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PETITION FOR I)ROBATE and GRANT 0(<' LETTERS
No. m._e2I~ 1 ~L~__9...Jk_._
To:
mo...... ...,. Register or Wills for Ihe
_.._.___m. .... __ , /)('('<'II.\'l'II. County of .-(".mJ1.t..dilJL in the
Soclol SI'('/lrlIY No. ....;<J1~,.: !~ )..- :J-."'.?L.. ('ollllllonwelllth of Pennsylvunia
The pellllon of Ihe undersigned res peel fully represents Ilull:
Your pelllloilt'r(s), whols/me I H years or IIge or older un Ihe exeeul-9R _._.__._.. Ill}med
Inlhe IlIst will of Ihe IIhove dm'denl, dllted .......... ...;'J.il.tL"'lLy__J._._____, 19!.O_
IInd mdlcll(s) dilled ............... . _..... __...m_...._........_...._...__...__.._...___.___..__
... '"' ......_ .0" ...._____....._~_.__n______..._._..__._.._..___n.__..________________.__
(\lllll' ll'lnlllll dll'lllll'.IIIlll'l'\, q:. Il'l1lllldllllnn, dellth Ull''(I,'I,'Ulllr, l'll'.)
lleeendt'llI WIlS dOllliciled UI de'llh In ./'U'-'/-u.......... _.......... ..' __ Counly, Penns~,411~lu, wllh
h..:er......llIsl I'lIl1lily O! principal residence 111.,\:" K.__.L-().I/, t.lv.___bll1l_~_...kJ"I" __
___......._.€J/ S.r-.... r,(u}I1".Iua.. tr'dn"'hi~y!..m...._....._..________.
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1I11)e~cn~~; :!:,'n_ V.~i{ ~ YCIA) :; Ir~~'~: ~"et\ 1-r ~~-'~:. .O=I"l~:/,~___~!_~'-------, 19 c; </ :
Eseepllls follows, deeedel~1 did Ilolmany, wus llol divorced lIud did llol huvc u child horn or adoptcd
after eseelllioll or Ihe will t~ffered 1'01' pm hale; wus oollhe I'lclim of II killlllg lInd WIIS ncver IIdJudlellled
iliepmpelelll: ..... ])/V,.,- ~.~ cL ..________....___.._.....w_._____.___
Ileecndelll III delllh oWlled properry wllh cSlimllled values liS follows:
(If domiciled in I'll.) All pl'rsonai properry
(If lIot domiciled ill I'a.) I'l'rsoulIl properry in Peunsylvallill
(If llol domiclkd in 1'11.) I'ersolllll p,operry ill Coullly
Vlllne or real eSlllle iu I'ellllsyll'allia
silullled lis follows:
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WHEREFORE, pelitlol1l'r(sl respeelfully re~~~ the prohllle of the IlIst will and codlcil(s)
prescnted herewilh IIlld Ihe grnnl of lellcrs....___.! -~l1l.'l!7il.t" __
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OATH OF PERSONAL RI<;PRESENTATIVE
COMMONWEAI,T1I01II'ENNS\'I.VANIA I l:Il:I
COllNTY OIl __.u~.~M!!..ERJl\~Q._n_~._nn__ J .
The pelllloom(s) uhove-nallled slI'eur(s) or IIffirlll(s) Ihullhe S1Ulelllenls In the foregulng potltlonure
Irne und eorre<:1 (I'lhe besl of Ihe knowledge ,lIId helieI' or pelllloner(.\) III1lI thllllls Ilcrsolllll reprcscn.
IlIth'e(s) of Ihe uho\'(' ,k<:edenl ,"'Iilionel'(s) will .I'ell und Irllly udmillisler Ihe est lite lIeeordlng to IIIII',
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EVELYN G. BUSEY
I, EVELYN O. BUSEY, of Cumberland County, Pennsylvania, declare this to
be my will and hereby revoke all prior wills and codicils made by me,
1, EXDenses, I direct that funeral expenses and the expense of
erecting a suitable monument for my grave be paid out of the funds of my
general estate.
2. Beouest. I bequeath, devise, and appoint all of the rest of my
property, of whatever nature and wherever sit.uated, including property over
which I hold a power of appointment, t.o my daughters, Rena Busey Shotsberger
and Evelyn Busey Shope, per stirpes,
3. Survival. If any beneficiary should dl.e within sixty (60) days
after me, then he or she shall be deemed to have predeceased me for all
purposes of this will.
4. SDentlthrift Clause, No interest of any beneficiary hereunder
shall be subject to anticipation, pledge, assignment, sale or transfer in any
manner, nor shall any beneficia~y have power in any manner to charge or
encumber his or her interest, nor shall the interest of any beneficiary be
liable or subject in any manner while in the possession of my fiduciaries for
any liability of such beneficiary, whether such liability arises from his or
her debts, contracts, torts, or other engagements of any type,
5. Facility of Payment for Minors or Incompetent~. Any amounts or
assets which are payable or distributable to a minor or incompetent hereunder
may, at the discretion of my fiduciar~es, be paid or distributed to the parent
or guardian of such minor or incompetent, to the person with whom such minor
or. inoompetent resides, or direotly to suoh minor or incompetent, or msy be
applied for the use or benefit of suoh minor or incompetent.
