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INHERITANCE TAX RETURN
RESIDENT DECEDENT
(TO BE FILED IN DUPLICATE
WITH REGISTER OF WILLS)
YEAR
NUMBER
fOR DATES Of DEATH Ann 12/31/91 CHECK HERE
If A SPOUSAL
PQYEI!!!..C!E.l?I!_IS.C~!ME~ [J
fiLE NUMBER
01\
COUNTY CODE
qv,
100
...
is
fil
III
'"
COMMONWfAI1H Of PfNU!l'l'lVANIA
DlPAR'M(NI Of II(VfNU[
OfP' 180M)!
__ t!~RR~!l~~~.9.'A 11118 ObOI
OICIOWI'~ NAMI IIA!>l III!>T. 4tH) ~1(Jlnllt~ITIAlI IH((llI,~I'!) COMPlIlI AOOlt!)!)
Shumberger., Glenn S. .. . .. .. .. 4ll Brilndy Lane
'&;]~~U9:~t~U~~;;~.'...._....... .10'~j';';~'~~ '-.J"";~;'~;~ Ill_]. ('!~' :e~~~~l~.~~~~_~~~'.~)^
,,' """"~::~':::.~"'::::~~"~':~'_.~''': "~'~':_.J':::':U."~...--__t~u:.:.~: <VI 0 ':,,""CI'O"'I
I~ 1. Original Relurn I I 2. 5upplemenlal Return [I 3. Remainder Relurn
(lor dolln 01 death prior to 12.13.82)
o 4. limited Eltate [ J 40. Fulure Inlerelt Compfamile [J 5. Federal ellal. Tal( Return Required
(for dalel of dealh aher 12-12.82)
l~ 6. Doc.d.nt Died re,tale LI 7. Dec.dent Maintained a living Tru't 9- 8. Tolal Number of Safe O.po,ll 80....'
(Allach copy of Will) IAlIach copy of Trusll
ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO,
t~AM( COM'lt Il MAIliNG ADOIlU~
James D. Bogar, Esquire 1 West Main Street
Tll(PHON(tWMIlI Shi.remanstown, P^
~~ 737-8761
17055
,;,'"
wffi
..",
..",
8~
17011 "
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3
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...
0:
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1')-----.--.---.....--- --.
(2) ..m.___________
(31_____.______..
(4) ____ _.____
IS) _10,-51.l!~L___.
(61 ~!. 68Q.~~_._
(7)
19,198.84
I, R.ol eslole (Schedule AI
2. Slacks and 80nds (Schedule 8)
3, Cloutly Held Stock/Partnership Inler.st (Sch.dul. C)
4, Mortgages and Notes R.c.ivable (Schedul. 0)
5, Calh, 80nk OeposiU & Miscellaneous Personal Property
ISchedule EI
6. Jointly Owned Property (Schedule F)
7. Tran,fe.. (Schedule GI (Schedule L)
8. Tolal Gro$$ Aueh (Iotallines 1.71
9. Funeral hpenses, Administrative Cas", Miscellaneous
hpenses (Schedule HI
10. DeblS, Mortgag. liabiliti.s, liens (Schedul. I)
11. Total Deductions (10101 lines 9 & 10)
12. Net Value of Estalo (line 8 minus line 11)
13. Charitable and Governmental Beques" (Schedule JI
lA. Net Valu. Subject to Tal( (line 12 minus line 13)
15. Spousal Tronsf.rs (far doles of d.ath after 6.30.94)
See Instructions for Ar,plicable Percenlage on Revers. (15)
Sid.. (Include valu., rom Sch.dul. K or Schedule M.)
16. Amount 01 Line 14 loxoble 01 6% role (161 8,545.91
(Include values from Schedul. K or Schedule M.)
17. Amount of Lin. 14 tal(oble at 15% rate (17)
(Include values from Schedule K or Sch.dule M.)
