HomeMy WebLinkAbout05-02-08
15056041125
REV -1500 EX (06-05)
PA Department of Revenue '*
~~~~~~~~~~~uaITaxes . INHERITANCE TAX RETURN
Harrisbur , PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
r>FF;; '{\.L;, ,i';:~, -(":f ,-.1 t
County Code Year
2 1 0 8
File Number
o 0 6 0
187242285
12202 007
09281930
Decedent's Last Name
Suffix
Decedent's First Name
Kermit
MI
L
Shultz
(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
[ZJ 1. Original Return
D 4. Limited Estate
[ZJ
D
2. Supplemental Return
D
o
o
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4a. Future Interest Compromise (date of
death after 12-12-82)
7. Decedent Maintained a Living Trust
(Attach Copy of Trust)
10. Spousal Poverty Credit (date of death 0 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. 0)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
6. Decedent Died Testate
(Attach Copy of Will)
9. Litigation Proceeds Received
o
o
o
o
8. Total Number of Safe Deposit Boxes
J 0 h n
C .
Zepp,
I I I
71752 8 890 0
City or Post Office
State
ZIP Code
r-...)
REG 1ST t5'ILLS US~L Y
s: :t) :::II:
rn~(") ::
::0 r-
~u>~ ~
000 -0
83'" :x
: ~ Cf!
~TE FILED 0
:;1, eG
r 1\ r.... j
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CJ
.T)
Firm Name (If Applicable)
Attorney
First line of address
A t
Law
P 0
Box
204
Second line of address
843 8
Carlisle
P i k e
-.........
Y 0 r k
Springs
P A
17372
Correspondent's e-mail address:
Wellsville
PA 17365
DATE rt
~ IY .O~
PA 17372
PRESENTATIVE
York Springs
PLEASE USE ORIGINAL FORM ONLY
Side 1
L
15056041125
15056041125
---I
~
......J
15056042126
REV-1500 EX
Decedent's Social Security Number
187242285
Decedent's Name: Kermit L. Shultz
RECAPITULATION
1. Real estate (Schedule A)
. . . . . . . . .. 1.
2. Stocks and Bonds (Schedule B)
. . . . . ..... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E)
5.
o. 0 0
2957.73
4. Mortgages & Notes Receivable (Schedule D)
.......................4.
6. Jointly Owned Property (Schedule F) 0 Separate Billing Requested. . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 0 Separate Billing Requested. . . . . .. 7.
8. Total Gross Assets (total Lines 1-7) .......................... . 8. 2 9 5 7 . 7 3
9. Funeral Expenses & Administrative Costs (Schedule H) 9. 9 4 5 5 . 3 0
............... .
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) . . . . . . . . . . . . 10. 1 9 1. 3 3
11. Total Deductions (total Lines 9 & 10) . . . . . . . . . . . . . . . . . . . . . . . . . . . 11. 9 6 4 6. 6 3
12. Net Value of Estate (Line 8 minus Line 11) 12. - 6 6 8 8 . 9 0
. . . . . . . . . . . . . . . . . . . . . . . . .
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.
-6688.90
TAX COMPUTATION - SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2) X.O _ 0 . 0 0
16. Amount of Line 14 taxable
at lineal rate X .0 0 . 0 0
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.
o. 0 0
O. 0 0
O. 0 0
O. 0 0
O. 0 0
16.
17.
18.
19. Tax Due
.. ..... .... ....... ....... ........ ....... .....19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
o
Side 2
L
15056042126
15056042126
......J
REV-15 O,EX Page 3
Dee dent's Complete Address:
DECE ENT'S NAME
Kernd 1. Shultz
STRE T ADDRESS
1 We t Penn
File Number
21 08 0060
CITY
Carli Ie
I STATE
PA
T ZIP
117013
Tax Payments and Credits:
1. T x Due (Page 2 Line 19)
2. C ~dits/Payments
A. Spousal Poverty Credit
8. Prior Payments
C. Discount
(1)
0.00
Total Credits (A + 8 + C) (2)
0.00
3. In eresUPenalty if applicable
D. Interest
E. Penalty
TotallnteresUPenalty ( 0 + E) (3)
4. If ine 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in avalon Page 2, Line 20 to request a refund. (4)
0.00
B. Enter the total of Line 5 + SA. This is the BALANCE DUE.
(SA)
(58)
0.00
0.00
0.00
5. If ine 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5)
A. Enter the interest on the tax due.
0.00
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; ...................................................................... D 00
b. retain the right to designate who shall use the property transferred or its income; ............................... D 00
c. retain a reversionary interest; or ................................................................................................ D 00
d. receive the promise for life of either payments, benefits or care? ....................................................... D 00
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? ....................................................................................... D 00
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? ......... D 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? .................................................................................................. 0 !XI
IF TH = ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
For datE 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. ~9116 (a) (1.1) (i)].
For datE 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. ~9116 (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 t x return are still applicable even if the surviving spouse is the only beneficiary.
For datE of death on or after July 1, 2000:
The tax ate 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. ~9116(a)(1.2)].
The tax ate 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. 9116(1.2) [72 P.S. ~9116(a)(1)].
The tax ate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. ~9116(a)(1.3)J. A sibling is defined, under
Section 102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1 08 EX + (6-98)
.
OMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTA E OF
Kern't L. Shultz
FILE NUMBER
21 08 0060
Include the proceeds of litigation and the date the proceeds were received by the estate.
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
IT M VALUE AT DATE
NUI\I~ER DESCRIPTION OF DEATH
1. Wachovia 2,815.28
Checking Account
2. Security Deposit refund 1.33
3. Comcast Refund 104.57
4. Embarq Refund 21.57
5. PPL (Electric Refund) 14.98
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
2,957.73
REV-1 11 EX + (12-99)
.
( OMMONWEAL TH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
ESTA E OF
Kern't L. Shultz
IT M
NUM 3EH
A.
B.
FILE NUMBER
21 08 0060
Debts of decedent must be reported on Schedule I.
DESCRIPTION
FUNERAL EXPENSES:
Dugan Funeral Home
ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative (5) Connie S. Shultz
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 308 Kralltown Road
City Wellsville
State P A
Zip 17365
Year(s) Commission Paid:
2
3
Attomey Fees John C. Zepp, III
Family Exemption: (If decedenfs address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
State
Zip
Relationship of Claimant to Decedent
4.
Probate Fees Cumberland County Register of Wills
5.
Accountanfs Fees
6.
Tax Retum Preparer's Fees
7.
8
9
1
1
I
Cumberland County Law Journal
The Sentinel
Moyer Glass (couch removal)
Cumberland County Register of Wills - Inventory
Cumberland County Register of Wills - Filing Return
Cumberland County Register of Wills - Family Agreement
TOTAL (Also enter on line 9, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
AMOUNT
7,489.70
1,500.00
73.00
75.00
166.60
65.00
15.00
15.00
56.00
9.455.30
REV-1 12 EX + (12-03)
'*'
SCHEDULE.
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
(OMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTA E OF
Kern't L. Shultz
FILE NUMBER
21 08 0060
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
I EM
Nl MBER
DESCRIPTION
1,
Pinker Associates (Toe Nail Trim)
4.
Check written prior to death clearing after
AARP
5.
Check written prior to death clearing after
Comcast
6.
Check written prior to death clearing after
PPL Electric
7.
Check written prior to death clearing after
PPL Electric
fmal BilI
VALUE AT DATE
OF DEATH
7.36
59.25
79.47
14.98
30.27
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
191.33
'~-"''''(*
SCHEDULE J
BENEFICIARIES
C MMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTA E OF
Kenn't L. Shultz
NUMB R
1.
NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
See, 9116 (a) (1.2)]
2.
Frederick L. Shultz
308 Kralltown Road
Wellsville, PA 17365
Debarah M. Thrush
163 N. Bedford St. Apt. 2
Carlisle, P A 17013
Jeffrey L. Shultz
222 Mulberry Ave,
Carlisle, P A 17013
FilE NUMBER
21 08 0060
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Lineal
Lineal
Lineal
AMOUNT OR SHARE
OF ESTATE
33.30
33.30
33,30
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
3.
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART 11- ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
KERMIT L. SHULTZ
I, KERMIT L. SHULTZ, of Tampa, Florida, being of sound and disposing mind,
memory, and understanding, do hereby publish and declare the following as and for my Last
Will and Testament, hereby revoking any and all Wills by me at any time heretofore made.
ITEM I
I direct that all of my legal debts, the expenses of my last illness, and my funeral
\ expenses be paid from my residuary estate, as soon as practicable after my decease, as
part of the expenses of the administration of my estate.
:r:-:~
. ..-..
;-'..
..,
ITEM II
-.1
All of the rest, residue, and remainder of my estate, real, personal or mixed, of ::::
_..~ ..
Ul
whatsoever kind and nature and wheresoever situate at the time of my decease, I give,'\
devise, and bequeath to my three children in equal shares. My children are as follows:
Frederick L. Shultz, Oebarah M. Thrush, and Jeffrey L. Shultz.
In the event that any of my children should predecease me, then the share to which
that child would have been entitled I hereby give, devise, and bequeath to that child's
children, per stirpes. In default of issue of any child of mine, then the share to which that
child would have been entitled I hereby give, devise, and bequeath to my then living
children in equal shares. Any of such effects distributed to a minor may be delivered to the
person with whom the minor resides, or such other person as may have custody and control of
the person of the minor, without the intervention of a guardian, and the receipt of any such
person shall be a full acquittance of my Executor as to such distribution.
ITEM III
I nominate, constitute and appoint my appoint my son, Frederick L. Shultz Executor of this
my Last Will and Testament. In the event my son should predecease me, resign,
renounce or be incapable of acting as the Executor of this my Last Will and Testament, then I
nominate, constitute and appoint my daughter-in-law, Connie S. Shultz, Executrix of this my
Last Will and Testament.
ITEM IV
I direct that no bond shall be required of any fiduciary, trustee, executor or guardian,
hereunder in any jurisdiction.
IN WITNESS WHEREOF, I, KERMIT L. SHULTZ, named herein, have
hereunto set my hand and seal to this my Last Will and Testament, consisting '6f'
;"1.. I
two (2) typewritten 'Pages, on this the ,,~'- ~
~.~~
~~J~
KERMIT L. SHULTZ c
(SEAL)
day of
,1999.
Signed, sealed, published, and declared by the above-named Testator as and for his Last
Will and Testament, and we, in his presence and in the presence of each other, and at his
request, have subscribed our names as witnesses hereto.
lcJ,....-A. ~
;-/frk ~~7~) · ,~
Address' /
i]e.::,d( 0't'~ fl'\~ 3,. ~
Address '-.~
2
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA )
) SS.
COUNTY OF ADAMS )
I, KERMIT L. SHULTZ, Testator whose name is signed to the attached or foregoing
instrument having been duly qualified according to law, do 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.
(SEAL)
Sworn or affirmed to and acknowledged
before ~~ by KERM!T L. SHULTZ,
this A \~ day of :&1
1999,
/7
.~/; /J . 114 ~
..'j'J(!1.ulJt ~'1.(
otary Public
NOTt~Ri^L SEAL -1
RICHARD E. STARE, Notary PUl'jEc I
Latimore Township, Adams C(Jun"J I
M om mission Expires March 3, ~en:i 1
....._..-..,.._"'JI
3
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA )
) SS.
COUNTY OF ADAMS )
We, tAl (J IJ, ~ ;!( ,. ~h<.tf'v1 and :J"bv........ 0.-..t....efP~{ , the witnesses whose names
are signed to t~e attache or foregoing instrument, being duly qualified according to law, do
depose and say that we were present and saw the Testator sign and execute the instrument
as his Last Will and Testament; that KERMIT L. SHULTZ signed willingly and that he
executed it as his free and voluntary act for the purposes therein expressed; that each of us in
the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our
knowledge, the Testator was at that time 18 or more years of age, of sound mind and under
no constraint or undue influence.
(SEAL)
Sworn and affirmed to and acknowledged
be.fore me by. D...J~ J!$. .~t<u.Nu~nd
duL. L. h~ '/ ,Wit . esses, thIs the
ti.1~ day of . \.3
1999.
J.,fn,v:/. r! ~
~ry Publrt
---............ -
NOTARIAL SEAL J
RICHARD E. STARE, Notary Public
Latimore Township, Adams County
ommlsslon Ex ires Match 3, 20~
4
InRe: ESTATEOFKERMITL.
SHUL TZ,
deceased
: IN THE COURT OF COMMON PLEAS
: CUMBERLAND COUNTY, (") ~
: PENNSYLVANIA ~g gg
. ~l~ !
. NO. 2008-60 -5:,...;t::lJ ..!..
C::j''''-''A ......
~ F AMIL Y SETTLEMENT ~~ ~
: INDEMNIFICATION AGRiEMEN~
. 0
: Filed on behalf of Connie S. Shultz
: Executrix of the Estate of
: KERMIT L. SHULTZ,
: Deceased
WHEREAS, KERMIT L. SHULTZ, with his last address at 1 West Penn, Carlisle, P A 17013, died
testate on December 20,2007; The Last Will and Testament dated July 21, 1999, was duly admitted
to probate on by the Register of Wills of Adams County, Pennsylvania on January 17,2008, at the
above number and term; and
WHEREAS, Connie S. Shultz has been duly appointed as Executrix of the Estate of
KERMIT L. SHULTZ, Deceased; and
WHEREAS, the parties in interest to the Estate of KERMIT L. SHULTZ, are:
(1) Frederick L. Shultz, Daughter, beneficiary
(2) Debarah M. Thrush, Daughter, beneficiary
(3) Jeffrey L. Shultz, Daughter, beneficiary
WHEREAS, all known outstanding debts and obligations of the Decedent have been paid in
full;
c)
WHEREAS, each of the parties to this Agreement has been furnished with a complete list of
the estate assets and receipts, attached hereto as Exhibit "A" and disbursements as set forth on the
accounting attached hereto as Exhibit "A"; and
WHEREAS, it is the desire of the parties to this Agreement, that final distribution of this es-
tate be accomplished without a formal accounting to the Orphans' Court Division of the Court of
Common Pleas of Adams County, Pennsylvania, or any other court of competent jurisdiction, it be-
ing the desire of the parties to avoid the expense of a formal accounting; and
WHEREAS, the parties to this Agreement each acknowledge they have received a proposed
Summary of Account attached hereto as part of Exhibit "B".
WHEREAS, the parties to this Agreement each acknowledge they have received a proposed
Schedule of Distribution attached hereto and marked as Exhibit "B"; and
WHEREAS, each of the parties to this Agreement does acknowledge their receipt from the
Executrix the distribution, if any, as evidenced by Approval of Account and Release, which is at-
tached hereto and marked as Exhibit "C".
NOW, THEREFORE, WITNESSETH, in consideration of the mutual promises, covenants
and agreements recited herein, the parties do agree as follows:
1. Each of the parties to this Agreement does hereby release and forever discharge
the Executrix from any and all liability which may from time to time arise in connection with
her service as Executrix of the Estate of KERMIT L. SHULTZ, Deceased. The parties do
further agree to indemnify and hold harmless the Executrix from any and all liability which
may arise against the estate from creditors or other claimants.
2. Each ofthe parties does hereby acknowledge receipt ofthe assets, if any, described
in the Exhibits attached hereto.
3. Each party to this Agreement acknowledges that this Agreement shall be indexed and
recorded in the estate proceedings in this or any other state, and that the terms hereof shall be
binding upon their respective heirs, successors, Executors and assigns.
4. This Agreement shall be governed by the laws ofthe Commonwealth of Pennsylvania.
Dated at York Springs, Pennsylvania this l!L day of
~
,
,2008.
~~/jJu~
~
(
ACCOUNTING OF THE ESTATE OF KERMIT L. SHULTZ, DECEASED
ASSETS
mm m..mmmmm..mmDescriptionmmm mmmm.mmmmmm"m
.y'{~~h~Y~.~~~h~.~~!~gb:~~9.~! ........m_
~~~~!.~!.yp.~P9.~!!.E~~9.-mmm ......... .mm.mmmmmmmmmm mm_o
Corneast Refund
g~l>~!.q~~f~~4m .
:P:P!':Q~:1.~~!.!.!~~~fl:1.~4)mm ...........mmm . mmmmm_mmmmmmmmmm
Amount
mmm~&I?:~~
1.33
104.57
21.57
14.98
Total
........ ....................................... ......... ...........J.......
,
mmm i
2,???:??.....
ACCOUNTING OF THE ESTATE OF KERMIT L. SHULTZ, DECEASED
DISBURSEMENTS BY EXECUTRIX
..............,.........
.....Q~g~...f~~~E~1..!.-I.9.~~....m m
....!..~.~..~..:...?:.~pp.~I!!....m
~~~l>~!.1.~~4..~g~~!y~~g!~!~!...gf..~}J1..~..
~~~l>~E1.~~4..~9.~~o/!.:.~~!~~~1....
The Sentinel
mM9.y~!..Ql~.~~{~~~~h.!.~~.~y~1.)m ...
:P!~~!.b:~~g~~~~~~(T~~~~gT!.!~)m.m .mm. mm_mmmmm. mOm
~h~~~~i~~.~..P!.!g!.!.~4~~!h~1.~~!~g~f.!~!)_~b:~mm ........ .mmm.......... m... .....mm...................
m~h~~~~!~~.~..P!.!~!.!.~A~~!.h~1..~mari~g~f.!~!.'.~g~~~~!m
~h~~t~i~~~p!.!.~!..!~9.-~~thm~1.~~!.!~g~f.!~!.,...:p.:p!.:...~1.~~~!.!~ ..mmm.............mm........... m...t........
~h~~~~i!!~~p!.!~!.!.9.4~~!h~1.~~!.i.~g~f.!~!.'P:P!.:~1.~~~!.i.~,~!~~1.mm.
.mDescription...mmmmmmmmmm. Amount
mmm ..mmmmm .mmmmmmmmmmmmmm. ......m?'.4~?:?9
...... .m.m mmmmmmmmm,m. .m J~?99:99m
, 73.00
...................... .......................................... .......................... ,.......... ......................... ....................
75.00
166.60
65.00
7.36
59.25
79.4 7
14.98
30.27
,
...................... ...........A.......
.................................... ............ ......... ...........+
..........~?,?~Q:~?....
Total
Exhibit "A"
ACCOUNTING OF THE ESTATE OF KERMIT L. SHULTZ, DECEASED
SUMMARY OF ACCOUNT
Estate Assets
Less Disbursements
$ 2,957.73
$ 9,560.63
BALANCE
$ -6,602.90
The following assets are hereby proposed for distribution to heirs pursuant to this Agreement:
Name Cash
Frederick L. Shultz 0.00
Debarah M. Thrush 0.00
Jeffrey L. Shultz 0.00
Exhibit "B"
RECEIPT OF DISTRIBUTION, APPROVAL OF ACCOUNT AND RELEASE
The undersigned being those interested under the Last Will and Testament of KERMIT L.
SHULTZ, Deceased, desire that the Estate be distributed without the formality of a court accounting.
The Executrix of the Estate is willing to consent to such distribution upon receipt of a proper release,
which is the purpose of this document to provide. In consideration of the willingness of the Execu-
trix to make distribution without the formality of a court accounting and agreeing to be legally bound
hereby, the undersigned, individually, and on behalf of their respective heirs, personal representa-
tives, successors and assigns, do hereby:
1. Waive the filing of an account of the administration of the Estate in any court.
2. Declare that they have examined the attached informal account and proposed state-
ment/schedule of distribution of the Executrix ofthe Estate of KERMIT L. SHULTZ, Deceased; find
it to be true and correct in all particulars; accept and approve it with the same force and effect as if it
had been prepared and filed with, audited, adjudicated and confirmed absolutely by a court of com-
petentjurisdiction; and as if the balance of principal and income had been awarded by the court in
accordance with the statement/schedule of distribution.
3. Warrant that the beneficiaries named in the informal accounts and statements/schedules of
distribution are entitled to receive the entire distribution thereof in accordance with the informal ac-
count and statement/schedule of distribution.
4. Warrant that they know of no outstanding and unsatisfied claims against the Estate and
approve the distribution of the balance of principal and income shown in the informal accounts and
statements/schedules of distribution to the persons set forth therein.
Exhibit "C"
5. Absolutely and irrevocably release and discharge the Executrix her heirs and personal repre-
sentatives of and from any and all actions, liabilities, claims and demands relating in any way to the ad-
inistration of the Estate and distribution in accordance with the informal account and state-
ent/schedule of distribution and without a court accounting and adjudication.
6. Agree to indemnify and hold harmless the Executrix her heirs and personal representatives
rom and against any claims, liabilities, loss or expense (including costs and counsel fees) arising from
y cause whatsoever, which the Executrix may incur as the result of the administration of the Estate and
i s distribution in accordance with this document to the extent to which they have received distribution
nder this agreement, including, but not limited to, any liability for any Federal Estate Tax, Pennsylvania
eritance Tax or any other death taxes, and any Federal or Pennsylvania Income Taxes and Pennsyl-
nia Personal Property Taxes, together with any interest, penalties and costs incidental thereto, relating
any way to the Estate and also including, but not limited to, any assets received or payments or distri-
b tions made by reason of any negligence or mistake of law or fact.
7. The undersigned hereby acknowledge receipt of those assets as set forth on the proposed
st tementlschedule of distribution as of the date of the execution of this receipt of distribution, approval
o account and release.
D te: if //111 [) ~
rederick L. Shultz
~~~
ebarah M. T sh ~