HomeMy WebLinkAbout03-0141 Regmtcr of Wills et' Cumberland County, Pennsylvania
PETITION FOR GRANT OF LETTERS
Estateof Gabriel R. Shughart NO.
also known as
Deceased Social Security No., 207-34-5540
Petitioner(s), who ia/are 18 yeers of ege or older, al~ply(ies) for:
(COMPLETE "A" OR "B" BELOW;)
A. Probate and Grant of Letters and aver that Petitioner(s) is/are the execut ors named in the Last Will or the
[ '~
Decedent,dated Pphr.~ry 3_. 2000 and codicil(s) dated n/a
State relevant circumstances, e.g., renunciation, death of executor, etc
Except as follows, Decedent did not marry, was not divorced and did not have a child born or adopted after execution of the documents offered
for probate; was not the victim of a killing and was never adjudicated incapadlated:
D B. Grant of Letters of Administration
(c.t.a.. d.b.n.c.t.a.: pendente lite. durante absentia; durerrta minorltate) ,
Petitioner(s) after a proper search has/have ascertained the Decedent left no Will and was survived by the following spouse
(if any) and heirs:
Name Relationship Residence
(COMPLETE IN ALL CASES:) Attach additional sheets If necessary.
Decedent was domiciled at death in Cumberland County, PennsYlvania, with his/her last family or principal
residence at 40 Montsera Road, Carlisle, PA 17013
(list street, number and municipality)
Decedent, then, .6.0 years ofage, died Jan. 18,..20p3 , at 40 Montsera Road, Carlisle
(Location)
Decedent at death owned property with estimated values as follows;
(if domiciled in PA) All personal property". ................. ~..j .................. $ ,~//O~ cO' O
(il' not domiciled in PA) Personal property in Penr,.sylvanla .................... $
(If not domiciled in PA) Personal property in County .............................. $
Value cf real estate in Pennsylvania ........................................................................................
Wherefore, Petitioner(s) respectfully request(s) the probate of the Last Will and Codicil(s) presented with this Petition ~nd the grant of letters in
the appropriate form to the undersigned:
Bradley S. Gerlach, Vice President
~__2- - ..... Orrstown Bank
P.O. Box 250
Shippensburg, PA 17257
'~_.~. "C2.~~~ Galen E. Sh_~ghart
RW-7
M~. Hc!!y Springs, ,~
7Z~ff
Oath of Personal Representative
Commonwealth of Pennsylvania
County of CUMBERLAND
The Petitioner(s) above-named swear(s) and affirm(s) that the statements Jn the foregoing Petition are true
and correct to the best of the knowledge and belief of Petitioner(s) and that, as person..aL(epresentat ye(s) of the Decedent,
Petitioner(s) will well and truly administer the estate according to Jaw...---, ..--, // )
before me this
day of
DECREE OF REGISTER
Estate of Gabr±el R. Shughart Deceased No. 21-03-14!
also known as
Social Security No: 207-34-.5540 Date of Death: .Tanuar¥ 18, 2003
AND NOW, FEBRgAR¥ 19. , .2..0.0..3._ , in consideration of the Petition
on the reverse side hereon, satisfactory proof having been presented before me,
IT I$ DECREED that Letters ~ Testamentary 6~ of Administration
(c.t.~,., d.b.n.¢.t.; pender~le lite~ durante =~bsentla; durance min,~ritsm)
are hereby granted to GALEN F.. S~UGBA_RT A~D . ORRSTO~L BAN~
in the above estate and that the instrument(s), if any, dated, February 3, 2000
described in the Petition be admitted to probate and filed of record as the last Will of Decedent.
FEES
Short Certificate(s) .,..4, .......... $ 12.00
Renunciation ..........................
Affidavit ( ) ....................... $
Extra Pages( 3 ) .............. $ 9.00
Codicil .................................$
JCP Fee .................................$ I n. nn Attorney: William S. Dick
Inventory & Tax Forms ............. $ I,D. No:
Other ...................................... $ Address: 13 West Main Street
Waynesboro~ PA 17268
TOTAL ............................. $ ,,, ,101.00 Telephone:
DATE FILED: FEBRUARY 19. 2003
RW-TA
MAILED TO BANK FEBRUARY 19, 2003
This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as
Local Registrar. The original certificate will be. forwarded to the State Vital Records Office for permanent, filing.
WARNING: It is illegal to duplicate this copy by photostat or photograph.
H105.14.4 Rev. 1/91 COMMONWEALTH OF PENNSYLVANIA ,, DEPARTMENT OF HEALTH · VITAL RECORDS
~PRINT CERTIFICATE OF DEATH
'ANENT . (Coroner)
CK INK
'' SEX SOCIAL BECURrI'Y NUMBER D
'. Gabriel R Shughart
~'" .... 13. 207 - 34 - 5540 J4 January 18, 2003
AGE (Last Bk-th~ay) UNDER 1 YEAR UNDER DAY DATE OF B RTH I B RTNPLACE (C~y anti I PLACE OF DEATH (Check o~y ~ne _ see inet ucr
E_CEDE S USUAL OCCUPATION ] KIND OF BLISINESS/1NOUSTRY I WAS OcCiDeNT EVER iNI --.~ ......... I~' ]10 Whi~e
DECEDENT' $ MA~UNG ADORE 8~ (StreeL C~ffown State. Z ~ Code) ~CI=UENT'$ '
,, Nelson P. Shughart
Ruth E. Wert
~, Galen E. Shughart 124 Peach PA 17241
Burial [~ C¢..,atk,.. [] RemovalfromState[:] (Month,'Oay. Year)
O~..,~[:]C,,.,¢,.~, [],,, 1/22/2003 Valley Mare. Carlisle, PA 17013
:rjr. (Mo~. Day. Yeer)
,4 pprx. 7:00 ~ ,, January'lB, 2003
,,,~ ~ ~.~) .... Occlusive Coronar~isease
[] Chief Deputy
Mechanicsburg, Pa. 17050
21-03-141
LAST WILL AND TESTAMENT
OF
GABRIEL R. SHUGHART
I, Gabriel R. Shughart, of 40 Montsera Road, Carlisle, Cumberland County,
Pennsylvania, being of sound mind and disposing memory, realizing the uncertainty of this
life, but with confidence in God and trust in His Son, my Lord and Savior, Jesus Christ, who
died for my sins upon the cross, and rose again to justify me and give me eternal life, do
hereby make, publish and declare this to be my Last Will and Testament, and hereby revoke
any and all prior Wills and Codicils made by me.
ITEM I. EXPENSES AND TAXER. I direct that as soon as may be convenient
after my decease there be paid from my estate all of my just debts, expenses incident to
my illness, my funeral expenses and, from the principal of the residue of my estate, all of
my state and federal inheritance and estate taxes.
ITEM II. TANGIBLE PERSONAL PROPERTY. I give such of my tangible personal
property as is set forth in a separate unsigned memorandum, which I shall place with my
will, to the persons therein designated. I give the remainder of my tangible personal property
in the nature of household goods and personal effects owned by me at my death, together
with insurance thereon, per stirpes to my lineal issue who survive me. To the extent my
Co-Personal Representatives deem it impractical or unwise to make distribution in kind,
my Co-Personal Representatives may sell said assets and make distribution of the proceeds
thereof to or for the benefit of my said lineal iSsue. As a matter of information, my lineal
abrlel ~. Shugl~rt -
issue living as of the time of the execution of this will are my children Dianna Garrett, Galen
Shughart, Ronald Shughart, Kathy Lyons, and Elaine Shughart.
ITEM III. DISTRIBUTION OF RESIDUF. I direct that the residue of my estate
be divided into five (5) equal shares and distributed to my lineal issue per stirpes.
