HomeMy WebLinkAbout01-10-121505610143
--' REY-1500 Ex(a,_,o> -;
OFFICIAL USE ONLY
PA Department of Revenue Pennsylvania courny code Year File Number
Bureau of Individual Taxes °B"N1MENTOF1~"'~
Po Box.28oso~ INHERITANCE TAX RETURN 21 11 0 691
Harrisburg, PA 17128-0601 RESIDENT DECEDENT
ENTER DECEDENT INFORMATION BELOW
Social Security Number Date of Death Date of Birth
190 16 1924 05 16 2011 12 Ol 1923
Decedent's Last Name Suffix Decedent's First Name MI
SHIVELY VIVIAN J
(If Applicable) Enter Surviving Spouse's Information Below
Spouse's Last Name Suffix Spouse's First Name
MI
Spouse's Social Security Number
THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
FILL IN APPROPRIATE OVALS BELOW
t. Original Return ^ 2. Supplemental Retum ^ 3. Remainder Retum (date of death
prior to 12-13-82)
^ 4. Limited Estate ~ 4a. Future Interest Compromise ^ 5. Federal Estate Tax Retum Required
(date of death after 12-12-82)
g Decedent Died Testate
(Attach Copy of Will)
^ ~, Decedent Maintained a Living Trust 0 8. Total Number Of Safe Deposit Boxes
(Attach Copy of Trustj
^ 9. Litigation Proceeds Received ^ tD• be~eenP2 3i ~i end ~iesS~~aU' ^ 11.Election to tax under Sec. 9113(A)
(Attach Sch. O)
CORRESPONDENT -THIS SECTION MUST SE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO:
Name Daytime Telephone Number
WM D SCHRACK III ESQ 717 432 9'~3 `~ ~~ =~`~'
~~ , ,~.
~ ,-.
r- - -
First line of address
124 W HARRISBURG STREET
Second line of address
City or Post Office
DILLSBURG
REGISTER OF WILG9 t~E~NLY -~
~ra ~:,
~'"~ v~ --
y3
7.> -'ert
~_
DATE FILED
State ZIP Code `
PA 170191268
Correspondents a-mail address: SchracklaW@comcast.net
Under penalties of perjury, I declare that I have examined this return, induding accompanying schedules and statements, and to tfte best of my knowledge and belief,
it is true, corned and complete. Dedaratron of preparer other than the persona representative is based IN1 all intomtation of which preparer has arty knowledge.
ATURE OF PERSO' RESPONSI~FOR FILING RETURN ~ ~+ uni t
'YYAA~r //// C.w.dw.:wL A Q.....Iw..w 11 / a.~~~/~
6 Villa a Roa ech "csbu PA 17050
SIGNATURE OF PR AR R T REPR THE DATE
Wm. D. Schrack III Esq. 1. ~ ~~,
124 W. Harrisburg Street, Dillsburg, PA 17019-1268
Side 1
L 1505610143 1505610143
1505610243
REV-1500 EX
Decedent's Social Security Number
Decedent's Name: Shively, Vivian J. 190 16 1924
RECAPITULATION
t. Real Estate (Schedule A) ....................................................................................... 1.
2. Stocks and Bonds (Schedule e) ............................................................................. 2. 3 , 157.62
3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C)......... 3.
4. Mortgages & Notes Receivable (Schedule D) ........................................................ 4.
5• Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) ............... 5. 37 , 16 6.10
6. Jointly Owned Property (Schedule F) ^ Separate Billing Requested............ 6. 30 , 813.8 9
7. Inter-Vivos Transfers & Miscellaneous I~nq-Probate Property
(Schedule G) LJ Separate Billing Requested............ 7. 72 , gO0 . 83
8. Total Gross Assets (total Lines 1-7) ..................................................................... 8. 143 , 938.44
9. Funeral Expenses & Administrative Costs (Schedule H) ....................................... 9. 13 , 433.50
10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .............................. 10. 4 , 417.53
11. Total Deductions (total Lines 9 & 10) ................................................................... 11. 17 , 851.03
12. Net Value of Estate (Line 8 minus Line 11) .......................................................... 12. 12 6 , 0 8 7.41
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. 12 6 , 08 7.41
TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES
15. Amount of Line 14 taxable
at the spousal tax rate, or
transfers under Sec. 9116
15
O
OO
(a)(1.2) X .00 . .
16. Amount of Line 14 taxable
12 6
0 8 7 .41
16
5
67 3.93
,
at -ineal rate X .045 . ,
17. Amount of Line 14 taxable
0
00
17
0
00
.
at sibling rate X .12 . .
18. Amount of Line 14 taxable
O
00
18
O
OO
.
at collateral rate X .15 . .
1s. Tax Due .................................................................................................................. 1s. 5,673.93
20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT.
Side 2
1505610243 1505610243
REV-1500 EX Page 3
Decedent's Complete Address:
File Number 21-11-0691
DECEDENTS NAME
Shively, Vivian J.
STREET ADDRESS
6 Village Road
CITY
Mechanicsburg STATE
PA ZIP
17050
Tax Payments and Credits:
1. Tax Due (Page 2, Line 19)
2. Credits/Payments
A. Prior Payments
B. Discount
3. Interest
6,250.00
283.70
q, If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check 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.
5,673.93
6,533.70
859.77
(5)
jj Make Check Payable to. REGISTER OF WILLS, AGENT.
.. .:4'4..,. .~l~ya.. "~:, ~~~~',-~r" _ `~~t~1"°~~' .~ ~~:.,... ";'"fit.. .~ _.. >.
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 ............................................................................................................... x
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 "in trust for" or payable 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 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 January 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 transferto 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)]. A
sibling is defined under Section 9102, as an individual who has at least one parent in common with the decedent, whether by b{ood or adoption.
(1)
Total Credits (A + B) (2)
(3)
(4)
Rev-1503 EX+ (6.98)
SCHEDULE B
STOCKS & BONDS
COMMONNiEAITH OF PENNSYlVAN1A
INHERITANCE TA% RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shively, Vivian J. 21-11-0691
All property Jointly-ownedwith right of survivormhip must be disclosed on Schedule F.
ITEM
NUMBER CUSIP
NUMBER
DESCRIPTION
UNIT VALUE VALUE AT DATE
OF DEATH
1 Series EE U. S. Savings Bonds (see attached) 3,157.62
TOTAL (Also enter on Line 2, Recapitulation) 3,157.62
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule B (Rev. 6-98)
Rev-1508 EX+ (6-98)
SCHEDULE E
CASH, BANK DEPOSITS, 8~ MtSC.
PERSONAL PROPERTY
COMMONNiEALTN OF PENNSYLVANIA
IMiERrrANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shively, Vivian J. _ 21-11-0691
Include the proceeds of la~lganon arrd the date the proceeds were received by the estate.
All property jointly-ownodwith the right oTsurvivorshlp moat be dixlosedon xhedulr. F.
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule E (Rev. 6-98)
Rev-1509 EX+ (6-98)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
ESTATE OF ,FILE NUMBER
Shively, Vivian J. 21-11-0691
K an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G.
SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT
A. Frederick A. Souders II 6 Village Road Child
Mechanicsburg, PA 17050
B.
C.
JOINTLY OWNED PROPERTY:
ITEM
NUMBER
LETTER
FOR JOIN
TENANT
DATE
MADE
JOINT DESCRIPTION OF PROPERTY
INCLUDE NAME OF FINANCULL INSTITUTION AND BANK ACCOUNT
NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR
JOINTLY-HELD REAL ESTATE.
DATE OF DEATH
ALUE OF ASSET /o OF
DECD'S
INTEREST
~vnLUE OFFTM
DECEDENTS INTEREST
1 A 10/01/1997 Metro Bank -checking account #82001496 61.627.77 50.000°k 30,813.89
TOTAL (Also enter on Line 6, Recapitulation) ~ 30,843.89
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule F (ftev. 6-98)
Rev-1510 EX+ (6-98)
SCHEDULE G
INTER-VIVOS TRANSFERS &
MISC. NON-PROBATE PROPERTY
cosunoNwfxrN oFVENNSnvANa
INF~RITANCE TAX RETURN
RESIDENT OECEDENi
ESTATE OF I FILE NUMBER
Shively, Vivian J. 21-11-0691
This schedule must be completed and filed K the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes.
ITEM
NUMBER DESCRIPTION OF PROPERTY
ITM LDATEE O TROANSFRER.SATTACFI ACOPY OFTTHE DEIED FOOREREAL EsT~ATE. DATE OF DEATH
VALUE OF ASSET % OF DECD'S
I~REST ( EXCI.usION
IF APPLICABLE) TAXABLE
VALUE
1 Vanguard Variable Annuity Contract #700005743 72,800.83 72,800.83
TOTAL (Also enter on Line 7, Recapitulation) I 72,800.83
(If more space is needed, additional pages of the same size)
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule G (Rev. 6-98)
REV-1151 EX+i10-06)
SCHEDULE H
COM~N~~D~~IYLVANw ADM NIBTRAT VE COS S
ESTATE OF FILE NUMBER
Shively, Vivian J. 21-11-0691
Debts of decedent must be reported on Schedule I.
ITEM DESCRIPTION AMOUNT
N M
A, FUNERAL EXPENSES:
See continuation schedules} attached
8,832.00
B.
1. ADMINISTRATIVE COSTS:
Personal Representative's Commissions
Name of Personal Representative(s)
Street Address
City State Zio
Year(s) Commission paid
2. Attorney's Fees Wm. D. Schrack III Esq. 4,500.00
3, Family Exemption: (If decedent's address is not the same as claimant's, attach explanation)
Claimant
Street Address
City State Zio
Relationship of Claimant to Decedent
4. Probate Fees 71.50
5. Accountant's Fees
6. Tax Retum Preparer's Fees
7. Other Administrative Costs 30.00
See continuation schedule(s) attached
TOTAL (Also enter on tine 9, Recapitulation) 13,433.50
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 10-06)
SCHEDULE H
FUNERAL EXPENSES AND ADMINiSTRATfVE COSTS
continued
ESTATE OF FILE NUMBER
Shively, Vivian J. 21-11-0691
ITEM
NUMBER DESCRIPTION AMOUNT
Funeral Ex en uses
1 Buffalo Valley Church of the Brethren -funeral luncheon 300.00
2 Myers-Buhrig Funeral Home and Crematory 8,532.00
H-A 8,832.00
Other Administrative Costs
3 Miscellaneous expenses during period of administration 15.00
4 Register of Wills -Inheritance Tax Retum filing fee 15.00
H-B7 30.00
Copyright (c) 2002 form software only The Lackner Group, Inc. Form PA-1500 Schedule H (Rev. 6-98)
Rev-1512 EX+(12A8)
SCHEDULE 1
DEBTS OF DECEDENT,
MORTGAGE LIABILITIES, ~ LIENS
coMtaoNwfw~TH of vENNSVwANu
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
Shively, Vivian J. 21-11-0691
Report debts ineuned by the decedent prior to death that remained unpaid atthe date of death, including unreimburssd rtMdic~ expenses.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
1 Azizkhan Internal Medicine Associates -last illness 41.41
2 Country Meadows Nursing & Rehabilitation Center -debt of decedent 4,061.25
3 Dr. Shah -last illness 20.00
4 Freedom Blue -debt of decedent (insurance premium) 161.00
5 Hospice of Central Pennsylvania -last illness 100.00
6 West Shore EMS -last illness 33.87
TOTAL (Also enter on Line 10, Recapitulation) I 4,417.53
(If more space is needed, additional pages of the same size)
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule I (Rev. 12-08)
REV-151 ~ EX+ (11.08)
~F,q7~ SCHEDULE J
COMI"R IID DECEDE~N RNAN~ BENEFICIARIES
ESTATE OF
FILE NUMBER
5hlvel , vlvian ~. 21-11-06 91
NAME AND ADDRESS OF RELATIONSHIP TO
SHARE OF ESTATE
AMOUNT OF ESTATE
NUMBER PERSON(S) RECEIVING PROPERTY DECEDENT (Words) ($$$)
I TAXABLE DISTRIBUTIONS [inGude outright spousal
~ distributions, and transfers
under Sec. 9116 a 1.2
Frederick A. Souders II Child residuary estate 126,053.54
6 Village Road
Mechanicsburg, PA 17050
Total 126,053.54
Enter dollar amounts for distributions shown above on lines 15 throw h 18 on Rev 15 00 cover sheet, as a r o riate.
