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HomeMy WebLinkAbout09-13-12 (2)WHEREAS: The rest, residue and remainder of the net estate was, according to the Will of William R. Shuman, to be distributed to his son, William L. Shuman; and WHEREAS: Lorraine C. Hughes has received a distribution or simultaneously herewith is receiving a distribution equal to $156,973.86; and WHEREAS: The following beneficiaries have an interest in the net Estate of William R. Shuman: Lorraine C. Hughes, Daughter of Decedent: William L. Shuman, Son of Decedent: One half of Specific Morgan Stanley Smith Barney Account or $156,973.86 Rest, Residue and Remainder of Net Estate NOW THEREFORE, Beneficiaries, do hereby acknowledge that each has been notified by Executor in his capacity as Executor of the Estate of William R. Shuman, of full satisfaction and payment of all sum or sums of money, legacies, bequests, and devises as given, devised and bequeathed to us pursuant to Pennsylvania Code, which amounts each does acknowledge; and which amounts, are in the amounts set opposite the Distributions to Each Beneficiary in the Inheritance Tax, and to be distributed as attached hereto and made part hereof after the agreed upon distributions as per the copy of the will. Advice of Counsel We, Beneficiaries, hereby acknowledge that this Family Settlement Agreement and Final Release contains provisions which may waive legal rights and assume legal responsibilities and encumbrances, or has other legal consequences, and that We have been informed to seek the advice of counsel before signing said Agreement. The above named hereby acknowledges that each has freely chosen to sign this Family Settlement Agreement and Final Release without the consent or advise of legal counsel. That each was given the opportunity to seek legal counsel to review this Agreement prior to signing, but choose instead to sign without such counsel. The above named acknowledges that each is of sound mind and disposition. We have read and understand the nature and importance of this Agreement, that we consider the provisions of this Agreement to be fair, just and reasonable, that we enter into it freely and voluntarily. Asreement to waive filing of formal account We, beneficiaries, hereby stipulate that in order to avoid the expense and rime involved in the filing of a formal account and schedule of distribution, we agree that no account is necessary and we hereby agree that we consent to distriburion being made without the filing of an account and schedule of distribution, with the same to be with the same force and effect as if they had been filed and confirmed by the Orphan's Court Division of the Court of Common Pleas, Cumberland County, Pennsylvania. Waiver of Liabilitv We, Beneficiaries, hereby remise, release, quit-claim and forever discharge Ezecutor, in his capacity as Eaecutor of the Estate of William R. Shuman, his heirs, executors, and Executors and assigns, and agents, of and from the said Estate and from all actions, suits, contests, payments, accounts, reckonings, claims and demands whatsoever for, or by reason thereof, or for any other use, matter, cause or thing whatsoever touching upon the Estate. Assumption of Liability We, Beneficiaries, FURTHER HEREBY COVENANT AND AGREE THAT, SHOULD ANY LIABILITY COME DUE TO THE ESTATE OF THE SAID DECEDENT AFTER THE SIGNING OF THI5 AGREEMENT, WE, AS BENEFICIARIES UNDER SAID WILL, SHALL CONTRIBUTE TO THE ESTATE IN ORDER TO SATISFY ANY AND ALL CLAIMS, DEMANDS, SUITS OR CAUSES OF ACTION WHICH MAY BE SUCCESSFULLY PROSECUTED AGAINST THE SAID ESTATE OR THE AFORESAID EXECUTORS OR AGENTS OF THE ESTATE, AFTER THE SIGNING, SEALING AND DELIVERY OF THIS FAMILY SETTLEMENT AGREEMENT AND FINAL RELEASE. SIGNATURE5 IN WITNESS WHEREOF, the parties to this agreement, intending to be legally bound, hereby have set their hands the day and year first above written. L. S~i~urlfan, Son of Decedent C:~C~~-4.