ITEM IV. PERSONAL REPRESENTATIVE.~. I appoint my son, Galen E. Shughart,
of 224 Chestnut Street, Apt. 1, Mt. Holly Spdngs, Pennsylvania and Orrstown Bank, a subsidiary
of Orrstown Financial Services, of Carlisle, Pennsylvania, as Co-Personal Representatives
of my estate.
ITEM V. I~[O_B_QI~. I direct that no fiduciary appointed hereunder shall be required
to post bond in this or any other jurisdiction.
IN WITNESS WHEREOF, I, Gabriel R. Shughart, the Testator, hereby execute on
this ~,-d day of Ju.-,c, 19~9, this my will, typewritten upon four (4) sheets of paper.
'~'/ Gabriel R. Sl~ugl~rt (SEAL)
page 2
Signed, sealed, published and declared by the said Testator, Gabriel R. Shughart,
to be his last will and testament in the presence of us, who were present at the same time,
and who subscribed our names as witnesses at the request of the said Testator and in the
presence of each other.
ACKNOWLI::OGMEN'r
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND :
I, Gabriel R. Shughart, the Testator whose name is signed to the attached or foregoing
instrument, having been duly qualified according to law, do hereby acknowledge that I signed
and executed the instrument as my last will; and that I signed it willingly and as my free and
voluntary act for the purposes therein contained.
Sworn to and acknowledged before me by Gabriel R. Shughart, the Testator, this
SM day of-.h:me~. '
i NOTARIAL SEAL
USA R SNYD£R, Notary Public
Ul~r Allen Twp, Cumberland C0unly Page 3
__MY-I~0rr~lssl0n Expires Mar. 12, 2001
COMMONWEALTH OF PENNSYLVANIA :
: SS
COUNTY OF CUMBERLAND :
whose names are signed to the attached or foregoing instrument, being duly qualified according
to law, do depose and say that we were present and saw the Testator sign and execute
the instrument as his last will; that the Testator signed willingly and executed Jt as his free
and voluntary act for the purposes therein expressed; that each subscribing witness Jn the
hearing and sight of the Testator signed the will as a witness; and that to the best of our
knowledge, the Testator was at that time 18 or more years of age, of sound mind and under
no constraint or undue influence.
sw°mt°andsubscribedt°beforemebyj~2 b~C~ Z ¢.T~~-x~ and
"--~Dt~fl/J. J~' ~/l~//'~m ,witnesses, this ,.?rd dayof~~
Notary Igublic ·
SNYDER, Notary Public ..
.IJ_p~r Allen Twp. Cumberland Counly JWitness
J._My~Commisslon Expires Mar. 12, 200i
Page 4
GABRIEL R. SRUGHART
WILLIAM S. DiCK
ATTORNEY AT LAW
NORTH CARLISLE ST., STE. 104
GREENCASTLE. Pa. 17225
February 20, 2003
To Whom It May Concern:
I Galen E. Shughart, current residence is:
124 Peach Orchard Road
Newville, Pa 17241
CERTIFICATION OF NOTICE UNDER RULE 5.6(a)
Name of Decedent: Gabriel R. Shuohart
Date of Death: 1/18/2003
Will No. Admin. No. 21-03-0141
To the Register:
I certify that notice of (beneficial interest) estate administration required by Rule 5.6(a) of the Orphan's Court Rules was
served on or mailed to the following beneficiaries of the above-captioned estate on 6/4/2003 -
Name Address
Dianna Garrett 519 South Pitt Street, Carlisle, PA 17013
Ronald Shughart 260 West Ridge Street, Carlisle, PA 17013
Kathy Lyons 107 Smithfield Court, Walkersville, MD 21793
Elaine Shughart 107 Smithfield Court, Walkersville, MD 21793
Notice has now been given to all persons entitled thereto under Rule 5.6(a) except:.
Date: 6/4/2003
Signature
Name: William $. I~ick
Address: 13 W. Main Street. Suite 210
Wavnesbor0, PA 17268
Telephone(717) 762- 1160
Capacity: Personal Representative
X Counsel for Personal
Representative
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died
without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY , PENNSYLVANIA
In re Estate of Gabdel R. Shughart , deceased,
File No. 2003-00141
Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below.
The Decedent, Gabriel R. Shughart , died on
~ . ~ I
X The Decedent died testate (with a Will) __ The Decedent died intestate (without a Will)
Name(s), address(es) and telephone number(s) of all personal representatives appointed:
Name Address Telephone
Galen E. Shughart 224 Chestnut St, Apt. 1, Mt. Holly Spdngs, PA
Orrstown Bank 77 East King St, Shippensburg, PA (717) 532-6114
If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of:
Cumberland County
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of:
__ A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication.
X A copy of the Will or Petition is attached.
-"~ ,~.~.-7~ ~ -~-~ -~.'~ ~' ~
Date ~ ~'~ Signature /¥'~-~[,',~-~_ .~;1
Name William S. Dick
Address 13 West Main Street, Suite 210
Capacity: Pereonal Representative Waynesboro PA 17268
X Counsel for Personal Telephone (717) 762-1160
Representative
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be determined wholly or partly by the decedents will. If the decedent died
without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY PENNSYLVANIA
In re Estate of Gabriel R. Shughart , deceased,
File No. 2003-00141
Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below.
The Decedent, Gabriel R. Shughart , died on :~(:~¥[L[~-C~ ~ )
X The Decedent died testate (with a Will) __ The Decedent died intestate (without a Will)
Name(s), address(es) and telephone number(s) of all personal representatives appointed:
Name Address Telephone
Galen E. Shughart 224 Chestnut St, Apt. 1, Mt. Holly Spdngs, PA
Orrstown Bank 77 East King St, Shippensburg, PA (717) 532-6114
If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of:
Cumberland County
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of:
__ a copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication.
X A copy of the Will or Petition is attached.
Date -~ ~,"-~ ~. .- Signature
Name William S. Dick
Address 13 West Main Street, Suite 210
Capacity: Personal Representative Waynesboro PA 17268
X Counsel for Personal Telephone (717) 762-1160
Representative
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be determined wholly or partly by the decedents will. If the decedent died
without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY , PENNSYLVANIA
In re Estate of Gabdel R. Shughart , deceased,
File No. 2003-00141
~ ~' ...... ' (address)
Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below.
The Decedent, Gabriel R. Shughart , died on ~,,~;~, ~ -~ ~;'~!i~
X The Decedent died testate (with a Will) __ The Decedent died intestate (without a Will)
Name(s), address(es) and telephone number(s) of all personal representatives appointed:
Name Address Telephone
Galen E. Shughart 224 Chestnut St, ApL 1, Mt Holly Spdngs, PA
Orrstown Bank 77 East King St, Shippensburg, PA (717) 532-6114
If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of:
Cumberland County
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills of:
__ A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication.
X A copy of the Will or Petition is attached.
Date -~c4,,-~ ~"/ ~;~(.'.~ Signature
Name William S. Dick
Address 13 West Main Street, Suite 210
Capacity: Personal Representative Waynesboro PA 17268
X Counsel for Personal Telephone (717) 762-1160
Representative
IMPORTANT NOTICE
NOTICE OF ESTATE ADMINISTRATION
THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE
ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE.
Whether you will receive any money or property will be determined wholly or partly by the decedents will. If the decedent died
without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania.
BEFORE THE REGISTER OF WILLS, CUMBERLAND COUNTY , PENNSYLVANIA
In re Estate of Gabdel R. Shughart , deceased,
File No. 2003-00141
Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below.
