HomeMy WebLinkAbout12-03-0815056041147
_~ REV-1500
EX 06-05
( ) •FFICIAL USE •NLY
PA Department of Revenue
Bureau of Individual Taxes co~nry code Year File Number
PO 60X.280601 INHERITANCE TAX RETURN
Harrisburg, PA 1712s-0601 RESIDENT DECEDENT 21 0 8 0 0 2 6 3
EIVTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
432209686 03072008 12131926
Decedent's Last Name Suffix Decedent's First Name MI
SHAFFER SHIRLEY B
(t1` Applicable) Enter Surviving Spouse's Information Below
Sppouse'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
FIILL IN APPROPRIATE OVALS BELOW
~~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return (date of death
prior to 12-13-82)
[] 4. Limited Estate ^ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Return Required
(date of death after 12-12-82)
~~ g Decedent Died Testate ^ ~~ each Copy Hof Trust)a Living Trust Q 8. Total Number of Safe Deposit Boxes
(Attach Capy of Wilq
^ 9. Litigation Proceeds Received ^ 1 p. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
('ORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
blame Daytime Telephone Number
RICHARD E. CONNELL ESQ. 7172328731
Firm Name (If Applicable)
BALL, MURREN & CONNELL REGISTER OF WILLS USE ONLY
rya
F=irst line of address C7 ~ -
2303 MARKET STREET s~ '~
~.~ -z, r~ 1
,`
:>econd line of address ~ ~ ~ I -
~
Lr'1 Wiz: W
ILEDI^-r - -
(Iity or Post Office State ZIP Code ~~ ~ ; `~~'
CAMP HILL PA 17011 ~~ ':: J~`
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v _
ra _, ;
Correspondent'se-mail address: Connell@bmc-law.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,
iit is true, correct and complete. Declaration of preparer other than the personal representative Is based on all information of which preparer has any knowledge.
SI.G~N TURE OF PER~ON RESPONSIBLE FOR FILING RETURN DATE_
/r~„i~ ~x~/'d~u~i ~/1 ~~.,s> ,- Teri Lynn Essey fC~L~'~/~~
52 Eaate-8treeL Charle~ais PA~1
SIG 'TURE OF PREPA IzR THER AN RESENT E DATE
Richard E. Connell Esq. 71 ~~d ~D
ADDRESS ~~
2303 Market Street, Camp Hill, PA 17011
Side 1
~_ 15056041147 15056041147 J
~~
REV-1500 EX
15056042148
oecedenPsName: SHAFFER, SHlRLEY B.
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) ....................................................................... g.
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/Sec 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,
Decedent's Social Security Number
432209686
210,000.00
187,683.99
88,369.97
486,053.96
32,993.66
32,993.66
453,060.30
453,060.30
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 .00 15.
16. Amount of Line 14 taxable
at lineal rate X .045 4 5 3, 0 6 0. 3 0 16.
17. Amount of Line 14 taxable
at sibling rate X .12 17.
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. Tax Due ..................................................................................................................... 19.
20. FILL IN THE OVAL 1F YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
20,387.71
20,387.71
Side 2
L, 15056042148 15056042148
R:EV-1500 EX Page 3 File Number 21 - 08 - 00263
C)ecedent's Complete Address:
DE EDEN' AME
Shaffer, Shirley B.
iTREET ADDRESS
514 Colony Road
c,ITY STATE ZIP
Camp Hill PA 17011
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 20,387.71
2'. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments 17,000.00
C. Discount 894.74
Total Credits (A + B + C) (2) 17,894.74
:s. Interest/Penalty if applicable
p_ Interest
E. Penalty
Total Interest/Penalty (D + E) (3) 0.0 0
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4)
Check box on Page 2 Line 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 2,49 2.97
A. Enter the interest on the tax due. (5A)
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 2 , 4 9 2.9 ]
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 :.................................................................................. ^ ^x
b. retain the right to designate who shall use the property transferred or its income :.................................... ^ ^x
c. retain a reversionary interest; or .................................................................................................................. ^
d. receive the promise for life of either payments, benefits or care? .............................................................. ^ x^
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
contains a beneficiary designation? ...................................................................................................................... ^ U
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURI
.x .. -- ,. - 1 -
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 P.S. §9116 (a) (1.3)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE A
REAL ESTATE
FILE NUMBER
ESTATE. OF Shaffer, Shirley B. 21 - 08 - 00263
All real property owned solely or as a tenant in common must be repported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a wilting seller, neither being compelled to buy or sell, both having
reasonalble knowledge of the relevant facts. Real property which is jointly-owned with right of survivorship must be disclosed on
schedule F.
ITEM DESCRIPTION VALUE AT DATE OI
NUMBER DEATH
1 514 Colony Road 210,000.00
Camp Hill (Hampden Township), PA
Parcel Tax ID # 10-20-1848-335
TOTAL (Also enter on Line 1, Recapitulation) ~ 210,000.00
SCHEDULE B
COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Shaffer, Shirley B. 21 - 08 - 00263
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM
NUMBERR DESCRIPTION UNIT VALUE VALUE AT DATE OF
DEATH
1 Morgan Stanley -Account Number 53842 ~ 132,494.31
SEE ATTACHMENT
2 Wachovia Securities -Account Number 5236-9732 14.11 55,189.68
Evergreen Equity TR
Asset Allocation A -Mutual Fund
(3911.388 shares)
SEE ATTACHMENT
I
TOTAL (Also enter on line 2, Recapitulation) ~ 187,683.99
Estate Valuation
Shirley B. Shaffer
Date of Death: 03/07/2008 Estate of: Shirley B. Shaffer
valuation Date: 03/07/2008 Account: 5236-9732
Processing Date: 06/19/2008 Report Type: Date of Death
Numb er of Securities: 1
File ID: 5236-9732
Shares Security Mean and/or Div and Int Security
or Par Description High/Ask Low/Bid Adjustments Accruals Value
1) 3911.38 8 EVERGREEN EQUITY TR (30023C350; EAAFX)
ASSET ALLOC A
Mutual Fund (as quoted by NASDAQ)
03/07/2008 14.11000 Mkt
14.110000 55,189.68
Total Value:
Total Accrual:
Total: $55,189.68
$0.00
$55,189.68
Portfolio Endnotes
Titled
SHIRLEY B SHAFFER
514 COLONY RD
CAMP HILL PA 17011-2009
Account was opened on 9/13/2005.
Page 1
This report was produced with EstateVal, a product of Estate Valuations & Pricing Systems, Inc. If you have questions,
please contact EVP Systems at (818) 313-6300 or www.evpsys.com. (Revision 7.0.4)
Ide -s
Date of Death Update 410 -53842 SHIRLEY B SNAPPER (DECD)
Lo in
Please rE:view the listed tax lots carefully. By selecting a tax lot, you are indicating that the position should be adjusted to the market value on the
date of death. The tax lot will also be marked as "inherited" and the holding period will report a long term status on all client reports using Gain and
Loss data.
When you have selected the proper tax lots, click "Submit" The Gain and Loss should be updated with Date of Death values within 3 business
days.
Office :410 Account :53842 Date of Death : 03/07/2008 Instructions/FAQ
Date of Death must be before 4/28!2008
Use Alternate Valuation : Yes + No
Date of Death must be before 10/28/2007
the executor of the estate must make the election to use the alternation valuation date. Individual beneficiaries cannot make this
:lection~. The alternate valuation election can be made by the executor only if it will reduce the value of the gross estate and the
amount of estate tax (and generation-skipping transfer (GST) tax, if applicable). It must apply to all estate property. It cannot be
nade on an asset by asset basis. Some assets may receive increased values. The election is made by the executor on the estate
ax return (Form 706).
„ t..% Yes
Are sorne/all of the shares in this account part of a "joint account with rights of survivor with a spouse from
a non-community property state? (see details.) ~' No
tal assets, such as stocks, bonds or mutual funds, ~olntly owned by husband and wife (in non-community property states)
ive a 50% stepped-up basis on the appreciation (or stepped-down, if the asset has depreciated) of each asset. That is, the new
basis for each share/unit is the average of the estates valuation for that asset and the original purchase price. In community
erty states, assets considered community property receive a 100% step-up (or step-down) basis upon the first spouse's death.
:ial rules apply to community property held as joint property with rights of survivorship.
additional information:
select ail ~ ~ -s6iect aii%
Page
Date Date Unit Total Ad%u.
Seleci' Security Name Acquired Sold Unit Cost Cost Co
~! MS INTERNATL VALUE EQUITY FD D 3/7/2008 3/13/2008 474.373 10.97 5,203.87 ;
MS INTERNATL VALUE EQUITY FD D 3/7/2008 3/13/2008 8.461 10.97 92.82
r MS INTERNATL VALUE EQUITY FD D 3/7/2008 3/13/2008 34.863 10.97 382.45
[~ MS INTERNATL VALUE EQUITY FD D 3/7/2008 3/13/2008 3.274 10.97 35.92
MS INTERNATL VALUE EQUITY FD D 3/7/2008 3/13/2008 88.897 10.97 975.20
r j MS INTERNATL VALUE EQUITY FD D 3/7/2008 3/13/2008 4.080 10.97 44.76
MS INTERNATL VALUE EQUITY FD D 3/7/2008 3/13!2008 81.136 10.97 890.06
MS INTERNATL VALUE EDUITY FD D 3/7/2008 3/13/2008 11.554 10.97 126.75
r MS INTERNATL VALUE EQUITY FD D 3/7/2008 3/13/2008 11.894 10.97 130.48
r MS INTERNATL VALUE EQUITY FD D 377!2008 3/13/2008 122.824 10.97 1,347.38
r MS INTERNATL VALUE EQUITY FD D 3/7/2008 3/13/2008 10.523 10.97 115.44
r MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 13.297 10.78 143.34
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 14.773 10.78 159.25
r MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 17.835 10.78 192.26
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 15.659 10.78 168.80
r MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 15.894 10.78 171.34
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 14.586 10.78 157.24
r, MS LIMITED TERM MUNICIPAL TR 3f7/2008 3/13!2008 15.506 10.78 167.15
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[~ MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 15.073 10.78 162.49
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 17.307 10.78 186.57
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 15.419 10.78 166.22
[~ MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 15.949 10.78 171.93
MS LIMITED TERM MUNICIPAL TR 3!7/2008 3/13/2008 17.836 10.78 192.27
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 14.956 10.78 161.23
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 17.572 10.78 189.43
r MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 16.205 10.78 174.69
J MS LIMITED TERM MUNICIPAL TR 3/7!2008 3/13/2008 17.777 10.78 191.64
r MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 15.541 10.78 167.53
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 15.946 10.78 171.90
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 5,074.331 10.78 54,701.29 5
r MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 16.481 10.78 177.67
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 17.972 10.78 193.74
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 19.299 10.78 208.04
MS LIMITEDT=RfilliuiUNiCIPAL TR 3/7/2008 's/i3i~008 .21.061 10.78 233.51
MS LIMITED TERM MUNICIPAL TR 3!7/2008 3/13/2008 10.154 10,78 109.46
MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 18.168 10.78 195.85
r( MS LIMITED TERM MUNICIPAL TR 3/7/2008 3/13/2008 15.910 10.78 171.51
MSIF TR MID CAP GROWTH INST 3/7/2008 3/13/2008 27.108 28.71 778.27
r MSIF TR MID CAP GROWTH INST 3/7/2008 3/13/2008 154.973 28.71 4,449.27
(ij MSIF TR MID CAP GROWTH INST 3/7/2008 3/13/2008 0.806 28.71 23.14
MSIF TR MID CAP GROWTH INST 3/7/2008 3/13/2008 0.896 28.71 25.72
rj MSIF TR MUNICIPAL INST 3/7%2008 ~ 3/13/2008 9.102 12.54 114.14
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 9.094 12.54 114.04
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 9.102 12.54 114.14
C MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 9.095 12.54 114.05
j MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 12.030 12.54 150.86
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 9.239 12.54 115.86
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 9.181 12.54 115.13
MSIF TR MUNICIPAL INST 3!7/2008 3/13/2008 9.253 12.54 116.03
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 10.434 12.54 130.84
MSIF TR MUNICIPAL INST 3!7/2008 3/13/2008 10.561 12.54 132.43
j MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 10.648 12.54 133.53
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 10.703 12.54 134.22
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 11.916 12.54 149.43
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 11.869 12.54 148.84
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 11.925 12.54 149.54
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 1,274.804 12.54 15,986.04 1;
(~ MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 4.002 12.54 50.19
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 4.040 12.54 50.66
r' MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 4.072 12.54 51.06
r MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 4.063 12.54 50.95
~? MSIF TR MUNICIPAL INST 3/7/2008 3!13/2008 4.115 12.54 51.60
r MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 1,599.209 12.54 20,054.08 21
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 9.137 12.54 114.58
r MSIF 7R MUNICIPAL INST 3/7/2008 3!13/2008 10.774 12.54 135.11
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MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 6.369 12.54 7g,g7
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 10.389 12.54 130.28
[~' MSIF TR MUNICIPAL INST 3/7!2008 3/13/2008 4.626 12.54 58.01
MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 10.787 12.54 135.27
r MSIF TR MUNICIPAL INST 3/7/2008 3/13/2008 11.243 12.54 140.99
MSIF US LARGE CAP GR INST 3/7/2008 3/13/2008 485.426 20.67 10,033.76
MSIF US LARGE CAP GR INST 3/7/2008 3/13/2008 0.406 20.67 8,3g
r MSIF US LARGE CAP GR INST 3/7/2008 3/13/2008 0.089 20.67 1.84
MSIF US LARGE CAP GR INST 3/7/2008 3/13/2008 1.989 20.67 41.11
j VAN KAMPEN COMSTOCK I 3/7/2008 3/13!2008 12.282 15.83 194.42
VAN KAMPEN COMSTOCK I 3/7/2008 3/13/2008 1.653 15.83 26.17
r; VAN KAMPEN COMSTOCK I 3/7/2008 3/13/2008 3.324 15.83 52.62
rj VAN KAMPEN COMSTOCK 1 3/7/2008 3/13/2008 3.139 15.83 49.69
VAN KAMPEN COMSTOCK 1 3/7/2008 3/13/2008 3.062 15.83 48.47
VAN KAMPEN COMSTOCK I 3/7/2008 3/13/2008 13.172 15.83 208.51
VAN KAMPEN COMSTOCK I 3/7/2008 3/13/2008 0.368 15.84 5.83
VAN KAMPEN COMSTOCK I 3/7/2008 3/13/2008 3.212 15.83 50.85
n VAN KAMPEN COMSTOCK 1 3!7/2008 3/13/2008 0.441 15.83 6.98
VAN KAMPEN COMSTOCK 1 3/7/2008 3/13/2008 3.315 15.83 52.48
j VAN KAMPEN COMSTOCK I 3/7/2008 3/13/2008 2.900 15.83 45.91
~J VAN KAMPEN COMSTOCK 1 3/7/2008 3/13/2008 3.040 15.83 48.12
VAN KAMPEN COMSTOCK I 3!7/2008 3/13/2008 28.721 15.83 454.65
[~ VAN KAMPEN COMSTOCK 1 3/7/2008 3/13/2008 2.022 15.83 32.01
VAN KAMPEN COMSTOCK I 3!7/2008 ' 3/13/2008 3.285 15.83 52.00
r` VAN KAMPEN COMSTOCK I 3/7/2008 3/13/2008 488.631 15.83 7,735.03
VAN KAMPEN COMSTOCK 1 3/7/2008 3/13/2008 4.554 15.83 72.09
r '' VAN KAMPEN COMSTOCK 1 3/7/2008 3/13/2008 28.477 15.83 450.79
VAN KAMPEN COMSTOCK 1 3/7/2008 3/13/2008 2.762 15.83 43,72
r VAN KAMPEN COMSTOCK I 3/7/2008 3/13/2008 3.109 15.83 49.22
Page
The Estimated Gain and Loss information is provided for informational purposes only and may not be relied upon in making any tax, acco
or regulatory filing or report. We recommend that you contact your tax advisor to determine the appropriate information to be used in the
preparGStion of your tax return. This Estimated Gain and Loss Summary is not a substitute 1099 form (or any other appropriate tax form) a
should not be filed with your taxes. The Total Cost, Unit Cost and Proceeds of eligible equity and options transactions with Choice Selects
pricing do not include commissions paid on your purchases or sales and therefore may 1SOt equal the acquisition price or principa.' amount
sale. Th:e figures should be independently verified. Estimated Gain and Loss information does not take into account a taxpayer's particular
circumstances such as the existence of hedging transactions, constructive sales ormarked-to-market pricing adjustments on certain option
at year-end.
Please note that although Morgan Stanley & Co. makes every effort to adjust the cost basis for such securities' capital changes, it does not
the cost basis for all events, including amortization of non-municipal bond premiums; exercise of unlisted stock options; securities deemed
have been sold and simultaneously repurchased; receipt of cash in lieu of fractional shares; or the net effect of wash sales andlor short sat
against the box.
For securities not purchased through Morgan Stanley & Co., for example, securities purchased elsewhere and later transferred to it, any c
included in the Estimated Gain and Loss information has been provided either by you or another financial institution. Whether provided b-
another• financial institution or Morgan Stanley & Co., it is your responsibility to ensure the accuracy of all of the Estimated Gain and Los
information. Please contact your Financial Advisor with any questions or to correct any information.
For Managed Futures and alternative investments, there are likely to be restrictions on redemptions, please see applicable offering docum
With respect to estimated gains and losses for listed equity options, Morgan Stanley & Co. has taken into account option premiums paid o;
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SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH OF PENNSYLVANIA PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
FILE NUMBER
ESTATE OF Shaffer, Shirley B. 21 - 08 - 00263
Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on schedule F.
ITEM DESCRIPTION VALUE AT DATE Of
NUMBER DEATH
1 Wachovia Bank NA
1. Certificate of Deposit
2. Certificate of Deposit
3. Certificate of Deposit
4. Certificate of Deposit
#8521 $43,769.52
#6431 5,110.81
#7968 5,445.13
#7287 10,944.51
65,269.97
2 Morgan Stanley Cash /Money Market
Account Number 410 053842 047
23,100.00
TOTAL (Also enter on Line 5, Recapitulation) ~ 88,369.97
SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA ~~
INHERITANCE TAX RETURN e~~/n~~'(~ J\'rA /~ !~/'~G~~Y~
RESIDENT DECEDENT ~-w~~n ~ ~ v~ ~ nl V VW ~ ~7
FILE NUMBER
ESTATE OF Shaffer, Shirley B. 21 - 08 - 00263
Debts of decedent must be reported on Schedule I.
ITEM
NUMBER FUNERAL EXPENSES: DESCRIPTION AMOUNT
A. 1 Neill Funeral Home 6,327.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Social Security Number(s) / EIN Number of Personal Representative(s):
Street Address
City State Zip
Year(s) Commission paid
2. Attorney's Fees Ball, Murren & Connell
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
4. Probate Fees Register of Wills (Cumberland County) Filing for Letters
5. i Accountant's Fees
6. ~ Tax Return Prepares s Fees
7. ' Other Administrative Costs
1 Cumberland Law Journal
2,500.00
79.00
75.00
TOTAL (Also enter on line 9, Recapitulation) 32,993.66
I:OMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT Schedule H
Funeral E~enses ~
Adminisfiative C06tS Continued
ESTATE OF Shaffer, Shirley B. FILE NUMBER
--- -- ------------------- 21 - 08 - 00263
2 The Sentinel 167.66
3 Sewer & Refuse 277.30
4 Plumbing Repairs 460.40
5 Water 63.68
6 Utilities 2,068.07
7 Real Estate Taxes (County) $1,538.33 1,973.74
Real Estate Taxes (County/Township) $435.41
8 Executrices Expenses 1,371.02
9 Household Maintenance/Repair 1,121.88
10 Lawn Care and Maintenance 680.65
11 Stamps/Materials for disposition of personal possessions 117.99
12 Reimbursement to Ball, Murren & Connell for costs advanced 54.04
13 Miscellaneous costs and expenses for continuing utilities and maintenance of Estate 956.23
real estate.
14 Reserve for costs of sale of Real Estate 14,700.00
(Commission, 1 % transfer tax)
Page 2 of Schedule H
REV-1513 EX+ 1;9-00)
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF Shaffer, Shirley B. ~ FILE NUMBER
21 - 08 - 00263
RELATIONSHIP TO j SHARE OF ESTATE AMOUNT OF ESTATE
NUMBE~ NAME AND ADDRESS OF PERSON(S) i - -DECEDENT - - I `- -(Words) -- - ($$$)
RECEIVING PROPERTY Do Not List Trustee(s)
I. ,TAXABLE DISTRIBUTIONS[includeoutrightspousal I
distributions, and transfers
under Sec. 9116 (a) (1.2)}
1 ~ Teri Lynn Essey Daughter
52 Eagle Street
Charleroi, PA 15022
i
2 ~, Blake Kenneth Shaffer Son
18584 Santa Isadora Street
i Fountain Valley, CA
one-half
one-half
Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet
11~ 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 It -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEETI 0.00
LAST WILL AND TESTAMENT
OF
SAIRLEY B. SAAFFER
Dated: June 3, 2002
Prepared by:
U.S. Army Reserve
Carlisle Barracks
Carlisle, PA
LAST WILL AND TESTAMENT
OF
SHIRLEY B. SHAFFER
I, Shirley B. Sheffer, a resident of the Commonwealth of Pemisylvania, make, publish and
declare Uiis to be my Last Will and TestvnenL revoking all wills and codicils at any time heretofore made by me.
FII2ST: I direct Uaat Uie expenses of mY last illness and fwleral, Use expenses of the
adninistration of my estate, and all estate, irilieritance and sinilar taxes payable with respect to property included in
my estate, whether or not passing under Uis will, v~d an_y interest or penalties thereon, shall be paid out of my
residuary estate, without apportionment and with no right of reimbursement from any recipient of any such property.
SECOND: I give all tangible personal property owned by me at the time.of my death, including
without linitation personal effects, clothing, jewelry, furniture, fiunislungs, household goods, automobiles and other
velicles, togeUier wiUi all insurance policies relating U~ereto. to those of my children Blake Kenneth Shaffer and
Trei Lynn Essey who survive me, in substantially equal shares, to be divided between them as U~ey shall agree, or if
Uiey cannot agree, as my Executor shall determine.
THIRD: I give all the rest, residue and remainder of my property and estate, both real and
personal, of whatever kind and wherever located, that I own or to which I shall be in any manner entitled at the time
of my deaUi (collectively referred to as my "residuary estate"), as follorvs:
(a) To U~ose of my clildren who survive me and to the issue who survive me of those of my
children ~vho shall not survive me, per stirpes.
(b) If no issue of mine survives me, I give my residuary estate to those who would take from me
as if I were U~en to die wid~out a will, umnarried and Use absolute owner of my residuary estate,
and a resident of the ComrnonwealUi of Per-nsvlvania.
FOURTH: If any property of my estate vests in absolute ownership in a rxunor or incompetent,
my Executor, at any tune and wiUrout court authorization, may: distribute the whole or any part of such property to
the beneficiary; or use the whole or any part for the healU~, education, maintenance and support of Use beneficiary; or
distribute the whole or any part to a guardian, committee or other legal representative of the beneficiary, or to a
custodian for the beneficiary under any gifts to minors or transfers to minors act, or to the person or persons wiUl
whom the beneficiary resides. Evidence of any such distribution or the receipt therefor executed by the person to
whom the distribution is made shall be a full discharge of my Executor from any liability tivith respect Uiereto, even
though my Executor maybe such person. If such beneficiary is a minor, my Executor may defer the distribution of
Use whole or any part of such property until the beneficiary attains the age of eighteen (18) years, and may hold the
same as a separate fund for the beneficiary with all of the powers described in Article SIX'I`1-I hereof. If the benefi-
ciary dies before attaining slid age, any balance shall be paid and distributed to the estate of the beneficiary.
FIFTH: I appoint Blake Kenneth Shaffer to be my Executor. If Blake Kemieth Shaffer shall fail
to qualify for any reason as ny Executor, or having qualiFied shall die, resign or cease io act for any reason as my
Executor, I appoint Teri Lynn Essey as my Executor. I direct that no Executor shall be required to Ele or furnish
any bond, surety or other security in any jurisdiction.
SIXTH: I grant to zny Executor all powers conferred on executors under the Pennsvlvania
Probate, Estates and Fiduciaries Code, as amended, or any successor thereto, and all powers conferred upon
executors wherever my Executor may act. 1 also grant to my Executor power to retain sell at public or private sale,
eschruige, grant options on, invest and reinvest, and o[henvise deal with any kind of property, real or personal, for
cash or on credit; to borrow money and encumber or pledge any properly to secure loans; to divide and distribute
property in cash or in kind; to exercise all powers of an absolute owner of property, to compromise and release
claims tivith or without consideration; and to employ attorneys, accountants and other persons for services or advice.
The teen "Executor" wherever used herein shall mean Use executors, executor, executrix or administrator in office
from time to time.
SEVENTH: I direct that for purposes of this will a beneficiary shall be deemed to predecease me
unless such beneficiary survives iue by more than flirty days.
I1V WITNESS WHEREOF, I, Shirley B. Shaffer, sign my name and publish and declare llis
instrument as my last will and testament tlis 3rd day of June, 2002.
~'
Shirley .Shaffer ~~
The foregoing instrument was signed, published and declared by Shirley B. Shaffer, the above-
named Testatrix, to be her last will and testament in our presence, all being present at the same time, and cve, at her
request and in her presence and in the presence of each other, have subscribed our names as witnesses on the date
abo e written.
having an addr ss al
s` PA
having an a Tess at
~~~ P~
2
ACKNOWLEDGMENT AIINCC~~D AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA, COUNTY OF emu- , ss.
We, the Testatrix and the tivitnesses whose Hynes are signed to dse attached or foregoing
instruunen[, being first duly swom, do hereby declare to the undersigned authority that the Testatrix, Shirley B.
Shaffer, signed a~~d executed said instnunent as her last will and testament in the presence and hearing of the
witnesses, and that she had signed willingly, and i]>at she executed it as her free and voluntary act and deed for the
purposes therein expressed, acid that each of the witnesses at the request of the Testatrix, in the presence and hearing
of the Testatrix and each other, signed the tivill as witness. and chat to the best of his or her ]cnowledge the Testatrix
was at the time at least eighteen years of age, of sound mind and under no constraint, duress, fraud or undue
influence.
~~
S1>;rley .Shaffer
Testatrix
Witness
~~~lo ;~~~t~
Wf tness
Subscribed, sworn to and acknowledged before me by the said Shirley B. Shall'er, Testatrix, and
subscribed and swom to before me by the above-named witnesses, lltis 3rd day of June, 2002.
-~ IS ' .
Notary Public
My commission expires on
NOTARIAL SEAL
Roxanne K. Wetter, Notary Public
Township of Susquehanna, Dauphin Gounty
My Commission Expires May 9, 2005
Member, Pennsylvania Association of Notaries