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HomeMy WebLinkAbout10-01-121505607122 REV-1500 EX (06-05) OFFICIAL USE ONLY PA Department of Revenue County Code Year File Number Bureau of Individual Taxes INHERITANCE TAX RETURN I------ - ~ r --- PO BOX 280601 ~ ' ~ ~ ~ i Harrisburg, PA 17128-0601 RESIDENT DECEDENT ~; 2 1 ~ 1~ 2~ ! ~ 0 ~ 2~ 5 ~ 3 ENTER DECEDENT INFORMATION BELOW Social Securit Number Date of Death Date of Birth __ Decedent's Last Name Suffix Decedent's First Name MI !SiH UIE YI -~ ~ ~ {- ( ! ~ i ( ~BIE~T-T"Y' ~_ ~ i - ~ Li (If Applicable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name MI I I w , ~ i ! ~ ; i , i ~ i r s I I I r ~ i ~ i'! I~ ! ~ , I 3 , Spouse's Social Security Number THIS RETURN MUST BE FILED IN DUPLICATE WITH THE _i __~ __~ i ----~ - -, ; ,i ~ i ~ ~ ' REGISTER OF WILLS ~~ FILL IN APPROPRIATE OVALS BELOW • 1. Original Return c~ 2. Supplemental Return ~~ 3. Remainder Return (date of death prior to 12-13-82) c~ 4. Limited Estate c~ 4a. Future Interest Compromise (date o 5. Federal Estate Tax Return Required of death after 12-12-82) • 6. Decedent Died Testate c~ 7. Decedent Maintained a Living Trust p 8. Total Number of Safe Deposit Boxes (Attach Copy of Will) (Attach Copy of Trust) 0 9. Litigation Proceeds Received c~ 10. Spousal Poverty Credit (date of death c~ 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 TO: Name _ -_~ _... i i :W I L~L ~ I ~ ~ E A F ; M (V R I A M K ' ~ Q S '~' ~ aytim eph m r 6 7 1 7 ~ ~~ -: . ' ? _ _; , ~ , -~ _ - ~_ , - _ ~- -! ---~ ! __i -! _ l -I- ~ _~- - ~ - . s~ ... - ; ~ -- - - - . , ` Firm Name (If A livable _ _ ._ _ , ~ I I _ i I ~ I ~ ~ ' ~ "~' ~~:, t _Y~ 1 REGIST ~ iNlz LS USE' NLY ` ~ r ; -_- --- - _ _ - - __- - ~ _ __ ... G : . .. First line of address -. ~ ~ ~ j ~ i i I i ~ , R T I ~ ' f N ! I ~ ~E ~ Y' 4 ~ 19 D ~ R I I ~~ E ~ ' I , ~ _. ~ ~-, ~ .. C~ `. ` ` ~ ~ . ~- -.r- z - ~ = ~~ _ _ - _ _ . _ ._ __ ! ------ ----_ -- - -- --_ - - Second line of address _. _-- - - _ _ .- -- - ---------T___ ___ _ -- _ --- - _ __ ~:. ~, ~ -~- ' .. .-... t ~ ~ i ~ , ~ ; B ' ~ ~ S U I T E ~ ~ i I i ~ ~ ~ ~ l _ - -- -- --- - ---- I ~ - - _ ~ ~ -- -~ ~ ~ DATE FILED City or Post Office State ZIP Code - - _. -~. ! i -- ~ ~ i ~ i ; ~ i ~ 1,1~ _ ~_NI I E C ry I A ~ N~_I_i ~--5'.B__~ ~ R_~_i_ _ _~_ ~- -~ ~-P A l il~?_ _~ (_ 5_L5' _4 ~ 3 ~1_--6 Correspondent's a-mail address: WfkaUfmBtl.WfklaW@COmC2St.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 otherthan the personal representative is based on all information of which preparer has any knowledge. OF PERSf~N RESP~SdJSIBL~ FOR FILING RETURN EXECUTRIX DA 7/~~ ADDRESS 615 HERMAN AVENUE, LEMOYNE, PA 17043 SIGNATURE OF PREPARER OTHER THAN REPRESENT~IVE~-yjj~sJ1 J DATE r it _ ESQ. ADDRESS ~ ~ ~ 940 CENTURY DRIVE, MECHANICSBURG, PA 17055-4 PLEASE USE ORI AL FORM ONLY Side 1 1505607122 1505607122 h~~ J 1505607222 REV-1500 EX Decedent's Social Security Number Decedent's Name: BETTY SHUEY ~20~3~p20~~9~1I 3!9': RECAPITULATION 1. Real estate (Schedule A) 1 ! _ ~ 7 ~ 5 ! 0 ~ 0 I 0 ~•~ 0' 0 ~ ~ ~ ! • I 0 0 ~ < 0 ~ 2. Stocks and Bonds (Schedule B) 2 . ~ -i ~ ~ ~ ~ I ~ 0 ~ 0 ~ i ~ ~ ~ + 0 ~ 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) 3 - • ., _ _ ___ -_ 4. Mortgages & Notes Receivable (Schedule D) 4. , , s ~ s ii ~ ' ~ ! 0 •~ 0 ' 0 - t ~_ _ ._ ~. . 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5.~ I ~ " ! ,G ~ 6 i 2 , 3 i•' 9 ~ 1 I ~_., 6. Jointly Owned Property (Schedule F) o Separate Billing Requested 6. I ~ ; Ii i ~ 8 : 0 ! 3 ~ 8 .' 8 0 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property ~ I , 0 0 0 ~• (Schedule G) o Separate Billing Requested • ; I ! I ~ _ - - -, , , - 8. Total Gross Assets (total Lines 1-7) 8 ` ; ~ ~' ~ 8 ~ 5 ; 6 ` 6 2 ~ 17 1 " ~ ~ I ~ j• 9. Funeral Expenses & Administrative Costs (Schedule H) 9., i ! ~ ~ 1 7 6 ~ 7 5 ~•' 0 ~ 5 h l I biliti & Li S d M Li b f D d 10 i ~ ~~ ~ i I ~ i 1 ~ 2 3 ! 2 7 ,.: 0 ' 6 ; ) ens ( c e u e ent, ortgage a es, 10. De ts o ece . ; ,, ; ~._z.a -_~.a_ _,,.._ 11. Total Deductions (total Lines 9 & 10) 11. ~ I~ ~ , 3 ~ 0-I,~ i_0 j 2 I.! .1 ~ 1 12. Net Value of Estate (Line 8 minus Line 11) 12 • ~ ~ ' ! !I ° 5 ! 5 I ~i 6 ~ 0 ~•' 6 0 _ ,_ _~ ;_~ ~ • 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 13 ` ~ ! ' ~ 0 ~ ~ + 0 an election to tax has not been made (Schedule J) . M •E 14. Net Value Subject to Tax (Line 12 minus Line 13) 14 i s ; i ; , 5 1511_-6 (6 ~ 0 ' ~ 6 ' 0 - ( 'I i TAX COMPUTATION -- SEE INSTRUCTIONS FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, or _ transfers under Sec. 9116 r I ~ ~ ~ i ~ ~ I ~ E 15 ' ~ i f ' ~ ~ ` ~ I ~ I ` . _ . ~ _ _ - ~ ~:_ a- - ~ ( t ~ " 16. Amount of Line 14 taxable 1 I- i I I~ ~ ` I , ~ ~ , ~ ~ ~ at lineal rate X 0.045 ! " ~ ~ ~ ~ 17. Amount of Line 14 taxable ; ~ ~ j i ; ~ ~ ! 17 ! ! + j 0 0 0 • at sibling rate X .12 • ' ?• i i ' ` , 18. Amount of Line 14 taxable ~ ~ ~ ? , , ~ ~ ; I ~ at collateral rate X .15 ! i I ~ ~ ! 'i ' 18• ? i ± ~ ! I I 0 i•i 0 i 0 19. TAX DUE 19. '• i ~ ICiS U ~t!.! f~~' ~ ~- ~--._ ~ t.