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Home My WebLink About08-31-07 (2) -..J 151l5bll41147 REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX.280601 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT 21 06 1122 Date of Birth 200367769 12072006 06151925 Decedent's Last Name Suffix Decedent's First Name MI SHAMBAUGH LAURA M (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW rxl 1. Original Return D 2. Supplemental Return D 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate D 4a. Future Interest Compromise D 5. Federal Estate Tax Return Required (date of death after 12-12-82) rKJ 6. Decedent Died Testate D 7. Decedent Maintained a Living Trust 1 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 9. Litigation Proceeds Received D 10 Spousal Poverty Credit {date of death D 11.Election to tax under Sec. 9113(A) . between 12-31-91 and -1-95) (Attach Sch. 0) Firm Name (If Applicable) "j .~.~~ C) 429 SOUTH 18TH STREET .. '..-.--- ~J ---l REGISTER~--Y;IILLS l:JSE ONLY _' '.~J >., First line of address .' c-,:-) : '- j -1'1 -n Second line of address C) C> -.J , , i - DATE FILED City or Post Office CAMP HILL State PA ZIP Code 17011 Correspondent's e-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNAl: RE OF PERSON R SIBLE F FILING URN DATE Larry E. Shambaugh %- -'30-0 430 Rolling Road, York Springs, PA 17372 S'r~A~URE OF'pR;PARER OT, HER T, ,~, SENTATIVE Y ~ V( 7 ///"_.../ ADDRESS Michael L. Bangs ~ATE Q ~ ,"'-,-o\-:J f..)--~y~ I ( 429 South 18th Street, Camp Hill, PA 17011 Side 1 L 151l5bll41147 151l5bll41147 ~~ PA Inheritance Tax Return Signature of Additional Fiduciaries ESTATE OF FILE NUMBER Shambaugh, Laura Mary 21-06-1122 Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Signature #2 ~ 9- -dl~~~T Sally J. Shambaugh 1159 S. Spring Garden St. Name Add ress 1 Address2 City, State, Zip Carlisle, PA 17015 Date ?13();O7 ~ 15056042148 REV-1500 EX Decedents Name Laura Mary Shambaugh Decedent's Social Security Number 200367769 RECAPITULATION 1. Real Estate (Schedule A)........................................................................................... 2. Stocks and Bonds (Schedule B)................................................................................. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C).............. 3. 4. Mortgages & Notes Receivable (Schedule D)............................................................ 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E).................... 5. 6. Jointly Owned Property (Schedule F) D Separate Billing Requested.............. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) D Separate Billing Requested.............. 7. 8. Total Gross Assets (total Lines 1-7)........................................................................ 8. 9. Funeral Expenses & Administrative Costs (Schedule H)............................................ 9. 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I)................................... 10. 11. Total Deductions (total Lines 9 & 10)....................................................................... 11. 12. Net Value of Estate (Line 8 minus Line 11 ).............................................................. 12. 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J).................................................... 13. 14. Net Value Subject to Tax (Line 12 minus Line 13)................................................... 14. TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, of transfers under Sec. 9116 (a)(1.2) X ~ 0 . 0 0 16. Amount of Line 14 taxable at lineal rate X .045 2 2 5 , 2 5 9 . 6 5 17. Amount of Line 14 taxable at sibling rate X .12 0 . 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 . 0 0 15. 16. 17. 18. 19. Tax Due......... ...................... ............... ................... .................................................... 