HomeMy WebLinkAbout12-08-0915056051047
REV-1500 EX (06-05)
OFFICIAL USE ONLY
PA Department of Revenue
County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box 28oso1
_ Harrisburg, PA 1712&0601 -~ RESIDENT DECEDENT 2 1 0 9 0 0 3 3 3
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
2 0 6 3 8 2 9 6 0 0 4 0 1 2 0 0 9 0 4 3 0 1 9 4 8
Decedent's Last Name Suffix Decedent's First Name MI
S C H E U R E N P E T E R J
(If Applicable) Enter Surviving Spouse's Inform ation Below
Spouse's Last Name Suffix Spouse's First Name MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FALL IN APPROPRIATE OVALS BELOW
®@ 1. Original Return O 2. Supplemental Return O 3. Remainder Return (date of death
prior to 12-13-82)
C7 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Return Required
death after 12-12-82)
®B 6. Decedent Died Testate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes
(Attach Copy of Wilt} (Attach Copy of Trust)
C~ 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A)
bet`aeen 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATI@1~SHOULD BE CTED T0:
Name c r-,
Daytime TelepF)nrt~lumber ~.a.
,
~
M A R L I N R M I C A L E B 7 1 7
,~ I~~ 7r`~ 7 .f~ `~
Firm Name (If Applicable) .
REGISTER'(ZfV~LS U3$'X~NLY'- }
E
e-_' ~-7 ~,-. _ ~
_.
, __
- ~.}
, ~..'
~
First line of address ~1
-- '
_
_ _
2 1 9 E A S T M A I N S T R E E T -'' .,.... ~~`%
Second line of address «_
P O B O X 2 3 0
City or Post Office State ZIP Code DATE FILED
M E C H A N I C S B U R G P A 1 7 0 5 5
Correspondent's a-mail address:
Under penalties of perjury, I declare that 1 have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATU E OF PERS _ R~ONSIBLE FOR FILING RETURN DATE r~
1--,Il~7A~iX~~/~, Executrix ~,,..~°'"~,/,' ~ L~s~
AD~RESs '3`e~esa J~ fey ' '
621,,~Georg~r->~ Place, Harrisburg, PA 17111
DATE
~-- ~P --
HIIURCJJ Iaua iaaa a.• .ate,. ~..wicar
v 219 East Main Street, Mechanicsburg, PA 17055 .~_- _.._. _. r
PLEASE USE ORIGINAL FORM ONLY
Side 1
15056051047 15056051047 ~ ~,
,~
REV-1500 EX Page 3 File Number
Decedent's Complete Address: 21 -
09 -
00333
DECEDENTS NAME
Peter J. Scheuren
__
STREET ADDRESS
6 Mellwood Lane
_.
..CITY. _ STATE ZIP
Mechanicsburg PA 17050
Tax Payments and Credits:
43, 888.09
1. Tax Due (Page 2 Line 19) (1)
2. Credits/Payments
0
00
.
A. Spousal Poverty Credit
6. Prior Payments 40, 000.00
- - - -
C. Discount
2 ,105.26
Total Credits (A + g + C) (2) 42 ,105.26
3. {nterestlPenalty if applicable
D. Interest
--- _-
E. Penalty
-- - ___ Total InterestlPenalty (D + E) (3) 0 , 00
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in oval on Page 2, Line 20 to request a refund. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1, 782.83
A. Enter the interest on the tax due. (5A) 0.00
B. Enter the #otal of Line 5 + 5A. This is the BALANCE DUE. (5B) 1, 782.83
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. retain the use or income of the property transferred :.......................................................................................... ^
b. retain the right to designate who shall use the property transferred or its income : ............................................ ^
c. retain a reversionary interest; or .......................................................................................................................... ^ 0
d. receive the promise for life of either payments, benefits or care? ...................................................................... ^ ^X
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .............................................................................................................. ^ Q
3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? .............. ^ ^X
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
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 oil death on or after July 1, 1994 and before January 1,1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spousE
is three (3) percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percen
[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 anc
filing a tax return are still applicable even if the surviving spouse is the only beneficiary.
For dates o~f 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, ar
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 it
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)J. Asibling is defined, unde
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
J
REV-1500 EX
Decedents Name: Peter J . Scheuren
Decedent's Social Security Number
2 0 6 3 8 2 9 6 0
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.
5. Cash, Bank Deposits ~ Miscellaneous Personal Property (Schedule E) ........ 5.
6. Jointly Owned Property (Schedule F) O Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) O Separate Billing Requested........ 7.
8. Total Gross Assets (total Lines 1-7) .................................... 8.
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) ................................ ... 11.
12. Net Value of Estate (Line 8 minus Line 11) ........................... ... 12.
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.
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.~ . 15.
16. Amount of Line 14 taxable
at lineal rate X .0 45 2 3 6 6 8 3. 9 8 16.
17. Amount of Line 14 taxable
2 7 6 9 7 7
5 8
•
at sibling rate X .12 17
18. Amount of Line 14 taxable
at collateral rate X .15 18.
19. TAX DUE ......................................................... 19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
15056D52D48
2 0 5 0 0 0. 0 0
0. 0 0
0. 0 0
0. 0 0
6 7 1 0 6. 3 5
0 0 0
2 7 6 9 7 7• 5 8
5 4 9 0 8 3 9 3
3 2 7 9 7. 8 4
2 6 2 4. 5 3
3 5 4 2 2 3 7
.
5 1 3 6 6 1• 5 6
5 1 3 6 6 1• 5 6
0. 0 0
1 0 6 5 0. 7 8
3 3 2 3 7• 3 1
0. 0 0
4 3 8 8 8 0 9
O
Side 2
15056052048 15056052048 J
REV-150'1. EX + (1-97)
SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
t~ i a ° t yr FILE NUMBER
Peter J. Scheuren SS~~ 206-38-2960 04/01/2009 21-09-00333
X411 real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price
at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable
knowledge of the relevant facts. Real property which is jointly-owned with ri ht of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION VALUE AT DATE
NUMBER OF DEATH
1. House and lot, - known and numbered as 6 Mellwood Lane, Silver 205,000.00
Spring Tonship, Cumberland County, PA; acquired by Decedent by
deed of The Donald L. and Janet L. Comerer Trust, dated
08/30/2004, recorded in Deed Book Volume 265, Page 3903; value
based on sale to Hung Duong and Tam Bui, his wife, on 06/12/2009.
TOTAL (Also enter on line 1, f
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc.
lation) ~$ 205 , 000.00
Form REV-1502 EX ~RP~ t_o~~
REV -150Ft EX + (1-97)
SCHEDULE E
CASH, BANK DEPOSITS, Ot M~JC.
COMMONWEALTH OF PENNSYLVANIA
IN RESIDENTDECEDENTN PERSONAL PROPERTY
ESTATE OF FILE NUMBER
PetE>.r J. Scheuren SS~~ 206-38-2960 04/01/2009 21-09-00333
In<:lude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of
survivorship must be disclosed on Schedule F.
ITEPA VALUE AT DATE
NUMEIER DESCRIPTION OF DEATH
1. Metlife Bank, N.A., - money market account ~~5001288645: principal 10,282.70
balance as of D.O.D.: $10,269.40; interest accrued to D.O.D.:
$13.30.
c! 1999 Mazda Protege DX sedan, - 4D, 130,000 miles; value based on 1,900.00
sale to Jonathan R. Nye on 06/13/2009.
