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PEprANE~iT NAME
This is to certify that the certificate hereunto attached is a true and accurate copy of the original
death record on file with the Division of Vital Records, and that Frank Yeropoli, whose name is
subscribed thereto, was at the time of subscribing the same and now is Director, Division of Vital
Records of the Department of Health, for the Commonwealth of Pennsylvania, duly appointed
and commissioned as directed by Act 66 of the General. Assembly, approved 29 June 1953, P.L.
304.
Date
AUG 162001
? .
Fran eropoli, ct
Division of Vital Records
P.O. Box 1528
New Castle, PA 16103
COMMONWEALTN OF PENNSYLIMNIA • DEPARTME?IT OF HEALTH • VITAL RECORDS
CERTIFICATE OF DEATH
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"' .....~„~,.,,rRw.w..uq SE,c SOCIALSEDUrurrNUMIER- - DAiEGFDENMiM6in.Dry.'~.f,
+• Mar E. Shue
:Female x 203 - 10 - 3065 March 31 1995
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1044 Swarthmore Road +n~+• PA ~
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New Cumberland, PA 17070
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REGISTRM'S SNiN/PURE AtiD NUMBEp k i L~ q a
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REV-1500 EX+ (7.94) ~
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INHERITANCE X RETURN FOR DATES Of DEATH AFTER 14131/91 CHECR7HERE
POVERTY CREDIT IS CLAIMED ^
:
~ RESIDEN ECEDENT FILE NUMBER
COMMONWEALTH OF PENNSYL An
DEPARTDEPi
280ei01YENUE (TO BE FI IN DUPLICATE
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HARR15tlURG
PA 17128
0601 IT
GISTER OF WILLS)
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. COUNTY CODE YEAR NUMBER
DECEDENT'S NAME (LAST, FIRST, AND MIDDLE INITIALI DECEDENT'S C
OMPLETE ADDRE
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w SOCIAL SECURIT N ER DATE OF DEATH TE OF BERTH ,
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Count
o IiF Av ICA6 I SUNVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) SOCIAL SECURITY NUMBER AMOUNT RECEIVED ISEE INSTRUCTIONS)
a+ ~ 1. Original Return ^ 2. Supplemental Return ^ 3. Remainder Return
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^ 4. Limited Estate (for dotes of death prior to 12-13-82)
^ 4a. Future terest Compromise ^ 5. Federal Estate Tax Return Required
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~, b. Decedent Died Testofe (for ales of death after 12-12-82)
^ 7. D edent Maintained a Living Trust ,.-~ 8. Total Number of Safe Deposit Boxes
(Attach copy of Will) troth copy of Trust)
A-~.~ ~OR~t~SPQNR~NCE AND CONFIpENTIA AX INFQRMATIQ[~ SHQ{JLD pE DIRECTED T 1:-~ ' .
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W AME COMPLETE MAILING ADDRES
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1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedule B)
3. Closely Held StocklPartnership Interest (Schedule C)
4. Mortgages and Notes Receivable (Schedule D)
5. Cash, Bank Deposits 8 Miscellaneous Personal Property
(Schedule E)
b. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G) (Schedule L)
8. Total Gross Asses (total Lines 1-7)
9. Funeral Expenses, Administrative Costs, Miscellaneous
Expenses (Schedule H)
10. Debts, Mortgage Liabilities, Liens (Schedule I)
1 1. Total Deductions (total Lines 9 $ 10)
12. Net Value of Estate (Line 8 minus Line 11)
13. Charitable and Governmental Bequests (Schedule J)
(1) 9 SS Dnu~°~ ~
(2) -
131
(4) ~~
l5)
(b)
(7) /
(9)
(10)
(11) 1 ~ (~g 5~0~
(12) ~ ~,da3 ~ ~.
(13)
14. Net Value Subject to Tax (Line 12 minus Line 13) (14) ~~,~. ~ Z
15. Spousal Transfers (for dates of death after b-30-94)
See Instructions for Applicable Percentage on Reverse (15)
Sid
l x,_=
e. (Inc
udo values from Schedule K or Schedule M.)
1 b. Amount of Line 14 taxable at 69'o rate (16) ~ 3 t f~ ~~. ~ ~ ,/ .~ `
x .Ob = ~, L ~• /7
(Include values from Schedule K or Schedule M.)
17. Amount of Line 14 taxable at 15% rate (17} x .15 =
z (Include values from Schedule K or Schedule M.)
o 18. Principal tax due (Add tax from Lines 15, 16 and 17.) (lg)
~ 19. Credits Spousal Poverty Credit Prior Payments
Dis
count Interest
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a 20. If Line 19 is greater than line 18, enter the difference on line 20. This is the OVERPAYMENT. (20)
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21. If Line 18 is greater than line 19, enter the difference on Line 21. This if the TAX DUE. (21) ~~~.~~
A. Enter the interest on the balance due on Line 21 A. (21A)
B. Enter the total of Line 21 and 21A on Line 21B. This is the BALANCE DUE. (21B)
Make Cbeck Payable to: Register of Wills, Agent
~- EIE ~~
nder penalties of perjury, I declare the
is true, correct and complete. 1 declare
ssec~.eli all information of which prepay
has
examtnetl this return,
real estate has been
accompanying schedules and statements, and to tht
at true market value. Declaration of preparer other
(8) ld~~I~~~~(1
~r my xnowtetlge and belief,
ie personal representative is
DATE
o~ c3,~~
DATE
REV-1502 EX + 112.85)
~` SCHEDULE A
COMMONWEALTH OF PENNSYLVANIA REAL ESTATE
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF FILE NUMBER
M~~ ~_~~-~E_y----- mss, ~
(Property iointly-owned wit R6 ight of Survivorship must be disclosed on Schedule F) All real estate should be reported at Fair market value
which 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 reasonoble knowledge of the relevant Facts.
ITEM VALUE AT DATE
NUMBER DESCRIPTION OF DEATH
~. Nou,S~ ~Np ~,ot SLT~aTor` pNO XNCwK A5 1~4~{ SwnRTNhO1Qi~
~~t~D i NEw CkM6~,RLANo ,1 A- - ~E-~6 I.oi ! , (3~o~-c Q. SEC 1
1f ~ 6,~1 Lt~NI~ '~A~K ~-~I,~ t~~F,a,~uoit ~ ~ P~+6>: 43, $~c
pEEp J31wK `~~ -A.~tiS' - So~-D t~uAE>~ ~ yc-aJ!L
SA~.~ s ~GREEMC~u'f
TATAI IAL.. ,,.,,~~ .,n lino 1 pe~nnih~Iniinnl
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REKISOfI EX• (287)
>,
COMMONWEALTH OF PEI
INHERITANCE TAX E
RESIDENT DECED
SCHEDULE E
CASH, BANK DEPOSITS AND
MISCELLANEbUS
PERSONAL PROPERTY
must be dleclosed on Schedule FI
LE
Please Print or
(Attach additional 81Fi" x il" sheets if more space is needed.)
Mt-~!y E. S.+kEw ~~• 15 - ~6~
(All property (ointly-owned with the Riyhf of Surv vorsbip
REV-1511 EXt I7.8BI
'
SCHEDULE H
~! FUNERAL EXPENSES,
COMMONWEALTH Of PENNSYLVANIA ADMINISTRATIVE COSTS AND
- INHERITANCE TAX RETURN
RESIDENT DECEDENT MISCELLANEOUS EXPENSES please Print or Type
ESTATE OF FILE NUMBER
I~i . v
ITEM
NUMBER DESCRIPTION
AMOUNT
A. Funeral Expenses:
t. ST~N1i ~ Mk~Rlly FkN~RA~ N,A-li X136.10
~• P1~AL~ws ~1.OwEws
1~3•~a
B. Administrative Costs:
1. Personal Representative Commissions
_ _
Social Security Number of Personal Representative:
~j ~~ ~"~a 0
Year Commissions paid
2. Attorney Fees ~y~s• OO
3. Family Exemption
Claimant "'~' Relationship
Address of Claimant of decedent's death
Street Address
City State Zip Code
4. Probate Fees ~ Iu1,o
C. Miscellaneous Expenses:
t. E v-IhdE~ LA N0 LAW J'~~ IWII - 1~t~+~MtTK C ~sTai'~ M0. ~0
2. ('~k1i R1~T ~w s
16~ • y
3. ~N ~ O ~~t-F F Jt~AN '~ NAT A'0`~ ~ V
4. REG~~r~~t, of 1~VIL.Ls - ~M.RT CE>xr~~cwTE S.S~
6. ~. I rl t~ ~ • T^ti K ~"TN ~ N ~ b~.11~
1~tt,EASf `.r~
9.
