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HomeMy WebLinkAbout97-00801 ."" 1\,' 'L ~ , j, " " ....... ~ . w.. 0 , ! ~ . .e 0 ... Z tit r- '-'\-' . " " PEl'l'I'ION FOR IJROIIATE Hlld GRANT OF I,ETTERS .l../~ '17 ~ i~j /!':vlale q{ PearL K.. ShambaLl9h also kllOll'1I as No, To: _..._u.._.._.... Regisler of Wills 1'01 Ihe ________. /)"('('(1,,'<1, ('oUllly of Cumberland ill the Sodal S.'("lflIY No, 178-16-1955 ('Ommollll'elllth of 1'1'lllIsylvllllill The petit 1011 of Ihe ulldelsiglled lespeel fully Il'ple"'ol' Ihat: YOUI petltiollerQcl. who is/XDlXIH Yl'als of age 01 ol,kl alllhe exenil or ill the IlIxl will of Ihe above deeedellt, daled Sept.ember 12 IInd codldl(s) dilled None . ______ nnl11ed u_.' 19...2!L hlUIC rl'll'\'an! L'itt'IHl,.,lall\'L'I" t'ot'.' Il'I\lllk'iat!111l, dl'''111 nr t'\l'l'Ulor, etc.) Decelf<lellt WllS domiciled al dealb ill GUt11Per.l,!nO -<_ her_____lns! family 0' plillclpallesi,knee at 913 Nixon Drive, r.lllnh..rJ.and County, "f1nnaylvania. (Ihl \1l\'L'l, Ill1lllhl't and 1l\1I11CipaliIY) __ _ ('OUllty, I'ennsylvnllin, wilh Mom:oe_.Township,...__u_u__ , D~eelllllent, Ihell. 86.___. vealS of a~e, died September_17.. ...., 19_92u__..~.__' nt _J:I..~~isl:>u..r9Hospital!' Harrisburg! PA_________________. Excepl lIS follows, decedellt did Illllmarry, wa, 1101 divorced nlld did 1I0t havc a child bOln 01 ndopled nftel executioll of Ihe will offeled for pmball'; wa" 1I0tthe vlclim of II killing alld was lIever ndjudlcnted 100:0I11pelenl: _NClJlEl-.------ Deec.lldelll nl delltb owned ploperly wilh cSlimnl,'d values as follows: (If domiciled illl'n,) All pelsOlll\1 plop"rly (If nol domiciled in I'n,) Personal property ill I'enllsylvnnin (If IH)t domiciled In I'n,) I'elsollnl properlY ill Coullly Value of real estllle in Pennsylvllnia sltullted ns follows: _t'<on~__ $ uUI'lCl.El\:~J:1Tl.il'l~~L_~_ $ ._u__._._....._.uu ......u..__. $ $ None-u__u'___ WHEREFORE, petitioner(1l respeclfully reqllesl(s) Ihe probale of Ihe lasl will and codlcll(s) presenled herewith and Ihe grnnl or letll'rs ..Testamentary. ..-.-__._._~._~_.._ (tl'SlaUll'tlt:\t'y; admlnimlllioll ,:.t.ll.; ndlllllllslriuloll d.h.II.C.I.ll.) Ihcron, ~ u Ii '0- ~ ^ "'~ l~ I~ 1/\ ~~--=-~ _ _Dillab.urg, .J2A...17.019.______._.u_ ~~_._--~---_..'.. ....,,, ...'-.'--------------" ____.___-<__._._.__...___~_n ______,________ . ". OATH (}I<' IJERSONAI, REIJRESENTAl'lVE COMMONWEALTH (W I'ENNS\'I.V ANIA I 'S COUNT\' (W ....Q!J!'1~.E;;R~No!P______________ r l';, The pelilioner(1t ahoveunamed sw<'ar(s) or affirm(s) thai Ihe slatements in Ihe foregoing retition nre tru~ Ilnd cot'I'C"ltolhe besl or the kllowledgl' alld helle! of pelitioner(lll and thai as personnlrcpresell' Inlive(. of Ihe llhove dee"dent pelillonerljt) will w:.~alld trnly.admini:ler Ihe estaleaccording loinII', Sworn to or affirmed and slIhs"ribed I ___~~~_k}!\. ............uuuu_u_.._ '" hefore me Ihls ,q'i'EJtu da) <,I' LarrYUtllU!!___________~ ~' .~m~~~r~~I,fl.~~9}k~~ti ...._______ _ ~ Mary cC/I.,eW1S')- Ut'g/\'tl'f' '[7 ,......""..._<"'_~'____~.__~ ~ /j--,)65 -/1 III"" 111 n'II1'lIIMf ~ PI"MAklMI IlUCIlIHIt " ~ ~ ,,-, ~ -I ';J "", ~ l' '" 1 I , ! ~ I ~ J I'lIi\ i', Itl (('llif\' lh,ll tll(' lldllllllolllllll hCIl' !',iH'II i.. l'lllnl!\ '111111'111111111 ,11111111',11\'\1 '1'lllIi,.ll\' \II \k,llll dld\ lik,l WIlli II\!' .l~ 1(1(",11 Hq',i\[lal, I'hl' Ollgillid li'Hili"llt. willltl' 1111\\'~lltkd III lilt, \(,ill" \ II:d J~\', "1'1, (Jill,,' htl 1"'ltll.lllt'IH lilill)'" WARNING: Ills III0llal to duplloate this oOPY by photostnt or photonrnph. hT IllI lhi\ l ('('1ifiril(l'. S},tlO 1 I ) . ~'"<l.l"(;(Jo...c. t;,(;J,J'.r.i!.Jffa.1~ 1_'11.11 1{('gl~II,11 q 4485786 I' ~)(I" t! ..d!t(/L/tIZf 1 t Il.Jt\., \'0, 1I1U&14,j1lhIIU COMMONWI:AlTttOf peNNSVLVANIA' OiiPARlMI!NT OF HeA.llH' VITA.L HIlOOROti OERTlFICATE OF DEATH i"JU~'~U_1I ~ ~~~~~bTI:~~~:~~~~~ ~_. .~.."~.~.]--~~~.-:--~_- w,"n. ____,_______~_ _. ~~"..1.~1-~"...- f~'~!~~~(VfU~~'wi;~~: ;~~.6.~_~~ o~i rA-tl;tl/)j~)j;~ -;- AQIII~llo.V"'jl .~'!!!!.,!l!!!!! ~"I~ O~1f0f'1Ilfl1tl !""hW\AC'IU'...., 1'I._~.~~~U~t,...,.!~'..! ':!l'..!'~...,,'~~?'l ~u __ --. I Dot,. II"....J........ 'l.~ ("'~ .....t iI"".'<'_~;"'-"'~'1 lloSl'llAl 1m.." - n - I,~~,~<_'~ _,_. __ __. 1~'3?"\~!I!,"'LII~.rT!~hllrL. ;;.'~'lx'. ,~M. -:_I_I']d",~'II___~":'.~), '''f,,-~.I. _='''::._, COWIl'fUl'OIAlH cr ikJflO rW'Of,...nt fAClln" ..\Il'H,.t..Wl\,....,,'I..~,..,~~~" ''''', ......OfCf(ltH10fIw NlCOfIill,HI IU>C. ~M_""WhIl.* . ~} ItJ~(tJl ~rl*II.,".."._ ,-, Jl41111h t n - ... - - "C.rrt ~bU(Q. .. ." .....' 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",. ... ., _~"!"71".!l-,._:i~: !_' 7 I '-...._~~.' . ".tIN";liRI"NlI~"loIIIIl)i .wf'~'li,....,#l..,_, r u___!\. u:u...u(JJ.~'-I(tr.j!I.!l-\ L~J IIJ1 (1J.1 ~~~: ~ f_'" ",bl('~ I~ _(trz A'~f~.Jfd'( (1'(, /'" ..~..j /-' '0<.141 /UI(~t.S~r.C"I'.t{AI(I..:! LII OlIIIOI'"lf.!i.n.fl"i:'III\!II.ll1l OOllOl'fl"'S"'u:'~I'IIJtflo.;t'.l r".,u";';,,";o'-["",""'~"i" ----.. _..~- Ull~"'lPflll)tlm g,"'1:J~r'Of CAUbf IN"..... (~ 'v..'" .......N. ( I ~. ""'-o,j~l""""'" ,.., I W" r,,, I J 100 VI ~....Io ( I ~""'I""Ftoo 10..", ".~ ,.. ,... U U,"-..-ill'i;\-'.~"H"'''f - ,c."llflIMll'HYlIl;IAN,I't.\... ...,...lI"""...",...,",y. .,'.....'~.' ""I' .""."" ."..,,,,,,,;,.,, ,..,; ,.......".,...,."".."......II'....""'......"'...~t#lfll"""'."...'.""'" 'I I l'!l PJ '^. ~ f .~ oJ 8 t. " ,'.... " ~ or, ~ o-l iff(, (, ~ ,8 ':. fJ 0 iJ' I .::l ~p CO '1/( I "" " I rt J ' "~ ~ >:i ~ ~ CI\ : ~ ::~. I I o-l N 1lil AIi, " ;1: .!: ~ ;, ----_._--..;.---_..~-_.. , NQ:!~!.c';!'.,c_QrcUgN I~ l':'lJ~J A"- I ~rl'E HF: S '.t.l.t!.-';;llJ~~J~IL DlH"ORE rl'lIP; REGIfl'l'lm 01' WII,W, COON'I'Y OF C.\Jl1J~!;;Rt.^-W,L.....,., PENNSYLVANIA III 1'e Ell tate 0 [ .I'llJ;IrJ..K,.Sh<l!llQ/,\y9h,__.c.__._..__...____....._.__...__, deceased, No. 1997:-gQ(lQL <.1 [ .-_. 'I'D l..__'-~~r.r.}' .A~. ..S.I-i8.r:tz ... ..----,._~-~~-_..!.._------------_._.. (bene(ic1at'YI (address) __.___._~3.