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04-07-09
~ REV-1500 EX (06-05) PA Department of Revenue Bureau of Individual Taxes PO BOX 280601 Hardsburo. PA 17128-0601 15056051058 OFFICIAL USE ONLY County Code Year File Number INHERITANCE TAX RETURN RESIDENT DECEDENT ~~ b ~ ~ ~1,~ ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death 186-07-8713 ~ ~ 03/21 /2008 Decedent's Last Name Suffix SHUEY J l (If ~4pplicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix SHUEY _ __ _ r I S souse's Social Security Number Date of Birth ' 03/13/1921 Decedent's First Name MI ~ EDWARD ~ F Spouse's First Name MI MARCELLA A p -- ~..__ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW ~~ 1. Original Return 2. Supplemental Return C~ 3. Remainder Return (date of death prior to 12-13-82) „n 4. Limited Estate 4a. Future Interest Compromise (date of C~ 5. Federal Estate Tax Return Required death after 12-12-82) CO 6. Decedent Died Testate ~+ 7. Decedent Maintained a Living Trust ~_. 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) D 9. Litigation Proceeds Received ® 10. Spousal Poverty Credit (date of death C~ 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number ' (717) 258-8558 AUL BRADFORD ORR F j Furm Name (If Applicable) LAW OFFICES OF PAUL ORR First line of address ;i0 EAST HIGH STREET Second line of address REGISTER OF WILLS USE ONLY rv n ~~ C: ~ ~_~_; _' 3 C~ ~, ~ ° _--~ t T~ -,.! City or Post Office State ZIP Code ~ -`:"3 ---- -. ' CARLISL ~PA 17013 ~ ~~- ~" ~.. ' =ii C u _ _ .e --- - --~ a..-~ . ___ .. _ y' Correspondent's a-mail address: paUlOfr@E'.nlb8fgn1811.COfil t-t1 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. SIGNA OF PER` ESPON LE FOR FILING RETURN DATE ADDRESS ~~~'J ;?060 COUNTY LINER D, YORK SPRINGS, PA 17372 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE P,DDRESS 50 EAST HIGH STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 "rt -' t -- t.J ~t t- ~~- ; ~ - 7 =r-! J 15056052059 REV-1500 EX Decedent's Social Security Number _ Decedent's Name: Edwafd F Shuey ~ 186-07-8713 RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. _. ~~~,~~._.~..-r 2. Stocks and Bonds (Schedule B) ....................................... 2. ~~.~, ...~__~ _"~~ .~"~.~~_,~,~.~ _I 3. Closely Held Corporation, Partnership or Sole-Proprietorship {Schedule C) ..... 3. i 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. j ~. ~.. ~",, ,wro~.~ _ ~ . ~ ~ ~.__.~ _~ m -~...~_.~ 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ........ 5. ~ 157,349.96 6. Jointly Owned Property (Schedule F) C'~ Separate Billing Requested .... ... 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property . ,"~ m... i "~. n~ (Schedule G) C~ Separate Billing Requested..... ... 7. ,~ _ ~__„ 8. Total Gross Assets (total Lines 1-7) ............................. . ... ... 8. - 157,349.96 9. Funeral Expenses &Administrative Costs (Schedule H) .................. ... 9. ? 23,072.33 10. Debts of Decedent, Mortgage Liabilities, & Liens {Schedule I) ............. ... 10. 35,874.96 s.~ 11. Total Deductions (total Lines 9 & 10) ................................ ... 11. ~ 58,947.29 12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12. ~ 98,402.67 13. Charitable and Governmental Be nests/Sec 9113 Trusts for which q ~,~.,,,".~.,~~.... m~_""'"" " `"'°'"`°"" """""' ""° an election to tax has not been made (Schedule J) ..................... ... 13. ', 14~. Net Value Subject to Tax (Line 12 minus Line 13) ................. . ...... 14. 98,402.67 T/'~X COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 1 £i. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 ; - -_ _ _ _ . ~ . ~ __ ~ _ .. ____ _ _ (a}(1.2) X .0 00 ~ 32,472.88 ~ 15. ~ __ _ 0.00 1Ei. Amount of Line 14 taxable ~ ~ ~.~.~._~,,._"`~~` ~ _°~"~~~"~ at lineal rate X .0 45 ~ 65,929.79 ~ 16. ~ 2,966.84 17. Amount of Line 14 taxable ~ - ~~~~ at sibling rate X .12 ~ ~ ~ ~. ~~'~~ ~ 17. ~ ~-~ ~......._.~. _ "~ 18. Amount of Line 14 taxable E at collateral rate X .15 ~ ~ ~ 18. l .._~____ _._ .....~ , _..~ , ~ .~m, ~ m-,~ 19. TAX DUE ....................................................... ..19. 2,966.84 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 C1 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number DECEDENT'S NAME DECEDENT'S SOCIAL SECURITY NUMBER Edward F Shuey 186-07-8713 STREET ADDRESS 325 Wesley Drive CITY Mechanicsburg STATE PA ZIP 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payrrients A. Spousal Poverty Credit _ B. Prior Payrnents _ C. Discount 3. InterestlPenalty if applicable D. Interest E. Penalty 43.49 Total Cretlits (A + B + C) (2) Total Interest/Penalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (3) (4) (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) Make Check Payable to: REGISTER OF WILLS, AGENT ,.. .. 0.00 43.49 2,966.84 43.49 3,010.33 ;~ z ,.. 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 :.................................................................................... ...... ^ b. retain the right to designate who shall use the property transferred or its income : ...................................... ...... ^ c. retain a reversionary interest; or .................................................................................................................... ...... ^ d. receive the promise for life of either payments, benefits 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 contains a beneficiary designation? .................................................................................................................. ...... ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN _'b••t ;~, ,. ~: ~•'hrk i- "~''.'~C'~{:kiaS ~:f.'%~y..-$~`'S~«5"-,~1. ;i.S..12'z ~'~, .. ._ a j:~, ~~3 ~, ~,..I. .,.s `t' ,.t~ ~i.q' __ 1•^~~`~i, K .kW':`', . 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 d~sath 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 (O) 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 dE;ath on or after July 1, 2000: The tax rate irnposed 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 iwelve (12) percent [72 P.S. §9116(a)(1.3)). Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. 