HomeMy WebLinkAbout12-22-11REV-1162 EX111-961
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601 PENNSYLVANIA
RECEIVED FROM: INHERITANCE AND ESTATE TAX
OFFICIAL RECEIPT NQ, CD 015379
SHOTSBERGER MARIrr E
3943 BROOKRIDGE DAR
MECHANICSBURG, PA 17050
fold
ESTATE INFORMATION: ssrv: ass-38-270
FILE NUMBER: 21 1 1 -0454
DECEDENT NAME: SFHOTSBERGER JAMES A
DATE OF PAYMENT: 1 / 22/ 201 1
POSTMARK DATE: 1 /22/201 1
couNTY: CUMBERLAND
DATE OF DEATH: 03/ 23/ 201 1
ACN
ASSESSMENT AMOUNT
CONTROL
NUMBER
101 ~ 57,052.15
TOTAL AMOUNT PAID:
REMARKS: RECEIPT TO ATTY
CHECK# 1 107
INITIALS: HEA
SEAL RECEIVED BY:
57,052.15
GLENDA EARNER STRASBAUGH
REGISTER OF WILLS
REGISTER OF WILLS
- -
ti
INVENTORY
REGISTER OF WILLS OF
CpMMpNWEALTH OF PENNSYLVMWIA } SS
COUNTY of Cumberland }
Justin A. Shotsberger
personal Representative(s) of the
File Number 21-11-0454
of James A. Shotstterger
Inducts all dthe personal assets wherever
iced, depose(s) and says that the items appearing in the following inventory • osite each
situate and all of the real estate the CommonweaHh of Pennsylvania of sale , a~ ~~~~~ ~~~ o~ estate
item of said inventory represen its fair value as of the date of the decedent
outside of the Commarntveatth o Pennsylvania except ihat whi rs in a memorandum at the end of this inventory-
I verify that the statementsl,made in this lnven- ~ f 1 ~
tory are true and correct. I understand that false state- ustin A. Shotsberger
menu herein are made subject Ito the penawes of i
78 Pa.C.S. § 4904 relating to urhswom falsification to j
authorities.
Attorney - (Name)
(Firm)
(Address)
(telephone}
DaTE of DEATH
03/2312011
Pp.sc~nal Proos~ti[
Cash .................~...............
FIGURES MUST BE TOTALED
Personal Pro ............................................
Stocics/Listed ..r ............................................................................
...............................
Stocks/Closely (Held ......................................
Bonds ... ... ........ ~............................................................................
Partnerships ar~d Sole Proprie#orships .....................................
.......................
Mortgages ...,Notes Receivable ........................
Ail Other Propelrty •-• ..................... .............._.........................
TOtai Personal Property ........................................
D.
&I
737.8761
~nsr ~stoENCe 3843 Brookridge Drive
Total Real Property ................................................
Total Personal and Real Property......--•.••-••••-••••--
DECEDENTS SOC. SEG. rx~.
196-38=2701
1813,797.19
C7 5,9tif~lib : a-~
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T'3 ~--- t~`r-,
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192,757.19
~t~~~57.i9
NOTE: The Memorandum of lest outside the Cortmronweeltl~ of Pennsylvania mays Pam. Ce S §~3307~ ~~~1 repreaent~t[ve inChade tt~e slue of eadi
item, but such T~ures stioulrJ not be e~dended into the tafal of the Inventory. (See
CUMBERLAND COUNTY, PENNSYLVANIA
(Supreme Court LD. No.) 19475
PA
Form R11N-09 Ftev. f0-f3-2006
s `-
INVENTORY
REGISTER OF WILLS OF CUMBERLAND COUNTY, PENNSYLVANIA
COMMONWEALTH OF PENNSYLVANIA ~ SS File Number 21-11-0454
couNTY OF Cumberland
DECEDENTS SOC. SEC. NO.
DATE OF DEATH LAS RESIDENCE 3943 Brookridge Drive
n312312011 ', Mechanicsburg, PA 17050 196-38-2701
~~ Estate of Hilda M. Shotsberger -James A. Shotsberger was the sole beneficiary of the 186,797.19
Estate of hiss mother, Hilda M. Shotsberger. The net value of Hilda M. Shotsberger's
Estate was186,797.19. (See attached Pennsylvania Inheritance Tax Return for the
Estate of Hillia M. Shotsberger, same being attached at the end of this Return.)
Total Cash 186,797.19
Personal Pronert=
1998 Chevrolet Corvette -VIN # 1G1yY23P9N5116882. Value is per attached Edmonds. 5,960.00
com report. Please note this car is in rough condition. It is not inspected. It has
mechanicalissues and body damage. The car is not driveable. A private party sale is
assumed a~ the car cannot be driven to a dealer for trade-in or sale.
Total Personal Property 5,960.00
Total Personal Property and Real Estate 192,757.19
;Attach additional sheets if nee essary)
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