HomeMy WebLinkAbout11-10-111505611180
REV-1500 EX (o2-~~) (Fi) OFFICIAL USE ONLY
pennsylvania
PA Department of Revenue DEPARIAENTOFREVENUE County Code Year File Number
Bureau of Individual Taxes INHERITANCE TAX RETURN ~r Dn ~ ~ ~ ~i
PO BOX 280601 1 `'' 7f
Harrisburg PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY
161-34-1106 10122009 10261942
Decedent's Last Name Suffix Decedent's First Name MI
LAUFFER ROY SCOTT
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name MI
LAUFFER REGINA N
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE BOXES BELOW
Qx 1. Original Return Q 2. Supplemental Return Q 3. Remainder Return (Date of Death
Prior to 12-13-82)
0 4. Limited Estate Q 4a. Future Interest Compromise (date of Q 5. Federal Estate Tax Return Required
death after 12-12-82)
Qx 6. Decedent Died Testate Q 7. Decedent Maintained a Living Trust 0 8. Total Number of Safe Deposit Boxes
(Attach Copy of Will) (Attach Copy of Trust)
Q 9. Litigation Proceeds Received Q 10. Spousal Poverty Credit (Date of Death Q 11. Election to Tax under Sec. 9113(A)
Between 12-31-91 and 1-1-95) (Attach Schedule O)
CORRESPONDENT - Tii1S SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTUIL TAX INFORMATION SHOULD BE DIRECTED T0:
Name Daytime Telephone Number
ROBERT G. FREY 7172435838
First Line of Address
5 S HANOVER ST
Second Line of Address
City or Post Office
CARLISLE
State ZIP Code
PA 17013
REGISTER OF WILLS USE ONLY
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Correspondents a-mail address: R F R E Y a1 F R E Y T I L E Y. C O M
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.
SIGNATUI~'f)APER^t'N R~ONSI$-et~OR F~~G R~TURN /~ DANE //
ADDRESS V " ~ (J
225 Hi h Mountain Roa Shi ensbur PA 17257
SIGN U OF P EP ROT R THAI~'REPRESENTATIVE / ~ pA~/
n 7 1--1 /
ADDRESS
5 SOUTH HANOVER STRE~E CARLISLE PA 17013
PLEASE USE ORIGINAL FORM ONLY
Side 1
L 1505611180 1505611180
1505611280
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: ROY SCOTT LAUFFER 161-34-1106
RECAPITULATION
1. Real Estate (Schedule A) ......................................... 1. N 0 N E
2. Stocks and Bonds (Schedule B) .................................... 2.
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. N 0 N E
4. Mortgages and Notes Receivable (Schedule D) ........................ 4. NON E
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... 5.
6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6.
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) OSeparate Billing Requested ....... 7. NON E
1641.00
18033.D0
0.00
8 Total Gross Assets (total Lines 1 through 7) 8. 19 6 7 4 . 0 0
9. Funeral Expenses and Administrative Costs (Schedule H) ................ 9. 14136 • 00
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.
42115.00
56251.00
-36577.00
0.. 0 0
14 Net Value Subject to Tax (Line 12 minus Line 13) ..... ... 14. - 3 6 5 7 7.0 D
TAX CALCULATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable at
the spousal tax rate, or
transfers under Sec. 9116
0 0
0
(a)(1.2) X .0 0 15. .
16. Amount of Line 14 taxable
0
0 0
at lineal rate X .0 4 5 16. .
17. Amount of Line 14
taxable at sibling rate X . 12
17.
0 . 0 0
18. Amount of Line 14 taxable
0 0
0
at collateral rate x .15 18. .
19. TAX DUE .................................................... ...19. D . 0 D
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT D
Side 2
L 1505611280 1505611280 ,J
REV-1500 EX (FI) Page 3
Decedent's Complete Address:
21-09-0980
File Number
(3)
DECEDENT'S NAME
ROY SCOTT LAUFFER
STREET ADDRESS
225 Hi h Mountain Road
CITY STATE ZIP
SHIPPENSBURG PA 17257
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
(1) o.oo
Total Credits (A + B) (2)
4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Fill in box 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.
161-34-1106
0.00
(4) 0.00
(5) 0.00
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:
f
d Yes
^ No
.................................................................................
erre
a. retain the use or income of the property trans ......
^ ~
b. retain the right to designate who shall use the property transferred or its income .................................... ...... ,
c. retain a reversionary interest .................................................................................................................... ...... ^
d. receive the promise for life of either payments, benefits or care? ............................................................
...... ^ ~°'
2. If death occurred after Dec. 12, 1982, did decedent transfer property within one year of death
? ^
........................:...........................................................................
without receiving adequate consideration ......
3. Did decedent own an "in trust for" or payable-upon-death bank account or security at his or her death? ...... ...... ^
4. Did decedent own an individual retirement account, annuity or other non-probate property, which
^
contains a beneficiary designation? .............................................................................................................. ......
IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN.
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 is 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(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, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption.
REV-1503 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
ESTATE OF
SCHEDULE B
STOCKS & BONDS
FILE NUMBER
Roy Scott Lauffer 2.1-09-0980
All property jointly-owned with right of survivorship must be disclosed on Schedule F.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1. Comcast Class A comon stock, 70 shares, 15.375 average share price 1,076
2. AT&T, 22 shares, 25.68 average share price 565
3.
TOTAL (Also enter on line 2, Recapitulati
(If more space is needed, insert additional sheets of the same size)
REV-1508 EX+ (11-10)
pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE E
CASH, BANK DEPOSITS, & MISC.
PERSONAL PROPERTY
ESTATE OF: FILE NUMBER:
Roy Scott Lauffer 21-09-0980
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
1 4 motorcycles and 1 Lark cargo trailer sold at Gateway Auction 6,077
2 Z-3 sold at Shippensburg Auto Auction 4,045
3 McGregor boat and trailer 976
4 Stingray boat and trailer 1,360
5 1995 Ford Van and 2002 Jeep, sold together 5,575
TOTAL (Also enter on line 5, Recapitulation) $ I 18,033
If more space is needed, use additional sheets of paper of the same size.
REV-1509 EX+ (01-10)
pennsylvania SCHEDULE F
DEPARTMENT OF REVENUE
JOINTLY-OWNED PROPERTY
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF: FILE NUMBER:
Rov Scott Lauffer __
If an asset became jointly owned within one year of the decedent's date of death, it must be reported on Schedule G.
SURVIVING JOINT TENANT(S) NAME(S) I ADDRESS ~ RELATIONSHIP TO DECEDENT
q. Regina Lauffer
e.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER LETTER
FOR JOINT
TENANT DATE
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
DECEDENT
INTEREST DATE OF DEATH
VALUE OF
DECEDENTS INTEREST
225 High Mountain Road, Shippensburg. Taken in foreclosure
1. A.
TOTAL (Also enter on Line 6, Recapitulation) I $
If more space is needed, use additional sheets of paper of the same size.
225 High Mountain Road, Shippensburg, PA 17257 (Spouse
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
Roy Scott Lauffer 21-09-0980
Decedent's debts must be reported on Schedule I.
ITEM
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home 8,489
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions: 1,000
Name(s) of Personal Representative(s) Regina Lauffer
Street Address 225 High Mountain Road
city Shippensburq State PA zIP 17257
Year(s) Commission Paid: 2011
2. Attorney Fees: 1,000
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) 3,500
Claimant
Street Address
City State ZIP
Relationship of Claimant to Decedent
4. Probate Fees: 147
5. Accountant Fees:
6. Tax Return Preparer Fees:
7.
TOTAL (Also enter on Line 9, Recapitulation) ~ $ 14,136
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 8~ LIENS
ESTATE OF FILE NUMBER
Roy Scott Lauffer 21-09-0980
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.
RBS Citizens NA, account 1687 8,519
2. West Asset Managment, claim withdrawn
3. Chase, account 2482, claim released
4. Chase, accounts 4672 and 1144, claims released
5. Citizens Automobile Finance,09 0056 29211; Vehicle repossessed
6. American Express, account 373993245714006 5,665
7. Citibank (South Dakota) NA Sears Gold Mastercard account 6051 11,078
8. Shippensburg Area EMS 1,063
9. Bank of America, Account 189584616. First mortgage. Real estate taken in foreclosure
10. Discover Bank, account 6011002170588107 5,922
11. Thousand Trails, account 730-298-094730 643
12. West Shore EMS, account 009009109 1,113
13. PNC Bank, account 4311 9675 2058 2574 8,112
TOTAL (Also enter on Line 10, Recapitulation) I $ 42,115
If more space is needed. insert additional sheets of the same size.
REV-1513 EX+ (01-10)
Pennsylvania
DEPARTMENT OF REVENUE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE J
BENEFICIARIES
ESTATE OF:
NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY
TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under
Sec. 9116 (a) (1.2).]
Regina Lauffer
1 ~ 225 High Mountain Road, Shippensburg, PA 17257
RELATIONSHIP TO DECEDENT
Do Not List Trustee(s)
Spouse
FILE NUMBER:
AMOUNT OR SHARE
OF ESTATE
of Estate
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 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.
If more space is needed, use additional sheets of paper of the same size.
1505611280
REV-1500 EX (FI)
Decedent's Social Security Number
Decedent's Name: ROY SCOTT LAUFFER 161-34-1106
RECAPITULATION
1. Real Estate (Schedule A) ......................................... 1. N 0 N E
2. Stocks and Bonds (Schedule B) .................................... 2. 16 41 • 0 0
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... 3. N 0 N E
4. Mortgages and Notes Receivable (Schedule D) ........................ 4. NON E
5. Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E) .... 5. 18 0 3 3 • 0 0
6. Jointly Owned Property (Schedule F) Separate Billing Requested ...... . 6. 0 . 0 0
7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property
(Schedule G) Separate Billing Requested ...... . 7, NON E
8 Total Gross Assets (total Lines 1 through 7) ...................... . 8. 19 6 7 4 . 0 0
9. Funeral Expenses and Administrative Costs (Schedule H) ................ 9. 14 3 3 7 • 0 0
10. Debts of Decedent, Mortgage Liabilities and Liens (Schedule I) ............ 10. 4 2115 • 0 0
11. Total Deductions (total Lines 9 and 10) ............................. 11. 5 6 4 5 2 • 0 0
12. Net Value of Estate (Line 8 minus Line 11) .......................... . 12. - 3 6 7 7 8.0 0
13. Charitable and Governmental Bequests/Sec 9113 Trusts for which
0 0
0
an election to tax has not been made (Schedule J) ..................... . 13. •
14 Net Value Subject to Tax (Line 12 minus Line 13) ...... ............. . 14. - 3 6 7 7 8.0 0
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 15. 0. 0 0
16. Amount of Line 14 taxable
at lineal rate X .0 4 5 16. 0. 0 0
17. Amount of Line 14
taxable at sibling rate X . 12
17.
0 . 0 0
18. Amount of Line 14 taxable
at collateral rate X . 15 18. 0 . 0 0
19. TAX DUE ...................................................... . 19. 0 . 0 0
20. FILL IN THE BOX IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT Q
Side 2
1505611280 1505611280 J
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
Roy Scott Lauffer 21-09-0980
Decedent's debts must be reported on Schedule I.
ITEM
NUMBER DESCRIPTION AMOUNT
A. FUNERAL EXPENSES:
1. Ewing Brothers Funeral Home 8,489
B. ADMINISTRATIVE COSTS:
1. Personal Representative Commissions:
Name(s) of Personal Representative(s) Regina Lauffer
Street Address 225 High Mountain Road
city Shippensburg State PA zIP 17257
Year(s) Commission Paid: 2011
2. ~ Attorney Fees:
3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.)
Claimant
Street Address
Ciry State
Relationship of Claimant to Decedent
ZIP
4. Probate Fees:
5. Accountant Fees:
6. Tax Return Preparer Fees:
7. Expenses of sale of vehicles (transfer charge, duplicate title fee, Battery)
1,000
1,000
3,500
147
201
TOTAL (Also enter on Line 9, Re
If more saace is needed, use additional sheets of gager of the same size.
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LAST WILL AND TESTAMENT
OF
ROY SCOTT LAUFFER
I, Roy Scott Lauffer, of Shippensburg, Cumberland County, Pennsylvania, declare this to be
my Last Will and revoke any prior Wills and codicils made by me.
ITEM 1. I direct that all my just debts, a nd t he e xpenses o f m y i llness a nd b urial,
including any necessary grave marker or any necessary inscription thereon, shall be paid from the
assets of my estate as soon as practicable after my death and as part of the expense of the
administration of my estate.
ITEM 2. I give, devise and bequeath the rest, residue and remainder of my estate, real,
personal or mixed, of whatever nature and wheresoever situate that I may own or have the right to
dispose of at the time of my death to my Wife, Regina M. Lauffer, provided she survives me by
thirty (30) days.
ITEM 3. If my wife, Regina M. Lauffer, should predecease me or fail to survive me
by thirty (30) days or should die by common disaster so that it is impossible to determine which
of us survived the other, then and in that event, I give, devise and bequeath all the rest, residue
and remainder of my estate of every nature and wherever situate unto my son, Gregory Brent
Lauffer, per stirpes.
ITEM 4. I hereby leave my other son, Brian Scott Lauffer, only my love and affection.
I have intentionally decided to leave my son, Brian Scott Lauffer, only my love and affection.
ITEM 5. Should any beneficiary of my estate be under twenty-five (25) years of age,
I direct that the share of such beneficiary shall be paid unto Sherri L. Lauffer as Trustee for said
beneficiary, on the following terms and conditions:
(a) My Trustee shall divide this sum into equal shares corresponding in
number to my beneficiaries surviving me, and each share shall be held in a separate trust
for each of my surviving beneficiaries.
(b) My Trustee shall hold, manage, invest and reinvest the shares so received,
and the accumulation of interest, and use and apply from time to time such portion of
income and principal thereof as they deem necessary for such beneficiary's health,
maintenance, comfortable support and education, or to make payment to any personal
guardian of such beneficiary. The term "education" means technical, preparatory,
college, graduate and professional education while enrolled in good standing in a
recognized educational institution.
(c) Any principal or income not so applied shall be distributed to such
beneficiary when he/she attains the age of twenty-five (25) years.
(d) All shares of principal and income hereby given shall be free from
anticipation, assignment, pledge or obligation of the beneficiaries and shall not be subject
to any execution or attachment.
(e) Should any beneficiary die prior to the termination of the trust fund, I
direct that any balance remaining in his/her fund shall be distributed to the issue of said
beneficiary. If said beneficiary is not survived by ' sue, I dir that any balance
Roy Scott Lauffer
-2-
remaining in his/her fund shall be distributed to my surviving beneficiaries in accordance
with the ratios set forth in this my Last Will.
ITEM 6. In addition to powers granted by law or by other parts of this Will, my
Executrix shall have the following powers.
(a) To retain any and all assets of my estate, real, personal, or mixed, without
regard to any principle of diversification, risk, or productivity, except as may be otherwise
expressly provided herein;
(b) To sell at public or private sale, to exchange, to lease, to pledge, to
mortgage, to transfer, to convert, or otherwise dispose of, and to grant options with respect
to, any and all property, real, personal, or mixed, at any time forming part of my estate in
such manner, at such time or times, for such purposes, for such price or prices and upon
such terms, credits, and conditions as may be deemed advisable;
(c) To invest and reinvest the property in stocks, bonds, mortgages, notes,
insurance policies, annuities, common trust fund participation, or other property of any
kind, real, personal, or mixed, irrespective of any statute, case, rule, or custom limiting the
investment of trust funds, except as expressly provided otherwise herein;
(d) To settle, compromise, contest, prosecute, or abandon claims in favor of or
against my estate as may be deemed advisable;
(e) To allocate receipts and disbursements to principal or income or partly to
both and to ascertain principal or income in accordance with the laws of the Commonwealth
of Pennsylvania;
0 ott Lauf er
-3-
(f) To make distribution or division of the estate in cash, in kind, or partly in
both; and to postpone distribution by agreement with a beneficiary;
(g) To exercise any law-given option to treat administration expenses either as
income tax or estate tax deductions, without regard to whether the expenses were paid from
principal or income, and without requiring reimbursement; and
(h) To disclaim any inheritance or transfer.
ITEM 7. No bond shall be required by my executrix, but if bond is nevertheless
required, it shall be without surety.
ITEM 8. I direct that all estate, inheritance, succession, death or similar taxes, (except
generations skipping transfer taxes) assessed with respect to my estate herein disposed of or any
part thereof, or on any bequest or devise contained in this my Last Will (which term when used
herein shall include any Codicil hereto), or any insurance upon my life or any property held jointly
by me with another or on any transfer made by me during my lifetime or on any other property or
interest in property included in my estate for such purposes, be paid out of my residuary estate and
shall not be charged to or against any recipient, beneficiary, transferee or owner of any such
property or interest in property included in my estate for such tax purposes.
ITEM 9. I appoint my wife, Regina M. Lauffer, as executrix of this my Last Will. If
my wife, Regina M. Lauffer, predeceases me, ceases or is unable to act as my executrix, I appoint
my son, Gregory Brent Lauffer, as executor of this my Last Will. If my son, Gregory Brent
-4-
Lauffer, predeceases me, ceases or is unable to act as my executor, I appoint my friend, Gary
Keeseman, as executor of this my Last Will.
IN WITNESS WHEREOF, I have hereunto set my hand this~,~ day o~~~/
2002.
The preceding instrument consisting of this and four (4) other typewritten pages identified by the
signature of the Testator was on the date thereof signed, published and declared by Roy Scott
Lauffer, the Testator therein named, as and for his Last Will and Testament, in the presence of us
who, at his request, in his presence and in the presence of each other, have subscribed our names as
witnesses hereto.
-- _ ~~~
.. _ . . ........... ... of f
~~ ~,~
~f ~ ~ of ~.- '~.
-5-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF DAUPHIN
SS
We, Roy Scott Lauffer, an ~ ~1J~t and
the Testator and the witnesses, respectively, whose names are signed to the attached or foregoing
instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testator
signed and executed the instrument as his last Will and that he had signed willingly (or willingly
directed another to sign for him), and that he executed it as his free and voluntary act for the
purposes therein expressed, and that each of the witnesses, in the presence and hearing of the
Testator, signed the Will as witness and that to the best of our knowledge the Testator was at that
time eighteen years of age or older, of sound mind and under no constraint or undue influence.
SWORN to or affirmed and acknowledged before me by the above named Testator and witnesses
this day of ~~ ~ , 2002.
~~ ~~~~
Notary Public
My Commission Expires:
(SEAL)
!)nrunaonl ft• 191747 1
NOTARIAL SEAL
KIMBERLY A. NALL, Notary Public
City of Harrisburg, Dauphin County
My Commission Expires January 19, 2004
6341 Inducon Drive East
Sanborn, NY 14132-9097
Secure online payment can be made at:
http://www.mercantilewebpymt.com Pass Phrase: 73006
CDOt •A-01-ZOJ-AM-12357-52
II~I~~~~IIII~II~III~~~II~~~I~II'iu~~~~~i~~li~li~"i~ii~ii`~~~ul
SCOTTLAUFFER
225 HIGH MOUNTAIN RD
SHIPPENSBURG PA 17257-9614
~~~
MERC:ANI~TLE
~~
Acx;ourtt Number: 5545140109111687
Reference Number: 15727966
• -.
Make Check Payable to ~ Remit to:
II~II'1'11'It'1'IIII1111"'/'tl"~Itltllll"11111"I~I111"/1' III
O BOXd 0116 ADJUSTMENT BUREAU, LLC ~
WILLIAMSVILLE NY 14231-9016 i
Ila
i~
PLEASE DETACH AND RETURN TOP PORTION WITH YOUR PAYMENT
MERCANTILE ADJUSTMENT BUREAU, LLC January 12, 2011
PO BOX 9016
WILLIAMSVILLE NY 14231-9016 ACCOUNT NO. 5545140109111687
SCOTT LAUFFER REFERENCE NO. 15727966
225 HIGH MOUNTAIN RD PREV CREDITOR:
SHIPPENSBURG PA 17257-9614 AMOUNT DUES ~8 5 g,~~BS CARD SERVICES-2ND
Your account owed to RBS CARD SERVICES-2ND has been listed with our office for collection. The entire balance of
$8,519.11 is due and payable.
Send the balance due to this office. If you don't agree with this balance, it is important that you contact our office to discuss
this matter.
MERCANTILE ADJUSTMENT BUREAU, LLC
PO BOX 9016
1U-866A809 V7506 NY 14231-9016
" Please note the return address (6341 Inducon Drive East, Sanborn, NY 14132) located on the front of this notice, is not the
address of MERCANTILE ADJUSTMENT BUREAU, LLC. This address is for processing undeliverable mail only. Please do
not send correspondence or payments to that address. Please'send payments or correspondence to MERCANTILE
ADJUSTMENT BUREAU, LLC, PO BOX 9016, WILLIAMSVtLLE'NY 14231-9016.
THIS COMMUNICATION IS FROM A DEBT COLLECTOR. THIS IS AN ATTEMPT TO COLLECT A DEBT. ANY
INFORMATION OBTAINED WILL_BE USED FOR THAT RURPOSE: ;
Unless you notify this office within 30 days after receiving this notice that you dispute the validity ofi the-:debt or any portion
thereof, this office will assume the debt is valid. if you notify this office in writing within 30 days from, receiving this notice, this
office will: obtain verification of the debf or obtain a copy of a judgment and mail you a copy of such judgment or verification.
If you notify this office in writing within 30 days after receiving, this notice, this office will provide you with the name and
address of the original creditor, if different from the current creditor.
Dept 11576
PO Box 1259
Oaks, PA 19456
IVIII)VIIIIIIIIVIIIVIIIIIIIIIIIIIVIIIIIII)IIIIIIIIIIVIIIVIIIIIII'IIIIIIIIIIIII
est West
Asset
n Management
7171 MERCY ROAD
OMAHA, NE 68106
Probate Court for the County of CUMBERLAND
RE: The Estate of: ROY LAUFFER
i~~li~~lli~~~~~~~i~~li~~ill~~i~~i~i~l~~~i~~~lllliil~lil~l~il~~l~~ s34,-,ozz Case Number: 21-09-00980
„xyt ROBERT FREY
5 S HANOVER ST
CARLISLE, PA 17013-3307
WITHDRAWAL OF CREDITOR'S CLAIM
The undersigned, WEST ASSET MANAGEMENT, INC., for CHASE BANK USA, N.A., requests the withdrawal of the
creditor's claim in the sum of $8,072.96 filed in the above entitled matter.
Dated this 07-27-2011
.~
WES ASSE~ANAGEMENT, INC
1-800-944-9244
Notice: Important Information
This is an attempt to collect a debt and any information obtained will be used for that purpose. This communication is
from a debt collector. To ensure professional service and legal compliance, all incoming and outgoing telephone calls to
West Asset Management are subject to recording and/or monitoring.
1022 - 9341 - WDCLM
Cardmember Service
PO Box 15548
Wilmington, DE 19886-5548
CHASE ~r
July 5, 2011
Robert Frey
5 S Hanover St.
Carlisle, PA 17013-3307
nliil„iliinil,I.,..iii~i,,I,i~iii,nlli,i„I,i„iinill~llilii
Account(s) Ending In: 2482
Dear Estate of: Roy Lauffer
We are writing to inform you Chase has reconsidered its claim(s) filed in this matter and has chosen to release
the claim(s) on the account(s) noted above. Please do not make any payments on this account. Chase will submit
all appropriate notices and filings and send to you documents to release the claim(s) on the above noted estate(s).
We are required by the IRS to provide information about certain amounts that are discharged as a result of a
cancellation of a debt on form 1099C. If we are required to notify the IRS, you will receive a copy of the form
1099C that is filed with the IRS.
Sincerely,
Customer Support Team
Account is owned by Chase Bank USA, N.A. LTRC566
A-A-00006085
Cardmember Service
PO Box 15548
Wilmington, DE 19886-5548
CHASE P
July 5, 2011
Rob Frey
5 S Hanover St.
Carlisle, PA 17013-3307
~~~~I~~~I~~irl~n~ll~l~~l~~i~~~l~l~~ll~l~~~i~il~~~~~~illl~illill
Account(s) Ending Ire: 4672, 1144
Dear Estate of: Roy Lauffer
We are writing to inform you Chase has reconsidered its claim(s) filed in this matter and has chosen to release
the claim(s) on the account(s) noted above. Please do not make any payments on this account. Chase will submit
all appropriate notices and filings and send to you documents to release the claim(s) on the above noted estate(s).
We are required by the IRS to provide information about certain amounts that are discharged as a result of a
cancellation of a debt on form 1099C. If we are required to notify the IRS, you will receive a copy of the form
1099C that is filed with the IRS.
Sincerely,
Customer Support Team
Account is owned by Chase Bank USA, N.A. LTRC586
A-A-00006076
Dept 11576
PO Box 1259
Oaks, PA 19456
IIIIIIIVIIIVIIIVIIIIIIIIIIIIIIIIIIVIII(IIIIIIIIIVIIIVIIIVIIIVIIIIIIIIIIIIIIII
10-31-2011
I"IIII'I'llllllllll"11111'IIII'lll'llllllllllll'll"I~I~I'lllll 9341-18
o ROBERT ROB FREY
g 5 S HANOVER ST
CARLISLE, PA 17013-3307
Dear Sir or Madam:
est ~e
a Management
7171 Mercy Rd
PO Box 6183
Omaha, NE 68106
RE: The Estate of:
Creditor:
Creditor Account Number:
Balance Due:
Case Number:
ROY LAUFFER
AMERICAN EXPRESS
**'`***'"`*'t14006
$5,664.54
21-09-00980
We represent AMERICAN EXPRESS and are following up on the above account which was held by AMERICAN
EXPRESS. We have filed a claim against the estate in CUMBERLAND under case number 21-09-00980.
Please provide us with the date the claim will be paid and if you have any questions, contact our office at 800-878-1267.
Our office hours are MONDAY -TUESDAY 7:OOAM - 8:OOPM, WEDNESDAY -FRIDAY 7:OOAM - S:OOPM, SATURDAY
7:OOAM - 11:OOAM CST/CDT.
Please make payment to:
WEST ASSET MANAGEMENT, INC.
P.O. BOX 956842
ST. LOUIS, MO 63195
Sincerely,
WEST ASSET MANAGEMENT, INC.
800-878-1267
Notice: Important Information
This is an attempt to collect a debt and any information obtained will be used for that purpose. This communication is
from a debt collector. To ensure professional service and legal compliance, all incoming and outgoing telephone calls to
West Asset Management are subject to recording and/or monitoring.
18-9341-FUCLM
sere ces
4150 OLSON MEMORIAL HIGHWAY, SUITE 20~
MINNEAPOLIS, MINNESOTA 55422-4811
TELEPHONE 763-852-8620 Hours (CT): 7:00 am - 9:00 pm M - TH
Fa,x 877-326-8784 7:00 am - 5:00 pm F
TOLL-FREE 877-326-5681 8:00 am - 12:00 pm S
October O1, 2010
ROB FREY FREY AND TALLEY
5 S HANOVER ST
CARLISLE PA 17013-3307
RE: Estate of:
Our Client:
Account No:
Unpaid Balance:
Reference No:
Probate Case Number
ROY LAUFFER
Citibank (South Dakota)
************6051
$11078.16
5770562
212009-0980
N.A. SEARS GOLD MASTERCARD
Dear Sir or Madam:
This letter is sent pursuant to 20 Pa.C.S.A. 3501.1. A significant amount of time has passed since the Personal
Representative was appointed. Our client wishes to minimize the burden to the Personal Representative of responding to
repeated requests for information regarding the Estate. For this reason, we have attached a Declaration which allows the
Personal Representative to comply with the duties prescribed by the code with minimal intrusion. We will accept the
completed Declaration in lieu of a Formal Accounting or Inventory, provided that the Estate complies with its duty to
supplement such information if additional assets are discovered. Citibank (South Dakota) N.A. SEARS GOLD MASTERCARD
requests a description of the status of the Estate and the payment of its claim. Please complete the attached Declaration
and return it promptly by facsimile or mail at the address or facsimile number listed above. Please consider that this request
is made pursuant to the probate code under which the Personal Representative has a duty to manage the affairs of the
Estate with the ordinary care and dilligence of a fiduciary and must pay all claims in order of priority to the extent that the
Estate contains sufficient assets to do so. Please note that the probate code does not exempt personal representatives of
independent or unsupervised estates from the duties to properly manage the affairs of the estate and to pay claims.
As an alternative to completing the Declaration or serving a copy of a Formal Accounting or Inventory, we will accept
$9416.44 as a resolution of the full amount owed, provided payment is received in our office on or before 10/28/10. Please
call one of our account representatives toll free at 1-877-326-5681 to confirm this arrangement or to make payment by
telephone.
Cordially,
DCM Services, LLC
This communication is from a debt collector. We are attempting to collect a debt and any information obtained will be used
for that purpose. Calls may be monitored or recorded for quality assurance purposes.
NOTICE: SEE REVERSE SIDE FOR IMPORTANT INFORMATION -Side 1 of 2-
~.
171!:18-7f76.3108
I'.(i. lux ±2,i;5
~itir~mansic»~-n. t~t~ i7iii I
August 30, 2010
~~~I11~~~1~~1~1~1~1~1~~~11,I~~~II~~~~~II~I~~I~~I~I~I~I~~~~
000263******************AUTO**ALL FOR AADC 170
ROYLAUFFER
C/O MRS ROY LAUFFER
225 HIGH MOUNTAIN RD
SHIPPENSBURG, PA 17257-9614
a~ ,
~~.
C~l~rnerr_ial ~~~e~~~n~~ ~'~r~pan~f
Aceourlts Receivizble Mc~~ia~;erriertc
Phone: (717) 901-4557
(800) 690-3857
Extension: 210--
CLIENT-NAME AGENCY CLIENT-# TOTAL-PAID BALANCE
~I#~`I'P'L~JG :AREA: -~E : N! ~ `S°~`T 9150 C~EPI=~B 4 9 - - _ _ __. __
TOTAL: $.OQ $1Db3.40
FINAL NOTICE
You have ignored all attempts to resolve this debt and ouroffice is considering'additanal action
againstyou to recover this money.
We can only assume from your silence: hat you are refusing o pay this obligation. If this is not the
case, you must contact your collection representative immediately. If your silence continues, we will
conclude that you are refusing to cooperate and further collection activity will result.
Unless satisfactory arrangements for prompt payment are made with this office within five (5) days
from receipt of this letter, we will proceed accordingly to bring this matter to a prompt conclusion.
This communication is from a debt collector. This is an attempt to collect a debt. Any infomration
obtained will be used for that purpose.
The representative assigned to your file is: BOBBY NAGLE at Extension 210--
You may now pay your bill online at our secure site, www.paycac.com. You will need to enter your agency number.
For security reasons, credit card payments will not be processed without the security code from the back of the card.
---=r-
c ria r ~; -_ Remit payment to:
CW2C{3QF p AASfjtft~~ _ ~~
---- ~_n.e..._.__.__._._ _..-__...._..___r I ..r..
__ __,._..._.__.v.~
GNai ~~i k~i'C?ATf<
I
~~ ~~ ~'``' sir+i Nur;tser BiN Clatc~_._.,-
~°'~ ~ °`~`°` P.O. Box 3268
$1063.40 I 579150 i 08/30/10 ~ Shiremanstown, PA 17011
t
Option. #1` I elect to pay OPTIONAL utility fee
Statement Date Account Number Due Date MONTHLY QUARTERLY TOTAL DUE
06/07/2010 730-298-094730 07/01/2010 $409.01 $502.63 $643.04
Please return appropriate coupon with US funded check for your chosen payment option
_ (fm) Please make corrections to address below
s
Roy S Lauffer
Regina M Lauffer
225 High Mountain Rd
Shippensburg PA 17257-9614
Make Checks
Payable to:
THOUSAND TRAILS
PO BOX 78843
PHOENIX, AZ 85062-8843
?302980947309361782073064304000643D49
. Detach above and return appropriate coupon wHh ~ ent. Please destroy unused r~upons.
Q~ption #2 1 elect to NOT pay OPTIONAL. utility fee
Statement Date Account Number Due Date MONTHLY QUARTERLY TOTAL DUE
06!07/2010 730-298-094730 07/01!2010 $393.01 $486.63 $627.04
Please return appropriate coupon with US funded check for your chosen payment option
{fm) Please make corrections to addrr ss below Make Checks
Payable to:
Roy S Lauffer THOUSAND TRAILS
Regina M Lauffer PO BOX 78843
225 High Mountain Rd PHOENIX, AZ 85062-8843
Shippensburg PA 17257-9614
73D298094730936178207406270400062704?
WSEMS -Chambersburg ALS ~~
205 GRANDVIEW AVE
SUITE 211 .~~
CAMP HILL, PA 17011 ~~~T SH~~
Phone #: (800) 367-0512 Federal Tax ID: 23-2463002 , ,;, ,•, ; ,., ., .j ,,; ,, , ~`, ,,., ,
PATIENT NAME: ROY LAUFFER
INSURANCE
009009109
ROY LAUFFER
225 HIGH MTN RD
SHIPPENSBURG, PA 17257
PATIENT NUMBER:
CALL NUMBER:
DATE OF CALL:
TIME OF CALL:
CALLER:
FROM:
TO:
REASON(S)
FOR
TRANSPORT
INVOICE
65862 REJ
009009109 RJ
10/12/2009
Police/Fire/911
225 HIGH MTN RD
CHAMBERSBURG HOSPITAL
CARDIAC ARREST
DESCRIPTION OF CHARGE QUANTITY UNIT PRICE AMOUNT
ALS EMERGENCY LEVEL 2 A0999 1.0 948.68 948.68
AMIODARONE 150mg Vial A0394 2.0 2.55 5.10
ATROPINE 1 MG A0394 2.0 5.39 10.78
EKG ELECTRODES (1) A0396 1.0 1.30 1.30
EPI 1 MG 1:1000 AMPULE A0394 4.0 2.93 11.72
ETC02 (ADULT) FILTERLINE SET A0422 1.0 25.80 25.80
King Airway a0422 1.0 94.50 94.50
LIDOCAINE 100MG A0394 1.0 5.25 5.25
NEEDLES (ALL) A0999 1.0 1.17 1.17
SODIUM BICARB 50MG A0394 1.0 6.22 6.22
SYRINGE (1000) A0394 2.0 1.05 2.10
1112.62
DESCRIPTION OF PAYMENT RECEIPT PAYMENT DATE AMOUNT
PLEASE PAY THIS AMOUNT -INVOICE DUE UPON RECEIPT -~
n~T~ ~onicn ruGrrr GcG _ Q~i nn
$1112.62
DETACH ALONG PERFORMATION AND RETURN STUB WITH PAYMENT
AMOUNT DUE 1112.62
PATIENT NAME: LAUFFER, ROY S CALL NUMBER 009009109 AMOUNT $
PATIENT NUMBER: 65862 BILLING DATE: 12/10/2009 ENCLOSED
THIS ACCOUNT IS PAST DUE! Send your payment now or contact ~ VISA
our office to make payment arrangements. ~ Mas
AND
MASTER CARD
ACCEPTED
WSEMS -Chambersburg ALS 205 GRANDVIEW AVE CAMP HILL, PA 17011
~ f ~
STATE OF PENNSYLVANIA STATEMENT ANO PROOF OF CLAIM FILE N0: 21.2009.0980
PROBATE COURT
CUMBERLAND COUNTY ,
Estate of ROY SCOTT LAUFFER
1, PNC BANK of ONE NATIONAL CITY PARKWAY, KALAMAZOO MI 49009 submit the following claim against the estate
for the sum set forth.
DESCRIPTION OF CLAIM AMOUNT
Type of Account: CREDIT CARD
Account Number: 4311 9675 2058 2574 $8,112.34
Date Opened: 211 611 9 9 5
There is now due on the claim, above all legal set-offs, the sum af: S8,112.34
[ 1 Notice to interested persons: This is a claim by a personal representative for an obligation that arose before the death of the decedent. A hearing will be
held to determine whether to allow the claim. You may object to the claim before or at the hearing.
I declare under penalties of perjury that this statement and proof of claim has bean examined by me and that its contents are true to the best of my
information, knowledge, and belief.
Date 3 , !~ ~ l 0
Attorne Signature
Name (t a or riot) C{aimant:.JANE ANDERSON 1 88.514.9121 EXT. 50281
PO BOX 5570
Address Address
CLEVELAND OH 44101.0570
Cit ,State, Zip City, State, Zip
' 7. Describe nature of claim or attach statement. Attach copy of receipt or other evidence of payment if submitted by assignee.
2. Claims must be presented either personally or by mail to the fiduciary on or before the last day for presentment of claims. This claim may
also be filed with the probate court (see reverse side for proof of service)'.
PLEASE SEE OTHER SIDE
Do oat write below this line -For court use only