10 _. ... :__ _.-..g"Ihe~_giwoft..PNn I. .--- I : 0.-) C,HF A~ [ : '" ~ DUE TO (OR AS A CONSEQUENCE Of): DUE TO (OR AS A CONSEQUENCE Of): ..~ \ WERE AUTOPSY FlNDlNQS -...&lE PfllOR 10 COMPlETION OF CAUSE Of'DEATH7 ::ROf~ Ace_ 0 _...., 0 OATE Of INJURY (Mont/l. Day. ""at, TIME Of INJURY INJURY fa WOftK7 DE5CRIlIE HOW INJURY OCCUflRED Homoeide o o o PlACE OF INJURY _ Ai _. Wlft, .......Iactofy. _ M. building, _. ISpec~.1 _. .... 0 NoD Pendong ~Iion NoD lA' I t;21 I L..<t o Could nul be delennanea :n, 34. LAST WILL AND TESTAMENT I, MARY BRODHECKER MILLER, of the Township of Hampden, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give and bequeath my highboy chest of drawers unto JULIE SHOVER, absolutely. THIRD. I give and bequeath my desk unto MARK MENDLOW, absolutely. FOURTH. I give, dev i::;e and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, in equal shares, unto my three (3) nieces, namely, CYNTHIA START, BARBARA McCACHREN IGNASIAK and HELEN McCACHREN KROSS, share and share alike, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my friend, namely, JULIE SHOVER, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint PNC BANK, NATIONAL ASSOCIATION, to be the Executor hereof, each and both to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, MARY BRODHECKER MILLER, have LAW OFFICES SNELBAKER. BRENNEMAN 8: SPARE hereunto set my hand and seal to this my Last Will and Testament, to which I have affixed my signature this 6th day of July, A.D. Two Thousand One (2001). th4~~ Mary Brodhecker Miller (SEAL) The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by MARY BRODHECKER MILLER, the Testatrix therein named, as and for her Last Will and Testamentl in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. ~q,&; COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) We, l\1ARYBRODHECI{ER MILLER, RICHARD C. SNELBAKER and JANE J. COONEY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. ~itn~' ~ LAW OFFICES SNELBAKER. BRENNEMAN 8. SPARE Subscribed, sworn to and acknowledged before me by MARY BRODHECKER MILLER, the Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. COONEY, the,witnesses, this 6th day of July, 2001. No18ri8I88eI .1 ~ L. zYch. NoI8ry Put*: ~ MId.. &~~"Id~. My EJcpII88 Now. 24. ~. -el~' ?JrA E""" CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Mary Brodhecker Miller, Deceased Date of Death: August 6, 2001 No. 2001-00740 PA No. 2101-0740 To the Register: I certify that notice of beneficial interest 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 or about August 15, 2001: Name Address Julie Shover 344 Andersontown Road Mechanicsburg, P A 17055-6024 Barbara Ignasiak 11 Toponce Pocatello ID 83204 Cynthia Start 40 Marta Drive Wilmington, DE 19808-4854 Helen Kross 3715 40th Avenue W Bradenton, FL 34205-2353 Mark Mendlow 532 Altavista Avenue Harrisburg, P A 1 'Z109 -.. Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: NONE. Date: August 15, 2001 . hard C. Snelbaker, Esquire 44 West Main Street Mechanicsburg, P A 17055-0318 (717) 697 -8528 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND } 55: Julie Shover being duly sworn according to law, deposes and says that sne ; $ th~ BY~("l]t,....; Y of the Estate of Mary Brodhecker Miller late of MAchanics~B_o~o_ugh , Cumberland County, Pa., deceased and that the within is an inventory made by .Tulie Shover _, the said Executrix of the entire estate of said decedent, consisting of all the personal prop~rty and real estate, except real estate outside the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value as of the date of decedent's death. ~W() Y'Tl and subscribed before me, ~ ;~Iu~' . / f: Executor. Administrator October 16 Xl& 2002 SOAdLv K ~~~ Julie Shover Notartat seat Sandra K. Showers, Notary MechanicsbuI'Q Boro, Cumberland My CommissIOO Expires Nov. 22, Manber, PennStVlvP.\'I~ A~~ nt "tr-+,~,,~~ 6th August Date of Death 2001 Day Month Year INSTRUCTIONS I. An inventory must be filed within three months after appointment of personal representative. 2. A supplement inventory must be filed within thirty days of discovery of additional assets. 3. Additional sheets may be aHached as to personalty or realty 4. See Article IV, Fiduciaries Act of 1949. . 0 . A.. .. Q) ~ ~ >- G) co to- W tit 0. >- 0::: to- Ia CI) 0 W < Q) .:::r ~ a.. to- u G) ~ t- O 0 ton Q) C\ >- 0 w 0::: w C .., ~ G) , ..... J: a.. Q. CO c to- ...J LL Ia ~ ~ r-i Z < 0 0 0 LL ...J Q. :s: , w < w ~ ...--l > 0 0::: >. ~ < N Z - Q) Z 0 c ~ C :3 ci ton Z 0 co C! U Z w < ... .. a.. ""'C ~ c Q) .., ~ - I: 0 Q) ~ ..0 ""'C -"l: rl Q) E 0 Q) - ..! .., :3 0 ~ ...J U u: all CI) Inventory of the real and personal estate of MARY BRODHECKER MILLER, Deceased PERSONAL TY: 1 Cash found in Decedent's residence 2 Proceeds from sale of miscellaneous coins and currency 3 Proceeds from sale of jewelry 4 Mahogany Highboy Chest of Drawers, appraised value 5 Curley Maple Slant Lid Desk, appraised value 6 Merrill Lynch CMA Investment Account, account #872-44761 which consisted of the following: a. Cash. $271,286.29 b. WHX Corp., 100 shares. $635.00 c. Urstadt Biddle PPTIES MD - 150 shares. $1,312.50 d. Urstadt Biddle PPTIES A. 150 shares - $1,222.50 e. PPL Corporation - 200 shares - $8,702.00 f. Pennzoil-Quaker State. 1,468 shares - $16,397.56 g. Merrill Lynch & Company. 1,000 shares - $28,340.00 h. Harsco Corp., - 300 shares. $9,081.00 i - DQE - 150 shares - $3,340.50 j. Fed Nat'L Mortgage Assoc, Gov. Security. 50,000 shares - $50,023.50 7 Mellon Bank, checking account #142-632-3190 8 United States Fidelity and Guaranty Co., premium refund on policy #HOM30934942506 9 Verizon, refund on account #7177610367 10 The Patriot-News, refund due on subscription 11 County Meadow Associates, refund due on resident care 12 AFLAC, premium refund on policy #OA173906 13 State Employees Retirement System, final pension payment TOTAL PERSONALTY: REAL ESTATE: Decedent owned no Real Estate at the time of her death TOTAL PERSONALTY AND REAL ESTATE: Page 1 $ 366.98 30.50 132.00 300.00 1,200.00 390,340.85 4,580.87 12.00 .1.76 5.40 :~,291.94 23.85 112.15 $ 399,393.39_ $ 0.00 $ 399,398.30 ESTATE NO. 21-01-0740 FIRST AND FINAL ACCOUNT AND STATEMENT OF PROPOSED DISTRIBUTION OF AND BY JULIE SHOVER, EXECUTRIX OF THE ESTATE AND UNDER THE LAST WILL AND TESTAMENT OF MARY BRODHECKER MILLER, DECEASED, LATE OF THE MECHANICSBURG BOROUGH, CUMBERLAND COUNTY, PENNSYLVANIA Julie Shover, Executrix as aforesaid and Accountant herein, avers as follows: DATE OF DECEDENT'S DEATH: DATE LETTERS TESTAMENTARY ISSUED: August 6. 2001 August 10, 2001 DATES EXECUTOR'S NOTICE ADVERTISED: Cumberland Law Journal Patriot-News Co. r ---- August 24,31, September 7,2001 August 21,28, September 4,2001 FIRST AND FINAL ACCOUNT PERSONALTY - PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of the Decedent's Personalty, goods and chattels as set forth in her inventory heretofore filed in the amount of: The Accountant claims the following additional receipts: 1. United States Treasury, refund on final Individual Income Tax Returns 2. Commonwealth of Pennsylvania, refund on Inheritance Tax 3. Gain on the sale of Urstadt Biddle PPTIES A, 150 shares TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, DEBITS: PERSONALTY - PRINCIPAL ACCOUNT CREDITS LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE The Accountant claims credit for the payment of the following items from Decedent's Personalty Account: 1. Commerce Bank, check printing fee 2. Pinnacle Health, short term resident care 3. Pinnacle Health, medical services 4. Malpezzi Funeral Home, funeral services 5. Chuck Bricker, appraisal fee 6. Register of Wills, Agent, estimated Inheritance Tax payment 7. Mumma's Jewelry, appraisal fee 8. Quantum Imaging & Therapeutic Assoc., Inc., medical services 9. Gingrich Memorials, memorial headstone 10. Register of Wills, filing fee for Inheritance Tax Return 11. Register of Wills, Agent, Inheritance Tax 12. Register of Wills, additional probate fee 13. Merrill Lynch, annual brokerage fee 14. The account claims a loss on the sale of the following securities held in the Merrill Lynch account: a. WHX Corp, 100 shares b. Urstadt Biddle PPTIES MD. 150 shares c. PPL, 200 shares d. Pennzoil-Quaker State, 1,468 shares Page 1 175.37 65.90 2,403.53 304.29 $399,398.30 749.00 118.42 112.60 $400,378.32 $ 16.00 1,351.00 18.34 7,708.90 30.00 45,000.00 50.00 73.91 845.00 15.00 5,487.61 70.00 125.00 4,714.19 e. Merrill Lynch & Company, 1,000 shares f. Hasco Corp., 300 shares g. DQE, 150 shares h. Fed Nat'l Mortgage Assoc., 50,000 shares The following items are to be paid subsequent to confirmation of accounting: 15. Julie Shover, Executrix Commission 16. Julie Shover, Power of Attorney services from February 2000 to August 6, 2001 17. Snelbaker, Brenneman & Spare, P.C., attorney services 18. Snelbaker, Brenneman & Spare, P.C., costs advanced a. Register of Wills, probate fee b. Cumberland Law Journal, advertising Executrix Notice c. The Patriot-News, advertising Executrix Notice d. Register of Wills, short certificates e. Vital Records, death certificate for Charles Brodhecker 19. Reserve for filing fees, accounting fees and other costs associated with the administration of Decedent's estate. TOTAL, PERSONALTY, PRINCIPAL ACCOUNT, CREDITS: PERSONALTY. INCOME ACCOUNT DEBITS The Accountant charges herself with the receipt of the following Income from the investment of Personalty Principal: 1. Merrill Lynch, dividends deposited into investment account 2. Merrill Lynch, investment account, interest TOTAL, PERSONALTY, INCOME ACCOUNT, DEBITS: PERSONALTY - INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items from the Personalty Principal Account: 1. PA Department of Revenue, 2001 Individual Income Taxes 2. Greenawalt & Company, P.C., preparation of 2001 Individual Income Tax Returns TOTAL, PERSONALTY, INCOME ACCOUNT, CREDITS: REAL ESTATE - PRINCIPAL ACCOUNT DEBITS The Accountant charges herself with the receipt of Decedent's Real Estate as set forth in her Inventory heretofore filed in the amount of: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, DEBITS: REAL ESTATE - PRINCIPAL ACCOUNT CREDITS LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE The Accountant claims credit for the payment of the following items from Real Estate Principal Account: TOTAL, REAL ESTATE, PRINCIPAL ACCOUNT, CREDITS: Page 2 315.28 961.62 458.73 29.47 252.00 75.00 113.10 6.00 28.00 19,500.00 1,450.00 16,000.00 474.10 2,000.00 $104,929.05 $ 2,405.13 6,134.49 $ 8,539.62 $ $ 80.00 230.00 310.00 $ NONE $ NONE $ NONE $ NONE LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE REAL ESTATE. INCOME ACCOUNT DEBITS The Accountant charges herself with the receipt of the income from the investment of Real Estate Principal Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, DEBITS: $ NONE $ NONE REAL ESTATE. INCOME ACCOUNT CREDITS The Accountant claims credit for the payment of the following items From the Real Estate Income Account: TOTAL, REAL ESTATE, INCOME ACCOUNT, CREDITS: $ NONE $ NONE Page 3 RECAPITULATION PERSONALTY: PRINCIPAL ACCOUNT: Debits $400,378.32 Credits $104,929.05 Balance $ 295,449.27 INCOME ACCOUNT: Debits $ 8,539.62 Credits $ 310.00 Balance $ 8,229.62 TOTAL PERSONALTY $303,678.89 REAL ESTATE: PRINCIPAL ACCOUNT: Debits $ NONE Credits $ NONE Balance $ NONE INCOME ACCOUNT: Debits $ NONE Credits $ NONE Balance $ NONE TOTAL REAL ESTATE: 0.00 TOTAL FOR DISTRIBUTION: $303,678.89 LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE Page 4 LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE COMMONWEALTH OF PENNSYLVANIA) SSe COUNTY OF CUMBERLAND) Julie Shover, being duly sworn according to law deposes and says: that she is the Executrix of the Estate and under the Last Will and Testament of Mary Brodhecker Miller, Deceased; that she is the Accountant herein; that the foregoing is a true and complete accounting of her administration of said Estate; that the attached list or schedule [*] contains the names, addresses and amounts due unpaid creditors who have given proper notice of their claims; that the attached list or schedule [**] contains the names and addresses of all persons interested in the distribution of said Estate; and that the facts set forth herein are true and correct to the best of her knowledge, information and belief. ~/ (9)1e Shover, Executrix Sworn to and subscribed before me this 16thday of October 2002 SQJldA~ ~ ~~ Notarial Seat Sandra K. Showers, Notary Public My~ Boro, Cumbertalad ~ Convnisslon expires Nov. 22, 2003 Membsr, PBrm~vf\"l:m!'~ ^~r.f~ of Mr"lo~~"" Page 5 LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE * UNPAID CREDITORS: ** PERSONS INTERESTED IN DISTRIBUTION OF ESTATE: 1. Julie Shover 344 Andersontown Road Mechanicsburg, PA 17055 2. Mark Mendlow 532 Altavista Avenue Harrisburg, PA 17109 3. Cynthia Start 40 Marta Drive Wilmington, DE 19808.4854 4. Barbara Ignasiak 11 T oponce Pocatello, ID 83204 5. Helen Kross 3715 40th Avenue W Bradenton, FL 34205.2353 Page 6 NONE LAW OFFICES SNELBAKER. BRENNEMAN Be SPARE STATEMENT OF PROPOSED DISTRIBUTION Julie Shover, Executrix and Accountant herein, proposes to distribute the balance of the Estate of Mary Brodhecker Miller, Deceased, to wit: $303,678.89 in accordance with the Last Will and Testament of said Decedent as follows: 1. TO: Julie Shover Mahogany Highboy Chest of Drawers, per Item Second of Will $ 300.00 2. TO: Mark Mendlow Curley Maple Slant Lid Desk, per Item Third of Will 1,200.00 3. TO: Cynthia Start 1/3 of residue as per Item Fourth of Will 100,726.29 4. TO: Barbara Ignasiak 1/3 of residue as per Item Fourth of Will 100,726.30 5. TO: Helen Kross 1/3 of residue as per Item Fourth of Will 100,726.30 TOTAL DISTRIBUTION: $303,678.89 Page 7 LA W OFFICES SNELBAKER. BRENNEMAN Be SPARE COMMONWEALTH OF PENNSYLVANIA) COUNTY OF CUMBERLAND: Julie Shover, being duly sworn according to law, deposes and SS. says that the facts set forth in the foregoing Statement of Proposed Distribution are true and correct to the best of her knowledge, information and belief. Sworn to and subscribed before me this16th day of October 2002 ~QAcLe t: ~ Notarial SaaJ Sandra K. Showers, Notary Pubftc ~~~22,~ Member, ~ ~.~JM nf" Page 8 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 SNELBAKER RICHARD C 44 W MAIN STREET MECHANICSBURG, PA 17055 -------- fold EST A TE INFORMATION: SSN: 209-12-7326 FILE NUMBER: 21-2001- 0740 DECEDENT NAME: MILLER MARY BRODHECKER DA TE OF PAYMENT: 10/31/2001 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/06/2001 NO. CD 000460 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $45,000.00 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: RICHARD SNELBAKER ESQUIRE CHECK#105 SEAL INITIALS: AC RECEIVED BY: REGISTER OF WILLS $45,000.00 MARY C. LEWIS REGISTER OF WILLS 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 SNELBAKER RICHARD C 44 W MAIN STREET MECHANICSBURG, PA 17055 _n_____ fold ESTATE INFORMATION: SSN: 209-12-7326 FILE NUMBER: 2101-0740 DECEDENT NAME: MILLER MARY BRODHECKER DA TE OF PAYMENT: 05/02/2002 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/06/2001 NO. CD 001140 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $5,487.61 I I I I I I I I TOTAL AMOUNT PAID: REMARKS: JULIE SHOVER C/O RICHARD C SNELBAKER ESQ CHECK# 113 SEAL INITIALS: SK RECEIVED BY: REGISTER OF WILLS $5,487.61 MARY C. LEWIS REGISTER OF WILLS L6-C:;4/?- 7 ~ BUREAU O{INDIV{DUAL TAXES \, INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX STATEMENT OF ACCOUNT * REY-1U7 EX AFP lOl-02) 'o/. RICHARD C SNELBAKER SNELBAKER ETAL 44 W MAIN ST l: MECHANICSBURG P~~17B55 1 ~.~ I :\ 5 DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN 07-15-2002 MILLER 08-06-2001 21 01-0740 CUMBERLAND 101 Allount Rellitted MARY B MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYllent. CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS ~ REv=iiiifj-Ex--AFP--coi-:021-------...-iNifERITANcE"-iAx--STA-fEME"tii-OF-ACCOljtif--.-..--------------------- ESTATE OF MILLER MARY B FILE NO.21 01-0740 ACN 101 DATE 07-15-2002 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: 06-03-2002 P R I NC I PAL TAX DU E : ..............................................................................................................-......................................................................................................... 52,737.61 PAYMENTS (TAX CREDITS): PAVMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) 10-31-2001 CDOO0460 2,368.42 451000.00 05-02-2002 CDOO1140 .00 5,487.61 06-26-2002 REFUND .00 118.42- TOTAL TAX CREDIT 521737.61 BALANCE OF TAX DUE .00 INTEREST AND PEN. .00 . IF PAID AFTER THIS DATEI SEE REVERSE TOTAL DUE .00 SIDE 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. ) \/6-02-Y9-7 BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG I PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX DATE ESTATE OF DATE OF DEATH FILE NUMBER }\ 8 :CCOUNTY ACN 06-10-2002 MILLER 08-06-2001 21 01-0740 CUMBERLAND 101 '02 JUr~ 1 7 RICHARD C SNELBAKER SNELBAKER ETAL 44 W MAIN ST MECHANICSBURG l..'.. PA 17 05~~Vrrl:, '* REV-1547 EX AFP (01-021 MARY B Allount Rellitted ) CHANGED (1) (2) (3) (4) (5) (&) (7) .00 .00 .00 .00 3991286.15 .00 112.15 (8) 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 ~ REY=is4-j-ix-AFP--col-:02i--No'fici--oF-i-tiHEifiTANci-TAx-jrPPRAisiifEN:r,--AL1-owANci-cfi----------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX ESTATE OF MILLER MARY B FILE NO. 21 01-0740 ACN 101 DATE 06-10-2002 TAX RETURN WAS: (X) ACCEPTED AS FILED 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) s. Cash/Bank Deposits/Misc. Personal Property (Schedule E) &. Jointly Owned Property (Schedule F) 7. Transfers (Schedule G) 8. Total Assets 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 If an assessment was issued previOUSly, lines 14, 15 and/or 16, 17, 18 and 19 will reflect figures that include the total of ~ returns assessed to date. ASSESSMENT OF TAX: 15. Allount of Line 14 at Spousal rate (15) 1&. Allount of Line 14 taxable at Lineal/Class A rate (1&) 17. Allount of Line 14 at Sibling rate (17) 18. Allount of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due NOTE: 44,841.00 2.973.25 CllJ Cl2) Cl3) Cl4) (9) ClO) .00 X 00 = .00 X 045= .00 X 12 = 351,584.05 X 15 = NOTE: To insure proper credit to your account, subllit the upper portion of this forll with your tax paYMent. 399,398.30 47.814 25 351,584.05 .00 351,584.05 (19)= .00 .00 .00 52,737.61 52,737.61 TAX CREDITS: .- ft. '-I~n I R~,,"~"''-I I (+) AMOUNT PAID DATE NUHBER INTEREST/PEN PAID (-) 10-31-2001 CDOO0460 2,368.42 45,000.00 05-02-2002 CDOOl140 .00 5,487.61 TOTAL TAX CREDIT 52,856.03 BALANCE OF TAX DUE 118.42CR INTEREST AND PEN. .00 TOTAL DUE 118.42CR . 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.) 0~K STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mary Brodhecker Mi ller Date of Death: August 6, 2001 Will No.: 21-01-0740 Admin. No.: Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes Gl No 0 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to No.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes]{X No 0 b. The separate Orphans' Court No. (if any) for the personal representative's accouht is: c. Did the personal representative state an account informally to the parties in interest? Yes 0 No 0 c. Copies of receipts, releases, joinders and approval of formal or informal accounts may be filed w. the Clerk of the Orphans' Court and may be attached to this re rt. Date: ----5.D.OjO 3 \tel c,;._!l?pequUl::} \1181:1 Richard c. Snelbaker Name Snelbaker, Brenneman & Spare, P.C 44 West Main Street Mechanicsburg, PA 17055 Address (717) 697-8528 Telephone No. _0 ,:~':;;,l:;~;~fjacity: 0 Personal Representative ~ Counsel for personal representative LV: Ol\l lZ A.VW fOe ~ REV-1500 EX. (6-00) OFFICIAL USE ONLY COMMONWEALTH OF PENNSYLVANIA REV-1500 /0-0249- 7 . DEPARTMENT OF REVENUE DEPT. 260601 INHERITANCE TAX RETURN FILE NUMBER HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 2001 0740 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER DECE- Miller, Mary Brodhecker 209-12-7326 DENT DATE OF DEATH (MM-DD-YEAR) I DATE OF BIRTH (MM-DD-YEAR) THIS RETURN MUST BE FILED IN DUPLICATE 08/06/01 11/16/1906 WITH THE REGISTER OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER ~ 3. Remainder Return CHECK 1. Original Return ~' Supplemental Return B (date of death prior to 12-13-82) APPRO- 4. Limited Estate 4a. Future Interest Compromise 5. Federal Estate Tax Return Required (date of death after 12-12-82) PRIATE 6. Decedent Died Testate 7. Decedent Mainta'lned a Living Trust 0 8. Total Number of Safe Deposit Boxes (Attach copy of Will) (Attach acopyofTrust) BLOCKS 9. Litigation 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 Seh 0) jjjl$$~~Mli$tj,jjgp~@ifilb;Al.ikIMmID$$P9@Il~~i@I~tiQt!rtiNij"AKjijl\Qi\M*'tjpj\ji$HQ!lWilmtij\'l~fjjptoi NAME COMPLETE MAILING ADDRESS COR- Richard C. Snelbaker 44 West Main Street RE- FIRM NAME (If Applicable) Mechanicsburg, PA 17055 SPON DENT Snelbaker, Brenneman & Spare, P.C. TELEPHONE NUMBER 717-697-8528 OFFICIAL USE ONLY 1. Real Estate (Schedule A) (1) None 2. Stocks and Bonds (Schedule B) (2) None 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule 0) (4) N=- ~ ~ I.. , 5. Cash, Bank Deposits & Miscellaneous Personal ~ -. c:i Property (Schedule E) (5) 399,286.;!i5: "'-' 6. Jointly Owned Property (Schedule F) 0 None :z.- Separate Billing Requested (6) -< RECA- I N PITULA- 7. Inter-Vivos Transfers & Miscellaneous TION Non-Probate Property (Schedule G or L) (7) 112.15 ,. Total Gross Assets (total Lines 1-7) (8) '~") 399,398.30 8. --.J 9. Funeral Expenses & Administrative Costs (Schedule H)(9) 44,841. 00 10. Debts of Decedent, Mortgage Liabilities, & liens (Schedule I) (1 0) 2,973.25 11. Total Deductions (total Lines 9 & 10) (11) 47,814.25 12. Net Value of Estate (Line 8 minus Line 11) (12) 351,584.05 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax (13) None has not been made (Schedule J) 14. Net Value Sublect to Tax (Line 12 minus Une 13) (14) 351,584.05 SEE INSTRUCTIONS ON PAGE 2 FOR APPLICABLE RATES 15. Amountof Line 14 taxable at the spousal tax rate, ortransfersunderSec. 