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Home My WebLink About02-08-06 . REV-15{iD EX (5-{lO) REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 FILE NUMBER 21 05 INHERITANCE TAX RETURN RESIDENT DECEDENT 00557 COUNTY CODE YEAR NUMBER I- Z W C W U W C DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) Bressler, Helen S. DATE OF DEATH (MM-DD-YEAR) 05/08/05 THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER 195-07 -7035 DATE OF BIRTH (MM-DD-YEAR) 04/15/16 (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) W I- ~!!:U) uO::~ wo..u :x:oo uO::..J 0..1IJ 0.. <( ~ 1. Original Return D 4. Limited Estate D 6. Decedent Died Testate (Attach copy of WDI) D 9. Litigation Proceeds Received D 3. Remainder Return (dale of death prior to 12.13.82) D 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes D 11 Election tc tax under Sec. 9113(A) iA~ach SO" 0) D 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12.12.82) D 7. Decedent Maintained a Living Trust (Attach copy of Trust) D 10. Spousal Poverty Credit (date of dealh between 12.31.91 and 1.'.95) I- Z W C Z o 0.. en W 0:: II:: o U NAME Wayne M. Pecht, Esq. FIRM NAME Ilf Applicable) Pecht & Associates, PC TELEPHONE NUMBER (717) 691-9809 COMPLETE MAILING ADDRESS 1205 Manor Drive, Suite 200 Mechanicsburg, PA 17055 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) (1) (2) (3) (4) (5) 0.00 44,511.72 0.00 0.00 6,950.00 ','~'" i .:.'~) \ C) 3. Closely Held Corporation, Partnership or Sole-Proprietorship r:~ 4. Mortgages & Notes Receivable (Schedule D) z o ~ .....I :J I- a. <( u w 0:: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 0.00 -...-, (6) (7) 0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) I~ 51,461.72 (8) 9,228.26 3,281.74 (11) (12) (13) 12,510.00 38,951.72 17,041.36 (9) (10) 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 21,910.32 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z o ~ I- :J a. :E o u g 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) x.O _ (15) 16. Amount of Line 14 taxable at lineal rate xO _ (16) 17. Amount of Line 14 taxable at sibling rate x .12 (17) 21 0.32 x .15 (18) 3,286.55 18. Amount of Line 14 taxable at collateral rate 19. Tax Due (19) 20.0 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT .~ '\ \ . Decedent's Complete Address: STREET ADDRESS 5225 Wilson Drive CITYM h . b ec amcs urg STATEpA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 8. Prior Payments C. Discount (1) 3,286.55 Total Credits (A + 8 + C ) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty 8. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5A) (58) 0.00 0.00 0.00 0.00 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) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) A. Enter the interest on the tax due. 3,286.55 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOllOWING QUESTIONS BY PtACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred;.......................................................................................... D ~ b. retain the right to designate who shall use the property transferred or its income; ............................................ D ~ c. retain a reversionary interest; or.......................................................................................................................... D ~ d. receive the promise for life of either payments, benefits or care? ...................................................................... D ~ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death 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? .............. 0 ~ 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ........................................................................................................................ 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 thai 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 pre parer has any knowledge. SIGNATURE ?F PERSON YTSPONSIBLE FOR FILING RETURN ~_____E2~_~L~___m____m~___~_m______ ADDRESS ?_~~_~~Erisb~E~-'=i~~,_.!?i~I~~~!;l~'-.!:~ 17q~_____~___.~_~_______________~_m_mm_____________~~_ SIG TU E OF PREPARE TH T N REPRESENTATIVE DATE . I mmmmmm_m____________~~__~_____________mm_~____m_92jSl-~__________ ADDRESS Wayne M. Pecht, Esq., Pecht & Associates, PC, 1205 Manor Drive, Suite 200, Mechanicsburg, PA 17055 DATE ...7-16 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. S9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. S9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax retum are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. s9116(a)(1.2)). The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. S9116(1.2) [72 P.S. s9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. s9116(a)(1.3)). A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF Bressler, Helen S. FILE NUMBER 21-05-0557 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER 1. DESCRIPTION Smith Barney Investment Account (Acct #724-06312-12364) VALUE AT DATE OF DEATH TOTAL (Also enter on line 2, Recapitulation) (If more space is needed, insert additional sheets of the same size) /', g1gg~ ;'?'?~ -<g<go S 5' ~ <Il <Il 0 O-O-<Il u,' (ij" ~ ~ ~ -0 _, __. -""I 0'0'0 a. a. <g o 0 tIl a a 3 ~~~ .... Cll ~ gn1 :3' III (1l "" .... ::J 0- -. ~, tB ~ rJl 5- rJl <Il c: '3 '3 III "" -< o .... 