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Home My WebLink About09-16-05 .1500 EX (1;.00) . OFFIClAL USE ONLY . COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER ~1_ COUNTY CODE ~L 0043 __,_ YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) BRINLEY GEORGE DATE OF DEATH (MM-DD- YEAR) DATE OF BIRTH (MM-DD- YEAR) 12/19/2004 10/23/1921 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) R SOCIAL SECURITY NUMBER 191-18-4180 THIS RETURN MUST BE FILED IN DUPLICATE WITH TH REGISTER OF WILLS SOCIAL SECURITY NUMBER u [X] 1. Original Retum ~(I) D ':ll:: 4. Lim~ed Estate ~o )0 r.;1 '...I Ul..J 6. Decedent Died Testate (Attach copy of Will) ~a1 ~ D 9, Litigation Proceeds Received D 2. Supplemental Retum D 3. Remainder Retum (date of death prior to 12.1 D 4a. Future Interest Compromise (date of death after 12-12-82) D 5. Federal Estate Tax Retum Required D 7. Decedent Maintained a Living Trust (Attach copy of Trust) L 8. Total Number of Safe Depos~ Boxes D 10. Spousal Poverty Credit (date of death between 12.3,.91 end 1.1-95) D 11. Election to tax under Sec. 9113(A)(A1lac!l THIS SECTION MUST BE COMPLETED. All CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Richard W. Stevenson, Es . FIRM NAME (If Applicable) McNees Wallace & Nurick LLC TELEPHONE NUMBER 717-237-5208 100 Pine Street, P.O. Box 1166 Harrisburg, PA 17108 1. Real Estate (Schedule A) 175,000.00 7,319.09 0.00 0.00 170,168.72 0.00 OFFlClALli$E ONLY (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Depos~s & Miscellaneous Personal Property (Schedule E) (5) 6. Jointly O\M'1ed Property (Schedule F) (6) o Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabil~ies, & Liens (Schedule I) (10) 11, Total Deductions (total Lin es 9 & 10) 143,764.30 (B) 18,350.72 937.60 496 252. 1 14, Net Value Subject to Tax (Line 12 minus Line 13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 19 288. 2 476 963. 9 O. 0 476 963. 9 0.00 21,463.37 0.00 0.00 21,463.37 (11) 12. Net Value of Estate (Line 8 minus Line 11) (12) 13. Char~able and Governmental Bequests/See 9113 Trusts for v.nich an election to tax has not been made (ScheduleJ) (13) 15. Amount of Line 14 taxable at the spousal tax z rate, or transfers under Sec. 9116 (a)(1.2) o ~ 16. Amou nt of Line 14 taxable at lineal rate ~ :::I ~ 17. Amount of Line 14 taxable at sibling rate o o 18. Amount of Line 14 taxable at collateral rate )( ~ 19. Tax Due 20.0 0.00 476,963.80 0.00 0.00 x .0 L(15) x,o 45 (16) x .12 (17) x .15 (18) (19) CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < /4645 1.000 f',...> ".-:" \ ;) :> r-'I "'-1 u;~ -) '1 ':,,) Ul Total Interest/Penalty (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 20 to request a refund (4) 109. 0 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) O. 0 A. Enter the interest on the tax due. (SA) O. 0 B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) O. 0 Make Check Pa able to: REGISTER OF WILLS, AGENT Yes o o o o without receiving adequate consideration? . . . . . . . . . . . . . . . . . . . . . . . . . . .. D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . " IX] D 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 perjury. I declare that i have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge, Decedent's Complete Address: STREET ADDRESS 320 Woodland Avenue Cumberland Count CITY New Cumberland ~ '-.. STAlE PA Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2, Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 0.00 20.500.00 1,073.17 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A + B + C) (2) 0.00 0.00 PLEASE ANSWER THE FOllOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 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 17070 c/o PO Box 1166, Harrisburg, PA 17108 ZIP 17070- I I I 21,463.~7 I I 21'573.~7 I No og og og og og og DATE 9-/~-(J~ 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. 99916 (a) (1.1) (i)). For dates of death on or after January 1, 1995, the tax rate imposed on the net value of tram The statute does not exempt a transfer to a surviving spouse from tax, and the statutory req the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: ~ A P D The tax rate imposed on the net value of transfers from a deceased child twenty-one years ( or a stepparent ofthe child is 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 be .[72 P.S. 89116 (a) (1.1) (ii) etum are still applicable even i :ural parent, an adoptive paren , 1116(1.2) [72 P.S. 99116(a)1)]. 1ed, under Section 9102, as a The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings i individual who has at least one parent in common with the decedent, whether by blood or ad 3W4646 1.000 :OMMONWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT STATE OF FILE NUMBER V-1502 EX + (6-98) · SCHEDULE A REAL ESTATE e EORGE R. BRINLEY 21 05 0043 All real property owned solely or as a tenant In common must be reported at fair market value. Fair market value is defined as the price at v.tIich property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both hailing reasonable kn~edge of the relevant facts. Real property which Is jolntly-owned with right of survivorship must be disclosed on Schedule F. ITEM DESCRIPTION VALUE AT DATE JMBER OF DEATH 1. Real Estate at 320 Woodland Avenue, New Cumberland, Cumberland County, Pennsylvania 175,000 00 See attached appraisal TOTAL (Also enter on line 1, Recapitulation) $ 175,000 00 (If more space is needed, insert additional sheets of the same size) 14695 1.000 V-1503 EX~ (6-98) e e SCHEDULE B STOCKS & BONDS :OMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF :ORGE R. BRINLEY ITEM USER 1.183 Shares MetLife 46961.000 FILE NUMBER VALUE AT DATE OF DEATH All property jointly-owned with right of survivorship must be disclosed on Schedule F. 21 05 0043 DESCRIPTION TOTAL (Also enter on line 2, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 7,319 09 7,319 09 :V-l508 EX. (6-98) e e COMM~L TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF GEORGE R. BRINLEY FILE NUMBER 21 05 0043 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jolntly-owned with the right of survivorship must be disclosed on Schedule F. ITEM UMBER 46,005 76 2 24 DESCRIPTION VALUE AT DATE OF DEATH 1 PNC Bank Checking Account Account No. 5140007274; See attached bank letter Interest accrued to 12/19/2004 2 PNC Bank Money Market Account No. 5003759074; See attached bank letter Interest accrued to 12/19/2004 THE FOLLOWING ASSETS (ITEMS 3 TO 7) WERE HELD AT PSECU. SEE ATTACHED BANK LETTER: 3 Regular Share Account Interest accrued to 12/19/2004 4 Vacation Club 5 60 Month Certificate of Deposit Interest accrued to 12/19/2004 6 36 Month Certificate of Deposit Interest accrued to 12/19/2004 7 24 Month Certificate of Deposit Interest accrued to 12/19/2004 8 Personal Property; Value estimated by Executor 9 2002 Bonneville; Valued per Kelly Blue Book Trade-In Value 10 Cash on Hand 11 u.S. Treasury - Refund re 2004 Income Taxes '46AD 1.000 TOTAL (Also enter on line 5 Recapitulation) $ (If more space is needed, insert additional sheets of the same size) 11,881 08 1 17 2,273 50 0 84 0 98 28,008 67 80 66 25,438 20 32 24 44,781 31 60 07 2,500 00 7,775 00 1,015 00 312 00 I I I 170,168 72 V-1510 EX + (6-98) e COMMONVVEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT nATEOF ;EORGE R. BRINLEY SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY e FILE NUMBER 21 05 0043 DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST 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. DESCRIPTlON OF PROPERTY TEM KllIlETf€ NM4E OF Tf€ TRANSFEREE. TrEIR RELATlONSHPTO OECEOENT t>m IMBER Tf€ DATE OF TRi'N3FER. ATIIlCH A OOPY OF TI-E DEEO FOR REAl. EST ATE TAXABLE VALUE 1. MetLife Annuity Account No. 077012238AB Beneficiary: Decedent's Children See valuation letter attached 66,858.71 100.0000 2 MetLife Annuity Account No. 073390129AB Beneficiary: Decedent's Children See valuation letter attached 62,704.02 100.0000 3 MetLife IRA Account No. 077012220AB Beneficiary: Decedent's Children See valuation letter attached 14,201.57 100.0000 TOTAL (Also enter on line 7, Recapitulation) $ If more space is needed insert additional sheets of the same size 16AF 1.000 EXCLUSION (IF IoPPUCABLEl 0.00 0.00 0.00 66,858 71 62,704 02 14,201 57 143.764 30 '-1511 EX:' (12-99) e COMMONWEALTH OF PENNSYLVANIA I/'H:RITANCE TAX RETURN RESIDENT DECEDENT rATE OF 1: R E R BRINLEY SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS Debts of decedent must be reported on Schedule I. ITEM 'lUMBER DESCRIPTION FUNERAL EXPENSES: 1. Funeral Flowers 2 Funeral Luncheon Total from continuation schedules . 