HomeMy WebLinkAbout04-0881
PETITION FOR GRANT OF LETTERS OF ADMINISTRATION
Estate of ~od~ ( L) hl\cJnQ(t No. 2-/- 01 -0 eN I
also known as . To:
Register of Wj.lls for the 1
' _peceased. County of i'U mber IOJY, in the
Social Security No. d Oq- 3 (0- 100 d, Commonwealth of Pennsylvania
The petition of the undersigned respectfully represents that:
Your petitioner(s), who is/are 18 years of age or older, appl for letters of administration
on the estate of
(d.b.n.; pendente lite; durante absentia; durante minoritatc)
the above decedent.
Decendent was domiciled at death in tUJnbe (Jay1~ ' .:>~untx,_pej1nSYlvan~, with
hiS last family or principal residence at 13') OQl l-hl) 1'-, Ci.((I\J/c It 17013
(list street, number and municipality)
Decendent, then 50 years of age, died 8 -dLI-~ oo'--{ ,.w-
at
Decendent at death owned property with estimated values as foIllows: ._ 0 _
(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:
Petitioner~ after a proper search ha_ ascertained that decedent left no will and was survived by
the following spouse (if any) and heirs:
Name Relationship Residence
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THEREFqRE, petitioner(s) respectfully request(s) the grant of letters of administration in the
appropriateftjrm to the undersigned.
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OATH OF PERSONAL REPRESENTATIVE
COMMONWEALTH OF PENNSYLVANIA } ss
COUNTY OF r u.mW/1? Nt'
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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
representative(s) of the above decedent petitioner(s) will well and
truly administer the estate according to law. ,
-,
Sworn to or affirmed and subscribed ( -lrcj:'rC. ;=C -f~_ ~
before me this L ~ , ' . , day of J ~
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No. Li - c4 - L 1 S I
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Estate of Kc Delli;; L ..) [ \hl''1~l'- , Deceased
GRANT OF LETTERS OF ADMINISTRATION
S [.1h [:1 It i3 L1~ 2[. 2cc1
AND NOW 18_, in consideration of the petition on
the reverse side hereof, satisfactory proof having been presented before me,
IT IS DECREED that Sc ~ '/ L. 5 n N E::"<.
@are entitled to Letters of Administration, and in accord with such finding, Letters of Administration
are hereby granted to J'CD.'i L. ...D1 r ...J[oR
in the estate of R~'L>Clt::R L, ~h ',.te) I) A?T
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I.j);.AUlct:: 6,\)\..i). ''!J,:1:[ "tV.{)"
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Register of Wills pVc V V\~Ul--
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FEES Q 'C
Letters of Administration ..... $ I, c ,
Sh C 'f () $ 3 ['", ATTORNEY (Sup. Ct. l.D. No.)
ort eft! lcates t .' . . . . . . . . \.-'
Renunciation ................ $ S
$icr' C' L~)
TOTAL _ $~L ADDRESS
Filed ........,............ A.D. 19_
PHONE
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H105.1....Rev.1/91 COMMONWEALTH OF PENNSYLVANIA. DEPARTMENT OF HEALTH. VITAL RECORDS
CERTIFICATE OF DEATH
~RINT (Coroner)
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~ANENT 1129-341 ST.<rEFIl.-ENUMBER
CKINK NAMEDFDECEDENTIF"S1.M'ddle,l.-asl) '" SOCIAl SECURITY NUMBER DATEOFDEATH(MonTh,Day,'o'@.'1
Rodger L Shughart ~. Male " 209-36-1602 . Au ust 24, 2004
UNDER' YEAR UNDER, DAY OAJEOFBIATH BIRTHPlACEIC,'y.nd PlACEOFDEATHICh<>.:kon'yor>e ...onst'ucMn''''''''he''''del
Montn. ~" ~"" M'n",., (Mon'h. Day. Yea,) Sla,.",FOC"'llnC""n"yl HOSPITAl
~rlisle,PA Inpalieo"ltO g'.':,tyIO
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CITY,BOR ",n" FACIl.-ITYNAME 1'lnOI'~"'lul'on,~<ve'i'''''''ndn"mbe') RACE .Am.~c.n Ir>dian. Bla<;k, WM.,..e !