--- - ----.1.._!_..- . 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT c~ Side 2 I 1505607222 1505607222 L.~ f REV-1500 EX Page 3 Decedent's Complete Address: File Number 211200253 DECEDENT'S NAME BETTY SHUEY DECEDENT'S SOCIAL SECURITY NUMBER 203-20-9139 STREET ADDRESS 1172 KINGSLEY ROAD CITY CAMP HILL STATE PA ZIP 17011 Tax Payments and Credits: 1. Tax Due (Page 2 Line 19) (1) $2,504.73 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount Total Credits (A + B + C) (2) $ 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty Total Interest/Penalty (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) $2,504.73 A. Enter the interest on the tax due. (5A) B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. (5B) $2,504.73 Make Check Payable to: REGISTER OF WILLS, AGENT 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; ^ Q b. retain the right to designate who shall use the property transferred or its income; ^ D c. retain a reversionary interest; or ^ 0 d. receive the promise for life of either payments, benefits or care? ^ Q 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration? ^ Q 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death? ^ D 4• Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation? ^ Q 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)]. 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. F~ZEV-1502EX + (6-98) '+ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE A REAL ESTATE ESTATE OF BETTY SHUEY FILE NUMBER 211200253 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. Real property which is jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH PRINCIPAL RESIDENCE, 1172 KINGSLEY ROAD, CAMP HILL, PA -SEE ATTACHED HUD-1 I $75,000.00 TOTAL (Also enter on line 1, Recapitulation) ~ $75,000.00 (If more space is needed, insert additional sheets of the same size) R'~V-1508 EX ~' (6-98) ~, 4. ~~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY ESTATE OF BETTY SHUEY FILE NUMBER 211200253 InGude the proceeds of litigation and the date the proceeds were received by the estate. All property jointly-owned with the right of survivorship must be disclosed on Schedule F. ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. FEDERAL INCOME TAX REFUND RECEIVABLE -SEE ATTACHED COPY OF 2011 RETURN $346.00 2. CLOTHING, FURNITURE, & MISC. PERSONAL EFFECTS -VALUED AT THRIFT SHOP VALUE 1,000.00 3. REFUND OF PREPAID EXPENSES UPON SALE OF PRINCIPAL RESIDENCE -SEE LINES 407-412 OF ATTACHED HUD-1 1,277.91 TOTAL (Also enter on line 5, Recapitulation) ~ $2,623.91 (If more space is needed, insert additional sheets of the same size) ~EC~~S~ ~ehn N Sruey 6? ~2i12u11 6 Betty L ~hraey 12~24~20ll Form Department of the Treasury-Internal Revenue Service 1040A U.S. Individual Income Tax Return c99) 2011 IRS Use Only-Do not write or staple in this space. Your first name and initial Last name OMB No. 1545-0074 ~ Your social security number John H .J~'C'eC ~~c_C~ ~Cr~sClc[% Shuey 166-20-7269 If a joint return, spouse's first name and initial Last name Spouse's social security number Betty L Shuey ~LC~?G S~-'~=~ 203-20-9139 Home address (number and street). If you have a P.O. box, see instructions. Apt. no. ® Make sure the SSN(s) above 1172 Kings ley Rd . and on line 6c are correct. City, town or post office, state, and ZIP code. If you have a foreign address, also complete spaces below (see instructions). Presidential Election Campaign Camp H 111 PA 17 011 Check here if you, or your spouse if riling jointly, want 53 to go to this fund. Checking Foreign country name Foreign province/county Foreign postal code a box below ~~~ill nol change your tax or refund. ^ You ^ Spouse Filing 1 ^ Single 4 ^ Head of household (with qualifying person). (see instructions.) StatUS 2 ©Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, Check only 3 ^Married filing separately. Enter spouse's SSN above and enter this child's name here. one box. full name here. ® 5 ^ Qualifying widow(er) with dependent child (see instructions) Exemptions 6a x^ Yourself. If someone can claim you as a dependent, do not check Boxes checked on bOX 6a. 6a and 6b 2 b Q Spouse No. of children 6 ho• If more than six dependents, see instructions. on c w lived with you did not live with you due to divorce or separation (see instructions) Dependents on 6c not entered above Add numbers on lines 2 d Total number of exemptions claimed. above- Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2. 7 Attach Form{s) W-2 8a Taxable interest. Attach Schedule B if required. 8a 9 0 . here. Also b Tax-exempt interest. Do not include on line 8a. 8b attach } m F 9a Ordinary dividends. Attach Schedule B if required. 9a s or 1099-R if tax b Qualified dividends (see instructions). 9b was 10 Capital gain distributions (see instructions). 10 withheld. 11 a IRA 11 b Taxable amount ou did not If distributions. 11 a (see instructions). 11 b y get a W-2, see 12a Pensions and 12b Taxable amount instructions. annuities. 12a (see instructions). 