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Home My WebLink About05-11-10 (2)f 1 15056041046 ~J REV-1500EX(05-04) OFFICIAL USE ONLY PA DeparUhent of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN ~/ Dept. 280801 / O Harrisbum, PA 17128-0801 RESIDENT DECEDENT qm e~ N -~ (If Appllwble) Enter SurMlving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI r 1:' d~?^M'H61Y tlktl4 .M 4i Spouse's Social Security Ipumber THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS PILL IN APPROPRIATE dVALS BELOW t~ 1. Original Return O 2. Supplemental Retum O 3. Remainder Return (date of death prior to 12-t3-82) Q 4. Limited Estate O 4a. Future Interest Compromise (date of O 5. Federal Estate Tax Retum Required death after 12-12-82) ~ 6. Decedent Died Te6tate O 7. Decedent Maintained a Living Trust ~ 8. Total Number of Safe Deposit Boxes (Attach Copy of 1Mill) (Attach Copy of Trust) O 9. Litigation Proceeds Received O 10. Spousal Poverty Credit (date of death O 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - TH S SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0: Name Daytime Telephone Number Q ~a ,~~ . ~.~'~ ~ 3 Firm Name IfA livable ( pp ) ' mcn r a n~.xax+ ~ +u , REGISTER OF WILLS 4~ ONLY L ' ~ ~F° ' _O C' .iIY$= First line of address YJP4xA ,^'HI d" vkS X h'43F.u ~N5 i ,rte. ~~ ~ tir/ ~ rn 3 a ~ ~ ~' : '. '- _.: S ~ . ' ~ ~ "~C _ . r G ~ . . M!. R N 3YS4VAfR Sewnd line of address a~xa, ~ p -ks ~ ,emu +ewsnw ~ JJ ~ ~ r~ ~ ~ I C • • - ~- City or Post Office State ZIP Code ~TE FIL EDlO • ~~YY!~~: t '.'k faN pRN WVttY4 M&Nfi. 'F: ~ B~P~` O l ~~ t'~4 Corespondent's a-mail address: ~[S,ie~tp,~~~$r/i!/gCoNtvrnrE/. Under penalties of pery'ury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete; Declaration of preps r other than the personal representative is based on all information of which preparer has any knowledge. SIGNATURE OF S NSIB IN ETURN D T ADDRESS SIGNATURE OF PREPARER DTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 1505E#041046 15056041046 1 L ~ J REV-1500 EX Number RECAPITULATION ~ - amo 1. Real estate (Schedule A) ........................................... ... 1. ~ ~ VWI4ei ~i ~~ ~ i. 2. Stocks and Bonds (Schedule B) ..................................... .. 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship ($chedule C) ... .. 3. 4. Mortgages 8 Notes Receivable (Schedule D) ........................... .. 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ...... .. 5. 6. Jointly Owned Property (Schedule F) G Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) G 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 q .............. .. 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 ~{ 16. 17. Amount of Line 14 taxable 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 15056D42047 O Side 2 15056042047 15056D42D47 J REV-1500 EX Page 3 Decedent's Complete Address: File Number o?O/o DECEDENT'S NAME ~ ~ ~~ - -- STREET ADDRESS -~_~ f!IPl- ~o.,. cf PLEASE ANSWER ~'HE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent malke a transfer and: Yes No a. retain the use or income of the property transferred :........................................... ^ b. retain the righq to designate who shall use the property transferred or its income : ..................................... ....... ^ c. retain a reversionary interest; or ................................................................................................................... ....... ^ p mise for life of either payments, benefits or care? ............................................................... d. receive the rq ....... ^ 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................... ....... ^ fff~~~t 3. Did decedent owrl an "in trust for" or payable upon death bank account or security at his or her death? ....... ....... ^ 4. Did decedent owrM an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ................................................................................................................. ....... ^ IF THE ANSWER TO ANY OF TIDE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. REV-1508IX • (7A7J SCHEDULE E COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, Ot MISC. INN~SIDENTDECEDENT~ PERSONAL PROPERTY WA FILE NUMBER Include the proceeds of litigation and! the date the proceeds were received by the estate. All properly joirrtly~owrred vdtlr the fight of survivorship must bs dlsebsed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH ,. Gv~c~w« ~. l (/!lo~-ay/Iarv mac, ~,~/ollB ~ /G7,~u a . O YrS J~w~v ,&~till~i~-.,~ /~Is•~ i9c<<f '~/yG oo idff~ ~' /S a9S. ~ 3. 19~1~1' FGr~ 7~Qorat ~SeAd ~/.~~/a) ~' y~ooa,-~ T ~l ~fCr~~"Av~' ~s~~: ~• ~ / rsr ~ Nillu+.s -- ~'9 l~ 6 Hs~ r~~~law -~'.f9.~ TOTAL (Also enter on line 5, Recapitulation) I i more space is needed, insert additional sheets of the same size) ,~ a 79, ~ ~ WACHOVIA Date Deposit Account Close Confirmation (Debit) WACHOVIA BANK, N.A. Customer Name(s) and Address Taxpayer ID Number 03/02/2010 WAYNE E SHEFFER 36 MELRON COURT CARLISLE PA 17015 ACCOUNT NUMBER; 1010118890926 Available Balance + Accrued Int : $43.46 -Fed W/Hd Due : $0.q0 - Admin Fee : $0.00 -Outstanding Db : $0..00 -Closing Fee : $0.00 $167,851.18 Paid To Customer : $167,894.64 S166127722 566596 CUSTOMER COPY OxRSTOwiv s~ ~~ Seven Gables Member F.D.LC. 3!2/2010 11:14:57 AM Effective Date: 03/02/2010 0262 4000 0107 Mi$c Checking Debit XXXXX01356 $15,293.73 Cash Amount: $0.00 Cash Back: $OAO ALL ITEMS ARE SUBJECT TO VERIFICATION & COLLECTION Thank gout Orntown rink - .; .• .., _ _ . ~~ ~ ; ,_ 1 ~~ i .~. ~ ~.~ ~ . t ,~; s' ~' ~ t. ~ ~ i• _ p p - _ Z_ t ~ o: o i ~„ O w71-~' ~~. ~Q' Q~ >a ~* i O C'7 S r :. {{~ m N n C7 '~:~ ~ >Z m .:~ 8 Z~ ", ~ m m ~O ._ ~' yov~v xc~n~~ C I > t~ s°° ~ ~ ~ ;~g~ ~° ~ } ..~ 0 s li~ ~:. c~. e. 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Yf ~ ~ : "FE"D;..- a~kic>SFic' ~' ~~:~ ?:= r ..> t ) NO'[fi:l s :.M. `~~.Ir•`µf~.. ~'is~.1sT®ANDrauwANrn~fimi.E•~%aE~ci~orE~IwwrTEWurrawm~.wowrr.o~.auRvErGaE~Br.(oN.DearNOP.oNE• . ~ . ~' DwNt= M1 YN1.E ' ;Gx1~',f .... ,. C.~. GTNEaw18E, THE t+tLE wlu. E~ weuEais•'f.SNrare w.wMMOIr (oN aPaTN'oFONE cwna4 wiEREST of Dfic6lstD - ~ S , . 1i. _ f- i GWNER•G~6 TO NIEIIIPJ~MEI ... - . !~T ') ~ ~w f9 P s A~ .$ •~ NOTI~JF]iFIENEII~~.I:E'Y~9'TO'~ E~~AM;AD1ADI:REN7AtrGN1EASED, NEHICCE,rd9EWCT#713.B6UGICU. IF BLOQC•19 GNfiCKED. COMPLETEAND A'fTACH:F~BMI,AVF~(Lr,' , ~~ MEEEENGER NO.: + .r;J .. i.~l`:: .2. DEALE3i /ISSUING AGENT` ~~"' " TUE/AtiR/27/2010 04:43 AM SOLLENBERGER 1'7013 FAX No, 7172498149 P. 001 TUE/A~R/27/2010 04:43 AM SOLLENBERGER 17013 FAX No. 7172498149 P•002 a.n' • ' .,,~ K..•.i : - .a :~ `G~E,RrT~.l+FJ CA~~sp F' ~'i~f~dT1.:• ~'S1~.1A`"1•I~E H 1tC LSE .~ :-;~.. _ _ . •~ ` .' ~rk •' •'Y. fit.°b ~;.i: "!," •;Sr'.:.i'...... L_~•x'•W... .. '~ w. • ~ ~ • :. "' ' • . • .. •. 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" '. t y •>rlEEIA [INIKN:IEED i:+ ::a RF'•' A~RN~ AB•R®GNfATNF : ' :.~.'. ... ~ AUTNEN~Gp~p®EIJfATiVF, .'.,e :.. -; .. ~a '~'f~t RQht LT .. . :,:~c~'13S.t£ ~'A~-7.71113 ~ . a rC'3: ~ , 1~:' , L '~p~p,~. • !~.I a11Yyw.d.EU.EW a•wrr•, Yu air ti.aa~ a tlr F«rRr~..:. Apia. •ALL£~AI :~' :'•~iyr'~gL,:.gx{.': •'•"~: a lwrpoiLw~ am uia •r pno.p) a ~9' nuwa iwnwn w or Mwu aM.r ~ ... ... ._ .