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HomeMy WebLinkAbout09-05-12N J 1505610140 REV-1500 EX (01-10) OFFICIAL USE ONLY PA Department of Revenue Bureau of Individual Taxes County Code Year File Number PO BOX 280601 INHERITANCE TAX RETURN 2 1 1 0 0 6 0 5 Harrisburg, PA 17128-0601 RESIDENT DECEDENT ENTER DECEDENT INFORMATION BELOW ~ Social Security Number Date of Death MMDDYYYY Date of Birth MMDDYYYY 1~, 1 9 3 3 6 2 7 4 3 0 5 1 6 2 0 1 0 1 2 1 0 1 9 4 3 ~ 7- ~(o~4'j6~ Decedent's Last Name Suffix Decedent's First Name MI AI s b a u g h Da v i d K (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) 9. Litigation Proceeds Received ~ 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 CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TU: Name Daytime Telephone Number Wi I I i am P Dougl a s 717 243 1790 REGISTER OF,WILLS USE ONLY First line of address ~ - L ~._~ 4 3 W S o ut h S t r eet ~T -~ ~-~' ~ Second line of address _ it.' ~'~. . ~ 1 ,; ~.+' r .. / ~.... ~- - ~ City or Post Office State ZIP Code ~ =~`. ~ DA(~$ FILED. i ="t _ ~.~ d C a r l i s l e P A 1 7 0 1 3 c~.~~ Correspondent's a-mail address: habdlo@earthlink.net 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 re presentative is based on all information of which preparer has any knowledge. SIGN RE OF PERSON SPO I LE FOR FILING RETURN DATE U/ 1. ~~ ADDRESS 405 Kauffman S et Boilin S rin s PA 17007 S NAT OF PREP OT ER TH REPRESENTATIVE --~ ~ DATE ^~j _~ ADDRESS 43 W South Street Carlisle PA 17013 1505610140 PLEASE USE ORIGINAL FORM ONLY Side 1 1505610140 ...~..` 1~~~.~ J REV-15ao Ex Decedent's Name: DAVID K . AT S PAU GH Decedent's Social Security Number 1 9 3 3 6 2 7 4 3 RECAPITULATION 1. Real estate (Schedule A) .................................... .... 1. 4 1 9 6 3 0 2. Stocks and Bonds Schedule B 2. 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) . .... 3. 4. Mortgages & Notes Receivable (Schedule D) .................... .... 4. 9 0 1 5 8 2 5. Cash, Bank Deposits 8~ Miscellaneous Personal Property {Schedule E) ... .... 5. 6. Jointly Owned Property {Schedule F) ^ Separate Billing Requested ... .... 6. 3 2 0 5 9 9 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property 4 1 0 2 2 8 (Schedule G) ~ Separate Billing Requested ... .... 7. 8. Total Gross Assets (total Lines 1-7) ....................... .... 8. 2 0 5 2 0 3 9 9. Funeral Expenses & Administrative Costs (Schedule H) ...... .......... 9. 6 7 4 5 5 2 10. Debts of Decedent, Mortgage Liabilities, ~ Liens (Schedule I) .. .......... 10. 11. Tota{ Deductions (total Lines 9 & 10) ................. .......... 11. 6 7 4 5 5 2 12. Net Value of Estate (Line 8 minus Line 11 } ............... .......... 12. 1 3 7 7 4 8 7 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 9 4 7 1 0 7 an election to tax has not been made (Schedule J} ........ .......... 13. 4 3 0 3 8 0 ........ 14. Net Value Subject to Tax (Line 12 minus Line 13} ..........14. TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X 0.00 15. 16. Amount of Line 14 taxable at lineal rate X 0.00 16. 17. Amount of Line 14 taxable at sibling rate X .12 ~ 7 ~ 3 ~$ . 2 ~ 17. 18. Amount of Line 14 taxable at collateral rate X .15 18. 19. Tax Due ........................................... .....19. 