~c.~2.c~-~ G' - Lorraine C. Hughes, Daughter of Q /~ ~ D e ~- /o-IZ. Date / 4, D e ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA : SS COUNTY OF ~ j n B~i'~~-~9~ ~ . On this the ~of ~t~T~rn6E.e . 2012, before me, the undersigned officer, personally appeared William L. Shuman, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement and acknowledged that he executed the same for the purp~o therein contained. COMMONWEALTH OF PENNSYCVA~J~A~ NOTARIAL SEAL MICHAEL R. CARANCI, Notary Public ~ Lemoyne Boro. Cumberland County '%~" • My Commission F~cpires June 15, 2014 ',~•`- ~~ Notary Public My cominission expires: ACKNOWLEDGMENT COMMONWEALTH OF PENNSYLVANIA COUNTY OF ~~.+~3"'~ ~~~~-~~~ :~ On this the /v~ of ~i~i~sd2c~/"1 , 2012, before me, the undersigned officer, personally appeared Lorraine C. Hughes, known to me (or satisfactorily proven) to be the person whose name is subscribed to the within Agreement and acknowledged that she executed the same for the purposes therein contained. COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL MICHAEL R. CARANCI, Notary Public Lemoyne Boro. Cumberiand County My Commission Expires June 15, 2014 ~._._. ~~ ~ Notary Pubiic My commission expires: ~~je ~.~~t ~fYX a~tb ~e~ta~mce~t Df WILLIAM R. SHUMAN I, WILLIAM R. SHUMAN, of Upper Allen Township, Cumberland County, Pennsylvania, being of sound and disposing mind, memory and understanding, do hereby make, publish and declaxe this my Last Will and Testament, hereby revoking and making void any and all prior Wills by me at any time heretofore made. 1. I direct the payment of all my just debts and funeral expenses as soon after my decease as the same can conveniently be done. 2. I direct that there shall be paid out of my residuary estate all estate, inheritance and like taxes together with any interest or penalty thereon imposed by the Government of the United States, or any state or territory thereof, or by any foreign govemment or political suY~division thereof, in respect to all ~roper!y required to be included in my gross~state _ for estate, inheritance or like tax purposes by any of such governments, whether t~~~ ~ property passes under this will or c~therwise. ~y ~l z ~ '.s~~; , . r1 ~7 .~~ l_) "fl . ~ . ; :_ _... ~ _.., ~ ~v .. ... 3. z. _r. - ~,, I give and bequeath one hal~ of my Morgan Stanley Smith Barney account #724- ~ 11548-19-364 to my daughter, LORRAINE C. HUGHES. -1- 4. All the rest, residue and remainder of my estate, real, personal and mixed, of whatsoever nature and wheresoever situate, I give, devise and bequeath to my son, WILLIAM LEE SHUMAN, absolutely and in fee simple. 5. Lastly, I nominate, constitute and appoint my son, WILLIAM LEE SHUMAN to be Executor of this my Last Will and Testament and I direct that no bond or other security be required of my personal representative to guazant.ee faithful performance of his duties. IN WITNESS WHEREOF,1 have hereunto set my hand and seal this/y a y of September, 2009. ~~~-. ~ ~ji`~~SEAL -. t iam . uman Signed, sealed, published, and delivered by William R. Shuman to be his last Will and Testament in the presence of us, the subscribing witnesses in his presence and in the presence of each other. < ~' ~ ~~~j,~/ , -~ -2- , REGISTER OF WILLS CUMBERLAND COUNTY PENNSYLVANIA CERTIFICATE OF GRANT OF LETTERS No . 2011- 01036 PA No . 21- 11- 1036 Es ta te Of : WILLIAM R SHUMAN fFirst, Middle, LesU Late Of: LOWERALLENTOWNSHIP CUMBERLAND COUNTY Deceased Social Security No: 193-12-9612 WHEREAS, on the 30th day of September 2011 an instrument dated September 14th 2009 was admitted to probate as the last will of WILLIAM R SHUMAN (First Middle, LasU ~ late of LOWER ALLEN TOWNSH/P, CUMBERLAND County, who died on the 21st day of September 2011 an WHEREAS, a true copy of the will as probated is annexed hereto. THEREFORE, I, GLENDA FARNER STRASBAUGH , Register of Wills in and for CUMBERLAND County, in the Commonwealth of Pennsylvania, hereby certify that I have this day granted Letters TESTAMENTARYto: WILLIAM LEE SHUMAN who has duly qualified as EXECUTOR(R/XJ and has agreed to administer the estate according to law, all of which fully appears of record in my office at CUMBERLAND COUNTY COURT HOUSE, CARLlSLE, PENNSYL VANIA. IN TESTIMONY WHEREOF, I have hereunto set my hand and affixed the seal of my office on the 30th day of September 201 ~. ,~,~~ ~ ~~~~ c~Q,e9~So ~~ C.~`.Xl l~ 1 X~n o~p.f 0 t gP.~~.~~~r~ eputy **NOTE** ALL NAMES ABOVE APPEAR (FIRST, MIDDLE, LAST) J ~5~5610105 REV-15ooIX~~-,=,~~~ PA Departm~mt of Revenue A~~~~a OFFtCI/VL USE ONLY Bureau of IndiNdua! Ta~res '~"•"'•`•~•• County Code Ynr _ FAe Numhar INHERITANCE TAX RETt1RN f-" -^ :` -" Po eOx zSo6oi , ~ Harrisbury, PA i7u8-o6oi RESIDEHiT DECEDENT i !' ENTER DECEDENT W FORAAATION BELOW Social Securiqr Numfier Date of DeaEh MMDDYYYY Date of Birth MM~YYYY ~93-12-9612 ~ : 0912'I/2b11 _ ; 03/29/'1922 ~ --~ . ~ Decedenf's Last Name - ---- _- Surtbc DecedenYs First Name MI __.__..._ --- ~ Shuman L ~ ~ I R ~ I ; Wdliam J -~ .:_. ~.______ ~! _. _.._...._.._ (RAppHeable)•Enbsr Surviving Spouae's biformaUon Below. Spouse's Last Nama -- Sufibc Spouse's Fcst Name MI I _i . .~..__.. !_. _. Spouse's Sociei Security Nwnber ~ --_... _.. _., ..° THIS RETURN MU3T BE FN.ED iN DLtPL1CATE WI'IH THE ;~ REGISTER OF WILLS FILL M APPROPRIATE OYALS BELOYY ~ Cp. !. Oripkid ReWm O 2 SupplerneMel Rehxn O 3. Retnai~der Reiim (Date d Deelh ' Priorto 12-13-82) p 4. Linrihed Estabe O Aa- Fuhr-e tnteresd Compromise (daFa of p 5. Fedefal Estala Tax Rehm Required d~tli aPoar 12-72-82) Q 8. Decadarrt DbG Te~ate O J'. DeoedMt Mai~tBined a Uaing Trust _~ S. Totel Nianber d SaFe Depoeit Bozes ta~a, coar ~ wai) (n~ma, co~ or rn,scy O 9. Litlpatlon Proceada Received O 10. Spa,sel PareAy C}e~ (6ale d Deetl~ 0 it. El~ction lo Tax uMer Sec. 8113I/~) Batwean 12-31-91 and 1-1-95) (Atfach Sd~eduM O) CORRESPONCENT -~ SECTION NUST BE COMPLETID. ALL CO~ONOENCE AI~ ~EHTIRL TAX QFORII~110N &IOULD BE OIRECTFD T0: Name _~ ------- - - -~-- -- --_ Daytlme Tebphone Numb~ .._.._.._._.__.-. .__..~-._, ~..._r..... ~ ; Bruce D. Foreman ~ . 1;(71~ 236-9391 ~ ___ , _ _._. ! ~ ...............~----------• -. . First L"me of Address _.._ ....... ....__ _ __ ___._ _ . ....._.__. .v~_ ._.._.__.,___ _ ~ i 112 Marlcet Street i ,.._-----.. _.__.._. .. _ - -- --- __ . . .....-- . ~.._.__....- ..._____ __W, 5eeond tk~ ofAddr~s . ~._..------.._._.._..__ -__._____...._._.._-_.-----..---- ~ 6th Floor _~..__ __ ___----........_ . . . ------ --,--, .. __ _ _ .-- - ~-- --- _ Ciry or Post Olfice St~e --- _..... ..~. - - - _....._.__ ~---~. ~ Hartisburg - . PA , ~.