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HomeMy WebLinkAbout01-21-09 (2)-I 15056041147 REV-1500 EX (O6-OS) OFFICIAL USE ONLY PA Department of Revenue county cone veer Ede Number Bureau of Individual Taxes INHERITANCE TAX RETURN PO BOX.280601 2 1 0 8 0 0 9$ 7 Harrisburg, PA 171213-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Binh 04 26 2008 09 03 1921 Decedent's Last Name Suffix Decedent's First Name MI SHEAFFER MERVIN J (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 ;X 1. Original Return ', 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-92) ~' 4. Limitetl Estate ~ qa, Future Imeresl compromisa ~ 5. Federal Estate Tax Return Re wired 4 ~ (Cale of tleath after 12-12-82) ~ X ' g. Decetlent Dietl Testate ~- - (Attach Copy of Wilp A Decedent Maintained a Living Trust 1 8. Total Number o/ Safe De o (Attach Copy of TrueQ p Sit BOXea 9. Litigation Proceeds Received '~. ' 10. Spousal Poverty Credit (dale or death '. 11. Election to tax under Sec. 9113(A between 12-31-91 entl 1-1-95) 3 (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Number JAN M WILEY 717 432 9666 Firm Name (If Applicable) THE WILEY GROUP First line of address 130 W. CHURCH STREET Second line of address City or Post Office DILLSBURG Correspondent's e-mail address: or per3ury, 1 declare that I have ezaminetl this return, and complete. Declaration of preparer other than the State ZIP Code PA 17019 REGISTER OF WILLS USE ONLY is ~ r~~x o __ _~i m~ .:o o c_ o - '_, DOFF X11-G~Fr +~. ~. -JG i c `i -1 c~T ~ N 1 schedules and statements, entl to the best of my is based on all information of which preparer has .! / i rn C~~/ _. e i• „ ~~ - Linda M Stoner ~~~ „/? ADD S~ ~f 50S Sharon Avenue, Mechanicsburg PA 17055 \SIGNr~TURE OF PREPARER OTHER THAN REPRE TE -~~1~n,a y~,~ _ ~ ~ J2~ _ Jan M Wiley ~~~~~ ADDRE$5 13 W. Church Street, Dillsburg, PA 17079 Side 1 L 15056041147 1505641147 ~~r\ ,~ ~~ ~Oo ~` ~, ~~ ~~~ . ~~\ ~~ \\ PA Inheritance Tax Return ESTATE OF FILE NUMBER Sheaffer, Mervin J. 21-08-00487 Signature of Additional Fiduciaries Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. Signature #2 Name Addressl Addressl City, State, Zip K. Date 12 Longwood Drive Mechanicsburg, PA 17050 /:J b O ~ 15056042148 REV-1500 EX RECAPITULATION 1. Real Estate (Schedule A) ........................................._................... _....................... ... L 1 1 9 8 9 2 8 8 2. Stocks and Bonds (Schedule B) ...................._............................ _..................... ... 2. 8 0, 9 9 4 9 6 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. 1 5 1 2 9 2 7 2 6. Jointly Owned Property (Schedule F) Separate Billing Requested ........... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) ' Separate Billing Requested ........... .. 7, 9 3 5 2 5 0 8. Total Gross Assets (total Lines 1-7) ..................................................................... .. 8. 3 5 6 0 3 3 0 6 9. Funeral Expenses & Administrative Costs (Schedule H) ............... ........................ .. g, 6 3 0 7 3 5 0 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule p .............................. .. 10. 3 9 9 9 1 2 11. Total Deductions (total Lines 9& 10) .................................................._...._.......... .. 11. 6 6 5 7 2 6 2 12. Net Value of Estate (Line 8 minus Line 11) ............................................_............. .. 12. 2 $ 9 Q 6 0 4 4 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. 2 8 9 4 6 0 4 4 TAXCOMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal taz rate, or transfers under Sec. 9116 (a)(1.2) X .00 0 0 0 15. 0 0 0 16. Amount of Line 14 taxable at lineal rate x .045 2 8 9 9 6 0 4 9 16. 1 3, 0 2 5 7 2 17. Amount of Line 14 taxable at sibling rate X .12 0 0 0 17~ 0 0 0 18. Amount of Line 14 taxable at collateral rate X .15 0 0 0 18. 0 0 0 t9. Tax Due .................................................................................................................... . 1s. 1 3 0 2 5 7 2 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 15056042148 Side 2 15056042148 REV-1500 EX Page 3 File Number 21-08-00487 Decedent's Complete Address: DECEDENT'S NAME Mervin J. Sheaffer STREET ADDRESS -- The Thornwald Home 442 Walnut Bottom Road CITY - STATE ZIP Carlisle PA 17013 Tax Payments and Credits: 1. Tax Due(PagelLinel9) (1) 13,025.72 2. Credits/Payments A. Spousal Poverty Credit g, Prior Payments 14,535.00 C. Discount 851.29 3. InteresVPenal (a licable Total Credits (A +B+C) ty i pp (2) 15,188.29 p, Interest E. Penalty Total InteresVPenalty (D + E) (3) q. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) 2 160.57 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) A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (SB) Make Check Payable to: REGISTER OF WILLS, AGENT 7!ceIvH'f ~tayf~H(;li'~ r t i r 1~ t .: .... ~L ._r , Fiji: 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 trans(erred :........................................... _.._................._.............. x ~. b. retain the right to designate who shall use the property transferred or its income :.................................... ~ !~ x c. retain a reversionary interest; or ......... ... ......... ................_.... ............. __.... ._ '~ x ' 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?... ......... x 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... '. x 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which containsa beneficiary designation?.. ._ ............... ..... x IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. n:..l fih..., 'ad,,t ,,, i..':) G.S. , tt=,m~'f-~'*rm ~ : rr-`-,^ ~.,. _..--,, ~*-^_--~i~r"R- 3ryR~l'~ For dates of death on or after July i, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for theuse 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 exemot 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 it the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The taz 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. ~~~k ill ttrt~ ~esZ~rrt~rtt OF MERVIN J. SHEAFFER BE IT T+FMG'~ERED, that I, MERVIN J. SHEAFFER, of 1'_00 Sheaffer Road, Diilsburg, Cumberland Co;:n *_y, Pennsylvania, beiny of sound mind, memory and ^nderstandiny, do make, publish and declare this as and for my LasT_ Will and Testament, hereby revoking and making nuil. and void any and all W llls and Testaments and writnys in [he nature thereof by me at any time heretofore made. ITEM 1: I direct that all my just. debts and funeral expenses be paid as soon after my demise as may be convenient. ITEM 2: All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever situate, whether it be real, personal or mixed, including property over which I have a power of appointment, I give, devise and bequeath in equal shares unto my children, LINDA M. STONER, LARRY J. SHEAFFER, and BETTY K. WOLF. In the event that any of my children predecease me, I then direct that their share shall be divided equally between their children, both bioloyi cal and step-children. ITEM 3: I direct my hereinafter named Co-Executors to pay all inheritance, estate, succession and legacy taxes of whatsoever nature and kind, to which my est.a to or the transfer of any property passing hereunder or otherw ise passing by reason of my demise, may be subject and to cha rqe such taxes against my residuary estate, it being my int=noon .WIT ESS: ~7 /~~'" ./.'~~~~ (SEAT.) MERVIN J. SHEAFFER 1 that none of the aforesaid taxes, either federal or state, on any property required to be included in my gross estate, under the provisions of any state or fedora ]aw r.ow in fcrcr= or hereafter enacted, shall be prorated among the persons interested in my estate to whom scch property is or may 'oe transferred or to whom any benefit accrucs_ ITEM 4: I appoint LINDA M. STONER, LARRY J. SHEAFFER, and BETTY K. WOLF as Co-Executors of this my Last Wil] and Testament. ITEM 5~ 1 direct that my Co-Executors shall not be required to give bond for the faithful pe rf ermance of their duties in any jurisdiction. ITEM 6: My Personal Representatives shall nave the following powers in addition. to those vested in thorn by Law and by other provisions of this, my Last Wii7. and Testament, exercisable without court approval, and effective until distribution of all property: 1. To retain any or all of the assets of my estate, real or personal, without restriction to investments authorized for Penr,s ylvania fiduciaries, as they from time to time may deem proper, without regard to any principal of diversification or risk. 2. To invest in all forms of property without restriction to investments authorized for Pennsylvania fiduciaries, as trey from time to time may deed proper, without regard to any principal of diversification or risk. 3. 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 pri r_es and upon such terms or conditions as they from time to time may deem proper. ESS: W1 MERVIN T. SHEAFFER ~ 2 9. To allocate receipts and exilerses to principal or income or partly to each as they `rpm. time to time may deem proper. 5. 'Po borrow money from persons cr _nslitai_i cns, themselves included, and to mo rtyage <,. pledge any or all real or personal property as they in their sole discreticr, sha'.l chcse, without regard to the dispositve prcvisic r.s of this instrument. 6. To compromise any claim or controversy asserted by or against my estate or trust estate. 7. To make distribution in cash or ir, kind or partly in cash and partly in kind, ar_d in sr,ch manner as they may determine, and at vaiuati ons finally to be fixed by them. IN WITNESS WAEREOF, I have hereunto set my hand and seal this ~ day of -Q.1 DOH 2001. ~~-, NE 5: 1M ~ ~ MERVIN J. SHEAFFER 3 COMMONWEALTH OF PENNSYLVANIA COUNTY OF YORK SS We, MERVIN J. SHEAFFER, JAN M. WILEY, ESQUIRE and SHAWNA L. VARNER, the Testator and the witnesses respectively, whew names are signed to the attached or foregoinc -nstrument, being first duly sworn, do hereby declare to the undersi.o ned authority that the Testator signed and executed the instrument as his Last Wi11 and Testament and That. he had signed wil,]nyiy (or willingly directed another tc sign for him), and that he executed it as his free and vol.uncary ac[ for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of 'he Testator, signed this Last Will and Testament as witness and that tc the best of their knowledge the Testator was ~. .. Che time eighteen (i8; years of age or older, of sound mind and under no constraint or undue influence. RVIN J. SHEAFFER I NESS TNESS Sworn to and subscribed before me this ,3o'~h day of 2001. S OfLh~ _ NOTARY PU. IC MY COMMISSION F.X PIRES: Notarial Seal S. Dawn Glatlleker, Notary Public Dillsburg Boro, York County MV Cnmm,~-:.., G.~ ~ MaV 17, 20p5 Memayi. renr~pvan:a 0.5SOda60rletNO~fleg G REVabs I x IT-orb ©.I~ .~ SAFE DEPOSIT'~'"~~.°~- BOXINVENTORY PA Uep~~Rnent of Rrveni.e 48SC7~047:~46 SOlep iecunfy or DeDlh Ce rti Lt CIO Number !)ale of fJE21h ~~~ Decedenl'ti Last Name Suffix ~~LE CAP PLEASE USE ORIGINAL FORM ONLY Cconly CD<Je Year FJe Nomhe~ 01 E ~~ l)o~l~~ F rtsl Name MI ADDRf SS Of DECEDENT SltiF l tt rt ~ :--, i t r E J -i ~ CIIV ~ ( E - -Fl~iC ZIP CODE _ - - NAME AND ADDRESS OF PERSON R ~,_ , ~ _ f~,l~ EOIIE STING THE OPENING OF THE SA - - f f DFF'OSIT RO% NP.Mf , T _ ,L9 ~- -. 'SJri'H f AJDI E SS - l IIV SI{,1P 111 Ui:UE NAME, ADDRESS AND RELATIONSHIP pF ANV) TO DECEDE NT, OP PE RSON __ -... _ IS) PRESENT AT T11E BOX OPENING __ a NAM I _ ~ ~ :: ~ __ RFIA`IONSHIF p ( ~ i "L~ ~Y - ` t t E. Y ~ s1uEErnDURE ti ~ - - - - (ITV - - _ Y ~ ~ ~ ' S T , Fn E i zIPC Tt OC i 1, r/ I ! _ I ~ - --. is_-' __. _... fY'.~t r Cn ~EP t I i _ - ~ ( " b. NAME • ~ y - - _.-- RE LAf10N '- _ >- I ! ,- ~ SHIP STRH T ADDRC SS -- -- - -- CITY ST I ' ~~ ~ ~ ~ A F IIF CODE - r l 5 / -"J-_ _ _ ~.-~. ~ ~9 ~ !" tl f ~j c NAME REI ATIONSHIP' - _ - STREET ADDRESS CITY . STAT P. ZIP CODE NAME AND ADDRESS OF FINANCIAL INSTITUTION WHERE THE SAFE DEPOSIT BOX IS LOCATED NAME 1 C~ ~~_ze2s _~~_ Ccn1C l~~ P~ -- STREET A UR S - - -- _ ~ ~' -_ f~irn ~ r~e--~~--/- ~I s6~To r~~ .NAME PERSON MA NT V ©. DA F C ~gCT TO RENT BOX • NUMBE F B X I TI E UNDER WHI~{$Ok VWJA ervivL.~ o NA A ADDRESS OF PERSONFS) HAVING ACCESS TO BOX T lk.-- ZIP 1,0- - ~~~v~~_ ENTRY a- __ erv~v~ J_` -~1eR es- b NAME !~an~ --_- _ -_ _ ~ ~ h eq~ e ~' STREET D RESS ~~~ ~h.ec~(-der ~ - STREET ADDRESS __ _ _ _ _ _ ~o~eee ~~, CITY. NAME AND TITLE OF TAKING THE INVENTORY __ I~~ .p~l CIS'. S"FATE ZIP CODE. _- WAS AWILL IN THE BOX7 ^ YES ~ NO I( yes, a. Date of will: b. Name and atltlress of personal representaGVe, if nametl in the will NAME STREET ADDRESS: CITY: c Name and atldress of attorney, if any NAME STREET ADDRESS: CITY: STATE ZIP CODE: STATE: ZIP CODE: 48500041046 48500041046 ,p~ ~g Prone n( f~1 ~ t£~` EX _...-_ s`rouY~ ~~~$a7E~ ~ ~l~E~ 's ~lt c~~~ ~f~€~ F~f.tCT6(3~' I_ _ _ ~I (~) Cash. F2e past Intal only _ _ _ - 1 '. f2) StnL ks 1151 In C 4+r every umnnon or pr eterred celtnu. .tn. wan nr~t or olhPr nghfs lound Ir ox Sbc4r re 'n be de onatcd by ~. u~ mr cl camp, ny rrrtlhcatt, nwnhcr. Cole of ter bhcatt Hance m rot I h slucF. Is rc p slered, anti r umbel of h r1 ~, and t. rss of stork '. (3) CJ UI1g a[IOns of U S_ Govern menC Number n; Hems, Cale of Ise;ur lace value names In vrh rh e q.ele~u, - .d lypc Df rrmnersbq. ', loinlly held payable on depth. etc I (4) Bonds' Designate by name, amount, s[Hial number, or other tleslgna bon (Hearer Bonds) I (5) Bank arTd Savings and Loan Passbooksc State name of deposde.r. nllmbel of book. last d ale appear riq In book. name of honk ' and branch, and balance ' (6) Jewelry, Coins, S[amps, Manuscripts, etc: LISP and descnhe as !ally as possble I (~ Deeds, Mortgages. Current Insurance Policies or other evidences of indebtedness: I Ist and dr_scnhc as fully as posvbla (8) All other contents. (9) Return completed form to' DE PART MFNt nc m vc nu 11 I CERTIFY UNDER PENALTY OF PERJURY THAT THE ABOVE RECORD IS PERSON RECEIVING COPY OF CORRECT AND PLETE TO HE BEST OF MY KNOWLEDGE AND BELIEF SAFE DEPOSIT BOX INVENTORY. sIk'yATU ~~~ n ~-- - rnrr. :owc ~ PRINT NAME AND CHECK APPROP121alF BOX BFLOW. __ _ _ '/~~ n ~ _ ___ _ _ PRINT TITLE ~ '-- "' - - DATE CHECK APPROPRIATE BOX E for im [] Aa rslraro p 1 Fslare Represenlelrve ~ Joml owner of sale Oeposrl Oox _ ..- .___ NOTE: Attach additional 6'/~' x 11" sheets if necessa ~ - -~- ~~- -_--~-- - -- ( 1 ry or use duplicates of this page of form. The Department is author¢etl by law, 42 U.S G §4051c)(2)(C)(i), to require disclosure of Social Security numbers in connection wlth atlministering state tax laws. The Department uses the Social Secunty number to identify the decedent and personal representatives of the estate. 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I ~ 13 I I J '~ ~ f-- l5\ l ~ J p , ~ O ~ ~~ ~ ~ ~ .~ `}~ V ~ S ' tv~ C~ T E ' _ i - i I ~ - __ : Z nn r ~ ~ S _- ~~ ~ ~ ~ ~ ~ D O O ~ l?~ l}~ v ~ ~, oo ~ S ~ ~ ~ ~ ,~~ Z ~t lP J ~ S S ~ ~ ~ ~ ~ S C' 4~ ~ S - ~ m y/~~ ~y~ ~~ / / ~ V" ~ O N _ m H _ _ _ m r ~ y m P ~ r n CX. ~ r ~ ~- ~' ~ C.~~ ~ Cl <X C1 ~ (~ ~ p y ~' n C, m O [0 Ti ~ N In _- ~- - - -_ _ ~ OC d~ ~ ` , /~ J ~ ~a ~ C m ''-~ C ~n A '°~ r O z . _ __ ___. - _ _ -_ < ~ C~ O ~ ~ c m O ,. ~ i ~~ A n O z J \' i ~+ T 4 ~ ~ A mo o t v ~ m U ~, ~ ~m ~ o n z 4l r ~ ,~ 30 mti ~ o ~ ~ ~ i I ~ k ~n 3 ~~ A €i ~, . <<, ,u,.,<~, ~, -, m , ~- r~ u d. p O 6 D <. ~:'~~ nj ~j! j V1 ~~ Z S w _~ ZA <~ ~ N Z ~ ~1 W 0 0 70 Z '~ v -N - 0 <> m 0 c n z c 3 z m o m ti m m ~ O m 0 z n 0 z f~ c z y 0 _~ z 5 ~ s 1 1 m c Rev~16p2 EX~j6-96) SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA% RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Shaeffer, Mervin J. 21-08-00487 All reel property owne0 solely or as a [enaM In common moat be reported at fair market value. Fair market value is de(inatl as the pace at whim properly woultl De exchanged Delween a willing buyer and a willing seller, neither Deing compelled to Duy or sell, both having reasonable knowletlge of the relevant leers. Real properly which Is joln[ly~ownatl with right of aurvlvorshlp moat be tllscloaetl on echetlule F. v~ ~~~~~_ ~p=== ~e neeDea, aomnonal pages or me same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule A (Rev. 6-98) - ---- __ q ~ ~ , ~ ..,~~E. ^6ETTLEMEM STAiEMf Nis Select Platinum Settlement Services, lLP 3912 Market Street Camp Hill, Pq 17011 (717)737-OHII4 FINAL -------- =xpproren OMe¢Ma x_~. 150115o1.pE65 a_ __ TYPE OE LOAN ^ F1N P. ~ FMHA 3 CY3 CONV. UNWS <. [] VA S {~ [ONV. INS. 6. ESCROW FILF NUMBER' 1 LOAN NUMR[R. - - 00081789-001 CER 0178493359 e MORTOAGEINHURANCF C0.5E NUMa[ft: C.NDTE. Tnis brm is h+mishetl to give youa sra(ementolacWal se Hlemen(coifs Amounts paitlroaMby the settlement agent are Shown. Iroms merkca'(P O.C.)"were paid ouhitle the dosLlg,-mey are shown here lpr inbmrabonal O. NAME Of RORROWEN ---- ~ purpg5¢SBnd dfe pOrinclLytb in (/Ia lOfa/5. Jason R. Simmons - -- __ ADDness of aoRROweR. 104 Coffeetown Road _ Dillsburq PA 17pig E. NAME or SELLER. Esiate of Mervin J. Sheaffer -~ ~- --- ADpRESS OF SELLER. T NAME Or LENDER. We$Far00 BaOk NA ~ --.---'--- _ AOORF55 OF LENDER. 2701 W6I5 Par90 Way -- - Minneapolis, MN 55427-1629 - c. PROPERrY LocnripH 1100 Sheaffer Road ~ --------._ Dillsburg, PA 17019 Cumberland County 22-12-0350-043 - - -- Parcel#22-12-0350-043 N sent EmENr ACErv,~ Select Platinum Settlemenl Services LLP ----~---~--- PLACE of SernEMENn , 3912 Market Street, Camp HiII, PA 17011 r SETTLEMENT DATE -- 9/l Z/2 W8 PRORATION GATE: ---" __ 9/12/2006 OISHUftSEMENi DATE - J. SUMMARY OF BORROWER'S iRgNSACTION K. aineu.w ~<«~~...... - 101. -- Contracl Sales Price -_. _ ----_- 114,000.00 4p1. ?FIm`.ti3 Contracl Sales Price r f. 102 Personal Property -- -.- __._ 114,p00.00 _ 402. Personal Propetly - 103. SeHlemen( charges to fionowel (6ne 1400) 5,99].09 403. --------- -- . - ---- 195 -- _-- 404 --.-__ - - __ _ __ 405. - -_ -~-- A IDfi pJUSTMENTSFORITEMSPAIDRP $EIIFRIN ADVAN - - C¢y/TO Taxes CE _-_ gOJUSTMENiS FOR ITEMS PgID 9Y 5E LLER --- IN gOVgNC --- -- H 406. _ C.ty/Town Taxes 1p] 108 C t~raxes 09112/08 I 12/31/08 -- _. A ssm nls _ 83.84 d0] dOB - ---- County Taxes O9/t 2IOB to 12/31/08 ~ B3.Bd T 109 __ ~ S hoot T 09112/08 t 06/30/09 -- 809 04 4 Assessments _ L. O __ . . 09. School Tax 09/1 NOB to p6/30I09 809 04 -_ 111 _ - - 410 -- . - -._ 112 _ - - __-_. __ _ - _ _ - _ _ ~ 411. 412 _ _ __ .. _ _ _ a- _-. __ _ 113 .__- - _- - __. - 413. -__ -_ _ -. -. _._ - _. 11 d. _-- _.- -. __ -_--. -- 414 - -~ -_. 115 - ..__ _ _. 120 GROSS _ 415. .-. -_. AMOUNT OUE FROM eOgROWfR - 120,889.9] q20. GROSS gMOUNT OUE iO SELLER -~ - ~,ppgAM©TiNTff 'iD Y 'I' FOF6dR L ~~AL ' S ~d' ~ ~ : - t14,A92B8 201 20 - , .. Depos4 e ear esi m ney _ P , _ 2SOp.00 501 Excess tleposit (see Instructions) ~ ~ un 2. cipalameunl of ne+loan(s) - 11fi,28000 502 Settlemenl charges [p Selle7(line 1400 203. 1 ng to n(s) t ken s Oiecl 1¢ 503 ) E 10,65].00 -- 204 -- - - ~-- x s[i q loa (sj lake s b) t t -- 205 ~ - - - 504. -- Pay Ho(frst mortgag loa ~ _ --" - 206 - --- _-.. - . 505 - Payoff at ecantl mortgage to - '- __ -- . L __ _.-- t06 - - _- _ - JO~ -I __ - - rye - - _f W _- T o6 - - - -- __- - - -- 1DS _ _. t _- - f sn9 _ - _ ~ _AD JUS INLNTS OR T M LN(ApR a L ~N 210 L y/I Ta es A ~ DJU=TM N $FOH IiEM$UN AND 9Y $CLEF --. R ._ ___ -- 2n ~. y - - - _---- - I ) ii0 _.. _- Cityrt Taxes _ -. -- ~ -_-~ -- __.__- - 212 - I_ A wzsmanis _.. _- I rn _.-- ll Ca tYTaxes --~ _ -. -.--. ___ - - s Assessments -._. 210 I- f - _ -. _- _- _-_ ---. ay} __ _... ltd - ~ -_..- _ __ -.- -_ - _-._ ---__-_ -- uld -_ - . 215 -. --_._ _.- __.-_- __-. - --. __ - - SiS 1 _ _-- _.__.-- 2tf _ __ I ___. --.. 1 5 ,J __ -__._ _ - _ _--. - - - 21] _ _ i `~lJ _. - _--_.. _.. _ - 119 1B - 219 _ SI9 220 IOrgL PAIp eY FOR pORRONER: 118 ]FO CO 20 TUTAL REOUCiIONS IN AMOUNT UUE SELLER 300 'CASH AT SETTCEMENYFRONITO''.90RROWER q $ Er .,,,,, °:yf' .5p' O~,FC~~g, q(~~El7~EryI~1 ~I~0~fvIS LLER.~ '~ 10 59 00 ~ C ~ 301 - C s amounttl i 9orrowc I c 1201 _ 1. - 120,609 9] h01 - Gros mo 10ue Ia5 le ll 6201 ~ , ~ ~ ~~~ 3W - - a unl pa d bylr p rrOwe ~~ 12L1 I. __-- . __ I .B,]Bp DD I 602 _ _ _ Less e et n n ± d. 39286 _. .. - ____ am 1 tl S Iler ll -~~~- 6201 a65r oD 303 -_ ASI }."FROM11 ~~ i0)OOHR IWLR _ -.. _ 1 21099] 603 _ CASH -~ 11] FROMI (11Z 105hL. Fft_ ____ ~ _ - _ 10413586 ~~rr.>I_, oN ;•R~rES 114.00006 ~m eo6o°n= s6,e4ooo urvlsleN or coM>n, s ;ION (u NL root ns wLLOws ]01 E -__ CA4r 00 m FRA NRFIm~ ~ ~ ' ]02 F 10 __-- --. - -___- /03 Cornm~ss o~ v. e al settle ne t -- ]04 Transalion bee to ERA NH! Inc. - - ---- -~ BORROWEN'S FUNDS $ELLFR'S AT SETTLPMENi FUNDSAi -~ ----- -~ SERIEMFNi -- _ 6 X40.00 iss oD iss Do 801 I can Odginaeon Fee ~~ A02 Loan Discount Fce _ _ 903 - APVralsa_F v - -_ _- - - le Cavil IP - - ceM gVPralsers ___804 Credll Re 1 - P __ - -- m elueL 1M ng geE+pr ----.-- esz _ 805 _ Le wersl p no Fee Io canllal PropeM APPraisers ~--- _ 806_ _ Mortga5e Insurance Applmalion Fee - _ 80] - Assumptran Fee -- -. 609 - - Pro ~ssmgt ., --_-.. __. - ___ .---.-__-_-.-_-.._._-__.__ 0 Mary V. WebO 809 -_--- _ _ Umenvritln r - _____-9_r'e - IP Wells Fargo Pank Nq _ 6ID Floo_tl Cen Fee- m WFFS '--- --- -- 611. 'See adachen tnr nro~ n.......-- -~ ~--_.-. eu l rmeresi From 09/12108 10 10101/06 ~ $20 i 902 MPdgage Insurance P --._ _ _ remwm br 0 Month(s) to 903 Hazard lnsmanre Premwm for 1 Vears(sl to -__ - _. 904 _..-. --_..- -_- 905 _--.-__._-_- 1DDL Hazare Insurance 4 no~ms~s~"~ 1002 Mon9agel - e rmn nsMS--~ 1003 GtY PrOpeny loxes monlns [ s 100d. GOVnty Property iaxe5 9 vss ® I 1005 Annual Assessments m o~ms®E 1006. School Taxes 4 .- _ _ ms ®{ E 100]. -. -omM~S . `~0~ g ~g egata Acq Adj. -- - nanms ~ S -- Per monlfl "ahl:JFi IP Per onto -------_---- 106.68 ___- Pe/mon10 ~ - _ . Oer manN 1 E '~ 181 _ 1 S Itl en[Prcos ng tee -' ' y. d 1102 Abstract m hLLe search --'- __--_ 1101 _ -_ _ _ Tp %Pml a0on - --"- _ _ -_ 1104 T le' .ura Q -- ~ - ~ -- -- 1195 _ Oo n rl! n of - -_ __ - '-.. . - ~ . _ 1106 Nol yteos 1 Itl menVGlei caVNOtary Fees - _-. - _ _ 110] Ano neV's Fe ~ - - -- - ----- _ SODO_ _ -iUAU _ Uccle b n sn -- -- _ _ 1108 1 T Ile In an t 5 lotl Plafn m Settlement Services LLP -. -. -- - _- -- --- I,da b to sn o --.. - 943 ]5 ~ -_ - 1185 1 Led rscP 9-_._- S 116,280.00 ---- --"- - _ _-- - - - - - ____ -_ 1110 _ O - .-.-.... cP~ age _ s 114,DO6.DO - --- --1- -- -- - 1111 F d .180_08 b.1 tP Select Pla0num SetOement $ervices LLP "-- - __ - 11 2 _ I s d Glos QI 1l t Soutnern TVe In Gary -" - 150 08 --- _ _ 1113 O r qhl Fees to 5 lect Plat um Setllement Seri ces. LLP ~ '-' G ?00;} OYERNMY~~pRp~NG J~ p Tf ih SF RG AR E ' ---. 35D0 3U ao - --"- 1201 _ 1 ~ $~ Rco dngF s Dne$ 38.50MOngage$ 6650R lease$ a (J~~ rty~o'C~ ~~~ 12oz G1lco m taa 1 m a - _- -_ ~ Y _ p _ DeedB t14000M n9a9 $ 16500_ ~ 1203 -- Sla tadsta - - -- _ 11 ____. DeedB 11d000 MOd~ 8 ~ _ __ _ 1140.OU -- 1204 -- - - it40.00 120ti _--__-__-_ _-_..-_ _ - v3]00 AQOITJpRpLiSE]TLEMENMM ~rCIiARGES ~~x~ ,».~y a,-.-3.. a - ~ . -r ~~ ~ ~ - 13U1 A y ,(,~ ~ S ey "'°`u..'aw' te ,+,w' C, _. ~^.. _'SY-., 1302 Pesl Ins -_ - - p -1 -.- _ ~- ~ 1 ]0 _ i G n Fee Re 0 5 enl 5- (PI L S dl e 1 5 LLP -_ - __. - _ 1304 Do i s NJ t S 1ec(Plan S tllomenl 5 c LLP - 0 /.88 1]05 W t lesi - I Inv TD9uest -- -- ~. 400 -- 136 HO CWandr' -' '- v t 1 .c H bFele -- - - I 14500 i- --- ~ 30] - - -__ _ ~ 4550U _ __ 14c_0 a crr ur rr,~~ =s1 ovsa ~1- „esaz s u~p - __ . _. _- _ _ r __.-. s_g5_]De ~. 1~_ es C o B r aunu.lr eway ra, e.ao 1u0 meme„is,-r.<,nP~a„am as ,...n ulmvxnow oee_ a r b s ovee ~m..re n=.~1N ml na~nrso:wrd _ _ _ _ _ lalemen. oral,eeeln aJ PUrsemer5made .aProlme uo- >enam ~,u1,lemen r,„y p ~ ~ Jason R Smmons ~ - - - --_. - ~'~~ ~ 1a~~i~~ - - h~' C~~U - EAa1e A(Mervm J. $hea9er _ -- - I ~y /" _ ~~uq~ B - - ~/7~.t ~_~ ~ - 2~ - j- S- v e Se s. ey sa ea m I ' ° G - s S.I A~~r l/{ J 1a. caa on 7 /~ A /! /~ f~ ~ se orw rv l~Aj/I] A 61 ~ / // L 1 , lenbrvx r, aaoro n r~, b ^'l ~/ i l~ 1. 6K ¢II..Lm¢i A 9 I ~/~a/O~ $elecl Al _ urtt .,ntt.e* 1~ rV CCs. ...J -. - 7J'e wABNIN, 1 ~,., <n,.,e ., ~.nvir ~ .o, r„r.,~ lame u,,m sum. u~ms ur a,v s.maa~rorm uw~e~,..:o-,~~anm Enruwrv,ee rva~,eus cuee seo~o~,.,ol,.asw.u~mw i ""°'~° =.uanane, .m ~nwnunme„r Escrow rvompeo OOOB 11a9~0e1 CER HUD 811 DETAILED BREAKDOWN OF ITEMS PAYABLE IN CONNECTION WITH LOAN Description P.O.C. Seller 812. Tax Service Fee [o WFRETS Amourrt 873. Mtg Bkr Comp 2.599% Pd by WFB to Blue Comet M rt 100.00 814. o gage Express (3,022 t2 Courier Fee to Blue Comet Mortgage Express ~ 815. Broker Fee to Blue Comet Mortgage Express 2222 ___ _ 350.00 __ Total as shown on HUD page 2 Line #811 47222 HUD 1200 DETAILED BREAKDOWN OF GOVERNMENT RECORDING AND TRANSFER FEES buyer Seller 1202. City 8 County Tax/Stamps Amount Amourrt City Tax/Stamps: Deed $1,140.00 Total as shown on HUD page 2 Line #1202 1,140.00 Guyer Seller 1203. State Tax/Stamps Amount Amount Slate Tax/Stamps Deed $1,140.00 Total as shown on HUD page 2 Line #1203 1,140.00 Rev-16ga EXi (6-99) SCHEDULE B STOCKS & BONDS COMMONWEALTH OF FENNSV WgNIN INHERITANCE TA%RETURN RESIDENT pECEpENT ESTATE OF FILE NUMBER Sheaffer, Mervin J. 21-08-00487 All property )olntlyawnatl with right o1 eurvlvorohlp moat De tllsclosetl on Schetlule F. ITEM NUMBER CUSIP NUMBER DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 1 78 shares of Prudential Financial stock: 77.637425 6,055.72 2 US Savings Bonds (see attached): 74,439.24 TOTAL (Also enter on Line 2, Recapitulation) 80,494.96 (If more space Is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. 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IOC 00 75.00 396.32 921.32 15357 e x.2091877510 . 100 00 75.00 396.32 421.32 15357 e x/2091877575 . 100 00 75.00 338.08 913.0E 15357 e V2091877670 . 100 G0 75.00 33A.0g 413.08 15357 e `J 2091877714 . 100 00 75.00 338.08 9;3.OH 15357 e ~ 20918777A5 . 75.00 391.96 416.9E 1535'7 e X2091877857 100.00 100 00 75.00 391.96 415.96 15357 e '2091877927 . 75.00 333.80 gp8.gp 15357 e '2091877966 100.00 75.00 333.80 40U.BC 15357 e X2093178172 100.00 75.00 333.80 908.80 15357 e X2093178227 100.0E 75.00 338.08 913.08 15357 e ~ 2093178299 100.00 100 00 75.00 338.08 413"C8 15357 e ~ 2093178369 . 100 00 75.00 338.08 4;3.08 15357 e X2096086890 . 100 00 75.00 338.08 413.08 15357 e xi2G96pA6953 . 75.00 391.96 916.96 15357 e X2096087091 100.00 75.00 391.96 916.96 15357 ee v 101]0259 100.00 200 00 75.00 333.80 408.80 15357 ee ~.1 0170309 . 200 00 100.00 401.52 501.52 15357 ee ~, 10179326 . 200 00 100.00 901.52 501.52 15357 ee x.10179380 . 200.00 100.00 100 00 391.68 99'.68 15357 ee X10985990 200 00 . 391. 6A 491.68 15357 ee x:10986054 . 200 00 100.00 391.68 991.68 15357 ce X10992739 . 200 00 100.00 391.68 991..68 15357 ee ~-10992791 . 200 00 100.00 369.12 969.12 15357 ee x'11009978 . 100.00 369.12 469.12 15357 ee x,12221554 200.00 200 00 100.00 359.92 455.92 15357 ee X12221609 . 200.00 100.00 100 00 359.92 459.92 15357 ee x'12532373 100 00 . 309.60 909.60 15357 ee X12532389 . 100 00 50.00 210.88 260.8"n 15357 ee X13029992 . 200 00 SC.00 210.88 26E.89 15357 ee x.13029999 . 200 00 100.00 309.60 409.60 15357 ee X13030097 " 200 00 100.00 309.60 9p9. 60 15357 ee X13030105 . 200 00 100.00 299.96 399.96 15357 ee X13339005 . 100.00 299.96 394.96 15357 ee v13339015 200.00 200 00 100.00 287.92 387.92 15357 ee ti13391366 . 200 00 100.00 287.92 387.92 . 100.00 278.80 378.90 Me mkerA Seres Bondy Face Purchase aopo rt able -- Value Amount interest Matt ~1 •.ic `-' ee 1396r21E ___ 15357 ee X13869228 200.OC i00.OC 278.60 ~ 9.8^~ 15357 ee ~ 19285499 200.00 200 00 100.00 271.26 371.;,, 15357 ee 19285551 . 20C OC IOC. 00 287.52 3E7 .9:. .3357 ee ~'14292II0 . zoo co 100.00 287.92 9' 77 J53 S/ ee v1929216E . 200 00 loo.oD `87.x2 P 9' 15357 ee x.743697 _2 . 200 00 100.00 287.92 3H7.92 15357 ee x/19977563 . 200 00 1C0 .00 279.90 378.90 15357 ee ~ 19477576 . 100.00 T11 .20 37;.20 15357 ee X19977550 200.00 100.OC 271.20 371 .2C 15357 ee v19977602 200 00 200 00 100.OC 271.20 371.2C 1535"1 ce ~7G563_9S . 1 000 00 100.00 263.76 363.7E 15357 ee yi9879783 , . 200 00 500.00 ],197.20 16^.7.20 15357 ee X14879833 . 100'00 278.80 376.Bn 15357 ee ~~2997453 200.00 200 00 106.00 271.20 371.20 15357 ee X2997469 . e""00 00 100.00 512.4(7 612.58 15357 ee x'2997982 . 200 00 100.00 517..98 612.98 15357 ee ~ 2964629 - . 200 00 100.C0 518.69 618.65 15357 ee ~ 2469695 . 100.00 519.64 678.69 15357 ee ~'296466C 20C.00 lOC.00 x18.69 61B.E/ 15357 ee x'2464 F,75 200.00 200 100.60 506.98 606.4E 1535'] ee X2969717 .00 1C0. 00 506.99 606.SF 15357 ee ~ 2969729 200.00 200 00 100.60 X SD 6'48 6C 6.49 15357 ee X2469797 . 00 00 506.48 606.48 15357 ee V2469757 200.00 X0 00 100.00 506.98 606.46 ]5357 ee ~ 4 2.64768 . 200 00 lOC.OG 506.48 606.98 15357 ee X2969789 . 200 00 100.00 955.89 555.09 15357 ee X2969798 . ]00.00 955.84 SS5 P; 15357 ee ~2969E12 200.00 200 O 100.00 495.96 _ '44'9E 15357 ee ~ 2964834 . C 1 00.00 999.96 594.9E 15357 ee X2469853 ZOD.00 100.00 994.96 54S 9F: 15357 ee x'2969872 200.00 ' 100.00 444.96 . 549.96 15357 ee ~ 2469P92 200.00 100.00 421.76 521.7E 153.,7 ee ° ~. 2612589 200.00 200 00 100.00 911.52 511.52 15357 ee ~.2612fOB . 200 00 100.00 506.99 606.48 15357 ee v 3427592 . 200 00 100.00 506.98 606.48 15357 ee x'3927597 . 100.06 911.52 511.52 15357 ee ~ 3927556 200.00 200 00 100.00 911.52 5'_1.52 15357 ee x'3927567 . 200 00 100.D0 411.52 511.52 15357 ee ~~3927571 . 100.00 90-~52 501.52 15357 ee x"3927583 200.00 200 00 100.00 401.52 501.52 15357 ee X3427592 . 200 00 100.00 901.5?. 501.52 15357 ee x.3927603 . 200 00 100.00 401.52 501.52 15357 ee x+3427609 . 100.60 901.52 501.52 15357 ee X3927619 200.00 100.00 901.52 501.52 15357 ee x.3927629 200.00 200 00 100.00 391.68 991.69 15357 ee X3927639 . 200 00 100.00 391.68 991.68 15357 ee ~+ 5143958 . 100.00 391.68 991.68 15357 ee ~ 5193975 200.00 100.00 921.76 521.76 15357 ee X5193999 200.00 200 00 100.00 911.52 511.52 15357 ee ~ 5195001 . 200 00 100.00 911.52 511.52 15357 ee X5195021 . 200 00 100.00 955.89 555.84 15357 ee ~ 5195091 . 200 00 100.00 955.84 555.84 15357 ee ~5195C66 . 200 00 100.00 444.96 599.96 15357 ee 5195081 . 100.00 499.96 594 9E 15357 ee _ 5145105 200.00 200 00 100.00 944.96 . 599.96 15357 ee X15195129 . 200 00 100.00 911.52 511.52 15357 ee .5209329 . 200 00 100.00 911.52 511.52 15357 ee X5209398 . 200 00 100.00 444'96 599.96 15357 ee X5209359 . 200 00 100.00 999.96 594.96 15357 ee X6095911 . 200 00 100.00 921.76 521.76 15357 ee x'6095920 . 100.00 911.52 511.52 15357 ee x.6098950 200.00 100.00 911.52 511 52 15357 ee ~. 6118791 200.00 100.00 401.52 . 501 57 15357 ee ~ 6118811 200.00 200 00 100.00 911.52 . . 511.52 15357 ee X8677341 . 100.00 911.52 511 52 15357 ee X8677399 200.00 200 00 100.00 391.68 . 991.68 15357 ee 8677358 . 200 00 100.00 369.12 469.12 15357 ee 8677368 . 200 100.00 369.12 969.12 15357 ee ~ 8677372 .00 100.00 359.92 959.92 15357 ee ~ 8677381 200.00 200 00 100.00 359.92 959.92 15357 ee ~+ 8677389 . 100.00 309.60 469 60 15357 ee X8677399 200.00 200 00 100.00 309.60 . 409.60 15357 ee X8677911 . 200 00 100.00 299.96 394.96 15357 ee ~, 8677920 . 200 00 100.00 299.96 354.95 15357 ee x 8677433 . 200 0 100.00 287.92 387.92 15357 ee 883008 . 0 200 100.00 287.92 387.92 .00 100.00 512.98 612.48 McTberk Ser e- eo~~dH Face Purchase Itepprt ab]e ____ V a 1oe Amouct Icte re.'t Nat.^, d&1-s ~ 7 ee ~~BH6222S 200 00 ~35~ ee 806965_+ 200 C0 10 C. 00 90].52 _O1 15357 ee ~'S342631 200 . 00 :00.00 9Q_.52 5CL 5~ 15357 ee `-999?633 . 0 qa 1.52 50:.52 200 .C0 100.00 ~C]_52 507-b7. S5, 'i 64 .29 ~~74439. 24 '. ... u.. Prudential D00130 IMPORTANT TAX RETURN DOCUMENT ENCLOSED Redpiem LINDA M STONER & BETTY K WOLF EX EST MERVIN J SHEAFFER P O BOX 536 MECHANICSBURG PA 17055 Irtrlll,IrllLrrrlJrrLlrllrrrll,LrrllrrllrrrrlLdlrrLLll ~,omputershare "'~" Computersham Trust Company, N.A. PO Box 43033 Providence, Rhode Island 0294D-3033 Within the US, Canada b Puerto Rico B00 3059404 Outside the US, Canada & Puerto Rico 732 512 3782 www.computershare.com(nvestor ~~OGI'C.s Holder Account Number 00030443535 FID ~~ SSNRNt Cartiaed Yea Symbol PRU -~---'-- -- - .__en1C50a93DOAai¢ggLUFEG Cls41t7)_bO5NW13fllaapl3afi Prudential Financial, anc. - Saie Atlvice / 20073 ~'aX Form 1Q99-i3 Summary Trade Date/fime t>srosrmo9 u:ot -- --- - ---- ----- - - - Class Description: COMMON STOCK -- -- , Transaction Description StlareslUnits Price Per Gross Amount Sold I SharelUnR (;- I of Sales (;) saga 7a.oooooo n.s37a2s s,oss.7z Deduction Deduction NetAmount Amount (E) I Type I of Sais (E1 17.24 Transaction Fee 6,039.48 time ova drsdose ale sauce amend Narlount 090^0 Won written reQl~esl. wYl provide ale tlenle of th exeatAng broker dealer assatiated vrial ale bansaction(a>. ant witllin a reasorede amount or aaWenuam received kom tlud parties in mnrlectlon wial ale hansac~n(s), a any. 71 UTX PRU "~' 1Cp7000a WHX2E UNRS Rev~t608 EX+ IB-98) CChNONWEgLTH OF PENNSYLVANIN INHERITANCE TN(RETORN RESIpENT OECEOENT SCHEDULE E CASH, BANK DEPOSITS, 8L MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Sheaffer, Mervin J. 21-08-00487 InGUtle the proceetls of litigation and the tlate the proceetls were recervetl by the estate. All propertyJolntlyownetl with the right of aurvlvorahlp moat be tllaclosatl on schatlule F. ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 1 1995 Oldsmobile Ciera SL Sedan to Larry Scott Britcher: 1,500.00 2 Citizens Bank Account Number 8249057957: 10,012.85 3 Citizens Bank Account Number 8249075965: 10,012.85 4 Citizens Bank Checking Account Number 6100743535: 1,174.88 5 Citizens Bank Savings Account Number 8140178517: 8,984.38 6 Cumberland County Veterans Benefit: 100.00 7 Embarq (phone refund): 20.49 8 Haar's Auction (sale of personal property): 1,106.80 9 IRS Stimulous check: 300.00 10 Nationwide (auto insurance refund): 181.70 11 Nationwide (homeowners insurance refund): 6.00 12 Nationwide (refund): 16.00 13 Susquehanna Valley FCU CD #50-8002: 15,034.19 14 Susquehanna Valley FCU CD#51-6453: 10,831.13 15 Susquehanna Valley FCU CD#51-8508: 10,878.15 18 Susquehanna Valley FCU CD#51-6789: 15,054.81 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 5, Recapitulation) 151,292.72 (IF more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) Rev-1698 E%t (898) SCHEDULE E CASH, BANK DEPOSITS, 8L MISC. PERSONAL PROPERTY COM.U' NWEgLTH OF PENNSYLVANIN INHERITgNCE Tq%ftETpRN continued RESIpENT pECEOENT ESTATE OF FILE NUMBER Sheaffer, Mervin J. 21-08-00487 ITEM NUMBER DESCRIPTION VALUE AT DATE OF DEATH 17 Susquehanna Valley FCU CD#51-7213: 10,027.99 18 Susquehanna Valley FCU CD#51-7267: 10,257.08 19 Susquehanna Valley FCU CD#51-7268: 10,026.28 20 Susquehanna Valley FCU CD#51-7670: 10,036.54 21 Susquehanna Valley FCU CD#52-5407: 10,030.06 22 Susquehanna Valley FCU Checking Account: 7,309.67 23 Susquehanna Valley FCU Savings Account: 10,611.09 TOTAL (Also enter on Line 5, Recapitulation) I 151,292.72 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98) ~~~i~~rt~ era Account Number_ Account Title Date Opened _ Account Type Principal Balance as of DOD Interest from Last Posting to DOD Account Balance as of DOD YTD Interest to DOD 6100743535 MERVIN SHEAFFER 1 /2/1981 $] 174.88 $ .00 $ 1174.88 $18.53 -- -.-_. ~ _ ____~ ~ii~en~ ~r~~~ ~- Account Number ~-__ 6140178517 _ Account Title _ __ MER_VIN SIlEAFFER _ Date Opened __ 8/23/1971 Account Type _ _Savings _ Pnne~pal Balance as of DOD $6964.36 _ Interest from Last Posting to DOD __ $ .00 _ Account Balance as of DOD _ b6964.36 YTD Interest to DOD $5.10 ~Cizens F~~r~~~ Account Number __ 6249057957 Account Title ___ __ _ MERVIN SHEAFFER Date Opened __ _ 5!1 I/2007 Account Type Time Deposits Principal Balance as of DOD __ $10000 00 Interest from Last Posting to DOD __ . $12 85 Account Balance as of DOD . $ i 0012 85 YTD Interest to DOD . $ ] 67.76 ~ii~~r~s ~~r~~t Account Number ---- -- ----- -- - 6249075965 Account Title - - - - -- - - - MERVIN SHEAFFEK Date Opened - - -- -__ --- 5/] 1/2007 Account Type - - -- ----- ----- Time Deposits Principal Balance as of DOD -- --- --- ---- $10000.00 Interest from Lzst Posting to DOD _ - - ~ - - $12 85 Account Balance as of DOD . _ $10012.85 YTD Interest to DOD $167.76 SUSQUEHANNA ALLEY FEDERAL CREDIT U N I O N May 29, 2008 S. Dawn Gladfelter, legal Assistant The Wiley Group 130 W Church St., Suite 101 Dillsburg, PA 17019 Dear Ms. Gladfelter; I regards to the account of Mervin J Sheaffer #3512. Mr Sheaffer had a savings account, a checking account, a premium checking, and numerous certificates with the Credit Union. 1. The saving account was opened 01/28/1985 and had a balance of $10604.56 and a dividend on $6.53 on the date of his death. f!~" ~u,ir I~ o°i~ 2: The checking account was opened-on 06/01/2001 and had a balance of$912.55 with no dividend on the date of his deathr 3. The-premium-checking was opened on 04/04/2006and had a balance of $730207 and a dividend of $2.60 on the date of his death. (~~, 3ii~. Ca'7~ 4. Certificates are as followed: #50-8002 balance $15000.00 div. $34.19 opened 02/29/08 #51-6453 $10800.90 $30.23 opened. 02/26/06 #51-6506 $10650:16 $27.99 opened 03/02/06 #51-7267 $10230.19 $26.89 opened 03/02/07 #51-7268 $10000.00 $26.28 opened 03/02/07 #51-7670 $10000.00 $36.54 opened 09/06/07 #51-7689 $15000.00 $54.81 opened 09/14/07 #52-5407 $10000.00 $30.06 opened 06/01/04 ~51'7~t3 ~ iuooo c~ ,~~~ ~!R o~e~- ~il~~b"7 If there are any other questions, please feel free to call our office. Sincerely, ,~ / ~,~`~'~~~"/~ L~'~22~ lcfi~ ret W Fisher :ions Manager SVFCU ~~~ 3850 HARTZDALE DRIVE • CAMP HILL, PA 1701 ]-7809 '_T LOCAL: (717) 737-4152 TOLL FREE: (800) 948-1454 FAX: (717) 737-0589 SUSQUEHANNA ALLEY FEDERAL CREDIT U N I O N 5. Dawn Gladfelter, Legol Assistant The Wiley Group 130 W Church St., Suite 101 Dillsburg, PA 17019 RE: Estate of Mervin J Sheaffer Dear Ms. Gladfelter; In regards to the Estate of Mervin J Sheaffer, the letter sent to you reporting all balances on Mr. Sheaffer's account with the credit union had two errors. a. The first error was item # 2, a checking account with a balance of $912.55. That checking account was actually closed in 2006, so that account had a balance of zero at the time of Mr Sheaffer's death. b. The list of certificates was missing one certificate: #51-7213 balance $10000.00 div. $27.99 opened 02-06-07 I am truly sorry for this error and any inconvenience that this has caused for you and the family. If you have any questions, please feel free to call our office. Sincerely, ~y~~ ~~ Margaret Fisher Operations Manager 3850 HARTZDALE DRIVE • CAMP HILL, PA 1 70 1 1-7809 ~~ LOCAL: (717) 737-4152 TOLL FREE: (800) 948-1454 FAX: (717) 737-0589 ~~ Rev-ib10 EX+18-BB) SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIH INHEgITPNCE TpX RETORN ftE510ENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Mervin J. 21-08-00487 This schetlule must he complete0 antl filetl i(ihe answer to any of questions 1 (hrough d on the reverse si0e of the REV-1500 DOVER SHEET is yes. I I tM NUMBER utSGKIF' I ION OF PROPERTY INCLUDE NAME OF TRANSFEREE THEIR RELATIONSHIP TO DECEDENTAND THE DATE OF TRANSFER. ATTACH A COPV OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %oF DecD~s INTEREST ExcwsloN (IF APPLICABLE TAXABLE ) VALUE 1 Citizens Bank IRA (Account Number 6140795346 ) 1 303 78 divided equally between three children: , . 1,303.78 2 Citizens Bank IRA (Account Number 6140829798 8 048 72 divided equally between three children: , . 8,048.72 TOTAL (Also enter on Line 7, Recapitulation) 9,352.50 (If more space is needed, additional pages of the same size) Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-7500 Schetlule G (Rev. 6-98) Account Number Account Title_ Date Opened Account Tyne Principal Balance as of DOD Interest from Last Posting to DOD_ Account Balance as of DOB Y'fD Interest to DOD 6140795346 MERVIN SHE_APF_E_R__ 6/1/2007 _ Time Deposits (IRA) $1299.78 _- $4.00 ___ $ l 303.78 ~itiz~ns ~n Account Number Account Title _ _ Date O ened -~-- - Account 1~voe Ynncipa] Balance as of DOD Interest from Last Posting to DOD Account Ba]ance as of DOD YTD Interest to DOD _ 6]40829798 _ MERVIN SHEAFTER ~ __ 6/1/200] -' Time Denosits (iRAI -~ $8024.04 $24.68 $8048.72 $1 ] 0.65 REV-1161 EXi t13-99) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAx RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ESTATE OF FILE NUMBER Sheaffer, Mervin J. 21-08-00487 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A, (FUNERAL EXPENSES: See continuation schedule(s) attached B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Linda M. Stoner Betty K. Wolf Social Security Number(s) / EIN Number of Personal Representative(s): Street Address 505 Sharon Avenue city Mechanicsburg state PA Z;p 17055 Year(s) Commission paid 2009 z. Attorney's Fees The Wiley Group, PC 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address Ciry State Zip Relationship of Claimant to Decedent 4. I Probate Fees Register of Wills: 5. Accountant's Fees 6. Tax Return Preparer's Fees 11,803.45 17,750.00 17,750.00 369.00 7. Other Administrative Costs 15,401.05 See continuation schedule(s) attached TOTAL (Also enter on line 9, Recapitulation) 53,073.50 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98) ' Rav~1601 EX~~6-98) SCHEDULE H-A FUNERAL EXPENSES continued COMMONWEALTH OF PENN6YLVANIA INHERITANCE TPX RETURN RESIDENT OECEOENT ESTATE OF FILE NUMBER Sheaffer, Mervin J. 21-08-00487 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-A (Rev. 6-96) Rav~160] EX~ (6-98) SCHEDULE H-67 OTHER ADMINISTRATIVE COSTS COMMONWEPLTH OF VENNSTLVNNIq INHERITANCE TAX RETURN con Inue RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Mervin J. 27-08-00487 ITEM NUMBER DESCRIPTION AMOUNT 1 Computershare (transaction fee): 17.24 2 Craig Britcher (mowing, yard work): 621.00 3 Cumberland Law Journal (advertise estate): 70.00 4 Dillsburg excavating: 370.00 5 Dillsburg Septic: 225.60 6 Larry Sheaffer (home repair and work on property for sale preparation): 2,000.00 7 Linda Stoner (reimbursement for postage and copies): 33.58 8 Mary Haring (hauling junk): 150.00 9 Mary Murray, Tax Collector: 994.47 10 Real estate closing costs: 10,657.00 11 Register of Wills (additional short certificates): 12.00 12 Register of Wills (filing fee): 30.00 13 Susquehanna Valley Credit Union (estate checks): 10.58 14 The Sentinel (advertise estate): 174.58 15 US Postmaster (6 months post office box): 35.00 Subtotal I 15,401.05 Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H-87 (Rev. 6-98) Rev~1613 EX+ (9-99) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSVLVRNIN INHERITANCE TA%RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Mervin J. 21-08-00487 Inclutle unralmburaetl metllcal eapanaea. ITEM D TE VA NUMBER DESCRIPTION H OF DEA 1 Betty Wolfe (reimbursement for Waste Management payment): 51.60 2 Carlisle HMA Physicians: 32.78 3 Carlisle Regional Medical Center: 103.89 4 Citibank: 255.00 5 Consumer Cellular: 20.39 6 Embarq: 57.03 7 Family Home Medicine: 2.00 8 Hanger, Inc. (Prosthetics/Orthotics): 68.33 9 Met Ed: 110.42 10 Millenium Pharmacy: 8.30 11 Moblex (chest x-ray): 34.55 12 Moffitt Heart 8r Vascular: 93.57 13 Nationwide (car insurance): 364.70 14 PPG: 190.69 15 Special Event Emergency: 133.60 16 Three Springs Physicians: 103.07 17 United Church of Christ Nursing Home: 1,832.16 Total of Continuation Schedule See attached page TOTAL (Also enter on Line 10, Recapitulation) 3,499.12 (If more space is needed, additional pages D(the same size) Copyright (c) 2002 form sokware only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) Rev-1613 EX~IB-98) SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETURN continued RESIDENT DECEDENT ESTATE OF Sheaffer, Mervin J. LE NUMBER 21-08-00487 Copyright (c) 2002 torm software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 6-98) REV-161] EXr 18-0U) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA INHERITANCE TA%RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF Sheaffer, Mervin J. FILE NUMBER 21 NUMBER I NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116(a)(1.2)] RELATIONSHIP TO DECEDENT Do Not Liat Trustees -08-0 SHARE OF ESTATE (WOrdS) 0487 AMOUNT OF ESTATE (§$$) 1 Larry J. Sheaffer Son 510 East High Street 96,477.16 Bellefonte, PA 16823 2 Linda M. Stoner 505 Sharon Avenue Daughter 96,486.72 Mechanicsburg, PA 17055 3 Betty K. Wolf 12 Longwood Drive Daughter 96,485.85 Mechanicsburg, PA 17055 Enter dollar amounts for distributions shown above on lines 1 5 through 18, as appropri Total ate, on Rev 1500 cover 289,449.73 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 II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET 0 OO Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 6-98) Jan M. Wiley David J. Lenox THE WILEY GROUP Atturnrye at Law January 2Q 2009 Register of Wills Cumberland County Courthouse One Courthouse Square Carlisle, PA 17013 In Re: Estate of Mervin J. Sheaffer, deceased File Number 21-08-00487 Dear Register: Enclosed for filing please find an Inventory, the inheritance tax return in duplicate, and the status report with regard to the above captioned estate. Also enclosed is a cheek in the amount of $30.00 representing the filing fee. Please return the recording receipts to my attention in the enclosed envelope. Thank you for your cooperation. Sincerely, Dawn Glad el er/Legal A~istant <~ ~ , /dg ~ ~~ .tom _t~ L ~~: encl. ~ ,. ,., zA ; _~->> ~~ '~ ~ <n N 130 W. Church Street, Suite 101 Dillsburg, PA 17019 Phone: p17) 432 '3666 (800) 682-4250 Fax: (7171432-0426 w o ~ a o /'no N (p W^ 1- y /o 00¢-~ a¢2t1`-NO ~m N Z¢ ~ ~ 7 M r .r_ ~ i o M WFMi O M ~Q a ~~ V ro ~~ a C r 0 ~y! a W x F 0 :.' 9rn `" o vQ a ~ ~ t ~~ U 3 0 B d,~ 4~0 ~2e9per b~~~i ~y~r'v JSas'! ®~'~ ,'~'r~y~1 p~~PSry~s~ d~ N r .v L.J (d n O .GO G~~ L LY ~ J ~_ °v° ~ c~ 's'vC~ ~ a~ ~- ~J~ZY ~~J 'Gpn`pi~d't d ~~~J•O~'YU 't~'~ SO~/7lisi