~_N~_!lJgb.. ptr:l:let ._____~lgl!!rvUJ.!?lc .!'fL1ZJQ'Z. Please take notice of the death 0[. decedent and the grant of letters to the personal representative(e) named below, You may have II beneficial inter:est in the estate as follows: None You were not named as n legatee, devisee or distributee in the Will. . However, the CUmberland County Rules of Court require this Notice be given to aU persons 1ill'ownoulanave'-TIiIi'erIEed property 1t tIle deceaenrwom.<nmVecU:ila- WI thout a-Wrr.r.---.----.-c----------., (if ad'ClTtToI,aCapace-Til-"eeJecCuseback of page) Name of decedent__Eearl.K~Shambau<;lh_.. Last known addl:ess of decedent 913 Nixon Drive ---,--~----,-------,---~,-,- ____________.l:1eCl~~.I11g_E!.bur.9.!-'.''''_.17Q~.~______________ /Jate o~ death~El2.t.el11ber_.!1L!~9J____.~___ __ Place of death_!!~rri~p.~r:..<;Lll~:9.p_i..ta~_.!larrisburg, PA County of grant of odgim: I letters Cumberland '1 /Jecedent dled __A._ tes tll t'l intestate, -~-- , A copy of the will Is Is ,not attached. __ll. Name(s), address(es) and tolephone number(s) of all pereona1 iepresentatives appoInted , . . , Telephone. (7171 432-2559 Name Address Larry Hair 50 Old Mill Road ______Dillsburq, PA 17019 __ . I \ ' . , REL~. Distribution of the balance in the handa of Larry Hair, Executor under the Last Will and Testament of Pearl K. Shambaugh, late of the Township of Monroe, County of Cumberland and state of pennsylvania, as shown by The First and Final Account of '!/lid Executor, confirmed by the Court of COlll11On pleas of Cumberland County - Orphans' Court Division, on October 13, 1998, and Release of the Legatees and Distributees of said decedent, to said Executor hereto attached. BALANCE FOO DIS'I1UoorIOO AS PER SAID Accam' 558,902.62 DIS'l'lUllU'l'IOO AND AWARD PER SAID Acaxm TO: steven ~I. Carr, Trustee for the Bankrupt Estate of Norna Cross - One-fourth (1/4) $ 14,725.66 TO: Larry flair - '!tires-fourths (3/4) 44,176.96 1.UrAL DI&'TRIlll1rIOO PER ACCOONT S 58,902.62 WIIEREAS, a statement of Proposed Schedule of Distribution of said balance, as ~ve set forth, was approved and confirmed by the Court of Common pleas of Cumberland County - Orphans' Court Division, and the said Accountant was directed to distribute the same in accordance therewith. ~ IQPoI AU, MEN BY THESE PRESENrS, that we, steven M. Carr, Trustee for the Bankrupt Estate of, Norma Cross, Norma Cross and Larry Hair, the residuary Legatees and Distributees under the Last will and Testament of Pearl K. Shambaugh, late of the Township of Monroe, County of CUmberland and state of pennsylvania, Deceased, do hereby declare and say that we, and each of us, have examined the foregoing Schedule of Distribution and do hereby acknowledge that we, and each of \IS, this day have had and received of and from Larry Hair, Executor of the Estate of Pearl K. Shambaugh, the cash set opposite our names in the above stated Schedule of Distribution, and the addi ti.onal sum set opposi to out' names in Schedule "A" attached hereto, in full satisfaction, payment, and discharge of all such sum or sums of money, share or shares, purparts and dividends which were due, owing, payable and belonging to us, and each of us, by any means whatsoever, for or on account of our, and each of our, full share, part or dividend of the Estate of pear.l K. Shambaugh, deceased, as given and confirmed to us by the said Schedule of Distribution. AND THEREFORE, we, Steven M. Carr, 1~ustee for the Bankrupt Estate of Norma Cross, Norma Cross and Larry Hair, do by these presents remise, release, quitclaim and forever discharge the said Larry l1air, his heirs and assigns, of and from our, and each of our, said share or dividends of the Estate aforesaid, and of and f,roo all actions, suits, payments, accounts, reckonings, claims and demands whatsoever, for any by reason ther.eof. ESTATE OF PEARL K. SIWl8AUGIl Additional Sums for Distribution . BI\LANC.l!J OF RFSERVED J.lUID: Reserved per Account LeaSl Expenditures: 9/09/98 10/20/98 10/20/98 Register of Wills - Filing Account william L. Sunday - Reiwbursement for certified Mail Register of wills - Filing Release $110.00 9.69 10.00 --- Total Expenditures Reserved Fund $129.69 Balance of Reserved Fund IN<XI'IE RPXlElVED AFl'ER PREPARATlrn OF ACCXXJm' 9/18/98 PNC Bank - Interest C/O #31000097845 $112.07 9/18/98 PNC Bank - Interest C/O #31300098775 125.75 9/24/98 PNC Bank - Interest Estate Account 8.29 10/18/98 PNC Bank - Interest C/O #310000097845 108.92 10/18/98 PNC Bank - Interest C/O #31300098775 122.92 10/21/98 PNC Bank - Interest E:state Account 6.23 10/21/98 PNC Bank - Interest C/O #31000097845 7.29 10/21/98 PNC Bank - Interest C/O #313000098775 8.19 10/22/98 PNC Bank - Interest Estate Account 2.29 --- Total Additiondl Income received $501.3l , Total lIdditional Sums for Distribution DIS'l'RI8l1l'lrn OF ADDITlav\L SlAS TO: Steve M. Carr, Trustee for the Bankrupt Estate of Norma Cross - one-fourth (1/4) TO: Larry Hair - three-fourths (3/4) 'lUl'AL l\DDITlOOAL DISTRIBI11'Iaf SCHEDULE · A. $175.00 $129.69 $ 45.31 $501.31 S546.62 $136.65 409.97 S~.62 . ~~~~~ ~ [I ~eJ~f)j f3 . II ~ ~~~~"' ~ II ",Z'!j 1:1 iii' f'jQ II ~f'j ~~ , II ~I ~~~~~ g ~ I ~ PI Ir'l 'il "J .l!l ':~ ~1l t~ '1ft,S " Jl " . f3 ~ ~ ~ \~ ,rift," . .; "' I P<I,i ~ ~ ~ :0:: f'j ~~ i." ~( 01 ~.g iI~ " ~ ~ ' J j ,0 ~ , illl' , : !~~~ ~ ' -....... ''I, ~ ~f) "" -- f< ' 1ft" . ' -..,,"....-............-....---- --_.~~ --..--- ---....----;------------ ----- -,~, '. " r PER,.'laW.TY INCDIE AOCDm RJ;X:EIPTS ACOOID'Itant char:qes hi_If with. the follOlting : 1~7 Sept .18 PNC Bank - Interest - C/D#31000097845 (9/17,,9/18/97 ) 3.42 18 PNC Bank - Interest - C/D#31300098775 (9/17-9/18/97) 3.83 oct 17 PNC Bank - Interest - C/D#31000097845 103.19 17 PNC Bank - Interest - C/D#31300098775 115.64 oct 28 PNC Bank - Interest - Money Market A/C (9/17-10/28) 85.68 28 Larry Hair - Contribution of Interest on Joint A/C 12.75 liIov 18 ~~C Bank - Interest - C/D#31000097845 107.07 18 PNC Bank - Interest - C/D#31300098775 120.04 21 PNC Bank - Interest - Estate Account 5.94 Dec 12 PNC Bank - Interest - C/Dn31000105952 (Redeemed) 84.44 18 PNC Bank - Interest - C/D#31000097845 104.06 18 PNC Bank - Interest - C/D#31300098775 116.71 24 PNC Bank - Interest - Estate Account 14.52 SUB-TOrAI. 