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Josephine M. Brinlev Social Security Number(s) I EIN Number of Personal Representative(s) Street Address 320 Woodland Avenue City New Cumberland State PA Zip 17070 2. Year(s) Commission Paid: Undetermined Attorney Fees McNees Wallace & Nurick LLC 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Josephine M. Brinley Street Address 320 Woodland Avenue City New Cumberland Relationship of Claimant to Decedent DAUGHTER State PA Zip 17070 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. 1 Clauser Real Estate Appraisals Real Estate Appraisal 2 Erie Insurance Homeowners Insurance Total from continuation schedules . e FILE NUMBER 21 4 TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) $ /46AG 1.000 AMOUNT 238.50 1,000.00 4,584.58 4,000.00 2,000 00 3,500 00 429 00 100 00 300 00 520 00 1,678 64 18 350 72 e Estate of: GEORGE R. BRINLEY Schedule H Part 1 (Page 2) Item No. Description 3 Mt. Olivet Cemetery Trust 4 Parthemore Funeral Home 5 Plaque for Crypt Total (Carry forward to main schedule) e 191-18- 180 Amount 300 00 4,269 58 15 00 4,584 58 e ~state of: GEORGE R. BRINLEY Schedule H Part 7 (Page 2) 3 Leffler Energy Oil Service 4 McNees Wallace & Nurick LLC Reserve for closing costs re duplicating, postage, etc. 5 McNees Wallace & Nurick LLC Costs Advanced as follows: Duplicating Copy of Deed Toll Calls Postage Legal Advertising Central Penn Jrn. Cumbo Law Jrn. Short Cert. $19.85 1. 00 .86 17.59 99.00 75.00 12.00 6 Mountain Top Tree Service Tree Trimming Charges 7 PNC Bank Safe Deposit Box Key 8 S&S Wildlife Mice Problem 9 Vital Records Death Certificates Total (Carry forward to main schedule) e 191-18- 180 266.00 75.00 225 30 600 00 12 00 475 34 25 00 , 1,678~64 \1-1512 EX+ (12-03) e COMMONWEALTH OF PENNSYLVANIA INl-ERlTANCE TAX RETURN RESIDENT DECEDENT :STATE OF R ~~~~-~.. SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS e FILE NUMBER 21 05 0043 VALUE AT DATE OF DEATH Report debts Incurred by the decedent prior to death which remained unpaid as of the date of death, Including unrelmbursed medical expenses. TEM IMBER 1. DESCRIPTION Comcast Cable Cable Service 2 Metro Med Service Medical Expense 3 New Cumberland Borough Sewer & Trash Service 4 PAWC Water Service 5 PP&L Electric Service 6 SERS Reimbursement of December 2004 monthly retirement benefit (deposited prior to decedent's death) 7 UGI Gas Expense 8 Verizon Telephone Service f46AH 2.000 (If more space IS needed, Insert additional sheets of the same size) TOTAL (Also enter on line 10. Recapitulation) $ 88.44 96.25 79.09 30 23 163 17 334 36 47 11 98 95 937 60 e - SCHEDULE J BENEFICIARIES V-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ,TATE OF ~ORGE R. BRINLEY FILE NUMBER 21 05 0043 RELATIONSHIP TO DECEDENT AMOUNT OR SHAR Do Not List Trustee(s) OF ESTATE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] Josephine M. Brinley 320 Woodland Avenue New Cumberland, PA 17070 NUMBER I 1 119,240 95 Daughter 25% Residue: 119,240.95 2 G. Robert Brinley, Jr. 167 Cooper Avenue Upper Montclair, NJ 07043 119,240 95 Son 25% Residue: 119,240.95 3 Stephen K. Brinley 730 wyndover Road Florence, AL 35630 119,240 95 25% Residue: 119,240.95 Son ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SH ET II NON-TAXABLE DISTRIBUTIONS: A. SPOUSALDISTRIBUTlONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS o 00 TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET (If more space is needed. insert additional sheets of the same size) $ V46All.000 Item No. Description Relation Amount - e ~state of: GEORGE R. BRINLEY 191-18- 180 Schedule J Part 1 (Page 2) 4 Jennifer B. Rockey 907 Brandt Avenue New Cumberland, PA 17070 25% Residue: 119,240.95 Daughter 119,240.95 e -- e e -- e ~. e - ESTATE OF GEORGE R. BRINLEY PENNSYLVANIA INHERITANCE TAX RETURN TABLE OF CONTENTS (EXHIBITS) A. Miscellaneous Documents 1. Table of Contents - Exhibits 2. Copy - Letters Testamentary issued by Cumberland County Register of Wills to Josephine M. Brinley, and copy of decedent's Will dated January 12, 1984 3. PA Department of Revenue - Official Receipt 4. Copy - Safe Deposit Box Inventory B. Schedule A - Real Estate; Real Estate Appraisal C. Schedule E- Cash, Bank Deposits, & Misc. Personal Property 1. PNC Bank (Items 1,2) 2. PSECU (Items 3-7) D. Schedule G - Inter-vivos Transfers & Misc. Non-Probate Property; MetLife Valuation Information - - -- e \ \ \ .---l-- G e e REGISTER OF WILLS CUMBERLAND County, Pennsylvania CERTIFICATE OF GRANT OF LETTERS No. 2005-00043 PA No. 21-05-0043 Es ta te Of: GEORGE R BRINLEY (First, Middle, Lestl a/k/a: Late Of: GEORGE R BRINLEY NEW CUMBERLAND BOROUGH CUMBERLAND COUNTY Deceased Social Securi ty No: 191-18-4180 WHEREAS, on the 14th day of February 7th 1972 to probate as the last will and January 2005 instruments dated: January 12th 1984 were admi t te codicil of GEORGE R BRINLEY (First, Middle, Lest) a/k/ a GEORGE R BRINLEY la te of NEW CUMBERLAND BOROUGH, CUMBERLAND County, who died on the 19th day of December 2004 and WHEREAS, a true copy of the will &codicil as probated is annexed he eto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in a d for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: JOSEPHINE M BRINLEY who has duly qualified as EXECUTOR(RIX) and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLISLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the s al of my office on the 14th day of January 2005. i') * *NOTE* * ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) '....,.... ';,y. -#. {'.--J '\.J/ I { -,j' ...) /i 0:~. '~ .~.~ s It e LAST WILL AND TESTAMENT OF GEORGE R. BRINLEY I, GEORGE R. BRINLEY, of the Borough of New Cumberland, County of Cumberland, and State of Pennsylvania, being of sound mind and memory, do hereby make, publish and declare this to be my Last Will and Testament, hereby revoking and making void any former Wills or testamentary dispositions heretofore made. 1. I devise and bequeath all of my estate of every nature and wherever situate to my wife, JOSEPHINE K. BRINLEY, providing she shall survive me by thirty days. II. Should my wife, Josephine K. Brinley, predecease me or die on or before the thirtieth day following my death, I deviee and bequeath all of my estate of every nature and wherever situate to my issue per stirpes living on the thirty- first day following my death. III. I appoint CUMBERLAND COONTY NATIOOAL BANK AND TRUST COMPANY, of New Cumberland, Pennsylvania, guardian of any property which passes, either under this Will or otherwise to a minor and with respect to which I am authorized to a guardian and have not otherwise specifically done so. Such guardian shall have the power to use principal as well as inca e (including college education, both graduate and undergraduate) without regard to his or her parent's ability to provide for such support and education, or to make payment for these purposes, without further responsibility, to the minor or to the minor's parent or to any person taking care of the minor. IV. I appoint my wife, JOSEPHINE K. BRINLEY, Executri of this my Last Will. Should my wife, Josephine K. Brinley, fail to qualify or cease to act as Executrix, I appoint my son , GEORGE ROBERT BRINLEY and STEPHEN KOHR BRINLEY, Co-Executors of this my Last Will. V. I direct that my Executrix or Guardian br their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. " IN WITNESS WHEREOF, I, GEORGE R. BRINLEY, have hereunto set my hand and seal this ~ day of 1972. (SEAL) \ SIGNED, SEALED, PUBLISHED and DECLARED by the Testator, above named, as and for his Last Will and Testament, and in the presence of us, who in his presence, at his request and in the presence of each other, have hereunto set our names ~;e't:<; kJ tness IIi'''....... \~~~' ~ tness , ~~ ~ R, !2.