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REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
21
COUNTY CODE
06 00248
YEAR NUMBER
1. Original Return
4. Limited Estate
2. Supplemental Return
COMMONWEALTH OF PENNSYlVANIA
DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG. PA 17128-0601
DECEDENT'S NAME (LAST. FIRST. AND MIDDLE INITIAL)
STINE, RUTH E.
DATE OF DEATH (MM-DD-YEAR)
DATE OF BIRTH (MM-DD-YEAR)
SOCIAL SECURITY NUMBER
204-01-5203
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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01/09/2006
02/10/1908
6. Decedent Died Testate (Attach copy
of Will)
9. Litigation Proceeds Received
4a. Future Interest Compromise (date of death aftar
12-12-82)
7. Decedent Maintained a Living Trust (Attach
copy of Tru8t)
10. Spousal Poverty Credit (date of daath between
o 3. Remainder Retum (date of death prior to 12-13-82)
o 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
AME
EDMUND G. MYERS
IRM NAME (If applicable)
JOHNSON, DUFFIE, STEWART & WEIDNER
ELEPHONE NUMBER
717/761-4540
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation, Partnership or Sole-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, Bank Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
o Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)
11. Total Deductions (total Lines 9 & 10)
12. Net Value of Estate (Line 8 minus Line 11)
301 Market St.
Lemoyne, PA 17043-0109
(1 ) None
(2) None
(3) None
(4) None
(5) 49,279.26
(6) None
(7) None
(8)
OFFICIAL USE ONLY
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(IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL)
(9)
(10)
5,384.18
628.34
(11 )
6,012.52
43,266.74
34,613.40
8,653.34
(12)
13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13)
(13)
(14)
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
15.Amount of Line 14 taxable at the spousal tax rate, x .00 (15)
or transfers under Sec. 9116(a)(1.2)
z .045 (16)
0 16.Amount of Line 14 taxable at lineal rate x
S
J (17)
'" 17. Amount of Line 14 taxable at sibling rate x .12
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~ 18. Amount of Line 14 taxable at collateral rate 8,653.34 x .15 (18) 1,298.00
...
19. Tax Due (19) 1,298.00
20. 0
CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Copyright 2000 form software only The Lackner Group, Inc.
Form REV-1500 EX (Rev. 6-00)
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Decedent's Complete Address:
STREET ADDRESS
MANORCARE
1700 MARKET STREET
CITY
I STATE PA
TZIP 17011
CAMP HILL
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1 )
1,298.00
Total Credits (A + 8 + C)
(2)
0.00
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Interest/Penalty (D + E)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
8. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(3) 0.00
(4)
(5) 1,298.00
(5A)
(58) 1,298.00
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTiONS BY PLACING AN "X" iN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred;.................................................................................. ~ I
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d. receive the promise for life of either payments, benefits or care?.............................................................
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without
receiving adequate consideration?.... ............... ....... ....... ............................................................. ........ ................ D
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3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?........
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation?................... ....................................... ..... ...... ................................................
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
Under penelties of pa~ury, I declare that I have examined this retum, including accompanying schedules and stataments, and to the best of my knowledge and balief, it is true, correct and complete. Declaretion of
preparer other than the personal representative is basad on all infOlTllation of which preparer has any knowledge.
SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS
RI(;HARD E. S MBAC
DATE
1701 FAIRMONT DRIVE
MECHANICSBURG, PA 17055-6185
ADDRESS
SIGNATURE OF PRE PARER OTHER THAN REPRESENTATIVE
EDMU G. MYERS
ADDRESS
DATE
301 Market St.
Lemoyne, PA 17043-0109
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For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the
surviving spouse is 3% [72 P.S. ~9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0%
[72 P.S. ~9116 (a) (1.1) (ii)]. The statute does not exemot a transfer to a surviving spouse from tax, and the statutory requirements for disclosure
of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural
parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. ~9116 (a) (1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. ~9116
1.2) [72 P.S. ~9116 (a) (1)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. ~9116 (a) (1.3)]. A sibling is defined,
under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
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1East Ifill attb Qftstauttttt
I, RUTH E. STINE, of the
Penns yl vania, being of sound and
hereby make, publish and declare
hereby revoking all other Wills and
Lower Allen Township, Cumberland County,
disposing mind, memory and understanding, do
this as and for my Last Will and Testament,
,
Codicils heretofore made by me.
ARTICLE I.
I direct the payment of all my just debts and the expenses of my last illness
and funeral from my Estate as soon after my death as conveniently may be done. I
direct that all taxes that may be assessed in consequence of my death, of whatever
nature and by whatever jurisdiction imposed, shall be paid from my residuary estate
as a part of the expense of the administration of my estate.
ARTICLE II.
I give, devise and bequeath; all the rest, residue and remainder of my Estate,
of whatever nature and wherever situate, unto my husband, JAMES I.H. STINE,
provided he shall survive me by thirty (30) days.
ARTICLE III.
Should my husband, JAMES I.ll. STINE, predecease me or die on or before the
30th day following my death, I make the following specific bequests:
A. I give and bequeath my Gateleg Table and my Spinning Wheel Chair unto
RICHARD HARRIS BACASTOW, Devon, Pennsylvania, provided he survives me.
B. I give and bequeath my David Smith 1836 Coverlet to MAJOR TODD
SMITH BACASTOW, Hershey, Pennsylvania, provided he survives me.
C. I give and bequeath all of my silver (except myoId silver coffee pot) and
silverware unto BETTY W. SHAMBACH, lVIechanicsburg, Pennsylvania, provided she
survives me.
D. I give and bequeath my glassware and my large oil painting above Virginia
sofa unto CYNTHIA PERlVIICI, Mechanicsburg, Pennsylvania, provided she survive me.
E. I give and bequeath myoId silver coffee pot, my banjo clock, and the oil
painting, September Morn, to MRS. RICHARD BEANER, Enola, Pennsylvania, proviqed
she survives me.
F. I give and bequeath my marble top tables unto JAN BEANER, Enola,
Pennsylvania, provided she survives me.
G. I give and bequeath my oil painting, Penny, unto MRS. EDWARD
CAMPBELL, Boiling Springs, Pennsylvania, provided. she survives me.
H. I give and bequeath my topsy pastel unto MRS. DONALD MARIK (formerly
Nancy Lake), Lancaster, Pennsylvania, provided she survives me.
ARTICLE IV.
Should my husband, JAlVIES I.H. STINE, predecease me or die on or before the
30th day following my death, I give, devise- and bequeath all the rest, residue and
remainder of my estate as follows:
A. Twenty (20%) percent thereof unto RICHARD E. SHAMBACH and BETTY W.
SHAMBACH, his wife, Mechanicsburg, Pennsylvania, or the survivor of them, with the
suggestion that they or the survivor of them divide the share among themselves and
their children, JEFFREY ALAN SHAMBACH and CYNTHIA PERMICI.
B. Fifteen (1596) percent thereof unto TRINITY LUTHERAN CHURCH, 2000
Chestnut Street, Camp Hill, Pennsylvania.
C. Five (596) percent thereof unto AMERICAN UNIVERSITY, Washington, D.C.,
to be contributed to the Scholarship Fund, College of Liberal Arts.
D. Five (5%) percent thereof unto BOSTON UNIVERSITY, Boston,
Massachusetts, to be contributed to the Scholarship Fund, School of Education.
E. Five (5%) percent thereof unto THE COMMONWEALTH OF PENNSYLVANIA
for use in the WILDLIFE RESOURCE PRESERVATION PROGRAM.
F. Five (5%) percent thereof unto the AMELIA GIVEN LIBRARY, Mount Holly
Springs, Pennsylvania.
"'
G. Five (5%) percent thereof unto WITF, Channel 33, Public Television, 1982
Locust Lane, Harrisburg, Pennsylvania.
H. Ten (10%) percent thereof unto THE BETHESDA MISSION, 611 Reily
Street, Harrisburg, Pennsylvania.
I. Ten (10%) percent thereof unto C.A.R.E., Box 13140, Philadelphia,
Pennsylvania.
J. Ten (10%) percent thereof unto THE AMERICAN RED CROSS, Harrisburg
Area Chapter, 230 State Street,' Harrisburg, Pennsylvania.
