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HomeMy WebLinkAbout04-0952 PETITION FOR PROBATE and GRANT OF LETTERS Estate of Mary Ann R. Shughart NO. ~t-04-q~5~).~ also known as To: Register of Wills for the County of Cumberland in the Commonwealth of Pennsylvania · Deceased. SocialSecurityNo. 180-01-3567 The petition of the undersigned respectfully represents that: Your petitioner(s), who is/are 18 years of age or older an the execut o r ~ in the last wilt of the above decedent, dated December 29, 2003 and codicil(s) dated named (state relevant circumstances, e.g. renunciation, death of executor, etc.) Decendent was domiciled at death in Cumber land County, Pennsylvania, with her last family or principal residence at 271 South College Carlisle. PA 17013 - (list street, number and muncipality) Decendent, then 87 years of age, died October !7. ?NN4 ,x~ , at Sarah Todd Memorial Home, 1000 West Soutl~ Street. C:~rl~l,., PA 17013 Except as follows, decedent did not marry, was not divorced and did not have a child born or adopted after execution of the will offered for probate; was not the victim of a killing and was never adjudicated incompetent: Decendent at death owned property with estimated values as follows: (1 f domiciled in Pa.) All personal property $ 1,000.00 (If not domiciled in Pa.) Personal property in Pennsylvania $ (If not domiciled in Pa.) Personal property in County $ Value of real estate in~Ee, nnsylvanigt $. 4 9,0 0 0.0 0 situated as follows:~/l South College Street Carlisle, PA 17013 WHEREFORE, petitioner(s) respectfully request(s) the vrobate of the last will a--n~ codicil(s) presented herewith and the grant of letters t ~ s t a m~ n t a r y ~o theron. 25 Rolling Drive Carlisle, PA 17013 ro (testamentary; administration c.t.a.;.achninistration d.b.n.c.t.a.) C-~'B ar bara ~rake 2366 North Quincy Arlington, VA 22207-5112 OATH OF PERSONAL REPRESENTATIVE COMMONWEALTH OF PENNSYLVANIA 3 COUNTY OF CUMBERLAND ; 88 The petitioner(s) above-named swear(s) or affirm(s) that the statements in the foregoing petition are true and correct to the best of the knowledge and belief of petitioner(s) and that as personal represen- tative(s) of the above decedent petitioner(s) will well and truly admin~ter~..AOn~estate according to law. Sworn to or aff~rm~e&and subscribed ~- ./~"A-~/~ ~x bet&re.me this *~. day of [ I/D~ ;~ ~h,~.~J~/..~ ~ ~ ~.~-Register(~-- ~a~rbara S. I5.r_~a4c~ - -- ~ Estate Of M^~v AMN I~ g51TTO51A'RT , Deceased DECREE OF PROBATE AND GRANT OF LETTERS AND NOW C'~d'~e the reverse side hereof, satisfactory proof having been presented before me, IT IS DECREED that the instrument(s) dated described therein be admitted to nrobate~and filed of record as the last will of and Letters Te~amentar¥ are hereby granted to ~ o~. CI.~L ~ , in consideration of the petition on Dale F. Shughart, Jr. and Barbara S. Drake FEES Probate, Letters, Etc .......... Short Certificates( ) .......... Renunciation ................ ~O..P TOTAL Filed . .~ 7.~ ~ .~ Register of Wills ~ ~. Dale F. Shughart~ Jr. ATTORNEY (Sup. Ct. I.D. No.) 19373 35 East High Street, Suite 203, ADDRESS.Carlisle, ~A 17013 (717) 241-4311 PHONE I]is is to certify that the infi, rmation here givcn is correctly copied from an original certificate of death duly filed with me as I.oca] Registrar. The original certificate will be forwarded to the State Vital Records Office for permanent filing. WARNING: It ia illogal to duplieato this copy by photostat or photograph. Fee fbr this certificate, $2.00 P 10783271 No. Local Registrar OCT 2 0 200 Date COMMONWEALTH OF PENNSYLVANIA · DEPARTMENT OF HEALTH · VITAL RECORDS CERTIFICATE OF DEATH 2. Female ~. 180- 01 -- 3567 ~ Oct. 17~ 2004 271 South College St. Carlisle, PA 17013 Michael Ratway r.18,1917 ?William. Penn, DATE OF DISPOSITION [] 014819 L 17013 219 N. Hanover St., Car]~a],, PA 17013 LAST WILl, AND TF~STAMF~NT I, MARY ANN R. SHUGHART, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any Will or Codicil previously made by me. ITEM I: I direct that all my just debts (except as may be barred by a Statute of Limitations) and my funeral expenses (including my gravemarker and expenses of my last illness) shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I give and bequeath all my tangible personal pro~, in ~e~ding b~.u.~.~ot limited to, any and all automobiles and other motor vehicles, household goods a~fumi~and furnishings; china, silverware, jewelry, ornaments, works of art, books pictures, ~aring apparel and personal effects, but excluding cash on hand and tangible evidences of int~ble personal property together with any policies of insurance applicable thereto including any prepaid premiums thereon to such of my children DALE F. SHUGHART, JR. and BARBARA S. DRAKE, as shall survive me, in as nearly equal shares as is practicable. ITEM III: I devise and bequeath the residue of my estate of every nature and wherever situate in equal shares (per stirpes) to each of my children, DALE F. SHUGHART, JR. and BARBARA S. DRAKE, as shall survive me by thirty (30) days. ITEM IV: In the event that both of my children should predecease me or die on or before the thirtieth day following my death, and should I not be survived by issue, then I devise and bequeath the residue of my estate of every nature and whenever situate as follows: A. One-Half (1/2) thereof to the DICKINSON SCHOOL OF LAW of the PENN STATE UNIVERSITY, for its scholarship fund, to endow scholarships for deserving students. These scholarships shall be, if feasible, known as the "Mary Ann R. and Judge Dale F. Shughart Memorial Scholarships." B. One-Half (1/2) there0f to the GRACE UNITED METHODIST CHURCH of Carlisle, Pennsylvania. ITEM V: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the administration of my estate. ITEM VI: I appoint my son, DALE F. SHUGHART, JR., and my daughter, BARBARA S. DRAKE, Co-Executors of ~his my Last Will. Should both of my said children fail to qualify or cease to act as Executors, I appoint, HAMILTON C. DAVIS, of Newville, Pennsylvania, substitute Executor, of this my Last Will. ITEM VII: I direct that my Executors or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM VIII: My individual fiduciary shall be entitled to reasonable compensation for his and/or her services rendered from time to time and to reimbursement of out of pocket expenses. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and 2 2003. (SEAL) MARY ANN R. SHUGHART The preceding instrument, consisting of this and (3) other typewritten pages, each identified by the signature or initials of the Testatrix, was on the day and date thereof signed, published and declared by the Testatrix therein named, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesses hereto. residing at ~ ~ r e s i ding ad.4~.,/t~Pj~/~jb~/~t~/ COMMONWEALTH OF PENNSYLVANIA: : SS. COUNTY OF CUMBERLAND : I, MARY ANN R. SHUGHART, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ANN R. SHUGHART Sworn to or affirflaed and acknawled, eed before me by j~///JJ Ltl ~..,~atrix, this ~_ day of "' "~ary Public"' I' Notar a Seal ~ Hamilton C. Davis, Notary Public ~ Shippensburg Bore, Cumberland County| My Comm~smon Expires Sept. 27, 20041 Member, Pennsylvania Association of Noleries COMMONWEALTH OF PENNSYI~.VANIA: : SS. COUNTYDF CUMBERLAND ..... and. :.~ _ ~ We, ~b~ ,.J~'~. ~/JlJ)/J'f IL) J~, (~'/~/('~-, J(fff-d( e~witness whose names are signed~to the attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the heating and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. e i' Notarial Sea Hamilton C. Davis, Notary Public Shippensburg Eloro, Cumberland Coun Yl My Commission Expires Sept. 27, 2004 4 CERTIFICATION OF NOTICE UNDER RULE Name of Decedent: Mary Ann R. Shughart Date of Death: October 17, 2004 Estate No. 21-04 952 To the Register: I certify that notice Rule 5.6(a) of the Orphans' the following beneficiaries of October 2004. 5.6 (a) of estate administration required by Court Rules was served on or mailed to the above captioned estate on Name Address 1. Dale F. Shughart, Jr. 25 Rolling Drive Carlisle, PA 17013 2. Barbara S. Drake 2236 Quincy Arlington, VA 22207-5112 Notice has now been under Rule 5.6(a) except: Date: November ~---, 2004 Capacity: given to all persons entitled thereto Dale F. Shugharkt~,[Jr/. 35 East High Street/ Suite 203 Carlisle, PA 170t~7 Telephone (717) 241-4311 Counsel for Personal Representatives Dale F. Shughart, Jr. and · Barbara S. Drake IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re Estate of Mary Ann R. Shughart, deceased Estate No. 21-04-952 TO: Dale F. Shughart, Jr. 25 Rolling Drive Carlisle, PA 17013 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. The Decedent Mary Ann R. Shughart, died on the 17th day of October, 2004, at Carlisle, Cumberland County, Pennsylvania. The Decedent died testate. The personal representatives of the Decedent are: Dale F. Shughart, Jr. Barbara S. Drake 25 Rolling Drive 2236 Quincy Carlisle, PA 17013 Arlington, VA 22207-5112 Phone: (717) 241-0711 Phone: (703) 243-2312 The will has been filed with the Office of the Register of wills of Cun~erland County. 1 Courthouse Square, Carlisle, PA 17013. Phone No. 717-240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and payi,,ng the charges for duplication. Date: ~ , 2004 Dale F. Shugha~,/~r.% Attorney Supreme Court I.D. #19373 35 East High Street, Suite 203 Carlisle, PA 17013 Telephone (717) 241-4311 Capacity: Counsel for Personal Representatives Dale F. Shughart, Jr. and Barbara S. Drake IMPORTANT NOTICE NOTICE OF ESTATE ADMINISTRATION THIS NOTICE DOES NOT MEAN THAT YOU WILL RECEIVE ANY MONEY OR PROPERTY FROM THIS ESTATE OR OTHERWISE Whether you will receive any money or property will be determined wholly or partly by the decedent's will. If the decedent died without a will, whether you will receive any money or property will be determined by the intestacy laws of Pennsylvania. BEFORE THE REGISTER OF WILLS, COUNTY OF CUMBERLAND, PENNSYLVANIA In re Estate of Mary A~n R. Shughart, deceased Estate No. 21-04-952 TO: Barbara S. Drake 2236 Quincy Arlington, VA 22207-5112 Please take notice of the death of decedent and the grant of letters to the personal representative(s) named below. The Decedent Mary Ann R. Shughart, died on the 17th day of October, 2004, at Carlisle, Cumberland County, Pennsylvania. The Decedent died testate. The personal representatives of the Decedent are: Dale F. Shughart, Jr. Barbara S. Drake 25 Rolling Drive 2236 Quincy Carlisle, PA 17013 Arlington, VA 22207-5112 Phone: (717) 241 0711 Phone: (703) 243-2312 The will has been filed with the Office of the Register of Wills of Cumberland County. 1 Courthouse Square, Carlisle, PA 17013. Phone No. 717-240-6345. A copy of the Will or Petition may be obtained by contacting the Register of Wills and paying the charges for duplication. Date: /f/p/~ , 2004 _~j~_~ Dale F. Shugha~ ~r/. Attorney Supre~ C~drt I.D. #19373 35 East High Street, Suite 203 Carlisle, PA 17013 Telephone (717) 241-4311 Capacity: Counsel for Personal Representatives Dale F. Shughart, Jr. and Barbara S. Drake 0 ~t 0 0 o~ COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT,280601 HARRISBURG. PA 17128-0601 AEV-1162 EX{11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT SHUGHART DALE F JR 35 EAST HIGH STREET SUITE 203 CARLISLE, PA 17013 u___n_ fold ESTATE INFORMATION: SSN: 180-01-3567 FILE NUMBER: 2104-0952 DECEDENT NAME: SHUGHART MARY ANN R DATE OF PAYMENT: 01/14/2005 POSTMARK DATE: 01/14/2005 COUNTY: CUMBERLAND DATE OF DEATH: 10/17/2004 NO. CD 004839 ACN ASSESSMENT CONTROL NUMBER AMOUNT 101 I $29,975.00 I I I I I I I I TOTAL AMOUNT PAID: $29,975.00 REMARKS: DALE SHUGHART JR CHECK# 1035 SEAL INITIALS: RSK RECEIVED BY: REGISTER OF WILLS GLENDA FARNER STRASBAUGH REGISTER OF WILLS . '. COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE DEPT 280601 HARRISBURG, PA 17128-0601 REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT V:;F Ct~L~' REV-l500EX+lb-OOl /' FILE NUMBER 21 COUNTY CODE 04 00952 YEAR NUMBER DECEDENTS NAME (LAST, FIRST, AND MIDDLE INITIAL) Shughart, Mary Ann R. SOCIAL SECURITY NUMBER !Z w o w " w o 180-01-3567 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM.DD.YEAR) THIS RETURN MUST BE FILED IN DUPLICATE WITH THE 10117/2004 04/18/1917 REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME (LAST, FIRST AND MIDDLE INITIAL) W I- :.:::$00 ,,0::< w"" ,,00 ,,0:-' .... .. " o 2. Supplemental Return D 4a. Future Interest Compromise (date of death after 12.12.82) o 7. Decedent Maintained a Living Trust (Attach copy of Trust) o 10, Spousal Poverty Credit (date of death between 0 11,Election to tax under See, 9113(A)(Attach Sch 0) 12.31.91 an~ H.95) _ THIS SECTION MUST BE COMPLeTED. ALL CORRI!SPONDENCS AND CONFIOENTlAL TAX INFORMATION SHOULD BE DIRECTED TO: NAME - -- - - . ~-- ----~-~~ ~,~, "~~-"-~~-"..-._-co-MPLETEMAILINGADDRE$--~ <-----~,--~~'~<,-,,~~-"-..--~~--"'~ Dale F Shughart, If. Esquire ~ o ~ o 3. Remainder Return (date of death prior to 12-13-82) 1, Original Return D o I 5. Federal Estate Tax Return Required 4. Limited Estate 6. Decedent Died Testate (Attach copy of Will) 9, Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes I- Z w o z o .. FIRM NAME (If applicable) 1, Real Estate (Schedule A) 2, Stocks and Bonds (Schedule B) 35 E. High Street, Suite 203 Carlisle, P A 17013 0 (1) 225,000,00 s: ,'01 C-) CDI C) iTl (2) 408.505,63 '-0 _0 :'0 ..' r- c."J - m '; cr.; ~ (.J r-n (3) None CJ -) c') 0 -u c) (4) None .'") (Ji, "n ::::r. -r1 :..:)c c5 . ::0 ~ (5) 146,328.93 ::o-l \___ f'rl p U1 f../) c:> (6) None \.0 .~l') (7) 16,000.00 TELEPHONE NUMBER 717/241-4311 3. Closely Held Corporation, Partnership or Sole-ProprietDrship 4. Mortgages & Notes Receivable (Schedule D) 5, Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6, Jointly Owned Property (Schedule F) o Separate Billing Requested 7, Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9, Funeral Expenses & Administrative Costs (Schedule H) (8) 795,834,56 10, Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) (9) (10) 46,965.30 5,652.21 11. Total Deductions (total Lines 9 & 10) (11) 52,617.51 12, Net Value of Estate (Line 8 minus Line 11) (12) 743,217,05 13. Charitable and Governmental Bequests/See 9113 Trusts for which an election to tax has not been made (Schedule J) 14, Net Value Subject to Tax (Line 12 minus Line 13) (13) (14) 743,217.05 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15, Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 743,217.05 .045 (16) 0 16,Amount of Line 14 taxable at lineal rate x F " I- ::J .. 17, Amount of Line 14 taxable at sibling rate x .12 (17) '" 0 " >< 18, Amount of Line 14 taxable at collateral rate ~ x .15 (18) 19, Tax Due (19) 33,444.77 33,444,77 20. D CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. ,,- . -" -~. ----~-~~',~""~-"~~ >> BE SURE TO AN$W&R AU. QUIi!S'ltoN.s~ REVJ5RSi:.SIOE AHo f1ECHI!CK MATH<< Copyright 2000 form software only The Lackner Group, Inc. Form REV-1500 EX (Rev. 6-00) D,ecedent's Complete Address: STREET ADDRESS 271 South College Street CITY Carlisle STATE PA i ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 33,444.77 29,975.00 1,577.63 Total Credits (A + B + C) (2) 31,552.63 3. InteresVPenalty if applicable D. Interest E. Penalty TotallnteresVPenalty (D + E) 4. If Line 2 is greater than Line 1 + Line 3, enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + SA. This is the BALANCE DUE. (3) 0.00 (4) (5) 1,892.14 (SA) (5B) 1,892.14 Make Check Payable to: REGISTER OF WILLS, AGENT 11#I~A""",,_.I!!i" li._~~ 1Jj!~*. "... 11 PLEASE ANSWER THE FOLLOWING QUESTIONS BY PLACING AN "X"'N THE APPROPRIATE BLOCKS y~ i ~j~ II 1. Did decedent make a transfer and: a. retain the use or income of the property transferred;................................................................................ b. retain the right to designate who shall use the property transferred or its income;..................................... c. retain a reversionary interest; or............................................................................................................... d. receive the promise for life of either payments, benefits or care? ............................................................. 2. If death occurred alter December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?...................................................................................................................... 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 4. Did decedent own an Individual Retirement Account, annuity, or other non-probate property which contains a beneficiary designation?..................................................................................................................... D D D ~ ~ ~ IF THE ANSWER TO ANY OF THE ABOVE QUESTIONS IS YES, YOU MUST COMPLETE SCHEDULE G AND FILE IT AS PART OF THE RETURN. DATE ADDRESS 2366 North ouipB~treet Arlington, VA _. Q'?rYl 35 E. High Street, Suite 203 Carlisle, P A 17013 7/;//ly DATE ~~s- '/ )If!():;;- 35 East High Street Carlisle, PA 17013 ADDRESS 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 3% [72 P.S. 99116 (a) (1.1) (i)l. 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 0% [72 P.S. 99116 (a) (1.1) (Ii)]. The statute does not exemot 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 sUNiving 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 0% [72 P.S. 99116 (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 4.5%, except as noted in 72 P.S. 99116 1.2) [72 P.S. 99116 (a) (1)]. The tax rate imposed on the net value of transfers to or for the use of the decedent's siblings is 12% [72 P .S. 99116 (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. '. SCHEDULE A REAL ESTATE COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 00952 All real property owned solely or as a tenant in common must be r~l?orted at fai~ marke.t 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 NUMBER I DESCRIPTION VALUE AT DATE OF DEATH 225,000.00 House and lot located at 271 South College Street, Borough of Carlisle, Cumberland County, PA; Prior deed reference: Deed Book "U", Vol. 13, Page 459. Cumberland County Tax Parcel #04-21-0322-185. Value based upon actual sale price. HUD-I attached. TOTAL (Also enter on Line 1, Recapitulation) 225,000.00 . SCHEDULE B STOCKS & BONDS COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 00952 All property jointly-owned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER I DESCRIPTION UNIT VALUE VALUE AT DATE OF DEATH 157,666.88 9,684.698 shares Vanguard Windsor Fund CUSIP # 922018106 @ 16.28 per share 16.28 2 615.3508 shares Orrstown Financial Services, common stock, CUSIP #687380105 @42.675 per share 42.675 26,180.75 3 3,600 shares Carlisle Corporation, common stock, CUSIP # 142339100 @ 62.405 per share 62.405 224,658.00 TOTAL (Also enter on line 2, Recapitulation) 408,505.63 ESTATE OF '. SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 00952 Include the proceeds 01 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 NUMBER I Cash on hand. DESCRIPTION VALUE AT DATE OF DEATH 6.71 2 Retainer on deposit in Dale F. Shughart, Jr. Escrow Account. 500.00 3 Household goods, furniture and furnishings distributed in kind or sold at appraised value, value based upon attached appraisal of Alyssa Loney. 11,996.50 4 Household goods, furniture and furnishings, sold at public acution, value is actual sale price. 3,527.00 5 1997 Buick sedan, value based upon actual sale price. 5,995.00 6 Orrstown Bank, checking account 11400440 Principal 5,502.03 Accrued interest .32 5,502.35 7 Orrstown Bank, checking account # 106210114 Principal 112,303.77 Accrued interest 88.92 112,392.69 8 Tax proration of sale ofreal estate 1,373.40 9 Hoffman-Roth Funeral Home, refund 201.00 10 Dalton Books, refund 158.05 II Agway, refund 861.14 12 Patriot News, refund 46.35 13 The Sentinel, refund 11.48 14 Corneas!, refund 4.59 15 Attorney Group Life Insurance Trust, refund 186.13 16 Travelers, auto insurance refund 224.00 17 AT&T, refund 5.29 18 Sprint, refund 25.25 Total of Continuation Schedule(s) TOTAL (Also enter on Line 5, Recapitulation) 3,312.00 146,328.93 .* SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY continued COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 00952 Include 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 NUMBER 19 U.S. Treasury, 2004 income tax refund DESCRIPTION VALUE AT DATE OF DEATH 2,605.00 20 P A Department of Revenue, 2004 income tax refund 214.00 21 National Grange Mutual Homeowners Insurance, refund 493.00 Page 2 of Schedule E SCHEDULE G INTER-VIVOS TRANSFERS & MISC. NON-PROBATE PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 00952 ESTATE OF ITEM NUMBER This schedule must be completed and filed if the answer to any of questions 1 through 4 on page 2 is yes. 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 Cash gift to son, Dale F. Shughart, Jr. on 1/11/04 11,000.00 100% 3,000.00 8,000.00 2 Cash gift to daughter, Barbara S. Drake on 1111/04, 11,000.00 100% 3,000.00 8,000.00 TOTAL (Also enter on line 7, Recapitulation) 16,000.00 .* COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE H FUlERAL EXPENSES & ADIIIINSTRA11VE COSTS ESTATE OF Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 00952 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. DESCRIPTION AMOUNT FUNERAL EXPENSES: Hoffman-Roth Funeral Home, funeral expenses 9,673.50 2 Carlisle Memorial Service, engraving 285.00 3 Lydia Hazlett, family reception 217.00 B. ADMINISTRATIVE COSTS: 1. Personal Representative's Commissions Social Security Number(s) / EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State _ Zip 2. Attorney's Fees Hamilton C. Davis (estimated) 5,000,00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City Relationship of Claimant to Decedent Probate Fees Register of Wills State Zip 4. 464.00 5. Accountant's Fees 6. Tax Return Preparer's Fees Mentzer & Co. 300.00 7. I Other Administrative Costs Register of Wills, Short Certificates 35.00 2 Orrstown Bank, checks 34.85 Total of Continuation Schedule(s) 30,955.95 46,965.30 TOTAL (Also enter on line 9, Recapitulation) ESTATE OF '. SchecUe H Fu1eraI Expet ISeS & Ach1illisbali\le CosIs contirLled COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 00952 3 Larry Lebo, commission on auto sale 1,630.00 4 IBIS Appraisal Service, personal property appraisal 420.00 5 Postmaster, certificd mail 4.42 6 UPS, overnight mail 15.69 7 Cumberland Law Journal, advertise Letters 75.00 8 The Sentinel, advertise Letters 129.47 9 Anthony Moore, electric rcpairs 1,500.00 10 Ebener & Associates, realtor's commission 6,775.00 II ERA NRT, Inc., realtor's commission 6,725.00 12 Recorder of Deeds, transfer tax 2,250.00 13 Darlene Moyer, county/bnrough real estate taxes 983.03 14 Borough of Carlisle, sewer and water 84.39 15 Rowe's Auction Service, commission on auction sale 881.00 ]6 Jane Wallace, cleaning, snow removal, maintenance, security, packing and moving, repairs 3,170.08 17 Steve Cornman, plumbing repairs 140.00 18 PP&L, electric 134.64 ]9 Suburban Energy, fuel oil 853.07 20 AT &1, phone 21.96 2] Walnut Bottom Landscaping, yard care 381.60 22 Jumper's Electric, electric repair 37.43 23 Sprint, phone 59.05 24 Michael D. Blumentha], home repairs 59495 25 L & M Heating, furnace repair 950.69 Pagc 2 of Schedule H '. SchedUe H fu1eraI Expet 1005 & AmirisbativeCosls ca1IirU!d COMMONWEAL TH Of PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 00952 26 Shirley Harrison, house cleaning 787.50 27 Stitzel's Mechanical, plumbing repairs 300.00 28 Veri Williams, trash removal 250.00 29 Barbara Drake, reimburse out of pocket expenses 647.73 30 Dale F. Shughart, Jr., reimburse out of pocket expenses 624.25 31 Register of Wills, filing inheritance tax return and inventory 30.00 32 Reserve for Accounting 500.00 Page 3 of Schedule H .* COMMONWEALTH OF PENNSYL VANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES, & LIENS ESTATE OF Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 00952 Include unreimbursed medical expenses. ITEM NUMBER I DESCRIPTION AMOUNT Checks written before death, clearing after death: 4347 National Grange, ins. premium 4348 PP&L, electric 4344 Laura Shughart, airline tickets 4345 Wayne Noss, flowers 4330 AT&T, electric 4315 P A Department of Revenue, taxes 4341 BonTon, charge account 4350 Citicard, Mastercard account 3,752.27 1,456.00 40.53 1,074.74 13.25 13.80 190.00 44.97 918.98 2 Jane Wallace, personal care and cleaning services 473.00 3 Jumper's Electric, tim repair 28.00 4 AT&T, phone service 23.80 5 Sprint, phone service 160.46 6 Citicorp Mastercard, account balance 53.22 7 PP&L, electric 26.54 8 Comcast, TV cable 12.01 9 L & M Heating, heating repairs 324.80 10 Carlisle Borough, sewer and water 16.18 II Walnut Bottom Landscaping, lawncare 267.85 12 Met Ed, electric 124.08 13 Sarah Todd Home, nursing care 390.00 TOTAL (Also enter on Line 10, Recapitulation) 5,652.21 REV-1513 EX+ (9-110) '. COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE J BENEFICIARIES ESTATE OF Shughart, Mary Aim R. FILE NUMBER 21 - 04 - 00952 NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY RELATIONSHIP TO DECEDENT 00 Not UstTrustee(s} AMOUNT OR SHARE OF ESTATE I. TAXABLE DISTRIBUTIONS (include outright spousal distributions) Dale F. Shughart, Jr. 25 Rolling Drive Carlisle, P A 17013 Son One-half estate 2 Barbara S. Drake 2366 North Quincy Street Arlington, VA 22207-5112 Daughter One-half estate Enter dDllar amounts for distributions shown above on lines 15 through 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 B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS TOTAL OF PART II - ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET A. Settlement Statement u.s. Department of Housing and Urban Development B. Tvoe of Loan OMB ADDroval No. 2502-0265 (exDires 9/30/2006) FINAL 1. OFHA 2. DFmHA 3. DCom. Unins. I 6. File Number I 7. Loan Number I 8. Mortgage Insurance Case Number 4. nVA 5. nConv.lns. MT2005-136JDF C. Note" It;~~~:,,~..{~I~~J'~~~;' =~Ii:..m~ elOflin~; lhey.~:=n'."'for~IIl~~'" andar.:t=: in thelOtall1. I TilleExpress Settlement System :'~~11~G~~lind::~ ~trWl~ci~~::~:e FS:~=~~:~Telt~n~~~~lltg~~ ~h~:.,~ora~~~:~~~i1~~eltlell upon Printed 03/29/2005 a116:18 KLL D. NAME OF BORROWER: Anthony J. Moore and Jennifer L. Moore ADDRESS: E. NAME OF SELLER: Estate of Mary Ann R. Shughart ADDRESS: F. NAME OF LENDER: Cash ADDRESS: G. PROPERTY ADDRESS: 271 S. College Street, Carlisle. PA 17013 Carli.le Borough H. SETTLEMENT AGENT: Saidis, Shuff, Flower & Lindsay, Telephone: 717.243.6222 Fax: 717.243.6486 PLACE OF SETTLEMENT: 26 We.t Hlah Street Carlisle PA 17013 I. SETTLEMENT DATE: 03/30/2005 J. SUMMARY OF BORROWER'S TRANSACTION: K. SUMMARY OF SELLER'S TRANSACTION: 100. GROSS AMOUNT DUE FROM BORROWER 400. GROSS AMOUNT DUE TO SELLER 101. Contract sales mice 225 000.00 401. Contract sales price 225 000.00 102. Personal Prooertv 402. Personal Prooertv 103. Setllement charaes to borrower (line 14001 3901.25 403. . 104. 404. 105. 405. Adiustments for items caid bv seller in advance Adjustments for items paid by seller in advance 107. Count'y' taxes 03/30105 to 12/31/05 746.02 407. County taxes 03/30/05 to12/31/05 746.02 108. School Taxes 03/30/05 to 06/30/05 627.36 408. School Taxes 03/30/05 to 06/30/05 627.38 109. 409. 110. 410. 111. 411. 112. 412. 120. GROSS AMOUNT DUE FROM BORROWER 230 274.65 420. GROSS AMOUNT DUE TO SELLER 226 373.40 200. AMOUNTS PAID BY OR ON BEHALF OF BORROWER 500. REDUCTIONS IN AMOUNT DUE TO SELLER 201. Deoosit or earnest money 5 000.00 501. Exce.s Deoo.ill.ee instructionsl 202. Princioal amount of new loans 502. Settlement charnes to seller (Ijne 140m 16 768.68 203. Existino loanlsl taken subiecl to 503. Existino loan(s\ taken subiect to 204. 504. Pavoff of First Mortaeoe Loan 205, 505. 206. Seller Assist 1 500.00 506 Seller Assist 1 500.00 207. 507. 206. 506. 209. 509. Adiustments for Items unpaid by seller Adiu.tments for items unpaid bv seller 213. 513. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. 220. TOTAL PAID BY/FOR BORROWER 6 500.00 520. TOTAL REDUCTION AMOUNT DUE SELLER 1 B 26B.6B 300. CASH AT SETTLEMENT FROM OR TO BORROWER 600. CASH AT SETTLEMENT TO OR FROM SELLER 301, Gross amount due from borrower IlIne 120\ 230,274.65 601. Gross amount due to seller !line 4201 226 373.40 302. Less amounls naid bvnor borrower nine 220\ 6 500.00 602. Less reduction amounl due seller lline 520l 18268.68 303. CASH FROM BORROWER 223774.65 603. CASH TO SELLER 206 104.72 SUBS!ITUTE FORM 1099 SELLER ST~TEMENT: The inforn:'atlon COl1~lned herein illmpcrt.