6. ~I, In addition to such other powers and duties as may be
granted elsewhere herein or which may be granted by law, my fiduciaries
hereunder shall have the following powers and duties, without the neceuity of
notice to or consent of any court:
(a) Tu retain all or any part of my property, real or
personal, in the form in which it may be held at the time of its
receipt, including any closely held business in which I have an
interest and the stock of any corporate fiduciary hereunder, as
long as in the exercise of their discretion it may be advisable so
to do, notwithstanding that said property may not be of a
character authorized by law.
(b) To invest and reinvest any funds held hereunder in any
property, real or personal, including, but not by way of
limitation, bonds, preferred stocks, common stocks and other
securities of domestic or foreign corporstions or investment
trusts, mortgages or mortgage participations, mutual funds with or
without salos or rede~ption charges, and common trust funds, even
t.hough such property would not be considered appropriate or legal
for a fiduciary apart from this provision,
(c) To sell, convey, exchange, partition, give options to
buy or lease upon, or otherwise dispose of any property, real or
personal, at the time held by them, at public or private sale or
otherwise, for cash or other consideration or on credit, and upon
such terms and for such price as they may determine, and to convey
such property free of all trusts.
(d) To borrow money from any person, including any
fiduciary hereunder, for any purpose in connection with the
administration hereof, to execute promissory notes or other
obligations for amounts so borrowed, to secure the payments of
such amounta by mortgages or pledges of any property, real or
personal, which may be held hereunder.
(e)
upon such
firms, or
To make loans, secured or unsecured, in such amounts,
terms, at such rates of interest, and to such persons,
corporations as they may deem advisable.
(f) To renew or extend the time for payment of any
obligation, secured or unsecured, payable to or by them as
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fiduciaries, for as long a period or periods of time and on such.
tsrms, as they may determine, and to adjust, settle, and arbitrate
claIms or demands in favor of or sgainst them,
(g) In dividing or distributing any property, real or
personal, included herein, to divide or distribute in cash, in
kind, or partly in oash and partly in kind.
(h) Without limitation of powers elsewhere granted
therein, to hold, manage and develop sny real estate which may be
held by them at any time, to mortgage any such property in such
amount. and on .uch terms as they may deem advisable, to lease sny
suoh property for suoh term or terms and upon such conditions and
rental. as they may deem advisable, whether or not the term of any
such lease shall exceed the period permitted by law or the
probable period of retention under this instrument; to make
repair., replacements and improvements, structural or otherwise,
in connection with any such property, to abandon any such property
which they may deem to be worthless or not of sufficient value to
warrant keeping or protecting, and to permit any such property to
be lost by tax sale or any other proceedings.
(i) To employ such brokers, banks, custodians, investment
counsel, attorneys, and other agents, and to delegate to them such
duties, rights and powers as they may detormine, and for such
periods as they think fit.
(j) To register any securities at any time in their own
~smes, in their names as fiduciary, (lr in the names of nominees ,.
with or without indioating the trust charaoter of the securities
so registered,
(k)' With respeot to any seourities forming a part of the
trust, to vote upon any proposition or eleotion at any meeting of
the corporation issuing such securities, and to grant proxies,
. discretionary or otherwise, to vote at any such meeting; to join
or become a party to any reorganization, readjustment, merger,
voting trust, consolidation or exohange, and to deposit any such
securities with any oommittee, depository, trustee or otherwis~,
. and to payout of the assets held hereunder, any fees, expenses
and assessments incurred in conneotion therewith, to exercise
conversion, subscription or other rights, and to receive or hold
any new seourities issued as a result of any such reorganization,
readjustment, merger, voting trust, consolidation, exchange or
exercise of conversion, subscription or other rights and generally
to take all action with respeot to any suoh securities as could be
taken by the absolute owner thereof.
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Inventory of the real and personal estste of
;;;"r;"L'I1J 6 l?cM~f-'
dlloeased
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COMMONWIALTH OP PINNSYLVANIA
COUNTY OP CUM.IRIAND
}
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b.lng duly
._______ .ccordlng 10 Ilw, d,pollI Ind I'YI Ih.t h.__
__________,__ of Ih. Eltall of ~"eUIN (.1. Bu.3cJ-'
1.1. of Ja'R...WJId~_t,;JNE I fi..N<X.I:L_ _______, Cumb.rl.nd Counly, Pa., d.e....d .nd th.tth.
within II In Invenlory mad. by --J~"---&'-'l ~f;' '----.-'_, ih. slid' r!t:",.-r.~1
of Ih. .nllre "I.Ie of Slid d.c.d.nl, conllsllng of III e p.rsonll prop'drly Ind rul"III., exc.pt ul .1111. ouhld.
Ih. Commonwu'Ih of Pennlylvftnll, Ind Ihal Ihe flgur" oppollle uch Item of Ih. Inv.ntory r.pr...nt 11'1 fair valu.
.. of Ihe date of decedent'l dulh,
19
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. ~r !...utor~~
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.nd subscrlb.d before me,
D~Ie of Oulh __.:4Q.
DIY
C<:!L;
Month
199'1-
v..,
INSTRUCTIONS
I, An Inv.nlory must b. fII.d within three monlhl Ift.r appolnlment of personal r.pr..entallv..
2. A luppl.m.nt Invenlory musl be flied within Ihlrty days of dllcovery of addltlonal....h,
3. Addlllon.1 I~eeh may b. alllch.d .. to personally or ru'Iy
~. Su Artlcl. IV, Flduclarl.s Acl of 1949.
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21 - 94 . 936
RENUNCIATION
In Re Bstate of
EVEL YN C'1J_BUSE Y
deCeased.
To the Realster of Wills ot _
CUMBERLAND .
. County, Pennsylvania,
The undersigned RENA BUSEY SHOTSBERGER . DAUGHTER
of
the above decedent, herebyrenounce(s) the rlaht to administer the estate and respectfully ask(s) that Lcllers
TESTAMENTARY
EVELYN BUSEY SHOPE
be IlIued to
WITNBSS
MY
~and this' 4TH day of NOVEMBER I 19....21-.
f fJ,__ J!.,~ _ _ .-fl~
(Slan_IUfe)
-t- /,,, j,y, c4H~ I /() ~ t!> ~'OI- 91-.fW
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INHERITANCE TAX RETURN
RESIDENT DECEDENT
COMMONWIAlltlOf PENNSYLVANIA (TO BE FILED IN DUPLICATE ,.0) (
DEPARb~WWJJ,\VINlJE WITH REGISTER OF WILLS) 7\
HARRISIURO,!~ 11119.0601 _ _ ______ .."._ __ __uh". __. COUNTY C()o.~.
D( orN '5 NAME lL"H. ""ST. AND MIDDLE INITlALI OfC!OHH'5 COMPtHf AODRESS
So(li.TIi~y~!i:l+-t;,.,'!.r::~~'f.I~fo?oh:it'------IO^iiOfiiAiI(' - --. ~~(!{~t~~~ /~:~f. z I ~S-
"2.~o -..1-_? --.5'?8L__ .JQ::f3c?--J'1't- ...a~t..q::I.$.9(1. CO,,'t..,-.G..{-'t?IM8..t..Ii@f-.----.
(If J.m't:Allfl 'U.~IVIII(lI'Ou'H H.l.IIII~.I.\l flH! MW M100IIII/l1I.I) SOCIAl SECURITY ~WMUIl AI.'OUW IUUi"t'EO ISH INSTIIUC IONS)
..--------. --~----------- -------_____.._______.. ...____ _._n'___.____.
rW1. Original Rolurn ['1 2. Supplomon'al Rolu,n rJ 3. Romalnd" Rolu,.
.- . (far dol.. of doalh prior 10 12.13.821
[I 4. lImllod Eltalo I] 40. Fuluro Inlo,o.1 Camp,oml.. [I 5, Fodo,al E.lalo TOK Rolurn Roqulred
1'0' dolol 01 doolh alto, 12.12.821
IEn. Oocodonl Olod TOllolo [] 7, Oocodon' Malnlalnod a living Tru'l
(AlJach copy of Willi (Allach copy of Trulll
eo..Ul'Oto!DINCI AND CON'IDINTIAL TAlC IN.ORMATION IHOULII.. DI.KTID TOI
COMPUTE MAlllNO ,4,0('111
!lOR i'.//Nte./k utile:
PtV~t'l1- /?cJZj'--'!'5"~
111 "'n u__.________.._______..
11 I ." nu__._.____.___._._.
(3 I _ ._uu___________
( 41._._.________________..
151 _u___"lZt2/n9.S5...L t2.._
16Im_.____._,s,1!:!..te...!..B'I-__
( 71 ._._______ n._.______._
191______4>~/8,;~
71. 7S"
(101 _________._.__
RIV,llCO II. II'.'R '
~
il!
1. Rool Ellalo ISchodulo AI
2. Slack. and Bond. ISchodulo BI
3. Clo.oly Hold Sluck/Po'lno"hlp Inlorall {Schoelulo CI
4. Mortgago, and Nolo. Rocolvablo (Schodulo 01
5. Cash, BClnk Deposils & M!ICellaneoul Personal Properly
ISchodulo EI
6. Jolnlly Ownod Propo'ly ISchodulo FI
7. Tran.'o" ISchodulo GllSchodulo II
B. Tolal Gro" A"oh Ilololllno' I.~)
9. Funeral hp.""., Admlnhlrallve COSh, Mllcelloneoul
EKponlol ISchodulo H)
10. Oobh. Morlgago lIabIIlH... lIo" (Schodulo II
11. Tnlol O.ducHon. 110101 Un" 9 & 101
12, Not Voluo of Ellololllno 8 mlnu.llno 111
13, Chorlloblo and Gavornmonlal Boquo.', (Schodulo JI
14, No' Voluo Sublocll~!~JlIno 12 mlnu.lIno 131
15, SpoUlal Tranlf." (for dolo I of doolh olt.r 6,30,941
St. In,trucl/oM for Applicable Percentage on Revene
Sid., Ilncludo valuo. from Schodulo K 0' Schodulo M.I
16, Amounl of lIno 14 IOKoblo 01 6% ral.