?I Comcast, - refund of cable charges. 20.85
4F Highmark Blue Shield, - reimbursement for medical expenses. 655.00
-`i Household goods, contents, furniture and furnishings. 3,032.00
Ei Long Term Care Partners, LLC, - refund of premium. 75.12
7 Long Term Care Partners, LLC, - refund of premium. 538.00
8 Long Term Care Partners, LLC, - refund of premium. 54.30
51 Long Term Care Partners, LLC, - refund of premium. 10.08
1C1 Mairs and Power, - Growth Fund ~~2480007013; principal balance as 5,784.81
of D.O.D.: $5,784.81.
1]_ Richard W. Fritz Funeral Home, - pre-paid Burial Reserve Account. 2,610.51
12 State Farm Mutual Automobile Ins. Co., - refund of automobile 174.67
insurance premium.
13 State Farm Fire & Casualty Co., - refund of homeowner's insurance 33.73
premium.
14F The Patriot-News, - refund of subscription. 14.10
1`i Third Avenue Fund, - account ~~0443-XXXXXX9026; principal balance 5,798.17
as of D.O.D.: $5,798.17.
lEi U. S. Treasury, - refund of 2008 federal income tax. 780.00
li' Vanguard Individual Account - (~~09958805714 and ~~09914697393) 35,336.08
lE3 West Shore Tax Bureau, - refund of 2008 local income tax. 6.23
TOTAL (Also enter on line 5, Recapitulation) $ 67, 106.35
(If more space is needed, insert additional sheets of the same size)
Copyright (c) 1996 form software only CPSystems, Inc. Form REV-1508 EX (Rev. 1-97)
REV-1510 EX +(1-97)
(:OMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS 8~
MISC. NON-PROBATE PROPERTY
ESTATE OF FILE NUMBER
Peter J. Scheuren SS~~ 206-38-2960 04/01/2009 21-09-00333
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE THEIR
RELAATTACH A COPY OFDTHE DEEDTFOR REAL ESTATESFER.
DATE OF DEATH
VALUE OF ASSET % OF
DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE VALUE
:1 Bogle Investment 2,625.77 100.00% 2,625.77
Management, - Acct.
~k0300-009091315, payable on
death to Teresa Lafey and
Mary Ann Snyder; principal
balance as of D.O.D.:
$2,625.77.
:? Buffalo Micro Cap Fund, - 2,403.96 100.00% 2,403.96
Acct. ~~1447000592, payable
on death to Teresa Joan
Lafey and Mary Ann Snyder;
principal balance as of
D.O.D.: $2,403.96.
3 Mairs and Power, - IRA 4,310.92 100.00% 4,310.92
Acct. ~k400036046, payable
on death to Teresa Lafey
and Mary Ann Snyder;
principal balance as of
D.O.D.: $4,310.92.
~'} Scottrade Roth IRA, - Acct. 15,236.21 100.00% 15,236.21
~~71996938, payable on death
to Mary Ann Snyder and
Teresa Lafey; principal
balance as of D.O.D.:
$15,236.21.
_`i Third Avenue Management 5,249.98 100.00% 5,249.98
Fund, - Acct.
~~0443-XXXXXX4351, payable
on death to Mary Ann Snyder
and Teresa Joan Lafey;
principal balance as of
D.O.D.: $5,249.98.
Fi Thrift Savings Plan, - 24,100.08 100.00% 24,100.08
Acct. ~~0607123020432,
payable on death to Mary A.
Snyder and Teresa J. Lafey;
vested account balance as
of D.O.D.: $24,100.08.
;~ Vanguard Roth IRA, - Accts. 168,574.55 100.00% 168,574.55
~p09914697343 &
Total of Continuation Schedule(s) 54,476.11
TOTAL (Also enter on line 7, Recapitulation
(If more space is needed, insert additional sheets of the same size)
Copyright (cl 1996 form software only CPSystems, Inc.
276,977.58
Form REV-1510 EX (Rev. 1-97)
Estate of: Peter J. Scheuren
Soc Sec ~~: 206-38-2960
Date o:E Death: 04/01/2009
Continuation of Schedule G
(Inter-Vivos Transfers & Misc. Non-Probate Property)
Item Description of Property
~~
Date of Death % Decd Exclusion Taxable Value
Value of Asset Intrst
~~09917630700, payable on
death to Maryann Snyder and
Teresa Lafey; principal
balance as of D.O.D.:
$168,574.55.
8 Vanguard Rollover IRA, -
Acct. ~~88023907568, payable
on death to Maryann Snyder
and Teresa Lafey; principal
balance as of D.O.D.:
$52,090.98; accrued
dividends: $6.23.
52,097.21 100.00% 52,097.21
9 Checking Account ~~41802-11,
Members 1st FCU, - in names
of Decedent and Teresa J.
Lafey (Teresa J. Lafey
added to account on
03/05/2009); principal
balance as of D.O.D.:
$3,411.62.
10 Savings Account ~~41802-00,
Members 1st FCU, - in names
of Decedent and Teresa J.
Lafey (Teresa J. Lafey
added to account on
03/05/2009); principal
balance as of D.O.D.:
$1,967.28.
3,411.62 100.00% 3,000.00 411.62
1,967.28 100.00% 1,967.28
--------------
54,476.11
REV-1511 EX+(t-97) SCHEDULE H
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES ~
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATIE OF FILE NUMBER
Peter J. Scheuren SS~~ 206-38-2960 04/01/2009 21-09-00333
I]ebts of decedent must be reported on Schedule I.
ITEM
NUMI9ER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
l Green's Restaurant, Lavelle, PA, - funeral luncheon. 349.16
2 Richard W. Fritz Funeral Home, - payment on account of funeral 2,610.51
expense.
3 Richard W. Fritz Funeral Home, - balance of funeral expense. 986.91
Total of Continuation Schedule(s) 30.00
8. ADMINISTRATIVE COSTS:
1.. Personal Representative's Commissions
Name of Personal Representative(s)
Social Security Number(s) / EIN Number of Personal Representative(s)
Street Address
City State Zip
Year(s) Commission Paid:
2. Attorney's Fees Law Offices -Marlin R. McCaleb 13 ,125.00
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 Register of Wills 330.00
5. Accountant's Fees
6. Tax Return Preparer's Fees 475.00
7. Other Administrative Costs
:L Brett Lechthaler CGA, - appraisal of real estate. 300.00
:? Cumberland Law Journal, - advertising Letters. 75.00
:3 Freysinger Mazda-Hyundai, - repair glove compartment latch on 40.33
1999 Mazda Protege DX sedan, in preparation for sale.
~+ Gary Radabaugh Heating & A/C, - repair furnace and air 91.25
conditioning system in preparation for sale of home (06/30/2009).
5 Gary Radabaugh Heating/Air Conditioning, - repair furnace in 130.50
preparation for sale of house (07/15/2009).
Total of Continuation Schedule(s) 14,254.18
TOTAL (Also enter on line 9, Recapitulation) $ 32 , 797.84
(If more space is needed, insert additional sheets of the same size)
Coovriaht(c1t996formsoftwareonlvCPSvstems.Inc. ~.,...,ocv_~c~~ rv,.,_ ,..,,
a
Estate of: Peter J. Scheuren
5oc Sec ~~: 206-38-2960
Date o:E Death: 04/01/2009
Continuation of Schedule H-A
(Funeral Expenses)
Item Description Amount
~~
4 Richard W. Fritz Funeral Home, - additional death certificates. 30.00
--------------
30.00
Estate of: Peter J. Scheuren
Soc Sec: ~~: 206-38-2960
Date of: Death: 04/01/109
Continuation of Schedule H-B6
(Tax Return Preparer's Fees)
Item Description Amount
~~
1 Greenawalt & Company, P.C., - preparation of 2008 personal income 475.00
tax returns.