-.tlax information and i. being fumi....ed 10 the IntltfT'lllll R.~enu. Service. If you are requir.d to file II retum, ~neyb~=.::a~~i~l~~l~ =i~;:.,'::n~~t~~li~.lllem IS required 10 be reported and the IRS determines that it has not bevn reported. Th. Conlrect Sales Price described on ~~~~ 1::~I~~eN~rt~ ~i~~ :~~j~ ~~~~r~~c:l=~b 'I;~~~~~, Sale Of &change of Principal Resldenca, for any gain, wilh you'" income I8x return; for othar Iransactions, ~~::,t~~a~ b~I:",~~g%~:ilt7: ~~~I~I:~ tirn~~X ~~I~~: Under penalties of Plt~~~ ~~~ ::~:ber~=\~~~l ~:re~~~~~~:~~de~lfl~~~J:~CC1tiOf1 TIN: SELLER(S) SIGNATURE(S); SELLER(S) NEW MAILING ADDRESS' U,S, DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT S~TTLEMENT 8T A TEMENT File Number. MT2005-136 FINAL PAGE 2 ~ TitleExnress Settlement System Printed 03/29/2005 al lS:18 KLL L. SETl'LEMENT CHARGES PAID FROM PAID FROM 70Q, TOTAL SALES/BROKER'S COMMISSION based on Drlce $225 000,00 [Q) 6,000 = 13 500,00 BORROWER'S SELLER'S Division of commission IIine 700\ as follows' FUNDS AT FUNDS AT 701, $ 6 775,00 to Ebener & Associates . SETTLEMENT SETTLEMENT 702, ~ 6 725.00 to ERA NRT Inc. 703, Commission naid at Setllement t3500.00 704. Transaction Fee to ERA NRT Inc. 125.00 800. ITEMS PAYABLE IN CONNECTION WITH LOAN 801, Loan Orinination Fee % 802, Loan Discount % 803, Aooraisal Fee 804, Credit Reoort 805, Lender's InsMdion Fee 80S. Moriaaoe Aoolleation Fee 807, Assumotion Fee 80S, 809, 810, 811, 900. ITEMS REQUIRED BY LENDER TO BE PAID IN ADVANCE 901 Interest From to 11il$ /dav 902. Mortaaae Insurance Premium for to 903, Hazard Insurance Premium for to 904. 905, 1000. RESERVES DEPOSITED WITH LENDER FOR 1001, Hazard Insurance mo, 11il$ Imo 1002, Mortoaae insurance mO,I1il$ /mo 1003, CItv Prooertv Tax mo, 11il$ Imo 1004. County Prooertv Tax mO,11il $ 81.92 Imo 1005, School Taxes mo. (al $ 205.19 Imo 1009, Aaareoate Analvsls Adiustment 1100. TITLE CHARGES 1101. Settlement or closino fee 1102. Abstract or title search 1103, Title examination 1104, Title insurance binder 1105. Document Preoaration 1106. Natarv Fees to Said is. Shuff Flower & Lindsav 4.00 1107, Attomev's fees /includes above items No: I 110S. Title Insurance to ACCP, Inc. 1 483.75 (Includes above items No: 1 1109. lender's Policy 1110, Owners Palic' 225000.00 .1 483.75 1111. 1112. 1113. 1200. GOVERNMENT RECORDING AND TRANSFER CHARGES 1201. Recordlnn Fees Deed $ 38.50 . Moriaane $ . Release $ 38.50 1202. Cltv/Count'taxlslamas Deed $2 250.00 ' Mortaaae $ 2 250.00 1203. State T axlstamns Deed $2 250.00 . MortaaDe $ 2 250.00 1204, 1205. 1300. ADDITIONAL SETTLEMENT CHARGES 1301. 2005 CtvlTwa Tax to Darlene Mover 983.03 1302. Final WaterlSewer Acct #04480Ala BorouQh of Carlisle 35.65 1303, Home Insoeetion to Buver POC 1304, 1305, 1306, 1307, 1308. 1400. TOTAL SETTLEMENT CHARGES (enter on lines 103 Section J and 502 Section Kl 3 901.25 16768.68 HUD CERTIFICATION OF BUYER AND SELLER I nave carefuUy reviewed the HUD 1 Seltlemenl Statement and to the belt of my knowledge and belief. it III e true end accurate ltatement of atl rec:i) and dlsbUflementll metht on my account or by me '""""~td"':'_'L::",""'''''''~~''d'~PY''f1''''HUD-1 S..'"".nISIaI.m",' ~ F. 'tr1 ~ MUlOny J Mock~ Jennl1er l. Mil , WARNING. IT IS A CRIME TO KNOWINGLY FALSE S ATfMENTS TO THE UNITED STATES ON THIS OR ANY SIMILAR F RM, PENALTIES UPON CONVICTION CAN INCLUDE A FINE AND IMPRISONMENT. FOR DETAILS SEE TITLE 18 U.S. COOE SECTION 1001 AND SECTION W10 The HUQ-1 Settlement Sta(em8llt which I have preplU"Eld is a true anrl ~cc:urlllilllccounl 01 this transactiOn Illsvll causllld or will cause the funds 10 be disbt.irsed in accordallCll with this alat@fll8nl. ~(LUJ~~G)~ ~-'3'-0"" Data of Death Stock Values: Carlisle Corp CUSIP 142339100 10/15/2004: Hi 62.71, La 62.10; aye 62.405 10/18/2004: Hi 62.31, La 61.70, aye 62.085 (Though this was Columbus Day, market was open.) Date of death value: 62.405 Stock was not ex-dividend either day. Orrstown Bank CUSIP 687380105 10/12/2004 (last day traded before 10/17): Hi 43.50, La 42.75; aye 42.75 10/18/2004: Hi 43, La 42.30; aye 42.65 Date of death value: 42.675 Stock not ex-dividend either day. Dale, The Vanguard Windsor fund close share price on October 15, 2004, was $16.27, and on Octoberl8, 2004, was $16.29. On October 17, 2004, there were 9684.698 shares in the account. At the average of those two prices, $16.28, the value of the shares was $157,666.88. Our respective tax basis would be half of the number of shares, and half of the dollar value. The same number of shares will be liquidated, as there have been no additions since that time. Barbara PS The share price as of the close on November 4th was $17.22, so unless it drops before the liquidation, we will have a longterm gain to report. (Our holding period is the same as Mom's). . 4 UPDATED & REVISED , APPRAISAL REPORT '.......... OF' . ',PERSPNALPROPERTY Olf ,"\; ,"-,", hI' r' , t.: ; ~, . APPRAISAL CER TIFICA TE I hereby certify that, upon the request for the estate appraisal of the personal property of Mary Ann Shughart, deceased, 271 South College St. Carlisle, P A 17013, I have personally and physically inspected the listed personal property. The personal property was appraised to determine the FAIR MARKET VALUE, AS OF d.o.d. October 17, 2004 & reported on January 13,2005. The date of inspection was January 10,2005. The information and values contained in this report are based upon my experience as an appraiser and other reliable sources. The personal property was found to be in GOOD to EXCELLENT condition, unless otherwise noted. Values are reported piece-by-piece, and/or as a whole. All values reported have been determined with consideration to the condition of the item, market conditions, and salability factors. . IBIS APPRAISAL _:&~;g~. ~~--- Alyssa i:-P;~I~tC:A.P.t>. 3 . APPRAISAL SUMMARY It is in my opinion, that as of d.o.d. October 17,2004, the Fair Market Value of the personal property of Mary Ann Shughart, deceased, 271 South College St. Carlisle, P A 17013: (Eleven Thousand Nine Hundred Ninety Six Dollars and Fifty Cents) ($11,996.50.00) IBIS APPRAISAL SERVICES 1J~'/ ----~~~~- -,~~~;~------------ Alyssa L. ~~n y, _1[.1 .1 . I The report must be read in its entiretv. The Appraisal Summarv ONLY is not the appraisal report. 4 . Photograph and CD-ROM Instructions Ibis Appraisal Services has provided you with a CD-ROM that houses all of the digital photographs of all of the items appraised. The CD-ROM also contains a saved copy of the appraisal report. This CD-ROM may be kept with the paper copy of the appraisal report or kept off-site, such as a safety deposit box. The photographs are saved in the JPEG picture format, meaning that all of the file names end with a ".JPG". The file names correspond to the written appraisal report's Corresponding Photograph File that is included at the end of each item appraised. Getting started with your CD-ROM 1. Insert the CD-ROM into your computer's CD-ROM Drive. If you do not have a computer or access to a CD-ROM Drive--a copy store, office supply store, or public library will be able to help you view and/or print your pictures. 2. Your computer may contain one or several different software programs that will allow you to view your pictures. Examples of these programs are Draw, Photo Editor, Picture It! Express, Photo Suite, My Photo Center, Photo Studio Lite, Photo Shop Pro, Picture CD, or Photo Deluxe. The program that is included with a digital camera is another way to view your pictures. · Select the program for viewing photographs and open the program. 3. Click FILE, and Click OPEN. 4. Use the Pull-Down, "Look in" Menu and select the D Drive (D:) or whichever drive is designated as your CD-ROM (sometimes this may be the E Drive (E:) on your computer). .. NOTE · Your CD-ROM Drive is designated with a small CD-ROM graphic Icon or a cartoon representing the drive. · The drives of your computer can be found under My Computer section of the Pull- Down "Look in" Menu. Common Drives are: A Drive (floppy disc drive), the C Drive (hard disc drive), the D Drive (CD-ROM Drive), and the E Drive (sometimes CD-ROM Drive; sometimes an external drive, like a CD-ROM Writer, Zip, or Jazz Drive). 5. Double-click on the photograph you wish to view. 5 . 4 5 8 17 24 25 26 Personal Property Listing Workbench. Vmtage wood work bench. Location: Basement. Corresponding Digital Photograph Files: r0304575-r0304576.jpg $10.00 Bench Grinder. Black and Decker 5" bench grinder. #7900 Type 3. Location: Basement. Corresponding Digital Photograph File: r0304577 $25.00 Filinll Cabinets. Three horizontal drawer metal filing cabinets. Location: Basement & Office. Corresponding Digital Photograph Files: r0304580 & r0304750.jpg $25.00 Chairs. Four metal folding chairs. Location: Basement. Corresponding Digital Photograph File: r0304589.jpg $6.00 Bench. Nineteenth century soft wood bench/box. 36" tall, 67" wide, 13 Yt" deep. Location: Basement. Corresponding Digital Photograph File: r0304597.jpg $325.00 Bar. Contemporary wood bar. 43" tall, 96' wide, 25" deep. Location: Basement. Corresponding Digital Photograph File: r0304598.jpg $150.00 Bar Stools. Four contemporary bar stools. Location: Basement. Corresponding Digital Photograph File: r0304599.jpg $40.00 6 . 