- GEOR R. BRINLEY ~ '- (SEAL) -" \ \. \ '. . , \ e It ..... FIRST CODICIL TO LAST WILL AND TESTAMENT OF GEORGE R. BRINLEY I, GEORGE R. BRINLEY, of Cumberland County, Pennsylvania declare this to be the first codicil to my will executed on February 7, 1972. 1. I hereby amend paragraph IV of my said will to read as follows: IV. I appoint my wife, JOSEPHINE K. BRINLEY, Executrix of this my Last Will. Should my wife, Josephine K. Brinley, fail to qualify or cease to act as Executrix, I appoint my daughter, JOSEPHINE M. BRINLEY, Executrix of this my Last Will. 2. In all other respects, and for all intents and purposes, I hereby republish, ratify and confirm my Last Will dated February 7, 1972. IN WITNESS WHEREOF, I, GEORGE R. BRINLEY, herewith set my hand to this, a codicil to my Last Will, typewritten on two (2) sheets of paper including the self-proving attestation clause and signatures of witnesses, this 12 day of January, 1984. Witnessed: -?Y~_''/K_ 111 ~1 /(, fJ~ residing at(2p.;e 60)(6333 C77&ef a n3/ / residing at /.-a?z !11~./J./~1wn 7;1 ( f1 /?(J7( / e e COMMONWEALTH OF PENNSYLVANIA SS: COUNTY OF Cumberland GEORGE R. BRINLEY (the testator), Michael Hennigan and Marilyn K. Adams (the witnesses), whose names are signed to the foregoing instrument, being first duly sworn, each hereby declares to the undersigned authority that the testator signed and executed the instrument as a codicil to his last will in the presence of the witnesses and that he had signed willingly, and that he executed it as his free and voluntary act for the purposes therein expressed, and that each of the wit- ne8ses, in the presence and hearing of the testator, 8igned the codicil as witness and that to the best of his knowledge the testator was at that time eighteen years of age or older, of sound mind and under no constraint or undue influence. WITNESS: TESTATOR: ~~ '----- GEORG R. BRINLEY - ~~ WITNESS: m IlA/f;/LI(, ~~ Subscribed, sworn to and acknowledged before me by GEORGE R. BRINLEY, the testator, and subscribed and sworn to before me by Michael Hennigalllnd Marilyn K. Adams the witnesses, this 12 day of January, 1984. /77~J(.~ . IIA LYI I.oMil Nra~ft\f,uC IfEW CUMBERlANO 8019 &U.,(RLAND COUNTY . IY COMMISSION EUiMWr. It. UI1 , ltemller. 'ellCleylvani. Associltiol of Mota,,,. - 2 - - , -- e '. ... 8 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INOIVIDUAL TAXES DEPT. 2B0601 HARRISBURG. PA 17128-0601 e e REV-1162 EX(11-9.6) vi ~~t ~~ ECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 00507:3 A ACN SSESSMENT AMOUNT CONTROL NUMBER - ------ 101 I $20,500.00 I I I I I I I I AID: $20,500.00 GLENDA FARNER STRASBAUGH REGISTER OF WILLS STEVENSON RICHARD W ESQ 100 PINE STREET POBOX 1166 HARRISBURG, PA 17108-1166 .----- told ESTATE INFORMATION: SSN: 1 91-1 8-41 80 FILE NUMBER: 2105-0043 DECEDENT NAME: BRINLEY GEORGE R DATE OF PAYMENT: 03/17/2005 POSTMARK DATE: 03/16/2005 COUNTY: CUMBERLAND DATE OF DEATH: 12/19/2004 TOTAL AMOUNT P REMARKS: CHECK# 1007 SEAL INITIALS: JA RECEIVED BY: TAXPAYER v ".,-"_...~,...--_.","",,,,,,. ,..;,...."'...-.>,;,.;.......;.";"",,...;, REV-4e5 FX. (9-00) . e SAFE DEPOSIT BOX INVENTORY COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE INHERITANCE TAX DIVISION DEPT. 280601 HARRISBURG, PA 17128-0601 Please Print or Type MUST BE COMPLETED BY REPRESENTATIVE OF FINANCIAL INSTITUTION WHERE SAFE DEPOSIT BOX IS LOCATED AND RETURNED TO ABOVE AD COUNTY CODE FILE NUMBER SOCIAL SECURITY OR DEATH CERTIFICATE NUMBER 05-0043 191-18-4180 21 . DECEDENT'S NAME (LAST, FIRST, MIDDLE) Brinle Geor e R. . ADDRESS OF DECEDENT (STREET) (CITY) 320 Woodland Avenue New Cumberland NAME AND ADDRESS OF PERSON REQUESTING THE OPENING OF THE SAFE DEPOSIT BOX (NAME) Jose hine M. Brinle Executrix (STREET NAME) (CITY) 320 Woo~land Avenue New Cumberland NAME, ADDRESS AND RELATIONSHIP (IF ANY) TO DECEDENT, OF PERSON(S) PRESENT AT THE BOX OPENING a. (NAME) (RELATIONSHIP) Jose bine M. Brinle Dau hter (STREET NAME) (CITY) 320 Woodland Avenue b. (NAME) Lee Ann C. Shu (STREET NAME) 100 Pine Street, P. O. Box 1166 c. (NAME) (STATE) PA (STATE) n (RELATIONSHIP) (STATE) PA (ZIP COD ) 17108-1166 (CITY) Harrisbur (RELATIONSHIP) (STREET NAME) (CITY) (STATE) (ZIP COD ) · NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED (NAME) PNC Bank (STREET NAME) 331 Brid e Street I NAME OF PERSON MAKING LAST ENTRY Geor e R. Brinle DATE OF CONTRACT TO RENT BOX NUMBER OF BOX 1/1976 437B NAME AND ADDRESS OF PERSON(S) HAVING ACCESS TO BOX a. (NAME) George R. Brinley (STREET ADDRESS) 320 Woodland Avenue (CITY) (STATE) New Cumb land PA . NAME AND TITLE OF EMPLOYEE TAKING THE INVENTORY (CITY) (STATE) Cumberland PA DATE AND TIME OF LAST ENTRY (ZIP COD ) 17070 b. (NAME) Jose bine K. Brinle (STREET ADDRESS) (STATE) (ZIP COD ) (ZIP CODE) 17070 (CITY) Lee Ann C. Shu WAS A WILL IN THE BOX? If yes, a. Date of will: b. Name and address of personal representative, If named in the will (NAME) (STREET NAME) (CITY) (STATE) (ZIP CODE C. Name and address of attorney, If any (NAME) (STREET NAME) (CITY) (ZIP CODE I (STATE) e -- . \ \ ---- ALL-STATE LEGAL@ 800-222-0510 * e e APPRAISAL OF REAL PROPERTY LOCATED AT: 320 Woodland Ave 25-25-0008-104 New Cumberland, PA 17070-1880 FOR: The Estate of George R. Brinley JodyBrinley,Ex~x Harrisburg, PA 17101 AS OF: 12-19-04 BY: George C. Clauser, 8RA Clauser Real Estate Appraisals PA Certified General Real Estate Appraiser CertifICation Number GAOOO233L p.O.Boxm Camp Hill, PA 17001-07n fom\ <>Ai - 'lOTAllor Wmdows' apjlI1isal software by a la mode, inc. -1-800-AlAMOllE Cumberland PA 17070-1680 e e R. Bttnle 5-0216 R-2 TABLE OF CONTENTS Cowr p. ....................................................,...............................................................".................,................................................"..........................." 1 Summai)' of Salient Features ..", ..,,,....,,........,............................................,,..................................................................................................................... 2 USPAP ldenIlIication ....... "... ........., .............. ",................. ........... ............... ............ ........................................................................... "......,..,.................... 3 lJRAR - 6r'93 ........................................................................................................................................................................................................"........... 4 Property History of Subject Property """"",,,,,,,,,,,,,,,,,,,,,,,,"'"''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''",,,,,,,,,"""'"'''''''''''''''''''''''''''''''''''''''''''''''''''''''''' 6 Subject I'l1oIo5 ...................................................... "........................................................................................................."............................ .................... 7 Building Sketch (page -I) """""""""""""",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,............"..........."......",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 8 Comparable Photus 1-3 .. ..... ................ ..... ............ .........".. ...... ............ ..............."................ ............................................................................................. 9 Location Map ..................................................................................................................................................................................................................... 10 Purpose and Function of AppraIsal ..................................................................................................................................................................................... 