18. PrindpaltaA due (Add tal( from lines 15. 16 and 17.)
19. Cr.dih Spousal Poverty Credit Prior Payments Discount Interelt
18)
( 9)
6,235.99
4,416.94
(10)
10.652.93
8.545.91
(111
(12)
(131
(14)
8,545.91
x._=
. .06 =
512.75
. .15 =
'"
'"
!;i
...
:>
..
:E
'"
u
)C
..
...
(18)
+
+
(191
(20)
20. If line 19 is gr.ater than line 1 B, .nl.r the diffefence on line 20. This is the OVERPAYMENT.
aD
Chock hore if you aro roqua,'ing a rofund of your ovorpayment.
512.75
121)
(2IA)
(21B)
21. If line 18 is greoler than line 19, .nler the difference on line 21. This is the TAX DUE.
A, Enter the interest on the bolonc. due on line 21A.
8. Enler thetolol of line 21 and 21A on line 218. This is the BALANCE DUE.
Make Ch,c~ Payable tOI Regllter of Willi, Ag,nt
~ ~ BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND TO RECHECK MATH ....
Under penalties of perjury, I declare that I have ....amin.d this return. including accompanying schedules and statements, and to the b.1l of my knowledge and belief,
it i, true, correcl and complete. I declare Ihot 011 real estale has been r.porl.d at true market value. Declaration 01 preparer other than the penonal represenlative is
baled on 011 informolion 01 which preparer has any knowl.dge.
~IG T "[Of'(Il~ON~ON!l181.fOllfnINGAtTUAN ADDllfS~ 224 Walnut Circle OAn
.:u..fiJ, ~IJV I' 17 11 9/25/96
n e: mDer er S nremanstown, P^ 0
SlGNAlU", or .."(~.~" IH' "m",,""" 'DO"," 1 W t M' S t t OAIf
. ? ' es a1n ree
L-,.alAv',,,,-- Shiremanstown, P^ 17011 9/25/96
James D. ar, ~squ1re
A. ... 011994 p~v""'" ,h. "dv'"'' ., ... ." "...'mp."d .. ... .., V"" ., ".......,. .. ,..
the use of the spouse, The rates as prescribed by the statute wlll be:
. ." t.03' will h. ."tk.hl.... ..,.... ., d...d.... dy'" .. .. .... 7/1/94... ...." 1111"
. ."t.03' will b. .,,!k.bI.... ........, d...d.... dyl.'" .. ....1111.. ..d b.'- 111191
. ,,,t.01\ will b. ."lInbl.,.. ....,..., d...'"'' dy'" .... ....111197 ..d b..." '/1'98
e Spousal transfers occurrIng on or after 111/98 wlll be ellempt from Inherllance tall,
PLEASE ANSWER THE FOLLOWING QUESTIONS
BY PLACING A CHECK MARK k) IN THE APPROPRIATE BLOCKS.
YES NO
1. Did decedent make 0 transler and:
x
a. retain the use or income 01 the property tronslerred, .......................................................
x
b. retain the right to designate who sholl use the property Iranslerred or its income, ...............
x
c. retain a reversionary inlerest; or ...................................................................................
x
d. receive the promise lor lile 01 eilher payments, benelits or core~ .......................................
2. II deoth occurred on or belore December 12, 1982, did decedent within two yeors preceding
death transler property without receiving adequate considerotion~ \I death occurred alter
December 12, 1982, did decedent transler property within one year 01 death without receiving
adequate consideratian~ ..................... ......................................................... .............. .......
x
x
3. Did decedent own on 'in trust lor' bonk account at his or her deoth~......................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES,
yoU MUST COMPLETE SCHEDULE G AND fiLE IT AS PART Of THE RETURN.
-:-_4 _ ~~. 1:"
-I
IIVlto1l1.12I1)
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEOUS
PERSONAL PROPERTY
~'J~.9.