--.-_ ._ .___ .,..,.. , _.._..______~.,_.._. - --•-' ' ' . Corrrspondsnt'a trmaH addross: Llndar per~allias d peiJury, I drdan tlnt I havt szprtined tnh roWm, iwiudnp B Js Ws. cdrr.t md complNa. Oedaradan d pispa~r otl~r than tl~e pasorv 9K~NA RE F ON RES 6 FOR FILMG REiURN . ,.-t.~ _ 260 Creek Roa~ amp Hill, PA 17011 si o~ R oniaz n~w R~zESExrAnvE ~- --~ REGISTER OF YYLL.B USE ONLY ZIP Code ~ w-~ ~ i 17101 -- - - -~_ _. _ ______ _ sehrd~se and riakrt~errb. and to IAe bed d my ImowlWpe ~d be~ef, e is haeed m an Inkrmetlon of which pnparar nec ary Imowlsdg~. . ~ %~~~ ~°"~~~/, ~-- ADDRESS A . _ ' . . 112 Markef Street, Bth.Floor, Harrisburg, PA 17101 PLEASE USE ORIGINAL FORM ONLY $If~@ ~ L 15~561~105 15DS61Q1~5 ~ ~ 15056102~5 REV-1500 EX (FI) Decedent's Social Security Number ~ecede~r5 Name: William R. Shuman 193-12-9612 RECAPITULATION t Real Estate (Schedule A) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. 190,000.00 2 . Stocks and Bands (Schedule B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2. 3 . Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) ... .. 3. 4 . Mortgages and Notes Receivable (Schedule D) . . . . . . . . . . . . . . . . . . . . . . . . . . . 4. 2,874.97 5 . Cash, Bank Deposits and Miscellaneous Personal Property (Schedule E). .... .. 5. 503,840.77 6. Jointly Owned Property (Schedule F) O Separate Billing Requested ..... .. 6. 7. Inter-Vivos Transfers & Miscelianeous Non-Probate Property ' ` (Schedule G) O Separate Billing Requested... ... .. 7. 8. Total Gross Assets (total Lines 1 through 7) . . . . . . . . . . . . . . . . . . . . . . . . . . . : . 8. 696,715.74 9. Funeral Expenses and Administrative Costs (Schedule H) . . . . . . . . . . . . . . .. . . . 9. 3,680.50 10. Debts of Decedent, Mortgage Liabiiities and Liens (Schedule I) . :. . . . . . . . . .. . . 10. 1,971.76 11. Total Deductions (total Lines 9 and 10) . .. . .. . . . . . . .. . . . . . . . . . . . . . . . .. . . 11. 5,652.26 12. Net Value of Estate (Line 8 minus Line 11) . .. . . .. . . . . . . . . . . . . . . .. . . . .. . . 12. 691,063.48 13. Charitabie and Govemmental Bequests/Sec 9113 Trusts for which "" an election to tax has not been made (Schedule J) . . .. . . . . . . . . . . . . . . . . .. . . 13. 691,063.48 14. Net Value Subject to Tax (Line 12 minus Line 13} . . . . . . . . . . . . . . . . . . . . . . . . 14. TAX CALCULATION - SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 _ . _. _ _ (a)(12}X .0_ 15. 16. , . ._ . Amount of Line 14 taxable at lineal rete X.0 45 691,063.48 ~6. 31,097.86 ~ 7. .. . Amount of Line 14 taxable _ at sibling rate X.12 17. 18. _ _ Amount of l.ine '14 taxable _ at coliateral rate X.15 18. 19. TAX DUE ........................................................ . 19. 31,097.86 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT p Side 2 ~ 1505610205 15056102~5 J REV-1500 EX (FI) Page 3 ~ Decedent's Complete Address: 2. File Number (1) Total Credits ( A+ B ) (2) 3. Interest 4. If Line 2 is greater than Line 1+ Line 3, enter the difference. This is the OVERPAYMENT. (3) Fiil in oval on Page 2, Line 20 to request a refund. ~q) 5. If Line 1+ Line 3 is greater than Line 2, enter the drfference. This is the TAX DUE. (5) Make check payable to: REGISTER OF WILLS, AGENT. , ,.+. ... ., . .'z*~:.. nm}*, ,~f `~ °~,~ h~` ~;` a-'~. '~~"a~ W' ~.r,~~`~'~ 'i~~v .,":`(~'~z3 -~ wr~' a sc ', ?'~~.:~ ~.'~_ ~ . ~ .. , . `~ 9 ~Y "M%'i r"F '~ ,XY.xi'.~^.~a* . 4. .~....?'v1n ' ::t'rvS" ?S`F' ~~:2t~.5~v.. .. w. PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X" IN THE APPROPRIATE BLOCKS 1. Did decedent make a transfer and: Yes No a. refain the use or income of the property transferred ......................................................................................... . ^ ~ b. retain the right to designate who shall use the property Vansferred or its income ........................................... . ^ ~ c. retain a reversionary interest ..............................................................................................:..........................:... . ^ ~ d. receive the promise for life of either payments, benefits or pre? ............................................. ....................... ~ . ~ 2. If death occurred after Dec. 12, 1982, did decedent Vansfer property within one year of death without receiving adequate consideration? ........:.......................................................... ........................................... ^ ~ 3. Did decedent own an "in ttust 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? ............................................................................................ ............................ ^ ~ IP 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 Jan.1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 3 percent [72 P.S. §9116 (a) (1.1) (i)j. For dates of death on or after Jan. 1, 1995, the tax rate imposed on the net value of transfers to or for the use of the surviving spouse is 0 percent [72 P.S. §9116 (a) (1.1) (ii)j. 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 stiil applicable even if the suroiving 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 21 years of age or younger at death to or for the use of a natural parent, an adoptive parent or a stepparent of the chitd is D percent (72 P.S. §9116(a)(1.2j]. • The tax rate imposed on the net value of transfers to or for the use of the decedenYs lineal beneficiaries is 4.5 percent, except as noted in [/2 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 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. Tax Due (Page 2, Line 19) CreditslPayments A. Prior Payments _ B. Discount Tax Payments and Credits: ;[V-i`t? C~~T ,.-'1-I;B.._ . ~ pennsyLvania SCHCDUL~ A DEPAF.TNENT OF ReVENUE ~EAL ESTATE 7NHE0.ITANCE TA7i RETURN RESIDENT DECED:NT ___. . . _ . __ - - _ ESTATE OF FILE NUMBER William R. Shuman 2011-01036 All real property owrred solely or as a tenant in common must be reported at fair market value. Fair mark?t value is defined as the pric: at which property would be exchanged be[ween a willing buyer and a willing sefler, neither bein9 compelled to 6uy or sell, both having reasonable knowledge of the relevant facts. Real property that is jaintly-owned witfi right of survivorship must he disdosed on Schedule F. Attach a mpy of the settlement sheet if the prop2rty has been soid. ITEM Indude a copy of the dzed showing decedent's interest if owned as tenant in common. VALUE AT DATE NUMBER OFDEATH DESCRIPTION 1~ 2112 Orchard Road, Lower Allen 7ownship, Cumbedand County, PA. AIK/A Tax Parcel 190,000.00 13-23-0549-049 $190,000.00 tax assessment times common level ratio of 1.0 equals $190,000.00. Transfer as per specfic bequest to Wiliiam Lee Shuman. TOTA! (Also enter on Line 1, Recapitulation.) ~ 190,000.00 If morz space is needed, insert additional sheets of the sam= size. REV-1507 EX+ t6-98) ~ . . . . SCNEDULE D COMMONWEALTH OF PeNNSn~,aN~a ~ MORTGAGES & NOTES . ~ INHERITANCE TAX RETl1RN RECEIVABLE ~ RESIDENT DECEDENT . . ~ ~ ESTATE OF FILE NUMBER William R. Shuman 2011-01036 All property jointly-owned with right of survivorship must be disclosad on Schedula F. Qf more space is needed, insert addflional sheets of the same s¢e) REV-i5o8 EX+ (i1-io) . . ~ ~ . ~ pennsytvania SCHEDULE E C'! oEPARTMeNT oF aeveNUe CASH~ BANK DEPOSITS & MISC. iNr+eairar~eeTnxReruaN PERSONAL PROPERTY RESIDENT DECEDEM . ESTATE OP: FILE NUMBER: William R. Shuman 2011-01036 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 VAIUE AT DATE NUMBER DESCKIPTION OF DEATH 1. Morgan Stanley Smith Bamey Account 724-75474-12 145,603.86 Owned one-haif. Market Value $145,603.86 divided by 2 equals $72,801.93 2. Morgan Stanley Smith Bamey Account 724-11548-19 313,947.72 Owned one-third. Market Value $313,947.72 divided by 3 equals $104,649.24 3. 2008 Toyota 4 Runner Automobile. Sold to Gaines Auto Sales 19,500.00 4, PNC Account - Checking 24,789.19 TOTAL (Also enter on Line 5, Recapitulation) $ 503,840.77 If more space is needed, use additionai sheetr of paper of the same size. ,•. RE'/-1~11 EX- ~10-09j ~ . ~ pennsylvania '~'~i DEPARTMENTOFREVENUE IfVHERIfANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES AND ADMINISTRATIVE COSTS ESTATE OF FILE NUMBER William R. Shuman 2011-01036 DecedenYs debts must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOIINT A. I FUNERAL EXPENSES: 1' Myers Funeral Home e. ADMINISTRATIVE COSTS: 1. Personal Representative Commissions: Name(s) of Personal Representative(s) Street Address City State ZIP Year(s) Commission Paid: Z• Attomey Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation.) Claimant Street Address ~~N State ZIP Relatlonship of Claimant to Decedent 4• Probate Fees: S. Accountant Fees: 6• Tax Retum Preparer Fees: ~• Advertising in Cumberland Law Joumal s. Advertising in Patriot News s. Deed Preparation, Recording and Notary If more_spaceTs needed, use TOTAL (Also enter on Line 9, Recapitulation) I$ sheets of paper ot the same size. 589.00 2,500.00 323.50 75.00 193.00 3,680.50 . RE~I_15iJE?'+(1Z-Ca) . ~ r~ennsylvania SCHEDULE I °EP^Fr^'ENT oF REVEN~E DEBTS OF DECEDENT, mHeRiTarvice Tax aeruRrv MORTGAGE LIABILITIES & lIENS . RESIDENT DECEDENT ESTATE OF FILE NUMBER William R. Shuman 2011-01036 Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including unreimbursed medical exuenses. tt more space is ne:ded, insert additionai sheets of the same size. .. + REV-1513 EX+ (01-10) ; i~ pennsylvania ~~y DEPAPTMENT OF FEVENIIE INHE0.fTANCE TN( RETURN ~ RESIDENT DECEDENT SCHEDULE ] BENEFICIARIES ESTATE OF; FILE NUMBER: William R. Shuman 2011-0103& RELATIONSHIP TO DECEDEN7 AMOIJNT OR SHARE NUMBER NAME AND ADDRE55 OF PERSON(S) RECEIVING PROPERTY Do Notlist Trustee(s) OF ESTATE I TAXABLE DISTRIBUTIONS [Incfude outright spousal distributions and transfers under Sec. 9116 (a) (1.2),] 1• William L. Shuman Son Rest,residue 206 Creek Road remainder Camp Hill, PA 17011 2. Lorraine C. Hughes Daughter 1/2ofSmithBarney 11 Creek Road Account7247547442 Camp Hill, PA 970i 1 Equaling $156,973.86 ENTER DOLLAR AMOUNTS FOR DISTRIBUT10N5 SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 CAVER SHEET, AS APPROPRIATE, u NON-TAXA8IE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SEC7ION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN: 1. I B. CHARITABLE AND GOVEItNMENTAt DISTRIBt1TI0NS: 1. TOTAL OF PART II- ENTER TOTAL NON-TAXABLE DISTRI6UTIONS ON LINE 13 OF REV-1500 COVER SHEET. +$ If more space is needed, use additional sheets of paper of the same size.