--------------
475.00
Estate of: Peter J. Scheuren
Soc Se<: ~~ : 206-38-2960
Date oi: Death: 04/01/2009
Continuation of Schedule H-B7
(Other Administrative Costs)
Item Description Amount
~~
6 Gary Radabaugh Heating/Air Conditioning, - repair furnace in 90.00
preparation for sale of house (07/23/2009).
7 Great Road Settlement Services, LLC, - real estate tax 10.00
certification fee.
8 Home Depot, - new carpet for sunroom in preparation for sale of 365.09
house.
9 Home Depot, - exterior stain and brushes for staining front and 80.39
back steps in preparation for sale of house.
10 Marlin R. McCaleb, - notary fee for deed, power of attorney, 10.00
Seller's affidavit.
11 PNC Bank, - check printing fee. 16.99
12 Recorder of Deeds, Cumberland County, PA, - PA Realty Transfer 2,050.00
tax.
13 Register of Wills, - short certificates. 4.00
14 Register of Wills, - short certificate. 4.00
15 Register of Wills, - filing Inventory and Appraisement. 30.00
16 Register of Wills, - reserve for filing Account, Releases, etc. 500.00
17 ReMax Realty Associates, - realtor's commission on sale of house. 10,250.00
18 ReMax Realty Associates, - transaction fee on sale of house. 150.00
19 Stauffers of Kissel Hi11, - three (3) scoops of landscaping mulch 125.37
in preparation for sale of house.
20 Stanley Steemer, - cleaning carpet in BR, DR, FR, LR, TV room, in 460.04
preparation for sale of house.
21 The Patriot-News, - advertising Letters. 108.30
--------------
14,254.18
REV-1512 EX+(1-97)
SCHEDULE I
DEBTS OF DECEDENT,
CO(tAMONWEALTH OF PENNSYLVANIA
T
RN
IN AND LIENS
MORTGAGE LIABILITIES
T
RE SIDE TDECEDE ,
ESTATE OF FILE NUMBER
Peter J. Scheuren SS~~ 206-38-29b0 04/01/2009 21-09-00333
Include unreimbursed medical expenses.
ITEM
NUMI3ER DESCRIPTION AMOUNT
:L Andrews and Patel, - account payable, medical. 56.70
;? Apria Pharmacy Network, - account payable, medical. 10.00
:i Associated Credit Services, - account payable, delinquent balance 104.55
owed to Citizens Bank.
~+ Harrisburg Pharmacy, - account payable, medical. 35.00
`i Holy Spirit Hospital, - account payable, medical. 400.00
Ei Law Firm of Peter J. Russo, - account payable, legal. 188.50
;7 Links2Care, - account payable, in-home nursing care. 986.48
E3 Silver Spring Township Authority, - account payable, sewer. 88.30
9 Silver Spring Ambulance & Rescue, - account payable, medical. 755.00
TOTAL (Also enter on line 10, Recapitulation) ~$ 2 , 624.53
(If more space is needed, insert additional sheets of the same size)
Copyright (cl 1996 form software only CPSystems, Inc. Pnrm REV-1579 FY ro.... , ~~~
REV-1513 EX + (9-00)
SCHEDULE ,1
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Peter J. Scheuren SS~~ 206-38-2960 04/01/2009 21-09-00333
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)~
.L Mae M. Scheuren Mother 236,683.98
404 Main Street
Lavelle, PA 17943
2 Teresa Lafey Sister 139,678.24
621 Georgian Place
Harrisburg, PA 17111
3 Mary Ann Snyder Sister 137,299.34
14 Youmans Ave.
Washington, NJ 07882
ENTER DOLLAR AMTS. FOR DISTRIBUTIONS SHOWN ABOVE ON LN. 15 THRU 18, AS APPROPRIATE, ON REV 1500 COVER SHEET
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SEC. 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
'TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV 1500 COVER SHEET ~$ 0.00
(If more space is needed, insert additional sheets of the same size)
Copyright ~c12000 form software only The Lackner Group,lnc. Form REV-1513 FY roo„ o ~re
LAST WILL AND TESTAMENT OF
PETER SCHEUREN
I, PETER SCHEUREN of 6 Mellwood Lane, Mechanicsburg ,
Pennsylvania.~17050 being of sound and disposing mind, memory and understanding,
do hereby make and declare this as my last will and testament and revoke all wills and
codicils heretofore made by me.
FIRST
I direct the payment of my debts and expenses of my last illness and funeral from
my estate as soon after my death as conveniently maybe done.
I authorize my personal representative to expend reasonable funds from my estate,
in such amount as my personal representative shall consider necessary and desirable, for
the purchase, erection and inscription of a suitable marker for my grave.
I direct that my remains be cremated and my ashes disposed of as my personal
representative sees fit.
SECOND
a. I give my mother, Mae M. Scheuren, my house located at 6 Mellwood Lane,
Mechanicsburg, Pennsylvania and whatever automobile(s) is/are owned by me at the time
of my death.
b. I give the proceeds of mynon-retirement fundsAmutual funds
p~ o my sisters, Teresa Lafey and Mary Ann Snyder, share
-'~' r J ~ and share alike.
3~IJ~~c~ THIRD
I give all the rest, residue and remainder of my estate real, personal or otherwise,
;,~to my .
~" /~to fi~u~~ il? /~~ ~ . ~c~tv 11.E
~L;~s~"~`v9
FOURTH
I direct that any and all inheritance, estate and transfer taxes imposed upon my
estate passing under my will or otherwise, shall be paid out of the principal of my
residuary estate.
FIFTH
Any and all payment or payments of any sums or sums, whether in cash or in kind
and whether from principal or income, payable to my beneficiaries, or any of them, shall
be made upon the sole receipt of the respective individual to whom the payment is made,
and free from anticipation, alienation, assignment, attachment, and pledge, and free from
control by the creditors of any such beneficiary. All shares of principal and income
herein given shall be free from anticipation, assignment, pledge or obligation of any
beneficiary, and shall not be subject to any execution or attachment.
SIXTH
Finally, I nominate, constitute and appoint my sister Teresa Lafey Executrix of
this my last will and testament. I hereby relieve my Executrix from the necessity of
posting security in connection with her duties as such in any jurisdiction in which she
maybe called upon to act insofar as I am able by law to do.
IN WITNESS WHEREOF, I have hereunto affixed my hand and seal to this, my
last will and testament.
This 5th day of March, 2009.
(SEAL)
ERSCHEUREN
Signed, sealed, published and declared by the above-named Testator, Peter
Scheuren as and for his last will and testament in the presence of us, who, at his
request, in his sight and presence, and in the sight and presence of each other, have
yes.
Signature
~~ .
`~.~~ ~ - Ica r~~ ~r
Address
2
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF CUMBERLAND
ss
W e, Peter S cheuren ~ p~ ~ . ~p~ AND
~~~ ~,~~ ,the Testator and the witnesses, respe ively, whose names
are signed to the attached or foregoing instrument, being first duly sworn, do hereby
declare to the undersigned authority that the Testator signed and executed this instrument
as his last will, and that he signed willingly, and that he executed as his free and
voluntary act for the purposes therein expressed, and that each of the witnesses, in the
presence and hearing of the Testator, signed the will as witnesses, and that to the best of
their knowledge, the Testator was at the time eighteen (18) years of age or older, of sound
mind, and under no constraint or undue influence.