19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. Side 2 L 15056042148 1. 179,814.71 64,506.30 244,321.01 10,395.61 8,665.75 19,061.36 225,259.65 225,259.65 0.00 10,136.68 0.00 0.00 10,136.68 o 15056042148 ~ REV-1500 EX Page 3 Decedent's Complete Address: File Number 21-06-1122 DECEDENT'S NAME Laura Mary Shambaugh STREET ADDRESS 1159 S. Spring Garden Street CITY I STATE !ZIP Carlisle PA 17015 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 10,136.68 9,700.00 506.83 Total Credits (A + B + C) (2) 10,206.83 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 2 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. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (5B) 70.15 Make Check Payable to: REGISTER OF WILLS, AGENT iii...... . - .iiir............ ............. --- - _.._~-_._....... "..... iIII .._--= PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS No D D D D D D D D D D 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?............... D D 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?....... ............................................................ ................................................ .... D D IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;..................................................................................... b. retain the right to designate who shall use the property transferred or its income;......................................... c. retain a reversionary interest; or.................. ......................... .... ............ ......................... .... ................... .......... 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?............................................................................................................... .......... Yes 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 three (3) percent [72 P .S. 99116 (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 zero (0) percent [72 P.S. 99116 (a) (1.1) (ii)]. The statute does not exempt 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 zero (0) percent [72 P.S. 99116 (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 four and one-half (4.5) percent, except as noted in 72 P .S. 99116 1 .2) [72 P .S. 99116 (a) (1 )]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P .S. 99116 (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. Rev-1502 EX+ (6-98) . SCHEDULE A REAL ESTATE COMMONWEAL TIi OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shambaugh, Laura Mary FILE NUMBER 21-06-1122 ESTATE OF All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value Is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or se", both having reasonable knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 Real Estate -1159 S. Spring Garden Street, Carlisle; sold on July 20, 2007; see settlement sheet attached. 179.814.71 TOTAL (Also enter on Line 1, Recapitulation) 179.814.71 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) Rev-1508 EX+ (6-98) SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shambaugh, Laura Mary FILE NUMBER 21-06-1122 ESTATE OF 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 VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1 Automobile - 1992 Chevrolet Truck (see Bill of Sale attached) 400.00 2 Automobile - 2000 Kia Sephia (see Bill of Sale attached) 2.000.00 3 Citizens Bank - Account #6100727602 2.802.53 4 Citizens Bank - Account #6200843876 28.771.26 5 Ohio National Financial Services - Life insurance paid to estate 3.588.22 6 Wachovia Bank, N.A. - Account #247412041056505 2.388.25 7 Wachovia Bank, N.A. - Account #247412041364989 1.667.84 8 Wachovia Bank, N.A. - Account #247412051747215 1.092.96 9 Wachovia Bank, N.A. - Account #3083380519060 21.795.24 TOTAL (Also enter on Line 5, Recapitulation) 64.506.30 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) REV-1151 EX+(12-99) *' SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shambaugh, Laura Mary Debts of decedent must be reported on Schedule I. FILE NUMBER 21-06-1122 ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT See continuation schedule(s) attached 538.10 B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State Zip 2. Attorney's Fees Michael L. Bangs 5,500.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Sally J. Shambaugh Street Address 1159 S. Spring Garden Street City Carlisle State PA Zip 17015 Relationship of Claimant to Decedent daughter 3,500.00 4. Probate Fees 310.00 5. Accountant's Fees 350.00 6. Tax Return Preparer's Fees 7. Other Administrative Costs See continuation schedule(s) attached 197.51 TOTAL (Also enter on line 9, Recapitulation) 10,395.61 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) Rev-1502 EX+ (6-98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shambaugh, Laura Mary FILE NUMBER 21-06-1122 ESTATE OF ITEM NUMBER DESCRIPTION 1 Hetrick Funeral Home AMOUNT 538.10 Subtotal 538.10 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA.1500 Schedule H-A (Rev. 6-98) Rev-1502 EX+ (6-98) . SCHEDULE H-B7 OTHER ADMINISTRATIVE COSTS continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIOE'fT OECEOE'fT Shambaugh, Laura Mary FILE NUMBER 21-06-1122 ESTATE OF ITEM NUMBER DESCRIPTION AMOUNT 1 Cumberland Law Journal - Estate Advertising 75.00 2 The Sentinel - Estate Advertising 122.51 Subtotal 197.51 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-B7 (Rev. 6-98) Rev.1512 EX+ (6-98) *' SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAA RETURN RESIDENT DECEDENT Shambaugh, Laura Mary IFILE NUMBER I 21-06-1122 ESTATE OF Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION 1 Claremont Nursing Home VALUE AT DATE OF DEATH 7.140.75 2 Embarq - Phone service 12/13/06 to 1/12/07 144.34 3 Hockley and O'Donnell Insurance - Homeowners Insurance 912.50 4 Met-Ed - 11/8/06 to 1/16/07 125.95 5 Nationwide Mutual Insurance Company - Automobile insurance (installment) 290.20 6 Penn Mutual Insurance - Reimbursement of January payment 15.54 7 Qwest Communication Corporation - Phone service 11/12/06 to 12/11/06 36.47 TOTAL (Also enter on Line 10. Recapitulation) 8,665.75 <If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-1513 EX+ (9-00) *' SCHEDULE .. BENEFICIARIES COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT NUMBER Shambaugh, Laura Mary NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not List Trustee(s) FILE NUMBER 21-06-1122 SHARE OF ESTATE AMOUNT OF ESTATE (Words) ($$$) ESTATE OF I. See attached schedule Total Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-15OO COVER SHEET 0.00 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) SCHEDULE .. BENEFICIARIES (Part I, Taxable Distributions) ESTATE OF: Laura Mary Shambaugh 200-36-7769 12/07/2006 Item Name and Address of Person(s) Share of Estate Amount of Estate Number Receiving Property Relationship (Words) ($$$) 1 Linda L. Marrero Daughter one-sixth 104 Laurel Street East Beaufort, SC 29906 2 Gerald A. Shambaugh Son one-sixth 1652 Osbourne Avenue Willow Grove, PA 19090 3 Larry E. Shambaugh Son one-sixth 430 Rolling Road York Springs, PA 17372 4 Michael L. Shambaugh Son one-sixth 124 West Portland Street Apt. 24 Mechanicsburg, PA 17055 5 Ronald L. Shambaugh Son one-sixth Box 163 Boiling Springs, PA 17007 6 Sally J. Shambaugh Daughter one-sixth 1159 S. Spring Garden Street Carlisle, PA 17015 Total 1 A U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT SETTLEMENT STATEMENT B. TYPE I 0 FHA 2. L 4. c: VA 5. c: 6. FILE NUMBER: 07-00155-ALT 8. MORTGAGE INS. CASE NO.: 1> OMB No 2502-0265 LOAN 3. ::::J CONY. UNINS. OF FHMA CONY. INS. 7. LOAN NUMBER C. NOTE: This form is furnished to give you a statement of actual senlement costs. Amounts paid to and by the seUlemen, agen' are shown. Items marked "(p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME & ADDRESS Sally J. Shambaugh OF BORROWER: E. NAME & ADDRESS Exhibit "A" Attached Hereto OF SELLER: F. NAME & ADDRESS Cash Sale OF LENDER: G. PROPERTI LOCATION: 1159 South Spring Garden Street, Carlisle, PA 17013 H. SETTLEMENT AGENT: Assured Land Transfers, Inc. PLACE OF SETTLEMENT: Michael L. Bangs, Esquire 429 South 18th Street, Camp Hill, PA, ]7011 1. SETTLEMENT DATE: 7/2012007 DISBURSEMENT DATE: 712012007 J. SummarY of Borrower's Transaction K. SummarY of Seller's TransactioD 100. Gross Amount Due From Borrower: 400. Gross Amount Due To Seller: 101. Contract sales price 1 1 80 000.00 401. Contract sales price 180000.00 102. Personal property I 402. Personal propertv 103. Settlernent charges to borrower: (line 1400) I 307.25 403. 104. 404. 105. 405. Adjustments For Items Paid Bv Seller In Advance: Adiustments For Items Paid Bv SeIJer In Advance: 106. Cityltown taxes to 406. Cityltown taxes to T 107. County taxes 07120107 to 12131107 102.25 407. County taxes 07120/07 to 12131107 i 102.25 108. Assessments to 408. Assessments to 109. School Taxes 712012007 to 613012008 893.]4 409. Schoo] Taxes 7/2012007 to 613012008 893.14 110 410. 111. 411. 112. 412. 113. 413. 114. 4]4. 115. 415. 116. 416. 120. Gross Amount Due From Borrower: 182,302.64 420. Gross Amount Due To Seller: 180,995.39 100. A mnJln'. . rrnwer: <;00. RedJlctinno 'ft A -ount n"p To ~pllpr: 201. Deposit or earnest rnoney 501. Excess deposit (see instructions) 202. Principal amount of new loan(s) 502. Settlemenl charges 10 seller (line 1400) 1.180.68 203. Existin21oan(s) taken subject to 503. Existin' loan(s) taken subiect to 204. 504. Payoff 1st Mtg. Ln. 105 505. Payoff 2nd Mtg. Ln. 206. 506. , 207. 507. 208. 508. 209. 509. i I I \ Adjustments For Items Unpaid By SeIlert I Adjustments For Items Unpaid By Seller: 210. Cityltown taxes to I 510. City/town taxes to 211. Countv taxes to 511. Countv taxes to 212. Assessments to 5]2. Assessments to 213. 513. 214. 514. ~- 515. 216. 516. 217. 517. I 218. 518. I 219. 519. 220. Total Paid By{For 520. Total Reductions 1,180.68 Borrower: In Amount Due SeDer: "\00. ttJ~~~ftt F;:;;;;;rr..- Bn~nwp,..: 600. Cash At <:ettJement Fromrro Seller: 301. Gross amount due frorn borrower'nine 120) 182 302.64 601. Gross amount due to seller (line 420) 18099539 302. Less amount paid by/for bOlTOwer (line 220) 602. Less reductions in amount due seller (line 520) I 180.68 303. Cash (IXJFROM) ,OrO) Borrower: 182,302.64 603. Cash iETO) (DFROM) Seller: 179,814.71 Previous Edition Is Obsolete Form No. 1581 3186 5B-4-3538-ooo-1 HUD-I (3-86) RESPA, HB 4305.2 Page 1 of 3 x X x X L. 700. Total SalesIBroker's Commission: Based On Price $ II SETTLEMENT CHARGES F %- Escrow: 07-00155-ALT Paid From Borrower's Funds At Settlement Paid From Seller's Funds At Settlement 7 . 703. 704. aid at settl 801. oan . ina' fee I 802 Loan Discouot I ~03. ADDrai~~ees: 04. ~redit e rt to: 805 ender's' SD tion fee % 80". Mortaaae ine,,~nce annlicatinn fee to I I R07. Aeeumnt;on Tee I I R08. I 809. I I RIO. I I 1(11 I I I 812. 81l 814. 81~ 816. onn Tt.mc 1>~...P"" . ", on 1 I nterest from to t@( /da" fO ~av<) 902 Mnrtaa". ;ne'''''"'ce """"';"m for mn.tn 903. Hazard insurance nremium fOT vrs. to 904. FIonA ;n."..n~e nTemium ~ vrs. tn 905. 906. 