00000;; 88888~ ro --I :>' iO' z'O o ~ =? o' Iii 0. @ C" ro o .... 00000 g8g88 === - - .:: - - -= - - - - - ~ -- --~ - ---- - - - - - - - - - ~ - '- - - - =-- --1--1 g,.g. ~~ .... < Cl> tIl C c :3 Cll tIl <Il g, o ~l':> :t~~ ~~- ....(0-" tA (.V om -"OJ \ I .. ~\~! ~\~ ~ Q1 .... 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REV-1508 EX+ (6-98) '*' COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF Bressler, Helen S. FILE NUMBER 21-05-0557 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1. Prepaid funeral policy (The Midland Policy #M08361) 6,950.00 TOTAL (Also enter on line 5, Recapitulation) $ (If more space is needed, insert additional sheets of the same size) Schedule of Benefits FORM NUMBER BENEFIT AMOUNT COVERAGE STARTS STOPS M015-900 SINGLE PREMIUM WHOLE LIFE $ 6,950 JAN 27, 1995 JAN 27, 2012 S C H E D U LEO F PRE M I U M S ANNUAL PREMIUM $ 5,710.58 YEARS PAYABLE 1 S C H E D U LEO F C H A R G E S THE FOLLOWING AMOUNTS ARE DEDUCTED FROM EACH PREMIUM PAYMENT -PREMlill1 EXPENSE ClIARGE ~50C. % $200.00 -POLICY FEE SURRENDER CHARGE TABLE - PER $1,000 OF SPECIFIED AMOUNT END OF END OF POLICY SURRENDER POLICY SURRENDER YEAR CHARGE YEAR CHARGE 1 $ 60.00 6 $ 48.00 2 60.00 7 36.00 3 60.00 8 24.00 4 60.00 9 12.00 5 60.00 10 0.00 Policy Data INSURED HELEN S BRESSLER POLICY NUMBER M08361 OWNER HELEN S BRESSLER POLICY DATE JAN 27, 1995 RATE CLASS STANDARD MATURITY DATE JAN 27, 2012 , .J SPECIFIED AMOUNT $6,950 AGE AND SEX 78 FEMALE SINGLE PREMIUM $5,710.58 , , TABLE OF GUARANTEED VALUES END OF GUARANTEED GUARANTEED POLICY ACCUMULATION SURRENDER YEAR VALUE VALUE 1 $ 5,120 $ 4,703 2 5,229 4,812 3 5,337 4,920 4 5,444 5,027 5 5,547 5,130 6 5,649 5,315 7 5,747 5,497 8 5,844 5,677 9 5,940 5,856 10 6,036 6,036 11 6,134 6,134 12 6,237 6,237 13 6,349 6,349 14 6,474 6,474 15 6,621 6,621 16 6,800 6,800 17 7,033 7,033 THE VALUES SHOWN IN THIS TABLE ARE FOR THE END OF THE POLICY YEARS. VALUES NOT SHOWN WILL BE FURNISHED ON REQUEST. PAGE 3A . . TABLE OF CORRIDOR PERCENTAGES AND GUARANTEED MAXIMUM MONTHLY INSURANCE RATES (FEMALE) INSURED'S ATTAINED CORRIDOR RATE PER AGE * PERCENTAGE $1,000** 78 38.73% $ 4.84 79 35.78 5.40 80 32.99 6.04 81 30.34 6.77 82 27.85 7.64 83 25.51 8.62 84 23.32 9.72 85 21.27 10.93 86 19.33 12.24 87 17.48 13.65 88 15.69 15.18 89 13.93 16.83 90 12.14 18.65 91 10.26 20.67 92 ...~ 8.24 2 2,~9-9 93 5.96 25.80 94 3.29 29.59 *INSURED'S AGE AT BEGINNING OF THE POLICY YEAR. **RATE PER $1,000 OF NET AMOUNT AT RISK. PAGE 4 General Contract Provisions The contract This policy, including a copy of the application which is attached, forms the entire contract. All statements in the application, in the absence of fraud, will be deemed representations and not warranties. No statement will be used by us to void this contract or to defend against a claim unless it is made in the application. Modification of the contract Any change or waiver of the contract's terms must be in writing and signed by one of our authorized officers. No one else may change the policy or waive our rights or requirements. Contestable period During but not after the contestable period, we can contest the validity of this policy or deny a claim for any misrepresentation or nondisclosure of a material fact in the application. The contestable period starts when the policy goes into force and ends when the policy has been .in force during the Insured's lifetime for two years from the policy date. Protection of payments Unless you and we agree to it, no one entitled to receive benefits under this policy may commute, pledge, sell or assign any part of such benefits. To the extent permitted by law, such benefits shall not be subject to the claims of any Payee's creditors or to legal process against any Payee. Misstatement of age or sex If the age or sex of the Insured has been misstated, the amount of the benefit will be that which the single premium would have purchased at the correct age or sex. Suicide If the Insured commits suicide, while sane or insane, within two years from the policy date, the death benefit we pay will be limited to the single premium paid less any net policy loan. We explain net policy loan in the Policy Values Provisions. Tax status This policy is intended to meet the requirements imposed by Federal and State laws on life insurance. We will change any policy provisions necessary to preserve the policy's status as life Insurance. If we make such a change,we will do so for all owners of policies written on this policy form. We will send you an endorsement describing the change. You have the right to refuse any such endorsement made to the policy. We cannot, however, accept responsibility for the tax treatment of this or any other life insurance policy. You should consult with your tax advisor for individual assistance. Ownership and Beneficiary Provisions Owner This is the person who owns the policy. As Owner, you may exercise all rights and receive all benefits while the Insured is living. Your rights may, however, be subject to the rights of a Beneficiary you name irrevocably. or to any rights you assign. The Owner is named on page 3. You may designate a contingent Owner to succeed to your rights should you die while the Insured is alive; otherwise the ownership will pass to your estate. Change of ownership You may change ownership of this policy to another person. To do so you must send us a signed notice of the change on a form satisfactory to us. When we receive your notice, the change will take effect as of the date you signed it. But the change will not affect any actions we take before receiving and recording your notice. Insured This is the person upon whose life the policy has been issued. The death benefit will be paid on the death of the M015-900 Insured, subject to the terms of this policy. The Insured is named on page 3. Beneficiary This is the person who is to receive the proceeds payable on the death of the Insured. The Beneficiary is named in the application. You may change the Beneficiary unless you named the Beneficiary irrevocably. To change the Beneficiary, you must send us a signed notice of the change on a form satisfactory to us. When we receive your notice, the change will take effect as of the date you signed it. However, the change will not affect any payment we make before receiving and recording the notice. If you name an irrevocable Beneficiary. you must obtain that person's consent before you can: . change the Beneficiary under this policy; . reduce or terminate the Beneficiary's rights to the proceeds; . change ownership of the policy or assign it; or . exercise any other policy right that may reduce the proceeds. Page 5 Cost of insurance rate The cost of insurance rate is based on: . the Insured's sex and age last birthday at the beginning of the policy year; and · the Insured's rate class. The rate class, sex and age are shown on page 3. The highest cost of insurance rates we can use are shown in the table on page 4. We may use cost of insurance rates lower than the rates shown. Any change in rates will be on a uniform basis for Insureds of the same age, sex and rate class whose policies have been in force for the same length of time. Net amount at risk The net amount at risk is the specified amount divided by 1.0036748; less the accumulation value. The net amount at risk will not be less than the corridor. We explain corridor in the Death Benefit Provisions. Rider costs Rider costs, if any, will be determined as provided in the riders. Interest rate The pOI lion of the accumulation value equal to the amount of any net policy loan will earn interest at an annual rate of41/2%. The portion of the accumulation value, if any, in excess of the amount loaned will earn interest at a rate determined by us. We may change the rate at any time, but we will always credit an annual rate of at least 4 1/2%. Surrender You may surrender this policy any time during the Insured's lifetime and before the maturity date. A surrender may be subject to the rights of other persons. The amount we will pay is called the surrender value. It is: . the accumulation value as of the end of the po/icy month in which we receive your request for surrender; less · any surrender charge; less · any net policy loaf). The table on page 3 shows the surrender charge rates at the end of each year. During the first policy year the surrender charge will be the amount shown as of the end of the first policy year. In subsequent policy years we will interpolate for partial years. The table on page 3A shows the guaranteed minimum surrender values at the end of each of the first 20 pOlicy years. To surrender this policy you must send us a signed notice on a form satisfactory to us and return this' policy. All insurance in force under this policy will terminate on the process day on or next following the day we receive your request. We may delay making payment for up to 6 months or the period allowed by law, whichever is less. If we delay making payment, we will credit interest at,anannual rate of at least 41/2% on the surrender value.'We cannot'delay making a payment if it is to be used to pay a premium to us. MO 15-900 Policy loan You may borrow against this policy during the Insured's lifetime and before the maturity date. We require only that you properly assign your policy to us. The maximum amount you may borrow is the surrender value as of the date we receive your request, less interest payable in advance to the next policy anniversary. The amount borrowed will be added to any existing loan. Loan interest accrues daily at 7.4% per year. On each policy anniversary, interest is due and payable in advance to the next policy anniversary. If any interest is not paid when due, we will make a loan to pay such interest and increase the loan accordingly. The loan balance less interest to the next policy anniversary is called the net policy loan. We do not require you to repay any loan to keep this policy in force unless the net policy loan exceeds the maximum loan value. In such case, we will notify you and any assignee of record, at the last known address of each, of the amount needed to keep this policy in force. This policy will terminate 31 days after such notification if no payment is received before that date. You may repay all or any part of a loan while this policy is in force. At the time of payment, we will refund interest to the next policy ::lnniV8L';nry on any amount repaid We can deiay making a loan for up to 6 months, or the period allowed by law, whichever is less. We cannot delay making a loan if the amount is to be used to pay a premium to us. Annual