-.r.•_..-.. :~ ..y ~Il ~ 6~d~ • erwgcr -'F M y~ ~ g ~ ..i . HGI ~ . , ..f~fY.. 1 . ~ •n•• • • : .: ~ `~ ~ ,q~ •r1Nw+ M ~ Y «..I °~ MR~MSYI~wrld M w-ne Mlde•MwION two 4Ei+PAT~ .~ t / ~FMY~' ! rN P ':'i'MMW ~ w •. •i~'nC w`S.. i n.M w. .. ~. .' :7MU UEaw064E ' :J I J!gp.'nwl.Qm anurarmm[aeumauaoaw[~ wvrtaaneou ~~ 1F NO•U&;1, CNEOK ' ~ .: C • •~ .N ~~ STATE AP ~.. TUE/A>;R/27/2010 04:44 AM SOLLENBERGER 17013 FAX No, 7172498149 P. 003 ~ - ~~ file by Mail Instructions for y r 20tf9 ` ! Tax; Return hnportar~ Your taxes ara not finished ' 1 steps are ownplefied. (If you prefer, you can still a file. Go to the erxi of these instructions for What You (deed to Wail Your tax return - The official return for mailing is included in this printout. Reaember to sign and date the return. Attach the first copy or Copy B of Form(s) 1099-R to the front of your Form 1040A. Mail your return and attachmeats to: Department of the Treasury Internal Revenue Service Center Kansas City, MO 64999-0015 Deadline: Postmarked by Thursday, April 15, 2010 Note: Your state return may be due on a different date. Please re~riew your state filing instructions. Do~h't forget correct postage on the envelope. What You NeedtO Keep I Keep these instructions and a copy of your return for your records. I If you did not print one before closing TurboTax, go back to the I program and select Print ~ File tab, then select the Print for Your I Records category. I 2009 I I Adjusted Gross Income S 6,841.00 Federal I Taxable Income $ 0.00 Tix I Total Tax $ 0.00 Return I Total Payments/Credits $ 1 00 Y I Ammunt to be Refunded $ 120.OQ I Effective Tax Rate I 0.008 Chirped I I You can still file electronically. Just qo back to TurboTax, select YourfOind I th® Print ~ File tab, then select the E-file category. We'll walk About I you through the process. Once you file, we will let you know if your e-fllMg~ I return is accepted (or rejected) by the Internal Revenue Service. Page 1 of 1 I t3alanc+e I Your federal tax return (Form 1040A) shows you are due a refund of Duel I $120.00. Refund I .. - L ET~o BANK ~,m trod .nom eM finer rrro receied br dapped s~bjeci b Me Pwieiais d tl~e UnMam Camns~W CaOe a rh' ipplcahb oobclbn agree~rM- ~/.~ a~ ~.r~ e8 13:18 5x3/2010 1111'"""`9832 /, TirDDDep ~ 120.00 l~'~ CARLISLE STOR~{11 S18 ~ ioroe irrr gg n Y ~ s ~ A s 4` 7F b J ~ ° ~. s" o n rn ~ ~a b ~= v n o ~ ~_ a 3 a $ o; P w C ~m ~. ~~ ~_~ ~ = - ~_ ~~' a 8~ ~~ ~~, ~~ a s ~ ~ !~? ~~ rrn.° ~ md-° ~~ '~° °~ J ~ 0 N N ~ ..'j~ ~~_ ~~ D "'~ 70 ~~ 3~ `G V ~$ x 8 _ '~ ~~~ O 4 1 A c C a v t, _O O m~ ~; e C e ~ ~ r3 ., s .o ~ O v W S' ~ r ~ L r ` ~ C U r R R Z Q 0 N CD LO O d A~ ~t m x .. cam'' O ~ o m w ~ m o N ~ ~~ ~ o rt ~ ~ x w m ~~ ~o ~o O 0 0 ~' W `~' ~ '~ a n sm `~~ ~ s~ ~~ ~~v 1 !~ ® IV ~~ 0 N ~~o ~~ m ~ O N a ~~ Co@ Qp~ 3 g ~~ ~~ S~ ~~ $~ $~ ~~ ~~I n z s ~~ ~ 0 3~ ~c ~v a$ ~o ~ A 8 REV-1509IX•11-0'7) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCHEDULE F JOINTLY-OWNED PROPERTY FILE ff an asset was made Joint with h one year of the decedent's date of death, it must be reported on Schedule a. SURVIVING JOINT TENANTtS) NAME ADDRDESS /~ RELATIONSHIP TO DECEDENT A. J t~~~ >E S~<~~N .,fa7 6~r~~ra.~ ~C~~Qr~•d~~ /7, ~~/I~ SOMA B. C. JOINTLY-0WNED PROPERTY: ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY Include name of financial institution and bank account number or similar identifying number. Attach dead forjointly-held real estate. ~ DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENT'S INTEREST ,. A• /h~~ Gt'iat:~a~a /~.vk/ro~~~c~,t~% ~' 0~//1~/a TOTAL (Also enter on line 6, Recapitulation) I ; ~ `~~ (If more space is needed, insert additional sheets of the same size) wA,cxovrA Deposit Account Close Confirmation (Debit) WACHOVIA BANK, N.A. Date Customer Name(s) and Address 03/02/2010 WAYNE E SHEFFER KEITH E SHEFFER 36 MELRON COURT • CARLISLE PA 17015 ACCOUNT NUMBER: 1010110870876 Available Balance $8,659.74 + Accrued Int : $0.24 -Fed W/Hd Due : $0.00 - Admin Fee : $0.00 -Outstanding Db : $0,00 -Closing Fee : $0.00 Paid fio Customer : $8,659.98 Taxpayer ID Number S166127722 566596 CUSTOMER COPY REV-1511 EX+ (10-06) s~NEOU~~ x COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES 8r INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE VF FILE NUMBER W~~/1~P ~ SlP~'~t/ aalO -DD/7O Debta of decedent must be reported on Schedule L ITEM I A. FUNERAL EXPENSES: ,. ~~/~K f,tv ~vrottia/ J~ /nr ~S`/3%7~~ro ~rr~Cr~n~.,~~~~ ,~' ~G g g :°- ,?. rz~~,~!/O~ IE~`Ivk D /Sr ~vrar./ /,~ rr~1 ~p,~,.rT ~' ~ e. ADMINISTRATIVE COSTS: ~ ,e. 1. Personal Representative's Commissions Name of Personal Representative(s) Street Address City State Zip Year(s) Commission Paid: 2. Attorney Fees L~,bW ~a ~/Y{ aAI/pr ~,$~~r/•~ ~ ~~/i =~ cQ.~rt pi} /~r3 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 DDecedent f 4. Probate Fees 'r > Q ~f /f7"rr' tn'f III fAes ~-~ot,f(Prf~ ... ,~'$l~•fv t' 33q. ~~3//oJ l~ ~1f~i~. u+!/1 /E7~`fyp S~ov~ C~rJ~l ~PO. ~, • /~~ 5. Accountant's Fees ~ / " 6. Tax Return Preparer's Fees (~//7!. L~/~~/a00y' ~j~{r~(1M,~{ 7/4~(•r ~ ~~ ~prXJ ~. ~ - f rP// ~~19 , ~nK ~~,Ir"i//o) .Z'it~~tw-t~lgw ~ ~/9~!~ t>/~ or a l / -~" bl //G b ~ 9 AT ee C~~ ~ ~ ~'v~~.raCla/l ~~ C. ICt7vrwd~W~~R'~oti~A~/~J ~Oir++rt7'CIf2'/~;~ ~/~D~ s~G/~e TOTAL (Also enter on line 9, Recapitulation) $ (.~~/(`Std"' (If more space is needed, insert additional sheets of the same size) :- , ~ HOLLINGER FUNERAL HOME & CREMATORY INC. Eric L Hol~r-ger, Supervisor 501 N. Badlimore Ave. Mt Hogg Springs, PA 17065 3TATE1MIEIVT OP F[IPI~ERAL GOODS AND SERVICES SELECTED Charges are only for those Items dbat Sou selected or dart are required. ff we are required by huv or by a cemetey or czematory 6o use airy ibrmc, we will esp~in dte reason in vtridug belaty. ~ ~s me ~ that may embal~g,~ as a funeral wbh vie~emg have to payfor ember. You der ~t have ~ fore For the Servlc!e ff ~ ' et~C/~ l9wL~' Charge to: -- ~ ~~ 7t~fS` A. CHARGE POR SERVICES SEL)3CTED: I . PROFESSIONAL SERVICES Services of Funeral DirectorYStaff .... f~ Embalming ...................... E Othtt ptepu~atiou of body /,A ............................... E SUBTOTAL OF F'ROFESSIOAIAL SERVICES......... Al i ~1 Other clothing f i Cremation uro ................... f (~ril~) OTHER f i f TOTAL MEiCHANDISE S$LHCPBD .................. B i 2. FACILITIES AND SERVICES Use of facilitits and services for viewing (VlsitaNaedWalce)......... f Use of faclities and sttvices for [unenl ceremony ... - ....... E Use of facilities and smices' for Memorial Strvicc ............... E Use of cquipment and sexvicks for graveside service ............. f Other use of facilities ............................... E SUB-TOTAL OP FACILTI'IES/l;QUII'1IENT ........... A2 f 3. AUTOMOTIVE EQUIPMENT Vehicle to transfer temaius teb Furterat Home. Local ........................... f Hearse (Casket Coach) Local ........................... t Limousine Local ........................... E Family car Local ........................... f Flower ca[ or floral disposition Local ............................ f - / Local .~j~,.u . ..`~~ ~ f./ Car for pallbeams Local ........................... f Out of town trutsportation ......... f t f SUB-TOTAL OF AUTOM EQUIPMENT........ 