12b 16, 033 . Enclose, but do not attach, any 13 Unemployment compensation and Alaska Permanent Fund dividends. 13 payment. Also, please use Form 14a Social security 14b Taxable amount Joao-v. benefits. 14a 3 , 4 5 9 . (see instructions). 14b o . 15 Add lines 7 through 14b (far right column). This is your total income. - 15 16 , 12 3 . Adjusted rOSS 16 Educator expenses (see instructions). 16 g 17 IRA deduction (see instructions). 17 income 18 Student loan interest deduction (see instructions). 18 19 Tuition and fees. Attach Form 8917. 19 c Dependents: (1) First name Last name (2) Dependent's social security number (3) Dependent's relationship to you (a) / if child under age 17 qualifying for child tax credit (see instructions) 20 Add lines 16 through 19. These are your total adjustments. 20 21 Subtract line 20 from line 15. This is your adjusted gross income. - 21 16, 123 . For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see separate Instructions. gqq Form 1040A (2011 } REV 12!01111 TTO Form 1040A (2011) Tax, credits, 22 Enter the amount from line 21 (adjusted gross income). and 23a Check j ^X You were born before January 2, 1947, ^Blind Total boxes a ments If~ l 0 Spouse was born before January 2, 1947, ^ Blind ~ checked - 23a P Y b If you are married filing separately and your spouse itemizes Standard deductions, check here - 23b Page 2 22 16,123. fOeauciron 24 Enter your standard deduction. 24 13 , 9 0 0 . • Peoplewho 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter -0-. 25 2 , 223 . check any box on line 26 Exemptions. Multiply $3,700 by the number on line 6d. 26 7 , 4 0 0 . 23a or 23b or 27 Subtract line 26 from tine 25. If line 26 is more than line 25, enter -0-. who can be claimed as a This is your taxable income. ® 27 0 dependent, see 28 Tax, including any alternative minimum tax (see instructions). 28 0 instructions. 29 Credit for child and dependent care expenses. Attach • All others: e or si Form 2441. 29 ng Married filing 30 Credit for the elderly or the disabled. Attach separately, $5,soo Schedule R. 30 0 . Married filing 31 Education credits from Form 8863, line 23. 31 jointly or Qualifyin g 32 Retirement savings contributions credit. Attach widow(er} , 600 $11 Form 8880. 32 , Head of 33 Child tax credit (see instructions). 33 household, 34 Add lines 29 throu h 33. These are our total credits. g y 34 0 . $s,5oo 35 Subtract line 34 from line 28. If line 34 is more than line 28, enter -0-. This is your total tax. 35 0 . 36 Federal income tax withheld from Forms W-2 and 1099. 36 3 4 6 . 37 2011 estimated tax payments and amount applied If you have a qualifying from 2010 return. 37 'child, attach 38a Earned income credit (EIC). 38a Schedule EIS. b Nontaxable combat pay election. 38b 39 Additional child tax credit. Attach Form 8812. 39 40 American opportunity credit from Form 8863, line 14. 40 41 Add lines 36, 37, 38a, 39, and 40. These are your total payments. ® 41 346 . Refund 42 If line 41 is more than line 35, subtract line 35 from line 41. This is the amount you overpaid. 42 346 . Direct 43a Amount of line 42 you want refunded to you. If Form 8888 is attached, check here - ^ 43a 3 4 6 . deposit? ® Routing - c T e: Checkin Savin s See b X X X X X X X X X yp ~ g^ g instructions number and fill in 43b, 43c, and 43d or Form 8888. ® d Account xxxxxxXxxxxxxxxxx number 44 Amount of line 42 you want applied to your 2012 estimated tax. 44 Amount 45 Amount you owe. Subtract line 41 from line 35. For details on how to pay, you owe see instructions. - 45 46 Estimated tax penalty (see instructions). 46 Third party Do you want to ~Ilow another person to discuss this return with the IRS (see instructions)? ^ Yes. Complete the following. ®No desi nee Designee's L~ ~ ' I ,, ~/) ?~/~ Phone I ~. _ ~; Personal identification g name - (~/ ',`(~~~1.~~L'~~- v na - ~ ~ ~ ~~li f ~ ~ / number (PIN) - Under penalties of perjury, I declare that I have a mined this return and accompanying schedules and statements, and to the best of my knowledge Sign and belief, they are true, correct, and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other here than the taxpayer) is based on all information of which the preparer has any knowledge. Joint return? Your signature Date Your occupation Daytime phone number See page l3. Retired (717) 802-1079 Keep a copy Spouse's signature. If a joint return, both must sign. Date Spouse's occupation If the IRS sent you an Identity Protection for your PIN, enter it records. Retired here (see inst.) Paid Print/type preparer's name Preparer's signature Date Check - ^ if PTIN self-employed preparer Firm's EIN - Firm'sname- SELF PREPARED use only Firm's address - Phone no. REV 1tio1n1 no Form 1040A (2011) REV-1509 EX +`(6-98) ~~ ®_~~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE F JOINTLY-OWNED PROPERTY ESTATE OF BETTY SHUEY FILE NUMBER 211200253 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 ADDRESS RELATIONSHIP TO DECEDENT A. BRENDA L. SWANGER 615 HERMAN AVENUE DAUGHTER LEMOYNE, PA 17043 B C JOINTLY-OWNED PROPERTY: 