K. Ten (10%) percent thereof, unto THE SALVATION ARMY, 1122 Green
Street, Harrisburg, Pennsylvania.
I further direct that in case any of the above-listed charitable organizations is
not in existence at the time for distribution, I direct that such share shall be
distributed in equal shares to the remaining charitable organizations named in this
Article. I further direct that any and all taxes assessed as a consequence of my
dea th shall be paid from and deducted from my residuary estate prior to the
calculation of the shares of the residuary beneficiaries so that each residuary
beneficiary, charitable or not, shall bear a portion of the burden of such taxes.
ARTICLE V.
I name, constitute and appoint DAUPHIN. DEPOSIT BANK AND TRUST COMPANY,
Harrisburg, Pennsylvania, Executor of this my Last Will and Testament.
IN WITNESS WHEREOF, I have hereunto set my hand and seal on this the
c2Jf!!-day of ~ ' 1986.
~ cf .Iiu~/
- Ruth E. Stine
(SEAL)
Signed, sealed, published and declared by the above-named Testatrix, as and for
her Last Will and Testament, in the presence of us, who, at her request, in her
,
presence and in the presence of each other have hereunto subscribed our names' as
witnesses.
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AFFIDAVIT
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COMMONWEALTH OF PENNSYLVANIA
ss:
COUNTY OF CUMBERLAND
We, \rJJL,.J <~~\,-'V----........-..., and t.Q.~,Jl KJ. ~r-...../ the witnesses
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whose names are signed to the foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw the Testatrix sign and
execute the foregoing instrument as her Last Will and Testament; that she signed
willingly and that she executed it as her free and voluntary act for the purposes
therein expressed; that each of us in the hearing and sight of the Testatrix signed
the Will as witnesses; and that to the best of our knOWledge, the Testatrix was at
that time eighteen (18) or more years of age, of sound mind and under no constraint
or undue influence.
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Sworn or affirmed to and subscribed to before me by vJ..!,L"J ~'vY'-""""""_ , and
W/yv"'-'....,.Q. .t::. ''<Y\.~witResses, this;) J.,..Q day of 'y." t~ ' 1985. ~
~~
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Notary PulijJ'C-
DIANNE lENIG, NOTARY PUBLIC
My Commission EXPIlt:, ." .:'.:';,ur 21. 1989
. amoyr~. PA CU. A;(;JniJ CountJ
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ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss:
I, RUTH E. STINE, whose name is signed to the foregoing instrument, having
been duly qualified according to law, does hereby acknowledge that I signed and
executed the instrument as my Last Will and Testament; that I signed it willingly;
and that I signed it as my free and voluntary act for the purposes therein
expressed.
~ c!. kd
Ruth E. Stfne
Sworn or affirmed to and acknowledged before me, by RUTH E. STINE, this
;2 ~ .....Q day of V'Y'\. c.v..~ ' 1986.
-S:L~~.~ ~lllie
DIANNE LENIG. NOTARY.PUBlIC
My Commission Expires December 21. 1 ~1I9
. ~moyr'!. PA Cu. .berland COUol.1.
.
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF STINE, RUTH E.
FILE NUMBER
21 - 06 - 00248
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE OF
NUMBER DEATH
1 PNC Bank - Checking Account No. 51-4006-2097 5,437.73
Date of death balance
2 Charles Schwab - Investment Account No. 8562-7110 40,028.30
Date of death balance
3 West Shore A.L.S. - refund 620.34
4 Country Meadows Associates - refund due decedent 3,162.09
5 Bequests under Article III - Paragraphs A through H - adeemed. 0.00
6 Cash 30.80
TOTAL (Also enter on Line 5, Recapitulation) 49,279.26
.
SCI-EDUlE H
FUNERAl.. EXPENSES &
ADI\IWtISTRATIVE COSTS
COMMONWEAlTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF STINE, RUTH E.
Debts of decedent must be reported on Schedule I.
FILE NUMBER
21 - 06 - 00248
ITEM
NUMBER FUNERAL EXPENSES:
A. 1 Myers-Harner Funeral Home - Funeral charges prepaid.
Balance due'
DESCRIPTION
AMOUNT
45.00
B.
