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Home My WebLink About09-29-11C 15056051058 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN Harrisburg, PA m2a-osol -~ RESIDENT DECEDENT 21 11 0698 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 188-20-6023 ' 12/29/2010 09/14/1925 Decedent's Last Name Suffix Decedent's First Name MI SHEERER DORIS H '' (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI Spouse's Social Security Number FILL IN APPROPRIATE OVALS BELOW t~~ 1. Original Return THIS RETURN MUST BE FILED IN DUPLICATE WITH THE REGISTER OF WILLS 2. Supplemental Return <:„"~: 4. Limited Estate s .: 4a. Future Interest Compromise (date of death after 12-12-82) ~~r 6. Decedent Died Testate 7. Decedent Maintained a Living Trust (Attach Copy of Will) (Attach Copy of Trust) 'rte, 9. Litigation Proceeds Received ... 10. Spousal Poverty Credit (date of death between 12-31-91 and 1-1-95) 3. Remainder Return (date of death prior to 12-13-82) 5. Federal Estate Taa Return Required ~ 8. Total Number of ;>afe Deposit Boxes _._.. 11. Election to tax under Sec. 9113(A) (Attach Sch. O) ~~rcKtsruNOENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name Daytime Telephone Nurnber ANDREW J. BENDER, ESQ. (717) 249-1177 Firm Name (If Applicable) ___ _ ~ REGISTERt~E~N.,LS USE ONLY -7-, ~ ALLIED ATTORNEYS _ ,, , -,: ~ _:. ~,-, First line of address l _ 1 ;, ;, 61 WEST LOUTHER STREET '? -- ; _..., Second line of address : , ::. , a _{ _ , City or Post Office DATE Flt-ED ~; -, State ZIP Code r--___.. CARLISLE PA 17013 Correspondent's a-mail address: ajbender.law@gmail.com Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. SIGN/~TUR•E OF PE O ESPON BLE FOR FILING RETURN DATE ADDRESS ~~ >? ~' - f ~ _ 283 SK INE VI ,CARLISLE, PA 17013 clr~I I1T1 IOC -•~•°~•~YC-'s~~^yfr/• ryl~n inArv tttF'KESENTATIVE DATE. ~ - ADDRESS y I ~.r6 rr ,/- -- 61 WEST LOUTHER STREET, CARLISLE, PA 17013 PLEASE USE ORIGINAL FORM ONLY 1 505605 1 058 Side 1 L 150560510:58 J 15056052059 REV-1500 EX Decedent's Social ;security Number ____ Decedent's Name: DORIS H SHEERER ____. __. _ 188-20-6023 _, ~_._ _._ _.~ ~.~~ F„~ _ u _._.. . __. _~_ APITULATION _, .na_ 1. Real estate (Schedule A) ............................................ . 1. 0.00 2. Stocks and Bonds (Schedule B) ...................................... . 2. 7,293.32 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... . 3. 0.00 4. Mortgages 8 Notes Receivable (Schedule D) ............................ . 4. 0.00 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ....... . 5. 10,117.76 6. Jointly Owned Property (Schedule F) ~ ~'~` Separate Billing Requested ...... . 6. 12,161.08 7. Inter-Vivos Transfers 8 Miscellaneous Non-Probate Property Schedule G ~-~~ ( ) _. ,_~ Separate Billing Requested........ 7. 0.00 8. Total Gross Assets (total Lines 1-7) .................................... 8. 29,572.16 9. Funeral Expenses & Administrative Costs (Schedule H) ..................... 9. 12,576.12 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 663.00 11. Total Deductions (total Lines 9 & 10) ................................... 11. 13,239.12 12. Net Value of Estate (Line 8 minus Line 11) .............................. 12. 16,333.04 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) ........................ 13. 0.00 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ ~ ~ 14. 16,333.04 TAX COMPUTATION -SEE INSTRUCTIONS FO ~~~ ~~ ~~ ~ ~~~ R APPLICABLE RATES ~~~ ~~~~~~ ~~~~ ~ ~ ~ ~~ ~~~~~~~~ ~~~~~~~-~~'-~ 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0 00 0.00 15. 0.00 16. Amount of Line 14 taxable at lineal rate x .0 45 16,333.04 is. 734.99 17. Amount of Line l4 taxable - at sibling rate X .12 0.00 17 0.00 18. Amount of Line 14 taxable -- at collateral rate X .15 0.00 18 0.00 19. TAX DUE ......................................................... 19. 734.99 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT «®4 15056052059 Side 2 15056052059 REV-1500 EX Page 3 Decedent's Complete Address: File Number _._ '; 21 11 ` .0698 DORIS H SHEERER DECEDENT'S SOCIAL SECURITY NUMBER 188-20-6023 STREET ADDRESS -- 283 SKYLINE VIEW CITY CARLISLE Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) 2. Credits/Payments A. Spousal Poverty Credit 0.00 B. Prior Payments 0.00 C. Discount 0.00 3. InteresUPenalty if applicable D. Interest 0.00 E. Penalty 0.00 STATE PA (1) Total Credits (A + B + C) (2) Total Interest/Penalty (D + E ) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Fill in oval on Page 2, Line 20 to request a refund. 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (3) (4) (5) (5A) (56) ZIP 17013 734.99 0.00 - 0.00 0.00 734.99 0.00 734.99 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? ....................................................................................................... ................. ^ 0 IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN For dates 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 three (3) percent [72 P.S. §9116 (a) (1.1) (i)]. For dates of death on or after January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is zero (0) percent [72 P.S. §9116 (a) (1.1) (ii)J. The statute does not ex .mnt a transfer to a surviving spouse from tax, and the statutory requirements 1'or 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 zero (0) percent p2 P.S. §9116(a)(1.2)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's lineal beneficiaries is four and one-half (4.5) percent, except as noted 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 twelve (12) percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. REV-1503 EX+ (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF DORIS H. SHEERER FILE NUMBER 21-'I 1-0698 All property jointly-owned with riah- of ~~~.~,~„~.~ti~....,.•~. s.., a:.._i--_~ __ .._~ . . - -----~ ..,....•. ,.,.,.~,~.,~ ~a~ anocw vi uie same size) REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY t~ iAi t ur FILE NUMBER DORIS H. SHEERER 21-11-0698 Include the proceeds of litigation and the date the proceeds were received by the estate. All property Jointly-owned with right of survivorship must ha disrlneaA ~~ Crhnrliiln c ..._. _ _ ........ ... ........ ~~~~ ~ a~~~~~~~~d~ snaeis or ine same s¢e) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ~~ihi~ yr FILE NIJMBER DORIS H. SHEERER 21-11-•0698 If an asset was made Joint within one year of the decedent's date of death, it must be reported on Schedule Ci. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A• CINDY L. JONES 283 SKYLINE VIEW DAUGIHTER CARLISLE, PA 17013 B' STEVEN J. SHEERER 36034 ROUTE 35 N SON THOMPSONTOWN, PA 17086 C. JOINTLY-OWNED PROPERTY: LETTER DATE ITEM NUMBER t FOR JOIN TENANT A~ 3 T MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET ~ OF DECD'S IN7ERGST DATE OF DEATH VALUE OF DECEDENT'S INTEREST . t 03/02/09 MEMBERS 1ST FCU SAVINGS ACCOUNT #347959-00 16,322.67 33% 5,440.89 2• A/B 03!02!09 MEMBERS 1ST FCU CHECKING ACCOUNT #347959-11 0.00 33% 0.00 3• A/B 06/16/10 MEMBERS 1ST FCU CD #347959-40 (SEE ATTACHMENT) 20,160.58 33% 6,720.19 TOTAL (Also enter on line 6 Recapitulation) I $ 12,161.08 (If more space Is needed, Insert additional sheets 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 DORIS H. SHEERER 21-11-0698 Decedent's debts must be reported on Schedule I. ITEM - NUMBER DESCRIPTION AMOUNT A• FUNERAL EXPENSES: I' GUSS FUNERAL HOME 2. FUNERAL MEAL (DONALD FREY) 3. TOMBSTONE ENGRAVING (BRENT ROBINSON) B. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) CINDY L_JONES, EXECUTRIX street Address 283 SKYLINE VIEW _ City _CARLISLE -_--------- _-- --- -- State PA zIP 17013 Year(s) Commission Paid: 2011 2. 3. 4. 5. 6. ~. B. Attorney Fees: Family Exemption: (If decedent's address is not the same as claimant's, attach explanation Claimant Street Address _ ____ ___ City _-_____..._- State Relationship of Claimant to Decedent ZIP Probate Fees: Accountant Fees: Tax Return Preparer Fees: THE PATRIOT NEWS (ADVERTISING FEE) CUMBERLAND COUNTY LAW JOURNAL (ADVERTISING FEE) 10,448.77 111.70 95.00 0.00 1,500.00 101.50 22.00 222.15 75.00 TOTAL (Also enter on Line 9, Recapitulation) I $ 12,576.12 If more space is needed, use additional sheets of paper of the same size. REV-1512 EX+ (12-08) Pennsylvania ~1, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE of FILE NUMBER DORIS H. SHEERER 21-11-0698 Report debts incurred by the decedent prior to death that remained unpaid at the date of death. inr~iidine ~~„~o~mti~~.~va ...ea:,.~~ s.,..,._...._ _~ ~~~~~_ ~Na~c a iieeueu, insert aaDiDOnai sheets of the same size. REV-1513 EX+ (01-10j Pennsylvania DEPARTMENT OF REVENUE INHERRANCE TAX RETURN RESIDENT DECEDENT SCHEDULE ~ BENEFICIARIES CJIAIE G DORIS NUMBER I 1, 2. 3. 4. 5. 6. F: H. SHEERER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] Cindy L. Jones, 283 Skyline View, Carlisle, PA 17013 Steven J. Sheerer, 36034 Route 35 N, Thompsontown, PA 17086 Christopher D. Jones, 7818 State Route 374, Clifford Twp., PA 18470 Amy S. Himelright, 5847 Simsbury Drive, Harrisburg, PA 17111 Zachary N. Sheerer, 365 High Street, Hanover, PA 17331 Heather M. Sheerer-Leach, P.O. Box 82, Thompsontown, PA 17086 FILE NUMBER: 21-11-0698 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) nF FcreTF Daughter Son Grandson Granddaughter Grandson Granddaughter ~ ~N o~ QorY,~S X14 0~ 80vwIS Il4 oG Q~wls ~~W o ~' Qo.,~ts ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS: 1. TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ If more space is needed, use additional sheets of paper of the same size. Calculate the Vah.le n''~'"~_1r Paper Savings Bonds; l~ . a~ i ~"~ '' ~: ~aieaai~•~ t~~~ ~t~:~e ~f l'r~a~r Paper Savi»~s 8ond{s) .- .. - ~ Instructions Value as of: Series: Deno minaiion: Bond Serial Number: Issue Date: EE Bonds ~ 1pp - Nates Cescri~YiaD NI Net Issued ----- ~ NE Not eligible for payment --- -i~,"~' C4 ="]~_ __ ~ PS Includes 3 month _ _ _ ~ Interest penalty MA Matured anA oo[ earning Oatcuia#or Results for Redernp#ion Da#e 01/2011 interest ^, ; - 41 550.00 $7 293 32 `'g5 743.32 .__ : - ~~~ ~._: $20.32 13cnds: 1-31 a` 31 ' ci3937436 c86964313 c86956's59 c82775042 c81895961 c791755o'G 09167233 s cfi7851915 - c730 18398 c65961233 + [60464,'17 c59068369 - c58458085 s c56393 E75 + c43790405 c43780474 " c42627092 c32575375 c325659T7 ~ c32859214 + c32652262 - c3zs429n c27886550 ~ c27864043 ] c2788025fi c27871483 = c27856963 c216435;6 c21636081 c21628554 ~ c9898722 _._ -~--~~- ~_ EE EE EE r EE t EE EE EE =_E EE EE EE c_ EE EE EE FE EE EE EE EE EE EE EE EE EE EE EE E= EE EE -_.- ;100 5100 5100 5100 R00 5190 ;100 SIUO 5100 510G 5100 5100 5100 5100 s1G0 5100 5'_00 ;100 ,iCU 5100 5100 51GG 5_.00 5100 57.00 ;100 ;100 5100 5100 51 CG 5100 0711984 U4/1985 03/1985 01,/1985 11/1984 1ij 1984 1011984 04/1984 05/1984 02;1984 01,/1984 11/1987 10/1983 GSi 1983 77'1983 05,1983 04/1983 02/1983 12;1982 L1/1982 10/1982 Ge/198z 06/1982 02j 1982 0111982 03/1982 12/1981 11/1981 0911981 08/1981 01/1981 07/2011 04;2011 03/2011 07,2011 05/2011 05/2011 04/2011 G4/2011 05/2011 02,2011 0?;2011 05(2011 D4/2011 02/2011 07/2011 OSi 2011 04/2011 02/2011 0612011 05/2011 04/2011 oz/2011 0612011 02,2011 OSi 20ll 03/2011 06/2011 05,2011 03/2012 02/2011 07/2014 04/2015 03/2015 01!2015 11/2014 11/2014 10/2014 04/2014 OS/2G14 02/2014 O1j2034 11/2013 10/20 L3 OBi 2013 07j 2013 05/2013 04j2013 02/Z013 12/2012 11/2012 10/2012 98/zmz 06/2012 02;2012 05!2012 03/2012 12;2011 11/2011 09;2011 08/2011 G1i 2011 ' 850.00 850.00 550.00 550.00 850.00 850,00 850.00 550.00 850.00 550.00 550.00 550.OG 850.00 550 AO 550.00 550.00 450.00 850.00 '>SG.00 550.00 850.00 ssG.oo 550.00 550.00 450.00 850,00 450.00 850.00 $50.00 850.00 850.00 8180.90 5143.00 5143.00 5146.84 5146.84 8146.84 5146.84 515G.b0 5150.80 4i 50.80 8154.80 8154.80 5156.40 5156.4G 5158.88 3158.88 5168.20 8203.92 5209.00 g209A0 5221.40 4zz1-4G 5226.84 8226.84 8226.84 8226.84 8232.36 5232.36 5232.36 4232.36 4256.88 4.00 % 4.OC%, 4.00°/, 4.00°~, 4.00 % 4.00 :~, 4.00°', 4.0040 4.00°.', 4.G0?b 4.00°io 4.001 4.CU'/° 4.G04~, 4.00%, 4.OU',', 2.10 % 4.00 % 4.00?.; 4.004% 4.OU4~~ 4.00% 1.00 % 4.004, 4AU'6 4.00°i, 4.OG 4.00°~0 4.0046 n,,Gpo~ 5200.80 - 5193.00 - $193.00 - 5196,84 ;196.84 5796.84 5196.84 5200.80 - 5200.80 ~~ 5200.80 5204.80 5204.80 5206.40 ' 5206.40 5208.88 5208.88 5218.20 5253.92 5259.00 5259.00 - ' 5271.40 ~ szn.aD 5276.84 5276.84 5276.84 5276.84 5792.36 5282.36 5282.36 4282.36 5306.88 i.. ~.,. Survey How would you rate this tool? Excellent Goed Falr Poor Page 1 of ] httn~//www treasurvdirect_env/RC/SRCPrice - 1 /2/201 l ATTACHMENT TO SCHEDULE F-JOINTLY-OWNED PROPERTY Members 15` FCU CD #347959-40 is an asset which was jointly owned by the decent with heir daughter, Cindy L. Jones, and her son, Steven J. Sheerer. This asset was established within one (1) year of the decedent's death on June 16, 2010. However, it was established via a transfer of funds from another jointly owned asset, Members 1St FCU Savings Account #347959-00. (See letter from Memk~ers 15t FCU dated September 9, 2011 attached hereto.) Since the funds which established this CD were jaintly owned the establishment of this CD is a rollover of one joint asset to another joint asset rather than a transfer within one (1) year of death and is accordingly included on Schedule F rather than'>chedule G. LAST WILL I, DORIS H. SHEERER a/k/a DORIS H. SHEARER, of the Borough of T'hompsontown, County of Juniata and Commonwealth of Pennsylvania, declare this to be my Last VViYI and revoke any Will previously made by me. ITEM I: I direct that all my just debts, funeral expenses, gravemarker and t:he costs of the administration of my Estate be paid from the assets of my Estate as soon as practical after my deatr.. ITEM II: I direct that all taxes that may be assessed in consequence oil my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from the assets of my Estate as apart of the administration thereof, to the end that no beneficiary hereunder, or any other person, shall be charged with or required to pay any part of such taxes. ITEM III: I devise and bequeath the residue of my Estate of every nature and wherever situate, including any property over which I may now have or hereafter acquirf;, a power of appointment to my husband, JOHN W. SHEERER a/k/a JOHN W. SHEARER, provided he shall survive me by ninety days. Should my husband, JOHN W. SHEERER a/k/a JOHN W. SHEARER, predecease me or die on or before the ninetieth day following my death: a. I bequeath such of my tangible personal property as is set forth in a separate signed memorandum, which I shall place with my Will, to the persons therein designated. b. I devise and bequeath the residue of my Estate of every nature and wherever situate, including any property over which I may now have or hereafter Oc.~ " ~ _ ~ ' ~;, ~ ~ a acquire, a power of appointment to my children, STEVEN J, SHEERER and ~ ~ --. --.~- ~ - .~ p~~' CINDY S. JONES, in equal share, provided that the share of either of m ~.:~. ~ ~:1 ~ ~,_ , _ J Q `t _Cn Z ~ w ¢ ~ y children who predecease me or die on or before the ninetieth day following my C~ • I I --, o ~ death shall be distributed to his or her issue, per stirpes, living on the ninety- •:~ U r~.J Page 1 of 2 first day following my death. ITEM IV: I authorize and empower my hereinafter named Executor or alternative co- Executors to convert any property, not specifically bequeathed and devised above, that I may own at my death, whether real, personal or mixed, at either private or public sale, whichever in his/their opinion is deemed best, thereby vesting in said Executor or alternative co-Executors full power and authority to make, execute, acknowledge and deliver good and sufficient deeds or assurances of title therefore. ITEM VII: I appoint my husband, JOHN W. SHEERER a/k/a JOHN R'. SHEARER, Executor of this my Last Will. Should my husband, JOHN W. SHEERER a/lc/a JOHN W. SHEARER, fail to qualify or cease to act as Executor, I appoint STEVEN J. SHEERER and CINDY S. JONES, alternative co-Executors of this my Last Will. IN WITNESS WHEREOF, I have hereunto set my hand this _r z- ~ day of G-~, , 2000. Doris H. Sheerer a/k/a Doris H. Shearer The preceding instrument consisting of these two pages, identified by the signature of the Testatrix, the date thereof signed, published and declared by DORIS H. SHEERER a/k/a DORIS H. SHEARER, the Testatrix herein named, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the presence of each other, have subscribed our names as witnesses hereto. ~ r ,% ~~ , Page 2 of 2 c~ p ~ ~~ ,~; D ~ -;1 ,... ~ L r-1 --~ MEIIIORAIVDUlYI ~~~`~ ~ _- ~:'~ R~ -_ .f G _--,-- DISPOSITION OF TANGIBLE PERSONAL PROPERTY ;_~~-" -_ ~ - ~/ U ~~~ ~-f- ~T i'h Q rii. ~= o~ ~CO S c'~~ .J ~ ~j C[ I"' C~ ~ S TCC ~/rC~.s"`~ / C~t-~4.~~ ,who rn ~. ~ ~. ~ ~ ~° I l7'~ /1'1 C~ Q 2_ ~ ~h -~ ~( S l1L . ~ a,,,~~ ~ ~ ,; t.~crh d~S min ~71v ~ a-n ~s ~? '~ ~ c~ .5 h ~-Q r'P ~--~, ~ . /Y~~ ~~ -- e~c C~o~LJ ~n~C/~>~~1 ~- ~ar l}~ `J C~ ~5~~ ,~ ~0 n - ~ j ~ 1 ~ 2~~ ~GC.t S ~/ ~-r..aL Gf h -~' ><`~t~? ~r- ~~ ~~j -ems ~ ,-~c'~. cL ~ -e ~ . GtrYt- G~ J'~//J ~itJ ~ ~'/~j `77j' /^ ~ - /~l f'.' K/1 D 7~,5 ~. ,~[C.~/'cfJ D /yj ~' Q, S ~C~--~ ~ /1 .S ~~1~5 ~C~t-i ~,-~ q~~ ~ ~Le,~- Dori/s''H. Sheerer a/k/a Doris H. Shearer re ~ ld coo SAS ~ ~ e~ ~ ` ~~~~ ~ ~~~t ~ ~ ,~ ~ l ~- GZ. ~ ~~ ,Ors ~~ ~~Q S ~- ~ e --~ ~i' ~ ~ ~~, c~/~ / ~ ~ t/iS ~ f .