877.29 1998 Jan 18 PNC Bank - Interest - C/D#31000097845 107.96 18 PNC Bank - Interest - C/D#31300098775 121.17 Jan 26 PNC Bank - Interest - Estate Account 16.51 Feb 18 PNC Bank - Interest - C/D#31000097845 104.93 ,I 18 PNC Bank - Interest - C/D#31300098775 121.74 Feb 23 PNC Bank - Interest - Estate Account 13.93 Mar 18 PNC Bank - Interest - C/D#31000097845 102.25 18 PNC Bank - Interest - C/D#31300098775 110.48 Mar 25 PNC Bank - Interest - Estate Account 13.88 Apr 17 PNC Bank - Interest - C/D#31000097845 109.74 17 PNC Bank - Interest - C/O#31300098775 122.84 Apr 24 PliIC Bank - Interest - Estate Account 13.86 CARRIED FOOWARD $1836.58. PEIll'lOOALTY INCDlE ACCXXlfl' RFXlEIPTS (~tinued) BROOGIlT FORWARD $1836.58 1998 May 18 PNC Bank - Interest - C/O#31000097845 106.65 18 PNC Bank - Interest - C/O#31300098775 119.45 May 22 PNC Bank - Interest - Estate Account 12.92 June 18 PNC Bank - Interest - C/O#31000097845 110.66 18 PNC Bank - Interest - C/O#31300098775 124.00 June 24 PNC Bank - Interest - Estate Account 12.42 July 17 PNC Bank - Interest - c/o #31000097845 107.55 17 PNC Bank - Interest - C/D #31300098775 120.57 July . 27 PNC Bank - Interest - Estate Account 11.10 Aug 18 PNC Bank - Interest - C/D #31000097845 111.59 18 PNC Bank - Interest - C/D #31300098775 125.16 Aug 25 PNC Bank - Interest - Estate Account 9.03 'l'Ol'AL PER.!:DW.TY INCDIE Acxxxm R1DIPl'S S 2007.68 PERSQW.TY INCDlE ACCXXlfl' EXPmDITURF.S Accountant asks credit for the following: 1998 March 14 14 Internal Revenue Service - 1997 Fiduciary Income Tax PA Department of Revenue - 1997 FiducIary Income Tax 26.54 31.48 'l'Ol'AL PER.!:DW.TY INCDIE Aanm' EXPEH>I'l.'URFS S 58.Q;l , 2.: ~.;J.- '" I,;; L- A.~: ,\~J (' _I,--~', ~(V\5t)l)&X,(l.l) .t~t. COMMON~9YLV^,M DErARIMrNI or REV(JllJl, DEPT. 2~OOOl H RRI PA 111 8 I Uf,CWENrfl NMlC llA!lT. f1ASf, AND MlomF INt1IALllJ~1I d bllllk blOC' l'l"p..1lI wOfd~ REV.1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FilE NUMIIU 7 B o 1 R " 9 2 ffi o w o w o P E:A H L (J~TE or OtAT!! K SHAM I3AUGlI SOCIALSrClJf1I1Y m'Mllf'H (lA,T!' OIUUHil 03/2711911 ==r THIS RETURN MUST 8E FiLED IN DUPLICATE WITH iiiT REGISTER OF WILLS ------ - ----~----~._- 1i1 I. Original Rolurn 0 2. Supplemenlal Retum [] 3. Remainder Relurn (d~lllotoo.1lhp!iOf~\ 11-136'1 [J 4.lImiled Estate [J 4a, Fulure Intorest Compromise ld~llloldtlolll18f1l1r \2.11,8il Ll 5. Federal Estate Tax RahIm Required [Xl 6. Oeco~anl Died Testate (An,v,h COpy 01 Will) 0 ], Decedent Malntainod a L1l/lng Trusl(AKiI:!>COJlyoflMt) _J 8 Total Number of SAfe Deposa Bo~e5 o 9. litigation Proceeds Received 0 10. Spousal Povorty Credit (dlle oldeolh OOlW81111 12.J1.91'0111.l.95) [J 11, Eloclion to tax under Sec 9113(A) (At~h SchO) THIS SECTION MUST BE COMPLETED, ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD SE DIRECTED TO: -- NNAE - Co..lfllElf:MAILINGAODR[SS .-----------.. 9/17/1 9 9 7 5 o 1 70-16-19 5 (II' APPlICAIllE) 5\1RVlVINO 51'OUSFS NAME (lAST. FIRST, AND "IIDDlE INIlIAL) SOCIAlSf:CIJIH!YNUI,lAUI N/A ~ il! I u william L. FIR~NAME (1lJI;IpllCabllll William L. Sunda~, Sunday, Esquire Attorney-at-Law 39 West Main street - Ste. #1 Mechanicsburg, PA 17055-6230 TELEPHONE NUMBER Real E'tatelSchedule AI (1) 2 Stocks and Bond, (Schedule BI 12) p'C"', :::;iF ~ :0 '"1 ~.. ;:o(~ 3. Clo,ely flald Corporalion,Pa~rte"hip or Sole.Prop~eto"hlp 131 C'. W( (I .', C; ::J; 4. Mortgages & Note, Receivable (Schedule D) (4) ::;: 5 Cash, Bank Deposlls & Miscellaneou, Pe"onal Property 15) N Z (Schedule E) 7 I, 1 0 B. ,8 4 'D 0 6. Jointly (iNned Property ISchedule E) 16) 7 9 7.'5, 4 'U ~ 3 I N 'I" 7, Inler.Vivos Transfers & Miscellaneous Non.Probc:le Property :'01" 0, 0 (7) 9 9, 3 4 3. ~;'4 ...... "'h :J (Schedule G or L) N I- 8 Total Oro.. A...ts (Iolal Lines 1.7) (81 ii: ' 1 7 4, 2 5 0' 2 2 0( 9. Euneral Expenses & Admlnistrali,e Cosls (Schedule HI 19) 0 9,9 ~ B 9 7 w IX 10. Debls of Decedent, Mortgage liabilities, & Liens (Schedule I) (10) 0 0 0 11 T otsl D.ductlons (toial Lines 9 & 10) (11) 9, 9 5 B' 9 7 12 N.t V.lu, 01 Estat. (Line 8 minus Line II) (12) I 1 6 4, 2 9 1, 2 5 13. Charitable and Governmental Bequests!See 9113 Trusts for which an elecllon 10 tax has not been 1\31 made (Schedule JI 0' 0 0 14 Nit V.lu. Subjectlo T"ILlne 12 minus Line 131 (141 , 1 6 4' 2 9 l' 2 ....L_ 15, Amount Oiiine 14 taxable ~ at the spousal lax rate , , O. 0 0 x ,0 lIS) , 0 0 0, 0 0 See InstruL110ns on reve1'5e side for applicable percentage F; 16. Amounl of itne 141axable ~g at6% rate 0, 0 0 x 06 (16) ,0 0 O. 0 0 t"~ 17. Amount 01 line 14 taxable at 15% rate , 1 6 4, 2 9 1, 2 5 x .\5 (17) 2 4, 6 4 3. 6 ~ () 18. Tax Due 1181 2 4, 6 4 3. 6 9 Ii · > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Under p6nallfeS of porjury, I declare tllal llla~a 6~amined lhis ralllln, including ~companying schedules al\d statoments, lIod to tllo best 01 my knowledge aM bOlle!.lt IS tfuO, corred and compleln Der;lilfa1ion 01 prnpilror olhor l!l.ID...!Mjl6rsonal romesentahve is basad ollJ!llnlofi11aUOn of which (lfe~! has an.. knowlodoa SI ATURE OF PERS RESPONSIBLE EOR ELLING RETURN ADDRESS DATE "'\)\,,),, lU)" 50 old Mill._RoadLDjJJ_~ur..9.L PA 17019 SIGNATlIR RJTHE)l;THAN RtPRESENTATIVE ADDRESS '-~:':l' ( yJ .-,,:i:~1Lc4-w 39..~~~~in St~.~echani~sburg I PA 17055-6230 'I ~ // May 'f- 'eJ 199B DATE May ~7 199B ____._.N__","~, Decedent's Complete Address: ~:~~:~~, ,~~,;,~~~:~~~,,^~-PA ~~,~ 1W5S .1 Tax Payments and Cl'lldlts: 1. TaxOue(Paga1Une1A) 2. Credll.,Paymenls A. Spousal Poverty Credil B Prior Paymenls C. Discounl (1) 24643.69 o 22/320.15 ---1201.06 --..-, Tolal Cre(iils (A t B t C) (2) 24021. 21 3. InleresUPenally il applicallle O,lnleresl E. Penally _.___....IL. Q....--.. 5, TolallnleresUPenally (0 t E) (3) if line 2 is grealer IlIan line 1 t line 3, onler Ihe difference This is Iho OVERPAYMENT, Check box on Page 1 Line 19 to requtet e refund (4) If line 1 t Iino 31s grealer Ihan IIno 2, enlor Ihe differen:". This Is Ihe TAX DUE, (5) 622.48 A, Enler the Inleresl on Ihe tax due. (SA) 0 8. Entor Ihe lolal of Line 5 t 5A. This is Il1e BALANCE DUE, (58) 622.48 Make Check Payable to: REGISTER OF WILLS, AGENT "'1111'- ..II IUlIIllU UJLI PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1, Old decedent make a transfer and: *Except as incident of joint owner- Yes a, retain the tlse or income of the property transferred; , .... ....,ship......... 0 ~, retain the right to designate who shall use the property Iransferred pr lis income;, '...... 0 c, retain a reversionary InleresC cr.. .. ".........,..,..... ........... ...... .....0 d. receive the promise for life of either payments, benefits or care? , ...........0 2, If death occurred on or before December 12,1982, did decedent within two years preceding death transfer property without receiving adequate consideration? If death occurred after December 12,1982, did deC6dant transfer property wllhin one year of death without receiving adequate consideration?.. .... ..... ....... ..,....,....,.. ....,.......... ......... UiI 3, Old decedent own an "in trust for" or payable upon dealt, bank account or security at his or herdealh? ..................................,. ....... .............. ..,.. .. [J 4, Old decedent own an individual retirement account. annuily, or otller non-probate property?.... 0 o 4, ': dFt'~. '" "1.'.,,,,~ 'H,_ "":".< ",,-,~,," No [K] * [K] * IBJ * IBJ o IX] IX] IF THE ANSWER )'0 ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN ':P.i'i~_!fl~ 72 P,S, ~9116 (a) (1.1) (I) provided for the reduction of the tax rate imposed on the net value oltransfers to or for the use olthe surviving spouse from 8% to 3% for dates of dealh on or after July 1, 1994 and before January 1, 1995, 72 P .S, ~9116 (a) (1,1) (Ii) provided for the reducllon oflhe rate imposed on the nel value of transfers 10 or for the uae of the surviving spouse from 3% to 0% for dat~'s of death on or after January 1, 1995. The slat ute does not exemp! a transfer to a surviving spouse from tax, and the statutory requiremems for disclosure of assets end filing A tax return are sllll applicable even if the surviving spouse Is the ollly beneficiary. ~'!F 4'\\"'0 " ,'~"'i fi;t _' .~l"'t:l.tt;;-1.~." '1f<\')~", 'J.F'iJ~!.I'~.. . FOR DATES OF DEATH ON OR AFTER JANUARY 1, 1995. Please answer the following question by placing an "x" in the appropriate space. Old the decedent create a trust or similar arrangement which Is solely for the surviving spouse's benefit for his or hsr entire lifetime? Yes [I No ~ if you answered yes to the above question, the tax on the trust or similar arrallgement is postponed until the death of Ihe second spouse, at which time II will be fully taxable al the rate(s) applicable to the remainder beneficiary(les), Enter the value of the trust on Schedule J, Part II, in order to remove it from the calculation of Ihe tax due in this estale. You may wish to file Schedule 0 In order 10 make the election evailable under Section 9113. if the election Is mada, the trust or similar arrangement Is taxed in the estate of the first decedent spouse, the portion of the trust or similar arrangement which benefits the surviving spouse Is taxed at the zero tax rate, and the remainder is taxed at the rate(s) applicablfJ to the remainder beneficiary(ies). If you choose to make the election, you must attach Schedule 0 to a timely.filed tax return, along wllh Schedule(s) K And/or M in order to sllow the apportionment of the trust or similar arrangement between the surviving spouse and the remainder beneficiary(ies) MV.itotU(I(l.I1) '*' SCHEDULE F JOINTLY -OWNED PROPERTY COMMONWEALTH Of PENNSYLVANIA INHERITANCE TAX RETURN . T T ESTATE OF Pearl K. Shambaugh FilE NUMBER 21-97-801 K.n ,...t was m,d. joint wtthln on. Y"' of Ih. d...d.nt'. dll' 01 d..th, n mu,l be "ported on S.hedule G. SURVIVING JOINT TENANTIS) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Larry L. Hair 50 Old Mill Road Dillsburg, PA 17019 Friend B, c. JOINTlY.OWNED PROPERTY: lETTER DATE DESCRIPTION OF PROPERTY %OF DA.TEOF(\EA.TH ITEM FOR JOINT MADE Include name 01 financlallnstitullo1'l8l\d bank account number ()( similar klenlifylng number. Attach DATE Of DEAHl DECO'S VAlUE OF NUMflER TENANT JOINT deed for loInUy.Mtd foal estalfl V4LUE OF ASSET INTEREST DECEDENT'S INTEREST 1- A l2/5f';6 Premium Plan Interest Checking Account # 50-7002-6321 in PNC Bank Balance @ Death $ 7593.35 50% 3796.68 Accrued Interest to Date of Death 1.72 50% .86 TOT AI. (Also 8flter on line 6, Recapltulallon) $ (If more space Is naeded, Insert additional sheels otthe same sizo) 3797.54 101"'11'''''''''* COMMONWEALlfI 01 PENNSYLVANIA INHEHIIANCI 1M HI'IUHN H' 'I' OCT I SCHEDULE H FUNERAL EXPENSES & . ADMINISTRATIVE COSTS - FILE NUMaEA 21-97-801 ESTATE Of Pearl K. Shambaugh _______._____.__.__.._n ..___....,_________._.~~__..._..._".,._~_~~__..__.___~_'-.----.---------- Debit of dtc~...n~".l~~t bl r.p~!d...~.!ched~'_'_~_.._~~.._._~~ ITEM NUMBER A DESCRIPTION ._..___~_._.___.__._.___.__.M_'____ t 2. FUNERAL EXPENSES Myers Funeral Home, Inc. - Funeral Gingrich Memorials Monument Expense B, ADMINISTRATIVE COSTS: 1. Pe"on.1 Repr.sentali,e's Commi.slons Name of Pernonal Reprasentall,e!'1 Social Sacun~ Number!.) I EIN Numoor of P.rnon.1 R.pr..ent.ll,e!.) St"et Address City --Sllote Zip 2, 3, Veao.) Commls.ion P.ld Marney Fees Family e'emptlon: !II docodenl'. addr.", is notlhe same as clalmanl's, allach e'planallon) Claimant Slreet Addre.s CI~ Relallonshlp of Clalmanllo Oecedent Sllole __Zip 4, Probale Feas 6. Accountant's Fee. 6, Tal Retum Prepare!i Fees 7, B. 9. 10. 11. 12. 13. 14. 15. Register of Wills - (2) Short Certificates The Sentinel - Executor's Notice Cumberland Law Journal - Executor's Notice Register of Will.';! - (l) Short CertIficate Postmaster - Certificates of Mailing Notices(Rule 5.6) Joseph James Jewelers - Appraisal - (2) rings Register of wills - I'iling I'ees (PA Inheritance 'rax Return and Inventory) charlyn Y. Guerriero - Notary I'oes Reserved for filing )pirst and Fini'll Account, Certified Mail, Recording Releases TOTAL !AISO onler on line 9, Recapitulation) . - (II more space Is needed, Insert andilional sheets 01 the same silel AMOUNT $ 4710.00 1093.17 3550.00 211.00 6.00 I,. 56.76 60.00 3.00 10.44 63.60 25.00 20.00 150.00 $ 9958.97 '.' , !It'rlSUE(.(11/) ~.k SCHEDULE I DEBTS OF DECEDENT, MOBIQAGE UABlb!!~!t & L1~!,,, -".~- FILE NUMBER 21-97-801 ,------'" COMMONWEAlHl Of PHlNSYLVANIi\ lWkHlrANCE lAX fltTUHN ""EsTATE OFJ<LSUJfNI DfCI'pENl ," ..'." --"""'".,~~ ~.- _~!..... K. Shambau9h-..._,__------...--c. Include unrelmbur.ed medica' expense.. ITEM ._-- NUMBER 1. DESCRIPTION AMOUNT !'lone - !'lone \ I i I \ I I I i I I I i - TOTAL (Also enter on line 10, Recapitulation) $ (If more space is needed, Insert addltl~nal sheets of the same size) None -- - COMMONWUllH 01 POINSYl\'ANIA DEPARTMENT OF REVENUE SURF.AU OF INOIVlDUAl TAKES PEPT, la0601 tlARRIUURG, PA l1ll."OUI * INFORMATION NOTICE AND TAXPAVER RESPONSE FILE NO. 21 97-0801 ACN 98101608 DATE 01'20-98 ~Hol~.1 (' ." II '''1 EST. OF PEARL K SHAMBAUGH 5.S, NO. 178-16-1955 DATE OF DEATH 09-17-97 COUNTY CUMBERLAND TYPE OF ACCOUNT IxJ SAVINGS o CHECKING o TRUST [J CERTlF, llll LARRV L HAIR 50 OLD MILL RD DILLSBURG REHIT PAYMENT AND fDRHS TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 PA 17019 PNC lANK hat prololld.'; the Oepartllllnt with th. Inforlllatlon listed belolil which has bun utlld In oalculatlng the potential t~~ dUI, Their record. Ind\cate that at the death of the abolole decudent, yoU were 8 Joint o~ner/b.neflclarY of thll account. If you f..1 thh Inforlll!ltlon h Incorrect, pl...e obtnln Iotrlttln correction frolll the financlfll Institution, attach a copy to this forlll and return It to the above addr..., This account 11 taxable In accordance with the Inherlt^nce Tax lawl of the COllllllonweelth at P.nnlylVlnAe, ~ue.'10n' llIay bl answ.red by calling {III) la7"SiZ/. COMPLETE PART 1 BELOW . . II SEE REVERSE SIDE FOR FILING AND PAYMENT INSTRUCTIONS Account No. 5000959855 D.t. 08-26-97 Est.blhh.d To In.ure proper cr..dlt to your account, two (2) caple. of thl, nottcl llIu,~ acco.pany your paYllllnt to the Reghter of "'11 Ill. "akl check payab~e tal "Regl.ter of Willi, Agent", Account Bohne. 16,064,14 P.rc."t To..bl. K 100 . 00 A.ount Subj.ct to ro. 16,064,14 T.. R.t. K .15 Potontlol To.Du. 2,409.62 PART TAXPAVER RESPONSE [!] r FAILURI TO RISPOND WILL RISUL T IN AN OFFICIAL TAX ASSESSMENT lASED ON THIS NOnCI I .. HOTEl 1f t~~ payMent, are ~ad. withJn thr.e (31 lIonthl of the decedent's date of death, you .ay deduct it !i% discount of the ta~ due', Any Inheritance tax due will beco.. delinquent nine (9) .onths aftlr thl datI of dl3th. [CHECK ] ONE BLOCK ONLY c=J The above Infor.atlon and ta~ due II cotreet. 1. You lI.y chao.. to r..lt paylllent to thl Regllter of Will. with two COp\I' of thl. notice to obtain a di.count or avoid lnter..t, or you .ay check box "A" and return thll notlce to the Register of Willi and an offlc1al al.I"lIlnt Iotill be Issued by thl PA nlp,rt.ent of Rlvenue, a. c=J Thl above as.et has be'n or will bl reported and t&~ paid with the Pennsylvania Inheritance Ta~ return to be filed by the decedent., repr..entat lve, C. ~ The above lnfor.atlon Is Incorrect and/or debtl and deductlonl wlr. ~~ldPY you. You IIIUlt co,plete PART 0 and/or PART ~ below. see Attall.,;.ued If YOIJ lndic.t. . differ.nt .t.x rat., pl.... state your" r.lationship to dacad.nt. OFFICIAL USE ONLY 0 AAF PA DEPARTMENT OF REVENUE PART ~ T_X RETURN - COM~UTATION LINE 1, O.t. E.t.bll.h.d 2. Account I.l.nea 5. Parcant r.x.bla 4. A~ount SUbject to T.x S. D.bt, and Deduction. 6. AMount '.x.bl. 7. T.x Rat. a. ....)( Dua T^X ON JOINT/TRUST ACCOUNTS ~ PAD 1 2 3 4 5_ 6 7 8 CLAIMED - OF 1 2 5 4 5 . 7 8 ~ PART I!J DATE ~S AND DEDUCTIONS PAID PAYEE DESCRIPTION AMOUNT PAID J TOTAL (Enter on Lina 5 of r.x Co~put.tlon) Und.~ p.n.ltl.. ~1 p.~ju~~, I decl.r. th.t ~h. f.ct. I ~.:"P.l.t. to th.(~,.t of .y kno~~.dg. .n~~ll.f. '-.:::J(\)\J\,~ I" -,>. J:\(\,I ,\ C/f~It\)li.)'\ TAXPAYER !l-l,~ATUR'i"' -- I . cprr.ct .nd \.~")~ ~-~ ,"..*"~_~....... till -".di' 'tIi . 'B' I . j ~ (. 'm ~ ] ~ <: It 8 \}- \'>.. . ~ . - , t<: 0' ~ ~ ~ \, '- ] U co '- ClI co '. - C1 "': ~ -j ~ ~ ~ z co l'1 U co Vl '~ i ~ " ;~ ~ ~ , 8 . < ~ I' . Ie: ()) ~ : H co . . ()) ~ ~ rl ~ I Ie: co \ . aJ \<l ;:;l U <Xl Vl PI .r.: ~ 8' ~ ~: i ~ I. In (. ., .~ (to I~ ~,~ ~ 'v) III ~ ,\,Il< In . . . ()) 1'1 l' ~~>-l t-1 ll\. NBI . I'l iN ~ I 8'm H (to 0 ll\ I .a~ ~~~ ~ H 0 Vl IS l ~ 8rl :gijtj )- i ~ -.. .c: i~ roHi I'l 'hll< H ~B' . I B I j! ~ fdj ~'! ~ ~ I~ H Vl I I 1 j I ~ ~I ~. I~ I :~ I~ UMihU ~~ ! ~ ~ J. 1. ~! ~ ~ ./ I-< . . ' GENERAL INfORMATION 1. PAlLUNE TO RESPOND WlLl "nUll IN AN OFFICIAL lAk ASSESSHf.NT with ltl',lllelllll. Iflter"t. baud IIn InforMlftlon .ub.",.d by thl fln,nol.l Inl"tutlo,\, 2, lnnerltlnClI '1M blea... d.lln~u.", nllll ,'UIfIUlt "Ihr thl dlced.nt'. dAtI tit d."th. ), A joint Iccount I. tl)(ftbl. Ivan though thl dl':ldl"t', 1\l'1.1 .11. lidded .. ""ft\111' of cOIWlnllntl. Ct, Acoounts llnc:lIudlnu thou h.ld b.tWI.n hlnlllmll ,.IId wlf,l Wtlll\I\ ,". dICldl!,t 'IUt In Jlllnt 11"..' within 111\1 Ylllr 'Hlol' to d..th .1'1 fully tlf)(lbl. .. trln,f.rt, !i, ActDuntl ..hblhh,d Jointly lllltw..n hu.bltnd And wlh 1I0ra ttllt" IInl ..,lIar 1II'Iur to c1."", II'I nrJt ",)(,,1111, 6. 'ceoun" held by II dlCldlnt "In HUI' 10'" 1I110th.r or oth.r. 111" lulttJllI fully. REPORTING INSTRUCTIONS - PART TAXPAVER RESPONSE 1. !lOCI( A - If thl Infor...tlon "no COMputet Ion In the notlca .ra corr.ct "nrt d.ductlons 8r. not blllng clrtllll.d, pll,Cl" ,,11 "II" in block ..... of Part 1 of the "raMpay.t Rupon.." I.ctlon, Sign two copl.. "tld sub.H th.. with ..,nur ch.ck lor tho ....ount of hN to tha Rlght.r of willi of the C()tjllt~ lndlcllt.d, TlI. I'. O.,llIrtlllllnt of R.....nu. wlll lUll. Itn offllllal a.......nt (forM REV-1S48 [10 upon r.cel",t of the return frOM the R.ght.r of wllh, 2. IlOCI( 8 . If the IItlet IP.clfled on thll notice has blllln or will ba reportlld IInd t"lC ""Id w1th thll 'I.nn'yl....nl. Inherlhnc' TIllC JI.turn fll.d by the dllc.dllnt'. r.pr...ntlltl..... plnee nn "II" In block "1\" of Plld I of the "lft)(I1Ily.r R..pon.... ..ctlon, Sign ona copy and return to the ".. Ollpllrtlllllnt of R.v.nu., Ih.Jrellu of Indlvldulll1 TrllClII, Ollpt 7.80&01, llarr!sllurg, PA 11118-0&01 In thl .nVl10p. pro...ld.d. S. 1l0el( C . If thl not Ie. Inforll.t1on II Incorract andlor d.ductlon. are b.lng chlll.d. ch.ck block "C" IInd cOllplet. """ts ? "nd S aceordlnv tll the IIl'ltrudlnn. halow. Slqn two cop Ie. and !lub.lt the. with \lour ehfilck fllr the tl.aunt of talC ''''I'IlIble to the R'Qht.r of Willi of the county Indicated. The PA O."artllllln\ of Ra\lllnua will lUll. an oHlcl,,1 IUlunllnt (forM RPJ-lli4A (III upon r.ulpt of the r.turn frn.. tha R.glltll' of Willi, TAX RETURN - PART 2 - TAX COMPUTATION LINE 1. Entllt thl dllta the account orlg1n.lIy wal utabilshed t)f tltl.d In the ..nner eIlllUng lit datil of de"th, HOTEl For a d.cedant dying after lU1UBll Accounts which the decedent I'llt In joint nUlls within one (I) ~8IIr of d.ath lira ta~abl. fully III tr'm,ferl. ttow.....r, there I. IIn .lCclullon not to IIlCend $.5,000 pllr tranlferllll nlgllrdle.. of thfl wll1u, of the ac~ount or the nUMb.r of lI~countl h.ld, If. doubh alte"lsk (11M) appears before your flrlt nllN. In the !'1I111rllu portion of thl. notice, the B,OOO I)(CIUllon alrUd'll ha. b.en dllductld fro. the IIClcount balanclI III rlllllorted by the flnllnclal Inltltutlon, 2, Ent.r thl totlli bahnu of thlll IIccount inclUding Inter.st accrued to the data of d,ath, S. Th. p.re.nt of the account that Is t"lCllbl. for Gllch suryi\lor Is d,te,..ln.d II' follo"l: A, Th. p.rc.n"t ta)(able for Joint f1..,t. estllblished Mor. than on. y,ar ",rior to the dllcedent'l duth, I DIVIDED BV TOTAL HUHIER OF JOINT OWNERS EN..pia, A Joint IISlat r.glst.r.d fJlVIOfO "'" TOUL HUM8ER Of. I< 100 . PERCENT TAlCABlE SURVIVlflG JOINT OWNERS In th. na.e of the d.e.d.nt and two oth.,. p."lonl. 1 DIVIDED BV 3 (JOINT OWNERS) DIVIDED BY 2 (SURYIVORS) . .161 )( 100 . 16,1% lTAIIABLE fOR EACtl SURVIVORl t. lh. plrclnt taNabl. for IUI'ts cr.llhd within on. ..,lIlIr of th. decedent', duth or IICIlOuntl own.d by tha dac.d.nt but h.ld In trUlt for .nother Indl...lduaUsl (tnlst b.neflclarlul: 1 DIVIDED IV TOTAL HUMBER Of SURVIVING JOINT OWNERS DR TRUST BENEFICIARIES I< 100 . Pf.RCENT lA)(AllE EM..phl Jtllnt account regllterld In the nll.1I of th& d.cad.nt find two othar p.rson. and ..tablhh.d within onl year of dll.th by thl d.c.dllnt, I DIVU'iED IlV 2 (SURVIVORS) . . SO lC 100 . 501: lTAKABLE fOR EACH SURVIVOR'i 4. Thll ..ount lubjlet to till tlln. 4) Is dat.r.inld by lIultlphlng the account bllhnce Clln. 2) by the perunt taMabl. Cllnl !). !;, F.nt..r the total of the d.bt. and dldue;Uonl I Istld In P.rt 1. 6. Th. ..ount tlll.bl. Ulnl 6) Is dltlraln.d by ,ubtrlllctlng the d.btt and dlductlonl <1 In. Sl fro. the ".ount .ubject to tiN (1 In. 4). 7. Ent.r thl app"oprlate ta~ "at. (11nl 1) .1 d.t.rlined below, A. For dat.. of d'lIth oecurrlng after 6/30/94. the tall tl'lt.. for tranlflrt to .pOUtll lira lit follow'l I. Oat.. of death on or flfter 711/94 and before 1/1/9S thl rate II 1%, 2. Dllt.. of d."th on or aftar 1/l/9S transf.rs to 'POUles will bl talC.d .t 01: telC rate. Notl' For dat.. of d..th prior to 111/94 transf.r' to spoules ar. tlllabl. lit 6%, B. Transf.rs to Ilne.l dlsc.ndflnt. inclUding father, loth.r, Ion. daugnt.r, grandchlldr.n, son'in'i.~, daughter'ln~hw, st.pchlld and th.lr l..uI arl ~a)(abl. lit 11M per cant (61:1. C.' Trantflrs to 1111 oth.r, Including broth.r. sllhr, unci.. lIunt, nephew and nl.c. are talCl'lbt. lit flft..n p.rcent <15;0. D. If YO" I.lhanlll the tall rat., pi"".. sp.clh your reh\lon'hlp to the dec.dant In the area provldad. .. Thl ..ount of tON dUI (1lne I) is d.terlln.d by lultlplYlng tha aMount tftl(lIbl. (lIne 6) by thl hlC rate (lJn. 1), CLAIMED DEDUCTIONS - PART 3 DEBTS AND DEDUCTIONS CLAIMED Allowable dabts .nd deductions IIr. dat.rlllned HI 'OUOWIl A. you IlIgllly ara rlllPonslbl. for pay".nt, or thl ..t.t. .Ubj.ct to adlllnlltrlltlon by a personal r.pr...ntatlvI Is Inlufflcllnt to pay the d.ductlbll It..,. I. You actu.IIY paid tha d.bh afh,. d..th of the dlc.dent Md can furnllh proof of plly.ent. C. Dlbts bllng el.i.ad .~.st b. 1t,.llIId fulh in part I. If IIddlUonal spau II n..ded. Uti phin pap.r . 1/2" N 11". Proof of pay..nt .ay b. requ.st.d by the PA Ollpart.ent of R.....nue. TAXPAVER ASSISTANCE IF VOU NEED FURTHER INFORMATION OR ASSISTANCE, CONTACT ANV REGISTER OF WILLS. PA DEPARTMENT OF REVENUE DISTRICT OFFICE OR CALL THE BUREAU OF INDIVIDUAL TAXES, TAXPAVER INQUIRV UNIT IN HARRISBURG AT (717) 707-8327. TOOt (7.7) 772-2252 (HEARING IMPAIRED ONLY) ~ . l.) .A (!c,' Ic~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES INHERITANCE TAK DIYISION DEPT, ZI0601 HARRISBURO, PA 17121'.0601 NOTICE OF INHERITANCE TAX APPRAISEHENT. ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESS"ENT Of TAX 08-31-1998 SHAMBAUGH 09-17-1997 21 97-0801 CUMBERLAND 101 [:-'.~~unT:~"med __:J MAKE CHECK PAYABLE AND REMIT PAYMENT TOI REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE. PA 17013 CUT ALONG THIS LINE ... RETAIN LOWER PORTION FOR YOUR RECORDS ~ iii"V: iiii'-E;( "Af:iQ'CIF97T" NiiTicE--liF -YNHEiiifAiicE- T"A'X" A"PPRA ISEifiN'f; -Ai.l"liwAiicE - iili'-" - -"- no -- - - - - -- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX PEARL K FILE NO. 21 97-0801 ACN 101 DATE ESTATE OF DATE OF DEATH FILE NUMBI!:R COUNTY ACN APPROVED DEDUCTIONS AND EXEMPTIONS I 9. Funeral Exp.n.../A~. Costs/Hilc. EKpansa. (Schedule H) 10. Debh/"ortgege Liebill tie./Lien. (Schedule 1 I 11. Totel Deduction. 12. Net Value of Tax R.tu~n 13. Charitable/Govern..nt.l Beque.ts; Non-eleoted ql13 Trust~ (Schedule J) 14. Net Velue of E.tete Subject tc Tex If .n .......ent wa. 1.sued prev1ou.ly, line. 14. IS and/or 16, 17 and 18 reflect figure. that include the total of ~ returns ...e..ed to date. ASSESSMENT OF TAXI IS. AMount of Line 14 at Spous.l rat. CIS) 16. AMount of Lina 14 t.xable at llneLI/Cl... A rat. (16) 17. Aoount of Line 14 texeble et Colleterel/Cle.. B rete 117) lB. Prlnclpel Tex Due WIlLIAM L SUNDAY ESQ STE 1 39 W MAIN ST MECHANICSBURG PA 17055 ESTATE OF SHAMBAUGH TAX RETURN WAS, I X) ACCEPTED AS FILED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ONI ORIGINAL RETURN 1. Reel E.tete ISchedule AI 2. Stock. end Bond. ISchedule BI 5. Clo..ly Held stock/Partnership Int.rest (So"edul. C) ~. Hortg.g.I/Not.. Receivable (Schedule D) 5. C..h/Bank Depo~ltI/Hl.c. Par.onal Property (Schedule E) 6. Jointly OWned Property ISohedule F) 7. Tranafars (Schedule 0) 8. Total A...t. NOTE I TAX CREDITS I PA Y"ENT DATE 12-15-1997 05-29-1998 RECEIPT NUHBER AA242552 AA270148 DISCOUNT 1+) INTEREST/PEN PAID (-I 1, 201. 06 ,00 ) CHANGED 11) 12) 13) 141 15) 161 (71 .00 . o I!.. ,00 .00 71.108.84 3,797.54 99.343.84 IBI ( * 19) 110) 9,958,97 UV,II't1I1U'm.'ll PEARL K .00 Ill! (12) 1131 (14) ,00 .00 164.291.25 X .00. K .06. X .15. (18) DATE 08-31-1998 HOTEl To in.ure proper credit to your account, lub~it the upper portion of this for. with your t.)( paYHnt. 174.250.22 Q.9'iA Q7 164,291. 25 .00 164,291,25 will ,00 ,00 24.643.69 24.643.69 TOTAL TAX CREDIT 24.643,69 BALANCE OF TAX~UE ,00 INTEREST AND PEN. ,00 -~ - TOTAL, DUE .00 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. AHOUNT PAID 22.820.15 622.48 IF TOTAL DUE IS LESS THAN .1. NO PAY"ENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT" ICRI, YOU "AY BE DUE A REfUND. SEE REVERSE SIDE OF THIS FOR" FOR INSTRUCTIONS,I Fit', HI" 'Jl '98 fllJl) 28 P? :(JU CI~'IL CUIllV , 1)/\ RESERVATION' btatn of dtc'.flh dYing on or bI4ore'08C8ItberlZ, 1geZ -~ Jf .oy future int.r..t in the .u.t. h transferred In pO.....lon or .nJo...nt to CI... · (oollet".,) botn.Il.I.rI.. of tn. ..o.don. .ft.r tho ..pll'.Uon of on. ..t.t. for 111. or fo, '..", tho Co..on....lth "'.b. .'P,..... r...rv.. tho rlUht to oop,.I" on. ...... tronll., .nherlt..... ,.... It the lawful CI... II (coJ.1atlroll rillt. on any luoh future Interest. fl\JRPOSE OF NOTICE I To fulfJl1 the requlr'..nts of Seotlon 2140 of the Inh.rJtanoe and Estat. T.~ Aot, Aot 21 of 1995, (12 p,S. Seotton 9140). PAYMENT I D.t..h tho top po,Uon of thh Hollo. .n. .u..lt wlth YOU, P....n. to 'ho R.Uht" of WUI. print.. on tho "..". .Ido, ~~"u;. chclok or "oney order payable tOI REGISTER OF HILLS, AGENT REFUND eeR); A refund of ft tax or.dJt, Nhlch liIdS not requested on the Ta)( Return, .ay be roque,ted by co.p.let!ng an "AppUoaUon for Refund of PennSYlvania Inheritance .nd Estat. Ta)(" (REY~1313), APP!JcatJuns ere avaUable at the Office of the Regi,t.rof Wills, any of the 23 R.venue District Offic.s, or by calling the 'peclal 24-hour .",,,erlng ..rvlce nUllb.rs for for.. ord.rlnG: In PennSYlvania 1-300~362-20S0, outsld. PennSYlvania INld "lthJn local Harrl.burg are. (717) 787~a094, TOO. (717) 772-2Z52 (Hearing lap"lred Only). OIJECTlONS I Any party In Intera.t not .atlofJed "Uh Ule appraise.ent, 8110"ano. or dlsallowanc. of d.ductions, or .u.....nt of tax (Including dhcount or 10t.re.U as sho"'lon this Notice aust Object wJthio sixty (60) d.y. of receipt of this "'oUee by: ADltIH ISTRATIYE CORRECTIONS. uwrltt:.n prote.t to the PA Depart..nt of Rev.nuII, noard of App.als, Oept. 281021, Harrisburg, PA )7123411)21, OR --eleotlon to h.v. the ..tt.r d.t.r.in.d at audit nf the aoc~unt of the personal r.pr..entattve, OR --appeal to the Orphans' Court. DISCOUNT. Factu_! errors dhcovered on thh .....".nt Ihould be .ddresud in writlnp. to: PA n.part..nt of Rev.nue, lur..u of Individual 'axes, ATTHI Post Ass..s..nt R.vie.. Unit, Dept. 280601, Harri.burg, PA 17128-0601 Phone (717) 787-6505. S.. pago 5 of the bookl.t "Instructions for Inheritanoe TaK R.turn for. R..ldlnt Dec.dentft (REV-ISOI) for an .xPlanatlon of adalnistratlv.lY correctabl. errors. PENALTYl If any taK due i. paid "Ithln three (3) oalendar .onths after the d.c.d.nt's death, ,. five p.rcent (5%1 dl'count of the t.x P.id is .llowed. IffrERESTI The 15% t.x une.ty non-pllrtlclp.Uon penalty is oOlputod on tho total of the tel( and Jnt."..t .......d, end not paId b.for. January 18, 1996, the flr.t day .fter the end of tho t.K aMne.ty period. This non-partioipation p.nalt.y is app..alable In tho .... ..nner .nd in tho the sallie thl. period a. YOU would appaal the taK anet Int.re.t that ha. b.en .......d a. jndloatod on this notice. Int.rut I. charged b.glnning with first cllly of d.linquency, or nino (9) Ilonths .nd Olle (II day froa the date of Math, to the date of paY.lnt. Tall.s which beca.. delinquont b.fore January I, 1982 bear Intere.t .t thll rate of .iIl (6%) pero.nt p.r annUlll calculatod It II dalh rat. of .000lM. Ail tal<u whioh beo... delinquent on INld aftar Jlnua,.y I, 1982 wlll baar intlr..t It II ratfl whloh wUl vary fl'oll calendar year to calenda,. y.ar with th"t rate announc.d by the PA Depart..nt of Revenue. The applicable inter..t rates for 1982 thrOUgh 1996 .1'., a'!! Int.r..t Rat. D.Uy Int.r.lit Faoto,. !!!r Intorest Rate DailY Inter.st Faotor 1982 20% .0005411 1987 9% ,000247 1983 16% .000438 19a1l~1991 11% .UOnOl 1984 11% .000301 1992 9X .0110241 19'5 13% .000356 1993-1994 7% .000192 19" 10% .000214 1995-1998 9Y. .01)0247 hIntarest i. o.lout.ted .. follON.1 INTEREST. BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR -"Any Notice i..ued afte,. the tax beODe'1I delinquent liUI reflect .n lote,'..t o'loulaUon to fJfteen (15) d.n beyond the date of the ........ot. If pav-.nt Is .ade .ftor the int.re't o~utation d.to shown on thll MoUoe, additional Interllt au.t be caloulated. /~ ~ ";;;0-5' 1'.:2./ 0-.1 COMMONWIALTH 01' I'ENNSYLVANIA COUNTY 01' CUM'E.LAND ! I "I [,an:)' !lair ..