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HomeMy WebLinkAbout03-0691 PETITION FOR PROBATE and GRANT OF LETTERS also known as To: Register of Wills for the. Deceased. County of C,,,,-~,,..., [~, ,,/ in the Social Security No..~n~ 6~ - 0 3 w G ~ ~_t Commonwealth of Pennsylvania The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut ,~ "' named in the last will of the above decedent, dated tD c. 4- o .b~,~-- and codicil(s) dated x~><~/ / '~ (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in. ~"o ~l~ -' .)~, ~,d( · County, Pennsylvania, with h I B .last family oLorincipal residence at t~r /ea.,'.~, ~J,'~.£ff .-~ac--. t3~ ~-- I"~ { (.'~ (list street, number and muncipality) Decendent, then 1~ O years of age, died . ~"~ ~ o~'~' ] ! ,99 , at Ct'-" [j~o_ ~-~-~,~..~ r~,d,'t,~ ] ~'x~-~ ~ . Except as follows, decec~nt did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: ©, (If domiciled in Pa.) All personal property $ (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in Pennsylvania $ situated as follows: WHEREFORE, petitioner(s) respectfully ~;equest(s) the probate of the last will and codicil(s) presented herewith and the grant of letters -} e..g ~ ,,~,e_,,c2)-,t, 4_ (testamentary; adm~istration c.t.a.; administration d.b.n.c.t.a.) theron. = I~-~air~i~ld OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF ~. ~ ~.--),.-,q/ f ss The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly administer the estat~e,itccording to law. Cx l~ ll// Sworn to or affirmed and subscribed ~'-~/~ r ~~C~ ~  before me this 2 l~t day of ~ [~ ~' Donna ~. otto-,~st 0~put~- fi/ Reg~skr 1--~ ~ 17.-/¢o.-/ STATUS REPORT UNDER RULE 6.12 ~r~n~ Co R~e 6.12 o[ the Supr~e Court O~h~~ Court Rules, I report fo~~ ~th respec~ ~o c~le~ion o[ ~he a~inisCracion of the above-cap~ioned estate: .1. State ~er a~~ation of the estate is c~lete: Yes Ho , 2. If the a~er is No, state vhen the person~ representative reaso~bly be~eves that the a~tration ~ be c;lete: 3. If the ~er to Ho. I is Yes, state the fo~g: a. Did the perso~l r~esentative f~e a f~ accost ~th the Court Yes No b. ~e separate O~b~s' Court No. (~ ~y) for the perso~l representative's accost ~: c. Did the persona~ representative state an account informally to the parties in interest: Yes / No d. Copies of receipts, releases, Joinders and approvals of formal or informal acounts may be filed vith the Clerk of the Orphans' Court and/,may be attached to this report. S:f~gnature . Nsme (Please t]rpe or pr/hr) Address ~ Telephone No. Capacity: Personal Representative ~Cotmsel for Personal Representative No. 21-2003-691 Estate Of ~-.e__x J~.,~ f, ,~,~ ~f._,- , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW Au gu s t 21 s t, 1~: 2 0,0, ~n consideration of the petition on the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated October 3Ot-h: 7001 described therein be admitted to probate and filed of record as the last will of LESTER A. SHEAFFER ; and Letters TESTAMENTARY are hereby granted to JAMES M. SHEAFFER Register of Wills Donna M. Otto,lst Depu;~! FEES Probate, Letters, Etc .......... $40.00 wa]i-er ~_ Galen # 39789 Short Certificatesi8 ) .......... $ 24.00 ^rrORN£¥ (Sup. Ct. I.D. No.) ~~;a~x...xr. Po.gea(3.)$ 9,00- 28 s. Pitt Street JCP $10.00 Copies 1 50 Carlisle ADDRESS . , PA 17013 (717) 245-9685 Filed AuSus. t..21at,.20.03...$..8..4.: .5.0.. Total PHONE CAll Attorney when letters are done 8/21/03 This is to certify that the information here given is correctly copied from an original certificate of death duly filed with me as Local Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It is illegal to duplicate this copy by photostat or photograph. P 960921 S No. ~ Date 21-2003-691 mos.~q,.,,. 2~' COMMONWEALTH OF PENNSYLVANIA * DEPARTMENT OF HEALTH · VITAL RECORDS ~ CERTIFICATE OF DEATH ,,Mt. Hottff Springs, PA17065 ~' ,~.6 ~~ Mt. Hottff Springs ,t James A. Sheaffer C. ~~,~~James fl. Sheaffer 18 Falr iegd St. Mt. Hoiiff Springs,PA 17065 01158~[ ~o~ , P~ 170~ LESTER A. SHEAFFER I, Lester A. Sheaffer, of Mt. Holly Springs, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do make, publish and declare this to be my Last Will and Testament, hereby revoking and making void all previous Wills and Codicils heretofore made by me. FIRST I order and direct my personal representative hereinafter named to pay all of my just debts, funeral expenses and expenses involved or connected with the administration of my estate as soon after my death as is reasonably possible. However, my personal representative need not accelerate and pay those unmatured obligations which, in his opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. I already own a burial plot and grave marker. It is my desire that final arrangements be made with Hollinger Funeral Home, Mt. Holly Springs, PA SECOND I give and bequeath the following items to my son, James M. Sheaffer, per stirpes: my rifles, any motor vehicle that I own at the time of my death, and my riding lawn mower as well as all items of personal property located in the home of my son at the time of my death. The inheritance tax payable on these items shall be paid from the residue of my estate. THIRD I give, device and bequeath the rest residue