~/ C/~'r~' c~ ,OLD ~ ~'1 ~ CC-C, c~ ~~C,~'CL S ~ C~ ~2~ ~c~~S ~~ Qil'~z. ~ 7y1 ~~~ cc I ~ lie . St MEMBERS 1St FEDERAL CREDIT tiNION REGULAR SAVINGS ACCOUNT• Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Joint Ownership Established CHECKING ACCOUNT• Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established Name of Joint Owner Date Joint Ownership Established CERTIFICATES OF DEPOSIT• Account Number/Suffix Date Account Established Principal Balance at Date of Death Accrued Interest to Date of Death Total Principal and Accrued Interest Name of Joint Owner Date Joint Ownership Established *Opened by transfer of funds from 347959-00. Estate of: DORIS H. SHEERER Date of Death: 12/29/2010 Social Security Number: 188-20-6023 347959-00 01 /30/2009 $16,317.60 $5.07 $16, 322.67 Cindy L. Jones 01 /30/2009 Steven J. Sheerer 03/02/2009 347959-11 01/30/2009 $.00 $.00 $.00 Cindy L. Jones 01 /30/2009 Steven J. Sheerer 03/02/2009 347959-40 06/16/2010 $20,137.56 $23.02 $20,160.58 Cindy L. Jones Steven J. Sheerer 06/16/2010 ' M ERS 1sT FEDERAL CREDIT N ~ -1~~~ Danielle A. Kline ` ~`~° Lending Insurance Support Specialist September 9, 2011 5000 Louise Drive P.O. Box 40 Mechanicsburg, Pennsylvania 17055 (800) 283-2328 ww~~:Inemberslst.org Guss Funeral Home 20 South Third Street Mifflintown, PA 17059 Karl E. Guss, Funeral Director Barbara Guss Partner, Funeral Director (717) 436-2149 Funeral Expenses for Doris H. Sheerer Date of death: December 29, 2010 Professional Services, Use of Facilities, and Equipment $4,255.00 Solid Oak SH Casket 3,670.00 Monticello Wilbert Vault 1,355.00 Cash Advance Items: Family Flowers 212.00 Lewistown Sentinel Obituary 138.40 Harrisburg Patriot Obituary 197 37 6 Certified Death Certificates 36.00 Gratuity for Pastor Mike Sigler 75.00 Gratuity for Cindy Kerstetter, Organist 75.00 Hairdresser (Diane Marshall) 25.00 Cemetery Charges: Grave opening and cemetery fee 525.00 Total Funeral Expenses $10,563.77 Less Juniata County Veterans' Widow death benefit - 75.00 Amount due Guss Funeral Home $10,488.77 1/6/2011 FNB of PA Burial Reserve -10.117.76 1/7/2011 amount due Guss Funeral Home $ 371.01 ` ~\ a~ (~ ~~ ~, This statement is net and payable in full on or before February 4, 2011. A late charges of 1.50% per month (18.00% annum) will be added to the unpaid balance. The friendship and good will you have accorded us is worthy of our most: heartfelt thanks. We appreciate the confidence you have placed in us and will continue to assist you in every way we can. We sincerely hope that our service has been in every way satisfactory and comforting to you. Most Respectfully, Barbara Guss Partner uH ~ t UtJGKit'l IUN KA ~ t Units GHARGtS GktUl f S BALANCE 12/27/2010 12/31/2010 Balance Forward PAYMENT RECEIVED - THA1~1K YOli! PVT -LEVEL 1 -CARLISLE 52.00 2 104.00 364.00 364.00 0.00 104.00 ~ ~ ~' i RESIDENT # 571191 CURREfJT 104.00 OVER 30 0.00 OVER o0 0.00 OVER 90 0.00 OVER 120 0.00 TOTAL AMOUPYt-T t1ttE ~` $104.00 ,.~~,~~~~ ~ ~~~~~~~ :vii. li~,tu~ ariir;~:tcr;K 1 °/~ finance charge mad be assessed if balance is not paid by the due date. "Thank You! Form PB-01 Please contact the Business Office directl~~ at 717-790-8220 if ~~ou have questions or concerns about your statement. STATEMENT This is a statement for professional services rendered by your physician. You may receive a separate bill from the hospital for its services. Doris H Sheerer ~~ • • • .. ~ 01/03/2011 12708 ~ ~ { Ou Doris H Sheerer 283 Skyline View Carlisle PA 17013 12/17/2010 12/17/2010 12/17/2010 12/30/2010 12/30/2010 Claim:21492, Provider: Mohammad Ismail, MD Facility: Carlisle Hospital 99232 SUBSEQUENT HOSPITAL CARE Aetna Life Insurance Company Payment Aetna Life Insurance Company Adjustment Your Balance Due On These Services ... 88.00 53.00 24.01 ~ ~ ~ ~ ~ • • PAY THIS 01/03/2011 Doris H Sheerer 12708 AMOUNT 11.00 MAKE CHECK Mohammad Ismail PAYABLE TO: We are pleased to offer you the option of check payment.