The Decedent, Gabriel R. Shughart , died on ~k~.L~'~'~ i~, ~.O(~
X The Decedent died testate (with a Will) The Decedent died intestate (without a Will)
Name(s), address(es) and telephone number(s) of all personal representatives appointed:
Name Address Telephone
Galen E. Shughart 224 Chestnut St, Apt. 1, Mt. Holly Spdngs, PA
Orrstown Bank 77 East King St, Shippensburg, PA (717) 532-6114
If the Decedent died testate, the Will has been filed with the Office of the Register of Wills of:
Cumberland County
If the Decedent died intestate, a Petition for the Grant of Letters of Administration was filed with the Office of the Register of Wills o~.
__ A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication.
X A copy of the Will or Petition is attached.
Name William S. Dick
Address 13 West Main Street, Suite 210
Capacity: Personal Representative Waynesboro PA 17268
X Counsel for Personal Telephone (717) 762-1160
Representative
CONNONHEALTH OF PENNSYLVANIA ~
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES INFORMATION NOTICE FILE NO. 21 05-01ql
DEPT. 280601 AND
HARRISBURG, PA 17128-060! TAXPAYER RESPONSE ACN 05129575
REV-IS4SEXAFP(,9-,O) DATE 08-27-2005
TYPE OF ACCOUNT
EST. OF GABRIEL R SHUGHART E~SAVINGS
S.S. NO. 207-5q-55~0 [~CHECKING
DATE OF DEATH 01-18-2005 O TRUST
COUNTY CUMBERLAND []CERTZF.
REMIT PAYMENT AND FORMS TO:
GALEN E SHUGHART REGISTER OF WILLS
12~ PEACH ORCHARD RD CUMBERLAND CO COURT HOUSE
NENVILLE PA 172R1 CARLISLE, PA 17013
ORRSTO#N BANI( has provided the Department ~lth the information listed belom which has been used in
caIculating the potential tax due. Their records indicate that at the death of the above decedent, you were a ~oint o~ner/beneficiary of
this account. Zf you feel this information is incorrect, please obtain written correction from the financial institution, attach a copy
to this fore and return it to the above address. This account is taxable in accordance with the Inheritance Tax Laws of the Commonwealth
of Pennsylvania. QuastJons may be answered by calling [717) 787-8327.
COHPLETE PART 1 BELON # ~ # SEE REVERSE S:XDE FOR FI:LING AND PAYMENT INSTRUCTIONS
Account No. q07955 Date 11-10-1995 To insure proper credit to your account, ttm
Established cz) copies of this notice must accompany your
Account Balance 52q. 95 payment to the Register of Mills. Hake check
payable to: "Register of Nills, Agent".
Percent Taxable X 5 0.0 0 0
NOTE: If tax peyeeflts ara made mithin three
Amount Subject to Tax 262. ~8 (5) sonths of the decadent's date of death,
Tax Rata X .15 you may deduct a 52 discount of the tax due.
Any inheritance tax due ail1 bacome delinquent
Potential Tax Duo 59.57 nine (93 months after the data of death.
PART TAXPAYER RESPONSE
~1 The above information and tax due is correct.
1. You may choose to remit payment to the Register of Hills with two copies of this notice to obtain
CHECK ~ a discount or avoid interest, or you amy check box "A" a,d return this net Jcl to the Register of
ONE Hills and an official assessment ail1 be issued by the PA Department of Revenue.
BLOCK ~ B. [] The above asset has been or will be reported and tax paid mJth the Pennsylvania Znheritance Tax return
ONLY to be filed by the decedent's representative.
C. [] The above information is incorrect and/or debts and deductions were paid by you.
You lust colp]eta PART [] and/or PART []
PART Tf you indicate a different tax rate, please state your
relationship ~o decedent:
TAX RETURN - COMPUTATION OF TAX ON JOINT/TRUST ACCOUNTS
LINE 1. Date Established
2. Account Balance 2
:5. Percent Taxable :5
q. Amount Subject to Tax
$. Debts and Deductions
6. Amount Taxable 6
7. Tax Rate 7
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAZM£n
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
TOTAL (Enter on Line $ of Tax Computation)
Under penalties of perjury, I declare that thm facts z have reported above_are true, correct and
woRK )
TAXPAYER SIGNATURE TELEPHONE NUMBER DA'T'~
GENERAL INFORHATION
1. FAILURE TO RESPOND #ILL RESULT ZN AN OFFICIAL TAX ASSESSNENT eith applicable interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the dacedant's date of death.
3. A joint account is taxable even though the dacedent's nasa aaa added as a anttar of convenience.
4. Accounts (includlng those held between husband and mira) ahich the decedent put in joint names within one year prior to
death are fully taxable ss transfers.
S. Accounts established jointIy bat~aan husband and wife more than one year prior to death ara not taxable.
6. Accounts held by a decadent "in trust for" another or others ara taxable fully.
REPORTING INSTRUCTIONS - PART I - TAXPAYER RESPONSE
1. BLOCK i - If the information and computation in the notice ara correct and deductions are not being claimed, place an "X"
in block "A" of Part I of the "Taxpayer Response" section. Sign two copies and submit them with your check for the amount of
tax to tho Register of Hills of the county indicated. The PA Department of Revenue mill issue an official assessment
(Fora REV-lSq8 EX) upon receipt of the return from the Register of Hills.
Z. BLOCK B - If the asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative, place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dapt ze0601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C" and complete Parts
according to the instructions baloa. Sign two copies and submit thaa with your check for the amount of tax payable to the Register
of Hills of the county indicated. The PA Department of Revenue will issue an official assessment (Fora REV-lSd8 EX) upon receipt
of the return from the Register of Hills.
TAX RETURN - PART Z - TAX COHPUTATZON
LINE
1. Enter the date the account originally was established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/12/82: Accounts which the decedent put in joint names within one (1) year of death ara
taxable fully as transfers. However, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the nuad3ar of accounts held.
If a double asterisk (aa) appears before your first name in the address portion of this notice, the $3,000 exclusion
already has been deducted from the account balance as reported by the financial institution.
2. Enter the total balance of the account including interest accrued to the date of death.
3. The percent of the account that is taxabIs for each survivor is determined as follows:
A. The percent taxable for joint assets established aero than one year prior to the dacadent's death:
I DIVIDED BY TOTAL NUHBER OF DIVIDED BY TOTAL NUHBER OF X 100 = PERCENT TAXABLE
JOINT OHNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and two other persons.
I DIVIDED BY $ (JOINT O#NERS) DIVIDED BY 2 (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVZVOR)
B. The percent taxable for assets created within one year of the decedant's death or accounts owned by the decedent but held
in trust for another individual(s) (trust beneficiaries):
I DIVIDED BY TOTAL NUNBER OF SURVIVING JOINT X 100 PERCENT TAXABLE
ONNERS OR TRUST BENEFICIARIES ~,~ ,
Example: Joint account registered in the name of the decedent and tho other persons and estab~shed Nith~one year of death by
the decedent, ill
I DIVIDED BY Z (SURVIVORS) = .SO X 100 = 50Z (TAXABLE FOR EACH SURVIVOR)
~. The amount subject to tax (line ~) is determined by multiplying the account balance (line Z) by the percent t~ble (line
5. Enter the total of the debts and deductions listed in Part 3.
6. Tho amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount sub~ect to tax (line ~).
7. Enter the appropriate tax rate (line 7) as determined below.
De~e of Death Spouse L~neal I Sibling Colla~_~e~a~l
07/01/9q ~o 12/31/9~ IX 6X 15X 15X~
01/01/95 ~o 06/30/00 OX 6Z lSX lSXr'~
07/01/00 ~o presen~ OX ~.SZ~ 12X 15X
aThe tax rate imposed on th; net value of transfers from a du~,bsed -~;~ ~ ..... ~y-one years ~ age .r younger at
death to or for the usa of a natural parent, an adoptive parent, or a stapparent of the child ]s OZ.
