HomeMy WebLinkAbout09-14-111505610140
~EV~1 ~ County Code Year File Number
PA Department of Revenue 2 1 1 1 0 0 8 7
Bureau of Individual Taxes INHERITANCE TAX RETURN
Po Box 28oso1 ~ RESIDENT DECEDENT
Harrisbur , PA 17128-0601 MMDDYYYY
ENTER DECEDENT INFORMATION BELOW MMDDYYYY Date of Birth
Date of Death
0 1 1 2 2 0 1 1 0 8 0 7 1 9 2
Social Security Number
1 80 26 5402 MI
Suffix Decedent's First Name ~,
Decedent's Last Name q N N
S H E P ~ EY MI
(If Applicable) Enter Surviving Spouse's Information Below Suffix Spouse's First Name
Spouse's Last Name
N / A URN MUST BE FILED IN DUPLICATE WITH THE
Spouse's Social Security Number THIS RET
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW ^ 2 Supplemental Return ^
a 1. Original Return ^
^ 4a. Future Interest Compromise (date of
^ 4. Limited Estate death after 12-12-82) ~
^ Trust -
7. Decedent Maintained a Living
a g. Decedent Died Testate (Attach Copy of Trust) ^
(Attach Copy of W ill) ^
. Liti ation Proceeds Received 10. Spousal Poverty Credit (date of dE:at
g g between 12-31-91 and 1-1-95}
CONFIDENTII
3. Remainder Return (date of death
prior to 12-13-82)
5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
11. Election to tax under Sec. 9113(A)
(Attach Sch. O)
L CORRESPONDENCE AND ~L TAX INFORMATION SHOULD BE DIRECTED T0:
Daytime Telephone Number
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. AL 3 4 4 1 8 2
7 1 7
Name E S ~ _ ,
E N J D Z U R A N I N ~ .:...
S T E P H REGISTER OF;~iI~ USE ONLY'
tT~e
First line of address
WI X WENGER &
Second line of address
PO BOX 845
City or Post Office
H A R R I S B U R G
_` ~ ~._.F
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l'~ ..h~''.Jyy .,IM ,.
W E I p N E R _..j 1~, ..,..,
~~
-~ ,-~ ti.
~, .w...
Z+ Y, ^.,;
DATE FILED_~_
State ZIP Code `----
P A 1 7 1 0 8 0 8 4 5
:.~7
. _ ~_.,
.-._
-~~ ~.~
--~ 'i
'n schedules and statements, and to the best of my knowledge and belief,
orres ondent's a-mail address: SDZU RANI N @ W W W PALAW •C~ arer has any knowledge.
C p
I declare that I have examined this return, including accompan}li
~,.ae~ .,cna-ties of perjury, _ _:...~.,~~or ether than the personal representative is based on all information of which prep - G~T~
it is true, correct and comp R FILING RETURN
cirNATUAE OF PERSON ~S ONSIB
10
SOUTHAMPTON PA 18966
DRIVE Q°
ER OTHER THAN REPRESENTATIVE
HARRISBURG
GER W EIDNER, PO BOX 845 INAL FORM ONLY
PLEASE USE ORIG
Side 1
q 17108
1505610140 ....~..~
1 1505610140
L.
J
1505610240
REV-1500 EX
.. ~. ~ -r cucDl FY
Decedent's Social Security Number
1 8 0 2 6 5 4 0 2
Decedent's Name: HIV 1 V ~ v ~ ~ ~-• --
RECAPITULATION 1
...............
1. Real Estate (Schedule A) . • • • - • • • • - • • •
2.
2. Stocks and Bonds (Schedule B) • - • • • • • • • • " " ~ • • • ~ • • • 3
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .
...........
4. Mortgages and Notes Receivable (Schedule D . • • • • •
Schedule E) • • • • • • • 5-
5. Cash, Bank Deposits and Miscellaneous Personal Property
. 6.
Schedule F) ^ Separate Billing Requested ..
6. Jointly Owned Property ( 7
7. Inter-Vivos Transfers & Miscellaneous N,~-PS paraterBill•ng Requested - - • • • • •
(Schedule G) ~~
,._...~ ~ a.,o~ 1 thrnuah 7) ........................... 8.
8. Total Gross p-ss~~a ~~~«.., ~•• •-- -
9.
9. Funeral Expenses and Administrative Costs (Schedule H) . • • • • • • • - • • • ~ ' '
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) .. • - • • -
_ ••...11.
.............
11. Total Deductions (total Lines 9 and 10) . • • • • • • - • • •
_ • , 12.