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 DECEDENT'S INTEREST 1. A. 02/12 M & T BANK CHECKING ACCOUNT, ACCOUNT # 78236584 -SEE ATTACHED $8,038.80 100% $8,038.80 STATEMENT TOTAL (Also enter on line 6, Recapitulation) I $8,038.80 (If more space is needed, insert additional sheets of the same size) Q MBTBank ACCOUNT N0. ACCOUNT TYPE 78236584 RELATIONSHIP CHECKING WITH INTEREST 00 0 06113M NM 017 BETTY L SHUEY BRENDA L SWANGER 1172 KINGSLEY RD CAMP HILL PA 17011-6110 INTEREST EARNED FOR STATEMENT PERIOD INTEREST PAID YEAR TO DATE 0.07 0.06 Z~C-'C''(1TTATT CTTMMZ~RV STATEMENT PERIOD PAGE DEC.24-JAN.25,2012 1 OF 2 HIGHLAND PARK BEGINNING BALANCE DEPOSITS & OTHER ADDITIONS CHECKS PAID OTHER SUBTRACTIONS CURRENT INTEREST PD ENDING BALANCE N0. AMOUNT N0. AMOUNT N0. AMOUNT 8,733.43 3 7,705.33 1 1,254.79 18 11,212.22 0.07 3,971.82 Z1("'(''(1TTTTT Z~f''TTZTTTV POSTING DATE. _:. :TRANSACTION DESCRIPTION.: :: DEQOSITS,INTEREST &.OTHER:ADDITIONS CHECKS &.OTHER SUBTRACTIONS DAILY BALANCE 12-24-11 BEGINNING BALANCE $8,733.43 12-28-11 WEB PMT Alert 195.78 12-28-11 WEB PMT Cumberland Goodwill Fire 173.45 12-28-11 WEB PMT UGI Utilities, Inc °3.00 12-28-11 WEB PMT PPL Electric Utilities 69.35 12-28-11 WEB PMT Verizon 44.58 12-28-11 WEB PMT Verizon 22.17 8,135.10 12-29-11 UGI HVAC SERVICES, 610-796-347.9p p 96.30 ~r 8038._-8"0:~ ~ 01-03-12 ~ US TREASURY 312 XXCIV SERV ~~v 1`-~-v' ~ 1, 246.82 01-03-12 US TREASURY 303 XXSOC SEC ~ ~ `~~ 184.00 01-03-12 BON-TON-CAMP-HILL #003CAMP HILL (~~?~Y,~ `Kf'~ 57.20 9, 412.42 O1-OS-12 CHECK NUMBER 3114 ~ y ~t~,k 8, 157.63 01-10-12 REVERSE DIRECT DEPOSIT T-'24'6 82 - ,,D ~~ ~ ~~ 184 00 01-10-12 . / REVERSE DIRECT DEPOSIT t~ ! ' . 01-10-12 ~cs ~~,~ h,~ u -. WEB PMT The Hartford I 230.36 01-10-12 WEB PMT Lower Allen Township 223.30 01-10-12 WEB PMT UGI Utilities, Inc 164.18 01-10-12 WEB PMT Verizon ~ ~ 22.68 01-10-12 ~~ WEB PMT Jackson Siegelbaum Gastr ~; 5.06 6,081.23 01-11-12 DEPOSIT ~~ ~jit.~ 6,274.51 12,355.74 01-18-12 !~Jj WEB PMT Parthemore Funeral Home~~(LZh.e.X. 8,329.00 01-18-12 WEB PMT PPL, Electric Utilities 28.80 01-18-12 WEB PMT PA American Water 26.19 3,971.75 01-25-12 INTEREST PAYMENT 0.07 3,971.82 ENDING BALANCE $3,971.82 CHECKS PAID SUMMARY 15738 3114 01-05-12 1,254.79 REV-1511 EX + (10-06) r ~ '~ COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUNERAL EXPENSES & ADMINISTRATIVE COSTS ESTATE OF BETTY SHUEY FILE NUMBER 211200253 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION AMOUNT A. FUNERAL EXPENSES: 1. PARTHEMORE FUNERAL HOME & CREMATION SERVICES, INC. -SEE ATTACHED INVOICE $9,583.79 2. BON-TON DEPARTMENT STORE -PURCHASE OF BURIAL CLOTHES 57.20 B 1 2 3 4. ADMINISTRATIVE COSTS: Personal Representative's Commissions Name of Personal Representative (s) Street Address City State Zip Year(s) Commission Paid: Attorney Fees Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent Probate Fees CUMBERLAND COUNTY REGISTER OF WILLS 5. I Accountant's Fees 6. ~ Tax Return Preparer's Fees 3,000.00 288.50 7. EXPENSES OF SALE - 1172 KINGSLEY ROAD -SEE LINES 1110-1204 OF ATTACHED HUD-1 895.00 8. REAL ESTATE TAXES, 1172 KINGSLEY ROAD -PAID BOTH BY EXECUTRIX & AT SETTLEMT 1,839.50 9. HOMEOWNER'S INSURANCE -THE HARTFORD - 1172 KINGSLEY ROAD -PAID 1 /10/12 230.36 10. HOMEOWNER'S INSURANCE -THE HARTFORD - 1172 KINGSLEY ROAD -PAID 3/13/12 52.84 11. HOMEOWNER'S INSURANCE -THE HARTFORD - 1172 KINGSLEY ROAD -PAID 4/16112 123.40 12. HOMEOWNER'S INSURANCE -THE HARTFORD -1172 KINGSLEY ROAD -PAID 6/18/12 52.04 13. HOMEOWNER'S INSURANCE -THE HARTFORD - 1172 KINGSLEY ROAD -PAID 7/24/12 52.04 14. SEWER & TRASH -LOWER ALLEN TOWNSHIP -PAID 1/10/12 223.30 15. SEWER & TRASH -LOWER ALLEN TOWNSHIP -PAID 4/18/12 234.20 16. TOTAL PER CONTINUATION PAGE FOR SCHEDULE H 1,042.88 TOTAL (Also enter on line 9, Recapitulation) $17,675.05 If more space is needed, insert additional sheets of the same size) `~ ~ ~ /~ A Family Tradition ®f Caring' A Fu Mrs. Brenda L. Sw er 615 Herman Avenu Lemoyne, PA 17043 1303 Bridge Street P.O. Box 431 New Cumberland, PA 17070 (717j774-7721 (Fax)774->j46 w~rw.parthemore.com Gilbert W. Parthemore, Founder Gilbert J. Parthemore, Supervisor Stephen IC. Parthemore, CFSP Bruce R. Parthemore, Pre-Need Coordinator, CPC Professio~lal Memberships: NFDA ~ PFDA DCFDA ~ CCFDA fnbmarinrd Ordrr ~yrM C7C~°?~LDEN ULE Tl~e Rule You Knorr. The People }cur Tivs~ ;~-=~-~ , -~-~ ~. ~;~~i i ° ~ ,~; ~. 0 __ For the Service of Betty L. Shuey e ~ Crern.a.ti®n Service~9 Inc. 1/3/2012 We sincerely appreciate the confidence you have placed in us and will continue to assist you in every way we can. Please feel free to contact us if you have any questions in regard to this statement. The following is an itemized statement of the services, facilities, automotive equipment and merchandise that you selected when making the funeral arrangements. Terms Due Date Account # Net 30 2/2/2012 2011086.0 Description Amount SERVICES & MERCHANDISE Traditional Funeral Service 6,195.00 Shepherd Stationery Set 135.00 20 Gauge Steel Casket, Burgundy/Silver 1,999.00 Total Services and Merchandise 8,329.00 CASH ADVANCE ITEMS Death Notice, Harrisburg Patriot 380.72 10 Certified Copies of Death Certificate 60.00 Hairdresser 40.00 Clergy Honorarium 200.00 Organist Honorarium 125.00 Soloist Honorarium 75.00 Flowers, Casket Spray 159.00 Flowers, Easel Spray 63.54 Flowers, Easel Spray 151.53 Total Cash Advances 1,24.79 D ~~,a, \ ~ v~ Total $9,583.79 PaymentslCredits $-9,583.79 balance Due $0.00 RcV-1512 EX k (12-03) ~._`~ ~~;~~, SCHEDULE COMMONWEALTH OF PENNSYLVANIA DEBTS OF DECEDENT, INHERITANCE TAX RETURN RESIDENT DECEDENT MORTGAGE LIABILITIES, & LIENS ESTATE OF BETTY SHUEY FILE NUMBER 211200253 Resort debts incurred by the decedent prior to death which remained unpaid as of the date of death, include unreimbursed medical expenses. (Ii more space Is neeaea, ms~i ~ auunwi iai of i~aw vi a is jai ~ is a~~c~ A~ 1 AV/ 1A_ 1 _ ti d' 0 `~`^ ~J 0 0 0 0 0 0 N I O +•• u~0 c , o' ~ I~ ~ ~ V l ,~ t ~ T i Al (. t•~. I i ~ ~.~ ~. w~. W++ ^... o --__- ~ `~-' ^ ~ ~' = ti ~'~ . ~, tO-L !fl V__-~I -- __..i ~' N~. {i __:.:......:._.I ~.-__ 1 `~ ;' c 0 a .~, ~ rn; ~ p; I " ~ c~ 0 u.. a~ U C t9 tB lb ti ai i~ V tiJ W U Q J Oa0 H O /~W~y'~ tL Z Z O U M Q 00 W Z UJ I- 2 Z fn W ~ m Z w 0 t1J O a ~ Z ~_ U _J ~ U ~ tai U ~~ - pennsylvan~a _~ DEPARTMENT OF PUBLIC WELFARE June 1, 2012 BRENDA SWANGER 615 HERMAN AVE LEMOYNE PA 17043 Re: Betty Shuey CIS # : 990808153 SSN: ###-##-9139 Gate of ueati~ : i ~/2y/2U 11 Dear Ms. Swanger: Please be advised that the Department of Public Welfare is attempting to recover the monetary value of any and all eligible assets in the subject estate. Although the amount in the estate may be considerably less than that which is owed to the Department, our claim is against the estate, no one else. Your responsibilities, as the primary next of kin/administrator/executor, is to advise the Department of any assets in the estate and to insure that the remaining money, after all funeral and administrative costs are deducted, is sent to the Department. The Department of Public Welfare maintains a claim in the amount of $7,492.29 against the above-mentioned estate. This claim is for restitution of medical assistance granted on behalf of the decedent for which the Probate Estate is now responsible to reimburse the Department according to Act 49, 62 P.S. 1412, effective August 15, 1994, as amended by Act 20-95, effective June 30, 1995. Enclosed is the Department's itemized statement of claim. A portion of this medical expense, namely $7,492.29, was incurred during the last six months of the decedent's life; therefore, it is a Class 3 claim pursuant to Section 3392 of the Decedents, Estates, and Fiduciaries Code, 20 Pa. C.S.A. 3392(3). The balance of the claim, namely ~, is to be entered as a priority Class 5.1 claim against the estate. Please acknowledge receipt of this letter and advise when payment may be expected. If the estate accounting is complete, please provide a copy. If the estate contains real estate, please provide copies of the deed, the latest tax assessment and a current appraisal, if available. ~ <; 7 G' c; ~~. ,!~t'C ~. l~ Sincerely, ~- j - Karen H. Peterson Claims Investigation Agent 717-772-6615 717-772-6553 FAX Enclosure Bureau of Program Integrity ~ Division of Thlyd Party Llabllity ~ Recovery Section PO Box 8486 ~ Harrisburg, Pennsylvania 17105-8486 REV-1513 EX + (9-00) ,~~~, SCHEDULE J COMMONWEALTH OF PENNSYLVANIA BENEFICIARIES INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF BETTY SHUEY FILE NUMBER 211200253 RELATIONSHIP TO DECEDENT aMOUrrrORSHaRE NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY Do Not List Trustee(s) aF6rATE TAXABLE DISTRIBUTIONS [include outright spousal distributions, and I transfers under Sec. 9116 (a) (1.2)] 1. BRENDA L. SWANGER DAUGHTER 25% 615 HERMAN AVENUE, LEMOYNE, PA 17043 2. JOHN R. SHUEY SON 25% 1209 MONTROSE CIRCLE, MECHANICSBURG, PA 17050 3. SUSANNE M. SHUMATE DAUGHTER 25% 406 SPRING HOUSE ROAD, CAMP HILL, PA 17011 4. TODD A. SHUEY SON 25% 510 W. KELLER STREET, MECHANICSBURG, PA 17055 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THR OUGH 18, AS APPROPRIATE, ON REV-1500 COVER SHEET II. NON-TAXABLE DISTRIBUTIONS: A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT BEING MADE 1. B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. TOTAL OF PART 0 -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET I $ 0.00 (If more space is needed, insert additional sheets of the same size) 4 CONTINUATION PAGE SCHEDULE _H__ ESTATE OF BETTY SHUEY FILE NUMBER 211200253 ITEM VALUE AT DATE NUMBER DESCRIPTION OF DEATH 1. GAS HEAT - 1172 KINGSLEY ROAD -UGI -PAID 1/10/12 $164.18 2. GAS HEAT - 1172 KINGSLEY ROAD -UGI -PAID 2/9/12 77.99 3. GAS HEAT - 1172 KINGSLEY ROAD -UGI -PAID 3/9/12 80.00 4. GAS HEAT - 1172 KINGSLEY ROAD -UGI -PAID 4/16/12 30.00 5. GAS HEAT - 1172 KINGSLEY ROAD -UGI -PAID 5/15/12 30.00 6. GAS HEAT - 1172 KINGSLEY ROAD -UGI -PAID 6/18/12 30.00 7. GAS HEAT - 1172 KINGSLEY ROAD -UGI -PAID 7/24/12 10.13 8. TELEPHONE - 1172 KINGSLEY ROAD - VERIZON -PAID 1/10/12 22.68 9. ELECTRICITY - 1172 KINGSLEY ROAD - PP ~ L -PAID 1/18/12 28.80 10. ELECTRICITY - 1172 KINGSLEY ROAD - PP ~ L -PAID 2/17/12 20.44 11. ELECTRICITY - 1172 KINGSLEY ROAD - PP & L -PAID 4/15/12 67.16 12. ELECTRICITY - 1172 KINGSLEY ROAD - PP 8 L -PAID 5/15/12 59.56 13. ELECTRICITY - 1172 KINGSLEY ROAD - PP & L -PAID 6/4/12 44.93 14. ELECTRICITY - 1172 KINGSLEY ROAD - PP & L -PAID 7/24/12 20.96 15. WATER - 1172 KINGSLEY ROAD - PA AMERICAN WATER CO. -PAID 1/18/12 26.19 16. WATER - 1172 KINGSLEY ROAD - PA AMERICAN WATER CO. -PAID 2!17/12 28.25 17. WATER - 1172 KINGSLEY ROAD - PA AMERICAN WATER CO. -PAID 3/13/12 30.07 18. WATER - 1172 KINGSLEY ROAD - PA AMERICAN WATER CO. -PAID 6/18/12 89.23 19. WATER - 1172 KINGSLEY ROAD - PA AMERICAN WATER CO. -PAID 7/24/12 17.63 20. WATER - 1172 KINGSLEY ROAD - PA AMERICAN WATER CO. -PAID 9/6/12 59.68 21. LAWN MOWING -1172 KINGSLEY ROAD -JEFF LAUER LAWN SERVICES -PAID 35.00 22. LAWN MOWING -1172 KINGSLEY ROAD -JEFF LAUER LAWN SERVICES -PAID 35.00 23. LAWN MOWING - 1172 KINGSLEY ROAD -JEFF LAUER LAWN SERVICES -PAID 35.00 TOTAL I $1, 042.88 OMB Approval No. 2502-0265 ~~~~~~ ~ A. Settlement Statement (HUD-1) B. T pe of Loan 6. File Number 7. Loan Number: 8. Mortgage Insurance Case Number: 1 . Q FHA 2. Q RHS 3. Q Conv. Unins. LAW-Shreffler- CASH DEAL 4. ~ VA 5. ~ Conv. Ins. A06143826 C. Note: This form is furnished 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. D. Name & Address of Borrower: E. Name & Address of Seller: F. Name & Address of Lender: Michael R. Shreffler Estate of Beity L. Shuey, Brenda L. Swager, 418 Lewisbeny Road Executrix New Cumberland, PA 17070 615 Herman Avenue Lemoyne, PA 17043 G. Property Location: 1172 Kingsley Road Camp Hill, PA 17011 Cumberland County H. Settlement Agent: Dethlefs-Pykosh Law Group, LLC, Darrell C. Dethlefs Phone Number: 717-975-9446 2132 Market Street Camp Hill, PA 17011 Place of Settlement: 2132 Market Street, Camp Hill, PA 17011 I. Settlement Date: 08/31 /2012 Disbursement Date:08/31/2012 J Summary of Borrower's Transaction K. Summary of Seller's Transaction .__ ... ...-._ ~__~ r,____..._.. dnn (.`.rnec Amnnnf r)up TA Seller 101. Contract sales rice 75 000.00 401. Contract sales rice 75 000.00 102. Personal ro ert 402. Personal ro ert 103. Settlement char es to borrower line 1400 1 909.50 403. 104 404. 105. 405. Adjustments for items aid b seller in advance Adjustments for items aid b seller in advance 106. Cit /town taxes to 406. Cit /town taxes to 107. Count taxes 08 31 2012 to 12 3I 2012 202.27 407. County taxes 08 31 2012 to 12 31 2012 202.27 108. Assessments 08 31 2012 tO 06 30 2013 1 023.82 408. Assessments 08 31 2012 t0 06 30 2013 Z 023.82 109. 17.93 409. I7. 93 110. 17.59 410. 17.59 111. 411. 112. 16.30 412•. 16.30 120. Gross Amount Due From Borrower $78, 187.41 420. Gross Amount Due To Seller 576, 277.91 - - - - _ _ ._ -.. rnn o.-al....a:...... 1.. A..~..•.....• ~l..r~ Tn Cnllnr LUU. NInUUIII`.i rd1U o vl 111 oallall vl uvllv.. c. 201. De osit or earnest money 52, 000.00 ---• --------- - --- 501. Excess deposit (see instructions) 202. Principal amount of new loan(s) 502. Settlement charges to seller (line 1400) 52,.942.22 203. Existing loan(s) taken subject to 503. Existing loan(s) taken subject to 204. 504. Payoff of first mortgage loan 205. 505. Payoff of second mortgage loan 206. 506. 207. 507. 208. 508. 209. 509. Adjustments for items unpaid b seller Adjustments for items unpaid b seller 210. City/town taxes to 510. City/town taxes to 211. Count taxes tO 517. Coun taxes to 212. Assessments to 512. Assessments to 213. 513. 214. 514. 215. 515. 216. 516. 217. - 517. 218. .518. 219. 519. 220. Total Paid B /For Borrower 52, 000.00 520. Total Reduction Amount Due Seller $2, 942.22 avv. ~.aall /1l ~7clllGlllclll r Ivllu 1 v uv~~v..~. 301. Gross amount due from borrower (line 120) 78 187.41 ---' ----- - -- ---- - - 601. Gross amount due to seller (line 420) 576, 277.91 302. Less amounts paid b /for borrower (line 220) ( 2 000.00 ) 602. Less reductions in amt. due seller (line 520) 52, 942.22 303. Cash l:s~ From ~~ To Borrower 576,187.41 603. Cash ~~ To ~~ From Seller 573, 335.69 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 ismandatory. 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 L. Settlement Charges 700. Total Real Estate Broker Fees Paid From Paid From Division of Commission line 700 as follows: Borrower's Sellers Funds at Funds at 701. $ to Settlement Settlement 704. ( P.O.C. by 1 800. Items Pa able rn ~:onnecuon vvrtn wan 801. Our origination char e $ (from GFE #1) 802. Your credit or char e ( oints) for the s ecific interest rate chosen $ (from GFE #2) 803. Your adjusted origination charges (from GFE A) $0.00 804. Appraisal fee to ( P.O.C. by ~ (from GFE #3) 805. Credit re ort to ( P.O.C. by ~ (from GFE #3) 806. Tax service to ( P.O.C. by ~ (from GFE #3) 807. Flood certification ( P.O.C. by ) (from GFE #3) 808. 809. 810. 811. 812. 