(Includo valuol from Schodulo K 0' Schodulo M.I
17, Amounl of LIne 14 laKoblo 0' 15% rolo
IIncluno voluo. from Schodulo K 0' Sch.dulo M,I
lB, Principal to, duolAdd 10;( f,am llno. t5. 16 and 17,)
19. Crecli', Spoulal Poverly Credit Prlo( Payment' Discount InlfH.\1
---.-.------. + 'U____hm_'____ +3~~t.Al__ -_________
20. If lIno 191. glOolor ,hon lIno 18, onlor tho dlfforonce on lIn. 20, Thl. il tho OVIRPAYMINT,
liD
{I1('(~ IIl'II' If VOU 111(' ""Pf('\llIIg U ll.hllHI of v011I OVI'f!HIV'"1'1l1
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rOR DATlS or DIATH AnlR 121~1191 CHICK HIRI
IP A SPOUSAL
POVIRTY CRIl~!!.!LC.~~.I"l!!! CJ______
PILI NUM".
9'1
YEAR
.__...u_ ___
0130
n,,_..___ ~IUM8E!
_ 8. Tolal Numbo, of Safo Dopa III Boxe.
-I'
181
12.~ /gl,f~
(Ill ~81c),t!5
(12) _L2ZL7~1 ,e~
(131
(141 /22.1 '('If,8L
1151____~_________~,_._..
(161 _j2_~-7tfLii.f..__---~ ,06.. ___!li.lil_i. .1;1___
(171 .______..... ________.~ .15 ..
(181
___7~_fd.!j.I___
_____9UJ,Z:..2..___
(191
1201 ----.-.-------
(211 .___~.yr_~.J.~______.___
121AI "7,--'-- .--.------
12181____J!l.t;LW___,_._
21. If llno 18 il oroolor Ihon llnu 19. onlor Iho dlfforonco on llno 21. Tliil 1,Iho TAX DUE.
A. Enter th, In'trlll on the balance due on line 21 A.
8, Enlor Iho 10101 of llno 21 and 21A an L1no 21B, Thl. is Iho BALANCI DUE.
V Make _Check Pavable 101 R.gl.le! af Will., Agent
I, ' .~ ."U.I TO ANaWI. ALL QUIITIONI ON- RIVI....IDI AND TO RKHICK MATH I
Undorplnalll.. of perlury, I declare that I havI examined Ihls return, Including accompanying Ichedul.. and statlmenh, and 10 lh, bl.1 of my knowledgl and b,ll. I
It I. truI, correct and comple'e. I d.dar. thaI 011 'eo I eslatt has bften reported citrus mark'l value. OeclaraHon of prepar., alhor Ihon ,h. perianal repre.tntallve II
bOlld on all Information of which prepare' has any knowledge.
iiOfi"Uli or ""ON m'6N'"'' 00. IL 0 IfTU'N ---AOO""------.-- !,-.-----------.-------- OAlI
l!L------'8r1LtJ""Ji{._f.:ltl.L_{;Llf..,1Ia.,._&4,_LZa..~s:_~_ __~_{l:!lY
$10 ATU_f 0 lPARU OTmll , IlHR!!i ''''IVf AOORfS~, 0,,1(
-----_._~---------~-------._---_..-._-
.'"
fl<llldlll'ln", fol' nn lr1llr, n p..rlnd 1I1' 1'01'Ill(l" of tlllln mill 1I11 "lIdl
tormn, nn f'hoy mill' d"'''1'I111110, nlld ,In n<lJlIlll, "nt'U" , mill nrhl 1'1'1Il'"
dn[m" 01' <I"mnnclA III fllVlll' of 01' 1Ir,1I1'''1I Ihnrn,
(g) [n cl[v[dlllg or <11"1 I'lhtlllng nllY 1'1'01'01't:y, I'no! 01'
pI,rAonnl, Lncluclod h"!'I'ln, to <Ilvldo 01' Illnl:rlhutl1 In ennh, In
kind, 01' pllrtly In ell"h nllCl pllrt:ly In kllld,
(h) Without: [llIIltlll:lllll of pow"l'n olnnwhoro grnntod
thorn1n, to hold, mnnl\r.lI nllel d"volop nllY I'..nl ontllto which mny bo
hnld'by thom lit nny tlrnn, 1'0 1II01'1r,ngo IIny "lIch propllrty In nlleh
IImollnts nn<l on nueh tOI'III" nn thoy IIIny dl'orn ndvl.nblo, to lonne IIny
RlIeh prllporty for RlIeh l'l'm Ill' IHm. mill tlpon .ueh eondlt LlInn nnd
rontnln liS thoy mllY <10"111 ndvl',nhlo, Wh"'I,,,1' or 1I0t tho torm of nny
Rtleh 10llRe Rhnll oxeo"d tho 1''' I' Illcl 1'01'10 I t:t od hy lllW Ill' tho
probllblo I'orio<l lIf rotellllllll utlll..1' Ihl" 11I"I'flunon!:; tll mnko
l'('!pn{r~1 1"p.plnr('lmoIlU:; nnd IlllpI'Ol/PIl1(1I1I'H, ~It ,'IIf.'l:ttrnl or ()t'.\wt'wl~w,
[II conllootl.lIn wi th nllY mlch 1'1'01'l'I'ly, III nhllllClOII nny mlch prllporty
which thoy IIIny dOI,m 1'0 100 Will'I hi",,,, Ill' 1101 lIf m,frlldelll vnLllo 1:1I
wnrrllnt keepIng or prot,'ctlng, "lid III I'ol'lnlt nny Rlwh I'l'lI1'orty tll
Illl lORt by tllX snlo Ill' IIny oth..1' I'I'0coodl "/:' ,
(1) TlI omp10y 911eh hl'okol''' , hnlll:!!, etlRtod1l1nR, IlIvestment
counso1, nttornoys, IInd oU.n,' IIg0llt., 111\(1 to dolegnte to them sueh
duties, right" IInd p"wern IIn thoy mny do torm1 no, nnd fill' ntleh
"nrinds no they think fH.
(j) To rogistnl' nllY Rnelll'lt1o. lit IIny timo in thoir lIwn
nnmos, in their nnmon ns fidllc[lIry, or In tho nnmOR of nominoos,
with or without indient[nr. the tru.t ehllrnetor of tho .ocnr[ties
so regLstered,
(k) With rORpeet to IIny sreul'l tlos forming n port of the
trust, to vote upon IIny pl'op"sII'lou or rlocl:[on at nul' moothlg of
the corporntf.lIn I.suing 9uch R"(,Ul'lll"s, lIud to gran I: pl'oxLon,
dlscrotlonllry or othorwl,so, to vofl' nl any such rnoot:lup,; to Jo[n
or bocomo II pliny to any rrorf',lInlznllon, rrnd.lu.tmont, Inorgor,
voting tfllRt, eonnolldlltlon or I'xdlnllgr, and t.o drposlt any such
socuritlon with nny (,lIlnlnlt.tor, ,1i'pon'lory, I'flwlor 01' lIthorwlso,
and to pny Otlt of tho II,RSOts h" I (I hOl'oul1dor, any fllo", oxponSOR
nnd aSSOR"monl:. lneurrrd In l'onnoeUon f l"'l'owl th, to oXOl'cl.o
oOllvor.iol1, RlIhserlptl('n Ill: olh,,1' right", IInd to roerlvo or hold
any 1l0W .oeurl t[o. iRnllod 0" II re",rJ I: of III1V nnoh rrlll'gnnlzotlon,
rondJuotmollt, morgor, vollng t eWIf:, cO'1901Idol'ion, oxohnl1go or
exorc[so of oonvorsllln, nllh"crlpl:lolI 01' othol' rlp,ht. and f,onornlly
to toko nll notion wIth l'o'P"I'1 1:0 OilY .Iu,h ,0CIlI'II'los IIn could he
tllkcn by tho nhsoluto 0\~1l/l1' i.l1l'I'"ol,
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ESTATE OF
Evelyn O. Busey
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
Plea Ie Print or Type
FILE NUM8ER
ITEM
NUMBER
~!lp,!P!~Y ~~llv:;w;;d;;;i~.lh!Riij,I;j i~~~;';-hip~;';u;tj,;dl;Ci;t;do. i;j,;d~i. ii ,
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DESCRIPTION
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VALUE AT
DATE OF DEATH
.._-..---- ._._~.._..._-- ._---~.-----_..._..- .-. ...-
MidPenn Bank. Certificate of Deposit
Harris Savings. Certificate of Deposit
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TOTAL ~o_ enter C?!'J.I.~ ~ Recapllu'ali~n
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7.--r--'.....-....~r__-.----...---~-r
,
(Ah.ch .ddlllo.oI8l\" K, II" ,h"1I II molt 'po" II ...d,d,)
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$100,517,42.
19,867,68
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$120,385.10
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* .' SCHEDULE F '
COMMoNWIAllH or PeNNSYLVANIA JOINTLY.OWNED PROPERTY
INHUITANCITAX RITURN '
RIIIDINT PICIDINT
iiiAflop - -
Ei/(f"cr'N S,-~(/SG.y
PILI NUMBIR
Join' 'ononlllll
A.
- -. - -- --.-----_ - .-_____ ._..___~_._u.________.____~_.___.. _.., _...___._._.._.. _____.__~..________. .____.____.__.
.- .------ ----NAMi .. ADDRISS_ RUATIONSHIP TO DICIDINT
EYOlyn Bille)' Shcpo
lOR Wlntor Lane
F.noIa, PA - 17025
Pa'w-
B,
C.
Joln,ly.ownocl propel1y.
ITIM LmlR DALI
POR DE~CRIPTlON OP PROPERTY TOTAL VALUE DECD'S DOLLAR VALUE OP
NUMBI JOltU MA I OP ASS" % INT, DICIDINT'S INTIRIST
TINA T JOINT
1.
A. 3/14/91 HarriI 8m. M.M. 12582,96 ~ 629l,48
2. A. 1111193 DaupbIn DepoeIt chok. IC01. 4910.72 50% 2455.36
"
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TOTAL (AI.o In'er on IIn. 6, nocopllulatlon)
(Ii mort .pact/' ."d.d Inllrl addltlonol.h,," of 'om. 'I..)
$
I"Blf __
. ... . ..... .1.. PI.... "" " T,po
___...__ ___~ l!~~'tl{,_a I li':~'='!._""_'__h__.,________._J:~_UMIIIR __~___
tttVUIlI.. (fill
.
SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCEllANEOUS EXPENSES
COMMONWEAltH O' PHINSYlVANIA
INHUITANCf fA. RETURN
._. ~.UIOf~' O~ECE~EN! ___h__~__~ ...
ISTAT! OP
ITEM
NUMBER
A.
1.
2.
3.
4.
5.
6.
B,
1.
DESCRIPTION
AMOUNT
Funeral IMpen...,
Muuolman', Funonl Home
BonFnnkIIn
KIm'. Foods
MIlIIIOImIt\'I Funonl HOlllo
Ologrich'l Momoriala
Milo, food atoroa
(~ funoral biD)
(OOWOl'matcrIa1)
(ohuroh IunchOOll)
(final funoral biD)
(momoria1 atono)
(lunchoonlrolatcd)
$4575.00
19.53
137.30
247.00
8$15.00
43.17
Admlnl.trallve Co.II,
Perianal Representallve Cammlnlans
Saclal Security Number of Perlonal Representallve,
Vear Commlnlonl paid ___
2. Attorney rees
3. Family Exempllon
Clolmant _ Relallonshlp
Addren of Claimant ot decedent's death
Street Addrell __...
Stale .__ Zip Code
269.00
(public nodco)
(pubHo DOtloo)
40.00
92.30
TOTAL (Also enter on line 9, Recapltulallonl
(If more 'pace I. needed, Intert additional .heet. of .ame .Iu,)
s C. slB,ao
I..
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(OMMQNWIAUH 0' 'h-lNSVI....NI~
INKlln"'NC' ,All: U'UlII)t
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2.
ITlM
NUMBIR
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SCHEDULE J
BENEFICIARIES
PILI NUMBIR
61/6LYN' r:J, BGJr5er
NAM! AND ADDRESS OP BINIPICIARY
AMOUNT OR
SHARI OP ISlATI
RILATIONSHIP
A, Taxablo Boquo""
Rena Bueoy Shotsbergor
603 N. Chippcwa- Apt. 103B
Anaheim, CA - 92801
Daughtor $64565.97
(50%)
Ewlyn Bu&cy Shope
BOR Wintor Lane
Enola, PA-17025
Deughtor $64565.97
(50%)
NAMI AND ADDRESS OP BINIPICIARY
AMOUNT OR
SHARI OP ISlATI
Bo Charllablo and Gavornmontal BoqUOll1I
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (AI.a onlor an lino 13, Rocapllulatian)
(If mar. .paco I. n..dod, Inlo" additional .h..,. of .amo .Iul
S / 9 I g/. flf
lJTn't''''';..J,;r~'I",'''''HI.".I''';" I," ,'."".,,, ~I"I'" ~" .,,'-'_"....' , "',,
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V RIV-1547 IX AFP 112-94~
t COHHONllEAl III Dr Pf.HNSVlVmA
DEPARTHf.Nl UF Rf.vf.NUE
IUREAU OF INDIvIDUAl IAHf.S
IX!PT. 180601
IIANRIIIURO, PA 11111'0601
,'1/ '1!J[')
1,/ ' "7,.) - ,"
HOTICE OF INNERITANCE TAK
APPRAISE HE NT , ALLOWANCE OR DISAI,LDWAHCE
OF DEDUCTIONS AND ASSESSHENT OF TAK
ACN 101
. L<r- '
i'
DATI 02-28-95
FILE NO. '
DATil OF DIATH 10-30-94 COUNTY CUMBERLAND
HOTEl TO INSURE PROPER CREOIT TU VDUR ACCDUHT, SU8HIT THE UPPER PORTION OF THIS FORH WITH YOUR TAK
PAVHEHT TO THE REGISTER OF WILLS, HAKE CHECK PAVABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TOl
EVELYN BUSEY SHOP~
80R WINTER LN
ENOLA PA 17025
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
l.
A.ount RI.lttld
-
CUT ALONG THIS LINI ~ RETAIN LOWER PORTION FOR YOUR RECORDS ....
iti"V: iStij"iif "AF," i 1'2":94"i" iioYi c niF" INtiiiii TAtiC'!" "r"AX "A.pjiRA"isiifiii't ~ - "A L Diw;iifC'!" OR""."".".." -"" -""
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATI 01' BUSEY EVELYN G FILE NO. 21 94-0936 ACN 101 DATI! 02-28-95
TAK RETURN WAS I I X I ACCEPTED AS FILED
RiiERVATION CONCERNING FUTURE INTEREST " SEE REVERSE
APPRAISED VALUE OF RETURN BASED ONI ORIGINAL
1. RIll E.t.t. ISohldul. Al
2, stook. .nd Bond. ISoh.dull BI
5, Clo,"ly Hlld Stook/P.rtn.r.hlp Intlrl.t ISohldul. CI
~, Hort...../Notl' Rlolivlbll ISohldul. D)
5. C..h/Blnk Dlpo.lt./Hi.o, Plr.on.1 ProPlrty ISohldul. EI
6. Jointly Own.d Proplrty (Sohldul. FI
7, Tr.n.flr. ISoh.dull G)
8, Tot.1 A..lt.