statement We will send you a statement as of the end of each policy year showing: . the currerit specified amount, accumulation and surrender values, and death benefit; . interest and monthly deductions recorded since the last statement; . the status of any riders; . the status of any policy loan; and . any other information required by law Additional statements may be requested at any time during a policy year. We may charge a fee for this service not to exceed $25. Projection of benefits and values We will provide a projection of illustrative death benefits and accumulation and surrender values any time you request it. We may charge a fee for this service not to exceed $25. Basis of reserves and surrender values Reserves and surrender values are based on the Commissioners 1980 Standard Ordinary -A and -G Mortality Tables, Ultimate, Age Last Birthday, with interest at 4 1/2% compounded annually. The surrender values for this policy are equal to or greater than the minimums required by law. A detailed statement of the method of computing surrender values has been filed with the insurance supervisory official of the state in which this policy is delivered. Page 7 Endorsement - Maturity Date . . TheMldland The policy to which this Endorsement is attached is amended to read as follows: The Coverage Stops date and the Maturity Date, as shown in the Schedule of Benefits and Policy data sections of the policy, are deferred for a period of 20 years from the date shown. After the original Maturity date: We will continue to credit interest to the accumulation value as stated in the Interest rate provision; The Death benefit will always be equal to the accumulation value, less any policy loan balance; Interest on any policy loan balance will continue to accrue; Any riders attached to this policy on the original Maturity date will terminate on the original Maturity date; and Monthly deductions will no longer be made; This endorsement is part of the policy to which it is attached. The date of this endorsement is the Policy Date unless otherwise shown below. Effective date ~-~'\ ~.I.\\. President PE 2'1.'3 The Midland Mutual Life Inauranee Company, 2150 Eaat Broad Street, Columbue, OH 432115 .14.22&.2001 TheMldland Endorsement The "Misstatement of sex and age" section of the General Contract Provisions is amended to read: If the age or sex of the Insured has been misstated, the amount of the adjusted death benefit and guaranteed cash value will be that which the single premium would have purchased at the correct age or sex. The accumulation value will be equal to the net premium, less the cost of insurance, plus interest credited on the balance. Such recalculation will be made on the monthly basis from the policy date to the current process day using the correct age and sex. Any surrender values will be based on the accumulation value as determined using the correct age and sex. The "Cost of insurance" section of the Policy Values Provisions is amended to read: We determine the cost of insurance monthly as of the process day. The cost of insurance is the cost of insurance rate times the net amount at risk divided by 1,000. The" Basis of reserves and surrender values" section of the Policy Values Provisions is hereby deleted and replaced with the following section: Basis of reserves and guaranteed surrender values Reserves and guaranteed surrender values are based on the Commissioners 1980 Standard Ordinary -A- or ~G- Mortality Tables, Ultimate, Age Last Birthday, with interest at 4 % % compounded annually. The guaranteed surrender values for this policy are equal to or greater than the minimums required by law. A detailed statement of the method of computing surrender values has been filed with the insurance supervisory official of the state in which this policy is delivered. This endorsement is part of the policy to which it is attached. The date of this endorsement is the Policy Date. ~~~PC~d~~\ Q The Midland Mutual Life Insurance Company PE265-900 09-90 250 E. Broad St., P.O. Box 182009 Columbus, Ohio 43218-2009 ASSIGNMENT OF INSURANCE OR ANNUllY PROCEEDS I transfer to YOu,Jc~~ tvwe.J Wk..i ,all rights to receive the death benefit from the (Name of Funeral Home) Insurance policy or annuity on the life of: Name (insured or annuitant): t/P!c~ S. fl.c-e~(Q-\ , Policy/Contract Number: Issued By: The Midland Mutual Life Insurance Company 250 East Broad Street Columbus, Ohio 43215 After you have satisfactorily provided the funeral goods and services listed in the Statement of Funeral Goods and Services Selected and you have provided certification to that effect to the insurance company, you have the right to demand and receive payment of the death benefit. You have this right even though a different beneficiary is named in the policy or contract. This Assignment notifies the insurance company and directs it to pay all benefits to you in accordance with our Agreement. You agree to pay any benefits in excess of those specified in our Agreement to the beneficiary named in the policy or contract. I UNDERSTAND THAT I MAY CANCEL THIS ASSIGNMENT AT ANY TIME BEFORE THE FUNERAL GOODS AND SERVICES ARE PROVIDED. AFTER THE DEATH OF 'THE INSURED OR ANNUITANT, I OR MY FAMILY, NEXT OF KIN OR OTHER REPRESENTATIVE MAY ALSO CANCEL THIS ASSIGNMENT AT ANY TIME BEFORE THE FUNERAL GOODS AND SERVICES ARE PROVIDED. ANY CANCELLATION MUST BE IN WRITING. I understand that I am agreeing to three sets of conditions - those of this Assignment, those of the Prearranged Funeral Agreement, and those of the life insurance policy or annuity contract. This agreement was signed at "tfkJ (J('1.