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HomeMy WebLinkAbout09-09-091 t 15056051058 ~ EX 06-05 OFFICIAL USE ONLY REV 1500 c ) - PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN 09 0105 Po aox 2ao6o1 RESIDENT DECEDENT 21 Harrisburg, PA 17128-0601 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Birth Date of Death 196-14-1108 11/26/2008 07/12/1924 Decedent's Last Name Suffix Decedent's First Name M~... ....................... ............................................................................... MARCELLA A SHUEY ~ _. _ . .............. . . .................. (If Applicable) Enter Surviving Spouse's Information Below MI ' Spouse's Last Name s First Name Suffix Spouse Spouse's Social Security Number ___ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW Remainder Return (date of death 3 ' .:;~;; 1. Original Return . ... 2. Su lerrrental Return .. • • ~ • • pp prior to 12-13-82) Future Interest Compromise (date of ..;'.. 5. Federal Estate Tax Return Required 4a :: 4. Limited Estate . .. .. death after 12-12-82) 1~; 6. Decedent Died Testate ,:: ~'"" 7. Decedent Maintained a Living Trust _...... 8. Total Number of Safe Deposit Boxes ~ ~ ~ ~ ~ ~ . (Attach Copy of Will) d Attach C of Trust ( oPy ) Spousal Poverty Credit (date of death ..::.. 11. Election to tax under Sec. 9113(A) 10 :: ...:.. 9. Litigation Proceeds Receive . .. .. 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: Daytime Telephone Number Name PAUL BRADFORD ORR (717) 258-8558 Firm Name (If Applicable) ......................... ........................................................................................... REGISTER OF WILLS USF~NLY .. ... LAW OFFICE OF PAUL ORR t~ C3 0 ~'~' ~ ~„•• r ~ " First line of address ~ cn r T ~ •~,~ ~ ~;_~ ~ ~ ~ ~ ~ -v ~ ro r F~ ti 50 EAST HIGH STREET ' ............... ........ .. ... Second line of address ......... ......... ~::~ - ~ h .~ ~,..,rl <`....~ ~ ~ r."~ FILED 'r" Y ....... City or Post Office State ZIP Code ~ W „ ~ ~'~ PA ~ 17013 ' " `~ CARLISLE _ _ _ ~ Correspondent's a-mail address: paulorrl~embargmail.com Under penalties of perjury, I deGare 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 pre rer h s any knowledge. SIGNA OF RS RESPO I • FOR FILING ETURN ~ ~ Er' ADDRESS /~ 2060 COUNTY LINE ROAD, YORK SPRINGS, PA 17372 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS 50 EAST HIGH STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 t ~ J 15056052059 REV-1500 EX Decedent's Social Security Number MARCELLA A SHUEY :196-141108 Decedent's Name: _....._... .. _; RECAPITULATION .............................................................................. 1. Real estate (Schedule A) . ............................................ 1. ............................................................................... 2. Stocks and Bonds Schedule B 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 4. Mortgages & Notes Receivable (Schedule D) ............................. 4. po P Y ( ) ........ 5. Cash, Bank De sits ~ Miscellaneous Personal Pro ert Schedule E 5. 43,122..51 6. Jointly Owned Property (Schedule F) ~;::~:~ Separate Billing Requested ....... 6. 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property (Schedule G) '~;:;::. Separate Billing Requested........ 7. 8 ; 8. Total Gross Assets (total Lines 1-7) .................................... .~ ............................................................................ 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 9,472.28 10. Debts of Decedent, Mortgage Liabilities, 8 Liens (Schedule I) ................ 10. 803.21 11. Total Deductions (total Lines 9 8 10) ................................... 11. 10,275.49 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 32,847.02 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14.: 32,847.02 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 _ 16. Amount of Line 14 taxable at lineal rate X .0 ~ 32,847.02 . 16. 1,478.12 17. ..............: Amount of Line 14 taxable at sibling rate X .12 - __,.....__..,_..._.........._ _ _..... 18. Amount of Line 14 taxable 18 at collateral rate X .15 . 19 1,478.12 19. TAX DUE ........................................................ . . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side 2 15056052059 L REV-1500 EX Page 3 Flle:Numbe.r,,,..::.:.,-....,-.._,. ., ;...... . 21 09 ::0105 Decedent's Complete Address: .........................: DECEDENTS NAME DECEDENTS SOCIAL SECURITY NUMBER MARCELLA A SHUEY 196-14-1108 STREET ADDRESS 325 WESLEY DRIVE STATE ZIP CITY MECHANICSBURG PA 17055 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) 1,478.12 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 3. Interest/Penalty if applicable 2.63 D. Interest E. Penalty Total Interest/Penalty (D + E) (3} 2.63 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4} Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1,478.12 A. Enter the interest on the tax due. (5A) 2.63 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (56) 1,480.75 Make Check Payable fo: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPR OPRIATE BLOCKS 1. Did decedent make a transfer and: Yes ^ No a. retain the use or income of the property transferred :.......................................................................................... ^ 0 b. retain the right to designate who shall use the property transferred or its income : ............................................ ^ c. retain a reversionary interest; or .......................................................................................................................... .................................... benefits or care? t h ^ .................................. s, er paymen d. receive the promise for life of eit 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 x 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. 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 o e survlving spouse is three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is zero (0) percent [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is twelve (12) percent [72 P.S. §9116(a)(1.3)]. 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. LOCAL REGISTRAR'S CERTIFIC,~4TION OF DEATH WARNING: It is illegal to duplicate this copy by photostat or photograph. ~ Fee for this certificate, $6.00 P 14810443 Certification Number Due to (a u a consepnerxre of): r d. r 30b. Were Auopsy Fxxiirgs 31. Manner of Death 32a. Daa d Injury (Month, day, year) 32b. Describe Fbw I Occurred Avaeable Prior to Completion ~ of Caws of Death? ~w ^ ~~de ^ Aatiden aEV 1t/2008 COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RECORDS PRINT IN ~KiN~ CERTIFICATE OF DEATH (See instructions and examples on reverse) STATE FILE NUMBER 1. Name d Decedent (Flrdl middle, last, sulfb~) 2. Sex 3. Social Security Number 4. Date of Death (Marro, day, year) Marcella A. Shuey Female 196 - 14 ~ 1108 November 26 2008 5. Age llasl Birthday) under 1 r under 1 b. Dale of &rm (Month, de ,year) ~. &rthplace (Cky end sate a fa corxray) ea. Place of Dsam (check one) Moose Days rave serxsee FloaFpnal: Omer 84 Yra. July 12, 1924 Philadelphia, PA ^,,,pe~nt ^ER/ Outpatient ^ DOA ®Nursirq Hans ^ Residence ^Other • Specify; t1b. County a Deem 8c. City, Beo, Twp. of Death 8d. FecWly Name (If not IrtsnNlbn, give sheet and raxnber) 9. Was Decerknt of Hispania Origin? No ^ Yea 10. Race: American Irwan, Back, VYhne, ate. ' Cumberland Lower Allen 'I~ap . Bethany Vi l la e (n yea, apedfy Cuban, g Mexican, Puerto Rkan, etc.) Whl to 11. Decedent's Usual Kind of work done moat ~ world INe. Do rat sae retired 12. Was Decedent ever in the 13. Decedents Education (Specfy only highest grade completed) 14. Marial Status: Monied, Never Married, 15. Survivl {and d Woric KIrW of Business / IMlust U.S. Armed Forces? Widowed Divorced ng Spouse (If wife, give maden name) HOmemaKer ~~ Hie ry ~ Elemenary /Secondary (0.12) College (1-a a s+) (~M ^Yes 2 Widowed 18.OecedenYsM~ Address Street, city I town, sate, zip axle) Decedents 325 Wes ley I~r . Actual Reaklence ,7a. sate PA ~' Mechanicsburg, PA 17055 17b. County Cumberland TownsMp? 18. Fenrer's Name (First, middle, ast, suN'a) 'Robert Elfreth 20a. IMonnenYa Name (type /Print) William Shuey 21 a. Merced d Dapoal,wn t cremenon ^ „ ^ Burial ^ Removal from State ~ Wa CzemeNort a t~p~ AtrNtc ^ Omer • saeaN: ~ by I~eaaf Ex.mM.°o c« Meta 23ec ary when r~rnlyirg 238. q dte non of pftyeidert a rtd avaneble at urns of dselh to t certlly caws d death. „~. I~ Yw, Decadent Lived in Lower Allen T ~P 17d. ^ No, Decedent Lived wihin Achrel Limia W Ciry / Boro 19. Mother's Name (Fkst, nAdde, maiden sarcoma) Marcella Tho son 20b. Informant's Malang Address (Sheet, cnY /town, sae, zip code) 2060 County Line Rd., York S 21b. Date a Df~silbn (Monet, der, year) 21c. Pace of oispo:dNor, (Name or certretery, aemetory a Deter pace) ~1 Yes ^No December 2 2008 Hollinger Funeral Home ~' `~'°° "t"nbef ~`~ "~"° andA`'~ ~ Fedl"'' Myers-Hamer Funeral Home .014819 L }pt me tkrre, daa end pace aaad. (signature era anal ,.,~ r y,e.,...r..,,,.,., aorta 24.28 mwt be b„ par8an who prortorxxx+s deem. 24. Time of 5 y ~ r M. f ~, „~„` 25. Praarxtced Dead '7~'( ~ CAUSE OF DEATH (Bee Inartructlons end sxunpNs) r Approximate interval: Nam 27. Part I: Eller the tifaM of eveMS - dseases, Mjuriea, a CorrrpliCenons -that dkectly posed the deaNt. DO NOT enter tertNnel everts such as cerdaC anesl , r Onset to beam rospkatory arrest, a venlrkuar flbrlNatlon witMut showing the etiology. lJat only one cause on each one. r N~~E coco'1?MMort ~re~g m r) -~ a. nn~~(~M I `1 1 r _' I Y L I V ~~~ Q 1 V i Duero (or as a conaeQue oQ. ~ Eller Bw UNDERLYNKi CAUSE (tea rasa ~g m d~wtlt~ o• Dw/to~ (or es a conaegwrx~ oQ: n ~^ ,,~ ~+ ,, y~ r ~ `C.~ I ~ ~ J ~/ 11 ~C,J V~ ~ I ~ i 30a. Was an Autopsy PeAombd? ^ Yea This is to certify that the information here given is correctly copied from an original Certificate of Death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. ~.--- DEC 110 8 Local Registrar Date Issued KIV~ ~J ~ 'VV .Itl 28. Was Case Referred to Medfrxd Examiner / Ceonar for a Reason Other than ^ Yes ~No P PA Donation? art II. Eller other 28. Did Tatracco Use Contribute b Deam? but not resdnng M the underlying cause given M PaA L [1 Yea ^ Probatrhj ^ yeB ^ ~ t ^ Pendxrg Investgetion 32d. Time of Injury 32e. Injury at Work? 32t. N TranspoAanon Injury (Specity) 32g. Location al ^ Suicide ^ Could Not be Deamrfned M ^ Yes ^ No ^ Drivx /Operate ^ Passenger ^ Pedestrian Omx - Spedty: 33e. Certifier (cAedc Doty one) 33b. S' and Tine of ration ' CerNfyMg Phy~ (Physician cerNfrng cause or deem when another pnyskaan has proraunced deem end completed nom 23) To tlu beat of my krawNrlge, death oeeurrod dw to Nb cause(s) end manner u sated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ^ - I~) ' Pf0"0Y1Ckw e~ ~Ai1eg Wtr~t ( ~+ r»ng deem and cennying ro caws of deem) 33c. Lbe a Number To tits heel of my IuawNdge, death occurred st the time, dNe, and pace, end dw to the cause(s) mM manner ae s1Med_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _, ^ • Ex.mlrter, Coroner M 0 ~ ~--~? ~ 3 3 On tM taele of exeminetlon and I a Inveetfgatbn, M my opinion, death oceurnM at the Nme, date, and place, ~d due toms cause(s) and memter ss sated_ ^ 35. Regrohar's re and District umber 36 Date F (Mon ,day, year ~ 02 ~Pa~ pv~~ - d" ~ ~ ~ ~ ~ ~ i ~ i ' i id ~~~ao~ 3 Sb i ~ni-~ dl M Q.~ cgs, PA 17372 21 d. Locaton ICIty I town, sate, zip txxie) Mt. Hollv SDri Daa Signed ( m, day, year) ^ No ^ Unkravm 29. II Female: ^ Not pregnant within peal year ^ Pregnant at time of death ^ Nol pregnant, but pregnant wimM 42 days of death ^ Not pregnant, txd pregnant 43 days l0 1 year before death ^ Unknown if pregnant wimM tlw past year 32c. Place of Injury: Flome, Fann, Street, FaGay, Oltke Building, etc. (Speciry) city I town, sate) 33d. Date Si (Monet, day, year) ~~ a~ ~~ (Item 27) Type / 'nt ,t 3)_~'1ni Pry) Diapaaitbn Parma, No. 0309040 P (~ l ~J"Q 1 ~ ~, r ~ ~+ SAIDIS SHUFF, FLOWER & LINDSAY Camp Hill, PA LAST WILL AND TESTAMENT ©F MARCELLA A. SHUEY I, MP,RCELLA A. SHUEY of the Lower Allen Township, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament, hereby revoking any will previously made by me. I. I direct the payment of all my just debts and funeral axperses --out of my ~ estate ds -socn~ as -r~tay fie" p~actica a ter my death. II. I devise and bequeath all of my estate of whatever nature and wherever situate unto my husband, Edward F. Shuey, providing he survives me by sixty (60) days. III. Should my said husband fail to be living on the sixty-first (61st} day following my death, then I devise and bequeath all of my estate of whatever nature and wherever situate as follows: A. I direct that any Ned Smith, Betty Snow or Doug Phillips prints and paintings which I still own at the time of my death shall be sold and the proceeds added to the residue of my estate. B. I bequeath certain items of my tangible personal property, not including cash and securities, in accordance with a written list made by me during my lifetime. In the absence of such a list or designation on said list, I direct that my executor hereinafter named distribute my household goods and ~~ `~ t ~ personal effects among my children in as nearly equal shares as possible, and that the remainder be sold and added to the residue of my estate. C. I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate unto my children, Robert W. Shuey, David E. Shuey and William M. Shuey. Should my son, David E. Shuey, be deceased, his interest shall be divided in equal shares among his wife, Donna Shuey, and hi s f our chi ldy en . Should my-- scn, Wi 11 iam M . Shue~r, be deceased, his interest shall pass to his wife, Gail Shuey. Should my son, Robert W. Shuey, be deceased, his share of my estate shall be distributed to his companion, Anna Church, provided that they are still cohabiting at the time of my death. IV. I appoint my husband, Edward F. Shuey, Executor of SAIDIS SHUFF, FLOWER & LINDSAY ~.~, :.,~,„C~ ~«Cr~ Camp Hill, I'A this, my Last Will and Testament. Should my said husband fail to qualify or cease to act as such, then I appoint my son, William M. Shuey. Should my son, William M. Shuey fail to qualify or cease to act as such, I then appoint my sons, David E. Shuey and Robert W. Shuey, to act in this capacity. None of my personal representatives shall be required to post bond in this or any jurisdiction. IN WITNESS WHEREOF, I have hereunto set my hand and seal on this, the - ~ ~ day of ~,~, 2002. ,t`~ _ ._-• ~" ti ~ ~ j ~ ` ~ ( SEAL - ~. Mar e l a A . ~"y ~" ` Signed, sealed, published and declared by MARCELLA A. SHUEY, therein named, on this and two (2) other sheets of paper as and for her Last Will and Testament, in our presence, who, in her presence, at her request, and in the presence of each other, have hereunto subscribed our names as attesting witnesses. SAIDIS SHUFF, FLOWER & LINDSAY ATTORtiEI'S•AT•L~11' 2109 Market Street Camp Hill, PA Name _, ~~ / ~ t ':~-' - Name 'C7r~'~Or~TEA~.:mu OF. PEN~~SYLt,7Ar~IP. COUNTY OF CUMBERLAND a~~ -~1~$ S~;C~,,~,o e P~ Addr ss ~' ~_- Address WE, the undersigned, the testatrix and the witnesses, respectively, whose names are signed to the foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the testatrix signed and executed the instrument as her Last Will and Testament and that she signed willingly (or willingly directed another to sign for her}, and that she executed it as her free will and voluntary act for the purposes therein expressed, and that each of the witnesses, in the presence and hearing of the testatrix signed the will as witnesses and that to the best of their knowledge the testatrix was at that time eighteen years of age or older, of sound mind, and under no constrain or undue influence. 1X f "~ Witness _ ,~- I_. i ,,..~~` Witness ,~ :; Subscribed, sworn to a°id acknowledged before me by the testatrix, and subscribed and sworn to before me by both witnesses, this fh day of [.GLtp,/i~l~ 2002. Notary Public Notaritt! Saal Sallie Alishouse, Notary Public ~~ Carlisle earo, Cumberlanc! Coun~y _ My Commission Expires Mar. 29. 2b04 t ~ COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND estate of MARCELLA A SH~iFv (First, Midd/e, Last/ in said county, deceased, to WILL/AM M SHUEY SHORT CERTIFICATE I , GLENDA EARNER STRA SBA UGH Register for the Probate of Wi 11 s and Granting Letters of Administration in and for CUMBERLAND County, do hereby certify that on the 2nd day of February, Two Thousand and Nine, Letters TESTAMENTARY in common form were granted by the Register of said County, on the late of LOWER ALLEN TOWNSHIP Irust, M/dd/e, Lastl and that same has not since been revoked . IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of said office a t CARLISLE, PENNSYLVANIA, this 2nd day of February Two Thousand and Nine . Fi 1 e No . 2009- 00105 PA Fi 1 e No . 21- 09- 0105 Date of Death 11/26/2008 S . S . # 196-14-1108 NOT VALID WITHOUT ORIGINAL SIGNATURE AND IMPRESSED SEAL ~ r REV-1508 EX+ (6-98) SCMEpVLE E COMMONWEALTH OF PENNSYLVANIA CASH BANK DEPOSITS & MISC. INHERITANCE TAX RETURN PERSONAL PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER MARCELLA A. SHUEY 2009-00105 t .--~ r--~ N 0 z 0 u~ a ~o ~~ z V '~ ~~ ~U a U U C/1 .~ G~ U O~ 8 N ~O N M ti ~ M c~ ~ A ~ W~ ~x u ~~ z a~ w ~ L Q ~ ~+ a d • ~~ w Z o ~ b o ~ ~ ~ S a ~ ~ a ~ ooso-5esoa ~wao a 0 ~U ~ ~' ~' o > ,~..~ = U L n ~ ~ O v Z v ~ ,~ ~ O Z m E m C~ ...., 4) ~° A W H p4 W A O U O ~~ o N a °o 0 LL W ~~.. ~s 4~`~ .. t ~- ~ ~ . o ~., : ~. ~ °~. c. a 0 rn c c m c E ~ C cn p a~ a ~" ~ 0 o ~ v~ 0 '^ aci a~i '~~ ~~~~ ~~ ~ ~ a~ 0 U U m ~ O ^®^~^ q O ~1 ~ o u o O N 00 ~ ~ ~ q,' N ~N \ .-1 co ~ b o 0 O z~ Z ` W ~N f~ Y Z zm ao m .~ 0 Q E a z z ~ ~ .: a p ~'-~ m L ~ 0 m o n`_ u N a- N A M W ~ a a vs ~ ~' z ~~ a ~ ~ U cas u ~l o D4 3 N ~ GWm-F- N rt U 4-1 O W U -~ b W O N U M ~ z Si ~'~,. ~ ~ g iW _ . ~. Q ` a~ ~ s l` ~ ~ Ft ~ ~-._ ~ F-- (~ Z g L ,~ ._ N '~ ~ ~' s `'~ V a ~ ~ '~ ~ 00 O O O "" U Y U W Q ~~ M ti ~ M O ~ ~ ~,U ~ C ~ ~ t`i~ co a N~ ~Y .o ~ y Z _~ ~ oa-m ZOO ~ m* U v ~.- Z ~ ~Ya 00 `n ~ C ~ ~"~ ~,~ C `= 0 0 o d~ ~00 VAN ~~CO ~ a~ o >'a.~.~ ~ ~' C~ ~~3'S ~,.~ t ~ t7' 3 ~ m.c ~ ~ c~ »r U ~ '}' ~ L _ .C W ~' ~ ~ rn ~' N ~ ~ M ~~~~ w Q W ~WZa W ~Jtn Q ~ ? ~ ~ ~ O ~ O J c Y I~-J_~p~ W ~ N ~ _~ c0 1'11 N O' 0 ra .a ru C~ 0 O •~ ~. ti 1 1 N ~~~ ~ ~ ~ w ~i Q ;$~ O ~ O ~a~~ .t. ~~ ~ ~ ti ~`~..~--- n. D ~- ;.~~ a ~~s~ ~^ ~~ yes N A D ~ / Z g~ ~ $ ~~ o~~~1t'~ ~ < ° ~ ~~~~~o ~ ~ ~~ ~~ ~ ~ e ~~ ;~~ ~ 90'COESE9'[0 6002/62/'[0 [9h4'[OE'[EO] ~ E ~ * ~v~irn rn M O O O.O o°d' ~~a~ O N ~ a .rte \ d' O N ood~ USN ~Mrl J30 C M~o ~~~ ° ° ~ ~ ~ ~ 0 3 ca ~ ~ N V j, Y N N >' Hcr33c~i i Q' Q' 0 ^ ..a ru 0 ti .. ~n ~. 0 ~. r'f1 0 1 ru [~- O O -. Free C~iec .king Account Statement Activity: Detail _ _ _ _ __ .:. Deposits andOther, Add'i~iOns- -- • . _ _ ., ,,, ,, .,. There:were 2 D~posits.and.Other Additions .., Date Amount Description <: _ _ _ ,, .. totaling: $1,$88.35. 01/26 ,. ,• , eposit Reference No 02,rir92032 - posit Reference No 024c-07178-- 01/23 ~ 44 00 `. , . `_~~ ~~ ,., ,/~ 1'C ~ ~ ~ ~~-11'1/ . Checks °and Substitute :Checks _ _ _ _ _ _ Check_ ::: .. :, _ ,., :Date _ :Reference Check :--.. Oate Reference.. number Amount paid number __ number iAmount Paid number . - 114.00 02/03 o852s'~e~5 3.00 02/17... - oa5G7s~o2 " Gap in check sequence _ _ _ There were 2 checks listed totaling .:,. $117.00. `.. Other. Deductions _ _ There were 2 Other Deductions totaling _ Date Amount Description $519.90. t}I f 3Q ._,.. __~.. :, ,.:,,r~Q0.00 . i:et~ep-~~ern _:~_ . __ _ .:, _. --9E1734G...._ - ..:~ _._ ,Y. <s . ~ _ - - - r. .~~, - - 02/02 .:..,.10.00 ; Retw-n Of Deposited Item -Fee ., ., _ , Free Checking Account Statement _ _ -, ~ itn. p.riod-oe/~~si~oas.ao o>r~z~~toos ,:. For 24-hour information, sign on to PNC Bank Ohline$anking - - - EST OF MARCELLA SHUEY DECD - on pnc.com.::.. ;.,, ,.:.......:. _:::. .... _... .: .. : , , ._ ,Primary account-number: 50-0357-7241.- _ _ _, . _ .. . ,.. _ _ _.. _: ._~... . r, . ,,. ..,,.-. .:.Page-2-of 2 .. ,,. ... .. _ . _' cre: its to your account or re sa to accept a : or part o t e eposrt .. , e w note a e to you or auy suc a ays ' or refusals _ rWe will.have, na obh atonao rovide_ ou with notice of an non a ,meat dishonor or rotest re ardin Y .. - _ .. ... ~Y p Y P g $ . . a items.. ~~ d,~t~d. ,#o:;Qr..c ed a ain our . ` st.... account w:. - .. _.:.: ...x, ,r..,.. ~.: ..~o: _. ... ~ . u :. ~ . FI''r~0" ~~tAC~fi~''AQCOt~it°.~t11/It11lA~ ., , ... ,. .-.. ... . , . ... _, . : ._ ., ... .Est Of-~N1arIla Shuey Decd . .. AccounYnu`mliet"`50"-0357-7211. .. T._ _.: ,.,..,.~..__ , ,.. - .. ., ..:: , . ._,: , . ". William:M.Shuey Extr _ ,. Overdraft'Prote~tion~Provided By. 'Corrtsat'IPNC tto°osttsifsRsh Ovord~aft'Protoction - • " - Balattcs. Suilrt~tiary ,. - _ .Please see the Activity-Detail section for ... .-:._ 9 . _ _: _ Be~innin 0 Checks and other _ ., ._ :additional information. - Ending _ .balance' °.. additions : ;,. ;_.. . - °'deductions .., , balance , , , -33,770.17 .. . . _ 8,225.26 _ - 10;016'.99' _:. 3:1,978:44' ,..,.. _ . _ .. ; : ..., .. . Average monthly .: tSala`nco -. ~ t LI. ~~ r N;~R ~ Charges.... __ and tees:' " _ _ ....30,108:51 16:99 -~ - _ ..~_ _,~. --_ ~. ,.. r Trainsactii~n-Summary. Y. .~; . - --~. Checks'paidl `"Check"Card"POS " Check Card/Bankcard ' withdrawals:.= signed-transactions - ROS-PIN #ransactions -- _ ,. ,: 0 -_ .. :::_ Total. ATM PNC Bank Other Bank _ - ,transactions" , ATM' Transactions ATM transactions ; Activity Detail ~ .. _ .._. - ., .: .. epositss aii~d :ether Addiilbons- , . _ : ~ " , ,_ , , ~. , ._._ .. _. „There was 1 Deposit or Other Addttton ,; _ .. _. Date_ . .Amount ;,: DQSCriptlon..: - .: :: , _. fotaling $8,,?,ZS.ZB .. _ . 07/U2 8,225.26 Deposit Reference No.. 522774316. , .:. DhealFS~ and Substtirte ,Checks - _.., Check.... .. ,Date . , ..Reference... , .. number Amount paid number ~ " - .:. , :., CheciC .: .:., , ...: .::: .. .. >.Qate _Reference .< number Amount paid number 5,000.00 06/22 o~;;ssai " ~. 7 * 5,000.00._.. 06/25 os5g~~ ,- * .Gap in check sequence There were 2 checks listed totaling ... , : ,: $10,000.00 ... ... et' edutafions, ". .....:, .. • - ..;.._ There was 1 Other Deduction totaling Date Amount : Description y $76.99. _ 07/02. 16.99 check Prinfing Fee ..; ... ,.: _ _ _.. . . ... , . , .. ..,, Dait~ .~i~n~ce Q:etaii . - _ l _ _ _ _ _.4_ _ - Date_:. Balance ,Date Balance. .,'.Date .., 06/,19 ; .:. ,3,3,770.17 .. 06/22. _::.:28,770.17 _. 06/'25, . _ - _ ~ - . 'Balance ._ ~ ~., Date: ~"' - .:. ° 8atance~~ ~` .'~~ ..: 23,770 ~7 .. , 0;7/02 31,97$.:44„ Traveling.~Ontside the United States? Stop by j~bnr local -PNC' hrancli to order foref gn currency before yon go - Convenience :- carry currency'with you for uriinediate expen$es=sucl~ ~asaax `fares tips and rileals: = Avoid delays 'ahd save' time` whertyou travel: -... - _ _ . ,, .: _ .. , :. , . . - - Having ~lvcal currency foryour-destination will gn~e you added peace-of mind. ~ -=~ .:. . Pe ~ _ .... _ .. - Com hhVe rates and no transaction fees: _ -When-you-return°wtlr~excess~:currency, PNC-can~buy ~it back-for U. S:`~•dollars~ ~ ~-.~ ~- -: Visit any. -PNC-branch for mbreinformation. Free ~hecl~ing Account Statement T~ rN ~ ~~I V~ PNC Bank r . _ _ , . - -: _Primary_ account number: 50-0357-7211. -.: For tho period 03/ZO/Z009 to 04/ZO/2009 ,Page 1.. f 2 .. 4 ,, Number of enclosures. 0 Q ..., ._,._.. __ . .:. -- - EST OF~ -~MARCEL LA- SHUEY -DECD .._. ~ For,24hour banking, and transaction or ., ~ WI Lt I~AM M` SHUEY EXTR - - ~; ., ,,,,, _ .- .. interest rate, information,,sign on to _ 20b0 COUNTY LINE RD. .. „a PNC Bank Online Banking_at pnc.com. , , _ YORK SPRINGS PA 1737-9742 For. customer service, call 1-888-PNGBANK , betweenahehoursof6AM_and,Mdnight,ET,,.:, ,, _ :.,. _ ..Para serxicio en;espaPfol, 1-866-HOLA-PNC _ , Moviiigt Please contact us at 1-888-PNC-BANK .. ., . _ __ _ ... ...:.. ~® Wnts to ,Customer Service .. .. , . . , . PO Box.609 - , . ..w.: __._._ ___ Pittsburgh PA:15230-9738 ._ .. ._ . .,, _ .. r,--- ,, ; ~--~- ... ~s~t~l r~ cam _. . _.~ ,. ,. :. .. TDD terminal 1=800=531 1648 . ... . , . _ For heazing impaired clients otily ,:.. ... Important Accoant Informafion ,:_.- . .... , .,~; ,. Amendment to the Business and Consumer Overdraft`1'rotecfion Agreement: ` _~` ~' ~ ~ ~ "" ~ ~ - .. _ ...... r _ ;~' .,.. The 'infor~natiori stated lielow sirierids certain information m'aur Btsmess' and Consumer Overdraft Protection Agreement. All' other ; . information in the agreement continues to ap l to our a ou t 'Pl p y y cc n . ease rirview the following nformahon'`atid ~fauit with yourrecords: Effective May 22 2009 ~,,.. _ _. _ _ ... . ,.;., ..- . .. -,.: Overdraft-Protection Aigreement , TI NG`ACCOUNT is a de osit account, PNC.Bank-will transfer the'exact amount.of the overdraft ~plus.applicab p le fees -from A ; ; the PROTECTTNG CCOUNT. If.the PROTECTING ACCOUNT is: a lutie of credit or credit card, PNC Bank will not make an automati transfer in amounts teas. than $50.00. . . y c _._ - - .. _. Note:. If a econd PROTECTING ACCOUNT is. a deposit account_and the first PRO,.TECTING ACCOUNT s aline of credit: or credit ard , . c , transfer amounts from the line of creditor credit card.to the PROTECTED ACCOUNT may be less, than $50..00.:. 1=ree Chednng..Account Summary . .. . _ _: , E t Of M .. , . ..~_ Account-number: 50-0357-7211 ~- _ . s arcella Shuey,Decd William M Shuey Extr BAIAIICA $YIIliMAI'y ., ,.. _, .... ,.. ,. . ._..,__ _ P(easesee,thB:Activity.Detailsection.for.. ...._. _ ____..._.. ......._. _.__.~~.-_~~~. -__.>:~...~~M. __. Beginning Deposits'and Checks and other - Ending _,_ __...__,<additiona!-iRfiormetlafr.~~_~° .:-,,. balance ., deductions balance..<. 1,052:67 33,000:00 171.25. 33,881:42...,.. _ . _ Average monthly _ . , Cha es r9 ._ .. :: , - , ,-_ ... .: -:balance ; . ,. and fees . _-vim P.'~'~~ C-rrri ~ n-~ 36 ,_, 8:06 , .:. .: 40 ,... .2; 1 Transaabon $ummairy .. Checks paid/ > Check Card 'POS Check Card/Bankcard °_ _. withdrawals signed ,transactions , ,._.... ROS. PlNaransactio_ns ..._ _: . :._ .. . ,.. _ _ 2 0 0 Total ATM _ _ .PNC Bank _. .: , Other Bank _ .,, transactions ATM transactions ............... ATM transactions - , , . . . ,_, - _ _ . ,. FORM953R-1005 ~1AK 14 ZOQB ESTATE OF EDWARD F. ~SHUEY, and :IN THE COURT OF COMMON PLEAS OF ROBERT W. SHUEY, :CUMBERLAND COUNTY, PENNSYLVANIA Co-Plaintiffs : vs. :CIVILACTION -LAW D ~~~~~~~ f, KEITH B. BURGARD, and ~ ~~ MELINDAA. BURGARD : - ~p~ ~ ~ ~~~~ ' No. 08 6713 CIVIL TERM Co-Defendant's : g Y: ______~5_______., O- AND NOW, this ~ day of ~~~ , 2009, upon consideration of the Petition for Approval of Wrongful Death and Survival Settlement, and finding that the proposed settlement is adequate to protect the interest of the estate and beneficiaries, IT IS THEREFORE ORDERED AND DECREED that payment of One Hundred Thousand Dollars ($100,000.00) in settlement of the Survival Action is APPROVED. The settlement proceeds shall be distributed as follows: TO: Estate of Edward F. Shuey, deceased, $59,853.50, for payment of any claims, debts,. inheritance taxes, and attorneys fees of the Estate, with the balance to be distributed to the beneficiaries of Decedent's Estate; TO: Estate of Marcella A. Shuey, deceased, $33,000.00 for her Beneficial interest; TO: Law OfFces of Paul Bradford Orr, $7,146.50, for legal services, and reimbursement of costs. BY THE COURT: Paul Bradford Orr, Esquire Attorney for Co-Plaintiffs Ms. Shannon E. Baker Trust Valuation Specialist David M. Smilek Claim Representative J. ~. s~ ~~. Y k ~ ~ REV-1511 EX+ (12-99) SCNEpVLE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FlLE NUMBER MARCELLA A. SHUEY 2009-00105 Debts of decedent must be reported on Schedule L ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: t' MYERS-HARNER FUNERAL HOME 3,548.00 2. ROLLING GREEN CEMETARY __ __ __ _ _ __ __ __ ___ _ _ _ __ __ __ ____ 842.50 . __ __ _ __ __ __ __ __ ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions _ _ 2,156.13 Name of Personal Representative(s) WILLIAM M. SHUEY, III Social Security Number(s)/EIN Number of Personal Representative(s) 266-32-6593 .............................. . Street Address 2060 COUNTY LINE ROAD City YORK SPRINGS StatePA Zip 17372 .................................... Year(s) Commission Paid: 2009 __ _ .............................. . 2. Attorney Fees ................ 2, 587.35 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) .................................. . __ ._ Claimant ............................... ............. .... ___ __ Street Address __ ..................... . _ __ __ City State .,.Zip _. Relationship of Claimant to Decedent 4. Probate Fees 129.00 5. Accountant's Fees 6. Tax Return Preparer's Fees _ _ __ 7~ CUMBERLAND LAW JOURNAL -ADVERTISING 75.00 8. THE SENTINEL -ADVERTISING..... _ _ _ _ _ 133.78 __ _ _ ___ __ __ ___ _ __ __ _ >. __ __ _ _ _ __ _ .__ _ _ _ __ __ TOTAL (Also enter on line 9, Recapitulation) $ 9,471.76 (If more space is needed, insert additional sheets of the same size) ` ~ ,*- ,,; 4 ~,~'' ra: Y 4 ~ ~ `. ~,.., _.:.x..Y.~. ~ ~ ~, r •~ a ' ,yam.. MYERS-HAR1vER FUNERAL HOME INC. 1903 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 717-737-9961 l.,Of..'Ai.,1.:Y O~VNF..D <1N:1) OPEKA'1.'E:D January 5, 2009 Mr. William Shuey 2060 County Line Road York Springs PA 17372-9742 Services for Marcella A. Shuey December 6, 2008 Total: Received from Insurance Company Total: Items not guaranteed under original contract: Obituary Certified Copies Cremation Container Balance Due: ~~~ ROBERT A.AARNER SUPERVISOR DUSTIN R BAKER FUNERAL DIRECTOR $ 3,238.00 - 2,343.44 $ ~$~+.~~ ~ ~~ ~~~ P~0 $ 233.00 70.00 140.00 (~~ k~ ~~l~ti~~ / / ~ 3 i~~~ , _: MYER - ~~ ~ : S HAh~NER -"~~;~~ ;, ,~ FUNERAL HOME, INC. 'nom' ~~~ Locally Owned And Operated 1903 Market Street Camp Hill, Pennsyl~~ania 17011 717-737-9961 Myers-Harner@comcast.net December 8, 2008 National Guardian Life Insurance Company 2 East Gilman Street P 0 Box 1031 Madison WI 53701-1031 Cremation with Service Cremation Container Cash Advanced Newspaper Notice/Local Certified Copies Flowers Coroner Fee Total: Fl ~~~~~ ~~ $ 333.00 90.00 100.00 25.00 1~~ ~~ 1 ~a~ Robert H. Harner Supervisor Dustin R. Baker Funeral Director $ 2,550.00 $ 140.00 $ 548.00 $ 3 ,~$~ Myers-Harner Funeral Home, Inc. 1903 MARKET STREET CAMP HILL, PENNSYLVANIA 17011 Robert H. Harner, 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 immediate burial. If we charged for embalming, we will explain why below. For the Service of C- Date of Death Charge to: ~ s~ CO ti ~.t fl t°i 1~ - L `~ ~ 7~/ Name Address Ciry St to O' A. CHARGE FOR SERVICES SELECTED: 1. PROFESSIONAL SERVICES Services of Funeral Director/Staff ........ $ ; nil Embalming ......................... $ i Other preparation of body Dressing & Cosmotology ............ $ 1 nL~- Casket Placement .................. $ ~"~ SUB-TOTAL OF PROFESSIONAL SERVICES ..... Al S ~~ Cremation urn ...................... $ (Description) Urn Vault ..........................$ (Description) r ~ $ OTHER $ TOTAL MERCHANDISE SELECTED ............ B ; l~QI~ C. SPECIAL CHARGES: Forwarding of remains to 2. FACILITIES AND SERVICES Use of facilities and services for viewing (Visitation/Wake) ........... $,~f~(~\ Use of facilities and services for funeral ceremony .................. $ Use of facilities and services for Memorial Service .................. ~ $~R~il' Use of equipment and services for graveside service ................... $ l /~G1- Other use of facilities Office Area ....................... $ ~ e~C.l. Preparation Room ................. $1nc 1 SUB-TOTAL OF FACILITIES/EQUIPMENT .... A2 ; ~- 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer remains to Funeral Home Local ............................$ 1 nC~- Hearse (Casket Coach) Local ............................ $ Flower car or floral disposition Local ............................$ .F1G ~. Lead cu/clergy car ~ Local ............................ $ ~ 1~C,) SUB-TOTAL OF AUTOMOTIVE/EQUIPMENT .. A3 ; j f~x (Funeral Home) Receiving of remains from (Funeral Home) Immediate Burial .................... $ Direct Cremation .................... $p~,~,~Q~.~iD SUB-TOTAL OF SPECIAL CHARGES ............ C $ ~.~.w~ D. CASH ADVANCED: Opening Grave ................... ...$ Newspaper Notice-Local $ CZ, Newspaper Notice-Out-of--town ..... ... $ Airfare .......................... ... $ Clergy/Mass Offering .............. ... $ ,~ Certifie Copies of the Death Cenificatc ~ # @ $~_ each .. ... $ ~~~ Flowers .......... ............... .'~ . $1t~o Vault Service Charge ............... :: . $ Organist ........................ ... $ ~_ Soloist .......................... ... $ / Altar Services ...................... .. $ Coroner Fee ...................... .. $ Too Milage ........................... ..$ SUB-TOTAL OF ADVANCES .................... D S~~ We charge you for our services in obtaining: TOTAL OF PROFESSIONAL SERVICES, (spaify cash advances that an married-upJ FACILITIES AND AUTOMOTIVE EQUIPMENT ................................ A i 11~C~ z B. CHARGE FOR MERCHANDISE SELECTED: SUMMARY OF CHARGES Casket ............................. $ A. Professional Services, Facilities and (Description) Equipment, and Automotive Equipment $ O° ...........................$ r Other Receptacle ..................... $ B. Merchandise .......................... _~ (Description) C. Special Charges ................. $ ~1Gt, D. Cash Advances . ....... $ ~~ ....................... Outer burial container ................ $ TOTAL OF ALL SECTIONS ;~ ~ (Description) PAID AT TIME OF OR PRIOR TO ARRANGEMENTS ... ,; Acknowledgement cards ............... $ -~,L BALANCE DUE ................................. ;~~ , ~ (,~~ Register book(s) .....................$ ..................... T Memory folders ..................... $ ~ Rfi~• REASON FOR EMBALMING Prayer cards ......................... $ C Temporary grave marker ............... $ ~ ~ Burial clothing ...................... $ ~ \.c.' ~ ' If any law, cemetery, or crematory requirements have required the purchase of Other clothing $ c~ , i,.~`" c~'~• any of the items listed above the law or requirement is explained below. $ ~ ~ . ~1 I I agree that I have examined the items of goods and services selected above and found them to be correct and according to the arrangements I have requested. I acknowledge receipt of a copy of this Statement of Funeral Goods and Services Selected. [represent that I have sufficient funds available for payment of the cash price for the goods and services selected. I aL~O to make payment of $ ~ it in ~_ days. I agree to be jointly and severally liable w h anyone else who signs below. A lace charge of $ / per month amounting to $ per year will be applied to the unpaid balance beginning ~_ days from the date of this agreement. I will so pay to the Funeral Director all reasonable costs paid by the Funeral Director to collect amounts I owe under this agreement. Those costs may include attorneys' fees, court costs and other costs. Any additional services or merchandise ordered or requested after the date of this agreement will be considered part of this agreeme t and t e cost thereo~f"wi~ll be reflected on the final bill or statement. ~y.~~ (Seal) ~~~~// / G ~ ~ oKJ (Pur (Seal) (Purchaser) (Licensed uneral Director) ~,~ ~ ~"~` ice' ~g +~, l~l±l rla~a .lid ~ ~+atR Pry I7!)31 A t71~FtSl~+tk7r~' ~~Jw~~~ CEMETERY INTERMENT RIGHTS, MERCHANDISE AND SERVICES PURCHASE/SECURITY AGREEMENT THIS AGREEMENT PROVIDES FOR ENDOWMENT CARE RETAIL INSTALLMENT CONTRACT ., .~ ~ . This Agreement is made this ..,!` % ~-~.,.~ da of t " ~.~ Y ~, ~~ ~ 19 ~ , ~ , by and between the understgned Seller' and ~ . r?f . ~., .~ ~;,~ .s ~ hereinafter 1 ca led the "Purchaser" a Address ~ ~ ;~, J y' ', ' ` ' ' ~`-~'^-"~1T~ r i ~ > . 7~" .L.s.. ~~."1.r.. Y-T~l; ~ ~. s ^~~ s l ~ 5 ~~~ ~ ~~ /r( .t ,. ResidenceTelephoneNo.( o"` ) ~ayTelephoneNo.(__) s"" z~ WITNESSETH THAT: The Seller agrees to sell and Purchaser agrees to buy the following described Interment Rights, Merchandise and Services. ^ Developed ^ Predeveloped ^ Lot ^ Lawn Crypt ^ Mausoleum ~iche ^ Other Description of Interment Rights: ,/', , ~ ,~' ,; „~,.~4j . .~, „`, ~ ,j b ~ ;, .~•' No. INTERMENT RIGHTS, MERCHANDISE AND SERVICES Interment Rights (inc. S ECF) S ~; Memorialization -Type ;~. , , _ Down Payment Cash ........................................................... (S ./,-'_... ;.L-:.. ;,~ ) SIZe DCalgrl Memorial Base -Type Credit For ( -- ) (S .:. : ~,~;;_ ... ~ ) Size Color (b) Total Down Payment ..................................................:. Memorial Installation![ ron Fee .............. ~ - nit ••••••••••• •• U id ' •••• (c) • npa Balance of Cash Price (Amount Financed)..... .~ i ..,a Memorial Maintenance .............................................. ........ (d) Service Charge (Finance Charge) •.. _ , Casket -Description (e) Time Balance (Total of Pa is ' ; ,; Material: Wood/Metal Gauge Y~ ) .............................: ~`~,~~ ,;.~ , • .... Other Burial Container-Type ~` ~ .: ,. ( ~ ;;, -x~ ,. ': ; (f) Time Sale Pnce .............................. $ r n.. ~ `~^.~ .............................. R Interment and Recording Fee ...... ...........1.~.r. ' ' "• ' " ............... ~. ~ .°ir i ,_ Processing Fee ................................................................ ~~ ... " ~ Other Remarks: Travel Protection Plan (see below) / f °~'~ ~~ Sales Tax .................................................... . ,,., ,. ~~ (a) Total Cash Price (Including Sales Tax) Ti'- 1 ° "•'" ` ' ~ ' The Travel Protection Plan beingpurchased hereunder is a product provided by World Access Service orporation, no y the certietery identi i above. World Access Service Corporation is not owned by or affiliated with such cemetery, and that cemetery shall have no responsibility for the performance of the services associated with the Travel Protection Plan. The Purchaser will be required to enter into a separate contract with World Access Service Corporation pertaining to Travel Protection Plan. That plan has been referenced in this Agreement and included in the purchase price above solely for the convenience of the Purchaser in making payments. ITEMIZATION OF AMOUNT FINANCED: $ shall be credited to your account with the Seller for the Interment Rights, Merchandise and Services the Seller is providing to you (this amount is equal to the Total Cash Price less your down payment, if any). ANNUAL PERCENTAGE RATE FINANCE CHARGE The dollar amount the Amouut Financed The amount of credit rovided to ou or Total of Payments The amount you wtll have id ft h d Total Sale Price The total cost of your ur- The cost of your credit credit will cost you. p y on your behalf. pa a er you ave ma e all payments as scheduled. chase on credit, including your down payment of as a yearly rate. . ,, . -,, .. ~ ~ ....,. ~, $ ;, ~ : r ~~ ~~ ~ ~ro) ~ r ~. Your payment schedule will be: Number of Pa ents Amount of Pa menu When P is Are Due Q $ Beginning n =, $ Prepayment: If you pay off.early, you will be entitled to a rebate of all or part of the Finance Charge. Security: You are giving a secunty. interest in the goods and property being purchased. Late Charges: If full payment is not made within 15 days after it is due, you will be charged $5.00 or 5% of Styilt payment, whichever is less. Other Provisions: See this Agreement for any additional information about nonpayment, default, any required repityment in full (exclusive of unearned finance charges) before the scheduled date, and prepayment rebates and penalties. If accepted by Seller, the parties hereto agree to the following terms and conditions: 1. Agreement to Pay. Having first been quoted both a Total Cash Price and a Total Sale Price for the items described above, and for value received, the undersigned Purchaser, jointly and severally, if more than one, promises to pay to the order of Seller, at its address shown below, the amount identified above as the Total of Payments in accordance with the payment schedule dates set out above. 2. Title. Seller will retain title to said Interment Rights and Merchandise until the Total Sale Price has been paid by Purchaser to Seller. 3. Cemetery Rules sad Regulatioea. Purchaser agrees that all rights conveyed under this Agreement are subject to, and Purchaser agrees to at all times comply with, the present (and as may be hereafter adopted, amended or altered) Rules, Regulations and Bylaws of Seller, which are available for examination in Seller's office. 4. Prepayment. Upon prepayment in full, whether voluntarily or upon acceleration by reason of Purchaser's default and payment in full or judgment being entered against Purchaser for the unpaid balance, Purchaser shall receive a rebate of any unearned Finance Charge computed in accordance with the "Actuarial Method". If the Total Sale Price is paid within 12 months of the date of this Agreement, or oa or before its maturity if it matures is less than 12 months, Pnrchaser will be entitled to a full rebate of say Fiaaace Charge. 5. Interment sad Recording Fee. Unless otherwise specifically provided herein, a charge for opening and closing the interment space and applicable cemetery document recording (herein referred to as "Interment and Recording Fee"), is not included in the Total Cash Price set forth herein, and there will be an added charge for this service at the time of need. If the Interment and Recording Fee is purchased hereunder, the payment of such Interment and Recording Fee entitles the Purchaser to protection against overtime charges which would otherwise apply if interment were to be necessary on a weekend, holiday or after normal working hours. If the prevailing price for Interment and Recording at the time of interment is less than the fees paid for such services under this Agreement, you will be refunded the difference. 6. Issuance otCertificate of Interment Rigtita. Upon payment of the Total Sale Price by the Purchaser, the Seller agrees to convey the above-described Interment Rights by issuance of a Certificate of Interment Rights to the person(s) designated below: NAME ~' !! r.'- ; ~' _ ~ j • ~ . ,~, ADDRESS „ -~ ; ~ r !~ ~ , ~- "This contract includes O.T.F.A. (Over Time Fletdbility Assurartce) b ~ ,~ _, . No additional charge for weekday overtime or weekend overtime CITY ,~' ~ ~ ~ , •,~` ; . x ~`.' ~i < interment services" NEXT OF KIN ••~ 'Within rtormal published overtime parameters • ~ ~~ . Notice to the Buyer - (1) Do not sign this Agreement before you read it or if it contains any blank spaces. (2) You are entitled to a completely Rlled-in copy of this Agreement. (3) Under the law, you have the right to pay off to advance the full amount due and under certain conditions to obtain a partial refund of the Service Charge. NOTICE: BY SIGNING THIS AGREEMENT, PURCHASER IS AGREEING THAT ANY CLAIM PURCHASER MAY HAVE AGAINST THE SELLER SHALL BE RESOLVED BY ARBITRATION AND PURCHASER IS GIVING UP HIS/I~R RIGHT TO A COURT OR JURY TRIAL AS WELL AS HIS/IIER RIGHT OF APPEAL. Buyer Hereby Acknowledges That This Agreement Was Comppleted As To All Essential Provisions Before It Was Signed By Buyer And A Copy Thereof Was Delivered To Buyer At The Time Thia Agreement Was Signed. } ~ 1 J~~~R'AND ti MAR 1 0 2009 BY.._.. ~~ S ~,~,A~ CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249166 Fax: (71 ~ 249-2663 March 6, 2009 RE: 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. TO: Paul Bradford Orr, Esquire Marcella A. Shuey Estate 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: February 20, February 27 and March 6, 2009 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by PROOF OF PUBLICATION OF NOTICE IN CUMBERLAND LAW JOURNAL (Under Act No. 587, approved May 16, 1929), P. L.1784 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss. Lisa Marie Coyne, Esquire, Editor of the Cumberland Law Journal, of the County and State aforesaid, being duly sworn, according to law, deposes and says that the Cumberland Law Journal, a legal periodical published in the Borough of Carlisle in the County and State aforesaid, was established January 2, 1952, and designated by the local courts as the official legal periodical for the publication of all legal notices, and has, since January 2, 1952, been regularly issued weekly in the said County, and that the printed notice or publication attached hereto is exactly the same as was printed in the regular editions and issues of the said Cumberland Law Journal on the following dates, V1Z: February 20, February 27 and March 6, 2009 Affiant further deposes that he is authorized to verify this statement by the Cumberland Law Journal, a legal periodical of general circulation, and that he is not interested in the subject matter of the aforesaid notice or advertisement, and that all allegations in the foregoing statements as to time, place and character of publication are true. ~--~- lsa Marie Coyne, Ed' or SWORN TO AND SUBSCRIBED before me this 6 day of March, 2009 8huey, ~tareeila A., deed. Late of Lower Allen Township. Executor: William M. Shuey, 2060 County Line Rd., York Springs, PA 17372. Attorney: Paul Bradford Orr, Es- quire, 50 East High Street, Car- lisle, PA 17013. Notary NOTARIAL SEAL. DEBORAH A COLLINS Notary Public CARLISLE BORO, CUh9BERLAND COUNTY My Commission Expires Apr 28, ~Ol p ~ ~ 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): February 14, 2009, February 21, 2009 and February 28,2009 COPY OF NOTICE OF PUBLICATION ., 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. Sworn to and subscribed before me this o~n~ `~ ~aDpl Notary Public My commission expires: COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL BAMBI ANN HECKEN~ORN; Notary Public Camp HiU Boro., Cumberland County ~~~~ ~'~~: ~~~~asinn Expires January 27, 2Q1~ i._._ ........,._ - - .. _. s (° s~ a O N U t,--t; - ~ . ~ N O ~ o ~ ~~:~ ~ ~ O ~ , U '~ . ~ # \ ~ ~ ~:: ~ ~: ~ ~ ~ ft~ ~ b ( -e~ ~ r-I ~ ~ ~ o N a N R~~ l -=.J ~ :; ~ ~ c o o~ RS ~-I • ~ ~ i~-i RS N z th C ~ ~ -~ ~- ~ `- N r S ~ i ° L = ~! i R R r-~I cd Q ~ acn ~ U ~ ~` ~ ~ a~ ao O ~ O o~ ~, ap '` ~ H td ~ N b -~ to ° a ~ ~ ~ ~ i ~ ~ ~ a b a ~ a~ p a ~ , + N -~ ~ ~ z ~ *'i W N N O ~ ~ ''d ~ a to ~ z ~ ~ N ~ G4 m c~1 O ~ C , , r RS O b a ~ •-1 N ~ U Z ~.~ Otl~rd A -~ ~ ~o a a z ~~~ ~ ~`~~ a 3 a o ~ ~ U ~ ~ O i a ~~a~~ a ~ Z ~ ~ ~°'~a o~ ~ ~ + ~ ~ ~ z ~ Z ~ ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ •. c~ to ~ ~ a ~ H L ~ - a -~ b ~ ~ ~ E' ° ~ a ' i ~aw ~ b~ O n~'~ M z H ~ r ° U ~ -~-~ ~~~~ Ned Mb~ ~ H a H 3 ~-I N ~ f~ aCl~ M ~ ~-I ~ ~+ bl ~ r-I .. ~ to t~ ~M ~ N tV a pa ~ F' ~ O H ~ ~ - ~ ~ ~ ~ -~ O~ ~~ ~ H (~ a c 11 - ~ O ~ .~.~ ~ O ~ ~~ a H ~ o ~ a ~ ~ o ~ H ~ ~ ow~z a `~ ~~"~ ~a ~ g ~~ a ~ ~ cu rd ~ ra N ~~ubi'~ ~ ~i tr~ o a a~ MHO a v r~ -~ a~ ~ ~ ~ ~ ~ zo H H H cn ~ ~b gab ~ b ~H~ ~, ~O OZ+ W ~ w O ~ ~ 4O-I 4O~IilltAf~ ~~ G}tl~Tf "~~ ccd' ~p,~ p~,a~ w o ~ N~-~It~l2 f~N ~fdN x ~ ~~ E ~M~1o t"IEi a W ~ a ~, ~ a ~~r ~ ~~ ~ N ; o cc Jl t~ m ~ a ` y ~ ~ b~~3 ~+UI ~Ufv1d a a a cn M o H ASH-~ HU w~+a ~ i RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse S uare Carlisle, PA 1713 SHUEY MARCELLA A Estate File No.: 2009-00105 Paid B~ Remarks: PNC BANK AJW ------------------- Fee/Tax Description PETITION LTRS TEST WILL SHORT CERTIFICATE JCP FEE AUTOMATION FEE Check## O1 Total Received......... Receipt Date: 2/02/2009 Receipt Time: 14:12:56 Receipt No.: 1055584 Receipt Distribution ----- -------- -------- --- Payment Amount Payee Name 60.00 CUMBERLAND COUNTY GENERAL FUN 15.00 CUMBERLAND COUNTY GENERAL FUN 24.00 CUMBERLAND COUNTY GENERAL FUN 10.00 BUREAU OF RECEIPTS & CNTR M.D 5.00 ---------------- CUMBERLAND COUNTY GENERAL FUN $114.00 $114.00 ~ i ::~ ~ ~~~>~ pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES 8E LIENS ESTATE OF FILE NUMBER MARCELLA A. SHUEY 2009-00105 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' U-HAUL STORAGE (MECHANICSBURG) 320.03 2. CHASE CARD SERVICES (PAY-OFF ACCOUNT 4417129136111255} 480.18 3. PA DEPARTMENT OF REVENUE (2008 TAX) 3.00 TOTAL (Also enter on Line 10, Recapitulation) ~ 803.21 If more space is needed, insert additional sheets of the same size. Interest Checking Accotult Statement ~ PNCBANK For 24-hour information, sign on to PNC Bank Online Banking on pnc.com. For the period 1?J05/Z008 to 01/06/2009 MARCELLA SHUEY Primary account number: 51-4005-7933 Page 3 of 3 Check Images ` EDWARD F. SHUEY ~ ,.:,,; •1 .' S`2~6 MARCELLA A. SHUEY ' 411Ci0 COUKfY LINE IiD ~~ - ' My Edtt7vl~ ~ YARK SPRIN69, NA t7Jtt /~ Ooto._..~~-~a~-~ G Ptp- en the ~'' /,t c. , r_ luc3_rc+~ S+ E`V .• C ~_ 1~ .v yt7 d / 6' Order v(_ ~..L n i eryr ~1 c~f+1Qreu ~ C ~ ~ ~-~- ~ ~ . OOA4tt5 B 1~~•• r PN CB1~NK `~' `N j : ~:-, r ~ ~ -_~.:-; r: ~ ~ c~ ~~ ~_ c~ r <- ~ . ~; i l r) ~ P:? U i~ l_= 1 5i !ir' Ia =' I ' VM' Din\, NA ~' for_ yyry,~'~/sG///:Z .SJ_%Y_ ~.~ff~~ ~ .r ' 1:03L31273BE: S140U57933~' •32LE .t'0 004ffOiB.~' , 321G $480.18 01/02/2009 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 additional options. FORM953R-1005 'i 1~ • `:~~~~~~~~~~ pennsylvania SCHEDULE DEPARTMENT OF REVENUE INHERITANCE TAX RETURN BENEFICIARIES RESIDENT DECEDENT ESTATE OF FILE NUMBER MARCELLA A. SHUEY 2009-00105 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a} (1.2}.] 1. ROBERT SHUEY, 325 WESLEY DRIVE, MECHANICSBURG, PA 17055 SON 1/3 __ __ 2. DAVID E. SHUEY,1547 MILL RACE LANE, WEST CHESTER, PA 19380 SON 1/3 3. WILLIAM A. SHUEY,2060 COUNTYLINE RD,YORK SPRINGS, PA 17372 SON 1/3 __ ___ _ _ __ __ __ __ ............... __ __ __ 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 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1. 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. ~~ ~ ~ ~-5.0~ ~d~o.c~ ~'~