) CflAHGED
20 Vj) ,..&..1
~n(\l
:1 ((I \1 (II (J
.". ':1 ,--
,
III " ,00 -q .,
, ..QQ. rn
121_ l:t:l
151 .J ,00 N
en
I~I , ,00
151 120.~85,10 '.'1
8,~p4 .....' ill i)
(6) C') _h
171 )> ,) 00 0
18) 129,131. 94
APPROVED DIDUCTIONS AND EXEMPTIONS I
6,318.30
9, Funlr.l E.pln.../AdM, Co.t./Hi.o. E'Pln.l. ISohldul1 H) 191
10, Dlbh/Hod.... LI.bUiUu/Li.n. ISth.dull II 1101 71,75
11 , Totol D.duoUon. 1111
12, H.t V.lu. of T.. R.turn 1121
15. Ch.rit.bIo/GovlrnM.nhl B.qullh ISoh.dul. J) IISI
I~, H.t V.lu. of Eatoto Subj.ot to ToH (14) _
NOTEI If.n ....a.m.nt WI' issued pr.viausly, linl. 14, 15 Ind,ar 1&, 17 Ind 18 will
r.fllat figurls thlt ingludl th. tat.l of abk rlturns .......d to d.t..
ASSESSMENT OF TAXI
IS, A.ount of Lln. 14 .t Spou..1 r.t. liS)
16, AMount of Lln. 14 t...bl. .t Lln..I/CI... A r.t. 1161
17, AMount of Llnl I~ t...bl. .t Coll.tlr.I/CI... B r.t. 1171
18, Prinoip.l T.. DUI
TAX CREDITS I
PAVHEHT
DATE
12-05-94
"'.390 nli
122,741.89
.00
122,741.:.!2..
,00 K .03.
122,741,89 K,06.
,00K,15.
(18)-
,00
7.364.51
.00
7,364,51
RECEIPT
NUHBER
MM913246
DISCOUNT 1+)
INTEREST 1-)
368,23
AHOUNT PAID
6,996,28
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTlREST
TOTAL DUE 1_
7,364.51
,00
.00
.00
. IF PAID AFTER DATE INDICATED, SEE REVERSE
POR CALCULATIOH OF ADDITIOHAL INTEREST,
IF TOTAL DUE IS LESS THAH tl, NO PAVHEHT IS REQUIRED,
IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU HAV BE DUE
A REFUND, SEE REVERSE SlOE OF THIS FORH FOR IHSTRUCTIOHS.)
~ ". "
.'
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Evelyn G. Busey Estate Acct, .
PIgO .L of 'Z..
30/0ctI94 'fotal
100517.42
19867.68
2455.36 (4910.72/2)
6291.48
'il!II!ljl!jl):
19,53
4575,00 "
137,30 11/3/94
43.17 "
6.25 11/4/94
269.00 "
40.00 "
65,50 "
247,00 11/14/94
895,00 "
92,30 11/25/94
6996,28 12/05/94
Eatate chedd amtJtranuct balance date
Initla1 deposit 102699.33 11114/94
dcpoeIt +19917,86 122617,19 11115/94
doposIt +4282.93 126900.12 11115/94
ok.l-B.P Ambulanco SorvIco -65,50 126834.62 11114/94
ok.2- B.J,Shopo/roirnb.of 1h miBc.oxp -257.60 126577.02 11114/94
ok.3- MuuoIman'. F.H.(Balanco) -247,00 126330,02 11/14/94
ck.4-Olngrich'. Momoriala(Slono) -895.00 125435,02 1lI14/94
ck,5-B.J,Shopo-rcimb,of 1h funOl'll oxp, -2287,50 123147,52 11116194
dopoeltEvio'. ~of517.42 c,d, intor, +258,71 123406,23 11117/94
ok,60 Rena Shotaborgor/dJabunm, -50000,00 73406.23 11123/94
ok.7- Bvelyn Shopol dlabunm -50000.00 23406,23 11/23/94
ok.9- PAlriotINows-prf/publioatlon -92,30 23313.93 11/25/94
dopoIlt Mot. Ufo policy ohock +42,52 23356,45 11/26194
ok.1()' R Ills A. lnhorit. lax -6996,28 16360.17 12/05/94
'II ,!!ilil!:1'I1 ;1' I
As8eU at death (Oct. 30, 1994 12913U4
mlnlll oxpolllOl -13386,33
Total 11S745.61
mile. dopoeita-Bluo CI'088 refund 279,60 11114/94
- ftowor 0IIh 45,()() "
- mldporm cd inlorolt 172.47 "
- Hania 18000 cd int. 50,18 "
- D,D, ohooklna inL 24.79 "
- MoL Ufo chock 42,52 11126194
lal. d18bUl'l.- (Evelyn &; Rena) 50000 x 2 -100,000 11/23/94
Totll 16360.17
:' ",,'. 1'.1 h.
.,' I
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. .
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.
.
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EveI1D G. Buley EItate Account
'i ','
Total of llItato ohookins lOOOunt oaniod forwlrd.
Aooumulatod mtnlt on IClOOUIIt.
CloIod out IClOOUltt on December 8, 1994
(DopoIltod injolntM.M. IClOOUIIt oponod In rwnOl of '
Evelyn J. Shope IIId Rena O. Shotabcracr>
.