11 AppralSII Addendum - SpecIal CondilIons .......................................................................................................................................................................... 12 S1atIment of Umiting CondilIons ....................................................................................................................................................................................... 13 Bectronlc SIgnature ComplIance .....................................................................................................................................................................................,.. 15 Certiflca1Jl ........................................................................................................................................................................................................................... 16 Involce..............................................................................................................................................................................................................................17 Form TOCNP - 'TOTAl. for Wmdows'lIIlKIisal soltwale by a la mode, Inc. -l-8OG-ALAMOllE e SUMMARY OF SALIENT FEATURES Subject Address 320 Woodland Ave Legal Descrtption 25-25-0008-104 Clty New Cumberland County Cumberland Slate PA Zip Code 17070-1880 Census Tract 42041-0108.00-6 Map Relerence 2049 A-5 Sale Price $ NA Date of Sale NA Booovref I Client IClient \he Ellate of George R. Brinley Lender The Estate of George R. Brinley Size (Square Feet) 1,956 Price per Square Foot $ Location Suburban Age 55+/- Condition Avg T utal Rooms 6 Bedrooms 3 8alhs 2 Appraiser George C. Clauser, 8RA Dale of Appiaised Value 12-19-04 Anal Estimate of Value $ 175,000 e Fonn SSO - 'TOTALloc Windows' awWl soItwaR by ala mode. ilc. -1-800-~ Cumberland APPRAISAL AND REPORT IDENTIFICAnON this appraisal conforms to lIIJlI of the following definitions: 181 Complete Appraisal (TIle act or procell of eatImaIIng value, or an opinion of value, perfOlll1ld wtlhout invoking the Departun Rule.) o Umlted Appraisal (The act or proceel of estimating value, or an opinion of value, perfOlll1ld under and mulling from ItwoIdng the Oeputure Rule.) ThIs report Is lHlIl of the following types: o Self Contained (A wrttten report pnlpared under Standaros Rule 2-2(a) of a Complete or limited Appraisal performed under STANDARD 1.) 181 Summary (A wrttten report prepared under Standards Rule 2-2(b) of a Complete or UmtIed Appraisal performed under STANDARD 1.) o Restricted (A written I'IlpGrt prepered under Standards Rule 2-2(c) of a Complete or limited Appraisal performed under STANDARD 1 for client use only.) Comments on Standards Rule 2-3 I certify that, to the beat of my knowledge and belief: . The stafemenls of fact contained In this report are true and correct. . The reported analyses, opinions, and conclusions are limited only by the reported assumptions and limiting conditions, and are my peI'IOl\lIl, Impartial, and unblased profasslonalanaly&es, opinions and conclusions. . I hall'll no (or the speclfied) present or prospective Interest In the property that Is the subject of this report, and no (or the specified) personal Interest wtlh respect to the paf1ies Involved. . I hall'll no bias wtlh respect to the property that Is the subject of this report or the parties Involved with this assignment. . My engagement In this assignment was not contlngent upon developing or reporting predetermined results. , My compensation for completing this assignment is not contlngent upon the development or reporting of a predetemlined value or direction in value thaf favors the cause of the client, the amount of the value opinion, the attainment of a stipulated result, or the occurrence of a subsequent event dlreclly related In the Intended use of this appraisal. . My analyses, opinions and conclusions were developed and this report has been prepared, in conformity with the Uniform Standards of Professional Appraisal Practice. . I have made a personal Inspection of the property that Is the subject of this report. _ DennIs L Stover has provided significant professional assistance In the preparation of this report, and did Inspect the property. Comments on Appraisal and Report Identification Note any departures from Standards Rules 1-2, 1-3, 1-4, plus any USPAP-related Issues requiring disclosure: APPRAISER: ~ Signature: ~ _ L ~ Name: Dennts L Slover 0alB Signed: 12-26-05 Stale Cel1iIlcation #: PA Certified Residential Real Estate APPraiser or State Ucense #: CertIfication Number: RL 138906 Stale: PA ElIpiIation Date of Certiflcation or License: 6130/2005 SUPERVISORY APPRAISER (onl, " required): Signature: ~('Yv. C CIb.uJ. SRA Name: Georae C. ~auser. SRA Date Signed: 12-26-05 State Certil\cation #: PA Cer1lIled General Real fatale Aol>nllser or Slate license If: Certification Number. GAOOO233L Slate: PA ExpIration 0alB of Certification or license: 613012005 o Did (gl Did Not Inspect Property GEORGE ClAUSER folm 1)2 - 'TOTAl fa! W1l\dowS' appraIsal.sol1.waf1 by a Ii mode, inc. - 1-800-AlAMOOE \ I 0 Flle No. 5-0216 R-2 Prooertv Address 320 Woodland Ave City New Cumberland State PA lio Code 17070-1680 Leoal Iloscriotion 25-25-0008-104 Coontv Cumberland Assessor's Parcel No. 25-25-0008-104 Tax Year 04-05 R.E. Taxes S 2 765.00 .- is NA Bonower ICllentlhe Estate of Georae R. Brinley Cunent Owner The Eslate of Georce R. Brinlev Occuoant: 15<1 Owner il Tenant r l Vacant Prooertv riohls aool1lised IXI Fee Simole I Leasehold Proiect Tvoe I I PUD I I Condominium (HUON A onlvl HOA $ NA /Mo. Nelohborhood or Proiect Name New Cumberland Mao Reference 2049 A-5 Census Tract 42041-0108.00-6 Sale Price $ NA Date of Sale NA nescrin~nn .nd s NA I ender/Client The Estate of Geome R. Brinley Address Jody Brinley. Executrix 100 Pine St. Harrisbum. PA 17101 AnOOllser Geome C. Clauser SRA Address P.O.Box 777 Camo Hill PA 17001-777 Location DUrban ~ Suburban 0 Rural Predominant ~~~&e family hol!'.!~ Preaent land UIe % Land UIe change Buitt up DOver 75% cgj 25-75% 0 Under 25% occupancy PAl AG One family ---1L.. o Not likely o Likely $(000) (yrs) Growth I1lte o Rapid cgj Stable o Slow [8J Owner ~Low~ 2-4family ~ cgj In process Property values I:8J Increasing o Stable o Declining D Tenant 850 Hioh 150 Multi-family ~ To: vacant land to Demand/supply cgj Shorlage D In balance 0 Over supply ~ Vacanl (0-5\) . ";:~~q Predominant r)~:.:~ Commercial 5 residential develooment Marketino time CXj Under 3 mos. Fi 3-6 mos. Fi Over 6 mos. I V.c Inv", ~'V.\ 145 25 Vacant 10 1010: Raco and Iho roclot composlllon of Iho nolghborhood aro nol appraisal faclors. Neighborhood boundaries and characteristics: The sub'ect neiahborhood consists of the Borauah of New Cumberland and surrcundina municinalities In Cumbertand Countv. PA. Factors that affect tile marketability of the properties in the neighborhood (proximity to employment and amenities, employment stability, appeal to marke~ etc.): The orooertv beina valued is located alona the west side of Woodland Ave. in the residential area known as New Cumberland. Shoooina. schools and churches are located within 3 miles of the orooertv. Full service shoooino is available at the Gamo Hill and Caoltal Cltv malls aooroximatelv 3-5 miles. Public school students attend the West Shore School District. Emolovment centers are located in Harrisburc. Camo Hill Yortk and Mechanlcsbum. Market conditions in the subject neighborhood (including support for the above conclusions related to the trend of property values, demand/supply, and marketing time - such as data on competitive properties for sale in the neighborhood, description of the prevalence of sales and financing concessions, etc.): Market conditions in the subiect neiohborhood are considered moderatelv active with low mortoaoe Interest rates beina the ortmarv catalvst. Sales in recent weeks have been moderatelv active. Aooraximatelv 10 houses of various sMes are for sale within 5 miles and are in comoetition with the