1nn1l R....rv... --;- 11101. l'I.?rn ;o<ur"n"A mo~( ner mnn'" I I I i I I I I 1007. ~';~:M. I : 102. Abstrac:;': titl~ ~earch to 103. TItle ex natto to I" 04. ~~le insurance bin~: t~ 1105 cumentllreDaratto 1002. Mortl!alTe insurance 1003. City Dronerty taxes 1004. Couoty DTODertv taxes 1005. Annual assessments 1006. Flood insurance months @ $ months (al $ months (al $ months (ql $ months (al $ months (al $ Der month Der month per month DeT month DeT month oer month I I I I I I ~ I 1106. Nnt.TV fee. tn I 1107. Attorney's fees to (includes above item Numbers: ) 1108. Title insurance to Assured Land Transfers, Inc. ~ (includes above item Numbers: 1101,1102,1103,1104 ) ] ,258.75 1100. T ...nder's ~overa~e ., 1110. Owner's covera"e $ '80000.00 Prem;um: q 258.75 1111. Nnt.TV Fee to r'.ch 10.00 10.00 1112. I --.J Ill". I ll14. I "nn 1201. Recordin.. fees: Deed -;; 18.50 'Mort"aae $ :ReleMes" 38.50 -- 1202. {"itv/countv taxfo+.mnc: D::A S . Mortaa"e ., 12111, "t.t.. taxfSt.mn.: D....nS 'Mortaaae S 1204. 1205. ,~nn 11,01. ""rvev to ] 302. Pest in<nPMion to 13c\?'. prn""rtv Tax t 11-2007 rnun"'lTnwnshin TOYes 226.20 1304 School Taxes to bel].:?007/o~chool ni<m~t T,ye< 939.48 1305. Tax Certification Fee to Judv Camnbell 5.00 130". 13117. I I T8. :3~~: Ll3l1. 11312. 1313. 1 dOn Tnt~t Sf'otttpmpnt rhar2P (F.ntp.T nn /int:! 101 ",P.r.!;,," , ~ and -Tim? 'i02 Sp-ctinn I() Form No. 1582 Page 2 on ~ 1107J IIRJ SB-4-3538-000-1 x x x x SELLER'S AND/OR BORROWER'S STATEMENT Escrow: 07-00155-ALT I have carefully reviewed the HUD-l Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-l Settlement Statement. Bon'owersfPurchasers Sellers ~-~~u~ augi} i:;r Lany E. Shambaugh & Sally 1. Shambaugh, Co-Executors of the Estate of Laura M. Sh~amgh ~. By: r . ~ty- 9 "V?~~7U::r- The HVD-I Settlement Statement which I have pre ared is a true and accurare account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statemen Settlement Agent: ~I ) d-b /J} Date: _ _~____.______.___ FA TIC Support, A red Land Transfers, Inc. W ARNlNG: It is a crime to knowingly make false statements to the United States on this or any other similar fonn. Penalties upon conviction can include a fine or imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. Page 3 00 ATIACHMENTTOHVD I Settlement Date: 7/20/2007 Escrow No.: Title No.: EXHIBIT A: Name & Address Of Seller: Larry E. Shambaugh & Sally J. Shambaugh, Co-Executors of the Estate of Laura M. Shambaugh 07-00155-ALT 07-001 55-ALT Page: 1 \ BILL OF SALE WE, LARRY E. SHAMBAUGH and SALLY J. SHAMBAUGH, Co-Executors of the Estate of Laura M. Shambaugh, do hereby sell a 1992 Chevrolet Truck, Vehicle Identification Number (VIN) lG C(S N ~ XtJ'i /53 % 07 to MICHAEL J. SHAMBAUGH for the sum of Four Hundred and 00/100 ($400.00) Dollars. Date: 1-2D-01 s~tiMB~tor BILL OF SALE WE, LARRY E. SHAMBAUGH and SALLY J. SHAMBAUGH, Co-Executors of the Estate of Laura M. Shambaugh, do hereby sell a 2000 Kia Sephia, Vehide Identification Number (VIN) K,vA{8 );]12 '15~ <g5~L/) toSALLYJ.SHAMBAUGHforthesumof Two Thousand and 00/100 ($2,000.00) Dollars. Date: 1-20-07 L~.~ror slffJt/lMB~r ........--~ D. Cltlzen$Ba.nk" 525 William Penn Place Suite 153-2618 Pittsburgh, PA 15219 January 18, 2007 MICHAEL L BANGS Esq 429 S 18TH ST CAMP HILL PA 17011 Estate of LAURA M SHAMBAUGH Date of Death: December 07,2006 SSN: 200-36-7769 Dear Sir: In accordance with your request, the attached information sheet has been provided in the above decedent's name as of her date of death. The decedent had 2 active accounts at the time of her death. For IL or LC accounts, contact our Loan Department at 1-800-708-6680. For all other inquiries, please call 1-888-999-6884 Sincerely, Phillip Lynch Operations Services DCltizens8ank" Account Nwnber 6100727602 Account Title PAUL R SHAMBAUGH or LAURA M SHAMBAUGH Date Opened 6/6/1966 Account Type Checking Principal Balance as of DOD $2,802.53 Interest from Last Posting to DOD $.00 Account Balance as of DOD $2,802.53 YTD Interest to DOD $11.01 a Citizens Bank ~ Account Number 6200843876 Account Title PAUL R SHAMBAUGH or LAURA M SHAMBAUGH Date Opened 1/6/2003 Account Type Checking Principal Balance as of DOD $28,771.26 Interest from Last Posting to DOD $.00 Account Balance as of DOD $28,771.26 YTD Interest to DOD $325.53 a Citizens Bank- Account Number 00600028900001204 Account Title PAUL R SHAMBAUGH or LAURA M SHAMBAUGH Date Opened 4/28/1989 Account Type Bank Deposit Box Carlisle Branch # 289 665 North East Street Carlisle, PA 17013 ~~ Transmission 1/19/2007 7:09 AM PAGE 1/002 Fax Servl~r :~:~ -~~-- ..:.'- -- ~ Rl:ferencc 10: 1892548 Wachovia Bank N.A. Balance Confirmation Services POBox 40018 Roanoke, VA 24022-7313 January 19, 2007 BANGS LAW OFFlCE 429 SOUTH 18TH STREET CAMP Hll-L, P A 17011 SUBJECT: Verification! Confirmation ol'Account 3!ld Balance Information provided for: Customer: LAURA M SHA\fBAUH (SSN# 200-36-'i'769) Date of Death: December 7~ 2006 ;Q~~~!!!!1nforRllltion Account Account Date of Death A veraj:e Date Maturity InteIeli t Accned YTJ.) Date Type Number Balance Balan. e. Opened Date Rate InteIl:st 11 terest P2jd Closed -------- -- ___.r__ . CERTIFICATE OF DEPOSIT 247412041056505 S2,388.25 2/16/2000 $4.61 S63.02 114/2007 LEGAL TIrLE: LAURA M SHAMBAUH PAUL RSHAMBAUH POA SAll,Y J SHAMBAUH CERTIFICATE OF DEPOSIT 247412041364989 SI,667.84 11/6/2000 $0.26 S45.61 114/2007 LEGAL TIrLE: LAURA M SHAMBAUH PAUL R S:'IAMBAUH POA SAll,Y J SHAMBAUH CERTIFICATE OF DEPOSIT 247412051747215 SI,092.9(; 4/2412002 S4.12 S31.30 1/412007 LEGAL TIrLE: LAURA M SHAMBAUH PAUL RSHAMBAUH POA SAll.Y J SHAMBAUH SAVINGS 3083380519060 $21,795.24 6/1/1980 $2.3 0 S21.71 LEGAL TIrLE: LAURA M SHAMBAUH POA SAllS J SHAMBAUH · Due to system limitations, we can onl:' provide a tw:lvc: month ilYerage l,alance on dep06itory accounts. ~ Transmission 1/19/2007 7:09 AM PAGE :~:::- - -;--s:,,:- c:.. - -_ 'WAcmJ9IA. No Safe Dt'}losit Box found for customer. · Date of death balance does not include a<:crooo interest 2/002 Fax S€!rVI~r RI,ferencc ID: 1892548 . If date of death occurrs on a weekend ora hcliday, date cf death balance does not include any transactions that were made during that time period. ~~ Audrey Troutt Servicenter Associate Phone: (540)563-7323 abs; at One Financial Way Cincinnati, Ohio 45242 ~gr\II"~ ~ @ Ohio National Financial Services @ Post Office Box 237 Cincinnati, Ohio 4520T-0237 Telephone: 513.794.6roo www.ohionational.com February 20, 2007 LARRY E SHAMBAUGH 430 ROLLING RD YORK SPRINGS PA 17372 Re: Policy 347899 Laura Shambaugh, Deceased Dear Mr. Shambaugh: The claim under policy 347899 has been approved for payment of the net death proceeds. We have calculated the net death proceeds as follows: Death Benefit Dividend Accumulations Interest on Accumulations Pro-Rata Dividends Paid in Cash Interest on Death Proceeds at 3% .:. Total Proceeds $1,000.00 $2,557.03 $8.09 $1.08 $22.02 $3,588.22 Enclosed is our check for $3,588.22 payable to Sally J. and Larry E. Shambaugh, executor of the Estate of Laura M. Shambaugh. Your receipt of these death proceeds satisfies our obligation under policy 347899. If you have any questions, please contact our office toll-free at 1-877-446-30 to. Sincerely, fr~e~ Donna McCosham Claims Analyst C: Dennis W. Thome #2253 The Ohio National Life Insurance Company Ohio National Life Assurance Corporation J "_'\ B. -v-:"'::> i c. oJ r .-..) ~ , .-J '- j '. ,.,.1 .,-_......,.'~...... ........ ~,"... .j'.. ~ .:5 ,..- _...:~ I ./ 0..,.-< .~ t J /,j Will I LAURA MARY SHAMBAUGH of 1159 S. Spring Garden Street, Carlisle, Cumberland County, Pennsylvania, declare this as my last will and revoke any will previously made by me. Item One: I direct that all my debts and funeral expenses induding my gravemarker shall be paid from my residuary estate as soon as practicable after my decease as a part of the expense of the administration of my estate. Item Two: I give, devise, and bequeath my entire estate to my wife Laura Mary if she survives me by 60 days. In the event that she predeceases me or is not then living on the 61 st day after my death, then I give and bequeath the following: A. To each of my two daughters: A set of dishes Stainless steel flatware To my son Larry E. Shambaugh: Cast Iron Frying Pans To each of my children, except Ronald L.: 2 plank bottom chairs. (Ronald has received his 2 chairs during his lifetime) .,..J ... ..:.. D. To my daughter Sally J.: E. To my son Michael L.: F. To my daughter Sally J.: G. To my son Ronald L.: H. To my son Gerald A.: 2 bookcases Cedar chest. My sterling silver My snowblower and riding mower. My rocking chair ...-- J I give, devise, and bequeath the rest, residue, and remainder of my estate to my children, equally, share and share alike, per stirpes. -) v~ ~\ I direct that when my residence at 1159 S. Spring Garden Street, Carlisle is sold, my children shall have the first opportunity and option to buy the residence at fair market value as determined by appraisal; in the event that no child exercises this option or more than one child makes an offer, then the Executor has the right to sell the residence at public sale, in their or his or her sole and absolute discretion. Item Three: I appoint my husband Paul Raymond Executor of this my last will. Should he fail to qualify or cease to act as Executor, I appoint my children Larry E. and Sally J. co-Executors or the survivor as Executor with the same rights, powers, and duties. Item Four: I appoint my children Larry E. and Sally 1. as co-guardians/trustees or the survivor as guardian/trustee of any property which passes to any person under the age of 18 years and with respect to which I am authorized to appoint a guardian/trustee and have not otherwise specifically done so. Guardian shall establish separate guardianship accounts and shall have the power to use income from time to time for the beneficiary's education, including technical and vocational training and graduate school, travel, support, and welfare without regard to his or her parent's ability to provide for such education, travel, support, and welfare, or to make payment for these purposes, without further responsibility, to the beneficiary or to the beneficiary's parents or to any person taking care ofthe beneficiary. Guardian shall administer the account until he or she becomes 18 years of age, at which time the guardian shall transfer the principal and income remaining in the separate guardianship account to my trustee, being the same person as my designated guardian, who shall then administer a trust account, of both principal and income and any other funds transferred to the accounts designated, for the beneficiary's education, including technical and vocational training and graduate school, travel. support, health, and welfare. When the guardianship or trust account is less than $5,000.00 or the J beneficiary of the separate trust becomes 25 years of age, the share of the beneficiary remaining V,/'" in the account shall be paid to the beneficiary in full and the guardianship or trust terminated. In :$ the event of the death of any beneficiary after my decease and prior to reaching the age of 25 ,,) years, his or her share shall be distributed equally among his or her children, equally; otherwise '-.!- to my surviving children or child to be administered in accordance with the guardianship and/or ,..> trust provisions. No interest under this instrument shall be transferable or assignable by any .,: beneficiary, or be subject during its life to the claims of creditors. Guardian and trustee shall not d be required to file accountings with any court. In the event that any provision of this will shall ~ be interpreted to violate the Rule against Perpetuities, then the remaining provisions of this will C.....- shall not be invalid. Trustee shall administer the trust and dispose of assets so as not to violate ~C' the rule, making distribution as required to a life or lives in being plus 21 years. ,~ Item Five: All estate, inheritance, succession, and other taxes, imposed or payable by reason d of my death, and interest and penalties thereon, with respect to all property comprising my gross :: estate for tax purposes, whether or not such property passes under this will, shall be paid out of I- the principal of my residuary estate, without apportionment or right of reimbursement. .I. J ,J ") ) -', d >Ly) Item Six: I direct that my personal representative or guardian shall not be required to give bond for the faithful performance of their duties in any jurisdiction. Item Seven: In addition to the rights and powers given to the fiduciaries by law or elsewhere in this will, I give to my Executor during the full time necessary and for the administration of my estate the following rights and powers to be exercised in his or her sole discretion. A. To retain any real or personal property which may at any time form a part of my estate so long as he or she deems it advisable. B. To invest in any real or personal property without restrictions to legal investments. C. To repair, alter, improve or lease for any period oftime any real or personal property and to give options for leases. D. To sell at public or private sale, for cash or credit, with or without security, to exchange or to partition, to mortgage or pledge real or personal property, and to give options for leases. E. To make distribution in kind. F . To compromise claims. IN WITNESS WHEREOF, I have hereunto set my hand this lj-1.b day of May, 2000. ,::) I ("\ Signea~Q"-,~ 7/,,,,,,, '.~1 L",c~, C Laura Mary Sham~ gh '\ ".\C , ) ., '..' The preceding instrument, consisting of this and three other typewritten pages each identified by the signature of the Testatrix was on the day and date thereof signed, published and declared by the Testatrix therein named as and for her last will, in the presence of us, who at her request, in her presence and in the presence of each other have subscri our es. ~, 9~u~h COMMONWEALTH OF PENNSYL VANIA ss COUNTY OF CUMBERLAND We John H. Broujos and ::JOyc.e J tePf" , witnesses whose names are signed to the attached or foregoing instrument being duly quafified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her last will; that she signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight ofthe Testatrix signed the will as witnesses; and that to the best of our knowledge, the Testatrix was at the time 18 or more years of a , of sound mind and under no constraint or undue influence. '\ G ~ \s'-1\ Sworn and subscribed to before me this --!f!!:- day of May, 2000. L~eJL W6J~ N TARY PUBLIC Notarial Seal Bridget Ann Corcoran, Notary Public Carlisle Bora, Cumberland County My Commission Expires June 10, 2002 COMMONWEALTH OF PENNSYLVANIA ss COUNTY OF CUMBERLAND I Laura Mary Shambaugh whose name is signed to the attached document, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my last will; that I signed it as my free and voluntary act for the purposes therein expressed. It) ". Sworn and affirmed to and acknowledged before me this ~ day of May, 2000. ~~.J L a-W~ NO ARYPUBLIC Notarial Seal Bridget Ann Corcoran, Notary Public Carlisle Bora, Cumberland County My Commission Expires June 10,2002 .. '\, ' . -, ~:,'f: _ t~,l"<-' \-1"" '.,l>J , " '-. '~""""""''''''''.~"-', "." ----"..' ....... - "..."" .~.~ "-~."'""--"""""'-"""" .'- ..-~:..... ~ ".,-..~,.. .-"",- ,."".-..... , ',- '" ~,... .. "_ .~,,"'.." ~',_. .,_,w,_ .. f -4f1 ~, BANGS LAW OFFICE 429 South 18th Street Camp Hill, PA 17011 Glenda Farner Strasbaugh, Register of Wills Cumberland County Courthouse t One Courthouse Square Carlisle, P A 17013 hhHU tJ.ttU',I'hl 1'1,"1 'JhrJUIH ""H' 'IJllf. II'