900. Items Re wired B Lender To Be Paid In Advance 901. Daily interest charges from to @$ /day (from GFE #10) 902. Mortgage Insurance Premium for months. (from GFE #3) to 903. Homeowner's insurance for years. (from GFE #11) to 904. ears. to 905. IVVV. ~~cacl~ca vcMv •• •• •. ••~-~• 1001. Initial deposit for your escrow account (from GFE #9) 1002. Homeowner's insurance months @$ per month $ 1003. Mortgage insurance months @$ per month $ 1004. Property taxes months @$ per month $ 1005. months @$ per month $ 1006. months @$ per month $ 1007. Aggregate Adjustment -$ 0.00 1 IVV. 1IlIC a.•1101 ca 1101. Title services and lender's title insurance (from GFE #4) $105.00 1102. Settlement or closin fee $ 1103. Owner's title insurance (from GFE #5) $762.50 1104. Lender's title insurance $ 1105. Lender's title policy limit $ 1106. Owner's title policy limit $ 75, 000.00 1107. Agents ortion of the total title insurance premium D-P Law Group, LLC $ 648.12 1108. Underwriter's ortion of the total title insurance premium security Title $ 114.38 1109. Sale 1110. Notary Fee to Darrell C. Dethlefs $5.00 $10.00 1111, Tax Certification Reimbursment Fee to D-P Law Group, LLC $10.00 1112. Tax Certification Rush Retrieval Fee to D-P Law Group, .LLC $100.00 1113. Deed Prep. Fee to William R. Kaufman, Esquire $125.00 1114. 1115. __ ILV V. VVVCI I~~~~ri~~a ~ 1201. Government recording charges: (from GFE #7) $62.00 1202. Deed $ 62.00 ;Mortgage $ ;Releases $ 1203. Transfer taxes (from GFE #8) $750.00 $750.00 1204. Ci /Count tax/stam s: Deed $ 750.00 Mortgage $ 1205. State tax/stamps: Deed $ 750.00 Mortgage $ 1206. $ 1207. $ 1208. $ 1209. $ IJVV. ~'aVV1a1V1~G~1 Vcaa~4~~••..••a v 1301. Required services that you can shop for (from GFE #6) 1302. $ 1303. $ 1304. 1305. 1306. Legal Fee(s) to William R. Kaufman, Esquire $1,225.00 1307. 2012 / 2013 School Taxe (2nd & 3rd Installments) to Bonnie K. Mil $822.22 1308. D-P Law Group Invoices (#8666, 8685 & 8722) $230.00 1309. 1400. Total Settlement Charges (enter on lines 103, Section J and 502, Section K) $1, 909.50 $2, 992.22 Previous editions are obsolete Page 2 of 3 HUD-1 Certification (continued from HUD-1) I have carefully reviewed the HUD-1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. I further certify that I have received a copy of the HUD-1 Settlement Statement. Seller or Borrower: ~~--~~ Date: ~ Z ~/ ~ Agent: Michael R. Shre 418 Lewisberry Road New Cumberland, PA 17070 ~~ ,/ '~iJG,c~; Date: ~'31- la Brenda L. Swager, ecutrix Estate of Betty L. Shuey 615 Herman Avenue Lemoyne, PA 17043 The HUD-1 Settlement which I have prepared is a true and accurate account of this action. I have caused or will cause the funds to be disbursed 'in accordance with this statement. Date: Settlement Agent: Date: Darrell C. Dethlefs 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. LAST WILL AND TESTAMENT OF BETTY L. SHUEY I, BETTY L. SHUEY, of Lower Allen Township, Cumberland County, Pennsylvania, make, publish and declare this as and for my Last Will and Testament, hereby revoking all other wills and Codicils heretofore made by me. ITEM I: I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, unto my husband, JOHN H. SHUEY, provided he survives me by sixty (60) days. ITEM II: Should my husband, JOHN H. SHUEY, predecease me or die on or before the sixty-first (61st) day following my death, I devise and bequeath all the rest, residue and remainder of my estate of whatever nature and wherever situate, including any property over which I hold power of appointment and together with any insurance policies thereon, in equal shares, to my children, BRENDA L. SWANGER, JOHN R. SHUEY, SUSANNE M. SHUMATE, and TODD A. SHUEY, provided that should any of my children predecease me, I give and bequeath such child's share unto his or her issue per stirpes by representation, and if there be a failure of same, then I give and bequeath such deceased child's share to my surviving children as provided herein. ITEM III: In addition to all powers granted to them by law and by other provisions of this Wili, I give the fiduciaries acting hereunder the following powers, applicable to all property, exercisable without court approval and effective until actual distribution of all property: A. To sell at public or private sale, or to lease, for any period of time, any real or personal property and to give options for sales, exchanges or leases, for such prices and upon such terms (including credit, with or without security) or conditions as are deemed proper. This includes the power to give legally sufficient instruments for transfer of the property and to receive the proceeds of any disposition of it. B. To partition, subdivide, or improve real estate and to enter into agreements concerning the partition, subdivision, improvement, zoning or management of real estate and to impose or extinguish restrictions on real estate. C. To compromise any claim or controversy and to abandon any property which is of little or no value. D. To invest in all forms of property, including stocks, common trust funds and mortgage investment funds, without