subiect. Tyoical financina for residential orooerties includes 80% to 90% loan 1-3 lXlints 5.5-6.5% mortoaoe interest rates for uo to 30 vears. Averaae marketina time is betvveen 90 & 180 davs. Project Information for PUO. (If applicable) - - Is the developerlbuilder in control of the Home Owners' Association (HOA)? U Yes U No Approximate total number of un~s in the subject project Approximate total number of units for sale in the subject project Describe common elements and recreational facilities: Dimensions 97x140x97x140 Topography Ava Site area .31 Acres Comer Lot DYes [8J No Size Ava Spec~ic zoning class~ication and description R 1 Residence Shape Rectanaular Zoning compliance (8J Legal D Legal nonconforming (Gl1lndfalhered use) D Illegal D No zoning Dl1linage Ava Hinhe<l ~ ""<1,,<0.. imnrav'd: ~ Present use n Other use {eXDlainl View Ava Utilities Public Other Off-aite Improvements Type Public Private Landscaping Ava Electricity (8J 200 Amo Street Macadam [8J 0 Driveway Surface Macadam Gas (8J Curb/gutter Concrete [8J 0 Apparent easements Of Record Onlv Water (8J Sidewalk Concrete [8J D FEMA Special Rood Hazard Area DYes [8J No Sanitary sewer ~ Street lights Incandescent 0 R FEMA Zone C Map Date 2/16/1977 Storm sewer Allev None il FEMA Mao No. 4203660001B Comments (apparent adverse easements, encroachments, special assessments, slide areas, illegal or legal nonconforming zoning use, etc.): landscaoino exhibits mature shrubs and olantinas. Subiect is an interior lot on the west side of Woodland Ave. There are na aooarent easements encroachments, soecial assessments, slide areas or illeaal or lei al nonconformina uses known. GENERAL DESCRIPTION EXTERIOR OESCRIPTION FOUNOATION BASEMENT INSULA liON No. of Units One Foundation ConcrBlock Slab 0 Area Sq. Ft. 1320 Roof _0 No. of Stories One EJderior Walls Wd/A1um Cl1lwl Space 0 % Finished 0% Ceiling ~ [8J Type (DetJ Att) Detached Roof Surface FG Shinole Basement Partial Ceiling Ooen Walls ~ [8J Design (Style) Ranch Gutters & Dwnspts. Aluminum Sump Pump None Walls Con Block Floor ~[8J Existin~roposed Existina Window Type DblHuna Dampness No Evidence Roor Concrete None _0 Age (Yrs.) 55+/- StomVScreens Screens Settlement No Evidence Outside Entry NA Unknown_ 0 Effective A e /Yrs.l 12 Manufactured House No Infestation No Evidence Floor Drain ROOMS Fover Livinn Dininn K~chen Den Famil Rm. Rec. Rm. Bedrooms # Baths Laundrv Other Area So. Ft. Basement Kitette 1320 Levell 1 1 1 3 2 1 1956 Level 2 Finished area above ol1lde contains: 6 Rooms' 3 Bedroom(s\: 2 Bath sl: 1 956 S uare Feet of Gross Livinn Area INTERIOR Materials/Condition HEATING KITCHEN EQUIP. ATTIC AMENITIES CAR STORAGE: Roors CaroeWinvl Avo Type FWA Refrigel1ltor D None D Fireplace(s) # ~ cgj None D Walls Plaster/Panel Ava Fuel Gas Range/Oven (8J Stairs 0 Patio NA D Gal1lge # of cars Trim'Rnish Wood Avo Condition Ava Disposal cgj Drop Stair [8J Deck NA D Attached 2 Car Bath Floor CoWinvt Ava COOLING Dishwasher cgj Scuttle 0 Porch NA 0 Detached NA Bath Wainscot Ceramic Tile Avo Central CA Fan/Hood D Floor 0 Fence NA 0 Buitt-In NA Doors Wood Ava Other NA Microwave D Heated R Pool NA ~ Carport NA Kitchen Floor-Vinvl Ayo Condition Ava WasherlDrver Fi Finished Woodstove Drivewav Macadam Additional features (special energy efficient ~ems, etc.): Dwellina aooears to be well maintained with aood housekeeoino. Condition of the improvements. depreciation (physical, functional, and external), repairs needed, quality of construction, remodelin!jladditions, etc.: Sub'ect is a ranch sMe dwellina in averaae condition with a tvvo car attached aaraae. Phvsical: Deoreciation due to aoe and condition. Functional: None External: No adverse locational features noted. Adverse environmental conditions (such as, but no! limited to, hazardous wastes, toxic substances, etc.) present in the improvements, on tile s~e, or In the immediate vicinity of the subject property.: None Known - aooraiser is not aualified to detect such substances. If the house is sold termite and radon certifications are suooested. Houses built before 1978 mav contain lead base oaint. FOOdle Mac Fonn 70 6193 I GEORGE CLAUSER IFORM RESIDENTIAL APPRAISAL - REPORT Summary Report PAGE 1 OF2 Fonn UA2 - 'TOTAl for Windows' appraisal software by a la mode, inc. -1-800-ALAMOOE Fannie Mae Fonn 1004 6193 -9 220 a II Summary Report WIFORM RESIDENTIAL APPRAISAL REPORT FIleNo. 5-0216 R-2 ESTNAlED SITE VALUE .._.... .... _. ..._......... ._._..'_ .._.........,. S 35000 Comments on Cost Approach (such IS, soun:e 0/ cost esamall, slle value, ESTNAlID REPRODUCTION COST~EW'()f lMPROVEMENlS: squll1l fool cak;glllon and for HUll, VA and FmHA,lhe esllmallld remalnIng Dwelling 1.956 Sq.R.@1 85.00 .. S 166,260 economic life o/lheproperty): 1 320 Sq. R. @I 12.00 15,840 Source of Cos1s: Marshall Valuation SelvIce and local Contract0r8. 5.760 187.860 Garagt/CarpoIt ~ Sq. R. @I --11J!!L = To/al Estimated Cost New ... _d......_.__.. d= 1 Less Physical functional External [)epBclation 45.0861 lleprtclallld Value 0/ Improvemen1ll d'" _ ." 'Aa-/s' Value 0/ Site Improvements .. _ ..... _ IllOICATED VALUEBY COST APPIIOACII .. ITEM SUBJECT 320 Woodland Ave N Cumbel1and b economic life of the dwelll la 50 -I =1 . =1 45 086 142774 15000 192,774 COMPARABLE NO. 2 1550 Brandt Ave. N_ Cumbeltand 1.00 miles COMPARABLE NO. S 539 Seventh SI. N_ Cumberland 0.45 miles 152 000 198 000 -10000 +8000 -1000 S\J8JECl Not Applicable COMPARABLE NO. 1 Not Applicable COMPARABLE NO. 2 Not Applicable COMPARABLE NO. S Not Applicable 175 000 o Did cgJ Did Not Inspect Property StllePA Stlte PA Or StIle PAGE 2 Of2 form UA2 - 'TOTAL fOf Wmdows'l!llllIisat sol\walt by a II mode, inc. -l-800-ALAMOOE PA " GEORGE ClAUSER Cumberland PA 5-0216 R-2 PROPERTY HISTORY OF SUBJECT PROPERTY In dewlopIng a ..... property appraisal, when the value opinion to be dewloped .. maritet value, lIIl appraiser must, If auclI InfonnatIon Is avlIIlabIe to the appraiser In the nonnaI course of busl_: (a) anaIy;re alllIlI....nents of..... options, or IlatIngs of the subject property current as of the effectlve date of the appraIaa1. (b) analyze all ..... of the subject property that occumd wlthln the three (3) yvara prtor to the efhc:tIve date of the appraIaa1. The IIpfll1IIa<< has lItt8mpled to obtain spec:lfle InfonnatIon on the subjec:t property wlth the following findings: o The subjec:t property has had no c:hange of ownership In the past three (3) )"NIS. IZI The subjec:t property has had no change of ownenhIp In the past fMt (5) ye..... o The subject property .. culT8f1tly under contract. DetaIls of the pendlng pun:haae ... summarl%ed below. o The subject property Is culT8f1tly offered for....: The IlatIng price Is $ o The subject property has been aoId In the past three (3) year peIIod. DetaIls of the previous aale(s) ... disclosed below. I_~ I-~ IW_~ ,- I~- o The subject property Is propoaed c:onatructIon end Is not culT8f1tly belng offered. o A previous..... history of the subject property could not be obtained by the appralser In the nonnaI course of business. Comments: fomI PliS2 - 'TOTAl. for Windows' waJsaI soIIware by IIa mode, Inc. -l-8OO-AlAMOOE \ I e Subject Photo Page /ClIent the EI18te of 320 Woodland Ave New Cumberland The Estate of R. Srinl CUmberland e PA Subject Front 320 Woodland Ave Sales Price NA Gross LMng Area 1 ,956 TolJI Rooms 6 ToIII Bedrooms 3 TolJI Bathrooms 2 location Suburban View Avg SltB .31 Acres Quality Avg Age 55+/- Subject Rear Subject Street Form PlCPlX.SR - 'TOTAL forWlldows'1IllIlII1saf soItwm by a Ia mode, i1c. -l-<<JO..AlAMOOE 17070-1880 e tit Building Sketch (Page - 1) CUmbel1and PA 17070-1880 320 WOODLAND AVE. FIRST FLOOR BASEMENT %U %U ...a :!I BEDROOM BEDROOM ~ I tAU BATH ~ ~ >/J.a STORAGE 11.0' BATH BEDROOM ~ MECHANICALS 111 FAMILY ROOM ~ '--- .. 2 CAR GARAGE .. b IT}IVING ROOM b ~ ~ ~ :t :t KITCHEN b1.f1 ~.a " >/J.U 14.a ":1 %U 21..4' NOT EXACT AND NOT TO SCALE IIIIIcftbrAf*.r.r- Comments: AREA CALCULATIONS SUMMARY LIVING AREA BREAKDOWN Code DeIocIlpClon Net_ Net T...... IIIWIkdown SuI**ls QLll.1 W'irat. noor US'.O U56.0 .irat. I'loor BS1CT a..