1.
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
RICHARD E. SHAM BACH
Social Security Number(s) I EIN Number of Personal Representative(s):
2,460.00
2.
3.
Street Address 1701 FAIRMONT DRIVE
City MECHANICSBURG State PA
Year(s) Commission paid
Attorney's Fees Johnson, Duffie, Stewart & Weidner
Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Zip 17055-6185
2,460.00
Street Address
City
Relationship of Claimant to Decedent
State
Zip
4.
Probate Fees
Register of Wills - Cumberland County
141.00
5. Accountant's Fees
6. Tax Return Preparer's Fees
7. Other Administrative Costs
1
Cumberland Law Journal- advertising Letters
75.00
Total of Continuation Schedule(s)
203.18
5,384.18
TOTAL (Also enter on line 9, Recapitulation)
*'
Schedule H
Funeral Expenses &
MTinisba611e CosIs continued
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF STINE, RUTH E.
IFILE NUMBER
21 - 06 - 00248
2
The Patriot-News - advertising letters
123.18
3
Register of Wills - file Inventory and Inheritance Tax Return
30.00
4
Reserve for close-out costs.
50.00
Page 2 of Schedule H
*'
SCHEDULE I
DEBTS OF DECEDENT, MORTGAGE
LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYlVANIA
INHERITANCE T AA RETURN
RESIDENT DECEDENT
ESTATE OF STINE, RUTH E.
FILE NUMBER
21 - 06 - 00248
Include unreimbursed medical expenses.
ITEM DESCRIPTION
NUMBER AMOUNT
1 Check that cleared after death - PNC Account No. 51-4006-2097 620.34
No. 10396 - West Shore EMS-ALS
2 PNC Bank - Bank Maintenance charges - Minimum Balance 8.00
Account No. 51-4006-2097
TOTAL (Also enter on Line 10, Recapitulation) 628.34
REV.1513 EX+ (9-00)
.
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
STINE, RUTH E.
I FILE NUMBER
21 - 06 - 00248
RELATIONSHIP TO AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE
Do Not List Trustee(e)
I. TAXABLE DISTRIBUTIONS (include outright spousal distributions)
1 Richard E. Shambach and Friends Twenty Percent
Betty W. Shambach Residue
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropria e, on Rev 1500 cover sheet
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT
BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1 Trinity Evangelical Lutheran Church 6,490.01
2000 Chestnut St., Camp Hill, PA 17011
2 American University - Bethany J. Bridgham, Sr. Associate General Counsel 2,163.34
4400 Massachusetts Avenue, NW, Washington D.C. 20016-8165
3 Boston University - Christy Olson, Alumini Affairs Officer 2,163.34
2 Shearborn Street, Boston, MA 02215
4 PA Dept. of Conservation & Natural Resources - Susan Wood, Asst. Counsel 2,163.34
Rachel Carson State Office Building, P. O. Box 8767, Harrisburg, PA 17105-8767
5 See Continuation Schedule for the remaining 21,633.37
Charitable Bequests totaling
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 34,613.40
Schedule J - Beneficiaries - Continued
Estate of: STINE, RUTH E.
------------------------------------------------------------------------------------------------------------------------------
21-06-00248
B. Charitable and Governmental Distributions:
5.
Amelia S. Given Library
114 Baltimore Street, Mount Holly Springs, P A 17065
6.
WITF TV-FM - Attn: Mary Wiley Myers, Sr. Development Officer
1982 Locust Lane, Harrisburg, P A 17109
7.
The Bethesda Mission - Administration Office
2001 N. Front Street, Suite 122, Harrisburg, P A 17102
8.
C.A.R.E.
Attn: Ms. Denise Berry - Office of Planned Giving
151 Ellis Street, Atlanta, GA 30303
9.
The American Red Cross
P A Capital Region Chapter
1804 N. 6th Street, Harrisburg, P A 1710 1
10.
The Salvation Army
Territorial Headquarters - Legal Dept.
440 W. Nyack Rd., P. O. Box C-635
West Nyack, NY 10994-1739
2,163.34
2,163.34
4,326.68
4,326.67
4,326.67
4,326.67
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