V~v1
j Witn~ •
~/
Witness
Sworn or affirmed to and acknowledged before me, this 5th day of March, 2009.
o a Pu ~c
COMMONWEALTH Op PENNSYLVANIA
MarAar~t A, Strawser Notary Public
~' ~Hartisbur9~ Dauphin County
E~ires Aug.10, 2010
Member, Permeylvanla Aseoclatlon of Notarlee
P.O. Box 6892
Bridgewater, NJ 08807
Marline R mcCaleb
RE: Estate of Peter J Scheuren
219 East Main St
P O Box 230
Mechanicsburg, PA 17055
etl.~fe
MetLife Bank, N.A.
,April 20, 2009 ~ RE: Account Number 5001288645
Dear Sir/Madam,
Thank you for notifying MetLife Bank of the death of account owner Peter J Scheuren. We would like
to extend our condolences to you at this time.
f'er your request {fisted below is the date of death balance of April 1, 2009 for the Decedent's
Account(s).
f~ccount Number
~i001288645
Amount
10, 269.40
Please be advised that MetLife Bank cannot make any changes to the above account(s) until we
receive the original required documents.
If you have any questions, please call one of our Banking Advisors toll free at 1-866-BankMet
(1-866-226-5638).
Sincerely, ,
MetLife Bank Customer Service
`'c`~"J°"` Member FDIC
SCHEDULE E, Item 1
P.O. Box 6892
Bridgewater, NJ 08807
Marlin R McCa{eb
RE: Estate of Peter J Scheuren
219 East Main St
Mechanicsburg, PA 17055
etLif e
MetLife Bank, N.A.
June 18, 2009 RE: Account Number 5001288645
Dear Sir/Madam,
'T'hank you for notifying MetLife Bank of the death of account owner Peter J Scheuren. We would like
i:o extend our condolences to you at this time.
Per your request listed below is the Accrued interest as of April 1, 2009 for the Decedent's
Account(s).
Account Number Amount
5001288645 Accrued interest $12.15
Please be advised that MetLife Bank cannot make ary changes to the above accounts} until we
receive the original required documents.
I~f you have any questions, please call one of our Banking Advisors toll free at 1-866-BankMet
(1-866-226-5638).
Sincerely,
MetLife Bank Customer Service
c~~ct_~:,r-,ar:~:- Member 1=DIC
SCHEDULE E', Item 1
LAW OFFICES May 11, 2009
MARLIN R. MCCALEB
FRANKEBERGER PLACE
219 EAST MAIN ST.
PO BOX 230
MECHANICSBURG PA 17055-0230 ,
REFERENCE NUMBER: 00349713
BUFFALO MICRO CAP FUND
ACCOUNT NUMBER: 1447000592
GREAT PLAINS TRUST CO TTEE
PETER J SCHEUREN ROTH IRA
Dear Mr. McCaleb:
This letter is in response to your recent request regarding the distribution options available to the
beneficiaries of the above referenced IRA account in the name of Peter J. Scheuren.
Our records show that Teresa Joan Lafey and Mary Ann Snyder are the non-spouse primary
beneficiaries with each receiving half of this IRA account. Anon-spouse beneficiary has the
following options:
Lump sum distribution
• Payments over a five year period
Payments over the life expectancy of Teresa Joan Lafey and Mary Ann Snyder, non-
recalculation
SCHEDULE G, Item 2
'To effect the distribution, the following items are required:
A letter of instruction, signed by Teresa Joan Lafey and Mary Ann Snyder and signature
guaranteed, which contains the following information:
o The payout option
o Instruction as to where to distribute the proceeds
o Instruction as to when (month and date) to distribute the proceeds
o A statement of withholding, indicating whether or not to withhold federal tax (state
withholding may apply)
A completed IRA application to the Buffalo Funds completed by the beneficiaries ifthey
choose to maintain their portion of the account.
A completed W-9 Form, completed by the benef ci:.ries ifthey choose the lump sum
distribution option.
This letter is proof of Teresa Joan Lafey and Mary Ann Snyder's claim to the assets. Teresa Joan
Lafey and Mary Ann Snyder should take this letter with when obtaining the signature guarantee.
A signature guarantee can be obtained at many commercial banks, credit unions, savings
associations or broker dealers. A notary public is unable to provide an acceptable guarantee.
The following table shows the value of the account as of the close of business on April 1, 2009:
Date Number of Shares Net Asset Value Total Value
04/01/2009 540.216 $4.45 $2,403.96
__ I
If you have any questions, please contact our Shareholder Services Department between 8:00
a.in. - 7:00 p.m. Central Time Monday through Friday at (800) 492-8332 or you may contact us
at the address stated on the enclosed envelope. We appreciate your confidence and investment in
the Buffalo Funds.
Sincerely,
M aY~xe.~- ~! . t~o~. Sto~c.~c ha.~.~~~ew
U.S. Bancorp Fund Services, LLC
As Transfer Agent for the Buffalo Funds
Enclosure(s): IRA Application
W-9
IRA Application
W -9
SCHEDULE G, Item 2
grade
~co
MEMBER FINRA/SIPC
12800 Corporate Hill Dr.
St. Louis, MO 63131-1834
314-965-1555 1-800-888-1980
June 1, 2009
Marlin R. McCaleb
Frankeberger Place
219 East Main Street
Mechanicsburg, Pennsylvania 17055
717.691.7770
Re: Estate of Peter J. Scheuren
Scottrade Account: 71996938
Dear Mr. McCaleb:
Thank you for your correspondence dated May 26, 2009.
The value of this account as of March 31, 2009 is available under the "Account
Summary" portion of the March 1, 2009 to March 31, 2009 statement. We only have
monthly account statements available and are unable to provide you with an exact date of
death value regarding the above referenced account.
In addition, we previously provided a copy of the "Transaction Summary" which
indicates there was no interest accrued from April 1, 2009 through May 20, 2009.
Thank you.
ery yours,
Corporate Paralegal
SCHEDULE G, Item 4
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SCHEDULE G, Item 4
Page: 1
~~r~~~~
More ttrak®r for your morray.
SCOTTRADE INC CUST FBO
PETER J SCHEUREN ROTH IRA
F'O 80X 419
LAVELLE PA 17943-0419
SCOTTF2ADE, INC
500 N THIRD ST #100
HARRISBURG, PA 17101-1111
(717) 234-4040
71996938 I 37D
03 / 01 / 2009 I 03 131 ! 2009
Iptional Dividend Reminder -optional dividends allow shareholders to choose between cash or stock for their dividend payment.
If the shareholder does not specify a preference, Scottrade will pay the dividend based on the issuing company's default selection.
1Jisit Scottrade's Knowledge Center for additional information on this and other investment topics.
VALUE THIS PERIOD OPENING BALANCE 1.43
CREDITS:
\/ALUE SECUR{TIES 1N POSITION 15,234.78
DIVIDEND/INTEREST INCOME 39.55
1,AONEY BALANCES : TOTAL CREDITS 39.55
DEBITS:
BROKERAGE ACCOUNT BALANCE 1.43 OTHER DEBITS -39.55
TOTAL MONEY BALANCE 1.43 TOTAL DEBITS -39.55
TOTAL ACCOUNT VALUE 15,236.21 CLOSING BALANCE 1.43
S
Estimated Market Estimated Annual
Symhol !
Type Cusip Quantity Description Price Vatue % Income Cur. Yld
CASH BRSIX 213.325 BRIDGEWAY ULTR SM CO MKT FD 8.39 1,789.80 11.75
CASH HSGFX 385.302 HUSSMAN STRATEGIC GROWTH FD 13.09 5,043.60 33.11 9.63 0.2
CASH MERFX 329.21 MERGER FUND 14.68 4,832.80 31.72 99.42 2.1
CASH PCRDX 575.578 PIMCO COMMDTY REAL RETRN 6.20 3,568.58 23.42 458.16 12.8
STFtAT D
TOTAL 15,234.78 100
Date Transaction Quantity Description Price Amount Balance
OPENING BALANCE 1.43
03/19/09 DIV REINVESTMENT 6.278 PIMCO COMMDTY REAL RETRN -39.55 -38.12 i
STRAT D PCRDX
REINVEST PRICE $6.300 ~i
03i19l09 TAXA6LE DIVIDEND 0 PIMCO COMMDTY REAL RETRN 39.55 1.43
STRAT D PCRDX ~
DIVIDEND ON 569.300 SHS@ .069
CLOSING BALANCE 1.43
SCHEDULE G, Item 4
Page 1 of 2
Household contents, estate of Peter J. 5cheuren
Contents to be sold via ad in newspaper Value
Laptop computer w/wireless router (purchased 2009) 500.00
Television w/stand (purchased 2004) 250.00
Desktop computer w/printer (purchased 2004) 100.00
Snowblower (used, purchased from co-worker) 100.00
Ladders, 2 fi0.00
Push lawnmowers, 2 (one runs, one doesn't) 50.00
Leaf blower 15.00
Contents to be donated to Salvation Armv or Goodwill
Sofa (purchased used from neighbor) 50.00
Dining table w/4 chairs, wood (used, from sister) 50.00
Recliner (purchased used from neighbor) 40.00
DVD/VHS movies 40.00
Writing desk, wood veneer 35.00
Desk (purchased used from neighbor) 35.00
Office-chair 35.00
Bookcases, 3, composite wood 30.00
Bed frames, 2, (full -and twin) 15.00
Rocking chair, wood (used, from friend) 10.00
Kitchen table w/4 chairs, metal (used, from friend) 10.00
Table w/ceramic the top (used, from co-worker) 5.00
Coffee table, wood (used, from mother) 5.00
End tables, 2, wood (used, from mother) 5.00
Nightstands, 2, round particle board 5.00
Metal 2-drawer filing cabinet 5.00
Bedspreads, towels 20.00
Lamps, 4 14.00
Pots/pans 10.00
Dishes (Corel)/ glasses 10.00
Flatware 5.00
Vacuum cleaner (used) 5.00
Plastic outdoor chairs, 2 4.00
Shovels, 2 6.00
Rake 3.00
Pick 5.00
SCHEDULE E, Item 5
Page 2 of 2
Contents already donated
Clothes (to Goodwill) 500.00
Police Uniforms, Coats (to Cumberland Army Depot) 300.00
Books (Mechanicsburg library book drive) 500.00
Walkers, 2 (Vl/orld Surgical foundation) 100.00
Nebulizer (Vl/orld Surgical foundation) 50.00
Med supplies, bandages, enteral food (Central Pa Hospice) 50.00
Total $3,032.00
Contents to be disposed of via trash hauler $300.00 fee
Mattress/box spring (full size)
Mattress/box spring (twin size, 2 sets)
Wood in basement from old deck
Vinyl siding scraps in basement
Contents to remain with house qer sales a~eement
Refrigerator
Range
Dishwasher
Microwave
Washer
Dryer
Lighting fixtures & ceiling fans
Window treatments
SCHEDULE E, Item 5
C~bancorp®
Fund Services, LLC L?
615 E Michigan Street
Milwaukee, WI 53202
LAW OFFICES Apri121, 2009
MARLIN R MCCALEB
ATTN MARLIN R MCCALEB
FRANKEBERGER PLACE
219 EAST MAINT STREET
PO BOX 230
MECHANICSBURG PA 17055-0230
REFERENCE NUMBER: 00348075
MAIRS AND POWER GROWTH FUND
ACCOUNT NUMBERS: 4000360466,
2480007013
PETER J SCHEUREN
Dear Mr. McCaleb:
This letter is in response to your recent inquiry regarding the distribution options available to the
beneficiary of the above referenced IR_A account in the name of Peter J. Scheuren.
Our records show that Teresa Lafey and Mary Ann Snyder are the non-spouse primary
beneficiaries of this IRA account. Anon-spouse beneficiary has the following options:
• Lump sum distribution
• Payments over a five year period
• Payments over the life expectancy of Teresa Lafey and Mary Ann Snyder, non-
recalculation
To effect the distribution, the following items are required:
• A letter of instruction, signed by Teresa Lafey and Mary Ann Snyder and signature
guaranteed, which contains the following information:
o The payout option
o Instruction as to where to distribute the proceeds
o Instruction as to when (month and date) to distribute the proceeds
o A statement of withholding, indicating whether or not to withhold federal tax (state
withholding may apply)
• A completed IRA application to the Mairs and Power Funds for Teresa Lafey and Mary
Ann Snyder
• A completed IRS W-9 Form, if the lump sum distribution option is selected
A signature guarantee can be obtained at many commercial banks, credit unions, savings
associations or broker dealers. A notary public is unable to provide an acceptable guarantee.
SCHEDULE E, Item 10
SCHEDULE G, Item 3
**~
The following table shows the value of the account 4000360466 as of the close of business on
April 1, 2009:
Date Number of Shares Net Asset Value Total Value
04/01/2009 94.166 $45.78 $4,310.92
To liquidate or change the registration of account 2480007013, we will require:
• A letter of instruction signed by the Personal Representative of the Estate. The signature
must be guaranteed. The signature guarantee requirement is to ensure that the
Representative has authorized this transaction to occur. You may obtain a signature
guarantee at many commercial banks, credit unions, savings associations or broker dealers.
A notary public is unable to provide an acceptable guarantee.
• Letters Testamentary appointing the Personal Representative, dated by the court no later
than 60 days from the request to transfer or liquidate.
• A completed W-9 Form giving the Estate's tax identification number.
To change the registration, please also complete the enclosed application for the new
registration.
The following table shows the value of the account 2480007013 as of the close of business on
April 1, 2009:
Date Number of Shares Net Asset Value Total Value
04/01/2009 126.361 $45.78 $5,784.81
Please return all necessary documents in the enclosed envelope.
SCHEDULE E, Item 10
SCHEDULE G, Item 3
If you have any questions, please contact our Shareholder Services Department between 8:00
a.m. - 7:00 p.m. Central Time Monday through Friday at (800) 304-7404 or you may contact us
at the address stated on the enclosed envelope. We appreciate your confidence and investment in
the Mairs and Power Funds.
Sincerely,
Stay Gino-w~v
U.S. Bancorp Fund Services, LLC
As Transfer Agent for the Mairs and Power Funds
Enclosure(s): IRA Application
IRA Application
Taxable Account Application
W-9
W-9
W-9
SCHEDULE E,, Item 10
SCHEDULE G, Item 3
**
THRIfT
SAVINGS
PLAN
5/29/2009
Marlin R. McCaleb
P.O. Box 230
Mechanicsburg, PA 17055
Re: Peter J. Scheuren
Dear Mr. McCaleb:
Thrift Savings Plan
P.O. Box 385021
Birmingham, AL 35238
This is in response to your letter to the Thrift Savings Plan (TSP) requesting information
regarding the TSP account of Peter J. Scheuren.
The TSP is one part of the retirement system created for Federal employees in the Federal
Employees' Retirement System Act of 1986 (See S U.S.C. § 8351, §§ 8401-79). The TSP is a
tax-deferred retirement savings plan similaz to those authorized under section 401(k) of the
Internal Revenue Code for private sector employees. The TSP began accepting contributions
from Federal employees in April 1987 and from members of the Uniformed Services in January
2002.
TSP accounts are valued on a daily basis at the end of each business day. As of April 1,
2009, Mr. Scheuren's TSP account balance was $24,100.08.
There were no loans issued on Mr. Scheuren's TSP account.
Sincerely,
~c,~d., ,~&,,,,.'
Mrs. Linda Dean
Chief Correspondence Officer
Signing on behalf of
Pamela-Jeanne Moran
Director, Office of Participant Services
Enclosure(s): Original Correspondence
ThriftLine: 1-TSP-YOU-FRST (1-877-968-3778)
Web: vrww.tsp.gov TDD: 1-TSP-THRIFT5 (1-877-847-4385) Fax: 1-866-817-5023
SCHEDULE G. Item h
'~Z[~~RSy71.LE SAFE DEPOSIT B a~x .•~~-D TRliST CO'~ZP.~.~"Y
~1~'ERSt,~. LE. PE\TSYZt~A'~7A 1'?5~
?iL~P Y.-~L RESER~`E .~'~CGL~'i
This a~reer,?Cit ~~:c: -= ~.:c t~s 30thdo e _March -~ 09 .by znd
bets°een Richard W. Fritz ;-'Merl Hone, \\•iv7 ;ts pr:rcip2] ~]zce Gf busi_ness Joc2ted at
Ashland CGL'nly Oi SCbuVI}:al. CC:~OG~.'eai;r: of Pe:~Svl\'2;772, •bere;a2fieI refer; ed :0 2S
ii
"Funeral Director'°znd Peter SCheuren
oftbe (berou2h_ cii~~, to~~?ship)ef Mechanicsburg . State of PA
;?ereirJz:=,er refe;Jed io zs "Buyer."
'~'~^Gtre2s, Buyer ve5'u`e5 :o :-..; ~i0 27 ar'aJ°_°_1T.'eJt +';~n Funeral Director to D7er2\
and pro\'iCe i0r ite - .";lent C1-211 }"ia;~'it7 ;~C:PI e?'.tnse~ GC =.~:Ge:~:cl CXte:'SCS c55
ociaied i~ere~~_t7.
C:iO7 i0 Buyer ~S GeZ_. v.'C7Ch S°.^. , :5 axe t0 DC =ro\';GeC v\'`EGCi periGr:ned by Funeral Direcio, 'ollo•~~.~E
i!]e Ct2th C'i :tee ^' ei 7.n CCCCru2.LCe'•\=:~ ..-...:.-:. 8er'..._is ..emsVeen 52_'G Bll1'er ZnG i.7~ ~ •-
' "~" ~ Funera• Director,
Sa;dariiiE°m:~!; _C!uGCScn Z^7ecG'utOi~ SJ:T:' _C.: 2.....L-~; 5.7Z1~ .:e deliVe,'ed to :~: ~liners\'i]le Szfe
Deposit Bank and Trust Company as Custodian or t_^e ~a•~-e ,t of said ;t~,e;:a e>:penses z:;d :LC;de,tz,
COSL, SubltCi'.0 iLe :e~S 2r7d CGP.Cii?0^5 cS _~, :G`_7 nere:n.
,.
Lai ]y 2i-,d fOI Llie C'~:JS7dera i": CMG Gi ine i::L'':L'Z' CGl [n2 t5 neren~
cont2ineti t}:e r.2; des •ereb',~ a`-e~ zs fol:o''~,s:
1. . he Funeral Director •,:;]l St7?,~'\' 1^e BU1'er'.>^111 ~??'ie721 SeI>'i=e5 2c Set f0)-i.'] ;n
2 ~ep27i:ie a~eemenI, 2 CODti of SJC!)'aill ~.°. i7]2iiii27ned G'J the Bu\'er 2nd sc;G
Funeral Director. ,~~
7
~~ ~. ~--~ ~ L,-c Q~ . J, .~ r D d
2. T be su_-r1 0~`~~' ~ . ~ ,~ji• ~ `z=~''`~,•~~/~~.. (5 ~~~ ~ ) sh_i] be
placed in 2n LJteresi I)C~: ~~C? aCCC'ui \\ii7i t!'iC ? Inerst~ille Safe Deposit Eai7iC
and Trust Compam-_ as Custodian, 2nd s:;211 be desi~n2ied 2s tl7e
pet~~SCheuren (8;:.:er) ?re-azid Funer2l Fund.
T:7e Pre-paid Ftiner2i : end ;hz]1 ;:-min on deposit •.:;th t:7e Custodian. i-7 za
L'7iCrest bezr.~Q cCCO'~i £i i=~ ~:'c" 7]le <'2 Dep OS' ~ ^d T^`c
Company and shill re-zi.-J L'7 s~c~ _.;ere~i be2:irJ2 zcco„~T7tt_^,tiJ :he de2ih oft
$uyer cCd7:c'~ iL.... ~~ ~\' ~,. . ,~:i`c\t~ L. the Funeral Director L"~0:7
present_:;o~ n; ~.A D--~.~~ Ce...:,__._ cf ~,.. B, er =- --"=°-d b: L':e Pe.-.L~'' _-.~
,.• ~ .,=
DepZ7rnen: C•f :..ecl,;'., Bureai7 Oi ''~•ii27 S:aiu5;~C5, ce; i?7;~r~ 2s to L:~ dLZi'7 ~:
the B u~-er, and G. .l •'' or :.Le u]] a--:o-~a ;...: eef znd not iJ-7 pint.
a. L'pon the dezth of Bu\•er: the ;,L:d sLz]) i:e deli•,~ered to •ue Funeral Director
by the Custodian zs pz.,-•ent ;o''\~zrd the cost Gf ii7e Funeral Services.
d. it is hereby zgreed by'Je p.z:~es t:2t i:;e Custodian is o: ]y the rerosiiory~ of we
IUnd 'end 15 not 7e5pon.iC]e ?-OZ L}~~ i~Jfl]ln?eni OI ine coniT2ct entered LT]10
bet\\•een the Funeral Director znd the Buyer, 2nd the Custodian shill not be
responsible for zpplica~on of we ;,. -'ds upon the \\'it?7drz\\~zl by or ra,m_?e:Jt of
the Funeral Director, i:_e responsibilii:es of L'7e Custodian shill lern-l;na,e.
6. Tl7e interest ezrned on ;te zccou:;i s:7zll be added to znd become pint of the
fund, zna shill e\'enrazily be disrosed Of lP i13e i77Z^yZier contemplzted znd
provided s Pzrze-rapb ; cf Ihis co ~azct.