~(tcd I /J1f on /-"2-'1 I ,19 ~ I understand and agree to the terms stated above. I also understand that a life insurance policy or annuity contract is being used to fund this funeral prearrangement and that all amounts paid for the policy or contract may not be refundable. X~J~ (S'gnalure ot SeleCTIng Party, Policy Owner) CUSTOMER SERVICE NUMBER: (717) 540-1303 \L \1 k"tOt-€ t. '* . ---.\ L N~ine ,L ,(l . , I t)A ~.(). J~x. Lt.~ \ }.XJJi) f.N..,kJeV\Dl 'f'/T 17{77d Funeral Home Address /'=. \ Funeral Home Tel. # t--77 j 7 J 'f - 772-) Original Copy: PFSC Second Copy: Funeral Home Third Copy: Applicant P A 4-94 Date: AGREEMENT TO ESTABLISH IRREVOCABLE ASSIGNMENT OF DEATH BENEFITS USED TO FUND PREARRANGED FUNERAL GOODS AND S~RVI~ES . _ I /-2-cf-9S Place: jJ~J{&~,k{~~ f)f This agreement is between the policyowner, JIe t/2/l -5, 13 t't44 Gz.r It .LJ _ f:} J <}'lame of Policy owner) . .1{>.rrl-Q/1C1'-€.. f/,-, 'M.ft5e.J ~_. :IJJ lA' / (Name of Funeral Horne) and In this agreement, "I", "me" and "my" refer to the policyowner named above. The "policyowner" refers to the owner of the life insurance or annuity contract, the death benefits of which have been assigned for the payment of funeral expenses. "You" and "Your" refer to the preneed company or funeral home named above. The" Agreement" refers to the Prearranged Funeral Agreement between the policyowner, the preneed company, and/or the funeral home designated to provide funeral goods and services. The "life insurance or annuity contract" is the contract which is the subject of the "Agreement." The "funeral home" refers to the funeral home designated in the Prearranged Funeral Agreement as the provider of funeral goods and services at the time of death. I understand that you are in the business of prearranging funeral services in the State of Pennsylvania and that from time-to-time yeu accept the assignment of aU-rights to cleat-h. bc-neftts under certain life insurance and annuity 'Contracts which may be used to pay for such services. I have previously assigned and transferred to you all of my right to the death bene~ a life insurance or annuity contract pursuant to the terms of the Agreement dated /- 2-- ~ - , . State legislatures and agencies have recognized that certain property and rig ts owned by recIpIents of pubhc assistance are of negligible value in enabling those persons to meet their daily needs and should not, therefore, be classified as available resources to such recipients. From time-to-time, certain persons who have prearranged their funerals and are receiving public assistance (or who wish to receive public assistance) may want to amend their prearranged funeral agreements to make them irrevocable so that the life insurance or annuity contract will qualify for a reduced valuation, in accordance with applicable State or Federal Law; THEREFORE, you and I understand and agree to the following terms and conditions so that I may qualify for, or continue to be eligible for, public assistance, in accordance with applicable State or Federal Law: 1. I hereby irrevocably waive any right I may have during my lifetime (a) to cancel or revoke the Agreement; (b) to receive any refund under the terms of the Agreement; (c) to surrender the life insurance or annuity contract for cash; or (d) to obtain a loan against the life insurance or annuity contract. 2. It is understood, however, that although I have irrevocably waived my right to any refund under the terms of the Agreement and to any cash surrender or loan value under the life insurance or annuity contract assigned and have committed all death benefits to the payment of funeral expenses, (a) I, and my family, next-of-kin or other representative, still have the right to change the funeral home designated in the Agreement and to select another funeral home to receive the death benefits upon the death of the insured or annuitant named in the life insurance or annuity contract, in return for the delivery of comparable funeral goods and services: and/or (b) upon my death, my family, next-of-kin or other representative, may cancel or revoke the Agreement at any time before the funeral goods and services are provided. 3. It is further understood that you and I still have obligations under the original Agreement, and all of the provisions of that Agreement which are not amended by this agreement are still in full force and effect. AJ.w {u.,..,6..a,rW __ P 4_ on the zcA day of l ::Jc:l1~~ .19 ~. Policyowner: ).je~ <$. _ c~lL2..c X~~~ This Agreement is signed at (Type or Print Name) ~ (Policyowner Signature) By: X ~ Original Copy: PFSC 2nd Copy: Funeral Home 3rd Copy: Applicant Application for Life Insurance TheMldland 'Proposed insured information .Ii? IJJT~ ~. f5~f.t?f Home address L' IS ~_, - ~/,,- ...b; I{p, 1C~"iI't4!y;/:() /70'- Years at this address ,/ Uk!:> 11 b' (Address) /I A (city) U,- (State} ( (Zipl /'" 1 --'1/ Birthplace ,ITC'..f'rf.5:> Cd. r,'f on I ." I') '"'It r Home telephone number \... 71 -0 70 t.:J -- '10 \. / 1._ (Birth date) Employer I i-erfif'&C./ Business telephone number T M08361 Full name Social Security Number i9:S* 07 /t)3r ~mployer's address (Address) (City) (Statel (Zip) Duties Proposed insurance Amount of coverage desired $ ',9fO - J Amount submitted $ PCkJI 5;7/0 - Plan name I G. r;riYJt1kc / It2 -I1('~Y:>r/l M.:s "0tt01 , Benefir:iaries: (Give names and relationships) Primary Contingent {Unless otherwise requested, 1. "children" shall mean any lawful children of the insured by birth or adoption; 2. proceeds shall be paid to joint beneficiaries equally or to the survivor{s); 3. proceeds shall be payable to the estate of the insured if no beneficiary is living at "0' _ t~~_i~l)_un~d"~ death;~nd~:_~h.e~o~n~! _~f _~he,policYJeserv~~_the ~!g!l!__to._~_~~_'1,.9!, be_~~fici~ri.es.L u. " Premiums will be paid: ~ Single 0 Annually Premium payment period if other than single: :.,1ail billing notices to: ~. Proposed insured o Other: Name o Semi-Annually o 3 Years DOwner o QU'8rterly o 5 Years o Monthly (By preauthorized check) o 10 Years (Address) (Cil1) (State) (Zip) General information about proposed insured 1. 0 Male ~ Female J J/1 ~2. Height ~ # /" Weight /36 Weight change in past year /VU y Due to Yes 3. Have you ever received treatment, or been advised by a member of the medical profession to seek treatment, for use of alcohol? 0 4. Have you been diagnosed by, or received treatment from a member of the medical profession for Acquired Immune Deficiency Syndrome (AIDS), or AIDS Related Complex (ARC)? 0 5. Have you had a test confirming exposure to the AIDS virus (HlV, HTlV-I\1)? 0 6. Have you consulted a physician, been examined or treated at a hospital or other medical facility for any illness or injury or had heart troubl e, stroke, cancer or diabetes, in the last to years? (Circle those which apply.) Do 1I0t include colds, flu, minor injuries, seasonal hay fever, hemorrhoids, appendicitis or tonsillitis. 0 7. Have ycu ever been declined, denied reinstatement or rated wher. applying for an insurance policy? 0 8. Will this policy replace an existing life insurance or annuity policy? A.~ITY PRODUCT G;:::- JA,N )7 ~ ,., f", ... l.~i 1 - No' ~ ~ Provide details for yes answers to the questions above. ( i~!']hJ~Q 19ctOr'S name fa addr_a ~ Rl 0]4 (7/7)737-f~/P Ho\.oor-6 CMI\ '17/"'> 1h'fvJ k ~1, ~d<.()Ij.I. C-I-bofi(jo, fn )?OSS- (j Owner information (Complete if applicant is other than proposed insured) Name Social Security Number Home address (Address) (City) (State) IZip) Page 1 of 4 NB-293PA 05-92 (PAl The Midland Mutual Life Insurance Company, 250 East Broad Street, Columbua, OH 43215 814.22&-2001 'Home office endorsement I i I , I understand that if I am not approved tor the life insurance policy applied for, a flexible premium annuity policy will be issued in its place. Initials of proposed insured Initials of owner if other than proposed insured. Authorization L the proposed insured, authorize any licensed physician, medical practitioner, psychotherapist, hospital, clinic or other medical or medically related facility, insurance company, the MIB, Inc., or any other organization, institution or person, that has any records or knowledge of my health, treatment, or other insurance coverage, to give any such information to The Midland Mutual Life Insurance Company (company) or its reinsurers. I also authorize Equifax, Inc., or any other investigation company which is employed by the company, to collect and transmit such records and information. I further agree that a photographic copy of this authorization will be as valid as the original. This authorization is valid for two years from the date of this application. Agreement The undersigned represent. each to the, best of his or her k.nowledge and belief, that all statements and answers in all parts of this application are complete, true and correctly recorded and further agree that: 1. No agent or medical examiner of the company is authorized to accept risk. or to make or modify contracts or to waive any of the company's rights or requirements. 2. With respect to all questions in all parts of this application, no information has been furnished to any agent or medical examiner that is not recorded in the answers to such questions. 3. The entire contract will consist of this application and the policy issued in response to it. 4. If a premium payment has been made, and a conditional receipt bearing the same name and date as this application has been received, no insurance will be effective before policy delivery unless all of the terms and conditions of the conditional receipt are met. 5. If a premium payment has been made and any of questions 3 through 7 in the General Information section of this application are left blank or answered yes, no insurance will be effective before policy delivery irrespective of the issuance of a conditional receipt, and the company will promptly return the premium payment. 6. If no such premium payment has been made at the time of making this application, or if the. company approves this application different from that applied for as to plan, amount or age, no insurance shall take effect until (a) the policy is delivered to and accepted by me and (b) the first full premium is paid and (c) the statements and answers in all parts of this application then remain substantially correct.. 7. Changes to this application relating to plan"amount or age shall be considered ratified only with the owner's written consent, and any other changes to this application made by the company and noted in the Home Office Endorsement section shall be considered ratified by my acceptance of a life insurance policy showing such changes. 8. Any person, with intent to defraud or who k.nowingly facilitates a fraud against an insurer, submits an application or files a claim containing a false or deceptive statement is guilty of insurance fraud. I acknowledge receiving a disclosure statement concerning (1) insurance information practices, (2) an investigative consumer report, and (3) disclosure of medical information. If a premium payment was made, I acknowledge receiving a conditional receipt and reading it!n full. Signed at ;.JCU)LI.JMW!o,-.e! pA (Clty/Statel f this '7 i.#-t. ~~ -J- day.! ;;JC.1ua .t9~ _ / /) IMonth) X.~ If?~ Proposed insured 3/t,16' No. '/... ~~can~an proposed insured) \k~. ~ \ ' Agent Agent information Credit to: Agent{s) Code Agency name Agency address (or Terr. Code) Agency phone RAL cERVICE CORP r^ FUt>l~LLEN.;;JTOWN BL,,'O. '7411~ '--1i! .HARRISBURG.PA~1 J I, J'" .. ......:.,,1 ;-1:)0,-, ( ). .. . ~ % ---.- % % uestions in all parts of this application are true and correct. I further '(1'."11 ot replace an existing r insu( ce or annuity policy now in force. ~ X ) Agent please note: Agent If the amount of life insurance on this application, plus any other life insurance in force 0 applied for with The Midland, including accidental death benefits, exceeds $250,000, or if any of questions 3 through 7 in the General Information section of this application are left blank or answered yes, do not accept a premium payment and do not use a conditional receipt. Page 2 of 4 NB-293PA 05-92 (PAl The Midland Mutual Life Inauranee Company, 250 E.at Broad Str.et, Columbua, OH 43215 1114.225-2001 REV-1511 EX+ (12-99. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF Bressler, Helen S. FILE NUMBER 21-05-0557 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. 1. DESCRIPTION AMOUNT B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions . Name.oJ PeJ:sonaIRepresentative( s) So~ial'Security Number(s)/EIN Number of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: Claimant Street Address City Relationship of Claimant to Decedent 4. Probate Fees 175.00 5. Accountant's Fees 6. Tax Return Pre parer's Fees 7. The Patriot News 8. Cumberland Law Journal 2. Attorn ey Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) TOTAL (Also enter on line 9, Recapitulation) (If more space is needed, insert additional sheets of the same size) 01/25/213135 14:25 71 77715545 PARTHEMORE PAGE 132 , . A Family Tradition Of Caring ~ . . PARTHEMORE Funeral ~~ Cremation Services; Ine" . . Mr, David S. Brcssle:r ~ '-"9 P 5/10/2005 ' ' 204 Harrisburg Pike t.,... . , Dillsburg, PA 17019 ' , . 1303 Bridge Street . P.O. Box 431 New Cumberland; PA 17070 .' . (717) 774-7721 (Fax) 774c5?46 . www.partbemore.com . . . . ..' , ".. ,', '" .' We sincerely appreciate the Confidence you have placedi,n us and will continue to as:rist you in every way . . ~c can;' Please feel free to contact US if you bave any questions in regard to this statement. The following' is an itemized statement of the sr;rviccs,' ra..ilitics, automotive equipment and merchandise thac you selected. when making the fun.era! arrangements. . . '. . ... . Due D~te . rc'.':-~cco~nt#-"-'- ..~~r;;~ .... ...L. 6/9/2005 2005051.0 Descrip~on . 'fraditional Funeral Service . . is Gauge. Steel "Pieta" Casket Amount Gilbert W. Parti;emore, Founder Total Services and Merchandise i . . . pca~ Notice~ H:anisbnrg Patriot, . Ce.ttifiedCopies of Death Certificates, . . Hairdresser . (2) Clergy Honoraria Flowers, Ca.~ket Spray i :1 5,150.00 . 2,421.00 7.571.00 . Oilbe:rt J. Pal'themore, Supervisor Sw.phen K. Partbemore, . . .. CFSP 188.00 48.60 40.00. 250.00 . 175.00 Total Cash AdvanGCS 701.00 Pre-Need Discount. . -745.64 Bruce R. Piuthemore, Pre-Need Coordi~ator, Q>C' Professional Memberships: . . ~A.PFDA' DCFDA .CCFDA G '-.<IdolIJida."'IN.. .~. , , .~ . Th~ Ruff; YQU KfW>1" The People 'Y()uTrusl Total . . . Payments/Credits ~-'.'.. . ....---.. " $7,526.36 $~7,S26.36 Balance' Due . $0,00 RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of wills One Courthouse Square Carlisle, PA 17G13 Rece~pt Date: Rece~pt Time: Recelpt No.: 6/20/2005 14:12:28 1041025 BRESSLER HELEN S Estate File No. : Paid By Remarks: 2005-00557 PECHT & ASSOCIATES SK Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 1855 Total Received......... Receipt Distribution ------------------------ Payment Amount Payee Name 90.00 15.00 20.00 10.00 5.00 ---------------- $140.00 $140.00 CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN CUMBERLAND COUNTY GENERAL FUN BUREAU OF RECEIPTS & CNTR M.D CUMBERLAND COUNTY GENERAL FUN JUN 2 2 ZOIPj ;S::CIl~O llls;~ ""0 :ciT!CJ1""O m ~~;s::mo o 0 ~:tI::I: 1ll .~~~ c 0- Qo 115 ::cz)> _ Ci) en 5 ~~ ~ ~; 80 ? ~ ~.~ L ~.sn '7 :c i5~. p ~.~ - C HARLAND STYLE XKJ cg :0 g~. J>~ J. ~. . - ~ ... o o - ..lJ o U-J ... 0 c:> c:::1 .. U3 IJJ / - OJ -U OJ -U - . . .f:I7 ED -.,..........-..'" :~; ~I [~; llC-"o;n ~~~:;; 0:-< l- . F\I..f - ~ " ~ ~ V \S\. "'~ ~.~ :r~ _.~ ....;,)" CO o W CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 August 19,2005 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Wayne M. Pecht, ESQUIRE RE: Helen S. Bressler, ESTATE Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. -------------------------------------------------------------------- --------------------------------------------------------- Advertisement inserted on following dates: AugustS, 12, 19,2005 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment Received $ 75.00 Total Amount Due $ 0.00 -------- -------- Payment received August 2. 2005 by Becky H. MorgenthallExecutive Director REV-1512 EX+ (12-03) '*' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. Bethany Skilled Nursing 2. Alert Pharmacy 3. West Shore EMS 4. Miscellaneous Expenses TOTAL (Also enter on line 10, Recapitulation) (If more space is needed, insert additional sheets of the same size) OlO;:J---71 E-; P:: fiI ...:J ,::t; . ~ Z 0 ::E: 10:: 0 ~. :r:: E-i Lf) Z 0"\ 0 ::E: 0"\ Lf) 0:: Lf) 0 rl Ii. r:a C!J 0:: ;g U + + . rl Lf) co \0 0 0 0 g t- O 0 0 rA ti> ~ ti> ti> ~. $ b b~ \0. r.: C'i C'l l- I- s ..... CO ...... I- ~ cc:, ~ Z- ~ g g LO ..::J ~ t-: "i-S2.. a $ & ~ \0 .t "'-> ~ ~ ~ :i .~ 0 'r g g 0 ~ 0 a C'i C'i ~ ..... ..... ~ .c r- ~ 0> co ~ ~ ~ b Q) ffi ~ <-;A r- ~ Q) .~ ~ ~ ~ ;; ? ?" to (/) Q) ';>-0 z .... a "% - ~ ~ .s Q) 3: Q) U1 a: (/) cO :x: Q) '6 <.) 9 ~ Q) to a '<1l ~ ro Q) en 0 ~ D ~ Q) c Q) -0 ex: <) 8 Q) ~ ~ ~ u.. .~ c c .,... % 0- ~ Q) :c, ~ 0 Ol 'E ~ ~ 8 g % <.) s G t ...J \0 \0 -0 ~ \0 \0 Q) 0 g 0 0 (/) ~ (/) ~ C\l ~ % '-% co ~ 'C:l % % ..... E. t') co 0 \n \n C:( \n \n Q) Q) :x: 0 0 0 0 D l% . W \0 \0 \0 \0 Q) Q) 0 '& 0 0 l% ei: It) ~ ~ ~ % % % d5 .52 0 (l.. \0 \n \n \n " 0 0 0 0 WEST SHORE EMS - BLS 205 GRANOVIEW AVE SUITE 211 CAMP HILL, PA 17011 Phone #: (800) 367-0512 Federal Tax 10: 23-2463002 ;~.p~ WEST SHORE EMERGENCY MEDICAL SERVICES URANCE: KME YWK195077035 PATIENT NUMBER: CALL NUMBER: DATE OF CALL: TIME OF CALL: CALLER: FROM: TO: 12187 PRIV 130403W NONE 04/29/2005 04:28 PM HOLY SPIRIT HOSPITAL HOLY SPIRIT HOSPITAL BETHANY VillAGE lENT NAME: HELEN BRESSLER 130403W MARY BRESSLER 204 HARRISBURG PIKE DILLSBURG, PA 17019 REASON(S) FOR TRANSPORT ATRIAL FIBRillATION 0" 'INVOICE INVALID COACH Transport Van Mileage A0130 A0999 1.0 6.0 81.12 1.51 81.12 9.06 f,o.",J>~1 ro \ S jtt{9-1 Total Charges 90.18 Total Credits 0.00 PLEASE PAY THIS AMOUNT -.. Miscellaneous Expenses 2005 Trinity UM Church 25.00 Pa Dept of Revenue 90.00 H & R Block 178.00 Bonnie Miller 9.80 Postmaster 7.40 David BM88i0r ~Jf,-t-C;Sl-&..f-300.00 donation 2004 income tax 2004 tax preparation local tax postage miscellaneous expenses for Helen's care total 610.20 USPS DILLSBURG, Pennsylvania 170191210 4134870019-0097 08/18/2005 (717)432-3035 01:44:13 PM Sales Receipt Product Sale Unit Final Description Qty Price Price HARRISBURG PA 17108 First-Ciass $0.60 ;:======== Issue PVI: $0.60 $0.60 HARTFORD CT 06156 First-Class ======== Issue PVI: $0.60 $0.60 HARRISBURG PA 17101 First-Class " ======:::= Issue PVI: $0.60 $7.40 Love 1 $7.40 $7.40 Bouqt PSA B~ ! Total: I~ 9J1'3~ '. / t9,;::'c-. Pal d by. . '1. !'~$9~0 Persona 1 Check , r (9 ~) . .' Order stamps at USPS.com/shop or call 1-800-Stamp24. Go .to . . USPS.com/clicknship to print shlPPlng labels with postage. For other information call 1-800-ASK-USPS. Bill#: 1000301992417 Clerk: 01 -- All sales final on stamps an~ postage. Refunds for guaranteed serv~ces only. Thank you for your buslness. Customer Copy REV-1513 EX+ (9-00) *' SCHEDULE J BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Bressler, Helen S. FILE NUMBER 21-05-0557 AMOUNT OR SHARE OF ESTATE NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) 1. David S. Bressler Nephew 204 Harrisburg pike Di11sburg I PA 17019 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Trinity United Methodist Church 2. Shriners Hospitals for Children (If more space is needed, insert additional sheets of the same size) TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 17,041.36 Glenda Farner Strasbaugh Register of Wills and Clerk of Orphans' Court Marjorie A. Wevodau First Deputy Kirk S. Sohonage, Esq Solicitor Register of Wills and Clerk of the Orphans' Court County of Cumberland One Courthouse Square Carlisle, PA 17013 (717) 240-6345 FAX. (717)240-7797 INVOICE Bill To: InvoiceNo: Invoice Date: Estate of: Estate No: 729 2/8/2006 Helen S. Bressler 21-05-0557 Pecht & Associates, PC 1205 Manor Drive Suite 200 mw Mechanicsburg, P A 17055 Qty 1 Fee Description Additional Probate Fee Total 45.00 $45.00 Total: $45.00 Checks should be made payable to the Register of Wills. Terms: Net 30. Please return one copy of this invoice with your payment. Thank you. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 REV-1162 EX(11-961 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 006305 BRESSLER DAVID S 204 HARRISBURG PIKE DILLSBURG, PA 17019 ACN ASSESSMENT CONTROL NUMBER AMOUNT ____un fold 101 $3,286.55 ESTATE INFORMATION: SSN: 195-07-7035 FILE NUMBER: 2105-0557 DECEDENT NAME: BRESSLER HELEN S DATE OF PAYMENT: 02/08/2006 POSTMARK DATE: 02/08/2006 COUNTY: CUMBERLAND DATE OF DEATH: 05/08/2005 TOTAL AMOUNT PAID: $3,286.55 REMARKS: CHECK# 104 SEAL INITIALS: MW RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS