HomeMy WebLinkAbout10-12-11JAN L. BROWN & ASSOCIATE~~
ATTORNEYS AND COUNSELORS AT LAVV
JAN L. BROWN, ESQUIRE BRENDA F. KEPHART, LEGAL ASSISTANT
JACQUELINE A. KELLY. ESQUIRE JUDITH A. EBERSOLE, ADMINISTRATIVE ASSISTANT
CHRISTA M. APLIN, E'.SQUIRE
October 6, 2011
Register of Wills `~n .~.
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Cumberland County Courthouse _~
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One Courthouse Square _
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Carlisle, PA 17013 r
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Re: Lois L. Sheaffer, deceased i l
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Gentlemen or Ladies: ~ ~~': ~,,
Enclosed please find the following items for filing with the Register of Wills:
1. An original and two copies of the Inheritance Tax Return.
2. Check payable to Register of Wills, Agent in the amount of $5,8:10.89 representing the
inheritance tax liability shown to be due.
3. Check payable to Register of Wills in the amount of $15 representing the filing fee.
Please time stamp and return our file copy of the Inheritance Tai: Return. Please note this
is being made within the 3 months for the discount. Also, please provide us with the appropriate
receipts.
If you have any questions, feel free to contact this office.
Sincerel
~~ ~ ~ I :~
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hnsta . Aplin
Enclosures
cc: David A. Sheaffer
Olde English Gap 845 Sir Thomas Court Suite 12 Harrisbl,trg, PA 17109
Telephone (717) 541-5550 Fax (717) 541-9223 Email: jlbassoc@verizon.net ~vww.janbrownlaw.com
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-Ofi01
RECEIVED FROM:
PENNSYLVANIA
INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT
N0. CD 015052
JAN L. BROWN & ASSOCIATES
845 SIR THOMAS CT, SUITE 12
HARRISBURG PA, 17109
fold
ESTATE INFORMATION: ssrv: ooo-oo-oooo
FILE NUMBER: - ~~ _~ ~ _ ~~~
DECEDENT NAME: SHEAFFER LOTS L
DATE OF PAYMENT: 10/12/201 1
POSTMARK DATE: 10/12/201 1
COUNTY: CUMBERLAND
DATE OF DEATH: 07/26/201 1
REMARKS: RECEIPT TO ATTY
CHECK#146
SEAL
ACN
ASSESSMENT- AMOUNT
CONTROL
NUMBER
101 ~ 55,830.89
TOTAL AMOUNT PAID:
INITIALS: HEA
REV-1162 EX(11-96)
55,830.89
RECEIVED BY: GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
1505610140 Q rr
REV-1500 ~ t01 t~l OFFICIAL USE ONLY (/1I! 1~ ~ P0~8~
PA Department of Revenue -
Bureau of Individual Taxes Gounty Code Year File Number
Po sox 2sosol INHERITANCE TAX RETURN a---__^_..---;'- ~ -~
Harrisburg PA 17128-0601 RESIDENT DECEDENT `(- ~- j
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
2 0 2 2 0 5 9 8 6 0 7 2 6 2 0 1 1 0 7 3 0 ], 9 2 7
Decedent's Last Name Suffix Decedent's First (Name MI
S H E A F F E R L O I S L
{If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Naime MI
Spouse's Social Security Number
FILL IN APPROPRIATE OVALS BELOW
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF 1fVILLS
^X 1. Original Return ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death
prior to 12-13-82)
^ 4. Limited Estate ^ 4a. Future Interest Compromise (date of ^ 5. Federal Estate Tax Return Required
death after 12-12-82)
^ 6. Decedent Died Testate ^ 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
^ 9. Litigation Proceeds Received ^ 10. Spousal Poverty Credit (date of death ^ 11. Election to tax under Sec. 9113(A)
between 12-31-91 and 1-1-95) (Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
C H R I S T A M A P L T N
First line of address
8 4 5 S I R T H O M A S C O U R T
Second line of address
S U I T E 1 2
City or Post Office
H A R R I S B U R G
State ZIP Code
717-54dr5550 "'
REGISTERd3~ILLS USE DNt.Y T7 ~-,~
' _ ~ I ~:
-T-, ___
_ ~ i _.
__,
~_. 7
-DATE FILED - - '''~~ ~-_
c. , i
P A 1 7 1 0 `~
Correspondent's a-mail address: CHRISTAJLBCu~VERIZON.NET
Under penalties of perjury, I deGare that I hav xamined this return, including accompanying schedules and statements, and to the best of my knowledge and belief,
it is true, correct and complete. DeGaration of reparer other than the personal representative is based on all information of which preparer has any knowledge.
SIGNATURE OF PERSON RES NS~B OR FILING RETURN DATE
-~ ..
5042 MIDFIELD f~'AD CINCINNATI OH 45244
SIG d~tE O REPAR OTHER TH N REPRE~NTATIVE '~ ~~ ` f'
845 SIR THOMAS COURT SUITE 12 HARRISBURG PA 17109
PLEASE USE ORIGINAL FORM ONLY
Side 1
1505610140 1505610140 J
1505610240
REV-1500 EX
Decedent's Social Security Num ber
Decedent's Name: L O I S L• S H E A F F E R 2 0 2 2 0 5 9 8 6
RECAPITULATION
1. Real Estate (Schedule A) ......................................... .. 1.
2. Stocks and Bonds (Schedule B) .................................... .. 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3.
4. Mortgages and Notes Receivable (Schedule D) ........................ .. 4.
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E)..... .. 5. 5 9 2 • 1 9
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested ..... .. 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) ^ Separate Billing Requested ..... .. 7. 1 4 4 3 9 7. 0 8
8. Total Gross Assets (total Lines 1 through 7) ......................... .. 8. 1 4 4 9 8 9 . 2 7
9. Funeral Expenses and Administrative Costs (Schedule H) .................. 9.
10. Debts of Decedent, Mortgage Liabilities, and Liens (Schedule I) ............. 10.
11. Total Deductions (total Lines 9 and 10) ............................... 11.
12. Net Value of Estate (Line 8 minus Line 11) ....... ........... ........ .. 12.
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
an election to tax has not been made (Schedule J) . ........... ........ .. 13.