ISpecrly)
Cumberland Lower Frankford 135 Oak Hill Road White
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DECEDENT'SUSUAlOCCUPATION KINDOFBU$INE$S/INDUSTRY WAS DECEDENT EVER IN MAAITAlSTATUS_M."ied $UAVIVING$POUSE
1~;V;;;'~,,;~':'~":~tu~';~,~i U_SARMEDFORCE$1 NOWI'M.";ed,Wido'Wed, (Ifwile,~".mat<l"n~me)
w..o NoOO Dil<<>reedlSpecolyl
11.. llb. " Never Married
DEcEDENrSMAll.-INGAODAESSISHoeI.C'1',fTown.St.'._ZipCO<lel DE EDENT'S PA 11e.5(I w'o, d~cedenll'vedio r r'ltJor J;'r;:l)nkf",..,rr'l
ACTUAL 17._Stal. 0< ,~
135 Oak Hill Rd. AESIDENCE deeMon'
(See,n",,,,,,,,,,,. Ii..ino
18. Carlisle. PA 17013 onol~"""~) C:llmhPrlnnn IOWO.~;~' \7d.O ~~h~~~~~7\i=C!
\7b.Couo"lt O"Y/bO'C
FAJHEA'$ NAME IF".,. M<l"'e LaOT) MOTHER'SNAME(F"st,M'ddle,Mat<lenSu"'am~)
1'. Lester' Eugene Shughart ,", Macy Louise Barnin er
INFOAMANT"$ NAME (Type/P'on') INFORMANT"SMAILINGAOOAE$$(Sl'ee!.c..,.rrcwn.s"'.,Z,pCOd<tl
ro..Jody Bitner ,~, 1142 Newville Rd., Carlisle, PA 17013
METHOOOfOISPOSITION DATEOFOISPOSITION Pl.-ACEOfDISPOSITION.NamecICemelery,C,emalory LOCATION-C'lyiTcwo.SI.te,Z,pC<><le
BurialD crom.ab""[)::: Aemov.fI",mSl.,.D jMonlh,O,y,l'ea'l c,Ot""'Pl8ce
Ott>o<lSpeco!y' 0 21b.A 26, 2004 2,~orktowne Cremation Serv. York, PA 17404
21d.
FFUNERA ~, '" RPEA ACNGASSUCH LICENSE NUMBER NAMEANOADOAES$OFFACILITV 0 man- 0 era orne
~ n" 220.
TOI~._clmy~nowIodge,cleathcoomredall""lj",e,"al..ndpj.e.atated liCENSE NUMBEA DATE SIGNED
1S>g""M.ondT~I., IMonth,Ooy,Yea'!
23.. 23b. ,~,
TIME OF DEATH Aprx. DATE PRONOUNCED DEADIMor>'h,O'y,Yearl WAS CASE REFE'ie~:j;['l EXAMINEfVCORONEA?
1:00 A. August i4. 2004 ~D
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27. PA.IlT I: Enl...t"" ,,;........., 'Olu"oso'"",mpheab"ns...hic~oau"';Il'.dealh. Donot.nle'lhemod~oldy'''ll,'''''ha.o.rd;aoo'feopi'.lOry."""" .hoekC'hea~!.ilur. ,ApWO"""'l. PART II: Othe"Ogo";o.o"Itcor>Clit~cor>1'ibuli"!lloclealh,oo'
llol only one ea_on..ch Ii"" :iol1~"'albelw"'o """.....~ln9ioth...-.lafty~ca.....g"""'inPARTI
. Multi-vessel Coronar Arter Disease ioo..,.MOOlth
DUETO/ORASACONSEOUENCEOF) .
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DUE1O(ORASACON5EQUENCEOf) :
DUE1OIORASACONSEOUENCEDFl .
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WEREAU10PSYFINDINGS MANNEH OF DEATH DATE Of INJURY TIME OF INJURY INJUAYATWORK? DESCAIBE HOW INJURY OCCUARED
AVAIl.-ABl.-EPAIOATO IMor>lhOay,l'ea"
COMPlET,ON OF CAUSE ~ 0 ~. 0 ".0
OF DEATH? Natu'al H"",;c;"~
~,~ Acci<leo"lt 0 PeMi"llin.est'gation o JOa '"' " ,~ 'M
".0 0 o PlACEOFINJURY-Alhom.,larm,,,,_.l.ctory.olloc. LOCATION 1St",.". C..,.t-'n"~ 51.,.)
Su<:"'" Ccul<lnc1b11de1.,m,ned buj'''ln9, e'c. ISpec,'Y'
2.b. ,", 'M, ,.,
CEATIFIEAICnockon'yon~) C , i
'CERTIFYING PHYSfCIAN IPI1y"""'~ c"",ly,nQ cau... dI ""aTh when anol~'" p/'ysoe'an Ms p,or>Qunc..., C!e.Th ,~" complelod 110m 231 0 Coroner
To__olmyk""wladg.,d.athoceu'redd...lo1t>ac.uHj.).....man""'...I.ted. .
OATESIGNEDIMonln.D.ay",",,)
'PRONOUNCING AND CERTIFYING PHYSICIAN iP~y"",,,n t>c,~ p,,,,,,,,,n,,,"Il a~.'h and cM"y.ng 'U Gause 01 ".athl 0310. J1d. Augus t 25, 2004
To1ha bntolmy~no..la<Iga, "".maceu""" .1_lIma, d.le,..... plac., aodduelO t... eau.o{.) .nd mao",",.. .l_ted,. NAME/lNOADDRESSOFPERSClNWHOCOMPlETEOCAUSEOfOEATH
(llem27)TypecrP'iol Michael L. Norris. Coroner
'MEDtCALEXAMINERICORONER
On the baale 01 u.mlnall"n .nd/or Inv"lIg8tf"n, In my opinion, death oceu're<l.t the lime. date, end pl.ce, Bnd lIua lo1he e.us~(.) .nd )f.J2 6375 Basehore Road, Suite #1
m.nn.....t.lecl.. Mechanicsburg. Pa. 17050
311.
REG'STAAA'SSIGNArUAEANDNUMBE~ Li- t:\. ~~~~-u" 14'\~, \,nl O,ouEFllED(Monln.D,y,Yoa,'
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RENUNCIATION
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To the Register of Wills of CU.l1l<1 ocr JOf.1J o{ County, Pennsylvania.
The undersigned GhlLdleV\ of
the above decedent, hereby renounce(s) the right to administer the estate and respectfully ask(s) that Letters
be issued to
j1Jafary S d
WITIiE3:'l and this C). ~_ day of V' , 211 d_,
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~iD1AflIAL SEAL
D>,WN !Vi GPUGH,~RT, i\.Vrtary P:Jt);;C
80m o( (;a(.1ll1!. C\n'\'!OOI1alld C<>Ul1ty ,,-,' ' ,
\MyCoo'T.iss!o~f-";~~:':'~:~C Lj\()1 CCU!t fit ~j Hard~6rJ.')j1
(Address) ~~f '-130":
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(Signature)
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Claimant: .",0 -r- ('"")
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Zizzi's Inc, :'~...:;..:u u::l i"'\ rn
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1448 Holly Pike .~ (') 0 -u C)CJ
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Carlisle, Pa. 17013 c)C ~,~ ,?5
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Defendant: 0'1 -..
Rodger L. Shughart c/o Jody L. Bitner, Executrix
13 5 Oakhill Rd 1142 Newville Rd.
Carlisl~ Pa. 17013 Carlisle,Pa 17013
;1.1-0 -~81
Brief history of claim:
On May 18, 2004 Rodger L. Shughart purchased a 12' X 20' wooden storage
shed from Zizzi's Inc. Delivery was made to 135 Oakhill Rd. on June 7,2004. On June 1,
2004 a partial payment was made by check # 670 in the amount of$ 894.54. On July 9,
2004 check # 670 was returned to Zizzi's Inc. for Non Sufficient Funds. On July 23,2004
Zizzi's sent Mr. Shughart notification of the bad check and a returned check fee now due.
Subsequent payment on the bad check was made by money order in the amount of $ 200
on August 9, 2004. No other payments on the bad check have been made and the balance
due remains at $ 719.54
An incident report was filed with the Pa State Police on August 5, 2004 prior
to Mr. Shughart's death. Notice of balance due was sent to Jody L. Bitner, Executrix on
October 1, 2004 after the Executrix Notice appeared in the Carlisle Sentinel.
Amount Claimed: $ 719.54
Attachments:
Copy of original invoice
Copy of delivery invoice
Copy of returned check
Copy of July 23, 2004 letter
Incident report to State Police
Copy of letter to Executrix Bitner
V
Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717)240-6345
Date: 01/10/2005
BITNER JODY L
1142 NEWVILLE ROAD
CARLISLE, PA 17013
RE: Estate of SHUGHART RODGER L
File Number: 2004-00881
Dear Sir/Madam:
It has come to my attention that you have not filed the
Certification of Notice Under Rule 5.7 ( a) in the above captioned
estate.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES,
NO. 103 SUPREME COURT RULES DOCKET NO. 1, for decedents dying on
or after July 1, 1992, the personal representative or his
counsel, within ten (10) days after giving proper notice to the
beneficiaries and intestate heirs as required by subdivision
(a) of Rule 5.7, shall file with the Register of wills or Clerk
of the Orphans' Court his/her Certification of Notice.
This filing will become delinquent on 01/07/2005
Your prompt attention to this matter will be appreciated.
Thank You.
Sincerely,
~/=:!!::;;t
Clerk of the Orphans' Court
cc: File
Counsel
Judge
CERTIFICATION OF NonCE UNDER RIlLE 5.6(a)
Name of Decedent: 'K()clge r L. ~fll~:JhQ r?1-
Date of Death: 0<4 /1/13' cRool.{
Will No. _{\ {) L0\.u \DOS M~ Admin. No..;21 - 0<-/ - 02& 1
To the Register:
I certify that notice of (beneticiallnterest) estate administration required by Rule 5.6(a) of the 1rs' COurt{UleS was
served on or mailed to the following beneficiaries of the above-captioned estate on 5:e ,~ CD :
N= Address
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:)ASbVl . tv. St\I,)~no.v+ ' I~O(lLJ-h /I ed tOAlLS Ie PC1 lID IJ
Notice has now been given to all persons entided thereto under Rule 5.6(a) except ~
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Date: 0 J" An ;:}OO) ~~
Signature
Name "J ad ~ 13'\'\--r1Lr
Address nLl.7 f0eWV\\~ ed
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b u-, Capacity: ~ersonal Representative
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Cumberland County - Register Of Wills
One Courthouse Square
Carlisle, PA 17013
Phone: (717) 240-6345
Date: 7/05/2006
BITNER JODY L
1142 NEWVILLE ROAD
CARLISLE, PA 17013
RE: Estate of SHUGHART RODGER L
File Number: 2004-00881
Dear Sir/Madam:
This notice is to serve as a reminder that the Status Report by
Personal Representative under Rule 6.12 is due on the below listed
date.
As per the AMENDMENTS TO SUPREME COURT ORPHANS' COURT RULES, NO. 103
SUPREME COURT RULES DOCKET NO. I, for decedents dying on or after
July I, 1992, the personal representative or his counsel, within two
(2) years of the decedent's death, shall file with the Register of
wills a Status Report of completed or uncompleted administration.
This filing is due by:
8/24/2006
Please feel free to contact this office with any questions you may
have. If you have already filed your Status Report, please disregard
this notice.
Sincerely,
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Glenda Farner Strasbaugh
Clerk of the Orphans' Court
cc: File
Counsel
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In Re: Estate of
SHUGHART RODGER L
ORPHANS' COURT DIVISION
COURT OF COMMON PLEAS OF
CUMBERLAND COUNTY
PENNSYLVANIA
NO. 2004-00881
NOTICE OF FAILURE TO FILE STATUS REPORT
Personal Representative:
BITNER JODY L
Counsel for Personal Representative:
Date of Decedent's Death: 8/24/2004
The Orphans' Court record indicates that neither the above named personal representative
nor the above named counsel for the personal representative have filed with the Register of Wills
or Clerk of the Orphans' Court his, her or its Status Report required by Rule 6.12, Supreme
Court Orphans' Court Rule and that the requisite notice, pursuant to Rule 6.12, Supreme Court
Orphans' Court Rules, is hereby given by that the you have ten (10) day to file the Status Report.
If the required 6.12 form is not filed in accordance with Rule 6.12 the Court will be notified of
such delinquency and the undersigned will requests that a Court conduct a hearing to determine
whether sanctions should be imposed upon the delinquent personal representative or counsel for
the delinquent personal representative.
Date:
8/29/2006
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· Sender: Please print your name, address, and ZIP+4 in this box ·
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Glenda Farner Strasbaugh
Register of Wills and Clerk of Orphans' Court
County of Cumberland
One Courthouse Square
Carlisle, PA 17013
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COMPLETE THIS SECTION ON DELIVERY
. Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
. Print your name and address on the reverse
so that we can return the card to you.
. Attach this card to the back of the mailpiece,
or on the front if space permits.
1. Article Addressed to:
B I TNr-.~R JODY L
1142 NEWVILLE ROAD
CARLISLE PA 17013
2. Article Number
(rransfer from service label)
PS Form 3811 , February 2004
D. Is delivery address diffe
If YES. ~r delivery ad
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o Agent
o Addressee
C. Dat~of~,E:ry
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o Insured:f!l!ar d- C.O.tl " .-:-)
4. Restricted Delivery? (Extra I'ee)
7005 0390 0003 2639 0230
Domestic Return Receipt
102S9S-Q2-M-1540
Register of Wills of Cumberland County
STATUS REPORT UNDER RULE 6.12
Date of Death:
~ L~
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Name of Decedent:
Estate No.:
Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following
with respect to completion of the administration of the above-captioned estate:
]. State whether administration of the estate is complete:
Yes4lJ No 0
2. If the answer is No, state when the personal representative reasonably believes that
the administration will be complete:
3. If the answer to No. 1 is Yes, state the following:
a. Did the personal representative file a final account with the Court?
Yesg No 0 ~\f ....\){b ~ RIV',
b. The separate Orphans' Court No. (ifany) for the personal representative's
account is:
c. Did the personal representative state an account informally to the parties in
interest? Yes 0 No.lX}
Date: .,
c. Copies ofreceipts, releases, joinders and approval offonnaI or informal
accounts may be filed with the Clerk of the Orphans' Court and may be
attached to this report. ~
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Signa re
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Address
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Telephone No.
Capacity: 0 Personal Representative
o Counsel for personal representative
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REV.l500 ex (&00)
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'*' COMMONWEALTH OF
PENNSYLVANIA
. DEPARTMENT OF REVENUE
DEPT. 280601
HARRISBURG, PA 17128-0601
REV-1500
INHERITANCE TAX RETURN
RESIDENT DECEDENT
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SOCIAL SECURITY NUMBER
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THIS RETURN MUST BE FILED IN DUPLICATE WITH THE
REGISTER OF WILLS
SOCIAL SECURITY NUMBER
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1. Original Retum
D 4. Umited Estate
D 6. Decedent Died Testate (AlIach copy of WIl)
D 9. Utigation Proceeds Received
D 2. Supplemental Retum
D 4a. Future Interest Compromise (dale 01 death after 12-12-82)
D 7. Decedent Maintained a living T[USt (AIach c:opyofTRlst)
D 10. Spousal Poverty Credit (8II1e of dealh belween 12-31-91 and 1-1-95)
D 3. Remainder Retum (dale oIdealhprio'lo 12-13-82)
D 5. Federal Estate Tax Return Required
8. Total Number of Safe Deposit Boxes
D 11. Election to tax under Sec. 9113(A) (AIach Sdl 0)
7. Inter-VIVos Transfers & Miscellaneous Non-Probate Property
(Schedule G or l)
8. Total Gross Assets (total Unes 1-7)
9. Funeral Expenses & Administrative Costs (Schedule H)
10. Debts of Decedent, Mortgage Uabilities, & Liens (Schedule I)
11. Total Deductions (total lines 9 & 10)
12. Net Value of Estata (line 8 minus Une 11)
13. Charitable and Governmental BequestsfSec 9113 Trusts for which an election to tax has not been
made (Schedule J)
NAME ,:5"QOLL f3ITNE:R:
FIRM NAM~AppicabIe) I
TELEPHONE NUMBER
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.COMPLETE MAILING ADDRESS
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held Corporation. Partnership or SoIe-Proprietorship
4. Mortgages & Notes Receivable (Schedule D)
5. Cash, ~Deposits & Miscellaneous Personal Property
(Schedule E)
6. Jointly Owned Property (Schedule F)
D Separate BiDing Requested
14. Net Value Subject to Tax (Une 12 minus Una 13)
(1)
(2)
(3)
(4) ~
(5) ~ 3'11./:.'eX)
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(6)
(7)
(9)~
(10)
$ 3rJLf. V
(8)
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(12) ~-'~e(,.OD
(13) ~
(14) -1t 4p(,O.--
SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES
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8-
x.O_ (15)
x.O_ (16)
x .12 (17)
x .15 (18)
(19) (:)
19. Tax Due
CHECK HERE IF YOU ARE REOUES11NG A REFUND O~ t,N OVl-RPAYMENT
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15. Amount of Une 14 taxable at the spousal tax
rate, or transfers under Sec. 9116 (a)(1.2)
16. Amount of line 14 taxable at lineal rate
17. Amount of Une 14 taxable at sibling rate
18. Amount of line 14 taxable at co8ateral rate
20.0
Decedent's Complete Address:
f~~~ =~
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I STATE ? 11
Tax Payments and Credits:
1. Tax Due (Page 1 Line 19)
2. CreditslPayments
A. Spousal Poverty Credit
B. Prior Payments
C. Discount
(1)
~
..::Pi'
%.~
to
P
(3)
(4)
(5)
(5A)
Total Credits (A + B + C )
(2)
3.
Interest/Penalty if applicable
D. Interest
E. Penalty
4.
Totallnterest/Penalty ( 0 + E )
If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT.
Check box on Page 1 Une 20 to request a refund
5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE.
A. Enter the interest on the tax due.
B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B)
Make Check Payable to: REGISTER OF WILLS, AGENT
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PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS
1. Did decedent make a transfer and: Yes
a. retain the use or income of the property transferred;.......................................................................................... D
b. retain the right to designate who shall use the property transferred or its income; ............................................ D
c. retain a reversionary interest; or.......................................................................................................................... D
d. receive the promise for life of either payments, benefits or care? ...................................................................... D
2. If death occurred after December 12, 1982. did decedent transfer property wnhin one year of death
without receiving adequate consideration? .... .... ............................. ....... .............. ... ............................................ ..... D
3. Did decedent own an 'in trust for" or payable upon death bank account or security at his or her death? .............. D
4. Did decedent own an Individual Retirement Accoun~ annuity, or other non-probate property which
contains a beneficiary designation? ...... ............ ...... ......... ....................... .... ........ ............................... ..................... D
No
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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 penallIes of perjllly, I declare that I have 8lCllIlIiled !his return, inctudlng accomPllnylng schedules and statements, and to the best of my knowledge and belief, it Is true, correct and complete.
Declaration of JlIlIIl8IlIf other than the personal representatlw is based on allnfonnation of which pnlparer has any knowledge.
SIGNATU RSON RESPONSIBLE FOR FILING RETURN (f'? L
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SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE
ADDRESS
DATE ay It-V 6-070
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DATE
For dates of death on or after July 1, 1994 and before January 1,
[72 P.S. 99116 (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 exemot a transfer to a surviving spouse from tax, and the statutory requirements for disdosure of assets and filing a tax retum 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 paren~
or a stepparent of the child is 0% [72 P.S. 99116(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)1. 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.
the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3%
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Hoffman-Roth Funeral Home, Inc.
219 North Hanover Street
Carlisle, P A 17013
(717)243-4511
October 5, 2004
Jamie Mitchell
4507 Carlisle Rd.
Gardners, P A 17324-
The Funeral Service for Rodger Lee Shughart
14353-163
We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please
feel free to contact us if you have ahy questions in regard to this statement.
THE FOLLOWING IS AN ITEMIZED STATEMENT OF THE SERVICES, FACILITIES, AUTOMOTIVE EQUIPMENT,
AND MERCHANDISE THAT YOU SELECTED WHEN MAKING THE FUNERAL ARRANGEMENTS.
(A) OUR SERVICE:
CREMATION PACKAGE # 2. . . . . . ...
FUNERAL HOME SERVICE CHARGES
SELECTED MERCHANDISE:
Wellington Casket (Insert) RENTAL "
Marbelon Universal Urn Receptacle .
Roman Urn. . . . . . . . .
THE COST OF OUR SERVICES, EQUIPMENT, AND MERCHANDISE
THAT YOU HAVE SELECTED . . . . . .
Casb Advances
Certified .Copies of Deatb Certificate .
Coroner Authorization Cremation Fee.
'.
TOTAL CASH ADVANCES AND SPECIAL CHARGES.
Total
Total Cost .
History
10/05/2004 lody L. Bitner
TOTAL AMOUNT DUE .
This statement is net and payable In full within 30 days of fecelpt.
$2525.00
$2525.00
$995.00
$340.00
$155.00
$4015.00
$20.00
$25.00
$45.00
$4060.00
$-4060.00
$0.00
Please return this portion with YOlJr Rer:!'ittance
----------------------------------------------------------.-------
$
Amount Enclosed
Service 10 # 14353-163
Rodger Lee Shughart
BUREAU OF INDIVIDUAL TAXES
INHERITANCE TAX DIVISION
PO BOX 2B0601
HARRISBURG PA 17128-0601
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
NOTICE OF INHERITANCE TAX
~i^~~~ :^~LOWANCE OR DISALLOWANCE
hti)'./~\~f::p~~~,n~N,S AND ASSESSMENT OF TAX
?t~(;\'2\ \' t~.\.(; :,~,';-' 1\,\ ;." ",
'*
REV-1547 EX AFP (06-05)
DATE 12-11-2006
ESTATE OF SHUGHART RODGER L
DATE OF DEATH 08-24-2004
FILE NUMBER 21 04-0881
COUNTY CUMBERLAND
ACN 101
APPEAL DATE: 02-09-2007
( See reverse side under Objections)
A.ount Re.ittedl I
MAKE CHECK PAYABLE AND REMIT PAYMENT TO:
REGISTER OF WILLS
CUMBERLAND CO COURT HOUSE
CARLISLE, PA 17013
CUT ALONG THIS LINE -+ RETAIN LOWER PORTION FOR YOUR RECORDS +-
-------------------------------------------------------------------------------------------
REV-1547 EX AFP (03-05) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHUGHART RODGER L FILE NO. 21 04-0881 ACN 101 DATE 12-11-2006
200~ OEe \ 5 M'1 \\: 32
JODY L BITNER
1142 NEWVILLE RD
CARLISLE PA
CLEP,\\ OF
ORPU"~"'S rClURT
\, 1,"-\\ \ '~' '~~)\;:'i-"': p'~
C\ \\!i~,-" "', ' I '. ,',"\
v" -, "
17013
TAX RETURN WAS:
) ACCEPTED AS FILED
( X) CHANGED
SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: ORIGINAL RETURN
1. Real Estate (Schedule A)
2.
3.
4.
5.
6.
7.
S.
Closely Held Stock/Partnership Interest (Schedule C)
Mortgages/Notes Receivable (Schedule D)
Cash/Bank Deposits/Misc. Personal Property (Schedule E)
Jointly Owned Property (Schedule F)
Transfers (Schedule G)
0)
(2)
(3)
(4)
(5)
(6)
(7)
.00
.00
.00
.00
374.00
.00
.00
(S)
NOTE: To insure proper
credit to your account,
submit the upper portion
of this form with your
tax payment.
Stocks and Bonds (Schedule B)
374.00
Total Assets
APPROVED DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests; Non-elected 9113 Trusts (Schedule J)
14. Net Value of Estate Subject to Tax
(9)
(0)
4,060.00
.00
(1)
(2)
(3)
(4)
4.0t;O.OO
3,686.00-
.00
3,686.00-
NOTE: If an assess.ent was issued previously, lines 14, 15 and/or 16, 17, 18 and 19 will
reflect figures that include the total of !U. returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate 05) .00 X 00 .00
16. Amount of Line 14 taxable at Lineal/Class A rate (6) .00 X 045 = .00
17. Amount of Line 14 at Sibling rate (7) .00 X 12 = .00
18. Amount of Line 14 taxable at Collateral/Class B rate (18) .00 X 15 = .00
19. Principal Tax Due (9)= .00
AX CREDITS'
PAYMENT RECEIPT DISCOUNT (+) AMOUNT PAID
DATE NUMBER INTEREST/PEN PAID (-)
TOTAL TAX CREDIT .00
BALANCE OF TAX DUE .00
INTEREST AND PEN. .00
TOTAL DUE .00
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
.\%
! \
( IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. . .
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A REFUND. SEE REVERSE SIDE OF THIS FORM FOR INSTRUCTIONS.)
r . .
REV-1470 EX (6-88)
'*
INHERITANCE TAX
EXPLANATION
OF CHANGES
COMMONWEALTH OF PENNSYLVANIA
DEPARTMENT OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG PA 17128-0601
DECEDENTS NAME
FILE NUMBER
2104-0881
101
Rodger L Shughart
ACN
REVIEWED BY
Deborah Washington
ITEM
SCHEDULE NO.
EXPLANATION OF CHANGES
The value of the estate has been adjusted as the result of the correction of an error in
arithmetic.
ROW
Page 1