'A3 i TOTAL OF PROFESSIONALS RVICES, FACH.tTIES AvroMO EQUIPMENT .. ~p~y ....... A ~~ `s% hF B. CHARGE FOR , Casker .......................... E .. (Description) ~: L~ Other Recepn .. C. SPECIAL CHARGES: Forwarding of remains to f (Fanual Home) Aeexiving of rdo~s from f {FutKrat Home) L~odiate Burial . .... E _ i SUB-TOTAL OF SPECIAL CBA[GIES ................ C f~~ D. CASH ADVANCED Opening Grave .................. i Y Equipment .............. E Lot and Deed......... (~.... .. i--¢~ Newspaper Notices-Loca~1f30~c f_$,~ ,/ ~,,~~ Ncwspaptt .... E1a'~~r~~ Airfare ......................... f Clexgy/Mass Offexiag .............. f FaIlbearets ...................... f CCertiiintcC. d• •~Dath Police Escort .................... f Fbwe[s ........................ f Vauh Service Charge .............. f E ~' ~ f E~ f s f JJ//gy~pp SUBTOTAL OF ADVANCES ....................... D E~ We charge you for out services in obgining; (specify cash adumrces that arc nrkP1 SUMMARY OF CHARG88 A . Profexsiom! Services, Fadlities eruct Equipment, and Atttaenotive ~~ Equipment ...................... E B. Merchandise ..................... f~ C. Spexial Charges .. . . . ............. t D. Cash Advanccs ................... i TOTAL OF ALL SECTIONS ....................... E~ -• Outer burial caatamtt ......... ~.. i PAm AT TI1~ OF Oi F310R TO ry 7.~ ~/ Gri ~j~pn) Alt1tANGF.1[lDif3 ......... ....... ~P~.......... i../Krf~6 '~ BA1aAifB DUB .................................. i i„`,` AdmoaledRemmt cards ........... t =F ~ON~F~Ot~ / ' Regiutt boor(s) .................. i _-~ll~8t'.T / ILl~/rJr Memo folders .................. i If ro9~ ~ P ~ .... i ~ ~ of the ~ a the bnv a to Gave Prayer cods ................. regnnptxnt is ezpmined below. ;/~'~, Temporary gnve marttt ........... i Burial tlothrog ................... i i agree dot l havc e:am®cd thr i[~a d seeds and sec~lca sebcted above aad lined them is be correct and aocordiob to the xra i hm iogr~d. l acknowledge rcaeipt of a mpy of thk Staumem of ~ Goods and Scr-ices Selecsed. I rcproeot thu 1 hme w~iCm hods avatlsble fur payme~ of the nsb price for the goods and services selected I also epee to m~lte payment of i witMO Sys. I agtet m bt joiedy and tnera9y liable ehh anyone she who signs bebw. A hte dntge of ~_ per moah amoamirig m ptt year wiH be ao the ®pgid bahma begirrmg days from the date of this agrcCmeot. I wRl wfO pay m the Pmaal Diroctnr >n reasoasble mats paid by the Ftmersl Director to mBert amomts I are ruder this agreement. Those costs may Mdrde aaotncys' mats and other oma My addilimal saviors err meerhmdiae ordered or rcquaoed alien the lase of this agreement will be teBatied ~ the final big or sntement. (seal a?Od (sea) ~ ® vawyi or.rw~s ~.soa.tk.y w.~r.t n:~ vvttow rse9 t*m)o. rwr c~uo~r form -600 Revised 5/02 1#~ b~ '~® \/ ~ - -... Hollin~`er Fungal Horne & Crernatnrq, Inc. Eric L. llollinger. Supervisor February 23, 20x4 Keith E. Sheffer 527 treason Road Carlisle, PA 1'7015 The Funeral Service for Wayne E Sheffer. We sincerely appl`eciate the confidence,you have placed in us and wilt continue to assist you in emery way we pn. Plea$e feeF free to contact us if you have any 4uestions in regaM to this statement. AT THE TIME FUNERAL ARRANGEMENTS WERE MADE, W€ ADVANCED CERTAIN PAYMENTS TO OTHERS AS AM ACCOMMC}DATK3N WHKH WERE Nt)T COVERED BYTHE t'REARRANGEMENT AGREEMENT. THE FflLLOWiNG LS Ali ACCOUNTING FOR THOSE CHARGES. Cash AdvanoEs Newspaper Notices -Patriot News $152.T Current Balance: 5352.77 ~~~~ . ~ ~~~ . _ ~ t __~ .~._. 501 N012TH BALTIM+pRE AI~ENUE ~ MOtIN? tiOI.LY SPRINGS. PENAISYLYAiJIA 17p63 ~ (717) 4$6-SOBS ~ FAX f T I7) 486-3233 arvv+p.IaoUingerfuneralhome.oom LINDSAY DARE BAIRD, ESQUIRE 37 S. Hanover Street Carlisle, PA 17013 (717)243-5732 ._ Fax: (717)243-8110 STATEMENT FOR LEGAL SERVICES RENDERED To: Keith Sheffer, Executor DATE: May 10, 2010 RE: Estate of Wayne E. Sheffer UNITS OR ' T A TC CFR VTC:R RF.NT)F.RF.T) ~ HOURS RATE TOTAL 4-5/10 Meet with cliwrnt; Calls with client, pay Notice invoices Letter to DPW, Form 5.6, Form 6.12, Estate Notices 2.00 0.50 200.00 200.00 400.00 100.00 C Cumberland Law Journal -Estate Notice 1.00 75.00 75.00 The Sentinel -Estate Notice 1.00 166.30 166.30 0.00 0.00 i 0.00 0.00 0.00 0.00 0.00 0.00 -___-__ TOTAL UNITS OR HOURS 4.50 SUBTOTAL 741.30 L ~'' In ~1M .fie ~~,~ ~e~ ~~ Less amount paid 300.00 BALANCE DUE $441.30 RECEIPT FOR PAYMENT GLENDA FARMER $TRASBAUGH Receipt Date: 2/25/2010 Cumberland County - Register Of Wills Receipt Time: 15:17:29 One Cp~ thouse Square Receipt No.: 1060124 Carl, PA 17013 SHEFFER WAYNE E Estate File No.: 2010-00190 Paid By Remarks: JODY L SHEFFER JN ------------------------ Receipt Distribution ----- -------- ------_ ____ Fee/Tax Description Payment Amount Payee Name PETITION LTRS 'TEST WILL 260.00 CUMBERLAND COUNTY ~3ENERAL FUN SHORT CERTIFICATE 15.00 16.00 CUMBERLAND CUMBERLAND COUNTY COUNTY GENERAL GENERAL FUN FUN AUTOMATION FEE JCS FEE 5.00 CUMBERLAND COUNTY GENERAL FUN 23.50 ------- BUREAU OF RECEIPTS & CNTR M.D Check# 1146 --------- $260.00 Cash 59 50 Total Received......... . $19.50 RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Cumberland County - Register Of Wills One Courthouse Square Carlisle, PA 17613 SHEFFER W~+,YNE E Estate File No,~: 2010-00190 Paid By Remark: K SHEFFER JN Receipt Distribution Receipt Date: 3/03/2010 Receipt Time: 11:13:08 Receipt No.: 1060186 Fee/Tax Description Payment Amount Payee Name SHORT CERTIFICMTE 20.00 CUMBERLAND COUNTY GENERAL FUN ---------------- Cash $20.00 Total Received........ $20.00 YVi1.ti~nt Ludwig Accouning S~rv~cs Date 3/29/2010 Cus1r' ~~ Wayne SFietfer Preparation of 2009 Federal & State tax n~tums $35.00 Total Due P~ ~~b ~lb~F Cassius Mullen's Auto Care Center 473 East North Street Carlisle, PA. 17013 Phone - 717-2434573 Fax - 717-243-3859 Bosch Authorized Service :ASE Certified Neater Technicians Work Completed Date : 03H8J2010 INVOICE 41383 Org. Est. ~ 072887 autoarepa~oorrgast.net Print Date ~ o3H ~rloi n 1999 Ford -Taurus LX 8ht>tffsr 3L, V8, VIN (U) 36 Mel Ron Court Lit # : GBT2675 Odometer In :27842 Carlisle, PA 17013 Unit #I Home 717-249-4003 Vin 8 : 1FAFP52U5XA1036~W Cunt ID : 5443 Ref tt : ~ ~ Part Description /Number Qly Sale E xtended Labor Extended sticker Test for Pa. 3taDdPerform Pa.Smte 44.90 si 1.00 Ilion phone data e1-erge Access Data Link and download emmisions info to state 1.00 Pa. State wish P.romision Tesaa.Testdrive car and Interstate Battery 85 matW move both tirortt a~ rear wheels to verify IKTP58R 1.00 89.95 89.95 brakes/steering and suspension pass. Front Tires Shop Suppliers 8.16 8.16 /32 Rear Tins 132 Front Brakes /32 Rear Braloes /32 Tire Repair Service le$ fiunt 26.95 Remove from rim , rephsx valve stmt tiroar inside and tramo»nt and bahmce .Check all lire pr+essees Dragnose primary electrical 9.95 _ __ _ _ i,°°d~edb~'rmeasFlr dG ._ Ed s t a [ te r a d aw p ~ ~ ~ , ~ j .~ ~y ~ ~ vEYlfied eha7latOr Oufpnt. Rephtce waava7 ]f •#lDi/i AAA IK~ber/Fltxt D1SCOlet 5.00% off parts, S.OOX off labor ( Technidans : 9igsr, Kyle l a9. Estirnab 517.16 Revisions sera Cunsnt E~stirnab s 1!7.,16 1~d~tiond cost Retired Eatimala ~~. 