--.ot 1320.0 1320.0 7.0 " 1.4.0 ".0 QUI A.ttached Garage 4.10.0 4.10.0 27.4 " It.' 1222.0 10.0 " 30.0 300.0 1.4.0 " 24.0 136.0 NelllV ABLE Area ( Rounded ) 1956 4 Items (Rounded) 1956 Folm SKT.BIdSld - 'TOTN-lor WIndows'IllllfIIsaI sd\ware by ala mode. i1c. -l-8OO-Al.AMOllE \ I e Comparable Photo Page Cumberland PA e 17070-1880 Comparable 1 634 Allen Sl Prox. 10 Subject Sale Price G!OS$lMng Area ToCaI Rooms Totallledruoms ToCaI Battvooms l.ocalIon View Sll8 OUaity Age 0.39 miles 177,000 2,421 8 3 2.5 Suburban Equal .25 Acres Avg 50+1- Comparable 2 1550 Brandt Ave. Prox. to Subject 1.00 miles Sale Price 152,000 Gross Living Area 1,936 Total Rooms 7 ToCaI 8edrooms 3 TolaJ Ilathrooms 2 location Suburban View Equal Site .34 Acres QuaJlty Avg Age 56 Comparable 3 539 Seventh SI. Prox. III Subject 0.45 miles Sale PrIce 198,000 Gross lMng Area 2,417 Total Rooms 11 Total8edrooms 4 Total Ba1hrooms 2 location Suburban VIeW Equal Site .30 Acres Quality Avg Age 56 Fonn PICPOC.CR - 'TOTAl. for Windows' IPjlIlisaI soItwal1l by ala mode, Inc. - 1-800-AlAMOOE - e ==------ klC. _1$l-HJ.MOOE by ala mode, .~~ W\ndIWf5 "lOl~ \Of fOO1I MAP.LOC- - SUPPLEMENTAL ADDENDUM - 5-0216 R-2 R. PA 17070-1880 PURPose AND FUNCTION OF APPRAISAL The purpose of the appraisal is to estimate the market value of the subiect property as defined herein. The function of the appraisal Is to assist the above named Lender/Client in evaluatinQ the subiect property for estate purposes. EXTENT OF APPRAISAL PROCESS OR SCOPE OF THE APPRAISAL The appraisal Is based on the Infonnatlon gathered by the appraiser from public records, other Identified sources, Inspection of the sub)ect property and nelghbortlood, and selectlon of comparable sales within the subject mar1<et area. The Original source of the comparables is shown In the Data source section of the mar1<et grid, along with the source of conflnnatlon, If available. The original source Is presented first The sources and data are considered reliable. When conflicting Infonnation was provided, the source deemed most reliable has been used. Data believed to be unreliable was not Included In the report, nor used as a basis for the valuation conclusion. FornI SlI' - 'TOTAL for W'IIldows'1PllI1isaI softwart by lla mode, i1c. - 1-800-AlAMOOE \ I PA 17070-1880 No. 5-0216 R-2 SPECIAL CONDITIONS ADDENDUM The following checked Items are speclfic special conditions that were identified by tha appraiser during the Inspection of the subject property, the Incomparable sales, and their nelghbot11oods and locations. 1. The subject Is located In a rural area and Is less than 25% built-up. The condition Is typical and common for the area and DOES NOT affect the marilet value. _X_ 2. Commercial uses are located within the subject's nelghbortlood. These uses ara typical of similar nelghbort1ood8 and DO NOT affect the marilet value. _X_ 3. Industrial uses are located within the subject's nelghbortlood. The presence of Industrial uses, Is typical for the nelghbot11ood and DOES NOT affect the marilat value. _X_ 4. Vacant and underdeveloped land uses ara Ioc8ted within the subject's neighborhood. These uses ara typical for the area and DO NOT affect the marilet value. 5. The predominant value In the neighborhood Is less than that of the marilet value of the subject property. This condition Is due to the superior qualities of the subject property as described In this report. ThIs condition DOES NOT affect the marilet value. 6. The subject property Is located In a F. I. A. identified Flood Zone. 7. Dampness Is noted In the basement of the subject. Standing or running water was not present on basement floor. _X_ 8. The subject Is older than five(5) years old. All mechanical systems Including the heating, electrical and plumbing system appears upon a visual exterior Inspection to be in working order. No warranties are Implied In this slatement. 9. The electrical system was not connected during Inspection. _ 10. The water service was not Connected during Inspection. _ 11. The heating system was shut down during inspection. _ 12. Well and septic are common to the area. _ 13. Repair Items were noted In the comments section of the report. These comments on repair Items are for descriptive purposes only and are not required repairs. The repair Items are cosmetic In nature and DO NOT affect the marilet value. _ 14. Subject Is new construction and was 90% completed on date of Inspection. Compliance and completion Inspections suggested prior to settlement. _X_ 15. Should property be sold, termite and radon certifications ara suggested. with appraised value based on clear results. _ 16. The land value exceeds 30% of total value due to the high demand for vacant land In this neighborhood. This condition Is considered common and typical for the neighbot11ood and DOES NOT affect the marilet value. _ 17. The land value exceeds 30% of total value. ThIs Is due to the large size of the site. this condition Is considered to be typical and common and DOES NOT affect there marilet value. _ 18. Individual adjustments were required that exceed 10%. These adjustments were required due to the lack of more similar comparables on that Individual rating. All three comparables are the BEST AVAILABLE. _ 19. Total adjustments exceed 15%. This Is due to the lack of comparables on that individual rating. All three comparables are the BEST AVAILABLE. _X_ 20. One or more comparable sales are older than slx(6) months old. Although there are comparable properties In the subject area, none have sold recently, therefore. sales In excess of six (6) months old had to be used. _X_ 21. One or more of the comparables used were in excess of one(l) mile from the subject property. Although there are comparables In the immediate area, none have sold recenUy. Therefore, It was necessary to use comparable sales outside of the immediate area. All comparables used are located In similar nelghbortloods and within the same mariletlng area. All three comparables used were the BEST AVAILABLE. _ 22. Roofing certification Is suggested. _ 23. Plumbing certffication Is suggested. _ 24. Electrical certification Is suggested. _ 25. Heating certification Is suggested. _ 26. Flood Hazard Insurance Is suggested. _ 27. Seller Is paying part or all of closing cost. This DOES NOT affect the marilet value. _X_ 28. All comparable sales are closed sales. _X_ 29. The subject property has not transferred In the past 3 years. _X_ 30. This appraisal Is a Summary Report with complete data retained In appraisal file. Folm SUP - 'TOTAl for WIIldows" appnlsal soltwar1 by ala mode. Inc. - 1-8OO-Al.NAOOE . e DEFINmON OF MARKET VALUE: The most probable pt1ce which a property should bIi1g kta competitive and open mIIkeI under all conditions ~ilIl ~ a fair sale, the buyer and seller, each acting prudenUy, knowledgeably and assuming the price Is not alIecl8d by undue sUmulus. mpllctt kI INs deftnltion Is the COI18UmmatIon of a sale as of a speclfled dale and the passing 01 title from seller ~ buyer under condltIons whenby: (1) buyer and seller are typicaJy rnotIvaIBd; (2) both parties are well ktformed or weIIalMsed, and each a~ In wIIat he consldel$ lis own best ilteI1st; (3) a IWOl1lble time Is dowed for exposulll kt the open matXel; (4) payment Is made ktlllrms 01 cash In U.S. dollars or ktlBrms 01 flnanclallITII1gements comparable thereto; and (5) the price I'ejlI1lStIIls the ncxmaI conslderallon for the property BOld llIllffected by special or crutlve financing or sales concessions" grll1tId by anyone usocla1Bd with the sale. "Adjus1menls III \he comparables must be made for special or creative financing or sales concessions. No adjus1menls are necessary for those costs wI1Ich are l1OITI1aIly paid by sellers as I mutt 01 tradition or law In I mIIkeI lI1la; these costs are readily Identifiable slnce the setIer pays these costs In Yirtually all sales transactions. Special or crutlve financing 1,*,s1menls can be made 10 the comparable property by comparisons III finlnclng IBrms offered by a Ifllrd party InstftuIIonaI lender 1hal Is not already lnvolved In the property or transacllon. Any adjustment should not be calculated on a mechanical doIar for dollar cost 01 \he flnancIng or concession but \he doIar amount of any a,*,stmenl should approJdmate the maf1(el's reacllon to \he fInanclng or concesslons basad on the IjlprIise( s judgement. STATEMENT OF LlMlnNG COMDlnONS AND APPRAISER'S CERnFICAnOM COmlGENT AID UMITING COlOmONS: The appralser's ceItiflcalIon that appeIIS In \he appraisal report Is subject III tie foIowIng concitIons : 1. The appraiser will not be IllSpOflslble lor matters oIa Iega/ nawlll that lIIect either \he property being appraised or the title 10 II. The appraiser usumes that the title Is good and marblable and, themore, will not I1lnder any opinions aboul\he title. The property Is appI1isad on tie basis 01 tt being under mponslb!e ownership. 