HomeMy WebLinkAbout05-14-08 (2)
....J
15056051058
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
INHERITANCE TAX RETURN
RESIDENT DECEDENT
OFFICIAL USE ONLY
County Code Year
File Number
21 07
0873
Date of Birth
195-16-3248
August 15,2007
March 17, 1925
Decedent's Last Name Suffix
Goff Jr.
Decedent's First Name
Harry
MI
L
(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
<.J 1. Original Return
2. Supplemental Return
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
4. Limited Estate
.'
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 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
8. Total Number of Safe Deposit Boxes
Andrew C. Sheely, Esquire
717-697-7050
PO. Box 95
(")0
Q--rl
:0
~
~~
-0
:x
127 South Market Street
US E:t'l.JLY
::Do
-<
Firm Name (If Applicable)
Andrew C. Sheely, Attorney at Law
First line of address
.s;;-
Second line of address
City or Post Office
Mechanicsburg
State
ZIP Code
7055
DATE fiLED
N
PA
Correspondent's e-mail address:~ndrewc.sheely@verizon.net
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.
Slr/~SO FO~ .. ... .mnnuu 6/1'!/Cff
~~;th A. Stager, 14 Re er Road, Camp Hill, PA 17011
SIGN~E OF PRE PARER OT~IH,AM:pRESENTAT'VE
,ACZt!~ -C--~----- ~- __n ----- ----------
Andrew C. Sheely, Esquire, 127 S. Market St., P.O. Box 95, Mechanicsburg, PA 17055
PLEASE USE ORIGINAL FORM ONLY
f)ATF
Sll~ /0;
Side 1
L
15056051058
15056051058
--.J
"
~
---1
15056052059
REV-1500 EX
Decedent's Name:
L. Goff
Jr.
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.
4. Mortgages & Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . .. 4.
5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) . . . . . . .. 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested . . . . . .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) 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, or
transfers un~or C::ec. 9116
(a)(1.2) X .0
16. Amount of Line 14 bv~ble
at lineal rate X .045
17. Amount of Line 14 taxable
at sibling rate X .12
18. Amount of Line 14 taxable
at collateral rate X .15
15.
493,435.35
16.
17.
18.
19. TAX DUE. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
0~'l
15056052059
Side 2
Decedent's Social Security Number
195-16-3248
204,557.40
210,760.41
15,320.54
89,401.21
520,039.56
16,434.90
10,169.31
26,604.21
493,435.35
493,435.35
22,204..59
15056052059
.-J
RE' '-1500 EX Page 3
File .N.umber
Decedent's Complete Address:
DECEDENT'S NAME
Q873
DECEDENT'S SOCIAL SECURITY NUMBER
195-16-3248
Harry L. Goff, Jr.
STREET ADDRESS
3816 Carriage House Drive
CITY
Camp Hill
I STATE
I PA
ZIP
17011
Tax Payments and Credits:
1. Tax Due (Page 2 Line 19)
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
22,204.59
20,500.00
1,07892
3. Interest/Penalty if applicable
D. Interest
E. Penalty
Total Credits (A + B + C ) (2)
21,578.92
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE.
(5)
(5A)
(5B)
625.67
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.
625.67
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;......................................................................................... 0 00
b. retain the right to designate who shall use the property transferred or its income; ........................................... 0 00
c. retain a reversionary interest; or.......................................................................................................................... 0 [i]
d. receive the promise for life of either payments, benefits or care? .................................................................... 0 [iJ
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. 0 00
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. 0 00
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ..................................................................................................................... ~ 0
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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. ~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 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 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. ~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 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 rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 PS. ~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.
HEV-1c-;02 EX+ (6-98)
SCHEDULE A
REAL ESTATE
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Harry L. Goff, Jr.
FILE NUMBER
21-07 -0873
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 sell, 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
1.
DESCRIPTION
3816 Carriage House Drive, Camp Hill, Cumberland County, PA 17011
VALUE AT DATE
OF DEATH
Property is Parcel Number 10-20-1848-217
2005 Assessed value of $167,670.00 X CLR (1.22)
204,55740
TOTAL (Also enter on line 1, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
204,55740
TaxDB Result Details
11/05/2007 12:47 PM
Detailed Results for Parcel 10-20-1848-217. in the 2004 Tax Assessment Database
DistrictNo
10
Parcel_ID
10-20-1848-217.
,38]6
Direction
Street CARRIAGE HOUSE DRIVE
Ownerl GOFF, HARRY L
Type R
CurLandVaI
, CurImpVal
CurTotVal
CurPret'Val
Acreage .36
CIGrnStat
_~04''''''_____ ._(....>$_.,_,,~______if(.j
TaxEx
SaIeAmt
SIOOO
SaleMo
08
01
SaleDa
SaleCe
19
Sale Y r
DeedBkPage
72
0023M-00374
_.'_I"'I~I!l~I""~JIlII I~ ~ 1~.6 ~,~__
Yeal"BIt
1968
HF _File_Date
0] 104/2005
HF _Approva'-Status A
http://taxdb,ccpa.net/details,asp?id= 10-20-1848-217 .&dbselect= 1
Page 1 of 1
SCHEDULE B
STOCKS & BONDS
COMMONWFMI I OF p[Nr.8"lVAI~IA
INIILJ11TAi~C[ Ti\X HEl!RN
HESIDENi DE:.CEDE \11
F~TATF OF
Harry L. Goff, Jr.
FILE NUMBER
21-07 -0873
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBER
10.
11.
12.
13.
H.
15
16.
2.
I
I DESCRIPTION
AT & T, Inc. r,ommon stock - 96 shares valued at $3780/share at date of death
Cigna Corporation common stock - 960 share valaued at $48.05/share at date of death
3.
Citigroup, Inc. common stock - 89 shares valued at $45.85/shares at date of death
4.
Exxon Mobil Corporation common stock - 1,048 shares valued at $82.88/share at date of death
5.
Ford Motor Company common stock - 438 snares valued at $8.13/share at date of death
R
General Electric Company common stock - 106 shares valued at $37 33/share at date of death
7.
Medtronic, IlIc. common stock - 1 share valued at $52.97/share at date of death
8
Microsoft Corporation common stock - 201 shares valued at $28.52/share at date of death
9.
Perkin Elmer Inc. common stock - 340 shares valued at $27.07/share at date of death
Rite Aid Corporation common stock - 480 shares valued at $4.94/share at date of death
Tenet Healthcare Corporation common stock - 300 shares valued at $4. 16/share at date of death
Ventas Inc. common stock - 26 shares valued at $68.56/share at date of death
i Verizon ConllTlunication common stock - 13 shares valued at $40.83/share at date of death
Wyeth common stock - 515 shares valued at S 45.37/share at date of death
: Blackrock Enhanced dividenci achiever trust - 1,000 shares valued at $12.43/share at date of death
i
John Hancock Tech Fund - at date of death
VALUE AT DATE
OF DEATH
$ 3.62880
$46,128.00
$ 4,08065
$86,85824
$ 3,56094
$ 3,95698
$ 52.97
$ 5,7:32 52
$ 9,20380
$ 2371.2D
$ 1,24800
$ 1. 782 56
$ 530.79
$233655h
$12,43000
$5,829.41
TOTAL (Also enter on line 2, Recapitulation) $ 210,760.41
(If more space IS needed. insert .,dcitional sheets Of the sanle Size)
REV-15GB EX+ (6.98)
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Harry L. Goff, Jr.
FILE NUMBER
21-07 -0873
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.
ITEM
NUMBER
DESCRIPTION
VALUE AT DATE
OF DEATH
$2,554.00
$2,20000
1. Sovereign Bank - checking Account
2. Vehicle -1994 BMW 540i, #WBAHE6319RGF26045, 98,994 miles
3. Personal Property per appraisel
$ 710 00
$9,85654
4. Janney Montgomery Scott money market account #3704-6037
TOTAL (Also enter on line 5, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
15,32054
lIV'f' uu ,-UUI
11l':_.~::J ~::Jq rn t1Unt.;;, 1 tJUJ \iltUUt' Kl:.flLTOl\
FAX NO. 7177630290
P. 03
4801 Carlltle PIM
Meohi\nlosblXg. PA 17000
CARLISLE PIKE
PREOWNEO
Fax
19:
'lOW
FM:
,......
,
,Phone:
DIIteI
ReI
CCI
. 0 urgent a For Rmerw Cl ....... GoIIIment 0 ,.... KepI" 0 P..... R.cyola
7 jYI.J,MI-r.sfr...JI-i>b1f~r fltlct.. el Vtl1o< ot
.JI.:l~OO, . Q t>., 1'1'i '1 IS 1"\ w 54 () ; P"w IlA H 64>31'1 R&f.;u.o'f S.
7 ~ '17'-!1t\;
~:,
s,. /r $ I"H" nt/f j ~ /'
C p.;/,'sle ~'k- ~ fft.(J Uf\l?J
't-2D-07
APPRAISAL
Personal Property of H It-P-..fzY )...../ C-OF F "EsT:.1Tt5
Appraised by Chuck E. Bricker AU094-L Date IJ-).. tJ - tJ 7
ITEM VALUE ITEM VALUE
-:::;oFA :2drJD
,2.... r' /fA "c' / LJ I.JC .2.. () 0 c,
<:, -n::- P....E D S lJ{j
3 L/fHP 7718Le:S /d,..;;IC :{tl 66
~ pc DJ ;V/fI.l.9 JZ.11 I S; lET g tJ, ()o
5Pc D/A;cTTc SET LJ() 11)0
~~ orA 8!!-d of), ~(.\
j. -fI1P S T4~d JO,OIJ
D~~K w/ 8{)()""c4-S~ TlJf 3 il, or)
;:ZC CL-/A/P-K 30t()O
Cd4-112- ...s-;()d
R 0 vtt. SnC-t-.r- ID (j (}
ffl Pt-c rUh,V" /dc4 30 lid
HA-PL.c- cJt&sr be) o()
~ Pc- MAPLC; R&~\ 1-1-- OR-tS$c{t.. / 6 11.1) tJ
J.j Pc --L/ re:- R Ec-f /{11, $c-T r; O. du
A- <:;: <,:T; ~_... A A .1 .. 20. tJ t)
J-HcTAL f}lfcL-F v,A/(r<.. ;l.. (J . ~ tJ
A <:<:;T. P/cTS aa {)d
:L. W b<J B (j OK SI(6LF-S 2.JJ (! 1\
.A s.-:<lT () rS!tCS/ 9L4-,,:)~ - PAI,U)' Ere CjtJ Va
--:# ?/tJ, do TlJ i7-fL A jJP /.U-j..5 4. L
~
7Jl. j, ~tMAA'Jw Q..,II _ ,H.., , I
A-UOQ4-L
,
;
:
i
HEV-1510 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Harry L. Goff, Jr.
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
FILE NUMBER
21-07-0873
This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
DESCRIPTION OF PROPERTY
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH % OF DECO'S EXCLUSION TAXABLE
NUMBER THE DATE OF TRANSFER. ATIACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET INTEREST (IF APPLICABLE) VALUE
1 M & T Bank IRA date of death value $ 40,000.00 100% $40000.0
2. Sun Regatta Platinum Variable Annuity - date of death value, Control Number $ 49,401.21 100% $49,4012
507907900291444, Cusip #866793854
TOTAL (Also enter on line 7 Recapitulation) $ 89,4012
(If more space is needed, insert additional sheets of the same size)
Ci
REV-1511 EX+ (12-99)
SCHEDULE H
FUNERAL EXPENSES &
ADMINISTRATIVE COSTS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
-ART ESTATE OF
~ Harry L. Goff, Jr.
FILE NUMBER
21-07-0873
Debts of decedent must be reported on Schedule 1.
ITEM
NUMBER
A.
DESCRIPTION
AMOUNT
1.
FUNERAL EXPENSES:
Neill Funeral Home
Funeral luncheon - Radisson
9,682.80
92080
2.
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative(s) Elizabeth A. Stager
Social Security Number(s)/EIN Number of Personal Representative(s)
Street Address 140 Reeser Road
City Camp Hill
. State PA
Zip 17011
Year(s) Commission Paid:
3,02500
2.
Attorney Fees
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City
. State
.Zip
Relationship of Claimant to Decedent
470.00
4.
Probate Fees
5. Accountant's Fees
6.
Tax Return Preparer's Fees
300.00
9
Misc. expenses - postage
Filing fees for inheritance tax return
Reimbursement to Co-Executor for estate administration, including tolls and travel expenses
Reserves to conclude administration of Est., including First & Final Accounting, advertisement,filing fees
15.50
15.00
1.40580
600.00
7.
8
10
TOTAL (Also enter on line 9, Recapitulation) $
16,43490
(If more space is needed, insert additional sheets of the same size)
Retutr\la tanai' oaaa_
PRINT F()R '
11/07/2007 15:57
7175619918
11/~6/~~07 82:89
SELLER:
1 n 17371B59
NEILLFUNERALHOME
l'C:%U- FH CAMP HIU-
PAGE 132
PA~ 01
PAR'!' ONE OF TWO I'AR'l"S
NJiP.... FUNIRAL MOM[
II-IQI I'ttAUI!I' llfMIT
~:F~'~lA 1"Ol'~" . '411. NO
AISit'- - 20Q~39
ST..,.DmNl' OJl"u!'4UAL GOODS A\llT. :SERVICES SBLEC'l'EM'IlR I,lGRaMlNT
D:rl.efo(~ltl..L..J-'l.1 " I;lQl<ln'$."'klIl~' ~....2.
MM Ml -W- ... Ili)' n
Nltfl1U''Oll'''la,..J HAMf.. L. IrooaF'F~ . gmnfDh1h ~~
~lclnLi1A1Mdro"" 3tu. ~...tp.ru:: "',.~ j)~.. \':Il}' C~, 'It;....._~"... /1t ZlpC4lll~ ,.,..,,"
"""'hR.<r"i"I:I1'l~ EJ.i'lAtV,Df ,0.. S'1"~R. _ F'hcmclND. ("')1 7'~.'J'?O_
l'IIl1:ft....,..'14nn,.^d~'.,'"'~ 12"~ f2J> OilY ~llIIo~ %I~CntIC ".#
COOl'l...h........ N.Ift. - ""- N... t--.J
r;...Pun:ha.,lII'lllt_ AtIdtto~
Anlftlf\l (lmup
!ItmItl<rr ~Ir 0:. CIJd.
l~\~i.'~;".~ l1lo W\ll'd. ~.~~1IlI YOUT 101"'1. Ih. Pun:h.!'C:r.1If1 co.ru..n..", ..r""l', .ls.ln, 11\1, AilI"'"""ot, Tho WOJ,!,..... 1I..n6 ~t IOf.' 1110 Iho ~.'/11Il'r<lYld.....r.r.;
whDllllll1m. .n61111rJ.....,..,' alma. ~or JlOQil1lll.d <'111..101. aaMld.mllM. whit" NC1I """" Il'lTl.D..III\l~ ..~I'ht.. fall IgM Collll, 1I~~, ..\1 ~1WI doaarlbod ,,"low
Vll1lI~1hn"r.Il '" 10 pro,..",.nd ~1I...r", Iho &1IIll' oI,ha dolll!llcmt no""", In thlft f\ iI'IC_r \lllOlIl ~\IIlt llle !\1ftC!,.11ll\1 iI4l"IICllI""" IllClUl'lho;fwpo IllllRtlln ...Id A\lI'"""",n..
we MVl Ilia rljlllllll <ICI1la:1~/llIk\ mea,", ~ae undar Ihl. AIIflGlllCIII """' '1\1III:J\lII.IIJlRlIl1I~^INIl\llllll111 PUrcllMtl or Co-PuI'lll1Ailel'.
Cbll'll'l!l .... nnr, IIr ...... \tlrrm tII," ". ___ a. Iloot Ill'll ......,. II' ... MIl '""""'" III 111'1 or I" I oeMwr w ",III/l", 10 IIlIll lIIIl' 1taII1I.
lit <\lIlIlIll'lc\ln "" _In OJPIII1Itlllelow. tI' Jft "'"'''' . ~ WIlli., MJIlIlOl 0I\l1ltlllllllll. "'~.. ru-.d wIOI """"_"" en"" ._tn JRf'" Iml1o...llI"
YIIn an nellllMl 1M IM\l' for -..mfll\l )DII GICI_ Il\lP~ ")'Ill' ~ I "/IIlIfIIlIl- 1nMlI1UI1!IoIlIit "",lM1Inn Clr ""......br 1111$1. ".... ....1'JIiIIIf "r ",,11.1....
wtwm~'wh7~" .
SECTI J . SERVIC'ES AND MERCHANDISE M&QCHAlliDlit
Cltllht.......llanmll"'CGn!llI"I!T..~~.tl"J1]f.~r.T........... $ 1O'K.tJ6
Ml1lUt""lllltll'SdllPl'~'_
Mad., NamolNllml1ot ~~llHol!'
Mmrzrlnt
"*"'" ~rWood
1ypeatMaI.t
WolflhllClmllJl;
Shell Slyl.
'nta.l..
llJ.icrt or C\>lor
.irvNJt/lAl. Dlltll.C'l'()ll A NO 8'T AFF SltRV1f;U
8~1. Pt.n.lla\onnl S....lc!. P....................,......"...................... ,_""!IeI. n'~_
P...c:i<AOt Pl.,\N$
r,l"<I1l1 Oi:fl1nrlan """."',' ..............-..... ........... ...................".. "-
lm/IICCIII\IQ '"".1....".,.....,. ........."..."....,.........................- ~
J'(Iiw~ln~ ll(mnl1l.' 10 An_r ".naml tImn<: ..,.........-..... $
Illllllh,IJlIIl.mnfn, rrvm An...t"" !I.11Ift11 f{Drna ,.................. 1\
$
~
-
~Q A.ND I"RD'A.RAUON OF ItIMAJNS
llIllM,1liIIA ....""".."...."""......."."......_..._................ ........... ~~7~.~
. Ildl.".tl'lllll'l\"....,....,..."..w..."."..."X~1.."m:.l""'...-""...."."'" , . . ~
. l)1~" 'I'QIll1C1lllnlJ,llr.llI.IJIil~L.9'~j\!Gl1O)".fr':rf.JI,fi.f.lI\lll, $ :m-._._
(D...~IlIl)_-=., ..-~
VSE 0' r~erLlm~$ANoST~
Us~ of~olllho~ond.s..rrfirvi~ I'aIVIHUnlldlll...Lda,r.1 $ !'-tfS,IPI'
tfJll 111' AulUl'lCIlonl18flllT !ltll'lllf;ltIl\lI'll<l!vlfl\! ill "'"' Clntpat S
~",.rrs"",l_ I'hr "".."', SaIWD.ln OtMr ""lIhV..."..."",,. $ .flE.... :
Lion"; Atolli, i~, l\lld 91.,1\' $.rvto.. I'm "-Imnrl.1 SWift
c..UhDin ",in"I., "",..ni) at our a.fICl1...."'...."..",............" $
SUltr St",lullll tar Mom.""1 S.IVI.. 'wl'110\11 mlIIIl.~ p~nl)
Al "'her AI.OIly .___.........._......"..."'...."..."..,.,.............-...-. $
8qt1l1ldlO11 Mil 8mlf lIoll'VI.....r... Clta...ldtl SatvIco............. S
OIlier U!IOllr I'lIon~lo' dml Slorr .."....""",.."'..........,,...,,~,._. S
(I)........,
TlU,~ll'rATlON
'n11. l\.rdlT1n, 11I\l'I'1t\4.1O 1\1. 1lGl'lIIIclmo ".........."...."'..m........- ~ ~
~nal'Dl \1I.hIde . Inm.".. ~
pimlty vohJl!la ~.. at U.lIlftl" '. - - :
flkI_vellklo It ..---- s _.
So","'" ..bi.l. Q ""....... $ .I'f.!J...11I
^cIlIl'~~'!n.""'ltMlolloD: ,~-
-.
~ COODS AND $RVICES
Mcm~r1nl nMk ........"...."......."..................,...._................_..
~,.,I... 1'o1~1il'......"..;."....,....".............""..,"..."",.".,,"...,,,...... I
P~r<ln'U\l..,,,......,..,,...,;.........,,.......,,,,....,,,......-..-.._..._.., .f:a ...
Ac'knnWti;ld:p;lonr III.~~ .1I..i.11AIII..,I......\ft.,..~If......,...., ...."......1. l-- --
Me1lll\!I., ,,,,,,lmll" ....................-r.......~"~.,.,....t...,,..."........ S
FltnW,,'~...,.r-..."'....,.I",.,'...,II...""".,I"IIII".n.....I..,I...'.....,....,n,,,",,'" I
(lltIJllllnll Q...lalnlll........."......"'..."'"m~. "._...._..,_.".'''....... $
C.""''''Y ..".......................................................""....."",."'.. S
CrI\n1I~lII')' '''''''''' ......... ..... ..... ........-....... .... .-. -_-. .."" '''' '''''''' ,
,Ii f1!"f"!'''' '1 t~, . ..... ..... .-:.... ....... .... ~ ,..... .... _.... ...._... ~~,..., "'l I. .""111'" S
.....'....."..'...........I.~".."'..."_..._.__...........n.."""t..ntI...mnnllll II
!...,....,..., '"..'....,....','.t...~..',..-..,....__......,......._..._............ ,....... $:
".......................,.........,......,.....,.".....,_.......,....,............-........... ,!.
...........!A.,'.....'...,.....,...."...,.....,......'............_,.....,..........,.,.".,..... "
...;: ......'..~,."....... ...""........"..., "..........", "... """ ,,,.... .,..,.......... I
1..'.+~..,ri.,...................................Ol_....n...,....,I...,....'...'.'.11111..... S
.""'..._I...,-........"..,III...."~..,......_....._.__..._.._,.._......tl.111"11111 S.
....._...._...... .._..._.............._.. ._................_...____.._..,.. I
\!""...'1...~..'...-"....lt..n.t""..",...."'.........'''tn''.''l.~-..-...-......t'I"',,, ~ ~
WlIIlo._I_C::"",
C1'l'
Sims
~I~ Coda
~ Ilq~...
~C!llhui:rrt Cttnrl\lnar ..""....,....",...'''.....n'.II...'....'...n.....'."...
""'.nu~IQlIl1'l!"llVI'PIIor ~
ModQll'llllllO/NI<I,\bclt 1! ~
""'.lOrI,,'
Um ,"""...",...................."..., ...."................................"............
Manulbmmm'$VIIIlllcr_
MaIlIll NooneINomllO' _
Mm~.lal
s--=-_
1I
$
1I
TOTAl,. ~C110N J ...."....,..",....".."""''''..."'''......,,,,......... ':l.l/-s.~
SECTIOlllll. CH"lll;ll!."l1O '1IN(lI,lR'R.~ BY 115 0" VOW DBHAU
<<:c~.l~ -:1<""". m.v \Ia ~lml'II\l' ''e'' l!\e~M Il'UmDlG(I., We e1lal1lll you fat elI'"
omIl...I" alII.lllt"" Ihll1lo IIlml', 1I\.'\f1r4lT "'illlmI "X;'
I3Q1t14!Cl')"R"'R.",""~"""" ,....,..........,.............n........._._......... L '.510.<liiio
a~""",,,,,,,,,,,,,,,,,,,ull'U,nnl)l"II""____""."'~".""",""1l1..,:1: .:
Q1lIo\01IIrI...R.......................,... ."....."...._......_._................... 'n' S
l;lOltlltllory II\OI~..........,...........--.-_...._.._."."........"... ,
Ql!JoeltflII.....,...."....,...~p......-:lIIo-....,......"..i~..-.......-...."... -
r:lC4tljRIlII """I.. ....~........!IIIl:4.~!".!I:9.I1Mo.............""...,," ~ ~o!II!I
a 0Iltlda l'.nlmll 01.-', B~pclm ........."................"......."", -
Q C_~II!lit.llllll'llIIm.'...... ."~..."n.....'................"...,......., ~.s.9."
o MO"Qlnn~ ~r SI.l\I,~.m..... ...."....,.................................._... S 1'111"-
o R'''I~~lft~.... ........-............-..-..................".. ..,........ ...,.... $
a Pllnnllll........._................._. ._.."..."'....,..""..""..."..""........" , ...
Q~~'" L....,~ ,~.~.
c S
Q S
C I
Q I
...
TOTAL5ECTlON D .........."..........,.....,..""-....-.........-.... s...J "f ~ 1. to
TOfA.L HC11(lN I tH^~GP.."....".........",...."........... II V:J.!J.S...1f1
....I)TAL Sl!CT1(lN n (:If ":ROIll...._................"'........... sill1-~
'l'OT^LSIICTION lAND D CK"RG~,..........,,""'....,,' ,~_.. ~ .'lD
-K~ ~
""n:. fa 11111.'. '" Date
VbII,,,.IlovaI...Alr,'lI'ollY I'ln. "._nallllll'lnp,r
-9' t.h.-n
W1lnn1l 1I11L101, It Dnle
.'f)lc'-1 PUN Clll'" REV. ,~"''''
11/07/2007 15:57
7175619918
NEILLFUNERALHOME
PAGE 03
1t/e6/2007 e~:e~
1117137Ua!l9
NEILL FH CAMP HILL
PA(ilE 82
1\\1lT,"""QI'TMlI'II,",
N.m,orDQtlIlll"'I~ C".~.~__. A~raamIlol~~~1...: N~ 200039
STATEM~'" OF lUNERAl. GOODS ,\,1\IlJ 9T!:mCES S.~ECJ'ijt)/PURCllA!lE AGRI!MI.NT
TOT~LIlEC'I'ION II\NDSEC'I'ION" CHARCflFl.........."..,...............,......... .....,..........................",,,.,,,,,.......,,....,.... .....""...."....""'....,,, $-.3&.u..IJ~
S"..c;TION lll. ALI.<'WII NC.l!S
$
$
$
.
,
$
s
-
-
TQT..... ^r,.J,.OWIlI'lC:~"...""""...",... ,.... ........ '''""." ". ""........ ...... ....'.,. ".", ,.",. ., ,.........., .........".....,..., ...."...." .........., ................., ........"...........
SECtION I". 'N.~
'lho\lla I'rllfo1.S""'tcm I + or. tloctkm 111..,..._..............."...".......................,. ,...."..",.................."..,."..""""..........",..................,...""."""... ~
LOM! Dt411oltl1lc.1.,..Ull"""t.....r"".".............,u,...u...tl"."IIUI,.........."" I ,..,1111""... II........,.... .......,""" ......,,,,....,,..,, ,........., ..... ....",.",., .............." .... S
TOTAL -r"XI;!! 'lio, .......... "",,,,,,,.,,..........................",,,..,.......".n.. ..................".m.""'''..............................,."...................".....,,- ~
TO'I'''l. (;H/lllGlliS': Stclllllll + fl + or. xii of' IV ~.......................................... . .".."..",......"......"..."..".....",.."..."".."...."..,.."...".."....",,",... f
Lc.~ CAtb RtriOMd ......, .....""I.IU"U.IlIIU.....,.~..., ......UII1l1.."UIlIl.'.111..h.~.dIU"lr."'llnl1 1 ..IIltlll "..I~.."Il."..I.'..Il.II"..I..'''...'n"I.,"''.,...,1 "......... ".'1""'.''''''"" .$
~.~..~~':l~:;........"...............................""...,............................,..,..,..':::: ::::::::.:::::~:~::':,::::::::::::::::.:::::::.:::::::::::::::::::::::::::::::::~:::~ : "lfo9i" . IiO
PAYMENT TI;IIMlh You u'''''I'A1n.~ thot lid .."aul"" n1' \llW1, 11\1 II/' .lIbJa.1 In fl:<Icval or 110'. <tadll dt/l/lIO~rt, 10000IIllmonl :oulal. l'f ~""" ~~~It",1It .1'I'l11
!Wl'IIffJ. ~ cotllClnphtt'" 117 Ihlo. ^I,MmOIll. ".,.. baw "" rlghl .~ ~Iftr IIlIl mont (If AllY .,'lIlml duo nnd\!1' lhll ApoatlleJl. '\'au lIlJTOo Iho' fllU al'G ~11b- II,' Ill.
r~t PA7manl ot m. ~ppIlO.bl. alunr. <<no .h~.,n un Ih. lll"ClmOM .,' I'uncrll 0"""0 n.~ 80lVl001 SeID.I.a .)1 111. ~1l1. Indla.l.d o. lbe Stntement,
GlI<hp.ymonl will bn mndo 111 UI'II ltm l\Ildlo1lo 101 rorth In rhl. I\JIIltmo:.1. Wllol", Ih. !\In nlllOllnl dun ",Ill fI1lr hn r'l~ prior In Ilia _rmn... '"~ 11lA ,"'"v,....
.'110d. In. by Ihi. .ll.lr~amQOI. ynll olllhl"I,. ", 10 loqalra Inlo )luu' <r.dl' M.IIl.Y,
JDIll'i'l'lnCATlO!l1^l'm ~r.s~1l.1l"Tro1'l OFMlli"Illl\T9RY lfEll1'S /\1'1~ ,%I'LIIHATtOfl QI' IZMMI.MINI; (,."\IA~GR: Woh"""ldanliRod ood d.."rl(,,~ bolltOl'"'7
141'1, cllmottry ... ."''''.II''~ I'tllorl..monu WII1.h ""mpQI '11* ....l'IIh... ll1' O"y II.m. lIM~d 10 Pn'" !)no o.d we II."" o"l'I.lood ..hy ... d~l.ed rot ombolmln..
You oak""wlc'l1C ~od a~lIlII tn.! .m""'o1f"~ on~/<'t prI'po..,loo "t .1'. ., 1"IIM ~.t Ira ,..,1\),.,0<1 ~I Ill. i'l; Ill~ 01 tho ,b......n:r.~nO.d rllMml born. tot 0\
hotho. r~ClII!r In., IJ dilly n<<..oll ~tod '~";rpC~ ,u J11'Uvld. .~.o~ .",.ICll,
..flM....+-1~-:~MS~_~-:~~ --
...fDiY\~~ a IitJll dl)_afl,.,if~ ~
.l!iL
---
d\lrol~ 70
'!r'Mt tollnrm 11,.1 l'TI\f ho,,* O'IIRlIIlltod all. .<ll'Vlee 1M 1~!\lbll4l... Itl!lll~ 1l~IRII 'n !tltl Olle ,"11 l'lMrIlI thlm III be eorretl Ind uclllll'lllllft 'h 1110
.r,ollj\ll!lI\hII. ..'.<tod .,,~ IhR' pl'le~ 10 .I""I,,~ l.l, 1!I1l1hmO"I. !till ~CWCII o,,~ n~ . ""mpleted otlll7 ftr lit', .1111...."'. 'YOlO nl,. CI""'II\
Ihlll )'0,,11071'. IJIlCll 'ol\mnosl tJt JOa. rill'" to !Illlllotl Oil, Ruch ",....It,,; OM nt..-.:hn,,",1!Ito "" ,!'tIll "oot.., 1m'! IlInt ,au hl~ I,", IGIIII ...,hl '" nrl'llllltG
111ft 'pll...1 ..~..I.08 rn, .... .100....d ftlm.1I .hD".
ACKNQWJ.,&DGMIi.NT I J.F D15CLOSURES/Dl$O,A f.M~"
Th"~.det,\IT"lfle Cl~mm"'I"" T..,,,. ~~lul'lln" ft.l. (I' "P"our.1 ,,~u.lry p,.lIlec," '.qa'"'' ..'Iath dl~I'n.urOI ,'od ~ruhl~I\~ ",1".~r...nL.llno..
T/lo ~I~wln~ I. ~ ."",,~UI<I WO ..k I~\m we ~.,.... In Nod .n,1 .IIJII 10 ..... '7 Ihac ,"" fun",al OTT1l"""",",1 .aufllllllW:r. ""'~ 00!l\1,..,..I 111 _pll.... with "'. 1101..
Ybu wit" ~.dO ,~~ .....g.nlon" tur Ih. fu"",nl .on final J!.~..III.n.r I.. .~oV\l'".muol d...d.M do h.,.b~ ,.lIc~! It'tht run.wln!::
I, "'" "".. 01"'0' Gcnar.ll'tlll, 1.1.! crrtOI"'o .,1 ~""!::r_ pliltl' In ~1~\I,,"IIl. I\JlloThl Ul'lllftJlO~nl' 0' "" f11loIell,,,,..r IllY hi"".' j\IInd... '1!T1I1C1l.1.
2, you.lft,. ,,","oft ,C."kol Prioa Lint or/lrclivcll1\ ,..~-~ ",10' ltI c11~m.IlDl :lil'~otn.
3. 'reu.wIiP!t .nnWII uil Q\ll., Burlul Cnll1<<lol!l' l'rteo r.i~ .rlktl.. .o~.z. ,r;~ ICO t11",1!Vlop Imrl.! ennl'll.,."
4. VIl'l'llllfll .!IlInlldlhnt 'Ilt l(tw dl'C,O"\Nqulro .mholml..~.O~lln oorlol. _L I..,O!\.
S; ~..om: nln lMlVf,ad ,nallmlll1lMlnv I~ .....1.... Ill. dl.... o",,,,,,lll,ITlL Imm",II'. haTlnl. '" . dn.1ld ,..ka. fllTlaml ...HtlIOI OlllWl.~ ftr olfllllll.. if tIllflD..utllllll. _I..hle!.
'~~lalO 11 1M.! low lTnop II\I111Iqlll~ fGlllIlo~ 10 '",at.........
~: YlII"~ liD! ~d.l~ed Ill" ftny ,n... fOj\IIIIl:H.' .ank..l flll' 01"01 e.enWI(1n or 11..1 no / cD.tnlnar. athor Ihon n" 11I~mlv. conla!"'," "'l~ll'lIa lll'dI"';. Gr;O\~II.....
" YQ\I ...... M,llla<Ilhnl ..". 1... line. II~' toqoira \110 pu,ll41,.'lt nr nA Mil"" t\l ".1 c~n\nI.1ll' nr ony nt tno fllllcrt\1 ~u..LI o. ..rvl... >"'" ""Icelcd .1"pI "' IIGI tmh 011 t'I'"
.SIM'.'''I.' lit I'll""..! (lnnil'.fIIl :krvh:Il' Svkru.odll'un:""". ^ilI"nlll11l,
I. N~ cl~lM" wel': mIlle I" ~~U I' to the mOM"'...."., "' 'Q",14IlII (iIlII~.lml"lt an. ""'/. "lal hll,l.1 ~llII1ol..ill. tho aff.ct llul cmbnllllill8 III' IIIe ,... III Iny IlIOMIlOlIlIlco avnlllble
I'Mm 'II" \WIUI~.4lGtAY Inll dv"'"'JlOl:tlltOl1 ~r 11lI1"l11'1"I, !'or n loll.l: 1Ill!ll M I" 'r,ApiIG Ihl... ~r !hol "." ",... m."Ihn.~I:!l1 wt.,I~ pmlaalllta hnd~ rmlll 8-<;11 IIlIIlM,necH.
N. "~O\I"';O"" (If W111'mA"" wo,e m"~c ,. )'AII aht>ll\ ,~. Ilftllltllvc ra.t. Q< or .~,kO\H lI1' ftlO"," nur'n' onnlnIO".I '"Iln' In.o U.... mod. hy ,he fti.ftllf'lelutlt. Th. .01V
..."nnll",., ..~ Of Im"Uod. !l"1,'fllln Il"MCIII., "llh J'<'I'ltl. ~1lI "'1111 ho runcml ocotvlu WIl "l'Mr,od VAl/l! ,h. ""p......d wrl_ ....r/t,"\ia.. ;r any. ul..""d hv Ihe
l11l\..'l\tAlIItlI~ or .1Ieb ~d., Nfl nlho. ...mrnlltl:l """' C1\1..do~ "" ~"
. .~. iVllu _.~vl~d UIOllhA funmll "m'.oMI IlIt 1M Ill!1llll nll'ad in r.l'l OM.~. II,,", II, mny he lIitPINlnr lI...ocl OIl Vl)hl)\\~ QI r...h dlr;ammlll 0' Ill~'" pn>fllMiCrlt./II..... .."lam.
..11... lJtl'Inillall by "'lllor'o",t1Im.
NOTIC'I!$ TO PlJllCBASERItO.I'U~
_, O'nlU mu rOil TIi:RM:$ MIlD CONDITIONS 1"^" AU I:.UtT OF TRIoS IIClI:El!MlNT. 1)1.1 NOT 8TC~ 1'1011 ^G"II!:~~ BJ;fOJtti
rQ'U REt\D ,., Oat W IT CQNTAlNS t\:o.'Y BUNK 811'''~' 1'0\1 Al :ltNOWI:."UGE R.ECEII'f ~n\' A N EXACT COPY 0II1R 1:\1 .40'REIlMENt.
BY sWNJ.ka 'tHffl AClRElMl!NT1. YOO AA.E AGllUIl'lG THAt Al (V a,.\lM YOU M1\V HAVlt "QMN8'l' TIll $ILLn. $)tAU.. ..JESOLVD
In' AIil8J'1'IIATfQN AND YOU AxE G'VT~c;.1lt' YOUR RIGflT ~'O 1\ COURT OR JURV 'ntIAL AS WELt. A,fl VQVlI ~rom or ""'lEAl..
By: '~s~.J
,. P11n.Ncmlt
~/~
~r2.'2. 'H.
~_/'l.,
!~tClIlCl1 rill, _ It. ~~yor _Mt:. ,ao&.. '
-~._~
PlII'CMot:r'~ Slpll'llll'll J!..-Zt/t .
Pr'rdlm;cr'a Social Ser;1..ril.y i'ln. '...1IJ,.~ J". r
Cn.Pvn;ltalGr'3 NUI1'l'l
o,.l'IIrdltW'~ ~i*".1lmI
.IlCCiPTI~ 1'01\ 51lLl,l\R:
OnoPn",IIIIi'U" Secin' !lowrlty 1'111,
':"":-'---- ~. .........""''''f<:"'"'~
"''''.m''~ ._ "".---IdlL . .
91!~.1l1l'01._ OlIte'~
-
RECEIPT FOR PAYMENT
-------------------
-------------------
GLENDA FARNER STRASBAUGH
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Receipt Date:
Receipt Time:
Receipt No.:
9/24/2007
16:26:14
1049998
GOFF HARRY L JR
Estate File No. :
Paid By Remarks:
2007-00873
AJW
Fee/Tax Description
PETITION LTRS TEST
WILL
SHORT CERTIFICATE
RENUNCIATION
JCP FEE
AUTOMATION FEE
Cash
Total Received.........
Receipt Distribution ------------------------
Payment Amount Payee Name
410.00 CUMBERLAND COu~TY GENERAL FUN
15.00 CUMBERLAND COUNTY GENERAL FUN
25.00 CUMBERLAND COUNTY GENERAL FUN
5 . 00 CUMBERLAND COUNTY GENERAL FUN
10.00 BUREAU OF RECEIPTS & CNTR M.D
5.00 CUMBERLAND COUNTY GENERAL FUN
$470.00
$470.00
REV-1512 EX+ (12-03)
SCHEDULE I
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
F~TATF OF
Harry L. Goff, Jr.
FII F NIJMRFR
21-07 -0873
Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses.
ITEM
NUMBER DESCRIPTION
1. Comcast - final TV bill
VALUE AT DATE
OF DEATH
$ 29.49
2. Verizon - final phone bill
609
The following costs/expenses have been incurred to date and are directly associated with sale of residence
followina death of decedent. House has been unable to sell due to staanant real estate market.
3. PPL - electric power
408.26
4. PAAmerican Water
209.79
5. Shipley Oil
1,96272
6. Shipley Oil - cleaning and repairs to furnace
102.95
7. Hampden Township sewer and trash
385.59
8. School Taxes - 2007-2008
1,60192
9. County Taxes
434.63
10. Veteran's Affairs - final medication bill
5680
11 . Bob Kanoff Electric Service
240.00
12. Cox Renovations - repairs to water damage existing as of date of death
750.00
13. Misc. lawncare services due date of death pending sale of real estate
767.60
14. Erie Homeowner's Insurance
301.00
15. Ben Wirth - winter storm clean-up
90.00
16. Carpet Mart - repairs to water damage existing at date of death/removal of damaged carpet
1,298.46
17. Lowe's/Home Depot - misc. costs/repairs to water damage existing at date of death
793.56
18. Paul Stager - painting to repair water damage existing at date of death
500.00
19. Miscellaneous advertising house for sale
230.45
TOTAL (Also enter on line 10, Recapitulation) $
(If more space is needed, insert additional sheets of the same size)
10,169.31
REV-1513 EX+ (9-00)
SCHEDULE J
BENEFICIARIES
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
Harry L Goff, Jr.
FILE NUMBER
21-07-0873
-
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under
Sec. 9116 (a) (1.2)]
1. Elizabeth A. Stager, 140 Reeser Road, Camp Hill, PA 17011 Daughter 50% of rest, residue &
rE'!m;:!inrlF'r of F"t::ltF'
2. David P. Goff, 1002 Hildebidle Dr.,Collegeville, PA 19426 Son 50% of rest. residue &
remainder of Estate
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-1500 COVER SHEET $
(If more space is needed, insert additional sheets of the same size)
LAST WILL AND TESTAMENT
OF
HARRY L. GOFF, JR.
I, HARRY L. GOFF, JR. of Camp Hill, Cumberland County, Pennsylvania, declare
this to be my Last Will and Testament hereby revoking all prior Wills and Codicils.
ITEM I. I direct that the expenses of my last illness and funeral be paid from my estate
as soon as practicable after my death.
ITEM II. All inheritance, estate, and succession taxes (including interest and penalties
thereon, but not including any generation skipping tax) payable by reason of my death shall
be paid out of and be charged generally against the principal of my residuary estate without
reimbursement from any person. This provision is not a waiver of any right which my
Executor has to claim reimbursement for any such taxes which become payable as the result of
any property over which I have the power of appointment.
ITEM III. I give, devise and bequeath in accordance with any memorandum which I
have either handwritten or signed, located with my Will or with my valuable papers and
found within 30 days of the probate of my Will. Gifts may only be to persons who survive
me or to organizations which exist at my death, and if there is a conflict, the memorandum
having the latest date shall govern.
ITEM IV. I give, devise, and bequeath all of the remainder of my estate of whatsoever
nature and wheresoever situate IN EQUAL SHARES to my children, ELIZABETH A.
STAGER, of Cumberland County, Pennsylvania, and DAVID P. GOFF, of Montgomery
County, Pennsylvania, Per Stirpes.
ITEM V. If a beneficiary under this Will, with the exception of ALEX C. STAGER,
has not attained the age of twenty-five (25) years, the share of the beneficiary shall be placed in
a separate Trust, for the benefit of that beneficiary.
ITEM VI. In the event that a Trust for minors, with the exception of ALEX C.
STAGER, is created by or as a result of any part of this Will, the terms and conditions of the
Trust shall be as follows:
A. To expend and apply so much of the net income and so much of the principal of
the trust as Trustee shall consider advisable for the support, care and education of the child
until the child attains the age of twenty-five (25) years.
B. Upon attaining the age of twenty-two (22), .one-third (1/3) of the child's remaining
share shall be distributed outright to the child.
C. Upon attaining the age of twenty-five (25), the remaining principal and
accumulated income of the child's share shall be distributed outright to the child.
2
D. If a child shall die before receiving final distribution of his or her entire share, the
undistributed balance shall be distributed outright to his or her surviving issue, per stirpes,
and in default of any such issue then any remaining principal and accumulated interest shall be
added equally to the shares of the other beneficiaries of this my Last Will and Testament who
so survive me by thirty (30) calendar days.
E. No beneficiary or remainderman of this Trust shall have any right to alienate,
encumber, or hypothecate his or her interest in the principal or income of the Trust in any
manner, nor shall any interest be subject to claims of his or her creditors or liable to
attachment, execution, or other processes of law.
ITEM VII. In order to carry out the purposes of the Trust established by this Will, the
Trustee, in addition to all other powers granted by this Will or by law, shall have the
following powers over the Trust estate, subject to any limitations specified elsewhere in this
Will:
(a) to retain in the form received and to sell either at public or private sale, any real
estate or personal property except that which I specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any
beneficiary,
3
(1) to file any federal income tax return for any year for which I have not filed such
return prior to my death,
(g) to make distributions in cash or in kind, or in both, and to determine the value of
any such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by
my Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct along with or with others, any business in which I am engaged in or
have an interest in at the time of my death, and
G) to receive reasonable compensation in accordance with their standard schedule of
fees in effect while their services are performed.
ITEM VIII. I hereby appoint my daughter, ELIZABETH A. STAGER, of
Cumberland County, Pennsylvania, as Trustee of the above Trust(s) for minors created in this
Will. In the event of the renunciation, death, resignation, or inability to act, for any reason
whatsoever of ELIZABETH A. STAGER, I nominate and appoint my son, DA VID P.
GOFF, of Montgomery County, Pennsylvania, as Successor Trustee of the above Trust(s) for
minors created in this Will.
ITEM IX. In the event ALEX C. STAGER inherits under this Will, his share shall be
placed in a separate Supplemental Needs Trust, for the benefit of ALEX C. STAGER, and
managed and administered according to the following Items.
4
ITEM X. Special Supplement Care Trust for ALEX C. STAGER, a disabled
individual. I hereby nominate and appoint ROBERT A. STAGER, as Trustee of the Special
Needs Trust under this my Last Will and Testament. If ROBERT A. STAGER is unable or
unwilling to serve, I appoint DAVID P. GOFF as successor Trustee. The share of my estate
that is set aside for ALEX C. STAGER shall be held by my trustee, ROBERT A. STAGER
or his successor, in trust for ALEX C. STAGER's benefit in a Special Supplemental Care
Trust in accordance with the following provisions:
A. INTENT
It is my intention by this trust to create a purely discretionary supplemental care fund
for the benefit of ALEX C. STAGER and not to displace financial assistance that may
otherwise be available to him. Illustrative of the kinds of supplemental, non-support
disbursements that would be appropriate for my Trustee to make from this trust for ALEX
c. STAGER include: sophisticated medical or dental or diagnostic work or treatment for
which there are not funds otherwise available, including plastic surgery or other non-necessary
medical procedures; private rehabilitative training; dental care; recreation and transportation;
differentials in cost between housing and shelter for shared and private rooms in institutional
settings; supplemental nursing care and similar care that assistance programs may not
otherwise provide; telephone and television service, companions for travel, reading, driving
and cultural experiences and payments to bring her siblings~or others for visitation in the
event my Trustee deems that appropriate and reasonable.
B. It is important that ALEX C. STAGER maintain a high level of human dignity
and that his care be humane. If this trust were to be eroded by creditors, subjected to liens or
5
encumbrances, or cause assistance benefits to be unavailable or terminated, it is likely that the
trust corpus would be deleted prior to his death, especially if the cost of care for him would be
high. In such event there would be no coverage for emergencies or supplementation to basic
needs. The trust provisions contained in this instrument should be interpreted by my Trustee
in light of these concerns and this intent.
C. My Trustee shall payor apply for the benefit of my grandson for his lifetime such
amounts from the principal or income, or both, of this trust up to the whole thereof, as the
Trustee, in the Trustee's sole and absolute discretion, may from time to time deem necessary
or advisable for the satisfaction of my grandson's special non-support needs, if any. Any
income not distributed shall be added annually to principle. As used in this instrument,
"special non-support needs" refers to the requisites for maintaining my grandson's good
health, safety and welfare when, in the discretion of the Trustee, such requisites are not being
provided by any public agency, office or department of the state where he lives or of the
United States, or are not otherwise being provided by other sources of income available to
him. Special non-support needs shall include but shall not be limited to the list of suggested
non-support items set out in this article.
D. In the event that he is unable to maintain and support herself independently, the
Trustee may, in the exercise of the Trustee's best judgment and fiduciary duty, seek support
and maintenance for him from all available public and private sources. The Trustee shall take
into consideration the applicable resources and limitations of any public assistance program
for which he is eligible. In carrying out the provisions of this trust, my Trustee shall be
6
mindful of the probable future needs of my grandson, but not of the trust remainder
beneficiaries.
E. No part of the corpus of the trust created by this article shall be used to supplant or
replace public assistance benefits of any county, state, federal or other governmental agency
that has a legal responsibility to serve persons with disabilities that are the same or similar to
those which ALEX C. STAGER may be experiencing. For purposes of determining my
grandson's public assistance eligibility, no part of the principle or undistributed income of the
trust shall be considered available to him. In the event that the Trustee is required to release
principle or income of the trust to or on behalf of ALEX C. STAGER to pay for benefits or
services which such public assistance is otherwise authorized to provide were it not for the
existence of this trust, or in the event the Trustee is requested to petition the court or any
other administrative agency for the release of trust principle or income for this purpose, the
Trustee is authorized to deny such request. My Trustee is authorized, in the Trustee's
discretion, to take whatever administrative or judicial steps may be necessary to continue the
public assistance program eligibility of ALEX C. STAGER, including obtaining instructions
from a court of competent jurisdiction ruling that the trust corpus is not available to the
beneficiary for such eligibility purposes. Further, my Trustee should cooperate with the
beneficiary's conservator, guardian, or legal representative to seek support and maintenance
for the beneficiary from all available resources, including hut not limited to, the Supplemental
Soc~al Security Income Program (SSI); the Medicaid Program; and any additional, similar or
successor programs; and from any private support sources. Any expense of the Trustee,
including reasonable attorney fees, shall be a proper charge to the trust.
7
F. SPENDTHRIFT PROVISIONS
No interest in the principal or income of this trust shall be anticipated, assigned or
encumbered or shall be subject to any creditor or to any legal process prior to the actual
receipt by the beneficiary. Furthermore, because this trust is to be conserved and maintained
for the special non-support needs of ALEX C. STAGER throughout his life, no part of the
corpus hereof, neither principal nor undistributed income, shall be construed as part of ALEX
C. STAGER'S estate or be subject to the claims of voluntary or involuntary creditors for the
provision of care and services, including residential care by any public entity, office,
department, or agency of any state or the United States or any governmental agency. Under
no circumstances can the beneficiary compel a distribution.
G. TRUSTEE AUTHORITY TO TERMINATE TRUST
Notwithstanding anything to the contrary contained in this trust, in the event that the
trust has the effect of rendering ALEX C. STAGER ineligible for any program of public
benefit, the Trustee is authorized, but not required, to terminate this trust. In determining
whether the existence of the trust has the effect of rendering ALEX C. STAGER ineligible
for any program of public benefit, my Trustee is granted full and complete discretion to
initiate either administrative or judicial proceedings, or both, for the purpose of determining
eligibility. All costs relating thereto, including reasonable attorney fees, shall be a proper
charge to the trust.
In the event of voluntary termination, the undistributed balance of the trust shall be
distributed IN EQUAL SHARES to PATRICK R. STAGER and PAUL A. STAGER, Per
Stirpes.
8
H. VOLUNTARY CARE
It is my wish that subsequent to the termination of the trust for the benefit of ALEX
C. STAGER, if my contingent beneficiaries are living and distribution has been made
outright to them, if ALEX C. STAGER is still living because there has been a voluntary
termination of the trust in accordance with the provisions of this article, that such contingent
beneficiaries will conserve, manage and distribute the proceeds of the former trust for the
benefit of ALEX C. STAGER to insure that he receives sufficient funds for his basic living
and supplemental needs when public assistance benefits are unavailable or insufficient. This
request pertaining to the use and management of the trust proceeds after the termination of
the trust is not mandatory, but is an expression of my wishes only.
1. BENEFICIARIES OF TRUST RESIDUE UPON DEATH OF DISABLED
BENEFICIARY
Unless sooner terminated, the trust created for ALEX C. STAGER shall terminate
upon his death. At that time all remaining trust assets shall be distributed IN EQUAL
SHARES to his heirs, Per Stirpes; in the event he has no heirs, then all the remaining trust
assets shall be distributed IN EQUAL SHARES to PATRICK R. STAGER and PAUL A.
STAGER, Per Stirpes. Distribution to any beneficiary, other than ALEX C. STAGER, who
receives from this Trust shall be administered according to Items V, VI, VII and VIII of this
Last Will and Testament.
J. TRUSTEE'S POWERS
Subject to the requirement that my Trustee be prudent, my Trustee shall have full
power and authority to manage and control the trust estate and to sell, exchange, lease, rent,
9
assign, transfer and otherwise dispose of any or part thereof upon such terms and conditions
as my Trustee may, in my Trustee's discretion, deem proper. My Trustee may invest or
reinvest all or any pan of the trust estate in such common or preferred stocks, bonds,
debentures, mortgages, deeds, deeds of trust, notes and other securities, investments of
property, including common trust funds, which my Trustee, in my Trustee's absolute
discretion, may select or determine. It is my express intention that the Trustee shall have full
power to invest and reinvest the trust funds as I might do if living, without being restricted to
forms of investments which trustees may be otherwise permitted by law to make, and without
any requirements as to diversification of investments. My Trustee may continue to hold in
the form in which received, any securities or any property which I might own at the time of
my death or which my Trustee may at any time acquire hereunder; and may invest any pan
of the trust funds in property located within or outside of the State of Pennsylvania
My Trustee is further authorized to invest in life, annuity, accident, sickness, including
disability, and medical insurance on behalf of and for the benefit of the trust beneficiaries.
My Trustee shall not be obligated to undertake litigation for collection of any benefits
or assets payable by reason of my death including, hut not limited to, such benefits under life
insurance policies, employee benefit plans or other contracts, plans or arrangements providing
for payment or transfer at death which are payable to my Trustee unless my Trustee is
indemnified to my Trustee's satisfaction against any liability and the expense of such
litigation. Payment to my Trustee and the receipt of or release by my Trustee shall fully
discharge any payor, and no payor need inquire into or take notice of my Will to see to the
application of such payment.
10
My Trustee shall, in addition to the powers granted above, have all powers otherwise
granted under the Pennsylvania Fiduciaries' Powers Act as amended after the date of my Will
and after my death.
My Trustee shall specifically have the powers to invest in non-income producing assets.
K. UNSUPERVISED ADMINISTRATION
The trust created by this Will may be administered by my Trustee free from the
control of any court that may otherwise have jurisdiction over my estate.
ITEM XI. I nominate and appoint ELIZABETH A. STAGER and DAVID P.
GOFF as Co-Executors of my Will. I direct that my Co-Executors be permitted to serve
without bond and in addition to those powers granted by law, I grant them power to sell both
real and personal property, at private or public sale, to invest cash without being limited to
statutory investments, to distribute in cash or in kind in like or in unlike shares and to file any
qualified disclaimer I could have filed if living.
Dated
t , I
A!J Y'
/ i
/ Ie
,2001
7{ c~7 1- /J1I-:ft/
HARRY r/GOFF, JR.
In our presence, the above-named HARRY L. GOFF, JR. signed this and declared
this to be his Last Will and now at his request, in his presence, and in the presence of each
other, we sign as witnesses.
Name
..~A&~ -tJ. gJ.Q)iQ,}7fj
(_~iJL-- 4~-
~
Address
'31{5 h,Jntmn5 C})~, ~ n/t~
JY'j/L~~ ~ ~ /?/>/~51
11
I, HA~Y L. GO~F, JR., Testator, who signed the foregoing instrument, having
been duly qualIfIed accordIng to law, acknowledge that I signed and executed this instrument
as my Will, and that I signed it willingly as my free and voluntary act for the purposes therein
expressed,
Sworn to or affirmed and
acknowledged before me by
HARRY L. GO~R.,,,pe T est.tor,
this \ La- day of L~ ,
2001, k?
11?Vl/l-v ~ A,/)//i
ARRY L. GOFF, JR.
~"t~~;..;lItIlllltll~:~~~\'.~~"\I.'~r;7''\,:~~~~~f'IMU~~1lIo;l'''';;i'i,y.''~i,\~
1 ~~I..! \ ;"1-:,,,..,1.,. ..;"tl~L. ,," ['
~ 'A',\ l t"f'1",,"" ~,f"l"~nl f;';"",I,,, ~
~ ~~ ,t'l . cu~u tt'~'.ijl ~'\i',1,;~'J.'\'.' 1 I) vl..~~."" 'J
"". ..~., ,...,t~~j~ "'.1ft N"'~' !
't. ,O.'~. ""I' pa. ;tton i \l'l.rp" iJl::U;J>. Ii,l C..> .J.,..,,,.,.,,.;!,. t'
" . \ ;~ n,'l ^~ u.. .,,1. .w, "j."-.,;il ~
' tJ~y ~~~Y!~~~S~.~~'I ,~!_~ l'II':_~~~~::::::'::D
We, the undersigned witnesses who signed the foregoing instrument, being duly
qualified according to law, depose and say that we were present and saw the Testator sign and
execute this instrument as his Will; that he signed and executed it willingly as his free and
voluntary act for the purposes therein expressed; that each of us in his sight and hearing signed
the Will as witnesses, and that to the best of our knowledge, that he was at that time eighteen
(18) years or more of age, of sound mind, and under no constraint or undue influence.
Sworn to or affirmed and
subscribed to before me
by ~'Je 55 / c.tL ,j); J-!-1)//tJ /{('I
and( C:e;o.~,,-- ~o-ro.-~
witnesses, thisQ ~
day 0 it-- , 2001.
;~
W;1ness 0~
12
tJJ;.;.fl~II~lOlIUllliUlur.:.uDiNr;tlI!1'!1I~l.lII~iJIl.:I<l~m~<llll~otIlIllIQllI,IlIII~!;'U:-\\
r10'Ol~1iAI. SEAL "
JAi~ L BmWm. N\}'t~lY Pli:hlic ~
Lower Paxton l'\'/!l" Oauphln Co\lrit>~
My CornmissJon Expires March 29, 2004
~ .. """1 1'lIlI 1 .........."'f