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT i50560U2126 0 0 0 0 0 0 8 7 6 9 9 8 7 6' 9 9 Side 2 15056042126 15056042126 R( `L~- i 5oG Ex Page 3 C~e'cedent's COrnplete Address: Fife Nurnier 0005 ' DECEDENT'S NAME DAVID K. ALSPAUGH - _ _ - _ _ - STREETADDRESS - - - - - - - - - --- - - 120 East Louther Street Apartment B CITY !STATE ;ZIP Carlisle ' PA 117013 Tax Payments and Credits: 8 7 6 9 9 ~ ~ Tax Due (Page 2 Line 19} (1) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B+ C) (2) 1 6 0 3 1 3. Interest/Penalty if applicable ~--p 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. Fill in oval on Page 2, Line 20 to request a refund. (4} $0.00 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. (5) 7 1 6 6 8 A. Enter the interest on the tax due. (5A) 7 1 6 6 8 B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) ~ _ Make Check Payable fo.~ REG/STER OF W/LLS, AGE/VT PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. retain the use or income of the property transferred : ................................................................ ...... ^ b. retain the right to designate who shall use the property transferred or its income; ......................... ...... ^ 0 c. retain a reversionary interest; or .......................................................................................... ...... ^ 0 d. receive the promise for life of either payments, benefits or care? ................................................. ...... ^ 0 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 "intrust 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 contains a beneficiary designation? ............................................................................................ ...... 0 ^ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND F ILE 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 adaptive 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)]. 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. y' i' ava ,.s- T~-.:e-.~.- oM~a p:r.;wrt+e~*•~_ ;i"sb>...~ ~5.'4y'"` '~ :~~. ~.r~...,-r f~Fi> tE;, ,.. ..^t~ • j+~ ~~Cti w1 :-1 _.ri§~~'Fs1r^~..,. _4-< _,.~n.r' ..ab~....,..e..~i .~x..~':es ~.- > _ .~i..~., ~v:v=.-, <,a.,:; ,. . _ .. _. _ _ - . .. - C~ '_' C ,-~ c~ - iJ ~- -' Ttj ~~ - -. ._,~ __ °_,_, ff J % ~ - . ~ _- _ - , _ ~~ ':} _ c'i v j C_.? I, David K. Alsbaugh, of Carlisle, Cumberland County, Pennsylvania, being of sound and disposing, memory and understanding, declare the following to be my last will and testament, hereby revoking any and all wills heretofore made by me. Item LI direct my executrix hereinafter named to pay all. my just debts and funeral expenses. Item II. I direct that I be cremated, and I have made arrangements through the Pennsylvania Cremation Society, of which my Executrix is aware. Item III. I direct that all of my property, both real and personal, be sold at public or private sale, and the proceeds distributed as follows: a. One-half of the residue to lung research, and preferably an organization close to Carlisle, so that the funds can be used locally. b. This remaining one-half shall be divided equally between cancer and aids research, once again to an organization close to Carlisle, so that the funds can be used locally. Item I ~~. I nominate, constitute and appoint Sharon Ann Shenk to serve as my executrix. In the event she is unable to serve, 1 appoint Janice L. Cole, {~ 1 1 rIs stiL~~~'~ ~~_~`!~' f,~_~Ltll_riZ _.?1 (1 _' ('1! r~~i rl~ i,_ `'1~ [lt`'T" 1i 6~ T t~;f? i"1 ..t}fT~' f(`l C ~ ~ 1~e~T1 ~-el ~d ~'~" ~ T ~'1l 10llt ~~~~IZ~t. iN ~`~ITNhSS ~~VHEKEOF, I h~ ve hereunt~~ ~~ ~ n,y hand and seal this ~~-" day of ~- , 200_x. ~ -- t ~ ~~ Q David K. Alsbaugh Signed, sealed, published and declared by the above named testator, as and for his last will and testament, who at his request, in his presence, in our presence, a~zd in the presence of each other have hereunto subscribed our names as attesting witnesses: ~J 1 ~ ;: ~~ CO~~Li~%IC~~T~ d'E_~~L~Tt-1 ~~j_ I~~~v~~~ L~~'~~~,~I_-~ / / ~~1%e,~ ~-~,, and ~~'-.~~i~/l -~%~~~-~ - `->>hose names are signed to the attached or fog going instrument, being duly qualified according to law, do depose and sa~~ that we tivere present and saw testator sign and execute the instrument as lus Iast ~~~~ill, and that 1-~e signed willingly and that he executed it as his free and voluntary act for the purposes therein contained, that each of us in the hearing and sight of the testator signed the wi11 as witnesses; and that to the best of our knotivledge, the testator was at that time 18 or more years of age, of sound mind and under no constraint or unEiue influence. .-i -~; i / ~ i ~f~~. ~~_" %i Sworn to and s~.~bscribed be re m this 2 y da of ~ ~' ~ ( ,2005 - r~'~~I ~ X11 j~ ~ ~'~ t 1~. ~. ' ... .. .. r..~ f~ _ '. j ~ T _. ~: d ._.., ., _..._ . vS Tq 4~ T~ S - 4{~ ~~~~Z"~24 2 i { t'.~ ~ ~ J ._a .. __ ~_.~_ c ._ ,. -y.... *~ ... - CO~~II~IC~N~vE~ L"I-H O P~ NN~YiJ~',~NI_~ coL N i ~ ~F cL~ ~ r~~Ri_..a ~~ L~ I, David K. Alsbaugh, ~-vhose name is si~;nec~ 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, that I signed it willingly; and that I signed it as nay free and voluntary act for the purposes therein expressed. CLt,w ~` David K. Alsbaugh Sworn to and subscribec~~ rr b me this the ~ day of (' ~ t , ?005. Notary REV-1503 EX + (6-98) SCHEDULE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID K. ALSPAUGH 0605 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. GENERAL ELECTRIC $1,404.80 80 Shares @ $17.56 /share 2. PENGROWTH ENERGY $1,483.50 150 SHARES @ $9.89 /share 3. BANK OF AMERICA $1,308.00 80 Shares @ $16.35 /share TOTAL (Also enter on line 2, Recapitulation) ~ $ 4 196.30 (If more space is needed, insert additional sheets of the same size) • ~ - % i %- b,t- j-~i--~ ~r-'~~ler We~1t~ bi~.r°.~g~~=ant C'~cup --- _a y~ ri., ~Ou•~Ee-n~~~ J Lf i:1Ce:.~'-' rI7Ve ,,~~E:;,r~~ r~r~.~.~s~Pc July- 30, 2010 Dou~las Law Office 43 ~V. South. Suet Carlisle, PA 17~~1~ ~; Date of Death Values David ~. Alsbaugh Dear Bill, Listed below' is the date of death values foz the above mezztioned estate: The date of death was ox~ Sunday, May 1. ~, 201 a as per ol~r coY~vErsation Y used the close of business Monday, May 17, 2010 fob the ~,~altzes. Numbez of Shares Cozzlpany Price per share Total value ~. Bank of ~izerica $16,3 $1,308.00 ~ ~s 80 ~ nx 80 General Electric ~17.5G X1,404.80 150 Pez~~'owtlz Enemy ~ 9.89 ~1,483.~0 lvloney market fiend ~ i ,793 .~5 ---- ~ ~ ~ _ a g_. -_ _ ___ If Y can be of further assistance, please hive nee a call.. Since - . , ,._ /~~'~ ~,yn K. ?~Tetf Servo Client Assoei r~ l Jennifer ~.. $u~ver, MPA ~- Thomss;~ieKee, MBA, CkPC' ~.cihi Consul*.ant Ser_ior Vice President • Invescr:~ents ' ° tc ~-it~c =:ee~nvFilsEazc~?ad-sisors.eo:ri Firsnci~l fldvisor .r i r jenn~~cr,DUe'~e7-~eisl~sgoa visors.com ~:endra Me}'~P Tricra Mazkasla Lynda K. Neff ~ R~4istei~d Client .~:s;GCi~tc 1 °O~fite iic_:~iStP,TZa Client '~.`_.~OCi~~C _ -. - ~lie::t .c7 ~ - ~• "~~We~~ ;'fiIrp~u ~: : ti.~Cri. JEniC'I' ~ 11 - - lcCl:~p8.r11e}'E'I~~==t115" *'~GSC~'1=0r?.GO?P u1C13-Rl~ Oai,L lv:id~-r_er~~?e;eLl =f~Igoad~ ~sc°~.ccrn ` REV-1508 EX + (6-98) SCHEDULE E CASH BANK DEPOSITS & MISC. COMMONWEALTH OF PENNSY V N , , L A IA RN PERSONAL PROPERTY 'N A E RESID ENT DECEDENT ESTATE OF FILE NUMBER DAVID K. ALSPAUGH 0605 Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. COMCAST Refund $67.61 2. NEW ERA LIFE INSURANCE COMPANY -Refund $139.96 3. CENTURYTEL, INC. -Refund $9.34 4. AUER CREMATION SREVICES OF PA, INC. $950.00 Pre-Paid Funeral Expenses 5. WACHOVIA -Certificate of Deposit $5,580.96 Account No. 247402042987398 6. UGI Refund $49.00 Refund for 1120 E Louther St 7. 1994 Chevorlet Corsica $425.00 V1N - 1 G1 LD55M5RY203242 8. WELLS FARGO -Money Market Fund $1,793.95 Account No. 1111-9029 TOTAL (Also enter on line 5, Recapitulation) I $ 9 015 82 (If more space is needed, insert additional sheets of the same size) COMCAST 1555 SUZY STREET ATTN: LEBANON SUPPORT SERVICES LEBANON, PA 17046 DAVID ALSBAUGH 30114 0328-51-89-3DG 405 KAUFFMAN ST BOILING SPRING, PA 17007-9799 ~~~~~~~~~~~~~~u ~~~~~~~~~~~i~~~~~~~~~~~~~~i~~~~~~~i~~i~~i~~i~~ ~C~~1CC~St. :,;. PAYMENT S UMMARY CHECK No: 0004706274 AccouNT No: 09547-36692201 CHECK DATE: Dear DAVID ALSBAUGH, 07/07/10 The attached check represents a subscriber'~'refund for account number 09547-36692201 in the amount of $67.61. If you have any questions or concerns regarding the refund check you can write us at the address above or call Comcast's toll free customer service number at 1-888-COMCAST. DETACH AND RETAIN THIS STATEMENT THE ATTACHED CHECK IS IN PAYMENT OF ITEMS DESCRIBED ABOVE. IF NOT CORRECT, PLEASE NOTIFY US PROMPTLY. NO RECEIPT DESIRED - _ _ _-------- . - - . _ -- - _ -- -- ---- -- ---- - --11]ntackiHn~ii - --- -______-~ CENTURYTEL, INC. ATTN: Controller's Group e'~j P.O. BOX 4065 ~I,' MONROE, LA 71211 1-877-386-7151 CenturyLink~~ Document Invoice Date Gross Amount Text Payment is made on behalf of EQ United Tel-PA, T856. 1900020680 7172580659 06/01/2010 9.34 Refund Questions? Call 1 888 723 8010 Sum total Document / Date 2000578735 / 06/03/2010 Your vendor number 500000 Deductions 0.00 9.34 0.00 Net Amount 9.34 9.34 Payment document? ~hec#~<~umber Date currency Payment amount ;< 200057$735 00027$886.: 06f03j2~1b USD. ~' ;~,~ ' _; ,_ ~,,,, Page 1 of ~ GenturyLin~ " 9Vlonthly Statement Account Number June 20, 2010 1©03683564 Payment Options & Contact Info Current Charges At-A-dance Pay Online w~vw.centurylink.com/residentia{ Pay by Phone 1-866-499-3949 Customer Service 1-866-236-2277 Repair Service 1-866-236-2277 Internet Address www.centurylink.com CENTURYLINK Services Lang Distance -Page 3 Taxes and Surcharges -Page 3 Tota I 9.94 2.3fi Total Current Charges $1230 ~~ ~ ja, \2_U ~`~ .~ ~ ~ o ~~ ~ ~~ ~~ ,~! 1. ~ `` V~' h ~ ti Previous Balance Payments & Adjustments Balance Total Current Charges Total Amount Due 24.61 I .00 I 24.61 ` 12.30 ~ $36.91 Current Charges Due By: 07113!2010 Please Recycle ~ ~~ r; Please return this p ortion with payment Customer Service Internet Address Invoice Date Account Number „~ 1-865-236-2277 vuww.centurylink.com 06/20/14 1Q03683564 Ce ntu ryLi nkT° Please pay past due amount of $24.fi1 immediately. Tota! Amount Due $3fi.91 Amount enclosed: MB 01 001869 90629 B 9 A 1'r rite your 10-digit account number on the check 'I~1"l~~l~lillt~l~fl~~~~"I'I~111'll~ll~~'I'll"11ill~~ll11~'{' Make checks payable to: DAVID K LASBAUGH 120 E LOUTHER ST APT B ll~~"III'~~'~~'Iilllil'~!I[,I~IiIII~~Illlllllllllllll~il~~~ll~t CARLISLE PA 17013-3051 CenturyLink P O BOX 1320 CHARLOTTE NC 28201-1320 ^n 7~~a3683564~ ~Q~000~®0~1,23D QOQQ3~`~~? ~,L~~9~D3 CHECK pAT~ VENt~~7R CODE 6/23/~fl 10 JPMORGAN CHASE BANK N.A. DALLAS, TEXAS 75201 ~y-~,~,~ ~d~i ~~ NEW ERA LIFE INSURANCE COMPANY P.O. BOX 4884, HOUSTON, TEXAS 77210 AY ONE HUNDRED THIRTY-NINE AND 96/100 DOLLARS TO THE ORDER OF ESTATE OF DAVID K. ALSBAUGH CHECK No. 15 0 0 9 9 81 1 88-88/1113 ~ < ~..F~~~k AiVFQ1JNT ~ ~ ~ ** 13;9 9> NOT VALID AFT 90 DAYS FROM DATE OF ISSUE TWO SIGNATURES REQUIRED IF OVER $7,500 -i' L 500998 L L~~' ~: L 1 L 300880: i~'06 3000 5 L60 ?~i' /~~~~~T~o~' s~~~: `,~~ .~~t'% -~l Otl ~one~to~cn Road ~ ~Iarrishur~, P:~ i -10) s ~ -x(10-~?C)-8? ? i a a~ -i ~-~_~ I ~)9=t~ • ~ha~~~n E. Carper. Super~~isor ~~''~~='~'S ~' L~'~-ti1 r~, ~ i~~t = = S €-~ar on Shen ~~~~ i.GuTTmar~ Street ~~, ~ i na Sir i ngs , ~~. s i ~(~? 1-' J L)avid x. P.lsi~au~'~ - 7eceased R~'~'~A~ ~~'HARC~~;S ~< ~ i rec t Crema ~. ? orF ri Nationwide Guarantee ProG_ram a^~o.r-E c~wi de Travel protect i cn -v`~AL uPEC~.~L Cf-iA1~?~s ~~ Services oT Funeral Director & StafT Otrier Rre~arat i on oT tt~e P,ad~T r~aci I i ties ~4: Stmt Tor i~iemorial Service 5taTT ~ ~c,ui~~~Eent Tor Memorial Service ~~itnessing the Crerr~ation private ~arnily Viewing/Witrlessin~ CrematiJn acxaging Ar_d r©rwarding Cremated Remain Lersonal ~1e1 iverY at Crematec_3 Remains Scattering oT Cremated Remains died ? ca 1 ;.}ocument s /Got~r i er ~'ee ''-';- 1 t?:~ P- RC1~~~S ~-C)I`v_T-ice SE~~JICE`: _'_ :`temOVa 1 Vey 1 G ~ e '`,eed ~;3.'"'jC~er~V Cyr s~ e r V .k ~ e V e f^ Y _~ cLgc . ~~( f,c ? udecf ~~.@ :C 1 udeQ ;~ ~J ~ l'~ ~er~~e~?~br~.nce ?'ac`'_a~e Cre,~~a t ~ cn. Cori t a ~ ner ?? ~.`~1Ceci?1 ~':~i1SeL ~C~. ~ ~et _ ',,~ "!,~{~e ~ -~~ ~@ J ;~" 3 ~~eepsaa:e Urns r ~! 3~ . @@ i~~ al'e, t~~e~':Cr ? 3 :i i`~c L~-iet '~~`~.~ ifF~tl-'As'V~`J1S GASH-i ~L)V.AT?CE~ ITE1~~S Grave G~~ening Cemetery Equipment I~Yewspa;~~ers ~lewspaper ~aLi 1 t Serv 1. Ce Ciiarg~= Clergy Church/Grganis~.jSolcist Fio~aers Cre~~a tar r t=barge li~C h ided di Cum~er 1 ar~d Count ~,? Caror~er Cremation Approves I ~ 2 ~ . @@ r ~~ { @ Cert IrieCz Copies or Death Certi ~icate ~6@.tt?I~ ~~ ~ Cert- i i_~ i eci Copies o~ Beath Cert i ~ i cafe ~3@ . @@ 1 L"1 `~ 7J ~'It~iAP~~ ~~F C HAkGE S Special Charges 51,79@.@@ Professional Services S@.@@ AutCiT~ot ive u~uipmer_t $tD . @@ Merc;~:any i se ~ 2 65 . @@ Case A~vanced Tte~rs 511.@@ 5~~ ~'G`l'A~ X2,17@.@(~ -~i~..r i_.1i U Ate{~r,~I~I`i' PREP~1~'~ .;ate Lec G , ~ 999 - $ 9@(~ . @@ %~~iJU~!`l PATE date ~~a`~' 17 ; 2@1v3 -$32@ . @@ ~2E5.@~ ~1~c.~~@ r~ ~ S S~_~A'~`~f~~~3r~-, ~~~A~; ~<<;~~~ ~,~~,r ~.~~:~~` u~~. NEWSPA~'~~c CH1~kGES ~~ACHOVlA TIME DEPOSIT WITHDRAWAL CONFIRMATION Office Name NE CNTRL PA /CARLISLE PA Date 06/16/2010 ~~ CURRENT BALANCE : $5,580.96 'Y' ~ ~ „~~r` ,. + ACCRUED INTEREST : $6.84 Avail Int WD/PenFree: $75.67 - PENALTY AMOUNT : $0.00 -FEDERAL W/HD DUE : $0.00 -WITHDRAWAL FEE : $0.00 -OUTSTANDING PYMT : $0.00 PAID TO CUSTOMER : $5,587.80 Customer Name(s), Address and Taxpayer ID Number DAVID K ALSBAUGH 120 EAST LOUTHER ST B CARLISLE PA 170133051 SXXXXX2743 FULL REDEMPTIO^! CD ACCOUNT NUMBER: 247402042987398 566594 WACH4VIA Opening Date This