14. Net Value Subject to Tax (Line 12 minus Line 13) . ........... ........ .. 14.
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
(a)(1.2)X.0 _ 0 0 0 15.
16. Amount of Line 14 taxable
at lineal rate X .045 1 3 6 3 9 5. 1 1 16.
17. Amount of Line 14 taxable
at sibling rate X .12 0 0 0 17.
18. Amount of Line 14 taxable
at collateral rate X .15 0 0 0 1 g,
19. TAX DUE ......................................................19.
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT
Side 2
1505610240
4 4 3 5. 5 4
4 1 5 8. 6 2
8 5 9 4. 1 6
], 3 6 3 9 5. 1 1
1 3 6 3 9 5. 1 1
0. 0 0
6 1 3 7. 7 8
0. 0 0
0. 0 0
6 1 3 7. 7 8
:L505610240 J
REV-1500 EX Page 3
Decedent's Complete Address:
File Numbeir
00
DECEDENT'S NAME
LOIS L. SHEAFFER
STREET ADDRESS
14 Columbia Drive
CITY STATE ZIP
Camp Hill PA 117011
Tax Payments and Credits:
~ Tax Due (Page 2, Line 19) (1) 6,137.78
2. CreditslPayments
A. Prior Payments
B. Discount 306.89
Total Credits (A + g) (Z) 306
89
3. Interest .
(3)
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. (4) 0.00
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 5.830.89
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 : ................................................................ ...... ^ ^X
b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ X^
c. retain a reversionary interest; or .......................................................................................... ...... ^
d. receive the promise for life of either payments, benefits or care? ................................................ ...... ^ ^X
2. If death occurred after December 12, 1982, did decedent transfer property within one year of death
without receiving adequate consideration? .................................................................................. ..... ^X ^
3. Did decedent own an "intrust for" orpayable-upon-death bank account or security at his or her death? .... ..... ^ ^X
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 (~ AND FILE IT AS PART OF THE RETURN.
For dates of death on or after July 1, 1994, and before Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse
3 percent [72 P.S. §9116 (a) (1.1) (i)].
For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the usE; of the surviving spouse is 0 percent
[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 21 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 percent [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 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 12 percent [72 P.S. §9116(a)(1.3)]. Asibling is defined, unde
Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1508 EX + (6-98)
SCHEDULE E
COMMONWEALTH OF PENNSYLVANIA CASH, BANK DEPOSITS, & MISC.
INHERITANCETAXRETURN PERSONAL PROPERTY
RESIDENT DECEDENT
ESTATE OF BILE NUMBER
LOTS L. SHEAFFER 0 0
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. Citizens Bank 137.25
Checking Acct #6100769054
2. PPL Electric Utilities Corporation 78,70
Credit
3. Travelers 23.00
Homeowners Cancellation Refund
4. Highmark 353.24
Premium refund
TOTAL (Also enter on line 5, Recapitulation) I $
(If more space is needed, insert additional sheets of the same size)
REV-1510 EX+ (08-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE G
INTER-VIVOS TRANSFERS AND
MISC. NON-PROBATE PROPERTY
ESTATE OF
1=1LE NUMBER
LOIS L. SHEAFFER 0 0
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.
ITEM
NUMBER DESCRIPTION OF PROPERTY
INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND
THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE.
DATE OF DEATH
VALUE OF ASSET
% OF DECD'S
INTEREST
EXCLUSION
(IF APPLICABLE)
TAXABLE
VALUE
1. Gift to Diane Fisher; daughter; 6/6/11 14,000.00 100.00 3,000.00 11,000.00
2. Gift to David A. Sheaffer; son; 7/6/11 2,500.OG 100.00 2,500.00 0.00
3. Proceeds from sale of 14 Columbia Drive, Camp Hill, PA 133,397.08 100.00 133,397.08
Gift to Diane Fisher; daughter; 7/25/11
TOTAL (Also enter on Line ~7, Recapitulation)I $ 144,397.08
If more space is needed, use additional sheets of paper of the same size.
REV-1511 EX+ (10-09)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE H
FUNERAL EXPENSES AND
ADMINISTRATIVE COSTS
ESTATE OF FILE NUMBER
LOIS L. SHEAFFER 0 0
Decedent's debts must be reported on Schedule t.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Rolling Green Cemetery Company 450.00
2. Musselman Funeral Home & Cremation Services, Inc. 655.84
3. Gullifty's Restaurant, Gullifty's Underground; memorial/funeral luncheon 1,068.70
4. Church 726.00
B.
2.
3.
4.
5.
6.
7.
8.
City State ZIP
ADMINISTRATIVE COSTS:
Personal Representative Commissions:
Name(s) of Personal Representative(s)
Street Address
Year(s) Commission Paid:
Attorney Fees: Jan L. Brown & Associates
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:
Register of Wills, Cumberland County; ITR filing fee
Citizens Bank; monthly maintenance fee
15.00
20.00
TOTAL (Also enter on Line 9, Recapitulation) I $ 4.435.54
1, 500.00
If more space is needed, use additional sheets of paper of the same size.
REV-1512 EX+ (12-OB)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULEI
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, & LIENS
ESTATE OF IFILE NUMBER
LOIS L. SHEAFFER 0 0
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. Pennsylvania American Water; closing bill 27.62
2. UGI; final bill 46.33
3. Special Event Emergency Medical Services Inc.; outstanding bill 70.00
4. Bethany Village; outstanding nursing home bill 4,014.67
TOTAL (Also enter on Line 10, Recapitulation) I $ 4,158.62
If more space is needed, insert additional sheets of the same size.
REV-1513 EX+ (01-10)
pennsylvania ~ SCHEDULE J
DEPARTMENT OF REVENUE
BENEFICIARIES
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
LOIS L. SHEAFFER 0 0
RELATIONSHIP' TO DECEDENT AMOUNT OR SHARE
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not Lust Trustee(s) OF ESTATE
I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
1. David A. Sheaffer Lineal
5042 Midfield Road one-third of Sch E
Cincinnatti, OH 45244 Sch G
2. Diane Fisher Lineal
9521 Southern Cross Lane one-third of Sch E
Burke, VA 22015 Sch G
3. Dennis Sheaffer Lineal
10253 Waterside Oaks Drive one-third of Sch E
Tampa, FL 33647
ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER S HEET, AS APPROPRIATE.
II. NON-TAXABLE DISTRIBUTIONS:
A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT ~fAKEN:
1.
1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS:
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 DOVER SHEET. $
If more space is needed, use additional sheets of paper of the same size.
REV-1500 Discount, Interest and Penalty W~Drksheet
Discount Calculation
Total Amount Paid within three calendar months of the decedent's date of death:
Discount: 306.89
Interest Table
Year
Before 1981
1982
1983
1984
1985
1986
1987
1988 through 1991
1992
1993 through 1994
1995 through 1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
TOTALS
Days Delinquent Balance Due
this time period this year
Interest
this period
Penalty Calculation
If the decedent's date of death was on or before March 31, 1993, insert the applicable arriount:
Total Balance Due on January 17, 1996:
Penalty:
6,1.37.78
P 17558074
'. REV 11/2006
PRINT IN
MANEM
1CK INN
COMMONWEALTH OF PENNSYLVANIA • DEPARTMENT OF HEALTH • VITAL RE(:ORDS
CERTIFICATE OF DEATH
(See instructions and examples on reverse) STATE FILE NUMRER
1. Name d Deaden (First. midde, ~. suRni) 2. Sex 7, Sodel SecvrM Number 1. Date of Deem IMOnm, say, Yearl
Lois L. Sheaffer feet -
6. Age Mast ardaay) Under t er Urae t 6. Dale d Bill (Monet, say, year) 7. Birtttpuce ( ens sole a ) 6e. Plea d Deam (Check Inej
83 ~" ~n ~~ July 30, 1927 Camp Hill, PA ome g ^Reaioena ^omer.spapM
vn. ^ In Went ^ ER I ONpetuml ^ DOA Nurvn Home
BD. County d Deem &. CM, 9do, iwp. d Dean Bd. FectlM Name (N rpt nstnueon, give steel an0 nmder) 9. Was Decedent d Hispank Ongin'+ ~ No ^ves 10. Race. Amencenlndan, Blatli, WMe, etc
Cumberland
Lower Allen
Bethany Village West (If yes. specM GIOaO,
Mezican,PuerroRian,etc, ;Speoly)
White
11. Deaderx's l!>ud son d work d one du' most d sle. Do nd sale reWed 72. Was Dxsdent ever h me 13. Decedents Eduatbn (Spedry mN hghest yede comP atedl tt. MarNM Status' Marred Never Hared, 16. Surviving Spo use III wile. give maiden name)
Kra d ICmd d glmnass! kAUSM U.S. Armed FaasT Elementary! SecorWary (072) Cdlege It-a a Se) W'd"'Bd' Divorcee ISpenly,
home maker ^Yes aC7Na 3 widowed
t6. Decedent's Maierq Address (Sheet, dry! Imm, stela. zq codel Decedents Db Decedent r~yT
DecededLneam Lower Allen T
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PA
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14 Columbia Dr. ~}
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T~i~p,
-Camp Hill, PA 1 7011 170. County Cumberland 177 ^ No-0ece0er1ne0 wn"'"
AnuatUmeaa sly edn
76. Falners Name (Fist, midde, last. sunial 19. MoNtefs Noma (Fxst, midde, maiden sumarne)
Elmer Landis Esther Conrad
20e. IMOmenra Nama Rype r Prmq zde. Idormenre Hsiang Address 19roeL oeY r town. elaro. zip code)
David A. Sheaffer
21 e. Metrwd of Disposition ^ Cremation ^ Donanm 21 D. Gate d Oispaaan (MOnM. day, year) 2t c. Place d Disposeaxt (Name of amnery crematory a deer pace) 2'~ d loUlan ;CM 'sown. sure. no copal
^Removal hom Sate
~Bune
l
y°Cmn E
A 4~a~ July 30
2011 Rolling Green Mem. Park Camp Hill
PA
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^
zaMner/Caoner
^Yea^NO
D , ,
epryeroon act es I
22a. Sgrr ro d Fu rtl Sella Liar 22b. License Nurtiber 22c. Name and Address d Feciary
~
- 01
Compble Ibrrm 20ai aroy wren cenityng
On/siaan 6 nd Meade al bM d death to 23e. Tc ate Dent d latowledpe. Oeadi covrred al are ,date all stated nand tltlel
~{~(
)~ 23D. license Number
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50 ~ o a ~ ~ 23c. ate Sgned fMmm, day. year)
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0
ally sae d death. I
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Name 2x26 mat De axrylNed M person 26. Time d Deem tlt, day, yeMl
26. Dale PronamaE~J a IM
/O
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' 26. Wes Cass Palemed Ip Medical Examiner I Coroner ld a Reason DInM than Greeters" or Daiatb"n
win preneurces Deem. O' ~ O M. -
~
/
/ - V 1 - O / ^ Yes ~ No
CAUSE OF DEATH (Sae Inetrudlona and exempts) r Appmx'smale Werval: Pad Ii: Emn olMr g 26. Did Tobarm Use CodriMe to Deam~
Item 27. Pan I' Eder dr tlwtl d eveds - eaeases, uryunes. a corr0eaatiorts - that direly eased the death. DO NOT enter terminal events such as wdac enest. Onset b Death hs not resurlag in Ire un0ertyag ease given n Pan I ^ves ~ ProDabty
respretory arrest, a ventricuur ebrNlatron w+etolA sMwatg Dte e0ology List ody one muse on each IiM.
^ No ^ lMKrgwn
IANIEOIATE CAUSE /Fhal eaease a /yt r~-Y1 ,Y~ ~,~Y n
mndad, resurorg st death) .~ a_ I f l Gr Y l ~ I v'7 -n C L•V N ~ ~1' `u f V~H`~ a (ry1 VLt ~
cH QON I C o ~ S'~ U CT t V E
29. NrrF~~emak.
N
Due to (or as a cpnseguerxx orl: ~
I
..