The lineal class of heirs includes grandparents, parents, chiIdrsn, and lineal descendents. "Children" incIudes natural children
ehether ar not they have been adopted by others, adopted children and step children. "Lineal descendents" includes all children of the
natural parents and their descendants, whether ar not they have been adopted by others, adopted descendents and their descendants
and stap-descendants. "Siblings" ara defined as individuals who have at least one parent in common with the decedent, whether by blood
or adoption. The "ColIataraZ" class of heirs includes ail other beneficiaries.
CLAIHED DEDUCTIONS - PART $ DE~TS AND DEDUCTIONS CLAIHED
Allowable debts and deductions ara determined as follows:
A. You ZagaZZy are responsible for payment, or the estate subject to administration by a personal representative is insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can furnish proof of payment.
C. Debts being claimed must be itasizsd fully in Part 3. If additional space is needed, use plain paper 8 1/2" x II". Proof of
payment may be requested by the PA Department of Revenue.
CO~ONHEALTH OF PENHSYLVANZA ~1~
DEPARTHENT OF RE~NUE
BUREAU OF INDIVIDUAL TAXES ZNFORHATZON NOTICE FILE NO. 21 05-0141
DEPT. Z80601 AND
HARRISBURG, PA 17128-0601 TAXPAYER RESPONSE ACN 05129575
REV-]64SEXAFPCOg-OO) DATE 08-27-2005
TYPE OF ACCOUNT
EST. OF GABRIEL R SHUGHART []SAVINGS
S.S. NO. 207-$4-5540 ~-~CHECK/NG
DATE OF DEATH 01-18-2005 []TRUST
COUNTY CUMBERLAND []CERTZF.
REHZT PAYHENT AND FORHS TO:
GALEN E SHUGHART REGISTER OF WILLS
124 PEACH ORCHARD RD CUMBERLAND CO COURT HOUSE
NEWVILLE PA 17241 CARLISLE, PA 17015
ORRSTO#N BANK has provldad the Department with the information listed baloa mhlch has been used in
calculating the potential tax due. Their records indicate that at the death of the above decedent, you were a joint owner/beneficiary of
this account. If you feel this inforention is incorrect, plaasm obtain .ritten correction frsm the financial institution, attach a copy
to this form and return it to the above address. This account is taxable in accordance .ith the Inheritance Tax Lams of the Comaonaealth
of Pennsylvania. Questions may be ensnared by calling (?17)
CONPLETE PART 1 BELOW N N # SEE REVERSE SIDE FOR FILING AND PAYNENT INSTRUCTIONS
Account No. 407955 Data 11-10-1995 To insure proper credit to your account, t~o
Established (Z) copies of this notice must accompany your
Account Balance 524.95 payment to the Register of Hills. Hake check
payable to: "Register of Hills, Agent".
Percent Taxable X 50.0 0 0
NOTE: if tax payaents ara aade Nithin three
Amount Subject to Tax ?62.48 (3) months of the decedent's date cf death,
Tax Rate X .15 you may deduct a 57. discount of the tax due.
Any inheritance tax due Hill become delinquent
Potential Tax Due 39.37 nine (9) months after the date of death.
PART TAXPAYER RESPONSE
A. ~Tha above in~oraation and tax due is correct.
You may choose to remit payment to the Register o~ Hills Nith t~o copies of this notice to obtain
CHECK -~ a discount or avoid interest, or you may check box 'A- and return this notice to the Register
ONE Hills and an official assessment ~ill be issued by the PA Department of Revenue.
~LOCK ~ D. [] The above asset has been or ail1 be reported and tax paid ~ith the Pennsylvania Inheritance Tax return
ONLY to be filed by the decedent's representative.
C. [] The above in~oreation is incorrect and/or debts and deductions ~ere paid by you.
You must complete PART [] and/or PART [] balo~.
PART zf you indicate a different tax rata, please state your
relationship to decedent:
TAX RETURN - CONPUTATZON OF TAX ON JOINT/TRUST ACCOUNTS
LTNE 1. Date Established 1
2. Account Balance 2
:3. Percent Taxable :3
~. Amount Subject to Tax
E. Debts end Deductions 5 -
6. Amount Taxable 6
7. Tax Rate 7 X
8. Tax Due 8
PART DEBTS AND DEDUCTIONS CLAZN;Q
DATE PAID PAYEE DESCRIPTION AMOUNT PAID
I
TOTAL (Enter on L/ne $ of Tax C~utation) $
Under penalties of perjury, T declare that the fac~s z have reported above ara true, correct end
complete to the ba~l: of m~ knowZadga and belief. HONE ('~/?)
TAXPAYER STGNAPI'URE TELEPHONE NUMBER
GENERAL ZNFORNATION
1. FA/LURE TO RESPOND NZLL RESULT ZN AN OFFICIAL TAX ASSESSMENT with appllcabla interest based on information
submitted by the financial institution.
Z. Inheritance tax becomes delinquent nine months after the decedent's date of death.
3. A joint account is taxable even though the decadent's name Has added as a matter of convenience.
4. Accounts (including those held between husband and wife) which the decedent put in joint names within one year prior to
death era fully taxable as transfers.
5. Accounts established jointly between husband and wife more than one year prior to death are not taxable.
6. Accounts held by a decedent "in trust for" another or others are taxable ~ully.
REPORTING ZNSTRUCT[ONS- PART I - TAXPAYER RESPONSE
1. BLOCK A - If the information and computation in the notice are correct and deductions ara not being claimed, place an "X"
in block "A" of Part I of the "TaxpaYer Response" section. Sign two copies and submit them with your check for the amount of
tax to the Register of Mills of the county indicated. The PA Department of Revenue will issue an official assessment
(Fora REV-1548 EX) upon receipt of the return from the Register of Hills.
Z. BLOCK B - If tho asset specified on this notice has been or will be reported and tax paid with the Pennsylvania Inheritance
Tax Return filed by the decedent's representative) place an "X" in block "B" of Part 1 of the "Taxpayer Response" section. Sign one
copy and return to the PA Department of Revenue, Bureau of Individual Taxes, Dept Z80601, Harrisburg, PA 17128-0601 in the
envelope provided.
3. BLOCK C - If the notice information is incorrect and/or deductions ara being claimed, check block "C"' and complete Parts Z and
according to the instructions below. Sign tho copies and submit them with your check for the amount of tax payable to the Register
of Mills of the county indicated. The PA Department of Revenue will issue an official assessment (Fore REV-1546 EX) upon receipt
of the return free the Register of Mills.
TAX RETURN - PART 2 - TAX COHPUTATZON
LINE
1. Enter the date the account originally Has established or titled in the manner existing at date of death.
NOTE: For a decedent dying after 12/12/8Z: Accounts which the decedent put in joint names within one (1) year of death are
taxable fully as transfers. Hoeevar, there is an exclusion not to exceed $3,000 per transferee regardless of the value of
the account or the number of accounts held.
If a double asterisk (ax) appears before your first name in the address port[on of this notice, the $3,000 exclusion
already hms been deducted from the account balance as reported by the financial institution.
Z. Enter the total balance of the account including interest accrued to the date of death.
5. The percent of the account that is taxable for each survivor is determined as foXlows: - ~.,~
A. The percent taxable for joint assets established more than Dna year prior to the decedent's~a~h:
1 DIVIDED BY TOTAL NUMBER OF DIVIDED BY TOTAL NUMBER OF X 100 = PERCENT ~TAXADLE '~
JOINT ONNERS SURVIVING JOINT ONNERS
Example: A joint asset registered in the name of the decedent and two other persons. F~i
I DIVIDED DY 3 (JOINT ONNERS) DIVIDED BY Z (SURVIVORS) = .167 X 100 = 16.7Z (TAXABLE FOR EACH SURVZ-~OR)
B. The percent taxable for assets created within one year of the decedent's death or accounts owned by th~acedent but held
in trust for another individual(s) (trust beneficiaries):
1 DIVIDED BY TOTAL NUMBER OF SURVIVING JOINT X 100 = PERCENT TAXABLE
ONNERS OR TRUST BENEFICIARIES
Example: Joint account registered in the ncaa of the decedent and tho other persons and established alan one year of death by
the decedent.
I DIVIDED BY Z (SURVIVORS) = .SO X 100 = SOZ (TAXABLE FOR EACH SURVIVOR)
4. The amount subject to tax (1ina 4) is determined by multiplying the account balance (line Z) by the percent taxable (line 3).
S. Enter the total of the debts and deductions listed in Part 3.
6. The amount taxable (line 6) is determined by subtracting the debts and deductions (line 5) from the amount subject to tax (1ina
7. Enter the appropriate tax rate (line 7) as determined below.
De~e of Death Spouse L/naa1 I Sibling Collateral
07/0~/94 ~o 12/31/94 3X 6X 15X
01/01/95 ~o 06/30/00 OX 6X 15X 15X
07/01/00 ~o presen~ OX q.$X~ 12X
xThe tax rate ilposed on thl net va[ua of Lie, .... tm== = ao~o~e=d child taentv-one years of age or younger et
death to or for the use of e naturaI parent, an adoptive parent) or a stepparent of the chiId is
The lineal class of he[rs includes grandparents, parents, children) and lineal descendents. "Children" incZudes natural children
whether or not they have been adopted by others, adopted children and step children. "Lineal descendents" includes al! children of the
natural parents end their descendents, whether or not they have been adopted by others, adopted descendents and their descendants
end step-descendants. "Siblings" are defined as individuals who have at least one parent in common with the decadent, whether by blood
or adopt[on. The "Collateral" class of heirs includes all other beneficiaries.
CLAIMED DEDUCTIONS - PART $ - DE~TS AND DEDUCTIONS CLAIMED
Allowable debts and deductions ara determined as follows:
A. You legally are responsible for payment, or the estate subject to administration by a personal representative [s insufficient
to pay the deductible items.
B. You actually paid the debts after death of the decedent and can ~urn[sh proof of payment.
C. Debts being claimed must be itemized fully in Part 3. If additional space is needed, uso plain paper 8 I/Z" x 11". Proof of
payment may be requested by the PA Department of Revenue.
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 002981
SHUGHART GALEN E
124 PEACH ORCHARD ROAD
NEWVILLE, PA 17241
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold ..........
03129575 $39.37
ESTATE INFORMATION: SSN: 207-34-5540
FILE NUMBER: 2103-0141
DECEDENT NAME: SHUGHART GABRIEL R
DATE OF PAYMENT: 09/05/2003
POSTMARK DATE: 09/04/2003
COUNTY: CUMBERLAND
DATE OF DEATH: 01 /18/2003
TOTAL AMOUNT PAID' 939.37
REMARKS' GALEN E SHUGHART
CHECK# 1522
INITIALS: AC
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96)
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
NO. CD 003154
DICK WILLIAM S, ESQUIRE
13 WEST MAIN STREET
WAYNESBORO, PA 17268
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
........ fold ..........
101 $1,824.90
ESTATE INFORMATION: SSN: 207-34-5540
FILE NUMBER: 2103-0141
DECEDENT NAME: SHUGHART GABRIEL R
DATE OF PAYMENT: 10/21/2003
POSTMARK DATE: 00/00/0000
COUNTY: CUMBERLAND
DATE OF DEATH: 01 /18/2003
TOTAL AMOUNT PAID: $1,824.90
REMARKS: ORRSTOWN BANK
C/O WILLIAM S DICK ESQUIRE
CHECK# 014399
INITIALS: JA
SEAL RECEIVED BY: DONNA M. OTTO
DEPUTY REGISTER OF WILLS
REGISTER OF WILLS
* REV-1500 EX + (8-00)
COMMONWEALTH OF
PENNSYLVANIA
OEP^RTMENT,OFREVENUE INHERITANCE TAX RETURN F'LE.U 'BER
DEPT. 280601
HARR,SBUR~,PA17~28-060~ RESIDENT DECEDENT 2 1-0 3 0 l 4 1
COUNTY CODE YEAR NUMI~ER--
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE tNmA[ SOCIAL SECURITY NUMBER
Z GabrieIR. Shuqhart 2 0 7-- 3 - 4 5 5
t'"t DATE OF DEATH (MM-DD-Year) DATE OF BIRTH (MM-DD-Year) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
I.U REGISTER OF WILLS
~ 01/18/2003 06/20/1942
LEI (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST, AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER
"' r~ 1. Odginal Return [] 2. Supplemental Retum [] 3. Remainder Return (date of death pliorto 12-13-821
~] 4. Limited Estate [] 4a. Future Interest Compromise (d~ ofdeath a~er 12-12-82) [] 5. Federal Estate Tax Return Required
[~ 6. Decedent Died Testate (Attach copy of wi.) ~'~ 7. Decedent Maintained a Living Trust (Attach copy of Trust) O 8. Total Number of Safe Deposit Boxes
[] 9. Litigation Proceeds Received ~ 10. Spousal Poverty Credit (d~ of death between 12-31-91 and 1-1-95) [] 11. Election to tax under Sec. 9113(A) (At~ach Sch O)
THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULDBE DIRECTED;TO:;
NAME COMPLETE MAILING ADDRESS
William S. Dick 13 W. Main street, Suite 210
FIRM NAME (If Applicable)
Stein & Schemel LLP
TELEPHONE NUMBER
160 Waynesboro, 17268
1. Real Estate (Schedule A) (1) 9 ,5~,(~O. 00 ,,,-z' OFFICIAL USE ONLY
2. Stocks and Bonds (Schedule B) (2)
3. Closely Held Corporation, Partnership or Sole-Proprietorship (3)
4. Mortgages & Notes Receivable (Schedule D) (4)
5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 57,914.91
(Schedule E)
6. Jointiy Owned Property (Schedule F) (6) 262.48
[~ Separate Billing Requested
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property, (7)
(Schedule G or L)
8. Total Gross Assets (total Lines 1-7) (8) 153~ 177.39
9. Funeral Expenses & Adroinistrative Costs (Schedule H) (9) 18,854.21
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule t) (10) 93,769.89
11. Total Deductions (total Lines 9 & 10) (11) 112,624.10
12. Net Value of Estate (Line 8 minus Line 11) (12) 40,553.29
13. Chadteble and Governmental Bequests/Sec 9113 Trusts for which an ele~on to tax has not been (13)
made (Schedule J)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 40,553.29
SEE INSTRUCTIONS ON REVERSE SIBE FOR APPLICABLE RATES
15. Amount of Line 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2) X ~ (15)
16. Amount of Line14 taxable at lineal rate 40,553.29 X .045 (16) 1~824.90
17. Amountof Line 14 taxable atsibling rate X .12 ~ (17)
18. Amount of Line 14 taxable at collateral rate X ,15 (18)
19. Tax Due (19) · 1,824.90
> > BE SURE TO ANSWER ALL QUESTIONS ON REVERSE SIDE AND RECHECK MATH < <
DecedenVs Complete Address:
STREET AODRESS
40 Montsera Road
aTY Carlisle I STATE PA IzIP 17013
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19) (1) 1,824.90
2. Credits/Payments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
Total Credits ( A + B + C ) (2)
3. Interest/Penalty if. applicable
D. Interest
E. Penalty
Total Interest/Penalty ( D + E ) (3)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page I Line 20 to request a refund (4)
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 1 ~824.90
A. Enter the interest on the tax due. (EA)
B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (EB) 1 ~824.90
Make Check Payable to: REGISTER OF WILLS, AGENT
PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes No
a. retain the use or income of the property transferred; ........................................................................... [] []
b. retain the right to designate who shall use the property transferred or its income; ........................................ [] []
c. retain a reversionary interest; or ' [] []
d. receive the promise for life of either payments, benefits or care? ............................................................. [] []
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................... : .......................................................................... [] []
' 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ................. [] []
4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which
contains a beneficiary designation? ....................................................................................................... [] []
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 penalt es of perjury, I declare that I have examined this return, including accompanying schedules and sta~ments, and to the pest of my knowledge and belief, it is true, correct and complete.