81.80 Part: 88.11 Sublet: 0.00 Discount: -8.58 Sub: 171.32 Tax: 10.28 [ Payments - ] ~ 3/J1/~ Total: 181.60 (VV/ Due: Free Slirtde Savuae mailable wit/riie the Carlin ~~~ Thank you for this opporhmity do service your vehicle. We take pride in the work we do and your smis5sction is important to us. In the evem something with our wutk goes vrrong we have a Napa Nationwide Warranty fur 12 months or 12000 miles whichever ca~mers first. Used parts have No Wamenty! l Call 1-SOp~LET NAPA only if bnealodown Dotes o»tside of itM mr"les. Odretvvise Call us ~ We stand behind our work. Free State inspection t+etG9t witlt'm 30 days. Visit otv WEBSITE at www.nap~cxracom/pa/cerlisle%assitu_mullens vvrMnn er W Keith Sheffer 527 Gleason RQ CarliAle 193 03/25/10 orlmnwasE sHOwN. ~YC64 we.E PERPORI®AT ----- tx8 FACfORT wARRANYY CatatrrtfrB4 ALL. ' NO CHAS TO OWNER. THER$ w NO QDIC.\i10N PROI 7HE OF TIRi wARRANi R$ wlfN RBR79CY TO 778; SUB OP TRB IIFIYflfE. TNH SBLL.6R HBlEBY ~~ ~'~ VH6~ Ue THAT ANY PAt7' euRe~.T ~M M S Au wARiAM~ ' I... REPAIRED pt RER.AL~D Tffi QwOt HAD ®N Y ~ l,~ ~ ~ oY j ~~ CONNECtFD 1N ANY NAY wRR AMY. I~I87GENC8 OR: p w ABAM q+~ Q PR1R3Sf POR A PARIICIRJIR PUR}OR8 ~~ NT90~. RECORD6 SUPFORTRq CIJ1Y ARE AYA®.ARi$ FOR IR$fl~R AS311Y8T NOR AUl81R~ ANY (q YEAR FROM TiRl M78 CP PA NO'!H'ICSV701i AT Tim 07IB FHl10N 7b w~R~ NOt R ANY $B 8O SFRVICRKi DFi1I.FR FOR BY NANUFACIURFi'S . ~ ~ wlfli THB ~~ OF RPlItE4ENTATIVE, 5.33 tSNiNHED) DHiVi,6~AL MANA®t AIJINOR®pp~pN NMTq CUSFOI~RSIGNAIVRE 4.13 ~-~.. ~ LY FORD FAMAY FO'~i YORK ROAD 176'PoRIt ROAD ~ISL$, PA 17013 Pa 17 caRtlsl~ .ra 17613 249-221s 1-800-745-4811 Invoice Rose Detailing Sheffer, Keith DATA nwoic~ # 4/15/2010 15054 P.O. NO. TERMS QUANTITY D~IPTION RATE AMOUNT _ Coilnplebe Detail Ford Tau~ruJs1/~~Br~aun De~dori~e `1/nl ~ PA'SalesTax - ~~ '" ~~ .Cv ~ ~ 179.95 35.00 6.00% 179.95T 35.OOT 12.90 ~,!O~~ i~irl iV Allen Road Veterinary Clinic 1909 Ritrrer Highway, Suite tf4 Carlisle, Pa 17013 Tel: 717-243-0087 Jody 8~ Keitlt Shef6er 527 treason Rd Carlisle, PA 17013. Gly Date Ratient Daseriotion Bill for Services DATE INV. NUM 03!10/10 89138 Acct no.: 20000990 John D. Stoner, D.V.M. Pry Ent Tn 1 3/10/2010 Ajt' OFFICE CALL $36.00 $36.00 0.4 3/10/2010 MAY ~ Lasix (Dias!) Inj /oc ~ ~ $8.45 10~ 3/10/2010 Missy ~ Primor 120 ~ ~ $12.15] 15 ~ 3/10/2010 MAY ~ Brethine 5 M<i ~ ( 531.20 1 ~ 3/10/2010 Il~lissy ~ ID Canine Can 13 oz ~ $2.23 $2.23 tx 1 ~ 3/10/2010 ~ MIRY I Your receptionist was Stephanie. I $0.00 ~ $0.00 Subtotal Pmnt 1: ck Amt: ($90.16) Note: #3413 Pmnt 2: Amt: $0.00 Note: Your confidence is greatly appreciated. Tax Bill total Prev balance Payment NEW BALANCE $90.03 $0.13 $90.16 $0.00 ($90.16) $0.00 Colder weather has arrivejd so fleas are going to find a warm place to settle which means on your pet a• in your house! Remember to keep using Iflee prevention. Thank you for choosing Allen Road Veterinary Clinic far your pets nestle Allen Road Veterinary Clinic 1909 Ritner Highway, Suite'a1F4 Carlisle, Pa 17013 Tel: 717-243-0087 Jody & Keith Sheffer 527 treason Rd Carlisle, PA 17013 CiiY Date !Patient Description Bill for Servit:es DATE INV. NUM 03J12/10 89221 I Acct no.: 20000990 John D. Stoner, D.V.M. Price Eatt Tx 1 ~ 3/12/2010f NAissy EUTHANASIA 20 LBS-LESS $58.00 $58.00 11 3/12/20101 iwisay CREM. W/ASHES RETURNED ~251ba I 5210.001 5210.001 I 1 1 3/1zrzolol NAissy our r~eceptionistwas stepr~e. I $o.ool $o.oo) subtotal $26s.oo Tax $0.00 Pmnt 1: do Amt:. ($268.00) BiN total $268.00 Note: #3414 Pmnt 2: Amt: $0.00 Prev balance $0.00 Note: _p8yment - - - - - (.$268.00) __ _ Yourconfidenoeis- - - a- - -- _ _ 9Y PPS: NEW BALANCE $0.00 Colder weather has arrived so fleas are going to find a wane place to settle vrhich means on your pet or in your house! Remember to keep using flea prevention. Thank you for d~oosin9 ANen Road Veterinary Ctlrtic for your pets needs D 5 1.334 -Crown Classic Blau Acxacunfnumber: t01~01.10870876. ~_ ,. ~.` ui~t'ow~rZs): WAIYNE€Si~IEP.F Account Summa onsoli+dated Statement 1 01 01 1 087: S 7y2 30 t7peninp balance iros EB 504 77 _Deposits and other kxedits 1369 51 + Interest paid 0 35 + :::.Checks 1 113.40 - Other withdrawals and service fejes 138 00 - '~u~ng~batance?JQ8 _ St~6Yf3:i' . g ~i2s 2/OB B1.12 ~~, 190.39. .018 0.35 _n_.. G .. ATED CREDIT INTERNATIONAL PA RN PMTSICC 'r7~ 1043581074 100129 PPD ATED CREDIT PRECISION CUSTOM PN PMTS/BG ,^3~ 1~j 1046748526 100201 PPD /_ C.O. ID. 3031036030 1 - --- --- --- - INTEREST FROM 01/09/2010 THROUGH OZJDB/2010 ~boss~ ~ ~6~/a ~ ~ ~G,f!- ~ C~18CI{S Number AmrrXN Date 1121 ~~376.00 1/13 1122 d 147.40 1/20 Numbe- A~lrk Owe 1123 40.00 2/02' 1124 550.00 2/02 N+meber AmoraM Date ,11 A WACHOVIA BANK, N.A. , CARLISLE page 2 of 4 Number of days this statemerrt perrod 31 ,:Annual pe age yield earned 0.05% `.Interest eamr ed this statement period f0.35 Interest paid this statemerK period) Mterest paid tills year ~ ~ ' REV-1513 EX+ (9-00) SCNEpYLE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF ~ A ~~ ~ ~~P ~~~/ FILE NUMBER 1 ao%~- oa/9o 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 Sz7 6r~.rd~- ~ ~Q r ~tJ ~~~ ~/~: ~/.~ ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 TH ROUGH 18, AS APPROPRIATE, O N REV-1500 COVER SHEET II NON-TAXABLE DISTF~IBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE ANq GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ (If more space is needed, insert additional sheets of the same size) r-~ -,~ i-J ca -.-~ ;..,.~ -() LAST WILL AND T~ STAM]~NT ' ~ ~ ~ _ -~>>~. - r- ._,;- <, ; OF ~~_; _ ~ ,., _ :-, ~: ~:-.. ~.~ -, WAYN~ ~. SH~~~~R KNOWALL MEN BYTHESE PRESENTS, that I , Wayne E. Sheffer, of 36 Mel-Ron Court, Carlisle, Cumberland County, Pennsylvania, being in good health and of sound and disposing memory, do hereby maize, declare, and publish this as my Last Will and Testament, hereby revoking all former Wills and Codicils heretofore made by me. ~ ; FIRST: I direct that all my just debts and expenses of my last illness and funeral expenses `~~ shall be paid by my Executrix, hereinafter named, from my estate as soon after my decease as shall be found convenient. \ SECOND: (a) I give personal gifts of the items listed and to the individuals named on the Listing of Personal Gifts attached to this Will. (b) I give, devise, and bequeath all the rest, residue, and remainder of my estate, whether real, personal or mixed, of any nature whatsoever and wherever situated, including any lapsed or void legacy, to my wife, Josephine R. Sheffer, if she survives me by ninety (90) days. (c) If my wife, Josephine R. Sheffer, predeceases me or is not living on the ninety-first day after my death, then I give the rest, residue, and remainder of my property whether real, personal, or mixed, to my son, Keith E. Sheffer, 527 treason Road, Carlisle, Pennsylvania. If my son Keith E. Sheffer predeceases me, then I give my estate to my two grandchildren, Chad W. Sheffer of 401 W. Redwood Street, Apt. 507, Baltimore, Maryland 21201, and Ryan K. Sheffer of 711 Ninth Street, Virginia Beach, Virginia 23451, each individual to receive fifty (50) percent. If either Chad W. Sheffer or Ryan K. Sheffer predeceases me, the percentage share that would otherwise,be distributed to that predeceased devisee shall lapse, and the share that devisee would have talzen shall go to the devisee who survives me. THIRD: I hereby nominate, constitute, and appoint my son, Keith E. Sheffer, as Executor of this my Last Will and Testament. If my Executor fails to serve, or for any reason fails to continue to serve, I then appoint my wife, Josephine R. Sheffer to serve as Executrix. 1 FOURTH: I direct that my Executrix, or her successor, shall not be required to furnish any bond or other security for the faithful performance of her duties, notwithstanding any provisions of law to the contrary. FIFTH: My Executrix shall have, in addition to the powers and authority conferred upon her by law, the following additional powers and authority: 1. To gift, sell at public or private sale, exchange, lease, mortgage, or pledge any property, , real or personal, constituting a portion of this estate, at any time, and upon such teens and conditions as she shall deem wise. 2. To ihvest any money at any time in such bonds, stoclzs, notes, real estate, mortgages, life insurance, ann~iities, or other securities, or such property, real or personal, as she shall deem wise, without being limited by any statute or rule of law regarding investments by the Executrix. `. 3. To retain, without incurring any liability, as investments, any property owned by me at the time of my death, as long as she deems it wise, and even though such property is not the hind of property she woµld purchase as an investment, and even though to retain such property might violate j 1~ sound diversifioation principles. ~_~\1~~, 4. To cause any security or other properly which may at any time constitute a portion of my estate to be issued, held, or registered in her own name, or in the name of a nominee, or in such form that title will pass by delivery. 5. To consent to the reorganization, consolidation, readjustment of the financial structure, or sale of the assets of any corporation or other organization, the securities of which constitute a portion of my estate, and to talxe any action with reference to such securities which, in the opinion of my Executrix, is necessary to obtain the benefit of any such reorganization, consolidation, readjustment ox sale; to exercise any conversion privilege or subscription right given to her as the owner of any securities constituting a portion of my estate; to accept and hold as a portion of my estate securities resulting from any reorganization, consolidation, readjustment, sale, conversion, or subscription. 6. To pay all costs, taxes, charges and expenses in connection with the administration of my estate. 7. To determine what is "Income" and what is "Principal" hereunder, and her decision thereon shall be final; and to purchase securities at a premium or discount, and to apply or charge said premium or discount against income or principal as she may determine. 2 8. To gift, transfer, sell, exchange, partition, lease, mortgage, pledge, give options upon, or otherwise dispose of any property at any time held by her, at public or private sale, or otherwise. 9. To borrow money from any person, firm or corporation, for the purpose of protecting and preserving or improving my estate or to execute promissory notes or other obligations for amounts so borrowed. 10. To employ legal counsel, accountants, brolxers, investment advisors, custodians, managers, and other agents and employees and to pay them reasonable compensation out of my estate or out of any fund held hereunder to which said compensation is attributable. a 11. To do all other acts in her judgment necessary or desirable for the proper ancfi~h advantageous management, investment, and distribution of my estate. ~• SIXTH: I direct that all transfer and inheritance taxes, state or federal, assessed because of ~ Y my death, whether the funds, property, or insurance proceeds to which such taxes are attributable pass ~ under this Will or not, shall be paid out of my residuary estate just as if they were my debts and none of those taxes shall be charged against any beneficiary; that my Executrix pay, or provide for payment of all such taxes at such time or times, and in such manner as my Executrix deems best. ~' c SEVENTH: All questions as to the validity of this, my bast Will, or the administration of ~/" the Will shall be governed by the laws of the Commonwealth of Pennsylvania. EIGHTH: If my wife and I shall die simultaneously or under circumstances which malxe it difficult to determine which of us died first, I direct that my wife, Josephine R. Sheffer, shall be determined to ~ave predeceased me, and I direct further that the provisions of this Will shall be construed upon that assumption irrespective of any provisions of law establishing a contrary presumption or requiring survivorship for a fixed period as a condition of talzing property by inheritance. NINTH: Should my wife, Josephine R. Sheffer, my son, Keith E. Sheffer, my grandchildren Chad W. Sheffer and Ryan K. Sheffer, and the issue of my grandchildren, all fail to survive me, then I give, devise, and bequeath all the rest, residue, and remainder of my estate of whatsoever nature and wheresoever situate to Jody h. Sheffer, 527 treason Road, Carlisle, Pennsylvania. 3 TENT~i: Except as otherwise provided in this Will, I have intentionally {ailed to provide for any other relatiWes or other persons, whether claiming to be an heir of mine or not. Insofar as I have failed to provide in this Will for any of my issue now living or later born or adopted, such failure is intentional and not occasioned by accident or mistalxe. IN WITNESS WHEREOF, I, Wayne E. Sheffer, the Testator to this, my Last Will and Testament, typewritten on four (4) sheets of paper which I have identified in the margin o{each page by my signature, hereunto set my hand and seal this 3`d day of March, 2006. /'. ~. ~~ ~ Wayne .Sheffer The preceding instrument consisting of four {4) typewritten pages, each identified by the signature of the Testator, Wayne E. Sheffer, was on this day and date signed, published, and declared by him, the Testator therein named, as and for his Last Will, in the presence of us, who at his ~ request, in his presence, and in the presence of each other have subscribed our names as witnesses. 1 ~ -~ !~ ~ ~~- ~' COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) I, Wayne E. Sheffer, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby aclzsiowledge that I signed and executed the instrument as ntly Last Will on the 3`d day of March, 2006; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. ~ ~ .~ ,~ Wayn E. Sheffer 4 Sworn or affirmed to and aclznowledged before me, by Wayne E. Sheffer, the Testator, this 3`d day of March, 2006 . ~. _`'~ A~41 ~ No ry Public .,;-:;1: ~. ;;)gird, Noiary F~stiut: Care-'~~s= Bono, Cumbedard Ccu~ ~t~~ ~liy Cun~.n~is,on Expires Oci. 27, %a-~" _ ._ ii.. gt_ i _ ..-?l~ ~,iu 3 rlssir7 +r9 n`?' ~ n~ ; COMMONWEALTH OF PENNSYLVANIA ) SS: COUNTY OF CUMBERLAND ) We, 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 Wayne E. Sheffer sign and execute the instrument as a codicil to his Last Will; that he signed willingly and that he executed it as his ~ree and Woluntary act for the purposes therein expressed; that each of us in the hearing and sight of Wayne'Ir. Sheffer signed the codicil as witnesses; and that, to the best of our Iznowledge, Wayne E. Sheffer was at the time eighteen (18) or more years of age, of sound mind, and under no constraint or umdue influence. /~ ,! /~ J ~ _ (/ Sworn or affirmed to and subscribed to before me by the above-named witnesses, this 3`d day of March, 2006. N ary ublic 5 .. .. j _ ..illi, ~.... REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2010- 00190 PA No . 21- 10- 0190 Estate Of : WA YNE E SHEFFER (First Midd/e, LasU Late Of: MIDDLESEX TOWNSH/P CUMBERLAND COUNTY Deceased Social Security No: 166-12-7722 WHEREAS, on the 25th day of February 2010 an instrument dated March 3rd 2006 was admitted to probate as the last will of WA YNE E SHEFFER (First, Midd/e, Lest/ late of M/DDLESEX TOWNSH/P, CUMBERLAND County, who died on the 15th day of February 2010 and WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA EARNER STRASBAUGH Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARY to: KEITH E SHEFFER who has duly qualified as EXECUTOR(R/Xl and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARL/SLE, PENNSYLVANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 25th day of February 2010. **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) , REV-1502 EX+ (6-98) COMMONWEALTH OF P INHERITANCE TAX RESIDENT DECI SCMEp11LE A REAL ESTATE ESTATE OF FILE NUMBER _ • -.•. _ _ __•__ __ •___ ~ -!.~~..~I..~ :~ Jai: J iLn nr:nn ni •ulrinA nrnnnrh, wn11III tiC (If more space is needed, insert additional sheets of the same size) ,REV-1503 EX+ (6-98) s~~c/~N~upu~E s COMMONWEALTH OF PENNSYLVANIA STVbKS $c BONDS INHERITANCE TAX RETWRN RESIDENT DECEDENT ESTATE OF FILE NUMBER All property Jo1Mly-owned with right of survivorahlp must be disclosed on Schedule F. (H more space is needed, insert addfiorlal 8tleets d the same Sae) ,REV-1504~EX+ (i-97) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNEDIlLE C CLOSELY HELD CORPORATION, PARTNER5HIP OR SOLE-PROPRIETORSHIP ESTATE OF FILE NUMBER Schedule C-1 or C-2 (including all supporting information) must be attached for each closely-held corporation/partnership interest of the decedent, other than a sole-proprietorship. See instructions for the supporting information to be submitted for sole-proprietorships. (If more space is needed, insert additional sheets of the same size) 'REV-1505 EX+ (6-98) SCNEp1lLE C-1 CLOSELY HELD CORPORATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN STCtCK INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER 1. Name of Corporation State on Incorporation Address Date of Incorporation City State Zip Code Total Number of Shareholders 2. Federal Employer I.D. Nunhber Business Reporting Year 3. Type of Business ProducUService Q. ~~' (~ ~ d~i ~ ~ i ~ y t~ ~~.~ 1 ~~ T• 't ,ry v !i, k , t,3~ f z i t y i Common $ _ Preferred $ Provide all rights and restrictions pretaining to each class of stock. 5. Was the decedent employed by the Corporation? ................... ......... ^ Yes ^ No If yes, Position Annual Salary $__~_ Time Devoted to Business 6. Was the Corporation indebted to the decedent? ................. ......... ^ Yes ^ No If yes, provide amount of indebtedness $~~ 7. Was there life insurance p>3yable to the corporation upon If yes, Cash Surrender Vallue $ Owner of the policy 8. Did the decedent sell or transfer an stock in this company within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Number of Shares Transferee or Purchaser Consideration $ Date Attach a separate sheet far additional transfers and/or sales. 9. Was there a written shareholder's agreement in effect at the time of the decedent's death? ....^ Yes ^ No If yes, provide a copy of the agreement. 10. Was the decedents stock sold? ..................................................... ^ Yes ^ No If yes, provide a copy of the agreement of sale, etc. 11. Was the corporation dissolved or liquidated after the decedent's death? .................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 12. Did the corporation have an interest in other corporations or partnerships? ............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's stock. B. Complete copies of financi2l statements or Federal Corporate Income Tax returns (Form 1120) for the year of death and 4 preceding years. C. If the corporation owned reel estate, submit a list showing the complete addresses and estimated fair market value/s. If real estate appraisals have been secured, attach copie6. D. List of principal stockholders at the date of death, number of shares held and their relationship to the decedent. E. List of officers, their salane$, bonuses and any other benefits received from the corporation. F. Statement of dividends paid each year. List those declared and unpaid. G. Any other information relating to the valuation of the decedents stock. theldecedent? ..... ^ Yes ^ No _ Net proceeds payable $ (If more space is needed, insen additional sheets of the same size) REV-1508 EX+ (9-00) SCHEDULE C-S PARTNERSHIP COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN INFORMATION REPORT RESIDENT DECEDENT ESTATE OF FILE NUMBER 1. Name of Partnership Date Business Commenced Address Business Reporting Year City State Zip Code 2. Federal Employer I.D. Number 3. Type of Business Product/Service 4. Decedent was a ^ General ^ Limited partner. If decedent was a limited partner, provide initial investment $ 5. A. B. C. D. 6. Value of the decedent's interest $ 7. Was the Partnership indebted to the decedent? ..... .1~...~ .. ~ ................. ^ Yes ^ No If yes, provide amount of indebtedness $ ~J S. Was there life insurance payable to the partnership upon the death of the decedent? ..... ^ Yes If yes, Cash Surrender Value $ Net proceeds payable $_ Owner of the policy 9. Did the decedent sell or transfer an interest in this partnership within one year prior to death or within two years if the date of death was prior to 12-31-82? ^ Yes ^ No If yes, ^ Transfer ^ Sale Percentage transferred/sold Transferee or Purchaser Consideration $ Date Attach a separate sheet fpr additional transfers and/or sales. 10. Was there a written partnership agreement in effect at the time of the decedents death? ...... ^ Yes ^ No If yes, provide a copy of tlhe agreement. 11. Was the decedents partnership interest sold? ....................................... ^ Yes ^ No If yes, provide a copy of thg agreement of sale, etc. 12. Was the partnership dissolved or liquidated after the decedents death? ................... ^ Yes ^ No If yes, provide a breakdown of distributions received by the estate, including dates and amounts received. 13. Was the decedent related to any of the partners? .................................... ^ Yes ^ No If yes, explain 14. Did the partnership have an interest in other corporations or partnerships? .............. ^ Yes ^ No If yes, report the necessary information on a separate sheet, including a Schedule C-1 or C-2 for each interest. A. Detailed calculations used in the valuation of the decedent's partnership interest. B. Complete copies of financial statements or Federal Partnership Income Tax returns (Form 1065) for the year of death and 4 preceding years. C. If the partnership owned reel estate, submit a list showing the complete addresses and estimated fair market values. If real estate appraisals have been secured, attach copir~s. D. Any other information relating to the valuation of the decedents partnership interest. ^ No REV-1507 EX+ (1-97) SCHEDYLE D COMMONWEALTH OF PENNSYLVANIA MORTGAGES Se NOTES INHERITANCE TAX RETURN RECEIVABLE RESIDENT DECEDENT ESTATE OF FILE NUMBER All property jointly-owned with right o} survlvorshlp must be disclosed on Schedule F. (If more space is needed, insert additional sheets of the same size) REV.151° E%~ rtb~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN SCHEDULE G INTER-VIVOS TRANSFERS 8r MISC. NON-PROBATE PROPERTY FILE This schedule must be completed and filed H the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET Is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCIUDETHENAMEOFTHETRPNeF~REE,THEIRRElATIONSNIPTOOECE~ENiANDTHEMTEOFTRIMSFER ATTACHAWWOF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET %OF DECD'S INTEREST EXCLUSION ~F APPLICABLE TAXABLE VALUE 1. TOTAL (Also enter on line 7, Recapitulation) I S more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAx RETURN RESIDENT DECEDENT SCI~IEDULE 1 DEBTS OF DECEDENT, MORTGAGE LIABILITIES, 8~ LIENS ESTATE OF FILE NUMBER Revert debts incurred by khe decedent prior to death which remained unpaid as of the date of death, including unreimbursed medical expenses. I (If more space is needed, insert additional sheets of the same size) REV-1514 EX+ (12-03) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCFIEpYLE K LIfE ESTATE, ANNUITY & TERM CERTAIN ;heck Box 4 on REV-1500 Cover Shet ESTATE OF FILE NUMBER This schedule is to be used for all single life, joint or successive life estate and term certain calculations. For dates of death prior to 5-1-89, actuarial factors for single life calculations can be obtained from the Department of Revenue, Specialty Tax Unit. Actuarial factors can be found in IRS Publication 1457, Actuarial Values, Alpha Volume for dates of death from 5-1-89 to 4-30-99, and in Aleph Volume for dates of death from 5.1-99 and thereafter. Indicate the type of instrument which created the future interest below and attach a copy to the tax return. ^ W~p ^ Intervivos Deed of Trust ^ Other ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which life estate is payable ..................... .. ..............$ 2. Actuarial factor per appropriate table .................. .......... ................ . Interest table rate - ^ 3 112% ^ 6% ^ 10% ^ Variable at ° 3. Value of life estate (Line 1 multiplied by Line 2) ........I~...~ ...~ ... ~. ~ ...............$ ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years ^ Life or ^ Term of Years 1. Value of fund from which annuity is payable ............................................$ 2. Check appropriate block below and enter corresponding (number) ......................... . Frequency of payout - ^ Weekly (52) ^ Bi-weekly (26) ^ Monthly (12) ^ Quarterly (4) ^Serni-annually (2) ^ Annually (1) ^ Other ( ) 3. Amount of payout per period ........................................................$ 4. Aggregate annual payment, Line 2 multiplied by Line 3 .................................. . 5. Annuity Factor (see instructions) Interest table rate - ^ 3 1',/2% ^ 6% ^ 10% ^ Variable Rate 6. Adjustment Factor (see inf;tructions) ................................................. . 7. Value of annuity - If usilhg 31/2%, 6%, 10%, or if variable rate and period payout is at end of period; calculation is: Line 4 x Line 5 x Lins 6 ..........................$ If using variable rate and period payout is at beginning of period, calculation is: (Line 4 x Line 5 x Line 6) + Line 3 ..................................................$ NOTE: The values of the funds which create the above future interests must be reported as part of the estate assets on Schedules A through G of this tax return. The resulting life or annuity interest(s) should be reported at the appropriate tax rate on Lines 13 and 15 through 18. (If more space is needed, insert additional sheets of the same size) Rw-'~' Ex ~ (~-a'I INHERITANCE TAX scNSOU~E ~ COMMONWEALTH OF PENNSV~.VANIA INHERITANCE TAX RETURN REMAINDER PREPAYMENT RESIDENT DECEDENT OR INVASION OF TRUST PRINCIPAL FILE NUMBER I. ESTATE OF (Lagt Name) (First Name) (Middle In@iaq This schedulle is appropriate only for estates of decedents dying on or before December 12, 1982. This schedule is to 4e used for all remainder returns when an election to prepay has been filed under the provisions of Section 7141of the Inheritance and Estate Tax Act of 1961 or to report the invasion of trust principal. II. REMAINDER PREPAYIIMENT: A. Election to prepay filed with the Register of Wills on (Date) B. Name(s) of Life Tena9nt(s) Date of Birth Age on date Term of years income or Annuitant(s) of election or annuity is payable C. Assets: Complete Spttedule L-1 1. Real Estate ...............................$ 2. Stocks and Bondis ......................... . 3. Closely Hekl Stook/Partnership .............. . A \AnA...~....n n..A AL.lc... 5. Cash/Misc. Persgnal Property ................$ 6. Total from Schedule L-1 ......................................................$ D. Credits: Complete Schedule L-2 1. Unpaid Liabilities ...........................$ 2. Unpaid Bequests ...........................$ 3. Value of Unincludlable Assets .................$ 4. Total from Scheduule L-2 ......................................................$ E. Total Value of trust ~issets (Line C-6 minus Line D-4) .................................$ F. Remainder factor (slee Table I or Table II in Instruction Booklet) ........................ . G. Taxable Remainder value (Line E x Line F) .........................................$ (Also enter on Line 7, RecapkulaGon) III. INVASION OF CORPUS: A. Irnasion of corpus (Month, Day, Year) B. Name(s) of Life Tenpnt(s) Date of Birth Age on date Term of years income or Annuitant(s) corpus or annuity is payable consumed C. Corpus consumed ............................................................$ D. Remainder factor (sse Table I or Table II in Instruction Booklet) ........................ . E. Taxable value of corpus consumed (Line C x Line D) .................................$ (Also enter on Line 7, Recapitulation) REV-1645 EX+ p-esl INHERITANCE TAX SCHEDULE L-1 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT.. -ASSETS- FILE NUMBER I. Estate of (Last Name) (First Name) (Middle Initial) II. Item No. Description Valve A. Real Estate (please describe) Total value of real estate $ (include on Section II, Line C-1 on Schedule L) B. Stocks and Bonds (please list) Total value of stocks and bonds S (include on Section II, Line C-2 on Schedule L) C. Closely Held Stock/Partnership (attach Schedule C-1 andlor C-2) (please lisT) Total value of Closely Held/Partnership $ (include on Section II, Line C-3 on Schedule L) D. Mortgages and Notes (please list) Total value of Mortgages and Notes $ (include on Section II, Line C-4 on Schedule L) E. Cash and Miscellaneous Personal Property (please list) Total value of Cash/Misc. Pers. Property $ (include on Section II, Line C-5 on Schedule L) III. TOTAL (Also enter on Section II, Line C-6 on Schedule L) $ (If more space is needed, attach additional 8'/s x 11 sheets.) REV-1646 EX+ (3-84) INHERITANCE TAX SCHEDULE L-2 COMMONWEALTH OF PENNSYLVANIA REMAINDER PREPAYMENT ELECTION INHERITANCE TAX RETURN RESIDENT