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Home My WebLink About03-1028 PETITION FOR PROBATE and GRANT OF LETTERS Estate of D~vi d I,_ ghett~l No. e~/-~_/0~ also known as To: -- Register of Wills for the Social SeCUrity No. 71 6-09-7~4J)eceased' County of Cumberland in the Cpmmonwealth of Pennsylvania The petition of the undersigned respectfully represents that: · ~ou, rp. eti!!,on~er(.l/), _whois/are~8yearsofageorolderanthe&C~t±ngent executrix . tn me last wm o! the above decedent dated Apr i 1 29 1 c~ ~ ~ . _~nameo he easC - -- testator hav~ed on October 23 2003. Linda Ka ~ is now Lin a-~-~-e-~e ~ ~, (state relevm~t circumstances~ e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h~ is last family or principal residence'at 375 Claremont Drive, Carlisle, Middlesex Townshi~p_z_ Cumber-~ ~ PA (list street, number and muncipality) Decendent, then 89 years of age, died November 4, 2003 · ~ ,1~× at_ Holy Spirit Hospital, East Pensboro Twp., ~umberland" County, Except as follows, decedent did not marry, was not d~vorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: · None Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $. (If notdomiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in. Pa.) Personal property in County $ Value of real estate in Pennsylvania situated as follows: $- 35,000.00 PA WHEREFORE, petitioner(x) respectfully re.quest(s) the probate of the last will ~ltfaX~ff, di~l~)t presented herewith and the grant of letters_ 'testamentary ~ o . /3 (testamentary- ther ~ . , , administration c.t.a.; administration d.b.n.c.t.a.) Linda Kay Shettel, formerly Linda Kay Josep], 9 HawthOrne Road - . Bluffton, SC 29910 OATH OF PERSONAL REPRESENTATIVE STATE OF SOUTH CAROLINA COUNTY OF BEAUFORT ; ss The petitioner~) abovemamed swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(g) and that as personal represen- tative(~ of the above decedent petitioner{g) wJ L~elLand truly administer the estate according to law. Sworn to or aff~rmegl ~.._d subscribed ~.~a~ t~his___ .~.' "'- __ day of formerly Linda Kay Joseph ~ v~ F w ' . No. Estate of ~v, J L ~~ ~ , De~eased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~~r~v ' &~ ~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated-~-o~, described th~erein be admittod4.o probate and filed of record as the last will of and Letters 1 ~-r-~ r~,~-~ are hercby granted to ]~lr~c~ ~ I~r~l~ '~_ ~L~c~fl ~t~ ~_~ _ FEES Probate, Letters, Etc .......... $ ShorJ_~Certificates( ) .......... $ ~a~.~t~on .. ............... $ $ Filed~~... TOTAL __$ ~..~ Richard L. Placey 07232 A~ORNEY (~p. Ct. I.D. No.) 3631 North Front Street Harrisburg, PA 17110-1533 ADDRP~S (717)236-9577 PHONE his is to certify that the information here given is correcdy copied from an original certificate oF death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records O£ficc for permanent fiiing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 No. Local Registrar Date 143 Rev. 2187 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH I NAME OF DECEDENT (FirsL Middle Last) STATE FILE NUMBER ~ ~ t ~,. . ~ I [ SEX I SOCIAL SECURITY NUMBER I DATE OF DEATH tMonth Da Yea ~AGEI,,,,t=~.~.,.) [ UNDER,VE~ I UND~:~'~pAV ' DATE OF B,RT- ' - 1. 13. 716 -- 09 -- 7947 ]4/Vove/v~/ge'/lq .~76x~ n ~RTHP~CE (~ty a~ IPLACE OF . . ' ....... ~ t~ ~,~ ~ [ , , Me U~/H [FACILI~NAME (If~insfitu~on g~esU~ andnu n~r) IWASD . ' . . ~6[ .... ~7, s~t, ' '-' I I MOTHER'S N~E (First. MMdle. Maffien ~ INFers ~E (T~I) [ E C R L fl ~,~n ~ Burial ~ Cr~,~ ~ .... I ~m State ~ {~. ~ .... ) or Other PAce . L~ATION - Ci~n~n. ' 121b. II'l-O~ [21c. PA Caem~oaff ~,d H~a&b~ , PA 17109 ~ SIGNORE ~NE~ ~RVICE LICENSEE OR ~ON ACTING AS SUCH [ LICENSE ~UMBER N~E ~O ADDRESS OF FACILI~ lco=~t,~23~<on~~- ~To~;~, '. _ .. ~ .' I22~.eluu JO~g~O~ ~0~ ~~ PA Z7~0~ ~ ~ is ~t av~b~ at t~ of ~a~ ~ [ ...... ~. ,~, aeain ~u~ at ~he ~me, date a~ pla~ s~ted { .............. oII(~. Day Year) ~ 124 D ~ 0 ~ u I Al ..... ;5 '~ t I .... ~="=~"REDTOaUED,CALE~M~NER/Cm~ER? IMMEDIATE CAUBE (Final disease or condition resulting in death) .-..---l. a. ' Iht cor~l~ b. }f any, leading lo immediate { r.41use. Enter UNDERLYING P-AUBE (Disease or injury c. that initiated avent~ resulting on death ) LAST d. DUE TO (OR AS A CONSE(~UENCE Of:): J¢oM.~ ~u~ttrOV,d,. DUE TO (OR AS A CONSEQUENCE OF): , inlen~al betw~e~ ; onset end dea~ not resuRing k~ the undedying cause given in PART I. Ur,Ac.,.? -t~.d- ,;-, C.d, PERFORMED? {AVAII. A~LE PRIOR TO DATE OF INJURY TIME OF INJURY J INJURY AT WORK? DESCRIBE HOW INJURY OCCURRED. ! COMPLETION OF CAUSE (iV~nl~. Day. Yam) IOF DEATH? Natura{ ~ Homicide IY"a NonI Accident[] Pending {nve$iigaPo. r-I 130a. 130b. M. YosE] NO Yes[] NO~. Suicide [] Could not bo determ~ned ~ PLACE OF INJURY Abome,.m , 13~c' 13Od' CERTIFIER (Check only one) . '~EI<flI'flNG pHy..I~_I_~_N ,ph.sician --...- -- .. Fi 181GNATUt}tAND TITLE OF CERTIFIER /o thl bill of my ]k~l:~wl~l~ ~. daa~l~.l~g cause ~ dealh when azmothor physician h~s ed death and I LICENSI~NUMB~R *PRONOUNCING AND CERTIFYING PHYSICIAN (Phy~ both pronouncin death and ' To the blt d nm knowl~d g cedifying Io cause of death) DATE SIGNED (Month, Day ~En 'D~ -A~L E'XA 'MINER/SORONER I ."..~_ANO,=DRE~ OF PERSON WRO CO"P~ETED CAUSE & D LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, DAVID L. SHETTEL, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and under- standing, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am married to THELMA M. SHETTEL and that I have three (3) children; PATRICIA ANN BENNETT, DAVID W. SHETTEL and LINDA KAY JOSEPH. II I direct that my debts and funeral expenses be paid as soon after my death as is practicable by my Executrix out of my residuary estate, but not from any assets, funds, death benefits or insurance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. III I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for death tax purposes, whether or not such property passes under this LAST WILL, shall be paid by my Executrix out of my resid- uary estate, but not from any assets, funds, death benefits or in- surance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. IV I give, devise and bequeath all of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my wife, THELMA M. SHETTEL, pro- vided that she survives me by thirty (30) days. V I give and bequeath my wife's diamond ring to my daughter, PATRICIA ANN BENNETT. If PATRICIA fails to survive me, then I give and bequeath the ring to my daughter, LINDA KAY JOSEPH. VI I give, devise and bequeath to my son, DAVID W. SHETTEL, the first right to receive real estate which I own and which is situate in Juniata County. If DAVID desires to obtain the real estate, then he may purchase it at its fair market value and offset one third of its value against his share of my estate. If DAVID does not desire to purchase the real estate, then I give this option to my daughter, PATRICIA. If neither DAVID nor PATRICIA desire to purchase the land, then it shall be sold and the proceeds distributed pursuant to the other provisions of this Will. VII Ail of the rest, residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, I give, devise and bequeath to my children, PATRICIA ANN BENNETT, DAVID W. SHETTEL and LINDAKAY JOSEPH, in equal shares, per capita. VIII I nominate, constitute and appoint my wife, THELMA M. SHETTEL, as Executrix of this LAST WILL, to serve without bond. If my wife is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my daughter, LINDA KAY JOSEPH, as Executrix, to serve without bond. IN WITNESS WHEREOF, I, DAVID L. SHETTEL, have set my hand to this LAST WILL, this ~Z~ day of ~'~~ , 1986. DAVIIf L .--~ETTEL -2- ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : I, DAVID L. SHETTEL, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified accord- ing to law, do hereby acknowledge that I signed and executed the in- strument as my LAST WILL; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn or affirmed to Testator, this ~ DAVID L. SHETTEL and acknowledged before me by DAVID L. S~ETTEL, day of ~?zz~- ~/ ,z1986.,, .~- .x _ No t A r y~u~I i c MURREL R. WALTERS, III, Notary Public /Vlechanicsbur~j, Cumberland Co., Pa. My Commission Expires November 21, 198JJ AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : ..~ .~ .- ,~ ~./ ~ . ~. ': ~ ~., ~'~?., ~ , the witnesses whose names are signed to the attached or foregoing in- strument being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL; that DAVID L. SHETTEL signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. Sworn or affirmed to and acknowledged before me this ~'~ ~' day of /i//~'~ ~ ~./ 1986~ Notary MURREL R. WALTERS, III, Notary Publk: Mechanicsburg, Cumberland Co., Pa. My Commission Expires November 21,191~8 DAVID L. SHETTEL I~IURREL R. WALTERS, 111 ATTORNEY AT LAW lOB EAST MAIN STREET MEC~HANICSBURG, PENNSYLVANIA I?OBB CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: Date of Death: Administration No.: David L. Shettel November 4, 2003 2003-01028 To the Register: I certify that notice of estate administration required by Rule 5.6(a) of the Orphans' Court Rules was given to the following beneficiaries set forth on the attached list on December 24, 2003. Notice has now been given to all persons entitled there!~l~der Rule 5.6(a). ~ '~BJei~ard L. Plac"ey~s~t~ir~ Attorney for the Estat~-~ 3631 North Front Street Harrisburg, PA 17110 (717)236-9577 Date: December 24, 2003 ESTATE OF DAVID L. SHETTEI, NOTICE GIVEN TO: Patricia Ann Bennett 12200 E. State Route 69 Dewey, AZ 86327 David W. Shettel 541 Third Street West Fairview, PA 17025 Linda Kay Shettel 9 Hawthorne Road Bluffton, SC 29910 REV-1500 EX 1600) REV-1500 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT. 280601 HARRISBURG, PA 17128-0601 INHERITANCE TAX RETURN RESIDENT DECEDENT I.- Z LLI r,, O Z Z O FILE NUMBER 21 _ 03 1028 COUNT(CODE YEAR NUMBER DECEDENTS NAME (LAS'E FIRST, AND MIDDLE iNITIAL) SOCIAL SECURITY NUMBER SHETTEL, David L. [ 716-09-7947 DATE OF DEATH (MM-OD-YEAR) i DATE OF BIRTH (MM-DO-YEAR ITHIS RETURN MUST BE FILED IN DUPLICATE WITH THE 11/04/2003 ;06/02/1914 iREGISTER, OF WILLS (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER n/a r~l. Original Return r--] 4. Limited Estate J"~ 6. Decedent Died Testate (Attach copy of Will) D g. Litigation Proceeds Received ~]2, Supplemental Return [~4a. Future Interest Compromise (dale of death after 12-12-82) [~]7~ Decedent Maintained a Living Trust (Attach copy of Trust) ---']10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) ]3. Remainder Return (date Gl deaff~ prior Io 12-13-82) r~5. Federal Estate Tax Return Required 1 8. Total Number of Safe Deposit Boxes r~11. Election to tax under Sec. 9113(A) (A,a¢~ Sch O) THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME COMPLETE MAILING ADDRESS Richard L. Placey, Esquir~ I 3631 Nodh Front Street FIRM NAME (IfApplicable) I' Harrisburg, PA 17110-1533 Placey & Wright TELEPHONE NUMBER (717) 236-9577 1. Real Estate (Schedule A) (1) 2. Stocks and Bonds (Schedule B) (2) 3. Closely Held Corporation, Padnership or Sole-Proprietorship (3) 4. Modgages & Notes Receivable (Schedule D) (4) 5. Cash, Bank Deposits & Miscellaneous Personal Properly (5) (Schedule E) 6. Jointly Owned Properly (Schedule F) (6) [~ Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Properly (7) (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 10. Debts of Decedent, Modgage Liabilities, & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) 12. Net Value of Estate (Line 8 minus Line 1t) 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election 1o tax has not been made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) 0.00 27,997.77 o.00 (8) 6,454.67 0.00 (11) (12) (13) (14) 30,510.87 6,454.67 24,056.20 0.00 24,056.20 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) 16. Amount of Line 14 taxable al lineal rate 17. Amount of Line 14 taxable at sibling rate 18. Amount of Line 14 taxable at collateral rate 19. Tax Due x .0 (15) 24,056.20 x .0 45 (16) x .12 (17) x .15 (18) (19) 0.00 1,082.53 0.00 0.00 1~082.53 > > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < < Decedent's Complete Address: STREET ADDRESS 375 Claremont Drive ClTYCarlisle '- i ' ~:r~PA ~- ] z'P17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) Total Credits ( A + B + C ) (2) 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty ( D + E ) (3) 4. If Une 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund (4) 1,082.53 0.00 0.00 0.00 1,082.53 0.00 1,082.53 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. (5) (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (58) 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 properly transferred or its income; ............................................ [] [] c. retain a reversionary interest; or .......................................................................................................................... [] [] d. receive the promise for life of either payments, benefits or care? ...................................................................... [] [] 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? .............................................................................................................. [] [] 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ............ [] [] 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate properly 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. Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Oedaration of preparer other than the personal representa~e is based on all information of which preparer has any knowledge. SIGNATURE OF PERSON RESPONSIBLE FOR FILING RETURN ADDRESS Linda Kay Shettel, Executrix, c/o Placey & Wright, 3631 N. Front Street, Harrisburg, PA 17110-1533 sIGNATuRE 0F PREP,~RER OTHER THAN REPRE~NTATIvE,,,,"3 ~ DATE ADDRESS ~/~ ~'/// Richard L. Place,, Esquir ~.~,.~N. ,3 N. ~F.~'~t ~t're~,;' B~ risburg, PA 17110-1533 ~'./~ For dates of death on or alter July 1. 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [72 RS. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 RS. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 RS. §9116(1.2) [72 P.S. §9116(a)(1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6~98,~.,~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE B STOCKS & BONDS ESTATE OF FILE NUMBER DAVID L. SHETTEL 21-03-1028 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION PNC Investments Account #82194858 (See valuation attached) TOTAL (Also enter on line 2, Recapitulation) VALUE AT DATE OF DEATH 2,513.10 $ 2,513.10 (If more space is needed, insert additional sheets of the same size) Date og Dsahh: 11/04/2003 vsluaelon Date: 11/04/2003 Prooe~sing Dace~ 03/25/200% 1) 67.203 AIM EOUIT~ FD$ IFC (001413806) C~ARTER FD B Hutual Fund {ag quoted byNA/;DAQ) 11/0%/2003 2) BLACKROCK FD~ (091927582} ~utual Ftu~ (as quoted by~DAQ) 11/0i/2003 3) 55.048 B:d~.CF~OC..I[ FD$ (091928~3~) HUtual Fund (as quoted by ~1/0~/~00~ FEDerATeD ~QUZTY FDS (314172834} LRG CP GRW B ~IAtual Ftmd (as quoeeg by ~ASDAQ) 11/0~/2003 Es~a~e Valuation Low/BAd 10.71000 7.75000 Mkt 7.15000 7.1~000 Mkt Estate of: DAVID L. ~me-T?EL Aeooune~ 82194555 ~'Tort Tylme~ Da:e oE Deat~ ~umber of Securities: 4 File ~: ~TT~L,DAVID Mean ~/or Div a~d ~t Se~ity AdJu~ent~ Acc~ls Value 10.710000 719.74 7.750000 56.00 7.150000 393.59 7.160000 1,343.77 Total Value: Total Accrual: Total: ~2,513.10 $0.00 ~2,513.10 Gina Albright Sales Assistant 717 730 2239 800 762 6111 717 730 2241F PNC INVESTMENTS 4242 Carlisle Pike Camp Hill Pennsylvania 17011 Page ! This repor~ wes produced with BstateVal, a product of ~stata Valuations & Pricin~ Systems, Inc. ~f 2on have please oontac: I~T ~y=teaa a~ (818) 313-6300 or www.ev~sys.com. (~evislon 7.0.3) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER DAVID L. SHETTEL 21-03-1028 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 2. 3. 4. 5. 6. 9. 11. 12. PNC Bank Cedificate of Deposit #31200200138 PNC Bank Certificate of Deposit #31500199926 PNC Bank Ce rtificate of Deposit//31600199773 PNC Bank Certificate of Deposit #31800199524 PNC Bank Checking Account #5002102724 PNC Bank Savings Account #5003147465 (See bank letter attached) Prudential Financial - life insurance policy #D51-896728 received as beneficiary, insured predeceased Highmark - policy cancellation refund Claremont Nursing and Rehab Center - credit in patient's visitor account Consolidated Railroad - November 2003 benefits Miscellaneous Personal Effects TOTAL (Also enter on line 5, Recapitulation) $ 2,243.06 1,241.26 9,174.98 5,703.45 3,O97.6O 1,574.45 3,214.30 106.11 1,473.96 168.60 0.00 27,997.77 (If more space is needed, insert additional sheets of the same size) PNCBAN lan~ary 30, .03- RJch~S ~ '~lac=v 3631 No:'tb From Street I-Ia_rr/_',burg, PA 17110-1533 Estate ef David L. Shettel, deceased $SN: 7[6-09-7947 DOD: Dear Mr. Placey: In response to your request for Date cf Death balances f,x ~e customer noted above., records show the following~ Certiflcales of Deposit Accouat ~3 i 200200138 DAVID L DOD balance: $2,2 ;2.76 - $.30 accrued haterest Account #31500i 99926 DAVID L SHETTEL DOF balance: $!,241.09 + $.17 accraed interest Act. ou.n.t ~,31600199773 DAVID L SH~ETTI:L D. 3D balance: $9, l 73.74 ~- SI .24 accrued interest Account #? 1800 1995.24 DAVID L SHETTEL DOD balance: $$,702.65 4- $.76 accrued imerest Checking Account Established n- .-~,.q ./> .,..'2000 Establh~ed 09/28.'200{) Established 09:2 S/2000 Established 09. 2 Accomat #5002102?24 DAVID L SItETIEL balance: $3,097.57 + $.03 aecraed interest Estabilshed Pase 1 of 2 Acco ,unx ~5003147465 F-slablish~l C,9/28,'..909 DAVID L $tIETTEL DOD balar.:e: $1,574.19 -~ $,26 ac:rued int~st Fer Brcz¢.~e inforrratioa. ~lease card 1-800-762-611 !. (Az¢ou~..:) INV #82194.556 Plea~,~. note that this office only provid¢a date of death b~!a~c~S for deposi~ accoum~ (LRAs, CDs, Checking and Savings aceouats). We do not process ~ny fi~ancis! transactions or provide $tatemesl~o If you ~eed assistance wilh any of lheae items. please call I-$88-PNC-BAN-K (1-888-~62.2265) or stop by your !oeal PHC Bani: branch office. Sincerely, RacheIle Wells 1..8,30-762~1775 PT-PF$C-O4-F 500 fiv~ P!tt~bur~ Page 2 of 2 Member FDIC REV-1511 EX+ (12-99)~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER DAVID L. SHETTEL 21-03-1028 Debts of decedent must be reported on Schedule ]. ITEM NUMBER 5. 6. 7. 8. 9. 10 11. DESCRIPTION FUNERAL EXPENSES: Cremation Society of Pennsylvania Kelly Hughes - reimb, miscellaneous funeral expenses, i.e. guest book, funeral cards, etc. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City . State Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedenrs address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent Probate Fees Accountant's Fees Tax Return Preparer's Fees Cumberland Law Journal - estate advertising The Patriot-News Company - estate advertising Cumberland Register of Wills - short cedifiicates Claremont Nursing & Rehabilitation - final bill Quantum Imaging - debt of decedent Reserve for future costs, taxes and expenses Zip . Zip TOTAL (Also enter on line 9, Recapitulation) AMOUNT 111.00 7O.O0 0.00 4,000.00 0.00 95.00 0.00 0.00 75.00 97.00 9.00 993.75 3.92 1,000.00 $ 6,454.67 (If more space is needed, insed additional sheets of the same size) REV-1513 EX+ (9-00) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF PAUL C. CHUBB FILE NUMBER 50-03-0198 NUMBER 1 1. 2. 3. RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF: ESTATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and transfers under Sec. 9116 (a) (12)] Patricia Ann Bennett, 12200 E. State Route 69, Dewey, AZ 86327 David W. Shettel, 541 Third Street, W. Fairview, PA 17025 Linda Kay Shettel, 9 Hawthorne Road, Bluffton, SC 29910 Daughter Son Daughter One-Third Estate One-Third Estate One-Third Estate ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 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, insed additional sheets of the same size) LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, DAVID L. SHETTEL, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and under- standing, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am married to THELMA M. SHETTEL and that I have three (3) children; PATRICIA ANN BENNETT, DAVID W. SHETTEL and LINDA KAY JOSEPH. II I direct that my debts and funeral expenses be paid as soon after my death as is practicable by my Executrix out of my residuary estate, but not from any assets, funds, death benefits or insurance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. III I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for death tax purposes, whether or not such property passes under this LAST WILL, shall be paid by my Executrix out of my resid- uary estate, but not from any assets, funds, death benefits or in- surance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. IV I give, devise and bequeath all of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my wife, THELMA M. SHETTEL, pro- vided that she survives me by thirty (30) days. V I give and bequeath my wife's diamond ring to my daughter, PATRICIA ANN BENNETT. If PATRICIA fails to survive me, then I give and bequeath the ring to my daughter, LINDA KAY JOSEPH. VI I give, devise and bequeath to my son, DAVID W. SHETTEL, the first right to receive real estate which I own and which is situate in Juniata County. If DAVID desires to obtain the real estate, then he may purchase it at its fair market value and offset one third of its value against his share of my estate. If DAVID does not desire to purchase the real estate, then I give this ootion to my daughter, PATRICIA. If neither DAVID nor PATRICIA desire to purchase the land, then it shall be sold and the proceeds distributed pursuant to the other provisions of this Will. VII All of the rest, residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, I give, devise and bequeath to my children, PATRICIA ANN BENNETT, DAVID W. SHETTEL and LINDA KAY JOSEPH, in equal shares, per capita. VIII I nominate, constitute and appoint my wife, THELMA M. SHETTEL, as Executrix of this LAST WILL, to serve without bond. If my wife is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my daughter, LINDA'KAY JOSEPH, as Executrix, to serve without bond. IN WITNESS WHEREOF, I, DAVID L. SHETTEL, have set my hand to this LAST WILL, this ~~ day of ~~~ , 1986. -2- ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA SS. COUNTY OF CUMBERLAND : I, DAVID L. SHETTEL, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified accord- ing to law, do hereby acknowledge that I signed and executed the in- strument as my LAST WILL; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. DAVID L. SHETTEL Sworn or affirmed to and acknowledged befoI~e me by DAVID L. S~ETTEL, Testator, this ~ day of ~?..~ //z , 1986~ x ./, NOtary~u~'lic MURR[[ q. WALTERS, III, N~!a~ PubLic M~char::csbur~, £umberland Co., Pa. My Commission Expires November 21, ]988 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : We,./~?,,-.'j. //"i//-~ ~_'~.~.:~/~-,':.' and "I , ../ x ..... .~ , the witnesses whose names are signed to the attached or foregoing in- strument being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL; that DAVID L. SHETTEL signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight o~ the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at the time 18 years of age or more; of sound mind and under no constraint or undue influence. ~. ~,. ~ Sworn -- this /~' , ,',. ,f/. · ~ f, ...... --~. or affirmed to a.n,d acknowledged before me °~ ~7' day of /~7/," ~' c__ ..~7/ 1986/~ .,.-~ .'.. /.-" ~Otary ~~~/ MURREL R. WALTERS, Ill, Notary PubliC Mechan~csbur~j, Cumberland Co., Pa. My Cummission Expires November 21, 1988 RICHARD L. PLACEY PLACEY & WRIGHT ASTORNEYS AT LAW 363 I NORTH FRONT STREET HARRISBURG, PENNSYLVANia 17110-1533 (717) Z3~-9577 FAX (717) ~3~-0843 WILLIAM K. WRIGHT (1943-1999) June 24,2004 Register of Wills CUMBERLAND COUNTY COURTHOUSE One Courthouse Square Carlisle, PA 17013 Estate of David L. Shettel Estate File No. 21-03-1028 Dear Madam/Sir: We enclose herewith for filing, in duplicate, Pennsylvania Inheritance Tax Return for the captioned decedent, together with estate check in the amount of $1,082.53 to pay the tax shown due, and estate check in the amount of $15.00 to cover the filing fee. Please return your receipt for the same to the undersigned in the enclosed, stamped, addressed envelope. Thank you. Very truly yours, RLP:hsk Enclosures cc: Linda Kay Shettel PLACEY &.-WRI GI:kT-~ -~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. REV-1162 EX(11-96) CD 004089 PLACEY RICHARD L ESQ 3631 NORTH FRONT STREET HARRISBURG, PA 17110-1533 ........ fold ESTATE INFORMATION: SSN: 716-09-7947 FILE NUMBER: 2103- 1028 DECEDENT NAME: SHETTEL DAVID L DATE OF PAYMENT: 06/25/2004 POSTMARK DATE: 06/24/2004 COUNTY: CUMBERLAND DATE OF DEATH: 1 1/04/2003 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $1,082.53 REMARKS: TOTAL AMOUNT PAID: $1,082.53 SEAL CHECK# 1005 INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS First Class Mail .... TO: PLAC£Y & WRIGHT ATTORNEYS AT LAW 3631 NORTH FRONT STREET HARRISBURG, PENNSYLVANIA 17110-1533 REGISTER OF WILLS CUMBERLAND COUNTY COURTHOUSE ONE COURTHOUSE SQUARE CARLISLE, PA 17013 Estate of Dmvid T,. ~hetto~] No. also known as To: PETITION FOR PROBATE and GRANT OF LETTERS Register of Wills for the Social SeCUrity No. 71 6-09 7~J4feceased' County of Cumberland in the - - Cpmmonwealth of Pennsylvania The petition of the undersigned respectfully represents that: .. /Contingent executriXnamed Your petitioner(l~, who is/al~18 years of age or older an me in the last will of the above decedent, dated Apr i 1 2 9 ~x~0~x~e~ Executrix, Thelma M. Shettel, preoeceaseo testator havinq died on October 23, 2003. Linda Kay Josep]$, Petitioner, is now Linda Kay Shettel. (state reJeva~t circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumberland County, Pennsylvania, with h is last family or principal residence at 375 Claremont Drive, Carlisle, Middlesex Township,. Cumberland County, PA (list street, number and muncipality) Decendent, then 89 years of age, died November 4, 2003 , I~X at Holy Spirit Hospital, East Pensboro Twp., Cumberland' Count!y, Except as follows, decedent di.d not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: ' None Decendent at death owned property with estimated values as follows: (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled inPa.) -Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: 35,000.00 PA WHEREFORE, petitioner(x) respectfully request(s) the probate of the last will presented herewith and the grant of letters... Eestamentary Iff er~/;~.~_ ,~/L,,~ ~ (testamentary; administration c.t.a.; administration d.b.n.c.t.a.) ~ Linda Kay Shettel, ~.=o formerly Linda Kay Joseph ~'= 9 Hawth~)rne Road - - ~ Bluffton, SC 29910 ~o OATH OF PERSONAL REPRESENTATIVE STATE OF SOUTH CAROLINA COUNTY OF BEAUFORT ) SS The petitioner~) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner00 and that as personal represen- tative(s~ of the above decedent petitioner(g) wi Sworn to or affirrr,ed-~.._d subscribed b~.e. fo~r~ this. ~. ~ day of and truly administer th, e estate aA:cording to law. ., · ¥(/S ettel, ~). formerl7 Linda Kay Joseph No. ~.1-,~-I,~~ Estate of {~'~ v,~ L ~'-=~ ] , De~eased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW ~r~-*v ' &~ ~ in consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated---~::~ I ~.~O. ]O~;7~ described therein be admitl~14.o probate and filed of record as the last will of and Letters T ~ ~_.-r- ~ v~ ~_~-r ~ & u are hereby granted to I~nd,, J~c, '~l~m,~l ~ £tn,:ia ~n,, ~o~?¼ _ FEES Probate, Letters, Etc .......... $ Short_Certificates( ) .......... $ ~on '. ............... s ~'~'° TOTAL $ Richard L. Placey 07232 ATTORNEY (Sup. Ct. I.D. No.) 3631 North Front Street Harrisburg, PA 17110-1533 (717)236-9577 PHONE his is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Ofrice for permanent fiiing. WARNING: It is illegal to duplicate this copy by photostat or photograph. Fee for this certificate, $2.00 NOV 0 C 003 No. Local Registrar Date 143 Rev. 2/87 COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH NAME OF DECEOENT,F., M.a. La.t, SEXSOC,AL COUN~OF DEATH C ~ ' I ' [ . B~O. ~P OF D~TH [ FAClLI~ NAME (If ~t {.$t~,'inn hive s~t aod n-,-~t I ............. [ . ) NO Ya~ ~ ~s ~ ~ban (~) ~ DECEDENTS USUAL ~CUPAT~N ' I KIND OF BUS NESS I INDUSTRY '~*'AS DECEDENT EVER IN" DECED ' ' ~ DECEDE~S ~'LING ADDRE88,8..1, C~.gn S~te Zip C~, J DECEDENTSJ12. 113. I Z I 1'4. [ MOTHER'S N~E (First, M~d~, Ma~ S~a~) ~SJG~RE~NE~L~RViCELiOENSEEOR~O~A ............ ' _I 12,c. r~ csem~oag J2sd. H~a~b~ , PA 17109 ~ ~ys~ ~ not e-~ ~b~ al t~ of dea~ te I ,~:~ .~s~ m~.~n~ge, oealh ~u~ at the ~e, data a~ pla~ s~ ed I LICENSE Nlltla== ' , ~ ==~=:=~: by E OF ~H: 0" I DATE~R~NOUNCED D~D (M'"~aY' Y=r~ ~ ~E REFERRED TOA MEDICAL E~M ~/C~ER? I ' : Ua _. In~ ~:=~:" -E~3 ~ ~**?~ ~ ~l~. Do n~ In~r h m~l of ddnI I~h II ~MtK or rll~rl~ I lit .h~k o hea~ fl,u~ ~ate PART I1' ~ S~ ~l~ ~ ' ~ IMME~TE CAUSE (Rnal .~ mte~al ~r ~ resu~ ~ ~e ~y~g ~use ~ m P~T I. if any, leading ~o immediate [ ] DUE TO'(O~ AS ^ COaSEaU~:~ o~): En~r UNDENLYING ~USE [Dl~ ~ ~ r~ul~ng ~ ~ ) WA~ ~ AUTOPSY ] WERE AUTOPSY FINDI~S I PERFOR~D? I AV~LE PRIOR TO I C~PLETI~ ~ ~USE I I~ D~TH? /"~. MANNER OF DEATH Natural ~ Homicide Accident[] Pending Invesligabon Su;'clde[] Could not be determined CERTIFIER (Check only ~xte) ' ~ El4¥11' YING pHy lAN (Physician ceftif'/ing cause of deadl when a~otber physician has nc~l death n 'PRONOUNClNG AND CERTIFYING PHYSiClAN (Physician beth pronounchlg death and cegli in tocauseofdeath 'MEDICAL EXAMINER/CORONER 31a. ' ................................................................ : ~ l ~0a, I ~b. M. I L~ATi~ (S~eet. Q~n. $~te) 1 3Of. LICENS~NUMB~R J DATE SIGNED (M~, Day, Ye~) 31c. ~ O~t~ O b ~E AND ADDRE~ OF PERSON WHO COMPLETED ~USE O~ D~TH (l~m 27) T~ ~ P~t 32. )ATE FI~E~ (M~, Day, YeaO LAST WILL AND TESTAMENT BE IT REMEMBERED THAT I, DAVID L. SHETTEL, a resident of Cumberland County, Pennsylvania, being of sound and disposing mind, memory and under- standing, do make, publish and declare this to be my LAST WILL and TESTAMENT, hereby revoking any and all Wills and Codicils previously made by me. I I declare that I am married to THELMA M. SHETTEL and that I have three (3) children; PATRICIA ANN BENNETT, DAVID W. SHETTEL and LINDA KAY JOSEPH. II I direct that my debts and funeral expenses be paid as soon after my death as is practicable by my Executrix out of my residuary estate, but not from any assets, funds, death benefits or insurance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. III I direct that all estate, succession, legacy, inheritance or other transfer taxes, however designated that shall become payable by reason of my death in respect of all property comprising my gross estate for death tax purposes, whether or not such property passes under this LAST WILL, shall be paid by my Executrix out of my resid- uary estate, but not from any assets, funds, death benefits or in- surance proceeds which are otherwise excludable or exempt from my gross estate for federal estate valuation or tax purposes. IV I give, devise and bequeath all of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment to my wife, THELMA M. SHETTEL, pro- vided that she survives me by thirty (30) days. V I give and bequeath my wife's diamond ring to my daughter, PATRICIA ANN BENNETT. If PATRICIA fails to survive me, then I give and bequeath the ring to my daughter, LINDA KAY JOSEPH. VI I give, devise and bequeath to my son, DAVID W. SHETTEL, the first right to receive real estate which I own and which is situate in Juniata County. If DAVID desires to obtain the real estate, then he may purchase it at its fair market value and offset one third of its value against his share of my estate. If DAVID does not desire to purchase the real estate, then I give this ootion to my daughter, PATRICIA. If neither DAVID nor PATRICIA desire to purchase the land, then it shall be sold and the proceeds distributed pursuant to the other provisions of this Will. VII All of the rest, residue and remainder of my property, whether real or personal, wherever situate, including any property over which I may have a power of appointment, I give, devise and bequeath to my children, PATRICIA ANN BENNETT, DAVID W. SHETTEL and LINDA KAY JOSEPH, in equal shares, per capita. VIII I nominate, constitute and appoint my wife, THELMA M. SHETTEL, as Executrix of this LAST WILL, to serve without bond. If my wife is unable or unwilling to act in that capacity, then I nominate, constitute and appoint my daughter, LINDA KAY JOSEPH, as Executrix, to serve without bond. IN WITNESS WHEREOF, I, DAVID L. SHETTEL, have set my hand to WILL, this ~-z~ day of ~~ , 1986. this LAST DAVIEf L.-$~ETTEL - - - -2- ACKNOWLEDGEMENT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : I, DAVID L. SHETTEL, Testator, whose name is signed to the attached or foregoing instrument, having been duly qualified accord- ing to law, do hereby acknowledge that I signed and executed the in- strument as my LAST WILL; that I signed it willingly and that I signed it as my free and voluntary act for the purposes therein expressed. DAVID L. SHETTEL Sworn or affirmed to and acknowledged before me by DAVID L. S]~ETTEL, Testator, this ~ day of ~z~- z ,~1986... ,~- ~ ·, . ' I..A / Notary ~ic MURRFL R. WALTERS, III, Notary Public Mechanicsbur~, Cumberland Co., Pa. My Commission Expires November 21, 1988 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : SS. COUNTY OF CUMBERLAND : ~ / - ~ ,.' ~ . ,, .') . We,~_~_>l~ ~ ~-_~:/~,~.-~,,~-=_ and ,~'~-/ ~ ? ~ the witnesses whose ~es are signed to the attached or foregoing in- strument being duly qualified according to law, do depose and say that we were present and saw Testator sign and execute the instrument as his LAST WILL; that DAVID L. SHETTEL signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testator signed the Will as witnesses; and that to the best of our knowledge, the Testator was at the time 18 years of age or more, of sound mind and under no constraint or undue influence. Sworn or affirmed to and acknowledged before me this ~ ~' day of /V/Z~ ~ /.~,/ 1986~~ MURREL R. WALTERS, III, Notary Publi~ Mechamcsburg, Cumberland Co., Pa. My Commission Expires November 21, 1988 DAVID L. SHETTEL MURREL R. WALTERS, 111 ATTORNEY AT LAW IO5 EAST MAIN STREET MECHANICSBURG, PENNSYLVANIA 17051~ BUREAU OF INDIVIDUAL TAXES TNHERTTANCE TAX DTVISTON DEPT. Z80601 HARRTSBURG, PA 171Z8-0601 COHHONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX REV-I;47 EX &FP (01-05) RICHARD L PLACEY ESQ PLACEY & WRIGHT $631 N FRONT ST t~ PA 17110 DATE 08-Z$-2OOq ESTATE OF SHETTEL DAVID L DATE OF DEATH 11-0q-2005 FILE NUMBER Z1 05-1028 COUNTY CUHBERLAND ACN 101 Aeoun~ Romi~ed I HAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALoNGi!ilTHZS L:]~J~E ~ RETAIN LONER PORTION FOR YOUR RECORDS 4 i ;,- ................. ;::"~ '~.:~'.~- ~ ~ALLONANCE OF DEDUCTIONS AND ASSESSMENT OF TAX TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Es~a~e (Schedule A) (1) 2. S~ocks and Bonds (Schedule B) (2) 3. Closely Held S~ock/Pertnership Zn~eros~ (Schedule C) ($) q. Hor~gages/No~as Receivable (Schedule D) (q) 5. Cash/Bank Deposits/Misc. Personal Proper~y (Schedule E) ($) 6. Jointly O~ned Proper*y (Schedule F) (6) 7. Transfers (Schedule Gl (7) 8. To,al Assa~s APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expensas/Adm. Costs/Misc. Expanses (Schedule H) (9) 10. Deb~cs/Morigage Liabilities/Liens (Schedule I) (10) 11. To,al Deductions 12. Net Value of Tax Re~urn 15. lq. Chari~able/Governeen~al Bequests; Non-elected 9115 Trusts (Schedule J) Ne~ Value of Es~a~e Sub~ec~ ~o Tax .00 2..513.10 .00 .00 Z7~997.77 .00 .00 (8) 6,~5~.67 .00 NOTE: To insure proper credi~ to your account, subei~ ~he upper portion of ~his fore wi~h your ~ax payment. NOTE: 30,510.87 (11) 6 .q~q. 67 (12) 2q,O56.ZO (15) . O0 (lq) Iq, 056.20 If an assessment ~as lssued previously, lines 14, 15 and/or 16, 17, reflect flgures that /nclude the total of ALL returns assessed to date. ASSESSMENT OF TAX: 15. Amoun'l: of Line lq a~ Spousal ra~e 16. Amoun~ of Line lq ~axablo a~ Lineal/Class A ra~e 17. Aeoun~ of Line lq a~ Sibling ra~a 18. Amoun~ of Line lq ~axabla a~ Collateral/Class B ra~a 19. Principal Tax Duo TAX CREDITS: PAYMENT I RECEIPT DISCOUNT (+) DATE NUMBER INTEREST/PEN PAID (-) 06-gq-200q CO00q089 . 00 18 and 19 ~ill IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATION OF ADDITIONAL INTEREST. (15) .00 x O0 = .00 (16) 2q,056.20 x Oq5= 1,082.53 (17) . O0 x 12 = . O0 (la) .00 x 15 = .00 (19)= 1,082.53 AMOUNT PAID 1,082.53 TOTAL TAX CREDIT 1,082.53 BALANCE OF TAX DUEI .00 INTEREST AND PEN. .00 TOTAL DUE .00 ( ZF TOTAL DUE IS LESS THAN $1, NO PAYMENT ZS REQUIRED. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTZONS.~ RESERVATION: PURPOSE OF NOTICE: PAYMENT: REFUND (CR): OBJECTIONS: ADMIN- ISTRATIVE CORRECTIONS: DISCOUNT: PENALTY: INTEREST: Estates of decedents dying on or before December 11, 1982 -- if any futura interest in the estate is transferred in possession or enjoyment to Class B (coIlaterml) beneficiaries of the decedent after the expiration of any estate for life or for years, the Commonmealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawful Class B (coliataral) rate on any such future interest. To fulfil! the requirements of Section 21~0 of the Inheritance and Estate Tax Act, Act 23 of 2000. (72 P.S. Section 91~0). Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Make check or money order payable to: REGISTER OF NILES, AGENT A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1315). Applications are available at the Office of the Register of Hills, any of the Z$ Revenue District Offices, or by calling the special 24-hour answering service for forms ordering: 1-800-362-2050; services for taxpayers with special hearing and / or speaking needs: 1-800-447-5020 (TT only). Any party in interest not satisfied with the appraisement, alloaanca, or disalloeanca of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. OR Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue, Bureau af Individual Taxes, ATTN: Post Assessment Revise Unit, Dept. 18060I, Harrisburg, PA 17118-060! Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-1501) for an explanation of administratively correctable errors. If any tax due is paid within three (5) calendar months after the dacadant's death, a five percent (SI) discount of the tax paid is allowed. The 151 tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after the end of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. 1982 1985 1984 1985 1986 1987 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID interest is charged beginning aith first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes ahich became delinquent before January I, 1982 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .000164. All taxes which became delinquent on and after January 1~ 1981 mill bear interest at a rate ahich will vary from calender year to calendar year aith that rate announced by the PA Department of Revenue. The applicable interest rates for 19B2 through 2004 are: Interest Daily Interest Daily Interest Daily Rate Factor Year Rate Factor Year Rate Factor lOX .000548 ~'~6-1991 Ill .000501 ~ 92 .000247 162 ,000438 1992 9Z .000247 ZOOZ 62 .000164 Ill .000501 1993-1994 72 .O0019Z 2003 52 .000137 15X .000356 1995-1998 92 .000247 2004 42 .000110 IOZ .000274 1999 7Z ,O00lgz 102 .000274 2000 7Z .000192 X NUHBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation date shown on the Notice, additional interest must be calculated. PLEASE FILE THIS REPORT WITHIN TWO YEARS OF DATE OF DEATH REGARDLESS OF THE STATUS OF THE EST A TE. IF EST A TE IS NOT COMPLETED, FILE a 6.12 FORM YEARLY UNTIL COMPLETION STATUS REPORT UNDER RULE 6.12 Name of Decedent: David L. Shettel Date of Death: November 4, 2003 Will No.: 2003-01028 Admin. No.: 21-03-1028 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes x No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: , 3. If the answer to No.1 is yes, state the following: A. Did the personal representative file a final account with the court? Yes No X B. The separate Orphans' Court No. (if any) for the personal representative's account IS: c. . Did the personal representative state an account informally to the parties in interest? Yes X No D. Copies of receipts, releases, joinders and approvals of formal or informal accounts may be filed with the Clerk of the Orphans' Court and may be attached to this report. ) [) 7 /? Date: 2/24/2005 I (,.~.': '_nJ! <: (\ I I r ("; Name (Please type or print) 3631 North Front street Harrisburg, PA 17110-1533 Address { '.,! (717) 236-9577 (MAH:rmt/AM3) Telephone No. Capacity: Personal Representative X Counsel for Personal Representative ,U1J RW, -27 (C(Q)[P'l[ IN RE: ESTATE OF DAVID L. SHETTEL, DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION APPROVAL OF ACCOUNT. RELEASE AND INDEMNIFICATION ESTATE OF DAVID L. SHETTEL. DECEASED The undersigned is one of the residuary beneficiaries of the Estate of David L. Shettel, Deceased. Linda Kay Shettel, Executrix of the Estate of David L. Shettel (hereinafter "Personal Representative"), is willing to make distribution of the assets of the estate without the formality of a court accounting upon the receipt of a proper release, receipt and indemnification, which it is the purpose of this document to provide. In consideration of the willingness of the Personal Representative to make distribution without the formality of a court accounting and agreeing to be legally bound hereby, the undersigned does hereby: 1. Waive the filing of an account of the administration of the estate in any court; 2. Declare that the undersigned has examined the attached informal Statement of Account of the Personal Representative; accepts and approves it with the same force and effect as if it had been prepared and filed with, audited, adjudicated and confirmed absolutely by a court of competent jurisdiction; and as if the balance of principal and income had been awarded by the court in accordance with the Statement; 3. Warrant that the undersigned is one of the residuary beneficiaries named in the infOlmal Statement of Account and is entitled to receive the distribution therein set forth; 4. Absolutely and irrevocably releases and discharges the estate, the Personal Representative and Placey & Wright, attorneys for the estate, their respective heirs, personal representatives, successors and assigns, of and from any and all actions, liabilities, claims and demands relating in any way to the administration of the estate and distribution in accordance with the informal Statement of Account, except for Two Hundred Fifty ($250.00) Dollars retained reserve; and 5. Agree to indemnify and hold harmless the Personal Representative and her personal representatives, successors and assigns, from and against any claims, liabilities, loss or expenses (including costs and counsel fees) arising from any cause whatsoever which the Personal Representative may incur as a result of the administration of the estate and distribution in accordance with this document and to refund to the Personal Representative any portion of the distribution of the undersigned which exceeds the amount ofthe undersigned's share as the Personal Representative finally determines. IN WITNESS WHEREOF, intending to be legally bound, the beneficiary has executed 1'7,14 day of SfPrMBKJ( ,2004. cd dtJ, J.l Jjji:f David W. Shettel (SEAL) COMM H OF PENNSYLVANIA . Notarial SelIl Matthew C. Groman. Notaly Nic EastPeMsborO Twp., eumberltnS cu.nv My Commission Expires June 1Q, 2008 Member. Pennsylvania Association Of Notaries Social Security No. / cr ~.... ]. () -- ~ I 3> 1 t(Q)[P1{ IN RE: ESTATE OF DA VID 1. SHETTEL, DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION APPROVAL OF ACCOUNT. RELEASE AND INDEMNIFICATION EST A TE OF DAVID L. SHETTEL. DECEASED The undersigned is one of the residuary beneficiaries of the Estate of David 1. Shettel, Deceased. Linda Kay Shettel, Executrix of the Estate of David 1. Shettel (hereinafter "Personal Representative"), is willing to make distribution of the assets of the estate without the formality of a court accounting upon the receipt of a proper release, receipt and indemnification, which it is the purpose of this document to provide. In consideration of the willingness of the Personal Representative to make distribution without the formality of a court accounting and agreeing to be legally bound hereby, the undersigned does hereby: 1. Waive the filing of an account of the administration of the estate in any court; 2. Declare that the undersigned has examined the attached informal Statement of Account of the Personal Representative; accepts and approves it with the same force and effect as if it had been prepared and filed with, audited, adjudicated and confirmed absolutely by a court of competent jurisdiction; and as if the balance of principal and income had been awarded by the court in accordance with the Statement; 3. Warrant that the undersigned is one of the residuary beneficiaries named in the informal Statement of Account and is entitled to receive the distribution therein set forth; 4. Absolutely and irrevocably releases and discharges the estate, the Personal Representative and Placey & Wright, attorneys for the estate, their respective heirs, personal representatives, successors and assigns, of and from any and all actions, liabilities, claims and demands relating in any way to the administration of the estate and distribution in accordance with the informal Statement of Account, except for Two Hundred Fifty ($250.00) Dollars retained reserve; and 5. Agree to indemnify and hold harmless the Personal Representative and her personal representatives, successors and assigns, from and against any claims, liabilities, loss or expenses (including costs and counsel fees) arising from any cause whatsoever which the Personal Representative may incur as a result of the administration of the estate and distribution in accordance with this document and to refund to the Personal Representative any portion of the distribution of the undersigned which exceeds the amount of the undersigned's share as the Personal Representative finally determines. IN WITNESS WHEREOF, intending to be legally bound, the beneficiary has executed this document this 9 day Of/~/nJ"<.l. , 2004. (SEAL) (CO)[P~t IN RE: ESTATE OF DAVID L. SHETTEL, DECEASED IN THE COURT OF COMMON PLEAS OF CUMBERLAND COUNTY, PENNSYLVANIA ORPHANS' COURT DIVISION APPROVAL OF ACCOUNT. RELEASE AND INDEMNIFICATION ESTATE OF DAVID L. SHETTEL. DECEASED The undersigned is one of the residuary beneficiaries of the Estate of David L. Shettel, Deceased. Linda Kay Shettel, Executrix of the Estate of David L. Shettel (hereinafter "Personal Representative"), is willing to make distribution of the assets ofthe estate without the formality of a court accounting upon the receipt of a proper release, receipt and indemnification, which it is the purpose of this document to provide. In consideration of the willingness of the Personal Representative to make distribution without the formality of a court accounting and agreeing to be legally bound hereby, the undersigned does hereby: 1. Waive the filing of an account of the administration of the estate in any court; 2. Declare that the undersigned has examined the attached informal Statement of Account of the Personal Representative; accepts and approves it with the same force and effect as if it had been prepared and filed with, audited, adjudicated and confirmed absolutely by a court of competent jurisdiction; and as if the balance of principal and income had been awarded by the court in accordance with the Statement; 3. Warrant that the undersigned is one of the residuary beneficiaries named in the informal Statement of Account and is entitled to receive the distribution therein set forth; 4. Absolutely and irrevocably releases and discharges the estate, the Personal Representative and Placey & Wright, attorneys for the estate, their respective heirs, personal representatives, successors and assigns, of and from any and all actions, liabilities, claims and demands relating in any way to the administration of the estate and distribution in accordance with the informal Statement of Account, except for Two Hundred Fifty ($250.00) Dollars retained reserve; and 5. Agree to indemnify and hold harmless the Personal Representative and her personal representatives, successors and assigns, from and against any claims, liabilities, loss or expenses (including costs and counsel fees) arising from any cause whatsoever which the Personal Representative may incur as a result of the administration of the estate and distribution in accordance with this document and to refund to the Personal Representative any portion of the distribution of the undersigned which exceeds the amount of the undersigned's share as the Personal Representative finally determines. IN WITNESS WHEREOF, intending to be legally bound, the beneficiary has executed this document this /7 ~ day of ~~ 2004. ( ~/<_/,.- _./ '. -. V- CA--/~ WI.. SS CV~~b~4SEAL) Patricia Ann Bermett . Social Security No. ~ ~ .:z ~ (d7Jb