2,966.84 REV-1508 EX+ (6-98} , SCNEpuLE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS 8c MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER EDWARD F. SHUEY 2008-0044 Indude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with rght of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. ! CASH ON HAND 8,217.00 2,' `ARTWORK (APPRAISAL DATED 5/1/08 ATTACHED) 20,525.00 3. PNC CHECKING ACCOUNT 46,302.00 4.' 'AFLAC BENEFIT 23,440.32 5. PERSONALTY -PROCEEDS FROM ROWE'S AUCTION SERVICE 1,100.00 6.' REIMBURSEMENT OF PREMIUM FROM PENN TREATY INSURANCE 2,102.00 7. REIMBURSEMENT FROM BETHANY VILLAGE 1,680.00 8.' 'SALE OFPERSONALTY -MAGNIFYING TELEVISION SCREEN 400.00 9. i SALE OF PERSONALTY -MOTORIZED SCOOTER CHAIR 500.00 10. ! REFUND CHECK FROM OVERPAYMENT OF UTILITIES 133.64 11. _ _ _ __ __ __ !CAMP HILL FIRE DEPARTMENT MEMBER DEATH BENEFIT 1,000.00 12. !INCOME TAX REFUND 1, 800.00 13. !REFUND FROM EAST PENNSBORO AMBULANCE 150.00 i 4. :PROCEEDS FROM WRONGFUL DEATH ACTION (3h0/09 CORRESPONDENCE ATTACHED) 50,000.00 TOTAL (Also enter on line 5, Recapitulation) S 157, 349.96 (H more space is needed, insert additional sheets of the same size) Performance Select Account Statement PNC Bank For the period 04/74/2008 to OS/09/Z008 H EST OF EDWARD F SHUEY DECD WILLIAM M SHUEY EXTR 2060 COUNTY LINE RD YORK SPRINGS PA 17372-9742 PNCBANK Primary account number: 50-0357-7158 Page 1 of 2 Number of enclosures: 0 O For 24-hour banking, and transaction or interest rate information, sign onto a PNC Bank Online Banking at pnc.com. For customer service call 1-888-PNC-BANK between the hours of 6 AM and Midnight ET. Para servicio en espaffol, 1-866-HOLA-PNC Movingt Please contact us at 1-888-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit us at pnc.com TDD terminal: 1-800-531-1648 For heazing impaired clients oily Sometimes bigger dreams require larger loans. With highly competitive rates and low down payments, we can offer more mortgage options and better fma.ncing solutions. Whether you're shopping for a new primary residence, a second home, or considering a refmance, we can tailor a jumbo mortgage that fits your big plans perfectly. For More Information: > Visit your local PNC Bank branch > Visit pncmc~rtgage.com > Call 1-800= 778-6678 Performance Select Est Of Edward F Shuey Decd Interest Checking Account Summary William M Shuey Extr Account number: 50-0357-7158 Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance .00 56,221.64 1,513.71 54,707.93 Average monthly Charges balance and fees 54,659.50 31.79 i ransactian Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 3 0 0 Total ATM PNC Bank Other Bank transactions ATM transactions ATM transactions 0 0 0 Interest Summary Annual Percentage Number of days Average collected Interest Paid Yield Earned (APYE) in interest period balance for APYE this period 0.59% 26 54,171.73 22.64 Please see the Activity Detail section for additional information. As of 05/09, a total of $22.64 in interest was paid this year. FORM953R-1005 Performance Select Account Statement For tho poriod 04/14/2008 to 05/08/2008 ( ~) For 2d-hour information, sign on to FNC Bank Online Banking EST OF EDWARD F SHUEY DECD -won pnc.com. Primary account number. 50-0357-7158 Arruunt nunthcrr: a0-t);ta7-71:.~t - ranlinued Page 2 of 2 4ctivity Detail deposits and Other Additions >ate Amount Description (' 1 I dt~,SOa.(x) hrlx~sit hrfc•renc•r Nc~ t)•.1`.4!);i 14 ) {,' l:~ ~,Y 17.01) hc•lx~.it hrli•t enrr \~~ tY_O lR 1(i 15 11 "_' 1 l ,li~:(t.t)O f)t~hr~cit Rrfrrc-urr \c~ (1':'? I;t 1(151 )5;/Ucl '~'~.li l Inlc•rrst P,t\'n-c•Ut Checks and Substitute Checks :heck Date Reference lumber Amount paid number 505.77 01i~~!) u'Lil~l2ui; ' Gap in check sequence Chock number Dther Deductions ~;ite Amowit Description li•_ { 31.7!) (:hrck 1'tiuting Fc•e There were 4 Deposits and Uther Additions totaling $56,221.64. Dot? Rarercnce Amount paid number `?;11.15 OS/Ol n'.Il~rtf~ll There were 3 checks listed totaling $1,481.82. There was 1 Other Deduction totaling S31.78. Daily Balance Detail Date Balance Date Balance Date Balance Date Balance 0~1:"21 ;ili,l!)!).Ix) O1.:"~rl ~i 1 ~-lt;.~11 O5;'O!) ~i-1.71)7.!-3 I'a\'llt 'L`C'D I'\(' R:u)k can rttin-idc solutions to all Four cducaticm financing nrcds. Call no\\• to trcic\c yotu• options \\~ith an cxlt. ricnccd loan ccnutsclor. tall I'\(' l;:u)k.: I-;(()0-7G2-1t)Ol IC~•ou rrrlcr to arrly onlinr, Visit us at pnconc:unpus.com. c~c~.~ ~ ~ ~ r ~ ~ ___. ~ ~ ~~. - /~ ~"1 ~'1 5 ,~,r~ i? v`tG-~ , `.-~ c., mCy n ~ :.., / ~ n CS ~~ I~ ~r~ ~c~c~~ a ~ w ~~ the ~~~~ garden gallery 10 N. Hanover Street Carlisle, PA 17013-3013 www.thegardengallerycom 717.249.1721 For the Estate of Edward F. Shuey May 1, 2008 The following is an appraisal of the fair market value of the below listed artwork belonging to the Estate of Edward F. Shuey. Given their condition, provenance, local appeal and market comparables, the fair market values are: `Big Woods Bobcat," signed and numbered 399/600 `'~ ~ $1,450.00 "A. Little Bit Cautious," signed and numbered 177/600 " $2,950.00 "C-ld Orchard Buck," signed and numbered 66/950 ~` $2,950.00 "Spring Gobbler," signed and numbered 567/600 ~ ~ " $850.00 signed and numbered 683/1500 "HLillside Takeoff, $550.00 "Whitetail Deer" by Ned Smith, signed in print only $25.00 2 Griginal Ned Smith Paintings "C:hickadees on Corncob" $4,000.00 "C;hickadees on Witch Hazel" $5,500.00 Don Phillips Painting "Etlue Say" $1,200.00 jZiQuglas Witrant Print "Least Bittern," signed and numbered 40/500 and remarqued $1,040.00 ~ /Ci ~ "r miscellaneous Prints "Bathroom Cats" by Whitcomb, signed and numbered 184/500 $50.00 Please feel free to call me at 717-249-1721, 10:00 a.m. to 5:00 p.m., Tuesday through Friday, if there are arty questions. Sin ly, Charles W. Andrews Appraiser ~ ;~ ~-~, ~'~ ~ f /cwa Enclosures ~• ~ TM Worldwide Headquarters 1932 Wynnton Road, Columbus, Georgia 31999-0001 1-500-992-3522 CHECK PJUMBER: 8005317886 DATE: 12/24108 POLICY NUMBER REASON FOR REFUND AMOUNT A04611 i~0 81 SHUEY ESTATE OF EDWARD F XXX-XX-8713 NKR $40.32 REFUND DUE TO DEATH LRCHECK w~. ~~nn PLEASE FOLD AND DETACH CHECK • ~ TM Worldwide Headquarters Columbus, Georgia 31999 Toll Free 1-800-99-Aflac (1-800-992-3522) 0 N ~II~II~~IIII~II~~~I~I~IIII~IIII~~~111~1~1iII11111~1~11~1~111~ ESTATE OF EDWARD F SHUEY 8257 EDWARD F SHUEY C/O: WILLIAM SHUEY C/O: WILLIAM SHUEY 2060 COUNTY LINE RD 2060 COUNTY LINE RD YORK SPRINGS PA 17372-9742 YORK SPRINGS, PA 17372 Aflac's promise is to be there for you in your time of need. Please tell your employer how much you appireciate your Aflac coverage. Let us know, too! Contact your Aflac associate/agent or a-mail ilovemyaflac@aflac.com. i_..........._. .... _ _.__:._._ .::.,-r.::. :-. _ ..e: ~_:e::~_._-. o..:: .. ...r ~py~_:::::::x:: ~ ~ __..__.._.__._........._....._.__..___._.._._...........__.._...___...___..... ...xx:e-::::o.ec:::c:..:_-i!._:_:_:ca =::so-_:__::c_ ___ __::~~::-~_:.-.~:_:._::__.=..::c:e~:,~.~_ ~;_:_~...___: s ': __......._.........__..._._ ......................._........................._....__._.__..._._._........_..._.... _c::::_c._e:ez m:x.::::~c::_:::_::~_:::::::::r.:c:::~::::::..-~__::::e-::::::._ex:::__. .__: =_:::e____e-:e:::_:F: _::ee:-.:::::::-:::_:.-ou= c:_~_~._::f::::':_:::=: .._...............___._._.._._.............. .. :_ _ _~...4::~.::mY.7=::_:...:c::::: ._ _-_ __ -_ _ _ _ _ - -_ _ _ .. {~,_~y __ __ _ e_ __ . :c~_:::::_:_ _=__ _'_:;:`::=_F: - _ ~~ ~ ~ _.._._._.._ ~. ~eB.sa:::e_ _ iF. ._...__._.... _..._... _:::_: :::x.:_:-::::_-r-:-:_:M::::-:=_ .::::~c___i_i: _ _:::._:__ =!: _-::::::::::::- _ . . =e::_::a:eeo_::::::c:::ene.::__:o:e:c::.-c:::-:::s:c::-_z ..........._....___ _ _:::i::::::::_ ... ... - - - -- _ _ . -__ _ _ .._.__...._ _._ :~R!:. ie:~ Ik - -- - - - - - -- :.:.: ,.::.u:. 314604059 EDWARD 19082 000000000 _:.:._-::.::-::.::.-_::._.. ... r- -- - _: . ~ ~ ~ ` : ? •: c e : U g=~ ' ~ ..........._.._ . .... ......... :::::::_:__._.__._ __::~_ iigiii: ._ i = :c - : :: ........:. .......__............ _ .........:.:::.-...:....._.: :_._._ .. ..: ::... .. .I.. ... v.. __.~!:._: iiii.iF. ~ _... ~ :ee' a si-i=i'eiie .:......._.. .~. :::: .. ..:::::.eae .. _.._ :eL:::::::::::: ==:e.. ;..: ._Ce_.:...........::..:._. ::..N.~!:rv. ..... ._.-:._._.._.. . _ .3 .... .._..__._.. iiii _::_:: ii_-=iie~ -_:i '~ :. °._ _ii ~i: ::::__ _ .. ... _._::_____::::_:=mar .._ . :.. _::c:. _ .......... ......___.___:....._.__F:.SeiEii:::':iii_._ .~SFF:FF'F:F:--:' ::: ......_.._...._._......_..._.... ... _..... ..5.y.~{ ,.........._......_..__..._. cijee_f5j2. =i =_i_-_ F ' :: 6F~:~ `e5-_ ~.:-=eeee'. ::::::.:e::::::..a-:::::-::::. - ::: _-:e::::..c:::c..:: .:....:..:.....__._._._...... .. ~l!~::::_____::::_-.:c:c..::- ::: :_ _ .-:__-_:::-:::~F~:::::F::F F::? i _ i: ie =3:T :: ..._.___..._._ ~... ... ... n.... __.____....._.. ee_<-eioe~_p is ' : :_ :: ~ '--___ :::v:::.::::..:::: :yy~~ .._::. .. -: - .._____ _ :ea:-:o:e::::!l~.~y____-:_.. __ _:_~ .__.._......3,°;::;::;~:__..__.:ii::-i::~:._._:ii:~-:::::.iii . :: _ ___ -- _ ___ __ ii__ _:v"' _i'~ 1 .:. ~ .. .:iLS'n;' _'iiiiiijj :::v___:vE.: - :..... _.. .._ .. ..':..': :: ::[ ~£'ei:i:i[ii:F 122'908 0049391251 11-24-06 04-05-07 $23,400.00 $0.00 $23,400.00 V2868 PA E99220 C TM Worldwide Headquarters Columbus, Georgia 31999 Toll Free 1-800-99-Aflac (1-800-992-3522) Aflac's promise is to be there for you in your time of need. Please tell your employer how much you appreciate your Aflac coverage. Let us know, too! Contact your Aflac associate/agent or a-mail ilovemyaflac@aflac.com. PAGE: 01 MAILING ADDRESS POLICYHOLDER'S NAME AND ADDRESS 0 0 ~I~II~II~~IIII~II~~~I~I~IIII~IIII~~~Ill~l~l'lllllll~l~ll~l~lll~l~ ESTATE OF EDWARD F SHUEY C/O: WILLIAM SHUEY 2060 COUNTY LINE RD YORK SPRINGS PA 17372-9742 8257 EDWARD F SHUEY C/O: WILLIAM SHUEY 2060 COUNTY LINE RD YORK SPRINGS, PA 17372 TREATMENT DATE: 11-24-06 - 04-05-07 AGEN 1 "5 NAMt: VV ILLIHMS tLIGHtlt I h J au~rv i rv~.: ~ 1 oav PATIENT'S NAME: EDWARD GROUP NAME: CAMP HILL FIRE CO RELIEF GROUP NO.: 19082 CLAIM NO.: 314604059 GEO CODE: 01041 EXPLANATION OF BENEFITS POLICY NUMBER DESCRIPTION TREATMENT UNITS AMOUNT REMARKS AND PLAN DATE A0461170-EHIC15 ACCIDENT GENE 112406 25 8,125.00 053 054 REDUCED BENE 112406 25 8,125.00 ~*~ TOTAL +~~~ 16,250.00 A0461170-EHIC15 REDUCED GENE 022607 22 7,150.00 021 053 054 *** TOTAL ~** 7,150.00 PAGE TOTAL 23 400.00 American Family Life Assurance Company of Columbus (Aflac) 1 iRFNI ROWE'S AUCTION SERVICE (RH 79L) 2505 Ritner Highway Carlisle, PA 17015 Bill RowE~ (AU 1538L) 249-1978 697-4794 249-2677 Dave Rowe (AU 2295L) Auctio~C Is Acton Call "Rowe" For Satisfaction -° ~ ..., SELLERS NAME ~ .~~ ~" a ~~ `~~. ~~ ~ 4 rw~j ~.. DATE ~' ~ ~"'.-- ' c'`i < i k ~ a -u. ..4 ~ : F :. f i r. ~ ~ ~ A ADDRESS ~_f ~ ~ `~ a ~:<~~ h~~ ~....-~. ~~~~ , _ r~~ e-, ~~ PHONE , .~ ; ~-. ~ ~~ `~ ~ ~~;_ OTHER ~_.~~ ~ ,~ ~' .~~~+~) : t v~ ~ .~ r: ~ ~ ~ ~~ ~ 'AUCTIONEER % :...^, k a.,, r~ E AUCTION DATE/LOCATION CLERK % '"""°LL" "- I Commission the Auctioneers to sell the merchandise to the highest bidder by Public Auction. Merchandise to be sold as is & grouped as necessary to obtain bids. I certify that I am the owner or authorized represen- tatiive of the merchandise, goods and or property and have good title and the right to sell and that they are free from all incumbrances. I agree to accept all responsibility for providing merchantable title and for delivery of title to the purchaser. I agree to holdarmless the Auctioneers against any claims of the nature referred to in this agreement. `~~ ~ ~ } t , -~ ~ ~ .~ ,__ ~ ~: `° _ . ..- .. -,J _ sr AU T`I`ON SIGNATU E SELLERS SIGNATURE To1ta1 Sales (Clerking Tickets Attached) $ Less Sale Expense: ' `' % Commission Auctioneer $ % Commission Clerks $ O'T'HER: e'~a'a:a a~-"~ ~¢ TCITAL SALE EXPENSE DEDUCTED $ SELLERS NET $ + ,. _~.'' ~,-l~ /~ a ~ ~ w. c !a Z, 7~ EG. :.. Penn Treaty Network America Insurance CompanysM (PTNA Life Insurance in CA) American Network Insurance CompanysM SM ]March 24, 2008 :EDWARD F SHUEY :2060 COUNTY LINE RD YORK SPRINGS, PA 17372-9742 1Ze: Policy Number P406672 Dear EDWARD F SHUEY: Enclosed please find our check in the amount of $2102.00, representing premium paid on the above referenced policy. This policy became eligible for Waiver of Premium effective 05/23/07, therefore it is not necessary to make renewal premium payments at this time. If you have any questions, please do not hesitate to contact our office. Sincerely, PENN TREATY NETWORK AMERICA INS CO Premium Services Department Enclosure cc: 28907*,99994*,99991 3440 Lehigh Street . P.O. Box 7066 • Allentown, Pennsylvania 18103 • (800) 362-0700 . Fax (610) 967-4616 W ~ ``~~, ~ .. .-+ ~ . p4 d ,,~ ~, U ~ ', ~ ~ ,~ ~ ~ „~~ H ~ _ ~ ~ U w d ~ ~ ~ F' z_ ~ C~ u' q r. x Q xU~- 0 p d z H Q d ~ O N ~ ++ p Q a o 0 N N a ~ ,~ N N 0 H U x v rI W N r o ~ ~ `o a~ ° ~ `" a 00 O N d' N O v O U U W U z +~ M F-~ ~ H ~ .-~ V¢ a ~~ d~ aW O a ~/ Q H z~ d~ a~ E+ w ~a 0 a M 0 ~~ +~+ ~ Sf~ ~ ~ ~ V ~ ~ W ~ W zw °~ O v ~~ H ~a 0 ~o O ~. v N c o March 10, 2009 Paul Bradford Orr, Esq. 50 East High Street Carlisle, PA 17103 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES PO Box 280601 HARRISBURG, PA 17128-0601 p ~G~3~~ ~ 1 ~ C~~~ Re: Estate of Edward F. Shuey File Number 2108-0414 Court of Common Pleas Cumberland County Dear Mr. Orr: The Department of Revenue has received the Petition for Approval of Settlement Claim to be filed on behalf of the above-referenced Estate in regard to a wrongful death and survival action. It has been forwarded to this Bureau for the Commonwealth's approval of the allocation cif the proceeds paid to settle the actions. Pursuant to the Petition, the 87 year old decedent died as a result of injuries from a prior rnotor vehicle accident. Decedent is survived by his spouse and three sons. Please be advised that, based upon these facts and for inheritance tax purposes only, this Department has no objection to the proposed allocation of the gross proceeds of this action, $50,000.00 to the wrongful death claim and $ 50,000.00 to the survival claim. Proceeds of a survival action are an asset included in the decedent's estate and are subject to the imposition of Pennsylvania inheritance tax. 42 Pa.C.S.A. §8302; 72 P.S. §9106, 9107. Costs and fees must be deducted in the same percentages as the proceeds are allocated. In re Estate of ;Merryman, 669 A.2d 1059 (Pa. Cmwlth. 1995). I trust that this letter is a sufficient representation of the Department's position on this matter. As the Department has no objections to the Petition, an attorney from the Department of Revenue witl not be attending any hearing regarding it. Please contact me if you or the Court has any questions or requires anything additional from this Bureau. Sin ely, n on .Baker Trust Valuation Specialist Inheritance Tax Division Bureau of Individual Taxes PLAINTIFF'S PHONE: 717 EXHIBIT -3467 EMAIL: shabakerC~state.ua.us REV-1512 IEX+ (12-08) ~ Pennsylvania SCHEDULE I DEPARTMENT OF REVENUE DEBTS OF DECEDENT, I"HERITANCE rax RETURN MORTGAGE LIABILITIES & LIENS RESIDENT DECEDENT ESTATE nF FILE NUMBER EDWAF;D F. SHUEY 2008-00414 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1• w..~_ ._ . _ ._ ~., ~ ..._F e.u~,.~ se ~~. 'ERIE PENSION OVERPAYMENT (FIIOC) 1,375 30 2. THE GARDEN GALLERY -APPRAISAL OF ARTWORK 1.150, 00 3. U-HAUL STORAGE 1,112.50 4. H & R BLOCK - PREP OF INCOME TAX RETURN 224.00 5. CONTINUING CARE RX 231.15 6. -AUCTION DELIVERY - BARRY JUNKINS HAULING (CASH PAYMENT) 250.00 7., BETHANY SKILLED NURSING 29,992.01 ~ 8.' ~NED SMITH FOUNDERS TREE 1,000.00 9. ~ ~ROWE'S AUCTION SERVICE COMMISSIONS 540.00 1 3 } S i 1 _ I 4. I . ... .. - _.. .. - . . TOTAL (Also enter on Line 10, Recapitulation) $ 35,874.96 If more space is needed, insert additional sheets of the same size. ~' ,'-n ~t ~' ~' ~ t"- ~~~ .~--- l~%Ms Sc~c~~w~ Sic ~ ~y)av~ls S S /9 6 /~/' 110 ~ ~~'" S ~.~t'&'~~`1 Final Notice of Overpayment Sic Qw ~, ~~- c c ~~.~,. ~ , ~~ S~ CS-~ 3 ~~-~ -~.~~.~ ~' C ~ r f (~~ ... O ~: Erie Insurance Group Retirement C~ 1-877-208-096 ervice for the Hearing Impaired 1-800-610-4015 June 3, 2008 E=STATE OF EDWARD SHUEY 4158 N BETHANY DR MECHANICSBURG, PA 17055 RE: File Number W001088-03APR08 ~ Dear Estate Of EDWARD SHUEY: ch~ ~C~ c1~. Sin ~ n ~ ,~ pL. Please accept our condolences for your loss. Our records show that The Estate of EDWARD SHUEY has received an overpayment of benefits from the Erie Insurance Group Pension Plan in the amount of $1,375.30, distributed on April 2008. The overpayment occurred because payments should have ceased after EDWARD SHUEY's death. E3ecause the Plan is a qualified plan, the Plan Sponsor is required by law to collect overpayments and return them to the Plan Trust. To date, we have not received a response to our request for repayment. The Estate of EDWARD SHUEY must repay the overpayment of $1,375.30 in one lump sum by July 3, 2008. Please make a check or money order payable to Fidelit Investments Institutional Operating Compan _ (FIIOC), complete the Repayment Form and return both to the Ene nsurance Group a Yemen ervice Center in the enclosed envelope. On the check or money order, indicate that this is an overpayment for E=DWARD SHUEY and include EDWARD SHUEY's Sociaf Security number. If The Estate of EDWARD SHUEY does not comply within the stated timeframe, the plan sponsor may take additional steps to correct this overpayment. One such step might be to recharacterize the portion of your distribution that represents the overpayment as miscellaneous income, report this amount on Form '1099MISC and reissue a corrected Form 1099-R. The Estate of EDWARD SHUEY may be required to pay FICA and any other tax that may be assessed on the amount of the reclassified overpayment. In addition, any portion of the overpaid amount rolled over to another qualified plan or IRA may be subject to a tax penalty assessment by the IRS. ?28460.001 3. TMP-8-531A IN001088-03APR08 OvrpyRepayReq_531A_44a garden gallery 10 N. Hanover Street Carlisle, PA 17013-3013 www.thegardengallerycom 717.249.1721 INVOICE 5/1/08 Paul Bradford Orr Attorney At Law 50 East High Street Cazlisle PA 17013 Appraisal of eleven artworks for Estate of Edward F. Shuey $1150.00 ~~ ~ ~ 0~ I~ ~ Balance Due $1150.00 ~„PNCBANC PNC Bank, N.A 040 Central PA PAY TO THE °~- /~~ ~~ ORDER OF ,/ J'7 1P C~'='~ +~t~'°h '1 ~'~-- ,~ ~1-1~:.~.5r t,~ o~, ~ h r~r,ca-t' r ter..-( ~ A ~- -~ i~ DOLLARS ESTATE OF ~~ ~ EXECUTOR/ ADMINISTRATOR FOR ~7 .1~e0 j' ~7s e,1 u ~ z~ r~ 7~'tc.ic~ r ~ _ . _ . ..... _ _. _ _ . _ _. _ _ ~ /// _ . _ .__. _ _ ......_!M' \ PERSONAL REPRESENTATIVE .TRUSTEE ~:03L3L27 8~. 5003577i58ii• NO.©~~~J~ s~. 60-1273/313 DATE ~ ~J' eMove History Page 1 of 1 ~~~~ Clean. Dry. Secure. Convenient locations all across North America f~o~z.S'ta.. I~t; WebSelfStorageT"" -Powering the eMoveOO Network Need Reservation Rssistance? 1-800-468-4285 ~~:,~~~.~ Home Make Payment Services Personal Information Receipts History Logout ~iAl'>~7i1' Room/Payment History Cha P d nge asswor Want a new password? Change Show Me Order Show Rooms Balance Due Itl All ~ Ascending ~ ALL. ~~ $0.00 FREE: Rent Reminder PD DUE THRU RM DESCRIPTION RATE QTY TAX TOT BAL Receive an email reminder V s242oo7 10232007 188 RENT s1o4.ss 1 $s.3o $111.25 $111.25 before your rent is due. V 9/24/2007 10/23/2007 186 PREMIER CUSTOMER CLUB FEE $10.00 1 So.oo $10.00 $121.25 9/24/2007 PERSONAL CHEGK ($121.25) $0.00 Reserve A Truck V 10/24/2007 11/23/2007 186 RENT $104.95 1 $8.30 $111.25 $11125 Online truck reservations ~ to/122007 PERSONAL CHECK ($111 25} $o oo available. . . V 11/24/2007 12/23/2007 188 RENT 5104.95 1 $6.30 $111.25 $111.25 "Site" Feedback ~ 1v1a/2oo7 PERSONAL CHECK ($111.25) $o.oo Send us ideas on how to V 12/24!2007 1/23/2008 186 RENT $104.95 1 $6.30 5111.25 $111.25 improve this site. $ 1va2oo7 PERSONAL CHECK ($111.25) $o.oo V 124/2008 2/23/2008 186 RENT $104.95 1 $6.30 $111.25 $111.25 Help/FAQ ~ 1~2ooe PERSONAL CHECK ($111.25) $o.oo Frequently Asked Questions. V 2242008 323/2008 186 RENT $104.95 1 $6.30 $111.25 $111.25 Y 2/52ooe PERSONAL CHECK ($111.25) so.oo ;' ~ ~ • ~~~~ V 324/2008 ` 4/23/2008 186 RENT $104.95 1 S6.30 $111.25 $111.25 ' ~ 3172008 PERSONAL CHECK ($111.25} $0.00 V 424/2008 523/2008 186 RENT $104.95 1 $6.30 $111.25 $111.25 ~`i 4/12008 PERSONAL CHECK ($111.25) $0.00 V 5242008 6232008 186 RENT $104.95 1 $6.30 $111.25 $111.25 5/19/2008 PERSONAL CHECK ($111.25) $0.00 V 6/24/2008 7/232008 186 RENT $104.95 1 $6.30 $111.25 $111.25 s/s2ooe PERSONAL CHECK ($111.25) $o.oo V 724/2008 8232008 186 RENT $104.95 1 $6.30 $111.25 $11125 7/82006 PERSONAL CHECK ($111.25) $o.oo V 8242008 9/232008 186 RENT $104.95 1 $6.30 $111.25 $111.25 6/6/2006 PERSONAL CHECK ($111.25) $o.oo V 9/242008 10/232008 186 RENT $104.95 1 $6.30 $111.25 $111.25 9/3/zooa PERSONAL CHECK ($111.25) $o.oo V 10/242008 11/23/2006 186 RENT $104.95 1 $6.30 $111.25 $111.25 10/102006 PERSONAL CHECK ($111.25) $o.oo V 11242008 12/232008 186 RENT $104.95 1 $6.30 $111.25 $111.25 11/5/2008 BUSINESS CHECK ($111.25) $0.00 V 12242008 123/2009 186 RENT $104.95 1 $6.30 $111.25 $11125 12/3/2006 BUSINESS CHECK ($111.25) $o.oo V 1/242009 2/232009 1$6 RENT $104.95 1 56.30 $111.25 $11 i .25 1/5/2009 BUSINESS CHECK ($111.25) $0.00 V 2/242009 323/2009 186 RENT $104.95 1 56.30 $111.25 $111.25 2/5/2009 BUSINESS CHECK ($111.25) $0.00 =Recorded Payment V =Paid In Full ~ =Reversed Cha rge Copyright ®2001-2008 eMove, Inc. All rights reserved. Copyright notice https://www.webselfstorage.com/customer/accountledgercustomer.asp?rerun=l 3/11 /2009 Comments $0.00 $6,446.25 $9,402.15 $8,370.00 $5,773.61 $29,992.01 ~ ~ Date i -_ - _ - _ Description ~ Da s! E y Rate Charges/ Payments ~ Batance ~ f , ,Units ' - ~ - - (Credit) - - - - - -- -' - - - Balance Forward _ $41,915.76 03/19/08 - 031'19/08 Payment Check # 3201 $10,000.00 03/12/08 - 03/12/08 OATH FOLEY SILI-FEAST 16 1 $7.60 $7.60 03/12/08 - 03/12/08 DRAINBAG ANTI-REFLUX TOWER 1 $6.60 $6.60 03/12/08 - 03/12/08 TRAY FOL NO CATH/BAG PVP 3000 1 $6.05 $6.05 03/18/08 - 03/18/08 Catheter Care 21 $6.25 $131.25 03/18/08 - 03/18/08 HEALTH SHAKES 119 $0.50 $59.50 03/18/08 - 03J18/08 Complex Wound Care 10 $11.00 $110.00 03/18/08 - 03'/18/08 Nebulizer Treatment 6 $6.75 $40.50 03/18/08 - O~i/18/08 Extensive Wound Care 12 $15.75 $189.00 03/18/08 - OiS/18/08 Oxygen Concentrator Rental 21 $6.25 $131.25 03/18/08 - 03/18/08 Incontinence Care -Mod/Heavy 9 $10.50 $94.50 03/21/08 - 03/21/08 Monthly Fee 1 $270.00 $270.00 03/21/08 - 03/31/08 Monthly Fee (11) $(270.00) $(2,970.00) TOTAL BALANCE DUE: $29,992.01 ~ ~~ ~~ ~ ~~~ ~ t ~ ~ ~~ FACILITY NAME RESIDENT NAME ACCOUNT NUMBER BETHANY SKILLED NURSING MR. EDWARD F SHUEY 2456 Board of Trustees Blaine Stzansland, Ed.D_ President Steen 4~'ilds, Esquire. l~ VP Scoti Dunkzlberver.'_'" VP 4ian' Iohnstan. Trzasurzr ~ i. Bruce Walter. Esquire, Seerztan' John Booth tiataliz Matra Desoto Linda Endzrs Greer Grabouicz Alisa Harris-Daniels Jeff Haste T=:moih}- Joseph John D. Laskow,•'ki C. Ted L'eck ;Valley Vleshaka, ir.. Ph. D Bob Pennell Gerald Pur Glenn Ressfzr ?.lien ShalTer, Esouire 31air TroRrtzr jameS L?str.:~squirz Patrick con l::z}serlin~* scoff Weidensaul Committee Chairs .4rttphitbeaASr Campai,;n Carole Desoto Grace M. Pollock -Iz-ilen Derr Kauffman. -lrchitectural Review .drys & Entertairnnent Carole Desoto .dudit ;alien Shaffer. Esquire Bylaws Review Task Force ]. Bruce Walter. Esouire Capital Canxpaign C. Ted Lick Education John D. Lasko~eski Executive Blaine Stzensland Ed.D Erbibit Walter Mzshakz k.. ??t. D Scott Vreidrnsaul Festival Donald Hzlin Finance & Personnel Marv Johnston Fund Devetopmenr "rank Felbaum Gafa Dinnesr Stzcz W'iids. Esquire Gntewat' Jiff Haste Investment ~4aro John_,ten Lands and Trails Scot 2. Bills ltembersb ip Kon• Enck .t`ominatFng Frank Soutbzer Public Relatimrs John Booth Trustees C'elebritr Classic John Booth Glenn Res:>ler #; i ,1uly 31, 2008 P.O. Box 33 •176 Water Compam- Road • Millersburg, PA 17061 Phone (?1?) b92-3699 • Fax (? 1?) 692-09?? E-mail: nedsmith@epix.net • ww~i~.nedsmithcenter.org ivlrs. ltisarcella Shue}' 2060 County Line Rd. York Springs, PA 1?372 dear I.ti.arceila, Thank you so;nuch far your generous gift of X1,000.00, to tl~e fed S-rzith :.enter for mature and ~ tbrough the "~o~.u~.der's `free" ~ rogza~-n. You?• support will help us realize our drearn of creaking a unique center -gnat will eart•~+ on the legacy of ~1ed Smith for future generations. ~. tree on our lands will be identified va-ith a piaque inscribed as follows: ~OLlllder'S ~r~e Dedicated in sionor of ~d~rard ~. and IVlarcella A. Shuey ~iease rotii~r us if you want to select the fee and arrangements ~v ill be made for you?• visit. If the inscription noted above is incorrect, please Lontack us at 717-6~2 ~69g. Th e Sourbeer and Lack 1lducation Center 4~ihich opened Ccto'oer 9, 2004. houses ars exhibition and interpretive gallery, gift shop, classrooms and of ices. k :. grounds feature ~-~Idlife, native plant gardens designed to `..J. aiaxacL Svijd;? ~, Sculpture, 2110 SP'vPrrl yni1~ j :Tr i ills .,~~ ? :'"r ~'~ : -= hank you for all you ilaVti°., dvrti: O_ti •.sui v~i"3cj ~ ~~iT_' S='~p~=` =..: ~`_i' `.~G%S t ~.s:%- _~ ~„ ~, Jer~-~7 i~egar~,,, i~%h~V~i~i V~\. r/k. J .TSe CUii~:G1`?~'~'I:IJ':t~.::~i~:~ij:C,:::: :~ Y J! -,~ J :.1 L .....,... :~. 51.000.00 . o goods or services t:er Gr o:'ided *~ ii:z, ., „~.,.:d , >:. _, idet fiJlCQtiOti ritzitiber is 1.i-173.1047. Tfris orgctt.r<ation is ? ?Fir c/3) tune .drrp, ur~c„t._a..v,.. r ~ ,ier_: iu•r Visit our new Sourbeer and Lick Education &uilding Hours for the Olewine Gallery and Gift Sliop are Tuesday thru Saturday. 10:00 AM to 4:00 PIvt Sunday. 12:00 noon to 4:00 PM from Memorial Day Weekend to Labor Day Weekend REV-1:111 EX+ (12-99) SCHEDULE N COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8c INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER EDVIIARD F. SHUEY 2008-00414 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FI~~ERgL.EXP~N.~~ .____~_ _.___~___ _____._ _ ___.__.__. ... . t' __. _. __ _,. __ ~_..._ .__._ ~_. ~ ~_ _. MYERS-HARNER FUNERAL HOME, INC. 3,380.00 2. iTRINITY EVANGELICAL LUTHERAN CHURCH (FUNERAL MEAL) 321.00 3. _ __ DAVID E. SHUEY -MEMORIAL DINNER 505.77 4. 'ROLLING GREEN CEMETARY 842.50 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions ~ .._.. .~~ . _ ~m_.. _ ,. _. , . _ _ ' 441.00'- 6 r Name of Personal Representative(s) ;WILLIAM M. SHUEY, III , Soaal Security Number(s)IEIN Number of Personal Representative(s) 26-6326593 ~ ~ - ~.._.__..-- ---_.___. __w____ ~.__._.__.n__ _ StreetAddress'`2060 COUNTY LINE ROAD ~__._ City'LYORK SPRINGS State' PA Zip 17372 Year(s) Commission Paid:'2008-2009 t _ . _.~.__.. __ ~ _ __-_ _ _ , -.._~ . __ _. 2. Attorney Fees 7,514.50 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant `MARCELLA A. SHUEY street Address :325 WESLEY DRIVE CityMECHANICSBURG =State ,PA =_Zip 117055 E _ .__ - - Rela6onship of Claimant to Decedent iSPOUSE .~.__.. _.~~,_, _,....k._. .~. _-_~.,., ~ . . 4_=...... ,,,~_.~.___ - , 4. Probate Fees 310.00 5. Accountant's Fees 0.00 _ ___ 6. Tax Return Preparer's Fees 0.00 7. ~~_ __~_. _ _ _ ~_., ___ _____ ._____ m_ _ _ __._._ ____ _ __.___ ____ ________ (Cumberland Law Journal -Advertising ,~ 75.00 s. __. ,_ 3 'The Sentinel Advertlsing ~ _~ I~_. _ ___. __~_ _ _ ___ _.____._.._ - ~ _..________~ ____ I _ _ _~__ _-__.__ ~_,._.__ ...___..~ _.__ . _ .___ __w_ ._ ,______._____. _ 3 182 56 .. , - _. ~ , TOTAL (Also enter on line 9, Recapitulation) S~ 23,072.33 ,' (If more space is needed, insert additional sheets of the same size) S -d Kr ~~ 111 f a~ ~' MYERS-HARMER FUNERAL HOME, It~TC. 1903 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 717-737-9961 LC)C:'A1..1.:Y OWI~'F;D:1~D OPF:Rrt'CF:D April 15, 2008 Mr. William M. Shuey, III 2060 County Line Road York Springs PA 17372 Services for Edward F. Shuey March. 26, 2008 Total: Less Credit for Veterans Benefits: Received check from Insurance Company Additional Certified Copies (10) Items not guaranteed under original contract: Crennation Container Ceri:if ied Copies Obi ltuary Flowers Balance Due: $ 140.00 100.00 330.00 175.00 $ 745.00 D~c13 ROBERT H. HARMER SUPERVISOR DUSTL*1 R. BAKER FUNERAL DIRECTOR $ 3,380.00 - 100.00 $ 3,280.00 - 2,314.54 $ 965.46 + 60.00 $ 1,025.46 Myers-Harper Funeral Home, Inc. 1903 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 Robert H. Harper, Supervisor Phone: (717) 737-9961 Dustin R. Baker, Funeral Director STATEMENT OF FUNERAL GOODS AND SERVICES SELECTED Charges are only for those items that you selected or that are required. If we are required by law or by a cemetery or crematory to use any items, we will explain in writing below. If you selected .a funeral that may require embalming, such as a funeral with viewing, you may have to pay for embalming. You do not have to pay for embalming you did not approve if you selected arrangements such as a direct cremation or i~m"mediate b~u'rial~If~we~charged for embalming, we will explain why below. n~ For the Service of ~ ~~~ ~ { - t~~ Date of Death ~~h a (~ O~/~ Chazge to:y~S 1' ~TC- M ~ ~j.La~ y ol0 6D Cot~/t~Y L.,~n c. ~ . S/arl~' S~?i+as~ Pi4 1737 Name Address City State A. CHARGE FOR SERVICES SELECTED: I. PROFESSIONAL SERVICES Services of Funeral Director/Staff ........ $ ~~., Embalming .........................$ ~~ Other preparation of body Dressing & Cosmotology ............ $ 1 - Casket Placement .................. $ $ ---_-- SUB-TOTAL OF PROFESSIONAL SERVICES ..... Al $ 1 J~GI _ 2. FACILITIES AND SERVICES Use of facilities and services for viewing (Visitation/Wake) ...... ..... $ _~ Use of facilities and services for funeral ceremony ............. ..... $ Use of facilities and services for ` ~ Memorial Service ............. ..... $ 1 r1G • Use of equipment and services for graveside service .............. ..... $ ~~ Other use of facilities Office Area .................. ..... $ Preparation Room ............ ~ ..... $ 1~Q~. SUB-T07:AL OF FACILITIES/EQUIPMENT .... A2 $ ~ (~C~- 3. AUTOII~IOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home Local ....................... ..... $,L /~'~- Heatse (Casket Coach) Local ....................... .....$ / Flower car or floral disposition Local ....................... ..... $ Lead car/clergy car Local ....................... ..... $ ~_ $ $ t SUB-T07:AL OF AUTOMOTIVE/EQUIPMENT .. A3 $ } M.~ TOTAL OF PROFESSIONAL SERVICES, FACILITIES AND AUTOMOTIVE EQUIPM:ENT ................................ A $~~ B. CHARGE: FOR MERCHANDISE SELECTED: Casket .............................$ - (Description) Other Receptacle ..................... $ (Description) Outer burial container ................ $ (Description) Acknowledgement cards ............... $ Register book(s) ..................... $ Cremation urn .......... ............ $ (Description) Urn Vault .............. ............$ (Description) ~ OTHER $ TOTAL MERCHANDISE SELECTED ............ B $ `yD .~ ,.r. C. SPECIAL CHARGES: Forwarding of remains to (Funeral Home) Receiving of remains from (Funeral Home) Immediate Burial .................... $ D' ct Cremation .................... $ SUB-TOTAL OF SPECIAL CHARGES ............ C $~~~, ~ D. CASH ADVANCED: Opening Grave ..................... . $ Newspaper Notice-Local ... .. esl:. $~ . Newspaper Notice-Out-of--town ....... $ .O~ Airfare ............................ . $ Clergy/Mass Offering ................ . $ Certified Copies of [he Death Certificate #~ C~ $ b - yD each .... . $ ~~ Flowers ........................... . $ ]~~~•~ Vault Service Charge ................. . $ Organist .......................... . $ Soloist ............................ . $ Altar Services ....................... . $ Coroner Fee ....................... $ p~~ - E%~ . Milage ............................ .$ SUB-TOTAL OF ADVANCES .................... D $71 D • ~'D We charge you for our services in obtaining: (specify cash advances that are marked-up) SUMMARY OF CHARGES A. Professional Services, Facilities and Equipment, and Automotive Equipment ........................ ` ... $ 1 /I~GI. B. Merchandise ....................... ... $ 1y0• ~ C. Special Charges ..................... . $ D. Cash Advances ..................... . . ~ . TOTAL OF ALL SECTIONS ........ . ............... /,/~ C~ $y~L,~ W PAID AT TIME OF OR PRIOR ~ TO ARRANGEMENTS ........... ............... $ BALANCE DUE ................... ............... $ \. '~ t? ~ O :~ ~. ~~ W w~`" ,.. ~ ~ a Q 0 Ll1 t/1' o ,~ ~~ a z` i i c'. o, . ~ R Z W ~,,, 0. ~' ~""" W a~ ~,,, r ~~ ~- J r'~' ~~~~ ~~N ~ ~~~ ~,. i`r W W U mot W O t7 = 4 pa, CL U W W O ,~ 4 W Q ~ W N ~ °~ ~ ~ O ~ W ~ V W 7 N N ~ O D U N W V1 Q J U Z N ~' _ _ Z U Q Z ~ ~ o a Q N t7 Z W Z ~ f n LL "` N Z N = W 4 ~ V O ~ 'Q W a 0 > 0 3 a ~ uJ W Q p ~ '~ W Q Z 1 0 7~ o tD a 0 U c m ~ ~ c`d ~ ~ y '~- ~ c~ m W ~ ~ > M W W ~ o ~' ROLLING GREEN MEMORIAL GARDENS, INC. MODERN LAWN TYPE CEMETERY NONSECTARIAN September 13, 1983 Mr. & Mrs. Edward F. Shuey :Z37 N. 17th Street (:amp Hill, Pennsylvania 17011 Dear Mr. & Mrs. Shuey: Park Office 1811 CARLISLE RD. P. O. BOX 128 CAMP HILL. PA. 17011 76 1-4055 We are pleased to acknowledge receipt of your agreement providing jEor space for two cremains, including plaque, in our Garden of the Gospels, Block "S". 7Che officers and employees of Rolling Green Memorial Gardens are ready to assist you at all times with any questions that may arise. All of our many facilities and services will be available at any l=ime . This will also acknowledge receipt of your down payment in the amount of $100.00. According to the terms of your contract, the balance in the amount of $820.00 is due November 1, 1983. Please :Forward the enclosed coupon along with this payment. We wish to congratulate you on your wisdom in making these pre-need arrangements. We feel sure that occasions to express satisfaction with your selection will arise and we know that you will recommend Rolling Green to your friends. S' erely, hn D . Shimmel executive Vice President .JDS/elw Enclosure Due 11-1-83 Payment 13 Dote.... /: ~~/ c~ -- Amount 1.820 X00 __.-, Check or -~~ ~r Order No.. ~.- :: ----»•• 4~. Belence ~J 7 This P'm't, Z•-•=~~~•'-i J. Stewart Hardy, Ph.D. SENIOR PASTOR John H. Brock, M.Div. ASSOCIATE PASTOR May 6, 2008 Mr. Bill Shuey 2060 County Line Road `fork Springs, PA 17372 t ~~„~/ poi T R I II I\I II T Y Evangelical Lutheran Church INVOICE Charges for the Edward Shuey Funeral Meal: Total cost of meal Total amount due $321.67 $321.67 Nancy R. Easton, M.Div. ASSISTANT PASTOR Guy S. Edmiston, Jr., D.D. SUPPORT PASTOR IN RESIDENCE [f you have any questions about this invoice, please feel free to call me at the church. 'Thank you, {~ ,: ~ 1~ _~ , ~ ~1 ~~ ~r Paul Hensel Financial Administrator d a~d~ t/ :~ ~ 5 2000 Chestnut Street, Camp Hill, Pennsylvania 17011 PxoNe 717.737.8635 • >=Ax 717.730.9297 • E-MAIL trinluthC~trinitycamphill.org • wEesITE www.trinitycamphill.org Yage 1 of 1 ~ U'S Al RWAYS° DIVIDEND MILES P~Aa~for' DAVID E SHUEY 44271120 0144 4025 April 2008 Statement Credit L61e: $25,000.00 Cash or CreditAvadab/e: 614,837.68 VISA~GNATURE - -- ----- ----_ --- - - - ----- -- - ----- ---- _ ~- -- -_-- ForlMonnetion on YourAcoount Writ - -- - _ `_. _ -_.- - _, ., ~ : ' _. , www.bankofamerica.com - Summary of Transactions - _. _. . - _ _ _~ _ _ ~ Billing Cyde acid Payme ,.. _ __.-; _ nt Information Caf toll-free 1-800-583-1820 Provious Balance $9,230.46 Days in Billing Cycle 28 TDD hearing-impaired t-800-22 2-7385 Payments and Crodits - $$,018.50 Closing Date ~1`~ Mad Pajments to Cash Advances + $0 00 BANK OF AMEPoCA . Purchases and Adjustments + $6,805.50 Payment Due Date 05!10/08 P.O. BOx 15714 WILMINGTON, DE 19886-5714 Periodic Rate Finance Char es + $144.86 9 Curran Payment Due $245.00 Merreiling/nquinesto: Transaction Fee Finance Charges + 60.00 Past Due Amount + $0.00 BANK OF AMERICA New Balance Total $10,162.32 Total Minimum Payment Due (''~~'`~'~ l~:_J P.O. BOx 15026 WILMINGTON, DE 19850-5026 Posting Transaction Reference Account Payments and Credits _ Date Date - Number Number Category Arrrount #AM2 AMAZON PAYMENTS AMZN.COMBILLWA 84420090938094 03/21 5331 4025 18.SOCI 000004080011975 MO 12100035DAVID SHUEY 04/08 6,ab.00 CI Purchases and Adjustments #QEL7AAIR a76719078LAdRANdE CiA 03/19 03117 5100 4025 C 176.5 04112 ATL/PHL ONEWAY #WAWA 208 0000208 FRAZER PA 03/19 03118 3911 4025 C 30 a #IIiON BRIDGE WINE COMP COLUMBIA MD 03/19 03/18 0398 4025 C _ 440.6 #ELAZTECA GLARKSVILLE MD 03/19 03/18 0578 4025 C 12 & ifSRR SIRIUS RADIO 888-539-7474 NY 03/20 0319 1888 4025 C . 12 s~ Ti,10cf519,1385 . #CABI LLC 310-6383333 CA 009989884 03/21 03/14 5418 4025 C 5g1,a #cAI~LSONwac~oNUTTR~-vesa-965-s45saA oy2, a3/is 0267 4026 c 3s a 031920587088829381 . #WAWA 208 0000208 FRAZER PA 03/21 03/20 3449 4025 C 51.0' ;rTWX AOLSERVICE 0308 800-827-6364 NY 03/21 03121 2479 4025' , C 9.91 M3K0411564630410 #NA1L PARADISE FRAZER PA 03/22 03120 0018 4025 C 57 a #WAWA 208 0000206 FRAZER PA 03124 03/23 4173 4025 C . '46.91 #QVC RETAIL #2 FRAZIER PA 03/25 03121 2707 4025 C 51 102 #NEW JERSEY E-ZPASS 888-AUTOTOLL NJ 80566799033 03/26 03/24 2865 4025 C . 75.d #PA BIOTECHNOLOGY ASSC 610-578-9220 PA 03126 03/24 001$ 4025 C 35 a 13124606105789220 . #1AfAWA 208 0000208 FRAZEA PA 03/26 03/25 8549 4025 C 36 3: #PAYPAL SOUNDVISION 402-935-7733 WI 03/26 03125 4001 4025 C . 91.9( CAIiAP HILL PA 03!'27 03/28 hansactions continued on page 3 ~''~ ~le~ ~ ash- ~a~ `S ~h•2rq~- .~rv ~ r C 15 01016232C1002450tiU[160000~00~4147360Q15741551] BANK O F AMERICA ~ Check here for a chsnge of marling addnrse or phone number(. Pkaee pmvide all correctbns on the reverse aide. P.O. BOX 15714 -- WILMINGTON, DE 19686-5714 - - -~ ----- 11 ~na~~~a~aa~aa~a~n~aa~~na~a~a~an~na~~a~aa~ua~~~ ~ACCOK/NTNUMBER.• 4427112001444025 NEWBA[ANCETOTAL: $10,162.32 PAYMENT DUEDATE.• OS/10V08 DAVID E SHUEY eiMrPirr""""'"°'re'°"°a~ 1547 MILLRACE LN .;~ WEST CHESTER PA 19380-5841-470 -- - Marl Ntis payment coupon abng with a check armonay order payable to: BANK OFAMEA/CA http://sz0120.wc.mail.comcast.net/service/home/~/luncheon%20receipt.jpg?auth=co&loc=... 3/13/2009 CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 May 23, 2008 j~gC~E~IIC~/gf' MAY 2 2008 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the official legal publication for Cumberland County and the legal newspaper for publication of legal notices. T'O: Paul Bradford Orr, Esquire Edward F. Shuey Estate R:E: Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: May 9, May 16, and May 23, 2008 Advertising Cost Proof of Publication Second Proof Request Payment received Total Amount Due $ 75.00 $ 0.00 $ 0.00 $ 0 .00 $ 75.00 Payment received by RECEIPT FOR PAYMENT r---~. ,,~, /7 GLENDA FARNER STRASBAUGH Receipt Date: 4/14/2008 Cumberland County - Register Of Wills Receipt Time: 10:28:41 One Courthouse S uare Receipt No.: 1052292 Carlisle, PA 1713 SHUEY EDWARD F Estate File No.: 2008-00414 Paid By Remarks: EDWARD F SHUEY AJW ------------------- Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check# 3211 Total Received......... Receipt Distribution ------ ------- -------- --- Payment Amount Payee Name 260.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 20.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 CUMBERLAND COUNTY GENERAL FUN ---------------- $310.00 $310.00 RETAIN THIS PORTION FOR YOUR RECORDS 'THE SENTINEL - LEGAL PAUL BFtADFOFLD ORR P.O. BOX 130, CARLISLE, PA 17013 AD NUIvIBER CLASS SALESPERSON BILLING DATE LINES 348506 10 PUBLIC NOTICES wolfs 05/27/08 44 * 2 AD DE:iCRIPTION START DATE STOP DATE ESTATE NOTICE LETTERS TESTAMENTARY 05/12/08 05/26/08 PUBLICATION INSERTIONS RATE NET AMOUNT GROSS AMOUNT 3 THE SENTINEL - LEGAL 3 LGL 175.56 TOTAL AD CHARGE 175.56 3 PROOF OF PUBLICATION O1PRF 7.00 YS IRUN ASE ORDER PAY THIS AMOUNT 182.56 Est.EdwardShueyr es. 219.07* MESSAGE: ~ ~~ . SCE Thank you for advertising with The Sentinel. ~I,~ ~ ~~ lin s for in-column le al advertisements: Monda is Frida at y` Dead e g Y Y 11 a.rn.; Tuesday is Friday at 4 p.m.; Wednesday is Monday at 12 Noon; Thursday is Tuesday at 12 Noon; Friday is Wednesday at 12 Noon; Sunday is Thursday at 12 Noon. If you have any questions regarding your Legal bill please call Tammy Shoemaker 717-240-7176 Fax your legals to 717-243-3754 attention Tammy Shoemaker You c<~n also EMAIL your legal to Classified ads: classified@cumberlink.com Please send a cover letter including your name and address as an attachment PROOF OF PUBLICATION State of Pennsylvania, County of Cumberland Erica Peterson, Classified Manager, of The Sentinel, of the County and State aforesaid, being duly sworn, deposes and says that THE SENTINEL, a newspaper of general circulation in the Borough of Carlisle, County and State aforesaid, was established December 13,1881, since which date THE SENTINEL has been regularly issued in said County, and that the printed notice or publication attached hereto is exactly the same as was printed and published in the regular editions and issues of THE SENTINEL on the following day(s): May 12,19, 26, 2008 COPY OF NOTICE OF PUBLICATION T E TI letters Testamentary for the Estate of EDWARD F. SHUEY, deceased, of Lower ANen Township,. Cumberland County, Pennsylvariia, have been granted to the undersigned. , All persons indebted to the Estate are requested to make immediate payment, and those having claims against the Estate are requested to present them for settlement without delay to: William~M. Shuey 2060 County Line Road York Springs, PA 17372 or to: Paul Bradford Orr, Esquire i 50 East High Street Carlisle, PA 17013 Affiant further deposes that he/she is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statement as to time, place and character of publication are true. l Sworn to and subscribed before me this 27~ da, oy f Ma,Y 2008. ~~~/ I/l../f~C Notary P lic My commission expires: ~~~/d~ COMMONWEALTH OF PENNSYLVANIA Notarial Seal Christina L. Wolfe, Notary Pttb6c Carlisle Born. Gxrttxxtartd County My Comrrilssion Expires Sept-1.2006 Member, Pennsylvania .Association Of Notaries MYERS-HARNER FUNERAL HOME, INC. 1903 MARKET STREET CAMP Fitl.I., PENNSYLVANIA (7011 717-737-9%1 LOCALLY OWNED AND OPERATED March 26, 2008 National Guardian Life Insurance Company P 0 Box 1191 Madison WI 53701-1191 Sen~ices for Edward F. Shuey Marc;h 26, 2008 Cremation with Service Cremation Container Cash Advanced iJewspaper Notice/Local Certified Copies ]lowers Coroner Fee Tot+al Less Credit fir b'eterans Benefits: Total: 430.00 60.00 175.00 25.00 ROBERT H. HARNER SUPERVISOR DUSTIN R BAKER FUNERAL DIRECTOR $ 2,550.00 $ 140.00 $ 690.00 $ 3,380.00 - 100.00 $ 3,280.00 REV-1513 EX+ (11-08) ~ ' Pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER ~~tNAi2i~ r SNU~u ,~tovS-.Oo`f~~{ NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 2116 (a) (1.2).] 1.~ :Marcella A. Shuey, 325 Wesley Drive, Mechanicsburg, PA 17055 ~ kSpouse 1/3rd 2. `Robert W. Shuey, PO Box 255, Averill Park, NY 12018 ~ `ESon ~ 2/9th 3. ~.-~_. ~a._.__ _ _ ~ David E. Shuey,1547 Mill Race Lane, West Chester, PA 19380 ~ _... _ _. __ ..._ Son 2/9th 4. ...,tee.. t 1 w ...,.._ z _........~... _~ I ___.._._~ William M. Shuey, 2060 County Line Road, York Springs, PA 17372 6 .... -. ..Q. .. ... v _..,._ .. , w . ............._ W .. s ..a f -.~.. .._ ._~. _ h ....._.. __..,., ._, .. __. ^..~ 3 ___ ~ _ _, .. fl ,Son ._. _. ...._.. - v ... _ _. ', I . 2/9th .. i ' . _ _.., ., .. ... ._ _ _ _... _-.. .. _ . __w _ .. ._ _ .......... ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 2113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN .,.~_ _-.. ___ __ __ .__ _.. ___~.__ _ ____ _ _. _.~__ _ _ ._.__. ~________._ -__ _ _ ______._ _ _ ~ __~ w. _ __-- --,_-.. a.wr. ~ _ ~, ...._ _, _. __. 1. = To Surviving Spouse Marcella A. Shuey 32,472.88 . _ _ B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS M, ~. 1. __.._l ~ . , t ,~ .~.~.~ _._ ~ m-.~ e_.~...u.._ -~,.~.._s.-.. ~.-~., __ e_w .~ ~__ ~ _~ a_.... __.w..e .. ~._~_~ ~. __.._,.~. ___ __. .__..~~_____ .~_ _._. - ~._ .~~,. _.__ _.._e.e<e.~_..e~~.~.,.._..~~...~.m~ _m ~...~.~_._..~..v ...~.~.~~-~.~ ~_.__I .. ___.. ; ~_... _. _._..__.___ _ ~___ _.___.._...__ _. .____.___ ~_ _ __ _-.. _._._ ____, __~_..w_____. __.._ T _m_ t__ ___ _ ., _ ... __.~ .. ~____ __.~._ i .__~ _.~ TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. ~ 32f472.88 If more space is needed, insert additional sheets of the same size.