~
COMMONWfAUH Of 'fNNSYlVANIA
INHlll1ANel TAX InUIN
1I110lHT OlelOINT
Please Print ar T e
FILE NUMBER
ESTATE OF
Glenn S. Shumberger
(All pr.,.rty loln,ly.own.d with tho light of Survlv.uhlp mull b. dl,cI.,.d .n Schldull '1
N~~~ER DESCRIPTION
1. Furniture and personal property - date of death
value $350.00
2. 1970 Broadmore Mobile Home, Title No.
21987507405 SH, sold at private sale
3. 1989 Ford vehicle, VIN 2FABP74FXKXl16067, sold
at private sale
4. Blue Shield refund
5. Agway - refund for service plan
6. Blue Cross refund
7. Pharmacy Corp. - insurance refund
(Anach additianal 8V.- )( u- sh..ts if marl spaco I, n..d.d.)
VALUE AT
DATE OF DEATH
$ 350.00
5,000.00
4,800.00
103.52
23.16
125.81
115.66
SlO,5l8.l5
IIVIS09llt 1""1 "
~
COMMONWEALTH Of PENNSYlVANIA
INHumANCE fAX RUUJlN
RESIDENT DECEDENf
SCHEDULE F
JOINTLY.OWNED PROPERTY
ESTATE OF
Glenn S. Shumberger
Jolnttenont(.).
FILE NUMBER
--------...--.....-. ...-..
NAME
A. Glenn B. Shumberger
RELATIONSHIP TO DECEDENT
Son
ADDRESS
224 Walnut Circle
Shiremanstown. PA 17011
B.
c.
Jointly-owned property.
ITEM LmER DATE
NUMBEI FOR MADE DESCRIPTION OF PROPERTY TOTAL VALUE DECO'S DOLLAR VALUE OF
JOINT OF ASSET % INT. DECEDENT'S INTEREST
TENANT JOINT
1. A 11/4/81 Mellon Bank, NA Passbook $17.361.37 50% $ 8,680.69
Savings Acct. No.
142-110-4165, date of
death alue $17,361. 37
TOTAL IAllo enle' on line 6. Recopilulotlon) S 8,680.69
(II more space is needed inserl additional sheers o( some sjze'
Glenn S. Shumberger
ITEM
NUMBER
A,
UVlm tit 1'.11'
1.
~J~:?C\
....ffif""..
COMMONWEALTH O. PENNSYlVANIA
INHunANCf TAX I[1UAN
RUIO[NT DECEDENT
J SCHEDULE H
FUNERAL EXPENSES,
ADMINISTRATIVE COSTS AND
MISCELLANEOUS EXPENSES
_PI.~.. Print or Tvp.
FILE NUMBER
DESCRIPTION
AMOUNT
Fun.ral Exp.na.a:
Malpezzi Funeral 1I0me - funeral expense
$ 5,315.10
B, Admlnlatratlv. Coati:
1. Personol Rep,esentative Commissions None claimed or l'aid
Social Security Number of Personal Represontative:
Vear Commissions poid
2.
4.
C.
1.
2.
3.
4.
5.
6.
7.
8.
Allorney Fees James D. Bogar, Esquire, as per agreement
625.00
3.
Fomily Exemption
Claimont None claimed
Add,ess of Claimant at decedent's death
Street Address
City
Stalo
Zip Code
Relationship
Probate Fees
Mlacellaneous Expenle..
Bell telephone - final bill
56.09
AT&T phone lCilsc - final bill
19.72
PP&L - final bill
106.15
22.93
46.00
16.00
25.00
SLlllllllons - TV cable - final bill
Elwood Stetler - lawn maintenance
Patriot News - advertisement for sale of mobile home
Register of WIlls - filing fee of Inheritance Tax
Return and Inventory
TOTAL (Also ontor an lino 9, Rocapitulatian)
(If mar. ap'"c. la ne.d.d, Ina.rt additional ah..tl of lam. alz..)
S 6,235.99
II~UIJI1. 11 "I
~.ttr' .IJ.