NON-TAXABLE DISTRIBUTIONS:
II. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN
B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS
TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET
Copyright (c) 2009 form software only The Lackner Group, Inc. Form PA-1500 Schedule J (Rev. 11-08)
CLIENTS\SHNELY, David\Vivian -Will
;rust ~;11 una ~estmecet~
OF
VIVIAN j. SHIVELY
BE IT REMEMBERED, that I, VIVIAN J. SHNELY, of 873 Hawthorn Avenue,
Mechanicsburg, Upper Allen Township, Cumberland County, Pennsylvania, being of sound
mind, memory, and understanding, do make, publish, and declare this as and for my Last Will
and Testament, hereby revoking and making null and void any and all Wills and Testaments and
writings in the nature thereof by me at any time heretofore made.
ITEM 1: I direct that my hereinafter named Co-Executors pay all my just debts, my
funeral expenses, and the expenses of the administration of my estate. With this direction, I
authorize and empower my Co-Executors to expend for my funeral expenses and interment such
amounts as may be considered necessary and proper, without regard to any limit that may be
rYescribed b;T a court of lave.
r-
ITEM 2: I direct my Co-Executors to pay all inheritance, estate, succession, and
legacy taxes of whatsoever nature and kind, to which my estate or t:he transfer of any property
passing hereunder or otherwise passing by reason of my demise, may be subject and to charge
such taxes against my residuary estate, it being my intention that none of the aforesaid taxes,
either federal or state, on any property required to be included in my gross estate, under the
provisions of any state or federal law now in force or hereafter enacted, shall be prorated among
the persons interested in my estate to whom such property is or may be transferred or to whom
any benefit accrues.
ITEM 3: I give and bequeath unto my spouse, DAVID G. SHIVELY, the right to
the use and enjoyment of my personal property and family antiques which are found in our
marital home at the time of my death.
ITEM 4: I give and bequeath unto my spouse, DAVID G. SHNELY, all of my
personal possessions that are stored in the basement of our home.
ITEM 5: I give and bequeath unto my son, FREDERICK .A. SOUDERS II, all of my
financial investments, antique corner cupboard, antique marble top stand, small milk glass lamp
with red shade, antique coffee grinder, antique crystal sugar holder, the large clear antique oil
lamp on the mantle, the five needlepoint pictures that were made by h.is grandmother, two pull-
up chairs with needlepoint seats and the contents found in boxes above the garage in an area
labeled "Vivian's Property".
ITEM 6: If my husband survives me, I give, devise and bequeath my one-half
interest in our marital premises known as 873 Hawthorn Avenue, Mechanicsburg,
Pennsylvania unto REBECCA L. BAILEY and JEFFREY L. BAILEY, Trustees of the Funded
Revocable Trust created by David G. Shively on February 1, 2005. On the occasion of my
i., ..
j
~~.
I a:
I
_..
r
=`'~
-_
Page -2-
husband's death, I then direct that my son, Frederick A. Souders II, and my husband's daughter,
Rebecca L. Bailey, arrange to have the residence property marketed and the net proceeds
divided into two equal shares, with one being distributed to my son, FREDERICK A.
SOUDERS II, and the other to my husband's daughters, REBECCA L. BAILEY and CRISTINA
M. POULIN.
ITEM 7: I appoint my son, FREDERICK A. SOUDERS II, as Executor of this my
Last Will and Testament, directing that he shall not be required to give bond for the faithful
performance of duties in this or any jurisdiction.
~~ ` ~~
IN WITNESS WHEREOF, I have hereunto set my hand and seal this ,^~.. day of
-- • ~~--'~ ,~~.~ , 2008.
= l r
H
~'
_ ,
VIVLAN j. SHNELY ~' ~'
The preceding instrument, consisting of this and two (2) other typewritten pages, was
on the day and date thereof signed, sealed, published, and declared by the Testatrix herein
named, as and for her Last Will and Testament, in the presence of us, who, at her request, in her
presence a din the presence of each other, have subscribed our names as witnesses hereto.
~. ~~- ~ ;`
:~ ~ ` f
~ OF '~ .,
--
Page -3-
COMMONWEALTH OF PENNSYLVANIA
COUNTY OF YORK _ /" ~
We, VNIAN J. SHIV,~LY,
SS. /
!`~
and
/ ~~ ( ~ ~~ ~ the Testatrix and the witnesses,
°- U
respectively, whose names are signed to the attached ar foregoing ir~stru,-nert, being first d~~ly
sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed
the instrument as her Last Will and Testament, and that she signed willingly, and that she
executed it as her free and voluntary act for the purposes therein expressed, and that each of the
witnesses, in the presence and hearing of the Testatrix signed the Will as witnesses, and that to
the best of their knowledge, the Testatrix was at the time eighteen (1'8) years of age or older, of
sound mind, and under no constraint or undue influence.
SWORN TO AND SUBSCRIBED
BEFORE ME THIS ~S~DAY
OF ~~-~~P/YN ~.~~ , 2008.
NOTA PU~LIC
COMMONW ALTH OF PENNSYLVANIA
[dot2ral Seal
Jane; S. ^o: ~. t.otay Pt~'ac
Dillsb~ry Boro, ''.^,.h County
My Commission E:~ ~ires (~. 25: 2010
Member, Penns~dvania Association of Notaries
culated Value of Your Paper Savings Bond(s)
~Iculated Value of Your Paper Savings Bond(s)
~z~culator Results for Redemption Date 05/2011
Page I of 1
Total Price Total Value Total Interest YTD Interest
$825.00 $3,157.62 $2,332.62 $52.82
Winds: 1-33 of 33
Serial # Series Denom Issue Next Final Issue Interest Interest Value Note
Date Accrual Maturity Price Rate
~03694379ee EE $50 `12/1986w06/2011" 12/2016 . $25.00 $56 76 ' 4 00% $81.76
"J3694378ee
EE
$50
'.11/1986 11/2011
11/2016 ~
$25.00
$58 40
!; 4.00% „ _
_.
$83.40
03694377ee EE $50 "10/1986.10/2011; .10/2016" $25.00 $67.74 4.00% $92.74
~503694376ee EE $50: 10/1986 10/2011'.. 10/2016 .
_$25.00 $67.74 .. 4.00% $92.74
_..~3694375ee EE $50 ;09/1986 09/2011: 09/2016 $25.00 $67.74 4.00%
_ $92.74
~r~.03694374ee
EE
$50
08/1986 08/2011;
08/2016
$25.00
$67.74 _
4.00%
$92.74
_r 3694373ee EE $50 07/1986 07/201,1: 07/2016 ,$25.00 $67.74 4.00% $92.
74
~:;3694372ee EE $50: .06/1986 06/2011 06/2016 $25.00 $67.74 ,
; 4.00% .
$92.74
_: -~3694371ee EE $50 .05/1986 11/2011 05/2016 $25.00 $69.60 4.00% $94.60
~_~~03694370ee
EE
$50;
04/1986 10/2011:.
04/2016
$25.00
$69.60
; 4.00% ,
$94.60
~~ ~'~3694369ee EE $50 ' 03/1986 09/2011 03/2016; $25.00 $69.60 4.00% $94.60
__~'J3694368ee EE $50 02/1986 08/2011.: , 02/2016 .$25.00 $69.60 ' 4.00% $94.60
~~„''3694367ee EE $50: 01/1986 07/2011 01/2016 .
$25.00 $69.60 '- 4.00%: $94.60
:'_~C3694366ee EE $50: 12/1985;06/2011; 12/2015: $25.00 $69.60 4.00% $94.60
~~!3694365ee EE $50: 11/1985 11/2011 11/2015 $25.00 $71.50 '
4.00% $96.50
_„~"3694364ee EE $50: 10/1985 10/2011._ 10/2015 ,
$25.00 „
$71.50 .
4.00% $96.50
~,~J3694363ee EE $50' 10/1985 10/2011 10/2015 $25.00 $71.50 '. 4.00% $96.50
~:-~~3694362ee EE $50 09/1985.09/2011 09/2015 $25.00 $71.50 4.00% $96.50
+'~3694361ee EE $50., .08/1985 08/2011,; 08/2015, „$25.00 $71.50 ; 4.00%! $96.50
:~'3694360ee
_ EE $50' .
07/1985 07/2011 07/2015 $25.00
_ $71.50
_ _ ' 4.00%'
_ _ $96.50
_
:~33694359ee
EE
$50:
06/1985 06/2011
06/2015
$25.00
$71.50
' 4.00% __ _ _.__
$96.50
;3694358ee EE $50 05/1985 11/2011 05/2015; $25.00 $73.42 '. 4.00% $98.42
6~.;3694357ee EE $50 " 04/1985 10/2011 ' 04/2015 .$25.00 $73.42 ',
4.00% $98.42
~~03694356ee EE $50 03/1985 09/2011 03/2015 $25.00; $73.42 ,
' 4.00% $98.42
~03694355ee: EE $50 02/1985 08/2011 02/2015 $25.00. $73.42 4.00%' $98.42
~•~~3694354ee EE $50 .
01/1985 07/2011'. 01/2015 $25.00
$73.42 °
4.00 /o
$98.42
""3694353ee EE $50 , 12/1984 06/2011 ' 12/2014 $25.00 ,
$73.42 4
.00% $98.42
. ~.;3694352ee EE $50 11/1984 11/2011 11/2014' $25.00
$75.40 :
_
°
;
4.00 %
$100.40
"^3694351ee
~~-~ EE $50' 11/1984 11/2011.,. 11/2014 $25.00 $75.40 ,
4.00%j $100.40
3694350ee
EE
$50',
10/1984 10/2011 '
10/2014
$25.00
$75 40
4 00% _ __ _ _
$100 40
~~'3694349ee EE $50. 09/198409/2011a 09/2014' $25.00 $75.40 : 4.00% $100.40
5~3694348ee
EE
$50'
08/1984, 08/2011 ~
08/2014
$25 00
$75 40
4.00% .
_..
$100.40
'__:C3694347ee EE $5D 07/1984 07/2011 07/2014 $25.00,
$75.40
: 4.00
$100.40
_._. Totals for 33 Bonds $825.00: .
$2,332.62 $3,157.62
Notes
"r~ :Not Issued
__ ._
`~~ :Not eligible for payment
a'~ 'Includes 3 month interest penalty
'•~ ": Matured and not earnin interest
~'.: ~:'/www.treasurydirect. govBC/SBCPrice 6/2/2011
i'
MEMBERS 1~
FEDERALCREDTf UNION
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 Beneficiary
CERTIFICATE OF DEPOSIT:
314173-00
09/19/2007
$1,073.96
$.11 -
$1,074.77
Frederick Souders
Account Number/Suffix 314173-40 314173-41
Date Account Established 07/14/2010 07/14/2010
Principal Balance at Date of Death $15,000.00 $20,000.00
Accrued Interest to Date of Death $6.78 $9.78
Total Principal and Accrued Interest $15,006.78 $20,009.78
Name of Beneficiary Frederick Souders Frederick Souders.
BERS 1ST FEDERAL CRE IT UNION
Danielle A. line • \:
Lending Insurance Support Specialist
June 16, 2011
Estate of: VIVIAN SHIVELY
Date of Death: 0 511 6/201 1
Social Security Number: 190-16-1924
5000 Louise Drive • '?O. Box 40 Mechanicsburg, Peiuzsyhalua 17055 (800) ?83-2328 w-w~~~-.memberslst.org
METRO
BANK
June 27, 2011
Law Office of Wm. D. Schrack Ill
124 W Harrisburg St
Dillsburg PA 17019
3801 Paxton Street 888.937.0004
Harrisburg, PA 17111 mymetrobank.com
RE: Estate of: Vivian J. Shively
Tax Identification Number: 190-16-1924
Date of Death: May 16, 2011
To Whom It May Concern:
This letter is in reference to decedent account information you requested for the individual listed above.
We are able to provide the following:
Account Type: Checking
Account Number: 52001496
Date Opened: IO/Ol/1997
Primary Owner: Vivian J. Shively
Secondary Owner: Fred A. Souders
Date of Death Balance: $61627.77
There is a Safe Deposit box under Vivian Shively's name held at our Simpson Ferry location. The address is 5032
Simpson Ferry Rd, Mechanicsburg PA 17050.
Please feel free to contact me at (717) 412-6127 if 1 may be of further assistance.
Sincerely,
~%~/_~/~
Diana Reynolds ~ - .
Metro Bank
Research Associate/Deposit Services
Van~uard`~
July 6, 2011
ESTATE OF VIVIAN J SHIVELY
C/O WM. D. SCHRACK III
124 WEST HARRISBURG ST
DILLSBURG, PA 17019-1268
Dear Mr. Schrack:
PO. Box 7105
Valley Forge, PA 19482-1105
www.vanguard.com
Thank you for your continued interest in the Vanguard Variable Annuity Contract
700005743. Below is the date-of-death value you requested for the above
contract.
Date-of-death value: $72,800.83 as of 5/16/2011
If you have any questions, please call Vanguard Annuity and Insurance Services
at 800-462-2391 on business days from 8 a.m. to 8 p.m., Eastern time.
For complete information about any of our investment services, please visit our
website at www.vanquard.com to access and download information. You may
also want to become a registered user of vanguard.com to manage your
accounts, 24 hours a day.
Sincerely,
Rachel Connors
Registered Representative
Annuity and Insurance Services
30292313
LAW OFFICE OF
WNI. D. SCHRACK III
124 WEST HARRISBURG STREET
DILLSBURG, PA 17019-1268
Telephone 717-432-9733 E-M~ul Address:
Telefax 717-432-1053 Schracklaw@comcastnet
January 9, 2012
Register of Wills ~"~- l~~
..~. c~
Cumberland County Court House "~, ~ ~
1 Courthouse Square _
i i "" ~-~ :~::
t y,r~-, --
Carlisle, PA 17013-3387 -= ~n ~ ~
Re: 'The Estate of Vivian J. Shively
~V
• • ~ ;-~,-
.x~ ~~
D/D: May 16, 2011 " ~-~
File #: 21-11-0691
SS#: 190-16-1924
Dear Register:
You will find enclosed herewith the original and one copy of'the REV-1500 Resident
Decedent Inheritance Tax Return that is filed on behalf of Executor Frederick A. Souders II.
Also enclosed is a cover sheet which is stamped "COPY". Please accept the Return for filing,
time-stamp the COPY, and return that to me in the envelope provided.
Additionally, I enclose the original and a copy of the Rule 6.12 Status Report, asking that
it be accepted, and that the COPY of that document also be returned to me.
Appended to the bottom of this letter is a check for the sum of $15.00, which covers the
cost of filing the Return. Thank you for your attention to this request.
Very y yours,
. D. Schrack
WDS/jsg
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