DECEDENT -CREDITS- FILE NUMBER I. Estate of (last Name) (First Name) (Middle Initial) II. Item No. Description Amount A. Unpaid Liabilities Claimed against Original Estate, and payable from assets reported on Schedule L-1 (please list) Total unpaid liabilities $ (include on Section II, Line D 1 n Schedule L) B. Unpaid Bequests payable from assets re orted S edule L-1 (please list) Total unpaid bequests $ (include on Section II, Line D-2 on Schedule L) C. Value of assets reported on Schedule L-1 (other than unpaid bequests listed under "B'" above) that are not included for tax purposes or that do not Form a part of the trust. Cormputation as follows: Total unincludable assets $ (include on Section II, Line D-3 on Schedule L) III. TOTAL ( Iso enter on Section II, Line D-4 on Schedule L) $ (If more space is needed, attach additionol 8Ys x 11 sheets.) ' REV-164i EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF SCNEDYLE M FUTURE INTEREST COMPROMISE Check Box 4a on Rev-1; FILE NUMBER This Schedule is appropriate only for estates of decedents dying after December 12, 1982. This schedule is to be used for all future interests where the rate of tax which will be applicable when the future interest vests in possession and enjoymenlt cannot be established with certainty. Indicate below the type of instrument which created the future interest and attach a copy to the tax return. ^ Will ^ Trust ^ Other L Beneficiaries NAME OF BENEFICIARY RELATIONSHIP DATE OF BIRTH AGE TO NEAREST BIRTHDAY 1. 2. 3. 4. 5. II. For decedents dying do or after July 1, 1994, if a surviving spouse exercised or intends to exercise a right of withdrawal within 9 months of the decedents death, check the appropriate block and attach a copy of the document in which the surviving spouse exercises such withdr~lwal right. ^ Wnlimited right of withdrawal ^ "mited right of withdrawal III. Explanation of Compromise Offer: N Summary of Compr'pmise Offer: 1. Amount of Future Interest .........................................................$ 2. Value of Line 1 exempt from tax as amount passing to charities, etc. (also include as pArt of total shown on Line 13 of Cover Sheet) ......$ 3. Value of Line 1 passing to spouse at appropriate tax rate Check One ~] 6%, ^ 3%, ^ 0% ......................$ (also include as psrt of total shown on Line 15 of Cover Sheet) 4. Value of Line 1 tastable at lineal rate Check One C+l 6%, ^ 4.5% ...........................$ (also include as pArt of total shown on Line 16 of Cover Sheet) 5. Value of Line 1 taxable at sibling rate (12%) (also include as pert of total shown on Line 17 of Cover Sheet) ......$ 6. Value of Line 1 taxable at collateral rate (15%) $ Li 18 f C Sh t f l h e ) ...... own on ne over ee tota o (also include as p rt o s 7. Total value of Future Interest (sum of Lines 2 thru 6 must equal Line 1) ......................$ (If more space is needed, insert additional sheets of the same size) wev-,sas Ex f,t-ssl SCHEDULE N SPOUSAL POVERTY CREDIT COMMONWEALTH OF PENNSYLVANIA (pypILABLE FOR DATES OF DEATH 01/01/92 TO 12/31/94) INHERITANCE TAX DIVISION ESTATE OF FILE NUMBER This schedulie must be completed and filed if you checked the spousal poverty credit box on the cover sheet. 1 . Taxable Assets total from IinQ 6 (cover sheet) ............................................ 1 . 2. Insurance Proceeds on Life Of Decedent ................................................ 2. 3. Retirement Benefits ................................................................ 3. 4. Joint Assets with Spouse ............................................................ 4. 5. PA Lottery Winnings ............................................................... 5. 6a. Other Nontaxable Assets: List (Attach schedule if necessary).. 6a. 6c. 6d. 6. SUBTOTAL (Lines 6a, b, c, tl) ................................ 6. 7. Total Gross Assets (Add line's 1 thru 6) ................................................. 7. 8. Total Actual Liabilities ............................................................ 8. 9. Net Value of Estate (Subtract line 8 from line 7) ........................................... 9. If line 9 is greater than $200,800 -STOP. The estate is not eligible to claim the credit. If not, continue to Part 11. Income: a. Spouse ........... b. Decedent .......... 1a 1 b, ~a• 2b. ~p• 3b. c. Joint ............. ic. 2c. 3c. d. Tax Exempt Income .. 1d. 2d• 3d• e Other Income not listed above ........ 1 e 2e. 3e. ,. win, . ~ , , 4. Average Joint Exemption Irwcome Calculation 4a. Add Joint Exemption Income from above: (1 f) + (2f) + (3fl = (+ 3) 4b. Average Joint Exemption Irycome ..................................................... _ 1. Insert amount of taxable trajnsfers to spouse or $100,000, whichever is less Part ~ 1. III. t 2. 3. 4. 5. 2. Multiply by credit percentage (see instructions) .......................................... . 3. This is the amount of the Resident Spousal Poverty Credit. Include this figure in the calculation of total cr dits on line 18 of the cover sheet . .............................. . 4. For Nonresidents, enter the ratio of the decedent's gross estate in PA to the value of the decedent's gross estate ............................................................ . 5. Multiply line 3 by line 4 anp enter the total here. This is the amount of the Nonresident Spousal Poverty Credit .Include thi$ figure in the calculation of total credits on line 18 of the cover sheet...... . gfv.,w9 Ex.l,-y~1 SCHEDULE 0 COMMONWEALTH OF PENNSYLVANIA ELECTION UNDER SEC. 9113(A) INHERITANCE TAX RETURN /CDf1I ICSI nISTRIBUTI~NSI ESTATE OF Do not complete this schedule unless the estate la making the election to tax assets under Section 9113(A) of the Inheritance & Estate Tax Act. If the election applies to more than one trust or similar arcangement, a separate form must be filed for each 1Nmarifal rasidual A. B. By-pass, Unified Credit, etc.). If a trust or similar arrangement meets', the requirements of Section 9113(A), and: a. The trust or similar arcangem~nt is listed on Schedule 0, and b. The value of the trust or simildr arcangement is entered in whole or in part as an asset on Schedule 0, then the transferor's personal represelptativemsy specifically identify the trust (all or a fractional portion or percentage) to be included in the election to have such trust or similar property treated as a taxable transfer in this estate. If less than the entire value of the trust or similar property is included as a taxable transfer on Schedule 0, the personal representative shall be conspdered to have made the election only as to a fraction of the trust or similar arcangement. The numerator of this fraction is equal to the amount of the trust or similar arcarjgement included as a taxable asset on Schedule 0 The denominator is equal to the total value of the trust or similar arcangement. PART A: Enter the description',and value of all interests, both taxable and non-taxable, regardless of location, which pass to the decedent's surviving spouse under a Section 9113 (A) trust or similar arrangement ~AL~E N~ PART B: and value of all interests included in Part A for Section election to tax is Part B Total I (If more space is needed, insert additional sheets of the same size)