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HomeMy WebLinkAbout09-25-06 J. REV-1500 OFFICIAL USE ONL Y COMMONWEALTH OF PENNSYLVANIA FILE NUMBER DEPARTMENT OF REVENUE DEPT. INHERITANCE TAX RETURN 280601 HARRISBURG, PA 17128-0601 RESIDENT DECEDENT 21 06 0551 COUNTY CODE YEAR NUMBER I- DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER 2: Brambley, Barbara E 008-14-2042 w DATE OF DEATH (MM-DD- YY) DATE OF BIRTH (MM-DD-YY) THIS MUST BE FILED IN DUPLICATE 0 W 6/13/2006 9/16/1922 WITH THE REGISTER OF WILLS 0 W (IF APPLICABLE) SURVIVING SPOUSE'S NAME SOCIAL SECURITY NUMBER 0 I UJ :xJ 1. Original Return 0 2. Supplemental Return o 3. Remainder Return <( ~!:::cn tJ 4. Limited Estate 0 o 5. Fed. Est. Tax Return Req'd oO::~ 4a. Future interest Compromise UJa.o :cOO txJ 6. Decedent Died Testate 0 0_ oO::~ 7. Deeedent had Living Trust 8. Total number of SOB's a.a:J a. -, 9. Lifg'tion Proceeds Rec'd n 10. Spousal Poverty Credit n 11. Election to tax wI See. 9113(A) c( I- a~i..tml1m:t.lUllWl$.tl.~_e~~&i!.C.~jH.'J$...mf~lij~J.tm~Mf~1~~1~n@11;m1i1 z NAME: COMPLETE MAILING ADDRESS: UJ c z Ronald E. Johnson, Esquire 0 a. FIRM NAME: Ronald E. Johnson, Esq. cn UJ Andrews & Johnson Andrews & Johnson a::: 0:: TELEPHONE NUMBER 78 W. Pomfret St. 0 0 717 243-0123 Carlisle, PA 17013 /",,) ,---. r,"-") 1. Real Estate (Schedule A) (1 ) $0.00 OFF1~L USE ON{, Y 2. Stocks and Bonds (Schedule B) (2) $13,590.00 ") 3.Closely Held Corporation. Partnership or Sole-Prop. (3) - - ;'.) 4. Mortgages & Notes Receivable (Schedule D) (4) $0.00 C/1 :2 5. Cash, Bank Deposits & Misc. Personal Prop.(Sch.E) (5) $16,933.57 -.,....,. 0 6. Jointly Owned Property (Schedule F) (6) $43,823.37 . I _._- - ~ --- .... --; :s D Separate Billing Requested --{ r-.-) - " ~ 7. Inter-VIVOs Transfers & Misc. Non-Propate Prop. (7) o. r-:} l- I.;;.) 0: 8. Total Gross Assets (total lines 1-7) (8) $74,346.94 c:( 9. Funeral Expenses & Administration Costs (Sch H) (9) $19,061.38 0 w 10. Debts of Decedent, Mortgage liabilities, & Liens (10) $16,513.06 0:: 11. Total Deductions (total lines 9&10) (11 ) $35,574.44 12. Net Value of Estate (Line 8 minus Line 11) (12) $38,772.50 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (13) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) $38,772.50 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES z 15. Amnt of Une 14 taxable at the spousal rate, e 1= or transfers under Sec.9116(a)(1.2) x.O_ (15) $0.00 ~ ::J 16. Amount of Line 14 taxable at lineal rate $38,772.50 x.045 (16) $1,744.76 Q. :IE 17. Amount of Line 14 taxable at sibling rate $0 x.12 (17) $0.00 e (J 18. Amount of Line 14 taxable at collateral rate $0 x.15 (18) $0.00 )( $1,744.76 i! 19. Tax Due (19) 20 o CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~~i@~~j~f:Mjj~1g1M~jg$W$~j~1~~~i_~1I.."W.jItU1'll:.:"::;":'.::':::.~':'..:.~"'<<$14.lm'W";j_._iMMflii[jg%1&~t~mf:jWlrg@flM~ :-0 r"" () (-"") x;~ -:-'j ;-:) C) -"1 ...." . C j '..1 t-TJ.:, C_:...) - Itt v dd Decedent's Complete A ress: STREET ADDRESS 4121 Mountain View Road CITY STATE ZIP Mechanicsburg PA 17050 If line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT , Tax Payments and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discounts Total Credits (A+B+C) 3. Interest/Penalty if applicable D. Interest E. Penalty 4. TotallnterestlPentalty (D+E) 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 5. (1 ) (2) (3) (4) (5) (SA) (5B) $1,744.76 $0.00 $0.00 $1,744.76 $1,744.76 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: yes no a. retain the use or income of the property transferred: b retain the right to designate who shall use the property transerred or its income: c. retain a reversionary interest: or d. retain the promise for life of either payments or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary disignation? CJ CJ CJ CJ CJ CJ l!:J ~ ~ r::J ~ El (!:J CJ 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. DATE DATE 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% [72P.S. Sec. 9116(a)(1.1 )(1)). For dates of death on or after January 1, 1995, the tax rate imposed on the net I/alue of transfers to or for the use of the survil/ing spouse is 0% [72 P.S. Sec. 9116(a)(1.1)(ii)). The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary For dates of death on or after July 1, 2000: The tax rate imposed on the net I/alue of transfers from a deseased child twenty-one years of age or younger at death to or for the use of a natur or a stepparenl of the child is 0% [72 PS. Sec. 