and remainder of my estate, wheresoever situated in whatsoever situated in equal shares, share and share alike, per stirpes to my children Margaret S. Simon, ¥onnie A. Bierman, Norman J. Sampson, Richard D. Sheaffer, Virginia A. Russell and James M. Sheaffer. FOURTH I nominate, constitute and appoint my son, James M. Sheaffer, as Executor of this my Last Will and Testament. FIFTH I hereby declare it to be my expressed desire that my personal representative employ Turo Law Offices of Cumberland County, Pennsylvania, for legal advise and assistance regarding this my Last Will and Testament, they having considerable knowledge of my affairs, views and wishes respecting any matters that may arise at the probate of this instrument, the administration of my estate, and the execution of the powers herein mentioned. IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Will and Testament this "~ day of ~ C_./-o-~ , 2001. Witness Lester A.-S'hea~er ~/'-/ - v Witl~e-ss -~7/- .... ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA · 'SS COUNTY OF CUMBERLAND · I, Lester A. Sheaffer, the Testator whose name is signed to the attached or foregoing instrument, having been duly qualified according to the law, do hereby acknowledge that I signed and executed the instrument as my Last Will and Testament; that I signed it willingly, and that I signed it as my free and voluntary act for the purposes therein expressed. L~t~r A. Sl~ea'f~er // Sworn or affirmed and acknowledged before me by Lester A. Sheaffer, the Testator, this .~ c2 day of (~_~Z~ ,2001. Notary P,,ublic i Notadal Seal .............. Robert J. Mulderig, Notary Publi¢~ Cafllate Boro, CumberlandCou~ty ~.Commission Expires Nov. 13, 2004 AFFIDAVIT COMMONWEALTH OF PENNSYLVANIA : :SS COUNTY OF CUMBERLAND : We, ,CJ //~<~""~' and .~(~?u~/.,/~,'~' ~.~6-, the witnesses whose names are attached to the foregoing document, being duly qualified according to the law, do depose and say that we were present and saw Testator sign and execute the instrument as his Last Will and Testament; that he signed willingly and that he executed it as his free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testator signed the Last Will and Testament as witnesses and that to the best of our knowledge the Testator was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. Sworn or affirmed and subscribed before me by /'~,.,..~74~, and ~: ~;,,~,~.'~' ~.F~-" this ,.j'~ day of ,×'~'~.'~:~.~'~'~ ,2001. Notary Public v ~.~ Notadal ~1 R~d J. Muldedg, Nota~ Publio I Cadisle Bom, Cum~dandCoun~ I ~ Commi~ion Expires Nov. 13,__ I LESTER A. SHEAFFER ~-'V-lmE~*l~-~l ~ ~ OFFICIAL USE ONLY co.~o~,.o~.~,~._v,~ INHERITANCE TAX RETURN ~.u~.~ ~P~ ~ R~NUE ~ ~.~, RESIDENT DECEDENT 2 ~ o3 0069 ~ ~I~URG, PA 171~1 ~ COUN~ CODE ~R NUMBER DECEDE~S NAME (~ST, FIRST, AND MIDDLE INITIAL) ~ SOCIAL SECURI~ NUMBER Sheaffer, Lcst=r A. 204-03-9406 DA~ OF D~TH (MM-D~Y~R) DATE OF BIR~ (MM~D-Y~R) 08/1 ]/2003 08/20/1922 REGISTER OF WlL~ IF APPLICABLE) SURVIVING SPOUSE'S ~ME ( ~ST, FIRST AND MIDD~ INIT~L) SOCIAL SECURI~ NUMBER [] 1. Original Retum [] 2. Supplemental Retum [] 3. Remainder Retum (date of death pnOr to12-13-82) o~ ~ ~ [] 4. Limited Estate [] 4a. Future12.12.82)lnterest Compromise (date of death after [] 5. Federal Estate Tax Return Required ~, [] 6. Decedent Died Testate (Attach copy [] 7. Decedent Maintained a Living Trust (Attach 8. Total Number of Safe Deposit Boxes O ~' ~ of Will) copy of Trust) < [] 9. Litigation Proceeds Received [] 10. Spousal Poverty Credit (date of death between [] 11.ElectJontetaxunderSec. 9113(A)(AttachSdaO) ...... 12-31-91 and 1-1-95) ~.ME COMPLETE MAILING ADDRESS ,~ ~ Galen R. Waltz ~'i :IRM NAME (if applicable) ~ Turo Law Offices 28 S. Pitt St. o Carlisle, PA 17013 tELEPHONE NUMBER 717/245-9688 1. Real Estate (Schedule A) (1) None... o~c~^L use ONLY 2. Stocks and Bonds (Schedule B) (2) Non~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (3) None 4. Mortgages & Notes Receivable (Schedule D) (4) None 5. Cash, Bank Deposits & Miscellaneous Personal Property (5) 5,82 0.0 0 (Schedule E) 6. Jointly Owned Property (Schedule F) (6) l 0, 165.83 _oZ [] Separate Billing Requested ,~ 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (7) None ~ (Schedule G or L) ;- 8. Total Gross Assets (total Lines 1-7) (8) ] 5,985.83 -' 9. Funeral Expenses & Administrative Costs (Schedule H) (9) 13,922.5 7 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (10) l, 612.52 11. Total Deductions (total Lines 9 & 10) (11) 15,535.09 12. Net Value of Estate (Line 8 minus Line 11) (12) 4 50.74 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been (13) made (Schedule J) 14. Net Value Subject to Tax (Line 12 minus Line 13) (14) 450.74 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) ~ 16. Amount of Line 14 taxable at lineal rate 450.74 x .045 (16) 20.28 ==' 17. Amount of Line 14 taxable at sibling rate x .12 (17) O ~ 18. Amount of Line 14 taxable at collateral rate x .15 (18) 19. Tax Due (19) 20.28 20. [] Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 18 Fairfield Street c~ Mt. Holly Springs ST^TE Pa ZIP 17065 Tax Payments and Credits: 1. Tax Due (Page I Line 19) (1) 20.28 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount 1.01 Total Credits (A +B+C) (2) 1.01 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (D + E) (3) 0.00 4. If Line 2 is greater than Line I + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page I Line 20 to request a refund 5. If Line I + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 19.2 7 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ] 9 o2 '7 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 propelly transferred; .................................................................................. b. retain the right to des~nate who shall usa the property transferred or ~ income; .................................... c. retain a reversionary interest; or .................................................................................................................. d. receive the promise for life of either payments, benefds or care? .............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ....................................................................................................................... [] [] 3. Did decedent own an "in trust for' or payable upon death bank account or security at his or her death? ......... r~ [] 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. Under penalties of perjury, I declare that I have examined this tatum, inciuding accompanying schedules and statements, and to the best of my knowfl~ge 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 eny kno~. SIGNATURE OF PERSON RESPONSIBLE FO~ FILING RETURN ADDRESS DATE James M. Sheaffer 4% / ) /',,/'~ ~F'PERSON RSSPONS,I~_ F~'r~E~URN ADDRESS Mt. Holly Springs, Pa 17065 / J / ~.~ ~J~I~E OF P~EPARL~R C~HER TH~REPRESENTATIVE ADDRESS DATE Galen Waltz J~/ 28 S. Pitt St. c~ Carlisle, PA 17013 For dates of death on or after July 1, 1994 and before January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3% [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% [72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempf; 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 twenty-one years of age or younger at death to or for the use of a natural parent, an adoptive parent, or a stepparent of the child is 0% [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%, 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% [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 blood or adoption.  SCHEDULE E CASH, BANK DEPOSITS, & MISC. co.~o.w~., o~.~.~v,~ PERSONAL PROPERTY INHEF~TANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Lester A. 21 - 03 - 00691 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivomhip must be disclosed on schedule F. ITEM DESCRIPTION VALUE AT DATE OF NUMBER DEATH 1 Cash 5,320.00 2 1991 Ford, VIN No. 1FAPP36X7MK123696, 500.00 TOTAL (Also enter on Line 5, Recapitulation) 5,820.00 INHERITANCE TAX RETURN A~M~n~A~ COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Lester A. ~ 21 - 03 - 00691 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1 Hollinger Funeral Home and Crematory, Mount Holly Springs, Pa. 7,149.64 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City State Zip Year(s) Commission paid 2. Attorney's Fees Turo Law Office 3,000.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant James M. Sheaffer Street Address 18 Fairfield Slreet City Mount Holly Springs State Pa Zip 17065 Relationship of Claimant to Decedent Son 4. Probate Fees Register of Wills 84.50 Family Agreement 25.00 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. Other Administrative Costs 1 The Sentinel, Executors Notice 88.43 2 Cumberland County Legal Journal, Legal Notice 75.00 TOTAL (Also enter on line 9, Recapitulation) 13,922.57 ~ SCHEDULE F CoMMo.v~,~. Or.E..S¥,V^.~ JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Lester A. 21 - 03 - 00691 If 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 James M. Sheaffer 18 Fairfield Street Son Mt l-lnllv RnHnoc: Pn 17(It~ JOINTLY OWNED PROPERTY: '~ DESCRIPTION OF PROPERTY LETTER DATE % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number DATE OF DEATH DECD'S NUMBER TENANT JOINT estate.er similar identifying number. Attach deed for jointly-held real VALUE OF ASSET INTEREST DECEDENT'sVALUEINTEREsTOF 1 03/21/2002 PNC Bank checking account No. 5140191008 20,331.65 50% 10,165.83 TOTAL (Also enter on line 6, Recapitulation) 10,165.83  SCHEDULE I DEBTS OF DECEDENT, MORTGAGE oo..:,.~-r.~,,,~v,~ LIABILITIES, & LIENS INHERITANCE TAX RETURN ESTATE OF FILE NUMBER Sheaffer, Lester A. 21 - 03 - 00691 Include unreimbursed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Met-ed electric bill 67.14 2 Central Penn Medical Group Emergency 18.22 3 West Shore EMS 1,527.16 TOTAL (Also enter on Line 10, Recapitulation) 1,612.52 ~EV-1513 EX+ (9-00) ~ SCHEDULE J co~,~onv~L~, oF PE..S~_VA.~ BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Lester A. 21 - 03 - 00691 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE lo TAXABLE DISTRIBUTIONS (include outright spousal distributions) 1 James M. Sheaffer, 18 Fairfield Street, Mount Holly Springs, Pennsylvania, Son Enitre estate! 17065 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet Il. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET COMMONWEALTH OF PENNSYLVANIA REV-1162 EX(11-96) DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG, PA 17128-0601 PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003214 GALEN WALTER R ESQUIRE 28 S PITT STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold .......... 101 $19.27 ESTATE INFORMATION: SSN: 204-03-9406 FILE NUMBER: 21 03-0691 DECEDENT NAME: SHEAFFER LESTER A DATE OF PAYMENT: 11 / 10/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/11/2003 TOTAL AMOUNT PAID: $19.27 REMARKS: GALEN RWALTZ ESQUIRE CHECK# 1154 INITIALS: JA SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS REGISTER OF WILLS Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Sheaffer, Eester ^. No. 21 - 03 - 00691 also known as Date of Death 8/11/2003 , Deceased Social Security No. 204-03-9406 James M. Sheaffer The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. I/We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unswom falsification to authorities. Personal Representative Attorney: Galen R. Waltz Signature: ~O~_~,~ JMnes M. Sheaffer I.D. No.: 39789 Signature: Signature: Address: 28 S. Pitt St. Address: 18 Fairfield Street Carlisle, PA 17013 Mt. Holly Springs, Pa 17065 Telephone: 717/245-9688 Telephone: 717 486-8053 Dated: / / / 0 Personal Property Cash 5,320.00 1991 Ford, VIN No. 1FAPP36X7MK123696, ' '..: 500.00 Total Personal Property $5,82o. o0 (Attach additional sheets if necessary) Total Personal Property and Real Estate $5,820.00 CERTIFICATION OF NOTICE UNDER RULE 5.6(a) Name of Decedent: L ~ .s) ~. ~- ~. .~' ~ ~.-<,-- '?'~ ~ ~ Date of Dea~: ~f '' /~ Will No. Q ~ O~ -- ,..% xD {~Q .[ Admin. No. To the Register: I certify that notice of (benefidal interest) estate administration required by Rule 5.6(a) of the Orphans' Court Rules was served on or mailed to the following beneficiaries of the above-captioned estate on ~' ]..:z ! / ¢~3 : Name Address Notice has now been given to all persons entitled thereto under Rule 5.6(a) except Date: ]-~.- ,~,Q3- 0_~Sig .~-~.~~ Name _ .~/~/~,,? Address Telephone (~17) · Capacity: ~ Personal Representative '~.Counsel for personal representative COHHONgEALTH OF PENNSYLVANIA ~ BUREAU OF INDIVIDUAL TAXES DEPARTHENT OF REVENUE DEPT. Z&060! HARRISBURG, PA 171Z8-0601 NOTICE OF INHERITANCE TAX APPRAZSEHENT, ALLO#ANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSHENT OF TAX RE¥-IS4?EXAFP(01-O$) DATE 12-29-2005 ESTATE OF SHEAFFER LESTER A DATE OF DEATH 08-11-2005 FILE NUNBER 21 05-0691 *~, -~ ~ COUNTY CUHBERLAND GALEN R NALTZ ..... ACN 101 TURO LAW OFFICES Amount Remitted 28 S PITT ST ~ CARLISLE PA 17015 HAKE CHECK PAYADLE AND RENZT PAYHENT TO: REGISTER OF HILLS CUHBERLAND CO COURT HOUSE CARLISLE, PA 17015 CUT ALONG THIS LINE I~ RETAIN LONER PORTION FOR YOUR RECORDS ~ REV-154T EX AFP [01-03) NOTICE OF INHERITANCE TAX APPRAZSENENT, ALLONANCE OR DZSALLONANCE OF DEDUCTIONS AND ASSESSNENT OF TAX ESTATE OF SHEAFFER LESTER AFZLE NO. 21 05-0691 ACN 101 DATE 12-29-2005 TAX RETURN NAS: (X) ACCEPTED AS FILED ( ) CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN 1. Real Estate (Schedule A) (1) O0 NOTE: To insure proper 2. Stocks and Bonds (Schedule B) (2) O0 credit to your account, $. Closely Held Stock/Partnership Interest (Schedule C) ($) O0 subait the upper port/on q. Nortgages/Notos ReceivabZe (Schedule D) (q) O0 of this form with your $. Cash/Bank Deposits/Nisc. Personal Property (Schedule E) (5) 51820 00 tax payment. 6. Jointly Owned Property (Schedule F) (6) 10~165 85 7. Transfers (Schedule G) (7) O0 8. Total Assets (8) 15,985.85 APPROVED DEDUCTIONS AND EXENPTZONS: 13,922.57 9. Funeral Expenses/Ada. Costs/Nisc. Expenses (Schedule H) (9) 10. Debts/Nortgage Liabilities/Liens (Schedule I) (10) 1,61Z.52 11. Total Daductions (11) l~.~tS.~q 12. Net Value of Tax Return (12) 150.71 15. Chariteble/Governaental Bequests; Non-elected 911~ Trusts (Schedule J) {15) .00 lq. Net Value of Estate Sub,eot to Tax (lq) ~50.7~ NOTE: Z~ an assessment ~as issued pPeviously, lines 14, 15 and/o~ 16, 17, 18 and 19 ~ill re~lect ~igu~ss that include the total o~ ALL Petu~ns assessed to date. ASSESSHENT OF TAX= 15. Amount of Line lq at Spousal rate (1E) .00 X O0 = .00 16. Amount of Line lq taxable at Lineal/Class A rate (16) 450.74 X 0~5 = 20.28 17. Amount of Line lq at Sibling rate (17) .00 X 12 = .00 18. Amount of Line lq taxable at Collateral/Class B rate (18) .00 X 15 = .00 19. Principal Tax Due (19)= 20.28 TAX CREDITS: PAYNENT RECEIPT DISCOUNT t+) AHOUNT PAID DATE NUNBER INTEREST/PEN PAID (-) 11-10-2005 CDO05211 1.01 19.27 TOTAL TAX CREDIT I 20.28 BALANCE OF TAX DUEI .00 INTEREST AND PEN. I .00 TOTAL DUE ] · O0 ZF PAID AFTER DATE INDICATED, SEE REVERSE ( ZF TOTAL DUE ZS LESS THAN $1, NO PAYNENT ZS REQUIRED. FOR CALCULATION OF ADDITIONAL INTEREST. ZF TOTAL DUE ZS REFLECTED AS A "CREDIT" (CR), YOU NAY BE DUE A REFUND. SEE REVERSE SIDE OF THIS FORN FOR INSTRUCTIONS. ) RESERVATION: Estates of decedents dying on or before December 1Z, 1982 -- if any future interest in the estate is transferred in possession or enjoyment to Class B (collateral) beneficiaries of the decedent after the expiration of any estate for life or for years) the Commonwealth hereby expressly reserves the right to appraise and assess transfer Inheritance Taxes at the lawfut Class B (cottataral) rate on any such futura interest. PURPOSE OF NOTICE: To fulfitl the requirements of Section 1140 of the Inheritance and Estate Tax Act, Act 13 of ZOO0. (?Z P.S. Section 9140). PAYNENT: Detach the top portion of this Notice and submit with your payment to the Register of Hills printed on the reverse side. --Hake check or money order payable to: REGISTER OF RILLS) AGENT REFUND (CR): A refund of a tax credit, which was not requested on the Tax Return, may be requested by completing an "Application for Refund of Pennsylvania Inheritance and Estate Tax" (REV-IS15). Applications are available at the Office of the Register of Hills, any of the 15 Revenue District Offices, or by calling the special Zq-hour answering service for forms ordering: 1-800-561-Z050; services for taxpayers with special hearing and / or speaking needs: 1-800-~7-5020 (TT only). OBJECTIONS: Any party in interest not satisfied with the appraisement, allowance, or disallowance of deductions, or assessment of tax (including discount or interest) as shown on this Notice must object within sixty (60) days of receipt of this Notice by: --written protest to the PA Department of Revenue, Board of Appeals, Dept. 281021, Harrisburg, PA 17128-1021, OR --election to have the matter determined at audit of the account of the personal representative, OR --appeal to the Orphans' Court. ADHIN- ISTRATIVE CORRECTIONS: Factual errors discovered on this assessment shouJd be addressed in writing to: PA Department of Revenue, Bureau of Individual Taxes, ATTN: Post Assessment Review Unit, Dept. 180601, Harrisburg, PA 17118-0601 Phone (717) 787-6505. See page 5 of the booklet "Instructions for Inheritance Tax Return for a Resident Decedent" (REV-IS01) for an explanation of administratively correctable errors. DISCOUNT: If any tax due is paid within three (5) calendar months after the decedant's death, a five percent (51) discount of the tax paid is allowed. PENALTY: Tho 15Z tax amnesty non-participation penalty is computed on the total of the tax and interest assessed, and not paid before January 18, 1996, the first day after tho and of the tax amnesty period. This non-participation penalty is appealable in the same manner and in the the same time period as you would appeal the tax and interest that has been assessed as indicated on this notice. INTEREST: Interest is charged beginning with first day of delinquency, or nine (9) months and one (1) day from the date of death, to the date of payment. Taxes which became delinquent before January I, 1982 bear interest at the rate of six (61) percent per annum calculated at a daily rate of .00016~. All taxes which became delinquent on and after January 1, 1982 will bear interest at a rate which will vary from calendar year to calendar year with that rate announced by the PA Department of Revenue. The applicable interest rates for 198Z through 2005 are: Interest Daily Interest Daily Interest Daily Year Rate Factor Year Rate Factor Yea__r Rate Factor 1982 ZOZ .0005~8 1987 91 .0002~7 1999 71 ,000192 1985 161 .000~58 1988-1991 Ill .000501 ZOO0 81 .000219 198~ Ill .000501 1992 92 .000247 ZOO1 91 .0002~7 1985 151 .000556 1995-199~ 72 .000192 2002 61 .00016~ 1986 iOZ .00027~ 1995-1998 91 .0001~7 Z003 51 .000157 --Interest is calculated as follows: INTEREST = BALANCE OF TAX UNPAID X NUNBER OF DAYS DELINQUENT X DAILY INTEREST FACTOR --Any Notice issued after the tax becomes delinquent will reflect an interest calculation to fifteen (15) days beyond the date of the assessment. If payment is made after the interest computation data shown on the Notice, additional interest must bm calculated. FAMILY SETTLEMENT AND FINAL RELEASE ESTATE OF LESTER A. SHEAFFER KNOW ALL MEN BY THESE PRESENTS, that Lester A. Sheaffer, late of Mount Holly Springs Borough, Cumberland County, Pennsylvania, deceased, died testate on August 11, 2003, having first made his Last Will and Testament, which was duly executed on October.30, 2001 and probated in the Office of the Register of Wills of Cumberland County, August 21,2003. WHEREAS, the said Lester A. Sheaffer, by the aforesaid Last Will and Testament, named James M. Sheaffer as Executor of said Last Will and Testament; WHEREAS, Letters Testamentary on the Estate of the said decedent were duly issued by the Register of Wills of Cumberland County, Pennsylvania, to the said Executor, hereinafter called personal representative; WHEREAS, the personal representative has gathered the assets of the Estate of the said decedent and the assets consist of personal and real property with the total value of $5,820.00 as set forth in Exhibit "A", which is a copy of the Pennsylvania inheritance Tax Return filed and approved by said personal rep~s,_entative, and which is attached hereto and made a part hereof, and marked Exhibit "A~ WHEREAS, the debts and deductions, including the payment of~n.', heritanCe tax in the said Estate, which have now been paid, leave a balance for~distributiOn of $1,759.11, also as set forth in the statement of said personal represer~tive,:wh ch is attached hereto and marked Exhibit "B"; WHEREAS, the balance for distribution as shown in the said statement marked Exhibit "B" has been reduced to cash and has been distributed as herein indicated in accordance with the terms of the Last Will and Testament of the said Decedent; NOW, THEREFORE, James M. Sheaffer, Virginia Russell, Margaret Simon, Connie Bierman, Norma Jean Simpson and Richard Sheaffer being all of the heirs under the Last Will and Testament of the said decedent, and being those persons entitled to inherit under said Last Will and Testament, do hereby each of us acknowledge that we have this day had and received from the aforesaid personal representative, in full satisfaction and payment of all sums of money, legacies, bequests, and devises as are given, devised and bequeathed to each of us respectively by the said Last Will and Testament, the amounts due us under said Last Will and Testament, which amounts we have received this day or prior to this day; and, each of us do hereby stipulate that in order to avoid the expense and time involved in the filing of a formal account and schedule of distribution,' we each agree that no account is necessary and we do hereby agree that we do consent to distribution being made without the filing of an account and schedule of distribution, the same to be with the same force and effect as if they had been filed and confirmed by the Orphan's Court Division of the Court of Common Pleas of Cumberland County, Pennsylvania. THEREFORE, we and each of us, do hereby remise, release, quitclaim and forever discharge the said personal representative, James M. Sheaffer, his heirs, executors, administrators and assigned, of and from the said estate and from all actions, suits, payments, accounts, reckonings, claims, and demands whatsoever for or by reason thereof, or for any other use, matter, cause or thing whatsoever, touching upon the Estate of the said decedent, and each of us do further hereby covenant and agree that should any liability come due to the estate of the said decedent after the signing of this Agreement, we and each of us do hereby covenant and agree with each other and the aforesaid personal representative, that we will contribute pro-rata our share of the Estate to satisfy any and all claims, demands, suits or causes of action which may be successfully prosecuted against the said Estate or the aforesaid personal representative after the signing, sealing and delivery of this Family Settlement Agreement and Final Release. IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date Witnes~ ~James Sheaffer Date Witness Virginia Russell Date Witness Margaret Simon Date Witness Connie Biermann Date Witness Norma Jean Sampson Date Witness Richard Sheaffer NOTARIAL SEAL CHERYL D SMITH, Notary Public Mt. Holly Springs Borough, Cumberland Co. My Commission Expires Feb. 18, 2006 IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date Witness James Sheaffer s ' ~ ' I VirginiaORussell ~;C, TARIA L SEAL ~'~i~lA A BREWBAKER, NoTAV~'I~0~L~i~ J Margaret Simon Carlisle Boro, Cumberland County My Commission Expires April 4, 2005 Date Witness Connie Biermann Date Witness Norma Jean Sampson Date Witness Richard Sheaffer IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date Witness James Sheaffer Date -~tness / Virginia Russell Date Witness ' ~ Margaret Simon Date Witness Connie Biermann Date Witness Norma Jean Sampson Date Witness Richard Sheaffer IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date Witness James Sheaffer Date Witness Virginia Russell Date Witness Margaret Simon ~ v~-U~"'ermann Date Witness Norma Jean Sampson Date Witness Richard Sheaffer IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date Witness James Sheaffer Date Witness Virginia Russell Date Witness Margaret Simon Date Witness Connie Biermann Date W~tness 'Norma Jean Sampsofi Date Witness Richard Sheaffer IN WITNESS WHEREOF, we have hereunto set our hands and seal the day and year noted below. Date Witness James Sheaffer Date Witness Virginia Russell Date Witness Margaret Simon Date Witness Connie Biermann Date Witness Norma Jean Sampson Witness Richard S CORMONUEALTHOF PENNSYLVANZA ~ r I DEPARTMENT Ok ~EVENUE' ZNFORMATZON NOTZCE" BUREAU OF INUIVIE~AL TAXES FILE NO. 21 05-0691 DEPT. Z8060! AND UARRZDSUE=, PA tTlZB-OSOt TAXPAYER RESPONSE ACN 03Zq5951 ~v-~.~.*.~.-.~ DATE 11-Z7-2005 TYPE OF ACCOUNT EST. OF LESTER A SHEAFFER i--~SAUI,a$ S.S. NO. 20q-os-gq06 i~ICHECKIN= DATE OF DEATN 08-11-2005 []TeUST COUNTY CUMBERLAND [~CERTZF. RE.IT PAYHENT AND FORMS TO= JAMES M SHEAFFER REGISTER OF NILLS 18 FAIRFIELD ST CUMBERLAND CO COURT HOUSE MT HOLLY SPRING PA 17065 ,~ CARLISLE, PA 17013 COMPLETE PART ! SELON ! t ~ SEE REVERSE SZDE FOR FILIN$ AND PAYMENT TNSTRUCTIONS Accoun~ No. 51q0191008 Da~e 05-21-2002 TO insure proper credit to ~our a¢¢amt, two Account; Balance ZO · 551 , 65 parable to: "Register of RJlls~ Agent". Percen~ Taxable X 50. 000 PART TAXPAYER RESPONSE  ONE ~ Uitls and an ef*l¢ial assessment will be issued by the PA Department o~ Revenue. TAX RETURN - COMPUTATION OF TAX ON dOZNT/TRUST ACCOUNTS PART DESTS AND DEDUCTIONS CLAZME~ DATE PAID PAYEE DESCRIPTION AMOUNT PAID NORK ( TAXPAYER SISNATURE TELEPHONE NUMBER Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Sheaffer, Lester A. No. 21 - 03 - 00691 also known as Date of Death 8/11/2003 , Deceased Social Security No. 204-03-9406 James M. Sheaffer The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the fntlowing Inventory include all of the personal assets wherever situate and all of the mai estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventor/represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory am tree and correct. I/We understand that false statements herein ars made subject to the penalties of 18 Pa. C. Sm Section 4904 relating to unswom falsification to authorities. Personal Representative~c.~/V~ 0 ~ Attorney: GalenR. Waltz Signature: w-.,,~,~J ,,- J~(nes M. Sheaffer I.D. No.: 39789 Signature: Signature: Address: 28 S. Pitt St. Address: t 8 Fairfield Stzeet Carlisle, PA 17013 Mt. Holly Springs, Pa 17065 Telephone: 717/245-9688 Telephone: 717 486-8053 Dated: [ / Personal Property Cash 5,320.00 1991 Ford, VIN' No. IFAPP36X7MK123696, 500.00 Total Personal Property $5,820.00 (Attach additional sheets if necessary) Total Personal Property and Real Estate $5,820.00 Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Sheaffer, Lester A. No. 21 - 03 - 00691 also known as Date of Death 8/11/2003 , Deceased Social Security No. 204-03-9406 James M. Sheaffer The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. I/We verify that the statements made in this Inventory are true and correct. INVe understand that false statements herein are made subject to the penalties of 18 Pa. C. S, Section 4904 relating to unswom falsification to authorities. Personal Representative C',/~ /)/0 Attomey: Galen R. Waltz Signature: ~~, )')'~. '~ l~nes M. Sh~aff'er ~' I,D. No.: 39789 Signature: Signature: Address: 28 S. Pitt St. Address: 18 Fairfield Slxcet Carlisle, PA 17013 Mt. Holly Springs, Pa 17065 Telephone: 717/245-9688 Telephone: 717 486-8053 Dated: [ I Personal Property Cash 5,320.00 1991 Ford, VIN No. 1FAPP36X7MKI23696, 500.00 Total Personal Property $5,820.00 (Attach additional sheets if necessary) Total Personal Property and Real Estate $5,820.00 *~,,~.~.~.~.s~v*.~ INHERITANCE TAX RETURN ~,~Nu.~R ~.~. 2~ RESIDENT DECEDENT 21 03 0069] DECEDENTS NAME (LAST, FIRST, AND MiDOLE )Ni~AL) SOCIAC SECURm~ NUMBER Sheaffer, Lester A. 204-03-9406 08/11/2003 08/20/1922 REGISTER OF WILLS ~ 4. Umi~te ~ ~.Fut~lnt~stCo~(~te~d~ 12-12~) ~ 5. F~eml E~te Tax Ream R~uJred Gal~ ~ W~m :IRM ~ME (E ~) Tm ~w Offices 28 S. PiE St. ~L~HONE NUMBER C~sle, PA 17013 7] 7~45-9688 1. Real Estate (S~ule A) (1) NO~e - OFF~C~A~ USE ONLY 2. Sto~s and Bonds (Sch~ule B) (2) None 3. CloseN Held Co~omtion, Padnemhip or Sol~rop~tomhip (3) None 4. Mo~ages & Not~ R~ab~ (S~u~ D) (4) NOne : 5. Cash, Bank ~posi~ & Mi~llaneous Pemonal Pm~ (5) 5,820.00 (S~edule E) 6. Join~ ~ Pm~ (S~ule ~ (6) ] 0,165.83 '" ~ Sepam~ Billing R~u~t~ 7. Inter-~wos Tmnsfem & M~llan~us Non-Probate Prope~ (7) N O~C (Sch~u~ G or L) 8. To~ Gm ~ (to~l Unes 1-7) (8) 15,985.83 9. Funeral ~pen~ & AdministratNe Costs (Sch~ule H) (9) ] 3,922.57 10. De~ of D~ent, Modgage Liabilities, & Liens (Sch~u~ I) (10) 1,612.52 11. T~I D~u~ (to~l Lines 9 & 10) (11) ] 5,535.09 12. N~ Value ~ ~ (Line 8 minus Line 11 ) (12) 450.74 13. Chaffiab~ and Governmental B~uest~Sec 9113 Tms~ ~r ~i~ an el~ion to ~x has not been (13) made (Sch~ule J) 14. N~ Val~ Sub~ to T~ (Line 12 minus Line 13) (14) 450.74 15.~ount of Line 14 taxab~ at the s~usal t~ ra~, x .0~ (15) or ~ns~m under S~. 9116(a)(1.2) 16.Amount of Line 14 taxable at lineal rate 450.74 x .04~ (16) 20.28 17.~ount of Line 14 t~able at sibling rote x .12 (17) 18. ~ount of Line 14 ~able at ~llateml rote x .1 ~ (18) 19. Tax Due (19) 20.28 20. ~ ' · ~ ' · ,- ~ , · --, , ~ ~ s~m on~ ~ ~ckner Group, )n~ Fo~ R~-1500 ~ (R~. 6~) Decedent's Complete Address: STREET ADDREss 18 Fairfield Street CITY Holly Springs [STATE Pa [ZIP 17065 Mt. Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) (1) 20.28 2, Credits/Payments A. Spousal PovertyCred~t B. Prior Payments C. Discount 1.01 Total Credits (A +B+C) (2) 1.01 3. Interest/PenaRy if applicable D. Interest E. Penalty Total Interest/Pena~ (D + E) (3) 0, 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Check box on Page I Line 20 to request a refund 5. if Line 1 + Line 3 is greater than Line 2, enter the ditference. This is the TAX DUE. (5) ] 9.2 7 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (5B) Make Check Payable to: REGISTER OF W~LLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN ~X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No retain the fight to deaignats who shall uso tha property tmnsfen-~l or its incoma: .................................... ¢. retain a mYereiona~¥ interest; or ................................................................................... d. mc~ive the promi.~, [or life of either poymants, I:~n~ts or cam? .............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate cons deret on? ........................................................... [] 3. Did decedent own an 'in tmst for' orpayableupondesthbankaccountorsecurityathisorherdeath? ......... [] [] 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 13' AS PART OF THE RETURN. (~'~aA^~ Ol ~' Y)/~. Ad Mt. Holly Springs, Pa 17065 / R. ~ 25 $. Pit~ St. C~rlisle, PA 17013 For dates o~ death en et a~ar Ju~/~, ~ g~4 and ~fore danuary 1, ~ ~5, the tax reta impoced en tha n~t value o[ tranaf~m to or ~er lhe u~ of tho suwMr~ spou~ is 3% [7~ P.S. §g11~ (a) (1.1) (i)l. Fer d~tea e~ desth oo er a~r danuery 1, ~5, the tm~ rete [ml~%~ ea the n~t v~lue of tmnatem t~ or f~r t['m usa o~ the suntiving epouce is 0% ['/~ P.S. §~1 ~ (a) (1 A) (iOl. The atatute d~ nnt ax~m~l a treesf~r taa suntiving spouv~ frem tax, and the atstnt~ requirements for diselesum The tax reta impo~d on the nat Yalue o~ tmnstem from a d~a~d ehi~ ~nl'/4na ~am ~ age or saungar st daath to or f~r tha us~ o[ ~ natural ~arent, an adnpfiw parent, er a atepoarent e[ tha e~ild ia 0% [72 P.S. §gl ~ (a) (1.2)l. ~.2) [72 P.S. §g~ (a) (~)l. The tax reta impo~:l on the net value e[ tmnstem to or ter tho ua~ ~f tha decedent'o ~i~lings is 1~% [7~ P.S. §~ ~ (a) (~.~)]. A $i~lin~ is de~n~, under,~eflea gl 0~, aa an indiv~cel whe hes at I~a~t one perent in commen with 1~ d~:lant, whether I~/b~od or ade~fion. SCHEDULE E CASH, BANK DEPOSITS, & MISC. oo~.~= o, ~v,~, PERSONAL PROPERTY ESTATE OF FILE NUMBER Sheaffer, Lcster A. 21 - 03 - 00691 Include the.proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on schedule F. ITEM VALUE AT DATE OF NUMBER DESCRIPTION DEATH I Cash 5,320.00 2 1991 Ford, VIN No. 1FAPP36XTMKI23696, 500.00 TOTAL (Also enter on Line 5, Recapitulation) 5,820.00 ESTATE OF FILE NUMBER Sheaffer, Lester A. 21 - 03 - 00691 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: I Hollinger Ftmcral Home and Crematory, Mount Holly Springs, Pa. 7,149.64 B. ADMINISTRATIVE COSTS: 1. Pemonal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Sheet Address City State __ Zip Year(s) Commission paid 2. Attorney's Fees Taro Law Office 3,000.00 3. Family Exemption: (if decedent's address is not the same as claimant's, attach explanation) 3,500.00 Claimant James M. S[lea~er Street Address ] 8 FaA*field Street City Motmt Hotiy Spl~gs State Da . Zip 17065 Relationship of Claimant to Decedent Son 4. Probate Fees Re,stet of'~/'~ls 84.50 Family Agreement 25.00 5. Accountant's Fees 6. Tax Return Pmparer's Fees 7, Other Administrative Costs I The Sentinel, Executors Notice 88.43 2 Cumberland County Legal Journal, Legal Notice 75.00 TOTAL (Also enter on line 9, Recapitulation) 13,922.57 SCHEDULE F ,.,E.IT^.CE T*X .E~U.. JOINTLY-OWNED PROPERTY RESIDENT DECEDENT ESTATE OF FILE NUMBER Sheaffer, Lester A. 21 - 03 - 00691 If an asse{ 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 James M. Sheaffer 18 Fairfield Street Son JOINTLY OWNED PROPERTY: DESCRIPTION OF PROPERTY LI= I I ER DATE % OF DATE OF DEATH ITEM FOR JOINT MADE Include name of financial institution and bank account number DATE OF DEAT;- DECD'S VALUE OF NUMBER TENANT JOINT or similar identifying number. Attach deed for jointly-held real 'VALUE OF ASSET NTEREST DECEDENTS INTERES' estate. I 03/21/2002 PNC Bank checking accotmt No. 5140191008 20,331.6.' 50% 10,165.82 TOTAL (Also enter on line 6, Recapitulation) 10,165.83  SCHEDULE I DEBTS OF DECEDENT, MORTGAGE o~o.w~,~v..~ LIABILITIES, & LIENS ESTATE OF FILE NUMBER Sheaffer, Lester A. 21 - 03 - 00691 Include unmimbumed medical expenses. ITEM NUMBER DESCRIPTION AMOUNT 1 Met-ed elect3ic bill 67.14 2 Central Penn Medical Group Emergency 18.22 3 West Shore EMS 1,527.16 TOTAL (Also enter on Line 10, Recapitulation) 1,612.52 SCHEDULE J ceMMo~ OF PE.N~-V^.~^ BENEFICIARIES INHERITANCE TA~ RE~JRN ESTATE OF ~ FILE NUMBER Sheaffer, Lester A. 21 - 03 - 00691 RELATIONSHIP TO AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY DECEDENT OF ESTATE Io TAXABLE DISTRIBUTIONS (include outright spousal distributions) I Jtunes M. Sheaffer, 18 Fairfield Street, Mount Holly Springs, P~nnsylvania, Son Enitre estate! 17065 Enter dollar amounts for distributions shown above on lines 15 through 18, as appropriate, on Rev 1500 cover sheet II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET COMMONWEALTH OF PENNSYLVANIA REV-'r 162 EX(11-96) DEPARTMENT O,F REVENUE PENNSYLVANIA RECEIVED FROM: INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 003214- GALEN WALTER R ESQUIRE 28 S PITT STREET CARLISLE, PA 17013 ACN ASSESSMENT AMOUNT CONTROL NUMBER ........ fold ......... 101 $19.27 ESTATE INFORMATION: SSN: 204-03*9406 FILE NUMBER: 2103-0691 DECEDENT NAME: SHEAFFER LESTER A DATE OF PAYMENT: 1 1 / 1 0/2003 POSTMARK DATE: 00/00/0000 COUNTY: CUMBERLAND DATE OF DEATH: 08/11/2003 TOTAL AMOUNT PAID: t~l 9.27 REMARKS: GALEN R WALTZ ESQUIRE CHECK# 1154 INITIALS: JA SEAL RECEIVED BY: DONNA M. OTTO DEPUTY REGISTER OF WILLS TAXPAYER Exhibit "B" Grave Lot 3 and 4 at Mount Holly Springs Cemetery = $ 500.00 Life Insurance for G. Sheaffer = $1,278.38 (beneficiary = Lester A: Sheaffer) $1,778.28 Inheritance Tax Paid From Residue of Estate $ 19.27 $ 1,759.11 Paragraph 3 of Lester A. Sheaffer's Last Will and Testament provides that the "rest[,] residue and remainder ... in equal sheares to Margaret S. Simon, Vonnie Bierman, Norman J. Simpson, Richard D, Sheaffer, Virginia A. Russell and James M. Sheaffer." Distribution Margart S. Simon $293.19 Vonnie A. Bierman $293.19 Norman J. Simpson $293.19 Richard D. Sheaffer $293.19 Virginia A. Russell $293.19 James M. Sheaffer $293.19