- at prepnad wdMn pest year
Dsl
^ ProquM al ume of deem
~~ oortdi0ore. / ~, b_ ,
,
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N
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a Due to (a es a Consepuence og-
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O ^ Nd pra~ant but pregnant wIIMn a2 tlays
Erax
UNDERLYINC C l1SE
iB
(daease a vqury tlaf irvCe~ad me
en
evenLS res
n deem) UST d death
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u
Due to for ss a cansegrence ary ^ Nd pregnant. Dul pregnant a3 days Io I Year
Delae death
0.
^ Unkrbwn it pregrWnl wimn me peel year
30a. Wes an Auopsy 700. Were Autopsy Fndrgs 31. Manner d Deam 32e. Dale d Inryry (Monet, daY. year) 32D. DeadiDe How Injury OavneO 32c Pus d inryry Home. Farm, Sreel, Faddy,
PerlameeT AveiaDk Prior to Completion
d wee d beam]
~ Nan,rd ^ Homasde DNrs BuNtleg, etc (Speay)
^ Yes ~ No ^ Yes ^ NO ^ ~iad ^ Pendrg Irwestgavm 32e. 7me of Iryury 32e. Irytpy el WorK1 321. N Transpatetan Injury (Spxdry) 32g. LaaGOn of Wary (Bred. dlY r sown, state)
^ Suiade ^ Cdea Nol Da Determned ^ Ves ^ No ^ bivd I Operates ^ Passenger ^Pedestrun
M Omer ~ Spenly:
73e. Cereier (dtxs ody arel 33D. Sguture end iNe d Certifier L '
• CetiMrq IxrYaaNn IPnys¢ian cenaYatg cause d Beam wneri anomer physaan naa pranaurcee deem and amplBlad rem 23; `i~/T/`~'I ~ ~'I / Yv1 t~
-
To the eea d mY lowaAadge, aaatlr xcurttd due to tM ease(s) end manner u atatee_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ ~
' hdqundrrg and rorlNying physkdn IPMsiaen Goer pronouncing dean all cerlMNg a ease of deaM)
l
r
^ 33c License Nurtaer 33d Data Sgnee IMmm. day. Yearl
o nre Ixeat d sly Imorv
eega, da.m o~rred m d,e tw,l.. e.t., .rw place, are sae to ma cau.s(a) srrd mnrw u stated_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
• YadIW EumMr/Caonr ~ ~ !' Z ( ~L 4N
"T "1 I z ~ ~ 2 o t t
On tM Deals d eumin.tan are I « Invesngeuon. m my opnwn. ee,m occurred a the Ixne. saes, are px., and ew to Ins r~o..(a) are manner a state4 ^ 3a
Name anti Adaess d Parsm wn, Caipleted Cause of beam olem z7J Type ;Pmt
.
I
36. Regetror's SigneNre stria Number
~ 36 Oeta (Mon ,dry, year) ~~ yr yet ~~"
N~ ~-}7 I 1
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v n.M..~. o.~e ~ o~ io ~3
a"""'Qr OMB Approval No. 2502.0266
3sa r ~
o A. Settlement Statement (HUD-1}
~.
9~rr e.~E~
B. Tvce of Loan
1. ^ FHA 2. ~ RHS 3. Q Conv Unins.
4. Q VA 5. Q Conv. Ins. 6. File Number:
MOR112-11 7. Loan Number:
0231714386 8. Mortgage Insurance Case Number:
tt1-10-6-0621901
C. Note: This (orm is lumished to give you a statement o/actual settlement costs. Amounts paid to aTM by the seHkrment agent are shown.
hems marked "(p. o.c.)" were paid outside the cbsing; they are shown hen: for informational purposes and Irro not included in tl1e rotals.
D. Name and Address of Borrower:
ALLAN MORALES
121 NORTH YORK STREET
MECHANICSBURG, PA 17055 E. Name and Address of Seller:
LOTS L. SHEAFFER
14 COLUMBIA DRIVE
CAMP HILL, PA 17011 F. Name and Address of Lender
FIRST FINIWCIAL SERVICES, INC.
6230 FAIR\rIEW ROAD, SUITE 450
CHARLOTI"E, NC 28210
G. Property Lowti~n:
14 COLUMBIA DRIVE
CAMP HILL, PA 17011
CUMBERLAND County, Pennsylvania H. Settlement Agent: 25-1619811
TRI-COUNTY ABSTRACT SERVICE
48 CENTF2AL BLVD.
CAMP HILL, PA 17011 Ph. (717)761-8870 1. Settlement Date:
July 25. 2011
Place of Settlement:
48 CENTRAL BLVD.
CAMP HILL, PA 17011
J. Summa of Borrowers transacton K. Summary of Seller's transaction
100. Gross Amount Due from Borrower: 400. Gross Amount Due to Seller:
101. Contract sales rice 152,000.00 401. Contred sake price 152,000.00
102. Personal ro 402. Personal ro
103. Battlement Chat es to Borrower line 1400 11,151.13 403.
104. 404.
105. 405.
Ad ustments for items Id Seller in advance Ad'ustments for Items id Seller In advance
106. C' /Town Taxes 0725/11 to 01/01/12 282.00 406. C' !Town Taxes 0725111 to 01/01/12 282,(X1
107. Coun Taxes to 407. Coun Taxes to
108. SCHOOL TAXES 0725/11 [0 07101!12 1,246.61 408. SCHOOL TAXES 0725/11 to 07/01/72 1 246.G1
109. SEWERlTRASH JULY-SEPT 0725!11 to 10/01!11 76.83 409. SEWER/TRASH JULY-SEPT 07!25!11 to 10101/11 76.83
110. 410.
111. 411.
112. 412.
720. Gross Amount Due from Borrower i 164,756.57 420. Gross Amount Due to Seller 153,605.44
200. Amounts Pald or in Behalf of Borrower 600. Reductions in Amount Due Scrller:
201. Da sit or earnest mone 2,000.00 501. Excess d sA see instrudions~
202. Princi al amount of new loans
155,268.00 _
502. Settlement cha s to Seller Line 1400 11,808.36
203. Existln loans taken su to 503. Exlsti loans taken subject to
204. 504. Payoff First Mo ege
205. 505. Pa H Second Mort e e
206. _
506.
207. 507. De it disb. as roceeds
208. SELLER CR. TOWARD PROBATIONS 516.87 508. SELLER CR. TOWAR PROBATIONS 516.87
209. SELLER CLOSING COST ASSIST 7,883.13 509. SELLER CLOSING COST ASSIST 7 883.13
Ad ustmerrts for items un Id Seiler Ad'ustments for items un aid b Seller
210. Ci /Town Taxes to 510. C' Rown Taxes to
211. Count Taxes to 511. Coun Taxes to
212. SCHOOL TAXES to _ 512. SCHOOL TAXES to '
213. 513.
214. _ 514.
215. 515.
216. 516.
217. 517.
218. , 518.
219. 519.
220. Total Paid ffor Borrower 165,668.00 620. Total Reduction Amount Due Seller 20,208.36
300. Cash at Settlement irom/to Borrower 600. Cash at settlement to/from Seller
301. Gross amount due from Borrower line 120
302. Less amount aid bylfor Borrower (line 220
303. Cash ~ From XD To Bortower 164,756.57
( 165,668.00)
911.43 601. Gross amcum due to Seller lin<r 420) 153,605.44
602. Less reductions due Seller Ilne 520) !(
603. Cash ~ To ~ Fran Seller i 133,397.08
a
The undersigned hereby acknowledge receipt of a completed copy of this statement & any attachments referred to nerein
Borrower 111~~tm. /~~.~.~ ~ Setter `'[?/~/~~^•~\p~ ~ ~-
ALLAN fJTORALES LOIS L. gHEgFFER 6Et. T a
TO THE BEST OF MY KNOWLEDGE, THE HUD-1 SETTLEMENT STATEMENT WHICH I HAVE PREPARED IS A TRUE AND ACI;URA E ACCOVNT OF THE FUNDS
WHICH WERE RECEIVED AND HAVE BEEN OR WILL BE DISBURSED 6Y THE UNDERSIGNED AS PART OF T S TTLEMEIJT OF HIS TRA CTION.
~ ~ ~\~-
ETTLEMENTAGENT, Settlement Agent
WARNING IT IS A CRIME TO KNOWINGLY MAKE FALSE STATEMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAF2 FORM PENALTIES UPON CONVICTI(~JN
CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18 U.S CODE SECTION 1001 & SECTION 1010
Tla> Pup11c Reporur~g BuOen for evs cpllecbvn of intormaeon ~s asixiueee al a5 rtvnutes per resppnse tar cgloceng, ravlawrrq, He0 ApoNng V» Nii Tftis agency nuV nq cotlett Ws iMOtmaGOn, orb You aye not reouvo0 b
rarnplete Iles lonn, pNess a E~sp~ays a wrrermy vako OMB cono-d rwrrn0er No conhoem~eary is ess~reC. I~u tliacbsure is rneMdtpry iMS Is Oespned Ig pmvi0a Ne Irar-es b a RFSPA coveTO kanaacCOn wiN ,nbmulgn
nunng rM settlement procaes
Page 1 of 3 HUD-1
(MOR112-11 PFDlMORtt2-11110;
L. Settlement Charges
700. Total Real Estate Broker Fees $ 8,700.00 p.m r rom poo rron,
Divis'on of commisslon line 700) as loilows e«rv«ers ssibr.
701. 8 7 .tXt to KELLER WILLIAMS OF CENTRAL PA FrtWS n r`oc' °'
702. (O s°r"a"°n s°°I°"'°^'
703. Commission aid at settlement 8 700.00
704.
705. TRANSACTION FEE to KELLER WILLIAMS Of CENTRAL PA 175.00
800. Items P able in Connection with Loan
801. Our o ' ination cha e $ 1,600.00 from GFE #1
802. Your credit or charge (points) for the specific interest rate chosen $ (from GFE #2)
803. Your adjusted origination charges from GFE #A 1,600.1)0
804. raisal tee to FFSIlRiDGE MARKETING ASSOCIATES from GFE #3 375.00 ~ "-,
805. Credit Re ort to FFSUCREDIT PLUS (from GFE #3 12.17 -...
806. Tax service to (from GFE #3)
807. Flo certification to (from GFE #3)
806. FINAL INSPECTION to FFSI/RIDGE MARKETING ASSOCIATES (from GFE #3) 100.00
609. (from GFE #3)
810. (from GFE #3)
811. from FE #3)
900. Items R uired Lender to Be Paid in Advance
901. Daily interest charges from 07!25111 to 08101!17 7 Q $20.7378001day (from GFE #10) 145.16
902. Mort a e insurance remium for months [o FIRST FINANCIAL SERVICES, INC. from GFE #3 3.268.00
903. Homeow s msurance or 1.0 ars o NA O IDE from GFE iWV 5837HP1 82235 627.00
904. from GFE #1
905. (from GFE #11)
7000. Reserves De ited with Lender
7001. InItIal deposd for your escrow account (from GFE #9)
434.17 _ -
,
omeowne s nsurnce moo s per moot
1003. Mort a e insurance months S r month $
1004. Property taxes $
Cilyffovm Taxes months Q $ per month
Assessments months $ er month
1005. $
1006. COUNTYlTOWNSHIP7AXES 6.000 months Q $ 53.61 per month $ 321.66
1007. SCHOOL TAXES 2.000 months Q S 111.17 per month $ 222.34
1008. $
1009. AGGREGATE ESCROW ADJUSTME~ $ -266.64
1100. Tithe Cha es
1101. TRIe services and lender's title insurance from GF fld) 1,418.25
1102. Settlement or dosi fee $
1103. Owner's le insurance to FIRS AMERICAN TITLE INSURANCE CO. from GFE #5
1104. Lende s title insurance to FIRST AMERICAN ITLE INSURAN E CO. $ 1,288.75 100 :100 8.1 -
1105. Lendefs title li limit $ 155,268.00 5011342-0029011
1706. Owners tRle oli limit $ 152,000.00 5011442-00:!1069
1107. A ant's ortion of the total title insurance remium to TRI-COUNTY ABSTRACT SERVICE S 1,095.4
1108. Underwriter's ortion of the total title insurance remium to FIRST AMERICAN TITLE INSURANCE ( $ 193.31
7109. PREPARATION OF DEED to DAVID R. BRESCHI, ESO.
115,00
1710. R •I BUR EM NT FOR TAX CER? to TRI-COUNTY A STRACT SERVICE 10.00
1111.
1112.
1113.
1200. Government Recording and Transfer Charges
1201. Government recordin char es to RECORDER OF DEEDS Irom GFE #7 156.00
12 2 Deed $ 62.00 Mortgage $ 94.00 Releases $ Other E
1203. Transfer taxes to RECORDER OF DEEDS (from GFE #8) 1,520.00
1204. Cfty/County tax/stamps $ 1,520.00 $ 1,520.00
1205. State tax/sta s $ 1,520.00 $
1206. RECORD POA to CUMBERLAND Recorders Office 32.00
1207.
1500. Additional Settlement Char es
1301. R uired services that ou can sho for from GFE #6 620.44
1302.
1303. TERMITE/PEST INSPECTION to RID-X $ 820.44
1304. HOME INSPECTION $
1305. See addR'I disb. exhibit to 5pp.p0 1,431.36
1400. Total Settlement Char s enter on lines 103, Section J and 502, Section K 11.151.13 11 808.36
BY signrp page t d fhre slabnrenl. Ne vgnalenea acklgw~e0g0 remipr pl • [Omplele0 tApy d page 2 d 3 Or Nµ.mre)(paga 12lemeM , _ ~ ~~ ~'
SE~'fLEMENTAGENT. Settlemen 9~n1 ~ '("!!! 'C .
CERTIFXED. TRUE AND CORRECT - -
Page 2 of 3 HUD-1
(MOR112-11 PFD/MOR112-11110)
Comparison of Good Faith Estimate (GFE) and HUD-1 Charges Good Fatith Estimate HUD-1
Charges That Cannot Increase HUD•1 Line Number
Our origination charge # 801 1,600.00 1,600.00
Your credit or charge (points) for the specnc interest rate chosen # 802
Your ad)ustad o ' ination cha es # 803 1,600.00 1,600.00
Transfer taxes #1203 1,520.00 1,520.00
Charges That in Total Cannot Increase More than 10% Goad Frith Estimate HUD-1
Government recording charges #1201 189.00 156.00
Appraisal fee # 804 425.00 375.00
Credit report # B05 18.00 12.17
FINAL INSPECTION # 808 100.00 100.00
Mortgage Insurance Premium #902 3,268.00 3,268.00
Title services and lenders title insurance #1101 1,578.75 1.418.25
Total _ 5,578.75 5,329.42
Increase between GFE and HU0.f Charges S -249.33 or 4.47
Charges That Can Change Good Frith Estimate HUD-1
Initial deposit for your escrow account #1001 1,900.00 434.11
Dairy interest charges # 9G1 $ 20.737800lday 311.07 145.16
Homeowner's insurance #903 600.00 627.OC
TERMITE/PEST INSPECTION #1303 75.OD 820.44
HOME INSPECTION #1304 375.00
Loan Terms
Your Initial loan amount is S 755,268.00
Your loan term Is 30 years
Your initial interest rate is 4.8750
Your Inittal monthly amount owed for principal, interest and S 821.69 includes
any mortgage insurance is ^X Principal
a Interest
Mortgage Insurance
Can your interest rate rlse9 ~X No ~ Yes, d can rise to a max,rnum of Yo. The first
change will be on and can change again every _ months after
. Every change date, your interest rate can increase or decrease
by %. Over the life of the loan, your interest rate LS guaranteed
to never be lower than % or higher than %.
Even if you make payments on ttme, can your loan balance rise? ~X No ~ Yes, R can rise to a maximum of S
Even if you make payments on time, can your monthly OX No ~ Yes, the first increase can be on and the monthly
amount owed for principal, interest. and mortgage insurance rise? amount owed can rise to 5
The maximum it can ever rise to is S
Dces your loan have a prepayment penalty? ~X No ~ Yes, your maximum prefayment penalty is S
Dces your loan have a balloon payment? ~X No ~ Yes, you have a balloon payment of $
due in _ years on
To[al monthly amount owed including escrow account payments ~ You do not have a monthly escrow payment for items, such as property
taxes and homeowner's insurance. You must pay these dams directly
yourself.
QX You have an adddional monthly escrow payment of 5217.03 that results
in a total initial monthly amount owed of 51,038.72. This includes
principal, interest, any mortgage insurance and any items checked below:
XQ Property taxes QX Homeowners insurance
Flood insurance
QX SCHOOL TAXES
.~.~. „ yvu ~m~c any quesnons aoom me Set-ement Charges and Loan Terms listed on this torn, please contact your lender.
Page 3 of 3 HUD-1
(MOR112-tt PFD/MOR112-t 1/10)
HUD-1 Attachment
Borrower(s): ALLAN MORALES
121 NORTH YORK STREET
MECHANICSBURG, PA 17055
Lender: FIRST FINANCIAL SERVICES, INC.
Settlement Agent: TRI-COUNTY ABSTRACT SERVICE
(717)761-$870
Place of Settlement: 48 CENTRAL BLVD.
CAMP HILL, PA 17011
Settlement Date: July 25, 2011
Property Location: 14 COLUMBIA DRIVE
CAMP HILL, PA 17011
CUMBERLAND County, Pennsylvania
Seller(s): LOIS L. SHEftFFER
14 COLUMBIA DRIVE
CAMP HILL, i'A 17011
Additional Adjustments For Items Paid By Seller In Advance (Borrower Debit)
Description Amount FromlThrough Prorated Amount
SEWER/TRASH JULY-SEPT 103.95 07!01/11 through 09/30!11 76-83
Total Line 109!409 76.83
Additional Disbursements
Payee/Description Note/Ref No. Borrower Seller
DAVID E- BINNER 500.00
REPAIRS
LOWER ALLEN TOWNSHIP 103.95
SEWER JULY-SEPT
BONNIE K. MILLER, TAX COLLECTOR 1.307.41
2011-12 SCHOOL TAXES ID #13-23-0547-563
TRI-COUNTY ABSTRACT SERVICE 20.00
WIRE FEE FOR PROCEEDS
Total Additional Disbursements shown on Line 1305 S 500.00 S 1,431.36
Adjusted Origination Charge Details
Origination Charge
UNDERWRITING FEE 850.00
to FIRST FINANCIAL SERVICES, INC.