~___n.n. JI\(Qrl1 .. according 10 law, dnpolOl ond uY' that he nlll...l:illllcutQt".._..._.. .-.- 0' Iho E,hto 0' _ J'~l\t;L~!~!.t!a!1tJa.\.!9IL ....... .n .--.--.-- lele 01 Monroe Township . ., Cumberlend County, Pa.. deceated end that the wllhln Is an Inventory made by . hiln_._, the laIL.I!;l\.I1c:.\!.!;c;n;:______ .. 01 Ihe enlire ..late 01 uld decedenl, conlllting of .11 iho p.rson.1 prop.rty end rul ..t,Ie, except r..1 eltate ouhlde Ihe Commonweallh 01 Ponnlylvanla, and Ih.I Iho ligur., 01'1'".110 onch IIem 01 Ihe Inventory reprelent II'" hlr value U 01 I"e d.le 01 decod.nl', de.I", Sworn ..J;Q__ and ,ub.cribed bolore mo, /./ (M~VI' /----.-.-n.-:r;--'i'C1lL-19 JL__ .' . / J tl'., ,( / . - '~-___ j .~-1l.{~'-Lt:, ,jl i\~7,,-- \.'-"/['.~~~l~ l ",...,40~~':":'_.":~":';"::':'~ . C', ...'-.,., I.'''I"I!'I ,_';l ".;_.P-, i',IH.:;,,':;,',' i..-l-:':"i-I:i!~;';;~,_~, ":.' -, .~- n, - ---;,.:- -'---'_"""_._~ - . '" ",J ,1','.'1-: !d.l,! (ll f'if)I~IIIi.'9 U~~~~~1Iii'--- .._.~o O!cLC>1.li.! _~CJ.lId.__ _.____.___ ._____..__~i}.lsbu.r\l_'__PA 17219.._________..._ Add"" of Death .. .__ .......u _ _ _ _._..__.._._____.._September----....-..--. .____1997__ Day Month V..r INSTRUCTIONS An Invantory mUlt be flied within I"reo monlh. aller appolntmenl of porsonal reprelentatlve. A ,upplomonl Invenlory mUll be IlIod within thirly day. 01 di,covery 01 additional....". Additional .hoo" may b. allachod al to personalty or realty See Artlel. IV, Flduelarl.. Acl 01 1949. ~ .... 1 I ~ ~ ~ j 0. ~ 'd ~ "- ~ u . 0 ~ 0 w w 0 '" " ~ ~ !z iE "- C/J ~ ... c -' LL ~ ~ ~ 0 0 LL -' . "- ~ W 0 < i<: i > ~ ~ Z j Z 0 0 c . ~ - al z II '" 0 Z < :E: ;It "- "0 m c ~ ... ;;: 'M 0 ~ ~ ..Q 1 ... ~ E 0 ... ;J: ~ d it : -' Inventory of tho relll and personal os tate of . l'eal:1 K. ShanbaUQh deceased -------.._.~.__.,...._.,,' ,..... .. -..,.....~~--~--------- ---+--"-'--'---.--- ___c'~<~r'_;'~:',-;:. ._n_'.::;:'';;-~--:::; _nu~ ... PBRSCIW. PROPI!R'n: 1. Premium Plan Money Market Account 150-0095-9855 in PNC Bank Balance on Date of Death Accrued interest to Date of Death 2. . Certificate of Deposit *31??oo97845 Issued by PNC Bank on Auguet 1.8, 1997 Balance on Date of Death Accrued inter.est to Date of Death 3. Certificate of Deposit *31300098775 iSBued by PNC Bank on August 18, 1997 Balance on Date of Death Accrued interest to Date of Death 4. Amari Gas - Refund (Propane Gas) 5. Bell Atlantic - Refund 6. Country Meadows of West Shore Campos - Refund 7. Keystone Health Plan Central - Senior Blue Premium Refund 8. Quantum Imaging - Refund 'IDl'AL PmlSCI'olAL PRCI'BRTY REAL FSl'ATB: None Recapitulation: Personal Property Real Estate $71108.84 o Tal'AL PROOATB FSl'ATE $71108.84 19044 13 20 01 25000 00 106 16 25000 00 118 90 163 02 5 27 1429 35 25 00 197 00 $71108 84 '._._n_ RELEllSE Distribution of the balance in the hands of Larry flair, ExecutQr under the Last Will and 'l'estament: of Pearl K. Sharrbaugh, late of the 'rownship of Monroe, County of Cumberland and State of Pennsylvania, as shown by rl'he First: and Final Account of said mxecutor, confirmed by the Court of ConlOOn Pleas of Currberland County - Orphans' Caur.t Division, on October. 13, 199B, and Release of the Legatees and Distr.ibutees of said decedent, to said Executor hereto attached. IlALlINCE FOR nIB'I'RIIlm'IOO lIS PEn SAID ACC<Ul'I' $58,902.62 DIS'l'RI1ll11'IOO AND I\WAlID P~::R SAID A<:.'CaMr . ,~ '10: steven M. Carr, Trustee for the Bankr.upt ~ J \, .' . ...\ ::'J ~ i', ,t, ,',.(', Estate of Norna Cross - One-fourth 0/4) $ 14,725.66 I." rl TO: Larry Hair - 'lhree-fourths (3/4) 44,176.96 ~ - : 'lUl'AL DIB'lRIIll1l'IOO PER Ae<nMl' S 58,902.62 '.:J WIIEREIIS, a statement of Proposed Schedule of DistributiQr1 of said balance, as above set forth, was approved and confirmed by the Court',qf Cornn6n Pleas of Clllrbedand County - Orphans' Court Division, and the said Accountant was directed to distribute the same in accordance therewith. tu'/ I\tUi Ar,L MFN BY 'l'llFSE PRESENl'S, that we, Steven M. Carr, 'l'r:ustee for the Bankrupt F.state of Norma Cross, Norma Cross and Larry Hair, the residuary Legatees and Distributees under the Last will and 'restament of Pearl K. Shambaugh, late of the Township of Monroe, County of Ounberland and State of Pennsylvania, Deceased, do hereby declare and say that we, and each of us, have examined the foregoing Schedule of Distribution and do hereby acknowledge that we, ,and each of us, this day have had and received of and from Larry Hair, Executor of the &'3tate of Pearl K. Shambaugh, the cash set opposite our names in the above stated Schedule of Distribution, and the additional sm, set opposite our names in Schedule "A" attached hereto, in full satisfaction, payment, and discharge of all such SUlll or sums 6f money, share or shares, purparts and dividends which were due, owing, payable and belonging to us, and each of us, by any means Whatsoever, for or on account of. our, and each of our, full share, part or dividend of the Estate of Pearl K. Shambaugh, deceased, as given and confirmed to us by the said Schedule of Distribution. AND ~, we, Steven M. Carr, 'l'r:ustee for the Bankrupt Estate of Norma Cross, Norma CJ:oss and Larry Hair, qo by these presents remise, release, quitclaim and forever discharge the said Larry lIair, his heirs and assigns, of and fran our, and each of our, said share 0[' dividend..q of the Estate aforesaid, and of and from all actions, suits, payments, accounts, reckonings, clain5 and demands whatsoever, for any by reason thereof. , -." '-~0--"'..r,t!~~;, " "~,, ..,,' '. -'f . ,_'I _'II" I ,~, ~' ,--, 4: \:.\- I; "~'~ ';''''' "".11 ,/ '," P,""',' I,' "'1~ ."lrn;')'f.I\'h ,''''( } . tIl-,! ft\I!j'J' . I" j. l'~' ,~'f...<i~~~ 'I 1 ' ~'ll- I' . r I 'j ~ , . \' I , ",. , ') " , , ! I, ~~l,;tr',~:\~ )"11/'\~"'" II ,..:>.tt },~,. , 'I~ '~, "/J!tJ't'f'\,btlj\~iJ.,I.,,/, ,,' ,j ',' ,r; Iv ,I', , ,r