,..,. '
""
COIoll,lON....t..llH Of "NN,,,,,,"'IA
INtUln...NCI ,.... IIIUIH
1_~~ID_IHt DICIDIN'_ m ~
SCHEDULE J
BENEFICIARIES
FILE NUMBER
ESTATE OF
Glenn S. Shumber er
ITEM
NUMBER
RELATIONSHIP
AMOUNT OR
SHARE OF ESTATE
NAME AND ADDRESS OF BENEFICIARY
A. T aJlable Boque"lo:
I.
Glenn B. Shumberger
224 Walnut Circle
Shiremanstown, PA 17011
SSN: 170-22-0168
Son
Rest, residLle
and remainder
Note: Elizabeth R. Shumberger, wife
of decedent, predeceased the
decedent, having died on
February 22, 1984.
ITEM
NUMBER
AMOUNT OR
SHARE OF ESTATE
NAME AND ADDRESS OF BENEFICIARY
8. Charitable and Governmental 8equeloh:
I.
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Allo enlor on IIno 13, Rocopllulolion) S
(If more Ipac. II n..d.d, inl.rt addlllonal .h.... 0' lam. linl
i.
LAST \~ILL AND TESTAHENT
I, GLENN S. SHUHBERGER, 0 f the Borough of ~lechan icsburg,
County of Cumberland and State of Pennsylvania, being of sound mind,
memory and understanding, do make, publish and declare this to be my
last Will and Testament, hereby revoking and making void all former wills,
codicils and other testamentary dispositions by me at any time hereto-
fore made.
1.
I direct my Executor, hereinafter named, to pay as soon as
practicable after my decease all my just debts and the expenses of my
last illness and burial.
2.
I give, devise and bequeath all of my estate - real, personal
and mixed - unto my wife, Elizabeth R. Shumberger, provided my wife
survives me by sixty (60) days.
3.
Should my said wife, Elizabeth R. Shumberger, predecease me,
or die within sixty (60) days of the day and date of my death, then and
in that event I give, devise and bequeath all of my said estate unto my
son, Glenn B. Shumberger.
4.
I hereby nominate, constitute and appoint my said son, Glenn B.
Shumberger, executor of this my last Will and Testament. Should my said
son fail to qualify or cease to act as executor, I hereby appoint my
grandson, Glenn B. Shumberger, II, executor of this my last Will.
IN WITNESS WHEREOF, I, GLENN S. SHUHBERGER, the Testator, have
hereunto set my hand and
...,.~ d ., I
j,~_ ayof ;;0,/
seal to this my last Will and Testament this
, 1978.
'-
)/ t 1'-.: . :~
(SEAL)
< .
I.l-- /.;? {~ - ?
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
IHtt:AlTAHC[ TAX DIVISION
DlPr. Zl0601
KARAlSIURO, Pi 17111-0601
NOTICE OF INHERITANCE TAX
APPRAISEHENT, ALLOWANCE OR DISALLOWANCE
DF DEDUCTIONS ANO ASSESSHENT OF TAX
DATE
ESTATE OF
DATE OF DEATH
FILE NUNDER
COUNTY
ACN
JAMES D BOGAR
1 W MAIN ST
SHIREMANSTOWN
PA 17011
01-13-97
SHUMBERGER
04-13-96
21 96-0760
CUMBERLAND
101
A.aunt H..ttt.d
.,
( -
*
111.11,4' (I fI' IU-WI
GLENN
S
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE .. RETAIN tOWER PORTION FOR YOUR RECORDS ~
ii'Ey:is4-j-EX-iii;j'--n-Z-:96Y-NOYicE--ciF-YNHEiiii'ANCE-YA"iC-'A-ppiiiiisEiiENi'-,--iiLi:ciiiANCE-iili-----------------