SCHEDULE E, Item 11
7. Lpfl~ ioe deat:~ Di )'~'e B ~~ er, i~ We e\'er~t the 7:..-:d shzi] exceed the costs
COL";; eD tip j~ r".'iCie u~ 5.":'''7CC5 25 fei i0i ~ LTl i'C il:DC72j C05L 2,: °_Ti2C:.~`..'
en~ercd i~~o bera•eea ~i'DE7AI Dli _°CiGr ::rJd T~~~\'°. r. 2;)V $L`7~]L)S ST,2~~ re 2.,^,rj)Cd
i0 ue :_.. ; i ~ ~:1`;~l CCS'S; 0: D seI ~=V :.. "e~.jec ' ,irD ]''2\' }~~Vt :'CC'~~ Cu
S1:~Ce .^e `ll •'] \;~2_c esiF.,..:che0, CST C. "~ D;' ~ JI]P.I'2j DirECIDr ;D the ES;:.... Oi
:be Pv~.~:-.
£. T,~s G<<•EI7JEP.l ~__^...l1 ,.~ .~..'~Q ~'~DJ we ~_.: 5, LO:::liJSi?c 0.5 Vii: CCeISCiIS cuD
!G. ! JA •t.L .. ..: C)CeG .:'E:C .. :O 1...C .C: JI1~ L.i lJ~ CD-'CiI~C[ t COQ'.-i GI I~~C~ .~•Fj P~: ~: G=CJ
/~.~:._... _ C.. .t7 _: 1,.'~ ~c..__-CC .h.° :\~_: ~-C\~~~:e CG:e L,e~'~S)t ~2~ G.1D ! J L:CI
r' V ~~ ~ ~
f ~ ~ ~ , ~` - ~! ~,11i~%'''~
' Peter Scheuren
. / ~. ~_
~_ '~C ~C --~`- a''= `r 404 Mai,z St . P.O. Box 419
dc:e.ss
.;cc,ess
.ACCEPTED BY CtSTODI.~~:
~~~RS~ZLLE S.aFE DEPOSIT B ~ ~K :~~~i TRZST CO~TP,S..~Y
e, PA 17943
BV $i£T''''~'"'< <'_'~.. :Je.^.1 ~S ::_ ..J:i\'ei ~~t ~C.. :C°- =-2jh~ Oi ~c'.;+ i~Pl 1 ...~,'e SL'='i,j)E'0 'u'.e
ca.-ect Tax is ~....ta~c~ \.~,_, :.e::o ,-.. 5a. , a_c .:a I L... c i:.S. ci..~c:i a,-.'~ ~:zt ' c._...-:J) _.. -- c, ,o
~~ ~ ~~,,''1i,,G~,yr'~ 206-38-2960 _
Bu~•er ` ~ Soc~] Security'~'umber
SCAEDUIJE E, Item 11
~N~
GLOBAL INVESTMENT
SERVICING
April 24, 2009
LAW OFFICES
MARLIN R MCCALEB
FRANKEBERGER PLACE
219 EAST MAIN STREET
PO BOX 230
MECHANICSBURG PA 17055
RE: Third Avenue Management
Reference Number: 9568862867(1097226
Account: (.1443-XXXXXX43 51
Registration: PFPC TRUST CO CUST ROTH IRA OF
PETERJSCHEUREN
Account: 0443-XX~~XX9026
Registration: PETER J SCHEUREN
Dear Attorney Marlin R. McCaleb:
This letter is in regard to your recent correspondence
As of the close of business on April 1, 2009, account number 0443-XXXXXX4351, was valued
at $5,249.98. This value is based on a balance of 422.704 shares at the Net Asset Value (NAV)
price of $12.42 per share.
As of the close of business on April 1, 2009, account number 0443-XXXXXX9026, was valued
at $5,798.17. This value is based on a balance of 466.841 shares at the Net Asset Value (NAV)
price of $12.42 per share.
Changing market conditions may cause the NAV price to fluctuate on a daily basis. Therefore,
the account value is subject to change. Please be advised that the accrued interest is not
applicable on the above referenced accounts.
Please note that the primary beneficiaries on account number 0443-XXXXXX4351, are as
follows:
Mary Ann Snyder 50%
Teresa Joan Lafey 50%
SCHEDULE E, Item 15
SCHEDULE G, Item 5
In order to redeem the above referenced accounts, we require the following:
• A letter of instruction clearly stating the desired transaction signed by the Executor/
Executrix beneficiaries. The letter must include the account number, the account
registration, and the capacity in which the ExecutorBxecutrix/beneficiaries are acting. In
addition, the signatures must be in original form, as photocopies are not accepted.
• The signatures on the letter must be Medallion Signature Guaranteed. The purpose of
the Medallion Signature Guarantee is to protect the shareholder against the possibilities
of fraud. Please see the enclosed for instructions regarding the Medallion Signature
Guarantee.
• To redeem/liquidate the accounts, we ask that the enclosed Forms W-9 be completed,
signed, and dated.
• An original Affidavit of Domicile be completed and signed in ink by the Executor/
Executrix beneficiaries. The form must indicate the state of domicile or permanent
residence for the decedent, capacity of affiant (individual supplying the affidavit),
decedent's name as it appears in the account registration, and identification of the fund
and account. The form must be notarized with an original signature of the notary public,
and bear the notary stamp or seal.
An original Inheritance Tax Waiver for Pennsylvania, if required by the state of residence.
The Inheritance Tax Waiver must be prepared by the county clerk or appropriate state
office and display the official state letterhead. Also, the waiver must refer to the specific
number of shares in the account as of the date of death.
Upon receipt of the above item in good order, we will promptly comply with the request. In
order to expedite your request, please indicate Reference Number 9568862867/1097226 in your
future correspondence. Enclosed is a reply envelope for your convenience.
If you have any questions, please contact Shareholder Services at 1-800-443-1021. Our
representatives are available Monday through Friday between 9:00 a.m. and 7:00 p.m.
Eastern Time and will be pleased to assist you. We invite you to visit our website at
www.thirdavenuefunds.com.
Sincerely,
Donna L. Crump
Sr. Investor Services Specialist
Enc.
SCHEDULE E, Item 15
SCHEDULE G, Item 5
Vanguard®
July 10, 2009
TERESA LAFEY
621 GEORGIAN PLACE
HARRISBURG, PA 17111
Re: Peter J. SCheuren
Dear Ms. Lafey:
Po. Box zsoo
Valley Forge, PA 19462-2600
www.vanguard.com
We are responding to your telephone call requesting a valuation of
Peter J. Scheuren's Vanguard accounts on April 1, 2009. The information
requested is included on the enclosed account value reports. _
If you have any questions, please call Vanguard Voyager ServicesT"^ at
800-284-7245. You can reach us on business days from 8 a.m. to 10 p.m. and on
Saturdays from 9 a.m. to 4 p.m., Eastern time.
Sincerely,
~~~
Debbie Nelson
Transition Specialist
Enclosure(s): **Account Value Report for Peter J. Scheuren
51249542
~- ~ 3 .,. e,.....r ~. r. N i.. 6,rr ~~. t r :,.
SCHEDULE E, Item 17
SCHEDULE G, Item 7&8
Peter J. Scheuren
404 Main St
PO Box 419
Lavelle, PA 17943-0419
Page > 1 of 3
W ~~~
w Vdli~Ldt'd fi
ReQOR~fO ~,~S.EEi~~ ~J~~~ _ ..
Voyager Services: 800-284-7245
Total report value: $256,007.84
(Total report value includes any accrued dividends.)
. _ . ,:
F'eter;l .Scheufien-lndivitl_ual;Account ~ ~: ~ ~ ~ ~ _' _ ,
~,c~oun"t a~~e summary ~ a.. ~ ~_.e m m ~ ~ _ ._' ,.
Nah~1c _- .. _
Fund & ~+~s.~ll'lt ~ Ga:r~ ~ Pnce Per Accrued
. Number Opened: i Shares ~ 'Share 'Value"'. Dividends
Total Int'I Stock Index 0113-09914697393 07/31/2002 ~ 1,412.165 $9.63 $13,599.15 -
N1id=Cap index Fund 'Inv :0859--09.9'141;J7893 07/31l200.2I ,. 1,67.342 $10..94- $11;676,72 -
500~Index Fund Inv 0040-09958805714 07/31/2002 134:729 $74.67 ~ $10,060.21 -
Totals . $35;3~6:tf8 $DQO
_ -- _ _
Uoesn't include accrued dividends.
1711481370 07/10/2009 08:57:13
SCHEDULE E, Item 17
SCHEDULE G, Item 7&8
Peter J. Scheuren
404 Main St
PO Box 419
Lavelle, PA 17943-0419
~,~ Page > 2 of 3
" Vanguard'
Voyager Services: 800-284-7245
Total report value:_ _ $256,007.84
(Total report value includes any accrued dividends.)
Peter J. Scheuren --Roth IRA;
Account;vaiue summary
Name ~ Fund & Account Date I Price Per Accrued
Number Opened Shares i Share Value* ~ Dividends
Small-Ca Value Index
P 0860-09914697393 03/20/2000 I 674.6751 $8..51 $5,741.48 -
E:tne>•ging Mkts Stk Idx Inv
:D~3'3-09914697393
04/24/2001 _ i
i 607.928 j X15.39
~ $9,356.01
-
E:xtended Mkt Index Inv 0098-09914697393 12/02/2008 I 961.617 I $21.84 I, $21,001.72 -
Utternatl Explorer Fund 0126-09914697393 01/12/20.04 ~ 561.411 $8:82 $4.,951:65
F'RIMECAP Core Fund 1220-09914697393 07/07/2006 897.558 $8.73' $7,835.68 -
F;EfTindex i=und Inv 0123-09914697393 D3/02/1998 685.390 $8:00 $5,483:12 -
Tetal Int'I Stock Index 0113-09917630700 1 12/24/2007 1,964.209 I $9.63 $18,915.33 -
International Value Fund 0046-099't7630700 04/04!2001 293.440 $2D:88 $6,'127;03 -
Health Care Fund Inv 0052-09917630700 04/20/1998 128.992 $93.44 $12,053.01 -
500Index Fund Inv. 0040-'09914fi97393 12102/2008- 947.476 $74:67 I $70,748;03 -
Vllindsor It Fund lnv 0073-09914697393 03/20/2000 375.309 $16.95 ! $6,361.49 -
Tntatls 5168,574.55 50:00
include
1711481370 07/10/2009 08:57:13
SCHEDULE E, ,Item 17
SCHEDULE G, Item 7&8
Peter J Scheuren
404 Main St PO Sox 419
Lavelle, PA 17943-0419
Page > 3 of 3
~~~ ~ 1Jan and g'
_ ~
Report for,04/01/2609 e , ._ , '
Voyager Services: 800-284-7245
Total report value: $256,007.84
(Total report value includes any accrued dividends.)
Feter J.$cheuren -•Rollover IRA
Account value summary
Name. _
500 Index Fund Adm
500 Index Fund Inv
E;dended Mkt Index Inv
Tr74a11nt'I Stock Index
Total Bond Mkt Index Inv
include accrued
Fund & Account
Date i
} i
Pnce f'er
Accrued
Number Opened 5itares Share Value* Dividend;
0540-88023907568 02(26(2008 0.000 $74.67 $0.00 -
004D-88023907568 11/26/2007 0.000` $74:67 $0:00 -
0098-88023907568 11(2612007j 0.000 $21.841 $0.00 -
0113-88023907568 II
11/26/20071 0.000 $9.63; $0.'00 -
0084-88023907568 11/26/2007 ; 5,152.421 $10.11 I $52,090.98 $6.23
--
Totals $52;090.98 $6.23
1711481370 07/10/2009 08:57:13
SCHEDULE E, Item 17
SCHEDULE G, Item 7&8
B PNC
GLOBAL INVESTMENT
SERVICING
May 18, 2009
MARLIN R MCCALEB
FRANKEBERGER PLACE
219 E MAIN STREET
PO BOX 230
MECHANICSBURG PA 17055-0230
RE:
Reference Number:
Account(s):
Registration:
Dear Attorney McCaleb:
Bogle Investment Management
9569136295/1126530
0300-XXXXXX1315
PFPC TRUST COMPANY CUST FBO
PETER JOSEPH SCHEUREN ROTH IRA
This letter is in regard to the above referenced account.
As of the close of business on April 1, 2009, the above referenced account was valued at $2,625.77. This value
is based on a balance of 280.831 shares, at the Net Asset Value (NAV) price of $9.35 per share. Changing
market conditions may cause the NAV price to fluctuate on a daily basis. Therefore, the account value is subject
to change.
There was no accrued interest from the date of the last interest payment to the date of death.
If you have any questions, please contact Shareholder Services at 1-877-264-5346. Our representatives are
available Monday through Friday between 8:00 a.m. and 6:00 p.m. Eastern Time and will be pleased to assist
you. We also invite you to visit our website at www.boglefunds.com.
Sincerely,
Richard Krinsky
Investor Services Specialist
SCHEDULE G, Item 1
St
MEMBERS 1St
FEDERAL CREDIT UNION
SAVINGS ACCOUNT:
Account NumbedSuffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
CHECKING ACCOUNT:
Account NumbedSuffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Joint Owner
Date Joint Ownership Established
INVESTMENT SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued interest to Date of Death
Total Principal and Accrued interest
Name of Joint Owner
Date Joint Ownership Established
ROTH IRA SAVINGS ACCOUNT:
Account Number/Suffix
Date Account Established
Principal Balance at Date of Death
Accrued Interest to Date of Death
Total Principal and Accrued Interest
Name of Beneficiary
LOAN ACCOUNTS:
Account Number/Suffix
Date Loan Established
Principal. Balance at Date of Death
Loan Type
Collateral Held as Security
Name of Co-Borrower
VISA CREDIT CARD ACCOUNT:
Account NumbedSuffix
Date Account Established
Balance at Date of Death
Name of Joint Cardholder
41802-00
01/17/1985
$1,967.28
$.00
$1,967.28
Teresa Lafey
03/05/2009
41802-11~
03!20!1998
$3,411.62
$.00
$3,411.62
Teresa Lafey
03/05/2009
41802-11
09/07(2004
$.00
$.00
$.00
Teresa Lafey
03/05/2009
41802-12
03/05/2009
$.00
$.00
$.00
Estate of Peter Scheuren
41802-05 41802-07
02/04!1992 05/25/2005
$.00 $.00
Personal Service Loan Home Equity Line of Credit
Contractual Pledge of Shares 6 Melwood Lane, Mechanicsburg, PA 17050
None None
4287590000418026
04/07/2005
$.00
None
M BERS~~1s~T FEDE L C ITtU,N_ION
Danielle A. Kline
Insurance Services Specialist
April 22, 2009
Estate of: PETER SCHEUREN
Date of Deatfi: 04101/2009
Social Security Number: 206-38-2960
5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 wwwmemberslst.org
SCHEDULE G, Items 9&10