restriction to investments authorized for 1 of 5 Pennsylvania fiduciaries, as are deemed proper, without regard to any principle of diversification, risk or productivity. E. To exercise any option, right or privilege granted in insurance policies or in other investments. F. To exercise any election or privilege given by the Federal and other tax laws, including, but not necessarily being limited to, personal income, gift and estate or inheritance tax laws. G. To make distributions to my herein named beneficiaries in cash or in kind or partly in each. H. To borrow money from themselves or others in order to pay debts, taxes, or estate or trust administration expenses, to protect or improve any property held under my will, and for investment purposes. I. To select a mode of payment under any qualified retirement plan (pension plan, profit sharing plan, employee stock ownership plan, or any other type of qualified plan) to the extent the plan or the law permits them to do so, and to exercise any other rights which they may have under the plan, in whatever manner they consider advisable. ITEM IV : I direct that all inheritance, estate, transfer, succession and death taxes, of any kind whatsoever, which may be payable by reason of my death, whether or not with respect to property passing under this Will, shall be paid out of the principal of my residuary estate. ITEM V : All interests hereunder, whether principal or income, which are undistributed and in the possession of the fiduciaries acting hereunder, even though vested or distributable, shall not be subject to attachment, execution or sequestration for any debt, contract, obligation or liability of any beneficiary, and furthermore, shall not be subject to pledge, assignment, conveyance or anticipation. ITEM VI: I nominate and appoint my husband, JOHN H. SHUEY, Executor of this, my Last Will and Testament. In the event of the death, resignation or inability to serve for any reason whatsoever of the said JOHN H. SHUEY, I nominate and appoint my daughter, BRENDA L. SWANGER, Executrix of this, my Last Will and Testament. I direct that my Executor or Executrix, as the case may be, and their successors, shall not be required to post security or a bond for the performance of their duties in any jurisdiction. 2of5 IN WITNESS WHE 4F, I have her unto set my hand and seal to this, my Last Will and Testament this ~ da of ~ 2010. ~_ Y f' ~ 'a2~ ~ • /~~ ~ (SEAL) BETTY L. S EY We, the undersigned, hereby certify that the foregoing Will was signed, sealed, published and declared by the above-named Testator as and for her Last Will and Testament, in the presence of us, who, at her request and in her presence and in the presence of each other, have hereunto set our hands and seals the day and year above written, and we certify that at the time of the execution thereof, the said Testator was of sound and disposing mind and memory. (moo C;~(SEAL) Residing at: ~ ~ ~ ~ ~~~ ~i¢ I7o// (SEAL) Residing at: .~~~ n,~:/A t/f i ~/~ 3 of 5 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss We, Betty L. Shuey, N'~' ~ ~`( ~ . CR a cK ~~`T ,and i2 ~• C:~~~ki=Y the Testatrix and the Witnesses, respectively, whose names are signed to th attached or foregoing instrument, being first duly sworn, do hereby declare to the undersigned authority that the Testatrix signed and executed the instrument as her Last Will, that she signed it willingly, and that she executed it as her free and voluntary act for the purposes therein expressed, and that each of the Witnesses in the presence and hearing of the Testatrix signed the Will as a Witness and that to the best of their knowledge the Testatrix was at that time eighteen (18) years of age or older, of sound mind and under no constraint or undue influence. ''l .~ ~, ~ Testatrix l.~i o C.VC~ Witness Witness Sworn to, acknowledged and subscribed before me by Betty L. Shuey, the Testatrix, and sworn to and subscribed befo~r~ehme by ~v4~v~y ~, ~ c2o ~I~~Yr and r,~cti ~ ~/1 ur_.~=r ,the Witnesses, this ~_ day of (7 , A.D., 2010. Attorney, Member, ar of Pennsylvania 4of5 COMMONWEALTH OF PENNSYLVANIA COUNTY OF CUMBERLAND ss I, William R. Kaufman, certify that the foregoing acknowledgement and affidavit was made before me. orney On this, the ~g~ day of ~~~f , 2010 before me, the undersigned officer, personally appeared William R. Kaufman, known to me or satisfactorily proven to be a member of the bar of the highest court of the Commonwealth of Pennsylvania and certie ied that he was personally present when the foregoing acknowledgement and affidavit we signed by the Testatrix and witnesses. WITNESS my hand and notarial seal the day and year aforesaid. Notary ublic COMMONWEALTH OF PENNSYLVANIA NOTARIAL SEAL pATRICIA A. BENDER, Notary Public East Pennsboro Twp., Cumberland County V 'ssion.Expires September 19, 2011 5 of 5 b ~ C J ~ ~ ~ w ~ c~ (~`''C~~ ~ n ~ ~ •.-. o ~ ~ . ~~~ ~~ ~~ a~ ~~ ~~ o~ ~ ~ . W~~ ~, CD C~ ~ o ~ ~ -..., r' i. ~,~. 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