12. Net Value of Estate (Line 8 minu uests/Sec 9113 Trusts for which
13. Charitable and Governmental Beq . • • , • - 13.
an election to tax has not been made (Schedule J) • - • • • • • • • • •
~ 14.
n :.-., f 7 mini ~C I InB 13) .
0.0 0
4705.09
0.0 0
0.0 0
2 3 2 0 3 2.0 7
1 1 14 8.4 4
2 4 7 8 8 5.6 0
3 3 1 9 2. 1 0
2 0 34 4.0 8
5 3 5 3 6. 1 8
19 4 34 9.4 2
1 9 4 3 4 9.4 2
TAX CALCULATION -SEE INe TRUCTIONS FOR APPLICABL
15. Amount of Line 14 taxab
at the spousal tax rate, or 0 0 ~ 15.
transfers under Sec. 9116
16. Amount of Line 14 taxable 2 5 ~ 1 $ 5 5 16.
at lineal rate X .045
17. Amount of Line 14 taxable 1 6 3 6 6 2. 6 5 17.
at sibling rate X .12
18. Amount of Line 14 taxable 5 6 6 8. 2 2 1 s.
at collateral rate X .15
19.
.................
19. TAX DUE ....... .... .
ILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
20. F
Side 2
0. 0 0
1 1 2 5, 8 3
1 9 6 3 9. 5 2
5 5 0. 2 3
2 1 6 1 5. 5 8
0
1505610240 ~.,J
1505610240
File Number
REV-1500 EX Page 3 21 11 0087
Decedent's Complete Address:
DECEDENT'S NAME
ANN T. SHEPLEY
STREET ADDRESS
MESSIAH VILLAGE
100 MT. ALLEN DRIVE STATE
CITY PA
MECHANICSBURG
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments 21000.00
A. Prior Payments 1 080.78
B. Discount
3. Interest
4. If Line 2 is greater than Line 1 + Line 3, enter the differeneSCet•a refund. a OVERPAYMENT.
Fill in oval on Page 2, Line 20 to requ
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
ZIP
17055
(1) 21 615.58
Total Credits (A + B) (2) 22 080.78
(3)
(4) 465.20
(5) 0.00
ke check a able to: REGISTER OF WILLS, AGENT
Ma p Y
ESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
PLEASE ANSWER THE FOLLOWING QU Yes tvo
1. Did decedent make a transfer and: ^
• ert transferred : ...................................................................... ^ Q
a. retain the use or income of the prop y ^ ^
b. retain the right to designate who shall use the property transferred or its income; • • • • • • • • • • • • • • • • ~ ~ • • ~ • • - • - ~ - - "
.............................................................................................. ^ o
c. retain a reversionary interest; or ..
.......................................................
d. receive the promise for life of either paymentsebedenlt t ansferproperty within one year of death
2. If death occurred after December 12,1982, did d •. ^
................................................,. 0
without receiving adequate consideration?
3. Did decedent own an "intrust for" orpayable-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 ...............
IS YES YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS
95 the tax rate imposed on the net value of transfers to or for the use of the surviving spouse i
For dates of death on or after July 1, 1994, and before Jan. 1, 19 ,
3 percent [72 P.S. §9116 (a) (1.1) (i)].
the tax rate imposed on the net value of transfers to or for the us tat toe re uirements forldiscposuee of assets and
For dates of death on or after Jan.1, 1995,
116 a 1.1 (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the s ry
[72 P.S. §9 () ( )
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: fers from a deceased child 21 years of age or younger at death to or for the use of a natural parent, an
• The tax rate imposed on the net value of trans
adoptive parent or a stepparent of the child is 0 percent [72 P.S. §9116(a)(1.2)].
f transfers to or for the use of the decedent's lineal beneficiaries is 4.5 percent, except as noted in
• The tax rate imposed on the net value o
72 P.S. §9116(1.2) [72 P.S. §9116(a)(1}]. 1 3 A siblin is defined, under
lue of transfers to or for the use of the decedent's siblings is 12 perclood o? ado §on16(a)(. )]• g
• The tax rate imposed on the net va
n 9102, as an individual who has at least one parent in common with the decedent, whether by b
Sectio
REV-1502 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
__ ~T nrncflCAIT
SCHEDULE A
REAL ESTATE
nC~wuv ~ v~..~••-.
ESTATE OF:
FILE NUMBER:
21 11 0087
. ~. _ _ ~ __ aL... mina ~+ ~~~hirh nrOb2rlV
ANN T. SHEPLEY
All real property owned solely or as a tenant in common must be reported at fair market value. alr mar e v ule F.
nd a willin seller, neither being compelled to buy or sell, both havinn Schedable knowledge of the relevant facts.
would be exchanged between a wllling buyer a 9
Real property that is jointly-owned with right of survivorship must be disclosed o
Attach a copy of the settlement sheet if the properly has been sold. VALUE AT DATE
Include a copy of the deed showing decedent's interest if owned as tenant in common. pF DEATH
ITEM
NUMBER DESCRIPTION 0.00
NONE
TOTAL (Also enter on Line 1, Recapitulation.) $ 0.00
If more space is needed, use additional sheets of paper of the same size.
REV-1503 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
r.rn mC~~7 nCr~FnFNT
SCHEDULE B
STOCKS & BONDS
ESTATE OF
FILE NUMBER
21 11 0087
ANN T. SHtrt_tY
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM DESCRIPTION
NUMBER
1, 101 METLIFE SHARES (CUSIP NO.59156R10) @ 46.585/SHAR
VALUATION SHEET ATTACHED
VALUE AT DATE
OF DEATH
4,705.09
TOTAL (Also enter on line 2, Recapitulation) $ 4 705.09
(If more space is needed, insert additional sheets of the same size)
REV-1504 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
NT
SCHEDULE C
CLOSELY-HELD CORPORATION,
PARTNERSHIP OR
SOLE-PROPRIETORSHIP
RESIDENT DECEDE FILE NUMBER
ESTATE OF 21 11 0087
ANN T. SHEPLEY
Schedule C-1 or C-2 (including all supporting information) must be attachedo~ineanformation tolbe submitted foasole-proprietorshipshe decedent, other than a
sole-proprietorship. See instructions for the supp 9 VALUE AT DATE
ITEM OF DEATH
NUMBER DESCRIPTION 0.00
1. NONE
TOTAL (Also enter on line 3, Recapitulation) ~ $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1507 EX + (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
SCHEDULE D
MORTGAGES & NOTES
RECEIVABLE
RESIDENT DECEDENT FILE NUMBER
ESTATE OF 21 11 0087
ANN T. SHEPLEY
All property jointly-owned with the right of survivorship must be disclosed on Schedule F. VALUE AT DATE
ITEM OF DEATH
NUMBER DESCRIPTION 0.00
1. NONE
TOTAL (Also enter on line 4, Recapitulation) $ 0.00
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX + (6-98)
SCHEDULE E
F PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
COMMONWEALTH O PERSONAL PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT FILE NUMBER
ESTATE OF 21 11 0087
-ANN T. SHEPLEY
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. VALUE AT DATE
ITEM OF DEATH
NUMBER DESCRIPTION 193,132.66
1. M&T BANK CHECKING ACCOUNT XXXX6961
DOD BALANCE: $193,132.09; ACCRUED INT: $.57
19,531.45
2. FULTON BANK CERTIFICATE OCCRUOEDIINTX$177530*
DOD BALANCE: $19,513.92, A
* -Fulton Bank Certificate of Deposit held as "In Trust for Joseph M. Punch."
Mr. Punch predeceased the decedent, having died on 11/112010.
9,450.96
3. M&T BANK IRA XXXX6987
DOD BALANCE: $9,449.5
I
D
(DECEASED)
Y
ES SHEPLE
DESIGNATED BENE: JAM
000.00
4
4, DEPOSIT FROM U.S. TREASURY REPRESENTED PRIOR TO DECEDENT'S DEATH
REDEEM ,
U.S. SAVINGS BONDS {SERIES HH)
TWO CEMETERY PLOTS SITUATE AT BLUE RIDGE MEMORIAL GARDENS,
5,188.00
5. HARRISBURG, PENNSYLVANIA
DIAMOND RING BEQUEATHED IN ITEM II(b) OF WILL
385.00
6, APPRAISAL ATTACHED
RUBY RING BEQUEATHED IN ITEM II(d) OF WILL 30.00
7. APPRAISAL ATTACHED
EMERALD CROSS PENDANT BEQUEATHED IN ITEM II(c) OF WILL
64.00
g, APPRAISAL ATTACHED
g. ORDINARY HOUSEHOLD GOODS, FURNISHINGS, AND CLOTHING
250.00
TOTAL (Also enter on line 5, Recapitulation) I $ 232,032.07
(If more space is needed, insert additional sheets of the same size)
REV-1509 EX+ (01-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
RESIDENT
FILE NUMBER:
ESTATE OF: 21 11 0087
ANN T. SHEPLEY
If an asset was made jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
ADDRESS RELATIONSHIP TO DECEDENT
SURVIVING JOINT TENANT(S) NAME(S)
A.
B
C
JOINTLY-OWNED PROPERTY:
LETTER DATE
ITEM FOR JOINT MADE
NUMBER TENANT JOINT
1. IA.
~o OF DATE OF DEATH
DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCIAL INSTITUTION AND RJOINTLY-OHEND REABESTATE IMILAR VA U ~O DASSET D NTED EST DECEDENTS NTEREST
IDENTIFYING NUMBER. ATTACH DEED FO
TOTAL (Also enter on Line 6, Recapitulation) $
If more space is needed, use additional sheets of paper of the same size.
REV-1510 EX+ (08-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
DENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
RESIDENT DECE -
FILE NUMBER
ESTATE OF 21 11 0087
ANN T. SHEPLEY
This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes.
DESCRIPTION OF PROPERTY DATE OF DEATH % OF DECD'S EXCLUSION TAXABLE
ITEM INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND VALUE OF ASSET INTEREST (IF APPLICABLE VALUE
NUMBER THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. 11,148.44 100.00 11,148.44
~. NATIONWIDE BANK SAVINGS ACCT. XXXX2479
DOD BALANCE: $11,146.61; ACCRUED INT: $1.83
POD: SHIRLEY KUBOLA AND JOSEPHINE CULLEN
TOTAL (Also enter on Line 7, Recapitulation) ~ $ 11_,148.44
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
pennsylvania SCHEDULE H
DEPARTMENT OF REVENUE FUNERAL EXPENSES AND
INHERITANCE TAX RETURN ADMINISTRATIVE COSTS
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
ANN T SHEPLEY 21 11 0087
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. FACKLER-WIEDEMAN FUNERAL HOME, HARRISBURG, PA 11,002.82
2. FUNERAL LUNCHEON 697.70
3. GINGRICH MEMORIAL 1,425.00
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) NANCY P. CULLEN
Street Address 1050 JEFFREY DRIVE
City SOUTHAMPTON State PA ZIP
Year(s) Commission Paid: 2011
2. Attorney Fees: WIX WENGER &WEIDNER (ESTIMATED)
g, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
City State ZIP
Relationship of Claimant to Decedent
Probate Fees: CUMBERLAND COUNTY REGISTER OF WILLS
Accountant Fees:
Tax Return Preparer Fees: ERNEST ROUSH (2010 AND 2011)
CUMBERLAND LAW JOURNAL (ADVERTISING)
THE SENTINEL (ADVERTISING)
COSTS OF UHAUL, MOVERS, AND GAS TO MOVE PERSONAL ITEMS
JEWELRY APPRAISAL
REIMBURSEMENT TO EXECUTOR FOR MILEAGE, TOLLS, MISC. OUT OF
POCKET EXPENSES INCURRED .DURING ADMINISTRATION OF ESTATE
JANNEY MONTGOMERY SCOTT (FEDEX REIMBURSEMENT)
WIX, WENGER &WEIDNER -OUT OF POCKET COSTS (ESTIMATED)
10,000.00
7,500.00
323.50
670.00
75.00
240.64
618.55
90.00
488.97
9.92
50.00
TOTAL (Also enter on Line 9, Recapitulation) $ 33 192.10
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-08)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF FILE NUMBER
ANN T ~HFPI FY 21 11 0087
Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. MESSIAH VILLAGE, MECHANICSBURG, PA 20,298.52
11 /10; 12/10; 1 /11
2. PUAL S. DELBY, DPM 15.00
3. ~ PEBTF
TOTAL (Also enter on Line 10, Recapitulation) I $
If more space is needed, insert additional sheets of the same size.
30.56
20,344.08
REV-1513 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
FILE NUMBER:
-IEPLEY 21 11 0087
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) (1.2).]
ROSEMARIE WATKINS Lineal 25,018.55
630 LENKER ROAD
HARRISBURG, PA 17111
Sibling
163,662.65
JOSEPHINE CULLEN
1051 79TH AVE., NORTH, #311
ST. PETERSBURG, FL 33702
64
00
KATHLEEN McANANEY Collateral .
920 RHAWN STREET
PHILADELPHIA, PA 19111
00
30
NANCY P. CULLEN Collateral .
1050 JEFFREY DRIVE
SOUTHAMPTON, PA 18966
SHIRLEY KABULA Collateral 5,574.22
508 STATE STREET
LANCASTER, PA 17603
00
0
JOSEPH M. PUNCH (DECEASED 11/1/10/NO ISSUE) Collateral .
JAMES SHEPLEY (DECEASED) Spousal 0.00
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE.
NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT TAKEN:
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
LAST WILL AND TESTAMENT
THE E)RIGINAb OF 'THIS I~CtitA YS C'tJttKENTLY BEING
~-,~IAlA1TAINEI~ IN THE SAFE DEPOSIT BOX OF THE
OF ~w F~ ~~ ~vnc, w~NC~, ~ ~
~i~ z.~.a~az
ANN T. SHEPLEY
I, Ann T. Shepley, of Harrisburg, Dauphin County, Pennsylvania, being of
sound and disposing mind and memory, do make, publish and declare this to be my Last
Will and Testament, hereby revoking all Wills and Codicils by me at any time previously
made.
Provision for Taxes
ITEM I: I direct that all inheritance and estate taxes becoming due by
reason of my death, whether such taxes may be payable by my Estate or by any recipient
of any property, shall be paid by my Executor out of the property passing under this Will
that is not specifically devised or bequeathed, as an expense and cost of administration
of my Estate. My Executor shall have no duty or obligation to obtain reimbursement for
any such tax paid by my Executor even though on proceeds of insurance or other
property not passing under this Will.
Specific Bequests
ITEM II: I hereby make the following specific bequests:
(a) To my stepdaughter, Rosemarie Watkins, of Harrisburg,
Pennsylvania, the two cemetery plots at Blue Ridge Memorial
Gardens.
(b) To my sister, Josephine Cullen of St. Petersburg, Florida, my
diamond ring.
(c) To my niece, Kathleen McAnaney of Philadelphia, Pennsylvania, my
emerald cross pendant.
Page 1 of 7
(d) To my niece, Nancy P. Cullen of Southampton, Pennsylvania, my
ruby ring.
(e) I may have placed with this Will or otherwise made known to my
Executor a separate writing giving certain items of personal
property to certain individuals. It is my intention that such items
shall pass to such individuals to be distributed by my Executor in
accordance with such writing. In the absence of such writing, or to
the extent it is incomplete or ineffective, then all my property, real,
personal, and mixed not specifically bequeathed in this Item II shall
be distributed in accordance with Items III and IV herein.
ITEM III: I direct that all my household furniture and furnishings,
automobiles, books, pictures, jewelry, china, linen, silverware, wearing apparel and all
other like articles of household or personal use and adornment be sold and the proceeds
therefrom included with my residual estate and distributed pursuant to Item IV hereof.
ITEM IV: I give, devise and bequeath all of the rest, residue and remainder
of my property, real, personal and mixed, to the following individuals, per sfirpes, in the
following percentages:
(a) Forty-seven percent (47%) to my sister, Josephine Cullen of St.
Petersburg, Florida;
(b) Forty-seven percent (47%) to my friend, Joseph M. Punch of
Harrisburg, Pennsylvania; and
(c) Six percent (6%) to my stepdaughter, Rosemarie Watkins, of
Harrisburg, Pennsylvania.
Appointment of Fiduciaries
ITEM V: I nominate, constitute and appoint my friend, Joseph M. Punch of
Harrisburg, Pennsylvania, and my niece, Nancy P. Cullen of Southampton, Pennsylvania,
or the survivor of them, to be my Co-Executors (herein collectively referred to as
"Executor"). In the event of the death, resignation, refusal or inability of both Joseph M.
Page2of7
Punch and Nancy P. Cullen to serve as my Executor, I nominate, constitute and appoint
my niece, Kathleen McAnaney of Philadelphia, Pennsylvania, to serve as Executor in
their place. My Executor and Guardian are specifically relieved from the duty or obligation
of filing any bond or bonds.
ITEM VI: If at any time any minor child or legally incompetent person shall be
entitled to receive any assets hereunder, I hereby nominate, constitute and appoint my
Executor to act as Guardian of the assets payable to such person. Said Guardian may
receive and administer all assets authorized bylaw and shall have full authority to use
such assets, both principal and income, in any manner said Guardian shall deem
advisable for the best interest of such person, including, without limitation, college,
university, post-graduate or other education, without securing court order. Said Guardian
shall have all the rights and privileges as to the Guardianship and the assets thereof as
are herein granted to my Executor as to my Estate and the assets therein.
Powers of Fiduciaries
ITEM VII: In the settlement of my Estate, my Executor shall possess,
among others, the following powers to be executed for the best interest of my
beneficiaries:
(a) To sell either at public or private sale and upon such terms and
conditions as my Executor may deem advantageous to my Estate,
any or all real or personal estate or interest therein, whether owned
by me severally or in conjunction with other persons or acquired after
my death by my Executor, and to consummate said sale or sales by
sufficient deeds or other instruments to the purchaser or purchasers,
conveying a fee simple title, free and clear of all trust and without
obligation or liability of the purchaser or purchasers to see to the
application of the purchase money or to make inquiry into the validity
of said sale or sales; also, to make, execute, acknowledge and
Page 3 of 7
deliver any and all deeds, assignments, options or other writings that
may be necessary or desirable in carrying out any of the powers
conferred upon my Executor in this Item VII(a) or elsewhere in my
Will.
(b) To pay all costs, taxes, expenses and charges in connection with the
administration of my Estate. My Executor shall pay expenses of my
last illness and funeral expenses.
(c) To distribute my Estate in kind or in money. If any assets are
distributed in kind, they shall be distributed at their respective
value(s) on the date(s) of their distribution.
(d) To retain any investments I may have at my death so long as my
Executor may deem it advisable to my Estate so to do.
(e) To vary investments, when deemed desirable by my Executor and to
invest in such bonds, stocks, notes, money markets, real estate
mortgages or other securities or in such other property, real or
personal, as my Executor shall deem wise, without being restricted
to so-called "legal investments."
(f) To mortgage real estate and to make leases of real estate.
(g) To borrow money from any party to pay indebtedness of mine or of
my Estate, expenses of administration or inheritance, legacy, estate
and other taxes.
(h) To vote any shares of stock that form a part of the Estate and to h
otherwise exercise all the powers incident to the ownership of suc
stock.
(i) In the discretion of my Executor, to unite with other owners of similar
property in carrying out any plans for the reorganization of any
corporation or company whose securities form a part of the Estate.
(j) To distribute my personal property directly to the Guardian of the
person of any minor beneficiaries hereunder.
(k) To elect such settlement options as deemed most appropriate by my
Executor with respect to any pension, profit sharing or other
retirement plan in which I am a participant.
Page 4 of 7
(I) To do all other acts in the judgment of my Executor necessary or
desirable for the proper and advantageous management, investment
and distribution of my Estate.
Miscellaneous Provisions
ITEM VIII: I hereby exercise all powers of appointment that I may have at the
time of my death in favor of my residuary estate, and all property subject to all such
powers shall be included in my Estate.
ITEM IX: Any person who shall have died at the same time as me, or in a
common disaster with me, or who shall fail to survive me by ninety (90) days, shall be
deemed to have predeceased me.
IN WITNESS WHEREOF, I have set my hand and seal to this my Last Will
and Testament, consisting of this page, the next two pages, and the preceding four pages
is ~TY' da of ~~~Ir , 2005.
th _~_____ y
Ann T. Shepley
Page 5 of 7
SIGNED, SEALED, PUBLISHED AND DECLARED by the above named
Testat Ann T. Shepley, as and for her Will, in the presence of us, who, at her requeses
in her esence nd in the presence of each other, have hereunto subscribed our nam
as w nesse~r~ tte ation thereof.
Address ~y s aye s~
~c~,~-,. lfi~1~ P~ 171/
Q Address ~
~ /70/
~~ ~ ~~ Address ~d~ ~S~ Un '~l~V~
~~~hJp~~-t ~~- l
ACKNOWLEDGMENT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF DAUPHIN
I, Ann T. Shepley, the Testator whose name is signed to the attached or
foregoing instrument, having been duly qualified according to law, do hereby that I si ned
acknowledge that I signed and executed the instrument as my Last Will, and g
it willingly and as my free and voluntary act for the purposes therein expressed.
Sw rn to or affirmed nd acknowledged before me by Ann T. Shepley, the
Testator, this ay of , 2005.
COMMONWEALTH OF PENNSYLVANIA Ann T. Shepley, Testator
Notarial Seal
)tiarva Owings Baughman, Notary Public
City of Hamsburg, Dauphin County /~
My Commission Expires July 12, 2008
Member, Pennsylvania Association of Notaries Notary P u b l i c
My Commission Expires: ?~~~~'
Page 6 of 7
AFFIDAVIT
COMMONWEALTH OF PENNSYLVANIA
SS.
COUNTY OF DAUPHIN
~ ~~~
we, S h~ ~ '~ ~ ~~n~.ce ~ ,
and ,the witnesses whose names are signed to the
attached or regoing 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 hert
Last Will; that the Testator signed willingly and executed it as her free and volunta ndac
for the purposes therein expressed; that each subscribing witness, in the hearing a
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. .
Sworn to or affirmed and
X1.1 0 Ch ,and ~~
~ , 2005.
COMMONWEALTH OF p~~gyY,VANIA
Notarial Scal
Harva Owings Baughman, Notary Public
City of Hamsburg, Dauphin County
My Commission Expires July 12, 2008
Member, Pennsylvania Association of Notaries
F:\dbw\WiIIslShepley\Ann - Will.doc
ascribed to before me by ~ ~~~~~~~,
P~ (~W 7i, witnesses, this j~. day of
S
fitness
.~
Witness v
Notary Public
My Commission Expires: ~~z~?.e~
Page 7 of 7
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M$T
499 Mitchell Road, Millsboro, DE 19966 Adjustment Services
Phone 888-502-4349
F ax (302) 934-2955
March 23, 2011
Wix, Wenger and Weidner
Attn: Denise Williamson
508 N 2~ Street
POBox845
Harrisburg, PA 17108
Re: Estate of Ann Shepley
Social Security 180-26-5402
Date of Death• January 1.2, 2011
Dear Sir or Madam:
in u' on March 14, 2011, please be advised that at the time of death, the above-named decedent ha
Per your q lry
on deposit with this bank the following:
1, Type of Account Checking Account
Account Number 77746961
Ownership (Names o, f) Ann Shepley
Opening Date 08/28/64
Balance on Date of Death $193,132.09
Accrued Interest $ 'S~
Total ................
$193,132.66
2. Type of Account Individual Retirement Account
Account Number 35004200926987
Ownership (Names o, fl Ann Shepley
James Shepley (Beneficiary)
Opening Date 10/05/06
Balance on Date of Death $9,449.53
Accrued bZterest $ 1.43
Total $9,450.96
For any additional information on the above accounts, including ownership and any changes, closures and/or reimbursement of funds,
please call the Union Deposit Office at #717-230-3541
We were unable to locate any safe deposit box for the above-mentioned decedent.
This letter does not include any accounts in which the deceased may have been hsted ~ Power of Attorney, Custodian of Uniform '1Yansfers,
Representative Payee, or Trustee under a Written Agreement
Sincerely,
1 ~ '~/
Tammy Spencer
Adjustment Services
LISTENING IS JUST THE BEGINNING.SM
January 31, 2011
Wix, Wenger & Weidner
A Professional Corporation
Attorneys at Law
508 North Second Street
p.0. Box 845
Harrisburg, PA 17108
Dear Ms. Williamson,
RE: Ann Shepley, deceased January 12, 2011
e to our recent inquiry concerning the accounts maintained in the name of
In respons y
dent lease be advised that the following account was open at the date of deat .
the dece , p
DATE OF DEATH ACC ROLL OVER MATURITY
CD# BALANCE INT RATE OPEN 1/21/11
033-0107010 $19,513.92 $17.53 1.49% 10/21/99 10/21/09
* Ann Shepley In Trust For Joseph M. Punch
u have an other questions, please feel free to contact me at (717) 291-2436.
If yo y
Sincerely,
Joshua A. Groff
Credit Confirmation Processor
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Fulton Bank, N.A. Member FDIC. Member of the Fulton Financial Family.
~~
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est. 7969
Ms. Ann Shepley
1050 Jeffrey Drive
Southampton PA 18966
215 806-1700
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~~~~ith~~mE~t~»,, Pilr~~j l~ <~ni~: 1 h966
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Registration No: ~ O~US3
`._.__-_.__.____.___._..__.__~ pESCRIPTION OF ARTKLE
LADIES DIAMOND ENGAGEMENT RING
one 14kt. Yel4ow Gold `Tiffany `Style Mounting; White Gdd Six Prong Crown Set Wth one Diamond- ,
Knife Edge Shank.
Shank Width:1.96mmTapers To 152mm, Depth:1,84mm Tapers To 1.18mm.
Size - 65 '
STYLE NO.- N/A
HALLMARK - 14KP '
GOLD WEIGHT- 1.19 DWT..
DIAMOND:
Cut- Round Brilliant
'~
i
Carat Weight - 0.47Ct. s.o2 - 5.10 x 3.00 approx. m m
I
` G!A Clarity- S!-2
raded In Mounting, Sarin Colibri)
GtA Color- H (g
te5: Polish: Good, Symmetry: Good, Culet: None, Girdle: Two Naturals On Medium To `'
No
Slightly Thick Polished Fluorescence: Medium. Grade Setting Indusions: Three Pm
points In Star Facet Five Dark Induded Crystal And Pin Pant Claud In Centerr Of
~! a{ M In Ad'acent Bete) Facet To linear Feather V'~sibte Thru ?
Table. Dark Inducted Cryst 1
Two tipper Girdle Facets Located In Two Lower Grdle Facets.
ESTIMATED
REPLACEMENT COST ._~_
$385.00
Pltiato Supplied
II
Gold Mtarlcet: 51355.00 Troy Ourxe /Source: New York Comex
~ F planes yye~ht gpproximated By G. i. A. Forrrtuta _ _ _._ . _._ . _ __. ___ _ ___--- -_ __---.__._ __
___ .
~~~
aanuary 20, 2011
;, ~v~ ~~ -
-_..___-____.___-___.___.____ __----------=---.__-----------.----- - Date
MARC E ALTMAN
~ Graduate Gemologist. GiA
~I 11~Ierrz~Pr- Jet.E~el~rs tiligilc~r7ce Committee, Jewelers of Arneri~a, Penrisylucznia ~eivelers Associc~tior~i
I. nflcl Gentolog~etrl Institz.tte of Arnerlc~ ~4ltcmni Assr~ciatior2
.~
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,:::
"I~t~:~~~~~'ttc~err~t J~~tr:~~i~ ;r.~1l~~1~•rri. .
~~.' . ~r r: ~~~t Road'-
_`~c~~~th,~,n(~s~~~~, ~ ~ ~~,,~~.~....i~~~ 18966
!~,~_. ~:_1=~) ~'.~'-8133
;,,,~.~;'i ~ :~?.-2633
~_' i ~) .,,Y'~-0100
-.emolo~iSt~~,1
est. 1969
-~
~:~
~~
r
Ms Ann Shepley
~; 1050 Jeffrey Drive
Southampton PA 189b6
z~ s sob- goo
Fstat~e ~V~aation.
Registration No: ~ 03454
_-~'_ -- ESTIMATED
QESCRIPTION OF ARTICLE ~ REPLACEMENT CUST
LADIES_RUBY RING & EMERALD CROSS PENDANT
2.26dwt. X $28.OOIdwt. _ $64.00
Emerald:
1.10mm Square Cut, x.30 X Z90mm, Clarity Type 3: t, Color. Medium Green.« $0 Value
Ruby Ring:
14kt. Yellow Gold Casted Mounting; Four Prong Set With One Ruby.
Gold Weight 1.09dwt X $28.00ldwt= $30.00
t
Ruby:
5.90mm X 4.10mm Oval Cut, Clarity Type 2: I Cola': Pinkish Red--. $0 value
Emerald Cross Pendarrt: 4
14kt. Yellow Gold Cross Mourning, Four Prong Set With One Emerald• Chain is A 14kt.
Yellow Gold Square Box Link With Spring Ring Clasp.l8 Inches. .
Pfxxa 5upptie+d
tyaid Matrlae~ $t 355A0 Troy Ou~oe ! Scw~+ce: New Yorfc Carrex
_____ January 20, 2011
MARC E. ALTMAN Date
Graduate C,ernologist, GIA
1~1e~n~er JE~ivelers Vigilcc~zce Committee, Jewelers of America, Pennsylvania Jewelers Association
i arlcl Gefnological Institute of Arrzeraca Alccrnrti Association
~'
~~ ,
~:
S~
6144356786 Nationwide Bank Nationwide Bank
ationwide Bank
N
.. .- Qn Your Side®
January 26, 2011
01:58:09 p.m. 01-26-2011
Wix, Wenger & Weidner
A Professional Corpora#ion
Attorneys At Law
508 North Second Street
PO Box 845
Harrisburg, PA. 17108
Re: Estate of Ann T Shepley
Dear Denise Williamson,
This letter is in regards to information on Ann's account. We respectfully submit
the following:
ACCOUNT DATE OWNERSHIP BALANCE
Savings 01 /12/2011 Single w/ Nancy Cullen, POA $11,148.44
Shirle Kubota-POD beneficiary
#100000602479 y
Josephine Cullen~POD beneficiary
( DOD balance includes accrued interest of $1.83)
If you have any questions, please contact me at 614-435-6788.
Sincerely,
~~~~
Tara Leonard
Nationwide Bank
2 /2