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's tineal beneficiaries is 4.5%, except as noted in 72 P.S. Se 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. Sec.9116(a)(1.3)). A sibling is d indil/idual who has at least one parent in common with the decedent, whether by blood or adoption. /3r ru~ Il/JtpD ."."-",,,,,,,"-- .. CODICIL TO THE LAST WILL AND TESTAMENT OF BARBARA E. BRAMBLEY I, Barbara E. Brambley, of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this Codicil to my Last will and Testament. Item III and Item IV of my Last will and Testament dated March 16, 1993, are amended and restated in their entirety as follows: ITEM III: I specifically give, devise and bequeath the following: (a) My cluster diamond ring to my granddaughter Stefanie Allia, now or formerly of Mechanicsburg, Cumberland County, Pennsylvania. (b) My two (2) diamond setting ring with gold band to my granddaughter Danielle Allia, now or formerly of Mechanicsburg, Cumberland County, Pennsylvania. (c) My three (3) diamond setting ring with gold band to my granddaughter Bonnie Brambley, now or formerly of Highland Heights, Kentucky. (d) All of my remaining jewelry, household furniture and furnishings, automobiles, books, pictures, china, linen, silverware, wearing apparel, and all other like articles of household or personal use and adornment to my daughter Sherry S. Allia, now or formerly of 4121 Kittatinny Drive, Mechanicsburg, Cumberland County, Pennsylvania 17055. In the event that any of the beneficiaries fail to survive me, than bequest shall pass to my residual distributed as specified thereunder. Page 1 of 2 Pages above specific that particular estate and be ITEM IV: I give, devise and bequeath all of the rest, residue and remainder of my property, real, personal and mixed, as follows: ( a) In the event my daughter and my son, Richard W. Brambley, now or formerly of Highland Heights, Kentucky, both survive me and there is any residual estate, it shall be divided in as nearly equal portions as possible between them by my Executor in his or her sole discretion. (b) In the event that either my son or daughter fail to survive me, then my real property and my stocks and bonds, as well as my entire residual estate, shall pass as follows: ( 1 ) Seventy-fi ve ( 75% ) percent of my entire residual estate to the surviving child of mine; and (2) Twenty-five (25%) percent of my entire residual estate to the then living issue of the deceased child of mine, per capita to be distributed by my Executor in as nearly equal shares as possible. ( c) In the event that nei ther my son nor daughter survive me, then my real property and my stocks and bonds, as well as my entire residual estate, shall pass to my then living grandchildren, per capita, to be distributed to them by my Executor in as nearly equal shares as possible In all other respects not inconsistent with this Codicil, my Last Will and Testament of March 16, 1993, is ratified and confirmed and shall continue and remain in full force and effect. IN WITNESS WHEREOF, I have hereunto set my hand and seal to this Codicil to my last will and Testament, consisting of this page and the one (1) preceding page this ( 3"'- day of April, 1995. ~~ ~ ~~~ Barbara E. Brambley Page 2 of 2 pages SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testatrix, Barbara E. Brambley, as and for a Codicil to her Will, in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. CjflUt.-1L 6-1~Jh/ Address A mlLrforrl ~14-d \ ' 6v~ 11\~~~ddress i1~ .'~ , . JYt~c:;louA6 ~U;f ~ Address 3;10'1 1_... fk rr.) tvr5i 1'4 ~ COMMONWEALTH OF PENNSYLVANIA SS. : COUNTY OF CUMBERLAND I, Barbara E. Brambley, the Testatrix whose name is signed to the attached or foregoing instrUment, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as a Codicil to my Last Will and Testament; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by Barbara E. Brambley, the Testatrix, this /3~ day of April, 1995. ~~~ Barbara E. Brambley, Testatrix ~~.~ , . './~~:;J . N ary P . c My Commission Expires: (SEAL) NOTAr-'I!t\L. SEAL SUSAN M. JANICSKO. Notary Public Lower Paxton Twp.. Dauphin County Mv Commission Expires June 26. 1995 COMMONWEALTH OF PENNSYLVANIA SS. : COUNTY OF CUMBERLAND We, John R. Beinhaur, Mark K. Emery and Margaret A. Fenstermacher, the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix, sign and execute the instrument as a Codicil to her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness, in the hearing and sight of the Testatrix, signed the Codicil as a witness; and that to the best of our knowledge, the Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affirmed and subscribed to before me by John R. Beinhaur, Mark K. Emery and Margaret A. Fenstermacher, witnesses, this J~~ day of April, 1995. Q cU-u (L 1rf,Uw- w~ ness / ~?/(.r/11/ itness !'"'"-----'..... .,. ' ........ -..-...----- SUSAt,I . '. . '., ,.,:.[. ,SU-L -1 'f M. JANV":"i\O . lower Paxton T';;; 0' Not~ry PUblic M CommIssion Ex': auphm County Ires June 26 1995 LAST WILL AND TESTAMENT m: BARBARA E. BRAMBLEY I, Barbara E. Brambley, of Mechanicsburg, Cumberland County, Pennsylvania, being of sound and disposing mind and memory, do make, publish and declare this to be my Last Will and Testament, hereby revoking all Wills and Codicils by me at any time made. ITEM I: I direct that all inheritance and estate taxes becoming due by reason of my death, whether such taxes may be payable by my Estate or by any recipient of any property, shall be paid by my Executor out of the property passing under this Will, which is not specifically devised or bequeathed, as an expense and cost of administration of my Estate. My Executor shall have no duty or obligation to obtain reimbursement for any such tax paid by my Executor even though on proceeds of insurance or other property not passing under this Will. ITEM II: I hereby exercise all powers of appointment which I may have at the time of my death in favor of my Executor, and all property subject to all such powers shall be included in my Estate. ITEM III: It is my specific intent to divide my property equally, according to monetary value, between my children if they are living at the time of my death. Towards that end, I specifically give and bequeath the following items: (a) My real property located at 4121 Mountainview Road, Mechanicsburg, Cumberland County, Pennsylvania to my daughter, Sherry S. Allia, now or formally of 3814 Leyland Drive, Mechanicsburg, Pennsylvania 17055. Page 1 of 6 Pages (b) All of my stocks and bonds to my son, Richard W. Brambley, now or formerly of Highland Heights, Kentucky. (c) My cluster diamond ring to my granddaughter, Stefanie Allia, now or formerly of Mechanicsburg, Pennsylvania. (d) My two diamond setting ring with gold band to my granddaughter Danielle Allia ,now or formerly of Mechanicsburg, Pennsylvania. (e) My three diamond setting ring with gold band to my granddaughter, Bonnie Brambley, now or formerly of Highland Heights, Kentucky. (f) All of my remaining jewelry, household furniture and furnishings, automobile, books, pictures, china, linen, silverware, wearing apparel, and all other like articles of household or personal use and adornment to my daughter Sherry S. Allia. In the event that either my son or my daughter fail to survive me, then both of those specific bequests shall fail and pass to my residual estate and be distributed as specified thereunder. In the event that any of the remaining specific beneficiaries fail to survive me, then that particular bequest shall pass to my residual estate and be distributed as specified thereunder. ITEM IV: I give, advise and bequeath all of the rest, residue and remainder of my property, real, personal and mixed as follows: (a) In the event my son and daughter survive me and there is any residual estate, it shall be divided in as nearly equal portions as possible between them by my Executor. Page 2 of 6 Pages (b) In the event that either my son or daughter fail to survive me, then my real property and my stocks and bonds, as well as my entire residual estate, shall pass as follows: (1) Seventy-five percent (75%) of my entire residual estate to the surviving child of mine; and (2) Twenty-five percent (25%) of my entire residual estate to the then living issue of the deceased child of mine, per capita to be distributed by my Executor in as nearly equal shares as possible. (c) In the event that neither my son nor daughter survive me, then my real property and my stocks and bonds, as well as my entire residual estate, shall pass to my then living grandchildren, per capita, to be distributed to them by my Executor in as nearly equal shares as possible. ITEM V: In the settlement of my Estate, my Executor shall possess, among others, the following powers to be executed for the best interest of the beneficiaries: (a) To sell either at public or private sale and upon such terms and conditions as my Executor may deem advantageous to my Estate, any or all real or personal estate or interest therein, whether owned by me severally or in conjunction with other persons or acquired after my death by my Executor, and to consummate said sale or sales by sufficient deeds or other instruments to the purchaser or purchasers, conveying a fee simple title, free and clear of all trust and without obligation or liability of the purchaser or purchasers to see to the application of the purchase money or to make inquiry into the validity of said sale or sales; also, to make, execute, acknowledge and deliver any Page 3 of 6 Pages and all deeds, assignments, options or other writings which may be necessary or desirable in carrying out any of the powers conferred upon my Executor in this Paragraph V (a) or elsewhere in my Will. (b) To pay all costs, taxes, expenses and charges in connection with the administration of my Estate. My xecutor shall pay expenses of my last illness and funeral expenses. (c) To distribute my Estate in kind or in money. If any assets are distributed in kind, they shall be distributed at their respective value(s) on the date(s) of their distribution. ( d) To retain any investments I may have at my death so long as my Executor may deem it advisable to my Estate so to do. (e) To vary investments, when deemed desirable by my Executor and to invest in such bonds, stocks, notes, money markets, real estate mortgages or other securities or in such other property, real or personal, as he shall deem wise, without being restricted to so-called "legal investments." (f) To mortgage real estate and to make leases of real estate. (g) To borrow money from any party to pay indebtedness of mine or of my Estate, expenses of administration or inheritance, legacy, estate and other taxes. (h) To vote any shares of stock which form a part of the Estate and to otherwise exercise all the powers incident to the ownership of such stock. (i) In the discretion of my Executor, to unite with other owners of similar property in carrying out any plans for the Page 4 of 6 Pages reorganization of any corporation or company whose securities form a part of the Estate. ( j ) To distribute my personal property directly to the Guardian of the person of any minor beneficiaries hereunder. (k) To elect such settlement options as deemed most appropriate by my Executor with respect to any pension,profit sharing or other retirement plan in which I am a participant. (1) To do all other acts in judgment of my Executor necessary or desirable for the proper and advantageous management, investment and distribution of my Estate. ITEM VI:. Any person who shall have died at the same time as Testatrix or in a common disaster with her, or under such circumstances that it is difficult or impossible to determine who died first, shall be deemed to have predeceased her. ITEM VII: If at any time, any minor child or disabled person shall be entitled to receive any assets hereunder, the parents or surviving parent or guardian of such minor child, shall act as Guardian of the assets payable to such person. Said Guardian may receive and administer all assets authorized by law and shall have full authority to use such assets, both principal and income, in any manner said Guardian shall deem advisable for the best interest of such person, including college, univerSity, post-graduate or other education, without securing court order. Said Guardian shall have all the rights and privileges as to the Guardianship and the assets thereof as are herein granted to my Executor as to my Estate and the assets therein. Page 5 of 6 Pages ITEM VIII: I nominate, constitute and appoint my daughter, Sherry S. Allia, to be my Executrix (herein referred to as "Executor"). In the event of the death, resignation, refusal or inability of Sherry S. Allia to serve as my Executor, I nominate, constitute and appoint my son, Richard W. Brambley, to serve as Executor. In the further event of the death, refusal or inability of Richard W. Brambley to serve as my Executor, I nominate, constitute and appoint my grandson, James J. Brambley, now or formerly of Atlanta, Georgia, to serve as Executor. My Executor and Guardian are specifically relieved from their duty or obligation of filing any bond or bonds. IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will and Testament, consisting of this, the next three (3) pages and the preceding five (5) pages this jbt( day of March, 1993. ~~~~ Barbara E. Brambley . Page 6 of 6 Pages ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA . . : 58. : COUNTY OF DAUPHIN . . I, Barbara E. Brambley, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Willi and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. Sworn to or affirmed and acknowledged before me by Barbara E. Brambley, the Testatrix, this 16th day of March, 1993. NOT AAJAL SEAL JOHN A. BEINHAUR. Notary Public M;ower P~xt.on Twp.. Dauphin Cou~ty CommIssIon Expires March 13. 199U SIGNED, SEALED, PUBLISHED AND DECLARED by the above named Testatrix, Barbara E. Brambley, as and for her Will, in the presence of us, who, at her request, in her presence and in the presence of each other, have hereunto subscribed our names as witnesses in attestation thereof. I 0JtLl~-1'lVc.J-...L-Address ;~._ 1/ , "f4'l tLJ ~ -~~~ t70n-- /2c /7//2- AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : : S8. : COUNTY OF DAUPHIN : We , /...{.'fUtJ. fU'trl-' F..eAt s ~.r k "(J C It..t.., p,. fr,"t: ,. 'l:. e tI. ~'i ~I , and Donuld P. e()~1s , the witnesses whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing wi tness, in the hearing and sight of the Testatrix, signed the Will as a witness; and that to the best of our knowledge, th~ Testatrix was at that time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn to or affipmed and subscribed to before me by 14 u."S 'O.,..b/- {:.e.,."Sf.e rlltruhr; f'af,.tc-la. C. r::r Sf ~ I , and r;o""'ftld p. ,eob..2r"tS ,witnesses this 16th day of March, 1993. ~{tl-4 c:..~ NOTARIAL SEAL JOHN R. BEINHAUR. Notary Public Lower P~x~on Twp.. Dauphin County My CommIssIon Expires March 13. 1995 SCHEDULE B STOCKS AND BONDS ESTATE OF FILE NUMBER Barbara E. Brambley 21-06-0551 ITEM NUMBER All property jointly-owned with Right of Survivorship must be disclosed on Schedule F DESCRIPTION VALUE AT DATE OF DEATH Morgan Stanley Qual Mun - 100 shares @ $13.590 per share (see letter attached to Schedule E $13,590.00 TOTAL (also on line 2, Recapitulation) $13,590.00 SCHEDULE E CASH, BANK DEPOSITS AND NnSCELL~OUSPERSONALPROPERTY ESTATE OF FILE NUMBER Barbara E. Brambley 21-06-0551 Include the proceeds of litigation and the date the proceeds were received by the estate AD property Jointly-owned with Ript or Survivonhip must be disclosed on Schedule F ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 Account no. 645-077015-224-Morgan Stanley (see letter attached) $1,118.66 $12,880.91 2 Time deposit account no. 346094074-Community Bank (see letter attached) Jewelry $2,386.00 3 4 Proceeds from sale of personal effects $300.00 5 The Hartford Insurance Co. - homeowners insurance refund $248.00 TOTAL (also on line 5, Recapitulation) $16,933.57 ~ MorganStanley June 26, 2006 Andrews & Johnson Attn: Ronald E. Johnson 78 West Pomfret Street Carlisle, P A 17013 FUE: 645-077015-224 Barbara E. Brambley Dear Ronald, Please find the Date of Death value for account 645-077015-224 under the name of Barbara E. Brambley as of June 13,2006: ILAF Money Market $1118.66 $13590.00 Morgan Stanley Qual Mun @13.590 per share 100 shares Total account value $14708.66 If you have nay questions, please do not hesitate to call me. Cliiistopher Heaven Financial Advisor 610 Old York Road P.O. Box 109 Jenkinrown. PA 19046 toll-free 800 473 3430 direct 215572 4500 fax 215572 4566 Communit\!Banks Decedent's Name Barbara E. Brambley Social Security Number 008-14-2042 Date of Death June 13, 2006 Account Number 346094074 Time Deposit 08/24/04 $12,851.86 $ $29.05 $ $12,880.91 $ 08/24/09 Individual Account Type Date Opened Principal Balance Accrued Interest at Date of Death Balance at Date of Death Maturity Date Account Ownership Names of Joint Owners, if any Date Joint OwnershiplBeneficiary was Established Interest Rate 3.9300% % Additional Information ~~\>-L\~"~~ Authorized Signature 1tst~~ Date P.O. Box 350 . Millersburg, PA 17061 . Phone 1-866-255-2580 SCHEDULE F JOINTLY -OWNED PROPERTY ESTATE OF FILE NUMBER Barbara E. Brambley 21-06-0551 if an asset was made joint within one year of the decedent's death, it must be reported on Schedule G Surviving Joint Tenant (s): NAME ADDRESS RELATIONSHIP TO DECEDENT A. Sherry S. Allia Suroviec 911 Silver Lake Road, Lewisberry, PA 17339 Daughter B. Richard W. Brambley 282 St. John Court, Destin, FL 32541 Son . tl d Jom ly-owne property: ntlM NUMBER IEl'TERFOR DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF TOTAL VALUE OF DECD'S % INT. DOIJ.AR. V ALUB OF DllCEDENT'S JOINT TENANT INSTmlTION AND BANK Accomrr NUMBER OR ASSET INTEREST SIMILAR. IDENTIFYING NUMBER. ATTACH DEED FOR JOJN11. Y.HIlLD REAL ESTATE 1 A&B 04/13/95 Real estate situate at 4121 Mountain View Road, Mechanicsburg, P A 17050 See Deed Book 121, Page 109 $118,697.45 1/3 $39,563.82 Net proceeds from sale (see attached settlement sheet) 2 A 05/08/00 Savings account no: 616108149-Commerce Bank $6,323.11 $3,161.56 (see letter attached) 3 A 04/16/85 Account no: 160021523 Fox Chase Bank (see letter $2,107.00 $1,053.50 attached) 4 A 10/05/89 Checking account no: 100089703 1 o 29-Wachovia $88.97 $44.4 9 Bank, N.A. (see letter attached) TOTAL (also on line 6, Recapitulation) $43,823.37 A. Settiement Statement u.s. Department of Housing and Urban Development ~ ,r OMB Approval No. 2502-0265 B. Type of LoIIn 1. 0 FHA 2. 0 FmHA 3.0 Conv. Unlns. e.FleNurrMr 4. 0 VA 5. 00 Conv.lns. 7. loin NIII11I:* e. Mol1gage ......nce Cae Number 0203993373 C. Note: This form Is furnished to give you a statemenl of actual selllement costs. Amounts paid to and by the setuement agent are shawn. Items marked "(p.o.c.)" were paid outside closing; \hey are shown here for Informallonal purposes and not Inc:tuded In the totals D. Nm1II and AddmI d~ Eo ... 8Ild Address d Seller F. HIIrne and Addren d Lend8r HASIBA OMANOVlC SHERRY S. SUROVIEC, MEMBERS 1 ST ENVER GOVEDARI STEPHEN HENRY SUROVIEC, FEDERAL CREDIT UNION 4149 CATALINA LANE, APT. J RICHARD W. BRAMBLEY, 5000 LOUISE DRIVE HARRISBURG PA 17109 JOANNE E. BRAMBLEY MECHANICSBURG PA 17055 G. PI'-'Y location H.SeIItemenlAgenl MEMBERS 1ST SETTLEMENT SERVICES, LLC TAX PARCEL NO. 10-15-1285-066 I. eew.n-I c.. 4121 MOUNTAIN VIEW ROAD Pl8ced~ MECHANICSBURG PA 17050 5000 LOUISE DRIVE 8/10/2006 MECHANICSBURG PA 17055 DsburMmenl c.. lilt: llIoc:k: J. Summary of Barroww'a TransKtIon 100 Groea Amount Due Frum Borrower 101. Contract..1es Driat 124000.00 .0101. ContractsalllS orIat 124 000.00 102. Perwonal property .0102. Personlll ~ 103. Settlement charges to bonowef mne 1400) 4 839.55 403. 104. 404. 105. .0105. AdlUS1menta for ltema paid by seller In adYllnc:e Adlu.lrnanta for Items aald bv ..11.1' tn adYllnc:a 108. Cltv/lOWn taxllS to 408. CIlvIlown taxllS to 107. County taxa 8110/2006 to 12/3112006 106.15 .0107. CounlvtaxllS 811012006 to 12/3112006 106.15 108. ~nta to 408. Aaenmentl to 109. to .0109. to 110. SEWER! 811012006 to 913012006 68.74 410. SEWER! 811012006 to 913012006 68.74 111. REFUSE to 411. REFUSE to 112. to 412. to 113. to 413. to 114. to 414. to 115. to 415. to 120. Grasl Amount Due From Borrower 129,014.44 1120. GI1lN Amount Du. To Seller 124,174.89 K. Summary of Sel..,.. Tranlac:llon 400 Groal Amount Du. To S.ller 200. Amounts Paid By Or In Behalf Of Borrower u n un us 0 e I' 201. [)epoaItar..~monev 501. Exc:aII deDlllllt l_lnslrucllonsl 202. PrlnclDaI.mcunl of MW Io8nCs) 124.000.00 502. Settlement ch8raes to aeller (line 1.??OO1 1 646.50 203. ExIs&1g Io8nlsl lalcen sublecl to 503. Exlstino Io8nCsllaken lubIel:t to 204. 504. p1IVDlf of firIt rnortoeoe toen 205. 505. P.w" of IIICOIllIlIIllItmlae Ioen 208. 506. 207. SELLER ASSISTANCE 3,720.00 507. SELLER ASSISTANCE 3 720.00 208. 508. 209. 509. AdlUltmen1l for ltema unDlld by 1.11.1' Adlu.lrnanta for ItlIma unnalel bv 1.11.1' 210. Cltvltown taxllS to 510. Cltvltown IaxlIS to 211. CounlvtaxllS to 511. Countv IaxlIS to 212. Asseamenls to 512. Assessments to 213. SCHOOL TAX 71112006 to 8/1012006 110.94 513. SCHOOL TAX 7/112006 to 8/1012006 110.94 214. to 514. to 215. to 516. to 218. to 518. to 217. to 517. to 218. to 518. to 219. to 519. to 220. Total Paid BylFor Borrower 127,830.94 520. Total Raductlon Amount Due Sell.r 5,477.44 lIOO Rad ctIonIl Amo t D T 5 lie 303. Cash 00 From o To Borrower 1,183.50 803. Cash I&J To o From Sell.r 124 174.89 5477.44) 118,697.45 SUBSTITUTE FORM 1099 SELLER STATEMENT The Infonnatlon contained In Blocks Eo G, H, and I end on 1Ine.olO1 (or, line 403 end 4(4) Is Important tax InformetIon end Is being lumlshed to the Intemel Revenue SeMce. If you a,. required to ftIe a return. a negIlgenc:a penelty or other eenctlon will be Imposed on you If thl81tem Is tequlJed to be reported end 1he IRS delermIMs . thet It has not been reported. If this reelllStllt. II your prlnc:lplll realdence, llle Form 2119, Sale or ExchlInge of Prtnclpel Residence. for .ny gain. with your Income tax return: for olher lrenaecllonl. complete the applicable peril of Form 4797. Form 8232 and/or Schedu19 D. Form 1040). You are required to provlde the Settlement Agent (named ebove) with your correct taxpayer IdenlillcBllon number. If you do not provide the Settlement Agent with your correct texpayer Idenllflcellon number. you may be subject to eM or aimlnal peneltles frr4Iosed by law. Under penelllea of perjury. I C8f1Ify the! 1he number lhown on lhIa statement II my correct taxpeyer ldenlilicellon number. (Sel.... Signature) L. S....ii\ Chanlea 700. Total SalnIBrobr'a Comml8alon based on .....ce . 124.000.00 G "Ie- Paid From Paid From DlvIsIon of CommIssIon mne 7001 as foIlowlI: BorrDWlIf'a Seliei'I Fundi Al Fundi At 701. $ 10 SelIIement Setllement 702. $ 10 703. Commlalon natd at SatIIemenl 704. 100. "'l1li P."able In ConnKtlon WIth Loan 801. loin OrlaInallon Fee 124000.00 % 802. Lcen Olsc;ount 124000.00 % 803. AlIIlnIIsaI Fee to 804.CredltRIIlllOft 10 llO!5. Lender'a InsDeCllon Fee 808. MartaslJll InsUIlInC8 AmIIc8l1on Fee 10 807. ..L Fee 808. APPLICATION FEE MEMBERS 1ST ($350.00 P.O.C.\ 809. UNDERWRITING FEE MEMBERS 1 ST 75.00 810. DOCUMENT PREP FEE MEMBERS 1ST 275.00 811. 812. 813. IlOO. Items R Ired B Landar To Ba Paid In Advance 901. Interelt from 8/1012006 10 8/3112006 902. II1IIlI'IIIClI PrwmIum for 903. Hazerd Inaurance PllImlum for 904. 905. 530.44 1000. Raea",.. Ited WIth Lender $ $ . $ $ $ $ 36.50 month month month 22.58 month month 84.36 month r month 109.50 1001. Hazard IIIlIUI1II1Cll 3 1002. InIuIllnC8 1003. tax.. 1004. l8xes 7 1005. Annual 8SSIlSIITIIlIl1s 1006. SCHOOL TAX 3 1007. 1008. 158.06 253.08 -90.35 1100.T1lIeChlil'llll 1101. SIIlIIemlInt or cIoaIna fee 10 1102. Aba1r8c:t or title _rch 10 1103. l1lIe IIIl8JTlIIllIIlon to 1104. l1lIe lnlUl1lIlCll blncler to 1105. Document DllIllIretlon to MURREL R. WALTERS III. ESQUIRE 75.00 1106. NotIrv re- 10 CASH 10.00 5.00 1107. AtlDrNN'a f_ to ANDREWS & JOHNSON 350.00 t1nc1udea abowl Ilema numbers: ) 1108. l1lIe InlurellCll 10 MURREL R. WALTERS III. ESQUIRE 1,081.00 (lncludesabowl "ems numbers: 1101-1104.1108 PENN ATTORNEYS TinE INS. CO. I 1109. Lendet's CO\I8r8ll8 $ 124.000.00 endorsements 100,300 8.1 1110. 0wner'I CO\I8r8ll8 $ 124.000.00 and 801 1111. 1112. 1113. 70.50 : Relea_ $ 110.50 1 240.00 $ $ 1 240.00 1300. Addition" Settlement Charaea 1301. Survev 10 1302. Pesllnsoectkln to 1303. 1304.2006/07 SCHOOL REAL ESTATE TAX MARIE HUBER 1 012.32 1305. TAX CERTIFICATION FEE MARIE HUBER 5.00 1308. 1307. 1308. OVERNIGHT MAIL FEES ANDREWS & JOHNSON 46.50 1..xJ. Total Settl_nt Chargea (enter on lines 103, s.ctIon J and 502, Sec;tIan K) 4 839.55 1.646.50 CERTIFICATION StBteme/lt end to the best of my knowledge and belief, II a lrue end acaJrele statement of ell receipts and d1lbul'StllTlllllts . I further certify lhet I have recelved . copy of lIie HUD-1 ~ BlII1'tlW8l' ..c- HASIBA 0 . Seller ~ . BolTOW8l' ~/ ENVER G . EDARI S emenl which I have prepered Is a lrue and 8CCUl'lta ea:ount of the t wt'd0r8 recelved and have been or wAl of thll trensacllan. ~ (0 ~ /_ Settlement Agent )'" Dale ES.lLC ' WARNING: "Is. crime to knowingly make falae statements to the United Stalea on lhiI or any other almllar form. PenalUes upon conviction can lncIuda a fine end Irnprtsonmanl For detalIa see: 'Tl\Ia 18 U.S. Coda Section 1001 and Section 1010. u.s.~___l"_ .t'ax 'l'ranSm1 t tal '113/2006 11:54 AM PAGE 1/002 Fax Server :~,- - ~ __~,,-,,",J ....,_ ~OVIA. RcClUlC ID; 1673343 Wachovia Bank N.A. Balance Confirmation Services POBox 40028 Roanoke, VA 24022-'7313 July 3, 2006 ANDREWS &: JOHNSON A1TORNEYS AT LAW 78 W POMFRET ST CARLISLE. P A 17013 SUBJECT: Verification I Confirmation of Account and Balance Information provided for: Customer: BARBARA E BRAMBLEY (SSNt# 008-14-2041) Date of Death: June 13, 2006 Accamt Type kCOlDt Nw:nbtc Deposit Account Information DE ofDc:ldll A'Yaap Due M8Iwi1y IDlmIt AcI%UCld YTD Date BalaDae Balmce' Opened Dale Rm Iaterest IDr.crest Paid ClcIed CHECKING 1000897031029 LEOAL'ITl'U: BARBARA E BRAMBLEY SHERRY B AIllA S88.97 10/5/1989 ltl.DO $0.14 612612006 IRA 257410060289792 LEGAL T111B: BARBARAE BRAMBLEY 51,068.15 1/10/2ooD 1;.70 $11.53 FOI' Beodiciary Caim Form iDf'onn8tion, pleale call1(BO0)669-2136. · Due to system limi.1ations, ~ QD. cn!.y (rOlide a twdw mcmIh avaqc ba1ana: on depoGitory 1alOUItts. Accolmt Type Accouat Number Rev..! Credit InfOnnatiOD Date afDcaih Credit Date Date T'IDICI l.epl Title Balm::c Limit Opcmed Cbcd Late SIGNATURE 7491.21733S7188 MaNA. Revclviug cndit accOUIIla uno lonp- rcmcecl by Wacbovia Bank. P1~ CODtad MBNA at 800-477-!l131. . June 27, 2006 Andrews & Johnson Attorneys at Law 78 West Pomftet St. Carlisle, PA 17013 Re: Decedent: Barbara E. Brambley To Whom It May Concern: Here is the information that you requested. 1. Type of account - Savings 2. Account number- 616108149 3. Owners - Barbara E. Brambley (primary), Sherry S. Allia (secondary) 4. Account opened - 5/8/2000 5. Balance - $6,323.11 - as of 6/13/2006 Please contact me with any questions. Sr. Customer Commerce Bank. Camp Hill Mall Store 3201 Trindle Rd. Camp Hill, P A 17011 (717) 920-5740 Commerce _Sank.. Commerce Bank / Harrisburg, N.A. P.O. Box 8599 100 Senate Avenue Camp Hill, Pennsylvania 17001-8599 . Fox CHASE BANIC June 28, 2006 Andrews & Johnson 78 West Pomfret St. Carlisle, P A 17013 RE: Estate of Barbara E. Brambley, deceased June 13,2006 Account Number 160021523 CK Title Barbara E. Brambley or Sherry Allia Date Opened April 16, 1985 Title Changed Date Changed Interest to D.O.D. $2,105.85 $1.15 $2,107.00 Principal Balance Interest from January 1,2006 to June 13,2006 $5.77 Other: Sincerely, ~~ Stephanie Campbell Deposit Services 4390 Davisville Road. Hatboro, PA 19040 . (215) 682-7400 . SCHEDULE G TRANSFERS ESTATE OF FILE NUMBER This sched e to e comp ete an e e answer 0 e ques on on e reverse 0 e cover yes. ITEM DESCRIPTION OF PROPERTY TOTAL VALUE DECD.% EXCLUSION TAXABLE INCLUDE THE NAME OF THE TRANSFERIlE. THI!IR. RELATIONSHIP TO DBCIlDENT ANt NUMBER THE DATE OF TRANSFEIt ATTACH A COPY OF THE DEED FOR REAL ESTATE. OF ASSET !NT (if applicable) VALUE 1 Wachovia Bank, NA-IRA Transferees are Sherry Allia Suroviec (daughter) and Richard W. Brambley (son) $1,068.15 100.0% $1,068.15 See letter attached to Schedule F 2 Fox Chase Bank - IRA Transferees are Sherry Allia Suroviec (daughter) and Richard W. Brambley (son) $21,312.29 100.0% $21,312.29 Barbara E. Brambley ul b 21-06-0551 I d dm difth fth ti th fth is TOTAL (aJso on line 7, Recapitulation) $22,380.44 . SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER B. ITEM DESCRIPTION AMOUNT NUMBER Funeral Expenses: 1 Shea Family Funeral Homes $10,575.00 2 Funeral Luncheon $729.24 Marty Moore Greenhouse - flowers $108.12 Administrative Costs: 1 Personal Representive Commissions Name of Personal Representative(s) Social Security Number of Personal Representative: Street Address: City: State: Zip: Year(s) commissions paid: 2 Attorney fees to Andrews & Johnson $3,000.00 3 Family Exemption Claimant Street: City: State & Zip Relationship of Claimant to Decedent: 4 Probate Fees to Register of Wills $200.00 5 The Hartford - homeowners insurance $263.00 6 PP&L - electric bill $47.09 7 Hampden Township - trash and sewer $124.00 8 AT&T $24.34 9 Verizon - final bill $46.07 10 House cleaning $180.00 11 P A American Water $20.19 12 PP&L - electric bill $45.26 13 USPS - overnight mail $22.58 14 PP&L - electric bill $11.38 15 P A American Water - final bill $10.30 16 Wyndham Place - homeowners association fee $45.00 17 MBNA - credit card interest $5.02 18 Richard W. Brambley - travel expenses from Florida to Vermont for funeral $2,415.89 19 Sherry Allia Suroviec - travel expenses from P A to Vermont for funeral $423.90 20 Register of Wills - P A Inheritance Tax Filing fee $15.00 21 Reserve for closing and account $750.00 (NOTE: Personal representative did not take a commission) TOTAL (also on line 9, Recapitulation) $19,061.38 Barbara E. Brambley Debts of decedent must be reported on Schedule I. 21-06-0551 A. . SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Barbara E. Brambley 21-06-0551 Report debts incurred by the dece.dent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH MBNA-credit card $52.00 2 Wyndham Place - homeowners association fee $90.00 3 Chase Fox - credit card $40.00 4 AT&T Universal- credit card $76.22 5 PP&L - electric bill $55.61 6 Boscovs - credit card $553.20 7 Verizon Wireless $18.61 8 GM Credit Card $826.00 9 J.C. Penney Life Insurance $22.26 10 P A American Water $24.33 11 GM Credit Card $1,000.00 12 Chase Gard Services - credit card $1,962.00 13 MBNA - credit card $668.30 14 Pnnacle Health Emergency - medical bill $124.00 15 GM Credit Card - payment of balance due $11 ,000.53 TOTAL (also on line 10, Recapitulation) $16,513.06 . .. SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER ITEM NUMBER I 1 2 3 4 Barbara E Brambley NAME AND ADDRESS OF BENEFICIARY TAXABlE DISTlUBunoNS linclude oulri&lt spounl distributions. IIICIlrIn5fcn under Sec. 9116(1)(1.2)) Sherry S. Allia Suroviec 911 Silver Lake Road, Lewisberry, PA 17339 Richard W. Brambley 282 S1. John Court, Destin, FL 32541 Danielle Allia 9 Red Barberry CouIt; Etters, P A 17319 Bonnie Brambley Phillips 11480 Bentham Court, Alpharetta, GA 30005 21-06-0551 RELA TIONSillP AMOUNT OR SHARE Do Not List Trustee(s) OF ESTATE Daughter 50% of residue Son 50% of residue Granddaughter ring valued at $1,036.00 Granddaughter ring valued at $600.00 II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. Charitable lJ1d Govenunental Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $0