HomeMy WebLinkAbout94-00768
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PETITION .'01{ PROBATE and GRANT OF LETTERS
Estat" oj Frederick C. Sheaffer No. .;:(/- <;1/ ~ 11prf
a/so k"oll''' as To:
Reglsler of Wills for Ihe
/)"c"ased. Counly of Cumber land In Ihe
Social S"c/trity No. 1 B 6 - 2 B - 453 B Conllllonweallh of Pennsylvania
The pellllon of Ihe undersigned respeclhllly represenls Ihal:
Your pelllloner(lQ, who Islare 18 years of age or older anlhe execul.!:b
Inlhe lasl will of Ihe above decedenl, daled September 16
and codlcil(s) daled n I a
named
,19~
(siDle rdevanl chcllIJI\lnnccs, e.l. renunciallon, death nl' C.'l.cCUlor, cIC.)
lIilmpden 'l'ownship,
Decendenl was domiciled al dealh In Cumb~nd CounlylPennsylvanla/wllh
Ib is lasl ramily or principal residence al 191 1I0.L.J.uay ^ venue, lampclen'l owns hip,
umberland County, Mechanlcsburq, Pennsylvania.
(Ii~1 511('tl, number and OlUllclrmlil)')
Decendenl,lhen 55 years of age, died October 10 ,19 93 ,
al 191 1101 iday ^ venue, lIampden Township 1 Mechan ics burq , penng.
Exeepl as follows, deecdenl did nolmarry, was nol divorced and did nol have a child born or adopled
aHer exeellllon or Ihe will offered for probale; was nollhe viclim of a killing and was never adjudicaled
Incompc(cllI: n /;l
()ecendenl al dealh owned properly wllh eslimRled values as follows:
(If domiciled In I'a.) All personal properly
(II' nol domiciled in I'a.) Personal properlY In Pennsylvania
(II' nol domiciled In Pa.) Personal properlY In Counly
Value of real eslale In Pennsylvania
sllualed as follows:
$...11t. 000.00
$
$
$
WHEREFORE, pelllioner(1l) respeelfully
prcsemed herewilh and Ihe granl of lellers
Iheron.
requesl(s) Ihe probRle of Ihe laS! will llIK1><llllditil,,>c
t" '" ,. "luen.l:.i1r.y
(leSIUI11C'1l1nr)': Qdl11ini\lrmlnn c.l.n.; ndllllrll\lrRllon d.h.n.c.I.D.)
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^.li.ce Il. Sheaffer
191 1I01j.d~y ^venue
-HflruillLiJ; s R.ill:g, I' ^ 170...5..5..
OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OFI>ENNSYLVANIA
COUNTY 01-' CUMI3ERL^ND
} ss
The pelilloner(>l) above. named swear(s) or affirm(s) Ihallhe slalemenls inlhe foregoing pelilion arc
lrue and correcllo Ihe besl of Ihe knowledge and belief or pelilioner(l-) and Ihal as pcrsonal represeno
laliveW of Ihe above decedenl prlitioner(x) will well and Irllly admillislfr Ihe eslale according 10 law.
/~,' ,r7 IL,~
Sworn 10 or arrirmcd1S~' ,"""';"" ~l' << ~! -"~. ~~ .
berore lIle Ihls 3 I day of ^.l] ce R. S lea fer ..
1lfiijt)~. AUGlJ.\.I.J.~ ~
"_ /Ii.> I'.u.. ~ ) 17 , ~
MAR, C. L WI S ' R,'xi.rter () Be
No. ~1 - qn - 7"R
Eslale of
I'/lEI>8111CK c. SIIE^i'i'lm
, Deceased
DEClum OJ. PIWIIATE AND GltAN'f OF LETTEIlS
AND NOW SEPTEMBER B 19~, In eonslllenlllon of Ihe pellllo" on
Ihe reverse side hereof, sallsfaclory proof having been presenled before me,
IT IS DECltEED Iha! Ihe lnslrumenl(ij daled SeptelllbeL-l6. 199]
descrlhed IherehLbe ad'{lIl1ed 10 probale and flied of record as Ihe Insl 11'11I of
FredericK c. S leafIer
and Lellers Tes talllen tarv
arc herebygrallled 10 ^lice R. Sheaffer
WlIlllook #
Page
71}tl-,(/ (} ~ /ff~ ,I1vA. 07>>. ~ fY1'
/ R<,hlrr or Will. (j
MARY C. LHIIS
FEllS
Probale, tellers, Ele. ......... $
Shorl Cerlineales( 1) . . .. . . .. .. $
RelLllncialion ................ $
X-pages $ b.OO
JCP 5.80
TOTAL _ $ 7/1 nn
Filed ..... .SEP.Hl:1fl.ER .e.. .l.!m.. .......
60.00
3,00
James D. Bogar 19475
A'rrORN~V ISup. Cr. J.D. No.)
5 W. Main Sf.
Shiremanstown, PA 17011
ADDRESS
(717) 737-B761
rIlON~
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Mailed letters and order to attorney on 9-8-94.
21 - 94 - 768
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LAST WILL AND TESTAMENT
OF
FREDERICK C. SHBAFFBR
I, FREDERICK C. SHEAFFER, of Hampden Township, Cumber-
land county, Pennsylvania, make, pUblish and declare this as and
for my Last Will and Testament, hereby revoking all other wills
and Codicils heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance pOlicies thereon, unto my wife,
ALICE R. SHEAFFER, provided she survives me by sixty (60) days.
SBCOND: Should my wife, ALICE R. SHEAFFER, predecease
me or die on or before the sixty-first (61st) day following my
death, I devise and bequeath all the rest, residue and remainder
of my estate of whatever nature and wherever situate, including
any property over which I hold power of appointment and together
with any insurance pOlicies thereon, to my daughter, DEBBIE A.
SHEAFFER or, should she predecease me, to her issue per stirpes
by representation.
THIRD: No provision is made in this, my Last will and
Testament, for my son, JACK C. SHEAFFER, not necessarily because
of any lack of affection for him, but because he is already well
provided for.
FOURTH: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at pUblic or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, sUbdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(0) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FIFTH: I direct that
succession and death
be payable by reason
all inheritance, estate,
taxes, of any kind whatsoever,
of my death, whether or not with
transfer,
which may
2
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AlV '''10'', I" Oil I fOA DAns Of DEATH AnEA 12131191 CflECK IlEnE
'-:::.~J;f~~i;';:::"':. J ',~~~ii~fri:~l~~i~;; :::::~~~: ~:;:':.= ~ """'"
fiTUfi(nR""n^M~nT;"""'IiTIf'Mj[lDI( INITIAl liTCTfilUI'S COMf',r,r ADDRlSS
BhCHfll'l', FnJd"dck C. I'll lIolid;IY ^Vl'llIle
loeIAlllelJ!," tlIIMifi~--"'--IDAII ", 11IAm-\"AUOfliim---- - Meehan iCB bu rg, I'^
106-211-45311 10/10/93 04/12/311 CUlllberlnnd
,._..,.._,..__. ____ .__Cownl,
K.I 1. O,lgillnl ReluI" r I 2. Supplemental Relu,n
LI 4. limited Estate 1.1 Aa. future Interest Compromlso
(lor da'e. 01 death oller 12.\ 2.B2)
KJ 6. Oocodr.nl Died T",late [I 7. Decadenl Maintained 0 lIylng TruI'
____. _~~~~_capy 01 Willi IAnach copy 01 Tru.') ._...
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TOI
I1AllI . eoMfllf(Mlomm; AIi1iUh
James D. Bogar 5 W. Main Sf.
Shlremanstown,
15. Amoun' 01 line 1d lax able 01 6% role (15) 13 , 4 08 . 29 )( ,06 =
llnclude values from Schedule K or Schedule M.)
16. Amount of IIno 14 taxable 01 15% rolo (16) )( .15 =
(Include \loloos from Schedule K or Schedulo M.I
17, Principal lox duo (Add laKlrom line 15 ond Irom Iina 16,) (17)
1 B. Crodits Spousol PO\lorly Credit Prior Poymenh Dhcoun' Intorost
536.33 + __-0- + -0- __-U~____ (lBI
I? If Iino 18 Is uroaler than line 17, onlor tho difference on line 19. ThIs Is tho OVERPAYMENT. (19)
DlI]
20. If line 17 Is oreoler than line 18, enler the difference on line 20. This Is tho TAX DUE. (20)
A. Enlor tho Interest on Ihe balance duo on line 20A. (20A)
B. En'.r Ihe 10101 of line 20 and 20A on line 20B. Thl. I. the BALANCE DUE. (208)
Male. Check Pavable tOI Regllter of Will., Agent
... ... BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SiDE AND TO RECHECK MATH""
~nder penohlel of perjury. I dltclate Ihal I havlI uomined Ihll retuln, lncludln:r o[(ampanylng uh,,"dule. Dnd "clemenh. cnd 10 the belt of my knowledge Dnd boli"i.
It h true. correct and completo. I dedare that all real .Ilole "01 been report' 01 hue mo'~et value. Declarallon of preporer olher Ihon Ihe personal reprelltntali~e il
ba'.~ ~.n <<:,lIlnfor~atlon 01 ~~.lth pr~arer hOI any ~nowllldgll. _ _. i(,'L)t.fil"l
liGflAI"'-P'!~~fTIiWP'H~I]Ji.'ffil~~I" Aoo,Bl191 1I0liday ^ve. 0'""
~i:'i.ce R .v's~~rY~' Mechanicsburg. p^ 17055 d'/' " I
li~;WUi! of PiIPIo~filHI!' hlAFl mill!lilAliVl-.liiJAB. 5 W. Ma in St. "Ai. '. "fe/.." -
___(i.W<JLILG.....<.'f." Shiremanst.own, p^ 17011
,James D. f3j>uar
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717
737-8761
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I, Reol E.lola (Schedule A) I I)
2, Stock. and Band. (Schedul. B) I 2)
3, Clo.ely Held Slock/Porln...hlp In'ere.1 (Schedule c) I 3)
4, MorlBag.. and Nole. Recelyable (Schedule 01 ( 4) _____ .-.-...--
5, Ca.h, Bank Oepo.l.. & Mlse.lloneou. Pellonol Properly( 5) 23 , 147 .95
(Scnodul. EI
6. Jalnlly Owned Prape,ly (Schedule FI
7. T,on.l... (Schedule GI(Schedule L)
8. Tolal Gran Assets (10101 line. 1.7)
9. funeral Expenses. Administrative Costs. Mllcellaneous ( 9)
Expensel (Schedule HI
10. Oeb... Morlgoge lIabllille., lie.. ISchedule I) (10)
11, Talol Oedu"lan. 110101 Iln.. 9 & 10)
12. Net Valuo of E.late (line 8 mlnul line 11)
13. Charlloble and Governmental Bequelts (Schedule J)
14. Nel Volu. Subie" 'a To, (line 12 mlnulline 13)
(6)
I 71
9,157.96
---.-
581.70
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'ck hero If vou aro roqueltlno a rofund of your ovorpayment.
U3,
[] 5,
_B.
......
17U55
Remainder Roturn
I'or do'e. 01 deo,h prior 10 12.13.n71
federal estale Tax
Return Required
Total Number 01 Sofe Deposl! Bou'\
p^
"C'
17011
I BI_23_,147.95
1111_2.739.66
(12) 13,408.29
(13)
(14)
804.50
!l..Q.~_~~_
536.33
268.17
---...- ---.
5.61
--.--.
.__.273.78
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING A CHECK MARK (V") IN THE
APPROPRIATE BLOCKS.
Y~S No
1. Did decedenl make 0 transfer and:
a. retain the use or income of the property transferred, .......................................
b. retain Ihe right to designate who shall use the property transferred or its income,
x
x
c. retain a reversionary interest or ....................................................................
x
d. recsive the promise for life of either payments, benefits or care? .......................
2. If dealh occurred on or before December 12, 1982, did dscedent within two years
preceding death transfer property without receiving adequate consideration? If death
occurred after December 12, 1982, did decedent transfer property wilhin one year of
death without receiving adequate consideralion? .................................................
3. Did decedent own an 'in trust for' bank accounl at his or her death?.....................
x
x
x
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
\
SCUIJUER
Scudder Sl'rvler COllJOlruion
1'.0. Box 2291
Uo<loll, MA 1l11117.Y9l-l
N,lllo11~1 TolI.Free Numher
800 22551(,3
August 18, 1994
James U. Bogar
Attorney at Law
5 W MAIN ST
SIIlREMANSIUWN JlA 17011.6327
Scudder Growth and Income Fund
Account Number: 00003351817
FREUERICK C. SIlEAFFER
Dear Mr, Bogar:
I am writing to provide you with the value of Hr. Sheaffer's above referenced
account on October 10, 1993.
On that date, there were 1278.186 shares in the account, The Net Asset Value
for the Scudder Growth and Income Fund on Friday October 8, 1994 was $18.11.
giving the account a collectible balance of $23,147.95 on October 10. 1993,
This account was established on March 17, 1978.
I hope this information has been helpful. If I can be of any further
assistance, please feel free to contact me at 1.800.225.5163, Ext, 85719.
Sincerely. I,
~ >>~'-M
Kevin M. Geraghty
Registered Representative
IIYISIlIl_I1",
:.!
"~,l\:h~,,
-.ol'llI.f,.
COMMONWlAUlt Of PENNnlvAtUA
INHUIfAt~C( IAlC .[JUIIN
IIUIO(HIOIClOlHl
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
Pleale Prill' or Tvpe
FllffWi.ilih .'--
21-94-0768
C. Sheaffer
I.
2.
B.
.t.
C.
1.
2.
3.
.t.
S.
6.
7.
8.
DESCRIPTION
AMOUNT
A, Funeral Exponle..
Cockli.n Funera.l 1I0me - Funera.l expense
$ 6,791.00
Stephenson's F.lowers - Flowers
16.96
Admlnlltrallve COI'I!
None claimed or paid
1.
Parsonal Reprelentative Commissions
Social Security Number of Penonal Represenlallvo:
Yoar Commlulanl paid
2.
Allornoy Fee. James D. Bogar, Esqu ire
250.00
3.
Family Exempllan
Clalmanl ^lice R. Sheaffer Relalion.hlp
Address of Clalmanl 01 decedenl'. death
Slreel Addren 191 1I0.liday ^venue
City Mechanicsburg Slale P^
Zip Code 17055
Spouse
2,000.00
Probale Fees & Short certificates - Register of Wi.lls
Mllcellanoous EMpenlDl1
Reserves to conc.lude administration of Estate
including filing of p^ Inheritance Tax Return
and Inventory
100.00
TOTAL IAlso enler on line 9, Rocapltulallan)
(If mare IpOCO II nooded, Inlerl oddltlonallhee" of lame Ilze.)
S 9,157.96
., V I ~ I' ,. . 110 .",
I
SCHEDULE I I
DEBTS OF DECEDENT,
MO~TGAGE L1ABLITIES ~ND L~ENS__ _____ _ _
~UMBER
21-94-0768
^~'~~-A?"
't..i"'t{',,,..
(O.......OIlW'.,IU 1l11'ltl"n'~'.fjI'
IUIlUII.Uq lal '''UIN
'UI11'"II'it.IIlIUl
ESTATE OF
Frederick C. Sheaffer
ITEM
NUMBER
DESCRIPTION
1. Oakwood Center - Ilndiation
2. RX Place - prescriptions
3. WalMnrt - prescriptions nnd .liquid food
4. Cummings ^ssoc. - Doctor bil.l
5. Dr. Meister - Medical expense
6. ^ndrews Patel ^ssoc. - Medical expense
NOTE: Items Nos. 1-6 No medical reimbursement
is expected.
TOTAL (AI.o enle, on line 10, Recopllulotlon)
(11 mot. spont is n..d.el in.er' addirional slleels of '0"11' .ize)
AMOUNT
$ 75.00
45.94
139.76
71. 00
150.00
100.00
$
581.70
flI I Itl~1l I' 11 Qll I I
,,~~:},y~ I SCHEDULE N
(uMI.\O"wlAt;~ ~ ;'IIIfIS'tAl"^ SPOUSAL POVERTY CREDIT \
"1f'[~"Atl(1 'A' IlIV'S10tl (AVAilABLE FOR DECEDENTS DYING AFTER 12/31/91)
EI~~:(~~~I<:k c-"-~~~a(fer --------. ------T~[l~~~ii!~7(l~------
1hi. ut".dulo rml\t he Wnlplr.lod und filet! if you (hc(~IHJ Iho \polJ\ul pnvcrly clIldil box on Ihe (OV('f .hnd!.
. .
'o",ohle Aunll lolul horn lino 0 (covor .heel).
I. 23,147.95
2, 10.000.00
3, -0-
4. _ 7,'/50.00
2 hm.HonCD Proceed, on Lilo 01 Docedenl ,
J Rolilcmnnl Benelit!. .
4.
Joint ^uoh with SpOU\o ..........
..."'..........."."'.-
. . . . . . . . , . . . ... , .. . ....
5
PA LoUclY Winning. ........"......
5. .._____=_Q::_______
60. Olhor Nontaxablo Ancl\: lI,t (AlIoeh uhodulo if noco"ory).. 60.
-0-
6b,
-0-
6e.
-0-
6d,
-0-..
6.
SUBTOTAllline. 6(1, b. c. dl .........................
................. 6.
-0-
.,............."",..,...........,...
7. Tolol GIOU Am" (Add line. I lhru 6)............
7.
40,897.95.
Snl.7(j
..........."'................,.........-.".
8.
9,
.............., 8,
9,
Income:
1. TAX YEAR, 19 90
--- ---------------.-------
.1" __~,_983.36
lb 17,880.20
2. TAX YEAR, 19 91 3, TAX YEAR, 1992
-~. .' _________u._.____
20 10,310.88 30 u}O ,072.49._._
2b 17,479.12 3b 17,044.18
2c. 3,.
2.1 3d
20 30
21. 27,790.00 31 27.916.58
+ (31) 27,916.58 =
Q.5pousu........
b. Decedent.."..
t. Joint............ ... 't.
d, T n~ Exempl lncomt> 1 d
0_ Olher Incomo nol
li\ted obove ,.. 10,
I. Tolal... ............. 11. 27,863.56
d. Averuoo Joinl E)l('mplion Income Colculolion
do Add Joint hemplion Income from abovo:
(11127,863.56 + (21) 27,790.00
db Avmago Joinl E)lOlTlplion Incomo ...................... ........................................ .. =
" line 4(b) is Droorer "ton 540,000 . STOP. TIm ('slule is nol eligible- 10 claim tll(.' Cfcdll.
. . . . I
I.
In\crll1mount of 1(I~oblo Iron\fon 10 spouso or S 100,000. whicheyor Is Ion.. ..
.... 1.
13.408.29_
4%
2.
3
Multiply by credil prrconlogo (\CO in'truclion\). .............................. 2.
Thi\ i\ tho amount 01 Ihe Re\idenl Spousal POYfHly Credil. Include Ihis figuw
in till! calculation 0110101 credih on line 18 ollho coyer ,hool. ............ ,-. .. 3.
For Nonro\lClonh, ""ter tho rolio of 11m decedent', '1ro\\ c\lalc in PA 10 Ihe \lnlU1' of Iho
de(C'donl's gro\! ('\tnlo . . . ..' 4
Multiply line> 3 hy lilll' .1 nnd cnlor Ihe 10101 hNf'_ Thi\ iSlhe "mount of Ihe> NOJl,,'\idr.nl SpOlJ\nl I
PO\lOfly Credit. Indude Ihi, ligulD in .he cnlwlntion 01 10101 ucdil' on line Ie 01 tIll' (O\ll'r ,hr.l!!. 5.
536,33
.1.
5
d II your tMd didn't live with you but is c1'lmed II your dlpendlnt under I prf.l98S'afumen1, thick hi" ~
. Total flumber or 111m tlo", claImed .
7 'Nagn, "Ilfie,. tips. etc. (IUtch Form(s) W.2) .
Sa Taubltlnterest Intome ("SO altach Sch.dulf 8 It o~" $400) .
b TII....mpt In,llreS11ncoml (see page 13), DOU'T Include on line e, b
9 Dividend income (.tso 'ftlCh Schedule B., O"fJr S400) .
10 TlI.bl, refunds 01 5111. and loul Income Illes. if .ny, ftomworksheel on pagt14
11 Alimont receIved
12 Buslri.n income or (Ion) (attach Schedule C) .
1] Capllalgain or (loss) (a!tach Schtdule 0) .
14 Capital Rain distllbutions not ,epartedon hne 13 (see page 14).
Allach check or 15 Other Silins or (Iones)(artach Fotm4797) . . . . . . . . . .
mon., o,de{ on 161 Tot.IIRA d"tubulion'. ,lI~!'j L-16b lalable amount (see page 14)
t:;~20~~ll~;~s" ,17. 'otalptOSlonundannulht!s Ll1'_ L17bTalableamount(seepllge 14)
W.2P, . 'J, '18 Renls, IO~i1lhl!s, pa,tnership", p.'\latn" trush, elc, (attach Schedultt E)
,. .' 19 farnl incollle or (Iou) (c1l1ach Schedufe F)
. . '\ ",'
."", . .\ 20 Une01plo~,"f!1I1 compensation (insurance)('\ce paKe 16)
f~.:' "-,.}~. ~ 21a SOCial '\ecurily henehts, . Un- I I 21b latable amounl (see paKe 16)
22 Other income (lisl t~pe and amounl-see paRe 16) ,.....,.........,....... .............
23 Add t"e iJmounts sho..m 1M the lar "Rhl columlllor lines 7 through 22. 'hiS IS )'our lot.llncom, ...
241 Your IRA deduction, from applicable walk sheet on page 11 or 18 ~~.'-
b Spou!oe's IRA dl!duction, ham lIPpll(.lble ....olksheet on page 1701 18 . l.4..b.
25 OM,hall of sl!'lIemptoyrnenllal (~l!e p"lle 18) . 25
26 Sell emplo)ed health insurance deductIOn, hom '#Iolksheet on page 18 26
27 Keogh retlrernenl pl~n and self-ernployed SEP deduction 27
28 Penalty on early wIlhdrawal 0' sa..,illgs "'~-
29 . Alimony p.lid. Rllcipient's SSN JI-: 29
30 Add lines 24a throuRh 29. Th"se afe your tot.l.d u.tm'"" . , , . . . . . . ·
31 Subtracl hne 30 Irom li!'1e 23. TIllS IS ~our Idlu.ted Ira.. "come. II th,s Jf1l0Ullt if fess Ihan
. $20,264 dlld" chIld fI'o'ed .,.",h you, Ite p.1Be 23'0 tmdouf .'you c..1n claIm the .Er!rned Income
Cftd,t. on Irnft 51, ' ...
,~ 1040
label
(s..
Instruchons
onpage8)
Use IRS labl'1
Otllt'r.....tse.
pltnepllflt
ortu>e.
r,nldonll.1
[Iedloo C.mp.llo la..
Sl'f! ,] e 9. ,
I
2
3
4
Filing Status
Check only
one bOI,
Exemptions
(5..
InstructIon,
on page
10.)
If more than 6
dependents, see
Inslructlon' on
P'SI 11,
Income
Attllch
Copy B 01 your
forms W,2, W.2G.
and W.2P hele.
If you do not
have a W.2. see
page 8.
. .
.'
Adjustments
to Income
(5..
IllstnJi:llons
o~paRe 17,)
Adjusted
Gross Income
Do you wont $110 go lo 11115 lundl. . . . , . .
lI'oint return does OUf S 01150 want 1 to 0 to thi' fund?
Smgle. (5~ pllRe 10 to hnd out II you can lI1e" head 01 household)
~ Mlwed hlmlllolnt leluln (even it only one had income)
MIlIIed hll"1 uplIIl. Itluln. [nl., 'POll"" IOtlIl uclIFllf no. .bo'l't .nd lull n.m. htrl. ...
Hud 01 household (With quail lying person). (See page 10.) If the quahf,ing person is ,our child but not your dependent.
enter lhis r.Md's name here. .
uahl in widower wllhde endentchlld ears ousedled ...19 See a e 10
'toun,lf If ,our pllent (or someone else) can claim you as . dependent on his or her tu
retuln, do nol check bel 61. But b, SUI' to check the boa on line 33b on plge 2
11..1'_"'.....", nllh.. I,,,",,,,,___I"I,,,,",llIp_..,,u.r."'..lr.
1I@90
(0)
U.S. Individual Income Tax Return
1')'Xl..,od,f
,19
'nlll'.. "IIIJ'" IlI'1': II l'no,o,nllll'II'1 ,."llI' ","".
'.,I."m,
SNlffl E/E€!!.
L
.
I
I
L
H
I
.
I
YOIll tll,l rwn",mluuh.1
__cfl..tDI!fl./CK_.- .
II. I"'nl ,..h,ln, '1101I\f""11\1 11,m.. 'IIIllfllll,1 l,nlll.me
__11tIC/!.------ 0 _._____SHfllU/fg
IInme 'l~l"\, tnum'...' JlHt ,IlHI) ~~ )01.1 h.....', 0 bol. '" pip 9 )
____L2.L- tlPl-JlJllv___ /lY&L.______
C.I,.lo...nOl fIll'....Q(I-,U. ,1"1. ,"d )<i1'fOllI" (II ,01.111'.' "oIP'an ,dd'.". ,..t' p.Jt19 t
t:"
I--;.p;- ;;0-
5
61
b ~ SpOUI.
t D.p.nd.nts:
(1)"I",.(II"I,IMIII.lnd 1111 n'rf1I)
t1I C~I(' OJ" 'ltl ot oldU. 'fpt~cl'~1I
du~d.. \OCtllll(Ulll,lIwmbtf
",
tl,Otpt"\cllftl'l
1N11OlI'~'lllorOIl
mHO olmo~11\1
t"td ill\OUI ~om,
III 990
QMU ria 15450014
Your ~tal M<UfIIJ numb.,
_L~I!..J.:J..835.1K-
Spou..'. .ocLlilluurltJ numbef
.fl' ;3~ i1.'C1L
For Prlvlcy Act Ind
Plperwork R.ducllon
Act Notlel....
In.lructlon..
Hol,:C"H,.,n. "VI"'",,,
1'101 ell,n,l your "f or
reduCt our "'und
o
Ho.ofMns
thtth4.nh
endi'
Ho.lfrou'
thlldftllon'c
.he:
, 11..4 .1th IOU
, dldn'tU"wllll
Joudvltt
dlvortl"
upmUtn(IH
p'I.1I1
HI. 01 olher
d.ptnd.n" on Ie
_dd "WlnMII
tnttlHt"
IIn".bOY..
(]]
~
-
10
/I
12
13
14
15
16b
HI!.
18
19
20
21b
22
23
.:!
30
31
, 2J'~'~ --
roll''' I~Oll9901
Tn
Compu.
lallon
IltClo...nIIRS
10 I~u'. ~our
I,U.IC"t'
In,llucllons 011
p",.19.
Credits
(Sr~
In,Uucllan,
on ;lo1ge 21 ,)
Other
Tales
Payments
Attach Forml
W.2. W,2G,
andW.2Pto
honl ..
Refund Dr
Amount
You Owe
I'ji.2
Jl AmouI11lrorll I.nt' J 1 (,adluSlt'd K'an ,"camt)
]Ja Check il: 0 You ~I'I' GS ot ollll'r 0 Ollnd; 0 Spoun~.u 65 01 oldPf
Add U" numbtl 01 bOll'S Ch..C"I'd "ba..e and ~nl" lht' 101.' hI'"
b ll'rourp'It'1l1 (OIIOI1I'Ollt' .11') ran clllun ~ou II II dtllrnlt,nl. dll!'C."" h,fe
c It ~OtJ ."t' "lo1'lItd 'lllf'8' \,p"',11t" It'hJflllnd ~ollr Ipnu.. IIPltll'''I ill'ducll(ll1l, or ~ou
lire II dual IlaluI .111'", Ire p"lir 19 and cllt'cll h". '., , ..".. ]Jc O.
( . Your It.nd"d d.ducllon (110"' Ih, ch,,,' CO,l ~OIl1shrrl)on p.1Ke )
]4 ["Irllhe 20 Ihal olPllh.llo ~ou). OR ',. ., .. I.
'''Ier . Yourlhmllfd deductions (hom Schr.lut.. 4, 11I1t' 27)
01. II~OUllt'Il"If'..1I1,1(hSchrdlllt'Aolndch..("'he'.". 0 .' ..
Sublract Ilnr 34 from 1111' 32 .
Mult.plr '2.050 by Ihe lolal nUIIlbf'1 of r't'ItlIJllons clallllrd onllflf! 6,
T.ulblelncom.. Suhlr,1CI hilI! JG 1r0nl hnl! 35 (If Imp. 36'1 ",llIe IIl"n hnt ]5, t'nterO. ) ,
El1lft In Ch.ck If hOIl1 I T)! f,,. f.1blp., bO la. R"le S[hrdul,.,. or c 0 fOfm 861Sh" P,.ell)
(ltanrllholllrorm(I)8814.f'nlt'llhalo1mollllthere .. d _____~_L- ) . , .
Addllionalt31tS (see page 21). Cht'ck It from: I 0 Fo'm 4970 b 0 rOlrn 4912 .
Add lines 38 and 39
IJ 'Bh~d " ::!:\ _;1.,,263 -=-
. .. 331 L , .
.. JlbO ";;;..:.
/i":/'.'
iff'.'.
%:{x
11;/ ~'I5"() -
I~;
~:' _~'a~ -
-1L_ .~~-
.)7._/ ~/:J-
i: --~ 1ft -
7")#'1 -
40
..!L ----~:;1W;
42 I !j~;..
-. ,- ;d},
43 ~:7k
1:1-%('(,
B
wz;"
~$;1.
46
47
..!.L
~.
50
_~L
52
53
54 I
WlI.li
%/:9'(.
;J!/j
::?:'l;,'l,
r;;;i<;
.11/1"
/}}?~;~,
'01.'~'
~~%~
'11(111
o/IiM:' ~ ....-'/,
.... ..l 7.::J 7 oJ
.. i-!~ 71t1_~
.. J,t. _7-IP_f.:=.._.
~t',~,
Iw:
i!I
35
36
J1
3S
39
40
41
U
43
44
Credlllo, child and dt~ndt'nl e,llt' '.pt'nus (dltolth form 2441)
Credit 10' Ihe .1dt',lr Dr Ihl! dll.1hlrd (.lttdch Scht'du1t R)
FOltlg" la. cf.dll (dlt/lch form 1116)
Genetal bus,"e" credIt. Chrck II from:
. 0 ro,m 3800 0' b 0 Fo..n C.po"fy) ...!!.
Credit lor ptlor rear mmimurn la. (dUdCh form 8801) , 45
Add Imt'1 411hrough 4S. . . . . . . , , . , . . .
Sublfaclllne 46 hom line 40 ur line 46 II male IhJI11ml!40, enler 0.).
Self,employment la. (altach Schedult Sf) .
Alternali...e mmlmum la. (dtl.lCh Form 6251)
RecIIPlure ta.el (ste p~ge 22). Che'ck If from: I 0 FOfm 4255 b 0 Form 8611 .
Soc.al "cullly la. on tip Income nol reported 10 emp'o~" (Jltdch Form"'J') .
Tall (In an IRA or. quahfied rehrrment plan (,It.lch form SJ29) .
Adwanct! rarned Incomecrrdll p,1~ll1enll from Form W.2 .
Add Imes 4 7thlouah 53. Tlus IS "OUI 101.11... . . .
..
..
!J ?/./q -
45
46
47
4S
49
50
51
52
53
54
55
56
S7
58
59
60
61
62
63
64
6S
66
5S
56
57
58
59
60
61
~9-
..
'J 71.1'1 -
Fedelallnconle loll withheld (II ."~ II from Form(l) 1099.
check" 0).
1990elllmaled la. pa~menlS3nd JmOUnl3ppl1ed Itom 1989 '1!Ill,"
hrn.d In com. credit (leI! page 23)
Amount paid Ytlth Form 4868 (e.lenslon requesl) .
E..cen socI.lsl!curitr Iu lInd RRTA tal WIthheld (sr! page 24)
Credit for Federal luon fuels (Jtt,JCh rorm 4136).
Rrgutaled in~l!Ilmenl company clldll (attach rorm 2439)
Add lines 55 thlough 61. These arl! ~our tol.l p.vmenll
If line 62 is more Ihan line 54, enler amount OVERPAID.
Amount 01 hno 63 to bo REFUNDED TO YOU. , . .
Amountol hn06310 bo APPLIED 10 YOUR 1991 ESTIMATED lAX" LnJ I
If line 54 is more than line 62. enlet AMOUNT YOU OWE. Allach check or mOlley Older fat lutl
amount pa~able to "Intrmal Rhenul! Ser....ice," Wille your name, addrell, socialsecu'ltr number,
d.~time phone number, and" 1990 Form 1040" all/I.
Estimated la_ penally (sel! pdge 25).
66
r'!:'7 .~71l'I,"/'l77," '~"'j.O;:
'11111", ;Wij'~/_(,I.,;!Ir.~/I',(, ":/,,.,
"
UM" p,nalll" 01 ""lllry, I d.clal.lh.ll hh. f'j,nlMfd thr' Iflurn Ind accom~"nr'''. SC"tdll'U ,,,d Ilal.mf'lll, ,"d 10 thf but 01 mr kno",',cR' ,n.t b.I"I.
tr'fr all 1'11', co'ltd. 'nd (ompl.I.. Ofct"ahon 01 plfplll!' (oln., Ih.n 1"Pj,fl).' butdon.1I mIO'IT1'llon 01 ...hlch PIfP"" hat In, ..no....lftlK..
~ YOu'I'ln,h". Oal. You, OCCllpjllOn
~ Spouu., .'lnllul'IIIIOlnl ,,'uln. Boru mllll "8n)
Sign
Hers
Kt'tP a coPy
ollhll return
fO'rour
rt'colds
Plld
Pllpmr's
Usa Onl,
67
: i 6~ I'
'I .
0iiI
SPOU\t'IOCCllp.llon
r~':.~~':;' ~~~l#a,...~ 01'.11~ 'I
~;;,;':~;:,~;d~~I' ~ _~ :".i;;;'C;tiI.r'J//iii.5/fMliL
jdd'u' ,
P"pll.,"'QCIIIII!!tlllll~no
~~.J~~9~_
:J..~~~'I.t?f..}.
Chttkll
ull..mpIO)fd
'Ul!t. Oow,~nl Pft'IlIl'O 0Iflc. 1;00 - 2f~ Ug
OMO tlo 15450074 rll.. 2
Your ,odlllftUfltJ numb.f
:1. ! 'SJ.r
Sctl..dutnA&O IrDlm 1040) 1990
N.mf'(\) 'hOw" 0" rDfm 1040 (Oo"ol.nltl ".-m. Ind 'O(I.t.I 'Hu"l, numbflf litho...." on olh!f tld. )
r-rR.(jJ/f,j..ICJ( SHrfl1f'r#..,. f/J./U R. NHf~
Schedule B-Interest and Dividend Income
'1,11
Inlm.1
InCllml
(See
Instructions
on pagfOI 13
and 30 )
Nolt: If.ou
rKrrvrd. form
1099.INT. form
1099,010.0'
subltltute
Itatrment. from
a brokerage h.m.
hst the lum',
name as the
pa~l!r and enler
the lotal Inlerest
shown on (hat
lorm.
'Irlll
Dividend
InCllml
Is..
nstructlons on
S~K)' 13 and
Nolt: If you
rKei...ed I form
1099,OIV.o,
substllute
stalement, from
a brokerage firm,
Ilstthefl,m'l
name as the
pa~er and enter
the total
dIvidends shown
on that form,
Att.ehm,nl . 08
S~u.nu No
II you rec.lv.d more thin $400 In ta..ble Inte,e.1 Incom., or you lIe clllmlnlthe e.clu.lon 01 Inl.,esl from
""I.. EE U,S. nvlnl' bond.l..u.d aft.r 1989 (..e pa.. 31), ynu mu.t compl.te ParI I. lI.. ALL Inlerest ,ecelv.d
In Part I. If you received more than $400 In t...ble Interest Income, you mUlt Ilia complete Plrt III. If you receIved,
.. . nomIne., Interelt thlt actually belongl to Inother person, Dr you received or paId Iccrued Interelt on
.ecurllles tran.f.rred b.lwe.n Interesl ~Iymenl d.tu,... pa.. 31.
Interest Income Amount
1 Inlere,t Income, (List name 01 payer-iI any inlerest income Is f,om seller.linanced
,"ortgages, see Insl,ucllons and hsllhallnlerest first.) ~.............................
..............................................................................-............
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
....................................,......................................................
1
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
2 Add Iheamounls on line I. Enlerlhelolal. . . . . . . . . . . . . .
3 Enler the e.eludab!e savings bond Inlerest, ilany. from Form 8815, line 14. AlIach
FOlm 881510 Form 1040. . . . . . . . . . . . . . . . . . .
4 Sublraclline 3 from line 2. Enle, Ihe resull here and on Form 1040 line aa ~
II you ree.lved more Ihan $400 In g'o.. dividend. Ind/or oth.r dl.trlbullon. on .tock, you mu.1 compl.te Pari. "
and Ill. II you rec.lved, as I nomln.., dlvld.nd.lhllaclullly belonlto Inoth.r person, .ee pile 31.
Oivldend Income. Amounl
5 Dividend Income. (List name 01 payer-Include on this line capllal gain dlstrlbullons,
nonla.able dlstrlbullons, elc.) ~ ,.,.. .............,..,............. ......... ...........
... .St.!fPPftJ?. . GP.I.~r!H.. t..II1MM. E/I.<!(P..................................
...........................................................................................
...........................................................................................
............................................... ...........................................
...........................................................................................
...........................................................................................
5
...........................................................................................
...........................................................................................
...........................................................................................
...........................................................................................
...................................................................................,.......
...........................................................................................
6 Add the amounts on line 5. Enler Ih.lolal. . . . .
7 Copllal gain dlslrlbullons. Enler here and on Schedule D' .
8 Nonluabl. dlSlrlbullon., (See Ih.lnsl. for Form 1040,lIn. 9,) .
9 Add Ihe amcunt. on lines 7 and 8. Enler Ihe lolal . . . .
10 Sublract line 9 from line 6, Enler the result here and on Form 1040, IIn. 9. . . ~
olf you received capital Baln dls/rlbutlons but do not need Schedull D 10 report any other Bains or Iou.., see the
Ins true lions lor Form 1040 lines 13 and 14.
II you rec.lved mar. Ihln $400 ollnt.,est or dlvld.nd., OR "you hid a lorelgn Iccounl or wore I Vas No
ranlor of or llran.leror 10 a lorel n Iru.1 au mu.tan.wer both uestlon.ln Part III.
Plrt III
Forelln
~unb
Ind 111 AI any lime during 1990, did you have an Inlereslln or I slgnalure or other authorlly overa financial account
fmlln In a foreign country (sueh as a bank accounl, securllles aecounl, or olher flnanclallccounl)l (Se. page 3101
Tru.h the Insl,ucllons for e,cepllonsand filing requllements for Form TO F 90-22.1.) . . . . . . . . .
lSee b II.V.... enl.rlhe n.me oflh.forelgncounlry ~ ............................................................. ~ ~
n'truclion. 12 Wele you Ihe granlor of, or Iransferor 10. olorelgn Iruslthat ..I,led durln~ 1990. whether or not you have any ~ ~
on p'g. 31.) beneftclallnlerest in 1I11l'Ves' ou ma have 10 file Form 3520 352lJ.A or 926 .
For P.perwork Reduction Act NoUc., It. Form l~O In,tructlon.. Schtdul. 0 (F"orm 1040) 1990
Declaration Conlrol Number (DeN)
LQloJ-121 ~Ip i Qlo tEl] -IQj~HI(o:o]-I~1
8453 U.s, Individual Incomo Tax Declaration
room for Electronic Filing
for 1110 ~l"" Jmlll:vy 1.0~cef11bet 31. 1991
~ See Instructions.
OMU ~jo. 15.&!t.Q936
~@91
01'.,..'1"''''''''''''. ""U...,
I",..'n.l' II.......".. o;~~..:,
Your loclal IIcunty numbe,
/1J,~'?: 4-,S:3.2'
SPOll"" 10Clll UCttf1ty number
17~ : ?>'U'J-.~~
T e1rf1hone number loptlonAI)
l1J.11 t,9 1- (J '7 S-S'
For Paperwofk neducllon Acl
Nollce. see '",Irucllons.
Use tho
IRS lobol.
Otherwlso,
plense
print or
typo.
L
.
o
E
L
l.1SllIlImlt
5 !I_A r:..Er-E R_
YOul 'pi Flo11118 .1nd ,",lla'
__r:S.I!P ~.Rl C /S,__
lI.t ,0'"' "llum '\PUIl!>'''' ""I 11.111'" .1"" .n.t,,,1 La!I,.,.lm@
___fJLLOi' g .tHA e p FE {C _
:"'jJr;'''ni1~ ~d,"7/~ 't"o A'V';:'~'~'I Tpl no
e'lr. IO~1l or po,,' OllIC", Slale. .1"d ,.111 codlt
J..J~cll~AJ/C S i3u.4?.G
II the ta)(paycr's name changed dUring the pas I 3 years due to mnrriage, divorce, otc" nnd he or she filed a Federollncomo tax
return lor such ycms using tho lo,"mr name, enter U10 most recently used Insl name here. ~
. , Tax Return Information hole dollars onl
1 TOlal,ncomo IForm 10.10, Iino 23: Form 1040A. line 14; Form 1040EZ, line 31 '
2 Tololla' (Form 10010. IIno 53: Form 1040A. line 27: Form 1040EZ, line 7)
3 Federal In como lox wilhheld (Form 10010. line 54; Form 1040A. lino 28a; Form 100l0EZ. IIno 6). II
any IS from Form(s) 1099. check hero ~ 0 ,
Aefund (Form 10"0. Iino 62: Form 10,IOA. line 30; Form 1040EZ.line 81. ,
Amount ou owe Form 1040.lino 64; Form 1040A. line 32: Form 1040EZ, Iino 9
Olrect De oslt of Refund See instructions,
6 Name of Iinallciallnstltution and, if applicable, branch name
It
E
n
E
I
~-.l
1
2
::L
,;z.
"
3
4
5
.3
-
~1!
o .
.. .
o~~
al;i.!
!;:"a:
1l;i~
5~-
20
0(",
7<5
1+1:('./<
7 Rouling Iranslt number (ATN)
o Olhor
DepOSllor account numbor (OAN)
Type of deposllor accoun!: 0 Savings
Ownership 01 deposll accoun" 0 5011
Declaration of Ta.pa er
UndlW pMI,'I,..s 01 p.."uty, "JItCI,)", thnll h,)vll (ompAled 11'" 1f1l0m',)11On (ontnll1f'd on my "Iu," wllh the mlOlmatlon I h'vlI plovodPd 10 my eleclronlC Illlum OI'O,n.tOlIEnOI
.nd
th,11 the .mnunlt flnCI'b"" In P,Jltl :100.... ,Jll'Hl ..nth Ihe ,)fllOutlll Vlo...n on Ihll colIlIP<l'''''Mq Itn.1 01 m... IOJ"t Fedll,,,llflcome I... lelum 1'0 thll besl 01 mv 10."0......10.
.nd
b.."el. Iny '1IIu'" 's lr1Je. COfrf'Ct. :lnd Crlmlll"!,, I con",nllhal "'y IlIlu'n, tf'(kJd,1lO Ih" dftCIAIDloon nM ...ecomp.1ny.ng SChfldul., and tl.1lemenlS, be sltfll 10 Ihe Ins by
my EFlO.
lf I h..... elected aiff"C' a.potlt, I dK"" thll the k1lorm.Uon tho.....n on linn' U1rouQh 11 In P.r111 llbo.. Iw conlct; I content th.t m., ,.rund be dll.clly d,pollted ..
dn.qn.l.d," Part II ~bo.e; .nd I luthori.. lhe Ins 10 Inform m... EnD Indlof ttl. IIIn.mllte, "",hllh., m., r.qunt lor Dlncl aepoln ...,ill be honolld, IIthlW ilium Iw .
lO.nllllUII'I ,Jnflltl. IIIUl\l1 '1 10 be dllf'Clly df'pl)S,IPd. Ih., " ..n ,IIlhOC3bll IIPpo.nlmlt'nl of It'l Ottlfl' tPOUSfl '" 111'1 IIg.nllo fec.,v' Ih. 1.luM. If I hll..I,lrtd .
boll.ne. dUI rltlum
..,,.d/Ol I'1K:1f'd 10 m3~8 ,ln ADEPT p"~"'enl. , utWlll'lll1ncJ Ih"I,1 Ihelns don nolll(e,vfl lutl aM !tmlIV p3~"Wlnl 01 my la~ h3blhly. I wllllllm.1fl ""'ble 10' thlllu "ab,litv and
III
3pphcabllllflll",,1 and pt!'nilll'"' II I h.1.. ',I..d .1 toont Fltde,al .1nd \I,1111I,u relum, I under,tAnd Ihal,llh". 's In M,OI on my tl4" '"Iwn mv Fedftllll f.lum w.A be Itltcled.
8
9
11
o
10 ProD I of accoun!:
Self and Spouso
o Check
o
o
Checking
Spouse
~ ~",f~~1-~tt,~~ I~?h~~ soJ.(#.!~~,13,.,u'n'DoTHI lS,,~nl
Declorallon of ElectronIc Return Originator (ERO) and Paid Preparer (See instructions.)
I dl'Clale th.l11 h.l~1I flhl!t...",llhe nbmlt li"ll,l~"" fltlurn ...nd 1hi1llhlt "'\111111 on r",m II"!!] "re COfT'lplelll .1"ll COIIIICI 10 Ihlt bft,1 01 my kno....ledq. tEna, ....he
II/II (0118'1:101' "11
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Dcclarntloll Cantlol Number (DeN)
10101-1213101010161-101 '1/ / 17 kl-131
8453 u.s. Individual Income Tax Declaration
room for Electronic Filing
rOl tho YOill J.1flllo1rY '.Orct!l1lhm 31. 1092
... See Inslfllcllol1s.
OMU"o '~4S.09J6
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...... CAR-RT-SORT..CR~~
IlADA 186-28-4638 176-34-9436828 At \~~
FREDER I C/( 3. ALl CE R SHAEFFER
110191 HOLIDAY AVE
MECHANICSBURG PA
e,l,!" .......... ...... _ ,.
SIIOUI.'. loel.llltcurUy numb.,
q I no
006
T P.!r.pholle numllN lopllollnlj
( 11,) is q 1- 0 7 ~- .11
FOf Paperwork neducllon Acl
Notice, 1ft, In'tnu:Uonl.
"
E
n
E
170B5
"
If tho lilll:Pily'Cf'S fliHllO changod during the past 3 yC'nrs duo 10 lI1imingo. divorce, ote. nnd he or silo Wed n Fedoral income lnx
relurn lor such yems using tho former nmno, t1lllor Iho most recently used Insl nome hmo, ..
fi!mI) Tox Rolurn Inlorll1ollon (Wholo dollnrs only)
1 Tolallncomo (Form 1040, hnl! 23; Form to40A. hno 14; Form 1040EZ, II no 3) .
2 TOlnllaK (Form 1040, hno 53; Form 10.lOA. 1"'0 27; Form 1040EZ. hno 7)
3 Fodornllncomo IOK wilhhcld (Form 1040, 1"'0 5,1; Form 1040A, IIno 20a; Form 1040EZ. lino 6), If
any Is from Form(s) 1099. chock horo ~ 0 .
4 Rofund (Form 1040, Ii no 62; Form 1040A, hno 30; Form to40EZ. IIno 0) .
5 Amounl au owo (Form 10.10. lino 64; Form to40A, IIno 32; Form 1040EZ. Ilno 9
Dlrcct DOEosll 01 Refund (See Inslructions,)
6 Name of financiollnslltulion and, if applicablo, branch nome
1 ,
2
3 l,'1S'
4 c
5
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The 'Its' two numbe,. 0' the nTN mUll
be 01 through 12 or 2t through 32.
B Deposllor accounl numbor (DAN)
D Typo of accounl: 0 Savings
11 Ownorship of accounl: 0 Self
Dcclorollon 01 Tax oyer
Under penalltes 01 perlury, I declare Ih31lhe mImmation I hit...!) p'ovldoo 10 my
ot~I'ontc relurn OIlglnalo, IEnOI and Ihe amounls Shown In PMt I aboIJ8 ag'eo
Wllh Ihe amounts shown on lhe COIFC5PondlOg Iincs of my 1992 r~llfal income
IA" ,elu,n, To Ihe besl 01 my knowl"dQe nnd belief, my 'elurn IS I,ue, (onecI,
and CO"'plote. I COMent Ihal my 'olum, Ihls dllcl.,rat1on, ilOd accompanyIng
schf>dulllS and sl,1111rnenls bo ..nnl to thn Ins by my Ena. I conllent thai my
relund be directly depollled n. deslgnnll'ld In Pflrt II above: I declafe Ihal
Ihelnlormallon shown on linn 0 ltuOllgh 11 In Par111 above I!II conect; and
I aulhorize Ihe IRS 10 Inlorm my EnO nnd/or Iranlmltter whether my requelt
o
o
Chocking
Spouse
o Check
10 Proof of accounl:
Solf and Spouso
o Olher
o
'or Dlrecl Depollt will be honored, II I have Illed A joinl ,elurn And e10cled
Ol'rcl Df)l)o5ll, Ihls IS an j"o~'ocAbln apDOlMlmollt 01 the ol"ef spouse as an agonl
10 I&C&lve U19 lolund. III have Moo a b11111nCft duo rolurn, I undersland thai II Ihe
Ins dOllS nol Im:elve 'ulland limely paymenl 01 my In.. liablhly,l Will remain liable
lor Ihe lall II11blhly and all applicable inlernsl and pOllalll"S. III have flied a loinl
Foderal alld 51,1t8 In.. lolurn and Ihert' IS an ono, on my stale rolurn,l undorsland
my federal f"turn 'WIll bo IlllOClcd. U the procelllng of my relum or r.fund Is
delnyecl, I aulhorlze Ihe IRS to dllclose to my EnO nnd/or Ihe I,.nlmmer
the rUlon(5110r the delny, or when the refund was sent.
Sign ~'\-;;;'0~~(.'Ff C,/y,V( Jt.-, ~CiJ~ t1. jL
Here , '(our SIQfl"lurn I ' 0,'10' Spouse's SIQnillUlC, II n joinl fOlurn( IH musl sIgn,
Im1!l Doclorotlon 01 Eloctronlc Return Originator (ERO) and Pold Preparer (Seo Instructions,)
I declare Ihilll ha~n IOVII'....Pd Ihn .1blJ~ft l.1'P.WOf's Htlum BmJ IlIall"o enlllOs arId h,1IJO lollowod nit olher Ifl'qUIFt!fnf'nts doscrlbod III Pub, 134', Handbook lor
on Form 0453 ArO complnlf> nnrJ cormc.lto Ihn b051 01 my knowlndgt't. III am Elo<:lromc rller, of IndivlllUilllncomo lnll Roturns (fnll Yonf 19921. III am nlso
only a collcclor, I undO/stnnl1I/liltI am /101 'tlspo",lblo lor rtlVIOWlng Iho ta"PtlYN'S tho PAid "'''PilIO', undo' p~nnlhos 01 pmjury I doct",o Ihnll havo cllamlnCod Iho
tolurn: I declnrft thai form IU53 nccur,1loly lellecls Iho dilln on Iho 'elurn. II Palt nho\'Q laJO:payor's 'elurn and tlccomp,1"Ylflg sChooulns nnd slntomenls. Bnd 10
1/ "cornplr.lod. I dl'cl",o Ihi'lll havn Vr.llrlfld tho la'Pilyo,''i prnol of ilccounl nnd Itln best 01 my knowlct1gn and belinl, I/my mn trUll, correct, and complelo. This
II ngren.. wllh tho nam" ~hlt....n 011 Itus dl'ClaFilIIOlI. I hnvo ohlil'rmd Iho tn-payer's dt'Clarnllon 01 raid Prepnrer IS basod on all Informahoo 01 WhiCh tho propilIor
!llgntlluro 00 form 8451 bulOln 5Ubm11l1h{) Ihl5 'olurn 10 Iho inS, havn providod hilS any I<nowtodgo.
Iho la"Pilyrr wllh a copy 01 all fOlms and trllomlaliolt 10 bo Mod wllh lhe InS,
~ Chl.'Ckif
EnO's )'" / II . alsopafd I....
ERO's "9""". U:()\.A,..:..~CJ_r..\ "'.p".' ,Q. 0 l II' :(,4: I. 0 ~ 0
Use "'m', nnm.,o, 'OU" ~ H&R BLOCK 44 : 0607650
O I Ilsol'.tlmplovndl
nand ilddmS5 lIP codo 17112
Undor ponalllOS 01 perjury, I dOCltuo thai I havo f111nminl"d Iho abovo la.peyor's 'eturn and f1ccompanring schoolllos llod statf!mnnl!l, and to Ihe besl of my knowledge
and beliol, they "ro Ilue, cOlfllet, and complolo, Decliuatlon 01 plcpalOr Is based on alllnformallon 0 which Iho pfeparor has tiny knowledgo,
Dale P,P-PllfOt'. &aclal secul1ty no.
Dnlo
'(our ..oclal socurJty numbol
Paid
Pre parer's
Use Only
Prrp:tfor's ~
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Film'!l namn (Of VOIJIS ~
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ro'm 8453 (1992)
-..-
LAST WILL AND TESTAMENT
01'
FREDERICK C. SIIEAFFER
I, FREDERICK C. SIIEAFFER, of Hampden Township, Cumber-
land county, Pennsylvania, make, publish and declare this as and
for my Last will and Testament, hereby revoking all other Wills
and Codicils heretofore made by me.
FIRST: I devise and bequeath all the rest, residue and
remainder of my estate of whatever nature and wherever situate,
including any property over which I hold power of appointment and
together with any insurance policies thereon, unto my wife,
ALICE R. SHEAFFER, provided she survives me by sixty (60) days.
SECOND: Should my wife, ALICE R. SIIEAFFER, predecease
me or die on or before the sixty-first (Glst) day fOllowing my
death, I devise and bequeath all the rest, residue and remainder
of my estate of whatever nature and wherever situate, including
any property over Which I hold power of appointment and together
with any insurance policies thereon, to my daughter, DEBBIE A.
SIIEAFFER or, should she predecease me, to her issue per stirpes
by representation.
THIRD: No provision is made in this, my Last will and
Testament, for my son, JACK C. SIIEAFFER, not necessarily because
of any lack of affection for him, but because he is already well
provided for.
FOURTH: In addition to all powers granted to them by
law and by other provisions of this Will, I give the fiduciaries
acting hereunder the following powers, applicable to all proper-
ty, exercisable without court approval and effective until actual
distribution of all property:
(A) To sell at public or private sale, or to lease,
for any period of time, any real or personal property and to give
options for sales, exchanges or leases, for such prices and upon
such terms (including credit, with or without security) or
conditions as are deemed proper. This includes the power to give
legally sufficient instruments for transfer of the property and
to receive the proceeds of any disposition of it.
(B) To partition, subdivide, or improve real estate
and to enter into agreements concerning the partition, subdivi-
sion, improvement, zoning or management of real estate and to
impose or extinguish restrictions on real estate.
(C) To compromise any claim or controversy and to
abandon any property which is of little or no value.
(0) To invest in all forms of property, including
stocks, common trust funds and mortgage investment funds, without
restriction to investments authorized for Pennsylvania fiduci-
aries, as are deemed proper, without regard to any principle of
diversification, risk or productivity.
(E) To exercise any option, right or privilege granted
in insurance policies or in other investments.
(F) To exercise any election or privilege given by the
Federal and other tax laws, including, but not necessarily being
limited to, personal income, gift and estate or inheritance tax
laws.
(G) To make distributions to my herein named benefici-
aries in cash or in kind or partly in each.
(H) To borrow money from themselves or others in order
to pay debts, taxes, or estate or trust administration expenses,
to protect or improve any property held under my will, and for
investment purposes.
(I) To select a mode of payment under any qualified
retirement plan (pension plan, profit sharing plan, employee
stock ownership plan, or any other type of qualified plan) to the
extent the plan or the law permits them to do so, and to exercise
any other rights which they may have under the plan, in whatever
manner they consider advisable.
FIFTH: I direct that all inheritance, estate,
transfer, succession and death taxes, of any kind whatsoever,
which may be payable by reason of my death, whether or not with
2
respect to property passing under this Will, shall be paid out of
the principal of my residuary estate.
SIXTH: I nominate and appoint my wife, ALICE R.
SHEAFFER, Executrix of this, my Last Will and Testament. In the
event of the death, resignation or inability to serve for any
reason whatsoever of the said ALICE R. SHEAFFER, I nominate and
appoint DEBBIE A. SHEAFFER, Executrix of this, my Last will and
Testament. I direct that my Executrix, and her successors, shall
not be required to post security or a bond for the performance of
their duties in any jurisdiction.
IN WITNESS WHEREOF, I have hereunto set my hand and
seal to this, my Last Will and Testament, this K.l~day of
~;'f~tlo"~~ (.., 1993.
Signed, sealed, published and declared by the above-
named Testator as and for his Last Will and Testament in our
presence, who, at his request, in his presence and in the
presence of each other, have hereunto subscribed our names as
attesting witnesses.
Address
-; dI/, /
IIN,,, t'//~(."t It.
! ..j
'/ '/
I lol {, 1/,) I
Address
3
.- -. ..... ,..,-,
~-- --- --- - ----.-- ~-- - --- -~--- -- - - --- ---
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f~~~t'l>{!-'ii>t:?'i.t;j .-.:. ';V.:l. >"',.:}_~ H(lI"~_.~;t"j'tio:'?ir:~'~!'io<l'!;Y " ...:,;i.-?l).'V:vk:" 'ff,!~ - i'.: "'::.?iJ
, ";J:li:fl~'/"]HCOMMONWEALTH.OF;PENNSYLVANlk,,f', . l~
D~9.!l. ; I? ;2 8::N(,;:~,~;'~'!m:ij';:;~;DipAiriMiNT;o~'RiVINuii~:;:~~f;\~.~:j\fltY;'~~:'.P';"c;.,.. .. f~
r;t\i~f:~i:A;:"ifjlA'iiJ:.I,OF"I~IALR~cEi~:'~.~pi,N.N~Y.i.VAN'AJ.NHERIT~!-t:c:tifi,,~D 'ESTAT~T~?(\t:a~;~t;:~i'l~~j'l 'i.,;t .-,.,",,;';1
ACN
ASSESSMENT P:'
CONTROL IiiI
NUMBER
RECEIVED fROM:
a
AMOUNT
BOGAR JAMES D
5 W MAIN STREET
101
.273.78
SHIREMANSTOWN PA 17011
lOtPtlUf -
ESTATE INfORMATION,
~ E NUMBER
~ 21-1994-0768
~ NAM FEED (LA
1:1 SHE F
II TE OF PI< MEN
m POSTMAR
COUNTY
SSN 18/'-ee-4538
I T (MI
REGISTER OF WILLS
m TOTAL AMOUNT PAID
/J!)'
("./ .
RECEIVED BY '.
MARV C. I.EWI
REGISTER OF
REMARKS
ALl CE R. SHEAFFER
SEAL
CHECKll 902
---------------------------------
r~"""--
,
~. ~._~-_~-'__:.-..__...~..... ..,~' Vh.o ,,-.'.
S'IWJ'lJS llIWO/l'l' UNDE/l /lULE 6, 12
Nome of Decedentl
Vrederlck C. Sheaffer
Date of lJeathl
October 10, 1<)<)3
Will No,
21-94-0766
^dmln. No.
Pursuant to 111110 Ii, 12 of the Supremo Court Orphans'
COUl't /lules, 1 report the following wIth respect to completion o(
the adminlstrallon o( the .~bove-cnplJ.oneu ostatel
1.
State whether ndministratlon of the estate is complete:
Yes,~_ No__
2. J f tho ,lnflWU': Is Nn, state whon the perflonal
representative roasonably belIeves that the adminIstratIon wIll be
completel__...___ ,
3. If the answer to No. 1 Is Yes, state the followingl
a. Did the personal representative file a final
account wIth the Court? Yefl No X
b. 'I'he sop,lrate OI:plh1ns' Court No, (if any) (or
thu personal ropL'esent,~tlve's account Is:
c. Did the personal representative state an
account informally to the partIes in Interest? Yes X No
d. CopIes of receipts, releases, joInders and
approvals of formal or informal accounts may be flIed wIth the
Cerk of the Orphans' Court and may be attached to this report.
Date:
10 I ~t;/CI'/
I /1 .
. ,(lfl' iJlz.;,;(tt--
Signature \J
James D. Bogar, Esquire
Name (Please type or prInt)
5 W. Main Sf.
Shiremanstown, P^ 17011
^ddress
~_J (,
(717) 737-8761
Tel. No.
(MMII rmf/^M3)
Capacity: Personal Representative
X Counsel for personal
representative
RtV-1547 EX AFP (12-94*
!/ItD""ONWEAl TH OF PENNSYlVANIA
DEPART"ENT OF REVENUE
BUREAU Df INDIVIDUAL tAXES .
DEPl. 2'&0601
IlARRISlURG, PA I71U.0601
ESTATE OF sHE'At''F"ER FlfEm FILE NO.
DATE OF DEATH 10-10-93 COUNTY CUMBERLAND
NOTE I TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBHIT THE UPPER PORTION OF THIS FORH WITlt YOUR TAX
PAYHENT TO THE REOISTER OF WIllS. HAKE CHECX PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
l'l-d33- Y
(,' --0~)L;-1
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWAtlCr
OF DEDUCTIONS AND ASSESSHENT OF TAX
ACN
DATE
00l
v
101
05-08-95
JAMES D BOGAR
5 W MAIN ST
SllIREMANSTOWN
PA 17011
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
AMount Ae"Ht.d
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
R'Ev:isW-EX-AFP-ri'2':9C,Y"iiiiWCE--OF--fNHEiiifANCE-YA'inrppiiiriSEii€iiT~--Ai.roiiiii;CE-b-R-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHEAFFER FREDERICK C FILE NO. 21 94-0768 ACN 101 DATE 05-08-95
TAX RETURN WAS I I X) ACCEPTED AS FILED
;:':" (8)
)...;..... '.1.
APPROVED DEDUCTIONS AND EXEMPTIONS: ~
9,157.96
9. Fun.rel Exp.n.../Ad.... COlta/Hisc. Expen... (Schedule HI (9J
10. Dabts/Hortg.ga Liabillti../Lhn. (Schedul. 1) nO) '581.70
11. Tot.l Deductions (11)
12. Hat Valu. of Tax R.turn (121
13. Charitable/Govern...ant.l Bequ..t. (Schedule J) (13)
lit. N.t V.lu. of E.t.t. Subject to Tax (14)
NOTE: I~ an assussmunt wus issuud pruviously, linas 14, 15 and/or 16, 17 and 18 will
ru~luct ~igurus that includu thu total o~ Ahh ruturns assussud to datu.
ASSESSMENT OF TAX:
15. AMount of Lina 14 at Spou.al rat. (15)
16. A.ount of Lina 14 l..able .t Lin..I/CI... A rat. (16)
17. A.ount of Lina 14 t.xabl. at Collat.raI/CI... 8 rat. (17)
18. Principal Tax Due
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..I E.t.t. (Schedule Al
2. stock. and Bond. {Schedule OJ
3. Clo.ely Held stock/Partnarship Int.r..t (Sch.dul. C)
4. Hartg.ga./Not.. Receivabl. (Schedule DJ
S. C.sh/Bank Depo.ita/Hi.c. Par.onal Property (Schedule EJ
6. Jointly Owned Property (Schedule FJ
7. Transfar. (Schedule GJ
8. Tot.l A...t.
1 CHANGED
11) ~('!OO \cj
12) ~-l '-. DO '"
(3) .00 --
.00 or-
14) -<
15) 23,147.95 I
.00 \11
16)
171 .00 :
-0'
.00
13.408.29
.00
X . DO.
X .06.
X .15.
118)
TAX CREDITS:
PAYHENT
DATE
10-10-93
10-27-94
DISCOUNT 1+)
INTEREST 1-)
.00
5.61-
RECEIPT
NU"8ER
SPOUSAL
MM913128
AHDUNT PAID
536.33
273.78
TOTAL TAX CREDIl'
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
. IF PAID AFTER DATE INaICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
:1J
"TI(":)
; , ()
;23,147.95
9,739 66
13.408.29
.00
13.408.29
.00
804.50
.00
804.50
804.50
.00
.00
.00
IF TOTAL DUE IS LESS THAN .1, NO PAYHEHT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY BE DUE
A REFUND. SEE REVERSE SIDE DF THIS FDRH FOR INSTRUCTIDNS.)
RESERVATION, E.t.t.. of dlcld.nt. dying on or b.far. O.c..b.r 12, 1912 ~. If .ny future Int.r..t In the ..t.t. I' tran.f.rr.d
In pa.....lon or .nJoy..nt to Cl... I (callat.r.l) b.n.flcl.rl.. of the d.c.d.nt .ft.r th. 'Mplr.tlan of any ..tat. far
Ilf. or for y..r., the Co..onw..lth h.r.by .Mpr...ly r...rv.. th. right to .ppral.. .nd ...... tran.f.r Inh.rltanc. TaM"
at the lawful Cia.. I tcallat.ral) rat. an any .uch future lnt.r..t.
PURPOSE OF
NOTICEI To fulfill the r.qulr...nt. of S.ctlon 21~0 of the Inh.rltane. and E.tat. TaM Act, Act 22 of 1991. 72 P.5.
S.ctlan 21U.
PAYHEHTI
O.t.ch the tap portion of thl. Notlc. and .ub.lt with your pay..nt to the R.gA.t.r of Will. prlnt.d on the r.v.r.. .Id..
..~"... ch.ck or .on.y ard.r payabl. tal REGISTER OF HILLS, AGENT
All pay..nt. r.c.lv.d .h.11 flr.t b. appll.d to any Int.r..t which ..y b. due with .ny r...lnd.r appll.d to the taM.
REf UNO (CR)I A r.fund of . taM cr.dlt, which WI' not raque.ted on the TaM R.turn, .ay be r.qu..ted by co.pl.tlng en "Application
for R.fund of p.nn'Ylvanla Inharltanca and E.tat. TaM" CREV~ISIS). Appllc.tlan. ar. .vallabl. at the Office
of the R.gl.t.r of Will., any of the 2S Aavenue Ol.trlct Offlc'" or by calling the .pacl.1 2~-haur
an.warlng ..rvlc. noabar. far fora. ard.rlngl In Plnn.ylv.nla 1-100-56Z~2D50, aut.ld. P.nn.ylvanla and
within local Harrhburg araa (717) 7117-1094, TDD. (7171 772.2252 (tl.arlng I.palrad Only).
OBJECTIONS I Any party In Intar..t not .etl.fl.d with the .ppr.I....nt, allawenc. or dl.allowene. of d.ductlon., or ........nt
of t'M (Including dl.count or Int.r..t) .. .hawn an thl. Hatlc. au.t abJ.ct within ,IMty (60) dey. of rec.lpt of
thl. Notlc. byl
-.wrlttan prot..t to the PA Oapart..nt of R.v~, la.rd of App.el., Dapt. Z11021, Harrl.burg, PA 17121-1021, OR
.~.Iactlon to h.v. the ..tt.r det.r.lnad at audit of the .ceount of the per.anal r.pre.ent.tlva, OR
.~.pp.al to the Orph.n.' Court,
AD"IN
ISTRATlVE
CORRECTIONS I
factu.l .rrar. dl.cav.rad an thl. ........nt .hauld be addr....d In writing tOl PA O.p.rta.nt of R.v.nu.,
Bureau of Indlvldu.1 T.u., ATTNI pa.t A.......nt R.vl.w Unit, n.pt. ZI06DI, tt.rrhburg, PA 17121-0601
Phon. (717) la7~6S05. Se. p.ga 3 of the boakl.t "In.tructlan. far Inherlt.nce T'M R.turn far a R..ld.nt
D.c.d.nt" tREV~1501) far en eMplan.tlon of a~lnl.tr.tlvely carr.etebl. .rror.,
If any t.M dua I. p.ld within thr.. (3) cel.nder aanth. eft.r tha dec.d.nt'. d.ath, . five p.re.nt (5~) dl.caunt of
the taM p.ld I. .Ilow.d.
Int.r..t I. ch.rg.d baglnnlng with flr.t d.y of d.llnqu.ncy, or nlna (9) aanth. .nd an. CIJ dey frae tha d.t. of
d.eth, to the d.t. of pey..nt. Tex.. which b.ca.. d'llnqu.nt b.far. J&,y.ry 1, 1982 b.er Int.ra.t et the r.t. of
.IM 16X) p.re.nt p.r .noue c.lcul.tad .t a dellY ret. of .000164. All t.M.. which b.c... d.llnquant an .nd eft.r
Janu.ry I, 1912 will ba.r Int.r..t .t . tet. which wIll v.ry fro. eeland.r y.er to c.l.nder y..r with thet r.t.
announc.d by the PA D.p.rt..nt of R'v,nu.. Th. appllcabl. Int.ra.t r.ta. far 198Z through 1995 ar'l
DISCOUNT I
INTEREST I
~ Intar." R.t. O.IlY Int"..t F.ctor !!!! Intar..t Rete O.lly Int.r..t f.ctar
1982 ZOlC .00D5ft8 1917 'X ,OD0247
1985 16lC .000431 19aa~I991 I1lC .00OSOI
191ft IIlC .0001Dl 1992 'X .ODOZ"'7
1915 lSiC .0001S6 1995-1994 1X .000192
1986 10lC .00DZ14 1995 'X .00021t1
--Intar..t I. c.lculat.d .. follawl1
INTEREST . BALANCE OF TAX UNPAID X NUnBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
.~Any Hotle. I..uad .ft.r the t.. b.ca... d.ltnquent will r.fleet .n Int.r..t cllcul.tlan to flftaen (15) d.y.
b.yond th. data of the ........nt. If p.y..nt I. .ade .ft.r the Intare.t ca.putetlCHI d.te .hawn an the
Hotlc., addltlonel Int.r..t au.t b. c.lcul.t.d.
, '" .}
,:^-f-f '1 6".1.. II ,? /,::) 'J
,
/ ~.)
. ,
/ '/ /~)
"~uJ
.I
ACN 101
NOTICE OF INIIERITANCE TAX
APPRAISEHENT, ALLOWANCE OR OISALLOWANCE
OF OEDUCTIONS AND ASSESSHENT OF TAX
RICHARD L PLACEV ESQ
232 N 2ND ST
PO BOX 99
HBG PA 17108
DATE 05-08-95
FILE NO.
COUNTY
REV"lS47 EX AFP (12"941*
.' CO""ONWUlHl or P[NNSYlVANIA
D[PARl"[Nl or RCYfHUE
BUR[AU or INDIVIDUAL lAMes .
DCPI. zaOUI
fl#.RRI5BUMO, PA 11118-060\
ESTATE -lfF-1l7(HffiLE FRAIl!{
DATE OF DEATH 09-25-94
CUMBERLAND
NOTE. TO INSURE PROPER CREaIT TO YOUR ACCOUNT. SUBHIT TilE UPPER PDRTION OF TillS FORN WITII YDUR TAX
PAYHENT TO TilE REGISTER GF WILLS. NAXE CIIECX PAYABLE TO "REGISTER GF WILLS, AGENT"
REMIT PAVMENT TO:
REGISTER OF WILLS
CUMBERLAND CO CDURT HOUSE
CARLISLE, PA 17013
A.ount R..I U.d
CUT ALONG THIS LINE ~ RETAIN LOWER PORTION FOR YOUR RECORDS .....
iiiV': iS4j"EX"ji Fji'"n 2':94"i "iieir iCE""OF-YNHEiii TANCE"TAX "jippiiiiis EHEii'r;" Ai.i."oWAiicE"iili m__m""""" - - -"
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF RAMSDALE FRANKLIN W FILE NO. 21 94-0868 ACN 101 DATE 05-08-95
TAX RETURN WAS. I X 1 ACCEPTED AS FILEa
RESERVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. R..l Eat.t. ISch.dul. A) Cl)
2. Stocka and Bond. CSch.dula B. (2)
3. Clo..ly H.ld stock/P.rtn.r.hip Int.r..t ISch.dul. C) (5)
4. Hortg.g../Hot.. R.c.lv.bl. ISch.dul. DJ 141
5. C..h/Bank D.podt./Hhc. P.r.on.l Prop.dy ISch.dul. E) 15)
&. Jolntly Own.d Prop.rty ISchadul. F) 1&1
7. Tr.n.f.r. ISchedul. Q) (7)
8. Tot.l A...h
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funer.l E~p.n.e./Adn. Co.t./HI.c. Expan... (Sch.dul. H) 191
10. Debt./Hortgag. Llabllltl../LI.ns CSchedula I) (10)
11. Total Deduct 10na
12. H.t Valua of Tax Raturn
13. Ch.rltabl./Gov.rn.ental a.qu..t. (Sch.dula J)
14. H.t Valu. of Eat.t. Subj.ct to T.x
If an assassmant was issued previously, lines
reflect figures that include the total Df ALL
ASSESSMENT OF TAXI
15. Anount of Llna 14 .t Spou.al
16. Anount of Line 14 ta)C.bl. .t
17. Anount of Lln. 14 t.xabl. .t
18. Principal T.x Du.
NOTEI
r.t.
Lln..l/Cl... A r.t.
Coll.teral/Cl... 8 r.t.
1151
1161
1171
TAX CREDITS:
PAYHENT
DATE
RECEIPT
NUHBER
DISCOUNT It I
INTEREST I-I
CIIANGED
an
c: I;' \(,
.J '. DO ul
.00 :.
. 00 ~~
.00 I
111
19,583.58
.00
. I. DO --.
F :.1..
)...; (8)1.;
.."
_,F.;
,..
19.,583.58
21,.1.lI3.23
.00
1111
1121
IUI
1141
'1.10:>\ ?3
1.519.65-
.00
1,519.65-
14, IS and/or 16, 17 and 18 will
returns assessed to date.
.00 X .03.
.00 X .06.
.00 X .15.
1181
.00
.00
.00
.00
AHOUNT PAID
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST
TOTAL DUE
.00
.00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REUERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
IF TOTAL aUE IS LESS THAN 'I, NO PAYHENT IS REQUIRED.
IF TDTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAY SE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORH FOR INSTRUCTIONS. 1
\
RESERVATIONt E,t,t., of dee.dant. dying on or bafor. Dlcl.bar lZ, 1'.2 .- If ~y future lnt.r..t In the I...t. I, tr~.f.rred
In po.....lon or .njoy..nt to el... a (collat.r,l) blnefle..,." of thl dlcldlnt .'t,r thl Ixplratlon of any ..t.t. 'or
II" Dr for v..r., thl Co..~.lth her.by Ixpr...ly ra..rvI' thl right to appra.'. BAd ...... trenl,.r lnh.,ltlnCl 'IX"
at thl lawful el... . (eolh's"U rat. on ."y such future Int.r..t.
PUIIPOSl: Of
NOTICE1 To fulfill thl raqulr...nt. 0' Slctlon Zl~D 0' the Inh.rltBnCI end E.t,t, 'aM Act, Act ZZ of 1991. 72 P.S.
S.ctlan 2140.
PAYHEH" O.hch tM top portion of thh HoUn Met ,ub.it with your plr''''' to thl Rlght.r of willi printed on thl nv.ua ddl.
.-Hah check or ~'Y ord., pnabll tal REOISTER OF MILLS, AOEHT
All ply..nts r.calvld ,hIll flr.t bl appllld to any Int.r..t which ..y b. due with any r...lnd.r 1PP1led to the t...
REFUND (CA)I .. nfund of . tl. cnd1t, which w.. not nqu..t.d on the h_ A.turn, ..y ~ requtt...d bY co_latina an ....ppllc.tlon
for A.fund of PlIIW1lYlvlWlla Inherltanca IMMS Es..t. Tax" (AEV.1SlS). APplication. ar. avaUabl. at the offlc.
of the AsgIstsr of Wills, any of the 2S A.v.nu. DI.trlct Offlc.s, or by cllllng the .p.clal Z'.hour
~.werlna s.rvlcl nueb.r. for 'or.' ord.rlngl In penn.ylvanla 1.100.S62-2050, outlld. Penn.ylvanl. and
within local Harrl.burg ar.. (717) 117.1094, TOOl (111) 712.2252 (H..rlng I.,elr.d Only).
OBJECTIONS I Any p.rty In Int.r..t not ..tl.fl.d with the appr.I....nt' ellow~' or dl..llowanc. of deduction., or ........nt
of ta. elncludlng dl.count or Int.r..t) .. shown on thl. Notlc. BYlt obJ.ct within .I.tv (60) d.y. of r.c.lpt 0'
this NoUca by'
.-wrltt.n prot..t to the P" D.p.rtaant of A.v.nua, Board of Appa.ll, D.pt. 211021. H.rrl,burg, PA 11121.10ZI, OR
...I.cUon to h.va the .aU.r d.hraln.d at audit of tha .ccount of the fMr.onal r.pr..ent.Uv., OR
...pp.11 to thl Orphan.' Court.
ADHIN
15TAAlIVE
CORAECTlONSI
INfEAESTI
FactuIl .rror. dl.cov.red on thl. .......ent .hould b. addr....d In writing tal PA D.part..nt of R.v,nu.,
Bur.au of Individual T...., ..TTNI Po.t A......ent A.vl.w Unit, O.pt. 210601, H.rrl.bUrg, PA 11121-0601
Phon. (717) 787.6505. 5.. pta. S of the booklet "In.tructlon. for Inh.rltanc. T.. A.turn for a A..ld.nt
D.c.d."t" (AEV-150U for en ..plen.tlon of adlllnhtratlvaly corr.ctabl. arror..
If any t.. dUI I. p.ld within thr.. eS) cal.ndar .onth. .ft.r thl d.Cld.nt'l d.ath, . flv. p.rcant e5%) dllcount of
the te. paid II .llow.d.
Int.ra.t Is charg.d b.glnnlng with flr.t dIly of d.llnquency, or nine (9) ~thl and on. (1) d.y froe the data of
d..th, to thl data of ply..nt. T.... which b.c..' dallnquent b.for. Janu.ry 1, 1912 b..r Int.r..t at the r.t. 0'
.1. (6X) parcant p.r annua cllculatad .t . dilly r.t. of .DOOI6A. All tl_.' which b.c... dallnqu.nt on ~ .ft.r
January 1, 1982 will b..r Int.r..t It . rat. which will v.ry fro. cal.ndar y..r to c.land.r y..r with that r.t.
announced by the PA O.part..nt 0' Rav.nu.. Th. appllcabl. Int.r..t r.t.. for 19.Z through 1995 .r.,
DISCOUNT I
~ Inhra.t R.t. D.lly Inhr..t F.ctor ~ Inhr..t A.t. Dally Inter..t Factor
19.2 20X .0005U 1987 9X .OOOZU
1915 lOX .DOOUI 1911~1991 \IX .000101
19.' \IX .000101 1992 9X .0002"
1915 I5X .GOon6 1995.1994 1X .00019Z
1916 lOX .GODZ7" 1995 9X .GOOU7
....lnt.r..t I. calcul.t.d a. follow.'
INTEREST' BALANCE OF TAX UNPAID X NU"BER OF DAYS DELINqUENT X DAILY INTEREST FACTOR
.-Any Notlca I..u.d aft.r the t.. b.co... d.ll~t will r.flect an Int.r..t c.lcul.tlon to flft..n (15) d.,.
b.,ond thl data 0' the .......ant. If pa,.ent I. .Ida .,t.r thl Int.r..t coaput.tlon-d.ta .hown on the
Notlc., additional Int.ra.t .u.t ~ c.lculated.
A
I
IC~ 1(' 7 fJ(ll'.//'1 /j.r'J 'I
~
IN RE: ESTATE OF
FRANKLIN W. RAMSDALE,
DECEASED
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS I COUR'f DIVISION
<Y I - <; 'I - fb .:f
APPROVAL OF ACCOUNT, RELEASE AND INDEMNIFICATION
ESTATE OF FRANKLIN W. RAMSDALE, DECEASED
The undersigned is one of the residuary beneficiaries
of the Estate of Franklin W. Ramsdale, Deceased.
Shirley J. Bolan and Frank R. Ramsdale, Co-Executors
of the Estate of Franklin W. Ramsdale (hereinafter collectively
"Personal Representative"), is willing to make distribution of
the assets of the estate without the formality of a court accounting
upon the receipt of a proper release, receipt and indemnification,
which it is the purpose of this document to provide. In consideration
of the willingness of the Personal Representative to make distribution
without the formality of a court accounting and agreeing to be
legally bound hereby, the undersigned, individually and on behalf
of the undersigned's heirs, personal representatives, successors
and assigns, does hereby:
1. Waive the filing of an account of the administration
of the estate in any court;
2. Declare that the undersigned has examined the attached
informal Statement of Account of the Personal Representative;
accept and approve it with the same force and effect as if it
had been prepared and filed with, audited, adjudicated and confirmed
absolutely by a court of competent jurisdiction; and as if the
balance of principal and income had been awarded by the court
in accordance with the Statement;
f
E
-
3. Warrant that the undersigned is one of the residuary
beneficiaries named in the informal Statement of Account and
is entitled to receive the distribution therein set forth1
4. Absolutely and irrevocably release and discharge the
estate, the Personal Representative and P1acey & Wright, attorneys
for the estate, their respective heirs, personal representatives,
successors and assigns of and from any and all actions, liabilities,
claims and demands relating in any way to the administration of the
estate and distribution in accordance with the informal Statement
of Account except for a reserve of $200.00 and without a court
accounting and adjudication1
5. Agree to indemnify and hold harmless the Personal
Representative and their heirs, personal representatives, successors
and assigns, from and against any claims, liabilities, loss or
expenses (including costs and counsel fees) arising from any
cause whatsoever which the Personal Representative may incur
as a result of the administration of the estate and its distribution
in accordance with this document and to refund to the Personal
Representative any portion of the distribution of the undersigned
which exceeds the amount of the undersigned's share as the Personal
Representative finally determines.
IN WITNESS WHEREOF, intending to
be legally bound,
, or/-..-
this / '/ day of
the beneficiary has executed this document
jl'l".v , 1995.
{{1, .
~( - /~<'L
/ .. F {~.. ~
Wi tness '-,
A~B/S-'~-
~hir1ey . cllan
(SEAL)
(
"-. ,.
- 2 -
\,-
l~-ii 'I rij'l.uL 1/'/ /~J ~
IN THE COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
.:J I _ q I{ - .\'(" ,I'
APPROVAL OF ACCOUNT, RELEASE AND INDEMNIFICATION
ESTATE OF FRANKLIN W. RAMSDALE. DECEASED
IN RE: ESTATE OF
FRANKLIN W. RAMSDALE,
DECEASED
The undersigned is one of the residuary beneficiaries
of the Estate of Franklin W. Ramsdale, Deceased.
Shirley J. Bolan and Frank R. Ramsdale, Co-Executors
of the Estate of Franklin W. Ramsdale (hereinafter collectively
"Personal Representative"), is willing to make distribution of
the assets of the estate without the formality of a court accounting
upon the receipt of a proper release, receipt and indemnification,
which it is the purpose of this document to provide. In consideration
of the willingness of the personal Representative to make distribution
without the formality of a court accounting and agreeing to be
legally bound hereby, the undersigned, individually and on behalf
of the undersigned's heirs, personal representatives, successors
and assigns, does hereby:
1. Waive the filing of an account of the administration
of the estate in any courtl
2. Declare that the undersigned has examined the attached
informal Statement of Account of the personal Representativel
accept and approve it with the same force and effect as if it
had been prepared and filed with, audited, adjudicated and confirmed
absolutely by a court of competent jurisdictionl and as if the
balance of principal and income had been awarded by the court
in accordance with the Statement 1
3. Warrant that the undersigned is one of the residuary
beneficiaries named in the informal Statement of Account and
is entitled to receive the distribution therein set forth;
4. Absolutely and irrevocably release and discharge the
estate, the Personal Representative and Placey & Wright, attorneys
for the estate, their respective heirs, personal representatives,
successors and assigns of and from any and all actions, liabilities,
claims and demands relating in any way to the administration of the
estate and distribution in accordance with the informal Statement
of Account except for a reserve of $200.00 and without a court
accounting and adjudication;
5. Agree to indemnify and hold harmless the Personal
Representative and their heirs, personal representatives, successors
and assigns, from and against any claims, liabilities, loss or
expenses (including costs and counsel fees) arising from any
cause whatsoever which the Personal Representative may incur
as a result of the administration of the estate and its distribution
in accordance with this document and to refund to the Personal
Representative any portion of the distribution of the undersigned
which exceeds the amount of the undersigned's share as the Personal
Representative finally determines.
IN WITNESS WHEREOF, intending to
be legallY_90und,
(, ;;:6
this I / day of
the beneficiary has executed this document
/) /,<.\., (
I' ~l(('\
Wi t:ness
, 1995.
)
('
.:J)l.d-nk t I2t!Ht-,!,('.b!
/ Frank . I Ramsdale
,
~
(SEAL)
(
..~...~.. )
- 2 -
12/16/95
02/21/95
02/21/95
02/21/95
EXPENSES AND DEBTS
Parthemore Funeral Home - funeral expenses
PA Dept. of Revenue - 1994 PA40EZ taxes
WESTAB - 1994 1% local tax
Cumberland County Register of Wills _
short certificate
First Federal Savings & Loan Association _
check charge
Nancy Fink - reimbursement costs advanced
Rev. Robert Graybill - honorarium - $100.00
Summerdale Apts. - rent due 196.00
Shirley J. Bolan - reimbursement
Rolling Green Cemetery _
Grave site
Chapel
Granite base for gravemarker
PP&L - final bill
Bell Atlantic - final bill
Patriot-News - debt of decedent
$ 6,008.50
8.09
2.91
3.00
16.15
costs advanced
296.00
Placey & Wright - attorneys' fees
Placey & Wright - reimbursement costs
Cumberland County Register of
Wills - probate and short certs. _ $
Cumberland Law Journal - est. adv.-
The Sentinel - est. adv.
Cumberland County Register of Wills
filing inheritance tax return
Notary Fees
Reproduction
PA Department of Revenue - PA41 estate
Cumberland County Register of Wills _
filing beneficiary Releases
Reserve for future costs and expenses
TOTAL
- 2 -
- $730.00
590.00
344.26
72.83
38.87
24.00
advanced
70.00
40.00
97.90
10.00
3.00
7.20
tax
1,799.96
1,200.00
228.10
1. 90
23.00
200.00
$ 9,787.61
v. . '.j,
""',I ,.
- I.',
n , ......
,
. t:1
" '.' >-
, ~
''OJ,
l."'1: jQ " f
ijj ~J
0" '!,:] ..::I
0:" UU