9116(03.)(1.2) X .0 (15) TAX 16. Amountof Line 14 taxable at lineal rate 0.00 X .0 45 (16) 0.00 0.00 - 0.00 COMPU- 17. Amount of Line 14 taxable at sibling rate X .12 (17) TATION 18. Amountof Line 14 taxable at collateral rate 351,584.05 )( .15 (18) 52,737.61 19. Tax Due (19) 52,737.61 20. []: Iq!:\el;:i(llell~!fYQ(jARj;jlj;I'l!lj;$TII!illAjl~l!Pl:mAil'QvellpA_!rtil c...v >~.BE. SUIlE. TO ANSWEil ALIL' QUE$TfON$ ON 'PAGE ia AND RECHECK MATH<< o PA15001 NTF 29755 Copyright 2000 Greatland/Nelco LP- Forms Software Only PA REV-1500 EX (6-00) .Decedllnt's Com lete Address: STREET ADDRESS Seidle Ho ital, 120 S. Filbert St. Page 2 Mechanicsb CITY Mechanicsb Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Boro., OJmber land Ct STATE PA ZIP 17055 (1) 52,737.61 45,000.00 2,250.00 Total Credits (A + 8 + C) (2) 47,250.00 3. Interest/Penalty if applicable D. Interest E. Penalty TotallnterestJPenalty (0 + E) 4. If Line 2 is greatar than LW.8 1 + Une 3, enter the d\'!'fnrence. This is ~hc OVERPAYMENT. Check box on Page 1 LIne 20 to request a refund 5. If Line 1 + Une 3 \s 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 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT (3) 0.00 (4) (5) 5,487.61 (SA) 0.00 (58) 5,487.61 :;"::',::::~':<?:':?>::;:::':{;::::::::>:"}{:::::::::'::?')/:::::',:::?}:,;,;:::",,':':)):/::;,::,)));::;,:::}:,::;,::}):{:,:',::"'/:\):;,:::::':::::}):;::,::::,':::):::::/:;:::':::))}:'::::':::))):: ~:':::/::)):;:::/:::::::~;;::: ......::',':';,-.;,;...':.;.,:.;':';-,."::-;':.:-;;-;,-.:-:.'::.':':';-.;.:,:-;.':"';':':':"-,-';.-.;:'.':".,.::,:,;,-,::,..::-.:-:::;,::-;-":-:-:",,,',.'::,':".:.,.:-,.:.:.,:,:..,,:.;.:.:-;.,.:.,:,: .-,,::;.,,:.;"";,-.:',.":",':';-"::--,;';,-.:',.,:,:.;,::-:';.,,:,:.,::-.;,:.,:,;",;,:--,:,.:.::;.".-,:,;,-,;,. PLEASE ANSWER THE FOl-Li:)WING QllI::STIONS BY PLACING "-'--"."-',",-,'-,'-'.'.'-',-,'-,-","-'-"-',','-,-"'-'.'-",','-,"'.'-'.'.'.'-,-,'--'-'.'.'-'-,-'-,-,".,.,-,.-""-,-,...-"..,, ,;';:::::::':::'::':"::"",,::::,,:'::,:,:,,',,:,:::::,,},:,:,;;,;,:::::;,:::':,:,,:,:::::::::::,:',=:';::'::::,,::::",:,:::",::,::,:",::,:,,,,:,::::,:,:::,::::' _.':"';'::",:.;,-,;':.":-';"":';""':-'."':';":,-,;'"-::".,:::,;,,,,:,:--.:':.'.':';"'.:,:,;';.-.:"':;."::--,.,;.-.;::":,:,:.;,,;,;,-,.:;--.._,,,,,:.;,:,;..,. AN "X" IN THE APPROPRIATE BLOCKS 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? If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. 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. Yes No ~ I B ~ 1. 2. o o Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on information of which preparer has any knowledqe. SIGNATURE OF PERSON RESPONSI8LE FOR FILING RETURN (, DATE , 026- ~.z. ) . /> -- .h /1115.j- Main Street, Mechanicsburg, PA 17055 ,,{,:::::),,::::::(,{t,::,{i:,:?:::'~:),:::/;:/;XL'?;:);,:{:,{?:H,':)',::::'{::;{'y,\?::,{'}/,/,:'}:){:::?\\D:://,\{,:?:>)/:<{,)\:{::((,':,,\,(,::')})\:',:},{(?:}:\:{{\{:::':(t,:::::}:')t::::\:{/}::n :}t}::){}})):'<}{})n?)://:U}:::~:r::U{{:U:t:':))j\j:t~::))),:?' For'dates of death on or after July '1, 1994 and before January 1, '1995, the tax rate i'mposed'o"n tt1t3,"'net value of transf"ers to or for the use o{i:he'slJ~viving spouse is 30/~ (72 P.S. 9 9116(a)(1.1)(i)]. FOT aa1es ot death on or after JanlJary 1,1995, the tax rate is imposed on the net value of transfers to orforthe use of the surviving spouse is 0%{72 P.S. 99116 (a}(1.1)(ii)]. The statute rtnp.!; nnt p.xp.mnf a transfer to a surviving spouse from tax, and tile statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse isthe 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 cl1ild twenty-one years of age or YOlJnger at death to or for the use of a natural parent, an adoptive parent. or a stepparent'('lf the child \15 0% {72 P.S.99116{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.!i 9116(1.2) [72 P.S. Ii 9116(a)(1)]. The tax rate imposed on the net value of transfers to or forthe use of the decedent'ssibhngsis 12% {72 P.S. !HI116\a)(1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parentin common with the decedent, whether by blood oradoption. o PA15002 NTF 29756 Copyright 2000 Greatland/Nelco LP- Forms Software Only Estate of: Mary Brodhecker Miller 21-2001-0740 The following person(s) are signing the retuxn as representative(s) of the estate: Julie Shover 344 Andersontown Road Mechanicsburg, PA 17055-6024 REV-1508 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Brodhecker Miller SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY FILE NUMBER 21-2001-0740 ITEM NO. DESCRIPTION Include proceeds of li1igatioli &. date proceeds were rece"lved by the estate. All Drop. Jointly-owned with rlaht of survivorship must be disclosed on Soh. F. VALUE AT DATE OF DEATH 1 Cash found in Decedent's residence 366.98 2 Proceeds from sale of miscellaneous coins and =ency 30.50 3 Proceeds from sale of jewelry 132.00 4 Mahogany Highboy chest of drawers, appraised value (appraisal attached) 300.00 5 Curley Maple slant lid desk, appriased value (appraisal attached) 1,200.00 6 Me=ill Lynch CMA Investrrent Account, #872-44761 390,340.85 7 Mellon Bank, checking account #142-632-3190 4,580.87 8 United States Fidelity and Guaranty Co., premium refund due on policy #HCM30934942506 12.00 9 Verizon, refund on account #7177610367 1. 76 10 The Patriot-News, refund due on subscription 5.40 11 County Meadows Associates, refund due on resident care 2,291. 94 12 AFlAC, premium refund on policy #0A173906 23.85 7 CPA81 NTF 10908 Copyright Forms Software Only, 1997 NalcD, Inc. TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 399,286.15 ~--_.----'-~ ._-,..---,.~-.......--"._.~-~~~ -..__....~--_._- -----'"-~_._-.--- ----..--.-.-.. ..----.----- I I I I I I I I I I I I .' APPRAISAL Personal Property of Jl1 /! i< 'I B / ;1f / L L c!<- (~S T.-4 T c, . d C E B k AU09L o cy Appraise by huck . ric er 47 ate -:27-0/ ITEM VALUE ITEM VALUE MA/1o OA .,,c,,! C#,I":s7 tJA/r:-/{'F<:7 3cJcJ dV ~)c J Vi 1,1 5;ro~{/L cuR L~Y ).1.<1,'< f -s' ^"T L"r'\ DF"'-"- 1i-tl:D,o () --'> /'//1" IZ He Pc' Lf ," I <7JIJ 6 i) J7) lA L 4//'~/ SA L c:/ ( / L, A :J:j;A . IL c::~/ ,k;~ /1uuCt-f' L C{/;n/o/ ---~~~ )<-- , ~"-.,,,.,.,..:ohi;,,,~,-,,_,,__'.. . , , ( , . . , ..., "." ,,' , . " " " .~ I REV-1510 EX. (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Brodhecker Miller SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY FILE NUMBER 21-2001-0740 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 State Employees Retirement System, 112.15 100 0.00 112.15 final pension payment TOTAL (Also enter on fine 7, Recapitulation) $ 112.15 7 CPAOl NTF 10910 (If more space is needed, insert additional sheets of the same size) Copyright Forms Software Only, 1997 Nelco, Inc. REV-1511EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Brodhecker Miller SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS FILE NUMBER 21-2001-0740 Debts of decedent must be reported on Schedule I. ITEM NO. DESCRIPTION A. FUNERAL EXPENSES: AMOUNT 1 Malpezzi Funeral Home, funeral services 7,708.90 2 Gingrich Merrorials, rrerrorial headstone 845.00 B. ADMINISTRATIVE COSTS: ,. Personal Representative's Commissions Name of Personal Representative(s) Julie Shover Social Security Number(s)/EJN No. of Personal Representative(s) Street Address 344 Andersontown Road City Mechanicsburq State 19,500.00 PA Zip 17055 Year(s) Commission Paid: 2. 3. Attorney Fees Name : Snelbaker, Brenneman & Spare Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 16,000.00 0.00 4. Probate Fees 252.00 5. Accountant's Fees 0.00 6. Tax Return Preparer's Fees 0.00 See Schedule attached Total from =ntinuation page (s) 535.10 7 CPA11 NTF10911 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) 44,841. 00 Estate of: Mary Brodhecker Miller Item No. SCHEDULE H, PART B -- Administrative Costs Description 7 Register of Wills, filing fee for Inheritance tax return 8 Ccmnerce Bank, estate check printing fee 9 Bricker's Auction, appraisal fee for chest on chest and desk 10 Mumma's Jewelry, appraisal fee 11 CUmberland law Journal, advertising Executrix notice 12 Patriot-News, advertising Executrix notice 13 Register of Wills, CUmberland County, short certificates 14 Greenawalt & Corrpany, p.e., ac=unting services for preparation of 2001 Final Individual Incane tax returns IDrAL. (Carry forward to main schedule) . . . . . . Page 2 21-2001-0740 Arrount 15.00 16.00 30.00 50.00 75.00 113.10 6.00 230.00 535.10 REV-1512 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary Brodhecker Miller Include unreimbursed medical expenses. ITEM NO. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21-2001-0740 DESCRIPTION AMOUNT 1 1,351. 00 pinnacle Health, resident care, ac=unt payable 2 pinnacle Health Herre Infus., medical services, account payable 18.34 3 Quantum Irraging & Therapeutic Assoc., Inc., medical services, account payable 73.91 4 PA Department of Revenue, 2001 personal income tax, account payable 80.00 5 Julie Shover, account payable for PJA services from February 2000 to August 6, 2001. 1,450.00 7 CPA12 NTF 10912 TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 2,973.25 Copyright Forms Software Only, 1997 Nelco, Inc. REV-1513 EX + (1-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE J BENEFICIARIES Mar' Brodhecker Miller No. NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Julie Shover 344 Andersontown Road Mechanicsburg, PA 17055-6024 2 Mark Mendlow 532 Altavista Avenue Harrisburg, PA 17109 3 Cynthia Start 40 Marta Drive Wilmington, DE 19808-4854 4 Barbara Ignasiak 11 Toponce Pooatello, ID 83204 5 Helen Kross 3715 40th Avenue W Bradenton, FL 34205-2353 FILE NUMBER RELATIONSHIP TO DECEDENT Do Not list Trustee(s) Friend Friend Niece Niece Niece 21-2001-0740 AMOUNT OR SHARE OF ESTATE 300.00 1,200.00 116,694.68 116,694.68 116,694.69 ENTER DOLLAR AMTS. FOR DISTRIBS. SHOWN ABOVE ON LINES 15 THROUGH 17 AS APPROPRIATE ON REV 1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS None 7 CPA13 NTF 10913 TOTAL OF PART II -- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET $ Copyright Forms Software Only, 1997 Nelco, Inc. (If more space is needed, insert additional sheets of the same size) 0.00 LAW OFFICES SNELBAKER. BRENNEMAN & SPARE LAST WILL AND TESTAMENT I, MARY BRODHECKER MILLER, of the Township of Hampden, County of Cumberland, and Commonwealth of Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this as and for my Last Will and Testament, hereby revoking and making void all former wills and codicils by me at anytime heretofore made. FIRST. I order and direct that all my just debts and funeral expenses be paid by my Executrix or Executor, as the case may be, hereinafter named, as soon as conveniently may be done after my decease. SECOND. I give and bequeath my highboy chest of drawers unto JULIE SHOVER, absolutely. THIRD. I give and bequeath my desk unto MARK MEND LOW, absolutely. FOURTH. I give, devise and bequeath all the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situated, in equal shares, unto my three (3) nieces, namely, CYNTHIA START, BARBARA McCACHREN IGNASIAK and HELEN McCACHREN KROSS, share and share alike, absolutely and in fee simple. LASTLY. I nominate, constitute and appoint my friend, namely, JULIE SHOVER, to be the Executrix of this, my Last Will and Testament, but if for any reason she should fail to qualify as such Executrix or cease so to serve, then and in that event, I nominate, constitute and appoint PNC BANK, NATIONAL ASSOCIATION, to be the Executor hereof, each and both to serve without bond or other security as a condition of qualification hereunder. IN WITNESS WHEREOF, I, MARY BRODHECKER MILLER, have hereunto set my hand and seal to this my Last Will and Testament, to which I have affixed my signature this 6th day of July, A.D. Two Thousand One (2001). I};;M~ ~Jf.vv ~ Mary Brodhecker Miller (SEAL) L....W OFFICES SNELBAKER, BRENNEMAN a SPARE The preceding instrument, consisting of this and one (1) other typewritten page, each identified by the signature of the Testatrix, was on the date thereof signed, sealed, published and declared by MARY BRODHECKER MILLER, the Testatrix therein named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her presence and in the presence of each other, have subscribed our names as witnesses hereto. Cf-q, tel-(.771A-( ) COMMONWEALTH OF PENNSYLVANIA) SS. COUNTY OF CUMBERLAND ) We, MARY BRODHECKER MILLER, RICHARD C. SNELBAKER and JANE J. COONEY, the Testatrix and the witnesses, respectively, whose names are signed to the attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will and Testament and that she had signed willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the Testatrix, signed the Will as a witness and that to the best of his or her knowledge, the Testatrix was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. /1/1""'-<-1 /1;~f.v..vc,e.e.JL, "J,n:Jj%!e.-v I T statrix _ -""~ ~'"wiSZ ~ Subscribed, sworn to and acknowledged before me by MARY BRODHECKER MILLER, the Testatrix, and subscribed and sworn to before me by RICHARD C. SNELBAKER and JANE J. COONEY, the witnesses, this 6th day of July, 2001. Nolllrl8l SeoI PublIC 1 SIl88IlL = ~ COIM1IV. i ~ ElcpIIe8 H<w. 24, 2003; 1 1olomt>Of. ,. k~~'7TA . Notary Public