Loading...
HomeMy WebLinkAbout07-18-0815056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 2 1 0 8 0 5 9 3 Po Box 2sosol RESIDENT DECEDENT Harrisburg, PA 17128-0501 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 0 7 7 1 8 4 1 6 3 0 3 3 1 2 0 0 8 0 1 1 9 1 9 2 4 Decedent's Last Name Suffix Decedent's First Name MI S H A W ~ D O N A L D (If Applicable) Enter Spouse's Information Below Spouses Last Name Suffix Spouse's First Name MI S H A W ~ F R A N C E S Spouse's Social Security Number '~ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 1 9 6 2 6 6 0 5 2 REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate ~ 4a. Future Interest Compromise (date of ~ 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate ~ 7. Decedent Maintained a Living Trust © 8. Total Number of SDB's (Attach Copy of Will) (Attach a Copy of Trust) 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (date of death O 11 . Election to tax under Sec. 91 t 3(A) between 12-31-91 and 1-1-95) (Attach Sch O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDEN TIAL TAX INFORMATION SHALL BE DIRECTED TO: Name Daytime Telephone Number T A Y L O R P A N D R E W S E S Q 7 1 7 2 4 3 0 1 2 3 Firm Name (If Applicable) First line of address 7 8 P O M F R E T S T Second line of address City or Post Office State Zi COde r~.a <7 ~: ~ c_, ..:~ - _~? ~_ <_-- - _~_n r-= ' I~ ._... DAB: ~ W C A R L I S L E P A 1 7 0 1 3 ~~~~ ~ _..t ._.. . - , ~ ~` 1 Correspondent's a-mail address: tpandrewstc'D-pa.net ~' ~,,~ n er pena ies o penury, ec are a ave examine is re um, inc u ing accompanying sc e u es an s a emen s, an o e es o my now a ge an a ie , i is rue, corn and compete. Declaration of preparer other than the personal representative is based on all the information of which the preparer has any knowledge. NATURE OF PERSON RESPONSIBLE FOR FILING RETURN DATE AD 71 Oak Circle, Newville, PA 17241 SIGNATUIjF,rOF E A HAN RE R ENTATIVE DATE ADDRESS 78 W. Po fr St.. Carlisle. PA 17013 Side 1 15056051047 15056051047 15056052048 REV-1500 EX 2. Stocks and Bonds (Schedule B) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 4. Mortgages & Notes Receivable (Schedule D) 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) Q Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) 0 Separate Billing Requested 2. $33,495.84 3. $0.00 4• ~ $0.00 5. $7,059.03 6. $0.00 7. $0.00 8. Total Gross Assets (total Lines 1-7) 8. ~ $40,554.87 9. Funeral Expenses & Administrative Costs (Schedule H) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 9. $6,280.00 10. $2,087.46 - 11. ~ $8,367.46 12. $32,187.41 13. $0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) 1a. $32,187.41 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15.Amaunt of Line 14 taxable at the spousal tax rate, or _ transfers under Sec. 9116 (a)(1.2) x .0 _ 15. $0.00 16.Amount of Line 14 taxable at lineal rate x .045 $32,187.41 16. $1,448.43 17.Amount of Line 14 taxable at sibling rate x .12 17. $0.00 18.Amount of Line 14 taxable at collateral rate x .15 18. $0.00 19. TAX DUE 20. FILL IN THE OVAL lF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 19 $1,448.43 l Side 2 15056052048 1505605204b 1. Real estate (Schedule A) 1. ~- $0.00 REV-1500 EX Page 3 File Number Decedent's Complete Address: Decedent's Name Donald Frederick Shaw STREETAUDRESS 71 Oak Circle CITY STATE ZIP Newville PA 17241 Tax Payments and Credits: 1. Tax Due 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discounts 3. Interest/Penalty if applicable D. Interest E. Penalty Total Credits (A+g+C) (2) (1) $1,448.43 Total InteresUPentalty (D+E) (3) 4• If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Fill in oval on Page 2, Line 20 to request a refund $0.00 5• If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) $1,448.43 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $1,448.43 Make Check Payable to: REG/STER OF W/LLS, 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: O b. retain the right to designate who shall use the property transerred or its income: c. retain a reversionary interest: or d. retain the promise for life of either payments or care? 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which i di ti ? t i b f i ic ary s gna on con a ns a ene 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 3 % {72P.S. Sec. 9116(a)(1.1)(f)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 % (72 P.S. Sec. 9116(a)(t.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 deseased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0 % [72 P.S. Sec. 9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. Sec. 9116(1.2) [72 P.S. Sec.9116(a)(1). The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12 % i72 P.S. Sec.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. $0.00 SCHEDULE B STOCKS AND BONDS ESTATE OF FILE NUMBER Donald Frederick Shaw 21-08-0593 All property jointly-owned with Right of Survivorship must be disclosed on Schedule F ITEM DESCRIPTION VALUE AT DATE NUMBER OF DEATH 1 701.276 Legg Mason Partners Appreciation Fund class B $9,838.91 2 645.193 Legg Mason Partners Investment Grade Bond Fund Cl B $7,200.35 3 1,369.148 Legg Mason Partners High Income Fund Class B $8,324.42 4 172 shares in Nationwide Financial Services, Inc. @ 47.28 $8,132.16 TOTAL (also on line 2, Recapitulation) $33,495.84 v ~ N ~n m ~ m o ~ a `` ~, Q ~' L Z A? ~ V V Q U Z •^^+ i Q ~ N ~ ~ r ~ ` \Y .~ .. m Q? ~ J ~ O J~ 2 p Q > '~1.+ R$RS m O a d~ ii n a c Vf ` j Y~ O~ ~ L ~ T- ~ N o~•~ ~xp~•E ~ m ° m U , i ~ y m m o C3 i _ V i ~ ?~ ~ F- ~ Q Z ~ o '. >°-U>° maw= u e~ 7- i 3. ~ v z: d ~ f F __.,~_ ~N~ T~ ° ~ ~ ~ . _~4 ~ N O U N '. V n Q . , O ` ~ ~ ~ ~ "1 A ~ V a N ~ o UJ C ~ Y ~ 2 0 1S' V Q 0 8 O N r m d m ~ d ~ _O ~ C7 f0 ~ b ~ ~ n o m ~ m 0. M a .~ N W U ~_° L O ~ ~ y ~ ~ •~ E v ~ c _U A ~ U y C N 7 y 'O ~ ~ c ~ N c ~ .` d •y U .~ o ~ Y ~ ~ ~ N t0 'T E ~ L d m -p C U f0 C ~ m d w O ~ N r C ~ c cn H O ~ Y ~ C _ . a ~ N 0 • ~ °' m a c ~ U O o ,. . ~ d ` g m o ~ n c ~ 8 ~ `o~ U y vi c O d ~ ~ ''~ D O N m ~ Q ~ ~ o$ a « mo i •; ~' . ._ O o U ~ L f- N d 'O a > C C N O _ h •- ~ ~ U U 7 O ~ O y 3 ` ~ to m m O a N ~ ~ ~ U N j f0 r d J ~ N N ~ d O ~ ~ r N IO AI a C ~ O 7 w =o d F V ~ C T E E d w ~ ~ N O ~ ~ ~~ o 0 01 M ~` N N O .t-~ N V w L m v I- ao d U 3] G1 ~ C E ,~ C ~ 7 -Y O O O U ~ A N ~ y O ~ C O 7 y dw d N ~ O T °' a c N ~ 7 coo. U y~ V d V H (Q U m d C m N ` •N U m c ~_ o a N f~ ~ a O 0 ~ L c y ~ ~ 7 ~ w H d y ~ ~ O U QQ ~ d 1~1~1~1 r~i 0 01 a t c o f0 ~ ~ L m w0.~ °i v a 0 0 °'I ~ ~/1 U d d 'NO r. .. c - - ~ > > ~ .~ cn fnN p I 1 Q ~~.1 m m ~ r~ ch N ~ N M ~ ro ~, N LC)'' L ~~ X N~ = d d N ~ d .C °'d3 a ~ c a m :Y d ~ ~ ~ d o ~ E v, ~ E ~ 3 c ` ° d c uNi H .~ ~ ~ ~ 0 ~ Y 01 ~ `n O 7 ~ Y m ' _ rt m ~ ~ R ~ O 3 C7 ~ c :: r ~ ~ c W N • • lp w ~ 7 r o m d f a m ~ ~ V t ~ -O U ~ m Q N U ~ F-I F~- L f ~ N N 0 +~ M m M w a v •> d L O ~g~ ^oc v_ m N N a$~ ~ C N w C y .~ v 3 u t0 ~ R • -0 3 v t rt x . -c .°_' 3 L m~•- •- 3 ~ O ~ ~ O. .` ~°'c v~ o a 01 •- t C 7 L •C v u C d R N a~i m a mzz C L W L ~_~ \~r ' V U 01 O ~ ~ O ~ a ~ O m - or O ~ d y ~ "' ' ~ w r ~' d ~ ~ ~ ~ •~ ~ ~ 0~ ~ ~ O ~ , C d ,a ~~ b o~ , lQ pl r U ti i C U •..~ V d U h . ~ ~ .~ i 0 i ~ v y o~ y ~ L L h d „~ O~ u d O v r -" O -~ ~ O 'Ct H O ~~ r ~ V ' i r a '~ 'Ct N d ' 3 C y ~ pQ d O ~, ~ ~ d ~ C y ,y ~ Ci ,~ do !p y = y C °~ V 'a ,w C m~ y p V O tpir ~ ~ ~' -°0 o E 4 ~ ~ ~ ~ h V C>Z, ~ •~ O •~~ O y n ° • ti r O y '~ ~•• •' ~ y d~ i O ~< ~'" ~ To•~ i .~ .O ~ d~ y ' ' C~ ~ O y'~ O . ~ ~ ~ d~ '~ ~ d d y U ~ ~ 'ti ti y ~ r. o~ ~ ~ y ~ U ti "" ~ ~ .y ~ .O ~ ,~ d d ~~ •ii pp O o „~ o~ ~~ 3 ~ ° ~ q ~ 5 ° o r:~' ~ G O w ~ O b ~ ,,, \ O d 0 ~ ~' ~~ O a r iy ' ~ y ~ z O C C i > ~ ~~ °p ~ i o ~ C O tl N '~ ~~ ~ :a ~ M C D .~ u '~ o '~ o o c m ~ .~~, ' h ~ ~ ~ d ~ ~ °p i ° ~' ~ y h ~ a ~ o~ :: /~ (Lf ~~ y ~ ~ v ~ 4 ~ h ° o~ h "-~". O ' ~ C V~ N ~ " ~ y •~ Zt C r ~ ~p '> u d L c~ 'b b y O d" oo V t: ~_ ` Q • ~ C y a d d ~ y ~ y ~ ~ ~ , r~ y~ d a' d .~ d ~ ~ ~ ~ 0 ~ R C OUP ~ y,~ GJ „p ~O~v ~ ~ ~" Q ~ v O ..p O db y O '~ O i ~ ~ d `~ ~ 01 L ~;b ~^.e ~ . ~~ L ' ~~ h>~ O~ U N~ h~~ St ti i °' ~~ i H S, y 3 ••~ ~ ~ ~ ~ ~ ~ O = O ~ •~~' d ~ s ~ ~ m " ~ ~ '~' '~ '^' O ~ ~ ~. ~ ~ U °' C o~ ~ ~ ~ C 5 a S C'~ o, ~ y ~ .g ~ ~o v ~ ;g ~ ~ w v vi ~ ~ 'y ~ O y d = i C ~~ ~~ y {~ ~ w i wb ~ o ~ ~ ct ~ G ~ ~ o H V .~ m R. ~ ?, O ~ ~ ~ ~'. ~ >' ~ w ti O ...ait~z:-- 4 5 ~5. .~ ?_ .v .~ 1p wU y 0 ~ 4~ i d O '~ ~ ~ d ~~ y r~ h :0 y b d O n i o h ~.: Ol ' ~ ~ h p ~ ~ ~ d r ~ ?~ ~~ ~ ~ •~ ~ a a~= ~o~ o= „~ ~o~ ' o V ' ~y ~~ ~. p U~ r o O ~ ." y b y 4, ~ d O O C) O O ti y, i ~ ~ p -0 ~ p C ,~ U ~ Ob`tie°ii °' ~ , - di •y ~ ~ ~ o U ~ h ~ ~ ~•o ~,ti O h y ~`~yo ~~ y ~ o~ :' °p .~ d ~ ~ ~ y o s ~ d O C cs o, ~ `= .O ~~ '~ d d ~ O " o ~ •~ nip V ~ ' d O O 4f O\Zt ~ C >, d ~ ,ate C•E ..~~ N J ~~ i h 3 °N' ~ .i., v~~ d ~ Q .. o d ~ ~ a ~ o ~ " ~•- ~ i ~n ~ u ` ~ Q F- ~~ q 4 ~ ~ 4° V c ~ 25 ~ y~ Opp u fl ~ ~ C h y C O ~ a;b r ~ d ~ H N y i O o a ~ w h o~ ~Z ~ , .~.. ~ C ~ ~ O ^'~ 4:a H~ F- a p ' ~: ~ n H K ~ . ~' O !p ~ _ " Q~l 7 ~ ~ ~ .~ ~ 'b i O N N O c N ~ a~ U ~ C U Q C N m~ m dam m m ~ o 0 m V m 2 c0 ~{ n ~ N ~ N ~ ~ N U > .,. ~~, o "d. a ~ v Uc « f/1 UI ~I ~ UI ~I «7 N a~ Et ~~ zo O m m m m m > > m N ~ m C C m Q O O U cn ~ m ~ U w > > O V 0 m m m U ? Z _ i0 tG N m m ~ ~ LL ~ b ~ m a m o m o a ~ Z Z ~ m ~ H m ~ O ~ C U O H cn Q t o ~ E ~ t m ~ m o~ ~ w a ; ~ w a > ~ d 0 _ m a K m C 7 C a ~ a C C F- LL K F- F LL 8 N at ~ O N ~ i. (") O N O 00 N ~D t0 f`N7 10 1~ dD 41 LO O ~ l 0 N w O m N J J (/1 W a `r ~ ~ ~ N m ~ n "' ~ N "" f0 ~I M1 MI MIS ~Iml~ ~ N t0 N ~ n N N N N ~ h Il'f fM n W m a rn M m C w ~ n ~ ~ _ O ~ ~ F- Z w m ~ ~ H m > ~ Z C m ~ J 7 w U U Z Q ~ « ~ 10 t0 N ~ Z 'O ~ ~ ~ O O Z O ~ ~ w o O Z t ~ ~ V Q m ° E E m ~ w y ~ ~ m c~ ° > > ~ C7 ~ ~ .5 ~ x --~ ~ ~ ~ ~ F C7 ~ CO N ~ ~ ~ O) ~ p of ~ ~ ui ~ ~ a a ~' ~ a o N M "' ~ Q m n a ~ a G! C ': ~ Q f V Y 1 i i a•+ pa ~ O ++ v ~ s' .E~' ~; ~ 2 ~ ~ e~ ~+ ~ ~ ~ *' r O J _~ U ~ Z U ~ ~o Y w z Q' d ~_ ~- ,~ ~ x,. ~,. ~ fi `, F, ~ ~- a f 0 N i a~ N . _ ~ m m ;. O o _. d:d. n W pp R ~ := .- _°. E V .. . O C U a C N ms ~ ~ } e - f0 m ~ m W t} ~} ?mm v, ~ n n a ~ v ~ r, ~ > m m a ~ ,a in ~ m ~ m ~° ~° Z C ~ ~ N J ~ J J J J (n [n fq . ~n iD N n ~ N ~ ©_ ~ O ~~ ~ ~ ~ - ~ ~, - ~ m m ~` rn n N a N a OD w pp g ~ o 0~1 ~ ~ N N N m m ~ N N tf) W .- fD 0 0 a) O f0 M G D C7 f+J ~ l U> C n ('~ ~ a N CO ~ 10 If) « N w N y~ $ o ~ ~ $ o ~ ~ U co co m co tc U o . ~ N m O W O ~ N !~ fq y ~ U ~ O n n n t0 t0 01 m U ~ ~ 8 ~ ~ g m ~ ~ ~ C7 In ~ ~ In ~ ~ n- n W ~ M d p cQi_ ~ ~ tF . <} • - ~ M N 1V N y ~ o 0 ~ ~ iE ~ COp c O ~ ~ ~ _ O O O a ~n z w ~ ~ m m o ~ m m > ~ - ] m O ~ ~ m ? m C = m m cn m O m ~ m v m w U U m w y ~j U~ a F Q N y Z~ d w m m ,' ~ j > m K a 'O U ; > ~ m ~ r s w m ~ a v ~" o o q ~ m O a Z~ ~ C y Z W N O m G w ~ U O Z L m Z . 0~ L c . c V L t0 m p Q m o~ y w o m°~ x d ~ 7 ~0 E a W 7 ~ E m 7 10 m m m v ~ 7 d> - ~ d d m m d> ~ a " is m ~ C C7 ~ v ~ c C7 O -> O U m c > c iC W ~ v c .~ ~ ~ w 0 0 o w z o m d m o o c . ' .m m y J 1- LL J- F' ~ ¢ F F- LL w 7 > 'a m a n y ma~~' N~ 1~ ~ ch ~ ~, E C ~` ~a m ~Ey u^i ~ a $ ~ i m °' m ~ o ~Z O h -. F f-.:.. C. ~, 0 ~' v C' '` ~' .~. ~' J -Q- ~I n ~ N M N a` I~ m [V m m H cZ C a° z ~~ _ ~m y m M (~h7 w U o Op ~ w y O O FZ- ~ O } H ~ O > ¢Zf+~w faro w a LL 0 Q as U O C7 Z 0 0¢ Z Z O¢ °m~Q°LL°oQ a ¢y aw¢N, oa a coo a w~ O m w Z 0 m J LL N J- LL N N N m C > c m 'm ¢ ¢ tL w ~ •~ Z ' 0 ' v e a a ~ Z Q a' ~ ~ V ; S ! d o _~ (`') 0 ~ _ M 0 N S ~ O ~ N fA C O m a C ~ O 7 = m ~ v m m r O m v c o m ~ r ~ a ~ 0 0 ~ w m a mm of o 0 0 m m m m m W ~ ~ W C L _L `V ~ .. .,; V O ti i w 4 '~ .•J p M T [ ~ ~_ tl V ~i i y d ~ In 7 N ~ ~ ~ [7. ;; O •p ~ W 4, n ~c ° ~ d o = E ~ Q w ~ O ~ • ~ /6 O m ~ ~ ~~ y rn W . ~ ~; ~, ., i r ., ~ ~ O ^' C O °; O w ~.... •~. L ' ~- r ~ tt ~ T > ~- CS tC tL Q 3 "o ° ~ Q, o y ~ l ~ S` E^* Sj ~ Q O 1 ~ ~ ,~ g ~ v V U V d ay,. .t] x ~ ~~ ~ .. y ~ ~ o o ~ % ~ ~ O~ '~ ~ a '~ ,, Z ~ ° ~ ~ O c ~ ~ ~ , a o -0 ~ ~ ~ fl ~ i ~ _ ~ N ' ' v ~ c3 ,`„ ~. V ~' d E• o o~~ C ~ v id ~ c ~ Ty=to ~o .~'~ ~~ V ~~ ~'. b ~~ ~ 5 3~ O d o i h G = w i. tl f- w W o V .a ~ ~ ~ p +.. 3 A V C. i+ ~ ~ ~ ~ .~ ~ ~ . ~ o« d. i T" d O "C O m ~ O v 0 ~ CJ ~ -~.. v a Q.E Q3 N ~ = « a o ~ o L w ~ Fq y ~ C _ 9^ O /~ ~ W ~ (~ ?} ~ O-J y~ Vw ~ ~, ~ C O ~ ° ~'~ ~ o ~ O1a ,~ ~~y,/r~ R5 _ ~ ~ . ~ h ~ ~ ~ ~p "' ~ of cS ~ V ~ ~ LL. O N ~ ~ ~ y ~ y .,.~ Q ~ Oj o ~ ~ a, d = .Q `~ at C) -D Ch 'y °' °~` `'~~O + ~ v r... ~- 4 (Sl ~ ~ o+ ~ Ci +. p ~ ~ O ~ 0,,, ~ C C ~ U ~ c k ~ 7 G ~ C ? ~ ~ ~ ~ U ~ ~ v ~ ~p ~ ci '~ m r ~ 6~ i O a p~ ~= S 1 u ~ "w. ~ ~~ w L~ E"' ~ d' w 7 O ~ N i Q U ~,,, ~ 7' y i }..~ Q w am ~° c. U U F . C ' tv of ~ .~ ~ L ~ ~~' h. ,~ Y ~ A h ~ Li ~ ~ ~ ~-. .~ , ~ V ~ ~ n ~ ~ ,~, ~ II. -w y'y ~...r C ~ ~ ..o ~ ~, rn y N ¢ 2 r ~ ~ '` v a o o .!Z .C ~ ..x fia ~ G . 7 ti ,,, ~ d y 3 V U O ~ ~ r„ ~"'' ? ti ~ ~ ~' ~ 4 o y ~ e~ ^ ~ ? ~ Z ~ T ~ y LUS ~ ~ Cl yZ _..-_„~ o, ~ a ~ ~~ ~~ ~~,~woo d `~ `L H 't3 :; O 'C C~ ~'° v 0 C ~ ,* o' N '` u 4 tS ~ Q< ~ Lt V ~ U h L~ ~ R w U ..,.i a . C ' ~ ' •, ~ J W cn Z v Z cn i R{ ~ of ~ a w ~; ~ ~ i .~ y ~ i TL m ~ y c Qa 4 V LL oN ~ ~ ~ ~ ~,~,«4 ~' ~ 4. U ~} C ,~ C'' ~, p ... U a w L Q H G, ~ O CJ1 LL ~ ~ w ~ ~` ~ ~ N ~ ~" ~ c v~ y' ~~ 0 4 m 4 w .Q W~ •2 R1 7,'eS v~ V W E y ti O . .~.. d d ~ ~ Q C7 ~ -~ c7 V . . o~ O o o .o n d u-, ~ ~ ~ '~ ~ is s .. '~ ~ ai W U'. J ? y ~ v ~ C ~ ~ ' h d 4i ~ ~t ~ O ~ ~ `." O b 'wtl ~ lp O O ~ m T ~ C U ~ ~ ,_. ~ y m' i ~ ~ ^' ^S3 `" q d ~ p ~ ~ tea.. Q C O ~ ~ ~ ~ ap ...~ sY y i ~ 0~7 ~ Q. m.. `~ y ~ ~ d •~ O H ti O o ~ }_ H v ~~ .,3 tl~clc ~ Op ~. 7 . ~ ~ O y Q ~ ~ 0 T7 A ~ .~ _ U ~ ~ ~ N C~ .~ 7 - ~ 01 h S ~ m. Y ~ r ~ y ~ ~ c.~ U "' ", y •.. ~ a-~ Q N L ~p ~ 4 ~ y C~~j I 01 N c'~ '~3 ~i ~ T O .~~. ?r m ~ _ w ,~.d \~ v SCHEDULE E CASH, BANK DEPOSITS AND MISCELLANIOUS PERSONAL PROPERTY ESTATE OF T)onald Frederick Shaw 21-08-0593 Include the proceeds of litigation and the date the proceeds were received by the estate FILE NUMBER ~.. _,.. ~ An.~mrs covnr~ NATIONAL BANK June 27, 2008 Andrews & Johnson Attorneys at Law Attn: Taylor P Andrews 78 West Pomfret St Carlisle PA 17013 Re: Estate. of Donald F Shaw Dear Mr. Andrews The following information is being provided as per your request: Acct. Type Account No. Account Accrued Ownership Date Principal on Interest to Opened D.O.D. D.O.D. Super NOW 223123 $7,059.03 $0.00 Individual 4/26/94 Account Inquiries concerning ACNB Corporation stock information should be directed to the Registrar and Transfer Company at 1-800-368-5948. If you need any additional information, please contact me at (717)339-5122. Sincerely, Barbara J ~~~rrr r Adams Co National Bank Deposit Services Representative II SCHEDULE H FUNERAL EXPENSES, ADMINISTRATIVE COSTS AND MISCELLANEOUS EXPENSES ESTATE OF FILE NUMBER D®nald Frederick Shaw 21-08-0593 Debts of decedent must be reported on Schedule I. A B. ITF,M DESCRIPTION AMOUNT NUMBER Funeral Expenses: 1 Auer Memorial Home $110.00 2 Administrative Costs: 1 Personal Representive Commissions Name of Personal Representative(s) Social Security Number of Personal Representative: Street Address: City: State: Zip: Year(s) commissions paid: 2 Attorney fees to Andrews & Johnson $2,500.00 3 Family Exemption $3,500.00 Claimant Frances C. Shaw Street: 71 Oak Circle City: Newville State & Zip PA 17241 Relationship of Claimant to Decedent: Wife 4 Probate Fees to Register of Wills $170.00 5 Accountant Fees to Patricia Rosendale, CPA 6 Tax Return Preparer's Fees 7 8 9 10 11 12 13 14 15 16 17 18 19 ~ TOTAL (also online 9, Recapitulation) ~ $6,280.00 15056052048 REV-1500 EX Decedent's Name: 12 minus Line 1 1CTIONS FOR A 1. Real estate (Schedule A) 1. $0.00 2. Stocks and Bonds (Schedule B) 2. $33,495.84 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3. $0.00 4. Mortgages & Notes Receivable (Schedule D) a. $0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5. $7,059.03 6. Jointly Owned Property (Schedule F) Q Separate Billing Requested 6. $0.00 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) Q Separate Billing Requested 7. $0.00 8. Total Gross Assets (total Lines 1-7) 8. $40 554 87 9. Funeral Expenses & Administrative Costs (Schedule H) 9. $6,280.00 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) 10. $2,087.46 11.Total Deductions (total Lines 9 & 10) 11. $8,367.46 12. Net Value of Estate (Line 8 minus Line 11) 12. $32,187.41 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 13. $0.00 14. Net Value Subject to Tax TAX COMPUTATION -SEE II 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 16. Amount of Line 14 taxable 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 19. TAX DUE Decedent's Social Security Number 1 187.41 $1 $0.00 20 FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Side 2 15056052048 19 $1,448.43 15056052048 SCHEDULE I DEBTS OF DECEDENT MORTGAGE LIABILITIES AND LIENS ESTATE OF FILE NUMBER Donald Frederick Shaw 21-08-0593 Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. TOTAL (also on line 10, Recapitulation) $2~Q$'7 SCHEDULE J BENEFICIARIES ESTATE OF FILE NUMBER Donald Frederick Shaw 21-08-0593 ITEM NAME AND ADDRESS OF BENEFICIARY RELATIONSHIP AMOUNT OR SHARE NUMBER Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS (include ouVight spousal distributions, and Vansfers under Sec. 911G(a)(L2)J 1 Douglas Ian Shaw Son I/3 16 Kennedy Dr., Southampton Village, NY 11968 2 Frederick W. Shaw Son 1/3 8 Packer Road, Edgewood, NM 87015 3 Elizabeth Jane Shaw Daughter 1/3 65 Parnidge Lane, Belmont, MA 02478 II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE None Charitable and Governmental Bequests: TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (also enter on line 13, Recapitulation) $Q LAST WILL AND TESTAMENT OF DONALD FREDERICK SHAW I, DONALD FREDERICK SHAW, of West Pennsboro Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any and all wills and codicils heretofore made by me. ITEM I: My personal representative shall pay from the residue of my estate the expenses of my last illness, funeral and burial debts duly allowed against my estate, and all death taxes (Pennsylvania inheritance tax and federal estate tax) occasioned by my death and incurred with respect to all property taxed to my estate regardless of whether such property ~j ~ passes by this Will or passes outside of this Will. -~" ITEM R: I bequeath those articles of my automobiles, personal effects, household goods, and other tangible personalty of like nature (not including cash or securities), i together with any existing insurance thereon, if any, as may be my individual property and not the property of my Wife or owned jointly by me with her, as set forth in a separate memorandum wluch I shall place with my Will to the persons therein designated. If I shall leave no separate memorandum, or with regard to my automobiles, personal effects, household goods, and other tangible personalty of like nature (not including cash or securities) not referenced by such memorandum, I bequeath such property to my Wife, FRANCES CAMPBELL SHAW, if she survives me by thirty (30) days. Should my Wife, FRANCES CAMPBELL SHAW, not be living on the thirty-first day after my death, I bequeath such tangible personalty and insurance thereon to my children, DOUGLAS IAN SHAW, FREDERICK W. SHAW, and ELIZABETH JANE SHAW to be divided among them by my Executor with due regard for their personal preferences in as nearly equal shares as practical. ITEM III: On the occasion of my death I forgive all amounts due me by any of my children. This direction is to apply whether or not there is evidence of the indebtedness. The amount forgiven is not to be considered in the calculation of the shares of my children. .ITEM IV: Provided that my Wife, FRANCES CAMPBELL SHAW shall ~ survive me by 30 days, I devise and bequeath the residue of my estate, of every nature and ~ wherever situate, to F&M Trust of Chambersburg, PA, IN SEPARATE TRUST, to hold, ~~ mana e invest, and reinvest the share so received in accordance with the following instructions: h~ g , ~' A. My Trustee shall pay the net income of this Trust to my Wife, FRANCES CAMPBELL SHAW, in periodic installments that shall be at least as ~ frequently as quarterly. B. Upon the death of my Wife, FRANCES CAMPBELL SHAW, the accrued income to the date of my wife's death shall be paid to my wife's estate, and the balance shall be distributed in equal shares to my children, DOUGLAS IAN SHAW, FREDERICK W. SHAW, and ELIZABETH JANE SHAW, per stirpes. C. There shall be no right to invade principal during my wife's life. ITEM V. Should my Wife, FRANCES CAMPBELL SHAW, predecease ine or die on or before the thirtieth day following my death, I devise and bequeath the residue of my estate, of every nature and wherever situate, in equal shares, to my children, DOUGLAS IAN SHAW, FREDERICK W. SHAW, and ELIZABETH JANE SHAW, per stirpes. ITEM VI: No interest of any beneficiary under this Will, any codicil hereto, or any Trust created herein, shall be subject to anticipation or voluntary or involuntary alienation. ITEM VII: My Executrix and Trustee, and their successors, shall have the following powers in addition to those vested in them by law, and by other provisions of my Will, applicable to all property, whether income or principal, including property held for minors, exercisable without court approval, and effective until actual distribution of all property: A. To borrow money from any person or institution, including my Executrix or Trustee, and to mortgage or pledge any or all real or personal property as my Executrix or 1 Trustee in its sole discretion shall choose. l~~ B. To compromise any claim or controversy. ~~~ C. To invest in all forms of property (including stock, common trust funds and mortgage investment funds, whether maintained by my corporate fiduciary or others) ~~ without restriction to investments authorized for Pennsylvania fiduciaries, as they deem proper, without regard to any principal of diversification or risk. D. To retain any or all of the assets of my estate, real or personal, without regard to any principal of diversification or risk. E. To sell at public or private sale, to exchange, or to lease for any period of time, any real or personal property and to give options. for sales, exchanges, or leases, for such prices and upon such terms or conditions as they deem proper. ITEM VIII: I appoint my son, DOUGLAS IAN SHAW, as Executor of my ~~ estate. Should DOUGLAS IAN SHAW fail to qualify or cease to act as Executor, I appoint my daughter, ELIZABETII JANE SHAW, as Executrix of my estate. ITEM IX: I appoint F & M Trust of Chambersburg, Pennsylvania, as Trustee of each and every Trust created by this Will. I hereby empower my wife to replace my designated Trustee by delivering a written direction to my Trustee with copies to my children, provided that she shall simultaneously appoint a replacement corporate trustee, and the replacement corporate trustee shall sign a written consent to serve. In such event the replacement Trustee shall have the same powers as I have given to the Trustee named herein. IN WITNESS WHEREOF, I, DONALD FREDERICK SHAW, have hereunto set my hand and seal to this my Last Will and Testament, consisting of six (6} printed pages, each of which bears my signature, this 2 ~ c Signed, sealed, published and declared by the above-named Testator, DONALD FREDERICK SHAW, as and for his Last Will and Testament, in the presence of us, who, at his request, in his sight and presence, and in the sight and presence of each other, have hereunto subscribed o es sses DONALD FREDERICK SHAW, Testator COMMONWEALTH OF PENNSYLVANIA ) . S5. COUNTY OF CUMBERLAND WE, DONALD FREDERICK SHAW, TAYLOR P. ANDREWS, and ~~~ ~Qr1G~S ~~rx-f}~'(~ ,the Testator and witnesses, respectively, whose names are signed to the foregoing or attached instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator signed and executed the instrument as and for his Last Will and Testament and that he signed willingly and that he executed as his free and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the 'Testator, signed the Will as witnesses and that to the best of their knowledge the Testator was at the time eighteen (18) or more years of age, of sound mind and under no constraint or undue influence. Subscribed, sworn to and acknowledged before me by DONALD FREDERICK SHAW, the Testa~r and subscribed to and sworn or affirmed to before me by TAYLOR P. Ay REWS and YQ6'~S L,-~~, l l t~~ ,witnesses, this ~ day of _ ~ t,~}~.~ , 2001. ' Notary Public NO7ARlAL SEAL SHELLY SEXTOiJ, NOTARY PUBLIC CARLISLE BOPO, CUR".6ERLAND COUNTY MY COMf~ilSSlGN EK?ll•IES A°R!L 26, 2003 Member, Penr~s~`iy~~.~r~~~;;c~;:@r of NoiarieS COURT OF COMMON PLEAS CUMBERLAND COUNTY, PENNSYLVANIA t : . _ _ N ~~, .~ ~_ -.. ~ ~ .:~ 1r ~ t.L.l.r'' _ ' _ UQ 7 ~ ~ v ORPHANS' COURT DIVISION O.C. N0. R.W. N0. o'2d~'S~-C~6~S.3 ESTATE OF DONALD FREDERICK SHAW, DECEASED DISCLAIMER I, Frances Campbell Shaw, hereby exercise the rights granted to me in Chapter 62 of the Probate, Estate and Fiduciaries Code, 20 Pa. C.S. 6201- 6207, and I hereby disclaim any and all rights that I may have pursuant to the provisions of Item IV of the probated Will of Donald Frederick Shaw. By this disclaimer I give up all rights to receive income from a trust to be established for my benefit from the residue of the Estate of Donald Frederick Shaw, and I agree that the residual Estate shall be distributed to the children of Donald Frederick Shaw in the same fashion as if I had predeceased Donald Frederick Shaw as per Item V of the Will. In Witness Whereof, and intending to be legally bound hereby, and intending that this Disclaimer shall be filed of record in the Office of the Clerk of the Orphans' Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania, as provided in 20 Pa. C.S. 6204(a), I have hereunto set my hand this ~_ day of 2008: Frances Campbell Shaw