Declaration of preparer other than the personal representative is based on all information of which preparer has any knowled.,g.e.
S,GNATURE OF.ERSON RES.ONS.. E F'UNG RETURN
ADDRESS P.O. Box 250
Shippensburg PA 17257
DATE
SIGNATURE OF PR,E?AJRER OTHER THAN REPRESE. NTATIVE
ADDRESS 13 West Main Street, Suite 210
Waynesboro PA 17268
For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
[72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0% [72 P.S. {}9116 (a) (1.1) (ii)].
The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if
the surviving spouse is the only beneficiary.
For dates of death on or after July 1, 2000:
The tax rate imposed on the net value of transfers from a deceased child twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent,
or a stepparent of the child is 0% [72 P.S. §9116(a)(1.2)].
The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is 4.5%, except as noted in 72 P.S. §9116(1.2) [72 P.S. §9116(a)(1 )].
The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P.S. §9116(a)(1.3)]. A sibling is defined, under Section 9102, as an
individual who has at least one parent in common with the decedent, whether by blood or adoption. ·
REV-1502 EX +~(6-98)
SCHEDULE A
CO MO.W ,TH Or PENNS¥,M^N REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gabriel R. Shugh~rt 21 03 0141
All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the pdco at which property would be
exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts.
Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Real estate situated at 40 Montsera Road, Carlisle, Pennsylvania 95,000.00
more fully described in Cumberland County Deed Book 170, page 759
Parcel #08-11-0294-025; assessed at $98,180; at appraised value
TOTAL (Also enter on line 1, Recapitulation) $ 95,000.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 F~ -~ (6-98)
SCHEDULE E
COMMO,W LTH OF PENNS¥'VAN,A CASH, BANK DEPOSITS, & MISC.
INHERITANCE TAX RETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Gabriel R. Shughart 21 03 0t41
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
1. Waypoint Bank, non-interest bearing checking account #90845457 1,301.59
2. V~aypoint Bank, certificate of deposit #8000044474 1,195.60
Principal balance - $1194.99
Interest accrued to date of death - $.61
3. Liberty Mutual, long-term disability payment 1,910.38
4. Carlisle Regional Medical Center, refund check 26.45
5. Sovereign Bank, escrow refund 105.05
6. Department of the Treasury, 2002 federal tax refund 2,107.00
7. Household goods, net of expenses 3,175.65
8. Livestock, net of expenses 2,425.82
9. Members 1st Federal Credit Union, account #153828-00 5,789.30
Principal balance - $5785.29
Interest accrued to date of death - $4.01
10. 2000 Chevrolet Pickup Truck, VI N #1GCEK14WOYE222766 11,620.00
11. 1991 Plymouth Station Wagon, VIN#1P4GH44R3MX507412 300.00
12. Land O Lakes, accrued vacation/sick time 1,879.85
13. Land O Lakes, final pay check 1,803.22
14. Farm machinery, at appraised value 24,075.00
TOTAL (Also enter on line 5, Recapitulation) $ 57,914.91
(If more space is needed, insert additional sheets of the same size)
REV-1511 EX +~ (12-99)
SCHEDULE U
COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES &
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
G~briel R. Shughart ;~1 03 0141
Debts of decedent must be reported on Schedule Io
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home, funeral expenses 5,310.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative's Commissions
Name of Personal Representative (s) Orrstown Bank 5,363.00
Social Security Number(s)/EIN Number of Personal Representative(s) 23-0934350
Street Address P.O. Box 250
City Shippensburg state PA Zip 17257
Year(s) Commission Paid: 2003
2. AttomeyFees Dick, Stein & Schemel, LLP 7,125.00
3. Family Exemption: (If decedent's address is not the same a_s claimant's, attach explanation)
, Claimant
Street Address
City State Zip
Relationship of Claimant to Decedent
4. Probate Fees Cumberland County Register of Wills 312.00
5. Accountant's Fees
6. Tax Return PrepareCs Fees
7. Cumberland Law Journal, advertising letters testamentary 75.00
8. The Sentinel-Legal, advertising letters testamentary 119.21
9. S.W. Barrett Real Estate & Appraisal, real estate appraisal fee 250.00
10. Closing costs and final attorney fees 300.00
TOTAL (Also enter on line 9, Recapitulation) $ 18~854.21
(If more space is needed, insert additional sheets of the same size)
REM.,1512 EX-~ (6-98)
SCHEDULE I
COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT,
INHERITANCE TAX RETURN
RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
Gabriel R. Shuahart 21 03 0141
Include unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1, GMAC Payment Processing Center, unpaid late charges 10.57
2. Sovereign Bank, loan #0176432175 - mortgage on real estate situated at 40 Montsera Rd. 72,629.22
Carlisle, Pa
Principal - $72431.03; interest accrued to date of death - $198.19
3. GMAC Payment Processing Center, account #020 1229 21439, truck loan 5,527.06
Principal - $5,509.38
Interest accrued to date of death $17.68
4. Citizens Bank of Southern Pennsylvania, loan #9600134860 546.37
5. Citibank, loan #4004644346750-20 11,330.62
Principal balance - $11303.07
Interest accrued to date of death - $27.55
6. Members First, co-borrower on loan #183655-01 1,958.11
Principal balance - $3916.22
7. Appalachian Orthopedic Ctr., Ltd., medical bill 297.80
8. Penn Credit Corporation, balance due on medical bill to Hershey Medical Center, 83.20
' Hershey, Pennsylvania
9. Collectech Systems, past due telephone bill to Sprint 263.51
10. Principal Life Insurance Company,: reimburse for overpayment of medical bill 47.52
Carlisle Regional Medical Center, Carlisle, Pennsylvania
11. Life of the South, reimbursement of disability payments made beyond date of death 462.47
12. Met Ed, unpaid utility bills 613.44
TOTAL (Also enter on line 10, Recapitulation) $ 93~769.89
(If more space is needed, insert additional sheets of the same size)
REV-1513 EX + (9:.nm
SCHEDULE J
COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
(~abriel R. Shughart 21 03 0141
RELATIONSHIP TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee{s) OF ESTATE
[. TAXABLE DISTRIBUTIONS [include outdght spousal distributions, and transfers under
Sec. 9116 (a)(1.2)]
1. Galen E. Shughart son 20% of the residue
124 Peach Orchard Road
Newv~le, PA 17241
2. Dianna Garrett daughter 20% of the residue
519 South Pitt Street
Carlisle, PA 17013
3. Roland Shughart son 20% of the residue
260 West Ridge Street
Carlisle, PA 17013
4. Kathy Lyons daughter 20% of the residue
107 Smifhfield Court
Walkersville, MD 21793
5. Elaine Shughart daughter 20% of the residue
107 Smithfield Court
Walkersville, MD 21793
, ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET
[1. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE
1.
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
1.
TOTAL OF PART I1 - 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)
APPRAISAL OF
LOCATED AT:
calllele~ p~, '17~3
FOR:
BY:
13.4-t~ NO4~T'J4 HANOVER g;'r~EIET, CAR/JOL~ I~A 'r?lOt3 747.,,,~l~.BGde. AND FAX 7'17,24..~-~
9ENT BY: ORR~?OWN BANK; 7175329342; 9EP-26-03 t1:2g; PA~E 7
S. W. B~Rl~--l-r RGAL GSTA'IT & APpR~d. SERVICES
Og/~/20Q2
6hlppMmburg, PA 172~
In accoreDn=e with your requont, I heYe personally Inspocled and appraised the real
~ Mo~
T~e property rJghlv appraised are the fee sim~le ~.terest in the site and improvements.
I~.~,pa~lfully mut)mltled. ~
~ .~ 8kmvl~mek
124-1~'1I NORTH HANOVER ,~TREET. CARLI~t.E, PA 17~15 717-~43,,~,41l AND FAX
9ENT ~Y! ORR,~TOWN GANK; 717~329342~ ~EP-26-03 ~'1:29j PAGE
~UM~RY ~P~ ~ORT
~,~.,~..~ ..... UNIFORM REGIDEN~ ~P~I~ REPORT ~.~ ~
~ENT BY! ORRgTOWN BANK; 7t 753~§34~; 9EP- :~8- 03 1 ~: 30; PAGE
:~m~wFm~~ NQM, C~Y J u~ 'UM~ :
~-- ~,~ : ~u ~ ~ ,~,~
' ~ . ; " .
Living
Skelr~ by AI3ex tV wlndow'J;TM
AREA"CALCULATIONS SUMMARY £NING AREA, B . ,RF_AKDOWN
~ ~,~,~e~,~, . a~. '. 'ltw~. ~. ' ' .... Ilma~=ia'' '
30.00 x ~6.Go
TOTAL LIVABLE (~) 10~ 2 ~s To~I (mu~) 10~
= i iiii i
131 NORTH H,RNOYP. R $11t~ET, ~'AItM~JLF_, PA 17iD15 ?"l~"),~.Jllllii AH~ 6A]~ 717-2A~-~127
~I~NT E¥." ORRgT'OWN I~ANK.; 717~32934~ 9EP-~(~-03 It :3t ~ PAGE
gEAR VIEW OF
~IUBJECT PROPERTY
S'I'REE'I' SC ENE
FROh'T v&'W OF
mJBJECT PROPERTY
R~AR VIEW OF
8UBdECT PROPERTY
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CHECKED ITEMS ARE ~PECIFIC ~FECIAL CONOIT~ON~3 THAT WERE IDENTIfiED BY 33119
IHSPECTION.
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S~NT BY:'ORRgTOWN ~ANK~ 7t7~S2§342; 9EP-~B-03 1t:3~ PAGE t~/t9
APPR.&J~ER~ CEATIIel CAt'/ON:
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SUPERVISORY APPRAI-~PR'$ CERTIFICATION; Ii' a
ADD~ OF PAOPERTY~D:
Oab~ ~3
CIA~ R~fld ~mlser ~ ~x~ ~pr~
Aug. 2~ '03 ~16:01 1234 GUTSHI~LLS ~2 TEL ?89-4930 P. I
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INVENTORY
Estate of Gabriel R. Shucjhart No. 21 03 0141
also known as Date of Death 01/18/03
late of Cumberland County, Carlisle, Pennsylvania , Deceased Social Security No 207-34-5540
Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following inventory include all of the
personal assets wherever situate and all of the real estate in the Commonwealth of Pennsylvania of said Decedent, that the valuation
placed opposite each item of said inventory represents its fair value as of the date of the Decedent's death, and that Decedent owned no
real estate outside the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this inventory. INVe
verify that the statements made in this inventory are true and correct. I/We understand that false statements herein made are subject to the
penalties of 18 Pa. C.S. Section 4904 relating to unswom falsification to authorities.
Personal Representative:
Name of
Attorney: William S. Dick Orrstown Bank
I.D. No.: 24566 Galen E. Shuqhart
Address: 13 W. Main Street, Suite 210 Dated /~/1~'/(~'.'3
Waynesboro, 17268
Telephone: 717-762-1160
Description Value
' Waypoint Bank, non-interest bearing checking account #90845457 1,301.59
Members 1st Federal Credit Union, savings account #153828-00 5,789.30
Principal balance - $5785.29
Interest accrued to date of death - $4.01
Waypoint Bank, certificate of deposit #8000044474 ~. _ 1,195.60
Principal balance - $1194.99
Interest accrued to date of death - $ .61
Liberty Mutual, long-term disability payment , 1,910.38
L
Carlisle Regional Medical Center, refund check 26.45
Sovereign Bank, escrow refund '- 105.05
Total
152,914.91
(Attach Additional Sheets if necessary)
NOTE: The Memorandum of real estate outside the Commonwealth of Pennsylvania may, at the election of the personal representative,
include the value of each item, but such figures should not be extended into the total of the Inventory.
RW-4
·-. Continuation of Inventory
Gabriel R. Shughart 21 03 0141
Paqe 1
Description of Inventory
Description Value
Department of the Treasury, 2002 federal tax refund 2,107.00
Household goods, net of expenses 3,175.65
Livestock, net of expenses 2,425.82
Real estate located at 40 Montsera Road, Carlisle, Pennsylvania 95,000.00
more fully described in Cumberland County Deed Book 170, page 759
Parcel #08-11-0294-025; assessed at $98,180; at appraised value
Land O Lakes, accrued vacation/sick time 1,879.85
Land O Lakes, final pay check 1,803.22
2000 Chevrolet Silverado 1500 Pickup, VIN #1GCEK14WOYE222766 11,820.00
1991 Plymouth Station Wagon, VIN @1P4GH44R3MX507412 300.00
Farm machinery, at appraised value 24,075.00
Subtotal $ 142,586.54
Grand Total $ 152,914.91
CONNONWEALTH OF PENNSYLVANZA ~
BUREAU OF ZNDZVZDUAL TAXES DEPARTNENT OF REVENUE
ZNHERZTANCE TAX DZVZSZON
DEPT. Z80601
HARRISBURG, PA 17128-0601 NOTICE OF INHERITANCE TAX
APPRAZSEHENT, ALLO#ANCE OR DZSALLO#ANCE
OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-1547EXAFP(01-O$)
DATE 12-15-2005
ESTATE OF SHUGHART GABRZEL R
DATE OF DEATH 01-18-2005
FZLE NUNDER 21 05-0141
~ ~ COUNTY CUHBERLAND
WZLLZAH S DICK ACN 101
DICK ETAL Amount Remitted
15 W MAIN ST STE 210
WAYNESBORO PA 17268 ,
HAKE CHECK PAYABLE AND RENZT PAYHENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17015
CUT ALONG THIS LINE ~> RETAIN LOWER PORTION FOR YOUR RECORDS ~
REV-1547 EX AFP (01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSNENT OF TAX
ESTATE OF SHUGHART GABRIEL R FILE NO. 21 05-0141 ACN 101 DATE 12-15-2005
TAX RETURN HAS: (X) ACCEPTED AS FZLED ( ) CHANGED
RESERVATZON CONCERNZNG FUTURE ZNTEREST- SEE REVERSE
APPRAZSED VALUE OF RETURN BASED ON: ORZGINAL RETURN
1. Real Estate (Schedule A) (1) 95;000.00 NOTE: To insure proper
2. Stocks and Bonds (Schedule B) (2) O0 credit to your account,
$. CZosely Held Stock/Partnership Znterest (Schedule C) (3) O0 submit the upper portion