111l1lll)' 26, 1995- Paid 1994 PA lJtatc Indivlduallnoomctax
of E.G. BIIN)', In the ItlIOIIftt of $54,74
Apil3, 1995-lRS refund of$133.00
.
AprlI4. 1995- DIatrlbullon of remainIna E8tatc fundi- Rena O. S~
, -EvolynJ.Shopc ,
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'69.5.
$16429.71
SI6374.97
$16507.97
8254.00
8254.00
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MEMORIALS
"A T,lhul.,o /1""
OrlOErl rom.1
524:1 SIMpson FollY Rand, M.ch.nlC!bmg, PA 17055 . (717) 766,5622
'J' l'
sOL~JrGrlll.~'dl j(ji<-:J.t1(i~ f..:Y'L\n...L
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Lettering
~fi4n
Supplier "__,,,,_ ._._ ______.______,
Ack, H ____.........._.. ______m_.".'______ ...'_.n__
Dale Aec'd ......._.._..._____ _____.__
Found. ordered m..____.._. Complete ___._
Poslllon verllled T7 ".-----,..-.----
~:~e~~~rdor _.. ,--l.-d1tll~z~,:!~u==~~~==:===
Location , .. ,__._._ ..___)i~d2 f'.t!.l-bilL!4__
Center Over _ .'-1.._...._ Graves r:"'~'_.--' Lot H -:;;;:z-.---..
ApproK, Dale 01 Completion ____ ~p.ill!;.,--,~-..._---
H ----. ,- .-- .:: . -- -- rJ- - ,
Order
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SIZ~.A'-i/~ )( * xI-. 't~ Finish ()llf,'iI-Jq:.f....J..c..tJ, -' IJ.ltr.l1, __Cd (\-'-__________
~~::.t) __ '4~;.l.. )f . '. (l Finish j-:f'.J~ I J a.LLl.? . __." __ ___~--------'---_.----
DeBlg~.J~f+du-T~7:Ji.(~-t~;.=TJF&~ZiL0il..?t:~ip=7YTll\~~b.J,.lie ~- _ _..:.....~=
---.C'fUlll Ff1._-ah.i..t/~czlt~-/,. ._L~.J/lc.l--:--_____________u__
Locetlon: _______n___.'. ___u_.____.n_._, (,1_..____ .__... .____m' . __..n___"__.________
o Vase ____....__.. u_.____.._.__.. .__....". 0 Corner Posls _,,,,,___,.____.__.__
Price
Foundation
"0"8m4111 A M'~ rlfIpntll k 'f'f1IJl1llrt rrlOllt'l l.'t'lf1'VTWIf1l:.m,f11 01 wmk
XI':; c"
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AOfllflIOpay,l.lItfl balAnC. ~(lrK\Ior"ll9'lrdkllt ollftbot !roobltl. (If .hll'l'fl\l"''l nI "1'1 OItWlf good 'flnon, lhl, oroor 0/ cooll1tl rllllOOl be C.nc.1Itd
by tlltlOffillI union 1!Jl'&td by both J!t1!101 The,flle" ht,tln ITlflllllnoed Ih"n '.mll~IIIIllIIIOfll'lI'y 01 Jim.. R. Olngrlch "'.motl.t. until ~Id ~l lull 'md
ltwly fflttlV.ll", rlqhlln IMl\(l~' Iht "'1M l'lllnl (\flld IIIlt,red
I.or" k)ur.lulloi j)fNlh..d ,II t\&me,.nd il.t.. Jot kCUf,CY and "r.~.pllvll rupon"bl\Ily IOf .ny '110ft ~ 01111,,/01" 'HI! AI! WILL III AN ADotTlOHAl
CHAAOI FDA ANY L1TTIAINO AODlD TO Tlfla MIMOAIAl AFTlA IAIOTlD OH THI CIMmAY,
TOTAL
Ilurttwlr .qtH 10 ~y Iht ballrn 11~lfI(lloJ thll wOlk ptrlollned '!Ode' thlt conlr'cl...~hlo lhlllV l:wll dllY' oll~e,,1 olllllll~\.' III'<<)lu .nri IUllhol .g'"
Ihll intl,..l &hIlace/\" ~IIM ,.,. 01 on'lInd OIl'hlll ""ctnlll I,....) ptlr month on 11\4 lIop"+d b/ll.nce nwed 10 Jam.. n OlnQtlc:h Mllmorlllt'l1nl!)lld DEPOSIT
wtIhln lNt\y (30) cUiy. 01 1M Involc., dill. In IIddltlOO IMftkl, I.gult "" ~omn MC....ry 101 JaIN'" Cltngrleh 10 tntlllule 1t~1 rrllCt.dlng 10 eol.el
.nyl~duellonlme 101 "'YtoMllI'lltwlIngPII'1 due IhInyIYlIdll.y., lOPlfY .IC,oU"CMltllod ann,IWlY' 1-.IIrW:Ullflrlby .IA1ne. R OlnQlleh Mllml'llhll'l Balance Due
I.'_;"""""~' )) ". Upon Completion $ ____.____
Dealet "h...__.~._~'J(...I;_IJ.__J..'m)(!LI Customer _ .i..L:.'J!"-'-'-J'.n__"~~~:' :!..;n_'-I.~_c...___.__
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