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HomeMy WebLinkAbout03-0992.STATUS REPORT UNDER RULE 6.12 Name of Decedent- FRANKLIN . HAFFER Date of Death' 9/9/2003 Will No. 2003-00992 Admin. No. Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate- State whether administration of the estate is complete- Yes × No . 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete · 3. If the answer to No. 1 is Yes, state the following: a. Did the personal representative file a final account with the Court ? Yes No b. The separate Orphans' Court No. (if any) for the personal representative's account is' c. Did the personal representative state an account informally to the parties in interest ? Yes X No d. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. Date · 11/1/2004 Signature Susan E. Lederer. Esq. Name (Please type or print ) 4811 donestown Rd, Suite 226 _.Harrisburq PA Address 17109 ,(717 ) 652-7323 Tel. No. Capacity · Personal Representative Counsel for personal representative PETITION FOR PROBATE and GRANT OF LETTERS Estateof Franklin C. Shaffer No. also known as To: Register of Wills for the · Deceased. County of Cumberlan~t Commonwealth of Pennsylvania Social Security No. 716-09-6148 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the executOr, Jeffery L. Shaffer in the last will of the above decedent, dated April 15, 1996 and codicil(s) dated June 6, 2003 in the named (state relevant cimumstances, e.g. renunciation, death of executor, etc.) Decedent was domiciled at death in Cumberland County, Pennsylvania, with h is last family or principal residence at 1000 Claremont Road. Middlesex Township, C~rlisIg, Cumberland CQ~ln~(1 PA 17013 (list street, number and municipality) Decedent, then 86 years of age, died 9/9/2003 at Middlesex Township, Carlisle, Cumberland, Counht, PA Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never ajudicated incompetent: Decedent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property (If not domiciled in Pa.) Personal property in Pennsylvania (If not domiciled in Pa.) Personal property in County Value of real estate in Pennsylvania situated as follows: 12,000.00 .WHEREFORE, petitioner(s) respectfully request(s) the probate of the last will and codicil(s) presented herewith and the grant of letters testam,ntarV thereon. (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) 1250 Bower Road Sherman, Dale PA 17090 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA COUNTY OF Cumber'l,n~.~ SS The petitioner(s) above-nar.~ed swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and~ly admin~ter thq estate according to law. to or affirmed and subscribed Sworn \before me thisc2~,ffa_.~.~ day of L /~ ~ ~ ' ~ ~ ~7 Estate of Franklin C. Shaffer , Deceased DECREE OF PROBATE AND GRANT OF LETTERS ANDNOW ~_~.~r,4',,,~,.,~ ,,D~. ,.~::~ , in consideration ofthe petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated Aoril 15.1996 and June 6, described therein be admitted to probate and filed of record as the last will of Franklin ¢. Sh0ffer and Letters TestamentOry are hereby granted to FEES .~o~te, Letters, Etc ..... ~..~1 .... Certificates ( ) . ~;nk'u~c~a~on.. TOTAL Filed ........................ Susan E. Lederer 44861 ATTORNEY (Sup. Ct. I.D. No.) 4811 Jonestown Road, Suite 226 Harrisburq PA 17109 ADDRESS 717-652-7323 PHONE 105.805 REX,; 9/86 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. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 Ix)cai Registrar P S 5 0 7 4 8 0 S£P 1 0 2003 No. ~ Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH 4' CI~.~RO.~POFDEATH FACL~NAME Itno ,,~ on es eela~ln~¢, I -' Cumberland Middlesex Claremont Nursing &. Rehab DECE~m'S USUAL ~CUp~DN " } Il. [,o. Whl te o--,,~,,, ....... ~,., IBethlehehem Steel ...El .~ I--"'~gl~.~ ' ,,~ "'~'L,%~,%V ...................... 1"~' b,. J,,12 ' I,,. married Relen C. Copp 749 Montour Rd ,c~u,t ,,,.s,,. Pa. Loysville, Pa. 17047 ........ ~ ,, ,~.co~.,__Cumberland 'FATHER'S NAME (F~sL ,adle. LaSl ,,. Raymon~ ~haffer Helen C. Shaffer MOTHER'S NAME ~F,,~l M,ddle. Ma*Oefl Surname) .Clly/t3o~ I,,.Hazel Reneker J,7~.49 Montour Rd. Loysville, Da. 17047 ~,~-12-03 /St. Johns Cemetery J ampden Twp. Cumb. Co · I,,c. . 1,,.. Pa ~,,.011248 L ~usselman F H & C S Inc 324 Hu , · - T ..... A~ n= · · - mmel To the heel ct my knowledge, death occurred due Io Ih, causeis) and manner as staled ..... " ~ 2.3~. ..................... [] FIRST CODICIL TO THE WILL OF FRANKLIN C. SHAFFER I, FRANKLIN C. SHAFFER, of 749 Montour Road, Loysville, Perry County, Pennsylvania, declare this to be a first codicil to my will dated April 15, 1996. FIRST: I revoke Article One, Section 2 of my will and substitute therefore the following new Section 2: Section 2. Children a. The name(s) and birth date(s) of my children: Birth date DARRYL FRANKLIN SHAFFER JEFFREY LYNN SHAFFER February 5, 1941 August 2, 1955 All references to my children in this instrument are to these children. I have made no provision in this agreement for my son, THOMAS CHRISTIAN BOUGHTER a/k/a THOMAS CHRISTIAN SHAFFER, his issue, or heirs, not because of any lack of affection or regard, but solely for the reason that I feel is otherwise well provided for. I have made no provision in this agreement for the issue and heirs of my deceased child, FREDERICK BOUGHTER. I voluntarily relinquished my parental rights to said child, and he was adopted by his stepfather during his lifetime. Therefore, the issue and heirs of FREDERICK BOUGHTER are not legally entitled to inherit from me and it is my specific intent not to include them as beneficiaries. SECOND: I revoke Article Two, Section 1 of my will and substitute therefore the following new Section 1: Section 1. Nomination of My Personal Representatives I appoint the following to be my Personal Representative: JEFFREY LYNN SHAFFER If for any reason the Personal Representative(s) named above are unable or unwilling to serve, the following successor Personal Representative(s) shall serve until the successor Personal Representative(s) on the list have been exhausted. Unless otherwise specified if Co-Personal Representatives are serving, the next following named successor Personal Representative shall serve only after all of the Co-Personal Representatives cease to act as Personal Representatives. RHONDA E. SHAFFER THIRD: In all other respects, I confirm and republish my will dated April 15, 1996. I signed this first codicil to my will on June 6, 2003. FRANKLIN C. SHAFFER~ / On the date last above written, we saw FRANKLIN C. SHAFFER, in our presence, sign the foregoing instrument at its end. He then declared it to be a First Codicil to his will and requested us to act as witnesses to it. We then, in his presence and in the presence of each other, signed our names as attesting witnesses, believing him at all times herein mentioned to be of sound mind and memory and not acting under constraint of any kind. COMMONWEALTH OF PENNSYLVANIA) ) COUNTY OF DAUPHIN ) We, ~ 5, I ~:~.q£o~'~ and ~¢ [/tA -'~", ~I-~{C[ , the witnesses whose names are signed to the attached or foregoing ]instrument, being duly qualified according to law do depose and say that we were present and saw the Testator sign and execute the instrument as a codicil to his Last Will; that the Testator signed willingly and executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the will as a witness; and that to the best of our knowledge the Testator was at that time eighteen or more years of age, of sound mind and under no constraint or undue influence. I, FRANKLIN C. SHAFFER, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as a codicil to my Last Will; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. FRANKLIN C. SHAFFER,'Test~ Subscribed and sworn to and acknowledged before me by FRANKLIN C. SHAFFER, the Testator, and subscribed and sworn to before me by ~c',D.c-~kth ~-. ~0~('q._( and \x,j '-~'-, O£eec~ , witnesses, on June 6, 2003. I ' Notar~ Public Notafinl Seal . [ mnay s. ~a~r, ~_ota7 },u_b]ic t I Lower ISaxton Twp., Dauphin coun_t~t_ I ~, Commissio~ ~.,,pi~ At~. ts, ~ ] Last Will of FRANKLIN C. SHAFFER I, FRANKLIN C. SHAFFER, a resident of Perry County, Pennsylvania, declare that this is my will. I hereby revoke all my previous wills and codicils. Article One Introductory Provisions Section 1. Marital Status I am currently married to HELEN C. SHAFFER, and all references to my spouse in this will are to her. Section 2. Children a. The name(s) and birth date(s) of my children: Name Birth date DARRYL FRANKLIN SHAFFER JEFFREY LYNN SHAFFER February 5, 1941 August 2, 1955 All references to my children in this instrument are to these children and any children subsequently born to or adopted by me. I have made no provision in this agreement for my son, THOMAS CHRISTIAN BOUGHTER a/k/a THOMAS CHRISTIAN SHAFFER, his issue, or heirs, not because of any lack of affection or regard, but solely for the reason that I feel is otherwise well provided for. Article Two Appointment of My Personal Representatives Section 1. Nomination of My Personal Representatives I appoint the following to be my Personal Representative: HELEN C. SHAFFER If for any reason the Personal Representative(s) named above are unable or unwilling to serve, the following successor Personal Representative(s) shall serve until the successor Personal Representative(s) on the list have been exhausted. Unless otherwise specified if Co-Personal Representatives are serving, the next following named successor Personal Representative shall serve only after all of the Co-Personal Representatives cease to act as Personal Representatives. (1) JEFFREY LYNN SHAFFER; THEN (2) RHONDA B. SHAFFER Section 2. Waiver of Bond No bond or undertaking shall be required of any Personal Representative nominated in my will. Section 3. General Powers My Personal Representative shall have full authority to administer my estate under the laws of the Commonwealth of Pennsylvania relating to the powers of fiduciaries. My Personal Representative shall have the power to administer my estate under the Pennsylvania Probate, Estates and Fiduciaries Code. 2 Article Three Disposition of My Property Section 1. Distribution to My Revocable Living Trust I give all of my property of whatever nature and kind and wherever located to my revocable living trust of which I am the Trustor known as: FRANKLIN C. SHAFFER and HELEN C. SHAFFER, Trustees, or their successors in trust, under the FRANKLIN C. SHAFFER LIVING TRUST dated APR 1 5 1996 and any amendments thereto Section 2. Alternate Disposition If my revocable living trust is not in effect for any reason, I give all of my property to my Personal Representative under this will as Trustee who shall hold, administer and distribute my property as a testamentary trust the provisions of which are identical to those of my revocable living trust on the date of execution of my will. Article Four Death Taxes Section 1. Definition of Death Taxes The term "death taxes" as used in my will shall mean all inheritance, estate, succession and other similar taxes that are payable by any person on account of that person's interest in the estate of the decedent or by reason of the decedent's death including penalties and interest but excluding the following: ao Any addition to the federal estate tax for any "excess retirement accumulation" under Internal Revenue Code Section 4980A. 3 Any additional tax that may be assessed under Internal Revenue Code Section 2032A. Any federal or state tax imposed on a generation-skipping transfer as that term is defined in the federal tax laws unless the applicable tax statutes provide that the generation-skipping transfer tax is payable directly out of the assets of my gross estate. Section 2. Payment of Death Taxes Pursuant to the terms of my revocable living trust all death taxes whether or not attributable to property inventoried in my probate estate shall be paid by the Trustee from that trust. However, if that trust does not exist at the time of my death or if the assets of that trust are insufficient to pay the death taxes in full, I direct my personal representative to pay any death taxes that cannot be paid by the trustee from the assets of my probate estate by prorating and apportioning those taxes among the beneficiaries of this will. Notwithstanding any other provision in my trust all death taxes incurred by reason of assets transferred outside of my trust or probate estate shall be assessed against those persons receiving such property. Article Five General Provisions Section 1. No Contest Clause If any person or entity other than me singularly or in conjunction with any other person or entity directly or indirectly contests in any court the validity of this will including any codicils thereto the right of that person or entity to take any interest in my estate shall cease and that person or entity shall be deemed to have predeceased me. Section 2. Captions The captions of Articles, Sections and Paragraphs used in this will are for convenience of reference only and shall have no significance in the construction or interpretation of this will. 4 Section 3. Severability Should any of the provisions of my will be for any reason declared invalid such invalidity shall not affect any of the other provisions of this will, and all invalid provisions shall be wholly disregarded in interpreting this will. Section 4. Governing Law This will shall be construed, regulated and governed by and in accordance with the laws of the Commonwealth of Pennsylvania. I signed this, my last will, on /~PR 1 5 ~99~ . FRANKLIN C. SHAFFER' -' / ~/ COMMONWEALTH OF PENNSYLVANIA · SS: COUNTY OF DAUPHIN · We, FRANKLIN C. SHAFFER, ~t,~a... 7~/'4&-- , and (.....~:~lSq L-.~'~,.o3:, the Testator and the witnesses, respectively, whose names are signed to the foregoing Will, having been sworn, declared to the undersigned officer that the Testator, in the presence of witnesses, signed the instrument as his last Will, that he signed, and that each of the witnesses, in the presence of the Testator and in the presence of each other, signed the Will as a witness. FRANKLIN C. SHAFFER ~'Y' -'WTTNESS, / WITNESS Subscribed and sworn before me by ~ /J~ z ~4 r-y~ and ,~, r9'¢' /'~ , 19 Notary Public My commission expires: __~KLIN C. SHAFFER, , the Testator, and by the witnesses on 7 The foregoing Will was, on the day and year written above, published and declared by FRANKLIN C. SHAFFER in our presence to be his Will. We, in his presence and at his request, and in the presence of each other, have attested the same and have signed our names as attesting witnesses. We declare that at the time of our attestation of this Will, FRANKLIN C. SHAFFER was, according to our best knowledge and belief, of sound mind and memory and under no undue duress or constraint. ~"WITNES, g/ Address: Address: 6 LAW OFFICE JAMES, SMITH & DURKIN P. O. BOX 650 HERSHEY, PENNSYLVA'NIA 17033-0650 November 28, 2003 Register of Wills Cumberland County Enclosed is the filing fee ($100.50) for the Will and Codicil of Franklin C. Shaffer. Also included is pre-payment for the State inheritance tax for the same. Please provide receipts for both. 1250 Bower Road Shermansdale, Pa 17090 717-582-8457 Jeff & Rhonda Shaffer 1250 Bower Rd Sherrnans Dale, PA 17090 7001 2510 0007 '?899 0000 170J3 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD REV-1162 EX(11-96) 003296 SHAFFER JEFFREY L 1250 BOWER ROAD SHREMANSDALE, PA 17090 ........ fold ESTATE INFORMATION: SSN: 716-09-6148 FILE NUMBER: 2103-0992 DECEDENT NAME: SHAFFER FRANKLIN C DATE OF PAYMENT: 12/02/2003 POSTMARK DATE: 11/28/2003 COUNTY: CUMBERLAND DATE OF DEATH: 09/09/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 97,190.00 TOTAL AMOUNT PAID: $7,190.00 REMARKS: JEFFREY LSHAFFER SEAL CHECK#104 INITIALS: AC RECEIVED BY' DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS Court of Common Pleas, Cumberland County, Pennsylvania CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Franklin C. Shaffer Date of Death: 9/9/2003 Will No. 2003-00992 Admin. No. 21-03-0992 To the Register: I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on 4/6//'O L~ ' Name Address Helen C. Shaffer 749 Montour Road, Loysville PA 17047 Jeffrey L. Shaffer 1250 Bower Road, Shermans Dale PA 17090 Notice has now been given to all persons entitled thereto under Rule 5.6(a) except: Date: Signature Name: Susan E. Lederer, Esq. Address: 4811 Jonestown Road, Suite 226 Harrisburg PA 17109 Telephone(717) 652- 7323 Capacity: X Personal Representative Counsel for Personal Representative June 2, 2004 Register of Wills Cumberland County Courthouse 1 Courthouse Square Carlisle, PA 17013 FRANKLIN C. SHAFFER SOCIAL SECURITY NO. 716-09-6148 FILE NO.: 2003-00992 To Whom It May Concern: Enclosed for filing with your office is one (1) completed Form REV-1500, in duplicate, together with the following attachments for the above decedent: 1. Check for Remaining Inheritance Tax due ($1.69); 2. Check for Filing Fee ($25.00); 3. Copy of the Last Will of Franklin C. Shaffer; 4. Copy of the First Codicil to the Will of Franklin C. Shaffer; 5. Copy of the Franklin C. Shaffer Living Trust; 6. Copy of the First Amendment and Restatement to the Franklin C. Shaffer Living Trust; 7. Copy of the Second Amendment to the Franklin C. Shaffer Living Trust; 8. Date of Death Valuation Letters; and, 9. Copy of IRS Form 706. Also enclosed for filing with your office is one (1) original Inventory for the above referenced Estate. Please advise if any additional fees or expenses are due with regard to this matter. One (1) additional photocopy of the front-page of the completed REV-1500 form and one (1) additional photocopy of the front-page of the completed Inventory for the Estate has been provided. Please time/date stamp these copies as received and return them to me in the envelope provided. 4811 JonestownRoad · Suite226 · Harrisburg~PA 17109 · Phone717.652.7323 · Fax 717.652.7340 · susan@ledererlaw.com www.ledererlaw, com Franklin C. Shaffer Social Security No. 716-09-6148 File No. 2003-00992 Page 2 of 2 If there are any questions or further requirements regarding this retum, please do not hesitate to contact me. Sincerely, Susan E. Lederer, Esquire Enclosures REV * 1500 EX + (6-00) COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 28O6O1 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FILE NUMBER 21 03 0992 COUNTY CODE YEAR NUMBER DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Shaffer, Franklin C 716-09-6148 ~ DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM-DD-YEAR) ~m THIS RETURN MUST BE FILED IN DUPLICATE WITH THE ~' 09/09/2003 04/21/1917 REGISTER OF WILLS uJ IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER Shaffer, Helen C 187-16-4844 ~:oo [] 1. Odginal Retum [] 2. Supplemental Return [] 4. Limited Estate [] 4a. Future Interest Compromise (date of death after 12-12-82) [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach of Will) copy of Trust) [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between ] 3. Remainder Return (date of death pdor to 12-13-82) [] 5. Federal Estate Tax Return Required 8. Total Number of Safe Deposit Boxes [] 11.Election to tax under Sec. 9113(A) (Attach Sch O) ',lAME Susan E. Lederer :IRM NAME (If applicable) Law Offices of Susan E. Lederer tELEPHONE NUMBER 717/652-7323 COMPLETE MAILING ADDRESS 4811 Jonestown Rd. Suite 226 Harrisburg, PA 17109 1. Real Estate (Schedule A) (1) None 14,883.04 None None None None 456,050.26 16,711.49 894.97 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) 4. Mortgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) (Schedule E) 6. Jointly Owned Property (Schedule F) (6) [] Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 11) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 0~ FiC!Ai.. USE ONlY (8) 470,933.30 17,606.46 453,326.84 283,205.70 170,121.14 (11) (12) (13) (14) SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, l, 896.44 x .00 or transfers under Sec. 9116(a)(1.2) 16. Amount of Line 14 taxable at lineal rate 168,224.70 x .045 17.Amount of Line 14 taxable at sibling rate x ,12 18. Amount of Line 14 taxable at collateral rate x .15 19. Tax Due 20. [] (15) 0.00 (16) 7,570.11 (17) (18) (19) 7,570.1 I Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev, 6-00) Decedent's Complete Address: ISTREET ADDRESS . 749 Montour Road ICITY Loysville STATE PA ZIP 17047 Tax Payments and Credits: 1. Tax Due (Page I Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Interest/Penalty if applicable D. Interest E. Penalty 7,190.00 378.42 Total Credits (A + B + C) (2) Total Interest/Penalty (D + E) (3) If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (1) 7,570.1 I 7,568.42 0.00 1.69 1.69 (4) (5) (5A) (5B) Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retaintheuseorincomeofthepropertytransferred; .................................................................................. ~ ~ b. retain the right to designate who shall use the property transferred or its income; .................................... c. retain a reversionary interest; or ............. .... IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. d. receive the promise for life of either payments, benefits or care? .............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ............ ~ .......................................................................................................... [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ......... [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ...................................................................................................................... [] Under penalties of pedury, 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 el preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLF--,~FOP..,,FILING RETURN ADDRESS SI~~,PI~RSOI~ESPO'~JSIBL~ FOR FILING RETURN SIGN.~TURE OF PREPARE~-OTHE'~I-~N~EPRESENTATiVE ADORESS Susan E. Lederer DATE Shermans Dale, PA 17090 ADDRESS 4811 Jonestown Rd. Suite 226 Harrisburg, PA 17109 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 3% [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 0% [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 0% [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 4.5%, 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 12% [72 P.S..§9116 (a) (1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. (~OMM~)NWEALTH OF PENNSYLVANIA I~HERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF Shaffer, Franklin C FILE NUMBER 21 - 03 - 0992 This schedule must be completed and filed if the answer to any of questions I througt 4 on page 2 es. DESCRIPTION OF PROPERTY ITEM Include the name of the transferee, their relationship to decedent and the date of transfer. DATE OF DEATH % OF NUMBER Attach a copy of the deed for real estate. ~/ALUE OF ASSET DECD'S EXCLUSION TAXABLE VALUE (IF APPLICABLE INTEREST 1 Real Estate located at 749 Montour Road, Tyrone 270,805.50 50% 3,000.0C 132,402.75 Township, Perry County, Pennsylvania titled in the name of Franklin C. Shaffer and Helen C. Shaffer, Trustees or their successors in trust under the Franklin C. Shaffer Living Trust dated April 15, 1996, and any amendments thereto and Helen C. Shaffer and Franklin C. Shaffer, Trustees, or their successors in trust under the Helen C. Shaffer Living Trust dated April 15, 1996, and any amendments thereto, as Tenants in Common. Said real estate was transferred to Jeffrey L. Shaffer on June 6, 2003. A copy of the deed is attached. (tax assessed value 257,910 x common level ratio 1.5) 2 Real Estate located at 203 Mountain Avenue,McHenry 38,821.95 100% 3,000.00 35,821.95 Township, Lycoming County, Pennsylvania, titled in the name of Franklin C. Shaffer and Helen C. Shaffer, Trustees, or their successors in trust, under the Franklin C. Shaffer Living Trust dated April 15, 1996, and any amendments thereto. Said real estate was tranferred to Darryl F. Shaffer on June 6, 2003. A copy of the deed is attached. (tax assessed value 26,055 x common level ratio 1.49) 3 22477.999 shares of Hi Yield Tax Exempt B in account # 98,857.78 100% 98,857.78 00000021532594732002 at American Express titled to the Franklin C. Shaffer Living Trust (4.390/sh)(accrued dividend $179.36) 4 198.006 shares of Hi Yield Tax Exempt A in account 871.15 100% 871.15 #00000041532594730002 at American Express titled to the Franklin C. Shaffer Living Trust (4.390/sh) (accrued dividend $1.90) 5 88.063 shares of New Dimensions F-B in account 1,861.65 100% 1,861.65 #000000106325947340002 at American Express held in custody for the Franklin C. Shaffer IRA, Helen C. Shaffer, beneficiary (21.140/sh) (accrued dividend $0.00) Total of Continuation Schedule(s) 186,234.98 TOTAL (Also enter on line 7, Recapitulation) 456,050.26 COMM~NWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY continued ESTATE OF Shaffer, Franklin C FILE NUMBER 21 - 03 - 0992 This schedule must be completed and filed if the answer to any of questions 1 throuc DESCRIPTION OF PROPERTY ITEM Include the name of the transferee, their relationship to decedent and the date of transler. DATE OF DEATH % OF NUMBER Attach a copy of the deed for real estate. VALUE OF ASSET DECD'S EXCLUSION TAXABLE VALUE INTEREST 0F APPLICABLE) 6 7.114 shares of Short Duration U.S. Government B in 34.79 100% 34.79 account 4/00000012432594732002 at American Express held in custody for the Franklin C. Shaffer IRA, Helen C. Shaffer, beneficiary (4.890/sh) (accrued dividend $0.00) 7 Money Market Account # 6613335, held at First National 87,745.47 100% 87,745.47 Bank of Miffiintown, titled to the Franklin C. Shaffer Living Trust (accrued interest $2.40) 8 Statement Savings Account # 068470681, held at The Bank 98,454.72 100% 98,454.72 of Landisburg, titled to the Franklin C. Shaffer Living Trust (accrued interest $264.22) Page 2 of Schedule G · ~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSE~ & ADMI~TIVE ~ ESTATE OF Shaffer, Franklin C FILE NUMBER 21 - O3 - 0992 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT 1 2 3 4 5 FUNERAL EXPENSES: St. John's Cemetery lot Pastor Ford (Service) Funeral Luncheon at Church Musselman's Funeral Home Baughman's (tombstone engraving and placement) ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid Attorney's Fees Law Offices of Susan E. Lederer Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Cumberland County Register of Wills Zip Accountant's Fees Tax Return Preparer's Fees Other Administrative Costs Surety Bond to Transfer Prudential Stock TOTAL (Also enter on line 9, Recapitulation) 1,850.00 100.00 263.00 8,115.20 3,232.64 3,000.00 100.50 50.15 16,711.49 COMMONWEALTH OF PENNSYLVANIA ~NHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shaffer, Franklin C SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS FILE NUMBER 21 - 03 ~ 0992 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION West Shore Ambulance - transfer from hospital to nursing home not covered by insurance (date of service 9/5/2003) Claremont Nursing Home, Carlisle, PA - patient care not covered by Medicare (dates of service 9/5/2003 - 9/9/20O3) TOTAL (Also enter on Line 10, Recapitulation) AMOUNT 93.41 801.56 894.97 REV-1513 EX+ (9-00) ~ "~ SCHEDULE J COMMONWEA'TR OF PENNSVLV^N~A BENEFICIARIES '~ '~ INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shaffer, Franklin C FILE NUMBER 21 - 03 - 0992 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT Do Nat List Tr,,.t~/.8) OF ESTATE L TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 Helen C. Shaffer Wife IRA accounts 749 Montour Road (Schedule G, Items Loysville, PA 17047 5&6) $1,896.44 2 Jeffrey Lynn Shaffer Son 1/2 interest in 1250 Bowers Road 749 Montour Road Shermans Dale, PA 17090 Loysville, PA 17047 $132,402.75 3 Darryl Franklin Shaffer Son 203 Moutain Avenue P.O. Box 3 McHenry Township General Delivery Lycoming County Cammel, PA 17723 Pennsylvania $35,821.95 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheel II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1 Franklin C. Shaffer Family Trust (Credit Shelter Trust) under Article Nine of the Franklin C. Shaffer 283,205.70 Living Trust dated April 15, 1996 and any amendments thereto. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET 283,205.70 FROM :. AMERICAN EXPRESS FIN. ADUISORS PHONE NO. : ~ ~ ,1, 761 19q4 Oct. Advisor Connect: NEW DIMENSIONS F - B - ,38 2138,3 1 &: P3 Advisor Co mect Home [ Table of Contents t Site Tour } Tips I Feedback ONLINE SERVICE & TRANSACTIONS NEW DIMENSIONS F - B .Account Pr,o~fll__~e I Activity I ChecEs Issued I Find Ne×t Client Log Off Arrangements j Account List Ownership information Account #: .Ownership: [~/alue As of 09/0~12003 ." "Shares ,["'I~iAV I Principa'i'Value "584.~87"! 21.140 J $12,349.71 ,,,l tb...... 00,0, 0020 6325 9473 3 002 FR/~KLI ,N. C SHA~:FER,,, Accrued Dividends $0.00 ,,Gross Value $12,349.71 Copyright © 1998-2001 American Express Company. All Rights Reserved. Users of this site agree to be bound by the terms of the American Express Web Site Rules and Regulatior~s. View Web Site P. ule-~ and Requ ations and trademarks of American Express. Bonds: 1 / BE/ $50/L21241314 2 / E / 25/D6279893712 Totals: Issue Date 07/1981 07/1978 Inventory Report Active Inventory Print Date: 11/06/2003 _ File Pricing Date: 09/2003 Date ,[ Date l.oteJ $~ $~ $107'00/ 4'00%/ 6'72%1 ~ -t ~ ~ 18.75J' 69.001 87.7,.5/ 4.00%J 6.27_~_ 01/2004 / ~ ~ Price I Interest I Value ~;43-75l' $151.00J ~;194.75 · 61 - bond was Cashed In · EX- bond was EXchanged for an HH bond · ME- bond is Matured and Exchangeable for an HH bond · MN - bond is Matured and Not exchangeable for an HH bond · NE - bond is Not yet Eligible for payment · NI - bond has Not yet been Issued · P5 - bond is a Series I or EE, was issued in or after May 1997 and includes a 3-month-interest Penalty until the bond is 5 years old · * bond is a Series I or EE, was issued in or after January 1990 and may be tax exempt if used for post-secondaW education " · 0 bond was Cashed In or EXchanged for an HH bond, but is being priced on a date prior to the cashed or exchanged date S:\Clients~Admin\Shaffer, Franklin, Estate o~Savings bond.sbw Page 1 of 1 .30, is the owner of One shares of fully paid and non-cumulative shares, of a par value of Ten Dollars ($10.00) per shsre, preferred stock of CUMBERLAND VALLEY CD-DPERATIVE ASSDCIATIEIN transferable only on the books of this Association in person or by Attorney, upon surrender of this certificate properly endorsed. The ho[d~r___~hall b~ ~nf[tled to r~c_e~e, whsn s.nd~s~LecJar~e 8oazd_of~Direc[ors from th~ ~srnlngs of this Associati~end~rat~r ~j~[.'~ntU__-~ p~ann~ on~val~he ~ond.ay of January ~eac~nd ~er__y-~ar. ~ ~ ~ : ~ _~ ~ ~ This ~d sf~/~ be ~ at a~me b~olufio~ Boa~recto~-~----~ Ten ~llars~10.00)per share, an~ccrued d~den~_. In ~nt ~ llquida~a~-c~..-~ dis~_lufi~ of f~ A~clafi~._~.~h.e h~preferred stock shall~e entifled~ro beCk-eld ~re~ fo common s=Toc~de~e ~ often ~(~l~r share and accrued dividends. IN WITNESS WHEREOF, the said Association has c~used this certificate to be signed by its duly authorized officers and ifs corporate seal hereto ~fflxed, af Shippensburg, Pa., this ....... .~.~.1; ................. day of Octobez' A.D. 197~. ©GO£S 177 Incol ~J5 l~l~ri[[[[t~ i[]at..Frl~nk.£ha,£.f, er ............................................................... is the owner of . .Twa shares of fully paid and non-cumulative shares, of a par value of Ten Dollars ($10.00) per share, preferred stock of BUh4BERLAND VALLEY BBBPERATIVE ASSDBIATIBN transferable only on the books of this Association in person or by Attorney, upon surrender of this certificate properly endorsed. The ._holdoLshall=.h_e ¢_~1- titled to-_~:_e~iaive,._~LLherLand=a-~ decla[eckb~ the Bn~f Directola_from_:the_earnings of this Ass~divi~ the~F~Ce~4"/._~aer~'n___ um~_~----~ar ~t)n ~h Monday This~ed s~k~ay be~ll-e~d at ~y time ~ re"solut~ ol~he a~d ~Dire~i~at me'-~Doll~ ($10.00) per shar~and accr~ d~end~r~the-~ent of I~ta~ion~r cl~olut~ ol~t~is ~oiati~~olders of preferre~ock shall-be eh-fitTed to~id~ prefere~b c~mmmo~toc~olde~s the~o-f Tb'h-D611hrs ($10.00) per share and accrued dividends .... IN WITNESS WHEREOF, the said Association has caused this certificate to be signed by its duly authorized officers and its corporate seal hereto affixed, at Shippensburg, Pa., this i day of June A. 19. 7~ ~orated un~ April 30, is the OWller of Fran~ Sba f f_e_r. share of the common stock of a par value of Ten Dollars ($10.00) per share of CUMBERLAND VALLEY CD-OPERATIVE ASSOCIATIDN The comnmn stock of this Association shall be sold to and held by patrons only; and the Association shall have an Ol~!~'ed~%l~-?~com~ s,t~ at ~va!~-whe er ~eof~s for a period of Twelve months ~e no busi,~ss w{~ fl~e~'aa~on; ~i~e .of ~ck s~ll be~i~ ~thout the writ~e.n consent of the A~bciatian, a{~, if t~ As~i~n~ith h~d~s ~m~se~ to s~h s~, ~Z~ the Association shall redeem su~~at ~~. ~ ~ ~ ~ ~ ~ ~~ ~ ~_ IN WlTNESSWHERt~OF, thesaidAssociation has caused this certificate to be signed by i.ts duly authorized officers and its corporate seal hereto affixed, at Ship- pensburg, Pa., this ~ day of oul~ A.D. 19_~_8___ Incor 1929 is the owner of l!hree shares of fully paid and non-cumulative shares, of a par value of Ten Dollars ($10.00) per share, preferred stock of CUMBERLAND VALLEY CDDPERATIVE ASSDCIATIDN transferable only on the books of this Association in person or by Attorney, upon surrender of this certificate properly endorsed. The .helde~shall b -~er~t~tted to~'e~ei~e, wh~_~nd~_,~,-~lar~e B~-'----=~_ Dire~o~rnings of this Assoc~ion,.~ivid~ds a'!~Jhe ra~2e of Fouler Cen~ (4%) ~r a~m ~ their v~e, on t ~h~four~ Monday of Januar~f =ea~ an~e~ear~--------- ~_~__----~__' ~ ~ --~ ~ ~ ~ ~ ~ This I~_~_ferred stQ~_'._ ~ be c~__--~ ed at a~'- time b~esolutio~of ~ Boa;~- of~J~irect~ ai Ten~olla~_ ($10.00) per share,~=3d accru~div~nds~ ~nt of li~n ~ di~uti~of _-~ ~-~io~lders of preferred stock shall be entitled to be paid in preference to common stockholders the sum of Ten Dollars ($10.00) )er share and accrued dividends. IN WITNESS WHEREOF, the said Association has caused this certificate to be signed by its duly authorized officers and its corporate seal hereto affixed, at Shippensburg, Pa., this I day of Jq~]v A.O. 19 ?R -/2.'.! 04 :" '"- ': ~-¢!' uuK ~' - r';' .U';'"' 01/22,/04 STOCK PUP, CHASE 01/22/04 STOCK PURCHASE 0!/22/04 STOCK PURCHASE DATE 0652 AMOUNT 054499 i0~00 054500 10,00 054501 20,00 054502 30,00 70,00 EQ_UlSERVE PRUDENTIAL ~IN&NGIAL, lNG. ¢1~ EOLIISERVE TRUST COI~/IPANY, N.A. P 0 BOX 43033 PROVIDENCE RI 02940-3033 Transaction Advice Please retain for your records January 20, 2004 Page I of I FRANKLIN C SHAFFER C/O HELEN C SHAFFER 749 MONTOUR ROAD LOYSVILLE, PA 17047-9213 Shareholder's Account Number Account Access PIN/Password Telephone Password 2S38745 58669959 58669959 PRUDENTIAL FINANCIAL, INC. Date Issue ID Class CUSIP Shares 01/20/2004 230010 COMMON 744320102 -62.0000 Book Entry Share Balance 0.0000 Transaction Description NORMAL TRANSFER PRUDENTIAL FINANCIAL, INC. IS ORGANIZED UNDER THE LAWS OF THE STATE OF NEW JERSEY. To obtain information about your account, sell shares, request a stock certificate or receive transfer of ownership instructions: By Internet: Go to http://prudential.equiserve.com, click on Account Access, and follow the instructions. Please have your PIN/Password available. Your PIN/Password is confidential and should not be shared with anyone. By Telephone: Call 1-800-305-9404 and follow the instructions. Please remain on the line until your transaction is processed. By Letter write to: PRUDENTIAL FINANCIAL, INC. c/o EQUISERVE TRUST COMPANY, N.A. P 0 BOX 43033 PROVIDENCE RI 02940-3033 The Corporation will furnish without charge to each shareholder who so requests a statement of the applicable designations, relative rights, preferences and limitations of the shares of each class and series of stock of the Corporation authorized to be issued and of the authority of the Board of Directors of the Corporation to divide the shares into classes or series and to determine and change the relative rights, preferences and limitations of any class or series of stock of the Corporation. Such request may be made to the transfer agent or the Office of the PRU: Historical Prices for PRUDENTIAL FINL - Yahoo! Finance Page 1 of: J[I--IOO[FINANCE ! Finance Home-_My Yahoo,- Yahoo,-Help Friday, March 5, 2004, 12:05pm ET - U.S. Markets close in 3 hours and 55 minutes. Welcome, Guest [~_i_g. Hn__I_.n_] To track stocks & more, R_e~qj_s_t_e.r Quotes & Info Enter Symbol(s): e,g. YHOO, ^DJI Prudential Financial Inc (PRU) · Free Dow Jones News! · 5 seconds: Our guarantee ....................................... Symbol Lookup I Finance Search At ll:45AM ET: 47.64 ~ 0.47 (0.98%) Reuters Click Here · Get Free Trades for a Month Historical Prices SET DATE RANGE Start Date: ~ ~ j~,~.3.,,,~,,i: Eg. ]an 1, 2003 Get Historical Prices for: ! ~ Daily · ,.r' Weekly C Monthly C: Dividends Only ADVERTISEMENT PRZCES Date 9-Sep-03 First I Prey I Next I Last Open High Low Close Volume Adj Close* 36.95 36.95 36.22 36.23 1,172,000 35.74 * Close price adjusted for dividends and splits. First I Prev I Next I Last ~ Download To Spreadsheet http://finance.yahoo.com/q/hp ?s=PRU&a=08&b=9&c=2003&d=08&e=9&f=2003&g=d 3/5/200, Recorded On 6/11/2003 At 10:13:54 AM * Instrument Type - DEED Invoice Number - 10175 * Grantor - SHAFFER, FRAN~I~ C * Grantee - SHAFFER, JEFFREY LYNN * Customer - SUSAN E LEDERER FEES AFFORDABLE HOUSING $10 . 00 RECORDING FEES - $17.00 RECORDER OF DEEDS COUNTY ARCHIVES FEE $2 . 00 JCS/ACCESS TO JUSTICE $10.00 STATE TRANSFER TAX $2 , 708 . 06 STATE WRIT TAX $0.50. ~EST PERRY SCHOOL $2,708 . 06 DISTRICT ROD ARCHIVES _WEE - TO $2.00 COUNTY RECORDER IMPROVEMENT $1 . 00 FUND - TO OFFICE TOTAL $5,458 . 62 Instrument Number - 200306781 * Total Pages - 6 This is a certification page DO NOT DETACH This page is now part of this legal document. RETURN DOCI/MENT TO: SUSAN E LEDERER 4811 JONESTOWN ROAD HARRISBURG, PA 17109 Instrument Number: 200306781 P.O. Box 223 New Bloomfield, PA 17068 I hereby CERTIFY that this document is recorded in the Recorder of Deeds Office of Perry Count, Pennsylvania. ~' "': ~' '-,--'.--;&..4 }i": * - Information denoted by an asterisk may change during the verification process and may not be reflected on this page. Parcel #270.126.00-078.000 Deed Thi id --' s n enture, made the ,-'~PA day of k\[ i("~,~p the year of our Lord two thousand and three (2003), , in Between FRANKLIN C. SHAFFER and HELEN C. SHAFFER, Trustees, or their successors in trust, under the FRANKLIN C. SHAFFER LIVING TRUST dated April 15, 1996, and any amendments thereto, and HELEN C. SHAFFER and FRANKLIN C. SHAPFER, Trustees, or their successors in trust, under the HELEN C. SHAFFER LIVING TRUST dated April 15 1996, and any amendments thereto, as Tenants in Common Grantors and JEFFREY LYNN SHAFFER, Grantee Witnesseth, That the Grantors, for and in consideration of the sum of One and No/100 ($1.00) Dollars, lawful money of the United States of America, unto them well and truly paid by the Grantee at or before the sealing and delivery hereof, the receipt whereof is hereby acknowledged, have granted, bargained and sold, released and confirmed, and by these presents do grant, bargain and sell, release and confirm unto the GranEee, his successors and assigns. ALL THOSE CERTAIN three tracts of land situate in Tyrone Township, Perry County, Pennsylvania, being more particularly bounded and described as follows: TRACT NO. 1: BEGINNING at a nail in the center!ine of Legislative Route 50026, which nail is located 625.55 feet measured westerly along said centerline from an iron pin in said centerline at the southwest corner of lands now or formerly of Elliottsburg Rod and Gun Club; thence North 69 degrees 01 minutes 20 seconds West 300.00 feet to an iron pin in said centerline; thence along same North 77 degrees 12 minutes 20 seconds West, 221.83 feet to a nail in said centerline; thence North 15 degrees 03 minutes 18 seconds East 770.13 feet to an iron pin at other lands of Hopewell Land Company; thence along same North 83 degrees 14 minutes 49 seconds East 560.14 feet te an iron pin; thence ateng same South 15 degrees 03 minutes 18 seconds West 1000 43 feet the point ef BEGINNING. ' CONTAINING 10.46 acres, and being part efa larger tract conveyed to Hopewelt Land Company as recorded on page 204 of Deed beak 233 in the Office of the Recorder of Deeds for Perry County, Pennsylvania, according ~o a survey of Dallas G Cleuser R S prepared April 28, 1976. ' .... TRACT NO. 2: BEGINNING at a nail in the centerline of Legislative Route 50026 at line of other land of the grantors; thence by the same North 15 degrees 03 minutes 18 seconds East a distance of 1000.43 feet to an iron pin; thence along same, North 83 degrees 14 minutes 49 seconds East a distance of 143.45 feet to an iron pin on line of land now or formerly of R. hamoaugn; thence along said Shambaugh lands South 30 degrees 35 minutes 16 seconds East a distance of 407.79 feet to an iron pin; thence continuing along same and lands now or formerly of the Houndsman's Club South 01 degree 36 minutes !5 seconds West a disUance of 576.14 feet to Lot No. 2 recorded in Plan Book 30, Page 69; thence by Lot No. 2 and Lot No. 2A South 87 degrees 49 minutes 53 seconds West a distance of 240.41 feet to an iron pin; thence along Lot No. 2A South 23 degrees 07 minutes 35 seconds West a distance of 170.46 feet to a nail in the centerline of Legislative Route 50026; thence through the centerline of Legislative Route 50026 North 69 degrees 01 minute 20 seconds West a distance of 306 83 feet to ~he place of BEGINNING. ' BEING Lot No. 1 on a subdivision made for Charles M. Dunkelberger recorded in Plan Book 30 Page 69 and containing 9.91 acres. ' TRACT NO. 3: BEGINNING at an iron pin, which iron pin is a corner common to this tract, to lands of Burleigh Anderson, and to lands of Boyd Reeder; thence along lands now or formerly of Boyd Reeder and lands now or formerly of R. Shambaugh South 29 degrees 25 minutes 44 seconds East 1484.18 feet to an iron pin on line of lands of R. Shambaugh; thence along lands now or formerly of Hopewell Land Company, South 83 degrees 14 minutes 49 seconds West 940.61 feet to an iron pin; thence along same North 06 degrees 45 minutes i1 seconds West 1169.69 feet to an iron pin on line of lands now or formerly of Burleigh Anderson; thence along said lands North 54 degrees 18 minutes 50 seconds East 412 94 feet to the point of BEGINNING. ' CONTAINING 19.53 acres according to a survey of Dallas G. Clouser, Registered Surveyor. TOGETHER with a 50 foot right of way over lands of Hopewell Land Company as follows: ' Beginning at an iron pin in the centerline of Legislative Route 50026, which iron pin is located 1900.16 feet e t 1 R. 500~6, ~rom w15 e Y~o o b ' -- North u Club; ~hence degrees 03 minutes 18 seconds East 255.21 feet to an iron pin; thence North 44 degrees 03 minutes 31 seconds East 169.13 feet to an iron pin; thence North 71 degrees 42 minutes 34 seconds East 553.38 feet to an iron pin on line of above described parcel; thence along said line South 06 degrees 45 minutes 11 seconds East 51.03 feet to an iron pin; thence South 71 degrees 42 minutes 34 seconds West 530.87 feet to a point; thence South 44 degrees 03 minutes 31 seconds West 143.90 feet to a point; thence South 15 degrees 03 minutes 18 seconds West 241.57 feet to a point in the centerline of L R 50006; North 75 ~ ..... u~r~es 45 minutes 20 seconds West 50.01 feet along said centerline to the point of Beginning. BEING the same premises FRANKLIN C S ~ · HA~FER and HELEN C. SHAFFER, husband and wife, of Perry County, Pennsylvania, by Deed dated March 14, 1997, and recorded March 18, 1997, in Record Book No. 999, Page 240 in the Office of the Recorder of Deeds in and for Perry County, Pennsylvania, granted and 'conveyed unto FRANKLIN C. SHAFFER and HELEN C. SHAPFER, Trustees, or their successors in trust, under the FRANKLIN C. SHAFFER LIVING TRUST dated April 15, 1996, and any amendments thereto, and HELEN C. SHAFPER and FRANKLIN C. SHAFFER, Trustees, or their successors in trust, under the HELEN C. SHAFFER LIVING TRUST dated April 15, 1996, and any amendments thereto, as Tenants in Common Grantors herein. , the TOGETHER with all and singular the building, improvements, ways, streets, alleys, passages, waters, water-courses, rights, liberties, privileges, hereditaments and appurtenances whatsoever thereunto belonging, or in any wise appertaining, and the reversions and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, ~roperty, claim and demand whatsoever of the said Grantors, ~n law, equity, or otherwise howsoever, of in and to the same and every part thereof. ' ' TO HAVE AND TO HOLD the said lot or piece of ground above described, with the messuage or tenement thereon erected, hereditaments and premises hereby granted, or mentioned and intended so to be, with the appurtenances, unto the Grantees, their successors and assigns, to and for the only proper use and behoof of the Grantees, their successors and assigns, forever· AND the Grantors, for themselves, their heirs, personal representatives and assigns, do covenant, promise and agree, to and with the Grantees, their successors and assigns, by these presents, that they, the Grantors their heirs personal representatives and ' - , assigns, all and singular the hereditaments and premises hereby granted or mentioned and intended so to be, with the appurtenances, unto the Grantees, their successors and assigns, against them, the Grantors, their heirs, personal representatives and assigns, and against all and every person and persons whomsoever lawfully claiming or to claim the same or any part thereof, by, from or under him, her, them or any of them, shall and will, Subject as aforesaid, WARR3LNT and forever DEFEND. IR ~~SS ~h~of, the Grantors have hereunto set th?ir hands and seals. DatedVthe day and year first above wrmtten. Sealed and Delive=ed in the Presence of: FRANKLIN C. SHAF~R, Trustee HELEN C. SHAFFER, ~ Trustee Certificate of Residence I hereby certify that the precise residence of the herein is as follows: c/o JEFFREY LYNN SHAFFER 749 Montour Road Loysvil!e, PA 17047 Grantee .,/' Attorney for ~J - Grantee Acknowledgement COMIMONWEALT!{ OF PENNSYLVANIA : : ss COUNTy OF DAUPHIN : On this the day Notary Public in and for the _~ 2003, before me~ a Co~onwealth of Pennsylvania~ the undersigned officer~ personally appeared F~KLIN C. S~FFER~ and HELEN C. S~AFFER~ Trustees, under the F~KLIN C. S~.FFER LIVING TRUST dated April 15, 1996, and any amen~ents thereto, and under the HELEN C. S~.FFER LIVING TRUST dated April 15, 1~96, and any ~en~ents thereto, kno~ to me (or satisfactorily proven) to be the persons whose n~es are subscribed ~o 5he within instr~en~ and acknowledged that they executed the same for the purposes therein contained. IN WITNESS ~EREOF, I hereunto se~ my hand '; -~" J J..~' -7..'- .'' COUNTY OF PERRY ) ) Noumal Seal Mindy S, Beaver, Notary Public Lower Paxton Twp., Dauphin County My Commission Expires Apr. 18, 2006 RECORDED in the Office of the Recorder of Deeds in and for Perry County, in Record Book , Page WITNESS my hand and official seal this day of RECORDER OF DEEDS TAX YEAR - - . . ~002--2003 WEQT.. PERRY,.,. S'~HI3OL DISTEICT . "~W.L~O: LOYSViLLE,' PA ' t~0~7 =~ ' : ' ~ dULv 31 gAR--I~DN DEC' - ~'": --' ' ' '~ ~'7002-4 BO~ ,' ' ' ' T) U~ · Z 0 ,.,u'., 2-i P 3:t4.8 Deed Instrument 200300013049 OR book Pa~ 4618 Parcel #28+,223.0-0124.K+-000 RECORDER OF This indenture, ~he year o~ o~r Lord %wo ~housand and ~hree (2003), , in Between FRANKLIN C. SHAFFER and HELEN C. SHAFFER, Trustees, or their successors in trust, under the FRANKLIN C. SHAFFER LIVING TRUST dated April 15, i996, and any amendments thereto, Grantors 20030oo13049 Filed got, Record in ANNABEL ~ZLLrR 06-27-2003 A~'01:34 DEED DARRYL FRANKLIN SHAFFER, Grantee STATE TAX 388.22 LOCAL T~X 388. S~ OR book 46i8 Page 79 - Witnesseth, ~ the Grantors, for and i~ consideration of the sum of One and No/!00 ($2.00) Dollars, lawful money of the Oni:ed States of i~aerica, unto them well and truly paid by the Grantee at or before the sealing and delivery hereof, the receip~ whereof is here~y acknowledged, have granted, bargained and sold, released and confirmed, and by these presents do grant, Bargain and sell, release and confirm unto t~e Grantee, his successors and assigns. 8:." ALL THOSE CERTAIN pieces, parcels and lots of land situate in the Township of ~cHenry, County of Lycoming and Commonwealth of Pennsylvania, being more particularly bounded and described as follows: T__RACT NO. 1: BEGINNING at a point marked with an iron pipe at the Southeast corner of the said lot of land; thence in a northerly direction a distance of four hundred fifteen (~15) feet to a point marked with an iron pipe; thence in a westerly direction, along the lands of the said grantors, a distance of two hundred ten (210) feet to a point marked with an iron pipe; thence in a southerly direction, along the lands of the said grantors, a distance of three hundred thirteen (313) feet to a point marked with an iron pipe; thence in an eastern direction, along the lands of John and Lois Fink, a distance of two hundred ten (2!0) feet to a point marked with an iron pipe, the place of beginning. Instrument 200300013049 OR book Page 4~t8 ., 82 Acknowledgement CO~ONWEA~TH OF PEN~SYLVA/~IA : : ss COUNTy OF DAUPHIN : On this, the day of ~- , 2003, before me, a Notary Public in and for the Commonwealth of Pennsylvania, the undersigned officer, personally appeared FRANKLIN C. SHAFFER, and HELEN C. SHAFFER, Trustees, under the FRANKLIN C. SHAFFER LIVING TRUST dated April 15, 1996, and any amendments thereto, known to me (or satisfactorily proven) to be the persons whose names are subscribed to the within instrument and .acknowledged that they executed the same for the purposes therein contained. ~ .I~ wITNEss WHEREOF I hereunto set my han~ and ~ o~cial Mindy S. Beaver, Notary Public ..Low_er Paxton Twp., Dauphin County My uommiaaion Expires Apr. 18, 2006 COMMONWEALTH OF PENNSYLVANIA COUNTY OF LYCOMING ) ) ss: ) RECORDED in the Office of the Recorder of Deeds in and for Lycoming County, in Record Book _ ~L/~ , Page _ ~g WITNESS ?y hand and official seal this ~Y~% day of ~O0~ _. RECORDER OF DEEDS · ; . . . . . · ... : .- ...... ,~.~ %-..' .,,~ ~:~-~ ~.:-:~: . ~ . . . '...... . . :. .. . · . .. .... :. ,' :..~_. .-?=~.~.::;:.:.::.:¥ ~< -~,. ~.: . .. . . . ,[: 'LDUR]NG JULY :~ND-"AUG . /,: . [,.J 123 '--t m z Z 0 FROM : AMERICAN EXPRESS FIN. ADUISORS PHONE NO. : ?17 761 1994 ,Advisor Connect: HI YIELD TAX-EX- B Oct. 38 2883 ll:27AM i-'lt.ge i oi i Advisor Connect l~ome [ Table of Contents t Site Tour I Tips [ Feedback ONLINE SERVICE & TRANSACTIONS HI YIELD TAX-EX - B Find Next Client Log Off Acc, gunt Profl.l_~ I Activity I Checks Issued I Arrangements ] Account List Pi 10w hip " L , ,,, ners Information Account #: j0000 0021 53~'5 9473 2 002 Dwnership: ' IFP-,ANKLIN C SHAFFER AND .... IHELEN C SHAFFER AS 'CI'EES ~)F THE FRANKLIN C SHAFFER LIV TR IU/A DTD 4-15-96 ..... 'Value As of 09t09/2003 Sha'res NAV" 'Principai Value Accrued Dividends Gross Value 22477.999. 4.390" $98,678.4,,2, $179.36 $98,857.78 Copyright © 1998-2001 American Express Company. All Rights Reserved. Users of this site agree to be bound by the terms of the American Express Web Site Rules and Regulations, View ,.,Web Site Rules and R. egu. l_at ons and .tradema_rks of American Express, h~m.q://advi.q~r6.aex~~c~m/~st/secure/Acc~u~tPr~~de/Acc~unt?r~ft~~Fu~dAs~fVa~ues~asp~~~ 10/30/2003 FROM : AMERICAN EXPRESS FIN. ADUISORS PHONE NO. : ?17 761 1994 Advisor Cormect: HI YIELD TAX-EX - A Advisor Connect Home [ Table of Contents [ Site Tour I Tips I Feedback Oct. 30 2003 II:2?AM P2 _wage i ul i ONLINE SERVICE & TRANSACTIONS HI YIELD TAX-EX . A Find Next Client Log Off Ag_count Pro. file I Activity J Checks Issued I Arrangements I Account List Dwnership !nf'ormation' Account #: ~Ownership: 10O'(~0 0041 5325 9473 0 (~'02 . IFRANKLIN C' ~;HAFFER ~ND '" ~HELEN C SHAFFER AS 'I-FEES IOF THE FRANKLIN C SHAFFER LIV TlR ..... IU/A D.,T.D 4-15-96 " f"09/09/2003 , ,, Value As o Shares NAV Principal Value Accrued Dividends Gross Value 198.006 4.390 $869.25 $1.90 $871.15 Copyright © 1998-2001 American Express Company. All Rights Reserved. Users of this site agree to be bound by the terms of the American Express Web Site Rules and Regulations. View Web Site Rules and Regulation_s_ and trademarks of American Express. httns://advis~r~~aext)~c~m/~st/secure/Acc~tmtPr~fi~e/Acc~~rttPr~fi~eFtmdAs~fVa~~es~as~>~~~ ] 073o/2ar)~ FROM : AMERICAN EXPRESS FIN. ADVISORS PHONE NO. : ?!7 761 1994 Oct. Advisor Connect: NEW' DIMENSIONS F-B Advisor Connect Home I Table of Contents ] Site Tour J Tips t Feedback ONLINE SERVICE & TRANSACTIONS NEW DIMENSIONS F - B 38 2883 11:28AM P4 Page 1 of l Find Next Client Log Off Accoun,t_Profile I Activity Checks Issued I Arrangements I Account List OWnership info_r, ination Account #: Ownership: IValue As 'of'~9/0912003"' ' .... "'~hares I N~V t Princi; ' "l' Accrued Dividends ., , 10'000 0010 6325 9473 4 002 ,, ' }AMERICAN EXPRESS TRUSf'COMPANY ~/O FRANKLIN C SHAFFER i~p~CUSTD FOR THE FRANKLIN C SHAFFER ' 1 I G'ross Value Copyright © 1998-2001 American Express Company. All Rights Reserved. Users of this site agree to be bound by the terms of the American Express Web Site Rules and Regulations. View Web ..Site Rules and Reclulations and ..tr.a..d._emarks_ of American Express. httn.q://advisor6 com/ost/ cure/A uatProfile/Account_P FROM : AMERICAN EXPRESS FIN. ADUISORS PHONE NO. : 717 761 1994 Oct. 30 2003 l l:28AM PS Page I of 1 Advisor Connect Home [ Table of Contents I Site Tour ] Tips I Feedback ONLINE SERVICE & TRANSACTIONS SHT DUR U.S.GOV - B Find Next Client Log Off Account Profile Activin' Checks Issued I Arrangements I Account List ,Ownership Inf0i-i~iaii0n Account #: ...... Ownership: I00 0012 4325 9473 2 002 ERICAN EXPRESS TRUST COMPANY /O FRANKLIN C SHAFFER CUSTD FOR THE FRANKLIN C SHAFFER Value As of 09/0912003 Shares1NAVI principalValueI AccruedDivid,nds 7.114 4.890 $34.79... $0.00 Gross Value $34.79 Copyright © 1998-2001 American Express Company. All Rights Reserved. Users of this site agree to be bound by the terms of the Amedcan Express Web Site Rules and Regulations. View Web Site Rules and Regulations and .t~._d...emarks of American Express. h~q'//arl,ei~t~'6 ae. rn.c, omlo,qt/secure/A, ccountPro~le/AccouritProfileFund_4~sOfValues.aso.,. 10130/200a RESPONSE TO ACCOUNT INQLFIXY FIRST NATIONAL BANK OF MWFLINTOWN PO BOX 96 MIFFLINTOWN PA 17059 TO: SUSAN E LEDERER DECEDENT: FRANKLIN C SHAFFER DATE OF DEATH: SEPTEMBER 9, .~00_, SOCIAL SECURITY#: 716-09-6148 We held account (s) in which this decedent had an interest at the time of his/her death as follows: ACCOUNT OWNER(S): FRANKLIN C SHAFFER OR HELEN C SHAFFER Type of Account: LIVING TRUST-MMA Principal Balance at D.O.D.: $87,743.07 Original Ope~zing Date · MAY 22, 1996 Account #: 6613335 h~terest Rate: 1.00% Interest to DOD: $2.40 ACCOUNT OWNER(S): Type of Account: Principal Balance at D.O.D.: Ori~nal Opening Date: Account #: Interest Rate: Interest to D.O.D.' ACCOUNT OWNER(S): Type of Account: Principal Balance at D.O.D.: Original Opening Date: .O.D.: Penalty is waived on withdrawal of decedent's fund before maturity: Safe Deposit Box: ZI Yes ~o The First NatiOnal Bank of Mifflintown Stock or other securities: Fiduciary Relationships: ZI Yes IiJ'No Z~'es U No Yes Mo Authorized Signatt~re~~ /Receptionist Date Thc Bank°F LandisbUrE ESTABLISHED 1903 P.O. BOX 179 · LANDISBURG, PA 17040 Bank records indicate the following account balances on_ 9/9/2003 for Franklin C Shaffer 749 Montour Rd Loysville PA 17047 ss # 716-09-6148 Acct Sole Jt. Acct Acct ~ Opened Ownership With (wife) 04/07/2000_, Helen C Sheller 0712361 ~/~ Living Trust Dated 04/15/96 -'(~,~08/04/93 Helen C Sheller (trustee) 08/03/99 Living Trust Dated 04/15/96 0 Franklin C Shaffer (trustee) 068491263 7/09/02 Living Trust Franklin C Shaffer (trustee) 700012290 068470681 Balance Type P~i6r T.~ Iht Accrued Interest Bearing Interest Money Market 18,332.48 ~tatement avzngs 98,190.50 Statement " parings _123~220.96 22~702.58 Yes 7.88 Yes 264.22 Yes 261.28 Yes 1.09 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004004 LEDERER SUSAN E 4811 JONESTOWN ROAD SUITE 226 HARRISBURG, PA 17109 fold ESTATE INFORMATION: SSN: 716-09-6148 FILE NUMBER: 2103-0992 DECEDENT NAME: SHAFFER FRANKLIN C DATE OF PAYMENT: 06/03/2004 POSTMARK DATE: 06/02/2004 COUNTY: CUMBERLAND DATE OF DEATH: 09/09/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 $1.69 REMARKS: TOTAL AMOUNT PAID: $1.69 SEAL CHECK//166 INITIALS' AC RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS BUREAU OF ZNDZVZDUAL TAXES ZNHERZTANCE TAX DI'VZSZON DEPT. Z8060! HARRTSBURG, PA 17118-0601 CONNONWEALTH OF PENNSYLVANZA DEPARTNENT OF REVENUE NOTZCE OF ZNHERZTANCE TAX APPRAZSEMENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTZONS AND ASSESSNENT OF TAX REV-1G¢7 EX AFP C01-03) SUSAN E LEDERER S E LEDERER LAN OFCS q811JONESTOWN RD 226 HBG PA 17109 DATE 09-06-200q ESTATE OF SHAFFER FRANKLTN C DATE OF DEATH 09-09-2005 FZLE NUHBER 21 0~.-.0992 CUt~LAN ' ~ COUNTY = . ]~ ~:~ ~ ACN 10 ~ :: ~:: Q, : I , HAKE CHECK PAYA~CE~AN~ R~ZT PAYHENT TO: REGISTER OF N~LLS ~ CUH~ERLAND CB~ COURT ~USE ~::::: ~ L CARLISLE, PA :~:~7'0~ ~ CUT ALONG THZS LZNE ~ RETA/N LOWER PORTZON FOR YOUR RECORDS ~ REV-15&7 EX AFP (01-03) NOTZCE OF ZNHERZTANCE TAX APPRAZSENENT, ALLOWANCE OR DZSALLOWANCE OF DEDUCTZONS AND ASSESSNENT OF TAX ESTATE OF SHAFFER FRANKLIN C FZLE NO. 21 05-0991 ACN 101 DATE 09-06-ZOOq TAX RETURN NAS: (X) ACCEPTED AS FZLED { ) CHANGED RESERVATZON CONCERNZNG FUTURE /NTEREST - SEE REVERSE APPRAZSED VALUE OF RETURN BASED ON: ORTGTNAL RETURN 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) $. Closely Held S~ock/Partnarship In~ares~ (Schedule C) ($) q. Hot,gages/No'es Receivable (Schedule D) (q) E. Cash/Bank Daposi~s/Hisc. Personal Propar~y (Schedule E) (5) 6. Jointly Owned Proper~y (Schedule F) (6) 7. Transfers (Schedule G) (7) 8. To~al Asse~:s APPROVED DEDUCTZONS AND EXENPTZONS: 9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9) 10. Deb:ks/Hortgage Liabil~Bs/Lians (Schedule T) (10) 11. Total Deductions 12. Ne~ Value of Tax Re~urn .00 lq~885.Oq .00 .00 .00 .O0 q56~050.26 16,711.q9 NOTE: To insure proper credit ~o your account, submi~ ~he uppar por~ion of ~his form wi~h your tax payment. 15. lI. NOTE: q70,955.$0 89q.97 (12) q55,~26.8q reflect figures that include the total of ALL returns assessed to date. ASSESSNENT OF TAX: 1,896.qq x O0 15. Amoun~ of Line 1~ a~ Spousal rata (15) = 16. Amoun~ of Line lq ~axable a~ Lineal/Class A ra~e (16) 168,22q.70 x Oq5 = 17. Amoun~ of Line 1~ a~ Sibling ra~e (17) . O0 X 1~ = 18. Amoun~ of Line lq ~axable a~ Collateral/Class B ra~a (18) . O0 X 15 = 19. Principal Tax Due (19)= 285,205.70 .00 Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (13) Ne~ Value of Es~a~e Subjec~ ~o Tax (1~) 170,121.1q :Zf an assesswent ~as issued previously, lines 14, 15 and/or 16, 17, 18 and 19 ~ill RECEIPT NUHBER CD005296 CDOOqOOq DISCOUNT ZNTEREST/PEN PAZD (-) ~S78.qZ .00 AMOUNT PAZD 7,190.00 1.69 7,570.11 .00 TAX CREDZTS: PAYHENT DATE 11-28-2005 06-02-200q ZF PAZD AFTER DATE ZNDZCATED, SEE REVERSE FOR CALCULATZON OF ADDZTZONAL ZNTEREST. .00 7,570.11 TOTAL TAX CREDZT / 7,570.11 BALANCE OF TAX DUEl .00 ZNTEREST AND PEN. .00 TOTAL DUE .00 ._~ ( ZF TOTAL DUE 1S LESS THAN $1, NO PAYMENT 1S REqUZRED. IF TOTAL DUE ZS REFLECTED AS A "CREDZT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SZDE OF THZS FORM FOR ZNSTRUCT~ONS'' ~ RESERVATION: PURPOSE OF NOTICE: PAYNENT: REFUND (CR): OBJECTIONS: ADHIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 12, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (collateral) rate on any such future interest. To fulfill the requirements of Section 2140 of the Inheritance and Estate Tax Act, Act 23 of ZOO0. (72 P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Register of gills printed on the rmvmrsa side. --Make check or money order payable to: REGISTER OF NZLLS, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available et the Office of the Register of Nills, any of the 23 Revenue District Offices, er by calling the special Z4-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-3020 (TT only). Any party in lnterest not satisfied ~ith the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. Factual errors discovered on this assessment should ba addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601 Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (3) calendar months after the decedant's death, a five percent (SI) discount of the tax paid is allowed. The 152 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after tho and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January 1, 1982 bear interest at the rate of six (62) percent par annum calculated at a daily rate of .000164. Al1 taxes which became delinquent on and after January 1, 1962 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 1982 through 2004 ara: Interest Daily Interest Daily Year Rate Factor Year Rate Factor ~ 20Z .00054B ~"'8-1991 112 .000301 1983 162 .000436 1992 97. .000247 1984 llZ .000301 1993-1994 7Z .000192 1985 137. .000356 1995-1998 9Z .000247 1986 IOZ .000274 1999 7Z .000192 1987 XOZ .000274 ZOO0 7Z .000192 --Interest is calculated as follows: ZNTEREST= BALANCE OF TAX UNPAZD Interest Dally Year Rata Factor ~'~ 92 .000247 ZOOZ 62 .000164 Z003 52 .000137 2004 42 .000110 X NUNBER OF DAYS DELXNQUENT X DAXLY ZNTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. BUREAU OF ZNDZVTDUAL TAXES ZNHERTTANCE TAX DTVTSTON DEPT. Z80601 HARRISBURG, PA 171Z8-0601 CONNONNEALTH OF PENNSYLVANIA DEPARTHENT OF REVENUE NOTICE OF DETERNZNATZON AND ASSESSHENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN REV-~83 EX ~FP (01-OS) SUSAN E LEDERER S E LEDERER LAN OFCS 4811JONESTONN RD 226 HBG PA 17109 DATE 09-06-2004 ESTATE OF SHAFFER FRANKLIN C DATE OF DEATH 09-09-2005 FILE NUHBER 21 COUNTY CUI~ E;R LAND::~__; .. ~*.? ~'~'*~F: ACN Z 0 ~ HAKE CHECK PAYABLE:AND REHZT PAYHENT TO: REGISTER OF ~LS ~ !::!i~ CUNBERLAND CO COURT [~I~USE CARLISLE, PA 17015 NOTE: To insure proper credi~ ~o your account, submi~ ~he upper portion of ~his form ~i~h your ~ex payment. CUT ALONG THIS LZNE ~ RETAIN LONER PORTION FOR YOUR FILES 4 REV-483 EX AFP (01-03) x~ NOTICE OF DETERNZNATZON AND ASSESSNENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL ESTATE TAX RETURN ~# ESTATE OF SHAFFER FRANKLIN C FZLE NO.Z1 05-0992 ACN 201 DATE 09-06-2004 ESTATE TAX DETERHTNAT:]:ON 1. Credi~ For S~a~e Death Taxes as Verified Z. Pennsylvania Inheritance Tax Assessed (Excluding Discoun~ and/or Interest) /nheri~ance Tax Assessed by O~her S~a~es or Territories of ~he United S~a~es (Excluding Discoun~ and/or Interest) 4. To,al Inheritance Tax Assessed 5. Pennsylvania Es~a~e Tax Due TAX CREDITS: 7/191.69 .00 .00 7/191.69 .00 PAYHENT RECEIPT DISCOUNT (+) DATE NUHBER INTEREST/PEN PAID (-) AHOUNT PAID ~ZF PA/D AFTER THIS DATE~ SEE REVERSE SZDE FOR CALCULATION OF ADDITIONAL INTEREST. TOTAL TAX CREDIT I .00 BALANCE OF TAX DUEl .00 ]:NTEREST AND PEN. ,00 TOTAL DUE . O0 (TF TOTAL DUE ZS LESS THAN $1~ NO PAYNENT TS REI~U/RED TF TOTAL DUE TS REFLECTED AS A "CREDIT" (CR)~ YOU HAY BE DUE A REFUND. SEE REVERSE STDE OF THTS FORH FOR TNSTRUCTTONS.) PURPOSE OF NOTICE: PAYMENT: To fulfill the requirements of Section Il40 (b) of the Inheritance and Estate Tax Act, Act Z$ of ZOO0. (7Z P.S. Section 9140). Detach the top portion of this Notice and submit with your payment to the Regis[ar of Nills printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. REFUND (CR): A refund of a tax credit may be requested by completing mn "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1513). Applications ara available at the Of;ice of the Regis[ar of Wills, any of the Z5 Revenue District Offices or from the Department's Z4-hour answering service for forms ordering: 1-800-36Z-ZO50; services for taxpayers with special hearing and / or speaking needs: 1-8gO-447-30ZO (TT only). OBJECTIONS: Any party in interest not satisfied with the assessment of tax as shown on this notice may object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-10Z1, --electing to have the matter determined at audit of the personal representative, OR --appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Ravenua~ Bureau of Individual Taxosj ATTN: Post Assessment Reviem Unitj Dept. Z80601, Harrisburg, PA 171Z8-0601, Phone (717) 787-6505. Sea page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. OR PENALTY: INTEREST: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of tho tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. For dates of death on or after 10-3-91, Pennsylvania Estate Tax based on the Fedora! Estate Tax return becomes delinquent at the expiration of nine (09) months from the date of death. For dates of death prior to 10-3-91, Pennsylvania Estate Tax based on the Federal Estate Tax return becomes delinquent at the expiration of eighteen (18) months from the date of death. Taxes which became delinquent before January 1, 198Z bear interest at the rate of six (6Z) percent par annum calculated at a dailv rate of .000164. A11 taxes which became delinquent on or after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2004 are: Interest Daily Interest Daily Interest Daily Yea~ Rate Factor Yaa__r Rate Factor Yea__r Rate Factor 1982 ZOZ .000548 1988-1991 XiZ .000301 2001 92 .000247 1983 162 .000438 1992 92 .000247 ZOOZ 62 .000164 1984 llZ .000301 1993-1994 7Z .00019Z 2003 52 .000137 1985 132 .000356 1995-1998 92 .000247 2004 4Z .000110 1986 lOX .000274 1999 7Z .00019Z 1986 102 .000274 ZOO0 82 .O00Z19 --Interest is calculated as folloas: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent mill reflect an interest calculation to fifteen (15) days beyond tho date of the assessment. If payment is made after the interest computation date shomn on tho Notice, additional interest must be calculated. BUREAU OF INDIVIDUAL TAXES ZNHERTTANCE TAX DZVTSZON P.O. Box Z80601 HARRISBURG, PA 171Z8-060! SUSAN E LEDERER S E LEDERER LAW OFCS 4811JONESTOWN RD 226 HBG PA 17109 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER REV-73& EX AFP C09-~) DATE 11-29-Z004 ESTATE OF SHAFFER FRANKLIN C DATE OF DEATH 09-09-2005 FILE NUMBER 21 05-0992 C,~UNTY CUMBERLAND ~AC'N~:' 202 Amoun~ Remi~ed HAKE CHECK PAYABLE AND REMZT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17015 NOTE: To insure proper cred/~ ~o your account, submi~ ~he upper por~:ion of ~chis form wi~h your ~cax peymenJ:. CUT ALONG THIS LINE ~ RETAIN LONER PORTION FOR YOUR FILES ~ REV-736 EX AFP (01-02) NN NOTICE OF DETERMINATION AND ASSESSMENT OF PENNSYLVANIA ESTATE TAX BASED ON FEDERAL CLOSING LETTER ~ ESTATE OF SHAFFER FRANKLIN C FILE N0.21 03-0992 ACN 202 DATE 11-29-2004 ESTATE TAX DETERHZNATZON 1. CredAt For State Death Taxes as Verif/ed .00 Z. Pennsylvania Inheritance Tax Assessed (Excluding Discount and/or Interest) Inheritance Tax Assessed by Other Stakes or Territories of the United States (Excluding Discount and/or Interest) Total Inheritance Tax Assessed 5. Pennsylvania Estate Tax Due 6. Amount of Pennsylvania Estate Tax Previously Assessed Based on Federal Estate Tax Return .00 7. Additional Pennsylvania Estate Tax Due .00 TAX CREDITS: 7,191.69 .00 7~191.69 .00 PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID DATE NUMBER INTEREST/PEN PAID (-) ~ZF PATD AFTER THTS DATE, SEE REVERSE STDE FOR CALCULATION OF ADDTTTONAL /NTEREST. TOTAL TAX CREDTT , BALANCE OF TAX DUE INTEREST AND PEN. TOTAL DUE (/F TOTAL DUE 1S LESS THAN $1, NO PAYHENT TS REI~UTRED TF TOTAL DUE TS REFLECTED AS A "CREDTT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THTS FORH FOR /NSTRUCTTONS. .0O .00 .00 .00 PURPOSE OF To fulfill the requirements of Section ZlqO of the Inheritance and Estate Tax Act, Act ZS of ZOO0. (7Z P.S. NOTICE: Section 91q0), OBJECTIONS: PAYMENT: Detach the top portion of this Notice and submit with your payment to the Register of NilIs printed on the reverse side. -- Make check or money order payable to: REGISTER OF NILLS, AGENT. REFUND (CR): A refund of a tax credit may ba requested by completing an "Application for Refund of Pennsylvania Inheritance and and Estate Tax" (REV-ISIS). Applications ara available online at uwv.ravenue.stata.ea.u;, any Register of Hills or Revenue District Office, ar from the Department's Iq-hour answering service for forms orders: 1-800-36Z-ZO50; services for taxpayers with special hearing and/or speaking needs: 1-BO0-q~7-3OZO (TT only). Any party in interest not satisfied with the appraisment, allowance or disallowance of deductions or assessment of tax (including discount or interest) as shown on this Notice may object within 60 days of the date of receipt of this notice by filing one of the following: A) Protest to the PA Department of Revenue, Board of Appeals. You may object by filing a protest online at www.boardofappaals.stata.pa.us on or before the expiration of the sixty-day appeal period. In ardar for an electronic protest to be valid, you must receive a confirmation number and processed date from the Board of Appeals wabsita. You may also send a written protest to PA Department of Revenue, Board of Appeals P.O. Box Z81021, Harrisburg, PA 171ZB-10Z1. Petitions may not be foxed. B} Election to have the matter determined at the audit of the account of the personal representative. C} Appeal to the Orphans' Court. ADMIN- ISTRATIVE CORRECTIONS: PENALTY: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, P.O. Box 280601, Harrisburg, PA 17128-0601, Phone (717) 787-6505. Sea page S of tho booklet "Instructions for Inheritance Tax Return for a Resident Decadent~ (REV-150I) for an explanation of administratively correctable errors. The iSX tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, I996, the first day after the and of the tax amnesty period. This non-participation panaIty is appaalabIe in the same manner and in the the same time period as you wouId appeal the tax and interest that has been assessed as indicated an this notice. INTEREST: Additional Pennsylvania Estate Tax assessed as a result of a change on the Federal Estate Tax closing letter becomes delinquent at the expiration of one (1) month from the date the final notice of the increase in Federal Estate Tax is received. Taxes which became delinquent before J~nuary 1, 198Z bear interest at the rate of six (6g) percent per annum calculated at a daily rate of .00016q All taxes which became delinquent on or after January 1, 198Z will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for lgBZ through Z00~ are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor --Year Rate Factor 1982 ZOZ .0005~8 1988-1991 llX .000301 ZOOI 9Z .O00Zq7 1983 162 .OOOqS8 1992 9Z .0002q7 ZOOZ 62 .O0016q 198q llZ .000501 199S-199~ 7Z .O0019Z ZOOS 5Z .0001S7 1985 13Z .000356 1995-1998 9X .O00Z~7 ZOOq qZ .000110 1966 10~ .O00ZT~ 1999 7X .O0019Z 1987 9~ .O00Z~7 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUHBER OF DAYS DELINI~UENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated.