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HomeMy WebLinkAbout09-01-09 15056051047 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~ INHERITANCE TAX RETURN PO BOX 280601 a l o~ o i l 7~ Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 182 ~ 9 ~ I.33 / / i6 aooS" d~ l 3 / 9/ 9 Decedent's Last Name Suffix Decedent's First Name MI ~If ~.~2 I FF STEL Lf} L (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Narne MI ~ ~ A- Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW i 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death prior to 12-13-82) O 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required death after 12-12-82) 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 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 TO: Name Daytime Telephone Number ~N ~,2'L F'S F S H~ E L .DS l~/ 7 l 7 7~ 6 oa O p Firm Name (If Applicable) REGISTER OF WILLS U~F ONLY C7 C'.? - _.... Q ~ ~ ' First line of address ~ Sf c~ c 1 f"~1 ~ CL o~aSE'~ ~O~D ,L~? -n ~ c'T I - Second line of address -`- ~~~ _;, ~jC= - City or Post Office State ZIP Code /1! ~' C ~ ~ N / C 5 C3 ~ ~~ off ' / '7 d .~' S 9 7' 3~'~' ~ ,-: - , Correspondent's a-mail address: e e $ a~ t ~/dS.3®COMC QSL i /i•eL 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 OF PERSON RESPONSIBLE FOR FILING RETURN nnTF PLEAS ORIGINAL FORM ONLY Side 1 15056051047 15056051047 ADDRESS L,~wJ^/~ ~' ~V~S ~ T ~ C'o"~/ier Or. ,/~e~hanicsbur~ . ~i~ /7oss 15056052048 REV-1500 EX ~1 Decedent's Social Security Number Decedent's Name: S iE~[/¢ ~. SHE7ZlFie / 8 2 o 5 0 1 3 3 RECAPITULATION 1. Real estate (Schedule A) ............................................. 1. . ~ ~ 2. Stocks and Bonds (Schedule B) ....................................... 2. + ~ 0 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. . ~ ~ 4. Mortgages & Notes Receivable (Schedule D) ........................... .. 4. + ~ O 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 6 ~ri S 7 D Q . S 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. • ~ ~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property R t d 7 ~ -0 eques e ...... (Schedule G) O Separate Billing .. . • 8. Total Gross Assets (total Lines 1-7) .................................. .. 8. ~p iD ~ 7 ~ 9 . ,~ 9. Funeral Expenses & Administrative Costs (Schedule H) ................... .. 9. ~ ~ ~ ~ 2 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............. .. 10. / O 3, ~ 3 , a, 11. Total Deductions (total Lines 9 & 10) ................................. .. 11. S 7 ~ 9 ~o • 0Z 12. Net Value of Estate (Line 8 minus Line 11) ............................ .. 12. ~ (~ p ,J ~ 3 . /~ 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 • ~ an election to tax has not been made (Schedule J) ...................... .. . 14. Net Value Subject to Tax (Line 12 minus Line 13) ...................... .. 14. W Q O S'~ 3 . S TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers undP- Sec. 9116 (a)(1.2) X .0 . O ~ 15. . O O 16. Amount of Line 14 taxable at lineal rate X .0 ~ 3 ~' 0 ^] ~ 7 . ~D d 16. / S 3 3 t1 7 . J~ y 17. Amount of Line 14 taxable at sibling rate X .12 ~ ~ 17. ~ 0 18. Amount of Line 14 taxable l~ 15 ~ ~O ~ 7 T S • ~ 7 l t X t ll t 18 4 Q / ~ D q ~ • O / ra e . a co a era . 19. TAX DUE .........................................................19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT SS'y9~•`~3 O Side 2 15056052048 15056052048 REV-1500 EX Page 3 File Number .2~- ~~f - ~~76 Decedent's Complete Address: ------... _ ... -.-- S TELL /} ~. ~~IZ/FF STREET ADDRESS ~~ TeDD G`i'R CL• clT _ _ _ - - _ /70/ - CA~L/SG~ __ _ STATE ~~ ZIP Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. CreditslPayments O A. Spousal Poverty Credit _ _. _ B. Prior Payments ~ ~f7 fi S~. 0O C. Discount '~ ~ ~ ~_ p ~, 00 Total Credits (A + B + (; ) 3. InterestlPenalty if applicable D. Interest 0 c1) S,S~~96 , y3 (2) ~Sv~ l60, m e E. Penalty O Total Interest/Penalty (D + E:) (3) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. D Fill in oval on Page 2, Line 20 to request a refund. (4) 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) ~ S, 33 6.'f,3 A. Enter the interest on the tax due. (5A) D B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~S, 3 3 (o. ~{ 3 Make Check Payable to: REGISTER OF WILLS, AGENT /~ PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: d t f h Yes ^ No :......................................................................................... rans erre e property a. retain the use or income of t . 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 receivin ade uate consideration? ........................................................................................................... 9 q ? " " .. ^ ^ ............ or payable upon death bank account or security at his or her death in trust for 3. Did decedent own an .. 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which ^ ~ ® ~ contains a beneficiary designation? ......................... .............. ~~~...••~ ~~~••••••••~~~ • ~ s~ SeHEOUC~ G ~~ iN,~Rnr~T~.~~~PaRFosES. •• IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed an 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)]. 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. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT is IAI t ur FILE NUMBER SHE~~F~ S7EZ Lf~ L . a2/-D~- // 7( All property jointly-owned with right of survivorship must 6e disrlnse~l ~n c~tio.~„io G ~u nwre space is neeaea, insen addmonal sheets of the same size) LEGAL OPINION OF CHARLES E SHIELDS HI ON THF, VALUE OR LACK THEREOF OF CERTAIN STOCKS LISTED ON A PROXY STATEMENT FOUND IN THE INVENTORY OF THE SAFE DEPOSIT BOX OF S. LENORE SHERIFF, a.lc.a. STELLA L. SHERIFF, AT THE PNC BANK BRANCH ON WEST SIMPSON FERRY ROAD, MECHANICSBURG, CUMBERLAND COUNTY, PENNSYLVANIA. On December 9, 2008, an inventory was made of the above referenced safe deposit box. Among the items inventoried and reported to the Pennsylvania Dept. of Revenue pursuant to the inventory was a proxy form or statement regarding the Fortune National Corporation. Although somewhat dated this form seemed to indicate that there could possibly be as many as 151 shares or more of the stock of the said Corporation held in the name of Ms. Sheriff in some form or fashion. A search was made of public records available online and it was determined that the stock of Fortune National Corporation had been incorporated under the laws of the Commonwealth of Pennsylvania on March 22, 1971. By March 26, 1996, when Fortune National made a detailed filing with the United States Securities and Exchange Commission, it listed as its only significant asset its holdings of 63.7% of the outstanding stock of Acap Corporation. Acap was incorporated under the laws of the State of Delaware on March 18, 1985 by the management of American Capitol Insurance Company to become the parent or holding company of American Capitol. Public records indicate there were further diverse mergers, acquisitions, stock transactions and the like involving both Fortune and ACAP which it would serve no useful purpose to relate herein in detail, the same being available by search inquiries on Google, Yahoo, or other similar search engines. We made a written inquiry to ACAP/Fortune on December 8, 2008 by certified mail, rettun receipt requested. The U. S. Post Office was unable to deliver the letter and was unable to forward it or to provide a forwarding address. We next solicited the help of Joy Dougherty, a registered broker for Morgan Stanley brokers and requested the help of their research department in New York City which has access to a very large database regarding stocks and their various transactions, filings, and liquidations. Tlu•ough the good offices of Ms. Dougherty we were able to ascertain that Fortune National Corporation went tlu•ough a lawful and supervised dissolution and liquidation in accordance with Section 1975 of the Pennsylvania Business Corporation Law and consonant with Securities and Exchange Commission Regulations. This liquidation was begun in late 1996 and proceeded apace. It is therefore n7y best legal opinion based on the information now available to us that Ms. Sheriff likely received all, if any, recompense or payment that she was entitled to during and tluough the said liquidation and dissolution process in 1996. The stock is therefore apparently worthless and will not be carried on the Inheritance Tax Return schedule B at any value. Respectfully submitted, ~~~;Q,~- Charles E. Shields, III REV-1508 EX. ry~97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, 8~ MISC. PERSONAL PROPERTY ESTATE OF ~L/~1~~ S~~G~ L , FILE NUMBER rT ~ ~/- off-- // 7~ Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ~. ~oV~'~2~/GPI/ ©f/N,(' NTs ' .4CCo~ /~. C D ~ /~ ~ S X09 /30 ~l 1, 03 5~ ~y ,B. .Lnt. Qccr. ~` ~ o• q! an 1/e~ ~ ~ l 3. iz C. C.D # /6~5' ~ /~8 %o, `182, l/ D. .1if. acct. ~ d.o.ct! orb ~fzm c ~/o,~y L'd7 -#~ /bas' 38.3 S9~a ~7, ~'S6. ~3 ~ .=nt. acct. ~ d.o. ~. oh .Z1'ern ~ ~'7 ~~ ft~. .~.e f. Q ~ c r. )~ a~• o. ~ on L /fit ~ R ~. 6 y .fin f. 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Sheriff Date of Death: 11/16/08 SS# 182-09-0133 Dear Mr. Shields, III: Per your request, enclosed please find account information as of the date of death for the above-named decedent. For your information, accrued interest in not included in the date of death balance. Please feel free to contact me if I can be of any further assistance. Very truly yours, ,. .~ ,.-•'' Nicole Job COP Specialist III Decedent Department (617) 533-1364 Sovereign Sank ESTATE OF S. Lenore Sheriff a/k/a Stella L. Sheriff SOCIAL SECURITY #: 182-09-0133 DATE OF DEATH: November 16, 2008 Account #: 1685209130 Type: CD In the name of: S Lenore Sheriff Date of Death Balance: $11,034.44 Int.(YTD) from 1/1!2008 to 10/31/2008 Accrued interest to date of death: $13.12 Other Info: Account #: 1685209148 Type: CD In the name of: S Lenore Sheriff Date of Death Balance: $10,482.11 Int.(YTD) from 1/1/2008 to 10131/2008 Accrued interest to date of death: $10.84 Other Info: Account #: 1685383596 Type: CD In the name of: S Lenore Sheriff Date of Death Balance: $7,856.23 Int.(YTD) from 1 /1 /2008 to 10/31 /2008 Accrued interest to date of death: $7.77 Otherlnfo: Account #: 1685383612 Type: CD In the name of: S Lenore Sheriff Date of Death Balance: $7,822.39 Int.{YTD) from 1/1!2008 to 10/31/2008 Accrued interest to date of death: $9.69 Otherlnfo: Account #: 1685386607 Type: CD In the name of: S Lenore Sheriff Date of Death Balance: $10,008.04 Int.(YTD) from 1/1/2008 to 10/31/2008 Accrued interest to date of death: $18.84 Other info: Open date: 9/25/1996 Clpen date: 7/28/1998 $312.10 Open date: 8/4/1998 $319.15 Open date: 2/1/1996 $209.13 Open date: 2/29/1996 $204.18 $338.26 Page 1 of 2 Sovereign Bank ESTATE OF S. Lenore Sheriff a/k/a Stella L. Sheriff SOCIAL SECURITY #: 182-09-0133 DATE OF DEATH: November 16, 2008 Account #: 1685391284 Type: CD In the name of: S Lenore Sheriff Date of Death Balance: $7,820.15 Int.(YTD) from 1/1/2008 to 11/3/2008 Accrued interest to date of death: $12.48 Other Infio: Account #: 1685392886 Type: In the name of: S Lenore Sheriff Date of Death Balance: Int.(YTD) from 1/1/2008 Accrued interest to date of death: Other Info: to CD $7,208.96 10/31 /2008 $ 8.40 Open date: 6!30/1997 $207.84 Open date: 10/1/1997 $203.25 Page 2 of 2 st 0 MEMBERS 13t FEDERAL CREDIT UNION REGULAR SAVINGS ACCOUNT: Account Number/Suffix 10094-00 Date Account Established 02/27/1968 Principal Balance at Date of Death $1,860.19 Accrued Interest to Date of Death $.76 Total Principal and Accrued Interest to Date of Death $1,860.95 Name of Joint Owner None CERTIFICATES OF DEPOSIT: Account Number/Suffix 10094-42 10094-43 Date Account Established 12/28/2006* 11/20/2007* Principal Balance at Date of Death $5,485.63 $10,432.98 Accrued Interest to Date of Death $11,34 $21.28 Total Principal and Accrued Interest to Date of Death $5,496.97 $10,504.26 Name of Joint Owner None None *Purchased by transfer of funds from 10094-00. CERTIFICATES OF DEPOSIT: Account Number/Suffix 10094-44 10094-45 Date Account Established 11/20/2007* 11/20/2007* Principal Balance at Date of Death $$10,482.98 $10,482.98 Accrued Interest to Date of Death $21.28 $21.28 Total Principal and Accrued Interest to Date of Death $10,504.26 $10.504.26 Name of Joint Owner None None *Purchased by transfer of funds from 10094-00. CERTIFICATES OF DEPOSIT: Account Number/Suffix 10094-46 10094-47 Date Account Established 11/20i2007* 11/20/2007* Principal Balance at Date of Death $10,482.98 $10,397.57 Accrued Interest to Date of Death $21.28 $11.62 Total Principal and Accrued Interest to Date of Death $10,504.26 $10,409.19 Name of Joint Owner None None *Purchased by transfer of funds from 10094-00. CERTIFICATES OF DEPOSIT; Account NumberlSuffix 10094-48 10094-49 Date Account Established 11/20/2007* 11/20!2007' Principal Balance at Date of Death $10,397.57 $10,397.57 Accrued Interest to Date of Death $11.62 $11.62 Total Principal and Accrued Interest to Date of Death $10,409.19 $10,409.19 Name of Joint Owner None None *Purchased by transfer of funds from 10094-00. 5000 Louise Drive PO. Boa 40 Mechanicsburg, Pemisylvania 17055 (800) 283-2328 «rww.lnemberslst.org CERTIFICATES OF DEPOSIT: Account Number/Suffix 10094-50 Date Account Established 11120/2007* Principal Balance at Date of Death $10,397.57 Accrued Interest to Date of Death $11.62 Total Principal and Accrued Interest to Date of Death $10,409.19 Name of Joint Owner None *Purchased by transfer of funds from 10094-00. CERTIFICATES OF DEPOSIT: Account Number/Suffix 10094-52 Date Account Established 01l23/2008* Principal Balance at Date of Death $8,712.50 Accrued Interest to Date of Death $16.83 Total Principal and Accrued Interest to Date of Death $8,729.33 Name of Joint Owner None *Rollover from certificate 10094-41, originally established 05!01!2003. **Rollover from certificate 10094-40, originally established 01/20/1998. 10094-51 11 /20/2007* $5,239.92 $10.64 $5,250.56 None 10094-53 01/23/2008** $9,473.'16 $18.30 $9,491.46 None M M ERS 1sTIF~D~E^RA CRE UNION J~.~ ~ t Danielle A. Kline Insurance Services Specialist January 14, 2009 Estate of: S. LENORE SHERIFF Date of Death: November 16, 2008 Social Security Number: 182-09-0133 he ~Cin~oF Lanc~isbur ESTABLISHED 1903 P.O. BOX 179 LANDISBURG, PA 17040 Bank records indicate the following account balances on November 16, 2008 for: S. Lenore Sheriff SS# 182-09-0133 250 Collier Drive Mechanicsburg, PA 17055 Acct Sole Jt. Acct. Account Type Balance Interest Accrued Opened Ownership With Number Bearing Interest 5/7/2007 Yes 700018148 CD $3,740.10 Yes $6.15 5/712007 Yes 700018149 CD $4,273.21 Yes $7.02 8/4(2008 Yes 700020621 CD $7,503.95 Yes $9.87 8/7/2008 Yes 700020623 CD $10,536.92 Yes $10.39 10/1/2008 Yes 700020746 CD $5,000.00 Yes $25.46 1 1 1612 0 0 8 Yes 700021144 CD $5,000.00 Yes $5.53 7/2(2004 Yes 2602199 NOW $24,072.25 Yes $6.57 Respectfully, Community Office anager ~~,~~ LANDISBURG - 717-789-3213 BLAIN - 536-3118 SHERMAN~ DALE - 582-8511 Q M8T'Bank 499 Mitchell Road, Millsboro, DE 19966 Mail Code DE-MB-12 Phone (888) 502-4349 Fax (302) 934-2955 January 9, 2009 Charles E. Shields, III Attorney At Law 6 Clouser Road Corner of Trindle and Clouser Roads Mechanicsburg, Pennsylvania 17055 Re: Estate of.~ S. Lenore Sher Social Security: 182-09-0133 Date of Death: November 16 2008 Dear Sir or Madam: Per your inquiry dated January 7, 2009, please be advised that at the time of death, the above-named decedent had on deposit with this bank the following: 1. Type ofAccount Checking Account Account Number 8639477 Ownership (Names o~ S Lenore Sher Opening Date 8/11/gg Balance on Date of Death $ 7, 035.34 Accrued Interest $ 0.20 $ 7, 035.54 - - --- -- ---- - Total 2. Type ofAccount Account Number Ownership (Names o~ Opening Date Balance on Date of Deat17 Accrued Interest Total Certificate of Deposit 31003910683290 S Lenore Sher 2/9/00 $108,298.74 $ 506.84 ____ _. $108, 805.58 3. Type ofAccount Certificate of Deposit Account Number 31003910990398 Ownership (Names o~ S Lenore Sheriff* Opening Date 8/25/00 Balance on Date of Death $ 5,379.33 Accrued Interest $ 33.66 Total __. _____ $ 5,412.99 4. Type of Account Certificate of Deposit Account Number 31003913914551 Ownership (Names o, fl S Lenore Sheriff" Opening Date 3/29/00 Balance on Date of Death $ 13,883.40 Accrued Interest $ 52.74 Total $ 13,936.14 5. Type of Account Certificate of Deposit Account Number 31003913914733 Ownership (Names o, fJ S Lenore Sher Opening Date 6!29/00 Balance on Date of Death $ 26, 842.26 Accrued Interest $ 150.31 Total $ 26,992.57 6. Type ofAccount Certificate ofDepasit Account Number 31003913914759 Ownership (Names o~ S Lenore Sher Opening Date 7/5/00 Balance on Date of Death $ 10, 062.40 Accrued Interest $ S. 73 Total $ 10, 068.13 7. Type ofAccount Account Number Ownership (Names v~ Opening Date Balance on Date of Death Accrued Interest Total 8. Type ofAccount Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total 9. Type ofAccount Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total 0. Type of,4ccount Account Number Ownership (Names of) Opening Date Balance on Date of Death Accrued Interest Total Certificate of Deposit 31003914395651 S Lenore Sher 9/1/92 $ 5, 043.77 $ 13.40 -- _ .._ . -- - __ $ 5, 057.17 Certificate of Deposit 31003914447288 S Lenore Sher 1/29/93 $ 5, 084.29 $ 30.37 $ S, 114.66 Certificate of Deposit 31003914458326 S Lenore Sher 5/2/94 $ 4,184.00 $ 79.86 $ 4,263.86 -_____.... Certificate of Deposit 31003914467260 S Lenore Sher 11/1/94 $ 6, 345.25 $ 7.22 $ 6,352.47 _ _,,:- _ _ _ __ _ _ 11. Type ofAccount Account Number Ownership (Names of) Opening Date Balance on Date of Death Accrued Interest Total 12. Type of Account Account Number Ownership (Names o• fJ Opening Date Balance on Date of Death Accrued Interest Total 13. Type ofAccount Account Number Ownership (Names o~ Opening Date Balance on Date of Death Accrued Interest Total 14. Type of Account Account Number Ownership (Names of) Opening Date Balance on Date of Death Accrued L7terest Total Certificate of Deposit 31003914502735 S Lenore Sher 6/1/95 $ 10, 808.84 $ 61.97 ___ __-_ __ __ $ 10,870.81 _ ___ __ __ Certificate of Deposit 31003914503692 S Lenore Sher 8/1/95 $ 5,310.33 $ 6.31 __ ---_.. __- ___ $ 5,316.64 Certificate of Deposit 31003915943780 S Lenore Sher 8/4/08 $ 5,261.17 $ 55.98 $ 5, 317.15 - - Certificate ofDeposit 31003915943798 S Lenore Sher 8/4/08 $ 13,961.21 $ 148.57 --- - - -_ $ 19,109.78 - l S. Type ofAccount Certificate of Deposit Account Number 3100391594385 Oia~nership (iVames of} SLenore Sher Opening Date 8/5/08 Balance on Date of Death $ 6, 000.00 Accrued Interest $ 73.26 otal __ __ _ __ __ _. _ ___ $ 6> 073.26 __ 16. Type ofAccount Certificate of Deposit Account Number 31003914538623 Ownership (Names o~ SLenore Sher Opening Date 9/25/96 Closed 8/4108** 17. Type ofAccount Certificate of Deposit Account Number 31003913914684 Ownership (Names o~ SLenore Sher Opening Date 5/26/00 Closed 8/4/08** 18. Type ofAccount Certificate of Deposit Account Number 31003910914570 Ownership (Nantes o,~ SLenore Sher Opening Date 7/5/OD Closed 8/5/08** Please be advised, there was no safe deposit box found for the above decedent. ** Please contact the Mechanicsburg Branch for all additional information on accounts closed prior to the date of death. * If upon reviewing the information above, you believe there are additional accounts not referenced, please provide us with an account number and/or name of any possible joint account holder. For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds, etc., please contact our Mechanicsburg Office # 717-255-2031. Sincerely, Tracie Hare Adjustment Services www.fmtrusto~ff~c.com TRUE January 9, 2009 Charles E. Shields, III Attorney At Law 6 Clouser Road Mechanicsburg, PA 17055 To Whom It May Concern: RE: S. Lenore Sheriff In reference to the above customer, our records show the enclosed information to be accurate of today's date. If I may be of any further assistance, please contact me. Sincerely, t ~~ ,`~~ ~` v Tricia Ganoe Deposit Operations Manager 717-261-3624 717-264-6116 888-264-6116 P.0. Box 6010 Chambersburg;, PA 17201-6010 FINANCfAI Sf11.IIT1(1NS_.. FR(1M P-F(1P1 F YClll KN(1W n n n n C~ D (D ~ CD .Z CD ~ ~' fD S lD O ,n.., C7 C7 (~ ~ ~ ~ N N N 7 7 CD fD (D lD D 0 0 0 ~ o m~ w o m N N N W N N W W Z ~I Cn C1i O O C CJ1 W N p N W J V o . ~ rn ~ O N o C O ~ W N O ~ 0 0 0 N N N N N ~ O O O O O p~ O O O O O ~ J o o v o n O N (D d CD ffl CTi 69 Ol b9 O ffl N !A W W O O O ~ ff7 O O Ul O W ~ OD O O O N ~ O O V n fD (I1 O O ~ O Do c~n ~ w ~ o D CO J j O Q A Qu W J ~ W W O CO ~ a ba 0 En 0 rn 0 ~ 0 e» 0 ~ 0 cfl 0 v~ CJl ds Cn ~ O) f» N cs~ W T O O 0 0 0 O O ~ O O ' O O Oo O W N V V A N Cn W W W W O J A N ~ n fD cn cn (n Cn cn D r r r r r ~ m m m m m o ~ 0 J 0 J 0 > 0 > 0 C N fD N CD fD l' ~ ~ ~ ~ ~ ~ N N N N N ~ 1 (p C . O m ~, ~' a O c ~ ~ m o O ~ ~ Z N N ~ 3 .. ~ Z Cn r m CD ~ o C7 fD (D 1 N O N CD O -+. fD N S + a U ,.x February 5, 2009 Charles E. Shields, I11 6 Clouser Rd Mechanicsburg PA 17055 RE: Estate of: S. Lenore Sheriff Tax Identification Number: 182090133 Date of Death: November 16, 2008 To Whom it May Concern: Commerce CBank This letter is in reference to decedent account information you requested for the individual listed above. We are able to provide the following: Account Type: Time Deposit Account Number: 1100114 Date Opened: 05/30/2000 Primary Owner: S. Lenore Sheriff Date of Death Balance: $6496.06 Accrued Interest: $8.68 Principal Balance: $6487.38 Account Type: Time Deposit Account Number: 1100356 Date Opened: 07/16/2001 Primary Owner: S. Lenore Sheriff Date of Death Balance: $8901.02 Accrued Interest: $0.66 Principal Balance: $8900.36 Please feel free to contact me at (717) 412-6127 if I may be of further assistance. Sincerely, Diana Reynolds Commerce Bank Research Associate/Deposit Services Commerce Bank /Harrisburg PO Sox 4999 3801 Paxton Street Harrisburg, PA 1 71 1 1-0999 commercepc.com Mar, 3, 2009 1;56PM PNC BANK 412-705-2747 ~~ [.EADII~G TfiL~ ~IiL1Y' March 3, 2009 Charles E Shields III Attorney At Law 6 Clouser Rd Mechanicsburg PA 17055 RE: S Lenore Sheriff SSN: 182-09-0133 DOD: 11-16-2008 Dear Mr. Shields: No. 9307 P. 1/2 In response to your request for Date of Death (DOD) balances for the customer noted above, our records show the following: Certificate of Deposit Account # 21001041259 S LENORE SHERIFF NICKEL FUNERAL HOME BURIAL RESERVE DOD balance; $ 8,509.66 + 17.04 accrued interest Interest paid 01-01-2008 ihru 11-16-2008 $216.82 YTD Account # 21001013210 S LENORE SHERIFF DOA balance: $ 5,044.48 + 10.10 accrued interest Interest paid 01-01-200$ thru 11-16.2008 $200.17 YTD Account # 21001041602 S LENORE SFTERIFF DOD balance: $ 4,233.10 + 3.13 accrued interest Interest paid O1-O1-2008 thru 11-16-2008 $166.02 YTD Account # 31300189402 S LENORE SHERIFF DOD balance: $16,081.38 + 23.00 accrued interest Interest paid Ol-O1-2008 thru 11-16-2008 $655.87 YTD Established: 02-26-1992 Established: 07-01-1993 Established: 08-01-1989 Established: 06-01-2000 Page 1 of 2 Mar, 3. 2009 1:56PM PNC BANK 412-705-2747 Account # 31600194295 S LENO,RE SHERIFF DOD balance: $ 6,256.53 + 4.62 accrued interest Interest paid Ol-O1-2008 thru 11-16-2008 $181.52 YTD Checking Account Account # 5140345783 S LI/TTORE SHERIFF DOD balance: $ 47,463.54 + 0.26 accrued interest Interest paid 01-01-2008 tbru 11-16-2008 $11.33 YTD No, 9307 P, 2/2 Established: 0 8-01-2000 Established: 03-03-1989 Please note that this.office provides date of death balances for deposit accounts (]RAs, CDs, Checking and Savings). We do not process any financial transaction9 or provide statements. If you need assistaace with any of these items, please call 1-888-PNC-BANK (1-888-762-2265) or stop by ,your local PNC Bank branch office. Sincerely, National Financial Services Center PNC Bank, N.A. Member FllIC Page 2 of 2 ~.ceQ s7~'lo~ s -- ~ 7551 A 581 669 154 ~•~•~F+` 000 ~.1#~~ ~! `T *`°°°~ Check No. 'L3, e 05 15 09 48 AUSTIN, TEXAS 230.9 87813163 ,~,,~ 2309 87813163 20090900 I30 OSHER KANS CYTAX REFUND i~ ..,., '. Pay to I~~~III~~~III~~„ICI,~isl~l~l~~~l~~lll,~„L~I~LLIL~~ILr~I ' ~ ', ~ -J the order of LONNA MYERS EXEC 1 2108 ~' 250 COLLIER DR 63 MECHANICSBURG PA 17055-9404 ~***1856*00 ' REUIONALDISBURSINOOFPICEP. VOID AFTER ONE YEAR 0 ii°Ir'I'I'"~'~Ii :IL-~I'"-I-l~- i~~r-~ i=r_rl lir'~-1 i° _.~-f-_ i~=1- r_ l_I ~ - I i -r- 00 9_I- ~ -- ~ i. ITS ~ I-lilt-'i"'r~-.;";1:rT._-!-= rl_I_r_,.=~-•--r-I_'i Il;i .r ~~I-'- ~- ~ 414hr1n ~ ~~=r:=~-i~r-1 ~=ii~_r~-I:I_li_ij-~ - ~il; ~~_~ I- •(, ~~~/ ?rr~--= .I. !:-~r- -I•r it 'i:~~-Trnri_~I~IV`~ ial_ir_I-ili~=h•I i- - - ; ;-r- P"~d u j~I-r_ri-irl_u'`fiirl~~'1-{_ ~i_i 11=11 ~_ i!:iiiili'lhi~Il' i=1,ae~l--.!iL-~r!ii~_cii~~~ ~~_i}I=~;l_i~ij(=I~=1=;-i-il: n' 2 :3:0"9 ~~r ll• ~:DOODOD 5 LBO: 8 7B L 3 L6 39u' 040 509 i//y~o5 G~.ri,( ~..~C E .~ Statement United Church of Christ Homes Sarah A. Todd Memorial Home 1000 West South Street Carlisle, PA 17013 Statement Date: 01/14/2009 Lonna Myers 250 Collier Drive Mechanicsburg, PA 17055 Due Date: 01/25/2009 Re: S. Lenore Sheriff Account Nr: 100938 --------------------------------------------------------------------------------- Date Description Days Rate Charges Payments Balance Quant --------------------------------------------------------------------------------- BALANCE FORWARD -2,658.69 -2,658.69 i~~ ~ ~ 5 70ii° Aso ~ i000 50 ~aa 20000 i 30 9~ i 3 3u° REV-1570 E%+(t-971 COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF SNEn 1JC't=~ S T~ZL~ L . FILE NUMBER ~/.r p ~ -//7~ This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDEiHENAMEOFTHE7RAN5FEREE,THEIRRELATIONSHIPTODECEDENTANDTHE DATE OF TRANSFER. ATTACHA COPY OF THE DEE~FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION IFAPPLICABLE TAXABLE VALUE ~ ~rrcvpCab~B ~uria~ Fund piu~al~le .n ~e~ ~ Nr'GKGI Fu~,eral fjosyre in ~ .4naoun-f ef' ~8, S'Z~ s/ joa~o ~~~ ~~, S~~ S~, ,C~'s1`c~ hem ~/' in/-vrixgi4'or-a/ ~ /aola ~pur~osts ondy. /Ylal~f4i~e•~ ~ PHC ,G~~, See u/so ~~f~y al` :S~he~! ~! a, ~~ /NFo~['/xf-%/oil~i~L ~ir.c'PosE3 icy,. ,~RKD~NT/<1L //VSK/7. CD. DF ~/sf~7~/L'~, ~:~a~~ flay G;,~ ~i.suntK«- o/ ~•e ~ ,doftt mf' wl,. cti ~ ~,a,6lc f ester 1i o~ a~ece~ert /ti . /~ojc~, ,~ 3 ~2 030 6 Syr ~a7, SBS. 4/ ,~. ~i9~~~y ~ ~z,8~~760 ~ /, 6~a. 6~ (~sc~ ~~MS 7/Z,S affnclrea~) TOTAL (Also enter on line 7, Recapitulation) ~ $ -~ O "' (If more space is needed, insert additional sheets of the same size) 712 :v . May 2000} Life Insurance Statement OMB No. 1545-0022 apartment of the Treasury eternal Revenue Service DeCedenf:-Insured (To be filed by the executor with Form 706, United States Estate (and Generation-Skipping Transfer) Tax Return, or Form 706-NA, United States Estate (and Generation-Skipping Transfer) Tax Return, Estate of nonresident not a citizen of the United States.) 1 Decedent's first name and middle initial 2 Decedent's last name 3 Decedent's social security number 4 Date of death Stella Sheriff S (if known) 182-09-0133 11/16/2008 5 Name and address of insurance company The Prudential Insurance Com an of America, PO Box 13902, Philadel hia, PA 19176 6 Type of policy 7 Policy number Limited Pay 421822760 8 Owner's name. If decedent is not owner, 9 Date issued 10 Assignor's name. Attach copy of 11 Date assigned attach copy of application. assignment. 05/04/1942 12 Value of the policy at the 13 Amount of premium (see instructions) 14 Name of beneficiaries time of assignment Lonna J Myers Executor Estate Of S $7.80 Lenore Sheriff 15 Face amount of policy 15 $ 177.00 16 Indemnity benefits 16 $ 17 Additional insurance 17 $ 1,389.65 18 Other benefits . 18 $ 38.00 19 Principal of any indebtedness to the company that is deductible in determining net proceeds 19 $ 20 Interest on indebtedness (line 19) accrued to date of death . 20 $ 21 Amount of accumulated dividends 21 $ 22 Amount of post-mortem dividends 22 $ 6.02 23 Amount of returned premium _ _ 23 $ 24 Amount of proceeds if payable in one sum 24 $ 1, 610.67 25 Value of proceeds as of date of death (if not payable in one sum) 25 $ 26 Policy provisions concerning deferred payments or installments. Note: If other than lump-sum settlement is authorized for a surviving spouse, attach a copy of the insurance policy. 27 Amount of installments _ ~ 27 28 Date of birth, sex, and name of any person the duration of whose life may measure the number of payments. 29 Amount applied by the insurance company as a single premium representing the purchase of installment benefits _ 29 30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits. 31 Were there any transfers of the policy within the three years prior to the death of the decedent? ^ Yes ^ No 32 Date of assignment or transfer. Month Day Year 33 Was the insured the annuitant or beneficiary of any annuity contract issued by the company? ^ Yes ^ No 34 Did the decedent have any incidents of ownership on any policies on his/her life, but. not owned by him/her at the date of death? _ _ ^ Yes ^ No 35 Names of companies with which decedent carried other policies and amount of such policies if this information is disclosed by your records. The undersigned officer of the above-named insurance company (or appropriate Federal agency or retirement system official) hereby certifies that this statement sets forth true and correct information. ~~~ ~~ ~ Vice President, Signature - ~~ Title - CUStOtl]er SerV1Ce Off C0 Date of Certification - 0 3 / 10 / 0 9 Cat. No. 10170V Form 712 (Rev. 5-2000) r~x7~. ~ ~, ~~ ~ ~ ~ 03 0 ~ ~~ t12 ,. May 2000) Life Insurance Statement OMB No. 1545-0022 .partment of the Treasury .nternal Revenue Service ' Decedent-If1SUred (To be filed by the executor with Form 706, United States Estate (and Generation-Skipping Transfer) Tax Return, or Form 706-NA, United States Estate (and Generation-Skipping Transfer) Tax Return, Estate of nonresident not a citizen of the United States.) 1 Decedent's first name and middle initial 2 Decedent's last name 3 Decedent's social security number 4 Date of death Stella L Sheriff (if known) 182-09-0133 11/16/2008 5 Name and address of insurance company The Prudential Insurance Com an of America PO Box 13902, Philadel hia, F'A 19176 6 Type of policy 7 Policy number Limited Pay 392030694 8 Owner's name. If decedent is not owner, 9 Date issued 10 Assignor's name. Attach copy of 11 Date assigned attach copy of application, assignment. 05/15/1939 12 Value of the policy at the 13 Amount of premium (see instructions) 14 Name of beneficiaries time of assignment Lonna J Myers Executor Estate Of S $10.40 Lenore Sheriff 15 Face amount of policy 15 $ 320.00 16 Indemnity benefits 16 $ 17 Additional insurance 17 $ 2 , 227 • 91 18 Other benefits . 18 $ 38.00 19 Principal of any indebtedness to the company that is deductible in determining net proceeds 19 $ 20 Interest on indebtedness (line 19) accrued to date of death . 20 $ 21 Amount of accumulated dividends 21 $ 22 Amount of post-mortem dividends 22 $ 23 Amount of returned premium 23 $ 24 Amount of proceeds if payable in one sum 24 $ 2 , 585.91 25 Value of proceeds as of date of death (if not payable in one. sum) 25 $ 26 Policy provisions concerning deferred payments or installments. Note: If other than lump-sum settlement is authorized for a surviving spouse, attach a copy of the insurance policy. / 27 Amount of installments 28 Date of birth, sex, and name of any person the duration of whose life may measure the number oi` payments. 29 Amount applied by the insurance company as a single premium representing the pt.irchase of ~~ installment benefits 29 30 Basis (mortality table and rate of interest) used by insurer in valuing installment benefits. 31 Were there any transfers of the policy wi±hin the three years prior to the death of the decedent? ^ Yes ^ No 32 Date of assignment or transfer: Month Day Year 33 Was the insured the annuitant or beneficiary of any annuity contract issued by the company? ^ Yes ^ No 34 Did the decedent have any incidents of ownership on any policies on his/her life, but not owned by him/her at the date of death? ^ Yes ^ No 35 Names of companies with which decedent carried other policies and amount of such policies if this information is disclosed by your records The undersigned officer of the above-named insurance company (or appropriate Federal agency or retirement system official) hereby certifies that this statement sets forth true and correct information. Jy~} /~ ~/,/ C/ V1Ce PreSldent, Signature - i~~K.vC L/~f ~c ,OK-Cs+.,`.Title - Customer Service Office Date of Certification - 0 3 / 10 / 0 9 Cat. No. 10170V Form 7'12 (Rev. 5-2000) REV-1511 EX+ (10-06) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER S h~Fi2/FF, STE"L L,~ L . ai -off - ii~~ Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. /-/; ~/le I ~unera/ l-lowte o~ Lo s v.'llc ~.~ SChtc/ G. P 0.1~. s+? curia Fwid errd~'l~ ~ $~ 7, '' /) rbnluvic~ 1e (see 6.!!: n9 affa~hed) oti ty = ~ £t5a, ~8 0// • -~ Ch urn o~ TuC Lr~V~11~/ Chr~ St ~ {v~ ~i4.n~ 1V-ea~()~P,~ ~/OO.00 B. I ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) _~ON/_V~/~ cT. /yl}~~pS _ _ ~a.`; ~ 9 s(', ° j~ Street Ad~drAess ~S~~~D/~e~' 17/- City / /! ~ Uh; csd Gt/^li State ~ Zip _~7OSS_ Year(s) Commission Paid: Z• Attorney Fees (~!?Qi-leS ~, ~/~ ~ elms .~ ~ s~' ~ lR, svo, o0 3• Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant NO GyYE CL! 6/i3 L~ /VOU~'~ __-_ - Street Address City State Zip __ Relationship of Claimant to Decedent 4. Probate Fees GV~1.~1 DI^l~//ld/ 1SSUG' D~ $~iorf ~erf'it~~'i,le.S l'/38',00 5. Accountant's Fees RoLert Gu. 1 "jrri5 -~~,~p c%s~ o~ yof~o,e~ . ~` a9s ao ti. l Tax Return Preparer's Fees ~~Dycl ~ctl~h es l o ~k ~ ~J~ 1 D~~~ p//tl ~I ~p,~, (CS~I„~ fi 3~,~~ ~• /~dvGr~is%nq ~'~rwbcrlan~ Lain f(.trha.~ 0 '~7S,Oo 8• C'arl,'s~ ~erihnel Nc.ws~P.~r ~d/erf,'s1n ~ ¢ / a4.7o °l. G•~/ 'n @ /o ~e isf~r of G~i//.s ~ OD ~ l S !D. f~ ~o/~i ~i D`I u ~ ~/~o ~!r le , oc~ ~~So - // ,-- _- % e-~_in-6urse m onf - a~-- -G'~/1rrl~S-cc-.Sti~~l~%s _ ~- - _,~r --_ - . _ ~O~io{v~o~~CS, /~°S~Jei ~~/rti~ed /l~lr~~~i~~s, ems'. ~~2. (00-- _. TOTAL (Also enter on line 9, Recapitulation) $ ~~~ ~~~, ~D (If more space is needed, insert additional sheets of the same size) SCNF~ ~l, e~ct~, ~S?. aF ~Ht~2/~ ~, L~7VaRE Fi~E ivd. a /-0 ~' -/~7c ~~. ~e;Mb fi C,h s F. ~h~el s 3 'f s,~. ~~. ao w~r~#' ------a-- --- -- -----~.---- ~r -~d~a ~--- - -- - -- ---- - --------- ---- a --- --- -_- - -- --- ---- - __-- _ - --- -- _ _ - ------ - --- RECEIPT FOR PAYMENT ------------------- ------------------- GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 SHERIFF S LENORE ~ H-~ z Receipt Date: 2/03/2009 Rece:~:pt Time : 14:08:32 Receipt No.: 1055601 Estate File No.: 2008-01176 Paid By Remarks: CHARLES E SHIELDS III CJ ------------------------ Receipt Distribution ------------------------ Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICATE 8.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Check# 1262 8.00 Total Received......... 8.00 ~ ~ m i~ ~ - Z a w ~ a m ~ ~ m C1 m m ~ -1 K ~ ~ z m A ~ ~ m m 3 O ~ -Di ~ 1 O m . z ~ D D f D Z ~ - m m 37 1 m p n n c z - p c S ~ m z - T ~ C z m ~ c r f O ~ Z m r d D ~ z m m w ~ m a cp w n ~ m w o m 3 4 m w I ~ n v m 1 to 4n uu is tv to cn tt± ORIGINAL - F. F. D. OF A. ~ f DUPLICATE-CLIENT ~I ~ ( I TRIPLICATE -FUNERAL HOME I z -~ Z D (n CJ m ma }D 3 ~ ~ n m ~ ~ < ~ -I N [D y ~ 0 $ o D O ~ p ' " ~ m w < - Sl m m O N m o ~ a co ~ ~ ~ n ~' m w ~ m N ~ m m a n , ~ p' v _ v ~ D ~ ~ z o m m• u En to 4 m to r~ En C C ~ ( !~ ~ D m m m C7~ Cn I O ~ < ` ~ ~ ~ ~ O ~ m ~ w ~ ~ ~ m cn .~ _I m m m m o m ~ D < O v w o m d m p m~ T n ~ n m ~'t w O ~ 3J I m (n m ~ < ~ D Z m C~ ~ ~ ~ ~ Q C m~ D { m m . ~ ~ m a 3 w m ~ z (A I .-. n cn ~ O C : m m Z ~ m -i ~ ~ ; n ~ ~~ '~ O R, ~ ~ m -I m z w _ ~ ~ -~ ~ O m D ~ N o a ~ m .. - ~ O f ~ lA (fl En ifi m di {fl (~ fR V1 .~ {~3 (~/i L7 m m s, D P~T1 yPp ry' ,P,~ ~ ~ M D n m ~ Om•"-ate?c z m •~9my ~ ~.aoa`mm O < p, o m~ ~ ~ m ~ m 'K~ U7 ma3oc~a: O Gi 3 G Q~ d m a'amn{ c r F m m o i.~ z ~' m n m m Z~ a-m m ~~m D O ~ ~ m m ~ n il~~ m ~ ~ ~ F ~~ 0 3 m ~~ N ~ `C C pp Q ,~ 4 c d fD ~ p ? ~ m ~ D T r t0 N 10 O Q: m ,5, ~mrac, . m4~`c~ 3croino~ ~. ci ~ '° to to ~o m~ 0 c m u~ m I n~ y ~~ \\\~ `~ I ~ 1 ~"~, 4.. \' ~, \\\\~ n ~ n ~~ m, m m m T m rn m a° v ~~ ~_ -wcp-i~~.o ^tD r y. 9 0 -~o ~ ~~ m m ~m °O O y£~~ c y C< D °3.°1 ~ C~~ $c.m C7 c~__ ~~mm 77~y 1m i om~m Z tri 7~~NIp^ yNOmy ~Nf0 T37 ~ ~K°-:ate .Dw°, wa rn °i 'm m~ ~ D~ y0.C :C ~ 3~m m p,~r m zwm°O<tOn ~ ~n ~mS ,37 -a ~ pd~m o.~N~mm 'm y. aye ~ ` ° 0~ Zo ~m ~ Qo3~a o m~ Pn~ O ~~cn-mi CO ~NN m z P G D o c ~ m~ 0 6 n ° m Oc ~ ~ O n 3oti p' Zm ^~,v'~ S1 _mm :T ,~3 0 2 ?om°~ mcmm~~' T m`?'n o_j. ° NCO p 9~ N -G ~ C N ~ P =J o f = r_~ {~y. y f I ff7 aa~m`~l ° z ~ NrnNO ('(~y N ~v_ ~ n ~°-mam ~o W ry~~ C7 ~10 ray O c~i m?~O N O~~N..a o a` m n m ~ w ~ m °_o _. O Oi,~O~R f_ p' i ;o= o c n~ 7 C y N w Z m o cx0 ~ pi ~ ¢3 - n a mm ~'~ _ -1 ' „~=? ~~n p~ _ I '--m C-.N d ml ~ y m rnl m ~~o3Q~ -omW~! rT , r; D G .-_. to n y ~ O'.4U'- 3m l ~ ~ ~ ~' y D QSro~ cn ~ _ {{ - i ~mRmGl .. I _ m ~ n=, r c m w -- Oo . m ! I _ - ___ a7- m mc Bm` .. I I ~ ~~, ~ ca v ~ m ro~ J y ~ m-o vvo ~ -p D n N' nl~ =m .~ DU7 ~roro+ N n D { -i m (- m~ I a r' - ( ~ o r^•~ ~i i ~ ° a ~" v mC ~ v PZm vd ~ ; m m __ n 5~ _ d '~ D .D „~ Qg Z P7, ~ co o. o. O m = G mt0, r I ~''~~ fi R 69 t~ ~ ~ ` CJ ~' Qo ~ti n t ~. `, • t m o m f/1 C O ~ ~ -' ~-^m °. o wCD7m cn j m ~ ~ 2 ~ m m D m ~ ~ n' ~ o O m ~ ~ cn z D ~ D O ~ ~ o T ~ po ~ $ m m _ ~ O m T ~ ~ z _ ~ m . T - Z . m 3 ~ ~ : ` -J m m v w ~ ~ T m 1~ n O ~ D Z ~ G~ ~ C7 ° w O ! (D m m : ~ a. ~ d N ~ S D ~ ~ d N O ~ N v; 2 ~ w (] N ~ 7 G ~ w m ~ ~ D ~`. ~ ~ c ~ ~ (} w - io O o ro c D a ~. 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O-__ -__. _~-__ ~ w --- ~ D ! i co ~ Z m ~ ~~ ~ ~ ` ~ REV-1512 EX+(12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF SNP/~~ S ~~G~ L , FILE NUMBER Report debts incurred by the decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. tir more space is neetletl, insert additional sheets of the same size) ~'otal Backing Statemexlt PNC~ANK For the period 11/15/2008 to 12/16/2008 ~ ~ For 24-hour information, sign on to PNC Bank Online Banking S LENURE SHERIFF DECD ~ on pnacol77. Primary account number: 51-4034-5783 Page 3 of 3 Check Images JOSEPH C. SHERIFF 2095 6. LENORE SHEPIFF ~.I:rvm la lnou cuxae A1'+ s n lE //- / -_~~_ CARLISLE. PA 1]013 Dn 71i~ nrt4.._~ut,,._f-Y.1_~u2~~~~.~~1__~% ~.2 _ kin„~...., YN+~It);~~IIF~ r /co INC 9.W.NA MO PriDlily u..~.n rA Plux rt:03131 P73F)t: 2CI95 n•5 1110 3 4 5 78 3n' l''00~ 269'7.' 2U95 $<,1,12G X19 1 l ~`"L0; 211oR JOSEPH C. SHERIFF Z 096 S. LENOPE SHERIFF ,/ w.Hrl„~~ I~~ lfi0(1 CIR~: LE AFT : A ~/- I7' L' H GARLISI.E, RR 11013 OAIc Y,;;fit'k'-,J?~r//eNivm _JP~,;+L"-/r1~/~~ ~l~ ____n~-.~J $ SF73.c3 ~,br ~G1:Ll~~~L~l'f:.~.+'~~F"_~.~ ra Lnr~l;^ Y1VL,]~1~, ~~ Pricri/ty .,,,., rNClliok~N.S_ HO -'. am.d r.t rlns ~(fj"yy~~~e.. ~ t:~313L27381: 2096 u•51403459031r_ (J ~ I 2119fi $RR3.03 11; ltl%21111£+ With PNC Online Banking, you can view, print and save up to the most recent 90 days of your canceled checks -front and back -FREE of charge. Please contact us for ac{ditional options. REV-1513 EX+ (9-00) SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER ~5y~72/Ff; STL-u/1~ L- oZ j -p~-'--/1710 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP 1'0 DECEDENT Do Not List Trustee(s) AMOUNT OR SHARE OF ESTATE I TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (1.2)] 1. L ~N~~ .7, i~ y~i25 ~~ D L'v//;fir fir, , /~1eCltl~vl rc s~ c~I~, Qr1~ l7o dau9ti ~cr 50 ~o ~. ~ei ti Scld /)'lary 9 ~y s,to~ 3 78 Sh~rm a,ns Vii - J~ 6~d., ~"//i offs.d u r~. ~ ~s•~ ~(a Kp~.t~r ~{D `~o ~ f,/T ~70o`Iy (lS~v~ 3. ,Toene ~,~ers Ner6~ 1550 lv ~ «i ums C~--rive ~d,, ~nf ~10~ ~'ra,7clr~(au~~f~+' d ~o Mec.~un,'csdur~, /,~¢ /?ass ~ysp°) 'y 17 wa~.,u° /j1r~rS c~-rcwtd s ort o2 q 5" Norf~i /3Q/f/NO/tr Sf', ~ /gox /5~/ ~`f S'l`o) bra rt Kl~ n ~vta~t , P~¢ /73z 3 -5'• M ~ c Gee. I l c /hy~-^5 Stie ff 'le ~ randdau~G>,tr~• e~ 35sn C'o%n;a/ /1d., ~over~ P~f X73 /S ~~ ~ (4~.S,~o~ J~a1 ~Scc C~~i~Siir s ENTER DOLLAR AMOUNTS FOR DISTRIB TIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) BAST WILL AND TESTAMENT OF S LENORE SHERIFF I, S. LENORE SHERIFF, of Monroe Township, Cumberland County, Pennsylvania, bein€; of sound and disposing mind, memory and understanding, do make, publish and declare this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of al] my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. All the rest, residue and remainder of my Estate, real, personal and mixed, whatsoever and wheresoever situate, I give, devise and bequeath to my beloved husband, JOSEPH C. SHERIFF, to his own use and benefit absolutely. 3. In the event my said husband, JOSEPH C. SHERIFF, should predecease me or die at about the same time I do, such as in an accident or disaster common to both of us, I hereby direct all the rest, residue and remainder of my Estate to be distributed as follows: A. Fifty (~0%) percent to my daughter LONNA J. MYERS B. Forty (40%) to my foster daughter IDA MARY REIGN C. Ten (10%) percent to be divided equally amongst my grandchildren through my foster daughter, IDA MARY, to wit: JOENE MYERS HERBERT; DWAYNE MYERS; MICHELLE MYERS SHETTLE; STEVEN REIGN; and DAVID REIGN. 4. In the event my said daughter, LONNA, should predecease me, then her share shall be divided and distributed as follows: A. The sum of one thousand ($1,000.00) dollars to the Church Of The Living Christ, of R.D. # 1, Loysville, Perry County, Pennsylvania. This gift is to be restricted to use for the building fund. B. The sum of one thousand ($1,000.00) dollars to the Heritage Christian School of the above-named chruch. C. Any balance then remaining shall be divided equally amongst my grandchildren of and from my said daughter, LONNA, per stirpes. 5. In the event my saidQfoster daughter, IDA MARY, should predecease me, then her share shall be divided and distributed as follows: A. The sum of one thouseand ($1,000.00) dollars to the Church Of The Living Christ, of R.D. # 1, Loysville, Perry County, Pennsylvania. This gift is to be restricted to use for the building fund. B. The sum of one thousand ($1,000.00) dollars to the Heritage Christian School of'the above-named church. C. Any balance then remaining shall be divided equally amongst my grandchildren oi.' and from my said foster daughter, IDA MARY, per stirpes. 6. In the event any of my grandchildren of and from either my said daughter, LONNA, or any foster daughter, IDA MARY, have predeceased me, then their share of the ten (10%) percent provided for above shall be distributed amongst the others so named above who do survive me, per capita. 7. I nominate, constitute and appoint my daughter, LONNA J. MYERS, to he the Executrix of this my Last Will and Testament. In the event that she should predecease me or for any reason be unwilling or unable to act as such Executrix, I nominate, constitute and appoint the said IDA MARY REIGH in her place and stead. I further direct that they shall not be required to file bond or other security in the Office of the Register of Wills for the purpose of administering my Estate. IN WITNESS WHEREOF, I have hereunto set my hand and seal this /s~ day of A.D. 2004. ~'"- CJ~-+r^^ U'~9. ~ /W`~17t] (SEAL) S. LENORE SHERIFF Signed, sealed, published and declared by the above-named S. LENORE SHERIFF as and for her Last Will and Testament, in the presence of us, who at her request and in her presence, and ir.. the presence of each other, have hereunto subscribed our names as witnesses. --~~ ~ its .~~ ~~ ~~ ~ ~~~~