2. The appraiser has pIO'Iided a sketch in the appraisal report to show approllimalll dimensions of \he Improvements and the sketch is included only 10 assist lI1e reader 01 the Illport In visualizing the property and understanding lI1e appraiser's determlnalion 01 its size. 3. The appraiser has egmjned the available IIood maps that are provided by 1I1e Federal Emergency Management AQency (or other data sources) and has noted In the appralsaI report whether the subject siIB Is located In an identified Special Flood Hazar1l ma. Because \he applliser Is not a surveyor, he or she makes no guaranlees, eJqlI1lSS or Implied, regarding this detennlnalion. 4. The appraiser will not give fllstimony or appur In court because he or she made an appraisal 01 the property In QIlestion, unless specific arrangements 10 do so have been made beforehand. 5. The appraiser has esIimateIlthe value 01 the land In the cost approach at its hlghest and best use and the Improvements at their contributory value. These separate valuations 01 the land and Improvements must not be used In conjunction with any other awralsal and are Invalid K they are so used. 6. The appraiser has noted In the appraisal report any adverse conditions (such u, needed repairs, depreciation, the presence 01 hazardous wastBs, 10llic substances, etc.) obsefved during the inspection oIl11e subject property or 1I1at he or she became aware 01 during tile ncxmaI I1lsellth involved In pertonning the appraisal. Unless oIherwise staled in the appraisal report, the appraiser has no knowledge 01 any hidden or unappnnt conditions 01 the property or adverse environmental condltions (mcludIng the presence of hazardous wastes, tolIic substances, etc.) that would make the property more or less valuable, and has usumed lhat there are no such conditions and makes no guarantees or warranties, elCpress or inpIied. Illgarding the condition 01 the property. The lpllIliser will not be IllSponsible for any such conditions that do ellist or for any engineering or testing that might be required 10 discover whether such conditions ellist. 8ecause \he awraiser is not an upert In 1I1e field 01 environmental hazaRls, the IpInisaI report must not be considered IS an environrnentll usessment 01 the property. 7. The appraiser obtained the ktformatiOll. estimallls, and opinions lhat were elCpI1lSsed In the appraisal Illport !rom sources that he or she considers III be reliable and believes 1I1em 10 be lnJe and convct. The appraiser does not assume IllSponslbUIty for the accuracy 01 such IIBms that were furnished by other pIIties. 8. The appraiser will not disclose the contents 01 the appraisal report except as provided lor In 1I1e UnIform S13ndards 01 P<<Jfesslonal AIlInlsal Practice. 9. The appraiser has based his or her appraisal report and valuation conclusion lor an appraisal 1I1at is subject 10 satisfacloly completion, repairs, or allBrations on the assumption lhat completion 0I1I1e fmtlrovements will be pertormed in a WOlkmanlike manner. 10. The appraiser must provide his or her pt10r wriIlBn consent before \he lender/client specified in the appraisal report can d1stribuIB the Ippralsal report Qncluding conclusions about \he property value, tile appraiser's lden1Ity and professional designations, and refelllnces 10 any professional appraisal organlutions or the linn with which 1I1e appraiser Is assoclalBd) 10 anyone other 1I1an the borrower; the IIIOItUlgee or tts successors and uslgns; the rnorIQage Nurer. COllSuIlants; professional appraisal organlzallons; any state or lederally approved financial institution; or any department. agency, or instrumentality of the United States or any stale or 1I1e District 01 Columbia; except lhal !he lender/client may disliibute lI1e property das~ section of the report only 10 data collection or reporting selVice(s) without having 10 obtain 1I1e appraiser's pt10r written consent. The appraise(s written consent and approval must also be obtained before the appraisal can be cooveyed by anyone III \he public lhrough advertising, public relations, news, sales, or other media. Freddie Mac Form 439 6-93 Page 1 012 GEORGE ClAUSER Form ACR - 'TOTAl lor W1ndows'lpInisaI software by a Ia mode, Inc. - 1-800-AlAMOOE fannie Mae Form 10048 6-93 \ I e e APPRAISER'S CERTlfICAnON: The AppraIser certifIeS and agrees lI1at 1. I have "sellChed lI1a subject mar1<at area and have salactad a minimum of three recent salas of IJlOIlIftlas most slmiac and \If01IIma1B \tIlha subject property lor COflIIdamlon In lI1a salas comparison analysis and have made a dollar adjus1manl wf1an appropriate kJ reIIac1l11a mar1<at IIICtIon kJ those IIIms 01 significant vll1ation. .. IlgnIficant ItBm In . compal1bIa property Is superior ltI, or mere I1Ivorab1a than, lI1a subject JlIOI*IY, I have made a negative adjustment kl redooe the adjusled sales price oIl11a comparable and, . a significant 118m In a comparable property Is Inferior ro, Of leas favorable than the subject property, I have made a posltlY8 adjustmanl kllncrwa lI1a adjusted sales price of lI1a comparable. 2. I have taklll Into consideration lI1a factllIs lhat have an Impact on value In my developmant of lhe eslimata 01 mar1<at value In lhe appIIIsal report. I have not IaIowIrvtI wIIIlIIeld any slgnIficant infoImation from the appraisal report and I baIlave, 1tI 1ha besl of my knowledge, lhat all staf!mants and Information i1 lhe appraisal report are true and correct. 3. I staI8d In lhe appraisal report only my own personal, unblased, and professional analysis, opinions, and conclusions, wllIch are subject only 10 lha conlIngenl WId Imlting conditions specffled In this form. 4. I have no present Of \IfOSpactiYa Infersslln lha property lI1at Is lI1a subject 10 1hIs report. and I have no presanI Of prospaclM parsonallnferssl or bias wtUI respect kl lhe participants In lhe lr1nsaction. I did not base, alther paI1ially or compIaleIy, my analysis ancVOf lI1a aslImalI 01 IlIIIbt vaIua In lha appmsaIlIpOIt on I1ll race, color, reIiglon, sex. lIandlcap, tamIIal $labl8, or national Ollgln ol ellhaf lha prospective owners Of occupan1I of lha subject property or oIlhe present owners or occupants of.lhe propar1ias In lha YicInIty oIlha subject property. 5. I have no pment Of COf1t8mplaled Mu" Infersslln lI1a subject property, and naI1I1er my current Of Mu" employment nor my compensation for !*f1ll1llinO \Ills appraisal Is contingent on lhe appraised YaIue of lhe property. 6. I was notl1qUred ro report a pIedatermInad value or ch:tion In value lhat faYOfS 1I1a cause of lhe client Of any reIatBd party, lhe amount of lhe vaIua as1inalll, Ila IlIaInment of a specifIC result. Of 1ha occ:urrence aI a subsequent event In order 10 racelve my compensation anclIor IIl1lloYmant for !*forming 1ha appraisal. I lid not base lhe appralsaI report on a requastBd minimum valuation, a specifIC valuation, or the need 10 approve a specific mo!lQage loan. 7. I !*fanned 1hIs appralsaIln confomtity with 1ha Unitom1 Standanls of Professional AppraIsal Practice lhat WlR adopt!d and promulgated by lhe Appraisal Standaros Board of The AppraIsal Foundation and 1hat ware In place as of 1ha effective date of 1hIs appraisal, with lI1a exception of 1ha departure provision of Ulose Standaids, which does not apply. I acknowtedge lI1at an esIimata of a reasonabla time 'Of IlIpOSUI1In 1ha open Il1IIf(et Is a condition In 1f1e daflllition of martet value and the estimate I developed Is conslstent with 1he ~ng time noted In the neighbort1OOd section of U1ls report, unless I have othnlse stated in 1I1e reconcl1iation section. 8. I have personaUy inspected Ihe interior and llIIenor areas of 1he subject property and Ihe eideriof of aM propel1ies fimd as comparables in the appraisal report. 11ut1f1er certify \hat I have noted any apparent or known adverse condl1ions In lI1a subject inprovements, on 1f1e subject site, Of on any site within 1f1e inmediate YicInIty of the subject property of which I am aware and have made adjustmants for lhesa adverse coOOitions In my analysis of \he property value 10 1ha IlIIentlhal I had martet avldaI1ce 10 support 1f1em. I have also ~ about 1f1e effect of 1f1e adverse condillon$ on the I1lIIbtabllily of the subject property. 9. I personaUy prepared aU conclusions and opinions about the real estalll \hat were set forth in lhe appraisal IllpOrt. . I relied on slgniflCant professiornl assistance from any Individual Of Individuals In 1f1e pertormance of 1ha appraisal Of lhe preparation of 1f1e applIisal report, I have named such Individual(s) and dsclosod the speclfic tasks performed by 1f1em in lhe reconcUiation sectioII of U1ls appraisal report. I certify 1hat any individual so named Is qualilied 10 perform lhe tasks. I have not aulhorized anyone III make a change III any item In 1ha report; 1herelOfe, << an unauthorized change Is made 10 1f1e appraisal report. I will lake no responsibMy lor it. SUPERVISORY APPRAISER'S CERTlFICAnON: . a supelVisory appraiser signed lhe appllllsal report. he or she certifies and agrees Ihat t directly supeMse 1ha appIIiser who prepared lha appIaIsal report. have reviewed lI1a appralsaI report.. agree with lhe statements and conclusions of the appraiser, agree III be bound by 1f1e appllliser's certiflcations numbered 41hrough 7 above, and am taking ful responsibility for \he appraisal and the appralsaI report. ADDRESS Of PROPERTY APPRAISED: 320 Woodland Ave, New Cumberland, PA 17070-1880 APPRAISER: Slgla1ure: ---:l L s-h Name: Oen~tover 0aIe Signed: 12.26-05 State Certification #: PA CeftIfied R4_nllll RAtaI EIllIIo AoIltalser or State Uctnse #: CertiflClltlon Number: RL 138906 State: PA Expiration Date of Cel1iflCltion or License: 6-3()"{)5 SUPERVISORY APPRAISER (onl, " required): SI9natu":,~v C, 0~Wl,J SRA Name: Ge6rI:Ie Q. Clauser, SRA Date S9Ied: 12-26-05 State Certification #: PA CertIfled General Real Estate AI>tmIIser or State license #: Certification Number: GAOOO233l State: PA Expiration Date of CertifICation Of Ucense: 0613012005 o Did ~ Did Not Inspect Property Freddie Mac form 439 6-93 Page 2 of 2 folm ACR - "TOTAl. for WI\dows' appraisal aoItware by a Is mode,lnc. -1.Ql-AlAMODE Fannie Mae form 10048 6.93 \ I Cumbel1and PA 17070-1880 SUPPLEMENTAL ADDENDUM No. 5-0216 R-2 ELECTRONIC SIGNATURE COMPLIANCE Wlntotal and Project 2000 are fully ASB (Appraisal Standards Board) COmpliant in their secut1ty. The signatures on this report have not been altered In any way and the digital signatures are to be considered as original. .Y Fonn SlP - "TOTAL lor Windows'IIlPI1isaI softwart by a Ia mode,lnc. -1-600-ALAMOOE CUmberland PA 17070-1880 e Certificate e R. Br1nle FoIm MAP.PlAT - "TOTAl for Windows" lpllllIisaI software by ala mode, Inc. -l-<<l().AlAMOOE - -- e - "\ e -- -- ~ e ~R-14-2005 21:01 PNCBANK Q PNCBAN< March IS, 2005 Linda M. Eshelman P.O. Box 1166 100 Pine Street Harrisburg, PA 17108-1166 RE: Estate of George R. Brinley, deceased SSN: 191.18-4180 000: 12/1912004 Dear Ms. Eshelman: e 412 768 3458 In response to your request for Date of Death balances for the customer noted above, our records show the following: Cbeekiag AecoUDt Account #5140007274 GEORGE R BRINLEY 000 balance: $46,005.76 + $2.24 accrued interest Interest Paid 1/112004 - 12/1912004. $SO.50 Saviqs A.ccoUJlt Account #5003759074 GEORGE R BRINLEY DOD balance: $11,881.08 + $1.17 accrued interest Interest Paid 1/112004 - 12/19/2004. $35.89 Safe Deposit Box #437B GEORGE R BRINKLEY Located: NEW CUMBERLAND BRANCH 331 BRIDGE STREET NEW CUMBERLAND PA 17070 717.714~8743 Page 1 of2 Established 01/01/1978 Established 10/1912001 Established 04/10/1987 P.01 e . MAR-14-2005 21:01 PNCBFN< 412 768 3458 Pleuc note that this office only provides date of death balances for depo5it accounts (IRAs, CDs, Checlclni and Savinp accounts). We do not procesl any flDanclll tranllc:tloD' or proYide .tatements. Jiyou need assiatancc with any of these items, please call1-888-PNC-BANK (1-888-762-2265) or stop by your local PNe Bankbrancb office. Sincerely, ~~ Rachellc Wells 1-800-762-1775 P7-PFSC..()4-F 500 fir1t Ave. Plttsburah P A 15219 Page 2 of2 Member FDIC P.e2 TOTFL P.~ I G \I PSE(~ e the financiallinkTM January 31, 2005 Account # 0191184180 LINDA M ESHELMAN MCNEES WALLACE &NURICK PO BOX 1166 HARRISBURG, PA 17108-1166 Dear MS ESHELMAN: The following is the status of GEORGE R BRINLEY's account with PSECU as of the date of death. Joint O'Mler's Name NONE Date of Death 12.19.2004 Date of Birth 10.23.1921 Share Description Open date Balance Accrued Dividend Maturity date Rate(%) SOl Regular Shares 03.26.1968 $ 2,273.50 $ 0.84 0.75 S02 Vacation 0.98 0.00 0.75 S04 Checking 0.00 0.00 0.25 S50 60 Month Certificate 01.10.1995 28,008.67 80.66 01.10.2010 4.41 S 51 36 Month Certificate 01.26.1996 25,438.20 32.24 01.26.2007 2.57 S52 24 Month Certificate 11.29.2000 44,781.31 60.07 11.29.2006 2.72 Loan Description Open Date Balance Accrued Interest LOl PSL Loan 08.25.1994 $ 0.00 $ 0.00 The dividend earned from January 1, 2004 through the date of death was $3,498.42. We do not have safe deposit boxes for our members. If you have any questions, please call 234-8484 in Harrisburg or our toll-free number, (800) 237-7328. At the menu prompt, enter 6 and then extension 2227. Sincerely, , ~ Member Service Representative Finance Support Unit PENNSYLVANIA STATE EMPLOYEES CREDIT UNION Main Address: 1 Credit Union Place, Harrisburg, PA 17110-2990 . (717) 234-8484. (800) 237-7328 Malllng Address: P.O. Box 67013, Harrisburg, PA 17106-7013 . (711) 777-2100 (TOO) . (800) 472-1967 (TOO) Web Address: www.psecu.com Snlnlll federllly Inlured up to $100,000 by the Nltlonll Credit Union Admlnlltrstlon. '.. . ALL'STATE~ LEGAL 800-222-0510 ED11 RECYCLED * . - II . . MetLife MCNEES WALLACE & NURICK LLC A TTN LINDA M ESHELMAN PO BOX 1166 HARRISBURG P A 1 7108-1166 RE CONTRACTS 073 390 129 AB 077012220 AB GEORGE BRINLEY 077012238 AB ANNUITANT Dear Ms. Eshelman, Thank you for notifying us of the death of our annuitant. Please relay our sincere condolences to the family on their recent loss. This letter is in response to your letter of February 1, 2005. The proceeds of contract 073 390 129 AB are payable to George's wife, Josephine Brinley, as joint owner of the contract. Please have Josephine complete a set of claim forms for this contract. The proceeds of contracts 077 012 238 AB and 077 012 220 AB are payable to George's children; G Robert Brinley, Josephine N Brinley, Stephen K Brinley, and Jennifer Rockey. Please have each child complete a set of claim forms and return them to us in the envelope provided. In addition to the completed claim forms, we do need an original or certified copy of the death certificate. The date of death value, current value and cost basis of each contract is as follows: Contract # 12/19/04 Value Current Value Cost Basis 073 390 129 AB $62,704.02 $63,010.46 $54,745.50 077012 238 AB $66,858.71 $67,181.94 $41,435.47 077012220 AB $14,201.57 $14,269.17 $0.00 (IRA) If you have questions, please feel free to call our toll-free number at 1-800-638- 7732. One of our Customer Service Consultants will be happy to assist you. Sincerely Patl'9 ~ Patty Clune Annuity Death Claims Unit Affiliated Annuity Operations-Tulsa February 8, 2005