Receipt Acknowledges That The Depositor Below Has Deposited With This Bank The Sum Of Depositor Name And Address Term Interest Payment Disposition Issued by WACHOVIA BANK TIME DEPOSIT PROD-TYPE: NOT TRANSFERABLE d Interest Payment FrequencylPeriod PROMO CD: X Authorized Signature Wachovia Bank and Wachovia Bank of Delaware are divisions of Wells Fargo Bank, N.A. X Date 566594 (Rev 02) Christopher Warner Automotive 8 Front Street P. ~. BOX 220 Boiling Springs, PA 17007 Name !Address SHENK, SHARON 405 KAUFFMAN ST BOILING SPRINGS, PA. 17007 Estimate Date Estimate # 6/22/2010 1 s Project Description Qty Cost Total 1994 CHEVROLET CORSICA 4 DOOR SDN SERIAL # 1G1LDS5MSRY203242 AUTO TRANS PS PB AIR MILES 74134 25.00 2s.00 Subtotal $42s.o0 Sales Tax (6.0°1°) ~o.oo Total $42s.oo _, .. _~. _ .._. ~~;C __~-~__~ -, r,~. 'tsp.-, ~~i:t':rJ_ i ~, ,lJ s r , • "~~ d~„ ~~r _ ~, is r..... i~; ~+ Ttzl~- ~0, ~~ i 1 Dou~Ias Lau' C~ 1Ce =, ~', ~4T. SOut~? JtrC~~ -, n 'r - -, t.arlisle, ~'~ ~ 1 ~ U 1 ~: Date of Death Values David ~. Als~~au~ Dear Bill, Listed belo~r 1s the date of death values for the abo`~Tc n1er~t%o~led estate: The date of death. was oz~ Sunday, May 1. ~, 20~ Q as per olu' co~~zversation Y used t~~e close of business Ivlor!day, May 17, 2010 for the va.lt.cs. i~urnbez~ of Shares Coz~.ipan~' Price per share Total value Bar~kofAz~1erica ~16~3~ X1,308.00 80 General Electric ~ 17.5 6 ~ 1;40.80 80 Pez~~owth ~nerBy ~ 9.85 ~1,483.~0 150 ~~OI]Cy rIl~Tl~e~ ~-1T1C~ ~1,/y~.`1~ ---- `' ~ ~. - _ If ~ caz~. be of further assistance, Tease b~ve z~ie a Call. S lI1Ce ~~ ~) ~ / s. /~ .~~,~~ ~,vn J ~= yeti Scz~o Ci_i_erit Assoc, R C V ,~ a u ~?-~ _ TF UiL~511~'~\F C~ 1 ~i_i~ ~d`.r. ~~ ___ _'-_ .e..-!".:~_:E°L^«c1lSt::iCO.=d:-1SOr~.~C ~_, r , '. F f~ , . .. en-i_e_r,_u~~_c_i_ ..~--- e , -' `5:_ its-~. ~ Sr _~-":iC ~~:~ ~ --~_~.Si~ _1?~ _~t - - :i~ ,r_~1.=.~~r ~-:., air _ _`_. _v~~ ----~ ---' REV-1509 EX + (6-98) SCHEDULE F COMMONWEALTH OF PENNSYLVANIA JOINTLY-OWNED PROPERTY INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID K. ALSPAUGH 0605 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 A. JOINTLY-OWNED PROPERTY: RELATIONSHIP TO DECEDENT ITEM NUMBER LETTER FOR JOINT TENANT DATE MADE JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY-HELD REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST DATE OF DEATH VALUE OF DECEDENTS INTEREST 1. A. Wachovia Bank Checking Acct 1000324152109 $2,382.00 50. $1,191.00 Joint with Sharon Shenk B. Wachovia Bank Savings Acct 3014172320122 $4,029.98 50. $2,014.99 Joint with Sharon Shenk TOTAL (Also enter on line 6, Recapitulation) $ 3 205.99 (If more space is needed, insert additional sheets of the same size) ,,,, Consolidated Statement ±~"~ 03 1000324152109 752 30 %HOVIA 0 14 119, 720 5/22/2010 th ru 6/21 /2010 rovvn Classic Banking utomated Checks n6er Amount Date Description 3204 / 37.26 5/24 AUTOMATED CHECK EMBARO BILL PYMT CO. ID. 2202975500 100524 ARC MISC 3204 3207/ 39.76 6/04 AUTOMATED CHECK UGI UTILITIES UTIL PMT CO. ID. 231174060 100604 ARC MISC 3207 3210 .~ 49.00 6/08 AUTOMATED CHECK UGI UTILITIES UTIL PMT CO. ID. 231174060 100608 ARC MISC 3210 tal $126.02 ther Withdrawals and Service Fees `e Amount Description ~7J 94.30 AUTOMATED DEBIT NEW ERA LIFE PREM FS2 CO. ID. 1742552025 100607 PPD tal $94.30 remium Savings count number: 3014172320122 count owner(s): DAVID K ALSBi4UGH SHARON A SHENK ccount Summary eninq balance 5/22 $4,029.81 crest paid 0.17 + tt ,'C: using balance 6/21 $4,029.98 eposits and Other Credits .re Amount Description '1 0.17 INTEREST FROM 05/22/2010 THROUGH 06/21/2010 tal $0.17 ~CHOVIA BANK , CARLISLE page 3 of 5 t ~;t p [ ~^ ~ ` f4 ~~, ~~4'~~, r ~~~~.1WEM1~~ l ~~, ~ ~U:~~~ ~ ~j ~~ .~ ~;.~:~ Zvi ~~~ ,~~ ~C< ~ y . ~ ~-; RC ' NI ~ -1 ~:-:~ . ~ fir` MA C~ COMMUNICATIONS REV-1510 EX + (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY ESTATE OF FILE NUMBER DAVID K. ALSPAUGH 0605 This schedule must be completed and filed if the answer to any of questions 1 through 4 on the reverse side of the REV-1500 COVER SHEET is yes. ITEM NUMBER DESCRIPTION OF PROPERTY INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. DATE OF DEATH VALUE OF ASSET % OF DECD'S INTEREST EXCLUSION (IF APPLICABLE) TAXABLE VALUE 1. WELLS FARGO $4,102.28 100. $0.00 $4,102.28 Retirement Account -Sharon Shenk Beneficiary 111-9031 TOTAL (Also enter on line 7 Recapitulation) I $ 4,102.28 (If more space is needed, insert additional sheets of the same size) ~, ~ o T C~7 O .-. O ~ Q ~ ".. rye T ' `i tea r' °w ^ NN m J~ a Qz ~ ~z as ~ ~ >U o Q U ~ ~a ~ a••~ 0 O ~ M N T a a ~ z a4. :~. ~ Q I,n0000N0 U')OOOOCD00 pp N W p00000~f~ N }. cp ~ O ~ ~ ~ = E{} ~} f- p O MOOOOOtc) (`00000 0p N ~ NOOOOON O W ~ c'7 ~ W ~ ct Eft d' d4 l--- ~ a L L C ~ , ~ ~ ~ (iS *_ i N Z N tII cn ~ ~ ~ ~ > ~ Q ~ CSf o~ ~ . o L ~~~~ L2.(~~«S~v.~ o .. c d. OUc/)Ucn ~U U Q. o p W o 0 o c~ W ~ ~ O Q Q U O ~ Z r o ~ - cn Z W Z o Q M O O ,-- O ° O O O O O O O O ~ T TT V/ O O ~ N z j W ~ N O O O ~ O O Lf') _ ~ Q M CD m O ~ ~ ~ ~ r ~_ Z UO W o Q T O O ~ a0 O O ~' ' . ooo~ o °~ O O ~ ~ O O O M N O O tf) o ~~ r o o ao O ~ M M W Q d= ~ cD ~- 0 o W J Q ch E{} 0 O O r N N O r ~' Ej-} 0 O 0 M ti N EA N U ~ C ~ c~ ~, [iS "i. ~ ~ U Q O N ~ ~ ~ W ~ Q- N ~ ~ ~ ~ ~ ~ H ~ ~ ~ ~ ~ cn •- ~ W ~ ~ +-~ ~ X ~ Q ~~~~ a H W N a REV-1511 EX + (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID K. ALSPAUGH - - _- ------- ---__ _ - --- -- _ _ 0605 - - - Debts of decedent must be reported on Schedule 1. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. AUER CREMATION SERVICES OF PA, INC. $2,170.00 B 2. 3. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Sharon A. Shenk Social Security Number(s)/EIN Number of Personal Representative(s) 202-36-5298 Street Address 405 Kauffman St city Carlisle State Pa Z;p 17013 Year(s) Commission Paid: Attorney Fees DOUGLAS LAW OFFICE Family Exemption: (If decedents address is not the same as claimants, attach explanation) Claimant 4. 6. 7. 8. 9. 10. 11. Street Address City State Zip Relationship of Claimant to Decedent Probate Fees Grant of Letters Acx;ountanYs Fees See Attachment Page(s) Tax Return Preparer's Fees Evening Sentinel Cumberland Law Journal Shipley Group Century Link $2,000.00 $2, 000.00 $93.50 $219.40 $75.00 $150.71 $36.91 TOTAL (Also enter on line 9, Recapitulation) I $ 6, 745.52 (If more space is needed, insert additional sheets of the same size) RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Receipt Date: 6/15/2010 Cumberland County - Register Of wills Receipt Time: 13:41:12 One Courthouse Square Receipt No. 106151.8 Carlisle, PA 17613 ALSBAUGH DAVID K Estate File No.: 2010-00605 Paid By Remarks: DOUGLAS LAW OFFICE CJ ------------------------ Receipt Distribution Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 30.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 20.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE 5.00 ----------- CUMBERLAND COUNTY GENERAL FUN Check# 1537 ----- $93.50 Total Received......... $93.50 r ~ y ; ~ DOUGLAS LAW OFFICE ~ ~~~~~ 43 W. SOUTH ST. .v~,~v~curnberlinkeo;n CARLISLE, PA 17013 ~~~~~''~' ~ ~~r~ 717-243-1790 .v---- r ~:~~~;. AD NUMBER PAGE NO. 385671 1 of 1 BILL DATE SALESPERSON 07/08/10 wolfc START DATE STOP DATE 06/24/10 07/08/10 AD NUMBER I AD DESCRIPTION CLASS LINES 385671 EXECUTOR'S NOTICE LETTERS TESTAMEN 10 PUBLIC NOTICES 40 * 2 cols Publication Insertions Rate Net Amount Gross Amount 3 THE SENTINEL -LEGAL 3 LGL $212.40 TOTAL A7 CHARGE $212.40 3 PROOF OF PUBLICATION 01 PRF $7.00 1i L ~' ~~~ ~,~ y t'~+rcnase Order ~sj.v.Aisbauyh PAY THIS AMOUNT:" $219.40 ~ $263.213*I ~_` _ _._._.~-~' ~*AFTER 08/02/10 THE SENTINEL Thank you for advertising with The Sentinel! Deadline for c/o LEE NEWSPAPERS in-column legal ads is 4:00 p.m. two business days prior to PO BOX 540 date of insertion. For questions, call (717) 240-7130. WATERLOO IA 50704-0540 Return this portion with your paymenf I Legal ~ T~ 1I"' AP^~~T^•Ir~ (-i Check # I-I Credit Card Adl Number 1385671 ~~~ aA~s _ ~`'=~'~ ~~ 03-SOi3l 0 PAY TC3 °~ ~ ~ t ~ =~ ,,j- <' j~a ~,, j~ I'4 ~ t~ '' It k ~ / ~ ` U` Do~LAns ~ ',.~ WACHOVI~ ~; Wachovia Bank, a division cf Wells Fargo Bank, N.A. %' ~, - ----- --- -- ~~'0000099 5i~' ~:0 3 X000 50 3~: 20000 ~, 7 2 56 4 59--' ~uiy y, ~v i u Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Gommon P{eas as the official legs! publication for Cumberland County and the legal newspaper for publication of legal notices. TO: William P. Douglas, Esquire RE: David K. Alsbaugh Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: June 25, July 2, and July 9, 2010 Advertising Cost $ 75.00 Proof of Publication $ 0.00 Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by, SHIPLEY GROUP SHIPLEY ENERGY SHIPLEY PROPANE SHIPLEY STORES SHIPLEY FUELS MARKETING REMITTANCE STATEMENT__. ~~~" VENDOR ENTERED 6/11/2010 10 DUE DATE INVOICE AMOUNT OF NUMBER INVOICE DISCOUNT TRANSACTION NUMBER BALANCE 1080 6/11/2010 104687 150.71 0.0 0 000032997 PAYABLE 6/16/2010 DAVID i SBAUGH ~ ~ ~ t I I I I ~ ~ ~ ~ i i ~ ~ i -- ~ ~ i ~ i ~ ~ i i 150.71 ~ ~ 150 71 ~ ~ i ' . 0.00 i ~ 150.71 I -~ ~-~` ~- - ~-~-~~d~. ~ Nv i-HIS uCCOUty i SHGULD 5E ADDRESSED ~ J TH= TREASURER SHIPLEY. YORK_ P.4 ~~.%-.SE ~~[,-t+r;H 'H~.S CTnTGr,.~~r.i- ~c r_nc~ nr~,~-~ .-..., REV-15'9 3 EX + (9-00) s SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF FILE NUMBER DAVID K. ALSPAUGH nuns 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 1. Sec. 9116 (a) (1.2)] ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 1$, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: 1. A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAXIS NOT BEING MADE B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. Penn State Hershey Cancer Research Fund I The Penn State University $4,735.54 214 103 Building University Park, PA 16802 2. Penn State Hershey Infectious Disease Research Fund /The Penn State University $2,367.77 214 103 Building University Park, PA 16802 3. Penn State Hershey Hematology/Oncology Research Fund /The Penn State University $2,367.76 214 103 Building University Park, PA 16802 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET $ 9 471.07 (If more space is needed, insert additional sheets of the same size)