27 29 31 36 38 39 40 41 Desk. Primitive soft wood school-type desk. 35" tal~ 25" wide, 33" deep. Location: Basement. Corresponding Digital Photograph File: r0304600Jpg $225.00 Oak Chairs. Set of four vintage oak chairs. 36" tall. Location: Basement. Corresponding Digital Photograph File: r0304602.jpg $40.00 Drvsink. Primitive pine Drysink. Three drawers over Drysink over two doors. 47" tall, 47" wide, 22 y," deep. Location: Basement. Corresponding Digital Photograph File: r0304604.jpg $350.00 Prints. Selection of miscellaneous framed and matted prints. Location: Throughout the Residence. Corresponding Digital Photograph File: r0304609Jpg $20.00 Table. Long pine 1able. 28" ~ 72" wide, 34" deep. Location: Basement. Corresponding Digital Photograph File: r0304611.jpg $225.00 $30.00 $45.00 $25.00 7 . 42 43 48 50 51 55 56 60 $30.00 Gnmiteware. VIntage graniteware. Location: Kitchen. Corresponding Digital Photograph File: r0304615jpg $12.00 Chairs. Three vintage wood chairs. 35" tall. Location: Kitchen, First Floor Bedroom & Second Floor Front Bedroom #2. Corresponding Digital Photograph File: r0304620jpg $60.00 Tin Plate. Vintage child's tin alphabet plate. Location: Kitchen. Corresponding Digital Photograph File: r0304623.jpg $38.00 Tin Plate. Vintage tin plate with beaded edge. Location: Kitchen. Corresponding Digital Photograph File: r0304624jpg $25.00 Television. Quasar 13" older model color television. Location: Kitchen. Corresponding Digital Photograph File: r0304627jpg $25.00 Print. Framed and matted western motif print. 24" x 19". Location: Dining Room. Corresponding Digital Photograph File: r0304631jpg $25.00 $85.00 Serving Items. Miscellaneous selection of glass and silverplate serving items including covered vegetable bowls, open vegetable bowls, platters, cake stands, and relish dishes. Location: Dining Room. Corresponding Digital Photograph Files: r0304635. r0304639, r0304641. . 8 62 65 69 74 76 82 Silver Case. Contemporary mahogany silver & jewelry case. 32" tall, 15" wide, }3" deep. Location: Dining Room. Corresponding Digital Photograph File: r0304637.jpg $125.00 Salt & PeDDer Shakers. Sterling silver salt and pepper shakers by Duchin. Location: Dining Room. Corresponding Digital Photograph File: r0304640.jpg $60.00 Drvsink. Vintage primitive drysink: with one drawer and two doors. Has copper insert. 33" tall, 45" wide, 18" deep. Location: Dining Room. Corresponding Digital Photograph File: r0304647Jpg $800.00 Candlestand Leather top candlestand 20" tall, 13 y," diameter. Location: Dining Room. Corresponding Digital Photograph File: r0304652Jpg $20.00 Comer Cuuboard. Vintage comer cupboard. Two door over two door. 76" tall, 37" wide, 23" deep. Location: Dining Room. Corresponding Digital Photograph File: r0304654.jpg $1,050.00 Carving Set Sheffield horn handle carving set: Three piece. Location: Dining Room. Corresponding Digital Photograph File: r0304666.jpg $40.00 9 84 85 86 88 89 90 91 ~. Oriental wool carpet with red field., navy and beige border and medallion center. Shahistan. 12' x 9.5'. Location: Dining Room. Corresponding Digital Photograph Files: r0304668 & r0304669.jpg Cake Stand American Fostoria cake stand. 7 Y:," tall, 10" diameter. Location: Dining Room. Corresponding Digital Photograph File: r0304673.jpg Bowl. Gold toned carnival glass rose with rose motif. 4 \1," tall, 10 \1," wide. Location: Dining Room. Corresponding Digital Photograph File: r0304674.jpg Box. Spoon carved wood box by Joseph Biirche11937. 5" tall, 7 \1," wide, 5 %" deep. Location: Dining Room. Corresponding Digital Photograph File: r0304675.jpg Prints. Two framed and matted print of Germanic European cities. Signed. 16 \1," x 13 \1,". Location: Dining Room. Corresponding Digital Photograph File: r0304676.jpg Chairs. Set of six Chippendale reproduction chairs with music harp motif. 34" tall Location: Dining Room. Corresponding Digital Photograph File: r0304677.jpg Table. Wood dining room table. 29" taIl, 61" wide, 40" deep. Location: Dining Room. Corresponding Digital Photograph File: r0304678.jpg $450.00 $45.00 $40.00 $30.00 $30.00 $300.00 $375.00 10 117 121 123 124 126 130 Print. One framed and matted print. 21" x 17". Location: Living Room. Corresponding Digital Photograph Files: r0304703 & r0304704jpg $25.00 Dresser Box. Ceramic Royal Copenhagen dresser box. Crackle glaze. 2" tall, 6 W' wide, 4" deep. Location: Living Room. Corresponding Digital Photograph File: r0304708jpg $23.00 Painting. Oil on canvas. Subject: Stream under road. Artist: Mary Ann Shughart Dated: 1975.28 y," x 24 W'. Location: Living Room. Corresponding Digital Photograph File: r0304711 jpg $40.00 Paintinl!. Oil on canvas. Subject: Tools against building. Artist: Mary Ann Shughart. Dated: 1976. 23" x 19". Location: Living Room. Corresponding Digital Photograph File: r0304712jpg $30.00 Chair. Contemporary plush blue chair. Location: Living Room. Corresponding Digital Photograph File: r0304714jpg $40.00 $20.00 Air Conditioner. One air conditioning unit Location: Sun Room. Corresponding Digital Photograph File: r0304719Jpg 13 134 139 140 141 142 146 ManiagelBirth Certificate. Cumberland County band painted maniage and birth certificate. 1857. Waggoners by James Shaw. 26" x 22". Location: First Floor Hallway. Corresponding Digital Photograph Files: r0304722&r0304723.jpg $275.00 Embroideries. A selection of miscellaneous framed embroideries and cross stitches. Location: First Floor Hallway. Corresponding Digital Photograph File: r0304728.jpg $30.00 ~ Oriental wool runner. Red field, multi-color border. Sarouk. 2.2' x 11.3'. Location: First Floor Hallway. Corresponding Digital Photograph File: r0304729.jpg $200.00 Chair. Vintage rounded wood chair. 26" tall, 19" wide. Location: First Floor Hallway. Corresponding Digital Photograph File: r0304730.jpg $45.00 Cabinet Pine cabinet, one door. 34" tall, 20" wide, 10 Yz" deep. Location: First Floor Bathroom. Corresponding Digital Photograph File: r030473/.jpg $35.00 $225.00 _ Washstand. Oak vintage washstand with towel rack. One drawer over two door. 53" tall, 31" wide, 18" deep. Location: First Floor Bathroom. Corresponding Digital Photograph File: r0304735.jpg 14 148 149 150 152 153 Chair. Victorian Eastlake chair. Location: Office. Corresponding Digital Photograph File: r0304738.jpg $75.00 Bookcases. Set of oak barrister bookcases, five units. Location: Office. Corresponding Digital Photograph File: r0304741.jpg $625.00 Chair. Vintage softwood chair. 31 \12' taIl. Location: Office. Corresponding Digital Photograph File: r0304739.jpg $45.00 Lamp. Brass table lamp. 22" taIl. Location: Office. Corresponding Digital Photograph File: r0304743.jpg $10.00 Desk. Vmtage oak roll top desk. 44 \1," tall, 44" wide, 30" deep. Location: Office. Corresponding Digital Photograph File: r0304742.jpg $325.00 15 154 158 160 161 163 164 165 Chair. Metal mid twentieth century office chair. All Steel Equipment. Location: Office. Corresponding Digital Photograph File: r0304744jpg $5.00 Trunk. Hump back trunk with tin sheeting. Location: Office. Corresponding Digital Photograph File: r0304748.jpg $150.00 Bookcases. Set of oak banister bookcases, four units Location: Office. Corresponding Digital Photograph File: r0304749jpg $500.00 Desk. Oak three drawer desk. 24" taIl, 47" wide, 23 Y:z" deep. Location: Office. Corresponding Digital Photograph File: r0304751.jpg $40.00 Desk. Oak desk. 2T' taIl, 20" wide, 28" deep. Location: Office. Corresponding Digital Photograph File: r0304753.jpg $50.00 Jellv Cupboard. Pine primitive jelly cupboard with shelf. 65" tall, 45 Y:z" wide, 18 Y:z" deep. Location: Office. Corresponding Digital Photograph File: r0304754.jpg $625.00 Print. Framed and matted print Title: Historic Carlisle. Artist: Alice Rockwall. 152/301. 18" x 21 Y:z". $35.00 16 166 167 170 174 176 ISO 182 Delft. Miscellimeous pieces of delft by Royal Goedewaagen. Location: Office. Corresponding Digital Photograph File: r0304755jpg $150.00 Chair. Child's red painted Windsor chair. "Our Darling". 18 Yo" tall. Location: Office. Corresponding Digital Photograph File: r0304756jpg $25.00 Crock. White glaze five gallon crock. Location: First Floor Bedroom. Corresponding Digital Photograph File: r0304759jpg $25.00 PaintinlZ. Oil on canvas. Subject: Farmland. Artist: Mary Ann Shughart. Framed. 30" x 23 %". Location: First Floor Bedroom. Corresponding Digital Photograph File: r0304763jpg $30.00 Chair. Plush and wood chair. 34" x 22 Yo". Location: First Floor Bedroom. Corresponding Digital Photograph File: r0304765.jpg $50.00 RockinlZ Horse. Child's toy sit-in rocking horse. Location: First Floor Bedroom. Corresponding Digital Photograph Files: r0304771 & r0304772jpg $100.00 Paintinl!:. Oil on board. Subject: Portrait Mary Ann Shughart. Artist: Ronald S. Keyes. Dated: 1951. Framed. 31 Yo" x 25 Yo". Location: First Floor Bedroom. Corresponding Digital Photograph File: r0304774.jpg $45.00 17 190 192 193 194 199 200 Plant Stand Two tier wood plant stand. 25" tall, 18" diameter. Location: Second Floor Landing. Corresponding Digital Photograph File: r0304783.jpg $40.00 Rocking Chair. Vintage oak pressed back rocking chair. Location: Second Floor Landing. Corresponding Digital Photograph File: r0304784jpg $80.00 Washstand F.:j~ll1l<p. washstand with one drawer over two drawers and one door. 39 Yo" tall, 31" wide, 17 Yo" deep. Location: Second Floor Landing. Corresponding Digital Photograph File: r0304785.jpg $275.00 Paintine:. Pastel. Subject: Portrait Artist: Wittben Framed and matted. 23" x 19 W'. Location: Second Floor Landing. Corresponding Digital Photograph File: r0304786jpg $15.00 Paintinl1. Oil on canvas. Subject: Sea shore & gulls. Artist: Mary Ann Shughart. Dated: 1976. Framed. 27" x 21". Location: Second Floor Landing. Corresponding Digital Photograph File: r0304791.jpg $30.00 Shoe Rack. Primitive wood shoe rack. 49" tall, 44" wide, 8" deep. Location: Second Floor Landing. Corresponding Digital Photograph File: r0304792jpg $115.00 18 203 204 207 208 211 212 Painting. Oil on canvas. Subject: Boats. Artist: Mary Ann Shughart. Dated: 1976.23 'I." x 19". Location: Back Bedroom. Corresponding Digital Photograph File: r0304795jpg $30.00 Drawers. Contemporary chest of drawers. Painted white. 32" tall, 36" wide, 13" deep. Location: Back Bedroom. Corresponding Digital Photograph File: r0304796jpg $35.00 Painting. Oil on canvas. Subject: Chickadees. Artist: Mary Ann Shughart. Dated: 1976. Framed. 17" x 13". Location: Back Bedroom. Corresponding Digital Photograph File: r0304799jpg $20.00 Blanket Chest Softwood blanket chest 18" tall, 36 'l2" wide, 17 'l2" deep. Location: Back Bedroom. Corresponding Digital Photograph File: r0304800.jpg $225.00 Mirror. Round framed mirror. 32" diameter. Location: Second Floor Front Bedroom # 1. Corresponding Digital Photograph File: r0304806jpg $10.00 Air Conditioner. Quasar air conditioner. Location: Second Floor Front Bedroom # 1. Corresponding Digital Photograph File: r0304807jpg $40.00 19 .. 213 214 215 219 220 222 Painting. Oil on canvas. Subject: Beach. Artist: Mary Ann Shughart. Framed 23" x 19. Location: Second Floor Front Bedroom # 1. Corresponding Digital Photograph File: r0304808.jpg $30.00 Painting. Oil on canvas. Subject: Wooded stream. Artist: Mary Ann Shughart. Dated: 1977. Fmmed. 26 'l'," x 20 'l',". Location: Second Floor Front Bedroom #1. Corresponding Digital Photograph File: r0304809jpg $30.00 Painting. Oil on board. Subject: Farm house. Artist: Mary Ann Shughart. Fmmed. 25 'l'," x 21 'l',". Location: Second Floor Front Bedroom # 1. Corresponding Digital Photograph File: r030481O.jpg $30.00 Chair. Victorian Eastlake chair with caned seat. 35" tall Location: Second Floor Front Bedroom #2. Corresponding Digital Photograph File: r03048J4.jpg $50.00 Ouilt Rack. Wood primitive quilt rack. 32" tall, 29" wide, 18" deep. Location: Second Floor Front Bedroom #2. Corresponding Digital Photograph File: r0304815.jpg $45.00 Chest Wood four drawer chest. 44" tall, 32" wide, 18" deep. Location: Second Floor Front Bedroom #2. Corresponding Digital Photograph File: r0304818.jpg $40.00 20 , . APPRAISAL SUMMARY (COPY) It is in my opinion, that as of d.o.d. October 17,2004, the Fair Market Value of the personal property of Mary Ann Shughart, deceased, 271 South College S1. Carlisle, PA 17013: (Eleven Thousand Nine Hundred Ninety Six Dollars and Fifty Cents) ($11,996.50.00) IBIS APPRAISAL SERVICES The report must be read in its entiretv. The Appraisal Summarv ONLY is not the appraisal report. 23 #oo~ ORRSTOWN BANK January 3, 2005 TO: Dale F Shughart Jr. Attorney At Law 38 East High Street Suite 203 Carlisle, PA 17013 FROM: Timothea Moose Cust. Servo Op. P.O. BOX 250 SHIPPENSBURG PA 17257-0250 RE: ESTATE OF Maryann R Shughart DATE OF DEATH: October 17, 2004 IT IS HEREBY CERTIFIED THAT THE ABOVE NAMED DECEDENT HAD, ON THE ABOVE DATE, THE FOLLOWING ACCOUNTS WITH ORRSTOWN BANK: CHECKING ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST 400440 Maryann R Shughart 3/25/94 5,502.03 .32 106210114 MaryannRShughart 3/31/98 112,303.77 88.92 SAVINGS ACCOUNTS ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST CERTIFICATES OF DEPOSIT ACCOUNT NO. TITLE OF ACCOUNT DATE OPENED PRINCIPAL & ACCRUED INTEREST P.O. BOX 250 SHIPPENSBURG, PA 17257 TEL. (717) 532-6114 LAST wn ,r. ANn TF,ST AMENT I, MARY ANN R. SHUGHART, of the Borough of Carlisle, Cumberland County, Pennsylvania, declare this to be my Last Will and Testament and revoke any Will or Codicil previously made by me. ITEM I: I direct that all my just debts (except as may be barred by a Statute of Limitations) and my funeral expenses (including my gravemarker and expenses of my last illness) shall be paid from my residuary estate as soon as practicable after my decease as a part of the administration of my estate. ITEM II: I give and bequeath all my tangible personal property, including but not limited to, any and all automobiles and other I?otor vehicles, household goods and furniture and furnishings; china, silvenvare, jewelry, ornaments, works of art, books pictures, wearing apparel and personal effects, but excluding cash on hand and tangible evidences of intangible personal property together with any policies of insurance applicable thereto including any prepaid premiums thereon to such of my children DALE F. SHUGHART, JR. and BARBARA S. DRAKE, as shall survive me, in as nearly equal shares as is practicable. ITEM III: I devise and bequeath the residue of my estate of every nature and wherever situate in equal shares (per stirpes) to each of my children, DALE F. SHUGHART, JR. and BARBARA S. DRAKE, as shall survive me by thirty (30) days. ITEM IV: In the event that both of my children should predecease me or die on or before the thirtieth day following my death, and should I not be survived by issue, then I devise and bequeath the residue of my estate of every nature and whenever situate as follows: ~ A. One-Half (1/2) thereof to the DICKINSON SCHOOL OF LAW of the PENN STATE UNIVERSITY, for its scholarship fund, to endow scholarships for deserving students. These scholarships shall be, if feasible, known as the "Mary Ann R. and Judge Dale F. Shughart Memorial Scholarships." B. One-Half (1/2) thereof to the GRACE UNITED METHODIST CHURCH of Carlisle, Pennsylvania. ITEM V: I direct that all taxes that may be assessed in consequence of my death, of whatever nature and by whatever jurisdiction imposed, shall be paid from my residuary estate as part of the expenses of the administration of my estate. ITEM VI: I appoint my son, DALE F. SHUGHART, JR., and my daughter, BARBARA S. DRAKE, Co-Executors of this my Last Will. Should both of my said children fail to qualify or cease to act as Executors, I appoint, HAMIL TON C. DAVIS, of Newville, Pennsylvania, substitute Executor, of this my Last Will. ITEM VII: I direct that my Executors or their successors shall not be required to give bond for the faithful performance of their duties in any jurisdiction. ITEM VIII: My individual fiduciary shall be entitled to reasonable compensation for his and/or her services rendered from time to time and to reimbursement of out of pocket expenses. IN WITNESS WHEREOF, I hereunto set my hand and seal to this my Last Will and 1npJ 2 Testament, written on (4) sheets of paper, dated this ~qM day of /;)c/&J() biJr) 2003. '1h~ ~ ;f~~~ MARY ANN R. SHUGHART The preceding instrument, consisting of this and (3) other typewritten pages, each identified by the signature or initials of the Testatrix, was on the day and date thereof signed, published and declared by the Testatrix therein named, as and for her Last Will, in the presence of us, who, at her request, in her presence, and in the presence of each other have subscribed our names as witnesses hereto. residing a 3 COMMONWEALTH OF PENNSYL VANIA: : ss. COUNTY OF CUMBERLAND I, MARY ANN R. SHUGHART, the Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last Will; and that I signed it willingly and as my free and voluntary act for the purposes therein expressed. ~M~(s;,.L) ANN R. SHUGHART Notarial Seal - ~-'i . Hamilton C. Davis, Notary Public Shlppensb~rg. BOrD, cumbo erland County My Commission Expires Sept. 27, 2004 Member, Pennsylvania Assoclalion of Notaries COMMONWEALTH OF PENNSYLVANIA: : ss. COUNTY OF CUMBERLAND : we,II~ I hlm))aev and .AJ/cho/eJ Kd/elfiwitness whose names are Sign~ attached or foregoing instrument, being duly qualified according to law, do depose and say that we were present and saw the Testatrix sign and execute the instrument as her Last Will; that the Testatrix signed willingly and executed it as her free and voluntary act for the purposes therein expressed; that each subscribing witness in the hearing and sight of the Testatrix signed the Will as a witness; and that to the best of our knowledge the Testatrix was at that time eighteen (18) or more years of age and of sound mind and under no constraint or undue influence. LU~ Sworn to or affirmed and~~1'k:~.k, A/,' before me by R\ol~ ~ 1V4l111iK-( a..tt! 4. ffie' w.''l'V'cf')t''1egt''tRJf; this ~ ., ~day of ~~w ,2003. Notary 1..-..---.-.-----....--.--- '.. . Notarial 8eal .i . Hamilton C. Davis, NoialY Public ! .ShIPl2.SnSb':l'Y' BOr?, c'.<mb8'."an. d CQ\.".l. [".'./'. My CornmrS(~~IOn J,:xplres Supt. 2.." 200.4.. .~\iI{~;r ~1)~;;n;~\:J.:!;;~;~i.!;~;.~;-~Zi~~rf!~~-~(;t..;7~;'.; I'; :-~~~ 4 -.. I Register of Wills of Cumberland County, Pennsylvania INVENTORY Estate of Shughart, Mary Ann R. No. 21 - 04 - 00952 , Deceased Date of Death 10/17/2004 Social Security No. 180-01-3567 also known as Dale F. Shughart, Jr. Barbara S. Drake The Personal Representative(s) of the above Estate, deceased, verify that the items appearing in the following Inventory include all of the personal assets wherever situate and all of the real estate located in the Commonwealth of Pennsylvania of said Decedent, that the valuation placed opposite each item of said Inventory represents its fair value as of the date of the Decedent's death, and that the Decedent owned no real estate outside of the Commonwealth of Pennsylvania except that which appears in a memorandum at the end of this Inventory. l!We verify that the statements made in this Inventory are true and correct. l!We understand that false statements herein are made subject to the penalties of 18 Pa. C. S. Section 4904 relating to unsworn falsification to authorities. 1.0. No.: 19373 Personal Representativde. ,,-- ~ -tv Signature - / v ale F. Shu hart, Jr Signature: "7i:v ./ . ~a';:'ts. Attorney: Dale F Shughart, Jr. Esquire Signature: Address: 35 E. High Street, Suite 203 Address: 35 East High Street Carlisle, PAl 70 13 Carlisle, PA 17013 Telephone: 717/241-4311 Telephone: 717-241-4311 Dated: 7/1 Z /()~ 9,684.698 shares Vanguard Windsor Fund CUSIP # 922018106 @ 16.28 per share o ~O --:n fD-o :IJ~P r---zrn /~ -:::I1 ;:~_ (f) ^ ;'..)00 ~')b-n ':JC : :::0 --1 j.2 ,....., <=> c;:;:t :TJ c...n --"'-1 ""1"'1 L i~::'l("~) I ~666.~~ ~;::~ .:.,~ c.-::J . '1 I--n W :TJ o:':J ~180.7j; q :::;:: :~':;0 ~ ',: [1'1 2~65R.A6) q Personal Prooertv 615.3508 shares Orrstown Financial Services, common stock, CUSIP #687380105 @42.675 per share 3,600 shares Carlisle Corporation, common stock, CUSIP #142339100 @ 62.405 per share Cash on hand. (1.71 + 5.00) 6.71 Retainer on deposit in Dale F. Shughart, Jr. Escrow Account. 500.00 Household goods, furniture and furnishings distributed in kind or sold at appraised value, value based upon attached appraisal of Alyssa Loney. 11,996.50 Household goods, furniture and furnishings, sold at public acution, value is actual sale price. 3,527.00 1997 Buick sedan, value based upon actual sale price. 5,995.00 (Attach additional sheets if necessary) Total Personal Property and Real Estate $779,834.56 Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of Shughart, Mary Ann R. No. 21 - 04 - 00952 Date of Death lOll 7/2004 also known as , Deceased Social Security No. 180-01-3567 Orrstown Bank, checking account #400440 Principal 5,502.03 Accrued interest .32 5,502.35 Orrstown Bank, checking account 11106210114 Principal 112,303.77 Accrued interest 88.92 112,392.69 Tax proration of sale ofreal estate 1,373.40 Hoffman-Roth Funeral Home, refund 201.00 Dalton Books, refund 158.05 Agway, refund 861.14 Patriot News, refund 46.35 The Sentinel, refund 11.48 Comcast, refund 4.59 Attorney Group Life Insurance Trust, refund 186.13 Travelers, auto insurance refund 224.00 AT&T, refund 5.29 Sprint, refund 25.25 U.S. Treasury, 2004 income tax refund 2,605.00 PA Department of Revenue, 2004 income tax refund 214.00 National Grange Mutual Homeowners Insurance, refund 493.00 Total Personal Property $554,834.56 2 r Register of Wills of Cumberland County, Pennsylvania INVENTORY continued Estate of Shughart, Mary Ann R. also known as , Deceased No. 21 - 04 - 00952 Date of Death 10117/2004 Social Security No. 180-01-3567 Real Estate House and lot located at 271 South College Street, Borough of Carlisle, Cumberland County, PA; Prior deed reference: Deed Book "U", Vol. 13, Page 459. Cumberland County Tax Parcel #04-21-0322-185. Value based upon actual sale price. HUD-I attached. 225,000.00 Total Real Estate $225,000.00 3 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT. 280601 HARRISBURG. PA 17128-0601 REV-1162 EX(11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005561 SHUGHART DALE F JR 35 EAST HIGH STREET SUITE 203 CARLISLE, PA 17013 ACN ASSESSMENT CONTROL NUMBER AMOUNT fold 101 $1,892.14 ESTATE INFORMATION: SSN: 180-01-3567 FILE NUMBER: 2104-0952 DECEDENT NAME: SHUGHART MARY ANN R DA TE OF PAYMENT: 07/13/2005 POSTMARK DATE: 07/1 3/2005 COUNTY: CUMBERLAND DATE OF DEATH: 10/17/2004 TOTAL AMOUNT PAID: $1,892.14 REMARKS: CHECK# 1077 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WillS REGISTER OF WILLS BUREAU OF INDIVIDUAL TAXES INHERITANCE TAX DIVISION PO BOX 280601 HARRISBURG PA 17128-0601 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE ~r IrIID~E DF INHERITANCE TAX RECORui:~&fRWlOO-, ALLOIlANCE OR DISALLOWANCE Df"DSDUCfIDNS AND ASSESSHENT OF TAX : <. i *' REV-1547 EX AFP (06-05) 09-13-2005 SHUGHART 10-17-2004 21 04-0952 CUMBERLAND 101 APPEAL DATE: 11-12-2005 ( See reverse side under Objections) Amount Remitted I I MAKE CHECK PAYABLE AND REMIT PAYMENT TO: REGISTER OF WILLS CUMBERLAND CO COURT HOUSE CARLISLE, PA 17013 CUT ALONG THIS LINE _ RETAIN LOWER PORTION FOR YOUR RECORDS _ REv:is4;-Ei-AFP-io3:osj-NoTlcE-OF-INHERITANCE-TAi-APPRAISEMENT:-ALLowANCE-OR--------------- DISALLOWANCE OF DEDUCTIONS AND ASSESSMENT OF TAX MARYANN R FILE NO. 21 04-0952 ACN 101 ('I CDI{ ('~ -..),-,-.1,\ '_ DATE ESTATE OF DATE OF DEATH FILE NUMBER COUNTY ACN MARYANN R Znne C'1;"D \ 3 Pi'l \: 45 uu,J ..)1..-1 DALE F SHUGHART STE 203 35 E HIGH ST CARLISLE 2DD'J./ ,'II,,"" JR ~.Q PA 17013 ESTATE OF SHUGHART DATE 09-13-2005 TAX RETURN liAS: (X I ACCEPTED AS FILED I CHANGED RESERVATION CONCERNING FUTURE INTEREST - SEE REVERSE APPRAISED VALUE OF RETURN BASED ON: ORIGINAL AND SUPPLEMENTAL RETURN NO. 01 1. R..l Est.t. (Schedul. Al III 225,000.00 NOTE: To insure ....o...r 2. stocks ..-.d Bonds (Schedule B) (2) 408.505.63 c....dit to your account, sub.it the upper portion 3. Closely Held Stock/PartnershIp Interest (Schedule C) (3) .00 of this for. with your 4. "ortgages/Nat.s Receivable (Schedule D) (4) .00 t.x payment. 5. C..sh/Il&nk lJeposits,"1sc. P.rson..l Prop.rty (S_dul.. EI (51 146.328.93 6. Jointly D-.I Prop.rty (Schedul. Fl (61 17 .866.65 7. Trensf.rs (Schedul. GI (7) 16,000.00 8. Tot.l Ass.ts (81 813,701. 21 APPROVED DEDUCTIONS AND EXEMPTIONS: 9. Funeral Expenses/Ad.. Costs/Hisc. Expenses (Schedule H) 10. Debts/Hortgage Llabilities/Liens (Schedule I) 11. Total Deductions 12. Net Value of Tax Return 13. ChBritabl./Gover~tal Bequests; Non-elected 9113 Trusts (Schedul. J) 14. Net Value of Estate Subject to Tax (9) 1101 47,020.30 5.652.21 (Ill 1121 1131 (141 Ii? .67' 1;1 761,028.70 .00 761,028.70 NOTE: I~ an assessment was issued previously. lines 14. 15 and/or 16. 17. 18 and 19 will re~lect ~igures that include the total o~ abb returns assessed to date. ASSESSMENT OF TAX: 15. Amount of Line 14 at Spousal rat. (15) 16. Amount of Llne 14 taxable at Lineal/Class A rat. (16) 17. Aaount of Line 14 ..t Sibling r.t. (171 18. A.aunt of Line 14 taxable at Collateral/Class B rate (18) 19. Principal Tax Due .00 X 00 = .00 761,028.70 X 045 = 34,246.29 .00 X 12 = .00 .00 X 15 = .00 1191= 34,246.29 T6Y CREDIT!II, 1+) AHOUNT PAID DATE NUKBER INTEREST/PEN PAID (-I 01-14-2005 CD004839 1,577 .63 29,975.00 07-13-2005 CD005561 .00 1,892.14 07-18-2005 CD005582 .00 801. 52 TOTAL TAX CREDIT 34,246.29 BALANCE OF TAX DUE .00 INTEREST AND PEN. .11 TOTAL DUE .11 . IF PAID AFTER DATE INDICATED, SEE REVERSE FOR CALCULATIDN OF ADDITIONAL INTEREST. IF TOTAL DUE IS LESS THAN $1, NO PAYMENT IS REQUIRED. IF TOTAL DUE IS REFLECTED AS A "CREDIT'" (CRI, YDU HAY BE DUE \\'1 A REFUND. SEE REVERSE SIDE DF TMIS FORK FOR INSTRUCTIONS. I ~, STATUS REPORT UNDER RULE 6.12 Name of Decedent: Mary Ann R. Shughart Date of Death: October 17, 2004 Admin. No. 21-04-0952 Pursuant to Rule 6.12 of the Supreme Court Orphans' Court Rules, I report the following with respect to completion of the administration of the above-captioned estate: 1. State whether administration of the estate is complete: Yes X No 2. If the answer is No, state when the personal representative reasonably believes that the administration will be complete: 3. If the answer to NO.1 is Yes, state the following: a. Did the personal representative file a final account with the Court? Yes No X b. The separate Orphans' Court No. (if any) for the personal representative's account is: c. Did the personal representative state an account informally to the parties in interest? Yes X No d. approvals of Clerk of the Copies of receipts, releases, joinders and formal or informal accounts may be filed with the Orphans' Court and may be attached to his report. ~te: September 28, 2005 c;; ('. Shughart, Court I.D. 1937 35 East High Street, Suite 203 Carlisle, PA 17013 (717) 241-4311 Counsel for Personal Representatives G._ o Ct) ~ c;-:- C.) i ~r; c:: (:-.:..) !, ..." 1..-(3.- REV. 1500 EX . ~6-(0) .. I!! ~5U) "II:" W"" :>:00 ,,11:-' ..10 .. <t .. .. '1. .~, COMMONWEALTH OF PENNSYLVANIA OEPARTMENT OF REVENUE DEPT,280601 HARRISBURG. PA 17128-0601 OFFICii':,.!. U~~F: (;rJI.\' -l REV-1500 INHERITANCE TAX RETURN RESIDENT DECEDENT FilE NUMBER 21 04 COUNTY CODE YEAR SOCIAL SECURITY NUMBER 0952 NUMBER f- Z W Q w " W Q DECEDENTS NAME (LAST. FIRST. AND MIDDLE INITIAL) Shughm1, Mary Ann R. 180-01-3567 DATE OF DEATH (MM-DD-YEAR) DATE OF BIRTH (MM.DD.YEAR) THIS RETURN MUST BE FilED IN DUPLICATE WITH THE 10/1 7/2004 04/18/19 I 7 REGISTER OF WILLS SOCIAL SECURITY NUMBER (IF APPLICABLE) SURVIVING SPOUSE'S NAME ( LAST, FIRST AND MIDDLE INITIAL) D D D D .f- UlZ Ww II:Q II:z 00 "" ~ 2. Supplemental Return o 4a. Future Interest Compromise (dale of death alter 12-12-82) o 7. Decedent Maintained a Living Trust (Al1ach copy of Trust) D 10. Spousal Poverty Credit (dale of death between D 11. Election to tax under Sec. 9113(A) (Attach Sch 0) 12-3tc9tand .U-95)... . ,.. . . THISSECTI()III~IJ.~!J!I;J~()MP"~!'P.!I!d-: C;.Q!'IRESI'ONDI;,,~ AND CONFIDENTIAL TAX INFOIWATlON ~OU1.0 BE DIRECTED TO: _~.'-_."_ NAME COMPLETE MAILING ADDRESS Dale F Shughart, Jr. Esquire 1. Original Return 4. Limited Estate D 3. D 5. Federal Estate Tax Return Required Remainder Return (date of death prior to 12.13~82) 6. Decedent Died Testate (AtlaCI1 copy olWiH) 9. Litigation Proceeds Received 8. Total Number of Safe Deposit Boxes FlAM NAME (II applicable) 35 E. High Street, Suite 203 Carlisle, P A 17013 (1) None (2) None (3) None (4) None (5) None (6) 17,866.65 (7) None r0 \..0 TELEPHONE NUMBER 717/241.4311 -r:1 - i-~, i~~-l (;.~) ~.) 1 --~ \:.~~} 11 \ 11 '~:' '..J :-) , ";;"l ,.j .- ;::~~.1 .- r-rl -,(, ~.,. 1 1. Real Estate (Schedule A) 2. Stocks and Bonds (Schedule B) rn ::D ~ '(~IO -::'::;2-n t~ N 3. Closely Held Corporation, Partnership or Sole-ProprietDrship co -::J :.:.;: 4. Mortgages & Notes Receivable (Schedule D) z o ;:: :s " f- 0: <t frl a: 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 6. Jointly Owned Property (Schedule F) D Separate Billing Requested 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G or L) 8. Total Gross Assets (total Lines 1-7) 9. Funeral Expenses & Administrative Costs (Schedule H) 55.00 (8) 17,866.65 (9) 10. Debts of Decedent. Mortgage Liabilities. & Liens (Schedule I) (10) 11. Total Deductions (total Lines 9 & 10) (11) 55.00 12. Net Value of Estate (Line 8 minus Line 11) (12) 17,811.65 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which an election to tax has not been made (Schedule J) 14. Net VBlue Subject to Tax (Line 12 minus Line 13) (13) (14) 17,811.65 SEE INSTRUCTIONS ON REVERSE SIDE FOR APPLICABLE RATES 15. Amount of Line 14 taxable at the spousal tax rate, x .00 (15) or transfers under Sec. 9116(a)(1.2) z 17,811.65 .045 (16) 0 16. Amount of Line 14 taxable at lineal rate x ;:: ;!: " (17) .. 17. Amount Df Line 14 taxable at sibling rate x .12 "' 0 " x 18. Amount of Line 14 taxable at collateral rate (18) ~ x .15 19. Tax Due (19) 801.52 801.52 CHECK HERE IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT. 20. 0 ..mm -----__~- __ _ ~--;:> BESUIl~i~~N'sWER~~LQUESTlOIllS ON REVERSEsu;E- AIIlDRECHECK MATH << Copyright 2000 form software only The Lackner Group, Inc. ~'~-'~'"":"^'''~''''"";'c~_'''''''''''~''''''_.._.'__'-'.__.. .....1 Form REV-1500 EX (Rev. 6-00) Decedent's Complete Address: STREET ADDRESS 271 South College Street CITY Carlisle STATE PA ZIP 17013 Tax Payments and Credits: 1. Tax Due (Page 1 Line 19) 2. Credits/Payments A. Spousal Poverty Credit B. Prior Payments C. Discount (1) 801.52 Total Credits (A + B + C) (2) 0.00 3. Interest/Penalty if applicable D. Interest E. Penalty (3) 0.00 (4) (5) 801.52 (5A) (5B) 801.52 T otallnterest/Penalty (0 + E) 4. If Line 2 is greater than Line 1 + Line 3. enter the difference. This is the OVERPAYMENT. Check box on Page 1 Line 20 to request a refund 5. If Line 1 + Line 3 is greater than Line 2, enter the difference. This is the TAX DUE. A. Enter the interest on the tax due. B. Enter the total of Line 5 + 5A. This is the BALANCE DUE. Make Check Payable to: REGISTER OF WILLS, AGENT :i!:!:iiill!}:iffiii!ill)I't...____f~lli~n~! Iii UIIII Ai m,f!~:''q] .11",1 -.III~ IlilllJ_liI 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;................................................................................ ~ I ~: ~::::~ ~h;e~;~:i:~~: :~~e~:s~~~. ~~~~~ .~.~.~..t.~.~. .p.r~~e.~. t~.an.sf~~~~~ .~:. ~~~. ~~~~~.~~'.: ::..:....... :...........:::::::::::::::::: d. receive the promise for life of either payments, benefits or care? ............................................................. 2. If death occurred after December 12, 1982, did decedent transfer property within one year of death without receiving adequate consideration?. .......... ..... .......................... ..... .................................................... ................... 0 ~ 3. Did decedent own an "in trust for" or payable upon death bank account or security at his or her death?......... 0 ~ 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 FilE IT AS PART OF THE RETURN. 25 Rolling Drive Carlisle, P A 17013 ADDRESS ADDRESS 2366 North Ouincy Street Arlington, VA 22207 35 E. High Street, Suite 203 Carlisle, P A 17013 For dates of death on or after J iy 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 3% [72 P.S. 116 (a) (1.1) (i)l. 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 0% [72 P.s. 99116 (a) (1.1) (ill]. 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 0% [72 P .S. 99116 (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 4.5%, except as noted in 72 P.S. 99116 1.2) [72 P.S. 99116 (a) (1)]. The tax rate imposed on the net vaiue oflransfers to or for the use of the decedent's siblings is 12% [72 P.S. 99116 (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. SCHEDULE F JOINTL V-OWNED PROPERTY COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shughart, Mary Ann R. FILE NUMBER 21-04-0952 If an asset was made joint within one year of the decedent's date of death, it must be reported on schedule G. ADDRESS SURVIVING JOINT TENANT(S) NAME A Dale F. Shughart, Jr. B Barbara S. Drake 25 Rolling Drive Carlisle, P A 17013 2366 North Quincy Street Arlington, VA 22207-5112 RELATIONSHIP TO DECEDENT Son Daughter JOINTLY OWNED PROPERTY: ITEM LETTER NUMBER FOR JOINT TENANT A,B 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. % OF DATE OF DEATH DATEOFDEATH DECO'S VALUE OF VALUE OF ASSET INTEREST DECEDENT'S INTEREST 53,600.00 33.3333 17,866.65 11/3011992 Two contiguous lots, combined for tax and future sale purposes known as Lot #1, #IB and 2 on Dale F. Shughart, Subdivision Plan recorded in Cumberland County Plan Book 79, Page 102 known as 680 Mountain Road (South Middleton Township) Boiling Springs, Cumberland County, P A 1007 and Cumberland County Tax Parcel #40-13-0120-024 a. Lot #1 contains 1.3961 acres and is improved with a one story seasonal cabin and shed. Conveyed by deed dated 11130192 in equal 113 interests as joint tenants with right of survivorship to Dale F. Shughart and Mary Ann Shughart, husband and wife, as tenants by the entirety, Dale F. Shughart, Jr. and Barbara S, Drake. Deed reference: Deed Book "A", Vol. 36, Page 550. b. Lot # IB and 2 contain 14.5467 acres of unimproved land conveyed by deed dated 911/99 in equal 1/3 interests as joint tenants with right of survivorship to Dale F. Shughart and Mary Ann Shughart, husband and wife as tenants by the entirety, Dale F. Shughart and Barbara S. Drake. Deed reference: Deed Book 207, Page 95. Dale F. Shughart died 10109/2000 and his interest thereby vested in his surviving spouse, Mary Ann Shughart, whose 1/3 survivorship interest passed equally to her two children Dale F. Shughart, Jr. and Barbara S. Drake on her death. Value based upon 2005 assessed value. Copy attached. TOTAL (Also enter on line 6, Recapitulation) 17,866.65 '. SCHEDULEH R.J-,IERAL EXP8\ISES & ADMNSTRA11VECOSTS CQMMOI\IWEAL TH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Shughart, Mary Ann R. FILE NUMBER 21 - 04 - 0952 Debts of decedent must be reported on Schedule I. ITEM NUMBER A. FUNERAL EXPENSES: DESCRIPTION AMOUNT B. 1. ADMINISTRATIVE COSTS: Personal Representative's Commissions Social Security Number(s) I EIN Number of Personal Representative(s): Street Address City Year(s) Commission paid State _ Zip 2. Attorney's Fees 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Add ress City Relationship of Claimant to Decedent State Zip 4. Probate Fees 5. Accountant's Fees 6. Tax Return Preparer's Fees 7. I Other Administrative Costs Federal Express, overnight mailer 40.00 2 Register of Wills, filing Supplemental Return 15.00 TOTAL (Also enter on line 9, Recapitulation) 55.00 COMMONWEALTH OF PENNSYLVANIA DEPARTMENT OF REVENUE BUREAU OF INDIVIDUAL TAXES DEPT, 280601 HARRISBURG, PA 17128-0601 REV-1162 EX{11-96) RECEIVED FROM: PENNSYLVANIA INHERITANCE AND ESTATE TAX OFFICIAL RECEIPT NO. CD 005582 SHUGHART DALE F JR 35 EAST HIGH STREET SUITE 203 CARLISLE, PA 17013 ACN ASSESSMENT CONTROL NUMBER AMOUNT nnun fOld 101 $801.52 ESTATE INFORMATION: SSN: 180-01-3567 FILE NUMBER: 2104-0952 DECEDENT NAME: SHUGHART MARY ANN R DATE OF PAYMENT: 07/18/2005 POSTMARK DATE: 07/1 8/2005 COUNTY: CUMBERLAND DATE OF DEATH: 10/17/2004 TOTAL AMOUNT PAID: $801.52 REMARKS: CHECK# 1084 SEAL INITIALS: JA RECEIVED BY: GLENDA FARNER STRASBAUGH REGISTER OF WILLS REGISTER OF WILLS Cumberlana County Board of Assessment Appeals PROPERTY OWNER INFORMAL REVIEW ACCEPTANCE OR REJECTION FORM . As of -3 !nJ 01-/ (date), I/we have requested an appeal of our assessment. . As of the above date, I/we have met with an official assessment representative to discuss my/our property assessment in question. . The parcel/account number of the subject property is as follows: ~ 0 ~ l~- VIJ0 -Od-L( Parcel/Account Number . The current Market Value of this property is $ ~OJ D qD . The current Clean and Green value (if applicable) of this property is $ Review Appraiser's Recommendation: C)l{~-\lV p ~choo ( Cff ~~ II t los II I \ O~ I Form 216 (v. 1.2) I to lower thli ent \ thari ent Sf1. Qverall pbi:~Q... 'iJ1CJ,rrJl, ,o$ep~rc", ,qi~ti$ that' . . . . '" . y. mean ~'" rrespon iilci'eas~i,. . !ri~. ..hges in taxes~i~1 depe' .... ..... .. '. '. . ...ropert}i's change asconip~re(t' to the. overall ch<i~gefC)~~l!~~iri9distfict. . The E:S.TIMAtED'i1:np~pt,stEl~~'iiJ~~l,p~rit~?belo"'; is Qurbest estimate ~f change, baSE!dOr~OQ4;G()Uf'!Ty.tCP(figures. THIS ESTIMATE DOES NOT INCLLJP~'~,A,tl.Y BOROUGH, TOWNSHIP; OR SC;HOOL DISTRlq I~PAvT~" . " , '; '~,-:<\ $ $ $ $ ,'-,- .- 2q04 2004. 2004' 2004 C::puBcy Cdt1rtty CClU#~Y: County TaX 'Tax. Tax Tax Cur~,$!~_,~:_-:, 2q'-9,A\:j~~iffl',j:~, :~:i.~s = Adjti~ted2004i9c>Utity lI1d,ll$ = BEFoBE Reassessment based' ono~d Mark.~t'\Ta.l\le, BEFORE, Reassessmeint based on old C~ea~ &Gr~e~. AFTER ReCisseslil:ment based on above Market Val1,1e. AFTER Reassessment based on above Clean & Green. 2.352 2.138