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHUMBERGER GLENN S FILE NO. 21 96-L760 ACN 101 DATE 01-13-97
TAX RETURN WAS' (X I ACCEPTED AS FILED
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Roo1 Eat.to (Schodul. A)
2. Stock. and Bondi (Schedule OJ
3. Clos.ly Hald stock/Partnership Intar.at (Schedul. C)
4. Hortg.g../Not.. Raceivabl. (Schedule 0)
S. Ca.h/Bank Deposita/Hilc. Parlonal Property (Schedule E)
6. Jointly Owned Property (Schedule f)
7. Transfar. (Schedule G)
8. Tot.l A...t,
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funaral Expans../Ad.. COlta/Hi.c. Expens.. (Schedule HI
10. Dobto/Hortg.g. Ll.bl11tl.aILl.n. (Schodulo II
11. Tot.1 Doductlona
12. H.t Value of rax R.turn
13. Charlt.bla/Govarnnant.l aequa.t. (Schadula J)
14. Hat Valua of eatate Subject to Tax
If an assessment was issued previously, lines
reflect figures that include the total of ALL
ASSESSMENT OF TAX:
15. A.ount of Lln. 14 at Spou.al rat. (15)
16. A.ount of Lln. 14 taxable at Lln.al/Cla.. A rat. (16)
17. AMount of lln. 14 taxabl. .t Co1lataral/Cla.. 8 rat. (17)
18. Principal Tax Due
NOTE:
TAX CREDITS:
PAYHENT
DATE
09-26-96
RECEIPT
NUHaER
AA146782
DISCOUHT l+ I
IHTEREST (-I
.00
111
121
(31
(41
(5)
(61
(71
(91
1101
I CHANGED
.00
.00
.00
.00
10,518.15
8,680.69
.00
(81
6,235.99
4,416.94
(111
1121
113)
1141
HOTE: To In.ure proper
credit to your account,
sub.it the uppar portion
of thl. for. with your
tax pay.ant.
19,198.84
In.6~' q3
8,545.91
.00
8,545.91
14, 15 and'or 16, 17 and 18 will
returns assessed to date.
.00 X .00=
8,545.91 X .06=
.00 X .15=
1181
AHOUNT PAID
512.75
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN.
TOTAL DUE
. IF PAID AFTER DATE INDICATED, SEE REVERSE
FDR CALCULATION OF ADDITIONAL INTEREST.
.00
512.75
.00
512.75
512.75
.00
.00
.00
( IF TOTAL DUE IS LESS THAN .1, NO PAYHENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CRI, YDU HAY 8E DUE
A REFUND. SEE REVERSE SIDE OF THIS FDRH FDR INSTRUCTIONS.)
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RESERVATIONI E,t.t.. of decedent. dylna on Dr belar. Oec~r 12, 1'8l .. If eny lulur. lnt.r..t In ~ I.tat. I. tr.n,'.rr.d
In pa.....lon or ~dDpent to Chu a (coll.l.r.l) beneflel.r... of th- decedent .ft.,. the .lIplr.t1on of any ..tel. for
11'. or far Y""" the Co..onwe.lth her.by .xpr...ly r...rv.. the right to appr.l.. and ...... tran.',,, Inherltenc. Tall"
.t the lawful Cl... a (coll.t.,.,l) rat. on any .uch lutur. Int.r..t.
PIJIll'OS[lIF
NOTICE,
To fulfill the r""lr......ta of Section 21U of th. InherUanu end E.t.t. lax Act, Act ZZ of 1991. 72 P.S.
s.ctlon 214D.
PAvttENT I
Detach the top partlon of thl. Holle. and ,ub.lt with your p.v-ent to the Regl.t.r of WIll. p,.lnt~ on th. ,..v.r.. .Id..
.-HeIl. check 0,. lIOMy order p.yabl. tal REGISTER OF MILLS I AOEH1'
All PIV-.ot. rac.lved shall flr.t b. applied to any Int.r..t whIch .ay b. ~ with any r..alnd.~ appll.d to the tax.
REfUND (CAh
A ~.fund of a taM c~~lt, which w.. not r~..t.d on the T.M R.turn, .ay b. reque.ted by coapl.tlng an ~Appllcatlon
fo~ R.f\nl of Pann.ylvanla Intwrltanc. and E.tata Tax~ (REY-UU). Application. .r. avallabla at tha offlc.
of the Regl.ter of Willi, any of the 23 Revenu. Dl.t~lct offlc.., or by callIng the .paclal 24-hour
anlVll~lng ..rvlce nueber. fo~ for.' ordering: In pam.ylvanla 1-800-362-2050, outlld8 p...,.Ylvanla and
withIn local "'r~hbu~g araa (717) 787-809", TDD' (717) 712-2252 W.arlng lapalred Only),
OBJECTIONS:
Any party In Int.r..t not ..thU.d with the apprals..."t, allowanc. or dlsallowanc. of deduction., o~ ........"t
of taM (Including dl.count or Int.r..t) a. .hown on thl. Notlc. au.t obj.ct wIthin .IMty (60) day. of rac.lpt of
this Notlu bYI
--w~lttan prota.t to the Pi Dapa~taent of R.venu., Board of App.al., Dept. 281021, Har~l.bUrg, PA 17128-IOZI, OR
--.Iectlon to have the ..tt.r d.taralned .t audit of the account of the p.rsonal rapre.antatlv., OR
--appeal to the Orphan.' Court.
ADHI"
ISTRATIVE
CORRECTIOHS:
factuel arror. dl.cov.r.d on thl. ........nt .hould b. addr...ed In writing tOI PA nepart.ent of Revenue,
Bureau of Individual TaMe., ATTNI Po.t A.......nt R.vl.w unit, Dept, Z80601, H.rrl.burg, PA 171Z8-0601
PhOne (717) 787-6505. See page 5 of the booklet ~In.tructlon. for Inheritance Tax Aeturn for a Ae.ldent
Decadent~ (REV-1501) for an .xplanatlon of ad.lnl.tratlvely corr.ctabl. .rror.,
DISCOUNT :
If any tax due I, paid within thr.. (3) calendar .onth. aft.r the d.c.dant'. d.eth, a flv. p.rcent (5X) dl.count of
the taM paid Is allowed.
PENALTY I
The 15~ tax aana.tv non-participation penalty I. coaput.d on the total of the tax and Inter..t .......d, and not
paid b.for. January 18, 1'96, the flr,t day .ft.r the gnd of the tax .an..ty parlod. Thl. non-participation
pan8lty I. appealabl. In the .... .ann.r and In the the .... tl.. parlod a. you would app.al the tax and Intar..t
that ha. bean ......ad a. Indlc.tad on this notlc..
INTEREST I
Intere.t I. chargad beginning with flr.t day of d.llnqu.ncy, or nlna (,) eonth. and one (I) day fro. the data of
daath, to the d.te of payaent. Tax.' whIch bee..e dellnquant b.for. January I, 198Z baar Int.re.t at the rat. of
slx U:() parcent p.r annuli calculated at . dally r.t. of .00DlM. all tax.. which b.ca.. d.lInquent on and after
Janua~y I, 198Z will baa~ Int.r..t at a rat. which will vary froa calenda~ y.ar to cal.ndar year with that rat.
announcad by the PA D.part.."t of Ravenu.. Th. .ppllcabl. Intar..t rat.. for 1'8Z through 1997 ar.:
'!!!! Int.rut Aat. nAlIY Int.rut Factor :!2r Intare.t Rata nally Int.ra.t FftCtor
1982 ZOX .0005,.8 1987 'X .000Z47
1'8S 161C .OOOUI 19&8-1991 1l1C ,ooun
1... llX .000SOI 1'" 'X ,OOOZ't7
Ins 15X .00US6 1995-I'94 n .0001'2
1'16 lOX .000274 1995-1997 ox ,OOOZ47
--Int.re.t I. calculated a. followlI
INTEREST = BALANCE OF TAX UNPAID X HUKBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR
--Any Motlc. I..uad aft.r the tax bacoae. delinquent will raflect an Inter..t c.lculatlon to flft.... CIS) day.
beYond ~ data of the .......ant. If pa~t I_ .ade .ft.~ tn. Intar..t coaputatlon data shoWn on the
Nottca, ftddltlonal Intarut au.t tMI c.lculated,
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
II:
_____Gl,:nn (].' ~l~~mberger__
b.lng duly __ _..!.wo::~_ _ _ occ.,ding 10 I.w, d.pos.s .nd s.ys Ih.t h. _ is _t!~e_ ___,.
_______!'~.<<:!.c.!!_~~JC. 01 tho E,lat. 01 G_~ ~n!1-3.~ ~1].u~!.!b.!:E,geJC..___
I.t. 01 __._ ni1lllprlen 'I'ownshi P ., Cumb.rl.nd County, P.., d.c....d .nd th.t tho
within Is .n Iny.ntory mod. by. _ him _ _ ._. __ __, the ,.ld Execu tor
01 the .ntir. ....1. 01 s.ld d.c.dent, consisting 01 .11 tho p.rson.1 prop.rly ond r..1 ....t., .xcopt r..1 ....t. ouhid.
the CommonwOllth 01 P.nnsylyonio, ond Ihol Ih. IIgur., opposit. e.ch it.m 01 tho Iny.ntory '.pr.s.nt It's f.lr y.lu.
.. 01 the d.t. 01 d.c.d.nt's de.th.
Sworn
.nd subscribed b.Ior. me,
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19 96
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.dtw.LLd')t~~(~,Lt..d/ft/ ______
E..cutor ~~
Glenn B. Shumberger
224 Walnut Circle
Not rial 5001
Cynthia A. Stimolm9, NOIJ'Y Public
Camp Hill BOlO, Cumbnrland Coun'Y
My CommissIon Expir.. Doc. 6. 1999
j
Shiremanstown, PA 17011
.----_.---- --.------
Addr."
D.t. of D..th ___ !.3.!..l!.___________
Ooy
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Month
1996
Yea,
INSTRUCTIONS
I. An iny.ntoty mu" b. fll.d within three months .ft.r .ppointm.nt of p.rson.1 r.pr.s.nt.tiy..
2. A suppl.m.nt iny.ntoty mu" b. liI.d within thirty doys of discovery of .ddition.1 ....h.
3. Addition.1 sh..h m.y b. .tt.ch.d ., to p.rson.lty or r..lty
4. S.. Articl. IV, Fiduci.ri.s Act of 1949.
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Inventory 01 the real and personal estate 01
Glenn S. Shumberqer
decoased
PERSONAL PROPERTY
Pharmacy Corp. - insurance refund
350 .00
5,000 .00
4,800 .00
103 .52
23. .16
"
, .
~: /125 .81',
-
115 .66
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TOTAL 10,518 .15
Furniture and personal property
1970 Broadmore Mobile Home
1989 Ford vehicle
Blue Shield refund
Agway - refund for service plan
Blue Cross refund
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STATUS HEI'OH'r UIIDEH HULE G. 12
Name of Decedent: Glenn S. Shumberger
Date of Death: April 13, 1996
Will No.
Admin. No.
,~\ - qLP - 1J:2.9
Pursuant to Rule 6.12 of the Supreme Court Orphans'
Court Rules, I report the following with respect to completIon of
the administration of the above-captioned estate:
1. State whether administration of the estate is complete:
Yes X No
2. If the answer is No, state when the personal
representative reasonably believes that the administration will be
complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final
account with the Court? Yes No X
b. The separate Orphans' Court No. (if any) for
the personal represe~tative'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 filed with the
Cerk of the Orphans' Court and may be attached to this report.
Da te : ~( l.'iW"
, / J (Lw 4 h~0-0~
'-Sf(jnatureU
James D. Bogar, Esquire
Name (Please type or print)
1 West Main Street
Shiremanstown, PA 17011
Address
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( 717) 737-8761
Tel. No.
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Capacity:
Personal Representative
X Counsel for personal
representative
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(MAII:rmf/1\M3)