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Home My WebLink About08-20-12 (2)15056051058 -~' REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes ~°" INHERITANCE TAX RETURN PO BOX 280601 21 12 0153 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death Date of Birth 204-26-7922 12/30/2011 .05/27/1933 Decedent's Last Name Suffix Decedent's First Name MI Shughart Helen P (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 1. Original Return 2. Supplemental Return 3. Remainder Return (date of death prior to 12-13-82) 4. Limited Estate 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) ! : 6. Decedent Died Testate 7. Decedent Maintained a Living Trust 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) Litigation Proceeds Received 9 10. Spousal Poverty Credit (date of death 11. Election to tax under Sec. 9113(A) . between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT -THIS SECTION MUST BE COMPLETED. ALL CO RRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DlRecrEO to: Daytime Telephone Number Name Lisa Marie Coyne, Esq. (717) 737-04 4 ~ ==R .. ble) li If A N LS USE tY GISTER~I ~~ ~} ~_T~ - f ~ ca pp ame ( Firm Coyne & Coyne, P.C. ,. RE ~I ~~' ~3 ±:. r j ; `~ is ~~ ~ ~ rv t- ' ~-~ First line of address 2 "'- ` ' ~' i-. ,___ 3901 Market Street "'~ ...,.,. ~ ~ ~~ - ,. - - ,~ ~ C_. r Second line of address W .;_ n=? DATE FILED +..,k City or Post Office State ZIP Code - "" Camp Hill PA 17011 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true. correct and complete. Declaration of preparer other than the personal representative is based on all information of which preparer has any knowledge. RE OF,HERSON,RE ~IySIBLE FAR FILIyG ~~~r UAIt ~ ~'}} Marlin E_ Shuahart. Jr. 10 Huntington Drive, Mountville, PA 17554 SIGNATURE OF PREPARER OTHER THAN REPRESENTATIVE DATE ADDRESS PLEASE USE ORIGINAL FORM ONLY Side 1 15056051058 15056051058 ~~~ J 15056052059 REV-1500 EX Decedent's Social Security Number Helen P Shughart 204-26-7922 Decedent's Name: RECAPITULATION 110,000.00 1. Real estate (Schedule A) . ............................................ 1. . 0.00 2. Stocks and Bonds (Schedule B) ....................................... 2. 0.00 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ..... 3. 0.00 4. Mortgages & Notes Receivable (Schedule D) ............................ . 4 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property (Schedule E) ........ 5. 2,545.77 6. Jointly Owned Property (Schedule F) Separate Billing Requested ....... 6. 0.00 7. Inter-Vivos Transfers 8~ Miscellaneous Non-Probate Property 7 0.00 (Schedule G) Separate Billing Requested........ . 8 112,545.77 8. Total Gross Assets (total Lines 1-7) .................................... . 9. Funeral Expenses 8~ Administrative Costs (Schedule H) ..................... 9. 38,990.66 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) ................ 10. 39,820.28 11. Total Deductions (total Lines 9 8~ 10) ................................... 11. 78,810.94 .............................. 12. Net Value of Estate (Line 8 minus Line 11) 12. 33 734.83 Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 . an election to tax has not been made (Schedule J) ........................ 13. 14. Net Value Subject to Tax (Line 12 minus Line 13) ........................ 14. 33,734.83 TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 15. (a)(1.2) X .0_ 16. Amount of Line 14 taxable 33,734.83 at lineal rate X .0 45 16. ' 1,518.07 17. Amount of Line 14 taxable 17. at sibling rate X .12 18. Amount of Line 14 taxable 18 at collateral rate X .15 . 1,518.07 19. TAX DUE ........................................................ .19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT 15056052059 Side2 15056052059 REV-1500 EX Page 3 File Number __ Decedent's Complete Address: 21 12 .0153 DECEDENT'S NAME DECEDENTS SOCIAL SECURITY NUMBER Helen P Shughart 204-26-7922 STREET ADDRESS 2100 Bent Creek Blvd. cITY Mechanicsburg STATE PA 17055 ZIP Tax Payments and Credits: (1) 1,518.07 1. Tax Due (Page 2 Line 19) 2. CreditslPayments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) 0.00 3. tnterestlPenalty if applicable D. Interest E. Penalty Total InterestlPenalty (D + E) (3) 0.00 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. (4) Fill in oval 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) 1, 518.07 (5A) 0.00 A. Enter the interest on the tax due. (56) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. 1,518.07 Make Check Payable to: REGISTER OF WILLS, AGENT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOC KS 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 .................................................................................................................... ^ d. receive the promise for life of either payments, benefits or care? .................................................................... .. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death ................ without receiving adequate consitleration? .••••••••••••••••••••••••••••••••••••••••~••~~•••~•• 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ........... ... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which . ^ a 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 January 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is three (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 zero (0) percent (72 P.S. §9116 (a) (1.1) (ii)]. The statute does not exempt a transfer to a surviving spouse from tax, and the statutory requirements for disclosure of assets and filing a tax return are still applicable even if the surviving spouse is the only beneficiary. For dates of death on or after July 1, 2000: The tax rate imposed on the net value of transfers from a deceased child 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 zero (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 four and one-half (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 twelve (12) percent (72 P.S. §9116(a)(1.3)]. Asibling is defined, under Section 9102, as an individual who has at least one parent in common with the decedent, whether by blood or adoption. RE'J-1502 EXw- ;11.-Gb; ~ Pennsylvania SCHEDULE A DEPARTMENT OF REVENUE. RE A ~ C~~ A ~C INHERITANCE TAX RETURN GM G M G RESIDENT DECEDENT ESTATE OF Helen P. Shughart FILE NUMBER 21-12-053 All real property owned solely or as a tenant in common must be reported at fair market value. Fair market value is defined as the price at which property would be exchanged between a willing buyer and a willing seller, neither being compelled to buy or sell, both having reasonable knowledge of the relevant facts. _ .. _~ __ __._~~.. _....._a ...:aw .....w} rf ~~~aa.,~r~ti~h n,~~~t hp disclosed on Schedule F. If more space is needed, mserc aaaiuonai sneers u. uic panic ~~~~. A.~µE N' ~, ^s~ ~F~~ yc~ OMB Approval No. 2502-0265 ' ~ ` ~ Z * 1 ~ * ~ A. Settlement Statement (HUD-1 ~n •' ~ •. 6. File Number: 7. Loan Number: 8. Mortgage Insurance Case Number. ', 1. ~ FHA 2. ~ RHS 3. ~ Conv. Unins. 4. ~ VA 5. ~X Conv. Ins. PS07-12 1540081605 C. Note: This form is famished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "{p.o.c.)" were paid outside the closing; they are shown here for informational purposes and are not included in the totals. i D. Name 8 Address of Borrower: Matthew D. Haggler ~ E. Name ~ Address of Seller: (Marlin Shughart, Jr., Executor of the Estate F. Name 8 Address of Lender: ~ Everbank j Hof Helen P. Shughart, deceased 116 N. Enola Dr 1758 W. Trindle Road 18100 Nations Way Enola PA 17025 Carlisle PA 17015 Jacksonville FL 3 2256 G. Property Location: H. Settlement Agent: . I. Settlement Date: Gregory R. Reed, Esq. 1758 W. Trindle Road, Carlisle 3120 Parkview Lane 7/9/12 Middlesex Township Harrisbur PA 17111 Cumberland County PA 17015 i Place of settlement:3120 Parkview Lane ~ ?arcel # 21-22-0119-069 and 21-22-0119-070 Harrisburg PA 1711 1 I :• 400. Gross Amount Due to Seller 401. Contract sales price ~ 110 000 00 402. Personal property , . ~ 403. 404. 405.8. ~ Adjustments for items paid by seller in advance l 406. City/town taxes to _ 407. County taxes 7/9/12 to 12/31 /12 247 11 408. Assessments to i . _ 409. to 410. to -~~ 411. to 412. a. 420. Gross Amount Due to Seller ~ .J 110 247 1 1 500. Reductions In Amount Due to Se Iler . . _ 50t. Excess deposit (see instructions) I __ 502. Settlement charges to setter (line f40o) I 8 571 81; 503. Existing loan(sy taken subject to , . ~ 504. Payoff of first mortgage loan ~ ~_J 505. Payoff of second mortgage loan _ i 506. Escrow for HVAC an pest control ~ 6 940 40; _ 507• Seller's het 1 , . 3 000 00 5oa. , . 509. a. Adjustments for items unpaid by seller 510. City/town taxes to 511. County taxes to j 512. Assessments to ; 1 513. School taxes 711/12 to7/9/12 33.82 514. to 515. to i j 516. 517. j 518. 519. a. ~ 520. Total Reduction Amount Due Seller ! 18,546.03: 600. Cash at Settlement tolfrom Seller . 601. Gross amount due to seller (line 420) i 110,247.11 'i 602. Less reductions in amount due seller (line 520) . ( 18,546.03) 603. Cash ~ To ~ From Seller I ~ 91,701.081 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reporting the data. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is assured; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. Previous editions are obsolete Page 1 of 3 HUD-1 . r-- 700. Total Real Estate Broker Fees ~ papd From Paid From Division of commission (line 700) as follows: Borrower's Sellers 701• $ 3,300.00 to Re/Max 1st Advantage~lnc. Funds at Funds at 702.5 3,595.00 to Prudential Homesale Services Grou includes $295 broker fee I Settlement ~ Settlement I 703. Commission paid at settlement _~ ~ 6,895.00 704. ! -~ 800. Items Payable in Connection with Loan i ' 801. Our origination charge $ 1900.00 (from GFE #1) I ~ ~ 802. Your credit or charge (points) for the specific interest rate chosen $ -4,180.00 (from GFE #2) I _ 803. Your adjusted origination charges (from GFE A) -2,280.001 804. Appraisal fee to StreetLinks Lender Solutions $390.00 POC-B {from GFE #3) ~ -~ 805. Credft report to (from GFE #3) 806. Tax service to LERETA (from GFE #3) 74.00 807. Flood certfication (from GFE #3) 808. a. 900. Items Required by Lender to Be Paid in Advance X Exclude last day in CelCS -line 901 ! ' 901, Daily interest charges from 7/9/12 to$/1/12 Cci7 $ 12.17 Iday (from G_FE_#10) ~ 279.86 F 90_2. M_ortgape insurance premium for months to (trom GFE #3) ;903. Homeowners insurance for 1 years to Erie Ins. Exchange (from GFE #11) I ~ 453.001 ~ 904. e. i 1000. Reserves Deposited with Lender 1001. Initial deposit for your escrow account (from GFE tf9) 1,572.39 100_2. Homeowners insurance 4 months @ $ 37.75 per month $ 151. 00 _ _ 1003, Mortgage insurance 1 months ~ $ 58.35 per month $ 58.35 I ~ j 1004. Properly taxes 6 months ~ $ 48 .07 per month 5 288.42 , _ _ 1005. School taxes 12 months ~ $ 126.17 per month 5 1,514.04 1006. a. 1 months ~ $ per month $ 1007. Aggregate Adjustment -$ 439.42 1100. Title Charges 1101. Title services and lender's title insurance (from GFE #4) I 1,470.001 1102. Settlement or closing fee $ ~ ; I, 1103. Owner's title insurance (from GFE #5) j 1104. Lender's title insurance includes end. 100, 300, 8.1, 1100 $ 1,200.00 , 1105. Lender's title policy limit $ 104,500.00 i ; 1106. Owners title policy limit 5 110,000.00 _ ~ 1107. Agent's portion of the total title insurance premium $ 1 j 1108. Underwriters portion of the total title Insurance premium $ ! ____ 11os.a. See Attachment Page(s) ', ~ 1200. Govemment Recording and Transfer Charges 1201. Govemment recording charges (from GFE #7) j 168.00 ~ ~ 1202. Deed $ 72.00 Mortgage $ 96.00 Releases 5 1203. Transfer taxes (from GFE #8) ; 1,100.00 1,100.001 1204. City/County tax/stamps Deed $ Mortgage $ ~ ~ 1205. State tax/stamps Deed $ Mortgage $ I 1206. a. 1300. Additional Settlement Charges 1301. Required services that you can shop for (from GFE #6) L 15.50; 1302. Flood Certification Fee to Elite Lender Services 5 15.5.0 ~ 1303. Home Ins ct Inc. $ 160.001 130a. Pest Ins ection i 85.00 ~, i 1305.x. Se tic ins ection reimburse Trac Wei el 240.00! • ~ ~ • - - ~ - ~ 3,337.75' 8,571.81 CERTIFICATION I have carefully revi d the HUD-1 Settl ent Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursem m u i or b e in this transaction. I furthe ertify that I have calved a py o t HUD-1 ttl ant Statement. ~ /~ /,~ ~ n Borrower:. ` Date: Se r GAG ~1 Date' tt e D. ug~ Marl hugha r., Ex or Borrower: Date: Seller: Date: To the best of my knowledge the HUD-1 Settlement Statement which I have prepared is a true and accurate u oft unds whi re received and have been or will be disbursed by the undersigned as part of the settlement of this transaction. Settlement 7 Date: Agent: _ Date: C~- Gr o eed, sq. WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. code Section 1001 and Section 1010. Previous editions are obsolete Page 2 of 3 HUD-1 Comparison of Good Faith Estimate (GFE) and HUD-1 Charges j 1 Good Faith Estimate HUD-1 I Charges That Cannot Increase HUD-1 Line Number I j . !Our origination charge # 801 3,450.00 1,900.00, Y u credit or charge (points) for the speck interest rate chosen # 802 -4,180.00 i -4,180.00 Your adjusted origination charges # 803 -730.00 -2,280.00, Transfer taxes #1203 1,100.00 1,100.00; Good Faith Estimate HUD-1 152.00 1_6_8.00 450.00 390.00 74.OD ~ 74.00 15.50 15.50 691.50 j 647.50 ':, - ' - $ 0.00 or 0.00 % Charges That Can Change Initial deposit for your escrow account #'1001 Daily interest charges # 901 $ 12.17~day Homeowner's insurance # 903 Title services and lender's title insurance # 1101 Home Ins ct iSeptic Inspection # 1303 # 1305 Lean Tprmc Good Faith Estimate HUD-1 1,887.35 1, 572. 9 365.10 279.861 480.00 453.00 1,463.75 1,470.00 450.00 160.00; 150.00 240.00 Your initial loan amount is $ 104,500.00 Your loan term is i 30 years ~ Your initial interest rate is 4.25 °~ Your initial monthly amount owed for principal, interest, and $ 572.43 includes any mortgage insurance is Principal XD Interest I >~ Mortgage Insurance Can your interest rate rise? ~ No. ^ Yes, it can rise to a maximum of °,6. The first change will be on and can change again every after i . Every change date, your interest rete can increase or decrease I by %. Over the life of the loan, your interest rate is guaranteed to never be lower than % or higher than °k. Even ff you make payments on time, can your loan balance rise? X^ No. ^ Yes, it can rise to a maximum of $ Even if you make payments on time, can your monthly X^ No. ^ Yes, the first increase can be on and the monthly amount, amount owed for principal, interest, and mortgage insurance rise? owed can rise to $ The maximum it can ever rise to is S I Does your loan have a prepayment penalty? X ~ No. ^ Yes, your maximum prepayment penalty is $ Does your loan have a balloon payment? U No. ^ Yes, you have a balloon payment of $ due in ~ years on j Total monthly amount owed irrduding escrow account payments ^ You do not have a monthly escrow payment for items, such as property taxes and homeownefs insurance. You must pay these items directly yourself. XD You have an additional monthly escrow payment of $ 211.99 that results in a total initial monthly amount owed of $ 784,42 . This incudes principal, interest, any mortgage insurance and any items checked below: 1 Property taxes [~ Homeowner's insurance '.,~ ^ Flood insurance a SCh001 taXes ^ ^ Note: If you have any questions about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Previous editions are obsolete Page 3 of 3 HUD-1 Continuation of Settlement Statement (HUD-1) Matthew D. Huggler 1540081605 Borrower's Name Loan Number Everbank 71s112 Lender's Name Page 1 Settlement Date 1100. Title Charges 1109. a. Closing rotection letter $75.00 1109. b. Tax certificates $40.00 j 11os. c. Overni ht closing package $30.00 11os.d. Additional lot and Escrow Agreement $125.00 i _~ 1300. Additiona! Settlement Charges 1305. b. 2012 county/township taxes j i 576.81 j Charges That Can Change Good Faith Estimate HUD-1 ;Pest Inspection # 1304 55.00 85.00 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCNED~ILE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF FILE NUMBER Helen P. Shughart 21-12-0153 Include the proceeds of litigation and the date the proceeds were received by the estate. All nronerty jointly-owned with right of survivorship must be disclosed on Schedule F. (If more space is needed, insert additional sneers of the same size s . Checking Accounts: Number: ~~~~~~~ Date Opened: ~ ~ ~ {p Balance at Date of Death: ~ ~~ Name of Joint {~0~ Owner, if any: ~ 1 ~~.,. Savings Accounts: Number: 4 -~ Date Opened: ~~ ' ~~ Balance at Date of Death: ~ ~~ ~ Name of Joint ~ ~ ~ Owner, if any: Certificates of Deposit: Number: ~ .~' Date Opened: Name of Joint Owner, if any: Balance at Date of Death: Maturity Date: Interest Rate: Interest Paid Quarterly, Semi-Annual, etc. Debts: Y1~1 ~,~ ~ ~~~I ~~ ~' ~ j~ i~l ~- Estate of: Helen P. Shughart Name of Bank: Cornerstone Federal Credit Union Date of Death: December 30, 2011 r Signature of Bank or Savings oc. Official REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS ESTATE OF Helen P. Shughart FILE NUMBER 21-12-0153 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A. FUNERAL EXPENSES: 1 ~ Hoffman-Roth Funeral Home 2. Reception 3. Honorarium B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)IEIN Number of Personal Representative(s) Street Address City .State Year(s) Commission Paid: 2. Attorney Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Relationship of Claimant to Decedent 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees ~. Closing Costs for sale of real estate s. Cumberland Law Journal --legal advertisement s. Patriot News --legal advertisement ~o. Inheritance Tax filing fee ~ ~ . Postage Subtotal from Continuation Page AMOUNT 5,766.03 300.00 200.00 Zip 6,500.00 Zip 111.50 1,000.00 18,546.03 75.00 116.45 15.00 88.00 6,272.65 TOTAL (Also enter on line 9, Recapitulation) I $ 38,990.66 (If more space is needed, insert additional sheets of the same size) A B C D E 1 ESTATE OF HELEN P. SHUGHART NO. 21-12-0153 2 ~ -- 3 4 CONTINUATION OF SCHEDULE H--- PAG -- -- - ~ 5 - s Item No. _ _ Description Amount 7 12 Cleanin Supplies _ - $ 300.00 s 13 Estate Checks _ ~ $ 25.00 - s 14 Lon Distance Charges - $ 50.00 10 15 Chris Wagner-- Lawn Care $ 180.00 11 16 Brid es at Bent Creek-- Final Room and Board $ _ 624.65 12 __ 17 New Locks on House ~ _ 51.92 13 _ 18 Septic Pumped _ _ $ _ 289.00 - 14 _ 19 Pinnacle Health _ $ 100.00 15 20 State Farm --Homeowners Insurance $ -_ 48.33 16 _ _ 21 York Waste--Trash Haulin _ $ 113.75 17 _ __ 22 Mileage for Executor @ $0.55/mile - $ - 990.00 _ _- 1s 23 Missed Work for Executor _ - $ 2,500.00 - 19 25 Reserves ~- $ 1,000.00 20 - ~ Subtotal - - ----- $ 6,272.65 --- - -- 21 - - -- 22 -- 23 - 24 _-- 25 - 26 _ _ REV-1.512 FX-~ ;12-C1~; r enns lvania SCHEDULE I p y DEBTS OF DECEDENT, DEPARTMENT OF REVENUE INHERITANCE TAX RETURN MORTGAGE LIABILITIES & LIENS ESTATE OF FILE NUMBER Shughart 21-12-0153 Helen P . Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical expenses. VALUE AT DATE ITEM NUMBER DESCRIPTION OF DEATH 1 ~ The Hartford -- refund of annuity payment 736.74 2. Cornerstone Federal Credit Union bank fee 30.00 3. Uncleared checks 3,653.02 4. Elizabeth Schlusser--Payment for Nursing home and taxes and upkeep for house 7,634.00 5. Betsy Wagner--Payment for Nursing home and taxes, Septic Repair for Sale, and upkeep for house 9,942.50 6. Marlin Shughart--Payment for Nursing home and taxes and upkeep for house 6,705.50 7. Heidi Cook--Payment for Nursing home and taxes and upkeep for house 10,448.52 320.00 8. PPL 350.00 9. UGI 10. TOTAL (Also enter on Line 10, Recapitulation) I $ 39,820.28 If more space is needed, insert additional sheets of the same size. REV-151.:3 EX-} (1.7.-Q8; ~ pennsylvania SCHEDULE ~ DEPARTMENT OF REVENUE BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER Helen P. Shughart 21-12-0153 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 (a) (1.2).] 1. Marlin E. Shughart, Jr. son 1/4 of residual 2. Elizabeth J. Schlusser daughter 1/4 of residual 3. Betsy Wagner daughter 1 /4 of residual 4. Heidi Cook daughter 1/4 of residual ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. II NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN 1 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. I $ If more space is needed, insert additional sheets of the same size. ?~rz~Y 3~i11 rzn~ C7PS~YttmPnk of HELEN P. SHUGHART I, HELEN P. SHUGHART, of the Carlisle, 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 malting 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, her or its opinion, it might be proper and more advantageous to retain or renew and pay as they become due and payable. If I do not own a burial plot or a grave marker at the time of my death, I authorize my personal representative, in his, her or its sole discretion, to purchase a burial plot and to erect a suitable grave marker at my grave, and to expend sums from my estate for this purpose. GRIFFIE, TURQ & GRELL.: A'F•t'a Ft N ESrs • AT• l.AW SUFTEdt3'F 3~16t MARKETSTFtEF:'.T CAMP MILL, PENNSYLVANIA f;yOlit 200 t~[OR'TH HAT~IOV>;R S`fi3E~l" CARLfsLE, PENNSYLVANIA'f74'f3 nnnT, ~ nn n LAST WILL AND TESTAMENT OF HELEN P.SHUGHART SECOND I give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatever nature and wheresoever situate to my beloved spouse MARLIN E. SHUGHART, SR., providing that F survives me by sixty (60) days. THIRD Should my spouse MARLIN E. SHUGHART, SR. predecease me or die on or before the sixtieth (60th) day following my death, then z give, devise and bequeath my entire estate together with all insurance proceeds thereon of whatsoever nature and wheresoever situate in equal shares tv my children who survive me by sixty (60) days per capita. It is further my desire that my personal representative, after consultation with any heir or heirs of mine who survive me, and in his, her or its own discretion, choose such articles from my tangible personal property (exclusive of cash, stock certificates, bonds, and all other tangible evidences of intangible personal property) as he, she or it believes will be useful to s?~ch heir or heirs or .desirable for him or her or them to have, either from a sentimental point of view or otherwise, and to deliver such articles to such heir or heirs or among such heirs in equal or unequal shares as determined by the further exercise of his, her or its discretion, provided no other -heir objects to the distribution. A11 tangible personal property ~ not so distributed is to be sold, either publicly or privately, GRII=FIE, TURD & GREL,[.. ATTORNEYS-AT-LAW 20D NORTH HANOVER STREET SUITE [Ot 34St MARKED 8TRi3E1' CAMP HIi..1_, PENNSYLVAi~1tA S701i CARk.ISE_E. PEhlNSYI.-VANIA 17013 par_~ ~ nF R LAST WILL AND TESTAMENT OF HELEN P. SHUGHART is to be sold, either publicly or privately, by my personal representative, adding the proceeds of such sale or sales to my residuary estate and to be disposed of in equal sha res among my surviving heirs after payment of my estate debts, taking into account the tangible personal property other~,rise provided to them. FaURTH If my spouse does not survive me and it is necessary to appoint a Guardian for one or more of my children, then I nominate, constitute and appoint MARLIN E. SHUGHART, JR. as Guardian of the person and property of each of my children who require a Guardian. If MARLIN E. SHUGHART, JR. is unable or unwilling to serve as Guardian, I nominate, constitute and appoint ELIZABETH SCHLUSSER to serve instead. I direct that no Guardian shall be required to give or post bond for the faithful performance of the Guardian's duties in this or any other jurisdiction. FIFTH I grant my personal representative the following powers in addition to and not in limitation of such. powers as_my personal representative shall hold by law: a To retain all property received including the stock of C ~ any corporate fiduciary acting hereunder, provided such property remains productive. GRIFFiE, 7UR0 8r GREL.T-. A'r'ro R tit eYS -AZ- i.-Aw SU17E i01 346'! MAFtK~t' 8-PF2E~E7' CAMP HEL.€..., PGNNSYLVANlA 17ta1t 2C~ NQRTH HANOVER STREET CARLiSE.C, pENNSYf-.VANEA i70}~ -.. ~ .tin ~ nn. n LAST WILL AND TESTAMENT OF HELEN P. SHUGHART {b} To join in any corporation, partnership, recapitalization, merger, reorganization or voting trust plan; to delegate authority with respect thereto; to deposit investments under agreements and pay assessments; and generally to exercise all rights of investors, including but not limited to, the voting of shares. (c} To manage, operate, repair, improve,_rnortgage or lease on any terms any real estate held or owned by my estate. {d} To operate any business that I may own at my death. {e} To invest any funds of my estate in any stocks, bonds, notes or other securities or property, real or personal, without regard to the principle of diversif ication or any other statute or general rule of law ~.n his, her or its absolute discretion, it being my intention to give my personal representative the broadest investment powers possible, providing such investments do not unnecessarily prevent the prompt settlement of my estate. (f} To sell or otherwise dispose of any property, real or personal, tangible or ~.ntangible, at any time forming a part of my estate in any manner and on such terms and GRiI~'FfE, TURD 8c GRELL ATl"ORh! e=Ys •A•i'• 1-.AW BUIT~ !Qt 3A6! MARt{&i' STRIrEi' ~CA14iP F-EELt, PENNSYi..VANtA S7Q1i 20a h20RTH HAi~lt]VER STREE"P CAF21_tSt_~, PENNSYLVANfA i70i3 -~ar~ ~ nF R LAST WILL AND TESTAMENT OF HELEN P. SHUGHART conditions as my persona. representative shall see tit in his, her or its absolute discretion. (g) To borxow money f or the payment of taxes or for any other proper purposes in the administration of my estate, and to mortgage or pledge estate assets as security. (h) To compromise claims without court approval including, but not limited to, any controversies with the United States of America or the Gornmonwealth of Pennsylvania concerning estate and inheritance taxes on any interests that may pass under this my Last Will and Testament. (i) To distribute in cash or in kind upon any division or distribution of my estate. (j) To undertake any and all acts deemed necessary and proper by my my personal representative for the proper, advantageous and prompt management of the settlement of my estate . (k) In general, to exercise all powers in the management of my estate which any individual could exercise in the management of similar property owned in his own right, upon such terms and conditions as to him, her or it may seem best and to execute and deliver all instruments and to do all acts which he, she or it GRiFFIE. TURD & GRELL ATTO F2N EYS-AT-L.AW Su1TS !Ot 34Fi~! MARKE.1" sTRSEf' ao0 i~IaRTH 1-lRrtOVSR STREET CAMP HILL, PENNSYLVANIA 5705 t CARLlBL..E, P~NNSYLVANiA 1'7af3 anr~ ~ !lr' R LAST WILL AND TESTAMENT OF HELEN P. SHUGHART deems necessary or proper to carry out the purposes of this, my Last Will and Testament. SIXTH No interest of any beneficiary of my estate, either in income or in principal, shall be subject to anticipation or pledge, assignment, sale or transfer in any manner, nor shah. any beneficiary have the power in any manner to charge or encumber his interest either in income or principal, nor shall the interest of any beneficiary be liable or subject in any manner while in the possession of my personal representative for the liability of such beneficiary. SEVENTH I nominate, constitute and appoint my spouse, MARLIN E. SHUGHART, SR., as of this my Last Will and Testament. In the event my spouse is deceased, unable or unwilling to serve or shall cease to serve for any reason whatsoever , then I nominate , constitute and appoint MARLIN E. SHUGHART, JR. as personal representative of this my Last Will and Testament. I direct that my personal representative shall not be required to give or post bond for the faithful performance of his, her or its duties in this or any other jurisdiction. EIGHTH I hereby declare it to be my expressed desire that my personal representative employ the law f irm of Griff ie, Tura & C3RIFFIE, TURD & GREL.L A'I'T'.O RN EY6 •AT• LAW :t00 NOfiTH }-lANOVF~2 STREET' 9Ui7E IOf 34.81 MARKET BTRSET CAMP HILL, PENNSYLVANIA 17CQi1 CAFZLESL~, F~ENNSYLVANIA S7Oi~ PAC~F h nF 8 LAST WILL AND TESTAMENT OF HELEN P. SHUGHART Grell, of Cumberland County, Pennsylvania, f or legal advice and assistance regarding this my Last Will and Testament, they having considerab3.e 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. GRIFF!>r, TURD ~ GREi.,L ATTORN8Y3-AT•l.Aw SUITE i0i 3R8~i MARICE"i' STR~~' 200 NORTH HAiVOV~32 STREET CAFJIF- N1LL, 1'~NNSYi--VANIA 17p11 CARLISLE, F~ENNSYLVANIA 17013 ~nn~ 7 n>a Q LAST WILL AND TESTAMENT OF HELEN P, SHUGHART IN WITNESS WHEREOF, I have hereunto set my hand to this my Last Wi~1~ and Testament this _.._.~~~~t.~___ day of 1.988 . WITNESS: /~~ ~~ ~ y-c.- --v 1 HELEN P, SHUGHART ~ S 3~~? i GRIFFIE, TURD & GRELL Arno~rrr,rs.AT•~.aw 8U1T1; tOt 34.6'1 MARKET' $TREE[' 200 Nc7RTH NAM1tOVER STREET CAMP !-!!Lt_, PENNSYLVANIA 57011 CARLISLE, PENNSYLVANIA 17013 T~Arryn Q nr O LAST WILL AND TESTAMENT GF HELEN P. SHUGHART ACKNOWLEDGEMENT CCMM4NWEALTH CF PENNSYLVANIA - s S S . CQUNTY ~F CUMBERLAND I, HELEN P. SHUGHART, the whose name is signed to the attached or foregoing instrument, having been duly qualified according to 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. I° JP~ ~~--'`ice' "u-f_i/_,! ~-G~-~ HELEN P. SHUGH RT Sworn or affirmed and acknowledged before me by HELEN P. 1~ SHUGHART the this _`~_ ~~~~~~~ day of r ~. 9 8.8 . N~taty ~~+~fw, ~~a;e ~. r n~~y vanfs Franklin CQun ~'~Y ComrNs~l4h ~ pfr~: July ~~, f$41 ~. GRtFFIE, TURD 8e GRELL AT'i'ORNEYS.AT-[.AW SUITE tOf 3.ds'1 MARiCE'T STREET' 200 NORTH HANOVER STF2EET CAMP Hf~L, F'~~~sYLVANtA f7os~ CARLISLE, PEfVIVSYi...VA~IIA 17Cl~ LAST WILL AND TESTAMENT OF HELEN P. SHUGHART AFFIDAVIT COMMONWEALTH OF PENI~'SYLVANIA SS. COUNTY dF CUMBERLAND ; WE ~ ar ,.r'. /s1u~..n~nf~ ____-~-_ and 4~~~. , t~ the witnesses whose names are attached to the foregoing document, being duly qualif ied according to law, do depose and say that we were present and saw sign and execute the instrument as Last Will and Testament; that signed willingly and that executed it as free and voluntary act .for the purposes therein expressed; that each subscribing witness in the hearing and sight of the signed the Last Will and Testament as witnesses and that to the best of our knowledge the was at the time 18 or more years of age, of sound mind and under no constraint or undue influence. ~ ~1~rZ~ ~U) _, ~ Sworn or affirmed and subscr %bed before me by ~~~~r-~ ~',~~.~ rc and ~~~~1~, ~N~t.~ _ this ~f..~ ~_ day of 1988. ~-mn.~ ~ q~ ~x Nof ryNu~1e, ~ec~~~~f-~1; Frankl)r~ ~ sYlyanTa My ~ammisstpn~~xytres J~~ ~$, i99i P GRIFFfF, TURD 8c GRELL A~r-ra R H EYS .A~r. t..Aw sU]TR i41 346'f h1AF2K~' STR~EC .200 i~lORTH HAIVGV~R S'f'f2EE1' aCAMP HlLI..., )'Ehi~1SYLVAN)A 170)1 CARLISLE, PENiVSYE.VAN)A l7af3