COMMITMENT FEE 750.00
to FIRST FINANCIAL SERVICES, INC.
Total $ 1,600.00
Origination CrediUCharge {points) for the specific interest rate chosen
Total $
Adjusted Origination Charges $ 1,600.00
Reserves Deposited with Lender
Homeowner's Insurance 156.75
3.000 at 52.25 per month
COUNTY/TOWNSHIP TAXES 321.66
6.000 at 53.61 per month
SCHOOL TAXES 222.34
2.000 at111.17 per month
AGGREGATE ESCROW ADJUSTMENT -266.64
month
Total $ 434.11
WARNING: It is a crime to knowingly make false statements fo the United States on this or any similar fo rm. Penalties upon c onviction can
include a fine and imprisonment For tletaifs see: Title 18 U.S. Code Section 1001 and Section 1010.
(MOR112-11 PFD/MOR112-1 Vf0)
HUD•1 Attachment- Continued
Title Services and Lender's Title Insurance Details BORROWER SELLER
INSURED CLOSING LETTER 75.00
to FIRST AMERICAN TITLE INSURANCE
ELECTRONIC DOCUMENT DELIVERY 25.00
to TRI-COUNTY ABSTRACT SERVICE
OVERNIGHT FEES 14.50
to TRI-COUNTY ABSTRACT SERVICE
NOTARY FEES 15.00
to CASH
Lender's title insurance 100 300 8.1 1,288.75
to FIRST AMERICAN TITLE INSURANCE CO.
Total $ 1,418.25 S 0.00
Lender's Title Insurance BORROWER SELLER
•fees also shown above in Title Services and lenders Title Insurance Details
Lender's Policy Premium 1,138.75
to FIRST AMERICAN TITLE INSURANCE CO.
Lender's Endorsement Charges 150.00
Endorsement Endorsement Charge
ALTA Endorsement Form 8.1 (Environmental Protection Lien) 50.00
ALTA Endorsement Form 9 (Restrictions, Encroachments, Min.) 50.00
PA ENDORSEMENT 300 MTG. SURVEY EXCEPTION 50.00
Total E 1,268.75 S 0.00
WARNING: It is a crime to knowingly make false statements to the United States on this or any similar form. Penalties upon conviction can
include a floe and imprisonment. For details see: Title 18 U. S. Code Section 1001 and Section 1010.
(MOR112-11 PFDlMOR112-11/101
..;
.~
KELLER WILLIAMS
~. criv~i rn
PRE-SETTLEMENT WALK-THROUGH INSPECTION
DATE OF SALE AGREEMENT: _ 1 \~2~~j , 2~0~~ I I ~~y-/ ~/~
RE: PROPERTY: ~ ~ -\ `'L_Ji'S.,-LSLJ
SELLER(S): i BUYER(S) ~' ~`'! C~ ~Ly
The undersigned Buyers a comp tel in. pecte the above-captioned as it property on~/ ~ ~ (
20 ~ ` , accompanied b t i c d have determined to their Satisfaction that the property was in
substantially the same condition as it was at the time of execution of the Agreement of sale. The buyer(s) acknowledge that all
non-real estate extras as outlined in the Agreement of the sale were on the premise at the time of inspection and all fixtures
were in place and functioning. The following items were noted as not being in satisfactory condition but were accepted in
"ASIS" condition. (Indicate if "NONE.) The Buyer(s) have received copies of all required certification and inspection and
understand that non warranties are included, unless specifically indicated on the written report. All terms and conditions in the
Agreement of the Sale have been Satisfactory met.
The following items were not noted as N01' being in satisfactory condition and NOT ACCEI'"I'ED by Buyer(s). Agreement
for resolutions is as follows:
In the case of an FHA insured or VA guaranteed purchase this certification shall neither supersede nor supplant the requisite
pre-settlement inspection certification but shall supplement same.
Buyer(s) warrants that they are not relying upon representation made by seller, Agent or Broker, and hereby release, quit claims
and forever dischazges, 5ellers)' Agents, Subagents, employees, and any officer or pazmer or an}' one of them and any other
person, firm or corporation, who may be Gable b}' or through them from any and all claims, losses, or demands, including
personal injuries, and all f [);te_conse Weer there of ,where now known or not, which map arise due to condition of subject
property. ((( ~`
1
1
Witness: ~ t; Buyer: _~ ~~.. fir(\,(~ ~i >o Date: _ ~ I } `•~ '
\Y/itness:
BUyer:
Seller(s) have been advised of the results of Buyer(s)
Witness:
Seller
Date:
inspection nd agree to exceptions or cesolutions noted herein.
Date: _ ~' ~ 1 t ~
Witness: Scllcr:
Seller's forwarding address:
New Telephone Number:
Date
INSPECTION WAIVER [Complete this section ONLY if inspection is waived by the Purchaser(s))
I (we), the undersigned Buyer(s) of the above<aptioncd property, have been advised of our right to apre-settlement
inspection. We hereby decline and waive our right to such utspection and the benefits there of and hereby release, quit claim,
and forever dischazge, Seller(s) Seller(s) Agents, Subagents, employees, and any officer or paztner o:: any one of them and any
other person, firm or corporation, who may be Gable by or tluough them ,from any and all claims, losses, or demands,
includng personal injuries, and all of t}te consequences drercof ,where now known or not, which ray arise due to condition
of the subject property.
Witness: Buyer:
Date:
\Y/fitness: Buyer: __ Date:
LAST WILL AND TESTAMENT
OF
LOTS L. SHF,AFFER
I, LOIS L. SHEAFFER, now domiciled in Cumberland County, Pennsylvania, declare this
to be my Last Will and Testament. I revoke all other wills and codicils that I may have previously
made.
Article I
My just debts and expenses of my last illness, funeral, and administration of my estate shall
be paid by my Executor from the principal of my residuary estate as soon as practicable after my
death.
Article II
All inheritance, estate, and succession taxes (including interest ~~nd penalties thereon, but not
including any generation skipping tax) payable by reason of my death on any property or interest in
property, including taxes assessed on jointly held assets and nonprobate assets, shall be paid out of
and be charged generally against the principal of my residuary estate without reimbursement from
any person. The tax shall be paid and allocated from my residuary estate before my residuary estate
is divided into shares for my residuary beneficiaries. This provision is not a waiver of any right
which my Executor has to claim reimbursement for any such taxes which become payable as the
result of any property over which I have the power of appointment.
Article III
1 give, devise and bequeath in accordance with any memor;~ndum which I have either
handwritten or signed, located with my will or with my valuable papers and found within 30 days of
the probate of my will. Gifts may only be to persons who survive me or to organizations vvhicl~ exist
at my death, and if there is a conflict, the memorandum having the latest date shall govern.
Article IV
All the rest, residue and remainder of my estate, of whatsoever nature and wheresoever
situate, I give, devise and bequeath IN EQUAL SHARES, to my son, DAVIll A. SHEAFFER, of
Cincinnati, Ohio, to my daughter, DIANE FISHER, of Burke, Virginia, and to my son, DENNIS
SHEAFFER, of Tampa, Florida.
If any of my beneficiaries predecease me or fail to survive me b_y thirty (30) days, I give,
devise and bequeath his or her share to his or her issue who survive me, per stirpes, or if he or she
has no issue, the share(s) are to be added equally to the other shares.
Article V
[ understand and direct that my life insurance, annuities, individual retirement accounts
(IRAs), in trust for bank accounts and any other assets on which I ma.y~ designate a beneficiary will
pass to the beneficiaries that I have named and will not be controlled b}~ the distribution provisions of
this Will. 1 also understand and direct that any assets 1 own jointly with another with rights of
survivorship or a presumed rights of survivorship (whether the joint ownership was created before or
-~-
after this Will) will pass to the surviving joint owner and distribution of such assets will not be
controlled by the provisions of this Will.
Article VI
I nominate, constitute, and appoint my son, DAVID A. SHEA~FFF,R, and/or my daughter,
DIANE FISHER, as Co-Executors of my Last Will and Testament. In the event of the renunciation,
death, or inability to act, for any reason whatsoever of both my Co-Executors, I nominate, constitute
and appoint my son, DENNIS SHEAFFER, as successor Executor of my Last Will and Testament.
I direct that my Co-Executors or successor Executor be permitted tea serve without bond and in
addition to those powers granted by law, I grant them power to distribute in cash or in kind in like or
in unlike shares and to file any qualified disclaimer I could have filed if living. My Co-Executors or
successor Executor shall receive reasonable compensation for services rendered to my estate.
Article VII
In addition to the powers conferred by law, I authorize my Co-Executors and successor
Executor, in his/her absolute discretion:
(a) to retain in the form received and to sell either at public or private sale, any real estate or
personal property except that which 1 specifically bequeath herein,
(b) to manage real estate,
(c) to invest and reinvest in all forms of property without being confined to legal
investments, and without regard to the principal of diversification,
-3-
(d) to exercise any option or right arising from the ownership of investments,
(e) to compromise claims without court approval and without consent of any beneficiary,
(f) to file any federal income tax return for any year for which I have not filed such return
prior to my death,
(g) to make distributions in cash or in kind, or in both. and to determine the value of any
such property,
(h) to employ any attorney, investment advisor, or other agent deemed necessary by my
Executor; and to pay from my estate reasonable compensation for all their services,
(i) to conduct alone or with others, any business in which 1 am engaged in, or have an
interest in at time of my death,
(j) to file any qualified disclaimer I could have if living, and
(k) to receive reasonable compensation in accordance with their standard schedule of fees in
effect while their services are performed.
IN WITNESS WHEREOF, 1, LOIS L. SHF,AFFER, hereby set my hand to this my Last
Will and Testament, on ~ ~~,~ 201 I .
,,
LOIS L. SHEA,FFER
In our presence, the above-named LOTS L. SHEAFFER signed this and declared this to be
her Last Will and Testament and now at her request, in her presencf;, and in the presence of each
other, we sign as witnesses.
Name Address
-4-
j
~ l ~ '(
I, LOIS L. SHEAFFER, Testatrix, who signed the foregoing instrument, having been duly
qualified according to law, acknowledge that I signed and executed thi;~ instrument as my Will, and
that I signed it willingly as my free and voluntary act for the purposes therein expressed.
Sworn to or affirmed and
acknowledged before me by
LOIS L. SHEAFFER, the "l~estatrix
on ~X ,2011.
f ( ,
Notary Public
LOIS~ .SHEAFFER --rte
NOTARIAL SEAL
CHRISTA M APLIN
Notary Public
LOWER PAl(TON TWP., DAUPHIN COUNTY
My Commissbn Expires Nov 16, 2013
We, the undersigned witnesses who signed the foregoing instrument, being duly qualified
according to law, depose and say that we were present and saw the Testatrix sign and execute this
instrument as her Will; that she signed and executed it willingly as her free and voluntary act for the
purposes therein expressed; that each of us in her sight and hearing signed the Will as witnesses, and
that to the best of our knowledge, that she was at that time eighteen (18) years or more of age, of
sound mind, and under no constraint or undue influence.
Sworn to or affirmed and ,-,
subscribed to before me ~ -
and ~. /~"?" , `,, -' ~s~,; ~`~ VViti~ess
witnesses, on ~ -- , 201 1. ~ ~ ~` -
~" ~ ~,, ~,
~otarv Public
NOTARULL SEAL
CHRISTA M APLIN
Notary Publk
LOWER PAXTON TWP., DAUPHIN COUNTY
My Commission Expires Nov 16, 2013
Witness" `` '
i/
~~j
-5-
GIFT' LIST FOR LOTS L. SHEAFFER
I, LOTS L. SHEAFFER hereby wish for the following items to be distributed to the
following persons:
ITEM
NAME OF RECIPIEN"T
Date
I,OIS L. SHEAFFER
~~_~' _ ~ -f~ ;~ OF
j ~ _ ~ .. .. ... J
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