TOTAL (Also enter on line 9, Recapitulation) $
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ScK EAuLE N
~ 1e PENS"~S
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Maay ~. ,Sf+~Ey
ID. CAM-p Nl~l ~AR~ C's~-7 !R.
17t. Nosy ~p~,~,Y /t/is~~TA~.. - resit Tit~.woss
I3 p~iTsE~. ~je.ra fps y.~c.
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11. C16NP ' S'l~+'gy T,/~S~AI-MCIi
~o. SKIT H R~o,e ~ o cy
41, f~oo M. Pa~ecscN ~ - l~ P~
p`~- C16NA._.. IRE ~+~Su~AN~e
~3. ~kN ~NNErti(~N - cSWiW6Lt5 ~ aR. ~ooF
~~. /~.~.. 'R~T3~MAJJ ~SSoc~ATES
1y • C.IEaNA _ ~NS•'• x.15"a1S
a~• Rn6~N GwSPGReTT~ IAxEs
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REV-1509 EX• (14.08(
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TA% RETURN
RESIDENT DECEDENT
SCHEDULE F
JOINTLY-OWNED PROPERTY
OF FILE NUMBER
L!~ARy E. ~MkE'~ ~1-9S-~b7
Joint fenanf(s):
NAME ADDRESS
A• r11~'Ril-pE'~s~~ RQNMfM~N lugl l.ILw~iddeRy Wp
e.
~.
Jointly-owned property:
RELAtIONSHIP TO DECEDENT
p~6N 7!'''R'
LET
ITEM
NUMBE TER
FOR
JOINT
TENANT
DATE
MADE
JOINT
DESCRIPTION OF PROPERTY
TOTAL VALUE
OF ASSET
DECD'S
°h INT.
DOLLAR VALUE OF
DECEDENT'S INTEREST
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a . A ~~-~~ sA~,N~s ~<<.w~t
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TOTAL (Also Doter on line 6, Recapitulation) $
(!f more spoce is needed insert additional sheets of same size)
REV~1511 EII+ X2.87)
/~ Y ,)
COMMONWEALTH OF PENNSYLVANIA
INHERITANCE TAX RETURN
RESIDENT DECEDENT
ESTATE OF
SCHEDULE J
BENEFICI/4RIES
FILE
J
TOTAL CHARITABLE AND GOVERNMENTAL BEQUESTS (Also enter on line 13, Recapitulation) I$
(If more space is needed, insert additional sheets of sam• size)
ITEM
NUMBER NAME AND ADDRESS OF BENEFICIARY AMOUNT OR
SHARE OF ESTATE
B. Charitable and Governmental Bequests:
w
Inventory of the real and personal estate of
MARY E. SHUEY
deceased
House and Lot situate and known as 1044 Swarthmore Road, New
Cumberland, Pennsylvania - Being Lot 1, Block B, Section 1, Highland
Park Hills, Plan Book 7, Page 23. See Deed Book 21-A-285 - Sold
under 1 year Sales Agreement
1994 Income Tax Refund
Household Furnishings
Property Tax Refund
Bell Atlantic Refund
Blue Shield Refund
95,000 00
61 00
2,203 00
..136 80
1 44
5 60
~~ 97,407 84
.,
F COMMAN~IVE%-LTN OF PENNSYLVANIA 1
BOUNTY OF 1l~11N~D ypRk f ~'
1MIAlaC~T M. BREli
being duly sworn according to law, deposes and says that She t a the F.x~~tr; x
of the Estate of *"'*~~E~ Slauev
late of 1044 5'tnrdrth[riore Road, New C~unberland, ,Cumberland County, Pa., deceased and that the
within is an inventory mode by Maraa_~t M. B _nn~n__ _ ., the said Exec~t*-ix
of the entire estate of said decedent, consisting of all the personal proparty end real estate, except real estate outside
the Commonwealth of Pennsylvania, and that the figures opposite each item of the Inventory represent it's fair value
as of the dote of decedent's death.
Sworn
end subscribed before me,
N 13 19 95
- `~ V .
Notarial Seal
Enld V. Martin, Notary Public
Fairview Twp. York County
My Commission Expires July 12, 1999
G~ 72~1~S~.fyL~
Exoeu4er - Adminislrefor
Addros:
Date of Death 31st March 1995
Day Monfh Y~~r
INSTRUCTIONS
I. An inventory must be filed within three months after appointment of personal representative.
2. A supplement inventory must be filed within thirty days of discovery of additional assets.
3. Additional sheets may be attached as to personalty or realty
4. See Article IV, Fiduciaries Act of 1949.
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REV-1547 EX AFP (12-95) .
COMMONNEALTH OF PENNSYLVANIA ACN 1 0 1
DEPARTMENT OF REVENUE NOTICE OF INHERITANCE TAX
BUREAU OF INDIVIDUAL TAxES APPRAISEMENT, ALLOWANCE OR DISALLOWANCE
DEPT. 280601 OF DEDUCTIONS AND ASSESSMENT OF TAX
HARRISBURG, PA 17128-0601 DATE 07-08-96
ESTATE OF SHUEY MARY E FILE N0. 21 95-0267
DATE OF DEATH 03-31-95 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE REGISTER OF WILLS. MAKE CHECK PAYABLE TO "REGISTER OF WILLS, AGENT"
REMIT PAYMENT TO:
ROBERT E MYERS REGISTER OF WILLS
100 YORK RD CUMBERLAND CO COURT HOUSE
NEW CUMBERLAND PA 17070 CARLISLE, PA 17013
Amount Remitted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS t
REV-1547 EX AFP (12-95) NOTICE OF INHERITANCE TAX APPRAISEMENT, ALLOWANCE OR
DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX
ESTATE OF SHUEY MARY E FILE N0. 21 95-0267 ACN 101 DATE 07-08-96
TAX RETURN WAS: ( ) ACCEPTED AS FILED ( X) CHANGED SEE ATTACHED NOTICE
RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE
APPRAISED VALUE OF RETURN BASED ON: SUPPLEMENTAL RETURN N0. O1
1. Real Estate (Schedule A) (1) .00
2. Stocks and Bonds (Schedule B) (2) .00
3. Closely Held Stock/Partnership Interest (Schedule Cl (3l .00
4. Mortgages/Notes Receivable (Schedule D) (4) .00
5. Cash/Bank Deposits/Misc. Personal Property (Schedule E) (5) .00
6. Jointly Owned Property (Schedule F) (6) .00
7. Transfers (Schedule G) (7l .00
8. Total Assets (g) .00
APPROVED DEDUCTIONS AND EXEMPTIONS:
.00
9. Funeral Expenses/Adm. Costs/Misc. Expenses (Schedule H) (9)
10. Debts/Mortgage Liabilities/Liens (Schedule I) (10) .0 0
11. Total Deductions (11) .00
12. Net Value of Tax Return (12) .00
13. Charitable/Governmental Bequests (Schedule J) (13) .00
14. Net Value of Estat• Subject to Tax (14) 9 3,003.42
reflect figures that include the total of ALL returns assessed to date.
ASSESSMENT OF TAX:
15. Amount of Line 14 at Spousal rate (15) •00 X .0 0_ .00
16. Amount of Line 14 taxable at Lineal/Class A rate (161 93,003.42 X .06. 5,580.21
17. Amount of Line 14 taxable at Collateral/Class 8 rate (17) .00 X .1 5. .00
18. Principal Tax Due (lg) 5,580.21
NOTE: If an assessment was issued previously, lines 14, 15 andior 16, 17 and 18 will
TAX CREDITS:
PAYMENT RECEIPT DISCOUNT (+)
DATE NUMBER INTEREST (-) AMOUNT PAID
06-22-95 AA047918 243.00 4,617.00 ~
11-15-95
AA082317
.00 i
787.21
TOTAL TAX CREDIT 5,647.21
BALANCE OF TAX DUE 67.000R
INTEREST AND PEN. .00
TOTAL DUE 67.000R
( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
* IF PAID AFTER DATE INDICATED, SEE REVERSE
FOR CALCULATION OF ADDITIONAL INTEREST.
R~V-lal0 E% (6-88(
COMMONWEALTH OF PENNSYLVANIA
DEPARTMEN OF REVENUE
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 17128-0601
DECEDENT'S NAME
"1~ r}' ~, Siltit'
SCHEDULE ITEM
NO.
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INHERITANCE TAX
EXPLANATION
OF CHANGES
EXPLANATION OF CHANGES
FILE NUMBER
ACN
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TAX EXAMINER: Ar~.essi+:, 't.vr~! PAGE
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i 'h~V-159 EX AFP (12-95) ASSESSMENT
COMMONNEALTH OF PENNSYLVANIA CONTROL NO. 101
DEPARTMENT OF REVENUE INHERITANCE TAX
BUREAU OF INDIVIDUAL TAXES
DEPT. 280601
HARRISBURG, PA 171za-obol RECORD ADJUSTMENT DATE 07-05-96
ESTATE OF S U Y MA Y FILE N0. 2 9 -0267
DATE OF DEATH 03-31-95 COUNTY CUMBERLAND
NOTE: TO INSURE PROPER CREDIT TO YOUR ACCOUNT, SUBMIT THE UPPER PORTION OF THIS FORM WITH YOUR TAX
PAYMENT TO THE ADDRESS SHOWN. MAKE CHECK PAYABLE AND REMIT PAYMENT T0: ,
ROBERT E MYERS REGISTER OF WILLS
i00 YORK RD CUMBERLAND CO COURT HOUSE
NEW CUMBERLAND PA 17070 CARLISLE, PA 17013
.Amount Remitted
CUT ALONG THIS LINE - RETAIN LOWER PORTION FOR YOUR RECORDS ~
----------------------------------------------------------------------------------------------------------------
REV-1593 EX AFP (12-95) x~ INHERITANCE TAX RECORD ADJUSTMENT ~(~(
ESTATE OF SHUEY MARY E FILE N0. 21 95-0267 ACN 101 DATE 07-05-96
ADJUSTMENT BASED ON: Ai)MTNTSTRATTV f'ORRF(•TTnu
VALUE OF ESTATE:
1. Real Estate (Schedule A)
2. Stocks and Bonds (Schedul• B)
3. Closely Hald Stock/Partnership Interest (Schedule C)
4. Mortgages/Notes Receivable (Schedule D)
5. Cash/Bank Deposits/Misc. Personal Property (Schedul• E)
6. Jointly Owned Property (Schedule F)
7. Transfers (Schedule G)
8. Total Assets
DEDUCTIONS AND EXEMPTIONS:
9. Funeral Expenses/Administrative Costs/
Miscellaneous Expenses (Schedul• H)
10. Debts/Mortgage Liabilities/Liens (Schedule I)
11. Total Deductions
12. Net Value of Tax Return
13. Charitable/Governmental Bequests (Schedule J)
14. Net Value of Estat• Subject to Tax
TAX:
15. Amount of Line 14 at Spousal rate
16. Amount of Line 14 taxable at Lineal/Class A rat'
17. Amount of Lins 14 taxable at Collateral/Class B rat'
18. Principal Tax Due
TAX CREDITS:
(1)
(2) . 00
(3) .00
(4) .00
(5) 2.407.84
(6) 6.780.63
(7l nn
(8)
(9)_ 10.235.05
(l0) . 00
(11) _ 10.235.05
(12) 93.95; 4
(13) . 00
(14) 93.953 42
(15) 00 X.00 = 00
(16) 93 .953 4 X.06 = 5 .637 _ 1
cln aDX.15= _00
(18) 5.637. 7
PAYMENT
DATE RECEIPT
NUMBER DISCOUNT (+)
INTEREST (-)
AMOUNT PAID
06-22-95 AA047918 243.00 4,617.00
11-15-95 AA082317 .00 787 21
TOTAL TAX CREDIT
BALANCE OF TAX DUE
INTEREST AND PEN. .00
TOTAL DUE 10.000R
* IF PAID AFTER DATE INDICATED, SEE REVERSE ( IF TOTAL DUE IS LESS THAN S1, NO PAYMENT IS REQUIRED.
FOR CALCULATION OF ADDITIONAL INTEREST. IF TOTAL DUE IS REFLECTED AS A "CREDIT" (CR), YOU MAY BE DUE
A RFFIIND_ SFF REVERSE STOF OF TNTS FORM FAR TNSTRIIrTTONC 1
Rl~'J-Id70 EX 16-BR)~' ~~ -
~ INHERITANCE TAX
COMMONWEALTH OF PENNSYLVANIA EXPLANATION
BUREAU OF INf)IVIDUAL TAXES OF CHANGES
DEPT. 280601
HARRISBURG, PA 1 7 1 2 8-060 1
DECEDENT'yS r~AME FILE NUIgIB
I~ ACN
SCHEDULE ITEM EXPLANATION OF CHANGES
NO.
- ~~.5~
f^ '
TAX EXAMINER:
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PAGE ~ 1~