4. Hot,gages/Notes Receivable (Schedule D) (4) O0 of this for. with your
5. Cash/Bank Deposi~s/Hisc. Personal Proper~y (Schedule E) (S) 57z914 91 tax payment.
6. Jointly Owned Property (Schedule F) (6) 262 48
7. Transfers (Schedule G) (7) O0
8. Total Asse~s (B) 155,177.59
APPROVED DEDUCTIONS AND EXEHPTZONS: 18,854.21
9. Funeral Expenses/Adm. Cos~s/Nisc. Expenses (Schedule H) (9)
10. Debts/Hot'gage Liabilities/Liens (Schedule I) (10) 95;769.89
11. Total Deductions (11) 112.6~I.10
12. Ne~ Value of Tax Re~urn (12] 40,55~.29
15. Charitable/Governmental Bequests; Non-elected 9115 Trusts (Schedule J) (15) .00
14. Net Value of Estate Subject to Tax (14) 40,555.29
NOTE: Zf an assessaent ~as issued prevlously, lines 1~, 15 and/or 16, 17, 18 and 19 ~ill
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rats (15) . O0 X O0 = . O0
16. Amount of Line lq taxable at Lineal/Class A rate (16) 40,555.29 X 045 = 1,824.90
17. Amount of Line 14 at Sibling rats (17) . O0 X 12 = . O0
18. Amoun~ of Line 1~ taxable at Collateral/Class B rats (18) .00 X 15 = .00
19. Principal Tax Due (19)= 1,824.90
TAX CREDZTS:
PAYH~NT RECE/PT DISCOUNT (+)
ANOUNT PAZD
DATE NUNBER ZNTEREST/PEN PAZD (-)
09-04-2005 CD002981 .00 $9.57
10-21-2005 CD005154 .75- 1,82~.90
TOTAL TAX CREDIT J 1,863.54
BALANCE OF TAX DUEl $8.64CR
INTEREST AND PEN. . O0
TOTAL DUE 58.64CR
ZF PAID AFTER DATE INDICATED, SEE REVERSE ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDI'T' (CR), YOU NAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS.)
RESERVATION: Estates of decedents dying on or before December 1Z, 198Z -- if any future interest in the estate is transferred
in possess[on or enjoyment to Class 8 (collateral) beneficiaries of the decedent after the expiration of any estate for
life or for years, the Commonwealth hereby expressly reserves the right to appraise end assess transfer Inheritance Taxes
at the lawful Class S (collateral) rate on any such future interest.
PURPOSE OF
NOTICE: To fulfill the rsquirsments of Section Z160 of the Inheritance and Estate Tax Act, Act Z3 of ZOO0. (TI P.S.
Section 9160).
PAYHENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side.
--Hake check or money order payable to: REGISTER OF #ILLS, AGENT
REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application
for Refund of Pennsylvania Inheritance and Estate Tax" (REV-1313). Applications ara available at the Office
of the Register of Hills, any of tho Z3 Revenue Oistrict Offices, or by calling the special Z6-hour
answering service for forms ordering: 1-800-36Z-ZOSO~ services for taxpayers with special hearing and / or
speaking needs: 1-800-667-30Z0 (TT only).
OBJECTIONS: Any party in interest not satisfied with the appraisement, alloeanca, or disallowance of deductions, or asssssesnt
of tax (including discount or interest) as shown on this Notice must object eithin sixty (60) days of receipt of
this Notice by:
--eritten protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 171ZS-lOZ1, OR
--election to have the matter determined at audit of the account of the personal representative, OR
--appeal to the Orphans' Court.
ADNIN-
ISTRATIVE
CORRECTIONS: Factual errors discovered on this assessment should be addressed in writing to: PA Department of Revenue,
Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 280601, Harrisburg, PA 17128-0601
Phone (717) 787-6505. See page 5 of the booklet "Instruct[ons for Inheritance Tax Return for a Resident
Decedent" (REV-1501) for an explanation of administratively correctable errors.
DISCOUNT: If any tax due is paid within three (3) calendar months after the decadant's death, a five percent (SI) discount of
the tax paid is alloeed.
PENALTY: The 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not
paid before January 18, 1996, the first day after the and of the tax amnesty period. This non-participation
penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest
that has been assessed as indicated on this notice.
INTEREST: Interest [s charged beginning eith first day of delinquency, or nine (9) months and one (1) day from the data of
death, to the data of payment. Taxes ehich became delinquent before January 1, 198Z bear interest at the rate of
six (6X) percent per annum calculated at a daily rata of .000166. All taxes ehlch became delinquent on and after
January 1, 1982 will bear interest at e rate which will vary from calendar year to calendar year with that rata
announced by the PA Department of Revenue. The applicable interest rates for 198Z through ZOOS ars:
Interest Daily Interest Daily Interest Daily
Year Rate Factor Year Rate Factor Year Rate Factor
198Z ZOZ .000568 1987 9Z .000267 1999 7Z .00019Z
1983 16Z .000638 1988-1991 llX .000301 ZOO0 8Z .000Z19
1986 llZ .000301 199Z 9Z .000267 ZOO1 9Z .000Z67
1985 132 .000~56 1993-1996 72 .O0019Z ZOOZ 6X .000166
1986 iOZ .000274 1995-1998 92 .000267 2003 5Z .000137
--Interest [s calculated as folloas:
INTEREST = BALANCE OF TAX UNPAID X NUMBER 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.
/z~.STATUS REP/~T UNDER RULE 6.12
'
Pursuit to Rule 6.12 f ~he Supreme Cou~ O~hans' Co~ Rules, I repo~l ~e
follo~dng with respect to completion of ~e ad~sCation of the above-captioned estme:
1. Star,ether a~s~ation of~e estate
Yes~ No ~ is complete:
2. If ~e ~swer is No, state when the personal representative reasonably beHeves
that ~e a~s~ation will be complete:
3. ~ the ~swer to No. 1 is Yes, state the f0Ilow~g:
a. Did the personal ~esentafive file a ~al accost with ~e Come
Yes _ No '
b. ~e sep~ate OCh~' Co~ No. (iffy) for the person~ representative's
accomt is:
c. Did the persona/representative,state an
in interest? Yes [] No ~. account informally to the pm-t/es
c. Copies of receipts, releases, joinders and approval of formal or
informal accounts may be filed with the Clerk of the Orphans' Court
and may be attached to this r~0~rt.
~ ?.,! Address
!//: :~ cl ~'~q-[]'[il ?0. Telephone No.
C~I~acity: ~/~ ?ersonal Re¢resentative
_[--] Counsel for~personal representative
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 12/01/2004
DICK WILLIAM S, ESQUIRE
13 WEST MAIN STREET
WAYNESBORO, PA 17268
RE: Estate of SHUGHART GABRIEL R
File Number: 2003-00141
Dear Sir/Madam:
It has come to my attention that you have not filed the Status
Report by Personal Representative (Rule 6.12) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO.
103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on or after
July 1, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
Wills a Status Report of completed or uncompleted administration.
This filing will become delinquent on: 1/18/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
GLENDA FARNER STRASB~UGH
REGISTER OF WILLS
cc: File
Personal Representative(s)
Judge
I..L_
C),:
Will No.:
Name of Decedent:
Date of Death:
Admin. No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the
following with respect to completion of the administration of the above-captioned estate:
1. State.,,;pether administration of the estate is complete:
YesAl No 0
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. I is Yes, state the following:
a. Did the personal reJ!resentative file a final account with the Court?
Yes _ NO~
b. The separate Orphans' Court No. (if any) for the personal representative's
account is:
c. Did the personal representati~. t.ate an account informally to the parties
in interest? Yes 0 No ~
c. Copies of receipts, releases, joinders and approval oHormal or
informal accounts may be fi with the Clerk 0 e Orphans' Court
and may be attached to t re
Date:~05
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